Lessons from the Iron Lung

Lingering Fear

I was born in 1957, two years after widespread use of the polio vaccine. American parents had only recently stopped asking, “Do you want to end up in an iron lung?” when children begged to go outside in the summer.

Like the echo of a bell that had just ceased ringing, there was lasting anxiety. Adults were afraid to trust that the horror of polio was over. Perhaps this is why I find the last man in an iron lung so thoroughly fascinating.

A Waking Nightmare

Maybe you’ve seen photos of children encased in large metal tubes and thought the disease that required them was ancient history. Perhaps you believed polio was in our collective rearview mirror. Possibly you see no similarities between polio and Covid-19. Paul Alexander’s story is here to shed some light.

Paul was 6 years old the summer of 1952 and clearly recalls the hot Texas summer when swimming pools and bowling alleys were closed. The fear of American parents was palpable and Paul’s mother knew the horrible truth the moment he walked through the screen door complaining of headache and neck pain.

The Alexanders immediately realized the demon, polio, had come to their family. Doctors advised home treatment because the hospitals were too full. Besides, maybe Paul’s would be one of the milder cases.

Over the following week, he would lose motor function and eventually need a tracheotomy to breathe. When he woke, Paul’s body was enclosed in a machine that forced air in and out of his lungs. A vinyl sheet surrounded his head and the first-grader thought he was dead.

When the tent was removed he saw dozens of other children in metal canisters like his own with only their heads visible. For the next 18 months Paul couldn’t talk but he could hear the wails of others. Sometimes he and another child would make eye contact and silly faces at one another. “But,” Paul said, “every time I’d make a friend, they’d die.”

Paul survived but the infection left him paralyzed from the neck down. When he was removed from the iron lung to be cleaned, he had to hold his breath.

Robber of Childhood

Poliomyelitis kills by suffocating its victims when it weakens the central nervous system. The disease became an epidemic in the 20th century due, ironically, to sanitation improvements. No longer were babies exposed to the virus while still protected by maternal antibodies. Instead, children contracted polio after the immunity protection was gone.

Every summer since 1916 brought a polio epidemic to part of the United States. In 1952, the year Paul became infected, there were 58,000 cases nationally and 21,000 individuals, mostly children, were left disabled. More than 3,000 Americans died that year of polio.

The Skill that Changed Everything

The turning point for Paul came from a physical therapist who worked with the March of Dimes. Mrs. Sullivan taught Paul a technique for bringing air into his lungs by using his mouth to “swallow” air. Paul called it “frog-breathing” and it changed everything.

Sullivan told Paul that if he could master frog-breathing for three minutes, she would get him a puppy. It took a year and his new companion, Ginger, was the reward. This experience became the title of Paul’s recently self-published book, “Three Minutes for a Dog: My Life in an Iron Lung”.

Paul still slept in the iron lung but he made the most of his days. At 21, Paul graduated high school without ever attending a class. He attended Southern Methodist University then University of Texas, where he earned his law degree. A lawyer in the Dallas area for decades, Paul represented clients from a modified wheelchair.

A much fuller life than one might expect from such a beginning unfolded. Paul has been on airplanes, fallen in love, and staged sit-ins for disability rights. He has outlived his parents and even his original “old iron horse” as he calls the machine that keeps him alive. Friends have helped Paul find parts to refurbish the machine.

Today, at 74, Paul is again confined to the iron lung but still has plans for the future. He hopes that his recent memoir might foster better understanding of the risks of viruses.

Two Epidemics in One Lifetime

As with Covid, there was plenty of misinformation connected to polio. During the 1916 polio outbreak, 80,000 dogs and cats were killed because of a false rumor that they spread the disease. DDT, a dangerous insecticide, was sprayed on the streets in neighborhoods even after scientists knew polio was not carried by mosquitoes. People refused to handle money or talk on the phone for fear of transmission.

Another similarity to today’s pandemic is the unpredictability of who will experience mild symptoms and who will be left with lifelong repercussions. Polio and Covid can both be transmitted by asymptomatic carriers, leading to increased fear of contact with others.

“It’s exactly the way it was,” Paul says of the current pandemic, “It scares me.”

We Were Almost There

While we deal with Covid, it’s easy to ignore the fact that polio is still with us. In 1988, the goal of the Global Polio Eradication Initiative was to have polio wiped out by 2000. Sadly, that dream did not come true but there is reason to hope.

India is a polio success story. Despite poor sanitation and dense population, the last recorded Indian polio case was in 2011. With its well-trained staff, open communication and strong political backing, India serves as a role model for polio eradication.

Just last year, Nigeria became the last African country declared free from wild polio. This is an impressive accomplishment, considering that a decade ago Nigeria accounted for half of the polio cases in the world.

Afghanistan and Pakistan have been less fortunate. From eight Pakistani cases in 2018 to nearly 100 last year, world health officials worry about a potentially wide resurgence.

The Taliban has forbidden door-to-door vaccinations due to concerns about health workers acting as spies. This fear is not totally unfounded — a fake vaccination campaign was used in the attempt to locate Osama Bin Laden in 2011. Rumors that health workers are bringing drugs to sterilize Muslims have also contributed to the polio eradication setback in this part of the world.

Where From Here?

The World Health Organization, the United Nations Children’s Fund, the Rotary Foundation, U.S. Centers for Disease Control and Prevention and the Gates Foundation are working with the Global Polio Eradication Initiative. The goal is to completely eradicate poliomyelitis from the world by 2023. If successful, polio would be only the second human disease to be eradicated. The first, smallpox, was wiped from the globe in 1980.

David Oshinsky, author of “Polio: An American Story”, asserts that success of vaccines in the past is why the anti-vaxx movement has grown in the past couple of decades. “These vaccines have done away with the evidence of how frightening these diseases were,” he said.

Paul always thought polio would return and the recent pandemic has brought back a lot of feelings about the disease that robbed Paul of his body. “I can see hospitals inundated by polio victims again,” he said, “I can see it so easily.”