David McCullough Library E-book Box Set

by David McCullough

  Every two feet gained meant a pound more of pressure. On December 18, when the caisson was grounded on the river bottom in thirty-seven feet of water, the pressure was at seventeen pounds. In Brooklyn the pressure had gotten up to only twenty-one pounds when that caisson was halted at a depth of forty-five feet. But here, where the water was so much deeper to begin with and the going so much easier, it took only about a month to reach forty-five feet. Even at that the bottom of the caisson was only eight feet into the river bed, which left twenty-three feet more, or the whole of the enormous timber roof, still surrounded by water. And bedrock was still a long way off. But at forty-five feet, just as at Brooklyn, some of the men began feeling a good deal of discomfort, and, in a few cases, severe pain.

  The number of men employed at any one time in the caisson varied from fifty to 125 in the daytime and from fifteen to thirty during the night. At first the workday was divided into two shifts of four hours each, separated by an interval of two hours. But at forty-five feet Roebling ordered the workday for caisson men shortened slightly, to seven and a half hours, in two shifts. At fifty feet, with the pressure increased another two and a half pounds, the day was again cut by half an hour. The majority of men were having trouble by now. The climb up to the surface after each shift, for example, had become so terribly fatiguing that Roebling had one spiral stairway pulled out and a steam elevator installed, as Eads had also done in St. Louis.

  It was not until late January, however, when the caisson reached a depth of fifty-one feet, that any serious effect among the men was observed. And it was at this point, when pressure in the chamber stood at twenty-four pounds, that Roebling decided there ought to be a doctor on hand.

  His name was Andrew H. Smith. He was a New Yorker, a former Army doctor, a surgeon, and a throat specialist at the Manhattan Eye and Ear Hospital. He was a man about the age of Roebling. Nine years later he would achieve national prominence by performing the autopsy on President Garfield that revealed the much-debated location of the assassin’s fatal bullet. Smith’s pioneer work on the bends, however, would be of far greater importance. His title was Surgeon to the New York Bridge Company and, except for Dr. Jaminet, Eads’s medical adviser, and some other St. Louis doctors, he was the only man in the country with any medical background to try to figure out what was causing the mysterious malady brought on by compressed air.

  Smith took his assignment very seriously and went right to work. His first step was to prepare a set of rules, just as Jaminet had done two years earlier in St. Louis. These he had posted conspicuously about the dock and inside the caisson. They read as follows:

  Never enter the caisson with an empty stomach.

  Use as far as possible a meat diet, and take warm coffee freely.

  Always put on extra clothing on coming out, and avoid exposure to cold.

  Exercise as little as may be during the first hour coming out, and lie down if possible.

  Use intoxicating liquors sparingly; better not at all.

  Take at least eight hours’ sleep every night.

  See that the bowels are open every day.

  Never enter the caisson if at all sick.

  Report at once at the office all cases of illness, even if they occur after going home.

  He next subjected every man to a physical examination, the idea being to exclude anyone suffering from heart or lung disease, anyone who struck him as too old for such work, and all obvious drinkers. Every new caisson man thereafter was required to have a work permit signed by him; and though only a few were actually rejected, the knowledge that an examination and a doctor’s permit were required doubtless discouraged many who were unfit from applying.

  In any case, Smith was convinced that the men he cleared were in the best possible physical condition. He also saw to it that each man got a strong cup of coffee every time he came up out of pressure. “It appeared to relieve, in a measure, the nervous prostration which marked the return to open air,” Smith wrote. He did his best, too, to get the men to stay quiet a while after each shift, in a special resting room he had fitted out. But once out of the caisson, the next stop for most men was the handiest saloon. There the terrible, numb fatigue or the outright pain the work left them with could be cured considerably faster, they believed, than taking the doctor’s coffee or spending time on a company bunk.

