S5 E9: Paralysis on Purpose: The Story of Botulism

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cause of Death twenty. Hi. I'm

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to Cause of Death one hundred seconds
to midnight. I'm your host, Jackie

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Morante. I've worked in research for
sixteen years in various capacities. If there's

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one thing I know about, its
infectious disease, and I think all of

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you should know about it too.
It's important that people have a basic understanding

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of the diseases that affect people,
animals, and the environment. I bring

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these stories to you through the lens
of history, education and my personal experiences

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in the lab. With that,
I want to start with a listener letter.

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I love listener letters. Mary sent
me an email with a news article

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attached. The articles said that forty
seven percent of people don't say that life

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will ever get back to normal after
the COVID nineteen pandemic. If you listen

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to the smallpox episodes, the Spanish
flu episode, and the polio episode,

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many of the same things happened that
happened during the COVID pandemic. Schools were

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shut down, social distancing was a
thing. People wore masks, They were

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encouraged to stay home. There was
grocery delivery, There were vaccine mandates,

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and there were travel cards. People
had to prove that they were vaccinated before

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they could travel. During the polio
epidemic, no one could leave New York

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City without proof that they had been
vaccinated. As I sit here today.

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The COVID nineteen pandemic has had relatively
little long term effect on people. We're

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no longer wearing masks or social distancing. I haven't had to show my vaccination

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card in ages. What it comes
down to is this, people as a

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rule are extremely shortsighted. They don't
see past next week or maybe next month.

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They think everything is going to last
forever, especially if that thing is

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something they view as negative. In
truth, very few policies surrounding healthcare crises

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remain permanent. Our society is more
concerned with war than public health. This

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is why nine to eleven caused way
more changes to society than COVID nineteen ever

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will. At the end of the
day, we're far more concerned about the

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cost of rebuilding infrastructure than we are
with any sort of human destruction, even

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though human destruction is priceless. Thank
you Mary for sending that in. It

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was a great article, and maybe
there will be an episode on that subject.

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It's something else to add to my
list. Now that I've given you

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that bit of insight, let's get
onto today's subjectism. This is the last

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disease in the restaurant Rogue season.
I'll have one more episode in season five

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on the difference between food poisoning and
food toxicity. Then we'll move on to

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what I think will be my favorite
season. Season six will be all about

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wildlife diseases. It's going to be
a rather long season with four wildlife diseases

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and at least three one hundred seconds
to midnight episodes all about how the clock

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is ticking for wildlife as well as
people. We're all connected, my friends,

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so if one of us goes down, we all go down. That

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season is going to be called Who's
Who Outside of the Zoo. Okay,

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let's begin where we always begin,
with ideology and pathology. Botulism is caused

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by a gram positive anaerobic spore forming
rod in the family Clostridium bachulie. While

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it can also be caused by C. Baratii or cebutyricum, these are very

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rare instances. These organisms form spores
that are ubiquitous in the environment and are

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capable of surviving indefinitely through most naturally
occurring conditions, as well as boiling and

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other routine cooking practices. People routinely
eat bogulism spores, but they rarely become

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ill. It's only when the spores
germinate that the toxin can become dangerous or

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even fatal. The circumstances have to
be just right for the spores to germinate,

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and the confluence of these events are
very very rare. The conditions have

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to be anaerobic, pH must be
lower than four point five. There must

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be a low salt and sugar content, and temperatures must range between thirty seven

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degrees fahrenheit or three celsius and ninety
nine degrees fahrenheit or thirty seven degrees celsius.

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And even that depends on the serotype
of the toxin. The precise lethal

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dose for bochulynum remains unknown, but
these toxins are the most potent biologic toxins

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known to man. To give a
bit of an idea of what we're dealing

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with here, lethal doses for purified
crystalline botulinum toxin type A in a one

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hundred and fifty four pound man are
estimated to be roughly seventy micrograms when induced

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orally. If the toxin is inhaled, the dose drops significantly to anywhere between

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point eighty and point ninety micrograms.
Again, this isn't something we know for

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sure it's just an estimate, but
that's not a lot of toxin to make

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someone die. There are seven antigenetically
distinct botulinum toxins A, B, C,

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D, E, F, and
G. Most strains produce a single

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toxin, but there have been strains
identified that produced two toxins. Type A

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is the most potent toxin, followed
by types B and F. Types A,

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B and E are usually associated with
systemic botulism and humans. Types C,

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D and E cause illness in other
mammals, birds, and fish.

