Friday, December 18, 2020

“Mountaineering and health” (9)

"The pass in sight" 
(Original title from the Badminton Library Series on Mountaineering)

Advice from a mountaineering medic of the silver age

Frostbite is a trouble that the mountaineer is less likely to meet with if he recognises the necessity for taking precautions against it. The mildest form is merely a deadness or numbness of the fingers or toes. The part affected becomes white the skin a little wrinkled, and sensation is lost. As the symptoms pass off, the part swells a little and becomes of a blueish-violet colour. Return of sensation is characterised by itching and tingling. 

The more quickly artificial warmth is induced the more pronounced are the after effects. It follows that in the treatment of slight, or, indeed, any degree of frostbite, the temperature of the part should be very gradually restored. The frost-bitten part being numb, the sensations of the sufferer cannot be trusted. Gentle friction or 'massage', the part being well anointed with oil or vaseline, will restore vitality. 

If the friction is too vigorous, and the superficial skin rubbed off; troublesome after consequences may result in the form of superficial sores difficult to heal. Friction with snow is a time-honoured remedy, but apt to damage the part and favour the formation of blisters. The hand or foot may be immersed in cold water, of which the temperature is only to be raised very gradually indeed to a warmth of 50 to 60° F. 

Avoid, especially, warming the affected parts at the fire, or placing them in contact with hot bottles. After rubbing, wrap up the frost-bitten part loosely in cotton-wool. A more severe degree of frost-bite is associated with the formation of blisters after a few days. Here the after-consequences may be serious as regards the frost-bitten extremities. The blisters may be pricked and the fluid gently pressed out. 

It is often impossible in the early stages to judge of the extent of frost-bite. After a severe frost-bite complete sensation will often not return for weeks or months. On the other hand, a part that appears gravely frost-bitten will frequently recover entirely, or perhaps with the loss of a nail or two, after days or weeks. 

The most profound stage of frost-bite is a complete freezing or stiffening of the whole body. The sufferer loses consciousness and falls into a state of suspended animation. This third degree is especially likely to occur when a man is overcome by fatigue and cold and lies down. The most gradual raising of the temperature must be resorted to. 

Gentle friction of the limbs towards the heart may be made for several hours. Artificial respiration (and every traveller should learn how to perform artificial respiration) may be necessary. A common error is to make the movements too quickly. Fifteen movements per minute is about the right number. So long as there is the slightest trace of heart-beat the efforts should be continued. 

If the frost-bitten parts become very painful as they recover vitality, it is a sign that the warmth has been applied too rapidly, and they may then be wrapped in cloths dipped in cold water. In applying any remedies to a hand that has been attacked, take care not to make any pressure on the sides or webs of the fingers. Such pressure is very likely to be made if the fingers are wrapped up separately and a bandage placed over the whole hand. 

The fingers and toes and tips of the ears are most liable to frost-bite. The point of the nose may be attacked. Tight boots especially favour frost-bite of the feet. Cold wind and moist cold are the most to be dreaded. In still dry air there is much less likelihood of the trouble. It is essential, therefore, to keep dry the parts that are likely to be attacked. 

The utmost attention must be given for days afterwards to any part that has been attacked by even the mildest degree of frost-bite. In mountaineering, the fingers are more often affected than any other part, especially after climbing on rocks in bad weather. 

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).

Thursday, December 17, 2020

“Mountaineering and health” (8)

"Proper snow spectacles are the most efficient preventive"
Photo courtesy of the American Alpine Club library (via Flickr)

Advice from a mountaineering medic of the silver age

Snow-blindness is a more serious affection. The commonest form is essentially an ophthalmia-that is to say, inflammation of the mucous covering of the eye and inner lining of the eyelids. The eyes become greatly bloodshot and very sensitive to light;there is a free watery discharge which gums the margins of the eyelids together; the slightest endeavour to use the eyes causes a copious flow of tears. The trouble usually subsides after a day or two, though sometimes the eyes remain weak and sensitive for days, or even for months.

