About 300 patients with tetanus have been seen in 25 years at the Cook County Hospital. Formerly the patients were mostly children; the treatment included sound-proof rooms, subdued lighting, and heavy sedation with barbiturates. In the past 10 years the patients have been mostly adults, with heroin addicts predominating; treatment has been improved by the use of meprobamate to control the spasms evoked by somatic stimuli and the use of better respiratory care. The mortality of tetanus in heroin addicts has remained high (about 70%). The use of hypothermia in this type of patient has decreased morbidity and increased survival time, but it has not yet greatly decreased mortality.