Jim Milledge has been one of the UK's leading figures in mountain medicine for many years. In 2018 he completed a long awaited memoir - "Mountains My Lab". Although Jim's intention was not to publish the book widely he has granted us permission to reproduce extracts on our blog. Over the course of this year we'll bring you images and text that describe Jim's extraordinary life.
Part 1 includes an overview of Jim's life.
Here's Part 8...
In November 1959 I was working as a Registrar at the Chest Hospital in Southampton. My chief, Dr. William Macleod, had suggested that it was time we started to do lung function tests on our patients with chest diseases. He gave me “The Lung” by Julius Comroe, a small green book that distilled the results of years of work in this field by a group of outstanding American researchers. I started reading without much enthusiasm but soon became fascinated with the possibilities of understanding the nature of our patients’ breathing problems. The patients were all short of breath on exertion but Comroe showed how, by using simple breathing tests, one could distinguish those patients whose breathlessness was due to increased resistance in the airways as in asthma or bronchitis, from those due to problems of exchanging gas between air and blood in the depth of the lungs. This is a less common cause of breathlessness and can be more difficult to recognize.
The Lung - Clinical Physiology and Pulmonary Function Tests by Julius H Comroe Jr, Robert E Forster, Arthur B Dubois, William A Briscoe and Elizabeth Carlsen.
Soon after reading the book, we had a patient with this sort of problem. He had been a farmer and went to his doctor complaining of shortness of breath when he exerted himself. His doctor could not find anything wrong and referred him to a chest specialist who also could not find any abnormal signs in his chest and his chest x-ray was normal. He continued to complain of increasing shortness of breath if he exerted himself at all, though he was perfectly all right when sitting quietly at rest. He was even referred to a psychiatrist since there seemed to be no physical cause for his complaint. Eventually he was sent to Dr. Macleod who suspected he might have Farmer’s Lung, a condition cause by inhaling the dust of moldy hay. By now, his chest x-ray was showing the very earliest sign of some generalised haziness; his lung function test showed no evidence of increased airways resistance, such as patients with asthma or emphysema have. I took a sample of blood from an artery (considered a rather bold investigation in those days, though now considered quite routine) and found that the level of oxygen was well below normal, indicating that his lungs were not passing oxygen across into his blood in the normal way. This defect caused no problem at rest but as soon as he began to need more oxygen for climbing stairs for instance, the lack of oxygen became acute and fully accounted for his symptoms.
It was because of this patient, and others like him, that I became fascinated in the workings of the lung, respiratory physiology, a subject I had found quite boring as a second-year medical student. I realised that the problems of the patient with Farmer’s Lung was similar to that of a mountaineer at high altitude. In both cases, the cells of the body are short of oxygen, especially on exercise. In the case of the patient with Farmer’s Lung, this is due to the disease having damaged his lungs so that the delicate membrane separating air in his lungs from the blood becomes thicker, so impeding the passage of oxygen into his blood. In mountaineers, at altitude, it is due to the reduction in barometric pressure and hence the pressure of oxygen in the air he breathes. This means that each breath contains fewer oxygen molecules than that at sea level. The interesting thing about mountaineers is the way they can acclimatise to high altitude, so that they not only stay alive and conscious but also can actually continue climbing and functioning almost normally, at an altitude (such as the summit of Everest) at which, if they were suddenly exposed, they would die in a few minutes. This process of acclimatisation had been studied for many years by a few scientists but was still not entirely understood. Indeed, that is still true today.
Getting onto the Silver Hut team
About this time (November 1959) I noticed a short paragraph in ‘The Telegraph’ announcing that Sir Edmund Hillary was going to lead an expedition next year to the Everest region of Nepal. It was to be a scientific and mountaineering expedition, which would “winter over” at high altitude in order to study the effects of altitude on the expedition members over a period of six months. Then, in the following spring, an attempt would be made on Makalu (8470m), the fifth highest mountain in the world. The physiology would be continued if possible at advanced Base Camp (6,300m) and on the Makalu Col (7,400m). The scientific leader was Dr. Griffith Pugh of the Medical Research Council. Pugh had been the physiologist attached to the successful ‘53 Everest Expedition. This sounded like just the sort of expedition I would love to go on! I dreamed about it for a few days, discussed it with Betty, my wife and then, with a feeling that I was being very cheeky, I wrote to Dr. Pugh. I mentioned my climbing and skiing experience, such as it was, then gave my medical experience which was fairly general such as might be useful as an expedition Medical Officer. I added that now I was interested in lung function testing and therefore in respiratory physiology. Might there be a place on his team either as assistant Medical Officer or assistant Physiologist?
