ObjectiveTo understand the role of a single laryngologist, Andrew Heermance Smith, in elucidating the mechanisms of Caisson Disease and controlling it effects on bridge workers.Data SourcesScientific and lay publications, letters and records of the Roebling family, obituaries and internet sources.Review MethodsHistorical review.ResultsAH Smith combined physiological observations and experiments in the Brooklyn Bridge caissons with a review of the existing engineering and medical literature to describe the Caisson Disease and to devise strategies to ameliorate its effects.ConclusionDespite an incorrect conclusion about the pathophysiology of decompression sickness, Smith's stringent standards and timely interventions allow completion of the masonry towers of the Brooklyn Bridge.Level of EvidenceNA Laryngoscope, 2024