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THE HYGIENIC AND [THERAPEUTIC ASPECTS OF CLIMBING.
1048
THE HYGIENIC AND [THERAPEUTIC ASPECTS OF CLIMBING. BY HERMANN WEBER, M.D. BONN, F.R.C.P. LOND.
everyone, varies very much in different persons.
party of five, including guides, I found that after
a
Thus in a first climb
of about 4000 ft. the pulses of the five varied in frequency from 76 to 132, and also in other qualities. This difference was partly due to the want of habit of climbing in some, for it diminished after a week’s active climbing to from 74 to 1221 MOST people regard climbing and other modes of exercise after a similar ascent, and later to from 74 to 105 ; but it was also partly due to differences in the nervous system and to as matters of daily life, about which everyone can easily of the heart. The difference in other irritability judge for himself ; but, nevertheless, they deserve the serious of the pulse-in rhythm, in volume, in the quicknessqualities of the The is men. so medical that consideration of subject large rise - were likewise well marked, and also the gradua2 I can here only enter on a few of the many points connected changes effected in them by regular climbing ; but these are with it. Climbing, for persons with healthy organs, is one not so easily described. Good sphygmographic tracings would of the most useful exercises, as it increases the activity be useful, and some years ago, when on a tour with my son, of all the organs of the body and at the same time Dr. Parkes Weber, the latter took sphygmographic tracings which I thought interesting, but perhaps clinical sphygmo occupies the mind, and all this in pure air. Roughly graphs are still too imperfect for such purposes. The beneficial effects of climbing tours, though more easily speaking, it may be said that by the increased action of the voluntary muscles the circulation and respiration are adapted to persons in earlier manhood, are perhaps still intensified, thus leading to increased metabolism in every more strikingly seen in those past the climax of energy or the age of forty-five, and up to that of sixty-five and tissue, including the nerve centres. Unfortunately, climbing after The muscular power, the condition of the skin, mere. cannot be practised everywhere, for the simple reason the action of the heart, the respiratory, digestive, and that mountains are not to be found in all localities. uro-genital functions, the whole nervous system, especially A moderate degree of climbing can, however, be obtained the memory and ability to perform mental work, all show in many parts of Great Britain, and in some districts a distinct rejuvenescence. We may imagine that this is even rather stiff climbing. The real "playground," how- effected by the increased activity of the smallest capillaries ever, in Europe for thorough climbing is the Alps. Long and lymphatic vessels, possibly the reopening of disused ones,. tours can be made there, offering every day new ground, and in consequence increased renovation of tissue. The new features of beauty, varied work on glaciers, rocks, snoweffects on the colour and turgor of the skin are obvious to fields, and also the more homely green slopes and lower every observer, and in many persons with grey hair and beard mountains. The main climatic conditions-viz., rarefied and the greyness becomes temporarily diminished a short time dry air, lower shade temperatures and strong insolation- after a successful climbing tour. I could also mention many fo m i nportant elements in Alpine tours. A great change cases of persons who had been in the habit of going to spas in( i3, mostly diminution in quantity and in nutritive like Homburg, Harrogate, Carlsbad and Wiesbaden, on power, has likewise to be taken into consideration, and not account of dyspepsia, sluggish portal circulation, rheumatic less so the entire change in the surroundings. Such tours and gouty troubles, but who finally obtained greater and more can be recommended therapeutically as means for re- lasting benefit from well-adapted climbing tours, followed gaining and promoting health and energy and as tending by active and abstemious habits. It is generally contowards longevity ; and they can be arranged according sidered that men above fifty-five or sixty years of age should to the state of the organs and the general condition of cease to climb, but this rule allows of many exceptions. health, including the climatic elements to be desired in It must depend, not so much on the number of years, as. the case of each person. The most frequent cases coming on the state of the tissues and the maintenance of the under this head are those of men, and also women, who habit of exercise. A man over fifty or sixty years of age have worked hard mentally in their various occupations, who has never climbed ought to begin with the greatest such as literary men, scientists, teachers, and other pro- care and only if there are no signs of disease, especially ol fessional men, who have not taken sufficient open-air atheroma and senile degeneration ; but a man who has kept exercise, have perhaps taken at the same time more food up the habit of active exercise and occasional climbing often, than was useful to their systems, and who, in consequence, is able to take moderate climbing tours with great advantage have become irritable, sleepless, dyspeptic listless, depressed, far beyond the age of sixty. As an instance, I may mention and unable to concentrate their thoughts-they have, in a medical man who between the ages of thirty and fifty year short, lost mental and bodily energy. In these cases, was always at the end of the season so much exhausted by if they are free from so-called organic disease, a tour insufficient exercise and sleep that he required a whole in the Alps of from three to eight weeks’ duration usually week and more of training before he could do any climbing, exercises a better f ffect than any other fo"m of holiday. but who after fifty years of age began to take regular and Habits and mental constitution have, however, to be taken sometimes comparatively severe walking exercise, even during into consideration. There are many who are so attached to the period of hard professional work, with the result that heyachting, shooting, deer stalking, fishing, and other active could in the holidays almost at once begin to climb, sports that a climbing tour would be a source of constant and was still able to do so in a moderate way at sixty-seven mental irritation, and would therefore be less beneficial than and sixty-eight years of age-viz , to walk and climb for from the accustomed holiday sports. Those who are inclined for a six to ten hours every day over glacier passes and ascend climbing holiday and are unacquainted with such modes of peaks of altitudes of from 10 000 ft. to 12,000 ft. Bad effects, however, are likewise occasionally observed a5 exercise must be advised to commence slowly and to put the heart, the bloodvessels, the lungs and the muscles gradatim being caused by climbing tours, partly from overlooking into training, and to test their powers judiciously before they defects in the heart and bloodvessels or in the lungs or nerveundertake difficult peaks or glacier passes. Further, they centres, and partly from insufficient training before the com-should not return directly from violent exercise to continued mencement of tours requiring great exertion. To the former sitting occupations and suddenly leave off active exercise, but group belong the two following cases. CASE 1 -This was that of a very muscular and strong; they ought to gradually diminish it and continue to take a certain amount during their usual occupations. The most slightly corpulent man aged fifty-six years, with hereditary usual effects of a judicious climbing tour are the return gouty taint from his father, who had died at the age of sixtyof natural sleep, the disappearance of mental irritability, four from apoplexy. He was an active man, but more with the ability to concentrate thought and form a clear regard to brainwork than to physical exercise, which, howopinion, and the improvement of digestion. Again and ever, he did not altogether neglect. He was a free liver,. again I have seen persons who were disturbed every night by and, though temperate in the usual sense, took every day painful forms of flatulence and palpitation, which had three glasses of sherry, and occasionally had port wine anti> resisted other treatment for months and years, lose their dis- champagne. He was considered to be a healthy man. He. comforts after the first or second week of mountaineering. joined some younger friends in walking from Zermatt by theThis is probably due to the improved state of the portal Riffel Alp to the Gorner Grat, and when close to the top had’ circulation, which is forced into activity by the movements of a first attack of angina pectoris ; but after a short rest he was. the voluntary muscles of the limbs and the more powerful able to enjoy the view and to descend without much difficulty. action of the be:1rt induced by the accelerated return of This occurred in August, 1881. The attacks recurred after -the blood from the extremities. I may mention here that his return to England, and he died in an attack of syncopethe influence of climbing on the healt, though visible in in January, 1882, with calcification of- the ooronary arteries.
