Volume 1
A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae.
- Date:
- 1907-10
Licence: In copyright
Credit: A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
95/986 (page 71)
![both fatal cases were bleeding from the mucous membranes of the mouth and lungs, accompanied by extreme lassitude and temporary paralysis of the respiratory muscles, which proved fatal. Since the famous ascension, which has been followed l>y many others, we have learned the effect of rarified air on the human organism. On the other hand, we know that travelers experience disagreeable symptoms when they climb mountains. Alterations of atmospheric j)ressure have been regarded by some as coincident with pulmonary congestion and with neuralgic and rheumatic pains; but a well-defined symptom-group due exclusively and directly to altered air pressure we find in: (a) mal des montagnes; and (b) caisson disease. Mountain Siclmess (Mal des Montagnes).—The physiological dis- turbances experienced on altitudes have been known since the fifteenth century when Da Costa described them under the name of mal des mon- tagnes. His first description has been verified and corroborated by many savants since, so that at present the condition has a clearly defined symp- tom-group. At the height of 3,000 to 4,500 meters the first noticeable symptoms are palpitation of the heart and rapid pulse. Soon the respira- tion becomes accelerated; the patient becomes restless, cannot sleep, and sometimes has vomiting-spells. There is more or less pronounced pain in the knees and legs. Walking is difficult, and the patient feels exhausted. At the same time thirst increases the suffering. The tongue is dry; the appetite is lost; nausea and eructations torture the patient. In extreme cases hemorrhages may occur which are followed by syncopal attacks. The hemorrhages are most frequently from the mucous membranes of the air passages. Lazarus also observed cyanosis of the extremities when a height of 7,000 meters is reached. The symptoms are therefore analo- gous to those of ascent in a balloon, but it is remarkable that in the latter case the effects of diminished pressure are not felt until twice the height has been reached. The reason of it lies in the wasting of considerable muscular energy in climbing. The wasting is accompanied by a larger loss of calories than the organism can supply, as the respiratory combus- tion cannot furnish a sufficient amount of heat because of low density of the air. The body temperature falls below normal and the ascent becomes difficult. Consequently in mal des montagnes we have two factors: the effects of rarefication of air and those of fatigue. The effects of mal des montagnes arc not uniform in various individuals and at various heights. They depend upon the age, habits, antecedent health, etc. At 3,000 meters the symptom-group is present in every case. Passive movements can be produced in healthy individuals without marked effect in their health even at the level of 4,000 meters. Active move- ments even at a lower height will produce the symptoms enumerated above. This observation is a sufficient hint for preventive measures. In addition to the latter, care should also be taken not to remain in the rarefied air longer than two to three hours. When a more or less prolonged sojourn in mountainous regions is taken up by persons who come from lower altitudes, they become subject to the following .symptoms, which are ])articularly marked when the barometer stands low: hemorrhages and l)ronchial and nasal catarrhs. Attacks of haemoptysis are often seen in tuberculous patients who come to high alti- tudes in search of health. Epistaxis is observed in perfectly healthy](https://iiif.wellcomecollection.org/image/b24907212_0001_0095.jp2/full/800%2C/0/default.jpg)
