19th Century Laryngologist Effectively Saved the Brooklyn Bridge

CLINICAL QUESTION

What role did the late 19th-century laryngologist Andrew Heermance Smith, MD, have in elucidating the mechanisms of Caisson disease and controlling its effects on bridge workers?

BOTTOM LINE

During the construction of the Brooklyn Bridge, Dr. Smith’s actions markedly decreased the rates of death and disability among the caisson workers.

BACKGROUND: Built in the 19th century, the East River Bridge employed a suspension design and materials on a never-before-seen scale. Its masonry towers required the use of pressured caissons for excavation. When workers began collapsing after exiting the caisson at day’s end, a laryngologist was called in to save the project.

STUDY DESIGN: Historical review.

SETTING: Departments of Otolaryngology–Head and Neck Surgery and Pediatrics, Lewis Katz School of Medi-

cine at Temple University, Philadelphia, Penn.

SYNOPSIS: Dr. Andrew H. Smith was a laryngologist whose 1870 paper, “Oxygen as a Remedy for Disease,” was published just as problems were arising in the building of a new bridge in New York City. The East River Bridge required the construction of two freestanding masonry towers, to be supported by caissons that were sunk to the riverbed beneath tons of limestone and granite. Among the bridge’s problems were the damaging health effects of the caisson’s pressurized air on its laborers. Project head Washington Roebling enlisted the help of Dr. Smith, who, after studying previously published observations on the physiology of compressed air in construction projects, installed additional compressors to improve ventilation in the caisson, doubling the number of workmen—thereby shortening and increasing the time between shifts—and excluded unfit workers. Dr. Smith’s combined readings, physiological observations, and experiments enabled him to describe Caisson disease and help ameliorate its effects. The laryngologist’s stringent standards and timely interventions allowed for the completion of the masonry towers of what would become the Brooklyn Bridge. The New York caisson was fully submerged and filled with concrete in July 1872.

CITATION: Isaacson G. The laryngologist who saved the Brooklyn Bridge[published online ahead of print January 29, 2024]. Laryngoscope: doi.org/10.1002/lary.31306.