WEBVTT - Ep 95 Tetanus: An inhuman calamity!

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<v Speaker 1>Hey, everyone, We're including a content morning for the first

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<v Speaker 1>hand account that we're about to read, which includes a

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<v Speaker 1>description of the death of an infant. To skip this

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<v Speaker 1>jump ahead about three minutes.

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<v Speaker 2>Missus Cyril Orchard Street, aged twenty four, was delivered of

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<v Speaker 2>her third child on Friday morning, September tewond eighteen fifty nine.

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<v Speaker 2>It was a male child, fine and apparently healthy in

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<v Speaker 2>every respect. From Friday till Wednesday, all was well. The

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<v Speaker 2>cord separated on Tuesday, the fifth day. On Wednesday, the

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<v Speaker 2>child was restless, cried and kicked. On Thursday, the mother

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<v Speaker 2>reported that he cried all day, could not open his mouth,

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<v Speaker 2>could not suck, and frequently stretched, and was stiff. The

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<v Speaker 2>next day, Friday, I saw him every few minutes. He

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<v Speaker 2>appeared as if struck by an electric shock. Every muscle

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<v Speaker 2>was thrown into distorted action. Will not attempt to describe

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<v Speaker 2>this drawing tells the wrinkled forehead, the elevated brow, the

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<v Speaker 2>closed eye, the dilated nostril, the rigid massiter, the fixed jaw,

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<v Speaker 2>the closed mouth, the corrugated lips, the bubbling saliva, the

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<v Speaker 2>retracted head, the shortened neck, the starting cervical muscles, the

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<v Speaker 2>turgid veins, the arched spine, the raised chest, the troubled breathing,

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<v Speaker 2>the catching diaphragm, the heaving abdomen, the separated arm, the

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<v Speaker 2>squared elbow, the bent wrist, the clenched fingers, the incurved thumb,

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<v Speaker 2>the extended and separated legs, the bent down toes, the

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<v Speaker 2>livid surface, the whole figure rigid as wood. A pitiful sight,

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<v Speaker 2>the paroxysm was renewed by a slight noise, the gentlest touch,

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<v Speaker 2>A placid interval of a few minutes succeeded, and then

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<v Speaker 2>another fit followed. On examining the child, the umbilicus was

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<v Speaker 2>seen prominent, at least half an inch long, red and

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<v Speaker 2>showing an unhealthy separating surface. The umbilicus continued to discharge

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<v Speaker 2>emaciation rapidly advanced. The skin assumed a brownish hue and

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<v Speaker 2>hung in shriveled folds of a leathery texture. Peace and

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<v Speaker 2>Pang pursued their sickening interchange. The child gradually became more feeble,

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<v Speaker 2>and on the tenth day of the disease and the

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<v Speaker 2>fifteenth of his existence, he sank by degrees.

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<v Speaker 3>Exhausted, it was really difficult to read, absolutely horrible.

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<v Speaker 1>Yeah, and thank goodness, there's a vaccine.

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<v Speaker 3>Yeah.

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<v Speaker 2>That was from an eighteen sixty case description of tetanus

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<v Speaker 2>in Phantom a ka neonatal tetanus or tet Yep.

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<v Speaker 1>Hi, I'm Aaron.

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<v Speaker 2>Welsh and I'm Aaron Almon Updike.

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<v Speaker 1>And this is this podcast will kill You.

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<v Speaker 2>And I'm sure you all know by now the subject

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<v Speaker 2>of today's episode.

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<v Speaker 1>Yeah, tetanus. It's a vaccine preventable disease that we haven't

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<v Speaker 1>covered yet, which is exciting, yep.

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<v Speaker 2>And it's obviously going to be difficult at times because

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<v Speaker 2>it's a really truly horrible disease.

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<v Speaker 1>I mean, absolutely horrific, devastating, awful.

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<v Speaker 4>Yeah.

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<v Speaker 2>Yeah, But there's going to be a lot of very

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<v Speaker 2>interesting biology. I know, there's going to be some fascinating

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<v Speaker 2>history that I can't wait.

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<v Speaker 4>To learn about.

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<v Speaker 2>And I have some thrilling things to talk about in

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<v Speaker 2>the current events section, Like I am really excited.

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<v Speaker 1>Yeah, ooh, I'm so intrigued.

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<v Speaker 2>So shall we, you know, get started on the important things?

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<v Speaker 1>Of course of course we should. What time is it?

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<v Speaker 4>Quarantiny time it is?

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<v Speaker 1>And this week we are drinking the Rusty Nail, which

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<v Speaker 1>just so happens to be an actual cocktail.

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<v Speaker 4>It's a real drink.

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<v Speaker 1>It is. It has Scotch and RAMBOUI and I think

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<v Speaker 1>that's it.

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<v Speaker 2>And we're gonna find a way to make the non

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<v Speaker 2>alcoholic version our Plasi Brita.

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<v Speaker 1>Yeah, it's gonna be an interesting one to make a

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<v Speaker 1>placy berita for. But you know, I think that it

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<v Speaker 1>might not bear too much resemblance to a Scotch and

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<v Speaker 1>a Scotch based liqueur. But I think that's okay as

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<v Speaker 1>long as it's delicious, right, I trust in you erin okay,

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<v Speaker 1>thank you, And we'll post the full recipe for this

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<v Speaker 1>quarantiny and non alcoholic plasy burrita on our website This

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<v Speaker 1>podcast will kill You dot com.

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<v Speaker 2>On our website This podcast will kill You dot Com,

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<v Speaker 2>you can find all of the things. You can find

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<v Speaker 2>just so much there.

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<v Speaker 1>Yeah, you did a great job. There's a lot there.

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<v Speaker 1>Go check it out. Can we dive.

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<v Speaker 2>Into us Yes, I think that we ought to right

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<v Speaker 2>after this break. So today we're talking about another clusterdium species,

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<v Speaker 2>Clusterdium tetani. We've covered this genus before, of course in

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<v Speaker 2>our botulism episode, and then I mentioned it again in

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<v Speaker 2>our sea Diiff episode, although Seaediff was reclassified as clusterritioides.

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<v Speaker 2>But anyways, today it's clus Tritium. Clusterridium tetani is an

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<v Speaker 2>incredibly widespread and hardy little bacterium. It's a rod shaped

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<v Speaker 2>gram positive spore forming bacterium that when it's making its

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<v Speaker 2>little spores, if you look at it under a microscope,

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<v Speaker 2>looks like a little match stick or like a tennis racket.

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<v Speaker 4>It's kind of cute, oh.

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<v Speaker 2>Because it makes it a little spore at the end.

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<v Speaker 2>It's like real pos interesting uh huh. And like its cousin,

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<v Speaker 2>Clusterridium botulinum, this is an anaerobic bacterium, which means it

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<v Speaker 2>likes to grow without any oxygen. But because it's a

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<v Speaker 2>spore former, these spores are incredibly hardy. They're very resistant

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<v Speaker 2>to heat, to to antiseptics to oxygen, and so this

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<v Speaker 2>is a bacterium that persists in the environment across the globe.

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<v Speaker 2>It makes its home in the soil, but Clusterridium tetni

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<v Speaker 2>can also thrive in the intestines of various animals, including humans.

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<v Speaker 1>I found that so interesting. And what is it doing there? Like,

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<v Speaker 1>is it just a part of your gut microbiota, Are

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<v Speaker 1>there any sort of negative effects or is it just

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<v Speaker 1>really hanging out?

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<v Speaker 2>As far as I know, at least they just hang out.

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<v Speaker 2>I'll be honest. I didn't do a lot of digging

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<v Speaker 2>into what they're doing in our guts. Okay, yeah, But

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<v Speaker 2>as this is a soil bacterium, and as this is

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<v Speaker 2>this podcast will kill you, and we're talking about the

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<v Speaker 2>disease caused by Clusterdium tetne. People are exposed through the

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<v Speaker 2>soil kind of in general. Usually exposure to this bacterium

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<v Speaker 2>tends to be from wounds, especially deep wounds or puncture

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<v Speaker 2>wounds that come into contact with anything contaminated with this bacterium,

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<v Speaker 2>which again can live almost anywhere. So this can be

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<v Speaker 2>anything from rusty nails to fence posts, thorns from a tree,

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<v Speaker 2>even potentially bites if they are contaminated really any kind

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<v Speaker 2>of deep wound, because those kind of wounds have pretty

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<v Speaker 2>limited exposure to air, which means limited exposure to oxygen,

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<v Speaker 2>and so as tissue death occurs deep within that wound,

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<v Speaker 2>the environment can become very anoxic, which can allow for

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<v Speaker 2>tetni spores that are present in the soil that contaminate

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<v Speaker 2>that wound to germinate and grow.

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<v Speaker 1>Interesting. Yeah, I have a really dumb question, okay. Anaerobic

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<v Speaker 1>environment meaning there's no oxygen, there's oxygen carried by your

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<v Speaker 1>blood if you're bleeding, is that an anaerobic environment.

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<v Speaker 4>It's a great question.

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<v Speaker 2>So no, if you have active blood flow to an area,

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<v Speaker 2>then that tissue is not going to become very anoxic.

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<v Speaker 2>What can happen in deep puncture wounds is that the

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<v Speaker 2>tissue can die like deep within, and so once you

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<v Speaker 2>have dead tissue, that tissue is not being supplied by

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<v Speaker 2>your blood supply very well. So that is why it

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<v Speaker 2>can become anoxic.

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<v Speaker 4>But that's a really good question. It's not a dumb

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<v Speaker 4>question at all.

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<v Speaker 1>That is okay, Yeah, I'm fascinated.

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<v Speaker 2>Yeah, that's why it's in theory. Any wound can become

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<v Speaker 2>contaminated with Clostridium tetani but not every wound is going

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<v Speaker 2>to be as susceptible to actually harboring a active tetanus

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<v Speaker 2>generating infection, if that makes sense. Now, I'll talk a

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<v Speaker 2>lot in this episode about neonatal tetanus, and the first

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<v Speaker 2>hand account that you heard was a description of neonatal tetanus.

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<v Speaker 2>This is a it's the same as regular tetanus in

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<v Speaker 2>kind of what it does to the body, but neonatal

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<v Speaker 2>tetanus is often classified as specific because it happens with

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<v Speaker 2>contamination of the umbilical stump, so the umbilical.

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<v Speaker 4>Cord that's left when a baby is born.

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<v Speaker 2>That's just kind of an open area that can very

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<v Speaker 2>easily become contaminated, and the base of that is dead

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<v Speaker 2>and dying tissue, because that's what's normally supposed to happen

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<v Speaker 2>with an umbilical cord, and so that's why it's a

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<v Speaker 2>place that's very easily and then of course babies have

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<v Speaker 2>almost no immune systems, so that.

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<v Speaker 1>Helps as well, right, right, So that's kind of.

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<v Speaker 4>How we get exposed.

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<v Speaker 2>And just like with Cloustridium botulinum and Clausterdioides, diffcill the

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<v Speaker 2>story here is not the bacterium itself. It's also not

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<v Speaker 2>the spores of this bacterium. The story of tetanus is

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<v Speaker 2>the story of the toxins that this newly germinated bacterium

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<v Speaker 2>can release within our body.

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<v Speaker 4>So let's talk about them.

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<v Speaker 1>Yeah, these toxins are Can I read a quote real quick? Actually?

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<v Speaker 1>Can I inse? Okay? Please do? I was hoping I

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<v Speaker 1>was going to be able to use it somewhere. Quote.

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<v Speaker 1>An amount of tetanus batchulinus or dysentery toxin, weighing no

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<v Speaker 1>more than the ink in the period at the end

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<v Speaker 1>of the sentence, presumably times New Roman twelve, would be

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<v Speaker 1>enough to kill thirty grown people. An ounce could kill

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<v Speaker 1>thirty million tons of living matter. Half a pound would

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<v Speaker 1>be more than enough to destroy the entire human population

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<v Speaker 1>of the world. I'm not sure when this was written,

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<v Speaker 1>but I think it probably would still be sufficient.

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<v Speaker 2>I love Okay, I feel like I remember you reading

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<v Speaker 2>that quote in our botulism episode.

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<v Speaker 1>I feel like I did too. Whoopsie, I'm pretty sure

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<v Speaker 1>you did.

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<v Speaker 4>No, it's not a whoopsie.

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<v Speaker 2>I'm really glad that you said that again, because I

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<v Speaker 2>was trying to classify, like how much, because the numbers

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<v Speaker 2>that we're going to talk about are so small, and

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<v Speaker 2>I was really worried that you were going to ask

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<v Speaker 2>me to be able to and I'm really glad you.

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<v Speaker 4>Just did it for me.

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<v Speaker 1>Why how about that?

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<v Speaker 4>All right?

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<v Speaker 2>So let's talk about those incredibly terrifying potent toxins, shall we.

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<v Speaker 1>Let's do it.

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<v Speaker 2>So. Exotoxins are proteins that bacteria make that can disperse

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<v Speaker 2>throughout our body and cause an effect. We've talked about

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<v Speaker 2>them a lot on this podcast. The toxin in Cloustridium

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<v Speaker 2>tetani is the causative agent of tetanus, not the bacteria themselves.

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<v Speaker 2>This toxin, the tetanus toxin tetni. As a side note,

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<v Speaker 2>it actually produces two different toxins. One is called tetno

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<v Speaker 2>lysin and the other tetno spasmin. Huh, techno lisin we

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<v Speaker 2>don't really understand, at least from what I read, like

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<v Speaker 2>maybe it helps establish an infection or something like that.

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<v Speaker 2>But tetnospasmin is tetanus toxin.

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<v Speaker 4>So that's what we're going to talk about today.

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<v Speaker 2>So, this tetanus toxin is a neurotoxin just like bochulinum

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<v Speaker 2>produced from Clostridium boculinum, and so it specifically binds to

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<v Speaker 2>our nerves and affects our nervous system. Let's recap what

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<v Speaker 2>we learned in our botulism episode, shall we. Then we

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<v Speaker 2>can do some compare contrast my favorite.

