September 18, 2025 • 19 mins
Tetanus: What is it? What are the symptoms? How do we treat or prevent it? In this episode, we will go over the history of tetanus, what actually causes the condition to occur, and the complications you may have if you get tetanus. Tune in to learn more!
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Resources:
UNICEF: https://www.unicef.org.au/
References:
https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625
https://www.kmedhealth.com/risks-of-reusing-syringes-and-needles/
https://www.mayoclinic.org/diseases-conditions/tetanus/diagnosis-treatment/drc-20351631
https://www.gavi.org/vaccineswork/giant-killers-7-historic-deaths-and-diseases-did-it
https://www.wikidoc.org/index.php/Tetanus_historical_perspective
https://sites.miamioh.edu/hst-journeys/2019/05/medicine-and-disease-in-history-tetanus/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11870127/
https://www.rch.org.au/kidsinfo/fact_sheets/Tetanus_prone_wounds/
https://www.ecdc.europa.eu/en/tetanus/facts
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
You stepped on a rusty nail over a week ago.
(00:02):
It went pretty deep, but you just brushed it off.
You could still walk and the cut was not bad enough
to even need stitches.
But when you woke up today, you felt strange.
Your jaw felt incredibly tight.
It's causing this strange and painful spasm
in the muscles around your jaw.
You look in the mirror
and you just see this strange grin on your face.
No matter how much you try to move your face, it's stuck.
(00:24):
Concerned, you walk down the stairs
and your wife is just horrified.
You try to calm her down, but you find it difficult to speak.
She decides then to drive you
straight to the emergency room.
(upbeat music)
Hello and Welcome to Anatomy Of Illness.
(00:51):
Today's episode is about tetanus or lockjaw.
Before we get into the condition,
we are going to start with the history.
So why do we know tetanus exists?
But before we get into this episode,
a quick reminder that our Kickstarter
for the next season is live.
So be sure to check that out
as there is only one more episode
after this left of our first season.
We begin with the ancient Egyptians around 1,500 BC.
(01:14):
This being in the Edwin Smith papyrus,
more specifically in the surgical section.
These are when we would have
the first documentations of tetanus.
In the Edwin Smith papyrus description in case seven,
it states, "One who has a gaping wound in his head,
which has penetrated to the bone
and violated the sutures of his skull,
who has a toothache whose mouth is clenched,
(01:35):
who suffers from stiffness in his neck,
an ailment for which nothing is done."
The ancient Egyptians understood
that the cause of tetanus was wound related.
However, there was little knowledge in the actual cause
along with any idea on how to treat the condition
back in those times.
Now we jump forward to Hippocrates in ancient Greece
between 460 to 370 BC.
(01:56):
This is where he would begin to formulate his own ideas
on how to treat tetanus,
like using strong wines and oil soaked clothes,
essentially encouraging the sufferer to just sweat it out.
He would also provide a more accurate description of tetanus
in his work known as epidemics.
In this, he would describe what happened
to a commander of a large ship,
(02:17):
including his case of tetanus.
“The anchor crushed his forefinger
and the bone below it on the right hand.
Inflammation developed, gangrene and fever.
He was purged moderately, mild fevers and pain.
Part of the finger fell away.
After the seventh day, satisfactory serum came out.
After that, problems with the tongue.
He said that he could not articulate everything.
Prediction made, the opisthonos would come.
(02:39):
His jaw became fixed, together then it went to the neck.
On the third day, he entirely convulsed backwards
with sweating.
On the sixth day after the prediction, he would die.”
Now tetanus without treatment is considered to be fatal,
even today, and we see with the two previous cases
that even with the medicines of the past,
that it was likely to have been entirely fatal in cases.
(02:59):
However, with the description of Aulus Cornelius Celsus
in the first century, in his book, De Medicina,
he described people surviving tetanus,
but this is likely to have been instead
other neurological conditions
that were mistaken for tetanus,
due to the fact that tetanus has such a high fatality rate,
basically being 100% when untreated.
Celsus would write,
(03:20):
"There is, however, 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,
now stretches out the neck straight and immobile.
The Greeks call the first opisthotonos,
the next emprosthotonos, and the last tetanus,
although some with less exactitude
(03:41):
use these terms indiscriminately.
These diseases are often fatal within four days.
If the patients survive this period,
they are no longer in danger.
They are all treated by the same method."
As we can see, that this is where
we get the term tetanus from.
The ancient Greeks, who would have come before Celsus,
and according to Celsus, we of course use the term wrong.
(04:01):
Not long after this time,
we would see the works of Areteus of Cappadocia.
He would discuss the horrors of tetanus,
claiming that it would be a blessing
when those suffering from tetanus
had the respiratory symptoms set in,
as this is when they were freed from their pain.
Areteus would also comment on the rigidness
of the limbs of those who had tetanus,
claiming that to loosen them,
you would have to cut off or break off
(04:24):
the limbs of a person living with tetanus
due to the severity of the condition
and the inability to actually help them.
