Paul Alexander, oldest iron lung survivor, dies aged 78

A polio survivor, who lived inside an iron lung for most of his life, has died at the age of 78.

Paul Richard Alexander was born on the 30th of January 1946 in Dallas, Texas. He was a bright and able student, but succumbed to a widespread outbreak of polio, which was common, even in first world countries, until the 1953 rollout of a highly-effective vaccine. But that was too late for many, including Paul, who were either killed or left with serious disabilities after contracting it.

Polio is a particularly cruel disease because it mostly affects children under five years old. That said, it is possible to contract it later in life and America’s longest-serving president, Franklin Delano Roosevelt, was diagnosed with it at the age of 39.

For the majority, the infection is largely asymptomatic, with few or no symptoms. But in about 1% of cases, the virus, which infects only humans and spreads through the air, faeces and in contaminated water, attacks the central nervous system, targeting the motor neurones that control our muscles. It robs them of their nerve supply and leaving victims with weakness and paralysis.

In the summer of 1952, Paul Alexander - who was just six-years-old - began to suffer from pounding headaches, lethargy and a stiff neck. His symptoms worsened and suspicions grew that he had contracted polio. Indeed, many of the public amenities in Texas - such as bars, cinemas and churches - had been closed in order to curb the spread of the virus. Nevertheless, cases continued to grow unabated.

When it was confirmed that Paul had polio, he was taken to Parkland Hospital in Texas. He was so ill that nobody expected him to live, and almost died before it was spotted that he wasn’t breathing. Paul underwent a life-saving tracheotomy so he could be ventilated, and when he awoke he found he was paralysed from the neck down and encased in a metal cylinder called an iron lung, with just his head poking out at the top. He would spend the vast majority of the rest of his life inside the medical contraption.

But how exactly did the iron lung keep him alive for so long? The polio infection effectively destroyed the nerve supply to the muscles that moved Paul’s chest and diaphragm, so he couldn’t breathe for himself. The iron lung rhythmically pulled air in and out from the box he was laying in. This periodically dropped the pressure inside to below atmospheric pressure, so the higher air pressure in the surroundings pushed air into Paul's chest, inflating his lungs.

Paul, however, did not let his illness - or his iron lung - define him. Following an eighteen month stint in hospital, he was allowed to return home. His parents rented a generator and a truck for his iron lung and, with the help of his therapist, he began to practise breathing techniques that would allow him to leave the iron lung for short periods of time.

He was one of the first homeschooled children in Texas and, on graduation from high school, Paul attended Southern Methodist University. In 1984, he gained a law degree from the University of Texas in Austin. He was admitted to the bar two years later, and practiced as a lawyer for a number of years, managing to leave his iron lung and attend court in his wheelchair for a few hours at a time.

In later life, Paul would continue to attempt new challenges - including writing a memoir which took him years to compose using a plastic stick to type on a keyboard and dictating to a friend. He also joined the social media site TikTok in the months before his death, and was recognised by Guinness World Records as the person who lived the longest in an iron lung. Paul’s brother, Philip Alexander, told the BBC how he would be remembered:

Health practitioners have made huge strides in tackling polio in recent years. Since 1988, wild poliovirus cases have decreased by more than 99%, thanks largely to a hugely successful vaccination campaign. Of the 3 strains of wild poliovirus (type 1, type 2 and type 3), wild poliovirus type 2 was eradicated in 1999 and wild poliovirus type 3 was eradicated in 2020. As of 2022, endemic wild poliovirus type 1 remained in just Pakistan and Afghanistan.