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<v Speaker 1>I was so looking forward to this.

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<v Speaker 2>I know, I actually just took some notes, like I

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<v Speaker 2>copypasted some notes from my any grade. It's a recap.

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<v Speaker 2>Botulinum toxin blocks the release of acetylcholine at our peripheral

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<v Speaker 2>nerve sine, if that sounds familiar. So what that results

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<v Speaker 2>in is a flaccid paralysis, meaning a limp paralysis, because

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<v Speaker 2>the signals from our brain don't ever actually make it

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<v Speaker 2>all the way to our muscles, so your muscles are

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<v Speaker 2>paralyzed in this flaccid limp state rather than a contracted state.

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<v Speaker 2>That happens when this botulinum toxin binds to our nerve

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<v Speaker 2>cells at the neuromuscular junction, which is the junction between

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<v Speaker 2>our nerves and the muscles that they innervate, and then

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<v Speaker 2>blocks the release of the transmitters at that junction. Okay,

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<v Speaker 2>Tetanus toxin does the exact same thing. It blocks the

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<v Speaker 2>release of neurotransmitters in a synapse in a junction, but

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<v Speaker 2>it does it in the inhibitory interneurons within our spinal

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<v Speaker 2>cold word I'll explain, But the bottom line is that

0:16:04.880 --> 0:16:10.680
<v Speaker 2>tetanus toxin has the exact opposite clinical effect. It causes

0:16:10.720 --> 0:16:14.400
<v Speaker 2>a spastic paralysis or muscles that are paralyzed in a

0:16:14.480 --> 0:16:17.840
<v Speaker 2>rigid or contracted state. So let's go through the steps,

0:16:17.880 --> 0:16:21.600
<v Speaker 2>shall we. Yeah, what happens in the case of tetanus

0:16:21.640 --> 0:16:25.440
<v Speaker 2>toxin is it binds actually to our nerve cells in

0:16:25.520 --> 0:16:29.720
<v Speaker 2>the same exact place as botulinum toxin. It binds to

0:16:29.880 --> 0:16:33.800
<v Speaker 2>our nerve cells at the neuromuscular junction the NMJ, and

0:16:33.880 --> 0:16:37.520
<v Speaker 2>it is internalized in those cells at the same place

0:16:37.680 --> 0:16:43.360
<v Speaker 2>as boculinum. But while boculinum toxin acts, it exerts its

0:16:43.400 --> 0:16:47.800
<v Speaker 2>effects right there at the neuromuscular junction, blocking the release

0:16:47.800 --> 0:16:52.360
<v Speaker 2>of acetylcholine. What tetanus toxin does instead of acting right

0:16:52.400 --> 0:16:57.760
<v Speaker 2>where it enters our cells, is it actually travels retrograde

0:16:58.200 --> 0:17:02.680
<v Speaker 2>along our nerve acxi allah like rabies virus.

0:17:02.920 --> 0:17:04.680
<v Speaker 4>Oh yeah, okay, that sounds familiar.

0:17:05.480 --> 0:17:09.320
<v Speaker 2>It travels all the way up our nerve axons like

0:17:09.440 --> 0:17:12.879
<v Speaker 2>from the muscle in your jaw, for example, all the

0:17:12.920 --> 0:17:18.000
<v Speaker 2>way up the nerve into our central nervous system where

0:17:18.000 --> 0:17:22.960
<v Speaker 2>the nerve came from, and then it enters the space

0:17:23.280 --> 0:17:28.400
<v Speaker 2>in between. It travels through that intersynaptic space inside our

0:17:28.440 --> 0:17:32.399
<v Speaker 2>central nervous system and enters another set of neurons in

0:17:32.440 --> 0:17:37.159
<v Speaker 2>our spinal cord, and there it blocks the release of

0:17:38.160 --> 0:17:42.040
<v Speaker 2>neurotransmitters the same way that bachulinum does. But it just

0:17:42.080 --> 0:17:45.280
<v Speaker 2>so happens that the neurons that it enters in our

0:17:45.320 --> 0:17:51.879
<v Speaker 2>spinal cord are the inhibitory neurons that primarily release neurotransmitters,

0:17:52.119 --> 0:17:57.359
<v Speaker 2>whose primary job is to inhibit or block the firing

0:17:57.480 --> 0:17:58.680
<v Speaker 2>of our motor neurons.

0:17:59.600 --> 0:18:02.440
<v Speaker 1>Okay, and so if they can't do their job, then

0:18:02.480 --> 0:18:05.639
<v Speaker 1>all those motor neurons are going shoo shoo, shoo shoo,

0:18:05.640 --> 0:18:10.399
<v Speaker 1>and then they're that's where you get the rigidity and spasms.

0:18:10.560 --> 0:18:11.040
<v Speaker 4>Exactly.

0:18:11.080 --> 0:18:12.800
<v Speaker 2>You just read my next line.

0:18:13.840 --> 0:18:16.480
<v Speaker 4>It's perfect. So exactly, if.

0:18:16.359 --> 0:18:22.239
<v Speaker 2>You can't inhibit the inhibitors, then your motor neurons are

0:18:22.280 --> 0:18:26.080
<v Speaker 2>getting signals from your brain like rapid fire, which leads

0:18:26.119 --> 0:18:30.320
<v Speaker 2>to this intense muscle rigidity, this spasm.

0:18:30.960 --> 0:18:37.040
<v Speaker 1>Okay, I have a question about wound location and course

0:18:37.160 --> 0:18:41.359
<v Speaker 1>of disease and stuff like that. So, Yeah, the classic

0:18:41.480 --> 0:18:45.320
<v Speaker 1>picture that I have of someone with tetanus, and I'll

0:18:45.320 --> 0:18:48.879
<v Speaker 1>talk about this actual picture later on, is like someone

0:18:48.880 --> 0:18:53.240
<v Speaker 1>who is completely Every single muscle is rigid.

0:18:53.680 --> 0:18:54.600
<v Speaker 4>Yeah.

0:18:55.160 --> 0:18:59.200
<v Speaker 1>Does that happen all the time? Does it happen in stages?

0:18:59.480 --> 0:19:01.560
<v Speaker 1>For instance, if you have a wound on your hand,

0:19:02.040 --> 0:19:05.920
<v Speaker 1>does that mean that the hand will become rigid? First?

0:19:06.560 --> 0:19:11.040
<v Speaker 4>Such a good question. In general, the course.

0:19:10.800 --> 0:19:15.720
<v Speaker 2>Of tetanus is the same always, and in general, the

0:19:15.840 --> 0:19:18.560
<v Speaker 2>course is that the muscles that tend to be affected

0:19:18.720 --> 0:19:23.600
<v Speaker 2>first are the facial nerves, so the muscles that are

0:19:23.600 --> 0:19:27.760
<v Speaker 2>in your face, like your jaw and your neck and

0:19:27.800 --> 0:19:30.399
<v Speaker 2>your head, and then it tends to travel kind of

0:19:30.480 --> 0:19:34.080
<v Speaker 2>downward and then affect your trunk and.

0:19:33.960 --> 0:19:35.119
<v Speaker 4>Your limbs, et cetera.

0:19:35.920 --> 0:19:37.400
<v Speaker 1>Why is that?

0:19:37.400 --> 0:19:40.080
<v Speaker 2>That's a great question. I don't know, and I don't

0:19:40.119 --> 0:19:44.359
<v Speaker 2>think that we fully know. So the nerve pathways to

0:19:44.960 --> 0:19:48.840
<v Speaker 2>our facial muscles are a lot shorter, like the distance

0:19:48.840 --> 0:19:51.000
<v Speaker 2>from the central nervous system to those muscles.

0:19:51.040 --> 0:19:51.919
<v Speaker 4>It is a lot shorter.

0:19:52.440 --> 0:19:57.159
<v Speaker 2>But it doesn't matter where you get exposed, if that

0:19:57.200 --> 0:20:00.280
<v Speaker 2>makes sense, Say you get a wound on your foot.

0:20:00.720 --> 0:20:03.800
<v Speaker 2>That tetanus toxin makes it in makes it to your

0:20:03.840 --> 0:20:06.480
<v Speaker 2>central nervous system, and it seems to be that it's

0:20:06.560 --> 0:20:11.280
<v Speaker 2>still the head and neck first and then the rest

0:20:11.320 --> 0:20:14.000
<v Speaker 2>of the body after that. It is really interesting. I

0:20:14.200 --> 0:20:19.200
<v Speaker 2>don't fully know why, so bizarre, I know it is.

0:20:19.320 --> 0:20:20.560
<v Speaker 4>It is really really interesting.

0:20:21.560 --> 0:20:21.760
<v Speaker 2>Huh.

0:20:22.400 --> 0:20:23.280
<v Speaker 4>Yeah.

0:20:23.320 --> 0:20:26.800
<v Speaker 2>And the same was true for botulism, where it often

0:20:26.880 --> 0:20:27.439
<v Speaker 2>went from.

0:20:27.320 --> 0:20:30.040
<v Speaker 4>The head down right. Yeah.

0:20:30.359 --> 0:20:36.400
<v Speaker 2>Yeah, So that is kind of how this toxin works

0:20:37.160 --> 0:20:40.479
<v Speaker 2>in general. The incubation period, the time from when you

0:20:40.520 --> 0:20:44.760
<v Speaker 2>are first exposed to when these symptoms start, it's quite variable.

0:20:45.480 --> 0:20:48.960
<v Speaker 2>Most sources on average say like three to fourteen days,

0:20:49.520 --> 0:20:52.400
<v Speaker 2>some say seven to ten. It really can just depend

0:20:52.640 --> 0:20:57.240
<v Speaker 2>on where you get exposed, whether you're talking about an

0:20:57.280 --> 0:21:01.560
<v Speaker 2>infant versus an adult, things like that. And like I said,

0:21:01.560 --> 0:21:05.040
<v Speaker 2>the symptoms do tend to follow this general progression. So

0:21:05.160 --> 0:21:11.439
<v Speaker 2>they often start with this neck stiffness, difficulty opening the mouth,

0:21:12.280 --> 0:21:16.600
<v Speaker 2>and then that progresses to the classic name for tetanus,

0:21:16.600 --> 0:21:20.240
<v Speaker 2>which is lockjaw, and that is from the spasm of

0:21:20.280 --> 0:21:23.280
<v Speaker 2>the muscles of chewing, the muscles of the jaw that

0:21:23.400 --> 0:21:29.159
<v Speaker 2>spasm shut and then that continues to progress. There is

0:21:29.240 --> 0:21:36.080
<v Speaker 2>a kind of characteristic facial posture called rhesus sardonicus, and

0:21:36.119 --> 0:21:40.359
<v Speaker 2>it's this really awful facial expression that's a very pronounced

0:21:40.560 --> 0:21:45.960
<v Speaker 2>closed mouth, teeth bared grimace because all of the muscles

0:21:45.960 --> 0:21:51.840
<v Speaker 2>of your face are just rigidly contracted. At this point,

0:21:52.160 --> 0:21:55.400
<v Speaker 2>the muscles of swallowing are very likely affected, so there's

0:21:55.440 --> 0:21:58.720
<v Speaker 2>going to be some degree of dysphagia or difficulty swallowing.

0:22:00.119 --> 0:22:02.760
<v Speaker 2>And as it continues to progress, the muscles of the

0:22:02.880 --> 0:22:06.960
<v Speaker 2>trunk can become affected, and this can lead to a

0:22:07.080 --> 0:22:13.399
<v Speaker 2>rigid posturing that's known as episthotonis, which is again really

0:22:13.440 --> 0:22:16.480
<v Speaker 2>really awful if you see pictures of it, but it's

0:22:16.520 --> 0:22:21.800
<v Speaker 2>this very rigid arched back with head jutted back because

0:22:21.840 --> 0:22:24.600
<v Speaker 2>all the muscles of your spine, like along your spine

0:22:24.640 --> 0:22:25.640
<v Speaker 2>become contracted.

0:22:27.359 --> 0:22:28.240
<v Speaker 4>At this point.

0:22:28.520 --> 0:22:30.880
<v Speaker 2>Because of all of this contraction.

0:22:30.520 --> 0:22:33.680
<v Speaker 4>Of all of these muscles, the chest wall is.

0:22:33.600 --> 0:22:37.320
<v Speaker 2>Not very compliant. So that means that you can't breathe

0:22:37.560 --> 0:22:40.960
<v Speaker 2>very well because the muscles between your ribs and your

0:22:41.000 --> 0:22:44.560
<v Speaker 2>back they're kind of in spasm, so it can be

0:22:44.600 --> 0:22:46.240
<v Speaker 2>really difficult to take in air.

0:22:47.040 --> 0:22:48.760
<v Speaker 1>Oh my goodness.

0:22:48.960 --> 0:22:53.040
<v Speaker 2>Yeah, there can also be kind of convulsions that happen

0:22:53.440 --> 0:22:56.920
<v Speaker 2>similar to seizures that can happen on top of this

0:22:57.240 --> 0:23:01.680
<v Speaker 2>generalized increase in muscle tone. So these spasms can look

0:23:01.720 --> 0:23:06.680
<v Speaker 2>a lot like seizures. But if these spasms affect muscles

0:23:06.800 --> 0:23:10.040
<v Speaker 2>like the LAYNX of the throat, then they can lead

0:23:10.080 --> 0:23:15.520
<v Speaker 2>to airway obstruction, which can be life threatening. And one

0:23:15.560 --> 0:23:17.880
<v Speaker 2>of the papers I wanted to read a quote from

0:23:18.560 --> 0:23:22.119
<v Speaker 2>because I think it kind of sums up just how awful.

0:23:21.800 --> 0:23:26.120
<v Speaker 4>This really is. They said, after this.

