mabel's normalcy: mabel purefoy fitzgerald and the study ... · physiologists mabel's...

PHYSIOLOGISTS

Mabel's normalcy: Mabel Purefoy FitzGeraldand the study of man at altitude

R W Torrance"Oxford, UK

Keywords: M P fitzGerald; altitude acclimatization; TS Haldane

The Physiological Society was started on theevening of 31 March 1876 at 48 Queen AnneStreet, London, the home of John BurdonSanderson, and it celebrated its centenary in 1976over dinner in the great halls of Trinity College,King's College and St Catharine's College duringits meeting in July of that year in Cambridge. Threeyears before its centenary, the Society elected anordinary member who was born on 3 August 1872,four years before it was founded. Her name wasMabel Purefoy FitzGerald.

Physiologists remember Mabel FitzGerald (18721973) principally for one important paper in whichshe described the observations she made in Coloradowhen she was a member of an Anglo-Americanexpedition of 1911 to study the effectsof high altitudeon breathing. She showed that breathing is increasedat altitude and so C~ is blown off. The reduction inthe amount or tension of C~ in the lung air (thealveolar partial pressure of C~ PACOl) that thisincrease in breathing brings about is related to thebarometric pressure and so to the amount of O2 in theair. These findings were reported under her namealone in the Philosophical Transactions of the RoyalSociety in 1913 and that is her best-known paper'.

In 1914 she published a second paper on thesame subject, this time in the Proceedings of the RoyalSociety2. It also dealt with the alveolar PACOl but atmore modest altitudes, up to 4000 feet, in theAppalachians. She concluded that the signs andsymptoms of the response of man to high altitudeare set off by the low tension or partial pressure ofoxygen (POl) in the arterial blood and not by a lowtotal concentration of oxygen in it, for the amountof oxygen is in fact greater at altitude because of theincrease in the concentration of haemoglobin thatdevelops in the blood at high altitude.

Mabel rediscovered

These two papers were known in Oxford - J SHaldane (1860-1936) had trained her there to do

"Deceased

Correspondence to: Mrs M Torrance, 49 Oakthorpe Road,Summertown, Oxford 0X2 7DB, UK

experiments on respiration - but they seem to havebeen little known to physiologists elsewhere. Shepersonally was forgotten even in Oxford and it wasonly when Haldane's successor in the Oxfordlaboratory, Dan Cunningham, happened to belooking up a number in the Oxford telephonedirectory in 1961 at the time he was organizing asymposium to celebrate the centenary of Haldane'sbirth that he came upon her name by chance. Shewas living in North Oxford at 12Crick Road, just tothe north of the Laboratory of Physiology acrossthe University parks. She was invited to the

Figure 1. Mabel FitzGerald at till.' Haldane cenienaru celebrations.Oxford. 1961. pictured witll C G Douglas and J B S Haldane.(Reproduced from ref 3, unth permission.)

Journal of Medical Biograplly 1999; 7: 151-165

152 Journal of Medical Biography Volume 7 August 1999

symposium and the proceedings- contain a photograph of her with C G Douglas and Haldane's son,J B S Haldane (Figure 1).

A story then started to emerge of her coming toOxford to live at 12 Crick Road. Haldane had beenher neighbour at Number 11, another typical largeNorth Oxford house, and so we supposed that itwas Haldane who had drawn Mabel into physiology, for, in addition to her papers alone on highaltitude, she was known for an earlier one withHaldane on the normal values of alveolar Pem atsea level in adults, both men and women, and inchildren'. That paper came out in 1905, the sameyear as Haldane's more famous paper withPriestley on CO2 in the control of breathing'',

Roger Elliott, the theoretical physicist, lived inCrick Road in Haldane's old house, and he wasthen a Fellow of St John's, so from time to time Iheard from him or Olga, his wife, about their nextdoor neighbour, Mabel. For example, I had to briefRoger when Mabel wanted to know, imperiouslyand urgently as always, what it meant that she hadbeen made an honorary member of the Undergraduate Osler Medical Society. The Elliotts helpedMabel a lot in her late eighties and in her nineties.

The centenarian

When she reached 100, in 1972, she received atelegram of congratulations from the Queen. Shewas interviewed and photographed and she wasreported in the Oxford Mail. More details of her lifeemerged. She spoke of studying physiology in theOxford laboratory in the late 1890s but she couldonly do that unofficially and with the collusion ofthe laboratory because the University would notthen allow women to take physiology officially.She got on so well in the examination papers ofthe Final Honour School in Physiology that FrancisGotch, the professor, soon had the regulationsaltered. She also talked of her scientific work withHaldane and of her later association with WilliamOsler (1849-1919).

Out of all this, Roger Elliott, who had become amember of the University's highest body, itsHebdomadal Council, and the Regius Professor ofMedicine, Richard Doll, also on Council, got Mabelput up for an honorary MA of the University andshe received it at a special congregation held in theOld Congregation House on 14 December 1972.Shewas taken there in an ambulance and before shewent into the ceremony, she was asked whethershe would like a little brandy. "Not now, afterwards perhaps." The public orator, Colin Hardie,introduced her in Latin as: "Amabilem Purae Fideiet filiis Geraldi, physiologam, viridis senectutisexemplum." Then this model of lively old age(Figure 2) was admitted by the Vice Chancellor,Alan Bullock. With the degree she made The Timesand she became famous nationally - the firstcentenarian to be given an Oxford MA.

Figure 2. Mabel FitzGt'rald aftt'r thedegree ceremonu in 1972, holdingherdegree certificaie. (With ,,"mission of the Oxford Mail.!

The national publicity produced a response evenfrom the committee of the Physiological Society.We all turned up to our next meeting clutching acopy of The Times with Mabel's photograph in it.She was elected an ordinary member of the Societyat the annual general meeting a few weeks later.

She was already a member of the AmericanPhysiological Society: indeed, she had been since1913 - 60 years earlier (Figure 3). She was thesecond woman they elected and was now theiroldest member. Oxford and England felt ratherguilty about her: they had ignored her.

I got more involved because Charles Michel andI were the examiners in respiration in the FinalHonour School of Physiological Sciences in 1973,and we decided to honour a centenarian by askingthe candidates to comment on a quotation from herprincipal paper. I immediately took a copy of thequestion paper to Olga Elliott and she gave it toMabel that day, while the candidates were stillwriting the paper. It had the best wishes of theexaminers written upon it (Figure 4). The next dayRoger called upon her and found her immenselypleased. As for the honorary MA and the membership of the Physiological Society, she felt that shehad those of right. But to be quoted in a paper of aFinal Honour School, which she had not beenallowed to take properly herself, was a judgementon the value of her work that she highly treasured.

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Torrance. Mabel Purefoy FitzGerald 153

The examiners, all of us, hoped to call on her butshe was already bedridden and she could not seeus. She died about two months later, on 24 August1973, aged 101.

