The Bends: Compressed Air in the History of Science, Diving, and Engineering By John L. Phillips, M.D. (review)

The Bends: Compressed Air in the History ofScience, Diving, and Engineering. ByJohn L. Phillips, M.D. New Haven and London: Yale, 1998. Pp. ix + 256. $30. One always welcomes a book which appears to be the first written about a particular multidisciplinary subject for a multidisciplinary readership. This book presents an easily understood account of a unique subject in human experience which, over the last 200 years or so, has engaged the minds of engineers, medical doctors, physiologists , and other scientists. The underlying topic is that of the exposure of man to changes of environmental pressure beyond those found naturally on the surface of this planet. Such an unphysiological experience was necessary for those who were first to be mining and building tunnels below water level. The adverse consequences of exposures beyond the range of the natural limits challenged the consciences of those concerned with the health and safety of those working in hazardous environments , and, indeed, such consequences continue to be of concern. By shining his spotlight into books andjournals which are now quite old, some of which can be found onlywith difficulty and considerable hard work in the basement archives of too few libraries,John Phillips has offered a new perspective ofan important era of industrial development. His principal subject relates to the illnesses suffered in the construction of many of the tunnels and bridges around the world which are used today by busy urban populations. Modern users accept the benefits of such engineering without a moment's thought. The author has presented his subject in a manner that not only addresses the technical issues but also illustrates the very slow development of social responsibility for those who died or became crippled because they were exposed to an unnatural hazard when building the city's infrastructure. Why has a book like this for the lay reader not been written before? Perhaps simply because those who are still active in this field generally confine their reading to recent scientific texts and then usually only to those relevant to their own work and writings. Of course, most who work in this field are aware in general terms of the history ofwhat has gone before, and a few may have read some of the milestone original texts. As one who has tried to break out of such temporal insularity by attempting to prepare a few articles with at least an historical approach, this reviewer is well able to appreciate the hard work which Dr. Phillips has done to collect the material for this book. Yet, from a rather surprising absence of biographical detail in the book or on its dust jacket, all this apparently has been completed by an individual with no obvious direct connection with the world of engineering, diving, or compressed air work. Other than some technical errors which should be forgiven , perhaps this very lack of established authority is what has given the book its charm and its strength. It has been written by an independent medical scientist, uninfluenced by the whims and trends of current hypotheses in the field and unbiased by an insider's personal experiences. This is a history and a commentary on both the physiological and sociological consequences of the development of work in compressed air, without which the transport systems, and thus the success of places such as London and New York, would not have been possible. The whole story is based on the theme of the bends, the illness that arises from the bubbles released in the body from gases dissolved while at raised environmental pressure. It begins, as it must, with an historical account of the "discovery of the atmosphere," its composition, the physics ofpressure Perspectives in Biology and Medicine, 42, 2 ¦ Winter 1999 | 299 and the development of pumps, the role of the lungs. It does so in a series of anecdotes and vignettes focussed on the persons responsible for these developments and continues in a similar style with accounts of the first diving bells, the first caissons , and the building of the Mississippi bridge at St Louis. In each phase the technical breakthroughs are accompanied by accounts of medical hypotheses, which were often erroneous, and gross morbidity among the...