Caisson and the Brooklyn Bridge

This is a part of the series on decompression by Jarrod Jablonski. To read part one of the series click here.

The Brooklyn bridge project employed 600 workers in 1873. The caissons were to a depth of 78.5 feet/23.8 m. These caissons were steam heated because it was thought that decompression sickness was due to extreme cold. Andrew Smith, an ENT surgeon, was the physician in charge. He described 110 cases of decompression sickness which he considered serious enough to warrant his attention (there were 119 cases in total). Fourteen of these died. He was the first to use the term “caisson disease”. He did not use recompression because he believed it to be a “heroic mode” of treatment. The chief engineer, Roebling, developed neurological decompression sickness (mainly spinal cord symptoms). He directed the project from his sickbed. He was not treated but made a slow spontaneous recovery. During this project, the colloquial term “the bends” was used. “Doing the bend” was used to describe the posture of the caisson workers who suffered from decompression sickness. These workers walked with a stoop resembling a posture known as the “Grecian bend” affected by fashionable women. “Doing the bend” was later changed to being bent or the bends. Some of the caisson workers wore bimetallic or “galvanic” bands either to prevent or relieve the symptoms of decompression sickness.

1889 E W Moir installed a medical lock during the construction of the Hudson River tunnel. He used recompression for treatment. When Moir became the superintendent the incidence of decompression sickness was high with a death rate of 25% from decompression sickness. Following the installation of the medical lock only 2 deaths occurred in the subsequent 120 cases. Moir did not publish these data until 1896 and they are probably the earliest reference to the routine use of recompression for treatment. Moir’s recompression regime was to recompress to 1/2 -2/3rds the working pressure followed by a stay at this pressure for 25-30 minutes and decompression of one psi per minute for his experiments. Haldane used some of Moir’s clinical data.

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