The things she left

I became more involved in her affairs at the beginning of October 1973, when I was asked to lookat her scientific apparatus and papers in 12 CrickRoad. The house was being sorted by her niece,Mrs Purefoy, the daughter of her naval brother,and Mr Cannon, a retired nurse who had helpedher in her later years and acted as her secretary.The house had been an extraordinary jumble: nopapers had been thrown out in half a century. Thewallpapers seemed to be the originals of the mid1870s, when the house was first lived in. There wasa mass of books and decrepit furniture, but somevery good things too. The papers I then receivedwere principally scientific and are now in theBodleian Library, together with papers relating toher Purefoy grandmother's acquaintance with thepoet Browning.

The scientific papers included notebooks of herobservations, many drafts of her papers, lettersfrom scientists (Figure 5) and applications for jobsand studentships. The originals of most of theletters from William Osler that she had annotatedwent to the Osler Library at McGill in Montreal andsome other Osler material had already been takeninto his small collection of Osleriana by the RegiusProfessor of Medicine, but there are copies of theOsler letters in the Bodleian. There were books and

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some apparatus: microscopes, one quite old, herhaemoglobinometer (Figure 6) and haemocytometer. The two gas analysis apparatuses were ofthe type Haldane devised for measuring smallconcentrations of CO2 in vitiated air of poorlyventilated rooms but they had been fitted with awider burette so that they would measure thehigher CO2 of alveolar air.

The apparatus formed the tools of her trade as astudent of acclimatization to high altitude. It evenincluded an altimeter, an explorer's set and abattered metal brandy flask inscribed "Quand vousavez froid, Pensez amoi".

There were two fascinating diaries, one, 1892, ofMabel's own and the other, 1895, of her eldestsister, Geraldine. Many more of the family diarieswent into the Bodleian. That library now has thescientific letters and many more personal andfamily ones; among the latter by accident are afew of the scientific ones. These are from Haldane,Douglas, Gotch, Mann, Dreyer and Henderson.There was a collection of Haldane's offprints andalso one of Henderson's and there were copies ofall her own papers. The offprints went to thelibrary of St Anne's College, which the old Societyof Home Students has now become. In its earlyperiod it would have been an entirely appropriatecollege for an Oxford resident such as Mabel tohave belonged to.

Figure 6. A Haldane gas allalysis appatatus for IIll'asurillg co! ill agas samplt'. Till' sampll' is drawlI illlo till' bulb of the uxncr-iackctedpipette 011 IIII' it'fl. ami III" CO! ;s abstJrlJ/.'d by potasl: 11'11,," III" gas ;sdril'l'lI over into IIII' lubillg 011 IIII' riglll by raising lilt' lIlerCliry. 51'1'11

herehangingfrom a rack and pillioll 011 IIII' door of II,,' apparatus.

It seemed to me that Mabel herself had selectedthe material in the hope that someone sometimewould find it interesting to work upon. The twodiaries, for example, and a postcard date-stamped"August 15, 1908 Colorado Springs" were notincluded by chance.

Mabel's family background

Mabel was born on 3 August 1872 at North Hall inPreston Candover, Hampshire. She was proud ofher ancestry and she tried to work out some of thedetails of it in her later years.

Her mother was Henrietta Mary Chester, thedaughter of a country clergyman, and her father,Richard Purefoy FitzGerald (1837-1895), belongedto an old family of country gentry which appears inBurke's Landed Gentry as the "Purefoys ofShalstone", a small village about 20 miles northof Oxford.

Mabel's Purefoy grandmother held the Shalstoneproperty for the whole of the second half of thenineteenth century and it helps to trace the familyback and forwards from her. She was born SarahAnne Elizabeth Purefoy [ervoise (1809-1898). Hermother was the daughter of an archdeacon and herfather, Richard Purefoy [ervoise (died 1811), a thirdson, was a major in the 1st Royal Dragoon Guardsin 1811 when he was killed in the Peninsular War.In 1832,Sarah married Thos FitzGerald JP DL (17771860). His mother was Anna McNeale, the daughter of a West Indian planter, and his father wasCaptain Edward FitzGerald of the 22nd Regiment,who died in Jamaica when his son was young.

Sarah inherited the Shalstone property from anuncle, her father's elder brother, Jane Austen'sdancing partner, George Purefoy [ervoise (17701847), when he died childless, and under his willthe property had to pass from Sarah to the third ofher six sons, Mabel's father, and anyone succeeding to Shalstone after Sarah had to take the namePurefoy. Thus when Sarah died in 1898, andMabel's father had already died in 1895,Shalstone went directly to his son, Mabel's eldernaval brother, Richard Purefoy (1862-1942), and heleft Shalstone to his only child, Mrs Purefoy.

George Purefoy [ervoise left his other property,the [ervoise property at Herriard not far fromPreston Candover, to his sister Mary and she andher husband adopted the name [ervoise. NorthHall went to the Purefoys and that is why Mabel'sparents were living there when she was born. Aftertheir parents' death it went to their elder, naval,son but he sold it in 1905.

The family was not insignificant: it contributed tothe life of the country. George Purefoy [ervoise, thegentleman commoner of Corpus, who danced withJane Austen, was set up financially by his richuncle, who then held the family property, and hedid this so that George could afford to enterpolitics. He was elected one of the two MPs for

Salisbury in 1813 at a by-election, but the electors ofSalisbury found their pair of MPs too keen onreform for their liking and at the next full election,in 1818, George was dropped even as a candidate.In 1820 he became MP for Hampshire, nearer to hishome.

Life at Preston Candover

For her first 22 years, Mabel (Figure 7) lived withher parents at North Hall. Richard PurefoyFitzGerald (1837-1895) had been in the forces, thenavy first and then the army. He managed land,farmed, shot, hunted, stood for election to thecounty council as a Conservative, sat on the benchof magistrates and travelled around the country tomeetings of the National Agricultural Union. Heattended rent audit dinners for farm tenants andthe church bells were rung in honour of hisbirthday.

He had two sons and five daughters. His eldestchild, Richard (1861-1942), was in the navy andhad been since 1875, when he was 13. he was amidshipman on a corvette with the future KingGeorge V. The fifth child and younger son, Henry(1867-1948), went to Keble College, Oxford, in 1892to read chemistry. He got a first in 1893 and he alsogot a hockey blue. A pamphlet of his, The LiverFluke, is dated 1886. After Oxford he went to teachscience at Wellington College. He was ordained inChrist Church, Oxford, in 1894 and later gave up

figure 7. Mabel fitzGerald agedperhaps 10. (With permission of theBodleian Library.)


teaching to work in a parish. C G Douglas (18811963), of whom more anon, was a boarder atWellington from about 1894 until 1897, when heleft to go as a day boy to Wyggeston School inLeicester, where his father was a doctor. Douglassaid that he moved because science was badlytaught at Wellington, but some thought that itwas because he was ragged at the boardingschool.

