"The Great Silk Road" and the First Description of Hypoxia.

The first written reports about the effect of high-altitude air on the human organism in Ancient China (the 30s BC) and in South America during the conquest (late XVI century) are discussed in this paper.

British medicine in the Peruvian Andes: the travels of Archibald Smith M.D. (1820-1870)

This article traces the travels of the Scottish physician Archibald Smith through the Peruvian Andes between the 1820s and 1860s. Despite his prominent role in the nineteenth-century Peruvian medical scene, almost nothing has been written on Archibald Smith. By exploring Smith's medical activities, publications, and debates, this article intends to uncover unexplored areas of Peruvian medical history, such as the animosity between local and foreign physicians during the post-Independence war era and the important role played by medical geography as a scientific discipline for redefining ethnical and regional issues.

O presente artigo traça a vida e obra do médico escocês Archibald Smith durante sua permanência no Peru, entre as décadas de 1820 e 1860. Apesar de sua proeminente contribuição para a medicina peruana, quase nada foi escrito sobre Archibald Smith. Através da investigação das atividades, publicações e debates de que Smith participou, o artigo pretende desvendar áreas inexploradas da história da medicina no Peru, tais como a animosidade entre os médicos locais e estrangeiros no pós-guerra de independência e o papel importante da geografia médica como disciplina científica que redefine questões étnicas e regionais.

La investigación en medicina de la altura en Bolivia, reseña histórica / Research in altitude medicine in Bolivia, outlines historical

Todos los profesionales en salud de los centros poblados del altiplano, ciudades y especialmente centros mineros situados en la cordillera, intuyen la necesidad de un conocimiento, asi sea básico, de los procesos normales y patológicos en los que influye la menor presión de oxígeno ambiental, (PIO2), sobre los sistemas del organismo humano.

Historia del conocimiento de la enfermedad aguda y subaguda de la altura en Bolivia / History of the knowledge of the acute and subacute disease of the height in Bolivia

Parece importante dejar en claro que esta comunicación no pretende dar a conocer estudios de investigación ni los aportes al conocimiento de la problemática en salud de la población que vive en la altura o mejor en las grandes alturas porque su prósito es señalar lo que se hizo en el área del llamado Alto Perú, parte del Virreinato de Lima o después de La Plata en la Colonia, o en la República con referencia al conocimiento de las enfermedades.

Prelude to Everest: Alexander M. Kellas and the 1920 high altitude scientific expedition to Kamet.

Following his untimely death due to illness during the early stages of the first Mount Everest Reconnaissance Expedition in 1921, Alexander M. Kellas has received relatively little attention in either mountaineering or scientific literature. He remains an obscure figure despite his noteworthy contributions to high altitude physiology and exploration. He can be considered not only one of the finest exploratory Himalayan mountaineers in history, but also the first person to apply state-of-the-art knowledge of high altitude physiology to field investigations at altitudes over 6000 m. By the time of his death, it is extremely likely that Kellas had spent more time above 6000 m than anyone on Earth, undertaking no fewer than eight Himalayan expeditions between 1907 and 1921. This article revisits and examines in some detail the most ambitious high altitude physiological field study undertaken through the second decade of the 20th century, A. M. Kellas and Henry T. Morshead's 1920 Kamet Expedition. This undertaking by Kellas and Morshead was unique because it specifically emphasized investigation of the practical difficulties inherent in climbing at very high altitudes. During this endeavor, Kellas carried out the first rigorous tests of the value of supplementary oxygen for climbing at high altitude. The results of the field studies conducted during the 1920 Kamet Expedition provided strong support for the use of supplementary oxygen at high altitude. However, after Kellas died on the approach march to Everest the following year, the British mountaineering establishment did not again have a similar proponent or exponent of extreme altitude field research until physiologist Griffith Pugh once again took up the challenge in the early 1950s.

Daniel Vergara Lope and Carlos Monge Medrano: two pioneers of high altitude medicine.

Daniel Vergara Lope from Mexico and Carlos Monge Medrano from Peru were brilliant scientists in their own countries. Both scientists studied high altitude physiology and defined the physiological and anatomical mechanisms of adaptation to high elevations. The Mexican physiologist proposed his ideas 40 years before his Peruvian counterpart. This paper studies the contribution of Vergara Lope and Monge Medrano to the understanding of high altitude medicine and proposes explanations of why history has given priority to Monge, whereas Vergara Lope is relegated to anonymity.

Herb Hultgren in Peru: what causes high altitude pulmonary edema?

Herbert Hultgren, a cardiologist who kept a careful diary all his career, arrived in Peru at the beginning of 1959 to study the occurrence of pulmonary hypertension in children at high altitude with patent ductus arteriosus. There, he was told about a strange condition, high altitude pulmonary edema (HAPE), and found that to Peruvian physicians looking after mine employees and their families, its occurrence was almost routine. With his Peruvian colleagues, Herb immediately began a systematic study of the condition, including catheter studies. Though the absence of left ventricular enlargement suggested a non-cardiac form of pulmonary edema, and though this is what he suggested in his first publication, in two subsequent papers, one written with Charles Houston, who contributed cases occurring in mountaineers, Herb wrote that the most probable cause was left ventricular failure. What is extraordinary is that before he finally submitted the two papers, he had certain knowledge that in one case of HAPE at least, left atrial pressure had been shown to be normal. Herb's contributions, then and later, to the elucidation of HAPE were enormous.

The Pariacaca or Tullujuto story: political realism?

The first documented description of acute altitude sickness was published by Father Acosta in 1590. Acosta described this sickness when he traveled through a pass across the Andean divide in central Peru near the mountain Pariacaca. Almost all the maps of modern Peru do not name this mountain. We present evidence that mountaineers who have climbed this mountain know it as Tullujuto. This change in name is the reason why physiologists have found it difficult to locate Acosta's route; consequently the altitude where Acosta experienced this sickness could not be determined until recently. Further, we speculate that political pressures in the late 18th century caused the place name of Pariacaca either to be obliterated or else to be changed to Tullujuto.

Acute mountain sickness: critical appraisal of the Pariacaca story and on-site study.

The physiological and medical literature on the description of acute mountain sickness by Father Acosta in the Peruvian Andes shows many historical misconceptions and clinical misinterpretations. A recent paper by Gilbert (1983) not only contains these traditional misinterpretations but also adds geographical errors in the description of the area where Acosta described his sufferings. In view of these facts the authors have made a review of the old and modern writings on the so called Pariacaca story and during an on-site visit to the area of Pariacaca have taken actual measurements of distances, altitudes and geographical locations which they hope will put this story in the context of historical and scientific objectivity.

The first documented description of mountain sickness: the Andean or Pariacaca story.

We describe here for the first time the actual route that Acosta took when he described mountain sickness so vividly in the sixteenth century. We have shown that when Acosta mentioned Pariacaca as the geographical site where he experienced high altitude sickness, this referred not only to the modern peak of Pariachaca, but to the snow covered mountains by this Cerro, and the Central Maritime Andean Range in Peru. In addition, the name Pariacaca also referred to a tambo or inn located on the plateau or Puno of Pariacaca. The location of this route has been obtained by locating primary descriptions on maps from the sixteenth to the eighteenth centuries. Using twentieth century maps, we have been able to identify the described sites along the road and the trail which still exists by them. In addition, using detailed topographical maps, an altitude profile of the trail was obtained. The maximum altitude on this trail or old road reached 4800 m (15750 ft), about the same elevation as the summit of Mt. Blanc, the highest mountain in western Europe.