Tetanus

Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio. Hello, and welcome to the podcast. I'm Tracy V.
Wilson and I'm Holly Frye. Hey. I'm thinking about vaccines
a lot right now for reasons including rapidly growing measles

(00:26):
outbreak that we have happening in the US right now.
I originally had numbers of cases here in the outline,
but that number increased by like two hundred just in
the time that I was working on this. Yeah, it's
impossible to track. By the time this comes out, those
numbers would be woefully out. Sabe. Yeah, two more weeks
are going to pass before this is out, so those
numbers would be wrong anyway by then. Also, just a

(00:50):
lot of upsetting and alarming developments happening in the US
Department of Health and Human Services and the National Institute
of Health. We have already done an episode on measles
that came out on February twenty eighth of twenty twenty four,
and that's a little bit more recent than we would
typically rerun as a Saturday Classic. So I decided to

(01:10):
take a look at another disease that's preventable today. Thanks
to vaccines which do not cause autism. Not any vaccine,
not for any disease. None of them cause autism. The disease, though,
is tetanus. Since this is an episode about a medical development,
of course there will be some medical experiment stuff in

(01:31):
the episode, including some experiments involving animals. I really don't
think any of that is particularly graphic, but just in case,
Uh yeah, I can handle it based on my read through,
which is a pretty low bar of getting upsetness. So
I think we're safe. But if not, I'm sorry. Tetanus

(01:53):
has probably been around for most of human history, possibly
even longer. It's caused by the bacteria Clostridium tetani, which
is present in the environment in a lot of the world.
It's described with words like ubiquitous. In the words of
John Sundwall in a lecture given under the auspices of
the Kansas Academy of Science in nineteen seventeen, quote, this

(02:16):
germ has a wide distribution, and its spores are found
wherever there is dirt. Barnyards are veritable repositories for them.
Rusty nails appear to be rendezvous. Even the dirt that
besmears the healthy living child may contain millions of these
spores of Tetanus basillai. The spores can only grow when

(02:38):
they gain deep entrance into the body and are shut
off from oxygen. One of the oldest known medical texts
in the world is the Edwin Smith Surgical Papyrus, named
for Edwin Smith, who bought it in eighteen sixty two.
This Egyptian medical text dates back to about fifteen hundred BCE,
and it includes a description of somebody with a head

(02:59):
injury that penetrated all the way through the futures of
the skull. Afterward, according to one translation, quote, the cord
of his mandible is contracted. He discharges blood from both
his nostrils and from both his ears, while he suffers
with stiffness in his neck. As this patient's condition progresses quote,

(03:21):
his mouth is bound, both his eyebrows are drawn, while
his face is as if he wept. This earliest description
is usually translated and interpreted as describing a case of tetanus,
but it doesn't entirely convey what tetanus is like as
an illness. Tetanus doesn't cause bleeding from the ears or nose.

(03:42):
That was probably a product of the patient's head trauma,
not the tetanus that followed it. Beyond that, without getting
into a lengthy backgrounder on neurotransmitters, Claustritium tetani produces two toxins,
and one of them, called tetanospasmen, interferes with neurotransmitter that
control motor neuron activity. The nerves start firing uncontrollably, which

(04:05):
causes intense muscle spasms. These can be excruciating and powerful
enough to cause compression fractures or other breaks in a
person's bones. Tetanus can also lead to suffocation and heart failure.
Even with medical treatment, tetanus is fatal between ten and
twenty percent of the time, and without treatment the fatality

(04:28):
rate goes up to eighty five percent or even more.
It sounds awful, yes it does. The muscles in the
face and the jaw are often affected in tetanus, and
that can cause a person to look like they are grinning.
The spasms also cause tristmas, also known as lockjaw, and

(04:48):
that can make it difficult or impossible for the persons
who open their mouth. The Edwin Smith Papyrus offers a
way to try to deal with this lock jaw that's
by placing a wooden brace padded with linen in the
patient's mouth to try to keep it open enough that
they can be fed a liquid diet while being kept upright.

