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Ernst Trier Mørch: Inventor, Medical Pioneer, Heroic Freedom Fighter

2000; Lippincott Williams & Wilkins; Volume: 90; Issue: 1 Linguagem: Inglês

10.1097/00000539-200001000-00043

1526-7598

Henry Rosenberg, Jean K. Axelrod,

Connective tissue disorders research

Trier Mørch’s Early Medical Training Born in Denmark in 1908, E. Trier Mørch (shown in Figure 1), in a family of eight children, was the only one who pursued a career in medicine. A tonsillectomy without anesthesia at the age of 5 yr spurred his later interest in alleviating painful medical treatment. He graduated from the University of Copenhagen Medical School in 1935 with the intention of becoming a surgeon. For the next 3 yr, he also studied psychiatry, obstetrics-gynecology, radiology, and postmortem pathology.Figure 1: Trier Mørch, in 1990, wearing medals awarded for rescue work and other humanitarian activities during World War II in Denmark.As a lieutenant in the Royal Danish Army Medical Corps, which he joined in 1937 hoping to further his surgical experience, he was assigned to the cavalry, where one of his duties was to reattach the ears of horses that were accidentally lopped off by officers drawing their long, heavy swords while galloping on horseback. Study of Human Genetics Returning to civilian life in Copenhagen in 1938, Mørch became a scientific assistant at the University Institute for Human Genetics. His desire for an academic career in medicine required him to present a thesis and earn a PhD degree supplementary to his MD degree. A grant from the Rockefeller Foundation, which had founded the institute, enabled him to pursue a field of special interest—the genetic makeup of chondrodystrophic dwarfs—because of his puzzlement over a family he knew in which two normal parents had only dwarf offspring. Mørch and his wife photographed and interviewed nearly every dwarf in Denmark, a delicate and lengthy undertaking because of the inherent shyness of those being studied. He eventually deduced that a single dominant gene was responsible for the disorder and that it occurs randomly in 1 in 10,000 births (1). In this seminal work in achondroplasia that earned him a doctorate in human genetics from the University of Copenhagen in 1942, he determined that a genetic mutation would occur spontaneously in 1 in every 10,000 births. This “Mørch Unit,” as he called it, became a reference point for the Atomic Energy Commission’s studies of mutations in a population that had been exposed to the atom bomb in Japan. When more than 1 in 10,000 children of normal parents were born with a genetic handicap, it signified the rate at which mutations had been caused by factors other than chance—most likely by radiation in the case of Japan. Surgical Practice Leads to Study of Anesthesiology Mørch finally was able to pursue his surgical career, beginning in 1942 at Copenhagen’s Rigshospital, 2 yr after the Nazis first occupied Denmark. He determined to become proficient in anesthetic techniques because he saw the need for far more exacting and sophisticated methods of administering anesthesia, especially in the new field of thoracic surgery, than those provided by overworked nurses and interns. With his natural bent for intense study and experimentation, and with the help of an anesthesia equipment salesman who taught him the fundamentals of new techniques, he soon became much in demand by other surgeons to administer anesthesia. The Nazi regime in Denmark was especially lenient toward physicians in the early years of occupation. Mørch was granted a 3-wk leave in 1943 to study anesthesiology in Stockholm’s Karolinska Institute under the famous Swedish anesthesiologist Thorsten Gordh. He returned to become totally involved in his new specialty, academically and clinically. Over the years, he published many journal articles (in Danish) on his experiments in the field, which included advocating the use of curare during anesthesia, a practice that was held in low esteem at the time. Medical supplies were tragically scarce during the war years. In Sweden, Mørch had learned to use a small respirator, the Spiropulsator, but he was unable to import one to Denmark. Therefore he actually fashioned the first respirator in use in his country from a sewer pipe discarded by the Nazis and such spare parts as a bicycle pump and a small electric motor that he was able to scrounge. Countless more modifications of existing anesthesia equipment, as well as refinements in his own respirator, were to follow. Trier Mørch’s World War II Activities As the war progressed, in Nazi-occupied Denmark restrictions already imposed on the populace became increasingly severe. When newspapers were censored, Mørch and his Danish resistance colleagues not only started an underground paper in the hospital but also stole the typewriter on which to compose it and the paper, ink, and copy machine with which to print it. News from the BBC about the true status of Allied actions was gleaned via a receiver on the roof of the hospital. The information was then dispersed via the resistance newspaper, undermining German propaganda and infuriating the Nazis. Mørch and his fellow resistance leaders also helped smuggle news to England via Sweden, transported by a courier carrying microfilmed, purloined reports in a rectal tube, about German plans for bombing missions over London. Some 8,000 Jewish people lived in Denmark during the war years. When anti-Jewish sentiment suddenly turned virulent in October, 1943, a decent German naval officer leaked news to the Danish underground that Jewish people were to be deported, starting within a week. Word was spread in synagogues during Rosh Hashanah services. Mørch and his fellow resistance