Tetanus.

 This is a work in progress.

In 1920, the main street of the town I live in, was compacted mud.  Horses were still ridden on it, and tied up in front of stores.  The farming around here was still primarily "pick and axe".  Life has changed hugely since 1920.  Farming is mechanised; fencing is mechanised; footwear and gloves vastly improved; tractors exist; streets are sealed; public sewage common and running water something that people in 1920 could only hope for.  Even so, if you did a serological survey in the community, whether vaccinated or not, you would still find higher levels of antibodies in the rural community than in cities.  Even within cities it will vary and those who love gardening will have higher levels of antibodies than those who don't.  This is totally independant of vaccination, because natural immunity does exist, and vaccinated people get their natural boosters from the environment.  The medical profession may greet this information with incredulity, but if they had on their shelves, the medical information I have on mine, there would be nothing they could say in rebuttal to what I have to say.

So first question.  Can the vaccine save your life?  Yes.  Is that a guarantee?  No. As this recent case in a fully vaccinated 14 year old boy shows.

So the following information is information which ALL people should know, since tetanus vaccination does NOT guarantee that you will NOT get tetanus.  While the medical profession likes to take the credit for ALL the decline of tetanus courtesy of a vaccine, this is simply NOT true.

The proof of that lies with neonatal tetanus in the developed world, which DISAPPEARED well before the existence of either anti-toxin or a vaccine, courtesy of the endless work of people like Florence Nightingale (who, by the way, was 90 when she died...) and the ignored greats, Drs Ignaz Semmelweiss and Oliver Wendell Holmes who both excoriated their colleagues for refusing to wash their hands, and unsanitary medical practice and facilities.  Both of them, at the end of their careers, had seen no progress on this issue.  Dr Semmelweiss committed suicide, and Dr Holmes was so pissed off, he went and wrote very average novels and poetry, but made it plain in his last paper, that he was doing so, because he was disgusted with his colleagues, who he accused of being systemic murderers, and that he was leaving medicine for the sake of his own sanity.

Real progress often only happens after people ahead of their time die.  Then everyone says, "Oh yes, that's blindingly obvious.'  Everything we have to be thankful for historically, in terms of zero puerperal fever, neonatal tetanus; safe childbirth and safe surgery can be laid at the feet of people who were treated by medical colleagues like criminals during the time in which they tried to change their colleagues medical practice.

I know how they felt. 

Anyone who thinks differently to "the system" will be treated as a criminal. If you land up in hospital with an unvaccinated child with tetanus, you WILL be treated as a criminal, particularly if you question their treatment, and ask for modalities that the hospital won't do.  You can be sure that doctors will not like the discussions you have with them.  This is the price you pay for thinking for yourself, and making choices they don't like.  

You may also end up re-evaluating habits you hadn't thought through before. 

The choice to vaccinate is yours, but whether you do or not, you should read all of the tome below, because while it may be long, it's all important, for two reasons:

1) The tetanus vaccine does NOT prevent all tetanus

2) Good health, does not come from the end of a needle.

Of all the diseases for which there are vaccines, tetanus is the one which frightens most people, and for good reason.

While most of us feel we can cope with chickenpox, measles, mumps and whooping cough, tetanus is the one disease which IF we get it, can be much more “uncontrollable”. So if you are going to chose not to vaccinate, there are certain things you must know, the first of which is that for ALL toxin mediated diseases to flourish in the body nutrition has to be inadequate, and if the disease gets out of control, you can be sure treatment will never include vitamin C, magnesium or appropriate nutrition.  Hospital nutrition is well known to create scurvy in children, and critically ill patients - who already have low levels in the first place. ( Fain and Galley)

This resource will be as a series of questions in this order:

a) The disease.
b) Standard Hospital treatment.
c) Treatments ignored by hospitals..
d) Information on the tetanus vaccine.
e) What you must know if you don’t vaccinate.

The disease: What is tetanus.

 

What are the symptoms of tetanus?

Here is a 1940 text which still provides some of the most valuable information on Tetanus that there is. It was written before antibiotics, and at a time when people had a very thorough knowledge of tetanus.

There are five kinds of tetanus.

All can be preceded by nonspecific premonitory symptoms such as restlessness, irritability and headache.

