Extreme Medicine (30 page)

———, and David B. Weaver. “Practical Methods for Near-Term Piloted Mars Missions.” Paper presented at AIAA, SAE, ASME, and ASEE Joint Propulsion Conference and Exhibit, Monterey, CA, June 28–30, 1993, document ID: AIAA P.93-2089.

FINAL FRONTIERS

I will never forget James Hudson; he was so full of life even during what was to be his last admission. Over the weeks that I looked after him, he told me the story of his remarkable life in installments and always implored me to come back so that he could tell me more. I would like to thank his daughter Valerie Russell for giving me permission to recount as part of this book some of the stories that I had been told.

Mr. Hudson had also contributed to a television documentary—
Lloyd George's War—
for the BBC in 1998, about his experiences during the First World War. The unedited footage from that program is kept at the Imperial War Museum archives, and it is from it that the story of his fumbled hand grenade comes. Additionally, the British Dental Association holds a number of records and articles that allowed me to trace his career more accurately, from apprentice to qualified dentist and finally to hospital surgeon.

As a junior doctor, I learned something of the trade of elder-care medicine at the Hammersmith Hospital from my then registrar Dr. Geoff Cloud, who is now a consultant in stroke medicine at St. George's Hospital. When it came to writing this chapter, I visited him again to ask his advice. In that conversation and in further reading, I got the impression that the field of gerontology is changing rapidly and, as elsewhere in medicine, our expectations have changed beyond any recognition. I hadn't previously appreciated the enormous complexity of the debate surrounding the search for a general theory of aging. I was able only to scratch the surface of that here but include all of the material for further reading.

Caspari, Rachel, and Sang-Hee Lee. “Older Age Becomes Common Late in Human Evolution.”
Proceedings of the National Academy of Sciences of the United States of America
101, no. 30 (July 27, 2004): 10895–900.

Chamberlain, Geoffrey. “British Maternal Mortality in the 19th and Early 20th Centuries.”
Journal of the Royal Society of Medicine
99, no. 11 (November 2006): 559–63.

Christensen, Kaare, et al
.
“Ageing Populations: The Challenges Ahead.”
Lancet
374, no. 9696 (October 3, 2009): 1196–1208.

Di Biase, D. and D. Shelley, “Death Notice” (James Alfred Hudson).
British Dental Journal
191, no. 5 (September 8, 2001): 282.

Gavrilov, Leonid A., and Natalia S. Gavrilova. “The Quest for a General Theory of Aging and Longevity.”
Science of Aging Knowledge Environment
no. 28 (July 16, 2003): 1–10.

Gems, David H., and Yila de la Guardia. “Alternative Perspectives on Aging in
Caenorhabditis elegans:
Reactive Oxygen Species or Hyperfunction?”
Antioxidants & Redox Signaling
19, no. 3 (July 20, 2013): 321–29.

Griffin, John P. “Changing Life Expectancy Throughout History.”
Journal of the Royal Society of Medicine
101, no. 12 (December 1, 2008): 577.

Hayflick, Leonard. “Entropy Explains Aging, Genetic Determinism Explains Longevity, and Undefined Terminology Explains Misunderstanding Both.”
Public Library of Science Genetics
3, no. 12 (December 14, 2007): e220.

Hudson, James Alfred. “The Dental Department at Redhill Hospital, Edgware, as a Criterion for the Hospital Services of the National Health Service.”
British Dental Journal
84 (March 1948): 100–102.

———. “Long in the Tooth: Witness for the Profession.”
British Dental Journal
171, no. 5 (September 7, 1991): 138–40.

“Hudson Receives Fellowship at 102.”
British Dental Journal
(News and Notes) 189, no. 10 (May 27, 2000): 589.

Kirkwood, Tom B. L. “Longevity in Perspective.” Reviews of
The Long History of Old Age,
by Pat Thane, and
The Long Tomorrow: How Evolutionary Biology Can Help Us Postpone Aging,
by Michael R. Rose.
Lancet
367, no. 9511 (February 25, 2006): 641–42.

———. “The Origins of Human Ageing.”
Philosophical Transactions of the Royal Society of London
, Series B,
Biological Sciences
352, no. 1363 (1997): 1765–72.

———. “Where Will It All End?”
Lancet
357, no. 9256 (February 24, 2001): 576.

———.
Time of Our Lives: The Science of Human Aging
.
London: Phoenix, 2000.

Langdon, James. “Mr. James A. Hudson.”
Annals of the Royal College of Surgeons of England
83 (2001 suppl.): 26–27.