1049 and atheromatous patches in the aorta. These, no doubt, had98f °8°. In these cases, on the diminution of the exertion on the isucceeding days, the natural rhythm was scarcely disturbed, existed before the climbing tour. CASE 2.-This was that of a fairly strong man thirty-six :and two of them bore later, after having become accus1 to climbing, considerable exertion without suffeiing years of age who had had slight hsemoptysis and early left-tomed J breathlessness or from change of rhythm of the heart. sided phthisis at the age of seventeen, but had apparently from ". one of my companions, a very active man aged thirtyentirely recovered. He was able to finish his universityIn 1 but with a rather weak muscular system, a remarkable career, and was occupied in a large manufactory. After two, having worked very hard during the summer of 1875 hephenomenon was observed on two occasions after comparatook a holiday in the Dolomites, and had ascended several tively moderate climbs (to 8000 ft. and 9000 ft.) in the neighsmall and easy peaks without any inconvenience when bourhood of Grindelwald. On his return home, somewhat he went up the Marmolata, over 12, 000 ft. high, and on exhausted, in the evening, the second aortic sound was descending had slight haemoptysis. This continued for somereplaced by a musical murmur, heard at the middle of the days, and ended in rapid phthisis, which caused his death sternum and a little to the right ; the first sound was rather within six months of the occurrence of the first attack of indistinct. The pulse ranged from 105 to 112, feeble, and hemoptysis. Besides the recent changes calcareous masses not like the pulse of regurgitation. On the following day the The lesson to be learnt from murmur had disappeared and the sounds were normal, the were found in the left apex. this case, which is a type of similar though less striking ones, pulse being 88. Two days later, after a similar climb, I heard is that those with quiescent or obsolete phthisis ought to be the same musical murmur, which again disappeared on the folcareful with regard to too active climbing. It is very pro- lowing morning. I urged him not to attempt any more climbing, bable that this man, if he had kept to small and easy tours, and heard later that he had returned to work in good health; requiring not more than from three to five hours’ walking but seven years after this occurrence I received the news that with moderate climbing, would have derived much benefit he had suddenly died from "Herzschlag," probably syncope. Other warnings are occasionally given by the bodily temperafrom his tour. As an instance of danger from hard climbing in a state of ture, which in a healthy person, climbing within his or her powers, ought to remain nearly natural, but which may imperfect training the next case may be mentioned. CASE 3. -The following is the case of a man aged forty- become increased to 100°, 101°, and 102O.at night after too six, apparently in perfect health, whose life had been passed hard climbing. This indicates the necessity of rest, which suffices generally to reduce it to the natural point within from as "first class" by one of the best insurance offices in London a short time ago. He was a City man, of some- twelve to twenty-four hours. Dr. Clifford Allbutt has what luxurious habits, who had taken little exercise for carefully watched the natural curves of his own temperature before as well as during a climbing tour, and has some years, though he was formerly a good Alpine climber. He went directly from London to the Saas valley, and within come to the conclusion that exertion under favourable the first week walked from the little Mattmark Hotel over circumstances tends slightly to raise the bodily temperathe Adler Pass to Zermatt, a walk of twelve hours’ duration, ture for the time, the elevation being compensated by a with some stiff climbing and glacier work. He became rather "earlier occurrence of the evening fall." This much fatigued, especially during the long descent, and could conclusion I can in the main corroborate, although I not take any food when he arrived at Zermatt. After some cannot claim that I have studied my own and my comdays he tried moderate tours, but had in ascending shortness panions’ curves before and during climbing so carefully as he of breath, with a dull pain in the region of the heart. When has done ; but my impression is that my own curves are not I saw him three months later the area of heart dulnessiso regular either under ordinary circumstances or during was increased, the pulse was often irregular, between climbing, and, further, that the rise during climbing is less 60 and 72, and the heart’s sounds were dull, without a marked. More rare than the rise seems to be the fall of tembruit. I regarded the case as one of overwork of the! perature. Dr. Clifford Allbutt noted on himself a depressicn heart, leading to dilatation. About fifteen months later to 95.5° on reaching the Grands Mulets (10,007 ft.) from a small quantity of albumen was, at first occasionally after Chamonix on Aug. 17th, but it is uncertain whether this can food, but later on regularly, found in the urine ; a dull, sys- be ascribed to climbing alone ; for on Aug. 20th, at 5 30 A.M., tolic mitral bruit likewise developed, and the case took the on rising (at Chamonix) he was astonished to find his temfeatures of arterio-capillary fibrosis, or fibrous degenerationiperature 954°, a fall which was followed by an attack cf of the heart and bloodvessels, and terminated with ursemic : diarrhoea. Dr. Marcet,2 who took his temperature under the coma three and a half years after the injudicious climb. It tongue, gives an important contribution on this subject. He is almost certain that this man would have been much im- came to rather different conclusions-namely, that the bodily proved in health if he had continued for a fortnight withi temperature becomes invariably diminished by the act cf small tours, which had agreed with him very well, instead offclimbing, and more so if this is done upon an empty stomach or if the climbing is associated with mountain sickness. Tt e undertaking a very fatiguing one too soon. Bad effects of a slighter nature are by no means rare and1 fall of temperature at elevations between 7000ft. and 13, CCO are fortunately often remediable. Thus I have repeatedly seena was from 2’50 to 4’30. He further found that on resting slight admixture of albumen with the urine, mostly withoutt the temperature rises rapidly to about its normal degree. Dr. distinct casts and without blood globules, and lasting generally7Lortet of Lyons, whose paper I cannot, unfortunately. :.t t",.,..,.." ",,.............1,........