Sawbones: Tetanus

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion.

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We came across a pharmacy with its windows blasted out.

Pushed on through the broken glass and had ourselves a luck around.

The medicines, the medicines, the escalate macabre for the mouth.

Hello, everybody, and welcome to Sawbones, a marital tour of misguided medicine.

I'm your co-host, Justin McElroy.

And I'm Sidney McElroy.

And Sid, what a dramatic day we had this week

out in the garden.

I did.

It was quite a perilous situation out there.

I did have a dramatic episode out in the garden that is the ex that's the

inspiration for this week's episode of Sawbones.

So I tend to garden barefoot.

That's not

good.

Good.

Don't do that.

Don't do that.

Even though I do it, you shouldn't do it.

And I shouldn't do it.

I don't have great boots just for this purpose.

I do, but I like to get out in the dirt.

I know we have talked a lot on this show about how grounding in the sense of, you know, actually receiving some sort of electrons from the earth that improve your health.

That's not, that's, that's pseudoscience.

That's not a real medical concept.

But I think it is fair to say that for a lot of us, activities like gardening where you get to dig in the earth can they make you happy.

And it's also fair to say that the sydney that hosts sawbones does not need to be the sydney that works in the garden she contains multitudes folks well thank you embrace embrace embrace it

so i was digging in the dirt digging in my i was actually preparing my squash box which is of course my raised bed that is specifically delic

delicated dedicated

it's a delicated delicata delegated it's a death it's delicate it's dedicated to delicate delicata

we've dedicated dedicated to delicata delicata squash.

And I had smoothed all of my new soil.

It was all prepared for planting, hopefully, this weekend.

And I stood up.

And as I did, I stepped directly on an old rusty screw that was jutting straight up out of the box.

The box had, it was a raised bed, and then it fell.

But then I just used it because it fell like right on the ground, still intact.

And so anyway, I stepped on a screw.

It went right into my foot, my bare foot.

My bare foot, which, by the way,

no, it's like it,

it's going to be a whole thing.

It's a whole thing.

It's going to be a whole thing to get that screw out.

But I had been.

We're not going to get the screw out, are we?

I'm realizing.

You're going to have to cut it.

Like, you're going to have to.

But how do you know where the screw?

Because it's flattened under the box.

Is there like a board where it's jutting

friendly on it?

No, no, no.

I know right where it is because it's on the edge of the squash box.

But I had been walking in my gardening box in the soil as I was smoothing everything out.

So my foot was dirty, covered in not just like, not just I'd been walking in the grass.

I mean, like, this was planting soil.

This was potting soil and mulch.

And so, like, the stuff you're right, the stuff you shouldn't walk barefoot in, I'd been walking barefoot in, and then I stepped on a screw.

And I am.

It's like bread for funkiness.

It is like, it is like engineered to be as funky and full of gunk as possible.

Because the concern is.

the concern here, I want to go ahead and debunk this myth right now.

Is the concern that the screw I stepped on rusty?

Yes, that is the main thing with tetanus is that if it's a rusty metal, then it can give you tetanus.

That's where the rust gives you the tetanus.

Okay, no, that is a myth.

I was not concerned that it wasn't.

Clearly, I was setting up.

You're welcome, by the way, because I can see a trap and I can walk into it just to keep the show moving.

Thank you.

No, I think that the idea that specifically we are talking about tetanus and that specifically the wrist comes with something rusty is usually because it's outside and it's old.

Is that so?

And yes, but it's not the rust itself that's the problem.

It's more the idea that this is something that's been outside for a long time and has then

has dirt particles that might contain the tetanus endospore in them.

That is the bigger concern.

So my concern was not that the screw that I stepped on was rusty.

It was that one, I'd been walking in the dirt.

Two, the screw was also dirty.

Three, it was a deep puncture wound.

That is, it's a dirty, deep puncture wound is the concern.

And that's where I think the rusty nail sort of idea gets in your head, but it's not the rust.

Could you get it from a non-metallic object?

Any deep.

penetrating.

Oh, yeah.

There are lots of different ways to get tetanus, Justin.

Don't worry.

Oh, I'm thrilled.

Wow.

What an exciting episode this is going to be.

So let me just, and I will preface with this.

I am up to date on my tetanus shot, as you may imagine.

They require that in medicine.

And with as much as we talk about vaccines on this show, it would be pretty shocking if I wasn't.

I am up to date, but at the at the tail end of my 10 years, I'm around on the eight-year-ish kind of area.

And so I got really nervous because it was a classic tetanus-inducing type wound.

You got nervous, but also you just love getting vaccines.

