The iron lung is a mechanical negative pressure ventilator (NPV) that polio sufferers historically relied on, which served as the forerunner of today’s sophisticated mechanical respiration devices. The iron lungs are used to aid breathing in cases where muscular control is impaired, such as in polio, botulism, or poisoning. In 1927, Philip Drinker and Louis Agassiz Shaw developed the iron lung at Harvard University. They developed a machine that could change the air pressure around the patient’s body by forcing air into and out of a metal tank and thus regulate breathing. A combination of an electric motor and two vacuums powered this innovation.
Paul Richard Alexander has been known for living in an iron lung for more than 70 years.
How Does the Iron Lung Work?
The patient lies supine within the iron lung, which is a horizontal cylinder sealed off from the outside and connected to an air pump. The patient’s head remains on the outside of the cylinder tank, and a rubber collar stops the air from escaping the patient’s neck. An electric pump alternates the air pressure inside the tank.
Alternating Air Pressure
1. When the pump is turned on, it slowly pulls the air out of the iron lung, creating a partial vacuum inside the tank. Thanks to this negative pressure, the lungs expand, and the air pressure inside the lungs lowers. Since the air pressure inside is now lower than the outside, the air begins to rush through the patient’s nose and mouth, filling the empty space inside the inflated lungs and allowing the person to artificially inhale.
2. In the second phase, the pump allows air to re-enter the iron lung, and the air pressure inside the chamber is increased again. This creates pressure on the body, and the lungs begin to contract. At this moment, the air is pushed out of the lungs to the only less pressured place, which is the outside of the patient’s head, allowing the patient to artificially exhale.
Bellows
Earlier iron lungs came with bellows at the end of the cylinder chamber, the same mechanism that was used in the earliest NPV in 1670. The expanding and contracting of bellows allow air to be pumped into and out of the iron lung.
Some iron lungs have a handle connected to the bellows in case of electrical failure. In this case, the nurse operates the bellows manually by moving the handle back and forward which allows the patient to continue to breathe.
In an iron lung, usually eight rubber-coated openings run down the sides, providing access for nurses to offer routine care for the patient. The openings can be sealed up completely with airtight flaps when not in use. In addition, the person’s body can be seen through transparent plastic windows.
What Is It Like Living in an Iron Lung?
Being confined to the iron lung is tough. If the iron lung’s airtight seal is compromised, for instance, patients may need mask ventilation immediately. Patients in less critical conditions are able to utilize the iron lung solely at night or for shorter periods of time.
When confined in the iron lung, a patient’s field of vision is restricted to the edge of the machine, the ceiling, and a book put on the glass shelf above them to read, and they still need help to turn the pages (or you can be Paul Alexander and turn the pages with an apparatus in your mouth). Some hospitals have been providing their patients with amenities like a TV above their heads.
Iron lung machines produce noise while operating. The sound from the iron lung’s motor echoed throughout the entire hospital ward in the 1950s during the height of the polio epidemic.
For some people, the sounds were soothing and comforting, but for others, they served as a continual reminder of their unstable living conditions.
“When 14-year-old Mary Berry awoke one morning in December 1949 in the polio ward in Bath, it took her a few moments to realize why the room sounded so strange. The iron lung across the room was now silent and empty; her friend Buffy had died during the night.”
From “Paralysed with Fear: The Story of Polio” by Gareth Williams, 2013; page 158.
Some iron lung patients are known to have developed psychosis while receiving treatment because of the ongoing threat that the potentially malfunctioning technology poses.
“Gallagher used to be woken in the middle of the night by the terror of imminent soffocation and unable to say a word, because an apparently sadistic physiotherapist had deliberatly switched off the motor to see how long he could last.”
From “Paralysed with Fear: The Story of Polio” by Gareth Williams, 2013; page 158.
Famous Iron Lung Cases
In 2006, June Middleton won the Guinness World Records for being the longest-living person in an iron lung, while Martha Mason also spent more than 60 years of her life in one.
Paul Alexander, who contracted polio in 1952, is the only person in the world who is still using an iron lung as of 2023.
After living in the machine for 70 years, Paul broke June’s record in 2022, and he also became the only living person using an iron lung in 2020.
Rosanna Benzi spent 29 years in an iron lung, while Giovanna Romanato stayed in her iron lung from 1956 to 2019 for 63 years, only out for brief periods of the day. Despite the many challenges she faced, she was able to find solace in the mundane tasks of everyday life:
“When I am in there, I am locked up; it is undeniable; however, I also feel protected. But when they bring me back out, after the initial fears, I appreciate that I can move in an open space. I see the world from another perspective, in all senses […] And I can perform gestures that for others are trivial but which in the lung I cannot do: scratching my nose, for example… This also makes you see the world from another perspective.”
From pages 16–17 of Enzo Melillo’s La farfalla nel bozzolo d’acciaio (The Butterfly in the Steel Cocoon), 2014.
History of the Iron Lung
Precursors (1670–1919)
External negative pressure ventilation was first proposed in 1670 by English scientist John Mayow. Mayow constructed a working model using a bladder and bellows to take in and release air.
Bellows were approved for use as a method of artificial breathing by the Royal Humane Society of England in 1782. This method has been widely used all across the world for 40 years.
By 1827, Frenchman Jean Leroy proved that using bellows might lead to emphysema and pneumothorax. The French Academy of Science recognized his discovery in 1832. The bellows method fell out of favor as a result of criticisms, and people were once again resorting to manual inflating.
