1004 
1004 
AVIATION MEDICINE 
IN 
THE A. E. F. 
PREPARED IN THE OFFICE OF 
THE DIRECTOR OF AIR SERVICE 
February, 1920 
GOVERNMENT PRINTING OFFICE 
1920 War Department 
Document No. 1004 
Office of The Adjutant General WAR DEPARTMENT, 
Washington, February 26, 1920. 
The following publication, entitled “ Aviation Medicine in the 
A. E. F.,” is published for the information of all concerned. 
[062.1, A. G. O.] 
By order of the Secretary of War: 
PEYTON C. MARCH, 
General, Chief of Staff. 
Official : 
P. C. HARRIS, 
The Adjutant General. 
3 FOREWORD. 
This publication contains an account written by Col. William H. 
Wilmer, Medical Corps, who was in charge of the Air Service Medical 
Research Laboratories at Issoudon, France, from September, 1918, 
until the armistice. The account describes the various phases of the 
physiological and psychological problems of aviation, the organiza- 
tion of the work in the A. E. F., and the application of the newly 
discovered principles to the maintenance of the efficiency of the flier. 
It also suggests the future possibilities that lie in aviation medicine. 
In addition, it records the tasks accomplished by the various depart- 
ments of the medical research laboratories, the character of the work 
with the British, conferences with various types of fliers, and it ana- 
lyzes accidents and their causes. 
At the beginning of the Great War, the medical principles involved 
in flying were realized even less than many of the other problems of 
aeronautics. But by a thorough study of the physiology and psy- 
chology of flying officers, resulting in care for their efficiency, 
much was done to decrease the accidents in the flying schools of 
France. The tests and standards thus established will be of inesti- 
mable value in all future work to determine the qualifications, not 
only of the military pilot and observer, but of the commercial flier 
as well. The great value of this account lies in the fact that it em- 
bodies matter that “will be of great importance in promoting the 
safety and more rapid development of aerial navigation.” 
M. W. Ireland, 
Surgeon General, TJ. S. Army. 
4 CONTENTS. 
Introduction. 
Chapter I. 
Organization and general aspect of the work of the Air Medical Service, A. E. F. 
Chapter II. 
AVIATION MEDICINE AND THE PLIER, A. E. F. 
Selection of the flier.—Care of the flier.—Reexamination.—Education of fliers in 
matters relating to health and efficiency.—Monthly reports.—Record blanks.— 
Flight surgeons.—Investigations relating to the flier.—Examination of American 
and French fliers from the front.—Conferences with American combat fliers.—Con- 
ferences with observers. 
Chapter III. 
DEPARTMENT OP PHYSIOLOGY. 
Section I.—Effects of high altitudes upon aviators and the altitude classification exami- 
nation.—Adaptive responses to altitude.—Rebreathing apparatus.—The classifica- 
tion examination.—The breathing when under progressive decrease of oxygen.—- 
Heart rate under progressive decrease of oxygen.—A. E. F. examinations.—Re- 
breathing examination as a test for staleness. 
Section II.—Efficiency tests.—British tests.—Application of British tests in A. E. F.— 
Comparison of breath-holding with rebreathing test.—Vital capacity and low oxy- 
gen.—Extra reserve factor.—The “U-tube ” fatigue test.—Clinical findings and stale- 
ness. 
Section III.—Circulatory efficiency tests.—Methods used in these tests.—Examina- 
tions made in the A. E. F.—Crampton’s vasomotor tone index.—Pulse rate after 
standard exercise.—A point system for grading the cardio-vascular efficiency tests.— 
Cardio-vascular and British efficiency tests.—Cardio-vascular efficiency and endur- 
ance of low oxygen. 
Section IV.—Hygiene of the aviator.—Exercise.—Sleep.—Habits.—Use of artificial 
oxygen. 
Chapter IV. 
Reaction time tests.—Numerical scores comparing fliers tested in United States with 
those tested in France-.—Steadiness test.—Correlation between tremor and flying.— 
Emotional stability of the aviator.—Personality of the aviator.—Alcohol and the 
aviator.—Observation report test for aerial observers.—Discrimination recognition- 
reaction time.—Relation of the performance of this test to success as an observer. 
DEPARTMENT OP PSYCHOLOGY. 
DEPARTMENT OP OTOLOGY. 
Chapter Y. 
The r61e of the labyrinth in flying efficiency.—Study of 768 cases in the A. E. F.— 
Normal type.—The hypersensitive-to-motion type.—The subnormal labyrinth.— 
Registering “joystick.” 
5 6 
CONTENTS. 
Chapter VI. 
department of ophthalmology. 
The eye in aviation.—Routine work.—Summary of eye examinations.—Effects of 
altitude upon ocular functions.—Effects of drugs.—Analysis of special eye exam- 
inations of aviators.—Ophthalmological problems that need further consideration.— 
Goggles.—New apparatus.—Effect of nose and throat infections upon ocular func- 
tions. 
Chapter VII. 
AVIATION ACCIDENTS. 
Number and distribution of accidents in training schools of the A. E. F.—Accidents 
and fatalities in relation to hours of flying.—Number and distribution of accidents 
in training schools in the United States.—The casualties in zone of advance.— 
Total fatalities of the American Air Service.—The causes of accidents and their 
prevention.—General rules and regulations governing flying at the third aviation 
instruction center.—Responsibility and accidents. 
Chapter VIII. 
WORK OF THE UNIT ATTACHED TO THE BRITISH AIR SERVICE. 
Aviation candidates’ commission board.—Invaliding board.—The “Medical flight.”— 
Lighter-than-air ships.—Seaplanes.—Chaltis Hill aerodrome.—Shotwick, Nether- 
avon, and Eastbourne training stations. 
Chapter IX. 
FUTURE OF AVIATION MEDICINE. 
Appendix. INTRODUCTION. 
From legendary times, man has sought to emulate the birds—to 
conquer the air. Yet at the beginning of the war, Aviation was in 
its pioneer stage—scarcely more advanced than marine navigation 
at the time that Columbus discovered America. It was only in the 
decade previous to the war that Wright had established the possi- 
bility of aerial navigation by his successful flight in the air. Several 
years after that famous exploit it was still considered unsafe to fly 
in a 10-mile breeze; to bank in turning was to tempt fate; to descend 
with a dead motor attracted wondering crowds. Lieut. Nesteroff, 
the courageous Russian officer, had just performed the first loop in 
the air, and M. Pegoud, the famous French flier, had made the first 
descent by parachute from a single-seated machine. The former was 
destined, on September 8, 1914, to offer himself upon the altar of 
Patriotism by destroying an enemy plane by running it down in the 
air, while Pegoud, in making the supreme sacrifice for his beloved 
France, so impressed himself upon the enemy that during his military 
funeral their planes dropped flowers and words of condolence. 
During that period of aviation history, the “ceiling” of the single- 
seater rarely exceeded 12,000 feet; a continuous flight of 250 miles 
was remarkable, and the motors were all low powered. 
When the United States authorities, in 1914, gave out specifications 
for a biplane with a maximum speed of 70 miles an hour and a climb 
of 4,000 feet in 10 minutes, the manufacturers thought the require- 
ments too strict. 
In the armament of fighting planes, hand grenades, bags of bricks 
for throwing into the enemy’s propeller, carbines, automatic pistols, 
cannon firing through the propeller hub, machine-gun firing from the 
upper wing of the aeroplane, gave place in turn to the synchronized 
machine-gun firing through the revolving propeller blades. 
Maj. McCudden, in liis “Five Years in the Royal Flying Corps,” 
sums up the condition of the British Air Force at the onset of the 
war as consisting of about 50 machines fit for military purposes, with 
40 trained pilots. The plight of the United States was even worse. 
Maj. McCudden very graphically described a fighting machine of[1914: 
“About one-half hour after the German had{departed a Henri Farnam, 
of No. 5'Squadron, fitted with a machine'gun, was still climbing steadily 
over the aerodrome at about 1,000 feet in a strenuous endeavor to 
7 8 
INTKODUCTION. 
catch the Boche. In these days every pilot and observer dabbled in 
many things—reconnaissance, artillery, observation, bomb raids, pho- 
tography, and fighting. But the service has since expanded so much, 
both in size and importance, that each squadron is made to specialize 
in one or two branches, while other specialists look after the re- 
mainder.” When the condition of the British Air Force in 1914 is 
compared with its wonderful efficiency and achievement by the close 
of the war, the results seem little short of miraculous. 
The increase in speed and “ceiling,” under the necessities of war, 
gave rise to many additional military, economic, and medical prob- 
lems. For without an efficient pilot as guide, the ever-improving 
plane would become a useless thing for all military purposes. Capt. 
Sweetser says in “The American Air Service:” “When the British 
analyzed their casualties during the first year of the war, they found 
that 2 out of each 100 fliers in the casualty list were killed by the 
enemy, 8 of them owed their misfortune to defects in their planes, 
while the other 90 came to the hospital or the grave because of them- 
selves, their carelessness or recklessness, their physical failings, and 
all other things which may be summed up in the human equation.” 
Therefore the proper selection, classification, and maintenance of 
efficiency among pilots are of the utmost economic, military, and 
humane importance. 
Aviation attracted Youth by its offer of the “great adventure.” 
In “The Airman’s Outing” is written: “Somewhere behind a ridge 
of clouds, in the nothingness of space, on the patchwork of the ground, 
the True Romance has hidden a new experience which can only be 
found by the venturer with alert vision, a quick brain, and a fine 
instinct for opportunity.” Maj. Bishop writes: “I do not think I 
was ever happier in my life. It seemed that I had found the one 
thing that I loved above all others. For me, it was not a business, 
or a profession, just a wonderful game.” 
For the proper appreciation of that wonderful game, and of the 
qualifications that make for success in it, one must consider the 
types of air work, the physical and the psychological standards of 
requirements, and make a profound study of personality. Tested 
by purely physical standards, Guynemer, the marvelous French 
flier, would have been disqualified. By certain psychological tests, 
he would, perhaps, have been classified as “nervously unstable.” 
But this tall, slender youth with “unforgettable eyes,” was the 
embodiment of that subtle “something” which exists in all “masters 
of fate.” It seems as hopeless to attempt to record this compelling 
force by correlative numerals as to measure the weight of the soul. 
Some of its component parts can be estimated—such as quickness 
of response, calmness, perseverance, and steadiness. Its existence 
can be recognized by intimate conferences ascertaining love for the 9 
INTRODUCTION. 
work, self-reliance, initiative, imagination, aggressive spirit, unbreak- 
able will, courage, infinite capacity for taking pains, and great desire 
to serve one’s country. All the star fliers of the allied services— 
notably Bishop and Ball of the British, and Rickenbacker, Lufbery, and 
Luke of our own—possessed these qualities in a marked degree, while 
Guynemer was their rarest expression. They have all embodied the 
beautiful idea of Col. Roosevelt’s as paraphrased to read: “Only 
those are fit to ‘fly’ who have not feared to die.” In connection with 
the early history of Guynemer (which showed a great skill in shooting 
and fencing with a fine ambition to excel) it may be interesting to note 
that certain sports like cross-country riding, polo, and sailing have a 
tendency to give the flier “hands”—most helpful in maneuvering a 
sensitive single-seater fighting machine. Diving also gives one a 
great sense of equilibrium. The Cavalry has produced a number of 
the most successful fliers, among them Bishop, Heurteaux, and the 
German pilot, Yon Richthofen. 
So many contradictory requirements for “picking the birdman” 
have been stated by those interested in the problem, that Maj. 
Patten’s analysis of the fighting pilot is both humorous and true. 
“He is a tall, short, stout, slim, blond, brunette, quiet, nervous, 
languid, alert, reckless, conservative individual.” Even after the 
“birdman” is selected, he may prove a wonderful flier without 
bringing down a single enemy plane, or he may be a fighter of the 
first class without giving much thought to the flying itself. Bishop 
modestly writes of himself: “I belong to the steady flier’s class, but 
some day soon I am really going to learn to fly—to do aerial acro- 
batics and everything.” It is impossible to make a clear composite 
picture of a group of men who are the highest exponents of indi- 
vidualism. For each adopts the method of fighting that suits his 
peculiar requirements. In addition, in the classification for efficiency, 
one has to consider the various kinds of work which have constantly 
become more specialized. In order to avoid repetition in the 
chapters that will present the work of the departments of the 
medical research laboratories, it seems best to give, at this point, a 
brief analysis of the varied types of air work for which the fliers 
were selected, each according to his individuality. 
The chasse, scout, or fighting pilot is the type of flier suggested to 
the public mind when the word “aviator” is used. He is the 
“birdman” of the press. His duties are various. He must fly to 
any height, changing altitude instantaneously, from “ground strafing” 
to the limit of the plane’s ability to climb. He must escort and pro- 
tect the other airmen in their special lines of work. He is, as Lieut. 
Rath aptly expresses it, “ the mine sweeper of the air.” In squadron, 
or stalking the enemy alone, he must be ready to fight without a 
-moment’s notice, always anticipating the maneuver that the enemy 10 
INTRODUCTION. 
is most likely to make. His reaction time must be quick but 
associated with cool, calm judgment. The most successful pilots 
achieve their victories with the first few shots, after taking deliberate 
aim. Like other types of airmen, he must be absolutely familiar 
with the topography of all the country over which he must fly. 
While many older pilots have been most successful, as a rule the fight- 
ing pilot is at his best from 19 to 25 years of age. 
The night chasse pilot has the duty of keeping the enemy planes from 
crossing the lines, and of protecting the targets (cities, etc.) from 
these raiders. The very nature of his work subjects him to the double 
danger of his own as well as the enemy barrage. Later in the war, 
the British night fliers met with great success at the front. In our 
own service, this branch of aviation work was just being inaugurated 
when the armistice was signed. 
The work of the observer each day was growing in importance, and 
all combat pilots are ready to pay tribute to his personal qualities 
and to the value of his work. He was fast developing into a skilled 
specialist in artillery and infantry liaison, with highly technical 
knowledge of radio, the making and interpreting of maps, photo- 
graphy, visual reconnaissance, with reports and aerial gunnery. 
Col. Reille, of the French Artillery, says: “The flying machine should 
not be considered so much as one arm of the Artillery as one of its 
eyes—and that the better one. The bringing down of the enemy’s 
plane blinds his Artillery.” Rickenbacker says: “I believe their 
function of seeing for the Army is the most important one that be- 
longs to the aviation arm in warfare.” Early in the war through the 
aerial reconnaissance of Capt. (now Gen.) Charleton, the attempt of 
the Germans to flank the British Army was discovered in time to 
save the latter by the great strategic retreat from Mons. The 
history of the Air Service to the very end of the war is replete with 
instances of the importance of observation. Richthofen says: 
“Frequently a photographic plate is more valuable than shooting 
down a squadron.” In spite of all that must be seen on the ground, 
only one-eighth of the time can be spared for this work when the 
observer is near the enemy’s lines, the rest of the time must be spent 
in looking for hostile planes. His duty carries him to all altitudes— 
from dropping a message at 300 meters to a long reconnaissance at 
5,000 meters. Because of the great need of mature judgment in 
such work, the observer may be somewhat older than the combat 
pilot—provided that he has a strong physique. 
Day bombing has been aptly described by Lieut. Rath as “ artillery 
on wings.” The objectives are in the immediate rear of the enemy’s 
lines, zone of activity, and strategical points far within the hostile 
country. These distant flights are frequently of four or five hours 
duration and often at an altitude of over 4,000 meters to avoid the INTRODUCTION. 
11 
enemy’s antiaircraft guns. The bomber must not be less minutely 
familiar with the topography of the country embraced in his mission 
than the fighting pilot. 
The night bomber seldom flies higher than 2,000 to 3,000 meters. 
But he must be thoroughly familiar with every foot of ground back 
of his own lines in order to make a landing without really seeing— 
should that necessity arise. He must be familiar with the topography 
of the hostile country in order to recognize guiding landmarks. He 
must be able to recognize all roads, rivers, woods, vineyards and 
towns—the latter largely by the geometrical formations. He must 
know the constellations and their positions on the compass. More- 
over, he must constantly consult his maps and compass. The 
following contretemps—due to unfamiliarity with the section—is 
told by some French fliers: “An expedition actually bombed Nancy 
instead of Metz and finally capped the climax by landing in Luxem- 
bourg.” Many night fliers have spoken of the very confusing effect 
of moonlight on the earth-mists which are so common in France 
during certain seasons. All allied fliers speak of the greater effective- 
ness of the enemy’s searchlights which leave one blinded for a long 
time. One of our fliers working with the British told of an amusing 
experience of a very successful night bomber, who, on a very beautiful 
day, went up for a “joy ride” and got lost. He was not accustomed 
to the landmarks in daylight. 
The aerial gunner’s work has now been taken over by the observer, 
who has added the use of the machine gun to his other duties. 
The aerial navigator is a late product of the war evolved by the ne- 
cessity of flying in foggy or rainy weather, and at night. He directs 
the flight of his pilot by map and compass. So far there are very 
few thoroughly trained aerial navigators. 
The ferry pilot flies the machine from a central station to some 
aerodome near the front. So he does not have to consider the 
questions of combat or of altitude. In the British service the ferry 
pilot usually flew the planes across the Channel. 
In the lighter-than-air ships, the altitude is usually not over 500 to 
1,000 meters, and the landing does not require the fine adjustment of 
sight and judgment Of distance. The pilot may be older than the 
combat pilot, but the long patrols are very fatiguing and require a 
strong physique. 
In the captive balloon, the work is of the most trying and nerve- 
racking type. Very few balloon observers have the nerve to resume 
their work after three or four forced descents with a parachute. The 
altitude is not usually over 1,000 meters. Good sight is of great 
value, but the observer is relieved of the responsibility in landing. 
In the free balloon, also the finest ocular adjustments are not neces- 
sary in landing. 12 
INTRODUCTION. 
In regard to the seaplane, Maj. McCombs, who has had much expe- 
rience in the matter, feels that owing to the heaviness of the ship and 
its slow response to the controls, a certain amount of physical strength 
is necessary for the pilot in “taking off” and in getting out of a 
“side slip.” There should also be sufficient length of legs to easily 
reach the rudder bar. He also says: “The level of the water is diffi- 
cult to judge,' especially when the water is very calm and at night.” 
The altitude is rarely over 500 meters. 
In addition to these divisions of air work—which keep the flier to 
some extent in the public eye—there are two types of aviation experts 
at the training centers whose work is less spectacular, though it is 
far-reaching in the development and success of the Air Service—the 
monitor and the tester. The monitor or instructor has to be in the 
air many hours a day and has to be always on the alert. Without 
him the successful combat pilot could not have existed. The tester’s 
work is still less understood, and it is certainly not generally realized 
that some of the most remarkable acrobatic fliers of the service belong 
to this group. It is the tester’s duty to see that there are no defects 
in flight or in maneuverability in the planes to be used by the student 
fliers. He “hops” up 500 to 1,000 feet to test the ship’s alignment—■ 
whether nose heavy or tail heavy, whether it leans too much in bank- 
ing or whether there is anything else that interferes with its stability. 
He indicates to the mechanics the necessary correction, and he con- 
tinues his flights until he is satisfied that all of the faults have been 
eliminated. To be successful the tester must be not only an excep- 
tionally good pilot, but he must be conversant with the theory and 
practice of rigging and mechanical flight, and he must possess a knowl- 
edge of the principles of engineering. The safety of the student flier 
depends upon his conscientious, painstaking, fearless carrying out of 
his important work. 
Toward the end of the war all types of fliers at the front joined in 
the sport of “strafing” the enemy. In this very effective phase of 
aerial warfare the aviator flies very low, at times within a few yards 
of the enemy whom he “sprays” with bullets from his machine gun. 
He is impartial, and he does not slight any group of the enemy from 
the front line trenches to the engineers of the troop trains in the rear. 
The period following our entrance into the World War was com- 
paratively too brief and the necessities of that conflict too great to 
further the research work upon many important aviation problems; 
but it is hoped that our experience both in the United States and in 
France may have some value for those who may, in the future, have 
the time and opportunity to pursue these investigations more com- 
pletely. 
The published work of our colleagues in the allied services has been 
of great assistance from the beginning of our task. It is most logical 13 
INTRODUCTION. 
that the nation which produced Paul Bert should have contributed 
so much towards elucidating the effects of reduced oxygen tension. 
Bert’s pneumatic cabinet still holds its place in the Sorbonne—an 
eloquent reminder of Science’s debt of gratitude to the great physiolo- 
gist. The French have also gathered together very valuable statis- 
tics upon various reaction times, which have been most helpful in our 
work. The Italians have contributed much data of importance con- 
cerning practical psycho-physiological examinations. The British 
have developed a number of practical tests for the selection of the 
flier, for the recognition of his fitness and for the detection of stale- 
ness. 
Aviation has been developed during the past decade, and medical 
aviation is still younger—only in the very infancy of its experimental 
stage. “Damnant quod non intelligunt.” Every new thing is liable 
to be met with indifference if not with actual hostility. It is there- 
fore a pleasure to note that moral support as well as material help 
were invariably extended to the medical research laboratories in the 
A. E. F. America’s genius for organization showed itself in the 
transportation and in the adequate housing of the laboratory equip- 
ment in the center of France at a time when every branch of the 
service was so severely taxed. 
In general, officers of all branches of the service have been interested 
and helpful. In particular, tribute is due to the chief of the Air 
Service, the chief surgeon, and the commanding officers at all the 
fields in the A. E. F. where laboratories were installed for their vision, 
their encouragement, and their unfailing assistance. It is not pos- 
sible to express adequate appreciation of the loyal and efficient work 
of the research board, of the units, and of the flight surgeons. To 
them the care of the flower of American Youth has been not only an 
absorbing scientific interest, but a sacred trust from the Nation. Chapter I. 
ORGANIZATION AND GENERAL ASPECT OF THE 
WORK OF THE AIR MEDICAL SERVICE, A. E. F. 
When the chief surgeon, A. E. F.—a man of fine scientific attain- 
ments and of broad culture—asked for the official report of the work 
of the medical research laboratories in France, he said: “Make it a 
human document rather than a collection of purely scientific data.” 
Therefore, it seems best to give some account of the happenings 
associated with the development of the work, even at the risk of 
some tedious detail. * 
Immediately upon the declaration of war the vital part that our 
Air Service should play in the conflict was recognized. The Surgeon 
General of the Army was logically in charge of that part of the 
preparation that pertained to physical standards, and he made the 
timely recommendation that this work be placed under the super- 
vision of one medical officer who, under the direction of the Chief 
Signal Officer of the Army, would assume control of the physical 
examination of aspirants for flying duty. Acting under verbal in- 
structions, Col. Lyster had, early in the summer of 1917, established 
and standardized the work of physical examining units in 35 of the 
large cities, so that at the time of issuance of the formal order, thou- 
sands of men had already been accepted for the Aviation Service 
and some of them had been sent overseas. As the organized units 
of the Air Service passed through the ports of embarkation, they were 
assigned medical officers and received their standard medical equip- 
ment for active service. But it was recognized that these medical 
officers—picked more or less at random—had not been trained with 
reference to the peculiar problems of aviation. They had had neither 
laboratory experience nor special opportunity of working with the 
fliers. 
The establishment of the central office and the work of organizing 
and standardizing the various examining units were closely followed 
by the formation of the Medical Research Board to “ investigate all 
conditions affecting the efficiency of pilots; to institute and carry 
out, at flying schools and elsewhere, such experiments and tests as 
will determine the ability of pilots to fly in high altitudes; to carry 
out experiments and tests to provide suitable apparatus for the supply 
of oxygen to pilots in high altitudes; to act as a standing medical 16 
AVIATION MEDICINE IN THE A. E. F. 
board for the consideration of all matters relating to the physical 
fitness of pilots. * * *. ” This board was officially established by 
paragraph 113, Special Orders 243, Adjutant General’s Office, October 
18, 1917, and met in the chief surgeon’s office or at the American 
University until the middle of the following January (1918), when 
the original research laboratory at Mineola was completed. The 
work now proceeded with constantly increasing volume, so that two 
months later it was found necessary to treble the size of the build- 
ing in order to properly house the different departments and 
to set in motion the machinery involved in training the personnel 
•required for branch laboratory units at the flying fields and at the 
ground schools, and also for the newly created “care of the flier” 
department, made up of flight surgeons and physical directors. By 
this time the strength of the laboratory force was considerably over 
100, commissioned and enlisted. 
In June, 1918, branch laboratories had been established hi many 
of the fields, and flight surgeons were on duty. Additional personnel 
were under instruction at the main laboratory and hundreds of fliers 
were undergoing the low-oxygen tension tests, either in the low- 
pressure tank at the Mineola laboratory or by means of the Henderson- 
Pierce rebreathing machines at the branch laboratories. The results 
immediately showed such value to the individual and to aviation that 
it was early determined to establish laboratory units at the ground 
schools so that the candidates could be classified prior to or immedi- 
ately following their entry into the service. 
The reports of the work of the Medical Research Laboratory at 
Mineola prior to August 6, 1918, have already been published in the 
“Manual of Medical Research Laboratory.” 
On August 6, 1918, in response to a cablegram from Gen. Pershing, 
a group of 33 officers and 15 enlisted men, who had been especially 
trained in laboratory methods, embarked for service in the A. E. F. 
The officers composed the following groups: Medical Research Board 
No. 1, Branch Units No. 1 and No. 2, Medical Aviation Unit No. 1 
(temporarily assigned to work with the Royal Air Force), and the 
Ophthalmo-Otological Unit. The personnel of the various groups 
were as follows: 
Medical Research Board No. 1: Col. William H. Wilmer, Medical 
Corps; Lieut. Col. Leonard G. Rowntree, Medical Corps; Maj. Edward 
C. Schneider, Sanitary Corps; and Maj. (later Lieut. Col.) Henry W. 
Horn, Medical Corps. 
Branch Unit No. 1: Maj. James L. Whitney, Medical Corps; Capt. 
(later Maj.) Conrad Berens, jr., Medical Corps; Capt. Claude T. Uren, 
Medical Corps; Capt. Floyd C. Dockeray, Sanitary Corps; First Lieut. 
George F. Hanson, Sanitary Corps; First Lieut. W. Harvey Kernan, 
Sanitary Corps; First Lieut. Prentice Reeves, Sanitary Corps. AVIATION MEDICINE IN THE A. E. F. 
17 
Branch Unit No. 2: Maj. Robert R. Hampton, Medical Corps; 
Capt. Frank M. Hallock, Medical Corps; Capt. George D. Carter, 
Medical Corps; Capt. Henry R. Skeel, Medical Corps; First Lieut. 
Schachne Isaacs, Sanitary Corps; and Second Lieut. Harold W. 
Gregg, Sanitary Corps. 
Medical Aviation Unit No. 1: Maj. Albert F. Beverly, Medical 
Corps; Maj. Robert S. McCombs, Medical Corps; Maj. John P. Gal- 
lagher, Medical Corps; Maj. Edwin S. Ingersoll, Medical Corps; Maj. 
Kosciusko W. Constantine, Medical Corps; Maj. Charles W. Hyde, 
Medical Corps; Capt. Eugene Cary, Medical Corps; Capt. Robert A. 
Trumbull, Medical Corps; Capt. John B. Powers, Medical Corps; First 
Lieut. Paul A. Garber, Medical Corps. 
Ophthalmo-Otological Unit: Maj. William C. Meanor, Medical 
Corps; Maj. Wilson M. Bassett, Medical Corps; Maj. Theo. S. Blakes- 
ley, Medical Corps; Maj. Andrew W. McAlester, Medical Corps; Maj. 
Richard W. Perry, Medical Corps, and Maj. William F. Patten, Medi- 
cal Corps. 
Capt. Harold F. Pierce, Sanitary Corps (later major), with the en- 
listed personnel, took overseas for the board a steel low-pressure 
chamber, the Dreyer nitrogen dilution apparatus, four sets of the 
Henderson-Pierce rebreathing apparatus, and equipment for 10 flight 
surgeons, in addition to extensive apparatus and equipment for car- 
rying out in every department of the laboratory, investigation and 
clinical work relating to the fliers. Altogether, there were 84 separate 
boxes in addition to the steel chamber, and the weight was approxi- 
mately 14 tons. 
All of the officers had been trained in the special problems of 
medical aviation, and many of them had been in aviation work from 
the time that the United States entered the war. They had all had 
experience in flying; some had even done solo work, while one member 
of the group won his “wings” later on in France. 
On leaving Liverpool the group assigned to the British was de- 
tached from the main body and proceeded to assist our colleagues in 
their work of examining and caring for the fliers. They remained in 
England doing a variety of very useful work until after the armistice. 
The ophthalmo-otological group proceeded from Havre to Vichy, 
while the board and the two laboratory units, after going through 
St. Aignan and Thes6e, finally reported at the Third Aviation In- 
struction Center, Issoudun, September 2, 1918. 
As a result of a general survey of the Third Aviation Instruction 
Center, we found that the 575 students, out of the approximate num- 
ber of 3,000 American fliers in France, were as fine a lot of youngsters 
as one would wish to see; but that, on the whole, their physical con- 
dition was bad. Their morale was low, and they had acquired a 
171364—20 2 18 
AVIATION MEDICINE IN THE A. E. F. 
fatalistic attitude of mind. At that time, there had been about 500 
flying hours per day with increasing fatalities, which in August 
reached the number of 17. There was very little venereal disease, 
but staleness was common. The men were overeating and under- 
exercising, constipation being very common. There was no physical 
training beyond some setting-up exercises before daylight—a recent 
innovation. According to an early post order, there was no medical 
examination—beyond a rotation test—before a man began flying; 
while a later post order—before Col. Bingham’s incumbency—had 
allowed a student to consult a doctor only with the permission of 
the commanding officer. Even after consultation the surgeon had 
power to recommend leave of only two days. 
In addition to an adequate camp hospital of some 500 beds, there 
was a Red Cross convalescent hospital for fliers established in a very 
pretty chfiteau—Ville-Chauvan. It was presided over by a very effi- 
cient French lady, and it could accommodate about 20 men. As it 
was only about 4 miles from the main field it was not very satisfac- 
tory. Its very proximity to the noisy fields made it impossible for 
the men to get the necessary mental rest from flying activities. The 
whirr of the motors was constant, and in consequence the men talked 
“shop.” The need of an adequate and quiet rest station, where tired 
and sick aviators could recuperate was most pressing and immediate. 
For this purpose Madame Siegfried had most generously and pa- 
triotically offered her beautiful home to the men—the ancient royal 
Chateau Langeais on the Loire, about 24 kilometers west of Tours. 
It was much regretted that the Red Cross decided that Langeais was 
too inaccessible to be practicable. 
Col. Thomas R. Boggs, Medical Corps, had made a comprehensive 
study of the Air Services of our Allies, and he had already sent in a 
valuable report to the Chief Surgeon and to the Chief of Air Service, 
A. E. F. Col. Boggs was made “Medical Consultant, Air Service, 
A. E. F.,” with headquarters at Neufchateau. Col. W. H. Wilmer, 
Medical Corps, was designated “Surgeon in Charge of Medical Re- 
search Laboratories, Air Service, A. E. F.” 
The board and the units, under command of Col. Wilmer, were 
given a cordial welcome at the Third Aviation Instruction Center, 
and throughout their stay they enjoyed the most helpful cooperation 
of headquarters and of Camp Hospital 14. Lieut. Col. Bingham, 
commanding officer, was not only helpful, hut inspiring. The cordial 
reception of the work by this aviation center is well illustrated by 
the following editorial in the “Plane News:” 
Investigations of the Medical Research Board of the Air Service have shattered the 
long-time belief of aviators that Fate is responsible for the large number of aviation 
casualties. Pilots formerly believed that when their time came to be “bumped off” 
they would be “bumped off,” regardless of how they attempted to guard against 
fatalities. Absolute scientific researches of the medical board have proved that this AVIATION medicine in the a. e. f. 
19 
is not true. The board is no longer an experiment. It has saved hundreds of aviators 
thus far, and with the cooperation of the pilots themselves will save hundreds more. 
What is necessary, is for the pilots to thoroughly understand that the board is not here 
to grab them off the flying list. The board was created to advise and cooperate and 
to assist the aviators in saving themselves. 
Human lives are not expendable; planes are expensive and hard to get. The pilots 
are needed on the front, and the aircraft is needed both for training purposes and for 
flights over the enemy lines. It therefore behooves every aviator to cooperate with 
the board in order that his life may be saved, not only for himself, but in order that 
he can be of service to the Government; furthermore, the pilot should remember that 
when he wrecks a plane and kills himself, due to causes which could have been avoided, 
he is criminally negligent. A pilot’s life and the planes are too valuable at this stage 
of the game for a man to permit himself to be guilty of such a crime. 
Plans were immediately submitted for a main laboratory at the 
Third Aviation Instruction Center, and for branch laboratories at 
Fig. I.—Medical Research Laboratory, Third A. I. C., A. E. F. 
the Second Aviation Instruction Center and at Columbey-les-belles. 
Capt. (now Maj.) Harold F. Pierce, Sanitary Corps, not only took 
charge of the transportation of the laboratory equipment, but he 
also rendered most valuable assistance in making the plans and carry- 
ing on the construction of the laboratory at Issoudun and at Tours. 
But the board did not wait for even the commencement of this con- 
struction. After a careful study of the hospital histories and a sur- 
vey of the medical needs of this center, work at the Third Aviation 
Instruction Center was begun, being carried on in the officers’ rooms 
(8 by 15 feet), in the reading room of the hospital, and in the ends of 
wards which were screened off by sheets. As the epidemic of influ- 
enza kept the hospital very full, the laboratory work was handi- 
capped by the lack of space. Maj. Boswell, in charge of the hospital, 
and his successor, Maj. Noe, gave us all the assistance in their power. 20 
AVIATION MEDICINE IN THE A. E. F. 
The various departments of the laboratory carried on their work in 
the rooms of the new building as soon as they were partially com- 
pleted. But the board was not able to hold its initial meeting in the 
new laboratory until November 19, 1918. 
On the afternoon of September 2, 1918, a tour of the outlying 
fields was made for the purpose of studying the machines in use, 
types of instruction, accidents, general conditions, and specific med- 
ical problems embraced in the altitude and time of flying, recreation, 
leaves, etc. At this time, there were nine fields, with the formation 
of three more under consideration. At field 8 combat work was 
taught, and accuracy in shooting was registered by the machine-gun 
camera. Maj. Davis, commanding officer of the field, and Lieut. 
Austin, instructor, were most interested in our work, and they were 
keen to improve the efficiency at their field. Lieut. Austin was not 
only the most finished exponent of combat flying himself, but re- 
markably successful in instruction. In all contests with visiting 
combat and acrobatic pilots he had been victorious. In a confer- 
ence with him on September 3 he expressed appreciation of the need 
of exercise, change of diet, shorter hours for work. In his experience 
the man who vomited and who did not feel all right immediately 
afterwards was a poor type, as a rule. An interesting fact about 
field 8 was noted. Men were often sick at this field who had never 
been sick before, although they had gone through similar acrobatics 
in their previous training. Relativity presented by the opposing 
machine, played an essential part. 
Lieut, (later Capt.) Ferguson, in command of field 5, was* a most 
broad-minded and efficient officer. In a very satisfactory conference 
with him on September 4, he deplored the overeating, the constipa- 
tion, the low morale, and the lack of physical training; for here, as 
at the other fields, the only exercise was a setting-up drill before 
daylight. The students worked four hours a day in landing and in 
spirals of all kinds,- in cross-country flying, in acrobatics, and in 
altitude up to 12,000 feet. The 15-meter Nieuport with 80 to 120 
horsepower motor was used here. The many accidents that occurred 
at this field in August, 1918, seemed to have been caused by the bad 
physical condition of the fliers. 
On September 13 Assistant Secretary of War Ryan and Gen. 
Patrick, Chief of Air Service, A. E. F., paid the Third Aviation 
Instruction Center an official visit of inspection. They were both 
very cordial in their reception of the work we had brought to the 
A. E. F. After the departure of the Secretary for Paris, Gen. Patrick 
remained, and there was a most satisfactory conference with him 
at the office of the commanding officer. The organization of the 
Medical Research Laboratory and the results of its labor in the 
States, together with the scope of the work proposed in the A. E. F., AVIATION MEDICINE IN THE A. E. F. 
21 
were fully described. Gen. Patrick was interested and helpful down 
to the smallest detail. He said: ‘‘I am delighted that you have 
brought this work over here where it is badly needed. You are in 
the nick of time. I am only sorry that you could not have come over 
earlier.” He was most interested in the work of the flight surgeon. 
The following day a request for a flight surgeon at the main field was 
received from Maj. Lamphier. Maj. Hampton was suggested and 
appointed, thus becoming the first official flight surgeon, A. E. F. 
Shortly afterwards several assistants to him were appointed. The 
surgeon in charge of the laboratories and Lieut. Col. Kowntree (as 
substitute) were requested to sit upon the accident board. 
A suggestion was made to post headquarters that a bulletin be sent 
to all the fields forbidding the use of drugs, such as aspirin, etc., 
without medical advice, and instructing all fliers to report to the 
flight surgeon whenever they were not feeling fit. Every morning at 
11 o’clock (except Sunday) the commanding officer held a meeting, 
which was attended by the commanding officers of all fields and by 
the officers in charge of the various departments. Everything con- 
cerning the good of the service was discussed. The daily meeting of 
these officers, whose duties were widely different, was of great value. 
Every one was kept en rapport with all the activities of the fields, 
and fine team work was thereby engendered. On September 18, 
1918, the surgeon in charge of the laboratories was requested by the 
commanding officer to attend this daily meeting of officers. On the 
same day there was an interview with Maj. Marsh, who felt that the 
men at the front should have clubs, with Yictrolas, magazines, papers, 
etc., for diversion, and that they should have a holiday every three 
months. Nearly everyone had lost a friend and had, in consequence, 
a fatalistic idea that he might be the next victim. Maj. Marsh’s 
experience agreed with our own, that the men in training who did 
not progress as rapidly as the others, should be kept longer on the 
more stable Avro, thus enabling them to gain more confidence before 
taking up work on the more sensitive Nieuport. 
Judiciously granted holidays and leaves are just as important at 
the training centers as at the front. This need was well illustrated 
by an accident that had occurred that day at one of the fields. The 
commanding officer of the field was inclined to be a little hard upon 
the monitor who was instructing at the time. In point of fact, the 
monitor had been working and flying for 18 months without a rest. 
The work of the monitor is quite as exacting and trying as that of 
the student flier. 
On September 19, at the officers’ meeting, the commanding officer 
announced that Maj. Lamphier had been made executive officer and 
that Capt. Ferguson had been placed in charge of flying'—both of 
them most efficient officers and most helpful in every way to the 22 
AVIATION MEDICINE IN THE A. E. E. 
Medical Research Board. At this meeting the need of an ambulance 
equipped with fire extinguishers and a pole to hook a pilot from a 
burning plane was brought out. The surgeon in charge of the labora- 
tories was asked to prepare a schedule of exercises and of physical 
training for the various fields. It was also suggested that all fliers 
should have a half holiday in the middle of the week without any 
regard to the weather; that all sports, particularly those with an 
element of competition, should be instituted, such as baseball (using 
soft indoor ball), handball, volley ball, medicine ball, tennis, squash, 
etc. The question of training with the Ruggles orientator to accus- 
tom fliers to vrilles was brought up. 
One of the very pleasant and useful things about life at this great 
instruction center was the association with the pilots returning from 
the front. We had a long conference with Lieut. Winslow (brother 
of Alan), who was typical of the splendid American youth at the 
front. He had just brought down his third official enemy plane. 
He spent the evening showing many photographs of interest and in 
relating many of his experiences. He said that whenever he was 
flying at a high altitude he was forced to breathe through his mouth, 
and with the mouth wide open; and that the mere exertion of moving 
the “joystick” winded him. He laid great stress upon the need of 
exercise and diversion both during training and at the front. He 
spoke of the great discomfort of the present tunic in flying-—the 
binding of the neck by the tight collar prevented the easy turning of 
the head in looking for enemy planes, etc. He had come over with 
200 other Americans to be trained by the British. Of that number, 
75 were lost in training and 15 in actual combat. 
On September 20 the laboratory group was much pleased by having 
an initial visit from Col. Boggs, who later gave them a very interesting 
talk. He stated that our “units had made medical aviation possible 
for the first time in the war.” 
About this time Maj. William C. Meanor, Medical Corps, who was 
in charge of the Ophthalmo-Otological Unit, came to the Third 
Aviation Instruction Center. He rendered most valuable assistance to 
the flight surgeon as well as to the laboratory. Later, Maj. Wilson M. 
Bassett, Medical Corps, came to the laboratory, where he was con- 
nected with the Department of Internal Medicine. The experience 
in aviation problems that these officers had gained in the United 
States proved most useful in the work in the A. E. F. 
At the officers’ meeting on September 24 a policy for dealing with 
the following types of student fliers was considered: Car-sick type; 
men who could be salvaged by operation and leave (sinus trouble, 
tonsils, etc.); men who were stale but in fairly good physical condition 
and who would respond quickly to rest and change. Another matter 
considered was the question of a clearance by the Medical Research AVIATION MEDICINE IN THE 4. E. E. 
23 
Board of every man before he returned to work, if he had been in the 
hospital for any accident or illness that would have a tendency to 
vitiate his fitness for flying. Later there was a conference with Maj. 
Lamphier, executive officer, who said that all old post orders in 
regard to medical examination would be abrogated and that the 
findings of the board would be definite and final. The questions of 
all kinds of leaves for students, instructors, and pilots from the front 
were discussed. It was felt that the car-sick man who could not 
overcome this trouble should be classified “unfit for flying,” leaving 
his disposition to headquarters. It was suggested that stale pilots 
from the front should be given a leave before they began their work 
as instructors. A cable was sent to the Surgeon General, United 
States Army, requesting that the films “Fit to fight” and “Fit to 
fly” be sent to the Third Aviation Instruction Center for purpose of 
instruction. 
On September 25 a communication was sent to Col. Boggs request- 
ing him to cable for the following personnel, together with equip- 
ment for two branch laboratories: Two physiologists, 2 psychia- 
trists, 2 clinicians, 2 ophthalmo-otologists, 1 psychologist, 10 enlisted 
men (4 of them having been trained in the laboratory at Mineola). 
It was suggested also that the inventor of the Ruggles Orientator 
and two of the apparatus be sent for. In a conference about the 
“joy riding” by the monitors, it was felt that it gave them relaxa- 
tion (so far without any serious accident) and that it had a ten- 
dency to keep the men in good training for the front. 
On September 27 there was a visit from Lieut. Gaylord who had 
been connected with a day bombing squadron for six months at 
the front. He had noticed that the observer was often troubled 
by gases from the engine. Lieut. Gaylord had suffered from eye 
strain and bad goggles. He had been so badly knocked out that 
he had had to take bromide and aspirin for headache. A few days 
previously he had been so dazed in landing that instead of throttling 
the engine, he had given her full gas, and had nearly run down a 
mechanic. He told about one flier who was stale and “fed up.” 
He applied for leave but instead he was given a compound cathartic 
pill and told to go back to his work. 
Special care for sick or injured aviators was a supreme necessity 
in order that their complete recovery could be effected before their 
return to flying duty. The hospital at Vitelle and Contrexeville 
were visited with Col. Boggs. For it was considered most important 
to keep the fliers under observation there until their recovery was 
sufficiently advanced to permit their transfer to Rest Chateaux. 
On September 30 Col. Boggs and the surgeon in charge of the 
laboratories visited some of the aerodromes at the front. Among 
them was the station of the First Pursuit Group, in charge of Maj. 24 
AVIATION MEDICINE IN THE A. E. F. 
(now Lieut. Col.) Hartney, who was an ideal commanding officer; 
suave, forceful, with a great vision. At this aerodrome there were 
6 squadrons, 125 officers, 91 fliers, 918 enlisted men. There were 3 
medical officers and 1 dentist. The aerodrome was situated on the 
hills and it was about half a mile distant from the town of Erize- 
la-petite. The infirmary was located on the immediate outskirts of 
the town. It had one ambulance in case of accident to take the 
injured man to Souilly. The weather on that day was wet, cold, 
penetrating, and the mud of such indescribable consistency that 
made its adherent qualities seem far superior to the cement obtain- 
able at that time. But it was warming to the cockles of one’s heart 
to see the trim Spads with the “ Hat-in-the-ring” on their sides, 
lined up in front of the hangars. Unfortunately, Rickenbacker and 
his incomparable companions were out that day “strafing” the 
enemy. At the same time Lieut. Luke, who had won 18 victories 
in less than six weeks of active flying at the front, had been reported 
missing for 24 hours. This brilliant, erratic flier was beloved by 
all at the aerodrome, and while there was some anxiety, there was 
a general feeling that he would turn up all right. At all the aero- 
dromes that we visited at the front, it was noted that the medical 
men, who were usually exceptionally efficient, did not live in close, 
constant contact with the fliers as would be the case with flight 
surgeons. 
On October 1, a call was made upon Col. (later Brig. Gen.) William 
Mitchell at his headquarters near Souilly. As Chief of the First 
Army Air Service, Gen. Mitchell had done wonderful work in build- 
ing up the service at the front. He was himself a fine flier, his 
brilliant accomplishments in tennis, in riding, and other outdoor 
sports having contributed much, no doubt, to his success in flying. 
While conferring wfth him, the presence was reported of two enemy 
observation planes over Clermont. 
There was great interest in having a sufficient number of flight 
surgeons for the spring campaign. So in order that there might 
be no delay in this plan, a wire was sent the Chief Surgeon, A. E. F., 
on October 7, giving approximate weight and cubic space required 
for the emergency field equipment for 50 flight surgeons and 4 
additional laboratories that had been previously recommended. 
On October 8 Col. Royce arrived from the front. He told of the 
increasing amount of contour flying there. He was present at the 
officers’ meeting. At this meeting, the commanding officer, in asking 
that all possible assistance be given the Medical Research Board, 
stated that despite the rains and the shortening days, the weekly 
record of the school had been broken by 300 hours, the number of 
flying hours in one day having amounted to 749 hours; that the 
post’s record had been broken by 40 hours; that in spite of the AVIATION MEDICINE IN THE A. E. E. 
25 
increase in flying hours and of the fact that more leaves had been 
granted than ever before (no recommendation of the board for leave 
having been turned down), the death rate had been lowered. These 
facts proved to his mind that efficiency at the fields consisted in 
keeping men in good physical condition and not in having numbers 
of inefficient men trying to fly. After the officers’ meeting, the 
Medical Research Board met at post headquarters with the heads 
of the Avro, acrobatics and combat work to consider the “car- 
sick” type of flier. 
It was always a privilege to have a visit from Col. Kilner who 
was admired by the heads of all of the departments at the field. 
At the officers’ meeting on October 9, he said that Issoudun was the 
greatest instruction center in the world and the backbone of the 
front. 
On October 10 the surgeon in charge of the laboratories was 
requested to look into the question of the windshields of the Nieu- 
ports, as the heavy metal rim was very dangerous to the face during 
a rough landing. On the next day he made his report suggesting 
the removal of the windshields on the 23-meter Nieuport for the 
following reasons: (1) To prevent injury to the pilot’s head by the 
rigid metal rim when the machine nosed over in landing. (2) In 
order that the monitor might instruct the student flier with greater 
ease. (3) In order that the vision of a short man might not be 
interfered with. While the short man might use a cushion to over- 
come the difficulty with the windshield, the extra height would 
make it harder for him to reach the rudder with his feet. (4) To 
render the flier independent of the windshield. If he were accus- 
tomed to a windshield, it would be hard for him to fly without one; 
but if he were trained to fly without the shield, he would enjoy it 
later on as an extra protection and not as a necessity. 
By request arrangements were made about this time for the mem- 
bers of the Medical Research Board and the heads of the laboratory 
departments to write weekly articles for the “Plane News.” These 
articles, while popular in character, were to deal with the medical 
and hygienic problems that had such influence upon the physical and 
mental fitness of the flier. 
On October 13 Clermont-Ferrand was visited. In conversation 
with Lieut. Col. Horn, Lieut. Col. Rader, the former commanding 
officer of the post, said in regard to flight surgeons: “At first I was 
very much opposed to them in the States. I feared that they would 
be butting in on something they knew nothing about. But before I 
left they had demonstrated their value to such an extent that 1 have 
a note in my pocket to take up the question of having one sent to this 
field.” In looking over the record of the accidents at Clermont- 
Ferrand we found that in one case the pilot was always sick in the 26 
AVIATION MEDICINE IN THE A. E. F. 
air. On the day of the accident, just before going up, he had taken 
a large dose of “Mothersill’s Seasick Remedy.” At 300 meters he 
had gotten into a vrille and could not get out of it. There had been 
only eight deaths at this school since its formation. 
Upon the return to issoudun from Clermont-Ferrand there were 
several letters from our British colleagues expressing their appre- 
ciation of the Medical Research Laboratory Manual (of the work in 
the States) which had been sent to them. Capt. (now Maj.) Rippon, 
Royal Air Force, wrote: “I desire to congratulate the American 
research committee on having developed what will be the most 
accurate method of examining pilots to date.” 
On October 15 the officer in charge of flying sent in a very interesting 
memorandum. Among its compilations were the following: Excess 
of flying hours over previous records, day, 22.11; week, 769.03; 
month, 1,869.47. There had been to date, from October 3, 4,436.46 
flying hours without a death, while the best previous record (June 
29 to July 10) had been 3,528.11 hours without a death. Col. 
Bingham was very enthusiastic over this great improvement at the 
field. On October 17 he announced that for the first time in the 
history of the field there were 600 planes in commission. He said 
that this breaking of the record was due to the efficiency of the 
Engineer Department and of the Medical Research Board. The 
latter, by keeping the men in fit condition, had saved machines as 
well as lives. 
Shortly after the arrival of the Medical Research Board at the 
Third Aviation Instruction Center, 12 articles of subsistence had been 
withdrawn by orders from G. H. Q. from sale at the commissaries, 
except to hospitals. So a request was made to the food and nutrition 
section for a survey of the messes of the flying officers, with sugges- 
tions in regard to their improvement. The following is a portion of 
the report on the subject sent in by Lieut. Hipps, Medical Corps, a 
nutrition expert: 
* * * there can be no question, I think, that they are in need of the very best 
of food, and that it should always be well prepared. Their problem is peculiar. 
They are in need of this, not that they should be pampered, but because they must 
be in perfect physical condition for their flying and especially for their stunt work. 
They are told by their instructors and flight surgeons that they must not “go up” 
if they feel the least bit “off color.” Improper food, constipation, etc., with re- 
sultant dizziness or even a tendency towards the same, might well produce a fatality 
in the case of a flier with very little experience when he attempts a vrille or some 
other form of aerial gymnastics that is a part of their daily routine. Their need of a 
well-managed mess is greater perhaps than in any other form of the service. 
On this day there was a visit from Capt. Eddy, who made the 
following suggestions in regard to the various messes: (1) To have 
a centralization of buying through Lieut. Watson, who had had much 
experience in this line; (2) to have Lieut. Hipps remain here and, by AVIATION MEDICINE IN THE A. E. F. 
27 
means of constant consultation, cooperate with the Medical Research 
Board upon the nutrition problems. 
At the officers’ meeting, October 18, it was reported that there 
were 637 planes in commission, with only 306 out of commission— 
the post’s best record. Notice was received from G-. II. Q., giving 
authority to the commanding officer of this center to grant immediate 
leave of two weeks upon recommendation of the board. 
On October 21 the accident board considered the case of a flying 
officer who was killed in his attempt to return to his own field with a 
stalled engine, when a landing in an adjoining field would have been 
a simple matter. When the motor stopped, he was seen making the 
attempt first to turn and then to redress. But he got into a vrille 
from which it was impossible to recover. This type of accident is 
very frequent, and it is interesting from a psychological standpoint. 
From the very first, fliers are instructed never to make this turn when 
the engine stalls. They talk about it constantly and they know the 
danger. They are conscious of their mistake after the fatal turn is 
started and they endeavor to redress. Making the first turn seems 
to be an automatic action, and when the higher cerebral centers 
endeavor to correct the move it is too late. Many experienced fliers 
have lost their lives in this manner, among them McCudden, one of 
England’s greatest combat pilots, who had brought down officially 
58 enemy planes. 
Among the questions taken up in an officers’ meeting about this 
time was the demoralizing effect of holding the funerals about half 
past 5 in the afternoon—just when the men were at dinner. The 
officer in charge of funerals did not see why an objection was made 
to the dirge, as it was beautiful and classical, being Chopin’s Funeral 
March. The surgeon in charge of the laboratory suggested that the 
best plan would be to take care of the flier and not have the funerals. 
The accident board convened on October 23 to consider the cause 
of death of two pilots from a collision in the air. The evidence 
brought out the fact that the student responsible for the accident 
had been disqualified in the States on account of imperfect sight. 
In training, he had passed through several fields until he reached the 
one where acrobatics were taught. The other pilot, an excellent 
flier, was just finishing his turn and was coming out of a vrille prepara- 
tory to landing. By virtue of the rules of the field and his “dead 
stick,” he had the right of way. But the student with poor sight 
ran into him without seeing him, and both were killed. 
On October 24 the Medical Research Board received from Capt. 
Ferguson the “Rules and Regulations Governing Flying.” The hoard 
felt that it was most important to study these rules minutely to see 
if there were any further suggestions that would improve the safety 
and efficiency of this work. At the officers’ meeting that day it was 28 
AVIATION MEDICINE I2s THE A. E. F. 
announced that in spite of the rain and the mud the daily flying hours 
had increased on the previous day to 850 hours. The next day brought 
the welcome announcement that one of the headquarters hangars 
had been turned over for use as a gymnasium and that a fund had 
been started to procure a first-class equipment. There were bright 
prospects for the men to have the opportunity of getting regular 
health-giving exercise in spite of the inclement weather. Only those 
who have spent a winter in this part of France can realize how 
inclement weather can be. As Lieut. Col. Emmerson said: “The 
sun goes entirely out of the shining and drying business.” 
On October 26 there was again the unpleasant duty of sitting 
upon the accident hoard. The flier who was killed had been ill and 
he was not in condition to fly. At the meeting of the board the fact 
was brought out that he had vomited in his plane before .going up, 
but he had concealed his condition for fear of losing time. 
Col. Kilner asked the Medical Research Board to formulate stand- 
ards of physical requirements for observers, balloon observers, 
bombers, and aerial gunners. He said that “the morale and the 
spirit of the fields had improved very rapidly and that every man 
was on tiptoe to do his bit. This condition had been brought about 
largely by the Medical Research Board because it made the fliers 
realize that though small in number they were of great value. They 
felt that they were being cared for and that infinite pains were being 
taken to look after their welfare and efficiency. I am delighted to 
say this, because I was scared of research boards. You know what 
a nuisance such a hoard could he if it were not the right kind.” 
On October 27 there was a long conference with three American 
fliers who had been trained with the British and had worked with 
them—Hall, Moffet, and Grimm. Lieut. Nordhoff, a delightful 
youngster, spent the evening with us. Speaking of some of his 
fights with the Richthofen circus under the younger Richthofen, he 
said: “After the war I would love to meet Richthofen and talk 
matters over with him.” This remark was quite characteristic of 
the fine chivalrous spirit shown by the allied fliers toward a foeman 
whom they considered worthy of their steel. McCudden says, in 
his work: “Rhys-David proposed a toast to Yon Richthofen ‘our 
most worthy enemy/ which toast we all drank except one nonflier.” 
In the Air Service even some of the enemy were infected with the 
spirit of chivalry. Richthofen the elder, in writing of his first 
victory, says: “I honored the fallen enemy by placing a stone on his 
beautiful grave.” Later, in speaking of the British, he says: “They 
absolutely challenged us to battle and never refused fighting.” 
In order to study the problems of physical standards for various 
types of fliers in combat, the hoard held a conference on October 28 
with the flight surgeons, and with Capt. (now Maj.) Kerens, Capt. 29 
AVIATION MEDICINE IN THE A. E. F. 
Ferguson (in charge of flying), Capt. Davis, Capt. Titus, First Lieut. 
Williams, First Lieut. Garside, First Lieut. McMillen, Second Lieut. 
Longley, and Second Lieut. Eales (the last seven from the front). 
There was the general feeling that good physical condition with good 
hearing, good sight, and normal color vision were absolutely neces- 
sary for entrance into the Air Service. After the conference a 
schedule of physical requirements for all types of fliers was prepared. 
It was announced that the record of 912 flying hours had been 
reached that day. On October 29 a general order was received 
grounding all fliers who were suffering from venereal diseases. 
On October 31 the goal of the field’s ambition of 1,000 flying 
hours for one day had been more than reached in the record of 
1,088 hours for that day, while the record for the month was 17,113 
hours. 
On November 4 the branch laboratory at the Second Aviation 
Instruction Center at Tours was opened under the supervision of 
Lieut. Col. L. G. Rowntree. Maj. R. N. Perry was flight surgeon. 
The laboratory personnel consisted of Capt. George D. Carter, in 
charge; Capt. R. H. Skeel, Lieut. George F. Hanson, and Lieut. 
Schachne Isaacs. The work had the heartiest support of Lieut. Col. 
Fitzgerald, the post commanding officer, and of his staff. Later, 
Capt. Cary was added to the group. His special work was to study 
all details concerning the duties of the observers, and to take charge 
of conferences with observers from the front who were undergoing 
examination and classification at the laboratory. Maj. John P. 
Gallagher and Capt. John P. Powers were also added to the unit, 
and Maj. W. B. McAlester was detailed to this station to make a 
special study of the visual functions involved in the work of the 
observers. His excellent report closed with the following words: 
“In view of the above I recommend that for observers a complete 
color field be taken and made a part of the record of the examination; 
that this be made in addition to the Jennings color test. Further, 
that stereoscopic vision is not a subject to be waived in the qualifi- 
cations of an observer.” 
The laboratory at Columbey-les-belles had not materialized by the 
date of the armistice, consequently the plans for the work at that 
center were reluctantly abandoned. 
Maj. McDonald, commanding officer of the Seventh Aviation 
Instruction Center at Clermont-Ferrand, where Maj. Blakesley had 
been detailed as flight surgeon, had desired the establishment of a 
branch laboratory at this center. This need could have been sup- 
plied if the war had continued. 
On November 16 the commanding officer requested the Medical 
Research Board to be very strict from that time on in passing the 
men who should come up for examination. Previous to the armi- 30 
AVIATION MEDICINE IN THE A. E. F. 
stice it had been the aim of everyone to salvage for the Government 
all men and material that presented possibilities. But the time for 
that had passed, and only the very fit were to be saved in the new 
process of elimination. No candidate for flying would be allowed 
even to begin his training unless he had been accepted by the board. 
Arrangements were made with the executive officer, Maj. Lamphier, 
for a DH-4 in order to experiment with the artificial use of oxygen 
at great altitudes. After a conference with Col. Bingham, on No- 
vember 18, an arrangement was made for the Medical Research 
Board to assist in the demobilization of the fliers by acting as a board 
of elimination. Upon examination the men were to be divided into 
the following three classes: (a) Men perfectly fit; (b) men who in all 
probability would not be able to do any flying for six months; (c) men 
who should not fly at all. As the board had done everything in its 
power to aid in building up the service, it was now hoped that it 
might help in the orderly and systematic closing of this great school. 
Mr. McCurdy, a well-known authority upon physical training, who 
had charge of this department of the Y. M. C. A. in the A. E. F., had 
spent several days at the field, and he had exhibited the great desire 
to help that was so characteristic of nearly all American officers. 
The following quotation is taken from a letter received from him on 
November 19: “I believe the work you are doing is not only funda- 
mental for the physical fitness of fliers, but may be made fundamental 
to the problem of racial fitness.” The board was informed that no 
more candidates for entrance into the service were to be examined. 
A notice was also received from G. H. Q. that it was desired to ship 
home all sick, wounded, and convalescents as soon as possible. 
On November 19, the board held its first meeting in the new 
laboratory—a red-letter day. 
By November 21 the work of the monitors and testers had been 
sufficiently lessened to enable more of them to undergo a thorough 
examination at the laboratory, the testing of this group having started 
in October. 
That afternoon was spent at field 14, where aerial gunnery was 
taught. The target was a silhouette of a German Bumpier. The 
plane used in training was the Nieuport 15 meter, with the Vickers 
machine gun. The jamming of the guns was the bete-noir of the 
student flier as well as of the combat pilot. The work of this field 
was excellent. 
The first contingent of the 10 men who had been working with the 
British arrived at Issoudun on November 23. On November 25 
there were visits from Col. Lister and Lieut. Col. Parsons, of the 
B. E. F., and from Lieut. Col. Greenwood and Lieut. Col. Derby, of 
the A. E. F. They all evinced much interest in the work of the 
laboratory. A portion of this day was spent in making tests with 
oxygen in an aeroplane. AVIATION MEDICINE IN THE A. E. E. 
31 
On November 26, the board had the privilege of a visit from 
Lieut. Col. Dreyer, of the British service. No one has done more 
toward the solution of the many medical problems of aviation than 
Col. Dreyer. He had a conference with the laboratory staff, and at 
this meeting he said, in substance, that the blood volume should be 
considered in relation to the surface of the body; that blood pressure 
Fig. II.—Room for records and for meetings of research board, Third A. I. C., A. E. F. 
was relative to muscular development; that a most important point 
was the relation of systole to diastole. Examination of the vital 
capacity, he felt, was more of a test of endurance than thing else, 
and that the British tests were only tests of endurance, lleaction 
times, as taken by the French, were tests of mentality, and Nepper 
had been correct in 90 per cent of his selection of fliers by these tests. 32 
AVIATION MEDICINE IN THE A. E. F. 
American pilots should be classified A-l—the best of all pilots 
owing to greater sensitivity and intelligence. But on long fatiguing, 
bombing trips they would not, perhaps, hold up as well as duller 
men. 
By this time all of our fields had compulsory physical exercise as a 
part of their regular instruction program, with a daily report upon 
the subject. 
On November 29, a conference was held with the chief surgeon, 
A. E. F., concerning the medical problems of aviation and the 
importance of the continuance of this work in- the future. In spite of 
the armistice, the work at the two laboratories progressed steadily. 
On the afternoon of November 30, the chief surgeon, A. E. F., with 
a number of other officers, visited the branch laboratory at Tours. 
He was particularly interested in the tests for classification and for 
visual memory. 
On December 3, the following communication was received by the 
commanding officer: 
From: Assistant Chief, Air Service. 
To: Commanding Officer, Third Aviation Instruction Center. 
(1) The Chief, Air Service, has already arranged for a series of laboratory tests to be 
made at Issoudun on pilots returned from the front. The details of this matter are 
understood to be under the supervision of Col. Wilmer. 
(2) The French and English Governments have been invited to send a number of 
pilots to take these tests in conjunction with our own men and the French Government 
notified our service to-day that they would send between 20 and 30 pilots. 
(3) It is requested that information be furnished as to when these tests will begin 
so that the French Government may be notified when to send their men to Issoudun. 
Assistant Chief, Air Service. 
Halsey Dunwoody, 
This letter was in reply to a request that a limited number of 
French and British aces be sent to the laboratory for examination and 
classification. It was felt that the results of these examinations 
would be of great scientific and practical value in standardizing still 
further the knowledge already gained in testing large numbers of 
American fliers. Later 12 French fliers arrived at Issoudun for 
examination. It was a great regret that on account of transportation 
and other difficulties, no British fliers were examined. During a visit 
to the Third Aviation Instruction Center on December 6, Col. Boggs 
said that he had written out a memorandum for an organization 
of the Medical Department of the Air Service, and that he had sug- 
gested to the Chief of Air Service that it should be a special service 
and separate from the Surgeon General’s Office. 
On December 10, Col. Birley of the British Air Service arrived at 
the laboratory for a visit. It would not be possible to find in any 
of the Air Services a man whose experience in the practical medical 
problems of aviation had been wider than his. He stated that artificial 33 
AVIATION MEDICINE IN THE A. E. E. 
oxygen had been of great value to the British squadrons whose duty 
was flying far back of the enemy lines at an altitude of 20,000 feet. 
With the oxygen and an extra supply of petrol, these squadrons were 
able to stay up four and five hours. Although their duty kept them 
at this high altitude for hours at a time, these men were able to go 
sometimes three months longer without getting stale than the men 
in the bombing squadrons who did not have the oxygen. On the 
same day, DH-4 No. 1584 was turned over to the laboratory for 
experimental altitude work with oxygen—a cause for great satis- 
faction. A report of this work will be found elsewhere in this history. 
Dinner was taken on Christmas Day with the officers, Capt. Oliver, 
Lieut. Peters, and Lieut. Malthan, of field 9. They were delightful 
and efficient men, and the general excellence of their work in flying 
was reflected in the character of their mess and of their pleasant 
quarters. The psychological effect of such surroundings is valuable 
at all times, but especially is this true when holiday seasons turn the 
thoughts homeward with a particular attraction. At training fields 
as well as at combat centers, good food and pleasant surroundings 
with diversion are of untold value in producing mental and physical 
fitness. The Government furnished ample food. The mess was 
good or bad according to the officer in charge. 
On December 26, Col. Bingham left the Third Aviation Instruction 
Center. His departure was greatly regretted. But we congratu- 
lated ourselves upon having such an efficient officer as Maj. Lamphier, 
as his successor. On December 27, the following letter was received 
from Col. Bingham by the surgeon in charge of the laboratory. 
It is inserted here because it is a tribute to the deep interest, to the 
efficiency and to the great value of the work accomplished by all of 
the officers of the laboratory and by the flight surgeons. 
Before leaving this post, I Want to take the liberty of telling you how greatly I have 
appreciated the cooperation and aid which the Medical Research Board has given us 
during the past four months. It was certainly a most fortunate circumstance for me 
that you should have arrived just at the beginning of my administration here. That 
we should have been able to break records in graduating pilots in October under a 
heavy strain and at the same time reduce the number of accidents and increase the 
morale of the aviators was due in such a large measure to your wisdom and counsel, 
that we are all of us under a great debt of gratitude to you. Please express to the 
members of your staff my sincere admiration and hearty appreciation of their great 
service in helping American aviation to be successful. 
Sincerely yours, 
Hiram Bingham, 
Lieutenant Colonel, Air Service. 
On December 27, the laboratory was most honored by the presence 
of Prof. Spearman of the British research committee, who made an 
official visit to study our laboratory methods. He was so full of 
171364—20 3 34 
AVIATION MEDICINE IN THE A. E. F. 
enthusiasm and he had had such broad experience that he could give 
us information that was most helpful and valuable. 
On January 6, 1919, a letter dated October 8, 1918, was received 
from Gen. Foulois. The last stage of its journey must have been 
made by the “Snake Limited.” In the letter, Gen. Foulois suggested 
the advisability of getting 12 physical directors overseas as soon as 
possible. 
On January 6, the first contingent of French fliers—five in number- 
arrived at the laboratory for examination. They were a fine and 
interesting group of men. All of them had been at the front several 
years though engaged in different types of work—ranging from 
combat flying to night bombing—and they had received many 
citations. One member of the group had flown in Russia and in 
Roumania. 
From January 6, 1919, until the various units of aviation medicine 
left this center on February 19, their time was spent in completing 
examinations, in studying records, in devising new forms of apparatus, 
and in making the necessary arrangements for departure. This 
routine was broken on January 20, by a pleasant visit from Gen. 
Patrick who was, as always, most interested in the work. 
Col. Boggs, Col. Wilmer, and Lieut. Col. Rowntree were selected 
as delegates to attend an Inter-Allied Medical Aviation Conference 
at Rome on February 15. An attack of influenza prevented Col. 
Wilmer’s attendance. At this meeting a permanent organization 
was formed under the name of the “Societe Scientifique pour l’Etudo 
Medicale Aeronautique.” Chapter II. 
AVIATION MEDICINE AND THE FLIER. 
In the preceding chapter, the main endeavor has been to give a 
general survey of the organization of the work of aviation medicine 
in the A. E. F., with some of the incidents connected with its develop- 
ment. 
The work itself fell under three principal heads: (1) The selection 
of the flier; (2) the care of the flier; and (3) investigations relating 
to the flier. 
Fig. I.—One of the rooms of the Medical Research Laboratory at the Third A. I. C., A. E. F 
1. THE SELECTION OF THE FLIER. 
This problem was much the same as it was in America. But the 
A. E. F. was not equipped with examining boards, so the research 
laboratories took on this function. Only one difference was en- 
countered. Wiiereas in America all applicants for flying chose the 
Air Service, it was soon learned that here many observers were 
assigned to this duty, in many instances, in spite of their preference 
for other branches of the service. This made a material difference 
in their attitude both toward the examination and toward the service. 36 
AVIATION MEDICINE IN THE A. E. E. 
2. CARE OF THE FLIER. 
A. Reexamination of Fliers. 
This consisted in a careful, general and special medical overhaul- 
ing, by the laboratory personnel, of the men who were either referred 
by the training department, or by the flight surgeon, or who had 
been returned from the front for special study. 
Following each examination the board met (the flight surgeon, 
and the heads of the various departments of the laboratory being 
present), decided the treatment necessary, referred the case to the 
hospital, recommended leave or sick leave, prescribed glasses, re- 
turned the flier to flying status, or grounded him as the case demanded. 
In this connection, the work was greatly facilitated through an order 
from headquarters which authorized the commanding officer of the 
post to grant leave or sick leave upon the recommendation of the 
board. 
A ward of the hospital was turned over to the board, which gave 
the opportunity for carrying out surgical procedures, and for the 
medical care of sick fliers. 
In addition, members of the board and laboratory staff acted as 
consultants to the camp hospital in all cases in which consultation 
was desired. 
In the development of the work relative to the flier, the board 
was confronted by the very serious problem of where to send the 
convalescent, tired, or stale men. This need was covered in the 
future plans of the Air Service to open, under the auspices of the 
Red Cross, chateaux in desirable districts for rest homes for aviators 
who needed such care. 
B. Classification Examination of Aviators in Relation to Altitude. 
9 
Fliers were examined by the rebreathing test, as occasion arose, 
to determine their ability to withstand the effects of low oxygen; 
and their instructors or commanding officers were advised as to the 
altitude at which they could work efficiently. 
This test was valuable also in assigning a flier to the type of work 
best suited to him and in indicating his general fitness. 
C Education of Fliers in Matters Relating to Health and Efficiency. 
Talks were given from time to time by members of the board, 
laboratory staff, and flight surgeons. In addition, a series of articles 
upon such subjects were published in the “Plane News,” among them 
‘‘The relation of physical condition to fatalities,” “Training essential 
to fitness,” “Spirit levels of the brain,” “The value of physical 
exercise,” “The effect of altitude in aviation,” “The nerves of the 
aviator,” “The eye and aviation,” “The effect of altitude on the 37 
AVIATION MEDICINE IN THE A. E. F. 
eye,” “Qualifications of observer and pilot.” The importance of 
training and of clean living were emphasized, and the warning 
sounded that indispositions that seemed trifling on the ground, 
frequently assumed serious proportions in the air. It was sought 
by every possible means to drive home the axiom that only the fit 
should fly. 
D. Extent, Growth, and Character of Work. 
The extent, growth, and character of the work is described in the 
following reports. Monthly reports are submitted for the Third 
Aviation Instruction Center, because the basis of classification 
underwent a great change with the signing of the armistice. Whereas 
prior to that time every effort was made to retain men in the service, 
even when minor operative procedures and rest were involved, 
subsequently, only those absolutely physically fit were graded “A.” 
It was the policy to send all others to the United States as soon as 
possible and compatible with the exigencies of transportation. 
September, 1918.—Sumvmry of board recommendations—124 cases. 
Return to active duty at once 25 
Number grounded 9 
Leave for rest 9 
Leave and further examination and treatment 6 
Leave after hospital treatment 2 
Leave after hospital treatment and release by ophthalmological department.. 2 
Leave after release by otological department 4 
Release from active duty for 1 week or less—rest 3 
26 
Not fly until reexamined 2 
Not fly until rebreathing test 1 
Not fly until released by otological department 3 
Not fly until released by ophthalmological department 6 
Not fly until hospital observation and treatment 16 
28 
Return to flying, but get corrected goggles 5 
Return to flying, but take eye-muscle exercises 2 
Return to flying, but further examination 5 
Return to flying, but rebreathing test 1 
Return to flying, but referred to flight surgeon 2 
Return to flying, but to a field in the States 1 
16 
Not indicated in record (Oct. 4, 1918), temporary owing to want of laboratory 20 
1 124 
Number grounded: 
No. 26. Sick in acrobatics; convergence insufficiency. 
No. 59. Temperamentally unfit. 
No. 68. Temperamentally unfit. 
No. 85. Valvular lesion; divergence excess. 
No. 8. Hyperthyroidism, Class D by hospital. 
No. 87. Hypertension; poor balance sense. 38 
AVIATION MEDICINE IN THE A. E. F. 
Number grounded—Continued. 
No. 96. Temperamentally and physically unfit. 
No. 72. Vertigo and nausea. 
No. 182. Vertigo and nausea. 
Why referred for examination: 
To see if in condition 39 
In air—dizzy, nausea, sick 22 
Stale, nervous, tired 22 
Physical condition—headaches, dizzy nausea 29 
Poor flying 4 
Eyes - 8 
124 
609 EXAMINATION, SEPTEMBER, 1918 (FORM 1.) 
Number examined 22 
Passed 12 
Disqualified 5 
Disqualified until operation 5 
[Rebreathing test. September, 1918.] 
Number examined 1 
Return to active duty at once 24 
Number grounded - 7 
Suggest transfer to observation 3 
Leave for rest: 
Sick leave 7 
Further examination and treatment 6 
After hospital treatment 2 
After hospital treatment and release by ophthalmological department... 1 
After hospital treatment and release by otological department 2 
18 
Not fly until reexamination 5 
Not fly until released by ear department 8 
Not fly until released by eye department 3 
Not fly until hospital observation and treatment 16 . 
Not fly until nasal or tonsil operation 17 
Not fly until released by ophthalmological and otological departments 7 
56 
Return to flying, but get corrected goggles 7 
Return to flying, but get wrist brace 1 
Return to flying, but take eye-muscle exercises 7 
Return to flying, but suggest ferrying 1 
Return to flying, but referred to flight surgeon 4 
Return to flying, but further examination 5 
Return to flying, but tonsillectomy at convenient time 11 
Return to flying, but tonsillectomy and eye exercises 2 
Return to flying, after overcoming hypersensitiveness to motion 1 
—- 39 
Total - 147 
Grounded: 
Present condition disqualifies for flying, No. 137. 
' Sent to Hospital 20 for observation and treatment, Nos. 154, 130, 164. 
Anxiety neurosis return to America, No. 179. 
October, 1918.—Summary of board recommendations—147 cases. 39 
AVIATION MEDICINE IN THE A. E. F. 
Grounded—Continued. 
Temperamentally unfit for flying, No. 155. 
Irreparable nasal condition, No. 171. 
Why referred for examination: 
To see if in condition 37 
To see if in condition after accident 10 
Physical condition—headaches, dizzy, nausea, or stomach 39 
In air—dizzy, nausea, or sick 13 
Stale, nervous or tired 12 
Poor flying 20 
Eyes 14 
Ears 2 
Total 147 
Number examined 20 
Number rated A 7 
Number rated B 4 
Number rated C , 5 
Number rated D 3 
Number not rated 1 
20 
REBREATHING TEST. OCTOBER, 1918. 
609 EXAMINATION, OCTOBER, 1918. (FORM 1.) 
Number examined 96 
Qualified 53 
For observers only 2 
Aerial navigation r 5 
Qualified after operation :.. 22 
Disqualified: 
Vestibular findings 1 
Tonsils 2 
Nose and tonsils 1 
Eyes and tonsils 2 
Tonsils and physical condition 1 
Nasal condition 2 
Equilibrium 2 
Eyes 4 
Urine 2 
Rebreathing 1 
Psycho-motor instability 1 
Incomplete 2 
21 
96 
November, 1918.—Summary of board recommendations—267 cases 
Return to active duty at once 174 
Number temporarily grounded (Class B) 55 
Medical for: 
Bronchitis 2 
Cardio-vascular 2 
Nervous instability 2 
Physical instability 2 40 
AVIATION MEDICINE IN THE A. E. F. 
Medical for-—Continued. 
Staleness 4 
Convalescent, influenza 6 
Convalescent, pneumonia ] 
Convalescent, jaundice ] 
Abscess teeth > 1 
Varicocele (painful) 1 
Glossitis, dissecting 1 
Old fracture, cervical vertebra, r 1 
Chronic pleurisy * 1 
Bursitis (shoulder) 1 
26 
Eye for: 
Astigmatism t 2 
Convergent insufficiency 4 
Hyperopia * 2 
Retrobulbar neuritis. 1 
Lack of stereoscopic vision 1 
For goggles 4 
—- 14 
Ear for: 
Hypersensitive labyrinth 4 
Chronic tonsilitis 1 
Deviated septum 2 
Chronic rhinitis 1 
Sinusitis 1 
Incomplete (sick in chair) 1 
10 
Neurological for: 
Temperamentally unfit a 2 
Nervous instability 1 
Nightmare - 1 
Tremor, marked 1 
5 
Number permanently grounded (Class C) 14 
Medical for: 
Heart lesion 1 
Tuberculosis suspect 2 
Physical instability 2 
Neuro-circulatory asthenia 3 
8 
Eye for: 
Diplopia 1 
Ear for: 
Hypersensitive to motion 2 
Hypersensitive to motion (car-sick type) 1 
Vertigo 1 
4 
Neurological for: 
Temperamentally unfit ; 1 
1 
14 
Suggest transfer as observer ' 1* 
Not to fly, referred to hospital 6 
Not to fly, recommend leave t 11 
Not to fly, returned to mechanic’s status 1 41 
Not to fly, above certain altitudes 2 
Hold for observation 1 
Hold for rebreather 1 
Record incomplete 1 
24 24 
Total 267 
Why referred for examination: 
Monitors, complete examination of 70 
Pilots returned from front 10 
Physical condition, headache, fainting, dizziness, etc 32 
In air, dizzy, nausea, or sick 24 
Poor flying, including acrobatics 7 
Poor landings H 
To see if in condition after accidents 11 
To see if in condition after shot down by enemy 1 
To see if in condition for court-martial 1 
To see if in condition for flying this field 16 
To see if in condition after sick leave 39 
To see if in condition for advanced flying 23 
Stale, nervous, and tired 8 
Tuberculosis suspect 2 
Eyes 11 
Ears 1 
Total 267 
AVIATION MEDICINE IN THE A. E. F. 
Number examined 38 
Number rated A 15 
Number rated B H 
Number rated C 12 
38 
REBREATHER TESTS. 
609 EXAMINATION (FORM l). 
Number examined 
Number qualified 27 
Number qualified for day work only 1 
Number qualified after operation 13 
Number disqualified: 
Eyes 3 
Hyperthyroidism and tonsils 1 
December, 1918.—Summary of board recommendations—207 cases. 
Returned to active duty at once 123 
Number classed “A” who should have leave 15 
138 
Number temporarily grounded (class B) 66 
Medical for— 
Neuro-circulatory asthenia 8 
Bronchitis 1 
Staleness 6 
Convalescent (pneumonia) 7 
Hyperchlorhydria 1 
Fracture 1 
Sinus arythmia 1 42 
AVIATION MEDICINE IN THE A. E. F. 
Number temporarily grounded—Continued. 
Medical for—Continued. 
Gunshot wounds in combat 2 
Malaria (enlarged spleen) 1 
Hyperthyroidism 1 
Convalescent (‘ * flu ”) 8 
Hernia 1 
38 
Eyes for— 
Poor vision 5 
Convergent insufficiency 5 
Hyperopia 1 
Eye strain (altitude) 1 
12 
Ear, nose, and throat for— 
Ethmoiditis 1 
Operation nasal occlusion _ 1 
Hypersensitive labyrinth 4 
Chronic tonsilitis 3 
Frontal sinusitis 3 
Chronic rhinitis 1 
Pharyngitis 1 
14 
Neurological for: 
Temperamentally unfit 2 
t 66 
Number permanently grounded (class C) 3 
Medical for— 
Syphilis 1 
Pyuria 1 
2 
Neurological for— 
Temperamentallv unfit 1 
1 
3 
Total 207 
Why referred for examination: 
Pilots returned from front 110 
Testers 6 
Monitors 1 
For classification 15 
For promotion 1 
In air, fainted 1 
In air, nausea and headache 3 
Physical condition, headache, dizziness, sick, etc 8 
Poor landings 3 
To see if in condition after accidents 3 
To see if in condition after sick leave 33 
To see if in condition for advanced flying 16 
To see if in condition to be monitor 1 
Nervousness 2 
Eyes 3 
Ears . 1 
Total : 207 43 
AVIATION MEDICINE IN THE A. E. E. 
DECEMBER, 1918, REBREATHING TESTS. 
Number examined 103 
Rated A 50 
Rated B 34 
Rated C 8 
Not graded 11 
— 103 
DECEMBER, 1918, 609 EXAMINATION (FORM l). 
Number examined 1 
Qualified 1 
—— 1 
January, 1919.—Summary of board recommendations—2S cases. 
Returned to active duty at once 18 
Number temporarily grounded (Class B) 5 
Medical for: 
Anefmia following hemorrhage 1 
Tachycardia 1 
Injury following crash 1 
Ear for: 
Hypersensitive labyrinth 1 
Accessory sinusitis 1 
Total..... 23 
Number examined 16 
Rated A 1 9 
Rate'd B 4 
Rated C 3 
16 
Report of all examinations made at the Medical Research Laboratory No. 2, Second Aviation 
Instruction Center, Tours, France, for the months of November and December. 
During the months of November and December, 158 officers have been examined 
at the Medical Research Laboratory No. 2, at the second aviation instruction center, as 
follows: 
No. 609 examination (Form 1) 48 
Reexaminations (Form 4) 18 
Rebreathing examinations 92 
Of the observers from the front, 66 were examined, and of these, 52 underwent de- 
tailed examination. 
I. Of the No. 609 (Form 1) examinations made, the following were— 
Accepted 31 
Disqualified 17 
48 
The disqualifying conditions were found on—• 
IV. Endocrine system 1 
V. Circulatory system , 3 
VII. Hernia 1 
VIII. Genito-urinary systems 2 
XIV. Hearing ., 1 
XV. Nose 6 
January, 1919.—Rebreathing tests. 44 
AVIATION MEDICINE IN THE A. E. F. 
XVI. Tonsils 2 
XX. Equilibrium 2 
XXI. Visual acuity 6 
XXIV. Accommodation 2 
XXV. Convergence 4 
Probably remediable 5 
II. Of the 18 reexaminations (Form 4) the men were referred to the laboratory for the 
following reasons: 
General examination 5 
Influenza 3 
Diarrhea 1 
Nervousness 2 
Cough and sore throat 1 
Eye examination r 1 
Injury to leg 1 
Age 1 
Grippe, stale 1 
Frontal sinusitis 1 
Gastritis 1 
Total 18 
After examination of these 18 cases, the recommendation of the Medical Research 
Board is as follows: 
To duty 5 
Grounded 5 
To hospital 2 
Two weeks’ leave 3 
Class B nasal operation 1 
Temporary rest (advised by ophthalmological department) 1 
Not indicated 1 
Total 18 
Of the 66 observers from the front given the rebreather examination, the grading is as 
follows: 
Department. 
A (1). 
B (2). 
C(3). 
D(4). 
32 
21 
13 
30 
25 
10 
1 
50 
13 
2 
1 
38 
27 
1 
Final 
21 
30 
13 
2 
In considering the preliminary examination of the 92 cases that underwent the 
rebreather test, the following is noted: 
1. The clinical department graded them— 
Class A 78 
Class B 11 
Class C 3 
Class B: 
(а) Neuro-circulatory asthenia 10 
(б) Diarrhea - 1 
Class C: 
(a) Valvular heart lesion 3 AVIATION MEDICINE IN THE A. E. F. 
