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- [00:05]
A
In Copenhagen, near The end of August 1952, 12 year old Vivi Ebert came home from school with a headache. The next day, she had difficulty moving her arms and legs. Soon after, she developed a fever, a stiff neck and partial paralysis, including trouble swallowing and breathing. She had come into contact with the Autumn Ghost, polio and Vivi Ebert was going to die. That was the fear for Vivi and for so many others crowding into the Blighdam Hospital.
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B
That's Dr. Hannah Wunsch, a professor and anesthesiologist at Weill Cornell Medicine in New York City. In 2020, she was researching the 1952 polio epidemic in Copenhagen for her book, the Autumn Ghost. Though the book artfully weaves together multiple stories, its principal setting is Copenhagen's Blydom Hospital, where the medical staff was overwhelmed by polio patients. Under immense pressure and surrounded by loss, doctors Henry Lassen and Bjorn Ibsen were faced with a seemingly unanswerable question. What can we do when so many patients afflicted with polio become too paralyzed to breathe? What followed was a near miraculous saga of medical innovation. Welcome to the Rotary Voices podcast. I'm Jeff Johnson, the senior editor at Rotary magazine. I recently sat down with Dr. Wunsch to discuss the stories chronicled in the Autumn Ghost, the emotional toll of the 1952 epidemic, the medical breakthroughs that followed, and the unexpected relevance of her book today. Hannah Wunsch, welcome to the Rotary Voices podcast. Thanks so much for joining us today.
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A
Thanks so much for having me. It's a real pleasure to be here.
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B
You know, let's begin at the beginning or even before the beginning. The title of your book is the Autumn Ghost. What exactly does that mean?
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A
So the Autumn Ghost actually refers to polio, and it refers specifically to polio as it occurred in Scandinavian countries, because in the United States and North America, most of the world, it would peak in the summer months and was referred to often as the summer plague. But certainly in Scandinavian countries, it tended to peak in the autumn. And so one writer back in the 1940s referred to it as the Autumn ghost because it would sneak in over the course of the summer and then really rear its head in the autumn months. And I was just so struck by that phrase because it is so sinister and in that sense, to me really fit the disease as this terror that would come every year.
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B
Your book also has a subtitle, how the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. That really gets at the gist of what your book is about.
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A
Yeah, it's a little bit of a mouthful, but we wanted people to really understand. And what's, I think, a little different about my book is that it deals with a very specific polio epidemic and centers around this one moment in time in Copenhagen in 1952, when there was this polio epidemic that really was important not just for the care of the polio patients themselves, but also for our understanding and moving medicine forward, because it was the great leap forward in how to ventilate people and how to support their breathing that involved what's called positive pressure ventilation, blowing air into the lungs. And so I celebrate it as this important innovation that occurred at that moment, spurred on by the need to care for polio patients.
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B
Now, you first encountered the story of the Copenhagen polio epidemic while studying in England at the London School of Hygiene and tropical medicine in 2001. What was it about that story that captured your imagination?
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A
Well, the very centerpiece of the story is an extraordinary image. What happened was they realized through the help of an anesthesiologist, that if they did a tracheostomy, a little tube into the throat, that they could blow air into the lungs and keep someone alive. This. It's what we do now. It's modern ventilation. But at the time, they didn't have ventilators. And so they called on the medical students of Copenhagen to come sit at the bedside 24 hours a day to hand ventilate these patients, some of them very small children, some adults. And that, to me, was just such an extraordinary image of that dedication, the terror they must have felt, and just the achievement of. Of having hundreds of students. In fact, at the end, they used over 1200 medical and dental students participating in care and such a community effort that that image really just always stayed with me. And then I also. I became an intensive care doctor. And so every time I would flick a switch on a ventilator to turn it on and hook up a patient, I just couldn't help but go back to that story in my head and marvel at how recent it is that we have this technology and the fact that it's 1952 and before that. So someone struggling to breathe. There was really nothing that could be done for them. And that's in the lifetime of so many people. So I just find all of that really extraordinary and something that's really important for us to remember and celebrate.
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B
Let's even back up a little bit. About 25 years before the epidemic in Copenhagen, a man in Boston named Philip Drinker introduced what came to be known as the Iron lung. Talk a little bit about that moment.
