**Abstract**

The history of hyperbaric oxygen therapy (HBOT) makes for fascinating reading. From pneumatic chambers and compressed air baths to empirical therapeutic applications during the nineteenth century, the impetus to scientific application of HBOT began in seeking solution for decompression sickness during various construction ventures. French physiologist Paul Bert's research was pathbreaking and provided a scientific explanation on the etiology of the "bends." In 1908, JS Haldane's experiments recommended staged decompression and made diving safe. In 1921, OJ Cunningham employed HBOT to treat hypoxia secondary to lung infections successfully. It was cardiac surgeon Ite Boerema who put HBOT on a solid footing with his open-heart surgery results in various pediatric cardiac conditions and rightly deserved the title of father of modern-day hyperbaric medicine. From 1937 onwards, HBOT research snowballed into treating a wide variety of diseases. In 1999, the Undersea and Hyperbaric Medical Society and Food and Drug Administration recognized the value of HBOT, and this led to its becoming a major tool in the armamentarium of clinicians, either as a primary or adjunctive therapy for a spectrum of diseases.

**Keywords:** history, hyperbaric oxygen therapy

### **1. Introduction**

Since 4500 BC, breath-holding dives for mother-of-pearl, sea sponges, and coral was a distinct occupation. These free divers could hold their breath for extended periods of time, and their work was confined to waters less than 30 m (100 ft) deep. It was undoubtedly a hazardous occupation, and many of them succumbed to decompression sickness after rapid surfacing. Persian king Xerxes the Great (520–465 BC) employed divers to salvage sunken goods and treasures from the wrecks of Greek ships he had sunk in numerous battles at sea. Some of these dives were recorded to depths of 20–30 m and lasting 4 minutes at a time. The ancient Greek historians Herodotos and Pausanias wrote about a Greek hero named Scyllias from Scione, who used a reed and diving capsule made from animal skins to cut the mooring lines of enemy ships. Pausanias even taught his own daughter Hydna to dive. Alexander the Great (365–323 BC), under the advice of a reputed astronomer named Ethicus, dived into the Bosphorus straits in a bathysphere, accompanied by a dog, a cat, and a rooster, after entrusting the security of the hoisting chain to his most loyal mistress. Taking advantage of the moment, she chose to elope with her lover after casting the chain into the sea, abandoning Alexander and leaving him to figure out his escape on his own! In 300 BC, Aristotle described the ruptured eardrum as a complication of undersea diving.

**Figure 1.** *Henshaw and his domicilium.*

While living in Venice in the late fifteenth century, Leonardo da Vinci designed diving suits to enable divers cut holes in the hulls of invading ships, but none seem to have been developed or used [1].

In 1620, Dutch inventor Cornelis Jacobszoon Drebbel (1572–1633) designed a wooden diving boat, sealed against water by greased leather, to travel in the River Thames at a depth of around 4 m, from Westminster to Greenwich. Air was supplied by two tubes with floats to maintain one end above water [2]. In sixteenth century England and France, full diving suits made of leather were used to depths of 60 ft with air being pumped down from the surface with the aid of manual pumps.

The first documented use of hyperbaric therapy was in 1662, when a British clergyman and physician named Nathaniel Henshaw used a system of organ bellows with unidirectional valves to change the atmospheric pressure in a sealed chamber called a domicilium (**Figure 1**). Without any scientific rationale whatsoever, Henshaw claimed that high air pressures would remedy acute conditions while lower pressures would yield salutary results in chronic disorders. His domicilium therapy was touted to improve digestion and prevent lung diseases by manipulating ambient pressures without increasing oxygen concentrations, as oxygen was not discovered until nearly a century later [2].

In 1690, Edmond Halley designed a diving bell ventilated with weighted barrels of air sent down from the surface. Employing this device, Halley, escorted by five of his close friends, undertook a dive to a depth of 60 ft in the River Thames in that bell and remained submerged at that depth for 90 minutes. Too heavy for salvage work, Halley made improvements to his bell, extending his underwater exposure time to over 4 hours. The first deep-sea diving suit was invented in 1819 by Augustus Siebe. It used compressed air supplied to the helmet for ease of movement underwater.

All of these early submersibles used ambient air and were called "pneumatic chambers" or "compressed air baths."

### **2. The era of empirical HBOT/HBO spas**

Nearly two centuries later, in the 1830s, there was a rebirth of interest in hyperbaric medicine in France. In 1834, the French physician Junod built a hyperbaric chamber designed by the steam engine inventor James Watt, who was well-versed in pressure physics. This appliance could generate a maximum of 4 atmospheres pressure and used to treat pulmonary afflictions using pressures

**67**

general health.

