From The New England Journal of Medicine
The nature of the atmosphere in which we live has fascinated humanity for thousands of years. It had always been clear that air was necessary for life -- but why? Observations of the motion of the lungs and the beating of the heart slowly brought understanding of the intertwining relations among air, respiration, circulation, and life. When oxygen, the "vital principle," was isolated, its importance was appreciated immediately. People began to explore mountains, which they had long worshiped for their remote beauty and later feared as they experienced their dangers. The venturesome soon wondered why going to a high altitude -- on mountains or in balloons -- often made them sick. The history of these explorations is fascinating stuff.
High Life will delight scientists and historians. West is the leading authority on hypoxia, and this elegant book is a welcome extension of his collection of landmark papers, High Altitude Physiology (Stroudsburg, Pa.: Hutchinson Ross, 1981). It is meticulously researched and covers much of what you might want to know about the history of altitude sickness. It will be less interesting for most clinicians and climbers.
Among the attractions of the book are the many biographical sketches and rare photographs of the major players. West gives interesting details about little-known people like Thomas Ravenhill and Alexander Kellas, and along with occasional flashes of humor these details give life to the facts. The reader soon realizes how much the famous owe to the work of those unknowns who went before.
In the first four chapters of High Life, West takes the reader through early speculations and discoveries about the nature of air and barometric pressure and the growth of understanding of why high altitudes make people sick. I would have liked more excerpts from the ancient Chinese writings about air and about the circulation of the blood; they were nearly right more than 2000 years ago. One chapter details the early history of Mount Everest; another describes many of the summit climbs.
West describes the early balloon flights, in which a few men were taken to great heights (where some died), but gives little attention to the flights of World War I, when many men could fly high enough to be badly affected. Barely mentioned is the work on altitude that took place during World War I and that was a major stimulus to later research.
True to the stated purpose of the book, the chapter on illnesses caused by high altitude is historical rather than clinical. West comments on a few selected old and recent medical cases but says little about the rush of knowledge over the past 60 years. An important 15th-century description of mountain sickness and acclimatization by a Mongol chieftain is not included.
Another surprising omission is any mention of the microscope, the use of which, among other things, filled the last gap in William Harvey's theory. Also not described is the tortuous path toward the understanding that breathing and the output of the heart are automatically controlled. Far too brief is the history of how we learned that foods could be "burned" to produce energy without the body's being consumed. Birds and animals that tolerate high altitude -- often very high altitude -- are not mentioned.
No one can write a complete and accurate history of a subject: perception always contaminates reality. Facts are immutable, but those who describe them are necessarily selective. Even Edward Gibbon was sometimes wrong and not free of bias. It is not surprising that West has scanted some pioneers; I would have liked to read more about the ancient Egyptians and the Greek and Roman philosopher-scientists, as well as the 15th-century physicians whose work made possible Harvey's great explanation of the circulation. Gaspar Berti's water barometer is barely mentioned, and West gives all the credit to Evangelista Torricelli for the one we use today.
This rich book is enjoyable to read. Along with Herbert Hultgren's High Altitude Medicine (Stanford, Calif.: Hultgren, 1997), written for practicing doctors; Michael Ward, James Milledge, and John West's High Altitude Physiology and Medicine (2nd ed. New York: Chapman & Hall Medical, 1995); my own Going Higher: Oxygen, Man and Mountains (4th ed. Seattle: Mountaineers, 1998), written for mountaineers; and of course Paul Bert's encyclopedic Barometric Pressure (Paris: G. Masson, 1878), High Life is a good base for a library on mountain medicine.
Reviewed by Charles S. Houston, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
" ... the book is well produced and well written. It does not demand an excess of specialist knowledge, and it will provide fascinating reading, not only for applied physiologists, but also for others with a passion for climbing." Canadian Journal of Applied Physiology (vol.25, 2000)
"This is the finest historical review of the movement of man into high altitudes....The book is an excellent reference for a study of the history of high altitude operations and basic reduced pressure physiology....Overall, igh Life is an excellent historical reference. It will become a primary authority on man's movement into the less dense regions of our atmosphere."--he Quarterly Review of Biology
"John West's High Life; a History of High-Altitude Physiology and Medicine is intended to guide the unacclimatised outsider into this isolated realm. West, a world-renowned authority who has devoted many years of field and laboratory research to this subject, is uniquely equipped to lead such an expedition...John West leads a stimulating trek into the field."--Lancet
"...a scholarly account of the development of knowledge of human responses to high altitude...In general, the book is well produced and well written. It does not demand an excess of specialist knowledge, and it will provide fascinating reading, not only for applied physiologists, but also for others with a passion for climbing."--Can. J. Appl. Physiol.
"...demonstrate the profound transformation that physiological research has undergone even just in the twentieth century....valuable introductions to...biological research that deserve more attention from historians."--Journal of the History of Biology
"John West, who himself has made important contributions to respiratory physiology, has written an account of physiology and medicine at high altitude from the time of Aristotle to 1996 that is so knowledgeable and comprehensive that the task need not be attempted again in the forseeable future....This book should be read by every physiologist and historian of medicine who can still define alveolar air, in these days when molecular biology has displaced classical physiology in our schools."--Bull. His. Med.
"High Life is extensively researched....West's passion for the subject is evident, and High Life is clearly written by someone very much part of this history who has had personal contact with many of its major players....I, for one, am glad that he has created this wonderful resource."--BMJ
"High Life must be essential reading for all those interested in high altitude medicine, or the history of respiratory physiology and will make a useful companion for anyone lecturing on these subjects....the wider audience will be intrigued by the historical events that have led us to our current understanding of what breathing is all about."--International Society for Mountain Medicine
"High Life is a unique book in several regards. It is the definitive work to date on the continuing quest to define the effects of high altitude on human physiology in an extremely hostile environment, and it is written by one of the premier researchers and thinkers in the field of hypoxia, John B. West, MD, ....This excellent and well-written book will be the primary reference source in its field for years. It should be required reading for serious students of high altitude physiology."--Journal of the American Medical Association
"High Life will delight scientists and historians. West is the leading authority on hypoxia, and this elegant book is a welcome extension of his collection of landmark papers...It is meticulously researched and covers much of what you might want to know about the history of altitude sickness....This rich book is enjoyable to read."--The New England Journal of Medicine
"All the materical in this quite extensive book is timely and interesting."--American Scientist