  The young doctor had no misconceptions about the off-hours recreation of the men or the living conditions most of them put up with. Many, he knew, slept in “lodginghouses,” as they were called, a damp cellar likely as not or one of the 14,872 tenements described in the 1870 census, where thirty people to a room was not uncommon, where the only light and ventilation came from a single passageway up to the street or to an ill-smelling common hall or kitchen. The ages of the men, as Smith noted, ranged from eighteen to fifty. They were of all nationalities, he found, but mostly Irish, immigrants who had known nothing else in New York but tenement life. The neighborhoods they went home to after a day in the caisson were famous as breeding grounds for measles, diphtheria, scarlet fever, the grippe. And in the teeming streets the one note of cheer was the saloon. “The habits of many of the men were doubtless not favorable to health,” Smith wrote, “but everything which admonition could do, was done to restrain them from excesses.”

  Smith had been down in the Brooklyn caisson once or twice at Roebling’s request. And now again, as at Brooklyn, he noted with much interest that when the men spoke to one another in the heavy air it was with strange shrill treble voices and that it was physically impossible to whistle. (“The utmost efforts of the expiratory muscles is not sufficient to increase materially the density of the air in the cavity of the mouth, hence on its escape there is not sufficient expansion to produce a musical note.”) He noticed, too, that the men were breathing faster under pressure, and suspecting they were breathing harder as well, he wrapped a steel tape about his own chest, then compared the measurements he got when breathing inside the caisson and up on the surface. Under pressure, he found, his chest expansion was nearly twice what it was normally.

  He studied the effect on circulation and discovered that while the normal pulse might rise sharply upon entering the caisson, after an hour or so it would drop back to normal or even below normal. The effect on the volume of the pulse was to diminish it. This, he thought, was caused by the pressure exerted on the artery. “Hence, the pulse is small, hard, and wiry.”

  He observed that the men coming out of the caisson all had a marked pallor that lasted twenty minutes or so and that their hands were slightly shrunken and the tips of the fingers shriveled, as if they had been in water for a long time. Inside the caisson he took the temperatures of several workers and found they were one, even two, degrees above normal. The whole force was running a fever, he concluded, and told them this was caused by the heavy, saturated air, which kept their bodies from cooling by evaporation as they would normally. It was the reason they were always wringing-wet with perspiration, he explained. It was not that they were perspiring so much more, but that the air was not drying them in the least.

  Like others before him, Smith was also impressed by the way the work seemed to increase the appetite. This he believed was caused by a generally increased waste of tissue, which was the result of an increased absorption of oxygen. But he was not absolutely sure about that—or much of anything else. He had no reliable data to go by, as he said, nor were the men particularly cooperative. His means of testing his theories were quite crude at best. To find out what effect the heavy atmosphere had on the metamorphosis of tissue, for example, he took four healthy pigeons, cut a wound under the wing of each, took two down into the caisson and kept the other two in the temporary hospital he had established on the dock. But at the end of six days he could find no discernible difference in any of them. The wounds all had healed about the same; the birds appeared to be in comparable health.

  A little later on he had a dog taken into the caisson and kept there for seven hours. Then he went dow
n himself, killed the animal with prussic acid, opened its neck, took a blood sample, and carried that back to the surface to see what if anything had happened to its oxygen content. Small quantities of air injected into the blood stream of a dog would, he knew, normally escape through the lungs. But perhaps time under pressure produced air in the blood that could not be expelled in the normal fashion. His sample from the dead dog, however, indicated no such thing, so he abandoned that approach, little realizing how close he was to the truth.

  But it was the suffering of the men that concerned him more than anything, and as the caisson continued downward, their suffering increased many times over. Smith was in daily attendance. He studied every symptom, kept careful notes, and though he was unable to put his finger on the exact chemical or physiological cause of the trouble, he began to have some ideas of his own about what the men were doing wrong and what might be done to help those suddenly “taken” by the effects of compressed air—“as if struck by a bullet” was the way they commonly described it.

