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Tell me some stories about yesterday
Journal of Wilderness Medicine 4, 14-16 (1993)
EDITORIAL
T ell me some stories about yesterday For most of us it's only as we get older that we appreciate history. Since there's not much to look forward to, we elders tend t9 look back. We quote Coleridge, "The lessons of the past illuminate the future", and smugly tell our juniors that, "Those who ignore the past will screw up the future". The young should also heed Santayana; "We mu~t welcome the future, remembering that soon it will be the past, and we must respect the past, remembering that once it was all that was humanly possible". There have been a few moments in time when something new happened, moments when someone suddenly saw a new dimension, was struck by a new idea, and took a giant step forward in understanding the human body. Sometimes such moments stretched into days, weeks or months. Others came in a rush during a period of only a few years. Still others must have happened during a moment of inspiration, such as that night in 1865 when Kekule visualized the benzene ring. We can imagine that one day, 2000 or more years ago, some miner deep underground noticed that his candle flickered and went out when he began to feel faint. Though he did not realize the momentous nature of this observation, he had made the first connection between oxygen, combustion and life. Many centuries would pass before this connection was appreciated. When Aristotle compared the weight of an empty leather bladder against its weight when filled with air, he concluded that air - like everything else - had weight. But he failed to recognize what this great moment implied. Aristotle also did not fully understand the human circulation; he taught that there were two separate systems which did not connect, and postulated that some venous and arterial blood mingled through tiny pores between the ventricles. Five centuries later, Galen repeated Aristotle's error, which persisted for another thousand years. Not until 1540 was it challenged by Servetus, who recognized that all the blood passed through the lungs; he was burned at the stake for this heresy. It was yet another hundred years before Harvey, building on observations of his predecessors, accurately described the circulation of the blood. Although Ibn-al-Nafis, Colombo, and Servetus laid the groundword for Harvey; they are almost forgotten. Later, 1500 years after Aristotle, Beeckman realized what the master had missed; in his doctoral thesis, he defied his elders and wrote that air pressed upon us as water does upon a fish. He was ostracized by his peers for his genius. Beeckman's famous contemporaries, Descartes and Galileo, stuck with Aristotle, while a young Italian lawyer, Gaspar Berti, filled a tall lead pipe with water and sealed the top to prove that a vacuum could exist - thus making the first crude barometer. Torricelli had the wit to use mercury in place of water for a prototype of the modern barometer. We honor his name when we use 'torr'; Berti is forgotten. 0953-9859 © 1993 Chapman & Hall
Editorial
15
Soon, Florin Perier carried two barometers up a small mountain and showed that atmospheric pressure decreased with altitude. He too has been forgotten, overshadowed by his cousin Pascal, who publicized the event. These great advances happened during a few decades of the 17th Century, despite war, disease and famine that killed a quarter of Europe's population, and even though telephone, radio, fax and computers were not available to disseminate information, true or false! In 1674, John Mayow placed birds, mice or lighted candles under a bell jar, and used von Guericke's newly invented vacuum pump to remove the air. He concluded that air contained 'nitro-aerial particles necessary for life and combustion', but he stopped there. A few years later Becher theorized that all substances contained three kinds of 'earth' - vitrifiable, mercurial, and combustible. His student Stahl proposed that an intangible substance, which he named phlogiston, was the combustible part of all matter. For a century, most leading scientists perpetuated the phlogiston theory. They were all wrong. This theory persisted for a century until Scheele challenged it, extracted oxygen from saltpeter, and told Lavoisier how to do so. Two years later, Lavoisier and Priestley raced to become famous as the discoverers of oxygen. Scheele is unknown today. Lavoisier went to the guillotine for opposing the French revolution; Priestley fled to Philadelphia after supporting it. During these two centuries, anatomy and physiology flourished. Using Leeuwenhoeck's microscopes, blood and tissue cells were visualized, capillaries were revealed, and the true circulation could be described. There came a rush of advances in understanding the human body, a rush even greater than that of today. Meanwhile, mountaineering had been born. Laurent de Saussure visited Chamonix in 1760, and fell in love with Mont Blanc. After having to turn back twice, he spent four hours on the summit describing changes in his pulse rate, respiration and temperature. He recognized that the decreased weight of the atmosphere on the body at altitude caused the symptoms which we know as mountain sickness. A century later, mountaineering became so popular that descriptions of altitude illness abounded, and the mitigating effect of acclimatization was appreciated. Explanations abounded. Dr Meyer-Ahrens, a leading Zurich physician in 1854, covered all bases by stating that mountain sickness was due to (a) a decrease in the absolute quantity of oxygen, (b) rapidity of evaporation, (c) intensity of light, (d) expansion of intestinal gases, and (e) weakening of the coxo-femoral articulation. Several leading doctors believed in this joint weakening, which they thought was evidenced by fatigue in the legs. Others preached that diminished atmospheric pressure caused the fluids and gases of the body to expand. An American surgeon blamed the earth's magnetism. Since early days, emanations from plants (rhubarb, marigolds, heather) or minerals (antimony, lead) were alleged to cause what was called 'puna', 'mareo', or 'soroche'. All these observers were wrong. A prominent Italian scientist, Angelo Mosso, working on top of Monte Rosa and in a small decompression chamber, concluded that loss of carbon dioxide (which he christened acapnia) was a major cause of altitude illness, though he conceded that lack of oxygen might contribute. He was only partly right. Paul Bert, the father of altitude physiology, proved by extensive studies in decompression chambers that lack of oxygen was the cause of altitude illness, and that breathing additional oxygen was the cure.
