Medical Report — Illness And Drugs

by Dan Jones

I give below an account of the main illnesses we encountered and the drugs we used in treating them.  First I will deal with the two casualties from our second accident.

Fracture of (R) Tibia and Fibula

This emergency occurred at Camp I.  The Sherpa concerned had to be transferred to Base Camp and from there by stretcher to Katmandu.  This journey took 15 days.  The fracture was compound and also (we learned later) comminuted.

Morphia was our first requirement, and we found the Omnopon ampoules very useful.  Later we used the Tabs Morphine Hydrochloride gr ¼ and distilled water.  We carried him to Base Camp on a pack frame, and after resting him there were able to continue to Katmandu by stretcher.  Morphia was not used beyond Base Camp.  I started by giving him Pethidine 50 mg B.D.  for the journey but when he appeared to suffer little or no pain I discontinued it.  I gave him Soneryl gr 3 at night but when he failed to sleep changed to Pethidine 50 mg + Soneryl gr 1½.  With this he slept well.  I continued this for six nights and then changed to Soneryl gr 3 again.  He continued to sleep.

We reduced the fracture as well as we could under Morphia.  At this time I was incapacitated by a dislocated shoulder and could only supervise proceedings.  We possessed no plaster shears and so would be unable to remove a plaster once set.  For this reason I decided to avoid plaster in case it was put on too tightly.  The leg was splinted from mid thigh to ankle using Cramer Splints padded with cotton wool and bandaged tightly.  I was able to uncover the wound partially every 4-5 days to keep an eye on it.

He was given Penicillin V Pulvules 2 tds prophylactically.  I suspect he didn’t take all these, for I found after 10 days that he had a small cache of them.  Those he took were not at any rate sufficient to curb infection.  Five days after the accident his wound was hardly infected at all, but four days later there was a wide area of redness and induration around it which extended laterally up into his thigh.  I gave him Crystapen 250,000 units bd and continued the Penicillin V pulvules making sure he took them.  Five days later nearly all signs of inflammation had subsided.

He also had lacerations to his face and to his (R) knee.  These, together with the compound fracture, were dressed with Penicillin Tulle.  Both face and knee lacerations healed well.

On reaching Katmandu he was admitted to the American Mission Hospital and his leg placed in skeletal traction.

Dislocated (R) Shoulder

I myself sustained a dislocated (R) shoulder.  One member of the party attempted to reduce the dislocation under morphia — following directions from me.  Unfortunately we were not successful.  After two days of Morphia and a further day of Pethidine I was able to limit myself to Codeine Co tabs 2 with Nembutal gr 3 at night.  I was.able to walk back to Katmandu with my arm in a sling and with practically no pain.

At Katmandu the dislocation was reduced with considerable difficulty under general anaesthesia.  I found that some super­fluous tissue in the joint cavity was preventing complete reduction, and this was subsequently removed operatively.

Dysentery

This comes high on the list of complaints although com­paratively speaking we did not suffer much from it.  During the three months abroad we all had from 1-3 very mild attacks lasting up to three days each.  One member had a moderately severe attack which lasted 10 days.  No one was bedridden.  Kaolin powder plus either Sulphaguanidine or Phthalyl-sulphathiazole tablets controlled these satisfactorily.  Anethaine ointment was used once for a sore anus following dysentery.

Respiratory Infections

These were almost non-existent, perhaps because we went no higher than 19,000 feet.  Two members of the party developed common colds which resolved satisfactorily.  One member had a chronic non-productive cough which failed to respond to any cough mixture.

Minor Injuries

These were more common amongst the Sherpas and porters than amongst us.  They were most frequent on legs and feet.  Surgical Spirit, Pigmentum Tinctorium, and a gauze or plaster dressing were used, the Sherpas being most impressed by the colour of the tinctorium ! I failed to take sufficient small ban­dages.  Injuries to the soles of feet were common as the porters went barefoot.  For the same reason it was impossible to make sticking plaster adhere properly.  Bandages were the only solution.  Elastoplast and Sleek were used very successfully for injuries elsewhere.  I didn’t have any Magnesium Sulphate paste with me which would have helped the treatment of certain inflamed wounds.

