Mountain Journeys 39 



or Mareo) is felt only moderately, the patient complains of a difficulty 

 in breathing, which compels him to stop after about ten steps, and he 

 tries in vain by deeper inhalations and a greater expansion of the chest 

 to draw more of the life-giving element into his lungs. He feels as if 

 he were shut up in a room without air, and the distressing sensation is 

 increased by the failure of all his attempts to conquer his loss of 

 strength'. The feet can hardly support the body, the knees bend, and 

 every opportunity to rest, no matter how frequent, even after only a 

 few steps, is welcome. It is a torment to climb streets sloping up- 

 ward, and while he heaves himself painfully towards home, it is a 

 real joy to find a doorway, a corner where he can stop and lean against 

 something, burdened as he feels. The distress lessens only during 

 absolute repose; but the conviction of the absolute necessity of the ill- 

 ness, the incapacity for any intellectual effort, and the sense of loss of 

 precious time bring on ill humor and discouragement, so that a vigorous 

 man acts like a little child. 



Those who are most seriously affected by this illness are often 

 seized with syncopes, symptoms of an afflux of blood to the head and 

 the lungs, with an indefinable distress; and without fever, even with a 

 feeling of inner chill, with hands and feet numb, their pulse beats at 

 the rate of 108 to 120 times per minute. The unconquerable fatigue, 

 the tendency to sleep are far from bringing on refreshing drowsiness, 

 so that they cannot find repose. In fact, night brings the strongest 

 feelings of suffocation, it is a real martyrdom; unable to endure a pros- 

 trate position any longer, the unhappy patient seeks comfort beside 

 the scanty fire which hardly keeps alive in the fireplace, at the risk of 

 breathing air laden with coal fumes. The eyes are so weak that one 

 can hardly read; in some, moreover, slight headaches appear, whereas 

 in others there predominate discomforts and disorders of the digestive 

 organs which resemble seasickness, from which, however, the puna 

 is distinguished by its course as well as by its causes. 



When this painful stage is nearly over, often very distressing 

 critical symptoms appear. After 6 or 7 days, the violent symptoms 

 usually ameliorate in those who have strong lungs and a good consti- 

 tution; otherwise, weeks may pass before the patient improves. An 

 eruption of urticaria appears over his whole body, or is limited to the 

 lips, on which it causes scabs, bleeding, or unendurable pain. ... In 

 persons with thin skin and fair complexion, blood may issue from the 

 skin without any wound, so that while the puna lasts, many dare not 

 shave. In spite of the severity of the symptoms, there are hardly any 

 cases in which they have caused death, and there is no danger except 

 for those with weak lungs and especially those with heart disorders. 

 (Vol. II, p. 84.) 



Poeppig then explains the reactions of different temperaments 

 and different races, and gives therapeutic advice; he admits a cer- 

 tain degree of acclimatization for Europeans. 



He next states that the residents of the country, even those born 

 there, are not absolutely immune to the illness, especially when the 

 nights are cold. The Indians have a sort of immunity. Beasts of 



