People inside an iron lung used bedpans and urinals, placed and removed either through small portholes built into the sides of the machine or by sliding the patient’s bed partway out of the tank. Because the machine had to maintain a seal around the patient’s body to keep them breathing, every bathroom-related task required careful coordination between the patient and their caregivers.
Bedpans, Urinals, and the Portholes
An iron lung is essentially a sealed metal cylinder that encloses the entire body from the neck down. The patient lies flat on a mattress inside, with only their head sticking out through an airtight collar. Since they can’t sit up or move to a toilet, all bathroom needs happen right there on the bed.
For urination, a urinal was slipped between the patient’s legs. For bowel movements, a bedpan was slid underneath them. Lee Roberts, whose father Ed Roberts lived in an iron lung after contracting polio, described the process simply: his father had a bedpan placed under him while lying down inside the machine, and a urinal positioned between his legs for peeing. Caregivers or attendants handled all of this.
The key engineering detail that made this possible was the porthole. Early iron lungs designed by Philip Drinker in the late 1920s were almost entirely sealed, making patient access extremely difficult. John Haven Emerson improved the design by adding circular portholes along the sides of the tank. These small openings had rubber gaskets that formed a seal around a caregiver’s arms, allowing them to reach inside and handle tasks like inserting a bedpan, cleaning the patient, scratching itches, and blowing noses, all without breaking the air pressure that kept the patient breathing. The Emerson model also had larger rectangular metal doors on both sides for more involved care.
Why Pressure Mattered So Much
The iron lung works by creating negative pressure (a partial vacuum) around the chest, which causes the lungs to expand and draw in air. Then the pressure returns to normal and the patient exhales. This cycle repeats about 12 to 20 times per minute, mimicking natural breathing for people whose respiratory muscles were paralyzed by polio.
Any gap or opening in the tank lets outside air rush in and disrupts that pressure cycle. This is why the portholes were designed with tight rubber seals: a caregiver could slide their arms through without creating a significant air leak. But for larger tasks that the portholes couldn’t accommodate, like thorough cleaning or physical therapy, the machine sometimes had to be opened more fully. That created a time limit measured in minutes.
When the Machine Had to Open
Some hygiene and bathroom tasks required more access than the portholes allowed. In those cases, caregivers slid the internal bed partway out of the cylinder. The Roberts family described bathing this way: attendants would pull the bed out, then wash Ed Roberts’ body section by section with a washcloth. They used little or no soap because he couldn’t scratch off residue or wipe away irritants on his own. For washing his hair, they lowered his head into a small basin with a slit opening designed for the purpose.
These open-air intervals had to be brief. When the machine was open, the patient wasn’t receiving mechanical breathing support. Some patients could survive outside the lung for a few minutes using a technique called frog breathing (glossopharyngeal breathing), which uses the tongue, cheeks, and throat muscles to gulp air and force it down into the lungs. This isn’t automatic or easy. It’s a learned skill that coordinates several muscle groups to compensate for paralyzed chest and diaphragm muscles. Patients who mastered it could buy themselves enough time for caregivers to complete essential tasks before sliding back into the sealed tank.
Not every patient could frog breathe, and those who couldn’t had even narrower windows for any care that required opening the machine.
The Daily Reality
For patients who spent months, years, or even decades inside an iron lung, bathroom routines were just one piece of a larger daily care schedule that depended entirely on other people. Attendants managed everything from bathing to feeding to repositioning. Lee Roberts noted that his father’s bathroom needs “might occur a couple of times” during the daily routine, treated as a normal, matter-of-fact part of the caregiving cycle.
Later developments in negative pressure ventilation tried to address some of these challenges. The Nu-Mo suit, a wearable alternative to the full tank, included an optional Velcro opening in the lower back specifically designed to allow toileting without removing the suit entirely. But for patients in traditional iron lungs, the combination of bedpans, portholes, and brief intervals outside the machine remained the standard approach throughout the polio era and beyond.
The practical answer is unglamorous but straightforward: you didn’t go to the bathroom so much as the bathroom came to you, handled by caregivers working through small openings in a machine that couldn’t stop doing its job of keeping you breathing.