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introduction

In the early 1900s, the human population around the world faced the poliomyelitis epidemic. This deadly disease, taking thousands of innocent lives, showed no mercy to its victims. Polio was a viral infection that attacked the whole body, primarily the nervous system, which often led to paralysis and death. Doctors sought out treatments to help patients survive and, if patients were lucky, cope with the disease. Some of these treatments applied mainly to patients in the early stage of polio (Chapman, 2015).  A patient can contract a nonparalytic or paralytic type of polio. The symptoms of nonparalytic polio can last for about 10 days. These symptoms include fever, sore throat, headache, vomiting, fatigue, back pain, and more. Paralytic polio is the most critical form of polio. This form has very similar symptoms to nonparalytic polio, but after a week or so, other effects take place. The body loses reflexes, limbs go “loose and floppy”, and severe muscle aches occur (Polio, 2017). The paralysis impacts a patient’s ability to breathe on their own. Because of their struggle to breathe on their own, a mechanical respirator is sometimes necessary. One such respirator known as the iron lung was a very well-known treatment. It assisted patients that were suffering from the harsh effects paralytic polio had on their central nervous system. However, the iron lung did not have an impact only on patients suffering from polio; it actually impacted and added a step of our society that helped it flourish. The iron lung polio treatment expedited the innovation of mechanical ventilators and contributed to the growth and awareness of disability rights, promoting equality for the disabled in society.

Background and How the Iron Lung Works

The effects of paralysis on a patient’s lungs called for a device that assisted breathing. The iron lung was created by Philip Drinker and Louis Agassiz Shaw Jr in the late 1920s (Chapman, 2015; Slutsky, 2015). The iron lung was a bulky metal tank that weighed 650 pounds. While patients used it, there was only part of the body that could be viewed from the outside  (Chapman, 2015). This apparatus worked similarly to a “vacuum with a motor creating and releasing pressure around the body. Air would be pushed into the lungs as decreased pressure forced the chest up. The lungs exhaled when the vacuum released the pressure, pulling the air out” (Chapman, 2015). Despite its success, there was still room for improvement with this device. One downside to the iron lung was how inaccessible it was to the patient’s body (Slutsky, 2015). This pushed for its innovation.

Beginning of the Iron Lung Innovation

The iron lung was also a milestone in the development and enhancement of mechanical ventilators. The use of mechanical ventilation for polio showed how beneficial this treatment actually was. In the article, “History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury” (Slutsky, 2015),  it explains that before polio, the use of mechanical ventilators was not very popular. The treatment was practically an overlooked medical breakthrough that eventually spread across the globe. One such predecessor was the Thunberg barospirator, which fully encased the patient’s head and body. Despite its limited clinical success, the barospirator helped in the conception of the innovation of the iron lung (Haddad, et al.). Doctors around the world started to work on the innovation of the system. This led to an international polio conference, in Copenhagen in 1951, attended by most of the world’s polio experts (Slutsky, 2015). People realized it was a necessity to come together and talk about how they could improve this piece of technology. According to Slutsky, technical parts of the ventilators have changed drastically due to this, especially over the past 60 years. This innovation included, “the development of new modes of ventilation..in the 1980s and 1990s, [produced] a paradigm shift from controlled ventilation to partial ventilation support, then to pressure support ventilation. The focus has been on improving the interaction between the patient’s drive to breathe and the ventilator’s delivery of each breath” (Slutsky, 2015). These steps to the improvement of mechanical ventilators all lead back to the use of the iron lung.

Psychological Impact of Using the Iron lung to Treat Polio

On the other hand, before its innovation, the iron lung mentally and physically took control of the patient’s body. The aforementioned description of how the machine worked, exemplifies how a patient is affected physically. A patient was isolated from their surroundings being encased in a huge machine, as seen in the picture above. Also, some cases of polio led not only to the inability to breathe properly, but also the inability to eat, swallow, and talk. Patients sometimes had to relearn these basic abilities (Chapman, 2015). A patient with polio explained her experience using the iron lung by stating, “I used to sit up perhaps to have a cup of tea, but then they would have to keep an eye on me because my fingers would go blue and in about 15 minutes I would have to go back in again” (Barr, 2010).  At one point she practically had to live in the iron lung. These physical limitations are an example of what made people feel trapped. The Washington Post also published an article about a patient “escaping from the iron lung”.  It told a story of a 19-year-old paralysis patient suffering from the harsh effects of this disease. After the patient was in the iron lung for 13 hours a day for months, he was allowed to come out for about 12 hours. This was seen as steps to giving him a “normal life” (“Youth ‘escaping’ from ‘iron lung’”, 1937). After polio turning the most simplistic aspect of independence into an obstacle, one can only imagine the toll this would take on a person psychologically. The iron lung did not assist with this feeling of helplessness. With the iron lung, the human body is no longer dependent on its own.