Life for the five girls seems to have been lessinteresting. They had been educated at home. Theyread widely and went to lectures on literature andhealth. They walked, painted, made music, playedtennis, cycled, met captains and majors and actedin amateur theatricals. They visited their grandmother at Shalstone and went to stay with friendsand relatives at Tunbridge Wells and at PortlandPlace, London. Geraldine (1863-1900) was theeldest of the sisters and she adored her navalbrother. She was given to headaches and at anycrisis she took to her bed. Mabel was the youngestand was of a more vigorous personality and of asharper judgement on other people. In 1892 shewas aged 20 and was having French lessons andlearning to play the violin (Figure 8). She describesa holiday in France near Le Havre, lasting about10 weeks. Mabel was there throughout but therest of the family, apart from her naval brother,came and went. She wrote in her diary withaffection of Henry, the scientist. He took her tothe Natural History Museum in 1889 and shefound it "quite lovely". Of her sisters, she wasclosest to Laura, who was seven years older thanherself.

Sudden change

Then the whole picture suddenly changed in 1895.Her mother was sent by the local doctor to Londonto consult a physician and then a surgeon, and shewent into a London nursing home for an operationon 16 February. While she was recovering inLondon, Mabel's father, who was then standingfor election to the Hampshire county council,caught pneumonia and died on 28 February. Hermother returned home to Preston Candover but on14 May she too died.

The children put a stained glass window in thesouth aisle of Preston Candover New Church as amemorial to their parents but in truth their deathsmay have been a liberation. Certainly they were forMabel. She was free to build a career for herself.The girls soon had left the country to live in Oxfordand both boys were married.

Immediately, though, the girls left PrestonCandover and went to live with their grandmotherin Shalstone for about a year. Mabel wrote on 9February 1896 of reading T H Huxley in the gardenthere. "Digestion," she says, "is very interesting."She later worked on the secretion of acid by thestomach.


Figure 8. Mabel FitzGerald holding a violin, photograpned in her lateteens. (With permission of the Bodll'ian Library.)

Choice of a careerIt was while she was at Shalstone in early 1896 thatMabel decided on a career in laboratory medicalscience and she worked at that career in threeplaces: Oxford (1896-1907), first studying and thenin research; New York (1908-15), doing research;and finally, in Edinburgh from 1915, in routinepathology until she retired back to Oxford in about1937.

Up until 1896 she had long gone to nursinglectures. While at Shalstone she attended morestrictly physiological lectures, for example one onthe heart and another on digestion. She talked a lotwith G H De'ath, the local doctor, and went aroundwith him to visit his patients. Dr De'ath also wasthe medical officer of health for the nearby town ofBuckingham and Mabel read a pamphlet of adviceabout cholera that he had written because cholerawas then threatening to reach England from theContinent: she did not think that the pamphletwould advance his reputation. He stressed to herthat she should first get some training in basicscience and he warned her against supervisors who

simply use their subordinates. Mabel wrote of G HDe'ath, "He [is] a real good friend to me." Heseems to have introduced her to bacteriology andinfectious diseases and among the subjects sheworked on during her career were bacterial, fungaland viral infections. She began her work at the timethe micro-organisms of disease were being discovered.

At that stage she rejected a career in clinicalmedicine. She had a medical objective in much ofwhat she did but she seems not to have beenprepared for the intense commitment that medicinewould have required of a woman, initially in itsstudy and then in its practice. She did, of course,work hard when studying physiology and, in oneof her bursts of research, she would get to a highstandard in a subject in a short time, but sheenjoyed travel and some of the social life she hadled while her parents were alive.

Old medical books replaced research as aninterest after she came back from the USA.Nevertheless, she did long have a hankering afterqualifying in medicine. She even kept an Oxfordmedical student's Grey Book record of studies withthe things she had done signed up in it, extendingfrom basic science in 1896 to anatomy in 1927, andshe used it to gain entry to a part of the LondonRoyal Colleges Conjoint Examination. But she didnot take up a challenge made to her in 1905 byOsler that if she really wanted to qualify inmedicine she would have to leave Oxford andmove to Edinburgh or to London where womenwere allowed to study medicine full time.

When she was living in New York after the highaltitude expedition of 1911, she came back to theidea of medicine. She studied part time at NewYork University and by 1915 she had just qualifiedto enter a New York medical school but she had yetto get a place. That all collapsed when she left theUSA finally in 1915. She was then 42.

The move to Oxford

Mabel wrote her name in a copy of T H Huxley'sLessons in Elementary Physiology and dated it"Oxford, October 1896". By that time Mabel hadstarted studying premedical sciences in Oxford,and the sisters had all moved there. At first, in1896, they lived at 26 Norham Road, presumablyrenting it, and then later in the year they moved to12 Crick Road nearby, buying the rest of a 99-yearlease which would fall in 1971, 75 years later. J SHaldane was then next door in Number 11, but by1900 he had moved to 4 St Margaret's Road and afew years later he built "Cherwell" at the end ofLinton Road where Wolfson College now stands.So Mabel and Haldane (and many of the otheractors in our play) were early residents of what isnow famous as "North Oxford". Their houses wereall part of the St John's College North Oxfordleasehold estate.

Study

In 1896-7 Mabel took chemistry and biology. Byautumn 1897she had started on the full physiologycourse. Many of her notebooks survive of lecturesshe attended. Most of them were given by Gotch,the professor, and they ranged widely overcirculation, respiration, the kidney and the nervoussystem. Gustav Mann taught histology and Mabelwas to do her first research with him.

There is no evidence that she attended lecturesby Haldane, though he was then working in thelaboratory and he usually did a lot of teaching. Hehad come to Oxford from Dundee when his uncle,Sir John Burdon-Sanderson, had moved fromUniversity College London to be the firstWaynflete Professor of Physiology in Oxford andhe stayed on when his uncle became RegiusProfessor of Medicine in 1895 and was succeededin physiology by Francis Gotch.

First research

The story now becomes fuller. In 1898 Mabelstarted to work with Gustav Mann. He had becomethe histologist in the laboratory when BurdonSanderson fired Dixey from the job for voting forthe retention of compulsory Greek as well ascompulsory Latin in Responsions, the examinationfor admission to the University. Dixey then becamea distinguished zoologist in Oxford.

First Mabel studied the skin during vaccinationand then she measured how the relative areas ofwhite and grey matter vary with segmental level inthe spinal cord, a substantial work that appearedunder her name alone in the Proceedings of the RoyalSociety in 19066•

We do not know whether she was paid to do anyof this work, but she does seem to have acceptedresponsibilities as an assistant to Mann. Forexample, she seems to have helped him duringexaminations: one of her slide boxes contains slidesstained, most of them badly, by candidates in theFinal Honour School, including J G Priestley, AMcNalty, H E Gibson and H S Souttar. Mannthanked her in 1902 for her help with his book onhistological technique.