45 
2. The ophthalmological department graded them— 
Class A 75 
Class B 16 
Class Q ... 1 
Class B: 
(а) N. P. C. faulty 5 
(б) N. P. A. faulty 2 
(c) Visual acuity faulty 4 
(d) Exophoria. 4 
(e) Esophoria 1 
Class C: 
(a) Red-green color blindness 1 
3. The nose and throat department graded them: 
Class A 70 
Class B 17 
Class C 2 
Not examined • 3 
Class B: 
(a) Chronic frontal sinusitis i 1 
(b) Hypertrophied tonsils 2 
(c) Cryptic tonsils 2 
Jd) Deviated septum 6 
(e) Ethmoiditis 1 1 
(/) Hypertrophied turbinates 4 
(g) Post-operative catarrh 1 
Class C: 
(а) Atrophic rhinitis 1 
(б) Deviated septum 1 
3-A. Equilibrium: 
Class A 74 
Class B 1 
Class C 6 
Not examined 11 
Class B: 
(a) Hypersensitive 1 
Class C: 
(a) Nystagmus 12--12 * .* 1 
(b) Nystagmus 15-15 1 
(c) Nystagmus 38-42 1 
(d) Rt. pp. -0.1. Left pp. 0.0 1 
• (e) Rt. pp. -0.0 1 
(/) P. P. -%-$ 1 
The following classification is A for those that have no discoverable defect. B for 
those who have a temporary or easily remedied defect. C for those who have a per- 
manent defect or one requiring long treatment. 
Number of cases receiving A in all departments 50 
Number of cases receiving one or more B 33 
Number of cases receiving one or more C 9 
Total 92 46 
AVIATION MEDICINE IN THE A. E. F. 
Summary of board recommendations—Second Aviation Instruction Center and Third 
Aviation Instruction Center—786 cases. 
Returned to active duty at once 369 
Grounded (temporarily Class B) 288 
Grounded (permanently Class C) 38 
Leave recommended. 73 
Suggest transfer as observer 4 
Referred to hospital 8 
Suggest transfer as mechanic 1 
Not to flv above certain altitudes 3 
1 784 
For medical 130 
For eye 38 
For ear 33 
For neurological 7 
Department not indicated 20 
Sent to hospital 32 
Tonsil operations 28 
288 
TEMPORARILY GROUNDED (CLASS b). 
For medical 19 
For eye 4 
For ear 8 
For neurological 7 
38 
PERMANENTLY GROUNDED (CLASS c). 
609 EXAMINATIONS (FORM l). 
Qualified 125 
Disqualified 47 
Disqualified until operation 40 
212 
ClassA 159 
Class B 64 
Class C 32 
Class D 3 
Not graded *. 12 
270 
E. Record Blanks. 
REBREATHER EXAMINATIONS. 
In order that the work instituted in medical aviation should yield 
its full value, the question of the best form of permanent records was 
closely studied—not only our own, but those of our allies. On the 
whole, the British triplicated copy system seemed the simplest and 
the most satisfactory. Some of the existing forms were revised and 
new forms were introduced for use in the A. E. F. (See Appendix.) 
Blank 609, used for recording the results of the examination of the 
candidates for entrance into the service in the United States, was 
improved upon, particularly in relation to the medical history of the 
case and from the standpoint of internal medicine. After these 
changes, it became the new admission blank, Form 1. The reex- 
1 Two recommendations not given. AVIATION MEDICINE IN THE A. E. E. 
47 
animation blank, Form 3, was gradually developed, as experience in 
the A. E. F. dictated the needs, and it met the needs of the service 
admirably.. 
Members of the Medical Research Board sat upon the official acci- 
dent board of the Third Aviation Instruction Center, and as a result, 
the accident blank was developed. It has proven very satisfactory, 
for it covers all the information about the history of the accident, 
the condition of the plane and of the motor before use, questions 
relating to training and the prevention of accidents, the cause of the 
accident, the responsibility involved, and the condition of the flier 
from a medical standpoint before and after the accident. It facili- 
tates greatly the statistical study of the accident problem. Blanks 
for use in conference with fliers or observers returning from the 
front were also devised. This record aids in the correlation of the 
results of the medical examination with the man’s actual experiences. 
The record blank which shows in chart form the flier’s resistance to 
oxygen want, and his ability to stand altitude, was devised and used 
in America. It was so excellent that no improvements have sug- 
gested themselves. The envelope was supplied to inclose the air- 
man’s complete medical history, including admission, examination, 
reexamination, flight surgeon’s report, and altitude classification. 
These papers accompanied the flier from station to station, or to a 
hospital, being always lodged with the executive officer and, there- 
fore, always available. A set of these forms with the envelope will 
be found in the appendix. 
F. The Flight Surgeon. 
The flight surgeon is the sine qua non in the organization for the 
care of the flier. Thoroughly grounded in internal medicine, the 
efficient flight surgeon must possess some knowledge of the general 
principles of physiology and of psychiatry, and he must be able to 
make certain important eye and ear examinations. In addition, 
he must be familiar with the modern methods of hygiene. With a 
deep and interested devotion to his work, he must be unselfish, 
approachable, adaptable, gentlemanly, possessing, at the same time, 
the firmness to give him the requisite authority. • Not too old, he 
must know and appreciate young men and their problems, and it is 
essential that he should fly. In training centers he must be able to 
impress the instructors with the fundamental fact that he is there 
to help not only the student fliers, but the monitors, as well, in all 
their problems; and in this way to do his part in raising the morale, 
and in promoting the general efficiency of the field. For the remov- 
ing of a man from flying, when he is not fit to go up, is not a loss of 
time—it may save a plane as well as a valuable life. 48 
AVIATION MEDICINE IN THE A. E. F. 
A flight surgeon (Maj. Hampton) was appointed to the Third 
Aviation Instruction Center, and several other flight surgeons were 
detailed for assisting in this work. In addition, a flight surgeon 
(Maj. Perry) was assigned to duty at the Second Aviation Instruc- 
tion Center, and another flight surgeon (Maj. Blakesley) was assigned 
to duty at the Seventh Aviation Instruction Center. 
At the Third Aviation Instruction Center, sick call was held twice 
daily for fliers. Simple ailments were cared for, while those requiring 
a careful, exhaustive examination were referred to the laboratory. 
As stated before, the flight surgeon met with the board, and the 
student was returned to duty, sent to the hospital, or leave was 
recommended, as circumstances -required. But the flight surgeon 
had power to recommend leave without a laboratory test, when the 
illness or the passing indisposition was well defined. In every sense, 
the welfare of the flier was constantly considered. The flight sur- 
geon lived with the students, messed with them, and knew them 
personally. He was always on hand when his advice or other serv- 
ices were needed. His attention was always centered on matters 
pertaining to the maintenance of mental and physical health, thus 
producing efficiency. In the organization of the mess, recreation, 
reading rooms, gymnasium, sports and games, he cooperated with 
all interested. With a thorough knowledge of the special medical 
problems of aviation, and gifted with thorough kindness, common 
sense, and desire to help, he did much to stimulate the best in the 
fliers, and to increase the morale of the school. Nothing will illus- 
trate this better than the following letter: 
Headquarters Third Aviation Instruction Center, 
A. P. O. 724, American Expeditionary Forces 
December 26, 1918. 
From: Commanding officer. 
To: Maj. Robert R. Hampton. 
Subject: Commendation. 
You have been for some months flight surgeon at this center, a school of approxi- 
mately 1,000 flying officers. It has been your duty as the sole flight surgeon of the 
post, and the first flight surgeon in France, not only to attend to the physical well- 
being of these officers, but also to act as their general adviser in matters of a personal 
and business nature. As such it is my firm belief that your efforts along these 
lines have in a great way tended to uplift the morale of the flying officers undergoing 
training at this center, and to maintain a constant spirit of fellowship, confidence, 
and devotion. Your labors, even more so because of their unique character, deserve 
the highest commendation. 
Hiram Bingham, 
Lieutenant Colonel, Aviation Service. 
The following is an extract from a lecture to flight surgeons by 
Capt. John B. Powers, Medical Corps: 
Duties.—He should hold sick call every day. This is for the purpose of keeping 
in touch with the flier’s physical condition and to enable the flight surgeon to become AVIATION MEDICINE IN THE A. E. F. 
49 
acquainted with affairs which he might not be able to discover in any other way. 
Personally, I do not believe the flight surgeon should prescribe or treat except for 
minor ailments when the patient reports for sick call or in quarters. In regard to 
those who are sick in the hospital, while the flight surgeon should keep in touch with 
his men, he should not attempt to treat them there, because of possible conflict with 
the hospital authorities. 
The flight surgeon should make a point of seeing each flier every day, either on the 
field, at mess, or in quarters, because he may recognize conditions to which the flier 
may pay no attention. 
The flight surgeon should keep in intimate touch with the flight commander and 
with the records of the flying office. He should consider himself as a member of the 
staff of the flight commander in an advisory capacity, and he must gain the confidence 
of the flight commander. 
The flight surgeon should spend as much time on the flying field as possible, watch- 
ing for defects in flying, such as bad landings, uncertainties of action, etc., and keep 
a record of each. For instance, a flier may start to the ground as if he is going to land, 
but instead he circles around the field. Still he does not come down although one 
can see that he expected to do so; but instead he goes around the field again without 
coming down and repeats this three or four times. When he finally does come down, 
the flight surgeon should get hold of him, because something of importance in regard 
to his nervous system, etc., that is just beginning to appear, may be discovered by 
prompt investigation. 
The flight surgeon should make repeated examinations of his men to determine 
their continued fitness for flying. The frequency, of course, of these examinations 
will depend upon the amount of flying that is being done. These examinations 
should be not only physical but mental as well. Because it comes on earlier in some 
than in others, the possibility of so-called “air staleness” should always be borne 
in mind. 
The flight surgeon should make a report in detail on every crash that occurs, stating 
the exact cause, extent of damage to machine, and whether pilot was injured or not; if 
injured, the degree and probable recovery, etc. If the accident was due to some men- 
tal or physical defect of the pilot, the defect should be corrected at once if possible; but 
if it is not remediable, grounding him at once should be advised. When in doubt, 
grounding should be advised while the man is being studied closely. No chance 
should be taken, for it may mean death to one or more men upon whom the Govern- 
ment has spent a large sum in training. 
The flight surgeon should see that his men have plenty of proper and suitable ex- 
ercise. He should impress upon the fliers the fact that they must regard themselves 
much in the light of athletes, and' that they must bear in mind the rules laid down 
for the training of athletes—regular hours and habits, temperance in all things, plenty 
of sleep, good food, comfortable quarters, etc. 
Furthermore, the flight surgeon should see that they have recreation of the right 
kind, for in no case is the old saying truer than in the case of the flier, that “all work 
and no play makes Jack a dull boy.” Besides this, wise recreation will make them 
happier and better satisfied, and more amenable to discipline. 
Upon every flight surgeon I would like to impress the following brief words of ad- 
vice: Be sure to attend to your work promptly. When you promise to do a thing for a 
man, do it at once. Keep your own work up, and it will help to keep up all of the 
work. Show interest in your work. If interest lags, it is your fault, and the sooner 
you recognize it the better. Let the men know you have their interests at heart, 
and you will succeed with them. 
Be kind, courteous, and considerate to the other medical officers of the post. Do not 
ask them to do what is your job; do not make a nuisance out of yourself. You have 
171364—20 4 50 
AVIATION MEDICINE IN THE A. E. F. 
your work to do, and they have theirs. Remember that the post surgeon is a man of 
importance as well as yourself, and he has the interests of the hospital or infirmary, or 
both, at heart. He is responsible, and he is jealous rightly of his authority. Keep 
your work separated from the other medical work on the post or field, and you will 
lessen chances of friction. I say these things because I know of friction that has oc- 
curred, and often because of the fact that the flight surgeon did not bear these things 
in mind. 
Now as a last word: Appreciate your work thoroughly. Value your opportunities 
highly, for I know of no work where there is more chance to accomplish something 
worth while than that of a flight surgeon. Where efficient flight surgeons have 
been placed, good results have been shown by a marked reduction in fatalities. Get 
busy and do your utmost to reduce them to a minimum—for, after all, your func- 
tion, in its final analysis, is to keep those mishaps and accidents that are due not to 
the machine but to the men themselves down to the lowest possible figure. 
The hygiene of the flier is considered fully in Section IV of the 
chapter on physiology. 
The value of the flight surgeon has been abundantly proved in the 
training schools of the United States and in France; but the signing 
of the armistice prevented the full realization of the hope that 
flight surgeons would be placed where they would be of the greatest 
value—at every aerodrome and balloon station at the front. 
It can readily be seen that a skillful flight surgeon would have been 
very valuable at the aerodrome where Guynemer had his headquar- 
ters. That marvelous flier had shown increasing nervousness and, 
physical unfitness for some time. In his delightful book, Mr. Driggs 
says, “A new Guynemer revealed himself to his friends and comrades. 
He became nervous, sick, and irritable. His comrades, unable to con- 
trol their captain, telephoned to Paris, informing their old command- 
ing officer, Brocard, that Guynemer was sick and in no condition to 
fly and imploring him to come back to the aerodrome to take their 
captain away for a much needed rest. He arrived about half an hour 
after Guynemer had left on his last flight.” 
Rickenbacker says: “It is plainly imperative that one keep one’s 
self always fit and clear-minded. It is a matter of life or death to 
every air fighter—this quick-thinking, unburdened mind.” His 
words in speaking of the fatal accident to Lieut. Kurtz are very illumi- 
nating: “I had noticed before starting that Lieut. Kurtz appeared 
nervous, but did not give the matter any great consideration. The 
explanation was given by a brother officer, who had come with Lieut. 
Kurtz to the squadron. Before starting on his last flight, Lieut. 
Kurtz had confided to him that he was subject to fainting spells when 
exposed to high altitudes, and the only thing he was afraid of was 
that he might be seized with such a fit while in the air. Alas, his fear 
had been only too well founded. But what a pity it was he had not 
confided to me, his flight commander.” 
After a flight of over 15,000 feet, Lieut. Kurtz was making a turn 
over an adjoining field, when his Nieuport dropped into a vrille, AVIATION MEDICINE IN THE A. E. E. 
51 
crashed, and caught fire. Experience has shown over and over again 
that a flier will confide in his flight surgeon when he will be silent with 
his commanding officer. 
During the latter part of September and the first part of October 
the visits to various aerodromes in the zone of advance made very ap- 
parent the need there of specially trained medical men. There was 
usually a medical officer attached to each squadron, and, therefore, at 
each field there would be three or four altogether. They were, as a 
rule, a fine body of young men—bright and eager to serve. But their 
want of knowledge of the special problems of medical aviation lay 
heavily upon them, and they welcomed the plan of instructions* in 
these problems. They usually lived together, but apart from the 
fliers. They felt a lack of confidence in their own judgment of a flier’s 
fitness, and therefore were not keen to be thrown with the men. 
They feared to take a flier from duty, and, conversely, they dreaded 
to keep him flying when they had a feeling of uncertainty of his real 
condition. This lack of confidence in their own judgment rather en- 
gendered a feeling of uncertainty on the part of the fliers. Alto- 
gether, there was not the team work and feeling of mutual confidence 
that would have existed if the medical men had been thoroughly 
familiar with the technical and medical problems of flying. There is 
no other part of the military establishment in which team work adds 
more to general efficiency than at the flying fields. 
If the armistice had not occurred so early the purposed laboratory 
at Columbey-les-belles would have been the place at the front where 
the flight surgeons, in case of doubt, could have sent a flier for a very 
thorough examination. 
The chief war functions of the Medical Research Laboratory were to 
furnish accurate, practical knowledge to the flight surgeon and to all 
who were concerned in the care of the flier, that the greatest efficiency 
might be given the service in the maintenance of physical and 
mental fitness, with a resultant economy of planes and prevention of 
unnecessary expenditure of valuable young lives. The men who were 
brought to France for work in the laboratory and as flight surgeons, 
had already shown their special training, their practical experience 
in flying, and their enthusiasm engendered by the fascination of the 
Air Service. In America, a brilliant flight surgeon had given his life 
to the service, and there was not a man in the group in France who 
was not willing to do the same. 
Personnel for flight surgeons at the front could have been taken 
from this group that had come to France in response to the cable 
asking for men who were experienced in aviation medicine. In 
addition to this selected personnel it was planned to take from the 
aerodromes the medical men who seemed best suited to this work 
and those who desired further training and to send them to the School 52 
AVIATION MEDICINE IN THE A. E. F. 
of Aviation Medicine, established in connection with the main labo- 
ratory at the Third Aviation Instruction Center. The plan for this 
school had been made almost immediately upon our arrival in France; 
for experience had already shown that the special mental and physical 
problems of the flier would require more than ordinary professional 
training in the men who were to be the successful medical advisers 
at the flying schools and at the combat centers. The faculty of the 
school was composed of the Medical Research Board, the laboratory 
staff, and representative flight surgeons. The school that had just 
opened so auspiciously with three medical officers as students, was 
brought to a close by the cessation of hostilities. 
3. INVESTIGATIONS RELATING TO THE FLIER. 
A. Study of More Important Medical Problems. 
An attempt was made to study all the more important medical 
problems confronting the pilot in the pursuit of his duties, In order 
that first-hand knowledge might be acquired members of the board 
have made flights of various kinds, having gone through all the 
acrobatics in order to better appreciate the mental as well as the 
physical effects. These flights included such acrobatics as loops, 
renversements, virages, vrilles, and altitude work up to 18,490 feet. 
One of the laboratory staff, Capt. Floyd C. Dockeray, Sanitary Corps, 
trained as a pilot and has been brevetted a E. M. A. 
Throughout the work two things were kept constantly in mind: 
First, the practical or clinical side, arrived at subjectively through 
conference with the fliers and their instructors, and through actual 
flights by members of the board; and, second, the fundamental proc- 
esses underlying the sensations produced, many of which could 
be more or less accurately reproduced in the laboratory. Throughout 
the work, a systematic effort was made to obtain a true grasp of the 
problem, reproduce it in the laboratory when possible, and to deter- 
mine the fundamental factors conoerned. In this work there was 
frequent recourse to conferences with instructors, testers, and pilots 
from the front. As a rule they were found to be particularly intel- 
ligent and cooperative. While the work of the board dealt mostly 
with physical conditions and physical responses, it was evident 
that the psychological features constituting “grit,” played a leading 
role in success or failure. Personality studies were made in a large 
proportion of the cases. Psychological, as well as physical, fitness 
is essential. Obviously, a perfect physical specimen might be useless 
as a flier,* and, conversely, sheer “grit” and nerve might compensate 
for certain physical defects.* Some of the tests in use determined, 
to a certain extent, perseverance and will power. Many of the 
fliers grounded by the board were classified as temperamentally 
unfit, while physically they were found to be in good condition. AVIATION MEDICINE IN THE A. E. F. 
53 
B. Altitude and the Use of Oxygen. 
The effects of altitude and the artificial administration of oxygen 
received deep consideration. Flights were made with and without 
oxygen on alternate days. Records were made of the same indi- 
vidual prior, and subsequent, to these flights in relation to steadiness, 
function of eye muscles, effect on blood pressure, pulse rate, etc., 
the efficiency of the pilot during the trip having been tested by his 
ability to use the camera gun. It is regretted that the vital neces- 
sities of war precluded more extended work in this field. 
C. The Examination of Monitors and Testers of the Third Aviation Instruction 
Center. 
It was deemed desirable to determine the fitness of the men engaged 
in the instruction of aviators. Consequently, most of the monitors, 
instructors, and testers of the Third Aviation Instruction Center, 
reported to the Medical Research Laboratory and were examined 
and classified physically, psychologically, and from the standpoint 
of withstanding the effects of altitude. In all, 78 such men were ex- 
amined, most of whom were found to be unusually fit compared to the 
student flier. They constituted a striking group even among men 
as carefully selected as the American fliers were. 
D. The Valuation of Tests Utilized in Studying the Flier. 
With the signing of the armistice the group from England and some 
members of the ophthalmo-otological group came to Issoudun, the 
former group bringing much information concerning the methods 
employed by the British in their work with the aviator. The com- 
pletion of the laboratory made available much greater facilities for 
work, while the return of the flier from the front through the Second 
and Third Aviation Instruction Centers, afforded opportunity for the 
investigation of the men who had been successful. This made pos- 
sible the correlation of laboratory findings with the result of the 
crucial test of experience. Consequently, the board requested that 
groups of fliers should be cleared by the research board before re- 
turning to America and that pilots returning from the front should 
bring with them statements from their squadron commanders con- 
cerning their ability in actual military operations. 
In all, 186 fliers from the American squadrons on the front were 
examined in this series. Of these, 66 were observers who were ex- 
amined at the Second Aviation Instruction Center, and 120 were 
pilots who were examined at the Third Aviation Instruction 
Center. In addition, 12 French fliers were sent to the Third Avia- 
tion Instruction Center by the French Government for special ex- 
amination. These men were all between the ages of 21 and 35 years, 
and they had had 220 to 1,163 hours flying in total, and 100 to 500 54 
AVIATION MEDICINE IN THE A. E. F. 
hours over the lines. They had all been in altitudes of 3,000 to 6,000 
meters. With the exception of one who was suffering from sinusitis, 
they were all acceptable physically and mentally. Two of them 
experienced discomfort on being turned in the chair and, as a group, 
they were somewhat more sensitive to motion stimulus, as shown 
by the rotation chair, than the average American flier. Because of 
long service, there was a larger percentage of staleness than in re- 
turning American fliers. In relation to altitude classification, 7 
were graded A, 3 should not fly above 15,000 feet, and 2 above 8,000 
feet. 
The usual routine in studying the men from the front comprised 
the following: A conference was held with the flier that covered his 
training, his work, his experiences at the front, and his specific and 
general observations; then he was given a medical examination which 
included the eyes, the ears, the general condition, and the personality. 
His reaction time was studied, the tactile, visual, and auditory reac- 
tion times being taken with the D’Arsonval apparatus. The English 
tests were applied, and postural changes recorded. He was tested on 
the rebreather and classified from the standpoint of his ability to with- 
stand the effects of altitude. Finally, he was photographed, when 
possible, both in profile and in full face. In this way, a complete 
permanent record was obtained covering his training, his work at the 
front, the opinion of his commanding officer concerning him and his 
work, his medical condition, his fitness, mental and physical, the 
results of the English, American, and French tests, and the greatest 
altitude at which he could do efficient work. 
E. Nausea, Vomiting, and Vertigo as the Result of Flying. 
“The hypersensitive-to-motion type of flier.” About 10 per cent 
of all the aviators who applied or were sent to the Medical Research 
Board, gave a history of being hypersensitive to motion. They com- 
plained of having been nauseated, of having vomited, or of having 
been dizzy in the air to a greater or less degree. Many of these cases 
were referred to the board by the monitors at the acrobatic fields. 
This group of men was subjected to special study. Many of them 
gave a previous history of having been sensitive to swings, merry-go- 
rounds, or riding in cars, and unusually so to motion at sea. Many of 
them showed hypersensitiveness to motion as indicated by prolonged 
nystagmus or vertigo, marked falling and past-pointing in the chair. 
A few of those who were most hypersensitive in their air work showed 
no corresponding indications in their labyrinthine examinations. 
It also became apparent that a certain type had been able to over- 
come this sensitiveness and were “lached” from the acrobatic fields. 
Certain pilots, for whom grounding was considered at first, had sub- 
sequently left this post finished and efficient fliers. In combat, in AVIATION MEDICINE IN THE A. E. F. 
55 
which relativity of position plays a great r61e, evidences of hyper- 
sensitiveness reappeared in some fliers. The board was impressed 
with the fact that hypersensitiveness to motion could be overcome 
through practice in some cases. One of America’s foremost aces is 
credited with having been a vomiting type while under training in 
the early days of the Third Aviation Instruction Center. Vomiting 
seems to be less serious than vertigo in this connection. 
F. Accidents. 
The statistical and analytical studies that have been made of the 
accidents in the Air Services are so important that a separate chapter 
has been devoted to their consideration. 
G. Conferences with American Combat Pilots. 
The excellent report by Maj. Patten and Maj. Hyde upon their 
conferences with American fliers from the front is given in a con- 
densed form. The full report covers the question of age, previous 
education, sports, training, present rank, organization, sector of 
operations, effects of altitude and cold, requirements for a successful 
combat pilot, use of goggles, balance mechanism, opinions regarding 
exercise, tobacco, alcohol, attitude toward the work, causes of ac- 
cidents, staleness, etc. 
Herewith you will find tabulated report and conclusions, the result of the examina- 
tion of 100 aviators of the United States Army. These officers have had considerable 
experience as chasse pilots, and it is believed they are representative of their branch 
of the Service. Throughout these conferences, we have followed a line of questions 
submitted to us for that purpose, and have presumed to add to that certain conclusions 
at which we have arrived. It has been our endeavor not to make these questions lead- 
ing, and it is believed their answers reflect as nearly as possible the opinions of the dif- 
ferent pilots on the subjects considered. 
From these conferences, it is concluded that the combat aviator should be young. 
The majority of the evidence indicates that the age should be from 18 to 25 years. It 
is of advantage to select the cadet in his adolescent or developmental period, before 
the habits of life are too firmly fixed, before his nervous system and physical energy 
are impaired by the strenuous demands of present-day life. At this age he learns 
more quickly, and what he acquires he reacts to in a natural manner that is almost 
instinctive, all of which is most essential to the combat aviator. With youth we have 
confidence and aggressiveness. It is the time of action, not the age of conservatism 
and deliberation. It is only fair to mention, however, that the oldest officer inter- 
viewed by us was 35 years and 3 months of age, that he had been 40 hours over the lines, 
had five combats, and was credited with two enemy planes. 
Of all the physical attributes, vision is most important, both for offensive and 
defensive chasse work. The consensus of opinion of the officers interviewed was that 
the eyes should be absolutely perfect in every particular to successfully do the work 
and to withstand the strain to which they are subjected. 
Here it is necessary to state that there is a difference between good eyesight and 
being able to see well. It was brought out in the conference that every pilot must 
learn to see in the air, that his ability to pick up objects improves with practice, which 56 
AVIATION MEDICINE IN THE A. E. F. 
is an intuitive interpretation of what one sees. This is called ‘ ‘ air sight,” and the longer 
he flies over the lines the better it becomes. Some pilots, however, are unable to 
develop this power and are obliged to give up or be shot down. This, perhaps, is mental 
and not visual. Many instances have been cited in which a new pilot has been shot 
at, or shot down, without seeing the enemy. The above emphasizes the necessity of 
a long period of training over the lines for our pilots before they go into actual combat, 
as it is a noteworthy fact that most of our pilots who were killed, lost their lives in the 
first few patrols over the lines. If they successfully return from the first few “shows,” 
they are thereafter comparatively safe. 
Most officers were of the opinion that color vision was of little importance to a chasse 
pilot, but when more closely questioned it was brought out that it was of importance 
in following the topography of the country, etc. 
Regarding the interpretation of “how men fly,” the composite conclusion is that 
flying is balance, and balance is a correlation of sensation complex received, subcon- 
sciously interpreted, and automatically executed in coordinate muscular movements, 
maintaining orientation in space—the eyes for lining up the ship with the horizon; the 
ears for the sound of the motor and sing of the wires; the skin for the feel of the force 
and direction of the air; the deep muscular and joint sensations for interpreting the feel 
of the “joy stick, ” the warp of the rudder and gravity and centrifugal force sensation; 
and the vestibular apparatus for sensing the direction of motion. 
Absolutely normal hearing is not necessary to the flier, for flying; but when ques- 
tioned closely, all admitted it would be better to be normal for the following reasons: 
The early detection of motor trouble would aid the flier in seeking a favorable landing 
place or restrain him from going into combat with a defective engine, thus perhaps 
saving pilot and machine from useless destruction; the hum of the wires are of some 
use in determining flying speed and posture of the ship; and the first intelligence of 
the approaching enemy has often been through the hearing of their machine gun- 
fire, especially so if the pilot’s observation has been at fault. 
Ten per cent of our returned pilots stated that they disliked the work or believed 
they were unfitted for it. It is regretted that these officers ever represented the 
United States over the lines and it will always be a question what proportion of the 
lost pilots belonged to this class. It is quite possible that a large percentage of the 
cadets killed in training (with a diagnosis of “bad flying judgment”), belonged to 
this type. It is believed that a considerable number of these cadets could have 
been eliminated from the Service entirely, or transferred to some other branch early 
in their aviation career if they had had the benefit of the observation of a medical 
man especially trained in the problems of aviation. This special medical care and 
attention could with benefit have been extended to the Front. 
H. Conferences with Observers From the Front. 
Capt. Cary’s interesting report upon the conference study of a 
group of observers who returned from the Front through the Second 
Aviation Instruction Center is given in brief. 
A conference was held with 89 observers returning from active duty on the Front. 
These men were questioned as to their training, experiences at the Front and what 
they considered to be the prerequisites of the successful observer. Their answers were 
usually of from three to five in number. These answers were collected and it was 
found that the 89 men gave 59 different answers. 
It will be noted in studying the following list of answers that some were repeated 
several times. (Only those answers are classified that contain the opinion of five or 
more observers.) AVIATION MEDICINE IN THE A. E. F. 
57 
Answers. 
Number 
of times 
repeated. 
33 
Be physically fit at all times 
25 
21 
21 
. 18 
Be able to use common sense 
8 
8 
7 
6 
6 
5 
22 
Get the best training and know his job 
10 
10 
9 
9 
9 
6 
5 
5 
Group 1.—Prerequisites. 
As the good observer is unquestionably above the average type of man, it was 
thought that some light would be shed on the subject if his previous occupation were 
investigated. With this in mind, 64 officers who had been observers were questioned 
and their occupation before entering the Army noted. These various occupations 
were tabulated and the men in each group were classed: Good, fair, or poor, accord- 
ing to their ability as an observer. (This list is given, although it is too small to allow 
any conclusion to be drawn from it.) 
Occupation. 
Number. 
Good. 
Fair. 
Poor. 
2 
2 
0 
0 
10 
7 
2 
1 
4 
1 
3 
0 
7 
3 
3 
1 
Newspaper man 
3 
1 
2 
0 
Manufacturing 
4 
1 
2 
1 
14 
5 
5 
4 
Miscellaneous (clerk, mine promoter, insurance investigator)... 
7 
3 
1 
3 
Auto business 
2 
1 
0 
1 
Architect 
3 
1 
0 
2 
13 
0 
2 
4 
0 
2 
2 
Total 
63 
26 
20 
17 
1 One broker. 
The classification of occupations. 
These men were also questioned as regards the influence of age on the observer, 
and the consensus of opinion was that the observer should be older than the pilot, 
but that he should not be too old, as the older men were more apt to be nervous than 
the younger ones. The majority believed that the ages should range between 22 and 
30 years, although some favored 25 and 30 years, while others placed the lower limit at 
20 years. 
The attitude toward the work is an important matter, for (as will be remembered) 
one of the prerequisites of an observer is that he must have his heart in his work. Sev- 
eral have expressed their belief that the Air Service should be voluntary, and that a 
man should never be drafted into it. This is substantiated by the fact that all the 
observers who were drafted into the work from other branches of the service against 
their wishes, did an inferior type of work. Of 89 observers questioned, 12 preferred 
other work; of these 3 were A, or good men, and in each instance, their desire was to 58 
AVIATION MEDICINE IN THE A. E. F. 
become a pilot, consequently their work was good. But of the other 9 there was not 
an A man, and with one exception, they were all C, or poor observers. The above 
must speak for itself. 
With very few exceptions, all observers stated that vision was of primary impor- 
tance and most essential to the success of a mission; for, as one of them put it, “if you 
can’t see what you are expected to, your mission is of no use,” and “if you don’t see 
clearly, your information is of little value.” They state that a man may have lenses 
ground into his goggles, but that often the goggles are either broken or blown off in 
the air. 
The ears (and by ears is meant in this connection the whole pneumatic mecha- 
nism including the eustachian tubes) are of importance and means should be furnished 
for their proper care; for, as one observer said, “50 per cent of the observers and pilots 
in the Ninetieth Aero Squadron had trouble with their ears.” This is more or less 
constant among squadrons that live in surroundings which predispose to head colds. 
The observer suggested that it would be of great benefit if each squadron medical 
officer were equipped with the proper instruments and ability to cope in a simple way 
with these conditions. 
With very few exceptions all the men agreed that they were none of them in good 
physical condition, and that secretly they would have welcomed some type of com- 
petitive exercise. This was more important on the days they did not fly as on flying 
days the work of maneuvering the machine-gun in combat and of straining against the 
propeller wash was quite enough exercise for the average. These men all said they 
would have been in better condition had they been able to do systematic exercise, 
but were nearly unanimous that they did not want drilling. 
The observers agree that staleness is a mental and physical depression brought 
about by the monotony of constantly being kept on the aerodrome with long hours 
in the air. It is characterized by loss of appetite, general debility, and dread of the 
morrow. With this goes jumpiness and loss of ambition. One observer stated that 
it was very contagious, and another, that it depended a good deal on the attitude of 
the Commanding Officer. This staleness was evident in some of the men that have 
come back from the Front as is evidenced in a resume of the following histories: 
No. 70.—A bombing observer, who was trained in France and who has been on 
the Front since April 17, 1918. He was 24 years old and had (previous to entrance 
into the Army) been a student. He “crashed ” the first night of the St. Mihiel drive, 
and then was run into by another plane in landing. He had had several narrow 
escapes but was never actually wounded although he only came out of a “vrille” 
just off the ground with a full load of bombs. He is a good type and has been classed 
A in conference. He is now, however, nervous and high strung and does not sleep 
well. He finds it very difficult to occupy himself and worries a good deal about getting 
home. It is difficult to suggest a remedy which will meet his situation. His objec- 
tive symptoms are nervousness, tremulous tongue and fingers, and very active tendon 
and superficial skin reflexes. His direct and consensual light reflexes are active. 
He has been advised to live temperately. 
The next history is No. 73, an aerial observer who was classed C in conference, and 
doesn’t care for air work although he was on the active Front for nearly three months. 
He got a position on the ground in liaison work with the Infantry. He is 21 years 
and 7 months old and previous to entrance into the Army was a student preparatory 
to being a mining engineer. He is decidedly temperamental, and a bit too much 
dependent upon his environment for the real pleasures of living. He looks tired, 
his hands and tongue are a trifle tremulous, his knee jerks, and consensual light 
reflexes are very active. He does not enjoy his work particularly and is anxious to 
get into another branch of the service. 
The first history typifies the man who has made good and who has gone “stale” 
through conscientious effort, while the second history is typical of the man who 
was not cut out to be an observer and who had become hypersensitive nervously, due 
probably to not being able to live up to his job. Chapter III. 
DEPARTMENT OF PHYSIOLOGY. 
Maj. E. C. Schneider, Sanitary Corps. 
Section I. 
THE EFFECTS OF HIGH ALTITUDE UPON AVIATORS AND THE ALTITUDE 
CLASSIFICATION EXAMINATION. 
It is a well-established fact that high altitudes exert a profound 
influence on the human body. As long ago as 1590 d’Acosta de- 
scribed symptoms of high altitude sickness. The more exact scientific 
investigations of the conditions pertaining to life at high altitudes 
began about 75 years ago. These investigations at first had a purely 
scientific aspect in which the physiological effects of altitude on man 
and other animals, were considered. With the coming into promi- 
nence of aviation a knowledge of the effects of altitude assumed 
practical importance. 
As soon as an attempt is made to interpret the physiologic phenom- 
ena of altitude in terms of their causes difficulties arise. Contra- 
dictory theories have been published. The reason is to be found in 
the complexity of the factors which enter into the environment at 
high altitudes. Among the climatic variables are the low atmos- 
pheric pressure, with its low partial pressure of oxygen, the sunshine, 
low temperature and humidity, the high winds, and the electrical 
conditions of the atmosphere. It has been found difficult to study 
these factors one at a time, but with the use of the pneumatic cabinet 
it is possible to eliminate all factors except the lowered barometric 
pressure, and also to study the added influence of other altitude 
factors. The consensus of opinion held to-day is that the physio- 
logic effects noted at high altitudes are due to the lack of oxygen 
resulting from the lowered partial pressure of oxygen. 
It is suggested that as one listens to the expression of opinions 
among aviators and “ground” officers who mingle with the fliers, 
one might consider the subject of altitude influence exhausted. 
However, a patient listener soon discovers such diversity of opinion 
that he becomes convinced that opinions are not backed up by 
experience and keen observation. There is a need for experimental 
study of the effects of altitude upon aviators, and a need for a popular 
educational campaign of instruction regarding facts as distinguished 
from opinion. The necessity of attention to the technical and other 60 
AVIATION MEDICINE IN THE A. E. E. 
duties of a flight may, in itself, suffice to divert the aviators’ notice 
from physical symptoms, unless they become very unpleasant; and 
further, it is well known that one of the most important effects of 
oxygen starvation is a dulling of the intellect and an unwarranted 
sense of well being and security. 
As the war progressed the altitudes to which aviators were forced 
to go became greater and greater. At the close, altitudes were 
commonly reached on the front which were, before the war began, 
impossible to attain because of the inadequacy of the airplane and 
its motor. But it should be here emphasized that flying at or above 
18,000 feet is the exception rather than the rule. 
Unfortunately toward the close of the fighting period the shortage 
of airplanes and the urgency of the campaign did not permit men on 
active service to do “ graduated flying.” An aviator physically 
incapable of withstanding very high altitudes was expected to do 
his full share of work, no matter what the altitude. This, then, defi- 
nitely raises the question: Are there dangerous altitude effects? 
The majority of American aviators have had only one or perhaps 
several high altitude flights. Most of the training was secured at 
altitudes under 5,000 feet, while only one altitude flight was required 
during instruction, and in that, immediately the maximum altitude 
was attained, the ship was nosed downward. Among 150 pilots 
who were questioned on returning from service at the front the vast 
majority had made only one so-called altitude flight. The maximum 
altitude was 22,000 feet and an average maximum of 19,465 feet 
was recorded. 
One hundred of the aviators who had been on active service at 
the Front when questioned regarding discomforts of altitude replied 
as follows: 32 per cent declared they had never suffered any incon- 
venience, 18 per cent that they suffered from shortness of breath 
alone, 10 per cent from cold and shortness of breath, 2 per cent from 
headache and shortness of breath, 6 per cent from headache, and 12 
per cent from feelings of physical exhaustion and mental depression. 
Attention is called to the fact that this is a very good showing for 
the fact that there is an altitude influence. The scout pilot (these 
men belonged to that class) enjoys comparative immunity from 
general high altitude effects in that he does not maintain great alti- 
tudes for long. The actual fighting, with very few exceptions, 
takes place at 15,000 feet or very much lower. 
ALTITUDE SYMPTOMS. 
Noticeable While in the Air. 
The symptoms experienced during flying at high altitudes may be 
observed on men when placed under the influence of reduced atmos- 
pheric pressure in the pneumatic or low pressure chamber. Low- AVIATION MEDICINE IN THE A. E. F. 
61 
pressure chamber observations made on a large number of men, show 
a remarkable variation among individuals in their capacity to with- 
stand lack of oxygen, and also that the disturbances caused by oxygen 
want, vary in character in different individuals. No symptom, or 
group of symptoms, is universal. 
Even an experienced clinician or physiologist will fail to feel alti- 
tude effects under 10,000 feet, but at 12,000 feet they are often evi- 
dent. However, many aviators have tolerated 18,000 feet so well 
that they have been unconscious of the adaptive changes that have 
occurred in their bodies. 
From an altitude of 12,000 feet and up, the following symptoms 
may occur: 
(a) Shortness of breath (dyspnoea).—This is extremely common 
but varies in degree. Very few aviators breathe through the nose 
above 12,000 feet. Breathlessness is usually noticed at 15,000 feet 
and is exaggerated by muscular exertion and by cold. 
(ib) Periodic breathing is occasionally reported.—Birley personally 
experienced Cheyne-Stokes breathing at 20,000 feet, which was re- 
lieved by breathing oxygen. One case is on record in which the 
periodic breathing came on at 18,000 feet in so violent a manner as to 
prevent the pilot from keeping his controls steady and, continuing 
as he descended, made it very difficult for him to land. 
(c) Sleepiness.—The flier gradually becomes dull and sleepy, he 
has no distress, and so insensibly becomes inefficient that he does not 
realize his condition. The same experience occurs in the low pres- 
sure chamber in which individuals who have gone to sleep revive 
when given oxygen, and declare it their opinion that they have been 
efficient or at least awake. 
It is probable that aviators who claim to feel perfectly fit at high 
altitudes may in reality have been quite inefficient and sleepy. 
Sleepiness is a common symptom that is often not recognized by 
the airman. 
(d) Impairment of intellect and judgment.—This also is a condition 
usually overlooked by the airman and with it there is often an unwar- 
ranted sense of security and well being. Birley reports an interesting 
case of this. A pilot met an enemy patrol at 18,000 feet. “He did 
not realize his danger, but waved his hand to them in spite of the 
protests of his observer. ” 
Birley continues: “Observers on high photographic reconnais- 
sances frequently get muddled and fog their plates. They are often 
unaware of their mistakes and indignantly attribute the bad results 
to some fault of the camera. ” 
(e) Impairment of vision and hearing.—This also is a result that 
comes on gradually and insensibly. Schroeder in his altitude flight 
to 28,900 feet recorded this experience as follows: “When I reached 62 
AVIATION MEDICINE IN THE A. E. F. 
25,000 feet I could hardly hear my motor run and I felt hungry.” 
He then took oxygen and kept on until it gave out, when he experi- 
enced impairment of judgment. “But the lack of oxygen was 
affecting me, I was beginning to get cross, and I could not understand 
why I was only 29,000 feet after climbing for so long a time. I 
remember that the horizon seemed to be very much out of place, but 
I felt that I was flying correctly and that I was right and the horizon 
was wrong. ” 
(f) Muscular weakness.—This is noticed chiefly by observers who 
find it hard to manipulate a camera when above 15,000 feet. Muscu- 
lar paralysis has been experienced at extremely high altitudes. 
(g) Headache.—This is usually frontal and often sudden in onset. 
McCudden in his book “Five Years in the Royal Flying Corps” says 
of his first high flight, “at last I got up to 11,000 feet, the highest I 
had yet been, and I got quite a headache over it, for I was not used 
to high flying in those days. ” At another time after going as high as 
18,500 feet he said: “I landed at Dover after having been up nearly 
two hours and was kept company by a splitting headache for the rest 
of the day. ” 
Headache is frequently an after effect of low oxygen, and it may 
persist for some hours. 
Qi) Fainting.—Some cases of sleeping may be confused with this. 
We have met several fliers of long air experience who believe that if 
an individual makes frequent flights at high altitudes he will sooner 
or later have the experience of fainting while in the air. Some feel 
faint and dizzy, but do not faint. 
Altitude Symptoms Noticed after Landing. 
Definite after effects are observed in all men who have been exposed 
to a marked oxygen want for any length of time. 
(a) Fatigue.—This is quite noticeable after all kinds of low-oxygen 
experiences. We find it common in individuals who have been in 
the low-pressure chamber for an hour or more at pressures corre- 
sponding to altitudes of 16,000 to 20,000 feet. All flying is fatiguing, 
but the condition is much more pronounced after a flight above 
15,000 feet. 
(b) Respiration often becomes subnormal both in rate and depth 
and may show periodicity. 
(c) Some believe they find evidence of circulatory fatigue in low- 
ered blood pressures and connect the fatigue with this. 
(d) The persistent headache has already been referred to. 
The war experience, especially that of our allies, has shown that 
much high flying without oxygen gradually undermines an indi- 
vidual’s ability to tolerate altitudes. He therefore, progressively 
finds his “ceiling” getting lower. Men undergoing such an experi- AVIATION MEDICINE IN THE A. E. F. 
63 
ence should be relieved from altitude work for a time, or a lasting 
effect may result which incapacitates for all flying. 
ADAPTIVE RESPONSE TO ALTITUDE. 
The human body is sensitive to the reduction in the available oxy- 
gen at high altitudes. While it may lose in efficiency as the altitude 
increases during an ascent, it nevertheless does have the power to 
adjust itself to the decrease in the oxygen supply of high altitudes. 
The ability to endure altitudes without loss in efficiency is dependent 
upon the ease and the quickness with which the adaptive adjust- 
ments are made. There are marked individual differences in this 
respect. Some men adjust so quickly and readily that they are not 
disturbed by heights which will render the average person quite 
inefficient. A few men fail entirely to respond to the altitude and 
become inefficient at relatively low altitudes. 
The adaptive changes that occur in the body as the aviator ascends 
are for the purpose of providing an adequate supply of oxygen to the 
nervous system, heart, muscles, and other parts. (1) The breathing 
gradually, and usually unconsciously, becomes deeper, thus increas- 
ing the amount of air passing into the lungs each minute. (2) The 
heart begins to beat more rapidly, which causes more blood with its 
load of oxygen to pass to the organs each minute. (3) In some 
fliers, the red corpuscles and percentage of hemoglobin increase in the 
blood. This permits a unit volume of blood to carry more oxygen 
than normally. The more perfect these three reactions, the better 
will the man withstand altitude and the higher will he ascend with 
comfort and safety. 
For each aviator there is an altitude beyond which he can not go 
without compelling his nervous system and muscles to work at great 
disadvantage because of insufficient oxygen. It will be then, that 
impairmant of vision, hearing, intellect, judgment, and difficulty in 
concentrating the attention will be experienced. If he is flying with 
a squadron in a formation he will begin to lag behind and by so much 
reduce the general level of efficiency of his group. 
Flying at altitudes higher than those to which the body easily adapts 
itself entails a serious strain, probably on the central nervous system, 
which will eventually hasten the onset of flying staleness. Flying 
fatigue is by no means thoroughly understood, but unless proper care 
is taken it is accumulative and soon spells staleness. The effects are 
more marked in some individuals than in others. 
Our altitude classification examination was developed for the pur- 
pose of determining the aviator’s power to respond to the influence 
of altitude and to classify him as fitted for particular levels of flying. 
Several respiratory tests have been developed for the purpose of 
determining the ability to react to the diminished oxygen of high 64 
AVIATION MEDICINE IN THE A. E. F. 
altitudes. Best known are the rebreathing method, Flack’s bag 
method, Dreyer’s nitrogen dilution method, and Bazett’s extra re- 
serve factor. The value of the low pressure or pneumatic chamber 
for this purpose has been recognized for some time. Certain other 
Fig. I.—Low pressure tank, Medical Research Laboratory, at the Third A. I. C., A. E. F. 
“short-cut” methods have been suggested and will be discussed, 
along with Bazett’s extra reserve factor, at another place in this chap- 
ter. Corbett and Bazett tried out, but did not find practicable, a 
method of breathing through a long tube to increase the dead space. AVIATION MEDICINE IN THE A. E. F. 
65 
We have given each method, except the last mentioned, a trial and 
have come to a definite opinion as to the value of each. The Flack 
bag method subjects the candidate to oxygen want for too short a 
period of time and does not permit of observation on the sequence of 
the adaptive responses. The Dreyer method proved to be very satis- 
factory, but the apparatus was a constant source oh annoyance, 
requiring frequent recalibration and checking up of the oxygen- 
nitrogen mixture. We have found commercial nitrogen to vary so 
much in composition that each tank used required chemical analyses 
for oxygen. This necessitated laborious calculations for corrections 
that were necessary for proper interpretation of data. 
The low chamber method permits of exactness of control and elimi- 
nation of complicating factors. It is an expensive method that lends 
itself well to exact scientific study but not to routine observation. 
The rebreathing method is not idnal but gives conditions of work j 
that are easily controlled and modified. The Henderson rebreathing 
apparatus is sturdy, control and adjusting devices are simple, and 
repairs are easily made. 
Fig. II.—Rebreuthing test of aviators at the Second A. I. C., A. E. F. 
The rebreathing apparatus employed in all our routine tests of the 
aviator’s ability to withstand low oxygen, is known as the Henderson- 
Pierce rebreathing machine. It consists of a tank T (Figure III) of 
THE REBREATHING APPARATUS. 
171364—20—-5 66 
AVIATION MEDICINE IN THE A. E. F. 
about 80 liters capacity. The volume of air used is determined by 
the amount of water run into it. The man under examination con- 
tinually rebreathes the air of the tank through the inspiratory and 
Fig. III.—The rebreathing apparatus employed In all routine tests of the aviator’s ability to withstand 
low oxygen. It consists of a tank, T, of about 120 liters capacity. The volume of air is determined by 
the amount of water that is run into it. The man under examination continually rebreaths the air of the 
tank (a clip is placed on his nose) through the inspiratory and expiratory valves, Vi and Ve. The 
oxygen is thus consumed and reduced. The exhaled carbon dioxid is taken up by sodium hydroxid 
in the absorber, A. The movements of respiration are recorded by the spirometer, S, connected to a 
smoked drum, K. As the oxygen is consumed and the air volume is thus reduced, the spirometer falls 
and the graphic record on the smoked drum rises. At the end of the test a sample of air is drawn from 
the tank and analyzed as a confirmation of the oxygen consumption and of the oxygen percentages 
(that is, altitudes) indicated by the graphic record. 
expiratory valves, Vi and Ve. The exhaled carbon dioxide is taken 
up in the absorber A by solid caustic soda cast in thin shells so as to 
expose a large surface to the action of the air. In order to maintain AVIATION MEDICINE IN THE A. E. F. 
67 
the contained air at approximately atmospheric pressure and to allow 
for changes in volume, a wet spirometer, S, carefully counterbalanced 
is mounted on the tank and communicates freely with its interior 
through a vertical pipe. A stylus attached to the counterweight 
records the movements of the spirometer, which are those of respira- 
tion, upon a smoked drum K. At the end of the test a sample of air 
is drawn from the tank and analyzed to determine the oxygen per- 
centage reached, which can be translated roughly into terms of alti- 
tude. 
Because of a shortage of water at the Third Aviation Instruction 
Center in France the rebreathing machine was slightly modified. In 
order to renew the air in the apparatus an electric fan, obtained from 
a vacuum cleaner outfit, was attached by a T tube to the expiratory 
pipe, Ve, and was used to aspirate the air from the machine. A per- 
fect renewal with fresh air could be obtained in two or three minutes. 
Water, to supply the volume lost by the absorption of oxygen during 
rebreathing, was run into the tank when needed, from a reservoir 
suspended from the ceiling and connected to the tank by rubber hose. 
At the close of each test the surplus water was again drained into the 
reservoir. 
THE CLASSIFICATION EXAMINATION. 
The rebreathing machine was so adjusted that the average test was 
between 25 and 30 minutes in duration. During the test physio- 
logical and psychological observations were made and the condition 
of the aviator closely watched by a clinician. By the physiologist 
the rate and per minute volume of respiration, pulse frequency, and 
systolic and diastolic pressures were observed for each subject. 
These data gave valuable evidence as to when the subject first re- 
sponded to the reduction in oxygen, and as to the efficacy of his 
adaptive responses. 
The psychological tests determined the effects on attention and 
motor coordination, and showed how well the subject preserved his 
efficiency under low oxygen. 
The methods and the interpretations of the data of the rebreathing 
test are given in detail in the Manual of the Medical Research Labora- 
tory. Experience in the States showed clearly that some men are 
so sensitive to oxygen want and compensate so well in their breathing 
and the circulation of the blood that they endure to as low as 6 per 
cent of oxygen. On the other hand others fail to compensate in one 
or both of these functions or compensate inadequately, and therefore 
do not endure so low an oxygen. All gradations between failure to 
compensate and adequate compensations down to 6 per cent of 
oxygen were found among aviators examined under the low oxygen 
of the rebreathing test. From the data obtained during the rebreath- 68 
AVIATION MEDICINE IN THE A. E. F. 
ing test it becomes possible to determine approximately the maximum 
altitude to which an aviator may safely ascend. 
In order that our study of A. E. F. cases may be more clearly fol- 
lowed, a statement of our early experiences with the rebreathing test 
is given. 
THE BREATHING WHEN UNDER PROGRESSIVE DECREASE OF OXYGEN. 
The rate of breathing often remains constant throughout the re- 
breathing test. The majority, however, show an increase of from 
two to four breaths per minute at between 8 and 6 per cent of oxygen. 
Poor types may show a decided increase in frequency. 
An increase in the per minute volume of breathing occurs in all 
who respond well to decreased oxygen. At percentages of oxygen 
between 8 and 6 an increase of 5.5 liters and more may be expected in 
an excellent response. A respiratory volume response of 1.5 liters 
gives an insufficient lung ventilation for comfortable toleration of 
such low oxygen as 8 per cent. 
It is the depth of breathing that ordinarily is increased by low 
oxygen. This increase in the tidal air may amount to from 20 to 
128 per cent when the subject is under from 8.5 to 6 per cent of oxygen. 
A good respiratory reaction to the gradual decrease in the oxygen 
of a rebreathing test is manifest in a slight increase in the depth of 
breathing which begins at 16 or 15 per cent of oxygen and continues 
progressively to increase until 12.5 or 9 per cent of oxygen is reached. 
From these percentages down to 8.5 and 6 per cent of oxygen, the 
total volume of breathing per minute increases much more rapidly; 
and the frequency may also increase from two to five breaths per 
minute. A total per minute increase in lung ventilation of at least 
5.5 liters should occur at the lower percentages of oxygen. 
THE HEART RATE UNDER DECREASING OXYGEN SUPPLY. 
At high altitudes, or under low oxygen, the blood may be less 
saturated with oxygen than at low altitudes. If, therefore, when the 
blood contains less oxygen the rate of blood flow through the capil- 
laries is increased, this would be a means of providing the tissues 
with the oxygen demanded for their activity. Such an increase in 
the flow of the blood stream can be obtained by increasing the per 
minute output of blood by the heart. This the heart ordinarily 
does by increasing the number of beats per minute. 
In' the rebreathing test there usually occurs an increase in the 
frequency of the heart beat. This is at first slight, but as the oxygen 
percentage decreases a greater increase in rate is likely to occur with 
each further decrement in oxygen. A very marked acceleration 
usually occurs when the oxygen has fallen to between 13 and 9 per 
cent. A total increase of from 15 to 40 and more beats in the heart 69 
AVIATION MEDICINE IN THE A. E. F. 
rate, during a rebreathing test in which the oxygen is lowered in 
half an hour to between 7.5 and 6d> per cent, constitutes a good 
reaction to oxygen want. A failure to respond by an acceleration 
of the heart rate to lowered oxygen means either inability to react 
to the low oxygen of high altitudes and early failure or that sufficient 
compensation is secured by the breathing and blood responses. 
Our experience indicates that failure to respond by an increase in 
heart rate is usually associated with poor toleration of low oxygen. 
THE ARTERIAL PRESSURES UNDER DECREASING OXYGEN. 
In the optimum type of response the systolic pressure remains 
unchanged until the oxygen has been lowered to between 14 and 9 
per cent, after which, as the oxygen is further lowered, it gradually 
rises, ordinarily not more than 30 mm. Hg. 
The best condition in the response of the diastolic pressure to a 
decreasing oxygen supply consists in an unchanged or slightly 
increased pressure throughout the test. Many men show a gradual, 
well controlled fall in the diastolic pressure during the terminal 
period when the systolic pressure is rising. A pronounced and rapid 
fall often occurs and is evidence of oncoming failure. 
Three types of circulatory reactions to a gradually increasing 
oxygen want have been observed. The first, the optimum, in which 
the pulse rate accelerates, the systolic pressure remains unchanged or 
shows a terminal rise, and the diastolic pressure remains unchanged 
or rises slightly. The second, the controlled diastolic fall, in which 
the pulse rate accelerates and the systolic pressure rises as the diastolic 
pressure gradually falls. The third, the syncope or fainting type, in 
which after a period of poor, fair or excellent response to moderate 
decrease in oxygen, the diastolic pressure suddenly begins to show a 
marked and rapid fall, and soon thereafter the systolic pressure may 
also fall and the pulse rate slow. 
Having a knowledge of what constitutes excellent, fair or 
poor response to low oxygen, it becomes possible to classify men ac- 
cording to their physiologic responses. 
In the A. E. F. the men were divided into Classes I, II, and III. 
The subject was rated I if his compensations in breathing and circu- 
lation were good and progressive to between 8 and 6 per cent of 
oxygen. He was rated II if the compensatory mechanisms showed 
decided insufficiency or failure between 10 and 8 per cent, and III 
if the failure occurred above 10 per cent of oxygen. 
No limitations were suggested as to altitudes to which men of 
Class I should fly. It was deemed best to make the maximum flying 
altitude for Class II 15,000 feet and to confine the work for Class III 
to low altitudes, not above 8,000 or 10,000 feet. A few who for one 
reason or another might not fly at all were placed in Class IV. 70 
AVIATION MEDICINE IN THE A. E. F. 
THE A. E. F. EXAMINATIONS. 
The number of altitude classification examinations made in the 
A. E. F. was small, because at first we were compelled to work in a 
cold room. The subject of necessity had to sit with the shirt open 
so that the clinician could use the stethoscope to listen to the heart, 
and the arm had to be bare for blood-pressure determination. We 
felt such exposure to cold was unfair to the men and so only made an 
occasional test until we had moved into the laboratory. 
A total of 290 men were given the rebreathing examination; among 
these, pilots from the front, 90; observers from the front, 92; moni- 
tors, 52; French aviators, 12; and officers referred by instructor 
and flight surgeon, 44. 
An analysis has been made of the results of 290 cases in which the 
ratings of the physiologist and psychologist have been compared 
with the final rating. The results are given in the table below: 
Class. 
Physiological. 
' Psychological. 
Pinal. 
Number. 
Percent. 
Number. 
Per cent. 
Number. 
Percent. 
I 
153 
52.8 
153 
52.8 
125 
43.1 
II 
92 
31.7 
79 
27.2 
100 
34.5 
Ill 
33 
11.4 
52 
17.9 
56 
19.3 
IV 
3 
1.0 
0 
0.0 
5 
1.7 
Not rated 
9 
3.1 
6 
2.1 
4 
1.4 
Table I. 
The final ratings are in about the same percentages as were those 
of an analysis of 374 examinations made at the Mineola Laboratory. 
In that group there were the following percentages: Class I, 40.5; 
Class II, 34.6; Class III, 20.3; and Class IV, 4.8. 
In Table I the “not rafed” group contained two men who refused 
to continue when about halfway through the test, and for two more 
men the test was unfair because the carbon-dioxide absorber was 
not working properly. There were five men not rated by the physi- 
ologist because at the time they were found inefficient by the psy- 
chologist the physiologic responses were still doing well. The 
psychologist likewise withheld several ratings because the subject 
was removed for physiologic reasons, such as oncoming syncope. 
Five of the cases were rated IV and disqualified for flying by the 
clinician for heart abnormalities. 
The physiological and psychological ratings were not in as com- 
plete agreement as the data in Table I indicates. They agreed that 
126 were Class I, 45 Class II, and 24 Class III. The final rating was 
always that of the lowest rating given by any one of the three depart- 
ments, clinical, physiological, and psychological. 71 
AVIATION MEDICINE IN THE A. E. E. 
. A detailed physiologic study of the types of reaction to low oxygen 
encountered among these 290 men, would be out of place here. An 
analysis of the records of the men from the Front supplied the details 
here given. 
Respiration responses. 
Class I. 
Class IT. 
Liters. 
4.8 
Liters. 
3.4 
19.8 
8.9 
.5 
.1 
15.5 
12.3 
27.8 
19.0 
8.4 
6.6 
1.1 
.8 
2.4 
1.4 
.5 
.4 
The striking feature is that the tidal air—that is, volume of a single 
breath—in the men who reacted well was decidedly increased, from an 
average of 480 c. c. to 1,100 c. c. in men in Class I. Shallow breathing 
does not ventilate the lungs well because of the dead space. With 
deeper breathing a greater proportion of fresh air reaches the alveoli 
of the lungs and therefore a larger supply of oxygen reaches the 
blood. 
Only about 26 per cent of the cases showed an increase in the rate 
of breathing, while about 50 per cent breathed less frequently. Those 
who did not change the rate or decreased it obtained the larger tidal 
volume. 
The observations that aviators who have experienced dyspnoea at 
high altitudes have been able to overcome it by educating themselves 
to breath more deeply and slowly, is explained by our data. The 
habit of slow and deep breathing constitutes a valuable asset for high 
altitude flying. 
There were no cases of very shallow breathers among our subjects. 
The greatest frequency of breathing observed was 24 breaths per 
minute. This man’s compensation to low oxygen was made by a 
decrease in rate and an increase in the volume of tidal air. 
Not a man declared by the clinicians to be normal failed to show 
the increase in the per minute volume of breathing. Three who failed 
to have an increase in the depth of breathing and only increased the 
rate by one or two breaths became inefficient so early that they were 
rated in Classes II and III by the psychologist. 
The pulse rate responses were as follows: 
Class I: Beats. 
Average increase 37 
Greatest increase 77 
Smallest increase 6 72 
AVIATION MEDICINE IN THE A. E. F. 
Class II: Beats. 
Average increase 33 
Greatest increase _ 54 
Smallest increase 9 
Class III: 
Average increase .. 32 
Greatest increase 41 
Smallest increase 22 
During our early experience with the rebreathing test we were 
disposed to consider an acceleration of more than 50 beats as a sign 
of poor toleration of low oxygen. Some of the above men with effi- 
ciency well maintained down to 6.5, or even 6 per cent of oxygen, 
showed an early acceleration and a steady rapid rise to the end. 
Experience has shown that it is impossible to predict how well a 
subject will do by noting the time the pulse begins to respond and 
the degree of its response. As noted above, Class I compensations 
were made by as great an acceleration as 77 beats and as few as 6 
beats. Efficiency under low oxygen depends upon an adequate 
supply of oxygen for the tissues, more especially for the nervous 
tissue. The burden of providing this oxygen supply is divided 
between the respiration, circulation, and the blood. In some men 
the burden falls heaviest on the circulatory mechanism and in others 
on the respiratory. The interplay of these mechanisms varies with 
the individual, so we are now of the opinion that a high pulse rate 
acceleration is not in itself a bad sign. 
The blood pressures grouped themselves according to the types of 
our earlier experiences. About 80 per cent of the men in Class II and 
III gave the fainting type of reaction. Corbett and Bazett believe 
that individuals whose diastolic pressures are normally below 60 mm. 
Hg are incapable of standing high altitudes. The majority of all 
men examined-by us who had a diastolic pressure below 60 did poorly 
under the low oxygen test. There were, however, three with dias- 
tolic pressures of 54, 58, and 58 who made excellent compensations 
and maintained efficiency down to 8, 7, and 6 per cent of oxygen. 
There has been a disposition to look upon a normal systolic pressure 
of 130 mm. Hg. or more in young men as a contraindication for flying- 
Among the 47 men from the front who made the Class I rating 13 
had a normal systolic of from 130 to 158 mm. These men not only 
reacted very well to low oxygen but also passed without adverse 
comment through the hands of the clinicians. 
THE REBREATHING EXAMINATION AS A TEST FOR “STALENESS.” 
There have been many incidents observed during the training of 
cadets and among fliers at the Front, that have suggested that aviators 
who have “gone stale” are very sensitive to low oxygen and par- 
ticularly liable to syncope when in the air. In the laboratory we AVIATION MEDICINE IN THE A. E. F. 
73 
have seen men with temporary indispositions, such as may follow a 
bad cold, recent illness, lack of sleep, alcoholic excess, etc., do poorly 
in the rebreathing examination who at some other time when feeling 
fit had compensated very well. 
In view of these observations a study of two groups of men may be 
emphasized. There were 22 aviators (see Table IV) among the men 
returning from the front who were considered by the several medica 
departments of the laboratory as temporarily unfit for flying. In the 
altitude classification examination there were rated Class I, 12; Class 
II, 7; and Class III, 2, and not rated, 1. There was also another group 
(see Table V) of 22 aviators who claimed to feel “ tired” and “stale7' 
but with whom the clinician found nothing wrong. In the low oxygen 
test they were rated as follows: Class I, 9; Class II, 10; and Class III, 
3. From these observations it appears that men may be physically 
below par and feel tired and yet react very well to the action of low 
oxygen, as judged by their physiologic and psychologic responses and 
efficiency. 
Among 46 men who were rated low in the cardio-vascular efficiency 
tests for fatigue and staleness, there were 23, or 50 per cent, rated 
Class I in their response to the low oxygen rebreathing test. 
The explanation of the occasional poor showing made by men who 
normally react well to the action of low oxygen, is not yet at hand. 
The war has focussed attention on “ staleness,” “effore syndrome,” 
and “neurosis” with the result that we now realize that there are 
many conditions included under each and that there are many over- 
laps. An analysis and reclassification of our knowledge of these ab- 
normalities are needed in order that the specific problems may be 
then investigated. 
The rebreathing low oxygen test was perfected to determine the 
ability of the human organism to respond to the decreasing oxygen 
tension of high altitudes. It has been shown that normal men react 
to deficiency of oxygen, and that all do not have the same power of 
adjustment. 
There is a remarkable variation among individuals in their capac- 
ity to withstand lack of oxygen. Some compensate well, others in- 
adequately, and others not at all. The test should be employed for 
searching out those unfit for flying by reason of inability to respond 
to altitude, and for approximating the altitudes safely tolerated. 
Physical fitness it appears must be measured by other tests. Alti- 
tude fitness can, we believe, be measured by the rebreathing test. 
For the present, at least, we believe emphasis should not bo given to 
the test as an aid in searching out staleness. 
The rebreathing altitude classification examination has shown that 
some aviators react so well to the action of low oxygen tensions that 74 
AVIATION MEDICINE IN THE A. E. F. 
they would have almost a complete immunity from discomfort at 
altitudes of 18,000 and even 20,000 feet. 
The examinations made in the A. E. F. seem to indicate that the 
proportion of Class I, II, and III men remains fairly constant, even 
during flying under the stress of combat service. 
Section II. 
EFFICIENCY TESTS. 
In discussing the available efficiency tests the writer has no desire 
to advocate one particular test or group of tests. The purpose of our 
study has been to give each a fair trial in order to fix upon those tests 
that most definitely and regularly indicate fatigue and the degree of 
physical fitness or unfitness. The value of some reliable test, easy of 
application, is well recognized by all who have watched the aviator 
from day to day and witnessed accidents that were the result of wear 
and tear that had gradually reduced the flier’s physical fitness and 
thereby his flying ability. 
It is certain that an aviator’s disinclination to fly must have its 
basis upon some temporary defect of body or mind. Men often re- 
main silent and do not confess their disinclination to fly fearing that 
they will be accused of having “cold feet.” Tests that reveal such 
defects, and do so without a questioning of the patient, and that can 
not be doubted because of opportunity for “faking” by the patient, 
are needed by the flight surgeon and others having to do with the 
physical welfare of the aviator. 
It is our purpose, therefore, to ask the plain question regarding 
each test used: Does it or has it seemed to indicate the physical state 
of the man tested ? If the advocated tests fail to give the evidence 
desired this should be known so that search for a reliable test may be 
continued until the needed method is found. 
Some simple test should be devised by which the incipient stages of 
accumulating fatigue may be detected. 
ENGLISH TESTS. 
In England, under the guidance of Lieut. Col. Martin Flack, a set of 
simple physiologic tests were devised to indicate subjects who were 
likely to suffer from discomforts in the air, such as headache, giddi- 
ness, fainting, dizziness, nausea, vomiting, pressure in the head, blood 
rushing to the temples, palpitation of the heart, etc.—symptoms which 
might be due to lack of proper oxygenation of the blood and likely to 
render the man unfit for flying. 
The tests grow in number with experience and the application of 
them was extended to detect flying stress or fatigue. More recently 
Flack has stated that he believes them to be of use in determining the 
physical efficiency of an individual. He emphasizes that these tests AVIATION MEDICINE IN THE A. E. F. 
75 
are not designed to supplant the work of the clinician in any way and 
when a man is reported as physically unfit on these tests it does not 
mean that the work of the physician is finished but that it is begin- 
ning. If the subject does not come up to standards then the psy- 
chologist, neurologist, cardiologist, or general physician will find 
something is wrong with him. The tests, it is believed, give indica- 
tions for such overhaul. 
In a complete physiological examination seven distinct sets of ob- 
servations are made upon the pilot. These include (1) the response 
of the pulse to a standard exercise, (2) time the breath is held in sec- 
onds after a full expiration and full inspiration, (3) a combination of 
1 and 2 after the standard exercise, (4) vital capacity, (5) extra re- 
spiratory reserve as represented by the factor respiration rate multi- 
plied by ventilation per minute divided by the vital capacity, (6) 
expiratory force, and (7) the fatigue test. The value of the tests 
depends on all being carried out in the same way on all occasions. 
The technique as adopted is as follows: 
(1) The response of the pulse to exercise. The subject standing 
before a chair places one foot upon the seat of the chair and steadily 
raises his whole body to the height of the seat five times in 15 seconds, 
one foot being retained on the chair throughout. With the subject 
still standing, the examiner continues to count the pulse in five- 
second intervals, and notes the acceleration and the time taken to 
return to the previous rate. 
(2) In holding the breath the subject in a sitting position is in- 
structed to expire once as deeply as possible, and then inspire fully 
and hold the breath as long as possible with the nose clipped or held. 
He may allow some air to escape if the breath has been too full but 
care must he taken that none is taken in. The subject is watched 
and the degree of suffusion of the face, etc., noted. The reason for 
giving up should be carefully noted and any abnormal answer 
recorded. 
(3) The third is a combination of the first two tests. Having the 
pulse response and breath holding, then the time the breath can be 
held after the standard exercise is taken. 
(4) In measuring the vital capacity the subject is asked to fill his 
chest and blow hard through a meter, taking precautions against 
overblowing the meter. The type of meter is important, its capacity 
should be such that it can not easily be overshot. Note should be 
made as to whether the subject experiences difficulty in blowing, 
suffusion of the face, and breathlessness. In routine work two or 
three determinations should be made. 
(5) The extra respiratory reserve factor has been secured from the 
respiration data taken with the subject wearing a nose clip while 
breathing through a system of inspiratory and expiratory valves 76 
AVIATION MEDICINE IN THE A. E. F. 
connected with a meter or spirometer, the rate and volume per min- 
ute being recorded. 
(6) For the determination of the expiratory force a U-tube ma- 
nometer filled with mercury, with an adjustable millimeter scale, is 
used. The subject is asked to blow up the column steadily as high 
as possible and not to swing it up by the momentum of the mercury. 
In case it is suspected that the subject is not doing his best the scale 
of the manometer is turned away and he is asked to repeat. The 
two determinations will not agree if he has not been trying. In the 
test the blowing power of the cheeks may be ruled out by holding 
the cheeks with a hand. Generally the cheeks make little or no 
difference in the reading. 
(7) The fatigue test is another with the U-tube manometer. The 
subject is asked to empty the lungs, take a deep breath, blow the 
mercury to the height of 40 mm. and hold it there without breathing 
for as long as possible. The nose should be clipped. During the 
test the pulse is counted each interval of five seconds that the mer- 
cury is sustained and for the period until it returns to normal after 
the subject stops blowing. The normal pulse rate should be deter- 
mined in five second intervals immediately before the test is made. 
The interpretations given of the data obtained from the above 
tests may be summarized as follows: 
(1) In a good subject the increase in the pulse rate after exercise 
is about 20, and the time of return to normal 15 to 25 seconds. “A 
pulse of 60 to 72 little raised by exercise (10 beats per minute), 
returning to normal in 10 seconds, is in our opinion a good sign, 
generally associated with excellent physique and good stability of 
the nervous system.” It is also maintained that an increased rate 
of over 25 and a return period of over 30 seconds are points calling 
for careful consideration of the subject’s cardio-vascular system. 
(2) The breath holding test was designed to show whether there 
was “oxygen want” and thereby whether the individual was likely 
to do well at high altitudes. It has been maintained that all candi- 
dates for aviation should be able to hold the breath a minimum, in 
three times, of 45 seconds. They found that good pilots manage 
60 seconds or more. If dizziness, blurred vision, etc., occur under 40 
seconds the candidate is rejected. 
The test also was shown to have other significance. “The man 
without resolution, for example, will give up early.” 
(3) The application of the test of holding the breath after regu- 
lated exercise has been used to give information of “oxygen want” 
or lack of tone in doubtful cases. Candidates who can not hold the 
breath 20 seconds after graduated exercise should be rejected and 
those who can not hold 30 seconds be held for further study and ob- 
servation. In the unfit the breath holding power comes down after AVIATION MEDICINE IN THE A. E. F. 
exercise while the fit man may possibly hold his breath as long as 
before. Good pilots after exercise hold at least 40 seconds, generally 
between 50 and 60 seconds. 
(4) A minimum vital capacity of 3,000 c. c. has been fixed by the 
commissions board of England. The standard appears to take no 
account of the size of the individual. It is maintained that for high 
flying no one with a capacity below 3,400 c. c. be accepted unless 
he can hold his breath for more than 45 seconds. 
(5) Bazett suggests that men with a large vital capacity, a low 
consumption of air per minute and a slow respiratory rate tolerate 
high altitudes better than others. The advantage is called extra 
reserve and is roughly measured by a factor— 
respiration rate X ventilation per minute 
vital capacity 
A low figure, it is believed, indicates a good type. A figure of 30 has 
been taken as' the standard, those above this being relatively bad. 
The average figure for the good type is 24.1, for the bad 46.3, and for 
the uncertain 36.8. 
(6) Tests 6 and 7 are believed to be valuable in “assessing” flying 
stress and also in determining the fitness of candidates for flying. 
The expiratory force test (6) is also thought to be a measure of the 
tone of the abdominal wall. The average normal is about 105 mm. 
Hg. It has been found that pilots suffering from flying stress can 
often only blow 40 mm. Hg. If the test is about 80 the pilot is con- 
sidered only suitable for low flying and if much below is probably in 
need of a rest from flying altogether. 
(7) Regarding the significance of the “fatigue test” it has been 
pointed out that it appeals to the sporting spirit, and the individual 
endowed with this is likely to do better than the one who is not. 
Determination is undoubtedly an important factor, so the test is in 
some respects a psychological one. According to one hypothesis the 
test is an indication of the tone of the respiratory center. The aver- 
age normal time of many cases is 50 seconds. Below 40 seconds is 
considered unsatisfactory and indicates that probably the subject is 
fit only for limited flying or is in need of rest. Pilots broken down 
from stress of service had an average of about 25 seconds. 
It is believed that the counting of the pulse during the period when 
the 40 mm. Hg. is sustained affords valuable indication of the degree 
of stability of the cardiomotor center. “Generally speaking, it may 
be stated that, starting at the fifth second, there is in the normal 
individual a steady rise in the rate of the pulse, or a fairly marked 
rise, which is sustained most of the time.” “A large rise in rate, 
for example from 72 to 132 or 144, is, generally speaking, unsatis- 
factory.” In case of flying stress with cardiovascular symptoms the 78 
AVIATION MEDICINE IN THE A. E. F. 
characteristic response seems to be for the pulse to rise quickly dur- 
ing the fifth to the tenth or fifteenth second, and then to fall to normal 
or even considerably below normal. 
It should be here emphasized that the claim is not made that each 
test is capable of rigid application. It is the combination of the 
tests that is important. 
The fact that the first indications of “fatigue” are associated with the loss of power 
to sustain 40 mm. Hg., and also frequently with a diminished capacity to hold the 
breath, suggests the tentative explanation that the first stage in the onset of flying 
fatigue is due in many cases to an altered tone of the respiratory center. This leads 
later to a diminution of the vital capacity, supplemental air, and loss of expiratory 
force. Defective respiratory ventilation then brings about lessened oxygenation of 
the body, which reacts upon other systems, particularly upon the circulatory and 
nervous systems. 
APPLICATION OF THE TESTS IN THE A. E. F. 
Normal standards have been determined in England by the ex- 
amination of healthy pilots. In Table II we have compared these 
with averages obtained in the A. E. F. for three groups of fliers: 
United States aviators returned from the front after the signing of 
the armistice, monitors from the Third Aviation Instruction Center, 
and a small group of French aviators. 
Table II—Group averages. 
Group. 
Vital 
capacity 
in c. c.. 
Time 
breath 
held in 
seconds. 
Expira- 
tory 
force in 
mm. Hg. 
Time in 
seconds 
holding 
42 mm. 
Hg. by 
blowing. 
119 U. S. aviators from the front 
4,390 
71 
123 
51 
50 Third A. I. C. monitors 
4,213 
60 
113 
48 
12 French fliers 
4,000 
72 
126 
50 
Average obtained bv English 
3,800 
66 
110 
52 
22 fit R. A. F. squadron officers and commanders 
4,062 
67 
112 
52 
24 fit pilots of R. A. F. home defense 
3,940 
72 
119 
50 
23 R. A. F. cadets at random 
3,823 
69 
106 
51 
It will be seen that the vital capacities and the respiratory force 
averages for our three groups are above the standards, while in the 
power to hold the breath the monitors fall below the standard, and in 
the “fatigue” test the three groups are slightly below standard. 
That the monitors, in ability to hold the breath and to sustain the 
column of mercury in the “fatigue” test, fall below the usual standard 
of the fit aviator is shown by the averages given for R. A. F. squadron 
officers, home defense pilots, and cadets. 
For the purpose of obtaining an understanding of the distribution 
of a typical group of young men in these respiratory tests, the three 
groups were placed together and redivided to show the normal varia- 
tions. They distribute themselves as follows: AVIATION MEDICINE IN THE A. E. F. 
79 
Breath holding. 
Seconds. 
Number 
of cases. 
Percent- 
age. 
Seconds. 
Number 
of cases. 
Percent- 
age. 
20 to 29 
1 
0.6 
90 to 99 
18 
9.9 
30 to 39 
13 
7.1 
100 to 109 
5 
2.7 
40 to 49 
18 
9.9 
110 to 119 
1 
.6 
50 to 59 
26 
14.3 
120 to 129 
6 
3.3 
fiO to 
41 
22 n 
70 to 79 
32 
17.6 
182 
100.0 
80 to 89 
21 
11.5 
Highest 
128 
Lowest 
do— 
29 
45 seconds or less 
Vital capacity. 
Cubic centimeters. 
Number 
of cases. 
Percent- 
age. 
Cubic centimeters. 
Number 
of cases. 
Percent- 
age. 
2 800 to 3,499 
15 
58 
57 
39 
17 
7.8 
30.0 
29.8 
20.4 
8.9 
5,500 to 5,999 
2 
3 
191 
1.1 
1.6 
100.0 
3,500 to 3,999 
to 
4,000 to <499 
4,500 to 4,999 
Total 
5,000 to 5,499 
Greatest vital capacity c. c... 6,620 
Smallest vital capacity ..c. c.. 2,800 
Below 3,400 c. c 13 or 6.8 per cent. 
Expiratory force. 
Millimeter. 
Number 
of cases. 
Percent- 
age. 
Millimeter. 
Number 
of cases. 
Percent- 
age. 
60 to 69 
2 
1.1 
150 to 159 
4 
2.7 
70 to 79 
6 
3.4 
160 to 169 
10 
5.6 
80 to 89 
20 
11.2 1 
170 to 179 
7 
3.9 
90 to 99 
25 
14.1 | 
180 to 189 
9 
100 to 109 
17 
9.5 
190 to 199 
1 
.5 
110 to 119 
28 
15.7 
200 to 209 
1 
.5 
18 
19 
10.0 1 
10.6 1 
130 to 139 
178 
100.0 
140 to 149 
11 
6.2 i 
II 
Highest 
Lowest 
80 mm. or less 
Fatigue test. 
Seconds. 
Number 
of cases. 
Percent- 
age. 
Seconds. 
Number 
of cases. 
Percent- 
age. 
10 to 19 
1 
11 
26 
49 
48 
21 
0.6 
6.2 
14.8 
27.8 
27.3 
11.9 
70 to 79 
14 
4 
1 
1 
7.9 
2.3 
.6 
.6 
20 to 29. 
80 to 89 
30 to 39. 
90 to 99 
100 to 109 
60 to 69. . 
176 
100.0 
Highest.....*. 
103 
Lowest 
.seconds. 
15 
40 seconds or less 
42 or 23.8 per cent. 
Among the 190 men under consideration the individual differences 
range in vital capacity from 2,800 to 6,620 c. c.; in ability to hold 
the breath from 29 to 128 seconds; in expiratory force, or power to 
blow up a column of mercury, from 62 to 208 mm.; in ability to sus- 
tain a column of mercury at 40 mm. during breath holding from 15 
to 103 seconds. 80 
AVIATION MEDICINE IN THE A. E. F. 
The Minimum for Normal. 
From a study of men who failed in aviation in England a minimum 
for normal has been established. This was found to be for vital 
capacity 3,400 c.c., for the ability to hold the breath 45 seconds, for 
the power of expiratory force 80 mm. Hg and for the endurance of 
the “fatigue” test 40 seponds. 
Among the American fliers that were under observation 13 or 6.8 
per cent had a vital capacity less than 3,400 c.c., 18 or 9 per cent 
could not hold the breath 45 seconds, 7 or 3.8 per cent could not blow 
(respiratory force) the mercury column above 80 mm., and 38 or 
21.6 per cent failed to sustain the mercury column at 40 mm. for 40 
seconds. 
Among the 190 fliers examined there were 54 or 28.4 per cent 
who fell below standard in one or more of the tests. Of these 35 or 
18.4 per cent were below in only one, 15 or 7.9 per cent were below 
in two, and 4 or 2.1 per cent in three of the tests. Not a man fell 
below the minimum standard in all of the tests. 
All of the meri were examined by the internist, neurologist, oph- 
thalmologist, and ear, nose, and throat expert. Of the 35 below the 
minimum standard in only one test, eight, or about 23 per cent, 
were found by the medical experts to have something wrong. The 
ailments included two with tonsil and nasal infections, two were 
neurological cases, one had extrinsic ocular muscle weakness, and 
three were described by the internist as stale but no definite findings 
were recorded. 
Among the 15 aviators below the minimum normal, in two of the 
tests only three, or 20 per cent, showed abnormalities; two had 
infected tonsils and one sinusitis. Of the four who were below in 
three tests one was passed as fit, by all, the second had chronic infec- 
tion of the tonsils, and the other two were classed as stale, by the 
internist and neurologist. A total of 14, or 26 per cent, of the 54 
aviators who were below normal in one or more of the English tests 
had ailments that were discovered in the medical overhaul. 
THE RELATION OF THE ABILITY TO HOLD THE BREATH AND THE 
ENDURANCE OF LOW OXYGEN. 
THE RELATION OF THE ABILITY TO HOLD THE BREATH AND THE 
If the time the breath can be held should prove to be an index of a 
subject’s power to respond to low oxygen it would provide a simple 
means of classifying aviators for altitude flying. 
Flack has stated his opinion of the breath-holding test as follows: 
“The test was originally designed to show whether there was ‘oxy- 
gen want/ and I still believe the test does show the subject who 
would suffer from ‘oxygen want.’ From my experience I found 
that people who were likely to suffer from ‘oxygen want’ would 
give up after a very short time in holding the breath and would 
almost invariably return an abnormal answer. A normal answer 
would be that the subject ‘had to give up/ ‘felt he would burst/ 81 
AVIATION MEDICINE IN THE A. E. E. 
an abnormal answer that the ‘blood rushed to his head/ ‘things 
became blurred/ etc. The deduction then is that the breath- 
holding test on an individual would be an idea as to whether he was 
likely to do well in the air. As the results appeared to show that 
poor breath holding could not last in the air, the breath-holding test 
was adopted at the Royal Air Force Commissions Board. In my 
opinion it is preventing people going into the air force who would 
not do well.” 
in the United States Manual of the Medical Research Laboratory 
from an analysis of 50 cases the following conclusion was drawn: 
‘ ‘ The length of time the breath was held did not give an indication 
of how low in oxygen the subject would go on the rebreathing 
apparatus. Fin. and Be., who fainted at 9.8 per cent (20,000 feet) 
and 9.2 per cent (21,800 feet), respectively, held the breath longer 
than the average. An., who managed only 40 seconds, withstood 6.8 
per cent oxygen (28,400 feet), and W., who held only 29 seconds, 
endured low oxygen down to 7.5 per cent (26,000 feet!.” 
There are 143 cases, among the aviators examined in the A. E. F., 
in which the data are satisfactory for a comparison of breath holding 
and the reaction to the low oxygen of the rebreathing test. Ten of 
these men were able to hold the breath only 45 seconds or less. From 
their responses to the low oxygen they were classified as follows: 
Number of cases in Class 1 6 
Number of cases in Class II 3 
Number of cases in Class III 1 
There is no limit placed on the altitudes for Class I; the second 
group, Class II, should not fly above 15,000 feet; and Class III not 
above 8,000 feet. 
An analysis of the records of 87 men from the front gave the fol- 
lowing results: 
Seconds. 
Class I: Average time of breath hold 78 
Highest 128 
Lowest 30 
Class II: Average time of breath hold 73 
Highest 122 
Lowest 41 
Class III: Average time of breath hold 75 
Highest 91 
Lowest 59 
From 44 monitors: 
Class I: Average time of breath hold 63 
Highest • 99 
Lowest 32 
Class II: Average time of breath hold 63 
Highest 99 
Lowest 31 
171364—20 6 82 
AVIATION MEDICINE IN THE A. E. E. 
