Tetanus

May 21, 2025

This is going to be a rough ride and an unpleasant read. It may scare the hell out of you, and it should. You’re about to learn quite a lot about some exceptionally scary things.

I do not believe in fear-mongering. Any person who follows my work knows my very vocal position on the manipulative bastards who ratchet up the fears for The People’s ears in order to gain clicks, hits, and views.

There are genuinely evil and terrifying things in this world, and they’re too common and boring to make it on the news. News isn’t about facts anymore, it’s about spectacle. The simple truth is that the odds of you ever being in any manner of “active shooter” situation, plane crash, or nuclear reactor meltdown, etc. are astronomically low. In fact, you’re much more likely to end up in a car crash on the way to the store, airport, or nuclear power plant.

You’re not going to die from a shark attack, you’re going to die from a heart attack - if you’re lucky enough to get past cancer first. It’s not guys with guns you need to be afraid of, it’s the fact that you ignore the advice of every person with a medical degree who have all said you need to eat less and move more. You’re not “big boned,” you’re fat. Bone doesn’t jiggle.

Real life is rather boring for most people, that’s why there’s an entire multi-billion-dollar industry for entertainment, piping hundreds of channels of gossip and drama directly into your life. But the real drama is that you’ve never been told or taught that there’s something living in your houseplants that makes Ebola look like Chicken Pox.

What I’m about to share with you here is incredibly common, and quite possibly the most terrifying thing you’ve ever read. It’s in your backyard right now. It’s in your house. It’s quite likely on your skin at this very moment, and may God have mercy on your soul if you’re not ready for it.

It’s a tiny spore called Clostridium tetani, and despite being far too tiny for you to see without a microscope, it’s the scariest little bastard you’ve ever met. It doesn’t care who you voted for. It doesn’t care who you pray to. It’s infiltrated your ghettos and gated communities, your farms and cities, from the suburbs to the subways - it's everywhere.

Clostridium tetani is just one of the billions of microscopic germs that are covering your body right now. At any given moment you have more microbes living in your body than there are individual people on this entire planet. There are about seven and a half billion people in the world, and there are well over a hundred billion microbes living inside you at this moment - more if you’re female.

Don’t ask, it’ll ruin your sex life. People are gross. Just lay back and think of England.

Clostridium tetani is just a common everyday germ. It’s out there in your world and spends most of its time as tiny spores in the dirt. On its own, just existing there, it’s harmless and isn’t any danger to you at all.

Just so long as you never happen to get any of that dirt on you, that is. Or dust in your house. Or pretty much anything after you get out of the shower. Because by the time you get your shoes on, you probably have several spores on you already.

And that’s fine, so long as they don’t get inside your body. You can have them on your skin, and they’re not terribly dangerous. Outside of your body, they can’t do anything to you.

But if you give them even the tiniest entry point, like touching your mouth, brushing your teeth, eating potato chips, or rubbing a fleck of dirt from your eyes, they’re in. The classic example everyone knows is stepping on a rusty nail, but it’s far more insidious than that.

If you get the tiniest scratch anywhere on your body, Clostridium tetani can find a way in. It’s not the rusty nail that’s so dangerous, it’s the puncture wound that it leaves. Narrow, deep, and impossible to properly clean, it’s the perfect injury.

It’s the blood blister you get from nipping your fingertip in a pair of pliers. It’s the scrape you get from starting your lawnmower. It’s the bug bite that shows up after a weekend of camping, or the cut on your shin from jumping a barbed-wire fence.

Babies often get it from the umbilical cord stump. Over 215,000 infants died from Tetanus in 1998. Thanks to advancements in science and education, that number dropped by nearly 90% within 20 years. Good job UNICEF :)

It’s common, forgettable, and inconsequential, and that’s the real danger. It’s some knucklehead thing that you won’t even imagine would need treatment, and that’s why you won’t stand a chance.

Once you have Clostridium tetani spores inside you, they’re going to develop into bacteria and multiply in the nice warm, wet incubator that is your body. It’s very good at this, and within a few days, you’re going to have millions of active and thriving bacteria growing, living, and multiplying inside your body.

And that’s fine, active and thriving they won’t hurt you at all. This is just one of the hundreds of everyday bacterial infections that your body is dealing with just to keep your floppy meatbag walking around conscious. You won’t even notice it’s there, just like you don’t notice the vast majority of the other infections you’re sharing your body with at this moment. This can go on for a week, a month, or more, giving the bacteria time to grow, move, and spread throughout your entire body.

This is called the Incubation Period, and it can be anywhere from a couple of days to a few months. This time was your last chance to stop it. A last chance ignored because you never even knew you were infected and colonized.

