The Ancient Roots of Hyperbaric Medicine
The history of hyperbaric medicine is deeply connected to the evolution of diving and the use of compressed gases in therapeutic contexts, with roots stretching back to ancient times. Though little is known about the earliest diving practices, records indicate that as far back as 4500 B.C., free-diving for mother-of-pearl was a recognized profession. By 320 B.C., Alexander the Great was reportedly lowered into the Bosphorus Straits in a glass barrel, marking one of the earliest documented uses of a pressurized environment. During the 1500s, Leonardo Da Vinci even sketched diving devices, though none were realized. Nevertheless, these early innovations laid the groundwork for future developments in hyperbaric therapy.
The First Experiments in the History of Hyperbaric Medicine
In 1620 Dutch inventor Cornelius Drebbel invented the first true diving bell. It had an open bottom and relied on the pressure of water to keep air trapped within the bell. The bell would be lowered into the water by crane and had ballast to keep the bell properly oriented. Air was pumped into the bell by a hose to keep fresh air within while excess gases would leak out from under the lip of the bell. As the bell sank deeper more air was pumped inside to keep the occupants comfortable. The bell was never meant to move under the control of the divers but served as an underwater base for free divers.
The first documented use of hyperbaric therapy actually came before the discovery of oxygen. In 1662, British clergyman named Joseph Henshaw, used a system of organ bellows to change the atmospheric pressure in a sealed chamber called a domicilium. This domicilium could create both hyperbaric and hypobaric environments. Despite lacking any scientific basis for his theories, Henshaw believed that acute conditions would benefit from increased air pressure, while chronic conditions would respond better to decreased air pressure. According to Henshaw, “In times of good health this domicilium is proposed as a good expedient to help digestion, to promote insensible respiration, to facilitate breathing and expectoration, and consequently, of excellent use for the prevention of most afflictions of the lungs.” Henshaw was only providing increased and decreased air pressure without increasing oxygen concentration. Oxygen was not discovered until 1773 by Swedish pharmacist Carl Wilhelm Scheele (although Joseph Priestley published his findings first), and the term “oxygen” was not coined until 1777 by French chemist Antoine Lavoisier.
The 19th Century Hyperbaric Revival ⚕️ A Turning Point in the History of Hyperbaric Medicine
In 1859, the history of hyperbaric medicine recorded its first documented death from Caisson Disease, now known as Decompression Illness (DCI) or “the bends,” during construction of England’s Royal Albert Bridge, where workers became ill after working under high-pressure conditions deep underground. Later, in 1873, Andrew Smith coined the term “caisson disease” to describe 110 cases of decompression sickness during the Brooklyn Bridge construction, which employed 600 compressed air workers but lacked on-site recompression treatment. Similarly, during the 1882 Hudson tunnel project in New York, one in four workers succumbed to the bends until a recompression chamber was introduced. Afterward, only three workers died of bends over the following 18 months.
Fontaine’s Breakthrough and Tragic End
In 1877, French surgeon Fontaine developed the first mobile hyperbaric operating room, using Henry’s Law, which states that the solubility of gas in a liquid increases with pressure. This innovative chamber was designed to aid surgeries, reduce hernias, and treat conditions like asthma, chronic bronchitis, emphysema, and anemia. Fontaine’s chamber, equipped with bellows, windows for natural light, and a small medical lock for transferring items, seated up to 10 people. Over three months, twenty-seven operations were successfully performed, prompting plans for a larger hyperbaric surgical amphitheater to seat 300, though it was never realized. Tragically, Fontaine died in an accident at the Pneumatic Institute, becoming the first physician martyr in hyperbaric medicine history.
Revolutionary Potential of Compressed Air Therapy
In 1885, C. Theodore Williams commented in an article “Lectures on the Compressed Air Bath and its Uses in the Treatment of Disease” the British Medical Journal, “The use of atmospheric air under different degrees of atmospheric pressure, in the treatment of disease, is one of the most important advances in modern medicine and when we consider the simplicity of the agent, the exact methods by which it may be applied, and the precision with which it can be regulated to the requirements of each individual, we are astonished that in England this method of treatment has been so little used”.