I I mean, you love these things.

I do.

And I want to talk, and I will talk a little bit more about, I had some other rationale for this.

But anyway, I did get a tetanus booster yesterday.

My wonderful nurse, Courtney, gave me a booster.

My boss, Matt, was nice enough to order it for me.

So I am still up to date.

I am well protected.

I'm not concerned that I got tetanus, but I can't believe we've never talked about tetanus.

It's one of those sort of classic diseases that have been depicted in art and literature throughout time.

And so I don't know how we missed this.

It feels weird for us.

I know that we've mentioned it, but I glanced off it, but I don't know.

I could not find anywhere in my personal documents or anywhere on the internet where we had talked about just tetanus.

The word comes from the Greek for rigid or tension, and this is related to the symptoms, which you may already kind of be familiar with, but we're going to get into.

Tetanus is caused by a bacterium, Clostridium tetani.

named for the disease that it causes.

And it's mainly, as we talked about, something that happens when these endospores, so the tetanum, the tetanus bacteria is this sort of like long rod-shaped thing.

Okay.

And it can form this little endospore, this hard, hardy little thing inside it that can survive in really extreme conditions and like specifically conditions where there is no air.

So it's an anaerobic bacteria.

Doesn't want air.

And so this is why these deep puncture wounds are the problem, right?

Because it gets, it's deep inside where there is no air.

But these little endospores are the real issue that we're dealing with with tetanus.

Okay.

So basically the endospores thrive in these environments where there is no oxygen.

So you step on something or something gets in you, deep in you somehow, a puncture wound.

And it doesn't have to be metal.

It doesn't have to be your foot.

It could be in your arm or leg or it could be from an animal bite.

It could be from a sting, like an insect sting.

Or from the wrestler

sting or from the singer sting?

No, you're not going to get, I don't, I think the odds of you getting tetanus from the singer sting is pretty low.

Okay, fair enough.

Yeah.

Injection drug use is actually a risk factor.

Higher than sting the size.

For tetanus.

Yes, definitely higher than sting the singer.

But it's some way that you're going to get these endospores deep into your tissues and then they're going to start reproducing because there's no oxygen and they love that.

And so, they look like these little drumstick-shaped things when they have the endospore in them.

They're rods when it's just the bacterium.

When they form that little endospore, they look like a little

way of thinking about this is that they it needs to be implanted.

It is to make it

find purchase.

Yeah, you're implanting it deep within your skin.

And that's again, I think that's the nail thing because it's long, and if you step on it, it's a deep puncture wound.

The symptoms are caused by a toxin that is produced by the tetanus bacteria.

Okay, it is specifically a neurotoxin, meaning it affects your nervous system.

And the way that it does that is it binds onto neurons, which are nerve cells, and it blocks the release of two different kinds of neurotransmitters, GABA and glycine.

To not get too technical, here's the important thing to know.

Neurons can cause a muscle to contract and relax, right?

Nerve cells, it's like the electrical

system for a muscle.

It innervates the muscle and causes it to contract and relax.

Squeeze and release, right?

Tighten and release.

GABA and glycine can stop a contraction and cause something to relax.

So if you inhibit the inhibitors,

you're blocking the blockers.

Then a contraction can't stop.

So what the neurotoxin is doing is when a muscle action is initiated, it can't stop now because of this toxin.

This toxin stops the things that stop, the, which is why you get some, I mean, really impressive muscle spasms and contortions and why you, you see like the classic depictions of tetanus with someone with their back arched or like, you know, sort of bent into an uncomfortable position because their nerves can't stop it.

Their nerves cannot stop that muscle contraction that has occurred.

Okay.

And then the first

like you lose the brake pedal.

Yeah.

You're just going full speed.

Exactly.

Movement.

You're just kind of locked where you're at.

You're locked there, which leads to the first sign, the classic lock jaw, trismus, locking of the muscles of the jaw.

And then you can get trouble swallowing.

Obviously, the muscle spasms anywhere.

The stomach is classic, but I mean, the back can arch.

There's muscle stiffness all over the body.

It can lead to seizures, headache, fevers, changes in your autonomic nervous system.

So like your blood pressure and heart rate can start to be affected.

And it can be deadly in many cases.

What is the speed at which this is like worsening?

Is this like, I know you said between three and 21 days, but like how, how quickly are these symptoms progressing once they start?

They're projecting, or they're progressing pretty quickly.

I mean, once the average is around eight days that you're going to have a lot of these symptoms.

So, I mean, things, things can happen pretty fast, which is why it is necessary to get to supportive care.

pretty quickly if you begin to develop symptoms of tetanus.

