Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Tetanus

Episode Date: April 29, 2025

It's a myth that tetanus is only found on rusty metal. What really matters is that a wound that is a dirty, deep puncture wound could to introduce the bacteria into the body. Dr. Sydnee and Justin talk about the long history of humans and tetanus, what it does to a body, and why maybe it's not a great idea to garden barefoot.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/National Immigration Project: https://nipnlg.org/about/who-we-are

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Alright, this one is about some books. One, two, one, two, three, four.

Two, three, we came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm.

We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm.

We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. We came across a farm. Hello everybody and welcome to Sawbones, a marital tour of misguided medicine. I'm your co-host, Justin McElroy. And I'm Sydney 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's the inspiration for this week's episode of Sawbones. So I tend to garden barefoot. That's not 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. You have any 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 of actually receiving some sort of electrons from the earth that improve your health, 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, they make you happy.

Right? 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 god. I was actually preparing my squash box, which is of course my raised bed that is specifically delicate

Delicated dedicated talk. It's a delicate and delicata delegate it. It's a death. It's delicate It's dedicated to delicate delicata delegated. It's dedicated to delicate delicata. We've dedicated it. Dedicated to 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 said 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 went right into my foot my bare foot my bare foot, which by the way No, it's like it it's gonna be a whole thing. It's like, it's gonna be a whole thing. It's a whole thing. It's gonna be a whole thing to get that screw out. But I had been-

We're not gonna get the screw out, are we? I'm realizing we're not. You're gonna have to cut it. Like you're gonna have to- But how do you know where the screw, I mean- Cause it's flattened under the box. Is there like one foot print? The board and it's jutting.

Is there a footprint on it? No, no, no, I know right where it is. Cause it's on the edge of the squash box. But's jetting. Oh, I know. Is there a footprint 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- Fertilizer. Right, the stuff you shouldn't walk barefoot in, I'd been walking barefoot in, and then I stepped on a screw. And I immediately-

It's like bread for funkiness. It is like engineered to be as funky and full of gunk as possible. Because the concern here- The gunk of life. The gunk of life gunk. I wanna 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 was rusting. Clearly I was setting up, you're, by the way. You're welcome. I can see a trap and I can walk into it just to keep the show moving.

Thank you. Now, 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 nails 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 gonna 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 tail end of my 10 years,

I'm around on the eight year-ish kinda 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 mean, you love these things. I do, 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 gonna 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 tetanus bacteria is this sort of like long rod shape thing.

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 gonna get, 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 the Sting. 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 gonna 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 turkey drumstick. So basically another way of thinking about this

is that it needs to be implanted. It has to make it fine 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, it's a neurotoxin, meaning it affects your nervous system. And the way that it does that is it binds on to 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,

which is why you get some, I mean, really impressive muscle spasms and contortions and why 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.

And then the first, I think- You lose the brake pedal. Yeah, yeah. You're just going full speed in 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 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 gonna have a lot of these symptoms.

So, I mean, 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, 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 introduced tetanus into my foot. This is so creepy for me to think about. I don't know if there's 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 it.

That sucks to think about. It does, because the hole is very tiny. It's deep, but tiny, and so 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 old 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 staff or strep or whatever's causing that big old boil pretty easily, okay? And that's how I'm gonna not just diagnose you with what bacteria caused this infection, but I'm also gonna 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 wound that would make this likely? There is a specific test that can be used. You can find like a report of it, report on it in the American Journal of Tropical Medicine and Hygiene.

So you can see this is not necessarily a test we would do often. I was not trained in this in the US, let me say. 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 flat, wooden, thin, and it's kind of, I don't know, shaped like the, do you see the spatula? Are you looking up a medical spatula? Yeah, it's just like, I mean. We're taking a long, thin, flat object and we're poking the back of the throat.