Seconds. 
Class III: Average time of breath hold 60 
Highest 72 
Lowest 45 
The average time for breath holding for all men rated was Class I, 74; 
Class II, 71; and Class III, 63 seconds. These differences are too 
small to suggest that breath holding gives a satisfactory index of 
ability to tolerate altitudes. 
The class differences are not constant and in one direction, as 
would he expected if a relationship existed between breath holding 
and low oxygen. Table III contains selected cases from Class I 
which show that men (Nos. 73, 77, 80, 110, and 154) of limited ability 
in breath holding often compensate to decidedly low oxygen. Our 
experience shows that had the breath-holding test been applied to 
eliminate men, five exceptional men (Nos. 73, 77, 80, 110, and 154) 
whom other tests showed to be fit would have been lost from our 
service. Two of these men had flown over the front, one had been 
credited with five and the other two official enemies; the other 
three being instructors at the Third Aviation Instruction Center, 
with a credit of 350 to 750 flying hours and altitude flights to between 
16,000 and 20,000 feet. 
In Table III are four cases, Nos. 55, 85, 109, and 127, in which 
fainting or complete inefficiency occurred at oxygen percentages 
varying between 11.1 and 10.3 and whose breath holdings were 99, 
59, 68, and 91 seconds. 
Table III.—Relation of vital capacity and breath holding to oxygen want. 
No. 
Rated by 
physiol- 
ogist 
class. 
Rated by 
psychol- 
ogist 
class. 
Lowest 
oxygen 
percent- 
age 
reached. 
Time 
breath 
held in 
seconds. 
Vital 
capacity 
in c. c. 
R. 64 
I 
I 
7.7 
53 
3,680 
R. 73 
I 
I 
7.4 
44 
3,780 
3,420 
R. 76 
I 
I 
7.6 
62 
R. 77 
I 
I 
6.4 
39 
3,880 
R. 79 
I 
I 
7.6 
60 
3,610 
R. 80 
I 
I 
7.5 
32 
4,400 
R. 83 
I 
I 
7.3 
59 
3,630 
3,980 
R. 88 
I 
I 
7.1 
66 
R. 100 
I 
I 
6.5 
60 
3,690 
R. HO 
I 
I 
7.7 
42 
4,020 
3,600 
R. 121 
I 
I 
6.7 
60 
R. 154 
I 
I 
6.0 
30 
4,600 
R. 36 
II 
III 
8.6 
31 
4,600 
R. 43 
II 
III 
9.5 
63 
5,190 
4,700 
R. 49 
II 
III 
9.0 
53 
R 55 
II 
III 
10.7 
99 
4,800 
R. 60 
II 
III 
8.4 
68 
4,180 
R. 61 
III 
III 
9.3 
71 
4,900 
R. 70 
III 
III 
9.3 
72 
3,670 
3,900 
R. 85 
III 
III 
11.1 
59 
R. 84 
111 
III 
7.3 
52 
4,220 
R. 90 
III 
III 
9.9 
58 
3,490 
R. 98 
II 
III 
9.0 
41 
5,170 
R. 112 
II 
III 
9.4 
55 
6,620 
R. 107 
II 
III 
9.9 
60 
3,950 
R. 109 
III 
III 
10.3 
68 
3,830 
R. 127 
III 
III 
11.3 
91 
4,680 
II 
III 
9.7 
69 
_ 5,000 83 
AVIATION MEDICINE IN THE A. E. E. 
No. 55 was fit but had never been higher than an altitude of 10,000 
feet. No. 85, who had been at the front, and was found to be stale by 
the neurologist, complained of being tired and reported breathlessness 
at moderate altitudes. No. 127 had ethmoiditis and was not fit. 
No. 109 had been at high altitudes (18,000 feet) and had five months’ 
experience at the front. He was, however, a heavy smoker and com- 
plained of being tired after flights at more than moderate altitudes. 
In an earlier study of 50 men the influence of exercise on the power 
of holding the breath and the relation of this to the endurance of 
low oxygen was considered. No definite advantage over breath 
holding without exercise was evident. 
Granted that the rebreathing low-oxygen examination gives 
satisfactory evidence of ability to compensate to low oxygen and 
high altitudes, the above evidence indicates that breath holding can 
not be used as an index of ability to respond to altitude. 
VITAL CAPACITY AND LOW OXYGEN. 
An analysis of 144 cases has been made with a view of determining 
whether the vital capacity test gives an indication of ability to 
respond to low oxygen. If an individual requires a large amount of 
air per minute, as in physical exertion or at high altitudes, it is 
evident that he may require a large vital capacity. We have found 
a few men who, when under 7 or 6 per cent oxygen, breathed 2,000 
to 2,400 c. c. of air per breath. It is obvious that an individual of 
small chest might be limited to rapid rather than deep breathing in 
order to secure sufficient ventilation of the lungs when at altitudes 
comparable to such oxygen tensions as these. The Commissions 
Board of England has fixed upon 3,000 c. c. as the minimum vital 
capacity. They suggest that no one with a capacity below 3,400 c. c. 
be accepted unless he can hold his breath more than 45 seconds. 
* Among our subjects the vital capacities distribute into the three 
altitude classes as follows: 
Number 
of cases. 
Percentage. 
Class I: 
1 
1.1 
22 
24.7 
54 
60.7 
11 
12.4 
6,000 c. c. or more 
1 
1.1 
89 
100.0 
Class II: 
2 
5.1 
3'400 to 3,999 c. c 
17 
43.6 
4’000 to c. c 
16 
41.0 
3 
7.7 
1 
2.6 
39 
100.0 
Class III: 
3’400 to 3,999 c. c 
31.3 
4,000 to 4'999 c. c 
8 
50.0 
2 
12.5 
6.000 c. c. or more 
1 
6.2 
16 
100.0 84 
AVIATION MEDICINE IN THE A. E. F. 
A larger proportion of the men in Class I had a vital capacity of 
4,000 c. c. than those of Class II. Class III contains too small a 
number to make comparison satisfactory. 
The average vital capacity for Class I is 4,340, Class II 4,060, and 
Class in 4,550 c. c. From all figures for Classes I and II it appears 
that a vital capacity of 4,000 c. c. or more may insure better tolera- 
tion of low oxygen and high altitudes. 
A study of the 16 men rated III (see Table III), who either failed 
to compensate to the decreasing oxygen or were limited in the power 
of response, shows that there are marked exceptions to the rule that 
a large vital capacity is favorable for air work. The man (R.112) 
with the largest vital capacity, 6,620 c. c., became completely ineffi- 
cient at 9.4 per cent oxygen and would have fainted had he not been 
restored to air immediately. One subject (R. 55) with a vital 
capacity of 4,800 c. c., failed at 10.7 per cent oxygen and another 
(R. 127) with 4,680 c. c., was unable to respond to stimuli at 11.3 per 
cent oxygen. 
In contrast with these may be cited three instances of men with 
small vital capacities, in which the compensations to low oxygen were 
excellent. The first with a vital capacity of 3,180 c. c. remained 
quite efficient down to 8 per cent oxygen; the second, vital capacity 
3,490 c. c., compensated down to 7 per cent; and the third with 
a vital capacity of 3,670 c. c. reached 6.7 per cent oxygen. 
Bazett examined an English aviator, a small man, with a vital 
capacity of 3,200 c. c., who was an excellent scout pilot. This man 
brought down 14 Huns during the next 18 days. 
Our experience does not include men with both a small vital 
capacity and a short period of breath holding. 
It appears from the above data that the vital capacity when taken 
alone does not give evidence as to a subject’s ability to respond tot 
low oxygen and altitudes. 
EXTRA RESERVE FACTOR. 
Bazett, from experience with respiratory tests for ability to stand 
high altitudes, concluded that a relationship exists between the 
respiratory rate, the amount of air breathed per minute and vital 
capacity, and a man’s power of enduring oxygen want. He estab- 
lished an artificial factor which seems to give some idea of the ability 
of the individual to stand high altitudes. This factor is expressed 
, ,, , respiratory rate X ventilation per minute , 
by the value — rz £the factor 
CRp^city 
is based upon certain reasonable physiological assumptions, namely, 
that a slow respiration, a large vital capacity, and a low ventilation 
rate, all indicate a reserve for use at high altitudes. 85 
AVIATION MEDICINE IN THE A. E. E. 
From the examination of three groups of aviators, good, bad, and 
uncertain at altitudes, he found the average factor for the good type 
is 24.1; for the bad, 46.3; and for the uncertain, 36.8. He accepts 
30 as the standard, those above this being relatively bad. Among the 
good type 24 per cent had a factor greater than 30, while 71.5 per 
cent of the bad and 47.3 per cent of the uncertain were above this 
figure. 
We have sufficient and satisfactory data from 123 of the American 
aviators who took our altitude classification test for calculating the 
Bazett’s extra reserve factor. During the rebreathing test the 
respiration rate, the volume of breathing, and the time in half-minute 
intervals were recorded on a kymograph. From these tracings we 
have calculated the respiratory rate and the per minute volume of 
ventilation during the first four minutes of the test. 
The results of these comparisons of the reserve factor and the 
rebreathing altitude classification give the following distribution: 
Number 
, of 
cases. 
Number 
factor 
30 and 
below. 
Number 
above 
factor 
30. 
Per cent 
above 30. 
Class I 
64 
41 
23 
35.9 
81.4 
43 
8 
35 
Class III 
16 
3 
13 
. 81.2 
The average reserve factor for the 64 men in Class I was 31, and 
out of this group for the 41 in which it was 30 and less, it was 24.5. 
This last figure is almost the same figure, 24.1, Bazett found for the 
good type. The average factors for Classes II and III were 40.7 and 
36, respectively. On eliminating from each the cases with a reserve 
factor of 30 or less the averages were 44.5 and 39. The reserve 
factor fails, therefore, to indicate the different abilities for low oxygen 
adaptation among the Classes II and III. 
A study of the cases in Class I with a factor greater than 30 brought 
out the fact that each responded normally and well by increased 
breathing and acceleration of the pulse rate down to oxygen per- 
centages varying between 7.8 and 6.2. 
There were 8 men in Class II who gave a reserve factor less than 30. 
Four of these the psychologist found reached a point of complete 
inefficiency at percentages of oxygen ranging between 9 and 8.2; the 
remaining four gave the fainting type of reaction at about the same 
oxygen percentages. 
Three men in Class III had low reserve factors, 18.9, 24, and 24.9. 
The first, who had the largest vital capacity, 6,620 c. c., found among 
our subjects fainted at 9.4 per cent oxygen; the second, whose cir- 
culatory adaptation was poor, was, according to the psychologist, 86 
AVIATION MEDICINE IN THE A. E. F. 
completely inefficient at 11.3 per cent; the third man was of the 
fainting type and became inefficient at 8.4 oxygen. 
The reserve factor seems therefore to be as effective for selecting 
those bad at adapting to low oxygen as its author found it to be for 
selecting those bad at altitudes. The weakness of the method errs 
in the safe direction, that is, it fails less frequently in selecting those 
who do poorly under low oxygen than those of the good type. It 
should only be used as a substitute for more exact methods when an 
emergency exists where a number of men must be passed upon 
hurriedly. 
THE U-TUBE FATIGUE TEST. 
Inasmuch as one hypothesis put forth is that this test gives an 
indication of the tone of the respiratory center, the results of the 
tests were compared with the altitude test ratings. The discrep- 
ancies between the two ran about as in the breath-holding test. 
Eighteen men who held on less than 40 seconds divided equally into 
two groups. Nine were rated I in ability to respond to a gradually 
decreasing oxygen, the other nine were placed as follows: Class II, 6; 
and Class III, 3. Birley after using the test in the field in France 
with the Royal Air Force concludes that “The above results do not 
warrant the assumption that high flying per se, at any rate at the 
stage at which pilots and observers are nowadays withdrawn from 
the line, produced an altered tone of the respiratory center of such 
a character as to be demonstrable by the manometer tests.” 
CLINICAL FINDINGS AND STALENESS. 
The great need in aviation, and it may be added in industry, is 
some test or set of tests, which will detect fatigue and the accumu- 
lated injurious effects of stress. A search for a reliable test is still on. 
It is of' interest to examine the English tests and incidentally the 
rebreathing and other tests from this standpoint. 
Our data have been compared with the findings of the internist, 
neurologist, opthalmologist, and ear, nose and throat department. 
Among the American aviators returned from the front after the 
signing of the armistice 22 were considered as temporarily unfit for 
flying by the several medical departments. The data on these men 
are tabulated in Table IV. In the aggregate these men show up 
very well in the English tests. Their averages were for vital capacity 
4,260 c. c., breathhold 72.3 seconds, expiratory force 122.1 mm. Hg., 
“fatigue” 50.9 seconds, reserve factor 30.9. The response of the 
pulse rate during the hold in the “fatigue” test was normal in all 
but four. Not a man was below the minimum standard in power 
to hold the breath or in expiratory force. In the “fatigue” test 
four fell below the minimum standard of 40 seconds. One had a 
vital capacity below standard. AVIATION MEDICINE IN THE A. E. F. 
87 
Number. 
’ 
Clinical finding. 
Rebreatbing classi- 
fication. 
Pulse rate. 
Cramp- 
ton 
index. 
Time 
breath 
held in 
seconds. 
Vital, 
capacity 
in c. c. 
Expira- 
tory force 
in mm. 
Hg. 
Time 
holding 40 
mm. Hg. 
by blow- 
ing in 
seconds. 
Pulse during 
fatigue tests. 
Reserve 
factor. 
Physiol- 
ogy. 
Psychol- 
ogy. 
Reclin- 
ing. 
Stand- 
ing. 
512 
I 
I 
S4 
104 
45 
87 
4,850 
102 
38 
17 
531 
TT 
TTT 
90 
129 
28 
68 
4 000 
136 
25 
579 
I 
II 
92 
120 
o 
52 
4,900 
114 
56 
23 
581 
i 
i 
70 
84 
58 
72 
3,180 
84 
38 
591 
II 
ii 
96 
108 
55 
51 
4,300 
112 
32 
132 
23 
596 
i 
i 
70 
84 
63 
65 
3,900 
186 
40 
35 
645 
I 
i 
64 
74 
88 
80 
4,210 
144 
55 
40 
624 
Neurologist 
i 
ii 
76 
90 
68 
66 
3,720 
112 
36 
40 
650 
i 
i 
78 
104 
53 
62 
4,130 
122 
55 
132.. 
29 
653 
I 
I 
80 
112 
50 
94 
5,000 
188 
77 
28 
658 
I 
i 
105 
105 
115 
84 
4,340 
118 
74 
25 
660 
I 
I 
100 
112 
30 
67 
5,800 
122 
48 
16 
661 
I 
ii 
84 
90 
83 
78 
3,920 
86 
50 
33 
673 
11 
II 
72 
82 
78 
101 
5,000 
148 
59 
v 33 
675 
i 
i 
70 
90 
85 
76 
3,780 
110 
51 
33 
676 
Ear and neurologist 
80 
102 
88 
73 
3,760 
114 
45 
23 
680 
.......... 
II 
78 
114 
78 
62 
3,200 
100 
40 
50 
688 
I 
i 
76 
90 
38 
65 
4,600 
118 
52 
29 
699 
i 
80 
105 
79 
73 
4,290 
114 
50 
25 
701 
I 
ii 
84 
102 
98 
79 
4,190 
128 
62 
144 
37 
I 
I 
68 
88 
55 
66 
3,830 
88 
55 
Good 
57 
Brewer 
ii 
hi 
68 
72 
55 
69 
4,990 
138 
66 
132. 
29 
Average 
80 
93 
63 
72 
4,260 
122 
51 
31 
Table IV.-—Found unfit by clinical departments. 88 
AVIATION MEDICINE IN THE A. E. F. 
In the low-oxygen altitude classification test nine of the group 
were rated as inferior, being placed in Classes II and III. 
Among the men returning from the front there were also 22 who 
claimed to feel “fed up,” tired or stale, but with whom the clinician 
found nothing wrong. Data from the altitude examination and 
the English tests for this group have been tabulated in Table V. 
They average higher than the “unfit” group. These averages are 
for vital capacity 4,350 c. c., breathhold 76 seconds, expiratorj' 
force 128.5 mm. Hg., “fatigue” test 55.4 seconds, and reserve 
factor 30.4. The pulse during the hold of the “fatigue” test was 
good in all but two. One subject was below the minimum standard 
in the breathhold and “fatigue” test and one in the respiratory 
force. The low-oxygen altitude rating gave the following grouping: 
Class I, 9; Class II, 10; and Class III, 3. 
A group of 20 men who showed up unusually well in the English 
tests is given in Table VI for comparison with the “unfit” and “com- 
plaining” groups. This picked group averaged in vital capacity 
4,340 c. c., breath-hold 92.3 seconds, expiratory force 137.9 mm. 
Hg., “fatigue” test 69.3 seconds, and “reserve factor” 35.4. No. 
701 was found to be stale by the internist and No. 490 complained of 
being worn out. In the altitude, or low oxygen, test they were rated 
Class I, 8; Class II, 11; and Class III, 1. 
From our experience with the so-called English tests we conclude 
that they do not give a reliable indication of how well a man will 
respond to diminished oxygen tensions, such as are encountered in 
flying to high altitudes. We recognize that the reserve factor may 
measure in a crude way the ability to stand high altitudes. 
As regards the value of the English tests in detecting fatigue and 
staleness we offer the opinion that it is too early to pass upon them. 
The subjects examined by us were freed from the stress and anxiety 
of fighting, from patrol and observation flights and had had time to 
recuperate. Birley, working with English aviators at the front, 
found that pilots and observers whose conditions warranted their 
transfer to England for a rest preserved a comparatively high degree 
of physical fitness as judged by the tests. He believes that the tests 
afford valuable information in assessing temperament and in indivi- 
dual susceptibility and reaction to shock. He found that they did 
not prove useful in searching out psychopaths, individuals who never 
feel confident in the air and sooner of later reach the hospital with 
well developed anxiety neurosis. 
It is the writer’s opinion that the tests require too much voluntary 
attention and hearty cooperation on the part of the patient. The 
results are not capable of physiological interpretation unless they 
represent the best effort the patient can put into each test. Indifferent 
subject and listless observer both vitiate the results. Determination AVIATION MEDICINE IN THE A. E. F. 
89 
Number. 
* 
Rebreathing classi- 
fication. 
Pulse rate. 
Cramp- 
ton 
index. 
Time 
breath 
held 
in 
seconds. 
Vital 
capacity 
in c. c. 
Expira- 
tory 
force • 
in 
mm. Hg. 
Time 
holding 
40 mm. 
Hg, by 
blowing 
in 
seconds. 
Pulse 
during 
hold. 
Reserve 
factor. 
Physi- 
ology. 
Psychol- 
ogy. 
Reclin- 
ing. 
Stand- 
ing. 
492 
II 
II 
65 
78 
65 
59 
3 570 
100 
56 
78 
490 
T 
II 
96 
96 
90 
76 
4 300 
132 
552 
III 
III 
80 
* 84 
95 
59 
8 900 
178 
36 
do 
567 
II 
II 
75 
112 
41 
61 
3 750 
70 
132 
605 
I 
II 
78 
84 
78 
9° 
4 900 
116 
97 
619 
IT 
II 
60 
SO 
70 
87 
3 970 
160 
635 
II 
III 
90 
90 
198 
60 
3 950 
122 
45 
do 
641 
i 
I 
7? 
82 
68 
113 
5 000 
118 
42 
do 
24 
647 
I 
I 
88 
102 
50 
82 
5 O’O 
108 
139 
I 
I 
72 
88 
100 
85 
4'060 
182 
70 
657 
I 
I 
76 
94 
78 
66 
4 670 
188 
45 
663 
ii 
II 
• 78 
88 
88 
4 230 
118 
31 
do. 
I 
I 
62 
78 
55 
75 
4 500 
190 
54 
669 
ii 
II 
50 
68 
63 
66 
3,590 
99 
52 
670 
ii 
II 
80 
96 
70 
68 
4 000 
118 
52 
671 
hi 
III 
64 
80 
60 
91 
4,680 
140 
61 
24 
677 
i 
I. 
72 
112 
40 
80 
4 780 
96 
55 
20 
691 
i 
II 
72 
76 
100 
84 
5 200 
174 
69 
45 
693 
i 
I 
76 
102 
83 
30 
4 600 
114 
23 
do 
24 
694 
i 
I 
80 
108 
65 
66 
4 460 
138 
54 
26 
697 
i 
I 
78 
104 
?8 
128 
4 300 
110 
70 
720 
ii 
II 
70 
82 
75 
91 
4 430 
130 
54 
25 
Average 
74.4 
90.4 
72 
76 
4,350 
128.5 
55.4 
30.4 
Table V.—Claimed to be “stale” and “fed up.” AVIATION MEDICINE IN THE A. E. F. 
Number. 
Rebreathing classi- 
fication. 
Pulse rate. 
Cramp- 
ton 
index. 
Time 
breath 
held 
in 
seconds. 
Vita] 
capacity 
in c. c. 
Expira- 
tory 
force 
in 
mm. Hg. 
Time 
holding 
40 mm. 
Hg, by 
blowing 
in 
seconds. 
Pulse 
during 
hold. 
Reserve 
factor. 
Physi- 
ology. 
Psychol- 
ogy. 
Reclin- 
ing. 
Stand- 
ing. 
490 
I 
II 
96 
96 
90 
76 
4,300 
132 
66 
52 
605 
I 
II 
78 
84 
78 
92 
4,900 
116 
97 
34 
619 
II 
II 
60 
80 
70 
87 
3,970 
160 
78 
28 
623 
11 
II 
8? 
96 
53 
90 
3,700 
90 
54 
48 
625 
III 
III 
64 
68 
75 
68 
3,830 
110 
63 
35 
637 
II 
I 
52 
80 
45 
73 
3,640 
112 
62 
Slowed 
62 
639 
I 
80 
84 
95 
96 
4,150 
166 
78 
34 
640 
II 
II 
72 
96 
80 
92 
4,640 
108 
52 
36 
642 
II 
I 
82 
110 
45 
96 
4,540 
170 
59 
do 
29 
646 
II 
75 
100 
39 
104 
5,180 
116 
74 
16 
654 
I 
I 
80 
102 
63 
105 
4,300 
105 
67 
50 
656 
I 
I 
72 
88 
100 
85 
4,060 
182 
70 
32 
664 
I 
I 
72 
92 
55 
84 
4,330 
164 
66 
31 
678 
I 
I 
88 
108 
45 
120 
4', 400 
142 
85 
22 
681 
I 
I 
* 68 
84 
85 
121 
3,800 
174 
77 
do 
55 
687 
I 
I 
54 
72 
98 
81 
5,410 
128 
68 
24 
692 
I 
I 
66 
76 
78 
120 
4,650 
120 
85 
35 
721 
II 
• I 
66 
96 
38 
106 
5^200 
134 
68 
26 
720 
II 
II 
69 
88 
56 
71 
3', 620 
122 
55 
31 
701 
I 
II 
84 
102 
98 
79 
4,190 
128 
62 
132 
37 
Average 
73 
90.1 
69.3 
92.3 
4,340 
137.9 
69.3 
35.4 
Table VI.-—Above the average. AVIATION MEDICINE IN THE A. E. E. 
91 
to do one’s utmost is an important factor. The tests are in some 
respects psychological, since if a man determines to hold the breath un- 
til discomfort is pronounced it can be done or he may give up with the 
first feeling of effort. To sustain the mercury column in the “fatigue” 
test requires some skill and a proper set of the lips may ease the per- 
formance so much that ten to twenty seconds are added to the length 
of the hold. The expiratory force test, if well done, requires great 
effort and the height of the blow often depends upon the ability to 
coordinate the contraction of chest and abdominal muscles. One 
often improves his record appreciably after several performances. 
The mental attitude of the patient may make or mar these tests. If 
the patient wishes a vacation, knowing that a pooc showing in the 
tests indicates fatigue and need of a rest, he can easily imitate the 
“all in” man. 
Section III. 
CIRCULATORY EFFICIENCY TESTS. 
The cardio-vascular changes associated with body posture and 
exercise have been considered by many experts in physical education 
and by clinicians to furnish important tests of cardiac and vasomotor 
efficiency. It has been assumed that fatigue relaxes the tone of the 
circulatory system and that the degree of action is indicated in 
changes in pulse rate and arterial blood pressures. A body damaged 
by disease, overwork or unhygienic living, or weakened by dissipation, 
or by inactivity, also undergoes a loss of tone which will be manifest 
by the circulatory changes when the subject is examined in the re- 
clining and standing postures or after exercise. The degree of loss 
of tone or injury is also estimated by the extent of reaction to selected 
forms of exercise. 
During brief or moderately prolonged periods of exercise the arter- 
ial blood pressure is raised and the heart rate accelerated. These 
changes occur very promptly after the exercise is started, the in- 
crease in heart rate preceeding the increase in pressure. The amount 
of increase in both depends on the degree of effort and on the rapidity 
and length of the exercise. When the exercise is stopped, there 
is a rapid fall of pressure and pulse rate. A primary fall in pulse 
rate usually precedes the fall in pressure; but unlike the latter, the 
pulse may remain for some time above its original rate and only 
gradually return to the normal level. The sudden and primary fall 
in the pulse rate is frequently separated from the secondary fall by a 
period of stationary rate. After short periods of exercise the pulse 
rate usually becomes subnormal for a period of time, varying with 
the kind of exercise. After fatiguing and exhausting exercise the 
pulse rate returns to normal slowly, and only rarely passes into the 
subnormal stage. Comparison of the pulse rate in athletic and non- 
athlctic individuals after a particular exercise shows that the acceler- 92 
AVIATION MEDICINE IN THE A. E. F. 
ation and the time of return to the normal are greater in the non- 
athletic persons. 
The systolic pressure after exercise, like the pulse, usually goes 
subnormal. It quickly returns to normal in the well trained but 
remains subnormal for some time in the physically untrained person. 
The amount of increase in the pressure is about equal in athletes and 
nonathletes, but the athlete normally has the higher initial pressure. 
When the body is in the recumbent posture the heart is not worked 
as hard as when one stands. The heart rate and the systolic blood 
pressure are ordinarily increased for the standing position. In per- 
fectly normal vigorous men the systolic pressure will rise from 8 to 10 
millimeters of mercury upon assuming the standing position. The 
pulse rate on the average accelerates about eight beats per minute. 
Crampton found that in an individual weakened by dissipation, 
overwork, lack of sleep, etc., the systolic pressure on standing tends not 
to rise but to fall, because the splanchnic area fails to increase its vaso- 
tone; and that the heart rate rises in proportion to weakness, as much 
sometimes as 45 beats per minute. He balanced mathematically 
the systolic pressure and pulse rate against each other to prepare a 
percentage table which expressed numerically the vasomotor tone. 
The 100 mark indicates a perfectly efficient working of the vasomotor 
system under test, the zero is approximately the point where the 
person’s circulation is inadequate to maintain the needs of the body 
in the erect posture. 
Means of measuring fatigue, staleness and weakness are suggested 
by the above statements. A pulse rate more rapid than the average 
in the reclining and standing postures, a large acceleration and a slow 
return of the pulse rate to normal after exercise may mean fatigue 
and weakness. A systolic pressure that fails to rise but falls when 
the subject stands, and a pressure that remains above the normal for 
a considerable time after exercise may likewise indicate weakness. 
A low rating on Crampton’s vasomotor tone index should also furnish 
evidence of staleness. 
THE METHODS USED. 
We required the candidate prior to examination to avoid doing 
physical work. For examination he was placed on a comfortable 
couch, a Tyeos sphygmomanometer was adjusted over the brachial 
artery, after which he rested for 5 minutes. The heart rate was 
then determined by counting the pulse for 20-second intervals. 
Counting continued until two successive intervals gave the same re- 
sult. The arterial pressures were then determined by auscultation, 
the diastolic pressure being read at the fourth phase. The candidate 
next stood, the heart rate was counted in 20-second intervals as 
before until it reached the “standing normal” when it was recorded 
and the arterial blood pressure then taken. AVIATION MEDICINE IN THE A. E. F. 
93 
The candidate next standing before a chair placed one foot upon 
the seat of the chair and raised his body to the height of the seat five 
times in 15 seconds, one foot being retained on the chair through- 
out. With the subject still standing the arterial pressures were 
immediately determined by one observer while a second counted 
and recorded the pulse rate in 15-second intervals for 2 minutes. 
At the end of the 2 minutes the arterial pressures were again read. 
The question of suitable exercise was discussed. McCurdy has 
pointed out that speed exercises such as his knee-raising test give a 
more uniform increase in heart rate than the strength exercises such 
as hopping 100 feet, squatting or trunk bending. We used the 
stepping upon the chair for two reasons. It was used by the English 
Army and it gave a simple and definitely controlled exercise. For 
purposes of comparisons we also had a small number of men do the 
knee-raising test in which the knees are alternately raised 20 times 
in 10 seconds (10 times for each knee). 
From a study of English aviators Flack and Bowdler conclude that 
with the stepping-upon-the-chair exercise an increased heart rate of 
over 25 beats and a return period of over 30 seconds are points 
calling for carefuh consideration of the candidate’s cardiovascular 
system. They believe that a rest rate above normal, especially if 
influenced by respiration, should not be regarded as necessarily 
throwing doubt upon the functional efficiency of the cardiovascular 
system. A pulse of 60 to 72 raised little by exercise (not over 10 
beats per minute), returning to normal in 10 seconds, is, in their 
opinion, a good sign, generally associated with excellent physique 
and good stability of the nervous system. While a diastolic pressure 
below 70, with a pulse pressure greater than 50 is regarded as strong 
evidence that the cardiovascular system is unsuited for air work. 
Birley, working with the English aviator at the front, found the 
average pulse rate for officers permanently unfit for flying was some- 
what higher than that of fliers in the home establishment. The 
average standing pulse rate was for pilots and observers in the home 
establishment, 85; for officers permanently unfit for flying, 100. 
A study of concussion cases averaged (a) granted sick leave and re- 
turned to duty, 74; (b) evacuated sick to England, 79. With regard 
to blood pressures he states that they are too variable to allow of 
any very definite conclusions being drawn. The chief points of 
interest are that all groups had a high average for systolic pressure—- 
Home establishment, 123; all concussion cases, 127; permanently unfit 
for flying, 130 mm. Hg. Secondly, there were a large number of ab- 
normal pressures. The abnormality tends considerably more toward 
high pressures than toward low. The high readings were in no 
case associated with arterial or renal changes and were looked upon 
as an indication of the strain of active service. In high-flying pilots 94 
AVIATION MEDICINE IN THE A. E. F. 
he found a pulse rate below rather than above the normal and a 
normal pulse pressure. 
THE EXAMINATION MADE IN THE A. E. F. 
The Pulse Rate in the Reclining and Standing Positions. 
Among several hundreds of cases who underwent the circulatory 
tests about 170 were also put through the low oxygen altitude test 
and the English efficiency tests. A special study has been made of 
this smaller group. Below are tabulated the data from 148 cases 
showing the distribution in pulse rates for the horizontal and stand- 
ing positions. It should be noted that the lowest rate is not equal 
to the minimum frequently observed in healthy individuals. Athletes 
in Oxford had rates, which may be considered normal, that ranged 
between 44 and 90; and a study of medical students at Cambridge 
gave a range between 47 and 90. Our data taken from aviators 
follows. 
Rates. 
Number 
of cases. 
Per cent 
of cases. 
Rates. 
Number 
of cases. 
Per cent 
of cases. 
50 to 54 
4 
2.7 
80 to 89 •. 
33 
22.4 
55 to 59 
6 
4.1 
90 to 99 
12 
8.1 
60 to 64 
19 
12.8 
3 
2.0 
22 
30 
14.9 
20.2 
70 to 74 
Total 
148 
100.0 
75 to 79 
19 
12.8 
Highest rate 
Lowest rate 
Average 
105 
50 
74.2 
Pulse rates while in the reclining position (148 cases). 
Rates. 
Number 
of cases. 
Per cent 
of eases. 
Rates. 
Number 
of cases. 
Per cent 
of cases. 
60 to 64 
2 
1.3 
95 to 99 
17 
11.5 
65 to 69 
7 
4.7 
100 to 109 
23 
15.5 
70 to 74 
9 
6.1 
110 to 119 
10 
6.7 
75 to 79 
21 
14.4 
120 to 129 
2 
1.3 
80 to 84 
29 
19.6 
1 
0.7 
7 
20 
4.7 
13.5 
90 to 94 
Total 
148 
100.0 
Highest rate 
Lowest rate 
Average 
132 
68 
89.4 
Pulse rates during standing (148 cases). 
A reclining position pulse rate above 80 is considered too rapid for 
the man in perfect physical condition. Almost a third, 32.4 per cent, 
of our cases had a rate of 80 and above. A “standing normal” does 
not, as a rule, exceed 95. But 35.8 per cent of these men had a rate 
of 95 and above. The pulse rates for the reclining and standing pos- 
tures indicate that about a third of the men examined were fatigued 
or not in the best physical condition. AVIATION MEDICINE IN THE A. E. F. 
95 
The Systolic Pressure in the Horizontal and Standing Position. 
The distribution of the systolic pressure for the two positions 
was as follows: 
The horizontal position (148 eases). 
Systolic pressure during standing (148 cases). 
Pressure in mm. Hg. 
Number 
of cases. 
Per cent 
of cases. 
Millimeters. 
Cases. 
Per cent 
of cases. 
90 to 99 
2 
1.3 
17 
11.5 
100 to 109 
26 
17.5 
46 
31.1 
110 to 119 
55 
37.3 
32 
21. 6 
120 to 129 
30.4 
35 
23.6 
130 to 139 
17 
11.5 
15 
10.2 
140 to 149 
1 
.7 
3 
2.0 
150 to 159 
2 
1.3 
148 
100.0 
Total 
148 
100.0 
Highest systolic pressure,reclining position mm. Hg.. 150 
Lowest systolic pressure, standing position mm. Hg.. 98 
Average mm. Hg.. 117.9 
Highest systolic 1 mm. Hg.. 154 
Lowest systolic mm. Hg.. 100 
Average mm. Hg.. 123.4 
If it be accepted that the normal systolic pressure for young men of 
aviator’s age ranges between 100 and 125 mm. Hg, then 35 men, or 
23.6 per cent, had in the reclining position a pressure above normal, 
and 54, or 36.5 per cent, were above normal while standing. These 
were 28, or 18.9 per cent, with a reclining posture systolic pressure 
below 110 mm., while in 12, or 8.2 per cent, it was below the normal for 
the standing position. Birley found a considerable percentage of 
high altitude English pilots with subnormal blood pressures. 
There is ordinarily a difference between the systolic pressures of 
the reclining and standing positions. The differences in our subjects, 
when the standing pressure was compared with that of the reclining 
position, were as follows: 
Number 
of cases. 
Percent- 
age of 
cases. 
26 
17.5 
19 
12.8 
70 
47.4 
28 
18.9 
2 
1.4 
3 
2.0 
148 
100.0 
In vigorous men a rise of systolic pressure occurs when the erect 
posture is taken. A fall in pressure is regarded as evidence of poor 
condition or weakness. According to this criterion 26, or 17.6 per 
cent, of our cases gave this evidence of weakness. 96 
AVIATION MEDICINE IN THE A. E. F. 
Crampton’s Vasomotor Tone Index. 
To estimate the vasomotor tone, the pulse rates and systolic pres- 
sures of the horizontal and standing positions are required. A subject 
may sometimes show weakness by a decrease in blood pressure and at 
other times by an increase in heart rate and vice versa. In rating a 
decrease in pressure of 1 millimeter of mercury was found to be equiva- 
lent to an increase in the heart rate of approximately two beats. 
Just what constitutes a poor record has not been determined. We 
may assume, however, that 50 or less means a poor vasomotor tone. 
Among the group of subjects here considered 32, or 21.6 per cent, had a 
vasomotor tone index of 50 or less; a percentage which corresponds 
fairly well with that of the criteria above considered. 
The Pulse Rate after the Standard Exercise. 
It is generally assumed that in vigorous physically fit men the rate 
of heart beat does not accelerate as much during a given exercise as in 
men out of training and, therefore, physically “soft.” Furthermore, 
in the physically fit the rate returns to normal quickly, while in the 
less strong a higher rate is maintained for some time after exertion. 
The change in pulse rate immediately after the standard exercise 
for our subjects was as follows: 
Change in rate. 
Number 
of cases. 
Percent- 
age of 
cases. 
4 
2.7 
4 
2.7 
62 
41.9 
58 
39. 3 
10 
6.7 
10 
6.7 
148 
100.0 
An acceleration of more than 20 beats occurred in 20, or 13.5 per 
cent, of the men. Accepting the suggestion that 25 or more consti- 
tute an excessive acceleration we find only 10, or 6.7 per cent, give 
this evidence of unfitness. 
The return of the pulse rate toward normal was followed for two 
minutes after the exercise. The counting was done in 15-second inter- 
vals. Assuming that when we found it to be normal in the third in- 
terval of 15 seconds that it came back within 30 seconds, there were 
61 men who returned within the 30 seconds considered normal by 
Flack and Bowdler. At the end of two minutes 49, or 33.1 percent, 
were still above normal. In an analysis of 170 cases, cadets exam- 
ined at Mineola and reported in the Medical Research Manual, we 
found at the end of the second minute that 33 per cent were above 
their “standing normal,” 16.8 per cent normal, and 50.2 per cent 
subnormal. AVIATION MEDICINE IN THE A. E. F. 
97 
The A. E. F. aviators had the following condition of the pulse rate 
at the end of two "minutes: 
• 
Number 
of cases. 
Per cent 
of cases. 
72' 
48.6 
27 
18.2 
49 
33.1 
A POINT SYSTEM FOR GRADING THE CARDIO-VASCULAR EFFICIENCY 
TESTS. 
In order to sum up the data obtained from the circulatory tests a 
scoring system has been devised. This system is based in part upon 
a plan proposed by Dr. J. H. McCurdy for rating infantrymen in 
cardio-vascular and neuro-muscular efficiency. It is recognized 
that fatigue or derangement may be evidenced in the high heart 
rate during reclining; during standing; in the number of beats the 
heart rate increases when the standing and reclining postures are 
compared; in the acceleration in the pulse rate after exercise; in the 
time taken by the pulse to return to normal; and, lastly, in the rise 
or fall in the systolic blood pressure on standing. An arbitrary 
scheme for grading each of the above six points has been prepared. 
The values as assigned will be found in Table VII, parts A, B, C, D, 
E, and F. The final rating is obtained by adding the score for each 
of the six points rated, 18 being a perfect score. 
The following illustrates the method of rating: Reclining pulse 
rate 72 = 2 points, pulse rate increase on standing 24 beats = 1 point, 
standing pulse rate 96 = 1 point, pulse acceleration after exercise 
8 beats = 2 points, pulse returned to normal within 45 seconds = 3 
points, systolic pressure rose 14 mm. on standing = 3 points. The 
subject made a total of 12 out of a possible 18 points. It should be 
noted that the number of beats the pulse increases on standing is 
rated on the basis of the reclining rate. In this example 72 occurs 
in the third line so the increase 24 is rated according to the third 
line in the third column of B. The same plan is used for the exercise 
increase, but it is compared with the standing and not the reclining 
pulse rate. 
The 148 men previously considered are by this point system of 
scoring distributed as follows: 
Efficiency score. 
Number 
of cases. 
Percent- 
age. 
Efficiency score. 
Number 
of cases. 
Percent- 
age. 
18-17-16 
21 
14.2 
3-2-1 
2 
1.3 
15_14_13. . 
30 
20.3 
0 
1 
0.7 
49 
33 1 
9-8-7 
28 
18.9 
148 
100.0 
6-5-4 
17 
11.5 
171364—20 7 98 
AVIATION MEDICINE IN THE A. E. E. 
(A) Reclining pulse 
rate. 
. 
(B) Pulse rate increase on standing. 
50- 60=3 points. 
61- 70=3 points. 
71- 80=2 points. 
81- 90=1 point. 
91-100=1 point. 
101-110=0 point. 
0-10 beats=3 points. 
0-10 beats=3 points. 
0-10 beats=3 points. 
0-10 beats=2 points. 
0-10 beats=l point. 
0-10 beats=0 point. 
11-18= 3 points. 
11-18= 2 points. 
11-18= 2 points. 
11-18= 1 point. 
11-18= 0 point. 
11-18=—1 point. 
19-26= 2 points. 
19-26= 1 point. 
19-26= 1 point. 
19-26= 0 point. 
19-26=—1 point. 
19-26=—2 points. 
27-34= 1 point. 
27-34= 0 point. 
27-34= 0 point. 
27-34=—1 point. 
27-34=—2 points. 
27-34=—3 points. 
35-42= 0 point. 
35-42= 0 point. 
35-42=—1 point 
35-42= —2 points. 
35-42= —2 points. 
35-42= —3 points. 
(C) Standing pulse 
rate. 
(D) Heart rate acceleration immediately after a standard exercise. 
60- 70= 3 points. 
71- 80= 3 points. 
81- 90= 2 points. 
91-100= 1 point. 
101-110= 1 point. 
111-120= 0 point. 
121-130= 0 point. 
131-140= —1 point. 
0-10 beats=3 points. 
0-10 beats=3 points. 
0-10 beats=3 points. 
0-10 beats=2 points. 
0-10 beats=l point. 
0-10 beats=l point. 
0-10 beats=0 point. 
0-10 beats=0 point. 
11-20= 3 points. 
11-20= 2 points. 
11-20= 2 points. 
11-20= 1 point. 
11-20= 0 point. 
11-20= —1 point. 
11-20=—2 points. 
11-20=—3 points. 
21-30= 2 points. 
21-30= 1 point. 
21-30= 1 point. 
21-30= 0 point. 
21-30=—1 point. 
21-30= —2 points. 
21-30= —3 points. 
21-30=—3 points. 
31-40= 1 point. 
31-40= 0 point. 
31-40= 0 point. 
31-40=—1 point. 
31-40= —2 points. 
31-40= —3 points. 
31-40= —3 points. 
31-40= —3 points. 
41-50= 0 point. 
41-50= 0 point. 
41-50=—1 point. 
41-50= —1 point. 
41-50= —2 points. 
41-50= —2 points. 
41-50=—3 points. 
41-50=—3 points. 
(E) Return of pulse rate to standing normal 
after exercise. 
(F) Systolic pressure, standing compared with 
reclining. 
0-60 seconds = 3 points 
61- 90 seconds = 2 points. 
91- 120 seconds = 1 point. 
2- 10 beats above at 120 sec- 
onds = 0 point. 
11- 30 beats above at 120 sec- 
onds = —1 point. 
Rise of 8 mm. or more = 3 points. 
Rise of 2-7 mm = 2 points. 
No rise = 1 point. 
Fall of 2-5 mm = 0 point. 
Fall of 6 mm. or more = —1 point. 
Table VII.—Cardio-vascular efficiency test tables of points for grading. AVIATION MEDICINE IN THE A; E. E. 
99 
That there may be value in assembling the circulatory data under 
such a point system is indicated from an analysis of 54 cases of avi- 
ators who, when examined by the medical officers of the departments 
of the laboratory, were found to be ailing and physically below stand- 
ard. The medical examinations included a study by the internist, 
neurologist, ophthalmologist, and ear, nose, and throat expert. The 
medical findings include a large variety of conditions, the majority 
being common to any group of men and in no way characteristic of 
aviators. 
That which was of greatest interest in this analysis was the final 
efficiency score of each patient. The cases were distributed as fol- 
lows : 
Efficiency score. 
Number 
of cases. 
Percent- 
age. 
Efficiency score. 
Number 
of cases. 
Percent- 
age. 
IS—17—16 
0 
0.0 
3-2-1 
9 
16.6 
15-14-13 
3 
5.6 
2 
3.7 
12-11-10 
3 
5. 6 
9-8-7 
22 
40.7 
54 
100.0 
6-5-4 
15 
27.8 
Only six of the 54 cases had a score of 10 or better, while 88.8 per 
cent had scores ranging between nine and minus one. These figures 
seem to indicate that a score of nine or less is characteristic of phys- 
ically unfit men. 
Starting then with the assumption that a score of nine or less gives 
indication that the clinician may find something wrong with the 
patient, we have listed all men among the 148 considered in the circu- 
latory test who had a low score. There were 46, or 32.4 per cent, 
with a score of nine or less. 
The medical examiners working independently recorded abnormal 
conditions in 30 of the 46 men. Thus 65.2 per cent of the men who 
showed up poorly when scored by the cardio-vascular efficiency tests 
were in other ways found to be below standard. Two of the men 
were unfit because of excessive smoking and one had recently used 
alcohol too freely. The neurologist reported five as stale or nervous, 
the internist alone found five unfit, six were tonsil or local infection 
cases, and the remainder were found wrong by at least two of the 
medical departments. 
It may be questioned whether the point system of scoring has been 
found to be more valuable than the Cramp ton Vasomotor tone index 
or than the use of exercise alone. In the unfit cases that we have 
studied the Cramp ton Vasomotor tone index has more frequently 
been above than below 50, while 25 per cent of these men had an iiicfex 
above 70. The advantage of the point system over the vasomotor 100 
AVIATION MEDICINE IN THE A. E. E. 
tone index is found in the inclusion of four factors omitted in calcu- 
lating the vasotone. 
When the increase in the pulse rate after exercise is alone consid- 
ered, the number of men singled out is much reduced. Out of the 20 
men with an exercise acceleration of 21 or more beats, only 7 had a 
cardio-vascular efficiency score below 10, and the proportion found 
below normal by the clinician was much smaller. The time required 
by the pulse to return to normal after exercise also showed that a 
number of men, found by other examinations to be below standard, 
would have been passed without question by this test. 
The point system for grading men on the basis of cardio-vascular 
efficiency tests can easily be applied by the flight surgeon. It is 
suggested that a score of nine or less gives reason for an overhaul of 
the patient by a clinician. Aviators with a low score might well be 
called back for further examination or observation. The scoring of 
cases should only be done to obtain an indication of condition and 
should not be considered as definite proof of efficiency or inefficiency. 
A poor rating suggests a search for a cause. If the cause is found, then 
apply the remedy which experience has proven most valuable. 
Table VIII.—Circulatory data on men from the front who exhibited a low score. 
No. 
Pulse. 
Systolic pressure 
' in mm. Hg. 
Diastolic pressure 
in mm. Hg. 
Crampton. 
Reclin- 
ing. 
Stand- 
ing. 
Exercise 
increase. 
Reclin- 
ing. 
Stand- 
ing. 
Reclin- 
ing. 
Stand- 
ing. 
Index. 
Score. 
R 68 
84 
104 
8 
120 
118 
66 
70 
45 
5 
R 85 
80 
84 
12 
150 
140 
50 
52 
95 
9 
R 98 
75 
102 
6 
112 
116 
68 
70 
51 
8 
R 99 
96 
108 
4 
138 
136 
72 
76 
55 
5 
R 108 
90 
96 
18 
114 
118 
70 
82 
78 
6 
R 115 
86 
102 
10 
126 
124 
72 
80 
50 
7 ■ 
R 117 
75 
100 
12 
106 
102 
72 
70 
39 
8 
R 118 
80 
96 
16 
108 
114 
62 
60 
70 
8 
R 123 
80 
112 
8 
114 
120 
44 
60 
50 
8 
R 122 
72 
80 
30 
116 
122 
60 
60 
78 
9 
R 124 
100 
112 
12 
122 
110 
70 
80 
30 
-1 
R 130... 
105 
105 
35 
110 
126 
84 
88 
2 
R 82 
92 
120 
8 
132 
116 
50 
50 
0 
2 
R 60 
90 
132 
0 
118 
127 
60 
72 
28 
4 
R 78 
75 
112 
0 
98 
103 
60 
58 
41 
7 
R 131 
82 
96 
4 
118 
116 
74 
76 
53 
8 
R 134 
78 
114 
14 
110 
110 
70 
74 
30 
4 
R 143 
80 
102 
14 
112 
128 
60 
72 
88 
8 
R 144 
82 
110 
6 
114 
116 
72 
76 
45 
6 
R 145 
88 
108 
8 
122 
120 
• 70 
72 
45 
4 
R 148 
76 
90 
14 
124 
116 
74 
74 
38 
7 
R 155 
84 
102 
8 
122 
140 
72 
80 
98 
8 
R 157 
78 
104 
8 
122 
116 
74 
78 
28 
7 
R 160 
84 
96 
16 
118 
136 
66 
70 
100 
6 
R 161 
72 
112 
-4 
122 
128 
68 
84 
40 
7 
R 163 
66 
96 
12 
120 
120 
72 
74 
38 
8 
R 165 
72 
84 
' 48 
110 
108 
60 
64 
55 
6 
R 166 
88 
99 
5 
138 
138 
78 
76 
61 
9 
R 167 
72 
108 
12 
120 
130 
72 
82 
55 
8 
R 169 
68 
82 
22 
116 
122 
74 
86 
73 
9 
R 171 
80 
102 
18 
120 
126 
74 
76 
63 
7 
R 180 
68 
72 
36 
124 
118 
62 
64 
55 
7 
R 135 
72 
92 
12 
104 
102 
60 
66 
55 
5 
Average. 
81 
101 
13.2 
118.8 
120.9 
67 
72 
59.1 
6.38 AVIATION MEDICINE IN THE A. E. E. 
101 
In Table VIII have been assembled the more important circulatory 
data obtained in France from 33 American aviators soon after return 
from the front after the signing of the armistice. This is the group 
that received a low cardio-vascular efficiency score. It is of interest 
to compare these data with other records obtained from men appar- 
ently physically normal. The average pulse rate for the reclining posi- 
tion for the 148 cases was 74. In this group of low-score men it was 
81. However, six of them had a rate of 74 or less. In the standing 
position the large group had an average pulse rate of 89, while the 
subnormal group averaged 101, and of these only five had a standing 
rate below 89. The systolic pressures do not show marked differences. 
The large group averaged, reclining 118 mm., and standing 123 
mm. Hg. The averages for our subnormal group were, reclining 119 
and standing 121 mm. The diastolic pressures were about the same 
for the two groups of subjects. About 23 per cent of the 148 cases 
had a diastolic pressure below 70 when standing, while at least 40 per 
cent were below during reclining. 
Birley states that “It has been shown by Starling and his co- 
workers by the use of the heart-lung preparation that the heart is 
capable of responding within wide limits to changes in the mechanical 
demands made upon it so that it is difficult to imagine a more per- 
fectly regulated machine than the heart. How wide these limits can 
be is demonstrated in the following tables, where high and low blood 
pressures are combined with fast and slow pulses in a seemingly ran- 
dom manner.” Our experience confirms his opinion that the rela- 
tionship of the rate of pulse and height of pressure follow no definite 
law. The arterial pressures seem to us, in themselves, to shed no 
light on the question of physical condition of the man. 
CARDIO-VASCULAR AND ENGLISH EFFICIENCY TESTS. 
It has been pointed out earlier in this chapter that the experience 
in the A. E. F. Medical Kesearch Laboratory at the Third Aviation 
Instruction Center in France failed to show the English tests useful 
in giving hint that the patient was below standard physically. The 
group of 46 men rated below standard in the cardio-vascular efficiency 
tests gave the following results with the English tests: Vital capacity, 
lowest 3.2, highest 6.1, average 4.5 liters; breath hold test, lowest 32, 
highest 128, average 85.4 seconds; expiratory force, lowest 70, high- 
est 188, average 124.5 mm. Hg.; “fatigue ” test, lowest 31, highest 85, 
average 53.4 seconds. The average for each test in this group of men 
is above our group averages and above the English averages which 
have been recorded in Table II. There is a complete lack of paral- 
lelism in the results of the two sets of tests. 102 
AVIATION MEDICINE IN THE A. E. E. 
CARDIO-VASCULAR EFFICIENCY AND ENDURANCE OF LOW OXYGEN. 
Since physical fitness has seemed to influence the ability of men to 
endure low oxygen it was thought that the cardio-vascular or other 
efficiency tests might be used to estimate the altitude that the aviator 
would tolerate. 
A study of 130 aviators at Hazelhurst Field, Mineola, Long Island, 
N. Y., in which the Vasomotor tone index was compared with the 
physiological responses during exposure to the influence of the low 
oxygen of the rebreathing test, showed that Cramp ton’s Vasomotor 
tone index did not give an indication of the subject’s ability to with- 
stand low oxygen. On checking the altitude low oxygen classifica- 
tions of the 48 A. E. F. cases against their Vasomotor tone indices we 
again fail to find any relationship. 
An examination of the data of the circulatory tests, separately and 
collectively, as in the “point system” for grading, also leads to the 
conclusion that a man may do poorly in these tests and yet respond 
well to oxygen want. Among 46 men with a cardio-vascular efficiency 
score of nine or less there were rated in the low oxygen test, Class 
I, 23; Class II, 14; and Class III, 7; and not rated, 2. 
Section IV. 
HYGIENE. 
It has repeatedly been asserted that aviation medicine has as a 
primary function the task of keeping the flier physically and mentally 
efficient and alert. When the United States entered the war it was 
evident that medical men were not informed as to the nature of the 
wear and tear to which the body of the flier was exposed in the pur- 
suit of this new occupation. That the ordinary standards of fitness 
for army service are not applicable in the case of a flying man was 
evidenced in the experience of our Allies. They found that even 
though the flier succeeded in avoiding accidents and was not injured 
or brought down by the enemy, nevertheless, the period of usefulness 
as measured by hours of air work was for the vast majority of men of 
short duration. 
It is obvious that the first aim of the leaders in aviation medicine 
was to determine standards of fitness required in air work and to find 
the explanation for the physical and mental deterioration observed 
among aviators. This knowledge was sought by researches carried 
on in the laboratory and in the field. The problem was to discover 
what the body is doing during flying and what it is able to do. The 
application of the methods of physiology soon began to reveal an- 
swers to these questions, but the complete answer will yet require fur- 
ther years of careful study. 
The facts as rapidly as discovered were passed on to a selected 
group of medical men whose business it became to apply this knowl- AVIATION MEDICINE IN THE A. E. F. 
103 
edge to the care of the aviator. From the field experience of these 
officers, many of whom were capable observers, and the collaboration 
between them and the experimentalist it has become possible to for- 
mulate a few definite facts on the hygiene of the aviator. 
It is recognized that aviation medicine and hygiene are still in the 
making. There is no agreement as to whether there is a clearly de- 
fined aviator’s sickness. Among the French, Ferry and Garsaux 
have described the “syndrome of aviator sickness.” Flack and 
Heald, speaking for the English, state that there are symptoms and 
signs which may now be considered as due directly to prolonged air 
work at various altitudes. “The symptoms are not so definite or 
simple that anything in the nature of a definite air disease syndrome 
can yet be claimed for them; but the appearance and reappearance 
of them in overlapping groups .is distinctly suggestive.” A German 
writer, Hirschlaff, finds no conditions distinctive of aviation alone, 
although he admits that the flier may develop acute sickness when 
at high altitudes. 
In the United States we do not admit an illness that appears only 
among aviators. It is recognized, however, that the flier’s body is 
subjected to an enormous strain, the result of sudden change. He 
rises from the ground level to which he is adapted to great altitudes 
to which he must suddenly adapt himself to secure the requisite oxygen; 
from a state of equilibrium in orientation to one of instability; from 
a region of comparative warmth to one of extreme cold; from a state 
of comparative quiet to a motion that has the effect upon him of a 
gale of wind. In passing from one extreme to another physiological 
responses and adjustments of unusual rapidity must be made. These 
reactions often tax the adjusting systems to the utmost and pre- 
sumably may overwork them. 
Experience has shown that in sports such as cycling, rowing, 
automobiling, etc., in which the subject is subjected to great physical 
and nervous strain, the period of efficiency is limited. It is in these 
impossible to fix upon the exact duration of this period. It depends 
upon the physical endowment of the subject and the care that he 
gives his body. However, each athlete has his day, some lasting 
only a short period, some for months and even years. The strain 
in aviation, as it is pursued in war, demands more of the human 
mechanism than any other sport. It also follows, therefore, that 
the period of efficiency is limited. It may vary in length from a few 
months to a few years. The exact duration of this period will depend 
upon the effort demanded from the subject and the conditions under 
which the flights are made. Above all it will depend upon the mode 
of life of the aviator. 104 
AVIATION MEDICINE IN THE A. E. F. 
Just as the athlete is unaware of the causes operating to limit the 
period of efficiency and is unfamiliar with the symptoms and sensa- 
tions that give hint of approaching staleness, so it is with most fliers. 
Ask the aviator what are the sensations experienced in the course of 
ascent and descent. He as a rule can not tell you much. Either 
his attention during flight has been so absorbed with the maneuver- 
ing of his ship and other details, or his power to make a subjective 
study of himself is so limited that he‘declares that he has never 
experienced air sensations and fatigue. Certain it is that the major- 
ity of aviators have failed to recognize the sensations due to altitude, 
possibly because as experienced by them they have been insignifi- 
cant and transitory. There is a small group the members of which 
freely avow the feeling of malaise with which they have been affected 
at different altitudes. 
The majority of athletes submit to the trainer’s rules regarding 
food, the bath, sleep, and amount of exercise, but as a rule can not 
explain the value of each. So with the aviator; we must not expect 
him to know value in hygiene unless he has made a careful study of 
all factors. 
In regard to the study of maintaining efficiency aviators assume 
four attitudes. 
(1) There is a large group indifferent to the value of physical 
fitness. Corbett and Bazett, from a wide experience with English 
aviators at the front, write, “We have seen numerous pilots who 
appear hardly to have heard of physical fitness and have never 
learnt to take any sort of pride in their bodily health.’' Such men 
fail to recognize that the human body is a machine and that it needs 
attention and care. They indulge every whim. They are liable to 
smoke excessively, play cards all night if the game is interesting, 
use alcoholic liquors immoderately, and in other ways overtax the 
mechanism. 
(2) A fatalism has made many careless. They believe each man has 
been numbered by fate and when that number is called the individ- 
ual’s work ends no matter how careful he may have been and what 
the condition of body and mind. 
(3) A small number emphasize the need of protecting the body 
against the effects of wind and cold. They even would use oxygen 
to overcome the effects of high altitudes. If these are done suc- 
cessfully they believe the period of efficiency may be maintained 
over a long period of time. 
(4) Another small group recognize that the human body is a 
machine. They believe that a healthy body will withstand the 
strain of flying and be ready to meet emergencies. Such men em- 
phasize the value of a proper amount of sleep, of physical exercise, 
and moderation in the pleasures of life. AVIATION MEDICINE IN THE A. E. F. 
105 
It is difficult to arouse young men to consider the problems of 
individual efficiency. The aviator is of that age when the bodily 
condition is at its best, and when he has not yet learned his limita- 
tions. He never stops to take account of stock. Filled with the 
energy and enthusiasm of youth, he frequently recklessly or unheed- 
ingly squanders his reserve of vitality. How to reach the individual 
aviator so as to secure his cooperation for efficiency has been a 
difficult problem. The daily life of every flier can not be personally 
supervised by the flight surgeon nor the physical trainer. Unless 
the individual understands the problem of efficiency and gives 
attention to those conditions of living that secure and maintain 
efficiency an early deterioration can with certainty be predicted. 
That young men are not always in excellent physical condition 
was well demonstrated by the military medical examinations of men 
drafted or volunteering for military service. More than one-third, 
about 38 per cent, of the young men were rejected because phy- 
sically and mentally they did not conform to the requirements. 
Experience has shown that to maintain efficiency the aviator 
should obey the simple rules of personal hygiene. Even though he 
recognizes that the results of following the rules give high efficiency, 
the average individual finds these simple things irksome and that it 
requires strength of mind to follow them day in and day out. 
The necessity for health comes from the fact that the aviator has 
need of all his physical energy and intelligence. Flying is a question 
of an active, well-balanced, decisive mind, and of sound, quick reflex 
actions. Not a thing can be left to chance. The aviator must be 
able to recognize at once the slightest difficulties with his machine. 
His senses must give him accurate information of changes in the 
rhythm of his motor, of the sing of air across the wires of the machine, 
and of his position in space. He must be master of his impressions 
and be ready to make prompt decisions in a calm, cool manner. His 
correcting movements should be made with precision and without 
exaggeration. 
It is now clearly recognized that the aviator’s reactions to stimuli 
are slowed down or disturbed by disease, worry, fatigue, after excess 
in alcohol, and after other excesses. A delay of a second or part 
of a second in correcting an error in difficulties in the air or in land- 
ing may mean all the difference between a crash and safety. Hence 
hygienic living is necessaiy to keep the body and mind in good 
condition. In addition excellent physical condition permits the 
body to react with more adequate compensations to altitude 
and cold. 
As has been stated, good health and efficiency are maintained by 
applying the ordinary simple rules of personal hygiene. Since these 106 
AVIATION MEDICINE IN THE A. E. F. 
rules are so ably set forth in many books on the subject, a lengthy 
statement of them is omitted here. The aviator’s attention should 
be directed to the following topics: 
One of the first essentials for good flying is a proper attitude of 
the mind. Nervous breakdown has been a frequent cause of failure 
among aviators. Fear and worry may temporarily or permanently 
make an individual unfit physically and mentally for flying. Fear 
removes the pleasure and interest of flying. It interferes with the 
judgment and decisiveness of the mind and causes movements of 
correction to be exaggerated and poorly coordinated. A nervous 
individual reacts in a variable and usually uncertain fashion. Fear 
frequently leads to frightful dreams during sleep. This disturbance 
of rest is a factor in fatigue which will be referred to later. Worry, 
like fear, exhausts the nervous system. It has been said that “to 
worry about the future is to dig your own grave; let the undertaker 
attend to that. The present is the servant of your will.” Worry 
interferes with digestion and other functions. It also causes insom- 
nia. In order to last long in aviation the individual must enjoy 
flying and lay aside fear and worry. Guilbert has written of the 
aviator: “The first thing that would be necessary to him is a great 
liberty of spirit. He should avoid family attachments and other 
liaisons too absorbing. He should accustom himself to react against 
anxieties and unpleasant conditions of all sorts. How can a pilot 
be a complete master of his apparatus if he is distracted in his mind 
and his thought is elsewhere?” 
Regularity in living gives most certain assurance of health and 
efficiency. Physical trainers, from experience in the conditioning of 
men, have learned the value of regularity, and that this, with a proper 
balance of rest, work, and a careful selection of food, gradually bring 
the individual to top form. 
Fatigue lowers efficiency in a measurable degree. Work and 
pleasure may when continued under fatigue cost more effort and 
greater injury than in normal life. Overwork, whether that of useful 
labor or that of excess in pleasure and alcoholism, injures health 
because of strain. It postpones rest beyond the point when rest can 
accomplish the needed repair. In the accumulated fatigue of over- 
work, organs, even though retaining the appearance of perfect health, 
may yet refuse to function properly. Among the evidences of fatigue 
may be nervous dyspepsia, nervous palpitation of the heart, nervous 
eyestrain, and other similar functional ills. 
Proper sleep is most important. Eight hours is a good average. 
Only a few men can do efficient work on seven hours or less. 
The alcohol problem, despite the opinion of many aviators to the 
contrary, is a grave one. All the belligerent nations found that in AVIATION MEDICINE IN THE A. E. E. 
107 
order to save men from drunkenness, from the inefficiency that comes 
from partial intoxication, and from venereal diseases that come from 
lack of self-control when under the influence of alcohol, it was nec- 
essary to reduce, and if possible, eliminate the use of alcoholic drinks. 
Unquestionably a number of serious crashes in France among Ameri- 
can fliers occurred on the day following an evening of excessive use of 
alcohol. Alcohol may falsify sensations and predispose to foolish 
action. 
Smoking when carried to such excess that it causes nervousness, 
palpitation of the heart, faintness, or double vision must be recog- 
nized as a cause of fatigue and loss in efficiency. Most aviators smoke 
too much. Few are honest enough with self to admit their limitation. 
In this connection, the use of drugs needs mention. Many aviators 
when not feeling well use aspirin. Unless absolutely necessary, a 
man should not fly when he feels ill or unfit. Drugs do not render 
one fit, but only temporarily hide the symptoms of fatigue and ill- 
ness. 
The diet should be generous and nourishing. The habit of eating 
between meals, of using soft drinks, and the constant or frequent 
eating of confectionery cause the digestive disturbances so commonly 
seen among aviators. 
Guilbert has pointed out that “It is never good to go up in an 
airplane without first having moved one’s bowels and voided the urine, 
so as to avoid, in case of a serious fall, the rupture which may result in 
the intestine or bladder. The old adage of our fathers, ‘Head fresh, 
abdomen free, feet warm,’ should be observed in aviation more 
particularly than elsewhere.” The bowels should also be attended 
to daily to avoid the intoxication which results from constipation. 
An added reason for voiding the urine is that the cold of high altitude 
leads to an increased formation of urine, and this causes distress 
when the flight is of long duration. 
Physical exercise, judiciously employed, will do much to secure 
physical fitness and serve to avert the onset of staleness. It also 
trains the body to sustain the compensations needed during flying 
at high altitudes. It is now well known that the man who is in 
the “pink of condition” as a result of physical training is much more 
resistant to altitude sickness than the physically “soft” man. The 
ability to endure high altitudes comfortably and well is dependent 
upon adaptive changes in the breathing, the circulation, and the 
blood. These adaptive changes are similar to those resulting from 
the regular and consistent following of a program of physical 
training. The physically untrained individual breathes more fre- 
quently and shallowly than the trained man whose breathing is slow 
and deep. Shallow breathing does not ventilate the lungs effectively. 108 
AVIATION MEDICINE IN THE A. E. F. 
The habit of deep breathing can readily be cultivated by exercise but 
not so satisfactorily.by voluntary effort. At a high altitude physical 
exertion makes a greater demand on the heart than the same amount 
of work does at sea level. However, in men in excellent physical 
condition the strain thrown on the heart is less than in the individual 
weakened by dissipation and fatigue. Consistent physical work 
increases the percentage of haemoglobin in the blood, and this is 
advantageous at high altitudes. 
Experience with aviators in France demonstrated that certain 
diseases made for inefficiency; chief among these were the venereal 
diseases and chronic local infections. “The four great factors that 
produce human ineffectives, as judged by recent experiences in the 
draft, are defective eyesight, poor teeth, bad feet, and venereal dis- 
ease.” The aviator with a venereal disease should at once place him- 
self under competent medical care. He should not fly until per- 
mitted to do so by the flight surgeon. The cold and the rush of air 
in flying predispose to infection in the head and throat. The aviator 
should, therefore, occasionally be examined to determine that teeth, 
gums, nose, and throat are in a healthy state. 
Rowntree advises the aviator to consult the flight surgeon— 
When he is ill, 
When he is not feeling fit, 
When he feels insecure in his work, 
When his flying records are poor, and 
When he has had an accident. 
Rapid descent sometimes causes a heavy feeling in the head, a 
sensation of stopped-up ears, and sometimes pain in the ears and 
throat. This ordinarily can be avoided by several times during the 
descent blowing with the nose and mouth closed. 
There are two ways for the aviator to meet the demands of flying: 
(1) To maintain the body in such a degree of fitness that it recognizes 
and responds properly to stimuli, that it quickly and adequately 
makes the adjustments necessary to supply the oxygen demanded for 
efficiency at high altitudes, and that the heat-producing and heat- 
conserving mechanisms respond adequately to the changes in atmos- 
pheric temperature. (2) To protect the body against the wind and 
cold by a proper use of clothing and helmets; to protect against the 
influence of altitude by providing a supply of oxygen. 
We have discussed maintenance of efficiency above, and will now 
briefly consider protective measures. 
Clothing worn while flying should not fit too tightly. That next 
to the skin should be made of wool, as this counteracts most advan- 
tageously the loss of heat. A combination suit, fur-lined, and fur- 
lined boots make a satisfactory outer covering. AVIATION MEDICINE IN THE A. E. E. 
109 
Frostbites may be prevented by smearing the face and hands 
with a thin layer of vaseline. If the dryness of high altitudes causes 
parching and chapping of the skin, cracking of the lips, and dryness of 
the nose and throat, these also may be prevented by an ointment or 
spray of petrolatum, etc. 
USE OF OXYGEN. 
The use of oxygen during flights, especially when at very high 
altitudes, has been urged for reasons that are simple and definite. 
As the ascent is made the oxygen pressure of the atmospheric air 
rapidly becomes less. The freedom with which oxygen enters the 
blood from the lungs and passes from the blood to the tissues is 
determined by the oxygen pressure in the air and in the blood. The 
higher the oxygen pressure the more adequately will the tissue needs 
for oxygen be supplied; a fall in oxygen pressure may result in a tissue 
shortage of oxygen. 
The human machine can adjust itself to some extent to the decrease 
in the oxygen supply of high altitudes. The adaptive changes that 
occur in the body as the aviator ascends are in some respects like those 
that occur during physical exercise. They involve the circulatory 
and respiratory mechanisms and the blood. The breathing becomes 
deeper and sometimes labored; the heart beats more frequently, thus 
circulating the blood more rapidly; and there may also be an increase 
in the haemoglobin of the blood. This increased work of the respi- 
ratory and circulatory mechanisms undoubtedly contributes to the 
fatigue of exercise and of flying. When adjustment is excessive, 
or inadequate, fatigue is more marked. 
Flack and Heald summarize the beneficial results of using oxyger 
as follows: 
(a) Mitigation of the fatigue always present after long flights. 
(b) Abolition of staleness from long periods of flying at the front. 
(c) Increase of mental alertness. 
(d) Increase of muscular vigor. 
(e) Amelioration of symptoms, such as giddiness, fainting, etc. 
A brief survey of physiological experiments conducted in the 
pneumatic or low pressure chamber at the Medical Research Lab- 
oratory at Mineola, Long Island, N. Y., illustrates the effects of 
altitude and beneficial influence of oxygen. 
When men are subjected to a reduced pressure equivalent to 18,000 
or 20,000 feet, the breathing shows a well-defined increase in depth 
which results in an augmentation of from 20 to 128 per cent. If to 
a man who has such an increase in breathing oxygen is administered, 
there results an immediate quieting of respiration. 110 
AVIATION MEDICINE IN THE A. E. E. 
The effects on the circulation are equally marked. Altitudes of 
18,000 and 20,000 feet may bring about an increase in the systolic 
blood pressure and invariably accelerate the frequency of the heart 
action by from 15 to 40 beats per minute. One subject at 20,000 feet 
had a systolic pressure of 140 mm. Hg. and a pulse rate of 112. One 
minute after he had received the oxygen the systolic pressure had 
dropped to 122 mm. and his pulse to 80. 
The beneficial effects are evidenced by an immediate slowing of 
the pulse rate and these effects continue for several minutes after 
the oxygen is again withdrawn. 
Two members of the Medical Research Laboratory by the use of 
oxygen withstood a rarefaction of the air equal to 34,400 feet without 
any trace of the respiratory or circulatory symptoms of altitude. 
The lack of oxygen at high altitudes manifests itself in other ways 
than those mentioned above. The stethoscope reveals the fact that 
the heart sometimes labors as though the subject were exercising. 
There usually is some cyanosis. The ocular functions are often dis- 
turbed. The power of attention and discrimination may be reduced. 
Oxygen administration, once these conditions have developed, will 
immediately restore each organ to normal. 
Experiments conducted for the purpose of determining the effect 
of low oxygen on handwriting and the ability to copy words show 
that at 18,000 feet in some subjects the handwriting becomes difficult 
to read; whereas errors in spacing, following the line, omission of 
words, etc., are more frequent. It was proven that the administra- 
tion of oxygen for two minutes completely restored the handwriting 
and the accuracy of copying to normal. 
From this evidence the conclusion follows that oxygen will at least 
mitigate the fatigue of high altitude flight, will increase muscular 
coordination and mental alertness, and maintain or restore clearness 
and accuracy of vision. 
Maj. Rippon, Royal Air Force, Medical Service, England, examined 
two officers before and after altitude flights with and without oxygen 
and found by the use of fatigue tests that without oxygen the pilot 
returned both mentally and physically fatigued, while with oxygen 
there was little or no evidence of fatigue. 
Testimony lias been made by English commanding officers of fliers 
and observers that shows the regular use of oxygen increases length 
of service and amount of work. 
The Squadron, which, as you know, has been using the oxygen apparatus 
for months, is doing six times the amount of work that any other squadron is doing 
without oxygen. 
There is no question that these men in my command who have used the oxygen 
apparatus are not by any means as tired as they used to be'before they used this AVIATION MEDICINE IN THE A. E. F. 
apparatus. Since the use of the oxygen the men have not complained of any head- 
aches, fatigue (except what you might call ordinary fatigue), or vertigo. 
Considerable after effects have been noted in individuals who have 
been subjected to the oxygen want while flying at very high alti- 
tudes. These, as has been pointed out, involve the respiratory and 
circulatory mechanisms. When oxygen is used during the flight 
these after effects do not occur. Birley found that the chief differ- 
ence between individuals who have done their work at high alti- 
tudes as compared with those who have flown at low altitudes lies 
in the more frequent occurrence among the former of blood pressures 
below normal, with which is usually associated a rather slow pulse. 
Unfortunately equality of service seems to have been the aim of 
aviation. Had it been recognized that all individuals are not and 
can not be endowed with equal capacity for response to the influence 
of low oxygen, and that many are incapable of sustaining the com- 
pensations day after day in that their “ceiling” gradually becomes 
lower, the use of oxygen would have been the rule rather than the 
exception. An aviator who can only compensate for moderate 
altitudes may fly with perfect safety to very high altitudes when 
supplied with oxygen. Furthermore, his “ceiling” then is deter- 
mined by the power of his aeroplane and not by his physical limita- 
tions. If equality of service must be our aim then the need of sup- 
plying oxygen by artificial means becomes imperative. 
Flying demands an individualism in a degree unknown in any 
other branch of the service. Individual initiative can only be main- 
tained when the intellect and the sense organs remain in a high state 
of efficiency. Our low-oxygen altitude examinations have revealed 
that the power of attention begins to deteriorate in many men who 
belong in Class I at moderate altitudes. This, it is believed, gives 
an added reason for using oxygen. 
Flack and Heald, writing on the value of oxygen to aviators at rela- 
tively low altitudes, stated that— 
It is not suggested that one flight, whatever be its nature, is in itself deleterious, or, 
except in the case of great altitudes, calls in any way for the administration of oxygen, 
except to those totally unfitted to fly. But, from what has been written, it will be 
seen that the strain of flying will tell, sooner or later, upon the aviator through the 
cardio respiratory, nervous, or muscular mechanisms, the degree depending largely 
upon the individual—thus causing many of the failures in the field. 
A question sometimes asked is whether the use of oxygen during 
a flight should be intermittent or constant. The studies in the low- 
pressure chamber show that after the beneficial effects of oxygen 
have been obtained and the artificial supply of oxygen is then cut 
off the effects last for from four to six minutes. However, within a 
minute after the oxygen is withdrawn the pulse rate will begin accel- 112 
AVIATION MEDICINE IN THE A. E. F. 
erating, at first only a beat or two, but with each added minute the 
acceleration is more pronounced. Respiration likewise soon again 
becomes deepened and protrudes itself into the field of consciousness. 
Intermittent use of oxygen would serve to keep the aviator efficient 
and alert. The action on circulation and respiration would be that 
of alternate periods of speeding up and slowing down. Just how 
fatiguing such alternating periods would be has not as yet been 
determined. 
Flack and Heald believe that it would be a good practice to ad- 
minister oxygen for a few minutes to all airmen after long flights 
at any altitude. This contention is supported by observations by 
Hill and Flack in which it was shown that in the fatigue of athletes 
oxygen inhalation increases the lasting power and decreases the 
fatigue, probably by maintaining or restoring the vigor of the heart. 
They believe that the fatigue which follows an athletic feat is mainly 
cardiac in origin and due to want of oxygen. Chapter IV. 
DEPARTMENT OF PSYCHOLOGY. 
Floyd Dockary, Captain, Sanitary Corps. 
The aviators examined by the Psychology Department in the 
A. E. F. may be divided into two groups. The first group included 
(a) flying officers who had shown certain defects in flying, (b) those 
about to go on leave, (c) those who had recovered from illness or 
injuries, and (d) a few aspirants who applied for the regular Blank 
609 examination. The second group included the monitors of the 
Third Aviation Instruction Center, and chasse pilots and observers, 
returning from the front after the armistice, who had proved their 
ability. Of these in the latter group, the monitors and chasse pilots 
may be considered a group of especially good fliers, for the command- 
ing officer of the instruction center reported that the monitors had 
been selected because of their aviation aptitude. He considered 
them equal to the aces. 
The examination of the first group was for purely diagnostic pur- 
poses with the assumption that the tests used were valid for the purpose. 
In this group, 131 officers and aspirants were examined either with 
the rebreather, or the reaction times, or both. In the case of the 
rebreathing experiment, the standards had already been determined at 
the Mineola laboratory. The reaction time tests were used with 
greater conservatism, depending upon the French standards as 
established by Dr. Nepper, in case a definite judgment of a man was 
necessary. 
The second group, the selected men, was used solely as a means of 
finally testing and revising, if necessary, the methods of examination 
which we had employed. As they were all men who had demonstra- 
ted their ability as flyers, either at the front or at the instruction 
center, it was hoped that more definite data regarding the tests 
might be obtained. 
The monitors were all in normal physical condition, on regular 
flying duty. With possibly a few exceptions, their attitude toward 
flying and toward the laboratory was good. There were two notable 
exceptions. One was particularly anxious to discontinue flying, 
and undoubtedly simulated unfitness. Another was one of the best 
flyers at the center, but he said he had no confidence in the work of 
171364—20 8 
113 114 
AVIATION MEDICINE IN THE A. E. E. 
the laboratory, and, therefore, did not cooperate satisfactorily in 
the experiments. The results of these and a few other doubtful 
cases, were omitted in the final consideration of the data. 
From the pilots and observers returning from the front, after the 
armistice, it was more difficult to select men that could be relied 
upon as to their physical condition and mental attitude. They were 
all examined first by the medical department for general physical 
fitness. But practically all of them were feeling the effects of the 
work at the front and the trip back to the instruction center, which 
had included one day or longer in Paris. We must add to this the 
intense desire, now that the war was over and they were on their way 
home, to get there as soon as possible. All of those diagnosed by 
the medical department as unfit because of staleness or for other 
more specific reasons, have been considered separately. In addition, 
several who showed definite signs of being unable to do their best 
work at this time, were also placed in this group of unfit. On the 
whole, the attitude and willingness to cooperate was excellent. 
As the work with the miscellaneous group contains no new material 
and the compiling of data at the Mineola laboratory will be more 
complete than the similar work in the A. E. F., this report will be 
confined more particularly to the study of the selected group. 
The monitors and chasse pilots were examined in the laboratory 
at the Third Aviation Instruction Center. The tests consisted of a 
general physical examination, the standard rebreather, simple reac- 
tion times to visual, auditory and tactual stimuli, and a steadiness 
test. The observers were examined at the laboratory at the Second 
Aviation Instruction Center. In addition to the rebreathing test, 
a new test devised by Lieut. Isaacs for testing the speed, reliability 
and confidence of observers, was used. 
The principal features of the results obtained with the rebreathing 
test, are those found when a comparison is made with the results 
obtained with cadets and flying officers in the United States. We 
may assume that, while those tested in the United States included 
many excellent men and men of long experience in flying, there were 
many inferior men who had not yet been eliminated. The more 
advanced the school, the fewer inferior men would we expect to 
find. The monitors and chasse pilots tested in the A. E. F., were all 
picked men, from whom all the inferiors, or unsuccessful flyers, had 
been eliminated. We may assume, therefore, that if the tests are 
capable of differentiating any marked mental characteristics, they 
may be shown by this comparison. The results obtained with the 
observers have been omitted, as certain complications in the manage- 
ment of the apparatus rendered these results unreliable. AVIATIOX MEDICIXE IN THE A. E. E. 
115 
Table 1.—Numerical scores. 
A.E.F. 
United States. 
Number 
cases. 
M. 
P.E. 
Number 
cases. 
M. 
P.E. 
Off by psychologist 
110 
20 
-11.77 
-21.5 
±0.96 
±2.74 
2,395 
947 
- 8.05 
-10.22 
±0- 22 
± .39 
130 
-13.26 
± .94 
3,342 
- 8 66 
± -20 
If we compare the numerical scores (Table 1) of the overseas group 
with those of the men tested in the United States, we find that the 
mean score of the former is somewhat lower. There was a considera- 
te difference in the mean score at the different fields in the United 
States. One of the factors in this difference was due to the fact 
that some fields were for more advanced flyers, with the consequent 
elimination of many of the unfit. A more pronounced factor 
however, seemed to be the personnel of the various examining units. 
Some were over-cautious ’while others ’were too lenient in their grading. 
The mean numerical scores of each psychologist working in the 
United States, have been compiled at the Mineola laboratory. These 
range from — 2±1.16 to —32.7±.85. If they are arranged in order 
of values, they range from 1 to 30. The mean score of the results 
in the A. E. F. correspond to the nineteenth place. One of the psy- 
chologists in the A. E. F. had also served at Hazelhurst Field and 
at Kelly Field. The mean of his scores at these two fields was —3.5 
±1.13 and occupies fifth place in the series. It ’will be seen, therefore, 
that the selected group of fliers does not make a particularly good 
showdng in numerical scores. 
It has been assumed in all the rebreathing tests that the first atten- 
tion and motor effects should appear at the same time; also, that the 
distinct attention and motor effects should appear together. As a 
matter of fact, actual experience demonstrates that in neither case 
is this the general rule. There is, however, some correlation between 
the time of appearance of the first effects, and a more decided corre- 
lation between the appearance of the distinct effects. (Table 1). 
Our correlation for the first effects is not as large as that in the United 
States, but our correlation for the distinct effects is practically the 
same. Our correlation of the length of the run, and the per cent of 
oxygen at the end of the run, is — .40 ± .053, indicating that those 
subjects'who continued longer reached a lower per cent of oxygen. 
The most interesting feature of our results is the relatively late 
appearance of the attention effects as compared with the appearance 
of the motor effects. In the curves of Plates I and II, the distances 
on the abscissae represent the differences in minutes of the appearance 
of the attention and motor effects, and the ordinates the number of 116 
AVIATION MEDICINE IN THE A. E. F. 
cases. Those cases to the left of the zero ordinate represent the cases 
in which the motor effect appeared earlier than the attention effect, 
and those to the right represent the cases in which it appeared later. 
It will be seen that the appearance of the first attention effects one 
minute after the first motor effects was most frequent, both in the 
United States and in the A. E. F. (PI. I.) However, a decidedly 
greater per cent of monitors and chasse pilots show a delay of one min- 
ute or more in the attention effects, than is shown by the home group, 
except in the extreme. A comparison of the distinct effects (PI. 
II) shows the same tendency. 
Whether this difference between the two groups is due to a selective 
process, in which the inferior aviators have been eliminated from our 
group, or whether it is due to the more extensive training of the moni- 
AEK 
V.S.A. 
Plate I. 
tors and chasse pilots, it is impossible to determine from our data. 
It does, however, mark a distinct difference between our selected 
group and the more general group. It may be further noted that 
this delay of the attention effects was at the expense of the motor 
effects, as the mean numerical scores of the monitors and chasse 
pilots is not particularly high. It was observed in the early days of 
the rebreathing test that the subject could compensate for either 
the attention or motor by a greater concentration of effort upon one 
to the neglect of the other. Capt. Johnson has suggested that the 
difference noted in our results (Pis. I and II), might be due to a 
variation in our method of giving the directions to the subject, or to 
the unintentional lengthening in the time that the lamps, to which 
the subject reacted, were lighted. As the lamps were operated by 
buttons pressed by an assistant, slight variations were possible. AVIATION MEDICINE IN THE A. E. E. 
117 
Both explanations are possible, though we are inclined to believe 
they did not play an important part in this particular case. 
If further investigation should confirm our results—that the 
superior aviators possess greater powers of attention, or are capable 
of greater attention at the expense of motor effort—it would indicate 
that the rebreathing test might throw some light upon the qualifica- 
tions of a good flyer in addition to his endurance of low oxygen. 
As the French depended upon simple reaction times as almost the 
only psychological examination in the selection of candidates for 
aviation, it was recommended by the Medical Research Board that 
A M.F 
UAA. 
Plate II. 
the psychology department investigate the validity of these tests. 
The monitors and chasse pilots afforded good material for this inves- 
tigation, as they were all men of proved ability. In addition, we were 
able to secure the rating of a large number of these men from the 
training department of the Third Aviation Instruction Center. The 
degree of correlation between their reaction times and the training 
department rating, should indicate the value of the tests. 
