Summary and Discussion 331 



plainly dicrotic, and is progressively smaller and more easily de- 

 pressed. The tracings made by M. Lortet during the ascent of 

 Mont Blanc (see page 112) are very clear in this regard. The 

 arterial tension decreases considerably. 



Other observers, on the contrary, have found the pulse full, 

 strong, "vibrating," says Guilbert, "as in aortic insufficiency" (see 

 page 54) . According to Junod, who experimented in closed vessels, 

 it is full, depressible, frequent (page 229) . Without losing strength, 

 says M. Lepileur, the pulse increases in rapidity considerably 

 (page 236). 



The venous system displays no less striking phenomena; full- 

 ness of the blood vessels, congestion of the skin, the lips, and the 

 conjunctiva; face violet or reddish, swollen; lips blue and swollen. 



Then sometimes the picture suddenly changes completely; the 

 face becomes pale; syncope seems imminent. Sometimes it actually 

 appears, going as far as complete loss of consciousness. Upright 

 posture is very likely to bring it on (see pages 79, 106) . 



The most terrifying, if not the most serious, of the circulatory 

 disturbances is hemorrhage; it appears less frequently than is 

 generally said; in order of frequency, we note first nasal and pul- 

 monary hemorrhages, then hemorrhages from the eyes, the lips, 

 the ears, and the intestines; finally, M. Martins experienced a 

 slight hematuria. Mile. Dangeville found that her menstrual period 

 was considerably advanced; but the violent exercise might explain 

 that. 



These losses of blood have been observed in animals, especially 

 horses and cattle. I mention in passing the important observation 

 of Dr. Clark, who remarked that the blood coming from the nose 

 was "darker than usual" (page 91). 



Locomotion. The heaviness of the lower limbs, the "blow on 

 the knees", a fatigue which the efforts made do not explain, are 

 among the first signs of mountain sickness. We have seen in 

 numerous quotations that at a certain height it becomes impossible 

 for the sturdiest walkers to take more than a few steps without 

 stopping. And this is a matter of altitude, not of the ordinary 

 difficulties of mountain journeys. "I made 34 miles on foot," says 

 Captain Gerard, "through country which would be called moun- 

 tainous by those who do not know the difficult parts of Koonawur, 

 more easily and quickly than I could walk 12 miles in these lofty 

 regions. When the altitude is more than 14,000 feet, every mile, 

 even when the road is good, requires at least twice as much time as 

 at the height of 7000 to 8000 feet" (see page 138) . 



