1 00:00:01,320 --> 00:00:04,240 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,400 --> 00:00:14,680 Speaker 1: of iHeartRadio. Hello, and welcome to the podcast. I'm Tracy V. 3 00:00:14,840 --> 00:00:19,439 Speaker 1: Wilson and I'm Holly Frye. Hey. I'm thinking about vaccines 4 00:00:19,800 --> 00:00:26,440 Speaker 1: a lot right now for reasons including rapidly growing measles 5 00:00:26,440 --> 00:00:28,960 Speaker 1: outbreak that we have happening in the US right now. 6 00:00:29,000 --> 00:00:32,919 Speaker 1: I originally had numbers of cases here in the outline, 7 00:00:33,520 --> 00:00:36,400 Speaker 1: but that number increased by like two hundred just in 8 00:00:36,440 --> 00:00:38,599 Speaker 1: the time that I was working on this. Yeah, it's 9 00:00:38,640 --> 00:00:40,960 Speaker 1: impossible to track. By the time this comes out, those 10 00:00:41,040 --> 00:00:43,160 Speaker 1: numbers would be woefully out. Sabe. Yeah, two more weeks 11 00:00:43,159 --> 00:00:45,800 Speaker 1: are going to pass before this is out, so those 12 00:00:45,880 --> 00:00:50,040 Speaker 1: numbers would be wrong anyway by then. Also, just a 13 00:00:50,080 --> 00:00:54,280 Speaker 1: lot of upsetting and alarming developments happening in the US 14 00:00:54,360 --> 00:00:57,440 Speaker 1: Department of Health and Human Services and the National Institute 15 00:00:57,480 --> 00:01:01,920 Speaker 1: of Health. We have already done an episode on measles 16 00:01:02,200 --> 00:01:05,000 Speaker 1: that came out on February twenty eighth of twenty twenty four, 17 00:01:05,080 --> 00:01:07,679 Speaker 1: and that's a little bit more recent than we would 18 00:01:07,720 --> 00:01:10,880 Speaker 1: typically rerun as a Saturday Classic. So I decided to 19 00:01:10,959 --> 00:01:14,920 Speaker 1: take a look at another disease that's preventable today. Thanks 20 00:01:15,000 --> 00:01:18,920 Speaker 1: to vaccines which do not cause autism. Not any vaccine, 21 00:01:18,920 --> 00:01:23,440 Speaker 1: not for any disease. None of them cause autism. The disease, though, 22 00:01:23,480 --> 00:01:27,920 Speaker 1: is tetanus. Since this is an episode about a medical development, 23 00:01:27,959 --> 00:01:31,240 Speaker 1: of course there will be some medical experiment stuff in 24 00:01:31,280 --> 00:01:35,679 Speaker 1: the episode, including some experiments involving animals. I really don't 25 00:01:35,680 --> 00:01:39,080 Speaker 1: think any of that is particularly graphic, but just in case, 26 00:01:39,840 --> 00:01:44,600 Speaker 1: Uh yeah, I can handle it based on my read through, 27 00:01:45,400 --> 00:01:48,960 Speaker 1: which is a pretty low bar of getting upsetness. So 28 00:01:49,240 --> 00:01:53,480 Speaker 1: I think we're safe. But if not, I'm sorry. Tetanus 29 00:01:53,520 --> 00:01:57,200 Speaker 1: has probably been around for most of human history, possibly 30 00:01:57,240 --> 00:02:01,960 Speaker 1: even longer. It's caused by the bacteria Clostridium tetani, which 31 00:02:02,000 --> 00:02:04,880 Speaker 1: is present in the environment in a lot of the world. 32 00:02:05,320 --> 00:02:09,080 Speaker 1: It's described with words like ubiquitous. In the words of 33 00:02:09,160 --> 00:02:12,160 Speaker 1: John Sundwall in a lecture given under the auspices of 34 00:02:12,200 --> 00:02:16,639 Speaker 1: the Kansas Academy of Science in nineteen seventeen, quote, this 35 00:02:16,760 --> 00:02:19,960 Speaker 1: germ has a wide distribution, and its spores are found 36 00:02:20,080 --> 00:02:25,080 Speaker 1: wherever there is dirt. Barnyards are veritable repositories for them. 37 00:02:25,720 --> 00:02:29,800 Speaker 1: Rusty nails appear to be rendezvous. Even the dirt that 38 00:02:29,840 --> 00:02:34,000 Speaker 1: besmears the healthy living child may contain millions of these 39 00:02:34,040 --> 00:02:38,079 Speaker 1: spores of Tetanus basillai. The spores can only grow when 40 00:02:38,120 --> 00:02:41,040 Speaker 1: they gain deep entrance into the body and are shut 41 00:02:41,080 --> 00:02:44,840 Speaker 1: off from oxygen. One of the oldest known medical texts 42 00:02:44,880 --> 00:02:48,280 Speaker 1: in the world is the Edwin Smith Surgical Papyrus, named 43 00:02:48,320 --> 00:02:50,959 Speaker 1: for Edwin Smith, who bought it in eighteen sixty two. 44 00:02:51,880 --> 00:02:56,200 Speaker 1: This Egyptian medical text dates back to about fifteen hundred BCE, 45 00:02:56,720 --> 00:02:59,320 Speaker 1: and it includes a description of somebody with a head 46 00:02:59,440 --> 00:03:03,000 Speaker 1: injury that penetrated all the way through the futures of 47 00:03:03,040 --> 00:03:08,480 Speaker 1: the skull. Afterward, according to one translation, quote, the cord 48 00:03:08,600 --> 00:03:12,880 Speaker 1: of his mandible is contracted. He discharges blood from both 49 00:03:12,919 --> 00:03:16,040 Speaker 1: his nostrils and from both his ears, while he suffers 50 00:03:16,040 --> 00:03:21,440 Speaker 1: with stiffness in his neck. As this patient's condition progresses quote, 51 00:03:21,480 --> 00:03:25,120 Speaker 1: his mouth is bound, both his eyebrows are drawn, while 52 00:03:25,160 --> 00:03:29,959 Speaker 1: his face is as if he wept. This earliest description 53 00:03:30,160 --> 00:03:34,639 Speaker 1: is usually translated and interpreted as describing a case of tetanus, 54 00:03:35,000 --> 00:03:38,320 Speaker 1: but it doesn't entirely convey what tetanus is like as 55 00:03:38,360 --> 00:03:42,520 Speaker 1: an illness. Tetanus doesn't cause bleeding from the ears or nose. 56 00:03:42,880 --> 00:03:45,680 Speaker 1: That was probably a product of the patient's head trauma, 57 00:03:46,320 --> 00:03:49,880 Speaker 1: not the tetanus that followed it. Beyond that, without getting 58 00:03:49,920 --> 00:03:55,640 Speaker 1: into a lengthy backgrounder on neurotransmitters, Claustritium tetani produces two toxins, 59 00:03:55,760 --> 00:04:00,360 Speaker 1: and one of them, called tetanospasmen, interferes with neurotransmitter that 60 00:04:00,440 --> 00:04:05,880 Speaker 1: control motor neuron activity. The nerves start firing uncontrollably, which 61 00:04:05,960 --> 00:04:11,400 Speaker 1: causes intense muscle spasms. These can be excruciating and powerful 62 00:04:11,480 --> 00:04:14,720 Speaker 1: enough to cause compression fractures or other breaks in a 63 00:04:14,760 --> 00:04:19,800 Speaker 1: person's bones. Tetanus can also lead to suffocation and heart failure. 64 00:04:20,600 --> 00:04:24,120 Speaker 1: Even with medical treatment, tetanus is fatal between ten and 65 00:04:24,240 --> 00:04:27,960 Speaker 1: twenty percent of the time, and without treatment the fatality 66 00:04:28,040 --> 00:04:30,760 Speaker 1: rate goes up to eighty five percent or even more. 67 00:04:32,120 --> 00:04:37,039 Speaker 1: It sounds awful, yes it does. The muscles in the 68 00:04:37,080 --> 00:04:40,520 Speaker 1: face and the jaw are often affected in tetanus, and 69 00:04:40,560 --> 00:04:43,400 Speaker 1: that can cause a person to look like they are grinning. 