Now, we are going to have a quick detour into the Bible.
Why is that?
Well, to discuss a potential mention of tetanus,
this being in the Gospel of Matthew,
specifically with this extract.
“When Jesus had entered Capernaum,
a centurion came to him asking for help.
(04:45):
‘Lord,’ he said, ‘my servant lies at home
‘paralyzed, suffering terribly.’
Jesus said to him, ‘shall I come and heal him?’
The centurion replied,
‘Lord, I do not deserve to have you under my roof,
but just say the word and my servant shall be healed.”
This is not a super descriptive account
of the state of the servant.
However, there are a few things
we could potentially rule out.
(05:06):
Firstly, rabies, as this would have been claimed
to be more of a demonic possession
due to the agitation and confusion
and potentially aggression.
Along with strychnine poisoning,
now this poison we do not see any mention of
in any records until the ninth century.
This poison comes from a tree in India.
Because of the paralysis and suffering,
it is potentially tetanus,
because this could technically be described in this way.
(05:28):
However, not exactly the most descriptive.
But anyway, moving into the Renaissance.
This is where another new and interesting treatment
for tetanus would come up.
What could this be?
Well, covering a patient in manure.
Yes, fecal matter, poop,
whatever you would like to call it.
But this does not help, so no poo baths for you.
We're going to move forward
onto less smelly pastures and into 1838.
(05:51):
More specifically, the 8th of October, 1838,
over at the Medico-Chirurgical Society of Bologna.
This is with Luigi Carlo Farini.
Here, he would discuss his prior experiment
on a man who was suffering from tetanus after being shot.
Because yes, gunshots can cause tetanus,
'cause bullets are not clean.
Anyway, in an attempt to cure his patient,
(06:13):
Farini would use electrical currents.
This, interestingly enough,
would cause a sort of paralysis in the patient,
but would relieve the symptoms of tetanus,
causing a relaxation of the patient's muscles,
causing the lockjaw to resolve,
and also restoring the circulation within the capillaries.
However, considering we do not electrocute people
who have tetanus,
you can hazard a guess that this was not a cure.
(06:36):
No, the electrical currents
would only relieve the patient's symptoms
for about 30 minutes, and the man would die soon after.
Not from electricity, from tetanus.
But this case would gain international recognition,
and interestingly enough, there would be similar cases,
like that of a woman around 10 years prior
who had developed tetanus because of a medical treatment
(06:56):
causing a blister to form on her chest.
However, she did not die.
Instead, the use of rectal opium and electricity
would allow her to survive the tetanus.
A quick footnote to this case.
Neither of these treatments
are approved treatments for tetanus.
Please do not use opium, it is illegal,
and do not put things up your butt.
Without a doctor's advice, it is not the purpose of the butt.
(07:19):
Also, do not go electrocuting yourself.
It is often deadly.
I get it, some people find it fun, play with electricity.
Don't go doing that, bad for you.
Considering these treatment methods,
it's pretty obvious we had no clue
of the tiny little microbe causing all the disease.
But in the year 1884,
we would start to hop on the tail of this bacteria.
This is when Giorgio Rattone, and Antonio Carle
(07:43):
would demonstrate tetanus' transmissibility,
this being through the use of rabbits.
But they did not identify the actual problem
causing these tetanus infections.
No, that would be done by Arthur Nicolaier
and the isolation of the tetanus bacterium
along with the first serum
that was capable of counteracting the tetanus toxins,
much like the wound left by a rusty nail.
(08:04):
This one is a bit of a sore spot.
This one, the Nobel Prize, went solely to Emil von Berhing,
but he was not the only one on the project.
No, he was actually actively collaborating
with a Japanese physician
by the name of Kitasato Shibasaburo,
who also happens to have been a co-discoverer
on the cause of the plague.
(08:25):
But of course, when it comes to their work on tetanus,
Kitasato was pretty snubbed.
They were not named as a co-winner of the Nobel Prize.
Now jumping on to less painful points,
the first passively transferred antitoxin for tetanus
was invented in 1897.
This was invented by Edmond Nocard
and was used throughout the First World War.
This would have lowered the numbers of tetanus infections
(08:47):
and tetanus deaths,
but this was not actually the first active tetanus vaccine.
This would come later.
This was actually developed in the year 1923.
This was by bacteriologist Gaston Ramon.
This used the inactivated tetanus toxin
to help prevent tetanus.
I guess you could say no one prevents tetanus like Gaston.
But anyway, if you are enjoying this episode
(09:08):
and think a friend may enjoy it,
then you should share it with a friend,
as it helps us grow.
So what actually causes tetanus?
So tetanus is caused by a bacterium
by the name of Clostridium tetani.
Now the bacteria produces a toxin known as tetanospasmin,
and this is what causes the symptoms of tetanus.
