Lockjaw isn’t how rich people talk; it’s actually a name for tetanus, a disease resulting from a neurotoxin called tetanospasmin produced by bacteria that live primarily in soil and dust. The neurotoxin causes muscle contractions in the neck and jaw, which eventually makes breathing impossible. The bacterial spores are contracted through puncture wounds in environments with dirt or dust, particularly if other bacteria are present and the injury was caused by a foreign object, such as a splinter, that gets lodged in the body.

It is possible for tetanus to develop from a gunshot wound, particularly if the bullet doesn’t go all the way through. Tattoos and body piercing with unclean equipment are also linked with tetanus, which is one reason illegal tattoos can be dangerous. The bacteria thrives best in really deep cuts, but any wound should be cleaned thoroughly as soon as possible to reduce the chance of infection.

In addition to cleaning the wound, someone with a particularly high-risk injury—one that occurs outdoors, involves soil or manure, or occurs in a dirty or dusty environment, as well as animal or human bites—should get vaccinated against tetanus if they haven’t been within the preceding five years. Children are routinely vaccinated for tetanus—generally combined with the diphtheria and pertussis vaccines—but the protection conferred by the shot fades, and boosters are needed about every ten years. Even if someone has been vaccinated, post-exposure prophylaxis, a shot after an injury that could result in tetanus, should be given when necessary. The fight against tetanus is particularly skewed towards prevention as opposed to treatment; prevention is both easier and more effective than addressing the infection once it has already occurred.

Vaccination is generally effective: fewer than 50 cases of tetanus occur annually in the United States. This success is all the more remarkable considering that post-exposure shots can take up to two weeks to reach full effectiveness. In some cases, doctors are advised to give the patient immune cells to jumpstart the response to the infection. People who do get infected will get stiffening of the facial muscles, and then the stiffness extends downward. As many as three-fourths of patients with tetanus died in years past, but with vaccination available the rate has fallen below 15 percent.

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