The attempt was made to reproduce, as nearly as possible, the ex- 
perimental conditions of the French methods as developed by Dr. 
Nepper. Owing to the fact that only 20 minutes were allotted to 
this department for special problems of this sort, reactions only to 118 
AVIATION MEDICINE IN THE A. E. E. 
visual and auditory stimuli were attempted at first. Later, the time 
was sufficiently extended to permit the use of reactions to tactual 
stimulus also. It was also soon found that the reactions to the visual 
stimulus with our apparatus were invalid, due to the presence of a 
simultaneous auditory stimulus which could not be completely 
eliminated, and it was necessary to discard these results. Another 
difficulty in securing data from a large number of men for comparison 
was the fact that many of the men examined in the laboratory had 
not been at this center for instruction, and consequently were not 
rated by the training department. After these various eliminations 
were all made we have left for comparison with the training depart- 
ment rating, 148 reactors to an auditory stimulus, 110 to a visual 
stimulus, and 68 to a tactual stimulus. The results obtained which 
could not be employed in these comparisons were of value in deter- 
mining the mean reaction times of monitors and chasse pilots. 
With the exception of the part of the reactions to the auditory 
stimulus that were recorded with the Dunlap chronoscope, all reac- 
tions were recorded with the D’Arsonval chronoscope used by 
Nepper. The former records in thousandths of a second while the 
latter records in hundredths of a second. We have, however, always 
expressed our results in thousandths of a second, reading half spaces 
on the dial of the D’Arsonval as 0.005 second. Though Nepper 
recorded only 10 reactions with each stimulus, we made it a rule to 
record 25. In spite of Nepper’s claims that 10 results gave as reli- 
able a mean as a larger number, this is against the opinion of Ameri- 
can psychologists who have done considerable work with reaction 
times. The results of our experiments confirm the latter view. 
Table 2. 
Number 
of eases. 
M. 
P. E. 
a 
Reaction time: 
148 
197 
±0.99 
17.9 
192 
. 155 
19. 5 
90 
143 
±1.76 
± .17 
24. 7 
Coefficient of variation: 
148 
8.3 
3. 
192 
11.4 
± . 16 
3.3 
90 
13.4 
± .23 
3.5 
Table 3. 
Reaction type. 
Class. 
M. 
P. E. 
cr 
189 
±2.98 
23 
Chasse (fit) 
197 
±1.15 
17 
Chasse (unfit) 
205 
±4. 22 
22 
153 
±1.54 
19 
Chasse (fit) 
157 
±1.24 
18 
Chasse (unfit) 
158 
±2.73 
20 AVIATION MEDICINE IN THE A. E. F. 
119 
Table 2 gives the results of the monitors and chasse pilots com- 
bined. In the first part of the table are given the mean (M), prob- 
able error of the mean (PEm) and the standard deviation of the 
mean (cr) for the entire group, based on the mean reaction times of 
each individual tested. The second part of the table shows the mean, 
Fig. I.—D’Arsonval apparatus for recording reaction time. 
probable error and standard deviation of the coefficients of variation 
of each individual from his mean reaction time. 
The corresponding mean reaction times reported by the French 1 
are 0.190 second for visual stimulus, and 0.140 second for auditory 
and tactual stimuli. They do not report definitely the amount of 
deviation from these means, except to say that more than 0.10 second 
1 Camus and Nepper, Recherches sur l’aptitude a 1’aviation. Institute general psychologique, Extrait 
du bulletin nos. 1-3 17° Ann6e, 1917. 120 
AVIATION MEDICINE IN THE A. E. F. 
lengthening in reaction time, was considered sufficient to bar a can- 
didate. They also apparently considered 0.10 second as the maxi- 
mum deviation of an individual from his own mean reaction time. 
It will be observed that our means are somewhat higher than the 
French, and that there is a wider deviation not only between indi- 
viduals, but also in the separate reaction times of each individual. 
In Table 3, we have separated the results of monitors and chasse 
pilots. The chasse pilots are further divided into the “fit” and the 
“unfit” on the basis of the report made by the medical department. 
All of the monitors were reported physically fit. Reactions to 
tactual stimulus are omitted from this table owing to the few monitors 
and unfit chasse pilots that are included. 
Though the unfit chasse pilots present the longest reaction times, 
their probable error and standard deviation from the mean are also 
large, showing that there were probably some very long, and also 
some very short, reaction times included in this group. The longest 
reaction time for the unfit was 0.220 second for the visual stimulus, 
while the longest for either other group was 0.200 second. The unfit, 
as a whole, grouped only a little above the mean for the entire group, 
and three present mean reaction times as low as 0.130 second. The 
best reaction time for the fit was only 0.120 second. If we should 
eliminate those with reaction times above 0.200 second, as the French 
advised, we should eliminate only one of those recognized by the 
medical department to be unfit. It may be, however, that the medi- 
cal examination was not infallible. But we would expect an error 
to be made in the other direction. The medical man might be ex- 
pected in the ordinary methods of examining, to overlook certain 
defects rather than to emphasize them. 
A further check upon the value of reaction times in the selection 
of aviators, is the comparison with their ratings in flying ability 
furnished by the training department. We should not expect too 
high a correlation, even though our test is a good measure of aptitude 
in flying; for, doubtless, the training department rating is frequently 
influenced by other factors, not directly related to flying aptitude. 
Strict observance of military forms, sociability, etc., can not be strictly 
eliminated from a rating of this sort. We might expect, therefore; 
that a man might be misplaced one or more classes in either direc- 
tion, due to these irrelevant factors. 
It was desired, for the convenience of handling the data, that the 
men be classified into 10 groups, according to general flying ability. 
Capt. Street, in charge of the training department, using all the 
records available in his office, performed this work for us. None 
of the men we examined fell in the last four groups, so there are 
practically six grades classified. The results of correlation of these 
ratings with the reaction times, and the coefficients of variation, of 
each individual, are given in Table 4. AVIATION MEDICINE IN THE A. E. F. 
121 
Table 4. 
Reaction type. 
Cases. 
r. 
P. E. 
Visual: 
R T 
Total 
110 
0.065 
0.058 
R T 
Fit 
93 
.113 
.069 
C 
Total 
110 
.136 
.064 
C .. . 
Fit 
93 
.073 
.070 
Auditory: 
R T . . . . 
Total 
148 
.106 
. 055 
R T 
Fit 
132 
.214 
.056 
c • . . 
Total 
148 
.042 
.055 
C 
Fit 
132 
-.267 
.046 
Tactual: 
r T 
Total 
68 
.075 
.082 
R T 
Fit 
60 
.047 
.087 
c 
Total 
68 
.015 
.083 
c 
Fit 
60 
.128 
.087 
Correlation of T. D. rating with average reaction times (R. T.) and coefficients of variation (C). 
The coefficient of variation is given, as it may be an index of 
stability or emotional control, as the French suggest. All the corre- 
lation values are small, but the fact that they all tend in the same 
general direction, with one exception, is significant. We would not 
expect a high correlation, due to the irrelevant factors that may 
influence the training department rating. We might, therefore, 
consider the correlations with auditory stimulus to be fairly high. 
Especially is this noteworthy when we consider the influence of the 
unfit in decreasing the correlation. This is to be noted in both the 
mean reaction time and in the coefficient of variation. 
The correlations with reaction times to visual and tactual stimuli 
are extremely small and unreliable; but the number of cases when the 
unfit are eliminated are too small to make it possible to draw defi- 
nite conclusions. The correlation with reactions to visual stimulus 
is higher when we eliminate the unfit, if we consider only the mean 
reaction time; but the correlation with the coefficient of variation 
is lower. In the case of the reactions to tactual stimulus, the results 
are reversed. 
We may conclude, from the results here presented, that under 
more favorable conditions, and with a more accurate rating scheme, 
a fairly high degree of correlation between flying aptitude and 
simple reaction times might be found. It is our opinion, however, 
that simple reaction times alone should never be used in the selec- 
tion of candidates. -Mental processes undoubtedly involve elements 
that can not be measured by a simple reaction to a known stimulus 
which is attempted in the simple reaction experiment. It is possi- 
ble that more complex reaction experiments, such as those that in- 
volve discrimination of varying degrees of difficulty, judgment, 
and other modes of association, may yield important results. Such 
experiments in the A. E. F., with the limited equipment and time 
at our disposal, could not be carried out satisfactorily. Experiments 
in choice reactions were attempted, but the results are too fragmen- 
tary to be of value. 122 
AVIATION MEDICINE IN THE A. E. E. 
A steadiness test was applied to 128 monitors and chasse pilots. 
This is a standard test in which the subject, while standing erect, is 
required to hold a stylus the size of a lead pencil in a small hole in 
a metal plate. The metal plate is adjusted so that it is on a level 
with the subject’s eyes. The stylus is connected with one pole of 
Fig. II.—Steadiness test apparatus. 
the electric battery, and the plate with the other pole. Consequently, 
if the stylus is allowed to touch the edge of the hole, a contact is 
made. A recorder, which is connected in series with the metal plate, 
records the contacts. In our tests, the subject was required to hold 
the stylus in the hole one minute with his arm kept free of his body. AVIATION MEDICINE IN THE A. E. F. 
123 
He was further instructed to attempt to breathe regularly and nor- 
mally, as holding his breath might cause disturbance and unsteadi- 
ness before the end of the minute. Four holes were used, the smallest 
of which was twelve sixty-fourths of an inch in diameter. 
In the treatment of the results, the records- were arranged in five 
groups on the basis of the tremor shown in the smallest hole. Group 
1 contains those records which show only a few scattering contacts, 
and group 5, those that show practically a continuous tremor. The 
others are distributed as accurately and evenly as possible in the in- 
termediate three groups. It was not considered reliable to depend 
merely upon counting the number of contacts, as many records varied 
in other ways. Several contacts might occur very close together, 
or one contact might be maintained for a longer or shorter time. 
For this reason, it was necessary to estimate the values. The rec- 
ords with the larger holes are not taken into consideration, though 
doubtless they have a significance distinct from the fine tremor that 
shows only in the smallest hole. The arrangement into five groups 
gives the following distribution: 
Group 1, 16 cases; group 2, 34 cases; group 3, 38 oases; group 4, 
19 cases; group 5, 21 cases. 
The best nine of the second group were selected and added to the 
first group, while the poorest four of the fourth group were selected 
and added to the fifth group, thus making 25 in each of the extreme 
groups. Of these it was found that the training department had 
rated 19 of those in the first group and 18 of those in the fifth group 
as follows: 
Rating. 
First 
group. 
Second 
group. 
Rating. 
First 
group. 
Second 
group. 
1 
i 
0 
5 
2 
7 
2 
5 
2 
6 
0 
0 
3 
9 
3 
7 
0 
0 
4 • 
2 
5 
8 
0 
1 
To determine the relation between this rating and our grouping 
according to tremor, Pearson’s cos II method 3 was used: 
■\jbc v 7. 1-1 
r = cos7CT n> P' E-r = ~F 
-ylad+-y/bc -yjn 
In this formula a represents the number of cases of very slight 
tremor (group 1) and high rating (1, 2, 3); b represents the number 
of cases of very marked tremor (group 5) and high rating (1, 2, 3); 
c represents the number of cases of very slight tremor (group 1) and 
low rating (4, 5, etc.); d represents the number of cases of very 
3 Whipple: Manual of Physical and Mental Tests, I, p. 48; Rugg; Statistical Methods Applied to Educa- 
tion, p. 294. 124 
AVIATION" MEDICINE IN THE A. E. F. 
marked tremor (group 5) and low rating (4, 5, etc.). This distribu- 
tion is shown in the following table: 
Rating 
1, 2, 3. 
Rating 
4, 5, etc. 
Total. 
a 15 
c 4 
19 
65 
d 13 
18 
20 
17 
37 
Applying the formulae to these results, we get r = .725 ± .181. 
This is a fairly high correlation, even when we consider the probable 
error (0.181) to be rather large. If we recall that it was assumed in 
the discussion of the correlations of reaction times, and training de- 
partment ratings, that the rating probably did not represent accu- 
rately the flying aptitude of the men rated, because of the personal 
equation of the rating officers, the present correlation must be con- 
sidered very high. 
The British have found that tremor showed a correlation with apti- 
tude in flying. According to Maj. Bowdler,1 of 54 candidates who 
were accepted in spite of marked tremor, the ratio of success to 
failure was 2.8 to 1. Among 2,000 candidates who showed no abnor- 
mal signs, 7.6 per cent only were ultimately rejected. 
According to Prof. Head,2 “tremor may be indicative of chronic 
indigestion or of alcoholic excess; unsteadiness of the fingers, espe- 
cially when they are abducted and brought together again, is a cer- 
tain sign of lack of control. Tremor is not so much an indication of 
a neuropathic temperament as of a definite disturbance of function. 
* * * But, apart from alcohol, it is one of the commonest signs 
of stress of war service.” 
Prof. C. Spearman suggested a modification of the steadiness test, 
which has been adopted by the British with favorable results. The 
subject is required to draw a line lightly and deliberately across the 
greater length of a sheet of foolscap. While drawing a second line 
in the same way, a loud and unexpected noise is made near his ear. 
In referring to this test, the British report3 states that in regard to 
the slight tremors, it “serves to differentiate the true significance of 
the tremor, and its general use is recommended in the examination 
of candidates.” 
There are many forms of steadiness test, both involving voluntary 
movement, as in Spearman’s test, and involving restraint of move- 
ment, as in the test we employed. Judging from the results of the 
British investigators, and from our own results, similar tests should 
1 Report of the Air Medical Investigation Committee, Special Report, Series No. 28,1919, p. 7 f. 
2 Henry Head, M. D., F. R. S.: “The Sense of Stability and Balance in the Air.” 
3 Report of the Air Medical Investigation Committee, No. 2,1918, p. 19. 125 
AVIATION MEDICINE IN THE A. E. E. 
be employed regularly in our Air Service. These results could be 
constantly checked with the records of the student flyers, and adapted, 
as seen fit, to give the most accurate diagnosis of a candidate’s flying 
aptitude, or of the regular flier’s present fitness to fly. No definite 
recommendations of the exact form of test to be used are given here, 
as there are so many possible modifications. The exact form of test 
to be used should be left to the present personnel of the psychology 
department of the Medical Research Laboratory. 
One of the officers of the psychology department at the Third 
Aviation Instruction Center was asked by the training department 
to apply for regular instruction in flying in order that the psychology 
department might obtain a more definite understanding of the 
problems with which it was attempting to deal. This officer, when 
assigned to flying duty, ate at the flying officers’ mess, reported at 
formations, and in every way possible conformed to the routine of 
flying training that a student flying officer undergoes. The complete 
R. M. A. course, including rouler, dual control, solo, acrobacy, and 
cross country, was taken. The types of machines flown were Nieu- 
ports, Avros, and DH. 4’s. The highest altitude reached was 10,000 
feet, and the longest cross country was about 150 kilometers. In addi- 
tion to the experience in flying, he was able to meet more intimately 
hundreds of flying officers, who talked much more freely than they 
did when they came to the laboratory. In this way the personality 
of the aviators and their flying aptitude, as observed on the field, 
were studied. The principal psychological factors observed during 
the first weeks of training can be only briefly stated here. 
It is well known to psychologists that in the acquisition of any 
complex act of skill there are often definite periods of lapse in im- 
provement due to certain difficulties in adjustment of the organism 
and also to the change in the attitude of the learner. The former 
should be understood by the monitors and others directly in charge 
of the cadet’s training, as it would be of assistance in preventing 
accidents as well as in judging the cadet’s ability. The latter is 
largely influenced by the student’s success, and also by the physical 
conditions surrounding him, such as quality of food, sleep, recreation, 
and the relation to his superiors. The writer could observe distinct 
set-backs in his own progress that were directly traceable to loss of 
sleep, due to restlessness. Also, the only time he experienced an 
approach to nausea in the air was following slight indigestion. He 
found it difficult on this day, after a “ vrille,” to level his plane again. 
There are also times when the aviator does not “feel like flying,” 
as he says. It is a common belief among aviators that he should not 
be compelled to fly at such times. There is no doubt that often this 
feeling can be overcome, but it is equally certain that it should 
always receive due consideration during the first weeks of training. 126 
AVIATION MEDICINE IN THE A. E. E. 
It is our belief that this “feeling” is misnamed. It is more like the 
experience of the tennis player when he has an “off” day. He can 
not account for his inability to play up to his usual standard. This 
is what happens to the aviator. The writer once experienced this 
“feeling,” but recognized that it was not typical of a lack of willing- 
ness or desire to fly. He attempted to fly, but after about 15 minutes 
in the air, during which time nothing seemed to go right, he decided 
it was needlessly dangerous for him to attempt it longer. This was 
after he had become fairly proficient in flying. On other occasions 
this feeling was more readily conquered, and he could “ pull himself 
together.” This characteristic should be thoroughly understood by 
those in charge of flying. Of course, in case of emergency, as at the 
front, it is another matter. 
A special condition, for which a psychological test should be de- 
vised, is the emotional stability of the aviator. The Italian psycho- 
physical laboratory made use of vasomotor reactions to measure 
the emotional disturbance caused by a pistol shot, a dash of cold 
water on the neck, etc. It is possible that this test, or the variations 
in reaction times as already noted, and claimed by the French, may 
be a sufficient test. However, it is believed that the experience of 
the sudden plunge of a plane in an unexpected direction is something 
no one can appreciate except those who have had the experience. 
The flier does not merely lose his balance at such a time. He has 
changed his position with reference to the earth by several hundred 
feet in a very few seconds. The rush of air, the abnormal pressure 
upon his viscera, and the loss of the direction of gravity, are capable 
of creating all the conditions of a violent emotion, which, if not 
checked quickly, become worse, and the aviator may lose all con- 
sciousness. There is no doubt that in many of the cases in which an 
aviator has been observed to dive or vrille a thousand feet or more to 
his death without an apparent attempt to right his machine, this 
condition has been responsible for his catastrophe. It seems, there- 
fore, that emotional stability is one of the important problems to be 
investigated. 
Balance in the air is undoubtedly controlled by the same factors 
as on the ground, viz, by the combination of impressions from the 
eyes, semicircular canals, skin, and muscles. As in normal activity, 
so in the air, a man may learn to do without one of these sense de- 
partments, particularly without vision, as in night flying, but it is 
extremely doubtful that he could learn to depend upon only one of 
them. Sensations from the skin and muscles are particularly 
important. 
A particular factor in landing, which seemed important, was 
ocular muscle balance, especially the speed of convergence. The 
writer observed that in landing he could judge distances fairly accu- AVIATION MEDICINE IN THE A. E. F. 
127 
rately except in the last part of the glide just before the redress. In 
the rapid approach toward the ground the muscles of convergence 
did not seem to act rapidly enough when he approached nearer than 
25 feet of the ground. The writer suffers from a slightly weak con- 
vergence, though it had never before been observed by him. 
As to the personality of the aviator, no general rule can be laid 
down. Quiet, methodical men were among the best fliers. What 
seems most needed by the aviator is intelligence; that is, the power of 
quick adjustment to a new situation and good judgment. He need 
not be so quick in motor adjustments providing he thinks clearly or 
makes rapid mental adjustments. The nervous, high strung, or those 
bordering on the temperamental, are the least reliable; for though 
they often become good fliers, no great reliance can be placed upon 
them. They are liable to become psychotic under stress. Excessive 
drinking is also a characteristic of this class. 
It is often claimed by aviators that a man can fly better when 
slightly under the influence of alcohol, and that a man who is not 
afraid, or too good, to drink is a better aviator. The latter observa- 
tion should not be limited, perhaps, to aviators; but its truth or 
fallacy need not be discussed here. The former statement bears 
some relation directly to flying, and there is an element of truth in 
the observation. It is a fact, acknowledged by psychologists, that 
alcohol in moderate doses tends to remove inhibitions that interfere 
with a man’s efficiency at the time, and thus increases his activity 
along directed lines. A sensitive, or bashful, individual is more free 
in his conversation, and more capable of talking to strangers or those 
he considers his critics in any way. In like manner, slight intoxica- 
tion removes the slight fear or consciousness of himself in the case of 
the aviator, and he is more able to direct his entire attention to the 
management of his plane. He is thus less awkward and more free 
and skilled in his activity. There are two dangers, however. Ex- 
cessive alcohol will remove inhibitions to the point that the flier 
becomes reckless, and wanting in good judgment. He may also lose 
control, both motor and mental. In the second place, alcohol has 
virtually the same effect as high altitude or low oxygen, as has been 
shown by preliminary experiments conducted by Maj. Dunlap at the 
Medical Research Laboratory, Mineola. The result would be to de- 
crease at the start the altitude to which a man might safely go. The 
result would be sudden intoxication, or complete mental and motor 
collapse. There is, therefore, nothing in the special claim of aviators, 
distinct from any other group, for the use of alcohol. 128 
AVIATION MEDICINE IN THE A. E. F. 
OBSERVATION-REPORT TEST FOR AERIAL OBSERVERS. 
Lieut. Schachne Isaacs, Sanitary Corps. 
A series of conferences was held with the instructors in the Observ- 
ers’ School at the Second Aviation Center, A. E. F., France. Some 
of these instructors had done very successful work at the front. 
Reports and discussions were given on the nature of aerial observation 
and the type of men best suited for it. Further information was 
obtained in informal talks with a number of observers who were 
returning through this center from active service at the front. The 
officer in charge, who was a clinician, and the psychologist of this 
medical research unit were already familiar with training of observ- 
ers in the States, having served on the unit at the School for Aerial 
Observers at Post Field, Fort Sill, Okla. The members of the unit 
were strongly impressed with the fact that the successful observer, 
on account of the demands made upon him and the importance of 
his work, must be a man carefully selected and highly trained to even 
a greater degree than the pilot. 
Some of the various duties of the observer have been briefly men- 
tioned in the introduction. These duties include visual reconnais- 
sance, missions in regard to air activity, as well as all matters of 
military importance taking place on the ground. These tasks are 
especially difficult on the days when the clouds are hanging low. 
What is called “Cloud reconnaissance”—a valuable type of work— 
gives a suggestion of the intelligence and keenness required of the 
observer. Very often the clouds are low and form a solid bank at 
probably 1,000 or 2,000 meters above the earth. The enemy takes 
advantage of the weather to move troops or convoys, which they 
would not attempt to do on clear days. To detect such movements, 
the observer climbs up through the clouds, then flies by compass 
until he arrives at the point he wishes to observe, dives down through 
the clouds, gets all the information that he can, climbs up through 
the clouds again, and goes to another point in the same manner. 
When the observer dives through the clouds, he must, of course, get 
his bearings and orient himself instantly, besides making accurate 
and detailed observations. 
Because of these demands on the observer, it was desirable to de- 
vise a laboratory test, capable of standard application and objective 
measurements of results, that might reveal individual differences in 
the quickness, accuracy and certainty of the observation of a situa- 
tion requiring definite study, especially of the nature and relation of 
parts, of its recall, and of its recognition when again presented. ' The 
test here described was applied to about 50 observers, and incidentally 
the introspection volunteered by many seemed to indicate that it 
involved a very similar mental performance to that in actual condi- AVIATION MEDICINE IN THE A. E. F. 
129 
tions of visual reconnaissance in aerial observation. A series of 
aluminum slides, 16 centimeters square, was prepared and each ruled 
off in 2-centimeter squares. At 6 or 7 of the 49 cross lines, holes 5 
millimeters in diameter were drilled. These holes were covered with 
red, green, or white tissue paper or gelatin. When a slide was inserted 
in the window of a light box and illuminated from behind, the holes 
appeared as colored lighted disks of about equal brightness on a 
black surface defined by a white border. The window was covered 
by a thin open-weave black cloth, and protected from side lights by 
a hood 14 centimeters deep. When unlighted, the surface of the 
slide appeared as a uniform black area. The light box, on a swivel 
base so that it could be swung around to the experimenter for chang- 
ing slides out of sight of the subject, was placed on the table at which 
the subject sat and about 1 meter in front of him. A slide was in- 
serted in the window, illuminated, and the subject given instruction 
and practice in plotting the arrangement by noting the relation of the 
disks to the border and to each other, and indicating their color on a 
piece of coordinate paper ruled in 1-centimeter squares. When the 
procedure was learned, the light was cut off and the practice slide 
removed and replaced by another. The subject had at hand a tele- 
graph key by which he could at will light the box and, by holding the 
key closed, keep it lit as long as he desired. He was instructed to 
turn on the light and study the arrangement of the colored disks 
Fig . III.—Observation-report test for aerial observers, 
171364—20 9 130 
AVIATION MEDICINE IN THE A. E. F. 
until he felt certain he could map them accurately with pencil on the 
coordinate paper and to do this in the shortest necessary time. The 
experimenter at his side, where he could watch his work, noted on a 
stopwatch: (1) The time taken for study. (2) The time to report the 
arrangement and indicate the colors. (3) Confidence of report under 
headings (a) “ Certain that it is accurate; ” (6) “ Doubtful if accurate,” 
indicating doubtful points by question mark; (c) “Certain that it is 
not correct,” the subject having been previously asked to say how 
certain he was of the accuracy of his report. (4) Accuracy of report 
and if incorrect or if confidence (b) or (c), another trial was given 
following the same procedure. (5) The number of trials necessary for 
accuracy and confidence (a). When this part of the test was com- 
pleted, the slide was removed, and a dozen slides (among which 
appeared several times at random the slide which had just been 
studied and mapped) were inserted in succession, illuminated by the 
experimenter, and the subject instructed to react by closing one of 
two keys as quickly as he identified each as the “same” or “ different” 
from the one he had learned. The time elapsing between the illumi- 
nation of the slide by the experimenter and the discriminative recog- 
nition reaction by the subject was measured by one one-hundredths 
seconds by a time marker on a kymograph. 
In scoring the results, the accuracy was graded on the basis of 100 
for correct reproduction, debiting 8J points for each misplaced disk, 
8J points for each wrong indication of color, and 16§ points for each 
disk added over the correct number, six, which was the number of the 
slide. The value of confidence was graded by assigning 100 for cor- 
rect report and judgment by the subject that he was certain of his 
accuracy (a); assigning 50 for both correct and incorrect reports 
where the judgment made was that he was uncertain as to accuracy 
(b); assigning 100 if incorrect and judged as certain that it was inac- 
curate (c); and assigning 0 where the judgment was made as certainly 
correct or certainly incorrect when the accuracy was the opposite of 
the judgment. Where several trials were necessary before a correct 
report with confidence “A” was made, the total time to study, the 
total time to report, the average accuracy, and the average value of 
confidence were calculated. The results of the group of 47 observers 
returned from service on the Front are given in Table 1. 
Table 1. 
M. 
P. E. M 
a 
Range. 
3.45 
±0.19 
1.93 
1 -8 
102.45 
±6.02 
61.20 
27.0-319.0 
149.04 
±9.33 
97.56 
18.0-434.0 
80.96 
±1.25 
12.68 
100.0- 50.0 
65.00 
±2.14 
21.75 
100.0- 17.0 AVIATION MEDICINE IN THE A.'E. E. 
131 
In the discriminative recognition reaction times comparison is 
made of the reaction times to the sixth and seventh slides in the 
series, the sixth being “different” and the seventh being “same,” 
having been preceded in the order: First, different; second, same; 
third, different; fourth, different, and fifth, same, the different slides 
in every case being different from each other as well. Forty-one 
observers returned from the front gave the results shown in Table 2. 
Table 2.—Discriminative recognition reaction time. 
1/100 seconds. 
Al. 
P. E.M 
<T 
C. 
Range. 
97.92 
±3.80 
36.10 
0.37 
46.0-227. 0 
92.55 
±3.30 
31.35 
.34 
34.0-159.0 
The difference between the averages of the two reaction times is 
very slight and not significant (D = 5.37, PED = 5.03), although the 
variability of the “ different” reactions is slightly more, and the range 
greater, than that of the "same.” 
An attempt was made to determine the relation of the performance 
in this test to success as an observer. Ratings 1, 2, and 3 (1 being the 
best) were made of these observers from the front by Capt. Cary, 
Medical Corps, at an interview which he held with each man, basing 
his estimate of the man’s success on a complex of impressions gained 
from the man’s appearance, manner, attitude, report of his experi- 
ence at the front, etc. Unfortunately, no more objective measure of 
the man’s success or failure at the front, and specifically as an observer 
on visual reconnaissance, could be obtained. For pdrposes of ade- 
quately verifying the test, such a rating would, of course, be neces- 
sary. Comparisons between two groups, Group 1 containing those 
rated 1, and Group 2 those rated 2 and 3, are shown in Tables 3 and 4. 
Table 3. 
Group 1 (24 cases), containing 
rating 1. 
Group 2 (23 cases), containing 
ratings 2 and 3. 
Group 1-group 2. 
1if. 
P. E. M 
<T 
C. 
M. 
P. E.M 
(J 
C. 
D. 
P. E. D 
Number of trials nec- 
essary 
3.75 
± 0.27 
1.99 
0.53 
3.13 
± 0.26 
1.84 
0.59 
0.62 
± 0.38 
Total time to study, 
seconds 
108.75 
± 7.05 
51.20 
.47 
95.85 
± 9.51 
67.80 
.71 
12.90 
±11.84 
Average time to 
study, seconds 
34.60 
± 2.29 
16.17 
.48 
37.20 
± 2.89 
20.60 
.55 
- 2.60 
± 3.68 
Total time to report, 
seconds 
162.51 
±14.26 
103.83 
.63 
135.00 
±12.42 
88.50 
.66 
27.51 
±19.12 
Average accuracy,per 
cent 
75.83 
± 1.82 
13.20 
.17 
86.30 
± 1.33 
9.46 
.11 
-11.30 
± 2.25 
Average value of con- 
fidence, per cent... 
59.17 
± 3.39 
24.42 
.41 
71.09 
± 2.39 
16.33 
.23 
-11.92 
± 4.15 132 
AVIATION MEDICINE IN THE A. E. E. 
Inspection of Table 3 does not seem to differentiate the two groups 
in any striking way. Differences in the means are present but not 
significant. The difference (D) between two means, in order to be 
significant, should exceed times the value of the probable error of 
the difference (PEP). In one case only, we find a significant differ- 
ence, that in the average accuracy, in favor of group 2. As to vari- 
ability (C), group 2 is somewhat more variable in the number of 
trials, average time to study, total time to report, and more so in 
total time to study, while group 1 is somewhat more variable in aver- 
age accuracy and more so in average value of confidence. In the case 
of average accuracy, while the difference in means is in favor of group 
2, the variability of group 1 is greater, and the coefficient of correla- 
tion between rating and accuracy was found to be high (0.482 ± 0.172, 
Pearson’s cos x method). Comparison of the two groups in discrimi- 
native recognition reaction time is shown in Table 4. 
Table 4. 
Group 1 (20 cases), contain- 
ing rating 1. 
Group 2 (21 cases), contain- 
ing ratings 2 and 3. 
Group 1-group 2. 
M. 
P. P. M 
(T 
C. 
M. 
P. E.„ 
a 
C. 
. D. 
P. P.D 
Reaction time “different,” 
1/100 second 
92.00 
±5.84 
38.78 
0.42 
98.32 
±4.61 
31.40 
0.32 
- 6.32 
±7.42 
Reaction time “s a m e,” 
1/100 second 
75.00 
±4.04 
26.84 
.36 
109.30 
±5.19 
35.30 
.32 
—34.30 
±6.58 
It is seen that group 1 is decidedly quicker than group 2 in recog- 
nizing the slide that has been studied and mapped (D = 34.30, 
PPD = ±6.58).' The coefficient of correlation was found to be very 
high between rating and quickness in this recognition (0.729 ± 0.173, 
Pearson’s cos x method). This fact is interesting when it is recalled 
how important such recognition is in conditions of actual aerial 
observation. Group 1 is quicker in identifying the “same” than the 
“different” (18.5 per cent), while group 2 is slower (11.2 per cent), 
although the difference in the means can hardly be regarded as 
significant (group 1, D = 17.00, PE»= ±7.10; group 2, D= — 10.98, 
P Ed — ± 6.94). 
It would be desirable if this test or some similar test could be ap- 
plied to a large number of cases and correlated more strictly with 
ability in visual reconnaissance, so that more reliable results could be 
obtained for developing a quick and trustworthy method of selecting 
the best men and eliminating the unfit for this important and highly 
specialized work in aerial observation. Chapter V. 
DEPARTMENT OF OTOLOGY. 
Lieut. Col. Henry Horn, Medical Corps. 
THE ROLE OF THE LABYRINTH IN FLYING EFFICIENCY.—A 
STUDY OF 768 CASES AT THE THIRD AVIATION INSTRUC- 
TION CENTER, A. E. F., FROM SEPTEMBER, 1918, TO 
JANUARY, 1919. 
The history of the birth of new discoveries, or the application of 
old principles in a new and radical manner, is usually the same; the 
proponents of the new ideas see the millenium well within their 
grasp; the opponents endeavor savagely to tear down the pillars 
which support the new structure. Out of it all comes finally the 
truth—conservative minds, not fired with the joys of discovery or 
exuberated by the strife, gradually sift out the best and give to the 
world that which can be used. 
The greater part of the otological examinations in detail in this 
department were made by Capt. Claude Uren, Medical Corps. 
The use of the turning chair and the importance of the labyrinth 
to aviators have led to much research work and arguments for and 
against. 
From the time of the first examinations, 768 aviators passed 
through the hands of the board, and not only were the cases studied 
from the standpoint of the otologist, but the most thorough examina- 
tions were made from the ophthamological, internal medical, physio- 
logical, psychiatrical, and psychological viewpoints as well. 
We are concerned in this study mainly with the otological side. 
The details of the findings of the other departments are to be found 
in other chapters. 
For several reasons these results are worthy of special considera- 
tion. The examinations were made by trained aviation medical 
men who had had large previous experience along exactly similar 
lines in the aviation camps in the United States; the aviators were 
under satisfactory conditions of military control, and an “esprit de 
corps” was early established by the flight surgeons and other men, in 
such a way that the Medical Research Board was freely consulted 
and the men were without fear that their flying status would be 
jeopardized or shortened by our studies. 134 
AVIATION MEDICINE IN THE A. E. E. 
It was early seen that the work, from the otological standpoint, 
would divide itself into two main groups: (1) Those aviators who 
complained of a hypersensitiveness to motion with disturbing laby- 
rinth symptoms of various kinds which would in some way interfere 
with their flying; (2) those who gave no history of hypersensitiveness 
to motion, but during routine examinations were found to show 
labyrinthine findings, which characterized the first group. 
Hypersensitive to Motion Type. 
The hypersensitive to motion type, as we designated the men in 
these groups, with its characteristic symptom complex, was naturally 
the most interesting and it early developed that in this group a dis- 
tinct history of sensitiveness to other forms of motion than that 
produced in the chair and the air could be brought out, even before 
its presence was noted in their air work. 
In drawing any conclusions from the results of these studies, it 
must always be clearly borne in mind that, on the one hand, all the 
candidates had been examined previous to their admission into the 
service for hypersensitive labyrinths, and the marked cases dis- 
qualified. On the other hand, it would be equally fallacious to 
consider that the hypersensitive men who came to our notice in the 
A. E. F. developed this hypersensitiveness after they entered the 
service, on the assumption that all men with 35 seconds or above 
or 16 seconds or below had been automatically cut out by the 
original entrance examinations. 
Hypersensitive Cases. 
The hypersensitive cases proved to be surprisingly few and con- 
firmed the belief that had been growing in the minds of most men 
experienced in this work, that, given a properly functioning, well- 
balanced labyrinth, low nystagmus time is a matter of very little 
importance. 
Certainly we can not get away from the practical fact that if a 
candidate goes through his training with honors, continues his flying 
without accident, and is satisfactory to his instructors he can be 
regarded as a reliable type. 
From this position only two conclusions are possible, if by chance 
we find that such men classed as satisfactory by the flying officers 
have abnormal labyrinthine findings: (1) Either such findings are of 
no value so far as efficiency goes, or (2) they have so accommodated 
themselves to the apparently hypersensitive labyrinth, that it bears 
no relation to the quality of their air work. 
Equally true it is that if the candidate appears before the board 
and complains of symptoms of hypersensitiveness in the air and the AVIATION MEDICINE IN THE A. E. F. 
135 
examination discloses the fact that he possesses a hypersensitive 
labyrinth—the conclusion is fair that the hypersensitive labyrinth 
plays a causal rdle in the matter. 
Another side of the question, which demands attention and which 
this work helped to solve, is whether in the light of our recent experi- 
ence the original labyrinth examinations for admission into the 
service were worth while and whether we should modify or omit 
such examinations in the future. 
A proper appreciation and a fair analysis of the factors involved in 
these various groups will help us add a little knowledge to the 
question involved in the title of this article. 
The material at the Third Aviation Instruction Center was unique 
and the facilities for study were such that one could scarcely hope 
ever again to have a body of men of certain definite types under 
such practical observational conditions. In the first place they were 
men who had been culled out in the States, both physically and 
through the attritional grinding of the ground schools. They were 
all fliers of more or less experience and were eager to cooperate with 
the Medical Research Board. They were intelligent and took a keen 
interest in the results of the examinations. They were all working 
toward the same end, namely, to make themselves as quickly fit as 
possible for the great adventure of their lives. The results of a great 
group study of such a body of men should be dependable and should 
give us a very fair viewpoint of the role of the labyrinth in flying 
efficiency. 
The Normal Type, 
Much discussion has arisen as to what constitutes the normal or 
average labyrinth findings and whether our standards for the aviation 
candidates, more or less empirically selected in the very beginning of 
the aviation examinations, were too high or too low. 
Table 1. 
Nystagmus. 
Totals of 842 cases (including monitors and men from 
Nystagmus to right.... 
. . 24. 32 
front). 
Totals of monitors, 79 cases 
.Nystagmus to right.. 
.. 24.40 
Totals of men from Front, 120 cases 
.Nystagmus to right. . 
.. 23.61 
Totals of men examined in States, over 50.000 
.Nystagmus to right. . 
.. 23.00 
Totals of 830 cases (including monitors and men from 
Nystagmus to left 
.. 24. 18 
Front). 
Totals of monitors, 78 cases 
.Nystagmus to left 
.. 24.32 
Totals of men from Front, 119 cases 
.Nvstagmus to left 
.. 23.77 
Totals 6f men examined in States, over 50,000 
.Nystagmus to left— 
.. 23.10 136 
AVIATION MEDICINE IN THE A. E. F. 
Past Pointing. 
Totals of 818 cases (including monitors and men from P. P. toright,riglithand. 2. 53 
Front). 
Totals of monitors, 79 cases P.P. to right, right hand. 2.27 
Totals of men from Front, 117 cases P.P. to right, right hand. 2.29 
Totals of men examined in States, over 10,000 P.P. to right, right hand. 3. 8 
Totals of 819 cases (including monitors and men from P. P. to right, left hand. 2. 31 
Front). 
Totals of monitors, 79 cases P. P. to right, left hand. 2. 25 
Totals of men from Front P. P. to right, left hand. 2. 20 
Totals of men examined in States, over 50,000 P. P. to right, left hand. 3. 7 
Totals of 614 cases (including monitors and men from P. P. to left, right hand. 2. 30 
Front). 
Totals of monitors, 78 cases P. P. to left, right hand. 2.35 
Totals of men from Front, 115 cases P. P. to left, right hand. 2. 22 
Totals of men examined in States, over 50,000 P. P. to left, righthand. 3. 8 
Totals of 811 cases (including monitors and men from P. P. to left, left hand.. 2. 35 
Front). 
Totals of monitors, 79 cases P. P. to left, left hand. 2. 34 
Totals of men from Front, 115 cases P. P. to left, left hand. 2. 32 
Totals of men examined in States, over 50,000 P. P. to left, left hand. 3. 7 
Totals of 55 cases (including monitors and men from .Vertigo 19. 6 
Front). 
Totals of monitors, 79 cases Vertigo 17.1 
Totals of men from Front, 115 cases Vertigo 19. 50 
Vertigo. 
A compilation of results of the labyrinth findings was made on 
more than 50,000 cases examined for admission into the Aviation 
Service by the Statistical Bureau at Washington. It will be recalled 
that these examinations were made by men specially trained in their 
work and all used, as far as possible, a standard technique. The 
results of such a large experiment must be accepted as nearly correct 
as lies within human capabilities. The very size of the aggregate, 
the fact that the results were obtained from different men in different 
parts of the United States, makes the average dependable. 
In order to make our present study as free from criticism as pos- 
sible, one examiner, who had examined thousands of candidates in 
the States, made over 75 per cent of all the otological examinations, 
and the results after final tabulation agree so closely with those given 
by the early examinations in America that the accuracy of both sets 
of statistics seems to be established. 
There is a limit of accuracy in the observations of nystagmus time, 
as well as a possible variation in all individuals from day to day, 
that makes it extremely questionable whether one is ever justified in 
drawing conclusions from results wherein the difference does not 
exceed two seconds. AVIATION MEDICINE IN THE A. E. F. 
137 
The idea held by many investigators that nystagmus time and 
past pointing are lowered by air work is not borne out by the fol- 
lowing figures. 
Table 1 is designed to give a bird’s-eye view and summary of all 
the vestibular examinations made by the Medical Research Board in 
the A. E. F. and at the same time compares them with the results 
of the 50,000 cases examined in the United States. The right and 
left hand tests are grouped separately. All statistics were calculated 
on adding machines and the results checked. The following observa- 
tions are allowable: 
NYSTAGMUS. 
There is no appreciable difference between the right and left 
side. This is in accordance with the American statistics. 
The apparent lowering of the average of the men from the front 
is interesting but has probably no significance. It runs a little, over 
a half a second lower as compared with the average run of men at 
the Third Aviation Instruction Center, but it is a little over a second 
higher than the general average given from the 50,000 candidates 
for admission into the Aviation Service at the beginning of the war. 
Our observations were made with extreme care and accuracy, one 
man examining practically all the cases, and frequent checkings 
would show less than a second’s difference between two observers. 
The fact that the monitors, who were doing from four to six hours 
of flying a day at the time of the examinations, show no reduction 
as against the students, is the best evidence that the apparent 
lowering in the men from the front is of no significance. 
PAST POINTING. 
Here there is very little difference between the various classes. 
The past pointing in the States is markedly higher, about 1.4 on the 
average. The ability to correct an exaggerated past pointing is 
rapidly acquired. It is a matter of fact that aviation students, all 
of them with previous chair or air experience, make earnest endeavors 
to accommodate themselves to vertigo, and for obvious reasons. 
This may be one reason why the general average was lower in the 
A. E. F., as it must be remembered that all of the men examined had 
had previous chair experience, while candidates in the States were 
having their very first sensation of vertigo, due to turning. 
Table 2.—Labyrinth findings, arranged by months. 
SEPTEMBER, 1918. 
Nystagmus, to right, 68 cases : 24. 55 
Nystagmus, to left, 67 cases 25.10 
Past pointing to right, with right hand, 67 cases 2. 47 
Past pointing to right, with left hand, 67 cases 2. 43 
Past pointing to left, with right hand, 68 cases 2. 25 
Past pointing to left, with left hand, 67 cases *. 2.18 138 
AVIATION MEDICINE IN THE A. E. F. 
OCTOBER, 1918. 
Nystagmus to right, 119 cases 25. 24 
Nystagmus to left, 111 cases 25. 41 
Past pointing to right, with right hand, 112 cases 2. 54 
Past pointing to right, with left hand, 112 cases 2. 35 
Past pointing to left, with right hand, 110 cases 2. 32 
Past pointing to left, with left hand, 109 cases 2. 43 
Vertigo to the right, 114 cases 23. 33 
Vertigo to the left, 36 cases 22. 36 
Nystagmus to right, 254 cases 24. 69 
Nystagmus to left, 254 cases 24. 32 
Past pointing to right, with right hand, 245 cases 2. 41 
Past pointing to right with left hand, 246 cases 2. 35 
Past pointing to left, with right hand, 243 cases 2. 32 
Past pointing to left, with left hand, 244 cases 2. 32 
Vertigo to the right, 245 cases 18.17 
NOVEMBER, 1918. 
DECEMBER, 1918. 
Nystagmus to right, 202 cases. 23.13 
Nystagmus to left, 201 cases 23. 25 
Past pointing to right, with right hand, 198 cases. 2. 2 
Past pointing to right, with left hand, 198 cases 2. 27 
Past pointing to left, with left hand, 197 cases 2. 231 
VERTIGO. 
The average time of vertigo is given with no claim as to the value 
of this test. It was taken as part of the routine examination in 
connection with other observations and represents in a general way 
an average. 
This test would at first seem to be subject to many inaccuracies. 
In fact, when used with candidates for admission or those unaccus- 
tomed to peculiar forms of motion, its accuracy is doubtful; but in 
the testing of men who have had air experience, the results of the 
vertigo examinations from day to day or from test to test were 
strikingly constant. Repeatedly there would be no difference at all, 
or perhaps a difference of less than two seconds, between two observa- 
tions on the same individual in different days. The wide variations 
found in nonfliers are due to the confusion produced by the vertigo, 
to which they are unaccustomed and which militates against accurate 
subjective observation. 
Table 2 is a separate study of the results of the same tests by 
months. It was thought worth while to see if, as the training 
progressed or if the terrific strain which the men were under in 
October and the early part of November, when students were being 
forced through the school as rapidly as possible, had any influence on 
the labyrinth reactions. AVIATION MEDICINE IN THE A. E. E. 
139 
The differences are all in fractions of a second, or less than a com- 
plete past pointing, and evidently represent no real differences due 
to the period of training or the effect of strain. The vertigo was 
4.19 seconds greater in October than November, and again in Decem- 
ber raised to 19.2 seconds over 18.17 seconds, but I am loath to admit 
this has any real significance. 
Table 3.—Comparison of seasoned fliers and inexperienced men. 
MEN FROM THE FRONT. 
Nystagmus to right, 120 cases 23. 62 
Nystagmus to left, 119 cases 23.18 
Past pointing to right, with right hand, 117 cases 2. 30 
Past pointing to right, with left hand, 117 cases 2. 20 
Past pointing to left, with right hand, 115 cases 2. 22 
Past pointing to left, with left hand, 115 cases 2. 32 
Vertigo to the right 19.51 
MONITORS. 
Nystagmus to right, 79 cases 24. 40 
Nystagmus to left, 78 cases -V , 24. 34 
Past pointing to right, with right hand, 79 cases 2. 27 
Past pointing to right, with left hand, 79 cases 2. 25 
Past pointing to left, with right hand, 78 cases 2. 358 
Past pointing to left, with left hand, 79 cases 2. 24 
Vertigo to the right 17.1 
SUMMARY OF AMERICAN STATISTICS. 
Nystagmus to right - 23. 00 
Nystagmus to left 23.1 
Past pointing to right, with right hand 3. 8 
Past pointing to right, with left hand 3. 7 
Past pointing to left, with right hand 3. 8 
Past pointing to left, with left hand 3. 7 
(Over 40,000 eases.) 
Table 3 is a regrouping of men from the front, monitors, and the 
statistics from the United States arranged to show the labyrinth 
reactions according to the group under study. It will be noted that 
the differences are remarkably small between the different groups. 
Exceptions in the case of the past pointing have already been 
mentioned. 
The conclusion seems obvious: That the amount of air work which 
these men have had, ranging in the case of students from an average 
of less than one hour a day or a total of 30-50 hours during their 
training, to the monitors who are in the air 4-6 hours daily, does 
not in any way materially lower their labyrinth reactions. It is 
equally obvious, judged from the practical standpoint of results 
achieved, that during the same period they accommodate themselves 
to new and unusual motion stimuli and are turned out finished fliers. 140 
AVIATION MEDICINE IN THE A. E. F. 
The mechanism of this accommodation to unusual forms of motion, 
of the rapid and complete compensation to the various forms of 
vertigo, brought about by air conditions, is a question of great com- 
plexity. A satisfactory explanation is not at hand, but it seems 
certain that it involves other factors than the simple accommoda- 
tion of the labyrinth to new stimuli. We are certainly here dealing 
with a problem in which the psychological element is an important 
one. Our studies along these lines are replete with interest. 
Every gradation of the ability of a hypersensitive labyrinth to 
accommodate itself to the requirements of successful flying has been 
met with. From a well-known American ace, who in his early acro- 
batic work on the field was a very hypersensitive type—even to the 
point of vomiting—to the extremely rare type of student, who, after 
his first experience in acrobatics, is willing to give up flying, we have 
encountered every phase. We are dealing with the unanalyzable 
phenomena of “nerve,” and this is a factor which is difficult to 
subject to statistical examination. 
With a large and generous quality of this typical American charac- 
teristic, many deficiencies were overcome. On the other hand, fight 
it out as they did, some of the grittiest of the students were unable 
to overcome the handicap of a hypersensitive labyrinth and were 
obliged to discontinue or modify their training. 
The exceptions do not prove the rule. These studies convince us 
that more than ever the original examinations were worth while. 
If we erred at all, it was on the side of too great leniency as far as 
the labyrinth examinations were concerned. The hypersensitive type 
is worthy of deep consideration, and where recognized should be 
admitted to the service with greatest caution. 
At a conservative estimate 10 per cent of the men who passed 
through the board, from the standpoint of the labyrinth, should 
never have been trained. The saving in lives and in time, in this 
effort to fit round pegs into square holes, would have been worth 
while. 
THE HYPERSENSITIVE TO MOTION TYPE. 
This term, although somewhat awkward, expresses exactly the 
condition of these men and is used throughout this article as fairly 
descriptive. 
It is the type “par excellence,” which comes within the region of 
labyrinth investigation, and its solution can in large part be shown 
by labyrinth findings. AVIATION MEDICINE IN THE A. E. F. 
141 
Table A.—Table of hypersensitive to motion type, arranged according to symptoms. 
No. 
Nystagmus. 
Past point- 
ing. 
Vertigo. 
Falling. 
Nausea. 
Vomiting. 
Turning. 
| Seasick. 
j Merry-go- 
I round. 
| Swing. 
Car. 
| Avro. 
u! 
'■< 
Remarks. 
122 
128 
(27-26 
2-2 2-1... 
Ex. 
0 
0 
0 
}° 
0 
0 
0 
0 
0 
0 
0 
Full duty. 
Hyper, laby. Class C. 
T. B. 
(23-24 (10/28) 
23-35 
2-1 1-2... 
5-5 
17 
N 
B 
0 
0 
0 
0 
0 
0 
Y 
0 
0 
130 
/25-30 
4-3 3-4... 
In 
0 
0 
0 
0 
(25-30 
T. B. 
1° 
131 
27-26 
30 
N 
0 
| 
0 
Y 
0 
Y 
Y 
0 
0 
Eye trouble. 
[33-42 
Ex. 
140 
•(32-40 
io 
0 
0 
Y 
Y 
Y 
0 
Y 
Y 
Hyper, laby. Class B. 
124-31 23-35 
(10/28)... 
Ex. 
1 
145 
(27-28 
2-2 '2-2... 
38 
Ex. 
0 
0 
0 
Y 
0 
0 
0 
Class B. Eye. 
(25-27 (10/24) 
27-25 
38 
Ex. 
0 
0 
0 
148 
158 
3-2 2-3... 
\ 
25 
Ex. 
Ex. 
Y 
Y 
Y 
Y 
0 
Y 
Observer. 
Grounded. 
123-30 
0 
0 
0 
0 
(22-28 
165 
26-27 
4-4 4-4... 
45 
Ex. 
Y 
0 
0 
Y 
0 
0 
0 
Y 
Y 
Full duty. 
Full duty. 
Temp, unfit. Class C. 
Finally overcame trouble. 
169 
30-30 
3-3 3-3... 
30 
N 
0 
0 
0 
Y 
0 
0 
Y 
0 
0 
179 
190 
33-35 
2-2 2-2... 
|5-2 1-1... 
30 
N 
Sub 
0 
0 
0 
0 
Y 
Y 
Y 
0 
0 
0 
0 
126-40 
0 
0 
0 
(25-40 
191 
'32-34 
2-2 2-2... 
16-15 
0 
0 
0 
0 
0 
0 
0 
Y 
Y 
Hyper, laby. Class B. 
(Sub normal case with 
116-17 
1-1 1-1... 
15 
Sub 
SI 
0 
0 
W 
0 
202 
(13-14 (10/25) 
30-32 
1-1 1-1... 
12-11 
0 
0 
0 
F 
\ nausea. 
210 
2-3 3-2... 
18 
Sub 
0 
0 
0 
Y 
Y 
Y 
Y 
0 
0 
Routine after Fly. F. D. 
Class A. 
No stereoscopic V-Class 
B, E. and L. 
Poor type, but passed 
test. 
227 
32-30 
3-3 3-3... 
25 
Sub 
0 
0 
0 
Y 
Y 
Y 
Y 
0 
0 
231 
28-27 
4-2 3-3... 
53 
Ex. 
Y 
0 
0 
Y 
Y 
Y 
Y 
Y 
Y 
134-36 
232 
4-4 4-4... 
38 
\ Ex. 
0 
0 
0 
0 
Grounded on Avro work. 
(11-42 40-42 
36-36 
31 
Y 
Y 
234 
33-34 
3-4 4-2... 
’ Ex. 
0 
0 
0 
Y 
Y 
* 
0 
Y 
Y 
Grounded on lab. 
237 
13-15 
T-l 1-T.. 
10-9 
SI 
0 
0 
0 
Y 
0 
0 
0 
Y 
Y 
Lack of conf. Ear.* 
240 
33-35 
T-T 1-1.. 
13—14 
N 
0 
0 
0 
0 
Y 
0 
0 
0 
0 
0 
Y 
T. B. Class C. 
120-20 
3-2 2-3... 
20 
Ex. 
Class C. Ears. 
247 
(16-16 (11/14) 
30-34 
16 
Ex. 
F 
0 
348 
3-3 3-3... 
N 
0 
o 
0 
0 
Y 
Y 
Y 
0 
0 
Full duty. 
Stopped flying at Avro 
field. 
Class A. 
87 
23-24 
4-3 3-4... 
23-20 
Ex. 
Y 
o 
0 
0 
Y 
0 
0 
Y 
0 
101 
30-30 
3-3 3-3... 
25-25 
Ex. 
0 
0 
0 
Y 
0 
0 
0 
0 
Y 
347 
24-17 
1-T 
25-25 
N 
N 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
Y 
Grounded-dipl. and deaf. 
(Trouble due to conv. 
126-20 
J-3-3 3-2... 
288 
\28-26 
0 
0 
0 
\ insu. 
521 
26-24 
4-3 3-3... 
22 
N 
0 
Y 
0 
0 
0 
0 
0 
Y 
Y 
Class A. Overcame 
168 
22-22 
4-5 5-4... 
37 
N 
0 
o 
0 
Y 
0 
0 
Y 
0 
0 
trouble. 
Full duty. Ear not 
poiiop 
Class C. Hyper Laby. 
Class C. Temp, unfit. 
Hyper, due to infection. 
Hyper. Ferry work. 
(Temp. cond. due to 
( drink. 
499 
372 
33-34 
20-18 
4-3 3-4... 
2-2 1-2... 
13 
23 
N 
N 
0 
Y 
0 
0 
0 
Y 
Y 
0 
0 
0 
Y 
Y 
0 
Y 
0 
0 
0 
Y 
268 
(48-43(11/5).. 
(35-34 (11/8).. 
30-30 
2-2 2-2... 
2-2 2-2... 
5-4 4-5... 
Vl 5 
N 
Y 
0 
0 
0 
Y 
Y 
265 
1 
35 
N 
N 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
124-20 
j.‘i-3 2-3... 
295 
(26-24 !. 
0 
254 
35-32 
4-3 3-4... 
22 
N 
Y 
0 
0 
0 
0 
0 
0 
0 
Y 
Full duty. 
Stop flying at Avro. 
Stop flying. Temp, unfit. 
Full duty. 
Flying record poor. 
Full duty. 
Class A. 
354 
30-24 
6-4 2-2... 
24 
Ex. 
0 
0 
0 
0 
0 
0 
0 
Y 
Y 
372 
20-18 
2-2 1-2 . 
23 
N 
Y 
0 
0 
Y 
Y 
Y 
Y 
0 
Y 
369 
33-32 
3-3 3-3... 
27 
Y 
0 
0 
Y 
Y 
Y 
Y 
Y 
Y 
37 
26-26 
4-3 1-2... 
0 
o 
Y 
0 
0 
0 
0 
0 
Y 
350 
33-32 
3-3 3-3... 
30 
N 
Y 
0 
0 
Y 
Y 
0 
0 
0 
Y 
365 
26-26 
2-2 2-2... 
22 
Ex. 
Y 
0 
0 
Y 
0 
0 
Y 
0 
1' 
171 
28-27 
3-3 3-3... 
23 
0 
0 
Y 
0 
Y 
Y 
0 
0 
0 
Discontinue training. 
252 
24-25 
2-2 2-2... 
30 
Ex. 
Y 
Y 
Y 
0 
0 
0 
0 
Y 
Y 
72 
7-8 7-4... 
35-37 
Ex. 
Y 
0 
0 
0 
0 
0 
0 
0 
Y 
Class A. 
48 
30-35 
3-1 1-3... 
0 
0 
Y 
0 
0 
0 
0 
0 
Y 
Fly. rec. 
Ferry pilot. 
Flying record poor. Fin. 
lashed from Avro. 
Put on large machine. 
30 
14-17 
2-1 1-1... 
16-14 
N 
Y 
0 
0 
0 
0 
0 
0 
0 
0 
29 
40-36 
3-3 1-2... 
Y 
0 
0 
0 
0 
0 
0 
0 
0 
26 
4 
31 35 
3-2 2-2... 
Y 
o 
Y 
Y 
Y 
Y 
Y 
0 
Y 
35-36 
3-3 3-2... 
Y 
0 
0 
0 
0 
0 
0 
0 
Y 
i 
21-21 
2-2 2-3... 
Mark. 
Y 
0 
Y 
Y 
Y 
Y 
Y 
Y 
Y 
Poor in Avro. Final air 
130-28 
6-7 7-6... 
| 
work good. 
102 
[-30-30 
l 
Mark. 
0 
0 
Y 
0 
0 
0 
0 
0 
Y 
To fly with caution. 
126-27 (11/14) 
122-35 
8-4 4-3... 
j-3—3 3-2... 
f 
0 
121 
N 
0 
0 
0 
0 
Full duty. 
(23-30 
143 
35-34 
2-2 2-2... 
(?) 
20-20 
N 
0 
0 
Y 
0 
Y 
0 
0 
0 
Full duty. 
Dizziness not due to ear. 
141 
25-25 
2-2 2-2... 
0 
0 
0 
0 
0 
0 
0 
0 
Y 142 
AVIATION MEDICINE IN THE A. E. F. 
Table 4.— Table of hypersensitive to motion type, arranged according to symptoms— 
Continued. 
© 
£ 
Nystagmus. 
Past point- 
ing. 
Vertigo. 
Falling. 
| Nausea. 
j Vomiting. 
| Turning. 
Seasick. 
1 Merry-go- 
round. 
Swing. 
Car. 
o 
> 
< 
*-4# 
< 
Remarks. 
97 
22-25 
2-3 
3-2... 
15-18 
0 
0 
0 
o 
0 
0 
0 
0 
Y 
438 
36-36 
3-4 
3-3... 
30 
N 
0 
0 
0 
0 
Y 
0 
Y 
Y 
Y 
Never passed beyond 
Avro. 
259 
30 29 
2-2 
2-2... 
18 
S.E. 
0 
0 
0 
0 
0 
0 
0 
0 
Y 
Dizziness not due to ear. 
289 
32-32 
14 
Y 
0 
Y 
0 
0 
0 
0 
0 
0 
416 
34-33 
4-4 
4-4... 
30 
Ex. 
Y 
0 
Y 
Y 
Y 
Y 
Y 
Y 
Y 
Dis. training at Avro. 
262 
34 33 
23 
N 
0 
0 
0 
5' 
Y 
Y 
Y 
0 
() 
252 
24-25 
2-2 
2-2... 
30 
S.E. 
0 
0 
0 
0 
0 
0 
0 
Y 
Y 
Full duty. 
342 
26-26 
3-3 
2-1... 
20-20 
N 
0 
0 
0 
Y 
Y 
Y 
Y 
Y 
Y 
Nothing in ear to acct. 
for hyper. 
262 
24-33 
3-3 
3-3... 
23 
N 
0 
0 
0 
Y 
Y 
Y 
Y 
0 
Y 
Full duty A. 
265 
30-30 
5-4 
4-5 -.. 
35 
N 
0 
0 
0 
0 
0 
0 
0 
0 
0 
Ear has not inf. on genl. 
cond. 
254 
35-32 
4-3 
3-4... 
22 
N 
Y 
0 
0 
0 
0 
0 
0 
0 
Y 
Air trouble, may be due 
to ear. 
416 
34-33 
4-4 
4-4... 
30 
Ex. 
Y 
0 
Y 
Y 
Y 
Y 
Y 
Y 
Y 
Hyper to motion. Class C. 
354 
30-24 
6-4 
2-2... 
24 
Ex. 
0 
0 
0 
0 
0 
0 
0 
Y 
0 
Ear has no inf. on genl. 
cond. 
295 
24 25 
3-3 
2-3... 
i20—24 
N 
0 
0 
0 
0 
0 
0 
0 
0 
Y 
Temp. cond. Class A. 
456 
36 34 
2 1 
4-4... 
29 19 
o 
0 
o 
o 
() 
0 
o 
o 
y 
2 
28-28 
3-3 
3-3... 
23 
N 
0 
0 
0 
0 
Y 
Y 
0 
Y 
Y 
Slight hyper. Air work 
216 
38-40 
6-6 
6-6... 
40 
S.E. 
0 
0 
0 
0 
0 
0 
0 
Y 
Y 
Grounded. 
423 
34-35 
2-4 
2-4... 
24 
N 
0 
0 
0 
0 
0 
0 
0 
0 
0 
Hyper due to F. I. 
369 
33-32 
3-3 
3-3... 
27 
Ex. 
Y 
0 
0 
0 
0 
0 
0 
Y 
Y 
Local infection caused 
trouble. 
300 
24-26 
3-3 
4-4... 
18 
N 
0 
0 
0 
Y 
0 
0 
0 
0 
Temp. cond. Class A. 
297 
25-23 
25 
N 
Y 
o 
0 
6 
0 
0 
0 
0 
0 
Class C. 
294 
30-26 
3-2 
2-1... 
22 
N 
0 
0 
0 
0 
0 
0 
0 
0 
Y 
Yellow. 
As it subsequently developed, it is unfortunate that in the original 
examinations for admission to the service more weight was not laid 
on the history of Tiypersensitiveness to motion. Candidates were 
originally asked if they had ever been seasick and, if so, how severely. 
In the light of our recent knowledge, as the following table will show, 
if the questions had been carried a little further much additional 
interesting information would have been obtained, and many of the 
truly hypersensitive cases could have been excluded. 
The types of motion which were particularly investigated were: 
Seasickness, swings, merry-go-rounds, car sickness, and air sickness 
due to motion of the plane. 
The combinations which Table 4 brings out are curious and show 
that a person is very seldom sensitive to one type of motion alone. 
There seems to be no one combination favored more than the others. 
That this history of hypersensitiveness to motion, when carefully 
elicited, should be taken seriously in the selection of candidates, is 
shown by the fact that of 76 cases, 40 were obliged to discontinue 
or modify their air career and that 17 or 22 per cent of them were 
grounded from this cause alone. 
In studying the way in which their air work was modified by this 
condition, full access was had to the official reports of the flying records 
of these candidates. Table 3 is given in detail in order to bring out 
the remarks taken from such records. 143 
AVIATION MEDICINE IN THE A. E. F. 
Table 4 is perhaps the most important one in this study. All 
cases wmch came betore the ooard and which gave a history of being 
hypersensitive to any sort of motion, whether they realized that it 
had affected their air work or not, are here analyzed. 
In many of these cases two examinations have been made and the 
second examination on a later date serves to emphasize the difference 
in the findings taken on different days. Thus in case 268 there is a 
difference of almost 10 seconds and in other cases even greater varia- 
tions may be noted. It is to be remarked that case 268 was put on 
ferry work, which means, simply flying machines from one place to 
another, and in which the element of acrobatics is entirely eliminated, 
or in the case of 232, where the man was grounded because he was 
unable to do his work properly on the Avro or acrobatic machines. 
It will also be noted that the vertigo runs unusually high in cases, 
and that this is often combined in the column of remarks with either 
poor flying or reasons for grounding. In the column of falling 
reactions, a far greater proportion than usual are marked “exagger- 
ated” (ex.), markedly exaggerated (mark), or slightly exaggerated 
(S. E.). 
Twenty-seven cases out of 57 are marked nauseated, which is over 
47 per cent. Seven out of the group vomited during the test. 
In the subsequent columns devoted to different types of hyper- 
sensitiveness motion “0” stands for negative answer and “Y” or 
“Yes” for positive answer. The men were quizzed very closely as to 
their experiences in merry-go-rounds (often designated as carousels), 
swings, trains, and street cars, experiences on the sea, the result of 
their work in the Avro, which was one of the airships used at Issoudun 
for trick flying and air acrobatics, and finally were questioned regard- 
ing their experience in air work in general. 
Often these experiences dated from early childhood, as early as 
the fourth and fifth year, and the hypersensitiveness had been over- 
come up to the time they commenced their air work. 
The questions were very carefully selected so that the ideas of 
hypersensitiveness would not be suggested to the candidate. 
In the column of remarks we had access not only to our own very 
complete histories of the cases but to the official records of their 
flying filed at headquarters. In this way a final estimate of the true 
status of the student as to his air work can be fairly arrived at. And 
one gains the impression that in the 57 cases out of the 76 who were 
either grounded or discontinued their flying it would have been far 
better if in the original entrance examinations greater attention had 
been paid to the history of hypersensitiveness to motion and the 
candidates disqualified even if labyrinth findings fell within appar- 
ently satisfactory limits. 144 
AVIATION MEDICINE IN THE A. E. F. 
Table 5.—Hypersensilive- to motion, 76 cases. 
Sea sick, alone 
0 
Sea sick, combined 
34 
Merrv-go-round, alone 
0 
Merry-go-round, combined 
31 
Swings, alone 
0 
Swings, combined 
26 
Car sick, alone 
0 
Car sick, combined 
21 
Avro, alone 
0 
Avro, combined 
27 
Avro and air, alone 
8 
Avro, air and sea sick 
3 
Air, alone 
15 
Air, combined - 
38 
Number of cases to full duty, or Class A 
21 
Number of cases grounded or discontinuing flying or training markedly modified. 
40 
Number of cases grounded with diagnosis hypersensitive labvrinth 
17 
Vomited during tests 
7 
Eye preponderating cause 
2 
SUMMARY. 
Table 5 is a summary of Table 4. In this table we tried to find out 
if any one form of hypersensitiveness to motion was combined with 
any other form in an exaggerated proportion. This does not seem to 
be the case, and furthermore it is shown that very seldom were the 
fliers susceptible to any one form of motion alone, without a combi- 
nation of some other form. This does not hold for the air alone, for 
here a positive answer was given in five cases. Almost any discom- 
fort which they experienced in their first flight was usually credited 
to dizziness. 
Finally it is to he remarked that 27 per cent of this series were 
returned to full duty, while a little over 47 per cent were either 
grounded or were obliged to discontinue flying on account of hyper- 
sensitiveness. And of this latter number, 17, or 29.08 per cent of the 
total, were disqualified with the diagnosis of hypersensitive labyrinth. 
Table VI is a record of 35 cases where there was absolutely no 
history of being hypersensitive to motion, but where in the routine 
examination a nystagmus of 30'seconds or more was noted. 
As a matter of convenience, 30 seconds was selected as a lower 
limit for hypersensitiveness, because it was found that as many cases 
had the characteristic symptom complex of hypersensitiveness to 
motion between 30 and 35 seconds as did those above. 
The remarks in this chart cover a wide range of subjects and were 
taken from our history of the cases. As far as can be judged, 10 of 
the 35 cases were normal (429, 229, 285, 276, 59, 473, 302, 386, 259, AVIATION MEDICINE IN THE A. E. F. 
145 
368) and show that nystagmus as high as 40 seconds (229) with a 
slightly exaggerated falling is not necessarily incompatible with good 
flying. 
Case (429) with 36 seconds nystagmus, 4-5, 3-3, past pointing and 
22 seconds vertigo was put in class A. 
In considering these 10 exceptions, it must be borne in mind that 
there were 10 such cases in nearly 800 men, so that as a class, men 
who have high nystagmus and still make good fliers are not particu- 
larly common. 
Table 6.—Cases with an entirely negative hypersensitive to motion history hut with 
nystagmus of 30 seconds or more. 
No. 
NysR. 
P. P. 
V. 
F. 
N. 
Flying history. 
Remarks. 
5 
89 
6 
117 
454 
456 
473 
302 
423 
386 
381 
50 
259 
362 
349 
368 
118 
223 
412 
345 
105 
104 
166 
116 
268 
33- 
32-30 
32- 
35- 
34- 
36- 
52-33 
35- 
34- 
33- 
33-32 
24-24 
30-29 
33- 
35- 
34- 
35- 
30-30 
35- 
30-30 
1 25-25 
30-30 
32-30 
36- 
37- 
2 30-33 
48-43 
3-3 
/ 3-3 
\ 2-2 
/ 2-2 
\ 2-2 
f 3-4 
l 4-3 
/ 3-3 
\ 3-3 
/ 2-1 
\ 4-4 
/ 2-2 
\ 2-3 
/ 3-3 
\ 3-3 
/ 2-4 
\ 2-4 
/ 3-3 
\ 3-3 
/ 3-5 
\ 3-3 
/ 5-4 
\ 4-3 
/ 2-2 
l 2-2 
/ 3-3 
l 3-5 
/ 3-3 
\ 3-3 
/ 3-3 
l 3-4 
/ 4-2 
l 2-4 
/ 3-3 
\ 3-3 
/ 3-3 
\ 3-3 
f 3-4 
\ 3-3 
/ 2-2 
\ 2-2 
/ 2-2 
\ 2-2 
/ 2-2 
\ 2-2 
f 3-1 
\ 1-3 
/ 2-2 
\ 2-2 
Ex. 
Mar. 
N. 
N. 
N. 
Ex. 
N. 
SI. 
N. 
N. 
N. 
N. 
Ex. 
N. 
N. 
N. 
N. 
N. 
N. 
N. 
N. 
S. 
N. 
N. 
N. 
Y. 
SI. 
Mentally incomp., Class C. 
Class A. 
Put on DH 4. 
Class B, conval. flu. 
No flying after exam. 
Increase prob. due to infect. 
Normal type. 
No flying after Nov. 21. 
Trouble not in laby. 
No flying after Nov. 21. 
To U. S. Dec. 7, ’18. 
Class A. 
fNerv. in air due to poor phys. eond • 
1 and incr. nys. an p. p. Lab. 
/Shows with these finding no results on 
l flying. 
/Incr. possibly due to infec. No fly. after 
1 exam. 
/Prob. lab. cond. had nothing to do 
\ with disinclination to fly. 
/Call attention to 30 Nys. and low vert. 
\ and sub-nor. falling. 
|Quoted to show Nys. of 30 and above, 
< may give nothing sub-nor. Note 
1 vert. and p. p. not above. 
/Type where high Nys. has no bearing 
t on history. 
INote dec. of irritability and incr. of 
l hearing after removal of focal infec- 
[ tion. 
/Focal infec. prob. had something to do 
1 with Nys. 
s Nov. 22. 
[■ 22-15 
\ 15-36 
} 
Fair 
Y. 
do 
| 20-20 
} 20-19 
} 23 
| 40-36 
} 24 
| 20 
} 32 
| 32 
} 18 
\ 20 
) 
| 22 
| 25 
|17-17 
j 35 
| 30 
| 24 
| 35 
J 42-12 
|15-15 
| 22 
|26-25 
24-25 
| 20 
i I 
0. 
Fair to good... 
Fair to good... 
Fair to good... 
Mediocre pilot. 
Fair to good... 
Very poor to 
poor. 
N. 
Good 
Fair to good... 
Good 
Y. 
/ 2-2 
\ 2-2 
N. 
>ec. 2. 
SI. 
Good 
171364—20 10 146 
AVIATION MEDICINE IN THE A. E. F. 
Table 6.—Cases with an entirely negative hypersensitive to motion history hut with 
nystagmus of 30 seconds or more—Continued. 
No. 
NysR. 
P.P. 
V. 
F. 
N. 
Flying history. 
Remarks. 
245 
176 
429 
64 
142 
285 
276 
429 
229 
188 
154\ 
115/ 
34-35 
126-27 
30-30 
36-36 
30-30 
30-30 
34- 
30-27 
36-36 
38-40 
238-38 
32-33 
35- 
/ 3-3 
i 5-3 
/ 3-3 
\ 3-2 
/ 3-2 
i 2-3 
/ 4-5 
i 3-3 
/ 3-3 
\ 3-2 
/ 4-5 
1 5-3 
/ 3-3 
\ 3-4 
j- 225 
| 25 
j 27 
\ 22-291 
/ 18 r 
|18-20 
]■ 30 
| 20 
’ 22-20 
} 22-20 
1 25 
} 25 
| 20 
’ 35-35 
SI. 
No record 
[Possible that some passing cond. may 
1 have incr. the Nys. temp., but 2d ex. 
| shown Nys. norm. Nothing in hist. 
1 to indicate Hyper, lab. 
Type of normal man with 30 sec. 
Class A. 
Vacation with conv. exerc. Report to 
eye dept, before fly. 
Type with rather high nys. 
/Nothing in hist, to show effects of high 
\ Nys. 
Class A. 
No Hyper, to motion hist. 
Full duty. 
Taken off fly.; trans. to hdqr. 
Refer to Tbc. Hosp. 
N. 
N. 
Mark. 
Ex. 
N. 
N. 
N. 
SI. Ex. 
Ex. 
SI. 
N. 
Good 
do 
j 4-5 
\ 3-3 
/ 3-2 
t 2-2 
/ 6-6 
1 4-4 
/ 3-3 
\ 3-3 
Poor to fair 
Good 
Y. 
Ex. 
Fair 
i Nov. 7. 2 Oct. 28. 
The cases under Table 6, where their flying career was markedly 
modified and can be charged to the hypersensitive labyrinth, are seven 
in number (6, 456, 381, 362, 349, 118, 188). 
It is to be noted in the “Remarks” that in five cases infections or 
focal infections are given credit for the labyrinth irritation. It is a 
point which in our experience is pretty well established, that local or 
general infections, the focal infections of the teeth, or the more 
common infection of influenza, certainly do temporarily increase the 
nystagmus time. During such temporary increases we have forbidden 
the men to fly, as many deaths are directly attributable to accidents 
while the men are sick from partially recovered infective conditions. 
Attention is called to cases 381, 345, 116, 245, where marked lower- 
ing of the nystagmus is obtained at a subsequent examination. 
So important do we consider this point and so many marked cases 
occur throughout our studies, that we find it unwise, in studying any 
pathologic case, to accept labyrinth findings unless they are taken 
under the same observational conditions at least a week apart. 
In admission examinatiohs also, we should think it only fair, where 
the history of hypersensitive to motion is at all doubtful and where 
the nystagmus time is excessive, to disqualify the candidate, with a 
subsequent examination a week later. A history of a cold or active 
infection would also demand a second examination after the trouble 
had cleared up. AVIATION MEDICINE IN THE A. E. F. 
147 
THE SUBNORMAL LABYRINTH. 
Table 7.—Cases with nystagmus of 16 seconds or below. 
No. 
Nys. 
P. P. 
V. 
F. 
N. 
Flying history. 
Remarks. 
290 
16-18 
/T-T 
\ 1-1 
1-1 
1-1 
| 10-11 
} 
N. 
Was at front... 
Held by eye dept. Not classified. 
/Class B, chronic indigestion. Bad focal 
\ infection, teeth and tonsils. 
286 
/ 16-10 
\ 17-12 
N. 
1 
266 
13-14 
/ 2~1 
19 
None. 
No record; fair. 
/Recom. as laby. below par that he be 
\ put on observer work. 
\T-T 
305 
15-15 
/ I”2 
1 1-1 
/T-T 
| 10-12 
N. 
Class B. Needs goggles. 
Low Nys. did not interfere with flying. 
Return to active duty. 
/Quoted to show possibility of lowering 
\ Nys. by constant turnings. 
243 
16-12 
j- 20 
I 
N. 
None. 
Good 
27 
16-16 
\ 1-T 
r 1-1 
I *_1 
\ 2-2 
N. 
230 
15-15 
| 20 
N. 
Very good 
156 
15-15 
( 1-1 
N. 
Class C. Chr. rhinitis. 
{ 1-1 
/ 5 
149 
16-16 
/ 2-1 
} 15 
N. 
None 
Class B. Temp, unfit. 
l 1-2 
12 
17-15 
/ 2-2 
\ 
/Sub. nor. and 
| Fair 
Trans, to Chief of Air Service. 
1 2-2 
\ ex. 
202 
[ 16-17 
!:! 
/ l-l 
} 15 
f N. 
Y. 
[Good 
Ferrying. 
1 
l113-14 
| 12-11 
l l-l 
j 
237 
13-15 
jT-1 
i 1-T 
| 10-9 
SI. 
/Class C. Shunt from vestibular to 
\ vagus. 
247 
20-20 
3-2 
•j 2-3 
1 20 
| Ex. 
Y. 
[Class C. No theory for this unless 
•J shunting theory through vagus and 
( Hyper, verticals. 
*16-16 
1 16 
30 
14-17 
/ 2-2 
\ 1-1 
|l6-14 
N. 
Prim.very poor 
Ferry pilot. 
i Oct. 25. 
* Nov. 14. 
As previously noted, these cases were extremely rare, but 14 with 
16 seconds or below and but 2 with 13 seconds or below. 
In the early days of the entrance examination in America the 
lower limit of 16 seconds was very closely adhered to, while the upper 
limit was more elastic. , 
The majority of us, I think, have deviated widely from that 
original conception. Very little evidence of any kind has been pro- 
duced that a hypersensitive labyrinth interferes with flying ability or 
that it dulls the perception of special localization and movement. 
We must have a perfectly intact, well-balanced labyrinth and the 
lower limit is a matter of very little moment. 
In this group of 14 cases, only 1 case was recommended for 
grounding on this cause alone (266). This was one of the very early 
cases and I have always felt it was a mistake. In the other casesy 
the remarks give a hint as to why they appeared before the board 
and the connection with the hypersensitive findings is very ques- 
tionable. 
MONITORS. 
The monitors at the Third Aviation Instruction Center were a 
group of men who had been selected as flying instructors because of 
their superior skill and experience as fliers. They had been culled 
out from the thousands of students who had passed through the 148 
AVIATION MEDICINE IN THE A. E. E. 
school because they represented in every way the ideal American 
aviator. No medical examination had influenced their selection as 
monitors. It was the cold-blooded judgment of the heads of the 
flying departments—the fact that they had made good without acci- 
dents, that they were dependable, morally, physically, and physio- 
logically, that resulted in their selection for this important and 
dangerous work. 
It is difficult to imagine where a finer group could be found for an 
intensive study of the American flier under conditions of intense 
mental and physical strain. They were all eager to cooperate with 
the examinations. They were all actively engaged daily with hours of 
air work and were in the best physical condition possible. (But 1 
out of the 110 was found physically unsatisfactory; the rest were 
normal.) 
The supervision of this group study was under the control of 
Maj. Edward C. Schneider, and elaborate studies were made of the 
rebreathing tests, the English tests for flying efficiency, and the 
physiological, psychological, psychiatrical sides. The eyes were 
studied and the ears and labyrinth examinations were made with 
great care. The results given in Table VIII speak for themselves. 
Table 8.—Summary of labyrinth statistics, taken from monitor study—Analysis of laby- 
rinth findings on 77 monitors at Third Aviation Instruction Center. 
No. 
Hours. 
Nys. R. 
Nys. L. 
P. P. R. 
P. P. L. 
Fall. 
Vert. 
1 * 
21 
20 
2 2 
2 3 
66 
60 
20 
20 
2 2 
2 2 
N 
71 
30 
21 
23 
2 2 
2 2 
N 
105 
120 
30-3 
30 
2-2 
2-2 
Sub. 
12-12 
303 
200 
20 
22 
1-3 
3-1 
N. 
34 
311 
5 500 
28 
24 
3-3 
3-3 
N. 
16 
315 
120 
16 
17 
2-2 
2-2 
N. 
4-4 
316 
100 
22 
24 
2-2 
3-2 
N. 
12 
317 
10,200 
24 
23 
3-3 
2-3 
N. 
15 
318 ! 
400 
28-30 
30 
3-2 
2-2 
N. 
15 
324 
70 
22 
20 
2-2 
2-2 
N. 
' 20 
325 
120 
24 
23 
2-3 
3-2 
N. 
10 
328 
325 
15 
16 
1-1 
1-1 
N. 
12 
329 
450 
22 
24 
2-2 
3-2 
N. 
16 
330 
80 
12 
11 
1-1 
1-1 
N. 
8 
331 
750 
26 
26 
3-3 
3-3 
N. 
17 
332 
200 
18 
17 
2-2 
2-2 
N. 
5-5 
333 
400 
16 
17 
1-1 
1-1 
N. 
6 
334 
200 
22 
23 
2-3 
3-2 
N. 
16 
335 
200 
22 
24 
2-2 
3-2 
N. 
12 
336 
150 
30 
28 
3-3 
2-3 
N. 
20 
337 
4,500 
20 
20 
2-3 
3-2 
N. 
20 
338 
550 
23 
22 
3-3 
2-2 
N. 
5-5 
339 
200 
22 
24 
2-2 
3-2 
N. 
20 
340 
180 
20 
20 
3-3 
3-3 
N. 
24 
341 
250 
22 
23 
2-2 
2-2 
S. E. 
22 
348 
500 
26 
25 
3-3 
3-3 
N. 
8 
300 
33 
34 
3-3 
3-3 
N. 
22 
350 
130 
33 
32 
3-3 
3-3 
N. 
30 
351 
250 
22 
23 
1-1 
1-1 
N. 
16 
352 
250 
23 
24 
3-2 
2-3 
N. 
12 
353 
250 
23 
22 
3-3 
3-2 
N. 
10 
41 
325 
25 
26 
3-3 
3-3 
N. 
28 
356 
300 
25 
25 
2-2 
2-2 
N. 
25 
357 
200 
25 
25 
2-2 
2-2 
N. 
28 
358 
200 
25 
24 
2-2 
2-2 
N. 
22 
359 
140 
20 
22 
2-3 
3-2 
N. 
14 
361 
150 
19 
17 
2-1 
2-2 
N 
24-25 
[Cases are given by number only.] 149 
AVIATION MEDICINE IN THE A. E. E. 
Table 8.—Summary of labyrinth statistics, taken from monitor study—Analysis of laby- 
rinth findings on 77 monitors at Third Aviation Instruction Center—Continued. 
No. 
Hours. 
Nys. R. 
Nys. L. 
P. P. R. 
P. P. L. 
Fall. 
Vert. 
362 
60 
33 
30 
3-3 
3-3 
N. 
20 
363 
60 
26 
27 
3-3 
4-3 
N. 
20 
366 
200 
22 
22 
2-2 
2-2 
N. 
14 
367 
200 
26 
26 
2-2 
2-2 
N. 
27 
376 
150 
22 
21 
2-2 
3-2 
N. 
16 
377 
40 
20 
19 
2-3 
3-2 
20 
378 . .. 
102 
16 
18 
1-1 
1-1 
12 
379 .. 
200 
25 
24 
2-2 
2-2 
15 
383 .. 
45 
26 
26 
2-2 
2-2 
22-22. 
384 .. 
150 
36 
30 
5-4 
4-5 
28 
385 
300 
27 
28 
2-2 
2-2 
15 
386 
800 
33 
34 
3-3 
3-3 
20 
387... 
150 
25 
25 
2-2 
2-2 
22 
388 .. 
200 
26 
25 
2-2 
2-2 
12 
389 .. 
500 
30 
30 
3-3 
3-4 
22 
390 . 
100 
26 
26 
2-1 
1-2 
19 
391 
390 
30 
30 
3-3 
1-3 
N. 
29 
56 
1,100 
25 
20 
2-4 
3-1 
23-22 
417 .. 
200 
■ 26 
26 
2-2 
2-2 
20 
406 . 
350 
26 
26 
2-2 
2-2 
15 
419 . 