70 00:04:44,160 --> 00:04:48,400 Speaker 1: The spasms also cause tristmas, also known as lockjaw, and 71 00:04:48,440 --> 00:04:51,279 Speaker 1: that can make it difficult or impossible for the persons 72 00:04:51,279 --> 00:04:55,200 Speaker 1: who open their mouth. The Edwin Smith Papyrus offers a 73 00:04:55,400 --> 00:04:58,680 Speaker 1: way to try to deal with this lock jaw that's 74 00:04:58,680 --> 00:05:02,080 Speaker 1: by placing a wooden brace padded with linen in the 75 00:05:02,160 --> 00:05:05,240 Speaker 1: patient's mouth to try to keep it open enough that 76 00:05:05,279 --> 00:05:08,839 Speaker 1: they can be fed a liquid diet while being kept upright. 77 00:05:09,680 --> 00:05:13,840 Speaker 1: Tetanus also appears in the Sashruda Samhita, which dates back 78 00:05:13,880 --> 00:05:16,719 Speaker 1: to about the sixth century BCE and is one of 79 00:05:16,720 --> 00:05:21,080 Speaker 1: the foundational texts of iervedic medicine. We did an episode 80 00:05:21,120 --> 00:05:25,120 Speaker 1: on Sashruda in January of twenty nineteen. In a chapter 81 00:05:25,279 --> 00:05:29,040 Speaker 1: on diseases of the nervous system, the Sashruda Samhita describes 82 00:05:29,080 --> 00:05:33,720 Speaker 1: one caused by enraged or agitated value that's the air 83 00:05:33,800 --> 00:05:38,880 Speaker 1: element in iervedic medicine. This disease quote rarely yields to 84 00:05:38,960 --> 00:05:42,760 Speaker 1: medicine and is cured in rare instances only with the 85 00:05:42,800 --> 00:05:48,200 Speaker 1: greatest difficulty. Its characteristic symptom being a paralysis of the jawbone, 86 00:05:48,520 --> 00:05:53,920 Speaker 1: which makes deglutition extremely difficult. This disease in the text 87 00:05:53,960 --> 00:05:57,000 Speaker 1: is described as bending the body like a bow and 88 00:05:57,120 --> 00:06:00,640 Speaker 1: in its extreme form, fixing the eyes in their sockets, 89 00:06:01,040 --> 00:06:06,400 Speaker 1: paralyzing the jaw and breaking the sides. The Chinese medical 90 00:06:06,480 --> 00:06:10,880 Speaker 1: text known as the Yellow Emperor's Classic of Internal medicine 91 00:06:11,520 --> 00:06:15,000 Speaker 1: is attributed to a semi mythical figure who's described as 92 00:06:15,040 --> 00:06:18,880 Speaker 1: living around twenty six hundred BCE, but it was probably 93 00:06:18,920 --> 00:06:22,680 Speaker 1: written more than two thousand years later than that. Traditional 94 00:06:22,720 --> 00:06:27,080 Speaker 1: Chinese medicine incorporates the idea of energy channels or meridians 95 00:06:27,160 --> 00:06:30,800 Speaker 1: in the body. The translation of the Yellow Emperor's Classic 96 00:06:30,839 --> 00:06:33,680 Speaker 1: that I had access to for research didn't use the 97 00:06:33,680 --> 00:06:37,520 Speaker 1: word tetanus anywhere, but it describes the collapse of the 98 00:06:37,640 --> 00:06:42,480 Speaker 1: chi in the bladder and small intestine meridian as causing opisthoughtanus, 99 00:06:42,760 --> 00:06:48,040 Speaker 1: stiffness in the back, convulsive spasms, paleness, and spontaneous sweating. 100 00:06:48,839 --> 00:06:54,360 Speaker 1: Once that sweating stops, the patient dies. Apisthoughtanus is the extreme, 101 00:06:54,680 --> 00:06:59,400 Speaker 1: very arching spasms that are associated with tetanus. The first 102 00:06:59,400 --> 00:07:02,520 Speaker 1: thing we'd think of as a really clear clinical description 103 00:07:02,640 --> 00:07:06,039 Speaker 1: of tetanus from a more Western medical perspective is from 104 00:07:06,080 --> 00:07:11,280 Speaker 1: Greek physician Hippocrates, written around the fifth century BCE. In 105 00:07:11,320 --> 00:07:17,760 Speaker 1: a treatise on Internal afflictions, Hippocrates describes three types of tetanus. First, 106 00:07:17,800 --> 00:07:21,320 Speaker 1: when it follows a wound, Hippocrates says, the patient's quote 107 00:07:21,640 --> 00:07:25,240 Speaker 1: jaws are fixed and he is unable to open his mouth, 108 00:07:25,800 --> 00:07:30,360 Speaker 1: his eyes shed tears and look awry. His back becomes rigid. 109 00:07:30,680 --> 00:07:34,600 Speaker 1: He cannot bend his legs, nor his arms and spine. 110 00:07:34,680 --> 00:07:38,760 Speaker 1: Hippocrates describes this disease as severe and requiring a media 111 00:07:38,800 --> 00:07:44,320 Speaker 1: attention and in many cases fatal. For treatment, Hippocrates advises 112 00:07:44,400 --> 00:07:49,200 Speaker 1: anointing the patient with warm oil infused with wormwood, bay leaves, 113 00:07:49,360 --> 00:07:53,360 Speaker 1: or hen made seed with frankincense soaked in white wine. 114 00:07:54,160 --> 00:07:58,320 Speaker 1: According to Hippocrates, the second type of tetanus is similar, 115 00:07:58,440 --> 00:08:02,920 Speaker 1: but it starts with angina also pronounced angina that's chest pain, 116 00:08:03,400 --> 00:08:06,880 Speaker 1: or with a saff infection or separation of the tonsils, 117 00:08:07,360 --> 00:08:10,679 Speaker 1: and occasionally it can also start with a wound. Quote 118 00:08:10,800 --> 00:08:14,760 Speaker 1: this patient is drawn backwards and cries aloud from the 119 00:08:14,800 --> 00:08:18,040 Speaker 1: pain in his back and chest. He is drawn so 120 00:08:18,440 --> 00:08:22,320 Speaker 1: forcefully that the attendants can hardly prevent him from falling 121 00:08:22,440 --> 00:08:26,560 Speaker 1: out of bed. Then the third form is less lethal, 122 00:08:26,880 --> 00:08:30,280 Speaker 1: arising from some of the same possible causes or from 123 00:08:30,400 --> 00:08:36,240 Speaker 1: having fallen backward. Another work by Hippocrates called on Epidemics, 124 00:08:36,360 --> 00:08:41,400 Speaker 1: also includes several examples of tennis cases, One developed after 125 00:08:41,440 --> 00:08:46,000 Speaker 1: a surgery, another after a javelin wound after a person's 126 00:08:46,040 --> 00:08:49,600 Speaker 1: finger was crushed by an anchor after an ankle injury 127 00:08:49,640 --> 00:08:54,040 Speaker 1: whose treatment involved irritating the wound, after being injured by 128 00:08:54,080 --> 00:08:57,239 Speaker 1: a piece of wood from a missile thrown by a catapult. 129 00:08:58,400 --> 00:09:02,080 Speaker 1: In the words of Roman author Alice Cornelius Celsus in 130 00:09:02,160 --> 00:09:05,760 Speaker 1: the first century CE, quote, there is no disease more 131 00:09:05,880 --> 00:09:09,720 Speaker 1: distressing and more acute than that which, by a sort 132 00:09:09,760 --> 00:09:13,319 Speaker 1: of rigor of the sinews, now draws down the head 133 00:09:13,400 --> 00:09:16,280 Speaker 1: to the shoulder blades, now the chin to the chest, 134 00:09:16,800 --> 00:09:20,800 Speaker 1: now stretches out the next straight and immobile. The Greeks 135 00:09:20,880 --> 00:09:25,960 Speaker 1: call the first aposthotanus, the next amprosthotanus, and the last tetanus, 136 00:09:26,360 --> 00:09:31,560 Speaker 1: although some with less exactitude use these terms indiscriminately. For 137 00:09:31,800 --> 00:09:36,120 Speaker 1: centuries after this, European medical writing on tetanus tended to 138 00:09:36,160 --> 00:09:40,760 Speaker 1: be really similar. Many physicians base their work on Hippocrates. 