In the May, 1954, issue of this Journal the authors presented a simplified guide for the use of tracheotomy in poliomyelitis.1 This guide has served effectively as an aid in guiding attending physicians, residents, and interns to a clinical decision as to whether a tracheotomy is indicated, not only in acute poliomyelitis but in a variety of other diseases which may present a similar problem. Such conditions as Guillain Barré syndrome, chronic lung disease, respiratory failure on any basis,2 diphtheria, and other conditions often present similar problems to that of the acute poliomyelitis patient and fall into the clinical groups to be described. The basic philosophy behind the use of prophylactic tracheotomy in poliomyelitis has been thoroughly presented in the medical literature.3,4 Several refinements have been developed both in the indications for tracheotomy and the care of the tracheotomy when present. We therefore feel that a re-presentation