That's the spatula test. Okay, but when you think spatula, you're thinking of like a wider spatula. In my head, like I don't think of a spatula. I think a spatula's- An offset spatula? Yes, I was thinking offset spatula. I think a spatula is an offset spatula That yes, I was thinking offset spatula, which it looks closer to an offset. It looks close to the metal spatula Yeah, and there wouldn't anyway. The point is you're using an object. You're poking the back

This is not a show about spatula 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 I don't want wanna get on a case of that. If I were to do that to you right now, I would expect a gag reflex, right? 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 down. 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. 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, with that, I mean, obviously you wanna obtain consent before any medical test or procedure. Yes. Or anything really.

Anything, yeah. That's our policy. And if that's like too restrictive. That's fine We're okay with me. Just like it's it for everything just be yeah, I'm taking set for everything and 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 like it would be a good way to pass the time to do,

it was kind of more of a goof of the show. I don't really think that we should be doing random tennis tests. This is a hard, this really butts up against something though that's hard for- Should not use the butt, that is not an ideal. No, that's hard for our kids to understand because 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. 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, 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. And said, whoa, whoa, whoa, what was in that? 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 harmed. Our kids were just a tiny bit bad. No, they didn't know. They didn't know. It was a tiny bit of a maniac, 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 as I have alluded to in, you know, 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- 200 years. No, much longer. I'm gonna 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, it can't. This is a science show. The medicines, the medicines That escalate my cough for the mouth

Justin, you know who I'm thankful for today? Who are you thankful for, Stacey? I am thankful for Courtney, who's the nurse I have the pleasure of working with every day in my job. And I'm 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. With some scrubs, Fig Scrubs specifically.

I thought they don't want no scrubs. They want these scrubs, I'm assuming. They want these scrubs, because Fig Scrubs are lightweight, breathable, stretchy. They are just some of the most comfortable scrubs you're ever gonna wear. I really love, I say nurses, but I'm a doctor and I love fig scrubs.

The pants that I get, the jogger pants, Zamora style, they are so comfortable. It doesn't feel like a lot of the traditional scrubs that you wear in hospitals kind of feel scratchy. That's not what you're gonna get with fig scrubs. They are so comfortable. They come in all kinds of flattering styles and colors. Cool colors.

They have so many pockets. I cannot stress how many pockets and how important having a lot of pockets. I need one for my phone. I need one for my pen. I need one for my multi-tool. 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 wanna wear for a long day in the hospital, in your clinic, wherever you work. Yeah, so wherever you wear Figs, in the ER, or rounds of the clinic, or even just running errands after a shift, make it count. Go to wherefigs.com, and as a Nurses Week exclusive

to get 20% off everything starting this Thursday, May 1st through May 7th, that's wherefigs.com to get 20% off. Happy Nurses Week. Happy Nurses Week, Courtney. 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 400? 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 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 where it's like obviously not addressed in an appropriate way, but like there's allusions to, you know, seizures, things like that, like biblically and stuff like that. Exactly. 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 and ailment for which nothing is done. This is a patient with locked jaw resulting from a penetrating wound, 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're 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 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 these, you know. 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 objective. Yeah, that's just not the purpose. 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 moder 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. 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 lockjaw. We're starting to see the symptoms of tetanus develop. Prediction made that opus thotinus. Really clean. I'm having, I should just say, I'm having a lot of trouble pronouncing this word. Okay, yeah. Opus thotinus.

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 a- Opus thotinus. One more time. Prediction made that opus thotinus 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, straighten and mobile. 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. There's no disease more distressing than this. Like that's gotta 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 they're giving 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 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. 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. 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 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's? Coke was the one with the postulates. Coke had the postulates, Bell had the palsy. Bell has a palsy. All right. Yes, that Bell of palsy fame.

Thank you. Dr. Charles, or Sir Charles Bell, Dr. Sir, Sir Doctor, Charles Bell, Dr. Sir, what do you think he preferred? Doctor or Sir? I don't know, either way. Either way. Just a palm leaf 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 Opis Thotinus as the title of the painting by Charles Bell. 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? There, you could think about having a depiction like this would actually serve a practical purpose too, right? Because we didn't have photography or 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. He had to do this whole painting and you can look it up. And so 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- The musculature. The musculature, well, no, maybe also more importantly, though, for the- The musculature. The musculature, right? Yeah, to show the rigid. To show, yeah.