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All bochulinum toxins have similar structures.
They consist of a zinc endopeptidase protein formed

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by a heavy chain of approximately one
hundred thousand daltons and a light chain of

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approximately fifty thousand daltons. These are
linked by a disulfide bond. All serotype

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interfere with neural transmission by blocking the
release of acetal cooline, which is the

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main neurotransmitter at the neuromuscular junction.
Intermuscular administration of botulinum toxin acts at the

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neuromuscular junction to cause muscle paralysis by
inhibiting the release of acetalcholine from presynaptic motor

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neurons. Bochulinum toxins act at four
sites in the body, the neuromuscular junction,

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the autonomic ganglia, postganglionic parasympathetic nerve
endings, and postganglionic sympathetic nerve endings

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that release acetal coline. The heavy
chain of the toxin binds selectively and irreversibly

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to high affinity receptors at the presynaptic
surface of cholinergic neurons, and the toxin

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receptor complex is taken up into the
cell by endocytosis. The disulfide bond between

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the two chains is cleaved and the
toxin escapes into the cytoplasm. The light

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chain interacts with different proteins in the
nerve terminals to prevent fusion of acetocholine vesicles

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with the cell membrane. There are
several different kinds of botulism, food born,

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wound, infant, adult intestinal colonization, inhalation, and injection. About

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one hundred and ten cases of botulism
are reported in the US each year.

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Of these, approximately twenty five percent
are food born, seventy two percent are

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infant botulism, and the rest are
wound botulism. Food born botulism is very

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serious and potentially fatal. However,
it's relatively rare. It's considered a food

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intoxication that's usually caused by ingestion of
neurotoxins that have formed in contaminated food.

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Symptoms of food born botulism begin with
marked fatigue, weakness in vertigo, usually

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followed by blurred vision, dried in
mouth, and difficulty swallowing and speaking.

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Vomiting diarrhea, constipation, and abdominal
swelling may also occur. As the disease

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progresses, there will be weakness in
the neck and arms. Then the respiratory

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muscles and the muscles of the lower
body will begin to weaken. Finally,

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there can be descending flaccid paralysis that
can cause respiratory failure. There will be

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no fever or loss of consciousness.
Symptoms will usually appear within twenty four to

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thirty six hours after exposure. This
disease is fatal in five to ten percent

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of cases. Immediate diagnosis and care
are paramount to survival. Machulinum toxin has

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been found in a variety of foods
in including low acid preserved vegetables such as

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green beans, spinach, mushrooms,
and beads, fish including canned tuna,

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fermented, salted and smoked fish,
and meat products such as ham and sausage.

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The big thing is home canning.
Most botulism cases come from improperly canned

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foods. Infant moutulism occurs mostly in
infants under six months of age. This

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occurs when infants ingest the spores,
which germinate into bacteria that colonize the gut

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and release toxins. Because children under
six months of age have developing immune systems,

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they are more susceptible to botulinum toxin. Symptoms include constipation, loss of

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appetite, weakness, an altered cry, and a loss of head control.

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There are several sources of infant bautulism, but the most common is honey.

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In recent years, it has been
sted that parents shouldn't feed honey to their

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children before they turn a year old. Wound botulism occurs when the spores get

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into an open wound and are able
to reproduce. Symptoms are similar to food

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born botulism and may take up to
two weeks to appear. This form of

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botulism has been associated with drug abuse, particularly when injecting black tar heroin.

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So just don't do that. Ever, inhalation botulism does not occur naturally.

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You're not going to get it from
sniffing flowers. This form is associated with

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accidental or intentional events which result in
the release of the toxins in aerosols.

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This can include acts of bioterrorism.
Botulism is on the list of potential bioterrorism

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sources. The medium lethal dose for
people has been estimated at two nanograms of

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botulinum talk and per kilogram of body
weight. This is about three times less

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than the doses for food boutualism.
The symptoms are the same for inhalation botulism

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as they are for food botulism.
Symptoms appear about one to three days after

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exposure and proceed along the same path
as food born intoxication, eventually ending with

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respiratory failure and muscle paralysis. If
inhalation exposure is suspected, additional exposure to

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others must be prevented. The patient's
clothing must be removed immediately and stored in

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plastic bags until they can be washed
thoroughly in soap and water. The patient

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should shower and be decontaminated immediately.
Botulism is often misdiagnosed as stroke, gullium

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bar syndrome, or myasthenia gravis.
Antitoxin should be administered as soon as possible

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diagnosis. The earlier this is treated, the better the prognosis. Severe cases

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will include supportive treatment, including mechanical
ventilation, which may be required long term.