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A
Yeah, that still gives me chills every time I think about it. Philip Drinker was a professor of public health at Harvard, and he was actually tasked with finding a way to help support breathing for people in workplace accidents, things like electrocution. But he also had walked through the polio wards at Boston Children's Hospital and saw the need there and saw the experiments a colleague of his was doing with a cat in sort of an equivalent of an iron lung, sealed into this little chamber and doing breathing experiments. And he realized that the way they'd sealed the cat in, if they pulled on the plunger that was attached to this box, he would suck air out of the chamber, which would suck the lungs open. And then if you push the plunger back in, it would cause the cat to breathe out. And he realized that this was a way to keep people alive. And he demonstrated, first on the cat and then on humans, that this worked. And it became the mainstay of treatment. And it was incredibly successful for taking care of patients with respiratory failure from polio, but only one form of respiratory failure, and that was what was called spinal paralysis, meaning it was affecting the muscles that allow the ribcage to expand and contract. But there was another form of respiratory paralysis from polio called bulbar polio, that caused people to have trouble with swallowing and coughing, and it was not effective for that. So it became a majorly important mainstay of treatment, but for a limited range of patients.
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B
Tell us a little bit about the autumn of 1952 and what happened in Copenhagen that really was so terrible, as we look back on it.
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A
Yeah. And in fact, it didn't start in the autumn of 1952. It, in fact, started in the summer of 1952. And that's actually what made it so terrifying, because they knew the epidemiology of this disease in their country, and they knew that it wouldn't peak until the autumn. And yet throughout the summer, they were seeing cases rolling in. And there was one main hospital in Copenhagen that cared for infectious disease patients called the Blydam Hospital, and it was run by a man named HCA Lassen, Henry Lassen, who was a world expert on polio. He'd seen a lot of cases in his lifetime, and they knew how to care for them. But the challenge was they'd never seen anything like this in terms of the number of cases. And also the fact that there was this form of polio called bulbar polio that was not helped by iron lungs. And they were Seeing many, many cases of. And so they were at their wits end. They were seeing dozens of deaths over the course of the summer. And they knew they needed to try something, but they didn't have a great understanding of breathing and what we call respiratory physiology at the time. What they were seeing actually was people dying from the buildup of carbon dioxide in the body that they literally just couldn't breathe it out. And a young doctor there had met an anesthesiologist in the city by the name of Bjorn Ibsen a few months earlier. And he suggested they bring in this guy, this kind of unknown young doctor and just thought he might have something to offer. And in fact, what he had to offer was this positive pressure ventilation, which was really radical at the time. It was used in the operating room to take care of patients during surgery, but it really wasn't used outside of operating rooms at the time, pretty much anywhere in the world. And so Henry Hassan was pretty resistant. He was not super excited by this explanation of what they should try. But with nothing else to offer, he did allow Bjarn Ibsen to demonstrate this on a little girl named Vivi Ebert to show that he could keep her alive when she was dying.
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B
And there had been this back and forth between Dr. Lassen and Dr. Ibsen. And Dr. Lassen finally says, all right, you have this theory. I'll give you one chance to see if you can make it work. And that chance was Vee.
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A
Yeah, it's an extraordinary moment that, you know, incredibly, we have his documentation. Dr. Ibsen's care of her. And so they do the tracheostomy. He actually has trouble ventilating her. She goes into what's called bronchospasm, meaning the airways close up. And he actually can't get the air into her. And everybody thinks that she's gonna die. And they actually. They literally go off to lunch. Cause they don't wanna see another death of a little girl. And he takes a risk and gives her anesthesia to allow her body to relax and break the bronchospasm. And after that moment, he' to control her breathing. And she wakes up and she's alert and interactive. And it's a successful treatment for keeping her alive. And she's stabilized. And they realize that this is the way forward to take care of these patients.
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B
You at one point described the intensive care unit as a place where patients might seek a reprieve from death. That's all because of these interventions introduced in 1952. And tell us again, why was that so revolutionary?
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A
Yeah, you know, early in the 20th century, really up until the 1950s and the 1960s, if you got sick to a certain point where you struggled with your breathing, your other organs were shutting down, that was it. We had no way to intervene, to help somebody, to buy time to allow their body to recover. But one of the things that was really learned in the polio epidemic was they needed this sort of integrated group of individuals to take care of patients who understood how the ventilation worked, the nurses who had experience with this, that they could be watched all in one place very carefully. And so all of that comes together after the polio epidemic into this idea of we can take care of not just polio patients, we can take care of anyone who's struggling to breathe with these types of interventions. Intensive care, often it's about supporting someone's body to keep them going until their own body can heal. It is a remarkable set of technologies and interventions that we can do to allow the body that time that didn't used to exist.
