Forty-one patients with tetanus in different stages of the disease on whom tracheostomies were performed are discussed in this paper. Out of these, 21 died, giving a mortality rate of just over 50%, which is about equal with those reported from other centers. It was found that patients in Stage III of the disease referred for tracheostomy hardly ever recovered. Patients in Stage II on whom tracheostomy was performed early stood the best chance of survival and recovery. However, if the operation was delayed in Stage II patients, there was a much greater chance for complications to develop, mostly due to aspiration of secretions into the tracheobronchial tree with consequent bronchopneumonia. There were four deaths, all in Stage III patients undergoing tracheostomy, where no definite or conventional identifiable cause could be determined. There were three deaths due to "technical failure" in tracheostomized tetanus patients, which underlines the difficulties and technical problems encountered in satisfactorily maintaining a totally paralyzed patient without any means of communication.