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제목 챔버의 구분-복실 챔버 02
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 c.잠수로 인해 치료챔버가 고안되었다

    Augustus Siebe가 고안한 놋쇠로 된 투구와 가죽잠수복을 1819년 처음 소개한 후로 이 잠수복이 상당한 기간 동안 100ft(30.5m)수심까지의 표면공급 공기잠수자들에게 이용되어 왔었다. 1825년 William H. James는 표면공급장치로부터 자유롭고 공기공급이 자유로운 이동용 자가보유(self-contained)잠수복을 고안하였다.

     

    초기 잠수사들에게 흔한 것들은 극도의 피로감과 감압병이었다. 그리고 실제적으로 21m이상의 잠수에서 흔히 이러한 일들이 일어났다. 프랑스인 의사인 L. R. de Mericourt가 1869년 처음으로 잠수사의 감압병에 대해 완전한 의학적인 보고서(comprehensive medical report)를 발표하였다. 1882년에 와서야 미해군 잠수사들도 제대로된 잠수과정에 대해 강의를 받게 되었다(Penzias and Goodman 1973). Seaman Gunners School에서 비록 잠수를 가르치고 졸업은 했지만 이들은 60ft정도의 잠수능력밖에 없었고 이들은 구조업무, 건설현장, 선박수리업무 등에 고용되어 작업을 하게 되었다.

     

    1905년 영국에서 안전한 잠수를 위한 대단한 발전이 있었고, 압축공기 잠수로 심해잠수를 하기 위한 위원회가 만들어졌다. 이 위원회의 한 사람인 영국의 생리학자 J. S. Haldane과 그의 동료들(Boycott et al. 1908)은 안전한 잠수를 위한 중요한 두 가지 제안을 하였다:

     

    첫째, 잠수사에게 공급한 공기의 양은 압력의 증가에 반드시 비례해서 증가한다라는 사실을 증명하였다.

     

    둘째, 감압 계획을 계산하기 위해 계단식개념을 도입하여 “ stage decompression(계단식 감압)”방법을 표면으로 부상할 때 안전한 방법으로 제안하게 되었다.

     

    이러한 대단한 Haldane의 제안은 1907년에 채택이 되었고, 210ft(64m)의 수심까지 잠수할 때 사용하게 되었다.

     

    1912년 미 해군의 Warrent Gunner George T. Stillson이 계단식 감압을 검증하기 위하여 "diving tanks(잠수 탱크)“를 고안했다. 그리고 이 탱크로 274ft 수심까지 잠수에 성공하고 이러한 성공에 힘입어 더 깊은 수심으로의 잠수가 가능하게 되었다. 그리고 이 시기에 미 해군의 잠수함전력이 급속하게 성장하게 되었고 이에 따른 잠수함의 많은 사고, 충돌, 가벼운 사고 등이 20년간에 걸쳐서 발생하게 되었고 이로 인해 미 해군의 구조능력이 급속도로 발전하게 되었다(U. S. Navy 1978).

     

     

    1924년 미 해군 잠수학교가 Rhode Island의 Newport에 설립되고 처음으로 U. S. Navy Diving Manual이 출판되었다. 이 책에는 심해잠수를 지원하기 위해서 가압챔버를 설명하는 부분이 포함되어 있었다. 1924년 미 해군의 심해잠수를 선발하기 위한 엄격한 신체조건이 명시되었고 자주 재검을 해야한다고 규정하였다. 더욱이 잠수사의 나이가 40세가 넘으면 자동적으로 실격되게끔 하였다. 표면 감압은 1925년 잠수함 s-51을 구조할 때 처음 사용되었다. 표면 감압은 1930년대에 기본적인 감압 방법으로 사용되어왔고, 그리고 미 해군은 재가압 사업에 관심을 돌리기 시작하였다. 그후 1937년 A. R. Behnke & L. A. Shaw에 의해 치료를 위해 감압중에 산소나 산소를 포함하는 기체의 사용에 관심을 가지기 시작하였다. 산소를 사용하는 연구와 치료의 발전은 챔버의 안전도에 대한 연구 발전보다도 훨씬 빠른 속도로 진전되어가다가 일련의 사고에 봉착하게 된다. 즉 산소가 풍부한 환경에서의 화재 문제였다. 한 예를 들어버면 1939년 선상챔버내에서 산소가 풍부한 챔버내의 공기가 열려져있는 챔버의 출입구를 통해 챔버 조작수의 담뱃불로 인해 폭발하게 되었다. 그중 4명은 질식사하였고 다행하게도 4명은 살았다.

     

    심해 잠수중에 공기호흡에 의해 발생할 수 있는 심한 정신적인 장애 문제를 해결하기 위해 헬륨과 산소 혼합기체 연구와 실험이 펜실베니아의 피츠버그에 있는 광산 실험실에서 처음 있었다. 1927년 이러한 잠수관련 연구와 실험을 통합하는 쪽으로 관심이 모아져서 미해군 실험잠수단(Naval Experimental Diving Unit; NEDU)이 워싱톤에 설립되었다. 그리고 바로 뒤에 미해군 잠수와 구조학교(Navy School of Diving and Salvage)가 워싱톤의 미해군 부지 내에 재 가동되었다. 이 시설은 1930년대까지는 350psi(788fsw)까지 가능한 탱크와 연결이 가능한 이중 잠금 장치가 되어있는 200psi(450fsw)의 압력을 유지할 수 있는 두 종류의 감압챔버를 가지고 있었다. 그리고 NEDU의 감압챔버는 고도 실험작업(altitude experimental work)을 위한 장비도 보유하고 있었다.