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B
We've Talked about the 1200 or so medical interns or students and you mentioned dental students and nurses. They weren't flipping on a machine to keep these people alive. Tell us what was going on at Blyda Masspadow.
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A
Yeah. So, you know, in 1952, ventilators as we know them, this idea of a machine you could hook up to someone with a tube that would push air in out of lungs. There were a few in operating rooms in Sweden and there were one or two people in the UK and the United States who were similarly experiments experimenting with this in operating rooms. But there were literally no ventilators in all of Denmark. The technology just didn't exist. And so that is why they had to bring in the medical and dental students to do the work of machines. And the students would sit there for six to eight hours at a stretch with a single patient. And they literally had to breathe for them. They had to take this bag and keep squeezing it at about 20 breaths per minute. They got a 10 minute cigarette break every hour and then a break for lunch or dinner. But a lot of these students were first year or second year medical students. Some of them had never touched a patient before. They would often get five minutes of explanation of what they were expected to do and then and left with a patient. If the next person didn't show up for some reason, they obviously they couldn't leave. So incredible dedication that went into this and incredibly scary. I mean, things did go wrong. You can imagine kinking of tubing and oxygen Tanks running out of gas unexpectedly and things getting plugged up. And so they had to create a whole safety system around that to safely take care of these patients and have backup oxygen tanks and backup tubing available and people coming around to suction out the secretions from people's throats. And it was really extraordinary what they instituted in a very short period of time.
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B
For some of these students, the experience had a long term impact on them.
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A
Absolutely. I was able to meet two of those students who were in their early 90s when I met them. And one had become an anesthesiologist because of her experience and named one of her children after one of the patients she cared for. This experience left an indelible mark on all of them, I think, and also traumatic marks on them as well. And I think that's important to recognize when I speak, particularly to medical audiences. I read a passage from the book which is about the aftermath of the epidemic, and one of the medical students describing his difficulty in processing what he'd been through and seeing people die, children dying because they didn't save everyone, and how hard that was. And it really resonates a lot with medical audiences who have been through similar experiences, but even more so with COVID And I often see people starting to cry when I describe this. And it really drives home that the experience of taking care of polio patients is not so different from the experience of taking care of. Of other patients today with other infectious diseases or other problems.
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B
You did talk a little bit about in your afterword. You were kind of wondering what sort of relevance this book you were working so hard on might have. And then the pandemic hit.
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A
Yeah, well, the pandemic hit and also changes in willingness to take vaccines has hit. So not only has mechanical ventilation, intensive care, suddenly it was headline news everywhere. So the relevance of this sort of central innovation was much more obvious. But it's been interesting certainly since the book has come out and it's been almost two and a half years now. Definitely the focus of my talking to people about the book actually has shifted a little bit from that as we put Covid behind us, and much more towards the importance of documenting the stories of the polio patients and using that to help people remember what polio did to people, and still does, obviously, because it's not completely eradicated from the world. And the passages I read from the book have changed from emphasizing the innovation and the technology that was discovered to really wanting to drive home to people the impact of polio itself on people's Lives.
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B
Well, the main line in Autumn Ghost is the. The epidemic in Copenhagen and the remarkable might even say miraculous response to it. There are other multiple stories seamlessly woven through your book. And really what makes your book such a joy to read. One of those parallel stories is the race to find a polio vaccine.
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A
Yeah, you know, I alluded a little bit to it earlier, but I thought it was really important to juxtapose the need to care for these patients in this epidemic with the fact that doctors, nurses, no one wanted to have to care for these patients, and that the kind of upstream prevention of a disease was what was most desired, and that there was this huge ongoing effort throughout, and they're just three years too late with the vaccine, in a sense, for this story. And so this epidemic occurs because they're in early stages of testing vaccines and they don't have one yet. So I thought it was important to tell the vaccine story as part of this, as kind of happening in parallel and reminding people of how desperately this was wanted. The vaccine was a really important point to make. Throughout and interviewing polio survivors, all of them talked about just how thrilled they were when the vaccine was announced. You know, and of course, it didn't help them. They are left with the paralysis and aftermath of having had polio, but that didn't matter. Right. The idea that others didn't have to go through what they had been through was an absolute universal theme. In speaking with polio survivors, many people described their parents breaking down in tears when the polio vaccine was announced. They remembered that vividly because it was so terrifying to people as a disease, and the wondering whether, you know, someone in the class was going to come back that year in braces or in a wheelchair. Everybody from that era has such memories of those images.
