The limited occurrence of the paralytic form of poliomyelitis, when contrasted with the widespread dissemination of the virus, suggests that certain factors may exist which determine whether clinical or subclinical disease will result following infection. The occurrence of the bulbar type of the disease after tonsillectomy is an instance of such an additional factor. According to Aycock this involves autarcesis of the host rather than immunity to the virus. The relationship between tonsillectomy and acute anterior poliomyelitis was reported by Sheppard in 1910 and by Ayer in 1928, and it has been reported in more extensive recent observations by Aycock and Luther, Silverman, Stillerman and Fischer, Top and Vaughan and others. Stillerman and Fischer1 found that tonsillectomy and adenoidectomy had been performed on 10 of 686 patients in a New York epidemic during the month antedating their illness; 6 of the 10 had the bulbar form of the disease.