A Home Made Iron Lung for the Hospital for Sick Children

I had some previous postings on home made iron or “wooden” lungs from the 1950s and 1940s. Here is a story of some home made ventilators built by the Hospital for Sick Children in Toronto Ontario to deal with the 1937 polio epidemic. It amazes me how the very same ethical dilemmas regarding shortages of ventilators we may face in an influenza pandemic were forced on these people in the 1930s.

From a Time Magazine article Sept 13 1937:

Toronto during the past fortnight was also the scene of some mechanical ingenuity. Hospital for Sick Children had only one mechanical respirator, and needed at least one more. The only professional manufacturers of this life-saving device are: Warren E. Collins, Inc. of Boston, which makes respirators designed by Professor Philip Drinker of Harvard's School of Public Health; and J. H. Emerson Co. of Cambridge, Mass., owned by John Haven Emerson, inventive son and namesake of New York City's onetime commissioner of health. The two companies long quarreled over patent infringements. Meanwhile, since 1929 only 250 Drinker respirators have been manufactured (price: $1,350 to $2,450), and since 1931 only 30 Emerson respirators (price: $1,000 to $1,600). Neither firm keeps many respirators in stock.

Faced with these conditions, Superintendent Joseph Henry Winteringham Bower of Toronto's Hospital for Children, a civil engineer by training, fortnight ago determined to build a duplicate of a Drinker respirator. All that was required was an airtight container out of which air could be intermittently pumped to inflate the patient's lungs, Superintendent Bower summoned his chief engineer, Harry Balmforth, and his carpenter William Hall. With pine boards, three hinges from a trunk, some metal rings, a rubber sheet, an air hose and a vacuum pump, they did the job. The work took only seven hours The cost was negligible because they used any old thing available. Before this "wooden lung was long in use. Denver set up a wail for a respirator. Two little girls there were taking turns dying without aid of the city's only respirator. Toronto heeded the plea, sent the wooden device. In spite of its use, one of the Denver children died.

Last week Messrs. Bower, Balmforth and Hall, with money provided by the Ontario government, were busily building six steel replicas of their wooden respirators. Final cost for each respirator will be less than $500.



Here is another account, from “The Middle-class Plague: Epidemic Polio and the Canadian State, 1936-37” by Christopher J. Rutty.

The Toronto press focused considerable attention on the need for more life-saving iron lungs as the 1937 epidemic worsened through August. The emergency was leaving "little tots struggling for breath" in hospitals. HSC’s single Drinker machine was used for a small number of mild chest paralysis cases, but on 21 August, a young girl in critical condition was placed in the lung, which happened to be open, but it was clear that she would have to remain in it for a long time. She would then have to be "weaned" off the iron lung when evidence of recovery was clear and periods outside the iron lung could then be progressively lengthened. This situation greatly concerned HSC’s Superintendent, Joseph H.W. Bower. The City of Toronto had ordered one commercial machine for Riverdale Isolation Hospital. London and Hamilton had also ordered lungs. Yet it would be several days at least before Riverdale’s lung arrived, and it would be ten days to two weeks before another one would be available. With this news, Bower knew he would have to build respirators at the hospital for any bulbar cases that might develop.

Meanwhile a four-year-old boy had been admitted with chest paralysis on the morning of 26 August. As the Drinker machine was in use, an experimental respirator for premature infants was modified and coupled with a quickly-built wooden box in which the little boy was placed and stabilized. This "emergency-made ‘lumber lung’" "saved" the child’s life. The boy’s mother then turned to the newspapers to plead for the "wealthy to buy iron lungs," each of which was worth some $2,000. The prominent place of this appeal in the Toronto press reflected the unusual vulnerability to polio among the well-to-do, whose wealth could not protect them from this disease. Two more commercial "lungs" were eventually bought, largely through an "Anonymous Donor." Meanwhile, at HSC, efforts were concentrated on building more lungs. By noon of 27 August, plans were complete and enough parts were ordered and delivered by the next evening to start assembling the first iron lung. Two days later this first lung was complete and placed on HSC’s Infectious Floor; within fifteen minutes a patient was placed in it. By 31 August, four "homemade" iron lungs had been assembled in the hospital’s basement.



Hospital for Sick Children Iron Lung

The iron lung symbolized the disease and its worst possible effects while at the same time it provided the medical community with a specific and hopeful technological tool against them. Still, the limited supply and success of iron lungs, especially during the crisis of an epidemic, frequently raised the difficult ethical dilemma of having to decide who to treat and for how long. Nevertheless, the iron lung also gave the provincial government another opportunity to demonstrate that it was doing everything possible against the worst effects of this disease.


