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Abstract
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An unusual outbreak of stramonium food poisoning re- lated to jimson weed consumption was reported from Hawkins County, Tennessee. Five persons in all became ill between 5 minutes and 5 hours after consuming tomatoes which contained the alkaloid.
Five minutes after eating, 2 adults became acutely ill at the luncheon table with visual hallucinations, disorientation, generalized weakness, blurred vi- sion, pronounced thirst, vertigo and nausea. They were hospitalized immediately. On physical examination, both had dilated, sluggishly reactive pupils. Within 5 hours of this meal, the 3 others sharing it had become ill with similar, but milder, symptoms.
The meal had consisted of fresh, sliced tomatoes, split pea soup, spaghetti, sweet milk, and cornbread. Both the split pea soup and spaghetti had been served 2 days earlier; they had been reheated for this meal. One individual had consumed 3-1/2 slices of tomato and 4 others had eaten 1 slice each of fresh tomato. Commercially canned tomatoes were used in the spaghetti. In a telephone call from the hospital to Dr. Cecil B. Tucker, Director, Division of Preventable Diseases, Tennessee State Health Department, it was noted that the tomatoes served at the meal had been "grown with jimson weed." Immediate examination of the State Toxicology files yielded a description of jimson weed poisoning, the toxic principal being the alkaloids stramonium, hyoscyamine, scopolamine, and stropine, Certain that jimson weed explained their symptoms, Dr. Tucker immediately tele- phoned this information to their physicians.
A description of each of the cases follows:
Case 1: Five minutes after eating 3-1/2 slices of tomatoes, a 48-year-old male developed blurred vision and experienced vertigo when he attempted to stand. Within the next hour, he experienced visual hallucinations (bugs and flowers). He at- tempted to pick objects out of the air and twist imaginary door knobs. He complained of extreme thirst, xerostomia, muscle spasms in the lower extremities, and mild cramping abdominal pain. When he presented to the emergency room, he was irrational, continued to hallucinate, and was incontinent of urine. His temperature was 99°F., blood pressure 120/80, pulse 100, and respirations 20. His face was moderately flushed and the oral mucous membranes were dry. Both pupils were widely dilated and reacted sluggishly to light. The remainder of the general physical and neurological examinations was unremarkable except for slight twitching of the lower extremities. Routine urinalysis and blood counts were normal.
The patient was started on oral pilocarpine after stramonium was implicated as the etiological agent, receiving a total of 30 mgm. during the night of admission. Rapid improvement followed with return of a clear sensorium. The patient was asymptomatic at the time of his discharge on October 30.
Case 2: Within five minutes after eating one tomato slice, a 30-year-old female cried out, "I'm going blind!" She became drowsy and laid her head on the table for a few moments. Then she attempted to stand, her vision again became blurred and she experienced marked vertigo. Mild nausea, abdominal cramping pain, and vomiting followed within the hour. She complained of extreme thirst and xerostomia, unrelieved by repeated gulps of water. On arrival at the hospital, she was disoriented and was having visual hallucinations. She was unable to walk or sit without support. Her temperature was 99°F., blood pressure 130/80, pulse 88, and respirations 22. Both pupils were dilated and reacted sluggishly to light. She continued to complain of blurred vision. The oral mucous membranes were dry. There was moderate tenderness to abdominal palpation. The remainder of the examination was normal. A sedimentation rate of 42 mm. per hour was the only abnormal laboratory value. She received the same treatment as Case 1 and was discharged from the hospital 2 days after admission.
Case 3: A 42-year-old female ate one tomato slice, felt somewhat "goofy" approximately one hour after the noon meal, and later experienced slight vertigo, xerostomia, generalized weakness, and loss of appetite. When examined that evening, she was found to have dilated, reactive pupils. Because of the mildness of her symptoms, she was not hospitalized but given 10 mgm. of pilocarpine orally at the emergency room. By the following day, she was entirely asymptomatic.
Case 4: A 31-year-old male experienced only mild nausea, diarrhea, and cramping abdominal pain approximately 5 hours following the noon meal. He ate one tomato slice. He was not hospitalized and received no medications.
