2021 · Review article
Historical Development of Hyperbaric Oxygenation
Historical and clinical review of hyperbaric medicine internationally and in Bulgaria
How to cite this article
Tsankova, K., & Dimitrova, M. (2021). Historical development of the hyperbaric oxygenation. Journal of IMAB – Annual Proceeding (Scientific Papers), 27(2), 3772–3777. https://doi.org/10.5272/jimab.2021272.3772
Extended Structured Summary
Context and relevance
Hyperbaric oxygen therapy (HBOT) involves breathing near-100% oxygen in a hyperbaric chamber at pressure above one atmosphere absolute; for clinical hyperbaric treatment, the Undersea and Hyperbaric Medical Society uses a threshold of at least 1.4 ATA. The field developed at the intersection of diving medicine, gas physics and respiratory physiology.
The history of HBOT illustrates a transition from empirical compressed-air treatment to a specialised discipline increasingly governed by physiology, clinical evidence and professional consensus.
Aim
To trace the development of hyperbaric oxygenation internationally and in Bulgaria and to systematise the major historical stages, scientific discoveries, clinical applications and the evolution of HBOT toward evidence-based practice.
Materials and methods
The review covers approximately 100 years of published work on hyperbaric oxygen therapy, drawing on English- and Bulgarian-language articles and books as well as documents from professional organisations concerned with clinical indications and good practice.
Historical development
Period 1: scientific discoveries and physical laws
Foundational discoveries include Torricelli's mercury barometer in 1643, Pascal's work on atmospheric pressure and hydrostatics in 1653, Boyle's law in 1661 and Mariotte's related work in 1676, alongside the discovery of oxygen and understanding of its role in respiration.
In 1662, the English physician Henshaw used a wooden compressed-air chamber known as the domicilium to treat pulmonary and gastrointestinal conditions, one of the earliest recorded therapeutic uses of increased atmospheric pressure.
Period 2: compressed-air therapy and diving physiology
During the nineteenth century, Junod, Tabarie and Pravaz developed chambers and applied compressed-air therapy to diverse conditions. In 1841, Jean Triger created a caisson chamber for high-pressure work; in 1854, Pol and Watelle described clinical manifestations of caisson disease.
Andrew Smith used therapeutic recompression in 1873. Paul Bert's 1878 work Barometric Pressure: Experimental Physiological Research became foundational to pressure physiology and described oxygen toxicity at high pressure.
By 1887, A. Arntzenius could compile almost 300 references in a monograph on the subject. John Scott Haldane later strengthened the scientific basis of decompression, and the British Admiralty tables published in 1908 became an important precursor of modern decompression practice.
Period 3: modern evidence-based hyperbaric medicine
The modern era accelerated in the second half of the twentieth century. In 1959, Boerema performed cardiac surgery in a large hyperbaric chamber in Amsterdam; in 1961, Boerema and Brummelkamp reported beneficial effects in anaerobic infection and gas gangrene.
During the 1950s and 1960s, more than 60 proposed indications were described. The period from 1980 to 1994 brought critical reassessment of such broad use, leading to tighter indication criteria and stronger emphasis on evidence-based medicine.
Contemporary evidence and clinical indications
Medline publications after 2000 show increasing experimental and clinical research on HBOT. Nevertheless, not all indications are supported by the highest levels of evidence, and randomised controlled trials are difficult or ethically problematic in some emergency conditions.
The article compares recommendations from the European Committee for Hyperbaric Medicine (ECHM, 2017) and the Undersea and Hyperbaric Medical Society (UHMS, 2019). Strongly established applications include carbon monoxide poisoning, decompression sickness, gas embolism, anaerobic infection and gas gangrene, severe traumatic ischaemia, selected radiation injuries and sudden sensorineural hearing loss.
Recommended or selectively used indications also include diabetic foot, compromised grafts and flaps, refractory osteomyelitis, burns and ischaemic ulcers. The authors emphasise that clinical indications should be judged according to evidence strength and international professional consensus.
Development of HBOT in Bulgaria
Bulgarian hyperbaric medicine began in the early 1960s and was initially closely linked to diving and military medicine.
HBOT was first used clinically in Bulgaria in 1967 at the Military Medical Academy in Sofia. Two years later, therapy was used in a chamber attached to a naval unit. In 1975, a chamber complex began operating at the Institute of Oceanology of the Bulgarian Academy of Sciences for experimental work, recompression and hyperbaric oxygenation.
Clinical application expanded during the 1990s in Naval Hospitals in Burgas and Varna; sustained use in Varna is reported from 1992. In 2003, the Oxygen Hyperbaric Medical Center was established with multiplace chambers.
After 2000, Bulgarian publications increased, particularly in clinical toxicology, diving medicine, surgery, neurology and hearing loss. Reported applications include carbon monoxide and smoke-gas poisoning, alcohol and mushroom toxicity, psychoactive substances, petroleum products, solvents, pesticides, severe burns, plastic surgery, non-healing wounds, diabetic foot, sensorineural hearing loss, crush syndrome, open fractures, post-traumatic ischaemia, osteomyelitis and aseptic osteonecrosis.
Main contributions and applicability
The review structures the history of hyperbaric medicine into three clear periods and connects global scientific development with the specific Bulgarian trajectory. This makes the article useful not only as a historical review but also as contextual evidence for research on organisation, quality, regulation and clinical implementation of hyperbaric medicine.
The national chronology is particularly valuable: 1967 — first clinical use; 1975 — chamber complex at the Institute of Oceanology; 1992 — sustained clinical use in Varna; 2003 — development of a specialised multiplace-chamber centre.
Conclusions
Hyperbaric oxygen therapy evolved from empirical compressed-air applications into a specialised medical discipline grounded in pressure physiology, clinical research and international consensus.
Scientific interest has continued to grow internationally and in Bulgaria. Alongside well-established indications, some applications still require stronger evidence. The future of hyperbaric medicine therefore depends on the continued integration of historical experience, clinical practice and rigorous evidence generation.