16
Editorial
By the start of this century mountain medicine became fashionable. Distinguished scientists went off to high peaks. Many great and some forgotten scientists developed the foundations for what we believe to be true today. Hypoxia was proven to be the major cause of altitude illnesses, though hypobaria cannot even now be completely excluded as a contributor. Mosso's acapnia now is thought to have a minor influence. There is still much, much more to be learned. Haldane claimed for many years that the lungs could actively secrete oxygen into the blood, even after Barcroft drew the first arterial blood at altitude and showed that arterial was always less than alveolar oxygen tension. Haldane was probably wrong. We live today among many great advances, though few are so basic or dramatic as in the past. Caution and peer criticism have robbed exploration in science of much of its bravado. There are fewer great blunders too, though plenty of missed opportunities and overlooked clues. The progress of science is like snowfall: first a few flakes, then a blizzard, gathering like avalanches, moving rapidly to form great glaciers, which advance slowly but on a grand scale. Great things are done today, but they do not seem to me to have the same electricity about them as when the world was younger. What are the lessons from the past which may light our way into the future? What can we learn from those who have gone before us? Are we doomed to repeat their mistakes? Often we do not seem to heed what history tries to teach us. Here is what I believe might guide us: Do not be afraid of to be wrong. You never know for sure until you go look and see. The only thing wrong with anecdotal evidence is to accept it without examination. An open mind is not empty, but prepared. "Great things are done when men and mountains meet; These are not done by jostling in the street". Let me close with a quote from an unlikely source. Walter Lippman wrote many years ago: "Man is no mere creature of his habits, no automaton in his routine, but in the dust of which he is made there is also fire, lighted now and then by great winds from the sky". CHARLES S. HOUSTON MD
Burlington, Vermont, USA
EDITORIAL
T ell me some stories about yesterday For most of us it's only as we get older that we appreciate history. Since there's not much to look forward to, we elders tend t9 look back. We quote Coleridge, "The lessons of the past illuminate the future", and smugly tell our juniors that, "Those who ignore the past will screw up the future". The young should also heed Santayana; "We mu~t welcome the future, remembering that soon it will be the past, and we must respect the past, remembering that once it was all that was humanly possible". There have been a few moments in time when something new happened, moments when someone suddenly saw a new dimension, was struck by a new idea, and took a giant step forward in understanding the human body. Sometimes such moments stretched into days, weeks or months. Others came in a rush during a period of only a few years. Still others must have happened during a moment of inspiration, such as that night in 1865 when Kekule visualized the benzene ring. We can imagine that one day, 2000 or more years ago, some miner deep underground noticed that his candle flickered and went out when he began to feel faint. Though he did not realize the momentous nature of this observation, he had made the first connection between oxygen, combustion and life. Many centuries would pass before this connection was appreciated. When Aristotle compared the weight of an empty leather bladder against its weight when filled with air, he concluded that air - like everything else - had weight. But he failed to recognize what this great moment implied. Aristotle also did not fully understand the human circulation; he taught that there were two separate systems which did not connect, and postulated that some venous and arterial blood mingled through tiny pores between the ventricles. Five centuries later, Galen repeated Aristotle's error, which persisted for another thousand years. Not until 1540 was it challenged by Servetus, who recognized that all the blood passed through the lungs; he was burned at the stake for this heresy. It was yet another hundred years before Harvey, building on observations of his predecessors, accurately described the circulation of the blood. Although Ibn-al-Nafis, Colombo, and Servetus laid the groundword for Harvey; they are almost forgotten. Later, 1500 years after Aristotle, Beeckman realized what the master had missed; in his doctoral thesis, he defied his elders and wrote that air pressed upon us as water does upon a fish. He was ostracized by his peers for his genius. Beeckman's famous contemporaries, Descartes and Galileo, stuck with Aristotle, while a young Italian lawyer, Gaspar Berti, filled a tall lead pipe with water and sealed the top to prove that a vacuum could exist - thus making the first crude barometer. Torricelli had the wit to use mercury in place of water for a prototype of the modern barometer. We honor his name when we use 'torr'; Berti is forgotten. 0953-9859 © 1993 Chapman & Hall
Editorial
15
