Editing Iron lung

{{Short description|Negative-pressure mechanically functioning respirator}}
{{Other uses|Iron Lung (disambiguation){{!}}Iron Lung}}
{{Use mdy dates|date=February 2021}}
{{Use American English|date=February 2021}}
{{Infobox medical intervention
| Name        = Iron lung
| Image       = Iron lung CDC.jpg
| Caption     = An Emerson iron lung
| ICD10       =
| ICD9        = {{ICD9proc|93.99}}
| MeshID      = D015919
| OPS301      =
| OtherCodes  =
| HCPCSlevel2 =
| field       = [[Pulmonology]]
}}

An '''iron lung''' is a type of [[negative pressure ventilator]], a [[medical ventilator|mechanical respirator]] which encloses most of a person's body and varies the air pressure in the enclosed space to stimulate breathing.<ref name="non_invasive_domiciliary_ventilation_sheerson">{{Cite journal |last=Shneerson |first=J. M. |date=1991-02-01 |title=Assisted ventilation. 5. Non-invasive and domiciliary ventilation: negative pressure techniques |url=https://thorax.bmj.com/content/46/2/131 |journal=[[Thorax (journal)|Thorax]] |language=en |volume=46 |issue=2 |pages=131–135 |doi=10.1136/thx.46.2.131 |issn=0040-6376 |pmc=462978 |pmid=2014494 |archive-url=https://web.archive.org/web/20230316212707/https://thorax.bmj.com/content/thoraxjnl/46/2/131.full.pdf |archive-date=March 16, 2023 |access-date=April 12, 2020}}</ref><ref name="initiating_1988_3_intensive_care_med">{{Cite journal |last1=Grum |first1=Cyril M. |last2=Morganroth |first2=Melvin L. |date=January 1988 |title=Analytic Reviews : Initiating Mechanical Ventilation |url=https://deepblue.lib.umich.edu/bitstream/handle/2027.42/68485/10.1177_088506668800300103.pdf?sequence=2 |format=PDF |journal=Journal of Intensive Care Medicine |language=en |volume=3 |issue=1 |pages=6–20 |doi=10.1177/088506668800300103 |hdl=2027.42/68485 |issn=0885-0666 |access-date=April 12, 2020}}</ref> It assists breathing when [[Muscles of respiration|muscle]] control is lost, or the work of breathing exceeds the person's ability.<ref name="non_invasive_domiciliary_ventilation_sheerson" /> Need for this treatment may result from diseases including [[polio]] and [[botulism]] and certain poisons (for example, [[barbiturates]] and [[tubocurarine]]).

The use of iron lungs is largely obsolete in modern medicine as more modern breathing therapies have been developed<ref>{{Cite journal|last1=Corrado|first1=A.|last2=Ginanni|first2=R.|last3=Villella|first3=G.|last4=Gorini|first4=M.|last5=Augustynen|first5=A.|last6=Tozzi|first6=D.|last7=Peris|first7=A.|last8=Grifoni|first8=S.|last9=Messori|first9=A.|last10=Nozzoli|first10=C.|last11=Berni|first11=G.|display-authors=6|date=March 2004|title=Iron lung versus conventional mechanical ventilation in acute exacerbation of COPD|journal=The European Respiratory Journal|volume=23|issue=3|pages=419–24|doi=10.1183/09031936.04.00029304|issn=0903-1936|pmid=15065832|doi-access=free}}</ref> and due to the [[Polio eradication|eradication of polio]] in most of the world.<ref name="americas_last_2017_11_22_independent_co_uk">{{cite news|title=America's last iron lung users on their lives spent inside obsolete ventilators|work=[[The Independent]]|first=Andrew|last=Buncombe|url=https://www.independent.co.uk/news/world/americas/polio-iron-lung-survivors-photos-lives-inside-ventilators-a8070881.html|date=November 22, 2017|access-date=April 16, 2019|archive-date=May 25, 2022|archive-url=https://ghostarchive.org/archive/20220525/https://www.independent.co.uk/news/world/americas/polio-iron-lung-survivors-photos-lives-inside-ventilators-a8070881.html|url-status=live}}</ref> In 2020 however, the [[COVID-19 pandemic]] revived some interest in them as a cheap, readily-producible substitute for [[Modes of mechanical ventilation#Continuous positive airway pressure|positive-pressure ventilators]], which were feared to be outnumbered by patients potentially needing temporary artificially assisted respiration.<ref name="modern_iron_lung_2020_04_06_newatlas">{{Cite web |last=Szondy |first=David |date=April 6, 2020 |title=Modern iron lung designed to address ventilator shortage |url=https://newatlas.com/medical/british-engineers-modern-iron-lung-covid-19-ventilator-alternative/ |url-status=live |archive-url=https://web.archive.org/web/20240820211409/https://newatlas.com/medical/british-engineers-modern-iron-lung-covid-19-ventilator-alternative/n|archive-date=2024-08-20 |access-date=April 11, 2020 |website=New Atlas |language=en-US}}</ref><ref name="one_kansas_company_2020_04_09_ksn_com">{{Cite news |last=Funk |first=Hunter |date=April 10, 2020 |title=One Kansas company is switching gears to make Iron Lung ventilators |url=https://www.ksn.com/news/one-kansas-company-is-switching-gears-to-make-iron-lung-ventilators/ |archive-url=https://web.archive.org/web/20221015023444/https://www.ksn.com/news/one-kansas-company-is-switching-gears-to-make-iron-lung-ventilators/ |archive-date=October 15, 2022 |access-date=April 11, 2020 |website=[[KSNW-TV]] |language=en-US}}</ref><ref name="hess_offers_2020_04_09_hdnews_net">{{Cite news |last=Allen |first=Margaret |date=April 9, 2020 |title=Hess offers iron lung for COVID-19 |url=https://www.hdnews.net/news/20200409/hess-offers-iron-lung-for-covid-19 |url-status=dead |archive-url=https://web.archive.org/web/20210225155211/https://www.hdnews.net/news/20200409/hess-offers-iron-lung-for-covid-19 |archive-date=February 25, 2021 |access-date=April 11, 2020 |work=[[Hays Daily News]]}}</ref>

The iron lung is a large horizontal cylinder designed to stimulate breathing in patients who have lost control of their respiratory muscles. The patient's head is exposed outside the cylinder, while the body is sealed inside. Air pressure inside the cylinder is cycled to facilitate inhalation and exhalation. Devices like the Drinker, Emerson, and [[Both respirator|Both]] respirators are examples of iron lungs, which can be manually or mechanically powered. Smaller versions, like the cuirass ventilator and jacket ventilator, enclose only the patient's torso. Breathing in humans occurs through negative pressure, where the rib cage expands and the [[Thoracic diaphragm|diaphragm]] contracts, causing air to flow in and out of the lungs.

