1836: The beginning of pressure therapy and Tabarie's Sphere

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Galileo (1564-1642) was perhaps the first to consider the idea that air had weight.  Yet it was his pupil, Evangelista Toricelli (1608-1647), who proved the existence of atmospheric pressure.  From there, it didn't take long for ideas to evolve for using changes in atmospheric pressure as therapy for various diseases, such as lung ailments  (3, page 52)

Tabarie's Sphere (3, page )

The major question Toricelli set out to answer was:  Why is it that water is prevented from being pumped up higher than 32 feet?  He performed a test, and proved the answer was due to the weight of the air, or atmospheric pressure.

Apparently influenced by folks who described the benefits of climate change or high altitudes, Nathaniel Henshaw (1628-1673) was the first to create a chamber for artificially raising or lowering atmospheric pressure so that it could be used to help people feel better.  Henshaw's called his chamber the "Domicilium," which was basically a "sealed room," that was attached to a "pair of large organ bellows."  This chamber is now considered the first hyperbaric chamber.  (5, page 1)

According to Tissier, the "chamber was built of masonry and supplied with doors and windows that could be closed hermetically.  It communicated with two bellows (the organ bellows) provided with valves, which worked in opposite directions, in such a way that it was possible, at will, to obtain compression or rarification of air." (3, page 55)  

Here we require a couple definitions:

1.  Compressed Air:  This was the original term used to describe increases in atmospheric pressure.  It's air with a larger volume of oxygen than ordinary air.  It is positive pressure. 

2.  Rarified Air:  This was the original term used to describe decreases in atmospheric pressure.  This is air that contains less oxygen that normal room air.  It is negative pressure. 

So, basically, Henshaw's organ bellows, when pressed, forced air into the chamber, and therefore increased the atmospheric pressure inside.  When the bellows were relaxed, pressure was decreased inside the chamber.  Future chambers, and portable apparatus's, would apply a similar technique to compress and rarify air.  

Other than Henshaw's work, there's little evidence pressure changes were considered for therapeutic use for diseases until the 1750s.  Yet by 1800 there was such strong speculation for the therapeutic use of pressure therapy that the Royal Society of Haarlem opened the idea up to a competition to determine "The influence of condensed air on animal and vegetable life."  Yet it was to no avail. (1, page 43)

However, the idea continued to circle the profession, and Sir John Sinclair suggested, based on his observations of the effects of pressure on animals, that changes in pressure may have therapeutic benefits for humans.  (1, page 43) 

Among the first to come to the challenge were Emile Tabarie and Junod.  In 1833 Tabarie discussed the topic with the Parisian Academy of Science, (2, page 19) and in 1835 Tabarie performed the first experiments.

Junod reported that when the "natural pressure of the atmosphere is augmented by one-half, the following effects will be observed:"

1. Disagreeable sensation of pressure in the ears, subsiding as equilibrium is re-established
2. Respiration is Facilitated.  The inspiration becomes deeper and less frequent
3. Circulatory changes occur
4. Functions of digestive apparatus are stimulated
5. Secretions of salivary glands and kidneys are very profuse

There were various theories to account to the perceived benefits of pressure changes on breathing. The pressure seems to open and keep the alveoli open to better receive the next breath.  The vessels of the body appear to be compressed, which stimulates the pulse to increase so it is "full and easily compressible. the caliber of the superficial veins is diminished, and the lumen may even become completely obliterated, so that the blood on its way back to the heart courses through the deeper veins."  (3, page 72)

If this is true, it was determined that the same effect must occur to the pulmonary vessels, and this results in "the quantity of venous blood contained in the lungs (to) diminish; and this probably explains why a much greater quantity of air can be drawn into the lungs at each inspiration that is possible under normal pressure. (3, page 72)

"Further, if an increase in the density of the air tends to diminish the caliber of the veins, it follows necessarily that a greater quantity of blood will enter the arterial system and more blood will also reach the principal nerve-centers; especially those in the brain, because the latter is protected from the direct pressure of the atmosphere by the resistant bony calvarium. The cerebral functions are accordingly enhanced, the imagination becomes more active, and in some persons there is a peculiar exaltation which stimulates drunkeness." (3, page 72)

By 1838 Tabarie had performed a variety of tests to study the effects on pressure changes on the various parts of the body, all except for the head. He studied the effects of both condensed and rarified air. By his experiments Tabarie determined that condensed air "retards the action of the heart and steadies the rhythm. This effect is very slight and may not be noticeable under normal conditions, but becomes quite evident in disease." (3, page 72)