0:23:26.400 --> 0:23:32.359
<v Speaker 2>Description of all of these symptoms, quote, consciousness is preserved,

0:23:32.960 --> 0:23:42.240
<v Speaker 2>making tetanus a truly dreadful disease. Oh no, yeah, yeah,

0:23:42.680 --> 0:23:47.879
<v Speaker 2>so it's a really horrible disease. Yeah, to say the least,

0:23:48.000 --> 0:23:51.320
<v Speaker 2>to say the least, And you can imagine there are

0:23:51.880 --> 0:23:55.520
<v Speaker 2>a lot of different ways that people can end up

0:23:55.600 --> 0:24:02.440
<v Speaker 2>dying from tetanus. And just like with botulinum, while there

0:24:02.600 --> 0:24:06.160
<v Speaker 2>is treatment for the effects of tetanus toxin, we have

0:24:06.880 --> 0:24:13.240
<v Speaker 2>tetanus IgG like antibody treatment. The treatment the main function

0:24:13.600 --> 0:24:17.480
<v Speaker 2>is to bind and neutralize any of this toxin that

0:24:17.640 --> 0:24:22.320
<v Speaker 2>hasn't yet bound into the central nervous system. But this

0:24:22.359 --> 0:24:25.800
<v Speaker 2>can only do so much because once tetanus toxin is

0:24:25.960 --> 0:24:29.560
<v Speaker 2>bound and internalized into our nerve cells. There's nothing that

0:24:29.600 --> 0:24:34.240
<v Speaker 2>we can do about it. It's permanent until our nerves

0:24:34.400 --> 0:24:37.760
<v Speaker 2>essentially regenerate, which is what has to happen. Those nerve

0:24:37.920 --> 0:24:42.600
<v Speaker 2>terminals have to actually, you know, remake themselves to be

0:24:42.680 --> 0:24:45.960
<v Speaker 2>able to then re send the signals that they need

0:24:46.000 --> 0:24:48.400
<v Speaker 2>to send to inhibit muscle contraction.

0:24:49.680 --> 0:24:52.360
<v Speaker 1>So if you don't get that early enough, it's.

0:24:52.000 --> 0:24:57.800
<v Speaker 2>Right, Yeah, Yeah, tetnus toxin doesn't kill any of the

0:24:57.840 --> 0:25:01.960
<v Speaker 2>nerve cells, which I think is really important, but the

0:25:02.119 --> 0:25:07.200
<v Speaker 2>neurons still do have to kind of remake those synapses

0:25:07.520 --> 0:25:11.800
<v Speaker 2>in order to be able to work again properly. So

0:25:11.840 --> 0:25:14.199
<v Speaker 2>you're not having to make entirely new nerves or anything

0:25:14.240 --> 0:25:17.320
<v Speaker 2>like that, but you can't stop the effects of the

0:25:17.320 --> 0:25:20.640
<v Speaker 2>toxin that have already been integrated into our cells.

0:25:21.240 --> 0:25:21.520
<v Speaker 4>Right.

0:25:22.400 --> 0:25:28.040
<v Speaker 2>So, on top of using treatments like the tetanus antibodies,

0:25:28.080 --> 0:25:31.000
<v Speaker 2>you also have to treat the source of infection, so

0:25:31.160 --> 0:25:34.440
<v Speaker 2>antibiotics or wound to breedment if there is some kind

0:25:34.480 --> 0:25:40.159
<v Speaker 2>of active wound that's still making more tetanus toxin. But

0:25:40.320 --> 0:25:42.679
<v Speaker 2>really the most important thing in terms of treatment is

0:25:42.840 --> 0:25:47.040
<v Speaker 2>supportive care and sedation, and one thing that's really interesting,

0:25:47.160 --> 0:25:52.919
<v Speaker 2>although incredibly depressing still is that after the advent of

0:25:53.119 --> 0:25:56.639
<v Speaker 2>mechanical ventilation, so like being able to intubate someone and

0:25:57.160 --> 0:26:00.960
<v Speaker 2>breathe for them while this process is taking place in

0:26:01.000 --> 0:26:04.719
<v Speaker 2>their body. This obviously helps keep people alive because they

0:26:04.800 --> 0:26:09.880
<v Speaker 2>usually would die from respiratory failure with tetanus. But since

0:26:09.920 --> 0:26:13.479
<v Speaker 2>we have invented that, we have found that tetanus reaks

0:26:13.560 --> 0:26:17.440
<v Speaker 2>even more havoc on the body than we realized. While

0:26:17.520 --> 0:26:22.520
<v Speaker 2>botch a lignum really only affects the motor nerves, because

0:26:22.560 --> 0:26:25.399
<v Speaker 2>tetanus goes into our central nervous system, it causes a

0:26:25.400 --> 0:26:29.240
<v Speaker 2>lot of autonomic instability as well that we didn't realize

0:26:29.640 --> 0:26:33.160
<v Speaker 2>until we had mechanical ventilation to keep people alive long

0:26:33.240 --> 0:26:37.480
<v Speaker 2>enough to see that process, if that makes sense, And

0:26:37.520 --> 0:26:40.199
<v Speaker 2>so it can cause a lot of you know, blood

0:26:40.200 --> 0:26:44.240
<v Speaker 2>pressure variation, It can cause heart rates to go really

0:26:44.280 --> 0:26:47.199
<v Speaker 2>really high and then drop really really low because it

0:26:47.240 --> 0:26:50.680
<v Speaker 2>basically is blocking your autonomic nervous system from being able

0:26:50.680 --> 0:26:56.760
<v Speaker 2>to send signals appropriately. So it's a very difficult disease

0:26:56.880 --> 0:27:00.600
<v Speaker 2>to treat with supportive treatment. Though it's not impossible, it's

0:27:00.680 --> 0:27:06.840
<v Speaker 2>absolutely possible, it's just really complicated. Jeez, and so because

0:27:06.880 --> 0:27:10.800
<v Speaker 2>of that, mortality rates for people who are unvaccinated, who

0:27:10.840 --> 0:27:15.960
<v Speaker 2>have never been vaccinated can still vary really widely. One

0:27:16.000 --> 0:27:19.200
<v Speaker 2>source that I read estimated anywhere from ten to sixty

0:27:19.240 --> 0:27:24.439
<v Speaker 2>percent mortality for neonatal tetanus, and of course neonatal tetanus

0:27:24.520 --> 0:27:28.480
<v Speaker 2>happens when babies are too young to be vaccinated, so

0:27:28.520 --> 0:27:32.359
<v Speaker 2>in adults, the mortality rate can vary from eight to

0:27:32.480 --> 0:27:38.119
<v Speaker 2>fifty percent I read, and it increases with age. So

0:27:38.280 --> 0:27:44.040
<v Speaker 2>it's a very complicated disease to treat, but it is

0:27:44.240 --> 0:27:47.000
<v Speaker 2>entirely preventable, which is amazing.

0:27:47.440 --> 0:27:49.760
<v Speaker 1>Yeah, truly, it really is.

0:27:50.119 --> 0:27:56.760
<v Speaker 2>We have an incredibly effective vaccine that has very long

0:27:56.840 --> 0:28:01.960
<v Speaker 2>lasting immunity, and it is I think the cheapest vaccine

0:28:02.119 --> 0:28:03.320
<v Speaker 2>to ever have been produced.

0:28:03.359 --> 0:28:05.679
<v Speaker 4>Is one thing that I read, which is, oh yeah,

0:28:05.720 --> 0:28:06.239
<v Speaker 4>I love that.

0:28:08.200 --> 0:28:10.159
<v Speaker 2>And it's been around for a really long time. So

0:28:10.920 --> 0:28:13.760
<v Speaker 2>that's the good news that we'll get to end this

0:28:13.800 --> 0:28:17.200
<v Speaker 2>episode later with at least some happy news because of

0:28:17.240 --> 0:28:20.440
<v Speaker 2>the vaccine. So that's the biology of Tetnus aarin.

0:28:21.440 --> 0:28:27.000
<v Speaker 1>It is just as maybe more horrifying than I anticipated

0:28:27.040 --> 0:28:27.399
<v Speaker 1>it would be.

0:28:27.520 --> 0:28:31.760
<v Speaker 4>Yeah, I know it really, it really is. Yeah.

0:28:32.040 --> 0:28:37.040
<v Speaker 2>Yeah, I have a question for you erin, how on

0:28:37.440 --> 0:28:40.760
<v Speaker 2>earth did this process evolve?

0:28:41.800 --> 0:28:43.680
<v Speaker 1>Oh?

0:28:43.720 --> 0:28:47.200
<v Speaker 2>Because okay, here's the thing, Arin, Yeah, yeah, you mentioned

0:28:47.400 --> 0:28:50.120
<v Speaker 2>up at the top, just how potent this toxin is,

0:28:50.480 --> 0:28:54.880
<v Speaker 2>right right, It is so potent. I didn't even know

0:28:54.960 --> 0:29:01.160
<v Speaker 2>this until researching. But getting infected with tetanus, getting infected

0:29:01.160 --> 0:29:05.360
<v Speaker 2>with Clustridium tetani and then surviving an infection does not

0:29:05.680 --> 0:29:10.920
<v Speaker 2>provide you with immunity because the tetanus toxin is so

0:29:11.280 --> 0:29:16.040
<v Speaker 2>potent that just the tiniest amount of it causes incredible symptoms,

0:29:16.360 --> 0:29:20.440
<v Speaker 2>but not enough to produce antibodies that we actually make

0:29:20.560 --> 0:29:24.040
<v Speaker 2>enough of to then produce immunity, whereas we know that

0:29:24.080 --> 0:29:27.200
<v Speaker 2>we produce immunity because we have a great vaccine.

0:29:27.440 --> 0:29:29.720
<v Speaker 1>And I mean, that's incredible.

0:29:30.080 --> 0:29:33.959
<v Speaker 2>And one source that I read said that the toxin

0:29:34.440 --> 0:29:39.560
<v Speaker 2>may constitute five percent of the weight of this organism,

0:29:39.920 --> 0:29:43.000
<v Speaker 2>so they're making a ton of this toxin.

0:29:43.800 --> 0:29:47.880
<v Speaker 1>It is so bizarre, and I'm not certain that I

0:29:47.920 --> 0:29:50.600
<v Speaker 1>have a satisfying answer, but I want to like get

0:29:50.600 --> 0:29:53.800
<v Speaker 1>into it. Okay, so let's take a quick break and

0:29:53.840 --> 0:29:55.240
<v Speaker 1>then I'll get started.

0:29:55.400 --> 0:30:02.400
<v Speaker 4>I can't wait.

0:30:22.800 --> 0:30:27.000
<v Speaker 1>I found the history of tetanus to be so interesting

0:30:27.360 --> 0:30:31.520
<v Speaker 1>for a number of reasons. First, it checks a lot

0:30:31.560 --> 0:30:36.640
<v Speaker 1>of the boxes for a classic TPWKY episode. Tetanus is

0:30:36.680 --> 0:30:40.800
<v Speaker 1>an infamous disease, there are plenty of ancient descriptions. Of course,

0:30:41.040 --> 0:30:44.840
<v Speaker 1>war plays a role, gets a mention, and also we

0:30:44.880 --> 0:30:48.120
<v Speaker 1>get to talk about the golden age of germ theory. Yeah,

0:30:48.200 --> 0:30:51.400
<v Speaker 1>all that good stuff. Second, we've covered a couple of

0:30:51.440 --> 0:30:55.120
<v Speaker 1>related pathogens before, as you mentioned, and so it was

0:30:55.240 --> 0:30:58.960
<v Speaker 1>kind of fun to compare the evolutionary histories or human

0:30:59.120 --> 0:31:04.840
<v Speaker 1>histories of the especially with Claustridi and bochelinum. Yeah. And Third,

0:31:05.200 --> 0:31:08.360
<v Speaker 1>there are parts of the history of tetanus that I

0:31:08.480 --> 0:31:13.720
<v Speaker 1>feel provided an opportunity to think about how perceptions of

0:31:13.760 --> 0:31:17.960
<v Speaker 1>a disease, especially who is most likely to get that disease,

0:31:18.400 --> 0:31:21.960
<v Speaker 1>can really find their way into how these diseases are

0:31:22.000 --> 0:31:25.760
<v Speaker 1>written about historically. And I think that's good to keep

0:31:25.800 --> 0:31:28.280
<v Speaker 1>in mind as we try to read between the lines

0:31:28.560 --> 0:31:35.080
<v Speaker 1>and understand how people were observing disease and why. So

0:31:35.200 --> 0:31:35.959
<v Speaker 1>let's get started.

0:31:36.040 --> 0:31:36.560
<v Speaker 4>I love it.

0:31:38.240 --> 0:31:43.360
<v Speaker 1>Where did tetanus come from? Great question? I wish I

0:31:43.400 --> 0:31:46.960
<v Speaker 1>had an answer. I can tell you where the word

0:31:47.000 --> 0:31:51.040
<v Speaker 1>tetanus came from. Which is the Greek verb tanno, meaning

0:31:51.120 --> 0:31:54.680
<v Speaker 1>to stretch. But from what I can tell, we don't

0:31:54.680 --> 0:31:58.880
<v Speaker 1>really know where this pathogen originated in the world and

0:31:59.080 --> 0:32:02.440
<v Speaker 1>when it's spread around the world, because it is like

0:32:02.760 --> 0:32:08.120
<v Speaker 1>globally distributed. Did its global distribution predate wide scale travel

0:32:08.160 --> 0:32:09.240
<v Speaker 1>by humans?

0:32:09.720 --> 0:32:10.920
<v Speaker 4>Maybe? Maybe?

0:32:11.360 --> 0:32:17.960
<v Speaker 1>Maybe it's a mysterious little little pathogen. We do know though,

0:32:18.000 --> 0:32:22.000
<v Speaker 1>that humans have been exposed to tetanus for at least most,

0:32:22.160 --> 0:32:25.240
<v Speaker 1>if not all, of written history, and probably have been

0:32:25.360 --> 0:32:28.680
<v Speaker 1>for all of you know, all of our prehistory as well.

