The document discusses the history of ventilators from their early development in the 1800s to their widespread use during polio epidemics in the 1900s. It describes some key events and innovations: 1) The iron lung was invented in 1929 by Philip Drinker to treat polio patients and worked by changing the pressure inside an enclosed chamber. 2) During a major polio outbreak in Copenhagen in 1952, over 200 patients per day needed ventilation but there was a shortage of equipment, so medical students manually operated ventilator bags. 3) Improvised ventilators were also developed using materials like vacuum pumps, tubing, and wood when conventional equipment was unavailable, showing

1. Ventilatorens historie
The Use of a New Apparatus for the Prolonged Administration
of Artificial Respiration
Folkehelse 1929: The iron lung was invented in 1929 by Philip Drinker (1893-
1977), a professor at the School of Public Health at Harvard University.
Enlisting the help of his brother, Cecil, and Louis Shaw (1886-1940) Drinker, built a
prototype, tested it on cats, and designed a device large enough for humans.
The first iron lung used in the treatment of polio victims was invented by Philip
Drinker, Louis Agassiz Shaw, and James Wilson at Harvard, and tested October 12,
1928 at Children’s Hospital, Boston.
The original Drinker iron lung was powered by an electric motor attached to two
vacuum cleaners, and worked by changing the pressure inside the machine
Drinker startet opp med støvsuger-motorer (ikke vaskemaskin!)
1 Ventilatorens historie

2. POLIO-UTBRUDDET I KØBENHAVN 1952
In the Copenhagen epidemic of 1952, large numbers of patients were ventilated by
hand ("bagged") by medical students and anyone else on hand, because of the large
number of bulbar polio patients and the small number of ventilators available
Fra august til desember 1952 ble 2241 pasienter med akutt polio innlagt ved Blege-
dam-hospitalet i København. I den uken epidemien var på sitt mest intense, ble 320
pasienter med akutt polio innlagt. Av de 2241 pasientene hadde 345 puste- og/eller
svelgeproblemer. De var uforberedt: de hadde EN jernlunge (Emerson) og six `cui-
rass respirators' til rådighet. Under epidemien kom det 50 nye pasienter per dag.
Anestesilegen Bjørn Ibsen måtte argumentere for at sluttstadiet av polio ikke var utslukking
av hjernefunksjoner, men at disse pasientene var underventilert for åndedrettslammelse og
kunne reddes ved god ventilasjon! Løsningen var ekstrem: jernlungene kunne de klare seg
foruten: Poliopasientene skulle ha trakeostomi, og bli ventilert for hand så de ble sikret til-
strekkelig oksygen til lungene.
Lassen was unconvinced, but he gave Ibsen the benefit of the doubt. There followed one of
the most dramatic and in its consequences, profoundly influential, moments in the history of
medicine.
Lassen picked a twelve-year-old girl, Vicki. She ws in a very bad condition with paralysis of
all four limbs. She was gasping for breath. Her temperature was a hundred and two degrees
Fahrenheit. She was cyanotic [blue] and dying. Ibsen asked the ENT surgeon to perform a
tracheostomy, through which he introduced a cuffed tube attached to a ventilator bag. In-
itially he found it very difficult to ventilate her lungs, as the airways were in spasm. Within
minutes she was dying. Discreetly the hospital physicians who had gathered to observe the
new treatment realised they had duties elsewhere and started to drift away.
The girl too was, not surprisingly, becoming very agitated, so Ibsen gave her a slug of barbi-
turate Pentothal, at which point her own weak respiratory' efforts ceased. And as she stopped
breathing, her bronchi relaxed and Ibsen was finally able to ventilate her. When the other
physicians returned ... the girl's skin colour had returned to normal. Both body temperature
and blood pressure were restored to normal too. This twelve-year-old girl was the first pa-
tient during the epidemic who survived as a result of this medical intervention.'
Slik begynte intensivmedisin slik det idag praktiseres ved modern anestesiavdelinger
De hadde fortsatt ikke maskiner, lungene ble ventilert for hånd, på dugnad. På slut-
ten av epidemien hadde 1500 medisinstudenter deltatt i manuell bagging!
2 Ventilatorens historie

3. TIMELINE
Tidligst: The earliest one called the ‘iron lung’, was originally developed by Dalziel.
In 1832, Dr. John Dalziel of Scotland developed a box to ventilate a "drowned sea-
man."
Dr. E.J. Woillez designed an artificial respirator in 1876 that was said to have looked
and operated much like the Drinker or Emerson iron lung.
The great American inventor Alexander Graham Bell even built a test version "va-
cuum jacket" in the 1880s with hand-operated bellows much like those on the iron
lung.
In 1889, Dr. O.W. Doe reported to the Obstetrical Society of Boston on the devel-
opment of an infant resuscitator box by Dr. Egon Braun in Vienna. This early form
of artificial respirator obtained a pressure seal by having the child's mouth pressed
against a rubber diaphragm opening, while the rest of the body was entirely enclosed
within the wooden box.
The operator blew into the pipe to force the chest to compress, causing air to ex-
haust out of the pipe creating a suction that would expand the chest. This provided
life-saving artificial respiration.
According to the report, the operator would repeat the process twenty to thirty times
in a minute. Doe reports that Braun had used the artificial respirator device in fifty
cases and was completely successful. In comparison to modern respiration devices,
this early model only lacked a system of regulation and automation.
In 1918, the South African Dr. W. Steuart came closest to developing a machine
most like the ones that later made Drinker and Emerson famous. Steuart's machine
was a sealed wooden box made specifically for treating poliomyelitis that operated
by variable-speed, motor-driven bellows. Although his machine was supposedly a
great success, the work was never formally reported and therefore became largely
forgotten.
3 Ventilatorens historie

