Speaker 1: Welcome to Stuff You Missed in History Class, a production
Speaker 1: of iHeartRadio. Hello, and welcome to the podcast. I'm Tracy V.
Speaker 1: Wilson and I'm Holly Frye. Hey. I'm thinking about vaccines
Speaker 1: a lot right now for reasons including rapidly growing measles
Speaker 1: outbreak that we have happening in the US right now.
Speaker 1: I originally had numbers of cases here in the outline,
Speaker 1: but that number increased by like two hundred just in
Speaker 1: the time that I was working on this. Yeah, it's
Speaker 1: impossible to track. By the time this comes out, those
Speaker 1: numbers would be woefully out. Sabe. Yeah, two more weeks
Speaker 1: are going to pass before this is out, so those
Speaker 1: numbers would be wrong anyway by then. Also, just a
Speaker 1: lot of upsetting and alarming developments happening in the US
Speaker 1: Department of Health and Human Services and the National Institute
Speaker 1: of Health. We have already done an episode on measles
Speaker 1: that came out on February twenty eighth of twenty twenty four,
Speaker 1: and that's a little bit more recent than we would
Speaker 1: typically rerun as a Saturday Classic. So I decided to
Speaker 1: take a look at another disease that's preventable today. Thanks
Speaker 1: to vaccines which do not cause autism. Not any vaccine,
Speaker 1: not for any disease. None of them cause autism. The disease, though,
Speaker 1: is tetanus. Since this is an episode about a medical development,
Speaker 1: of course there will be some medical experiment stuff in
Speaker 1: the episode, including some experiments involving animals. I really don't
Speaker 1: think any of that is particularly graphic, but just in case,
Speaker 1: Uh yeah, I can handle it based on my read through,
Speaker 1: which is a pretty low bar of getting upsetness. So
Speaker 1: I think we're safe. But if not, I'm sorry. Tetanus
Speaker 1: has probably been around for most of human history, possibly
Speaker 1: even longer. It's caused by the bacteria Clostridium tetani, which
Speaker 1: is present in the environment in a lot of the world.
Speaker 1: It's described with words like ubiquitous. In the words of
Speaker 1: John Sundwall in a lecture given under the auspices of
Speaker 1: the Kansas Academy of Science in nineteen seventeen, quote, this
Speaker 1: germ has a wide distribution, and its spores are found
Speaker 1: wherever there is dirt. Barnyards are veritable repositories for them.
Speaker 1: Rusty nails appear to be rendezvous. Even the dirt that
Speaker 1: besmears the healthy living child may contain millions of these
Speaker 1: spores of Tetanus basillai. The spores can only grow when
Speaker 1: they gain deep entrance into the body and are shut
Speaker 1: off from oxygen. One of the oldest known medical texts
Speaker 1: in the world is the Edwin Smith Surgical Papyrus, named
Speaker 1: for Edwin Smith, who bought it in eighteen sixty two.
Speaker 1: This Egyptian medical text dates back to about fifteen hundred BCE,
Speaker 1: and it includes a description of somebody with a head
Speaker 1: injury that penetrated all the way through the futures of
Speaker 1: the skull. Afterward, according to one translation, quote, the cord
Speaker 1: of his mandible is contracted. He discharges blood from both
Speaker 1: his nostrils and from both his ears, while he suffers
Speaker 1: with stiffness in his neck. As this patient's condition progresses quote,
Speaker 1: his mouth is bound, both his eyebrows are drawn, while
Speaker 1: his face is as if he wept. This earliest description
Speaker 1: is usually translated and interpreted as describing a case of tetanus,
Speaker 1: but it doesn't entirely convey what tetanus is like as
Speaker 1: an illness. Tetanus doesn't cause bleeding from the ears or nose.
Speaker 1: That was probably a product of the patient's head trauma,
Speaker 1: not the tetanus that followed it. Beyond that, without getting
Speaker 1: into a lengthy backgrounder on neurotransmitters, Claustritium tetani produces two toxins,
Speaker 1: and one of them, called tetanospasmen, interferes with neurotransmitter that
Speaker 1: control motor neuron activity. The nerves start firing uncontrollably, which
Speaker 1: causes intense muscle spasms. These can be excruciating and powerful
Speaker 1: enough to cause compression fractures or other breaks in a
Speaker 1: person's bones. Tetanus can also lead to suffocation and heart failure.
Speaker 1: Even with medical treatment, tetanus is fatal between ten and
Speaker 1: twenty percent of the time, and without treatment the fatality
Speaker 1: rate goes up to eighty five percent or even more.