-C ...::1....-.... ’l.1f.............. , present procure, came to similar results on his ascents of Mont lassitude occur, but thesee Blanc. In my own numerous examinations on my companions, inability to take food, symptoms disappear after a few days’ rest with restricted1 guides, and myself I have only rarely met with such condiet. Other indications of physical overwork show themselvess siderable drops of temperature. Occasionally a fall of from 10 in great frequency and irregularity of the pulse (up to 1300 to 1’50 was recorded, and this was usually associated with and more). It may fall after some hours’ rest to aboutt insufficient ingestion of food. Only once in myself a, fall 100, but mostly remains at or above 90 for several dayss from 98 6° to 97° occurred near the top of the Great in persons whose usual pulse does not exceed 75. Thee Aletschhorn (about 13,500ft.) at about noon, after a very pulse cannot well be separated from the heart, and thoughh fatiguing climb from soon after midnight, with little ford at I have not examined the latter’s behaviour on climbing g first, and total inability to take it towards the end of the as often as that of the pulse, I have occasionally received a ascent on account of mountain sickness. This fall was assowarning from it. As a rule, under favourable circumstancesis ciated with great breathlessness for about two hours and a very the moderate increase of the pulse-rate is accompanied by y frequent, weak, and rather irregular pulse of from 128 to 135. an increased impulse of heart and by rather more pro)A similar fall occurred in one of my companions on the ridge nounced first sounds ; and the relative length between the e of the Eiger (about 13,000 ft.), where he was seized with first and second sounds and the second and next first is is nausea, vomiting, and diarrhoea. The temperature fell from maintained. In several cases, however, when the climbing g 98 5° in the morning to 96 8°, and the fall lasted for several had led to breathlessness and great rapidity of the pulse, to .0 hours, in spite of rest in his not very comfortable position. 132 and 136, the first sound was rather indistinct and the le The pulse was 116, very feeble, and rather irregular. The interval between the first and second sound was very short, t, temperature became nearly normal after the descent. A t similar but greater fall to 94 6° and 95 4° occurred twice in a. pointing, Sir W. Broadbent would probably say, to imperfect ie systole and the commencement of the diastole before the 1 Proceedings of the Royal Society, No. 126, 1871, and Alpine Journal, systole was completed. It took one or more hours’ rest before the natural rhythm was restored. In one of these May, 1891. 2 Observations sur la Température du Corps Humain à Différentes cases a rise of temperature to 1020 F. occurred at night, while Altitudes, à l’État du Repos et pendant l’Acte de l’Ascension. Archives during and immediately after climbing it was from 98° to de Sciences et tome xxxvi., p. 247, 1869. Physiques Naturelles, :
.
,
.
’
-
-
and great
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1050 young, ill-nourished Italian porter on the Breithorn and again unavoidable exposure to wet and cold on long Alpine at the Zwillings Pass (about 13,000 ft.), and was followed on tours. Dr. Brinton assured me, however, that in his case tthe first occasion by normal and on the second by slightly raised climbing removed the headache and "mental dimness and temperatures (99 8°). The temperature in my experiments sluggishness" in a marvellous way, and sometimes the while climbing was mostly taken under the tongue, but albumen for many days ; but I ought to mention that in occasionally in the axilla, and only rarely at night in the Dr. Brinton’s case the beneficial effects of the Alpine tours rectum. were enhanced by the fact that he took in the Alps very little How are these peculiar falls of temperature to be inter- food besides milk. Further experience has convinced me that preted ? Dr. Marcet seems to think that the available the risks are too great to countenance climbing in such cases, force of the body being limited, the large amount taken excepting in those where a very slight passage of albumen iap by motion leaves an insufficient quantity for the production with the urine is a remnant of an affection long past, such of heat. I was inclined to adopt a similar explanation, but on as scarlet fever or syphilis. To one point more I will allude-namely, that climbing further thought the matter does not seem to be quite so simple. In all the cases which came under my observation the fall has been accused of bringing on aortic aneurysm, but I think without sufficient reason. I do not forget in saying this the was associated with excessive shortness of breath, very feeble and frequent contractions of the heart, and usually with nausea. case mentioned above of the musical aortic murmur proRest from climbing was not always followed by recovery of the duced by moderate ascents, but in this case the root of the normal temperature, as the case of my companion who was aorta and the aortic valves were probably not sound when the attacked by mountain sickness on the ridge of the Eiger climbs were attempted. Alpine climbers, past and present, shows. The main phenomena seem to be associated with the certainly do not suffer more from aortic aneurysm than other pneumogastric centre, and it occurred to me that possibly the men, and the exertion of climbing does not tax the aorta as nervous mechanism for heat regulation may be influenced by much as severe rowing or the injudicious use of dumb-bells. the pneumogastric centre. I am unfortunately not sufficiently Possibly the fact that two excellent physicians, dear to all acquainted with the effect of other severe bodily exercises on who knew them-Dr. Sibson and Dr. Hilton Fagge-who had the temperature. Dr. Pavy, in his most interesting papers on both been climbers in former years died from aortic aneurysm the Effect of Prolonged Muscular Exercise on the System,3 has given rise to the