So the Clostridium tetani bacterium
is normally in a dormant state,
(09:28):
where you can find it in the soil or even animal faeces.
I know, joy, don't go peeing in poop.
Now, when you get a wound
that has this bacteria introduced,
the bacteria essentially wakes up
as the wound is a great place for the bacteria to live.
When the bacteria wakes up,
they start growing and multiplying.
They also start releasing the toxin tetanospasmin.
(09:49):
This toxin is what will cause you to have symptoms,
as it impairs the nerves in your body
that are important for the control of your muscles,
as it is a neurotoxin.
But what are the risk factors
for developing tetanus symptoms?
Considering we have a vaccine.
When it comes to tetanus,
the greatest risk factor for developing the condition
after a wound is not being vaccinated against tetanus
(10:09):
or not having a booster in the last 10 years.
So essentially not keeping up to date
with your tetanus vaccinations.
But there are also other risk factors
that also increase the risk of tetanus.
These include cuts or wounds exposed to soil or manure.
This is why we always clean a wound.
If your wound has a foreign body,
so this is something like a splinter
or a nail that is still in the wound,
having a history of immunosuppression,
(10:31):
having an infected skin lesion, if you have diabetes.
We covered diabetes in episode 26,
if you want to learn more about that.
Sharing needles, reusing needles,
and unsanitary needle usage during illegal drug practices.
Doing this not only increases your risk
of developing tetanus,
but many other medical conditions
like hepatitis C, hepatitis B, and HIV.
Having an infected umbilical cord
(10:51):
in the case of a mother who is unvaccinated
or is not fully vaccinated.
Giving birth in an unsanitary place,
especially if you are not up to date in your vaccinations.
How do doctors diagnose tetanus?
When it comes to a tetanus diagnosis,
receiving a diagnosis of this
is primarily based on a medical exam,
physical exam, and your vaccination history.
(11:11):
Along with, you know,
if you have a history of stepping on a rusty nail
or having any sort of history
of something that could cause tetanus
in the past couple of weeks.
As tetanus can occur between three to 21 days
after exposure, most often in the 10 day span.
So, you know, like, oh, I stepped on a rusty nail
and ignored it 10 days ago,
or I've had this splinter for 10 days
(11:32):
and I haven't done anything about it.
You know, I haven't cleaned it,
haven't done anything about it.
So if you are having the muscle rigidity
and pain along with muscle spasms
and are not up to date with your tetanus shots,
then it will be considered.
A laboratory test may be ordered to confirm the diagnosis
if they suspect other conditions as well.
And if there is a wound that is, you know, still open,
they may swab it to test for cultures
(11:53):
along with blood tests as well.
We'll get right into the symptoms and presentation
right after this little break.
(upbeat music)
This podcast is supported by listeners like you
on Buy Me a Coffee.
(12:13):
What symptoms might you have
if you were to have tetanus or lockjaw?
When it comes to tetanus,
the symptoms don't come on immediately.
After exposure, it can take between three to 21 days
to have symptoms.
Although it is most often around 10 days
before your symptoms will appear.
After this incubation period,
there are three different types of tetanus
or lockjaw you can have.
The most common out of these being generalized tetanus.
(12:34):
The symptoms of this type begin gradually
and will worsen over two weeks
or maybe sometimes faster depending on your severity.
Symptoms often begin in the jaw
and progress downwards through the body.
This is why we call it lockjaw.
As you know, it locks up your jaw.
So when it comes to the signs and symptoms
of generalized tetanus,
these signs and symptoms include painful muscle spasms
(12:55):
and muscle rigidity in your jaw.
So this is stiff muscles that feel like you are unable
to move them in your jaw specifically.
This is the first sign.
You may also have a persistent grin or kind of like a smile.
It's not a, you know, happy smile.
It's like one of those weird odd smiles.
This is because the tension in the muscles around the lips,
the tension does not always cause a grin or smile though.
(13:15):
So it may be a grimace or just like, you know,
basically your teeth are always showing.
Painful spasms and rigidity in the muscles of the neck.
Difficulty swallowing, rigid abdominal muscles.
When it comes to the progression of tetanus,
it causes repeated painful seizure-like spasms.
These can last for several minutes at a time.
These spasms usually cause the neck and back to arch,
(13:36):
the legs to become more rigid,
the arms drawing into the body
and the hands closing up into fists.
With this, the muscle rigidity in the neck and abdomen
can cause breathing issues.
With these severe spasms,
they are often triggered by events
that we would consider minor.
These events are stimulating your senses.
Examples of this are stuff like loud sounds,
physical touch, the breeze or a draft,
(13:57):
going across your skin and even just a little bit of light.
With progression of tetanus,
it can cause even more symptoms like high blood pressure,
which is hyper tension or low blood pressure,
which is hypo tension.
Rapid heart rate, this is tachycardia,
extreme sweating and even a fever.
There are other forms of tetanus
rather than just generalized.