fighters were able to hide many of the Jewish people in hospitals, by having them admitted under such names as Hansen and Christensen, or in private homes or churches while the resistance movement designed evacuation plans. Fishing boat captains were paid (sometimes with stolen money, according to Mørch) to smuggle the Jewish people into neutral Sweden, some 5 to 15 miles by water. When the Gestapo started to use bloodhounds to detect Jewish people hidden below false bottoms of the boats, Mørch and a pharmacist friend developed a rabbit-blood-and-cocaine powder that was sprinkled on the decks to anesthetize the dogs’ noses. To quiet hidden children, barbiturate suppositories were distributed to their parents, and Swedish physicians were made available on debarkation especially to look after the comatose and deeply sedated infants (2). All the Jewish people who were smuggled into Sweden survived. Those <500 Jewish people who refused to believe the warnings and remained in Denmark were sent to concentration camps. Just before the end of the war, Mørch joined a Red Cross caravan, organized by his good friend Count Folke Bernadotte of Sweden, that made many perilous trips into Germany to rescue Scandinavian prisoners whom Bernadotte had convinced Heinrich Himmler to collect at the Neuengamme concentration camp near Hamburg. Mørch coauthored a book (3) (in Danish) on the experience, which is filled with incredible stories of heroism on the part of resistance fighters. Years later, 1 mo before his death, Mørch was interviewed on videotape by the Shoah Foundation of Visual History, founded by Steven Spielberg, to add to a permanent record of the tales of the victims and rescuers of the Holocaust. Post-War Study of Anesthesiology Mørch’s first academic training in anesthesiology occurred in 1946 when he was offered a scholarship from Great Britain, after a suggestion from the Danish thoracic surgeon Erik Husfeldt, to study at Oxford University under renowned anaesthetists Sir Robert MacIntosh and William Mushin. In 1947, he presented a paper to the Royal Society of Medicine in London, advocating mechanically controlled ventilation (4). As a result, many colleagues accepted the idea of using a ventilator to assist patients with respiratory depression, in marked contrast to the suspicion accorded ventilators by earlier generations of physicians. Returning to Copenhagen, Mørch campaigned for the establishment of a separate department of anesthesiology at the University of Copenhagen. Even though he was the only trained MD anesthesiologist in Denmark, the author of the first anesthesiology textbook in Danish, and the man who drafted the first rules and requirements for anesthesiology as a specialty, his request was opposed by the powerful department of surgery. Even his appeal in the lay press for better training in the field, supported by reports that the probable cause of much patient mortality was poor anesthetic technique, went unheeded. Among Mørch’s supporters was the Danish king who accorded him the dubious honor of anesthetizing his favorite horse, a feat that had never been successfully accomplished in Denmark. Calling his “nothing is impossible” motto into play and demonstrating his creativity in problem solving, Mørch rigged a balloon to a six-foot piece of garden hose to effect a seal. He then intubated the horse with a laryngoscope he had designed especially for the animal and bounced up and down on its side to ventilate it manually while surgery was performed. The horse survived. When the ultimatum Mørch issued about leaving Denmark was ignored, he packed up his wife and three children and came to the United States as a practicing anesthesiologist in 1949. His leaving caused an uproar in the press, drawing attention to the need for the separation of anesthesiology from surgery. The Anesthesiology Center Copenhagen, a postgraduate training program, was established in 1951, sponsored by the World Health Organization, which soon acquired an international enrollment. Medical Career in America Mørch first practiced anesthesiology at Doctors’ Hospital in Washington, DC, while preparing for American board certification. He relocated to Kansas City, KS, to become an attending anesthesiologist at the new University of Kansas Medical Center, a position he held from 1950 to 1952. There, he redesigned the artificial ventilator he had invented in Denmark. In contrast to the “torture chamber” of the iron lung in which negative pressure provided ventilation, Mørch’s ventilator delivered intermittent positive pressure ventilation and only required contact with the patient through a tracheostomy. It was also the first ventilator that could be used over long periods of time. The Mørch ventilator incorporated several unique features (5). It was the first in the United States to have a concertina-shaped bellows to read tidal volume and was available as a separate unit or as a component of several anesthesia machines. All parts in contact with the inspired gas could be easily sterilized. It was the first ventilator that could be used either as a pressure-sensitive assistor or as a volume-controlled ventilator. Most of the controls could be operated by foot with the ventilator out of the way under the bed, an important consideration in respiratory centers that evolved during the polio epidemics of the 1950s. Above all, “it was so simple even a doctor could operate it,” Mørch often said. (One of Mørch’s ventilators is on display in the Wood Library and Museum.) Dr. Alon P. Winnie, himself a patient on the Mørch ventilator, described the device (1) as “an extremely reliable volume ventilator. … The most innovative gadget in the system, however, in terms of patient comfort, was the Mørch tracheostomy