idea. Their climbing, however, had, I gives an account of Weston’s (the great American walker) think, nothing to do with the aneurysm. Dr. Sibson, temperature before, during, and after his walks. Sometimes many years after his first ascent of the Lyskamm, enjoyed there was only a slight fall, at others none. Long walks in perfect health ; he was, however, in the habit of flourishing hilly parts of England often cause me great fatigue, a frequent, a very heavy iron stick every morning on his walk before weak pulse (120 and more), but never a considerable drop of breakfast with the view of exercising the muscles of his arms. temperature-sometimes an increase of a few tenths of Dr. Hilton Fagge had long given up climbing, on account of degrees, sometimes a slight decrease. I regret to have no the limited holidays he allowed himself, before the first experience about hard rowing, or about the relations of symptoms of his rapidly progressing disease showed themsea-sickness to bodily temperature. selves ; but he, I confess, was perhaps never in a condition to It is occasionally a difficult matter to decide whether countenance very active climbing during holidays. The matter is different with regard to aneurysm of the persons with some pathological complication ought to be allowed to climb. No one would think of permitting persons femoral arteries and their continuations, as these arteries are with atheromatous affections, disease of the aortic valves, much more taxed during climbing. With regard to this matter, very weak or dilated hearts, advanced emphysema, active I cannot forget having met, in 1863 or 1864, the late Dr. King phthisis, or Bright’s disease to climb. In all these conditions Chambers at Zermatt, when he described the difficulty he I have seen bad effects follow even moderate climbing, espe- had experienced in dragging his legs" to the top of the cially in disease of the aortic valves. Fairly hard riding is Grauhaupt and over the Theodul Pass (both about 10, 000 ft.). sometimes borne, as in the case mentioned by Dr. Lauder During the following winter popliteal aneurysm developed Brnnton,4 but even moderate climbing taxes the heart more itself. Those whoremember this amiable and accomplished On the other hand, there are physician know that he was fond of spending his leisure in than the hardest riding. morbid conditions about which one may be doubtful. Such sketching, that he took little active exercise, and recommended generous living. It was therefore no wonder that a one is old mitral disease, with perfect accommodation and good general health. I know of some men who could climb his arteries were rigid and could not stand the great strain. I will abstain from discussing any further points, but I think moderately and derive benefit from it ; I have myself crossed the Theodul Pass (10,000 ft.) with a man aged thirty- I have said enough to show : (1) that judiciously arranged eight who had had mitral disease since boyhood, and who Alpine tours deserve a place in general therapeutics ; (2) that could keep his health only by great bodily activity, shooting, they can be rendered eminently beneficial by adapting them deer stalking, hunting, and climbing. The climb from Breuil to the capacities and requirements of each case ; (3) that bad influenced his heart much less than mine ; it had raised Alpine tours need not berestricted to the period of the greatest his pulse only from 68 to 95, while it had raised mine from vigour, but may be used also in favourable cases after the T4 to 122. Although one often speaks of a heart with old climax of life for the recovery and preservation of health and affection of the mitral valves as of a heart with mitral valve energy, and the prolongation of life ; and (4) that it is, however, disease, such a heart may frequently be considered as healthy, necessary to forbid climbing to persons just recovering from and may be more vigorous and more useful than many acute disease, to those affected with some chronic or quiescent ordinary hearts with perfectly healthy valves but with disease (phthisis, arterio-capillary fibrosis), or with senile weak musculature. On the other hand, I have seen great decay, and except with great caution to those who are out of harm follow even moderate climbing in recent mitral training or affected with obesity. affections of rheumatic origin, and in cases inclined to Grosvenor-street, W. acute and subacute rheumatism, and also in imperfectly cured inflammatory sciatica ; while in ordinary chronic rheumatism with normal or subnormal temperature I have IS THERE A DEXTROCARDIAC-RESPIRAoften seen great benefit derived from judicious climbing. I TORY REFLEX ? have myself repeatedly had at the end of the season rheumatic pains in the arms and finger-joints to such a degree that the BY D. B. LEES, M.A., M.D.CANTAB , F.R.C.P. LOND., ice axe slipped from me on the first trials owing to imperfect PHYSICIAN TO. AND LECTURER ON MEDICINE AT, ST. MARY’S HOSPITAL closure of the hands, but after less than a fortnight’s exercise AND PHYSICIAN TO THE HOSPITAL FOR SICK CHILDREN, GREAT ORMOND-STREET. I have become quite free from pain. Many years ago, on meeting the late Dr. Brinton in the Tyrol, I discussed some points of Alpine therapeutics with him, amongst them being the question THE object of this paper is to suggest for the consideration as to whether cases of slight albuminuria of obscure nature, of physiologists the question whether there is not a physiosometimes intermittent, were suitable for climbing tours. logical reflex from the right ventricle of the heart to the He was inclined to answer this in the affirmative, while 1 respiratory centre similar to that-from the left ventricle to jfegarded it as hazardous, partly on account of the great the vaso-motor centre along the depressor nerves, and with a strain on the capillary vessels, which were not healthy in similar function-viz., the automatic relief of over-distension some of these cases, and partly owing to the occasionally of the ventricle. The suggestion is founded on the following observations of clinical phenomena. 3 THE LANCET, Feb. 26th. and March 4th, 11th, 18th and 25th, 1876. 4 Rest in Cardiac 1. The dyspnœa of pericarditis.-I have lately had under vol. 1893. Affections, Practitioner, v., p. 190,
THE HYGIENIC AND [THERAPEUTIC ASPECTS OF CLIMBING. BY HERMANN WEBER, M.D. BONN, F.R.C.P. LOND.
