Expedition Medicine: How to Plan It

by Richard Gregson

In the 1981 expedition, no-one was badly injured or seriously ill. This is how the Club Medical Officer helped to bring this healthy state of affairs about.

Before we went

Most of the things that prevent people from caving on expeditions (apart from laziness) are not serious - of the serious things that can happen, the most likely is an accident: the most likely sort of accident is a road accident (if you cave safely!). The reason to really worry about road accidents is not only the inconvenience to the expedition, but also because of the expense that may be involved. A lorry driver was recently released after four months in jail because an Arab driver killed himself driving into the back of his stationary truck. He was jailed because he was not insured. The most important part of expedition medicine is adequate insurance for the members: imagine the cost of helicoptering a casualty from the advance camp to an NHS hospital - you might not want to take advantage of local hospitals, especially if you're outside Europe.

The next most important thing is immunity from infectious diseases. By far the most important of these is malaria, because you are so likely to get if you don't take anti-malarial tablets, and because it is serious. Other diseases can be prevented e.g. typhoid, cholera, yellow fever, hepatitis, rabies. Smallpox inoculation is now no longer required for any country. Of all these 'jabs' the most important is polio: be certain that every member is immune: the other diseases are either treatable, not serious, or (in the case of rabies) preventable after the event.

Whilst We Were There

Most of the problems encountered are very minor, but nevertheless they can prevent people from caving. The things which did this were knees, elbows, festering cuts, sores and piles. We had few cases of diarrhoea - probably because we cooked nearly all we ate and drank spring water.

1. Festering Cuts - the 'Ario Festers' - are an occupational hazard. They seem to be caused by splinters of quartz and my own cuts healed rapidly if I cleaned them well - on subsequent expedition I shall take several tweezers.
2. Knees and Elbows - get cut, swell up, hurt etc. Part of this is the 'way you cave'. The caving was much tougher and there was more of it, so knees and elbows needed more care and better protection. One of the great successes of the medicine box was to pad and dress a gaping hole in someone's knee - about the size of a cup - with the result that it healed over whilst the person continued to kneel on it when caving. This wound was clean - another one became an abscess: it was helped by a shepherd's remedy of a boiling hot salt and vinegar compress, application of which caused a great deal of amusement! This abscess was lanced and drained, and the sufferer went caving the next day, having been unable to walk before! Another problem was 'bursitis' - a fluid-filled bag which develops over a joint which has been subjected to too much pressure. In the knee, this is 'housemaid's knee' - in the elbow 'olecranon bursitis'. This can only really be cured by rest, but aspiration of the fluid and possibly also injection of steroid (in which case you have to be sure it isn't an abscess).
   Lastly, cartilages in the knee may 'go', resulting in an inability to straighten the leg. These never heal, but sometimes the broken bit of cartilage can flop out of the way. The knee should never be forcibly straightened as this can wreck the knee. Only an operation to remove the broken bit of cartilage sorts this out, and this is best done in England.
3. Piles - apparently the majority of people suffer from piles. Maybe they were common on OUCC expeditions because of straining whilst caving plus constipation (due to diet and dehydration). Steroid cream, local anaesthetics and a high fibre diet (or a laxative) are the best expedition treatments.
4. Jock Rot - a condition maybe unique to caving, where a tight sit harness, worn for over twelve hours at a go, plus sweat and sand, erodes away the skin. It is unclear if this condition is confined to males, as we had no women underground that long (you can't win them all). This was effectively cured by talk (on the surface) and by not wearing underpants beneath the furry (underground). Make sure that you buy an easily adjustable sit harness!

In summary, we suffered from only simple ailments in Spain. We had quite an ample medicine chest, and also a reasonable rescue kit (I.V. fluids and antibiotics, powerful analgesics, splints, superb sleeping bags, stretcher, Paul's tubing, soup etc.). We used the medicine chest for very minor ailments, and never used the rescue kit at all. Safe caving is worth a thousand rescue kits, and was the most important feature of our remaining well in Spain. We were also well because we were Insured and because we were Inoculated.