Expansion into the 20th Century ⚕️ Foundations of Hyperbaric and Diving Medicine
In 1908, Scottish physiologist John S. Haldane began pioneering experiments at London’s Lister Institute of Preventive Medicine, working with Royal Navy Lieutenant Guybon Damant, an experienced diver, and physiologist Edwin Arthur Boycott. To start, they assembled a herd of 85 goats, placing groups in compression chambers for controlled durations. After decompression by stages, the animals were released, and as expected, observations confirmed that gradual decompression prevented symptoms of the bends. Furthermore, through these studies, Haldane introduced the concept of “half times”—the period required for tissue to become half-saturated with gas—and thus developed decompression protocols, particularly effective at shallower depths. As a result, these findings led to the creation of Admiralty decompression tables for the Royal Navy, which became essential for preventing decompression sickness. Haldane, known for his bold self-experimentation, significantly advanced our understanding of gases and human physiology. In 1910, influenced by his work, the German Navy equipped the SMS Vulkan with a sanitary lock to provide immediate hyperbaric treatment to divers, thereby reinforcing the critical connection between diving and hyperbaric medicine.
Advancements in Hyperbaric Simulation
The Hyperbaric Hotel
In 1921, as the First World War drew to a close, Orval J. Cunningham built a hyperbaric chamber in Lawrence, Kansas, where he treated patients affected by the Spanish influenza epidemic sweeping the United States. Cunningham theorized that atmospheric pressure, or barometric factors, contributed to higher mortality rates among those living at higher elevations. He reported significant improvements in cyanotic and comatose patients. Tragically, a mechanical failure one night caused a complete loss of pressurization, resulting in the deaths of all his patients. However, this did not diminish Cunningham’s commitment to hyperbaric therapy. He continued using it to treat conditions such as syphilis, hypertension, diabetes, and cancer, believing anaerobic infections played a role in these diseases. In 1928, Cunningham built the largest hyperbaric chamber in the world in Cleveland, Ohio—a massive steel structure known as the “Hyperbaric Hotel.” Standing five stories tall and 64 feet in diameter, the chamber featured 12 bedrooms on each floor, equipped with amenities to resemble a fully functioning hotel.
The increasing attention to Dr. Cunningham’s hyperbaric treatments led the Bureau of Investigations of the American Medical Association (AMA) to repeatedly request validation of his claims. While some believed he refused to cooperate with the AMA, others suspected he was a complete fraud. Ultimately, the largest hyperbaric chamber in the history of hyperbaric medicine was dismantled in 1937 and sold for scrap metal during World War II.
Military and Diving Applications
Modern Hyperbaric Oxygen Therapy ⚕️ Advancements Rooted in the History of Hyperbaric Medicine
Hyperbaric Organizations and Clinics
In 1972, Dr. Richard A. Neubauer opened the Ocean Hyperbaric Neurologic Center in Lauderdale by the Sea. Throughout his life, despite being viewed with suspicion by skeptics, Dr. Neubauer continued to treat and report the effectiveness of hyperbaric oxygen therapy in the management of various central nervous system disorders. Neubauer is considered the grandfather of HBOT in Neurology.
Recent Developments and Widespread Use
In 1990, former microbiology professor Igor Gamow invented and patented the Gamow Bag. The low pressure hyperbaric bag provided high altitude climbers with an effective method to treat high altitude sickness or AMS. Designed to fit a single person inside, this portable hyperbaric chamber was pressurized with a foot pump to about 2 pounds per square inch of pressure. The Bag simulates a descent of as much as 7,000 feet.
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Hyperbaric Oxygen Therapy Today ⚕️ Insights from the History of Hyperbaric Medicine
