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Iron Lung

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A girl is struck down by polio during the terrifying epidemic of the early 1950s. Paralyzed and unable to breathe on her own, she is committed to the hospital in Copenhagen and placed in an iron lung. Forty years earlier, a child grows up in an orphanage for boys outside of Budapest. The child goes by the name of 'Boy' but is not like the others, as their body seems to transcend the categories of boy or girl. Between these two young people, there is a powerful, enigmatic bond that stretches across time and space. Iron Lung is a poetic allegory of adolescence, and an unsettling and subtle commentary on sexuality, medicine, and technology.

269 pages, Paperback

First published April 13, 2023

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Kirstine Reffstrup

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Displaying 1 - 13 of 13 reviews
Profile Image for Paul Fulcher.
Author 2 books1,961 followers
September 14, 2025
Here is what I know. I was born two times. First on New Year's Eve, in another city, under another roof in Europe. In the rift between two centuries, I broke the membrane. Twelve strikes and the clocks rang in the new year, time whirred on, the year 1900. I was born in the light between a boy and a girl. I am neither boy nor girl. I drink the bitter waters of the womb. I am far from home, and I sing from this hollow, where I am and am not.

Iron Lung is Hunter Simpson's translation from Norwegian of Jernlungen by Kirstine Reffstrup, and is published by Peirene Press. This is the June 2025 book from the brilliant Republic of Consciousness Book of the Month club, which raises funds that support the UKs most exciting annual book prize, as well as showcasing a collection of books from the vibrant small independent press scene.

The narrator of the novel, or perhaps part of the novel, is Agnes, a 13 year old in 1952, a victim of the polio epidemic of that year which was at its most intense in Copenhagen, confined to the Blegdam Hospital and encased in an iron lung.

I call the machine Mother. I sing with it, stroke my left hand across its smooth sheath, scratch the iron shell with my nails. I listen to all its sounds, its creaking and sighing and panting. When it sleeps, I sleep, and I wake with it. I call to the iron lung in my dreams. The machine is always here, it is all I have, and it holds me gently, peels layer after layer off me, off my body, which is now a mere husk, without blood, without muscles, off my life, which appears only in quick flashes, the house, the soft green lawn beneath my bare feet, Mother's dry hands, the sweet smell of her Nivea cream, before it all disappears again, and the only thing I want to do is stretch my arms and walk through a big room full of light and air. But now I am here. I no longer believe I will walk again upon the light green grass or feel its long, feathery blades tickle the soles of my feet. In this silence I am free. I have surrendered myself entirely to the iron lung, which dispenses its love to me calmly, steadily, strokes my belly with its cool air. The machine lives on electricity and my breath, it wraps itself around me, never rests, gives me everything I need to live. My milk is the oxygen that is pumped in and out, that swirls around my chest, through the iron wombshell.

This part of the story paints a lyrically and emotionally intense picture of what Agnes experiences, her mother too busy keeping the family afloat to visit too much and experiencing adolescent life vicariously through the stories of her sister Ella.

And this is a timely novel - even more so now that when originally published. The longest surviving iron lung patient Paul Alexander, died in 2024, leaving just one person still living in one (Martha Lillard).

The skilful medical improvisations and inventions of the doctors of the real-life Blegdam hospital dealing with polio patients, including the extremely high mortality rate of those using iron lungs, gave rise, as the Smithsonian magazine explains ("even Emerson tank ventilators remained prohibitively expensive for most hospitals and served as little more than a costly and claustrophobic deathbed for eight out of ten patients with bulbar polio"), to the modern day ventilator and techniques which were used to deal with the Covid epidemic. And, as with Covid, the eventual management of the polio epidemic was a case study for the successful use of vaccines and vaccination programs - and amongst all the other madness which has infected the United States, the new US regime has appointed a Secretary of Health and Human Services who is a vaccine sceptic.

However, for an account of the polio epidemic the Smithsonian and similar articles would be a better source that this novel, because it's ambition, I'm pleased to say, is so much more than mere historical fiction.

I am the child the mothers cast away.
I breathe down through the century.


Agnes is also visited by visions - dreams? memories of a past life? - of another 13 year old from 49 years earlier, in 1913 , whose story is also told in the first person. They were born on the stroke of the transition from 1899 to 1900, and, just as their birth is caught between two centuries, their gender identity is equally unclear, their mother abandoning them with a isolated home for abandoned boys near to Budapest.