28 
27 
1-1 
1-1 
20 
420 
400 
30 
30 
2-2 
2-2 
19 
430 
250 
26 
26 
3-3 
3-3 
Ex. 
15 
105 . .. 
175 
26 
26 
2-2 
2-2 
20 
403 
100 
26 
26 
3-3 
3-3 
22 
122 
27 
26 
2-1 
2-2 
. 17 
404 
250 
28 
29 
4-2 
2-4 
20 
418 
150 
18 
20 
2-2 
2-2 
22 
481 . 
350 
20 
19 
2-2 
3-2 
6 
364 .. 
200 
24 
26 
3-3 
3-2 
18 
471 
340 
22 
20 
3-2 
2-3 
12 
472 
80 
30 
30 
3-3 
3-3 
26 
473 
225 
32 
33 
2-2 
2-2 
23 
474 
200 
26 
26 
2-2 
2-2 
18 
400 
22 
21 
2-2 
2-2 
14 
483 
89 
20 
21 
2-2 
3-2 
18 
491 
200 
25 
25 
3-4 
3-3 
25 
514 
160 
27 
28 
2-2 
3-2 
22 
Examinations made between Sept. 16 and Nov. 
27, 1918. 
Lowest age 20. highest age 30 
No. 420 was 20 years. No. 418 was 30 years. 
All general physical examinations showed normal findings except No. 430, classified 13 for general 
physical instability. 
All eve examinations normal. 
All nasal examinations normal except No. 105; tonsil operation advised. No. 317 advised nasal treat- 
ment No. 333 deviated septum. No. 351 deviated septum: operation advised when convenient. No. 122 
neurological examinations all normal as to personality. No. 419 stale. 
No. 122 not aggressive. 
Table 8 and the following charts give in detail the results of these 
investigations from the otolog'ical standpoint. 
In passing it might be said that from the standpoint of the normal, 
ideal flier these statistics have never been equaled. None of these 
110 men deviated physically except one man who had just returned 
from active duty at the Front and who had to be put on temporary 
monitor work. 
In every single case the eye findings were normal and the men 
checked up normally from the physiological and psychological sides. 
OTOLOGICAL STUDY. 
There was no case in which the nystagmus exceeded 36 seconds. 
There was only one case in which the nystagmus fell below 16 seconds, 
on both sides (330). The lowest past pointing was 1-1 (328, 333, 
378, 419). The highest 5-4 (384). The falling reaction was generally 
normal, in one case exaggerated, in one case subnormal. Their 150 
AVIATION MEDICINE IN THE A. E. F. 
falling curves as shown on the self-registering joy stick were invari- 
ably normal. The vertigo was constantly low. No case of nausea 
or vomiting was noted. The averages are given in Table I. The 
only deviations from the normal for the eyes, the medical or psychi- 
atrical examinations, are those given in the footnotes at the end of 
the table. 
If this group study shows one thing, it is that by natural selection 
men have finally become to be monitors, and that the unfit tempera- 
mentally and physically have fallen by the wayside. The terrible 
strain of the work, the accidents and natural elimination, have 
dropped the weaklings and the hypersensitive to motion type by the 
roadside. 
If this group of men represents our highest type of air men, then 
certainly if these physical findings correspond exactly with the 
original standards for admission into the service, we may conclude 
that these requirements as laid down in the original “609” examina- 
tions were very close to the ideal. 
One suggestion which was constantly made in America, was that 
practice would materially lower the nystagmus and other vestibular 
reaction times. The analysis in Table 9, as well as statistics pre- 
viously given, effectively disproves this theory. Fields 2, 5, 8, and 
9 were given over almost exclusively to instruction in acrobatics. 
Some of these monitors were in the air five and six hours a day, 
doing various forms of air stunting, such as tail spins, turnings, loops, 
etc. Certainly, if we are to find the influence of constant move- 
ment in cutting down the nystagmus or influencing the other tests, 
we would find it here. 
Table 9.—Comparison of reactions of monitors from various fields. 
79 cases, all fields, nystagmus to right 
24.40 
3 cases, field, nystagmus to right 
26.6 
5 cases, field 9, nystagmus to right 
21 
10 cases, field 5, nystagmus to right 
22.5 
29 cases, field 2, nystagmus to right 
25.1 
78 cases, all fields, nystagmus to left 
24.32 
9 cases, field 5, nystagmus to left 
26.4 
5 cases, field 9, nystagmus to left 
21.6 
10 cases, field 5, nystagmus to left 
22.3 
29 cases, field 2, nystagmus to left... 
24.3 
79 cases, all fields, P. P. to right, with the right hand 
2.27 
9 cases, field 8, P. P. to right, with the right hand 
2.6 
5 cases, field 9, P. P. to right, with right hand 
2.0 
10 cases, field 5, P. P. to right, with right hand 
2.2 
29 cases, field 2, P. P. to right, with right hand 
2.3 
79 cases, all fields, P. P. to right, with left hand 
2.25 
9 cases, field 8, P. P. to right, with left hand 
2.4 
5 cases field 9, P. P. to right, with left hand 
2.2 
10 cases, field 5, P. P. to right, with left hand 
2.3 AVIATION MEDICINE IN THE A. E. F. 
151 
Table 9.—Comparison of reactions of monitors from various fields—Continued. 
29 cases, field 2, P. P. to right, with left hand 
2.4 
78 cases, all fields, P. P. to left, with right hand 
2.35 
9 cases, field 8, P. P. to left, with right hand 
2.4 
5 cases, field 9, P. P. to left, with right hand 
2.4 
10 cases, field 5, P. P. to left, with right hand 
2.2 
29 cases, field 2, P. P. to left, with right hand 
2.5 
79 cases, all fields, P. P. to left, with left hand 
2.34 
9 cases, field 8, P. P. to left, with left hand 
2.6 
5 cases, field 9, P. P. to left, with left hand 
2.0 
10 cases, field 5, P. P. to left, with left hand 
1.9 
29 cases, field 2, P. P. to left, with left hand 
2.3 
76 cases, all fields, vertigo 
17.9 
9 cases, field 3, vertigo.. 
23.2 
5 cases, field 9, vertigo 
17.0 
10 cases, field 5, vertigo 
15.3 
29 cases, field 2, vertigo - - - 
16.7 
Table 10.—Monitors, taken by fields. 
FIELD 2. 
No. 
Date. 
Kame. 
Total 
hours. 
Nys. 
P. P. 
Vert. 
Falling. 
105 
Oct. 1,1918 
D.H 
120 
30-30 
2-2 
12-12 
Sub. norm. 
315 
Oct. 13,1918 
G.E.S 
120 
16-17 
J 2-2 
\ 2-2 
| 2-2 
2-2 
} 4-4 
Norm. 
31fi 
J.H.T 
100 
22-24 
- 
Do. 
[ 3-2 
1 
H.B.H 
120 
24-23 
/ 2-3 
} 10 
Do. 
328 ■ 
Oct. 14,1918 
R.M.B., jr 
325 
15-16 
i i-i 
1 i-1 
J 2-2 
1 3-2 
/ 1-1 
} 12 
Do.' 
W.J.R 
450 
22-24 
Do.' 
330 
R.B.M 
80 
12-11 
8 
332 
B.M. W 
200 
18-17 
f 2-2 
/ 
\ 5-5 
334 
Oct. 13,1918 
T.L.D 
200 
22-23 
/ 2-3 
\ 3-2 
} 16 
Do. 
335 
J.P.M 
200 
22-24 
f 2-2 
) 3-2 
/ 3-3 
i 2-3 
f 2-3 
1 12 
Do. 
336. 
Oct. 14,1918 
R.S.D 
150 
30-28 
/ 
1 20 
Do. 
337 
H.F.D 
4,500 
20-20 
J 
1 20 
Do. 
339 
W.E.R 
200 
22-24 
r 2-2 
/ 
1 20 
Do. 
340 
do 
R.C.G 
180 
20-20 
f 3-3 
\ 3-3 
r 2-2 
i 2-2 
f 3-3 
3-3 
J 
\ 24 
Do. 
341 
I. R. W 
250 
22-23 
/ 
1 22 
SI. exag. 
348 
Oct. 15,1918 
F.W.H 
500 
26-25 
/ 
} 8 
Norm. 
349 
H. W. S 
300 
35-34 
/ 3-3 
1 22 
Do. 
350 
do 
J. W. S 
130 
33-32 
f 3-3 
1 3-3 
f 3-2 
\ 2-3 
f 3-3 
1 3-3 
/ 
1 50 
Do. 
352 
do 
H.O.F 
250 
23-24 
J 
} 12 
Do. 
362 
Oct. 18,1918 
W.E.C 
60 
33-30 
1 20 
Do. 
363 
do 
G.V.W 
60 
26-27 
/ 3-3 
1 20 
Do. 
364 
Nov. 18,1918 
W.M.W 
200 
24-26 
l 4 6 
f 3-3 
\ 3-2 
} 18 
Do. 
471 
J.B.S 
340 
22-20 
f 3-2 
i 3-3 
f 3-3 
\ 3-3 
} 12 
Do. 
472 
Nov. 26,1918 
B.F.C 
80 
30-30 
} 26 
Do. 152 
AVIATION MEDICINE IN THE A. E. E. 
Table 10.—Monitors, taken by fields—Continued. 
No. 
Date. 
Name. 
Total 
hours. 
Nys. 
P. P. 
Vert. 
Falling. 
473 
Nov. 26,1918 
J.P.M 
225 
200 
90 
200 
160 
32-33 
26-26 
20-21 
25-25 
27-28 
2-2 
» 2-2 
f 2-2 
1 2-2 j 
f 2-2 I 
3-2 ! 
f 3-4 
{ 3-3 
f 2-2 
l 3-2 j 
23 
■ 18 
18 
• 25 
► 22 
Norm. 
Do. 
Do. 
Do. 
Do. 
474 
W. W.R 
483 
Nov. 18,1918 
Nov. 27,1918 
E.A.G 
R.G 
491 
514 
C.P.M... 
1 
FIELD 3. 
311 
Oct. 11,1918 
A. 
S.F.A 
B. 
500 
150 
200 
200 
45 
500 
250 
400 
28-24 
19-17 
22-22 
26-26 
26-26 
30-30 
28-29 
30-29 
f 3-3 
\ 3-3 
/ 2-1 
\ 2-2 
1 2-2 
\ 2-2 
/ 2-2 
1 2-2 
/ 2-2 
2-2 
/ 3-3 
l 3-4 
J 4-2 
\ 2-4 
/ 3-3 
\ 3-3 
‘ 16 
► 24-25 
1 “ 
27 
}• 22-22 
j- 22 
j. 20 
| 20 
Norm. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
361 
366 
Oct, 18,1918 
367 
R.S.O 
W. R.B 
G.D.F 
A. J. R 
383 
Oct. 20,1918 
389 
404 
Nov. 20,1918 
Nov. 22,1918 
440 
H.L 
FIELD 5. 
71 
Sept. 26,1918 
Oct. 11,1918 
Oct. 13,1918 
R.R 
30 
200 
1,200 
400 
270 
750 
400 
550 
250 
250 
21- 
20-22 
24-23 
28-30 
22- 
26-26 
16-17 
23-22 
22- 
23- 
/ 2-2 
\ 2-2 
f 1-3 
l 3-1 
/ 3-3 
\ 2-3 
/ 3-2 
\ 2-2 
/ 2-2 
\ 2-2 
f 3-3 
\ 3-3 
{ 
/ 3-3 
\ 2-2 
f 1-1 
l 1-1 
/ 3-3 
\ 3-2 
} 
Norm. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
303 
C.S.G .. 
L.L.H 
:: 
} 15 
| 20 
} 17 
} 6 
| 5-5 
I 16 
} 10 
317 
318 
H.E. W 
324 
Oct. 12,1918 
Oct. 14,1918 
H.C.M 
331 
W. J.H 
333. . 
W. S 
338 
Oct. 13,1918 
Oct. 15,1918 
F. W. M.,jr 
J. E. M 
351 
353 
L. M. D 
FIELD 8. 
66... 
Sept. 24,1918 
Oct. 16,1918 
I.D.F 
D.K 
60 
325 
300 
200 
200 
140 
150 
300 
800 
390 
20-20 
25-26 
25-25 
25-25 
25-24 
20-22 
36-30 
27-28 
33-34 
30-30 
/ 2-2 
\ 2-2 
/ 3-3 
\ 3-3 
/ 2-2 
\ 2-2 
/ 2-2 
Y 2-2 
/ 2-2 
\ 2-2 
/ 2-3 
\ 3-2 
/ 5-4 
\ 4-5 
/ 2-2 
\ 2-2 
/ 3-3 
\ 3-3 
f 3-1 
l 1-3 
} 
Norm. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
Do. 
41 
1 28 
| 25 
| 28 
| 22 
} U 
} 28 
} 15 
| 20 
| 29 
356 
W.D.H 
H.B.S 
A.P.F 
S.E.L 
V.D.H 
357 
358 
359 
3S4 
Oct. 20,1918 
385 
G.S.V 
J.H.C 
L.H.S 
386 
391 
I 
FIELD 2—Continued, AVIATION MEDICINE IN THE A. E. E. 
153 
Tabie 10.— Monitors, taken by fields—Continued. 
FIELD 9. 
• No. 
Date. 
Name. 
Total 
hours. 
Nys. 
P. P. 
Vert. 
Falling. 
376 
Oct. 19,1918 
H. W.P 
150 
40 
102 
200 
100 
22-21 
20-19 
16-18 
25- 
26- 
2-2 ; 
( 3-2 
2-3 
16 
20 
Norm. 
Do. 
Do. 
Do. 
Do. 
377 
J.C.P.,jr 
378 
C.P.R 
S.B.M 
R.H.Mc 
3-2 j 
{ U] 12 
{ tl}22-22 
( H \ 22 
379 
403 
l J 
FIELD 10. 
387 
Oct. 19,1918 
R. 
S. 
J. K. N 
150 
200 
100 
110 
200 
350 
400 
250 
175 
25- 
26- 
26-26 
25- 
26- 
26-26 
28-27 
30-30 
26-26 
26-26 
27- 
18-20 
30-30 
J 2-2 
\ 2-2 
/ 2-2 
\ 2-2 
f 2-1 
l 1-2 
/ 2-4 
\ 3-1 
f 2-2 
i 2-2 
/ 2-2 
i 2-2 
/ 1-1 
\ 1-1 
/ 2-2 
\ 2-2 
f 3-3 
i 3-3 
/ 2-2 
1 2-2 
/ 2-l 
\ 2-2 
f 2-2 
\ 2-2 
1:1 
[■ 22 
\ 12 
} 19 
| 23-22 
| 20 
} 15 
| 20 
} 19 
} 15 
j- 20 
} 17 
| 22 
} 15 
Norm. 
Do. 
Do. 
Moderate. 
Norm. 
Do. 
Do. 
Do. 
Exag. 
Norm. 
Do. 
Do. 
Do. 
388 
390 
Oct. 20,1918 
Oct. 19,1918 
Oct. 20,1918 
56 
J.C 
417 
P.V.A 
H.L.B 
W.T.E 
J. W. E 
406 
419 
420 
Oct. 19,1918 
Oct. 20,1918 
430 
G.A.B ,.. 
T.V.L 
I. J.H 
405 
122 
Sept. 30,1918 
Nov. 19,1918 
Dec. 19,1918 
418 
G.C.P 
A.E.G 
150 
300 
704 
FIELD NOT GIVEN. 
431 
Nov. 23,1918 
Nov. 8,1918 
Nov. 9,1918 
D.M. Y 
350 
400 
38 
20-19 
22-21 
/ 2-2 
\ 3-2 
/ 2-2 
\ 2-2 
} 6 
} 15 
Norm. 
Do. 
Do. 
475 
W.E. W 
18.. 
J. Q. K., jr 
I % 
Table 10 gives the detailed findings of the monitors by fields. A 
comparison of these tables shows no constant variation. We are 
always forced back to the same conclusion that there is no evidence 
that actual flying conditions lower the labyrinth reactions, hut that 
the general averages given in Table I represent the true status, both 
as to’ the experienced and nonexperienced fliers. The difference 
between the two groups is simply in their ability to adapt themselves 
to the vertigo and not have it interfere with their air work. 
THE MEN FROM THE FRONT. 
Naturally, the one group which the Medical Research Board desired 
to make a study of was the men who had been subjected to the 
actual strain of fighting. 154 
AVIATION MEDICINE IN THE A. E. F. 
In this we were somewhat disappointed as far as any far-reaching 
effects in the way of staleness were concerned. Our men were not 
subjected to the fearful strains that the English and French had to 
endure during the first three years of the war, and in addition many 
of them, as can be seen by the following tables, had but a few short 
hours over the lines. Our observation of these 110 men, who had 
actually had experience at the front, with from 40 to 250 hours 
over the line, leads us to the inevitable conclusion—-the general 
type is the same; the comparison of the labyrinth reactions shows no 
striking changes. 
Table 11.—Summary of labyrinth findings—Taken from Maj. Schneider's study of men 
returned from front. 
No. 
Hours. 
Nys. R. 
Nys. L. 
P.P.R. 
P.P.L. 
F. 
V. 
Date 
arrived. 
Hours. 
Com- 
bats. 
Huns. 
487 
350 
20 
20 
2-2 
N 
21 
243 
o 
490 
300 
20 
20 
2-2 
2-2 
N 
17 
250 
o 
492 
300 
25 
25 
2-2 
2-2 
N 
31 
180 
o 
512 
230 
26 
26 
3-2 
2-3 
N 
18 
150 
1 5 
513 
300 
25 
25 
3-2 
2-3 
N 
25 
0 
0 
516 
450 
24 
24 
3-2 
2-3 
N 
15 
40 
0 
531 
250 
31 
30 
3-4 
3-5 
N 
25 
200 
1 
532 
290 
26 
26 
2-1 
1-2 
N 
18 
215 
0 
534 
300 
25 
24 
1-1 
1-1 
N 
16 
200 
535 
300 
16 
16 
1-1 
1-1 
N 
12 
200 
0 
536 
500 
27 
27 
3-3 
3-3 
N 
28 
200 
1 
537 
80 
20 
20 
3-4 
3-3 
N 
9 
o 
o 
546 
325 
26 
28 
3-3 
3-3 
N 
26 
185 
4j 
547 
350 
22 
22 
1-2 
2-2 
N 
15 
0 
o 
552 
150 
20 
20 
2-2 
2-2 
N 
15 
30 
o 
561 
350 
27 
28 
1-1 
1-1 
N 
11 
o 
o 
562 
300 
22 
24 
2-2 
2-2 
N 
16 
o 
o 
563 
175 
22 
23 
3-2 
2-3 
N 
18 
o 
o 
566 
200 
25 
25 
3-3 
3-3 
N 
19 
o 
o 
567 
250 
27 
26 
2-2 
2-2 
N 
5 
o 
o 
568 
250 
15 
15 
1-2 
2-1 
15-13 
52 
o 
569 
120 
25 
25 
2-2 
2-2 
N 
20 
45 
o 
570 
240 
20 
25 
2-2 
2-2 
13 
80 
o 
571 
200 
20 
22 
1-1 
1-1 
N 
14 
75 
o 
572 
120 
20 
21 
2-2 
2-2 
N 
15 
2 
o 
573 
300 
22 
20 
1-1 
1-1 
Sub. N 
12 
76 
o 
574 
150 
27 
29 
3-4 
3-3 
N 
25 
8 
o 
577 
200 
30 
31 
3-3 
3-3 
N 
22 
50 
1 
578 
160 
22 
20 
2-2 
2-2 
N 
17 
12 
o 
579 
350 
28 
28 
4-4 
4-4 
N 
20 
75 
o 
580 
225 
17 
19 
2-2 
2-2 
Sub.N 
32 
80 
o 
581 
210 
22 
24 
2-2 
2-2 
N 
20 
50 
o 
582 
150 
25 
25 
3-3 
3-3 
N 
20 
o 
o 
583 
125 
16 
16 
1-1 
1-1 
Sub.N 
15 
35 
1 
584 
250 
27 
25 
3-3 
3-3 
N 
20 
60 
1 
585 
150 
26 
26 
4-4 
4-4 
18 
60 
o 
586 
250 
26 
28 
3-3 
3-3 
N 
25 
0 
o 
587 
140 
26 
26 
3-2 
2-3 
N 
12 
21 
, 
1 
591 
110 
28 
27 
3-3 
3-3 
N 
22 
50 
2 
592 
250 
25 
27 
2-1 
1-2 
N 
22 
69 
1 
596 
300 
22 
24 
2-2 
2-2 
N 
17 
120 
o 
597 
325 
23 
24 
1-1 
1-1 
N 
13 
40 
o 
605 
150 
24 
24 
3-2 
2-3 
N 
26 
40 
1 
607 
200 
20 
21 
3-3 
2-2 
N 
27 
0 
o 
533 
175 
24 
23 
2-2 
2-2 
N 
19 
125 
o 
588 
200 
22 
22 
3-2 
2-3 
'N 
17 
90 
2 9 
613 
300 
28 
31 
2-4 
3-2 
N 
23 
70 
1 2 
619 
700 
21 
20 
2-2 
3-3 
N 
14 
40 
l 4 
620 
125 
25 
26 
2-1 
3-2 
N 
12 
0 
0 
621 
450 
25 
27 
3-3 
3-3 
N 
21 
40 
l 2 
622 
450 
25 
27 
2-2 
3-3 
N 
13 
400 
1 4 
623 
255 
18 
15 
2-1 
1-2 
N 
12 
120 
5 
625 
350 
26 
28 
2-2 
3-2 
N 
12 
112 
1 6 
635 
800 
21 
22 
2-1 
1-2 
N 
15 
0 
0 
624 
650 
30 
29 
2-2 
2-2 
N 
20 
50 
1 2 
637 
250 
29 
33 
4-5 
28 
115 
1 5 
639 
175 
21 
20 
2-1 
1-1 
N 
12 
Sept. 7 
60 
8 
2 1 
640 
250 
13 
14 
1-2 
3-2 
15 
July 25 
100 
20 
6 
1 Official 
2 
Unofficial. 
[Numbers refer to history numbers.] AVIATION MEDICINE IN THE A. E. E. 
155 
Table 11.—Summary of labyrinth findings—Taken from Maj. Schneider’s study of men 
returned from front—Continued. 
No. 
Hours. 
Nys. R. 
Nys. L. 
P.P.R. 
P.P.L. 
F. 
V. 
Date 
arrived. 
Hours. 
Com- 
bats. 
Huns. 
641 
1,000 
24 
26 
2-2 
2-2 
14 
Aug. 
18 
60 
12 
i 2 
642 
200 
20 
20 
2-2 
2-2 
12 
84 
3 
643 
200 
27 
29 
1-1 
2-1 
15 
100 
1 
645 
275 
23 
23 
3-4 
2-2 
S 
18 
May 
19 
200 
50 
1 2 
646 
250 
21 
21 
1-2 
2-2 
13 
80 
0 
647 
350 
32 
32 
2-2 
2-2 
27 
70 
(3) 
650 
250 
24 
26 
4-4 
4-5 
S 
131 
180 
2 
653 
250 
18 
20 
2-2 
2-2 
s 
10 
Aug. 
21 
63 
8 
(4) 
654 
200 
28 
24 
2-2 
2-2 
s 
13 
July 
3 
140 
5 
2 
655 
250 
31 
30 
2-2 
3-3 
32 
100 
1 
1 
656 
212 
26 
26 
2-2 
2-2 
15 
Aug. 
15 
100 
6 
0 
657 
200 
26 
26 
2-2 
2-2 
s 
18 
Aug. 
27 
95 
12 
0 
658 
200 
18 
17 
3-3 
3-3 
35 
July 
15 
110 
25 
0 
660 
200 
26 
120 
50 
(6) 
661 
300 
22 
22 
2-2 
2-2 
s 
20 
July 
10 
40 
2 
0 
663 
200 
20 
20 
2-2 
2-2 
15 
Aug. 
25 
100 
3 
0 
* 664 
300 
30 
30 
3-3 
3-3 
45 
Aug. 
26 
100 
5 
6 2 
225 
26 
26 
2-2 
2-2 
12 
25 
0 
666 
150 
20 
20 
2-2 
2-2 
s 
15 
10 
667 
100 
37 
38 
3-3 
3-3 
25 
Dec. 
1 
668 
175 
26 
26 
2-2 
2-2 
s 
24 
Aug. 
11 
54 
10 
i i 
669 
120 
27 
28 
3-3 
3-3 
s 
30 
Oct. 
3 
26 
4 
11 
670 
300 
18 
19 
1-1 
1-1 
s 
10 
July 
20 
150 
50 
(«) 
671 
250 
20 
18 
2-2 
2-2 
s 
10 
Aug. 
15 
100 
5 
(7) 
672 
325 
16 
17 
1-1 
1-1 
S' 
15 
50 
2 3 
673 
250 
18 
18 
2-1 
1-2 
s 
14 
Feb. 
15 
125 
20 
0 
675 
300 
20 
20 
3-3 
3-3 
S. L. 
35 
July 
18 
105 
40 
(8) 
type. 
676 
450 
28 
27 
3-3 
3-3 
Hyper. 
30 
June 
25 
250 
100 
1 2 
677 
250 
31 
27 
2-3 
2-2 
N 
26 
130 
0 
678 
120 
31 
30 
2-2 
2-2 
N 
22 
Sept. 
16 
33 
6 
2 
679 
110 
30 
29 
2-2 
2-2 
N 
15 
680 
375 
30 
27 
29 
July 
1 
100 
6 
o 
681 
180 
18 
18 
1-1 
1-1 
N 
17 
May 
15 
75 
20 
1 2 
682 
300 
30 
32 
3-3 
3-3 
N 
22 
683 
250 
27 
25 
2-2 
2-2 
N 
16 
Feb. 
19 
135 
25 
i 6 
685 
300 
24 
23 
2-2 
2-3 
N 
18 
July 
20 
100 
15 
(9) 
687 
350 
22 
22 
3-2 
2-2 
N 
20 
Apr. 
16 
154 
18 
3 
688 
250 
17 
18 
2-2 
3-2 
N 
22 
Sept. 
1 
55 
5 
(10) 
691 
200 
37 
35 
4-3 
3-4 
N 
21 
May 
31 
100 
0 
0 
692 
160 
24 
22 
2-1 
1-1 
N 
12 
June 
1 
110 
9 
5 
693 
190 
26 
26 
5-3 
4-4 
N 
19 
June 
22 
105 
20 
4 
694 
210 
24 
24 
2-2 
3-2 
N 
16 
May 
14 
120 
10-40 
4-22 
695 
200 
25 
25 
3-3 
3-3 
N 
20 
May 
20 
60 
34 
3-1 
696 
225 
22 
22 
2-2 
2-2 
N 
12 
May 
14 
80 
10 
2-4 
697 
300 
21 
21 
3-2 
2-2 
Sub. N 
20 
May 
6 
160 
87 
6 
699 
25 
25 
3-3 
3-3 
25 
19 
40 
1 
701 
85 
28 
28 
4-4 
4-6 
N 
28 
12 
0 
707 
180 
26 
26 
2-2 
2-2 
N 
20 
July 
29 
25 
8 
1 2 
708 
300 
22 
23 
2-2 
3-2 
N 
29 
Apr. 
15 
30 
15 
714 
100 
20 
20 
1-1 
1-1 
N 
15 
3i 
2-2 1 
716 
250 
20 
20 
1-1 
1-1 
None. 
25 
Aug. 
28 
30 
1 
1-111 
717 
200 
11 
12 
2-1 
0-1 
N 
11-13 
...do.. 
100 
8 
13 
718 
280 
22 
22 
4-3 
4-3 
N 
Aug. 
11 
60 
8 
15 
719 
100 
20 
22 
3-3 
3-2 
N 
Sept. 
29 
15 
2 
1-12 2 
720 
150 
18 
18 
1-1 
1-1 
N 
Sept. 
18 
42 
3 
11 
721 
200 
19 
18 
2-2 
2-2 
N 
14-15) 
Aug. 
26 
70 
6 
1 4 
723 
250 
18 
19 
2-2 
3-2 
N 
16 
725 
400 
20 
20 
2-2 
2-2 
N 
15 
60 
3 
22 
Jan. 3 
200 
20 
20 
3-2 
2-3 
N 
23 
1 Official. 
2 Unofficial. 
8 3 official; 2 unofficial. 
41 balloon; 2 unofficial. 
5 1 balloon. 
® 1 official; 2 unofficial. 
11 official; 1 unofficial, 
s 2 balloons; 3 unofficial. 
9 5 balloons; 7 official; 2 planes. 
10 3 balloons; 1 plane. 
11 Assist. 
12 Shared. 
All these men were examined between Nov. 27,1918, to Jan. 3,1919. 
The ages varied between 19 and 31. 
The medical examination in all cases was normal except as follows: 512, not fit to fly B; 531, heart not 
fit; 561, suggest class B; 577, pus in urine; 591, needs rest; 597, class B; 533, not fit; 645, stale now; 650, stale 
B; 655, not fit to fly; 658, needs rest; 660, not fit, B; 661, not fit to fly; 666, cardio vascular instability; 672, 
class B; 673, not fit, B; 675, needs rest; 680, needs rest; 688, stale; 699, unfit, B; 701, unfit. 
All eye findings were normal except 592, B class, and 721, unfit. 
The ear findings were all normal except 512, not fit to fly; B,chronic rhinitis; 568, frontal sinusitis, radical 
operation four years ago; 581, tonsilitis, B, chronic enlarged cervical glands; 637, hypersensitive, C tests 
not completed on account of nausea; does not feel fit; 655, hypersensitive, nausea and vomiting, hypersensi- 
tive to motion; 658, slightly hypersensitive, slight nausea, probably stale; 660, hypersensitive, could not 
complete turning, has been sick at stomach for several days; 661, not fit to fly; bronchitis, infection posterior 
sinuses; 666, tonsils,septic; 676, hypersensitive, exaggerated falling nausea; 670, should have tonsils removed. 
Septic tonsils; 671, not fit, ethmoiditis acute; 676, hypersensitive to turning motion: stale. Uren; 717, 
slightly subnormal, in labyrinth findings, no indication that it affected flying. 
Neurologically and from personality study all O. K. or of A type except 561, not fit; 578, not fit; 580, 
stale; 596, stale, B; 597, stale, B; 624, stale; 650, B. 156 
AVIATION MEDICINE IN THE A. E. E. 
Table 11 gives a detailed review of the labyrinthine findings in 
these men. In the column of rerparks can be seen the hours over the 
lines and the number of air victories placed to their credit. We are 
impressed with the few whose nystagmus time goes over 35 seconds— 
only one case on both sides. 
One man (637), who was hypersensitive and could not have his 
test completed on account of the nausea, had 29-30 seconds and 4-5 
past pointing and was credited as an American ace. 
The second (655), with 31-36 seconds nystagmus, was also hyper- 
sensitive and brought down two planes. 
A third (660), with 26 seconds, was also nauseated. 
The rest were all in the normal class. The three exceptions with 
no excessive nystagmus showed evidences of staleness and were 
temporarily indisposed. 
If we refer again to the general summary given in Table 1 we note 
how closely these men approach the general average. More inter- 
esting, however, is the fact that when Table 11 is studied in detail 
we note, as in the monitor group study, an absence of the hypersen- 
sitive to motion type. 
It is the striking normality of the successful type that interests us, 
a type which had to be picked out, as far as the labyrinth is concerned, 
almost empirically at the beginning of the war. These statistics 
speak volumes for the accuracy and soundness of the original 
standards. 
Table 12.—Study of American aces 
No. 
Date. 
Name and rank. 
Age. 
Hours. 
Nys. 
Past 
pointing. 
Ver- 
tigo. 
Falling. 
Remarks. 
Yrs. ms. 
512... 
Nov. 29 
B uckley, captain. 
22 
8 
230 
26-26 
3-2 
2-3 
18 
Normal 
Not fit to 
fiy(B). 
625... 
Dec. 9 
Stevall, first lieu- 
tenant. 
23 
9 
350 
26-28 
2-2 
3-2 
12 
do 
Normal. 
637... 
Dec. 7 
Steerley, first 
lieutenant. 
22 
1 
250 
29-33 
4-5 
28 
Do. 
640... 
Dec. 9 
Guthrie, first lieu- 
tenant. 
22 
7 
250 
13-14 
1-2 
3-2 
15 
Normal 
Do. 
675... 
Dec. 14 
Luff, first lieu- 
tenant. 
22 
5 
300 
20-20 
3-3 
3-3 
35 
Slightly hy- 
persen- 
sitive. 
Needs rest. 
708... 
Dec. 19 
Healey, first lieu- 
tenant. 
24 
8 
300 
22-23 
2-2 
3-2 
29 
Normal 
Normal. 
534... 
Dec. 3 
Oliver, first lieu- 
tenant. 
23 
8 
300 
25-24 
1-1 
1-1 
16 
do 
Do. 
567... 
Dec. 2 
Clark, second 
lieutenant. 
20 
8 
250 
27-26 
2-2 
2-2 
5 
do 
Do. 
it is a matter of interest purely that we tabulate eight men, Table 
12, examined by the Medical Research Board, who had brought 
down five or more enemies, thus putting them in the class of American 
aces. AVIATION MEDICINE IN THE A. E. E. 
157 
Had the war lasted but a few months longer many names would 
have been added to this list. In a large measure they had opportu- 
nities that the others did not have. 
In giving their findings we ar§ taking no credit from them when 
we show that they deviate in no essential particular from the other 
men we have examined. Their nystagmus time never reaches 30 
seconds and there are no hypersensitive types among them. 
1. In conclusion, it might be said that the statistics for this paper 
were worked up with great care and exactness. The fact that we 
were dealing with the human organism had no place in the manner 
in which the examinations were conducted. The nystagmus was 
observed .as carefully as possible, the past pointing and falling never 
guessed at. 
But when the cases are totaled and compared with the statistics 
from America we again take into consideration the variability of the 
human element. The slight differences but strengthen the belief that 
as a result of continuous air work—acrobatic work, monitor work, or 
work over the lines—the labyrinth reactions are not changed in any 
essential particular. 
2. Among the select and the successful the hypersensitive to motion 
types are few and far between. 
3. Many typical hypersensitive to motion types can accommodate 
themselves to this handicap and become successful. 
4. A very considerable per cent who slipped through the entrance 
examinations or who were on the border line of the hypersensitive 
to motion type are not able to overcome the handicap and are dropped 
by the roadside. 
5. Given an intact and well-balanced labyrinth—there is nothing 
to indicate that the lower nystagmus limit is of consequence even as 
far down as 13 seconds. 
6. The normal labyrinth findings, as previously determined, are 
substantiated by our studies. 
7. Special care should be exercised in allowing candidates with a 
hypersensitive to motion history and nystagmus around 30-35 
seconds to enter the service. Thirty-five seconds is the extreme 
margin of safety. 
8. One can exceptionally overcome almost any handicap of hyper- 
sensitiveness to motion, but why risk it ? 
CONCLUSION. 
THE LABYRINTH AND FLYING. 
Capt. Claude T. Uren, Medical Corps. 
The work in the Otological Department of the Medical Research 
Laboratory, A. E. F., afforded an excellent opportunity to draw 
some conclusions on the value of testing the labyrinths of fliers. 158 
AVIATION MEDICINE IN THE A. E. F. 
Fifty records of so-called hypersensitive labyrinths are divided into 
six types, as follows: 
Type 1. Nystagmus, Over 30 Seconds; Vertigo, Over 22 Seconds; Exaggerated Falling 
Eight pilots sent to the laboratory from field No. 3 because they 
were sick and dizzy in the air. All cases gave a history of seasick- 
ness, car sickness, and merry-go-round sickness. Nystagmus from 
30 to 40 seconds, vertigo from 22 to 42 seconds; falling, exaggerated. 
Four were nauseated wrhile in the chair and four wTere not. 
Six pilots discontinued training at this time because of air sickness. 
One pilot was sent back to training, got into an unintentional tail 
spin on his first solo flight, and crashed. Two broken legs caused 
him to discontinue training. One pilot continued’ through the 
training with a fair flying record. 
Type 2. Nystagmus, Under 30 Seconds; Vertigo, Over 22 Seconds; Exaggerated 
Falling. 
Eleven pilots sent to the laboratory because they wrere sick or 
dizzy in the air. Eight of them gavte a history of sea, car, and merry- 
go-round sickness. Nystagmus, 20 to 28 seconds; vertigo, 22 to 53 
seconds; falling, exaggerated. Six vrere nauseated wiiile in the 
chair and five were not. 
Seven pilots of this type discontinued training at this time because 
of air sickness. Two of the four who continued had good flying 
records, one fair to good, and one fair. 
Type 3. Nystagmus, Under 30 Seconds; Vertigo, Under 22 Seconds; Exaggerated 
Falling. 
Five pilots sent to the laboratory because they were dizzy in the 
air. One pilot gave a history of sea, car, and merry-go-round sick- 
ness. Nystagmus, 20 to 30 seconds; vertigo, 15 to 22 seconds; 
falling, exaggerated. Three were nauseated while in the chair, two 
were not. 
Two pilots of this type discontinued training at this time because 
of dizziness. Two made good flying records and one only fair. 
Type 4. Nystagmus, Under 30 Seconds; Vertigo, Variable; Normal Falling. 
Seven pilots sent to the laboratory because they vomited in the 
air. History of nausea and vomiting but no dizziness. Always 
feel fit after emptying the stomach. Nystagmus, 13 to 26 seconds; 
vertigo, 9 to 40 seconds; falling, normal. Two were nauseated while 
in the chair. 
One pilot of this type discontinued training after the armistice 
was signed. He had put up with the vomiting until this time. Two 
made good flying records, two were ordered to duty as ferry pilots, 
and two made fair records. 159 
AVIATION MEDICINE IN THE A. E. F. 
Type 5. Nystagmus, Over 30 Seconds; Vertigo, Over 22 Seconds; Normal Falling. 
Six pilots sent to the laboratory because they were dizzy in the 
air. Nystagmus, 30 to 36 seconds; vertigo, 23 to 36 seconds; falling, 
normal. 
Two pilots of this type made good flying records; two fair to good; 
one fair; and one was ordered to duty as a ferry pilot. 
Type 6. Nystagmus, Over 30 Seconds; Vertigo, Under 22 Seconds; Normal Falling. 
Thirteen pilots with no symptoms of air sickness. Nystagmus, 
30 to 36 seconds; vertigo, 13 to 22 seconds; falling, normal. 
Nine pilots of this type made good flying records; three fair to 
good; and one wvas ordered to duty as a ferry pilot. 
SUBNORMAL LABYRINTHS. 
Fifteen pilots with so-called subnormal labyrinths were examined. 
These pilots had had from 50 to 1,000 hours in the air. Nystagmus, 
10 to 17 seconds; vertigo, 5 to 20 seconds; falling, none to normal. 
Two pilots were sent to the laboratory because of poor air work, 
two because they were sick in the air, and the others found on routine 
examination. 
Nine pilots of this type made good flying records; two made fair 
records; one made a poor record; one ordered to duty as a ferry 
pilot: one was found to be temperamentally unfit, and one discon- 
tinued training because of hypermetropia. 
CONCLUSIONS. 
It will he seen in the classification that 24 of the 50 pilots with 
hypersensitive labyrinths fall in the first three types and that 16 of 
these 24 pilots were forced to discontinue training because of air- 
sickness. In all of these cases there was an exaggerated falling or 
hypersensitive vertical canals. It would seem then that the vertical 
canals play a very important part, especially so in stunt flying, and 
a more accurate measure of the stimulation from these canals should 
be sought. This we did by timing the falling, and by the addition 
to the chair of a self-recording control stick. 
Timing the Falling. 
The pilot is turned five times in 10 seconds, with his head forward 
on his knees. At the end of the fifth turn, he is instructed to sit 
up, with his eyes closed and to regain the upright position as soon 
as possible, keeping the eyes closed throughout the test. The time 
between the end of turning and the pilot’s recovery from the falling 
is taken with a stop watch. This time varied between 0 and 70 sec- 
onds. Pilots with an exaggerated falling did not recover under 20 
seconds and were often nauseated. 160 
AVIATION MEDICINE IN THE A. E. E. 
“Joy Stick.” 
A stick freely movable in any direction was inserted into the foot 
board of the chair. Into the top of the stick was placed a small 
brass rod resting on a steel spring. A table was fastened to the foot 
board of the chair so that any movement of the stick would make a 
Fig. I.—Rotating chair with self-registering “joy stick” attached. 
tracing on paper fastened to the under side of the table. (See 
Fig. I.) Carbon paper between two sheets of writing paper takes the 
record. The pilot sits in the chair with his head forward resting 
on the table and grasps the stick with his right hand, holding it 
back and to the right. The position of pilot and stick during a 
vrille to the right. (See Fig. II.) AVIATION MEDICINE IN THE A. E. F. 
161 
The chair is turned to the right five turns in 10 seconds. Just 
before the last turn is completed, the pilot is instructed to push the 
stick into neutral, which is the perpendicular. As the chair stops 
turning, he is instructed to sit up, keeping his eyes closed. This is 
repeated to the left. The record is then removed and examined. 
(See Figs. Ill, IV, V, VI.) These records show the amount of stim- 
ulation both from the turning and upon changing the position of 
the head after turning. 
A vrille can not be exactly duplicated in the chair. In the ship 
there are two distinct revolving motions together with a rapid 
descent. Furthermore, the rudder is the more important control 
used in coming out of a vrille. 
Fig. II.—Subject in position for being rotated, with right hand grasping the self-registering “joy stick.” 
A series of tracings taken in actual flight, to compare with the 
records on the chair, was planned. 
Type 4 represents the vomiting type in which the chair shows us 
very little. This type can possibly be accounted for by supposing 
a hypersensitive vagus. They are not confused by the vertigo of 
the first three types, and in most cases this vomiting is overcome. 
Type 5 shows that hypersensitiveness of the horizontal canals is 
not a dangerous type except perhaps for the confusion that may 
come from the vertigo. This is overcome by frequent flying. 
Type 6 shows that a prolonged nystagmus time in itself means 
nothing. 
None of the subnormal type discontinued training because of their 
labyrinths. Some of these were said to have had normal labyrinth 
responses at the time of their acceptance into the service, but these 
responses became gradually shorter at each examination as the pilots 
171364—20——11 162 
AVIATION MEDICINE IN THE A. E. F. 
C. S. C., first lieutenant; 4J months at the 
front; flight commander; 3 Huns official. 
No history of dizziness. 
Nys. 
Vert. 
P. P. 
Falling. 
20 
20 
} 12 
/ 2-2 
\ 2-2 
j-Normal. 
Fig. III.—Normal curve made by pilot with four and a half months’ flying at the front, 
G. D. F.; monitor field 3; 500 
hours flying 22,000 feet. 
Nys. 
Vert. 
P. P. 
30 
30 
| 22 
/ 3-2 
\ 3-4 
Fig. IV.—Normal curve made by a monitor from field 3, where much acrobatic flying is done. AVIATION MEDICINE IN THE A. E. F. 
163 
B. P.; hypersensitive to motion; could not pass 
avro work; sick in air, seasick; car sick; merry- 
go-round sick. 9,000 feet. 45 hours. 
Nys. 
Vert. 
P. P. 
Exag. falling. 
34 
33 
} 30 
/ 4-4 
\ 4-4 
j-Nausea. 
Fig v.—Curve of hypersensitive labyrinth. Shows marked stimulation and confusion. Made by pilot 
who is hypersensitive to motion and could not pass strict acrobatic tests. 
H. E. T.; hypersensitive; could not pass avro 
work. Comes out of vrilles cock-eyed. Loses 
head. 
Nys. 
Vert. 
Exag. falling. 
Oct. 8 
33 
42 
Exag. falling. 
32 
40 
Oct. 18, after 5 
23 
33 
Exag. falling. 
turns in avro. 
24 
37 
Oct. 28 
24 
31 
23 
35 
Made good on one occasion, which was a day 
after drinking wine. Later failed to make good. 
Class B. Hypersensitive labyrinth. 
Fxg. VI.—Curve of a hypersensitive labyrinth shows marked stimulation and compression. 164 
AVIATION MEDICINE IN THE A. E. F. 
continued their training, and especially where they had done con 
siderable stunt flying. This has not been confirmed because previous 
records were not available. 
One pilot, a professional gymnast with a nystagmus of 12 seconds, 
no past pointing and no falling, showed both labyrinths functioning 
but unequal when douched. lie passed a most satisfactory exam- 
ination in the avro (airplane) and made a good flying record. 
Another pilot, the best exhibition flier at this field, had responses 
far below the average. He had perfect control of a ship, doing such 
maneuvers as vertical banks around the w'ater tower, coming out of 
a loop at the top in a half barrel roll, and looping a monoplane 300 
consecutive times in 67 minutes. 
The results of labyrinthine stimulation vary greatly. They are 
influenced by anything that may upset the general nervous tone, such 
as acute and chronic infections; drug toxaemia (alcohol and cigarettes); 
and prolonged nervous strain (staleness). Col. Birley of the British 
Air Medical Service first called attention to the latter and it was found 
in several fliers returning from the front. 
Finally it would seem that the kinetic static labyrinth is a retro- 
grade organ in man, being highly developed in birds, less so in fish 
and least in man. It undoubtedly undergoes training with the 
pilot. By force of will, many hypersensitive labyrinths are over- 
come during training. A functionating labyrinth should be required 
of a pilot, but there should be no set limits on nystagmus. It would 
be a safe rule to disqualify those who fall in the first and second types 
of the classification. Chapter VI. 
DEPARTMENT OF OPHTHALMOLOGY. 
Col. W. H. Wilmer, Medical Corps, 
and 
Maj. Conrad Berens, Jr., Medical Corps. 
THE EYE IN AVIATION. 
The “Eye of the Army” must have good eyes himself. Of all the 
physical qualifications necessary for the military aviator there is 
not one that is more important than good sight. 
Richthofen says: “Only a wonderfully trained, practiced, and 
observant eye can see anything definite when one is traveling at a 
great height and at a terrific speed. I have excellent eyes.” “Con- 
tact” writes in his “Air-man’s Outing”: “The eye must cover every 
direction and cooperate with the brain in perfect judgments of time 
and distance.” A submarine many feet under the surface of the 
water may he invisible to a ship but it does not escape the keen- 
sighted airman. 
At a conference with 100 successful American fliers from the front, 
each one placed keen vision as the most important of all physical 
qualifications; while of 89 observers from the front, the largest num- 
ber considered physical fitness the most important of the physical 
requirements, the next largest number felt that good vision was the 
most necessary. 
While keen vision is a most important physical asset in all types 
of air work, it is more important in some than in others. It is 
necessary in the early and positive recognition of enemy airplanes, 
in judging distance, in detecting speed and direction of motion, in 
following the topography of the country, in accurate shooting and 
in making a good landing. It is of relatively less importance to 
the day bomber on account of the size of his targets; to the night 
bomber owing to the fact that good dark adaptation is not of necessity 
associated with acute vision; and to the aerial navigator because he 
could wear correcting glasses with more safety than other airmen. 
Maj. McCudden, Royal Flying Corps, graphically describes the 
tragedy of the unseeing pilot: “I shall never forget how that Fokker 
looked on the 2-C’s tail, whilst the British pilot was calmly flying 
straight, not looking behind him at all, and no doubt thinking of 166 
AVIATION MEDICINE IN THE A. E. F. 
Blighty, home, and Beauty.” One of our pilots very tersely puts it: 
“Men with poor vision did not come back.” 
Should, however, some ocular error become manifest in a flier 
who is good otherwise, the error should be carefully corrected, prefer- 
ably by having the correction ground in his goggles. He should, 
however, be carefully advised of the fact that goggles may he blown 
off or be broken, or become fogged or soiled with water or oil. 
Of the Allies, Guynemer, Bishop, and Rickenbacker (with scores of 
others) had very acute vision. Among the enemy, the elder von 
Richthofen and Boelke were the possessors of good sight. Even the 
keenest sight becomes better by practice over the lines. 
The problem of the one-eyed man should not exist in civil or in 
military flying, save during the exigencies of war. All men experi- 
enced in the requirements of aviation agree that only the man with 
two eyes should be admitted to a flying status. However, where a 
successful combat pilot with trained “air vision” loses an eye it is 
quite another question—one of the utmost military and economic 
importance. The British, with their usual efficiency, have it now 
under consideration. The objections to returning him to duty are 
based upon the facts of a diminished field of vision and the impair- 
ment of the ability to judge speed and distance, with consequent 
difficulty in landing. The restricted field of vision is of lesser 
importance owing to the nature of seeing in the air which is achieved 
by the constant twisting of the head in all directions—it may he 
described as a “rubber neck” type. Many fliers have spoken of the 
enlargement of the neck muscles by this constant motion. The 
difficulty in landing is more serious. But the gradual return, or 
failure to return, of the ability to take off and to land, could he tested 
with a fast ship at the aerodrome. Great stress has been laid upon 
the economic value of the training, judgment, and experience of the 
combat pilot. Another consideration is that the number of men 
who get to the front is very small in proportion to the number 
entering training—one-fourth to one-half. In our service, approxi- 
mately a little less than one-half of the observers and one-third of 
our pilots, who started training, got to the front. The first few 
trips over the lines are the critical ones. Further considerations 
are the length of time it requires to make an aviator, and that not 
all good fliers are good in combat. Therefore, it might seem wise, 
in certain exceptional cases of this type, to consider the possibility 
of returning such a flier to his combat status if he is keen to return. 
Under such circumstances, a few British combat pilots did return, 
and they continued to be successful. 
The proper recognition of colors plays an important part in the 
success of all types of fliers. On the maps generally used by observ- 
ers the woods are green, rivers blue, roads yellow, railroads black, AVIATION MEDICINE IN THE A. E. F. 
167 
and towns brown. Sky-rockets with a parachute are white, red, 
or green; and cartridges, with and without parachutes, are of 
similar colors. Bengal flares, which are used in woods and heavy 
underbrush, are red and white. The aerodromes use red and green, 
or white lights for homecoming planes, while the planes themselves 
carry a red light on the port and a green light on the starboard side. 
In a “dog fight,” fliers of great experience state that it is necessary 
to recognize colors on a machine to avoid the possibility of shooting 
down a friend. In artillery work the sense of color is necessary to 
detect false woods, trenches, and guns which have been camouflaged 
by colored screens, trees, etc. Infantry contact is one of the most 
trying pieces of work that an aviator is called upon to do. Rapid 
recognition of color is most helpful in this branch of work. In addi- 
tion to everything else, the Infantry airman must recognize the 
various uniforms. All types of fliers (over land) are liable to have 
to select quickly a place for a forced landing. In this connection, 
Capt. S. J. Allen, Royal Air Force, states that good color vision is 
necessary to detect differences of color on the ground. “A light 
field indicated stubble; a dark green field, grass or wet and marshy 
ground; dark green stripes running across fields, water or ditches; 
yellow, sand; and rough brown spots, bumps.” If a flier who has 
been successful in training is found later to be color blind, he can be 
used as an instructor, ferry pilot, or night bomber, provided only 
white lights are used at his aerodrome. In great emergencies, he 
could be used as a day bomber owing to the height at which he 
usually flies. 
Good muscle balance has been considered of great importance by 
all of those experienced in aviation. In 1914 Halben, who was so 
liberal in his views in regard to vision, laid emphasis upon the danger 
of the laming of an eye muscle, thus producing a false projection and 
a disturbance of orientation. Our British colleagues have recognized 
the importance of good muscle balance and have established a school 
of heterophoria under Maj. Clements. Many pilots have been sal- 
vaged for their country by his painstaking work. In addition to 
well-balanced muscles, strong convergence, and accommodation, we 
realize the necessity for muscles resistant to the strain of air work. 
We also feel that a rapid change of accommodation for different 
distances, with this strength well balanced in each eye, is of great 
importance. 
The value of stereoscopic vision has been questioned owing to the 
recognized fact of the predominant eye, and for the reason that a few 
men with only one eye, and some with poor stereoscopic vision, have, 
nevertheless, been successful in flying. However, it is of great value 
in judging distance in landing and in studying stereoscopic plates. 
The British have found good correlation between stereopsis and 168 
AVIATION MEDICINE IN THE A. E. E. 
good flying. In our personal experience, it is possessed by all the 
very successful fliers whom, we have examined. 
A good dark adaptation is essential to the night flier. It is also of 
value to all types of fliers. For, during the exigencies of war, pilots, 
either of necessity, or by the lure of the contest, were deluded by 
the light of the higher altitudes, and, in consequence, they were sur- 
prised to find darkness upon their return to their aerodromes. Land- 
ing then became a different matter. McCudden, writing of a pilot 
flying at night, says: “He left the ground in the dark to fly 20 miles 
across France to an aerodrome, and as soon as he was off the ground 
Fig. I.—Ophthalmologies! room, Medical Research Laboratory Third A. I. C., A. E. F. 
he flew through the side of a house. The only thing undamaged was 
himself.’ ’ 
Quick visual reaction time, which is so important to the acrobatic 
flier, is also of advantage to the combat pilot, if it is 
cool decision and accurate muscular coordination. Kichthofen”says: 
“It followed that the victory would accrue to him who was calmest, 
who shot best and who had the clearest brain in a moment of danger. 
We have lost many good fighting pilots through their getting excited 
and dashing headlong into an unequal combat.” The most success- 
ful combat pilots did not press the trigger until they had taken 
deliberate aim and the enemy was within the proper range. They 
frequently brought down their opponents with the first burst, and 
occasionally by the first bullet. AVIATION MEDICINE IN THE A. E. F. 
169 
In general, affections of only passing inconvenience on the ground 
may be serious in the air, such as scintillating scotoma, muscae 
volitantes, photophobia, heterophoria, and, for the night flier, poor 
dark adaptation. Eric Wood very aptly brings out the similarity 
of distant planes to -“muscae.” He writes: “There presently 
appeared a little bunch of black spots, which to any but a man whose 
eyes had been trained to see, might have been taken, perhaps, for 
the dancing, mocking dots, which are to many the signs of indi- 
gestion.’' 
ROUTINE WORK. 
The exigencies of war prevented the carrying on of much research 
in France, so that the work there consisted mainly in the practical 
application of the information that had been gained in the Medical 
Research Laboratory at Mineola, and at the flying fields in the 
United States. 
In addition to 168 entrance examinations and the cases that were 
daily referred to the laboratory, examinations were made of testers, 
monitors, American fliers from the front, and French fliers. The 
fliers from the front were often tired and nervous. The strain of 
flying, altitude, loss of friends, and personal danger had left a deep 
impress. This was demonstrated by the records of the near point of 
convergence, near point of accommodation, the duction tests, and 
particularly the fatigue of accommodation and convergence, as 
tested with the ergograph. These showed relaxation of muscle tone 
and tendency to easily fatigue. As a rule it was found that a rest of a 
week or 10 days did more to help the ocular conditions than keeping 
the men at the post and giving them muscle exercises. Examina- 
tions were made of student fliers who were having difficulty in landing, 
or who had crashed, or who were not sure of themselves in judging 
distance in the air. Examination of the men who were habitually 
poor landers, often showed some derangement of the ocular muscles 
although in some cases, we were unable to discover any ocular cause. 
The most common trouble was a marked weakness in the converging 
power as shown by the usual tests, even more graphically by the 
fatigue test. The accommodation was also affected. In those cases 
that were not helped by rest and muscle exercises, a focus of infection 
was frequently found, and many of them improved rapidly after 
removal of diseased tonsils, the extraction of teeth with abscessed 
roots, or the drainage of infected nasal sinuses. In some cases, de- 
rangement of binocular vision was the whole cause of the difficulty 
in judging distance. When one is accustomed to using both eyes 
there is often great difficulty in effecting a landing when only one eye 
can be relied upon—which may be the case in the rapid descent 
with a dead motor from a great altitude. We had several examples 
of the different types of cases (1) where there was constant difficulty 170 
AVIATION MEDICINE IN THE A. E. F. 
in maintaining binocular vision and (2) where this disturbance was 
temporary—due to a sudden change of altitude. 
Two crashes occurred at our field about the same time. The first 
accident was caused by a paralysis of the superior oblique muscle of 
one eye of the flier, who not only experienced trouble in judging 
distance in landing but had difficulty in walking about, although his 
diplopia field was small. The second crash was due to a temporary 
disturbance of binocular vision—the result of a rapid descent from a 
great altitude. The flier in this case was a monitor who had never 
made a bad landing previous to this experience. Under usual condi- 
tions his eyes were normal. He was flying one day at a high altitude 
when his motor stopped. He glided down rapidly to his own field. 
When he thought he was within 50 feet of the tops of some trees at 
the edge of the field he leveled off to pick out a landing place, 
but upon looking over the side he realized that he was probably 
200 feet above the trees instead of 50 feet. He nosed over again, 
and this time came within about 50 feet of the tops of the trees. 
The field was full of machines, but he quickly located a spot for a 
landing, glided down, and leveled off, as he thought, a foot or so from 
the ground. As soon as he had lost flying speed he let the machine 
down and crashed. He was examined in the hospital at the Third 
Aviation Instruction Center within an hour and a half, but no physical 
defect could be found to account for his crash. He had misjudged 
his distance the second time, and, instead of being 2 feet from the 
ground when he leveled off, he was at least 15 feet above it. He had 
been at an altitude of 15,000 feet for about an hour, and had come 
down so rapidly that his ocular muscles could hardly have had time 
to have adjusted themselves. This accounted for his difficulty in 
judging distances. To prevent such occurrences as this every student 
flier is supposed to make a “tour de piste” before attempting to 
land. 
We have always felt—and practical experience in the field has 
demonstrated the fact—that men with weak converging power 
frequently have trouble in landing. In one man who was sent to us 
from the British because of inability to judge direction in the air 
(supposedly due to a low degree of myopia) there was convergence 
weakness combined with divergence excess, which was evidently 
the cause of his trouble in judging distance and direction. He stated 
that after having flown at an altitude of 16,000 feet or over for a 
period of an hour he had upon three occasions cut across the flight, 
and that before this occurred he had difficulty in judging distance 
and direction. As his vision was 20/20 under homatropine and 
20/20 — 2 without homatropine, we felt justified in eliminating myopia 
as the cause of the difficulty. Our entrance requirements excluded 
men with more than 1° of hyperphoria or with more than 2° of exo- AVIATION MEDICINE IN THE A. E. F. 
171 
phoria at 6 meters. As a general rule we found that men with 
hyperphoria and exophoria had difficulty under flying conditions in 
France. In rare instances, however, men with normal vision in each 
eye but with so much hyperphoria and exophoria that they were 
unable to use both eyes together, had made good fliers and apparently 
had had no difficulty in judging distance or in landing fast machines. 
In only one instance was it necessary to transfer a man because of 
inability to fuse distant objects. This pilot had never been able to 
use his eyes together in spite of an early muscle operation and fusion 
training, and he had had considerable trouble in judging distance in 
tennis. After repeated tests he was forced to give up trying to land 
a fast plane, although he was usually able to land a slow one. After 
two months’ work with this pilot, in the attempt to fit him for his 
duties, he was finally transferred to a school for observers, where he 
was to be given work in which the rapid and accurate judgments of 
distance and direction were not so necessary. 
In the A. E. F. the work of classification (from an ocular stand- 
point) of the flier as to his fitness for flying and his ability to with- 
stand the lack of oxygen was determined by the careful routine eye 
examination. After a very thorough examination, it did not seem 
necessary to examine the eyes during the rebreathing test—which 
was done in all cases in the United States. From our experience in 
examining over 600 pilots at Mineola, we were convinced that we 
could usually foretell the type of case that would fail ocularly to 
withstand the lack of oxygen. If the eyes were normal under this 
very rigid examination the break in them would be secondary to 
other physical or psychological causes, and the flier would therefore 
be classified accordingly by the other departments. A complete 
history of the pilot was taken, which included family and personal 
history, previous eye and medical history, flying record, and present 
condition. An estimation of his general physical make-up and the 
notes taken from the physical examinations in the other depart- 
ments were recorded on the eye blanks. The vision, with and 
without correction, was then recorded, and the correction also, if 
glasses were worn. If his vision were not 20/20 or better, or if he 
showed a high degree of manifest hypermetropia as recorded, 
routinely, by the fogging method, a complete refraction was usually 
made under homatropine. The interpupillary distance, near point of 
accommodation for the right and left eye as recorded in millimeters 
from the anterior surface of the cornea, and the near point of conver- 
gence in millimeters from the same point, were then taken. The muscle 
balance, the converging power, the diverging power, and sursumverg- 
ing power (all at 6 meters and at 25 centimeters) were then recorded. 
The tension, fields, lids, lachrymal apparatus, ocular movements, con- 
junctiva, cornea, iris, lens, media, and fundus were then examined. 172 
AVIATION MEDICINE IN THE A. E. F. 
Color vision was tested by the Jennings color test and the findings 
checked with Stilling’s plates and Williams lantern. For central color 
defects the Abnev-Oliver color test and the small aperture in the 
Williams lantern were used. Stereoscopic vision was tested by means 
of the usual stereoscopic pictures and checked by asking the candidate 
to make judgments in regard to. distant objects in the landscape. 
A modification of Herring’s test was installed for use at 25 feet. 
Unfortunately, the apparatus for determining reaction time in the 
judgment of distance was not completed in time to be put to the 
practical test. The retinal sensitivity was tested roughly with Reeve’s 
wedge and Reeve’s contrast squares. The Hare perimeter and the 
tangent screen were used for testing the visual fields, muscle anoma- 
lies, mapping out scotomata, and outlining the blind spots. The 
Howe’s modified ophthalmic ergograph was used, routinely, in the 
Fig. II.—Two records of the fatigue of convergence of Lieut. R. C. are recorded by the modified Howe’s 
ophthalmic ergograph. The time is recorded in half minutes. The horizontal lines correspond to 10, 
20, and 30 prism degrees and are so marked. N ote the increase in strength of the converging power between 
Oct. 23, 1918, and Nov. 4, 1918. 
making of diagnoses, in giving converging exercises, and in recording 
the accommodation fatigue. We believe that the Ferree apparatus 
will prove valuable in the eye problems of aviation as well as in 
clinical problems, and we regret that we were able to make only a few 
estimations with it. 
After an examination in the eye department, a summary of the find- 
ings, the diagnosis, and recommendations were typewritten on the 
history, signed by the officer who had made the examination, passed 
by the officer in charge of the department, and then sent to the board. 
All fliers were examined when they were discharged from the hos- 
pital, and they were not permitted to resume flying until they had been 
cleared by the various departments. This probably saved many 
accidents. 
It was realized that a monthly examination of the pilot’s eyes was 
advisable whenever practicable. The careful prescribing of the 173 
AVIATION MEDICINE IN THE A. E. F. 
proper lenses to be worn in the goggles was an important part of this 
work. 
The dazzling of the retina by artificial lights and by the sun 
is a most important subject. Zade examined 150 men from his 
service for the after effects of dazzling, but he did not discover a single 
case of scotoma. Among 162 men examined in the Antiaircraft 
Service, he found that 31 members of gun crews showed scotomata 
following retinal dazzling. The scotomata in these cases were always 
peripheral and usually in the lower part of the visual field, in the neigh- 
borhood of the 40° and 50° meridians. That the aviator is occa- 
sionally blinded by glaring light is well known, and two accidents 
from this cause have been reported—one from blinding in daylight 
and the other from the dazzling effect of a searchlight. 
The treatment of the ordinary ocular troubles fell naturally under 
our supervision. 
Table 1,—Summary of eye examinations. 
Examinations and treatments: 
A. Number of individual cases 794 
B. Total examinations and treatment . l,t)74 
Special examinations: 
A. Monitors ; 70 
B. Testers 8 
C. Fliers from American front 112 
D. French fliers 12 
Diagnoses: 
A. Congenital anomalies— 
3. Arterial loop on righ t disk 1 
B. Colorblindness 3 
C. Lids— 
1. Marginal blepharitis 14 
2. Burn of lids 1 
D. Lachrymal apparatus— 
1. Stenosis of right lachrymal duct 1 
E. Conjunctiva— 
1. Chronic conjunctivitis 5 
2. Follicular conjunctivitis 1 
3. Acute conjunctivitis 1 
4. Muco-purulent conjunctivitis 1 
F. Cornea— 
3. Macula of cornea 3 
2. Nebula of cornea (traumatic) 1 
G. Iris— 
1. Foreign body in right iris 1 
H. Choroid— 
1. Chorio-retinitis 7 
2. Rupture of choroid with secondary partial atrophy 1 
I. Retina— 
1. Neuro-retinitis 1 174 
AVIATION MEDICINE IN THE A. E. F. 
Table 1.—Summary oj eye examinations—Continued. 
Diagnoses—Continued. 
J. Optic nerve— 
1. Optic neuritis .. 8 
2. Optic atrophy 2 
3. Traumatic neurosis (hysterical amblyopia) 1 
K. Arteries— 
1. Arterio-selerosis 1 
L. Muscles— 
1. Convergence insufficiency 74 
2. Convergence excess . 2 
3. Divergence excess 11 
4. Divergent strabismus 2 
5. Muscle imbalance 1 
6. Fusion sense defect 1 
7. Paralysis of left inferior rectus 1 
8. Paralysis of left levator palpebrae superioris 1 
9. Paralysis of right superior rectus 2 
10. Paralysis of right superior oblique 1 
M. Refraction— 
1. Emmetropia 431 
2. Ilypermetropia 213 
3. Compound hypermetropic astigmatism 10 
4. Hypermetropic astigmatism... 13 
5. Compound myopic astigmatism 5 
6. Myopic astigmatism 7 
7. Myopia 12 
8. Mixed astigmatism 4 
The ocular difficulties that arose from nose and throat infections 
formed another part of the work of the Ophthalmological Department. 
In a number of these cases there was an enlargement of the blind spot— 
a condition most important to detect in the aviator. In mapping out 
the blind spots the Hare perimeter was used, the head of the subject 
being kept accurately fixed by using a wooden tongue depressor as a 
mouth bite. A 1-millimeter black dot was made upon the back of the 
pilot’s own history card (5 by 8), which was fixed upon the arc of the 
perimeter at 27 centimeters distance from the front of the cornea. 
This dot corresponds to the center of rotation of the arc of the per- 
imeter. A 3-millimeter black circle upon a light rod was used as a 
test object. This method had the advantage of saving time, detecting 
very small enlargements of the blind spot, and preserving upon the 
permanent history record the graphic, diagrammatic changes in the 
size and contour of the spot, as shown in Fig. III. 
During the war the effect of altitude upon the ocular functions was 
of increasing importance owing to the great altitudes at which air 
combats took place. Many physiological studies upon the effects of 
altitude have been made in balloons, in decompression chambers, and 
EFFECT OF ALTITUDE. AVIATION MEDICINE IN THE A. E. F. 
175 
on mountains. But with the exception of an occasional reference to 
the fact that vision was disturbed, or that things became black before 
the eyes, very little study of the effect of altitude upon ocular func- 
tions has been found in the literature at our disposal—apart from the 
records of our own work at Mineola. 
The effects of a lowered oxygen tension upon vision, visual fields, 
color vision, the motor and accommodative apparatus, stereopsis, 
and the perception of the direction of motion, have already been 
touched upon in the Manual of the Medical Research Laboratory, 
Air Service. But it will be necessary from time to time to refer 
briefly to our former work. While this research work was hasty by 
reason of the spur of war, and not always conclusive, it is hoped 
that it may prove an incentive to further and more exhaustive study 
of these subjects. 
2nd Lieut. R.G.W., A.S. 
Diagnosis; Optic neuritis, Retro bulbar, 0.~U« (Tonsils) 
-October 11, 1918- 
-October 18, 1918- 
-October 21, 1918- 
o.s. 
O.D. 
October 11, 1918. - Blind-spots for form at 27cm. - Black ink. 
October 18, 1913. i Blind-spots for form at 27cm. - Red ink. 
October 21, 1918. - Blind-spots for form at 27 cm.- Green ink. 
Fig. III.—Rapid clinical method of recording the size of the blind spots. 
Visual Acuity. 
In the American Expeditionary Forces, as in the United States, 
visual acuity was tested chiefly by the Ives apparatus. Irom our 
experiences at Mineola, we feel that the effect of altitude upon the 
ocular functions is simulated in the laboratory best by holding the 
subject at an artificial altitude from about 18,000 to 20,000 feet, for 
from 30 minutes to an hour. Pilots have often spoken of blurred 
vision, both at the training stations and during flights at the front. 
Schroeder, in the account of his altitude flight record, thus described 
the effect of lowered oxygen tension on his sight: “When I reached 
25,000 feet I noticed the sun growing very dim * * * the trend 
of my thought was that it must be getting late, that evening must be 
coming on, and that was the reason for the sun’s getting so dim 
* * * as soon as I started to inhale the oxygen the sun grew 
bright again * * * and the day seemed to be a most beautiful 
one.” 176 
AVIATION MEDICINE IN THE A. E. F. 
In the manual published in 1918 we spoke of the test of visual 
acuity under the influence of nitrite of amyl to ascertain if there 
were any improvement of the vision by an artificial stimulation of 
the cerebral centers. Of the 12 very accurate subjects examined for 
this purpose, only one (a myope) experienced improvement at any 
stage of the tests. In this case the vision grew better owing to the 
relaxation of the accommodation. Practical experience gained later 
has served to increase our belief that the sight of the slightly myopic 
pilot is less affected by altitude than one with hyperopia. 
35Kin. 
Central Average 
July a. 
Re-breathind 
JHfect of low owden tension 
Upon strength Ocular 
35 Ken. 
tenoral Averade 
July a. 1018 0 
Low ?res Chamber — — — — 
— —— 
Fig. IV.—Weakening of the duction power of the ocular muscles from artificial altitude. 
Color Vision. 
From our experience before going to France we feel that there is 
diminution in the power of the retina to recognize colors as the 
altitude increases. We were mindful of this fact, but the cases exam- 
ined were too few and the tests not sufficiently sensitive to permit the 
drawing of any definite conclusions. 
Muscles. 
To avoid repetition, it will be sufficient to say that our practical 
experience in France convinces us that our previous reports were, in AVIATION MEDICINE IN THE A. E. E. 
177 
the main, correct—showing as they do that at 20,000 feet and over 
there occurs a loss of duction, accommodation, and convergence 
power with a restriction of the fields of binocular fixation. While 
this change takes place in a large percentage of cases, it varies with 
the general resistance of the flier to oxygen want, and specifically in 
accordance with his refraction and muscular balance and strength at 
the beginning. Figure IV shows the average decrease (in 35 men) in 
the strength of the ocular muscles due to artificial altitude, and also 
the recovery of the muscle strength after the administration of 
oxygen. The ordinates represent prism degrees. In ascertaining 
the fatigue of accommodation, our tests on the rebreathing apparatus 
and in the low-pressure chamber usually showed a rapid onset of 
fatigue at 20,000 feet, as compared with the control records. It is 
possible that the pilot whose near point of convergence is greater 
than normal, but who is able to withstand fatigue, might have less 
difficulty in the air than one who could converge at the normal point 
for only a very brief period. Aviators of great experience have 
recognized the fact that it is very difficult to judge distance after 
high altitude flights. For this reason, the descent is made as slowly 
as possible, and the field circled before landing is attempted. In this 
connection Rickenbacker’s precautions in landing are very inter- 
esting, though he does attribute the difficulty to atmospheric 
pressure. Fie says: “Another of those little precautions that might 
spell the difference between life and death was the habit I forced 
upon myself always to make one or two complete circles of the 
aerodrome before landing at the end of a patrol * * *. Diving 
swiftly and suddenly from 15,000 feet altitude, where the air is thin 
and very cold, to the ground level where the change in the pressure 
upon the temples is often very severe, may easily make the airman 
dizzy. He may misjudge the distance above the earth and crash 
violently when trying only to skim the ground. A circuit or two 
just above the surface of the landing field will give him time to adjust 
his vision and to accustom himself to the change in air pressure.” 
Stereoscopic Vision. 
The importance of this qualification seems to grow greater as our 
experience increases. We feel that this function which so largely 
depends upon the dynamic conditions of the intrinsic and extrinsic 
eye muscles is of necessity affected by altitude changes. However, 
in our previous work upon the subject in the low-pressure chamber 
only the ordinary stereoscopic charts were available and therefore 
changes that were slight could not be recognized. In actual fly- 
ing the return to normal is too rapid to be detected after the land- 
171364—20 12 178 
AVIATION MEDICINE IN THE A. E. F. 
ing is made. But with the apparatus of Prof. Spearman, Maj. 
Berens, and Capt. Howard we feel that the changes in the power of 
stereopsis under altitude conditions will be easily demonstrated in the 
laboratory. This function can also be tested in the roomy new 
planes. 
Visual Fields. 
We have so far not been able to detect any marked restriction of 
the visual fields that is due to diminished oxygen. This restriction 
has been small indeed compared to the limitations of the ordinary 
goggles. 
Retinal Sensitivity. 
The contrast sensitivity was tested quickly with the Reeve’s wedge 
and contrast squares. The threshold sensitivity test was made with 
the wedge and a minute point of light of fixed photometric value, the 
retina having been previously dark adapted. Other methods of 
making more accurate tests were being worked out, but the lack of 
time was a very real handicap. We are not familiar with any test of 
this type that can be completed within an hour. However, the test 
is of such importance that the expenditure of time in making it is 
well worth the while in the case of one who has to fly at night. 
Perception of Motion and Its Direction. 
From our. tests of the peripheral retina at Mineola, there is seem- 
ingly an average difference of approximately 10° between the point 
where the test object is first noted and the point where the direction 
of motion can be accurately perceived. It was hoped that a test of 
this sort might be of value in selecting aviators. But the fields for 
perception of motion and direction of motion have seemed to bear 
such a close relation to the visual fields as usually taken that the latter 
test has been sufficient for practical purposes. However, the subject 
requires a more thorough investigation. The determination of direc- 
tion of motion by central vision is most important, particularly in 
maneuvering for position and in using a machine gun. It is some- 
times difficult to rapidly determine direction. In the words of Capt. 
Allen, Royal Air Force: “To a young pilot there are certain posi- 
tions a near-by plane may assume in which it is rather hard to judge 
the exact direction of motion. For example, wffien the enemy plane 
is above, in front of, and to the starboard side.” Bearing this in 
mind, we have devised an apparatus which will record reaction time 
in the judgment of direction of a moving plane. We believe that the 
time element with the influence of altitude upon it, is most important 
and we hope that practical experience in the future will demonstrate 
the value of some such test. 
The following are the results of tests made before and after flight 
without oxygen and with its artificial use: 179 
AVIATION MEDICINE IN THE A. E. F. 
Altitude test (16,000 feet for one hour). 
[J. C., second lieutenant, Aviation Section.] 
Without oxygen, 
Nov. 23,1918. 
With oxygen, 
Nov. 24,1918. 
Before 
flight. 
After 
flight. 
Before 
flight. 
After 
flight. 
Accommodation OD (average) 
Accommodation OS (average) 
Mm. 
80 
76 
31.6 
Mm. 
96.6 
102 
50 
Mm. 
90.6 
89 
47.3 
Mm. 
99.6 
99.6 
46.3 
Fatigue of accommodation, slight (Fig. V). 
Fatigue of convergence, slight (Fig. V). 
[H. A. C., second lieutenant, Aviation Section.] 
Accommodation OD (average) 
Mm. 
109.3 
Mm. 
126.6 
Mm. 
103.3 
Mm. 
105.6 
Accommodation OS (average) 
105 
121.6 
104 
96.3 
Convergence (average) 
51.6 
47 
37.3 
36.6 
Fatigue of accommodation, marked. 
Fatigue of convergence, slight (had been using convergence exercises for several weeks previous to this 
test). 
J. Canfield, Second Lieut., A. S., Nov. 22, 1918. 
1.45 p. m. At 16,000 feet, 1 hour. Convergence for 
25 cm., N. P. C., before test 35-30-30. After test 
47-50-53. Convergence at 25 cm., 10 minutes after 
landing. 
ALTITUDE TEST WITHOUT OXYGEN. 
H. A. Colver, Second Lieut., A. S., Nov. 22,1918, 
1.45 p. m. At 16,000 feet, 1 hour. Descent at 3.25 
p. m., N. P. C., before test 55-45-45. After landing 
47-47-47. Exercise case. Convergence fatigue at 
25 cm. 20 minutes after landing. 
Accommodation fatigue, Jaeger type, 110 mm. 
from cornea one-half hour after landing. 
Accommodation fatigue, Jaeger test type No. 1 at 
115 mm. from cornea 40 minutes after landing. 
Fig. V.—Record of fatigue of accommodation and convergence after a flight without use of oxygen. AVIATION MEDICINE IN THE A. E. F. 
H. A. Covert, second lieut., A. S., 
Nov. 23, 1918. At 16,000 feet, 
1 hour. Descent at 1.40 p. m. 
N. P. C. 40-35-35; convergence at 
. 25 cm. 10 minutes after landing. 
Accommodation fatigue, Jaeger 
test type, 110 mm. from cornea 20 
minutes after landing. 
Fig. VI.—Record of fatigue of accommodation and convergence, of two pilots, after a flight with use of oxygen. 
Accommodation fatigue, Jaeger 
test type, 110 mm. from cornea 20 
minutes after landing. 
J. Canfield, second lieut., A. S., 
Nov. 23, 1918, 1.40 p. m. At 16,000 
feet, 1 hour. Descent at 1.40 p. m. 
Convergence for 25 cm., N. P. C 
47-45-47; convergence at 25 cm. 10 
minutes after landing. 
ALTITUDE TEST WITH OXYGEN. 
H. A. Covert, second lieut., A. S., 
Nov. 23, 1918, 11.40 a. m. Normal 
convergence for 25 cm., N. P. C. 
40-37-35; convergence at 25 cm. 10 
minutes before flight. 
Accommodation fatigue, Jaeger 
test type, 110 mm. from cornea 20 
minutes before flying. 
J. Canfield, second lieut., A. S., 
Nov. 25,1918,11.40 a. m. At normal 
convergence for 25 cm., N. P. C. 
52-45-45; convergence at 25 cm. 10 
minutes before flight. 
Accommodation fatigue, Jaeger 
test type, 110 mm. from cornea 20 
minutes before flying. AVIATION MEDICINE IN THE A. E. E. 
181 
In both cases where oxygen was used during the flight there was 
less change in the near points of accommodation and convergence 
than when the flight was made without it. In the fatigue tests when 
oxygen was used there was practically no change. (Fig. VI.) 
The ideal method of making these tests would be to have the 
observer and apparatus in the plane with the pilot so that the exami- 
nations could be made in the machine itself, before and after flight, 
as well as several times during flight. With the construction of the 
comfortable new planes, these examinations could easily be carried 
out. 
We know, from decompression chamber and rebreathing experi- 
ments, that the ocular functions often return to normal rapidly after 
an altitude test, and this accounts for the slight difference found 
upon examination after a flight. It can be well understood that- 
flying an aeroplane at the front adds a strain which is not experienced 
in ordinary flying. 
As a rule one does not realize that the observer’s duty is very 
fatiguing. But working a machine gun at high speed in the terrific 
blast of the propeller, while attempting to observe things all about 
him, requires great strength and endurance, and, above all, normal 
eyes which are able to withstand the effect of altitude. 
In addition to much routine and classification work, by Capt. H. 
R. Skeel, Medical Corps, in the eye department of the Second Aviation 
Instruction Center, at Tours (training school for observers), careful 
examinations were made of the eyes of 92 observers from the front 
when the men were undergoing the rebreathing test. Color blindness 
was found in only one case. But in a large proportion of the men 
who had seen very trying work at the front, there was a disturbance 
of the motor apparatus of the eye. This was shown by a weakened 
power of accommodation and convergence. 
CONCLUSIONS. 
1. In altitude experimentally produced the chief effect is a dis- 
turbance of the muscular apparatus of the eye, though it is possible 
that sensitivity is lessened at extreme altitudes. 
2. Up to 10,000 feet ocular changes noted are not constant. Occa- 
sionally apparent improvement is noted; but in averaging the exami- 
nations of a number of men, there is usually little change. Beginning 
weakness of the ocular functions is usually noted between 10,000 and 
15,000 feet, and changes are nearly always more marked at 20,000 
feet and over. 
3. From our findings we believe that at lower altitudes the ocular 
functions may possibly he stimulated for a brief time, hut at higher 
altitudes weakness results. The apparent improvement occasionally 
noted at low altitudes may be due partly to the difficulty in obtaining 
the maximum effort in the preliminary examinations. The factor of 182 
AVIATION MEDICINE IN THE A. E. F. 
excitement, in the first few minutes of a new experience, may bring 
forth greater muscular effort. But we doubt that the early changes 
are due to oxygen want. At increasing altitudes, depending upon 
the individual, the eye ceases to function. This is secondary to 
cerebral or circulatory breakdown. 
4. The administration of oxygen prevents the onset of changes due 
to altitude, and quickly restores ocular functions to normal even 
when there is lowered atmospheric pressure. 
5. The results obtained on the rebreathing apparatus and in the 
low-pressure chamber are for practical purposes identical. The 
experiments that were made after actual flights were small in number 
but they agree with the results obtained at an altitude produced 
artificially. 
Tobacco. 
THE EFFECT OF TOBACCO, ALCOHOL, AND DRUGS. 
It is a well-known fact that men living under the strain of war 
conditions use more tobacco than ordinarily. This was particularly 
true of the aviator at the front, for he frequently had long hours of 
waiting with little to do except smoke. The cigarette was smoked 
almost universally in the Air Service, and many of the men we met 
inhaled the smoke from 30 or 40 cigarettes a day. Knowing condi- 
tions in regard to the use of tobacco, Capt. Underwood tested in 
1918, in the ophthalmological department of the Medical Research 
Laboratory, Mineola, the effect of smoking on ocular functions. He 
has since revised and enlarged his work, which will later be published. 
Later on in France there was some research work carried on con- 
cerning the effect of tobacco smoking upon the eyes. The subjects 
examined were relatively too few to determine so large a question 
or to enable very specific conclusions to be drawn. However, it may 
be said in general that the inhaling of several cigarettes, or the 
smoking of one cigar, seemed to impair some of the ocular functions 
for a time, even in habitues. Among the aviators examined at the 
laboratory in France, the effect was transient, passing off, as a rule, 
within an hour. 
Drugs. 
There was also some investigation of the effects of alcohol and such 
drugs as quinine, aspirin, and phenacetin upon the eye functions. 
Here, too, the cases were too few for definite conclusions to be drawn. 
But the importance of having some accurate knowledge of the effect 
of these substances upon the eye is very great. In our experience a 
number of aeroplane accidents occurred after the fliers had been using 
such drugs as aspirin, phenacetin, bromides, and an advertised remedy 
for seasickness. Table II. 
Type of 
aviator. 
Ace, American 
Number 
exam- 
ined. 
Age. 
Type of work. 
Diagnosis. 
j 
Visual acuity (uncorrected). 
Wore correction 
in goggles. 
Manifest 
hypermetropia. 
Interpupillary 
distance. 
Near point convergence. 
Near point accomniodation. 
Muscles. 
Flying history. 
Hours of flying 
at front. 
Enemies. 
Chief complaint. 
Ocular 
examination. 
! Color vision. 
Stereoscopic 
vision. 
1 
j Recommendations. 
6-meter. 
25-centimeter. 
21 
Average 23.10 
High 31.9 
Low 21.6 
2 or 9.5 per cent 
. Average.. 0.44S 
High 1.25S 
Low 25S 
Average 63 
High 68 
Right. 
j Left. 
Divergence (power of). 
Divergence (power of). 
Average 18 
Hours. 
Total 6,255 
Average.. 298 
High 1,000 
Low 160 
Landing. 
All OK. 
No. of 
crashes. 6 
Shot down 3 
(For 15 men.) 
Total 2,051 
Average.. 137 
High 400 
Low 100 
Total ... 137 
Average.. 6.5 
High 12 
Low 5 
P.ct. 
No complaint... 53 
Nervous 18 
Restless 14 
Tired out 10 
Poor condition . 5 
All normal 
All normal. 
All normal.. 
Convergence in- 
sufficiency and 
rest, 1. 
Held by ophthal- 
mologies! depart- 
ment, 1 (correc- 
tion in goggle). 
Hypermetropia... 5 
Comp, myopic 
astigmatism 1 
Convergence in- 
sufficiency 1 
Undiagnosed re- 
Av 
erage 51 
j Average 
j High 
106 
130 
80 
1 106 
130 
60 
Average 5 
Right. 
! Left. 
. P. ct. 
Average 14 
High 25 
Low 8 
Average 36 
High 55 
Men 
Per 
cent. 
Men 
Per 
cent. 