139 00:09:41,600 --> 00:09:45,800 Speaker 1: Even if Hippocrates wasn't cited, they still usually described tetanus 140 00:09:45,840 --> 00:09:49,840 Speaker 1: as following a wound. Most commented on how often the 141 00:09:49,880 --> 00:09:53,600 Speaker 1: condition was fatal, and many of the recommended treatments related 142 00:09:53,600 --> 00:09:56,680 Speaker 1: to things that one might hope would relieve the spasms, 143 00:09:57,160 --> 00:10:00,360 Speaker 1: like being rubbed with oils or wines or liniments or 144 00:10:00,400 --> 00:10:04,600 Speaker 1: wrapped in warm dressings or given warm baths. In the 145 00:10:04,640 --> 00:10:09,840 Speaker 1: sixteenth century, past podcast subject Amboise Parre developed an instrument 146 00:10:09,920 --> 00:10:13,000 Speaker 1: to open a tetanus patient's mouth so that they could 147 00:10:13,000 --> 00:10:16,839 Speaker 1: be fed. Overall, the focus was on trying to get 148 00:10:16,840 --> 00:10:20,040 Speaker 1: the muscles to relax and supporting the patient with the 149 00:10:20,120 --> 00:10:24,160 Speaker 1: hope that they would recover, but often a certainty that 150 00:10:24,240 --> 00:10:28,520 Speaker 1: they would not. Knowledge of the cause of tetanus and 151 00:10:28,600 --> 00:10:31,480 Speaker 1: how to treat and prevent it didn't really start to 152 00:10:31,559 --> 00:10:34,880 Speaker 1: advance until the nineteenth century, which we will get to 153 00:10:35,080 --> 00:10:47,600 Speaker 1: after a sponsor break. As we said, before the break, 154 00:10:47,800 --> 00:10:51,840 Speaker 1: people figured out that tetanus was connected to wounds thousands 155 00:10:51,880 --> 00:10:55,480 Speaker 1: of years ago, but it wasn't until the nineteenth century 156 00:10:55,520 --> 00:10:57,520 Speaker 1: that we started to get a sense of exactly what 157 00:10:57,720 --> 00:11:01,440 Speaker 1: was happening inside those wounds and elsewhere in the body. 158 00:11:02,440 --> 00:11:06,040 Speaker 1: In eighteen thirty eight, Luigi Carlo Ferini gave an address 159 00:11:06,120 --> 00:11:09,880 Speaker 1: before the Medical Turgical Society of Bologna in which he 160 00:11:10,120 --> 00:11:14,000 Speaker 1: described the use of electricity in the treatment of tetanus. 161 00:11:14,800 --> 00:11:17,760 Speaker 1: He had based this on the work of Carlo Mettiucci, 162 00:11:17,960 --> 00:11:22,920 Speaker 1: who was experimenting with electricity and frogs. Farini found that 163 00:11:23,000 --> 00:11:25,920 Speaker 1: the application of direct current to the body of a 164 00:11:26,000 --> 00:11:29,880 Speaker 1: patient who had developed tetanus after a gunshot wound seemed 165 00:11:29,920 --> 00:11:35,160 Speaker 1: to interrupt the spasms. Unfortunately, this effect was temporary. It 166 00:11:35,240 --> 00:11:39,240 Speaker 1: lasted only about thirty minutes. This didn't really provide a 167 00:11:39,280 --> 00:11:43,000 Speaker 1: breakthrough in the understanding of tetanus, but it was connected 168 00:11:43,040 --> 00:11:46,640 Speaker 1: to the electrical activity of the neurons that is part 169 00:11:46,679 --> 00:11:51,280 Speaker 1: of the disease. Several discoveries were made. In eighteen eighty four, 170 00:11:52,080 --> 00:11:56,800 Speaker 1: Italian scientists Antonio Carle and Giorgio Rotone had both studied 171 00:11:56,800 --> 00:12:00,920 Speaker 1: medicine in Turin. They exposed a rat but to fluid 172 00:12:00,960 --> 00:12:03,599 Speaker 1: from a sore from someone who had died of tetanus, 173 00:12:04,000 --> 00:12:08,440 Speaker 1: and that rabbit also developed tetanus. This showed some kind 174 00:12:08,520 --> 00:12:11,920 Speaker 1: of contagion was causing the disease. But to be clear, 175 00:12:12,200 --> 00:12:16,600 Speaker 1: tetanus is not transmitted from person to person. You would 176 00:12:16,640 --> 00:12:20,760 Speaker 1: have to really do something on purpose like this. Also 177 00:12:20,760 --> 00:12:24,000 Speaker 1: in eighteen eighty four, Arthur Nicolier, who was a twenty 178 00:12:24,040 --> 00:12:28,160 Speaker 1: two year old medical student in Germany, identified a bacillus 179 00:12:28,280 --> 00:12:31,600 Speaker 1: in the soil. If you look at this basillis under 180 00:12:31,640 --> 00:12:34,880 Speaker 1: a microscope, it looks kind of like a tiny straight pin. 181 00:12:35,240 --> 00:12:38,880 Speaker 1: There's this rod like basillis with a knob on the end. 182 00:12:39,720 --> 00:12:43,240 Speaker 1: That knob is the spore. Today, we know that these 183 00:12:43,280 --> 00:12:48,320 Speaker 1: spores are incredibly hearty, they are resistant to most disinfectants, 184 00:12:48,679 --> 00:12:52,120 Speaker 1: and they can survive freezing and being autoclaved at a 185 00:12:52,120 --> 00:12:54,920 Speaker 1: temperature of one hundred and twenty one degrees celsius or 186 00:12:54,920 --> 00:12:57,920 Speaker 1: two forty nine point eight fahrenheit for ten or fifteen minutes. 187 00:12:58,880 --> 00:13:02,880 Speaker 1: Nicolier induce tetanus in mice by injecting them with soil 188 00:13:02,960 --> 00:13:07,640 Speaker 1: that was contaminated with this spore forming basillis. He concluded 189 00:13:07,640 --> 00:13:11,560 Speaker 1: that the basillis produced a poison that acted similarly to strychnine. 190 00:13:12,320 --> 00:13:15,840 Speaker 1: Within a few years, multiple researchers all concluded that this 191 00:13:15,920 --> 00:13:20,679 Speaker 1: basillis could produce a toxin. While Nicolier was able to 192 00:13:20,920 --> 00:13:24,400 Speaker 1: find the tetanus basillis in the soil, he was not 193 00:13:24,720 --> 00:13:28,520 Speaker 1: able to isolate it in a lab. Credit for that 194 00:13:28,760 --> 00:13:33,680 Speaker 1: goes to Japanese physician and bacteriologist Kitasato Shiva Siburo in 195 00:13:33,800 --> 00:13:37,839 Speaker 1: eighteen eighty nine. Kitasato was born in Japan and had 196 00:13:37,880 --> 00:13:41,240 Speaker 1: earned his medical degree from the University of Tokyo Medical 197 00:13:41,320 --> 00:13:45,559 Speaker 1: School in eighteen eighty three. Two years later, the Japanese 198 00:13:45,679 --> 00:13:48,800 Speaker 1: government had sent him to the Institute of Hygiene in 199 00:13:48,920 --> 00:13:54,719 Speaker 1: Berlin to study bacteriology and infectious diseases with groundbreaking microbiologist 200 00:13:54,840 --> 00:13:59,800 Speaker 1: Robert Koch. It was while in Berlin that Quitasato isolated 201 00:13:59,840 --> 00:14:05,680 Speaker 1: the tetanus bacillis Clestridium tetanani is an anaerobic microorganism, so 202 00:14:05,840 --> 00:14:09,959 Speaker 1: doing this required Kitasato to develop new methods for growing 203 00:14:10,040 --> 00:14:15,720 Speaker 1: bacteria while also keeping them isolated from the air. Kitasato 