A more serious form of snow-blindness is an affection of the deeper parts of the eye. Here there is much less superficial inflammation, but extreme intolerance of light. The symptoms are much graver and the effects pass away much more slowly. Both forms are tolerably familiar to those engaged in electric lighting work. 

As in the case of sunburn, vaporous misty days do not render the mountaineer exempt from snow-blindness. Proper snow spectacles are most efficient preventives. They should be put on before the glare begins to be felt. 

A five per cent solution of cocaine dissolved in rose-water, and with a little boric acid added, acts like a charm in snow-ophthalmia. It is not easy, unless the right method is adopted, to introduce the fluid into the eye, for directly the lids are separated a gush of tears ensues and washes out all the lotion. The sufferer should be directed to lie down with the back of his head to the light and with the eyes closed; a few drops of the solution are then poured into the little depression which is above the inner angle of the eyelids by the side of the nose. 

If the eye is then covered, and the sufferer directed to blink the lids a few times the fluid will be drawn in. Cold compresses give a good deal of relief. For the more serious snow-blindness, prolonged rest of the eye is really the only means of cure.

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).

Wednesday, December 16, 2020

“Mountaineering and health” (7)

"Lady mountaineers are especially concerned...."
Sun protection as modelled by Mrs Main on Piz Morteratsch, c.1880s

Alpinistic advice from a mountaineering medic of the silver age

The inflammation of the exposed parts of the skin consequent on the intensity of the sun's rays is a very familiar trouble. The affection is essentially the same as that experienced in milder degrees by those who work with intense electric illuminants, or are exposed much to the sun's rays reflected off water. 

In the case of arc electric lights, the direct rays set up the trouble, but on snow the rays reflected from the surface are the chief agents. A strong cold wind aggravates the trouble by producing dryness of the skin. Freshly fallen snow at great elevations is the most powerful reflector of the irritant rays. It seems probable that the effect is produced largely by the 'chemical ' rays. 

The burning is felt at the time to some extent, but the worst of the discomfort comes on after a few hours, often at night. Fair people suffer more than than the dark-complexioned. Sometimes a considerable degree of inflammation is set up. A tolerably acute condition of eczema may be produced if adequate precautions are not taken.

The cracks and blisters that ensue are not only painful, but rather unsightly, and in the Alps, at any rate, mountaineers should, from motives of regard for others' feelings if not for their own comfort, take measures to mitigate sunburn. Lady mountaineers are especially concerned, for the effects, like those of tattoo marks, may be somewhat permanent, and have to be repented of at leisure. 

A convenient and efficient application is 'Toilet Lanoline,' which can be purchased in small tubes. A little of this smeared from time to time on the parts most likely to be affected will prevent any trouble. The application should be renewed every two or three hours. Cold cream or zinc ointment is recommended by some, and answers almost as well. Glycerine is useless. 

Whatever is used should be employed as a preventive. The effect of powdering the face with starch-powder over some ointment renders the mountaineer rather like a 'Pierrot,' but is extremely efficient. Professor Mosso advises blackening the face with burnt cork. Undoubtedly a thin layer of soot is the most efficient preventive, but in the much frequented Alps the method is unlikely to meet with favour. 

Vaseline or grease will remove the burnt cork. Red veils, for the reasons already pointed out, will prove more efficient than green or blue. A very thin red veil will answer better than a thick blue one. 

The skin may be as severely burnt on a foggy, cloudy day, as when the air is clear. For, as pointed out by Professor Bonney, a very large portion of the light which reaches us does not come directly from the sun, but is reflected to us by the vapours of the atmosphere. 

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).


"Mountaineering and health" (6)

Alpinistic advice from a mountaineering medic of the silver age

The special discomforts to which mountaineers are subject are sore feet, sunburn, snow-blindness, and frost-bite. Under certain conditions, marked symptoms due to the rarity of the air occur which are spoken of, collectively, as 'mountain sickness'. 