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There is a vaccine, but it
is rarely used because the efficacy has

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not been proven and it has some
very severe side effects. Bachelinum toxin has

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been used for a variety of medical
conditions. People have been using it cosmetically

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since the late eighties, but it's
been prescribed for a variety of medical conditions

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as well. It has been improved
for use in certain cases of overactive bladder,

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treatment of incontinence, neurogenic detrusor overactivity, chronic migraines, muscle spasms,

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cervical dystorha axillary hyperhydrosis, strabismus,
and disorders of the seventh cranial nerve.

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Off label uses include TMJ disorders,
myofascial pain, neurogenic thoracic outlet syndrome,

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epicondolitis, post stroke pain, post
herpetic neuralgia, diabetic neuropathy, trigerminal neuralgia,

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neuropathic pain, spinal cord injury,
and bladder pain. Since batilinum toxin

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is an acetocholine inhibitor, it does
reduce muscle contraction and spasm. Cosmetically,

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the paralysis of facial muscles temporarily treats
wrinkles. Let's face it, folks,

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You're going to get older, and
unless you want to totally paralyze your face,

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it's going to wrinkle. Contraindications are
pretty severe. Muscles can permanently atrophy,

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Exonal sprouting may begin, and extrajunctional
acetocholine receptors can be formed. Reinnervation

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may also occur, which will reverse
the effects of the toxin. If toxicity

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occurs, the patient will experience neuromuscular
weakness, dysphasia, dysphonia, weakness,

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00:20:11.599 --> 00:20:18.200
dyspinia, or respiratory distress. In
recent years, there have been several incidences

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00:20:18.279 --> 00:20:25.440
of adverse effects on people who have
received botox treatments by unlicensed estheticians. Some

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00:20:25.519 --> 00:20:32.960
of these instances have had irreversible consequences. Okay, we're going to take a

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True Consequences. Come by and meet
Eric carter Landein and I We would

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love to meet you. Food born
botulism has probably been around since a DNA

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mankind. The ways that people stored
food were perfect for growing sea botulinum,

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ham stored in barrels of brine,
poorly dried and stored, herring trout packed

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00:23:48.839 --> 00:23:55.920
to ferment in willow baskets, sturgeon
row not yet salted and piled on heaps

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of horse hides, lightly smoked fish
or ham in poorly heated smoking chambers.

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Then, of course, there are
insufficiently boiled blood sausages. There have been

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ancient dietary laws that could reflect botulism
toxicity, going back to the tenth century,

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when Emperor Leo the sixth of Byzantium
banned the manufacture of blood sausage.

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There have also been some ancient case
reports of atropa belladonna intoxication that parallel food

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born botulism, but the combination of
dilated pupils and fatal muscle paralysis can't be

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attributed to belladonna poisoning. There was
a time when shamans would suggest adding just

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a touch of botulism to the plate
of a guest that the maharajas would rather

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00:24:48.480 --> 00:24:55.279
see dead. The Shamans even had
a recipe for such a thing. They

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would take a bit of the powder
extracted from blood sausages. This powder would

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00:25:00.359 --> 00:25:06.319
be dried under anaerobic conditions and added
to the enemy's food at a banquet.

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Death would occur days after said enemy
jested the fatal dose, so no one

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would be the wiser. In seventeen
ninety three, thirteen people were involved in

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the first well recorded bachulism outbreak in
the small German town of Wildbad. Six

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00:25:25.440 --> 00:25:30.160
of these people died at first blush. It was believed that all thirteen had

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suffered from atropine poisoning, but as
scientists tend to do, they argued over

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00:25:34.720 --> 00:25:41.480
it, and the term sausage poisons
started getting thrown around the medical experts of

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00:25:41.519 --> 00:25:47.279
the time to blame blunson, which
was a popular local food made from cooked

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00:25:47.359 --> 00:25:56.039
pork stomach filled with blood and spices. I'll pass thanks. By the end

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00:25:56.039 --> 00:26:00.920
of the seventeen hundreds, the instances
of bachulism increased amatically due to the poverty

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caused by the Napoleonic Wars. Of
course, when there is a critical event

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that causes people to lose everything they
have, infrastructure gets lost. Also,