Speaker 1: It sounds awful, yes it does. The muscles in the
Speaker 1: face and the jaw are often affected in tetanus, and
Speaker 1: that can cause a person to look like they are grinning.
Speaker 1: The spasms also cause tristmas, also known as lockjaw, and
Speaker 1: that can make it difficult or impossible for the persons
Speaker 1: who open their mouth. The Edwin Smith Papyrus offers a
Speaker 1: way to try to deal with this lock jaw that's
Speaker 1: by placing a wooden brace padded with linen in the
Speaker 1: patient's mouth to try to keep it open enough that
Speaker 1: they can be fed a liquid diet while being kept upright.
Speaker 1: Tetanus also appears in the Sashruda Samhita, which dates back
Speaker 1: to about the sixth century BCE and is one of
Speaker 1: the foundational texts of iervedic medicine. We did an episode
Speaker 1: on Sashruda in January of twenty nineteen. In a chapter
Speaker 1: on diseases of the nervous system, the Sashruda Samhita describes
Speaker 1: one caused by enraged or agitated value that's the air
Speaker 1: element in iervedic medicine. This disease quote rarely yields to
Speaker 1: medicine and is cured in rare instances only with the
Speaker 1: greatest difficulty. Its characteristic symptom being a paralysis of the jawbone,
Speaker 1: which makes deglutition extremely difficult. This disease in the text
Speaker 1: is described as bending the body like a bow and
Speaker 1: in its extreme form, fixing the eyes in their sockets,
Speaker 1: paralyzing the jaw and breaking the sides. The Chinese medical
Speaker 1: text known as the Yellow Emperor's Classic of Internal medicine
Speaker 1: is attributed to a semi mythical figure who's described as
Speaker 1: living around twenty six hundred BCE, but it was probably
Speaker 1: written more than two thousand years later than that. Traditional
Speaker 1: Chinese medicine incorporates the idea of energy channels or meridians
Speaker 1: in the body. The translation of the Yellow Emperor's Classic
Speaker 1: that I had access to for research didn't use the
Speaker 1: word tetanus anywhere, but it describes the collapse of the
Speaker 1: chi in the bladder and small intestine meridian as causing opisthoughtanus,
Speaker 1: stiffness in the back, convulsive spasms, paleness, and spontaneous sweating.
Speaker 1: Once that sweating stops, the patient dies. Apisthoughtanus is the extreme,
Speaker 1: very arching spasms that are associated with tetanus. The first
Speaker 1: thing we'd think of as a really clear clinical description
Speaker 1: of tetanus from a more Western medical perspective is from
Speaker 1: Greek physician Hippocrates, written around the fifth century BCE. In
Speaker 1: a treatise on Internal afflictions, Hippocrates describes three types of tetanus. First,
Speaker 1: when it follows a wound, Hippocrates says, the patient's quote
Speaker 1: jaws are fixed and he is unable to open his mouth,
Speaker 1: his eyes shed tears and look awry. His back becomes rigid.
Speaker 1: He cannot bend his legs, nor his arms and spine.
Speaker 1: Hippocrates describes this disease as severe and requiring a media
Speaker 1: attention and in many cases fatal. For treatment, Hippocrates advises
Speaker 1: anointing the patient with warm oil infused with wormwood, bay leaves,
Speaker 1: or hen made seed with frankincense soaked in white wine.
Speaker 1: According to Hippocrates, the second type of tetanus is similar,
Speaker 1: but it starts with angina also pronounced angina that's chest pain,
Speaker 1: or with a saff infection or separation of the tonsils,
Speaker 1: and occasionally it can also start with a wound. Quote
Speaker 1: this patient is drawn backwards and cries aloud from the
Speaker 1: pain in his back and chest. He is drawn so
Speaker 1: forcefully that the attendants can hardly prevent him from falling
Speaker 1: out of bed. Then the third form is less lethal,
Speaker 1: arising from some of the same possible causes or from
Speaker 1: having fallen backward. Another work by Hippocrates called on Epidemics,
Speaker 1: also includes several examples of tennis cases, One developed after
Speaker 1: a surgery, another after a javelin wound after a person's
Speaker 1: finger was crushed by an anchor after an ankle injury
Speaker 1: whose treatment involved irritating the wound, after being injured by
Speaker 1: a piece of wood from a missile thrown by a catapult.