everyone, varies very much in different persons.
party of five, including guides, I found that after
a
Thus in a first climb
of about 4000 ft. the pulses of the five varied in frequency from 76 to 132, and also in other qualities. This difference was partly due to the want of habit of climbing in some, for it diminished after a week’s active climbing to from 74 to 1221 MOST people regard climbing and other modes of exercise after a similar ascent, and later to from 74 to 105 ; but it was also partly due to differences in the nervous system and to as matters of daily life, about which everyone can easily of the heart. The difference in other irritability judge for himself ; but, nevertheless, they deserve the serious of the pulse-in rhythm, in volume, in the quicknessqualities of the The is men. so medical that consideration of subject large rise - were likewise well marked, and also the gradua2 I can here only enter on a few of the many points connected changes effected in them by regular climbing ; but these are with it. Climbing, for persons with healthy organs, is one not so easily described. Good sphygmographic tracings would of the most useful exercises, as it increases the activity be useful, and some years ago, when on a tour with my son, of all the organs of the body and at the same time Dr. Parkes Weber, the latter took sphygmographic tracings which I thought interesting, but perhaps clinical sphygmo occupies the mind, and all this in pure air. Roughly graphs are still too imperfect for such purposes. The beneficial effects of climbing tours, though more easily speaking, it may be said that by the increased action of the voluntary muscles the circulation and respiration are adapted to persons in earlier manhood, are perhaps still intensified, thus leading to increased metabolism in every more strikingly seen in those past the climax of energy or the age of forty-five, and up to that of sixty-five and tissue, including the nerve centres. Unfortunately, climbing after The muscular power, the condition of the skin, mere. cannot be practised everywhere, for the simple reason the action of the heart, the respiratory, digestive, and that mountains are not to be found in all localities. uro-genital functions, the whole nervous system, especially A moderate degree of climbing can, however, be obtained the memory and ability to perform mental work, all show in many parts of Great Britain, and in some districts a distinct rejuvenescence. We may imagine that this is even rather stiff climbing. The real "playground," how- effected by the increased activity of the smallest capillaries ever, in Europe for thorough climbing is the Alps. Long and lymphatic vessels, possibly the reopening of disused ones,. tours can be made there, offering every day new ground, and in consequence increased renovation of tissue. The new features of beauty, varied work on glaciers, rocks, snoweffects on the colour and turgor of the skin are obvious to fields, and also the more homely green slopes and lower every observer, and in many persons with grey hair and beard mountains. The main climatic conditions-viz., rarefied and the greyness becomes temporarily diminished a short time dry air, lower shade temperatures and strong insolation- after a successful climbing tour. I could also mention many fo m i nportant elements in Alpine tours. A great change cases of persons who had been in the habit of going to spas in( i3, mostly diminution in quantity and in nutritive like Homburg, Harrogate, Carlsbad and Wiesbaden, on power, has likewise to be taken into consideration, and not account of dyspepsia, sluggish portal circulation, rheumatic less so the entire change in the surroundings. Such tours and gouty troubles, but who finally obtained greater and more can be recommended therapeutically as means for re- lasting benefit from well-adapted climbing tours, followed gaining and promoting health and energy and as tending by active and abstemious habits. It is generally contowards longevity ; and they can be arranged according sidered that men above fifty-five or sixty years of age should to the state of the organs and the general condition of cease to climb, but this rule allows of many exceptions. health, including the climatic elements to be desired in It must depend, not so much on the number of years, as. the case of each person. The most frequent cases coming on the state of the tissues and the maintenance of the under this head are those of men, and also women, who habit of exercise. A man over fifty or sixty years of age have worked hard mentally in their various occupations, who has never climbed ought to begin with the greatest such as literary men, scientists, teachers, and other pro- care and only if there are no signs of disease, especially ol fessional men, who have not taken sufficient open-air atheroma and senile degeneration ; but a man who has kept exercise, have perhaps taken at the same time more food up the habit of active exercise and occasional climbing often, than was useful to their systems, and who, in consequence, is able to take moderate climbing tours with great advantage have become irritable, sleepless, dyspeptic listless, depressed, far beyond the age of sixty. As an instance, I may mention and unable to concentrate their thoughts-they have, in a medical man who between the ages of thirty and fifty year short, lost mental and bodily energy. In these cases, was always at the end of the season so much exhausted by if they are free from so-called organic disease, a tour insufficient exercise and sleep that he required a whole in the Alps of from three to eight weeks’ duration usually week and more of training before he could do any climbing, exercises a better f ffect than any other fo"m of holiday. but who after fifty years of age began to take regular and Habits and mental constitution have, however, to be taken sometimes comparatively severe walking exercise, even during into consideration. There are many who are so attached to the period of hard professional work, with the result that heyachting, shooting, deer stalking, fishing, and other active could in the holidays almost at once begin to climb, sports that a climbing tour would be a source of constant and was still able to do so in a moderate way at sixty-seven mental irritation, and would therefore be less beneficial than and sixty-eight years of age-viz , to walk and climb for from the accustomed holiday sports. Those who are inclined for a six to ten hours every day over glacier passes and ascend climbing holiday and are unacquainted with such modes of peaks of altitudes of from 10 000 ft. to 12,000 ft. Bad effects, however, are likewise occasionally observed a5 exercise must be advised to commence slowly and to put the heart, the bloodvessels, the lungs and the muscles gradatim being caused by climbing tours, partly from overlooking into training, and to test their powers judiciously before they defects in the heart and bloodvessels or in the lungs or nerveundertake difficult peaks or glacier passes. Further, they centres, and partly from insufficient training before the com-should not return directly from violent exercise to continued mencement of tours requiring great exertion. To the former sitting occupations and suddenly leave off active exercise, but group belong the two following cases. CASE 1 -This was that of a very muscular and strong; they ought to gradually diminish it and continue to take a certain amount during their usual occupations. The most slightly corpulent man aged fifty-six years, with hereditary usual effects of a judicious climbing tour are the return gouty taint from his father, who had died at the age of sixtyof natural sleep, the disappearance of mental irritability, four from apoplexy. He was an active man, but more with the ability to concentrate thought and form a clear regard to brainwork than to physical exercise, which, howopinion, and the improvement of digestion. Again and ever, he did not altogether neglect. He was a free liver,. again I have seen persons who were disturbed every night by and, though temperate in the usual sense, took every day painful forms of flatulence and palpitation, which had three glasses of sherry, and occasionally had port wine anti> resisted other treatment for months and years, lose their dis- champagne. He was considered to be a healthy man. He. comforts after the first or second week of mountaineering. joined some younger friends in walking from Zermatt by theThis is probably due to the improved state of the portal Riffel Alp to the Gorner Grat, and when close to the top had’ circulation, which is forced into activity by the movements of a first attack of angina pectoris ; but after a short rest he was. the voluntary muscles of the limbs and the more powerful able to enjoy the view and to descend without much difficulty. action of the be:1rt induced by the accelerated return of This occurred in August, 1881. The attacks recurred after -the blood from the extremities. I may mention here that his return to England, and he died in an attack of syncopethe influence of climbing on the healt, though visible in in January, 1882, with calcification of- the ooronary arteries.
