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July 4, 1986

The Great Breathlessness Mountains

Author Affiliations

Rush Medical School Chicago West Suburban Hospital Medical Center Oak Park, Ill

JAMA. 1986;256(1):81-82. doi:10.1001/jama.1986.03380010085031

Between 37 and 32 BC, the high Chinese official Too-Kin reported on the difficulties an armed escort would encounter crossing what was probably the Kilik Pass (4827 m, or 15 837 ft)1 into what is now Afghanistan. He wrote of the lifeless desert, the absence of food, the proud yet cringing, cruel, and crafty inhabitants, and the route, which crosses "the Great Headache Mountain" and "the Little Headache Mountain" where "men's bodies become feverish, they lose colour, and are attacked with headache and vomiting."2

What Too-Kin described was acute mountain sickness (AMS), which is a common affliction that comes on one or two days after ascending too high too fast. Acute mountain sickness is usually transient and is invariably cured by descent, but it may occasionally worsen and manifest itself as high-altitude cerebral and pulmonary edema (HACE and HAPE), both of which may be fatal, as was the