The Off-Key Bard
History

This Day in History — The Iron Lung Gives Patients a Fighting Chance

On this day in 1928

In October 1928, Boston doctors tried the Drinker-Shaw iron lung on a girl with polio, the first clinical test of a machine that breathed for paralyzed lungs.

The Off-Key Bard enters a hospital ward in Boston in 1928. The children here are fighting a disease that can turn an ordinary fever into paralysis within days. Some can no longer move their arms or legs. Others face something even more terrifying: their lungs still work, but the muscles needed to breathe have stopped responding. Medicine has few answers. Then two researchers arrive with an enormous metal machine.

"What if a person's lungs could keep breathing, even when their muscles could no longer make them?"

In October 1928, an eight-year-old girl named Bertha Richard became the first patient treated with a revolutionary mechanical respirator developed by Philip Drinker and Louis Agassiz Shaw Jr. at the Harvard School of Public Health. October 12 is the date widely commemorated as the first clinical use of what became known as the iron lung, although the most detailed account of Bertha's treatment places her first session in the machine on the afternoon of October 13. For patients whose breathing muscles had been paralyzed, the device offered something physicians had struggled to provide: a way to keep air moving in and out of the lungs long enough for the body to recover.

A Disease That Stole the Breath

To understand why the iron lung mattered, it helps to remember just how frightening polio was in the early 20th century. Poliomyelitis is an infectious disease caused by the poliovirus, which can attack the nervous system. Most infections produce few or no noticeable symptoms, but in a small percentage of patients the virus damages the motor neurons that control muscles. Some patients were left with weakness or permanent paralysis in their limbs. Others suffered paralysis of the chest muscles, including the diaphragm, which does most of the work of breathing.

In those cases the lungs were not necessarily damaged. The body had simply lost the ability to operate them, and without mechanical help, severe respiratory paralysis was frequently fatal. Polio epidemics struck communities across the United States and beyond, and the disease was especially feared because children were among those most visibly affected. Hospitals could offer supportive care, but they had few options for a patient who could no longer breathe independently.

Breathing by Pressure

Philip Drinker approached the problem as an engineer. A professor of industrial hygiene at Harvard, he had originally been focused on resuscitating workers overcome by gas or electric shock rather than treating polio. Working with physiologist Louis Agassiz Shaw Jr., he investigated whether changes in the air pressure around the body could do the work of failing respiratory muscles.

The idea rested on a basic principle of physiology. Normally the diaphragm contracts and moves downward, expanding the chest and lowering the pressure inside the lungs relative to the air outside, so that air flows in. When the diaphragm relaxes, the chest recoils and air flows back out. Drinker and Shaw realized they could imitate that cycle without the patient's muscles at all.

Their solution was a large, airtight chamber. The patient lay inside with the body enclosed and the head extending through an opening at one end, where a flexible collar sealed around the neck. A pump alternately lowered and restored the air pressure inside the chamber. When the pressure dropped below that of the room, the patient's chest expanded and air flowed into the lungs; when it returned toward normal, the chest recoiled and air flowed out. The machine was not forcing air down the throat, as most modern ventilators do. It was changing the pressure around the body, a method known as negative-pressure ventilation.

The early apparatus was anything but elegant. The cylinder was a galvanized metal box roughly three feet by seven feet, weighing around 700 pounds, and its pump was built from the motors of secondhand household vacuum cleaners. It was noisy, cumbersome, and unlike anything most hospital patients had ever seen. But it could breathe for someone whose muscles could not.

Bertha Richard

By October 1928, Drinker and Shaw believed their respirator was ready for a clinical trial. The opportunity came when Bertha Richard, a child from Waltham, Massachusetts, was brought to Children's Hospital in Boston with respiratory paralysis from polio. Her pediatrician, Charles McKhann, called Drinker and Shaw, who brought their machine to the hospital.

The first session did not go smoothly. Bertha was placed in the machine and then removed, and her condition worsened. When she was put back in with the pressure set higher, she improved dramatically within about fifteen minutes. She regained color, was able to speak, and asked for ice cream. For the people watching, it was an extraordinary moment: a machine had taken over one of the body's most essential functions.