Polio and the Iron Lung’s impact on Disability Awareness

The impact polio and treatments like the iron lung took on a person’s life increased the number of advocates for disability awareness. The widespread use of the iron lung led to the dissemination of the word across society, giving it new meaning. According to “’Iron lung’ as a metaphor”, “The term iron lung… was not the same as the material reality of the object… [but] described the lived experience, providing a shared and logical understanding of what the apparatus meant to the people that interacted with it both physically and conceptually” (Lawerence-Mackey, 2021). As development of the new medical technology accelerated, society attached deeper meaning to the term “iron lung”, describing the entrapment and claustrophobic nature of the machine and the effect it had on people’s lives beyond the literal definition of its existence. This awareness assisted with the improvements to the iron lung. Franklin Delano Roosevelt was a victim of this deadly disease too. It is said that FDR’s diagnosis was originally kept hidden with the help of reporter’s cooperation and the Secret Service. He did not want any photos taken of him in a “disabled or weak state” (Berish, n.d.). The disabled were not always respected and FDR joined a “group” that was often looked down upon. However, his ability to change how people saw the disabled was impeccable. FDR “became a symbol of strength and perseverance to Americans” (Berish, n.d.). His personal connection to the handicapped pushed him to fundraise (Franklin Roosevelt founds March of Dimes, 2009).  As the polio epidemic increased, FDR soon turned to the public to help fundraise for polio research for vaccines and rehabilitation for survivors. The president’s infection brought awareness to the rest of society about the severity of the disease. This foundation was originally called the National Foundation for Infantile Paralysis but was renamed March of Dimes Foundation in 1938 (Franklin Roosevelt founds March of Dimes, 2009). The foundation actually contributed to the innovation and the advancements in the iron lung.  Without FDR’s ability to move society from looking down on the disabled to focusing on helping them, the iron lung’s innovation may have not been as successful.  His advocacy has impacted the medical advancements we have today.

FDR was not the only advocate for disability rights that suffered from the infectious polio disease.  Mark O’brien at the young age of six was diagnosed with polio. His case was so severe to the point where he needed “assistive respirators for the rest of his life”.  A part of his life consisted of him being in this large metal tank, the iron lung. The tank he lived in had an,  “movable mattress that gave the iron lung the more endearing nickname of the cookie tray” (Chapman, 2015). When he went to the University of California, he would have to use a motorized gurney to get through the campus, then go home to use the iron lung. The iron lung was practically seen as another home because he had to live in it for four decades, due to his paralysis (American Documentary, .Inc,  2006). As he grew up he noticed that polio survivors, including him, were extremely excluded from the world around them. The iron lung added to this feeling of seclusion. O’Brien sought out ways to bring an end to this. His drive to end the discrimination against the disabled inspired him to co-found the Lemonade Factory, which was “a small press in Berkeley that publishes poetry by people with disabilities” (Honan).  This gave people with disabilities a voice to the public. There was also a film directed by Jessica Yu called, “Breathing Lessons: The Life and Work of Mark O’Brien”. The film connects the audience to O’Brien’s struggle to live life independently.  The films delves into O’Brien’s life from his prospective by providing “an intimate window into the reality of a life of severe disability, as well as an illuminating portrait of a remarkable artist” (American Documentary, .Inc,  2006).  Sadly, this did not completely stop the discrimination and the disease all together considering that these are still issues today.

THE IRON LUNG: SIGNIFICANT STORIES

The helpless feeling of the iron lung did not stop some individuals from striving forward in their personal accomplishments. Up to the modern day, iron lung patients continue to break free from the psychological and physical shackles the iron lung places on them and manage to succeed in their endeavors. The Iron Lung, over the course of its existence, has exerted control over its patients’ lives; however, despite the overwhelming adversity before them, patients were able to make it through childbirth, pursue higher education, and become prominent figures for disability awareness.

Ingeborg Cully was a 35-year-old woman and a mother of three children when she passed away in 1961 after taking a “sudden turn for the worse” (New York Times, 1961) in her battle against polio. A few years prior in 1956, after just having contracted polio, she experienced a normal childbirth with her second child. For this magnificent feat, she was awarded the Queen’s Polio Mother of the Year award in 1958 (New York Times, 1961). However, over time, Cully became paralyzed from the waist up. As her third pregnancy approached its due date, the delivery was slated to be more difficult than the previous birth. Cully was “taken from her iron lung for ninety minutes during the complicated and difficult birth… air [had to be] pumped to her lungs through a tube in her throat” (New York Times, 1961). The delivery was successful, and although she passed away within the year, Cully overcame the overwhelming adversity before her by making it through childbirth and showcasing an interplay of technology and willpower.

