Armstrong – Table of Contents

the motor nerve, the toxin passes to an electrically sensitive area (pre-synaptic terminal)
where it blocks the release of a neurotransmitter that inhibits impulses going to the nerve
controlling muscle function. Loss of the inhibitory influence results in unrestrained
central firing with sustained muscular contraction. The shorter the peripheral nerve
pathways, the shorter the incubation period, and the sooner the affected muscles become
involved to produce the muscle spasms and contractions. Spasm of the of the facial and
jaw muscles give rise to the “lockjaw” and the familiar frozen smile or “risus
sardonicus”. The prognosis for recovery depends on the amount of nerve toxin produced
and fixed in the central nervous system, regeneration of nerve tissue, the extent of total
body muscle involved, and the intensity of the treatment employed to reduce excess
spasms, support respiration and maintain nutrition. Mortality is high. Tetanus is a
preventable disease. Tetanus toxoid administration is part of a regular schedule combined
with other primary childhood immunizations including pertussis and diphtheria. During
adulthood, tetanus and diphtheria toxoids are combined for periodic booster doses. The
incidence of tetanus is diminishing gradually in the United States.
In the initial manuscript (1) Armstrong reported 11 cases of post vaccination
tetanus, most of whom died, following the use of bunion pads as a vaccination dressing.
His colleagues, Dr. Ida A. Bengston and Mr. Conrad H. Kinyoun, demonstrated tetanus
organisms in approximately 25 per cent of 200 bunion pads of the same make as those
used on cases developing tetanus. The organisms were usually incorporated into the glue
of the pads. The criterion of infection of the pads was the development, on appropriate
bacteriologic growth media, of an organism morphologically like tetanus that developed a
toxin lethal for mice and neutralizable with tetanus antitoxin. In 9 of the 11 cases the