0:32:29.240 --> 0:32:31.680
<v Speaker 1>But we'll get to that in a second, because first

0:32:31.760 --> 0:32:35.240
<v Speaker 1>I want to talk about some aspects of tetanus ecology

0:32:35.320 --> 0:32:39.000
<v Speaker 1>and evolution. So, like I said, we don't know where

0:32:39.040 --> 0:32:42.880
<v Speaker 1>geographically tetanus emerged, but we do know that it doesn't

0:32:42.920 --> 0:32:47.040
<v Speaker 1>really seem to change all that much. Its genome is

0:32:47.280 --> 0:32:50.920
<v Speaker 1>highly conserved, which is actually, I think something that we've

0:32:50.960 --> 0:32:54.640
<v Speaker 1>seen for a few other spore formers, which I think

0:32:54.720 --> 0:32:55.120
<v Speaker 1>is cool.

0:32:55.280 --> 0:32:55.600
<v Speaker 4>Yeah.

0:32:55.920 --> 0:33:02.360
<v Speaker 1>Anthrax, right, Anthrax especially, Yeah, bacheline Clustridium botulinum is less stable,

0:33:02.920 --> 0:33:08.080
<v Speaker 1>but anyway, the plasmid carrying the tetanus toxin gene is

0:33:08.200 --> 0:33:14.200
<v Speaker 1>more variable, but the gene itself is not is very stable. Yeah, Yeah,

0:33:14.200 --> 0:33:15.480
<v Speaker 1>it doesn't make sense.

0:33:15.760 --> 0:33:19.240
<v Speaker 2>That's so interesting though, because like with botulism, there's more

0:33:19.400 --> 0:33:24.360
<v Speaker 2>than a few different types of the toxin, but with tetanus,

0:33:24.360 --> 0:33:25.880
<v Speaker 2>it's really just tetnus toxin.

0:33:26.360 --> 0:33:29.720
<v Speaker 1>Yeah, And with the botulinum toxin, it's found in many

0:33:29.800 --> 0:33:36.160
<v Speaker 1>different strains of Clostridium, whereas, yeah, the tetanus neurotoxin only

0:33:36.240 --> 0:33:38.240
<v Speaker 1>in clusterdim tetani.

0:33:38.680 --> 0:33:39.760
<v Speaker 4>Yeah.

0:33:39.960 --> 0:33:44.400
<v Speaker 1>And like you said, these two neurotoxins are structurally and

0:33:44.480 --> 0:33:49.880
<v Speaker 1>functionally similar, but they seem to have followed different evolutionary pathways.

0:33:50.480 --> 0:33:52.560
<v Speaker 1>And I think it's really cool to look at the

0:33:52.600 --> 0:33:56.880
<v Speaker 1>ecology of these bacteria to see like maybe why that

0:33:57.000 --> 0:34:02.320
<v Speaker 1>might be, or why these different characteristics of these two

0:34:02.360 --> 0:34:06.400
<v Speaker 1>bacterial species, why they contribute to the patterns that we

0:34:06.480 --> 0:34:12.759
<v Speaker 1>see in disease and outbreaks and sporadic cases stuff like that. So,

0:34:12.920 --> 0:34:18.320
<v Speaker 1>both Claustridium tetani and Clustridium bochulinum are anaerobic soil dwelling

0:34:18.800 --> 0:34:22.480
<v Speaker 1>and they produce this deadly and potent neurotoxin. But why

0:34:22.680 --> 0:34:25.359
<v Speaker 1>why do they do this? Why are you the way

0:34:25.360 --> 0:34:28.640
<v Speaker 1>you are with the title of our bochulism episode, because

0:34:28.640 --> 0:34:32.000
<v Speaker 1>we were like why why why? And we talked about

0:34:32.040 --> 0:34:35.600
<v Speaker 1>how Claustridium botulinum will be picked up by a dabbling

0:34:35.680 --> 0:34:39.440
<v Speaker 1>duck or something, and then the toxin will kill the bird.

0:34:39.600 --> 0:34:42.840
<v Speaker 1>That carcass becomes a great anaerobic replicating ground for the

0:34:42.880 --> 0:34:47.480
<v Speaker 1>bacteria and also a great source of environmental contamination as

0:34:47.600 --> 0:34:50.360
<v Speaker 1>other animals either nibble on the corpse or around the

0:34:50.400 --> 0:34:53.800
<v Speaker 1>corpse or in like you know, the more dabbling ducks

0:34:53.920 --> 0:34:58.120
<v Speaker 1>than the soil whatever, right, I remember that a lot. Yeah,

0:34:58.200 --> 0:35:00.879
<v Speaker 1>it was a very cool thing to visual like, oh,

0:35:00.960 --> 0:35:05.760
<v Speaker 1>that's why this exists. And so having this deadly neurotoxin

0:35:06.000 --> 0:35:11.440
<v Speaker 1>is key to the life cycle of Claustridium boculinum. By

0:35:11.520 --> 0:35:14.560
<v Speaker 1>killing its host, it can now contaminate a big chunk

0:35:14.600 --> 0:35:17.920
<v Speaker 1>of the environment and spread to other hosts. And the

0:35:17.960 --> 0:35:22.240
<v Speaker 1>tetanus toxin isn't too much different. Really, it's a potent

0:35:22.280 --> 0:35:26.120
<v Speaker 1>neurotoxin that can kill its host. But one key difference

0:35:26.239 --> 0:35:30.279
<v Speaker 1>is that the boculinum neurotoxin can survive ingestion, and that's

0:35:30.320 --> 0:35:34.640
<v Speaker 1>like how it creates disease, while the tetanus neurotoxin cannot.

0:35:35.800 --> 0:35:39.520
<v Speaker 1>And this difference is why we see outbreaks in botulism

0:35:39.680 --> 0:35:44.040
<v Speaker 1>in nature and in food poisoning outbreaks, whereas we mostly

0:35:44.080 --> 0:35:47.040
<v Speaker 1>see isolated, sporadic cases in Tetanus.

0:35:47.640 --> 0:35:54.560
<v Speaker 2>Whoa, uh huh, so it makes even less sense.

0:35:55.800 --> 0:35:59.319
<v Speaker 1>It makes even less sense, but it also does it

0:35:59.360 --> 0:36:03.239
<v Speaker 1>does make sense to a degree, right, So this is

0:36:03.760 --> 0:36:06.200
<v Speaker 1>likely a costly toxin to.

0:36:06.200 --> 0:36:06.879
<v Speaker 4>Make, uh huh.

0:36:07.360 --> 0:36:10.439
<v Speaker 1>It has to help the bacteria. It has to help

0:36:10.480 --> 0:36:16.320
<v Speaker 1>Clusterium tetani to survive, to be transmitted, to help it

0:36:16.320 --> 0:36:18.560
<v Speaker 1>complete its life cycle in some way. I mean, these

0:36:18.560 --> 0:36:22.440
<v Speaker 1>are soil dwelling microbes, so they don't necessarily need hosts

0:36:22.480 --> 0:36:27.160
<v Speaker 1>to live to proliferate. But it would be great if

0:36:27.200 --> 0:36:30.399
<v Speaker 1>a host came along with a little cut on their

0:36:30.440 --> 0:36:35.040
<v Speaker 1>foot and picked up some Tetanus spores tetani spores, and

0:36:35.080 --> 0:36:38.840
<v Speaker 1>then that host, after it died, became another great breeding

0:36:38.880 --> 0:36:44.280
<v Speaker 1>ground for more contamination. So it might be a combination

0:36:44.400 --> 0:36:48.720
<v Speaker 1>of the fact that like this is a very useful

0:36:48.800 --> 0:36:54.600
<v Speaker 1>tool for the bacteria, and also they're spore formers. Yeah,

0:36:55.200 --> 0:36:56.520
<v Speaker 1>so I don't know.

0:36:56.480 --> 0:37:00.600
<v Speaker 2>The whole gut thing. That's just so interesting. I feel

0:37:00.640 --> 0:37:03.880
<v Speaker 2>like that was such a big part of the bochu

0:37:04.000 --> 0:37:06.799
<v Speaker 2>Linum story, where you know, then you eat it and

0:37:06.840 --> 0:37:08.480
<v Speaker 2>then you continue it, et cetera.

0:37:09.200 --> 0:37:11.200
<v Speaker 4>And so to know that that's not part.

0:37:11.040 --> 0:37:15.240
<v Speaker 2>Of the story here is really interesting.

0:37:15.719 --> 0:37:19.440
<v Speaker 1>Yeah. I mean I feel like the story makes sense still,

0:37:20.080 --> 0:37:23.720
<v Speaker 1>like the toxin plays an important role, but it isn't

0:37:23.840 --> 0:37:27.879
<v Speaker 1>as satisfying. Yeah, nearly as satisfying, right, And maybe that's

0:37:28.040 --> 0:37:32.160
<v Speaker 1>the lesson is that, like evolution doesn't always tell us satisfying,

0:37:33.000 --> 0:37:35.919
<v Speaker 1>it doesn't always make sense. Yeah, it doesn't always make sense.

0:37:35.960 --> 0:37:40.480
<v Speaker 1>It doesn't follow logic, it's just just is what it is. Sometimes.

0:37:41.440 --> 0:37:44.880
<v Speaker 1>That being said, if anyone listening is like, wait, no,

0:37:45.000 --> 0:37:48.000
<v Speaker 1>I know why this happens, or you have a paper

0:37:48.200 --> 0:37:50.920
<v Speaker 1>where you can show me exactly, because I spent hours

0:37:50.920 --> 0:37:53.880
<v Speaker 1>and hours on Google scholar trying to find out the

0:37:53.920 --> 0:37:59.239
<v Speaker 1>elutionary ecology of this neurotoxin, please shoot us an email. Yeah,

0:37:59.360 --> 0:38:00.440
<v Speaker 1>I would love to read it.

0:38:00.480 --> 0:38:02.040
<v Speaker 4>We have so many more questions.

0:38:02.280 --> 0:38:07.320
<v Speaker 1>Yeah. But the good thing about this relatively non exciting

0:38:07.560 --> 0:38:11.440
<v Speaker 1>or maybe not satisfying evolutionary history and the super stable

0:38:11.480 --> 0:38:15.200
<v Speaker 1>genome of cluster name tetane is that this means that

0:38:15.239 --> 0:38:20.400
<v Speaker 1>the vaccine is very widely and highly effective and we

0:38:20.480 --> 0:38:23.200
<v Speaker 1>don't have to worry about the emergence of strains that

0:38:23.239 --> 0:38:26.880
<v Speaker 1>the vaccine doesn't protect you against, which is good because

0:38:27.080 --> 0:38:34.719
<v Speaker 1>this disease is horrible, absolutely horrible. Tetanus causes this dramatic,

0:38:35.600 --> 0:38:39.440
<v Speaker 1>visually dramatic and deadly infection, and so it should come

0:38:39.440 --> 0:38:42.840
<v Speaker 1>as no surprise that it has been mentioned in so

0:38:43.040 --> 0:38:44.880
<v Speaker 1>many ancient texts.

0:38:44.719 --> 0:38:46.319
<v Speaker 4>Like all of them, all of them.

0:38:46.719 --> 0:38:51.520
<v Speaker 1>It's really back to back classic TPWKY with trachoma and chlamydia,

0:38:51.640 --> 0:38:54.560
<v Speaker 1>last episode and now this. So we're going to run

0:38:54.640 --> 0:38:59.160
<v Speaker 1>through these ancient medical texts again protet us. So we've

0:38:59.160 --> 0:39:03.280
<v Speaker 1>got the edwins Smith Surgical Papyrus written around fifteen hundred

0:39:03.280 --> 0:39:08.040
<v Speaker 1>BCE that mentions it. The ancient Indian physician Sushruda from

0:39:08.040 --> 0:39:11.440
<v Speaker 1>around six hundred BCE made a possible reference to it.

0:39:11.960 --> 0:39:14.880
<v Speaker 1>Early Chinese medical texts from around four hundred to two

0:39:15.000 --> 0:39:18.440
<v Speaker 1>hundred BCE described it, and of course we've got the

0:39:18.520 --> 0:39:23.640
<v Speaker 1>Hippocratic texts from around the four hundreds BCE yep, yep.

0:39:24.400 --> 0:39:28.320
<v Speaker 1>Hippocrates and other contributors to the text. Because it wasn't

0:39:28.360 --> 0:39:33.719
<v Speaker 1>just Hipocrates actually wrote quite extensively about tetanus, both the

0:39:33.800 --> 0:39:39.480
<v Speaker 1>local and systemic forms, and included some very colorful descriptions

0:39:39.600 --> 0:39:44.760
<v Speaker 1>of the disease. Quote a man who was struck from behind,

0:39:44.840 --> 0:39:47.520
<v Speaker 1>by a sharp dart a little below the neck had

0:39:47.520 --> 0:39:50.040
<v Speaker 1>a wound which did not look serious because it did

0:39:50.040 --> 0:39:52.960
<v Speaker 1>not go deep. But sometime later, when the point had

0:39:53.000 --> 0:39:57.320
<v Speaker 1>been extracted, the patient was seized with backward bending convulsions

0:39:57.400 --> 0:40:02.279
<v Speaker 1>like those of Opisthetonis. His jaws were locked, and any

0:40:02.320 --> 0:40:05.800
<v Speaker 1>liquid that he attempted to swallow was returned through his nostril.

0:40:06.520 --> 0:40:07.759
<v Speaker 1>He died on the second day.

0:40:09.239 --> 0:40:10.520
<v Speaker 4>Oh goodness, h h.