204 00:14:15,840 --> 00:14:19,280 Speaker 1: started working with physiologist Emil von Behring, who is from 205 00:14:19,320 --> 00:14:24,240 Speaker 1: West Prussia in what's now Germany. While Kitasato was studying tetanus, 206 00:14:24,320 --> 00:14:28,520 Speaker 1: von Behring was studying diphtheria. We have talked about diphtheria 207 00:14:28,560 --> 00:14:31,320 Speaker 1: in our episode on the Nome Serum run that ran 208 00:14:31,360 --> 00:14:35,480 Speaker 1: as a Saturday Classic on January twenty second, twenty twenty two. 209 00:14:36,000 --> 00:14:40,560 Speaker 1: These diseases have some similarities. They're both caused by bacteria 210 00:14:40,680 --> 00:14:45,440 Speaker 1: producing toxins rather than by those bacteria reproducing and proliferating 211 00:14:45,480 --> 00:14:49,360 Speaker 1: within the body. This is one reason why still today 212 00:14:49,640 --> 00:14:53,760 Speaker 1: there's no definitive lab test for tetanus. Once a person 213 00:14:53,800 --> 00:14:57,680 Speaker 1: has developed symptoms, tetanus bacteria are found in their wound 214 00:14:58,120 --> 00:15:00,920 Speaker 1: only about thirty percent of the time time, and the 215 00:15:00,960 --> 00:15:03,760 Speaker 1: bacteria can also be present in the wounds of people 216 00:15:03,800 --> 00:15:08,400 Speaker 1: who have no symptoms and never develop the disease. In 217 00:15:08,560 --> 00:15:13,040 Speaker 1: eighteen ninety, Kitasato and von Behring published a paper titled 218 00:15:13,160 --> 00:15:17,800 Speaker 1: the Mechanism of Immunity and Animals to Diphtheria and Tetanus. 219 00:15:18,640 --> 00:15:22,080 Speaker 1: This paper described a method they had found to prevent 220 00:15:22,200 --> 00:15:26,920 Speaker 1: tetanus and healthy animals. From an English translation of the paper, 221 00:15:27,160 --> 00:15:30,160 Speaker 1: they summed it up in a sentence quote, the immunity 222 00:15:30,200 --> 00:15:33,920 Speaker 1: of rabbits and mice which have been immunized against tetanus 223 00:15:34,280 --> 00:15:37,840 Speaker 1: depends on the ability of the cell free blood fluid 224 00:15:38,200 --> 00:15:43,240 Speaker 1: to render harmless the toxic substance which the Tetanus bacillis produces. 225 00:15:44,080 --> 00:15:47,680 Speaker 1: In their experiments, these two men exposed animals to a 226 00:15:47,720 --> 00:15:51,880 Speaker 1: weakened version of the toxin, gradually building up their immunity. 227 00:15:52,800 --> 00:15:55,280 Speaker 1: Then they did a series of experiments to show that 228 00:15:55,320 --> 00:15:58,880 Speaker 1: the blood serum of these animals could neutralize the toxins 229 00:15:59,320 --> 00:16:04,400 Speaker 1: in other aias animals. In other words, the serum contained antitoxins, 230 00:16:04,720 --> 00:16:10,120 Speaker 1: also called antibodies. Kittasato and von Bearing injected rabbits with 231 00:16:10,280 --> 00:16:14,080 Speaker 1: serum that contained these antibodies, and then they exposed the 232 00:16:14,200 --> 00:16:18,200 Speaker 1: rabbits to an amount of tetanus bacteria that had previously 233 00:16:18,280 --> 00:16:23,360 Speaker 1: been proven to be fatal. Every rabbit remained healthy. And 234 00:16:23,400 --> 00:16:26,040 Speaker 1: then the same was true if the treated rabbits were 235 00:16:26,080 --> 00:16:29,760 Speaker 1: injected with tetanus toxin instead of with the bacteria that 236 00:16:29,840 --> 00:16:34,000 Speaker 1: produce it. These rabbits could withstand a dose of toxin 237 00:16:34,080 --> 00:16:37,080 Speaker 1: that was twenty times higher than what it would take 238 00:16:37,120 --> 00:16:41,800 Speaker 1: to kill an untreated rabbit. Kittasato and von Bearing also 239 00:16:41,960 --> 00:16:46,040 Speaker 1: said that the serum from these immune animals could be 240 00:16:46,160 --> 00:16:49,800 Speaker 1: used as a therapeutic treatment on animals that had already 241 00:16:49,840 --> 00:16:54,520 Speaker 1: developed tetanus. A week after this paper was published, Von 242 00:16:54,560 --> 00:16:58,080 Speaker 1: Bearing published another paper on his own, which was focused 243 00:16:58,080 --> 00:17:01,920 Speaker 1: only on diphtheria, and the work he started eventually led 244 00:17:01,920 --> 00:17:05,880 Speaker 1: to a reliable treatment for that disease. He was awarded 245 00:17:05,880 --> 00:17:08,920 Speaker 1: the Nobel Prize in Physiology or Medicine for this work 246 00:17:08,960 --> 00:17:12,119 Speaker 1: in nineteen oh one, the first time that prize was 247 00:17:12,160 --> 00:17:16,080 Speaker 1: ever awarded. Since the Nobel Prize committee was focused on 248 00:17:16,119 --> 00:17:20,320 Speaker 1: diphtheria and not tetanus, Kitasato was not included in the 249 00:17:20,359 --> 00:17:25,520 Speaker 1: award or mentioned in the speech. Side note. Kitasato left 250 00:17:25,640 --> 00:17:29,960 Speaker 1: Germany in eighteen ninety one, returning to Japan and establishing 251 00:17:30,000 --> 00:17:34,600 Speaker 1: his own laboratory that was later subsidized by the Japanese government. Then, 252 00:17:34,600 --> 00:17:37,399 Speaker 1: in eighteen ninety four, he was sent to Hong Kong 253 00:17:37,560 --> 00:17:42,239 Speaker 1: during an epidemic of bubonic plague. There he isolated and 254 00:17:42,359 --> 00:17:46,200 Speaker 1: identified the Bacillis that was causing that disease, a couple 255 00:17:46,200 --> 00:17:51,160 Speaker 1: of days before Swiss researcher Alexandra Yersen made the same discovery. 256 00:17:52,000 --> 00:17:56,760 Speaker 1: Although Kitasato published his work on this first, Yarson's was 257 00:17:56,920 --> 00:18:01,359 Speaker 1: seen as more conclusively linking the disease to the basillis, 258 00:18:01,400 --> 00:18:06,040 Speaker 1: and that bacillus today is known as Rcinia pestis after him. 259 00:18:06,800 --> 00:18:11,359 Speaker 1: Quitasato and von Bhring had made definitive connections between tetanus bacteria, 260 00:18:11,720 --> 00:18:15,119 Speaker 1: the toxin it produced, and the protective value of blood 261 00:18:15,200 --> 00:18:18,960 Speaker 1: serum from animals that had developed an immunity to that toxin, 262 00:18:19,800 --> 00:18:23,439 Speaker 1: but their work was just small animals like rabbits, guinea pigs, 263 00:18:23,480 --> 00:18:27,520 Speaker 1: and mice. It didn't immediately lead to workable treatments for 264 00:18:27,680 --> 00:18:32,520 Speaker 1: humans or for other large animals. That started to change 265 00:18:32,520 --> 00:18:37,040 Speaker 1: in eighteen ninety five, when Edmund Nocard reported success with 266 00:18:37,280 --> 00:18:43,040 Speaker 1: horses tetanus bacteria really thrive in horse manures, so tetanus 267 00:18:43,080 --> 00:18:47,800 Speaker 1: could be a serious problem for cavalry units, farmers, basically 268 00:18:47,880 --> 00:18:51,440 Speaker 1: anywhere that there were lots of horses. No Card was 269 00:18:51,480 --> 00:18:55,440 Speaker 1: a veterinarian, a veterinary professor, and a biologist who had 270 00:18:55,440 --> 