1049 and atheromatous patches in the aorta. These, no doubt, had98f °8°. In these cases, on the diminution of the exertion on the isucceeding days, the natural rhythm was scarcely disturbed, existed before the climbing tour. CASE 2.-This was that of a fairly strong man thirty-six :and two of them bore later, after having become accus1 to climbing, considerable exertion without suffeiing years of age who had had slight hsemoptysis and early left-tomed J breathlessness or from change of rhythm of the heart. sided phthisis at the age of seventeen, but had apparently from ". one of my companions, a very active man aged thirtyentirely recovered. He was able to finish his universityIn 1 but with a rather weak muscular system, a remarkable career, and was occupied in a large manufactory. After two, having worked very hard during the summer of 1875 hephenomenon was observed on two occasions after comparatook a holiday in the Dolomites, and had ascended several tively moderate climbs (to 8000 ft. and 9000 ft.) in the neighsmall and easy peaks without any inconvenience when bourhood of Grindelwald. On his return home, somewhat he went up the Marmolata, over 12, 000 ft. high, and on exhausted, in the evening, the second aortic sound was descending had slight haemoptysis. This continued for somereplaced by a musical murmur, heard at the middle of the days, and ended in rapid phthisis, which caused his death sternum and a little to the right ; the first sound was rather within six months of the occurrence of the first attack of indistinct. The pulse ranged from 105 to 112, feeble, and hemoptysis. Besides the recent changes calcareous masses not like the pulse of regurgitation. On the following day the The lesson to be learnt from murmur had disappeared and the sounds were normal, the were found in the left apex. this case, which is a type of similar though less striking ones, pulse being 88. Two days later, after a similar climb, I heard is that those with quiescent or obsolete phthisis ought to be the same musical murmur, which again disappeared on the folcareful with regard to too active climbing. It is very pro- lowing morning. I urged him not to attempt any more climbing, bable that this man, if he had kept to small and easy tours, and heard later that he had returned to work in good health; requiring not more than from three to five hours’ walking but seven years after this occurrence I received the news that with moderate climbing, would have derived much benefit he had suddenly died from "Herzschlag," probably syncope. Other warnings are occasionally given by the bodily temperafrom his tour. As an instance of danger from hard climbing in a state of ture, which in a healthy person, climbing within his or her powers, ought to remain nearly natural, but which may imperfect training the next case may be mentioned. CASE 3. -The following is the case of a man aged forty- become increased to 100°, 101°, and 102O.at night after too six, apparently in perfect health, whose life had been passed hard climbing. This indicates the necessity of rest, which suffices generally to reduce it to the natural point within from as "first class" by one of the best insurance offices in London a short time ago. He was a City man, of some- twelve to twenty-four hours. Dr. Clifford Allbutt has what luxurious habits, who had taken little exercise for carefully watched the natural curves of his own temperature before as well as during a climbing tour, and has some years, though he was formerly a good Alpine climber. He went directly from London to the Saas valley, and within come to the conclusion that exertion under favourable the first week walked from the little Mattmark Hotel over circumstances tends slightly to raise the bodily temperathe Adler Pass to Zermatt, a walk of twelve hours’ duration, ture for the time, the elevation being compensated by a with some stiff climbing and glacier work. He became rather "earlier occurrence of the evening fall." This much fatigued, especially during the long descent, and could conclusion I can in the main corroborate, although I not take any food when he arrived at Zermatt. After some cannot claim that I have studied my own and my comdays he tried moderate tours, but had in ascending shortness panions’ curves before and during climbing so carefully as he of breath, with a dull pain in the region of the heart. When has done ; but my impression is that my own curves are not I saw him three months later the area of heart dulnessiso regular either under ordinary circumstances or during was increased, the pulse was often irregular, between climbing, and, further, that the rise during climbing is less 60 and 72, and the heart’s sounds were dull, without a marked. More rare than the rise seems to be the fall of tembruit. I regarded the case as one of overwork of the! perature. Dr. Clifford Allbutt noted on himself a depressicn heart, leading to dilatation. About fifteen months later to 95.5° on reaching the Grands Mulets (10,007 ft.) from a small quantity of albumen was, at first occasionally after Chamonix on Aug. 17th, but it is uncertain whether this can food, but later on regularly, found in the urine ; a dull, sys- be ascribed to climbing alone ; for on Aug. 20th, at 5 30 A.M., tolic mitral bruit likewise developed, and the case took the on rising (at Chamonix) he was astonished to find his temfeatures of arterio-capillary fibrosis, or fibrous degenerationiperature 954°, a fall which was followed by an attack cf of the heart and bloodvessels, and terminated with ursemic : diarrhoea. Dr. Marcet,2 who took his temperature under the coma three and a half years after the injudicious climb. It tongue, gives an important contribution on this subject. He is almost certain that this man would have been much im- came to rather different conclusions-namely, that the bodily proved in health if he had continued for a fortnight withi temperature becomes invariably diminished by the act cf small tours, which had agreed with him very well, instead offclimbing, and more so if this is done upon an empty stomach or if the climbing is associated with mountain sickness. Tt e undertaking a very fatiguing one too soon. Bad effects of a slighter nature are by no means rare and1 fall of temperature at elevations between 7000ft. and 13, CCO are fortunately often remediable. Thus I have repeatedly seena was from 2’50 to 4’30. He further found that on resting slight admixture of albumen with the urine, mostly withoutt the temperature rises rapidly to about its normal degree. Dr. distinct casts and without blood globules, and lasting generally7Lortet of Lyons, whose paper I cannot, unfortunately. :.t t",.,..,.." ",,.............1,........