(05:09):
Tetanus also appears in the Sashruda Samhita, which dates back
to about the sixth century BCE and is one of
the foundational texts of iervedic medicine. We did an episode
on Sashruda in January of twenty nineteen. In a chapter
on diseases of the nervous system, the Sashruda Samhita describes
one caused by enraged or agitated value that's the air

(05:33):
element in iervedic medicine. This disease quote rarely yields to
medicine and is cured in rare instances only with the
greatest difficulty. Its characteristic symptom being a paralysis of the jawbone,
which makes deglutition extremely difficult. This disease in the text

(05:53):
is described as bending the body like a bow and
in its extreme form, fixing the eyes in their sockets,
paralyzing the jaw and breaking the sides. The Chinese medical
text known as the Yellow Emperor's Classic of Internal medicine
is attributed to a semi mythical figure who's described as

(06:15):
living around twenty six hundred BCE, but it was probably
written more than two thousand years later than that. Traditional
Chinese medicine incorporates the idea of energy channels or meridians
in the body. The translation of the Yellow Emperor's Classic
that I had access to for research didn't use the
word tetanus anywhere, but it describes the collapse of the

(06:37):
chi in the bladder and small intestine meridian as causing opisthoughtanus,
stiffness in the back, convulsive spasms, paleness, and spontaneous sweating.
Once that sweating stops, the patient dies. Apisthoughtanus is the extreme,
very arching spasms that are associated with tetanus. The first

(06:59):
thing we'd think of as a really clear clinical description
of tetanus from a more Western medical perspective is from
Greek physician Hippocrates, written around the fifth century BCE. In
a treatise on Internal afflictions, Hippocrates describes three types of tetanus. First,
when it follows a wound, Hippocrates says, the patient's quote

(07:21):
jaws are fixed and he is unable to open his mouth,
his eyes shed tears and look awry. His back becomes rigid.
He cannot bend his legs, nor his arms and spine.
Hippocrates describes this disease as severe and requiring a media
attention and in many cases fatal. For treatment, Hippocrates advises

(07:44):
anointing the patient with warm oil infused with wormwood, bay leaves,
or hen made seed with frankincense soaked in white wine.
According to Hippocrates, the second type of tetanus is similar,
but it starts with angina also pronounced angina that's chest pain,
or with a saff infection or separation of the tonsils,

(08:07):
and occasionally it can also start with a wound. Quote
this patient is drawn backwards and cries aloud from the
pain in his back and chest. He is drawn so
forcefully that the attendants can hardly prevent him from falling
out of bed. Then the third form is less lethal,
arising from some of the same possible causes or from

(08:30):
having fallen backward. Another work by Hippocrates called on Epidemics,
also includes several examples of tennis cases, One developed after
a surgery, another after a javelin wound after a person's
finger was crushed by an anchor after an ankle injury
whose treatment involved irritating the wound, after being injured by

(08:54):
a piece of wood from a missile thrown by a catapult.
In the words of Roman author Alice Cornelius Celsus in
the first century CE, quote, there is no disease more
distressing and more acute than that which, by a sort
of rigor of the sinews, now draws down the head
to the shoulder blades, now the chin to the chest,

(09:16):
now stretches out the next straight and immobile. The Greeks
call the first aposthotanus, the next amprosthotanus, and the last tetanus,
although some with less exactitude use these terms indiscriminately. For
centuries after this, European medical writing on tetanus tended to
be really similar. Many physicians base their work on Hippocrates.

(09:41):
Even if Hippocrates wasn't cited, they still usually described tetanus
as following a wound. Most commented on how often the
condition was fatal, and many of the recommended treatments related
to things that one might hope would relieve the spasms,
like being rubbed with oils or wines or liniments or
wrapped in warm dressings or given warm baths. In the

(10:04):
sixteenth century, past podcast subject Amboise Parre developed an instrument
to open a tetanus patient's mouth so that they could
be fed. Overall, the focus was on trying to get
the muscles to relax and supporting the patient with the
hope that they would recover, but often a certainty that
they would not. Knowledge of the cause of tetanus and

(10:28):
how to treat and prevent it didn't really start to
advance until the nineteenth century, which we will get to
after a sponsor break. As we said, before the break,
people figured out that tetanus was connected to wounds thousands

(10:51):
of years ago, but it wasn't until the nineteenth century
that we started to get a sense of exactly what
was happening inside those wounds and elsewhere in the body.
In eighteen thirty eight, Luigi Carlo Ferini gave an address
before the Medical Turgical Society of Bologna in which he
described the use of electricity in the treatment of tetanus.

