Stuff You Missed in History Class: Tetanus
Hosted by Holly Fry and Tracy V. Wilson
Release Date: May 12, 2025

Introduction to Tetanus

In the episode titled "Tetanus," hosts Holly Fry and Tracy V. Wilson delve deep into the history, biology, and societal impact of tetanus—a disease that has plagued humanity for centuries but remains a significant health concern in certain parts of the world.

Holly Fry opens the discussion by setting the stage:

"Tetanus has probably been around for most of human history, possibly even longer." [05:20]

Ancient Descriptions and Early Understanding

The conversation begins with an exploration of tetanus in ancient medical texts.

Tracy V. Wilson references the Edwin Smith Surgical Papyrus, dating back to around 1500 BCE, describing a patient with symptoms resembling tetanus:

"His mouth is bound, both his eyebrows are drawn, while his face is as if he wept." [06:05]

Holly Fry adds context, clarifying that while the papyrus describes symptoms similar to tetanus, some manifestations like bleeding from the ears or nose were likely due to head trauma rather than the tetanus infection itself.

"Tetanus doesn't cause bleeding from the ears or nose. That was probably a product of the patient's head trauma, not the tetanus that followed it." [06:05]

Further, they discuss the Sashruta Samhita from around the 6th century BCE, a foundational text of Ayurvedic medicine, which describes a disease analogous to tetanus:

"This disease rarely yields to medicine and is cured in rare instances only with the greatest difficulty." [07:47]

Tracy also touches upon the Yellow Emperor's Classic of Internal Medicine, noting that while it doesn't explicitly mention tetanus, its descriptions align closely with tetanus symptoms:

"Opisthotinous stiffness in the back, convulsive spasms, paleness, and spontaneous sweating. Once that sweating stops, the patient dies." [08:42]

Greek and Roman Contributions

The hosts highlight Hippocrates' detailed accounts of tetanus in his treatises.

Holly cites Hippocrates' description:

"Jaws are fixed and he is unable to open his mouth. His eyes shed tears and look awry." [09:36]

Tracy elaborates on the different types of tetanus Hippocrates identified, emphasizing the severity and often fatal outcomes of the disease:

"He described this disease as severe and requiring immediate attention and in many cases, fatal." [10:31]

Tracy also references Roman author Aulus Cornelius Celsus' depiction of tetanus:

"There is no disease more distressing and more acute than that which by a sort of rigor of the sinews..." [11:35]

Medieval to Early Modern Period

The discussion moves through centuries of European medical understanding, noting that treatments largely remained symptomatic and ineffective.

Holly remarks on the continuity of tetanus descriptions:

"Many physicians based their work on Hippocrates. Even if Hippocrates wasn't cited, they still usually described tetanus as following a wound." [12:08]

19th Century Breakthroughs

Significant advancements in understanding tetanus arose in the 19th century.

Tracy discusses Luigi Carlo Ferrini's 1838 experiments with electricity in treating tetanus:

"The application of direct current to the body of a patient who had developed tetanus after a gunshot wound seemed to interrupt the spasms." [17:04]

Holly and Tracy continue by highlighting Antonio Carle and Giorgio Rittone's 1884 experiments demonstrating the contagious nature of tetanus in animals, even though tetanus itself isn't transmitted person-to-person:

"Clostridium tetani can survive freezing and being autoclaved at high temperatures." [18:34]

Tracy introduces Arthur Nicolier, who identified the tetanus bacillus in soil:

"He concluded that the bacillus produced a poison that acted similarly to strychnine." [19:16]

Kitasato Shibasaburo and Emil von Behring’s Contributions

The episode underscores the pivotal work of Kitasato Shibasaburo and Emil von Behring in isolating the tetanus bacillus and developing antitoxins.

Holly explains Kitasato’s challenges and breakthroughs:

"Clostridium tetani is an anaerobic microorganism. So doing this required Kitasato to develop new methods for growing bacteria while also keeping them isolated from the air." [20:33]

Tracy details their collaborative research:

"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 bacillus produces." [21:26]

Holly further describes their experiments:

"Every rabbit remained healthy. These rabbits could withstand a dose of toxin that was 20 times higher than what it would take to kill an untreated rabbit." [22:02]

Despite their groundbreaking work, von Behring received the first Nobel Prize in Physiology or Medicine in 1901 solely for his work on diphtheria, with no mention of Kitasato’s contributions.