00:18:59,880 Speaker 1: worked with Louis Pasteur. After his initial success, no Card 271 00:19:00,000 --> 00:19:04,480 Speaker 1: produced about seven thousand files of anti tetanus serum and 272 00:19:04,560 --> 00:19:09,440 Speaker 1: he distributed it among his veterinary colleagues. The first anti 273 00:19:09,480 --> 00:19:15,600 Speaker 1: tetanus serums used in humans followed not long afterward. Throughout history, 274 00:19:15,920 --> 00:19:18,760 Speaker 1: one of the groups most at risk for tetanus infection 275 00:19:19,000 --> 00:19:22,879 Speaker 1: has been newborn babies, but among medical researchers in the 276 00:19:22,960 --> 00:19:26,479 Speaker 1: late nineteenth century, tetanus was more often thought of as 277 00:19:26,520 --> 00:19:30,040 Speaker 1: a hazard on the battlefield. There had been five hundred 278 00:19:30,160 --> 00:19:33,600 Speaker 1: five reported cases during the US Civil War with a 279 00:19:33,640 --> 00:19:37,520 Speaker 1: mortality rate of eighty nine percent, and three hundred and 280 00:19:37,520 --> 00:19:40,840 Speaker 1: fifty reported cases during the Franco Prussian War with a 281 00:19:40,880 --> 00:19:45,560 Speaker 1: mortality rate of ninety percent. Tetanus became a bigger threat 282 00:19:45,640 --> 00:19:48,800 Speaker 1: during World War One, which started about twenty years after 283 00:19:48,840 --> 00:19:52,240 Speaker 1: not cards discoveries, and we'll get into that after a 284 00:19:52,280 --> 00:20:05,159 Speaker 1: sponsor break earlier In the episode, we read from a 285 00:20:05,240 --> 00:20:09,600 Speaker 1: lecture given by John Sundwall in nineteen seventeen. Here is 286 00:20:09,680 --> 00:20:13,080 Speaker 1: something else that lecture had to say about tetanus quote. 287 00:20:13,160 --> 00:20:16,359 Speaker 1: It is known as the fourth of July bacillis. It 288 00:20:16,560 --> 00:20:20,760 Speaker 1: was once a customed to exhibit our copious and excessive 289 00:20:20,920 --> 00:20:28,240 Speaker 1: patriotism with every form of pyrotechnic art. Frequently premature explosions 290 00:20:28,280 --> 00:20:32,639 Speaker 1: of the firecrackers, et cetera drove the accumulated dirt on 291 00:20:32,720 --> 00:20:36,879 Speaker 1: the hand with its numerous spores, deep into the skin, 292 00:20:37,480 --> 00:20:40,639 Speaker 1: and as a rule, the obituary column of the local 293 00:20:40,720 --> 00:20:44,320 Speaker 1: press within a few days would announce the subsequent fate 294 00:20:44,480 --> 00:20:49,080 Speaker 1: of many of our little patriots. This basic idea also 295 00:20:49,200 --> 00:20:53,199 Speaker 1: applied to the battlefield during World War One. Advances in 296 00:20:53,280 --> 00:20:57,000 Speaker 1: munitions and explosive meant that more soldiers were being struck 297 00:20:57,040 --> 00:21:01,440 Speaker 1: with shrapnel and debris that could drive tetanusors deep into 298 00:21:01,440 --> 00:21:05,520 Speaker 1: their bodies a lot more often. The proliferation of trench 299 00:21:05,600 --> 00:21:09,240 Speaker 1: warfare also meant that more soldiers were developing conditions like 300 00:21:09,600 --> 00:21:12,840 Speaker 1: trench foot and frostbite, both of which could lead to 301 00:21:12,880 --> 00:21:15,680 Speaker 1: breaks in the skin that could provide an entry point 302 00:21:15,720 --> 00:21:19,639 Speaker 1: for tetanus bacteria. Over the course of the war, doctors 303 00:21:19,680 --> 00:21:24,520 Speaker 1: also concluded that infections with aerobic bacteria could facilitate tetanus 304 00:21:24,520 --> 00:21:28,720 Speaker 1: infections by consuming the oxygen in a wound, leaving an 305 00:21:28,840 --> 00:21:33,959 Speaker 1: environment that was hospitable to the anaerobic Tetanus bacillis. In 306 00:21:34,000 --> 00:21:38,399 Speaker 1: the years before the war, researchers had started producing tetanus 307 00:21:38,440 --> 00:21:42,760 Speaker 1: antitoxin for use in humans by building up the immunity 308 00:21:42,840 --> 00:21:47,240 Speaker 1: of horses and then harvesting their serum. By the time 309 00:21:47,440 --> 00:21:51,840 Speaker 1: the war started, the Institute Pasteur was preparing about eighty 310 00:21:52,000 --> 00:21:56,840 Speaker 1: thousand vials of tetanus anti toxin for humans using about 311 00:21:56,880 --> 00:22:02,560 Speaker 1: three hundred horses. By nineteen the institute had nearly fifteen 312 00:22:02,840 --> 00:22:07,040 Speaker 1: hundred horses, producing more than six hundred thousand vials of 313 00:22:07,119 --> 00:22:11,159 Speaker 1: anti toxin per month. The Institute Pastor was not the 314 00:22:11,200 --> 00:22:14,399 Speaker 1: only place that was doing this. That's just what I 315 00:22:14,440 --> 00:22:18,560 Speaker 1: had the numbers for. Over the course of the war, essentially, 316 00:22:18,600 --> 00:22:22,840 Speaker 1: through trial and error, civilian and military doctors and surgeons 317 00:22:22,880 --> 00:22:27,399 Speaker 1: worked out treatment and prevention protocols for tetanus in injured soldiers, 318 00:22:27,640 --> 00:22:31,159 Speaker 1: and that was through use of these serums. Ultimately, the 319 00:22:31,200 --> 00:22:35,440 Speaker 1: treatment started with treating the wound itself, excizing all wounds 320 00:22:35,440 --> 00:22:39,640 Speaker 1: and removing all the damage tissue, ideally within twelve hours 321 00:22:39,640 --> 00:22:43,000 Speaker 1: of the injury. This is because doctors found a clear 322 00:22:43,080 --> 00:22:46,520 Speaker 1: connection between the presence of tetanus bacteria and the wounds 323 00:22:46,520 --> 00:22:50,760 Speaker 1: of soldiers whose injuries were surgically treated and those who weren't. 324 00:22:51,480 --> 00:22:54,560 Speaker 1: Like we said earlier, it's often not possible to find 325 00:22:54,600 --> 00:22:57,760 Speaker 1: bacteria in the wounds of people who developed tetanus, but 326 00:22:57,840 --> 00:23:02,160 Speaker 1: there was still a clear correlation there. Tetanus rates were 327 00:23:02,200 --> 00:23:05,960 Speaker 1: lower in soldiers whose wounds had been exized, even if 328 00:23:06,040 --> 00:23:09,760 Speaker 1: that first excision didn't lead to satisfactory wound healing and 329 00:23:09,800 --> 00:23:13,679 Speaker 1: it had to be redone and then after their wounds 330 00:23:13,680 --> 00:23:18,000 Speaker 1: were excised, the soldiers were treated with tetanus antibody serum, 331 00:23:18,359 --> 00:23:21,760 Speaker 1: both as a prophylactic measure if there was enough available, 332 00:23:22,000 --> 00:23:25,560 Speaker 1: and as a treatment if they started developing signs of tetanus. 333 00:23:26,320 --> 00:23:29,919 Speaker 1: One bulletin from the UK War Office Committee for the 334 00:23:29,960 --> 00:23:34,720 Speaker 1: Study of Tetanus advised nurses to be alert for symptoms quote. 