ACUTE ILLNESS AND REHABILITATION

In the fi rst half of the 20th century, polio was one of the most feared of conditions in the UK and USA. Few people were unaffected during the epidemics of the 1940s and 50s, which preceded the introduction of immunization with the Salk inactivated vaccine in 1956 and the Sabin live at-tenuated vaccine in 1962. Patients remember the anxiety and mass hysteria surrounding each new outbreak of poliomyelitis, and fear of polio was often greatest amongst medical personnel, many of whom were affected (Gould 1995; Mulder 1991; Halstead 1995). This fear is graphically illustrated on the cover of Tony Gould’s classic description of the history of poliomyelitis in the 20th century (Fig. 1) (Gould 1995). There are striking accounts of the acute illness – patients recall bathing in affected areas and de-veloping non-specifi c fl u-like symptoms, often following periods of prolonged exertion (Rus-sell 1949). When the diagnosis was suspected they were frequently admitted to large ‘isolation hospitals ’ in the country outside major areas of population. Many were not allowed to see their family or friends, and all speak of their profound anxiety and helplessness. They were treated with strict bed rest and some required ventilation with an Iron Lung (an effi cient form of ventilation particularly suited to polio be-cause it allowed concurrent physiotherapy and postural drainage) (Fig. 2). Those with severe bulbar weakness required a tracheostomy to protect the airway, but few survived. io functiona