Wednesday, June 14, 2017

1929: The Drinker Respirator

A clipping from a newspaper article, probably sometime around 1928.
Photo form the University of Virginia Historical Collections. Photo
originally published in "The use of a new aparatus for the prolonged
administration of artificial respiration" by Phillip Drinker and Charles
F. McKhann. (1, Iron Lung)
The first effective ventilator that gave breaths without an operator was the Drinker Respirator by engineer Phillip Drinker (1894-1972).  The product was  introduced to the world in a 1929 article by Dr. Phillip Drinker and Dr. Charles F. McKhann. (1, Iron Lung)(4)

The report highlighted the fact that manual resuscitators (such as the lungmotor or pulmotor) forced too much air into the lungs too fast, and could only be used for so long due to worker fatigue. Plus, they wrote that "respiratory excursion obtainable by manual efforts is most disappointing. In our experience, it is almost impossible to produce and maintain adequate oxygen interchange by manual methods of artificial respiration alone, in cases requiring long term administration." (4, page 1658)

Their solution was the Drinker Respirator.  It was the first mass producible negative pressure ventilator, otherwise known as the iron lung, mechanical respirator, or tank respirator.

Image of the Drinker Iron Lung.  You can see the marine like port
holes on the sides of the tank that could be used to see the patient.
Small holes could be accessed for basic toughing. (5, page 232)
This respirator is often referred to as the Drinker and Shaw respirator because Phillip Drinker worked with his brother Cecil and Dr. Louis Shaw to create and test the device. The Consolidated Gas Company of New York came up with the idea and recruited Harvard Professor Cecil Drinker. He in turn recommended his brother, who was a chemical engineer. Dr. Shaw was a colleague of Phillip. (1, Iron Lung)

The final product was first introduced to physicians at Harvard in 1928. Actually, the original name for this respirator was the Drinker Tankrespirator, but the name iron lung is the name that ultimately stuck. No one knows for sure who came up with the term "iron lung." One article cited an "anonymous journalist."

While it was useful for many types of patients (morphine overdose, carbon monoxide poisoning, electric shock, near drowning, etc) it was originally made for those affected by coal gas poisoning.  (7, page 93) Yet it is is most remembered as being associated with the polio epidemics, used to breathe for the many children most severely stricken with the disease infantile poliomyelitis.

The machine consisted of a metal tank that completely enclosed the patient's body except for the head.  The patient would lie on his back on a bed.  The bed would then be slid into the tube or tank.  The neck would be sealed around rubber collars to provide a seal to prevent air from entering or escaping the tank.

Inside the tank was completely air tight.  Pumps, which were originally two vacuum cleaners with bellows, and a manometer used to operate the device, sat on a table next to the tank, and they were operated by electricity and a large bedside oxygen tank.  The rate could be set by adjusting dials on the gearbox.  While there was no means of measuring tidal volume, breaths could be provided at a constant depth and rate. There are reports that the machine was quite noisy, so one must imagine this only compounded the stress of patient.

A patient could live inside one of these tanks for days or weeks without harm.  The patient, since his head was outside the tank, could "adapt themselves quickly to their new method of breathing and learn to eat, drink and sleep without having the attendant stop the machine." (6, page 95)

To examine, treat, and bathe the patient the bed would have to be slid out of the tube.  If necessary, manual methods of ventilation could be used while these procedures were being performed.  (5, page 232)

Image of the Drinker Respirator.  You can see that the pumps
and manometer were on a separate table to the left.  To access the
patient, the bed was slid out as shown. While outside the tank
the patient could be kept alive with manual methods of respiraiton
if necessary. As you can see, maintaining the tanks and
caring for the patient was a cumbersome task.   (5, page 231)
For less invasive procedures, such as taking temperatures, blood pressures, auscultation, checking IV lines, and basic touching of the patient, there were "small holes (pipe taps) on the sides of the tank.  For the basic observation of the patient there were "marine like port holes' also on the sides of the tank.  (5, page 234)

Here you can see the rubber collar that secures
tightly around the patients neck so that the
head could rest outside the tank on the
adjustable support.  (5, page 233)
Over time the iron lung was improved in order to make the machines more accessible to patient care, and to make the machines easier to operate and move from one room to another.  For example, by the 1950s the pumps and bellows would set under the tank to make the unit more compact, and wheels were added to the legs.  Of course another reason this was probably done was to keep up with the competition.  

The Drinker Respirator was ideal because it allowed physicians an opportunity to keep their patients alive long enough to treat them, thus allowing their bodies a chance to recover.  While the machines were ideal for victims of all ages, they were most remembered as being used for the many children stricken with the most severe forms of infantile poliomyelitis, which causes respiratory paralysis. Without the ventilator these kids would often succumb to fatigue, respiratory failure, and ultimately death.

While the devices may have been cumbersome, uncomfortable and noisy:
"The response of these patients to the respirator was very gratifying," according to a 1931 article in the Western Journal of Medicine.  "Usually before their condition became alarming they were told that if they became too fatigued they could have the help of the respirator, and in several instances patients asked to be placed in the machines for a trial.  A few of the children were very apprehensive and had to be given opiates over a short period when first placed on the respirator.  None of these patients had any difficulty in adapting themselves to the rhythm of the machine."  (2, page 5)
Many children with poliomyelitis recovered after a week or two in the iron lung, and went on to live normal lives. .  

The Technical Exposition:  Opportunity to try the Dinker Respirator:  Warren E. Collins Inc. will exhibit the Dinker Respirator, for prolonged administration of artificial respiration in cases of infantile and diptheretic paralysis, gas and drug poisoning, electric shock, alcoholic, coma, etc.  Doctors are invited to make a personal trial of the Respirator to see how it feels. New improvements on the Roth-Barach oxygen tent and the Benedict-Roth Metabolism Apparatus will also be of interest, and demonstrations will be gladly given without obligation.  See these in Booth 110, near the main entrance.  (3, page 1617)

References:
  1. "Iron Lung: 1929 Dinker Respirator," University of Virginia Historical Collections at the Claude Moore Health Sciences Library,"  http://historical.hsl.virginia.edu/ironlung/pg4.cfm, accessed February 26, 2012
  2. Shaw, E.B.,  H. E. Thelander, and M. A. Limper, "Respiratory Failure in PolioMyelitus -- it's treatment and the Dinker Respirator," Western Journal of Medicine, 1931 July; 35(1), pages 5–7
  3. "The technical exposition," Journal of the American Medical Association,  1931, vol. 96, no. 19, page 1617, http://jama.ama-assn.org/content/96/19/1615.full.pdf
  4. Drinker, Charles, Charles F. McKhann, "The Use of a New Apparatus for the Prolonged Administration of Artificial Respiration: A Fatal Case of Poliomyelitis," Journal of the American Medical Association,  May 18, 1929, reprinted in same publication on March 21, 1986, volume 255, no. 11, pages 1473-1475; 
  5. Drinker, Phillip, Louis Shaw, "An apparatus for the prolonged administration of artificial respiration,"  Journal of Clinical Investigation, June 29, 1929, 7 (2), pages 229-247
  6. "Philip Drinker '15 given medal of invention," The Princeton Alumni Weekly, October 23, 1931, volume 32, page 95
  7. "Obituaries: Phillip Drinker 1894-1972," Anal of Occupational Hygiene, 1973, 16 (1), pages 93-94
  8. truy this one or this one or htis one. or htis one 'list of landmark articles,            check out this presentation

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