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High-altitude medicine
SFAR in the service of scientific research

Excerpt from: Swiss Foundation for Alpine Research, 1939 to 1970. Published in Zurich in 1972

High-altitude physiology and investigations into the effects of long-term stress on mountain climbers and participants in expeditions

 

Even in the first few years of its activities, the Foundation for Alpine Research was concerned with the problems of high-altitude physiology. Suitable oxygen equipment had to be developed so that mountaineers could venture into the eight-thousand-metre mountains. This technical task was completed step-by-step, by exchanging knowledge on an international level.

 

The first individual work can be traced back to Dr. med. Edouard Wyss-Dunant. Later on, Jürg Marmet from the Foundation for Alpine Research won international recognition as an expert on oxygen problems. He had studied chemistry at the ETH (the Swiss Federal Institute of Technology) and was subsequently employed at the Employment Physiology Institute at the ETH, before moving into private business.

 

Jürg Marmet acted as a mountain guide in the Baffinland Expedition in 1953, under Col. P.D. Baird, as reported in an article about this subject in Mountains of the World, Vol. IX, 1954. As part of the scientific programme, he carried out basic metabolic rate measurements under field conditions on other participants in the expedition. The diary of one of his test subjects records that these measurements were not particularly highly regarded, since they forced their victims to live off nothing but carbohydrates for 24 hours.

 

Jürg Marmet worked carefully through all the questions relating to the physiology of breathing. In doing this, he acquired the expertise that gave him the basis for successful development of oxygen equipment for ascents to greater heights. Not least, his preliminary scientific/technical work contributed to the success of the 1956 Everest-Lhotse Expedition. Jürg Marmet climbed the summit of Mount Everest as a participant in this expedition.

 

Where Marmet’s professional interests mainly centred around the problems associated with oxygen supply at high altitude, expedition doctors Eduard Leuthold and Georges Hartmann were concerned with a much broader range of medical and sports-physiological matters related to mountaineering. Their investigations cast light on the subject of the human ability to cope in extreme conditions in the widest sense. They posed the question about the physical and psychological limits of human beings subjected to unusual long-term stress, and thus contributed to the assessment of an expedition’s health risks.

 

Eduard Leuthold took part as expedition doctor in the 1956 Everest Expedition. In 1961, he participated as the doctor in the Axel-Heiberg Expedition from McGill University in Montreal, under the leadership of Prof. Fritz Müller. Later, he went to Yemen, the Middle East and Biafra, as a member of the ICRC medical missions. On the Everest Expedition in 1956, he worked on work-related physiological problems on behalf of Prof. Alex. von Muralt, Bern, with particular emphasis on the behaviour of the pulse and blood pressure under stress at high altitude. This work was continued at the Institute of Flight Medicine, Dübendorf, and finally published as a dissertation. In his own, objective way, Eduard Leuthold sifted critically through the specialist medical literature relating to any questions that bore upon the business of expeditions. Based on personal experience, he recognised the practical limits placed upon medical research activities under the extreme external conditions of a Himalayan or Arctic Expedition. His reservations with regard to special medical investigations within the framework of mountaineering or scientific expeditions, where the results are hardly ever worth the financial cost, paved the way for the preparations for the “high performance test” in March 1969.

 

Dr. Georges Hartmann went to Nepal on behalf of the ICRC for 4.5 months in 1961, and carried out most of his work in the high valleys of the Himalayas. In 1965, he took part as doctor in the Swiss Cordillera Bianca Expedition, for which the Foundation had taken on the role of Patron. In 1969, he led the Swiss expedition to Tukuche Peak in Nepal (Mountains of the World, Vol. XVII, 1968/69). As a doctor, he was interested in matters of general prophylaxis against accidents, and was particularly fascinated by problems of nutrition, metabolism and water balance under the extreme conditions experienced by mountaineers during long-term stress in the high mountains. He recognised the significance of the provision of liquids for retention of the ability to perform. High water loss levels at the beginning of strenuous mountain treks can set off a whole chain of physical and psychological reactions that interact closely to produce a state of exhaustion, with a massively increased risk of injury.

 

The experiences of both Dr. Leuthold and Dr. Hartmann prompted us to carry out an internal study of the ability to cope in expedition mountaineers. Analysis of original reports and the personal statements of participants in unsuccessful expeditions exposed the high risks associated with crises of exhaustion. Blunted senses, impairment of the ability to judge, a tendency towards aggressive outbursts or depressive moods, and a collapse of the sense of responsibility and self-criticism are all dangerous symptoms of an advanced state of exhaustion, which all too often preceded an accident in the expedition. The results of this analysis led to the preparation of an Alpine high-performance test, which was carried out in the Berner Oberland in March 1969.

 

A group of well-known mountaineers attempted to cross a ridge, 35 kilometres in length (from the Eiger to the Schilthorn) within 14 days in the high Alps in the winter (average height, 5500 m). At the suggestion of Toni Hiebeler, this Alpine expedition began with the ascent of the central ridge of the Eiger under extreme winter conditions. The traverse was followed by crossing the Mönch. After a short interim pause on the Jungfraujoch, the mountaineers carried on along the following route: Lauitor – Gletscherhorn – Gletscherjoch – Ebnefluh – Ebnefluhjoch, from where they – after 14 km – descended the Ebnefluh glacier and the Lötschenlücke into the Lötschental.

 

From the very beginning, this high-performance test was intended as an experiment to discover the performance limits of highly-trained mountain climbers. From the scientific viewpoint, the small number of participants meant that it was clear from the start that the whole enterprise should be regarded as a preliminary experiment to acquire test experience, and to establish the principles upon which to evaluate systematically-planned tests at a later date. The participants had a major say in the arrangements for provisions, the choice of equipment and the planning of the timetable. They were thoroughly examined (clinically and by laboratory tests) by a team of doctors in accordance with a programme co-ordinated by Dr. Hartmann, at the beginning and at the end of the test. They undertook to enter certain observations in a diary throughout the entire duration of the test; they noted their consumption of food and drink; they were expected to collect their own urine in containers and to hand them over to the supervising doctor at certain point en route. We secured the services of a psychologist in order to record the extremely important sociological adaptation processes that take place between the individual members of a mountaineering team on expedition. No-one was appointed as group leader, so that there were no external influences on the development of the group.

 

A group of experts under the leadership of Dr. Hartmann worked on the scientific evaluation of these tests.

 

Popular publications were issued, as well as scientific publication of the results. Toni Hiebeler wrote an account of his experiences in Alpinismus at the beginning of 1971. The photographer and mountain guide from Arosa, Ruedi Hornberger, had accompanied the mountaineers on their strenuous journey, and made a colour film to inform the general public about the enterprise.

 

This high-performance test brought together important elements of the traditional activities of the Foundation for Alpine Research in one single project. It aimed to make use of its experience of expeditions to provide certain stimuli for  research into sports medicine, and to awaken the interest of a wider circle through specialist and general publications.

Swiss Foundation for Alpine Research . Schweizerische Stiftung für Alpine Forschung . Fondation Suisse pour Recherches Alpines . Fondazione Svizzera per Ricerche Alpine
SFAR . SSAF . FSRA . FSRA