tube, that used a unique swivel adaptor to connect the rubber tubing from the valve to the tracheostomy cannula. … Because of the loose-fitting swivel connector of the Mørch tube, movement of either the patient or the rubber tubing is not transmitted to the cannula or the person on the proximal end of the tube. …. The air leak resulting from the uncuffed tube allowed me to talk, albeit during inspiration. The ability to communicate while paralyzed and conscious is extremely comforting.” Another life-saving use of intermittent positive-pressure ventilation (IPPV), via the Mørch ventilator, was that of treating severe crushed-chest injuries. In the initial case (6), a patient was admitted to the hospital moribund and in deep shock with a flail chest as a result of multiple bilateral fractures of all ribs and crushing organ injuries. To counteract the respiratory acidosis caused by inadequate ventilation, Mørch used his piston ventilator for continuous hyperventilation by intermittent positive endotracheal insufflation. This stopped the grinding motions of the broken rib ends so dangerous to the lungs, and the air blown into the lungs made a “pillow” on which the broken ribs lay immobile until they healed. Mørch also advocated the use of IPPV via an uncuffed tracheostomy tube (7), because it was easier to insert than a cuffed tube, and high capacity IPPV can compensate for leakage through the larynx. Advantages included the absence of tracheal pressure necrosis, a risk if the cuff is over inflated. Other Mørch innovations included a laryngoscope (8), modified for easier sterilization with the bulb moved to the handle and a piece of removable stainless steel for the blade, a new instrument for vaginoscopy and anoscopy (9), as well as improvements in a number of anesthesia machines. Named Director of Anesthesia at Billings Hospital of the University of Chicago in 1953, Mørch completely modernized the department during his 6-yr tenure, architecturally as well as procedurally. When he arrived, intubation was forbidden except in emergencies, a practice he quickly overturned. One interesting side of this energetic man—he obtained a pilot’s license so he could fly around the country demonstrating his ventilator. He was next appointed Director of Anesthesia at Cook County Hospital, after which he established a private practice at Garfield Park Hospital and Mount Sinai Hospitals in Chicago, while his children attended college. He returned to academia and the clinical practice he preferred as the senior attending anesthesiologist at Presbyterian-St. Luke’s Hospital, Chicago, from 1967 to 1978. Forced to retire at age 70, he accepted the position of Nassau General Hospital’s (now Baptist Medical Center Nassau) only anesthesiologist in Fernandina Beach on Amelia Island, in northern Florida, where he also served for a time as Chief of the Medical Staff. The hospital’s uncommon policy that board members had to be elected by the county attested to Mørch’s remarkable presence, charisma, and influence in a town in which he had been unknown 10 yr before the election. Offering to serve as the house physician at the local detention facility instead of disrupting the peace at the hospital when a prisoner came in for treatment, he was appointed the town’s deputy sheriff. Today, his associates at the hospital describe Trier Mørch as a dedicated humanitarian, a man whose insatiable curiosity never waned, and an elegant, courteous gentleman with enviable European manners. They remember him as an outspoken voice in medical circles, most often introducing innovative hospital policies. Mørch remained in Florida until the lung cancer that was to end his life at 87 became so severe that he moved to NY to live with his daughter Sys. Mørch’s Motto: “Nothing Is Impossible” In 1959 Mørch struck up a lasting friendship with Alon Winnie, then a resident and now esteemed Chairman of the Department of Anesthesiology at Cook County Hospital. Stricken with bulbospinal poliomyelitis so virulent that, within hours, he was completely paralyzed from the neck down, Winnie was intubated and connected to a Mørch piston ventilator. Mørch appointed himself chief guardian and caregiver for the stricken man and became the mentor who convinced Winnie, who is still a wheelchair user, to become an anesthesiologist. Although Winnie told many tales of his mentor’s sense of fun and his slightly wicked sense of humor tempered by thoughtfulness, he has also stated repeatedly, “He saved my life.” Mørch was so colorful a character that Winnie gave a “Nothing is Impossible” roast and toast in his honor in 1996 at the Midwestern Anesthesiology Conference shortly after Mørch’s death. The evening proved to be a joyous occasion, filled with anecdotes from family and friends ranging from his childhood and student days in Denmark through his fearless underground activities in World War II to his Fire Island projects in which he turned his innovative talents to Sys’s summer home. She presented some of the essays he wrote on his retirement days in Florida, including the pleasures of raising “beefalo” and his “Gator Cookbook.” When discussing his wide-ranging accomplishments through a career that spanned four decades, Mørch had proclaimed that working for the Danish resistance movement was “the most exhilarating time of my life” because “I didn’t have time to be afraid,” and because it was, he said, “such fun to steal for a noble cause.” (10) Special thanks to Ms. Sys Trier Mørch, a remarkable person in her own right, to Drs. Alon P. Winnie, John Severinghaus, Robert L. Taylor, and J. G. McCully, and Messrs. Patrick Sim, Wood Library of Anesthesiology, and James Mayo and Michael Burling of Baptist Medical Center Nassau, who assisted with much of the information.