335 00:23:34,880 --> 00:23:39,320 Speaker 1: All nursing sisters engaged in dressing wounds should be warned 336 00:23:39,400 --> 00:23:42,560 Speaker 1: to give the alarm if the muscles round the wound 337 00:23:43,040 --> 00:23:45,840 Speaker 1: are found to be harder or more rigid than the 338 00:23:45,920 --> 00:23:50,240 Speaker 1: muscles of the uninjured limb or side. Over the course 339 00:23:50,280 --> 00:23:55,040 Speaker 1: of the war, doctors also developed standard doses of tetanus antitoxin. 340 00:23:55,800 --> 00:23:59,560 Speaker 1: By nineteen nineteen, the prophylactic dose was five hundred units 341 00:23:59,600 --> 00:24:03,440 Speaker 1: contained in three cubic centimeters or less of horse serum. 342 00:24:04,080 --> 00:24:07,240 Speaker 1: A unit was quote ten times the least quantity of 343 00:24:07,359 --> 00:24:10,800 Speaker 1: anti technic serum necessary to save the life of a 344 00:24:10,840 --> 00:24:14,280 Speaker 1: three hundred and fifty gram guinea pig for ninety six hours, 345 00:24:14,359 --> 00:24:18,080 Speaker 1: against the official test dose of a standard toxin furnished 346 00:24:18,280 --> 00:24:21,320 Speaker 1: by the Hygienic Laboratory of the Public Health and Marine 347 00:24:21,320 --> 00:24:27,400 Speaker 1: Hospital Service, a super easy unit of measures. I'm assuming 348 00:24:27,560 --> 00:24:31,439 Speaker 1: that the Germans had a different standard, probably at this point, 349 00:24:31,560 --> 00:24:37,760 Speaker 1: maybe not. Under ideal circumstances, an injured soldier was given 350 00:24:37,800 --> 00:24:41,840 Speaker 1: the first prophylactic dose by injection as soon as he 351 00:24:41,880 --> 00:24:46,200 Speaker 1: had been removed from the line of fire. Subsequent injections 352 00:24:46,240 --> 00:24:50,119 Speaker 1: were shown to significantly reduce the risk of developing tetanus, 353 00:24:50,119 --> 00:24:54,359 Speaker 1: but whether soldiers actually got those additional doses just really 354 00:24:54,400 --> 00:24:58,560 Speaker 1: depended on whether there was enough serum available and whether 355 00:24:58,680 --> 00:25:02,720 Speaker 1: the medical staff had the capacity to do it. If 356 00:25:02,760 --> 00:25:06,720 Speaker 1: they were just really overwhelmed. It might not happen even 357 00:25:06,760 --> 00:25:10,159 Speaker 1: when soldiers only got one injection, though they tended to 358 00:25:10,200 --> 00:25:14,040 Speaker 1: have milder or more localized cases of tetanus if they 359 00:25:14,080 --> 00:25:18,720 Speaker 1: still developed it. Doses of anti toxin for treatment rather 360 00:25:18,760 --> 00:25:23,040 Speaker 1: than prophylaxis, could be much higher, ranging from fifty thousand 361 00:25:23,160 --> 00:25:26,120 Speaker 1: to one hundred thousand units in the early days of treatment, 362 00:25:26,520 --> 00:25:29,719 Speaker 1: depending on whether the patient's body seemed to be responding 363 00:25:29,800 --> 00:25:32,840 Speaker 1: to it. One of the reasons for working out the 364 00:25:32,920 --> 00:25:37,200 Speaker 1: lowest effective dose of antitoxin was, of course, to conserve 365 00:25:37,280 --> 00:25:40,960 Speaker 1: a limited supply, but another was the risk of severe 366 00:25:41,000 --> 00:25:43,960 Speaker 1: allergic reactions to the horse serum, which was known as 367 00:25:44,040 --> 00:25:48,560 Speaker 1: serum sickness. This risk seemed to be higher at higher doses. 368 00:25:49,160 --> 00:25:52,600 Speaker 1: For example, a nineteen nineteen report by the UK War 369 00:25:52,640 --> 00:25:55,840 Speaker 1: Office Committee for the Study of Tetanus reported that two 370 00:25:55,880 --> 00:26:00,000 Speaker 1: million prophylactic doses of anti tetanic serum had been administered 371 00:26:00,200 --> 00:26:03,240 Speaker 1: to soldiers being treated in England, and there had been 372 00:26:03,440 --> 00:26:07,840 Speaker 1: eleven cases of shock related to the serum. All of 373 00:26:07,880 --> 00:26:11,919 Speaker 1: those patients did recover, but in the fourteen hundred cases 374 00:26:11,920 --> 00:26:15,040 Speaker 1: of tetanus they were treated with therapeutic doses in England, 375 00:26:15,320 --> 00:26:18,720 Speaker 1: there were forty nine cases of shock, or three point 376 00:26:18,840 --> 00:26:23,240 Speaker 1: five percent of the patients. Among those patients, twelve died 377 00:26:23,440 --> 00:26:27,240 Speaker 1: or zero point eight percent of those fourteen hundred cases, 378 00:26:27,800 --> 00:26:30,600 Speaker 1: but some of those deaths likely were not related to 379 00:26:30,640 --> 00:26:34,280 Speaker 1: the anti toxins, so this was rare, but it could happen. 380 00:26:35,040 --> 00:26:40,600 Speaker 1: The development of tetanus anti taxin almost completely eliminated tetanus 381 00:26:40,640 --> 00:26:44,280 Speaker 1: among injured soldiers by the end of the war. For example, 382 00:26:44,400 --> 00:26:47,240 Speaker 1: in France, at the start of the war, about one 383 00:26:47,280 --> 00:26:50,120 Speaker 1: and a quarter percent of the soldiers who were admitted 384 00:26:50,160 --> 00:26:54,600 Speaker 1: to the hospital developed tetanus, and all of those patients died. 385 00:26:55,560 --> 00:26:59,120 Speaker 1: After the tetanus anti toxin serum was introduced to that 386 00:26:59,240 --> 00:27:03,840 Speaker 1: number of tetans cases dropped to zero. Results were pretty 387 00:27:03,840 --> 00:27:07,760 Speaker 1: similar across other armies involved on both sides of the war. 388 00:27:08,800 --> 00:27:12,879 Speaker 1: While tetanus anti toxin could be administered to soldiers prophylactically 389 00:27:13,040 --> 00:27:16,520 Speaker 1: after they were injured, it wasn't a vaccine that could 390 00:27:16,520 --> 00:27:20,320 Speaker 1: offer more long term resistance to the disease. But in 391 00:27:20,400 --> 00:27:25,439 Speaker 1: nineteen twenty four, another French veterinarian and bacteriologists, Gaston Ramon, 392 00:27:26,000 --> 00:27:30,800 Speaker 1: developed the first tetanus vaccine. Ramon had previously developed a 393 00:27:30,840 --> 00:27:36,320 Speaker 1: similar vaccine for diphtheria. This vaccine is known as tetanus toxoid. 394 00:27:37,040 --> 00:27:40,720 Speaker 1: Toxoid is a toxin that's been inactivated so that it's 395 00:27:40,800 --> 00:27:44,800 Speaker 1: no longer dangerous, so the immune system learns to produce 396 00:27:44,880 --> 00:27:48,400 Speaker 1: antibodies to the toxin before it encounters the real thing. 