*Taberie's pneumatic chamber.*

**Figure 2.**

the patients (**Figure 2**).

inflow and outflow of the air (**Figure 3**).

each chamber could also be individually controlled [3].

*Historical Aspects of Hyperbaric Physiology and Medicine*

between 2 and 4 ATA. Junod referred to his treatment as "Le Bain d'air comprimé" (the compressed air bath), and claimed that it increased circulation to the internal organs and the brain, resulting in feelings of well-being and better

Taberie designed a spherical pneumatic chamber made of cast iron with two pipes, one to provide pressure from a hydraulic compressor run by steam and the other to allow for ventilation. Carpet covered the floor to conceal the pipes, and it featured an antechamber to allow the physician to enter and exit without disturbing the pressure. The passage was also used to stock books, newspapers, and drinks for

Lange had a cylindrical chamber constructed out of wrought iron, designed to accommodate four persons. The temperature of the compressed air within the chamber was lowered in two ways. The first employed a stream of cold water directed against the force pump and the supply pipes. The second method was by filling a cup-shaped space at the top of the chamber with cold water and allowing it to cascade down the sides to soak sheets of linen and cool the air by evaporation. In winter the chamber was kept at a comfortable temperature by heating. The chamber was also provided with a device for regulating the flow of the incoming air so that it entered in a steady stream (instead of a succession of puffs in earlier versions) by a force pump. The pressure was secured, as in Tabarie's system, by regulating the

Leibig's pneumatic chamber was located at Dianabad in Reichenhall, Bavaria, Germany. This pneumatic chamber had three chambers, each one capable of accommodating three persons. One antechamber connected all three rooms, allowing the physician to enter and exit without affecting the ambient pressure. The antechamber also acted as a large pressure regulator, preventing the patients from being affected by sudden surges of pressure. A ventilation pipe through an opening in the ceiling provided good ventilation (**Figure 4**). The temperature and pressures within

In 1837, Pravaz built the largest hyperbaric chamber in Lyon, France, to seat 12 patients and treat patients with pulmonary conditions including tuberculosis, laryngitis, tracheitis, and pertussis, as well as unrelated conditions such as cholera,

*DOI: http://dx.doi.org/10.5772/intechopen.85216*

*Historical Aspects of Hyperbaric Physiology and Medicine DOI: http://dx.doi.org/10.5772/intechopen.85216*

**Figure 2.** *Taberie's pneumatic chamber.*

*Respiratory Physiology*

**Figure 1.**

*Henshaw and his domicilium.*

to have been developed or used [1].

discovered until nearly a century later [2].

chambers" or "compressed air baths."

**2. The era of empirical HBOT/HBO spas**

While living in Venice in the late fifteenth century, Leonardo da Vinci designed diving suits to enable divers cut holes in the hulls of invading ships, but none seem

In 1620, Dutch inventor Cornelis Jacobszoon Drebbel (1572–1633) designed a wooden diving boat, sealed against water by greased leather, to travel in the River Thames at a depth of around 4 m, from Westminster to Greenwich. Air was supplied by two tubes with floats to maintain one end above water [2]. In sixteenth century England and France, full diving suits made of leather were used to depths of 60 ft with air being pumped down from the surface with the aid of manual pumps. The first documented use of hyperbaric therapy was in 1662, when a British clergyman and physician named Nathaniel Henshaw used a system of organ bellows with unidirectional valves to change the atmospheric pressure in a sealed chamber called a domicilium (**Figure 1**). Without any scientific rationale whatsoever, Henshaw claimed that high air pressures would remedy acute conditions while lower pressures would yield salutary results in chronic disorders. His domicilium therapy was touted to improve digestion and prevent lung diseases by manipulating ambient pressures without increasing oxygen concentrations, as oxygen was not

In 1690, Edmond Halley designed a diving bell ventilated with weighted barrels of air sent down from the surface. Employing this device, Halley, escorted by five of his close friends, undertook a dive to a depth of 60 ft in the River Thames in that bell and remained submerged at that depth for 90 minutes. Too heavy for salvage work, Halley made improvements to his bell, extending his underwater exposure time to over 4 hours. The first deep-sea diving suit was invented in 1819 by Augustus Siebe. It used compressed air supplied to the helmet for ease of movement underwater. All of these early submersibles used ambient air and were called "pneumatic

Nearly two centuries later, in the 1830s, there was a rebirth of interest in hyperbaric medicine in France. In 1834, the French physician Junod built a hyperbaric chamber designed by the steam engine inventor James Watt, who was well-versed in pressure physics. This appliance could generate a maximum of 4 atmospheres pressure and used to treat pulmonary afflictions using pressures

**66**

between 2 and 4 ATA. Junod referred to his treatment as "Le Bain d'air comprimé" (the compressed air bath), and claimed that it increased circulation to the internal organs and the brain, resulting in feelings of well-being and better general health.