Hypermetropia 23.4 
Mvooia 4.8 
Comp, myopic 
astigmatism 4.8 
Convergence insuf- 
ficiency 4.8 
Undiagnosed re- 
fractive error 4.8 
Below 20/20.. 
I 20/20 
5 
7 
9 
0 
23.8 
33.3 
42.9 
0 
S 4 
5 
i 12 
| 0 
19 
23.8 
57.2 
0 
Rt. sursumvergence. 
Rt. sursumvergence. 
20/15 
20/10 
High 2J 
Iliffh 
Low 2J 
Low 2£ 
French fliers.. 
12 
Night bomb- 
Emmetropia 7 
• 
Divergence (power of). 
Divergence (power of). 
Average 19 
High 50 
Low 10 
Convergence. 
Hours. J 
Total 6,308 
Average.. 525 
High 1,163 
Low 220 
Landing. 
No. of 
j crashes. 2 
Total 3,030 
Average.. 275 
High 500 
Low 110 
(Chasse only.) 
Total 19 
Average.. 3.80 
High 11 
Low 3 
Balloons. 2 
P.ct. 
No complaint. 91.7 
! Complaint 8.3 
P.ct. 
Not normal 33.3 
Normal 66.7 
All normal.. 
All normal. 
All Jit. 
Hypermetroria 3 
Myopic astigma- 
tism 1 
Chorio retinitis 
(central) 1 
P.ct. 
Emmetropia 58.4 
Hypermetropia... 25 
Myopic astigma- 
tism 8.3 
Chorio retinitis 
(central) 8.3 
Average.. 0.53S 
High l.OOS 
Low 25S 
Left. 
Average.. . 55S 
High 1. S 
Low...’.. 21 
cent 58.4 
Chasse, per 
cent 41.6 
Night bomb- 
ing 7 
Chasse ... 5 
Right. 
Left. 
Right. 
Left. 
Average 8 
High ii 
Low 6 
Convergence. 
Average 14 
Men. 
Per 
cent. 
j Men 
Per 
cent. 
Av< 
Hig 
Lo\ 
jrasre.... 41 
Averat 
High. 
se 
89 
115 
60 
88 
115 
55 
Low 
High 25 
Low 25 
Exophoria (5 men). 
j Average 3 
High 60 
Low 18 
Exophoria. 
Below 20/20... 
20/20 
20/15 
! 20/10 
1 
4 
! 7 
i 0 
8.33 
33.34 
58.33 
0 
3 
2 
6 
1 
25 
16.67 
50 
8.33 
I High./ :. 5 
| Low- 1 
Esophoria. 
1 Average 1.3 
! High 2 
i Low 1 
Rt. sursumvergence. 
| Average 3 
i High 4 
! Lowr 2 
High.: is 
Low 2 
Esophoria. 
None. 
None. 
None. 
Rt. sursumvergence. 
Average 3.2 
High 4 
Low' 3 
8 
Average 24.8 
Emmetropia 3 
Nnnp 
Average.. 0.53S 
High 1. S 
Low 25S 
Average 61 
High 70 
Right. 
Left. 
Average 
Exophoria 1 
for 2 men. 
Exophoria 4.5 
Hyperphoria 25 
Hours. 
Total 3,450 
Average.. 431 
P.ct. 
Nervousness.. 12.5 
N o complaint. 87.5 
P.ct. 
Not normal 12.5 
Normal 87.5 
All normal.. 
All normal.. 
A1 fit. 
1 High 29.1 
Low 22.2 
Hypermetropia 5 
P.ct. 
Emmetropia 37.5 
Hypermetropia... 62.5 
Average 56.6 
Average 
111.9 
150 
90 
113.1 
150 
90 
Right. 
Left. 
Hig 
Lo\ 
High 
Esophoria 1 
Low 60 
Landing. 
Crashes. 
Low 58 
Low 
Low 0 
Men. 
Per 
cent. 
Men. 
Per 
cent. 
Exophoria: 
High 5 
Low 4 
Below 20/29... 
j 20/20 
j 20/15 
20/10 
1 
3 
4 
o 
12.5 
37.5 
50 
0 
0 
2 
6 
0 
0 
25 
75 
0 
Monitors 
70 
Average 24.8 
High 35.3 
Low 20. 7 
Bombing 12 
Nieuport 12 
Observer 1 
Acrobatics... 7 
Rouleur 19 
Emmetropia 56 
Hypermetropia 9 
Myopia 1 
Comp, hyper, astig- 
matism 1 
None 
! 
Average.. 0.63S 
High 1.12S 
Low 0.0S 
Divergence (power of). 
Average 5.8 
High 15 
Low 2 
Convergence. 
Average 16.5 
High 25 
Low 6 
Divergence (power of). 
Average 14 
Hours. 
Total... 16,149 
Average. 245 
High.... 1,200 
Low 12 
Landing. 
No. of 
crashes 3 
None 
P. ct. 
Complaint... 4.3 
No complaint 95.77 
P. ct. 
Not normal 5.7 
Normal.... 94.3 
All normal.. 
All normal.. 
Unfit temporarily, 
1. 
Cross country 5 
Combat 4 
Not given.... 11 
Others 6 
80 
Instruction in 
Convergence insuffi- 
ciency 3 
P.ct. 
Emmetropia 80 
Hyperopia 13 
Right. 
Left. 
Right. 
Left. 
High 20 
Low 7 
Convergence. 
Average 22 
High 31 
Men. 
Per 
cent. 
Men 
Per 
cent. 
Ave 
Higl 
Low 
Averag 
103 
140 
65 
105 
140 
65 
High .... 68 
Instruction in 
2 types 4-4 
10 
Total. .~7cT 
Comp, hyper, astig- 
matism 1.5 
Convergence insuffi- 
ciency 4 
Below 20/20... 
20/20 
6 
17 
45 
2 
8.57 
24.28 
64.29 
2.86 
6 
22 
39 
3 
8.57 
31.43 
55.7 
4.3 
BMlfi££iiii us.-. a 
Rt. sursumvergence. 
Rt. sursumvergence. 
20/15 
20/10 
Exophoria. 
Average 1.07 
High 2 
Low 1 
Esophoria. 
Average 1.4 
Exophoria. 
Average 4. 7 
High 12 
Low 2 
Esophoria. 
Average 
Low 5 
Hyperphoria. 
Average 5 
' 
Low 
Right. 
Average.. 0.566 j 
High l.ro 
Low 12 
Left. 
Average.. 0.605 
High 1.50 
Low 12 
Men from front 
(including 
aces). 
112 
Average 24.1 
High 31.9 
Low 19. 7 
All chasse (1 in 
charge of train- 
ing also). 
Emmetropia 66 
Hypermetropia 34 
Comp, myopic astig- 
4 or 3.58 per cent. 
Mm. 
Average... 63.6 
Average . 43.06 
Right. 
Left. 
Divergence (pow'er of). 
Average 5.9 
10 
Low 3 
Convergence. 
Average 13.7 
High 35 
Low 1 
Divergence (power of). 
Hours. 
Total... 29,850 
Average. 269 
High.... 1,200 
Low.... 100 
Landings 100 per 
cent OK. 
No. of 
crashes 
(20 men 
or 18.3 
percent) 20 
Shot down 
(6 men or 
Total 9,606 
Average.. 101 
High 400 
Low' ’!) 2 
Total 286 
Lack of exercise, 1 
or 0.9 per cent. 
Staleness, 2 or 1.85 
per cent. 
Poor eyesight, 1 or 
0.9 per cent. 
Complaints, 4 or 3.65 
per cent. 
No complaints, 96.35 
per cent. 
All normal.. 
All normal.. 
Unfit temporarily 
3 or 2.75 per cent . 
Convergence ex- 
cess, 1 or 0.9 
per cent. 
Long rest, 1 or 0.9 
cent. 
Not to fly until re- 
leased by oph- 
thalmologies! de- 
part ment, 1 or 0.9 
per cent. 
Normal, 97.25 per 
cent. 
102.1 
130 
65 
100.9 
130 
60 
Conv. weakness 2 
Higl 
Low 
85 
25 
High.:. 
Average, per 
cent 3.2 
High 12 
Low' 0 
Right. 
High 78 
High.' 25 
Myopic astigmatism 1 
Mixed astigmatism. 2 
Diverg. excess 1 
Muco purulent con- 
junctivitis 1 
Hyper, astigmatism 1 
P. ct. 
Low 9 
Convergence. 
Average 38.1 
High 90 
Men. 
Per | 
cent. ; 
Men. 
Per 
cent. 
15.32 
32.43 
51.39 
.9 
Below 20/20 
20/20 
17 | 
41 j 
53 ! 
15.31 
36.94 | 
47.75 1 
17 
36 
57 
1 
Rt. sursumvergence. 
Average 2 
Rt. sursumvergence. 
Hypermetropia... 30 
Comp, myopic 
astigmatism 1.7 
20/15 
20/10 | 
High 2.5 
High.'. 2.5 
Conv. weakness... 1.8 
M"or>ia 2.4 
Myopic astigma- 
tism 9 
Mixed astigma- 
(1 man no record.) 
_______ i 
Exophoria 
(26 men or 23.2 per cent). 
Average 1 g 
High.. 13 
Low 5 
Low 1 
Exophoria 
(56 men or 50 per cent). 
Average 5.11 
5.7 per 
cent) 6 
Hyper, astigma- 
tism 9 
Diverg. excess 9 
Muco purulent con- 
junctivitis 9 
High 18 
Esophoria 
(26 men or 23.2 per cent). 
Average 1 54 
Esophoria 
(6 men or 5.35 per cent). 
High-- 3 
Low 5 j 
High . 4 
L. hyperphoria 
(3 men or 2.7 per cent). 1 
Average 1 17 
High ; 3 1 
Low 5 | 
L. hyperphoria 
(2 men or 1.5 per cent). 
Average 1.5 
High 2 
Low 1 
r 
Total 
223 
Average 24.5 
High 35.3 
Low 19.7 
Monitors 70 
Chasse 138 
Testers 8 
Bombing 7 
P. ct. 
Emmetropia..... 64.57 
Hypermetropia.. 25.15 
Mvopia 2.24 
Comp, myopic 
astigmatism.... 1.34 
Convergence in- 
sufficiency 2.24 
6 or 2.7 per cent. 
Average 0.5715S 
High... 1.50S 
Low 12S 
Mm. 
Average.. 63.49 j 
High 78 
Low 55 
Divergence (power of). 
Average 5.82 
High 11 
Low 2 1 
Divergence (power of). 
0 
Average 16.47 
High 50 
Hours. 
Total... 62,012 
Average. 279 
High.... 1,500 
Low.... 100 
Men crashed, 34 
or 15.25 per 1 
cent. 
Men shot down, 
9 or 6.2 per 
cent. 
(No monitors or i 
testers in ! 
eluded in this 
(For 139 men.) 
Average. 105.40 
High 500 
Low 2 
P. ct. 
No complaint 84. 85 
Complaints.. 15.15 
P.ct. 
Normal... 96 
Not normal. 4 
All normal.. 
All normal.. 
Temporarily unfit, 
6 or 2.68 per cent. 
Right. 
Left. 1 
Right. 
Left. 
Men. 
Per : 
cent. 1 
Men. 
Per 
cent, i 
Aver 
High 
Low 
age 
Mm. 
47.3 
115 
20 
bIS85' 
102.4 
150 
60 
P.ct. 
102.41 
150 
55 
Average(per 
chasse pi- 
lot) per 
cent 3.29 
High 12 
Convergence. 
Average 14.1 
Hjgh 35 | 
Low 3 
Convergence. 
Average 38.02 
High 90 
Mvopic astigma- 
Below 20/20—j 
20/20 
20/15 j 
20/10 
30 ! 
72 
118 
2 
13.52 1 
32.43 | 
53.15 
.9 
30 
67 
120 
5 
13.52 
30. is 
54.05 
2.25 
All other 3.56 
Near-point convergence. 
Near-point accommodation. 
Age. ' Men. 
Aver- 
Right ey< 
Low 1 
High- 
45 
80 
70 
100 
110 
115 
65 
65 
80 
80 
55 
80 
45 
40 
! 
Low. 
30 
27 
20 
25 
30 
30 
25 
30 
30 
30 
30 
60 
30 
35 
Left eye. 
Rt. sursumvergence. ! 
1 
Rt. sursumvergence. j 
1 
1 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
35 
3 
8 
44 
44 
29 
31 
21 
9 
10 
5 
5 
3 
4 
2 
1 5 
age. 
36.67 
45.875 
45.25 
47.4 
48.86 
49.645 
46.24 
48.33 
50.3 
46 
41 
66.67 
38. 75 
37.5 
j 
Average 
81.67 
90. 875 
104.55 
102.57 
102.1 
104.68 
93.24 
105.22 
107.5 
110 
108 
106.67 
112.5 
102.5 
High 
90 
110 
130 
130 
130 
140 
120 
140 
150 
120 
120 
130 
130 
110 
Low. 
65 
80 
80 
85 
60 
80 
65 
85 
80 
100 
100 
80 
85 
95 
Average 
High 
L 
i Low. [ 
Average 2.54 
Average 2.57 
number.) 
• 
80 
95.625 
102.95 
103.4 
101.9 
103.74 
90.7 
108 
106. 5 
110 
107 
106.67 
112.5 
102. 5 
90 
110 
130 
130 
130 
140 
110 
145 
150 
120 
120 
130 
130 
110 
65 
75 
| 75 
[ 85 
85 
80 
j 60 j 
90 ! 
80 
100 
95 
75 ! 
85 j 
95 1 
Low 1 
Exophoria. 
Average 1 s 
Exophoria. 
High 13' 
Low 
Esophoria. 
Average 1 43 
High 3' 
Low' 5 1 
High 18 
Low 1 
Esophoria. 
Average 2.5 
High 4 
L. hyperphoria. 
Average 715 
L. hyperphoria. 
223 
High 3 
High./ 2 
SUMMARY 
SUMMARY. 
In the muscular measui 
Used tO eXDress thn nriern 
ements the degree sign is 
2 
6.64 
218 
47.17 
115 
20 
102.68 
150 
60 
102.1 
150 
55 
171364—20. (To face page 182.) 
5No record. AVIATION MEDICINE i E A. E. E. 
183 
ANALYSIS OF SPECIAL EYE EXAIS .ATIONS OF AVIATORS. 
Eye examinations were made of 112 e pilots from the Ameri- 
can front (21 of whom were American 70 monitors, 8 testers, 
and 12 French fliers. The results of these examinations are out- 
lined in the following table in which the 21 American aces appear 
twice—in a group by themselves and again in the group of fliers 
from the American front. Although 58 per cent of the French fliers 
examined were night bombers, the results show that their eyes were 
well above the average. The table shows that the American ace was 
not ocularly supernormal compared with the French pilots or with 
the other American fliers. But it does show, however, that his 
ocular standard was in line with his other high attributes, for the 
American ace was a remarkably fine specimen of manhood. 
Vision. 
These men, with 442 enemy planes to their credit, had excellent 
uncorrected vision. In 118 cases (53.15 per cent) the vision in the 
right eye was 20/15 or better. In 120 cases (54.05 per cent) the 
vision in the left eye was 20/15 or better. Only 2.7 per cent of the 
number wore correction in their goggles, and those who needed cor- 
recting lenses were myopic and corrected to 20/15 or better. 
Color Vision. 
Every one of the men examined had normal color vision. One 
hundred and twenty-four had flown at the front and the other 78 
had been selected as instructors or testers. Ninety-one and seven 
tenths per cent of the men, questioned about normal color vision, 
declared that it was most necessary; 8.3 per cent considered the 
matter unimportant, but they themselves passed Jenning’s test 
without an error. 
Accommodation. 
According to the present requirements for entrance into our Air 
Service, a near point of accommodation greater than 110 mm. at 20 
years of age; greater than 130 mm. at 25 years; or greater than 150 
mm. at 30 years, disqualifies. Of the men examined, the average 
near point of accommodation at 20 years of age, in this table is 81.67 
mm., high 90 mm., low 65 mm,; at 25 years, average 104.68 mm., 
high 140 mm., low 80 mm.; at 30 years, average 108 mm., high 120 
mm., low 100 mm. These figures show that the present require- 
ments give sufficient latitude in selection. Although no allowance is 
made for the hypermetropia (which averaged +0.57 D in the total 
number of examinations), these measurements correspond closely 
with Donder’s figures as amended by Duane. 184 
AVIATION MEDICINE IN THE A. E. F. 
Extrinsic Ocular Muscles. 
The duction power of the ocular muscles at 6 meters and at 25 cm. 
should he part of the record. For practical reasons, the adduction 
should be tested last. In this table, at 6 meters the average prism 
divergence is 5.82°, prism convergence 14.1°, and prism sursumver- 
gence 2.54°. At 25 cm. the same tests give correspondingly 16.47°, 
38°, and 2.67°. Therefore, it seems that the converging power 
should never be less than double the diverging power at all distances. 
Near Point of Convergence. 
The average near point of convergence of those men whose ages 
averaged 26.64 years is 47.17 mm. The highest average figure of 
66.67 mm. happens to correspond to the average of 31 years of age, 
though four of the men were 32 and two were 35 years old. It would 
seem wise, therefore, to consider a near point of convergence of over 
95 mm. a cause for disqualification. 
The Master Eye. 
To determine whether the master eye gives an indication as to 
which side the pilot looks in landing, 12 aviators were examined. All 
the pilots were right-handed, the right eye was the master eye in 
72.72 per cent, and yet 58.1 per cent looked to the left on landing 
and only 24.9 per cent looked to the right. Eight and five tenths per 
cent looked ahead and 8.5 per cent either side indiscriminately. The 
fact that the pilot was right or left handed or that the right or left 
eye was the master did not give any indication of the side to which 
he would look in landing. 
Stereoscopic Vision. 
All the men examined had normal stereoscopic vision and most of 
them made their judgments quickly and accurately. This fact is 
strongly suggestive of the value of normal stereoscopic vision for the 
successful pilot. 
OPHTHALMOLOGICAL PROBLEMS THAT NEED FURTHER CONSIDERA- 
TION. 
One of the most important of the problems that should have further 
investigation is the question of the effect of altitude upon the visual 
acuity for near and distant vision. The findings for the distance 
would be of particular value if the accommodation were paralyzed 
and the full correction worn during the test. In determining the 
effect of altitude upon near vision, the Johnson apparatus will give 
useful information. The tests made at Mineola to ascertain the 
ocular changes at altitude should be repeated under the added effect 
of cold. 185 
AVIATION MEDICINE IN THE A. E. F. 
The problem of the effect of altitude upon the extra and intraocular 
muscles is a large one and it is most important where it touches the 
study of stereopsis and the more complicated problems of judging 
distance and direction in flying and in shooting. In this last prob- 
lem some apparatus similar to Spearman’s stereoscopic test with the 
latest improvements for recording findings on a smoked drum would 
probably furnish one of the best methods for studying the effect of 
altitude upon stereopsis. In this test the subject endeavors to keep 
two pieces of milk glass (viewed through a slit) edge to edge. The 
fact that one piece of glass is kept in constant motion by means of a 
small motor necessitates careful attention upon the part of the sub- 
ject. The addition of a timing clock gives some indication of his 
speed in making judgments. The effect of altitude and lowered 
temperature upon accommodation, muscle balance, and muscle 
fatigue are among the problems most worthy of further research. 
The work on color vision requires much investigation, for we con- 
sider that it is most important for the aviator to he able to recognize 
colors rapidly in a reduced light and in a fog. These conditions can 
be approximated in the laboratory. 
The question of dark adaptation is being studied by the Italians, 
the British, and by Capt. Cobb in the Medical Research Laboratory 
at Mineola. When the results of this research work are applied to 
solving the problems of night flying, the photometric value of stars, 
moonlight, white and colored flares, searchlights, etc., will require 
special investigation. Capt. Jones, working in the Psychological 
Department, University of London, with his modification of the 
Spearman apparatus will soon have some results for publication. 
Prof. Spearman’s apparatus is a small box containing a half-watt 
standardized lamp connected with Becker’s three-dial resistance 
coil. After the subject had been ‘Tight adapted” by looking at a 
white screen illuminated by a 1,000-candle-power lamp for five min- 
utes, he is placed in complete darkness for five minutes. Small win- 
dows may he opened in the front of the box, permitting the projec- 
tion of light squares upon a concave screen 20, 40, and 50 degrees 
from the central point of fixation, which is a small circle of luminous 
paint. Snellen’s 10 and 30 foot type are used opposite the central 
window, and the intensity of illumination is increased until the letters 
or squares are just visible. Examinations are made every few min- 
utes during the entire period of adaptation. 
More careful recording of pupillary diameters and the reactions of 
the irides to light and accommodation at high altitudes would give 
valuable information as to the general muscle tone and reactions. 
The few tests made at Mineola have been spoken of in the manual. 
Blind angles of the aeroplane were the subject of early study, 
mainly by means of the stereoscopic camera held in the position of 186 
AVIATION MEDICINE IN THE A. E. F. 
the observer’s or pilot’s head. Examination of these pictures shows 
how easy it is for accidents to occur in planes of the usual construc- 
tion. These pictures also demonstrate how much of the ground is 
visible to the pilot, laterally, in making a landing, but how little he 
can see directly ahead. Pilots often state that they do not look at the 
ground in landing, but we doubt if they realize how much of the 
ground is seen with the peripheral retina. The large blind angle straight 
ahead accounts in part for accidents caused by the landing of one 
plane upon another. Maj. Clements, R. A. M. C., believes that most 
of the head-on collisions occur in angle 17, corresponding to the 
blind spot of the normal eye. The cause of these accidents, in his 
judgment, is the fact that many of the fliers suppress the image of 
Fig. VII.—Loening monoplane demonstrates how improved aeroplane construction is eliminating 
dangerous blind angles. 
one eye and the plane is lost in the blind spot of the other. This 
does not seem likely. Probably blind angles of the plane and lack of 
attention upon the part of the pilot would be a better explanation. 
That improved construction will soon do away to a great extent 
with blind angles due to the plane, may confidently be predicted, 
and the Loening monoplane (Fig. VII) shown is a big step forward 
in this direction. In the future, mirrors and periscopic apparatus will 
undoubtedly decrease the danger from blind angles. Maj. Clements’ 
findings, demonstrating the frequency of partial or complete sup- 
pression of one image by the aviator, are very interesting. The 
number of cases of this kind among our pilots, and the part that 
the blind spot plays in aeroplane accidents, should be studied in this AVIATION MEDICINE IN THE A. E. F. 
187 
country. Actual tests in planes would yield interesting and valuable 
information in regard to those men who are known to suppress one 
image. 
Little work has been done upon the effect of altitude and low 
temperature in relation to reaction time. The work upon dis- 
criminating tests under these conditions would be of special value. 
It would be very valuable to determine the reaction time in the 
judgment of distance, direction of motion, form discrimination, color 
discrimination, and orientation in map reading. Such tests would 
aid in the efficacy of classification standards. 
The effects of tobacco, alcohol, phenacetin, aspirin, quinine, etc., 
upon the ocular functions—particularly upon visual reaction time— 
should be thoroughly investigated. It would be valuable, also, to 
make ocular examinations before and shortly after the typhoid 
inoculations. 
GOGGLES. 
While a number of good goggles have been manufactured, there is 
still much room for improvement. Unfortunately, some goggles 
that are distinctly dangerous have been put in circulation; they 
lessen visual acuity; create an irregular astigmatism; limit the field 
of vision; finally certain tints used in the lenses seriously alter the color 
values of objects necessary for following the topography of the ground 
or recognizing certain changing meteorological conditions. A very 
successful British pilot early in the war said in regard to an issued 
goggle: “They would be certain death overseas.” McCudden, the 
famous British flier, writes: “I am a 1 stickler’ for details * * *. 
It may sound absurd, but such a thing as having dirty goggles makes 
all the difference between getting or not getting the Hun.” 
Among the 100 American pilots from the front selected for con- 
ference, 86 were dependent upon goggles in flying, 6 used them only 
occasionally and 8 did not wear them at all. It is reported that 
several of the most famous British aces did not use any protection 
for the eyes in flying. The flier was not always inclined toward the 
wearing of goggles, chiefly because the average goggle did limit 
materially the extent of the visual fields, and a feeling of diminished 
visual acuity was the result. The British triplex and the goggles 
provided for our fliers early in the war did limit the visual fields to a 
marked extent. In taking the perimetric readings with and without 
the average goggles with the eyes in the primary position, it was 
usually found that the goggles restricted the field of vision about 20° 
in all meridians. Although the head is capable of much twisting in 
order to see in all directions, no goggle should be permitted if it 
restricts vision in any way. One type of goggle used by many of the 
allied fliers gave an almost perfect field of vision, but the projecting 
metal edges were dangerous because they were not rolled or padded. 188 
AVIATION MEDICINE IN THE A. E. F. 
Pig, VIII.—Visual fields, measured with service goggles, Oct. 5, 1917, bj’ daylight, noon, clear, northern exposure. 1 isual fields markedly diminished. AVIATION MEDICINE IN THE A. E. E. 
189 
Fig. VIII.—Visual fields measured without goggles, Oct. 5, 1917, by daylight, noon, clear, northern exposure. 190 
AVIATION MEDICINE IN THE A. E. F. 
Other types of eye protectors devised by different manufacturing 
firms in the United States gave good temporal fields, but the large 
size of the lenses made it very difficult to grind the correction required 
by a refraction error. Goggles protect the eyes from dust, water 
and oil, from flying insects and the drying effects of wind and the 
injurious exposure to cold. The vision when goggles are worn is 
better than any that can be obtained by partially closing the eyes. 
Lenses of a yellow-green tint (which absorbs the light of short wave 
lengths) are valuable in the prevention of ocular and nervous fatigue. 
This tint allows the maximum visual acuity and it does not seriously 
disturb useful color values. It is especially effective in bright sun- 
shine and in flying over snow and water or above the clouds. It 
improves vision in mist and haze, and in detecting camouflage that 
is produced by means of various pigments. But this tint should not 
be of such an optical nature that all of the blue spectral light would 
be absorbed. For in that case certain color values would be altered 
too radically. Fliers object to lenses that are deeply smoked or of 
certain tints because, in addition to other disadvantages, they 
increase the difficulty in recognizing uniforms and in selecting the 
proper ground for a forced landing. Some of the pilots who had 
flown at the front used tinted lenses, but they usually carried in 
addition a pair of goggles with colorless lenses. Zade constructed a 
lens which eliminated many of the disadvantages of the ordinary 
colored glass and permitted adaptation to marked changes in intensity 
of light. The lens was colorless below, gradually blending into 
yellow and finally into dark smoke gray above. By a slight move- 
ment of the head the appropriate portion of the lens could be used. 
Halben feels that the monocle possesses certain advantages in 
all types of flying. But we have had no experience with this type of 
glass. 
By the use of some nonshatterable substance, such as mica or a 
piece of celluloid placed either in front, behind, or between two pieces 
of glass, a great deal has been done to protect the eyes from breaking 
glass. Mica cracks and breaks readily and celluloid usually dete- 
riorates with age, becoming yellow and less transparent. If the 
glass is on the posterior surface of the celluloid, small chips can break 
off and fly into the eye, no matter by what process the adhesion is 
produced. Even with this defect, however, the piece of celluloid 
may occasionally prevent the driving of large pieces of glass into the 
eye. The danger from broken glass has been overrated. For in 
two years’ experience in flying fields, in this country and abroad, 
we have never seen a penetrating wound of the eyeball by glass 
except in one instance. But the general injuries in this case were so 
serious that the man died on the day after the accident. The number 
of eye injuries from bad landings have been reduced by cutting a AVIATION MEDICINE IN THE A. E. F. 
191 
portion of the rim of the cockpit, by proper pneumatic padding of 
rigid places, by changing the dangerous metal rim of the wind shield, 
and by using goggles with well-rounded, protected edges that lie 
flat against the face. As the danger from breaking glass is relatively 
so slight, the safety afforded by a protective layer of some non- 
shatterable material seems hardly necessary even when applied to 
the posterior surface of the lens, a method sometimes used. In 
regard to industrial accidents, good optical glass is in itself a pro- 
tection rather than a danger to the eye; for in 30,000 of these acci- 
dents where protecting lenses have been shattered, the eyeball was 
penetrated in only one instance. However, the force with which the 
goggles are struck in aeroplane accidents would make penetrating 
wounds more common in aviation. We agree with most of the 
pilots with whom we have spoken on this subject, that in case of 
trouble or in landing on rough ground, the goggles should be pushed 
well up on the forehead. 
Although our manual has already mentioned the qualities that the 
ideal goggle should possess, a brief outline at this point seems wise in 
order to emphasize the importance of their future development. 
Material. 
The material must be noninflammable. So far, glass is the best 
material, though the future may produce something more suitable. 
The glass should be a good optical glass, not hardened under tension. 
It should be carefully ground and not less than 2 mm. in thick- 
ness. White glass should have a light transmission of more than 
90 per cent. 
Visual Fields. 
The goggles of the future should not limit the monocular or bin- 
ocular fields. 
The Central Blind Angle. 
In the construction of goggles, it is very important to eliminate 
the blind angle. This may be accomplished by using a very narrow 
central hinge or by connecting the lenses by a horizontal strip of 
metal curved in such a manner that it arches upward well over the 
bridge of the nose. It is therefore entirely out of the line of vision. 
These features appear in a new model of goggles. This model has 
been cut down so as to give an almost perfect visual field, and the 
dangerous edges rolled and protected. Even a small central bar may 
interfere with binocular vision when the pilot’s head is turned to the 
side as it is in landing. We agree with Maj. Clements, R. A. M. C., 
that the presence of a broad central bar accounts for many errors in 
judgment of distance in flying and in landing. 192 
AVIATION MEDICINE IN THE A. E. F. 
Lightness, Strength, and Comfort. 
Goggles should be simply yet strongly constructed. They should 
be light in order to be comfortable. They should not press upon the 
bridge of the nose and the frame should he easily and quickly adjust- 
able to the face. They should be arranged so as to permit easy re- 
moval with one hand. 
Protection of Eye and Surrounding Structures From Injury. 
All parts of the goggle coming in contact with the brow, nose, and 
cheeks should be flat against the face. All edges should be rounded 
and protected by some pliable material. 
Adjustable Interpupillary Distance. 
Adjustable interpupillary distance is most important in goggles, 
especially when a refraction error has to he corrected. In spite of 
the very strict visual requirements for entrance into our service, it 
was necessary to prescribe correcting lenses in seven cases during 
our first month at Issoudun. 
Lenses Quickly and Easily Changed. 
Some method should be devised whereby lenses could be quickly 
and easily removed for cleaning, or for replacement when new lenses 
are needed. The box which carries the goggles should have small 
compartments for holding extra sets of lenses. Everything about 
the goggles should he vermin proof. 
Protection of Sinuses. 
Sufficient covering should be connected with the goggles, or sup- 
plied in such a way that it might he quickly fitted to the goggles in 
order to protect the sinuses from the cold. The cold of high alti- 
tudes causes great pain in the frontal regions. 
Ventilation. 
Some indirect method of ventilating is most important to prevent 
steaming on the ground and frosting at high altitudes. The heat and 
moisture from the face will cause fogging rapidly unless there is a 
properly constructed ventilating system to carry the outside air to 
the posterior surface of the lenses. In this connection, Maj. Schroe- 
der’s account of his altitude record flight is very interesting: “ While 
still climbing in large circles, my goggles became frosted. The 
temperature at this altitude (he was then more than 16,000 feet) was 
2° below zero C. * * *. I believe that if my goggles had been 
better ventilated, they would not have frosted * * *. When I 
was about 27,000 feet I had to remove my goggles. The cold, raw 
air made my eyes water, and I was compelled to fly with my head 
well down inside the cockpit.” AVIATION MEDICINE IN THE A. E. F. 
193 
Frosting. 
Some chemical substance should be more perfectly developed for 
applying to the lenses before flight in order to prevent frosting. The 
following words of Maj. Schroeder are very suggestive: “I gazed 
about through the small portion of my goggles which had no frost— 
due to a drop of oil which had splashed on them from the motor.” 
Tint. 
When a tint is required, it should allow the maximum vision, be 
restful to the eye, and not alter color values seriously. 
Future Construction. 
The question of supplying the aviator with a well-constructed 
goggle and with properly ground lenses (where necessary) for con- 
stant wear in flying is an important one and our experience in France 
demonstrated how inadequate the facilities were for providing proper 
goggles and lenses. 
In order that the best goggle may be obtained, the whole matter 
should be placed in the hands of a committee composed of an experi- 
enced flier, an ophthalmologist, a physicist, and a skillful goggle maker. 
This committee should draw up the specifications, pass upon the sam- 
ples presented, and they should have power to accept, or to reject if 
necessary, the finished product. 
During the rush of war this plan was not feasible. But the great 
future of military and commercial aviation calls for a thoroughly 
efficient goggle which, so far, has not been produced. Now is the 
time for carrying out this plan—while the shortcomings of the present 
goggles are still vividly in mind. 
NEW APPARATUS. 
The following apparatus was devised or modified in France by Maj. 
Berens: 
A stand with tongue depressor bite for fixing head, to be used in 
connection with the tangent screen and with the perimeter in taking 
fields and mapping out blind spots. (Figure IX.) 
Method and apparatus for testing fatigue of accommodation and 
convergence. 
Howe's ophthalmic ergograph modification.—It is found that a 
tongue-depresser mouth bite for fixing the head in taking accommo- 
dation is valuable to prevent the drawing away of the head from the 
headrest when the accommodation becomes fatigued. A string is 
passed from the accommodation test object, through the rod under 
the chin of the subject, and at the end of this string a grip is attached. 
This permits the subject to make his own record without arm fatigue. 
The accommodation apparatus is placed in connection with the con- 
vergence apparatus and the two are screwed down to a perimeter 
171364—20 13 194 
AVIATION MEDICINE IN THE A. E. F. 
Fig. IX.—Tongue depressor fixation to be used in connection with perimeter. AVIATION MEDICINE IN THE A. E. F. 
195 
table. The drum is walled off from the view of the subject and the 
same point is used to record the findings for accommodation and con- 
vergence. Maj. Pierce gave valuable assistance in suggesting and 
supervising changes in this apparatus. (Figure X.) 
Shutters for Recording Visual Reaction Time. 
A. Simple shutter worked by hand.—This shutter is a 20 by 30 centi- 
meter piece of 2-millimeter sheet brass, with a 4 by 13 centimeter 
Fig. X.—Howe’s modified endograph. 
rectangular opening, centrally cut 4 centimeters below the upper 
edge of the screen. A shutter, 41 by 14 centimeters, sliding in a slot 
and suspended by rubber bands, is manipulated in front of this open- 
ing by means of a thumb hold. Electrical contacts are so arranged 
that the “break” occurs as the upper edge of the covering screen 
passes the upper edge of the pupil and the “make” occurs again as 
the upper edge of the screen covers the upper edge of the pupil. The 
contacts are connected with the D’Arsonval apparatus which records 
time in one-hundredths of seconds. 196 
AVIATION MEDICINE IN THE A. E. F. 
B. Complex screen working on the lever principle.—This screen is 
much the same as the simple one, except that a lever and weight 
govern.the rapidity of movement of the shutter, and that the width 
of the shutter can be changed. (Figures XI and XII.) 
Apparatus for determining the reaction time for the determination of 
motion, rapidity• of motion, and direction of motion by the eye.—The 
Fig. XI.—Visual reaction time screen shutter open. 
complex shutter is used, and a test object (for aviation purposes, an 
aeroplane) is moved in any direction at any desired rate of speed, 
within two large steel rings which may be moved in any position, the 
inside ring sliding on the outside ring. This apparatus can be used 
in connection with a camera machine gun, arranged with aeroplane 
sights to determine rapidity and accuracy in shooting a machine gun. AVIATIOjST medicike IH THE a. e. f. 
197 
Reaction time in the judgment of distance, where the direction of mo- 
tion and the monocular 'parallax are considered.—Either the simple or 
the complex shutter may be used, and the test may be employed at 
any required distance. A 20 by 60 centimeter plate of sheet steel is 
grooved out to receive a large carriage which will carry 10 upright rods 
as test objects, and which will move in the anterio-posterior direction. 
Other tracks are grooved out diagonally to receive a smaller carriage 
carrying three upright rods. The rods are painted a neutral gray 
and may be of any desired size. Five and ten millimeters are the 
sizes in use in this laboratory. The best method of making the rods 
is to mill them out of steel. The carriage is milled out to receive these 
Fig. XII.—Screen and shutter for recording visual reaction time, shutter closed. 198 
AVIATION MEDICINE IN THE A. E. F. 
rods which are held in place by a spring and cap. The carriage is 
marked off in millimeters in the milling machine, and the rods may be 
placed from 1 centimeter to 20 centimeters apart at will. Motion is 
imparted to the carriage by means of a small phonograph motor, and 
a string working around guides. Screens are placed, one in front of 
the rods (corresponding to the fuselage of the aeroplane) and painted 
neutral gray, and the other in back of the rods, which may be either 
a neutral gray, a landscape with houses and trees, or a background of 
small rods. The lighting comes from a filament lamp connected 
with a rheostat and it may be placed in any position, front or back, 
to test the different conditions of lighting upon the judgment of dis- 
tance. One or both eyes may be used, and by this method it is be- 
lieved that some of the conditions which an aviator faces in the 
judgment of distance may be simulated. 
Reaction time for color discrimination.—Aeroplane lights, four in 
number, are placed on a board, 20 feet from the observer. Three of 
the lights are on at a time and the reaction time for determining which 
lights are on is taken. The colors are obtained by the use of color 
filters. Conditions which must be met with in flying are simulated 
by means of neutral filters. Cloths used in different uniforms may 
also be used as test objects. Reaction time for telling which three 
of the four colored lights, or colored cloths, are presented, is recorded 
each time. 
Reaction time for orientation in map reading.—Two maps (one of 
which may be swung) are exposed through the timing screen. A 
point is marked on one screen and the rapidity with which orientation 
is accomplished is recorded. 
Reaction time for discrimination for form.—Different test objects 
for aviation (aeroplanes, or models of aeroplanes) are exposed through 
the timing screen, and reaction time for discriminating between 
different types of planes recorded. Practice in rapidly recognizing 
enemy and allied planes should be given to every man in the service. 
Silhouettes of planes may be thrown on a moving picture screen and 
a record made of the reaction time when type of plane is recognized. 
A Simple Device for Changing Colors on the Hare Perimeter. 
Two small pieces of brass are fitted to the upper and lower part of 
the color carrier, and two steel rods are bent and held in position on 
the back of the arc. This permits the changing of colors rapidly and 
easily and it does away with the long cords, which soon get out of 
order. 
Test for Inertia of Adjustment of Accommodation. 
The Ferree apparatus seems to be a valuable help in testing this 
most important function; and if a more simple way of recording find- 199 
AVIATION MEDICINE IN THE A. E. E. 
ings could be devised, it should prove to be of great value in testing 
aviators who are having-difficulty in landing or in making visual ad- 
justments in the air, inasmuch as the fliqr, whose accommodation is 
sluggish, is probably at a disadvantage in landing a fast machine and 
in making the accommodative changes required in observing and 
fighting. But we were not able to test practically the few changes 
that were made in this apparatus. 
EFFECT OF NOSE AND THROAT INFECTIONS UPON THE 
OCULAR FUNCTIONS. 
Maj. Conrad Berens,]!-., Medical Corps, and Capt. Claude T. Uren, Medical Corps. 
In studying the results of operative interference in nose and throat 
infections of 38 pilots in the A. E. F., it was found that many of the 
men who required operation by the Otological Department were 
diagnosed temporarily unfit to fly by the Ophthalmological Depart- 
ment. Therefore the eye records were examined in regard to the 
following questions: 
1. How many pilots requiring operation by the Otological Depart- 
ment were under observation in the Ophthalmological Department, 
and what were the diagnoses in the latter department ? 
2. What relation existed between the nose and throat infections 
and the blind spots, and what were the results of treatment ? 
3. In a similar way the effect on vision. 
4. What was the effect of the infections upon the ocular muscles? 
What results were obtained by treatment ? 
1. In answer to the first question the following data were found: 
Records of 38 pilots treated by the Otological Department were 
found in the Ophthalmological Department. Nineteen, or 50 per 
cent, showed some ociilar trouble which possibly had infection of the 
nose and throat as the underlying cause. Search was made by means 
of X-ray and laboratory examination, in addition to physical exami- 
nation for other foci of infection. The ophthalmological diagnoses 
were as follows: 
Number. Percent. 
Retro-bulbar neuritis or congestion 6 15. 80 
Convergence weakness 9 23.63 
Divergence excess with convergence insufficiency 1 2.63 
Acute catarrhal conjunctivitis 1 2. 63 
Marginal blepharitis 1 2. 63 
Photophobia and lachrymation (blind spots not examined in last case)... 1 2. 63 
2. The second question is given the following answer: 
Six (15.80 per cent) of the 38 pilots showed definite enlargement of 
one or both blind spots. The blind spots were examined by a rapid 
clinical method and compared with findings on the Bjerrum screen. 200 
AVIATION MEDICINE IN THE A. E. F. 
Resume of the history of six pilots diagnosed retro-bulbar neuritis: 
1. R. C. Referred from Nose and Throat Department, October 12, 1919. Nose 
and throat diagnosis. Deviated septum. Infection of sphenoidal and posterior 
ethmoidal sinuses bilateral. 
Eye examination: V. 0. D. 20/15-4. O. S. 20/15-2. 6 meters. Esophoria $°. 
Divergence 5°. Convergence 8°. 25 centimeters exophoria 11. Divergence, 21°. 
Convergence, 15°. Chief complaint, photophobia. Eye examination, including 
central color vision, showed fields and fundi normal except that the right pupil was 
1 mm. larger than the left. Physical examination was negative except for a subacute 
bronchitis. 
October 18, 1918, submucous resection of nasal septum. 
October 22, 1918, enlarged blind spots. 
Eye diagnosis, retro-bulbar neuritis or congestion (bilateral). Convergence weak- 
ness. 
October 23, 1918, convergence weakness shown by ergograph. To have converging 
exercises three times a week. 
October 26, 1918, blind spots normal and convergence fatigue less marked. 
November 4, 1918, convergence fatigue normal. 
November 8, 1918, near point of convergence, 60 mm. 6 meters. Divergence, 4°. 
Convergence, 30°. 
Results: Nasal, physical and ocular conditions improved. 
Continued training as a pilot. 
2. L. W. B. Second Lieutenant Air Service Aviation. 24. Single. October 8, 
1918. 
Chief complaints: Photophobia, dull pain back of eyes. Right eye vision blurs 
periodically. Smokes cigarettes. Does not drink. Denies venereal infection. Has 
had no trouble in flying. Photophobia. Pain back of eyes and blurred vision for 
one month. Dilated right pupil noted one month ago. 
Eye examination: V. O. D. 20/40-1. O. S. 20.15 — 1. O. D.-f .75 cyl. ax. 
90/20/20-4. O. S.+25 cyl. ax 90=20/15. 
N. P. C. 65 mm. N. P. A. both 105 mm. 6 meters Ortho. 25 cm. Ex., 29. 
O. D.: Globe is tender and there is tenderness upon pressure back of globe. Right 
pupil, 44 mm. Left pupil, 34 mm. Right reacts slightly to eserine. Right nerve 
slightly congested. Central color vision normal. Right blind spot greatly enlarged. 
O. S.: Blind spot slightly enlarged. 
Diagnosis: Retro-bulbar neuritis (bilateral). 
Ear: Negative. 
Nose: Chronic hyperplastic rhinitis. Worse on right side. Bilateral infection 
of the posterior ethmoid sinuses. Deviation of nasal septum. 
Throat: Chronic follicular tonsilitis. 
Teeth: Medical: Neurological and Laboratory: Negative. 
Course and Treatment: October 12, 1918, submucous resection of the nasal septum 
followed by local treatment. October 21, 1918, blind spots smaller. November 17, 
1918, vision with correction: O. D. 20/20-1 right pupil still dilated. O. S. 20/15 
photophobia. Right blind spot still enlarged. 
Nose shows marked improvement. 
Results.—Ocular improvement seemed to be in conjunction with nasal improve- 
ment. 
3. T. O. D. First Lieutenant, Aviation Service. 25 years. Single. October 25, 
1918. 
Chief complaint: Referred because of many bad landings, 
Previous history and habits: 15 cigarettes a day. Wine, no other spirituous liquors. 
Never to excess. Denies venereal infection. Pneumonia eight years ago, no com- 
plications. Wears reading glasses occasionally. Otherwise normal. Has made many AVIATION MEDICINE IN THE A. E. F. 
201 
poor landings. Had one crash from altitude 1,200 meters. Slight injury to hack but 
able to keep on flying. 
Present history: Feels well at present. Is nervous about landings. Eyes tire easily 
and ache at times. 
Physical examination: 
Eye: V. ou. 20/20-1. N. P. C. 40 mm. =N. P. A. both 120 mm. Muscles 6 meters. 
Ex. 1°. Divergence, 5°. Convergence, 8° 25 cm. Ex. 3°. Divergence, 15°. Con- 
vergence, 16°. Both blind spots somewhat enlarged. Left more than right. Ocular 
examination including central color vision negative. 
Diagnosis: Retro-bulbar neuritis (bilateral) convergence weakness. 
Ear: Negative. 
Nose: Negative. 
Throat: Large mass of adenoids. Septic tonsillitis. Other examinations negative. 
Treatment and course: November 9, 1918, no improvement. Refused operation. 
Results: Removed from flying and given ground position. 
4. J. C. K. Second Lieutenant, Aviation Service. 23. Single. October 4, 1918. 
Chief complaint: Constipation, nervousness, sleeps poorly, appetite poor, feels con- 
stantly fatigued, blurred vision and photophobia. 
Past history: Three cups of coffee a day. No alcohol, no tobacco, never has had 
trouble with eyes. 
Eye examination: Y. O. D. 20/15-j-3 homatropine. O. S. 20/30-2 refraction. Ac- 
cepted plus 0.25 cylinder axis, 90°, but this did not improve vision. Near point con- 
vergence, 275 mm. Near point accommodation, O. D., 114 mm. O. S., 260 mm. 6 
meters divergence, 4°. Convergence, 6°. Fundi normal. Central color vision nor- 
mal. Fields contracted, more on the left. 
Ear: Nerve deafness, left ear. 
Nose: Normal. 
Throat: Considerable amount of pus expressed from both tonsils. Moderate mass of 
adenoids. 
Dental: Negative. 
Medical: Fatigued and nervous. 
Neurological: Negative. 
Psychological: Negative. 
Laboratory: X rays of head (two examinations) negative. 
Wasserman blood test negative. Spinal fluid negative. 
Diagnosis: Retro-bulbar neuritis. (Infectious.) 
Treatment: Adenoids and tonsils removed October 10, 1918. Complained of severe 
pain in eyes when tonsils were removed. Both blind spots greatly enlarged after 
operation. Septic clot in tonsillar fossa. Converging exercises and blind spots taken 
at regular intervals, showing no improvement. Blind spots greatly enlarged and out 
of proportion. No change in central color vision. December 31, 1918. Y. O. D. 
20/50-2. O. S. 20/50-2. N. P. C. 440 mm. N. P. A. O. D., 380 mm. O. S., 410 
mm. 6 meters. Divergence, 2°. Convergence, 3°. Fields contracted, left more 
than right. Blind spots greatly enlarged, left more than right. Retro-bulbar tender- 
ness, slight pallor of left optic disk; central color vision normal. Ordered to the 
United States, after this examination. 
Result: Ocular condition worse. General health improved. Ordered to United 
States, so the final result was not ascertained. 
5. C. H. S. Second Lieutenant, Aviation Service. 24. Single. October 30,1918. 
Wore glasses for a time for close work. 
Smokes seven cigarettes a day. 
Does not feel well. Headaches. Sleeps poorly. 
Eye examination: O. D. 20/10-2. O. S. 20/10-1. N. P. C. 35 mm. N. P. A. 
O. D., 100 mm. O. S., 105 mm. 202 
AVIATION MEDICINE IN THE A. E. F. 
Right blind spot slightly enlarged. 
Diagnosis: Retro-bulbar neuritis O. D. 
Ear: Negative. 
Nose: Acute empyema right antrum. 
Throat: Pus in both tonsils. 
Dental: Negative. 
Medical: Recovering from influenza. 
Neurology: Negative. 
Psychology: Negative. 
Laboratory: X ray shows cloudiness of right antrum. 
Treatment: Tonsillectomy, November 5, 1918. November 15, 1918, throat healed, 
feels better, headaches gone. Blind spots normal. 
Results: 1. Ocular condition improved. 2. Physical condition improved. 
6. R. G. W. Second Lieutenant, Air Service. 21, single. October 3, 1918. 
History: Smokes 10 cigarettes a day. Wore glasses five years ago for study. Feels 
sick most of the time. Fatigued constantly. 
Eye examination: V. both 20/15-1. Pd 65 N. P. A. O. D. 115 mm. N. P. C. 
55 mm. O. S. 115 mm. 6 meters Ex. 2°. Divergence, 6°. Convergence, 18°. 25 
Cm. Ex. 14°. Divergence, 20°. Convergence, 40°. October 11, 1918: Right blind 
spot enlarged. Fig. No. 6. 
Diagnosis: Retro-bulbar neuritis or congestion 0. D. 
Ear: Negative. 
Nose: Negative. 
Throat: Chronic septic tonsilitis. 
Dental: Dental X-rays negative. Lower right wisdom tooth not fully erupted but 
not causing trouble. 
Medical: Fainting spells. 
Neurological: Anxiety neurosis. 
Laboratory: Negative. 
Treatment: October 12, 1918: Tonsillectomy. Considerable edema in soft palate 
following operation. October 18, 1918: Right blind spot larger. October 21, 1918: 
Throat healed. Blind spot normal. Headaches improved. 
Result: 1. Ocular condition improved. 2. Headaches and general physical con- 
dition improved. 3. Class B. Anxiety neurosis. 
CONCLUSIONS. 
1. The blind spots are, seemingly, frequently enlarged in nose and 
throat infections before vision or other ocular functions are affected- 
2. Repeated examinations of the blind spots in nose and throat 
infections give information as to the efficacy of treatment and often 
show the need for more radical measures. 
3. Fliers who are receiving treatment for focal infection should have 
their blind spots examined routinely. 
In answer to the third question concerning visual acuity, our records 
revealed that 2 of the 38 pilots with nose and throat infections had 
diminished visual acuity which could only be partially corrected by 
lenses. The case histories of these two officers appear in detail above. 
Case 2, L. W. B., and case 4, J. C. K. Both complained of periodic 
blurring of vision, photophobia, and pain back of eyes. The vision 
of one, L. W. B., was slightly improved and the size of the blind spots 
reduced by resection of the nasal septum followed by local nasal AVIATION MEDICINE IN THE A. E. F. 
203 
treatment. The vision of J. C. K. became worse and the blind spots 
larger, following tonsillectomy and adenectomy. The blurring of 
vision was very troublesome and at times made it difficult for them 
to judge distance in landing. 
Conclusion 1.—-The periodic blurring of vision in nose and throat 
infections is sufficiently common to be the cause of an occasional crash. 
Conclusion 2.—Pilots suffering from nose and throat infections 
should not be permitted to fly, particularly when there is any en- 
largement of the blind spots. 
In answer to the fourth question it was found that 10 of the 38 
pilots with nose and throat infections had affections of extra or intra- 
ocular muscles, divided as follows: 
Extraocular Muscles. 
Convergence weakness. Nine pilots had this defect. 
TYPICAL HISTORY. 
1. R. 0. October 12, 1918. 
History given under Case l, R. O. in retro-bulbar neuritis group. 
Nose and throat diagnosis: Infection of posterior ethmoids and 
sphenoid sinus. 
Eye diagnosis: Convergence weakness. (See fig. No. 2.) 
Result: Converging power improved after resection of septum and 
converging exercises. Continued training as pilot. 
Divergence excess with beginning convergence insufficiency, one 
pilot. 
Only 3 of the 38 pilots showed any affection of the intraocular 
muscles. 
R. C. (Case 1, retro-bulbar neuritis). Right pupil dilated. Ac- 
commodation unaffected. 
L. IF. B. (Case 2, retro-bulbar neuritis). Right iris dilated 
(recent). Accommodation unaffected. 
J. C. K. (Case 4, retro-bulbar neuritis). Marked weakness of 
accommodation, but irides unaffected. Accommodation weaker 
after tonsillectomy. 
INTRAOCULAR MUSCLES. 
CONCLUSIONS. 
1. Many of the pilots who showed little weakness of converging 
power as measured by the near point of convergence and prism con- 
verging power showed rapid onset of fatigue when tested on the 
ergograph. The same was true of accommodation, only fewer men 
were examined for fatigue of accommodation. 
2. Our experience leads us to believe that weakness and rapid 
onset of fatigue of the extra and intraocular muscles are frequently 204 
aviation medicine in the a. e. f. 
associated with nose and throat infections and that this subject is 
worthy of further study. 
3. Weakness in the converging power was often associated with 
bad landings. Whether this was due to derangement of binocular 
vision or to the general disturbance associated with the convergence 
weakness is treated more fully elsewhere. 
THE EQUIPMENT OF THE OPHTHALMOLOGICAL DEPARTMENT, THIRD A. I. C. 
1 acuity test, Ives. 
1 apparatus, Ferree. 
4 brackets, extension, W. P. shades. 
1 cabinet, medicine, with usual drugs. 
1 cabinet, Yalk, with instruments. 
1 card for stereoscope, 4 sets. 
2 cards, test, Black’s sets. 
4 cards, test, Snellen’s and E’s. 
1 case, trial, with mult, maddox rod. 
1 clock, Seth Thomas. 
2 clusters, Benjamin. 
3 color tests, Jennings. 
1 diaphragm, Iris, with stand, DeZeng. 
1 diaphragm, test, Harmon. 
1 ergograph, Howe’s. 
2 frames, trial, Rodgers. 
1 headrest, photographer’s. 
3 illiterate cards, E. 
1 instrument, drafting set. 
1 kymograph. 
1 lamp, alcohol, metal. 
1 lamp, operating, on stand. 
1 lantern, Williams. 
1 lens, condensing, 16 D. H. R. rim. 
1 lens measure, Geneva. 
1 Loupe corneal. 
1 meter stick. 
1 ophthalmoscope, electric, Hare. 
1 ophthalmoscope, Hare. 
1 ophthalmoscope, May. 
1 perimeter, Hare. 
2 perimeters, Schweiger, modified. 
1 photometer, Williams, simplex. 
1 prisms, £-50, set. 
1 prisms, square, box. 
1 pupillometer. 
1 rack, Marple, set Skiascopy. 
1 retinoscope. 
3 retinoscopes, folding. 
2 rheostats, 1 De Zeng and 1 Meyrowitz. 
3 rules, Prince, fitted for nose. 
1 rule, 5-foot tangent. 
2 rules, small, 15-cm. 
1 scissors, bandage. 
1 screen, tangent on roller, Bjerrum. 
1 stand, DeZeng, with lamp and iris 
diaphragm. 
1 stereoscope. 
1 sterilizer, w. c., 13-inch.' 
3 stools, adjustable. 
1 table, glass top. 
2 tables, perimeter. 
1 test, color, Oliver-Abney. 
1 transilluminator, Wurdemann. 
2 trays, instrument, 10 by 12. 
12 type, test, Jaeger, with 1 case. 
1 verascope. 
1 wand, Wilmer. 
1 watch, stop. 
6 wedges, Reeves. Chapter VII. 
AVIATION ACCIDENTS. 
Lieut. Col. L. G. Rowntree, Medical Reserve Corps. 
Nature’s laws are inexorable. They operate continuously and can 
never be annulled. Her forces may be overcome temporarily through 
the operation of superior forces but their effectiveness becomes ap- 
parent immediately upon the withdrawal of such forces. 
Aviation is a new art, made possible through science. The heavier 
than air machine is subject to Newton’s laws just as is the apple. 
Langley discovered, appreciated, and partially succeeded in applying 
the forces capable of keeping afloat the heavier-than-air machine. 
Science has finally succeeded in applying them through utilizing a 
powerful motor, great speed and a skilled pilot. 
The weight factor is constant; the laws governing it, merely cir- 
cumvented. Speed is attained through mechanical ingenuity, in- 
volves increasing the weight and is of no avail except as controlled 
by skilled pilots. These are created only through mastery of the 
art of flying. The training involved is a hazardous one; art is long 
but war needs urgent. Flying is beset with danger, and skill has 
been bought at the expense of safety. 
For the British in the Boer war and for the American in the Spanish 
war typhoid fever accounted for more deaths than combat. Acci- 
dents have proven the greatest source of fatalities in the American 
Air Service in the present war, for every flier killed in combat three 
succumbed to accidents. War has its by-problems. Typhoid fever 
has been brought under control but the accident problem remains 
unsolved. 
NUMBER AND DISTRIBUTION OF ACCIDENTS IN THE TRAINING SCHOOLS 
OF THE A. E. F. 
At the signing of the armistice 169 American fliers had been listed 
as killed in combat, while 203 had succumbed to accidents in the 
training schools in France, and 42 to accidents at the front. Sta- 
tistical studies define the problem more definitely and also serve to 
emphasize its importance. 
Prior to November 13, 1918, there had been in all 5,646 pilots 
and observers, of whom 2,141 were still under training; 1,940 turned 
over to the zone of advance; 94 with allied squadrons; 821 instructors, 
test, transfer, and staff pilots; 349 discontinued from training; 98 206 
AVIATION MEDICINE IN THE A. E. F. 
killed with allied squadrons and 203 killed in training. Chart I 
presents weekly data covering the distribution and fate of the flying 
personnel (pilots and observers) of the A. E. F. from May 1, 1918; 
until the time of the signing of the armistice. 
Thirty-four and three-tenths per cent of the men entering the 
training school were turned over to the zone of advance while 
DLSTRtBUTTON OR PERSONNEL ~ A. E F 
P/LOTS 3HO OBSERVERS 
NOY JURE JULY 3U6 SEPT OCT. HOY. OEC. 
8 'S 22 29 S >2 '3 26 J >0 '2 24 }/ / M 2/ 28 * // 8 2S L 9 !6 23 SO t /3 20 27 * P If LS 
6800 
6400 
6000 
S600 
5200 
4800 
4400 
| 4000 
3000 
3200 
2800 
2400 
2000 
'800 
1200 
300 
400 
0 
LEGEND 
MEN AT n2LOS. 
ruer/EO oOep ro z or 4. 
- WITH /4LL LEO SQM DOOMS. 
/PSTPOCTOPS, TEST PILOTS ETC, 
0/SCOP T/Ht/EO rPA/8/PS 
Pilled tutu allied solmopops 
PULED L/PDEP TPAIP/P6 
ho/toer OE PTE/V 
CHART I 
POOPS 3/P SEPO/CE -3-E E 
TPP/P/H6 SECT/OP 
PECOPOS 8P3PCP 
another 1.6 per cent were attached to the allied squadrons. Two 
thousand and thirty-four fliers or approximately 36 per cent of those 
entering the training schools in France actually arrived at the front. 
Ten per cent as many men were killed in training in France as 
reported for service in the zone of advance. AVIATION MEDICINE IN THE A. E. F. 
207 
Of the 5,646 men, 3,905 were pilots and 1,741 observers, or ap- 
proximately 70 and 30 per cent respectively. Inasmuch as the work 
of the pilot and observer differs fundamentally, these two groups 
should be considered separately. 
Chart II gives the weekly distribution of the piloting personnel, 
AJE. F., until November 13, 1918. In total there were 3,905 pilots 
D/Sr/?/0VT/O.AT OF fi/LOT/A/6 PEFSOM/VE/L - A.E.E 
nor jt//vE juir *t/6. see ocr nou. dec. res. 
/ 8 IS ZZZ9 S U 1323 3 !0P 243/ 7 M i/IS 4 // /t 2S 2 9 /6 23 30 6 132027 4 // /S 25 / t IS 22 29 S /2 /i 
s/oo 
4.BOO 
4500 
4200 
5900 
3600 
3300 
3000 
2700 
i 
2400 
i 
I 
2/00 
/eoo 
7500 
/.200 
900 
600 
300 
O 
HEN 4T HELDS. 
TO PM ED OVE.P TO Z.OE/t. 
#/T// T711/ED S0O4OP0//S 
///STPUCTOPS, TEST P/LOTS. ETZ. 
D/SC OPT/A/OED TP4/N///6. 
E/ll ED W/TH4LHED S0U4OPOPS. 
PULED UA/OEP TPP/N/NG. 
L£G£/VD 
/ffAf 
POOP'S. 4/P JEPV/CE PEE 
TP4/A//A/6 SECT/O/V 
PECOPDS SP4//CM. 
CHtiPT £ 
in the A. E. F., distributed as follows: 1,411 still with the fields; 1,195 
turned over to the zone of advance; 86 with the allied squadrons; 
735 instructors, transfer, test and staff pilots; 196 discontinued from 
training; 86 killed with allied squadrons and 196 killed under training. 
One thousand two hundred and eighty-one pilots or 32.8 per cent of 
those entering the schools of France reached the front either in the 208 
AVIATION MEDICINE IN THE A. E. E. 
zone of advance or with the allied squadrons. For every 100 men 
who arrived at the front more than 15 were killed through accidents 
in the training schools of France. 
Data relative to weekly distribution of the observing personnel 
for the A. E. F., for the same period, are given in Chart III. 
D/ST/?/B(JT/OH OF OSOFRV/A/G PERSOHHEl A.-£rF 
ftSy JUNE JULY SU6. SEPT OCT. NOV. DEC. JSN. EES. 
8 IS 2229 3 12 1926 3 10 !7 243V 7 !4 2! 28 4 H IS 2S 2 9 E 23 30 6 !3 2027 4 H 18 25 I 8 IS 22 29 S 12 19 
3000 ' 
2700 
24-00 
2100 
1800 
LEGEA/0 
MEN ST FIELDS 
TUSNED OVEE TO Z.OF* 
WITH FLUES SOUSOPONS. 
IHSTPUCTDPS TEST PHOTS ETZ. 
DISCONTINUED TPS/N/N6. 
KILLSO WITH SLUED SOSSDPONS. 
KILLED SHOES TPS/N/N6. 
NSNBEP Of EEN 
1500 
1200 
SO o'* 
600 
300 
O 
CHART HI 
H.D. O'PS S/P JEP)>/CE SEE 
TES/N/NG SECT/OH 
EE CO DOS BESHCH 
In total there were 1,741, of whom 730 were still in the fields; 745 
turned over to the zone of advance; 8 with the allied squadrons; 86 in- 
structors, transfer, staff and test phots; 153 discontinued from training; 
12 killed with the allied squadrons and 7 killed under training. 
More than 43 per cent of the observing personnel reached the zone 
of advance or allied squadrons. For every 100 trained observers AVIATION MEDICINE IN THE A. E. F. 
209 
arriving at the front only one man was killed in training. This is 
in striking contrast to the data just presented relating to pilots, 
and indicates that in France the hazards of training were 15 times 
greater for the flier than for the observer. 
In order to facilitate a comparison of the data relating to the fate 
of the total flying personnel, of pilots and of observers, these figures 
have been tabulated. (See Table I.) 
Table I.—Flying personnel, total, pilots and observers. 
Distribution. 
Total. 
Pilots. 
Observers. 
Total •. 
5,646 
3,905 
1,741 
Still under training ; 
2,141 
1,141 
730 
Turned over to zone of advance 
1,940 
1,195 
745 
With allied squadrons 
94 
86 
8 
Instructors, transfer, test, and staff pilots 
821 
735 
86 
Discontinued training.. .* 
349 
196 
153 
98 
86 
12 
203 
196 
7 
It is evident that the incidence of fatalities varies with the character 
of the work. In the training of observers only the larger and more 
stable machines are utilized and these are always piloted by trained 
fliers. Although the observer directs the activity of the plane, he is, 
so far as its actual control is concerned, merely a passenger, the pilot 
being the chauffeur. This combination, of the the large stable 
machine and the trained pilot, accounts for the relative infrequency 
of accidents to observers in France. 
All phases of the training of the pilot are not equally hazardous. 
The greatest danger is encountered in training on the small unstable, 
fast machines. Chart IV reveals the fact that in the Third Aviation 
Instruction Center 90 per cent or more of the accidents occurred in 
pursuit or advanced training. In connection with the chart it should 
be stated, however, that observation and bombardment were but 
recently added to the curriculum of the Third Aviation Instruction 
Center, and that at the time of the armistice they played but a small 
part of the total instruction given in that center. Nevertheless, the 
fact remains that the greatest danger encountered was in pursuit 
and advanced training. Of the 2,221 taking pursuit training, 49 
were killed; of the 2,486 taking advanced training, 26 were killed; 
and of the approximately 600 taking observation and bombardment, 
6 were killed. The data showing the weekly distribution of the 
training personnel in relation to pursuit and advanced training, 
observation, and bombardment are shown in Charts V, VI, and VII, 
respectively. 
The education of the flier involves danger not only to himself but 
to his instructor. Of the 203 fatalities due to accidents in the train- 
171364—20 14 210 
AVIATION MEDICINE IN THE A. E. F. 
/550C/0L/N 
COPfPPPPT/JE CHPPT OF FPTPL/T/ES 
FEB. 27™ 
MPP. IS™ 
n>pp. to™ 
PPP/L !0TH 
PPP/L 24™ 
M4Y /ST 
p/py /s™ 
pipy 22M 
NPY 29™ 
JUNE. S™ 
JUNE /2'* 
JUNE 26™ 
JULY 3*° 
JULY !7™\ 
JULY 24™| 
JULY J/ST\ 
PUG. 7™ | 
PUG. /4™ j 
PUG. 2/sr\ 
wtf. 28™ 
sept 4™ 
■SEPT. II™ 
LEGEND 
PUPSUIT TPPLN/N6 
ODV4NCED TPP/N/NG 
TEST PILOTS 
OBSEMPT/OH &. BOMB#ROMEN7 
0 
pomps' P/P JEPU/CE P.E.F 
TPP/N/NG SECYION 
PECOPOS BPPNCN 
CHART BE /SSOUDl/N 
CO/dP/lff/dr/VE CHPPT OP PPT/fL/T/ES 
LEGEND 
pursuit tppinino 
POUNCED TRPININ6 
TEST PILOT 
OSEPdPTION A BOPIBRRDHENT 
M0.R.R.S PUR SERd/CE BEE 
TRP/P///G SECT/OM 
RECORDS BRPNCR 
CHN2T 1ST (Comt‘/?.) 
P'/Z/TS/d/P TMP/A'/A'S 
/5 SOi/£>C//d 
IT&FVD 
- Commenced training 
-Comfl/eted - 
Under 
" D/sconf/nued ——— 
- Killed 
— — 
/fif fit's. *4//? <Senv/ct rf^r 
7?m/n/ms- secp/om 
/records J3ramc A 
C/-/<4/?r y. ADVANCED TRAINING 
I5SOUDUN 
LEGEND 
Commenced Training _ 
Completed " _ 
Under " 
D/scontinued " 
Killed _ 
' a/otc:- 
TAe sc co/ 'ect 4g/\a met >ct 
7 ~roir /no i■v'cty} dn cor t/n reo on 
C net s to jer As i ve/ e 
7 ran ye. rec ’ To . v//? erA ors 7!T 
cr O/rse/ vat, "on 
CHART V/ 
HOQ/tJ, A/A S&tytCE A. 5. C 
TRA/N/N6 5ECT/ON 
NBC0RD3 BRANCH 
OBSEHl//7r/OAJiBO/dSA//D/VE/VT 
/SSOU0L//Z 
LEG£77& 
Commenced froinmq 
Comp/e feed - 
Under _ ■. 
PASCon7//7t/ec7 •• 
HH/ed 
Ctf/tffTM, 
Hdlprj. zf//f Ss/fy/cr st.F./r 
TAA/t/AA/A/G S*c/-/oa/ 
Records Sronc/i AVIATION MEDICINE IN THE A. E. F. 
213 
ing schools of the A. E. F., 161 were killed under training and 42 
administering instruction. (Chart VIII.) There were in all 821 
. instructors, transfer, and test pilots. 
The percentage of fatalities, 5.6 per cent, is large when one con- 
siders that these were all trained pilots. When, however, the nature 
of the work of the instructor and test pilot is understood this figure is 
not surprising. Many of these lives were sacrificed in the effort to 
determine factors of safety for the student flier. 
FATALITIES 
at TMNIN6 centtps ate 
CHART TER 
HD'OW AW 3£m>/cc- fl.C.r: 
TWINING JECT/ON. 
PECOPDS BPNNCH. 
ACCIDENTS AND FATALITIES IN RELATION TO HOURS OF FLYING. 
For comparative studies accidents and fatalities are best expressed 
in relation to the flying hours. Data dealing with number of acci- 
dents per training center or per period of time have no great signifi- 
cance. In instruction centers the work accomplished is calculated 
entirely on the basis of hours flown, it being taken for granted that 
this represents the hours devoted by the students to the mastery of 
the art of flying. In the beginning of his training and in his intro- 
duction to acrobatic flying the student pilot has an instructor with 214 
AVIATION MEDICINE IN THE A. E. E. 
him in his flight, while the advanced student flies alone and pilots 
his own ship. The “hours flown” represent the total hours that 
the total number of machines are actually in the air, irrespective of 
the number of occupants of the machine. 
The number of passengers, however, plays a definite role in statis- 
tics dealing with fatalities, since frequently both pilot and passenger 
are killed simultaneously. 
Chart l'X presents graphically the comparisons of the flying hours, 
accidents, and fatalities for the training centers of the A. E. F. until 
the end of October, 1918. The total hours flown were 132,586 (more 
than 15 years); the number of crashes was 550, and of fatalities 184. 
The number of flying hours per month per crash decreased from 525 
to 318. During the first four months of the year a steady improve- 
ment was noted, but crashes were relatively four times as frequent in 
May as in April. The fatalities were more than doubled in May and 
were almost quadrupled in August as compared with April. An ex- 
planation seems necessary for this marked increase in crashes and 
fatalities, but none is at hand. The average number of flying hours 
per crash showed a marked, progressive decrease after April; 
whereas the number of average flying hours per fatality showed a 
general tendency to increase—721 hours per fatality in October as 
compared to 464 in January. There were more crashes as time went 
on, but they were less fatal. 
NUMBER AND DISTRIBUTION OF ACCIDENTS IN TRAINING SCHOOLS OF 
THE U. S. A. 
The fatal accidents in America outnumbered those abroad, though 
relatively to the number in training they were much less numerous. 
The scope of training in America prior to the armistice can best be 
shown by the number of men under training on November 11, the 
number trained to that date, graduated, and the number of hours 
flown. 
Table II. 
[Figures in parentheses indicate pilots.] 
Under 
training 
Nov. 11. 
Total number 
to Nov. 11. 
Graduated. 
Number 
hours 
flown. 
Number 
of 
fatalities. 
2,764 
12,231 
835 
> 8,688 
742 
653,009 
56,425 
32,312 
204 
82 
13 
430 (630) 
325 (226) 
414 
853 (1,084) 
1,399 (1,435) 
1,003 
414 (329) 
8 
907 (1,192) 
479 
35,801 
43,712 
22 
16 
r 
821,259 
263 
1 R. M. A. 215 
AVIATION MEDICINE IN THE A. E. F 
COMPARISON OF FLYING HOURS , ACCIDENTS (CRASHES) 
AND DEATHS OF PILOTS AND PASSENGERS AT TRAINING CENTERS LISTED BELOW 
STUDCUT 
on oerr 
r*M»« 
MlWfct 
TOTALS TO DATE 
nuhbcr or 
atn noNTM 
fiaKAGC. Nl/NBER 
PLYIIIC HOURS 
TO DATE 
FLYING 
HOURS 
mm 
wan 
CRASH 
WWllTY 
CRXS x 
TMl 1T r 
611 
5M6 
5363 
10 
it 
525 
+6+ 
525 
404 
603 
jOiec 
11409 
19 
23 
&S0 
531 
040 
+ 86 
67© 
ona 
19©£8 
32 
33 
647 
©42 
633 
60T 
1365 
.007-5 
5/ 
43 
64© 
128© 
629 
749 
1465 
0170 
46491 
148 
68 
159 
5T3 
314 
684 
1£4£ 
J>ICI 
61237 
244 
88 
15+ 
737 
251 
698 
1143 
0131 
T6430 
332 
103 
1T3 
1013 
230 
742 
ioee 
m-* 
946 73 
426 
128 
194 
330 
222 
739 
113© 
-0210 
108761 
4 rs 
133 
266 
564 
229 
Til 
1729 
Of 7 9 
<52306 
530 
104 
310 
769 
241 
72.1 
Air Service A.E. F. 
TRAINING SECTION 
Records Branch 
FUR SARA ITALY VOVE.S 
ISSOUDUN MUECON 
LC CROTOY CHATILLON 
SAUAUR 
SOUGE 
ST JEAN DE MONTS 
TOURS 
CHART- IX 
AVORD 
CHATEAUROUX 
CLERMONT-TERRAND 
CAZAUX 
COETQUIDAN 
ENGLAND 
FOGGIA ITALY 
LEGEND 
FLYING HOURS 
ACCIDENTS (CRASHES) 
FATALITIES 
Flying 
HOURS 
JANUARY 
FEBRUARY 
MARCH 
APRIL 
MAY 
JUNE: 
JULY 
AUGUST 
BEPTEF1BU 
OCTOBER 
NOVEMBER 
DCCE FIBER 
ACCIDENTS 
TATALI TIES 216 
AVIATION MEDICINE IN THE A. E. F. 
Above are tabulated under the various forms of training, primary 
fields, instructors’ school, bombarding, observing, and pursuit train- 
ing, with the number of fatalities. 
Prior to the armistice approximately six times as much training 
was done in America as in France—821,259 hours, or more than 93 
years. There resulted 263 fatal accidents or one fatality for every 
3,122 hours flown. 
The “hours flown” per fatality to date (Apr. 21, 1919) was stated 
by the Air Service to be 2,801.39. Accidents were relatively much 
less frequent in the United States. On the other hand, larger and 
more stable machines were used as a rule—ships which, although use- 
ful for training purposes, are totally unsuitable for fighting at the 
front. 
The causes of the fatal accidents have been classified by the Air 
Service up to April 2, 1919, as follows: 
Tail spin, 111; nose dive, 47; stall, 15; collision, 56; steep bank in 
strong wind, 1; side slip, 19; fire, 13; loss of control, 5; fall from 
plane, 3; collapse of plane, 7; motor trouble, 6; struck by propeller, 
13; struck by plane, 4; crash and fire, 2; upside down in air, 1; 
unknown, 23; other causes, 15. 
These make a total of 341 in all. Since 263 occurred prior to, 78 
must have occurred subsequent, to the armistice. 
Tail spins, nose dives, etc., are listed by the War Department as 
causes. Strictly speaking, this is not altogether correct, since, in 
many instances, these maneuvers on the part of the ship occurred 
subsequent to and were the result of the real underlying cause. They 
represented, therefore, the manner or mechanism of the crash rather 
than the underlying cause. It may be stated that any ship is liable 
to fall into a tail spin or vrille when flying speed is lost. Although 
the ship when observed just prior to crashing is in a tail spin, the 
tail spin per se may not be the cause of the accident. 
The number and type of planes involved in casualties in the United 
States are as follows: 
Fatalities to Apr. 3, 1919. 
Accidents to Ayr. 3, 1919. 
Standard J-l. 23 
Curtiss JN-4 176 
Curtiss R-4 5 
Canadian Curtiss 55 
Thomas-Morse Scout 11 
DII-4 5 
Caproni 1 
No record (No Standard J-ls) 31 
Le Pere 1 
Total 308 
Curtiss JN-4 156 
Standard J-l 10 
Canadian Curtiss 27 
No record 26 
Le Pere 1 
Total 220 AVIATION MEDICINE IN THE A. E. E. 
217 
These figures, though interesting, have no groat significance since 
they convey no real indication of the relative stability of the various 
types concerned. This can be ascertained through a consideration 
of the number of hours flown per type per crash—data which were 
not available to the writer. 
In comparing the data for the same period relating to the training 
schools at home with those of the A. E. F., certain facts become 
apparent: 
1. The bulk of the training was given in the United States. 
2. Fatal accidents at home outnumbered those of the A. E. F. 
3. The number of fatalities (263 as compared with 203) for hours 
flown was relatively much smaller at home than abroad—the hours 
flown per fatality being 2,801 in the United States and 721 abroad. 
Accidents were, therefore, relatively four times more frequent in 
the A. E. F. 
4. Combining the data for home and abroad it is seen that the total 
accident loss in training was 466 for approximately 950,000 hours; 
2,034 men in total arrived at the front (1,281 pilots and 753 observers). 
For every 100 trained flying personnel arriving at the front, 24 had 
been killed; for every 100 pilots, 33 and for every 100 observers 
approximately 4 had been killed. 
THE CASUALTIES OF FLIERS IN THE ZONE OF ADVANCE. 
Nineteen hundred and forty pilots and observers were turned over 
to the zone of advance and 94 to allied squadrons. The casualties 
among these as listed by the personnel division, headquarters Air 
Service (Table II, section A), relate to the fliers in the American 
sector and (section B) to the American fliers serving with allied 
squadrons. 
Of the men on the American front, 137 were killed in combat. 
Altogether 360 were lost outright to the service and in addition 109 
were wounded. On combining the data, sections A and B, it is seen 
in section C that 427 were lost—killed in combat 169, missing 72, 
prisoners 137, killed in accidents 42, died of disease 4, interned 3. In 
addition, 127 were wounded. Even at the front accidents played a 
great r61e, since 25 per cent as many fatalities occurred in accidents 
as in combat. 
TOTAL FATALITIES OF AMERICAN AIR SERVICE. 
Deaths in the flying personnel of the American Air Service num- 
bered 681, of which 508” were due to accidents (263 in America, 203 
in training schools, A. E. F., and 42 at the front), 169 to combat, and 
4 to disease. Accidents accounted for approximately 74.6, combat 
for 24.8, and diseases for 0.6 per cent of fatalities. 218 
AVIATION MEDICINE IN THE A. E. F. 
The total casualties of the flying personnel of the Air Service were 
1,020;7 killed, 681; missing, 72; prisoners, 137; interned, 3; and 
wounded, 127. The total flying personnel arriving at the front in 
FLYING PERSONNEL AT FRONT - FATALITIES 
AMERICAN AIR SERVICE 
TOTAL PLYING PERSONNEL AT FRONT • £034 
LEGEND 
Zona of Action 
Allies 
Pilots 
Observers — — 
TOTAL KILLED - SSI 
LEGEND 
Acc! de nta — 
Combat 
Disease 
total KILLED IN ACCIDENTS- 508 
LEGEND 
Schools of An>«rjce 
Schools of France — - 
At the Fro r»f — — — — 
CHABT-X 
American squadrons and with Allies was 2,034. These facts are 
graphically shown in Chart X. 
1 This figure does not include nonfatal accidents occurring in training schools of America and France. AVIATION MEDICINE IN THE A. E. F. 
219 
Table II. 
A. AMERICAN CASUALTIES AT THE FRONT. 
Killed in 
combat. 
Missing. 
Prisoners. 
Killed in 
accident. 
Died of 
disease. 
Wound- 
ed. 
Interned. 
6 
4 
5 
4 
2 
4 
5 
6 
1 
9 
6 
24 
1 
11 
23 
3 
14 
4 
10 
58 
25 
47 
8 
28 
2 
33 
18 
14 
16 
2 
38 
6 
7 
12 
1 
12 
Total 
137 
59 
119 
40 
2 
109 
3 
B. AMERICAN FLIERS SERVING WITH OUR ALLIES. 
Killed in 
combat. 
Missing. 
Killed in 
accident. 
Wound- 
ed. 
Prisoners. 
Died of 
disease. 
4 
1 
1 
2 
3 
4 
2 
2 
July 
6 
2 
2 
2 
10 
3 
7 
7 
2 
2 
4 
5 
3 
1 
1 
1 
4 
1 
2 
Total 
32 
13 
2 
18 
17 
2 
C. SUMMARY. 
A. E. F. 
With 
allies. 
Total. 
Killed. .. . . 
137 
32 
169 
59 
13 
72 
119 
17 
136 
40 
2 
42 
2 
2 
4 
3 
3 
360 
66 
426 
109 
18 
127 
Statistics such as' these indicate the enormity of the problem. 
When it is realized that for every 100 trained pilots leaving the 
training institutions of France for work at the front, 15 had succumbed 
to accidents in training; that in October, 1918, when our training 
schools were at the maximum of efficiency a crash occurred, in the 
schools of the A. E. F., for every 241 hours flown and a fatal accident 
occurred for every 721 hours flown, the importance of accident 
problems becomes manifest. When it is further realized that 
many of the student fliers entering the schools of France had been 
already trained in America, and that even a larger number had 
already succumbed to accidents in training there, the problem 
assumes even greater importance. Finally, when it is realized that 
one man was killed in accidents for every three trained pilots arriving 
at the front, and that three fliers were killed in accidents for every 220 
AVIATION MEDICINE IN THE A. E. F. 
one killed in combat, the accident problem establishes itself as the 
most important medical problem of aviation. 
AVIATION ACCIDENTS IN THE ITALIAN AIR SERVICE. 
The experience of America is not unique. Italy also lost more 
fliers in accidents in 1918 than she did in combat, as will be seen 
from the study of Table III, A and B, the data for which were kindly 
submitted to the writer by the general commanding the Sanitary 
Service of the Italian Army. A letter accompanying these figures 
stated that they were approximate only, as the final analysis was 
not yet complete. 
Table III.—Wounded, taking more than 10 days to cure, or wounded fatally in the 
aviation schools of the territorial zone, from Jan. 1, 1918, to Sept. 20, 1918. 
(A) Wounded: 
Taking more than 10 days days to cure 255 
Fatally. * 161 
(B) Aviators killed in the war zone in 1918: 
In aerial combat— 
Officers 26 
Privates 21 
In flying accidents—■ 
Officers 74 
Privates < 62 
From undefined causes— 
Officers 5 
Privates ; 8 
Total—• 
Officers 105 
Privates 91 
Those who died in the enemy’s territory are not included. 
It is clear that in the Italian air service 161 were killed up to 
September 20, 1918, in the aviation training school and that in the 
war zone 196 were killed throughout that entire year. But of these 
196 only 47 were killed in combat and 136 in accidents. Therefore, 
in the Italian air service, in 1918, 357 in total, were killed and of this 
number 297, or 83.41, were killed in accidents. Five fliers were 
killed in accidents in the Italian air service for every one killed in 
combat. 
THE CAUSES OF ACCIDENTS AND THEIR PREVENTION. 
Broadly speaking, the causes of accidents can be divided into 
mechanical imperfections of plane or motor, bad flying judgment, 
weather conditions, collisions, and propeller accidents. Each of 
these demands most careful consideration. The first belongs prima- 
rily to the engineering and the second to the medical and training 
departments. An attempt should be made to control each factor to AVIATION MEDICINE IN THE A. E. F. 
221 
the utmost and where control is impossible, as in weather conditions, 
flying should be avoided except where it is absolutely necessary. 
(a) Ships on Acceptance Should Be Mechanically Fit. 
I. MECHANICAL IMPERFECTION OF MOTOR AND PLANE 
This is essentially an engineering proposition. The engineering 
world is striving to eliminate mechanical imperfections and to attain 
mechanical perfection, but this is a matter of evolution and evolution 
is a matter of time. One who is studying the accident problem is 
brought face to face with certain fundamental principles which he is 
forced to accept. Only those types of machines and motors should 
be accepted which represent the closest possible approach to perfec- 
tion, mechanically and from the standpoint of material. 
This involves the employment of the highest grade of mechanical 
ingenuity, skill in design and construction of the plane, and the utili- 
zation of only the best material in their production. This in turn 
involves absolute integrity on the part of the manufacturer, absolute 
adherence to specifications, and great care in the selection and testing 
of all material utilized, together with expert supervision of the manu- 
facture and assembling of all parts. This is the function of aircraft 
production, but it is the function of the administration to see that 
these specifications are fulfilled and that only ships mechanically fit 
are accepted for service. 
(b) The Machine Must Be Kept Fit. 
The wear and tear on the aeroplane is great. The machine itself 
is a complicated piece of apparatus. Yet a loose bolt, a twisted wire, 
or a dirty spark plug may result in death. Each machine, therefore, 
should be mechanically right prior to every flight. This can not be 
taken for granted. A careful inspection by a competent mechanic is 
essential before every flight. In addition a thorough overhauling is 
needed every morning before placing the ship on the line. These 
rules should be absolute and should be enforced in every flying 
organization. No ship in need of repairs should be taken into the air. 