Speaker 1: In the words of Roman author Alice Cornelius Celsus in
Speaker 1: the first century CE, quote, there is no disease more
Speaker 1: distressing and more acute than that which, by a sort
Speaker 1: of rigor of the sinews, now draws down the head
Speaker 1: to the shoulder blades, now the chin to the chest,
Speaker 1: now stretches out the next straight and immobile. The Greeks
Speaker 1: call the first aposthotanus, the next amprosthotanus, and the last tetanus,
Speaker 1: although some with less exactitude use these terms indiscriminately. For
Speaker 1: centuries after this, European medical writing on tetanus tended to
Speaker 1: be really similar. Many physicians base their work on Hippocrates.
Speaker 1: Even if Hippocrates wasn't cited, they still usually described tetanus
Speaker 1: as following a wound. Most commented on how often the
Speaker 1: condition was fatal, and many of the recommended treatments related
Speaker 1: to things that one might hope would relieve the spasms,
Speaker 1: like being rubbed with oils or wines or liniments or
Speaker 1: wrapped in warm dressings or given warm baths. In the
Speaker 1: sixteenth century, past podcast subject Amboise Parre developed an instrument
Speaker 1: to open a tetanus patient's mouth so that they could
Speaker 1: be fed. Overall, the focus was on trying to get
Speaker 1: the muscles to relax and supporting the patient with the
Speaker 1: hope that they would recover, but often a certainty that
Speaker 1: they would not. Knowledge of the cause of tetanus and
Speaker 1: how to treat and prevent it didn't really start to
Speaker 1: advance until the nineteenth century, which we will get to
Speaker 1: after a sponsor break. As we said, before the break,
Speaker 1: people figured out that tetanus was connected to wounds thousands
Speaker 1: of years ago, but it wasn't until the nineteenth century
Speaker 1: that we started to get a sense of exactly what
Speaker 1: was happening inside those wounds and elsewhere in the body.
Speaker 1: In eighteen thirty eight, Luigi Carlo Ferini gave an address
Speaker 1: before the Medical Turgical Society of Bologna in which he
Speaker 1: described the use of electricity in the treatment of tetanus.
Speaker 1: He had based this on the work of Carlo Mettiucci,
Speaker 1: who was experimenting with electricity and frogs. Farini found that
Speaker 1: the application of direct current to the body of a
Speaker 1: patient who had developed tetanus after a gunshot wound seemed
Speaker 1: to interrupt the spasms. Unfortunately, this effect was temporary. It
Speaker 1: lasted only about thirty minutes. This didn't really provide a
Speaker 1: breakthrough in the understanding of tetanus, but it was connected
Speaker 1: to the electrical activity of the neurons that is part
Speaker 1: of the disease. Several discoveries were made. In eighteen eighty four,
Speaker 1: Italian scientists Antonio Carle and Giorgio Rotone had both studied
Speaker 1: medicine in Turin. They exposed a rat but to fluid
Speaker 1: from a sore from someone who had died of tetanus,
Speaker 1: and that rabbit also developed tetanus. This showed some kind
Speaker 1: of contagion was causing the disease. But to be clear,
Speaker 1: tetanus is not transmitted from person to person. You would
Speaker 1: have to really do something on purpose like this. Also
Speaker 1: in eighteen eighty four, Arthur Nicolier, who was a twenty
Speaker 1: two year old medical student in Germany, identified a bacillus
Speaker 1: in the soil. If you look at this basillis under
Speaker 1: a microscope, it looks kind of like a tiny straight pin.
Speaker 1: There's this rod like basillis with a knob on the end.
Speaker 1: That knob is the spore. Today, we know that these
Speaker 1: spores are incredibly hearty, they are resistant to most disinfectants,
Speaker 1: and they can survive freezing and being autoclaved at a
Speaker 1: temperature of one hundred and twenty one degrees celsius or
Speaker 1: two forty nine point eight fahrenheit for ten or fifteen minutes.
Speaker 1: Nicolier induce tetanus in mice by injecting them with soil
Speaker 1: that was contaminated with this spore forming basillis. He concluded
Speaker 1: that the basillis produced a poison that acted similarly to strychnine.
Speaker 1: Within a few years, multiple researchers all concluded that this
Speaker 1: basillis could produce a toxin. While Nicolier was able to
Speaker 1: find the tetanus basillis in the soil, he was not
Speaker 1: able to isolate it in a lab. Credit for that
Speaker 1: goes to Japanese physician and bacteriologist Kitasato Shiva Siburo in
Speaker 1: eighteen eighty nine. Kitasato was born in Japan and had
Speaker 1: earned his medical degree from the University of Tokyo Medical
Speaker 1: School in eighteen eighty three. Two years later, the Japanese
Speaker 1: government had sent him to the Institute of Hygiene in
Speaker 1: Berlin to study bacteriology and infectious diseases with groundbreaking microbiologist
Speaker 1: Robert Koch. It was while in Berlin that Quitasato isolated
Speaker 1: the tetanus bacillis Clestridium tetanani is an anaerobic microorganism, so
Speaker 1: doing this required Kitasato to develop new methods for growing
Speaker 1: bacteria while also keeping them isolated from the air. Kitasato
Speaker 1: started working with physiologist Emil von Behring, who is from
Speaker 1: West Prussia in what's now Germany. While Kitasato was studying tetanus,
Speaker 1: von Behring was studying diphtheria. We have talked about diphtheria
Speaker 1: in our episode on the Nome Serum run that ran
Speaker 1: as a Saturday Classic on January twenty second, twenty twenty two.