Even to the modern day, iron lung patients continue to overcome adversity by pursuing higher education. Paul Alexander is a 74-year-old polio patient who spends every day confined to an iron lung. He contracted the disease back in 1952 at six years old and very quickly “lost his ability to walk, swallow, and breathe” (Charpentier, 2021), resulting in his being forced into the iron lung. Eventually, after many attempts resulting in him passing out, he learned how to breathe outside of the iron lung for periods of time and set his sights on higher education. Alexander graduated from the University of Texas at Austin School of Law in 1984 and went on to represent clients in Dallas from his wheelchair for decades (Charpentier, 2021). Now, as he spends every day as one of the last living users of the iron lung, he has proven that regardless of the control that the iron lung exerts over its patients’ lives, overcoming that adversity and pursuing a higher education was not out of reach.

However, Paul Alexander is not the only modern iron lung patient who overcame adversity and achieved significant feats. Mona Randolph and Jim Costello are two separate examples of patients who went on to become prominent figures for the disabled through the creation of organizations for disability awareness. Mona Randolph, who spent the majority of her life in the iron lung, formed The Whole Person, a “dynamic organization which still exists as an advocate for all individuals with disabilities in Kansas City” (Randolph, 2021). She also “served on the board of the Coalition of Independence which coordinated direct assistance to the disabled” (Randolph, 2021). Mona Randolph passed away on February 18th, 2019, leaving her mark on the world as another figure of perseverance that overcame the grip of the iron lung. Additionally, Jim Costello is a 73-year-old previous iron lung patient from Ireland who contracted polio when he was fifteen. Heavily paralyzed, Costello went on with six others to “[set] up a charity to help people who had polio or who have ‘Post Polio Syndrome’” (Costello, 2016). For his efforts, he was awarded the Louis Pasteur Polio Hero medal in Paris in 2016. Both Mona Randolph and Jim Costello are examples of those who overcame the adversity before them by escaping the psychological shackles of the iron lung and became prominent representatives for disability awareness and role models for other victims of polio alive today.

Overall, the helpless feeling of the iron lung did not stop Ingeborg Cully from giving childbirth, Paul Alexander from pursuing law, or Mona Randolph and Jim Costello from creating organizations for disability awareness. These stories from the iron lung showcase how regardless of the psychological and physical shackles placed on them, many iron lung patients were able to overcome their adversity and manage to succeed in their endeavors.

Different patients have different views of the iron lung mainly because although it was something they needed it was something they didn’t want. The main issue that patients went through is getting used to the new life of using the iron lung because it was needed to survive. An issue that I found was the patients were silenced and their voices weren’t heard.

One personal experience from a patient, Marshall Barr,  wrote about his experience in life and having to use the iron lung. In his writing about his experience being attached to the iron lung, he said, “I came home about September time assuming that I was OK. But a week of being without the iron lung was absolutely impossible” ( Barr,  2010).  This became a part of his daily life, even when he thought he could live without it, he was quickly hit with a sad reality. With the advancement of technology, society got more advanced “iron lung” machines.  This made life earlier for the different polio patients.

Another patient, Rebecca Wadlinger, chose to write about her experience using a poem. This personally was a great way to captivate the audience and inform them about her experience in the iron lung. She starts her poem off with, “I said I’m dead” (Wadlinger,  2012), this is a great way to begin the poem because it sets the tone of the poem and we get a personal feeling. This was captivating her audience because we rarely hear about how patients really feel about the iron lung. Throughout the poem, she informs the reader about her terrible experiences in the iron lung. Then she ends the poem with, “say it last words I breathe” (Wadlinger,  2012), she shows how she really felt from having to be attached to the iron lung for his life.

These two experiences have given personal experiences about how the iron lung has affected polio patients. With the iron lung being invented it has brought a whole new experience and another life to those patients. The only problem most polio patients experience is having to be attached to the machine their whole lives. With new advancements in technology, it made it easier to use the iron lung because it became smaller and more compact.

Science and Technology in Society with the Iron Lung

This disease has not fully been defeated with the iron lung’s innovation, but the likelihood of contracting this disease globally has decreased immensely. According to the Mayo Clinic, “In the U.S., the last case of naturally occurring polio was in 1979. Today, despite a wor

ldwide effort to wipe out polio, poliovirus continues to affect children and adults in parts of Asia and Africa” (Polio, 2017). The creation of the iron lung can not take all the credit for partial eradication of polio. However, its ability to push advocates to seek more rights for the disabled increased awareness and foundations. This added to the research to improve the iron lung, which lead to the polio vaccine and different types of mechanical ventilations. Today there are portal ventilators being used all over the world weighing only 9 pounds, which is nothing compared to the 650-pound iron lung. As seen in the timeline above, the iron lung was still being used by 39-people in 2004. The invention of the iron lung was a breakthrough for society in the 1900s. This shows how this invention is still currently impacting us and how the application of science and its impact is often overlooked. So overlooked to the point where some are so blind to the fact that it practically mended our civilization (Rull). Science and technology contribute to our world by adding knowledge. This knowledge gave society a step to grow. The iron lung was the inspiration to the innovation of mechanical ventilators and expanded the advocates and awareness of disability rights, which increased equality for the disabled in society.