However, these are less common.
(14:18):
An example of this is localized tetanus.
So this is tetanus which occurs around the wound,
so it is local to the area,
causing muscle spasms and is usually less severe.
However, it can progress into generalized tetanus.
There is also cephalic tetanus.
So this is tetanus of the head resulting from a head wound.
This is a rare form of tetanus.
(14:38):
This form causes weakened muscles in the face
and spasms of the muscles in the jaw.
Like localized tetanus,
this form can progress into generalized tetanus.
What complications should a doctor be aware of
when it comes to tetanus?
When it comes to tetanus infection,
there are several infections a doctor should be aware of.
These include breathing problems.
During tetanus, especially during a generalized spasm,
there is a possibility for breathing issues to occur.
(15:00):
This being due to a tightening of the vocal cords
along with the muscle rigidity in the neck and abdomen.
Pneumonia, due to the generalized tetanus,
the spasms can potentially cause
inhaling something into the lungs.
This can cause an infection called aspiration pneumonia,
as you aspirate the thing into the lungs.
Essentially, you accidentally inhale the thing into the lungs
like this can be saliva, food, or fluids like water.
(15:24):
Pulmonary embolism.
This is a blockage of one of the arteries in the lung.
This blockage is caused normally by a blood clot
that has traveled from somewhere else into the lungs.
This is potentially dangerous as it can cause a block
in the main artery or one of its branches,
preventing blood flow into the lungs,
also preventing the blood from being oxygenated
and essentially backing up the blood
(15:44):
and increasing the pressure.
This is not good for the lungs or the arteries.
Broken bones.
When you have generalized spasms, these can cause fractures.
These can occur in the spine or in the other bones.
Death.
Tetanus can become so severe it causes death.
Death from tetanus
can be caused from a number of different things.
These include the airway becoming blocked during a spasm,
damage to the nerves that control your breathing,
(16:05):
heart rate, or other important organ functions.
Tetanus can lead to organ failure.
How do we treat tetanus?
When it comes to tetanus,
we primarily focus on the prevention through vaccination.
However, when it comes to a tetanus infection,
there are methods that doctors can use
when there has been exposure or potential exposure
to the bacteria that causes the condition.
When you have, say, stepped on a rusty nail
(16:26):
or does like to expose yourself to tetanus,
doctors may use something called antitoxin therapy.
So this therapy is used to target the tetanus toxin
when it has not affected the nerves.
This treatment can also be known as passive immunization.
It uses the human antibody to the toxin.
There are also other methods to help with tetanus infection
and prevention of infection.
These include vaccination.
If you were just exposed to a potential source of tetanus,
(16:49):
you may be vaccinated again against tetanus,
as this helps your immune system to fight the toxins
that are produced by the bacteria.
So this is done obviously if your vaccination
was out of date or if the wound is severe,
if they don't know when your vaccination was.
You know, sometimes it can be done
if you were vaccinated five years ago,
but there is a high risk of you getting tetanus.
Sedatives.
(17:09):
If you have ended up with a tetanus infection,
using sedatives which slow the nerve function
can help with the muscle spasms that the condition causes.
Antibiotics.
Using antibiotics, which can be given
either through an injection or orally,
may help to fight the tetanus bacteria
causing the infection.
Are there any famous people who have or have had tetanus?
Yes.
(17:29):
However, when it comes to famous tetanus cases
and tetanus deaths, these have not been recent,
which we can be thankful for.
Why?
Because it means the tetanus vaccinations work.
So for the famous case we are going to discuss
is a death from all the way back in 1902.
This being that of Manchester City footballer, Di Jones.
In the case of Jones, he was at a preseason training match
(17:51):
when he fell and his knee was cut deeply,
all the way down to the bone by a piece of glass
that happened to be on the field.
He walked off of the field over to the ambulance,
which took him to the hospital.
Here they wiped off the wound with a rag and stitched it up,
then sent him on his merry way.
Considering that the wound was firstly not properly cleaned,
he got an infection.
There was mud, pus and grass oozing from the wound,
(18:12):
as well as the issue of the tetanus symptoms.
A week and a half after he cut his knee,
Jones, who was only 35 at the time,
would pass away from tetanus.
If you want to check out an episode of a TV show
which features a character with tetanus,
you can check out "Grey's Anatomy" season 10, episode 18.
In this episode, they encounter a patient with tetanus.
In this, it shows some of the symptoms
(18:33):
that a person with tetanus would have.
Now, when it comes to foundations,
there are no nation-based foundations for tetanus.
As in many countries, this condition
has been part of a vaccination schedule,
so we rarely see cases of this condition.
But on a more international scale,
as a way to decrease mortality rates
from various medical conditions,
UNICEF raises funds that go towards vaccination programs
(18:54):
that provide immunization against diseases like tetanus.
If you want to check out the sources,
social media links or any other links,
you can head to anatomyofillness.com.
