Botulinumtoxin: from poison to medicine. A historical review

Botulinumtoxin (BTX) is a neurotoxin produced from Clostridium botulinum un der anaerobic conditions and is responsible for botulism,a notifiable, bact erial form of food poisoning. The first case of botulism is believed to hav e occurred in 1735. An epidemic in Southern Germany in 1793 claimed the dea th of over the half of those patients who had become ill through eating unc ooked blood sausages. The term "pharmakon" is Greek and implicates that a d rug originates from poison (potion, remedy). Theophrastus Bombast von Hohen heim known as Paracelsus (1493/94-1541)first described this duality with hi s dictum "alle ding sind gift und nichts on gift; alein die dosis macht das ein ding kein gift ist" [only the dose makes a remedy poisonous). In Baden -Wurttemberg in 1817, the poet and physician Dr. Justinus Christian Kerner described the symptoms of botulism, so that at this time botulism was also called Kerner disease. Until the turn of the century the reason for poisoni ng was not known. Van Ermengem succeeded in isolating the anaerobic bacteri um causing botulism, but the specific mechanism of BTX was only established after the second World War. In the late seventies the ophthalmologist Dr. Alan Scott used BTX the first time in the treatment of strabismus. The drug was then used in the treatment of several muscle spasticities such as, for exam pie, torticollis or hemifacial spasm. Only recently BTX has been succ essfully used for focal hyperhidrosis. We review the history of botulinum t oxin from its discovery in the nineteenth century and the research into its effect in the middle of the 20th century up to its clinical use at the pre sent time.