Original publish date: May 7, 2020
Last month the General Motors Kokomo plant began mass production of the Ventec Life Systems V+Pro critical care ventilator under contract to the U.S. Department of Health and Human Services. The announcement stirred up memories of World War II plant production in paces like Indianapolis, Anderson, Marion, Muncie, Fort Wayne and other Hoosier cities and towns. The news also stirred up memories of a subject I’ve written about before: Polio. Perhaps America’s last great pandemic fight. I traveled down to Warm Springs, Georgia a decade ago to visit the campus of the Polio hospital there and met with several former patients, doctors and nurses along the way.
One of the subjects I meant to cover, but never got around to, was an urban legend from my childhood. Now seems as good a time as any to cover it. In 1927, cigarette manufacturers introduced new cellophane packaging for their over-the-counter individual packs of cigarettes. Along with the cellophane came a red waxed “paper” opener strip around the top of the pack to tear open the wrapper. Those red stripes have all but disappeared from cigarette packs today, but for over 60 years, they were as ubiquitous as the pull tab on a pop top can.
For many years, the legend was that if you saved the “red tear strip” on your cigarette wrappers you could redeem them later in life to use for time on an iron lung machine should you ever get Polio, lung cancer or any other health problem that might require you to use the machine. The red tear strip may have been the very first of the so-called “redemption rumors” that have been floating around as urban legends since before the Civil War. Redemption rumors usually claim that corporations will exchange product packaging material (bar codes, can tabs, gum wrappers, cigarette packages, etc.) for medical equipment (wheelchairs, iron lungs, dialysis machines, etc.) donated to hospitals or individuals.
The big problem with these rumors is that they are not tied to the companies that actually have such programs, so that they motivate people to collect huge numbers of bottle caps, empty packets and the like to no avail. The biggest companies are usually the most frequently targeted, recent years those have been mostly soft drinks, beer, cigarettes, and tea. Sadly, before kidney dialysis came along you typically were told to save cigarette packs to earn time on an iron lung. Knowing the damage smoking causes to the lungs, these red stripe redemption rumors truly proved to be a “sick bargain”.
Most redemption rumors were false, but not all of them. From 1948 till 1979 the makers of Vets Dog Food made a one to two cent donation to train seeing-eye dogs for every Vets label redeemed. Today Heinz baby food labels can be redeemed to benefit children’s hospitals and Campbell’s soup labels can be used to buy school equipment. In Indianapolis, funds received from the recycling of pop tabs add up to between $30,000 and $50,000 annually for Riley Children’s Hospital. All this money helps with the operating expenses of the Ronald McDonald House Charities of Central Indiana and traditionally covers the cost of operating 3 rooms in the House for an entire year. With redemption rumors, it can sometimes be hard to separate fact from fiction.
The Red Stripe / Iron Lung legend went nowhere and resulted only in kitchen drawers full of angry little strips of blood red cellophane exploding and filling the air every time a drawer was opened too quickly; static electricity causing them to adhere firmly to every flat surface in sight. The legend took root during the height of the Polio epidemic in the 1930s, 40s and 50s when images of helpless little children confined in menacing looking steel tubes viewing life only through the confines of a tilted rear view mirror placed inches above their chin were routinely found in every newspaper and magazine of the day.
Even though it was a hoax, it didn’t mean it was a bad idea. In the 1950s, the Betty Crocker franchise started a coupon program run by General Mills. Most folks redeemed the coupons for kitchen utensils, but beginning in 1969 General Mills OK’d several fundraising campaigns in which coupons were used to purchase some 300 kidney dialysis machines. The company soon stopped dialysis drives due partly to complaints that it was “trading in human misery.” The program ceased operation in 2006.
Humans, like most mammals, breathe by negative pressure breathing in which the rib cage expands and the diaphragm contracts, 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 decrease (it becomes negative, relative to the atmosphere), and air flows into the lungs from the atmosphere: inhalation. When the diaphragm relaxes, 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.