Speaker 1: These diseases have some similarities. They're both caused by bacteria
Speaker 1: producing toxins rather than by those bacteria reproducing and proliferating
Speaker 1: within the body. This is one reason why still today
Speaker 1: there's no definitive lab test for tetanus. Once a person
Speaker 1: has developed symptoms, tetanus bacteria are found in their wound
Speaker 1: only about thirty percent of the time time, and the
Speaker 1: bacteria can also be present in the wounds of people
Speaker 1: who have no symptoms and never develop the disease. In
Speaker 1: eighteen ninety, Kitasato and von Behring published a paper titled
Speaker 1: the Mechanism of Immunity and Animals to Diphtheria and Tetanus.
Speaker 1: This paper described a method they had found to prevent
Speaker 1: tetanus and healthy animals. From an English translation of the paper,
Speaker 1: they summed it up in a sentence quote, the immunity
Speaker 1: of rabbits and mice which have been immunized against tetanus
Speaker 1: depends on the ability of the cell free blood fluid
Speaker 1: to render harmless the toxic substance which the Tetanus bacillis produces.
Speaker 1: In their experiments, these two men exposed animals to a
Speaker 1: weakened version of the toxin, gradually building up their immunity.
Speaker 1: Then they did a series of experiments to show that
Speaker 1: the blood serum of these animals could neutralize the toxins
Speaker 1: in other aias animals. In other words, the serum contained antitoxins,
Speaker 1: also called antibodies. Kittasato and von Bearing injected rabbits with
Speaker 1: serum that contained these antibodies, and then they exposed the
Speaker 1: rabbits to an amount of tetanus bacteria that had previously
Speaker 1: been proven to be fatal. Every rabbit remained healthy. And
Speaker 1: then the same was true if the treated rabbits were
Speaker 1: injected with tetanus toxin instead of with the bacteria that
Speaker 1: produce it. These rabbits could withstand a dose of toxin
Speaker 1: that was twenty times higher than what it would take
Speaker 1: to kill an untreated rabbit. Kittasato and von Bearing also
Speaker 1: said that the serum from these immune animals could be
Speaker 1: used as a therapeutic treatment on animals that had already
Speaker 1: developed tetanus. A week after this paper was published, Von
Speaker 1: Bearing published another paper on his own, which was focused
Speaker 1: only on diphtheria, and the work he started eventually led
Speaker 1: to a reliable treatment for that disease. He was awarded
Speaker 1: the Nobel Prize in Physiology or Medicine for this work
Speaker 1: in nineteen oh one, the first time that prize was
Speaker 1: ever awarded. Since the Nobel Prize committee was focused on
Speaker 1: diphtheria and not tetanus, Kitasato was not included in the
Speaker 1: award or mentioned in the speech. Side note. Kitasato left
Speaker 1: Germany in eighteen ninety one, returning to Japan and establishing
Speaker 1: his own laboratory that was later subsidized by the Japanese government. Then,
Speaker 1: in eighteen ninety four, he was sent to Hong Kong
Speaker 1: during an epidemic of bubonic plague. There he isolated and
Speaker 1: identified the Bacillis that was causing that disease, a couple
Speaker 1: of days before Swiss researcher Alexandra Yersen made the same discovery.
Speaker 1: Although Kitasato published his work on this first, Yarson's was
Speaker 1: seen as more conclusively linking the disease to the basillis,
Speaker 1: and that bacillus today is known as Rcinia pestis after him.