Before the work on the spinal cord was writtenup, she had already extended her interest in moreclinical problems. She went to lectures on pathology given in Oxford by James Ritchie, thenProfessor of Pathology, and to pathology lecturesgiven in London by Almroth Wright. There wereclinical lectures and demonstrations by Osler. Shespent eight months in Salamonsen's laboratory inCopenhagen working on pathology with GeorgeDreyer. She had met Dreyer, a near contemporaryof hers, in 1900 when he was working underBurdon-Sanderson in the Oxford physiologicallaboratory and, in 1907, Dreyer, helped by her,succeeded as the Pathology Professor when Ritchie


moved to Edinburgh. Also she worked on theopsonic index in Cambridge with Strangeways.

So the papers for which she had done the mainexperimental work (Figure 9) before she startedwith Haldane dealt with much that was relevant tomedicine.

Work with Haldane

Her work that is best-known today was inspired byHaldane and it is the work she herself recalledwhen she was interviewed as a centenarian. Thefirst part was on the normal value of alveolar CO2in men and women and in children at sea level. Thegas tension of the CO2 in the mixture of gases in thealveoli in the depth of the lung is called the alveolarpartial pressure of CO2 (PAe02)' Her notebookshave the names of the children in full instead of justtheir initials as in the published paper'. Jack (JBS)Haldane was then aged 12~ , 5 foot 2~ inches talland he weighed 8 stone 13 lb. He was at the DragonSchool, so-called because they beat St George's atrugger. His seven-year-old sister, Naomi, was alsoa subject then; she later became a novelist (NaomiMitchison). Jack, of course, became the verydistinguished scientist and left-wing propagandist,whom Peter Medawar found "in some ways the

Figure 9. Mabel FitzGerald aged about 28 years, in the OxfordPhysiological LAboratory. (With permission of the Bodleian Library,)


cleverest and in others the silliest man I have everknown". When she was aged 90, Mabel recalled thefun when her subjects were small boys from theDragon.

The joint paper with Haldane came out in 1905,the same year as the more famous one of Haldaneand Priestley on the stability of alveolar PC025. Thiswork of hers, like more of the rest of her work onrespiration, is a survey of alveolar PC02 in groups ofsubjects at rest.

Haldane's two papers from 1905 stand together.With Mabel he established the normal values ofPAC02 and with Priestley he described its control.This relationship was repeated in the mountains ofColorado in 1911.

But again, in respiration, Mabel had a medicalinterest. On 18 July 1905, Haldane wrote that Oslerwas willing for her to study alveolar PC02 inpatients in the Radcliffe Infirmary (see Figure 5).Some of them had anaemia and others hadrespiratory and circulatory disease. Mabel's eldestsister, Geraldine, had died from this disease in1900. She measured the patients' PAC02 and theirhaemoglobin and she counted their red cells. Irondeficient hypochromic microcytic anaemia wasthen called chlorosis and, as the old books tell usthey should be, the patients with chlorosis weremaids. Their haemoglobin as a percentage ofnormal was very low.

Ellen Talmadge, 21, kitchen maid Hb 40%Florence Morten, 18, housemaid

at that grand hotel, The Randolph Hb 31%Elizabeth Weston, 18, housemaid at

the undergraduate sportsmen's club, Vincents Hb 34%

PAC02 was little different from normal in anaemiaand that observation was to be drawn togetherwith her Colorado observations to reach theconclusion that we had set for comment in theexamination paper in 1973.

It was not all that long before she began to workin Oxford with Haldane that Mabel got to knowhim. Haldane says that they did not meet until shehad finished her course in physiology and hadstarted on research with Gustav Mann, and thenHaldane was no longer her neighbour in CrickRoad. Haldane cannot have had any part indrawing Mabel into physiology: she had chosen itbefore she reached Oxford.

We do not know how Mabel set up her informalarrangement to study in Oxford. Perhaps herbrother, Henry; helped for he was a scientist. Hehad only recently left Oxford and, as a schoolmaster, he would have maintained contact with hisold University.

Off to New York

Mabel applied twice, in 1904 and 1910, for thePhilip Walker Studentship in Pathology, but she

never held it, even though her referees wereSalamonsen, Mann and Sherrington in 1904, andMcCallum, Haldane and Mann in 1910.Sherrington commended her "thoroughness, untiring zeal and truly critical spirit", and he wroteher a long letter about her work on the spinal cord.

But in 1907 she won a Rockefeller TravellingFellowship. Osler had encouraged her to apply andhe cabled her from the USA to tell her that she hadgot it. She sailed for New York at the end ofDecember 1907 to work at the Rockefeller Institutefor the year 1908.

The 1908 visit was not her first to the USA. Shehad spent two months there in the autumn of 1900with friends of her family at Pojac Point in RhodeIsland. She was there when Geraldine died.

In 1908 she was first with Hideyo Noguchi inbacteriology for about eight months studyingsporulation in bacilli of the Aerogenes capsulatusgroup, but during that time at Rockefeller she hadsome sort of a clash with Simon Flexner. Thedifficulty seems to have arisen because Mabelfirmly believed that she would return to Oxfordafter the year at Rockefeller and would work inpathology under George Dreyer, her friend whohad just become the professor, and she toldSimon Flexner that she would. But Dreyer didnot come up with any specific proposal for workor even a general invitation to his laboratory.Flexner got to know of this. Mabel wrote to hersisters: "Dr. Flexner must think I am the mostawful liar." She was furious with Dreyer - "not agentleman" - but perhaps he was being prudentin not wanting a personal friend as his assistant,particularly a friend who had some part in gettinghim his chair.

All this fed on her distaste for the authoritarianatmosphere of Rockefeller and she decided thatshe had to leave. She thought of resigning herfellowship and wrote to Osler about it, but insteadshe went on to Toronto in Canada in September1908 to be with A B McCallum in the physiologydepartment until July 1909, studying secretion inthe stomach with a histological technique forjudging where an acid first appears: it is in thecanaliculi of the oxyntic cells. Again, the paperappeared under her name alone in Proceedings ofthe Royal Society 7.

Gustav Mann, her mentor in histology, also leftOxford in 1908 for the USA to become Professor ofPhysiology at Tulane University in New Orleansand he and Mabel met unexpectedly just afterChristmas 1908 at the annual meeting of theAmerican Physiological Society in Baltimore. Shehad come from Toronto with McCallum and hespoke well of the work she had already done in hislaboratory in but a few months. "The Rockefellermen there were exceedingly kind and pleased withthe paper that Professor McCallum gave with meon my recent work," she told her sisters. Flexnerwas also there. Mabel wrote, "He seemed embarrassed at meeting either of us."

