25 days in the summer of 1952 were hotter than 100 degrees Fahrenheit (38 degrees Celsius), and the “cool” days weren’t much more relaxed. Swimming pools, however, were closed throughout the state. Theatres, pubs, and billiard halls also fall under this category.
Worship at the churches was put on hold. Cities sprayed their streets with DDT pesticide; health authorities at this point understood that mosquitoes did not carry the illness, but they had to be seen to be doing something. We tried everything, but nothing worked. The number of reported cases of polio skyrocketed as the summer progressed.
CREDIT: John Young / The Dallas Morning News
Paul Alexander, then six years old, played in a Dallas suburb in the rain one rainy day in July. His head and neck ached, and he felt generally ill. He slammed the screen door behind him as he stepped barefoot into the kitchen, having left his dirty shoes outside. His mother’s first reaction upon seeing his hot face was shocked. She sent him out to get his shoes, then told him to go to bed.
CREDIT: PAUL ALEXANDER
Paul stayed in his parent’s bed the whole first day, coloring in Roy Rogers’s books. However, the family doctor insisted that his parents not rush him to the hospital, even as his temperature rose and his limbs ached.
The doctor indicated there were too many patients to do anything about the man’s polio diagnosis. At home, Paul’s chances of making a full recovery were higher.
The boy’s health continued to deteriorate over the following several days. Paul could no longer hold a pencil, talk, swallow, or cough five days after he stepped barefoot into the kitchen. They took him in an ambulance to Parkland Medical Center.
Despite having a qualified staff and a special polio ward, the hospital could not cope with the number of patients. As a result, an overwhelming number of ill children and inadequate medical facilities. While she waited, Paul’s mom cradled him in her arms.
The doctor informed the boy’s mother that he was hopeless when he finally saw him. St. Paul was abandoned on a gurney in the corridor, barely holding his breath. If a different physician hadn’t opted to take a look at him, he likely would have passed away.
When his paralyzed body could not clear the congestion from his lungs, a second doctor lifted him and rushed him to the operating room, where he had an emergency tracheotomy.
After three days, Paul regained consciousness. The contraption that housed his body wheezed and groaned as it worked. There was nothing he could do. He was at a complete loss for words. He couldn’t cough.
The vinyl hood that kept the air surrounding his head wet and the mucus in his lungs loose had fogged up, so he couldn’t see out of it. The notion of dying had already crossed his mind.
The nurses in their crisp white uniforms and headgear floated between the metal canisters holding the remains of the other children, which he could only see when the tent was lifted. “Iron lungs in neat rows as far as the eye can see. “It was packed with kids,” he said, reflecting on it lately.
The subsequent 18 months were a living hell. Although he could not express himself verbally due to his tracheotomy, he could hear the screams of other suffering youngsters. He sat in filth for hours, lacking the language skills to request assistance.
He was almost overcome by his own mucous. His parents visited him almost daily, but his life was otherwise monotonous. Paul said that if he and the other kids made a buddy, that person would soon die.
CREDIT: SMILEY N. POOL/THE DALLAS MORNING NEWS VIA AP
Paul survived the first illness, but polio left him almost paralyzed from the neck down. The iron lung took over for his failing diaphragm. Paul was lying on his back, head propped up on a cushion, with the metal cylinder encasing his body from the neck down.
A pair of leather bellows operated by a motor drew air out of the cylinder, creating a vacuum that caused his lungs to expand.
His lungs deflated somewhat due to the pressure difference when the air was reintroduced. The steady hiss and sigh of this mechanism were what kept Paul going.
His lung prevented him from escaping. He had to hold his breath whenever the medical personnel opened the door to bathe him or attend to his bodily functions.
Paul’s strongest recollection of his time on the ward is of the physicians commenting on him when they made their rounds.
They predicted that today would be his last. “He has no right to be here.” This infuriated him to no end, giving him newfound motivation to continue living.
Paul’s mother received a call from a physical therapist at the March of Dimes, a US organization working to eradicate polio, in 1954, when Paul was eight.
After months in polio, the ward left Paul wary of medical professionals, his mother soothed him, and Mrs. Sullivan, the therapist, started making twice-weekly visits.
Paul explained to the therapist how he had passed out and gone blue when physicians had made him attempt to breathe without the lung.
