Mountain Sickness Research Articles

Introduction to a previously unpublished paper by A. M. Kellas.

the Possibility of Ascending Mount Everest,” by A. M. Kellas, which was written in 1920, is a previously unpublished landmark for people who have a historical interest in the physiology of extreme altitude and, in particular, the challenge of climbing Mt. Everest. The circumstances of the manuscript have been discussed in detail elsewhere (West, 1987), but a brief summary is appropriate here. Alexander Mitchell Kellas (1868–1921) (Fig. 1) was exceptional in that he combined pioneering contributions to the exploration of the Everest area with a great deal of insight into the physiological problems of its immense altitude. Between 1907 and 1921 he took part in eight expeditions to the Himalayas, mainly on his own or with a few Sherpa companions (West, 1989), and when permission was given by the Tibetan authorities for the first official expedition to Everest in 1921, he probably knew more about the approaches to the mountain than anybody else. At the same time, he probably had as much experience as anybody of the difficulties of climbing to altitudes over 6000 m, and he had developed a keen interest in the physiological problems of extreme altitudes. The present paper is an exact printed version of an unpublished typescript that has been languishing in the archives of the Alpine Club in London for some 80 years (Fig. 2). Another almost identical manuscript is in the archives of the Royal Geographical Society in London. The original typescript is not easy to read and includes a number of longhand additions made by Kellas in elegant but very small writing, but careful scrutiny has resulted in an authoritative version. It is very rewarding to finally be able to publish this manuscript on the 80th anniversary of Kellas’s death. As in the case of all historical manuscripts, some parts are more useful than others. For example, the long section on mountain sickness and the physiology of acclimatization (printed here in a smaller typeface), while containing some points of historical interest and a snapshot of knowledge around 1920, may be tedious to some people. However, because the opportunity has finally arrived to let the manuscript see the light of day, it seemed best to print it in its entirety. The most interesting parts of the manuscript deal with Kellas’s predictions for physiological variables on the Everest summit, including barometric pressure, alveolar PO2, arterial oxygen saturation, maximal oxygen consumption, and maximal climbing rate. In addition, there HIGH ALTITUDE MEDICINE & BIOLOGY Volume 2, Number 3, 2001 Mary Ann Liebert, Inc.

Genetic lessons from high altitude.

What lessons can we learn from mountain sickness or wellness that may apply to our patients? Does hypoxia affect us similarly regardless of its cause? Millions of individuals are as hypoxic from congenital or acquired heart or lung disease as healthy individuals may be at altitude. Certain adjustments enable many of such patients to lead nearly normal lives. I will compare their adjustments to those seen in the acclimatization of healthy persons to altitude. Some living organisms use strategies which enable them to tolerate a degree of hypoxia lethal to man. Are there lessons we can learn from them? In my short talk I will raise a few provocative questions, and these will lead me to discuss the relevance of basic research to the resolution of vexing human ailments. When does commercialization of research become a form of intellectual prostitution?

Medical mountain rescue in the Mont-Blanc massif.

Because of its peculiar geographic location beneath Mont-Blanc, the Chamonix Hospital plays an important role in the management of mountaineering- and skiing-related traumatic injuries. The authors, thanks to the study of 5200 mountain rescue medical reports, set out to explain the different aspects of this activity: epidemiology, specific equipment, care in the field, reception and primary survey, dispatching, common therapeutic attitudes, progress, and results. In the dangerous environment of the high mountains, emphasis is put on the physicians' experience, allowing an early evacuation in the best conditions to the hospital. Diagnosis at the scene of the accident is very basic, and the initial treatment is based on immobilization, analgesia, and sedating. In the case of resuscitation, only the vital maneuvers are performed; these actions are carried on during the short flight and improved in the crash rooms. Finally, different specific pathologies are mentioned, including cold- or heat-related injuries, exhaustion, lightning strikes, and mountain sickness.