The house lies at the edge of the forest. Beside the house flows the river, bending and running south, where the insects hatch. In the garden there grow acacias, walnut trees and great, knotty oaks, whose long, thick roots are and weave themselves across the ground. Behind the garden begins the forest. We can see the tops of the birch trees swaying in the wind. We can see the fog coming through the tree trunks like the white, unknown ocean in which we've never swum. Behind the forest we can see the mountains. And on the other side of the forest, far away from us, lies the city. The river is the Danube. They call the city Budapest.

Tara inherited the house. She lives here with her sister Maria and us. The sisters take care of us, watch over us, the abandoned children. Our eyes are shiny coins. Lonely alms cups. Our bones and tendons grow long, our wounds deep. Knots of cartilage, growing flesh, layer upon layer of fat. Our hair, cut above our ears and straight across our foreheads, hangs down our necks. Tara calls us: My warriors. The sisters raise us, clothe us with clothes they've sewn themselves: a shirt with a high, stiff, cylindrical collar, a pair of brown trousers with soft lining, a blue summer jacket, and a grey woollen coat with a fur collar for the cold months. We roll the trousers halfway up our shins. The jackets have wide trumpet sleeves. Maria sewed them with three silk strips and the word home embroidered on the sleeve with pink thread, so people will know where we come from if we ever run away.

She says: My boy. You are my strange Boy. And every morning she examines me to make sure that it's true. But I have watched the boys in secret. Oh, I've seen them. Tears in my eyes. Sweat on my palms. Their dangling flesh and two boiled plums when they pull off their trousers at night.
I've seen them spray urine and watery milk from that soft rod that rises. Shame on you. One must keep one's fingers over the blanket, Tara says, one must be clean. But my eyes suck up the boys' milk. I have slender wrists and light down over my lip. My sex is smooth and arching like a big goose egg. Sex is a word Tara and the doctors have taught me, but the word does not belong to me. If I touch the egg with my fingertips, I feel a soft fold, and when I rub it with my thumb, my body quivers and I double over, gasping. But I almost never caress it, because Tara says: You must never touch yourself.


Tara doesn't give any of the boys names, until they grow-up and leave, so our narrator goes simply by 'Boy', but does take them, wearing a blindfold, to Budapest to be examined by an eminent doctor using the then nascent X-ray technology, although he is unable to determine their gender.

And as they mature and start to explore their sexuality, Boy provoke first the curiousity and later the hostility of the other boys, here when they try to fake the thin line of an early moustache, and later when they form a relationship with another of the boys:

I take a bite of the bread Tara serves, the priceless dark yellow butter, of which there will now be no more, which we must now wait weeks to have again, because the milk has been stolen. I stare at the teeth marks. I beam at the boys with my fat butter-smile. Their hands reach out, their eyes ravenous. Adam's apples jutting. The boys' joy at mealtimes, the light in their eyes, the grease on their lips. Their shoulders, their flat chests heaving and falling beneath their scratchy, clean shirts. I speak in a deeper register, like them. I stick out my throat, like them.
Then they notice my moustache, the thread of soot.
The boys laugh and drum their fingers.


Boy eventually flees to Budapest itself where they find a home with denizens of the flourishing queer night scene in an Austro-Hungary sleepwalking into a major conflict which would lead to its demise - and as World War I begins, Iggy (as Boy is named by their new friends, a deliberately ambiguous abbreviation of the girl's name Ignatia and/or the boy's name Ignatius) also witnesses, through their friend, and object-of-their-desire Lulu, the rise of Communism, and the teachings of Rosa Luxemburg.

The two stories contain a number of thematic links - new and potentially threatening but also life-saving medical technology (X-rays and Iron Lungs); looming Communism (a beacon of hope in 1913-1917; more of a threat in 1952 as the Cold War begins - e.g. Agnes's sister reads the newspaper stories on the Catalina affair impacting nearby Sweden); and a strong sense of isolation, rejection and otherness, particularly from birth mothers, with Tara and the iron lung respectively acting as surrogates.

But Boy/Iggy experiences life in a sensuous way which Agnes can only recall or imagine:

I crouch down, barefoot in the milk cellar at dawn. A chill pounds up through the cold tiles. My white breaths swell, a veil over my mouth. I look into the wooden pails of milk that have been set out to gather cream. A daddy-long-legs flails in a dizzy, confused dance atop the thick milk. There are dead flies caught in its yellow skin, in the pearls of creamy fat. I dip my hands into the tubs and pick out the flies. Tara says that it's not for us to drink, that the milk is for cream and cheese and churned butter, but my pulse beats my body warm and I take what I want. I hold one of the tubs up to my mouth and silently drink until it is empty. The milk bubbles in my mouth, runs thick as oil down my chin and my neck. I lick away my milk moustache, dazed and dizzy.

