“A lot kills, a little cures,” wrote the father of toxicology, and botulinum toxin is the poster child for this important pharmaceutical concept. Depending on the dosage and route, this potent bacterial toxin is either a devastating foodborne poison – one of the most deadly toxins known to man, capable of causing paralyzing death – or a wildly popular wrinkle antidote, harnessed and wielded in the pursuit of clearer skin.
Yes, botulinum toxin, or Botox, is best known for its use in cosmetic treatment, smoothing facial crinkles and crow’s feet, but its applications go far beyond the superficial: botulinum toxin can quell migraines, deactivate excessive sweating and salivation, and alleviate painfully contracted limbs in people with cerebral palsy. The therapeutic wonders of botulinum toxin and its wide range of medical applications have only been fully realized since the 1980s, but an inkling of appreciation for the vast possibilities of this powerful neurotoxin were first appreciated over 200 years ago in the work of a physician poet with a passion for psychic phenomena and marionette theatre (1).
This young doctor, Justinus Kerner, was the first person to identify botulinum toxin as the causative agent of a series of devastating outbreaks in Germany caused by suspiciously bad sausages. He is renowned for not only providing the first systematic clinical description of the toxin’s effects but also for testing it on himself and accurately prophesying its use as a curative for a variety of medical ailments.
Food-borne botulism is the unhappy culmination of consuming food contaminated with the botulinum toxin or with spores of the bullet-shaped microbe Clostridium. This bacteria is a hardy organism, found in soil throughout the world. The microbe can contaminate produce and meat and, in warm conditions where oxygen is lacking, will produce the botulinum toxin. Common culinary culprits of botulism include poorly preserved food such as pickled products, prison-made hooch, jam and jelly, and salted meats.
In the late 1790s and early 1800s, the Kingdom of Württemberg in southern Germany was plagued with sausages gone bad. Amidst the ongoing Napoleonic Wars from 1803 to 1815, adequate food production was stymied by poverty and lapses in food hygiene (2). Cases of fatal poisoning spiked in the region, prompting the capital of Stuttgart to issue an edict in 1802 on the dangers of the “harmful consumption of smoked blood-sausage.” These sporadic outbreaks were characterized by an odd constellation of symptoms: blurry vision, drooping eyelids, slurred speech, difficulty swallowing, vomiting, and severe muscle weakness.
To put the scientific landscape in perspective, just a half a century prior, witches were blamed for outbreaks of food poisoning and the concept that bacteria might sicken us wouldn’t emerge for another hundred-odd years (3). Amidst the paralysis and death by sausage in Württemberg, many assumed the poisonings to be the result of ingestion of prussic acid, otherwise known as hydrogen cyanide, and yet Justinus Kerner, a 29-year old medical officer living in the Württemberg region amidst the simmering outbreak had a hunch, a radical idea at that time and age, that the food poisoning was caused by an organic, biological poison.
In 1820, Kerner published his monograph detailing 76 cases of “sausage poisoning,” systematically chronicling this strange syndrome, which he observed to attack the gastrointestinal tract, the neuromuscular network, and the autonomic or “fight-or-flight” system. This would be the first accurate description of the clinical presentation of food-borne botulism. He accurately noted that his patients’ cognition and sensory system remained intact, though their muscles became weak with signs of neurological impairment. The cause of death from botulism, he discovered, was ultimately through respiratory and cardiac failure secondary to muscle weakness.
Two years later, he published a second monograph chronicling the outcomes of 155 cases, speculating on the mechanism of what he would dub “the fat poison.” Kerner administered extracts of spoiled sausage mixed with honey to a menagerie of small captured animals – including flies, locusts, snails, birds, frogs, rabbits, and cats – finding identical presentations of “sausage poisoning” in fly and frog alike (2). He also made small incisions in the thighs of a rabbit and cat, daubing the exposed tissue with sausage extracts and found that the “fat poison” brought about a localized paralytic effect with complete recovery of the animals. Kerner also poisoned himself. Placing just a few scant drops of extract on his tongue, he noticed a “feeling of contraction and choking in the area of the larynx … some drops of the acid brought onto the tongue cause great drying out of the palate and the pharynx.”(2) The extract tasted sour, much like the spoiled sausages.
Kerner recognized that the “sausage poison” had clinical similarities to other known neurological poisons, including nicotine, snake venom, and atropine from the belladonna plant. From his meticulous experiments, he deduced that this poison had its function in blocking signals in the nervous system, thus disrupting what he referred to as the “chemical process of life.”(2) He would write that “the capacity of nerve conduction is interrupted by the toxin in the same way as in an electrical conductor by rust.”
Not satisfied with his identification of this poison’s mechanism, Kerner was the first to propose that this “sausage poison” could be put to good use as a therapeutic agent by using small doses to disrupt an overactive neurological system, leading the way to its current applications in urology, neurology, and urology.
Although Kerner was unable to properly isolate the toxin in its pure form, he was able to accurately speculate on its method of action and is recognized as the “intellectual instigator of modern botulinum toxin therapy.”(2) Following his publications in the early 1800s, Kerner was appropriately known as the expert on “sausage poisoning” and deemed “Wurst-Kerner” or “Sausage Kerner.” Another 70 years would elapse before the toxin-producing Clostridium botulinum would be discovered in a piece of contaminated ham and be rightfully anointed using the Latin word for sausage, “botulus,” honoring the diligent work of this scientist and visionary.
Previously on Body Horrors
A true Renaissance man, Kerner was also a renowned poet and scholar who was fascinated by ink-blot drawings, sleepwalking, and demonic possession. Read more about this remarkable man here.
1) HB Segel (2014) Travel Shadows by Justinus Kerner. Newcastle upon Tyne: Cambridge Scholars Publishing
2) FJ Erbguth & M Naumann (1999) Historical aspects of botulinum toxin: Justinus Kerner (1786-1862) and the “sausage poison.” Neurology. 53(8): 1850-53
3) S Pellett. (2012) Learning from the past: historical aspects of bacterial toxins as pharmaceuticals. Curr Opin Microbiol. 15(3): 292–299
4) FJ Erbguth (2004) Historical notes on botulism, Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin. Mov Disord. 19 Suppl 8: S2-6