Paul Alexander is offered a cut while within an iron lung in his residence in Dallas, Texas. Photograph: Allison Smith/The Guardian
When he was six, Paul Alexander contract polio and was paralysed because that life. Now he is 74, and one the the last human being in the human being still using an stole lung. Yet after making it through one fatal outbreak, the did not suppose to find himself intimidated by another


The summer that 1952 was hot, also by Texas standards: 25 days above 100F (38C), the “cool” work not lot cooler. But across the state, swimming pools to be shut. Cinemas, too, and bars and bowling alleys. Church solutions were suspended. Cities doused their highways with DDT insecticide; by now, health officials knew the mosquitoes didn’t spread the disease, however they had to be viewed to it is in doing something. Nothing seemed to work. Together the summer wore on, the numbers of polio cases grew.

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One work in July, in a quiet Dallas suburb, a six-year-old boy called Paul Alexander to be playing exterior in the summer rain. That didn’t feeling well – his neck hurt, his head pounded. Leaving his muddy shoes in the yard, he walked barefoot right into the kitchen, letting the display door slam behind him. Once his mommy looked up in ~ his feverish face, she gasped. She made him operation out and grab his shoes, climate ordered him come bed.


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Paul spent the an initial day in his parents’ bed, filling in Roy Rogers colouring books. However even as his fever soared and also aching pains blossomed in his limbs, the household doctor advised his parents not to take him to hospital. It was clear that he had actually polio, however there were simply too plenty of patients there, the medical professional said. Paul had a far better chance that recovering in ~ home.

Over the next few days, the boy’s problem worsened. Five days ~ he had walked right into the kitchen barefoot, Paul could no longer host a crayon, speak, gulp down or cough. His parents rushed him come Parkland hospital. Despite the employee were well trained and also there to be a dedicated polio ward, the hospital was overwhelmed. There to be sick youngsters everywhere, and also nowhere to treat them all. Paul’s mother hosted him in her arms and also waited.

When the young was finally seen by a doctor, his mom was told the there was nothing to be done for him. Paul to be left on a gurney in a hallway, right breathing. He would certainly have passed away had an additional doctor not decided to examine him again. This 2nd doctor choose him up, ran with him to the operation theatre and performed an emergency tracheotomy come suction out the congestion in his lungs that his paralysed human body couldn’t shift.

Three job later, Paul woke up. His body was encased in a an equipment that wheezed and sighed. He can not move. He can not speak. He can not cough. He couldn’t see with the fogged home windows of the heavy steam tent – a vinyl hood that retained the air about his head moist and the mucus in his lungs loose. He believed he was dead.

When the tent was at some point removed, every he could see were the heads of other children, your bodies encased in steel canisters, nurses in starched white uniforms and caps floating between them. “As far as you have the right to see, rows and rows of stole lungs. Full of children,” that recalled recently.


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Children in stole lungs during a polio outbreak in the united state in the 1950s. Photograph: Science history Images/Alamy stock PhotoThe next 18 months were torture. Although he couldn’t talk since of the tracheotomy, he could hear the cries that other youngsters in pain. The lay for hours in his own waste since he can not tell the employee he necessary to it is in cleaned. He almost drowned in his very own mucus. His parental visited nearly every day, yet his visibility was unrelentingly boring. He and also the other youngsters tried to communicate, making deals with at each other, but, Paul said: “Every time I’d make a friend, you will do it die.”

Paul recovered from the initial infection, however polio left him almost completely paralysed native the neck down. What his diaphragm could no much longer do for him, the iron lung did. Paul lay flat on his back, his head resting on a pillow and also his human body encased in the metal cylinder native the neck down. Waiting was sucked out of the cylinder by a collection of leather bellows it is provided by a motor; the an adverse pressure developed by the vacuum required his lungs to expand. When the air to be pumped back in, the adjust in pressure gently deflated his lungs. This to be the consistent hiss and sigh that preserved Paul alive. He can not leave the lung. When medical staff opened it to wash him or manage his bodily functions, he had actually to hold his breath.

What Paul remembers many vividly around the ward is hearing the doctors talk about him when they walked through on your rounds. “He’s walking to die today,” lock said. “He shouldn’t be alive.” that made him furious. The made him want to live.

