Being used to the good doctor’s non sequiturs, I expressed suitable incredulity. He explained that his once-beloved hot dogs were always disappointing and heartburn-inducing. I told him it’s not just indigestion they can cause—and I’m not talking about coronary artery disease. Sausages can kill!
Go back to Roman times, and they already knew that a dodgy wee wiener could see you off. But it wasn’t until 1822 that a German physician, Justinus Kerner, made the link between moldyblood sausage and a fatal outcome. He described sufferers enduring the wurstkind of misery before succumbing: spasms, nausea, vomiting, constipation or diarrhea, double vision (more on that later), unsteady gait, difficulty swallowing, even reduced earwax production (go figure), paralysis, and finally, death.
In 1870, another German, Dr. Müller, coined the term “botulism” from the Latin botulus—sausage. The culprit is Clostridium botulinum, a belligerent bacterium that thrives in spoiled food and produces one of the most potent biological toxins known. Ironically, that same poison now helps those seeking eternal youth look lovely. Well, sort of.
Acetylcholine is the chemical messenger that tells muscles to contract. Botulinum toxin blocks its release, rendering muscles temporarily flaccid and non-functional. These hardy bacteria live in soil and in the intestines of animals and can survive without oxygen.
Kerner, far ahead of his time, speculated that limited doses of lousy links might be therapeutically useful in treating St. Vitus’ dance, a now-defunct term for a range of diseasesnamed for an Italian saint who liked to boogie. These movement disorders cause jerky, dancelike motions with many symptoms including psychiatric changes and the “milkmaid’s sign”—rhythmic hand contractions resembling milking a cow. Kerner’s prescience wouldn’t be fully appreciated for another 150 years.
By the 1950s, scientists had purified the toxin, and in the 1970s Dr. Alan Scott used it experimentally to treat strabismus (crossed eyes). The FDA approved this use in 1989. Simply put, paralyze the muscles pulling the eye off target, and normal alignment returns. Soon clinicians discovered it could also relax muscles causing eyelid twitching (blepharospasm) or frown lines, and in 2002 the FDA approved Botox for cosmetic wrinkle reduction.
Other applications quickly followed: reducing spasticity in cerebral palsy, relieving muscle dysfunction after stroke, calming an overactive bladder, and treating cervical dystonia (painful neck spasms). By relaxing overactive muscles near arthritic joints, Botox can also ease severe chronic pain. Excessive sweating (hyperhidrosis), especially in the armpits, responds remarkably well to injections that block sweat-gland activation.
Botox can even help with certain digestive disorders. In nutcracker esophagus, where over-tightened muscles cause painful chest contractions, targeted injections can temporarily relieve symptoms and improve swallowing. Similarly, in anal fissure, where spasms of the anal sphincter perpetuate a painful tear, Botox can break the cycle. Another option is glyceryl trinitrate (GTN) ointment, the same drug used under the tongue for angina. GTN dilates blood vessels and can resolve chest pain rapidly—but often causes headaches. In fact, doctors used to joke that if an angina patient applied GTN to the chest, then shared a romantic embrace, their partner might inherit both the ointment and the headache!
Leon Fleisher, the renowned American pianist, developed a disabling hand dystonia from over-practicing and played one-handed for decades. After many failed treatments, Botox restored his function—allowing him to perform again with both hands.
Botulinum toxin is just one example of a deadly natural substance turned therapeutic. Others include curare,initially South American arrow poison now used to induce muscle relaxation during anesthesia; digitalis, derived from foxglove, a mainstay heart medication; and atropine from deadly nightshade (belladonna), which dilates pupils—a look prized in Renaissance Italy, hence the name “beautiful woman.”
Today, Botox injection is the world’s most common aesthetic medical procedure. When administered by a skilled professional, it is generally safe. However, in untrained hands it can be dangerous. Dr. Guest and I once encountered a patient who received facial injections at a strip-mall spa and developed temporary paralysis preventing her from closing her eye or mouth. With supportive care and patience, the effects wore off—but she learned an expensive lesson.
There’s also a social side: immobilizing some of the face’s 43 muscles can create a mask-like appearance, blunting emotional expression and even complicating the diagnosis of certain neurological or psychiatric conditions.
Botulism itself—whether from improperly canned food or infected wounds—is thankfully rare but potentially life-threatening. Treatment involves antitoxin and intensive supportive care, though diagnosis can be tricky unless the source is suspected.
Because Botox’s medical and cosmetic uses are so diverse, always consult your AME before considering any injection. After all, changing how you raise your eyebrows might just affect how you raise your aircraft’s nose.
And speaking of raised eyebrows—once taboo, plastic surgery is now commonplace. The thing is,Botox jokes never get old.
Fly well!
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PS: I use the term “Botox” to refer to any of the commercially available botulinum toxin-related products.
