The work of a respiratory unit in a neurological hospital.

THE management of respiratory failure in polio-myelitis has advanced by crisis rather than by planned progress. When the 1946 epidemic struck Great Britain, the supply of cabinet-type respirators was woefully inadequate, a situation from which we were rescued by the energy and munificence of Lord Nuffield, who produced large numbers of this type of respirator. A similar situation arose in Copenhagen in 1952, when 2,722 cases of poliomyelitis occurred in a period of five months, 3 6 of which had respiratory complications (Lassen, I953). This crisis was not without benefit, because it led to the development of the method of treating respiratory failure by intermittent positive pressure respiration (IPPR). The story of IPPR provides a fascinating chapter in medical history. Though it was developed in response to the problem of respiratory failure in poliomyelitis, it rapidly became apparent that it would be of value in a variety of other diseases. There are many conditions in which the primary lesion is potentially reversible, but in which death from respiratory failure is not uncommon. Examples are temporary muscular paralysis in polyneuritis and myasthenia gravis, obstruction of the airway in deep unconsciousness due to head injury and barbiturate poisoning, and impairment of the movement of the chest wall by the muscle spasm of tetanus or by extensive trauma. Attempts had been made to-treat some of these conditions by tracheotomy and the use of a cabinet-type respirator, but the practical difficulties encountered when nursing seriously ill patients in a cabinet-type respirator led to it being used rather as a last resort than as a routine method of treatment. The introduction of IPPR, the establishment of special units to provide this treatment, and the increased awareness of the importance of preventing and treating respiratory failure has revolutionized the position. The present paper describes the experience of the Batten Respiratory Unit since its inception in 1954. During this period 229 patients have been Paper presented to the Meeting of the Harveian