And that really accounts for, and we'll get into this later in the show, but the differences we see, especially today in like the case fatality rate, like how likely are you to die from tetanus, it has a lot more to do.

I mean, certainly there are personal risk factors, your own health and age and things like that, but it has a lot more to do with how much access you have to supportive care, to like an intensive care unit, to a ventilator, to things like that.

The more access you have to those things, the more likely you are to survive.

The less access you have, the less likely, unfortunately, you are to survive.

It can be very hard to get the bacteria from the wound.

Most often they don't.

So like, I don't know if I introduce tetanus into my foot.

This is so creepy for me to think about.

I don't know if there's tetanus in my foot right now from stepping on that screw the other day,

but it would be really hard if you stuck a little culture swab up in there to try to get some of the bacteria and then grow.

That sucks to think about.

It does because the hole is very tiny.

It's deep but tiny.

And so you, ooh, it would hurt.

Could you swab the.

Okay, now let me ask you this.

Could you swab the nail?

You could, but again, it would be very hard to, it's hard to grow this stuff.

You can.

I'm not saying it's impossible, but it's just hard.

We don't usually diagnose tetanus by growing it in a Petri dish.

Like we do with many other things, right?

Like if you've got a big old abscess, which boil is like often the colloquial term.

You got a big ol' abscess and we make a hole in it, stick a culture swab in there, a little Q-tip.

rub it on a petri dish and grow it.

I can probably grow staph or strep or whatever's causing that big ol' boil pretty easily.

Okay.

And that's how I'm going to not just diagnose you with what bacteria cause this infection, but I'm also going to test it against a bunch of antibiotics and be like, this is the one that works.

We can't always do that when we see something in medicine.

And tetanus is one of those cases where it's a lot harder to do that.

So we diagnose it mainly on presentation, on the symptoms and the history.

Do you have a, you know, a wound that would make this likely?

There is a specific test that can be used.

You can find like a report of it, a report on it in the American Journal of Tropical Medicine and Hygiene.

So you can see this is not this is not necessarily a test we would do often i was not trained in this in the u.s let me say um but it's called the spatula test

and basically you're going to use some sort of soft tip instrument you can use a when they say spatula they don't mean a kitchen spatula

there is a tool that we use in medicine called a spatula that's like a little uh flat wooden thin and it's kind of uh i don't know shaped like the do you see see the spatula are you looking up a medical spatula yeah it's just like a I mean

we're we're taking a long thin flat object and we're poking the back of the throat that's

so that's the spatula test you okay but when you think spatula you're thinking of the like a wider spatula In my head, like, I don't think of a spatula.

I think a spatula is...

An offset spatula?

Yes, I was thinking offset spatula, which it looks closer to an offset.

It looks closer closer to the metal spatula, yeah.

And they're wooden.

Anyway, the point is you're using an object, you're poking the back of your throat.

This is not a show about spatulas.

It is not.

But a lot of times people say spatula when they mean like a flipper or a fish turner.

That's all I don't want to get on.

I don't want to get on a

case about it.

If I were to do that to you right now, I would expect a gag reflex.

Okay.

Because

if I poke the back of your throat, what we expect to see is an attempt, an involuntary attempt to push the spatula back out.

That's what the gag reflex is.

It's you trying to go like, get out of my mouth.

But the tetanus would keep that from happening.

You'd clamp down on it.

That's when you're worried about tetanus is when they bite you.

So rather than a.

Oh, okay.

Interesting.

I got you.

Yeah.

And it's got a high specificity and sensitivity, too.

So it's a pretty good test if you have no idea if somebody has tetanus or not and you're not really sure.

This could be a good test to each.

So that's fun.

You could just walk up to people and do that.

Like, real quick, would you like to know if you have tetanus?

Like, I could tell you pretty authoritatively.

I wouldn't recommend doing that.

Okay.

I mean, without, I mean, obviously, you want to obtain consent before any medical test or procedure.

Yes.

Or

anything, really.

Anything.

Anything.

That's our policy.

And if that's like too restrictive, that's fine.

We're okay with being

consent for everything.

Just be, yeah, obtain consent for everything.

And especially, like, I mean, like, in this case, specifically, I'm saying, like, I'm gonna, I'm gonna stick this thing in your mouth.

Yeah.

Like, now, I didn't actually feel like it would be a good way to like pass the time to do, it was kind of more of like a goof of the show.

Like, I don't really think that we should be

doing random, random tests.

This is a hard thing.

This really butts up against something, though, that's hard for us.

Not use the butt.

That is not an ideal.

No, that's hard for our kids to understand.

