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How iron lungs work: Life-saving contraption devised in the 1920s saved the lives of thousands of polio victims - and had to be repaired by mechanics

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For more than 70 years, Paul Alexander — who died aged 78 this week — was kept alive with the help of 'iron lungs'.

The spooky contraption, created in the 1920s, allowed him to breathe after he was completely paralysed as a child by polio.

It saw him lay flat on his back, with his head resting on a pillow and body encased in the metal cylinder from the neck down.

Polio, known medically as poliomyelitis, does not directly damage the lungs.

Instead, the virus attacks motor neurons in the spinal cord. As such, it can weaken or sever communication between the central nervous system and the muscles.

For more than 70 years, Paul Alexander ¿ who died aged 78 this week ¿ was kept alive with the help of 'iron lungs'. The spooky contraption, created in the 1920s, allowed him to breathe after he was completely paralysed as a child by polio. It saw him lay flat on his back, with his head resting on a pillow and body encased in the metal cylinder from the neck down

For more than 70 years, Paul Alexander — who died aged 78 this week — was kept alive with the help of 'iron lungs'. The spooky contraption, created in the 1920s, allowed him to breathe after he was completely paralysed as a child by polio. It saw him lay flat on his back, with his head resting on a pillow and body encased in the metal cylinder from the neck down

The lung, which Mr Alexander called his 'old iron horse', saw air sucked out of the cylinder by a set of leather bellows powered by a motor. The negative pressure created by the vacuum forced his lungs to expand. When the air was pumped back in, the change in pressure gently deflated his lungs. It was this rhythmic hiss and sigh sound that kept Mr Anderson alive. In spite of physical constraints, he became an avid painter, traveller and author

The lung, which Mr Alexander called his 'old iron horse', saw air sucked out of the cylinder by a set of leather bellows powered by a motor. The negative pressure created by the vacuum forced his lungs to expand. When the air was pumped back in, the change in pressure gently deflated his lungs. It was this rhythmic hiss and sigh sound that kept Mr Anderson alive. In spite of physical constraints, he became an avid painter, traveller and author

The ensuing paralysis means that the muscles that make it possible to breathe no longer work.

What his diaphragm could no longer do for Mr Alexander, the iron lung did.

First used at Boston Children's Hospital to save the life of an eight-year-old girl in 1928, the iron lung was made by a team at Harvard University to counteract paralysis of the chest muscles.

It soon became a feature of the polio wards of the mid-1900s, with around 1,000 iron lungs in use in the US and 700 in the UK.

The lung, which Mr Alexander called his 'old iron horse', saw air sucked out of the cylinder by a set of leather bellows powered by a motor.

The negative pressure created by the vacuum forced his lungs to expand.

When the air was pumped back in, the change in pressure gently deflated his lungs. It was this rhythmic hiss and sigh sound that kept Mr Anderson alive.

While iron lungs were built to last, they were initially intended to be used for two weeks, to give the body a chance to recover.

In an interview with The Guardian in 2020, Mr Alexander revealed that, after three years in the lung, he could leave it for a few hours at a time after learning 'glossopharyngeal breathing'.

First used at Boston Children's Hospital to save the life of an eight-year-old girl in 1928, the iron lung was made by a team at Harvard University to counteract paralysis of the chest muscles. It soon became a feature of the polio wards of the mid-1900s, with around 1,000 iron lungs in use in the US and 700 in the UK

First used at Boston Children's Hospital to save the life of an eight-year-old girl in 1928, the iron lung was made by a team at Harvard University to counteract paralysis of the chest muscles. It soon became a feature of the polio wards of the mid-1900s, with around 1,000 iron lungs in use in the US and 700 in the UK 

In an interview with The Guardian in 2020, Mr Alexander revealed that, after three years in the lung, he could leave it for a few hours at a time after learning 'glossopharyngeal breathing'. The technique, which he nicknamed 'frog-breathing', involves taking bigger breaths than you would normally. The gulping action mirrors a frog gulping. He claimed the action quickly became muscle memory and allowed him to leave the lung for short periods, instead sitting in a wheelchair

In an interview with The Guardian in 2020, Mr Alexander revealed that, after three years in the lung, he could leave it for a few hours at a time after learning 'glossopharyngeal breathing'. The technique, which he nicknamed 'frog-breathing', involves taking bigger breaths than you would normally. The gulping action mirrors a frog gulping. He claimed the action quickly became muscle memory and allowed him to leave the lung for short periods, instead sitting in a wheelchair

The yellow iron lung, with its black rubber wheels, could be raised to different heights to suit Mr Alexander's caregiver. Pictured, Paul Alexander with his brother Philip. In a heartbreaking Facebook tribute, Philip called his sibling 'loving' and 'also a pain in the as**'

The yellow iron lung, with its black rubber wheels, could be raised to different heights to suit Mr Alexander's caregiver. Pictured, Paul Alexander with his brother Philip. In a heartbreaking Facebook tribute, Philip called his sibling 'loving' and 'also a pain in the as**'

The technique, which he nicknamed 'frog-breathing', involves taking bigger breaths than you would normally.