The motor also requires special and expert attention. Irrespective 
of the way it works it should be overhauled at stated intervals. In 
the Third Aviation Instruction Center this was done for every 40 
hours of flight. Every motor defective in any respect should be 
thoroughly investigated before a flier is permitted to take it into the 
air. Prior to every flight the motor should be thoroughly tested 
again by the pilot in order that he may know from personal experi- 
ence what it can do and what he can demand of it. If it does not 
meet with his entire approval it should be again overhauled. 
In the event of breakage or defects in either plane or motor, repair 
and replacing of parts should be done only by expert mechanics 222 
AVIATION MEDICINE IN THE A. E. F. 
specially trained for this work, and the parts substituted should them- 
selves be mechanically perfect. Except after very minor repairs 
appropriate tests should be carried out by specially trained testers 
before the machines are returned to the line. Obviously this involves 
a great expenditure of time and labor. The administration, however, 
should see that this is done. It is estimated that six men on the 
ground are necessary for every machine that flies. Too much care 
can not be exercised to insure ships fit for flying. “Only the fit 
should fly” applies to planes and motors as well as to pilots. 
(c) Gas and Oil. 
In addition to seeing that the ship is fit it is necessary to see that 
it is also supplied with suitable gasoline and oil. Special precaution 
must be taken to insure a gas free from water. Neglect of this, not 
infrequently, is the source of trouble. The aeroplane must depend 
on its gas and unless a good quality can be supplied the ship should 
not be allowed to fly. 
(d) The Condition of the Ship and the Confidence of the Flier. 
Fliers have marked preferences in regard to aeroplanes. Some have 
confidence and feel comfortable in the larger stable planes but never 
acquire the same attitude toward smaller fast planes. Others de- 
light in the speed, power, and maneuverability of the Nieuport, 
Moran, or Spad. This is largely a matter of temperament and of 
training. Nevertheless, it must be recognized as a fundamental fact 
that a man who fails to acquire confidence in any particular type of 
machine will probably not make a successful pilot of that machine. 
Since the machine itself and its gas and oil are all extremely inflam- 
mable and since fires originating during the flight almost always prove 
fatal, the question of fire is one worthy of the greatest consideration. 
Infinite care should be exercised in the construction of the motor, in 
the feed of gasoline, and in the location of the gas tank from the stand- 
point of fire. The fliers themselves are temperamental and greatly 
affected by accidents. The spectacle of a ship aflame in the air 
markedly affects those seeing it, and through them the entire flying 
personnel of the organization. A very strong prejudice was created 
against one of the planes used by Americans, owing to the frequency 
of fire. The pilots characterized this particular machine as the 
“ Flying Coffin.” The absolute and relative locations of the motor and 
of the gas tank are matters of great importance. 
(e) Adaptability of Planes to Types of Work. 
The selection of the ship should be made in relation to the type of 
work to be carried on. There are many types of planes and motors 
each with its advantages and disadvantages which will soon become 
apparent to skilled pilots. The administration must familiarize itself AVIATION MEDICINE IN THE A. E. F. 
223 
with the strength and weakness, the advantages and disadvantages, 
the value and limitation of each type of plane and motor. The ship 
should be selected for its adaptability to the desired use. A ship 
admirably suited for one branch of work may prove a failure in another 
connection. Some machines, such as the Avro, are stable, easily 
controlled, and admirably adapted to the teaching of acrobacy, a 
branch of training essential to combat. In actual combat, however, 
the fast and stable machines, such as the Spad and the 15 m. Nieuport, 
are utilized. Special bracing of the machines is frequently desirable 
when they are to be used in acrobacy or combat. 
(f) Familiarity with Types of Plane. 
As far as possible it is advisable for a pilot to use the same ship 
in order that he may have the advantage of his experience in han- 
dling it. It is essential that he know just what he can expect and 
demand of his ship, and as this varies with the individual machine 
it is decidedly advantageous for him to constantly use the same one. 
As a rule this is only possible at the front or in the case of the instructor. 
During student days it is necessary to train a flier on many types 
of planes. It is desirable for him to receive his instruction in each 
type of work on the type of plane best adapted to this work. Special 
care should be exercised, however, that he be as thoroughly familiar- 
ized as possible with the peculiarities of each type as he encounters 
it prior to actual flight. All differences in control or in response to 
control should be clearly outlined before the machine is permitted to 
take to the air. 
(g) Necessity of Knowing the Aeroplane and the Science of Flight. 
The pilot should be instructed in the science involved in flight. He 
should understand his motor and plane and all that pertains to them. 
In this connection he should receive definite instruction and every 
possible assistance which can be rendered in the training schools 
through the senior officers, instructors, monitors, testers, and the 
engineering department. He should know the aeroplane and the 
science as well as the art of flying. 
Every machine has its limits and every machine will fail if taxed 
beyond them. Many accidents for which the plane or motor are held 
responsible are caused by overtaxing the machine or by poor flying. 
A perfect motor will fail through faulty handling of the manettes, the 
feeding of imperfect admixtures, or to overtaxing, such as is encoun- 
tered in prolonged zooms or climbs. The pilot should know his plane 
and his engine, the capabilities of both, and treat them accordingly. 
Mechanically the essential features to fulfill are to supply a reliable 
ship and motor, to keep them fit, to supply proper gas and oil, to see 
that the ship is used in the type of work for which it is adapted, to 224 
AVIATION MEDICINE IN THE A. E. F. 
see that the pilot is familiar with each new type, its peculiarities, and 
its limitations prior to flight. 
II. POOR JUDGMENT AND BAD FLYING. 
These are responsible for the majority of accidents and involve the 
questions of physical fitness and of training. The former chiefly 
concerns the medical; the latter, the training department. 
(a) Physical Condition—Fitness and Lack of Fitness. 
Lack of fitness may be either permanent or temporary in character. 
The examination of a candidate for admission involves a careful 
physical examination which is intended to exclude the permanently 
unfit (physically or temperamentally) and to admit only those in 
perfect somatic health with perfect sensory functions. 
Too much consideration can not be given to the character of the 
examination, to the standards adopted,8 and to the personnel carry- 
ing out the examinations of applicants for admission. 
With these factors properly controlled, waivers should be granted 
not at all or only upon the rarest occasions. A waiver involves 
danger not only to the pilot concerned, but to other fliers, as in the 
following case: An applicant was rejected by several boards on 
account of poor vision. He persisted in his attempts and finally 
entered the service. During training he collided in flight with an 
experienced pilot who had flown many hundred" hours. Evidence 
presented to the board appointed to investigate this accident seemed 
to clearly indicate that the first pilot did not see the other machine 
and crashed into it, killing both himself and the other flier. In addi- 
tion two valuable machines were totally wrecked. This occurred at 
the time when both machines and fliers were most urgently needed 
at the front. 
Temporary unfitness may result from many causes. Many of these 
can only be detected through the constant watchfulness of the 
physician who comes in close personal daily contact with the flier. 
For this purpose the flight surgeon has been introduced into the air 
service. It is his duty to assure physical fitness through personal 
contact with the fliers, the instructors, and the administration. 
TRAINING IS ESSENTIAL TO FITNESS. 
None but the jit should jly.—If medicine could enforce this rule, 
accidents would decrease materially in number. But medicine can 
not control the situation until the administration and the flying per- 
sonnel recognize the necessity of making this rule absolute. 
Rene Fonck, the leading French ace, recently made the following 
observations to La Guerre Aerienne: 
8 These standards are considered elsewhere in this volume. AVIATION MEDICINE IN THE A. E. E. 
225 
One must be in constant training, always fit, always sure of oneself, always in perfect 
health. Muscles must be in good condition, nerves in perfect equilibrium, all the 
organs exercising naturally. 
Alcohol becomes an enemy—-even wine. All abuses must be avoided. It is indis- 
pensable that one goes to a combat without fatigue, without any disquietude, either 
physical or moral. 
It must be remembered that combats often take place at altitudes of twenty to 
twenty-five thousand feet. High altitudes are trying on one’s organism. This indeed 
is, at bottom, the reason that keeps me from flying too continuously. And I never fly 
except when in perfect condition. I am careful to abstain when I am not exactly 
fit. Constantly I watch myself. 
It is necessary to train as severely for air combats as for any other athletic contest, 
so difficult is the prize of victory. Yet if one finds oneself in prime condition, all the 
rest is play. 
1. Temporary indisposition or minor ailments.—Among the tempo- 
rary causes the chief to be considered are minor ailments, the use of 
drugs, intemperance or excess of any nature, flying stress, and stale- 
ness. 
When flying, the pilot’s life depends upon the quickness of his wit 
and the accuracy of his muscular control. A temporary indisposition 
such as an attack of influenza, tonsilitis, bronchitis, or migraine, while 
perhaps trivial in itself, absolutely unfits a man for flying for the time 
being. A medical principle should be laid down that any general 
illness requiring medication is an indication for temporary suspension 
from flying. In several instances of apparently inexplicable accidents 
to noted flyers it has developed, upon investigation, that the victim of 
the accident was suffering at the time from some temporary indispo- 
sition such as those listed above, and that he was undergoing self- 
administered medication. Many flyers have been killed while taking 
aspirin. Whether the underlying disease or the aspirin, or both, 
should be held responsible, is still to be determined. Three of the 
fifteen fatalities occurring at the third instruction center in October, 
1918, were to flyers convalescing from the “flu.” None of these 
pilots had been examined by the medical research board. 
2. Intemperance and excesses.—Indulgence in alcohol, late hours, 
excessive venery, loss of sleep, unquestionably play a considerable 
r61e in the etiology of accidents. In the majority of instances, how- 
ever, it is extremely difficult to obtain data relative to some of these 
factors. 
3. Flying fatigue—Staleness.—Flying involves great stress. Two 
periods, two hours each, constitute a good day’s work even for the 
experienced pilot. Fatigue is particularly complained of, if more 
than six hours of flying per day is persisted in for any period of time. 
Students called upon to fly six hours per day, as they frequently are 
in mastering formation flying, consider themselves driven to death. 
In the Third Aviation Instruction Center the commanding officer of 
171364—20 15 226 
AVIATION MEDICINE IN THE A. E. E. 
one of the fields demanded rest for the student pilots coming to his 
field because he believed that they were suffering from flying staleness. 
He stated that they were not fit to fly. Upon investigation it 
developed that these men had been flying six hours per day in the 
preceding field. 
Flying stress results in both temperamental and physical unfitness. 
Judgment becomes seriously impaired. Flying efficiency is lost. 
The pilot’s attitude toward his work is distorted and he frequently 
assumes a "don’t care” attitude. He fails to heed even the funda- 
mental rules of flying. Sleep becomes irregular or impossible, broken 
by dreams relating to flight. Imaginary accidents are nightly occur- 
rences during his sleeping hours. Confidence is lost and with it, flying 
efficiency. Frequent accidents result. 
Physical rather than temperamental defects are frequently the basis 
of these accidents. The strain of eye muscles resulting in muscular 
imbalance—convergence insufficiency or divergent excess—are respon- 
sible for many bad landings and many crashes. The diagnosis of 
flying staleness is frequently made by the commanding officer of the 
field or by the flight or squadron commander. 
4. Altitude.—Altitude brings new problems which but recently 
have become of great practical importance in aviation. In war, 
originally, the aeroplane was used for reconnoissance and at relatively 
low levels. With the advent of the machine gun in planes, combat 
became a prominent feature and the value of altitude in relation to 
this became apparent. Consequently, planes were built with this 
idea in view. Whereas, in 1915, an altitude of 12,000 feet for a war 
plane was unusual, by the end of 1917 altitudes of 22,000 feet were of 
common occurrence. 
Altitude involves decreased barometric pressure and decreased 
oxygen tension. The latter is the factor responsible almost entirely 
for the symptoms produced at high levels. Two forms of altitude 
sickness are known. The first is acute, characterized by tachycardia, 
lividity, headaches, nausea, vomiting, buzzing in the ears, dimness of 
vision, marked prostration, and fainting attacks. The second form 
presents many of the same phenomena but it is delayed in its onset. 
Nervous and cardiac symptoms are apt to predominate. Marked 
panting and inability to move, a weakness or paresis of the limbs and 
marked general asthenia. A dazed condition associated with eupho- 
ria, or even unconsciousness may supervene. In most cases the 
euphoria which accompanies altitude sickness is unfortunate, in that 
it robs the pilot of the opportunity of recognizing that he is in danger. 
He feels fit and believes himself to be in possession of all of his senses. 
He feels perfectly capable of controlling his ship, whereas, in fact, he 
may suddenly lose control and behave as one suffering from an attack 
of petit mal, or he may actually faint. Under such conditions he 227 
AVIATION MEDICINE IN THE A. E. E. 
may, if he is fortunate, awaken to find his ship flying out of control 
usually at a much lower level. Providing he has a true fainting 
reaction he may not recover at all, in which event a crash and usually 
a fatality is the result. 
Acute altitude effects have been carefully investigated within the 
last two years in the Air Service. By the use of the Henderson 
breathing apparatus it is possible to bring the subject to 10 or even 
6 per cent oxygen within half an hour under conditions in which 
cardiovascular (blood pressure and pulse) and psychological condi- 
tions can be carefully noted. Roughly speaking, two types of reac- 
tions occur. First, those showing marked cardiovascular changes, 
ending, if the test is not interrupted, in a fainting reaction from which 
it takes considerable time to recover. Second, those exhibiting a 
dazed condition in which the subject, though he does not fall or 
collapse, is mentally and physically incapacitated, with failure on 
his part to recognize his helpless state. The condition in this respect 
somewhat resembles petit mal. Quick recovery ensues on resump- 
tion of breathing or the administration of oxygen. In many instances 
the subject must be told to take a deep breath, otherwise he makes 
no effort to breathe on the removal of the mouthpiece and nose clip. 
The fainting reaction is the more serious. Subjects falling into this 
group are apt to crash before recovery occurs. Most pilots who 
state that they fainted in the air and awakened to find themselves 
thousands of feet lower probably belong to the second group. 
Individuals differ widely in their ability to withstand the effects 
of altitude. Each individual has his own ceiling. This, however, 
may vary from time to time. Slight indispositions, trivial in them- 
selves, may exercise a marked effect in decreasing capacity to with- 
stand the effects of low oxygen tension. This fact has been clearly 
demonstrated by the Medical Research Board. 
Experience has taught pilots that altitude flights affect their judg- 
ment of distance, and result often in poor landings. Many of the 
best pilots make it a rule following flight at great heights not to land 
without first making a “Tour de piste.” 
It is interesting to get the airman’s point of view in regard to 
altitude sickness. McCudden, one of the leading British aces, in his 
interesting book, “Five years in the R. F. C.,” speaks of air sickness 
which he encountered in a combat which started at the height of 
21,000 feet. “I felt very ill indeed. This was not because of the 
height or rapidity of my descent but simply because of the intense 
cold which I experienced up high. The result was that when I got 
down to a lower altitude and could breathe more oxygen, my heart 
beat more strongly and tried to force my sluggish and cold blood 
through my veins too quickly. The effect of this gave me a feeling 
of faintness and exhaustion that can only be appreciated by those 228 
AVIATION MEDICINE IN THE A. E. F. 
who have experienced it. My word! I did feel ill, and when I got on 
the ground and my blood returned to my veins I can only describe 
my feeling as agony.” 
(b) Inexperience and Training. 
Inexperience is a very common cause of accidents. In 15 fatalities 
occurring in October, in the Third Aviation Instruction Center, 6 
occurred in the first flight on a new field with a new type of plane. 
This tells its own story. Obviously this problem is for the training 
department and one difficult of solution. 
In training, the student pilot is taken through the ground school 
and then into the air in double control. He is given the necessary 
instruction, allowed to pilot the ship, and is made the object of study 
by his monitor. When the monitor feels confidence in the student’s 
ability to handle the ship, then, and then only, is he allowed to go 
“solo.” But many a man who handles his ship well in double control, 
knowing that an accident is unlikely because of the presence of an 
experienced pilot, loses confidence and with it his flying ability 
when he realizes that his life is in his own hands. This constitutes a 
most difficult problem. 
Training is commenced on a two-seated machine, which is relatively 
large, slow, and stable. The first solos are usually taken in the same 
type of machine in which the student has been trained. He then 
passes to faster and smaller machines. The peculiarities of the latter 
are carefully outlined before he is allowed to take them up, but if it 
is a single seater he must handle it alone when he takes it into the 
air. Slight differences in handling the control, in maneuverability, 
and in responses to control on different machines lead to many 
accidents. 
After simple flying is learned, formation, acrobacy, and combat 
must be mastered. 
1. Formation flying.-—Inasmuch as most of the work of the chasse 
pilot at the front is now carried out by formations rather than by 
single machines, formation flying is essential and must be learned. 
In formation the machines aim to keep together in predetermined 
relative positions. This remains constant in straight flight, but in 
making turns, changes in relative position are also made. Rules 
governing changes in speed, altitude, and direction, and counting for 
safety are prescribed. Nevertheless, accidents are frequent. Infinite 
care and watchfulness are constantly needed in formation flying, 
especially in the execution of turns. 
2. Acrobacy.—Acrobacy is essential to combat. In the latter days 
of the war, with the advent of formation tactics, it did not play as 
large a role in combat as formerly. But a good scout pilot must be 
able to do acrobacy in order to extricate himself from difficult posi- AVIATION MEDICINE IN THE A. E. E. 
229 
tions in combat or in order to meet emergencies arising in flight. It 
is essential for the pilot to be familiar with the emergencies of flying 
and the effects of these upon the behavior of the ship. When the 
motor stalls, the machine tends to drop into a vrille, or it side-slips. 
Unless the pilot is familiar with the methods of control of the ship 
in a vrille or side slip, a crash is almost inevitable. 
The fundamentals of acrobacy, as of simple flying, are first taught 
under dual control. Only after the instructor is satisfied that the 
student is capable of handling himself in various maneuvers, such 
as loops and renversements, does he permit him to attempt them 
alone. In mastering these maneuvers the student is taught in one 
of the stable machines, such as the Avro, under the supervision and 
guidance of an instructor. After preliminary training he actually 
handles the machine himself, but still under the supervision of the 
instructor, who notes and attempts to correct all faults in the tech- 
nique of flying. Subsequently the student is obliged to execute these 
maneuvers alone and in faster and less stable machines. In so doing 
he is intentionally exposed to the emergencies, dangers, and pitfalls 
of flying and is obliged to extricate himself. In this work accidents 
occur from time to time. A few pilots are killed, but those who sur- 
vive become skilled, ready to meet any contingency. Since emergen- 
cies inevitably occur, they must of necessity be met sooner or later. 
Training is a prophylactic measure, results in greater flying skill, and 
protects the pilot in emergencies and in combat. 
The administration should make certain that in acrobacy only 
machines capable of standing the strain are utilized and that machines 
used in this work are effectively braced. 
3. Combat.—Combat training is dangerous but absolutely essential. 
It involves mastery of the tactics and acrobacy involved in actual 
fighting. The machine gun is replaced by a camera gun. The 
student is taught how to attack, how to fight, and how to extricate 
himself if attacked; how to convert a defensive position into an 
offensive one. This work is carried out in fast single seaters. 
The training involves competition, and hence excitement. In the 
heat of combat collisions are not infrequent. Inasmuch as the pilot 
must constantly watch the other machine, ample air space and alti- 
tude are requisites. In combat there is a constant tendency to lose 
altitude. Unless combat is taught only at a considerable altitude 
and desisted from also at a fair altitude, accidents are bound to occur, 
since the pilot’s mind and eye are concentrated on the other machine. 
Air sickness, nausea, vomiting, and vertigo are of frequent occur- 
rence among students learning acrobacy and combat. In the latter, 
relativity of position, together with strenuous acrobacy, are the 
causes. Students, especially those who are known to be hyper- 
sensitive to motion, should not be rushed in training in combat or 230 
AVIATION MEDICINE IN THE A. E. F. 
acrobacy, since vertigo and vomiting may prove great sources of 
danger. Nausea and vomiting may be overcome in many cases 
through training which involves systematic and repeated subjection 
to vrilles. Only after the flier has overcome vertigo and can bring 
his ship out of a vrille with his wings level should he be permitted to 
try it alone. 
Training schools have attempted to formulate rules and regulations 
covering flying which would protect both the student and instructor. 
These are the result of experience and of careful investigation. They 
should be familiar to all the flying personnel and should be absolutely 
enforced in every training center. 
The rules and regulations governing flying were compiled at our 
suggestion, by Capt. Ferguson, officer in charge of flying, at the 
Third Aviation Instruction Center. They are as follows: 
General Rules and Regulations Governing Flying on Individual Fields. 
(Oct. 21, 1918.) 
[Training Department Third Aviation Instruction Center.] 
GENERAL REGULATIONS. 
The following regulations are in effect at all fields at this center. Each student 
will thoroughly familiarize himself with them and will he held responsible that they 
are carried out at all times. 
In addition to these regulations, each field has its own additional rules with which 
students must familiarize themselves before starting flying at the various fields. 
1. No airplane will he taken into the air except by signal of the officer in charge 
of flying or his assistant, and under no circumstances must any of the training fields be 
crossed by machines of another field at an altitude under 500 meters. 
2. Before going into the air the pilot will familiarize himself with the rules for 
turning for that field. 
3. (a) Each pilot will make a careful inspection of the airplane before flying, special 
attention being paid to the controls, control surfaces, and landing gear. 
(b) Controls should always be worked on the ground prior to a flight, to see that 
they function properly. Check direction of actions. Frequently in replacing cables, 
the cables are put in crossed. This invariably results in an accident, if mistake is 
unnoticed. 
4. The pilot will repeat the words “coupe” and “contact” after the mechanic, 
but in no case will he say “coupe” unless the switch on the side is closed and the 
switch on the stick pushed down. This is the only occasion upon which pilots may use 
the switch on the stick. 
5. Machines will be taken off and landed against the wind only. 
6. No turns will he made under 150 meters. 
7. The pilot must at all times keep within gliding distance of the field unless 
receiving special orders to the contrary. 
8. When within 50 meters from the ground, and distance enough to land in has 
been assured, cut the switch on the side of the machine. Under no circumstances 
land with the switch cut on the stick. AVIATION MEDICINE IN THE A. E. E. 
231 
9. Pilots of this post meeting French machines in the air, will not fly closer to them 
than 500 meters nor practice acrobatics near them. 
10. No acrobatics will he performed over main field, except by testers or with 
special permission from the officer in charge of training. 
11. No acrobatics will be performed over surrounding towns or hospitals. 
12. No acrobatics will be performed at less than 1,000 meters altitude. 
13. No student will carry a passenger in an airplane. 
14. In case of serious accidents no one shall in any way examine or alter the damaged 
plane, other than that necessary in removing the pilot, until a photograph has been 
taken of the accident by the statistical department. 
15. In any case of forced landing, it is the duty of the pilot to telephone or telegraph 
the field service department at once. 
16. In case of machine being wrecked, or partially wrecked, the field service crew— 
if convenient, the crew of that machine—and the detachment of the Medical Corps, 
will go to the wreck. No one else except the officer in charge of flying, engineer officer, 
and their assistants. 
17. All machines must be equipped with safety belts for pilot and passenger.. 
18. Always use safety belts. In case of accident, do not release belt until after 
accident. It will probably save injury, especially if the machine turns over. 
19. If any flier finds something wrong with his machine which, in his estimation, 
makes it unsafe for the next flier to use the machine, he will instruct the next man 
to hold the machine on the ground, and will immediately report the trouble to the 
officer in charge of the field. 
20. If any flier finds something wrong with the planes or the controls of the planes 
which he is flying, he will make his criticism to the officer in charge of field and to 
no one else. All criticisms will receive due consideration. 
21. Do not turn machine sharp in taxying. When on starting line instead of turning 
short on the line, have the tail lifted around, and avoid turns which strain the fuselage. 
22. Never run motor so that blast from the propeller will blow on another machine 
or in direction of hangars. 
23. Machines gliding into field have preference over those about to leave. Machines 
landing have greater speed than those leaving, so be careful not to misjudge your start 
and be overtaken by another machine that is powerless to keep from having an acci- 
dent as the result of your misjudgment. 
24. Never leave a machine tail to the wind; nose machine into the wind. Always 
leave the propeller horizontal. If wind blows machine over on its nose, propeller 
will be broken unless it is horizontal. 
25. No pilot will leave the ground if the motor is not working properly. If a motor 
develops a skip within 150 meters altitude, land immediately, continuing in a straight 
line from runway irrespective of the ground. 
26. When direction of the wind is such that students are required to take off directly 
toward hangars, they will take off so that they will pass by the comers of the hangar 
group and not directly over hangars and machines on the line in front of same. 
27. No pilot will get into a machine unless he is feeling well physically. 
Note.—Each student will receive a copy of these general regulations upon his arrival 
for which he will sign receipt. 
Upon departure he will return same to Office of the Training Department at Head- 
quarters detachment. 
Ignorance of the rules will not be accepted in any case as an excuse for violations 
of same. 
Fields 1 and 2. 
ROULERS—TAKING OFF—LANDINGS—HOPS. 
1. No low flying is permitted. 
2. No cutting across fields in front of other machines making a tour de piste. 232 
AVIATION MEDICINE IN THE A. E. F. 
3. All turns will be made in the direction indicated by the flag on the cross beam 
of the tower in the center of the field. 
4. The line to which moniteurs land will be determined by the color of the flag, 
red or blue, on cross beam. 
5. Any form of acrobacy in a dual control plane is prohibited. 
Field 3.—Main Field. 
1. No airplane will be taken into the air except by signal of the chef de -piste, and 
under no circumstances must any of the adjoining fields he crossed at an altitude of less 
than 300 meters. 
2. Do not take to the air if motor is not working properly. 
3. Climb slowly. Do not turn under 150 meters and throttle down to 1,050 or there- 
abouts after first turn. 
4. Twenty-three meter singles will be used for cross country purposes under no con- 
ditions whatsoever unless authority is given in writing by either post commander, 
officer in charge of training, officer in charge of flying, field commander, or field adju- 
tant. Such written permission will be presented to the senior N. C. O. at the field, 
and a suitable machine will be furnished. This rule will be strictly adhered to. 
Field 4.—Acrobacy. 
GENERAL RULES. 
1. All machines must taxi out from the line before taking off. 
2. No machine should leave the ground without a signal from the flagman. 
3. The signals of the flagman will be as follows: 
Red flag is a danger signal. All machines should stop where they are until the red 
flag is withdrawn. The signal to start will be pointing the white flag at a particular 
machine, followed by a wide sweep. The signal to taxi is the waving of the white 
flag below the waist line. When the flagman points in any direction with both flags 
he is giving the direction in which to take off. 
4. All pilots are directed to take directly into the wind and to make the first turn 
only after having acquired an altitude of at least 200 meters (600 feet). All landings 
should be made into the wind. Side-slip landings or landings with the wings low or 
gliding in with one wing low are forbidden. The last hundred meters of altitude 
should be lost in a straight glide. 
1. The flagman at the landing field will use the same system of signals as described 
above. The diiection of the “tour de piste” will be determined by the officer in 
charge of landing. 
2. The wind direction is shown by a white “T ” on the ground. All pilots landing 
on the landing field will land to the left. 
3. Machines not occupied by pilots and those in field repair will be taxied or rolled 
into position on the right side of the “T.” 
4. Pilots will practice air work as far as possible in the air area allotted to them. 
RULES FOR THE LANDING FIELD. 
RULES FOR THE SPIRAL CLASS. 
1. Pilots in the spiral class will take off at the signal from the head flagman. 
2. The direction of their “tour de piste” will de determined by the officer in charge 
of the spiral class. 
1. Pilots in the cross country class will take off and land immediately in front of 
the hangars and will receive their signals from the head flagman. 
RULES FOR THE CROSS COUNTRY. AVIATION MEDICINE IN THE A. E. E. 
233 
Field 5. 
LANDINGS—SPIRALS—CROSS COUNTRY—-ACROBATICS—ALTITUDE. 
1. No landings will be made that in the event of misjudgment will endanger lives 
or property in the vicinity of hangars. 
2. Motors will be throttled for all work after altitude has been gained. 
3. All students when assigned to positions in the air will be very careful to remain 
exactly over the territory assigned to them so as not to confuse other pilots who are 
assigned to like positions in the vicinity. 
4. No student will fly when he is not feeling well, and in the event of becoming 
sick in the middle of class, he will be sure to notify the officer in charge of the class, 
and he will be readily excused. 
5. Instructors will not engage in any kind of dangerous flying around hangars or 
over the field, because of the bad example set for students. 
6. No flying officers from this field will fly over or near any hospitals or convales- 
cent homes, as the condition of some of the men is very serious and the noise of an 
aeroplane motor brings back very vividly their past experiences. 
No pilots will engage in steep turns close to the ground. When meeting a machine 
in the air, a pilot will pass him 300 feet to the left. 
Field 7. 
Formations from this field will not fly over any other flying field of this center 
at altitudes less than 1,200 meters. 
Formations will not fly at less than 500 meters altitude, and will always fly above 
1,000 meters when practicable. Should clouds force the leader lower than 500 meters, 
he will immediately return with his flight to the aerodrome. 
All flying will be done within certain specified, well-marked boundaries. Lines 
connecting Bourges—Chateauroux—Itomorantin—Vierzon are the flying limits of 
this field (consult map in lecture room). A forced landing outside these limits is an 
infraction of the rule and a breach of discipline. 
Acrobatics, stunting, etc., while you are a student at this field are absolutely for- 
bidden. A sharp turn or “virage” is not considered a stunt. 
Your attention is again called to memorandum headquarters training department, 
August 19, 1918, in regard to contour flying, etc. Chandelles and dangerous turns 
near the ground in take-offs and landings are an infraction of this rule. Students 
violating this rule are liable to suspension and reclassification. Instructors who 
persist in this practice will be dispensed with. 
Flight leaders will be responsible for the presence of menfbers of their respective 
groups at all formations. 
Each student during his stay at this field will prepare and hand in two papers on 
distance estimation. On the first he will give details of what parts of the machine he 
can distinguish at 50 yards, 100 yards, 200 yards, and 300 yards, and also with the 
observer standing at a 45° angle to the rear of the machine. The second paper will 
be a repetition of the first but at some later time. Distances are staked out east of 
hangars from last machine in line. Students will not be lached from this field until 
these papers are handed in and approved. 
In the event of forced landings, the field service at this center (phone No. 80) will 
be notified direct. This is done in order to avoid delay and possible error in getting 
information as to the exact location of plane. Field service will in turn notify the field 
from which plane originated and also this department and hospital where crashes 
are serious and medical attendance is required. 
FORMATION FLYING. 234 
AVIATION MEDICINE IN THE A. E. E. 
Always look carefully at the field and well about you before landing. An accident 
in which one pilot collides with another in landing is inexcusable. Always give way 
to a pilot lower than yourself, as it is practically impossible for him to see your plane. 
After you have landed, always look carefully around, both on the ground and in the 
air, to see that there are not other planes in your path for taxying and also so that you 
will not taxy into the path of another pilot who is about to land. 
When coming down from an altitude flight or any flight of 2,000 meters or more, 
always make a tour de piste of about 200 meters before landing to accustom your eyes 
to the ground; otherwise you will redress anywhere from 10 to 50 feet in the air. 
If, when landing you see that you have misjudged the field, it is no disgrace 
to make another tour and land where you originally aimed. It is not probable that 
you will always have a 40-acre field to land in at the front and it is invaluable to be 
able to land plane just where you want to. 
Patrol leaders should always carry an altimeter and have a streamer on proper side 
of plane. All pilots must carry watches. Maps and other equipment are optional if 
pilot knows the country to be covered. 
Machines which are to take the air will be started and stopped at farther line from 
the hangars. 
BLACK SMOKE FIRES. 
Black smoke fires burning on the landing field indicate danger. LAND IMMEDI- 
ATELY. Keep close watch for landing planes. 
FOGS. 
Leaders of formation will be especially watchful and on the alert at all times in 
order not to be overtaken by a fog. Land your plane; it is foolhardy to try to outfly 
a fog, which may last throughout the day. 
Fogs generally originate from swamps, etc., and quickly gather, rolling like clouds 
over the surrounding country at low altitudes. When you are flying high, pay atten- 
tion to the earth, for although it may be clear and sunny at your altitude, if you are 
surprised by a fog, the earth will be completely enveloped below you, and landings 
become not only extremely dangerous but often impossible. 
The use of “cross-over” 90° turns in offensive and defensive formation flying at 
this field will be discontinued in patrols numbering more than three pilots. The 
“cross-over” turn will be used only in case of light patrols, i. e., a patrol of three 
pilots, after such pilots have practically completed their course of instruction at 
this field. 
Field 8.—Combat. 
This is a bad field to land on. There is a road on the ridge in front of the hangars 
running parallel to them which is very bumpy. Don't land there. If you do, don’t 
blame your bad landing on the bump. The bump didn’t come to you—you came 
to it. If your motor is running you have no good excuse for hitting the bump. 
If you desire to fly low during solo periods, you may, but don’t fly low over forests 
and other bad ground. It may not be your fault if your motor poops, but it is your 
fault if you have flown your machine into a position from which you can’t land safely. 
Leave other machines alone. They have their own business to attend to. Don’t 
combat with anybody except members of this field who show an evident desire to 
combat. Swaying the machine from side to side will be understood as an indication 
of such a desire—otherwise leave the plane alone. 
Never fly in a straight line for more than a few seconds. Practice turning con- 
tinually. Turning adds to your skill and reduces danger of collision. 
Watch out for calm air in the shelter of the hangars which may cause you to over- 
shoot. 
In case of fire remember that a side slip is the safest descent in most cases. 
If you are feeling ill don’t fly. * AVIATION MEDICINE IN THE A. E. E. 
235 
General Notes on Field Testing op Airplanes. 
INSTRUCTIONS. 
All motors should be warmed up at low speed before flight. After the motor is warm 
the pilot should open it up momentarily to assure himself that it is running properly 
and that the oil is circulating. 
Pilots while taxying type 27 Nieuports will, at all times, hold the stick well forward 
to relieve the strain on the tail skid. 
Pilots before making cross-country or formation flights will examine their gas 
gauges. 
In addition to the above it is desirable to lay more emphasis to the following rules: 
1. Only the fit should fly. Illness of any kind constitutes a contraindication to 
flying. Consult the medical officer. In the event of more serious illness, always 
consult the medical officer before returning to flying status. If illness arises in flight, 
land as promptly as possible. 
2. All officers and students who have been off flying status for a period longer than 
one month should fly double control before going solo. 
3. Do not take-off with a motor that is skipping. Never attempt a turn with a dead 
motor until flying speed has been acquired. This is only possible with altitude. If 
altitude is less than 200 meters, always land straight ahead. 
4. A student who is flying poorly should be carefully watched. In the event that 
he goes to another field, information concerning his flying and the need of special 
care should be sent promptly to the new field before his first flight. 
5. Rules should be made for each field concerning taking-off and hangars. Limits 
should be set as to how close to the hangars it is safe to take-off. 
6. Students should be held and trained in acrobacy under double control until 
the instructors are convinced that they are capable of executing the maneuvers alone. 
Fliers can not be made according to pattern. If so, they would be 
inefficient. Individuality, initiative, daring, and willingness to take 
a chance are essential to the pilot. Limits, however, are set for the 
protection of the student. The rules and regulations outlined above 
can be enforced without destroying those characteristics which count 
for success in work at the front. 
(c) Foolhardiness—Recklessness. 
Even excellence brings dangers. Many fall victims to their own 
prowess. Jnst as Capt. Webb met his death at Niagara in attempting 
the almost impossible, so many great pilots die as the result of their 
excellence and the temptation it brings in its track. 
The flier fundamentally is temperamental and loves thrills. He 
loves to have them and loves to give them. Loops, renversements, 
vrilles, and barrels are attempted at low levels. The slightest miscal- 
culation or misjudgement on the part of the pilot or a failure on the 
part of the motor leads to a crash and usually to a fatality. 
Acrobacy at low levels is usually thrilling. The spectator as well 
as the pilot is constantly in doubt whether the maneuver can be 
successfully executed or not. The flier who indulges in it is knowingly 
flirting with death. Death is never far remote. Sooner or later a 
crash is inevitable. 236 
AVIATION MEDICINE IN THE A. E. F. 
In indulging in acrobacy at low level a perfect knowledge of the 
machine is necessary. Slight differences in the response to control, 
such as exist between the Nieuport 27 and 28, may prove fatal if 
unknown to the pilot. In this way a brilliant pilot was killed in the 
Third Aviation Instruction Center while doing stunts which he had 
done repeatedly in a Nieuport. He was sacrified through ignorance 
of a peculiarity of the new type ctf machine which he was flying. A 
few hours spent in practice at a good altitude would have revealed 
the fact that this type of Nieuport required a trifle longer to straighten 
out when emerging from loops. 
Although stunting is constantly indulged in, in all large training 
centers, it is encountered in its most pernicious form during the 
so-called “shows” which are put on for the benefit of celebrities 
visiting training centers. I have repeatedly seen groups of men who 
have spent months in the aviation instruction centers, become highly 
excited in the course of exhibitions of this kind. Competition plays 
a role. Each flier attempts to outdo his fellow. Often the flying 
becomes utterly reckless. Some means of control is desirable in this 
connection. 
(d) Overcautiousness. 
In many instances accidents have been ascribed to overcautious- 
ness. The pilot is apt to under control, hesitates to bank his machine 
in making a turn, and as a result he sideslips. In making a landing 
on small fields he overshoots obstacles at the proximal end of the 
field and crashes at the distal end. The student who is overcautious 
should be warned. He needs special attention just as does the reck- 
less flier. 
(e) Turning with a Dead Motor. 
There exists in aviation a fatal trap through which many a trained 
pilot has gone to his death. It is well known to every flier. Every 
student is warned against it. But student and master alike fall into it. 
The pilot takes off with a missing engine which later stalls or he 
zooms and the engine fails at an altitude of one or two hundred feet. 
Flying speed is just sufficient to keep the machine afloat. Instead of 
gliding down and attempting a landing the pilot turns in an attempt 
to return to the field from which he has taken off. Flying speed 
being lost, the machine falls into a vrille or sideslips. At this altitude 
redress is impossible. A crash is inevitable. 
The explanation is difficult. A fundamental instinct akin to a 
homing instinct may be responsible. Immediately upon the stalling 
of the motor the maneuver is attempted without thought. Thought 
does not enter into it, since the instructor who has spent his time 
teaching the student to avoid this trap falls into it himself in many 
instances. Old trained pilots have attempted this turning with a AVIATION MEDICINE IN THE A. E. E. 
237 
perfect landing field immediately in front of them. Obviously, the 
reason is deep seated. Instinct appears to be responsible. By the 
time conscious thought is exercised the maneuver has been begun, 
the machine has nosed down and fallen into a vrille. Time does not 
permit of redress. Capt. McCudden, one of the leading British aces, 
was killed in this manner, after having flown five years in the II. F. C., 
brought down 58 enemy planes, and having served a considerable 
part of the time as a flying instructor. A paragraph appended to his 
book reads as follows: 
He flew across the Channel on a machine which he had especially chosen for his 
own particular style of fighting, and landed safely in France. On starting again and 
on the last stage of his journey he was killed in a trivial accident of the kind which 
has cost us so many of our best pilots. On leaving the aerodrome his engine stopped. 
He tried to turn in order to get back into the aerodrome, but he sideslipped into the 
ground. 
In the official investigation of one of the fatal accidents in the 
Third Aviation Instruction Center a witness under examination stated 
that he was standing behind the commanding officer of the field as 
the machine in question took to the air with a missing motor, which 
finally stalled at an altitude of about 100 feet. The commanding 
officer said, “If he turns he is killed.” As the words were uttered 
the pilot attempted to turn, fell into a vrille, and was killed. 
Just how this problem is to be met is difficult to decide. Knowledge 
alone does not suffice. It is, however, deserving of the greatest con- 
sideration on the part of the training department. Special training, 
reproducing the conditions and attempting the turn at high altitude, 
might be of some avail. 
(f) Hedge Hopping. 
This is a new form of training necessitated by ground strafing 
which came into vogue in the later months of the war. It consists 
in flying at low levels in close proximity to the ground, in hurdling 
trees, buildings, etc. In the event of motor failure, mishaps of many 
kinds happen. Air holes or sudden gusts of wind give rise to frequent 
crashes. In this type of training it is necessary to set aside a special 
district. There and there only should hedge hopping be tolerated 
during training. 
Col. Bishop, the leading British ace, relates instances in which he 
found hedge hopping his only recourse in returning over the lines. 
With the air full of enemy planes and the antiaircraft active, hedge 
hopping became at times the safest procedure. 
(g) Fright in Relation to Flying. 
Instructors and pilots not infrequently ascribe accidents to fright. 
In double control a student pilot occasionally loses his head in the 
course of some maneuver and “freezes to the control.” Under 238 
AVIATION MEDICINE IN THE A. E. F. 
such conditions the instructor may experience difficulties in bringing 
the machine into control. It is possible that many unexplained acci- 
dents are due to this cause. Numerous instances are known of 
ships falling from an altitude of four and five thousand feet in a 
vrille from which there has been no attempt at redress, and in the 
execution of which it was necessary for the control to be held in one 
position. It is possible that reaction time studies and fright reac- 
tions will throw some light on this subject. Trainers should study 
the mental and emotional reactions of the students. 
(h) Rate of Training and Urgency of Needs. 
In France the urgent need of men at the front was a fruitful source 
of accidents in the training schools. Pilots were needed and de- 
manded. 
They had to be produced. Training of necessity had to be accel- 
erated. All due care was exercised. Some accidents occurred that 
under other conditions might have been avoided. A small number 
of student fliers were sacrificed but large groups of pilots were turned 
out to meet the crying need at the front. There was sacrifice, but it 
was legitimate. 
(i) Forced Landings. 
Forced landings are inevitable and dangerous. They are occa- 
sioned by the defects of plane or motor, faults or failures of pilots, 
lack of petrol, and by unfavorable air conditions. Altitude, the 
size, character, and proximity of a landing field, and the relation of 
the machine to the direction of wind are important desiderata. 
Forced landings from low altitudes are particularly dangerous since 
no opportunity is afforded for the exercise of judgment relative to 
the other factors, i. e., choice of field or attention to the wind. 
Mishaps to machines in flight are not infrequent. An unusual 
strain, an oversight on the part of mechanics or instructors may 
result in a wing dropping off or in a control failing to work at the 
critical moment. The writer knows of one instance where the 
motor actually dropped out of a plane during flight. Through 
magnificent flying, the pilot landed his machine without mishap. 
In forced landings during fogs, chance reigns supreme. The machine 
may land in a forest, in a town, in a lake or stream, or in an open 
field. In the making of good landings and in the recognition of 
direction of motion, vision is essential. Since vision is effaced in a 
fog the machine is apt to land at any angle and in any position. 
III. AIR CONDITIONS. 
The most important air conditions from the flier’s point of view are 
fogs, clouds, winds, and holes. Fogs prohibit flying absolutely. 
Unfortunately they sometimes arise suddenly and roll in under a AVIATION MEDICINE IN THE A. E. F. 
239 
machine which has attained great altitude. Landing in a fog, as 
has been indicated, is a matter of chance and not of skill. 
Clouds. 
Clouds constitute a danger only when they are low-hanging, under 
which conditions they do not afford sufficient space for maneuvering 
in the event of the machine coming through from above, or permit 
sufficient altitude in flying to furnish an adequate factor of safety. 
A low ceiling makes for unsafe flying. 
Winds. 
Winds are occasionally responsible for accidents. This occurs 
most frequently in machines taking off or landing with the wind or 
across it. Sudden gusts at low altitudes will always constitute a 
danger. The speed and strength of a modern aeroplane make it 
possible for the skilled pilot to fly successfully even in a strong wind 
provided altitude is attained and the rules governing taking off and 
landing are observed. 
Holes. 
With the improvement in the aeroplane and in our increase in 
knowledge of flying, holes constitute a decreasing menace. Never- 
theless, they do exist and are apt to prove dangerous, especially in 
low flying. 
Collisions are still frequent. The blind angles of the machine, the 
crowded conditions of flying centers, the neglect of regulations gov- 
erning taking off and landing, momentary inattention or slight 
faults in maneuvers in formation flying, are the most frequent 
causes. 
A collision may result in several deaths, since almost without fail 
the ships are so damaged that they fall entirely out of control. One 
poor flier is a menace to an entire squadron. In formation flying a 
man is his brother’s keeper. Since formation fighting is essential to 
supremacy in the air, too much attention can not be centered upon 
this form of training. Erratic fliers should not be accepted. If a 
good flier becomes erratic, he should be investigated medically. 
Blind angles are unavoidable in the present day construction of 
the aeroplane. Every effort should be made, however, to minimize 
them to the utmost. 
In the selection of aviation fields the space element should be given 
due consideration, particularly in relation to acrobacy and combat. 
Care should be exercised that vrilles and other maneuvers in acrobacy 
be carried out at a sufficient distance from landing areas. 
IV. COLLISIONS. 240 
AVIATION MEDICINE IN THE A. E. F. 
These constitute a larger proportion of accidents than would be 
assumed by the uninitiated. In starting the motor strict adherence 
is necessary to the regulations governing the use of the words “ coupe 
and contact,” both by the starter and the pilot. 
Once the motor is started, no one should be allowed in front of it. 
By spectators, suicidal intent has been surmised at times in relation 
to propeller accidents. The possibility of a strong suction force is 
usually overlooked. 
V. PROPELLER ACCIDENTS. 
THE CAUSES OF ACCIDENTS AT THE FRONT. 
At the front accidents are also numerous, as evidenced by the fact 
that in the A. E. F. 42 pilots were killed in the zone of advance while 
only 137 were killed in combat. This proportion seems large since 
all the fliers at the front were presumably skilled pilots. Forced 
landings due to weather conditions or to engine trouble (especially 
in the Spad), or running out of gas accounts for many of them. 
One pilot returning from the front stated that many of the accidents 
were due to stunting over the squadron airdrome following victory 
in combat over the enemy. This, of course, is a dangerous procedure 
since the machine may have been injured in combat to such an ex- 
tent that it will no longer withstand the strain of acrobacy. Col. 
Bishop states that this proved so frequent a cause of accidents with 
the British airmen at the front that it became necessary to forbid 
stunting after combat. 
In the event of engine trouble, lack of gas, or forced landings from 
any other cause, the pilot can but do his best. Altitude and landing 
fields are merely a matter of chance. 
In the cause and prevention of accidents, morale plays a tremendous 
role. This is something which does not exist to the outsider but it 
is very evident to students and instructors in instruction centers, 
and to the flier and the administration at the front. It involves the 
attitude of the man toward his work, physical and mental fitness, 
and adherence to rules and regulations. Anything which counts 
for increase in morale counts for efficiency and for decrease in acci- 
dents. 
Individuality is desired, but discipline is absolutely essential. If 
the morale is right, discipline and individuality do not necessarily 
conflict. 
Marcel Nadaud in the “Flying Poilu” dramatically illustrates the 
conflict of individuality and discipline. 
In a French flying squadron, Chignole, an observer, in the absence 
of the rest of the squadron, takes up a plane, cranking it himself 
ACCIDENTS AND MORALE AVIATION MEDICINE IN THE A. E. F. 
241 
and attempts to engage the enemy who were active over the aero- 
drome. On alighting he was met by the captain in charge who says: 
“Chignole, my boy, it was mad of you! Crazy! Idiotic! Chic! 
Wonderful! I am going to ask the military medal for you.” He 
stopped a moment, hesitated and then deciding: “But for an act of 
serious indiscipline, I am obliged to ask for your transference to the 
Infantry.” He stopped again, then grasping Chignole in his arms, 
“Pardon me, my boy, oh! pardon me. But understand that I just 
can’t do otherwise!” 
INVESTIGATION OF ACCIDENTS. 
All fatal aeroplane accidents in the instruction centers in the 
A. E. F. were investigated by a special board of five, appointed for 
the purpose. The objects of the investigation were to fix the 
responsibility, to determine whether or not the accident was an 
aviation accident and whether it occurred in the line of duty. The 
board submitted a sextriplicate copy of its proceedings covering all 
the essential details of the accident. 
The board and recorder were sworn in, after which the commanding 
officer of the field concerned, or one of the instructors, the engineer 
officer in charge, the mechanic responsible for the engines and 
machines, two eye witnesses (when possible), and the attending 
medical officer were questioned. The hospital report and the 
autopsy findings were appended. In addition, at the Third Aviation 
Instruction Center, a report on the previous health and habits of 
the victim was presented by the flight surgeon. This report was a 
result of either personal acquaintanceship or of careful questioning 
of the friends of the flier. 
The membership of such a board is a matter of vital importance. 
Only those deeply interested in the care, training, and welfare of the 
flier should act in such a connection. The board should comprise a 
thinking medical man, an engineer who is in no way responsible for 
the condition of the machine concerned, and an officer who is either a 
flier himself or is familiar with all the rules and regulations governing 
flying generally and at that instruction center in particular. An attempt 
should be made to determine the fundamental cause of the accident 
and whether it was avoidable or not. The information obtained should 
be utilized immediately where possible, for the prevention of repeti- 
tion of accidents and where necessary, suggestions should be sub- 
mitted to the commanding officer concerning the need of rules and 
regulations. The attention of the proper authorities should be 
called to all mechanical, medical, or training deficiencies held re- 
sponsible. 
171364—20 16 242 
AVIATION MEDICINE IN THE A. E. F. 
Need of Investigation of Nonfatal Accidents. 
Investigations have been limited entirely to fatal accidents. This 
is a great mistake. Since the victim is dead, only indirect and cir- 
cumstantial evidence can be elicited. Every crash is potentially a 
fatality. If the same mechanism were utilized to officially investi- 
gate nonfatal accidents and the same thoroughness exercised, a much 
deeper grasp of the accident problem would result. This phase of 
the problem has been generally neglected. Efforts were made in the 
Third Aviation Instruction Center to carry out such investigations 
through the flight surgeon. This should be recognized as a distinct 
advance, but investigations by an official board would probably yield 
greater results. 
Record of Accidents. 
A new accident blank was developed in the Third Aviation In- 
struction Center (a copy of which will be found in the appendix). It 
necessitates a careful study of each accident, considering as it does 
information concerning the history of the accident, the condition of 
the plane and motor, questions relating to training and experience 
of the pilot, the cause of accident, the responsibility involved, and the 
physical condition of the flier before and after the accident. It 
greatly facilitates statistical and other studies of the accident problem. 
Avoidable and Unavoidable Accidents. 
Naturally it is desirable to divide accidents into avoidable and 
unavoidable classes. This is extremely difficult. It presumes an 
assignable cause. In a large proportion of accidents the cause is not 
apparent and in all but the more obvious cases it is a matter of in- 
ference. In this connection it is interesting to consider the October 
fatalities of the Third Aviation Instruction Center of which there were 
fifteen. One or more causes could be assigned for ten, while for five 
absolutely no explanation could be discovered. Supposedly the latter 
were unavoidable. Of the ten where a cause was inferred or assigned, 
eight appeared to be avoidable. They included one man with poor 
vision who collided with an experienced pilot, resulting in two deaths; 
one man flying while obviously ill; two men flying while recovering 
from the ‘ 'flu,” for which they did not consult the proper medical 
authorities; one man taking off too close to a corner of a hangar; 
two men breaking rules and regulations of combat, fighting without 
permission and prior to having received instructions; one man falling 
into the death trap of the fatal turn with a dead engine in an attempt 
to return to the aerodrome, and one man carefully avoiding hangars 
and wires at the proximal end of the small flying field and crashing 
at the distal end. AVIATION MEDICINE IN THE A. E. E. 
243 
With the exception of the last two these accidents appear avoidable. 
They involve, however, the most widely distributed responsibility. 
Until responsibility is brought home to those concerned no relief is in 
sight. The solution of the accident problem is to be found, I believe, 
in fixing the responsibility and in holding the responsible individual 
accountable. This, so far as the writer knows, has never been done 
in the Air Service. The accident occurs, the accident is investigated, 
a report is made, a regret is expressed, but the responsibility is not 
fixed and only too frequently the source of danger continues to exist. 
THE RESPONSIBILITY OF ACCIDENTS. 
When one considers that only 2,034 fliers and observers were turned 
over to the zone of advance and to allied squadrons and that prior 
to the armistice 506 were killed in accidents, while only 169 were killed 
in actual combat, certain questions may be legitimately asked. Why 
is the proportion killed in accidents so large ? Whose is the responsi- 
bility? Inasmuch as responsibility has not been fixed in the ma- 
jority of instances, it is impossible at the present time to present 
statistics covering it. Nevertheless, general principles covering re- 
sponsibilities can be laid down and brought to the attention of those 
concerned in order that all may concentrate in an effort to decrease 
the number of accidents. 
Aircraft Production. 
This department is responsible for seeing that only such ships as are 
mechanically fit are delivered to the service and that all parts are con- 
structed and assembled strictly in accordance with specifications. 
Engineering Department. 
This department is responsible for mechanical excellence. They 
should see (1) that the most effective mechanical principles are 
utilized and that all parts are constructed to yield maximal efficiency 
with minimal dangers; (2) that the parts are assembled and put to- 
gether in such a way as to render maximum efficiency; (3) that once 
the ship is placed on the line, maximum efficiency be maintained; (4) 
that no ship in need of major repairs be allowed on the line; and (5) 
that frequent inspections by competent expert mechanics be made 
routinely in order to discover and correct mechanical defects. 
The Medical Service. 
The Medical Service is responsible for physical fitness. It should 
see—- 
(1) That only those fit to fly be admitted to the service. 
(2) That, through investigations (clinical and laboratory), stand- 
ards be determined covering every function which relates to flying. 244 
AVIATION MEDICINE IN THE A. E. E. 
(3) That maximum efficiency be maintained, through supervision 
and regulation of the life of the flier, in regard to such matters as ex- 
ercise, sleep, diet, habits, etc. 
(4) That an effective mechanism to meet these needs be supplied 
through flight surgeons, laboratories, etc., and through the establish- 
ment of the proper relations between the flying personnel and the 
Medical Department. 
(5) That fliers not making satisfactory progress in training be in- 
vestigated medically. 
(6) That fliers not making proper progress in training, who exhibit 
physical or mental unfitness from any point of view, be properly cared 
for. This includes proper medication, sound advice, periods of rest, 
hospitalization, etc., and involves the provision of properly equipped 
and properly manned institutions for this purpose. 
(7) That the medical and training departments cooperate in an 
effort to overcome disability of any kind. 
(8) That all permanently unfit be removed from flying status. 
These may represent mistakes in admission or may result from con- 
ditions arising subsequent to admission. 
(9) That all medical information concerning the flier be available 
for the medical officer into whose hands the flier comes in the event 
of emergency or illness. This involves an adequate system of 
records. 
(10) That the Medical Service be granted authority sufficient to 
render action possible for the prevention of accidents. The Medical 
Department should have authority to say that a man may or may not 
fly and in the latter event to dispose of him as it sees fit. 
(11) That no flier be returned to flying status unless physically fit. 
(12) That the Medical Service be allowed to participate in the in- 
vestigation of accidents from the medical point of view in order to 
determine the responsibility involved. 
(13) That men be grouped, so far as possible, relative to their ap- 
titude or fitness for various types of work. This involves classifica- 
tion from the standpoint of withstanding altitude effects and from 
the standpoint of physical and temperamental fitness of the indi- 
vidual flier for various types of work. 
(14) That all information concerning the progress and mainte- 
nance of efficiency of the flier be supplied to the flier and to the admin- 
istration. This involves such questions as supply of oxygen, goggles, 
protection from cold, wind, etc. 
Training Department. 
The Training Department is responsible for training and for flight. 
It should see— 
(1) That only those fit to instruct be placed in charge of training. 
(2) That the best judgment be exercised in relation to when and 
where flying be indulged in. AVIATION MEDICINE IN THE A. E. F. 
245 
(3) That the student be thoroughly familiar with all the informa- 
tion, rules, and regulations fundamental to flying. 
(4) That the student be held in double control until the instructor 
is thoroughly satisfied that he is capable of flying alone. 
(5) That discipline and morale be maintained and that rules and 
regulations be explicitly followed. 
(6) That the student be thoroughly informed concerning manage- 
ment of types of ships new to him prior to indulging in flight. 
(7) That the student be familiar with the rules and regulations of 
the individual field. 
(8) That all cases of unsatisfactory progress be reported to the 
Medical Service. 
(9) That all cases of illness, even though apparently trivial, be. 
reported to the Medical Service and that cooperation be had with the 
Medical Service in an effort to overcome disability from any cause. 
(10) That all students be warned of the sources of danger in flying 
and that they be prepared as far as possible to meet all the emer- 
gencies in flying. A special course of instruction in relation to 
accidents is desirable. 
The Flying Personnel. 
For the flier the danger is personal. His life is in his own hands. 
He pays the penalty irrespective of where the responsibility lies. It 
is essential— 
(1) That he be satisfied to stay out of the service when he is ad- 
judged unfit by the medical or training department. 
(2) That he keep himself at his maximum efficiency and follow 
the advice of the medical and training departments in this connection. 
(3) That he be cognizant of and conversant with all rules and 
regulations, general and specific, to training centers governing flight. 
(4) That he follow all rules and regulations implicitly. 
(5) That he understand the mechanics and science of flight and 
that he possess as perfect knowledge as possible of planes and motors. 
(6) That he be absolutely honest and frank in his relations with 
his monitors and instructors. 
(7) That he acquire as much information as possible concerning 
the maneuverability, response to control, and the strength and quick- 
ness of each type of machine and of each particular machine prior to 
his first flight in that machine. 
(8) That he report all disabilities and indispositions to his instruc- 
tor or flight surgeon immediately upon the development of same. 
(9) That he inspect and test his machine personally and that he 
look over and try out his motor prior to flight in order to ascertain its 
efficiency. 246 
AVIATION MEDICINE IN THE A. E. F. 
Administration. 
It is the function of the administration to correlate the work of the 
various departments, to supervise it and see that it is effectively car- 
ried out and to fix responsibility in the event of failures. The admin- 
istration is also responsible to a very large extent for the morale of 
the service. It is desirable, also, that the administration assume 
charge of the dissemination to the service of all information relative 
to the accident problem and the responsibility concerned. 
Conclusion. 
The accident problem is the greatest problem of the air service. 
Until responsibility is fixed and accountability established, great 
progress can not be made. Thorough investigation of all flying acci- 
dents (nonfatal as well as fatal) and the establishment of responsi- 
bility and accountability are essential for the prevention of accidents. Chapter VIII. 
WORK OF THE UNIT ATTACHED TO THE BRITISH 
AIR SERVICE. 
The 10 American medical men who composed this group were as- 
signed to work with the British. After a preliminary meeting in 
London, the members were sent to the various examining groups 
and training centers. They were afforded every opportunity for 
observation and investigation. Our British colleagues have com- 
mended these officers most highly for their fine work, their great as- 
sistance, and their personal qualifications. It is much to be regretted 
that the admirable reports sent in by some of the members of this 
group upon the conclusion of their service in England can not be 
given in full. 
Subsequent to the armistice this group took up work in France with 
the laboratories at the Second and Third Aviation Instruction Centers. 
Their knowledge of the British tests enhanced in no small measure 
the work on the monitors, on men returning from the front, and 
French fliers sent in for special study. 
MAJ. E. S. INGERSOLL, MEDICAL CORPS. 
Maj. E. S. Ingersoll, Medical Corps, was assigned to the examination 
of aviators at Hampstead. The following extracts are taken from the 
report of his observations upon the wurk of the Medical Service of the 
Royal Air Force: 
Candidates for admission to training as pilots in the Royal Air Force receive their 
preliminary physical examinations at various stations throughout the United Kingdom. 
There are six such stations in England and Scotland, with others in South Africa and 
in the other colonies, with the exception of Canada. In Canada the candidates 
receive the complete examinations. 
At these stations the candidates are given a preliminary examination, which is very 
similar to that required for ground commissions in the United States Army. The 
obviously defective are rejected and the others sent to London for the final physical 
tests. 
The final examination is conducted at the Aviation Candidates’ Medical Board, 9 
Arkwright Road, Hampstead, London, N. W. The building used was formerly a large 
private home. Aside from the space used for the clerical work, there are 12 rooms 
devoted to the examination, divided as follows: 
Medicine, 3; surgery, 1; eye, 1; otology, 4; assessors, 3. Groups of applicants are 
started simultaneously in the different departments. The examination blanks are 248 
AVIATION MEDICINE IN THE A. E. F. 
looked after by orderlies during the course of the examination, and are never in the 
hands of the men who are being examined. 
The otological work is divided into two distinct parts; the inspection of the ear, 
nose, throat, and teeth, with the testing of hearing by the whisper; and secondly, the 
testing of muscular coordination and tremor. 
The inspection is done in practically the same way as in our service. Defective 
.hearing and perforated drums are causes for rejection. Chronically infected tonsils 
are removed, and nasal septa, deflected in a sufficient degree to interfere with func- 
tion, are corrected by operation. 
In general, the teeth of the British applicants are in bad condition. Many young 
men of 19 and 20 have complete sets of false teeth, and it is a notable exception to find 
a young man who is not in immediate need of dental attention. The present dental 
practice in England seems to be to extract rather than to repair; and for the British to 
accept our standard requirement of four opposing molars would mean the exclusion 
of a large number of candidates. 
The testing of muscular coordination and nervous control is done by the otologist 
as well as by the medical examiner. 
The first test in this connection is to have the candidate stand with eyes closed, 
tongue protruded, and arms extended with hands dropped and fingers separated. 
Note is made of fine or coarse tremor of eyelids, tongue, or fingers. 
The apparatus for the second test consists of a thin board about 14 inches long by 5 
broad, and a metal spindle 5 inches long by one-fourth inch diameter, with a round 
metal base 1 inch in diameter. The spindle is set upright on the board 3 inches from 
the distal end. The candidate is instructed to grasp the proximal end of the board, 
protruding over the edge of a table of ordinary height, and to raise the board and 
spindle to the level of the shoulder with the eyes open. He is then told to close his 
eyes and replace the board on the table without upsetting the spindle. The spindle 
is very unstable, and good control is required to accomplish the test successfully. 
The third muscle coordination test consists of standing (with the eyes closed) on one 
foot, with the other leg flexed at the knee and not touching the supporting leg. This 
position is maintained for 15 seconds and repeated with the other leg. Note is made 
of unsteadiness. Figures compiled by the British seem to show that a large propor- 
tion of men who are unsteady in this test are not successful in training. It was inter- 
esting to note in this connection that the candidates from South Africa, who were 
examined within three days after the completion of their sea voyage, showed uniformly 
poor results. 
The examination blanks refer to this latter test as the vestibular test. There is no 
attempt to stimulate the labyrinth in any of the tests during the examination, and the 
term used is plainly a misnomer, except in the sense that the static function of the 
labyrinth is called into play. 
After the applicant has been examined in all of the departments he is brought to the 
assessor, who repeats such tests as he may wish, and renders the final decision. 
The system of routine and paper work of the Aviation Candidates’ Medical Board 
was excellent and a tremendous amount of work was accomplished. As many as 350 
men have been examined in a day. 
During our stay there and for several months previously the problem confronted by 
the British in regard to procuring material for pilots was a very severe one, and the 
one that necessitated a physical standard much below that which the authorities fully 
realized should have been used. It was a case of selecting the best of a poor collection, 
There were apparently two reasons for the scanty supply of acceptable young men. 
The country in the last months of the war had comparatively few men of early military 
age left; and, secondly, the Air Service did not appeal at this period to the better class 
of young Englishmen, while the public-school boy, on becoming 18 years of age, sought AVIATION MEDICINE IN THE A. E. E. 
249 
some other branch of the service. I have heard this latter condition commented 
upon several times, but no adequate reason could ever he found to account for it. 
These conditions, in my opinion, render it somewhat unfair to make a strict com- 
parison between the British standards and our own. They had to take such chances 
with their men, in the best interests of the service, that with us at the present time 
would constitute a flagrant disregard of consequences. 
The question of a functionally perfect vestibular apparatus as a necessary requisite 
for a pilot has not received much consideration from the British. They have not been 
able to see that it is of fundamental importance, and have not devoted much time to 
its investigation. 
There were several opportunities for discussing our ideas and methods with members 
of the British Research Committee, notably Drs. Henry Head, Sydney Scott, and 
Lieut. Col. Martin Flack, R. A. F., M. S. They have become interested in motion 
perception as appreciated by the vestibular apparatus, and they propose to carry out 
more extensive investigations. 
There is one development in aviation medicine established by the Royal Air Force 
which it seems well to consider. At the Hendon Aerodrome, just outside of London, 
the medical administrator has established what is known as “the medical flight.” 
This is a training field to Which are sent all men under training as pilots who have 
been declared unfit by their instructors at the regular schools. 
No cadet in training may be discharged because of temperamental unfitness without 
passing through the office of Lieut. Col. Flack in the Air Ministry in London. In the 
case where no disqualifying physical defect is found the cadet is posted to the medical 
flight for further flying instruction. The field is commanded by a major who has seen 
considerable service at the front and who, in addition to being a remarkable flier, is a 
man of keen judgment and sympathetic understanding. The medical officer is greatly 
interested in aviation medicine and is at present working on several problems relating 
particularly to motion perception and reaction time. The instructors are chosen 
largely for their qualities of patience and understanding of human nature. The 
figures compiled at this field show that they save to the service approximately 50 per 
cent of the cadets who would otherwise have been lost to the air force. This effects 
a large saving in both men and money, and also gives an indication of some faults in 
the present system of teaching. 
Certain conclusions may be drawn from the Work seen in England: 
1. The physical examination and the requirements of the United States Air Service 
are much superior to those of the Royal Air Force, more because of our fortunate posi- 
tion in having a wealth of material than because the British consider their standards 
adequate for pilots. 
2. The British have no adequate evidence of, or grounds for, their belief that a 
perfectly functioning vestibular apparatus is not necessary for a perfect pilot. 
3. The medical flight established by the medical administrator of the Royal Air 
Force, and maintained directly under his control, is an excellent economic institu- 
tion and a plan worthy” of consideration. 
CAPT. PAUL A. GARBER, MEDICAL CORPS. 
During the three months (approximately) that Capt. Paul A. 
Garber, Medical Corps, worked with the British he collaborated with 
two different boards, the Invaliding Board and the Aviation Candi- 
dates’ Medical Board, both located at Hampstead. 
The Invaliding Board was composed of medical officers who had worked with the 
aviators either on the aerodromes in England or abroad, so the members knew from 
that experience the qualifications of the aviator. The aviators and cadets who 250 
AVIATION MEDICINE IN THE A. E. F. 
appeared before the board had been in a hospital from disease, accident, or wound, 
or were sent direct from the front or aerodrome by the medical officer. Most of the 
men sent direct from the front were cases of “staleness,” while those from the aero- 
dromes at home were men who had been crashing frequently or else had “wind up.” 
The flier appearing before the board has his history taken and he then is given a 
brief physical examination. The superficial and deep reflexes are tested and tremors 
are elicited. Only one member of the board sees the case unless there is some doubt 
as to the condition. The board had the power to grant a leave of absence up to four 
weeks and also to take him off flying permanently. 
The last two months I was with the R. A. F. were spent with this board. The men 
appearing before this board had previously been examined at the reception depot, 
and only the survivors of the depots were examined at the board. From 600 to 800 
men were examined at the board every week, and from 60 per cent to 75 per cent of 
the candidates were passed for training. I examined only those candidates who had 
failed to hold their breath at least 50 seconds for the medical examiners. Of the total 
number I examined I kept records of 465. The records, with a report, were turned 
over to Maj. Bowdler, the president of the board. The breath-holding test, in my 
opinion, is more of a te3t of nerve than a physiological test. The expiratory force test 
requires practice. The fatigue te3t is the only one of the three that is of possible value. 
This te3t will show a cardio-vascular disturbance by the pulse rate, but the exercise 
test will be of as much value in that respect as this test. 
MAJ. K. W. CONSTANTINE, MEDICAL CORPS. 
With Maj. Ingersoll and Capt. Garber, Maj. K. W. Constantine, 
Medical Corps, was stationed at Hampstead, where he made ophthal- 
mological examinations. The following paragraphs are taken from 
his report of his work there: 
During the last four months of the war 600 to 800 candidates for the R. A. F. applied 
to the medical examining board for admission to the service. 
The candidate was disqualified if the vision was below 6/18 in one eye and 6/24 in 
the other; if vision was better than 6/12 with a spherical +3.0. D. lens before the eyes; 
and if color blind. If the vision was 6/9 and 6/12 the candidate was accepted as far 
as his eyes were concerned, provided the color vision was normal according to the test 
with Eldridge-Green lantern. 
The following cases were referred to the ophthalmic room: (1) All candidates with 
vision below 6/9 in one eye and 6/12 in the other. (2) All subjects with doubtful color 
vision. (3) Border-line cases from other departments. The remainder of the oph- 
thalmologist’s time was spent in making complete eye examinations of as many pilots 
and observers as possible. The tests comprised vision, refraction (without a cyclo- 
plegic), muscle balance (distant and near), the duction strength, stereoscopic vision 
(distant and near), and the determination of the master eye. Further duction tests 
were made only in the cases that showed more than 2° of exophoria, 4° of esophoria, 
or 1° of hyperphoria at 6 m. Brailey’s muscle test was used. The tests were carefully 
recorded, with the intention of seeing later what effect eye anomalies might have 
upon flying capacity. 
Men who made bad landings were sent to Maj. Clements at Greenwich. There they 
werfe trained with the amblyoscope and stereoscope, checking the progress of the case 
with Biship Harman’s diaphragm apparatus. 
CAPT. JOHN B. POWERS, MEDICAL CORPS. 
Capt. John B. Powers, Medical Corps, was also stationed at Hamp- 
stead where he assisted in the examination of candidates for the AVIATION MEDICINE IN THE A. E. E. 
251 
R. A. F. In his experience the candidates varied in age from 17 to 
30 years. Nearly all of the candidates over 30 years of age were 
rejected on account of physical disabilities, however, rather than by 
reason of age. The candidates were drawn from the following classes 
of young men (mentioned in their order of efficiency): “Tommies/1 
officers from other branches of the service, observers who desired to 
become pilots, and young boys who were just being called into service. 
Candidates from the colonies were examined also. Capt. Powers 
concluded that: ‘‘Good vision, keenness to fly, and grit” were three 
great essentials in the making of a good pilot. 
After the armistice, Capt. Powers did most efficient work in tho 
Department of Medicine both at the Main Research Laboratory at 
Issoudun and at the branch laboratory at Tours. In Chapter II, 
there is an extract from his talk to flight surgeons. 
MAJ. A. F. BEVERLY, MEDICAL CORPS 
The following extracts are from the report made to the Medical 
Administrator, Royal Air Force, by Maj. A. F. Beverly, Medical 
Corps, upon the close of his work with the British: 
GENERAL DESCRIPTION OP AIRSHIPS AND THEIR WORK. 
In considering the subject of the physical requirements necessary for an Airship 
Officer, it was thought desirable that a few service flights should be undertaken in 
order that the conditions to which such airmen are subjected while in the air could 
be more easily appreciated. 
During these flights, it was possible, to a certain extent, to form an opinion of the 
mental and physical fatigue associated with the piloting of an airship, whether of 
the small type (S. S. Zero) with its open car and single control, or of the larger types 
(N. S. and rigids) whose crews are more sheltered from the weather by reason of their 
being inclosed, and whose control is shared by the coxswain and the captain. 
The types of airships generally in use at present can be simply classified, however, 
according to the work which they perform. 
(1) Those which stay out for comparatively short periods. 
(2) Those which may be called upon to remain out for 24 hours up to 3 days. 
In the first class may be placed the S. S. Zero, the Coastal, and the C/ or improved 
Coastal. 
In the second class may be placed the N. S. (or North Sea) type and the rigid type. 
In both of these larger ships, there are fair facilities for cooking food, taking rest, and 
having a certain amount of very restricted exercises. There are open closets fitted 
as in the Coastals. 
On account of the cars being constructed of metal (aluminum) in the rigid type, 
there is considerable noise from the engines when in the air. This necessitates the 
engineers wearing sound mufflers in their ears. Some officers find this noise very 
tiresome. 
All these types of airships are at present used for antisubmarine patrols and con- 
voying of ships at sea. They may be likened to destroyers, with certain limitations, 
particularly as to the weather in which they can operate, and with certain advantages, 
such as increased field of observation. The larger varieties are able to operate at a 
greater distance from their bases than are the smaller types, but their work does not 
as a rule necessitate their going to greater heights than 1,500 to 3,000 feet, though they 252 
AVIATION MEDICINE IN THE A. E. F. 
are capable of going higher. In the case of the rigid, we understand that the time is 
not far distant when the “ceiling” of such craft will be in the vicinity of 20,000 feet. 
It will be of interest to compare the sensations of flying in an airship with those 
that are experienced in an aeroplane. The rush through the air, the headlong up- 
ward swing, the quivering and shaking, the sudden little upward and downward 
starts—all these are toned down in the airship. The noise from the engine is very 
much less, the vibration can hardly be felt even in the smaller types of ships, and the 
rush of air, which is so terrific in the speedier heavier-than-air machine, is practically 
absent in her lighter-than-air sister. On leaving the ground, there is no apprehension; 
engine failure, necessitating a hasty forced landing, ceases to cause anxiety; the ship 
floats into the air and when well clear of the ground, the engines are speeded up and 
she climbs to a few hundred feet. 
The four principal causes of anxiety in the air appeared (from conversations we had 
with numerous airship pilots) to be: 
(1) Engine failure when over the sea. 
(2) Rising wind. 
(3) Fog. 
(4) Fire. 
Lastly, sheer boredom from the dull monotony of patrolling over the sea, enters 
largely into the question of strain. We consider this to be more pronounced in the 
smaller ships, such as Zeros and Coastals. For hours, the captain of such a ship will 
have nothing to do but listen to his engine and steer a compass course; for hours he 
may see nothing save the grey sea beneath him and the seagulls hovering immediately 
below his ship. If it begins to blow fairly hard, he will have to struggle with the wind 
for hours and hours trying to get home, making possibly five knots, at other times being 
actually blown backwards. Such a position means that the pilot is subjected to a 
considerable mental as well as a physical strain, for he knows that all depends upon 
the holding out of his engine or engines and upon the wind velocity decreasing. From 
conversations with experienced airmen who have flown both in lighter-than-air and 
heavier-than-air craft, there does not appear, however, to be the same nervous tension 
constantly present when patrolling or convoying in the former as compared with 
service flying in the latter. 
The actual physical exertion entailed in flying an airship, particularly if it be of 
the Zero or single control type, is considerable. Especially is this so if the wind be 
strong. In such a small ship, the pilot may be constantly ruddering with his feet, 
exerting at times nearly all of the force of which he is capable. At the same time, he 
has to control the upward and downward movements of the ship with his left hand on 
the elevating wheel, and lastly, must not forget his many instruments registering his 
pressure, all of which require to be frequently controlled by opening and shutting 
valves. 
In Coastals and C' type airships, the control is shared by the coxswain and the offi- 
cer navigating the ship, thus relieving the physical exertion to some extent even 
though the controls are heavier. 
In larger ships (N. S. and rigids) the physical exertion does not appear to be quite 
so great, the steering and elevating being operated separately by two people, a cox- 
swain and the captain or some officer of the ship. In addition to this, the cabins of 
these ships provide a considerable degree of protection and comfort to the crew. Even 
in the smaller ships it is possible for the pilot to be relieved for a short spell by his 
engineer, and thus to stretch his cramped limbs. 
In the larger ships, the question of changing position does not enter as there are 
relief crews and at least two officers. At the same time, it is comparatively seldom 
that the captain of the ship has the peace of mind to take advantage of his relief to 
sleep when in the air. AVIATION MEDICINE IN THE A. E. E. 
253 
The hours of flying vary considerably according to the time of the year. Were it 
not that the periods of intensive flying were punctuated by periods of involuntary 
rest, due to nonflying weather, we should be inclined to recommend that the hours 
of flying be controlled, for undoubtedly during good flying weather both pilots and 
crews have long hours and little rest. This is particularly applicable to the Zero 
type, where the captain has to fly the ship himself practically all the time. During 
good weather in the summer such a ship may do as much as 60 hours a week in spells 
of from 6 to 10 hours. At other times weeks may elapse without any flying taking 
place. Therefore, it will be seen that the question of preservation of efficiency is not 
so much one of the limitations of the hours of flying as (a) that of affording facilities 
for absolute rest during spells of hard work and (b) that of the proper occupation of 
the relatively long hours of leisure during spells of bad weather. 
The larger ships, like the smaller, are controlled at present by the elements, but 
owing to their ability to stay out longer may do as much as 100 hours a week in per- 
fect summer weather. 
From a medical aspect it seems most desirable that there should be proper occupa- 
tion of leisure time by both officers and “ratings.” The habits of pilots become 
increasingly of medical interest the more it is recognized that for a man to be truly 
fit he must be occupied in some wholesome mental or bodily exercise during the 
greater part of the day. 
There seems to be a tendency, in consequence of lack of occupation, for the pilots 
and crews of airships in wintertime to become stale. All depends upon the man 
himself. If he has intellectual resources, he is able to make good use of his spare 
time studying and intellectually improving himself, as well as taking part, when 
possible, in all outdoor recreations. On the other hand, a man who is intellectually 
superficial and who has few resources within himself finds time hang heavily, and 
if opportunity is afforded he very easily makes it a habit to drink and smoke too 
much. 
At some of the stations we visited there are opportunities for shooting and fishing, 
should an officer be interested in such sports. At the same time games of football and 
cricket are got up two or three times a week, and, according to the time of year and 
the locality, golf, tennis, and other outdoor sports may be indulged in. There are 
cinema shows and concerts about twice a week or oftener, in the evening, according 
to the individual efforts of the officers on the station. There does not appear to be 
lack of opportunity so much as lack of energy in many of the officers at the stations 
in regard to exercise. For this reason we are led to recommend some form of com- 
pulsory daily exercise. 
The question of bad landings in regard to heavier-than-air machines does not apply 
to airships. 
The age of the pilot varies from 18 to 37. There does not appear to he any draw- 
back attending either age limit, though it would seem that for the monotony of patrol- 
ing the older man is more suitable temperamentally than the younger. Provided a 
man is physically healthy, there would appear to be no objection to recommending 
that candidates be taken from 18 up to 38 years of age. 
The height measurement ranges between 6 feet 2 inches and 5 feet 4f inches. 
It is recommended that no officer under 5 feet 4f inches be taken into the service for 
employment as a flying officer in Zeros, as it is thought that a man of smaller stature 
would find difficulty with the controls. Should it be possible, however, for an officer 
to be employed directly in Coastals, O', rigids, or North Sea type, there would seem 
to be no objection to the usual standard of 5 feet 2 inches being adhered to. The 
adoption of a lower standard than this does not appear to be advisable. 
CONCLUSIONS. 254 
AVIATION MEDICINE IN THE A. E. E. 
The question of the past flying history in relation to altitude is not of so much 
importance for the present, owing to the fact that when at work an airship rarely 
ascends to over 1,500 feet, most of the patrols being done at 600 to 1,000 feet. 
The standard of vision is good, though not perfect without glasses, in several cases 
examined. While it is admitted that an officer with slight visual defects may be 
able to carry out the actual flying of a ship, the efficiency of his work when patrolling 
depends largely upon his own visual acuity. It would seem, therefore, that the 
standard already adopted for aeroplane pilots, should be insisted upon in the case of 
airship officers. 
The question of hypermetropia of more than 3 diopters, which might affect accom- 
modation when landing, does not concern airship officers, and it is recommended 
that it should not be a bar to their acceptance. 
The movement and power in all limbs should be good. 
The history of seasickness or trainsickness should not be a bar to the acceptance of 
candidates, nor should asthma be considered a serious drawback unless the attacks 
are frequent or have caused physical defects. 
Neither malaria nor dysentery appeared to be aggravated by flying, and it Would 
seem that histories of either of these ailments should not in themselves debar a can- 
didate. 
On account of the low altitudes at which airships work, the former history of concus- 
sion, even if severe, would not appear to be of the same significance as in candidates 
for heavier-than-air machines. 
Digestive trouble would seem, on the other hand, to be a drawback to a candidate, 
as the irregularity of meals, and the form of food consumed when actually flying 
are liable to increase gastric troubles. 
Sunstroke or heatstroke should not be a bar to acceptance for work in a temperate 
climate. 
Brain fever should not in itself be a cause for rejecting a candidate, though the 
general nervous stability of such a man should be carefully estimated. 
Previous chest trouble or gassing, provided that the general health is good, would 
appear for the present, in view of the low altitudes at which flying is done, to be no 
drawback. 
Provided the candidate has recovered, a history of shell shock should not be a bar 
At present, on account of the low altitudes at which airships fly, the cardio-vascular 
condition of the airship officer does not appear to be of as much importance as in the 
heavier-than-air ship pilot. It would seem that, provided the heart is organically sound 
and there is no history of syncopal attacks, the candidate should be allowed to train 
for this branch. 
The respiratory tests as devised by Lieut. Col. Flack, while most useful in studying 
the general condition of the airship officer, would appear to be less useful at present 
in the examination of candidates for this section of the R. A. F. It is therefore 
recommended that too much stress be not laid on these tests at the entry examination 
for airship candidates, but that they be used at airship stations as an adjunct in the 
periodical examination of the officers. 
The relation of a flabby abdominal wall to splanchnic flooding does not appear at 
present to be of such moment to the airship officer as it is to the heavier-than-air ship 
pilot, in view of the low altitudes at which the ships work. It would therefore seem 
that a more lenient view might be taken in regard to this. 
Little definite knowledge as to the fitness of the officers examined was obtained 
from an examination of the reflexes, presence or absence of tremors and balance. 
It may be said that in the officers who had done most flying, the reflexes were brisk 
or .exaggerated, but exceptions to this rule were also obtained. Tremors of marked 
degree were noticeable by their absence. The sense of balance was on the whole AVIATION MEDICINE IN THE A. E. F. 
255 
poor, and did not appear to have much bearing upon the ability of the officer to do 
good work in airships. 
Although one or two of those examined who had slight auditory defect appeared 
to be carrying out their duties well, it is recommended that a high standard of hearing 
be demanded in view of the fact that orders must be quickly heard and obeyed. 
Tympanic weaknesses on the other hand might be regarded more leniently in view 
of the fact that the alterations in atmospheric pressures are much more gradual than 
in the heavier-than-air machine and never so extreme. 
No true mouth breathers were found. In view of the altitudes at which the majority 
of the work is performed, this would not appear to be of importance, provided it has 
not undermined the general physique. 
The officers, as a whole, performed poorly in the tuning-fork balancing test. No 
relation could be found between their muscle sense and their ability to fly airships. 
There did not appear to be any relation between the previous civilian occupation 
of the officer under consideration and his ultimate success in flying airships. While 
it may be said that those accustomed to hard work and fond of outdoor life probably 
make the best officers, no general rule can be laid down in this respect. 
Lastly, the question of transfer of aeroplane pilots or observers to airships and vice 
versa must be considered. This appears to be largely a matter of individual tem- 
perament; at the same time it would seem from conversations with several officers 
who have worked with both branches that to the average man the strain of flying 
on active service in heavier-than-air machines is infinitely more than patrolling in 
an airship; also it must not be forgotten that in the former the altitudes at which 
work is performed are much greater. On the other hand an officer may be “timid” 
in airships and yet do well when transferred to heavier-than-air machines. 
It is difficult to dogmatize; but as a working rule it would seem that provided a 
man is medically sound, in the ordinary sense of the word, but with some drawbacks 
(age, breath-holding, balancing, exaggerated reflexes, etc.) to his becoming an aero- 
plane officer, he should be allowed to try airships, provided he appears to be tem- 
peramentally and nervously suitable. In regard to observers, etc., turned down for 
pilots in aeroplanes by the A. C. M. B., there appears to be no reason why these 
officers suitably chosen according to the lines of this report should not do well in 
airships. Above all things, however, the candidate must want to fly airships, for 
without “keenness” he will attain little. 
Maj. Robert S. McCombs, Medical Corps, was detached to work 
with the British at the Felixstowe seaplane station. The British 
tests are fully described in the chapter upon physiology. In regard 
to these tests Maj. McCombs has made the following report: 
MAJ. ROBERT S. McCOMBS, MEDICAL CORPS. 
