How the iron lung paved the way for the modern-day intensive care unit (2024)

By Mia Taylor,Features correspondent

How the iron lung paved the way for the modern-day intensive care unit (1)How the iron lung paved the way for the modern-day intensive care unit (2)Getty Images

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.

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, particularlyfrom 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.

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."

How the iron lung paved the way for the modern-day intensive care unit (3)How the iron lung paved the way for the modern-day intensive care unit (4)Getty Images

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.

Subsequent medical innovations

The development of the iron lung is often seen as a milestone in the development of mechanical ventilators, which were not widely used prior to the polio outbreak.

"Ventilation science came into brighter lighting as a result of the iron lung," says Peter Gay, a pulmonary, critical care and sleep physician with the Mayo Clinic. "The physiology of gas exchange was better understood once they mechanised moving air in and out of the body."

One of the early ventilator developments was pioneered by Bjorn Aage Ibsen. In 1953, Ibsen proposed using "positive pressure" ventilation. In contrast to the iron lung, which relied on negative pressure ventilation that suctioned air into a patient's lungs, positive pressure ventilation would push air into the lungs by hand, without the aid of machine.

Subsequent ventilator developments, which blow air into the lungs, were more portable than the iron lung – and far less cumbersome and invasive. This type of positive pressure approach would later be used routinely in the operating room by anesthesiologists.

How the iron lung paved the way for the modern-day intensive care unit (5)How the iron lung paved the way for the modern-day intensive care unit (6)Getty Images

While ventilator technology has evolved dramatically over the years and expanded, it remains very similar in concept to what was developed early on. Modern ventilators that sit at a patient's bedside delivering positive pressure in an intensive care unit can be traced back to the polio epidemic.

The development of iron lung technology "created the concept that you could put a whole lot of people into a room and support them with this life-saving gas exchange that they needed," adds Gay. Thus, the idea of an Intensive Care Unit (ICU) was born.

According to the Respiratory Care Journal, "The first ICUs were set up to manage in some cases dozens of patients, of all ages, requiring negative-pressure ventilation because of poliomyelitis [polio]."

"You had these units with all of these polio patients using the iron lung, and that's where the idea of intensive care units really took off," continues Gay. "That's why anesthesiologists initially became the critical care experts. Because anesthesiologists were largely the first to administer this type of intensive care."

More like this:

Wunsch concurs, pointing out that "creating respiratory centres for the care of polio patients supported by iron lungs helped cement the idea that complex care of patients required a dedicated area, with highly skilled caregivers. This concept is also very much at the heart of modern ICUs."

Equally important, the ability to support a patient’s respiratory system more effectively has allowed for better treatment of many other critical illnesses.

"So often, when people have critical illness, respiratory failure accompanies the illness – when patients are septic, or have pneumonia or infections – the respiratory system has to be supported in order for any other organ failure to be recovered," adds Gay.

Ventilators and the coronavirus pandemic

Polio was feared around the world at the peak of its epidemic. The disease left hundreds of thousands of children paralysed each year. The iron lung helped save many of them: In the United States alone, it was used by 1,200 people in 1959.

Fast-forward to late 2019 and early 2020, and the world one again found itself grappling with a frightening disease. During the Covid-19 pandemic peak, ventilation was once again at the forefront of treatment. Most recently, a team of engineers and doctors has invented the modern version of the iron lung – technology that serves as a breathing aid for patients with Covid-19.

The new device, which is still in development and has not yet been brought to market, is named Exovent NPV. It is also a negative pressure ventilator, and works by decreasing "the pressure outside the body to allow lung tissue to expand and function in a way that resembles normal breathing," according to the Institution of Mechanical Engineers. There is also hope that the device may be used to help with conditions such as pneumonia. The Exovent is merely the latest example of a medical innovation that can trace its roots back to the invention of the iron lung.

--

If you liked this story, sign up for The Essential List newsletter – a handpicked selection of features, videos and can't-miss news delivered to your inbox every Friday.

Health

Technology

Trending

How the iron lung paved the way for the modern-day intensive care unit (2024)

FAQs

How the iron lung paved the way for the modern-day intensive care unit? ›

The development of iron lung technology "created the concept that you could put a whole lot of people into a room and support them with this life-saving gas exchange that they needed," adds Gay. Thus, the idea of an Intensive Care Unit (ICU) was born.

How did the iron lung help people? ›

The iron lung was born in 1927, when Philip Drinker and Louis Agassiz Shaw at Harvard University devised a machine that could maintain respiration, pulling air into and out of the lungs by changing the pressure in an airtight metal box.

What is the significance of the iron lung? ›

Popularly named the iron lung, the Drinker respirator supported thousands of patients afflicted with respiratory paralysis during the polio era. It was being superseded by positive-pressure airway ventilators just as the polio era came to a close. Today the Drinker respirator has disappeared virtually without a trace.

