The World’s Deadliest Fish

Most folks think great white, tiger, and mako sharks are the world’s deadliest fish. They’re dangerous all right, but the deep’s deadliest distinction goes to the cute little pufferfish you remember from Disney’s Little Mermaid. Also called blowfish and sunfish, these sashimi delicacies known as fugu kill 10 times more people per year than sharks. And they do it a lot slower and far more viciously.

Shark attack deaths are super rare. Sharks kill an average of 5 people each year worldwide, although statistics show at least 80 violent human-to-shark encounters happen annually. Most shark victims are seriously injured like having an arm or leg torn apart, yet somehow survive. Not so with pufferfish poisoning.

Pufferfish death statistics are hard to nail down, but the World Health Organization and an article in National Geographic confirm at least 50 people expire every year after ingesting neurotoxins found in pufferfish livers, ovaries, testicles, intestines, and skin. Hundreds more become seriously ill and only bounce back through immediate medical intervention.

What makes pufferfish so toxic is tetrodotoxin. It’s 1,200 times more powerful than potassium cyanide which the Nazis used in their poison pills. Tetrodotoxin is the world’s deadliest substance by volume next to anthrax and a chemical inside the tropical cone snail. In fact, tetrodotoxin is far more lethal than venom found in the common death adder and the notorious taipan snake. Injecting 1 microdot of pure tetrodotoxin will kill the average-sized human. That’s equivalent to 10 nanograms, which is an amount impossible to see with the naked eye.

So why are powerfully poisonous pufferfish such a preferred palatable pleasure?

It’s because specialized fugu chefs know how to safely filet this culinary delight. In Japan, where fugu is so popular, chefs undergo a state-required licensing program. Apprentice fugu chefs train for 3 years before taking a written, oral, and practical exam on the 30 prescribed steps for properly preparing pufferfish. Only a third pass.

Fugu chefs are extremely cautious about processing their pufferfish. They meticulously remove the toxic parts and treat the offal like nuclear waste. Pufferfish flesh is delicate and exceptionally tasty. The Japanese have a high demand for this sashimi dish, but it’s popular all through the warm water world where pufferfish naturally occur.

There are over 120 different pufferfish or tetrodontiforme sub-species. An adult dwarf blowfish is only an inch long and too small for a meal. But the largest fugu fish reach two feet in length and weigh up to five pounds. Pufferfish get their common name from a defensive ability to swallow water and expand their stomachs up to four times. Blowing into a ball shape makes pufferfish hard to grip by predators’ teeth. Many sub-species have sharp, poisonous spikes on the skin surface which lay flat when uninflated. However, when alarmed and expanded, pufferfish turn into deadly mines.

Pufferfish don’t manufacture tetrodotoxin within a body system.

Rather, tetrodotoxin is a by-product made by invasive bacteria that pufferfish ingest in their food. Snails are the main part of pufferfish diet. These subtle sea creatures contain a combination of alteromona, shewanella, and vibrio bacteria which react with pufferfish innards to isolate tetrodotoxin. Evolution created a pufferfish immunity to the toxin where sodium channels are mutated. This is why the bacterial doesn’t kill its host.

But tetrodotoxin certainly tries to kill anything trying to eat a pufferfish, particularly human beings. It does this by molecularly bonding to cells and blocking the sodium channels which allow neurological information instructing cells to be elastic. When sodium channels are blocked, cells remain neutral or paralyzed. If enough tetrodotoxin is taken, the victim suffers total paralysis including the diaphragm’s ability to move. There’s no lung inhaling or exhaling and the stricken person smothers while remaining totally conscious.

It’s a nasty way to die—lying there with eyes open and knowing the end is near. But not all pufferfish poisoning patients die. It greatly depends on the amount or dose of tetrodotoxin consumed. It also depends on having medical assistance present. Standard treatment for tetrodotoxin cases is keeping the ailing victim on mechanical ventilation while the person metabolizes the toxin and excretes it. This can be several days or even weeks if a person becomes comatose. There’s no known antidote.

