William P. Frank, M.D.
JAMA. 1953;152(8):757. doi:10.1001/jama.1953.03690080101029.
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To the Editor:  —The article in the March 28, 1953, issue of The Journal (page 1099) entitled "Four Fatal Cases of Bulbar Poliomyelitis in One Family" deserves comment. The cause of death in patients with poliomyelitis is well known. They die of asphyxia from impairment of respiration. This impairment is due to weakness of the primary muscles of respiration, to obstruction of the airway, or to a combination of the two. Rarely is the respiratory center involved. In bulbar poliomyelitis, difficulty arises from obstruction of the airway, because of impairment of swallowing or paralysis or spasm of the vocal cords. With paralysis of the muscles of deglutition, the patient is unable to rid himself of pharyngeal secretions, and he aspirates them and is eventually asphyxiated.The treatment of these conditions is well known. Tracheotomy should be performed, and the airway should be kept free of obstructing materials. If these measures


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