Out west

Between her times in New York and in Toronto,she spent August 1908 travelling by herself in thewest of the USA. A postcard date-stamped"August 15, 1908 Colorado Springs"; and addressed to her sister Laura, who was staying withthe Dreyers in Denmark, says:

Oh, I am having a glorious time. The Rockies are all Ianticipated. Today I have been riding up a lovely canyon,riding true western fashion, cross saddle. Washington beautifulcity, Chicago appalling. Denver good trip from there up Mt.McClellan, 14000 ft. exquisite. Going to New Mexico tonight.

She went out west again in 1909.She was joined inMay by Laura in Toronto, and when she hadfinished her experiments in July the sisters spentthree months travelling in Canada and the USA. Itwas on this trip west that Mabel first went to the topof Pikes Peak. The sisters left their hotel room inColorado Springs at night and arrived at the top ofPikes Peak just in time to see the glorious sunriseover the plains to the east. They timed it this way toavoid the mountain sickness that develops in mostpeople who go up to the top on the previous eveningand wait there overnight for the sun to rise.

Mabel and Laura got back to New York in theautumn of 1909 and they stayed on until mid-191O,with Mabel writing up her research and Laurakeeping house in 416 E 65th St, to the east of thesouth end of Central Park. This was always Mabel'saddress when she was in New York between 1908and 1915 but perhaps she did not retain anapartment there during all her trips away.

The sisters had been together for a year whenthey arrived back in Oxford in June 1910. Mabeldid not return to New York until January 1911, sowhile she was in Oxford for the second half of 1910she must surely have heard from Haldane of hisplan to study acclimatization to altitude in the hotelon the top of Pikes Peak in Colorado, a plan whichhad arisen that August during a discussion thatHaldane and Douglas had with Henderson of Yaleat the International Physiological Congress inMunich.

By that time, of course, Mabel was an oldColorado hand - she had twice been out there and she knew the hotel on Pikes Peak. This mayhave encouraged Haldane to invite her to join hisexpedition to Colorado in the summer of 1911 andto do another of her surveys of PAe02' He did notwant her to join in the work on the top of PikesPeak but rather to carry out a quite distinct study ofher own, lower down. She was to study the state offull acclimatization in subjects who had long livedat altitude while the summit party studied theprocess by which full acclimatization developed.However, she could not finally agree until a veryfew weeks before she did set off, early in July. Shehad money problems and the Royal Society grantto Haldane would pay only her rail fares.


The money problems arose because she nolonger had the Rockefeller Fellowship. She musthave had some private income, as presumably eachof the sisters had, but she needed more. There aresome hints of where it came from.

A Colorado newspaper said that she representeda private scientific school in New York. She mayhave been teaching at that time. She was taken onpart time by the US Navy Ventilation Commissionat $50 a month: she believed that would help butshe did not know how part time it was to be andHaldane told her that she was not being paidenough. Henderson had her study the effects ofacidosis on breath holding and Yale paid her $125for helping him.

Her 1915 passport (Figure 10) calls her a clinicalpathologist. That was what she was returning to doin Edinburgh, but she may already have done it ina New York hospital. Certainly she was alreadywell respected in the subject, for in 1915,when shehad just returned to work in Edinburgh, she wasinvited to London to set up a collection of typecultures at the Lister Institute. She was already avery capable laboratory worker in a wide range ofsubjects. It is true that she got the job in Edinburghin 1915 because a man had gone off to the war but

PHOTOGRAPH OF BE R

t -

SIGNATURE OF BEARER.

Figure 10.Mabel FitzGerald's passport of 1915, whichsays "Aged 42,height 5ft 5~ ins, forehead medium. eyes blue, mouth medium. noselong,chin square. hairlight brown." (With permission of the BodleianLibrary.)


she got it against the disadvantage that she had noformal qualification.

Pikes Peak

A few months after Mabel returned to New York inearly 1911, she did the study around Pikes Peakwhich has become her most famous work. Thebasic story of the expedition itself can be built upfrom the scientific papers on the expedition but along series of letters from Haldane to Mabel adds amore personal flavour. They deal mostly with theplanning and the writing up. The earliest of theletters (Figure 5) have to do with Osler providingpatients in 1905 and with getting Mabel's observations on them published.

Haldane's first letter (23 March 1911) about PikesPeak thanks her for her advice and "for all theinformation you are sending and have sent ... abase of operations at Colorado Springs will be agreat help". A letter dated 14 May reads:"Schneider has been working at Yale and wehave now arranged for him to join the expeditionand to make his laboratory at Colorado College,Colorado Springs our local base." Schneider wasProfessor of Biology at Colorado College and hadtaken his doctorate at Yale in about 1900but not onrespiration. Before 1911 he had done little more onaltitude than measure a few blood pressures: PikesPeak made him. He worked for the Americanforces in the war on the resistance of pilots to lackof oxygen at altitude and continued with suchproblems after the war. Perhaps it was Mabel whoraised the possibility of a base in Colorado Springsand of getting Schneider to join the expedition, forshe might have met him during one of her earliervisits to Colorado, but then again YandelHenderson may already have known him at Yale.

Mabel could not agree finally to join theexpedition until the house in Oxford had been letby her sisters. They seem often to have let thehouse during the summer and gone off to visitfriends and relatives or travelled abroad whereliving could be much cheaper for them.Presumably Mabel's share of the rent wouldprovide her with some income which wouldallow her to take time off from earning money ather job in New York.

Mabel met up with the men in Colorado Springs,then a town of about 20,000 people. Pikes Peak risesto the west of it to a height of 14,000 feet, standingforward prominently from the Rockies far behindand overlooking the prairies which extend eastwards. The pioneers of Californian gold miningcrossing the prairies on their way out west couldsee the peak from a great distance and "Pikes Peakor bust" became a well known American motto.

The timing of the work in Colorado was that thewhole group worked hard making preliminaryobservations for a few days in Schneider's laboratory in Colorado College. Mabel enjoyed being

with the men. Then the men all went quickly to thetop of Pikes Peak on the rack railway from ManitouSprings on 12 July and stayed there for five weeks.Mabel remained in Colorado Springs after they hadleft and started her own work on the survey. Shestudied men and women acclimatized to a range ofheights: large towns - Denver (5100 feet) andColorado Springs (6000 feet); small towns in themining areas - Ridgeway (6990 feet), Ouray (7780feet) and Telluride (8870feet); and mines where theminers lived and worked - Portland (10,090 feet),Camp Bird (11,300 feet), Tom Boy (11,500 feet),Lewis mine (12,500 feet), and Altman, "a decliningmining camp which still boasts its position as thehighest incorporated town in America (10,780 ft.)."As Mabel said, "Colorado proved eminentlysuitable" for her purposes.