Even the slightest amount of tetrodotoxin will cause discomfort and distress.

First, the lips and face feel tingly. Similarly, the finger and toes tips are affected. Headache, nausea, and vomiting follow. Then total muscular paralysis occurs along with the inability to breathe. Respiratory failure causes a loss of oxygenated blood to the heart and the patient suffers cardiac arrest.

Tetrodotoxin is non-soluble in water and heat resistant. A chef can’t flush tetrodotoxin from pufferfish sashimi flesh. Nor can they cook it out. But tetrodotoxin never occurs naturally in pufferfish flesh. It’s only introduced when an organ is punctured. Once the flesh is contaminated by a leaky liver, gut, bladder, or reproductive organ, it’s impossible to rid. It’s also impossible for the untrained eye to spot a leak as the toxin is colorless.

Despite pufferfish being so dangerous, there’s no hesitation to eat the stuff.

Japan is the largest fugu-consuming country. It’s an important part of their culinary culture. Fugu is a seasonal commodity as the fish’s toxicity is directly related to water temperature. Even though pufferfish require warm, sub-tropical water, tetrodotoxin intensity stays relatively low during the fall and winter when waters are cooler. Once the spring and summer heat hits, the bacteria blooms and pufferfish become far too toxic to risk handling. Even pufferfish urine absorbed through the skin can be lethal.

The finest fugu pufferfish come from the Shimonoseki region in southern Japan. It’s a city of 250,000 and boasts 500 licensed fugu chefs. Shimonoseki’s fish market is a Mecca for fugu aficionados. It’s world renown in fugu circles, having a giant brass pufferfish statue outside. Live and processed pufferfish are shipped worldwide every day from Shimonoseki and command the industry’s highest price.

The fugu fishing industry is tightly regulated with a restriction on licenses. Fishing openings are on a lottery base and apply daily. Shimonoseki’s fugu market processes over 300 tons of pufferfish yearly. Every day, the market hosts a pufferfish auction where buyers secretly bid with the auctioneer by hand signals concealed in a black cloth bag. This way, no one knows the current price except the successful bidder and auctioneer. This allows fluctuating market prices which is considered healthy for the fugu industry.

Fugu dining isn’t just a palatial experience.

The Japanese have fugu down to an art form. Not only are fugu chefs trained not to poison customers, they’re skilled at delighting guests who will pay $200-300 USD for a fugu dinner. Most fugu is sliced as ultra-thin shimini wafers and accompanied with sushi rice rolls and sauces. This is expected, but the presentation can be breathtaking.

Top fugu chefs take enormous pride and enjoy tremendous recognition for preparing and presenting their pufferfish. Commonly, fugu platters are laid out in traditional Japanese patterns representing swans and chrysanthemums. They’re a thing of beauty and so is how a fugu dinner unfolds.

Most fugu dinners run from five to seven courses eaten over several hours. The best fugu restaurants have live tanks where guests pick their personal pufferfish. It’s then prepared in front of the table with the fugu-master fileting the fish and plucking the poison. Guests are progressively served raw or shimini-style fugu followed by cooked fugu in soups, stews and hot sake.

But for every honorable and noble fugu establishment, there are always those pushing the rules.

Believe it or not, there’s a flourishing fugu black market where patrons seek seedy sushi saloons. Some fugu daredevils thrive on devouring fugu tainted with tetrodotoxin. They claim it gives them an incredible high found nowhere else. And where there’s a buck to be made, someone will take it.

Finally, there’s a fugu subculture with its own rules and regulations. For instance, it’s considered bad manners to ask someone else to first try a fugu serving in fine restaurants. It’s also considered crude to take a fugu bite, then mockingly grasp the throat and recoil in agony. And no patron should ever appear shocked when presented their fugu bill.

Kill Zoners: Have you ever used poison (the weapon of women) in your stories? If so, tell us about it and how it turned out. Also, has anyone out there tried fugu?

