PHYSICIANS ON THE FRONT LINE
(continued from page 23)
Delano Roosevelt contracted the disease on Campobello Island in
1921. This probably led to the great support given to The National
Foundation for Infantile Paralysis (NFIP) run by Basil O’Connor, his
law partner, and the race to a vaccine funded by this NFIP. It made
a shrine out of Warm Springs, Ga., where the president established
the “Little White House” because he felt the warm spring waters
had helped him recover. Here he would frolic with other younger
polio patients and was known as “Uncle Rosie.” It’s worth a visit
sometime. Certainly, it led to the March of Dimes on our streets and
the President’s Birthday Balls all over the country, held on President
Roosevelt’s birthday, as fundraisers for this cause. The doctors at the children’s hospital were initially bothered by
a moral question: once they had succeeded in saving a polio life by
means of a machine, would the patient be obliged to stay on the
machine forever? Therefore, you might not ought to put patients
in an iron lung. Soon, it was evident that most patients regained
breathing ability and could come out of the lung. So, an instrument
developed by industry became a savior for patients with polio.
The disease affected the gray matter, thus the name poliomyelitis
from two Greek words meaning “gray” and “marrow” (of the spinal
cord), and the results were devastating, especially if at the brainstem
level. [5] As a result, there could be loss of respiratory capability as
well as swallowing function, with disastrous results. The need for
artificial means of ventilation was great. I worked on the wards of the Louisville General Hospital before
my senior year in medical school during the last epidemic here in
1954, and we had some 18 iron lungs in action at one time. After
that, the incidence of polio declined markedly due to the successive
vaccines of Drs. Salk and Sabin. Dr. Sabin’s oral vaccine “polished
off ” the disease as a threat in the early 1960s. This was in large part
due to the NFIP.
Our story next turns to the Consolidated Gas Co., New York City,
in 1925, looking for a method to breathe for workers overcome by
gas or electrocution, not at all related to polio. Their need would lead
to the creation of the artificial respirator or iron lung. The Warren
E. Collins Company in Braintree, Mass. built the respirators.
A few months later in October 1928, an eight-year-old girl
with polio developed progressive weakening of respiration, and
the new machine was brought into her room so she could see it
and get used to the noise for a few hours. Early the next morning,
when comatose from hypoxia she was placed in the machine. The
staff was afraid to turn on the power. The pump was started, and
in less than a minute they saw the child regain consciousness. She
then asked for ice cream. Everybody in the room stood and cried.
24
LOUISVILLE MEDICINE
Soon iron lungs were being positioned around the country and
the world to meet the needs of polio patients. The nation and world
had settled into a recurrent pattern of polio care through the 1954
epidemic, the last before the release of the Salk vaccine in 1955.
The United States Air Force had become involved in the move-
ment of polio patients through the Military Air Transport Service
(MATS) (now Air Mobility Command). Commercial services for
moving such patients left much to be desired. The machine the Air
Force developed called the SAM lung worked, and in January 1955,
the School of Aviation Medicine reported on 50 patients moved in
1952-54 [6] . There were no fatalities.
Earlier air evacuation efforts had mortality, I suspect, because
the patients did not have tracheotomies, and it was essential to be
able to suction the airway regularly and irrigate with saline since the
air aloft was dry on board. These patients also could not effectively
cough in the iron lung. Regular cleaning of the inner liner of the