In 1954, when Paul to be eight, his mother gained a call from a physical therapist who worked with the march of Dimes, a united state charity devoted to eradicating polio. Paul’s months on the polio ward had actually left him v a are afraid of doctors and also nurses, however his mommy reassured him, and so the therapist, granny Sullivan, started visiting twice a week.

Paul called the therapist about the times he had been compelled by medical professionals to shot to breathe without the lung, exactly how he had actually turned blue and also passed out. He additionally told her around the time he had gulped and “swallowed” part air, virtually like breathing. The an approach had a technological name, “glossopharyngeal breathing”. You trap air in your mouth and throat cavity by flattening the tongue and also opening the throat, as if you’re speak “ahh” because that the doctor. V your mouth closed, the neck muscle pushes the air down past the vocal cords and into the lungs. Paul dubbed it “frog-breathing”.


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Paul Alexander in his stole lung. Photograph: Allison Smith/The GuardianSullivan do a attend to her patient. If he might frog-breathe without the iron lung for 3 minutes, she’d offer him a puppy. It take it Paul a year to discover to do it, yet he acquired his puppy; he referred to as her Ginger. And also though he had to think around every breath, he got better at it. Once he can breathe reliably for long enough, he could get the end of the lung for brief periods that time, first out top top the porch, and also then into the yard.

Although the still required to sleep in the stole lung every night – he couldn’t breathe once he was unconscious – Paul didn’t stop at the yard. In ~ 21, he came to be the first person come graduate indigenous a Dallas high school without physically attending a class. He acquired into southerly Methodist college in Dallas, after recurring rejections by the university administration, then right into law college at the college of Texas at Austin. Because that decades, Paul to be a lawyer in Dallas and also Fort Worth, representing clients in court in a three-piece suit and a modified wheelchair that hosted his paralysed human body upright.

At a time once disabled human being were less often seen in publicly – the Americans through Disabilities Act, i beg your pardon banned discrimination, wouldn’t be passed till 1990 – Paul to be visible. Over the food of his life, he has been top top planes and also to strip clubs, viewed the ocean, prayed in church, please in love, live alone and also staged a sit-in for disability rights. He is charming, friendly, talkative, quick to anger and quick to make a joke.

At 74, he is when again confined to the lung full-time. Only one other human being in the united state still uses one. The last human to usage an iron lung in the UK passed away in December 2017, in ~ the age of 75. No one expected someone who required an iron lung come live this long. And also after enduring one deadly epidemic, Paul walk not intend to uncover himself endangered by another.

Poliomyelitis kills by suffocation – no by damaging the lungs, together Covid-19 does, but by attacking motor neurons in the spinal cord, weakening or severing communication in between the central nervous system and also the muscles. The taking place paralysis means that the muscles the make it possible to breath no longer work.

Polio exist in isolated outbreaks about the world for millennia, however it didn’t become epidemic until the 20th century – helped, ironically, by enhancements in sanitation. Poliovirus start the body with the mouth, via food or water, or unwashed hands, contaminated with infected faecal matter. Until the 19th century, almost all youngsters would have come in call with poliovirus before the period of one, while lock still appreciated protection from maternal antibodies transferred from mom to baby during pregnancy. However, as sanitation improved, youngsters were less likely to come into call with poliovirus together babies; once they encountered it as older children, their immune solution were unprepared.

In the US, from 1916 onwards, every summer carried an epidemic that polio in some component of the nation. At its top in the 40s and 50s, the virus was responsible for much more than 15,000 instances of paralysis in the united state each year. During this same period, it killed or paralysed at least 600,000 civilization annually worldwide. The year Paul contract the virus, 1952, saw the largest single outbreak the polio in us history: virtually 58,000 cases across the nation. That those, more than 21,000 civilization – mostly children – were left with varying degrees of disability, and 3,145 died.


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A caregiver adjusts Paul’s head rest. Photograph: Allison Smith/The GuardianThough polio was not the many lethal of epidemic diseases, it transformed almost everywhere it touched. “It was like the plague, it drove anyone mad,” Paul called me as soon as I an initial spoke to him critical year. In areas where outbreaks occurred, households sheltered in fear at residence with the home windows shut. All kinds of public gathering places closed. Human interactions were laced with uncertainty. According to the historian David Oshinsky, some people refused to talk on the phone out of concern that the virus could be sent down the line. Throughout the first major outbreak in new York in 1916, 72,000 cats and also 8,000 dogs were eliminated in one month after a rumour went roughly that pets transmitted the condition (they don’t). By the 40s, parents had actually their kids perform “polio tests” every day during the summer – touch their toes, tuck their chin to their chests, checking because that pain or weakness – if insurance carriers sold “polio insurance” to parental of brand-new babies.

