Stab Wounds of the Heart

in 1890. The desire to use ever-increasing amounts of antiserum,3 in the hope of reducing mortality, has recently been questioned by controlled investigations.4 Evidence is now accumulating regarding the futility of A.T.S., once clinical tetanus has occurred. In a well-controlled trial of 470 patients6 we did not find any difference in the final outcome in the groups of cases receiving 15,000, 30,000, and 50,000 units of A.T.S. as compared to the one who was receiving no antiserum at all. The money spent on A.T.S. would be better spent in immunizing healthy people with toxoid. The vulnerable groups are pregnant women (accounting for 26%/,, of cases during the delivery period) and children and adolescents (accounting for 43.5%/. of cases). By imnmunizing these we would expect about a 70% reduction in the incidence of tetanus. In our own hospital, proper organization, proper nursing care, and constant medical surveillance have reduced the mortality from 95 % to 79% in neonatal cases, and from 65% to 49.5% in other cases of tetanus. This mortality rate is still horrifying.-We are, etc.,