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JAMA 100 Years Ago
July 24/31, 2013

The Blood Phenomena of Altitude

JAMA. 2013;310(4):435. doi:10.1001/jama.2013.5225

Originally Published July 26, 1913 | JAMA. 1913;61(4):283-284

The arrival of the summer months, marking the return of the season of mountain climbing, revives the old problems of the physiology of higher altitudes. We are reminded anew of questions that are of perennial interest, some of which are apparently little nearer their permanent solution than they were a decade or even a generation ago. Foremost among them is the relation of altitude to the circulation, particularly to the number of red blood-cells and their hemoglobin content. In 1882 Paul Bert observed that the blood of animals from La Paz in Mexico, at an altitude of 3,700 meters (12,140 feet), had an oxygen-carrying capacity far in excess of that exhibited by the animals on the lower plains. An explanation of this was forthcoming when, in 1890, Viault found that at the height of 4,392 meters (14,410 feet) in Peru, his blood exhibited from 7 to 8 millions of red corpuscles per cubic millimeter instead of the customary 5 millions. The same facts have since been observed over and over again. But how are they to be interpreted? Are we confronted, in this interesting finding at higher altitudes and their accompanying rarefied atmospheres, with an actual new formation of corpuscles? If so, this is a unique illustration of the adaptive response of the organism to the necessities imposed by the diminished oxygen tension. This interpretation of the blood phenomena of altitude proposed by its earliest investigators has been assailed from time to time by subsequent students of the subject. The objections interposed are themselves of interest because they suggest still other features of the effect of rarefied atmospheres and also modify our views as to the therapeutic possibilities of residence at higher altitudes. Thus it has been maintained that the greater dryness of the air in these environments, together with increased muscular activity, enhances the loss of water from the body through the respiratory tract in particular, and thereby leads to a concentration of the blood. The corpuscular elements will accordingly exhibit an apparent increase in number in a given volume of blood without any real increase in the absolute numbers present in the entire organism. Zuntz and his pupils have emphasized the possibility of an altered distribution of the corpuscles in different vascular areas, leading to a so-called vasomotor displacement of the cellular blood-elements whereby they become more concentrated in those peripheral regions from which specimens for examination are conventionally taken. Abderhalden has analyzed the entire bodies of animals maintained at high altitudes, and failing to find any pronounced increase in hemoglobin, he explains the undoubted augmentation observed in blood-samples by a concentration of the blood through exudation of plasma into the lymph-spaces. It has further been suggested that the red corpuscles may be conserved better at high altitudes and thus a comparative increase result from the failure of normal destruction. Finally, errors in the technic of blood measurements, etc., due to the diminished pressure at altitudes, have repeatedly been propounded.