The History of Hyperbaric

The use of compressed air for treatment of medical problems was first attempted in 1662 by a British clergyman named Henshaw. He didn't have any scientific basis for this, but it "seemed like a good idea" to him. He built a sealed chamber called the "Domicilium" which had organ bellows connected with valves to adjust the air pressure. Acute conditions were treated with increased air pressure, and chronic problems were felt to be better treated with a lowered air pressure. His apparatus was nowhere near truly functional, so any effects were psychological at best.

In the late 1800s, a number of "pneumatic institutes," a type of health spa, popped up in Europe. They were large, well-appointed chambers, which could reach pressures of two or more atmospheres. Some could accommodate up to 10 people and were a popular rival to the mineral water spas that were all the rage then. There was no scientific research or proven usefulness to this therapy.

1879 saw the first true medical application of pressurized air. The French surgeon Fontaine built a mobile operating room, which could be pressurized, and used it to perform surgical procedures using nitrous oxide as an anesthetic. The increased pressures inside the chamber allowed for higher levels of oxygen getting to the patient during anesthesia, and this was a safer method of anesthetic administration than was available at standard room pressures.

Compressed air therapy came to the US several years later, with the major supporter being Orville J. Cunningham, a professor of anesthesia at the University of Kansas in Kansas City. He had already noted that people with heart disease became worse when living at higher altitudes but improved when living at sea level. During the influenza epidemic in 1918, he put a very sick young physician in a chamber, which was being used for animal studies, and improved his respiratory failure by compressing the air and raising the levels of oxygen in his system. This success led him to build an 88-foot-long, 10-feet-diameter chamber in Kansas City, in which he treated multiple patients with a variety of disorders. Unfortunately there was little scientific rationale for most of his work.

However, one patient that Cunningham treated, Mr Timkin of the Timkin Rollerbearing Company, felt that the time he spent in Cunningham's chamber cured his uremia. In 1928 as a show of gratitude, Timkin built a steel sphere, which was 6 stories tall, and 64 feet in diameter, the largest hyperbaric chamber ever built. Cunningham used this hospital, located in Cleveland, to treat patients with a number of ailments. It was well appointed, with dining rooms, private patient rooms, plush carpets, and even a smoking room on the top floor! Without any scientific rationale for his work, he was forced to close down by the AMA and the Cleveland Medical Society in 1930, and the steel ball hospital was cut up for scrap during World War II. This essentially ended the era of compressed-air hyperbaric therapy.

In the 1950s, the concept of "flooding" the tissues with extra oxygen was brought up by Ite Boerema of the Netherlands. A surgeon, Boerema worked with the Royal Dutch Navy in animal experiments with surgery inside a hyperbaric oxygen chamber. He had enough success that a large operating room chamber was built at the University of Amsterdam, and he did a number of complicated heart and lung operations under pressure.

Dutch and Scottish doctors continued to work on hyperbaric oxygen as therapy for gas gangrene infections and carbon monoxide poisoning in the 50s and 60s. A fairly large number of chambers were installed in hospitals across the country, including the two large chambers, which are still being used at St. Luke's Medical Center in Milwaukee.

Some of the chambers thoughout the country were surgical chambers. These were used mostly for cardiac surgery, though practitioners started looking for other uses as well. Soon a variety of maladies were being treated, such as strokes, emphysema, senility, and arthritis. There was not a lot of good scientific research done, however, so the treatments did not show any real benefits.

The cardiopulmonary bypass machines that were put into use in the 1960s effectively eliminated the use of hyperbaric chambers for cardiac surgery, so by the early 1970s many of the chambers in place across the country were being mothballed. By then, however, the lay press and non-medical hyperbaric gurus had begun treating people with little to no scientific basis. Hyperbaric oxygen treatments became a bit of a circus show.

Fortunately, the Undersea Medical Society, founded in 1967 by six Navy diving and submarine medical officers, had grown steadily over the years. By the mid 1970s, UMS began working with practitioners to rebuild the credibility of the field. A multi-authored textbook, Hyperbaric Oxygen Therapy (edited by Jefferson Davis and Thomas Hunt) was published in 1977. That same year, the UMS formulated a set of medical diagnoses which were appropriate for HBO therapy, and this report was accepted by the major insurance carriers as a basis for payment. With the guidance of the leaders in the field, UMS developed certification programs for nurses, technicians, and respiratory therapists which have been formalized and used today for certifying many of the workers in the field.

Training programs and certification for physicians also began to be formalized, with heavy involvement of the Navy and Air Force medical personnel. In 1976, Dr Eric Kindwall held the first formal course for civilian physicians at St. Luke's Medical Center in Milwaukee. Since then, a number of programs have been developed and these train hundreds of physicians a year. Hyperbaric Medicine fellowships, yearlong training programs focused on HBO therapy, have been formalized and are offered at several hospitals throughout the country.

The history of hyperbaric medicine has been an up and down ride. But currently, there are over 300 operating chambers throughout the country. The field has grown into a well-respected, effective means of treating diving injuries, certain infections and poisonings, traumatic and atherosclerotic vascular problems, burns, and cancer radiation injuries. Much research is being done to look at new ways this treatment can benefit patients with other problems as well. It will be an interesting next few years to see how specialists in hyperbaric medicine can continue to use this unique and often-misunderstood treatment to improve the health and well-being of thousands of patients across the globe.

Reference: Hyperbaric Medicine Practice, Kindwall and Whelan, Best Publishing Co, 1999

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