Much to my surprise he replied by return; he said that actually the team was more or less made up but that if I happened to be in London to come and see him at the MRC Laboratories on Holly Hill in Hampstead. Well, I made sure that I “happened” to be going to London the very next day. I found Griff in the tower office of his cluttered laboratory in the red brick block of the MRC Labs. He was quite welcoming in his absent-minded way. We chatted about my background briefly and about the expedition and it began to emerge that one member of the team was uncertain about coming.
Griff’s method of choosing the team was to decide what pieces of work he wanted done, then to choose people with the necessary expertise to do them. One project was to repeat, at altitude, the work, which had been done at the Oxford University Physiology Department on the chemical control of breathing. Both carbon dioxide and lack of oxygen stimulate the breathing (make you breath more – make you breathless} and the workers at Oxford had been studying the details of this control mechanism. Because of the lack of oxygen at altitude (due to the lower barometric pressure) it was almost certain that acclimatisation to high altitude involved changes in this control. We knew that the body seemed to become more sensitive to carbon dioxide in some way, but what about changes in response oxygen lack? Did the body become more or less sensitive to this stimulus? No one knew. Griff had asked the Oxford workers, Dan Cunningham and Brian Lloyd, if they could suggest a man to join the expedition and do a project along these lines. This was the man whose joining was uncertain. If Cunningham and Lloyd would accept me as Oxford’s man (and if Hillary was satisfied with me as a member) then I might get on board.
I felt it unlikely with all the keen young men available in Oxford, that Cunningham and Lloyd would choose an unknown red-brick graduate like me as their representative on the expedition. However, I went to Oxford to meet them. They were very affable and rather than interview me in the conventional way they took me into one of the large class laboratories and using the blackboard which covered all of one wall, Lloyd went through their work in detail. It involved not only conventional respiratory physiology but also quite a lot of mathematics, which were very much on the edge of my grasp. They seemed to judge my suitability by my response to this erudite exposition and the questions I asked. We parted amicably and I suppose I must have satisfied them because the next thing was a telegram from Griff inviting me to join the expedition.
Preparing for the expedition
In the early months of 1960 I got permission to spend an occasional day at Oxford. I would drive up there early in the morning from Southampton. Then we would do one of these three hour control of breathing experiments in which a volunteer subject would breathe various gas mixtures while we monitored his rate and depth of breathing and collected samples of his expired air.
Conducting an experiment in the physiology labs, Oxford.
In the afternoon we would analyse these samples using Brian Lloyd’s modification of Haldane’s apparatus for measuring carbon dioxide and oxygen in expired gas, by chemical means.
Born in Scotland in 1860, JS Haldane was an important respiratory physiologist based in Oxford in the early years of the 20th century. He had led one of the first expeditions to high altitude to study acclimatisation: the 1911 Pikes Peak Expedition in the Rockies. He invented apparatus for the accurate measurement of carbon dioxide and oxygen in gases. Nowadays, electronic instruments can do such analyses in a fraction of a second while the experiment is in progress; whereas the Haldane apparatus, even in the most expert hands, requires about 10 minutes per sample. Each experiment would produce 10-15 samples, which had to be analysed in duplicate. The chemical method is still used for checking the calibrating gases needed to calibrate these electronic instruments. In order to become familiar with the Lloyd-Haldane apparatus, I took one home and practiced with it. It is a beautiful looking piece of apparatus of blown glass, filled with mercury and coloured reagents. However, in using it, it is all too easy to pull the reagents into the wrong part of the apparatus then the whole lot has to be emptied, cleaned out and refilled, a job taking an hour or more. Even at sea level, when this happens, it is hard to control one’s language; at altitude, impossible! But one of the unsung achievements of the expedition was that John West, with my nudging, learnt to use the Lloyd-Haldane in the Silver Hut at 5,800m. But I anticipate!
During this period we worked out how we would carry out this sort of experiment at high altitude without all the resources of a physiology laboratory. In particular, how we could to manage without large cylinders of oxygen, nitrogen and carbon dioxide, which they used in Oxford. We hit on the idea that in order to steadily increase the level of carbon dioxide, we would collect the expired air in a large plastic bag and then have a subject breathe this gas and again collect his expired gas. In this way he would breathe successively, mixtures containing more and more CO2, which would stimulate his breathing.
