Editorials

Preventing and treating tetanus

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7381.117 (Published 18 January 2003) Cite this as: BMJ 2003;326:117

The challenge continues in the face of neglect and lack of research

  1. C L Thwaites (lthwaites@hcm.vnn.vn), Wellcome Trust training fellow,
  2. J J Farrar (jeremyjf@hcm.vnn.vn), Wellcome Trust senior fellow
  1. Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam

    One hundred and twenty years ago, the BMJ contained the following report: “Death from tetanus induced by hypodermic injection. An inquest was held by the coroner for the city of Dublin last week on the body of a governess, aged fifty-six years, [who] used to inject morphia herself subcutaneously, for the relief of neuralgia arising from bad teeth … Dr Austin Meldon was of the opinion that the cause of tetanus must have been the injury of some nerve by the needle.”1

    In fact, the governess's tetanus probably resulted from chronic dental infection or using a dirty needle, not the nerve injury the doctor supposed. Six years after this report, Arthur Nicolaier showed that tetanus resulted from contamination of wounds with soil bacilli, which, he correctly deduced, produced a “strychnine-like” toxin responsible for the disease.2

    More than a century later much more is known about the tetanus toxin; its deoxyribonucleic acid has been sequenced and its mechanism of action established. We are equipped with antitoxin and a vaccine to prevent the disease, yet tetanus continues to be a major public health problem throughout much of the developing world.

    In 2000 only 18 833 cases of …

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