BOTOX® -the wonder drug of the 21st Century (Part1)..by Dr Patrick Treacy
Botox ® is the most popular non-surgical cosmetic procedure performed. In the year 2007 there were 5.3 million Botox procedures performed. This is the story of how it moved from military laboratories to become a 21st century wonder drug. .
Press Release (PressBurner) Mar 31, 2009 - 1793 was an eventful year by any standards. It started with the French King Louis XVI being guillotined in front of a cheering crowd in Paris and ended later that year with the execution of his wife, Marie Antoinette. The fact that Louis had tried to escape Louis and was captured while trying to make a purchase at a store, where the clerk recognised his face on the coinage, only added to the drama. It was in that same year that the British Admirality began to supply citrus juice to its Navy ships to prevent scurvy and the Holy Roman Empire decided to declare war on France after it banned Roman Catholicism.
Across the Rhine, in Southern Germany a food poisoning epidemic caused by eating uncooked blood sausages was claiming the death of over the half of those patients who fell ill. The symptoms of the disease included malaise, nausea, vomiting, diarrhoea, double vision, dilated pupils, fatigue, unsteady gait, difficulty swallowing, thirst and when fatal, unconsciousness, rigour and ultimately death. The disease and the remnants of the century passed and the Act of Union of 1800 united the Kingdom of Great Britain with the Kingdom of Ireland. The nineteenth century actually started off well with the armies of new United Kingdom finally ending the Napoleonic wars and subsequently dismissing the armies of the French and the Prussians to their homes.
However, in this poverty sticken landscape, disease and pestilence was never far away and in 1817, the dreaded uncooked sausage food poisoning returned to the town of Baden-Wurttemberg. All this mention of disease and food poisoning in the days before antibiotics would have passed idly into history except for the actions of a meticulous medical doctor called Justinus Kerner.
Justinus, who later became one of Germany’s greatest Romantic poets, was born in the small town of Ludwigsburg, in 1786, the same year that the first British convict ships set sail to Botany Bay in Australia. During his teenage years he was apprenticed in a cloth factory but in 1804, he entered the University of Tübingen to study medicine. In 1808, he graduated and settled as a practicing physician in Wildbad.
In 1815 he obtained the official appointment of district medical officer in Gaildorf, and three years later he was transferred to Weisberg, where he was to spend the rest of his life. The local townspeople gave him a house at the foot of the historical Schloss Weibertreu and within these walls he dedicated all his spare time to discover the cause of the dreaded food poisoning, which was killing half of his patients. In the space of five years Kerner investigated 155 cases, treated 12 patients and performed autopsies on some of the patients. He also gave extracts from sausages that had been confiscated by the police to different animals and observed their reaction before dissecting the remains.
In 1822, he published the first systemic description of the clinical picture of botulism, a lethal type of food poisoning known since the era of the Roman Empire. At the end of his publication, he concluded that there was no cure for sausage poisoning and recommended that ‘all blood sausage and liverwurst still on the fireplace by February should be thrown out by the chimney sweep with the other rubbish’.
And where is all this leading?
With great foresight, in the dying throes of his sentinel paper (1) the poetic doctor also noted that small amounts of the sausage poison might be useful for neurological conditions such as St Vitus’ dance. Without knowing it, Justinus Kerner laid the opening shots in the greatest contribution of biology to the world of cosmetic medicine…..he was actually describing the neurological action of Botulinum toxin, later to be known to a different world in another century as Botox ®!
But there were many pieces of the jigsaw to put together before cosmetic medicine could safely harness the power of this deadly killer disease into its eventual role as the ultimate anti-ageing cure and penicillin of the twentieth century. Kerner could isolate the toxin and use it to kill other animals but he was lacking the biggest piece of the jigsaw, what was it and how was it formed. The next part of the journey takes us back across the Rhine to meet one of the greatest scientists that the world has ever known, Louis Pasteur.
His sentinel work from the late 1850s proved that milk became sour because of as yet unknown living organisms and by verifying the 'germ theory', he would change the whole outdated post Aristotelian pathology and surgery forever. Of course, this great work led to the discovery that van Leeuwenhoek’s microscopic bacteria of 1668, could cause disease and illness and ultimately to the introduction of antiseptic procedures into surgery via Joseph Lister. Pasteur died in 1895, the same year as Oscar Wilde lost his case against the Marquis of Queensbury and his last play ‘The Importance of being Earnest’ was staged at St James' Theatre in London.
In that year also the dreaded disease struck again, and this time in the exalted company of the salted pork dish at the annual gathering of the Music Society in the town of Ellezelles in Belgium. Three people eventually died from the resultant food poisoning, amongst them a close friend of one of the society’s eminent members, the microbiologist Professor Emile P. Van Ermengem. The Professor took the death of his friend personally and armed with the twin technologies of van Leeuwenhoek’s microscope and Pasteur’s closed flasks, he became the first person to isolate the microbe Clostridium Botulinum from both the food and the postmortem tissue of victims who had died. He also knew that the disease process was caused by a toxin produced by this bacterium (2).But this knowledge remained unheralded within the dusty pages of science books because at the end of the nineteenth century, the sexy end of microbiology was tropical disease, increasingly important with the ever-expanding Empire, thrusting young soldiers of the Kingdoms into ever more unfamiliar climates. In 1898 Robert Ross proved mosquitoes were the cause of malaria, and in the same year the Spanish American War prompted new research into yellow fever.
The new century came and with it more effective ways for the soldiers to kill their enemies. The first chemical agent to be used was chlorine gas, on April 22, 1915, near the Belgian village of Ypres. Over 5,000 allied troops died in that first attack and a similar number in a second attack at Ypres two days later. Both attacks wounded about 15,000 men and within the following year both the British and German forces were also using mustard gas and phosgene gas. Overall about 113,000 tons of chemical weapons were used in World War I killing around 92,000 and a total of 1.3 million casualties. But the biggest problem with chemical attacks during this time is their effective ability could change rapidly if the winds shifted, and they often did.
The use of biological agents in warfare have been known since time immemorial. During the sixth century the Assyrians poisoned their enemies wells with ergot and in 1346, the Tartars threw the bodies of their Bubonic Plagued soldiers over the cities walls to force a surrender during its siege of Kaffa. Russian soldiers used the same tactic against the Swedish in 1710. And it didn’t end there. Pizarro is known to have given variola contaminated blankets to South American natives in an earlier period and the British used the same tactic against the native Indians loyal to the French in the Indian War of 1754 to 1767. The smallpox eventually caused widespread disease amongst the natives defending Fort Carillon allowing Sir Jeffery Amherst’s plan to work with great effect.