"Iron Lung Man": Living in an Iron Can, Power Outage Means Death

Imagine that you are lying in a "tin coffin" and the can is whirring, but you can clearly hear your partner's voice in the noise. He is openly planning with his new young lover when to kill you.

You are extremely angry, but you cannot move. A sealed leather sleeve is wrapped around your neck, with your head exposed. Only your eyeballs can move freely so that you do not look like a corpse. And your breathing depends entirely on the electricity in the "iron coffin". Once there is a power outage or a malfunction, you will die within ten minutes...

Like this | Wikimedia Commons

Do you think it’s scary? This scene appeared in the 1955 Alfred Hitchcock drama “Alfred Hitchcock’s Tales of Suspense”. People today may be unfamiliar with the iron machine in the drama, but for the audience in 1955, it was a medical device they were familiar with - the iron lung.

Iron lung: a ray of hope for polio patients

In the 1950s, nearly 15,000 people were infected with epidemic polio every year. For humans at that time, its horror was no less than the current COVID-19. Perhaps the only thing scarier than it was the mushroom cloud of an atomic bomb.

Unlike the new coronavirus, polio has a long history. As early as the 14th century BC, people in ancient Egyptian lithographs showed symptoms of polio - atrophied right calves. In 1789, the first complete and detailed record of the disease appeared in history. In 1909, physiologists Karl Landsteiner and Erwin Popper isolated the polio virus. Seven years later, the first polio pandemic broke out in the United States, followed by more frequent outbreaks.

Typically, polio causes only brief discomfort—fever, nausea, pain in the limbs. Rarely, the virus attacks the central nervous system, causing muscle weakness that can lead to flaccid paralysis. This paralysis often occurs in the legs, but it can also affect the muscles of the head, neck, and even the diaphragm. The diaphragm needs to work properly so that the lungs can expand and we can breathe. If the diaphragm muscles become paralyzed, the patient will have difficulty breathing.

Illustration of how an iron lung works | Penlite / Wikimedia Commons

In order to help these patients breathe smoothly, the prototype of the iron lung, the negative pressure ventilator, appeared in 1864. It has a similar principle to the iron lung: the human body is placed in a sealed container, leaving only the head exposed, and the air pressure in the container is changed to negative pressure, allowing the chest cavity to expand and the lungs to inhale gas.

Iron lung | Jenni Konrad / Flickr

In 1928, Philip Drinker and Louis Shaw jointly designed the iron lung. In its first clinical application, it saved an 8-year-old girl from the brink of death from respiratory failure, which caused a social sensation at the time. After many improvements, the function of the iron lung became more complete. There is also a version of the iron lung that is made of plywood and has wheels for easy mobility. The production cost has also dropped from US$2,000 to about £100, and it has been truly put into clinical treatment. Even so, iron lungs are still in short supply. In order to save space and treatment costs, there was even a time when multi-person iron lungs appeared.

Nurse with a young patient in an iron lung | City of Boston Archives / Wikimedia Commons

Even with an iron lung, there are still many difficulties

Theoretically, most patients will stay in the iron lung for a few weeks to a few months. During this period, they can rest with the help of the iron lung and temporarily leave the iron lung when they need to eat or defecate. As muscle strength recovers, they can eventually breathe completely independently and leave the iron lung. But a few more unfortunate patients can no longer recover their own breathing, and life in the iron lung is tantamount to life imprisonment for them.

Just by looking at the appearance, we can imagine that life in an iron lung must be difficult, and the long-term survival rate of patients is only 10% to 30%. While lying on their backs and unable to move, they may even choke on their own sputum, leading to suffocation. In addition, in order to cope with power outages, the iron lung is also designed with a manual operation mode, but nurses are required to watch over it. An iron lung user once recorded the nightmare scene of a power outage: "You can feel your heart beating, you breathe desperately, but you can't breathe at all"; "We can't speak, we can only flick our tongues desperately to call for the nurse. The whole ward is like a chicken coop, full of the sound of flicking tongues."

A film promotional photo promoting the use of the iron lung, published in 1953 | Food and Drug Administration

In 1952, polio broke out in Copenhagen, but there was only one iron lung and six armor-type negative pressure ventilators in the area. In desperation, the local hospital decided to try positive pressure breathing, equipping patients with artificial tubes or tracheotomies, and asking medical students to squeeze rubber balls to increase the pressure. They found that using this simplest positive pressure "ventilator" could significantly reduce the mortality rate of patients to about 25%, which is much lower than the mortality rate of iron lung users. Most of the various ventilators commonly used in hospitals now also apply the principle of positive pressure breathing.

Why do many patients still choose to use iron lungs for a long time when there are more advanced modern positive pressure ventilators? A patient who has used an iron lung for 68 years said: "I have tried various ventilators, but I still feel that breathing with an iron lung is the most useful and comfortable."

For patients who use iron lungs for a long time, their lives are even more difficult. Over time, even the smallest inconvenience will be magnified into pain and despair: "If you laugh and tears come out, they flow into your ears, which is annoying, but you can't do anything about it."

Fortunately, with the advancement and promotion of polio vaccine technology, this terrible disease has gradually disappeared from people's lives. However, for iron lung users, new difficulties have arisen. In 1970, iron lungs were discontinued. In order to ensure airtightness, the rubber ring on the patient's neck needs to be replaced every few months, but the manufacturer no longer provides these accessories. The remaining iron lung users are now looking at the last few sealing rings and feel extremely scared: "I am so desperate. This is the scariest thing in my life now-I can't find anyone who can make these collars."

Family members visit patients being treated in iron lungs | National Museum of Health and Medicine

Compared with staying alive, the quality of life of iron lung users seems insignificant, but some people still notice it. In 2012, the movie "Intimate Treatment" tells the story of an iron lung user who longs for sex. In addition to his physical defects, he feels incomplete and incomplete because he has never had sexual experience. How can patients enjoy sex and live with dignity? This is not only the dilemma of iron lung users, but also the problem faced by other people who have lost their mobility due to illness.

Finally, let's go back to the plot at the beginning of this article. The final ending of this terrible story is unexpected - you, lying in the iron lung, paid your partner's lover $50,000 to hire this killer to kill your partner. Your only request to the killer is: "Please make sure that my partner dies without pain."

References

[1]https://en.wikipedia.org/wiki/Polio

[2]https://en.wikipedia.org/wiki/Iron_lung

[3]https://www.advisory.com/daily-briefing/2017/11/28/iron-lung

[4]https://melnickmedicalmuseum.com/2010/01/27/hear-the-iron-lung-at-work/

[5]http://wangjieshu.com/2015/05/23/p7jxlb-3h/

[6]https://gizmodo.com/the-last-of-the-iron-lungs-1819079169

[7]https://archive.org/details/TheEvolutionOfIronLungsrespiratorsOfTheBody-encasingType/page/n5/mode/2up

[8]https://www.npr.org/2021/10/25/1047691984/decades-after-polio-martha-is-among-the-last-to-still-rely-on-an-iron-lung-to-br

https://www.smithsonianmag.com/smart-news/texas-man-lives-70-years-in-an-iron-lung-i-never-gave-up-180979008/

[9]https://en.wikipedia.org/wiki/The_Sessions_(film)