Iron lung

An iron lung. The patient lies within the chamber, which when sealed provides an effective oscillating atmospheric pressure. This particular machine was donated to the Centers for Disease Control & Prevention Museum by the family of polio patient Barton Hebert of Covington, Louisiana, who had used the device from the late 1950s until his death in 2003.

An iron lung is a large machine that enables a person to breathe when normal muscle control has been lost or the work of breathing exceeds the person's ability. Properly, it is called a negative pressure ventilator.

Persons using the iron lung are 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. When the pressure falls below that within the lungs, air from outside is sucked in via the person's nose and airways to fill the lungs; when the pressure rises above that within the lungs, the reverse occurs, and air is expelled. In this manner, the iron lung mimics the physiologic 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 machine was invented by Philip Drinker and Louis Agassiz Shaw, of the Harvard Medical School. It found its most famous use in the mid-1900s when victims of poliomyelitis (more commonly known as polio), stricken with paralysis (including of the diaphragm, the cone shaped muscle at the bottom of the rib-cage whose action controls intrathoracic pressure), became unable to breathe, and were placed in these steel chambers to survive. The first iron lung was used on October 12, 1928 at Children's Hospital, Boston, in a child unconscious from respiratory failure; her dramatic recovery, within seconds of being placed within the chamber, did much to popularize the "Drinker Respirator."[1] Entire hospital wards were filled with rows of iron lungs at the height of the polio outbreaks of the 1940s and 50s. With the success of the worldwide polio vaccination programs which have virtually eradicated the disease, and the advent of modern ventilators that control breathing via the direct intubation of the airway, the use of the iron lung has sharply declined.

Iron lung ward filled with Polio patients, Rancho Los Amigos Hospital, ca. 1953

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. However, there are patients who still today use the older machines in their homes, finding that they actually work better than today's modern version. A problem occurs in that the replacement parts sometimes needed in the older version are no longer being manufactured. Also, 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), the machine still finds use.

Patient in the tank of a modern negative pressure ventilator. The tank has a clear acrylic lid and a gasket around the patient's neck. The ventilator itself is the small box in front.