The concept of external negative pressure ventilation was introduced by [[John Mayow]] in 1670. The first widely used device was the iron lung, developed by [[Philip Drinker]] and [[Louis Agassiz Shaw Jr.|Louis Shaw]] in 1928. Initially used for [[coal gas]] poisoning treatment, the iron lung gained fame for treating respiratory failure caused by polio in the mid-20th century. [[John Haven Emerson]] introduced an improved and more affordable version in 1931. The Both respirator, a cheaper and lighter alternative to the Drinker model, was invented in Australia in 1937. British philanthropist [[William Morris, 1st Viscount Nuffield|William Morris]] financed the production of the Both–Nuffield respirators, donating them to hospitals throughout Britain and the British Empire. During the polio outbreaks of the 1940s and 1950s, iron lungs filled hospital wards, assisting patients with paralyzed diaphragms in their recovery.

[[Polio vaccination]] programs and the development of modern ventilators have nearly eradicated the use of iron lungs in the developed world. [[Positive pressure ventilation]] systems, which blow air into the patient's lungs via intubation, have become more common than negative pressure systems like iron lungs. However, negative pressure ventilation is more similar to normal physiological breathing and may be preferable in rare conditions. {{As of|2024}}, after the death of [[Paul Alexander (polio survivor)|Paul Alexander]], only one patient in the U.S., [[Martha Lillard]], is still using an iron lung. In response to the COVID-19 pandemic and the shortage of modern ventilators, some enterprises developed prototypes of new, easily producible versions of the iron lung.

==Design and function==
[[File:Iron lung action diagrams.png|thumb|Iron lung cylinder (black), patient head exposed through sealed opening. Diaphragm (yellow) mechanically extends/retracts, varying cylinder air pressure, causing patient chest to expand (inhale) (top) and contract (exhaling) (bottom)]]
[[File:Two types of 20th century respirator. Wellcome L0001309 (Fig A).jpg|thumb|A patient wearing a cuirass respirator]]
[[File:HOE WERKT EEN IJZEREN LONG-PGM4011588.webm|thumb|1939 Dutch newsreel on the function of the iron lung|thumbtime=0:38]]

The iron lung is typically a large horizontal cylinder in which a person is laid, with their head protruding from a hole in the end of the cylinder, so that their full head (down to their voice box) is outside the cylinder, exposed to ambient air, and the rest of their body sealed inside the cylinder, where air pressure is continuously cycled up and down to stimulate breathing.<ref name="what_is_the_background_2019_04_11medscape">{{Cite web |last1=Jackson |first1=Christopher D. |last2=Muthiah |first2=Muthiah P. |date=April 11, 2019 |editor-last=Talavera |editor-first=Francisco |editor2-last=Mosenifar |editor2-first=Zab |others=Additional contributions by Ryland P. Byrd Jr. and Thomas M. Roy |title=Mechanical Ventilation |url=https://emedicine.medscape.com/article/304068-overview#a1?form=fpf |url-status=live |archive-url=https://web.archive.org/web/20220702172810/https://www.medscape.com/answers/304068-104770/what-is-the-background-of-the-iron-lung-form-of-mechanical-ventilation |archive-date=July 2, 2022 |access-date=April 12, 2020 |website=[[Medscape]]}}</ref>

To cause the patient to inhale, air is pumped out of the cylinder, causing a slight vacuum, which causes the patient's chest and abdomen to expand (drawing air from outside the cylinder, through the patient's exposed nose or mouth, into their lungs). Then, for the patient to exhale, the air inside the cylinder is compressed slightly (or allowed to equalize to ambient room pressure), causing the patient's chest and abdomen to partially collapse, forcing air out of the lungs, as the patient exhales the breath through their exposed mouth and nose, outside the cylinder.<ref name="what_is_the_background_2019_04_11medscape" />

Examples of the device include the Drinker respirator, the Emerson respirator, and the Both respirator. Iron lungs can be either manually or mechanically powered, but are normally powered by an electric motor linked to a flexible pumping diaphragm (commonly opposite the end of the cylinder from the patient's head).<ref name="iron_lung_2016_01_11_openpediatrics_you_tube">Rockoff, Mark, M.D., [https://www.youtube.com/watch?v=cUCqsl6JROg "The Iron Lung and Polio,"] {{Webarchive|url=https://web.archive.org/web/20230409094515/https://www.youtube.com/watch?v=cUCqsl6JROg|date=April 9, 2023}}, video (8 minutes), January 11, 2016, OPENPediatrics and [[Boston Children's Hospital]] on [[YouTube]], retrieved April 11, 2020 (historical background and images, explanatory diagrams, and live demonstrations)</ref> Larger "room-sized" iron lungs were also developed, allowing for simultaneous ventilation of several patients (each with their heads protruding from sealed openings in the outer wall), with sufficient space inside for a [[nurse]] or a [[respiratory therapist]] to be inside the sealed room, attending the patients.<ref name="iron_lung_2016_01_11_openpediatrics_you_tube" />

Smaller, single-patient versions of the iron lung include the so-called ''cuirass ventilator'' (named for the [[cuirass]], a torso-covering [[body armor]]). The cuirass ventilator encloses only the patient's torso, or chest and abdomen, but otherwise operates essentially the same as the original, full-sized iron lung. A lightweight variation on the cuirass ventilator is the ''jacket ventilator'' or ''poncho'' or ''raincoat'' ventilator, which uses a flexible, impermeable material (such as plastic or rubber) stretched over a metal or plastic frame over the patient's torso.<ref name="modern_iron_lung_2020_04_06_newatlas" /><ref name="iron_lung_and_2020_04_11_oxy_gen">[http://oxygen.milano.it/en/the-iron-lung-and-the-modern-ventilation/ "The 'iron lung' and the modern 'ventilation',"] {{Webarchive|url=https://web.archive.org/web/20200411122747/http://oxygen.milano.it/en/the-iron-lung-and-the-modern-ventilation/ |date=April 11, 2020 }} Oxy.gen, retrieved April 11, 2020</ref><ref name="poncho_dima_italia_sri">[https://www.dimaitalia.com/en/tag/poncho/ "Poncho,"]{{Dead link|date=October 2023|bot=InternetArchiveBot|fix-attempted=yes}} by medical device manufacturer [[Dima Italia Srl]] of [[Bologna, Italy]] (picture of jacket ventilator ["poncho"], and other information.), retrieved April 12, 2020</ref>{{overcite|date=October 2024}}