  One of the workers in the caisson about this time may have been an undersized Irish boy named Frank Harris, later to become a man of letters in England and author of the sensational autobiography My Life and Loves. Harris said he went to work in the caisson a few days after landing in America and was only sixteen at the time. He never wrote anything about the experience until years afterward, which may explain the inaccuracies in his account. But he was also known his whole life for his inability to separate fact from fancy, so what he says may or may not be the way things happened. * Still, it is among the very few accounts written from the point of view of the men themselves and vividly conveys the terrible fear they had of contracting the bends:

  In the bare shed where we got ready, the men told me no one could do the work for long without getting the “bends”; the “bends” were a sort of convulsive fit that twisted one’s body like a knot and often made you an invalid for life. They soon explained the whole procedure to me…. When we went into the “air-lock” and they turned on one air-cock after another of compressed air, the men put their hands to their ears and I soon imitated them, for the pain was acute. Indeed, the drums of the ears are often driven in and burst if the compressed air is brought in too quickly. I found that the best way of meeting the pressure was to keep swallowing…

  When the air was fully compressed, the door of the air-lock opened at a touch and we all went down to work with pick and shovel on the gravelly bottom. My headaches soon became acute. The six of us were working naked to the waist in a small iron chamber with a temperature of about 80 degrees Fahrenheit: in five minutes the sweat was pouring from us, and all the while we were standing in icy water that was only kept from rising by the terrific pressure. No wonder the headaches were blinding. The men didn’t work for more than ten minutes at a time, but I plugged on steadily, resolved to prove myself and get constant employment; only one man, a Swede named Anderson, worked at all as hard…. Anderson was known to the contractor and received half a wage extra as head of our gang. He assured me I could stay as long as I liked, but he advised me to leave at the end of a month: it was too unhealthy: above all, I mustn’t drink and should spend all my spare time in the open. After two hours’ work down below we went up into the air-lock room to get gradually “decompressed,” the pressure of the air in our veins having to be brought down gradually to the usual air pressure. The men began to put on their clothes and passed around a bottle of schnapps; but that I was soon as cold as a wet rat and felt depressed and weak to boot, I would not touch the liquor. In the shed above I took a cupful of hot cocoa with Anderson, which stopped the shivering, and I was soon able to face the afternoon’s ordeal.

  Still, he could make two weeks’ wages in a day, he said. If he could last a month, he would have enough to live on for a year. But by the fifth or sixth day, he had terrible shooting pains in his ears and he was told he might be going deaf. An Irishwoman he was boarding with in a shanty beside Central Park fixed up a remedy—“a roasted onion cut in two and clapped tight on each ear with a flannel bandage.” Harris said it worked like magic, relieving his pain in minutes. But not many days later he saw one of the men fall and writhe on the ground, blood spurting from his nose and mouth, and that was enough to decide young Harris, who quit soon after and who later took the literary license to say that the man’s legs were “twisted like plaited hair.”

  Smith assumed medical charge of the caisson workers on January 25, 1872, and was on duty until May 31, when he resigned. During that time there were 110 cases of sickness that he could attribute directly to compressed air and that were severe enough to require treatment. Not by any means, however, did every man suffering pain or discomfort report to him—as he was well aware. The feeling was that a man might not get hired again at some future time if it was known he had had a dose of the Grecian Bends. (It was a feeling that would also persist among future and supposedly more enlightened generations of “sand hogs,” a term not yet in use in the 1870’s.) As Roebling would write in his own report, scarcely any man escaped without being affected by intense pain in one form or other. Martin and Collingwood both suffered attacks. Charles Young, the foreman who had collapsed in the Brooklyn caisson the same time Roebling did, had again become so much affected by the compressed air that on the advice of his own doctor he resigned, taking a job overseeing work on the dock instead.

  But those cases Smith was able to treat and study, he described at some length in his notebooks:

  Case 11—E. Riley. Taken sick Feb. 16th, one hour after leaving the caisson. Pressure 26 lbs. Epigastric pain and pain in the legs. No loss of sensibility. Profuse cold perspiration. Pulse, when I saw him, two hours after the commencement of the attack, was 96. The pain, which at first was very severe, had by this time become much less. Gave him an ounce of brandy and a teaspoonful of fluid extract of ergot. In 10 minutes the pulse had fallen to 82. Was able to resume work the next day.