Dr. John Dalziel of Scotland created a ventilating box in 1832 that could save the life of a seaman who had drowned. This was the first step toward the iron lung.
However, artificial respirators similar to the Drinker or Emerson iron lungs were first presented by the French physician Eugene Woillez in 1876. Woillez invented a new negative pressure ventilator he called the “Spirophore.” The hand-operated bellows-driven Spirophore was the precursor of the iron lung machines.
Alexander Graham Bell developed a hand-operated “vacuum jacket” in the 1880s that was similar to the bellows in an iron lung. Vienna-based physician Egon Braun created a wooden box that enclosed the bodies of newborn babies in 1889. In the first newborn resuscitator, the operator’s breath into the pipe compressed the patient’s chest, causing air to exhaust from the pipe and creating a suction that expanded the person’s chest.
Dr. Stueart of South Africa created a comparable airtight machine for treating polio in 1918. It had motor-driven bellows, and the patient’s waist and shoulders were sealed with clay. In 1919, Felix P. Chillingsworth and Ralph Hopkins of Tulane University used an electric pump to test a dog plethysmograph. With a properly pressurized neck seal, this machine could have served as a respirator.
First Practical Iron Lung (1928)
Chemical engineer Philip Drinker of the Harvard School of Public Health is credited with developing the first practical iron lung in 1928. Drinker and his colleague Louis Agassiz Shaw Jr. were conducting an experiment in which they measured the breath of an anesthetized cat in a metal cage with the animal’s head outside the box and confined by a metal collar. It was at this time that Philip Drinker came up with the notion of the iron lung.
Drinker reasoned that by changing the pressure within the box, he could simulate breathing. To create a pressure difference within the box, he immobilized the cat’s breathing muscles. He then pushed air in and out of the box by hand to change the pressure. This enabled the cat’s chest to expand and compress, allowing it to take in and out air.
The next stage was to adapt the same basic idea into a “human-sized” machine. Drinker and Shaw developed the first mechanical iron lung with funding from the Consolidated Gas Company of New York in the fall of 1927 with a check for $5,000 (roughly $88,000 in 2023).
First Person to Use the Iron Lung
The iron lung was first used on October 12, 1928, on an eight-year-old girl who was brought to Children’s Hospital in Boston with paralytic polio (or poliomyelitis). Drinker’s sister Catherine described the poor girl’s first experience with the iron lung as follows:
“Phil started the pump, and in less than a minute saw the child regain consciousness. She asked for ice cream. Phil said he stood there and cried.”
Catherine Drinker Bowen: Family Portrait (1970), pp. 241–2.
Three days later, the girl passed away from lung inflammation (pneumonia), a typical occurrence for patients on the respirator due to a lack of access to adequate sanitary treatment. However, the iron lung’s therapeutic power was visible for the first time, and it was only getting better from there.
Evolution of the Iron Lung
In the United States
The Alligator, which John Haven Emerson created in 1932, got its name because the patient could be “swallowed” by being placed inside the machine after opening its front lid. The Emerson Respirator was cheaper, quieter, and more efficient than the iron lung. This prompted Drinker to sue Emerson for infringing on his patent.
However, Drinker was unsuccessful in his legal action since others had previously developed comparable prototypes (as discussed above). In 1918, for instance, Stueart of South Africa built a wooden airtight box for the purpose of treating polio.
In Australia
Because of a polio epidemic in 1937, Australia had to resort to using iron lungs, most of which were located in the United States. The American iron lungs were prohibitively costly, hard to operate, and cumbersome to ship by vessel.
Edward Both of Australia responded with his so-called Both Respirator. The innovative device’s modular plywood construction made it simple for medical staff to move and install the device wherever it was needed.
Because of these improvements, the price of the Both Respirator was only £100 compared to the £2000 steel iron lung in the United States.
Discovery of the Polio Vaccine
Since Jonas Salk developed and first made the polio vaccine available to the public on April 12, 1955, the use of the iron lung has significantly decreased.
However, since the virus had already paralyzed some polio patients’ respiratory systems, the iron lung was still necessary for them. This is why patients like Paul Richard Alexander are still in an iron lung today.
Developments in Iron Lung Technology
St. Thomas’ Hospital in England (near Westminster in London) and the John Radcliffe Hospital in Oxford are two medical centers that continue to use the iron lung and similar devices to help polio sufferers survive today.
The iron lung was the first step in the development of pressure ventilator devices that would make patient mobility more comfortable.
The newer and more modern version of the iron lung is called the Cuirass Ventilator. It is much more compact than iron lungs. The Cuirass Ventilator, which gets its name from the same Middle Age armor, generates negative pressure by covering the body’s rib cage with an air chamber.
Despite the benefit of increased mobility, incidences of skin damage have been documented owing to the contact of the Cuirass Ventilator with the body. In recent years, a polycarbonate covering has been developed, and the device has been outfitted with a pump that can both expand and compress the rib cage, creating what is known as “biphasic ventilation.”
The Poncho, also called the Poncho Lung, is another version of the Cuirass Ventilator. It consists of a rigid plastic cage placed over the chest and a raincoat-style jacket worn over it that is tight at the neck, wrists, and thighs to create a depression to facilitate breathing. It is also called a jacket ventilator.
