Medical Minute – What the Heck is Patriotic Tetanus?

By: Dr. James Lee

Long, hot days, garden fresh vegetables, and the arrival of big tents around town; yup, the Fourth of July is almost here. Soon, fireworks will be flying high as we celebrate Independence Day. However, that is not the only thing that is skyrocketing. Nearly 91,000 people visit the emergency rooms in the U.S. for treatments of injuries on July 4 and 5. This is by far the highest daily number of visits in the entire year. The biggest reason for the spike in injury-related ER visits? No surprise: fireworks.

Furthermore, injuries from fireworks are on the rise. In 2020, there were 18 non-occupational deaths due to fireworks, which increased from 12 the year before. On average, between 2005 and 2020, there were 8.5 deaths per year in the U.S. In addition, the number of emergency room visits for fireworks accidents is increasing as well. From 10, 000 in 2019 to 15,600 in 2021. By comparison, in 2008, the total number of firework injuries was 7,000, with 66% of them between June 21 and July 21. Firecrackers and sparklers were the main culprits.

It was John Adams, who first suggested our traditional celebration, including fireworks, when he wrote to his wife Abigail on July 3, 1776. His letter expressed to her that the nation’s independence should be commemorated “. . . it ought to be solemnized with Pomp and Parade, with Shews, Games, Sports, Guns, Bells, Bonfires and Illuminations from one End of this Continent to the other from this Time forward forever more.” [sic] Americans have since gleefully complied with our 2nd President’s recommendations. By the late 19th Century, fireworks were intimately associated with patriotic holidays, politics, and campaigns. An industry developed out of this which supplied revelers with inexpensive entertainment. However, with the increased availability of firecrackers, Roman candles, and miniature cannons, there was a rise in the cases of tetanus.

Historically, this became known as “patriotic tetanus,” Fourth of July tetanus,” or “patriotic lockjaw.” Tetanus, or lockjaw as it was also known, causes widespread spasms in muscles including the jaw. It is caused by the bacteria Clostridium tetani, whose spores are ubiquitous in soil. We now have true preventative vaccines for tetanus and tetanus antibodies for treatment, but before this, when left untreated, tetanus gruesomely killed 90% of victims with muscle spasms strong enough to break bones.

Initially, it was thought that the spores somehow contaminated the fireworks. However, it was later discovered that the tetanus-laden dirt from the surrounding environment was being thrust into the wounds at the time of injury. So grave was this that the American Medical Association began tracking this patriotic tetanus. In 1903 there were 406 cases of fatal patriotic tetanus. Tetanus antitoxin became increasingly available in the 1900’s and was widely in use by WWI. By WWII, the preventative vaccine, tetanus toxoid, was widely available and continues to be today.

Two recent high-profile incidents in 2015 and 2021 illustrate the risk of fireworks. In 2015, Jason Pierre-Paul was an All-Pro outside linebacker, 2-time Pro-Bowler, first-round draft pick for the New York Giants and Super Bowl Champion. He rented a U-Haul van, and purchased $1,100 worth of fireworks for his whole neighborhood to enjoy for July 4th. Near the end of the supply, he lit a firework that went off in his hand, permanently disfiguring his right hand. Graphic pictures are available on the internet. For those of faint heart, he lost half of his thumb, all his index finger, and most of his middle finger. He had to have multiple surgeries on the remaining fingers and hand. Amazingly enough, he has continued his career and even repeated as Super Bowl Champion with the Tampa Bay Buccaneers.

Others have not been so lucky. On July 4, 2021, NHL Columbus Blue Jackets’ Goaltender, Matīss Kivlenieks, was attending an Independence Day celebration and the wedding of his coach’s daughter. Ironically, though he had been playing in the U.S. since 2013, this was his first July 4 celebration in the U.S. During a nine-shot firework, which was legal and operated by a non-impaired individual, the mortar began to fall and sent fireworks into the crowd. Matīss was struck in the chest while trying to protect others, including the pregnant wife of his friend. It was initially reported that he had fallen and hit his head in the panic and confusion, but the autopsy showed his death was due to major chest trauma to his heart and lungs secondary to the percussive injury caused by the firework.

So, if you are out celebrating Independence Day this weekend, and you choose to use fireworks, be sure to follow the following safety tips:
1. Never allow young children to handle fireworks
2. Older children should use them only under close adult supervision
3. Never use fireworks while impaired by drugs or alcohol
4. Anyone using fireworks or standing nearby should wear protective eyewear
5. Never hold lighted fireworks in your hands
6. Never light them indoors
7. Only use them away from people, houses, and flammable material
8. Never point or throw fireworks at another person
9. Only light one device at a time and maintain a safe distance after lighting
10. Never ignite devices in a container
11. Do not try to re-light or handle malfunctioning fireworks
12. Soak both spent and unused fireworks in water for a few hours before discarding
13. Keep a bucket of water nearby to fully extinguish fireworks that don’t go off or in case of fire
14. Never use illegal fireworks

Better yet, grab a blanket and a patch of lawn, kick back and let the experts handle the fireworks show.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.

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