The utmost care should be taken to prevent abrasions or blisters on the feet. Hints on this subject will be found elsewhere in this volume. Bathing the feet in a solution of alum hardens the skin. 

Soaping or greasing the stockings is an efficacious but unpleasant preventive. A small abrasion can be held in check by covering with gold beater skin or oiled silk painted red with collodion so as to adhere to the skin. 

A corn plaster judiciously applied prevents rubbing. If abrasions form, they are best treated by the application of mild boracic ointment thickly spread on a piece of clean lint. If blisters form, do not be in a hurry to puncture them When the fluid has escaped, the surface skin is easily rubbed off, and a sore results. In 48 hours or less, a new cuticle will have formed underneath, and the uplifted surface skin can be cut away without smarting being caused. 

The domestic practice of drawing a thread through the blister is bad. If matter forms in the blister, a red raised ring will form round it and the part will throb and become painful. The blister should then be pricked or cut at one edge and the matter let out. Blisters containing blood are dark. They are best treated in the same way as those containing clear fluid.

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).

Tuesday, December 15, 2020

“Mountaineering and health” (5)


Alpinistic advice from a mountaineering medic of the silver age

There is no need to carry much of a medicine-chest, and the drugs taken should be such as are simple and whose action is understood. The modern tendency to the rather indiscriminate use of powerful remedies is to be deprecated unless the traveller has some medical knowledge and experience. 

Many of these fashionable preparations are very depressing, and their precise action is imperfectly understood. The less in fact that people under the special conditions of travel and climbing practise as amateur physicians on themselves the better. A few simple surgical wrinkles and methods may be advantageously learned. Books may suggest what these should be, but books cannot teach how they should be practised properly. 

For the mild diarrhoea that often attacks mountain travellers chlorodyne is in most cases a simple and efficient remedy, but it does not suit all. It is best taken in small doses of ten or fifteen drops, repeated two or three times at intervals of an hour. The heartburn that often occurs at night after a long walk can be controlled by bicarbonate of soda lozenges. 

It is always unwise to start early in the morning on a perfectly empty stomach. When solid food is distasteful, milk, if procurable, will carry a traveller a long way. Some take a flask of rum with them, and a few drops of this in the milk is perhaps less objectionable before an ascent than any other spirit: rum is a strong respiratory stimulant. 

Warm food is best: tins of chocolate and milk can be bought which form an excellent breakfast. It is well always to carry some chocolate in the pocket. Kola chocolate or biscuits answer well.

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).

Monday, December 14, 2020

“Mountaineering and health” (4)


Advice from a mountaineering medic of the silver age

Fatigue is a condition that the mountaineer cannot wholly escape. To a great extent he can prepare himself by carefully regulating his pace and the length of his expeditions, allowing due intervals of rest, until he has brought himself into good condition. Without entering into any physiological details, it may be pointed out that fatigue is a complex condition involving something more than the mere tiring of the muscles. 

Ordinary walking is an action so familiar that it becomes automatic, and the mind is not conscious of making any effort; but directly extra work is entailed, as in walking up hill or climbing, or wading through deep snow, the automatic mechanism ceases to be sufficient, and an effort has to be made; the will, in short, has to be called in to stimulate the muscles to do their work. 

At first the mind simply becomes conscious of the muscles; later on this consciousness amounts to discomfort, and then to a sensation of pain. In other words, the unduly exerted muscle becomes recognised and the tired muscle becomes painful. Additional exertion, that is, additional will power-is required to overcome the sensation and to stimulate the activity. This expenditure of energy involves waste, and in a measure explains fatigue. 

That the mental factor is a strong element may be seen any day on the mountain-side. A man who seems utterly tired out, if placed in sudden peril or confronted with something unexpected, becomes immediately capable of great exertion. 

The practical outcome is that the keen and determined men are able to make their muscles do more work than the apathetic, and the men who on the mountainside find constant employment for their minds, whether in attending to the details of the route, enjoying the beauties of the scenery, or in pursuing some scientific aim, will go better than those who treat a mountain as a treadmill.

