Navy Medicine and the Eradication of the Tetanus Menace

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Due to the research and practice of immunization not one American serviceman or woman would die of the disease in World War II.

By André B. Sobocinski, BUMED Historian

Before the advent of tetanus antitoxin, “lock-jaw” attacked many of the wounded and killed almost all of its victims. Antitoxin prophylaxis and treatment improved the situation but, in spite of the best possible use of antitoxic serum, tetanus still occurred, and those who developed the infection, the mortality remained high.

~Capt. W.W. Hall, MC, USN

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Even before the days of Hippocrates tetanus was a well-known and grisly disease recognized as producing muscle spasms, muscular rigidity (e.g., lock-jaw), seizures, broken bones and even death.  Caused by the anaerobic bacterium C. tetani that thrives in soil, rusty metal, and manure, it is transmitted through simple cuts, scrapes and puncture wounds.  The disease can take as little as days to manifest and can kill up to thirty percent of its victims.

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Hall was dispatched to the Naval Academy at Annapolis, Maryland to test the toxoid injections on a larger population of volunteers.

Thanks to immunization and a booster shot taken every ten years the tetanus horror of yesteryear has been wiped from our collective memories.  Nevertheless, for those in the armed forces there is no denying the disease once proved a real problem.

On the battlefields of France and Belgium during World War I contracting tetanus could be a death sentence.  One source cites that between 80 to 90 percent of tetanus victims in the Great War died.  Typically, the soldier was inoculated with an antitoxin only after suffering an injury and already infected with the disease. The antitoxin provided a very limited “passive immunity” against the disease.

In the 1920s, Louis Bazy and George Ramon of the Pasteur Institute developed a tetanus toxoid that would stimulate the body’s ability to make antitoxins for immunizing (i.e., “active immunization”).  Many of early toxoid studies were continued in the United States in the 1930s; and beginning in June 1934, the U.S. Navy pioneered the largest experimental tetanus toxoid study ever conducted on a control population.

Led by researcher Lt. Cmdr. (later Capt.) W.W. Hall, Medical Corps, and taking place aboard the hospital ship USS Relief (AH-1), the Navy study looked at the proper intervals between injections as well as the required number of injections for successful immunization with an alum-precipitated toxoid.

The study offered promising results and showed that the body’s resistance to the disease was greater than the “natural or artificial introduction of an antigen.”  Soon after, Hall was dispatched to the Naval Academy at Annapolis, Maryland to test the toxoid injections on a larger population of volunteers.

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After the second dose was administered identification tags (“dog tag”) were die-stamped with a capital “T” followed by the month and last two digits of the year of immunization.

In 1938, Hall, in conjunction with Capt. Reynolds Hayden, commanding officer of Naval Hospital Annapolis, inoculated the entire student body at the academy (2,300 midshipmen) with alum-precipitated tetanus toxoid.  The researchers found that although the toxoid provided immunity it also yielded too many reactions.  Researchers determined that it was necessary that future batches of tetanus toxoid be tested to ensure safety and effectiveness.

In part due to the success of USS Relief and Annapolis trials, in 1941, BUMED instituted a program of immunizing all Navy and Marine personnel against tetanus with the alum-precipitated toxoid

Originally, consisting of three doses of 1 cc each administered subcutaneously with an interval of three weeks between injections, in August the course of immunization was changed to two injections of .5 ½ cc of alum-precipitated tetanus toxoid with an interval of between four and eights weeks.  A year later a “booster” injection of .5 ½ cc was given.  After the second dose was administered identification tags (“dog tag”) were die-stamped with a capital “T” followed by the month and last two digits of the year of immunization.

Due to the research and practice of immunization not one American serviceman or woman would die of the disease in World War II.