Tetanus Prophylaxis-Reply

Abstract

To the Editor:— I agree that antitoxin still has a place in the prophylaxis of tetanus. I believe that the drug is over-used and that its administration should never be routine. The small, trivial wound which has had meticulous local treatment does not have the potential of the massive, or dirty, or late wound. The use of antitoxin for these wounds would have greater hazard than that from potential tetanus. Powder burns, rusty nail puncture wounds, or deep wounds harboring foreign bodies are not trivial by my definition. In the last analysis, the judgment as to the severity of a wound, its potential for clostridial infection, and the indication for antitoxin must remain with the individual physician caring for his patient. It should be reemphasized that, if a patient has had horse serum, and especially if he is sensitive to it, protection from antitoxin is greatly lessened and may be