Let me begin, then, by stating that my attention was attracted several years ago by that unique complex of symptoms known as the "caisson or tunnel disease." As most physicians are aware, the caisson disease is an affection of the spinal cord, due to a sudden transition from a relatively high atmospheric pressure to one much lower. Hence, those who work in caissons, or submerged tunnels, under an external pressure of two atmospheres or even more, are liable to be attacked by the disease shortly after leaving the tunnel. The seizure never, however, occurs while the subject is in the caisson, or in other words, while he remains under pressure. Moreover, when the transition from the condensed atmosphere to that of ordinary density is gradually accomplished, which may be done by letting the air escape from the lock very slowly, the caisson disease is rarely if ever set up. It is the systematic disregard of this principle by those who work in compressed air that is responsible, or largely responsible, for the occurrence of the disease.
The chief clinical features of the caisson disease are pain, which may be relatively mild, as when confined to a circumscribed area of one extremity, or of frightful intensity, as when it appears in the ears, knees, back, or abdomen; anæsthesia and paralysis, usually of paraplegic type; bladder symptoms, assuming the form of retention or incontinence; and, more rarely, rectal disturbances (usually incontinence).
These phenomena, or rather some of them, appear some time within half an hour after the subject has left the compressed atmosphere. It was while investigating this most interesting affection as it occurred in the course of the construction of the Hudson River tunnel, that I was able, at the same time, to study the effects of compressed air upon the organism, and especially upon the nervous system, as exhibited in a large number of persons.
The results of these studies I now submit without hesitation, and in all candor, to the judgment of the profession, believing, as I certainly do, that their practical significance from a neuro-therapeutic standpoint is assured. Without anticipating, however, let me state that the first thing which impressed me about compressed air was its extraordinary effect upon cerebral and cerebro-spinal function.
Those who remain for a certain length of time, not too long, however, in the condensed atmosphere, exhibit a most striking exacerbation of mental and physical vigor. They go up and down ladders, lift heavy weights, are more or less exhilarated, and, in short, behave as though under the influence of a stimulant.
Hardly had I observed these things, which are perfectly well known to those who have been able to familiarize themselves with the ordinary effects of compressed air as used in caissons and submarine works of various kinds, when my attention became attracted by what at first appeared to be a phenomenon of trivial importance. In a word, I observed that some of the men exposed to the effects of the compressed air were more exhilarated by it than others. Upon superficial reflection one might have supposed that this discrepancy in physiological effect was to be accounted for merely on the basis of constitutional idiosyncrasy; maturer thought, however, convinced me that the exaggerated effects of the condensed air were both too numerous and too constant to be amenable to such an explanation. This led me to study the habits of the men; and thus it was that I arrived at a discovery of real practical value to neurotherapy. To be brief, I found that a certain percentage of the men, before entering the compressed air employed in the construction of the Hudson River tunnel, were in the habit of drinking a quantity of alcohol, usually in the form of whisky. So long as these men remained outside the tunnel, where the atmospheric conditions were normal, they were not visibly affected by their potations. When, however, they entered the compressed air of the tunnel, but a short time elapsed before they became exhilarated to an inordinate degree, acting, as one of the foremen graphically expressed it, "as though they owned the town."
On the other hand, when the customary draught of alcohol was withheld from them, these same men were no more, if as much, exhilarated on entering the compressed air as were their fellows.
The effects of alcohol, then, are enhanced by exposing the subject to the influence of an atmosphere condensed to a considerable degree beyond that of the normal atmosphere.
Acting on the hint derived from this discovery, I proceeded to administer absinthe, ether, the wine of coca, vermouth, champagne, and other stimulants, before exposing the subject to the influence of the condensed atmosphere, and invariably observed analogous effects, i.e., palpable augmentation of the physiological effects of the remedy.
Upon what principle does this augmentation of physiological effect depend? how is it to be accounted for?