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High altitude medicine and physiology.
  1. Fred Macsorley
  1. The Church Walk Surgery, 28 Church Walk Lurgan, Co Armagh BT67 9AA, N Ireland

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“We have tried to strike a balance between being too academic on the one hand and competing with the pocket guides on high altitude emergencies on the other” proclaim Michael Ward, James Milledge, and John West, three internationally respected authors on the subject of high altitude medicine. Their third edition is an attractively covered book, its suprising weight giving suitable notice of the serious reading within.

Each chapter starts sensibly with a list of contents followed by a carefully worded summary. I found this increasingly useful as the majority of text favours the clinical specialist and high altitude physiologist. By chapter six I was struggling with M = (PA−PV)Qá(1−e−D/Qá). Those of you who recognise this as relating to the total transfer of a gas will be at one with this book. I suspect the majority of readers will silently thank the authors for providing those chapter summaries.

In the midst of this text I could sense John West's influence predominate, with the profusion of scientific tables and graphs sprinkled with references to the pioneers of high altitude physiology, and it was in these scientific chapters that the authors seemed most at ease. As a GP with an interest in mountain rescue, I found the latter third of the book much more relevant. The conditions of high altitude pulmonary oedema and cerebral oedema (HAPE and HACE), hypothermia, exhaustion, and fatigue are covered in workable detail, and there is useful information on how clinical conditions such as diabetes, COPD, and IHD are affected by high altitude.

So have the authors succeeded in their aim? On balance this is of more interest to the research scientist or high altitude specialist rather than readers like myself. There are cheaper (much) books that cover the clinical aspects at least as well, but none so logically laid out, beautifully presented, or as thoroughly researched (I counted 1557 references!). One for the serious high altitude buff who won't even see the price tag.