ADAPTATION T HIGH ALTITUDE 



High-Altitude Medicine — Despite 

 the fact that over 25 million people 

 live at high altitudes, no information 

 regarding their special medical prob- 

 lems is available. The following sub- 

 jects need to be treated: (a) high- 

 altitude diseases such as acute and 

 chronic mountain sickness and high- 

 altitude pulmonary edema; (b) mod- 

 ification by high altitude of diseases 

 that are common at sea level such 

 as pneumonia, coronary disease, and 

 shock; (c) action of drugs such as 

 opiates and anesthetics that are modi- 

 fied by high altitude; (d) occupa- 

 tional diseases at high altitudes. The 

 emphasis should be on clinical medi- 

 cine rather than physiology. 



Evaluation of the Effects of Pul- 

 monary and Cardiac Disease upon 

 Cardio-Respiratory Function at High 

 Altitude — Pulmonary function and 

 hemodynamic studies should be car- 

 ried out in high-altitude residents 

 with silicosis, stanniosis, and follow- 

 ing pneumonectomy. The working 

 capacity of such patients should be 

 evaluated by appropriate methods. 



Techniques of early detection of in- 

 dustrial pulmonary disease at high 

 altitude should be evaluated and ap- 

 plied to workers. 



Factors Affecting Biliary Cholelithi- 

 asis in Native Highlanders — Choles- 

 terol stones are commonly observed 

 at high altitude, with probably a 

 different sex incidence than usually 

 observed at sea level. Since this is 

 an important cause of illness, the 

 causative factors should be studied. 

 The study should include an inves- 

 tigation of dietary habits and serum 

 lipids of patients with proven chole- 

 lithiasis compared to control subjects 

 living in the same area with normal 

 cholecystograms. 



Drug Action at Different Alti- 

 tudes — Drug action is probably sig- 

 nificantly modified in the hypoxic 

 high-altitude environment. Toxicity 

 may be enhanced or diminished and 

 the therapeutic effect may be altered. 

 Studies should be made and known 

 information collected regarding the 

 effect of selected drugs at various 



altitudes in the world. Drug' 

 as narcotics, anesthetics, analgesics, 

 opiates, pressor drugs, and cardiac 

 glycosides should be investigated. 



Vital Statistics in Relation to Al- 

 titude — Vital statistics of WHO are 

 arranged for countries according to 

 many categories — but not altitude. 

 Such information is necessary in 

 order to determine the effect of al- 

 titude upon the incidence of disease 

 and mortality. 



Functional and Intellectual Cor- 

 relates of Altitude Hypoxia in Chil- 

 dren — It is important to determine 

 if the development and function of 

 the central nervous system is ad- 

 versely affected by the chronic hy- 

 poxia of high altitude. Suitable 

 physiologic tests should be developed 

 to quickly determine the degree of 

 chronic hypoxia in children. Tests of 

 central nervous system functions that 

 could be affected by chronic hypoxia 

 should be designed that would be 

 suitable for field studies. 



ADAPTATION TO SMOG AND CARBON MONOXIDE 



Smog is a vaguely defined word, 

 certainly not a well-defined chemical 

 species. In general, it means the 

 totality of community air pollution, 

 though it has been applied more 

 specifically (a) to sulfur oxide and 

 particulate pollution, occurring chiefly 

 in coal-burning areas, and (b) to 

 photochemical air pollution, common 

 in southern California, which is af- 

 fecting an increasing number of ur- 

 ban cities with intense pollution from 

 motor-vehicle exhaust. 



Smog in southern California has 

 not been shown capable of increasing 

 the short-term fatality rate, but both 

 types of community air pollution 

 cause respiratory irritation, both can 

 aggravate asthma (though they prob- 

 ably do not cause it), and both are 



suspected of a part in the develop- 

 ment of chronic respiratory disabil- 

 ity — emphysema in the case of 

 photochemical pollution, and chronic 

 bronchitis in the case of sulfur oxide 

 and particulate pollution. Readily 

 measurable impairment in airway 

 resistance and other respiratory func- 

 tions occurs among the populations 

 most likely to show increased fre- 

 quencies of chronic bronchitis and 

 emphysema. The distinction between 

 the two diseases as causes of death 

 is largely related to the extent to 

 which there are adaptive mechanisms 

 in the airways causing increased se- 

 cretion of mucus. 



Man is exposed to carbon mon- 

 oxide (a) in cigarette smoking, (b) 

 in occupational exposures to com- 



bustion products, (c) in connection 

 with community air pollution, (d) 

 in confined areas contaminated by 

 motor-vehicle exhaust, and (e) when 

 household cooking and heating ap- 

 pliances are not adequately vented. 

 Carbon monoxide can and does kill, 

 especially in association with occupa- 

 tional exposure and poorly vented 

 appliances. There is growing suspi- 

 cion that the excess mortality from 

 coronary heart disease among ciga- 

 rette smokers may be due to carbon 

 monoxide, a major toxic constituent 

 of cigarette smoke. (See Figure XI-7) 

 There is also a suspicion that carbon 

 monoxide, as a community air pollu- 

 tant, may interfere with the survival 

 of patients with acute myocardial in- 

 farction (heart attacks), and that it 

 may play a role in impairing the op- 

 eration of motor vehicles. 



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