1) Subacute tetanus which is characterised by some degree of neck stiffness involving the muscles at the back of the neck; spasticity, as well as increased muscle stretch reflexes, especially in the lower limbs. Patients usually have brief nocturnal generalised spasms There is ankle clonus, but the plantar response is always flexor. The term “mild tetanus” is inappropriate because the presence of generalised muscle spasms is generally felt to imply at least “moderate tetanus” which is not the case in subacute tetanus.

2) Local tetanus (rare) where the contractions of the muscles are only in the area of the injury. These contractions can persist for weeks when treated by the traditional hospital method.

3) Cephalic tetanus (very rare) which can often occur after otitis media with a burst ear drum, or removal of teeth or dental work, with inappropriate wound management.  (But again, host conditions determine the outcome). Clostridium tetani can be found from swabs taken from the middle ear, but sometimes the entry point can be from the cone put in the ear by the doctor to have a look, or from fingers transferring tetanus spores into the ear. The main symptoms for this form of tetanus are in the head and face area.

4) Generalised tetanus (most common sort about 80%) The symptoms start at the head and work down. Reflex spasms normally occur within 24 – 72 hours, known as the “onset time”. First the person will find it hard to open their mouth; will have a stiff neck and have difficulty swallowing.

Symptoms vary hugely.  Sometimes, the tetanus is very mild, sometimes moderate and sometimes serious.  The intensity of spasms and sequance of muscle involvement is quite variable and individual, dependant on nutritional status.

Then there will be spasms, as the muscles react to the toxin, the stomach muscles will go tight. The temperature will rise in response to the toxin; there will be sweating, raised heart-rate and the blood pressure will rise.

Characteristically, the manifestation of tetanus increase in severity for about 3 days after the first signs, and then remain stable for the next 5 – 7 days. After about 10 days, spasms begin to occur less frequently and by the end of 2 weeks, they disappear altogether - when treated properly. 

Residual stiffness may persist but most people recover completely in 4 weeks. Occasionally, spasms can continue for 3 – 4 weeks under normal hospital treatment, with complete recovery taking months in really serious cases. Emotional, visual, physical and aural stimulation can cause muscle spasms.

5) Neonatal tetanus was eliminated from developed countries BEFORE either a vaccine or antibiotics were invented primarily because of basic cleanliness.  Now, neonatal tetanus occurs primarily in undeveloped countries, particularly those which still put animal dung on a newbord's umbilical cord.  Yes, it still happens. 

Neonatal tetanus is usualy very severe, and usually occurs within 10 days of birth.  Early signs include difficulty in sucking, irritability and excessive crying, associated with peculiar grimacing.  There is intense rigidity, flexion of the arms, clenched fists, extension of the legs and plantar flexion of the toes. Spasms occur eith minimal stimuli.   Neonatal tetanus in developing countries is a specific problem relating to disgusting unhygiene practices surrounding bad indigenous midwifery practices.

_______.

All the effects of tetanus toxin are self-limited and completely reversible in patients who recover from the disease., usually leaving no residual effects.  Correctly treated tetanus requires NO physical or occupational therapy in recovery, 

The symptoms of tetanus spasms, seizures, back arching and locking of the jaw are cause by a toxin called tetanospasmin, released by the spore form of a bacteria called Clostridium Tetani of which there are many distinct types. All have one or more common antigens, and produce at least two toxins. Tetanospasmin which is the exotin which acts on the nerves, is as toxic as strychnine and is identical across all different clostridial types.

Tetanus spores are everywhere in the environment. On your bookcase, in your back yard, in clothing and house dust. and in your mouth and faeces. Tetanus has been known to follow surgery and innocuous procedures such as skin testing or intramuscular injections of medications; injecting drug addicts, and I also have many case histories of cases following haemorrhoid and other surgery.

Clostridium bacteria are especially common in the intestines and faeces of rats, guinea pigs, chickens, cats, dogs, sheep, cattle and horses. Approximately 5% of humans have clostridium tetani multiplying in their guts yet don’t even know it, although the 1940 text puts that figure at 25%.