Cause I will say it is not uncommon for Cooper to walk up to me and she has something in her hand and she's like, Open your mouth.

And I'm like, No.

She's like, No, trust me.

No, I don't.

See, I love you very much, but I don't know what it, and it could be a piece of candy and it could be wonderful, or it could be an Oreo with mayonnaise on it, which they got me with once and now they try to do again.

No, thank you.

I don't care.

Make boo-boo-eyes all you want.

I'm not eating another mayonnaise Oreo as long as I live.

Or it could be that I have COVID and I can't, I've lost my taste and I can't taste anything.

And so we think it's funny to make mommy drink things that are gross, including mouthwash.

Yeah.

Which mommy couldn't taste, but mommy felt the burning.

That was

what was in that.

What a, what a, what a, what a, what a challenging time that was.

It was a challenging time.

It was a challenging time when the kids were making you drink mouthwash, you know?

It was just a tiny bit of mouthwash.

I don't want anyone to think that was.

I wasn't warm.

Our kids are just a tiny bit bad.

No, they didn't know.

They didn't know.

To be fair, it led to a really great conversation as to why you don't drink mouthwash,

why it's dangerous, and please don't do this.

So, Justin, we've kind of gone through tetanus, what it is, and

why we're concerned about it.

Obviously, these symptoms are very severe.

And as I have alluded to,

depending on where and when in history you have gotten this disease, you can die from tetanus, and many people have.

How long have we known about it?

At least 80 years.

Longer than that, Justin.

Okay, 100?

Much longer.

You can 100 years.

No, much longer.

I'm going to let you contemplate that while we go to the billing department.

It can't be longer than 6,000.

I'll just say that.

Just, it can't.

Just think about it.

This is a science show.

The medicines, the medicines that escalate my gods for the mouth.

Justin, you know who I'm thankful for today?

Who are you thankful for, Tony?

I am thankful for Courtney, who's the nurse I have the pleasure of working with every day in my job.

And coming up, we should all show thanks to the nurses in our life, whether you're like me, you're a physician who works with a wonderful nurse every day, or you have a nurse in your family or a friend, because nurses week is coming up.

And you know a great way to show thanks to the nurses in your life?

I have a guess, but go ahead.

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I cannot stress how many pockets and how important having a lot of pockets.

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I know that's not typically a doctor tool, but it is for me.

And fig scrubs have exactly the kind of scrubs that you want to wear for a long day in the hospital, in your clinic, wherever you work.

Yeah.

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Happy Nurses Week, Courtney.

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You know, we've been doing my brother, my brother me for 15 years.

And

maybe you stopped listening for a while, maybe you never listened, and you're probably assuming three white guys talking for 15 years, I know where this has ended up.

But no,

no, you would be wrong.

We're as shocked as you are that we have not fallen into some sort of horrific scandal or just turned into a big crypto thing.

Yeah, you don't even really know how crypto works.

The only NFTs I'm into are naughty, funny things, which is what we talk about on my brother, my brother, and me.

We serve it up every Monday for you if you're listening.

And if not, we just leave it out back and goes rotten.

So check it out on Maximum Fun or wherever you get your podcasts.

All right, we're over 70 episodes into our show.

Let's learn everything.

So let's do a quick progress check.

Have we learned about quantum physics?

Yes, episode 59.

We haven't learned about the history of gossip yet, have we?

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Same episode, actually.

Have we talked to Tom Scott about his love of roller coasters?

Episode 64.

So how close are we to learning everything?

Bad news.

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Woo!

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Join us every other Thursday on Maximum Fun.

Sydney, unless I missed my guess, you were alluding before the break that we have known about tetanus for upwards of 300 years.

Is that possible?

Much longer.

We have known about tetanus

since ancient times.

I think it's another one of those.

800 years.

We talk about these diseases sometimes on sawbones where if something has really obvious, dramatic clinical presentation, like symptoms, signs and symptoms that are very dramatic,

we can kind of trace that history back further because even before people were calling it tetanus necessarily, and certainly long before we knew why it happened.

If memory serves, it's been a while.

Like epilepsy was one of those where like that's even one that, where it's like obviously not addressed in an appropriate way, but like there's, there's allusions to, you know, seizures, things like that, like biblically and stuff like that.

It's very exactly it.

Not to say that epilepsy is the only thing that causes sutures, but still.

No, no, but that is a good example because tetanus similarly can have very dramatic symptoms.

And so we've been documenting those symptoms for a very long time.

There are some descriptions from ancient Egypt where they talk about,

here's one, 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, who suffers from stiffness in his neck, an ailment for which nothing is done.