(11:14):
He had based this on the work of Carlo Mettiucci,
who was experimenting with electricity and frogs. Farini found that
the application of direct current to the body of a
patient who had developed tetanus after a gunshot wound seemed
to interrupt the spasms. Unfortunately, this effect was temporary. It

(11:35):
lasted only about thirty minutes. This didn't really provide a
breakthrough in the understanding of tetanus, but it was connected
to the electrical activity of the neurons that is part
of the disease. Several discoveries were made. In eighteen eighty four,
Italian scientists Antonio Carle and Giorgio Rotone had both studied

(11:56):
medicine in Turin. They exposed a rat but to fluid
from a sore from someone who had died of tetanus,
and that rabbit also developed tetanus. This showed some kind
of contagion was causing the disease. But to be clear,
tetanus is not transmitted from person to person. You would
have to really do something on purpose like this. Also

(12:20):
in eighteen eighty four, Arthur Nicolier, who was a twenty
two year old medical student in Germany, identified a bacillus
in the soil. If you look at this basillis under
a microscope, it looks kind of like a tiny straight pin.
There's this rod like basillis with a knob on the end.
That knob is the spore. Today, we know that these

(12:43):
spores are incredibly hearty, they are resistant to most disinfectants,
and they can survive freezing and being autoclaved at a
temperature of one hundred and twenty one degrees celsius or
two forty nine point eight fahrenheit for ten or fifteen minutes.
Nicolier induce tetanus in mice by injecting them with soil
that was contaminated with this spore forming basillis. He concluded

(13:07):
that the basillis produced a poison that acted similarly to strychnine.
Within a few years, multiple researchers all concluded that this
basillis could produce a toxin. While Nicolier was able to
find the tetanus basillis in the soil, he was not
able to isolate it in a lab. Credit for that

(13:28):
goes to Japanese physician and bacteriologist Kitasato Shiva Siburo in
eighteen eighty nine. Kitasato was born in Japan and had
earned his medical degree from the University of Tokyo Medical
School in eighteen eighty three. Two years later, the Japanese
government had sent him to the Institute of Hygiene in

(13:48):
Berlin to study bacteriology and infectious diseases with groundbreaking microbiologist
Robert Koch. It was while in Berlin that Quitasato isolated
the tetanus bacillis Clestridium tetanani is an anaerobic microorganism, so
doing this required Kitasato to develop new methods for growing

(14:10):
bacteria while also keeping them isolated from the air. Kitasato
started working with physiologist Emil von Behring, who is from
West Prussia in what's now Germany. While Kitasato was studying tetanus,
von Behring was studying diphtheria. We have talked about diphtheria
in our episode on the Nome Serum run that ran

(14:31):
as a Saturday Classic on January twenty second, twenty twenty two.
These diseases have some similarities. They're both caused by bacteria
producing toxins rather than by those bacteria reproducing and proliferating
within the body. This is one reason why still today
there's no definitive lab test for tetanus. Once a person

(14:53):
has developed symptoms, tetanus bacteria are found in their wound
only about thirty percent of the time time, and the
bacteria can also be present in the wounds of people
who have no symptoms and never develop the disease. In
eighteen ninety, Kitasato and von Behring published a paper titled
the Mechanism of Immunity and Animals to Diphtheria and Tetanus.

(15:18):
This paper described a method they had found to prevent
tetanus and healthy animals. From an English translation of the paper,
they summed it up in a sentence quote, the immunity
of rabbits and mice which have been immunized against tetanus
depends on the ability of the cell free blood fluid
to render harmless the toxic substance which the Tetanus bacillis produces.

