The development of hyperbaric oxygen medicine can be said to have gone through a long and tortuous process. The origin of hyperbaric oxygen first began with high pressure, and human understanding of hyperbaric oxygen must also start from high pressure.
1、 The beginning of high-pressure medicine
Human exposure to high pressure began with diving. In 332 BC, Alexander the Great used a simple diving device in the Battle of Tyre, which was a pottery shaped helmet that used a conduit to breathe air from the surface of the water. Soldiers wearing this helmet can lurk underwater. In 717 AD, Hally used a diving bell for the first time and dived to a depth of 18 meters underwater. In the book "Tiangong Kaiwu" published in 1637 in China, there were detailed records of the symptoms and treatment methods of diving diseases. The earliest written record in the West dates back to 1820 when Hemrll from Russia described feeling uncomfortable after diving.
The application of high pressure in medicine was first proposed by Greek physiologists in 1662. In 1664, British doctor Henshaw first built a sealed dome shaped cabin and used a snake skin blower to inflate the cabin, creating a high-pressure environment. He believes that high air pressure can alleviate acute illnesses, promote respiration, aid digestion, and prevent various respiratory diseases. Due to the limitations of scientific theory and technological level at that time, as well as the lack of oxygen, Henshaw's suggestion did not receive much attention from the medical community and was shelved.
2、 High pressure medicine lays the foundation for hyperbaric oxygen medicine
In the late 18th and early 19th centuries, the European Renaissance promoted the progress of science and technology. In the field of physics, laws such as Boyle, Marius, Charles, Henry, and Dalton have been continuously invented. Promoted the rapid development of high-pressure theory. In 1775, Priestley was the first to separate oxygen from mercury oxide. At that time, it was only known that this gas was non flammable, but could support combustion. People are beginning to recognize oxygen. The following year, it was discovered in animal experiments that this gas had therapeutic effects on certain diseases. In 1777, Lavoisier discovered the presence of this gas in the air and named it "oxygen". From then on, scholars vigorously studied the physiological value and clinical applications of oxygen. In 1795, Beddoes was the first to create an oxygen inhalation device. The discovery and utilization of oxygen laid the foundation for hyperbaric oxygen medicine. In 1834, French man Junod and others used steel to create a high-pressure air chamber with a diameter of 1.5m, and used compressed air of 202.6-405.2kPa (2-4 atmospheres) to treat "lung disease". He believes that due to the increased blood circulation in the internal organs, the patient feels good. In 1837, Pravaz built a cabin in Lyon that could accommodate 12 people, treating respiratory diseases such as bronchiectasis, tuberculosis, tracheitis, chronic pharyngitis, deafness, uterine bleeding, cholera, etc. In 1860, Sandhal, Grindricd, and others successively carried out high-pressure treatment. In 1862, Berlin first began hyperbaric oxygen therapy by inhaling oxygen inside a high-pressure chamber, but it was not given much attention at the time. In 1867, Valenzalela first reported the absorption of oxygen at 2026 kPa (2 atmospheres). In 1879, Fontaine successfully performed his first surgery under general anesthesia in a high-pressure chamber. He pointed out that surgery in a high-pressure chamber has the advantages of quick postoperative recovery, no cyanosis or suffocation. Subsequently, there was a wave of construction of high-pressure chambers throughout Europe, with larger chambers capable of accommodating up to 50 people. Due to the complex and expensive oxygen production process at that time, air at 202.6 to 405.2 kPa (2 to 4 atmospheres) was still used in the high-pressure air chamber. Soon, this treatment known as "high-pressure air bath" became popular in Europe, and even American patients came to Europe for treatment. The first high-pressure chamber for treatment in North America was built in Ottawa, Canada in 1860. In 1891, Curningham published a paper titled "Hyperbaric Oxygen Therapy for Mental and Neurological Disorders" in the United States. In 1921, Curningham first built a large high-pressure ship with a diameter of 3m and a length of 25m in the United States. At that time, there was a pandemic of influenza in the United States, and they found that the mortality rate in high-altitude areas was higher, which was believed to be related to low high-altitude air pressure. Therefore, they administered hyperbaric oxygen therapy to some critically ill patients (including those in the purple group and coma), which showed significant therapeutic effects. Once, due to a compressor malfunction, the pressure could not be increased, resulting in the death of all patients. Curningham believes that this fact contradicts the efficacy of hyperbaric oxygen therapy. They began to expand their indications, such as syphilis, cancer, diabetes, etc. Curningham, who had an overheated mind, built a five story building in 1928 with a super large luxury high-pressure chamber, which included facilities such as bedrooms, reception rooms, dining rooms, game rooms, and bathrooms, allowing patients to live in it for a longer period of time. Due to the widespread use of hyperbaric oxygen therapy in Europe and America, a large number of side effects and accidents have occurred. In 1878, Paul Bert first discovered and reported oxygen poisoning, and later discovered barotrauma and other conditions. Incidents of casualties and injuries to patients and medical staff due to high-voltage device accidents have also occurred frequently. Due to the limitations of technology and medical technology at that time, the side effects of hyperbaric oxygen could neither be explained nor reliably prevented. Therefore, hyperbaric oxygen has been criticized by medical professionals. Since the beginning of the 20th century, the hyperbaric oxygen medical industry has entered a low point. The luxury cabins built by Curningham during World War I were also dismantled, leaving only a few cabins for the treatment of decompression sickness. Some scholars are still conducting research.
