CPP Curiosities: The Iron Lung

Logo for CPP Curiosities

Greetings, patient historico-medico aficionados. After a brief hiatus, your monthly dose of the medically weird is back again. In keeping with our transition from CEPI to the Center for Education, CEPI Curiosities is also receiving a new moniker: CPP (as in College of Physicians of Philadelphia) Curiosities. Make no mistake, however, despite the new name we are sticking to our tried-and-true formula of medical history stories to surprise you or at the very least make you look at the world of medicine just a bit differently.

This time around we are tackling the strange and fascinating history of the negative pressure ventilator, more commonly known as the “iron lung.”

Emerson Iron Lung at the Mütter Museum

Emerson Iron Lung at the Mütter Museum

“Iron Lung” is a colloquial term for a variety of artificial respiration machines that encapsulate all or part of a patient’s body. They help a person breathe through a method called negative pressure ventilation where the air pressure surrounding the patient’s body is reduced, forcing their lungs to expand and take in air; the pressure around the patient is then increased, causing them to exhale. For a time, iron lungs were a common treatment during the twentieth century for conditions where a patient could not sufficiently breathe unassisted.

However, they are most commonly associated with one particular disease: polio. Also known as infantile paralysis or poliomyelitis, polio is caused by the poliovirus, a contagious virus most commonly spread through infected feces that comes into contact with a patient’s mouth. The majority of people exposed to the poliovirus exhibit no symptoms; according to the Centers for Disease Control and Prevention, one in four people infected with the poliovirus will have relatively mild symptoms, including sore throat, nausea, fatigue, headaches, and stomach pain, and these symptoms generally go away after a few days (this is known as “abortive polio”). However, a small percentage of people exposed to the poliovirus develop temporary or permanent neurological symptoms, ranging from light sensitivity and stiffness to muscle spasms to partial or total paralysis.

Image of a patient's legs with chronic anterior poliomyelitis, Source: Historical Medical Library of the College of Physicians of Philadelphia

Image of a patient’s legs with chronic anterior poliomyelitis, Source: Historical Medical Library of the College of Physicians of Philadelphia

According to our sister page, History of Vaccines, the earliest reported polio outbreak in the United States took place in 1894. The nation’s most severe outbreak occurred in the 1930s-1950s. The development of polio vaccines and public health initiatives to inoculate the public significantly reduced the number of polio cases. Thanks to vaccines, polio has been largely eradicated in the developed world (it was eliminated in the US in 1979). However, periodic outbreaks occur in areas with limited or inadequate medical resources. Between 2013 and 2015, a polio epidemic spread through Syria and into neighboring Iraq followed by a second outbreak in Syria in June 2017 as well as another in the Congo around the same time.

Conceptually, negative pressure ventilation dates back to the late 1700s, and the earliest negative pressure devices emerged in the mid 1800s. In 1864, Alfred F. Jones of Lexington, KY, filed the first patent for a negative pressure respirator. His device, which he dubbed a “Restorator,” required the patient to sit upright in a small chamber with only their head exposed, covered in a specialized hood to maintain an air seal. Air circulated through the chamber through a hand pump. However, it’s unclear if Jones ever developed a model for mass production. In 1876, a French physician named Eugene Woillez developed what is considered the first functional negative pressure ventilator. Woillez’s “Spirophone” allowed for a patient to lie flat on their back, encasing them up to their neck in a sealed enclosure. Air was pumped into the Spirophone through the use of hand-operated bellows.

Image of Alfred Jones' "Restorator" from his patent application US Patent No: US44198

Image of Alfred Jones’ “Restorator” from his patent application US Patent No: US44198

However, the negative pressure ventilator did not receive wide usage or exposure until the early 20th century. In 1928, a pair of Harvard University professors–Drs. Philip Drinker and Louis Agassiz Shaw–developed an automated negative pressure ventilator. Similar to the Spirophone, a patient lay flat on a movable table with all but their head and neck encased within the device. The Drinker respirator generated negative pressure via a motor that pumped a bellows (this silent film demonstrates it in action). They initially tested the device by conducting preliminary experiments on a cat before moving into to human testing on an eight-year-old girl with respiratory paralysis from polio. According to Drinker’s later accounts the girl’s breathing significantly improved after being encased in the Drinker respirator for a short period of time, and their “iron lung” quickly gained wide circulation as a treatment for polio-induced respiratory failure (Louis A. Shaw, “Cutaneous Respiration of the Cat,” American Journal of Physiology. 85 (1928): 158-167; Philip Drinker and Charles F. McKhann, III. The Use of a New Apparatus for the Prolonged Administration of Artificial Respiration: I. A Fatal Case of Poliomyelitis. JAMA. 92.20 (1929): 1658-166). In 1931, a Boston machinist named John Haven Emerson devised improvements for the Drinker and Shaw design; reportedly, Emerson approached Drinker with his ideas but found a tepid response, prompting him to design and sell it on his own. The Emerson Iron Lung proved lighter, more efficient, and significantly cheaper to produce than the Drinker model and became a staple in polio treatment wards across the country (Drinker also unsuccessfully attempted to sue Emerson for patent infringement). The College of Physicians has an Emerson Iron Lung among its vast collection; however, it is not currently on display.

