The continuing problem of tetanus.
Thirty-eight instances of tetanus were treated during a recent 20 year period at the University of Mississippi and Jackson Veterans Administration Medical Centers. One patient had received a single prior dose of tetanus toxoid and the remainder had never received tetanus toxoid. Sixteen patients sought medical care for their tetanus wound prior to the onset of clinical tetanus, but none received specific antitetanus prophylaxis. The majority of tetanus wounds were located on lower extremities and often were chronic vascular ulcers. The over-all mortality was 37 per cent and survival rate was not affected by patient age, duration, location or severity of the tetanus wound or presence of associated diseases. Aggressive surgical treatment of the tetanus wound was associated with decreased mortality for uncertain reasons. Although low mortality from tetanus is possible with improved intensive care technology, the disease should be virtually preventable by the provision of proper tetanus prophylaxis to all patients at risk.