Ward, Milledge and West's High Altitude Medicine and Physiology

Andrew M Luks, Philip N Ainslie, Justin S Lawley, Robert C Roach, Tatum S Simonson

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9780429814761
• Edition: 6
• Topic: Medizin
• Subtopic: Arbeitsmedizin

This pre-eminent work has developed over six editions in response to man's attempts to climb higher and higher unaided, and to spend more time at altitude for both work and recreation. Building on this established reputation, the new and highly experienced authors provide a fully revised and updated text that will help doctors continue to improve the health and safety of all people who visit, live or work in the cold, thin air of high mountains.
The sixth edition remains invaluable for any doctor accompanying an expedition or advising patients on a visit to altitude, those specialising in illness and accidents in high places, and for physicians and physiologists who study our dependence on oxygen and the adaptation of the body to altitude.

1

History of high altitude medicine and physiology

• Introduction
• Early descriptions of the effects of high altitude and altitude illness
  • Classical Greece and Rome
  • Chinese Headache Mountains
  • Possible early reference to high altitude pulmonary edema
  • Joseph de Acosta's description of mountain sickness
• Early scientific advances
  • Invention of the barometer
  • Invention of the air pump
  • Discovery of oxygen
  • First balloon ascents and the recognition of severe acute hypoxia
  • Mountain sickness in mountaineers
  • Paul Bert and the publication of La Pression Barométrique
  • Two new, permanent high altitude laboratories
• Scientific expeditions and laboratory explorations: 1900–1950
  • Tenerife expedition
  • Anglo-American expedition to Pikes Peak
  • Mabel FitzGerald's field work in Colorado
  • International high altitude expedition to Cerro de Pasco, Peru
  • International high altitude expedition to Chile
  • Operation Everest I
  • Human's quest to climb Mount Everest: Scientific underpinnings
• High altitude research in the latter half of the 20th century
  • 1960s
  • 1970s
  • 1980–90s
• Major research programs in the early 21st century
  • High altitude chambers
  • Caudwell Xtreme Everest Expedition
  • AltitudeOmics
  • University of British Columbia (UBC) Okanagan high altitude research program
  • Expanding frontiers in hypoxia research
  • Recent breakthroughs in high altitude genomics
• References

Introduction

While references to the effects of hypoxia on the human body can be traced as far back as the ancient Greeks, research into the physiological effects of hypoxia began in earnest in the latter part of the 19th century and continues to this day among several large and active research programs. Before examining the results of these extensive efforts in the pages and chapters that follow, this first chapter provides an overview of the history of high altitude medicine and physiology. Readers who desire more details can find these in perhaps the most comprehensive work on this rich and colorful history written by John West (1998).

Early Descriptions of the Effects of High Altitude and Altitude Illness

Classical Greece and Rome

It is perhaps surprising that there are so few references to the ill effects of high altitude in the extensive writings of classical Greece and Rome. The Greek epics and myths, in particular, are so rich in the accounts of travelers and the foibles of human nature that one might expect there to be a reference to the deleterious effects of high altitude, but this is generally not the case. However, 17th-century writers believed that the ancient Greeks were aware of the thinness of the air at high altitude. For example, Robert Boyle (1627–91) claimed that Aristotle (384–322 BC) held this view when he wrote:

That which some of those that treat of the height of Mountains, relate out of Aristotle, namely, That those that ascend to the top of the Mountain Olympus, could not keep themselves alive, without carrying with them wet Spunges, by whose assistance they could respire in that Air, otherwise too thin for Respiration: … (Boyle 1660)

However, modern historians have not been able to find this statement in Aristotle's extensive writings. Similar attributions to Aristotle can be found in the writings of Francis Bacon (1561–1626) and St. Augustine of Hippo (AD 354–430). See West (1998) for additional information.

