Armstrong – Table of Contents

consistent with observations published previously in the medical literature by other
authors. He stated that the diagnosis in a single or index case might present difficulties
since initial signs and symptoms could mimic other medical conditions. The occurrence
of other cases in an outbreak helps to clarify the diagnosis. Mortality in outbreaks has
varied and occasionally reached 100 per cent. The prognosis, according to Armstrong,
was that that patients who escaped death could expect complete recovery, but it might
require weeks, or even months, in the more serious cases. During this recovery period,
bronchopneumonia was the most feared complication. Weakness was the symptom that
was slowest in disappearing from the survivors.
The mortality in 1919 was as high as formerly indicating the unsatisfactory status of the
availability of specific treatment. Treatment, as one would expect in 1919, was largely
symptomatic and empirical. Gastric lavage and induced emesis was used to remove
residual offending food from the stomach. Purgatives and colonic irrigations were
advocated. The therapeutic manuals also recommended strychnine to “improve the action
of the of the damaged nervous system. Cardiac and other stimulants were to be used as
indicated”. Emphasis was on the maintenance of adequate nutrition and fluid intake when
possible. In 1919, treatment such as specific antitoxin, antibiotics, and nutritional and
mechanical respiratory support for patients with botulism was not available. The
employment of these modern therapeutic measures have helped decrease the mortality
currently when the diagnosis is suspected or confirmed early in the course of illness.
Occasionally, the diagnosis can be made, even in the absence of laboratory evidence of
botulinum toxin in the blood or feces, especially, when the illness occurs in the midst of
an outbreak of similar illnesses and a compatible epidemiological background.