Speaker 1: Quitasato and von Bhring had made definitive connections between tetanus bacteria,
Speaker 1: the toxin it produced, and the protective value of blood
Speaker 1: serum from animals that had developed an immunity to that toxin,
Speaker 1: but their work was just small animals like rabbits, guinea pigs,
Speaker 1: and mice. It didn't immediately lead to workable treatments for
Speaker 1: humans or for other large animals. That started to change
Speaker 1: in eighteen ninety five, when Edmund Nocard reported success with
Speaker 1: horses tetanus bacteria really thrive in horse manures, so tetanus
Speaker 1: could be a serious problem for cavalry units, farmers, basically
Speaker 1: anywhere that there were lots of horses. No Card was
Speaker 1: a veterinarian, a veterinary professor, and a biologist who had
Speaker 1: worked with Louis Pasteur. After his initial success, no Card
Speaker 1: produced about seven thousand files of anti tetanus serum and
Speaker 1: he distributed it among his veterinary colleagues. The first anti
Speaker 1: tetanus serums used in humans followed not long afterward. Throughout history,
Speaker 1: one of the groups most at risk for tetanus infection
Speaker 1: has been newborn babies, but among medical researchers in the
Speaker 1: late nineteenth century, tetanus was more often thought of as
Speaker 1: a hazard on the battlefield. There had been five hundred
Speaker 1: five reported cases during the US Civil War with a
Speaker 1: mortality rate of eighty nine percent, and three hundred and
Speaker 1: fifty reported cases during the Franco Prussian War with a
Speaker 1: mortality rate of ninety percent. Tetanus became a bigger threat
Speaker 1: during World War One, which started about twenty years after
Speaker 1: not cards discoveries, and we'll get into that after a
Speaker 1: sponsor break earlier In the episode, we read from a
Speaker 1: lecture given by John Sundwall in nineteen seventeen. Here is
Speaker 1: something else that lecture had to say about tetanus quote.
Speaker 1: It is known as the fourth of July bacillis. It
Speaker 1: was once a customed to exhibit our copious and excessive
Speaker 1: patriotism with every form of pyrotechnic art. Frequently premature explosions
Speaker 1: of the firecrackers, et cetera drove the accumulated dirt on
Speaker 1: the hand with its numerous spores, deep into the skin,
Speaker 1: and as a rule, the obituary column of the local
Speaker 1: press within a few days would announce the subsequent fate
Speaker 1: of many of our little patriots. This basic idea also
Speaker 1: applied to the battlefield during World War One. Advances in
Speaker 1: munitions and explosive meant that more soldiers were being struck
Speaker 1: with shrapnel and debris that could drive tetanusors deep into
Speaker 1: their bodies a lot more often. The proliferation of trench
Speaker 1: warfare also meant that more soldiers were developing conditions like
Speaker 1: trench foot and frostbite, both of which could lead to
Speaker 1: breaks in the skin that could provide an entry point
Speaker 1: for tetanus bacteria. Over the course of the war, doctors
Speaker 1: also concluded that infections with aerobic bacteria could facilitate tetanus
Speaker 1: infections by consuming the oxygen in a wound, leaving an
Speaker 1: environment that was hospitable to the anaerobic Tetanus bacillis. In
Speaker 1: the years before the war, researchers had started producing tetanus
Speaker 1: antitoxin for use in humans by building up the immunity
Speaker 1: of horses and then harvesting their serum. By the time
Speaker 1: the war started, the Institute Pasteur was preparing about eighty
Speaker 1: thousand vials of tetanus anti toxin for humans using about
Speaker 1: three hundred horses. By nineteen the institute had nearly fifteen
Speaker 1: hundred horses, producing more than six hundred thousand vials of
Speaker 1: anti toxin per month. The Institute Pastor was not the
Speaker 1: only place that was doing this. That's just what I
Speaker 1: had the numbers for. Over the course of the war, essentially,
Speaker 1: through trial and error, civilian and military doctors and surgeons
Speaker 1: worked out treatment and prevention protocols for tetanus in injured soldiers,
Speaker 1: and that was through use of these serums. Ultimately, the
Speaker 1: treatment started with treating the wound itself, excizing all wounds
Speaker 1: and removing all the damage tissue, ideally within twelve hours
Speaker 1: of the injury. This is because doctors found a clear
Speaker 1: connection between the presence of tetanus bacteria and the wounds
Speaker 1: of soldiers whose injuries were surgically treated and those who weren't.
Speaker 1: Like we said earlier, it's often not possible to find
Speaker 1: bacteria in the wounds of people who developed tetanus, but
Speaker 1: there was still a clear correlation there. Tetanus rates were
Speaker 1: lower in soldiers whose wounds had been exized, even if
Speaker 1: that first excision didn't lead to satisfactory wound healing and
Speaker 1: it had to be redone and then after their wounds
Speaker 1: were excised, the soldiers were treated with tetanus antibody serum,
Speaker 1: both as a prophylactic measure if there was enough available,
Speaker 1: and as a treatment if they started developing signs of tetanus.