This is a patient with lock jaw resulting from a penetrating wound, probably, probably tetanus.

And some of those writings date back to like 3000 BCE.

So we have very, very ancient writings.

There is some thought.

I found some descriptions as I was reading about the history of tetanus that there are biblical references, possibly.

By the way, as you mentioned, epilepsy, there are, but I mean, there's a lot of, there gets to be a lot of debate when it comes to, is this a biblical reference to this disease I would guess though even if you're just using

If there was a disease where I think anything where you lose control of like your body or things like this where some sort of it would look like you were being tortured or something like that like I feel like that always gets tied with possession, you know a lot.

Exactly.

And I think because a lot of those writings are seen through that lens, it can be really hard.

I mean, these are not clinical descriptions, right?

We're not, we don't have like a scientist who's trying to very clearly like document objective truth, like here is what I'm seeing without any sort of editorializing.

If you have writings that have a purpose, if they're trying to convey a spiritual or faith-based understanding of the world,

they're probably not going to be.

That's not your right.

We also see Hippocrates wrote a very early description of tetanus in which he describes the commander of the large ship.

the anchor crushed his forefinger and the bone below it on the right hand.

Inflammation developed, gangrene, and fever.

He was purged moderately.

So, we get into some of the treatments, by the way, in this description as well.

So, it would be very common in the Hippocratic tradition because we believed in the four humors.

You got to balance your four humors.

And so, making someone either puke or poop would be a very common treatment or pee, something, just get something out.

Bleeding, obviously, just free some of the humors to balance them out better.

Mild fevers and pain, part of the finger fell away.

Oops.

After the seventh day, satisfactory serum came out.

This was, again, a belief of the time that if you could irritate a wound and make stuff come out of it, that this was a good thing, that pus was a good thing, not necessarily.

After that, problems with the tongue.

He said he could not articulate everything.

So we're starting to see lock jaw.

We're starting to see the symptoms of tetanus develop.

Prediction made

that

opasthodinus.

Really clean.

I'm having, I should just say, I'm having a lot of trouble pronouncing this word.

Okay, yeah.

Opasthodanus.

Okay.

That's like the arching of the back.

Rachel, please leave all of that in.

Otherwise, none of this will make any sense.

Okay, so it was.

Opisthodonus.

One more time.

Prediction made that opisthodonus would come.

His jaws became fixed together.

Then it went to the neck.

On the third day, he was entirely convulsed backwards with sweating.

On the sixth day, he died.

So, I mean, you see, this is a pretty good description.

There you go, like an objective.

Here is the order of events.

I like that Hippocrates is like prediction.

He's like doing the like Johnny Carson thing with the envelope.

Like he just wants everybody to know what's happening.

Celsus went on to describe.

And I think, again, this probably, this description, tells you why we have so many documentations of this throughout history.

He writes, there is, however, no disease more distressing and more acute than that 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.

So you can see that's a very distressing, like your body being contorted against your will.

You're clearly in a lot of pain.

You can see why so many people took the time to write and draw and paint.

Because there's no disease more distressing than this.

Like that's got to be pretty intense because I bet a lot of stuff was distressing back then.

And he writes, these diseases are often fatal within four days.

So there gives you an idea of how fast tetanus can progress.

If the patients can survive that, they're no longer in danger, but often they couldn't.

And then they treated with bloodletting.

So these were a lot of the, you know, a lot of the common treatments of the time, in addition to the purging and the pooping and the bloodletting.

You would try to wrap them in oil-soaked cloths,

drink strong wines.

In ancient China, they might put needles around the patient's ears.

That was a common treatment.

In the Renaissance era, they would cover you in manure, which would be

bad.

But

there wasn't necessarily a lot of progress made in terms of what is tetanus, why is it happening?

We definitely, by the 19th century, had this concept that wounds can lead to tetanus.

Now, obviously, there are other ways to get tetanus, but then by and large, the association that some sort of wound can then cause these muscle nervous issues.

That was definitely known.

And then as you move into the 1800s, you start to see a lot of like battlefield depictions of it, tying it even more closely to somebody who's been wounded.

Right.

That makes sense.

Like, you know, because a penetrating wound could often result from some sort of battlefield injury.

And as always, war provides such a great laboratory for quickly repeating these sorts of experiments.

Like it makes it really easy to trace the last time you were punctured with something.

That's, that's exactly, Justin, you're exactly right.

And that's why we have so many medical and surgical developments that come from the military, that come from the battlefield.

And that led to

following the Battle of Waterloo, Scottish physician, Sir Charles Bell.

Yes, that bell.

Of Bell's postulates?