During the polio outbreaks of the 1930s-1950s, if paralysis impeded a person’s ability to breathe (respiratory paralysis), they would be placed into an iron lung until such time as they could breathe on their own, usually after 1-2 weeks of treatment. However, in cases of extreme paralysis, patients may periodically be encased in one over the course of months or years. For those curious about what it is like to be in an iron lung, in 2010, the Journal of the Royal Society of Medicine published an account from Marshall Barr, a patient who regularly used an iron lung for fifteen years.

Robert Hicks, Mütter Museum Director Robert Hicks in an iron lung for an episode of the YouTube series Grey Matter

Robert Hicks, Mütter Museum Director Robert Hicks in an iron lung for an episode of the YouTube series Grey Matter

With the rise in positive pressure ventilation devices (the kind used in modern ventilators), negative pressure respirators like the iron lung generally fell out of favor. However, there are reportedly a small handful of patients who still utilize an iron lung to help them breathe.

Until next time, catch you on the strange side!

The Out4STEM and Teva Interns Become Crime Scene Investigators

Sheets of fingerprints collected at the Arcadia Crime Scene House are spread across a table.

During these next two months, students in our various youth programs are active in both the classroom, in the laboratory, and in the community. Recently, students from the Out4STEM Internship program journeyed to Arcadia University to visit the Arcadia Crime Scene House. Opened in 2015 as part of Arcadia’s Forensic Science Program, the Crime Scene House provides simulations of crime scenes for students to home their observation skills. Together, the interns examined a simulated crime scene and gathered evidence, such as fingerprints, blood spatter, and shoe prints.

Students from the Center for Education's youth programs gather evidence from a human dummy simulating a victim at the Arcadia Crime Scene House

Meanwhile, students in the Teva Pharmaceuticals Internship Program conducted their own crime scene investigation here at the College of Physicians. Under the guidance of Gladys “GG” Seibert, an expert in crime scene analysis, the interns examined a mock crime scene. Braving the summer heat, they meticulously gathered evidence. Endowed with their newfound investigatory experience, they will take part in other lessons in processing that information. Along the way, they will also investigate the societal impact of violent crime and mechanisms for addressing and coping with violence.

Students in the Teva Pharmaceuticals Internship Program investigate a mock crime scene at the loading dock behind the College of Physicians of Philadelphia

The Teva Interns Reach New Heights

Students in the Teva Pharmaceuticals Internship Program pose in the Liberty Place Observation Deck

While many students are taking the summer off, the students in the various youth programs of the Center for Education have been hard at work expanding their knowledge and learning how to make a difference in the world. Last week, we welcomed the latest cohort of the Teva Pharmaceuticals Internship Program. They will take part in four weeks of lessons, field trips, and hands-on activities that will expand their understanding of science, forensics, and social justice. As part of building a greater sense of community within the City of Philadelphia and among each other, the interns met with Michael Nairn, professor of Urban Studies at the University of Pennsylvania and a regular participant in our exploits here at the Center for Education. Last week, Professor Nairn gave each student a map and asked them to color in sections of the city in which they felt safe in one color and those where they did not feel safe in another. Together they compared their results and offered their thoughts on the layout of the city.

On Monday, they continued their discussion outside the classroom and traveled to the Liberty Place Observation Deck. From the 57th floor, our Teva interns got a glimpse of Philadelphia from one of the tallest buildings in the city. Thanks to the breathtaking view and a brief lecture from Professor Nairn, the students had the opportunity to view the city from a different perspective, both literally and theoretically. They marveled at the beauty and majesty of Philadelphia’s architecture and landscape, including observing the city’s grid-based layout and unique neighborhoods. They each tried to pinpoint notable landmarks as well as their own neighborhoods, with varying levels of accuracy.

Students in the Teva Pharmaceuticals Internship Program hear a lecture from Penn Urban Studies professor Michael Nairn at the Liberty Place Observation Deck

It was a view of the city they had never witnessed before and certainly one they won’t soon forget.

…In with the New

Logo for the Center for Education of the College of Physicians of Philadelphia

With the end of the school year comes a time for self-reflection and re-invention. In the spirit of renewal, we are happy to announce some dramatic new changes to our department and our online presence. We now have a new name: say goodbye to the Center for Education and Public Initiatives (CEPI) and hello to the Center for Education (CFE).

You may also notice we have changed the name of our weblog from CEPI@CPP to Mütter EDU. This is to reinforce our close connection with the Mütter Museum. This close connection is reflected in our new social media handles. You can now follow us on Instagram or Twitter under the handle @mutterEDU. Keep a careful eye on this space for other new changes and surprises.