majority of outbreaks when anaerobic conditions and non-acid foods allow the
germination of spores, growth of the vegetative forms of the bacterium and toxin
production. The foods incriminated most frequently include meats, sausage and a variety
of fruits and vegetables.
Clinical symptoms and signs include fatigue, weakness, dizziness, headache, and sore
throat initially, followed by the nervous system manifestations of double vision, trouble
speaking and swallowing, loss of voice, and descending muscle weakness. Death is
usually from heart or respiratory failure. Treatment management is primarily the use of
specific antitoxin, supportive treatment for breathing difficulties and meticulous nursing
care. Antibiotics are used as adjuncts to destroy any residual vegetative forms of the
bacterium.
Armstrong reviewed the knowledge up to 1919 of major outbreaks of botulism. In a
footnote, he also described 5 deaths in Detroit, Michigan reported after his description of
the Ohio outbreak. He indicated that the Ohio and Detroit outbreaks were both due to
eating California packed fruits – ripe olives.
Armstrong described in detail (9) the outbreak of poisoning that developed in a group of
people who were in attendance at a banquet held on the evening of August 23, 1919, at a
country club near Canton, Ohio. About 200 people from Canton and the surrounding
towns were present at the banquet. Following the dinner, 14 cases of poisoning occurred
- 11 among guests and 3 among employees of the club. Five guests and 2 employees
died. The guests who became ill were all members of a party given by Mrs. I.W.G. (who
died) of Sebring, Ohio and had been served at a separate table, thereafter described in the