0:40:11.400 --> 0:40:14.360
<v Speaker 1>And if you're looking for treatments, the Hippocratic texts have

0:40:14.440 --> 0:40:21.040
<v Speaker 1>got you covered. Fatbird soup, vapor baths, cold water baths, pepper,

0:40:21.320 --> 0:40:23.800
<v Speaker 1>hell bore and of course you have to throw in

0:40:23.840 --> 0:40:28.080
<v Speaker 1>some blood letting, of course, of course. And over the

0:40:28.120 --> 0:40:33.000
<v Speaker 1>next hundreds of years nothing really changed for tetanus. Seven

0:40:33.120 --> 0:40:38.000
<v Speaker 1>hundred years after the Hippocratic texts, Aretaeus of Cappadocia added

0:40:38.040 --> 0:40:41.880
<v Speaker 1>his thoughts on the disease. And you can really tell

0:40:42.320 --> 0:40:46.880
<v Speaker 1>how badly he felt as a physician, completely unable to

0:40:46.880 --> 0:40:52.719
<v Speaker 1>help his patients. Quote and inhuman calamity, an incredible sight,

0:40:53.320 --> 0:40:57.920
<v Speaker 1>a spectacle, painful even to the beholder, an incurable malady.

0:40:59.080 --> 0:41:05.440
<v Speaker 1>He listed tree after treatment, frankincense, the hair of a polly, fleabane, turpentine,

0:41:05.560 --> 0:41:09.400
<v Speaker 1>et cetera. And this variety just kind of goes to

0:41:09.480 --> 0:41:14.000
<v Speaker 1>show again that nothing seemed to help. Classic tetanus like

0:41:14.040 --> 0:41:16.520
<v Speaker 1>what you would see in an adult human wasn't the

0:41:16.560 --> 0:41:20.440
<v Speaker 1>only thing that these ancient physicians noticed. There was also

0:41:20.560 --> 0:41:24.640
<v Speaker 1>mentions of equine tetanus and neonatal tetanus which was sometimes

0:41:24.760 --> 0:41:28.800
<v Speaker 1>called trismus and not necessarily recognized to be the same

0:41:28.840 --> 0:41:33.240
<v Speaker 1>thing as tetanus for hundreds of years. Interesting from these

0:41:33.280 --> 0:41:37.200
<v Speaker 1>ancient texts, I'm gonna skip way ahead until the eighteen hundreds,

0:41:37.280 --> 0:41:41.920
<v Speaker 1>kind of like I did also for chlamydia slash trachoma,

0:41:41.960 --> 0:41:45.400
<v Speaker 1>because not very much happened in terms of tetanus until

0:41:45.400 --> 0:41:49.279
<v Speaker 1>that time. I mean, yeah, sure, there were additional descriptions

0:41:49.280 --> 0:41:53.080
<v Speaker 1>of it and case reports and shifting hypotheses as to

0:41:53.120 --> 0:41:56.440
<v Speaker 1>what caused the disease, but overall, the way that it

0:41:56.480 --> 0:42:00.239
<v Speaker 1>was characterized in the Hippocratic texts didn't change much. A

0:42:00.320 --> 0:42:04.160
<v Speaker 1>tiny injury, like one instance I read from the bite

0:42:04.160 --> 0:42:08.400
<v Speaker 1>of a tame sparrow in the seventeen hundreds. WHOA, I know,

0:42:08.640 --> 0:42:10.760
<v Speaker 1>there's a lot to take in in that sense, Yeah.

0:42:10.600 --> 0:42:11.200
<v Speaker 4>There really is.

0:42:12.840 --> 0:42:16.360
<v Speaker 1>But this tiny injury could lead to a horrifically painful

0:42:16.400 --> 0:42:20.040
<v Speaker 1>infection that was ultimately fatal a lot of the time,

0:42:20.640 --> 0:42:25.839
<v Speaker 1>with no reliable, effective treatments. Even in eighteen ninety two,

0:42:26.040 --> 0:42:29.120
<v Speaker 1>when doctors had slightly better tools to help with feeding

0:42:29.239 --> 0:42:33.240
<v Speaker 1>and muscle relaxation, the mortality rate was eighty percent after

0:42:33.280 --> 0:42:33.960
<v Speaker 1>four days.

0:42:34.239 --> 0:42:35.479
<v Speaker 3>Yeah.

0:42:35.800 --> 0:42:39.560
<v Speaker 1>For much of human history, tetanus remained a sporadic disease

0:42:40.280 --> 0:42:44.279
<v Speaker 1>except in a few instances or populations, and one of

0:42:44.320 --> 0:42:47.640
<v Speaker 1>these was, of course, soldiers or during times of war,

0:42:48.120 --> 0:42:51.400
<v Speaker 1>for all the usual reasons of basically not having access

0:42:51.440 --> 0:42:55.959
<v Speaker 1>to sanitation, an increase in both small and large wounds, etc.

0:42:57.160 --> 0:42:59.720
<v Speaker 1>There's a famous painting this is the picture of Tetanus

0:42:59.719 --> 0:43:04.440
<v Speaker 1>I met that you've probably seen, depicting a soldier in

0:43:04.480 --> 0:43:09.480
<v Speaker 1>a violent, rigid spasm from tetanus infection. And I'm gonna

0:43:09.520 --> 0:43:13.160
<v Speaker 1>post this probably for like the announcement release post for

0:43:13.239 --> 0:43:16.640
<v Speaker 1>this episode on our social media. That was painted in

0:43:16.760 --> 0:43:20.520
<v Speaker 1>eighteen o nine by surgeon and artist Sir Charles Bell.

0:43:21.320 --> 0:43:26.000
<v Speaker 1>It's titled Tetanus following Gunshot Wounds and guess where the

0:43:26.120 --> 0:43:32.799
<v Speaker 1>soldier got those gunshot wounds during the Napoleonic Wars. I

0:43:32.800 --> 0:43:37.680
<v Speaker 1>mean again, Napoleon. It's just so many parallels. Yeah, specifically

0:43:37.760 --> 0:43:42.400
<v Speaker 1>if you're interested in the Battle of Karuna. I distinctly

0:43:42.719 --> 0:43:46.360
<v Speaker 1>remember seeing that painting for the first time in my

0:43:46.560 --> 0:43:51.520
<v Speaker 1>high school biology textbook or something, and being so fascinated

0:43:51.560 --> 0:43:56.479
<v Speaker 1>but also terrified by it. Yeah, Like I couldn't believe

0:43:56.520 --> 0:43:57.399
<v Speaker 1>it was a real thing.

0:43:57.840 --> 0:43:58.160
<v Speaker 2>Yeah.

0:43:58.960 --> 0:44:03.920
<v Speaker 1>Yeah. And soldiers, of course, weren't the only ones that

0:44:03.960 --> 0:44:09.160
<v Speaker 1>were disproportionately affected by this pathogen. In the mid eighteen hundreds,

0:44:09.320 --> 0:44:12.560
<v Speaker 1>several doctors in the American South became interested in what

0:44:12.600 --> 0:44:17.400
<v Speaker 1>they called trismus nessentium, which would later be called neonatal tetanus,

0:44:18.000 --> 0:44:21.800
<v Speaker 1>and they remarked that it was quote no uncommon disease

0:44:22.200 --> 0:44:26.520
<v Speaker 1>among infants born to enslaved people in the South. I

0:44:26.560 --> 0:44:30.120
<v Speaker 1>want to take a minute to talk about neonatal tetanus

0:44:30.160 --> 0:44:33.360
<v Speaker 1>in the American South before the Civil War because I

0:44:33.400 --> 0:44:38.000
<v Speaker 1>think it's important for several reasons. First, it gives us

0:44:38.000 --> 0:44:41.800
<v Speaker 1>an opportunity to see how much the established knowledge about

0:44:41.800 --> 0:44:46.200
<v Speaker 1>a disease is so dependent on who's looking and especially

0:44:46.400 --> 0:44:51.520
<v Speaker 1>whom they're looking at. Second, neonatal tetanus is I think

0:44:51.680 --> 0:44:56.000
<v Speaker 1>a really clear example of how differently medicine was practiced,

0:44:56.440 --> 0:44:59.920
<v Speaker 1>how medical stats were collected and whom those stats represent

0:45:00.480 --> 0:45:04.520
<v Speaker 1>between the American North and the Confederate South. And third,

0:45:05.000 --> 0:45:07.520
<v Speaker 1>I think it highlights the beginning of a shift in

0:45:07.640 --> 0:45:13.160
<v Speaker 1>medicine overall, from heroic medicine, so called heroic medicine, to

0:45:13.440 --> 0:45:14.319
<v Speaker 1>preventive care.

0:45:14.920 --> 0:45:16.400
<v Speaker 4>I love it, okay.

0:45:17.080 --> 0:45:21.279
<v Speaker 1>So, neonatal tetanus, as you described, Aaron, and as our

0:45:21.320 --> 0:45:25.080
<v Speaker 1>first hand account so vividly and horribly described, is when

0:45:25.280 --> 0:45:29.560
<v Speaker 1>the umbilical stump gets infected with the tetanus pathogen. It's

0:45:29.640 --> 0:45:34.520
<v Speaker 1>tightly linked to access to sanitation and hygiene practices following delivery,

0:45:35.040 --> 0:45:38.720
<v Speaker 1>and it is like adult tetanus, incredibly horrific and deadly.

0:45:39.120 --> 0:45:43.960
<v Speaker 1>Those are not even adequate adjectives and inhuman calamity. Yeah,

0:45:44.040 --> 0:45:48.319
<v Speaker 1>maybe we could borrow that phrase from airtase. Before the

0:45:48.440 --> 0:45:53.120
<v Speaker 1>US Civil War, enslavers would frequently employ doctors to monitor

0:45:53.160 --> 0:45:56.360
<v Speaker 1>the health of enslaved people, not out of the goodness

0:45:56.360 --> 0:46:00.000
<v Speaker 1>of their hearts, of course, but to protect their financial interests.

0:46:01.040 --> 0:46:04.440
<v Speaker 1>These Southern doctors began to notice high rates of neonatal

0:46:04.480 --> 0:46:08.160
<v Speaker 1>tetanus in the infants born to enslaved people. And when

0:46:08.200 --> 0:46:12.400
<v Speaker 1>I say high rates, I mean very high. Some doctors

0:46:12.520 --> 0:46:16.000
<v Speaker 1>estimated that up to two thirds of the deaths among

0:46:16.080 --> 0:46:18.560
<v Speaker 1>these infants were due to neonatal tetanus.

0:46:19.239 --> 0:46:19.759
<v Speaker 4>Oh Man.

0:46:20.400 --> 0:46:26.200
<v Speaker 1>Yeah. Because of this, neonatal tetanus was labeled by many doctors,

0:46:26.600 --> 0:46:30.240
<v Speaker 1>especially those in the North, as a disease of the South,

0:46:30.560 --> 0:46:35.480
<v Speaker 1>or more specifically, a disease of enslaved black people. But

0:46:35.760 --> 0:46:39.399
<v Speaker 1>was it especially so, We don't really have any good

0:46:39.400 --> 0:46:43.319
<v Speaker 1>way of knowing, considering that statistics weren't widely used at

0:46:43.320 --> 0:46:48.040
<v Speaker 1>the time, but it almost certainly wasn't. There may have

0:46:48.080 --> 0:46:50.880
<v Speaker 1>been a few things that contributed to the high rates

0:46:50.960 --> 0:46:54.560
<v Speaker 1>observed by southern doctors. For instance, there were some post

0:46:54.640 --> 0:46:59.040
<v Speaker 1>natal practices, such as using cow dung or charcoal to

0:46:59.080 --> 0:47:01.239
<v Speaker 1>wrap the cut of the biblical cord, that could have

0:47:01.280 --> 0:47:04.640
<v Speaker 1>increased exposure, and some of those practices are still used

0:47:04.640 --> 0:47:07.560
<v Speaker 1>today in various places, and they are associated with higher

0:47:07.640 --> 0:47:12.080
<v Speaker 1>rates of neonatal tetanus. But it was also probably a

0:47:12.080 --> 0:47:17.440
<v Speaker 1>matter of visibility. Neonatal tetanus was certainly present in the North,

0:47:17.719 --> 0:47:21.640
<v Speaker 1>but northern doctors probably didn't see it as much because,

0:47:21.719 --> 0:47:25.800
<v Speaker 1>unlike the Southern doctors who wrote about neonatal tetanus, Northern

0:47:25.840 --> 0:47:29.960
<v Speaker 1>doctors didn't treat nearly as many people living in conditions

0:47:30.000 --> 0:47:33.239
<v Speaker 1>that put them at risk for the infection. Mostly they

0:47:33.280 --> 0:47:36.160
<v Speaker 1>would work at hospitals, and so if someone came into

0:47:36.160 --> 0:47:39.000
<v Speaker 1>the hospital maybe then they would see them. But they

0:47:39.000 --> 0:47:42.600
<v Speaker 1>didn't travel as widely and to his varied urban and

0:47:42.760 --> 0:47:45.719
<v Speaker 1>more rural centers the way that Southern doctors could do

0:47:46.640 --> 0:47:49.560
<v Speaker 1>people who were living with a lack of access to sanitation,

0:47:50.280 --> 0:47:53.680
<v Speaker 1>people living in poverty, et cetera. Northern doctors weren't getting

0:47:53.719 --> 0:47:58.760
<v Speaker 1>paid to treat these people, unlike Southern doctors. In addition,

0:47:59.040 --> 0:48:03.080
<v Speaker 1>Southern doctors, especially those that were employed by enslavers, were

0:48:03.200 --> 0:48:06.759
<v Speaker 1>much more likely to encounter cases of neonatal tetanus than

0:48:06.800 --> 0:48:11.200
<v Speaker 1>their northern counterparts, since it was midwives that mostly attended

0:48:11.239 --> 0:48:14.560
<v Speaker 1>the birthing and postnatal care in the North. And another

0:48:14.600 --> 0:48:17.680
<v Speaker 1>big difference was that the Southern doctors tended to keep

0:48:17.800 --> 0:48:21.640
<v Speaker 1>more detailed records of the people they treated, not because

0:48:21.680 --> 0:48:25.680
<v Speaker 1>they were inherently more meticulous, but again because it was

0:48:25.840 --> 0:48:29.920
<v Speaker 1>more a matter of business and economics, and slavers wanted

0:48:29.960 --> 0:48:32.960
<v Speaker 1>to know which diseases were contributing to the most death

0:48:33.040 --> 0:48:37.359
<v Speaker 1>and disability or in their eyes, lost profit, and this

0:48:37.480 --> 0:48:42.240
<v Speaker 1>informed to some degree, which diseases were given priority for study.

