The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man's land" with love for art, nature, and humankind.

The anterior petrosal approach, or Kawase's approach, is a commonly used technique in skull base surgery to access the brainstem in the posterior fossa from the middle fossa, and has the advantages of minimizing brain retraction and preserving hearing. It was first successfully performed by the legendary Japanese neurosurgeon, Takeshi Kawase, for the clipping of a basilar artery aneurysm in 1981. To date, no historical article has shed light on Kawase's intriguing personal history. In this historical vignette, the authors depict Kawase's unique background, talent, passion, as well as struggles that ultimately shaped his career. By sharing Kawase's personal story from the hospital where he first successfully performed his original approach, the authors hope to pass on to future generations Kawase's spirit and philosophy that have impacted the global neurosurgical community.

The Death Zone: Lessons from History.

This Lessons from History article about the naming of the extreme altitude "Death Zone" explores the historical mountaineering and medical literature relevant to the topic. Swiss alpinist and radiologist Edouard Wyss-Dunant (1897-1983) authored several reports and books about expeditions to arctic regions, deserts, and the Himalaya. Encouraged by the success of a Swiss expedition to the Garhwal Himalaya in 1947, Wyss-Dunant joined his fellow climbers from Geneva on a 1949 expedition to several peaks in the Kanchenjunga region. Wyss-Dunant was then invited to lead the spring 1952 Swiss Everest expedition. Despite this being the first Swiss attempt on Everest and on an untried route, Raymond Lambert and Tenzing Norgay nearly summitted Everest from the Nepal side. Wyss-Dunant earned mountaineering immortality by coining the phrase the Death Zone during the expedition's foray into the upper regions of Everest. Wyss-Dunant went on to become a president of the Swiss Alpine Club and the International Climbing and Mountaineering Federation. His writings and that of others provide an evocative supporting narrative to illustrate some of the problems of living (or dying) at extreme altitude.

Stanhope Speer, Physician and Alpinist: In 1853, First to Describe Mountain Sickness?

In 1853, Stanhope Templeman Speer published a two-part paper in The Association Medical Journal on Mountain Sickness. Speer was a physician who had worked at the Brompton Hospital for Chest Diseases in London and had been Professor of Medicine in Dublin. He was also an Alpine climber and had made the first ascent of one of the Wetterhorn peaks. His article ran to ten and a half pages in the Journal and to 50 pages in a reprint. It consists of anecdotal accounts of symptoms suffered at altitude from the literature and from his own experiences in the European Alps. He asks three pertinent questions. Is there a condition of mountain sickness? Are these symptoms felt by all persons alike and at the same height? What are the causes, and whence the explanation of such phenomena? In the course of the article, he answers the first two questions but, like us, 162 years later, is unable to answer the third. This article seeks to present Speer's original work and such facts about his life as I have been able to discover.

[POLISH EXPEDITION TO SPITSBERGEN IN 1934]. / POLSKA WYPRAWA NA SPITSBERGEN W 1934 ROKU.

Polish expedition to Spitsbergen in 1934 was already the second Polish polar expedition to the Arctic. It was scientific-mountaineering in character. 7 persons took part in it: Witold Biernawski (1898-1957)--film-maker and radiotelegraph operator, Stefan Bernadzikiewicz (1907-1939)--expedition leader, Henryk Mogilnicki (1906-1999)--photographer and radiotelegraph operator, Stefan Zbigniew Rózycki (1906-1988)--geologist, Stanislaw Siedlecki (1912-2002)--meteorological observer, Sylweriusz Bohdan Zagrajski (1892-1940)--triangulator, Antoni Rogal-Zawadzki (1896-1974)--topographer and photogrammetrist. The purpose of this expedition was to collect data in geology and cartography, and to a lesser degree--in glaciology, botany, zoology and meteorology. It lasted from May 20 to September 16, 1934. The time between June 20 - August 28 the group spent on Spitsbergen's Torell Land. The outcome: an area of app. 300 square kilometres of previously undiscovered land was marked by triangular system, covered by photogrammetric photos and surveyed. Geological research covered the land of app. 500 square kilometres and the group collected geological specimens of app. 800 kg in weight. On the basis of their research, two maps (at a scale of 1:50 000 and 1:200 000) were published. The participants collected also botanical and zoological material. Meteorological observations were carried out at the base over Van Keulen fjord throughout the whole expedition. Different objects on Torell Land were named by the expedition, their names referring largely to Poland (Annex I). Approximately 200 photographs and a film were shot by the expedition. Apart from scientific research, the participants published also diaries of the expedition.

THE HIGH-ALTITUDE RESEARCH OF MABEL PUREFOY FITZGERALD, 1911-13.

Home schooled without a science education, Mabel Purefoy FitzGerald (1872-1973) attended physiology lectures at Oxford in 1897, even though the school was closed to women. She found work as a researcher, published early noted papers and earned the active respect and support of senior scientists of her day. Her laboratory work with the physiologist J. S. Haldane saw her invited to the join the Pikes Peak Expedition in 1911. While the male team members measured the physiological effects of long-term residency at 14101 feet, as the sole woman FitzGerald took measurements of haemoglobin and alveolar air from herself and from mining staff and families at altitudes from 6000 to 12500 feet, travelling to remote mining communities in the Colorado Rockies. A subsequent expedition collected data at lower altitudes. Recorded in two papers, the results presented pioneering evidence of the role of oxygen in breathing.

Dull Brains, Mountaineers, and Mosso: Hypoxic Words from on High.

