Peoria botulism outbreak, 40 years later

PEORIA — Tracy Pinkham remembers all of it: The way the onions looked slimy and how she woke the next morning with a dry mouth and blurry vision that got worse as the day went on. Her head falling to her shoulders as her husband drove to a walk-in clinic that diagnosed her with an inner-ear infection and sent her home. The crowded emergency room. The doctor who scoured his medical textbook for answers. The two months on a breathing machine, paralyzed. The nightmares. The decades of muscle weakness that never seemed to get better despite physical therapy.

“I used to joke that I died and somebody different came home,” said Pinkham, 64. “In essence, that is the truth. I wasn’t the same person when I came home, mentally or physically, and it had long-term consequences.”

Over three days in October 1983, Pinkham and 27 other diners at the Skewer Inn, a beloved restaurant in Peoria’s Northwoods Mall, ate onions unknowingly contaminated with botulinum, one of nature’s deadliest toxins.

One person died. Several others spent months in intensive care units, hooked up to ventilators. The toxin left them paralyzed but conscious. They heard every word, felt every needle prick. And yet, they couldn’t move or speak or open their eyes.

They were, essentially, prisoners in their own bodies.

At the time, it was the country’s third-largest botulism outbreak of the 20th century and remains to this day one of the nation’s largest.

Often mischaracterized as food poisoning, botulism is a potentially fatal illness that has been documented in every U.S. state and countries around the world. In September, an outbreak in southwest France killed one person and sickened 14 others who ate homemade preserved sardines at a restaurant.

About 200 U.S. cases are reported to the Centers for Disease Control and Prevention each year, agency data show. Most involve a form of the illness that affects infants. Because botulism is so rare, it remains a largely unknown illness — even to some in the medical community — often misdiagnosed on first examination.

“Published literature on botulism and its treatment is sparse and characterized by disparate, low-quality data, some of it many decades old,” doctors with the CDC wrote in a 2017 paper. “Gaps exist in our knowledge of basic facets of botulism.”

Even less is known about the long-term effects of the toxin on its victims. But Pinkham and some other survivors of the Peoria outbreak say that 40 years later, they’ve never fully recovered.

“I had no idea that botulism is actually the opposite of what you think of,” said Mary Lou Dobrydnia, 69. “It grabs hold of you and stays. I don’t know if we ever got rid of it.”

The thing I remember most about the incident was that I originally had ordered a “roast beef sandwich” to which the waitress replied, “that the roast beef wasn’t very good that night.” Noting that a hamburger was hard to beat I ordered a “patty-melt” and left the restaurant. I left a larger tip for the waitress because of her recommendation. — John Mason, botulism survivor, in a letter to his attorney in 1989, six years after the outbreak

Friday, Oct. 14, 1983. It’s the heyday of suburban shopping malls, and 6 miles north of Peoria’s riverfront, the afternoon traffic inside Northwoods Mall slowly grows toward its weekend peak.

Linda Peavler and her mom, Sandra Spore, 47, pick out a baby book for her daughter Tiffany, born 17 days earlier. Tiffany and her brother Greg, 15 months, have joined mom and grandma on the shopping trip.

They visit Peavler’s husband, Jan-Paul, who manages a men’s store in the mall, and then decide on lunch. Farrell’s is an ice cream shop that also serves food. But it could be too loud for Tiffany, they think.

On the first floor, near the escalator, the Skewer Inn is a quiet, sit-down restaurant with soft lighting and booths on either side — better for a sleeping baby. The restaurant is beloved among Peoria’s residents for its gyros and salad bar. But Peavler, 26, and her mom both order something they’ve not tried.

The patty melt is a $3.50 burger topped with American cheese and a pile of sauteed onions sandwiched between toasted rye bread. Peavler worries the onions could affect the taste and smell of breast milk but decides to splurge.

Her son Greg is a picky eater, and he refuses to touch the burger pieces his grandmother has put on his plate.

A few hours later, Mary Lou Dobrydnia and three friends sit down in a booth near the front. Dobrydnia, then 29, orders the patty melt and offers a bite to her friends. They all politely decline.

They stop at a bar after dinner before Dobrydnia heads home; a friend is picking her up at 6:30 the next morning to drive to Macomb, where their field hockey team is playing in a tournament.

Back at Peavler’s home, she and her husband sit down to watch “The Exorcist.” She hasn’t eaten since lunch and yet still feels full. She goes to bed early, unable to finish the movie, and wakes up in the middle of the night to nurse Tiffany, who seems heavy in her arms.

