The Deadly Dinner party & Other Medical Detective Stories
The get-together began as an afterthought, recalls Pam Stogess, a forty-three-year-old city legislator from Kingston, New York, a town nestled between Catskill State Park and the Hudson River. "My husband, my daughter, and I were planning to go out for Mexican food. I asked our friend Steve Gelson to join us, but he invited us to his house to eat. Steve is a marvelous chef and had hosted a party the night before and had plenty of food left over. He said, 'nothing formal, don't get dressed up, just come over.' My husband and daughter were set on Mexican, but I went to Steve's. It was a totally last-minute affair."
Five other guests (the names of all persons in this story have been changed) attended the dinner party on Sunday, February 19, 1989: Miles Walsh, Steve's business partner in an ad agency; Arthur Landry, vice principal of the local high school; his wife, Barbara Landry, co-owner of their family travel agency; Janie, their thirteen-year-old daughter; and her friend Sara, also thirteen. The meal included a homemade cheese ball, salad, a pasta casserole with sausage, sweet-and-sour meatballs, garlic bread, and wine, followed by coffee and homemade fudge cake.
It turned out to be a memorable menu in more ways than one. "I doctored up the leftover pasta dish and made garlic bread out of pita slices," Gelson recalls. "It was a relaxing evening; we talked a lot of politics. Pam and I are active local Republicans, and Art, a Democrat, had just been told he would soon be appointed to a city commission."
"It was very informal," says Pam. "Steve arranged the food on the kitchen counter, and the adults ate in there. The girls took their plates into the living room and watched videos. We had a grand time, but it was a school night, so by 10 PM, we finished our coffee and the party was over."
By Tuesday morning, Pam knew something was wrong. "I was working in the kitchen; I looked up at something, and my eyes wouldn't work right. I thought maybe I'd put my contact lenses in backwards, so I went into the bathroom, cleaned and checked them, and put them back on. But things still weren't right; it was like I was looking at my nose cross-eyed. I figured I had the flu.
"I phoned Steve's office, because as trustees of the Ulster County YWCA, we had a noon meeting. His secretary told me he was home sick, and when I called him, his speech was slurred, and he complained of nausea. He said he wouldn't be coming to the meeting. I said that I'd speak with him at dinner time and to let me know what he wanted and that I'd make it and bring it over to him.
"By that evening [Tuesday]," Pam continues, "my eyes were worse and my speech had also become slurred. I was having trouble talking and remember having to form the words to get them out. I called Steve again that evening and he could hardly speak. Then the idea occurred to me that Steve and I had the same bug."
Still, Pam isn't the panicky type and still wasn't particularly concerned about her own health. She assumed that she probably just had a virus that would eventually run its course.
"Wednesday morning, I started to drive to do some errands, but as I pulled out of the driveway, the street didn't look wide enough for the car, so my husband drove me. When I went to sign a check, I couldn't find the right line. I was trying to hold some toothpicks but kept dropping them. It was odd. I was having perceptual problems and it gave me a whole new perspective on how handicapped people must have to deal with the world."
By Thursday morning, Pam felt so feeble "that it was all I could do to walk, my legs were so weak. By now I was getting nervous, and I'm not the nervous type. My husband and I own a funeral home, and the prospect of death doesn't frighten me. I remember telling my husband, 'I think I've had a stroke,'" Pam recalls. "I felt intoxicated and totally out of touch perceptually. I telephoned Steve's house and there was no answer. I called his secretary, who told me he'd gone to Kingston Hospital. That's when I thought, 'My God, maybe someone else has it.' I called Art Landry's house.
"Janie picked up and said her dad couldn't come to the phone; he was sick and couldn't speak. Janie and Barbara were fine, though. By now, I was having difficulty swallowing, chewing, or even moving my tongue. I called Dr. Mauceri, Steve's doctor, and told him about Art and me. He said we should both come to the emergency department at Kingston City Hospital [where Steve was being evaluated] for tests."
Dr. Mauceri had already paid Steve two house calls. Mauceri was not only Gelson's doctor but also a friend; in fact, he had been a guest at the first dinner party on Saturday night. He saw Steve at home on Wednesday and was somewhat concerned, but when he saw him again on Thursday, at about 2 PM, he sent Gelson straight to the hospital. "I remember he took my portable phone," said Steve, "and called a neurologist, Dr. Pickard, on the telephone. He said, 'I've got a patient I'd like you to see today. I'm concerned he could have Guillain-Barre syndrome.'"
By four o'clock that afternoon, the consulting neurologist, Dr. Leonard Pickard, was evaluating Steve Gelson in the emergency department. Pickard at this point was still unaware that Art and Pam were also ill. When he finished examining Steve, he was both puzzled and worried. Two major possibilities occurred to him -- myasthenia gravis and Guillain-Barre syndrome, both potentially fatal neurological disorders. "But Steve's symptoms didn't quite fit with either diagnosis," Pickard recalls, "and there was one other possibility that Dr. Mauceri and I discussed."