If you enjoyed this episode and would like to hear more,
subscribe to be notified about our latest episodes.
If you would like to join our community,
you can join us on Discord or Instagram.
Otherwise, stick around for the next episode.
(upbeat music)
Did you know that the toxin produced by the tetanus bacterium
(19:28):
is actually one of the most potent toxins
relative to its weight?
Once inside of the cell, the antitoxin for this
will not actually neutralize the toxin.
This is why preventative treatment is best,
along with treatment at exposure,
rather than treatment at symptoms.
You stepped on a rusty nail over a week ago.
(00:02):
It went pretty deep, but you just brushed it off.
You could still walk and the cut was not bad enough
to even need stitches.
But when you woke up today, you felt strange.
Your jaw felt incredibly tight.
It's causing this strange and painful spasm
in the muscles around your jaw.
You look in the mirror
and you just see this strange grin on your face.
No matter how much you try to move your face, it's stuck.
(00:24):
Concerned, you walk down the stairs
and your wife is just horrified.
You try to calm her down, but you find it difficult to speak.
She decides then to drive you
straight to the emergency room.
(upbeat music)
Hello and Welcome to Anatomy Of Illness.
(00:51):
Today's episode is about tetanus or lockjaw.
Before we get into the condition,
we are going to start with the history.
So why do we know tetanus exists?
But before we get into this episode,
a quick reminder that our Kickstarter
for the next season is live.
So be sure to check that out
as there is only one more episode
after this left of our first season.
We begin with the ancient Egyptians around 1,500 BC.
(01:14):
This being in the Edwin Smith papyrus,
more specifically in the surgical section.
These are when we would have
the first documentations of tetanus.
In the Edwin Smith papyrus description in case seven,
it states, "One who has a gaping wound in his head,
which has penetrated to the bone
and violated the sutures of his skull,
who has a toothache whose mouth is clenched,
(01:35):
who suffers from stiffness in his neck,
an ailment for which nothing is done."
The ancient Egyptians understood
that the cause of tetanus was wound related.
However, there was little knowledge in the actual cause
along with any idea on how to treat the condition
back in those times.
Now we jump forward to Hippocrates in ancient Greece
between 460 to 370 BC.
(01:56):
This is where he would begin to formulate his own ideas
on how to treat tetanus,
like using strong wines and oil soaked clothes,
essentially encouraging the sufferer to just sweat it out.
He would also provide a more accurate description of tetanus
in his work known as epidemics.
In this, he would describe what happened
to a commander of a large ship,
(02:17):
including his case of tetanus.
“The anchor crushed his forefinger
and the bone below it on the right hand.
Inflammation developed, gangrene and fever.
He was purged moderately, mild fevers and pain.
Part of the finger fell away.
After the seventh day, satisfactory serum came out.
After that, problems with the tongue.
He said that he could not articulate everything.
Prediction made, the opisthonos would come.
(02:39):
His jaw became fixed, together then it went to the neck.
On the third day, he entirely convulsed backwards
with sweating.
On the sixth day after the prediction, he would die.”
Now tetanus without treatment is considered to be fatal,
even today, and we see with the two previous cases
that even with the medicines of the past,
that it was likely to have been entirely fatal in cases.
(02:59):
However, with the description of Aulus Cornelius Celsus
in the first century, in his book, De Medicina,
he described people surviving tetanus,
but this is likely to have been instead
other neurological conditions
that were mistaken for tetanus,
due to the fact that tetanus has such a high fatality rate,
basically being 100% when untreated.
Celsus would write,
(03:20):
"There is, however, 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,
now stretches out the neck straight and immobile.
The Greeks call the first opisthotonos,
the next emprosthotonos, and the last tetanus,
although some with less exactitude
(03:41):
use these terms indiscriminately.
These diseases are often fatal within four days.
If the patients survive this period,
they are no longer in danger.
They are all treated by the same method."
As we can see, that this is where
we get the term tetanus from.
The ancient Greeks, who would have come before Celsus,
and according to Celsus, we of course use the term wrong.
(04:01):
Not long after this time,
we would see the works of Areteus of Cappadocia.
He would discuss the horrors of tetanus,
claiming that it would be a blessing
when those suffering from tetanus
had the respiratory symptoms set in,
as this is when they were freed from their pain.
Areteus would also comment on the rigidness
of the limbs of those who had tetanus,
claiming that to loosen them,
you would have to cut off or break off
(04:24):
the limbs of a person living with tetanus
due to the severity of the condition
and the inability to actually help them.
Now, we are going to have a quick detour into the Bible.
Why is that?
Well, to discuss a potential mention of tetanus,
this being in the Gospel of Matthew,
specifically with this extract.
“When Jesus had entered Capernaum,
a centurion came to him asking for help.
(04:45):
‘Lord,’ he said, ‘my servant lies at home
‘paralyzed, suffering terribly.’
Jesus said to him, ‘shall I come and heal him?’