  Case 12—Joseph Brown, foreman, American, aged about 28. Taken on the 28th of February, about an hour after coming up from a three hours’ watch. Excessive pain in left shoulder and arm, coming on suddenly, “like the thrust of a knife.” Pain continued until he went down again for the afternoon watch, when it ceased immediately….

  Case 13—Henry Stroud, a diver by occupation, began work on the morning of April 2d. Half an hour after coming up from the first watch, was taken with numbness and loss of power in the right side, also dizziness and vomiting. This was followed by severe pain over the whole body. Excessive perspiration. Was treated with stimulants and ergot, and in five hours was well enough to return home.

  Case 14—John Barnabo, Italy, 42, reports on the 13th of March, while in a car returning home, he was taken with severe pain in both arms. This was followed by dimness of sight and partial unconsciousness. Extremities very cold. Remained in this condition for two hours. Was obliged to keep to his bed for three days. For a week afterward was unable to work, feeling very much oppressed about the chest. Had no medical attendance. Had a similar but less severe attack about a month previously.

  Savage cramps in the legs were the most common first sign. Sometimes the pain lasted all night, in the knees mostly, and it felt as though the joint was being violently twisted apart and every muscle torn away from the bones—or worse. There was really no way to describe the pain, most men said. A modern medical textbook describes the pain as deep and relentless, and not throbbing. “When it is severe, local numbness, weakness, and faintness resemble the sickening pain of a blow on the testicle.”

  In one out of four cases the attack was accompanied by dizziness, double vision, and repeated vomiting. All of a sudden a man would begin to stagger, bend double, retch horribly, and fall. Sometimes there was no pain at all, just a massive numb feeling and an inability to walk or to stand upright.

  The victim of an attack always looked the same, whether there was pain or not, the face a leaden color with cold beads of sweat standing out all over, which were probabl
y signs of impending shock. Men complained, too, of excruciating pains in the chest and bowels. Some had their speech affected, as though they had had a stroke. In numerous cases the joints—knees, wrists, elbows—were swollen all out of shape, burning hot to the touch, badly discolored, and extremely tender.

  By the first week of April the caisson was down past sixty feet, still descending steadily, and conditions had grown very serious indeed. The remedies Smith employed were all very simple. To alleviate pain he promptly administered ergot and often in quantity. Or he doled out whiskey and ginger. Or he gave injections of atropine, a poisonous alkaloid used as an antispasmodic. When nothing else worked, he used morphine. Since the average attack generally lasted only a few hours, his solution for severe cases was simply to drug the patient so heavily that he felt little or nothing.

  He applied hot poultices to swollen joints. Paralyzed legs were soaked in hot baths, arms were packed in ice, spines were doused with ice water. Men with heaving stomachs were spoon-fed bits of ice or “a scruple of calomel,” i.e., twenty grains of a white tasteless purgative. Sometimes these things worked, or seemed to. But the prevailing attitude among the workers and the engineers in charge was that it did not matter much what Smith did. As Collingwood noted at a gathering of the American Society of Civil Engineers later that spring, almost every man recovered eventually anyway, regardless, it seemed, of how much or how little was done for him.

  In a few instances, when a man reported back to the job after recovering from an attack, Smith told him to find other work. Patrick Rogers, for example, a forty-year-old Irishman from Brooklyn, was on his way home on the ferry one night when all at once he had no feeling at all in his right side and very quickly after that was unable to stand up or move a muscle. When the boat docked, he was placed in a horse cab and taken home. As with most of the cases Smith recorded, the pain Rogers was in, terrible as it was, lasted less than twelve hours. But when he returned to the caisson, ready to go down again, he told Smith of a continued “trembling” in his chest and Smith advised him to go away and not come back.