Now is when the first generation of the bacteria that have been living inside you reach the end of their natural life and begin to die.

And now, you have problems.

You see, because inside each and every one of these little bacterial cells is a tiny bit of a nerve toxin. It's called Tetanospasmin ("tetanus toxin"), and it’s on the shortlist of the nastiest, deadliest toxins we’ve ever discovered. A lethal dose is under 2.5 nanograms per kilogram of body weight. That’s 0.0000000025 grams. An average adult human is about 62 kilograms. This means that only 155 nanograms of Tetanospasmin will kill you.

This stuff is well over fifty-thousand times deadlier than VX Nerve Gas.

It’s hard to put such a small number into a frame of reference that can make sense to the average person but think of it like this: That’s less than the weight of the dust on one of your eyelashes right now.

It’s a tiny fraction of the weight of a teaspoon of air.

As the entire first generation of Tetanus dies off, the neurotoxin in every single one of them is flooded into your entire body. You are now doomed, and you don’t even know it yet because at this point you still won’t have any symptoms.

The Tetanospasmin will take two main paths. Some of it is released directly into your bloodstream and is now targeting nerves all over your body. The rest is released inside your muscles and will attach to nerve endings. It will move along them, finding its way directly to your brain. The toxin itself can be tracked as it moves, grinding its way through your body at a rate of about one-quarter, to one-half inch, per hour.

Eventually, it will reach your central nervous system, and this is where we have to take a moment and talk about how nerves work. Think of your nervous system like a computer network. Signals from your brain don’t go in a continuous cable all the way to wherever they’re heading, they work much like the internet and things get handed off from one neuron (an individual nerve cell) to the next.

Nerves are strung end to end, and relay signals along as they go. Inside the neurons the signal is electrical, and some of them are even insulated like wires. In order to pass the signal from one neuron to the next, it has to be converted from an electrical signal into a chemical signal and then gets handed across the gap to the next neuron. There is a tiny space between each neuron called the Synapse; it’s about a millionth of an inch across.

I’m leaving out quite a bit and trying to make this as simple as possible, but please understand that it’s actually much more complicated than this and people spend entire careers researching Nerve Conduction Physiology. For now, that’s enough to help you get a handle on what’s happening.

Because now is when things start to happen. It’s in that gap, that millionth of an inch, where Tetanus is going to start causing problems - Tetanus chucks a bigass wrench in between the gossamer gears of your nervous system.

This is now the moment you realize you have a problem.

Typically, it starts with your jaw muscles. You can’t open your mouth. The classic name for this is called Lockjaw, which sounds so much like it wants to be an 80’s metal band that I always want to put umlauts on it whenever I write it.

Löckjäw, 8pm tonight at The Reptile House, $5 admission. Thinking back, that was a great place to get Tetanus.

Now, when I say you can’t open your mouth, it’s not at all what you’re thinking. It comes back to how nerves work, and the fact that you’re actually a great deal stronger than you think you are.

You know when you read articles about people performing superhuman feats of strength in times of crisis? That’s Adrenaline, and it lets you get a bit of a neurological turbo-boost for short periods of time. It’s quite handy for a lot of things, and we use a version of it in medicine on a daily basis. The most commonly used local anesthetic for dental surgery is 2 percent Lignocaine mixed with a ratio of 1 in 80,000 Adrenaline.

Without Adrenaline the effect would wear off in a few minutes. It’s added to the solution to constrict the blood vessels, and thus improve the anesthetic efficiency, dramatically increasing the effective duration. It also provides a near bleedless operative field, all because it tightens the blood vessels down as small as they can constrict.

The thing is, your muscles are incredibly strong, all the time. But there are a lot of limiting factors along the way that reduce how much of your muscle capacity you can summon at any given moment. It’s perfectly possible for my scrawny 5’10”, 140 lb body to pick up a 250 lb man and toss him across a room - that is, if I had the ability to harness and control the full capacity of my muscles at any given moment.

Sounds like a pretty cool superpower, eh?

It’s not. You’d be in a wheelchair in a week. It turns out there’s a lot more going on in your body than just muscles, and you’d destroy all of the other supporting mechanisms while you were out trying to impress girls.

Now that the Tetanospasmin is spreading through your nerves, you’re about to get an idea of just how strong you are! Tetanus doesn’t have the limitations that you do...

By weight, human bone is about four times stronger than concrete, and tooth enamel is even stronger still. The Tetanus toxin that has gotten its leftovers into the gaps between your neurons is now wreaking havoc and short-circuiting the connection between your motor neurons and your brain. This means that signals are being sent to command your muscles that aren’t coming from your brain.

You are now no longer in control of your muscles. It’s like being tased, only far more powerful.

