History of Medicine

                                MEDICINE AT HIGH ALTITUDES

 

         In the late nineteenth century, high-altitude ballooning became popular and adventurous mountain trekkers found ever-higher peaks to conquer. At the extreme elevations participants in both activities encountered difficulties that eventually led to a new specialty: high-altitude medicine. 

         The title, “father” of high-altitude physiology (and of aviation medicine),” is usually awarded to Paul Bert, a French physician and investigator. Another French physician, though, deserves to be included as a “co-father” – Denis Jourdanet. The work of the two might be considered a collaboration between a laboratory investigator, Bert, and a clinically oriented physician, Jourdanet, with Jourdanet supplying the funds.

         Paul Bert (1833-1886) was born in the Burgundy area. He trained as a lawyer but he was intrigued by the mysteries of nature and

Paul Bert (Wikipedia)

eventually took enough courses to sit for a degree. Claude Bernard, one of his examiners, was so impressed with his thesis on respiratory physiology that he took him on as an assistant after he first obtained his medical degree. Bert did experiments on tissue grafting, said to have been helpful to surgeons in the Franco-Prussian War and for which he received a prize from the Academy of Sciences. Bernard got him a professorship at the University of Bordeaux followed by one at the Sorbonne. Bert was politically active, very left-wing, and constantly at odds with the Jesuits. His university appointment was opposed by a group of bishops but, with the influence of Louis Pasteur, he obtained it.

         Denis Jourdanet (1815-1892) was born in the Pyrénée

Denis Jourdanet (Wellcome Library)

mountains and remained there until university age, then studied medicine in Paris. Restless, he shipped off to Mexico before finishing his degree and set up a practice in the Yucatan peninsula. Through the French consul he became well-connected and married the daughter of a wealthy Mexican diplomat. After a return to Paris to obtain his medical degree he moved to Mexico with his wife, who had tuberculosis, and settled, eventually, in Mexico City, where he joined the faculty of the medical school. His wife improved temporarily at their 2240-meter altitude leading Jourdanet to become interested in the effects of altitude and measure barometric pressures on various mountaintops. His wife succumbed to TB in 1859 and he returned to Paris, where he published on the beneficial effects of higher altitudes and drew attention to the similarity of the symptoms of anemia and those seen after rapid ascent to high altitude.

         He designed low pressure air chambers for treatment of tuberculosis and other illnesses and published a book on his work in 1861. That same year France invaded Mexico and shortly after

Low-pressure chamber used by Jourdanet
for treatments (from La Pression Barométrique, 
Hathi Trust)

installed Maximilian as Emperor. Maximilian asked Jourdanet to be his personal physician but Jourdanet declined (wisely). In 1865 he remarried into another wealthy Mexican family and eventually settled in Paris to conduct research. It was then that he met Paul Bert.

         Bert was aware of Jourdanet’s idea that a deficiency of oxygen was the common factor responsible for the comparable symptoms seen with anemia and high-altitude exertion and wanted to study this using low-pressure chambers. Lacking funds, he advertised openly for money and Jourdanet, now wealthy, answered the call. Meanwhile Jourdanet continued treatment of various diseases with the low-pressure chamber, which he called “aerotherapy.” (He was not the first to use this treatment.) In 1875, he published a large tome, Influence de la Pression de l’Air sur la Vie de l’Homme, a two-volume work with numerous illustrations. Following an extensive historical background, he describes his treatment methods and lays out his ideas on hypoxia as the common problem in anemia and high altitude.

         Paul Bert, grateful for the support of Jourdanet, used both high and low-pressure chambers to establish the critical role of oxygen. He subjected animals and humans, including himself, to low pressure states, then reversed the symptoms with added oxygen.

Concentrations in blood of O2 (bottom) and CO2 (top)
plotted against partial pressures (horizontal)
from Pression Barométrique (Hathi Trust)

Conversely, he deprived the air of oxygen at normal pressures, all the while measuring partial pressures of oxygen and CO₂ in the blood. He was the first to map the hemoglobin disassociation curve, though his version was incomplete, and establish that the partial pressure of oxygen is the determinant factor.

         Bert eventually, in 1878, produced his magnum opus, La Pression Barométrique: Recherches de Physiologie Expérimentale. In it he describes his experimental work and presents a thorough history of high-altitude studies and lore up to 1878. In the introduction he gives full recognition to the help he received from Jourdanet, both financial and scientific. The work did not achieve the praise it deserved at first, allegedly because Bert was involved in several political activities that diverted attention, but in time it was recognized as a master work that has endured.

Bert's lab at the Sorbonne. Presure chambers on right wall, air pump in center
(from Regnard, P, La Cure d'Altitude, Hathi Trust)

         Bert was indeed involved in political activities. He was especially forceful in promoting free, secular, and obligatory education with no church involvement. He wrote a science textbook for use in schools. He became a member of the Chamber of Deputies and eventually Minister of Public Instruction. Finally, he was sent to Hanoi to become Governor General of French Indochina, where he liberalized the French rule and reduced the role of the military in governance. Sadly, after only five months in office, his life and career ended with a bout of severe dysentery.

         Many investigators subsequently refined the relation of oxygen to hemoglobin, determined that oxygen diffused into blood and was not secreted (the latter a position held by J. S. Haldane), and worked out the physiology of high-altitude pulmonary edema and acute and chronic mountain sickness. The benefits continue to flow to mountaineers, pilots, and intensive care units. 

 

SOURCES:

West, John B., High Life: A History of High-Altitude Physiology and Medicine. 1998, Oxford Univ. Press.

Olmstead, J. M. D., “Father of Aviation Medicine." 1952; Scientific American, 186 (1): 66-73.

West, John B. and Richalet, Jean-Paul, “Denis Jourdanet (1815-1892) and the Early Recognition of the Role of Hypoxia at High Altitude.” 2013; Am J Physiol Cell Mol Physiol 305: L333-L340.