3、 The rapid development of hyperbaric oxygen medicine
After nearly 50 years of silence in the hyperbaric oxygen industry, Haldane achieved success in treating acute carbon monoxide poisoning with hyperbaric oxygen therapy in 1950. In 1952, Cross and Wangensteen used hyperbaric oxygen therapy to effectively treat experimental intestinal obstruction. In 1955, Churchill Davidson found that combining hyperbaric oxygen therapy with radiotherapy for malignant tumors could increase the efficacy. In 1956, Boerema from the Netherlands successfully performed open heart surgery in a hyperbaric oxygen chamber. Especially Boerema's experiment: pigs were bled and fed with saline and colloidal solutions, resulting in hemoglobin levels as low as 1g/L (0.1 g%) and almost no red blood cells. This pig was placed in a pure oxygen chamber at 303.9 kPa (3 atmospheres) and was able to survive smoothly for 15 minutes with a normal electrocardiogram. After blood transfusion and decompression, the animal lived well. Based on this, Boerema published a paper titled "Bloodless Life" in the American Journal of Surgery in 1960, which caused a sensation in the world and aroused widespread interest and attention in the medical community. Due to the high-tech level in the 1960s, oxygen chamber equipment became more sophisticated and safe, and people gained a new comprehensive understanding of the physiological effects, treatment mechanisms, and side effects of hyperbaric oxygen. There has also been significant progress in the treatment and prevention of side effects. So the climax of hyperbaric oxygen was reignited, gradually making it an emerging discipline. The high-pressure oxygen industry is advancing rapidly worldwide. Hyperbaric oxygen chambers are found all over the world. The development of hyperbaric oxygen technology is particularly prominent in countries such as the Netherlands, Scotland, the United States, Japan, Canada, the former Soviet Union, and Australia. In Europe, America, Australia, Japan, and the former Soviet Union, it is developing at a rate of adding 60 cabins per year. In 1971, the United States had only 37 cabins nationwide, which increased to over 200 in 1986. Japan increased from 100 units in 1984 to 310 units in 1990. The former Soviet Union had only 84 units in 1980, but rapidly increased to 1200 units in 1988, ranking first in the world. As of 1991, there were over 2000 hyperbaric oxygen chambers worldwide (excluding China), an increase of 8 times in 10 years. The number of hyperbaric oxygen chambers in China is increasing rapidly, and currently there are more than 3000 hyperbaric oxygen chambers in the country, ranking first in the world in terms of quantity. Since 1963, ten international conferences on hyperbaric oxygen and underwater medicine have been held in the Netherlands, the United Kingdom, the United States, Japan, Canada, Scotland, the former Soviet Union, the United States, and Australia. Experts from the Chinese Society of Hyperbaric Oxygen participated in the 8th, 9th, and 10th conferences and presented their papers, receiving praise from experts around the world. The 11th International Conference on Hyperbaric Oxygen and Underwater Medicine, held in Fuzhou, China in September 1993, was a complete success. The World Conference on Hyperbaric Oxygen Medicine was held in Beijing in October 2008, and the rapid development of hyperbaric oxygen medicine in China has attracted worldwide attention.
4、 The Development of Hyperbaric Oxygen Medicine in China
China's hyperbaric oxygen industry started relatively late. Before the liberation, only the Shanghai Salvage Bureau had a pressurized cabin for divers to prevent and treat decompression sickness, which was almost non-existent in the field of hyperbaric oxygen medicine. In 1954, after liberation, the Naval Medical Research Institute built a pressurized cabin for training divers and treating decompression sickness. In 1958, the Academy of Military Medical Sciences built a hyperbaric oxygen chamber for animal experiments. In 1960, a large pressurized chamber with a pressure of 2026kPa (20 atmospheres) was built in Beijing for experimental diving. But medical hyperbaric oxygen chambers began in the early 1960s. In 1963, Professor Li Wenren, an expert in cardiac surgery at Fujian Union Medical College Hospital, was inspired by the article "Life Without Blood". With no drawings or equipment, he designed, constructed, improved, and experimented on his own, and built the world's third largest high-pressure surgical chamber with a diameter of 3m and a length of 7m. And successfully underwent open heart surgery. In 1965, Professor Li Wenren gave a report on the clinical application of hyperbaric oxygen at the National Society of Cardiology, which received great attention from the domestic medical community. Hospitals from all over the country came to visit. Since the 1970s, hyperbaric oxygen chambers have been built in cities such as Hangzhou, Beijing, Guangzhou, Qingdao, and Harbin. In 1974, Chaoyang Hospital in Beijing completed the construction of a large three cabin, three bedroom, seven door high-pressure air chamber group, and began clinical treatment. The National Hyperbaric Oxygen Medical Committee was established in 1976, leading the national hyperbaric oxygen academic activities and organizing sixteen national academic conferences, each of which published a compilation of academic papers.