Taberie designed a spherical pneumatic chamber made of cast iron with two pipes, one to provide pressure from a hydraulic compressor run by steam and the other to allow for ventilation. Carpet covered the floor to conceal the pipes, and it featured an antechamber to allow the physician to enter and exit without disturbing the pressure. The passage was also used to stock books, newspapers, and drinks for the patients (**Figure 2**).

Lange had a cylindrical chamber constructed out of wrought iron, designed to accommodate four persons. The temperature of the compressed air within the chamber was lowered in two ways. The first employed a stream of cold water directed against the force pump and the supply pipes. The second method was by filling a cup-shaped space at the top of the chamber with cold water and allowing it to cascade down the sides to soak sheets of linen and cool the air by evaporation. In winter the chamber was kept at a comfortable temperature by heating. The chamber was also provided with a device for regulating the flow of the incoming air so that it entered in a steady stream (instead of a succession of puffs in earlier versions) by a force pump. The pressure was secured, as in Tabarie's system, by regulating the inflow and outflow of the air (**Figure 3**).

Leibig's pneumatic chamber was located at Dianabad in Reichenhall, Bavaria, Germany. This pneumatic chamber had three chambers, each one capable of accommodating three persons. One antechamber connected all three rooms, allowing the physician to enter and exit without affecting the ambient pressure. The antechamber also acted as a large pressure regulator, preventing the patients from being affected by sudden surges of pressure. A ventilation pipe through an opening in the ceiling provided good ventilation (**Figure 4**). The temperature and pressures within each chamber could also be individually controlled [3].

In 1837, Pravaz built the largest hyperbaric chamber in Lyon, France, to seat 12 patients and treat patients with pulmonary conditions including tuberculosis, laryngitis, tracheitis, and pertussis, as well as unrelated conditions such as cholera,

**Figure 3.** *Lange's pneumatic chamber.*

**Figure 4.** *Leibig's pneumatic chamber.*

conjunctivitis, deafness, menorrhagia, and rickets. In 1855, Bertin wrote a book on compressed air therapy and even constructed his own hyperbaric chamber.

Compressed air therapy was first introduced into the USA by JL Corning in 1871. In 1876, Kelly treated a patient in a "Compressed Air Bath Apparatus" having two locking plates operated from outside to seal pressures. In 1877, French surgeon Fontaine developed the first mobile hyperbaric operating theater. The high ambient pressure was claimed to facilitate the reduction of hernias and provide relief for patients with lung diseases. Over the next 3 months, 27 surgeries were successfully performed within this mobile hyperbaric chamber (**Figure 5**). Spurred by the results, Fontaine ventured to erect a mammoth hyperbaric surgical amphitheater to accommodate 300 patients in one sitting. This did not see the light of day as Fontaine died from an accident at the Pneumatic Institute to become the first physician to be martyred in the history of hyperbaric medicine [4].

In 1885, C Theodore Williams published his "Lectures on the Compressed Air Bath and its Uses in the Treatment of Disease" in the *British Medical Journal*, extolling the use of atmospheric air under different degrees of atmospheric pressure to treat diseases. He remarked that this mode of therapy was among the most important advances in modern medicine and expressed astonishment at its being ignored in England [5].

Back in the USA, during the closing days of the World War I, Kansas-bavsed physician Orval J Cunningham built a hyperbaric chamber in 1921 at Lawrence, Kansas. He used the facility to treat victims of the Spanish influenza epidemic that

**69**

*Historical Aspects of Hyperbaric Physiology and Medicine*

swept North America. Noticing that people in the valley fared better than those living in the mountains, Cunningham theorized that atmospheric pressure or barometric factors were responsible for the higher mortality rates in those residing at higher elevations. He observed remarkable improvements in patients treated with HBO, especially those who were cyanotic and comatose. In 1923, heat from open gas burners warming the chambers in winter scorched the insulation and started a fire, but all patients were safely evacuated. In another incident, a mechanical failure caused a complete loss of pressure within the chamber and all patients died. This did not, however, deter Cunningham's enthusiasm for hyperbaric air. He went on to treat diseases such as syphilis, hypertension, diabetes mellitus, and cancer, believing that anaerobic infections played a role in the etiology of all these afflictions. In 1928, with the financial backing of Henry H. Timken, a roller bearing manufacturer and tycoon, Cunningham built the largest hyperbaric chamber in the world along the shores of Lake Erie in Cleveland, Ohio, at a cost of 1 million dollars. This "Steel Ball Hospital" or "Cunningham's Sanitarium" was a five-story high steel sphere, 64 ft in diameter with 60 rooms and weighing 900 tons. Each floor of this structure had 12 rooms, with all the amenities of a good hotel (**Figures 6** and **7**). The growing popularity of Cunningham's treatments prompted the Bureau of Investigation of the American Medical Association (AMA) to request the doctor to validate his claims