Use of acetazolamide at high altitude: Mechanisms, indications, and efficacy

Use of Acetazolamide at High Altitude: Mechanisms, Indications, and Efficacy Peter H Hackett, MD / Affiliate Associate Professor of Medicine, University of Washington, Seattle Descent to a lower altitude is the treatment of choice for all forms of high altitude illness. Similarly, gradual ascent allowing adequate t ime for acclimatization is the ideal technique for prevention. However, these are not always available options, and the judicious use of drugs may be useful, either combined with descent or independently. Although controlled studies are lacking, clinical experience and physiological reasoning support the use of oxygen as the first-line therapeutic agent in high altitude illness. Oxygen helps to reverse the symptoms of acute mountain sickness, although curiously, not as well as descent. Oxygen improves the severe arterial oxygen desaturation in high altitude pulmonary edema (HAPE}, may be lifesaving, but is rarely available in the quantity required to completely resolve HAPE (24 to 72 hours of continuous flow). Again, descent is more effective. An important advance in clinical high altitude medicine in the past decade has been !nvestigation into the use of the carbonic anhydrase inhibitor acetazolamide. It is proven to be an effective, safe and fairly well-toleratedagent , and is the drug of choice for ehemoprophylaxis against acute mounta in sickness {AMS). There is substantial anecdotal evidence that it prevents HAPE. Studies of its mechanism of action have aided our understanding of the pathogenesis of altitude illnesses. Recently, dexamethasone was shown to prevent AMS and to be useful for treatment. Other drugs which have been shown to be useful include methylene blue, furosemide, aspirin, spironolactone and methazolamide. Cur ren t cont roversy concerns the ind ica t ions for chemoprophylaxis against high altitude illness, the dose and duration of medication, the mechanism of action of acetazolamide and dexamethasone, the use of drugs for treatment rather than prevention, and the relative merits of the individual agents. The presentation will provide a critique and offer reasonable guidelines for a pharmacological approach to prevention and treatment of high altitude illness.

Medical Aspects of Mountain Rescue by Helicopter

In summer, mountain accidents may include falls, causing contusions and open wounds; fractures and torn ligaments; external bleeding;internal bleeding in the head, thorax and abdomen; injuries to the spinal column and extremities; falling rocks causing skull injuries; and falls into crevasses causing additional hypothermia, frostbite and drowning. In winter, there are skiing accidents with fractures and torn ligaments; and avalanches resulting in asphyxia, hypothermia and frostbite. In addition, there are mountain sickness; pulmonary edema of high altitude; snow blindness; heatstroke; sunstroke; heart attack; diarrhea and vomiting; pneumonia; snakebite; drowning in torrents or lakes; and burns, explosions and cuts acquired in huts. First aid, medical support and transport to hospital may vary widely.

Management of Wilderness and Environmental Emergencies

Interest and participation in wilderness sports have notably increased in recent years, and, not surprisingly, there has also been a concomitant increased incidence of environment-related injuries and illnesses. Therefore, this book should be a most welcome addition to the libraries of physicians and other health professionals who treat or advise mountaineers, trekkers, skiers, scuba divers, and other outdoors enthusiasts. The book consists of 21 chapters and an appendix that address the major problems common to wilderness sports—hypothermia, heat illness, lightning injuries, burns, solar dermatitis, submersion injuries, hazardous marine life, toxic plant ingestions and dermatitis, mammalian bites, arthropod envenomations, and venomous snake bites. In addition, some specific activities are discussed—alpine and nordic skiing injuries, diving and barotrauma, mountain sickness and other high-altitude illnesses, aerospace medicine, and problems encountered in wildland fire fighters. The chapters are by persons knowledgeable in the clinical and practical aspects of these conditions, especially with regard to

Spironolactone prophylaxis in mountain sickness.

Spironolactone prophylaxis in mountain sickness.

The clinical biochemistry of phosphorus

Summary 1. Considerable evidence indicates that the long term use of antacids may result in a “phosphorus depletion syndrome”. Furthermore, the widespread treatment of peptic ulcer with non-absorbable antacids makes recognition of this syndrome clinically important. 2. “Mountain sickness” may result when a marked rise in 2,3-diphosphoglycerate acid (2,3-DPG) fails to take place within the red cells; this rise normally facilitates oxygen release at physiological tensions. The 2,3-DPG level is likely to be depressed in uremia when hypophosphatemic patients are treated with aluminum hydroxide gel. 3. ACD (acid-citrate-dextrose) stored blood becomes severely depleted of 2,3-DPG in less than two weeks and massive blood transfusions with 2,3-DPG depleted blood may be hazardous. CPD (citrate-phosphate-dextrose) solutions affect the organic phosphates such as adenosine and aid in maintaining the 2,3-DPG level of stored cells. 4. The chemical methods for the determination of phosphorus have been reviewed including blood collection procedures, preparation of protein-free filtrates, the automated method utilizing dialysis, and the newer direct phosphorus procedures. 5. Current methodology in use in the clinical laboratories of New York State has been evaluated.

