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THE PHYSICIAN's GUIDE to DIVING MEDICINE the PHYSICIAN's GUIDE to DIVING MEDICINE Tt",,.,,,,., , ••••••••••• ,

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THE PHYSICIAN's GUIDE to DIVING MEDICINE the PHYSICIAN's GUIDE to DIVING MEDICINE Tt THE PHYSICIAN'S GUIDE TO DIVING MEDICINE THE PHYSICIAN'S GUIDE TO DIVING MEDICINE tt",,.,,,,., , ••••••••••• , ......... ,.", •••••••••••••••••••••••• ,. ••. ' ••••••••••• " .............. .. Edited by Charles W. Shilling Catherine B. Carlston and Rosemary A. Mathias Undersea Medical Society Bethesda, Maryland PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Main entry under title: The Physician's guide to diving medicine. Includes bibliographies and index. 1. Submarine medicine. 2. Diving, Submarine-Physiological aspects. I. Shilling, Charles W. (Charles Wesley) II. Carlston, Catherine B. III. Mathias, Rosemary A. IV. Undersea Medical Society. [DNLM: 1. Diving. 2. Submarine Medicine. WD 650 P577] RC1005.P49 1984 616.9'8022 84-14817 ISBN-13: 978-1-4612-9663-8 e-ISBN-13: 978-1-4613-2671-7 DOl: 10.1007/978-1-4613-2671-7 This limited facsimile edition has been issued for the purpose of keeping this title available to the scientific community. 10987654 ©1984 Plenum Press, New York A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors The contributors who authored this book are listed alphabetically below. Their names also appear in the text following contributed chapters or sections. N. R. Anthonisen. M.D .. Ph.D. Professor of Medicine University of Manitoba Winnipeg. Manitoba. Canada Arthur J. Bachrach. Ph.D. Director. Environmental Stress Program Naval Medical Research Institute Bethesda. Maryland C. Gresham Bayne. M.D. Assistant Adjunct Professor of Medicine University of California. San Diego Albert R. Behnke. Jr.. M.D. Adjunct Professor of Exercise Science University of Massachusetts. Amherst Peter B. Bennett. Ph.D. Director. F. G. Hall Laboratory Duke University Medical Center Durham. North Carolina Walter R. Bergman Special Assistant for Diving Naval Sea Systems Command Washington. District of Columbia Robert J. Biersner. Ph.D. Naval Medical Research and Development Command Bethesda. Maryland Mark E. Bradley. M.D. Naval Medical Research Institute Bethesda. Maryland v vi Contributors Carl Edmonds. M.B .. B.S. Diving Medical Centre Cremorne. New South Wales. Australia Delbert E. Evans. Ph.D. Naval Medical Research Institute Bethesda. Maryland Morris D. Faiman. Ph.D. Department of Pharmacology and Toxicology University of Kansas. Lawrence Joseph C. Farmer. Jr .. M.D. Di vision of Otolaryngology Duke University Medical Center Durham. North Carolina William P. Fife. Ph.D. Professor of Physiology Texas A & M University. Bryan Harold M. Ginzburg. M.D. National Institute on Drug Abuse Bethesda. Maryland Robert F. Goad. M.D. U.S. Navy Medical Corps Duke University Medical Center Durham. North Carolina John M. Hallenbeck. M.D. Naval Medical Research Institute Bethesda. Maryland R. W. Hamilton. Ph.D. Hamilton Research. Ltd. Tarrytown. New York George B. Hart. M.D. Director. Baromedical Department Memorial Hospital Medical Center Long Beach. California H. V. Hempleman. Ph.D. Superintendent Admiralty Marine Technology Establishment Alverstoke. United Kingdom Donald D. Hickey. M.D. Hyperbaric Research Laboratory Department of Physiology State University of New York at Buffalo Suk Ki Hong. M.D .. Ph.D. Department of Physiology State University of New York at Buffalo Contributors vii Eric P. Kindwall, M.D. Director. Department of Hyperbaric Medicine St. Luke's Hospital Milwaukee. Wisconsin JoAnn S. Kinney, Ph.D. Naval Submarine Medical Research Laboratory Groton. Connecticut Kenneth W. Kizer, M.D., M.P.H. Division of Occupational Medicine University of California, San Francisco David R. Leitch. M.B .. Ch.B .. Ph.D .. M.F.O.M. Institute of Naval Medicine. Royal Navy Gosport. United Kingdom Paul G. Linaweaver. Jr .. M.D. Santa Barbara Medical Foundation Clinic Santa Barbara. California Claes E. G. Lundgren. M.D .. Ph.D. Hyperbaric Research Labonltory Department of Physiology State University of New York at Buffalo H. F. Nicodemus, M.D. Chairman, Department of Anesthesia Naval Hospital. Bethesda. Maryland Arvi<J Pasche. M.Sc. Research Scientist Norwegian Underwater Technology Center Bergen. Norway R. R. Pearson, M.D .. M.F.O.M. Institute of Naval Medicine Alverstoke. United Kingdom David H. Peterson. B.S. National Oceanic and Atmospheric Administration Rockville. Maryland Paul J. Sheffield. Ph.D. Hyperbaric Medicine Division USAF School of Aerospace Medicine Brooks Air Force Base. Texas Charles W. Shilling, M.D. Executive Secretary Undersea Medical Society. Inc. Bethesda. Maryland Joel Kevin Sims. M.D. Chief. Emergency Medical Services