In the Second World War active immunisation of all troops sent overseas was practised, and the results proved the value of inoculation. There were few cases of tetanus recorded among New Zealanders, although it is not known that any of the soil over which they fought was highly infected.

The procedure for prophylaxis was for each man, shortly after mobilisation, to be inoculated with two doses of 1 ccm. of tetanus toxoid at an interval of six weeks. After a further interval of at least six months a third dose of 1 ccm. was given, with further doses at intervals of a year or less.

As soon as possible after an injury was inflicted each wounded man was given a dose of 3000 international units of anti-tetanus serum (ATS). This was intended to cover any gaps in the protection offered by active immunisation.

There are three reports of cases in 2 NZEF during the war. Captain Borrie recorded two deaths from tetanus at Kokkinia prisoner-of-war hospital in Athens. One was a Maori, but the force to which the other belonged was not stated.¹ Both had severe page 134 wounds, no adequate surgery, and had had no ATS after wounding. Both had had tetanus toxoid a year previously. Boyd and Maclennan, RAMC pathologists, in 1942 recorded two cases, both Maoris, one of whom died. The Consultant Surgeon CMF recorded two New Zealand cases in a total of 42 Allied cases in Italy. Both survived. There are no other reports of cases in the 2 NZEF.

This gives a total of a certain five (and possibly six), with two (or three) deaths during the whole period of the war. Two, or possibly three, were wounded in Crete and had no ATS and inadequate surgery. Three were Maoris, two of whom were wounded in Crete, and two died. The report of 2 General Hospital on the Maori who developed tetanus in the hospital eight days after being wounded in Crete stated that a complete recovery followed massive injections of ATS intramuscularly and intravenously.

It would appear that the lack of prophylactic ATS, associated with lack of adequate surgical treatment, together produced a dosage of toxin in the body sufficient to overwhelm the protective barrier produced by the tetanus toxoid injections.

There may also be a relative lack of immunity in the Maori race, but as there appear to have been no further cases after July 1942 this can hardly be a matter of much importance.

Boyd and Maclennan emphasized that early diagnosis must be based on clinical signs and symptoms as bacteriological examination gives no timely positive assistance. They consider that immunisation by tetanus toxoid in three doses has proved eminently satisfactory, but that prophylaxis by ATS and particularly adequate surgical treatment are both still necessary and that massive production of tetanus toxin in the body can still be fatal in spite of immunisation and prophylaxis.