When she had finished her work in ColoradoSprings, she visited the men on the peak for a fewhours on 16 July before moving round behind thepeak to work at about lO,OOO feet in Altman and atthe Portland mine. Then she went to Denver, buton the way she stopped off in Colorado Springs on30 July to visit the men on the peak for a secondtime (Figure 11). After Denver, she went about 400miles west to Ouray (11-17 August) and then toTelluride (23-25 August) nearby for the highestmines. She got back to Colorado Springs by 26--28August and then set off sightseeing into Utah butwas back in New York to see Douglas and Haldanebefore they left for home on 9 September.

The timing of her movements is not exact: it isderived mostly from the dates and places in hertable of observations on her own PAC02. She alsoreports on her experience of mountain sickness present on her first visit to Pikes Peak but not onher second, which was soon after she had spent lOdays at lO,OOO feet.

Mabel did her long-distance travelling by railand the journey to Ouray from the east of Coloradomust have seemed "exquisite" to her, going up the

Figure 11. Mabel FitzGerald on Pikes Peak, with (lift to right)Haldane, Henderson, Schneider and Douglas. From the papers of C GDouglas, a keen photographer, who seems to have taken this with adelayed exposure.

canyon of the Arkansas River, crossing the continental divide at 10,856 feet and then downthrough the Black Canyon of the Gunnison andup the valley of the Uncompahgre to Ridgewayand Ouray.

But when going to the high mines she went onhorseback, sometimes helped by a guide and withher gas analysis apparatus and other thingsstrapped to the saddles of the horses.

Her temporary laboratory varied from the officeof a mining engineer in a skyscraper to the woodenhut of a miner. In the towns, her subjects wereprofessional people and students; at the mines theywere managers or miners. She required that hersubjects had lived at altitude for at least a year andat the same altitude for six weeks. Some had beenthere from birth but it was not realized then thatthe height of a person's birthplace usually affectslifelong sensitivity to lack of oxygen.

She stayed at a mine for several days, living withthe people working there. She became well knownfor her work and she was reported in the localpapers, as were the names of the people who gaveher samples of their alveolar air to analyse.

She usually studied a group of about 10 men ateach place but the groups of women were muchsmaller and there were fewer of them except that atTom Boy mine, for some reason or other, shestudied only women. Around Telluride, the groupsof men also were much smaller: she had hoped tomake enough time to study them thoroughly bycrossing a col directly from Ouray to Telluride onhorseback, but the trail was blocked by snow evenin August and she had to waste several days goinground by rail along the valley bottoms and over theDallas Divide between.

The gas analysis apparatus she used was thesmall and easily portable one that Haldane devisedfor measuring CO2 in the vitiated air of rooms andthe technique she used was the one she describedin her earlier work: a sample of end expired gaswas drawn directly into the apparatus and sheanalysed it immediately (a three-minute job)(Figure 12).

Her observations stand today. They were oftenreferred to by Haldane and are summarized inFigure 13. They show that changes of Pm affectbreathing even around sea level.

After she had finished the survey she wentfurther west to see Salt Lake City in Utah, but shegot back to New York in time to dine with Douglasand Haldane when they were about to leave.Haldane then remarked: "Your work has beenmuch more adventurous than ours."

It had been the sort of travelling she delighted inand the work had gone perfectly as planned, exceptwhen the snow on the col blocked the trail. It wasMabel who saw to it that it did go perfectly. Hertwo earlier trips out west had served as rehearsals.No wonder that Haldane had been prepared towait for her to be able to come until the lastmoment.

Torrance. Mabel Purefoy fitzGerald 161

Figure 12. Mabel FitzG"ald measures theamountof haemoglobin in asample of blood in one of two tubes by diluting the sample until itmatches the standard in the other tube. (Photograph from HeraldTelegraph. Colorado Springs, 8 July 1911.)

Study in New York and publication

At the time of the Pikes Peak expedition andafterwards she seems not have been engaged fulltime in regular research. It was then that shematriculated at New York University and studiedto qualify for entry to a medical school in NewYork State. Notes survive in economics and ingeography and an essay of hers discusses theconditions for a police force to be honest, written inNew York. But the subject she really got stuck onwas algebra. She had knocked off American historyin 24 hours and physics in 28 hours but algebratook her 173 hours. She did eventually pass it in1915 and the Regents let her by overall. Haldanehad written on 15 April 1912:

I heard that you had got ploughed in algebra and sincerelysympathise. I suffered much from examiners myself and wasploughed in physiology for the M.R.CS. besides other similarexperiences.

It may have been the distraction of her academicwork at New York University and poor health thatmade it necessary for Haldane to write a series ofletters asking her first for a tabulated set of herresults around Pikes Peak and then pressing her fora draft of her paper. He even offered to write thepaper for her. It had been decided that she should


They make beautiful graphic representations except for theladies of Ouray who for some reason have too muchhaemoglobin and ought never to have been born ... The womenof Highlands are, like the ladies of Ouray, a disgrace tophysiology as regards their haemoglobin. It was lucky that themen's haemoglobin played up .

Women in physiology

In 1913 Haldane wrote that it seemed silly to himthat women were not full members of thePhysiological Society for they often were presentat the meetings, so he had proposed that theSociety should elect women. That incident led totheir becoming members in 1915. Mabel had givenup working in physiology by that time and so shewas not regarded as eligible for election.

While at Highlands Sanatorium, Mabel returned tomaking pathophysiological observations, this timeof PAC02 in patients with pneumothorax, and herfindings provoked Haldane into comments onvasoconstriction in the pulmonary blood vesselsof collapsed lungs.

The letters from Haldane, taken alone, do somewhat suggest that Mabel then was a rather lonely,dull woman, given to poor health, niggling argument and cranky complaint, but the personal lettersshow that that most certainly was not true. She wasthe most effective and vivacious of the five sistersand they depended on her capability for bigdecisions on managing the house in Crick Roadand in their other affairs, and they did not have toomuch money to spend.

She did not marry but most of the brides at thattime among the Purefoys and the Jervoises wereheiresses, while Mabel was a fifth daughter withtwo brothers. Many of her men friends were a lotolder than she was, just as Thos FitzGerald, hergrandfather, had been 32 years older than hisheiress wife, Sarah Purefoy [ervoise, whose fatherhad died in the Peninsular War when she was onlytwo.

Mabel had many friends and so, in those daysbefore the telephone, she wrote many letters, andlong, lively and sometimes quite affectionatecorrespondences from several very intelligentmen have survived.

