The High Life: A History of High-Altitude Physiology and Medicine. John B. West. Oxford University Press: London, 1998. $79.50.

In 1979, when I was in my pulmonary fellowship at the University of Washington, John West invited me to be a climber-scientist on the 1981 American Medical Research Expedition to Everest (AMREE). It was a pivotal event, both professionally and personally. My passion for the high mountains flourished with my growing interest in hypoxia and high-altitude physiology (strands of which have continued to weave intrigue into my day-to-day life as a pulmonary and critical care physician.) I had read about the high-altitude work in the Silver Hut in 1960-’61 that West, Jim Milledge, and Sukhamay Lahiri had done, and suddenly I was going to be mentored by them on this great adventure to Everest, at the end of an era when we were the only expedition there. My life as an academic physician was launched.

It was, therefore, with some trepidation that I accepted the invitation to write a review of John West’s book, The High Life: A History of High-Altitude Physiology and Medicine. What if the book were flawed or overly biased? How could I publicly criticize someone who had been so supportive of me ever since AMREE? My fears soon dissolved as I was consumed by the lives and adventures of those men and women with whom I have shared a curiosity about high-altitude physiology. We have wanted to know how humans and animals “work” under such stresses, laced with the unknown and unidentifiable.

Years ago, in a lecture on the history of high-altitude research, I heard one of my professional heroes, Dr. Jack Reeves from the University of Colorado, say that we stand on the shoulders of giants who have gone before. This same recurrent theme emerges throughout the book by West. From the early experiences on trade routes at high altitude to the discovery of barometric pressure by Torricelli to the exploration of the possibilities of climbing the world’s highest peaks, West spins a compelling story that is superbly and engrossingly written in a way that makes this book not only an excellent resource but also a compelling and suspenseful tale.

This task would normally be difficult for most writers, but as always, West writes in a style that carries the reader on a wave of anticipation. He takes joy in the human side of these explorers, scientists, and climbers as he recounts their histories and personal lives as well as their achievements. He conveys that he, too, stands on the shoulders of giants of old, while making us realize we stand on his and his contemporaries’ shoulders, whom he generously lauds. For example, regarding Torricelli’s discovery in 1644 that “we live submerged at the bottom of an ocean of air,” West writes, “how simple and striking this is, shows astonishing perception and clarity.” His adoration of bright and enterprising physiologists of the past and present is refreshing.

The volume is thoroughly documented and beautifully illustrated with old figures and photographs of historic events and people. I recognize many familiar, albeit younger, faces (Milledge with dark hair and ears!) in the photograph of the 1961 Haldane Symposium in Oxford. For instance, the photographs of the 1911 Pike’s Peak team (Haldane, Fitzgerald, Schneider, Henderson, Douglas); Barcroft; and the 100-year-old Mabel Fitzgerald finally receiving her recognition and degree from Oxford in 1973 are marvelous to see and a product of West’s typically thorough research. The dapper but gentle face of Ravenhill, who gave such poignant descriptions of altitude illness at the high mines of Chile in the early years, gives a prescient look into where the rest of his life as an artist after the trauma of WWI would take him. The nomadic but prodigiously talented Alexander Kellas, whose solo forays into the high Himalaya in the early 1900s provided precious speculation about the difficulties of extreme altitude climbing, is here as well. There are copies of original documents and graphs, all of which bring tangibility to the past. (They all look so much more serious and proper than I think many of us ever felt in the 1980s and ’90s!)

High Life is not a climbing book per se, but for those who want foundation in their zeal for going to altitude, this is a climber’s book. How can one not be inspired by the obsession of Kellar, who unfortunately died of a non-altitude related illness on one of his many forays to the unexplored Himalaya, by the ultimate quest, political and otherwise, of Everest in 1953 and the ascents of Everest by Messner, Habeler, and others without supplemented oxygen? (Remember that in the very early 1900s it was thought that human ascent above 21,000 feet or so was not possible.) The feats of the Duke of Abruzzi on K2 and the British Everest expeditions of the early 1920s astounded mountaineers and physiologists alike. One can’t help but sense West’s excitement about those early years.

I can not validly comment on the accuracy of the early history. It is all well documented, but the “modem era” (1950s to the present) is more familiar to me. The chronological unraveling of high-altitude pulmonary edema by the Peruvians, Hultgren, Houston, and others is a joy to read. The debate on limitation of performance at extreme altitude with particular emphasis on the field (AMREE) and chamber (Operations I, II) studies is appropriately given a lot of space, as the physiologists and climbers are still trying to find the mechanism (the joy of science!). All of this makes even the most rigid scientist marvel and wonder if there just isn’t something unmeasurable that we’ll never know.

If there is any room for comment on High Life, it would be in the proportioning of space and emphasis on the recent and ongoing projects, most of which have shifted out of the U.S.A. For instance, the Campana Margherita Hut on Monte Rosa seems to be short-changed. Over the past ten years, under the direction of Dr. Peter Bartsch of Heidleberg, this facility has been the most productive in research in the field of high-altitude illness. Others may want more space as well, and Messner probably remembers 1978, rather than 1990, as being the year he scaled Everest (page 407), but these are all minor points.

For me, this book is a treasure, both as a climber and as a scientist. Both appetites should be tantalized (whether they exist in the same person or separately). The human drive for achievement (in this case climbing), and the curiosity of how it can be achieved physiologically co-exist. High Life is a well-balanced diet that doesn’t leave us wanting, but only wondering what the next chapter will bring.

Robert B. Schoene