Botulism is only rarely diagnosed. Only about 110 cases of the bacterial infection are reported annually. So perhaps it stands to reason that books on the deadly toxin are difficult to come across, too.
Dr. Jane Talkington's new book, Recognizing Botulism: New Insights from Old Narratives, suggests the illness is actually a lot more common than most people think. The associate director of the Turner School for Entrepreneurship and Innovation at Bradley University is also a self-described "botulism historian." Her interest in botulism is personal.
"I had a friend that had botulism, and she went undiagnosed for about eight months. And when you're undiagnosed, you don't get treated. You might get treated for things you don't have," Talkington said. "So she just got worse and worse. She almost died. She couldn't walk for three or four months. It's a very serious disease, usually lethal."
Botulism mounts a full-frontal attack on the body's nervous system. The illness is often transmitted through food, but there's other types, too. Those include botulism that enters through a wound, intestinal botulism, and infant botulism. Botulism toxin that is injected for cosmetic reasons can also lead to symptoms.
Muscle paralysis and difficulty breathing are some of the more common signs. But those symptoms are often conflated with more common conditions, and clinical observation remains the best method for obtaining a diagnosis.
Talkington said the last comprehensive book written about recognizing the symptoms of botulism dates back to 1918, written by Stanford University academics after the 1913 epidemic on their campus. But as time goes by as the principal players in that outbreak died, Talkington said that knowledge has faded.
Peoria itself had a major botulism outbreak in 1983. Twenty-eight people were diagnosed with foodborne botulism after eating sauteed onions at the Skewer Inn. Talkington refers back to one patient's initial experience in that case to illustrate how elusive an accurate diagnosis can be. In the Peoria case, botulism was identified as the cause of the outbreak, but Talkington believes it's a lot more common than most think.
"We don't know how much it's missed. We don't know the misdiagnosis rate, because we don't ever find out what they really have. So there could be millions of cases of botulism that go unrecognized," Talkington said.
That's why Talkington said she's spent the last decade harvesting knowledge about botulism from the past to compile a new guide that's accessible to the lay people of today.
"I found the descendants of the of the families that [got botulism infections], got family photographs, and was able to get the whole context of where they lived, how far out of town they were, how far they drove, all the details that the newspaper would capture," Talkington said. "So you triangulate the public health reports with the medical journal articles with the newspapers, and you get a pretty clear picture of what was happening."
The earliest accounts come from a time before a treatment was developed. For instance, around the turn of the 20th century, three hikers in the mountains near Los Angeles died after they ate contaminated canned pork and beans. But around 1915, an antitoxin was developed at the University of Illinois.
Talkington said the newspapers start to relate accounts of the medicine being rushed out to New York or California as cases cropped up. But even then, the experimental drug wasn't always trusted.
"And so they would have the antitoxin in hand and still not use it. And of course, that would result in a fatality," she said. "So every death is a lesson, right?"
Recognizing Botulism is out now from Collaborative Medical Research Publishers. Talkington said she set the price at $19.19 because the year 1919 was "the golden age of botulism research."