-C ...::1....-.... ’l.1f.............. , present procure, came to similar results on his ascents of Mont lassitude occur, but thesee Blanc. In my own numerous examinations on my companions, inability to take food, symptoms disappear after a few days’ rest with restricted1 guides, and myself I have only rarely met with such condiet. Other indications of physical overwork show themselvess siderable drops of temperature. Occasionally a fall of from 10 in great frequency and irregularity of the pulse (up to 1300 to 1’50 was recorded, and this was usually associated with and more). It may fall after some hours’ rest to aboutt insufficient ingestion of food. Only once in myself a, fall 100, but mostly remains at or above 90 for several dayss from 98 6° to 97° occurred near the top of the Great in persons whose usual pulse does not exceed 75. Thee Aletschhorn (about 13,500ft.) at about noon, after a very pulse cannot well be separated from the heart, and thoughh fatiguing climb from soon after midnight, with little ford at I have not examined the latter’s behaviour on climbing g first, and total inability to take it towards the end of the as often as that of the pulse, I have occasionally received a ascent on account of mountain sickness. This fall was assowarning from it. As a rule, under favourable circumstancesis ciated with great breathlessness for about two hours and a very the moderate increase of the pulse-rate is accompanied by y frequent, weak, and rather irregular pulse of from 128 to 135. an increased impulse of heart and by rather more pro)A similar fall occurred in one of my companions on the ridge nounced first sounds ; and the relative length between the e of the Eiger (about 13,000 ft.), where he was seized with first and second sounds and the second and next first is is nausea, vomiting, and diarrhoea. The temperature fell from maintained. In several cases, however, when the climbing g 98 5° in the morning to 96 8°, and the fall lasted for several had led to breathlessness and great rapidity of the pulse, to .0 hours, in spite of rest in his not very comfortable position. 132 and 136, the first sound was rather indistinct and the le The pulse was 116, very feeble, and rather irregular. The interval between the first and second sound was very short, t, temperature became nearly normal after the descent. A t similar but greater fall to 94 6° and 95 4° occurred twice in a. pointing, Sir W. Broadbent would probably say, to imperfect ie systole and the commencement of the diastole before the 1 Proceedings of the Royal Society, No. 126, 1871, and Alpine Journal, systole was completed. It took one or more hours’ rest before the natural rhythm was restored. In one of these May, 1891. 2 Observations sur la Température du Corps Humain à Différentes cases a rise of temperature to 1020 F. occurred at night, while Altitudes, à l’État du Repos et pendant l’Acte de l’Ascension. Archives during and immediately after climbing it was from 98° to de Sciences et tome xxxvi., p. 247, 1869. Physiques Naturelles, :
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1050 young, ill-nourished Italian porter on the Breithorn and again unavoidable exposure to wet and cold on long Alpine at the Zwillings Pass (about 13,000 ft.), and was followed on tours. Dr. Brinton assured me, however, that in his case tthe first occasion by normal and on the second by slightly raised climbing removed the headache and "mental dimness and temperatures (99 8°). The temperature in my experiments sluggishness" in a marvellous way, and sometimes the while climbing was mostly taken under the tongue, but albumen for many days ; but I ought to mention that in occasionally in the axilla, and only rarely at night in the Dr. Brinton’s case the beneficial effects of the Alpine tours rectum. were enhanced by the fact that he took in the Alps very little How are these peculiar falls of temperature to be inter- food besides milk. Further experience has convinced me that preted ? Dr. Marcet seems to think that the available the risks are too great to countenance climbing in such cases, force of the body being limited, the large amount taken excepting in those where a very slight passage of albumen iap by motion leaves an insufficient quantity for the production with the urine is a remnant of an affection long past, such of heat. I was inclined to adopt a similar explanation, but on as scarlet fever or syphilis. To one point more I will allude-namely, that climbing further thought the matter does not seem to be quite so simple. In all the cases which came under my observation the fall has been accused of bringing on aortic aneurysm, but I think without sufficient reason. I do not forget in saying this the was associated with excessive shortness of breath, very feeble and frequent contractions of the heart, and usually with nausea. case mentioned above of the musical aortic murmur proRest from climbing was not always followed by recovery of the duced by moderate ascents, but in this case the root of the normal temperature, as the case of my companion who was aorta and the aortic valves were probably not sound when the attacked by mountain sickness on the ridge of the Eiger climbs were attempted. Alpine climbers, past and present, shows. The main phenomena seem to be associated with the certainly do not suffer more from aortic aneurysm than other pneumogastric centre, and it occurred to me that possibly the men, and the exertion of climbing does not tax the aorta as nervous mechanism for heat regulation may be influenced by much as severe rowing or the injudicious use of dumb-bells. the pneumogastric centre. I am unfortunately not sufficiently Possibly the fact that two excellent physicians, dear to all acquainted with the effect of other severe bodily exercises on who knew them-Dr. Sibson and Dr. Hilton Fagge-who had the temperature. Dr. Pavy, in his most interesting papers on both been climbers in former years died from aortic aneurysm the Effect of Prolonged