Sources 

Barr, M. (2010, June 1). The iron lung – a polio patient’s story. Retrieved October 11, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878826/.

Berish, A. (n.d.). FDR and Polio. Retrieved November 11, 2019, from https://www.fdrlibrary.org/polio.

Chapman, G. (2015, July 8). From iron lung to independence. Retrieved October 11, 2019, from https://americanhistory.si.edu/blog/iron-lung-independence.

Charpentier, M. (2020, September 1). One of the Last People to Live in an Iron Lung Is a Longhorn. Alcalde: The Official Publication for the Texas Exes. https://alcalde.texasexes.org/2020/09/one-of-the-last-people-to-live-in-an-iron-lung-is-a-longhorn/

Costello, J. (2016, December 11). Living in an Iron Lung: ‘It was a long, airtight coffin-shaped box with my head sticking out at one end’. TheJournal. https://www.thejournal.ie/readme/what-is-life-like-for-a-polio-survivor-3128107-Dec2016/

Haddad, C. S., Wang, J., & Alston, T. A. (2019). Thunberg’s Barospirator, a Fully Encasing Predecessor of the Iron Lung. Journal of Anesthesia History, 5(4), 147–148. https://doi.org/10.1016/j.janh.2019.08.001

History.com Editors. (2009, November 16). Franklin Roosevelt founds March of Dimes. Retrieved from https://www.history.com/this-day-in-history/franklin-roosevelt-founds-march-of-dimes

Honan, W. H. (1999, July 11). Mark O’Brien, 49, Journalist And Poet in Iron Lung, Is Dead. Retrieved October 11, 2019, from https://www.nytimes.com/1999/07/11/us/mark-o-brien-49-journalist-and-poet-in-iron-lung-is-dead.html.

Lawrence-Mackey, F. (2021). “Iron lung” as metaphor. Science Museum Group Journal, 15(15). https://doi.org/10.15180/211512

MOTHER IN IRON LUNG DIES UNEXPECTEDLY. (1961, Mar 07). New York Times (1923-) http://libproxy.clemson.edu/login?url=https://www.proquest.com/historical-newspapers/mother-iron-lung-dies-unexpectedly/docview/115371946/se-2?accountid=6167

Polio. (2017, December 9). Retrieved from https://www.mayoclinic.org/diseases-conditions/polio/symptoms-causes/syc-20376512.

Randolph, M. (2019). Mona Randolph. Polio Place. http://www.polioplace.org/sites/default/files/files/Mona%20Randolph%20Life.pdf

Rull, V. (2014, August 18). The most important application of science. Retrieved October 31, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198034/.

Slutsky, A. S. (2015, April 3). History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury. Retrieved from https://www-atsjournals-org.libproxy.clemson.edu/doi/full/10.1164/rccm.201503-0421PP

True Lives: Breathing Lessons: The Life and Work of Mark O’Brien by Jessica Yu: a presentation of American Documentary Inc. and National Educational Telecommunications Association. (2006). Retrieved November 21, 2019, from https://www.truelives.org/pg_breathinglessons.html.

Wadlinger, R. (2012). from “The Iron Lung Poem”. Ploughshares, 38(1), 169+.  https://link.gale.com/apps/doc/A285887805/AONE?u=clemsonu_main&sid=bookmark-AONE&xid=5de8c96b

Youth ‘escaping’ from ‘iron lung’. (1937, Aug 16). The Washington Post (1923-1954) Retrieved from http://libproxy.clemson.edu/login?url=https://search-proquest-com.libproxy.clemson.edu/docview/150918150?accountid=6167

Figures

“Iron Lung” by Hewa is licensed under CC BY 3.0

“This 1960 historic photograph depicted a nurse caring for a victim of a Rhode Island polio epidemic, who was inside an Emerson respirator, a” by Centers for Disease Control and Prevention is in the Public Domain.

” File:FDR-Wheelchair-February-1941.jpg” by FDR Presidential Library & Museum photograph by Margaret Suckley is in the Public Domain, CC0

“Coin Donation Bank – March of Dimes – Reproduction of the “Iron Lung” Which Has Saved the Lives of Many Infantile Paralysis Victims” by National Museum of American History is licensed under CC BY-NC 4

“Polio: from iron lung to eradication” by Sanofi Pasteur is licensed under CC BY-NC-ND 2.0