Tabarie ultimately devised a chamber, or sphere, that was made of iron that allowed up to twelve people to enjoy the benefits of pressure changes.  "He advised sittings of two hours duration with an increased pressure of from one-half to two-thirds of an atmosphere.  Bertin, who used the spheres, reported the cure of fifteen cases of uncomplicated emphysema, and ninety-two cases of nervous and catarrhal asthma with associated emphysema.  Air chambers, cumbrous, expensive and not portable, were thus far used." (1, page 44)

Various pneumatic chambers were devised and used around this time, with a variety of shapes being used. However, they were all based on the design of Tabarie's Chamber. They contained two pipes, one for for supplying the air and connected to a hydraulic compressor operated by steam.  The other pipe was for ventilation.  

References:

1. Minnesota State Medical Society, "Transaction of the Minnesota State Medical Society," 1886, St. Paul, H. M. Smyth Printing Co.
2. Foster, Frank, editor, "Practical Therapeutics," Volume I, 1897, New York, Appleton and Co., page 19
3. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co., pages 296-224.  If the profession of respiratory therapy existed in their era, we would be reading their books.  However, as it was, their books were written for the medical profession. All of the material from this post is from Tissier's book unless otherwise noted in the above paragraphs. Tissier page 72
4. Rose, A., "Treatment of Disease of Respiration and Circulation by the Pneumatic Method," New York, The Medical Record: A Weekly Journal of Medicine and Surgery, Edited by George F. Shrady, M.D., Volume 10, Jan. 2, 1875 to Dec. 25, 1875, New York, William Good and Co., page 577
5. Clarke, Dick, "History of Hyperbaric Therapy," Chapter 1 of the book, "Physiology and Medicine of Hyperbaric Oxygen Therapy," 2008, Philadelphia, Saunders, page 1-2
6. Picture is from an advertisement placed in the Medical Press of Western New York, volume II, No. 6, June, 1887, Roswell Park M.D., editor, New York, Bigelow Brothers, page 338

1870-1900: Pneumatic Chambers

(1, page 91)

By 1903 the pneumatic chamber was a viable method of treating patients with various lung ailments.  The therapy was generally referred to as a "compressed air bath," and was provided by means of a compressed air chamber, or pneumatic chamber.

By this time such chambers were refined so that they contained carpet, windows, electric hydraulic compressors, and even humidity.  Some of the devices that were available in 1903 were described by Paul Tissier in is 1903 book "Pneumotherapy: Including Aerotherapy and Inhalation Methods."  Some are as follows:

1.  Tabarie Sphere's:  This was a sphere made of cast iron with two pipes, one to provide pressure from a hydraulic compressor run by steam, and the other to allow for ventilation. Carpet covered the floor mainly to cover the first pipe.  There was an antechamber to allow the physician to enter and exit without disturbing the pressure, and to provide books, newspapers, and drinks to the patients.  It's basically this device that was later copied by others who refined the pneumatic chambers.  I wrote about the Tabarie Sphere in this post.  

Figure 13 and 14

2.  Lange's Pneumatic Chamber: According to Tissier, "Lange's pneumatic chamber differs in shape, and in certain devices for ventilation and the regulation of the temperature, from Tabarie's apparatus. It is cylindrical, constructed of wrought-iron, and accommodates only four persons. The temperature of the compressed air within the chamber is lowered either by means of a stream of cold water directed against the force-pump and the supply-pipes, or by filling the cup-shaped space at the top of the chamber with cold water and allowing it to flow down along the sides, where it is taken up by sheets of linen and cools the air by evaporation. In winter the chamber is kept at a comfortable temperature by heating in the ordinary way the room where it is set up. The chamber is also provided with a device for regulating the flow of the incoming air so that it enters in a steady stream instead of in a succession of puffs corresponding with the strokes of the force-pump. The pressure is secured, as in Tabarie's system, by regulating the inflow and outflow of the air." (1, page 91)

3.  Aerotherapeutic Installation at Jewish Hospital at Berlin:  Here the air is pumped through a large pipe that was connected to a filter to filter out bacteria and dust.  The air then passes through a wooden box where it is warmed by heated steam.  The pipes containing heated air are wrapped in a cloth to prevent condensation.  The air can also be cooled if so desired.  A pipe around the floor of the chamber provides pressure from a compressor in the engine room (see figure 13).
Another pipe allows for ventilation.  To see the device check out figure 14.  (1, page 95)

4.  Dr. Dupont's Pneumatic Chamber:  This was a later design described by Tissier as having both the ability to provide electric lighting at night and telephone service.  They were large enough to hold two or three patients.  It was located at the  Etablissement AeVotheVapique of Dr. Dupont in Paris.  Tissier provides a neat picture of it here on page 93.  