==Method and use==
[[File:Iron Lung ward-Rancho Los Amigos Hospital.gif|right|thumb|An iron lung ward, as mocked-up for a film, circa 1953]]

Humans, like most mammals, breathe by ''negative pressure'' breathing:<ref name=stemnet>{{cite web|title=Gas Exchange in Humans|url=http://www.stemnet.nf.ca/~dpower/resp/exchange.htm|access-date=July 1, 2011|url-status=dead|archive-url=https://web.archive.org/web/20090423113840/http://www.stemnet.nf.ca/~dpower/resp/exchange.htm|archive-date=April 23, 2009}}</ref> the rib cage expands and the [[Thoracic diaphragm|diaphragm]] contracts, expanding the [[chest cavity]]. This causes the pressure in the chest cavity to decrease, and the [[lung]]s expand to fill the space. This, in turn, causes the pressure of the air inside the lungs to decrease (it becomes negative, relative to the atmosphere), and air flows into the lungs from the atmosphere: [[inhalation]]. When the diaphragm relaxes, the reverse happens and the person [[exhalation|exhales]]. If a person loses part or all of the ability to control the muscles involved, breathing becomes difficult or impossible.

==Invention and early use==
===Initial development===
[[File:Museum-gt-eiserne-lunge.jpg|thumb|Iron lung from the 1950s in the [[Stadtmuseum Gütersloh|Gütersloh Town Museum]]. In Germany, fewer than a dozen of these breathing machines are available to the public.]]

In 1670, English scientist John Mayow came up with the idea of external negative pressure ventilation. Mayow built a model consisting of bellows and a [[Waterskin|bladder]] to pull in and expel air.<ref name=Schlager2000>{{cite book|last=Schlager|first=Neil|title=Science and Its Times: Understanding the Social Significance of Scientific Discovery, Vol. 6: 1900–1950|page=[https://archive.org/details/scienceitstimesu0000unse/page/348 348]|publisher=Gale|location=Farmington Hills, Michigan|year=2000|isbn=978-0-7876-3938-9|url=https://archive.org/details/scienceitstimesu0000unse/page/348}}</ref> The first negative pressure ventilator was described by British physician John Dalziel in 1832. Successful use of similar devices was described a few years later. Early prototypes included a hand-operated bellows-driven "Spirophore" designed by Dr Woillez of [[Paris]] (1876),<ref>{{cite journal|last1=Emerson |first1=John H |title=Some Reflections on Iron Lungs and Other Inventions |journal=Respiratory Care |date=July 1998 |volume=43| issue = 7 |page=577 |url=http://www.jhemerson.com/pdfs/Emerson%20-%20Some%20reflections%20%281998%29.pdf |access-date=October 12, 2016 |url-status=dead |archive-url=https://web.archive.org/web/20060324195608/http://www.jhemerson.com/pdfs/Emerson%20-%20Some%20reflections%20%281998%29.pdf |archive-date=March 24, 2006 }}</ref> and an airtight wooden box designed specifically for the treatment of polio by Dr Stueart of South Africa (1918). Stueart's box was sealed at the waist and shoulders with clay and powered by motor-driven bellows.<ref name="Gould">{{cite book| last=Gould| first=Tony| title=A Summer Plague: Polio and Its Survivors| publisher=[[Yale University Press]]| location=New Haven| year=1997| page=90| isbn=978-0-300-07276-1}}</ref>

===Drinker and Shaw tank===
[[File:Drinker iron lung.JPG|right|thumb|A Drinker iron lung displayed at the chapel of [[Netley Hospital]], 2018]]

The first of these devices to be widely used however was developed in 1928 by Phillip Drinker and Louis Shaw of the United States.<ref name=Gilgoff2002>{{cite book|editor-last=Gilgoff|editor-first=Irene S.|last=Laurie|first=Gini|title=Breath of Life: The Role of the Ventilator in Managing Life-Threatening Illnesses|chapter=Ventilator users, home care, and independent living: a historical perspective|pages=161–201|publisher=Scarecrow Press, Inc.|location=Lanham, Maryland|year=2002|isbn=978-0-8108-3488-0|chapter-url=https://books.google.com/books?id=ngA1izcCrFQC&q=%22Ventilator+users%2C+home+care%2C+and+independent+living%3A+a+historical+perspective%22&pg=PA161|access-date=October 18, 2020|archive-date=September 24, 2021|archive-url=https://web.archive.org/web/20210924185139/https://books.google.com/books?id=ngA1izcCrFQC&q=%22Ventilator+users,+home+care,+and+independent+living:+a+historical+perspective%22&pg=PA161|url-status=live}}</ref> The iron lung, often referred to in the early days as the "Drinker respirator", was invented by Philip Drinker (1894–1972) and Louis Agassiz Shaw Jr., professors of [[Occupational hygiene|industrial hygiene]] at the [[Harvard School of Public Health]].<ref name=Sherwood1973>{{cite journal|last1=Sherwood|first1=RJ|title=Obituaries: Philip Drinker 1894–1972|journal=The Annals of Occupational Hygiene|volume=16|issue=1|pages=93–94|year=1973|doi=10.1093/annhyg/16.1.93}}</ref><ref name=Gorham1979>{{cite journal|last1=Gorham|first1=J|title=A medical triumph: the iron lung|journal=Respiratory Therapy|volume=9|issue=1|pages=71–73|year=1979|pmid=10297356}}</ref><ref name=Lehigh>{{cite web|author=P.C. Rossin College of Engineering and Applied Science|title=Philip Drinker '17|work=Distinguished Alumni: Great Talents & Bright Minds|publisher=Lehigh University|location=Bethlehem, Pennsylvania|year=2011|url=http://www3.lehigh.edu/engineering/about/drinker.asp|access-date=July 1, 2011|url-status=dead|archive-url=https://web.archive.org/web/20110615142114/http://www3.lehigh.edu/engineering/about/drinker.asp|archive-date=June 15, 2011}}</ref>{{overcite|date=October 2024}} The machine was powered by an electric motor with air pumps from two vacuum cleaners. The air pumps changed the pressure inside a rectangular, airtight metal box, pulling air in and out of the lungs.<ref name=NMAH2011>{{cite web|author=Kenneth E. Behring Center|title=The iron lung and other equipment|work=Whatever happened to polio?|publisher=National Museum of American History|location=Washington, DC|year=2011|url=http://americanhistory.si.edu/polio/howpolio/ironlung.htm|access-date=July 2, 2011|archive-date=June 4, 2011|archive-url=https://web.archive.org/web/20110604101823/http://americanhistory.si.edu/polio/howpolio/ironlung.htm|url-status=dead}}</ref>
The first clinical use of the Drinker respirator on a human was on October 12, 1928, at the [[Boston Children's Hospital]] in the US.<ref name=Gorham1979/><ref>{{cite web |url=http://www.tebyan.net/Events_History/World_Events/2010/10/12/140096.html |title=Today in History: Iron Lung Used for the First Time (1928) |publisher=Tebyan.net |access-date=November 14, 2013 |archive-date=August 15, 2011 |archive-url=https://web.archive.org/web/20110815063326/http://www.tebyan.net/events_history/world_events/2010/10/12/140096.html |url-status=live }}</ref> The subject was an eight-year-old girl who was nearly dead as a result of [[respiratory failure]] due to polio.<ref name=Lehigh/> Her dramatic recovery within less than a minute of being placed in the chamber helped popularize the new device.<ref name="OSHHarvard">{{cite web |year=2010 |title=2010-2011 Student Handbook |url=http://www.hsph.harvard.edu/research/erc/files/no_whoswho_editsept10updates.pdf |archive-url=https://web.archive.org/web/20110102095012/http://www.hsph.harvard.edu/research/erc/files/no_whoswho_editsept10updates.pdf |archive-date=January 2, 2011 |access-date=July 2, 2011 |publisher=The Harvard Education and Research Center for Occupational Safety and Health |location=Cambridge, Massachusetts}}</ref>