The centurion replied,
‘Lord, I do not deserve to have you under my roof,
but just say the word and my servant shall be healed.”
This is not a super descriptive account
of the state of the servant.
However, there are a few things
we could potentially rule out.
(05:06):
Firstly, rabies, as this would have been claimed
to be more of a demonic possession
due to the agitation and confusion
and potentially aggression.
Along with strychnine poisoning,
now this poison we do not see any mention of
in any records until the ninth century.
This poison comes from a tree in India.
Because of the paralysis and suffering,
it is potentially tetanus,
because this could technically be described in this way.
(05:28):
However, not exactly the most descriptive.
But anyway, moving into the Renaissance.
This is where another new and interesting treatment
for tetanus would come up.
What could this be?
Well, covering a patient in manure.
Yes, fecal matter, poop,
whatever you would like to call it.
But this does not help, so no poo baths for you.
We're going to move forward
onto less smelly pastures and into 1838.
(05:51):
More specifically, the 8th of October, 1838,
over at the Medico-Chirurgical Society of Bologna.
This is with Luigi Carlo Farini.
Here, he would discuss his prior experiment
on a man who was suffering from tetanus after being shot.
Because yes, gunshots can cause tetanus,
'cause bullets are not clean.
Anyway, in an attempt to cure his patient,
(06:13):
Farini would use electrical currents.
This, interestingly enough,
would cause a sort of paralysis in the patient,
but would relieve the symptoms of tetanus,
causing a relaxation of the patient's muscles,
causing the lockjaw to resolve,
and also restoring the circulation within the capillaries.
However, considering we do not electrocute people
who have tetanus,
you can hazard a guess that this was not a cure.
(06:36):
No, the electrical currents
would only relieve the patient's symptoms
for about 30 minutes, and the man would die soon after.
Not from electricity, from tetanus.
But this case would gain international recognition,
and interestingly enough, there would be similar cases,
like that of a woman around 10 years prior
who had developed tetanus because of a medical treatment
(06:56):
causing a blister to form on her chest.
However, she did not die.
Instead, the use of rectal opium and electricity
would allow her to survive the tetanus.
A quick footnote to this case.
Neither of these treatments
are approved treatments for tetanus.
Please do not use opium, it is illegal,
and do not put things up your butt.
Without a doctor's advice, it is not the purpose of the butt.
(07:19):
Also, do not go electrocuting yourself.
It is often deadly.
I get it, some people find it fun, play with electricity.
Don't go doing that, bad for you.
Considering these treatment methods,
it's pretty obvious we had no clue
of the tiny little microbe causing all the disease.
But in the year 1884,
we would start to hop on the tail of this bacteria.
This is when Giorgio Rattone, and Antonio Carle
(07:43):
would demonstrate tetanus' transmissibility,
this being through the use of rabbits.
But they did not identify the actual problem
causing these tetanus infections.
No, that would be done by Arthur Nicolaier
and the isolation of the tetanus bacterium
along with the first serum
that was capable of counteracting the tetanus toxins,
much like the wound left by a rusty nail.
(08:04):
This one is a bit of a sore spot.
This one, the Nobel Prize, went solely to Emil von Berhing,
but he was not the only one on the project.
No, he was actually actively collaborating
with a Japanese physician
by the name of Kitasato Shibasaburo,
who also happens to have been a co-discoverer
on the cause of the plague.
(08:25):
But of course, when it comes to their work on tetanus,
Kitasato was pretty snubbed.
They were not named as a co-winner of the Nobel Prize.
Now jumping on to less painful points,
the first passively transferred antitoxin for tetanus
was invented in 1897.
This was invented by Edmond Nocard
and was used throughout the First World War.
This would have lowered the numbers of tetanus infections
(08:47):
and tetanus deaths,
but this was not actually the first active tetanus vaccine.
This would come later.
This was actually developed in the year 1923.
This was by bacteriologist Gaston Ramon.
This used the inactivated tetanus toxin
to help prevent tetanus.
I guess you could say no one prevents tetanus like Gaston.
But anyway, if you are enjoying this episode
(09:08):
and think a friend may enjoy it,
then you should share it with a friend,
as it helps us grow.
So what actually causes tetanus?
So tetanus is caused by a bacterium
by the name of Clostridium tetani.
Now the bacteria produces a toxin known as tetanospasmin,
and this is what causes the symptoms of tetanus.
So the Clostridium tetani bacterium
is normally in a dormant state,
(09:28):
where you can find it in the soil or even animal faeces.
I know, joy, don't go peeing in poop.
Now, when you get a wound
that has this bacteria introduced,
the bacteria essentially wakes up
as the wound is a great place for the bacteria to live.
When the bacteria wakes up,
they start growing and multiplying.
They also start releasing the toxin tetanospasmin.
(09:49):
This toxin is what will cause you to have symptoms,
as it impairs the nerves in your body
that are important for the control of your muscles,
as it is a neurotoxin.