397 00:27:49,200 --> 00:27:52,560 Speaker 1: This vaccine can also help prevent tetanus from developing if 398 00:27:52,560 --> 00:27:56,600 Speaker 1: it's administered to an otherwise unvaccinated person after they have 399 00:27:56,720 --> 00:28:01,159 Speaker 1: sustained an injury. During World War Two, so tetanus toxoid 400 00:28:01,240 --> 00:28:05,040 Speaker 1: became a routine vaccine administered to soldiers, and then it 401 00:28:05,080 --> 00:28:08,520 Speaker 1: became more widely available to the general public after the 402 00:28:08,560 --> 00:28:12,840 Speaker 1: war was over. It seems like deaths from tetanus started 403 00:28:12,880 --> 00:28:15,640 Speaker 1: to drop as soon as the vaccine was put into use, 404 00:28:16,240 --> 00:28:19,720 Speaker 1: but there isn't consistent data on that. In the US, 405 00:28:19,800 --> 00:28:23,399 Speaker 1: for example, tetanus did not become a reportable disease until 406 00:28:23,480 --> 00:28:26,919 Speaker 1: nineteen forty seven, so before that point we don't have 407 00:28:27,000 --> 00:28:30,840 Speaker 1: an exact number for how many people contracted tetanus. But 408 00:28:30,960 --> 00:28:34,200 Speaker 1: the largest number of tetanus cases reported in the United 409 00:28:34,200 --> 00:28:37,800 Speaker 1: States was in nineteen forty eight, and from there the 410 00:28:37,920 --> 00:28:42,440 Speaker 1: numbers declined. Deaths from tetanus have decreased by ninety nine 411 00:28:42,480 --> 00:28:47,160 Speaker 1: percent in the US since nineteen forty seven. The vaccine 412 00:28:47,200 --> 00:28:50,320 Speaker 1: that was being used when it was first introduced targeted 413 00:28:50,400 --> 00:28:54,960 Speaker 1: three illnesses tetanus, diphtheria, and protessis, all of which are 414 00:28:55,000 --> 00:28:59,800 Speaker 1: caused by toxin producing bacteria. Today, in the United States, 415 00:28:59,840 --> 00:29:03,120 Speaker 1: the two versions of the tetanus vaccine that are most 416 00:29:03,240 --> 00:29:06,400 Speaker 1: widely used are teet APP, which targets all three of 417 00:29:06,440 --> 00:29:12,120 Speaker 1: those diseases, and td which targets only tetanus and diphtheria. 418 00:29:12,240 --> 00:29:16,640 Speaker 1: Tetanus antitoxin is still also used to treat people who 419 00:29:16,680 --> 00:29:20,280 Speaker 1: do develop symptoms of tetanus and to prevent it in 420 00:29:20,360 --> 00:29:23,040 Speaker 1: people who sustain some kind of injury and have not 421 00:29:23,200 --> 00:29:28,360 Speaker 1: been vaccinated. It's usually called tetanus immune globulin, and it 422 00:29:28,360 --> 00:29:32,680 Speaker 1: can be made using horse serum or serum from donated 423 00:29:32,840 --> 00:29:36,960 Speaker 1: human blood, which carries less of a risk of serum sickness. 424 00:29:37,480 --> 00:29:41,800 Speaker 1: Because tetanus exists in the soil and forms very hardy spores, 425 00:29:42,360 --> 00:29:45,640 Speaker 1: it isn't a disease that could be eradicated like smallpox 426 00:29:45,720 --> 00:29:48,880 Speaker 1: or render pest, at least not with any technology that 427 00:29:48,960 --> 00:29:53,120 Speaker 1: exists today. We do have episodes about the eradication of 428 00:29:53,160 --> 00:29:56,640 Speaker 1: both smallpox and render pest for more information on those. 429 00:29:57,480 --> 00:30:01,240 Speaker 1: Tetanos spores are basically all around all the time, and 430 00:30:01,360 --> 00:30:04,680 Speaker 1: recovering from tetanus doesn't make you immune to it later on, 431 00:30:05,480 --> 00:30:09,360 Speaker 1: so the closest thing to eradication is ensuring broad vaccine 432 00:30:09,400 --> 00:30:12,920 Speaker 1: coverage so that people who are exposed to tetanus bacteria 433 00:30:13,120 --> 00:30:17,920 Speaker 1: don't develop the disease. Today, the World Health Organization recommends 434 00:30:18,000 --> 00:30:23,080 Speaker 1: a six vaccine series that stretches over a person's infancy, childhood, 435 00:30:23,080 --> 00:30:27,200 Speaker 1: and adolescence. This six shot series is close to one 436 00:30:27,280 --> 00:30:32,120 Speaker 1: hundred percent effective. Some countries, including the United States, also 437 00:30:32,240 --> 00:30:37,719 Speaker 1: recommend a booster every ten years. Tetanus is rare and 438 00:30:37,840 --> 00:30:41,320 Speaker 1: wealthy parts of the world where there are robust vaccine 439 00:30:41,360 --> 00:30:45,320 Speaker 1: programs and where the vaccine is also available in places 440 00:30:45,400 --> 00:30:50,240 Speaker 1: like doctors' offices, urgent care centers, and emergency rooms for 441 00:30:50,320 --> 00:30:53,960 Speaker 1: people who sustain some kind of injury and need that vaccine, 442 00:30:54,440 --> 00:30:57,240 Speaker 1: but it is still a major cause of death in 443 00:30:57,400 --> 00:31:01,760 Speaker 1: poorer countries than regions where that's not the case. Tetanus 444 00:31:01,760 --> 00:31:07,160 Speaker 1: cases can also spike after major natural disasters like earthquakes, tsunamis, 445 00:31:07,160 --> 00:31:11,840 Speaker 1: and hurricanes. Today, the majority of tetanus cases and deaths 446 00:31:12,120 --> 00:31:15,320 Speaker 1: are in newborns. Babies who are born in surroundings that 447 00:31:15,320 --> 00:31:19,320 Speaker 1: aren't sanitary, or whose umbilical cords are cut with instruments 448 00:31:19,320 --> 00:31:22,800 Speaker 1: that are not sterile, or whose umbilical stumps are covered 449 00:31:22,800 --> 00:31:27,400 Speaker 1: in non sterile dressings. People can also contract tetanus after 450 00:31:27,440 --> 00:31:32,040 Speaker 1: giving birth in these kinds of environments. In the nineteen eighties, 451 00:31:32,120 --> 00:31:36,680 Speaker 1: the World Health Organization and other organizations embarked on the 452 00:31:36,760 --> 00:31:42,560 Speaker 1: Maternal and Neonatal Tetanus Elimination Initiative. This initiative was then 453 00:31:42,680 --> 00:31:46,960 Speaker 1: relaunched in nineteen ninety nine, and it involves multiple strategies 454 00:31:47,320 --> 00:31:52,240 Speaker 1: including improving access to skilled birth attendants who use hygienic 455 00:31:52,320 --> 00:31:58,000 Speaker 1: practices during delivery and newborn care, and vaccine programs, including 456 00:31:58,160 --> 00:32:03,040 Speaker 1: immunizing people during pregnantancy. When somebody is immune to tetanus, 457 00:32:03,080 --> 00:32:06,320 Speaker 1: that immunity passes to their child and it protects the 458 00:32:06,400 --> 00:32:09,400 Speaker 1: newborn during their first weeks of life until they can 459 00:32:09,400 --> 00:32:13,240 Speaker 1: get their own vaccines. Same thing is true for protessis 460 00:32:13,280 --> 00:32:16,880 Speaker 1: and diphtheria, which are the other two diseases prevented by 461 00:32:16,920 --> 00:32:22,200 Speaker 1: the t EDAPP vaccine. This transfer of maternal tetanus antibodies 462 00:32:22,280 --> 00:32:25,840 Speaker 1: was studied back in the nineteenth century, when German physician 463 00:32:25,960 --> 00:32:30,680 Speaker 1: Paul Irlick conducted experimentss with mice and goats and their offspring. 464 00:32:31,600 --> 00:32:35,360 Speaker 1: Between nineteen ninety eight and twenty eighteen, tetanus rates in 465 00:32:35,480 --> 00:32:39,360 Speaker 1: newborns dropped by about ninety seven percent around the world 466 00:32:39,440 --> 00:32:43,600 Speaker 1: thanks to these programs, But even with that success, around 467 00:32:43,640 --> 00:32:47,440 Speaker 1: twenty five thousand newborns still died of neonatal tetanus in 468 00:32:47,480 --> 00:32:51,880 Speaker 1: twenty eighteen. Numbers have not changed much since then, in 469 00:32:51,960 --> 00:32:55,880 Speaker 1: part because of disruptions caused by the COVID nineteen pandemic. 