 

    1930년대 미해군 군의관인 C. W. Shilling, A. R. Behnke, 그리고 O. E. VanDerAue가 최초로 미해군 실험잠수대의 의무진으로 참여하게 되었다(Carter 1977). 이들의 기념비적인 가압챔버에 대한 연구 결과는 선상 감압챔버에서의 잠수사의 표면 감압, 잠수함내에 공기조절장치 설치, 산소호흡으로 최대 수심 결정, 그리고 심해잠수를 위해 헬륨과 산소의 혼합기체 사용 등이다.

     

    1939년에 헬륨과 산소를 이용한 혼합기체를 사용하여 챔버잠수로 500ft를 시행하였고, 잠수함 Squalus침몰 사고 때 74m(243ft)의 수심에서 승조원 50명중에 33명을 구조하는 실해잠수에 성공하였다. 이때 구조챔버로 Commander Allen R. McCann이 고안한 잠수종을 처음으로 사용하였고 혼합기체 잠수를 하여 승조원을 구출하고 이들을 표면에서 산소를 이용한 감압으로 승조원과 구출팀을 치료하였다(Carter 1977).

     

    1950년대에 와서는 한층 더 빠른 속도로 발달된 헬륨과 산소를 이용한 혼합기체를 사용하여 더 깊은 수심과 진보된 호흡조절장치(built-in breathing systems; BIBS)의 진전을 볼 수 있었다. 산소독성 연구로 스쿠버 잠수로써의 산소호흡 제한수심을 알 수 있었다.

     

    1909년 F. L. Keays가 3692명의 감압병 환자를 보고하고, 그가 감압병의 치료원칙은 재가압하는 것이라고 주장하였지만, 그 주장은 1924년 미 해군 잠수 지침서(U. S. Navy Diving Manual)가 출판되기 전까지는 받아들여지지 않았다. 그러나 불행히도 그 미 해군의 공기 감압과정은 치료자의 약 50%이상에서 증상이 재발하였다(VanDerAue et al. 1945). A. R. Behnke와 L. A. Shaw(1937)가 공동 연구한 산소 치료표는 미 해군 의무감실의 인정을 받았지만, 그 초기 산소치료 계획표는 환자의 재발을 막는데 큰 도움이 되지 못했다.

    1945년 미 해군 의학 연구소(Naval Medical Research Institute)에서 감압병과 공기색전증 치료를 위한 일련의 완전한 표를 발표하였고, 이것이 1965년까지 미 해군에서 사용한 치료표(table I-IV)이다. 이러한 치료표로도 심한 경우의 감압병 환자의 치료 성적이 좋지 않았기 때문에 M. W. Goodman and R. D. Workman(1965)은 산소 치료표 5, 5A, 6, & 6A를 개발하였다. 그리고 이것이 오늘날 감압병과 공기색전증의 표준 치료표로 사용되고 있는 것이다. 잠수 기술의 가장 혁명적인 발전중의 하나는 아마 스쿠버의 전후 변형(postwar modification)일 것이다. J. Y. Cousteau에 의한 Aqua-lung, E. Gagnan과 C. J. Lambertsen의 수륙양용호흡기(Amphibious Respiratory Units)는 2차 세계대전 중에 수색을 하거나 수중장애물 폭파 등의 작전에 사용되었다(U. S. Navy 1978). 1950년대에 와서 스쿠버 관련장비의 발전이 있었고 이로 인해 일반인들도 사용할 수 있게 되었으며, 1959년 미 해군 표준 공기감압표(U. S. Navy Standard Air Decompression Tables)가 발표되면서 미국에서 가장 빠르게 성장한 스포츠중의 하나인 스포츠 스쿠버 잠수산업이 상업적으로 발전하게 되었다. 그런데 이런 과정에서 고압 챔버는 이제 스포츠 잠수 사고를 치료하는 새로운 국면을 맞이하게 되었다.

     

    d.항공의학과 치료챔버

    1917년 초기에 Yandell Henderson은 조종사에게도 감압병에 이완될 가능성이 있다고 지적하였다. 1930년대, 비행선과 비행기의 고도기록이 50,000ft(15,250m)를 넘게 되고 고도 감압병 환자(altitude decompression sickness)가 발생하기 시작했다. 1959년까지, 743명의 중증 환자가 발생하여 적어도 17명의 비행사가 이 질환으로 사망하게 되었다(Davis et al, 1977). 그 동안에 의료계 일각에서는 이러한 질환의 원인론과 처치방법, 그리고 이 질환의 용어를 어떻게 사용해야 할 것인가에 대해 논의하기 시작했다. 비록 A. R. Behnke가 1941년에 고도 감압병환자를 치료하였지만, 1960년 A. M. Donnell과 C. P. Norton이 1959명의 환자를 보고하기 전까지는 고도 감압병의 치료원칙에 대해서 알려진바는 없었다. 1959년과 1963년사이에 군 비행사의 고도 감압병을 고압 챔버로 치료하여 놀랄만한 실적을 보았고 이로 인하여 미 공군에서는 정상적인 고압의학 과정(Hyperbaric Medicine Program)이 생기게 되었다.

 
 
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