Though outbreaks of botulism are occurring with diminishing frequency, the mortality in the United States and Canada remains very high. The deathcase percentage for type A is 60, for type B 48.7, and for type E 43.9. This death rate is an affront to modern medicine. Botulism is both curable and preventable. In this issue (p 303) Armstrong and colleagues point out that important factors in the high fatality incidence are the confusing symptoms and the failure to differentiate between botulism and acute gastroenteritis, intestinal obstruction, myocardial infarction, appendicitis, Guillain-Barré syndrome, cerebrovascular accident, myasthenia gravis, or belladona poisoning. The clinical features relate to the gastrointestinal, peripheral nervous, respiratory, and circulatory systems. Typically, there is a history of ingestion by several persons of home-packed or commercially canned food products. They become acutely ill within 18 to 36 hours, with nausea, vomiting, dysphagia, obstipation, diplopia, ptosis of the eyelids, hoarseness, and in