A silent epidemic? Poliomyelitis, disability burden, and social impact in Turkey (1942–1968)

BACKGROUND: Historical scholarship has largely framed poliomyelitis through narratives of biomedical progress and vaccination success, often marginalising its long-term clinical and social consequences in the pre-vaccination era. This study examines the experience of poliomyelitis in Turkey between 1942 and 1968 by focusing on the discrepancy between official epidemiological indicators and the disease's actual societal burden. METHODS: Using a historical epidemiology approach, the study integrates multiple source types, including official health statistics, medical reports, contemporaneous clinical assessments, and national press coverage. These sources were analysed to assess trends in reported cases and deaths, patterns of underreporting, and the broader social and clinical consequences of poliomyelitis beyond conventional epidemiological measures. RESULTS: The analysis suggests that, despite relatively low reported case and mortality figures, poliomyelitis in Turkey generated a substantial cumulative burden through permanent disability, long-term care needs, and widespread social anxiety. A marked increase in reported cases in 1956 represents a non-linear trajectory characterised by persistence and periodic intensification rather than a single epidemic wave. Contemporary medical assessments consistently highlighted systematic underreporting, undermining the reliability of official statistics. Limited rehabilitation capacity, inadequate surveillance, and unequal access to healthcare shifted much of the long-term disease burden into the household sphere. CONCLUSION: Conceptualised as a 'silent but destructive' epidemic, poliomyelitis in Turkey can be interpreted as illustrating how low numerical visibility can coexist with substantial social impact. These findings underscore the importance of assessing epidemics beyond mortality- and incidence-based indicators, incorporating disability outcomes, care burdens, and structural inequalities into evaluations of public health impact.