0:48:43.400 --> 0:48:46.960
<v Speaker 1>Neonatal tetanus garnered a substantial amount of interest in the

0:48:47.000 --> 0:48:50.600
<v Speaker 1>mid eighteen hundreds in the southern US because it contributed

0:48:50.680 --> 0:48:54.960
<v Speaker 1>so highly to infant mortality among babies born to enslaved people,

0:48:55.560 --> 0:48:59.200
<v Speaker 1>and several doctors started to try to understand why that

0:48:59.440 --> 0:49:04.759
<v Speaker 1>was doctor Mary and Simms, infamous so called father of

0:49:04.920 --> 0:49:10.160
<v Speaker 1>modern gynecology. I can't resist like an opportunity to diss

0:49:10.200 --> 0:49:12.600
<v Speaker 1>Mary and Sims, or at least call him out for

0:49:13.320 --> 0:49:19.240
<v Speaker 1>being someone who absolutely tortured so many an untold number

0:49:19.400 --> 0:49:23.680
<v Speaker 1>of enslaved black women. Yeah. Mary and Simms was one

0:49:23.719 --> 0:49:26.239
<v Speaker 1>of the doctors who tried to say, oh, I know

0:49:26.640 --> 0:49:30.640
<v Speaker 1>the cause of neonatal tetanus, and he thought it had

0:49:30.680 --> 0:49:33.879
<v Speaker 1>to do with the formation of the skull. He said,

0:49:33.920 --> 0:49:36.840
<v Speaker 1>you should put the baby. People were obsessed with skull

0:49:36.880 --> 0:49:41.920
<v Speaker 1>shape for decades too long. He said, you know, if

0:49:41.960 --> 0:49:43.719
<v Speaker 1>you put the baby in a crib, you should make

0:49:43.719 --> 0:49:45.920
<v Speaker 1>sure there are lots of pillows around the baby in

0:49:46.000 --> 0:49:49.160
<v Speaker 1>position the baby very carefully so that the skull could

0:49:49.160 --> 0:49:50.160
<v Speaker 1>grow properly.

0:49:50.520 --> 0:49:53.080
<v Speaker 4>Oh dear, oh no.

0:49:53.480 --> 0:49:57.560
<v Speaker 1>And one of his horrifying treatments involved drilling a hole

0:49:57.600 --> 0:50:02.920
<v Speaker 1>in the baby's skull in all no, yeah, and there

0:50:02.960 --> 0:50:07.000
<v Speaker 1>was no evidence, of course, to support his hypotheses, and

0:50:07.200 --> 0:50:11.239
<v Speaker 1>a couple of other doctors fortunately were around to pick

0:50:11.280 --> 0:50:15.719
<v Speaker 1>apart his arguments. William Baldwin, a physician who graduated med

0:50:15.760 --> 0:50:21.040
<v Speaker 1>school Transylvania University in Lexington, Kentucky, at age nineteen.

0:50:21.719 --> 0:50:22.120
<v Speaker 4>Wow.

0:50:22.280 --> 0:50:24.880
<v Speaker 1>Yeah, I mean it was the eighteen fifties, eighteen forties.

0:50:26.320 --> 0:50:29.280
<v Speaker 1>He wrote that Simms was wrong and that the disease

0:50:29.400 --> 0:50:33.399
<v Speaker 1>was more common among enslaved people, not because of how

0:50:33.440 --> 0:50:36.080
<v Speaker 1>they laid an infant in a crib, but because of

0:50:36.160 --> 0:50:40.480
<v Speaker 1>living conditions and lack of access to sanitation. He didn't

0:50:40.520 --> 0:50:43.319
<v Speaker 1>agree with Sims's and others claims that there was a

0:50:43.400 --> 0:50:48.080
<v Speaker 1>racial disposition to disease, but instead thought it was living

0:50:48.160 --> 0:50:51.759
<v Speaker 1>in an environment that led to greater exposure, which is

0:50:51.960 --> 0:50:55.440
<v Speaker 1>pretty like incredible to hear, or like more forward thinking

0:50:55.480 --> 0:50:59.239
<v Speaker 1>than I anticipated, considering this was the eighteen fifties.

0:51:00.080 --> 0:51:03.160
<v Speaker 2>But I feel like that was we you know, malaria,

0:51:03.560 --> 0:51:09.239
<v Speaker 2>et cetera. Like, yeah, people knew of this environmental yeah, miasma.

0:51:08.920 --> 0:51:12.359
<v Speaker 1>Yeah exactly. Yeah, So I think that was definitely part

0:51:12.360 --> 0:51:14.359
<v Speaker 1>of it. But I also think he might have been

0:51:14.400 --> 0:51:18.440
<v Speaker 1>ahead of his time with this next quote because he

0:51:18.600 --> 0:51:24.360
<v Speaker 1>suggested that it was quote a grain of dust or sand,

0:51:24.640 --> 0:51:28.359
<v Speaker 1>or other particle of foreign substance, however small may be

0:51:28.480 --> 0:51:32.640
<v Speaker 1>lodged in the delicate granulations of the umbilicus just after

0:51:32.760 --> 0:51:34.040
<v Speaker 1>the detachment of the cord.

0:51:35.360 --> 0:51:35.879
<v Speaker 4>There you go.

0:51:36.239 --> 0:51:39.040
<v Speaker 1>So there it's I mean, that's not that's not wrong.

0:51:39.160 --> 0:51:42.520
<v Speaker 2>Really, no, that's exactly exactly what it is.

0:51:42.520 --> 0:51:42.640
<v Speaker 4>Is.

0:51:42.680 --> 0:51:47.320
<v Speaker 1>I found that fascinating, and Baldwin wasn't alone. Another physician

0:51:47.440 --> 0:51:50.840
<v Speaker 1>named John M. Watson from Tennessee took up the charge

0:51:50.880 --> 0:51:54.719
<v Speaker 1>and further dismissed Sims in eighteen fifty nine, like kind

0:51:54.719 --> 0:51:59.480
<v Speaker 1>of harshly and directly. I appreciated it. He too, believed

0:51:59.520 --> 0:52:02.440
<v Speaker 1>that it was irritation of the wound and suggested that

0:52:02.520 --> 0:52:07.560
<v Speaker 1>instead of Sims's barbaric sculdrilling practice, people should try for

0:52:07.800 --> 0:52:11.920
<v Speaker 1>simply cleaning the wound, having a more sanitary environment overall,

0:52:12.360 --> 0:52:18.160
<v Speaker 1>basically practicing preventative medicine, which was not in fashion at

0:52:18.160 --> 0:52:23.360
<v Speaker 1>the time. Instead, doctors tended to practice heroic medicine, which

0:52:23.440 --> 0:52:27.960
<v Speaker 1>I talked a bit about in the antibiotics episode. Essentially,

0:52:28.040 --> 0:52:32.120
<v Speaker 1>it was a way of practicing medicine through intervention. Only

0:52:32.640 --> 0:52:35.919
<v Speaker 1>your patient came in sick and you thought, Okay, how

0:52:35.920 --> 0:52:39.840
<v Speaker 1>can I stop this? You made your patient sweat, purge, bleed,

0:52:40.320 --> 0:52:44.120
<v Speaker 1>get a fever, be freezing cold, whatever to shock their

0:52:44.120 --> 0:52:48.880
<v Speaker 1>body back into balance. Medicine was about activity and treatment

0:52:49.080 --> 0:52:53.799
<v Speaker 1>rather than prevention. The concept of cleanliness and sanitation as

0:52:53.840 --> 0:52:58.360
<v Speaker 1>a method of disease prevention was a fairly new one

0:52:58.560 --> 0:53:01.840
<v Speaker 1>in some degree. Yes, there was a miasma theory, but

0:53:01.960 --> 0:53:06.600
<v Speaker 1>in terms of like Semulweis and Lister, you know, like

0:53:06.680 --> 0:53:10.760
<v Speaker 1>all of those sanitation right, it was starting to come around.

0:53:11.920 --> 0:53:16.720
<v Speaker 1>But most doctors thought that cleaning a wound that doesn't

0:53:16.719 --> 0:53:20.000
<v Speaker 1>make you a doctor. Sawing off a gangrenus limb in

0:53:20.080 --> 0:53:25.920
<v Speaker 1>five seconds that Shir did. But the tide was turning

0:53:26.480 --> 0:53:31.480
<v Speaker 1>from heroic medicine to preventive medicine, partially because of germ theory,

0:53:31.680 --> 0:53:35.200
<v Speaker 1>and also partially because of people like Lister and Semblevice,

0:53:36.440 --> 0:53:42.040
<v Speaker 1>and also partially because the emerging field of epidemiology allowed

0:53:42.080 --> 0:53:45.680
<v Speaker 1>people to see wide scale patterns of disease and how

0:53:45.760 --> 0:53:50.760
<v Speaker 1>interventions such as hand washing or ventilation affected the spread

0:53:50.920 --> 0:53:55.920
<v Speaker 1>of disease. But the origin story of epidemiology is more

0:53:56.000 --> 0:53:59.480
<v Speaker 1>complex than the classic story of John Snow and his

0:53:59.600 --> 0:54:03.440
<v Speaker 1>collar maps. One of my favorite things about this podcast

0:54:03.800 --> 0:54:08.919
<v Speaker 1>is that we are wrong sometimes and we read more

0:54:09.000 --> 0:54:12.400
<v Speaker 1>like we get to learn new stuff all of the time,

0:54:12.640 --> 0:54:15.919
<v Speaker 1>every day, every day, and that makes us I think,

0:54:16.000 --> 0:54:18.640
<v Speaker 1>both look back and go, oh, my goodness, I didn't

0:54:18.640 --> 0:54:21.759
<v Speaker 1>know that I said that wrong. I didn't understand the

0:54:21.760 --> 0:54:25.640
<v Speaker 1>context for this, And part of me is like, oh,

0:54:25.680 --> 0:54:27.600
<v Speaker 1>I wish I could go back in time, But another

0:54:27.640 --> 0:54:30.600
<v Speaker 1>part really likes to observe the fact that we are

0:54:31.360 --> 0:54:36.200
<v Speaker 1>learning and growing. Yeah, and this is one of those instances.

0:54:37.120 --> 0:54:41.360
<v Speaker 1>Epidemiology didn't come about because of John Snow and his

0:54:41.560 --> 0:54:44.560
<v Speaker 1>cholera maps. Of course they played a role, but it's

0:54:44.760 --> 0:54:49.680
<v Speaker 1>more complicated story than that. So we've talked about how

0:54:49.840 --> 0:54:53.239
<v Speaker 1>tropical medicine as a field was largely created during the

0:54:53.400 --> 0:54:57.560
<v Speaker 1>huge period of colonialism in the late eighteen hundreds right

0:54:57.680 --> 0:55:03.000
<v Speaker 1>to help the imperialist to quote conquer an area. In

0:55:03.040 --> 0:55:08.080
<v Speaker 1>a similar way, epidemiology developed out of colonialism, out of slavery,

0:55:08.160 --> 0:55:12.080
<v Speaker 1>out of war, when doctors were incentivized to study and

0:55:12.200 --> 0:55:17.680
<v Speaker 1>treat populations rather than individuals that they may not have otherwise.

0:55:18.520 --> 0:55:22.759
<v Speaker 1>These circumstances provided doctors the opportunity to see disease on

0:55:22.840 --> 0:55:27.719
<v Speaker 1>a scale that they hadn't before moving through army hospitals,

0:55:27.960 --> 0:55:32.960
<v Speaker 1>prison camps, ships, etc. You and I learned the story

0:55:33.000 --> 0:55:37.000
<v Speaker 1>of epidemiology, and we've told the story of epidemiology as

0:55:37.120 --> 0:55:41.600
<v Speaker 1>one of the early epidemiologists of John Snow and the

0:55:41.600 --> 0:55:45.880
<v Speaker 1>Broad Street Pump. But you and I, as well as

0:55:46.440 --> 0:55:49.120
<v Speaker 1>the Royal we those who are also in the field

0:55:49.120 --> 0:55:54.000
<v Speaker 1>of public health, we haven't fully or ever acknowledged the

0:55:54.040 --> 0:55:58.080
<v Speaker 1>people who made up those maps, who are mentioned in

0:55:58.160 --> 0:56:01.520
<v Speaker 1>those early studies of the spread of the disease simply

0:56:01.560 --> 0:56:05.799
<v Speaker 1>as cases. And many of these people were disenfranchised. They

0:56:06.600 --> 0:56:13.440
<v Speaker 1>had no consent or knowledge of their involvement. And this theme,

0:56:14.000 --> 0:56:19.480
<v Speaker 1>this new exploration of the origins of epidemiology, is the

0:56:19.560 --> 0:56:24.640
<v Speaker 1>subject of next week's Bonus episode, as well as the

0:56:24.760 --> 0:56:28.279
<v Speaker 1>topic of a new book by doctor Jim downs who

0:56:28.320 --> 0:56:30.240
<v Speaker 1>is my expert guest for next week.

0:56:31.400 --> 0:56:32.640
<v Speaker 4>I cannot wait.

0:56:33.120 --> 0:56:35.640
<v Speaker 1>I am thrilled to be chatting with doctor Downes, who

0:56:35.680 --> 0:56:38.920
<v Speaker 1>was a professor of history at Gettysburg College, about his

0:56:39.040 --> 0:56:43.840
<v Speaker 1>latest book called Maladies of Empire, How colonialism, slavery and

0:56:43.960 --> 0:56:48.600
<v Speaker 1>war transformed medicine. I am super excited for this conversation,

0:56:48.719 --> 0:56:49.960
<v Speaker 1>So mark your calendars.

0:56:50.080 --> 0:56:51.120
<v Speaker 4>Oh, I can't wait.

