Hyperbaric oxygen therapy: the history

In 1662, a British clergyman named Henshaw, without scientific basis, thought it would be a good idea to raise the ambient pressure around a patient for therapeutic purposes. He later built a "domicilium," a sealed chamber that could either raise or lower pressure depending on adjustment of the valves.

He reported that acute diseases of all kinds responded favorably to increased ambient pressure.

In the 19th century, following up on Henshaw's ideology, pneumatic institutes began to sprawl around the European continent. These large chambers often were able to accommodate more than one person and could sustain pressures of two or more atmospheres. These pneumatic institutes started to rival the popularity of mineral-water spas.

It was not until 1879 that semi-scientific efforts were made in the field. A French surgeon named Fontaine built a mobile operating room on wheels that could be pressurized. He performed over 20 surgeries in the unit using nitric oxide as the anesthetic.

Fontaine noted that he could achieve deep surgical anesthesia because it increased the effective percentage of nitrous oxide in the patient's body, accompanied by a higher oxygen partial pressure (i.e., compressed air at two atmospheres given an effective level of 42 percent inhaled oxygen).

Fontaine also noted that hernias reduced more easily, and the patients were not their normal cyanotic color when coming out of anesthesia.

Compressed-air therapy was first introduced into the United States in 1871 by Dr. J.L. Corning.

In the early 1900s, Dr. Orville Cunningham, a professor of anesthesia at the University of Kansas, noted that patients with heart disease and other circulatory disorders had difficulties acclimating to high altitudes.

He postulated that increased atmospheric pressure would be beneficial for patients with heart disease. To test his hypothesis (1918), he placed a young resident physician suffering from the flu into a chamber used for animal studies. The physician was successfully oxygenated during his hypoxic crisis when compressed to 2 ATM.

Cunningham, realizing that his concepts were sound, built an 88-foot-long chamber, 10 feet in diameter, in Kansas City and began treating a multitude of diseases, most of them without scientific rationale.

The American Medical Association (AMA) and the Cleveland Medical Society, failing to receive any scientific evidence for his rationale, forced him to close his facility in 1930.

But scientific evidence did later become available.

Cunningham tore the chamber down before the Nobel Prize for Medicine was awarded in 1931 to Otto Warburg, who noted the importance of oxygen in metabolism and the suggestion that higher levels of oxygen in tissues might be associated with improved health.

The advent of the use of hyperbaric oxygen in modern clinical medicine began in 1955 with the work of Churchhill-Davis, who helped to attenuate the effects of radiation therapy in cancer patients using high-oxygen environments.

That same year, Dr. Ite Boerma, a professor of surgery at the University of Amsterdam in Holland, proposed using hyperbaric oxygen (HBO) in cardiac surgery to help prolong the patient's tolerance to circulatory arrest. He conducted surgical operations under pressure, including surgical corrections of transposition of the great vessels, tetralogy of Fallot and pulmonic stenosis.

In 1960, Dr. Boerma published a study on "life without blood." It involved exsanguinating pigs and removing their erythrocytes before exposing them to 3 ATM of HBO. These pigs were noted to have sufficient oxygen in the plasma to sustain life when they where given HBO at 3 ata.

It is frequently said that the history of "hyperbaric oxygenation" goes back "over 300 years," probably referring to the work of Henshaw. This is incorrect, in that oxygen was not discovered until 1775 by Joseph Priestly. All the early chambers were pressurized with compressed air, and oxygen was not a consideration.

Clinical hyperbaric oxygen goes back only about 55 years, beginning with the work of Churchill-Davidson and Boerma.

In 1967 the Undersea Medical Society (UMS) was founded by six U.S. Navy Diving and Submarine medical officers as an organization dedicated to diving and undersea medicine. The UMS was later renamed Undersea and Hyperbaric Medical Society (UHMS) in 1986. This professional society was established for those practicing hyperbaric medicine or diving medicine. They are responsible for publishing approved indication for HBO treatments.

The American Board of Preventive Medicine started to offer board certification in undersea and hyperbaric medicine in 1999, later co-sponsored by the American Board of Emergency Medicine in 2001. The National Board on Diving and Hyperbaric Medical Technology began offering board certification in hyperbaric technology in 1991 and in hyperbaric nursing in 1995.

There is a specialty in human medicine called the American College of Hyperbaric Medicine and also a veterinary group called the Veterinary Hyperbaric Medicine Society. Currently there are about 200 lists of hits on hyperbaric therapies this year on the Internet that are associated with clinical care that applies to veterinary medicine.

Dr. Crowe is chief of staff at Pet Emergency Clinics and Specialty Hospital, Ventura, Calif.