But Bertha's story did not have a happy ending. She spent about 122 hours in the respirator, and pneumonia overwhelmed her. She died on the evening of October 19, 1928, at the age of eight. That outcome is important to acknowledge. The iron lung's first clinical use demonstrated a major technological capability, but it did not save its first patient. Nevertheless, it showed physicians that respiratory paralysis did not have to mean immediate death, and that with refinement the technology might give patients the time they needed.

Wards of Steel Cylinders

That is exactly what happened. Drinker and Shaw's design attracted considerable medical interest, and improved versions soon entered hospitals. One of the most important contributors was John Haven Emerson, an American inventor who introduced a modified iron lung in 1931. His version was less expensive and easier to use, with a bed that slid in and out of the cylinder and portholes that let attendants reach the patient, and it helped bring negative-pressure ventilation to far more hospitals. Emerson later prevailed in a patent dispute with Drinker and Harvard, which ended with Drinker's patents declared invalid.

As outbreaks increased, the iron lung became one of the most recognizable symbols of the struggle against polio. Photographs from the era show hospital wards lined with rows of large metal cylinders, each holding a patient who depended on a machine to breathe. The sight could be unsettling, but those chambers also represented hope. Many patients needed help only temporarily; as the infection subsided and muscle function returned, some recovered enough to breathe on their own and leave the machine. Others were not so fortunate, and for those whose paralysis proved permanent, assisted breathing could become a lifelong necessity.

Living with an iron lung demanded extensive adaptation. Sleeping, eating, communicating, and receiving medical care all had to be organized around the equipment, and mechanical failures or power outages could become emergencies. Some survivors nonetheless built remarkable lives. Paul Alexander, who contracted polio at the age of six in 1952, spent most of the next seven decades in an iron lung. He went on to finish college, earn a law degree, and practice as a courtroom attorney for about thirty years. He died in March 2024 at the age of 78.

From Iron Lungs to Intensive Care

The iron lung also helped transform respiratory medicine. During the 1952 polio epidemic in Copenhagen, Danish anesthesiologist Bjørn Ibsen helped show that patients could be kept alive by positive-pressure ventilation delivered through a tracheostomy, at first by medical students squeezing bags by hand around the clock. His insistence on organized, round-the-clock respiratory care led Copenhagen Municipal Hospital to set up what amounted to an early intensive care unit, a forerunner of the modern ICU. Today's ventilators work very differently from the iron lung, monitoring pressure, airflow, and oxygen delivery with a precision Drinker and Shaw could scarcely have imagined, but they address the same fundamental need: maintaining breathing when a patient cannot do it alone.

Yet the biggest change in the story of polio came not from treating respiratory paralysis but from preventing the disease. On April 12, 1955, Dr. Thomas Francis Jr. announced that the field trial of Jonas Salk's inactivated polio vaccine had found it safe, effective, and potent. Mass vaccination campaigns dramatically reduced polio cases in the United States and elsewhere, and later oral vaccines extended immunization worldwide. As fewer people were infected, fewer needed respiratory support, and the iron lung gradually disappeared from routine medical practice.

Its legacy did not. The iron lung showed that engineering could temporarily replace a failing physiological function and carry a patient through an otherwise fatal crisis. And it gave physicians something enormously valuable: time. Time for injured nerves and muscles to recover. Time for the body to fight an infection. Time for medical science to develop better treatments.

"A chamber of steel, a measured breath,
A fragile defense against certain death.
When muscles failed, the machine stood by —
And gave the sick more time to try."

The iron lung is remembered partly because of how it looked: an enormous metal cylinder surrounding nearly the whole body of a patient. But its importance was never really about the size of the machine. It was about the idea that engineering could support one of life's most essential functions. For the children and adults who depended on it, the iron lung was not simply an impressive invention. It could mean the difference between surviving an illness and dying from an inability to breathe.

In October 1928, eight-year-old Bertha Richard became the first patient to be treated in Drinker and Shaw's iron lung. She did not survive her illness, but her treatment helped demonstrate a possibility that would ultimately benefit thousands of others. What began as an experimental machine became a life-preserving technology, and it showed that even when the body could no longer draw its own breath, science might provide another way.

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