He also told her about when he had taken a big breath and “swallowed” air. Glossopharyngeal breathing was the formal term for the method. To achieve this, you flatten your tongue and open your neck, as if saying “ahh” to the doctor, to create a pocket of air.
When you breathe in with your lips closed, the muscle at the back of your throat guides the air through your vocal cords and into your lungs. According to Paul, this is akin to frog breathing.
With her patient’s consent, Sullivan struck a bargain. She promised him a dog if he could do the frog breath for three minutes without the iron lung.
Paul finally got his dog after learning the ropes for a year and naming her Ginger. In addition, he improved his breathing skills despite having to monitor each breath actively.
After stabilizing his breathing for a while, he could spend brief amounts of time outside, first on the porch and then in the yard.
Paul didn’t stop at the yard even though he still had to sleep in the iron lung every night (he couldn’t breathe while asleep). He was the first to graduate online from a Dallas high school at 21.
After being repeatedly rejected by the administration, he was eventually accepted to law school at the University of Texas in Austin and Southern Methodist University in Dallas. Paul practiced law in Dallas and Fort Worth for many years, representing clients in court while seated in a specially adapted wheelchair.
Paul was prominent in an era when persons with disabilities were not as standard; the Americans with Disabilities Act, which prohibited discrimination, would not be implemented until 1990.
He has traveled by airline and to the strip club, seen the ocean, attended church, been in love, lived alone, and protested for the rights of people with disabilities. He’s generous, chatty, quick to rage, crack a joke, and a joy to be around.
Now 74 years old, he is permanently restricted to a lung. I am the only other person in the United States who still uses one.
UK’s last iron lung user passed away in December 2017 at 75. Nobody thought someone who required an iron lung would make it this far. Paul had narrowly avoided a catastrophic pandemic and was unprepared to face a similar danger again.
To cause death, poliomyelitis attacks motor neurons in the spinal cord, weakening or cutting the connection between the central nervous system and the muscles and ultimately leading to asphyxia. The inability to use certain breathing muscles is a direct result of paralysis.
Even while sporadic cases of polio have been documented for millennia in different parts of the globe, the disease did not become endemic until the 20th century, with the aid of better sanitary practices. It is possible to get polio by ingesting contaminated food or drink or touching your face or hands after touching feces that have not been adequately sterilized.
Even with the protection of maternal antibodies passed from mother to child during pregnancy, almost all children in the 19th century would have been exposed to poliovirus before their first birthday. However, as cleanliness increased, children were less likely to come into touch with poliovirus as infants; thus, their immune systems were unable to deal with the virus when they were older children.
Each summer in the United States, from 1916 forward, had a new polio outbreak in some regions. Amidst the height of the polio epidemic in the 1940s and 1950s, the virus caused more than 15,000 cases of paralysis annually in the United States.
At the same time, it was responsible for the deaths or disabilities of at least 600,000 people yearly around the globe. There were over 58,000 cases of polio in the United States in 1952, the year Paul caught the infection. More than 21,000 persons, primarily youngsters, suffered some handicap, and 3,145 died.
Even though polio wasn’t the worst pandemic illness, it profoundly impacted every region it swept across. When I initially talked to Paul this time last year, he said, “It was like the plague; it drove people nuts.” During epidemics, residents in affected areas stayed indoors, with the windows closed out of fear. Anywhere people commonly congregated stopped operating. Uncertainty permeated all human relationships.
The historian David Oshinsky claims several individuals avoided making phone calls for fear of spreading the infection. In 1916, when the illness first appeared in a big city, 72,000 cats and 8,000 dogs were murdered in a single month because of a false rumor that the animals were the source of the epidemic.
Insurance firms in the 1940s began offering “polio insurance” to new parents, and doctors advised them to have their children do daily “polio tests” during the summer (touching their toes, tucking their chin to their chests, testing for discomfort or weakness) to detect the disease.
There was no means of knowing who would go through a polio illness with a headache and who would never walk again before the development of a vaccine in 1955. Most people showed no symptoms of the condition.
Even among the roughly 30% who exhibited symptoms, the vast majority had mild sickness. However, a tiny percentage (around 4-5%) had severe symptoms such as delirium, high temperature, and severe muscle pain.