The Excruciating Death of Mister Red Pepper Paste Man

Coroners are different folk. A coroner requires a blend of things. Investigative skill, comprehensive training, personality quirk, life experience, legal and forensic knowledge, compassion, empathy, curiosity, gray or white hair, strong stomach, and a good sense of black humor. I guess I was a good fit as a coroner.

I was involved in around 2,500 human death investigations during my run as a coroner. That’s an approximation because I never kept track. I could go back through my notebooks and count but, at my stage, I really don’t care about stats.

I can’t possibly remember them all. Nor can I remember names. What I remember are unique cases which we, in the Coroner Service, appropriately nicknamed according to their death circumstances.

For instance, I distinctly recall Betty Cutter, not Betty Crocker. She cut her own throat with her kitchen’s electric carving knife and her name was Elizabeth. Same with The Flying Dutchman— a guy named Hoogenstratten (sp?) who, with an alcohol level three times the legal driving limit, crashed his sizzled ultralight after buzzing into high-voltage power lines. Then there was Grizzly Adam whose name was Adam and was mauled to death by a grizzly bear.

Who could forget Dallas? He doused himself with gasoline, lit himself on fire, and blazingly ran around in a snowy backyard until he extinguished for good. To establish time of death, I canvassed a neighbor. She watched it all from her kitchen window and timed her snackage interruption as being the commercial break three-quarters through watching the TV show Dallas.

And I’ll never forget another case. I was a junior, understudying with a coroner who I describe as like travelling with Yoda. Barbara McCormick was, without a doubt, the highest IQ person I ever encountered. And it was Barb who monickered the death victim Mister Red Pepper Paste Man. Let me tell you his story that I once posted in my blog at DyingWords.net.

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“Sounded like someone was skinning a live cat,” the next-door lady told us. She sniffed, wiping her eyes. “Then loud crashing and banging, then… everything went quiet. I waited a while, didn’t hear nothing more, so I went and checked and found him dead on the floor.”

I was in my first year of coroner service and shadowing my mentor, senior coroner Barbara McCormick. We were in the kitchen of a tiny suite at the low rent side of town, standing over this skinny, old guy who was in a semi-fetal position with one arm wrapped around his abdomen and his other hand clutching his throat. I’ll never forget his wide-open eyes or the gritting grimace of teeth—the expression of excruciating pain etched in a cold, deathly stare.

“Heart attack or brain aneurysm, Barb?” I asked, ready to flip a coin. I was new to the coroner service, but no stranger to dead bodies after a career as a homicide cop. There was zero sign of foul play at this scene, and my experience told me people usually drop dead from one of these two natural events.

Barb was bent over, starting the head-to-toe examination that coroners do before removing a body for a thorough autopsy back at the morgue. “Wouldn’t bet on either.” Barb was trying to pry his jaw for a look down the throat. “Check his color. Blue-gray. Looks like he’s asphyxiated. I’m thinking he might have choked on something but, for the life of me, I don’t know how he could let out a curdling cat-scream if something was stuck in his yap.”

While Barb was messing with his head, I snooped around. It was typical digs for a single pensioner—a bachelor suite crammed with junk. Empty booze bottles and overflowing ashtrays testified to a lifestyle that suggested he should be dead of something by now. I checked for meds, which was routine. The pathologist would want to know what was likely in his system and the toxicology lab would want it for sure.

I found the usual pill vials indicating treatment for coronary and respiratory ailments that heavy drinkers and smokers all have. The place was relatively clean, although cluttered, and didn’t reek of garbage and bodily waste like most of these places do. I saw a part-eaten sandwich on the table and a freshly cracked beer—seemed like the old boy was doing lunch when violently seized by the death monster and taken down hard to the mat.

Barb stood up. She was puzzled. “I have no idea. Should be an interesting postmortem.” We finished photographs, bagged the man, then stretchered him out to the transport van and drove him off to the morgue.