====Variations====
Boston manufacturer Warren E. Collins began production of the iron lung that year.<ref name=Silver2007>{{cite book|author1=Julie K. Silver|author-link1=Julie K. Silver |author2=Daniel J. Wilson|title=Polio Voices|url=https://archive.org/details/poliovoicesoralh00silv|url-access=limited|location=Santa Barbara|publisher=Praeger Publishers|year=2007|page=[https://archive.org/details/poliovoicesoralh00silv/page/n153 141]|isbn=978-0-275-99492-1 }}</ref><ref>[https://books.google.com/books?id=qOIDAAAAMBAJ&pg=PA975 "Artificial Lung on Wheels Prove Life Saver" ''Popular Mechanics'', December 1930] {{Webarchive|url=https://web.archive.org/web/20200815202050/https://books.google.com/books?id=qOIDAAAAMBAJ&pg=PA975 |date=August 15, 2020 }} photo of earliest production units from Boston</ref> Although it was initially developed for the treatment of victims of coal gas poisoning, it was most famously used in the mid-20th century for the treatment of respiratory failure caused by polio.<ref name=Sherwood1973/>

Danish physiologist [[August Krogh]], upon returning to [[Copenhagen]] in 1931 from a visit to New York where he saw the Drinker machine in use, constructed the first Danish respirator designed for clinical purposes. Krogh's device differed from Drinker's in that its motor was powered by water from the city pipelines. Krogh also made an infant respirator version.<ref name="Kirby">{{cite book| last=Kirby| first=Richard R.| title=Mechanical Ventilation| publisher=[[Churchill Livingstone]]| location=New York| year=1985| page=9| isbn=978-0-443-08063-0}}</ref>

In 1931, John Haven Emerson (1906–1997) introduced an improved and less expensive iron lung.<ref name=Geddes2007>{{cite journal|last=Geddes|first=LA|title=The history of artificial respiration|journal=IEEE Engineering in Medicine and Biology Magazine|volume=26|issue=6|pages=38–41|year=2007|pmid=18189086|doi=10.1109/EMB.2007.907081|s2cid=24784291}}</ref><ref name="NMAH lung">{{cite web|title=Iron Lung|publisher=National Museum of American History|url=http://americanhistory.si.edu/collections/object.cfm?key=35&objkey=114|access-date=July 1, 2011|archive-date=June 30, 2011|archive-url=https://web.archive.org/web/20110630184434/http://www.americanhistory.si.edu/collections/object.cfm?key=35&objkey=114|url-status=live}}</ref> The Emerson iron lung had a bed that could slide in and out of the cylinder as needed, and the tank had portal windows which allowed attendants to reach in and adjust limbs, sheets, or hot packs.<ref name=NMAH2011/> Drinker and [[Harvard University]] sued Emerson, claiming he had infringed on [[patent rights]]. Emerson defended himself by making the case that such lifesaving devices should be freely available to all.<ref name=NMAH2011/> Emerson also demonstrated that every aspect of Drinker's patents had been published or used by others at earlier times. Since an invention must be novel to be patentable, prior publication/use of the invention meant it was not novel and therefore unpatentable. Emerson won the case, and Drinker's patents were declared invalid.{{citation needed|date=October 2024}}

The United Kingdom's first iron lung was designed in 1934 by Robert Henderson, an [[Aberdeen]] doctor. Henderson had seen a demonstration of the Drinker respirator in the early 1930s and built a device of his own upon his return to Scotland. Four weeks after its construction, the Henderson respirator was used to save the life of a 10-year-old boy from [[New Deer]], [[Aberdeenshire]] who had poliomyelitis. Despite this success, Henderson was reprimanded for secretly using hospital facilities to build the machine.<ref name="Wills">{{cite book| last=Wills| first=Elspeth| title=Scottish Firsts: A Celebration of Innovation and Achievement| publisher=[[Mainstream Publishing]]| location=Edinburgh| year=2002| pages=[https://archive.org/details/scottishfirstsce00will/page/51 51–52]| isbn=978-1-84018-611-6| url-access=registration| url=https://archive.org/details/scottishfirstsce00will/page/51}}</ref><ref name="Thomas">{{cite web| last=Thomas| first=Campbell| date=February 15, 2000| url=http://www.heraldscotland.com/sport/spl/aberdeen/dr-robert-henderson-1.249085| title=Dr Robert Henderson| work=[[The Herald (Glasgow)|The Herald]]| access-date=March 10, 2013| archive-date=May 4, 2013| archive-url=https://web.archive.org/web/20130504092234/http://www.heraldscotland.com/sport/spl/aberdeen/dr-robert-henderson-1.249085| url-status=live}}</ref>