Some infected individuals developed paralysis as the virus progressed through the spinal cord’s neural tissue, a condition medically called paralytic polio. Paralytic polio has a meager fatality rate (5-10%), while it was much greater before the widespread usage of the iron lung.
We are being reminded once again how terrifying epidemics can be, in case we had forgotten. In April, Paul and I last chatted via Skype from our separate lockdowns: him in his iron lung in a Dallas apartment with a rotating team of full-time caretakers and an Amazon Echo next to his head, and me in my home in Surrey, England.
Covid-19, like polio, may be spread by asymptomatic carriers, and it has paralyzed society as polio did. And like polio, we’re counting on a vaccine to save the day.
There is even discussion of reviving the iron lung, with one project in the United Kingdom working on getting a new negative-pressure ventilator called Exovent into hospitals for use with Covid-19 patients.
Unlike positive-pressure ventilators, this tiny iron lung would fit over the patient’s chest. It would enable the patient to stay aware, talk, eat, and take medicine orally while the machine breathes for them.
Paul said that the similarities between polio and Covid-19 were “just the way it was. It’s almost frightening to me.” It gives me the willies.
Paul’s life hasn’t altered much since the pandemic’s beginning, even though he will surely die from this virus if he contracts it. It’s been years since he spent more than five minutes outside his lung. It’s not a burden for him; it’s his life, as one of his friends said. So, let me introduce you to Mr. Shelter-in-Place.
When I heard about Covid-19, I asked Paul whether he was concerned. Asserting, “Certainly, sure,” he agreed. After that, he said, “Well – I don’t sit around and worry about it. I seem to be passing away often. The answer is “it doesn’t matter.”
Paul’s health has been fragile for as long as anybody can remember, but it has worsened recently. When I first met him in May, he had been a long-term patient at Clements Hospital in north Dallas.
Over four months before, he had been hospitalized with a prolonged respiratory illness. Every time his legs are moved, he experiences excruciating agony. Looking up from a cushion on a broad board tied to one end of the lung, he said, “It’s not about to go away.”
He had thought the physicians might help him handle the agony. His speech is sluggish and harsh, with occasional gasps. Paul is accustomed to hearing his voice above the machine’s continual sighs, so he doesn’t mind being the center of attention.
CREDIT: SMILEY N. POOL
A transparent plastic stick beside Paul’s head had a pen on end. The post was approximately a foot long. Once upon a time, Paul’s father made him a stick much like this one, and ever since then, Paul has used various iterations of that stick.
He uses the pen end of the post by clamping it in his mouth and manipulating it to write, type, and punch buttons on the telephone; he used it to signal the hospital’s waiver permitting him to speak to me, although he was irritated that he had to sign anything to tell me his tale.
He moaned, “That is the most ludicrous thing.” Paul has used the stick for so long that his teeth have worn down and become flat. His neck is 18 inches across, and his jaw muscles protrude, yet his body within the lung is hardly more significant than when he was a toddler due to muscular atrophy.
Paul’s iron lung, also known as his “old iron horse,” is the buttery yellow of retro kitchen equipment from the 1950s. Windows at the top enable the carer to look inside, and four portholes on the sides allow them to reach in.
It stands on metal legs that finish with black rubber wheels. Caregivers must loosen the seals at the machine’s head to open the almost 300-kilogram device and slide the individual out on the inside bed. Everything about it, from the portholes to the pressure valves to the cylindrical form and the color, suggests a rugged little submarine.
No one expected the individuals wearing iron lungs to live very long, but the lungs were constructed to survive. Medical engineer Philip Drinker and physiologist Louis Shaw of Harvard University devised the device in 1928.
According to his sister and biographer, Catherine Drinker Bowen, Drinker was disturbed by what he witnessed in the Boston Children’s Hospital polio ward, including “the little blue faces, the dreadful gasping for oxygen.”
Thousands of youngsters would have perished because of his innovation, a simple device that replaced exhausted muscles. The maximum recommended time spent in an iron lung is two weeks to let the body recuperate.
The restrictive iron lung grew to symbolize the terrible consequences of polio throughout time. Those were reserved for the sickest patients; even if they survived, they often had permanent disabilities.