We’d recorded his personal details, which is part of a death investigation, but his real name never stayed with me. Most are like that. In the death business it’s not a good idea to get too close to your clients, but some you never forget because of how they checked out.

It’s normal—in black humor behind the scenes—for coroners to name their files by earned handles. I’ll always remember Capn’ Crab Bait, Voltage Vern, Methlab Mikey, Arachnoid Ann, Lawn Tractor Guy, Tarzan of the Caterpillars, Freight Train Ference, The Krosswalk Kidd, The Drill Sergeant, Pole Dancer, Cats-Sup, and… as long as I live… I’ll never forget Betty – the Electric Carving Knife Lady.

And, it came to pass, I’ll also never forget the dead little man we’d just rolled into the cooler.

Next morning my favorite pathologist, Dr. Elvira Esikanian, was on the roster to autopsy our guy from the kitchen floor. I loved dealing with Elvira. She’s Bosnian with a wicked sense of dry humor and an equally wicked curriculum vitae, including exhuming mass graves for the UN and serving in some of the busiest morgues around the world where she’d often do a dozen different cuttings per day.

Although Elvira was exceptionally thorough, she was a go-to-the-throat prosector. She’d assess the circumstances, then head straight to the most likely cause.

“I’m suspecting an acute respiratory event,” Elvira stated. “Note the petechiae in the eyes.” She pointed to pricks of blood in his whites. “We normally see petechiae in cases of sudden and severe loss of oxygen, such as in strangulation, although on this man I see no sign of exterior trauma.”

We Y-incisioned the thorax/abdominal cavities and began removing organs.

“His lungs are clear, with the exception of tobacco effects.” Elvira had cross-sectioned them. “And his airway is unobstructed. This man did not choke, nor was he suffocated by fluid.” She examined the heart, which showed expected signs of advanced coronary artery disease. “And he did not suffer a heart attack.” Elvira placed the gastro-intestinal tract in a plastic tub and set it aside on her bench.

She proceeded straight to a cranial exam, inspecting for the tell-tale bleed of a cerebral hemorrhage. “Nothing obvious here.” Elvira put the brain in a stainless bowl. “You indicated this man was eating lunch when he expired.” She looked at me. I nodded. She reached for her plastic tub. “I’m going to examine the stomach.”

For most pathologists and coroners, digging in the digestive tract is the most unpleasant part of the job. It was no different with this man. Elvira incised the stomach and poured its contents into a clear, glass tray. She flipped on her magnifiers and bent a gooseneck light overtop. Immediately, she let out a wolf-whistle. “Look at this!”

To me, it was a messy slime-goo of chewed bread mixed with some rude and red, pasty substance.

To Elvira, it was the smoking gun.

I watched Elvira excise a culture, fix it in a slide, and examine it under her microscope.

“Have a look.” She directed me to the eyepieces.

What I saw was a squiggling biological mass of sub-terrain aliens—looking out-of-this-world like agitated, animated, turquoise tampons breathlessly mingling in a magnified mess of greenish-gray snot.

I swear they had heads, horns, and hoofs.

“Clostridium  Botulinum,” Elvira announced. “Botulism. I’m sure this man died from the deadliest food poison known.”

Now, I’d heard of botulism. Everyone has. That’s why my mum would sniff the tin cans when she opened them and why she’d boiled preserves for four hours. But this was the first time I’d seen a real case of botulism.

“We won’t know the strain or the severity level until we get toxicology results but I can tell you, given how quickly this poor fellow expired, it must be an extremely toxic ratio.”

Elvira went on. “What happens is the neurotoxin produced by the botulinum bacteria acts as a blocking agent preventing neurotransmitters from issuing instructions to the muscles. Once this poison hit his system, every nerve in his body would have felt on fire and he’d quickly fall into total paralysis. That would soon stop his lungs and he’d fall into a state of anoxia, or lack of oxygenated blood to the brain. He’d be conscious throughout and would feel everything… but would be unable to react.”

