Iron lung
Encyclopedia
A negative pressure ventilator (often referred to colloquially as an iron lung) is a form of medical ventilator
that enables a person to breathe
when normal muscle
control has been lost or the work of breathing exceeds the person's ability.
contracts, expanding the chest cavity. This causes the pressure in the chest cavity to decrease, and the lung
s expand to fill the space. This, in turn, causes the pressure of the air inside the lungs to decrease (it becomes negative, relative to the atmosphere), and air flows into the lungs from the atmosphere: inhalation
. When the diaphragm relaxes, the reverse happens and the person exhales
. If a person loses part or all of the ability to control the muscles involved, breathing becomes difficult or impossible.
The person using the iron lung is placed into the central chamber, a cylindrical steel drum. A door allowing the head and neck to remain free is then closed, forming a sealed, air-tight compartment enclosing the rest of the person's body. Pumps that control airflow periodically decrease and increase the air pressure within the chamber, and particularly, on the chest. When the pressure is below that within the lungs, the lungs expand and atmospheric pressure pushes air from outside the chamber in via the person's nose and airways to keep the lungs filled; when the pressure goes above that within the lungs, the reverse occurs, and air is expelled. In this manner, the iron lung mimics the physiological action of breathing: by periodically altering intrathoracic pressure, it causes air to flow in and out of the lungs. The iron lung is a form of non-invasive therapy.
The first negative pressure ventilator was described by Scottish physician John Dalziel in 1832. Successful use of similar devices was described a few years later.
The first of these devices to be widely used however was developed by Drinker and Shaw in 1928. The iron lung, often referred to in the early days as the "Drinker respirator", was invented by Phillip Drinker (18941972) and Louis Agassiz Shaw Junior, professor
s of industrial hygiene
at the Harvard School of Public Health
. The machine was powered by an electric motor with air pumps from two vacuum cleaners. The air pumps changed the pressure inside a rectangular, airtight metal box, pulling air in and out of the lungs.
The first clinical use of the Drinker respirator on a human was on October 12, 1928 at the Children's Hospital
in Boston
. The subject was an eight-year-old girl who was nearly dead as a result of respiratory failure
due to poliomyelitis
(often called polio or infantile paralysis). Her dramatic recovery, within less than a minute of being placed in the chamber, helped popularize the new device.
Boston manufacturer Warren E. Collins began production of the iron lung that year. Although it was initially developed for the treatment of victims of coal gas
poisoning, it was most famously used in the mid-20th century for the treatment of respiratory failure caused by poliomyelitis.
In 1931, John Haven Emerson
(February 5, 1906February 4, 1997) introduced an improved and less expensive iron lung. The Emerson iron lung had a bed that could slide in and out of the cylinder as needed, and the tank had portal windows which allowed attendants to reach in and adjust limbs, sheets, or hot packs. Drinker and Harvard University sued Emerson, claiming he had infringed on patent rights. Emerson defended himself by making the case that such lifesaving devices should be freely available to all. Emerson also demonstrated that every aspect of Drinker's patents had been patented by others at earlier times. Emerson won the case, and Drinker's patents were declared invalid.
programs have virtually eradicated
new cases of poliomyelitis in the United States. Because of this, and also the development of modern ventilators
and widespread use of tracheal intubation
and tracheotomy
, the iron lung has virtually disappeared from modern medicine. For example, in 1959, there were 1,200 people using tank respirators in the United States, but by 2004 there were only 39.
Positive pressure ventilation systems are now more common than negative pressure systems. Positive pressure ventilators work by blowing air into the patient's lungs via intubation
through the airway; they were used for the first time in Blegdams Hospital, Copenhagen
, Denmark during a polio outbreak in 1952. It proved a success and soon superseded the iron lung throughout Europe.