However, once the vaccine was given to children throughout the United States, beginning in 1955, the rate of measles cases dropped dramatically. Positive-pressure ventilators, developed in 1952 by an anesthetist in Copenhagen during a polio epidemic, were used to treat patients who needed short-term breathing help but were too weak to breathe independently.
These introduce air into and extract it from the lungs without going via the trachea, either through the mouth while the patient is sedated or through a hole cut into the trachea
. These, like the iron lung, were only meant to be used temporarily; the minority of persons who need respiratory assistance for the remainder of their life saw the permanent hole in their neck as a fair trade for the freedom that positive pressure provided. Iron lungs ceased production in the ’60s.
CREDIT: SMILEY N. POOL
However, Paul had become acclimated to life in his lung by the time positive-pressure ventilators became commonplace, and he had even learned to breathe without them for short periods. The thought of another hole being bored in his throat was equally unwelcome, and the iron lung remained in place.
The fear of polio has mostly disappeared from collective memory in the West due to the disease’s decrease and the fact that physical reminders of it are now confined to many homes and care facilities.
As Paul put it, “you can’t believe how many people strolled into my legal office and saw my iron lung and said: ‘What is that?'” It’s an iron lung, I’d say. How does it work? “Please take a deep breath for me,” he said. “Why?” “When I was a kid, I was struck by polio.” “What is polio?” Uh oh.”
Author of “Polio: An American Story,” David Oshinsky, claims that the anti-vax movement’s current rise may be directly attributed to vaccinations’ effectiveness in eliminating formerly widespread illnesses. He assured me that thanks to immunizations, we no longer have to worry about the terrifying nature of these illnesses.
It was clear that Paul was treated as somewhat of a medical celebrity when I met him at Clements Hospital; no one there had ever seen an iron lung. Two nurses entered the room while we were having this conversation.
They claimed to be from a different unit but were interested in seeing the guy in the iron lung. Paul excused himself, saying he was in the midst of an interview. A more senior nurse reassured the patient, “That’s all right, sir; we’ll just listen for a moment.” Paul informed me after they departed that this kind of thing often occurs. Simply put, he compared life in the city to a zoo.
Those who meet Paul usually go away feeling a little more modest about themselves. Retired nurse and longtime friend Norman Brown has known Paul since 1971 and has nothing but praise for him.
When they first encounter him, most people are struck with amazement. Paul is happy to field inquiries because, as he puts it, “I’m a lawyer. I’m paid to speak!”
What scares him more than the prospect of Covid-19 is that people would forget what it was like to have polio and what he accomplished despite it, so he enjoys talking about his experiences with the disease and the lung.
CREDIT: SMILEY N. POOL
A year and a half after Paul’s first admission at Parkland Hospital, on Christmas Eve 1953, his parents borrowed a generator and truck to transport him and his iron lung back to their house.
The trip was brief but nerve-wracking: “Any minute, it seemed like that old generator might go off,” Gus Sr. told a Texas newspaper afterward.
It was constantly exploding, and I wasn’t sure whether we would make it back safely. Since Paul’s prognosis was terminal, he was allowed to go home from the hospital.
On the other hand, Paul did not pass away. He put on weight after eating the most incredible bacon he’d ever had, prepared by his elder brother on the day he returned home.
His family shared the same first-floor living room he did, and they slept there every night with one eye open in case the swish-swish of the machine ever stopped.
It happened when there were blackouts—even now, Texan storms and tornadoes sometimes take down power lines—and his parents had to pump the machine by hand with the aid of their neighbors.
It took three years, but eventually, Paul could spend a few hours away from his lung. He informed me that frog breathing had become second nature, like riding a bike. During his 18 months on the ward, his schooling had fallen by the wayside. His mother decided to teach him to read, so she brought home many books from the local elementary school.
“I had so many lofty goals. “I was going to be president,” he said. It took almost a year for his parents and the parents of other challenged children in the Dallas area to persuade the school district to let him study at home.
At 13 in 1959, Paul was among the first pupils to sign up for the district’s new program for youngsters in their homes. “I realized that the only way I could do anything worthwhile was through my mind. He said, “I decided I wasn’t going to be a basketball player.”
Around the time when other students left school, he would wheel out front and wait for them in his wheelchair. His pals would push him about the city, and when they were older, they would take him to restaurants, pubs, and movies.
