Medicine for Mountaineering & Other Wilderness Activities

461 Pages·1993·2.8 MB·English

by  James Wilkerson

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title: Medicine for Mountaineering & Other Wilderness
Activities
author: Wilkerson, James A.
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isbn10 | asin: 0898863317
print isbn13: 9780898863314
ebook isbn13: 9780585358413
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Page 1
Medicine for Mountaineering & Other Wilderness Activities
Fourth Edition
Edited by
James A. Wilkerson, M.D.
Merced Pathology Laboratory
Merced, California

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Page 2
© 1967, 1975, 1985, 1992 by The Mountaineers
All rights reserved
First edition 1967. Second edition 1975. Third edition 1985. Fourth edition: first printing 1992, second printing
1993, third printing 1994, fourth printing 1996, fifth printing 1998
No part of this book may be reproduced in any form, or by any electronic, mechanical, or other means, without
permission in writing from the publisher.
Published by The Mountaineers
1001 SW Klickitat Way, Suite 201, Seattle, Washington 98134
Published simultaneously in Great Britain by Cordee, 3a DeMontfort, Street, Leicester, England, LE1 7HD
Manufactured in the United States of America
Copyedited by Linda Gunnarson
Illustrations by Marjorie Domenowske
Cover design by Elizabeth Watson
Layout by Laurie Radin
Typography by Graphics West
Cover Photo: Eldorado Peak and McAllister Glacier, North Cascades National Park, Washington. Bob and Ira
Spring.
Cover Insets, from left to right: Cyclist in redwoods, Whakare Warewa Forest Park, New Zealand.
Kirkendall/Spring. Snowshoer, Cascade Mountains, Washington. Kirkendall/Spring. Campsite on Norse Peak,
Washington. Kirkendall/Spring. Cruising in Puget Sound, Washington. Marge and Ted Mueller.
Library of Congress Cataloging in Publication Data
Medicine for mountaineering & other wilderness activities / edited by James A. Wilkerson.
4th ed.
p. cm.
Rev. ed. of: Medicine for mountaineering. 3rd. ed. 1985.
Includes bibliographical references and index.
ISBN 0-89886-331-7
1. MountaineeringAccidents and injuries. 2. Sports medicine. I. Wilkerson, James
A., 1934- . II. Mountaineers (Society) III. Medicine for mountaineering. IV. Title:
Medicine for mountaineering and other wilderness activities. (DNLM: 1. First Aid
handbooks. 2. Mountaineering handbooks. 3. Sports Medicinehandbooks.
QT 39 M4892)
RC 1220. M6M4 1992
617.1'027dc20
DNLM/DLC
for Library of Congress 92-25641
CIP

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Page 3
CONTENTS
Contributors 5
Foreword 7
Acknowledgments 9
Introduction 11
Section One: General Principles
1. Diagnosis 16
2. Basic Medical Care and Evacuation 23
3. Special Problems 36
4. Psychologic Responses to Accidents 49
5. Immunizations, Sanitation, and Water Disinfection 65
Section Two: Traumatic and Nontraumatic Disorders
6. Soft-Tissue Injuries 82
7. Fractures and Related Injuries 93
8. Burns 118
9. Heart and Blood Vessel Disorders 126
10. Respiratory System Disorders 140
11. Chest Injuries 157
12. Gastrointestinal Disorders 165
13. Acute Abdominal Pain 189
14. Abdominal Injuries 202
15. Neural Disorders 208
16. Head and Neck Injuries 214
17. Eye, Ear, Nose, and Throat Disorders 226
18. Genitourinary Disorders 234
19. Infections 245
20. Allergies 259
Section Three: Environmental Injuries
21. Medical Problems of High Altitude 266
22. Cold Injuries 295
23. Heat and Solar Injuries 315
24. Animal Bites and Stings 325

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Page 4
Appendixes
A. Medications 347
B. Therapeutic Procedures 380
C. Medical Supplies 393
D. Legal Considerations 397
E. Glossary 400
Index 408