Muscular Exercise on the System,3 has given rise to the idea. Their climbing, however, had, I gives an account of Weston’s (the great American walker) think, nothing to do with the aneurysm. Dr. Sibson, temperature before, during, and after his walks. Sometimes many years after his first ascent of the Lyskamm, enjoyed there was only a slight fall, at others none. Long walks in perfect health ; he was, however, in the habit of flourishing hilly parts of England often cause me great fatigue, a frequent, a very heavy iron stick every morning on his walk before weak pulse (120 and more), but never a considerable drop of breakfast with the view of exercising the muscles of his arms. temperature-sometimes an increase of a few tenths of Dr. Hilton Fagge had long given up climbing, on account of degrees, sometimes a slight decrease. I regret to have no the limited holidays he allowed himself, before the first experience about hard rowing, or about the relations of symptoms of his rapidly progressing disease showed themsea-sickness to bodily temperature. selves ; but he, I confess, was perhaps never in a condition to It is occasionally a difficult matter to decide whether countenance very active climbing during holidays. The matter is different with regard to aneurysm of the persons with some pathological complication ought to be allowed to climb. No one would think of permitting persons femoral arteries and their continuations, as these arteries are with atheromatous affections, disease of the aortic valves, much more taxed during climbing. With regard to this matter, very weak or dilated hearts, advanced emphysema, active I cannot forget having met, in 1863 or 1864, the late Dr. King phthisis, or Bright’s disease to climb. In all these conditions Chambers at Zermatt, when he described the difficulty he I have seen bad effects follow even moderate climbing, espe- had experienced in dragging his legs" to the top of the cially in disease of the aortic valves. Fairly hard riding is Grauhaupt and over the Theodul Pass (both about 10, 000 ft.). sometimes borne, as in the case mentioned by Dr. Lauder During the following winter popliteal aneurysm developed Brnnton,4 but even moderate climbing taxes the heart more itself. Those whoremember this amiable and accomplished On the other hand, there are physician know that he was fond of spending his leisure in than the hardest riding. morbid conditions about which one may be doubtful. Such sketching, that he took little active exercise, and recommended generous living. It was therefore no wonder that a one is old mitral disease, with perfect accommodation and good general health. I know of some men who could climb his arteries were rigid and could not stand the great strain. I will abstain from discussing any further points, but I think moderately and derive benefit from it ; I have myself crossed the Theodul Pass (10,000 ft.) with a man aged thirty- I have said enough to show : (1) that judiciously arranged eight who had had mitral disease since boyhood, and who Alpine tours deserve a place in general therapeutics ; (2) that could keep his health only by great bodily activity, shooting, they can be rendered eminently beneficial by adapting them deer stalking, hunting, and climbing. The climb from Breuil to the capacities and requirements of each case ; (3) that bad influenced his heart much less than mine ; it had raised Alpine tours need not berestricted to the period of the greatest his pulse only from 68 to 95, while it had raised mine from vigour, but may be used also in favourable cases after the T4 to 122. Although one often speaks of a heart with old climax of life for the recovery and preservation of health and affection of the mitral valves as of a heart with mitral valve energy, and the prolongation of life ; and (4) that it is, however, disease, such a heart may frequently be considered as healthy, necessary to forbid climbing to persons just recovering from and may be more vigorous and more useful than many acute disease, to those affected with some chronic or quiescent ordinary hearts with perfectly healthy valves but with disease (phthisis, arterio-capillary fibrosis), or with senile weak musculature. On the other hand, I have seen great decay, and except with great caution to those who are out of harm follow even moderate climbing in recent mitral training or affected with obesity. affections of rheumatic origin, and in cases inclined to Grosvenor-street, W. acute and subacute rheumatism, and also in imperfectly cured inflammatory sciatica ; while in ordinary chronic rheumatism with normal or subnormal temperature I have IS THERE A DEXTROCARDIAC-RESPIRAoften seen great benefit derived from judicious climbing. I TORY REFLEX ? have myself repeatedly had at the end of the season rheumatic pains in the arms and finger-joints to such a degree that the BY D. B. LEES, M.A., M.D.CANTAB , F.R.C.P. LOND., ice axe slipped from me on the first trials owing to imperfect PHYSICIAN TO. AND LECTURER ON MEDICINE AT, ST. MARY’S HOSPITAL closure of the hands, but after less than a fortnight’s exercise AND PHYSICIAN TO THE HOSPITAL FOR SICK CHILDREN, GREAT ORMOND-STREET. I have become quite free from pain. Many years ago, on meeting the late Dr. Brinton in the Tyrol, I discussed some points of Alpine therapeutics with him, amongst them being the question THE object of this paper is to suggest for the consideration as to whether cases of slight albuminuria of obscure nature, of physiologists the question whether there is not a physiosometimes intermittent, were suitable for climbing tours. logical reflex from the right ventricle of the heart to the He was inclined to answer this in the affirmative, while 1 respiratory centre similar to that-from the left ventricle to jfegarded it as hazardous, partly on account of the great the vaso-motor centre along the depressor nerves, and with a strain on the capillary vessels, which were not healthy in similar function-viz., the automatic relief of over-distension some of these cases, and partly owing to the occasionally of the ventricle. The suggestion is founded on the following observations of clinical phenomena. 3 THE LANCET, Feb. 26th. and March 4th, 11th, 18th and 25th, 1876. 4 Rest in Cardiac 1. The dyspnœa of pericarditis.-I have lately had under vol. 1893. Affections, Practitioner, v., p. 190,