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J. C. Geiger, M.D.
JAMA. 1941;117(1):22. doi:10.1001/jama.1941.72820270003007c.
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On March 22, 1941 a family of 6, 2 adults and 4 children aged 7, 9, 11 and 12 years respectively, partook of a meal designated as supper at approximately 6 p. m. The supper consisted of macaroni, prepared with commercially canned mushroom sauce designated as Italian style, milk, apples and oranges. The food of all previous and later meals was considered of no consequence in the light of the clinical symptoms developing in 3 of the children andthe subsequent field or epidemiologic investigation. It is of importance to note that the commercially canned mushroom sauce was not heated but was poured directly over the cooked macaroni and served, the 3 children affected obtaining the first servings. The remaining persons, 2 adults and 1 child aged 7 years, likewise consumed this mixture of macaroni and unheatedmushroom sauce.

The first symptoms of botulism occurred in 1 child, aged 11, at 4:


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