Saturday, Oct. 15, 1983. The aspirin Dobrydnia took has done nothing to ease the headache that started when she woke up and continued the entire 70-mile ride west to Macomb. She wonders how three beers can cause such a bad hangover.

From the opening whistle, Dobrydnia can’t catch her breath. Her legs feel like anchors. She heads to the bench.

“Something’s wrong with me,” she tells her teammates.

Just north of Peoria in Dunlap, the late-morning light coming through the window blinds Peavler, who’s still in bed. She and her husband assume she’s just tired from having recently given birth.

Her grandmother calls throughout the day to check on her. Noticing her granddaughter’s labored breathing and slurred speech, she tells Peavler’s husband to leave work. Back at home, he has to carry his wife over his shoulder to get her to the car.

They drive to Spore’s house. By now, Peavler can barely keep her eyes open. Her breathing is shallow. Family thinks she has the flu.

Spore also doesn’t feel well. She has double vision, dizziness and dry mouth. A relative takes her to the emergency room at St. Francis Medical Center.

Dr. John Ruthman is in the midst of a 12-hour shift when he picks up Spore’s medical chart. His examination begins with the standard diagnostic questions. One answer stands out. Spore says she and her daughter both have double vision, and they don’t live together.

“Have you seen her recently?” he asks.

“We had lunch yesterday at the Skewer Inn.”

“What did you eat?”

“We both had the patty melt.”

Despite having never encountered a previous case, Ruthman makes an initial diagnosis of botulism. Years later, Peavler and others will credit him with saving lives.

“I’m not the real hero here,” said Ruthman, 71, now retired and living in Florida. “The heroes are the nurses and doctors who took care of patients daily. I only had one day of involvement in this. It was an important day, and I think I did most of the things I was supposed to do right.”

The CDC and the Peoria Health Department are notified. At his home, infectious disease specialist Dr. Stephen Doughty gets a call about a possible botulism case at the hospital.

Yeah, right, he thinks. Still, he heads to the hospital.

Meanwhile, Peavler and her husband arrive at the emergency room. She’s quickly taken to the intensive care unit.

Her husband thinks it’s a bad case of food poisoning, that she’ll be sick for a couple days.

He has no idea what’s about to happen. Few do.

I remember Dr. Kaylan-Raman Krishna telling me I had either a stroke, a concussion, or botulism. I knew about the first two, but I couldn’t even spell the last and didn’t know what it was. — Excerpt from John Mason’s 1989 letter to his attorney

Forty years after the outbreak, on a Tuesday afternoon in Peoria, professor Jane Talkington and her research assistant, Bradley University student Makenzie Eldridge, met at the campus library and reviewed a newly obtained photograph of a cemetery in northwest Canada where close to a dozen botulism victims were buried 100 years earlier.

Talkington considers herself to be one of the only living botulism historians, having spent the last decade poring over the details of botulism outbreaks from the previous century.

“The medical community knew more about botulism symptoms in 1920 than it does now — much more,” said Talkington, who, in addition to her botulism work, is associate director of Bradley University’s Turner School of Entrepreneurship and Innovation.

“I think the loss of knowledge is important.”

In her forthcoming book, “Recognizing Botulism: New Insights from Old Narratives,” Talkington aims to close that knowledge gap through the stories of 82 cases from 13 outbreaks in the early 20th century.

“I think there are a lot of people who will appreciate being given really good research without having to look for it,” Talkington said.

The bacteria that lead to botulism, Clostridium botulinum, exists in nature, often in soil and in lakes, rivers, ponds and oceans. It’s harmless. But when deprived of oxygen and kept in a low-acid environment under certain temperatures, it can produce the deadly toxin.

There are five forms of botulism. The most common, infant botulism, happens when bacteria enters the intestines of a baby younger than 6 months and then produces the toxin. Honey is one known source of infant botulism, which is why public health officials caution against feeding it to babies.

About 70% of reported U.S. botulism cases each year are in infants, CDC data show.

Another form, called wound botulism, accounts for around 30 reported cases a year and is often linked to intravenous drug use. Diagnosis is difficult, the CDC says, since symptoms can be mistaken for an opioid overdose.

Iatrogenic botulism is the name given to rare cases where people fall ill after being injected with a type of purified botulinum toxin — commonly known in the public by the brand name Botox — approved by the U.S. Food and Drug Administration for a range of cosmetic or medical purposes, from smoothing wrinkles to preventing migraines.

