The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology

Abstract

The 1952 Copenhagen poliomyelitis epidemic provided extraordinary challenges in applied physiology. Over 300 patients developed respiratory paralysis within a few weeks, and the ventilator facilities at the infectious disease hospital were completely overwhelmed. The heroic solution was to call upon 200 medical students to provide round-the-clock manual ventilation using a rubber bag attached to a tracheostomy tube. Some patients were ventilated in this way for several weeks. A second challenge was to understand the gas exchange and acid-base status of these patients. At the onset of the epidemic, the only measurement routinely available in the hospital was the carbon dioxide concentration in the blood, and the high values were initially misinterpreted as a mysterious "alkalosis." However, pH measurements were quickly instituted, the Pco(2) was shown to be high, and modern clinical respiratory acid-base physiology was born. Taking a broader view, the problems highlighted by the epidemic underscored the gap between recent advances made by physiologists and their application to the clinical environment. However, the 1950s ushered in a renaissance in clinical respiratory physiology. In 1950 the coverage of respiratory physiology in textbooks was often woefully inadequate, but the decade saw major advances in topics such as mechanics and gas exchange. An important development was the translation of the new knowledge from departments of physiology to the clinical setting. In many respects, this period was therefore the beginning of modern clinical respiratory physiology.

Fig. 1.

Weekly admissions of patients with poliomyelitis to the Blegdam Hospital in Copenhagen in July to December 1952. Note the very rapid increase in the first part of August. The figure also shows that about half of the patients had some paralysis. From Lassen (19).

Fig. 2.

Apparatus for manual mechanical ventilation. The tank was 50% O₂-50% N₂. At the bottom is the cuffed endotracheal tube that was inserted through a tracheotomy. From Lassen (19).

Fig. 3.

Photograph of a patient being manually ventilated with the apparatus shown in Fig. 2. From Lassen (21).

Fig. 4.

Bjørn Ibsen (1915- ), Danish anesthesiologist who suggested positive pressure ventilation for the patients with respiratory paralysis. From Zorab (36).

Fig. 5.

Poul Astrup (1915–2000) who ushered in the modern period of clinical acid-base physiology. From Severinghaus and Astrup (28).

Fig. 6.

Nomogram that was used for determining the blood PCO₂ from the total CO₂ content and plasma pH. From Van Slyke and Sendroy (32).

Fig. 7.

Sketches by Arthur Dubois that were prepared for the course on clinical respiratory physiology given at the University of Pennsylvania in March 1953.

Fig. 8.

Illustrations from the book The Lung... by Comroe et al. (9) showing how the sketches of Fig. 7 appeared in the book.