Mountaineering Medicine, by Darvill, Fred T., Jr., M.D. Published by Skagit Mountain Rescue Unit, Inc., P. O. Box 2, Mt. Vernon, Washington 98273; 36 pages, price $1.00, weight 1½ oz.

In spite of the somewhat expansive title, this booklet is not a textbook of mountaineering medicine; it is a specialized first aid handbook (a good one), written for the layman, providing clear and concise information on major emergency first aid problems such as hemorrhage, artificial respiration, cardiac resuscitation, head and back injuries and fractures. The pocket-sized format makes it ideal for inclusion in a lightweight first-aid kit, and printed information of this sort should be mandatory for mountaineers who lack solid training in first aid.

It should be pointed out, however, that many aspects of mountaineering medicine, such as prevention of illness and long-term medical management, are not covered in great depth. The scope of the booklet and quantities and nature of the first aid materials prescribed would not be adequate for a major expedition to a remote area. Quantities of each of the medicines (the numbers immediately following the "#"signs) generally allow for only 12-24 hours’ treatment. If these drugs are truly needed, one day’s supply might not be sufficient (if each climber carried such a kit, pooling of the group’s supplies might provide adequate quantities). Certain medications and supplies called for in the text are not included in the first-aid kit; for example: Scolex; Globaline and Halazone; and antihistamines (one is included—Teldrin—but it is not identified as an antihistamine). Many mountaineers would probably want to add a few of their own favorite remedies such as Zincofax Skin Cream, which is excellent for lip protection.

The obvious disadvantage of attempting to present the essentials of mountaineering first aid in such a succinct form is that a great deal must be left out: 1) more information on the use of some drugs such as Dexedrine, pontocaine and morphine would be desirable. Morphine, for example, should be used with great caution at high altitudes because of the possibility of respiratory depression which could be very hazardous. 2) More distinction might also be made between medicines which can be used for routine complaints and those which should be reserved for true emergencies. 3) The dangers of reducing circulation to the extremities through the use of tourniquets, splints, Ace bandages, or adhesive tape (which should never be wrapped entirely around an extremity) are discussed, but the risk to the patient, particularly in cold weather, cannot be overemphasized. The author points out the urgency of immediate initiation of mouth-to-mouth respiration and external heart massage when required. It is important to remember too that resuscitation efforts should not be interrupted until the outcome is evident. 4) Much other information which would be required on a major expedition simply cannot be included in a book of this size. The prevention and treatment of diarrhea through dietary regulation, an important problem on most expeditions, is one example. These shortcomings are pointed out merely to suggest to the reader who is organizing an expedition that this booklet and the list of first-aid materials should not constitute his sole medical support.

The author has intended that this handbook be studied carefully and thoroughly and the user is cautioned to read the advice set forth under "Working Outline” (page 2) and to refer to sections of the text concerning the specific conditions prior to using any of the medications. Many practical ideas are presented, such as "cocoon” warming of a seriously cold or "shocky” climber, and these ought to be adopted and used, when necessary, by all mountaineers. Dr. Darvill’s discussions of the life-threatening emergencies are particularly well handled. Carried with the first-aid kit, this small book will unquestionably be useful in many situations; on a larger expedition it will serve as a useful complement to Medicine for Mountainers (also reviewed in this issue).

Thomas O. Nevison, Jr., M.D.