Incidentally, the Hospital for Sick Children (Sick Kids) is a national treasure, I know several people who work there and have had one of my own children treated there as well. They still provide first rate care.


In Australia they also built their own ventilators when they could not purchase enough of the Drinker commercial models in 1937.



Australian made "wooden" Iron Lung

Some Royal Navy men made a ventilator to save the life of a young army officer afflicted with polio in 1944.

A Personal Account of Home Made Ventilator Saving a Life

My post from last week about homemade ventilators used during the polio epidemics in the 1940s and early 1950s (Everything Old is New Again) generated some response. I received a personal account of a ventilator being quickly made for a child during a polio outbreak in Marquette Michigan. This is an account I got from Joan and Don Miller in Marquette, who generously let me reprint it here.



THE IRON LUNG IN MARQUETTE

These are some recollections of mine regarding the iron lung that I saved from my grandfather Max Reynolds belongings. It appears that the story I remember takes place in the late 1930's here in Marquette during the polio epidemic. I will start out with a bit of background on the gentleman and then relate the story of this device.

Grandfather Max came to Marquette as a civil engineer with an explosives company. He married into the Peter White family, one of the founding fathers of Marquette. As time went along Grandfather got very involved with what then was St. Lukes Hospital- now Marquette General Hospital, The Michigan Crippled Children's Clinic, and Bay Cliffs Health Camp. He also pursued two of his most cherished hobbies- boating and photography. The boating interest lead to the building of the Lake Superior Yacht Yard along with it the shop where many things were created and built.

Maxwell K. Reynolds became a director and chairman of the board at the hospital, then a small nonprofit hospital. So he was very interested in the day to day operations of the hospital. When the polio sickness arrived, he got started creating and building the Iron Lungs. I'm not really sure where he picked up the ideas, but he was a very inventive and creative person. So he guided his staff in making a number of these devices. Some of the lungs he made were built out of old oil drums, boxes, or about anything else he could find.

One day the hospital called with an urgent request for a lung. Apparently, they had a patient that required help quickly, and could he help. Max said he would provide a device. He went quickly to the old railway station and found an old refrigerator box- made of plywood in those days. He got that to the Shop and the crew started putting together the unit I still have. A door was made on one side, secured with window sash locks. The neck hole was secured with a rubber knelling pad with hole to fit the youngsters neck. Next, a source of vacuum, so grandmas vacuum cleaner was connected to the box. The air was let into the box with a simple plug valve that would be operated by an attendant to control the child's breathing. Later they tried a phonograph as an actuator, but that required some extra time to perfect. So the story goes, from the first call to the time the unit was delivered was 4 hours!

I guess there are not too many people around now that can assist with this accounting. This is as I recall, and I must add that grand pa Max died when I was about 8 years old. He had many talents and tried to get me started on some of them. I only wish that we had a bit more time, since he was quite a guy!

Recalled by Peter W. Frazier, grandson to Maxwell K. Reynolds, Marquette, Michigan



There is a similar account in the Marquette Monthly of Sep 2006, Back Then.

Link here:
The Wooden Lung, Fighting polio with boxes and vacuum cleaners. by Becky Kratz

Everything Old is New Again

Workshop Built Ventilators

I return to something I mentioned in an earlier post about homemade (wooden) iron lungs described in a 1950s Popular Mechanics article. the link under the picture will take you to a site that posts the original complete assembly plans.

Intended only for emergency use until a commercial respirator could be obtained, this “wooden lung” was designed by engineers and built by a volunteer group under the supervision of Dr. Gerald M. Cline, Dr. Homer O. Dolley, and Sister Celine of the medical staff of St. Joseph’s Hospital, Bloomington, Illinois. On completion, the unit was put into immediate use in emergency treatment of eight-year-old Rudy Landheer, a victim of polio in the epidemic of 1949. The original unit did emergency service for 12 hours until a conventional iron lung could be obtained.

Popular Mechanics Jan 1952 Emergency Wooden Iron Lung

I will also talk about some of the earliest positive pressure ventilators built in Great Britain and home made iron lungs used in the United States.

The British ventilators were built in Newcastle for anesthesia and also the polio epidemic in the late 1940s and 1950s. These ventilators were built by the inventive Newcastle professor of Anesthesia Edgar Pask, his chief technician Norman Burn and his staff of highly able technicians using war surplus parts.

