The history of high-altitude physiology and medicine is such a rich and colorful topic that it is surprising no one has undertaken a comprehensive account before. From the early balloonists to various high-altitude expeditions, culminating in the great feat of climbing Mount Everest without supplementary oxygen, the basic biological challenge of hypoxia has underpinned the human experience at high altitude. Of key importance in several areas of medicine including pulmonology, critical care, anesthesiology and cardiology, this topic is also of general interest to other life sciences such as biology and ecology, because hypoxia is encountered by many organisms throughout the animal kingdom.
High Life covers the topic from its earliest beginnings with the Greeks to the last two or three years, and highlights many geographical locations, such as China, Japan, India and Russia. Including 185 illustrations, over 800 references, and three appendixes detailing the chronology of main events, databases of high-altitude publications, tables of high-altitude locations, a list of classical books on the topic and narratives of classical and modern high-altitude expeditions, this book is a comprehensive reference text which should be of value to anyone interested in high altitude and hypoxia.
"synopsis" may belong to another edition of this title.
John B. West, Professor of Medicine and Physiology, University of California, San Diego.From The New England Journal of Medicine:
The nature of the atmosphere in which we live has fascinated humanity for thousands of years. It had always been clear that air was necessary for life -- but why? Observations of the motion of the lungs and the beating of the heart slowly brought understanding of the intertwining relations among air, respiration, circulation, and life. When oxygen, the "vital principle," was isolated, its importance was appreciated immediately. People began to explore mountains, which they had long worshiped for their remote beauty and later feared as they experienced their dangers. The venturesome soon wondered why going to a high altitude -- on mountains or in balloons -- often made them sick. The history of these explorations is fascinating stuff.
High Life will delight scientists and historians. West is the leading authority on hypoxia, and this elegant book is a welcome extension of his collection of landmark papers, High Altitude Physiology (Stroudsburg, Pa.: Hutchinson Ross, 1981). It is meticulously researched and covers much of what you might want to know about the history of altitude sickness. It will be less interesting for most clinicians and climbers.
Among the attractions of the book are the many biographical sketches and rare photographs of the major players. West gives interesting details about little-known people like Thomas Ravenhill and Alexander Kellas, and along with occasional flashes of humor these details give life to the facts. The reader soon realizes how much the famous owe to the work of those unknowns who went before.
In the first four chapters of High Life, West takes the reader through early speculations and discoveries about the nature of air and barometric pressure and the growth of understanding of why high altitudes make people sick. I would have liked more excerpts from the ancient Chinese writings about air and about the circulation of the blood; they were nearly right more than 2000 years ago. One chapter details the early history of Mount Everest; another describes many of the summit climbs.
West describes the early balloon flights, in which a few men were taken to great heights (where some died), but gives little attention to the flights of World War I, when many men could fly high enough to be badly affected. Barely mentioned is the work on altitude that took place during World War I and that was a major stimulus to later research.
True to the stated purpose of the book, the chapter on illnesses caused by high altitude is historical rather than clinical. West comments on a few selected old and recent medical cases but says little about the rush of knowledge over the past 60 years. An important 15th-century description of mountain sickness and acclimatization by a Mongol chieftain is not included.
Another surprising omission is any mention of the microscope, the use of which, among other things, filled the last gap in William Harvey's theory. Also not described is the tortuous path toward the understanding that breathing and the output of the heart are automatically controlled. Far too brief is the history of how we learned that foods could be "burned" to produce energy without the body's being consumed. Birds and animals that tolerate high altitude -- often very high altitude -- are not mentioned.
No one can write a complete and accurate history of a subject: perception always contaminates reality. Facts are immutable, but those who describe them are necessarily selective. Even Edward Gibbon was sometimes wrong and not free of bias. It is not surprising that West has scanted some pioneers; I would have liked to read more about the ancient Egyptians and the Greek and Roman philosopher-scientists, as well as the 15th-century physicians whose work made possible Harvey's great explanation of the circulation. Gaspar Berti's water barometer is barely mentioned, and West gives all the credit to Evangelista Torricelli for the one we use today.
This rich book is enjoyable to read. Along with Herbert Hultgren's High Altitude Medicine (Stanford, Calif.: Hultgren, 1997), written for practicing doctors; Michael Ward, James Milledge, and John West's High Altitude Physiology and Medicine (2nd ed. New York: Chapman & Hall Medical, 1995); my own Going Higher: Oxygen, Man and Mountains (4th ed. Seattle: Mountaineers, 1998), written for mountaineers; and of course Paul Bert's encyclopedic Barometric Pressure (Paris: G. Masson, 1878), High Life is a good base for a library on mountain medicine.
Reviewed by Charles S. Houston, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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