But what are the risk factors
for developing tetanus symptoms?
Considering we have a vaccine.
When it comes to tetanus,
the greatest risk factor for developing the condition
after a wound is not being vaccinated against tetanus
(10:09):
or not having a booster in the last 10 years.
So essentially not keeping up to date
with your tetanus vaccinations.
But there are also other risk factors
that also increase the risk of tetanus.
These include cuts or wounds exposed to soil or manure.
This is why we always clean a wound.
If your wound has a foreign body,
so this is something like a splinter
or a nail that is still in the wound,
having a history of immunosuppression,
(10:31):
having an infected skin lesion, if you have diabetes.
We covered diabetes in episode 26,
if you want to learn more about that.
Sharing needles, reusing needles,
and unsanitary needle usage during illegal drug practices.
Doing this not only increases your risk
of developing tetanus,
but many other medical conditions
like hepatitis C, hepatitis B, and HIV.
Having an infected umbilical cord
(10:51):
in the case of a mother who is unvaccinated
or is not fully vaccinated.
Giving birth in an unsanitary place,
especially if you are not up to date in your vaccinations.
How do doctors diagnose tetanus?
When it comes to a tetanus diagnosis,
receiving a diagnosis of this
is primarily based on a medical exam,
physical exam, and your vaccination history.
(11:11):
Along with, you know,
if you have a history of stepping on a rusty nail
or having any sort of history
of something that could cause tetanus
in the past couple of weeks.
As tetanus can occur between three to 21 days
after exposure, most often in the 10 day span.
So, you know, like, oh, I stepped on a rusty nail
and ignored it 10 days ago,
or I've had this splinter for 10 days
(11:32):
and I haven't done anything about it.
You know, I haven't cleaned it,
haven't done anything about it.
So if you are having the muscle rigidity
and pain along with muscle spasms
and are not up to date with your tetanus shots,
then it will be considered.
A laboratory test may be ordered to confirm the diagnosis
if they suspect other conditions as well.
And if there is a wound that is, you know, still open,
they may swab it to test for cultures
(11:53):
along with blood tests as well.
We'll get right into the symptoms and presentation
right after this little break.
(upbeat music)
This podcast is supported by listeners like you
on Buy Me a Coffee.
(12:13):
What symptoms might you have
if you were to have tetanus or lockjaw?
When it comes to tetanus,
the symptoms don't come on immediately.
After exposure, it can take between three to 21 days
to have symptoms.
Although it is most often around 10 days
before your symptoms will appear.
After this incubation period,
there are three different types of tetanus
or lockjaw you can have.
The most common out of these being generalized tetanus.
(12:34):
The symptoms of this type begin gradually
and will worsen over two weeks
or maybe sometimes faster depending on your severity.
Symptoms often begin in the jaw
and progress downwards through the body.
This is why we call it lockjaw.
As you know, it locks up your jaw.
So when it comes to the signs and symptoms
of generalized tetanus,
these signs and symptoms include painful muscle spasms
(12:55):
and muscle rigidity in your jaw.
So this is stiff muscles that feel like you are unable
to move them in your jaw specifically.
This is the first sign.
You may also have a persistent grin or kind of like a smile.
It's not a, you know, happy smile.
It's like one of those weird odd smiles.
This is because the tension in the muscles around the lips,
the tension does not always cause a grin or smile though.
(13:15):
So it may be a grimace or just like, you know,
basically your teeth are always showing.
Painful spasms and rigidity in the muscles of the neck.
Difficulty swallowing, rigid abdominal muscles.
When it comes to the progression of tetanus,
it causes repeated painful seizure-like spasms.
These can last for several minutes at a time.
These spasms usually cause the neck and back to arch,
(13:36):
the legs to become more rigid,
the arms drawing into the body
and the hands closing up into fists.
With this, the muscle rigidity in the neck and abdomen
can cause breathing issues.
With these severe spasms,
they are often triggered by events
that we would consider minor.
These events are stimulating your senses.
Examples of this are stuff like loud sounds,
physical touch, the breeze or a draft,
(13:57):
going across your skin and even just a little bit of light.
With progression of tetanus,
it can cause even more symptoms like high blood pressure,
which is hyper tension or low blood pressure,
which is hypo tension.
Rapid heart rate, this is tachycardia,
extreme sweating and even a fever.
There are other forms of tetanus
rather than just generalized.
However, these are less common.
(14:18):
An example of this is localized tetanus.
So this is tetanus which occurs around the wound,
so it is local to the area,
causing muscle spasms and is usually less severe.
However, it can progress into generalized tetanus.
There is also cephalic tetanus.
So this is tetanus of the head resulting from a head wound.
This is a rare form of tetanus.
(14:38):
This form causes weakened muscles in the face
and spasms of the muscles in the jaw.
Like localized tetanus,
this form can progress into generalized tetanus.
