Medicine for Mountaineers, Wilkerson, James A., M.D., Editor. Published by The Mountaineers, P.O. Box 122, Seattle, Washington 98111; c. 330 pages. The need for a comprehensive handbook of medicine for mountaineers has been recognized for years. There are few individuals or groups who are capable of isolating themselves so completely, both in time and in distance. Furthermore, in many mountaineering accidents and illnesses, first aid training is clearly not sufficient to provide the kind of treatment required. With this problem in mind, and the belief that mountaineers as a group are highly intelligent and fully capable of carrying out more than simple first aid, Dr. Wilkerson has undertaken the ambitious and precarious task of compiling a textbook of medicine and surgery for the layman. This is a task, incidentally, which has taken over five years to complete. The contributors to this book are all physician-mountaineers, most of whom have had major expedition experience: Earle E. Cammock, Fred T. Darvill, Ben Eisman, Thomas F. Hornbein, Charles S. Houston, Herbert N. Hultgren, and even this reviewer, who has made minor contributions.
Dr. Wilkerson has done an excellent job of selecting material for this book, providing substantial coverage of the most important and most pertinent conditions and eliminating vast areas of medicine which are not applicable to the mountaineering situation. Wherever possible, physiological or pathological background material has been provided to give the reader some practical, common-sense insight into what would otherwise be a "cookbook” approach to treatment. A major requirement, of course, was to keep the size (and weight) of the book to a reasonable and useful level. Undoubtedly, there are some gaps which will only become evident as the handbook is used. One serious objection to a layman’s book with many authors or contributors is the general problem of arrangement, terminology, readability, different viewpoints and gaps or duplications. The editor has largely overcome these difficulties, using the special experience and qualifications of the various contributors to good advantage. Not unexpectedly, the substantial content of the book makes it somewhat hard to use quickly in a true medical emergency (such as resuscitation) where seconds count. To riffle through twenty-six chapters and five appendices looking for resuscitation (in Chapter III, "Special Problems”) might take several minutes. In such cases, Dr. Darvills booklet, Mountaineering Medicine is an ideal supplement. For comprehensive treatment and expedition use, however, Medicine for Mountaineers is a "must". The two books are complementary.
Physicians and non-physicians alike may have some complaints about this book. Non-physicians may wonder exactly where to place an intramuscular injection, or be bewildered by some of the terminology (there is a clear, concise glossary). Physicians may wonder about the advisability of including procedures such as tube thoracotomy or even intravenous fluid therapy. In each important case, however, the indications as well as the dangers and contraindications of these procedures are clearly spelled out. These procedures are included simply because they may some day save a life in the absence of outside medical help. Some mention of the danger of respiratory depression by morphine at high altitudes should have been included in the discussion of contraindications of that drug. A good index, including common names as well as professional termi- nology, would be a helpful addition. The various medical kit lists offer a good starting point, but medical supplies, particularly those for a major expedition, must be carefully individualized according to the duration, location and season of the expedition, as well as the medical experience of the party. This handbook should probably be taken on every expedition (mountaineering or otherwise), and each member ought to read the introduction and the first five chapters, and at least skim the rest of the book. Even if there is an expedition physician, it is possible that he will not be in a position to help in an emergency. Mountaineers sometimes take calculated risks” but there is no longer any excuse for trusting to luck alone in avoiding or handling medical problems. Even the healthy, careful climber "… must expect sooner or later to be involved in misfortune, if not his own, then someone else’s.”
Thomas O. Nevison, Jr., M.D.