===Both respirator===
{{Main|Both respirator}}

The Both respirator, a negative pressure ventilator, was invented in 1937 when Australia's epidemic of poliomyelitis created an immediate need for more ventilating machines to compensate for respiratory paralysis. Although the Drinker model was effective and saved lives, its widespread use was hindered by the fact that the machines were very large, heavy (about 750&nbsp;lbs or 340&nbsp;kg), bulky, and expensive. An adult machine cost about $2,000 in the US in 1930 ({{Inflation|US|2000|1930|r=-3|fmt=eq}}), and about £1,500 sterling in Europe in the mid-1950s ({{Inflation|UK|1500|1955|r=-3|fmt=eq}}). The cost of one delivered to [[Melbourne]] in 1936 was AU£2,000 ({{Inflation|AU|2000|1936|r=-3|fmt=eq}}). Consequently, there were few of the Drinker devices in Australia and Europe.<ref name="Trubuhovich">{{cite journal |last=Trubuhovich| first=Ronald V.| title=Notable Australian contributions to the management of ventilatory failure of acute poliomyelitis| journal=Critical Care and Resuscitation| year=2006| volume=8| issue=4| pages=383–85| doi=10.1016/S1441-2772(23)02078-1| pmid=17227281| doi-access=free}}</ref>

The [[Government of South Australia#Department for Health and Ageing (SA Health)|South Australia Health Department]] asked Adelaide brothers Edward and Don Both to create an inexpensive "iron lung".<ref name="Healey">{{cite web| last=Healey| first=John| year=1998| url=http://www.samhs.org.au/Virtual%20Museum/Medicine/Bothurinlung/bothironlung-netley.html| title=The Both Brothers and the 'Iron Lung'| publisher=South Australian Medical Heritage Society Inc| access-date=March 10, 2013| archive-date=April 9, 2013| archive-url=https://web.archive.org/web/20130409052234/http://samhs.org.au/Virtual%20Museum/Medicine/Bothurinlung/bothironlung-netley.html| url-status=live}}</ref> Biomedical engineer [[Edward Both]] designed and developed a cabinet respirator made of plywood that worked similarly to the Drinker device, with the addition of a bi-valved design which allowed temporary access to the patient's body.<ref name="Trubuhovich" /> Far cheaper to make (only £100) than the Drinker machine, the Both Respirator also weighed less and could be constructed and transported more quickly.<ref name="Trubuhovich" /><ref name="SMH">{{cite news| date=December 7, 2004| url=https://www.smh.com.au/news/National/Memories-of-polio-and-those-who-wrestled-with-it/2004/12/06/1102182223039.html| title=Memories of polio and those who wrestled with it| newspaper=[[The Sydney Morning Herald]]| access-date=March 10, 2013| archive-date=March 26, 2013| archive-url=https://web.archive.org/web/20130326023339/http://www.smh.com.au/news/National/Memories-of-polio-and-those-who-wrestled-with-it/2004/12/06/1102182223039.html| url-status=live}}</ref> Such was the demand for the machines that they were often used by patients within an hour of production.<ref name="Langmore">{{cite book| editor-last=Langmore| editor-first=Diane| title=Australian Dictionary of Biography: Volume 17 1981–1990 A–K| publisher=[[Melbourne University Publishing]]| location=Carlton, Victoria| year=2009| page=129| isbn=978-0-522-85382-7}}</ref>

Visiting London in 1938 during another polio epidemic, Both produced additional respirators there which attracted the attention of William Morris (Lord Nuffield), a British motor manufacturer and philanthropist. Nuffield, intrigued by the design, financed the production of approximately 1700 machines at his [[Morris Motors|car factory]] in [[Cowley, Oxfordshire|Cowley]] and donated them to hospitals throughout all parts of Britain and the British Empire.<ref name="Langmore" /> Soon, the Both–Nuffield respirators were able to be produced by the thousand at about one-thirteenth the cost of the American design.<ref name="Healey" /> By the early 1950s, there were over 700 Both-Nuffield iron lungs in the United Kingdom, but only 50 Drinker devices.<ref>{{cite journal|last=Lawrence|first=Ghislaine|title=The Smith-Clarke Respirator|journal=[[The Lancet]]|date=February 23, 2002|volume=359|pmid=11879908|issue=9307|page=716|doi=10.1016/s0140-6736(02)07819-4|s2cid=54283110}}</ref>

<gallery widths="200" heights="160">
File:Both Cabinet Respirator in WWII.jpg|A Both cabinet respirator being used to treat a patient at the 110th Australian Military Hospital in 1943
File:Iron lung on display at Thackray Museum of Medicine.jpg|Both–Nuffield iron lung display at the [[Thackray Museum of Medicine]], Leeds. Pictures show assembly at the Morris motor works.<ref>{{Cite web |title=113.001 {{!}} Collections Online |url=https://collections.thackraymuseum.co.uk/object-113-001 |access-date=2024-08-05 |website=collections.thackraymuseum.co.uk}}</ref>
</gallery>

=== Polio epidemic ===
[[Image:Poumon artificiel.jpg|thumb|Staff in a [[Rhode Island]] hospital examine a patient in an iron lung tank respirator during a polio epidemic in 1960.]]