Foodborne cases are often caused by homemade foods that have not been properly canned or preserved. In 1977, the 20th century’s largest botulism outbreak was linked to home-canned jalapeno peppers used to make a hot sauce served to diners at a restaurant in Pontiac, Michigan. Fifty-nine people fell ill, none fatally.

The next year, the century’s second-largest botulism outbreak sickened 34 people, two fatally, in Clovis, New Mexico. The CDC traced the source of the outbreak to bean salad and potato salad served at a country club.

In the Peoria outbreak, the microscopic bacterium was on onions that, according to the CDC, were cooked with margarine and other seasonings and kept with more melted margarine in a pan on a warm stove.

The margarine acted as a seal, Doughty said, that blocked oxygen and allowed the toxin to grow.

The toxin has no taste or smell, so diners had no way of detecting it until it began attacking their nervous system, which usually happens in less than 48 hours but can be as fast as two hours after ingestion.

I remember my brother, George, kissing me on the forehead. Telling me he loved me. Then my father was there, my son. I can’t see them. I can only hear and feel them. Not for a very long time did it occur to me that they were there to say, “Good-by (sic).” — Excerpt from John Mason’s 1989 letter to his attorney

Saturday, Oct. 15, 1983. Sheila Winfield crawls out of her dorm room bed and stumbles over to her ringing phone.

The St. Francis hospital nurse on the line tells her she needs to come to the emergency room.

“I can’t, I feel too sick,” Winfield answers. “I’ll come when I feel a little better.”

Before she can get back in bed, the phone rings again.

“Sheila, this is serious,” the nurse says. “You have to get here.”

“I can’t,” replies Winfield. “I have to lay down.”

Winfield, then a 20-year-old Bradley University nursing student, and a friend ate at the Skewer Inn the previous day. She ordered a burger platter; her friend ordered the patty melt.

“That looks good,” Winfield told her friend, who offered to trade dishes.

“Our running joke to this day is I saved your life because that was your patty melt,” Winfield, 60, said.

That Sunday morning, she woke up to a splitting headache and double vision, which she first blamed on a night of partying. When her symptoms didn’t improve, a friend took her to Methodist hospital, where a doctor told her to go home and come back if she didn’t get better.

Back in her dorm room, her phone rings a third time. A friend who came to check on her answers.

“Sheila,” she says, “they want to send an ambulance for you.”

Instead of waiting, her friend takes Winfield to St. Francis’ emergency room. By the time they arrive, Winfield can barely talk. Her eyelids are nearly shut. Soon, she’ll have a tube down her trachea keeping her alive.

News outlets have reported about the possible botulism outbreak and Peoria’s two main hospitals are inundated with people thinking they’ve ingested the toxin.

By now, more possible cases are identified: John Mason, 42, a press foreman for the Peoria Journal Star. Randall Brown, 36, an employee at Caterpillar. Viola and Clifford Yakley, 64 and 73, from Davenport Iowa.

Meanwhile, officials with the CDC and the health department try to identify the exact source of the toxin. Most of the patients ate the patty melt. But officials initially suspect the growing outbreak came from the pickles served alongside the sandwich. Months later, they would identify the onions as the carrier.

Antitoxin is flown in from CDC sites and from Canada. The antitoxin, derived from horses, has antibodies that neutralize the poison in the bloodstream. But it doesn’t affect the toxin already attached to a person’s nerve endings.

In other words, while it can stop further harm, it can’t reverse the damage already done.

I hear of the botulism patients that have left the hospital and about those who are getting better. What’s the matter with me? — Excerpt from John Mason’s 1989 letter to his attorney

Monday, Oct. 17, 1983. The back row of students in Mary Lou Dobrydnia’s driver’s education class at Limestone Community High School look like blue outlines. Nothing more.

She has to prop her hand under her chin to keep her head from falling. Her tongue feels heavy.

She excuses herself from the classroom. The teacher’s lounge is only 20 steps away, but Dobrydnia slams into lockers as she teeters down the hall.

A friend and fellow teacher eventually takes her to Methodist hospital. Dobrydnia had been there the previous day. But in the chaos, they lost her blood and stool samples. She was sent home and told to come back if she didn’t feel better.

Back at Methodist, she’s given a pen to sign her name on some form, possibly a release, to receive the antitoxin. Unable to grip the pen, the best she can do is make an X on the line.

Even as she gasps for air, she vows, “I will not go on a ventilator!”