Intrusões: Guimarães Rosa-Bogotá Notas para uma tradução de “Páramo”

This paper comments on the first Spanish translation of João Guimarães Rosa's short story "Páramo", which narrates the exile of a Brazilian lost with mountain sickness in a cold and hostile Bogotá. This translation is briefly explained in the following pages, giving special emphasis to some prominent features of the original version, in addition to the cultural context, critical and theoretical readings and the translation strategy evident in the translator‘s intervention. Finally, it is made clear how a certain perspective of the other – present in the original version as well – passes through the translation process and indicates the conditions of its presentation in the target language. The original article is in Portuguese.

"Mountain sickness" at low altitude due to hypophosphatemia.

"Mountain sickness" at low altitude due to hypophosphatemia.

"Mountain sickness" at low altitude due to hypophosphatemia.

"Mountain sickness" at low altitude due to hypophosphatemia.

Energy metabolism at high altitude

During construction work of a drive way near Tateyama Murodo (ca. 2400m above the sea-level), a good many, not yet acclimatized, labourers suffered from mountain sickness. To establish reasonable labour conditions for them, we have carried out some basic studies on the physiological responses to high altitude stress. Six healthy male adults were chosen as subjects, and ventilation, oxygen consumption, respiratory quotient, pulse rate and blood pressures were measured, and, as for the control data, those of the same subjects at Senju-ga-hara (ca. 460m above the sea-level) were measured.The following results were obtained:1) After a 4-5 day duration at Murodo, the BTPS ventilation and STPD oxygen consumption increased approximately 30% more than at sea-level.2) After a 1-2 day duration at Murodo, however, the STPD ventilation decreased.3) After a 1-2 day duration at Murodo, the mean values of RQ ranged from 0.90 to 0.96 at rest.4) After a 4-5 day duration at Murodo, systolic blood pressure and pulse rate were higher than those at sea-level but the diastolic pressure showed no change.

OBSERVATIONS ON MOUNTAIN SICKNESS IN THE COLOMBIAN ANDES

OBSERVATIONS ON MOUNTAIN SICKNESS IN THE COLOMBIAN ANDES

Cardiac output in man in rest and work during and after acclimatization to 3,800 m.

Cardiac output during rest and work determined via carbon dioxide method at 3800 m altitude

Mountain sickness. By B. Bhattacharjya, M.B., B.S. (Patna), M.R.C.P., M.R.C.S., D.P.M., Deputy Director of Medical Services, Army H.Q., India. 8¾ × 5⅝ in. Pp. 58, with 6 plates and 7 illustrations. 1964. Bristol: John Wright & Sons Ltd. 12s. 6d

Mountain sickness. By B. Bhattacharjya, M.B., B.S. (Patna), M.R.C.P., M.R.C.S., D.P.M., Deputy Director of Medical Services, Army H.Q., India. 8¾ × 5⅝ in. Pp. 58, with 6 plates and 7 illustrations. 1964. Bristol: John Wright & Sons Ltd. 12s. 6d Mountain Sickness. By B Bhattacharjya, M.B., B.S. (Patna), M.R.C.P., M.R.C.S., D.P.M., Deputy Director of Medical Services, Army H.Q., India. 8¾ × 5⅝ in. Pp. 58, with 6 plates and 7 illustrations. 1964. Bristol: John Wright & Sons Ltd. 12s. 6d. British Journal of Surgery, Volume 51, Issue 12, December 1964, Page 948, https://doi.org/10.1002/bjs.1800511227 Published: 08 December 2005

Mountain sickness as described by Fray Joseph De Acosta, 1589

Mountain sickness as described by Fray Joseph De Acosta, 1589

Studies on Acid-Base Balance Before and During Repeated Exposure to Altitude, or to Hypoxia and Hyperventilation