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00:26:12.680 --> 00:26:19.559
sanitary measures began to decline in rural
food production. In July of eighteen o

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00:26:19.680 --> 00:26:26.920
two, the Royal Government of Wootenburg
in Stuttgart issued a public warning about the

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00:26:26.960 --> 00:26:33.839
consumption of smoked blood sausages. These
outbreaks prompted early research in the cause of

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00:26:33.880 --> 00:26:37.880
the disease. It also prompted the
royal government to ban the production of blood

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00:26:37.880 --> 00:26:44.400
sausage for a while. In August
of eighteen eleven, the medical section of

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00:26:44.480 --> 00:26:51.000
the Department of Internal Affairs of the
Kingdom of Wittenburg at Stuttgart again began studying

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00:26:51.039 --> 00:26:56.880
the sausage poisoning problem. At this
point they thought it had something to do

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with hydrocyanic acid, also known as
prussic acid. The members of the medical

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00:27:03.480 --> 00:27:08.359
faculty of the University of Tuggingjen disputed
that prussic acid could be the culprit.

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00:27:08.920 --> 00:27:15.319
They put the idea forth that this
had to be caused by some biological agent.

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00:27:17.400 --> 00:27:25.519
Johann Heinrich Ferdinand Attenrith was a professor
at the University of Tubigin He asked

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00:27:25.519 --> 00:27:30.440
the government to collect the reports of
doctors and health officers on cases of food

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00:27:30.440 --> 00:27:37.640
poisoning for scientific analysis data data data. I cannot make bricks without clay.

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After Ottenrith studied the reports, he
compiled a list of symptoms of sausage poisoning.

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This list was issued to health officials
with the comment that he blamed housewives

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for the poisoning because they didn't soak
the sausages long enough in boiling water.

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In eighteen fifteen, a health officer
in the village of Hahrenberg, J.

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00:28:03.799 --> 00:28:10.640
G. Steinberg, sent reports of
seven patients who had gotten botulism from eating

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00:28:10.720 --> 00:28:15.559
liver, sausage and peas. Three
of the patients had died so much for

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00:28:15.640 --> 00:28:22.200
soaking blood sausages and boiling water.
Justina's Kerner, who was oddly enough a

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00:28:22.359 --> 00:28:27.920
medical officer and a romantic poet.
I guess that at least one of those

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00:28:27.960 --> 00:28:33.200
professions would make a decent living,
reported a lethal food poisoning from the small

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00:28:33.319 --> 00:28:37.920
village that he was living in at
the time. Art and Writhe took the

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00:28:38.000 --> 00:28:42.960
reports of Steinbuch and Kerner into consideration
and published both of them in a medical

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00:28:44.039 --> 00:28:51.240
journal called two Binger Papers for Natural
Sciences. In eighteen seventeen, Kerner also

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00:28:51.319 --> 00:28:56.599
suspected a biological agent as the cause
of food poisoning by sausage. He continued

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00:28:56.640 --> 00:29:00.960
to look into the events, and
after observing a few more cases, he

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00:29:00.000 --> 00:29:06.839
wrote a paper in eighteen twenty called
New Observations on the lethal poisoning that occurs

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00:29:06.960 --> 00:29:12.119
so frequently in Wurtenburg, owing to
the consumption of smoked sausages, in which

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00:29:12.160 --> 00:29:18.920
he summarized the case histories of seventy
six patients and gave a complete clinical description

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00:29:18.039 --> 00:29:26.039
of what we now call botulism.
Kerner compared various recipes and ingredients of the

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00:29:26.119 --> 00:29:30.880
sausages that his seventy six case studies
had consumed. He found that the recipes

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00:29:30.920 --> 00:29:36.440
differed in the type of meats,
blood, liver, brain, fat,

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00:29:36.839 --> 00:29:41.599
salt, pepper, coriander, pimento, ginger, and bread. The only

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00:29:41.720 --> 00:29:48.680
common ingredients were fat and salt.
He ruled out salt and concluded that it

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00:29:48.720 --> 00:29:53.359
had to have something to do with
the fat. He later speculated about the

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00:29:53.359 --> 00:30:00.160
connections between what he was now calling
fat poison and other known poisons, which

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00:30:00.160 --> 00:30:06.359
as atropine, scopelman, nicotine,
and snake venom. Somehow he came to

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00:30:06.440 --> 00:30:11.920
the conclusion that fat poison was a
biological poison rather than an acid or other

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00:30:11.039 --> 00:30:18.240
poison. In eighteen twenty two,
he published another paper that included one hundred

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00:30:18.279 --> 00:30:23.000
and fifty five case reports, including
post mortem studies of patients with botulism.