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Page 5
CONTRIBUTORS
C. KIRK AVENT, M.D., Professor of Medicine, Infectious Disease Division, The School of Medicine, The
University of Alabama in Birmingham, Birmingham, Alabama. (Chapter Nineteen)
EARL E. CAMMOCK, M.D., General Surgeon, Mount Vernon, Washington; Clinical Instructor in Surgery,
University of Washington School of Medicine, Seattle, Washington. (Chapter Seven)
FRED T. DARVILL, M.D., Diagnosis and Internal Medicine, Mount Vernon, Washington; Clinical Assistant
Professor of Medicine, University of Washington School of Medicine, Seattle, Washington. (Chapter Twelve)
BEN EISEMAN, M.D., Professor of Surgery, University of Colorado School of Medicine; Chairman, Department
of Surgery, Rose Medical Center, Denver, Colorado. (Chapters Eleven, Thirteen, and Fourteen)
CHARLES S. HOUSTON, M.D., Internist and Cardiologist, Burlington, Vermont; formerly Professor of Medicine,
The University of Vermont College of Medicine, Burlington, Vermont. (Chapter Ten)
HERBERT N. HULTGREN, M.D., Professor Emeritus of Medicine, Stanford University Medical School; formerly
Chief, Cardiology Division, Palo Alto Veterans Administration Medical Center, Palo Alto, California. (Chapter
Nine)
DRUMMOND RENNIE, M.D., Adjunct Professor of Medicine, The University of California, San Francisco,
School of Medicine, San Francisco, California; Senior Editor, The Journal of the American Medical Association.
(Chapter Twenty-one)
LAWRENCE C. SALVESEN, M.D., Psychiatrist, Pownal, Maine; Staff Psychiatrist, Outpatient Stress Unit,
Veterans Administration Hospital, Togus, Maine; Mental Health Member, Southern Maine and Tri-County Stress
Debriefing Teams. (Chapter Four)
JOSEPH B. SERRA, M.D., Orthopedist, Stockton, California; Assistant Clinical Professor of Orthopedics,
University of California, Davis, School of Medicine, Davis, California. (Chapter Seven)

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Page 6
JAMES A. WILKERSON, M.D., Pathologist, Merced, California.
Note: The chapter listings indicate the chapters for which each contributor was primarily responsible. However, as
in earlier editions of the book, the text has been edited to provide the uniform approach and consistent style
desirable for the nonprofessional audience to which this book is directed. The contributors have been most
understanding in consenting to such changes in the manuscripts they have submitted.

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Page 7
FOREWORD
Mountaineering: The Freedom of the Hills had been off the press scarcely long enough for copies to traverse the
continent to the shores of the Atlantic Ocean when I received a letter from there commenting on a serious
imbalance. The writer, a climber completing his medical education at Johns Hopkins, commented that while the
chapters on snowcraft and geology were admirably thorough, the chapter on first aid, though expertly written by
climber-physicians, was the barest of elementary outlines. The book told more about the snow under climbers'
boots and the rocks in their hands than it did about their bodies.
Given this level of instruction, what could the average wilderness traveler do about pyelonephritis, a pulmonary
embolism, a retinal hemorrhage? Could he/she cope with snakebite, a flail chest, a "cafe coronary"? Or for that
matter, swollen wisdom tooth, fecal impaction, poison oak?
In the Climbing Course of The Mountaineers, and in a companion course in mountaineering first aid, we went a
considerable distance into second aid and urged students to enroll, as well, in a Red Cross program. Still, the
unspoken rule was: Don't get badly hurt or seriously ill at any distance from civilization unless you have an M.D.
in the party. Or, to paraphrase an old Alpine maxim, "When a climber on a weekend trip comes down with the flu
or breaks an ankle, he apologizes to his friends. When he gets acute appendicitis three days from the road his
friends apologize for him."
Halfway and more through the twentieth century, wilderness mountaineers were recapitulating the frontiering of
their nineteenth-century ancestors, settlers of lonesome lands where in emergencies they could turn only to
themselves and God, and where, ministers and physicians being equally rare visitors, the family library like as not
consisted of two volumesthe Bible and the "doctor book."
Our ancestors were better off than we, because they had a doctor book. Jim Wilkerson's offer to prepare one was
welcomed enthusiastically by those of us who had produced Freedom of the Hills, yet never in the wildlands been
free from submerged anxieties (does that sudden stabbing pain in the abdomen emanate from the appendix? or the
salami?), anxieties that erupted as panic when a companion took a hard hit in the head (is it a fracture? a
concussion? is blood coming out of the ears? or flowing into them from a cut in the scalp?).
As a nonprofit publisher we had no need to consider the potential sales, if any; we expected to sell fewer copies
than we gave away to indigent expeditions unable to recruit an M.D. We were contentif on one climb in one
mountain range of the world

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Page 8
the book ever saved one life, it was worth doing. We were certain there would be, over the years, many more than
one.
Supposing, though, all the wilderness travelers who ever owned copies were guarded by an incredibly lucky star
and never experienced or witnessed mortal peril? Even so, the book would be a blessing, for the confidence it gave
in "copability." To be sure, it could not help a layman remove an inflamed appendix, but it could help him
distinguish a dozen feel-alikes from the real thing, and that would be a comfort. Those travelers under the
incredible star might never turn the pages, yet in all their lucky years would gain peace of mind from having the
book in their rucksacks.
In the early 1960s we of The Mountaineers book-publishing program took great satisfaction and pride in
encouraging Dr. Wilkerson to proceed, and knew the discriminating few would be grateful. What surprised us was
that, far from the pages yellowing on the shelves, the book soon was moving out of our warehouse at a rate
exceeded only by that of Freedom itself. That it has continued to do so and now, after these twenty-five years,
comes forth in a state-of-the-art fourth edition shows how wrong publishers can be. Plainly, the merit of the
volume has been recognized by the discriminating many.
HARVEY MANNING
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