ARTICLESStudies on Acid-Base Balance Before and During Repeated Exposure to Altitude, or to Hypoxia and HyperventilationJ. H. Boutwell, C. J. Farmer, and A. C. IvyJ. H. Boutwell, C. J. Farmer, and A. C. IvyPublished Online:01 Jan 1950https://doi.org/10.1152/jappl.1950.2.7.381MoreSectionsPDF (891 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInEmailWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformationCited ByOBSERVATIONS ON MOUNTAIN SICKNESS IN THE COLOMBIAN ANDESThe Lancet, Vol. 288, No. 7465 More from this issue > Volume 2Issue 7January 1950Pages 381-387 https://doi.org/10.1152/jappl.1950.2.7.381History Published online 1 January 1950 Published in print 1 January 1950 Metrics

A note on a possible allergic factor in altitude sickness

Abstract From the records of a random sample from private practice of 500 individuals in Mexico City, fifteen years of age and under, about 50 per cent were found to be frankly allergic. Of the five hundred, 167 had either severe hives, urticarial rashes or eczema, and one hundred had gastrointestinal symptoms directly related to the ingestion of certain foods. Evidence indicates that these symptoms are either milder or do not occur at all in these same individuals at lower altitudes. In those coming to Mexico City, a period of about three weeks is usually required in the older children for the effect to accumulate and become manifest in symptoms. It is suggested that anoxia occurring at this altitude may result in a greater permeability of the gastrointestinal tract to offending substances. In view of the similarity in many of the cases to conditions found in mountain sickness, the possibility is suggested that similar factors may be contributing causes in such conditions, and may be of interest in aviation medicine.

The gaseous exchange in man during short exposures to a low barometric pressure.

In four series of experiments conducted under a reduced barometric pressure in a low pressure chamber consistent results have shown that the gaseous metabolism may be for a time reduced by a decrease in available oxygen. In many cases the decrease was not evident until a correction was made for the additional use of oxygen that resulted from the further muscular effort of increased respiration. The reduction in oxidation was present in one case at a barometric pressure of 530 mm., partial pressure of oxygen 110 mm.; in others at 443 mm., partial pressure 92 mm.; while in one case it began at 317 mm., partial pressure 66 mm. Observations on the gaseous content of the blood showed that less oxygen was withdrawn from 100 cc. of blood as it flowed through the arm when the individual was under a barometric pressure of 350 mm. than when under 760 mm. The rate of blood flow through the arm was not increased under the low barometric pressure and, in some instances, was somewhat below normal. With a prolonged exposure to a pressure of 400 mm., the oxidations of the body were at first reduced; but, after a period of several hours, tended to return to or even rise above normal. The increased rate of metabolism appeared to be associated with the onset of “mountain sickness” symptoms.

Mountain Sickness

THE reference in the Notes columns of NATURE of January 25 (p. 415) to the physical failure experienced in mountain-climbing at high altitudes sent me to the very instructive (and suggestive) article by Dr. A. M. Kellas, in the Geographical Journal. And the great interest now attached to one of the inevitable problems of the immediate future gave me to think that a few supplementary notes might,be of sufficient interest for publication. The mountain sickness which forms the association that specially interests the physiologist and the physician was impressively brought under the notice of the latter in the fall of the fifteenth century; when the gold-thirst of the ruthless Spanish invader of the western Eldorado made him familiar its symptoms directly after reaching the very elevated backbone of the southern section of the New World. The oldest special description that appeared in print would seem to have been that of Da Costa; and the very human appetite for novelty proceeded very soon to make the mal de montagnes a phrase-name as familiar to Western Europe as that of the mal francaisso very unhappilyrapidly came to be. The syndrome was referred to in the various linguistic territories bordering the giant Cordilleras as: Soroche, mareo des Cordilleras, asthma des montagnes, etc. And the native prophylactic, on the colossal slopes and towering cliffs of the Cordilleras of Peru, was slow and continuous mastication of prepared pellets of the dried juices of Erytliroxylon cocathe original version of American gum-chewing. The phenomena came in time to receive definite scientific discussion, notably at the hands of Bouguier (Voyage en Peru) in 1745, and Condamine (of Peruvian bark fame) in 1751.