The first documented use of air therapy was of a British Physician named Rev. Henshaw who used a pressure tight chamber, called a ‘domicilium’, to treat people under pressure. The domicilium could be used to control the climate and pressure conditions which he believed would aid healing. It used bellows to control the levels of internal pressure, so it was unlikely that the pressures achieved would have been very high.
Oxygen was discovered by an English scientist called Priestly. He noted the benefits of oxygen to wound healing. It was much later before anyone discovered that high concentrations of oxygen could be toxic. A Thomas Beddoes was noted to use oxygen for medical purposes in 1796.
In France, Junod and Fabare built a copper sphere hyperbaric chamber which could achieve pressures of 2 – 4 atm. They used this from 1834 to treat pulmonary disease. Later in 1837, in Lyon, a hyperbaric chamber was being built large enough to seat 12 patients.
The first recorded death from ‘Caisson Disease’, which we later came to call Decompression Illness (DCI) or Decompression Sickness or most commonly known as ‘the bends’. This occurred during the building of the Royal Albert Bridge, a railway bridge in England spanning the River Tamar from Saltash to Plymouth. Workers were taken ill when working deep underground, working under pressure.
The first hyperbaric chamber was used in North America in 1860. In 1861 Cornin was using one in the USA to treat nervous disorders. In 1876 in the USA it is noted that Kelly treated a patient in a ‘Compressed Air Bath Apparatus’ described as having a medical lock with two closing plates sealing with pressure and a lock valve on the outside which could be controlled externally.
In the late 1870s an early hyperbaric chamber was built using the latest engineering developments and innovations. Fontaine’s Air Chamber used bellows, could seat 10 people and had windows which allowed light in and enabled observation. It contained a small medical lock allowing small items to be moved in and out of the chamber without changing pressure.
In 1878, a Paul Bert discovered oxygen toxicity and recommended ‘normobaric’ oxygen should be used to treat Caisson’s Disease, i.e. the giving of oxygen in a non-pressurised environment.
This was a time of many great engineering projects such as the construction of bridges and tunnels, often using ‘caissons’ under pressure to keep water from flooding excavations below the water table. Workers in these pressurised environments began to suffer mystery illnesses, leading to major injuries and even death. Hence the early name for decompression illness as Caisson Disease.
The construction of the Brooklyn Bridge produced 110 cases of Caisson Disease. The first workers successfully treated for Caisson Disease in a hyperbaric chamber where from the construction of the Hudson Tunnel in New York.
In the UK the first documented scientific approach to using hyperbaric oxygen therapy was by John S Haldane.
It is around this time that diving and hyperbaric medicine began to overlap. In 1908 Haldane developed the Admiralty decompression tables I and II. When in 1910 the German Imperial Navy submarine salvage vessel the ‘SMS Vulkan’ was deployed with heavy lifting gear and divers aboard, it was equipped with a sanitary lock to treat divers immediately once back on board.
In 1912 the US Navy built diving simulators and a testing tank. It had an internal diameter of 2.14m, a height of 3.05m and an access shaft centrally arranged with a 1m diameter.
In 1913 the Germans built diving and pressure simulators and conducted experiments on the reaction of humans to breathing pure oxygen in a hyperbaric environment. The Dragerwek Lubeck testing tank had a 2m diameter, 3m height and a maximum pressure of 20 bar.
By 1917 early portable chambers were developed.
In Kansas (USA) Cunningham was ‘curing’ people with influenza and kidney disease. A grateful patient then built a chamber in Cleveland in 1928 of a monumental 20m diameter to be pressurised to a maximum of 2 bar. Within the 6 storeys and 72 rooms it had dining facilities, rich carpets, private quarters and even a smoking room! It was however scrapped after 2 years.
Noldecke & Hartmann describe the construction of the Naval Research Institute for Submarine Medicine. It was used for wound treatment.
In 1942 End & Long used hyperbaric oxygen therapy to treat carbon monoxide (CO) poisoning.
In the 1950s the use of HBO widened further as Churchill-Davidson used HBO to treat radiosensitivity of tumours and Boerema carried out cardiac surgery in chambers.
1960s to 90s
The extended use of HBO continued through the 1960s for conditions such as gas gangrene and ischemias. HBO facilities expanded across the world, opening up in places such as Japan, the USSR and China.
1983 the American College of Hyperbaric Medicine and in 1986 the Undersea and Hyperbaric Medical Society (UHMS) were set up. The European Committee for Hyperbaric Medicine (ECHM) followed in 1990. Finally in 1993 the British Hyperbaric Association (BHA) was created, although it was initially known as BIGHT.
The European Baromedical Association (EBAss) was set up in 2009 to oversee the certification of technicians and nurses.
Recent developments have focussed on further developing research and understanding of both diving medicine and hyperbaric medicine. There has been a focus on ethics and the avoidance of past mistakes to take the field of hyperbaric medicine forward more positively and to widen understanding of the medical applications which are effective.