How the Iron Lung Paved the Way for the Modern-Day Intensive Care Unit
By features correspondent Mia Taylor, for the BBC
“With the passing of iron lung patient Paul Alexander, a look back at how the device paved the way for subsequent life-saving medical innovations.”
Image Source: Getty Images
“Long before the polio vaccine, there was the iron lung. A large, cumbersome device that, by some accounts, looked like a "coffin with legs," the iron lung was groundbreaking in its day.
The device enabled hundreds of individuals to survive polio, a viral infection that attacks the body and can lead to paralysis and death within a matter of hours as breathing muscles become immobilised. However, with the iron lung, a massive machine that encases patients and provides air pressure to help the impacted individual's paralysed lungs function, life could continue for years.
Such was the case for Paul Alexander, known globally as "The Man in the Iron Lung", who died this week at the age of 78. Alexander contracted polio in 1952, when he was just six years old, leaving him paralysed from the neck down. Although he made tremendous progress learning to breathe on his own for short periods of time – he attended school and practised as a lawyer – Alexander lived the remainder of his life relying on the iron lung to survive.
Developed in 1927 by a faculty member from the Harvard T.H. Chan School of Public Health, industrial hygienist Philip Drinker, the iron lung was first used to save the life of a child in 1928. It swiftly became a fixture in polio wards during the polio outbreaks of the subsequent decades, particularly from 1948 until the vaccine was developed in 1955. And its creation paved the way for many subsequent medical innovations.”
How the iron lung works
“During the early 20th century, polio outbreaks were occurring around the world, spread via contaminated food and water. And up until the 1955 vaccine, the iron lung was the primary mode of treatment for severe cases and was considered state-of-the-art technology.
Image Source: Getty Images
A giant, airtight metal cylinder that weighs as much as 650lb (295kg) that's connected to a bellows, the iron lung requires polio patients to slide inside up to their neck. The bellows, which is attached to a pump, continuously cycles air in and out of the box, helping the patients continue breathing by sucking the chest open, forcing air to rush in to fill the lungs. This form of artificial respiration is known as External Negative Pressure Ventilation (ENPV).
‘The invention of the iron lung irrevocably changed the relationship between humans and machines,’ says Hannah Wunsch, a critical care physician with Weill Cornell Medical Center Anesthesiology and author of The Autumn Ghost, a book that traces how intensive care units and mechanical ventilation are the foundation of modern medical care. ‘For the first time, an individual struggling to breathe for an extended period of time could receive support, with the machine doing some or all of the work of breathing. ‘ "
Some patients spent just a short time in the iron lung, perhaps weeks or months until they were able to regain chest strength and breath independently again. But for patients whose chest muscles were permanently paralysed, the iron lung remained the key to survival.
While it was a lifesaving development, there were also many limitations with the iron lung for both patients and medical providers. Many patients felt trapped inside of the device, and it was difficult for doctors to access a patient's body and provide treatment to someone encased in the iron lung. But the invention, nevertheless, laid the foundation for many future medical advances.
‘That concept of supporting an organ, such as the lungs, became the centrepiece of modern critical care,’ says Wunsch.”
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