Speaker 1: One bulletin from the UK War Office Committee for the
Speaker 1: Study of Tetanus advised nurses to be alert for symptoms quote.
Speaker 1: All nursing sisters engaged in dressing wounds should be warned
Speaker 1: to give the alarm if the muscles round the wound
Speaker 1: are found to be harder or more rigid than the
Speaker 1: muscles of the uninjured limb or side. Over the course
Speaker 1: of the war, doctors also developed standard doses of tetanus antitoxin.
Speaker 1: By nineteen nineteen, the prophylactic dose was five hundred units
Speaker 1: contained in three cubic centimeters or less of horse serum.
Speaker 1: A unit was quote ten times the least quantity of
Speaker 1: anti technic serum necessary to save the life of a
Speaker 1: three hundred and fifty gram guinea pig for ninety six hours,
Speaker 1: against the official test dose of a standard toxin furnished
Speaker 1: by the Hygienic Laboratory of the Public Health and Marine
Speaker 1: Hospital Service, a super easy unit of measures. I'm assuming
Speaker 1: that the Germans had a different standard, probably at this point,
Speaker 1: maybe not. Under ideal circumstances, an injured soldier was given
Speaker 1: the first prophylactic dose by injection as soon as he
Speaker 1: had been removed from the line of fire. Subsequent injections
Speaker 1: were shown to significantly reduce the risk of developing tetanus,
Speaker 1: but whether soldiers actually got those additional doses just really
Speaker 1: depended on whether there was enough serum available and whether
Speaker 1: the medical staff had the capacity to do it. If
Speaker 1: they were just really overwhelmed. It might not happen even
Speaker 1: when soldiers only got one injection, though they tended to
Speaker 1: have milder or more localized cases of tetanus if they
Speaker 1: still developed it. Doses of anti toxin for treatment rather
Speaker 1: than prophylaxis, could be much higher, ranging from fifty thousand
Speaker 1: to one hundred thousand units in the early days of treatment,
Speaker 1: depending on whether the patient's body seemed to be responding
Speaker 1: to it. One of the reasons for working out the
Speaker 1: lowest effective dose of antitoxin was, of course, to conserve
Speaker 1: a limited supply, but another was the risk of severe
Speaker 1: allergic reactions to the horse serum, which was known as
Speaker 1: serum sickness. This risk seemed to be higher at higher doses.
Speaker 1: For example, a nineteen nineteen report by the UK War
Speaker 1: Office Committee for the Study of Tetanus reported that two
Speaker 1: million prophylactic doses of anti tetanic serum had been administered
Speaker 1: to soldiers being treated in England, and there had been
Speaker 1: eleven cases of shock related to the serum. All of
Speaker 1: those patients did recover, but in the fourteen hundred cases
Speaker 1: of tetanus they were treated with therapeutic doses in England,
Speaker 1: there were forty nine cases of shock, or three point
Speaker 1: five percent of the patients. Among those patients, twelve died
Speaker 1: or zero point eight percent of those fourteen hundred cases,
Speaker 1: but some of those deaths likely were not related to
Speaker 1: the anti toxins, so this was rare, but it could happen.
Speaker 1: The development of tetanus anti taxin almost completely eliminated tetanus
Speaker 1: among injured soldiers by the end of the war. For example,
Speaker 1: in France, at the start of the war, about one
Speaker 1: and a quarter percent of the soldiers who were admitted
Speaker 1: to the hospital developed tetanus, and all of those patients died.
Speaker 1: After the tetanus anti toxin serum was introduced to that
Speaker 1: number of tetans cases dropped to zero. Results were pretty
Speaker 1: similar across other armies involved on both sides of the war.
Speaker 1: While tetanus anti toxin could be administered to soldiers prophylactically
Speaker 1: after they were injured, it wasn't a vaccine that could
Speaker 1: offer more long term resistance to the disease. But in
Speaker 1: nineteen twenty four, another French veterinarian and bacteriologists, Gaston Ramon,
Speaker 1: developed the first tetanus vaccine. Ramon had previously developed a
Speaker 1: similar vaccine for diphtheria. This vaccine is known as tetanus toxoid.
Speaker 1: Toxoid is a toxin that's been inactivated so that it's
Speaker 1: no longer dangerous, so the immune system learns to produce
Speaker 1: antibodies to the toxin before it encounters the real thing.
