Clinical Presentations and Significance of Decompression Sickness: an Analysis of Incidents from Commercial Diving Operations 1977–87

  • C. M. Childs
Conference paper
Part of the Advances in Underwater Technology, Ocean Science and Offshore Engineering book series (AUTOO, volume 14)


A review of the symptomatology of decompression sickness must make reference to present understanding of the cause of the condition. Since Boyle1,2 was able to produce decompression sickness (DCS) in animals by changes in ambient pressure, it has been held that at least the initial stimulus to the development of the condition is the formation of bubbles of inert gas within tissues and small blood vessels. The converse of this process, achieving elimination of these bubbles by recompression, was first realized in 1863.3 The mechanical effects of undissolved gas liberated from solution within tissues and the bloodstream are not, however, sufficient to explain the variable symptomatology, and cannot account for variations in individual susceptibility, time of onset, duration, and the nature of the response to treatment. Explanations of the pathophysiology of decompression sickness are not complete, but it has been known since 19374 that activity at the surface of undissolved gas has the potential in plasma for causing alterations in the structure and reactivity of substances within the plasma. It is currently thought5 that these alterations may lead to the denaturing of plasma proteins and the formation of lipid micelles from triglycerides, sterols and fatty acids normally contained within blood lipoproteins. These changes in the macromolecular constitution of blood will lead to changes in the flow characteristics of blood,5 with increased viscosity and decreased local flow.


Respiratory Symptom Decompression Sickness Repeated Episode Medical Fitness Diving Technique 
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  1. 1.
    Boyle, R. New pneumatical observations about respiration, Phil. Trans. R. Soc. London 1670; 5 2011 – 2031.CrossRefGoogle Scholar
  2. 2.
    Boyle, R. Continuation of observations concerning respiration, Phil. Trans. R. Soc. London 1670; 5 2035 – 2056.CrossRefGoogle Scholar
  3. 3.
    Foley, A. E. Du Travail dans l’Air Comprimé. Étude Médicale, Hygiéniue et Biologique Faite au Pont d’Argenteuil, Paris: Bert, 1863.Google Scholar
  4. 4.
    Bull, H. B. and Neurath. H. The denaturation and hydration of proteins. II. Surface denaturation of egg albumin J. Biol. Chem. 1937; 119 163–175.Google Scholar
  5. 5.
    Hallenbeck, J. M. and Andersen, J. C. Pathogenesis of the decompression disorders, in P. B. Bennett and D. H. Elliott (Eds),The Physiology and Medicine of Diving, London: Baillière Tindall, 1982. 435–460.Google Scholar
  6. 6.
    Swindle, P. F. Occlusion of blood vessels by agglutinated red cells, mainly as seen in tadpoles and very Young kangaroos, Am. J. Physiol. 1937; 120 59–74.Google Scholar
  7. 7.
    Lee, W. H. and Hairston, P. Structural effects on blood proteins at the as-blood interface, Fedn. Proc. 1971; 30, 1615–1622.Google Scholar
  8. 8.
    Goldin, F. C. Grifths P. Hempleman H. V. Paton W. D. M. and Walder D. N. Decompression sickness during construction of the Dartford Tunnel, Br. J. Ind. Med. 1960; 17, 167–180.Google Scholar
  9. 9.
    Elliott D. H. and Kindwall E. P. Manifestations of the decompression disorders in P. B. Bennett and D. H. Elliott Eds, The Physiology and Medicine of Diving, London: Bailliere Tindall, 1982. 461–472.Google Scholar
  10. 10.
    Doll, R. E. Decompression sickness among US Navy operational divers: an estimate of incidence using air-decompression tables Navy Experimental Diving, Unit 1965 Research Report 4–64.Google Scholar
  11. 11.
    Ciria Underwater Engineering Group. RNPL Metric Air Diving Tables, 1976; Report UR7.Google Scholar
  12. 12.
    Hanson R. de G. and Sowden R. R. Trials for testing diving tables, Admiralty Marine Technology Establishment 1979 Tech Memo AMTS(E) TM 79, 403.Google Scholar
  13. 13.
    Hennessy, T. R. Decompression Diving: Which Tables to Use South African Underwater Union 1975.Google Scholar
  14. 14.
    Shields, T. G. and Lee, W. B. The incidence of decompression sickness arising from commercial offshore air diving operations in the UK sector of the North Sea during 1982–83. Department of Energy, London, 1986.Google Scholar
  15. 15.
    Department of Energy. Diving Safety Memorandum No. 7/86. Department of Energy, London, 1986.Google Scholar
  16. 16.
    Slark, A. G. Treatment of 137 cases of decompression sickness, Medical Research Council, RN Personnel Research Committee Report 1962; 63/1030.Google Scholar
  17. 17.
    Rivera, J. C. Decompression sickness among divers: an analysis of 935 cases, Milit. Med. 1964; 129: 314–334.Google Scholar
  18. 18.
    Behnke, A. R. Decompression sickness following exposures to high pressures, in J. F. Fulton (Ed.), Decompression Sickness, London, Philadelphia: Saunders, 1951.Google Scholar
  19. 19.
    Rashbass, C. Aetiology of itching on decompression, Medical Research Council, RN Personnel Research Committee Report 1957; UPS 167.Google Scholar
  20. 20.
    Miles, S. Underwater Medicine, London: Staples Press, 1966.Google Scholar
  21. 21.
    Philp, R. B., Inwood, M. J. and Warren, B. A. Interaction between gas bubbles and components of the blood: implications in decompression sickness, Aerospace Med. 1972; 43, 946–956.Google Scholar

Copyright information

© Society for Underwater Technology (Graham & Trotman) 1988

Authors and Affiliations

  • C. M. Childs
    • 1
  1. 1.Occupational Health LimitedUniversity of AberdeenUK

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