In any epidemic of poliomyelitis the death rate occurs largely in cases of the bulbar type. A large percentage of this mortality is furnished by patients with paralysis of respiration and deglutition.
The immediate cause of death may be the severe infection and paralysis, but, in my opinion, many deaths are due to drowning. The throat and bronchial tubes fill with a profuse secretion of mucus which the patient can neither swallow nor raise.
The observation that drowning, rather than paralysis, causes death in this type of case is not original. I heard it several years ago in an informal conversation between several well known pediatricians. Who made it I cannot now recall. It is not mentioned in any textbook, nor have I found anywhere in the literature any suggestion of the simple method of treatment here described which this view of the situation suggested to me. I am confident
DURAND JI. POSTURAL TREATMENT IN BULBAR INFANTILE PARALYSIS. JAMA. 1929;93(14):1044–1045. doi:10.1001/jama.1929.02710140010004