The gulping action mirrors a frog gulping. He claimed the action quickly became muscle memory and allowed him to leave the lung for short periods, instead sitting in a wheelchair.

But by the end of his life he wasn't able to venture outside the lung for more than five minutes.

The yellow iron lung, with its black rubber wheels, could be raised to different heights to suit Mr Alexander's caregiver.

Windows at the top allowed them to see inside, while four portholes on the sides let them reach in.

A mirror attached above the machine also allowed Mr Alexander to see what was happening around him.

To open the machine, which weighed almost 660lbs (300kg), carers must release the seals at the head and slide the user out on the interior bed. 

In a video posted to TikTok last month with his carer Patricia he also revealed she helps him use the toilet. 

'I have to unlock the iron lung that he uses and he uses a urinal and a bed pan when needed,' she told the video, seen more than 5.7million times.

At 78, Mr Alexander lived long after the invention of the polio vaccine in the 1950s all but eradicated the disease in the Western world. Pictured, Paul Alexander and Kathy Gaines, his carer of 30 years, who he met from a newspaper advert

At 78, Mr Alexander lived long after the invention of the polio vaccine in the 1950s all but eradicated the disease in the Western world. Pictured, Paul Alexander and Kathy Gaines, his carer of 30 years, who he met from a newspaper advert

She added: 'Just like he would be if he was in the hospital but he is at his home, where he belongs.'

The last person to use an iron lung in the UK died in December 2017, at the age of 75.

At 78, Mr Alexander lived long after the invention of the polio vaccine in the 1950s all but eradicated the disease in the Western world.

He outlived both of his parents, his brother and even his original iron lung, which began leaking air in 2015.

It was repaired by mechanic Brady Richards after a YouTube video of Mr Alexander pleading for help was uploaded.

Advances in medicine made iron lungs obsolete by the 1960s, replaced by modern-age ventilators.

But Mr Alexander kept living in the cylinder because, he said, he was used to it.

WHAT IS POLIO? 

Polio is a serious viral infection that used to be common all over the world.

The virus lives in the throat and intestines for up to six weeks, with patients most infectious from seven to 10 days before and after the onset of symptoms. 

But it can spread to the spinal cord causing muscle weakness and paralysis. 

The virus is more common in infants and young children and occurs under conditions of poor hygiene.

How deadly is it? 

Most people show no signs of infection at all but about one in 20 people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting. 

Around one in 50 patients develop severe muscle pain and stiffness in the neck and back. 

Less than one per cent of polio cases result in paralysis and one in 10 of those result in death.

Of those who develop symptoms, these tend to appear three-to-21 days after infection and include:

  • High temperature
  • Sore throat
  • Headache
  • Abdominal pain
  • Aching muscles
  • Nausea and vomiting

How does it spread?

People can catch polio via droplets in the air when someone coughs or sneezes, or if they come into contacted with the faeces of an infected person.

This includes food, water, clothing or toys.

Are there different strains?

There are three strains of 'wild' polio, which has been largely eradicated throughout Europe, the Americas, Southeast Asia and the Western Pacific.

Types 2 and 3 were eliminated thanks to a global mass vaccine campaign, with the last cases detected in 1999 and 2012 respectively.

The remaining, type 1, wild polio remains endemic in only two countries, Afghanistan and Pakistan.

Wild polio has been eliminated in almost every country in the world thanks to vaccines.

But the global rollout has spawned new types of strains known as vaccine-derived polioviruses.

These are strains that were initially used in live vaccines but spilled out into the community and evolved to behave more like the wild version. 

Is polio still around in the UK?

The last polio outbreak was in the 1970s.

The last case of person-to-person transmission in the UK was in 1984, which also marked the last wild polio case.

But there have been several dozen cases of vaccine-derived polioviruses, although they have been one-offs, with no onward transmission.

Am I vaccinated against polio?

The polio vaccine is offered as part of the NHS routine childhood vaccination programme.

It is given at age eight, 12 and 16 weeks as part of the six-in-one vaccine and then again at three years as part of a pre-school booster. The final course is given at age 14.

Uptake has fallen slightly nationally during the Covid pandemic but remains above 90 per cent nationally. 

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