You prepared your entire adult life for this moment. You acquired a modest arsenal, stockpiled ammunition, outfitted a GI-surplus Hummer as the ideal bugout vehicle, and kept yourself in top physical shape. As you watched the chaos simmer and then boil over, you took solace in being prepared to do whatever it took to keep your family safe. But what about Tetanus?

When the end of the world finally came, it came quickly. You just had time to get the kids and the gear loaded before the roads clogged. The last obstacle between you and open country was an overturned utility truck. Pine lumber, discarded tools, and construction supplies littered the road. You carefully dismounted your vehicle to drag the last bits clear when it happened.

Tetanus Prevention

The pain was quite literally breathtaking. You shouted involuntarily, reflexively spewing words your kids seldom heard you use. You hobbled back to the vehicle and climbed inside with difficulty. Your wife held the flashlight while your 12-year-old fetched a pair of needle-nosed pliers from the tool kit. Taking a firm grip on the nail head now flush with the sole of your sneaker, you gritted your teeth and yanked. The two-inch finishing nail came free, but you could feel the blood filling your shoe.

This was a bad place. There would be an opportunity later to tend to your foot. Reaching deep into your reserves, you pulled the vehicle around and over the scattered debris and roared down the open road. Each time you pressed the accelerator, paroxysms of pain shot up your leg. Three hours later, you found a secluded roadside park and gingerly removed your shoe. The wound didn’t look too bad, but the nail had nicked the bone. The damage was done.

Two weeks later, you were dead, passing mercifully in the night where the kids couldn’t see in a quivering pool of feverish sweat. The infection had charged inexorably up your leg like Sherman’s march to the sea. Without the antimicrobials to check the advance, there really would never have been any hope. You were dead the moment that nail pierced your foot. You just didn’t know it yet.

Real World Scenario

The aforementioned dark vignette was inspired by actual events. I was out cutting the grass on my rural farm just as I had a hundred or more times before. We built the house eighteen years ago. I thought I knew every square inch of the place. Surely by now, all the old nails were accounted for.

I was in a hurry. I’m forever in a hurry. I planted my foot and twisted to get the mower over and around a handy paving stone when it suddenly felt like I had rammed a red-hot poker deep into my right heel. The nail was rusted and gnarly and a full two inches long. I immediately lost all interest in mowing.

Never one to miss a writing opportunity, I decided to see how the foot would fare in an austere environment. I scrubbed the wound vigorously and verified that my tetanus shot was current, but I figured I’d try to manage this injury as though it was the zombie apocalypse. I made it three days.

By day three, my right foot was red, swollen, ugly, and throbbing. Not wishing to lose my leg over some stupid little survival experiment, I called in the appropriate oral antibiotics and pulled up a shot of Gentamicin. Thirty-six hours later, I could walk without a limp. Modern medicine is really amazing, and we take it for granted.

Disease, The Real Killer on the Battlefield

Scottish scientist Alexander Fleming discovered penicillin in 1928. He crudely synthesized the stuff from Penicillium rubens mold. At the onset of World War 2, the US national stockpile of penicillin was adequate to treat ten patients. By the end of the war, penicillin and sulfa drugs were universally administered to injured soldiers at the front lines. Antibiotic medications saved literally countless lives during the war.

660,000 Americans perished on both sides during the American Civil War. Two-thirds of those fell to infectious disease rather than direct combat action. Pneumonia, typhoid, dysentery, and malaria were known colloquially as the “Third Army” because of the ghastly butcher’s bill they exacted on campaigning troops.

Nothing about that is any better today. If anything, evolutionary pressures have shaped our modern hostile biome into something even nastier than what our forebears faced. If we’re serious about survival, we should devote a little time and effort into defending against the real killer on tomorrow’s urban battlefield.

A Brief Word About Tetanus

Of the 30,000 or so formally named bacterial species thus far cataloged, some 1,400 are known to cause human disease. Their downrange effects range from annoying to catastrophic, with everything in between. However, not all of them get their own dedicated vaccine. Clostridium tetanus is vile enough to warrant that honor.

C. tetanus is a ubiquitous organism in soil. A rod-shaped, Gram-positive bacterium that is absolutely everywhere, C. tetanus is a cousin to Clostridium botulinum, the beastie that causes such vile food poisoning. C. tetanus looks like a tiny little tennis racquet under the microscope when forming spores. Following inoculation into a wound, C. tetanus produces tetanospasmin, a lyrically horrible poison that quite effectively interferes with motor neurons. 