The iron lung now has a marginal place in modern respiratory therapy
. Most patients with paralysis of the breathing muscles use modern mechanical ventilators
that push air into the airway with positive pressure. These are generally efficacious and have the advantage of not restricting patients' movements or caregivers' ability to examine the patients as significantly as an iron lung does. However, negative pressure
ventilation is a truer approximation of normal physiological breathing and results in more normal distribution of air in the lungs. It may also be preferable in certain rare conditions, such as Ondine's curse
, in which failure of the medullary respiratory centers at the base of the brain result in patients having no autonomic
control of breathing. At least one reported polio patient, Dianne Odell
, had a spinal deformity that caused the use of mechanical ventilators to be contraindicated. There are patients who today still use the older machines, often in their homes, despite the occasional difficulty of finding the various replacement parts. Joan Headley of Post-Polio Health International stated to CNN that there are approximately 30 patients in the USA still using an iron lung. That figure may be inaccurately low; Houston
alone had 19 iron lung patients living at home in 2008. Martha Mason
of Lattimore, North Carolina
died on May 4, 2009, after spending 60 of her 72 years in an iron lung.
On the 30th of October 2009, June Middleton
of Melbourne, Australia, who had been entered in the Guinness Book of Records as the person who spent the longest time in an iron lung, died aged 83, having spent more than 60 years in her iron lung.
Biphasic Cuirass Ventilation
is a modern development of the iron lung, consisting of a wearable rigid upper-body shell (a cuirass
) which functions as a negative pressure ventilator.
Medical ventilator
A medical ventilator can be defined as any machine designed to mechanically move breatheable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently....
that enables a person to breathe
Breathing
Breathing is the process that moves air in and out of the lungs. Aerobic organisms require oxygen to release energy via respiration, in the form of the metabolism of energy-rich molecules such as glucose. Breathing is only one process that delivers oxygen to where it is needed in the body and...
when normal muscle
Muscles of respiration
The various muscles of respiration aid in both inspiration and expiration, which require changes in the pressure within the thoracic cavity. The respiratory muscles work to achieve this by changing the dimensions of the thoracic cavity....
control has been lost or the work of breathing exceeds the person's ability.
Method and use
Humans, like most other animals, breathe by negative pressure breathing: the rib cage expands and the diaphragmThoracic diaphragm
In the anatomy of mammals, the thoracic diaphragm, or simply the diaphragm , is a sheet of internal skeletal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity from the abdominal cavity and performs an important function in respiration...
contracts, expanding the chest cavity. This causes the pressure in the chest cavity to decrease, and the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s expand to fill the space. This, in turn, causes the pressure of the air inside the lungs to decrease (it becomes negative, relative to the atmosphere), and air flows into the lungs from the atmosphere: inhalation
Inhalation
Inhalation is the movement of air from the external environment, through the air ways, and into the alveoli....
. When the diaphragm relaxes, the reverse happens and the person exhales
Exhalation
Exhalation is the movement of air out of the bronchial tubes, through the airways, to the external environment during breathing....
. If a person loses part or all of the ability to control the muscles involved, breathing becomes difficult or impossible.
Invention and early use
The first of these devices to be widely used however was developed by Drinker and Shaw in 1928. The iron lung, often referred to in the early days as the "Drinker respirator", was invented by Phillip Drinker (18941972) and Louis Agassiz Shaw Junior, professor
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...
s of industrial hygiene
Occupational hygiene
Occupational hygiene is generally defined as the art and science dedicated to the anticipation, recognition, evaluation, communication and control of environmental stressors in, or arising from, the workplace that may result in injury, illness, impairment, or affect the well being of workers and...
at the Harvard School of Public Health
Harvard School of Public Health
The Harvard School of Public Health is one of the professional graduate schools of Harvard University, located in the Longwood Area of the Boston, Massachusetts neighborhood of Mission Hill, which is next to Harvard Medical School. HSPH is considered a significant school focusing on health in the...
. The machine was powered by an electric motor with air pumps from two vacuum cleaners. The air pumps changed the pressure inside a rectangular, airtight metal box, pulling air in and out of the lungs.
The first clinical use of the Drinker respirator on a human was on October 12, 1928 at the Children's Hospital
Children's Hospital Boston
Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
in Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
. The subject was an eight-year-old girl who was nearly dead as a result of respiratory failure
Respiratory failure
The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial...
due to poliomyelitis
Poliomyelitis
Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route...
(often called polio or infantile paralysis). Her dramatic recovery, within less than a minute of being placed in the chamber, helped popularize the new device.
