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The Fourth of July As Tetanus Day

Vincent Iannelli, MD

You likely think of the Fourth of July as a day of sun, fun, and fireworks. You probably don’t think about tetanus, do you?

Believe it or not though, the Fourth of July was once known as Tetanus Day…

The Fourth of July As Tetanus Day

If you’re a pediatrician, you do often think of working to prevent burns, cuts, and fractures from firework accidents.

But tetanus?

Yes, tetanus.

In addition to Tetanus Day, the Fourth of July was known as the Bloody Fourth.

In the pre-vaccine era, minor wounds could lead to kids getting and dying with tetanus.

“Blank cartridge wounds cause more deaths in the annual celebration of the Fourth of July than all other factors combined. In seven years, 794 deaths have been caused by this one factor! Most of the victims were bright active boys, aged from 6 to 18 years, and they were doomed to die the most awful death known to medical science, a death the agony of which is probably not paralleled even by the tortures of the Inquisition. If this annual sacrifice were really necessary, it would be far more merciful to pick out the hundred or more youths each year and deliberately shoot them.”

Fourth of July Injuries and Tetanus. The Seventh Annual Compilation by the Journal of the American Medical Association.

Before it became widely publicized, hundreds of children and teens would die each year on Tetanus Day!

Yes, homeopathic hospitals were once a thing…

While some of the tetanus deaths followed injuries from traditional fireworks, like firecrackers, most followed the use of blank cartridge pistols, which were popular at the time.

“Physicians often treat blank cartridge and other Fourth of July injuries, unless of a serious character, as trivial, contenting themselves with picking out the plainly seen pieces of wad, powder, etc., and applying a dressing. In a few days the patient returns with symptoms of tetanus and then, when it is too late, antitoxin is given, the wound is thoroughly cleaned out, and perhaps a piece of wad or clothing found in it.”

The Danger and Prevention of Tetanus from Fourth of July Wounds

Injuries which often seemed “trivial” when they were first seen, which may be why they didn’t get treated with antitoxin. Also remember that tetanus antitoxin was a very new treatment and at the time, many thought it should be given directly into the spinal cord for best effect!

Tragically, the great majority of these folks who developed tetanus died. Of the 1,012 Fourth of July tetanus cases between 1903 and 1909, there were 901 deaths.

Interestingly, even before the Journal of the American Medical Association started printing their yearly compilation of Fourth of July tetanus cases in which they advocated for early treatment with antitoxin, a newspaper article first raised awareness of this issue.

Fourth of July Tetanus Death List

On July 17, 1899, The Chicago Tribune published a Fourth of July Death List…

They noted that many of these Fourth of July deaths were from tetanus.

Their yearly lists of Fourth of July tetanus deaths eventually got the Journal of the American Medical Association to compile their own list!

Where was the American Academy of Pediatrics in all of this? The AAP wasn’t formed until 1931…

There were at least 8 deaths in 2023 from teens and adults using fireworks. So while we can no longer call the Fourth of July Tetanus Day, the Bloody Fourth nickname is still appropriate.

So those journalists helped save a lot of lives!

Unfortunately, we can still easily post Fourth of July death lists from fireworks. The only difference is that as most folks are vaccinated and protected and fireworks have gotten much more powerful, these days folks aren’t dying with tetanus on the Bloody Fourth of July.

Hopefully this will be a good reminder that if you decide to ignore the advice to leave fireworks to the experts, you will at least make sure that your kids are up to date on their tetanus vaccines!

Health care providers should also be sure to check the tetanus vaccine status of anyone who has a fireworks injury, in addition to other types of injuries.

More on History of Tetanus

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