"Since the Nobel Prize committee was focused on diphtheria and not tetanus, Kitasato was not included in the award or mentioned in the speech." [23:09]

World War I and the Rise of Antitoxin Use

The narrative transitions to the application of tetanus antitoxins during World War I.

Holly recounts the severe impact of tetanus on soldiers:

"There had been 505 reported cases during the U.S. civil War with a mortality rate of 89%." [25:32]

Tracy emphasizes the advancements made by Edmond Nocard in producing and distributing antitoxin serum:

"By 1918, the institute had nearly 1,500 horses, producing more than 600,000 vials of antitoxin per month." [31:10]

Holly discusses the treatment protocols developed:

"Treatment started with treating the wound itself, excising all wounds and removing all the damaged tissue, ideally within 12 hours of the injury." [32:48]

They highlight the effectiveness of antitoxins in reducing tetanus cases among soldiers:

"By the end of the war, tetanus rates among injured soldiers had been almost completely eliminated." [36:45]

Development and Impact of the Tetanus Vaccine

The discussion moves to the creation and implementation of the tetanus vaccine.

Holly introduces Gaston Ramon's development of the first tetanus vaccine in 1924:

"This vaccine is known as tetanus toxoid. A toxoid is a toxin that's been inactivated so that it's no longer dangerous." [36:45]

Tracy explains how the vaccine works and its widespread adoption during World War II:

"During World War II, tetanus toxoid became a routine vaccine administered to soldiers, and then it became more widely available to the general public after the war was over." [37:10]

Decline of Tetanus in Developed Countries

With the introduction of vaccines, tetanus cases began to decline sharply in wealthier nations.

Holly notes:

"Deaths from tetanus have decreased by 99% in the US since 1947." [37:47]

Tracy discusses the current state of tetanus prevention:

"Today, the World Health Organization recommends a six-vaccine series that stretches over a person's infancy, childhood, and adolescence." [39:14]

Persistent Challenges and Global Impact

Despite significant progress, tetanus remains a major health issue in poorer regions and in specific contexts.

Holly points out that tetanus cannot be eradicated due to its ubiquitous presence in soil and resilience of its spores:

"Tetanus spores are basically all around all the time, and recovering from tetanus doesn't make you immune to it later on." [39:14]

Tracy highlights the ongoing challenges faced in eliminating maternal and neonatal tetanus:

"Even with the success of the Maternal and Neonatal Tetanus Elimination Initiative, around 25,000 newborns still died of neonatal tetanus in 2018." [42:08]

Conclusion

Holly and Tracy wrap up by emphasizing the importance of continued vaccination efforts and public health initiatives to combat tetanus, especially in vulnerable populations and regions lacking robust healthcare systems.

Tracy reflects on the global efforts:

"Between 1998 and 2018, tetanus rates in newborns dropped by about 97% around the world thanks to these programs." [42:08]

Holly concludes:

"The closest thing to eradication is ensuring broad vaccine coverage so that people who are exposed to tetanus bacteria don't develop the disease." [39:14]

Notable Quotes

• "Tetanus has probably been around for most of human history, possibly even longer." — Holly Fry [05:20]

• "This disease rarely yields to medicine and is cured in rare instances only with the greatest difficulty." — Tracy V. Wilson [07:47]

• "There is no disease more distressing and more acute than that which by a sort of rigor of the sinews..." — Aulus Cornelius Celsus [11:35]

• "Every rabbit remained healthy. These rabbits could withstand a dose of toxin that was 20 times higher than what it would take to kill an untreated rabbit." — Holly Fry [22:02]

• "By the end of the war, tetanus rates among injured soldiers had been almost completely eliminated." — Tracy V. Wilson [36:45]

• "Deaths from tetanus have decreased by 99% in the US since 1947." — Holly Fry [37:47]

• "Tetanus spores are basically all around all the time, and recovering from tetanus doesn't make you immune to it later on." — Holly Fry [39:14]

This episode provides a comprehensive overview of tetanus, tracing its historical accounts, scientific breakthroughs, and the ongoing efforts to combat it globally. Through engaging dialogue and detailed research, Holly and Tracy illuminate the strides made in understanding and preventing tetanus, while also shedding light on the areas that still require attention.