Tetanospasmin is related to botulinum toxin and is one of the most potent poisons known to man. One hundred ninety nanograms is a potentially lethal dose for a healthy adult human. To put that in perspective, 1cc of water weighs 1,000,000,000 nanograms. Once released in a wound, tetanospasmin travels via lymphatics and blood to attack the nervous system at disparate locations. Following activation, this toxin acts by blocking the release of glycine and gamma-aminobutyric acid neurotransmitters at motor nerve endings. The result is disseminated and uncontrollable muscle spasm, hence the colloquial term lockjaw. 

Stay Vaccinated

Thankfully, while Clostridium tetanus is everywhere, acquiring a genuine tetanus infection is still fairly tough. I have only seen that once in a quarter century of medical practice, but the guy died. Suffice it to say, you really don’t want to get any of that in you. 

You treat an acute tetanus infection with tetanus immune globulin to bind with and dispose of circulating tetanospasmin. However, a better solution is keeping your tetanus vaccine current. This vaccine is called tetanus toxoid and consists of tetanospasmin inactivated via formaldehyde. It is generally assumed that a tetanus vaccine provides decent protection for about a decade. 

Everyone should keep their tetanus vaccines up to date. Most primary care clinics and many pharmacies will do this for you. I treat mine like the batteries in my red dot sights. Make a note somewhere and get a fresh one on a schedule before the decade runs out, and you’ll be fine.

Other Tiny Threats

Properly wielded, antibiotics are like rifles. You pick just the right tool for just the right target. There is no single drug that does everything really well. Some families are most effective above the waist, while others work best down south. A few overlap. It takes a fair amount of experience to manage antibiotics well. The fact that many folks, even those who do what I do for a living, are still fairly indiscriminate with this stuff is the reason we are facing rampaging levels of antibiotic resistance.

The specifics of tetanus are beyond the scope of this article, and I’d sooner not get sued for dispensing medical advice over the Internet. However, the information is out there. Staph or Strep causes most skin structure infections I encounter professionally. Puncture wounds through wet, sweaty tennis shoes are notorious for involving a particularly nasty bug called Pseudomonas aeruginosa. Concern over that little monster drove me to start antibiotics after my foot swelled following the lawn-mowing incident. 

If you want a decent survival stash of antimicrobials, read a bit about the subject and then befriend a handy physician or nurse practitioner. It is not uncommon for folks to ask me about stuff like that in the clinic while I am seeing them for other things. Explain your reasoning, and most guys like me will hook you up with a brief treatise on antibiotic utility and stewardship and an emergency prescription. With a few exceptions, as this stuff gets old, it doesn’t become poison. It just loses its efficacy.

An Ounce of Prevention

The best way to treat illness is not to get sick in the first place. Some basic precautions can pay huge dividends when you are deep in the suck. For starters, I dug out my old jungle boots with the steel shanks in the soles designed to guard against Punji stakes in Vietnam. That will be my standard uniform for cutting the grass going forward. Checking to make sure that your favorite pair of survival footwear comes thusly equipped will typically be proof against rusty nails and the like.

Don’t ever, not even once, drink water from questionable sources, particularly in a hostile environment. You’re better off being thirsty. Back in the day when, infant mortality was so dreadful that it was quite often the result of dehydration in kids secondary to gastrointestinal infections. Start spewing top and bottom in a survival situation because you drank stump water, and you’re as good as dead. Under those circumstances, a decent camping water filter is worth its weight in gold. I have lived for weeks on end using such a nifty trinket in the wilds of Alaska, and it thrived. 

You can also purify water with Clorox bleach at four drops per quart of water. First, filter the water using coffee filters or clean socks and agitate it after mixing in the bleach. Then, let it sit for half an hour, preferably in the sun. The end result will smell slightly of bleach and might leave you a bit queasy, but it won’t kill you like untreated water might.

Ruminations

It’s often not the big stuff like gunshot wounds and peckish zombies that get you. It’s the little unexpected things like tetanus. I can tell you from personal experience that jamming a rusty nail through your foot will suddenly become the absolute center of your universe, no matter what else is going on around you. Be careful, take basic precautions, expect the unexpected, and survive.