(15:44):
In their experiments, these two men exposed animals to a
weakened version of the toxin, gradually building up their immunity.
Then they did a series of experiments to show that
the blood serum of these animals could neutralize the toxins
in other aias animals. In other words, the serum contained antitoxins,

(16:04):
also called antibodies. Kittasato and von Bearing injected rabbits with
serum that contained these antibodies, and then they exposed the
rabbits to an amount of tetanus bacteria that had previously
been proven to be fatal. Every rabbit remained healthy. And
then the same was true if the treated rabbits were

(16:26):
injected with tetanus toxin instead of with the bacteria that
produce it. These rabbits could withstand a dose of toxin
that was twenty times higher than what it would take
to kill an untreated rabbit. Kittasato and von Bearing also
said that the serum from these immune animals could be

(16:46):
used as a therapeutic treatment on animals that had already
developed tetanus. A week after this paper was published, Von
Bearing published another paper on his own, which was focused
only on diphtheria, and the work he started eventually led
to a reliable treatment for that disease. He was awarded
the Nobel Prize in Physiology or Medicine for this work

(17:08):
in nineteen oh one, the first time that prize was
ever awarded. Since the Nobel Prize committee was focused on
diphtheria and not tetanus, Kitasato was not included in the
award or mentioned in the speech. Side note. Kitasato left
Germany in eighteen ninety one, returning to Japan and establishing

(17:30):
his own laboratory that was later subsidized by the Japanese government. Then,
in eighteen ninety four, he was sent to Hong Kong
during an epidemic of bubonic plague. There he isolated and
identified the Bacillis that was causing that disease, a couple
of days before Swiss researcher Alexandra Yersen made the same discovery.

(17:52):
Although Kitasato published his work on this first, Yarson's was
seen as more conclusively linking the disease to the basillis,
and that bacillus today is known as Rcinia pestis after him.
Quitasato and von Bhring had made definitive connections between tetanus bacteria,
the toxin it produced, and the protective value of blood

(18:15):
serum from animals that had developed an immunity to that toxin,
but their work was just small animals like rabbits, guinea pigs,
and mice. It didn't immediately lead to workable treatments for
humans or for other large animals. That started to change
in eighteen ninety five, when Edmund Nocard reported success with

(18:37):
horses tetanus bacteria really thrive in horse manures, so tetanus
could be a serious problem for cavalry units, farmers, basically
anywhere that there were lots of horses. No Card was
a veterinarian, a veterinary professor, and a biologist who had
worked with Louis Pasteur. After his initial success, no Card

(19:00):
produced about seven thousand files of anti tetanus serum and
he distributed it among his veterinary colleagues. The first anti
tetanus serums used in humans followed not long afterward. Throughout history,
one of the groups most at risk for tetanus infection
has been newborn babies, but among medical researchers in the

(19:22):
late nineteenth century, tetanus was more often thought of as
a hazard on the battlefield. There had been five hundred
five reported cases during the US Civil War with a
mortality rate of eighty nine percent, and three hundred and
fifty reported cases during the Franco Prussian War with a
mortality rate of ninety percent. Tetanus became a bigger threat

(19:45):
during World War One, which started about twenty years after
not cards discoveries, and we'll get into that after a
sponsor break earlier In the episode, we read from a
lecture given by John Sundwall in nineteen seventeen. Here is

(20:09):
something else that lecture had to say about tetanus quote.
It is known as the fourth of July bacillis. It
was once a customed to exhibit our copious and excessive
patriotism with every form of pyrotechnic art. Frequently premature explosions
of the firecrackers, et cetera drove the accumulated dirt on

(20:32):
the hand with its numerous spores, deep into the skin,
and as a rule, the obituary column of the local
press within a few days would announce the subsequent fate
of many of our little patriots. This basic idea also
applied to the battlefield during World War One. Advances in

(20:53):
munitions and explosive meant that more soldiers were being struck
with shrapnel and debris that could drive tetanusors deep into
their bodies a lot more often. The proliferation of trench
warfare also meant that more soldiers were developing conditions like
trench foot and frostbite, both of which could lead to
breaks in the skin that could provide an entry point

(21:15):
for tetanus bacteria. Over the course of the war, doctors
also concluded that infections with aerobic bacteria could facilitate tetanus
infections by consuming the oxygen in a wound, leaving an
environment that was hospitable to the anaerobic Tetanus bacillis. In
the years before the war, researchers had started producing tetanus

