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April 1949


Arch Surg. 1949;58(4):478-483. doi:10.1001/archsurg.1949.01240030486007

THE RECOGNITION of the importance of respiratory obstruction due to tracheal and pharyngeal secretion in certain conditions and the ability to control it have led to a completely changed prognosis in many diseases. This has been true especially in bulbar poliomyelitis.1 During the year 1947 no patient with anterior poliomyelitis died at the Evanston Hospital although there were 60 cases, 7 of which were of the bulbar type. Five of these required tracheotomy. One patient with myasthenia gravis, accumulation of throat secretions and impending asphyxia was treated on the same basis, with rapid relief.

Certain other states would seem to have the same common denominator of respiratory obstruction, anoxia, respiratory weakness and danger of drowning from aspirated secretion. We thought that tetanus, with convulsions under control by curare, would present much the same picture and respond to the same measures. When a patient with severe tetanus came under our