About this time, I met Sir Edmund Hillary in Griff’s lab on one of his trips through London. I had met him briefly soon after the ’53 Everest Expedition, with his New Zealand friend George Lowe, who was also also on the ’53 Everest expedition.
I remembered him then as very much “one of the boys”. Now 7 years later he seemed very much more mature and clearly a leader of men. Betty had no ties and was very keen to come with us to Nepal. She knew she would be welcome at Shanta Bhowan Hospital where her anaesthetic skills would be put to good use. We arranged with Ed that she would act as liaison officer for the Expedition in Kathmandu in return for her fare there and back. In May 1960 I resigned from the National Health Service and we went to live in London.
Griff and Ed had been together in Antarctica in 1956-7 (as well as of the ’53 Everest Expedition) when Foulks and his UK team made the first crossing of the continent. Hillary and his New Zealand team supported him by laying supply dumps from the NZ base on the other side of the continent. So they discussed the possibility of a combined mountaineering and scientific expedition to the Himalaya to study the effect of really long term exposure to high altitude on the physiology of the members. Their plan for the expedition was an ambitious one. It would start after the monsoon, leaving Kathmandu in September, spending the autumn in establishing a Base Camp and building a high altitude winter station. Griff insisted that condition for the winter should be as good as enjoyed by scientists in Antarctica. So a hut must be provided for accommodation and lab work, which could be warm, comfortable and provide accommodation and lab space for up to 8 people. There should be electricity for lighting and for lab equipment. It must be capable of being carried out from Kathmandu to the Everest region by porters, so loads must be not more than 30 kgs at most and its erection should not be too difficult at altitude. Griff and Ezra Leven (of the Timber Research association) designed such a hut. It was made up of panels using marine plywood with three inches of fiber inside for insulation. It worked very well and with its stove for heating and cooking was almost too warm!
I was to spend 3 months full time in preparation for the expedition working with Griff from his laboratory. Besides getting all the equipment together, we had to carry out the sea level control experiments on the expedition members against which we would compare our results at altitude. It was a very busy and varied three months. Mike Gill, a New Zealand medical student and a strong climber, came over and worked with us for some of this time and I met John West and Mike Ward, two more members of the scientific team, as they came to do their exercise tests in Griff’s lab. John was just making a name for himself as a leading young physiologist at the Postgraduate Medical School, Hammersmith Hospital. Mike had been with Griff and Ed on the ‘53 Everest Expedition as well as having masterminded the ‘51 reconnaissance expedition, which discovered the southern route up Everest. He was our expedition Medical Officer and Griff had chosen him because of his proven ability to function at high altitude. Some people just do not seem to be able to adapt to high altitude. The ability to do so cannot be predicted; except by a history of precious good experience of altitude. There was no guarantee that any of us novices would be capable. In the event we all acclimatized quite well, though some took more time than others.
During this time the high altitude laboratory, the “Silver Hut", was being made for us. The Sherpas referred to it as the Silver Hut because of the silver paint used on its wood panels, and eventually the expedition became known by that name. Griff’s idea of making and taking out a hut for our use in the winter was novel for a mountaineering expedition. It was no doubt based on his idea that good science required good living conditions and from his experience of the Cho Oyu and Everest Expeditions, as well as his Antarctic experience. He insisted that if we were to do good work we must have good conditions to live and work in. Also, we wanted to be sure we were studying the effects of high altitude alone without the effects of cold, starvation or dehydration, so we had to have warmth, plenty of food and fluid. The Silver Hut was the answer; it was constructed from boxed up plywood members, painted silver, 5 inches thick, containing 3 inches of plastic foam insulation and silver foil to reflect radiant heat back into the hut. These sections fitted together with pegs and holes like a three-dimensional jigsaw puzzle. The shape was cylindrical like the section of a London Underground carriage. At one end was a door with a snow porch within and the other end had large windows with four panes of Perspex separated by air gaps. The whole hut rested on three longitudinal beams and these on two cross beams with four jacks as legs, the idea being that if the glacier melted on one side we could jack it up. Wires with turn buckles pulled the sections together circumferentially and longitudinally. No piece was more than a porter load (30 Kg.) nor too bulky to be carried on the trail. Inside were 8 bunks, a table, stove and lab benches. It was a brilliant design and worked perfectly in the field. Many of the expedition members came together at the builders in Marlow to have a practice assembly. This was a very good idea and meant that when we came to erect it at 5800m on the Mingbo Glacier it went up fast and efficiently. After this practice, Sir John Hunt (as he was then) invited us to his gracious home near Henley on a lovely June afternoon with tea on the lawn.