(21:38):
antitoxin for use in humans by building up the immunity
of horses and then harvesting their serum. By the time
the war started, the Institute Pasteur was preparing about eighty
thousand vials of tetanus anti toxin for humans using about
three hundred horses. By nineteen the institute had nearly fifteen

(22:02):
hundred horses, producing more than six hundred thousand vials of
anti toxin per month. The Institute Pastor was not the
only place that was doing this. That's just what I
had the numbers for. Over the course of the war, essentially,
through trial and error, civilian and military doctors and surgeons

(22:22):
worked out treatment and prevention protocols for tetanus in injured soldiers,
and that was through use of these serums. Ultimately, the
treatment started with treating the wound itself, excizing all wounds
and removing all the damage tissue, ideally within twelve hours
of the injury. This is because doctors found a clear

(22:43):
connection between the presence of tetanus bacteria and the wounds
of soldiers whose injuries were surgically treated and those who weren't.
Like we said earlier, it's often not possible to find
bacteria in the wounds of people who developed tetanus, but
there was still a clear correlation there. Tetanus rates were
lower in soldiers whose wounds had been exized, even if

(23:06):
that first excision didn't lead to satisfactory wound healing and
it had to be redone and then after their wounds
were excised, the soldiers were treated with tetanus antibody serum,
both as a prophylactic measure if there was enough available,
and as a treatment if they started developing signs of tetanus.

(23:26):
One bulletin from the UK War Office Committee for the
Study of Tetanus advised nurses to be alert for symptoms quote.
All nursing sisters engaged in dressing wounds should be warned
to give the alarm if the muscles round the wound
are found to be harder or more rigid than the
muscles of the uninjured limb or side. Over the course

(23:50):
of the war, doctors also developed standard doses of tetanus antitoxin.
By nineteen nineteen, the prophylactic dose was five hundred units
contained in three cubic centimeters or less of horse serum.
A unit was quote ten times the least quantity of
anti technic serum necessary to save the life of a

(24:10):
three hundred and fifty gram guinea pig for ninety six hours,
against the official test dose of a standard toxin furnished
by the Hygienic Laboratory of the Public Health and Marine
Hospital Service, a super easy unit of measures. I'm assuming
that the Germans had a different standard, probably at this point,

(24:31):
maybe not. Under ideal circumstances, an injured soldier was given
the first prophylactic dose by injection as soon as he
had been removed from the line of fire. Subsequent injections
were shown to significantly reduce the risk of developing tetanus,
but whether soldiers actually got those additional doses just really

(24:54):
depended on whether there was enough serum available and whether
the medical staff had the capacity to do it. If
they were just really overwhelmed. It might not happen even
when soldiers only got one injection, though they tended to
have milder or more localized cases of tetanus if they
still developed it. Doses of anti toxin for treatment rather

(25:18):
than prophylaxis, could be much higher, ranging from fifty thousand
to one hundred thousand units in the early days of treatment,
depending on whether the patient's body seemed to be responding
to it. One of the reasons for working out the
lowest effective dose of antitoxin was, of course, to conserve
a limited supply, but another was the risk of severe

(25:41):
allergic reactions to the horse serum, which was known as
serum sickness. This risk seemed to be higher at higher doses.
For example, a nineteen nineteen report by the UK War
Office Committee for the Study of Tetanus reported that two
million prophylactic doses of anti tetanic serum had been administered
to soldiers being treated in England, and there had been

(26:03):
eleven cases of shock related to the serum. All of
those patients did recover, but in the fourteen hundred cases
of tetanus they were treated with therapeutic doses in England,
there were forty nine cases of shock, or three point
five percent of the patients. Among those patients, twelve died
or zero point eight percent of those fourteen hundred cases,

(26:27):
but some of those deaths likely were not related to
the anti toxins, so this was rare, but it could happen.
The development of tetanus anti taxin almost completely eliminated tetanus
among injured soldiers by the end of the war. For example,
in France, at the start of the war, about one
and a quarter percent of the soldiers who were admitted

(26:50):
to the hospital developed tetanus, and all of those patients died.
After the tetanus anti toxin serum was introduced to that
number of tetans cases dropped to zero. Results were pretty
similar across other armies involved on both sides of the war.
While tetanus anti toxin could be administered to soldiers prophylactically

(27:13):
after they were injured, it wasn't a vaccine that could
offer more long term resistance to the disease. But in
nineteen twenty four, another French veterinarian and bacteriologists, Gaston Ramon,
developed the first tetanus vaccine. Ramon had previously developed a
similar vaccine for diphtheria. This vaccine is known as tetanus toxoid.