Before the come of a vaccine in 1955, what make polio for this reason terrifying was that there to be no method of predicting that would walk far from an infection through a headache, and also who would never ever walk again. In many cases, the disease had no discernible effect. The the 30% or so who verified symptoms, many experienced only minor illness. Yet a little proportion, 4-5%, displayed serious symptoms, including excessive muscular pain, high fever and also delirium. Together the virus hacked its means through the neural tissue of the spinal cord, a couple of of those infected were paralysed; this progression of the virus was recognized as paralytic polio. About 5-10% of patient who captured paralytic polio died, back this number to be far greater in the days before widespread usage of the stole lung.

If we had forgotten the terror that epidemics, us are currently being forcibly reminded. The critical time i spoke come Paul, in April, it was over Skype, indigenous our corresponding lockdowns – him in his iron lung in an apartment in Dallas, with a rotating staff of permanent carers and an Amazon Echo next to his head, and also me in my house in Surrey, England.

Like polio, Covid-19 have the right to be sent by silent carriers who don’t know they have actually it. Prefer polio, it has actually put common life ~ above hold. And also just as with polio, we room pinning our wishes on a vaccine. Over there is even talk the bringing back the stole lung – a UK-based initiative is trying to bring a new negative-pressure ventilator called Exovent come hospitals because that Covid-19 patients. Unlike positive-pressure ventilators, this smaller sized iron lung would fit over the patient’s chest, enabling them to continue to be conscious, speak, eat and take medicine orally as a machine breathes for them.

“It’s exactly the means it was, it’s nearly freaky to me,” Paul claimed of the parallels between polio and Covid-19. “It scares me.”

Though this virus, if he it s okay it, will most likely kill him, life hasn’t readjusted dramatically because that Paul due to the fact that the start of the pandemic. The hasn’t been able to venture outside of his lung for an ext than 5 minutes in years. As among his friends told me: “It’s no a strain because that him, the his life. This is grandfather Shelter-in-Place.” i asked Paul if he is worried about Covid-19. “Sure, sure,” that said. Then he added: “Well – ns don’t sit around and also worry around it. I’m dying a lot. It no make any kind of difference.”

Paul’s wellness has constantly been precarious, however it has decreased in the past couple of years. As soon as I very first met him in might 2019, he to be a irreversible inpatient in ~ Clements Hospital in north Dallas. Much more than 4 months earlier, the had arisen a persistent respiratory tract infection, which had actually sent him come hospital. He likewise suffers ache in his foot every time the is moved. He had hoped the physicians could aid him control that pain, but, the told me, “It’s not around to go away,” looking up from a pillow ~ above a broad board attached come one finish of the lung. His voice is slow, raspy and sometimes punctuated by gasps. Listening Paul end the machine’s consistent sighs calls for the listener to focus on him and also tune out the lung; accordingly, that is offered to gift listened to.

Next come Paul’s head was a clear plastic stick, flat and around a foot long, with a pen attached to the finish of it. His dad crafted a stick choose this as soon as Paul to be a child, and he has been making use of versions of the since. That clamps the end of the rod in his mouth and also manipulates the pen to write, type and push buttons on the phone; he provided it to sign the hospital’s waiver permitting him to talk to me, although that bristled at having actually to authorize anything at all to tell me his own story. “That is the most ridiculous thing,” the grumbled. Paul’s teeth are flattened and also worn from year of using the stick. Despite his body within the lung is scarcely larger than the was once he to be a child and his muscles atrophied, his neck actions 18 customs around and also his jaw muscles bulge.

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Paul’s steel lung – his faithful “old steel horse” as he calls it – is the butter-yellow colour of 50s kitchen appliances. Its metal legs, ending in black rubber wheels, progressive it to a elevation that suits a caregiver, while home windows at the top enable them to see inside, and four portholes ~ above the political parties let them reach in. To open up the machine, i m sorry weighs virtually 300kg, carers have to release the seals in ~ the head and slide the user the end on the interior bed. The portholes, the press valves, the cylindrical shape and also the colour all provide the impression the a sturdy miniature submarine.