*DOI: http://dx.doi.org/10.5772/intechopen.85216*

*Fontaine's mobile hyperbaric operation theater.*

*Cunningham's hyperbaric hotel—outside and inside view.*

**Figure 5.**

**Figure 6.**

*Historical Aspects of Hyperbaric Physiology and Medicine DOI: http://dx.doi.org/10.5772/intechopen.85216*

*Respiratory Physiology*

**Figure 3.**

**Figure 4.**

*Leibig's pneumatic chamber.*

*Lange's pneumatic chamber.*

conjunctivitis, deafness, menorrhagia, and rickets. In 1855, Bertin wrote a book on

In 1885, C Theodore Williams published his "Lectures on the Compressed Air Bath and its Uses in the Treatment of Disease" in the *British Medical Journal*, extolling the use of atmospheric air under different degrees of atmospheric pressure to treat diseases. He remarked that this mode of therapy was among the most important advances in modern medicine and expressed astonishment at its being ignored in England [5]. Back in the USA, during the closing days of the World War I, Kansas-bavsed physician Orval J Cunningham built a hyperbaric chamber in 1921 at Lawrence, Kansas. He used the facility to treat victims of the Spanish influenza epidemic that

compressed air therapy and even constructed his own hyperbaric chamber. Compressed air therapy was first introduced into the USA by JL Corning in 1871. In 1876, Kelly treated a patient in a "Compressed Air Bath Apparatus" having two locking plates operated from outside to seal pressures. In 1877, French surgeon Fontaine developed the first mobile hyperbaric operating theater. The high ambient pressure was claimed to facilitate the reduction of hernias and provide relief for patients with lung diseases. Over the next 3 months, 27 surgeries were successfully performed within this mobile hyperbaric chamber (**Figure 5**). Spurred by the results, Fontaine ventured to erect a mammoth hyperbaric surgical amphitheater to accommodate 300 patients in one sitting. This did not see the light of day as Fontaine died from an accident at the Pneumatic Institute to become the first physi-

cian to be martyred in the history of hyperbaric medicine [4].

**68**

**Figure 5.** *Fontaine's mobile hyperbaric operation theater.*

**Figure 6.** *Cunningham's hyperbaric hotel—outside and inside view.*

swept North America. Noticing that people in the valley fared better than those living in the mountains, Cunningham theorized that atmospheric pressure or barometric factors were responsible for the higher mortality rates in those residing at higher elevations. He observed remarkable improvements in patients treated with HBO, especially those who were cyanotic and comatose. In 1923, heat from open gas burners warming the chambers in winter scorched the insulation and started a fire, but all patients were safely evacuated. In another incident, a mechanical failure caused a complete loss of pressure within the chamber and all patients died. This did not, however, deter Cunningham's enthusiasm for hyperbaric air. He went on to treat diseases such as syphilis, hypertension, diabetes mellitus, and cancer, believing that anaerobic infections played a role in the etiology of all these afflictions. In 1928, with the financial backing of Henry H. Timken, a roller bearing manufacturer and tycoon, Cunningham built the largest hyperbaric chamber in the world along the shores of Lake Erie in Cleveland, Ohio, at a cost of 1 million dollars. This "Steel Ball Hospital" or "Cunningham's Sanitarium" was a five-story high steel sphere, 64 ft in diameter with 60 rooms and weighing 900 tons. Each floor of this structure had 12 rooms, with all the amenities of a good hotel (**Figures 6** and **7**). The growing popularity of Cunningham's treatments prompted the Bureau of Investigation of the American Medical Association (AMA) to request the doctor to validate his claims

**Figure 7.** *Cunningham's hyperbaric hotel—exterior and interior views.*

regarding the effectiveness of hyperbaric therapy. Cunningham refused to share the details or cooperate with the AMA, leading to his being labeled a quack and a fraud. The chamber was dismantled in 1937 and sold for scrap during World War II [6].
