Tetanus is an infectious disease caused by the clostridium tetani bacterium, which typically occurs following contamination of an open wound. Although tetanus cases worldwide are on the decline due to improved healthcare and vaccination programs, it remains a serious problem in many developing nations. Cannabis appears to be a historic treatment for tetanus.
Tetanus is often associated with rusty nails or blades, as the uneven surface of the oxidised metal allows a greater surface area for the bacteria to colonise, and the sharp point or edge causes the wound itself. Tetanus is particularly associated with hot, humid climates and areas with soil rich in manure—the reproductive spores are distributed via the excrement of livestock.
Today, much of the developed world has effective vaccination programs in place. The only cases that arise in such countries normally involve individuals who have not kept up-to-date with booster shots (which should be given every ten years). Injecting heroin users have also been demonstrated to be at increased risk.
In 2010, 61,000 fatalities were recorded as a result of tetanus—less than 25% of the 1990 figure of 272,000. And according to the World Health Organization, 30,848 newborn children died from neonatal tetanus in 2017. That’s a 96% reduction from the roughly 787,000 newborns who died from tetanus within a month of being born in 1988.
Much of the reduction in worldwide fatalities is due to the massive improvements made in recent years in eradicating maternal and neonatal tetanus (MNT) in the developing world. Neonatal tetanus arises, usually at the site of the umbilical cut, in infants who have not acquired ‘passive’ immunity as their mothers were not immunised. Worldwide, this accounts for around 8% of all neonatal deaths.
Maternal tetanus is defined as tetanus during pregnancy, and usually arises as a result of unsafe medical practices or facilities. In recent years, millions of women of childbearing age in high-risk areas have been immunised against tetanus, with dramatic results.
What are the symptoms of tetanus?
Tetanus is best-known for its ability to cause muscle stiffness and spasms, which usually begin in the jaw (hence the colloquial term ‘lockjaw’) before spreading throughout the body. These spasms are initially mild (normally commencing 3-21 days after initial exposure to the bacterium), but progress to the point of causing various consequential problems.
When affecting the muscles of the back, tetanus can cause arching; when affecting the larynx and diaphragm, respiratory problems often result. Excessive salivation and perspiration, hypertension, fever, increased heart rate, difficulty swallowing, and uncontrolled urination and defecation have also been documented. The severity of the spasms can also lead to muscle tears and even bone fractures.
Fatality of tetanus
If left untreated, tetanus often results in death. Respiratory problems can become so severe that asphyxia occurs, or heart rate and arrhythmia can increase to the point of cardiac arrest. Respiratory failure is the leading cause of death in tetanus cases.
Cardiac arrest can also result through lack of oxygen, or due to a combination of effects on the autonomic nervous system (the system that controls heart rate, breathing and most involuntary functions) causing total collapse of the circulatory system.
Tetanus is fatal in over 50% of cases in the developing world. Neonatal tetanus is even more devastating, with an estimated 70% mortality rate. In the developed world, fatality has been reduced to around 10%-20% of cases; severe cases often necessitate intensive care measures that may not be widely available except in developed countries.
How does tetanus produce its effects?
The action of the tetanus bacterium, C. tetani, within the body produces an extremely potent neurotoxin known as tetanospasmin. It’s estimated that just 240g of tetanospasmin would be sufficient to wipe out the entire world population. This toxin affects the skeletal muscle by binding to peripheral nerve endings, then advancing across synaptic junctions until it reaches the central nervous system (CNS).
Once within the CNS, the toxin can block key inhibitory neurotransmitters, responsible for inhibiting nerve impulses along the motor neurons (nerves that control movement). Without these neurotransmitters, the continuous impulses naturally produced by excitatory neurotransmitters are unchecked, and the muscle controlled by the overstimulated motor nerve goes into spasm.
O’Shaughnessy describes treating tetanus with cannabis
The Irish doctor William B. O’Shaughnessy (1809-1889), who worked for the British administration in India, was arguably responsible for introducing cannabis to mainstream, contemporary Western medicine in 1843. This was accomplished through an article submitted to the Provincial Medical Journal (later to become the British Medical Journal).