This is the Newcastle ventilator. (Known as a respirator at the time.) Just as we named our ventilator “Vinnie”, they named the ventilator they designed and built. They named theirs “Mother”.

"Mother"

The electric motor was controlled by mercury switches. A spinning disc allowed speed variation, and a camshaft moved four small bellows up and down to provide the ventilation.

After the success of their first ventilator design they wanted to design another that could be easily and cheaply and quickly constructed by any able technician. They were building these ventilators to save lives in the polio epidemic. There simply were not enough “iron lungs” available in Britain to deal with this epidemic. There were about 1000, but many of these were already in use. There were 1000 cases of polio in 1946 in England and Wales, but this increased to 9000 by 1947. The use of a ventilator could reduce the death rate of those polio victims that were afflicted with respiratory paralysis from 90% to 30%.

One version of a cheap and easy to build ventilator was the Bang ventilator of 1953. This design was shared with others and similar units were built elsewhere.

The Newcastle "Bang" ventilator

The “Bang “ ventilator design worked well, but it required frequent adjustment and maintenance. The mercury switches it used were important for anesthesia, but were not required for polio patients. They could also be difficult to obtain.

They then built two prototype "polio ventilators" out of materials that were readily available in any workshop. The “blow” side of a domestic vacuum cleaner powered these ventilators. Up to 10 ventilators could be powered from one Hoover.

Two Polio Ventilators

These ventilators were made of plywood and perspex. The one on the left, used a magnet to operate its main valve. Inflation pressure was varied by adding weights onto the hinged flap on top much as we do with our design. There were no electronic controls and alarms. Cycling was controlled by regulating the leak out of the plastic bag under the flap. When the bag emptied, the magnet lowered and opened the main valve, allowing inspiration until the bag had filled enough to again lift the magnet from the valve, which would then shut until the bag was empty again

The device on the right used the "flick over" rocker from a light switch as a main switch which opened and closed a piece of tubing to allow gas flow. Inflation pressure was varied by altering tension in springs rather than by using weights, while controlled gas leak was still used to control cycling.

Both these devices split the inlet air, from the vacuum cleaner, to both the patient and the control bag. The expansion of the bag triggered the main valve that stopped the flow of air and allowed expiration.

The inspiratory and expiratory phases of the wooden polio ventilator

Above is a more functional diagram of one of the “Polio” ventilators. These devices seem incredibly crude by today’s standards. Even with the most basic of control systems and electrical valves, a far more sophisticated and reliable system can be constructed today. The people that designed and built these early ventilators were very inventive, brave and capable. They saw the need for ventilators during the polio epidemic and did whatever was required, in order to supply them. Although these units seem crude, they, and others like them saved many lives that would have been lost.

These early ventilators were followed by many more, for both adults and infants. "Home made" ventilators of all shapes and sizes were used for another thirty years at the Royal Victoria Infirmary.




In America, the polio epidemic also caused a large demand for ventilators. There was more demand than could be supplied by the existing stock of "iron lung" negative pressure ventilators.

An Iron Lung ward filled with polio patients. 1953

Rancho Los Amigos Hospital, Downey California

During the height of the polio epidemic years, the iron lung became such a crucial part of treatment that Philip Drinker and Edgar L. Roy offered instructions for building a makeshift emergency ventilator for cases of life-threatening paralysis. Although this emergency version of an iron lung was only intended for use until a board-approved version arrived, it was functional enough to save lives.

Image of an emergency ventilator, from the article by Drinker and Roy.

In contrast to the original, professionally crafted iron lung of 1929, Drinker and Roy employed common household and conveniently available hardware store materials in their emergency respirator. The materials included a car inner tube for a rubber collar, a common vacuum pump to provide pressure, a six-inch square piece of double-thick glass, a piece of sole leather to serve as the valve, a glass U-tube with colored water to show pressure, and several pieces of spruce wood. Drinker and Roy provided detailed construction plans and clearly indicated that it was an emergency respirator that could only accommodate small children and was not meant to replace the standard-size iron lung. Nonetheless, they fully supported its use in emergency situations

Assembly diagram

You can see these and more at :

The Brian Welsh Memorial Museum of Anaesthesia

Popular Mechanics Jan 1952 Emergency Wooden Iron Lung

University of Virginia Historical Collections at the Claude Moore Health Sciences Library


Here is a personal account of a homemade ventilator quickly built and used to save the life of a child