Some HBOT suppliers:

Companion Animal Hyperbarics
Hyperbaric Chamber Clearing House
Performance Hyperbarics

Suggested readings:

Feldmeier JJ. Hyperbaric Oxygen Therapy 2003: Indications & Results. The Hyperbaric Oxygen Therapy Committee Report. Kensington, MD: Undersea & Hyperbaric Medical Society, 2003
Gimbel ML, Hunt TK. Wound healing and hyperbaric oxygenation. In EP Kindwall (ed), Hyperbaric Medicine Practice. Flagstaff, AZ: Best Publishing (2002); pp 169-204
Hammarlund, C. The Physiologic effects of hyperbaric oxygen. In EP Kindwall (ed), Hyperbaric Medicine Practice. Flagstaff, AZ: Best Publishing (2002); pp 37-68
Sheffield PJ, Smith AP. Physiological and pharmacological basis of hyperbaric oxygen therapy. In DJ Bakker (ed) Hyperbaric Surgery: Perioperative Care. Flagstaff, AZ: Best Publishing (2002); pp 63-110
Kindwall EP. A History of hyperbaric medicine. In EP Kindwall (ed), Hyperbaric Medicine Practice. Flagstaff, AZ: Best Publishing (2002); pp 1-20 Boerma I, Meyne NG, Brummelkamp WH, et al. Life without blood: A study of the influence of high atmospheric pressure and hypothermia on dilution of blood. J Cardiovascular Surgery 1960; 1:133-146
Sheffield PJ. Measuring Tissue Oxygenation. In Davis JC, Hunt TK Problem Wounds: Role of Oxygen, New York: Elsevier, 1988; 17-51
Sheffield PJ. Tissue oxygen measurements with respect to soft tissue wound healing with normobaric and hyperbaric oxygen. Hyperbaric Oxygen Review 1985; 6 (1): 18-46
Cross FS. Effects of increased atmospheric pressures and the inhalation of 95 percent oxygen and helium oxygen mixtures on the viability of the bowel wall and the absorption of gas in closed loop obstructions. Surgery. 1954;36:1001-1026
Cross FS, Wangensteen OH. Effect of increased atmospheric pressures on the viability of the bowel wall and the absorption of gas in closed loop obstructions. Surg Forum. 1952;3:111-116
Hunt TK, MP Pai . Effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surgery, Gynecol. And Obstet. 1977; 135:561-567
Hunt TK, J Niinikoski, BH Zederfeldt. Oxygen in wound healing enhancement: Cellular effects of Oxygen, In Hyper Baric Therapy JC Davis and TK Hunt (eds) Bethesda: The Undersea Medical Society, 1977; 111-122
Niinikoski J. Effect of oxygen supply on wound healing and formation of experimental granulation tissue. Acta Physiol Scand Suppl 1969; 334:1
Bouachour G, Cronier P, Gouello JP et al. Hyperbaric oxygen therapy in the management of crush injuries: a randomized double blind placebo-controlled clinical trial. J. Trauma. 1996;41:333-339
Nylander G, Nordstrom H and Eriksson E. Effects of hyperbaric oxygen on edema formation after a scald burn. Burns, 1984:10(3): 193-196
Nylander G, Lewis DH, Nordstrom H. R. Reduction of post ischemic edema with hyperbaric oxygen. Plast. Reconstr. Surg. 1985;76: 596-601
Elayan, Ikram M, Milton J. Effect of hyperbaric oxygen treatment on nitric oxide and oxygen free radicals in rat brain. J Neurophysiology. 2000; 83: 2022-2029
Oury TD, Ho Y, Piantadosi CA. Extracellular superoxide dismutase, nitric oxide, and central nervous system O2 toxicity. Proceedings of the National Academy of Sciences 1992;89:9715-9719
Zhao LL, Davidson JD, Wee SC. Effect of hyperbaric oxygen and growth factors on rabbit ear ischemic ulcers. Int J Radiat Oncol Biol Phys 1998 Jan 1; 40(1): 189-196
Wang X, Ding I, Xie H. Hyperbaric oxygen and basic fibroblast growth factor promote growth of irradiated bone. Growth Factors 1995;12(1): 29-35
Pakman LM. Inhibition of Pseudomonas aeruginosa by hyperbaric oxygen. I. Sulfonamide activity enhancement and reversal. Infect Immun. 1971;4:479-487
Park MK, Muhvich KH, Myers RAM. Hyperoxia prolongs the aminoglycoside-induced post antibiotic effect in pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991;35:691-695
Park MK. Effects of hyperbaric oxygen in infectious diseases. Basic Mechanisms. In EP Kindwall (ed), Hyperbaric Medicine Practice. Flagstaff, AZ: Best Publishing (2002); pp 205-244
Thom SR, Mendiguren I, Hardy K, Bolotin T. Inhibition of human neutrophil beta2-integrin-dependent adherence by hyperbaric O2. Am J Physiol. 1997;26:82-86
Zamboni WA, Wong HP. Effect of hyperbaric oxygen on neutrophil concentration and pulmonary sequestration in reperfusion injury. Arch Surg 1996;131:756-760
Sheffield JC, Sheffield PJ, Ziemba AL. Complications rates of HBO treatments: a 21-year analysis. Proceedings of XIV International Congress on Hyperbaric Medicine, Flagstaff, AZ: Best Publishing, 2002