Why iron lung instead of ventilator? ›

Iron Lungs & Ventilators.

The iron lung provided negative pressure ventilation which is very similar to the manner which we naturally breathe. However, the design of the iron lung made it very difficult to care for patients and it could not support patients with other types of lung disease such as severe pneumonia.

Why is the iron lung still used? ›

Need for this treatment may result from diseases including polio and botulism and certain poisons (for example, barbiturates, tubocurarine). The use of iron lungs is largely obsolete in modern medicine as more modern breathing therapies have been developed and due to the eradication of polio in most of the world.

What is the modern alternative to the iron lung? ›

The new model, the Exovent, is a cutting-edge reinvention of the archetypal iron lung, a Negative Pressure Ventilator (NPV), which is non-invasive and allows the patient to remain conscious throughout treatment.

How successful was the iron lung? ›

Most patients only used the iron lung for a few weeks or months depending on the severity of the polio attack, but those left with their chest muscles permanently paralyzed by the disease faced a lifetime of confinement. In 1959, there were 1,200 people using iron lungs in the U.S., but by 2017, there were only three.

How do iron lung patients shower? ›

Then directly afterwards then we had the bathing, and the iron lung would pull out. The attendants would have a tub that they would have sometimes in their hand but then would bring a stool over put the tub there, and they would go lower body first, always the chest, the arms, washcloth, not sponge.

How many people are still in an iron lung? ›

Decades after polio, Martha is among the last to still rely on an iron lung to breathe. At least one other American was known to be relying on an iron lung in recent years: Martha Lillard, who contracted polio one year after Alexander.

Why didn't Paul Alexander leave the iron lung? ›

Paul had survived a serious bout of polio, but had been left quadriplegic. After an emergency tracheostomy operation, he was unable to breathe without the iron lung machine that now encased his small body.

Are iron lungs still required? ›

As polio case numbers have dropped, iron lungs have disappeared from use, with only a handful of people who were already in the devices, like Alexander, still using them. Nowadays, patients who need help to breathe are instead given modern ventilators, which don't require a person to be immobilized in a tube.

Who was the girl in the iron lung? ›

Dianne Odell (February 13, 1947 – May 28, 2008) was a Tennessee woman who spent most of her life in an iron lung.

Who is the last person in an iron lung? ›

Alexander died in Dallas on March 11, 2024, at age 78. Although he had been hospitalized for COVID-19 in February, the actual cause of death was unclear. He was one of the last two people still using the technology, alongside Martha Lillard, who first entered an iron lung in 1953.

What invention replaced the iron lung? ›

But for patients dependent on them to breathe, the old iron lungs were gradually replaced with modern ventilators. Ventilators are used today in intensive care units and emergency wards rather than for polio victims.

Did the iron lung save lives? ›

In the early 1950s, before the polio vaccine was introduced, the iron lung enabled hundreds of people to survive the debilitating disease. The massive metal machine encased patients, using air pressure to do the work of their paralyzed diaphragms and help them breathe.

What is the life expectancy of someone with post polio syndrome? ›

Outlook. In most cases, post-polio syndrome life expectancy is good. PPS is rarely life-threatening, though symptoms can vary from mild to severe. If you have PPS, talk to your doctor about how to manage your condition.

How many people did the iron lung save? ›

The disease left hundreds of thousands of children paralysed each year. The iron lung helped save many of them: In the United States alone, it was used by 1,200 people in 1959. Fast-forward to late 2019 and early 2020, and the world one again found itself grappling with a frightening disease.

Do people still need iron lungs? ›

As polio case numbers have dropped, iron lungs have disappeared from use, with only a handful of people who were already in the devices, like Alexander, still using them. Nowadays, patients who need help to breathe are instead given modern ventilators, which don't require a person to be immobilized in a tube.

Why did Paul Alexander stay in an iron lung? ›

Paul had survived a serious bout of polio, but had been left quadriplegic. After an emergency tracheostomy operation, he was unable to breathe without the iron lung machine that now encased his small body.

How do people use the bathroom in an iron lung? ›

And for going to the bathroom, it might occur a couple of different times, but my father had a bedpan, that was placed under him. He was lying down in the iron lung. Or he also had the same thing to pee into and that just go, you know, right between his legs.

Top Articles
Latest Posts
Article information

Author: Arline Emard IV

Last Updated:

Views: 5872

Rating: 4.1 / 5 (72 voted)

Reviews: 87% of readers found this page helpful

Author information

Name: Arline Emard IV

Birthday: 1996-07-10

Address: 8912 Hintz Shore, West Louie, AZ 69363-0747

Phone: +13454700762376

Job: Administration Technician

Hobby: Paintball, Horseback riding, Cycling, Running, Macrame, Playing musical instruments, Soapmaking

Introduction: My name is Arline Emard IV, I am a cheerful, gorgeous, colorful, joyous, excited, super, inquisitive person who loves writing and wants to share my knowledge and understanding with you.