Speaker 1: This vaccine can also help prevent tetanus from developing if
Speaker 1: it's administered to an otherwise unvaccinated person after they have
Speaker 1: sustained an injury. During World War Two, so tetanus toxoid
Speaker 1: became a routine vaccine administered to soldiers, and then it
Speaker 1: became more widely available to the general public after the
Speaker 1: war was over. It seems like deaths from tetanus started
Speaker 1: to drop as soon as the vaccine was put into use,
Speaker 1: but there isn't consistent data on that. In the US,
Speaker 1: for example, tetanus did not become a reportable disease until
Speaker 1: nineteen forty seven, so before that point we don't have
Speaker 1: an exact number for how many people contracted tetanus. But
Speaker 1: the largest number of tetanus cases reported in the United
Speaker 1: States was in nineteen forty eight, and from there the
Speaker 1: numbers declined. Deaths from tetanus have decreased by ninety nine
Speaker 1: percent in the US since nineteen forty seven. The vaccine
Speaker 1: that was being used when it was first introduced targeted
Speaker 1: three illnesses tetanus, diphtheria, and protessis, all of which are
Speaker 1: caused by toxin producing bacteria. Today, in the United States,
Speaker 1: the two versions of the tetanus vaccine that are most
Speaker 1: widely used are teet APP, which targets all three of
Speaker 1: those diseases, and td which targets only tetanus and diphtheria.
Speaker 1: Tetanus antitoxin is still also used to treat people who
Speaker 1: do develop symptoms of tetanus and to prevent it in
Speaker 1: people who sustain some kind of injury and have not
Speaker 1: been vaccinated. It's usually called tetanus immune globulin, and it
Speaker 1: can be made using horse serum or serum from donated
Speaker 1: human blood, which carries less of a risk of serum sickness.
Speaker 1: Because tetanus exists in the soil and forms very hardy spores,
Speaker 1: it isn't a disease that could be eradicated like smallpox
Speaker 1: or render pest, at least not with any technology that
Speaker 1: exists today. We do have episodes about the eradication of
Speaker 1: both smallpox and render pest for more information on those.
Speaker 1: Tetanos spores are basically all around all the time, and
Speaker 1: recovering from tetanus doesn't make you immune to it later on,
Speaker 1: so the closest thing to eradication is ensuring broad vaccine
Speaker 1: coverage so that people who are exposed to tetanus bacteria
Speaker 1: don't develop the disease. Today, the World Health Organization recommends
Speaker 1: a six vaccine series that stretches over a person's infancy, childhood,
Speaker 1: and adolescence. This six shot series is close to one
Speaker 1: hundred percent effective. Some countries, including the United States, also
Speaker 1: recommend a booster every ten years. Tetanus is rare and
Speaker 1: wealthy parts of the world where there are robust vaccine
Speaker 1: programs and where the vaccine is also available in places
Speaker 1: like doctors' offices, urgent care centers, and emergency rooms for
Speaker 1: people who sustain some kind of injury and need that vaccine,
Speaker 1: but it is still a major cause of death in
Speaker 1: poorer countries than regions where that's not the case. Tetanus
Speaker 1: cases can also spike after major natural disasters like earthquakes, tsunamis,
Speaker 1: and hurricanes. Today, the majority of tetanus cases and deaths
Speaker 1: are in newborns. Babies who are born in surroundings that
Speaker 1: aren't sanitary, or whose umbilical cords are cut with instruments
Speaker 1: that are not sterile, or whose umbilical stumps are covered
Speaker 1: in non sterile dressings. People can also contract tetanus after
Speaker 1: giving birth in these kinds of environments. In the nineteen eighties,
Speaker 1: the World Health Organization and other organizations embarked on the
Speaker 1: Maternal and Neonatal Tetanus Elimination Initiative. This initiative was then
Speaker 1: relaunched in nineteen ninety nine, and it involves multiple strategies
Speaker 1: including improving access to skilled birth attendants who use hygienic
Speaker 1: practices during delivery and newborn care, and vaccine programs, including
Speaker 1: immunizing people during pregnantancy. When somebody is immune to tetanus,
Speaker 1: that immunity passes to their child and it protects the
Speaker 1: newborn during their first weeks of life until they can
Speaker 1: get their own vaccines. Same thing is true for protessis
Speaker 1: and diphtheria, which are the other two diseases prevented by
Speaker 1: the t EDAPP vaccine. This transfer of maternal tetanus antibodies
Speaker 1: was studied back in the nineteenth century, when German physician
Speaker 1: Paul Irlick conducted experimentss with mice and goats and their offspring.
Speaker 1: Between nineteen ninety eight and twenty eighteen, tetanus rates in
Speaker 1: newborns dropped by about ninety seven percent around the world
Speaker 1: thanks to these programs, But even with that success, around
Speaker 1: twenty five thousand newborns still died of neonatal tetanus in
Speaker 1: twenty eighteen. Numbers have not changed much since then, in
Speaker 1: part because of disruptions caused by the COVID nineteen pandemic.