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00:30:25.039 --> 00:30:30.599
He put forth the hypothesis that quote
the fat poison or the fatty acid and

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00:30:30.720 --> 00:30:37.599
its effects on the animal body system
a contribution to the examination of the substance

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00:30:37.680 --> 00:30:45.160
responsible for the toxicity of bad sausages
end quote. He gave a very accurate

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00:30:45.200 --> 00:30:51.119
description of the muscle symptoms and clinical
details of the entire range of autonomic disturbances

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00:30:51.200 --> 00:30:56.799
that had occurred in the patients that
he had observed. These included mydriasis,

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00:30:56.519 --> 00:31:03.759
decrease of lacrimation and secretion from the
salivary glands, and gastro intestinal and bladder

305
00:31:03.799 --> 00:31:10.200
paralysis. He experimented on various species
of animals by feeding them the extracts of

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00:31:10.359 --> 00:31:17.400
bad sausages, and finally he began
to experiment on himself. He found from

307
00:31:17.400 --> 00:31:22.519
clinical symptoms that he experienced that the
toxin could interrupt the motor and autonomic nervous

308
00:31:22.519 --> 00:31:30.079
signal transmission. His conclusions were quote
the nerve conduction is brought by the toxin

309
00:31:30.240 --> 00:31:37.240
to a condition in which its influence
on the chemical processes of life is interrupted.

310
00:31:37.359 --> 00:31:42.920
The capacity of nerve conduction is interrupted
by the toxin in the same way

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00:31:44.279 --> 00:31:51.960
as in electrical conductor by rust end
quote. He also listed his findings as

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00:31:52.279 --> 00:32:00.039
one that the toxin develops in bad
sausages under anaerobic conditions, two that the

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00:32:00.079 --> 00:32:07.240
toxin acts on the motor nerves and
the autonomic nervous system, and three that

314
00:32:07.359 --> 00:32:14.400
the toxin is strong and lethal even
in small doses. He also postulated that

315
00:32:14.440 --> 00:32:21.640
the toxin could be used as a
therapeutic agent in cases of quote hyper excitability

316
00:32:21.759 --> 00:32:29.519
of the nervous system end quote.
He mostly leaned towards treating psychological disorders,

317
00:32:29.519 --> 00:32:32.519
but who knew that almost three hundred
years later, we would be using boche

318
00:32:32.599 --> 00:32:40.960
linum toxin as a cure for several
physical disorders. On December fourteenth of eighteen

319
00:32:42.039 --> 00:32:46.519
ninety five, a botulism outbreak after
a funeral dinner in the small Belgian village

320
00:32:46.519 --> 00:32:53.400
of Zelles led to a breakthrough in
research. Thirty four people who had attended

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00:32:53.400 --> 00:33:00.400
the lavish funeral celebration of eighty seven
year old Antoine Creeteur were struck down by

322
00:33:00.480 --> 00:33:07.799
botulism after they ate smoked ham.
This led to the discovery of the pathogen

323
00:33:07.920 --> 00:33:13.880
by Emil Pierre van Irmagem, professor
of bacteriology at the University of Ghent.

324
00:33:15.519 --> 00:33:20.759
Van Ermagem had worked with Robert Coke
in Berlin in eighteen eighty three, and

325
00:33:20.920 --> 00:33:28.079
this taught him a thing or two. He isolated the bacterium from the ham

326
00:33:28.160 --> 00:33:32.240
and the bodies of the victims.
He grew it and he began experimenting on

327
00:33:32.480 --> 00:33:39.359
various species of animals. He described
the toxin itself and called it Bacillus baculinus.

328
00:33:40.480 --> 00:33:49.440
Bodulus is the Latin word for sausage. His observations were published in the

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00:33:49.559 --> 00:33:55.359
Journal of Hygiene and Infectious Disease in
eighteen ninety seven. His paper concluded that

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00:33:55.519 --> 00:34:02.480
sausage poisoning was caused by an anaerobic
micro organism produced during the salting process.

331
00:34:04.960 --> 00:34:12.239
He put forth his findings as one, botulism is an intoxication, not an

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00:34:12.280 --> 00:34:20.519
infection. Two, the toxin is
produced in food by a bacterium. Three,

333
00:34:21.239 --> 00:34:27.679
the toxin is not produced if the
salt concentration in the food is high.