0:56:52.400 --> 0:56:54.760
<v Speaker 1>Okay, But for now, let's get back to the history

0:56:54.800 --> 0:56:58.640
<v Speaker 1>of tetanus. Moving into the second half of the eighteen hundreds,

0:56:59.000 --> 0:57:02.080
<v Speaker 1>tetanus was still very much present, but it would soon

0:57:02.239 --> 0:57:06.000
<v Speaker 1>meet its match, first in the form of antitoxin and

0:57:06.040 --> 0:57:09.480
<v Speaker 1>then in the form of a vaccine. In eighteen eighty four,

0:57:09.719 --> 0:57:12.799
<v Speaker 1>Carlo and Ratone took puss from the skin lesion of

0:57:12.840 --> 0:57:17.240
<v Speaker 1>an infected human's face who later died of tetanus, and

0:57:17.400 --> 0:57:21.440
<v Speaker 1>injected it into a rabbit, which began showing signs of tetanus,

0:57:21.600 --> 0:57:24.320
<v Speaker 1>confirming the presence of the pathogen in that lesion, and

0:57:24.400 --> 0:57:27.960
<v Speaker 1>so like the story of the microbiology of tetanus began.

0:57:28.640 --> 0:57:32.960
<v Speaker 1>Later that same year, a guy named Arthur Nikolaier injected

0:57:33.000 --> 0:57:37.280
<v Speaker 1>soil samples into animals who also developed tetanus symptoms. He

0:57:37.520 --> 0:57:41.720
<v Speaker 1>isolated a rod shaped bacillus from these animals and hypothesized

0:57:41.720 --> 0:57:45.600
<v Speaker 1>that the bacteria produced a toxin resembling strychnine in its action,

0:57:46.400 --> 0:57:49.560
<v Speaker 1>which we should add to our future topics.

0:57:49.920 --> 0:57:50.720
<v Speaker 4>It's on our list.

0:57:50.880 --> 0:57:55.440
<v Speaker 1>Okay, good, But he didn't isolate the organism in pure culture.

0:57:56.040 --> 0:57:59.919
<v Speaker 1>That would be done by shibasaburo quitisato in eighteen eighty

0:58:00.240 --> 0:58:02.960
<v Speaker 1>nine from a fatal case of a soldier in Berlin.

0:58:04.120 --> 0:58:07.360
<v Speaker 1>Does his names sound familiar to you a little bit? Yeah,

0:58:07.560 --> 0:58:12.800
<v Speaker 1>diphtheria episode theory makes sense. So Key Desado and Emil

0:58:12.880 --> 0:58:16.640
<v Speaker 1>von Behring worked closely together on a dipia anti toxin.

0:58:17.320 --> 0:58:20.120
<v Speaker 1>Von Behring got the first Nobel Prize in Medicine in

0:58:20.200 --> 0:58:22.560
<v Speaker 1>nineteen oh one for the work that they did, and

0:58:22.840 --> 0:58:27.280
<v Speaker 1>Key Desato did not. Anyway. With this pure culture of

0:58:27.480 --> 0:58:31.480
<v Speaker 1>Clastridium tetani, Key Desato was able to see that it

0:58:31.720 --> 0:58:34.920
<v Speaker 1>was indeed a toxin produced by the bacteria that caused

0:58:34.960 --> 0:58:38.240
<v Speaker 1>some of the symptoms, which spurred him on to look

0:58:38.280 --> 0:58:43.040
<v Speaker 1>for other toxin producing bacteria, including the one that causes diphtheria.

0:58:43.840 --> 0:58:47.440
<v Speaker 1>Key Desato and von Bhing's work on producing anti tooxin

0:58:47.600 --> 0:58:51.600
<v Speaker 1>for tetanus and diphtheria is I mean essentially that started

0:58:51.640 --> 0:58:56.080
<v Speaker 1>the field of serum therapy. Wow, and this was great.

0:58:56.320 --> 0:59:00.400
<v Speaker 1>Having an anti tooxin was revolutionary in a number of ways,

0:59:01.160 --> 0:59:02.640
<v Speaker 1>but it wasn't perfect.

0:59:02.960 --> 0:59:03.160
<v Speaker 2>Right.

0:59:03.280 --> 0:59:05.360
<v Speaker 1>You have to administer it early on for it to

0:59:05.400 --> 0:59:08.400
<v Speaker 1>be effective, and in the case of tetanus, you had

0:59:08.400 --> 0:59:11.680
<v Speaker 1>to keep the wound clean. When both of those things

0:59:11.720 --> 0:59:15.640
<v Speaker 1>were pretty difficult. If you were like a soldier at

0:59:15.880 --> 0:59:21.960
<v Speaker 1>high exposure risk and we have some numbers to back

0:59:22.400 --> 0:59:26.320
<v Speaker 1>that up too. Dear, it's not that bad. I mean,

0:59:26.400 --> 0:59:28.320
<v Speaker 1>it's bad to begin with, and then it gets better.

0:59:28.640 --> 0:59:28.960
<v Speaker 4>Okay.

0:59:29.440 --> 0:59:33.480
<v Speaker 1>In eighteen oh eight, so pre germ theory, pre tetanus, antiitoxin,

0:59:33.680 --> 0:59:38.920
<v Speaker 1>pre vaccine, the rate of tetanus was twelve point five

0:59:39.080 --> 0:59:42.440
<v Speaker 1>per one thousand in soldiers and the author of this

0:59:42.520 --> 0:59:46.640
<v Speaker 1>didn't say which soldiers and where, But in the first

0:59:46.720 --> 0:59:50.520
<v Speaker 1>months of World War One that dropped to eight per

0:59:50.520 --> 0:59:55.120
<v Speaker 1>one thousand wounded. Still high, yeah, and then as wound

0:59:55.200 --> 0:59:58.800
<v Speaker 1>care and anti tooxin delivery improved, it dropped further to

0:59:58.920 --> 1:00:02.200
<v Speaker 1>one point five per one thousand, and by the time

1:00:02.240 --> 1:00:04.520
<v Speaker 1>the US entered the war it was down two point

1:00:04.640 --> 1:00:05.960
<v Speaker 1>sixteen per one thousand.

1:00:06.240 --> 1:00:08.280
<v Speaker 4>Wow. Okay, great, that's pretty cool.

1:00:08.480 --> 1:00:13.600
<v Speaker 1>Yeah. Interestingly, tidbit here, where you were fighting like physically

1:00:14.160 --> 1:00:17.320
<v Speaker 1>played a role in your tetanus risk. Fields that had

1:00:17.320 --> 1:00:21.480
<v Speaker 1>been fertilized with manure over long periods of time had

1:00:21.520 --> 1:00:25.160
<v Speaker 1>more tetanis and led to the misconception that horses were

1:00:25.160 --> 1:00:28.840
<v Speaker 1>the reservoirs for the bacteria. Interesting, but really it can

1:00:28.880 --> 1:00:31.680
<v Speaker 1>be carried, like you said, in all kinds of animals

1:00:31.720 --> 1:00:36.320
<v Speaker 1>and humans like rats, chickens, cows, horses, I'm sure many

1:00:36.360 --> 1:00:41.960
<v Speaker 1>many other animals. Yeah, but further declines in tetanis were

1:00:42.080 --> 1:00:45.760
<v Speaker 1>in the future, and not just for soldiers but for everyone.

1:00:47.120 --> 1:00:50.560
<v Speaker 1>The tetanus vaccine was developed in nineteen twenty four by

1:00:50.640 --> 1:00:55.640
<v Speaker 1>Gaston Ramon, and widespread vaccination meant a drastic drop in

1:00:55.680 --> 1:00:59.800
<v Speaker 1>tetanus wherever the vaccine was available. Soldiers in World War

1:00:59.800 --> 1:01:02.680
<v Speaker 1>I TiO you experienced tetanus at a rate of point

1:01:02.840 --> 1:01:04.720
<v Speaker 1>zero four per one thousand.

1:01:05.240 --> 1:01:05.800
<v Speaker 4>Wow.

1:01:06.440 --> 1:01:09.000
<v Speaker 1>Yeah, and I think there was I saw a stat

1:01:09.080 --> 1:01:11.720
<v Speaker 1>that like, no one who was vaccinated got tetanus.

1:01:11.760 --> 1:01:12.280
<v Speaker 4>Wow.

1:01:12.640 --> 1:01:16.720
<v Speaker 1>And neonatal tetanus rates also dropped as researchers realized that

1:01:16.840 --> 1:01:20.480
<v Speaker 1>vaccination during pregnancy offered some protection to the newborn.

1:01:20.880 --> 1:01:24.000
<v Speaker 2>That's the most amazing and my favorite thing.

1:01:24.280 --> 1:01:28.400
<v Speaker 1>Yes, it's so important, It is so important. And these

1:01:28.920 --> 1:01:32.919
<v Speaker 1>drops in tetanus continued throughout the twentieth century and into

1:01:32.920 --> 1:01:36.880
<v Speaker 1>the twenty first, but not I'm guessing as much as

1:01:36.880 --> 1:01:39.880
<v Speaker 1>they should have. So yeah, this is kind of just

1:01:39.960 --> 1:01:42.680
<v Speaker 1>like a quick little scoot through the twentieth century on

1:01:42.800 --> 1:01:45.960
<v Speaker 1>my end, But I'm curious to know erin where we

1:01:46.000 --> 1:01:48.320
<v Speaker 1>stand today when it comes to tetanus.

1:01:48.520 --> 1:01:51.760
<v Speaker 2>I can't wait to tell you right after this break.

1:02:21.920 --> 1:02:28.040
<v Speaker 2>So in the US, we'll start here. From two thousand

1:02:28.080 --> 1:02:33.840
<v Speaker 2>and nine to twenty seventeen, only two hundred and sixty

1:02:33.960 --> 1:02:38.240
<v Speaker 2>four cases and nineteen deaths were.

1:02:38.040 --> 1:02:39.880
<v Speaker 4>Reported from Tennis.

1:02:40.720 --> 1:02:43.400
<v Speaker 2>Wow, I know that's pretty major.

1:02:43.800 --> 1:02:47.720
<v Speaker 1>Yeah, across the globe.

1:02:48.200 --> 1:02:55.240
<v Speaker 2>While the decrease in cases overall is still very impressive, unsurprisingly,

1:02:55.400 --> 1:02:59.240
<v Speaker 2>we still do have a ways to go. The World

1:02:59.280 --> 1:03:03.200
<v Speaker 2>Health Organization estimated in twenty eighteen, which is the latest

1:03:03.240 --> 1:03:08.000
<v Speaker 2>data that they have as of today, that in twenty eighteen,

1:03:08.320 --> 1:03:14.120
<v Speaker 2>twenty five thousand newborns died from neonatal tetanus twenty five

1:03:14.200 --> 1:03:19.320
<v Speaker 2>thousand worldwide. What and as depressing as that number is,

1:03:20.200 --> 1:03:24.840
<v Speaker 2>that is an eighty eight percent reduction from cases in

1:03:24.880 --> 1:03:28.440
<v Speaker 2>the year two thousand and a ninety six percent reduction

1:03:28.600 --> 1:03:30.160
<v Speaker 2>from cases in the nineteen eighties.

1:03:30.280 --> 1:03:34.920
<v Speaker 1>Oh my goodness, I know I had no idea just

1:03:35.080 --> 1:03:39.840
<v Speaker 1>how widespread tetanus was even as recently as the nineteen nineties.

1:03:40.240 --> 1:03:44.480
<v Speaker 2>For example, a paper from two thousand and one estimated

1:03:44.960 --> 1:03:49.200
<v Speaker 2>eight hundred thousand to one million deaths worldwide from tetanus

1:03:49.280 --> 1:03:53.480
<v Speaker 2>every year, including over half a million from neonatal tetnis.

1:03:54.440 --> 1:04:00.240
<v Speaker 2>That's two thousand and one paper estimated, and another paper

1:04:01.120 --> 1:04:04.120
<v Speaker 2>from two thousand and seven, which was talking about data

1:04:04.160 --> 1:04:08.520
<v Speaker 2>from the nineties, estimated that up to five percent of

1:04:08.760 --> 1:04:13.440
<v Speaker 2>maternal mortality was due to tetanus and fourteen percent of

1:04:13.520 --> 1:04:20.440
<v Speaker 2>neonatal mortality was due to tetanus. The scale of this disease.

1:04:21.880 --> 1:04:23.040
<v Speaker 4>I had no idea.

1:04:24.960 --> 1:04:28.440
<v Speaker 1>I cannot I mean, I can't even formulate I know

1:04:28.560 --> 1:04:29.680
<v Speaker 1>a sentence.

1:04:29.440 --> 1:04:29.760
<v Speaker 2>I know.

1:04:31.320 --> 1:04:32.920
<v Speaker 4>I feel very much the same.

1:04:34.320 --> 1:04:38.880
<v Speaker 2>So we have come an incredibly long way. The World

1:04:38.960 --> 1:04:44.440
<v Speaker 2>Health Organization, who tracks data on vaccinations as well as cases,

1:04:45.120 --> 1:04:49.360
<v Speaker 2>estimated that worldwide in twenty nineteen, eighty six percent of

1:04:49.480 --> 1:04:53.240
<v Speaker 2>children were covered by DTP three, which is the three

1:04:53.280 --> 1:04:56.640
<v Speaker 2>doses of vaccine in the first year of life. Okay,

1:04:57.160 --> 1:05:00.560
<v Speaker 2>so eighty six percent of children. And I want to

1:05:00.560 --> 1:05:04.440
<v Speaker 2>take a minute to emphasize here just how preventable this

1:05:04.560 --> 1:05:09.600
<v Speaker 2>disease really is. Vaccination generally starts at two months old,

1:05:09.880 --> 1:05:12.520
<v Speaker 2>and it's a series of three shots initially, and then

1:05:12.520 --> 1:05:16.320
<v Speaker 2>a booster around kindergarten, and then boosters every ten years

1:05:16.440 --> 1:05:21.120
<v Speaker 2>or so to maintain immunity. But like you mentioned Aaron,

1:05:21.600 --> 1:05:28.000
<v Speaker 2>vaccination during pregnancy also confers protection against neonatal tetanus, and

1:05:28.080 --> 1:05:32.560
<v Speaker 2>it's been estimated vaccination during pregnancy to reduce mortality from

1:05:32.640 --> 1:05:35.520
<v Speaker 2>neonatal tetanus by ninety four percent.