No, not postulates.

Bell's.

Coke was the one with the postulates.

Coke had the postulates.

Bell had a palsy.

Bell has a palsy.

All right.

Yes, that bell of palsy fame.

Thank you.

Dr.

Charles, or Sir Charles Bell.

Doctor, sir.

Sir, Dr.

Charles Bell.

Doctor, sir.

What do you think he preferred?

Doctor or sir?

I don't know.

Either way.

He's home late for dinner, right?

He was one of the physicians who were attending to

people recovering after the Battle of Waterloo, and he painted a soldier with tetanus in 1809.

And you can look up this

Opisthodonus is the title of the painting by Charles Bell.

So just the way Sydney's pronouncing it?

I had to practice this so many times.

And he, and you can see a very,

this depiction of tetanus, I've seen so many times in my medical education.

Doctors really love when somebody like took the time to like paint a disease.

And then we can be like, look how old this disease is.

Here's a soldier.

Can I say something, though, if you think about it?

you could think about having a depiction like this would actually serve a practical purpose too, right?

Because we didn't have photography.

The written word is only so good.

If you have a very evocative way of saying this is tetanus, that I have a saying that I came up with that a picture is worth a thousand words.

Oh.

That's a really clever saying, Justin.

You came up with that?

A painting is worth.

at least 10 times that because someone had to do it all, you know?

I know.

He had to do it all.

Yeah.

He had to do this whole painting, and you can look it up.

It's a wonderful depiction of tetanus.

That sounds weird to say.

Like, it's not wonderful.

It's, I mean, it's sad.

Like, the guy looks like he's in pain, but it's a very accurate, how about that?

Accurate depiction of tetanus.

Although, typically my patients, when I'm caring for them, aren't naked.

So.

Well, yeah, maybe that's for the painting.

I don't know.

That's probably just for the arts, the art part.

But that's for the, well, no, maybe also more importantly, though, for the

musculature.

The musculature.

Yeah, to show the rigid.

Yeah, the contracted muscles.

Now, what was hard is asking that guy to just not move.

Just please stay exactly like that, please.

Well, it probably wasn't hard, Justin, because he couldn't.

Oh, that's true.

Yeah.

Oh, that's a good point.

Maybe it was just that he made a perfect subject.

Yeah, maybe it's like, I have to paint you.

I'm sure this sucks for you.

He was documenting it for medical rigor for the halls of academia.

There was, so like I said, there was not a ton of progress made in what we do with it.

I did read this great account of a physician, Luigi Farini, who back in 1838 presented to the Medical Surgical Society of Bologna that he was treating tetanus using electricity.

And this, and that it would relieve the spasms.

I found this kind of fascinating because, I mean, I guess that that could work, right?

Like if you're counteracting, I mean, you're shocking.

Your nervous system is not, I mean, it's similar.

So, like, you're, you're shocking.

Like, we know that we can affect the body through shocks.

That's how we

try, right?

Like, that's how we try to jumpstart and restart and fix the heart when it's in a series of different electrical malfunctions.

So, anyway, muscle, like, for pain and stuff like that, people use those little shocky things.

Yeah, electric stimulators, and we do testing, do nerve conduction studies, and electrodes.

And anyway, so that, I mean, I, he's, he's kind of hitting on something, um, the idea that it has something to do with the nerves.

But unfortunately, doing something like that, even if it does relieve a contraction, what he documented is that it only lasted about 30 minutes and then you're right back into tetanus.

But it was a very interesting and probably helped further elucidate what was happening with tetanus.

It wasn't until 1884 when doctors Carly and Ratone did infections where they basically took pus from a person who had had tetanus from the wound and they injected it into rabbits and the rabbits developed tetanus and they were able to isolate from these rabbits Clostridium tetani, the bacteria that we knew eventually, you know, caused tetanus.

Even at that point, all that they were doing was saying like there's something in here that causes tetanus.

It wouldn't be until Arthur Nicolier.

looked at that under a microscope and was able to further elucidate what exactly is this bacteria.

I mean, it's like a lot of things.

We see this sort of

domino effect.

Yeah, like our technology, our understanding gets better, and also the equipment gets better.

And so the equipment improves the understanding.

Yes.

We didn't actually isolate the actual agent.

So we kept seeing things.

We kept being able to transmit things.

The actual agent was isolated by a Japanese physician,

Dr.

Shibasa Burrow.

And he was also, by the way, one of the co-discoverers of the bubonic plague.

Ooh.

Yeah.

Along with Alexandre Yerson, which is why it's called Yersinia pestis, by the way.