Rows of iron lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s, helping children, and some adults, with bulbar polio and bulbospinal polio. A polio patient with a paralyzed diaphragm would typically spend two weeks inside an iron lung while recovering.<ref name="NMAH">{{Cite web| url=http://amhistory.si.edu/polio/howpolio/ironlung.htm| title=NMAH &#124; Polio: The Iron Lung and Other Equipment| website=[[National Museum of American History]]| publisher=[[Smithsonian Institution]]| access-date=March 28, 2020| archive-date=August 16, 2015| archive-url=https://web.archive.org/web/20150816093454/http://amhistory.si.edu/polio/howpolio/ironlung.htm| url-status=live}}</ref><ref>{{Cite web|url=https://www.theatlantic.com/national/archive/2012/01/what-america-looked-like-polio-children-paralyzed-in-iron-lungs/251098/|title=What America Looked Like: Polio Children Paralyzed in Iron Lungs|first=Brian|last=Resnick|date=January 10, 2012|website=The Atlantic|access-date=March 7, 2017|archive-date=March 15, 2017|archive-url=https://web.archive.org/web/20170315120956/https://www.theatlantic.com/national/archive/2012/01/what-america-looked-like-polio-children-paralyzed-in-iron-lungs/251098/|url-status=live}}</ref>
===Outcomes===
Patients treated in iron lungs for polio experienced varying outcomes depending on the severity of their condition and the duration of their treatment:<ref>"The Iron Lung"  ''Science Museum'' (October 14, 2018) [https://www.sciencemuseum.org.uk/objects-and-stories/medicine/iron-lung online]</ref>  Most patients needed the iron lung for only a few weeks or months. However, a minority with permanently paralyzed chest muscles faced a lifetime of confinement in the iron lung.  Learning to breathe again outside the iron lung was often a difficult and frightening process for patients. Most gradually built up strength in their chest muscles through therapy, allowing them to spend increasing amounts of time outside the device.   Some patients were able to fully recover and end the treatment.  In severe cases, fatal complications set in, especially aspiration pneumonia and central respiratory center involvement. In the late 20th century vaccination programs have virtually [[Poliomyelitis eradication|eradicated]] new cases of poliomyelitis in the developed world. Because of this, the development of modern [[Medical ventilator|ventilators]], and widespread use of [[tracheal intubation]] and [[tracheotomy]], the iron lung has mostly disappeared from modern medicine. In 1959, 1,200 people were using tank respirators in the United States, but by 2004 that number had decreased to just 39.<ref name="NMAH" /> By 2014, only 10 people were left with an iron lung.<ref>{{cite web| url=http://www.washingtontimes.com/news/2014/aug/24/north-texan-one-of-10-still-living-in-iron-lung/| title=North Texan one of 10 still living in iron lung| first=Shelly| last=Conlon| date=August 24, 2014| agency=Associated Press| publisher=The Washington Times| access-date=2020-03-28| archive-date=August 16, 2015| archive-url=https://web.archive.org/web/20150816085525/http://www.washingtontimes.com/news/2014/aug/24/north-texan-one-of-10-still-living-in-iron-lung/| url-status=live}}</ref>

==Modern development and usage==

=== Replacement ===
[[Positive pressure ventilation]] systems are now more common than negative pressure systems. Positive pressure ventilators work by blowing air into the patient's lungs via [[intubation]] through the airway; they were used for the first time in [[Blegdams Hospital]], Copenhagen, Denmark, during a polio outbreak in 1952.<ref name=Reisner2009>{{cite web|author=Louise Reisner-Sénélar|title=The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways|year=2009|url=https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B7CdB217pf6yN2QxOGI5NTUtZWIzYS00N2NhLWFhODQtOGZjMjdhZTlkZGE5|access-date=2011-07-01|archive-date=November 22, 2023|archive-url=https://web.archive.org/web/20231122112229/https://drive.google.com/file/d/0B7CdB217pf6yN2QxOGI5NTUtZWIzYS00N2NhLWFhODQtOGZjMjdhZTlkZGE5/view|url-status=live}}</ref><ref name=Wackers1994>{{cite book|last=Wackers|first=Ger|chapter=Chapter 4 |title=Theaters of truth and competence. Intermittent positive pressure respiration during the 1952 polio-epidemic in Copenhagen|year=1994|chapter-url=http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4 |access-date=2011-07-01 |url-status=dead |archive-url=https://web.archive.org/web/20071223223131/http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4 |archive-date=2007-12-23 }}</ref> It proved a success and by 1953 it had superseded the iron lung throughout Europe.<ref name="auto">{{cite web | url=https://www.smithsonianmag.com/innovation/how-polio-outbreak-copenhagen-led-to-invention-ventilator-180975045/ | title=How a Polio Outbreak in Copenhagen Led to the Invention of the Ventilator | access-date=March 15, 2024 | archive-date=March 15, 2024 | archive-url=https://web.archive.org/web/20240315115543/https://www.smithsonianmag.com/innovation/how-polio-outbreak-copenhagen-led-to-invention-ventilator-180975045/ | url-status=live }}</ref> 

The positive pressure ventilator has the asset that the patient's airways can be cleared and the patient can be in a semi-seated position in the acute phase of polio. The fatality rate on using iron lungs on respiratory paralysis patients could be as high as 80% to 90%, most patients either drowning in their own saliva as their swallowing muscles had been paralyzed, or from organ shutdown due to [[acidosis]] due to accumulated [[carbon dioxide]] in bloodstream due to clogged airways. By using the positive pressure ventilators instead of iron lungs, the Copenhagen hospital team was able to decrease the fatality rate eventually down to 11%.<ref name="auto"/> The first patient treated this way was a 12-year-old girl named Vivi Ebert, who had bulbar polio.

The iron lung now has a marginal place in modern [[respiratory therapy]]. Most patients with paralysis of the breathing muscles use modern [[mechanical ventilation|mechanical ventilators]] that push air into the airway with positive pressure. These are generally efficacious and have the advantage of not restricting patients' movements or caregivers' ability to examine the patients as significantly as an iron lung does.{{citation needed|date=April 2022}}

=== Continued use ===
Despite the advantages of positive ventilation systems, negative pressure ventilation is a truer approximation of normal physiological breathing and results in a more normal distribution of air in the lungs. It may also be preferable in certain rare conditions,<ref name="non_invasive_domiciliary_ventilation_sheerson" /> such as [[central hypoventilation syndrome]], in which failure of the medullary respiratory centers at the base of the brain results in patients having no [[Autonomic nervous system|autonomic control]] of breathing. At least one reported polio patient, [[Dianne Odell]], had a spinal deformity that caused the use of mechanical ventilators to be [[contraindicated]].<ref name=Sydney2008>{{cite news|title=Power failure kills iron lung lady|work=The Sydney Morning Herald|date=May 29, 2008|url=https://www.smh.com.au/news/world/power-failure-kills-iron-lung-lady/2008/05/29/1211654160059.html|access-date=2011-07-01|archive-date=July 21, 2018|archive-url=https://web.archive.org/web/20180721140140/https://www.smh.com.au/news/world/power-failure-kills-iron-lung-lady/2008/05/29/1211654160059.html|url-status=live}}</ref>

At least a few patients today still use the older machines, often in their homes, despite the occasional difficulty of finding replacement parts.<ref>{{cite web|url=https://www.nbcnews.com/health/60-years-iron-lung-us-polio-survivor-worries-about-new-2D11641456|title=60 years in an iron lung: US polio survivor worries about new global threat|website=[[NBC News]]|date=November 30, 2013|access-date=October 7, 2019|archive-date=October 29, 2019|archive-url=https://web.archive.org/web/20191029204724/https://www.nbcnews.com/health/60-years-iron-lung-us-polio-survivor-worries-about-new-2D11641456|url-status=live}}</ref>