Pam Stogess remembers, "Shortly after 4 PM, Art and I joined Steve at the emergency room, and we must have been quite a sight. Steve's head hung limp to one side. His eyelids drooped shut so that when he spoke, he had to pry them open with his fingers. Art, a community leader, looked like a drunken bum. He hadn't shaved for a couple of days, and he wore a baseball cap cocked to one side."
"After I examined Mr. Gelson," recalls Dr. Pickard, "his father told me about Pam Stogess and Art Landry. The clustering of cases was what clinched it. Even though I'd never seen a case, I knew they had botulism."
Botulism, which derives from botulus, the Latin word for sausage, is a rare but often fatal form of food poisoning caused by the bacterium Clostridium botulinum. According to Dr. A. Barnett Christie's eminently readable textbook on epidemiology and infectious diseases, the history of the word "botulism" and the discovery of the causative organism dates back more than two hundred years. Christie wrote, "The term was first used in the last years of the eighteenth century following an outbreak of the disease in Wildbad, in Southern Germany, in 1793: a large sausage had been shared by thirteen people, all of whom became ill and six of whom died."
Much of what is currently known about the clinical effects of botulism was catalogued by a young district medical officer in the duchy of Wurttemberg named Dr. Justinus Kerner. At the beginning of the nineteenth century in the area surrounding Stuttgart, the medical administration of the dukedom noticed an increase in cases of fatal food poisoning, which they ascribed to the general decline in hygienic measures for food production that resulted from the poverty caused by the devastating Napoleonic wars. In July 1802, the government in Stuttgart issued a public notice and warning about the "harmful consumption of smoked blood sausages."
Kerner, who also developed a lasting reputation as a Romantic poet, began publishing his findings in 1817. By 1820, he had written a monograph that included data from seventy-six patients he had seen with "sausage poisoning," as it was referred to at the time. Kerner performed animal experiments and did many autopsies on patients who had died from botulism. By the mid-1820s, he had established most of what we currently know to be true. He wrote, "The tear fluid disappears, the gullet becomes a dead and motionless tube &hellip; .No saliva is secreted. No drop of wetness is felt in the mouth, no tear is secreted anymore."
Using various extracts that he made from the sausages, Kerner experimented on cats, rabbits, birds, snails, insects, and frogs. He was able to produce all the typical symptoms -- dilated pupil, droopy eyelids, vomiting, problems with swallowing, and respiratory failure -- in these animals. But Kerner went even further. Like many physicians of his time, he experimented on himself. After taking very diluted extracts from the sausage, he wrote, "some drops of the acid brought onto the tongue [produced] great drying out of the palate and the pharynx." When the university professor who had been his instructor discovered that Kerner was poisoning himself in the name of research, he wisely forbade future self-experimentation.
Although Kerner tried in vain to produce the toxin, he did uncover the three major principles about sausage poisoning: he learned that the toxin is created in the bad sausage when it is stored in an oxygen-free state; that the toxin acted on both the motor and autonomic portions of the nervous system; and that the toxin was extremely potent and could lead to symptoms in very small doses. Most remarkably, Kerner speculated in his 1820 report that certain diseases that are caused by a "hyperstimulated" or "hyperexcited" nervous system might in fact be treated by the toxin.
It was not until 1870 that the word "botulism" was formally coined by another German physician. It took nearly thirty more years for the causative organism to be defined, in part because the necessary tools of bacteriology were still in their infancy during the late nineteenth century.
Finding the organism that was actually causing botulism is a story in itself. It starts in the tiny village of Ellezelles, Belgium. Thirty-four individuals attended a funeral on a cold day in December 1895. The food served for the occasion included both smoked and pickled ham. The latter had been pickled within twenty-four hours of slaughter and kept in brine for eleven days before it was consumed. It didn't look right and it didn't smell right, but that did not seem to have dampened the enthusiasm with which it was eaten by the guests and members of the village band, who apparently were playing both for the funeral as well as a local festival. The first victims fell ill in less than twenty-four hours, and in all, twenty-three people became sick. Three died, and ten nearly died. Some who had eaten smaller amounts had a mild illness, and a few, who had eaten only fat or very small pieces of the meat, had no symptoms at all.
Dr. Emile Pierre van Ermengem, who had studied under the great German pathologist Robert Koch, investigated. He found a large anaerobic (grows in the absence of oxygen) bacillus (long bacterium) in the ham that had been served at the funeral and in the tissues of some of the victims as well. From these samples, he grew the bacteria in the laboratory. Finally, when he fed cats food laced with the organism, they developed paralysis. Dr. Ermengem had finally found the cause. He published his findings in a German microbiology journal. This was the first recorded isolation of Clostridium botulinum. Nine years later, in 1904, an outbreak of botulism from canned white beans surprised researchers, for it had been thought that only meat or fish could lead to the disease.
Over succeeding decades, researchers worked out additional details that built on the early pioneers' theories.