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Going Higher, the Story of Man and Altitude

Going Higher, the Story of Man and Altitude. Charles S. Houston, M.D. Boston, Little, Brown and Company, revised edition, 1987. 324 pages, 39 black-and-white illustrations, bibliography. Price $10.95.

This is the second revision of the book originally entitled Going High, which was published in 1980. The back cover states that Dr. Houston “believes strongly that medicine must be made intelligible and interesting to the general public” and the book succeeds admirably in this respect. Charlie Houston has an enviable reputation in both mountaineering and medicine. He began climbing in the European Alps in 1925, was a member of the first successful ascent of Nanda Devi in 1936 and leader of attempts on K2 in 1938 and 1953. He describes himself as an internist and long-time family doctor. Few can claim to have as much experience in the medical problems of high altitude.

The book is in three sections. The first chapters are an entertaining account of the history of man’s attempts to climb (or fly) higher and higher. This is followed by four chapters introducing the reader to the physiology of respiration and circulation and how these adapt to high altitude. The remainder of the book deals with medical problems of high altitude including acute mountain sickness, high-altitude pulmonary edema, high-altitude cerebral edema, acclimatization and other problems.

The book is written in a fresh, breezy style that makes it deservedly popular among climbers. The previous editions have had a considerable influence in informing climbers about the health hazards of high altitude, and Charlie Houston has been rightly honored for his unique contributions in this area.

Perhaps it is churlish to point to errors in a book which has done so much good and which is targeted at the non-medical climber. However, Charlie Houston is a prolific, persuasive writer and it seems in order to state that the book contains some opinions not shared by other medical people interested in high altitude, and also some factual errors. In the original review of the first edition in the 1981 AAJ, Dr. Herbert Hultgren, another experienced physician- climber, pointed out that some of the advice was of dubious value. He noted, for example that Houston’s recommendation of the careful use of the powerful diuretic “furosemide” (Lasix) in the treatment of high-altitude pulmonary edema can be dangerous. Nevertheless the same advice appears in this most recent revision.

The first edition had many factual errors and though many of these have been corrected, some persist in the present edition. For example on page 255 in a discussion of altitude and barometric pressure, the author states that the aneroid altimeter frequently used by climbers “may show the actual linear feet of elevation but only under specific conditions and in certain places, and unless corrected it does not (usually) give ‘physiological’ altitude”. Actually the opposite is true. The barometer will give the physiological altitude because it records the barometric pressure which is what matters to the oxygen-deprived climber. However, it will not accurately give the actual elevation because the relationship between barometric pressure and altitude depends on latitude and other factors. Other errors include the statement about 2,3,DPG at the bottom of page 217, and the comment about heat loss at the top of page 73. Again it is not true that the intestines are unaffected by oxygen lack, (page 171), and this is a far more likely explanation of HAFE than Boyle’s Law (page 181).

A surprising omission is any discussion of the possibility of residual impairment of brain function after return from extreme altitudes. This is a topic of great current interest and importance to modern Himalayan climbers with their alpine-style techniques. The only reference is in a disparaging comment about the possibility at the bottom of page 316 which is difficult to understand because Operation Everest II (masterminded by Houston) confirmed and extended the observations on residual brain damage made by the American Medical Research Expedition to Everest.

Does it matter whether there are errors in a book principally targeted at the non-medical climber? I think it does because the book is also read by paramedical people (for example those involved in mountain rescue) and even physicians who occasionally see patients who have been to high altitude. It is not impossible to combine scientific accuracy with clear simple writing.

But these are quibbles. No other book so entertainingly presents the basic physiology and medical problems of high altitude to the interested climber, and the book deserves its enormous popularity. I look forward to the error-free apotheosis which will presumably be called Going Highest.

John B. West, M.D.