Due to the eradication of Polio in most of the world, the iron lung has become largely obsolete in modern medicine. Not to mention, superior breathing therapies have been developed and modern ventilators, like those General Motors is creating in Kokomo, are more efficient at a fraction of the cost and size. Although a common sight to our grandparents generation, the iron lung is unfamiliar to our modern eyes. An iron lung is a ponderous sight to behold, as is the patient contained within it.
The most common iron lung, known as a “Drinker respirator”, was designed to provide temporary breathing support for people suffering paralysis of the diaphragm and intracostal muscles, which are essential for respiration. Developed in 1929, it came to be an important tool for the care of sufferers of paralytic polio. Strictly defined, “the iron lung is a large horizontal cylinder, in which a person is laid, with their head protruding from a hole in the end of the cylinder, so that their nose and mouth are outside the cylinder, exposed to ambient air, and the rest of their body sealed inside the cylinder, where air pressure is continuously cycled up and down, to stimulate breathing. To cause the patient to inhale, air is pumped out of the cylinder, causing a slight vacuum, which causes the patient’s chest and abdomen to expand (drawing air from outside the cylinder, through the patient’s exposed nose or mouth, into their lungs). Then, for the patient to exhale, the air inside the cylinder is compressed slightly (or allowed to equalize to ambient room pressure), causing the patient’s chest and abdomen to partially collapse, forcing air out of the lungs, as the patient exhales the breath through their exposed mouth and nose, outside the cylinder.” (The Iron Lung, Science Museum Group, Kensington, London, England, U.K)
In some cases, especially during the height of the Polio epidemic, larger “room-sized” iron lungs were also developed, allowing for simultaneous ventilation of several patients at once (each with their heads protruding from sealed openings in the outer wall), with sufficient space for a nurse or a respiratory therapist to be inside the sealed room, attending the patients. Rows of iron lungs filled hospital wards during the 1940s and 1950s, helping children and some adults, with bulbar polio and bulbospinal polio. A polio patient with a paralyzed diaphragm would typically spend two weeks inside an iron lung while recovering. The iron lung was used on patients before they were able to recover and either breathe on their own, or with the use of assistive respirators.
By 2018, there were only 3 of these 700 pound behemoth iron lung machines operating in the United States. Some machines have a tray that slides out of the tube, others require the patient to climb into the bed of the pod, upon which the patient lays and is then pushed into the machine. The patient’s head is the only part of the body visible once the machine is closed, and the neck collar is adjusted to keep it airtight. Since the head is exposed, patients can eat and drink in the machine but, since both are done while laying down, swallowing can be a challenge and must be done carefully. Since the machine is pushing / pulling the patient, swallowing must occur while the machine is breathing out. Coughing and sneezing can be a challenge since both are involuntary and cannot be properly timed with the rhythm of the machine. The mechanics are under the bed, which produces a vibrating sensation for the patient.
Today’s ventilators, like those being made in Kokomo right now, are much more portable and are mostly described as “breathing machines” that can be carried as easily as a briefcase. For extreme breathing cases, smaller single-patient iron lungs, known as “Cuirass ventilators” (named for the Cuirass, a torso-covering body armor worn by armored knights), are used. The Cuirass ventilator encloses only the patient’s torso, chest or abdomen, but otherwise operates essentially the same as the original, full-sized iron lung. The lightweight variation of the cuirass is a jacket ventilator or poncho / raincoat ventilator, which uses a flexible, impermeable material (such as plastic or rubber) stretched over a metal or plastic frame placed over the patient’s torso.
And, although the idea of the old fashioned iron lung mostly only survives in the collective public memory of baby boomers, the COVID-19 pandemic has revived some interest in the device. Thanks to the internet, public safety scams and urban legends proliferate our life daily. As silly as the idea of saving red stripes from packs of cigarettes to exchange for time in iron lungs sounded to the enlightened twenty years ago, when viewed through the periscope of new age social media theory today, it fits right in. And Covid-19 has reignited fears of epidemics past including Polio and the Spanish Flu (which allegedly originated in Kansas by the way). So, in short, there is nothing new under the sun and the takeaway from all of this is that, hopefully, this too shall pass.