Impressive

Interview with the author here

The publisher - Peirene Press, to whom I'd proud to subscribe

An award-winning independent publisher of new voices and great books from across the world.

Founded in 2008, we’ve been a key player in the thriving UK independent publishing scene for over a decade, publishing books from 25 countries and 20 different languages. Traditionally a publisher of European novellas in translation, we now publish writing from all over the world and are expanding our list to publish literary fiction of all shapes and sizes. Our books are regularly listed for significant UK literary and translation prizes, including the International Booker Prize, and in 2023 we won the Dublin Literary Award with our book Marzahn, Mon Amour by Katja Oskamp, translated from German by Jo Heinrich.

Our subscribers are the foundation of everything we do at Peirene. Their support and commitment empowers us to make bold editorial choices and to invest in ambitious, thought-provoking writing.
Profile Image for Gemma W.
348 reviews5 followers
April 29, 2025
From my Peirene Press subscription.
There are two stories going on here.
The first is set during the 1952 Copenhagen Polio epidemic, of which I was unaware, but led me down a rather interesting Wikipedia hole, that also complimented my recent reading about the history of Tuberculosis. Ella is 13 years old when she is struck down with polio like “a spider wrapping itself round her spine”. She is placed in an iron lung, and we follow her sensory experience as she loses more and more of her bodily autonomy and as her family lose hope.
For me this part was a solid four stars.
The second story which is linked by the author by some sort of mystical transcendence, but really just seemed linked by the fact they were two interesting stories the author seemed to want to tackle simultaneously, is of a young baby born with intersex characteristics left by their mother on the doorstep of some hell hole children’s home for boys near Budapest in 1913.
The headlines aren’t good, and this is unlikely to end up being a happy tale, and I enjoyed the experience much less.
The thing that stands out about this book, mostly the second story is the sensory nature of it. I’d say the author uses a fair few shock tactics, of making you feel physically uncomfortable during the read. The sights, the sounds, the smells are all very vivid. This is done quite impressively but not necessarily very pleasantly.
I would warn away if you are at all squeamish about milk as its consumption runs through both texts endlessly. In many places it felt like the author was being overtly grossly over the top in some of her sensory descriptions – thinking the sheep’s pelt melting into the body – and for me personally I think I would have preferred it be less explicit.
I was much more interested in Boy’s life once they joined Budapest, but felt that was rushed a little towards the end.
Overall, a compelling read, it definitely had me turning the pages and left me wanting to find someone to discuss it with.
Profile Image for G Batts.
143 reviews7 followers
August 13, 2025
A gothic Middlesex as if written by Moshfegh but make it literary.
Profile Image for Camilla Hornung.
23 reviews6 followers
May 21, 2023
Selvom jeg var dybt fascineret af det smukke sprog, mistede jeg grebet om fortællingen.
Profile Image for Emma Harwell Jones.
75 reviews1 follower
Read
September 29, 2025
i think some of it was a bit too artistic/went over my head haha. however, i got this one when we were in copenhagen and it was so special reading it. i was reminded of our trip and i loved envisioning the characters in the city. also when i got this book, a girl outside the store stopped me and said this was her favorite book ever and she loved the author! unfortunately none of her other books have been translated so im hoping this one gets big and i get to read her other works (or i can commit to learning danish haha).

this story is set in two different cities, at two different time periods, with two different characters. One is a young girl in copenhagen in the 1950s who contracts polio and lives in an iron lung. Another character lives in the woods outside of budapest in the early 1900s and is given the name “Boy” but doesn’t feel like they belong in their body.

i think this book did a really interesting job comparing how black and white culture tends to be and exploring the gray spaces that we occupy. we can be both/and. i was expecting this to be more dialogue on what the experience of being a child with polio and living in an iron lung would be but it was much more cerebral than that.

some parts of this book were difficult to read: some SA, violence, and abuse. it was also interesting to read about the medical systems in these time periods and how different advances were made, but mostly at the costs of vulnerable people. makes me feel grateful for advances modern medicine has given us, but i grieve the people who have been taken advantage of for us to get there.

i enjoyed the questions the book asked like, what makes us who we are? how can we find ourselves and how can we trust others to see us as we are? how can we heal and reclaim the lost parts of ourselves?

“death sat on the bedpost…and puffed himself up, making a mockery of me. But then I saw Ella, and his face went pale at her laughter, dissolved, and disappeared.”

“the iron lung rules over me. it decides when i move and when i will be still. the only thing that’s mine is my voice.”

“history is a river, great and shining. we bathe in it. we are born in it, again and again we rise from the water.”

“it has the hospitals scent, which has also become my own…my skin melted into the machine… it was as if the skin belonged to me but was no longer wholly mine.”

