Background |
Hyperbaric
medicine is born |
Hyperbaric
fashion!
20th Century |
Modern hyperbaric medicine
Background
The origins of hyperbaric medicine go back to the origins of diving. The first
detailed records of use of diving equipment to extend time underwater are attributed
to Alexander the Great in 320 BC. It is said that he was lowered into the Bosphorus
Straits in a glass barrel during the siege of Tyre.
Leonardo Da Vinci made sketches of diving vessel chambers in 1500 but did not
develop them for practical use. In 1620, a Dutch inventor by the name of Cornelius
Drebbel developed what is thought to be the first true diving bell. This vessel
had the ability to be compressed to 1 atmosphere but had no supplementary oxygen.
In 1691, Edmund Halley, of comet fame, introduced a diving bell with a replenishable
air supply.
Top
Hyperbaric medicine is born
The first recorded attempt to use a hyperbaric chamber in medicine was made by
Dr Henshaw, a British physician, in 1662. The chamber was fitted with a large
pair of organ bellows, with valves paced so that air could either be compressed
into the chamber or extracted from it. In the ‘domicilium’ increased pressures
were used for the treatment of acute disease, and reduced pressures for the
treatment of chronic diseases.
In the Netherlands, the Dutch Academy of Sciences sponsored a prize in 1782
and subsequent years, for the design of an apparatus to study the effects of
higher pressures in biology. There were no contenders, nor any recipients of
the prize.
Top
Hyperbaric fashion!
In the 1830’s, France led something of a hyperbaric craze. It became very fashionable to be treated in chambers. Hyperbaric chamber
exposures of between 2 and 4 atmospheres absolute were stated to increase the
circulation to the internal organs, improve the cerebral blood flow, and produce
a feeling of well being.
Junod first made these observations and they were taken up avidly by his peers.
At a French iron shop he 1834 built the first hyperbaric tank. It was a copper
sphere five feet in diameter with viewports and compressed air fittings. He
used it with many patients and hyperbaric enthusiasm spread among the European
countries during the next 40 years with people travelling from as far afield
as the United States for treatment
Fontaine (1877) developed the first mobile hyperbaric operating theatre, and
by this time hyperbaric chambers were available in all major European cities.
The approach to dosage was somewhat ad-hoc, and prescriptions varied from one
physician to another. No methods were available to estimate the partial pressure
of oxygen in blood, which at 2 ATA of air is about double that at sea level. In
comparison, if pure oxygen is breathed at 2 ATA, the partial pressure of oxygen
in the arterial blood is twelve times higher than normal.
During the second half of the nineteenth century, hyperbaric centers were being
advertised as comparable to health spas. Junod referred to his treatment as
“Le Bain d’air comprime” (the compressed air bath). In 1855 Bertin wrote a
book on this topic and constructed his own hyperbaric chamber. The literature
on hyperbaric medicine up to 1887 was reviewed by Arntzenius and contains a
remarkable 300 references.
Hyperbaric chambers were recommended to reduce effects of hernia, for patients with asthma, emphysema, chronic bronchitis and anemia. Success was so great that a large hyperbaric surgical amphitheatre which would hold 300 people was planned, but never actually came into being. Fontein had an accident whilst at the Pneumatic Institute which resulted in his death, the first physician martyr to hyperbaric medicine.
Top
20th Century
In the United States, in 1928 Dr Cunningham of Cleveland constructed the largest
chamber ever built – five stories high and 64 feet in diameter. Each floor
had 12 bedrooms with all the amenities of a good hotel. At that time it was
the only hyperbaric chamber known to be operating in the world. As the publicity
surrounding his treatments grew, Dr Cunningham was repeatedly requested by the
American Medical Association to document his claims regarding the effectiveness
of the treatment.
Other than a short article in 1927, Cunningham made no efforts to describe or
discuss his technique in medical literature. He was eventually censured by
the AMA in 1928 in a report that stated: “Under the circumstances, it is not
to be wondered that the Medical Profession looks askance at the ‘tank treatment’
and intimates that it seems tinctured much more strongly with economics than
with scientific medicine. It is the mark of the scientist that he is ready
to make available the evidence on which his claims are based.
Dr Cunninghmam was given repeated opportunities to present such evidence but
never did so. The Cunningham chamber was dismantled for scrap in 1937, which
brought to a temporary end the era of Hyperbaric Oxygen Therapy for medical
disorders.
Drager, who in 1917 devised a system for treating diving accidents, first realized
the potential benefits of using oxygen under pressure for the treatment of decompression
sickness. For some unknown reason, however, Drager’s system never went into
production. It was not until 1937 – the very year that Cunningham’s “air chamber”
hotel was demolished – that Behnke and Shaw actually used hyperbaric oxygen
for the treatment of decompression sickness.
Top
Modern hyperbaric medicine
In the 1950's and 60's work carried out by a number of physician's progressed
hyperbaric medicine into what we know today. Churchill-Davidson began to use
hyperbaric oxygen to treat radiotherapy damaged patients, something which it
is still used for today. In 1956 Boerema of Holland pioneered the use of open
heart surgery in the hyperbaric environment.
Carbon monoxide poisoning was treated in 1962 by Sharp and Smith of Scotland,
and osteomyelitis by Perrins in the UK in 1965. The Undersea Medical Society
was formed in 1967 and changed to the Undersea and Hyperberbaric Medical Society
in 1986. This society has promoted a modern scientific basis for the use of
hyperbaric oxygen. Now, a range of 13 conditions have sufficient scientific
evidence to support the use of hyperbaric oxygen.
Top
