Between January 1955 and July 1967, 42 cases of tetanus were treated at Metropolitan Hospital. All but four cases occurred in narcotic addicts. The disease was severe and rapidly progressive; the case fatality rate was nearly 90%. Since 1955, the majority of cases of tetanus in New York City reported have been in addicts. The majority of these have been Negro women (80%) from the Harlem area. The case fatality has been high. Subcutaneous injections appear to have been the site of injury for the majority. Particular therapeutic agents were less important in the outcome of the disease than tracheostomy care and bronchial toilet. A respiratory death was strongly suggested in the majority of cases. Tetanus is the single most difficult medical complication of drug addiction to treat.
Charles E. Cherubin. Clinical Severity of Tetanus in Narcotic Addicts in New York City. Arch Intern Med. 1968;121(2):156–158. doi:10.1001/archinte.1968.03640020044008