Liebig's Pneumatic Chamber; here is one of three chambers

5.  Leibig's Pneumatic Chamber:  At the Dianabad in Reichenhall was built a pneumatic chamber which basically had three chambers, with each chamber holding up to three persons.  It should be obvious by looking at figure 15 from Tissier's book, the chamber has five chairs, so perhaps this is a later design.  One antechamber connects all three rooms, and allows the physician to enter and exit without disturbing the pressure.  The antechamber also acts as a large pressure regulator, preventing the patients from feeling the sudden effects of pressure changes in the chambers.  A ventilation pipe through an opening in the ceiling is supposedly designed in such a way as to provide "perfect ventilation."  It is operated by steam from an engine, which communicates with the chamber through a pipe.  The temperature in the chambers can be controlled, and a different pressure can be obtained in each of the chambers.  

There are a variety of other chambers described, although it appears that for the most part a particular doctor constructed a chamber design for a specific medical institution.  Some patients would have to travel a long way to seek treatment, and even then there was no evidence it did any good.  I suppose in a way it would be similar to patients with certain cancers or chronic pain traveling from all over the United States to seek the treatment of experts at the Mayo Clinic.  

I will mention one more chamber here.

Hauke's Pneumatic Tub

6.  Hawke's Pneumatic Tub:   Well, it was small chamber as compared to the ones mentioned above, and far less expensive, and probably even portable.  It was build in such a way that it could provide compression and rarification of air by turning a crank, and was an alternative to the chambers mentioned above, and to the portable pressure apparatus's I describe in this post.  


Hauke originally recommended using a cuirass that created rarified air, but he ultimately decided the tub provided a better effect. The patient sat in the tub, and a rubber hood was set over the head, slid over the shoulders like a shirt, so that only the face was exposed.  The atmospheric pressure around the body is compressed and then rarified so as to create inspiration and expiration with greater ease than a patient's normal efforts.  (1, page 231)

Tissier describes the device like this (1, page 231):

"(The device is) so constructed that the patient introduces the entire body with the exception of the head, and therefore breathes air under ordinary pressure. The cabinet communicates with two reservoirs, one containing condensed, the other rarefied air. During inspiration the air in the cabinet is rarefied, and expansion of the chest is facilitated. During expiration the air in the cabinet is condensed, the result of which is to aid thoracic retraction and render it more vigorous. By this means the two phases of respiration are influenced, and in an absolutely mechanical manner. The procedure may be truly said to be a method of artificial respiration. Hauke recommends his apparatus especially for children, who generally refuse to breathe into the so-called portable appliances, and, in fact, experience great difficulty in doing so. He has used it successfully in a variety of cases. Kaulich has also obtained good results."

Tissier makes note here of the next phase of pressure therapy: the invention of portable pressure apparatus's, which were generally referred to as pneumatometers.  Hawke became the first to invent such a device, and it was introduced to the market in 1870 and I describe it in detail in this post.   

Figure 3 -- William and Ketchum's Pneumatic Cabinet (6)

7.  William and Ketchum's Pneumatic Cabinet:  There were similar devices, such as William and Ketchum's Pneumatic Cabinet, such as the one you can see in the advertisement in Figure 3.

By the 1900s the chambers were refined so that electricity was used to run the hydraulic compressor, windows provided the ability to see outside, temperature could be controlled, and humidification added.   

Most of the chambers contained an antechamber that allowed the physician to leave and enter the chamber without disturbing the pressure.  This also allowed the opportunity to bring entertainment to the patients, such as "books, newspapers, drinks, and the like, without interrupting inturrupting his treatment." (1, page 88-89)

And also keep in mind there were many of the above such chambers, tubs and cabinets at various medical institutions.  Which one you would use would recommend on your ailment, symptoms, physician, and location.  

References:

1. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co., pages 88-98, or as noted above.  If the profession of respiratory therapy existed in their era, we would be reading their books.  However, as it was, their books were written for the medical profession. All of the material from this post is from Tissier's book unless otherwise noted in the above paragraphs. 

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