Her oxygen levels are constantly monitored, but Dobrydnia is never hooked up to a breathing machine — she credits being an athlete as the reason why.

By the end of the week, the full scope of the outbreak becomes clear. Thirty-seven people are hospitalized. Twenty-eight are confirmed to have botulism. All but four are in intensive care. A dozen need ventilators to breathe.

At St. Francis, Linda Peavler and her mom are kept on opposite ends of the ICU in case one of them takes a turn for the worse.

The victims become minor celebrities. Those that can speak give interviews with reporters. Others feel like oddities displayed for the medical students who shuffle through their hospital rooms.

At one point, Peavler overhears a conversation about her. She doesn’t recognize the voice and can’t open her eyes to see who it is, but the person doesn’t think Peavler is going to make it. Later, a doctor will put a sign above Peavler’s bed to remind people that, despite her catatonic appearance, she can hear everything.

In another room, Tracy Pinkham (then, Tracy Dearing), is scared the toxin will attack her brain. In junior high, she and her classmates had to write out all 1,005 words of Henry Wadsworth Longfellow’s classic poem, “Paul Revere’s Ride.” In her head, she recites each line over and over again, along with the Serenity Prayer. She rarely sleeps, and when she wakes, she’s afraid that someone will unplug her ventilator, which she calls “Big Blue.”

Victims’ families and friends settle into a routine of visits, updating each other on their loved ones’ conditions and bonding in the waiting room over shared circumstances. Dobrydnia’s friends sneak beer and pizza into her room and sit on the floor, playing games to keep her company.

Winfield’s uncle visits and, leaning over her bed, shouts: “Sheila! It’s your uncle Pat!”

In her head, she shouts back: Would you back up! But of course, she can’t speak, and he continues to yell in her ear until her dad returns and tells him, casually, that unless he just blew out his niece’s eardrums, she hasn’t lost her hearing.

Being unable to communicate is one of the hardest parts of the illness, and over the weeks to come, their families and the medical staff look for any way to fix that.

An astute nurse realizes Winfield can move her right index finger, so they find a child’s toy called a Magic Slate. With her nail, she can scribble a few words on the wax paper covered in a translucent plastic film that, when lifted, would erase whatever is written. Pinkham’s then-husband bought the same toy for her and some other botulism patients.

John Mason’s wife connects with a company that makes a then-experimental device called “Venti-Voice” that allows people on ventilators to speak. A month after he was hospitalized, in a mechanical, robotic-sounding voice, he utters his first words: “Thank you.”

I had convinced myself that once I got home everything would be all right. This whole ordeal would be over. Emotionally, I was ready and very much needed to come home. Physically, I had no business leaving the hospital. I couldn’t raise my arms up high enough to reach the cabinet doors in the kitchen, and couldn’t pull anything out, even if I did need to. — Excerpt from John Mason’s 1989 letter to his attorney

April 9, 1984. After 25 weeks in the hospital, 43-year-old Barbara Clapp comes home. Media reports say she’s welcomed by family and friends and a banner with the slogan: “Inch by inch, it’s a cinch.”

Only one person, Anna Hiter, remains hospitalized. The rest have been released to begin months of grueling therapy as they try to rebuild their crippled bodies.

Faced with mounting medical bills and lost wages, survivors and their families turn to the courts. About two-dozen lawsuits are filed against the restaurant, the mall, the food supplier and the city and county governments, which faces criticism for allowing the restaurant to remain open until the Monday after the outbreak was first discovered, when it voluntarily closed.

Most of the suits are settled years later.

“The amount we got did not cover 40 years and how much work some of us lost,” Pinkham remembered.

The Skewer Inn attempts to reopen a month after the outbreak. The Associated Press reports a line of customers on the first day.

“This is the safest place to eat in continental America,” then-Bradley University basketball coach Dick Versace tells the AP.

But despite a $10,000 advertising campaign — its slogan, “Aren’t you glad we’re back?” — the restaurant permanently shutters a few months later. Today, its existence in the mall is undetectable and the since-remodeled space is vacant.

A message left with a phone number possibly belonging to one of the co-owners was not returned. The other co-owner declined to be interviewed for this story.

Days after Clapp’s release, survivors are stunned to learn that Hiter, 73, has died. She had been off her ventilator for about 10 days and preparing to go home for Easter when she stopped breathing.

In his letter, Mason wrote:

The nightmare of the whole ordeal came to the surface of my mind. I would relive my pain as I thought of hers. There is a bond shared with people in any given situation. I had never met Anna, I didn’t know her, I didn’t even know what she looked like, but she was one of “us.” And we lost her. Damn.

