Q: Since polio was largely conquered in the early 1950s with the Salk vaccine, is there still a need for the iron lung machine?
P.G.F., of Steeleville
A: Paul Alexander still can see the shock in his mother’s face as she looked at her wet, filthy 5-year-old that fateful day in 1952.
“I remember walking into my mom’s kitchen and her turning around and saying, ‘Oh, no,’” he told the Waxahachie (Texas) Daily Light in 2014. “She said, ‘Paul, go get a bath. Right now.’ After I got the mud off, she put me in her bed, and she knew instantly. Every parent in Dallas, and everywhere else, was so afraid that the polio epidemic was going to come see their child. So, she knew right away.”
For the next week, he took his new coloring books and colored as much and as fast as he could, but day by day holding onto his crayons became increasingly difficult. Polio was slowly paralyzing him from the neck down just as it would to some degree more than 21,000 others in the U.S. during the terrible epidemic that year.
“It was like the devil going through my body,” said Alexander, who cried at the memory. “Shooting all the lights out.”
Soon after his father found he had to hold his son on the toilet to keep him from falling off, Paul was hospitalized. There, he continued to weaken until one day doctors noticed he wasn’t breathing and declared him dead. But before his body could be taken to the morgue and his name added to the list of 3,145 others who died of polio that year, yet another doctor decided the tow-headed boy still had a fighting chance and ran him upstairs to an iron lung.
“Nobody ever knew what happened or why he picked me up, and, unfortunately, I never got to ask him,” Alexander said. “But he picked me up in both arms and ran upstairs with me, and performed the tracheotomy, so they could get all the congestion out and so I could breathe. He did all that, and I don’t know what he saw but for whatever reason he was motivated to save this one child.”
Today, 65 years later, Alexander is thought to be one of just 10 people in the world (as of 2014) who continue to spend all or much of their lives in these monstrous coffinlike machines known as iron lungs. But just because these contraptions eventually will become museum relics doesn’t mean their life-saving abilities will follow suit — not by a long shot. Today similar machines that work on a different principle are used on hundreds of thousands of hospitalized patients each year. Only now they’re called “ventilators.”
As early as 1670, English scientist/doctor John Mayow devised what he thought would be a way to ventilate patients by using crude bellows and a bladder to draw in and expel air. The idea was so promising that scientists kept tinkering with it until Philip Drinker and Louis Shaw Jr., professors of industrial hygiene at Harvard, finally perfected the Drinker respirator — i.e., the iron lung. It was used for the first time on Oct. 12, 1928, at Boston Children’s Hospital to quickly save an 8-year-old girl who had nearly died of respiratory failure due to polio.
The machines immediately gained favor in medical circles and soon became a mainstay at hospitals across the country as polio epidemics continued to ravage its victims. For some reason, one of my most vivid cinematic memories from childhood was the scene from “The Five Pennies” in which bandleader Red Nichols (Danny Kaye) walks through a hospital ward filled with iron lungs to visit his stricken daughter. Beside himself with grief, he later throws his trumpet off the Golden Gate Bridge.
What made these machines unique was that they allowed a person to breathe as they do naturally — by negative pressure. A person is placed into the chamber, which is then sealed off from the neck and head, forming an air-tight compartment. Pumps then continually increase and decrease air pressure on the chest wall within the chamber.
When the pressure inside the chamber is below that in the lungs, the atmospheric pressure outside pushes air into the lungs through the mouth and nose. When the pressure inside the chamber increases, air is forced out of the lungs, and the patient exhales. Although the person must stay in the iron lung, no tubes down the throat are needed. For some rare conditions, newer forms of the iron lung that consist of a wearable shell (a biphasic cuirass ventilator) may be employed.
On the other hand, the modern ventilator uses the principle of positive pressure because it uses masks or tubes to force air into the lungs. They have become commonplace in medical institutions and often become a focus in right-to-die cases. Today, there are upwards of 800,000 hospitalizations involving mechanical ventilation in the United States and account for roughly 7 percent of all hospital days, according the American Association for the Surgery of Trauma.
Meanwhile, the remaining old-fashioned iron lungs continue to be held together by the mechanical equivalent of spit and chewing gum. When his machine began to fail in 2015, Alexander had to rely on the skills of a hobbyist mechanic who happened to see Alexander’s YouTube SOS. Another patient, Martha Ann Lillard, relies on a machine cobbled together from two other iron lungs, according to a story last month in the British tabloid The Sun. She says she cannot use a modern “vent” because of polio-related inflammation.
So they continue to be grateful for the life they’ve been given and hope they can keep their machines functioning for many more years.
“My parents taught me to have a lot of pride and self-respect, and God taught me to believe I could do anything I dreamed of — and I did,” said Alexander, who spent 15 years earning three college degrees and became a lawyer. “So instead of letting polio break me or kill me, I fought it hard. The more it would knock me down, the angrier I would get. That anger, I’ve often said, is what kept me alive.”
True or false: Brothers Felipe, Matty and Jesus Alou started at least one game together in the outfield for the San Francisco Giants.
Answer to Friday’s trivia: Deputy Bing Foster, who wandered through the streets of Virginia City on 57 episodes of TV’s “Bonanza,” was played by Neil Oliver “Bing” Russell, father of Emmy- and Golden Globe-nominated actor Kurt Russell (and grandfather of former pro baseball star Matt Franco).