Clinical tetanus, for some unknown reason, has a male/female ration 2.5/1. Toxin production is favoured by dead or necrotic tissue with little oxygen, which are the ideal breeding ground for spores, which are taken there by phagocytes.  Tetanus can be detected in human faeces and human bites, and as Holmes 40 states, tetanus CAN routinely live inside our bodies, so the existence of tetanus spores inside us is NOT the ultimate cause of tetanus.  Were that the case, the earth would have no people or animals in it.  Conditions must exist - which create an environment - which will result in the tetanus suddenly causing problems, and those conditions depend on the HOST, not the tetanus.  One of the biggest dangers is something called the Standard American Diet, where so much of the calories eaten are empty and lacking core nutrients which are important to a fully functioning innate immune system. 

In developing countries, the biggest risk factor outside of neonatal tetanus, is MALnutrition.  Not enough food. and lack of sanitation and clean running water.

In devloped countries, one of the biggest risk factors if MALnutrition.  As in, enough food, but food which isn't worthy of being eaten.  And yes, many New Zealand children are fed Standard American diets.  Just watch what goes in the average family's Pak'N'Save trolleys.  The contents are often enough, to curl any nutritionist's toes.

There are no laboratory tests for tetanus, which is diagnosed solely on symptoms. However, other tests may be used to rule out strychnine poisoning which looks very like tetanus.

Other diagnoses which have to be ruled out are: dental infections, local infections, Hysteria, neoplasm, encephalitis and dystonia. (Hegazi – last slide)

Dystonia can also be caused by drugs like stemetil, Stelazine and chlorpromazine (Largactil) so in cases where tetanus is considered, “pseudotetanus” as a result of drug ingestion should be ruled out first.  Benztropine of Diazapam are the antidotes recommended for tetanic like symptoms from drugs. (Which makes you ask the question, "how do drugs act on the nerves to cause conditions that look like tetanus?")

WHO DOES TETANUS PRIMARILY AFFECT?

In the medical literature is the constantly repeated phrase throughout history, particularly before paved streets, running water and flush toilets..., that tetanus primarily affects the very young, the old and the immunocompromised - however they understood that concept in those days.  Generally though, the "weaker" would have been protected from tetanus, since they didn't have the energy of ability to do work which would constantly expose them to tetanus spores.

The "rusty nail" originated when horses were always on the road, and barefoot people stood on horseshoe nails, often embedded in mud impregnated with horse dung.  Today, we know that tetanus spores are everywhere.  Puncture wounds which do not bleed are the most dangerous, and "rusty nails" aren't the only things which can carry tetanus spores into someone's body.  In children, feet will be the most likely portal of entry, because they are more likely to run barefoot, but the portal of entry for older children, or adults is far more likely to be hands, knees, elbows - and if medical literature is taken not of - burst middle ear drums and... surgery!

Spores are ubiquitous. They can be found on any surface in hospital, on your bookcase, in your spit. Human bites and bullet wounds are potential portals of entry.  The fact that the world was well habituated before a tetanus vaccine shows us that natural immunity existed and continues to exist in the face of commonsense cleanliness.

Today, in undeveloped countries, the primary risk groups is babies whose parents or the local midwives put camel or other dung as a traditional ritual on the umbilical cord, and older people with cuts which haven't been cleaned out properly.

When Captain Cook came here, there weren't a whole lot of Maori dead from tetanus.  More maori will have died from their constant inter-tribal utu and wars than would ever have died from tetanus.

When Europeans came here, everything had to be done by hand, and even then people weren't dying from tetanus hand over foot.  (bad pun) and you know that.  How?  Well, most of you have a family tree.  How many in YOUR family tree died of tetanus?

Yes tetanus happened and can happen today... and that's why this is written.

You need to know a whole lot of information.  Even more than is put here, so that you can make choices, and whatever those choices are, know what you are going to do, and why.

Are splinters the only things which cause tetanus?

No.  Tetanus has been noted after skin abscesses, gangrene, burns, frostbite, middle ear infections, surgery, abortions, childbirth and drug abuse, primarily "skin popping".  Sometimes, no "portal of entry" can be figured out.  In terms of puncture injuries, sometimes the smaller ones are the more dangerous because people don't tend to clean them out.

COMPLICATIONS of tetanus. 