Boston manufacturer Warren E. Collins began production of the iron lung that year. Although it was initially developed for the treatment of victims of coal gas
Coal gas
Coal gas is a flammable gaseous fuel made by the destructive distillation of coal containing a variety of calorific gases including hydrogen, carbon monoxide, methane and volatile hydrocarbons together with small quantities of non-calorific gases such as carbon dioxide and nitrogen...
poisoning, it was most famously used in the mid-20th century for the treatment of respiratory failure caused by poliomyelitis.
In 1931, John Haven Emerson
John Haven Emerson
John Haven "Jack" Emerson was an American inventor of biomedical devices, specializing in respiratory equipment. He is perhaps best remembered for his work in improving the iron lung.-Early life:...
(February 5, 1906February 4, 1997) introduced an improved and less expensive iron lung. The Emerson iron lung had a bed that could slide in and out of the cylinder as needed, and the tank had portal windows which allowed attendants to reach in and adjust limbs, sheets, or hot packs. Drinker and Harvard University sued Emerson, claiming he had infringed on patent rights. Emerson defended himself by making the case that such lifesaving devices should be freely available to all. Emerson also demonstrated that every aspect of Drinker's patents had been patented by others at earlier times. Emerson won the case, and Drinker's patents were declared invalid.
Modern usage
Rows of irons lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s. Polio vaccinationPolio vaccine
Two polio vaccines are used throughout the world to combat poliomyelitis . The first was developed by Jonas Salk and first tested in 1952. Announced to the world by Salk on April 12, 1955, it consists of an injected dose of inactivated poliovirus. An oral vaccine was developed by Albert Sabin...
programs have virtually eradicated
Poliomyelitis eradication
The global eradication of poliomyelitis is a public health effort to eliminate all cases of poliomyelitis infection around the world. The global effort, begun in 1988 and led by the World Health Organization, UNICEF and The Rotary Foundation, has reduced the number of annual diagnosed cases from...
new cases of poliomyelitis in the United States. Because of this, and also the development of modern ventilators
Medical ventilator
A medical ventilator can be defined as any machine designed to mechanically move breatheable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently....
and widespread use of tracheal intubation
Tracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
and tracheotomy
Tracheotomy
Among the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
, the iron lung has virtually disappeared from modern medicine. For example, in 1959, there were 1,200 people using tank respirators in the United States, but by 2004 there were only 39.
Positive pressure ventilation systems are now more common than negative pressure systems. Positive pressure ventilators work by blowing air into the patient's lungs via intubation
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
through the airway; they were used for the first time in Blegdams Hospital, Copenhagen
Copenhagen
Copenhagen is the capital and largest city of Denmark, with an urban population of 1,199,224 and a metropolitan population of 1,930,260 . With the completion of the transnational Øresund Bridge in 2000, Copenhagen has become the centre of the increasingly integrating Øresund Region...
, Denmark during a polio outbreak in 1952. It proved a success and soon superseded the iron lung throughout Europe.
The iron lung now has a marginal place in modern respiratory therapy
Respiratory therapy
Respiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic respiratory problems. These specialists are termed Respiratory Therapists in most places internationally but may also be referred to as Respiratory Scientists or...
. Most patients with paralysis of the breathing muscles use modern mechanical ventilators
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
that push air into the airway with positive pressure. These are generally efficacious and have the advantage of not restricting patients' movements or caregivers' ability to examine the patients as significantly as an iron lung does. However, negative pressure
Negative pressure
Negative pressure may refer to:*negative pressure as opposed to positive pressure*stretched liquid*vacuum*negative gauge pressure, a way of expressing pressure measurements below atmospheric pressure*suction*transpirational pull...
ventilation is a truer approximation of normal physiological breathing and results in more normal distribution of air in the lungs. It may also be preferable in certain rare conditions, such as Ondine's curse
Ondine's curse
Ondine's Curse, also called congenital central hypoventilation syndrome or primary alveolar hypoventilation, is a respiratory disorder that is fatal if untreated...
