|Neonatal tetanus in two island communities in the North Atlantic. Vestmannaeyjar and Grímsey (Iceland) during eighteenth and nineteenth century|
|Neonatal tetanus is a well-known disease in Third World countries today. It is caused by a bacterium Clostridium tetani that grows in animal faeces, dead tissue and decaying substances. The bacterium is found in soil and animal excrement, and often on the surfaces of skin and tools. Transmission takes place when there is direct contact between bacteria and the umbilical stump and is therefore often related to unhygienic cord cutting or the application of filthy substances to the umbilical stump. Today the transmission of the disease is often related to home delivery and untrained assistance during delivery. Signs of neonatal tetanus appear two to ten days after birth and normally death occurs within two weeks from birth
The problem of neonatal tetanus has received relatively little attention amongst medical historians. Since the transmission of the disease is generally linked to unsanitary conditions, and in particular to contact with animal faeces, there is little doubt about its existence in rural societies in past times. Delivery frequently occurred under primitive conditions and the fact that domestic animals were often kept in human dwellings increased the risk of transmission.
This paper discusses the occurrence of neonatal tetanus in two island communities in Iceland (Vestmannaeyjar in the south and Grímsey in the north) during the late 18th and early 19th centuries. Both islands were known for extremely high neonatal mortality rates. Mortality from tetanus remained high in Grímsey throughout the nineteenth century whereas battle against the appalling neonatal tetanus in Vestmannaeyjar can be seen as an interesting example of successful public health intervention. Through a series of public health measures, neonatal mortality levels in Vestmannaeyjar dropped permanently to levels close to the national average. This happened s early as the 1840s, i.e. several decades prior to the bacteriological revolution of medical knowledge.