When polio strikes

Abstract

“Life inside the iron lung was difficult and sometimes horrific. Inside the chamber, the patient wore only a light gown; until internal heating came along, it could get very cold at night…The greatest curse was constipation, the result of immobility and a hospital diet. This was often so obstinate that it defeated laxatives and enemas—which only left manual disimpaction by the nurse's gloved finger”.Paralysed with Fear (2013), Gareth Williams. By the time the 20th century arrived, the principle of mechanical ventilation had been well established. English physiologist John Mayow (1641–79) offered the first demonstration in 1670, using a bellows to inflate and deflate an animal bladder. The middle of the 19th century saw the advent of contraptions such as the Spirophore, which enclosed the body in a sealed metal chamber, while an attached bellows, operated by hand, stimulated respiration. Mechanical ventilation was just one of the scientific landmarks that became vital in the treatment of poliomyelitis. In his book Paralysed with Fear, Gareth Williams explores the history of the struggle against the disease, and the advances made in research and treatment. A German invention of the early 1900—the pulmotor—involved securing a facemask to the patient and pumping in oxygen at high pressure, which was then just as violently withdrawn. A 1925 article in Time Magazine breathlessly recounted the tale of a baby in peril. “In Manhattan, an infant, delivered, appeared to be a corpse; there was no action of the heart, though the lungs exhibited a faint, spasmodic twitching. For 15 minutes Dr Israel Kassow, attendant physician, worked in vain, suddenly remembered reading of how a pulmotor had been used in a similar case in Chicago. He seized a telephone, called up the Northern Union Gas Company, explained his need; an emergency pulmotor crew raced to the hospital with siren roaring. The pulmotor forced air into the apparently lifeless lungs, sucked it out again; the lungs responded…” In reality, the pulmotor was not built to play the hero: all that high pressure tended to damage the lungs. Williams contends that the device actually cost more lives than it saved. However, in 1927, Harvard academics Philip Drinker and Louis Agassiz Shaw revealed the first iron lung, a 7-foot long behemoth, powered by an electric motor alongside air pumps taken from two vacuum cleaners. The first patient was an 8-year old girl, whose chest muscles were no longer able to sustain respiration after she had contracted polio. Within moments of entering the steel cylinder, with her head protruding uncomfortably at the top, her breathing was restored. A dramatic recovery, but it was short-lived. Within days the girl had died from pneumonia. The early operators of the Drinker respirator—a negative pressure ventilator or tank respirator—had yet to appreciate the importance of ensuring that patients' lungs did not fill with secretions. Infections of the bladder and bowels were also concerns, as were bedsores. “Even in centres of excellence such as New York's Willard Park Hospital, 60–80% of patients entrusted to the iron lung died inside it”, notes Williams. The next few years saw improvements to Drinker's machine. A modified version crafted by John Emerson (1906–97) was rolled out in the USA. Portal windows allowed the attendants to access to the patient within, and a sliding bed eased the patient's entry. In the UK, the Australian-designed plywood Both respirator became the standard form. It could be built onsite, in hospital workshops, for £100—at the time, importing an American iron lung to Europe cost around £1500. Most patients who used the iron lung needed it for only a week or so. Today, modern techniques of ventilation and mass vaccination campaigns have rendered it all but obsolete. However, for a small fraction, the iron lung became a permanent encasement, and their plight is a salutary reminder of the damage wrought by polio—its eradication, promised for so long, would help us all to breathe a little more easily.