, in which failure of the medullary respiratory centers at the base of the brain result in patients having no autonomic
Autonomic nervous system
The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...
control of breathing. At least one reported polio patient, Dianne Odell
Dianne Odell
Dianne Odell was a Tennessee woman who spent most of her life in an iron lung. She contracted "bulbo-spinal" polio at age 3 in 1950 and was confined to an iron lung for the rest of her life. Due to a spinal deformity caused by the polio, she was unable to change to a portable breathing device...
, had a spinal deformity that caused the use of mechanical ventilators to be contraindicated. There are patients who today still use the older machines, often in their homes, despite the occasional difficulty of finding the various replacement parts. Joan Headley of Post-Polio Health International stated to CNN that there are approximately 30 patients in the USA still using an iron lung. That figure may be inaccurately low; Houston
Houston, Texas
Houston is the fourth-largest city in the United States, and the largest city in the state of Texas. According to the 2010 U.S. Census, the city had a population of 2.1 million people within an area of . Houston is the seat of Harris County and the economic center of , which is the ...
alone had 19 iron lung patients living at home in 2008. Martha Mason
Martha Mason (writer)
Martha Mason was a writer born and based in Lattimore, North Carolina.-Early life:Afflicted with polio at age 11, Mason was sent home from the hospital in an iron lung, in which she remained for her entire life...
of Lattimore, North Carolina
Lattimore, North Carolina
Lattimore is a town in Cleveland County, North Carolina, United States. The population was 419 at the 2000 census.-Geography:Lattimore is located at ....
died on May 4, 2009, after spending 60 of her 72 years in an iron lung.
On the 30th of October 2009, June Middleton
June Middleton
June Margaret Middleton was an Australian polio victim who spent more than 60 years living in an iron lung for treatment of the disease. In 2006, Guinness World Records recognized Middleton as the person who had spent the longest amount of time living in an iron lung.Middleton was born on 4 May...
of Melbourne, Australia, who had been entered in the Guinness Book of Records as the person who spent the longest time in an iron lung, died aged 83, having spent more than 60 years in her iron lung.
Biphasic Cuirass Ventilation
Biphasic Cuirass Ventilation
Biphasic cuirass ventilation is a method of ventilation which requires the patient to wear an upper body shell or cuirass, so named after the body armor worn by medieval soldiers. The ventilation is biphasic because the cuirass is attached to a pump which actively controls both the inspiratory and...
is a modern development of the iron lung, consisting of a wearable rigid upper-body shell (a cuirass
Cuirass
A cuirass is a piece of armour, formed of a single or multiple pieces of metal or other rigid material, which covers the front of the torso...
) which functions as a negative pressure ventilator.
Further reading
- Martha MasonMartha Mason (writer)Martha Mason was a writer born and based in Lattimore, North Carolina.-Early life:Afflicted with polio at age 11, Mason was sent home from the hospital in an iron lung, in which she remained for her entire life...
, a polio survivor, penned a best-selling memoir, Breath, about her life inside an iron lung. - Margaret AtwoodMargaret AtwoodMargaret Eleanor Atwood, is a Canadian poet, novelist, literary critic, essayist, and environmental activist. She is among the most-honoured authors of fiction in recent history; she is a winner of the Arthur C...
mentions an iron lung in her book Cat's Eye - Peg KehretPeg KehretPeg Kehret is an American writer. Her writing primarily targets younger children between the ages of 8 and 14....
mentions the use of an iron lung in her autobiographical book, Small Steps: The Year I Got PolioSmall Steps: The Year I Got PolioSmall Steps: The Year I Got Polio is an autobiography account of author Peg Kehret's childhood experience of polio.-Plot:In 1948, twelve-year-old Peg Kehret starts to notice some twitching in her leg during her school choir class, and then she also falls. When she gets home, she and her parents... - Elizabeth BergElizabeth Berg (author)Elizabeth Berg is an American nurse turned writer, born on December 2, 1948 in Saint Paul, Minnesota, USA, now living in Chicago, earlier in Boston. She studied English at the University of Minnesota, but later ended up with a nursing degree. Her writing career started when she won an essay contest...
shares a fictionalization of the true story of Pat Raming, the first woman to give birth to baby while in an iron lung, in her book, We are all Welcome Here. 2006.