The considerations for handling the 362 cases of acute poliomyelitis at the N. Carolina Orthopedic Hospital during the summer of 1948, most of whom had bulbar and/or respiratory involvement, are discussed. Only 1 case out of 357 had a persistently negative spinal fluid. The belief that immunity against poliomyelitis exists during the first 6 mos. of life was contradicted by the fact that 10 cases were within that age group, 3 of which were under 8 weeks. Hot packs were used sparingly since it was found that adequate comfort to allow early institution of gentle progressive physical therapy could be obtained by adequate doses of aspirin and phenobarbital. Various drugs including neostigmine, thiazolyl, aureomycin and para-aminobenzoic acid did not provide any beneficial effect upon the course of the disease. The respirator was promptly used in those cases with respiratory weakness if nasal oxygen did not suffice. Weaning was performed as soon and as rapidly as possible but with attention to the element of fatigue and anxiety that was present in most cases. Some positive pressure Was always used to prevent pulmonary edema. In the care of bulbar cases, restricted hydration by means of proctoclysis was found very effective in controlling pharyngeal secretions so as to cut down the irritative effect of frequent suctioning. Freedom from pharyngeal secretions also allowed the use of the respirator in those bulbar cases with involvement of the respiratory center. Tracheotomy was performed in 8 cases, 7 of whom died; but in no instance was death due to suffocation. Gastric feeding by Levine tube in bulbar cases is condemned since the vagus paralysis produced stasis of the fluids in the stomach which produced respiratory difficulty by pressure against the diaphragm with the patient in the Trendelenburg position. In the coma occurring with poliomyelitis encephalitis the eyes should be bandaged or even sutured shut to prevent exposure keratitis. The possibility of acute myocarditis must be considered in those cases where dyspnea persists despite adequate oxygenation and respiration.