So, it’s not that you can’t open your mouth, it’s that the muscles that close your mouth are being activated and you cannot physically stop them - regardless of what signals your brain is trying to send, the contamination of your nerves will block it. That’s the entire point of the neurotoxin.

Your muscles are now being activated far more than you’ve ever imagined possible. Your body is trying to clamp down your mouth with such force that it will shatter your teeth in gut-churning little pops and shred the inside of your mouth with the jagged stumps.

And we’re just getting started...

At this stage, it comes in spasms and waves. The nerves are affected but not completely blocked. For a bit, you’ll be fine, perfectly free to move, and then instantly clenched and locked with a body part in a position you never knew it could be. Your hands hook and curl in terrifying ways, and it spreads quickly throughout your entire body.

The pain is unimaginable. I’ve read accounts of people who listed the worst ways to die, they’re all about drowning, buried alive, and burned to death.

Pffffff, amateurs.

How about feeling your muscles contract so violently that after they break the bones they’re attached to, they rip themselves to shreds. You’re breaking every bone in your own body, ripping yourself to pieces, and doing it all while just laying on a hospital bed unable to scream.

The spasms become more frequent and last longer, eventually, everything is locked solid. You are a grotesque human statue of agony and suffering, and it’s only getting worse. The longer it lasts, the stronger they clench. Eventually, it will spread to every muscle in your body - and you’re absolutely full of muscles.

This doesn’t just affect the giant muscles in your arms and legs, your entire body is wrapped and filled with muscles of all sizes. Every goosebump you’ve ever had is caused by a tiny muscle called an arrector pili. There’s a wall of muscle separating your body right in half that makes you breathe. Your tongue is a muscle, and so is your heart.

Every one of them is cranked up to eleven and destroying itself, anything it’s attached to, and anything it can crush. Your joints get pulled and bent apart into permanent dislocation. At this point, the huge collection of muscles in your back now take center stage.

This is where we go full blown and get the image that you’ll find in all the online articles and ancient pictures of someone dying from Tetanus. We achieve Opisthotonus.

Yeah, that’s the picture. Looks fun, doesn’t it? The only thing worse than seeing that is hearing the sounds you’re trying to make. The sound of your bones breaking as you try to scream and suffocate at the same time.

Eventually, the neurotoxin will take hold of your thoracic diaphragm, and you’ll suffocate to death. In the vast majority of cases, that’s what finally kills you.

Thankfully, this entire process, despite being around since the very first humans walked this Earth, is now incredibly rare in most parts of the world. The vast majority of people in developed countries will never experience Tetanus.

There are two reasons for this: Treatment and Vaccines.

If you manage to get to a hospital right away when the very first symptoms develop, you’ll have a roughly 90% chance of “living”. But honestly, if it were me, the first thing I’d suggest is to take the elevator to the top floor of the hospital and jump off the roof. It’s better than the infection/treatment process and has more pleasant results.

Also please realize that even in an absolute state-of-the-art facility, you’re still going to have a 10% death rate under totally perfect conditions when nobody makes a mistake, the diagnosis happens instantly, and you respond by the book to every one of the pharmacopoeia of drugs they’re about to fill you with.

First, we’re going to stuff as much Metronidazole IV and Penicillin as we can fit through a needle into what we hope is the original entry point and origin of the infection. Then we’re going to pump you to the gills with HyperTET. This is an anti-tetanus immunoglobulin (TIG), and the goal is to give you the antibodies you need to disable the neurotoxin.

Those will tackle the infection and hopefully handle the primary thing that’s trying to kill you.

While that’s happening, the other primary thing to handle is you trying to kill yourself. So they’re going to flood your body with enough diazepam and lorazepam that you’re basically a houseplant. This will, hopefully, counteract the spasms. Either way, between the Tetanus or the drugs, you won’t really be able to move.

Now that we’ve got the motor neurons handled, we can tackle the background noise as well. Remember, you’ve got muscles all over. So, in addition to dealing with the big showy ones, we have to sort out the autonomic nervous system with high doses of opioids and beta-blockers to get you through the unimaginable pain.

If you’re lucky, that’s the worst of it.

If you’re not lucky, things get more intense. Most people aren’t lucky.

Welcome to the majors.

Here, we step up to Human tetanus immunoglobulin injected directly into your spine. It’s exactly as pleasant as it sounds.

You’re going to get a Tracheotomy (that’s a breathing hole in your neck, you can’t open your mouth anyway) and ventilation for a month. Tracheotomy is recommended for securing the airway because the presence of an endotracheal tube is a stimulus for the spasms. In some cases, they have to paralyze the person with curare-like drugs and use a mechanical ventilator.