Some friends

PAC02 in long-term residents at altitude. She haddone this in Colorado using apparatus thatDouglas and Haldane had brought out withthem. This time US customs made them take itback straight away, so in the Appalachians sheused her own small Haldane apparatus. The datapoints from both studies are plotted together in thesecond paper and they fit quite well to theirstraight lines (Figure 13), though Haldane doesremark:

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North Carolina: lower altitudes

Haldane was interested in altitudes lower thanthose around Pikes Peak and he got Mabel to makeobservations at 2000-4000 feet in the Appalachiansin 1913, working from a base at HighlandsSanatorium in North Carolina. Again she measured

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have a quite distinct paper under her own namebut that it should appear in the same issue ofPhilosophical Transactions as the one on the summit,but her progress was slow. All the men got theirparts of the summit work written up and thatpaper came out first.

At this time, Henderson came to suspect thatMabel was being done out of getting full credit forher work by having her paper appear later, but aletter to him from Douglas, copied in Mabel's hand,firmly and at length rejects the suggestion andrecounts Haldane's difficulties in getting any copyout of Mabel. Eventually Mabel returned to Oxfordfor two months up to October 1912 and so she andHaldane got the paper properly written. Amongthe many drafts of the paper in her own handwriting, there is an early draft in Haldane's writingof the summary, with places left for exact figures tobe inserted. (It was from the summary that CharlesMichel and I had taken our quotation for commentin the 1973 examination paper.) Haldane's son Jackcontributed to the paper by calculating the graphrelating barometric pressures to altitude.

At last Mabel's paper came out early in 1913 andvery little later than the summit one and it was atleast planned that offprints of the two paperswould be sent out from Oxford together to give theimpression of a single body of work.

Figure 13. Graph of measurements made on man at altitude. Takenfrom Haldane's first version of his Silliman Lectures, entitled"Organism and environment", given to Yale in 1916 and publishedthere in 1917.

Osler managed to get her to collect books for hislibrary, but she managed to get him to support, andto get elected, her candidate, Dreyer, to succeedRitchie as Professor of Pathology in 1907 and Oslerteased her about this in 1913 when he asked herwhich of the candidates, Starling, Hill, Haldaneand Sherrington, was her candidate to succeedGotch as Professor of Physiology. Osler wanted herto return from the USA to work in a clinicallaboratory that he hoped to set up in the RadcliffeInfirmary. She also charmed Lady Osler withviolets in her cabin when the Oslers set off fromLiverpool at the end of 1906; Osler replied withflowers in Mabel's cabin on New Year's day 1908when she was in mid-Atlantic on her way to NewYork.

In the USA she met many old friends again. For20 years she wrote to one of these, RichardWinning, a member of the family she visited atPojac and a Harvard man. He was a counsellor atlaw in Wall Street and a prime mover in theNational Self Government Committee, an organization of which Eleanor Roosevelt approved. Hesometimes replied in French and he told her onceof his sorrows with his horse when he was aide-decamp to the grand marshal of a presidentialinauguration parade.

She also made new friends. For example, shewrites to "Dearest Girls", her sisters (15 January1913):

I lunched with Mrs. Franklin Roosevelt last Saturday, theSenator's wife ... she asked me to stay at Hyde Park, theircountry place up the Hudson, so you see I am being taken up bythe 400! and today Mrs. Forbes asked me to dine.

Perhaps the writing up of poor old Pikes Peak gotpushed aside by more exciting things.

One of her later correspondents, Dr J J GrahamBrown (1853-1925), wrote only when he or she wasaway from Edinburgh - "As you know, I miss youhorribly. The Royal Society Club is still myaddress". At first it was "Dear Miss FitzGerald"and his full signature, as it always was withHaldane over 20 years, and with the other scientistsexcept Dreyer, but later it became "Dear Mabel"and "Graham". When once he was away inOxford, he wrote of his delight in walking pastthe house where she lived and also of feelinginadequate when he dined in Magdalen and thepoet laureate was present in the common room andso also was Sherrington. Graham Brown was anEdinburgh physician who taught in the medicalschool and wrote books on clinical methods andnervous diseases. He was President of theEdinburgh Royal College of Physicians 1912-14.In 1885 he had gone to Spain with Sherrington tostudy cholera for the Royal Society, and at the timeof his letter to Mabel from Oxford, he was stayingthere with Sherrington in Chadlington Road. Hisson, Thomas Graham Brown FRS (1882-1965), aneurophysiologist, also worked with Sherrington.

Torrance. Mabel Purefoy fitzGerald 163

Mabel had the confidence of her background indealing with people. Many junior women wouldhave been too timid to get themselves to be soleauthor of their papers, but Mabel's professors wereallowed no droit de seigneur to add their names toher papers. Mabel could manage men. She had thegreat good fortune that Haldane had recentlydevised so elegantly simple a procedure formeasuring PAC02 that she could use it on her ownin accumulating observations in respiratoryphysiology and pathophysiology. In contrast,Douglas usually appears as joint author withHaldane between 1909 and 1922 but their workrequired two pairs of hands and had a morecomplex argument for its interpretation. But bothfor Mabel and for Douglas, Haldane was the greatinitiator.

Return from the USA

Mabel had finally qualified to enter medical schoolin mid-1915 when she decided to return home, butshe needed a job and her sisters were on thelookout for her. She heard from Ritchie thatEdinburgh Royal Infirmary wanted a clinicalpathologist to help in working up the bacteriological side of cases. The academic pathologydepartment had Lorrain Smith, a pupil ofHaldane, as its head and that was used to tempther with the chance of research. She accepted andreturned in June 1915. Clinical pathologist inbacteriology seems to have been her basic professional status for the rest of her working life. Shelived at 54a George Square, then an elegant oldsquare near to the medical school, but she stillretained her base in Crick Road. When Haldanecrossed the Atlantic to give his Silliman Lectures atYale in 1916 he had her make up a new slide of herobservations (Figure 13) and she asked him tobring back apparatus for use in her clinicalpathology such as gonococcal antigen andWassermann pipettes, but he had to apologizebecause one of the pipettes he did manage to getwas damaged in the Liverpool docks. It was onlyon a short trip in 1922 that she ever went back tothe USA.

In addition to her laboratory work in Edinburgh,she used to lecture in the medical school of theroyal colleges, but to do this formally she had firstto be examined, for still she had no degree. Theritual was gone through, the president of theEdinburgh Royal College of Physicians signed thenoble document and she was allowed to holdcourses in the colleges' medical school, but she didhave to pay rent for her lecture theatre; thestudents paid her individually. Her position inthe colleges' medical school was lecturer. She wasalso recognized as an extra-academical teacher ofthe University of Edinburgh and she wasappointed an examiner. These advances in herstatus must have somewhat compensated her for


her lack of a degree: they allowed her to teach inthe Edinburgh School of Medicine for Women.

