Paul Alexander, the Texas polio survivor who spent his life in an iron lung from childhood until his death in 2024, remains the longest-known person to live with the device — and his story still resonates in a region where polio has not yet been eradicated.
Alexander was six years old when polio struck him in Texas during one of the disease's most devastating periods. The infection left him paralysed from the neck down, and after an emergency tracheostomy he could no longer breathe independently. When he regained consciousness, he found himself enclosed inside a large metal cylinder, with only his head visible outside the machine.
He relied on that iron lung for the rest of his life. According to The Times of India, his story became a record of persistence, adaptation and the ordinary routines he insisted on protecting despite extraordinary circumstances.
What does an iron lung do, and why did he need one?
Polio caused paralysis in only a small proportion of infections, but the consequences could be severe. According to the World Health Organization, around one in 200 infections leads to irreversible paralysis, and some patients whose breathing muscles became paralysed did not survive without respiratory support.
The iron lung worked by using changes in air pressure around the body to inflate and deflate the lungs. It required electricity to operate, which meant that during power failures someone had to pump the machine manually until power returned.
For many people, the device belongs to history books. Rows of large metal cylinders once filled hospital wards before vaccines transformed public health, keeping patients alive when damaged muscles could no longer draw breath. Most disappeared decades ago as medical care changed.
A family decision, then "frog breathing" and a puppy
After nearly two years in hospital, doctors had begun to doubt that Paul would live much longer. His parents chose to bring him home instead of leaving him in institutional care — a decision that altered the course of his life.
Living at home meant constant attention. Neighbours sometimes came to help keep the iron lung running during power outages, and Paul's father designed a system that allowed his son to ring an alarm using only his mouth whenever he needed immediate assistance.
Although the machine remained essential, Paul gradually learnt a demanding technique known medically as glossopharyngeal breathing, commonly called "frog breathing." Instead of relying entirely on the iron lung, he trained himself to gulp small amounts of air into his lungs using muscles in his throat.
His younger brother Philip later recalled that an unusual promise helped motivate him through those difficult early sessions. Paul desperately wanted a puppy, and his family told him that if he could remain out of the machine for three minutes using the new breathing method, he would get the dog. He managed it.
As his confidence increased, the hours outside the iron lung slowly became longer. He could leave home in his wheelchair, spend time with neighbourhood friends and experience childhood activities that had once seemed impossible. Whenever he became tired, he returned to the machine for respiratory support.
From home schooling to a Dallas law practice
Because attending school in the usual way was difficult, Paul completed much of his education at home before earning admission to the University of Texas. His parents helped install the iron lung in student accommodation before leaving him to begin university life.
A paid caregiver who had been expected to assist him failed to arrive, leaving Paul unexpectedly dependent on the kindness of fellow students. Classmates gradually stepped in where needed, pushing his wheelchair, helping with daily tasks and forming an informal support network that allowed him to complete his studies.
Rather than stopping with a university degree, Paul decided to study law. After qualifying, he established a legal practice in Dallas. Meeting a lawyer who worked while lying inside an iron lung often surprised first-time clients, yet conversations soon shifted away from the equipment and towards the legal matters that had brought them there.
His professional life reflected something he learnt over many years: independence did not always mean doing everything alone. Sometimes it meant organising the right people, understanding what help was required and maintaining control over the decisions that mattered. Supporting him required skills rarely taught in formal healthcare — moving someone safely in and out of an iron lung demanded patience and experience, and new caregivers usually learnt through observation because there was no handbook explaining the process.
Philip never viewed his brother as someone defined by illness. The brothers argued, laughed, attended concerts and shared ordinary family experiences. Looking back, Philip often described Paul simply as his brother rather than someone whose disability dominated every moment.
Why the longest iron lung survivor still matters in South Asia
For a global Bangladeshi and South Asian diaspora readership, Alexander's story carries particular resonance. Polio remains endemic in parts of Pakistan and Afghanistan, and vaccination campaigns across South Asia continue to target the virus.
His decades-long survival stands as a record of individual determination and a reminder of why eradication efforts matter. The exact date of his death in 2024, and his age at the time, were not detailed in accounts reviewed for this article — an open footnote to a life otherwise documented in remarkable detail.