(27:37):
Toxoid is a toxin that's been inactivated so that it's
no longer dangerous, so the immune system learns to produce
antibodies to the toxin before it encounters the real thing.
This vaccine can also help prevent tetanus from developing if
it's administered to an otherwise unvaccinated person after they have
sustained an injury. During World War Two, so tetanus toxoid

(28:01):
became a routine vaccine administered to soldiers, and then it
became more widely available to the general public after the
war was over. It seems like deaths from tetanus started
to drop as soon as the vaccine was put into use,
but there isn't consistent data on that. In the US,
for example, tetanus did not become a reportable disease until

(28:23):
nineteen forty seven, so before that point we don't have
an exact number for how many people contracted tetanus. But
the largest number of tetanus cases reported in the United
States was in nineteen forty eight, and from there the
numbers declined. Deaths from tetanus have decreased by ninety nine
percent in the US since nineteen forty seven. The vaccine

(28:47):
that was being used when it was first introduced targeted
three illnesses tetanus, diphtheria, and protessis, all of which are
caused by toxin producing bacteria. Today, in the United States,
the two versions of the tetanus vaccine that are most
widely used are teet APP, which targets all three of
those diseases, and td which targets only tetanus and diphtheria.

(29:12):
Tetanus antitoxin is still also used to treat people who
do develop symptoms of tetanus and to prevent it in
people who sustain some kind of injury and have not
been vaccinated. It's usually called tetanus immune globulin, and it
can be made using horse serum or serum from donated

(29:32):
human blood, which carries less of a risk of serum sickness.
Because tetanus exists in the soil and forms very hardy spores,
it isn't a disease that could be eradicated like smallpox
or render pest, at least not with any technology that
exists today. We do have episodes about the eradication of

(29:53):
both smallpox and render pest for more information on those.
Tetanos spores are basically all around all the time, and
recovering from tetanus doesn't make you immune to it later on,
so the closest thing to eradication is ensuring broad vaccine
coverage so that people who are exposed to tetanus bacteria
don't develop the disease. Today, the World Health Organization recommends

(30:18):
a six vaccine series that stretches over a person's infancy, childhood,
and adolescence. This six shot series is close to one
hundred percent effective. Some countries, including the United States, also
recommend a booster every ten years. Tetanus is rare and
wealthy parts of the world where there are robust vaccine

(30:41):
programs and where the vaccine is also available in places
like doctors' offices, urgent care centers, and emergency rooms for
people who sustain some kind of injury and need that vaccine,
but it is still a major cause of death in
poorer countries than regions where that's not the case. Tetanus

(31:01):
cases can also spike after major natural disasters like earthquakes, tsunamis,
and hurricanes. Today, the majority of tetanus cases and deaths
are in newborns. Babies who are born in surroundings that
aren't sanitary, or whose umbilical cords are cut with instruments
that are not sterile, or whose umbilical stumps are covered

(31:22):
in non sterile dressings. People can also contract tetanus after
giving birth in these kinds of environments. In the nineteen eighties,
the World Health Organization and other organizations embarked on the
Maternal and Neonatal Tetanus Elimination Initiative. This initiative was then
relaunched in nineteen ninety nine, and it involves multiple strategies

(31:47):
including improving access to skilled birth attendants who use hygienic
practices during delivery and newborn care, and vaccine programs, including
immunizing people during pregnantancy. When somebody is immune to tetanus,
that immunity passes to their child and it protects the
newborn during their first weeks of life until they can

(32:09):
get their own vaccines. Same thing is true for protessis
and diphtheria, which are the other two diseases prevented by
the t EDAPP vaccine. This transfer of maternal tetanus antibodies
was studied back in the nineteenth century, when German physician
Paul Irlick conducted experimentss with mice and goats and their offspring.

