In most epidemics of poliomyelitis a variable percentage of the patients have bulbar involvement. In some epidemics the majority of such cases are rapidly fatal, while in other outbreaks some of these patients make a satisfactory recovery if symtomatic treatment is adequate.
Usually a prominent feature in bulbar poliomyelitis is inability to swallow because of paralysis of the muscles of deglutition. As a result of this paralysis there is a constant stasis of mucous secretion in the pharynx, and the removal of this secretion is probably the most important measure in the care of the patient. When it is not possible to have a special nurse constantly with a patient who requires frequent aspiration, there is always danger of the patient drowning in his own secretions. But even in cases in which suction is frequent a grave hazard exists that small amounts of material may lead to an aspiration pneumonia,