334
00:34:28.039 --> 00:34:34.320
Four After ingestion, the toxin is
not activated by the normal digestive process,

335
00:34:35.679 --> 00:34:43.400
five the toxin is susceptible to inactivation
by heat, and six not all

336
00:34:43.519 --> 00:34:51.400
species of animals are equally susceptible.
These findings would springboard further research into the

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00:34:51.480 --> 00:34:57.400
causes and effects of botulism for years
to come. In nineteen o four,

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00:34:57.480 --> 00:35:01.639
an outbreak of botulism occurred after several
people in the city of Darmstadt, Germany,

339
00:35:01.800 --> 00:35:07.159
consumed white beans. This led to
the realization that there was more than

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00:35:07.280 --> 00:35:15.280
one stereotype of botulism. The present
letter designations would be assigned in nineteen nineteen

341
00:35:15.280 --> 00:35:22.639
by Georgina Burke. Commercial canning processes
would change after an outbreak of baculism occurred

342
00:35:22.679 --> 00:35:27.679
in nineteen o six. Commercially canned
pork and beans was the culprit in that

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00:35:27.880 --> 00:35:34.159
instance, and it would spur food
manufacturers to lower the pH to below four

344
00:35:34.679 --> 00:35:40.760
and heating requirements would change to prevent
the toxin from growing. Type C would

345
00:35:40.760 --> 00:35:45.119
be found in nineteen twenty two by
Bankston in the US and in Australia by

346
00:35:45.199 --> 00:35:51.760
Seton. Type D would be discovered
in the US by Meyer and Gunnison,

347
00:35:52.360 --> 00:35:55.840
and type E would be found in
Ukraine in nineteen thirty six by Bier.

348
00:35:58.719 --> 00:36:05.159
Type F was ident fight in Scandinavia
by Muller and Scheibel in nineteen sixty and

349
00:36:05.239 --> 00:36:12.320
finally type G was discovered in nineteen
seventy in Argentina by GMx and Ciccarelli.

350
00:36:14.960 --> 00:36:20.440
In nineteen forty nine, Virgin and
his colleagues found that Baculinum toxum blocked the

351
00:36:20.480 --> 00:36:28.920
release of acetacoli neuromuscular junctions. Therapeutic
research began in the nineteen seventies and has

352
00:36:28.960 --> 00:36:35.760
continued ever since. I'm going to
add an episode on bacteria as therapeutic agents

353
00:36:35.840 --> 00:36:39.119
in my never ending list of things
to talk about, but it may be

354
00:36:39.199 --> 00:36:45.199
a while before I get to it. For now, that's botulism. Next

355
00:36:45.239 --> 00:36:52.280
time, I'll talk about the differences
between food poisoning and food intoxication, and

356
00:36:52.480 --> 00:36:58.800
that will wrap up season five on
The Restaurant Rogues. The beginning of season

357
00:36:58.880 --> 00:37:04.239
six will kick off with my podversary
episode. I've been at this for two

358
00:37:04.320 --> 00:37:08.599
years and I've got a very special
episode coming up that I hope will spark

359
00:37:08.679 --> 00:37:15.599
some conversation and debate on my socials. If you'd like to get in touch

360
00:37:15.639 --> 00:37:19.920
with me, you can email me
at Jackie at Cause of Death one hundred

361
00:37:19.920 --> 00:37:24.800
secs dot net, or leave a
message on my website at www cause of

362
00:37:24.880 --> 00:37:30.599
Death one hundred sex dot net.
Please check the show notes for all of

363
00:37:30.639 --> 00:37:36.079
my social media platforms and ways that
you can get involved with my Facebook page,

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my Facebook group, my Twitter feed, and my TikTok. There are

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several ways to support the show.
You can leave a rating and review on

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most importantly, you can share this
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like to support the show monetarily,
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on Apple subscriptions, and don't forget
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check the show notes for links to
all my amazing sponsors and the discount codes.

371
00:38:15.760 --> 00:38:21.199
Thank you all for listening, and
special thanks to all that have subscribed

372
00:38:21.280 --> 00:38:25.199
on Apple subscriptions. I can't call
you out by name unfortunately, but you

373
00:38:25.239 --> 00:38:30.599
know who you are. Your support
means the world to me. Until next

374
00:38:30.599 --> 00:39:50.679
time, keep the pH of your
sausage below four and I'll see you in two weeks