Chinese Headache Mountains

There is a tantalizing reference to what may have been acute mountain sickness (AMS) in the classical Chinese history, the Ch'ien Han Shu, which dates from about 30 BC. One of the Chinese officials warned about the dangers of traveling to the Western regions, probably part of present day Afghanistan, when he stated that travelers would not only be exposed to attacks from robbers but they would also become ill. One of the translations reads:

Again, on passing the Great Headache Mountain, the Little Headache Mountain, the Red Land, and the Fever Slope, men's bodies become feverish, they lose colour, and are attacked with headache and vomiting; the asses and cattle being all in like condition …

Several people have tried to identify the site of the Headache Mountains, suggesting for instance that it is the Kilik Pass (4827 m) in the Karakoram Range on the route from Kashgar to Gilgit (Gilbert 1983). However, there is not universal agreement on this.

Possible early reference to high altitude pulmonary edema

Fâ-Hien was a Chinese Buddhist monk who made a remarkable journey through China and adjoining countries in about AD 400. He related that when crossing the “Little Snowy Mountains” (probably in Afghanistan) his companion became ill, “a white froth came from his mouth,” and he died. It is tempting to identify this as the first description of high altitude pulmonary edema.

Joseph de Acosta's description of mountain sickness

Joseph de Acosta (1540–1600) was a Jesuit priest who traveled to Peru in about 1570. While he was there, he ascended the Andes and gave a very colorful account of illness associated with high altitude. This was first published in 1590 in Spanish (Acosta 1590) (Figure 1.1), and a new English translation entitled Natural and Moral History of the Indies appeared in 2002 (Acosta 2002). The following is from his account when the party crossed the Pariacaca mountain range:

I have said all this in order to speak of a strange effect caused by the air or wind that prevails in certain lands in the Indies, which is that men become ill from it, not less but much more than at sea. Some think it a legend and others call it an exaggeration, but I will tell what happened to me. In Peru there is a very lofty mountain range that is called Pariacaca; I had heard of this alteration that it causes and went prepared as best I could according to the advice given me by those called vaquianos there, or experts; yet after all my preparation, when I climbed the Staircases, as they are called, the highest part of that range, almost in an instant I felt such mortal anguish that I thought I would have to throw myself off my mount onto the ground. Although many of us were making the journey, each one was hurrying and not waiting for the others in order to get out of that bad situation. I was left with only one Indian, whom I begged to help hold me on my mount…. Finally, I will say that if it had continued I would have been certain of dying, but it lasted only a matter of three or four hours until we had gone a good way down the mountain and reached a more tolerable altitude, where I found all my companions, of whom there were some fourteen or fifteen, completely exhausted. Some had asked for Confession along the way, thinking that they were dying; others had dismounted and were in a wretched condition with vomiting and flux. Some told me that they were sure their end was at hand from that illness. I saw another who threw himself to the ground and screamed from the terrible pain that the transit of Pariacaca had cost him. But commonly it does not result in any great harm, apart from the feelings of nausea and extreme discomfort that it causes while it lasts. (Acosta 2002, pp. 119–120)

Figure 1.1Title page of the first edition of the book by Joseph de Acosta published in Seville in 1590. (Source: Acosta 1590.)

Acosta's book was widely read such that, for example, Robert Boyle was familiar with his description of mountain sickness. Various people including Gilbert (1991) have attempted to identify the site of Pariacaca but there is some disagreement over this.

Early Scientific Advances

Invention of the barometer

A key advance in high altitude science was the recognition that barometric pressure falls with increasing altitude. In 1644, Evangelista Torricelli (1608–47) wrote a letter to his friend Michelangelo Ricci in which he described how he had filled a glass tube with mercury and inverted it so that one end was immersed in a dish of the same liquid (Torricelli et al. 1644) (Figure 1.2). The mercury descended to form a column about 76-cm high, and Torricelli argued that the mercury was supported by the weight of the atmosphere acting on the dish. His letter included the striking sentence: “We live submerged at th...