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The principle is deceptively simple. Little oxygen is normally dissolved in the fluid portion of the blood, which relies on the hemoglobin in its red cells to carry oxygen, in a loosely combined form, to all the body's tissues. Dr. Boerema learned from animal experiments and his gas gangrene patients that it matters little during an operation whether the amount of oxygen carried by hemoglobin is increased: what counts is that under high pressure the watery part of the blood dissolves a considerable amount of gas. In Dr. Boerema's operations, that gas is life-saving oxygen. And the operation fixes up the children's circulation so that later the hemoglobin itself can do its job better.
Dry Dive. At Children's Hospital Medical Center in Boston, where surgery on children's hearts was born under the meticulous scalpel of Dr. Robert E. Gross in 1938, Dr. William F. Bernhard wanted to try the Boerema technique. First he went to Newport to ask the Navy for an old compression chamber. The Navy wasted no time telling him to go home: just the tank he wanted had been gathering dust since 1934 in a Harvard lab, only a few yards from Children's Hospital.
Last week Dr. Bernhard told the Society of University Surgeons meeting in Seattle that four blue children have had operations in the chamber. Two died of complications. But two who were suffering from one of the most surgically forbidding of all congenital defects, transposition of the great vessels (aorta and pulmonary artery), are doing well after palliative operations.
Dr. Bernhard works in an 8 ft. by 10 ft. compartment of the chamber, with an assistant surgeon, an anesthesiologist and a nurse. After an operation, the patient and surgical team are decompressed even more carefully than current Navy practice calls for; the process of surfacing from a "dry dive'' that reaches 80 ft., or almost 3½ times normal atmospheric pressure (about 50 Ibs. per sq. in.), is stretched out over an hour. Says Surgeon Gross: "Operating under pressure gives us one golden hour to achieve results impossible under normal conditions. We are going to hear a lot more about this technique in the next three or four years."