1:05:36.480 --> 1:05:38.880
<v Speaker 1>That's incredible, it's amazing.

1:05:40.400 --> 1:05:45.400
<v Speaker 2>So we have the capacity to protect people from this disease.

1:05:46.520 --> 1:05:50.040
<v Speaker 2>But a really important thing is that this is a

1:05:50.160 --> 1:05:56.360
<v Speaker 2>continual struggle, or at least it's a continual process, because

1:05:56.400 --> 1:06:00.000
<v Speaker 2>this is not a human specific disease that, for example,

1:06:00.160 --> 1:06:03.480
<v Speaker 2>like smallpox, if you can interrupt the chain of transmission

1:06:03.480 --> 1:06:07.360
<v Speaker 2>between humans for long enough, you can eliminate the disease.

1:06:08.200 --> 1:06:11.280
<v Speaker 2>You can't do that with this because it's environmental pathogen

1:06:11.360 --> 1:06:14.600
<v Speaker 2>that has always, like you said, Aaron, and likely always

1:06:14.640 --> 1:06:18.040
<v Speaker 2>will be in our environment. So it is a process

1:06:18.120 --> 1:06:23.960
<v Speaker 2>of continual protection through these incredibly efficacious, incredibly safe vaccines.

1:06:25.400 --> 1:06:30.040
<v Speaker 2>And as we have seen, for example in the COVID pandemic,

1:06:31.040 --> 1:06:36.040
<v Speaker 2>things that drastically alter the global landscape pose really big

1:06:36.200 --> 1:06:40.160
<v Speaker 2>challenges to vaccination. So you know how I said, in

1:06:40.200 --> 1:06:43.320
<v Speaker 2>twenty nineteen, eighty six percent of children were covered by

1:06:43.400 --> 1:06:47.320
<v Speaker 2>DPT three, while in twenty twenty that number had gone

1:06:47.360 --> 1:06:51.520
<v Speaker 2>down to eighty three percent. So an estimated twenty three

1:06:51.600 --> 1:06:54.240
<v Speaker 2>million children under the age of one did not receive

1:06:54.280 --> 1:06:57.720
<v Speaker 2>their basic vaccines in twenty twenty, and the number of

1:06:57.800 --> 1:07:02.240
<v Speaker 2>completely unvaccinated children GLOW increased by nearly three point four

1:07:02.520 --> 1:07:05.480
<v Speaker 2>million in that year alone.

1:07:05.680 --> 1:07:06.760
<v Speaker 4>So we're not done yet.

1:07:07.360 --> 1:07:09.320
<v Speaker 1>No, we're never done.

1:07:09.520 --> 1:07:13.360
<v Speaker 2>We're never But I want to end this episode on

1:07:13.400 --> 1:07:16.760
<v Speaker 2>some really high notes and also just like keep ragging

1:07:16.840 --> 1:07:21.760
<v Speaker 2>about the tetnus vaccine. It's fantastic, yeah, and really the

1:07:21.800 --> 1:07:27.600
<v Speaker 2>tetanus toxoid. So the tetanus vaccine is a toxoid vaccine.

1:07:27.640 --> 1:07:32.400
<v Speaker 2>A toxoid is just an inactivated toxin, right, and the

1:07:32.440 --> 1:07:37.480
<v Speaker 2>toxin is a protein, so it's easy, it's cheap to produce.

1:07:38.480 --> 1:07:43.240
<v Speaker 2>And this tetanus toxoid that is easy to produce, that

1:07:43.400 --> 1:07:47.360
<v Speaker 2>is cheap, that is very immunogenic to our immune system,

1:07:48.040 --> 1:07:50.880
<v Speaker 2>is used to make a whole bunch of other vaccines,

1:07:51.400 --> 1:07:55.960
<v Speaker 2>like our new Macocco vaccine, our Meninjocco vaccine hib All

1:07:56.000 --> 1:08:00.360
<v Speaker 2>of these vaccines are made by conjugating or combining things

1:08:00.440 --> 1:08:05.440
<v Speaker 2>like sugars, polysaccharides to the tetanus toxoid protein to induce

1:08:05.560 --> 1:08:09.160
<v Speaker 2>a better protective immunity against these other diseases as well.

1:08:09.520 --> 1:08:12.000
<v Speaker 1>That is just so cool, isn't it beautiful?

1:08:12.200 --> 1:08:14.840
<v Speaker 2>And on top of that, the other reason that tetnus

1:08:14.920 --> 1:08:17.680
<v Speaker 2>toxoid makes for such a good vaccine is that it's

1:08:17.760 --> 1:08:21.600
<v Speaker 2>really shelf stable. It doesn't have to be frozen or refrigerated.

1:08:21.960 --> 1:08:25.280
<v Speaker 2>It's stable at room temperature for months. So it's really transportable,

1:08:25.320 --> 1:08:28.520
<v Speaker 2>even to remote areas that don't have access to refrigeration.

1:08:29.040 --> 1:08:30.320
<v Speaker 1>That's fantastic.

1:08:30.840 --> 1:08:32.160
<v Speaker 4>There's more. Aaron.

1:08:34.120 --> 1:08:37.599
<v Speaker 2>Literally, not ten minutes before we were going to record,

1:08:38.600 --> 1:08:42.519
<v Speaker 2>I was eating dinner and I was googling because I

1:08:42.560 --> 1:08:45.439
<v Speaker 2>remember a very long time ago you were like, hey,

1:08:45.439 --> 1:08:48.280
<v Speaker 2>did you see this news article about something that we

1:08:48.280 --> 1:08:50.960
<v Speaker 2>were going to record? And never had it crossed my

1:08:51.040 --> 1:08:55.960
<v Speaker 2>mind to google news articles about whatever we're talking about.

1:08:57.080 --> 1:08:59.439
<v Speaker 2>And ever since then, and that was a long time ago. Now,

1:08:59.479 --> 1:09:02.080
<v Speaker 2>I always like, the last thing that I do before

1:09:02.120 --> 1:09:05.360
<v Speaker 2>I wrap up my research is I google tetanus and

1:09:05.400 --> 1:09:07.160
<v Speaker 2>I press the news button on Google.

1:09:07.479 --> 1:09:08.240
<v Speaker 1>Oh, I love it.

1:09:08.520 --> 1:09:11.320
<v Speaker 2>So I did that while I was eating dinner, right

1:09:11.320 --> 1:09:15.800
<v Speaker 2>before we recorded, and lo and behold, this paper was

1:09:15.840 --> 1:09:20.240
<v Speaker 2>published one week ago. A group out of Albert Einstein

1:09:20.439 --> 1:09:24.800
<v Speaker 2>College of Medicine published a study in Science Translational Medicine

1:09:25.120 --> 1:09:30.719
<v Speaker 2>that used a combination of Listeria monocytogenies, which is a

1:09:30.720 --> 1:09:36.080
<v Speaker 2>bacteria that we'll cover eventually, we haven't, right, No, okay,

1:09:37.320 --> 1:09:43.040
<v Speaker 2>So a combination of this bacteria and tetanus toxoid to

1:09:43.240 --> 1:09:45.799
<v Speaker 2>treat pancreatic cancer.

1:09:46.439 --> 1:09:48.120
<v Speaker 1>Incredible, I know.

1:09:49.640 --> 1:09:56.000
<v Speaker 2>Essentially, briefly, they injected mice that had pancreatic cancer that

1:09:56.200 --> 1:09:59.240
<v Speaker 2>had also been vaccinated for tetanus like before they got

1:09:59.240 --> 1:10:04.479
<v Speaker 2>cancer with a listeria that had been engineered to have

1:10:04.560 --> 1:10:10.840
<v Speaker 2>the tetanus toxoid protein. And for whatever fascinating reason has

1:10:10.920 --> 1:10:16.520
<v Speaker 2>to do with listeria, it preferentially congregates in these cancer cells,

1:10:17.080 --> 1:10:19.240
<v Speaker 2>I think because the immune system wipes it out in

1:10:19.280 --> 1:10:23.479
<v Speaker 2>other places. And then the mouse's immune system has a

1:10:23.520 --> 1:10:29.120
<v Speaker 2>bunch of antibodies that recognize the tetanus toxoid because they

1:10:29.120 --> 1:10:33.559
<v Speaker 2>were vaccinated, and so boom they end up attacking the

1:10:33.680 --> 1:10:38.799
<v Speaker 2>cancer that has these bacteria that have this toxoid protein.

1:10:39.120 --> 1:10:43.400
<v Speaker 1>What That's amazing And also, first of all, that's fantastic

1:10:43.680 --> 1:10:47.719
<v Speaker 1>news for pancreatic cancer, I know, but secondly, I feel

1:10:47.760 --> 1:10:51.240
<v Speaker 1>like that could be a model for many other types

1:10:51.280 --> 1:10:54.080
<v Speaker 1>of cancer treating exactly. Yeah, Oh so cool.

1:10:54.320 --> 1:10:57.200
<v Speaker 2>I know, these mice had their pancreatic tumors decrease in

1:10:57.240 --> 1:11:02.160
<v Speaker 2>size by eighty percent and metastases decreased by eighty seven percent,

1:11:02.240 --> 1:11:05.400
<v Speaker 2>and they lived forty percent longer than untreated mice.

1:11:05.680 --> 1:11:09.400
<v Speaker 4>But it's a mice, but like, this is a big deal.

1:11:09.680 --> 1:11:10.439
<v Speaker 1>It's a big deal.

1:11:11.160 --> 1:11:13.760
<v Speaker 2>So that's a high note to end on and I

1:11:13.760 --> 1:11:15.679
<v Speaker 2>will absolutely link that paper.

1:11:15.960 --> 1:11:16.320
<v Speaker 1>Cool.

1:11:16.800 --> 1:11:24.439
<v Speaker 2>Yeah, so tetanus is a horrible disease, but we have

1:11:24.479 --> 1:11:27.160
<v Speaker 2>a vaccine and it is awesome.

1:11:28.000 --> 1:11:28.439
<v Speaker 1>I love that.

1:11:29.160 --> 1:11:33.800
<v Speaker 4>Yeah, yeah, any sources, sources.

1:11:36.479 --> 1:11:40.560
<v Speaker 1>I have a large number of sources for this episode.

1:11:40.640 --> 1:11:44.240
<v Speaker 1>I'm going to shout out three right now and put

1:11:44.240 --> 1:11:47.479
<v Speaker 1>the rest on our website. One is called No Uncommon

1:11:47.520 --> 1:11:52.040
<v Speaker 1>Disease by Sally McMillan. Another is called an Essay on

1:11:52.080 --> 1:11:56.479
<v Speaker 1>the History of Lockjaw by William Shalian, and the last

1:11:56.479 --> 1:12:00.240
<v Speaker 1>one i'll shout out is called the population structure sure

1:12:00.320 --> 1:12:04.200
<v Speaker 1>of Claustridium tetani deduced from its pan genome, and that

1:12:04.360 --> 1:12:09.559
<v Speaker 1>is by Chapaton Montes at All from twenty nineteen.

1:12:10.640 --> 1:12:14.560
<v Speaker 2>I had just a few papers for this episode. I

1:12:14.600 --> 1:12:18.000
<v Speaker 2>really enjoyed. Actually, a nineteen ninety four paper called the

1:12:18.040 --> 1:12:22.080
<v Speaker 2>Mechanism of Action of Tetanus and Botulinum neurotoxins. It was

1:12:22.160 --> 1:12:25.519
<v Speaker 2>pretty thorough, and then a twenty nineteen Botulinum and Tetanus

1:12:25.600 --> 1:12:28.720
<v Speaker 2>Neurotoxins kind of an update, a few other papers on

1:12:28.760 --> 1:12:31.679
<v Speaker 2>the epidemiology as well as links to the World Health

1:12:31.760 --> 1:12:36.599
<v Speaker 2>Organization and the CDC surveillance, and then that awesome paper

1:12:36.800 --> 1:12:39.320
<v Speaker 2>that just came out in March of twenty twenty two

1:12:39.920 --> 1:12:44.360
<v Speaker 2>was titled Listeria delivers tetanus toxoid protein to pancreatic tumors

1:12:44.560 --> 1:12:47.639
<v Speaker 2>and induces cancer cell death in mice. So it really

1:12:47.640 --> 1:12:51.840
<v Speaker 2>tells you the whole study. And we'll post the list

1:12:51.920 --> 1:12:55.439
<v Speaker 2>of these sources and every source from every one of

1:12:55.479 --> 1:12:58.120
<v Speaker 2>our episodes on our website, This podcast will kill You

1:12:58.200 --> 1:12:58.679
<v Speaker 2>dot com.

1:12:59.320 --> 1:13:02.920
<v Speaker 1>Thank you Tomobile for providing the music for this episode

1:13:03.000 --> 1:13:04.400
<v Speaker 1>and all of our episodes.

1:13:05.000 --> 1:13:07.000
<v Speaker 4>Thank you to the Exactly Right Network.

1:13:07.640 --> 1:13:11.800
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1:13:21.479 --> 1:13:25.840
<v Speaker 4>Thank you so much for listening. To begin with, we

1:13:25.920 --> 1:13:28.000
<v Speaker 4>love it and we love you so much.

1:13:28.240 --> 1:13:32.160
<v Speaker 1>We do and also a special shout out to our

1:13:32.439 --> 1:13:39.120
<v Speaker 1>wonderful patrons. You're incredible, just the best. Okay, Well, until

1:13:39.160 --> 1:13:41.040
<v Speaker 1>next time, wash your hands

1:13:41.400 --> 1:14:02.840
<v Speaker 2>You filthy animals. M.