Complications contribute significantly to deaths in tetanus. The death rate varies from country to country and hospital to hospital, and to a degree, depends on the immune system of the person with tetanus.  In underdeveloped countries with minimal medical assistance the death rate is far higher than in western countries.

In developed countries, death usually results from a secondary bacterial complication introduced by intubation, tracheotomy, or a nosocomial (hospital acquired) infection.  Some other complications result from overly vigorous therapy and prolonged bed rest, while others can be attributed to the tetanus toxin itself, and failure to neutralise it adequately. According to one medical text, high fever later in tetanus, usually signifies secondary infection. Pneumonia is the most common late complication and is found in up to 70% of autopsied cases. (which I believe is scurvy induced because of high levels of toxins, and because hospitals don’t use vitamin C in the treatment of tetanus.)

The death rate from tetanus in developed countries is entirely dependant upon the quality of medical care, treatment and nutrition given during tetanus infection.  Secondary bacterial infections may become more of an issue, as continued overuse of antibiotics by the medical system drives the development of more and more superbugs.

The most current e-medical article on four of these sorts of tetanus, and the treatment can be read here:  with another emedicine site being for paediatric tetanus here: 

What is the standard hospital treatment in developed countries?

The standard treatment options are covered in the emedicine article above. A powerpoint on clinical features can be seen here. (Hegazi)

And New Zealand?

In New Zealand, feedback over the years has shown that New Zealand hospital treatment depends on the symptoms, but usually involves the antibiotic metronidazole  (which is primarily used against anaerobic bacteria and Giardia) and tetanus immunoglobulin.  Penicillin is not an antibiotic of choice, because it causes more spasms, and tetracycline should never be used, because it strips the body of vitamin C which is crucial in clearing and resolving the symptoms of any toxin mediated disease.

Antibiotics make no difference to the course of tetanus disease – but they use them anyway.   In turn, antibiotics trash the gut flora, which may make the patient more susceptible to hospital acquired bacteria such as streptococcus pneumonaie, clostridium difficile and cMRSA or other superbugs. They also trash good gut flora affecting the ability of the body to absorb minerals and vitamin K, B etc. The detrimental results of heavy duty antibiotic damage on gut flora can be permanent.  Here is the proper version of the study. On this basis, you wonder why they continue to use an antibiotic that has little effect on the course of the disease, but systemically napalms the whole body without discrimination.

Depending on the spasms, sedation may be midazolam and morphine, as well as a paralysing agent such as pancuronium for spasms. Morphine however, can make some people vomit which is not a good idea as that can cause massive spasms, so morphine should be carefully monitored.  Morphine usually constipates a patient, which can make tetanus worse, because toxins also come into play from e.coli in a static bowel. The room might be darkened and stimulation discouraged. If a temperature is present, the ubiquitous paracetamol will be used.

For some stupid reason, staff continue to want to bed-bath patients daily.  This is totally unnecessary, and leads to spasms.  The only things that need good cleaning are the room the person is in, doctors and nurses hands etc; luer areas; equipment used in and on the person and the skin in those areas.  Physical stimulation should be kept to a minimum.  So while hospitals continue to want to wash patients daily, in my opinion, washing should be kept to a minimum.

NZ hospitals regularly turn to avoid bed sores, and during this time, sheets should be changed.  This requires competent precise minimal movement of the patient, and should be practiced, not just for tetanus, but for any bed-ridden patient.  Avoidance of bed sores, and clean linen are crucial.

New Zealand hospitals also push vaccination, on the basis that they say the disease does not confer immunity, and therefore the person needs vaccines “immunity” by the time immunoglobulin wears off. Furthermore, hospitals and doctors push the use of vaccine which contain other disease antigens as well. So while parents are often told their child will get a "tetanus vaccine" what the child is given is the Hexavalent vaccine, which includes Diphtheria, pertussis, tetanus, Polio 1, 2 and 3, Hepatitis B, and Haemophilus influenzae.  This is called "captive vaccination".  In other words, put in everything at once.  You'd think they would be more interested in letting the immune system deal with the tetanus when needed, but such a concept is foreign to the medical profession.

The New Zealand Health Department stopped bringing in single tetanus antigens in March 2007.