Case 5: A 3-year-old boy ate one tomato slice and remained asymptomatic until approximately 5 hours following the noon meal when he developed blurred vision, vertigo, loss of appetite, and visual hallucinations (crawling bugs). Later that evening, he was observed to have dilated, reactive pupils. During the following day, he complained of abdominal pain with vomiting and diarrhea. He was asymptomatic on the following evening. He was not hospitalized and received no medications. The tomato consumed at the meal was obtained from a tomato plant grafted to the root of a jimson weed (Datura stramonium). This had been done in an attempt to produce a larger tomato, more resistant to cold.
Case Number 1 had become familiar with this grafting procedure through a neighbor (not a victim). This neighbor had attempted tomato grafting with several plants for 5 years, but had been successful only with the jimson weed. He had only occasionally tasted tomatoes from these plants. He never experienced ill effects.
The tomato consumed at the above meal was the first to be eaten from Case Number 1's plants. Following this incident, it was learned that Case Number 1's grafts were made with an above-ground secondary branch of the jimson weed, whereas the neighbor had always grafted the stalks to the roots below ground.
Tennessee health authorities conclude that this modification in technique may have accounted for the toxicity of Case Number 1's tomatoes.
One whole tomato was retrieved from Case Number 1's home and forwarded to the Tennessee Industrial Hygiene Laboratory. This was produced by the same grafting technique but did not come from the same plant that yielded the tomato consumed at the above meal. Three tomatoes were also obtained from the neighbor's home (grown by grafts made to the root stalks).
Case Number 1's tomato yielded 4.2 milligrams of stramonium alkaloids per 100 grams of tomato; the neighbor's tomatoes yielded 1.9 milligrams per 100 grams. The tested tomato would contain about 1.0 milligrams of total alkaloid per slice, according to calculations from the laboratory results; since the ingested tomato was not analyzed, direct comparison of dosage and symptomatology is not possible
Reported by W. L. Clark, Church Hill. Tenn.; R. H. Jernigan, Kingsport, Tenn.; J. W. Erwin, Director. Sullivan County Health Department; Margaret Davidson, Public Health Nurse, Hawkins County; and Cecil B. Tucker, Director, Division of Preventable Diseases, Tennessee State Health Department.)
Editor's Note: Numerous case reports of Jims on weed poisoning have appeared in the medical literature; yet there is no available report of the stramonium alkaloids being transferred to a second plant grafted to the host jimson weed.
The jimson weed (Datura stramonium), also known as thorn apple, Jamestown weed, stink weed, devil's apple, and apple of Peru, is a species of the Solanacea family to which the red pepper, tobacco, tomato, and belladonna plants belong. The plant is prevalent in this country and in all temperate and tropical zones,flowering in late spring and with the fruit ripening in early fall. All parts of the plant are poisonous, especially the seeds. It is a rank-scented, tall, branched plant which attains a height of three to six feet with trumpet-shaped flowers and spinous capsule which contains numerous black-brown seeds.
The plant grows wild around barn yards, manure piles, and road slides, and is readily available to the sampling of inquisitive children. Mitchell^ reported that between 1950 and 1955, jimson weed intoxication accounted for 4 percent of pediatric patients admitted to the University of Virginia hospital because of the accidental ingestion of toxic substances. In this hospital this was approximately the same frequency as intoxications due to lead, alcohol, barbiturates, and insecticides. Most cases result from the plant's use in Jimson weed tea, reported to be an effective treatment for asthma and other respiratory ailments.
REFERENCES
1. Jennings, R.E.: Stramonium poisoning: review of the literature and report of two cases. J. Pediat. 6: 657, 1935.
2. Mitchell, Joe E., and F.N. Mitchell: Jimson weed (Datura stramonium) poisoning in children. J. Pediat. 47:227, 1955.
3. Goodman, L.S., anil Alfred Gilman:The pharmacological basis of therapeutics, The Macmillan Company, second edition, New York, 1958, pages 552-553. |