An Australian woman, who spent a world record-breaking 60 years confined to an iron lung after contracting polio died Saturday in a Melbourne nursing home, aged 83.
June Middleton was paralysed when she entered the respiratory chamber in 1949, aged 23, and doctors gave her a slim chance of survival.
Family friend Robyn Butterworth said Middleton, who was thought to hold the world record for the longest time spent in an iron lung, was an inspirational woman.
"She went through a lot but she had a great sense of humour, liked to tell a joke," Butterworth told state radio, confirming Middleton's death.
"She just loved life. Whatever was given to her she lived it day by day." Middleton said she had no idea how she contracted polio, which was at epidemic levels at the time, but never felt pity for herself.
"I went to get out of bed to go to the toilet, which was down the other end of the flat. I couldn't get further than putting my legs over the bed. It's no respecter of age," she said in a 2006 interview with a television channel.
What is an iron lung?
An iron lung is a machine that enables a person to breathe when normal muscle control has been lost or the work of breathing exceeds the person's ability. It is a form of medical ventilator. Properly, it is called a negative pressure ventilator.
Humans, like many other animals, breathe by negative pressure breathing: the rib cage expands and the diaphragm pulls down, expanding the chest cavity.
This causes the pressure in the chest cavity to decrease, and the lungs expand to fill the space. This, in turn, causes the pressure of the air inside the lungs to fall (it becomes negative, relative to the atmosphere), and air flows into the lungs from the atmosphere: inhalation.
When the chest cavity is contracted, the reverse happens and the person exhales.. If a person loses part or all of the ability to control the muscles involved, breathing becomes difficult or impossible.
The person using the iron lung is placed into the central chamber, a cylindrical steel drum.
A door allowing the head and neck to remain free is then closed, forming a sealed, air-tight compartment enclosing the rest of the person's body. Pumps that control airflow periodically decrease and increase the air pressure within the chamber, and particularly, on the chest.
When the pressure falls below that within the lungs, the lungs expand and atmospheric pressure pushes air from outside the chamber in via the person's nose and airways to keep the lungs filled; when the pressure rises above that within the lungs, the reverse occurs, and air is expelled. In this manner, the iron lung mimics the physiological action of breathing: by periodically altering intra-thoracic pressure, it causes air to flow in and out of the lungs. The iron lung is a form of non-invasive therapy.
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. It proved a success and soon superseded the iron lung throughout Europe.
The iron lung now has a marginal place in modern respiratory therapy. Most patients with paralysis of the breathing muscles use modern 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.
However, negative pressure ventilation is a truer approximation of normal physiological breathing and results in more normal distribution of air in the lungs. It may also be preferable in certain rare conditions, such as Ondine's curse, in which failure of the medullary respiratory centers at the base of the brain result in patients having no 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.
Thus, there are patients who today still use the older machines, often in their homes, despite the occasional difficulty of finding the various replacement parts. Joan Headley of Post-Polio Health International told CNN that there are approximately 30 patients in the USA still using an iron lung. That figure may be low; Houston alone had 19 Iron Lung patients living at home in 2008. June Middleton of Thornbury, Victoria, who died on Saturday, having spent 60 of her 83 years in an iron lung, holds the record for the longest time spent in a iron lung.