Then he visited a religious establishment. The Alexanders are members of the Pentecostal church, a branch of Christianity that emphasizes having an up-close and personal relationship with God.
The congregation is encouraged to pray at the altar after each service. Paul’s younger brother Phil told me, “My dad would take me down there to pray with him, and he would let all his emotions out there.” Said, “He’d weep and cry.”
Paul used a unique approach to handling his feelings. He was helpless since polio had taken away his mobility. There was a lot of venting of his rage. Phil said, “He was a talker. That’s quite clear to me. My parents never stopped him from venting his frustrations by letting him rage, scream, and swear in front of the television; they knew their son, Paul, needed a release and considered it “normal.”
For Paul, just thinking about it now causes pain. “There were moments when I was so frustrated that I wanted to shout. But his mother and father were “very tolerant. They appeared to understand,” he claimed. A steady stream of tears ran from his temple to the cushion as he spoke.
Paul, now 21 years old, finished high school in 1967 with almost perfect grades. He got a B in biology because he could not dissect a rat. Saying, “I was furious,” he elaborated. (And he still is.)
He had hoped to study at Dallas’ Southern Methodist University but was turned down despite his stellar grades. “I was too handicapped,” he replied wistfully. “It hurt me. I struggled with them for two years, calling them constantly. Well, hold on there, I’d say, “I want you to rethink, think about this. I’m on my way over there; I need to see you!
The faculty at his high school supported him. The admissions dean eventually agreed to let him in, but only on two conditions: (1) he finds a way to get to his courses, and (2) he obtains the polio vaccination.
In the words of Paul, he was “scared to death” when he walked into his first lesson. For context: “You need to know that in those days, nobody was disabled. Nothing else existed on campus, and I was alone.
There was no one else around everywhere I went. My first impressions of the restaurant and the movie theatre were, “Wow, there’s nobody out here. He responded, “I’ll clear the path. I always saw myself as a spokesman for the masses. Exactly because of this, I went to war. To paraphrase: “What do you mean I can’t return there? I mean, “I miss it and want to visit again.” As in, “That’s not something you can accomplish.” Yes, of course, I can! Always one to pick a battle, I was.”
Paul fell in love with Claire, a lady he met. This led to an engagement. But when he phoned one day, her mother — who had long disapproved of the connection — answered, wouldn’t allow him to speak to her, and urged him to stop contacting her daughter.
Years, he stated, were needed to recover from it. He decided to attend the University of Texas, so he moved there. After living at home while attending Southern Methodist University, he decided to go out on his own. His mother and father were petrified.
When Paul’s hired caretaker failed to show up for work at UT, the men in his dorm took care of him, including “the most personal stuff,” he recalled, for a whole month until he could find someone else.
After Paul received his diploma in 1978, he decided to pursue further education by enrolling in law school. In November 1980, he was once again the subject of press coverage: “Iron-willed man quits iron lung to vote,” read the headline in the Austin American Statesman.
Paul graduated from the University of Austin in 1984 with a law degree.
He began teaching legal terminology to court stenographers at an Austin trade school, even though he supported a full-time carer while pursuing his career.
He once told a reporter, “I don’t allow people to be uncomfortable for very long.” when asked whether his pupils were uneasy in his class.
After passing the bar test on May 19, 1986, he stood before the chief judge of the Texas Supreme Court and lifted his right thumb slightly as he swore an oath of honesty and integrity. He was 40 years old, well-dressed in a three-piece suit, single, and able to spend most of his day away from the artificial life support system that kept him going.
Central to Paul’s self-concept is how he learned to breathe independently. It symbolized the grit that allowed you to go to college, get your legal degree, and live a life of relative freedom.
His autobiography, released in April, is titled Three Minutes for a Dog, which comes from this experience. Over eight years, he tapped down his tale on the computer using a plastic stick and a pen or dictated it to his friend and former nurse, Norman Brown.
Although Kathy Gaines chose the book’s title, it was her choice. Kathy, 62, has been Alexander’s “arms and legs” since he arrived in the Dallas-Fort Worth region after completing law school, yet neither can pinpoint the exact moment they met.
