10 August 2009

Iron lung

The invention: Amechanical respirator that saved the lives of victims of poliomyelitis. The people behind the invention: Philip Drinker (1894-1972), an engineer who made many contributions to medicine Louis Shaw (1886-1940), a respiratory physiologist who assisted Drinker Charles F. McKhann III (1898-1988), a pediatrician and founding member of the American Board of Pediatrics A Terrifying Disease Poliomyelitis (polio, or infantile paralysis) is an infectious viral disease that damages the central nervous system, causing paralysis in many cases. Its effect results from the destruction of neurons (nerve cells) in the spinal cord. In many cases, the disease produces crippled limbs and the wasting away of muscles. In others, polio results in the fatal paralysis of the respiratory muscles. It is fortunate that use of the Salk and Sabin vaccines beginning in the 1950’s has virtually eradicated the disease. In the 1920’s, poliomyelitis was a terrifying disease. Paralysis of the respiratory muscles caused rapid death by suffocation, often within only a few hours after the first signs of respiratory distress had appeared. In 1929, Philip Drinker and Louis Shaw, both of Harvard University, reported the development of a mechanical respirator that would keep those afflicted with the disease alive for indefinite periods of time. This device, soon nicknamed the “iron lung,” helped thousands of people who suffered from respiratory paralysis as a result of poliomyelitis or other diseases. Development of the iron lung arose after Drinker, then an assistant professor in Harvard’s Department of Industrial Hygiene, was appointed to a Rockefeller Institute commission formed to improve methods for resuscitating victims of electric shock. The best-known use of the iron lung—treatment of poliomyelitis—was a result of numerous epidemics of the disease that occurred from 1898 until the 1920’s, each leaving thousands of Americans paralyzed. The concept of the iron lung reportedly arose from Drinker’s observation of physiological experiments carried out by Shaw and Drinker’s brother, Cecil. The experiments involved the placement of a cat inside an airtight box—a body plethysmograph—with the cat’s head protruding from an airtight collar. Shaw and Cecil Drinker then measured the volume changes in the plethysmograph to identify normal breathing patterns. Philip Drinker then placed cats paralyzed by curare inside plethysmographies and showed that they could be kept breathing artificially by use of air from a hypodermic syringe connected to the device. Next, they proceeded to build a human-sized plethysmographlike machine, with a five-hundred-dollar grant from the New York Consolidated Gas Company. This was done by a tinsmith and the Harvard Medical School machine shop. Breath for Paralyzed Lungs The first machine was tested on Drinker and Shaw, and after several modifications were made, a workable iron lung was made available for clinical use. This machine consisted of a metal cylinder large enough to hold a human being. One end of the cylinder, which contained a rubber collar, slid out on casters along with a stretcher on which the patient was placed. Once the patient was in position and the collar was fitted around the patient’s neck, the stretcher was pushed back into the cylinder and the iron lung was made airtight. The iron lung then “breathed” for the patient by using an electric blower to remove and replace air alternatively inside the machine. In the human chest, inhalation occurs when the diaphragm contracts and powerful muscles (which are paralyzed in poliomyelitis sufferers) expand the rib cage. This lowers the air pressure in the lungs and allows inhalation to occur. In exhalation, the diaphragm and chest muscles relax, and air is expelled as the chest cavity returns to its normal size. In cases of respiratory paralysis treated with an iron lung, the air coming into or leaving the iron lung alternately compressed the patient’s chest, producing artificial exhalation, and the allowed it to expand to so that the chest could fill with air. In this way, iron lungs “breathed” for the patients using them.Careful examination of each patient was required to allow technicians to adjust the rate of operation of the machine. Acooling system and ports for drainage lines, intravenous lines, and the other apparatus needed to maintain a wide variety of patients were included in the machine. The first person treated in an iron lung was an eight-year-old girl afflicted with respiratory paralysis resulting from poliomyelitis. The iron lung kept her alive for five days. Unfortunately, she died from heart failure as a result of pneumonia. The next iron lung patient, a Harvard University student, was confined to the machine for several weeks and later recovered enough to resume a normal life.

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