On the first anniversary of the outbreak, a group of survivors organizes a dinner in Peoria with their families and some of the nurses who took care of them. A server places a bowl of French onion soup in front of the nurse sitting next to Pinkham. The nurse stares at the bowl, then turns to Pinkham.

“I’m so sorry,” she says. “I wasn’t thinking.”

Memory problems would plague me. Vocabulary became a problem. I would know what I wanted to say and could explain it, but I couldn’t find the word, both at home and at work. These problems would be addressed and dealt with. Some overcome; some to remain to the present. — Excerpt from John Mason’s 1989 letter to his attorney

Dobrydnia has a word for it: “Botchy.” It’s how she describes botulism’s lasting damage to her body. In the years since the outbreak, she returned to teaching and continued to play recreational sports. But the crushing headaches never went away, nor did the extreme fatigue that hits when she overexerts herself.

She’s overly sensitive to bright lights and to choking. Her lips will at times go numb. And when she gets tired, her left leg will drag.

Maybe a year after the outbreak, she needed her first of eight root canals all within a span of 24 months. Her suspicion is that the toxin’s damage extended to the nerves in her teeth.

Ten years ago, she contracted another rare disease, Guillain-Barré syndrome, which causes the immune system to attack part of the peripheral nervous system. It left her on a ventilator and paralyzed for a time. Because both are so rare, doctors don’t know whether botulism played a role in her getting GBS.

“I definitely have immense scars,” she said. “But I also have immense faith.”

Linda Peavler and her mom, Sandra Spore, could never regain the full use of their arms and shoulders. Before her death in January 2020, Spore would often remark, “that damn botulism,” when she struggled to lift anything. For years, Peavler’s body had trouble producing tears or saliva. She needed frequent teeth cleanings because of it. She’s had persistent respiratory illnesses and a lingering cough she thinks could be from the botulism, or from being on a ventilator so long.

After the outbreak, they both went back to school to study respiratory therapy and worked for a time at St. Francis hospital, where they helped patients on ventilators.

Sheila Winfield (now Winfield Bouie) eventually finished nursing school and moved to Memphis, where she’s the dean of health and natural sciences at Southwest Tennessee Community College. She used to share with nursing students her experience as a botulism patient and ask them to think about how they could comfort patients who can’t communicate with them.

She can’t point to any lasting symptoms of botulism. “I used to say that it took away my singing voice,” she joked, “but I could not sing ever.”

Michelle Waltenburg, a botulism subject matter expert with the CDC, said it’s not uncommon for some botulism survivors to report lingering effects while others have none.

“Some patients will need supportive care, respiratory or physical therapy, for months or even years, while others recover completely within weeks or months and report no persisting problem thereafter,” she said.

There have only been a handful of studies on the long-term damage of botulism, including one done on Peoria survivors three years after the outbreak, and another in 2017 that looked at 200-plus cases in the Republic of Georgia.

“The long-term consequences of botulism are a largely unexplored topic and more research is needed in this area,” Waltenburg said.

Afternoon Briefing

Weekdays

Chicago Tribune editors’ top story picks, delivered to your inbox each afternoon.

For Pinkham, the nerve pain lasted nearly 20 years. She never regained full strength in her arms, which made it difficult for her to continue her work as a physical therapist assistant. To this day, lifting anything at chest level is a struggle. Like some others, she is prone to choking and fatigue. She’s had gastrointestinal problems that she thinks could be related. In her 40s, she developed Type 1 diabetes, which, she wondered, could also have been an aftereffect of botulism.

The mental scars have also never fully healed. Every year since, she marks Oct. 16 and Jan. 9 as the days she entered and left the hospital.

“Sometimes I think, oh, you need to let it go. It’s been so many years,” she said. “But you just can’t. It’s not that I sit and dwell on it, but I have something physically every day that reminds me. It’s a new norm.”

The day she was admitted to the hospital was her and her then-husband’s six-month anniversary. The strain of her hospitalization and recovery took its toll on their marriage and, 20 years later, they divorced.

She eventually remarried and, 12 years ago, moved with her husband near the Great Smoky Mountains in Tennessee. She had to retire from physical therapy work and took a job as a host at a restaurant. There’s no patty melt on the menu. And even if there was, it wouldn’t matter. Like some of the other survivors, Pinkham hasn’t ordered one in 40 years.

[email protected]