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Undersea and hyperbaric medicine (UHM) is among the newest subspecialties of emergency medicine, although the origins of hyperbaric therapy are much older. The history of the clinical use of hyperbaric medicine is tied closely with diving. Dating back to ancient times, there is some evidence that Hippocrates referred to the effects of diving accidents in his work. Aristotle made reference to Alexander the Great's use of a manned pressurized submersible in the battle of Tyre in 332 BC. During the middle of the 17th century, Henshaw used pressurization to treat various diseases. In 1662, he built a pressurized room he referred to as a “Domicilium.”1 He treated people for therapeutic purposes without any documented scientific basis.

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In 1834, Junod made the first observations of increased circulation to internal organs. A few years later, Pravaz began treating a variety of illnesses focusing primarily on pulmonary diseases in 1837. Nearly 40 years later, Dr Andrew Smith termed the phrases “caisson disease” and “compressed air illness” and noted 110 cases of decompression sickness during the construction of the Brooklyn Bridge. The nickname “the bends” was termed, and it was used to describe the Brooklyn Bridge workers' posture after leaving the pressurized construction site that was very similar to the ladies of the “Grecian Bend” period.

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History of Hyperbaric Medicine

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Hyperbaric medicine moved into the operating room in 1877 when Fontaine began the first hyperbaric operating theater for hernia repairs. In 1878, Paul Bert discovered nitrogen gas bubbles released from tissues and blood during or after decompression caused decompression sickness and showed the advantages of using oxygen instead of air in the hyperbaric treatment environment. In 1885 during the construction of the Hudson River Tunnel in New York, C.W. Moir used a medical lock to successfully treat many patients with caisson disease. Prior to the use of the medical lock, the death rate was 25% from caisson disease. After the installation and initiation of hyperbaric treatments, the death rate fell from 1 worker per month to 2 workers in 15 months.2

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In 1912, the first United States Navy decompression tables were developed by French and Stillson for the USN Bureau of Construction and Repair. The decompression tables were instituted to plan and conduct dives to reduce the probability of decompression sickness. Since then, several subsequent generations of tables have been developed. In the 1920s, Dr Orval Cunningham used hyperbaric oxygen therapy to treat Spanish influenza patients and those with cardiac disease. He observed higher mortality in patients from higher elevation areas. Specifically, the survival rate was higher for patients living at sea level when compared to those living in the Rocky Mountains. Postulating that these differences were due to the differential effects of the partial pressure of oxygen, he built a series of hyperbaric facilities of ever-increasing size to treat patients with various illnesses and diseases, culminating in a 5-story high, 64 ft in diameter facility ...

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