What complications should a doctor be aware of
when it comes to tetanus?
When it comes to tetanus infection,
there are several infections a doctor should be aware of.
These include breathing problems.
During tetanus, especially during a generalized spasm,
there is a possibility for breathing issues to occur.
(15:00):
This being due to a tightening of the vocal cords
along with the muscle rigidity in the neck and abdomen.
Pneumonia, due to the generalized tetanus,
the spasms can potentially cause
inhaling something into the lungs.
This can cause an infection called aspiration pneumonia,
as you aspirate the thing into the lungs.
Essentially, you accidentally inhale the thing into the lungs
like this can be saliva, food, or fluids like water.
(15:24):
Pulmonary embolism.
This is a blockage of one of the arteries in the lung.
This blockage is caused normally by a blood clot
that has traveled from somewhere else into the lungs.
This is potentially dangerous as it can cause a block
in the main artery or one of its branches,
preventing blood flow into the lungs,
also preventing the blood from being oxygenated
and essentially backing up the blood
(15:44):
and increasing the pressure.
This is not good for the lungs or the arteries.
Broken bones.
When you have generalized spasms, these can cause fractures.
These can occur in the spine or in the other bones.
Death.
Tetanus can become so severe it causes death.
Death from tetanus
can be caused from a number of different things.
These include the airway becoming blocked during a spasm,
damage to the nerves that control your breathing,
(16:05):
heart rate, or other important organ functions.
Tetanus can lead to organ failure.
How do we treat tetanus?
When it comes to tetanus,
we primarily focus on the prevention through vaccination.
However, when it comes to a tetanus infection,
there are methods that doctors can use
when there has been exposure or potential exposure
to the bacteria that causes the condition.
When you have, say, stepped on a rusty nail
(16:26):
or does like to expose yourself to tetanus,
doctors may use something called antitoxin therapy.
So this therapy is used to target the tetanus toxin
when it has not affected the nerves.
This treatment can also be known as passive immunization.
It uses the human antibody to the toxin.
There are also other methods to help with tetanus infection
and prevention of infection.
These include vaccination.
If you were just exposed to a potential source of tetanus,
(16:49):
you may be vaccinated again against tetanus,
as this helps your immune system to fight the toxins
that are produced by the bacteria.
So this is done obviously if your vaccination
was out of date or if the wound is severe,
if they don't know when your vaccination was.
You know, sometimes it can be done
if you were vaccinated five years ago,
but there is a high risk of you getting tetanus.
Sedatives.
(17:09):
If you have ended up with a tetanus infection,
using sedatives which slow the nerve function
can help with the muscle spasms that the condition causes.
Antibiotics.
Using antibiotics, which can be given
either through an injection or orally,
may help to fight the tetanus bacteria
causing the infection.
Are there any famous people who have or have had tetanus?
Yes.
(17:29):
However, when it comes to famous tetanus cases
and tetanus deaths, these have not been recent,
which we can be thankful for.
Why?
Because it means the tetanus vaccinations work.
So for the famous case we are going to discuss
is a death from all the way back in 1902.
This being that of Manchester City footballer, Di Jones.
In the case of Jones, he was at a preseason training match
(17:51):
when he fell and his knee was cut deeply,
all the way down to the bone by a piece of glass
that happened to be on the field.
He walked off of the field over to the ambulance,
which took him to the hospital.
Here they wiped off the wound with a rag and stitched it up,
then sent him on his merry way.
Considering that the wound was firstly not properly cleaned,
he got an infection.
There was mud, pus and grass oozing from the wound,
(18:12):
as well as the issue of the tetanus symptoms.
A week and a half after he cut his knee,
Jones, who was only 35 at the time,
would pass away from tetanus.
If you want to check out an episode of a TV show
which features a character with tetanus,
you can check out "Grey's Anatomy" season 10, episode 18.
In this episode, they encounter a patient with tetanus.
In this, it shows some of the symptoms
(18:33):
that a person with tetanus would have.
Now, when it comes to foundations,
there are no nation-based foundations for tetanus.
As in many countries, this condition
has been part of a vaccination schedule,
so we rarely see cases of this condition.
But on a more international scale,
as a way to decrease mortality rates
from various medical conditions,
UNICEF raises funds that go towards vaccination programs
(18:54):
that provide immunization against diseases like tetanus.
If you want to check out the sources,
social media links or any other links,
you can head to anatomyofillness.com.
If you enjoyed this episode and would like to hear more,
subscribe to be notified about our latest episodes.
If you would like to join our community,
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Otherwise, stick around for the next episode.
(upbeat music)
Did you know that the toxin produced by the tetanus bacterium
(19:28):
is actually one of the most potent toxins
relative to its weight?
Once inside of the cell, the antitoxin for this
will not actually neutralize the toxin.
This is why preventative treatment is best,
along with treatment at exposure,
rather than treatment at symptoms.
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