So New Zealand hospital offer/push adults to have the Quadracel (diphtheria, tetanus pertussis and polio), and for children hospitals insist on Infanrix-Hexa, which has diphtheria, tetanus pertussis, polio, hepatitis B and Haemophilus.

As we stated in our second book in 2008, we view this attitude of the system to be major impediment to anyone wanting to vaccinate against tetanus - before or after tetanus ( not during ). In our opinion, the dropping of the single tetanus antigen, and the of Quadracel or Infanrix-hexa is "wide net casting" to “trap” people into having all vaccines.  In our view, any vaccine administered to anyone with tetanus is a totally unnecessary assault on the immune system on a body which already has more than enough to do BECAUSE the vaccine cannot possibly BENEFIT a patient WITH tetanus. 


Furthermore, there is no medical clinical rationale to vaccinate while undergoing heavy duty treatment to survive tetanus. Neither are there any trials to see whether it affects the disease outcome. The body has better things to do than derail the immune system resulting in a T4/T8 ratio to produce an immunological profile which looks like that of someone with AIDS,  It has since been discovered that the influenza vaccine also results in a prolonged aberrant immune profile as well. To vaccinate someone while their body is fighting a serious disease lacks common sense.

For anyone chosing to vaccinate against tetanus at any time, single tetanus antigens, or paediatric DT can still be found in this country, but requires going under the radar to find medical practices who privately import vaccine stock from Europe. 

The statement that the disease (or exposure to tetanus spores) does not confer immunity is a nonsense.

It is quite common - if antibody tests are done on admission with tetanus, for the test to come back showing plenty of antibodies.  Parents who request this test, and where it comes back positive will be told that THOSE antibodies cannot protect the child - but that the same antibodies made by vaccines can. (The same is said about diphtheria, and some other toxin mediated diseases).

I believe this statement to be a nonsense.

Some references on this are: http://www.ncbi.nlm.nih.gov/pubmed/6680401 ... http://www.ncbi.nlm.nih.gov/pubmed/1092755 “ The existence of natural immunization was unquestionably demonstrated by presence of protective levels of tetanus antitoxin in the blood of the majority of 59 surveyed subjects considering that none of them had ever received any tetanus toxoid and most of them never received a single shot of any drug.” http://www.ncbi.nlm.nih.gov/pubmed/2651348  ...    http://www.ncbi.nlm.nih.gov/pubmed/6114281;,,,,  http://www.jstor.org/stable/30115079 . WHO recognizes these studies, but dismisses them, and it’s easy to see why.

The absolute key to tetanus management is careful around-the-clock attention to mucus build-up in the lungs, use of magnesium to stabilise the heart and blood pressure and simply good nursing; keeping the patient well hydrated, paying attention to electrolyte balance, sedation, reduction of sensory overload, and excellent nutrition. Patients with tetanus require about two and a half times MORE calories than normal daily life, due to the metabolic requirements on the body of fighting tetanus. Any nerve dysfunction and breathing irregularities need to be carefully managed.

Just relying on tetanus immunoglobulin and sedation gets you nowhere fast.

Unfortunately, hospitals in this country are noted for their abysmal lack of understanding about nutrition, and often have to be pushed into other treatment, depending on the knowledge of the patient's advocates.

What treatments do New Zealand hospitals not use?

1) New Zealand hospitals do not generally use magnesium even though it IS a standard medical treatment. If you want magnesium treatment you may have to push for it.

Magnesium should be a first line treatment for tetanus .  Magnesium stabilises the heart and reduces blood pressure; reduces the need for sedation, and also makes nursing simpler. The medical evidence for Magnesium is sound, with the most recent 2010 article on magnesium in adults is found here:  and a 1997 medical article on magnesium in tetanus, can be found here: . A more recent 2004 article by Attygalle can be found here. A 2003 article by Cevilla on the use of magnesium in children can be found here.

Other articles can also be found on pubmed. 

Magnesium was extensively used between 1900 and 1945, because tetanus anti-toxin was not developed until 1924, and then  tetanus anti-toxin developed a bad reputation for killing people, primarily because it was made from horses. But with the advent of slightly safer anti-toxin, and antibiotics, the medical profession supported patented pharmaceuticals rather than using s