Since the reform and opening up, China's hyperbaric oxygen medicine industry has made greater leaps forward. Manifested in:
1. The speed of cabin construction has accelerated, and the capacity and quality of cabin construction have significantly improved. In 1982, there were only 166 high-pressure chambers in China, which increased to 334 in 1987. By the end of 1991, there were 880 chambers registered with the National Hyperbaric Oxygen Society alone, and so far there have been nearly 2000. Taking Beijing and its suburban counties as an example: in the 1970s, there were only 3-4, but so far more than 60 have been in operation. In addition, there are still ongoing constructions. At present, China can independently design and manufacture more than ten types of large and small high-pressure chambers and pressurized chambers. There has been progress in both quality and aesthetics. Over the past 30 years, there have been more than ten accidents, all of which were caused by improper operation and use, except for one incident where the observation window was broken.
2. The number of doctors, nurses, technicians, and personnel engaged in hyperbaric oxygen therapy has significantly increased, strengthening the team of hyperbaric oxygen medicine. Under the leadership of the Ministry of Health, hyperbaric oxygen training courses have been established in Shanghai, Hunan, Beijing and other places, greatly improving the professional quality of practitioners, ensuring the safety of hyperbaric oxygen therapy, and improving the quality of hyperbaric oxygen therapy.
3. After nearly 30 years of practice and application, the indications for hyperbaric oxygen therapy have increased from 44 diseases recommended by the Hyperbaric Oxygen Professional Committee in 1982 to 122 diseases. The indications for hyperbaric oxygen therapy have been widely used in various fields such as internal medicine, external medicine, gynecology, pediatrics, neurology, facial features, orthopedics, plastic surgery, dermatology, oncology, genetics, occupational diseases, sports medicine, diving, and healthcare.
4. Academic research: There have been many studies and reports on the physiological effects of hyperbaric oxygen and the treatment of certain diseases. The quantity and quality have gradually increased, and many projects have received rewards.
5. Under the leadership of the Chinese Medical Association, the National Hyperbaric Oxygen Society was officially established in 1992, and the chairman, vice chairman, committee members, and standing committee members were elected. After the establishment of the National Society, various regions have set up branches, and some provinces and cities have established hyperbaric oxygen quality control centers to strengthen the management of hyperbaric oxygen chambers in various regions and organize national academic activities.
6. From 1993 to 1994, there were three large and medium-sized high-pressure air chamber fires in China, resulting in a high number of deaths. After being reported by the media, it had a significant impact on the high-pressure oxygen industry and the general public nationwide. In recent years, there have been several unsatisfactory accidents due to usage and maintenance issues. In 2004, the Chinese Medical Association's hyperbaric oxygen medicine division gradually improved the "Management and Application Standards for Medical Hyperbaric Oxygen Chambers". In September 2005, under the organization of the Ministry of Labor, the Ministry of Health, and the State Administration for Quality Supervision and Administration, the national standard for medical air pressurized oxygen chambers was revised. Gradually leading the field of hyperbaric oxygen medicine towards standardization.
7. In 1992, the Journal of Hyperbaric Oxygen Medicine and its editorial department were established. In 1994, the Chinese Journal of Navigation Medicine was founded, which included the editorial department of hyperbaric oxygen medicine. In 2003, the Chinese Journal of Navigation Medicine was revised to the Chinese Journal of Navigation and High Pressure Medicine. The level and quantity of articles on hyperbaric oxygen medicine have gradually improved, greatly promoting the development of the national hyperbaric oxygen industry.
With the development of modern technology, the theory and practice of hyperbaric oxygen medicine are constantly being updated, and the equipment in hyperbaric oxygen chambers is becoming safer, more practical, and more humane. The management of hyperbaric oxygen medicine is also becoming more perfect and standardized. The application of hyperbaric oxygen medicine in clinical practice is becoming more and more widespread. We believe that with the joint efforts of hyperbaric oxygen professionals, we will surely hold on to a better tomorrow!
(Note: This article is partially selected from the Hyperbaric Oxygen Medical Information Network)