Speaker 1: In twenty twenty one, which is the most recent year
Speaker 1: that statistics are EVD available and estimated, twenty four thousand
Speaker 1: newborns died of tetanus, and as of twenty twenty four,
Speaker 1: there are ten countries where maternal and neonatal tetanus have
Speaker 1: not been eradicated yet. I tried to track down whether
Speaker 1: the various funding cuts to foreign aid and foreign health
Speaker 1: programs that's been happening in the US is affecting this
Speaker 1: particular project, and I do not know the answer. That's
Speaker 1: what I know about tetanus, though. Do you have some
Speaker 1: listener mail that may or may not have antibodies in it.
Speaker 1: It kind of does have antibodies in it. I instead
Speaker 1: of reading one email, I just wanted to thank the
Speaker 1: enormous number of people who sent us emails and Facebook
Speaker 1: comments and Instagram comments, even a couple of comments on
Speaker 1: x that used to be Twitter and on Blue Sky,
Speaker 1: which I don't think we've ever set out loud on
Speaker 1: the podcast that we're on Blue Sky now now in
Speaker 1: response to the beginning of our Spring Unearthed episode. I
Speaker 1: have not responded to any of these email or emails
Speaker 1: or comments. I did read all of them. The response
Speaker 1: was truly, truly overwhelming. I was going to make a
Speaker 1: list of everybody's names and just say thank you everybody,
Speaker 1: but even that got overwhelming, and I was also afraid
Speaker 1: I would miss people. And like we said at the
Speaker 1: beginning of the episode, a couple of weeks are going
Speaker 1: to pass between recording this and it coming out, probably
Speaker 1: get more emails during that time. Basically, we got a
Speaker 1: lot of really really great email, and so thank you
Speaker 1: everyone for that. A lot of people expressed concerns that
Speaker 1: we were going to get a lot of hate or
Speaker 1: flack or be hassled in some way. I just wanted
Speaker 1: to say thank you all very much for your concerns.
Speaker 1: This was a reasonable concern. I feel we got almost
Speaker 1: no flak. I was really braced for impact. We only
Speaker 1: got good impact. We got a giant, ongoing, multiple weeks
Speaker 1: long impact of hugs basically with minimal badness in all
Speaker 1: of that. Hooray, which was great, honestly, because I was
Speaker 1: afraid that was not going to be what would happen,
Speaker 1: because like like we said, we don't typically make just
Speaker 1: explicitly direct political statements on the show, so we've gotten
Speaker 1: way worse response to way more oblique things that we've
Speaker 1: said before. Honestly, So again, thank you so much to
Speaker 1: all of you. I've read and appreciated all of your stuff. Also,
Speaker 1: I wanted to say, so many people in your emails
Speaker 1: said that the beginning of that episode made you feel
Speaker 1: less alone, So I just wanted to say, hey, you
Speaker 1: are not alone. We heard that from so many people
Speaker 1: in the emails. It's clear that a lot of people
Speaker 1: are feeling really alone right now. But it's obvious to
Speaker 1: me from that response that none of us are alone
Speaker 1: in this moment, even if we might feel alone in
Speaker 1: some way, like the Big Hands Off March marches across
Speaker 1: the country and the world. Honestly, on April fifth. I
Speaker 1: saw some criticisms of those marches for like not having
Speaker 1: a clear objective set out from the beginning and not
Speaker 1: being disruptive. But one of the things I thought was
Speaker 1: really good about them was showing how there were crowds
Speaker 1: of hundreds of people even in tiny little towns where
Speaker 1: people were probably feeling like they were only one or
Speaker 1: only a handful. So I just wanted to say I
Speaker 1: absolutely empathize with the feeling of a loneness. Living in
Speaker 1: Massachusetts right now, I don't feel very alone. I feel
Speaker 1: like I'm surrounded by angry people taking action, But having
Speaker 1: lived previously in North Carolina and Georgia, I didn't always
Speaker 1: feel that way. So again, you're not alone. And thank
Speaker 1: you again for all of these lovely, lovely emails and
Speaker 1: Facebook comments and Instagram comments and all of that that
Speaker 1: we have been getting over the last couple of weeks. Now,
Speaker 1: if you would like to send us some notes about
Speaker 1: this or any other podcast or a history podcast at
Speaker 1: iHeartRadio dot com. You can subscribe to our show on
Speaker 1: the iHeartRadio app and anywhere else that you like to
Speaker 1: get podcasts stuff you missed in History Class is a
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Speaker 1: favorite shows.