**3. A historical account of decompression sickness and its treatment**

In 1840, Charles Pasley, charged with the recovery of the sunken warship HMS Royal George, commented that, of those who made frequent dives, "not a man escaped the repeated attacks of rheumatism and cold." In 1841, Trigger, a French mining engineer, used a pressure chamber to deliver workers to the bottom of the river to extract coal. In 1845, he reported that some of his miners complained of joint pains and nervous disorders after surfacing. The first recorded death from "caisson disease" (which later came to be known as decompression illness (DCI) or acute decompression sickness) occurred in 1859 during the building of the Royal Albert Bridge, a railway bridge in England spanning the River Tamar from Saltash to Plymouth. Several workers were taken ill after emerging from deep underground after long hours of work under high atmospheric pressure conditions. In 1871, during the construction of the Eads Bridge in St. Louis, 352 compressed air workers, including Alphonse Jaminet, the physician in charge, were employed. Thirty workers developed serious conditions with 12 ending fatally. Jaminet himself suffered decompression sickness, and his personal description was the first such recorded. It was in 1873 that Andrew Smith first utilized the term "caisson disease" to describe 110 cases of decompression sickness that occurred during construction of the Brooklyn Bridge. The project employed 600 compressed air workers, and recompression treatment was not available on site. In 1882, during the Hudson tunnel construction in New York, every fourth worker died of bends until a recompression chamber was installed to treat the condition. Only three workers died of bends over the next 18 months.

Paul Bert, a French professor of physiology and a student of Claude Bernard, is considered the father of pressure physiology (**Figure 8**). In 1878, while working closely with Dr. Alphonse Gal, the first doctor to actually dive in order to study

**71**

**Figure 9.**

*Historical Aspects of Hyperbaric Physiology and Medicine*

how the body reacted underwater, Bert studied Gal's reports on divers who became symptomatic or died while surfacing. He conducted a series of dog experiments, exposing them to 7–9¾ atmospheres and subjecting them to rapid decompression. A majority of them died and exhibited grossly distended bodies with their right heart chambers filled with gas. When decompression was done at slowly over 1–2 hours after exposure to similar pressures, none of the dogs succumbed. Applying Dalton's and Henry's gas laws, Bert concluded that too rapid a decompression induced a pathophysiologic insult secondary to supersaturation of body tissues with nitrogen, causing the formation of nitrogen bubbles. He also went on to suggest that divers stop halfway to the surface to allow for slow decompression after a deep dive—what is now known as deep stops. Bert was also the first to describe oxygen toxicity at pressures in excess of 1.75 ATA. This adverse effect on the central

In 1908, Scottish physiologist John Scott Haldane conducted experiments at the Lister Institute of Preventive Medicine in London assisted by Lieutenant Guybon Damant of the Royal Navy, an expert diver and amateur scientist, and a physiologist Edwin Arthur Boycott. A herd of 85 goats was assembled, and the researchers put groups of up to eight goats inside compression chambers for specific periods of time. Pressures were then normalized before releasing the animals into the institute's yard for observation. These studies confirmed that those goats decompressed by stages did not exhibit signs of the bends (**Figure 9**). Haldane then introduced the concept of half times—the time required for a particular tissue to become half saturated with

nervous system came to be known as the "Paul Bert effect" [7, 8].

*Bends in the foreleg of a goat after experiments performed by physiologist Haldane [9].*

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

**Figure 8.**

*Dr. Paul Bert (1883–1886).*

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

**Figure 8.** *Dr. Paul Bert (1883–1886).*

*Respiratory Physiology*

**Figure 7.**

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].

In 1840, Charles Pasley, charged with the recovery of the sunken warship HMS Royal George, commented that, of those who made frequent dives, "not a man escaped the repeated attacks of rheumatism and cold." In 1841, Trigger, a French mining engineer, used a pressure chamber to deliver workers to the bottom of the river to extract coal. In 1845, he reported that some of his miners complained of joint pains and nervous disorders after surfacing. The first recorded death from "caisson disease" (which later came to be known as decompression illness (DCI) or acute decompression sickness) occurred in 1859 during the building of the Royal Albert Bridge, a railway bridge in England spanning the River Tamar from Saltash to Plymouth. Several workers were taken ill after emerging from deep underground after long hours of work under high atmospheric pressure conditions. In 1871, during the construction of the Eads Bridge in St. Louis, 352 compressed air workers, including Alphonse Jaminet, the physician in charge, were employed. Thirty workers developed serious conditions with 12 ending fatally. Jaminet himself suffered decompression sickness, and his personal description was the first such recorded. It was in 1873 that Andrew Smith first utilized the term "caisson disease" to describe 110 cases of decompression sickness that occurred during construction of the Brooklyn Bridge. The project employed 600 compressed air workers, and recompression treatment was not available on site. In 1882, during the Hudson tunnel construction in New York, every fourth worker died of bends until a recompression chamber was installed to treat the condition. Only three workers died of bends over

Paul Bert, a French professor of physiology and a student of Claude Bernard, is considered the father of pressure physiology (**Figure 8**). In 1878, while working closely with Dr. Alphonse Gal, the first doctor to actually dive in order to study

**3. A historical account of decompression sickness and its treatment**

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

**70**

the next 18 months.

how the body reacted underwater, Bert studied Gal's reports on divers who became symptomatic or died while surfacing. He conducted a series of dog experiments, exposing them to 7–9¾ atmospheres and subjecting them to rapid decompression. A majority of them died and exhibited grossly distended bodies with their right heart chambers filled with gas. When decompression was done at slowly over 1–2 hours after exposure to similar pressures, none of the dogs succumbed. Applying Dalton's and Henry's gas laws, Bert concluded that too rapid a decompression induced a pathophysiologic insult secondary to supersaturation of body tissues with nitrogen, causing the formation of nitrogen bubbles. He also went on to suggest that divers stop halfway to the surface to allow for slow decompression after a deep dive—what is now known as deep stops. Bert was also the first to describe oxygen toxicity at pressures in excess of 1.75 ATA. This adverse effect on the central nervous system came to be known as the "Paul Bert effect" [7, 8].

