Preface and Acknowledgements

PREFACE AND ACKNOWLEDGEMENTS — First edition

Several large books and various papers have been written in past years on poliomyelitis. These have mostly described the management of the patient with acute poliomyelitis, and nearly all have described the management of poliomyelitis in economically rich countries. The majority were written over 40 years ago, and even then the methods of treatment were geared almost without exception to sophisticated centres management The management of patients with deformities in chronic poliomyelitis has been evaluated in orthopaedic text books, but these have usually described the management of relatively minor deformities again in economically rich countries. Unfortunately, little has ever been written on the modern management of severe deformities by simple methods in developing countries where millions of patients with poliomyelitis and other deformities still remain untreated. The splinting of paralysed patients has also almost always been geared to providing sophisticated supports at exorbitant prices, and these supports, apart from price, are often quite unsuited to the needs of two-thirds of the world's population. Finally, most books on rehabilitation have described the management of disabled patients in countries which have vast social services and large numbers of voluntary agencies. could have

It is the purpose of this book to describe the needs of the millions of untreated polio and other paralysed patients in the world and to describe practical but highly effective methods of management for these patients. These include simple operations, cheap but effective splints of various kinds, and rehabilitation geared to the facilities available in developing countries whether they be in Africa, India, Asia or South America. These methods have nearly all been personally developed over 14 years in Uganda and in other developing countries and have been proved to be highly effective in personally straightening, mobilising and rehabilitating over 7,000 paralysed patients. The methods advocated would be of value not only in poliomyelitis but in numerous other orthopaedic disabilities in both developing and developed countries. The many operations and appliances described would also have a very real place for spastic and stroke patients, as well as others with orthopaedic deformities or those patients needing effective cheap supports of various kinds. There are still many poor and elderly patients in economically rich countries who would benefit from such procedures or supports.

It is hoped that this book, which has been written in a simple dogmatic style for clarity, will be of value not only to doctors working in developing countries, but also to those who need to visit such countries. It could also be of practical use to physiotherapists, nurses, orthopaedic technicians, orthopaedic assistants, workers in the social and rehabilitation fields and all those interested in treating the paralysed and otherwise disabled patient both in developing and developed countries. It could also be of value to students both in medicine and in the various paramedical disciplines who will need to understand the management of such patients as well as have a simple overall approach to deformity and paralysis in disabled patients.

I should like to acknowledge the assistance given by the many voluntary and other workers over 14 years in various economically poor countries. It would be impossible in a simple practical book such as this to mention them all individually, but I would like to name a few who have been of particular help. The National Fund for Research into Crippling Diseases and its Director, Mr. Duncan Guthrie, have given considerable assistance since 1961 to the research and development of the simple appliances described, to the organisation of a huge immunisation scheme and to the setting up of numerous rehabilitation centres in Uganda. Without this assistance little could have been achieved. The members of the Kampala Round Table, past and present, have also given me constant help in the development of the Round Table Polio Clinic, and through their efforts many of the voluntary workers were recruited.

The Royal, College of Surgeons of England elected two Laming Evans Research Fellows each for a two year period, Mr. A. M. Bain and Mr. C. V. Horn and both proved of great assistance. Other individuals who have been of particular help have included Mr. George Wilson, Mr. Donald Gibson, and my various registrars, orthopaedic colleagues and house surgeons, physiotherapists, technicians and orthopaedic assistants over many years in Uganda. In particular I should like to mention Professor Sir Ian McAdam, Sir Herbert Seddon, Dr. B. Ganatra Messrs. G. Ealdon, Sharad Hardikar, E. Johnson, David Kisumba, J. Mackenzie, I. Misanvu, B. Mugaya, I. G. Nantamu, B. Nyirinkindi, E. Sendi, W. Serumaga & Leo De Souza. The deep interest shown by His Holiness Pope Paul VI during his visit to Uganda in 1969 has also been of great help to the patients in the Clinic.

The research workers who have helped to extract and collate the vast amount of statistics in this survey have included Mrs. M. J. Aerni, Miss E. M. Evans, Miss J. Gits, Mrs. D. Leeland,, Mrs. C. Lewis, Mrs. G. Nelson and Miss Susan Huckstep. Mrs. Joyce Marriott, a voluntary worker, was responsible for all the original drawings in this book, which were drawn accurately from actual patients, and these speak for themselves, as does the clear way in which Mr. Frank Price has converted them into the line drawings suitable for this book. The Managing Director and the publication staff at Churchill Livingstone have been as usual most helpful at all times, and I am very grateful to them.

I am indebted to Mrs. Rosemary Blaxland, Mrs. Carol Bye, Miss Nola Johnson, Miss Hilary Newman, Mrs. Judy Nieuwenhuisen, Mrs. M. C. Polo, Mrs. Jane Rogers and Mrs. Maureen Sara for secretarial assistance, and to Dr. Elizabeth Cooke for checking the manuscript. I am also indebted to Care/Medico for their help in the publication of this work. Finally, I should like to thank the many voluntary workers who have worked in the Kampala Polio Clinic, and in particular my wife who has spent many hours over a 12 year period helping in the development and documentation of polio and orthopaedic clinics in developing countries, and who has typed and edited the many booklets, papers and films which were the precursors of this book.

R.L.Huckstep Sydney, 1975

COPYRIGHT — The author owns the copyright of this book. Provided acknowledgement of the source is made, any of the text or illustrations in this book may be copied without charge. This includes details of the manufacture of the calipers, wheelchairs and other appliances.