Kathy’s inability to drive stems from her being legally blind for many years due to her type-1 diabetes. Each day of Paul’s five-month hospitalization last year, she rode the bus or hitched a ride there. She educated both the nurses and Paul on how to use the equipment.
Kathy handed Paul a plastic bendy straw and me a cup of hospital coffee as we spoke. She placed it where he could reach it with his tongue and lips, but it wasn’t in his way. When Paul says “biscuit,” Kathy knows to assume he means “English muffin,” shave his face, change his clothing and linens, cut his hair and nails, give him his toothbrush, take care of his paperwork, schedule his appointments, conduct his grocery shopping, and more. If she believes he’ll be uncomfortable with his head in a particular posture, she’ll sometimes shift it without asking. (That’s something he doesn’t always value.)
Paul claims that Kathy is well familiar with him. “Kathy and I developed together… she extended herself over as many things as I required,” he remarked. Kathy has spent most of their time together, living with Paul or nearby.
As a result of his unprofitable legal practice, they’ve had to uproot their lives often. Kathy now resides in the penthouse unit of their shared apartment complex. Whether in the office or not, she will run across him daily.
Paul and Kathy have never had a romantic connection, but Paul’s brother Phil likens their bond to that of a married couple. Paul “has always been assertive about things that he wants and requires around other people,” he claimed.
That guy is picky, and Kathy is much more particular than he is. They have their disagreements, but they always manage to resolve them.
Paul had always yearned to go out on his own. However, his ability to breathe hinges on his carers getting to work on time, his iron lung not overheating, and the lights on. Since he was only six years old, he has relied entirely on the generosity of others.
And he’s accomplished this via the power of his voice, Norman Brown said. I would sacrifice my morals and do things for him that I usually wouldn’t. He allegedly said I wanted to egg the manager’s door after being booted from an apartment.
Moreover, if he says, “I want to do anything,” take it as a command: you will carry it out. Brown joked, “We bought some eggs and went to the manager’s residence.
One of Paul’s biggest pet peeves is being overlooked. Once upon a time, he and his friend would go out, and the waiter would always inquire, “What will he be having?” The thought of that made him so angry that his voice trembled.
People dare to stand there and tell me what to do with my life, so I fight so hard: I don’t want anybody telling me what to do with my life. Saying, “You have no right to tell me what to do,” he continued. Thank God it wasn’t you while bowing down to the ground.
Paul has lost his immediate family: mom, dad, and big bro Nick. His childhood pals are all dead now. He even outlived the iron lung he was given, and the airtight seals failed and began leaking in 2015. Iron lung components and competent technicians are hard to come by.
Still, a Dallas engineer came through for Paul after his buddy uploaded a video of him online pleading for assistance.
Paul still has ambitious goals; he thinks his book will ” slam across the globe,” but Covid-19 poses a new threat. According to Phil, “perhaps the most susceptible you can become” is Paul regarding a virus like this.
He’s trying to have an optimistic outlook, but we’ve had talks about how this is the last straw, and there’s a high chance of it happening.
Paul had always feared that polio threatened to kill him and might return. I can see hospitals flooded with polio patients again and almost feel the pandemic coming. The physicians, I assure them, must prepare themselves. When I saw him in the ICU this time last year, he said, “They don’t believe me.
There hasn’t been a new incidence of polio in the United States since 1979 and in the United Kingdom since 1984, all because of widespread vaccination campaigns. By the year 2000, the whole western Pacific and the Americas were proclaimed polio-free by the World Health Organization.
After years of intensive vaccination efforts, in 2014, India was officially declared polio-free, despite having averaged over 200,000 annual cases in the 1990s. Just Afghanistan, Nigeria, and Pakistan remain endemic to the poliovirus, with only a few dozen new cases reported yearly.
However, Paul was correct in his assertion that the public has mostly forgotten the horrors of polio, just as we have forgotten the horrors of other illnesses we now regularly vaccinate against, such as diphtheria, typhus, measles, and mumps.
And if we let our guard down, it might provide them with the ideal conditions for a comeback. The likelihood of us forgetting about Covid-19 amid this epidemic is low. However, we may. The following day, it’s usually challenging to recall the details of our worst night time terrors. We need to remember the lesson of polio every time we are forced to face our own dreadful frailty and emerge unscathed.