For. A. Month.

Let that sink in.

You’re also going to get Magnesium sulfate as an intravenous (IV) infusion to control spasms and autonomic dysfunction, and you should probably start buying stock in diazepam since you’re going to be getting truckloads of it as a continuous IV.

The autonomic effects of tetanus can be exceptionally difficult to manage, because you’re going to be alternating from hyper- to hypotension, hyperpyrexia to hypothermia, and may require IV labetalol, magnesium, clonidine, or nifedipine.

Since you can’t even breathe through your mouth, and consciousness won’t be much of a thing for you most of the time (be thankful), you’re going to get a percutaneous endoscopic gastrostomy so they can just pipeline food directly into your stomach. You can expect a hearty 3500-4000 calories a day of the finest that science has to offer, with at least 150 grams of protein on the side.

You’re getting such high-caloric diet maintenance because of the increased metabolic strain brought on by the “increased muscle activity” (bone crushing spasms). Full recovery takes 4 to 6 weeks because the body has to heal every broken bone, every shredded muscle, and regenerate all the destroyed nerve axon terminals - and that is not an easy, pleasant, or simple process.

The antibiotic of choice is Metronidazole. It can be given intravenously, by mouth, or by rectum. You won’t be using your mouth very much, so it’s most likely going in by the bag unless you have some particular desire to have it crammed up your tailpipe.

Penicillin also works well, but because it inhibits the GABA receptor, which is already affected by Tetanospasmin, that can be more of a pain in the ass than the Metronidazole.

And after all of that… we wait and see.

Ten percent of people don’t survive to this stage. Out of the rest, typically most of the people will regain most of the peripheral nerve function in time. The problem is that your brain won’t heal - it can’t. Any damage done there is forever, and you will never fully recover from this level of trauma. Will you be alive? Sure, but is that a life you want? You’re probably going to be severely mentally handicapped, and most likely paralyzed for the rest of your life. You’re going to be in a constant-care environment forever, and life as you once knew it is over.

Even after all of this, even after being pumped full of antibodies, even after you’ve kicked death in the jimmy, even if you’re still alive and (twitch) functional years later…

You can still get Tetanus all over again... lather, wince, repeat.

This is why it’s fundamentally important to not just get a Tetanus vaccine but get a new one at least every ten years. If you’re a higher risk, like a construction worker, farmer, or someone with any manner of rough and tumble job, that drops down to every few years.

The best part of this, the radiant and amazing bit of awesome news, is that all of it is easily and inexpensively preventable with just a simple little shot.

The Tetanus vaccine was first discovered by Emil von Behring’s team all the way back in 1890. By 1924 we had invented the first inactive Tetanus toxoid, and it went into production shortly after. In 1938, a new version of the vaccine was developed and was used extensively to protect troops in World War II.

The classic “Tetanus Shot” that most of the people reading this remember was invented in 1948 and was actually called DTP. It was a combined vaccine for Diphtheria, Tetanus, and Pertussis and became the standard used from 1948 until 1991 when it was replaced with an acellular form of the pertussis vaccine due to safety concerns.

This is particularly cool because that vaccine had been used for 42 years and was well proven to be safe, reliable, and effective. However, people were annoyed by it because of the classic trope that getting a Tetanus shot was painful. They didn’t want to have anything that would discourage people from getting the vaccine, so they developed a whole new one.

It turns out that the Tetanus part of the vaccine wasn’t the problem, it was the Pertussis part. About half of the people who had gotten the original DTP vaccine experienced a mild redness and discomfort around the injection site. Some people even had slight swelling. None of this was serious, and the symptoms went away quickly, but it had become enough of a nuisance that researchers took another shot at it and made it better.

In 1992, not just one but a pair of new versions became the standard for the next generation. These are also combination vaccines for Tetanus, Diphtheria, and contain Acellular Pertussis (TDaP and DTaP) as well. The big benefit of these is that they’re designed to be given to adults as well, the previous vaccine was designed to be given primarily to children.

There are those who will read this that hold strong opinions on vaccination. Many will agree with Science, and many will take the side of Politics and Pseudoscience.

I ask that each of you stand up for what you believe in. Those of you who believe in science, get your vaccinations, keep them up to date, and be responsible for your safety and the wellbeing of those under your care.

Those of you who choose Politics over Logic, Reason, and Science, stand up for your beliefs! Stay true to your ideals! And if you want to complain about vaccines, don’t get any of them. That includes a Tetanus shot.

But for God’s sake, stop being a hypocrite, preaching bad ideas, and holding strong opinions on things you don’t actually understand.

Time and Science will take care of the rest.

With kindest regards,

Chris Boden

Captain's Log

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