Old books

There is no evidence of Mabel doing research aftershe came back from the USA. She had beeninterested by Osler in old medical books veryshortly after he arrived in Oxford in 1905 and shewas of course in a fine strategic position to collectthem for him in Edinburgh, where there was then along tradition of medical scholarship. She produced her own book lists and circulated them andso she must have held books herself. She continuedselling to the Osler library when Osler himself haddied (in 1919) but Lady Osler and her nephewWillie Francis were still expanding the library andwere getting it ready, all eight tons of it, to move toMcGill in Montreal in 1928. Willie Francis askedher to look out for particular books. For example,he wrote of a "scandaliferous" one, Flagellation andtheFlagellants, by the Reverend Wm M Cooper BA, apseudonym.

After Osler's death, Mabel circulated her listsand sold books to Harvey Cushing, Osler'sbiographer, and then later she read the proofs ofthe Readings in the History of Physiology of John FFulton, Cushing's biographer. Selling books musthave been a commercial operation but for HarveyCushing, at least, Mabel did not put prices to thebooks on her list, leaving it to Cushing to decidewhat he thought right.

Return to Oxford

And then Mabel gave up Edinburgh, and returnedto live in Oxford sometime in the late 1930s, whenshe was about 65. Haldane died in 1936, butDouglas was not yet 60 and he worked in thelaboratory for another 15 years. She was known tofriends around the country and around the worldand to her neighbours in North Oxford, particularly to the Elliotts from 1957. All the other sistershad died by 1956, all of them unmarried.

Mabel continued in 12 Crick Road. The leaseexpired in 1971 and so the house could then havebeen made to fall to St John's but the Bursar did notdo so: Roger Elliott saw to that.

By that time physiology, in the person of DanCunningham, had already rediscovered Mabel andin 1961 she had come to the celebration ofHaldane's centenary. And when she reached herown centenary in 1972, her world took off again.

Mabel FitzGerald today

Why should we bother about Mabel FitzGerald'swork on high altitude today?

She worked on people who had acclimatized tohigh altitude. But having to acclimatize to height isno longer just a problem for a few heroic climbers

struggling to the top of a remote Himalayan peak,as it usually was in Mabel's day: now thousands ofminers work in the Andes at up to 4000 m andmore but they commute to work from their homeson the coast. Also, thousands of skiers fly intoColorado for a week or two at over 3000 m. It is thenewly arrived who suffer: a healthy long-termresident can withstand the altitude. To help thepeople with altitude sickness, you should at leastknow what a healthy person is like who hasacclimatized completely to a high altitude, forthat is what you would like the new arrival tobecome instantly. And that must be acclimatizationto a particular altitude: acclimatization to onealtitude does not imply acclimatization to allother altitudes.

Mabel fitzGerald was the first person to measureany aspect of full acclimatization over a wide rangeof altitudes, from sea level to over 4000 m. Youneed to lower the blood bicarbonate so that a fall inPAC02 does not alter the alkalinity of the blood.Haldane" remarked that bicarbonate could bereduced with NI-4Cl, and you can calculate that,in order to do this, a man would need to take about1 g of NH4Cl for each 1000 feet ascended", ButNH4Cl still needs to be tried out properly, and thecommuting miners of the Andes would makesplendid subjects for a trial.

Normalcy

This example shows how Mabel's work can bevaluable even today. Nevertheless, it does notdescribe completely the steady state of a man whois fully acclimatized to altitude. For example, weknow that his body fluid volumes change soonafter arrival at altitude, but have they returned totheir sea level values when acclimatization iscomplete? And is the HOC3- he got rid of ataltitude simply replaced by Cl"? So there are manythings yet to be done to complete Mabel's work onwhat is normal at altitude.

In this context, the word normality seems to beused for man at sea level only. A man of Denver isthen that epitome of sea level man, a New Yorker,who is in respiratory alkalosis compensated bymetabolic acidosis. How much better it would be toaccept that what is normal is the relation of a wholearray of variables to altitude, of PC02, Cl : , plasmavolume and so on. But the word normality hasbeen pre-empted for a single altitude, sea level we learn that 40 torr, the value of PC02 at sea level,is the normal value. So instead, Dempsey et al. 10

have, for this wider meaning, used normality'ssynonym, normalcy, the word made famous byWarren Harding. Normalcy is used for the wholeset of relations of bodily variables to altitude: andnormalcYDenver (or normalcY1550 m) describes a manwho is fully acclimatized to Denver. On returningto Denver after a period in New York, our man isimmediately a man of Denver again, but to begin

with he is in respiratory acidosis and metabolicalkalosis by the standards of Denver, and ismoving towards normalcYDenver' And also there isnormalcYLeadville, normalcy-; paz, normalcYDead Sea'and normalcyeverywhere else' as well.

Oxygen secretion

Mabel was very eager for her work around PikesPeak to be associated with the work of Haldaneand the other men on the summit, but it could wellbe that this association with Haldane's workcontributed to her being forgotten.

Haldane thought that O2 may be pumped intothe blood in the lungs'! and that would obviouslybe a good thing at high altitude. To show that thishappened, he used a complex and indirect methodwhich involved measuring the amounts of Oz andCO combined with haemoglobin. But about 10years later, Barcroft used a quite direct method toshow that Oz is not pumped, for the alveolar paz isabout equal to blood paz, even at altitude. Andsince then, people have been wondering whyHaldane came to his wrong conclusion. There aretwo groups of possibilities: either his measurements of gases combined with haemoglobin werewrong, or his arguments from his measurementswere wrong, and this could have been because hethought that CO does nothing in the body exceptcombine with haemoglobin. But it is now realizedthat CO is actually formed in the body. If, then, thegas measurements are accepted, they mean thatCO, a dangerous natural product of the body, isactively excreted by the lungs, a very differentteleology from the Oz secretion one, but still a verysatisfying one. Haldane never really gave up on Ozsecretion, and his tenacity over it must havecontributed to the general view of him.


Mabel's normalcyThe oxygen secretion incident may have contributed to Mabel being forgotten, and so may herchoice, soon after Pikes Peak, to settle into work ona subject quite apart from physiology. But physiology seems to be the subject that is noticing heragain. Perhaps physiologists are realizing that theyneed to know a lot more about the state of fullacclimatization to altitude and about the relation ofmore variables to altitude in that state. They needto know more about normalcy. About Mabel'snormalcy.

References1 FitzGerald MP. The changes in the breathing and in the

blood at various high altitudes. Philos Trans R Soc (London)1913;203:351-71

2 FitzGerald MP. Further observations on the changes inbreathing and in the blood at various high altitudes. ProcSoc (London) 1914;88:248-58

3 Cunningham DJC, Lloyd BB. The Regulation of HumanRespiration. Oxford: Blackwell, 1963

4 FitzGerald MP, Haldane JS. The normal alveolar carbonicacid pressure in man. J Physiol (London) 1905;33:486-94

5 Haldane JS, Priestley JG. The regulation of lung ventilation.J Physiol (London) 1905;32:225-66

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