ALPINE WINTER: MEDICAL PERSPECTIVES
CONTENTS HISTORY THE ATMOSPHERE GEOGRAPHY AND THE HUMAN RESPONSE TO ALTITUDE ALTITUDE ACCLIMATIZATION AND DETERIORATION VENTILATORY RESPONSE TO HYPOXIA AND CARBON DIOXIDE PULMONARY GAS EXCHANGE CARDIOVASCULAR SYSTEM HEMATOLOGY BLOOD-GAS TRANSPORT AND ACID–BASE BALANCE PERIPHERAL TISSUES EXERCISE LIMITING FACTORS AT EXTREME ALTITUDE SLEEP NUTRITION, METABOLISM AND INTESTINAL FUNCTION ENDOCRINE AND RENAL SYSTEMS AT ALTITUDE CENTRAL NERVOUS SYSTEM HIGH ALTITUDE POPULATIONS ACUTE MOUNTAIN SICKNESS HIGH ALTITUDE CEREBRAL EDEMA HIGH ALTITUDE PULMONARY EDEMA CHRONIC MOUNTAIN SICKNESS AND HIGH ALTITUDE PULMONARY HYPERTENSION OTHER ALTITUDE-RELATED CONDITIONS: NEUROVASCULAR DISORDERS, EYE CONDITIONS, ALTITUDE COUGH, ANESTHESIA AT ALTITUDE THE PHYSIOLOGY AND PATHOLOGY OF HEAT AND COLD PRE-EXISTING MEDICAL CONDITIONS AT ALTITUDE WOMEN AT ALTITUDE EXTREMES OF AGE AT ALTITUDE: CHILDREN AND THE ELDERLY COMMUTING TO HIGH ALTITUDE FOR COMMERCIAL AND OTHER ACTIVITIES ATHLETES AND ALTITUDE CLINICAL LESSONS FROM HIGH ALTITUDE PRACTICALITIES OF FIELD STUDIES REFERENCES HISTORY 1 1 INTRODUCTION 1 2 CLASSICAL GREECE AND ROME 1 3 CHINESE HEADACHE MOUNTAINS 1 4 POSSIBLE EARLY REFERENCE TO HIGH ALTITUDE PULMONARY EDEMA 1 5 JOSEPH DE ACOSTA’S DESCRIPTION OF MOUNTAIN SICKNESS 1 6 INVENTION OF THE BAROMETER 1 7 INVENTION OF THE AIR PUMP 1 8 DISCOVERY OF OXYGEN FIRST BALLOON ASCENTS AND THE RECOGNITION OF SEVERE ACUTE HYPOXIA 1 10 MOUNTAIN SICKNESS IN MOUNTAINEERS 1 11 PAUL BERT AND THE PUBLICATION OF LA PRESSION BAROMÉTRIQUE 1 12 HIGH ALTITUDE LABORATORIES 1 13 EARLY SCIENTIFIC EXPEDITIONS TO HIGH ALTITUDE 1 14 PERMANENT RESIDENTS OF HIGH ALTITUDE 1 15 HIGH ALTITUDE STUDIES FROM THE LAST 50 YEARS SUMMARY THE HISTORY OF HIGH ALTITUDE MEDICINE AND PHYSIOL- OGY IS ONE OF THE MOST COLORFUL IN THE WHOLE OF THE LIFE SCIENCES ALTHOUGH THERE WERE A FEW ANECDOTAL REFER- ENCES TO MEDICAL PROBLEMS AT HIGH ALTITUDE BEFORE 1600, JOSEPH DE ACOSTA’S DESCRIPTION OF ACUTE MOUN- TAIN SICKNESS, ORIGINALLY PUBLISHED IN 1590, IS A WATER- SHED SHORTLY AFTER THIS THE MERCURY BAROMETER WAS INVENTED BY EVANGELISTA TORRICELLI IN 1644, AND VERY QUICKLY IT WAS RECOGNIZED THAT BAROMETRIC PRESSURE DECLINED WITH ALTITUDE ROBERT BOYLE AND ROBERT HOOKE CONSTRUCTED THE FIRST AIR PUMP FOR PHYSIOLOGI- CAL MEASUREMENTS IN 1660 AND BOYLE THEN PROPOSED HIS FAMOUS LAW DURING THE SEVENTEENTH AND EIGH- TEENTH CENTURIES THE NATURE OF RESPIRATION WAS ELUCI- DATED AND THE RESPIRATORY GASES WERE FIRST CLEARLY DESCRIBED BY LAVOISIER IN 1777 SOON THE EFFECTS OF ACUTE ASCENT TO HIGH ALTITUDE WERE DRAMATICALLY SHOWN BY THE EARLY BALLOONISTS INCLUDING SEVERAL FATALITIES FROM THE SEVERE HYPOXIA THE FRENCH PHYSI- OLOGIST, PAUL BERT, WAS THE FIRST TO CLEARLY IDENTIFY THE LOW PARTIAL PRESSURE OF OXYGEN AS RESPONSIBLE FOR HIGH ALTITUDE ILLNESS WITH HIS LANDMARK PUBLICATION LA PRESSION BAROMÉTRIQUE IN 1878 WHEN CLIMBING BECAME POPULAR IN THE EUROPEAN ALPS IN THE MID-NINETEENTH CENTURY MANY INSTANCES OF ACUTE MOUNTAIN SICKNESS WERE DESCRIBED THE CONSTRUCTION OF THE OBSERVATOIRE VALLOT IN FRANCE AND THE CAPANNA MARGHERITA IN ITALY FACILITATED EARLY MEDICAL AND PHYSIOLOGICAL STUDIES OF HIGH ALTITUDE THE EARLY TWENTIETH CENTURY SAW THE BEGINNING OF SPECIAL EXPEDITIONS TO HIGH ALTITUDE TO MAKE MEDICAL AND PHYSIOLOGICAL MEASUREMENTS INCLUDING THE IMPORTANT PIKES PEAK EXPEDITION OF 1911 A LIVELY TOPIC AT THIS TIME WAS THE POSSIBILITY OF OXYGEN SECRE- TION BY THE LUNG AND THIS WAS FINALLY RESOLVED IN FAVOR OF PASSIVE DIFFUSION ATTEMPTS TO CLIMB THE HIGHEST MOUNTAIN IN THE WORLD, MOUNT EVEREST, COMPRISE A GREAT SAGA CULMINATING IN THE FIRST ASCENT IN WHEN SUPPLEMENTAL OXYGEN WAS USED, AND THE FIRST ASCENT WITHOUT BOTTLED OXYGEN IN 1978 MORE RECENTLY, THERE HAVE BEEN SEVERAL DEDICATED EXPEDITIONS TO EXPLORE THE PHYSIOLOGY OF EXTREME