The Death of a Disease: A History of the Eradication of Poliomyelitis

5. Freed from the Iron Lung

40 The Death of a Disease 40 5 Freed from the Iron Lung Europe, 1952–1954 In 1952, a polio epidemic in Denmark gave rise to an invention that changed the lives of polio victims suffering from respiratory complications and revolutionized emergency room techniques throughout the world. Beginning in the mid-1930s, patients in danger of respiratory paralysis were placed in iron lungs, enormous metal boxes that enclosed the entire body up to the neck. Inside, the alternation between sub-atmospheric and atmospheric pressure caused the thoracic cage to move and kept the patient breathing. The machine was first developed by Dr. Philip Drinker and his team at the Harvard School of Public Health to provide assistance to premature babies and newborns in respiratory distress. It was improved and developed by the Warren Collins Corporation in the United States, which produced the machine commercially for polio victims . Officially known as the Drinker Respirator, it was soon Freed from the Iron Lung 41 referred to as the iron lung, a name that helped conjure up the terror that polio inspired in the public’s mind. During the 1952 polio epidemic, hospital physicians in Copenhagen could scarcely cope with the number of patients with respiratory paralysis. Only a few iron lungs were available , and these were insufficient in both number and efficacy to prevent death by asphyxiation. A Danish physician, Dr. Henry Lassen, and his colleague, Dr. Bjorn Ibsen, an anesthetist, suggested treating these patients by using a technique that had been employed with success in surgery. A rubber tube was inserted through the patient’s mouth to the trachea to allow air to enter the lungs. Someone at the patient’s bedside applied manual pressure to a balloon containing a mixture of air with oxygen so that the air entered and left the lungs according to a natural pattern of inhaling and exhaling. The main drawback with this technique was that patients required assistance for days and even weeks. The advantage was that the patient’s respiratory passageway could be cleared of secretions through the tube, thereby preventing asphyxiation. Medical staff worked day and night to help patients breathe. Students took turns pedaling bicycles whose chains worked the machines. Soon it became clear, however, that the tube to the lungs could not be left in the patient’s mouth for more than a few days. The doctors then suggested performing a tracheotomy, a surgical incision in the trachea through which is inserted a cuffed tube that is hooked up to a mechanical respirator. A tracheotomy establishes direct access to the bronchi, and the tube can be left in place for a long period of time. It is more comfortable for patients and prevents the airways from being clogged up with secretions. Doctors used penicillin, the first antibiotic, which had recently become available, 42 The Death of a Disease to prevent the risk of infection through the opening of the airways. Doctors and engineers combined their efforts to improve on these “home-made” devices and develop more sophisticated artificial respirators on an industrial scale. One of these new machines was the Engström Respirator, the “Rolls Royce of artificial respiration” according to Dr. Jean-Jacques Pocidalo, who helped introduce the respirator in France. “It was met with much-deserved success in Europe,” he said. In the mid-1950s, the French health authorities, aware of the ravages wrought by polio epidemics in the Scandinavian countries, braced themselves, expecting the worst. Dr. Pierre Lépine, a polio specialist at the Pasteur Institute, asked Dr. Pierre Mollaret, who held the chair of Infectious Diseases at the Claude Bernard Hospital in Paris, to take steps to prepare to care for the most seriously affected patients. Physicians in Paris knew about the Engström Respirators but no one had experience with using them for long periods of time. Pierre Mollaret, together with Jean-Jacques Pocidalo and others, spent the winter of 1953–1954 drawing up plans for a medical center equipped to care for a large number of polio victims suffering from respiratory paralysis . Ultramodern wards were equipped with brand-new Engström Respirators imported from Denmark and Sweden. An oxygen distribution unit was set up in the basement of the center. To regulate the ventilation provided by the respirators, biologists developed a way to rapidly dose the amounts of oxygen and carbon dioxide in the patients’ blood. The doctors prepared to perform tracheotomies. Nurses...