High Altitude Medicine and Physiology. Michael P. Ward, James S. Milledge and John B. West. University of Pennsylvania Press, Philadelphia, 1989. 515 pages. $89.95.

As the golden age of Himalayan climbing climaxes, it’s not surprising to find aparallel interest in high altitude. But mountain sicknesses are not limited to those who climb the highest mountains: in fact the greatest number of cases occur among the millions who ski, climb, trek or simply vacation among more moderate mountains. More than a quarter of all who visit 8000 to 10,000 feet have significant symptoms and quite a few die from altitude illness.

So this is a timely book, aimed primarily at doctors and scientists, but a good read for anyone going to the mountains. It’s quite simply the best medical text on high altitude.

The three authors know their stuff: all are veteran climbers and scientists who have dealt with illness and accidents in high places and have contributed to research as well. In this book they describe the history, geography and demography of mountainous regions and detail the normal and abnormal reactions of man to oxygen lack. They tell amusing stories of how we learned what we know today and describe how and why we breathe, and how the heart, lungs, blood, and cells function normally and when short of oxygen. Hypothermia and frostbite are well described but oddly separated from an excellent discussion of how thermal balance is controlled.

What we know and don’t know about the various forms of altitude illnesses is summarized, though the classification British authors use differs from ours. Case reports lighten the text and there is some stimulating comparison of healthy man at altitude with man hypoxic from illness at sea level—a subject still relatively unexplored.

Though the authors draw most heavily from their own experience, and a few disputed data are advanced as fact and others ignored, the book is quite even-handed. There are ample references for those who want to read more. Unfortunately the index is poor.

These are minor warts: this book, primarily a medical text, is good reading for any one seriously interested in going high and the ideal source of information about high altitude for the mountaineering doctor.

Charles S. Houston, M.D.