Lloyd George's War
. BBC
Timewatch,
1998, unedited interviews for program, held by Imperial War Museum, London, catalog no. TV 112X.

Montagu, J.D. “Length of Life in the Ancient World: A Controlled Study.”
Journal of the Royal Society of Medicine
87, no. 1 (January 1994): 25–26.

Shay, Jerry W., and Woodring E. Wright. “Hayflick, His Limit, and Cellular Ageing.”
Nature Reviews: Molecular Cell Biology
1, no. 1 (October 2000): 72–76.

Walsh, John. “The Last Soldier.”
Independent
(London), November 11, 1999, p. 1.

The page numbers in this index refer to the printed version of this book. To find the corresponding locations in the text of this digital version, please use the “search” function on your e-reader. Note that not all terms may be searchable.

 

Note: Page numbers in
italics
refer to illustrations.

ABC priority, 99–100, 105, 109, 110

abdominal surgery, 74

accelerometers, 220, 236, 248

acidity, 160, 166

Adams, Douglas,
The Hitchhiker's Guide to the Galaxy,
190

Admiral Duncan pub, bomb site, 115–16

adrenaline, 144

Advanced Trauma Life Support (ATLS) protocol, 100, 105, 109, 111, 113

age, chronological vs. physiological, 250–51

aging, 241–52

and breathing, 247

and disease, 249, 252

and entropy, 248–49, 252

life expectancy, 245, 250

and muscles, 246–48

air:

fresh, 241

and lungs, 154, 157, 169

ocean of, 168

oxygen in, 170, 183–84

pressurized, 169

Airbus, 215

aircraft fuel, burning temperature of, 42

airliners, cruising altitude of, 183

airlock, 185

air pressure, 168–69, 170–71

air safety, 256

airway, in ABC priority, 99–100

Aldrin, Buzz, 212, 254

algae, 227

altitude:

Armstrong line at, 184–86

high, 182

medical problems of, 182–86

alveoli, 77, 157, 169, 184

Amundsen, Roald, 9, 28, 72, 253–54

anaerobic respiration, 166

anesthesia, 144, 243

and cardiac surgery, 87

and intensive-care medicine, 129

and polio, 130–35

unconsciousness of, 128–29, 134

aneurysm, 23

angiosomes, 51

Antarctica, 9, 12–14, 15, 27–28

anterior horn, 125

antibiotics, 85, 87, 88

antiemetic medications, 221

Apollo space program, 213, 254

Archimedes principle, 154

Aristotle, 73

Armstrong, Harry George, 185

Armstrong, Neil, 212, 213, 252–53, 254

Armstrong line, 184–86

arterial gas embolism, 169–70

arthritis, 135

Artificial Gravity Pilot Project, 233–36

astronauts, 190, 221–24

and absence of gravity, 221, 229–31

disorientation of, 223

on the Moon, 253

postflight orthostatic intolerance, 223

reacclimatizing, 223–24

and reentry, 204–5

and RTLS abort, 193–94

and Soyeon, 197–203, 205–8

and weightlessness,
210
, 214, 216, 221, 232

Atlantis,
186–90, 208

atmospheres, 168

auto accidents:

fatal injuries in, 246

first, 244–45

axons, 125

bacterial endocarditis, 80–81, 85

Bågenholm, Anna, 15–23, 26, 29, 257

Bailey, Charles, 87, 88, 90–92, 256

balance, 9

barotrauma, 170

Battle of Britain, 38–41, 256

Battle of the Bulge, 82

Billroth, Christian Albert Theodor, 74

biomolecules, 248, 249

Bjørneboe, Mogens, 129–30

Blegdam Hospital, Copenhagen, 129, 132–33

blisters, 37

blood:

air in contact with, 157

bleeding to death, 112–13

and bypass machine, 20–21, 26

carbon dioxide in, 132, 160, 167

circulation to the heart, 76–77

hemoglobin in, 141, 184

hemorrhaging, 110, 113

loss of, 83, 112

oxygen in, 142, 163

and skin, 49

supply to the face, 51–52, 60, 61, 62

transfusions, 83, 87–88

blood pressure, measuring, 164–65

blood vessels, constricting underwater, 164

body, repair and regeneration of, 249

bombing incident, 102–5, 109–11, 115

Bonaparte, Napoléon, 95

bones:

and aging, 248

and force of gravity, 218

Bower, Albert, 132

Bowers, Henry, 27

brain:

and aging, 248

autopilot of, 128

damage to, 53

human, 14

neurons in, 124–26

visual cortex in, 210

brain-stem death, 53–54

breath-hold diving, 163–65, 167

breathing, 155–58

in ABC priority, 99

act of, 156–57, 159–61

and aging, 247

at altitude, 184

in diving underwater, 170

and exercise, 174–75, 176

holding your breath, 155, 160, 163

as human drive, 161, 167

and lungs, 156, 161

Brigham and Women's Hospital, Boston, 55, 61–64

British Antarctic Survey, 28

Brock, Russell, 87

bronchial tree, 156–57

Brudon, Pascale, 137–38

buoyancy, 154–55

and lungs, 157

negative, 155, 158

burns:

and blisters, 37

deaths from, 37, 38

disfigurement from, 57

electrical, 57

extent of affected area, 38, 49

inflammatory response provoked by, 37–38

pain from, 42

and plastic surgery, 44–48

and skin,
see
skin

and survival, 38

bypass circuits:

and hypothermia, 20–21, 24

and risk, 252–53

and survival, 257

Calment, Jeanne, 250, 251

cancer, 135, 257

Cape Canaveral, 187, 191–92

carbon dioxide:

in blood, 132, 160, 167

expulsion from lungs, 132, 133

scrubbing out, 226

cardiac arrest:

at altitude, 185

and blood loss, 83, 112

and downtime, 18

in space, 194–95

cardiac surgery, 74, 79, 84, 87–92, 157

cardiovascular system, and absence of gravity, 222

carotid artery, 51

cell, derivation of word, 124–25

Centers for Disease Control (CDC), 138

central nervous system, 126

centrifuge, 232, 234

Chain, Ernst Boris, 85

Challenger,
186, 190, 205

Chen, Johnny, 136, 138–39

Cherry-Garrard, Apsley, 27

China, atypical pneumonia in, 136–40

chronic illness, 135

Churchill, Edward Delos, 80

circulation:

in ABC priority, 99, 110

at altitude, 185

remapping, 50

shutting down underwater, 166

Cold War, 254

Collins, Michael, 254

Columbia,
186, 190, 205

consciousness, 123, 166

consumption, 135

Copeland, David, 116

Copenhagen, polio virus in, 127, 129–35, 148, 256

coronavirus, 147

Craig, Albert B., 163–64

crash, and cardiac arrest, 18

CT (computerized tomography) scans, 60

Cutler, Elliott Carr, 80

cytoplasm, 124

D-Day, 82

DDT, 27

death:

avoidance of, 14

bleeding to, 112–13

from hypothermia, 11, 12, 14, 26

life after, 52

newly defined, 53

simplicity as synonymous with, 11

decompression illness, 176

dermis, 35

Derosier, Jean-Paul, 139

Dezhbod, Esmail, 23–25

diaphragm, 156

disability, in trauma priority, 100

Discovery,
27, 186, 251

dive reflex, 167

diving:

ascending slowly after a dive, 171

breath-hold, 163–65, 167

and breathing, 170

free diving, 163–64, 166–67

mammalian reflex, 164

narcotic effects (“narcs”), 170, 171

oxygen in, 166

at Qalito, 171–77

scuba,
152
, 167–68

skin diving, 162–63

diving tables, 171

Domagk, Gerhard, 85

downtime, and cardiac arrest, 18

drowning, 158, 166

Dykes, Andrea, 115–16

Dykes, Julian, 115

Eagle,
253

Earth:

circumnavigation of, 255

gravitational load on, 232

orbit of, 225

orbiting, 212–13

water covering, 177–78

Edrich, Tom, 59–60, 62–63

elder care, 241–44

life expectancy, 245, 250

risk-benefit equation in, 243, 252–53

electrical burns, 57

electrical neutrality, 10

Elefteriades, John, 24–25

Ellis, Lawrence Brewster, 86

embolisms, 169–70

encephalitis, 132

Endeavour,
186

endocarditis, bacterial, 80–81, 85

energy, 10

absence of, 12

Enterprise,
180
, 195

entropy, 248–49, 252

epidermis, 34–35

burns of, 36

equipoise, 9

erector spinae, 217

European Space Agency, 215

evolution, 115, 128, 207, 218

exercise, and breathing, 174–75, 176

exploration, 257

exposure, in trauma priority, 100

eyeballs, 219–20

face:

blood supply to, 51–52, 60, 61, 62

donation of, 54, 62

full transplants of, 52, 54, 55, 58–64, 257

roles of, 57–58

sculpting of features, 64, 257

Falkenberg, Marie, 15–16, 17

fight-or-flight response, 175

“First, do no harm” (
primum non nocere
), 78

Fleming, Alexander, 85

flight, dynamic phases of, 205

Florey, Howard, 85

flu infections, 146

Fong, Ah Yoong, 121, 123

fovea, 219–20

free diving, 163–64, 166–67

free flap, 50, 58

French Hospital, Hanoi, 137–38

Gagarin, Yuri, 208, 211, 254

gasp, involuntary, 161, 166

Geckeler, George, 88

genes, and aging, 252

genetic code, 56

Gilbert, Mads, 20

Gillies, Harold, 44, 45

glaciology, 27

Gleave, Tom, 39–41, 42–45, 47

Glenn, John, 251

global warming, evidence of, 28

golden hour, concept of, 96

Golgi apparatus, 124

Gomersall, Charles, 142–46

gravity, 216–18

absence of, 221–22, 229–31

artificial, 230–32, 233–36

one-G, 231

and orbit, 190

prescribing, 232

and space training, 216

and space travel, 221–22

zero-G, 214

Grey Turner, George, 74–76, 77–79, 80, 82, 84

Guinea Pig Club, 47–48, 65

gunshot wounds, 68–71

to the heart, 74–76, 77–78

Hakka people, 121

Harken, Dwight E., 79–84, 86–87, 88–92, 256

Hawley, Paul R., 79, 81

healing:

and immune system, 114

new cell growth in, 36–37

heart:

and aging, 247

anatomical complexity of, 76

bacterial endocarditis in, 80–81

beating, 76

blood circulation of, 76–77

bypass operations, 20–21, 24, 252–53, 257

cardiac arrest, 112–13

closed-heart surgery, 90, 256

contraction of, 222

gunshot wound to, 74–76, 77–78

and hemorrhage, 113

intraoperative resuscitation of, 82–83

and lack of gravity, 222

location of, 71–72

missiles lodged in, 74, 75–76, 77–78, 82, 84

mitral valve in, 85–86

moving, 84

repair of, 85

safe routes through, 83–84

slowing underwater, 164, 166

heart-lung bypass machine, 20–21, 24, 252

and hypothermia, 20–21, 24

and risk, 252–53

and survival, 257

heart transplants, 53, 61

helicopter crash training, 153–54

Helicopter Emergency Medical Service (HEMS), 104

helicopter evacuation, 96, 257

Helicopter Underwater Escape Training (HUET), 154, 158–59

hemoglobin, 141, 184

hemorrhage, 110, 113

Heroic Age of exploration, 28

histology, 33–34, 50

Hudson, James, 250–52

birth of, 245

in the Great War, 239–40, 245–46

and maxillofacial surgery, 246

as over a century old, 244, 245–48, 250

hypercalcemia, 221

hyperventilation, 158, 183

hypothermia:

and Bågenholm, 17, 18–23

and circulatory arrest, 24–25

death from, 11, 12, 14, 26

and Dezhbod, 23–25

overcoming, 15

and resuscitation, 18–23

and Scott, 9, 12–14, 26

Ibsen, Bjørn, 130–34, 135, 143, 256

immune system:

and aging, 240

attacking the body's own tissues, 85–86

fighting disease, 165

and infections, 56, 141

inflammation in, 143

and multiorgan failure, 143

suppression of, 56

and transplants, 55–56

and trauma, 114–15

infantile paralysis, 127;
see also
poliomyelitis

infection, protection against, 126

inflammatory response, 37–38

inner ear, 218–20, 231, 233, 236, 248

innovation:

and survival, 111, 114–15

vs. experimentation, 92

intensive-care unit:

and anesthetics, 129

eighteen-year-old patient in, 119–20, 149–50

improvements in, 143–44

and polio epidemic, 130–31, 135, 148, 256

roles of, 120–21, 135, 146, 147–48, 256–57

and SARS, 148

and survival, 257

and trauma, 115

International Space Station (ISS), 187, 195, 196, 200–202

ion-channel control, 42

ions, 10–11

iron lungs, 131, 132–33, 256

Janis, Jeff, 57

Japanese amas, diving, 162

Joosten, Kent, 231

KC-135 weightless training aircraft,
210

Kennedy, John F., 254

Kennedy Space Center, 187, 191–92

keratin, 34

kidney dialysis, 144