But anyway, the point is, this is where we're into like the late 1800s before we really

understand this is what causes tetanus.

Here it is.

We've named it.

We know what it is.

We know how it happens.

We know there's a toxin.

What do we do about it?

And in 1890,

we see a group of German scientists who are able to produce the first serum that can counteract tetanus toxins.

And the way we do that is if we have somebody with tetanus, we can take some of their the serum from their blood and isolate the things that are counteracting the part of the blood.

Like if you separate out like the cells, the rest of the stuff, the plasma, the stuff that's in the blood that isn't like the red blood cells and all the other cells.

We're looking for all the other things that are floating around in there.

So if you have somebody with tetanus, you can find like antibodies against it, right?

Or antitoxins in this case, things that are fighting the Texas, the tetanus, not the Texas toxin.

Texas toxin.

Texas toxins.

That's what they always call tetanus.

The Texas toxin.

And that was for a while.

Like if we look to World War I, again, a lot of people develop tetanus as a result of battlefield wounds.

You see a lot of people.

treated with this passive antitoxin.

So like basically we

we found it in humans and so then we started injecting tetanus into horses and then getting serum from the horses with the antitoxin in it that they naturally developed because they were exposed to it.

And then giving that serum to people who were infected with tetanus.

Does that make sense as a way of, and I will say today, even though this isn't something where I'm going to get from a horse, we can treat somebody with tetanus antitoxin, IVIG, so IV immunoglobulins against tetanus.

That could be a treatment.

So let's say that I had been, especially with the wound that I got the other day, if I had not been vaccinated against tetanus ever, so I was completely non-immune, and I waited longer, I might have gone to the ER and said, like, this happened to me, and they may have given me tetanus IVIG, which is very similar to what they were doing back in World War I.

But again, this is sort of a reactive thing.

We're not preventing tetanus at this point.

That wouldn't be until we found a way to isolate just the toxin, the tetanus neurotoxin that causes causes the problems, and inactivate it, creating a toxoid.

Great word.

Yeah, with formaldehyde.

So we take the toxin, we inactivate it with formaldehyde, we create the toxoid, and the toxoid vaccine is what we still use to this day.

Amazing.

Yes.

And that was in 1923 by Dr.

Ramon.

Okay, just,

okay, I thought as much.

It looks like toxoids are in Metal Heroes and

Stellaris and World of Warcraft has a character named Toxoid.

I just wanted to make sure that the word toxoid, enough people had heard that and thought, I'm going to name something toxoid.

So yes, a lot of things have been named toxoid.

Thank you, human race.

You rule.

And it really, like,

after we introduce this vaccine, and we see a lot more studies to refine it, like it has an aluminum adjuvant in it.

And the reason is because it's much more effective and it is completely safe.

So when you hear about things like there's aluminum in a vaccine, it's because it makes the vaccine work better and because we've also done extensive trials to say that putting an aluminum in a vaccine in tiny amounts is safe and makes it work better and protects you from getting it.

And there's also iron in your Wheaties.

Calm down.

In 1948, we first put the tetanus vaccine in a combined vaccine with diphtheria, toxoid, and pertussis,

whooping cough.

Yep.

The T-DAP or D-tap.

We'll get to those.

I'm going to tell you.

Hold on.

Okay.

We introduced them into routine childhood vaccines in the late 40s.

At that time, there were between 500 and 600 cases in the U.S.

each year.

Okay.

True.

After the 40s, we saw them drop precipitously because, you know, vaccines.

There were about 50 to 100 cases by the mid-70s.

And as of

last year, there were about 30 cases.

There were about 15 the year previous.

So you can see very few cases in the U.S.

at this point.

At this time of recording, I feel like things changed so quickly.

Every state still requires children to receive their series of

DTAPs, which is

April 25th, 2025.

Right.

But we can see that not only have we watched cases of tetanus drop precipitously, but we are much better at managing it now.

There were

in 2018, we had 23 cases and no deaths.

We have very few deaths from tetanus tetanus now.

In the U.S., because we do in most places, not all, but in most places, you do have the availability of an intensive care unit, a ventilator, supportive medications, and all the things that we do to help manage tetanus.

The fatality rate is 10% or lower.

In other parts of the world, I just should clarify, it can be much higher.

It depends on if you can access those supportive services, those supportive resources from healthcare while your body is going through sort of the hype.

to to like get a shot like because you obviously got your shot the day after you got the it is what's like the countdown it's recommended that if uh you need a booster if you get a wound like that and you need a booster it's recommended you get it within the first 48 hours now i will say we have up to 21 days following an exposure to give you the vaccine or the ivig we have a long

But once it takes a long time for things to develop.

