The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care
A Book Review By Pamela Sergey
The COVID-19 pandemic has underscored the importance of intensive care units (ICUs) and mechanical ventilators in our medical system – but you’ve probably never given either a second thought or wondered how they were developed. Would it surprise you to know that their development was due to polio?
The Autumn Ghost by Hannah Wunsch, MD
The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care by Hannah Wunsch is an enlightening and deeply impactful story of this critical moment in medical history. Through meticulous research and compelling storytelling, Wunsch, a Professor of Anesthesiology and Critical Care Medicine at the University of Toronto and a practicing intensivist at Toronto’s Sunnybrook Hospital, delves into the gripping account of the 1952 polio epidemic in Copenhagen - and how it changed the world.
During the 1950s in the US, polio usually erupted during the early summer months. In Northern countries such as Denmark, it manifested itself as an “Autumn Ghost”. At the height of the 1952 Danish polio epidemic, Wunsch transports us to Blegdam, a 500-bed infectious disease hospital in Copenhagen where medical professionals were baffled by an already high mortality rate in young patients with bulbar polio, which affects the respiratory and swallowing muscles. By the end of August 1952, 27 out of 31 patients had died. And still, polio patients continued to arrive at the hospital, up to 50 a day including 10-12 in respiratory distress. During the last five months of 1952 the hospital received roughly 3,000 patients diagnosed with poliomyelitis, about one-third with paralysis.
The hospital was woefully undersupplied with iron lungs and portable ventilators. It faced an overwhelming challenge of simultaneously caring for 70 paralyzed children who were unable to breathe on their own. With a team consisting of 1,200 to 1,500 medical, nursing and dental students, the hospital embarked on an unprecedented mission to develop and implement respirators, blood gas monitoring, and intensive care units (ICUs) to keep these children alive. The sickest patients were grouped together, and students provided 24/7 manual ventilation using a rubber bag attached to a tracheostomy tube. The hospital’s mortality of polio patients requiring ventilation fell from 87% in July 1952 to 22% in November 1952. The unusual methods implemented were working!
The narrative unfolds with a perfect blend of historical context and personal anecdotes of those involved, which allows the reader to truly comprehend the magnitude of the crisis and the extraordinary efforts undertaken by the medical community. Wunsch skillfully paints a vivid picture of the hospital's atmosphere during those harrowing times, creating a sense of urgency and empathy within the reader while highlighting the remarkable ingenuity and resilience that emerged in the face of such adversity.
One of the book's most significant strengths lies in its meticulous attention to detail. Wunsch went to the Copenhagen City Archives where she found the 1952 “Black Book” detailing every death at Blegdam. She provides a comprehensive understanding of the technological advancements made during that period and their subsequent adoption in the US and other parts of the world. This book is an essential read for anyone interested in medical history, as it offers both knowledge and inspiration.
Drawing on compelling testimony from doctors, nurses, medical students, and patients, “Autumn Ghost" is a testament to the power of human perseverance and ingenuity in the face of a devastating epidemic. It serves as a reminder of the transformative impact that dedicated medical professionals can have on society, and sheds light on a remarkable chapter in the ongoing fight against infectious diseases. Despite their differences, both polio and COVID-19 have resulted in outbreaks that tested health care workers while solidifying the need for ICU care, blood gas monitoring, and ventilators. With the COVID-19 pandemic technically over, it is not unusual to ask if, like polio, there will be long term health ramifications in 20, 30, or 40 years.
SOURCES:
The Epidemic of Poliomyelitis in Copenhagen, 1952 By H. C. A. Lassen, published October 1953 https://journals.sagepub.com/doi/pdf/10.1177/003591575404700119