Monday, June 26, 2017

1950: Life for polio victims inside an iron lung

This is Richard Daggett in an iron lung. The photo was
added by Dagett at Poliotoday.org
There were various versions of the Emerson Lung, and the Drinker and Shaw Respirator, that were available in hospitals around the United States and Europe by the 1950s. Richard Daggett, in his 2010 book "Not just polio: my life," explains that the machines made a whooshing sound as air entered and exited the patient's lungs. He explained that he was placed in a Drinker Collins Iron Lung in the early 1950s, and he described waking up in the machine: (4, page 30, 31)
There was a mirror over my head and, in the mirror, I could see a row of large black bellows across the room.  They were going up and down.  I didn't know much about respirators, but I figured one of them must be making me breathe.  I tried to figure which one it was by timing my breathing with the motion of each bellows.  None of them seemed to match my breathing pattern. It wasn't until later in the day, when my mirror was adjusted upward, that I realized that those bellows were all attached to the underside of other respirators.  I couldn't see mine because it was beneath me.... I was in a Drinker Collins Iron Lung."  (4, page 29)
Daggett and his parents during his first trip home from the hospital
in December of 1953.  Photos added by Daggett at Poliotoday.org
Daggett said that as a child it was difficult to grasp the seriousness of having bulbospinal polio and, ultimately, pneumonia.  He wrote: "I was very naive. I had no understanding of how serious my condition was.  Oh, I knew I was completely paralyzed, but the long-term impact did not sink in.  My greatest concern was that I might miss the first day of school." (4, page 33)

It must have been common for these patients to develop pneumonia, as their would have been constant secretions forming in the upper air passages that needed to be cleared, or they would be inhaled, thus causing respiratory infections such as pneumonia.  Daggett mentions the constant urge to blow his nose, which he often did "without even using a tissue." (4, page 31, 33)

Daggett during a trip home in 1954.  He is wearing
metal hand sprints, and sitting in his first wheel chair.
Photo added by Daggett at Poliotoday.org.
The desire to clear secretions would be a constant concern for caregivers because due to paralyzed muscles they did not have the ability to swallow, and therefore these patients lost the ability to control their airway.  This would have posed a greater serious problem back when the Drinker Respiratory was first used on polio victims, as a patient may survive because of the respirator only to later drown in his own secretions a few days later.

To treat this problem the patient's bed had to be slid out from iron lung, and the patient had to be turned by one attendant, while another used rags to wipe away secretions.  This probably would have been necessary often for some patients, further compounding the workload of the staff and the stress of the patient.

However, this problem was remedied somewhat with the invention of a suction device in 1937. By the 1950s caregivers could simply apply suction to the nose and mouth and suck out secretions.  Many such patients had a tracheostomy in place for just this reason.  And this brings me back to Daggett.

Daggett describes being awake when the tracheostomy was inserted into his neck.  He was later put inside an iron lung, which proceeded to breathe or him.  He notes that it was by means of his tracheostomy that his caregivers, all of whom wore cloth gowns (some wore masks), would clear his air passages, probably with one of these original suction devices.  (4, page 30, 33)  Of the tracheostomy, he wrote:
Those of us with significant paralysis of our breathing muscles also had additional air forced into our lungs through a tracheostomy.  The tracheostomy can also be used to suction mucous from our lungs.  I'm sure the tracheostomy saved my life." (4, page 30)
While iron lungs gave medical professionals an opportunity to save lives, they were also viewed as a terrible way to spend the end of ones life, although, thankfully, they allowed many children, such as Daggett, an opportunity to live to tell about it.

Iron lungs were ultimately replaced by other more complicated machines, such as intermittent positive pressure breathing (IPPB) machines, the Monaghan Ventalung Respirator, and the Bird Mark 7 Respirator. All of these newer ventilators were among a new breed of respirators that applied positive pressure to the lungs, as opposed to negative pressure.

So the iron lung has a significant place in the history of respiratory therapy.  It was an idea created to save the lives of millions of children who would have otherwise met an early demise due to a disease called infantile poliomyelitis.  To all the children saved from a dreaded diseases they were simply a Godsend.

Daggett was ultimately transferred to Rancho Los Amigos Hospital (now Rancho Los Amigos National Rehabilitation Center) where he could be rehabilitated.  He went on to become an "active journalist" who lives in Southern California who has "written extensively on disability and the human condition."  (1, last page)

References:
  1. Daggett, Richard Lloyd, "Not just polio: my life story," 2010, Bloomington, IN, iUniverse

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