When was hyperbaric medicine first used?

The first pressurized medical chamber was built by British physician Henshaw in 1662. He called it the 'domicilium' and used it for respiratory conditions, though without any understanding of oxygen. Modern hyperbaric medicine with oxygen began in the 1930s-1940s with Behnke and Shaw's work on decompression sickness.

Who founded the modern field of hyperbaric medicine?

Multiple researchers contributed, but Ite Boerema's 1956 cardiac surgery experiments in Amsterdam are often cited as the scientific foundation. His 1960 paper 'Life Without Blood' demonstrated that animals could survive on plasma-dissolved oxygen alone at clinical pressures — the core mechanism behind HBOT. Behnke and Shaw's 1937 DCS work and the UHMS founding in 1967 also mark pivotal milestones.

When did Medicare begin covering hyperbaric oxygen therapy?

Medicare established National Coverage Determination (NCD) 20.29 for HBOT during the 1990s, codifying coverage for 14 approved indications. This gave the field formal payer recognition and standardized which conditions qualified for coverage.

What was 'pneumatic quackery' in hyperbaric history?

From the 1890s through the 1930s, pressurized air chambers called 'pneumatic institutes' spread across the US and Europe making broad and often unsupported health claims. These predated scientific understanding of HBOT mechanisms and damaged the credibility of legitimate hyperbaric research for decades.

When was the UHMS founded and what does it do?

The Undersea and Hyperbaric Medical Society (UHMS) was founded in 1967. It evaluates clinical evidence, publishes the approved indications list that Medicare follows, trains and credentials hyperbaric physicians, and accredits facilities. It's the primary professional body for the field.

The History of Hyperbaric Medicine: From 1600s Diving Bells to Modern HBOT

Hyperbaric medicine has a longer history than most people realize — and a messier one. The field was nearly discredited by decades of fraudulent “pneumatic institutes” before diving medicine gave it a scientific foundation. Understanding that history explains why the regulatory and evidence standards for HBOT are stricter than for many other medical interventions.

The First Pressurized Chamber: 1662

British physician Nathaniel Henshaw built what may be the first pressurized medical chamber in 1662. He called it the “domicilium” — a sealed room where bellows could increase or decrease air pressure. Henshaw used it for respiratory conditions, believing that compressed air might help with lung disease.

There was no concept of oxygen yet. Oxygen wasn’t isolated until 1774 by Priestley and Scheele. Henshaw was working with pressurized air and clinical intuition. His results were modest and his mechanism wrong, but the basic concept of pressurized environments for medical purposes started here.

The Pressurized Surgery Theater: 1870s

French surgeon Fontaine built a mobile pressurized operating theater in the 1870s. He reported better outcomes with nitrous oxide anesthesia under increased pressure and used it for surgical cases. This was a practical application rather than a theoretical one — pressure changed anesthetic pharmacology in ways Fontaine documented, even without fully understanding why.

The Pneumatic Institutes Problem: 1890s-1930s

Here’s the part of hyperbaric history that nearly killed the field. From the 1890s through the 1930s, “pneumatic institutes” spread across the United States and Europe. These were commercial operations offering pressurized air treatment for everything from respiratory disease to arthritis to general weakness.

Orval Cunningham, an American physician, built the largest in 1928 — a steel sphere in Cleveland large enough for multiple patients, nicknamed the “Steel Ball Hotel.” He claimed compressed air cured cancer and heart disease. The American Medical Association investigated and found no supporting evidence. The facility was eventually closed.

This era established a credibility problem for hyperbaric medicine that legitimate researchers spent decades overcoming. Any mention of HBOT for unconventional conditions still carries the echo of that history, which is partly why regulatory standards are strict.

The Scientific Foundation: Diving Medicine (1937)

The field’s legitimate scientific foundation came from diving medicine. Behnke and Shaw published the first use of recompression therapy for decompression sickness in 1937. DCS — caused by nitrogen gas bubbles forming in tissue when divers ascend too quickly — responded directly and predictably to pressure treatment.