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B
I love the fact you've made this point that polio survivors were so ecstatic that this was a fear that their children and their grandchildren would never have to face. All because of the vaccine.
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A
Yeah. Yeah. And polio has very visual reminders in a way most other diseases don't. You would know if someone had paralytic polio because they were often in leg braces, needing crutches, neck braces, wheelchairs. It was very obvious walking down the street if somebody had been affected. And most diseases don't do that. You can't tell if someone is dealing with many of the sequelae of different diseases, but with polio you can. And I think that really helped to make it feel particularly scary. And, of course, it really affected people's Day to day life for the rest of their lives. Now some recovered fully. And I want to emphasize that not everybody who gets the disease ends up with paralysis. There's many sort of variations, many in fact are asymptomatic and just pass it on. But for those who were affected, it was absolutely huge life changing events.
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B
You've identified what you call a nonchalance towards polio among people who live in countries where polio no longer exists. They kind of have this feeling of it can't happen here. Why is that a worrisome attitude?
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A
I think that it's a tribute to our success in public health in many high income countries up to this point that we have almost completely eradicated polio from the world. But not quite day to day infections are not part of people's lives and thoughts and that's fantastic. But we only achieve that through herd immunity and by enough people vaccinating and recognizing that there is a community benefit to a vaccine. And I think that a lot of the emphasis has shifted and been placed on personal choice and personal preference and decisions. And really lost in that conversation is the fact that if you vaccinate, you are not only protecting yourself or your child, you are protecting the people around you, that you are protecting the community you live with and work with. And I hope that message starts to get picked up again that we are only all healthy if we are all willing to support each other in that way.
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B
As a doctor working at one of the biggest cities in the world in New York and a major hospital, what is your greatest fear?
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A
My greatest fear is hearing that there's a polio case in the hospital. I just would be devastated to ever hear and of course not just my hospital, in any hospital in a country that has worked so hard to eradicate the disease. And I do want to make the distinction. There is what, what's called vaccine derived polio, which comes from the efforts for to eradication. What I'm talking about is wild type polio, the polio that's still out there circulating in the world. And there's so many diseases that I've never had to treat as an intensive care doctor. You know, I've never seen a case of diphtheria. I've never seen a case certainly of smallpox. And that's extraordinary to have lived in a time and trained in an age where none of those diseases were ever presented to me except in textbooks. And I want to keep it that way. And I know that's not the case for measles. Many people have now seen measles in clinics, in the hospital. But the idea of polio in particular being diagnosed in one of our patients would just be devastating.
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B
As you said, polio is still out there circulating in the world. So why is it important that organizations like Rotary International, the World Health Organization, the Gates foundation, be allowed to finish the task of eradicating polio?
- [22:42]
A
Well, first, we're so close. We live in an interconnected world. As long as polio is somewhere in the world, no one is completely safe. This isn't a problem that is defined by country boundaries or villages or specific towns. This is a worldwide problem as long as it's still out there. And so it really does take an international effort, people like Rotary and Gates foundation and others who are committed to wiping it out. Because once we wipe it out and it's really no longer a problem, we can turn our attention elsewhere. We can move on to other diseases. We can also stop, ultimately, down the road, vaccinating. You know, I never got a smallpox vaccine. I didn't need to because it was fully eradicated. It completely changes the calculation and where the efforts and energy need to go. So to have the. That push to really eradicate polio just makes sense on so many levels and will allow every single parent and family member to sleep at night, not worried that their child is going to wake up and get polio. But the idea that never having that concern again anywhere in the world would be extraordinary.
- [23:55]
B
You've had the opportunities to speak to Rotary clubs about the Autumn Ghost, and the response has been, as you tell me, enthusiastic. Why does that book resonate so much for members of Rotary?
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A
Well, I think it can become a little bit abstract as to what you're fighting for. But to have a book that really documents and reminds people of what life was like when polio was a real sort of scary problem the world over does resonate to your point. You pointed out there's a lot of really wonderful people in the book who shared their stories with me and wanted their stories to be told to help with this fight. And that really resonates. And then the story I tell of this major innovation in medical care that came from polio. First of all, it's not a story people know, and it is a story of triumph and success in the middle of a horrible situation. I like the idea that I told a relatively happy story while acknowledging there's a lot of terrible things that happen along the way. So I think it resonates on many levels for that reason. And people do enjoy hearing a dramatic story. And I wrote it in such a way I really wanted it to be accessible to the general public. I wanted it to be narrative nonfiction so that people would pick it up and think, wow, this is a great story. And along the way they're learning important information.