Systems Branch Department of Health. Hawaii Honolulu. Hawaii viii Contributors CharlesJ. Stahl. M.D. Professor of Pathology Quillen-Disner College of Medicine East Tennessee State University. Johnson City Barbara B. Tabeling. M.D. Department of Anesthesiology Mercy Hospital. Urbana. Illinois D. N. Walder. M.D. Department of Surgery University of Newcastle-upon-Tyne United Kingdom J. Michael Walsh, Ph.D. National Institute on Drug Abuse Bethesda. Maryland Reviewers An expert reviewer was selected for each chapter. Their voluntary effort is greatly appre­ ciated. They are listed alphabetically. E. E. P. Barnard, M.B., B.S., Operational Medical Services. Royal Navy D.Phil. Institute of Naval Medicine Alverstoke. United Kingdom C. Gresham Bayne. M.D. Assistant Adjunct Professor of Medicine University of California. San Diego Alfred A. Bove. M.D .. Ph.D. Mayo Medical School and Mayo Clinic Rochester. Minnesota John M. Hallenbeck. M.D. Naval Medical Research Institute Bethesda. Maryland R. deG. Hanson. M.D .. Ph.D. .Consultant in Occupational Medicine Royal Navy. United Kingdom William L. Hunter. Jr .. M.D. Naval Regional Medical Center Jacksonville. Florida Paul G. Linaweaver. Jr., M.D. Santa Barbara Medical Foundation Santa Barbara. California Norman K. I. Mciver. M.B .. B.S. North Sea Medical Center Great Yarmouth. United Kingdom John Naquin. M.A. Naval Medical Research Institute Bethesda. Maryland ix x Reviewers Lawrence W. Raymond. M.D. Assistant Medical Director Exxon Corporation. New York Associate Professor. Cornell University Medical College. New York. New York Albert J. Smith U.S. Navy Edward D. Thalmann. M.D. U.S. Navy Experimental Diving Unit Panama City. Florida O. E. VanDcrAue. M.D. U.S. Navy (Retired) Washington. District of Columbia James Vorosmarti. Jr.. M.D. Commanding Officer Naval Medical Research Institute Bethesda. Maryland S. A. Warner. D.Sc. Department of Energy United Kingdom Advisory Committee James Vorosmarti. Jr.. M.D. Commanding Officer Naval Medical Research Institute Bethesda. Maryland Robert C. Bommann. M.D. Medical Corps. U.S. Navy Claes E. G. Lundgren. M.D .. Ph.D. Hyperbaric Research Laboratory Department of Physiology State University of New York at Buffalo xi Preface This book is designed to be a physician's guide for those interested in diving and hyperbaric environments. It is not a detailed document for the erudite researcher; rather, it is a source of information for the scuba-diving physician who is searching for answers put to him by his fellow nonmedical divers. Following the publication of The Underwater Handbook: A Guide to Physiology and Performance for the Engineer there were frequent requests for a companion volume for the physician. This book is designed to fill the void. Production of the book has been supported by the Office of Naval Research and by the Bureau of Medicine and Surgery, Research and Development Command, under Navy Contract No. NOOOOI4-78-C-0604. Our heartfelt thanks go to the many authors without whose contributions the book could not have been produced. These articles are signed by the responsible authors, and the names a~e also listed alphabetically in these preliminary pages. Every chapter was officially reviewed by at least one expert in the field covered and these reviewers are also listed on these pages. Our thanks go to them for their valuable assistance. We are grateful to Marthe Beckett Kent for editing Chapter III. Our thanks also go to Mrs. Carolyn Paddon for typing and retyping the manuscripts, and to Mrs. Catherine Coppola, who so expertly handled the many fiscal affairs. The Advisory Committee-Drs. Vorosmarti, Lundgren, and Bornmann-along with the three of us have deliberated on every section of the text several times. We believe it covers the field adequately. The context, however, does not necessarily reflect the position of the Navy or the Government, and no official endorsement should be inferred. CHARLES W. SHILLING CATHERINE B. CARLSTON ROSEMARY A. MATHIAS xiii Foreword Submarine Medicine Practice (NAVMED P-5054) was a Navy classic. Published initially in 1956, it was a beautifully written training text and reference for the Navy submarine and diving medical officer. Very popular inside and outside the Navy, within the U.S.A. and overseas, its appearance was also timely as deep diving and underwater swimming began the tremendous development and expansion which they experienced in the 1960s and I970s. Physicians and medical scientists were taxed to make these longer and deeper dives possi­ ble, useful, and safe. The subsequent explosion of new information and new applications eventually outstripped the descriptions of "Submed Practice." But no second edition, revision, or new volume was published
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