O851 - The pathology of tetanus

I read this review from 1930, which was basically everything that was known in 1930 about how tetanus works. I'm not sure how much of the claims are still held as true today though.

One interesting claim was that the wound that introduces the tetanus bacteria into the body could be as small as flea bites or bee stings. Another was that the spores can remain in the body for weeks to months.

There's a claim that the tetanus vaccine is unnecessary because all that's needed to prevent tetanus is keeping wounds cleaned out. Ignoring the difficulty that cleaning wounds isn't always a possibility, the above statements from this review make that more questionable. Though of course cleaning out wounds (debridement) is important too, as this review mentions.

Other interesting stuff related to how the toxin (which causes the paralysis) passes through the body, and how the antitoxin works to prevent that. The toxin definitely interacts with nervous tissue mainly, though it wasn't quite clear if it only passes through nerves or also through the bloodstream and such. Some had found that injecting toxin into the blood caused systemic tetanus, while intramuscular or subcutaneous injection only caused local paralysis. Antitoxin (with its antibodies) doesn't really interact with nerves or affect toxin that's already bound to nerves; it only binds to circulating toxin to prevent it from getting to the nerves. Which is why it's important (for non-immunized people) to get antitoxin quickly, before the toxin does too much damage.

There was a mention of an unfortunate incident in St. Louis, where horse serum was used as diphtheria antitoxin, but apparently it contained tetanus toxin, and people died. But that might've been pretty bad luck, since the toxin doesn't stay in the blood very long, only until it starts causing symptoms.

I'm not sure of the quality of the evidence for these claims, but this is what people thought in 1930 at least.

Reference: Hall, I. C. The pathology of tetanus. Arch. Pathol. 9, 699–709 (1930).