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July 15, 1968

Management of Tetanus

JAMA. 1968;205(3):187-188. doi:10.1001/jama.1968.03140290079030

To the Editor:—  Tetanus is relatively rare in America today. The rise of cases among addicts, however, and the increasing service of American physicians in underdeveloped regions in which immunization is rarely practiced demand greater familiarity and skill in the care of this disease. To the aspects of clinical management suggested by Henry Brown, MD (204:614, 1968), I would add some comments based on treating more than 100 neonatal and adult patients with tetanus in Haiti.Since both treatment and prognosis are directly related to severity, early objective classification of the degree of severity should always be made. Patel's five-grade system is simple to follow and in common use.1 Mortality ranges from none in grade I to nearly 100% in grade V cases, and this system permits evaluation of the effectiveness of new drugs and treatments. Patients with tetanus pass through three distinct phases, the "build up" or