Soon, Florin Perier carried two barometers up a small mountain and showed that atmospheric pressure decreased with altitude. He too has been forgotten, overshadowed by his cousin Pascal, who publicized the event. These great advances happened during a few decades of the 17th Century, despite war, disease and famine that killed a quarter of Europe's population, and even though telephone, radio, fax and computers were not available to disseminate information, true or false! In 1674, John Mayow placed birds, mice or lighted candles under a bell jar, and used von Guericke's newly invented vacuum pump to remove the air. He concluded that air contained 'nitro-aerial particles necessary for life and combustion', but he stopped there. A few years later Becher theorized that all substances contained three kinds of 'earth' - vitrifiable, mercurial, and combustible. His student Stahl proposed that an intangible substance, which he named phlogiston, was the combustible part of all matter. For a century, most leading scientists perpetuated the phlogiston theory. They were all wrong. This theory persisted for a century until Scheele challenged it, extracted oxygen from saltpeter, and told Lavoisier how to do so. Two years later, Lavoisier and Priestley raced to become famous as the discoverers of oxygen. Scheele is unknown today. Lavoisier went to the guillotine for opposing the French revolution; Priestley fled to Philadelphia after supporting it. During these two centuries, anatomy and physiology flourished. Using Leeuwenhoeck's microscopes, blood and tissue cells were visualized, capillaries were revealed, and the true circulation could be described. There came a rush of advances in understanding the human body, a rush even greater than that of today. Meanwhile, mountaineering had been born. Laurent de Saussure visited Chamonix in 1760, and fell in love with Mont Blanc. After having to turn back twice, he spent four hours on the summit describing changes in his pulse rate, respiration and temperature. He recognized that the decreased weight of the atmosphere on the body at altitude caused the symptoms which we know as mountain sickness. A century later, mountaineering became so popular that descriptions of altitude illness abounded, and the mitigating effect of acclimatization was appreciated. Explanations abounded. Dr Meyer-Ahrens, a leading Zurich physician in 1854, covered all bases by stating that mountain sickness was due to (a) a decrease in the absolute quantity of oxygen, (b) rapidity of evaporation, (c) intensity of light, (d) expansion of intestinal gases, and (e) weakening of the coxo-femoral articulation. Several leading doctors believed in this joint weakening, which they thought was evidenced by fatigue in the legs. Others preached that diminished atmospheric pressure caused the fluids and gases of the body to expand. An American surgeon blamed the earth's magnetism. Since early days, emanations from plants (rhubarb, marigolds, heather) or minerals (antimony, lead) were alleged to cause what was called 'puna', 'mareo', or 'soroche'. All these observers were wrong. A prominent Italian scientist, Angelo Mosso, working on top of Monte Rosa and in a small decompression chamber, concluded that loss of carbon dioxide (which he christened acapnia) was a major cause of altitude illness, though he conceded that lack of oxygen might contribute. He was only partly right. Paul Bert, the father of altitude physiology, proved by extensive studies in decompression chambers that lack of oxygen was the cause of altitude illness, and that breathing additional oxygen was the cure.
16
Editorial
By the start of this century mountain medicine became fashionable. Distinguished scientists went off to high peaks. Many great and some forgotten scientists developed the foundations for what we believe to be true today. Hypoxia was proven to be the major cause of altitude illnesses, though hypobaria cannot even now be completely excluded as a contributor. Mosso's acapnia now is thought to have a minor influence. There is still much, much more to be learned. Haldane claimed for many years that the lungs could actively secrete oxygen into the blood, even after Barcroft drew the first arterial blood at altitude and showed that arterial was always less than alveolar oxygen tension. Haldane was probably wrong. We live today among many great advances, though few are so basic or dramatic as in the past. Caution and peer criticism have robbed exploration in science of much of its bravado. There are fewer great blunders too, though plenty of missed opportunities and overlooked clues. The progress of science is like snowfall: first a few flakes, then a blizzard, gathering like avalanches, moving rapidly to form great glaciers, which advance slowly but on a grand scale. Great things are done today, but they do not seem to me to have the same electricity about them as when the world was younger. What are the lessons from the past which may light our way into the future? What can we learn from those who have gone before us? Are we doomed to repeat their mistakes? Often we do not seem to heed what history tries to teach us. Here is what I believe might guide us: Do not be afraid of to be wrong. You never know for sure until you go look and see. The only thing wrong with anecdotal evidence is to accept it without examination. An open mind is not empty, but prepared. "Great things are done when men and mountains meet; These are not done by jostling in the street". Let me close with a quote from an unlikely source. Walter Lippman wrote many years ago: "Man is no mere creature of his habits, no automaton in his routine, but in the dust of which he is made there is also fire, lighted now and then by great winds from the sky". CHARLES S. HOUSTON MD
Burlington, Vermont, USA