Sleep

Apart from those injured by the second accident only one member of the party had to use sleeping tablets with any frequency.  Nembutal was used in preference to Soneryl because of its shorter action.  It was found to be very satisfactory with no hypnotic hangover on the following morning.  Chloral Hydrate was used httle as the bitter taste of the tablets made it unpopular.  Both it and Soneryl when used were satisfactory.

Sun

Evans Suncream proved most satisfactory.  It was quite as effective as any of the proprietory brands and many times more economical.  It was also extremely pleasant to use.  We were all most grateful for it.

Acriflex antiseptic cream was used to soothe the skin of those unfortunates who were too late in applying their suncream.

Lipsyl was moderately effective in protecting the lips.  One person developed a sun sore which became infected and only responded when Pigmentum Tinctorium was used.

Diet Supplements

Adexolin capsules and Fersolate tablets were issued to be taken every second day.  It was felt that on the mountain our biggest dietary deficiency was Vitamin C; Niscorbin tablets were to be taken daily.  Members of the party took these with varying degrees of regularity.  No appreciable difference in health was noticed between them.

Insects

Not much could be done to affect mosquitoes in the outside atmosphere.  However we only came across these in the plains.  Paludrine 100 mg daily was taken prophylactically over this period.  No one contracted malaria.

D.D.T.  and Talcum Puffers were very useful, especially for delousing chmbers who felt they had ‘ caught’ something !

Dimethyl Phthalate, although effective, was not popular as the bottles leaked and as it was oily and tended to pick up much dirt when applied to one’s hands and face.  Its main purpose would have been as a leech repellant in the monsoon, but we returned before the monsoon started.

Aperients

These were not generally required.  However when they were required the Emuls Paraffin Liq e Agar proved rather too mild and the Castor Oil capsules rather too severe.

I have not as yet mentioned the ailments we encountered in the local inhabitants of the regions through which we passed.  They made full use of the ‘doctor sahibs’ services.  Many of their complaints were vague and not substantiated by clinical findings — vague tummy pains and head pains which we suspected were designed to obtain a pill wrapped in silver paper from the doctor.  Such cases were usually given Solprin or Codeine Co.  However certain illnesses were very real.

Dysentery was common and appeared to be chronic — presumably amoebic.  It was treated as already mentioned.

Respiratory Infections occurred with fair frequency — were usually chronic and were often limited to a cough with no physical signs.  Some of this may again have been in order to acquire a spoonful of medicine.  Quite a number, however, had physical signs in the chest.  A few cases of cough with blood­stained spectum suggested tuberculosis.  If physical signs were present a course of Sulphamezathine or Sulphatriad was given.  Otherwise Toclase, Ethnine or Piriton cough syrup were used alone.

Eye Conditions were very common, were nearly always chronic and often showed irreversible changes.  Trachoma was common but all I could do was to insert one or two doses of Sulphacetamide ointment into the affected eyes.

Children

A number of young children were brought up, several with infective skin conditions or burns.  Systemic Penicillin and a local dressing was all I could do.

One child had otitis externa for which I used Terramycin Otic drops.

Another child was almost moribund with possible cholera.  I gave this child two injections of Terramycin I.M.  When I returned four weeks later the child was alive and well.

This last cheerful note completes the survey of illness encountered on the expedition.  I have mentioned all the drugs we had cause to use; for them and for all the other drugs and medical equipment which we had to take with us but fortunately did not use we should like to thank the Donors very much indeed.

All drugs and equipment which we did not use ourselves were given to the Mission Hospital in Katmandu.  I was a patient in this hospital for a while and was most impressed by the efficiency of its Staff and the large amount of useful work they do amongst the Nepalese.

Drugs donated by

Allen & Hanbury Ltd.
Evans Medical Supplies Ltd.
Glaxo Laboratories Ltd.
Eli Lilly & Co.  Ltd.
Parke Davis & Co.  Ltd.
Pfizer Ltd.

Packed by

Evans Medical Supplies Ltd.