An Oklahoma resident was hospitalized in Arkansas for progressive dizziness, blurred vision, slurred speech, difficulty swallowing, and nausea. On examination the patient was found to have ptosis, extraoculuar palsies, facial paralysis, palatal weakness, and impaired gag reflex. He eventually required mechanical ventilation. A stool culture detected Clostridium botulinum, type A. Botulism toxin, type A, was found in homemade beef stew that had been eaten by the patient. The stew had been cooked and then left on the stove for three days before eating it without reheating it first.