470 00:32:56,640 --> 00:32:59,000 Speaker 1: In twenty twenty one, which is the most recent year 471 00:32:59,040 --> 00:33:02,760 Speaker 1: that statistics are EVD available and estimated, twenty four thousand 472 00:33:02,800 --> 00:33:06,200 Speaker 1: newborns died of tetanus, and as of twenty twenty four, 473 00:33:06,560 --> 00:33:10,360 Speaker 1: there are ten countries where maternal and neonatal tetanus have 474 00:33:10,520 --> 00:33:14,680 Speaker 1: not been eradicated yet. I tried to track down whether 475 00:33:16,160 --> 00:33:20,000 Speaker 1: the various funding cuts to foreign aid and foreign health 476 00:33:20,040 --> 00:33:23,800 Speaker 1: programs that's been happening in the US is affecting this 477 00:33:23,880 --> 00:33:28,240 Speaker 1: particular project, and I do not know the answer. That's 478 00:33:28,280 --> 00:33:30,440 Speaker 1: what I know about tetanus, though. Do you have some 479 00:33:30,480 --> 00:33:33,880 Speaker 1: listener mail that may or may not have antibodies in it. 480 00:33:34,840 --> 00:33:39,200 Speaker 1: It kind of does have antibodies in it. I instead 481 00:33:39,200 --> 00:33:42,240 Speaker 1: of reading one email, I just wanted to thank the 482 00:33:43,080 --> 00:33:47,440 Speaker 1: enormous number of people who sent us emails and Facebook 483 00:33:47,440 --> 00:33:52,000 Speaker 1: comments and Instagram comments, even a couple of comments on 484 00:33:52,560 --> 00:33:55,680 Speaker 1: x that used to be Twitter and on Blue Sky, 485 00:33:55,760 --> 00:33:58,280 Speaker 1: which I don't think we've ever set out loud on 486 00:33:58,320 --> 00:34:01,440 Speaker 1: the podcast that we're on Blue Sky now now in 487 00:34:01,560 --> 00:34:09,160 Speaker 1: response to the beginning of our Spring Unearthed episode. I 488 00:34:09,200 --> 00:34:12,680 Speaker 1: have not responded to any of these email or emails 489 00:34:12,760 --> 00:34:17,000 Speaker 1: or comments. I did read all of them. The response 490 00:34:17,160 --> 00:34:20,719 Speaker 1: was truly, truly overwhelming. I was going to make a 491 00:34:20,840 --> 00:34:24,600 Speaker 1: list of everybody's names and just say thank you everybody, 492 00:34:24,640 --> 00:34:28,440 Speaker 1: but even that got overwhelming, and I was also afraid 493 00:34:28,440 --> 00:34:30,880 Speaker 1: I would miss people. And like we said at the 494 00:34:30,880 --> 00:34:33,000 Speaker 1: beginning of the episode, a couple of weeks are going 495 00:34:33,000 --> 00:34:35,760 Speaker 1: to pass between recording this and it coming out, probably 496 00:34:35,760 --> 00:34:40,440 Speaker 1: get more emails during that time. Basically, we got a 497 00:34:41,239 --> 00:34:44,000 Speaker 1: lot of really really great email, and so thank you 498 00:34:44,080 --> 00:34:50,160 Speaker 1: everyone for that. A lot of people expressed concerns that 499 00:34:50,239 --> 00:34:53,080 Speaker 1: we were going to get a lot of hate or 500 00:34:53,160 --> 00:34:56,800 Speaker 1: flack or be hassled in some way. I just wanted 501 00:34:56,840 --> 00:34:59,600 Speaker 1: to say thank you all very much for your concerns. 502 00:34:59,640 --> 00:35:03,560 Speaker 1: This was a reasonable concern. I feel we got almost 503 00:35:03,719 --> 00:35:07,720 Speaker 1: no flak. I was really braced for impact. We only 504 00:35:07,760 --> 00:35:12,720 Speaker 1: got good impact. We got a giant, ongoing, multiple weeks 505 00:35:12,800 --> 00:35:19,440 Speaker 1: long impact of hugs basically with minimal badness in all 506 00:35:19,480 --> 00:35:25,600 Speaker 1: of that. Hooray, which was great, honestly, because I was 507 00:35:25,640 --> 00:35:29,160 Speaker 1: afraid that was not going to be what would happen, 508 00:35:29,320 --> 00:35:32,799 Speaker 1: because like like we said, we don't typically make just 509 00:35:32,880 --> 00:35:39,800 Speaker 1: explicitly direct political statements on the show, so we've gotten 510 00:35:39,880 --> 00:35:43,040 Speaker 1: way worse response to way more oblique things that we've 511 00:35:43,080 --> 00:35:48,120 Speaker 1: said before. Honestly, So again, thank you so much to 512 00:35:48,239 --> 00:35:51,600 Speaker 1: all of you. I've read and appreciated all of your stuff. Also, 513 00:35:51,760 --> 00:35:55,719 Speaker 1: I wanted to say, so many people in your emails 514 00:35:56,000 --> 00:35:59,600 Speaker 1: said that the beginning of that episode made you feel 515 00:35:59,800 --> 00:36:04,319 Speaker 1: less alone, So I just wanted to say, hey, you 516 00:36:05,040 --> 00:36:10,200 Speaker 1: are not alone. We heard that from so many people 517 00:36:10,360 --> 00:36:12,919 Speaker 1: in the emails. It's clear that a lot of people 518 00:36:13,000 --> 00:36:17,600 Speaker 1: are feeling really alone right now. But it's obvious to 519 00:36:17,640 --> 00:36:21,480 Speaker 1: me from that response that none of us are alone 520 00:36:21,600 --> 00:36:25,560 Speaker 1: in this moment, even if we might feel alone in 521 00:36:25,600 --> 00:36:30,560 Speaker 1: some way, like the Big Hands Off March marches across 522 00:36:30,960 --> 00:36:34,239 Speaker 1: the country and the world. Honestly, on April fifth. I 523 00:36:34,239 --> 00:36:37,160 Speaker 1: saw some criticisms of those marches for like not having 524 00:36:37,239 --> 00:36:42,000 Speaker 1: a clear objective set out from the beginning and not 525 00:36:42,040 --> 00:36:44,279 Speaker 1: being disruptive. But one of the things I thought was 526 00:36:44,360 --> 00:36:48,840 Speaker 1: really good about them was showing how there were crowds 527 00:36:48,840 --> 00:36:52,080 Speaker 1: of hundreds of people even in tiny little towns where 528 00:36:52,120 --> 00:36:55,600 Speaker 1: people were probably feeling like they were only one or 529 00:36:55,640 --> 00:37:00,560 Speaker 1: only a handful. So I just wanted to say I 530 00:37:00,600 --> 00:37:04,719 Speaker 1: absolutely empathize with the feeling of a loneness. Living in 531 00:37:04,719 --> 00:37:07,480 Speaker 1: Massachusetts right now, I don't feel very alone. I feel 532 00:37:07,480 --> 00:37:12,120 Speaker 1: like I'm surrounded by angry people taking action, But having 533 00:37:12,160 --> 00:37:15,720 Speaker 1: lived previously in North Carolina and Georgia, I didn't always 534 00:37:15,719 --> 00:37:21,759 Speaker 1: feel that way. So again, you're not alone. And thank 535 00:37:21,800 --> 00:37:25,520 Speaker 1: you again for all of these lovely, lovely emails and 536 00:37:25,800 --> 00:37:28,640 Speaker 1: Facebook comments and Instagram comments and all of that that 537 00:37:28,680 --> 00:37:32,239 Speaker 1: we have been getting over the last couple of weeks. Now, 538 00:37:32,840 --> 00:37:35,280 Speaker 1: if you would like to send us some notes about 539 00:37:35,880 --> 00:37:39,359 Speaker 1: this or any other podcast or a history podcast at 540 00:37:39,360 --> 00:37:44,080 Speaker 1: iHeartRadio dot com. 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