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May 20, 1974

Splinter Hemorrhages at High Altitude

Author Affiliations

Rush Medical College Chicago

JAMA. 1974;228(8):974. doi:10.1001/jama.1974.03230330016002

To the Editor.—  On the recent American Expedition to Dhaulagiri, Nepal, (8,167 meters [26,795 feet]), the sixth highest mountain in the world, I developed numerous splinter hemorrhages in my fingernails. They appeared spontaneously during a restful evening when I was at base camp (5,880 meters [19,300 feet]), and the next morning I counted 46, of which 11 were beneath each thumbnail. The hemorrhages were thin, red, longitudinal streaks between 0.5 and 4 mm long, arranged near the distal part of the nail bed in a corona (Fig 1). As they grew out, they could be seen to lie in the soft, thin layer peeling off the undersurface of the nail.I had spent the previous five weeks in good health, transporting loads of 18 to 27 kg (40 to 60 lbs) from 760 meters (2,500 feet) to base camp, where I had been living for six days. The previous day