Sponge divers of the Aegean and medical consequences of risky compressed-air dive profiles.

Historically, Turkey once had a substantial number of professional sponge divers, a population known for a relatively high incidence of diving-related conditions such as decompression sickness (DCS) and dysbaric osteonecrosis (DON). Sponge diving ended in the mid-1980s when nearly all of the sponges in the Aegean and Mediterranean Seas contracted a bacterial disease and the occupation became unprofitable. We reviewed the records of Turkish sponge divers for information on their level of knowledge, diving equipment, dive profiles, and occupational health problems. Information was collected by: 1) interviewing former sponge divers near Bodrum, where most of them had settled; 2) reviewing the relevant literature; and 3) examining the medical records of sponge divers who underwent recompression treatment. These divers used three types of surface-supplied equipment, including hard helmets, Fernez apparatus, and hookahs; the latter were preferred because they allowed divers the greatest freedom of movement while harvesting sponges underwater. These divers used profiles that we now know involved a high risk for DCS and DON. We were able to access the records of 58 divers who had received recompression treatment. All of the cases involved severe DCS and delays from dive to recompression that averaged 72 h. Complete resolution of symptoms occurred in only 11 cases (19%). Thus, we were able to document the several factors that contributed to the risks in this occupational group, including unsafe dive profiles, resistance to seeking treatment, long delays before recompression, and the fact that recompression treatment used air rather than oxygen.