Among the Last in An Iron Lung

An iron lung sponsored by the March of Dimes helps a young boy with polio breath during the 1950s. (Photo by Kirn Vintage Stock/Corbis via Getty Images)

Lawyer Paul Alexander contracted polio at age 6 in the summer of 1952. The disease left him paralyzed from the neck down and unable to breathe without assistance, but it didn’t stop him from living his life. As Linda Rodriguez McRobbie reports at The Guardian, Paul, with help from a therapist who promised him a puppy, learned to breathe on his own for periods of time, giving him respite from his iron lung. Today, at age 74, after surviving a polio infection in an epidemic from a different time, coronavirus is a looming threat.

What Paul remembers most vividly about the ward is hearing the doctors talk about him when they walked through on their rounds. “He’s going to die today,” they said. “He shouldn’t be alive.” It made him furious. It made him want to live.

Paul told the therapist about the times he had been forced by doctors to try to breathe without the lung, how he had turned blue and passed out. He also told her about the time he had gulped and “swallowed” some air, almost like breathing. The technique had a technical name, “glossopharyngeal breathing”. You trap air in your mouth and throat cavity by flattening the tongue and opening the throat, as if you’re saying “ahh” for the doctor. With your mouth closed, the throat muscle pushes the air down past the vocal cords and into the lungs. Paul called it “frog-breathing”.

Sullivan made a deal with her patient. If he could frog-breathe without the iron lung for three minutes, she’d give him a puppy. It took Paul a year to learn to do it, but he got his puppy; he called her Ginger. And though he had to think about every breath, he got better at it. Once he could breathe reliably for long enough, he could get out of the lung for short periods of time, first out on the porch, and then into the yard.

Although he still needed to sleep in the iron lung every night – he couldn’t breathe when he was unconscious – Paul didn’t stop at the yard. At 21, he became the first person to graduate from a Dallas high school without physically attending a class. He got into Southern Methodist University in Dallas, after repeated rejections by the university administration, then into law school at the University of Texas at Austin. For decades, Paul was a lawyer in Dallas and Fort Worth, representing clients in court in a three-piece suit and a modified wheelchair that held his paralysed body upright.

Before the arrival of a vaccine in 1955, what made polio so terrifying was that there was no way of predicting who would walk away from an infection with a headache, and who would never walk again. In most cases, the disease had no discernible effect. Of the 30% or so who showed symptoms, most experienced only minor illness. But a small proportion, 4-5%, exhibited serious symptoms, including extreme muscular pain, high fever and delirium. As the virus hacked its way through the neural tissue of the spinal cord, a few of those infected were paralysed; this progression of the virus was known as paralytic polio. Roughly 5-10% of patients who caught paralytic polio died, although this number was far higher in the days before widespread use of the iron lung.

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