In this article, O’Shaughnessy famously described successfully treating the muscle spasms of tetanus patients with extract of Cannabis indica, and sparked off a flurry of related studies in subsequent years.
In his study, a tetanus patient that had been treated with large doses of opium to no effect was administered cannabis extract dissolved in alcohol. After around ten days, the tetanus symptoms disappeared, but the patient later died due to complications of the original wound. However, two subsequent patients treated with cannabis extract recovered fully.
Other examples from history
O’Shaughnessy also describes two other doctors at hospitals in Calcutta successfully treating tetanus with cannabis extract: a Dr. O’Brien, who assisted five of seven patients to recovery, and a Dr. Bain, who treated three patients, saving two and losing one. O’Shaughnessy also describes a patient of his cousin, also a doctor, being successfully treated and making a full recovery.
On the basis of O’Shaughnessy’s work and related later works by other authors, cannabis extract became a common treatment for tetanus in Europe and the USA, with varying results. An article from 1845 by a Dr. James Ingles of Halifax, England described some easing of severe tetanus symptoms after administration of cannabis; however, the patient later died.
Another article, submitted to the New England Journal of Medicine in 1846 and written by a Dr. Isaac Hiester of Reading, Pennsylvania describes successfully treating a 16-year-old male with acute symptoms of tetanus over the course of about two weeks.
A Bulgarian doctor, Basilus Beron, was so convinced of the efficacy of cannabis extract against tetanus that he wrote in an influential 1852 dissertation that “after having used almost all known antitetanic drugs without result, the sick person … was totally cured after use of the Indian hemp”.
Cannabis and the autonomic nervous system
There has been little modern research into cannabis as a treatment for muscle spasticity and the related symptoms of tetanus. However, there have been various studies into the ability of cannabis to treat dysfunction of the autonomic (also known as sympathetic or peripheral) nervous system.
Cannabis has been demonstrated to be effective in reducing muscle spasticity resulting from multiple sclerosis (MS) and Huntington’s disease (HD) , both illnesses that affect the motor neurons. One of the key inhibitory neurotransmitters blocked by the tetanospasmin neurotoxin is γ-aminobutyric acid (GABA), which also has a role to play in both MS and HD.
GABA decrease and muscle spasms
Clinical trials have shown that when treated with gabapentin, a drug which increases levels of GABA in the central nervous system, muscle spasticity in MS sufferers was significantly reduced. In HD, a degenerative brain disease that causes increasing loss of motor control, GABA levels have been shown to be significantly altered and reduced. As tetanus spasms are caused by inhibition of GABA, it would appear that related processes are at work.
Several studies have suggested that the CB1-receptor antagonist THCV works to increase GABA levels, as does CBD, and the non-specific antagonist CBD works to increase GABA levels. Oddly though, studies also indicate that THC, a non-specific agonist, decreases GABA levels. However, it appears that this effect may be reversed in certain circumstances.
Cannabis and gram-positive bacteria
Cannabis has been noted to successfully destroy various types of gram-positive bacteria, including Bacillus subtilis and Staphylococcus aureus(the bacterium that causes MRSA). Tetanus is also a gram-positive bacterium, although there’s apparently no existing research into the action of cannabinoids on C. tetani itself.
It’s known that THC and CBD are both effective gram-positive bactericidal agents, and recent research has indicated that the cannabinoids CBN, CBG, and CBC also display potent antibacterial activity against MRSA.
Is there a place for cannabis in modern tetanus treatment?
As tetanus is rapidly being eradicated throughout the world, and access to vaccines becomes more readily available, cannabis’ importance to management of the disease is clearly less important than in the past, when neither vaccines nor effective medications existed.
However, the disease is still important in global terms, and as many of the countries that are still affected by tetanus also produce abundant cannabis, there may be advantages in devoting further study to the use of cannabis as a potential low-cost method of managing symptoms.
- Disclaimer:This article is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with your doctor or other licensed medical professional. Do not delay seeking medical advice or disregard medical advice due to something you have read on this website.