Tetanus is often associated with rusty nails and going barefoot.
However, there is a lot of mythology associated with both, and I thought I’d sort that out a bit.
Tetanus, or “lockjaw”, is caused by a bacterium that normally resides in the soil. The actual symptoms, horrible muscle spasms, and the cause of death, are the result of a neurotoxin produced by the bacteria.
Obviously, it takes a while for an infection to take hold, and for the bacteria to produce the toxin. While it is possible to administer a tetanus immune globulin after-the-fact, almost all of us have been vaccinated against it since we were babies. Problems can arise, however, when that protection wears off. Current recommendations are to have one’s tetanus vaccination renewed every 10 years.
A lot of people seem to think that rusty nails are the only way to get tetanus, or that iron or rust is part of the infection route. This is not true.
What is true is that the tetanus bacterium, Clostridium tetani, is an anaerobic bacterium. That is, it cannot live in the presence of oxygen. Its spores (which are encapsulated against oxygen) sit in the soil, and once they are in an oxygen-free environment, the bacteria can develop. (By the way, botulism is another member of the Clostridium family of bacteria.)
That is why nails are so effective at transmitting the disease. They sit in the soil and can collect spores, and then the nails are really, really good at injecting the spores deep into our tissues, where even a good cleaning out of the wound is unlikely to get out all of the spores. Then, when the wound closes up, those spores are sitting in their perfect, oxygen-free environment. Note that the iron has nothing to do with any of this; it’s only become associated with tetanus because nails are usual made of iron. (This is an interesting lesson on how myths can get made from misunderstandings.)
However, it’s not even necessary for the spores to be deeply injected (that just makes it more likely to get the disease). Any wound associated with soil that is not sufficiently cleaned (and the tetanus spores are pretty resistant to heat and most antiseptics) and is then closed to oxygen is quite susceptible to giving one tetanus.
However, once the bacterium was discovered (back in 1884), the importance of cleaning wounds became much more apparent, and the incidence of tetanus began to decline.
The vaccine came into wide use in the late 1940s. It actually has two components. One component is against the bacterium itself; the other component is against the toxin that it produces.
Obviously, while going barefoot and stepping on a sharp object was one way to get tetanus, all it required was the wound. Looking at old newspapers, it turns out that the Fourth of July was a very “popular” time to get exposed to tetanus. Kids playing with fireworks often injured themselves (duh!) and those injuries would sometimes become infected with tetanus. Here’s part of a story from a 1909 story in the New York Tribune:
Despite the effective efforts for a “safe and sane” celebration which were made in some communities, the slaughter roll of the Fourth of July this year was longer than ever before. According to “The Journal of the American Medical Association,” 215 persons were killed by fireworks or firearms or other explosions, an increase of 52 over 1908 and 57 over 1907. Of these, 37 were literally burned to death, while 125, less fortunate, perished in the agonies of tetanus. More than 80 per cent of these deaths were due to blank cartridges, chiefly in toy pistols. In the seven years in which the association has compiled these ghastly statistics 794 deaths from tetanus have occurred from the use of those mischievous devices.
I bet that would never have occurred to you as a danger from the Fourth.
And of course, shoes really weren’t a protection from tetanus, either. I also found a lot of newspaper stories of people who got tetanus when a nail penetrated the sole of a shoe. Here is one example from a story in the 1906 Galveston Daily News.
Silsbee, Tex., Dec. 6.—Not long since your correspondent from this place made mention through the columns of The News the death of Wade Hendricks, an excellent boy of good parentage, having died from lockjaw following a wound in the foot as the result of a nail puncture. This matter is again referred to because of the fact that on yesterday another fatal case of lockjaw occurred at this place, and the causes of and from whence this tetanus germ found its way into the dust of that village is now puzzling the medical fraternity here. The last case was one of an old negro by the name of Jerry, whose surname I failed to learn. Uncle Jerry lived alone in a single room hut, doing odd jobs here and there for white people for a sustenance. Gathering from historical events, especially his supposed age during the meteorical shower of 1833, he must have been 85 years of age, but had no relation whom he knew. While out in the country some twelve or fifteen days ago doing work for a farmer, on his return to his hut just in the city limits, he had the misfortune to step on a nail in a board. Uncle Jerry removed the nail, as well as his shoe, and made the balance of the trip on barefoot. In due time he developed a typical case of lockjaw, from which he died. . . .
It really behooves us (or “befoots us” :-)) to keep our vaccination up-to-date, whether a barefooter or not. It is possible that we might inadvertently re-vaccinate ourselves by stepping on something, or even simply by working in the garden. If we acquired the tetanus spores while still protected by the vaccine, that would provoke an immune response that would extend the period of protection. But of course, we have no idea if that has occurred. It is much better, and safer, to make sure that we keep our tetanus vaccination current.
With today’s modern methods of medicine, there is no reason for a barefooter to be concerned about tetanus.