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B
You are a fabulous storyteller. And the Autumn Ghost is eminently readable. It's a great story.
- [25:19]
A
Thank you very much.
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B
I want to take a slightly different tack here and I want to talk about Rotary members have what's called a four way test. They're asked to apply to the things they say and do. And the first of these is the question, is it the truth? Why should that same question be an integral part of rigorous scientific research and day to day medical care?
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A
I don't even know where to start with that question because I can't imagine any alternative, right. That the truth is just the centerpiece of what we're seeking with scientific research, with medical care. And there is a lot of uncertainty in scientific research. And I want to acknowledge that, that there's a lot of things where we're not sure. And in fact, I just had a discussion about this yesterday with someone about the importance as a physician, as a researcher of being able to say, I don't know. But when we do know, when we reach that point where something has been so clearly established as accurate, truthful, I think the idea that we're questioning that really sets us back decades, centuries. I don't know where we end up when we stop acknowledging and accepting the truth in front of us.
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B
And these days, when people are confronted by so much conflicting medical advice, where do you think they should be turning to for information that they can trust?
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A
I think first and foremost is a trusted medical practitioner. And that really is for most people, the best place to start. There is a reason people go to medical school, end years training. They really have a knowledge and understanding of the medicine and options that most people just, they don't have that training. And I worry that we've reached a point where people have stopped even kind of acknowledging that that training is useful in any way. So the idea that just surfing on the Internet is going to give you the same useful information as a deep, meaningful conversation with a trusted medical professional, that's where I would start. I think a lot of the major organizations, American Pediatrics association for things like vaccines and organizations like that, are really careful and thoughtful in their recommendations. A lot of the hospitals have great information on their websites. Places like the Mayo Clinic have fantastic websites that provide a lot of detailed patient Information. And unfortunately, right now, in this day and age, some of the federal websites can be useful, but I think that they have been politicized to some degree. And I think we need to focus people on getting information from the people closest to them that are trusted and trained.
- [28:15]
B
In medicine, in addition to being a doctor, you're an historian your times a biographer. In those roles too, you are in pursuit of the truth. How do you know when you found it? How do you know that you've got it right?
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A
It's a great question and I'll be honest. I am a historian, but self taught, very much so in the process of writing this book. And one of the things I found most fascinating was the challenge of memory and recall and the fact that you're asking people to remember events that happened a long time ago. And so I tried to be very careful in as much as possible sort of triangulating information, trying to find second sources that seem to corroborate things that had been said. There's one character in the book, his name's Ernst Trier Morch. He was actually the first anesthesiologist in Denmark. An extraordinary man who did an enormous amount, was a real hero of the resistance in World War II. But I had to be very careful that anything I wrote about him, I found other information to back up what he was saying in some of his stories. And there were a few kind of choice tidbits that I ended up leaving out because I really couldn't corroborate them. So I do think that that's a lot of it is just being careful in the way you present things when you write about it. And I was very careful if I wasn't sure that I might still include it, but make it clear that this was speculative, that this makes for a good story, but we don't know for sure if it's true. I think that there is a core of information that is 100% the truth of what happened. And there's lots of documentation, for instance in my story of hospital records and things. But historical work is challenging for that reason. And anyone who's ever been in a court probably has the same view. Right. That recall can be challenging at times.
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B
Gloria Steinem has a great quote and she gave it on the occasion of the 100th anniversary of the ratification of the 19th amendment. She said, There are two things, history and the past, and they are not the same.
- [30:27]
A
That's a great quote. Yes.
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B
Well, I want to say again, encourage people listening to pick up the Autumn Ghost and read it it's it is such a good story. You are such a great storyteller. Hannah Wunsch, thank you so much for talking with us today. Thank you for the Autumn Ghost.
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A
Well, thank you for all you do. As an organization, Rotary, supporting polio eradication, that is incredibly important. And I'm just grateful that my book can be maybe a tiny piece of the conversation to help people continue that support.
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B
This episode of the Rotary Voices Podcast was produced by JP Swenson and edited by Wen Huang. Production by Joe Dassault. I'm Jeff Johnson. If you enjoyed the show, please rate us five stars on Apple Podcasts and Spotify and share it with your friends. The Rotary Voices Podcast is produced by Rotary Magazine, the official monthly publication of Rotary International. Thanks for listening.