“The Iron Lung and Polio” by Mark Rockoff, MD for OPENPediatrics

“The Iron Lung and Polio” by Mark Rockoff, MD  for OPENPediatrics

The Iron Lung and Polio, by Dr. Mark Rockoff. Poliomyelitis, commonly referred to as polio,
is a frightening, contagious viral disease that can have devastating effects on the central
nervous system. Children are most often affected, but adults can also be vulnerable as scene
when future president, Franklin Delano Roosevelt, became infected in 1921 at the age of 39. Though this illness has likely been around
for millennia, it became more prevalent in the early to mid 1900s, as large epidemics
occurred around the world. Ironically, these often happened in developed nations, including
the United States, as improved sanitation led to reduced naturally acquired immunity. Many children who were infected developed
a fever and soon were unable to move their limbs. Some had such extensive involvement
of their spinal chord that they also could not breathe effectively. When this occurred,
death often resulted from respiratory failure. For many, little other than comfort measures
were available for treatment. However, Philip Drinker, an engineer at the
Harvard School of Public Health, developed a simple, mechanical ventilator that could
be used to provide effective respirations for individuals who were too weak to breathe
on their own. This large device, which because of its construction became known as an iron
lung, was first used to treat an eight-year-old girl with polio in 1928 at Boston Children’s
Hospital adjacent to the Harvard School of Public Health. Soon thereafter, iron lungs were being mass
produced and used to treat polio patients around the world. In the early 1950s, during
the last large polio epidemics that occurred, much of Boston Children’s Hospital was devoted
to treating polio victims. However, due to the pioneering research work of John Enders,
a microbiologist at Boston Children’s Hospital, and his colleagues at the hospital, techniques
were developed to culture the polio virus in the laboratory. This enabled Dr. Salk and Sabin to develop
vaccines that rapidly led to the eradication of this deadly disease. And in 1954, Drs.
Enders, Weller, and Robbins received the Nobel Prize in medicine for their work. By the 1980s,
iron lungs were virtually obsolete, having been replaced by much smaller and less cumbersome
mechanical ventilators that are now used to treat patients with respiratory failure from
other causes. In order to appreciate how an iron lung functions, the archives program
at Boston Children’s Hospital has restored an old lung and created this short video. This is a restored Emerson model iron lung,
originally manufactured in Cambridge, Massachusetts. An iron lung is, I think, aptly named, because
it is quite a heavy and somewhat unwieldy device. It is made out of iron parts. And
it is very bulky and large, and it’s very difficult to move around. It often takes two
or sometimes three people to push these big devices. A patient with respiratory failure was placed
inside the device by opening the front end and sliding out a small bed. The bed was reinserted
into the machine, and the device closed and sealed. A collar was then secured around the
patient’s neck to establish an airtight seal. Depending upon the strength of their respiratory
muscles, some of them had to be in there 24 hours. Some were in at night only. Some were
in for two or three hours at a stretch, and then they would be out for half an hour. Boston Children’s Hospital even developed
a room size iron lung that could accommodate several patients at one time, as seen here
with nurses inside and outside the room. The iron lung worked by generating negative pressure
within the device when a large diaphragm at the far end of the machine pulled back. And
this would draw air into the patient’s lungs via the mouth and nose, which were extended
outside the machine. By rhythmically moving the diaphragm of the
iron lung, negative pressure could be generated, simulating natural respirations. The rate
of ventilation and the extent of negative pressure generated by the machine were controlled
with adjustable knobs. The device was powered by electricity but could be operated manually
during a power failure. Smart engineers back then thought there should
be a mechanism to have these iron lungs operate. So there’s actually a very large lever that
you can pull back and forth so that you can physically move the bellows in and out of
the iron long to create the negative pressure. It also has a place for your foot because
again, to really generate the pressure that the patient might need, you would have to
use a fair amount of force. So you had your foot and your upper body strength to do that. Operating the diaphragm by hand took much
work and was tiring. Hospital staff were trained to relieve each other every few minutes in
order for the patient to effectively ventilate. It could be many hours to facilitate unimpeded
ventilation. When you got into the rhythm, you sort of
counted the rhythm. It was counted and you just picked it up and you continued to pump. During this time, limited access to the patient’s
body was possible through portals in the side of the iron lung. The portals maintained an
airtight seal after a caregiver’s hands were inserted. This enabled nurses to keep the
patient clean and comfortable. Physical therapists prevented patients from developing muscle
contractions in weak limbs. To see how negative pressure mechanical ventilation
works, one merely needs to observe a patient in an iron lung trying to speak. When the
machine’s diaphragm extends to create negative pressure within the iron lung, air is sucked
into the patient’s lungs and the patient is unable to speak. Then, as a patient exhales,
sound can be produced. Here you can hear a healthy volunteer inside an iron lung counting
while the iron lung is operational. OK, let’s hear you count to 20. Two, three, five, six, eight, nine. Note localization is only effective during
that part of the ventilator’s cycle when exhalation occurs. Iron lungs did their work back when technology
wasn’t available, or more sophisticated– we certainly didn’t have the microchip back
then. And this was really the best way to support patients’ respiratory function. Fortunately, the widespread utilization of
polio vaccine since 1955 has resulted in the disappearance of polio in all but a few, remote,
underdeveloped regions of the world. Families no longer have to fear their children will
suddenly be affected by this dreadful disease. And the few remaining iron lungs are now medical
artifacts. Please help us improve the content by providing
us with some feedback.


