Avisak Baishnab

English 21007

Caisson Disease

In the text “The Brooklyn Bridge” by Elizabeth Mann, we learn about the struggles and the process that took place in order to make the Brooklyn Bridge. The Brooklyn Bridge was a structure that connected today’s lower Manhattan and Brooklyn but this bridge wasn’t built very easily. We learn about the story of John A. Roebling, who was the original designer of the Brooklyn Bridge, his son Washington A. Roebling, who led the construction of the Brooklyn Bridge after his fathers death, and Emily Roebling, who was Washington’s wife and continued to lead the construction of the bridge after Washington fell ill to caisson disease. We also learn that the total number of deaths for the construction of the Brooklyn Bridge was 21 deaths including John A. Roebling. Most of these deaths were due to caisson disease. Caisson disease still exists today but is not as dangerous as it was back in the 1870’s.

Caisson disease is a disease that we see most often on divers. It occurs when you travel in between different levels of pressure leaving you with fatigue in both your muscles and joints. As Richard E. Moon writes in his article “Decompression Sickness,” he states “As outside pressure decreases during ascent from a dive or when leaving a compressed air environment, the accumulated nitrogen that cannot be exhaled immediately forms bubbles in the blood and tissues. These bubbles may expand and injure tissue, or they may block blood vessels in many organs—either directly or by triggering small blood clots.” This disease was really prevalent during the creation of The Brooklyn Bridge because, in order to make the towers, the workers needed to find a solid level of bedrock so the towers would remain strong and stable. Workers had to go underwater in caissons, which were enormous rooms with no floors that were slid into the sea, and dig out the clay and dirt underneath it until they found a solid foundation. When these workers would later come up from the caissons, they would begin to deal with immense fatigue in their joints and muscles. During this time period, there was no real treatment for caissons disease and most often these workers would die from it. 

In our world today, divers still deal with caissons disease but are able to treat it and are able to reduce the likelihood of them getting the disease by rising back to the top at a slower rate. There are other types of medical treatments. As Jeffrey S. Cooper and Kenneth C. Hanson wrote in their article “Decompression Sickness” published in National Library of Medicine on August 10, 2022, they state “The treatment of DCS is with 100% oxygen, followed by recompression in a hyperbaric chamber. In most cases, this will prevent long-term effects. However, permanent injury from DCS is possible. To prevent the excess formation of bubbles leading to decompression sickness, divers limit their ascent rate. The recommended ascent rate used by popular decompression models is about 10 meters (33 ft) per minute.” We deal with different levels of pressure without even knowing on a smaller scale. When trains go underground and your ears pop, that is due to the difference in pressure. This also occurs when riding a plane. When you first take off, you will realize that your ears pop which is also due to a difference in pressure. Divers deal with this on a more serious level and take many precautions by ascending up at a slower rate. 

When it comes to the actual science behind caisson disease, it occurs because there is a release of nitrogen gas bubbles in the blood vessels of the spinal cord and the brain. This can also lead to major respiration issues and habits like smoking can also increase the chance of getting caissons disease. As Uday A. Phatak, Eric J. David, and Pravin M. Kulkarni wrote in their article “Decompression syndrome (Caissons disease) in an Indian diver” published in National Library of Medicine they state “Acute decompression syndrome (Caisson’s disease) is an acute neurological emergency in divers. It is caused due to release of nitrogen gas bubbles that impinge the blood vessels of the spinal cord and brain and result in severe neurodeficit… There are multiple factors in the pathogenesis of Acute decompression syndrome (Caisson’s disease) such as health problems in divers (respiratory problems or congenital heart diseases like atrial septal defect, patent ductus arteriosus etc), speed of ascent from the depth and habits like smoking that render divers susceptible for such neurological emergency.” The difference in pressure that occurs affects you negatively and can have very harsh effects on your breathing. 

Caissons disease led the majority of the deaths when making The Brooklyn Bridge and had little to no treatment back then. In our society today, caissons disease is not seen as often and due to the expansion in the medical field, we have treatments for this disease. Although we do have treatments, divers still take precautions when coming back to the top at a slower ascending rate. Caissons disease is not as serious as it used to be but still exists in today’s society. 

Sources

Richard E. Moon, R.M. (Updates Sep 2022). Decompression Sickness. MD, Duke University Medical Center https://www.merckmanuals.com/home/injuries-and-poisoning/diving-and-compressed-air-injuries/decompression-sickness

Cooper JS, Hanson KC. Decompression Sickness. [Updated 2022 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537264/

Phatak, U. A., David, E. J., & Kulkarni, P. M. (2010). Decompression syndrome (Caisson disease) in an Indian diver. Annals of Indian Academy of Neurology, 13(3), 202–203. https://doi.org/10.4103/0972-2327.70868