This is the twentieth report of the Safety Committee and the seventh in conjunction with the Alpine Club of Canada. Data from such accidents that occurred in former years and not previously reported have been incorporated in the statistical tables.

In looking back over the years it has been interesting to note that in a given year a certain group of factors seems to be important in the causation of accidents. For example, one year there are a number of accidents due to faulty rappelling; in another year lightning strikes a number of times, and in a third year loss of control in voluntary glissades are preeminent. All of these are factors every year—but in some years more so than others.

This year the problems seem to have been a variety of illnesses or disabilities. Three accidents were due to an individual developing a dislocated shoulder while climbing. In each instance such a dislocation had occurred previously and had been recognized as such by the individual involved. Fortunately none of these incidents resulted in serious injury.

In another case a person who had had dizzy spells and temporary lapses of consciousness was involved. Whether the accident was the result of a recurrence of such spells was not clear.

In a third instance the climber involved had had a history of thyroid hyperactivity which had made him tense and nervous. Again the role that this played is unclear.

The most serious condition has been pulmonary edema. Three incidents that probably represent this condition are reported this year. Two resulted in death. It must be emphasized that two of these episodes (one fatal) occurred at altitudes of about 9,000 feet. In two instances there were additional factors that were probably important; in one there had been a previous attack of pneumonia and in the other there was considerable fatigue and cold exposure. The relatively low level at which two of these cases occurred indicates the need for careful conditioning of individuals who go to altitude. It is particularly important in those areas where persons live at or close to sea level and have easy access to altitudes of 9,000 feet or more by automobile or who may fly to such altitudes readily. The case that survived was removed' promptly by plane to a lower altitude. Fortunately a plane was readily available. In another instance considerable time was lost waiting for a plane rather than starting a prompt evacuation that might have been life-saving. As more persons go to higher altitudes we should expect to have more susceptible persons exposed. It will be well to be on the alert for this condition and to take prompt action. If a member of a party at altitudes above 9,000 feet complains of lethargy, fatigue, shortness of breath, or chest discomfort, one should assume the worst—that this is the early stages of pulmonary edema. Prompt return to a lower altitude is indicated. Certainly going higher or having that individual engage in further exercise at that altitude is not wise.

Other medical conditions that have come up in the past have involved diabetics. Diabetes per se does not rule out an individual as a climber. But the individual must be acutely aware of his limitations and the severity of his diabetes. He probably should not go on an extended physically demanding trip because of the difficulties of regulating his medication in the face of extreme physical activity.

Any person with a physical disability or medical condition that could endanger himself or other members of his party should inform the leader of his condition. He should also have obtained a medical opinion concerning the advisability of his engaging in mountaineering or any other comparable sport or activity. The purpose of this is not to eliminate such individuals from mountaineering, but rather to educate them concerning the possible hazard to ensure that they operate within limits that are safe for them and others.

Responsibility, of course, also lies with leaders of climbs or trips and may even involve clubs that sponsor such climbs. A recent review of some of the legal implications has appeared in the American Bar Association Journal by Joyce Blalock (Am. Bar. Assoc. J. 53, 58-62, 1967). This points out many possible areas for legal contention and includes the requirement by individuals who have a disability or illness to make this fact known at least to the leader.