In 1908, Scottish physiologist John Scott Haldane conducted experiments at the Lister Institute of Preventive Medicine in London assisted by Lieutenant Guybon Damant of the Royal Navy, an expert diver and amateur scientist, and a physiologist Edwin Arthur Boycott. A herd of 85 goats was assembled, and the researchers put groups of up to eight goats inside compression chambers for specific periods of time. Pressures were then normalized before releasing the animals into the institute's yard for observation. These studies confirmed that those goats decompressed by stages did not exhibit signs of the bends (**Figure 9**). Haldane then introduced the concept of half times—the time required for a particular tissue to become half saturated with

a gas—and recommended staged decompression, especially at shallower depths. He prepared detailed practical dive tables for the Royal Navy to prevent acute decompression sickness. These guidelines remained the foundation of all diving operations until 1956 [10]. Heinrich Drager was the first to explore the use of pressurized oxygen in decompression sickness (**Figure 10**). His protocols were put into practice by Behnke and Shaw, who used HBOT for treating decompression sickness in the late 1930s. They replaced oxygen in place of compressed air, and their work resulted in the use of the first nitrogen-oxygen mixtures and hyperbaric treatment being tailored to the severity of the injury [11]. In 1939, the US Navy began treating divers suffering decompression sickness with hyperbaric oxygen therapy. After World War II, the US military conducted extensive research in HBOT, and this expanded the existing knowledge about survivable pressures and popularized HBOT in the late 1950s and early 1960s. In the 1980s, Paul Harch began an in-depth study of brain decompression illness (DCI) and evaluated divers with this disorder. He concluded that it was not residual gas that was being treated but ischemic brain injury. He went on to develop individualized treatment protocols for over 50 different chronic neurological disorders. Harch is considered to be the foremost authority in the use of HBOT and SPECT brain blood flow imaging in neurology [12–14]. In 1990, former microbiology professor Igor Gamow invented and patented the Gamow Bag that provided mountaineers with a mobile and effective method to treat high-altitude sickness. This bag is a single-place portable hyperbaric chamber, pressurized with a

**Figure 10.** *Drager and his recompression chamber.*

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**Figure 12.**

*Dr. Boerema with children operated by him.*

*Historical Aspects of Hyperbaric Physiology and Medicine*

tica" in boxers and cerebral palsy and autism in children [15].

being the father of modern-day hyperbaric medicine [17].

foot pump, to simulate a descent to 7000 ft (**Figure 11**). In 1992, Harch treated the first delayed decompression sickness, which led to the treating of "dementia pugilis-

In 1937, Brazilians Ozorio de Almeida and Costa pioneered the use of HBOT in treating leprosy [16]. In the 1950s, Ite Boerema, a cardiac surgeon from the Netherlands, conceived the idea of "flooding" the body's tissues with extra oxygen. Working with the help of the Royal Dutch Navy, Boerema conducted a series of animal experiments and operations within a hyperbaric oxygen chamber (**Figure 12**). These went off without a hitch and led to the installation of a large operating hyperbaric chamber at the University of Amsterdam. Many children with congenital heart diseases like tetralogy of Fallot, transposition of great vessels, and pulmonic stenosis were operated in this facility with great success. Boerema mooted the concept of "Life without blood" using HBO, when dissolved oxygen sufficed to meet the entire body's oxygen needs without the need for red cells or hemoglobin. Boerema is credited with

In 1955–1956, I Churchill-Davidson evaluated clinical trials on HBOT as a potentiator for radiation therapy in cancer patients at St. Thomas Hospital in London [18]. Public interest in hyperbaric oxygen therapy started to grow in the 1960s after publicity about its use in treating President John F Kennedy's sick infant. In 1961, a colleague of Boerema, W. H. Brummelkamp, published a paper on inhibition of anaerobic infections by HBOT [19]. In 1962, Smith and Sharp reported the enormous benefits of HBO in carbon monoxide poisoning. They recommended that all those having a verified carboxyhemoglobin level above 25% needed immediate HBOT at 3 ATA for 90 minutes, followed by two or three more sessions for full recovery, making HBO very cost-effective [20]. Global interest in HBOT was rekindled by this finding, resulting in hyperbaric units being installed at many centers like Duke University, New York Mount Sinai Hospital, Presbyterian Hospital and Edgeworth Hospital in Chicago, Good Samaritan in Los Angeles, St. Barnabas Hospital in New Jersey, Harvard Children's Hospital, and St. Luke's Hospital in Milwaukee. In 1965, Perrins from the UK demonstrated the effectiveness of HBOT

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

**4. Treating diseases with HBO**

**Figure 11.** *The Gamow Bag.*

foot pump, to simulate a descent to 7000 ft (**Figure 11**). In 1992, Harch treated the first delayed decompression sickness, which led to the treating of "dementia pugilistica" in boxers and cerebral palsy and autism in children [15].