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 this. I'm sure this sucks for you, but. 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 it would relieve the spasms. I found this kind of fascinating because, I mean, I guess that could work, right? Like if you're counteracting, I mean, you're shocking. Your nervous system is not, I mean, similar. So like you're shocking.

Like we know that we can affect the body through shocks. That's how we- It's the principle of the heart. 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. Also for muscle, like for pain and stuff like that,

people use his little shocky things. Yeah, electric stimulators, and we do testing, nerve conduction studies and electrodes. Anyway, so I mean, he's kinda hitting on something, 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 caused tetanus. Even at that point, all that they were doing was saying like, there's something in here that 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 Nicolay 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. And yeah.

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 Burow. And he was also, by the way, one of the co-discoverers of the bubonic plague. 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 the serum from their blood and isolate the things that are counteracting the part of the blood. Like if you separate out 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 antibodies against it, right?

Or anti-toxins in this case, things that are fighting the tetanus, not the Texas toxin. Texas toxin, 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 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 withitoxin 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? Yeah. As a way of, and I will say today, even though this isn't something where I'm gonna 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, 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 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 gonna name something Toxoid. It's a good one. But yes, a lot of things have been named Toxoid. Thank you, human race, you rule. and thought I'm gonna name something toxoid. But 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 vaccine in tiny amounts is safe and makes it work better and protects you from getting tetanus. There's also iron in your weighties, calm down. In 1948, we first put the tetanus vaccine in a combined vaccine with diphtheria toxoid and pertussis. Tdap.

Whooping cough, yep. The Tdap or D-tap. Why? We'll get into those. I'm gonna 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 US 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 US at this point. At this time of recording, I feel like things change so quickly, every state still requires children to receive their series of DTAPs,

which include the tetanus vaccine. As of 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. In 2018, we had 23 cases and no deaths. We have very few deaths from tetanus now. In the US, 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 the height. How long do you have to get a shot? Because you obviously got your shot the day after you got the wound. What's the countdown? It's recommended that if you need a shot, like, cause you obviously got your shot the day after you got the wound. What's the countdown? It's recommended that if 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, 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 gonna 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 the D-tap. This has to do with how much of different things are in there. Diphtheria, tetanus, acellular pertussis, that's what DTAP stands for. And in children, the DTAP 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. That's when the DTAP comes into play. Now for all of us adults and preteens,

so you're gonna get a Tdap at 11 or 12, you're gonna get your first Tdap. And then from then it's every 10 years, you can either get a Tdap or a TD, which is just tetanus diphtheria. Now, why am I suggesting that a Tdap is what I wanted and what I received? I don't know.

On a side note, pertussis is part of the Tdap, as we've 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 gonna 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 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 Tdap 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 Tdap 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 Tdap. For me, every 10 years, I'm gonna keep getting the Tdap 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 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 healthcare 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, I agree. Don't take things or receive things that you're allergic to. We've been very consistent about that, the unsolved ones. But it is definitely something, and I will say people who are pregnant also get the Tdap 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 on your boosters. As somebody who really relies on you every day, I'm happier taking care of yourself. Well, no problem, Justin. I really don't wanna get, it does look very dramatic, you know? Yeah, but I know.

I do like drama. Easier ways to get attention, for sure. 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 Ren Fair. It's at Harris Riverfront Park. You can get tickets at bit.ly forward slash Harmony House

Ren Fair with an E. You can go there and get tickets. We're gonna be doing a live Sawbones. We're going to be doing some signings for the Adventure Zone. And for 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 using their song, Medicines, as the intro and outro of our program. Thanks to you for listening. It's gonna do it.

Until next time, my name is Justin McElroy. I'm Sydney McElroy. As always, don't drill a hole in your head. All right! Maximum Fun, a workaround network of artist-owned shows, supported directly by you.