iron lung While ‘iron curtain’ has a provenance that is clear, the origins of the term ‘iron lung’ are uncertain. First records of its use surfaced in newspaper articles during the poliomyelitis epidemic of the 1920s, when reference was made to a rigid case fitted over the patient's body, used for administering prolonged artificial respiration by means of a mechanical pump. Yet already in 1670 John Mayow had advanced the concept that negative pressure draws air into the chest, and subsequently John Dalziel, a Scottish physician, described a negative pressure device which augmented respiration in his paper ‘On sleep, and an Apparatus for Promoting Artificial Respiration’. The first practical demonstration of the technique was provided by Dr Woillez of Paris, who was awarded the silver medal of the 1876 Le Havre Exhibition of Life Saving Equipment for his hand-operated bellows, the
Spirophore. He was to be followed some 40 years later by Dr Stewart in South Africa, who built a wooden box sealed at the shoulders and waist with clay. However, it was not until the polio epidemic of the 1950s that the use of such a device became commonplace.
In the 1920s experiments were being made on anaesthetized cats to record the positive pressure changes caused by inspiration in an enclosed chamber around the animal's thorax. The investigator's colleague, Dr Philip Drinker of the Harvard School of Public Health, acutely aware of the clinical problem at the nearby Children's Hospital, of respiratory failure in infantile paralysis, repeated the experiment with cats paralysed with curare. He found that animal could be ventilated and kept alive by the suction action of a syringe attached to the box enclosing the animal's body. Drinker sought and obtained funding from the Consolidated Gas Company of New York (who had previously sponsored a committee chaired by Drinker, which reported on improved methods of resuscitation in cases of gaseous poisoning), and with Louis Shaw he built a wooden cabinet, which opened and shut like a drawer, to contain the human torso.
In 1926 his first iron lung (perhaps named for the iron of the pump) was left at the bedside of an eight-year-old girl affected with respiratory paralysis due to polio. As she deteriorated she was placed in the cabinet, but the staff, unfamiliar with the device, feared to turn on the pump, which was left to Drinker himself. Within minutes the moribund young girl was revived, only to die soon after of pneumonia.
Thus it had been established that artificial respiration could maintain life, but little was known of the natural history of such respiratory paralysis. Would this mean the prospect of an entire lifetime in an iron lung? Although this was the case for some, the second patient to be treated, at the adjoining Peter Bent Brigham Hospital, recovered respiratory muscle function, and the era of
life-support was begun.
In the 1930s, ‘Drinkers’ as they also became known, were found throughout the US; in the UK a cheaper alternative, designed by Both, an Australian, was also available, being paid for by the motor car manufacturer and philanthropist Lord Nuffield. By 1937, 965 of these were to be found throughout the UK and elsewhere. Improved access for patients was achieved with a hinged opening of the tank, like the jaws of an alligator (or Alligator tank) this time by Captain Smith-Clarke of the Alvis Motor Car Company. Cape Engineering company produced aluminum versions, of which 150 were sold between 1954 and 1967. An additional modification was introduced in 1961 by Dr W. Howlett Kelleher of the Artificial Respiration Unit at the, Western Hospital, Fulham. This was a rotating version of the Iron Lung, which permitted chest physiotherapy in all positions.
The non-invasive application of positive pressure through nose masks has largely superceded the iron lung in the treatment of respiratory failure, but the final chapter in the story of the iron lung is still to be written. In the UK a few patients remain ventilated for part or all of the day using the iron lung, and it is still used by some in the short term for people with acute exacerbations of chronic airways obstruction.
Adrian J. Williams
See also
artificial ventilation;
breathing;
resuscitation.