She glanced at the cut-open cadaver on her examining table. “What a positively excruciating way to die.”

Barb McCormick already had her digital camera out and was scrolling through shots from the scene. “This might be it.” Barb enlarged a photo showing the kitchen. Evident was a jar with its top off, containing a reddish substance.

Realizing the lethality of the situation and the danger to others, Barb and I immediately went back to the apartment. There, on the counter, was a jar of red pepper paste with a label indicating it originated in China and was far past its expiry date. A tag showed it’d been purchased at the Dollar Store.

Cautiously, we peered inside.

And—I’m here to tell you—that red, peppery, pasty scum was actually moving.

It took over a month for the toxicology results to come back. They proved positive for Botulinum toxin—Type E—and the dosage was staggering.

Toxicology measures the presumed lethal dose of a substance in digital units of LD50/ (mg/kg) which translates to the Lethal Dose (LD) required to kill half of the tested laboratory animals in a controlled volume and time.

The LD for Botulinum toxin is 0.00001. Our red pepper paste man’s reading was over 0.02000—two thousand times the amount needed to kill a human being.

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It’s been a few years since the red pepper paste case and I thought I’d review the pathology around Botulinum toxin. Here’s a quote from a paper by the World Health Organization on the medical process of how botulism works on the human body:

To understand the role of Botulinum toxin, it is necessary first to understand how the brain initiates a muscle contraction as it is in this process that Botulinum toxin intervenes.

Muscles are connected to the brain by the nervous system which is a complex network of neurons – these are long cells that can pass information using either electrical or chemical signals. Chemical signals pass between neurons and muscles through synapses, which are specialized connections linking cells. The chemicals that are used to pass these messages are called neurotransmitters.

In the case of a muscle contraction, the chemical signal is passed using a neurotransmitter called acetylcholine. This sits in the neuron in a vesicle, a small bubble surrounded by a membrane, until it is required. When the neuron receives a message from the nervous system to initiate a muscle contraction, the acetylcholine is released from the vesicle and passes through the synapse into the muscle fiber.

To achieve this, the vesicles need to be transported to, and fuse with, the neuron membrane that adjoins the synapse between the nerve and the muscle. This process is controlled by a group of proteins called the SNARE complex.

The three main proteins involved are Syntaxin (which connects to the nerve membrane), Synaptobrevin (which connects to the vesicle) and SNAP-25 (which helps the other SNARE proteins link up). These proteins join together to cause the vesicle to move to the nerve membrane and fuse with it. The acetylcholine can then be released across the synapse and pass into the muscle. This then triggers a chain of events that causes the muscle contraction.

Botulinum toxin prevents the release of acetylcholine through the synapse.

Botulinum toxin is produced by a bacterium called Clostridium Botulinum. This bacterium is associated with causing botulism, a rare but deadly form of food poisoning.

Botulinum toxin is exceptionally toxic but, when purified and used in tiny, medically controlled doses, it can be used effectively to relax excessive muscle contraction and is now commonly used in cosmetic surgery.

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Hmmm… BOtulinum TOXin… BoTox.

The same gruesome stuff in the red pepper paste that painfully killed our old man is commonly stuck into people’s faces to make them look younger and pretty.

I’m sure, for the most part, BoTox injections are perfectly safe. But… if you’re thinking of cosmetically shedding some years, remember the Excruciating Death of Mister Red Pepper Paste Man.

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What about you Kill Zoners? Would you take Botox injections? And does this post make you wanna check expiration dates in your fridge and in your cupboard? BTW, feel free to use this toxin to kill off your characters.

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Garry Rodgers is a retired homicide detective and coroner. Now he’s reinvented himself as a crime writer and deadly blogger. Probably an upcoming podcaster, too. 😉

Garry has a popular website at Dyingwords.net and a Twitter handle—@GarryRodgers1  Followers say Garry Rodgers is cool so be like Garry.