The expenditure of energy has to be made good in two ways – by taking in oxygen through the lungs, and by the ingestion of food. The natural inclination of the tired man is to stimulants, or at any rate to drink, for fluids are rapidly absorbed, and relief, therefore, is brought about more quickly. Unfortunately, the benefit is only transitory. 

The great point with a tired man is to feed him. When you have a weak man in the party, it is well to feed him early, while he can still eat, and feed him often. If a man is utterly tired out, it is better to let him rest till he can eat, however little, than to attempt to stimulate that which is incapable of response. 

One of the worst possible things to give a man when in this condition is brandy, though it seems to be considered a universal panacea. A little champagne, however, will often provoke an appetite in an exhausted man. Thirty to sixty drops of 'sal volatile' in a little water answers almost equally well. 

It cannot be expected that the digestive powers will be in perfect order after severe exertion, and the traveller who arrives at an inn somewhat tired, at night, will do best to take very light food and abstain from wine altogether. When the entire body is in need of rest before anything else, it is injudicious to throw on it the labour of digesting a heavy meal. 

On the other hand, if no food at all be taken, that best of restoratives, sleep, will keep aloof. Weak tea for those who can take it, or soup of not too rich a nature (and many of the tinned soups are extremely rich), will probably prove more efficient in inducing sleep than a meal of meat. Hot bread and milk is an excellent light supper.

Many of the slight intestinal derangements that travellers in the mountains experience might be obviated by the adoption of simple precautions. The chilling due to rapid evaporation from the surface of the skin is one of the commonest causes of these troubles. 

From anatomical reasons, chill of the surface of the abdomen provokes very directly derangements of the viscera beneath. There is no better preventive of trouble than a cholera-belt. Immediately on arriving at an hotel after a walk, it is wise to bathe in tepid water and to change the damp clothes. If at a bivouac or hut, a vigorous dry rub, with a change at least of flannel shirt and stockings, will serve almost as well.

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).
 

Sunday, December 13, 2020

“Mountaineering and health” (3)


Advice from a mountaineering medic of the silver age

A certain amount of time is required to enable anyone to accustom himself to change of diet and surroundings. The diminution of atmospherical pressure, too, exerts a sensible, although perhaps not much recognised, effect even at elevations of six or seven thousand feet. The matter of diet may be almost summed up in the advice to get the very best you can and to take as much of it as you feel inclined, and this applies to actual climbing as well as to life in valleys. 

The question of alcohol or no alcohol has of course been debated warmly with regard to mountaineering. On the whole, the less taken on mountain expeditions the better, particularly in ascending. 

The majority of the Swiss guides, it is true, do not abjure wine when engaged in their work, especially when it is provided for them free of cost; but then they are in their own country, and accustomed to the native wines from their youth up. Many guides hold to the tradition that on the mountains white wine is bad, inasmuch as it 'cuts the legs.' 

Each one must find out the kind of drink that suits him best, and it need only be noted that in case of fatigue alcoholic stimulants do harm rather than good, and that the thin and sour bottled mixtures which do duty as wine in Alpine resorts are more prone to derange the digestion than to restore strength. 

There is a prejudice in the minds of some against drinking glacier water. It is of course unwise, when much heated, to drink largely of any cold water just before a rest; but while on the march water-drinking, in moderation, will not do the slightest harm. 

The water from the glacier pools is particularly good. Streams coming from melted snow patches need not be avoided unless in trickling over the surface the water has acquired some ingredients injurious to health. This will not be the case in high regions. 

It will be prudent to abstain from drinking water that courses near chalets or in the neighbourhood of herds of cattle. It is best to avoid water when any nettles are seen growing close by the stream. In the valleys, and especially in the villages, of countries such as the Caucasus, it is not wise to trust the water even when it has been filtered. All doubtful water should be boiled before drinking.

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).