Joan Headley of [[Post-Polio Health International]] said that as of May 28, 2008, about 30 patients in the US were still using an iron lung.<ref name=CNN2008>{{cite news|title=Woman dies after life spent in iron lung |date=May 28, 2008 |url=http://www.cnn.com/2008/US/05/28/iron.lung.death.ap/index.html |access-date=2011-07-01 |url-status=dead |archive-url=https://web.archive.org/web/20081022162511/http://www.cnn.com/2008/US/05/28/iron.lung.death.ap/index.html |archive-date=2008-10-22 }}</ref> That figure may be inaccurately low; [[Houston, Texas|Houston]] alone had 19 iron lung patients living at home in 2008.<ref name=Neergaard2009>{{cite news |author=Lauran Neergaard |title=Emergency officials struggle to find those on life-support during power outages |date=January 13, 2009 |url=http://www.ems1.com/survivability/articles/447100-Emergency-officials-struggle-to-find-those-on-life-support-during-power-outages |access-date=2014-01-01 |archive-url=https://web.archive.org/web/20220919095626/https://www.ems1.com/ems-products/consulting-management-and-legal-services/articles/emergency-officials-struggle-to-find-those-on-life-support-during-power-outages-dC7pGAWxEseuXoOv/ |archive-date=2022-09-19 }}</ref>

[[Martha Mason (writer)|Martha Mason]] of [[Lattimore, North Carolina|Lattimore]], [[North Carolina]], died on May 4, 2009, after spending 61 of her 72 years in an iron lung.<ref name=Fox2009>{{cite news|last=Fox|first=Margalit|title=Martha Mason, Who Wrote Book About Her Decades in an Iron Lung, Dies at 71|work=The New York Times|date=May 10, 2009|url=https://www.nytimes.com/2009/05/10/us/10mason.html|access-date=July 1, 2011|archive-date=April 13, 2019|archive-url=https://web.archive.org/web/20190413134948/https://www.nytimes.com/2009/05/10/us/10mason.html|url-status=live}}</ref>

On October 30, 2009, [[June Middleton]] of Melbourne, Australia, who had been entered in the ''[[Guinness Book of Records]]'' as the person who spent the longest time in an iron lung, died aged 83, having spent more than 60 years in her iron lung.<ref name=Sydney2009>{{cite news|title=Dead after 60 years in iron lung|work=The Sydney Morning Herald|date=November 1, 2009|url=https://www.smh.com.au/national/dead-after-60-years-in-iron-lung-20091101-hqyy.html?autostart=1|access-date=July 1, 2011|archive-date=February 5, 2010|archive-url=https://web.archive.org/web/20100205074015/http://www.smh.com.au/national/dead-after-60-years-in-iron-lung-20091101-hqyy.html?autostart=1|url-status=live}}</ref>

In 2013, the [[Post-Polio Health International]] (PHI) organizations estimated that only six to eight iron lung users were in the United States; as of 2017, its executive director knew of none. Press reports then emerged, however, of at least three (perhaps the last three)<ref>{{cite magazine |last1=Mazziotta |first1=Julie |title=Polio Survivor, 82, Is One of the Last 3 People in the U.S. to Use an Iron Lung |url=https://people.com/health/polio-survivor-last-3-people-use-iron-lung/ |magazine=People Magazine |date=August 21, 2018 |access-date=January 12, 2019 |archive-date=January 13, 2019 |archive-url=https://web.archive.org/web/20190113063034/https://people.com/health/polio-survivor-last-3-people-use-iron-lung/ |url-status=live }}</ref> users of such devices,<ref name="The Last of the Iron Lungs">{{Cite web |url=https://gizmodo.com/the-last-of-the-iron-lungs-1819079169 |title=The Last of the Iron Lungs |last=Brown |first=Jennings |date=November 20, 2017 |website=Gizmodo |access-date=November 25, 2017 |archive-date=November 20, 2017 |archive-url=https://web.archive.org/web/20171120172630/https://gizmodo.com/the-last-of-the-iron-lungs-1819079169 |url-status=live }}</ref> sparking interest amongst those in the [[makerspace]] community such as [[Naomi Wu]]<ref name="Parts for an Iron Lung">{{Cite web |url=https://hackaday.com/2017/11/25/a-callout-parts-for-an-iron-lung/ |title=A Callout: Parts for an Iron Lung |last=Lewin |first=Day |date=November 25, 2017 |website=Hackaday |access-date=November 25, 2017 |archive-date=November 25, 2017 |archive-url=https://web.archive.org/web/20171125201632/https://hackaday.com/2017/11/25/a-callout-parts-for-an-iron-lung/ |url-status=live }}</ref> in the manufacture of the obsolete components, particularly the gaskets.<ref name="Running out of collars for her iron lung.">{{Cite tweet |number=933619850806620167 |user=reaksexycyborg |title=Via @NireBryce – we've got a nice old lady running out of collars for her iron lung. Lot of 💩 going on in the world we can't do anything about – but this seems 100% doable. @hackaday, @make, textile tech folks – any ideas? From https://gizmodo.com/the-last-of-the-iron-lungs-1819079169 … |author=Naomi Wu |date=November 23, 2017|archive-date=October 13, 2022|archive-url=https://web.archive.org/web/20221013074613/https://twitter.com/reaksexycyborg/status/933619850806620167|url-status=dead}}</ref><ref>{{cite magazine |url=https://www.wired.co.uk/article/iron-lung-maker-community |title=A woman on an iron lung is running out of the spare parts she needs to live. Cue the maker community... |magazine=[[Wired (magazine)|Wired]] |first=Nicole |last=Kobie |date=November 28, 2017 |access-date=October 26, 2021 |archive-date=October 26, 2021 |archive-url=https://web.archive.org/web/20211026065119/https://www.wired.co.uk/article/iron-lung-maker-community |url-status=live }}</ref>

In 2021, the [[National Public Radio]] programs ''[[Radio Diaries]]'' and ''[[All Things Considered]]'' gave a report on Martha Lillard, one of the last remaining Americans depending on the daily use of an iron lung, which she had been using since 1953. In her interview, she reported that she was having problems obtaining replacement parts to keep her machine working properly.<ref>{{cite episode |url=https://www.npr.org/2021/10/25/1047691984/decades-after-polio-martha-is-among-the-last-to-still-rely-on-an-iron-lung-to-br |title=Decades after polio, Martha is among the last to still rely on an iron lung to breathe (includes audio interview) |network=[[National Public Radio]] |series=[[All Things Considered]] |date=October 25, 2021 |first1=Erin |last1=Kelly |first2=Alissa |last2=Escarce |transcript-url=https://www.radiodiaries.org/iron-lung-transcript/ |transcript=(Written transcript of audio episode) |access-date=October 26, 2021 |archive-date=March 13, 2024 |archive-url=https://web.archive.org/web/20240313162045/https://www.npr.org/2021/10/25/1047691984/decades-after-polio-martha-is-among-the-last-to-still-rely-on-an-iron-lung-to-br |url-status=live }}</ref>

