HOW A POLIO OUTBREAK IN COPENHAGEN LED TO THE INVENTION OF THE VENTILATOR

[Judi Lynn]

After one hospital struggled to sustain the breathing of hundreds of patients, engineers found a solution that saved lives and sparked an ethical firestorm

BY BRADLEY M. WERTHEIM
SMITHSONIANMAG.COM | June 10, 2020, 10:56 a.m.

More patients than ventilators. Understaffed hospitals. A snowballing pandemic. Seven decades before COVID-19, a similar crisis strained the city of Copenhagen. In August 1952, the Blegdam Hospital was unprepared and overwhelmed. A 12-year-old victim, Vivi Ebert, lay paralyzed before anesthesiologist Bjørn Ibsen, “gasping for air” and “drowning in her own secretions.” Seven years after liberation from Nazi occupation, a new shadow darkened the streets: the poliovirus. With his hands, a rubber bag, and a curved metal tube, Ibsen reset the boundary between life and death and taught the world how to breathe.

“We were very afraid,” remembers Ibsen’s daughter Birgitte Willumsen of the 1952 outbreak, “everyone actually knew somebody” affected by polio. Waves of young people with fever, headache, upset stomach and stiff neck heralded the arrival of the “summer plague” in cities throughout the United States and Europe. Masquerading as a common stomach virus, the infection established itself in the gut before spreading to the brain and spinal cord. The clinical picture ranged from a self-limited stomach bug to paralysis, shock and asphyxia. Some recovered, but lasting disability, or death, was typical. At the time, the best way to treat respiratory complications of polio was with the "iron lung," a tank that encased polio victims but allowed them to breathe with the help of a vacuum pump. Researchers understood that the virus was contagious, but they could not yet agree on its manner of spreading. Recalls Willumsen, “We really learned to wash our hands.” Nonetheless, the modern sanitation, water supply, housing and medical infrastructure of Western cities offered little protection. A vaccine was not yet available.

Blegdamshospitalet was the designated “fever hospital” for treating infectious diseases among the 1.2 million citizens of Copenhagen. During the summer of 1952, the staff treated more children with severe polio than they had in the previous decade. At the peak of the epidemic, up to 50 new patients limped, wheeled and wheezed onto the wards each day. With higher attack rates than preceding outbreaks in the U.S. and Sweden, the Copenhagen epidemic was the worst polio crisis that Europe—and perhaps the world—had ever seen. “During these months we have in fact been in a state of war,” wrote Henry Cai Alexander Lassen, Blegdam’s chief physician. “We were not nearly adequately equipped to meet an emergency of such vast proportions.” Hundreds of patients with bulbar polio. One state-of-the-art iron lung ventilator, and a few older, mostly impotent, devices. Concluded Lassen: “Thus the prognosis of poliomyelitis with respiratory insufficiency was rather gloomy at the outbreak of the present epidemic in Copenhagen.”

The prognosis was especially gloomy for young Vivi Ebert, who was dying in front of Ibsen and his colleagues on August 27, 1952, at the height of the epidemic. Vivi suffered from the bulbar variant of polio infection; in addition to causing paralysis, the virus disrupted brainstem control centers for swallowing, breathing, heart rate and blood pressure. At the time, about 80 percent of bulbar polio patients died comatose in the iron lung.

More:
https://www.smithsonianmag.com/innovation/how-polio-outbreak-copenhagen-led-to-invention-ventilator-180975045/