There were three types of members - climbers, scientists and other specialists. Some, of course, were in more than one category. Then, some came for the autumn, some for the winter and some for the spring parts, some for two or all three parts. Altogether there were 21 members.
London to Kathmandu
Eventually in mid-August, Betty and I with 45 crates of equipment (including the Silver Hut) set sail from Tilbury for Bombay on the S.S. Oriana. Lila Bishop, wife of Barry Bishop an American member, also came with us by sea. The other members all traveled by air. We had a delightful trip especially as having to book rather late, only a first class cabin was available. I remember particularly in the Red Sea enjoying days with marvellous buffet lunches served beside the ship’s swimming pool. At Bombay we anticipated problems with Customs and these there were. Our previous experience of the Far East stood us in good stead and with patience, we got through in three days. One incident, which typifies Indian bureaucracy, I remember. I was waiting in a large shed in which there were rows of desks occupied by officials each with piles of files on each desk and on the floor. I watched one 3-ring official peruse a file slowly then initial it. He looked up and with an imperious wave summoned a Pune (messenger) from the end of the shed. The Pune weaved his way slowly between the desks and the piles of files to the august person who handed him the file and with an upward tilt of his chin indicated that the Pune was to take the file to the next desk, a distance well within the reach of this official!
We now had to get our 45 crates and ourselves across India to Patna. There we were to meet Peter Mulgrew and Wally Romanes - two New Zealanders who were bringing the main bulk of the expedition equipment, tents, climbing gear clothing and food, by road from Calcutta. Peter was an officer in the New Zealand Navy and a close friend of Hillary and Wally was a carpenter and builder. Both were also climbers. From Patna we were to fly it all and ourselves to Kathmandu. We were to go by train and the first leg was uneventful, Bombay to Ahmadabad. There we had to change and catch the Delhi-Calcutta express. There was only 10 minutes to spare but with a great effort and a small army of porters we got our 45 crates out of the guards van and across to the correct platform. However, when the express pulled in, the guard took one look at our mountain of crates and pronounced that there was no hope of getting them into his van. So Betty and Lila went on to Patna in our reserved sleeper and I stayed. Fortunately there was a fast goods train going that night and I was able to arrange for all our crates to go in one locked truck. I followed by slow passenger train.
It was good to meet more members of the Expedition in Patna including Peter Mulgrew and Wally Romanes. We were very well entertained there by the British Council representative, Jeremy Jasper. We charted a DC3 (Dakota) aircraft, which for 3 days shuttled us and our baggage between Patna and Kathmandu. In Kathmandu we renewed acquaintance with our friends in Shanta Bhowan Hospital who we had met two years before when we had visited from Hong Kong. They were delighted to welcome Betty as an honorary staff member for nine months. The expedition made its headquarters at the Royal Hotel, a hotel set up in an old Rana Palace and run by a larger-than-life white Russian, Boris. Its main advantage was a large area in front where we could unpack and repack our baggage. Inside, it had character and quaintness with its “Yak & Yeti” bar, but a high incidence of gut infections. Poor Peter Mulgrew got amoebic dysentery and most of us had minor degrees of gut rot. Only now, as we gathered together, could we appreciate the size of our expedition.
Composition and shape of the expedition
There were about equal numbers of British, New Zealanders and Americans. The scientists were mostly British; the climbers mostly New Zealanders and America supplied various specialists - an animal man, a biologist, a geologist, a doctor/bioengineer and our sponsor’s public relations man. The finance was from the Chicago based World Book Encyclopedia. Although the original concept was for a scientific and mountaineering expedition, Ed had decided that, partly as an acclimatisation exercise and partly because he was genuinely interested, that during the autumn the main body of the expedition would try and solve the question of the existence of the Yeti. I think that this objective may have been the main reason for World Books sponsoring the whole expedition. At any rate it was, of course, the aspect that the media latched on to and there was a real danger of the whole expedition being seen as just another Yeti hunt.
