In the winter of 1820, in a small tavern in Württemberg, a group of local musicians shared a simple dinner of homemade sausages. This evening, which should have ended with laughter and toasts, marked the beginning of one of the strangest stories in medicine. … modern. A few days later, several guests fell ill with disconcerting symptoms: double vision, difficulty speaking, paralyzed muscles, difficulty breathing. It was neither the plague nor cholera, but a mysterious “sausage poison” which transformed the body into an organism trapped in itself.
The German doctor and poet Justinus Kerner, who witnessed this tragedy, did not imagine that this deadly toxin – “botulinum toxin” – would one day be used to relieve chronic pain, correct muscle spasms and erase wrinkles from the human face. Even less, two centuries later, millions of people would voluntarily and without fear accept their injection, seeking to rejuvenate by three millimeters of skin what time had eroded.
The poison of sausages
Kerner was the first to describe the nature of this recurring food poisoning in rural southern Germany. He observed that it was linked to poorly prepared canned foods, lacking oxygen and high in fat, a perfect environment for a still invisible microorganism: Clostridium botulinum. Its victims suffered from generalized flaccid paralysis without fever or convulsions, a mysterious calm before relentless asphyxiation.
Driven by the romantic intuition that every poison also contains therapeutic potential, Kerner even experimented on himself – in small doses – to understand the poison’s mechanism. He concluded that it worked by interfering with nerve transmission to muscles and fantasized about its possible use to “tame the motor hyperactivity of certain diseases.”
Decades later, with the rise of microbiology in the 19th century, Emile van Ermengem identified the causative agent after an outbreak at a funeral: Clostridium botulinum, an anaerobic bacteria that produces one of the most potent substances known. In small doses, it blocks the release of acetylcholine in nerve endings, preventing muscle contraction. At higher doses, life.
From food enemy to medical tool
Getting this deadly poison to the medical laboratory took more than a century. During World War II, American researchers feared its use as a biological weapon. However, it was in the 1950s and 1960s that a small group of physiologists began studying the toxin with another interest: as a model for understanding how the synapse works. At the San Francisco Eye Research Institute, Dr. Vernon Brooks observed that when injected locally into animals, focal and reversible muscle paralysis was produced. This opened a therapeutic door: if he could control the toxin as if it were a chemical scalpel, perhaps he could modulate abnormal muscle contractions.
The Canadian neurologist and ophthalmologist Alan Scott continued this line in the seventies. He was looking for a less invasive treatment for strabismus, which had previously required surgery. He purified a dilute, stable form of type A toxin, tested it on monkeys and then, cautiously, on human patients. The result was revolutionary: When injected into an overactive eye muscle, it temporarily relaxed, allowing the two eyes to better align without the need for a scalpel.
The wrinkle that changed aesthetics
The transition from therapeutic to aesthetic was an almost accidental discovery, another example of chance. While treating patients with blepharospasm – involuntary spasms of the eyelid – Canadian doctors Jean and Alastair Carruthers noticed that some patients came back surprised: their facial wrinkles had temporarily disappeared. By paralyzing the muscles responsible for these involuntary contractions, the face gains softness and a serene expression.
The discovery was repeated so many times that it could not be attributed to chance. In 1992, they published the first controlled studies on the cosmetic use of botulinum toxin to reduce wrinkles between the eyebrows and forehead. The scientific community had difficulty accepting the idea of a nerve agent becoming a cosmetic, but success was immediate. In 2002, the FDA officially approved Botox Cosmetic for facial treatments. Since then, its use has expanded beyond belief.
One more demonstration that side effects are sometimes the germ of a new therapeutic field.
The Botox paradox has fascinated doctors and philosophers of science: the same toxin that can cause death by respiratory paralysis becomes, in microdoses, a symbol of vitality and youth. It is the modern echo of Paracelsus’ principle: “Only the dose makes the poison”.
On the other hand, no medical discovery escapes its social reading. Botox, more than a medicine, has become the symbol of an era. It represents a society that fears aging and seeks to chemically control time. Its popularity is growing at the rate of the expansion of visual culture: television, digital photography, social networks.
In a world where the face is the calling card, dominating one’s expressions seems a form of power.
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