(32:31):
Between nineteen ninety eight and twenty eighteen, tetanus rates in
newborns dropped by about ninety seven percent around the world
thanks to these programs, But even with that success, around
twenty five thousand newborns still died of neonatal tetanus in
twenty eighteen. Numbers have not changed much since then, in

(32:51):
part because of disruptions caused by the COVID nineteen pandemic.
In twenty twenty one, which is the most recent year
that statistics are EVD available and estimated, twenty four thousand
newborns died of tetanus, and as of twenty twenty four,
there are ten countries where maternal and neonatal tetanus have
not been eradicated yet. I tried to track down whether

(33:16):
the various funding cuts to foreign aid and foreign health
programs that's been happening in the US is affecting this
particular project, and I do not know the answer. That's
what I know about tetanus, though. Do you have some
listener mail that may or may not have antibodies in it.
It kind of does have antibodies in it. I instead

(33:39):
of reading one email, I just wanted to thank the
enormous number of people who sent us emails and Facebook
comments and Instagram comments, even a couple of comments on
x that used to be Twitter and on Blue Sky,
which I don't think we've ever set out loud on
the podcast that we're on Blue Sky now now in

(34:01):
response to the beginning of our Spring Unearthed episode. I
have not responded to any of these email or emails
or comments. I did read all of them. The response
was truly, truly overwhelming. I was going to make a
list of everybody's names and just say thank you everybody,

(34:24):
but even that got overwhelming, and I was also afraid
I would miss people. And like we said at the
beginning of the episode, a couple of weeks are going
to pass between recording this and it coming out, probably
get more emails during that time. Basically, we got a
lot of really really great email, and so thank you
everyone for that. A lot of people expressed concerns that

(34:50):
we were going to get a lot of hate or
flack or be hassled in some way. I just wanted
to say thank you all very much for your concerns.
This was a reasonable concern. I feel we got almost
no flak. I was really braced for impact. We only
got good impact. We got a giant, ongoing, multiple weeks

(35:12):
long impact of hugs basically with minimal badness in all
of that. Hooray, which was great, honestly, because I was
afraid that was not going to be what would happen,
because like like we said, we don't typically make just

(35:32):
explicitly direct political statements on the show, so we've gotten
way worse response to way more oblique things that we've
said before. Honestly, So again, thank you so much to
all of you. I've read and appreciated all of your stuff. Also,
I wanted to say, so many people in your emails

(35:56):
said that the beginning of that episode made you feel
less alone, So I just wanted to say, hey, you
are not alone. We heard that from so many people
in the emails. It's clear that a lot of people
are feeling really alone right now. But it's obvious to

(36:17):
me from that response that none of us are alone
in this moment, even if we might feel alone in
some way, like the Big Hands Off March marches across
the country and the world. Honestly, on April fifth. I
saw some criticisms of those marches for like not having
a clear objective set out from the beginning and not

(36:42):
being disruptive. But one of the things I thought was
really good about them was showing how there were crowds
of hundreds of people even in tiny little towns where
people were probably feeling like they were only one or
only a handful. So I just wanted to say I
absolutely empathize with the feeling of a loneness. Living in

(37:04):
Massachusetts right now, I don't feel very alone. I feel
like I'm surrounded by angry people taking action, But having
lived previously in North Carolina and Georgia, I didn't always
feel that way. So again, you're not alone. And thank
you again for all of these lovely, lovely emails and

(37:25):
Facebook comments and Instagram comments and all of that that
we have been getting over the last couple of weeks. Now,
if you would like to send us some notes about
this or any other podcast or a history podcast at
iHeartRadio dot com. You can subscribe to our show on
the iHeartRadio app and anywhere else that you like to

(37:48):
get podcasts stuff you missed in History Class is a
production of iHeartRadio. For more podcasts from iHeartRadio, visit the
iHeartRadio app, Apple Podcasts, or wherever you listen to your
favorite shows.

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