The Yeti part of the expedition, complete with our colourful journalist, Desmond Doig, and the World Book PR man, the animal man, Martin Perkins (who had his own TV show in the States), capture guns, trip wire cameras etc. set off a day ahead of the small party that I was assigned to. They were going into the remote Rolwaling Valley to hunt their Yeti and reach the Everest region via a high pass, the Tessi Lapcha. Our party would take the usual Everest march-in trail and take the bulk of the expedition supplies for the winter, plus the Silver Hut and scientific equipment.
With me were Norman Hardie, the leader of this group, Wally Romanes and Barry Bishop. Norman was an experienced New Zealand climber, an engineer, who had climbed Kangchenjunga with Charles Evans’ successful, first ascent expedition in 1954. Norman had a great love for the Sherpas and on the march-out passed on to us, all the Sherpa lore he had acquired from trekking and living with them for 6 months after the Kangchenjunga expedition. Wally was also from New Zealand, a builder, electrician and general handy man. He was a strong climber and a delightful companion who would contributed enormously in setting up our huts in the autumn and acting as maintenance man during the winter. Barry Bishop was from the States. He came as Glaciologist having majored in that subject after a degree in Geography. He was on the staff of the National Geographic and a keen semi-professional photographer. He was also a climber and three years later climbed Everest with the’63 (first) American Everest Expedition. He was very conscious of the public relations slant that seemed to be required by the National Geographic magazine and on which his job and prospects seemed to depend. This meant that the glaciological project, which Griff regarded as important, was always being interrupted to pursue various photographic ventures.
The working party - left to right - Wally Romanes, me, Barry Bishop and Norman Hardie.
The march to Solu-Khumbu
Our march out was, on the whole, delightful. It was the post-monsoon season with occasional heavy showers, but the country was green and lush. The first day of a trek is often a bit chaotic before the party gets into a routine and this trip was no exception. With 300 or so loads to assign and a deal of haggling over the less popular, awkward ones, we were late leaving. So we reached the nights camp, as it was getting dark. I seemed to have the job of finding food for our group from amongst the many loads. I had spotted some crates of tinned steamed pudding. So I prised one of them open to find the two dozen tins were Christmas pudding. I banged the nails back and opened another, Christmas pudding again. A third crate was also Christmas pudding. It was Ed who had chosen our stores and although this manufacturer made a range of steamed puddings Ed had chosen only crates of Christmas pudding.
On the march out we were very well looked after by our Sherpas. The day would start by our Sherpa waking us with tea and tsampa. Tsampa is fine ground roasted barley. The Sherpas make porridge with it and eat it hot or cold; I liked a spoonful of it in my tea. Then we would strike camp and get a few miles completed during the cool of the day before a breakfast stop at some pleasant spot usually beside a stream. While breakfast was cooking we might wash and bathe, write diaries or read. Norman often gave us rudimentary Hindi lessons and by the end of the 18 days march out I could carry on some sort of conversation with the Sherpas in kitchen Hindi. Hindi, of course, was not their mother tongue either but a trade language, so neither of us was much concerned with the niceties of grammar. After a leisurely breakfast we would complete the day’s march and if we did not hurry, by the time we arrived at our campsite, tents would be pitched and tea ready. I would then do a sick parade with the help of Ang Tsering, a Sherpa who had quite good English. My patients were drawn from our porters and the local people near where we camped. Mostly they had trivial complaints and no doubt in many cases were just curious to try a bit of western medicine, but more serious problems included loose teeth, or in one case a root abscess requiring extraction. There was also one lad with multiple inflamed sores round the front of his neck, oozing pus. I gave him penicillin but wondered very much how he got on afterwards, as I could not see him again.
So, our trek continued. At Junbaisie we had to leave the usual trail because the bridge over the Dhude Khosi had been washed away. This was an expected annual event in the monsoon. It meant that we had to use a lesser trail over a 4,550m pass. We were very conscious that the Swiss Everest Expedition, 4 years before, had lost two lowland porters on the pass in bad weather. The weather was not good for us and we waited one day hoping it would improve. We crossed the pass the next day but only with difficulty and Norman and a Sherpa were needed to help a number of porters. After the crossing one more day brought us to the first village in the Dhude Khosi Valley. If post monsoon clouds often obliterated the distant views, the wild flowers at our feet made up for this and so we arrived in the Khumbu, the heartland of the Sherpas.
The British Mountain Medicine Society (BMMS) are organising a Science Day in the Peak District on the 13th November 2019. Why not come along? Details can be found here.