On March 11, 2024, [[Paul Alexander (polio survivor)|Paul Alexander]] of Dallas, Texas, United States, died at the age of 78. He had been confined to an iron lung for 72 years from the age of six, longer than anyone, and was the last man living in an iron lung. With his death, [[Martha Lillard]] is the only person in the U.S. known to use an iron lung.<ref>{{cite news |title=Langer Atem |url=https://www.sueddeutsche.de/projekte/artikel/magazin/eiserne-lunge-polio-paul-alexander-texas-beatmung-e348607/?reduced=true |access-date=12 March 2024 |publisher=Süddeutsche Zeitung Magazin |date=12 March 2024 |archive-date=March 12, 2024 |archive-url=https://web.archive.org/web/20240312123003/https://www.sueddeutsche.de/projekte/artikel/magazin/eiserne-lunge-polio-paul-alexander-texas-beatmung-e348607/?reduced=true |url-status=live }}</ref>

=== COVID-19 pandemic ===
In early 2020, reacting to the COVID-19 pandemic, to address the urgent global shortage of modern ventilators (needed for patients with advanced, severe [[COVID-19]]), some enterprises developed prototypes of new, readily-producible versions of the iron lung. These developments included:

* a compact, torso-sized "exovent" developed by a team in the United Kingdom, which included the [[University of Warwick]], the [[Royal National Throat Nose and Ear Hospital]], the [[Marshall Aerospace and Defence Group]], and the [[Imperial College Healthcare NHS Trust]], along with teams of medical clinicians, academics, manufacturers, engineers and citizen scientists<ref name="modern_iron_lung_2020_04_06_newatlas" /><ref name="exovent_2020_04_02_theengineer_co_uk">{{cite news|date=April 2, 2020|title=Exovent iron lung concept offers alternative to Covid-19 ventilators|work=The Engineer|url=https://www.theengineer.co.uk/exovent-covid-19-ventilator/|access-date=August 17, 2020|archive-date=July 23, 2020|archive-url=https://web.archive.org/web/20200723134634/https://www.theengineer.co.uk/exovent-covid-19-ventilator/|url-status=live}}</ref>
* a full-size iron lung developed in the United States by a team led by Hess Services, Inc., of [[Hays, Kansas]]<ref name="one_kansas_company_2020_04_09_ksn_com" /><ref name="hess_offers_2020_04_09_hdnews_net" />

==See also==
{{Portal|Medicine|History}}
* [[Ventilator]]
{{Clear}}


==References==
{{Reflist|2}}

==Further reading==
* Dhawan, Naveen. "Philip Drinker versus John Haven Emerson: battle of the iron lung machines, 1928–1940." ''Journal of medical biography'' 28.3 (2020): 162-168.

* Drinker, Philip A., and Charles F. McKhann. "The iron lung: first practical means of respiratory support." ''JAMA'' 255.11 (1986): 1476-1480. [https://jamanetwork.com/journals/jama/article-abstract/403323 online]

* Markel, Howard. "The Genesis of the Iron Lung: Philip Drinker, Charles F. McKhann, James L. Wilson, and Early Attempts at Administering Artificial Respiration to Patients with Poliomyelitis." in ''Caring for Children: A Celebration of the Department of Pediatrics and Communicable Diseases at the University of Michigan'' (Historical Center for the Health Sciences Monographs, no. 5, Ann Arbor, 1998) pp. 75–92. [https://books.google.com/books?hl=en&lr=&id=dtbhAAAAMAAJ&oi=fnd&pg=PA75&dq=History.+%22+Iron+Lung.%22&ots=r5_Dpa-f7x&sig=dSc1QKkPbH1c0mUdGP4cL91Q2Ik online]

* Maxwell, James H. "The iron lung: halfway technology or necessary step?." ''The Milbank Quarterly'' (1986): 3-29. [https://www.milbank.org/wp-content/uploads/mq/volume-64/issue-01/64-1-The-Iron-Lung.pdf online]

* [[Elizabeth Berg (author)|Elizabeth Berg]] shares a fictionalization of the true story of Pat Raming, the first woman to give birth to a baby while in an iron lung, in her book, ''We Are All Welcome Here''. 2006. {{ISBN|9780099499527}}
* {{cite book |last1=Emerson |first1=JH |author-link1=John Haven Emerson |last2=Loynes |first2=JA |url=https://litfl.com/wp-content/uploads/2021/11/Evolution-of-Iron-Lungs.pdf |title=The evolution of iron lungs: respirators of the body-encasing type |publisher=J.H. Emerson Company |location=Cambridge, Massachusetts |year=1978}} {{No ISBN}}

* [[Martha Mason]], a polio survivor, wrote a best-selling memoir, ''Breath'', about her life inside an iron lung. [https://books.google.com/books?hl=en&lr=&id=NhSiAwAAQBAJ&oi=fnd&pg=PR12&dq=History.+%22+Iron+Lung.%22&ots=boeKs_xnUW&sig=V92GUmHmaXlYKDTLGC4eZbxgNDA online] {{ISBN|9781608191192}}
* [http://ariwatch.com/VS/TheIronLung/RespirationWithoutBreathing.htm Respiration Without Breathing] – about the Thunberg "barospirator" built by John Emerson.
* J Gorham (January–February 1979) [https://www.ncbi.nlm.nih.gov/pubmed/10297356 "A medical triumph: The iron lung"], ''[[Respiratory Therapy (journal)|Respir Ther.]]'', 9(1):71–73, on PubMed, NCBI, [[National Institutes of Health]]

==External links==
{{Commons category|Iron lungs}}
* [http://historical.hsl.virginia.edu/ironlung/ "Iron Lung."] Claude Moore Health Sciences Library, [[University of Virginia]]
* [http://www.powerhousemuseum.com/australia_innovates/?Section_id=1030&article_id=10022&behaviour=view_article Both respirator] at the [[Powerhouse Museum]]

{{Breathing apparatus|medical}}
{{Respiratory system procedures}}
{{Authority control}}

{{DEFAULTSORT:Iron lung}}
[[Category:Respiratory therapy]]
[[Category:1928 introductions]]
[[Category:Mechanical ventilation]]
[[Category:Medical breathing apparatus]]