4. 1919 Only a year later, Tulane University physiologists Felix P. Chillingsworth and
Ralph Hopkins developed and tested a dog plethysmograph which produced ventila-
tion by means of an electric pump that produced rhythmic variations in pressure.
This device could have operated as a respirator had it been fully pressurized with a
neck seal.
1920 During the 1920s people who could not breathe on their own were aided by a
pulmonator. This was a machine similar to fireplace bellows. It inflated and deflated
the lungs by forcing air in and then sucking it back out again.
Previous artificial resuscitators, such as the pulmonator, were also poor solutions as
their air supplies were too forceful and damaged other organs.
1929 Drinker and McKhanns studies found that manual methods of artificial re-
suscitation had been ineffective in providing the necessary oxygen interchange and
could not be used for extended periods of time. They outlined several main objec-
tives in their respirator design: long and steady function, adaptability to many ages
and sizes, the ability to regulate the rate and depth of respiration, and the ability to
provide proper artificial respiration without harming the patient.
In 1931, inveterate tinkerer John Haven "Jack" Emerson unveiled a less expensive
iron lung. Drinker and Harvard promptly sued Emerson for patent violations, which
proved unwise. In the subsequent legal battles Emerson demonstrated that every
aspect of Drinker's patents had been patented by others at earlier times. Emerson
won the case, and Drinker's patents were declared invalid.
In 1977, the National Health Interview Survey reported that there were 254,000
persons living in the United States who had been paralyzed by polio.
4 Ventilatorens historie

5. SELVHJELP - NØDVENTILATOR
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, bilslange
a common vacuum pump to provide pressure, støvsuger
a six-inch square piece of double-thick glass,
a piece of sole leather to serve as the valve, (skosåle lær)
a glass U-tube with colored water to show pressure,
and several pieces of spruce wood. furuplanker
Image of an emergency respirator, from the article by Drinker and Roy.
5 Ventilatorens historie

6. IMPROVISASJON
Ideene ble tatt i bruk. Her er fra en BMJ artikkel i 1958.
SIR, On a recent trip to New Zealand a passenger contracted poliomyelitis of a rapid-
ly ascending type.
De var altså til sjøs, uten noen andre til å hjelpe seg og klarte å bygge et apparat så
han kunne puste, og holdt liv i ham en stund med denne kassa:
Se litt på denne arbeidstegningen:
6 Ventilatorens historie

7. CASE: LT WESSELHOEFT:
Fisher var en prest som hadde arbeidet i Kina i 16 år,
I 1943 hjalp han noen amerikanere fra ATCs India-China division.
I en annen artikkel i samme bladet (forsiden) er Glenn Miller meldt savnet….
Her sitter piloten alene i flyet, flyr med den ene hånden og pumper luft i pasienten
med den andre:
Among Fisher's American guests was a non-flier, Lt. Robert Wessel-
hoeft, Jr., stricken with infantile paralysis, while on a photo-
mapping expedition. Unable to breathe, Wesselhoeft was kept alive
14 days at the Fisher mission by artificial respiration, and then flown
out in an L-5
whose pilot, Maj. Welch, worked the lever of a primitive lung-
compressing apparatus with one hand and flew the little plane with
the other for three hours.
Wesselhoeth was later taken by ATC to Calcutta in a hospital plane
and after more than two months in a hospital, was flown to Wash-
ington in an improvised iron lung, stopping at the Azores to pick up
Lt. Mary E. Hoadley, a flight nurse who had once attended Fred
Snite, Jr., in his iron lung in Miami.
Lt. Wesselhoeft arrived in Washington sufficiently recovered from
his ordeal to joke with reporters.
7 Ventilatorens historie

8. IMPROVISASJON 2
Disse kom fra et hangarskip til et militærhospital med en jernlunge og to pasienter..
så da måtte de bygge en:
it was suggested that H.M.S. Hermione should attempt the manufacture of an iron lung, as
the only available one was in use.
from the experience of these two cases it is obvious that a unit, sufficient for the immediate
purpose and at little expense, can be put together in a very short time; secondly, that the unit
can be made from materials readily available in H.M. ships,
Oljetønne med motor fra en vaskemaskin ….
8 Ventilatorens historie

9. REDNINGSAKSJON
Her forteller de om to pasienter I jernlunge som blir reddet fra sykehuset under
flommen i Winnipeg i 1950
Flere redningsoperasjoner:
I boken: God's Mountain by James G. Ashwin
the battle to save Jim's life at Ludhiana; the hasty improvisation to repair the iron
lung on which his life depended, with automobile innertubes and a coupling from a
railroad car
9 Ventilatorens historie

10. ARBEIDSTEGNINGER
Her er koblingen til støvugeren
Inntil støvsugeren kunne kobles på, matte medhjelpere gjøre manuell brystkompre-
sjon:
10 Ventilatorens historie

11.
Problemet var at….
The vacuum cleaner was taking part of the air out of the cylinder, but
it wasn’t forcing any back. Its blower was just ventilating positive air
pressure into the room.
There was the problem: to make some sort of a compound ,valve with
ports that could use, in correct sequence, both the negative and posi-
tive pressure, already available.
Moreover, it had to deliver a choice in operating speed. Human beings
of different ages breathe at different rates.
Figuren viser hvordan det ble lost. I dag er polio vaksinen effektiv, og moderne anes-
tesi utøver god kontroll på ventilasjon:
11 Ventilatorens historie