But once the symptoms develop, you need to get to the hospital because you're probably going to require some amount of supportive care to get you through this, which we are capable of doing in many, many, most cases, but not all.

And certainly in other parts of the world where you don't have easy access to an ICU,

we see a higher fatality rate because of that.

The most important thing you can do is get your...

tetanus vaccines, your toxoid vaccines on this recommended schedule.

So Justin, you asked specifically in kids, they get get the D-tap.

This has to do with

how much of different like

things are in there.

Diphtheria, tetanus, acellular pertussis.

That's what D-tap stands for.

And in children, the D-tap is what they get.

So

at two months, four months, six months, you get another booster at 15 through 18 months and another booster four to six years.

Okay.

That's that's where that's when the D-tap comes into play.

Now, for all of us adults and preteens, so so you're going to get a T-DAP.

At 11 or 12, you're going to get your first T-DAP.

And then from then, it's every 10 years.

You can either get a T-DAP or a TD, which is just tetanus diphtheria.

Now,

why am I suggesting that a T-DAP is what I wanted and what I received?

I don't know.

On a side note, pertussis is part of the T-DAP.

as we have discussed, right?

And the

pertussis, which is whooping cough, we've done an episode on pretty recently.

The immunity to pertussis, even though we still say you should get your TDAP every 10 years,

the immunity to pertussis may wane sooner.

To tetanus, it's pretty good at 10, but it's going to last you those 10 years probably.

For pertussis, there's a little more variability, and your immunity to whooping cough may be gone as early as five years.

You may last up to that 10 years, but it may be five years.

There are currently outbreaks of whooping cough in many places in the country.

Specifically, there's been one in West Virginia.

I had already been debating since I was coming up on my 10 years and I was getting closer.

Should I just go ahead and get that T dap booster a little early for the pertussis component?

Obviously, this puncture wound tipped me over the edge and said, just go ahead and get the T DAP.

For me, every 10 years, I'm going to keep getting the T-DAP.

and keep that pertussis booster in there because we are seeing more and more cases of whooping cough.

And while it certainly does not have the fatality rate that tetanus does by any stretch, I'd rather not get whooping cough.

And I certainly don't want to communicate it to somebody who may be more medically vulnerable than myself to something like that.

So if you are not sure, if you get a puncture wound and you don't know when your last tetanus booster was, it is safe to go get one.

If it's been to, I have received tetanus boosters early multiple times because of pregnancy.

That is safe to do.

If you go to the ER and they say, we think you need a tetanus shot, have you had one within the last 10 years?

And you have no idea,

it is safe to opt and get a tetanus booster.

Now, obviously, if you have concerns, ask your health care provider.

If you have allergies to certain vaccine components, please discuss that with your healthcare provider.

There are reasons at times why people are allergic and can't get the TDAP.

And so, certainly, I'm not advising you to if you're allergic to it.

Good call.

Yeah.

Don't take things or get receive things that you're allergic to.

We've been very consistent about that.

Yeah, on solvents.

But it is definitely something.

And I will say, people who are pregnant also get the T-DAP vaccine, again, for the whooping cough component.

But that's a nice little boost that you also get your tetanus

in the same shot.

So that's the most important thing.

You don't have to get tetanus.

The vast majority of people who do get tetanus are because they either were not immune to tetanus, they never got a vaccine, or they've fallen behind on their immunization schedule.

Thank you, Sydney, for that update.

And thank you for staying up to date date on your boosters.

As somebody who really relies on you every day, I'm happy you're taking care of yourself.

Well, no problem, Justin.

I really, I really don't want to get...

It does look very dramatic, you know?

I do like drama.

Easier ways to get attention.

Yeah, but I would rather get attention in a more positive way.

Thank you so much for listening to this program.

May 3rd is coming up very soon.

We're going to be at the Harmony House Wren Fair.

It's at Harris Riverfront Park.

You can get tickets at bit.ly forward slash harmony house wren fair with an e

you can go there and get tickets we're going to be doing a live sawbones we're going to be doing some signings uh for the adventure zone and for for uh all the information go to bit.ly forward slash harmony house ren fair get tickets it's gonna be a lot of fun Yeah, it's gonna be so much fun.

Please, everybody, if you can, come.

I mean, it's gonna be such a big event.

My mom is organizing it, and it's gonna be quite the to-do.

Thanks to taxpayers for the use of their song Medicines as the intro and outro of our program.

And thanks to you for listening.

It's going to do it.

Until next time, my name is Justin McElroy.

I'm Sidney McElroy.

And as always, don't drill a hole in your head.

All right.

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