This was different from the pneumatic institute claims. The mechanism was clear (Boyle’s Law: pressure reduces bubble size), the effect was immediate and reproducible, and it worked. Military diving medicine during World War II expanded this understanding significantly.

Boerema and “Life Without Blood”: 1956-1960

Ite Boerema at the University of Amsterdam conducted the experiments that gave HBOT its modern scientific identity. In 1956, he used HBOT to perform open-heart surgery on pigs — operating in a pressurized environment while patients breathed 100% oxygen.

His 1960 paper, “Life Without Blood,” published in Surgery, demonstrated that animals could survive with almost no red blood cells when breathing 100% oxygen at 3.0 ATA. Plasma-dissolved oxygen alone, at sufficient pressure, could sustain life. This was the direct experimental proof of the core HBOT mechanism.

Brummelkamp and others in Boerema’s circle then expanded HBOT to anaerobic infections — gas gangrene and clostridial myonecrosis — where the oxygen-rich environment was directly lethal to anaerobic bacteria. These applications in the 1960s gave HBOT its first clearly documented clinical benefits beyond DCS.

Carbon Monoxide and Expanding Indications: 1960s-1970s

Researchers in the 1960s established HBOT for carbon monoxide poisoning, demonstrating that clinical-grade pressure reduced carboxyhemoglobin half-life and provided plasma-dissolved oxygen to CO-poisoned tissue. Clinical programs established in hyperbaric chambers during this period.

The 1970s and 1980s saw formal training programs develop, hyperbaric nursing emerge as a specialty, and hospital-based chamber programs expand. The specialty was gaining institutional recognition.

UHMS, Medicare Coverage, and Standardization: 1967-1990s

The Undersea and Hyperbaric Medical Society was founded in 1967, providing the professional infrastructure for evidence evaluation, physician training, and facility standards. The UHMS indications list — which Medicare later adopted — began developing through this period.

Medicare established National Coverage Determination 20.29 during the 1990s, formalizing coverage for 14 approved indications. That NCD, updated periodically, remains the coverage standard today. See what the UHMS does for how these organizations interact.

The Current Era: TBI, Aging Research, and Off-Label Expansion

Post-2001 wars in Iraq and Afghanistan brought large numbers of blast-injury TBI cases. Veterans returning with TBI and PTSD created a population with urgent need for effective treatments and motivated researchers to investigate HBOT in neurological applications. Multiple VA and Department of Defense trials launched in the 2010s.

The Efrati lab at Tel Aviv University began publishing on HBOT for neurological aging beginning around 2013, with the 2020 telomere study generating broad attention in longevity research communities. This research thread continues in active trials.

The current situation: HBOT has a solid evidence base for 14 FDA-approved indications, a growing investigational evidence base for neurological and aging applications, and an ongoing struggle with off-label marketing by wellness clinics making claims the evidence doesn’t support.

That pattern — legitimate science alongside dubious marketing — has been part of hyperbaric medicine since the pneumatic institutes of the 1890s.

FAQ

When did hospitals first get hyperbaric chambers? Hospital-based chambers expanded significantly in the 1970s and 1980s as training programs formalized and clinical indications became better established. Major teaching hospitals were early adopters, followed by wound care centers in the 1990s.

Has HBOT ever been pulled from clinical use? No approved indications have been removed from clinical practice, though the evidence supporting some indications has been updated over time. The AMA’s action against Cunningham’s Cleveland facility in the 1930s was against fraudulent claims, not legitimate hyperbaric medicine.

Why don’t more hospitals have hyperbaric chambers? Chamber installation costs $200,000 to $1 million or more per unit, plus facility construction, staffing, and certification costs. Smaller hospitals often refer patients to regional hyperbaric centers rather than operating their own chambers.

Is hyperbaric medicine a recognized medical specialty? It’s a recognized subspecialty. The American Board of Preventive Medicine (ABPM) and the American Osteopathic Association (AOA) offer board certification in undersea and hyperbaric medicine through the UHMS exam process.

Medical Disclaimer: The content on this page is for informational purposes only. It is not medical advice and does not create a doctor-patient relationship. Historical information is provided for educational purposes. Consult a licensed physician for any medical decision related to hyperbaric oxygen therapy.