“what if the house calls me home, and i have to obey?”
275 reviews5 followers
April 8, 2025
A girl is struck down with polio during the terrifying epidemic of the early 1950s in Copenhagen. Paralysed and unable to breathe, she is placed in an iron lung. Forty years earlier, near Budapest, a baby is abandoned at an orphanage for boys but the baby is in fact neither a boy nor a girl and causes quite a stir in medical circles as (s)he develops. Between these two young people there is a connection that stretches across time and space.

So based on that blurb, I am not sure what I was expecting but whatever it was, it wasn’t what I got. This short novel of just over 250 pages is certainly very powerful and packs a punch but it is so raw at times that it was quite harrowing to read. The polio epidemic is described exceptionally well and whilst heartbreaking, it gives a real feeling as to what it must have been like for the families affected. As for the storyline set forty years prior, I found it very upsetting, it contains a lot of abuse of differing kind and I had to read in chunks to be able to digest it. What I missed from the story is the explanation or understanding as to why these two people were linked as they were. Maybe it is in there and I just didn’t get it.

This is a very different kind of book, both from the point of view of the content and that of the writing style. Is it wrong of me to say I’m not sure I understood it fully? Still, the beauty of a book subscription, through which I got this book, is that it exposes you to all styles of literature and books you may otherwise not pick up.
217 reviews1 follower
May 27, 2025
There are two completely separate stories in this book, both are about 13 year old teenagers. One is set in Budapest in 1913, just before the war begins. The other is set in 1952 in Copenhagen during the polio epidemic. Agnes has contracted polio and is confined to the hospital in an iron lung which is keeping her alive. She dreams about Boy/Iggy, who was born at the beginning of 1900 and who is neither male nor female. They have been abandoned by their mother and are brought up in a home for boys. They are treated as a boy while in this home. The implication is that there is a link between the two teenagers ..reincarnation is mentioned but the link is not explored fully. I liked the first story. It sent me down a rabbit hole of the polio epidemic of the 1950s. I found the second story hard. There was a lot of difficult parts to read. It was very graphic and really brought you into the story which definitely made me uncomfortable. Both stories were dark and definitely not an enjoyable read. 2.5 stars from me.
Profile Image for Maximus.
26 reviews
July 28, 2025
3.5/5, rounded to 4.
was very easy to sink into, finally a book that has managed to get me out of my reading slump. I was a big fan of the writing and the concept.
Was hoping for the main characters — Agnes and Boy — to be more intertwined. they often felt too separated, as if I was reading two completely unrelated stories. It's not something that impacted the plot much (and I loved the plot!), but often I was left yearning for a surrealist touch that I, personally, believe the book could have benefited from.
either way, I absolutely loved the book and was completely engrossed with it. I'm certain a lot of the imagery will stick with me for a while.
Profile Image for alexia.uu.
39 reviews
September 29, 2025
2.5/5

I am so confused about this novel, and I find it hard to rate because I genuinely did not understand one third of it. The writing is extremely lyrical, but it probably should not have been translated, as it loses some of its poetry and meaning.

The two main themes, iron lungs and intersex, definitely seem interesting, and I would love to read about them again, because I am not sure I learnt anything here. The atmosphere was generally uncomfortable (despite my uncomprehension) which I enjoyed. However, I still have not grasped the association between the two characters.

It is more frustrating than anything, as I know I would have loved to read this kind of novel in French.
Profile Image for Trine.
62 reviews
April 5, 2023
En gjennomført historie, delene sklir elegant over i hverandre. Synes nok det blir litt vel oppkonstruert/historisk roman når disse avantgardistene også befatter seg med politikk og Rosa Luxemburg. Litt for mye «tidskoloritt» med diverse sitater og tidstypiske referanser, blir nesten litt irriterende. Men mer enn lesverdig dette😊
1 review
June 7, 2025
A beautiful lyrical book exploring the absurdity of inhabiting a body and the arbitrary categorisations placed upon them. I finished this just over 24 hours after buying. The book had a beautiful lyricism that flowed like warm honey.

I may be biased as a fan of 'splatterpunk'. If you're looking for a linear novel then it won't be for you, but as a extended poem it is a delight to read.
Profile Image for Cecilie Lykke.
90 reviews21 followers
May 7, 2024
DNF. 3. lydbog.
Er normalt en sucker for smukke sætninger og beskrivelser, men i den her var det som om, at man var gået mere op i sætningernes udfoldelse end selve fortællingen. Det gik ud over historien, og jeg mistede interessen. Hader den dog ikke, derfor 2 stjerner.
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