Dull and hypoxic brains have been a frequent subject in the medical and mountaineering literature. Deterioration of cognitive and other neurological function occurs at high altitude, with or without high altitude cerebral edema. This historical essay explores a 2014 first-ever English translation of cerebral blood flow studies by nineteenth century physiologist Angelo Mosso. Some of the medical history and physiology of brain function is discussed, but much of the style focuses on quotations from the writings of mountaineers and mountaineering physicians to provide color commentary about dull brains at high altitude.

Mountaineering, Masculinity, and the Male Body in Mid-Victorian Britain.

Golden-age mountaineers attempted to codify gender, like flora and fauna, by altitude. They zoned the high Alps masculine. As women also reached into the highest regions, male alpinists increasingly turned to their bodies, and the bodies of their guides, to give scientific validity to their all-male preserve. Edward Whymper traveled to the Andes in 1879, where he transformed Chimborazo into a laboratory and his own body and those of his guides into scientific objects. His work helped spearhead a field-based, vertical approach to human physiology that proliferated after the turn of the century. By viewing gender through a spatial lens and using the sides of mountains to map it, this essay highlights the gendered notions that directed early research in high-altitude physiology.

Dilated hearts at high altitude: words from on high.

From the time of the turn of the twentieth century, dilated hearts and presumed cardiac fatigue in expeditionary climbers and scientists have been the subject of much commentary in the medical and mountaineering literature. Although largely attributed by most, but not all, to left heart strain, the description of dilated hearts in these accounts is clearly that of right heart dilation as a consequence of high and sustained hypoxic pulmonary vasoconstriction with hypertensive remodeling. This essay will feature quotations from the writings of high altitude pioneers about dilated, strained, or enlarged hearts. It will give some brief physiology of the right side of the heart as background, but will focus on the words of mountaineers and mountaineering physicians as color commentary.

Extreme altitude: words from on high.

Medical science has its own objective language for describing the effects of high altitude. Mountaineers' words and metaphors tell the story with subjectivity and feeling. This essay will include only limited physiology about lowlanders and high altitude. Instead, the focus will be literary, using the quotations of 20th-century mountaineers and mountaineer physicians to provide color commentary about the hardship. These are Words From on High.

The physiology of extremes: Ancel Keys and the International High Altitude Expedition of 1935.

This article examines the International High Altitude Expedition of 1935 and its significance in the life and science of Ancel Keys. Both the expedition and Keys's story afford excellent opportunities to explore the growing reach of interwar physiology into extreme climates-whether built or natural. As IHAE scientists assessed human performance and adaptation to hypoxia, low barometric pressure, and cold, they not only illuminated the physiological and psychological processes of high altitude acclimatization, but they also drew borderlines between the normal and the pathological, paved the way for the neocolonial exploitation of natural and human resources in Latin America, and pioneered field methods in physiology that were adapted and adopted by the Allied Forces during the Second World War. This case study in the physiology of place reveals the power and persistence of environmental determinism within biomedicine well into the twentieth century.

Because it's there The education of George Mallory.

Initiative, creativity, and resolve represent both the pillars of the Wilderness Medical Society (WMS) and the story of George Mallory. His journey from humble beginnings to his rise to become one of history's most legendary mountaineers is a testament to the impact of great mentors as well as the development of Mallory as a mentor himself. In this light, the path of George Mallory in mountaineering and the role of WMS in wilderness medicine share a common theme. This essay is not only a tribute to George Mallory but also a testament to the importance of mentorship and the role of WMS in inspiring mentorship and education to future pioneers.

Medicines, travellers and the introduction and spread of 'modern' medicine in the Mt Everest region of Nepal.

The significant contribution of medicines in the introduction and spread of 'modern' medicine has, with the exception of vaccination, been neglected in historical studies, yet medicines have been a significant factor in people's experiences of sickness and in their use and non-use of health services. Although medicines are implicitly acknowledged in the literature as important in the provision of healthcare, this article uses a case study of the Mt Everest region of Nepal during the second half of the twentieth century to argue that medicines have had an explicit and central role in the introduction and spread of modern medicine in this region. It also highlights the importance of travellers in the process. While this article focuses on biomedical products, modern medicine, as elsewhere in the wider Himalayan region, continued to be practised within a changing but plural medical environment. The first part of the article discusses medicines and travellers who, in the absence of biomedical services, were the main source of medicines prior to the mid-1960s, while the second part considers medicines and Khunde Hospital, which was built in 1966 by the area's most famous overseas traveller and became not only the area's main provider of modern health services but also the main source of medicines.

Raymond Greene: physician, mountaineer, and raconteur.

C. Raymond Greene (1901-1982) was a man of many talents. After graduating from medical school in 1927, he spent a decade in general practice. He subsequently became heavily involved in the emerging specialty of endocrinology and went on to gain considerable recognition in the treatment of thyroid disorders before eventually becoming involved in the world of medical publishing. Aside from Greene's mainstream vocational and intellectual pursuits, from boyhood he nurtured a passionate interest in mountaineering--first in his native Great Britain, and then the European Alps, and ultimately in the high Himalayas. His involvement in landmark climbs, such as the successful Kamet venture in 1931 and Everest attempt in 1933, earned him a place in the pantheon of Himalayan explorers and mountaineers and stimulated Green's interest in high altitude physiology and medicine. He made notable additions to the literature on this subject in publications such as Nature and Journal of Physiology. Apart from his remarkable life achievements in the areas of medicine, mountaineering, and publishing, Greene was perhaps best remembered by those close to him (and by contemporary readers who are devotees of his writing) as a peerless storyteller with a sardonic sense of irony.