Prevention of tetanus during the First World War

Abstract

The emergence of tetanus in wounded soldiers during the first months of the First World War (WWI) resulted from combat on richly manured fields in Belgium and Northern France, the use of modern explosives that produced deep tissue wounds and the intimate contact between the soldier and the soil upon which he fought. In response, routine prophylactic injections with anti-tetanus serum were given to wounded soldiers removed from the firing line. Subsequently, a steep fall in the incidence of tetanus was observed on both sides of the conflict. Because of fatal serum anaphylaxis associated with administration of serum at a time when purification methods still needed to be improved, it must be presumed that tens to hundreds of men might have died as a result of the routine administration of anti-tetanus serum during WWI. Yet anti-tetanus serum undoubtedly prevented life threatening tetanus among several hundred thousands of wounded men, making it one of the most successful preventive interventions in wartime medicine. After the abrupt fall in tetanus incidence in 1914 due to introduction of anti-tetanus serum, the incidence of the disease tended to become even lower as the war went on. This was probably due to earlier and more thorough surgical treatment, consisting of opening, cleaning, excision and drainage of wounds as early as possible. In this overview, recent battlefield findings from the Meuse-Argonne offensive in 1918 are used to illustrate common practices employed in the prevention of tetanus during WWI.

Introduction 1

“…Alongside casualties directly invoked by violence, many men fell victim to the influenza epidemicbetter known as the Spanish Fluthat hit hardly upon European armies in 1918. 40 Yet other men were separated from their families for long because they were captured as prisoners of war (POWs, whose numbers are estimated at 7 to 9 million) and did not come back before 1919, or, for the Russian prisoners, sometimes not even until1922.…”

Clinical vaccine development

“…Following their seminal investigations, many other studies were performed and led to improved regulations (e.g., The Biologics Control Act of 1902), which resulted in the development of valid live and/or attenuated vaccines. New vaccines against diseases including rabies, typhoid fever, diphtheria, shigellosis, tuberculosis, tetanus, and pertussis were developed by 1930 [ 1 , 7 , 8 ]. However, during this period, vaccine research was limited to the areas of public and/or military need (World War I) because of restricted funding resources.…”

Emerging and re-emerging infectious diseases: challenges and opportunities for militaries

“…Military personnel are often also involved in disaster management, where they interact with displaced populations, themselves at risk of infectious diseases [64]. Water storage or stagnant water around temporary dwellings promotes breeding of vectors, made worse by the absence or interruption of vector control programmes.…”