  1. It is a good demonstration. This piece of equipment saved so many polio victims. And the relative simplicity of design shows the ingenuity of the times. What a wonderful day for all of humanity when the polio vaccine was created. It would have improved the video to hear from a person who had been in an iron lung

  2. ca pose le probleme de l eutanasie
    pour qu une telle demande soit recevable
    la maladie est incurable
    il n existe dans le monde aucune therapie connue
    le malade doit souffrir au dela du raisonnable ou etre incapable de bouger ses 4 membres ou etre dans l incapacite de parler
    son etat comateux ne lui permet plus de communiquer avec de tierces personnes
    la volonte de se donner la mort ne doit appartenir qu au malade apres que 4 experts aient rendu leur rapport dans un delai d un mois
    la duree totale de toutes les expertises ne peuvent exceder un mois
    sa volonte de terminer l acharnement therapeutique devrait etre recu par le Tribunal qui se transportera au chevet du malade dans le delai d une semaine
    l appel et la decision de la Cour devrait etre instruit et recu dans un delai de 15 jours maximum
    le malade devrait pouvoir interrompre la procedure a tout moment
    une nouvelle demande d eutanasie ne pourrait plus etre deposee pendant un delai de 6 mois
    de quoi faire reflechir nos enarques aui passent le temps a pondre des imbécilités

  3. There's a few polio survivors in the u.s. still and they are still in need of iron lungs even knowing that medical technology is so far in advance that there's no purpose of the iron lung there still people out there who have polio who do need the iron lung so my question is if medical technology so far advanced it should be able to manufacture iron lungs again and maybe even better

  4. The people that have Ireland now can you take them off of that take them can you take the people off of iron lung machine machine En qué parecen can you give patients medicine for. Now now we have new now we have technology that's it. And you can do things now cuz I heard a story about a little girl they what she had and I are learning machine and that machine her parents were getting too old and she said I don't know where we can take care of me and she said I thought I wish I could I don't want to be like that she said I forgot her name I don't want to be like this but I want to die so when I heard the story about her she said she wanted to die a bad storm happen I don't know where it was but I forgot I'm bad storm happened and her hometown and what happened was she sing when it lightning was striking and the telephone poles strike if telephone fell and she died she died that was one where she's dying she died happily after after she never going to suffer or sick anymore bless her in heaven up above I say but she was a fighter of everything she fight everything that she passed away her parents want to thank you for helping her helping her for everything helping her try to make her get better what she said and now I'm resting in peace thank you doctor and nurses for trying to help me

  5. As a precaution shouldn't they have at least a few thousand iron lungs if there was a polio outbreak or maybe even to countries that still have the illness

  6. Very interesting, as my late MOM had POLIO. It is mentioned that the first patient of the I L was in 1928. I remember my MOM talking about having been in one. As she was born in 1912. and contracted the virus at just 2 years of age, i.e. 1914, how could this be possible?

  7. there still is a man using one today he got Polio in the 50s , search "The Last Few Polio Survivors – Last of the Iron Lungs" amazing story

  8. My grandmother survived Polio she got it in her leg in the late 20`s the first epidemic before the 50`s, she was like ten years old they ended up cutting out a section of bone from her leg and stuck the peace in her ankle to fuse the bones together because the musicale in her lower leg where useless,,, She was one of the lucky ones the Polio stop there and when in to remission ,, She told me a story`s about being in an isolation hospitable where she see many kids show up and die and many end up in an iron lung for a few weeks but end up dieing 🙁

  9. Feedback – this was a good video, the narrator was good, it was informative and simple, with a live demonstration of what was being talked about as well as good historical images

  10. Iron lungs are still in use and not just 'medical artifacts' https://youtu.be/lf30N30Of94
    A little research shows where people still are using them, albeit expensively, because they are no longer manufactured by the original maker. Most parts either have to remove parts from dysfunctional systems that still work or they must be hand machined

  11. Good demonstration, BUT a few polio victims in the USA still require an iron lung. For them, the new methods mentioned do not work.

  12. There is several people inn Iron lungs around. Like this guy ho was looking for someone to help him with his Iron lung for 2 years.

  13. I have seen quiet alot of iron lung videos now. Somehow I got stuck to this topic and got very interested about it. It is a very intimidating machine for me. It is like laying in a space capsule and you have to relay 100% to it. I can imagine how many people freaked out in that machine, in the thought, something could start to fail. I defenitly would !!!
    This is a very good video, which shows the physical mechanisem and the function on the body. I couldn't believe that a small number of people are still using this machine, because the passive way of breathing should be more pleasant for them, as the positive preasure method.
    Thanks for the video!!!!

  14. I I'm 53 got Post Polio when I was 7 months old will I be needing a Iron lung machine later in life? Plz someone get in touch with me . More videos about Post Polio my doctor's are shock to know I have Polio at my age.

  15. When I was a young girl in the 1950's, our youth group would visit a young woman who lived in an iron lung in her parents' living room.

  16. As the demonstration involved a healthy volunteer, could he not have used his own chest muscles to breathe himself whilst counting effectively overriding the machine; or is that impossible because the machine’s force is too strong?

  17. Can iron lung substitute a tracheostomy or a person to be intubated or maybe just a person to leave attached to a bed with a tracheostomy?

  18. What a cumbersome device – seems some type of face mask or mouthpiece could have been devised to provide air exchange to patients.

  19. Very interesting, as it certainly opens one's eyes to the devastation polio caused. I was born in the 60s and had the vaccine I thank god and all the medical teams involved in a cure. Great work to all involved in making the Iron Lung to getting a vaccine to eradicate it. Thank you.

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