The Bad and the Beautiful

During the apple harvest last year I found myself in Tieton, an orchard town in central Washington state. The occasion was a poetry convention known as LitFuse. The poetry was great, the company was great, and the food was great. And—no one got botulism.

But the talk turned to botulism. During her session, workshop leader Holly Hughes passed around sweet cherry tomatoes for us to taste, the better to put tomatoes on the page. That afternoon Holly allowed that she was thinking of canning tomatoes once again. Her poem “Making Green Tomato Jam” suggests that she has committed tomatoes to Mason jars before. But Holly worried out loud about botulism.

I plan to never can tomatoes again, having spent an inordinate amount of time at this hot and steamy labor during my rural childhood. But I’m always pleased to confabulate, and on this occasion I freely and with good humor dispensed the following misinformation:

1. Don’t worry. If a jar of tomatoes has botulism, the lid will swell. (Wrong: the lid may not swell and you should worry. Most of the 10 to 30 cases of food-borne botulism outbreaks per year in the United States result from errors in home canning.)

2. Anyhow, tomatoes are acidic, and acid kills botulism. (Wrong again: Acid does kill the bacteria Clostridium botulinim, but plant breeders have bred tomatoes to be sweeter, and, most are no longer acidic enough to kill botulism. If you must can tomatoes, add vinegar and measure the PH.)

Back in Seattle, my sister Liz, a critical-care-unit nurse, had just begun the care of a botulism patient who, being paralyzed, breathes with the assistance of a ventilator. This person and all other botulism patients are lucky to be patients and not corpses. Many people who have ingested the toxin produced by the bacterium Clostridium botulinum are dead. But if you can get yourself to the ER in time, and a correct diagnosis of your developing paralysis (starting at the top of the head and moving down) can be made, an antitoxin is administered and recovery can be good, though lengthy (weeks or months). This food-borne type of botulism is not the only kind, but it’s the most deadly.

What is botulism? Clostridium botulinum is an anaerobic (living without oxygen) bacterium. Its spores are common in the soil, on plants, and in the gut of fish and other animals. They are coated with a hard protective covering, and can sit there doing nothing for a long time.

So, why are we all still alive?

The spore does no harm. But if it finds itself in a congenial environment (warm, alkaline, anaerobic), the bacteria will germinate and emit the botulinum toxin, one of the most deadly on Earth. A small aerosol vial of the stuff could kill a million people. The toxin is in the A (High Threat) category of the Department of Homeland Security’s list of biological warfare substances. Any outbreak of botulism is considered a public health emergency.

The botulinum toxin is a neurotoxin that, in humans, blocks the nerves that signal muscles to move. One part of the toxin attaches to the neuron, and a second part enters the nerve cell and interferes with the release of the neurotransmitter acetylcholine. Unable to release acetylcholine, the neuron can’t stimulate the muscle to move. There you have paralysis. The neurotoxin takes several hours or days to start working. The toxin-induced paralysis begins with the cranial nerves, at the top of the head. It then moves down: eyes, face, tongue, etc. Death typically occurs from respiratory failure.

But the botulism toxin has a use. Beauty. What could be more important? Permanent frowns are muscles in permanent contraction. Botox—a minute diluted amount of botulinum toxin—paralyzes frown muscles and smoothes that frown away. And as this beauty treatment was being tried, the now-more-comely subjects discovered that they no longer got migraines. But of course. The paralysis begins at the cranial nerves, the nerves that cause the pain of the killer headache. So now Botox is also used to treat migraine.

This just goes to show that some evil things are not all bad.