The chief object of these tests is to furnish the medical officer with a practical, 
clinical means of determining, in a short time, the fitness of any man for flying. It 
was impracticable, in the British service, to apply the more elaborate tests used by 
the American Army, owing to the impossibility of obtaining the necessary equip- 
ment and to the large numbers of candidates passing through the Arkwright Road 
Board, which was the only assessing unit for the Royal Air Force. Time was such an 
essential factor that short clinical tests were imperatively demanded. 
The chief value of Flack’s tests lies in their adaptability to “field service,” where 
the medical officer, acting as a flight surgeon, is daily called upon to pass on the 
fitness of many fliers for duty. It is impossible, under such conditions, to refer 
men back to the base laboratories for reexamination unless they are obviously unfit. 
A ready and reliable test is of more practical value than the finest equipped laboratory 
if that laboratory is not available. 256 
AVIATION MEDICINE IN THE A. E. F. 
A graphic chart devised by the author is given below. It is divided into five 
second intervals and the number of pulse beats in five seconds is indicated on the 
left-hand margin. 
Of equal importance to the above is the charting of the subject’s sensations in 
response to effort. It is necessary to discover why he was forced to .give up, or what 
sensations developed during the test. Ask immediately, “Why did you stop?’ 
Flack claims that exhaustion in the early stages is shown by breathlessness, suffoca- 
tion, tightness across the chest, palpitation, giddiness, pain, suffusion of the face. 
It is possible that many of these sensations may be provoked by a healthy heart 
when it is forced to work after its store of reserve force is exhausted; it is the too 
ready production of them which indicates an abnormal limitation of endurance. 
In the cases where the most severe exhaustion exists without any physical sign 
being present, the subjective symptoms and the action of the pulse elicited by the 
test afford an index to the danger and prove a valuable danger signal. 
The author’s interpretation of his findings by the “sustaining-the-mercury test” 
are based upon the daily supervision of 82 war pilots over a period of three months 
of most active duty during the closing days of the war at a seaplane station in the 
SUMMARY OF TESTS. 
Name Capfj.C.: ' 
Diagnosis "Jfa/i;'' 
r/>*£ /» sccovcs 
Date Auq J. Jp&. 
Subjective Symptons /teac/ache a//es 7cjt 
r 
$ 
s 
1 
;? 
5 
* 
Royal Air Force. These men had to fly boats weighing 5 tons each, fully manned 
and equipped, on patrols of from three to eight hours each. 
After carefully charting all examinations made, it was possible to divide the pulse 
reactions into three classes. These have been designated A, B, C, on the com- 
posite chart shown below, each curve representing the composite reactions of 10 
pilots. Class A, 10 of the best pilots physically. Class B, 10 of the average. Class 
C, 10 of the men who were relieved from flying as physically stale or unfit. All the 
others could be placed in one of these three classes. 
Class A. Ten of the best pilots physically. 
Class B. Ten of the average pilots. 
Class C. Ten who were relieved from flying. 
It will be noticed that each curve shows an initial rise in the first 10 seconds 
then a drop towards normal. ✓ . 
In “Class A,” the pulse remained normal, or slightly below, until the breath had 
been held for 50 seconds, when there was a gradual increase in the frequency up 
to 75 seconds. From this point, there was a more rapid slowing until they “ gave up ” 
COMPOSITE CHART. AVIATION MEDICINE IN THE A. E. E. 
257 
at 88.3 seconds, followed by a quick rebound of the pulse, which gradually fell to 
normal in 25 seconds. 
Class B shows the same initial reaction; but then the pulse remained fairly steady 
at about its maximum until they gave up at 46.2 seconds, followed by a gradual 
decline to normal in 30 seconds. 
Class C shows what the writer calls the “break.” There is no secondary stabilizing 
of the pulse, but a rapid slowing until the subject gives up at its minimum point 
after only 35.7 seconds—usually complaining of subjective symptoms—and the 
return to normal is protracted, lasting 60 seconds or more. 
T/ME /N SECONDS 
SUCSC JS/tTJ SAC// S JSCS. 
Classes A and B were considered normal, but Class C in the writer’s experience shows 
beginning exhaustion. 
Heart murmurs.—If a murmur exists which may be considered functional, i. e., 
heard during systole, only, best over the base of the heart, not transmitted, with no 
history of possible cardiac infection, without enlargement of the heart, and no altera- 
tion in the rhythm or other symptoms of failing reserve force in the heart’s action 
during the test, the murmur may be disregarded. Pilots with such murmurs were 
permitted in the R. A. F. to perform their full duties, and no grave errors were re- 
7/ME /N SECONDS 
ewess *£»7V &rc//sjsca#/>s. 
corded. Organic murmurs, likewise, can be assessed possibly by this method; and 
some valuable men were retained in the service who had organic heart lesions, but 
who proved by the tests that their reserve force was equal to, and in some cases above, 
that of the average normal individual. 
COMPOSITE CHART OP PIVE CASES OP MITRAL REGURGITATION RETAINED IN PULL DUTY. 
Of the pilots in the two wings over which I had supervision, the average length 
of time of holding the mercury at 40 mm. was 65 seconds (82 pilots). At the Medical 
Research Laboratory in the A. E. F., in 122 pilots returning from the front it averaged 
171364—20 17 258 
AVIATION MEDICINE IN THE A. E. F. 
71 seconds, and in 60 Monitors it averaged 60 seconds. The Arkwright Road Board 
considered 60 seconds good, 40 seconds fair, and 30 seconds disqualifying. In the 
young and immature boys of 18, it is not so long. Therefore, taking 40 seconds as the 
minimum, and 65 seconds as the maximum averages for normal individuals, the 
approximate status of any individual case can be judged—taking into consideration 
his stamina. All the men I had to remove from flying fell below 40 seconds, except 
one who held on through sheer grit with his pulse showing a marked arythmia. One 
man’s case in particular was instructive. He could not last over 22 seconds and was 
accordingly reported as relieved from flying, but through a mistake was sent on patrol 
wise seats each s secs 
TINE !M 5EC0N0S 
during which he fainted and was killed in the crash which followed. There were 
four others in the plane who testified to his having fallen forward on his controls while 
flying straight away, after having lifted his seaplane from the water in a rather difficult 
take-off. - 
All the pilots who were doing the routine work were well up in their tests, and 
all those who were stale were low. 
The appended charts are tracings from individual cases: 
Case I.—A captain 21 years of age, who had fought over the lines in France for 
three years as a scout pilot. He had 15 Huns officially to his credit, had won the 
T/NE IN SECONDS 
WISE SEATS EACA S SECSAES 
military cross and was a flight commander. He fainted from exhaustion in the air 
at 8,000 feet and crashed. The test was taken about 5 months after the accident, 
following which he had never flown. It shows undoubtedly that his previous good 
form had been due to the fact that his pulse is basically of the “Class A” type, but at 
present still intermittent while taking the test. It is not intermittent when taken 
at other times. 
Case II.—A lieutenant, a Camel Scout pilot, one of the best men we had, taken 
after two hours of continuous stunting. It shows the characteristics of Class B. 
Cases III and IV.—Pilots who were relieved from all flying duties. They show the 
characteristics of Class C. AVIATION MEDICINE IN THE A. E. F. 
259 
During the test one officer developed a headache which lasted for two hours. He 
was sent to the board at Arkwright Road, from whence he was returned as-permanently 
unfitted for pilot or observer. 
On repeated tests, this officer showed similar form. He was held as an observer. 
T/Sf£ /H J£COHOS 
re/ZS£ S£A7S £AC# S Jecavas 
Case V.—Shows the effects of excessive tobacco which the writer found to be 
characteristic. When smoking 50 cigarettes a day, there was a tendency to gradual 
acceleration of the pulse until the man gave up at its highest rate, followed by a 
sharp “break.” The second tracing shows the improvement after two weeks absti- 
nence. 
r/cfe /// sscoa/os 
rw.se asm ercse secorr/u 
In his report to the British Air Ministry, Maj. McCombs con- 
sidered very carefully the physical standards for the seaplane pilot, 
because of the great weight (12,000 pounds) of these planes. After 
drawing attention to the desired stature, visual requirements, cardio- 
roue aerrj ercrs jsco/vas 
T/n£ /» sec oh os 
vascular and temperamental requisites, he closes this report with the 
following: 
It was possible to classify the pilots (according to the results of their tests) 
into 10 different classes. This was done by a purely arbitrary method. They were 260 
AVIATION MEDICINE IN THE A. E. F. 
given a percentage of 25 for each test in which they reached the station average; if 
they reached -the average but had some physical defect—like heart murmur or im- 
perfect vision—they were given 12J per cent. Attached is the result of this classi- 
fication. It is of interest to note that all of the pilots who are doing the daily patrolling 
are in Classes I, II, III, and IV; and that practically every man, who has crashed, 
is in a class lower than V. 
It would seem from this, that the selection of the pilots by the senior flying officer 
for their skill corresponds in a remarkable degree to their classification on these tests, 
the results of which were arrived at independently and without any previous knowledge 
of their ability as pilots. 
A weekly report was sent to the senior flying officer giving the names of the fit 
pilots, those who needed reexamination and those who had not reached the standard 
for pilots. 
The result of these frequent reexaminations and the elimination of the men who 
were considered unfit to fly, has raised the average of the station to the following 
figures: Holding breath, 69.36 seconds; expiratory force, 107.84 mm.; 40 mm. Ilg., 
60.04 seconds. 
This seems to be a fair standard of what should be required upon these tests for a 
successful sea-plane pilot. 
The interest of the men Was maintained by designating Class I as “Berlin Bombers” 
and this stimulation seemed to increase the keenness of their effort. 
CLASSIFICATION OF PILOTS AS RESULT OF TESTS. 
Average tests taken as a standard. Twenty-five points were given where station 
average was reached in a test. If station average was reached in all four tests, it gives 
a percentage of 100, three tests 75 per cent, two tests 50 per cent. Where some physical 
defect exists even though the average test is reached, the percentage given is 12| per 
cent. 
Men. 
Class I. (Well over average in all 
tests.) 8 
II. (Average of 100) 12 
III. (Average of 87.5) 8 
IV. (Average of 75) 20 
V. (Average of 62.5) 9 
Men. 
Class YI. (Average of 50) 6 
VII. (Average of 37.5) 2 
VIII. (Average of 25) 4 
IX. (Average of 12.5) 1 
X. (Did not reach average in 
any test) 5 
MAJ. JOHN P. GALLAGHER, MEDICAL CORPS. 
Maj. John P. Gallagher, Medical Corps, during his connection with 
the R. A. F., was stationed at Chaltis Hill Aerodrome, England, which 
was the school at which scout pilots were trained. The planes used 
in the training there were Camels, Avros, and Bristol scouts. 
In my experience at flying fields (nine months in the U. S. Air Service and three 
months in the R. A. F.) the number of pilots referred after crashes or bad landings that 
could he attributed to defective vision or muscular imbalanc e, were less in percentage 
in the U. S. Air Service. Most of the bad landings that were due to eye defects in the 
U. S. Air Service, in my opinion, were attributable to lack of normal convergence or 
muscle balance—especially the latter; and that most, of these conditions were fatigue 
effects caused by the strain of flying and climatic conditions—especially in the wanner 
climates. The effect of altitude as a factor in some of the pilots referred, is undoubted, 
especially in pilots flying over 10,000 feet. This effect in the majority of cases was 
apparently slight, as most of their flying was between 2,000 to 8,000 feet. Visual acuity 
or astigmatic defects were not factors in the majority of cases. AVIATION MEDICINE IN THE A. E". F. 
261 
The majority of these flyers after a rest of from 4 to 30 days, were markedly improved, 
and could make fairly good, or good landings. 
In peace or war a flyer can fly and drink, but he can not drink and fly. 
SUMMARY. 
Good eyesight, muscle balance, muscular coordination, reaction time and cardio- 
vascular system, with a hyposensitive ear mechanism, constitute physical require- 
ments which meet closely the needs of the chasse pilot. By a subnormal ear mechan- 
ism, a nystagmus of 12 to 20 seconds, and not over 26 seconds, is implied; one to three 
past pointings; and a slight reaction to vertical stimulation or subnormal falling. Spon- 
taneous past pointing is serious. 
Only physicians especially trained in the medical aspects of aviation and the care of 
the flier, with practical experience in aviation as pilot or observer, should be appointed 
to care for the flier. Preferably he should be single and between the ages of 25 and 40 
years, with physical requirements which at least would qualify for entrance into the 
Regular Army. 
MAJ. CHAS. W. HYDE, MEDICAL CORPS. 
From August 28 to November 20, 1918, Maj. Chas. W. Hyde, 
Medical Corps, was attached to the Medical Department of the Royal 
Air Force and stationed at the training depot, Shotwick, England. 
This station was a permanent one, and offered training to both cadets and officers. 
It included patrol and combat as well as preliminary aerial gunnery. The personnel 
consisted of about 170 cadets and officers, and an average of 70 serviceable ships, the 
entire complement, including enlisted men, being 800. The ships in service were 
Avros, Camels, and Dolphins. The instructors consisted of two types, successful 
over-sea pilots, Who were returned to England for rest and Who were afterwards sent 
to this station as instructors; graduate officers from home platoons chosen with regard 
to special fitness for this type of work. For the observation and care of this station, 
there were two medical men, each with rank of first lieutenant, recently chosen 
from civil life and without previous military experience; also one hospital sergeant 
and six hospital orderlies. The hospital facilities were such that some care could be 
given to eight men and two officers. Seriously injured or gravely sick officers and 
men were sent to Chester War Hospital, 6 miles from the field. During flying hours, 
an ambulance and hospital orderly were stationed on the flying field. A special 
motor bicycle was kept at the station hospital for the use of the medical officer. 
My duties were to advise and consult with the medical officers concerning the care 
of cadets and officers, and to make complete physical examinations of earh cadet and 
officer at least once in two months. During my first six weeks’ stay at this post, such 
examinations could not be made in full on account of inadequate medical equipment. 
Complete records were kept of the results of 150 examinations and tabulated. This 
tabulation included the results of the British tests which are described in another 
place in this history. 
The range of expiratory force Was from 84 to 185, the latter being made by an Ameri- 
can boy whose height was 5 feet and weight 102 pounds. He was an especially good 
instructor without having had over-seas service. The lowest figure was obtained on 
several candidates, cadets, and officers alike. There was no apparent cause for this 
low reading and they Were men of average type. 
The facilities for study of vision were limited, consisting of Snelling test cards alone. 
This revealed numerous cases of subnormal vision, and muscle imbalance was occa- 
sionally found. There was an occasional candidate with minor degrees of deafness but 
no suppurative ears were found. Diseased tonsils were comparatively frequent and 
they were responsible for some sickness. When occasion demanded, separation from 262 
AVIATION MEDICINE IN THE A. E. F. 
the service or leave of absence beyond seven days (not on account of acute illness or 
accident) the candidate was sent to an invaliding board, accompanied by history of 
case, result of physical examination, and advisory remarks. As far as I know, the 
medical officers’ opinions were invariably followed by this board. Candidates could 
also avail themselves of examination by this board through military channels, by 
request. It is difficult for those who have been at war for a comparatively short time 
to appreciate the lack of medical men and of medical equipment that is the result of 
the long and excessive drain upon these resources by long continued warfare. 
As far as medical care in selection and continued attention is concerned, it is my 
opinion that the personnel in the United States Air Service is indeed fortunate. 
The morale of the English training camp is of the best and the men and officers are 
without complaint, although “carrying on” under many adverse circumstances. / 
Capt. Eugene Cary, Medical Corps, whose report upon conferences 
with American observers from the front appears in Chapter II, was 
stationed, during his service with the British, at Netheravon, Wilt- 
shire, England. This field is a pooling station for bombing and night 
flying. In addition to Capt. Cary, two other medical men (British) 
were stationed there. There were about 600 fliers, including Cana- 
dians, who had a good many Americans among their number. 
CAPT. EUGENE CARY, MEDICAL CORPS. 
The following extracts are taken from the report of Capt. R. A. 
Trumbull, Medical Corps: 
CAPT. R. A. TRUMBULL, MEDICAL CORPS. 
The 10 officers sent to England were assigned to the medical administrator of the 
Royal Air Force, August 22, 1918. We spent one week in London, during which 
time we had many conferences with the medical administrator and his assistant, 
Col. Martin Flack. During these conferences, the various examinations used in the 
Royal Air Force were fully discussed. We also visited the aviation examining board, 
the invaliding board, and an aerodrome where the men who had been declared unfit 
had their final test. 
On August 28 I was sent to 50 T. D. S., at Eastbourne, Sussex. This was a six- 
squadron field. There were approximately 215 officers and cadets under training at 
this station. Camels and Avros were used in training. The aerodrome was situated 
a short distance from the sea. The wind was against flying, for it blew at a high rate 
almost daily. It rained nearly every day. The cadets were quartered in tents at the 
aerodrome. I did not think this particularly conducive to good flying, so took the 
question of quarters up with the commanding officer, and the same day the men were 
moved to billets. The officers on the staff and the officers under instruction were 
quartered in the mess, which was an old boys’ school located about 2\ miles from the 
aerodrome. Here the surroundings were quite good although quite cold, due to the 
shortage of fuel. The food being rationed was practically the same each day. In this 
mess was a bar. The discipline at the aerodrome was rather lax. If a man wanted to 
fly, he flew; if he did not, it was quite easy to get out of it by simply not going to the 
aerodrome. This was later remedied by a new commanding officer. There was 
practically no physical training on the station, and each man we spoke to wanted more 
physical exercise. An examination was given the fliers every two months. 
The British have been forced to lower their standards (as compared with ours) on 
account of the lack of material. This will no doubt account for some of the tests given 
the fliers. There were some men in the Royal Air Force who were frank in stating AVIATION MEDICINE IN THE A. E. F. 
263 
that they were in the Air Service only to escape the Infantry or Artillery. Men with 
this idea in mind are not the type of men who would make the kind of fliers necessary 
to win the war. It seems to me that the standards used in the American Air Service 
for the selection, classification, and care of the flier are superior to those that are em- 
ployed in the Royal Air Force. 
The medical officers who were assigned to the work in England 
without exception feel that they are greatly indebted to our British 
Allies for much useful knowledge and experience gained during their 
period of service. They are most appreciative of the courtesy and 
assistance that was afforded them everywhere in England, and they 
are deeply impressed by the fine spirit of the Royal Air Force. They 
are especially grateful to Dr. Henry Head, Dr. Sydney Scott, Maj. 
Bowdler and Lieut. Col. Martin Flack, in addition to many other 
officers. Col. Flack, by his fine scientific attainments and his execu- 
tive ability, has done much to push the splendid constructive work 
of the medical administrative committee of the Royal Air Force. Chapter IX. 
FUTURE OF AVIATION MEDICINE. 
“History repeats itself with the most monotonous reiteration. 
The present is the past entered through another gate,” wrote Lord 
Roberts. That this may not prove true in any line of preparedness 
in the United States is the deep desire of all thinking Americans 
whose hearts have been in the great war; and it is their fervent hope 
that the history of aviation in America may not resemble the Corypha, 
an interesting tree of Granada, that at the end of ten years bears 
flowers and fruit and then dies. 
The science of flying, horn in America, passed through a brilliant 
infancy into a period of arrested development. Golden oppor- 
tunities in past years had been allowed to slip by unnoticed and 
America was enormously behind Europe in matters pertaining to 
flying—even the essential features of an efficient combat plane were 
unknown to us. The last year before the outbreak of the great 
war, America’s appropriation for aviation was one one-hundred-and- 
eightieth of the amount voted for that purpose by Germany. From 
almost nothing—two small flying fields, a handful of instructors, less 
than 100 students—America was asked to produce within a year 
4,500 planes and 5,000 pilots, which was three times the production 
of France during the first three years of the war. But America’s 
assets were her wonderful natural resources and her incomparable 
human material. No one could visit the wonderful training centers 
and aerodromes in France—some of which had been converted from 
mud holes into flying cities as if by magic—without experiencing a 
great thrill of pride in our country. 
In addition to technical unpreparedness, the medical problems of 
aviation had remained practically untouched. The early method 
of training which was based upon the principle of the “survival of 
the fittest, ” was neither humane nor efficient. It was certainly not 
efficient to send a pilot to an altitude of 20,000 feet if he became ill 
at 15,000 feet; or to do acrobatics when he was hypersensitive to 
motion; or to fly at night if he were unable to see in the dark. This 
savors too much of the methods of Procrustes of mythological times, 
who made his guests fit his bed by pruning the tall and stretching 
the short. 
The war has revealed the possibilities that lie in aviation, and it 
has accomplished on a broad scale investigation, experimentation, AVIATION MEDICINE IN THE A. E. E. 
265 
and realization relative to flying, that would otherwise have been 
impossible. But the great future of aviation largely depends upon 
the further development of the meager medical knowledge that has 
been acquired under the spur of war. 
The deep need for this continued development is apparent from 
the following bulletin from the War Department which has recently 
been made public: 
[Prepared by Statistics Branch, General Staff, War Department, Oct. 25,1919.] 
Statistic Series. 
TEXT SUMMARY, AIR SERVICE. 
Only 4 per cent of flying fatalities due to failure of machine. 
Since January 1, 1918, the Air Service has had 390 fatalities at flying fields in the 
United States. Of these 14, or 4 per cent, were attributed to failure of engine, or 
collapse of plane; the cause of 9 per cent of all fatalities is unknown. 
Number of 
fatalities. 
Per cent 
of total. 
118 
30 
61 
16 
47 
12 
36 
9 
21 
5 
Stall 
19 
5 
Fire 
15 
4 
14 
4 
13 
3 
46 
12 
390 
100 
That 96 per cent of these fatalities were due to faults or circum- 
stances directly connected with the pilot himself—evidences the 
fact that there are many medical problems of aviation awaiting 
solution. To say that the pilot got into a stall, a vrille, a side slip, 
or a nose dive, does not explain the cause of the accident. It merely 
tells by what mechanical means the crash occurred. It is very 
important to investigate still further and to ascertain the circum- 
stances under which the uncorrected maneuver took place, and why 
it was not possible for the pilot to reoover his' control. Such prob- 
lems as these can be solved only by scientific psychological and 
physiological research. But the first step toward reducing the num- 
ber of accidents is a full realization of the necessity of a strict adher- 
ence to the physical standards that have been adopted, and of the 
fact that a waiver of any physical disability is always an invitation 
to death. 
The peace aspects of aviation have been very ably summarized 
by Representative Gard: 
When war shall have ceased the result of invention and industry will have been 
such that the development of the flying machine will be no development of hazard,. 266 
AVIATION MEDICINE IN THE A. E. F. 
sport, or slaughter but afford a new and efficient means of transportation in times of 
peace, bringing increased efficiency and happiness to all people. 
In the realms of science, aviation will open up a large field for 
exploration everywhere from the equator to the poles. It will be 
valuable also in the study of gravity, meteorology and many phases 
of physiology. The field for careful, painstaking peace time work 
seems practically inexhaustible. In fact, the use of the aeroplane 
may become so universal that the words of the Prophet Ezekiel will 
be fulfilled: “And when they went, I heard the noise of their wings 
like the noise of great waters. ” But it must be remembered that no 
matter how great the strides of aeronautics, the guiding spirit will 
still be man—man moving in an entirely new environment for which 
he was not specially constructed, and to which he must adapt him- 
self by definite physiological changes. In order that man himself 
may keep pace with the progress of aviation, medical science should 
apply itself faithfully to the study and development of all matters 
that can influence the safety and protection of the flier. That 
nation is wise that learns from the past, and possesses a vision of the 
future and the will to do. 
The signing of the armistice has but stimulated the British, the 
French, and the Italians (among our Allies) in the many psycho- 
physiological studies of aviation problems. The low-pressure tank 
that was so valuable in the work of the Medical Research Laboratory 
at Issoudun, has been placed in the laboratory at Oxford University, 
England, where it will be very useful in the British investigation of 
all questions of diminished oxygen tension. Within the last year, 
the French and Italians have developed new apparatus for studying 
the many medical problems of aviation. 
At the Allied Medical Conference for Aeronautics held in Rome, 
February 15, 1919, a society was formed for the study of all medical 
problems connected with the future of flying. The knowledge thus 
gained is to be disseminated among the allied nations by means of 
yearly meetings. Later, at the Peace Conference, certain definite, 
physical standards were decided upon. 
It would be deplorable if the United States, the youngest, most 
vigorous, and most resourceful of the Allies in the Great War, should 
fail to take her place among the nations in the scientific study of all 
the phases of aeronautics. “He that gathereth in the summer is a 
wise son, but he that sleepeth in harvest is a son that causeth shame” 
are ancient words, but they are none the less applicable to the present 
status of aviation in our country. There are no misgivings about 
the ability and the will of America in the face of an emergency— 
“whene’er her soul is up and pulse beats high.” But with the passing 
of the great emergency there is grave concern that she may fail to 
profit by her experience in unpreparedness. AVIATION MEDICINE IN THE A. E. F. 
267 
It is to be hoped that a far-seeing Congress will realize the enormous 
handicap under which the United States will labor in the future unless 
a sufficient appropriation is made for constructive development of 
the Air Service, with full recognition of the essential part that medical 
science must play in this program. Judicious yearly appropriations, 
efficiently administered, may save heavy expenditure of money, 
blood, and human sorrow in the future. If a constructive program 
should be determined upon—‘‘ a consummation devoutly to be 
wished”—it is hoped that with recognition of the indissoluble linking 
of medical science and the art of flying, there will be an appreciation 
of the value of the Office of the Chief Surgeon, of the necessity for 
further development of the Medical Research Laboratory and the 
establishment of a School of Aviation Medicine for the training of 
flight surgeons. Connected with this school, there should be an 
adequate collection of reports, records, maps, photographs, and all 
data and literature of our own and allied countries, in order that the 
training of the flight surgeons might be of the most comprehensive 
character. 
Aviation, the dream of the past, is the realization of the present. 
But the human mind can only dimly surmise the wonders of the 
future development which will embrace all the national needs, 
military and economic, over land and sea. 
Men, my brethren, men the workers, ever reaping something new, 
That which they have done but earnest of the things that they shall do. APPENDIX. 
FORMS IN USE BY THE ALLIED ARMIES. 
UNITED STATES. 
[Forms 1 and 2.J 
Place Date . 
Name Rank and organization Age 
Home address Prev. Army service M. or S 
GENERAL MEDICAL SECTION. 
I. Medical history 
A. Family history: F M B S W 
Ch 
Tuberculosis, mental or nervous breakdown 
B. Past illness: Have you ever had measles, mumps, scarlet fever, diphtheria, pneumonia, 
typhoid, malaria, tuberculosis in any form, chronic cough, chronic bronchitis, catarrh, 
enlarged glands, tonsil trouble, rheumatism, St. Vitus’ dance, gonorrhea, syphilis, heart 
trouble, anemia, asthma, hay fever, nervousness or nervous breakdown, accidents, 
especially to head, unconsciousness, fainting, operations or any other serious trouble. 
(Full details and dates) 
C. Personal history: Education 
Sports Occupation 
Habits: Sleep Alcohol Tobacco 
D. Present condition 
II. General build: Height inches. Weight lbs. Any change? 
III. A. Chest measurement: Expiration inches. Inspiration inches. 
B. Lungs 
IV. Skin Endocrine system 
V. Circulatory system: 
(а) Pulse rate: Standing Recumbent , After exercise >. 
(б) Blood pressure: Systolic Diastolic „ 
(c) Condition of arteries 
(<f) Heart-Insp. P. M. I Palp. P. M. I. and thrills 
Perc. L. B. 5th I. S R. B. 4th I. S 
(e) Veins Varicosities Varicocele Hemorrhoids 
VI. Digestive system: 
A. Teeth • Devitalized 
B. Abdomen: Tenderness Liver and spleen 
VII. Hernia 
VIII. Genito-urinary system 
IX. Urinalysis: Specific gravity Albumen Sugar 
Reaction Casts, pus and blood 
X. Blood: Hemoglobin Red cell count 
XI. Why did you choose the Air Service? 
What is your attitude at present? 
Attitude of your family? 
Pupils, size, shape, and reaction ' 
Coordinaton Knee jerks Tremors 
XII. Personality 
Accepted Disqualified on No Examiner 
EAR. 
XIII. A. History of ear trouble (tinnitus, discharge, mastoiditis) 
B. History of dizziness 
C. Sea sick, car sick or carousel; hypersensitiveness to these 
XIV. A. External auditory canal 
B. Membranae tympani R L 
C. Hearing,watch R L Whisper, R L 
D. Tuning forks E. Nasopharynx 
XV. Condition of nares ; 
XVI. Condition of tonsils and history of tonsilitis 
XVII. Adenoids 
XVIII. Eustachian tubes 
XIX. Static tests Dynamic test 
XX. Equilibrium, (vestibular) (a) Nystagmus R L (6) Vertigo R L 
(c) Falling R L (d) Past pointing 
Remarks 
Accepted Disqualified on No Examiner 
Physical Examination of Applicants, Air Service U. S. Army, A. E. F. AVIATION" MEDICINE IN THE A. E. E. 
269 
EYE. 
XXI. Visual acuity 0. D O. S 
A. Vision with plus 2 DS. OU |q" j V. 
B. Corrected vision O. D O. S 
XXII. History 
XXIII. Examination (external) 
A. Inspection O. D O. S 
B. Fields (confrontation) O. D O. S 
C. Lids O. D O. S 
D. Ocular movements O D O. S 
1-Nystagmus *... O. D O. S 
E. Conjunctiva O. D O. S 
F. Lachrymal apparatus O.D O. S 
G. Cornea O. D O. S 
H. Iris: 1. Inspection O.D O. S 
2. Reaction O. D O. S 
a. Light: 1. Direct O.D O. S 
2. Indirect O.D O. S 
b. Accommodation O. D O. S 
XXIV. Near point of accommodation (from cornea) O.D mm. O. S mm. 
XXV. Near point of convergence (from cornea) mm 
XXVI. Stereoscopic vision 
XXVII. Color vision 
XVIII. Muscle 6 g! s^r°f.^1"!!]!!]!]]! 1!i! 
iftroubie)33cm.{^v:::::::;::;:::;;«^r;-:;:::;;::;:::::;: g; 
XXIX Ophthalmoscopic examination 
Accepted Disqualified on No Examiner 
XXX. Is the candidate physically qualified for aeronautical duty? 
Signed 
Air Service, U. S. Army, A. E. F. 
[Forms 3 and 4.] 
Reexamination op Flier. 
Place Date 
N ame R auk Organization 
Age Duty Date of commission 
Home town M. or S Previous Army service 
Referred by Why referred 
I. Family history , 
II. Personal history 
III. Education Sports Prev. occupation 
IV. Aviation history: Total flying Flyingrecord 
Aviation school work 
Date, duties, and hours of flying 
Altitude Symptoms 
Accidents 
Reasons for choosing aviation 
Attitude at present Attitude of family 
V. Present condition '. 
VI. Personality 
VII. Physical examination: (a) Lungs 
(b) Circulatory system (1) Pulse: Standing Recumbent 
After exercise 4 
Quality (2) Condition of arteries J 
(3) Blood pressure: Systolic Diastolic 
(4) Heart: Inspection, P. M. I Palpation, P. M. I Thrills 
Percussion, L. B. 5th I. S R. B. 4th I. S 
Auscultation standing Recumbent After exercise 
(c) Digestive system: (1) Teeth , (2) Abdomen 
Remarks: 
VIII. Eye examination: Visual acuity: R L 
Near-point of accom.: R mm. L mm. Near-point of conv mm. 
Muscle balance 6 m.: Eso Exo R. of L. Hyper ,r 
Remarks: 
IX. Ear, nose, and throat: (a) Sea sick, car sick, carousel, air sick, hypersensitiveness to these 
(b) Tonsils (c) Nares 
(d) Equilibrium (vestibular): (1) Nystagmus: R L (2) Vertigo: R L 
(3) Falling: R... L (4) Past pointing 
Remarks: 
X. Conclusions and recommendations from examinations 
Dept, medicine 
Dept, ophthalmology ; 
Dept, otology 
Dept, neurology 
XI. Recommendation of board 
Signature 270 
AVIATION MEDICINE IN THE A. E. F. 
[Forms 5 and 6.] 
Report op Accident to Flier. 
Place Date 
Name ' Rank 
Squadron or wing . Unit Date of commission 
Type of work Type of machine 
History of accident 
Date Day of week Time of day 
Locality Weather conditions 
Exact position of airman when found 
Was telephone fitted? Was he pinned down hy any part of the machine? , 
Did machine catch fire? Was fire extinguisher used? 
Condition of motor and plane before flight 
Condition after accident • 
Was he pilot or passenger? Name of other flier 
Condition of other flier 
Was any mishap observed? 
Report of eyewitness 1 
2 
At what altitude Attempts to redress 
At what stage of flight did accident occur? 
Previous flying record 
Number of hours of flying 
Hours in this type of work Number of minutes in air, day of accident . 
Nature of injuries 
Research board examination 
Nature of medical aid first rendered 
Time of first medical aid 
Hospital report 
Condition after accident, fatal or nonfatal Fracture at base 
If fatal, state exact cause 
Neurological findings: Unconscious Headache Vomiting 
Nightmare Amnesia Character of 
Flier’s personal report of accident 
Health immediately before accident Was doctor seen? 
Date and result of last medical examination 
Habits: Sleep Alcohol Tobacco.... 
Report of friends on health 
Helmet worn, and type 
Belt and type Did belt give way? 
Goggles and type Were eyes injured by goggles? 
Chief injuries at post-mortem 
Signature 
Air Service, U. S. Army, A. E. F 
Air Service, U. S. Army, A. E. F. 
[Form 8.] 
Name: 
Date of commission: 
Rank: 
1. This envelope contains the flimsy copies of forms 1, 3, 5, and the classification examination. 
2. It is to he kept in the executive office of his station with other personal papers. It is to he treated'as 
strictly confidential. 
3. On the transfer of the officer or cadet to another station or hospital it is to he forwarded with other 
personal effects to the commanding officer of the station or hospital to which the transfer is made. 
[Envelope to contain the medical history of an officer or cadet in the Air Service.] 
Date. Station. Hospital. Date of forwarding. 
Filing No 
Medical Research Board, Air Service Signal Corps, U. S. A., A. E. F. 
AND U. S. A. 
TEST OF AVIATOR UNDER LOW OXYGEN TENSION. 
(Place.) (Date.) 
(Name.) (Military status.) (Organization.) 
Res Ocq /12 SMW. 
(Age.) 
Fam. Hist. F M B S. 
Wife Ch AVIATION MEDICINE IN THE A. E. F. 
271 
Tuberculosis, chr. cough, etc., in family, contacts, etc 
Pers. Hist.—Educa - 
Hab. Tob Ale 
Experience in athletics, dates 
How recently or constantly have you been in hard condition (training)? 
Are you so now? 
Experience in aviation Hrs to Max. Alt ft. for min 
Other exp. at altitudes (mountains, etc.) 
Symptoms at altitudes.... 
Previous medical history: Have you had measles, scarlet fever, diphtheria, pneumonia, typhoid, malaria, 
tuberculosis in any form, chr. cough, chr. bronchitis, enlarged glands, tonsil trouble, adenoids, nasal 
obstruction, catarrh, rheumatism, gonorrhea, syphilis, accidents, especially to head, unconsciousness, 
fainting, operations, ear trouble, any other serious illness (full details and dates) 
When did you last consult a physician, why? 
Previous eye hist. Use of glasses Symptoms when not wearing glasses 
laehr ymation photophobia diplopia headache 
Present condition—Give details of present health 
Time of last meal 
Appetite Weight Digestion 
Are you feeling fit to-day? (Loss of sleep, dissipation, nervous tension, overwork, indisposition, eye 
strain, indigestion, cold, etc.) 
Other remarks 
Physical examination—(If deviation from normal is found, note in great detail.) 
General build 
General appearance (note especially cyanosis, mottling, coldness of extremities, pallor, sweat, etc.) 
Eyes—Vision it. E L. E Muscle Bal Ret. Sens 
Ergograph Color Vision Field Binoc. Fix. + 
Ears 
Nose v 
Throat 
Lungs - 
Heart: 
Apex felt (point farthest out) in sp cm. to L. of Mid. 
L. Border (dullness) in 6th sp cm.; 5th sp ; 4th sp cm.; 3rd sp 
cm. to L. of Mid. 
Upper border R. border cm. to R. of Mid. 
After 5 min. reclining, B. P.... Pulse On standing, B. P Pulse 
After standard exercise, B. P Pulse 2 min. after exercise, B. P Pulse 
Blood vessels 
Abdominal 
General impression, psychological 
Summary of observations during low-tension tests: 
Recommendation of board as to fitness of aviator: 
Signed 
(Name.) (Date and hour.) 
Type of test ... Duration minutes seconds. 
Phys. cond. at time of test 
Exact condition at close of test 
Recovery - 272 
AVIATION MEDICINE IN THE A. E. F. 
Remarks 
Observers: Phys Clin Psy Oph. 
On machine Plotted by 02% start finish 
Legend 02% Pulse Resp. in deoil, per min. Syst. B. P. 
Diast. B. P. Pulse Pressure Accom. in mm. Convergence in mm. 
Diagram. 
[Face.] 
TIME IS MINUTES 
Filing No. 
Medical Research Board, Air Service Signal Corps, U. S. A. 
[Back.] 
EXAMINATION CINDER LOW OXYGEN TENSION. 
Name i 
Rank 
Rating 
(Date) 
This report is to be made in triplicate. One copy will be filed at the Medical Research l aboratory, 
Hazelhurst Field, Minneola, L. I.; one copy filed in office of chief surgeon, A. S. A. C.; one copy will be 
delivered to the commanding officer of the aviator and when the.aviator is transferred this copy will 
be sent to the commanding officer at the new station. It is not to come into the possession of the 
aviator himself. In case a report is lost application should be made at once to the Medical Research 
Laboratory, Hazelhurst Field, Minneola, L. I., for a duplicate copy. AVIATION MEDICINE IN THE A. E. F. 
273 
Air Service, U. S. Army. 
[Form 9.] 
REPORT OP MEDICAL RESEARCH BOARD. 
Place Date 
Name 
Rank Organization 
Why referred 
Rcommendation of board 
Remarks on fitness 
Signature 
FRENCH AIR SERVICE 
[War Department. Air Service.] 
[Ministere de la Guerre. Aeronautique.] 
Medical Record 
Livret Medical 
Of pilot 
De pilote 
Of observer 
De observateur 
Surname 
Nom 
Given names 
Pr&ioms 
Rank 
Grade 
Class 
Classe 
Date of joining Air Service ; 
Date d’arrivSe dans P Aviation 
[War Department. Air Service. Medical Office.] 
[Mimstere de la Guerre. Aeronautique. Centre Medical.] 
(Date) 19 
, le 19.. 
Medical Card (Record) 
Fiche Medicale 
No. 
N° 
Student Pilot . 
of Eteve Pilote 
de' Student Observer 
Eteve Observateur 
Surname 
Nom 
Given names 
Pr6noms 
Rank 
Grade 
Class 
Classe 
Age.. * 
Age 
Former branch of military service 
Arme d’origine 
Profession 
Profession 
Former sporting activities or military training 
Antecedents sportifs ou entrainement militaire 
anterieur 
1. General Medical Examination 
1° Examen de Medeeine generate 
Antecedents 
Antecedents 
General hygiene 
Hygiene generate 
Use of tobacco and intoxicants 
Tabagisme, intoxications 
Height Weight 
Poids 274 
AVIATION MEDICINE IN THE A. E. E. 
Constitution 
Constitution. 
Abdominal girth 
. Sangle abdominale. 
Heart 
Coeur. 
Aorta 
Aorte 
(a) While lying on back 
(a) Dans le"decubitus dorsal... 
(6) While standing 
(b) Dans la station debout 
Pulse 
Pouls. 
(c) Changes of pulse during 
(c) Modifications du pouls a... 
inspiration 
l’inspiration... 
expiration 
l’expiration... 
Blood pressure 
Pression arterielle. 
Pachon oscillometer v 
(Oscillometre de Pachon). 
Vaquez-Laubry sphygmotensiometer 
(Sphvgrnotensiomelre de Vaquez-Laubry). 
Circulatory apparatus 
Appareil circulatoire.. 
Test of cardiac adaptability to exertion 
Epreuve d’aptitude cardiaque it 1’effort.. 
'(a) In repose 
(a) Au repos 
(6) After 3 minutes’ exercise (not rythmic gymnastic 
exercise) 
(b) Apr&s 3 minutes d’exercice (pas gymnastique cadence) 
(c) After 3 minutes’rest 
L(c) Apres 3 minutes de repos 
Pulse 
Pouls 
(a) While lying on back 
(a) Dans le decubitus dorsal 
(b) After 3 min. exercise (not rythmic gym;) 
(b) A pres 3 m. d’exerciee (pas gym. cadence) 
(c) After 3 minutes’ rest 
,(c) Apres 3 minutes de repos 
Blood pressure 
Pression arterielle. 
Peripheral circulation 
Circulation peripherique 
Vasomotor action in the extremities 
.Vaso-motricite des extremity. 
Respiratory apparatus 
Appareil respiratoire... 
Teeth 
Dentition 
Stomach, intestines 
Estomac, intestin.. 
Liver 
Foie 
Digestive apparatus 
Appareil digestif 
Amount of urine 
Volume des urines. 
‘(a) constituents 
(a) Elements normaux 
(b) Abnormal constituents 
(ft) Elements anormaux 
Albumin 
Albumine 
Sugar 
Sucre 
Renal functions 
Fonctions renales. 
Chemical analysis 
Analyse chimique. 
Chloride retention 
Retention chloruree 
Uric acid in the blood 
Azotemie 
Average excretion of urea 
Constante ureo-secretoire. 
Skin 
Appareil tegumentaire.. 
Remarks and conclu-f 
sions 
Observations diverses,1 
conclusions. I 
2. X-Ray Examination 
2° Examen Radiologique 
Physician in charge of examination, 
he Medecin charge de l’Examen. 
1. Apices of lungs 
1° Sommets 
2. Limits of lungs 
2° Plage pulmonaire 
3. Hilus shadow 
3° Ombre hilaire 
4. Mediastinum 
4° Mediastin 
5. Costo-diaphragmatic border 
5° Sinus costo-diaphragmatique. 
6. Movements of diaphragm 
6° Mouvements du diaphragme. 
7. Wall of thorax 
7° Paroi thoracique AVIATION MEDICINE IN THE A. E. E. 
275 
8. Heart and aorta 
8° Coeur et aorte 
Remarks and conclu-| 
sions. 
Observations diverses,] 
conclusions. 
Physician in charge of examination. 
Le Medecin charge de l’Examen. 
3. Neurological Examination. 
3° Examen de Neurologie. 
Antecedents 
Antecedents 
General psychology of candidate 
Psyehologie generate du candidate 
Emotional disposition 
Emotivite 
General motor activity 
Motricite generate 
Coordinat ion,tremors, loss of coordination, faulty coordination, dysmetry 
Coordination, tremblements, asynergie, dysmetrie 
Superficial and deep reflexes, stereognosis" 
Sensibility superficielle et profonde, stereognosie. 
Tendon reflexes 
Reflexes tendineux 
Cutaneous reflexes 
Reflexes cutands 
Pupillary reflexes 
Reflexes pupillaires 
Sphincters 
Sphincters . 
Remarks and conclu- 
sions. 
Observations diverses,' 
conclusions. 
Physician in charge of examination. 
De Medecin charge de l’Examen. 
4.—Physiological Examination. 
4°. Examen Physiologique. 
Inspiration 
Insp. 
Expiration 
Exp. 
Difference 
Diff4rentielle 
Thoracic meas- 
urements 
Ampliometrie 
thoracique.. 
'%) At the Xyphoid 
i) Xyphoilienne... 
b) Axillary 
6) Axillaire 
c) Umbilical 
,c) Ombilicale 
Spirometry 
Spirometrie.. 
1. Respiratory 
physiology. 
1 Physiologic res- 
pirat oire. 
Spiro-manome- 
try. 
Spiro-manomA 
trie. 
Ia) Inspiratory pressure 
a) Pression inspiratoire 
6) Expiratory pressure 
6) Pression expiratoire . 
Time breath can 
be held. I 
Durda de la sus-1 
pension resp. 
a) During rest 
a) Au repos 
b) After moderate exercise. 
.6) Aprd; unexercice mod<§:6 - 
Holding breath under pressure of cm. ol mercury 
Tenue respirat. sous pression de cent, de mercure 
Resistance to lowered atmospheric pressure 
R6;istance a la d£pression atmospherique — 
2. Muscular physiology.—Ergography 
2° Physiologie musculaire.—Ergographie. 
3. Psychomotor re- 
actions. 
3° Reactions psy- 
cho-motrices. 
'Sight 
Visuelles. 
Hearing 
Auditives 
Touch 
Tactiles.. 
Remarks and con- 
clusions. 
Observations di- 
verses, conclu- 
sions. 
Physician in charge of examination. 
Le Medecin charge de l’Examen. 276 
AVIATION MEDICINE IN THE A. E. F 
Nasal fossae 
Fosses nasales 
Expiratory defects 
Taches expiratoires.. 
Inspiratory pressure 
Pression inspiratrice. 
Naso-pharynx 
Cavum 
Pharynx 
.Pharynx 
5.—Examination of Ear, Nose, and Throat. 
5° Examen Oto-Rhino-Laryngologique. 
I. Upper respira- 
tory passages. 
I. Voies respirato 
ires sup4rieu- 
res. 
Tyinpani 
Tympans 
Tubal permeability 
P4rmeabilit4 tubaire 
Weak whispering voice 
Voix chuchot4e faible 
Speaking voice 
Voix par!4e 
Telephone inductor (dist. 0.5 meter) 
Inducteur t414ph. (dist. 0m-50) 
Tuning-fork Ut-1 (32 V. D.) 
Diapason Ut-1 (32 V. D.). 
Tuning-fork Ut-7 (4096 V. D.) 
Diapason Ut-7 (4096 V. D.) 
Weber test 
Weber 
Rinne test 
Rinne 
Cochlear-palpebral reflex 
R4flexe cochleo-palp4bral 
Accommodation (Gel'4 test) 
Accommodation (Gell4) 
Auditory orientation 
Orientation auditive 
Left ear. 
O. G. 
Right ear. 
O. Dr. 
II. Hearing (coch- 
lear apparatus). 
II. Audition (voies' 
coch!4aires). 
Romberg test (feet together) 
(feet one behind the other) 
Stationary marching (marking time) 
Romberg (pieds joints) 
(pieds l’un devant l’autre) 
Marching blindfolded forward and back (Babinski-Weill) 
Marche sur place (marquer le pas) aveugle alleret retour (Babin- 
ski-Weill) 
III. Equilibrium 
(semicircular 
canals) 
III. Equilibration 
(voies vestibu- 
laires.) 
1. Spontaneous dis- 
equilibration 
1° D434quilibration 
spontan4e. 
a) Romberg test after 3 complete rotations/Right side 
(note delay mrecovering balance) (R.Foy)lLeft side 
а) Romberg apr4s 3 tours comnlets sur soi-fFlanc Dr 
mft:ne (noter en retard de l’4quilibration)\Flane G 
(R. Foy). 
б) Stick test (Moure) 
6) Epreuve du t&ton (Moure) 
c) Galvanism: +to left +to right 
c) Galvanique: +4 G. +& Dr. 
Vertigo, sitting 
Vertige assis 
Vertigo, standing, feet together 
Vertige debout pieds joints 
Vertigo, standing (one foot in front 
of other) 
Vertige debout pieds Pun devant 
l’autre 
Test of marking time (R. Foy) 
Epreuve du marquer le pas (R. Foy) 
2. Provoked loss of 
equilibrium 
2 D4s4quilibration 
provoqu4e. 
d) Marching blindfolded or Romberg 
test after thermic test (cold air) 
d) Marche aveugle ou Romberg epr4s' 
4preuve thermique (air froid) 
Labyrinth right 
Labyrinth left 
Lab Dr 
Lab. G. 
III. Equilebrium 
(semicircular 
canals.) , 
III. Equilibration 
(voies vestibu- 
laires.) (Suite.) 
a) Post pointing after 5 rotations (Gri- 
vot) 
a) Indication apr&s 5 tours de rotation' 
sur soimfime (Grivot) 
Right side 
Left side 
Flanc Dr 
Flanc G 
3. Provoked reac- 
tions (pointing 
with the finger) 
£» Mouvements 
r4ic. provoqu4s 
(indie.) 
6) Post pointing after thermic test (cold 
air). 
6) Apres4preuve thermique (air froid).' 
Right labyrinth 
Left labyrinth 
Lab. Dr 
Lab. G 
Sagittal 
deviation 
D4v. sagit. 
Lateral 
deviation 
D4v.lat4r 
c) After test in rotating' 
chair 
c) Aprfss 4preuve giratoire 
. (fauteuil-kyn4m4- 
trigue 
To the right 
To the left 
Par flanc Dr. 
Par flanc G.. 
a) After rotating 
a) Post-giratoire _ 
To the right 
To the left 
Par flanc Dr... 
Par flanc G 
4. Nystagmus 
4° Nystagmus 
6) After thermic test (cold 
air) 
b) Post-thermique (air 
froid) 
Right labyrinth 
Left labyrinth 
Lab.Dr 
Lab. G AVIATION .MEDICINE IN THE A. E. F. 
277 
Interpretation.. 
Interpretation. 
Conclusions 
Conclusions... 
Physician in charge of examination. 
Le Mddecin charge de l’Examen, 
6.—Ophthalmic Examination. 
e° Examen Ophtalmologique. 
1. Lachrymal ducts, eyehds, conjunctivas 
1° Voies lacrymales, paupteres, conjonctives <■ 
2. Pupils during repose or during exertion 
2° Pupilles a l’4tat statique et dynamique 
3. Deep membranes 
3° Membranes profondes 
4. Visual acuity a) Right b) Left 
4° Acuity visuelle. a) Droite b) Gauche 
5. Field of vision a) Right b) Left 
5° Champ visuel. o) Droite b) Gauche - 
6. Color vision 
6° Sens chromatique - 
7. Binocular vision 
7° Vision binoculaire 
1. Rapidity of normal acuity 
1° Vitesse de l’acuite normale 
2. Acuity above normal 
2° Acuity hypernormale 
3. Nocturnal vision 
3° Vision nocturne 
4. Vision in dazzling light or toward sun 
4° Vision d’6blouissement ou a contre-soleil 
5. Stereoscopic vision 
5° Vision stdrdDscopique 
Supplementary 
tests 
Epreuves complb- 
mentaires , 
Remarks and con- 
clusions 
Observations; con- 
clusions. 
Physician in charge of examination. 
Le M6decin charge de l’Examen. 
7.—Remarks and Conclusions. 
7° Observations et Conclusions. 
The Chief Physician. 
Le M&leein-Chef. 278 
AVIATION MEDICINE IN THE A. E. F. 
ITALIAN AIR SERVICE. 
OPPICE OF PSYCHOPHYSIOLOGICAL EXAMINATIONS OP AVIATION CANDIDATES 
Ufficio di Ricerche Psicofisiologiche sui Candidati dell’Aviazione 
- (?o°rsoT?affa'elfo?&1- TORINO 
POINTING TEST 
PROVA DELL' INDICAZIONE 
LEFT HAND 
MANO SINISTRA 
Before rotating 
ftlOHT HAND 
MANO DESTRA 
Before rotating 
PRIM A DELLA ROTAZIONE. 
Mftt&NL 
l'HIMA DKLI.A ROTAZIONE ( 
After rotating . 
DOI'O la kota/iont: ( AVIATION MEDICINE IN THE A. E. F. 
279 
(No. 1.) 
(N. 1.) 
Command of Aviators 
Com ando Aviatori. 
Office of Psychophysiological Examination of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche sui Candidati dell’Aviazione. 
Examination No. Turin 19.. 
Esame N Torino, li 
RECORD OF EXAMINATION. 
RELAZIONE DI VISITA. 
Undergone by pupil 
Subita dall’ allievo 
Rank Corps 
Grado Corpo 
Full name 
Cognome e nome - 
Son of 
Figliodi 
of the class from 
della classe da 
The result of the examination made in this office is that the above-named soldier is 
Dalle visite praticate in questo ufficio risulta che il sunnominato militare h 
to flying service 
al servizio in volo 
The Director of the Office. 
II Direttore dell’ Ufficio 
Office of Psychophysiological Examination of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche sui Candidati dell’Aviazione. 
1. PHYSICAL EXAMINATION. 
1. ESAME SOMATICO. 
No. Rank Corps 
N Grado Corpo 
Surname and given name 
Cognome e nome - 
Date 
, LI 
Past history 
Anamnesi , 
Heredity 
Gentilizio 
Habits 
Abitudini: 
(a) Tobacco 
(а) Tabagismo 
(б) Alcohol 
(6) Alcoolismo 
Former sporting activities 
Precedenti sportivi 
Former illnesses 
Malattie pregresse - 
So far as you know have you ever had syphilis 
Ammette lue 
(If so, account of infection) 
(Eventualmente storia dell’infezione) 
Wounds (date, circumstances, description, outcome) 
Traumatismi (data, circostanze, descrizione, esito) 
Former medico-legal proceedings 
Pro v ve dimenti me dico-lg gali prece denti 
Subjective symptons 
Sintomi soggettivi 
I declare that the information given by me concerning my personal and family medical history is true, 
complete, and faithfully recorded. 
Dichiarochelenotizie da me date, suimiei precedenti personalie famigliari,sono vere, complete e fedel- 
mente registrate. Dichiaro anche che sonostato avvertito delle conseguenze di una dichiarazione errata 
Signature 
Firma: 
Objective examinations 
Esame oggettivo 
External examination—Constitution and defects of skeleton and joints 
Esame esterno—Costituzione e alterazione dello scheletro e articolazioni 
Muscular development and hypertrophies 
Sviluppo muscolare e ipotrofie 280 
AVIATION MEDICINE IN THE A. E. F. 
Gait 
Deambulazione . . 
State of nutrition and adipose tissue 
Stato di nutrizione e pannicolo adiposo 
Weight and height Weight in kg Height in meters and cm. 
Peso e statura Peso kg Statura m. 1 e cm 
Measurement of chest and abdomen Chest .. cm. Abdomen .. cm. 
Perimetro toracico e addominale. Torace cm Addome cm 
Skin and mucous membranes (color, abnormalities, cicatrices) 
Cute e mucose (colorito, alterazioni, cicatrici) . 
Peripheral lymphatic glands 
Ghiandole linfatiehe periferiche 
Thyroid and ductless glands 
Tiroide e ghiandole endocrine 
Remarks 
Osservazioni 
Respiratory organs 
Organi respiratori 
Inspection, palpation, percussion, and auscultation 
Ispezione, palpazione, percussione e ascoltazione 
Spirometry 
Spirometria 
Remarks 
Osservazioni — 
Cardio-vascular system 
Sistema cardiovascolare 
Heart and large blood vessels 
Cuore e grossi vasi 
Inspection, palpation, percussion, and auscultation 
Ispezione, palpazione, percussione e ascoltazione 
Remarks 
Osservazioni '. 
Peripheral vessels with Riva Rocci sphygmomanometer 
Vasi periferici: col “Riva Rocci” m/m 
Blood pressure at.. o’clock by Pachon method Max mm Min. .mm. 
Pressione arteriosa a ore col “ Pachon” massima m/m minima m/m 
Quality of pulse, frequency 
Qualita del polso, frequenza 
Varicose veins, cyanosis, etc. 
Variei, cianosi, ecc 
Abdominal walls and organs 
Pareti ed organi addominali 
Genitals 
Organi genitali 
X-Ray 
Radioscopia 
Nervous system responsiveness 
Sistema nervoso. Mobility attiva 
Tremors 
Tremosi 
Romberg’s sign 
Fenomeno di “Romberg” 
Abdominal and cremasteric reflexes 
Riflessi addominalie e cremasterici 
Tendon and periosteal reflexes 
Riflessi tendinei e periostei 
Pupils and pupillary reflexes 
Pupille e riflessi pupillari 
Demography 
Dermograftsmo 
General sensibility (touch, heat, pain) 
Sensibility generate (tattile, termica e dolorifica) 
Psychopathic signs 
Fenomeni psicopatici 
Remarks 
Osservazioni 
Urine 
Orina: 
Appearance 
As petto 
Color 
Colore 
Reaction 
Reazione... 
Density 
Densita 
Albumin 
Album ina 
Sugar 
Glucosio 
Microscopic examination of sediment 
Esame microsc. delsedimento 
Remarks 
Osservazioni AVIATION MEDICINE IN THE A. E. F. 
281 
Special annotations 
Annotazioni speciali 
Conclusions 
Resultato complessivo 
Signature 
(Firma) 
Motorist. 
Motorista. 
Assembler. 
Montatore. 
No. 
N 
Rank. Corps. 
Grado Corpo 
Full name. 
Cognome e nome .' 
Father. 
Paternity 
Date of birth. 
Giomo dinaseita 
Place. 
Luogo di naseita 
District. 
Distretto - 
Civilian occupation. 
Professione da borghese 
Date of enlistment. 
Data di arruolamento - 
Have you ever flown? When? 
Ha mai volato ; quando 
In what capacity? 
In che qualita 
Since what date? 
A1 fronte dal 
In what capacity? 
In che quality : 
Is at the school of. since. 
Si trova alia Scuola di ; dal 
Date of presentation at the office. 
Data di presentazione all’ ufficio 
FORMER ILLNESS AND RELATIVE MEDICO-LEGAL STATUS. 
MALATTIE PREGRESSE E PROVVEDIMENTI MEDICO LEGALI. 
Do you desire to fly? 
Se desidera volare 
The undersigned declares that all the above answers are correct and that he has been warned of the 
punishments incurred in the case of false statements. 
II sottoscritto dichiara che quanto sopra corrisponde alia verita ed b stato avvertito delle punizioni 
in cui incorre nel caso di false dichlarazioni. 
Signature. 
Firma 
MEDICAL EXAMINATION. 
VISITA MEDICA. 
Pathological and abnormal conditions. 
Fatti patclogici o anormali - 
Fit. Uriiit for. 
Idoneo Inabile per 
Signature. 
Firma 282 
AVIATION MEDICINE IN THE A. E. F. 
Pathological and abnormal conditions. 
Fatti patologici o anormali 
Fit. Unfit for. 
Idoneo Inabile per 
Signature. 
Firma 
VACUUM CHAMBER. 
CAMPANA PNEUMATICA. 
Effects. 
Comportamento 
Signature. 
Firma 
FINAL DECISION. 
CIUDIZIO FINALE. 
The Director. 
. II Di rettore 
EXAMINATION OF EARS. 
VISITA OTOIATRICA. 
Office of Psychophysiological Examinations 
of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche 
sui Candidati dell’Aviazione. 
VII. VARIOUS PHYSIOLOGICAL EXAMINATIONS. 
VII. ESAMI FISIOLOGICI VARI. 
No. Rank. Corps. 
N Grado Corpo 
Surname and given name. 
Cognome e Nome 
rrtir’.iiiiiiinri 
I. EXCITABILITY. 
I. EMOTIVITA. 
General reaction. 
Reazione generate 
Vasomotor. 
Reazione vasomotoria ; 
Pulse. 
Reazoine del polso 
Respiration. 
Reazoine del respiro 
Tremor. 
Reazione del tremito 
Conclusion; excitability. 
Giudizio complessivo; emotivity 
II. MUSCULAR SENSE. 
II. SENSO MUSCOLARE. 
Type. 
Tipo 
Regularity. 
Regolaritl, 
Fitness. 
Idoneita 
m. 
hi 
Signature. 
Firma AVIATION MEDICINE IN THE A. E. F. 
283 
Office of Psychophysiological Examinations of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche 
sut Candidati Dell’Aviazione. 
IX. PSYCHICAL EXAMINATION. 
IX. - ESAME PSICHICO. 
No. Rank Corps 
N Grado Corpo 
Surname and given name 
Cognome e nome 
Date 
Data , .' 
Progression of times of exposure 
(Progressione dei tempi di esposizione ) 
(a) Speed of perception-. 
(a) Velocity di appercezione. 
Series. Minimum time. 
Segno. Tempo minimo. 
1 
2 
3 
4 
5 
6 
7 .'. 
8 
9 
10 
(6) Extent of perception. 
(6)Estensione di apperce- 
ziorie. 
Minimum time. 
_ Tempo minimo. 
Series. 
Serie. 
1 2 3 4 5 
1 .*..... 
2 
3 
4 
5 
6 
7 
8 
9 . 
10 
(r) Speed of comparison. 
(c) Velocity di comparazione. 
! Series. Minimum time. 
j Serie. Tempo minimo. 
1 
2 
3 
4 
5 , 
Mean minimum time. , 
Tempo minimo medio. 
(d) INTENSITY OF ATTENTION. 
(d) INTENSITY DI ATTENZI6NE. 
Mark to be No. of marks to be No. of marks 
canceled. canceled. canceled. Ratio of errors. Total time. 
Segno da N.° dei segni da N.° dei segni Eapporto errori. Tempo totale. 
cancellare. cancellare. cancellati. 
"1 * ’ f . 
REMARKS. CONCLUSION. 
OSSERVAZIONI. GIUDIZIO. 
(a) (a) ----- 
(&) <6> • 
(c) (C) 
(d) 
Psychical behavior (from all the tests in the psychological examination) 
Comportamento psichico (dal complesso delle prove per l’esame psicologico) 
Signature 
Firma 284 
AVIATION MEDICINE IN THE A. E. F. 
Office of Psychophysiological Examinations of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche 
Sui Candidati Dell’Aviazione. 
vm. resistance to pressure variations. 
VIII - RESISTENZA ALLE VARIAZIONI DI PRESSIONE. 
No. Rank Corps 
N° Grado Corpo 
Surname and given name 
Cognome e nome 
Barometric pressure Temperature Date 
Pressione barometrica Temperatura li— 191... 
Past history and present status 
Note anamnestiche e stato presente 
Hours and Pressure. Annotations, 
minutes. I res- Temper- Annotazioni. 
Ora e minuti. sione. atura 
Remarks 
Osservazioni 
Conclusion 
Giudizio complessivo 
Signature 
Firma 
Office of Psychophysiological Examinations of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche Sui Candidati Dell’ Aviazione. 
IV. Examination of vestibular apparatus. 
IV. Esame dell’ apparecchio vestibolare. 
No. Rank Corps 
N Grado Corpo 
Surname and given name 
Cognome e Nome * 
Place and date 
li 
Past history as to psychophysiological data 
Anamnesi speciale 
The undersigned declares that the above data are true and complete 
II sottoscritio dichiara che i dati surriferiti sono veri e completi. Signature, Firma 
Spontaneous nystagmus 
Nistagmo spontaneo - 
Duration of rotary nystagmus Right Left 
Durata del nistagmo postrotatorio D S 
Behavior during rotation: 
Comportamento nella rotazione: 
With head erect 
A capo eretto 
With head bent at 90° 
A capo flesso a 90° 
Character of gait after excitation 
Comportamento della deambulazione dopo eccitazione AVIATION MEDICINE IN THE A. E. F. 
285 
Standing tests On both feet On right foot On left foot 
Prova statica Sui due piedi Sul piede D Sul piede S 
Pointing tests 
Prova dell' indicazione 
Static sense of position: 
Senso statico della posizione: 
Ahead. Behind. Right. Left. 
In avanti, Indietro. A destra. A sinistra. 
Degrees. Mean error. Degrees. Mean error. Degrees. Mean error. Degrees. Mean error. 
Gradi. Errore medio. Gradi. Errore medio. Gradi. Errore medio. Gradi. Errore medio. 
Verticalitv (falling tests): 
VerticalitA: 
Inclination—forward—backward. Inclination—lateral. 
Inclinazione antero posteriore. Inclinazione laterale. 
Mean error Mean error Mean error Mean error 
forward. backward. Mean error. right. left. _ Mean error. 
Media errori Media errori Errore medio. Media errori Media errori Errore medio, 
in avanti. indietro. a destra. a sinistra. 
Remarks 
Osservazioni « 
Resuit 
Resultato 
Signature 
Firma 
Error in estimating the inclination: 
Errore nell’apprezzare l’inclinazione: 
Incline forward Incline backward Incline to right Incline to left 
Inclinazione in avanti Iclinazione indietro Inclinazione a destra Inclinazione a sinistra 
Deg Estimate Error Deg. Estimate Error Deg. Estimate Error Deg. Estimate Error 
Grad’i Apprezzati Errore Gradi Apprezzati Errore Gradi Apprezzati Errore Gradi Apprezzati Errore 286 
AVIATION MEDICINE IN THE A. E. F. 
Error in estimating vertical position: 
Errori nell’apprezzare la posizione verticale: 
In inclination—forward—backward. In lateral inclination (right, left). 
Nell’ inclinazione antero posteriore. Nell’ inelinazione laterale. 
A=forward. D = back ward. D=right. S=]eft. 
AD ADADADADDSDSDSDSDS 
I 
Mean of forward error. Mean error to right. 
Media degli errori in Media errori a D 
avanti 
backward. left. 
Media degli errori in Media errori a S 
indietro 
Mean error. Mean error. 
Errore medio Errore medio 
Office of Psychophysiologucal Examination's of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche 
Sui Candidati Dell’Aviazione. 
V. REACTION TIME IN THOUSANDTHS OF A SECOND 
V. TEMPI DI REAZIONE IN' 0"001 
No. Rank Corps 
No Grado Corpo 
Surname and given name 
Cognome e Nome 
Rate 
li 
Information furnished by the subject No. of flights Maximum altitude Maximum duration 
Notizie fornite dal soggetto No. deivoli Quota massima... Durata massima 
(Speeialmente per il personale navigante) 
(Especially for the flying personnel) 
lust coming from (service, rest, furlough, hospital, etc.) for 
Proviene da (servizio, riposo, licenza, ospedale, ecc.) per 
Incidental happenings 
Ineidenti 
At present he states that 
Attualmente accusa: 
Troubles in flight, former 
Disturbi in volo: precedenti 
Troubles inflight, present 
Disturbi in volo: presenti 
Sensitivitv in flying 
Sensitivita di volo: 
Equilibrium Orientation 
Orientnmento 
Disturbances of attention (before) (after) 
Disturbi dell’attenzione: (prima) (dopo) 
Disturbances of memory (before) (after) 
Disturbi della memoria: (prima) (dopo) 
Disturbances of will (before) (after) 
Disturbi della volontit: (prima) (dopo) 
Disturbances of (after) 
Disturbi della carattere: (prima) (dopo) 
Sleep Dreams 
Sonno Sogni 
ITe attributes the present disturbances to 
Attribuisce i presenti disturbi a 
Remarks 
Osservazioni varie: AVIATION MEDICINE IN THE A. E. F. 
287 
General remarks. 
Conclusion. 
Osservazioni generali. 
Risultato complessivo. 
1. Normality 6. Distractability 
1. Normalita 6. Distraibilita 
2. Regularity 7. Liability 
2. Regolarita 7. Lability 
3. Short reaction 8. Instability 
3. T. R. brevi 8. Instability 
4. Long reaction time 9. Adaptability 
4. T. R.lunghi 9. Adattamento 
5. Variability 10. Bearing 
5. Variability 10. Contegno 
Signature 
Firm a 
To visual stimulus. 
A stimolo visivo. 
Reading a watch. 
Letture orologio. 
Remarks. 
Osservazioni. 
No. T. R 
Discarded 
Scarti 
Total 
Totale 
Mean 
Media 
Extreme values 
Valori estremi 
Normal group 
Grupponorm 
Mean deviation 
Deviaz media 
Coefficient ofvaria- 
bility 
Coefficiente divari- 
ability 
Errors 
Errori 
Values of reaction time. 
Valori dei T. R. 
% % % % % 
To acoustic stimuli. 
A stimolo acustieo. 
Reading watch. 
Letture orologio. 
Remarks. 
Osservazioni. 
No. T. R 
Discarded 
Scarti 
Total 
Totale 
Mean 
Media 
Extreme values 
Valori estremi 
Normal group 
Grupponorm 
Mean deviation 
Deviaz media 
Coefficient of varia- 
bility 
Coefficiente di vari- 
ability 
Errors 
Errori 
Values of reaction tjmo. 
Valori dei T. R. 
% % % % % 288 
AVIATION MEDICINE IN THE A. E. F. 
Curve frequency. 
Curve di frequenza. 
Total p f.pnj- 
value. ler.c®nt- 
V. S Ac- 
— 100 
101-110 
111-120 
121-130 
131-140 i 
141-150 
151-160 
161-170 
171-180 
181-190 
191-200.... 
201-210. 
211-220 
221-230 
231-240 
241-250 
251-260 
261-270 J 
271-280 
281-290 
291-300 
301 + 
Total 
Totali. 
vahS Fer/tent- 
V. S. Ac- 
Discarded 
Scarti 7 
Total 
Totali 
Mean ' 
Medie - 
Extreme values 
Valori estremi 
Normal group 
Grupponorm 
Mean deviation 
Deviaz media 
Coefficient of variability 
Coefficiente di variability 
Errors 
Errori % % 
Candidate Pilot 
Candidato Pilota 
Candidate Observer 
Candidato Osservatorc 
Pilot 
Pilota 
Observer. 
Osservatore 
Office of Psychological Examination of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche sui Candidati dell’Aviazione. 
Examination No. Date 
Esame No , li 
RESULT OF EXAMINATION. 
RESULTATO DELL’ESAME. 
taken by (rank) (Corps) 
subito dal (grado) (Corpo) 
Surname and given name 
Cognome e N ome , 
Father Birth place Date of birth 
paternity luogo di nascita data di nascita 
INFORMATION FURNISHED BY CANDIDATE. 
INDICAZIONI FORNITE DALL’INTERESSATO. 
Date of enlistment 
Data dell’arruolamento 
Declaration of citizenship 
Professione da borghese 
Former aeronautic experience (if pilot, date of commission, where located, etc.) 
Precedenti aeronautici (se pilota, data del brevetto; dove prestb servizio, ecc.) 
Accidents and injuries 
Incidenti sofferti e traumi : 
Malattie famigliari e personali pregresse : 
Medico-legal proceedings 
Provvedimenti medico-legali 
Subjective disturbances 
Disturbi soggettivi 
Tobacco 
Habits Itabacco 
Abitudini ‘ Alcohol 
alcohol 289 
AVIATION MEDICINE IN THE A. E. F. 
Result of Examinations. 
Esito Degli Esami. 
I. PHYSICAL EXAMINATION. 
I.—ESAME SOMATICO. 
General condition—Skin and mucous membrane 
Stato gene rale .—Cute e mucose 
1. Weight and measurements 
1. Pesoemisure 
Weight in kg. Height in meters 
Peso Kg Statura m 
Chest in cm. Abdomen in cm. 
Perimetro toracico cm Perimetro abdominale cm 
2. Respiratory organs 
2. Apparecchio respiratorio 
3. Cardio-vascular apparatus 
3. Apparecchio cardiovascolare.... Pulse (frequency) Blood pressure at o’clock 
Polso (frequenza) Pressione arteriosa a ore 
4. Abdominal and genital organs 
4. Organi addominali e genitali 
5. Lymphatic and glandular organs 
5. Linfatici ed organi ghiandolari 
6. Urine 
6. Orine 
7. Nervous system 
7. Sistema nervoso: 
(a) Motility 
(а) motilita 
(fr) General sensitivity 
(б) sensibility gener 
(e) Reflexes 
(c) riflessi 
8. Psychopathic symptoms 
8. Sintomi psicopatici 
9. Motor organs 
9. Organi dimoto 
10. Are these objective symptoms of infection? 
10. Se esistono sintomi obiettivi di infezione 
II. EXAMINATION OF VISUAL APPARATUS AND ITS FUNCTIONING, 
n.—ESAME DELL’APPARECCHIO E DELLA FUNZIONE VISIVA. 
1. Objective examination 
1. Esame obiettivo 
2. Refraction Right eye Left eye 
2. Rifrazione.... Occhio destro Ocehio sinistro 
3. Sight Right eye Left eye 
3. Visus Occhio destro Occhio sinistro 
4. Crepuscular vision 
4. Visione crepuscolare 
5. Field of vision 
5. Campovisivo . 
6. Campo di sguardo 
7. Accommodation Right eye Left eye 
7. Accomodamento Occhio destro Occhio sinistro 
8. Stereoscopic vision 
8. Visione stereoscopica 
9. Color vision 
9. Senso dei colori — 
1. Auditory apparatus 
1. Apparecchio uditivo: 
(a) Objective examination 
(a) esame obiettivo 
(b) Auditory acuity 
(6) acuity uditiva 
2. Nose 
2. Naso: 
(а) Objective examination 
fa) esame obiettivo 
(б) Perviousness 
(6) pervietfi, 
3. Pharynx 
3. Faringe 
in. EAR EXAMINATION'. 
HI.—ESAME OTOKINOIATRICO. 
171364—20 19 290 
AVIATION MEDICINE IN THE A. E. F. 
IV. EXAMINATION OF VESTIBULAR APPARATUS. 
IV.—ESAME DELL’APPARECCHIO VESTIBOLARE. 
1. Dynamic 
1. Dinamico: 
(a) Rotation 
(а) rotazione 
(б) Gait 
(6) deambulazione. 
2. Static 
2. Statico: 
(a) Verticality (falling test) 
(a) verticalita 
(6) Inclination. 
(b) inclinazione 
V. REACTION TIMES. 
V.—TEMPI DI REAZIONE, 
Normal Coefficient 
Mean value (with error) deviation ofvaria- 
and extreme values, (with error). bility. Errors %. 
Valore medio (con er- Deviazione Coefficiente Errori%. 
rore) e valori estremi normale di varia- 
(conerrore) bilita 
1. Visible without previous information 
1. Visivosenzapreavviso ± ... (.../...) ... ± 
2. Visible with previous information 
2. Visivo con preavviso ± ... (.../...) ... ± 
3. Hearing 
3. Uditivo ± ... (.../...) ... ± 
Remarks 
Osservazioni: 
VI. TIME OF CHOICE AND DETERMINATION. 
VI.—TEMPI DI SCELTA E DETERMINAZIONE. 
1. Mean comprehensive value 
1. Valore medio complessivo 
2. Ratio of mistaken reactions to the whole 
2. Rapporto delle reazioni sbagliate sul totale 
3. Existence of systematic errors 
3. Se esistono erroi sistematizzati 
Remarks 
Osservazioni: 
VII. EXCITABILITY EXAMINATION. 
VII.—ESAME DELL’ EMOTIVITA. 
Vffl. RESISTANCE TO PRESSURE VARIATIONS. 
VIII.—RESISTENZA ALLE VARIAZIONI DI PRESSIONE. 
Speed variations. 
Velocity delle variazioni 
General behavior 
Comportamento generale 
Cardio-vascular reaction 
Reazione cardiovascolare 
Respiratory reaction 
Reazione respiratoria 
Hearing apparatus 
Apparecchio uditivo 
Remarks 
Osservazioni. 
Diminution of pressure.! 
Diminuzione della 
pressione 
Depression in mm... 
—ascent of m... in mm... 
Depressions mm 
pari a ascensione 
dim in minuti 
Diminished pressure. 
Pressione diminuita 
Pressure in mm = 
meters per minute 
Pressione mm 
pari a m 
per minuti 
Increase of pressure. 
Aumento della 
pressione 
Compression of.. ..mm, 
— descent of . .m. in mm. 
Compressions di mm... 
pari a discesa dam 
in minuti 291 
AVIATION MEDICINE IN THE A. E. F. 
IX. PSYCHICAL EXAMINATION. 
IX.—ESAME P3ICHICO. 
Behavior (including all tests) 
Comportamento (dal com- 
plesso delle prove) 
1. Speed of perception 
1. Velocita. de appercezione - 
2. Extent 
2. Estensione di appercezione 
3. Attention 
3. Attenzione 
CONCLUSION. 
GIUDIZIO COMPLESSIVO. 
- ■ 
DECLARATION OF FITNESS. 
DICHIARAZIONE DI IDONEITl. 
The Director of the Office. 
II Direttore dell’ Uffieio 
Office of Psychophysiological Examinations of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche sui Candidati dell’ Aviazione. 
m. EXAMINATION OF EAR, NOSE, AND THROAT. 
III. ESAME DELL’ ORECCHIO, DEL NASO E DELLA GOLA 
No. Rank Corps 
N Grado Corpo 
Surname and given name 
Cognome e nome 
(Date) 
(Data) * 
Anamnesiriguardantelaspecialitit 
The undersigned declares that the above data are true and complete. 
II sottoscritto dichiara che i dati surriferiti sono veri e completi. 
Signature 
Firma.... 
Right ear Left ear 
Objective examination AD AS 
Esame obbiettivo - 
Otoscopic examination 
E same otoscopico .. 1 
Rhinoscopic examination 
Esame rinoscopico - - 
Pharyngoscopic, Rhinopharyngoscopic andlaryngoscopic examination 
Esamef iringoscopico, rinofaringoscopico e laringoscopico 
Functional examination Eight ear Left ear 
Esame funzionale -A- D AS 
Hearing acuity Phonometer at meters 
AcuitS, uditiva Fonometro a m. gradi - - 
Low meters 
Fonemihassi metri ... 
Whispering voice Medium 
Voce afona Fonemi medi metri 
Sharp 
Fonemi acuti metri • 
Standard watch 
Orologio campione 
Tuning fork 
Esame coi diapason 292 
AVIATION MEDICINE IN THE A. E. E. 
Perviousness of nasal passages: 
Pervieta nasale: 
Catheter in the nostril 
Catetere nella narice 
Inspiration pressure mm H2O— 
Pressionenell’ ispirazione mm H2 O— 
Expiration pressure mm H2O+ 
Pressione espirazione mm H2O+ 
•Tracing 
Tracciato 
Remarks 
Osservazioni - - 
Conclusion 
Risultato 
• Signature 
Firma 
Field of Vision 
Campo Visivo 
~ Field of viear * 
Campo di Sguardo 
Signature 
Firma AVIATION MEDICINE IN THE A. E. F. 
293 
Office of Psychophysiological Examinations of Aviation Candidates. 
Ufficio di Ricerche Psicofisiologiche sui Candidati dell’ Aviazione. 
II. EYE EXAMINATION. 
II. ESAME DELL’ OCCHIO. 
No. Rank Corps 
N Grado Corpo 
Surname and given name 
Cognome e nome 1 
Date 
li 
Past history as to eyes 
Anamnesi riguardante la speciality 
Right eye 
Objective examination O D 
Esame obbiettivo 
Surrounding parts of eyeball 
Annessi 
Refracting media 
Mezzicifrangenti 
Inner membranes 
Membraneinterne 
Refraction 
Rifrazione 
Functional examination 
Esame funzionale: 
Visus 
Crepuscular vision and luminous sense 
Visionecrepuscolare e senso luminoso: 
Photometry 
Fotometro - 
Photometric tables 
Tavole fotometriche 
Field of vision 
Campo visivo 
Field of view 
Campo di sguardo 
Accommodation 
Estensione accomodativa 
Stereoscopic vision 
V isione stereoseopica 
Color sense 
Senso cromatico: 
Examination with the tables 
Esame con le tavole. * 
Examination with wool 
Esame con le lane 
Examination with instruments 
Esame con strumentale 
Left eye 
O S 294 
AVIATION MEDICINE IN THE A. E. F. 
CREPUSCULAR VISION. 
VISIONE CREPUSCOLARE. 
With daylight sees at a distance of meters Right eye test type No Left eye test type No 
Least visual angle Least visual angle 
A luce diurna vede alia distanza di m O D segno N O S segno N 
angolo visivo minimo = angolo visivo minimo = 
Minimum Luminosity of the fundus 
light Luminosita del fondo. 
required 
Luce 
sufliciente 
minima. x , 
DfctflnpA initial 
in cm. Iniziale 9/10 8/10 7/10 6/10 5/10 4/10 3/10 2/10 1/10 
Distanza =* 
in cm. 
R.E. No. of smallest 
O D test type recog- 
nized 
N. del segno mini- 
mo riconosciuto 
Corresponding vis- 
ual angle in sec- 
onds 
Angolo visivo (Av) 
corrispondente 
insecondi 
Visual angle 100 
Av 100 
Initial visualangle 
Aviniziale 
L. E. No. of smallest test 
O S type recognized 
N. del segno mini- 
mo riconosciuto 
Corresponding vis- 
ual angle in sec- 
onds 
Angolo visivo (Av) 
corrispondente 
insecondi j 
Visual angle 100 
100 Av I 
Initial visual angle 
Aviniziale 
i ' I 
Remarks 
Osser vazioni . 
Conclusion 
Resultato complessivo 
Signature 
Firma 
OFFICE OF FSYCHOPHYSIOLOGICAL EXAMINATIONS 
UFFICIO DI RICERCHE PSICOFISIOLOGICHE 
SUI CANDIDATI DELL’AVIAZIONE 
Of Aviation Candidates. 
VI. TIME OF CHOICE AND DECISION 
VI. TEMPI DI SCELTA E DI DETERMINAZIONE 
No. Rank Corps 
N (Grado) (Corpo) 
Surname and given name 
Cognome e Nome 
Torino, li AVIATION MEDICINE IN THE A. E. E. 
295 
Commands Average values “XSoni” ' 'v'Sutty' 
Comandi Valor! Medl “ST D°v£SSi MErrore 
1. Forward 
1. Avanti 
2. Backward 
2. Indietro 
3. To left 
3. A sinistra 
4. To right 
4. A destra 
5. Negative 
5. (Negativo) 
Mean values 
Valorimedi 
Is there any regularity in the errors and what 
Esiste ana regolarita negli errori e quale? 
DECISION 
GIUDIZIO 
Signature 
Eirma 
Series of successful tests 
Serie delle prove successive 
Reading watch 
Letture orologio 
I 
2 3 5 1 4 
4 1 2 4 .. 3 
1 2 5 2 5 
5 4 3 1 2 
3 1 1 3 1 
5 3 4 4 2 
1 2 3 2 1 
2 5 5 5 3 
4 4 1 2 3 5 
3 5 1 1 4 
1 2 4 4 3 
4 3 5 2 5 
I I 
REMARKS 
OSSERV AZIONI 296 
AVIATION MEDICINE IN THE A. E. E. 
Values of reaction time for single commands 
Valori dei TR ai singoli comandi 
Forward Backward Left Right 
1. Avanti 2. Indietro 3. Sinistra 4. Destra 
N. Valore dei TR N. Valore dei TR N. Valore dei TR N. Valore dei TR 
1 1 1 1 
2 2 2 2 
3 3 3 3 
4 4 4 4 
6 5 5 5 
6 6 6 6 
7 7 7 7 
8 8 8 8 
9 9 9 9 
10 10 10 10 
11 11 ...• 11 11 
12 12 12 12 ~... 
Sum 
Somme 
Means 
. Medie 
Extreme values 
Valori estremi 
Mean deviation 
Deviazione media 
Coefficient of variabi- 
lity 
Coefficiente di 
variability - - 
Errors 
Errori 
Errors 
Errori 
Quality of error. 
Qualita 
degli errori Value of TR 
Valore dei TR 
Comandi Errori 
No. of errors 
N.° Degli errori 
at command 1 on 12 
alCom. 1 su 12 
” ” 2 su 12 
” ” 3 su 12 
” ” 4 su 12 
” » 5 su 12 
Total on 60 
Totale su 60 AVIATION MEDICINE IN THE A. E. E. 
297 
BRITISH AIR SERVICE. 
Aviation Candidates’ Medical Board, R. A. F. 
EXAMINATION OF CANDIDATE FOR COMMISSION IN THE ROYAL AIR FORCE. 
[F. S. Form 205.] 
Rank and number Name Date Age 
Vision. ;;;;;;;:;;;;;;;;:;}with glasses 
Color vision 
Physique 
Wounds and injuries 
Surgical abnormalities 
Mentality Initials 
1. SURGICAL EXAMINATION. 
2. MEDICAL EXAMINATIONS. 
T. T 
Moderate 
Mod. B. B 
Habits: Cigarettes and pipes p. d. Inhales Alcohoh 
Games and sports 
Occupation, civil life 
Army (period and unit) 
Foreign service{|[^®— 
Illnesses (to be underlined, and notes made below): Asthma, hay fever, malaria (residence in hot 
climate), rh. fever, digestive disturbances, nervous debility, migraine, petit mal, chorea, sea sickness, 
train sickness, operations, accidents, wounds, gassing, shell shock, concussion, syphilis, gonorrhea, other 
illnesses. 
Family history. Tuberculosis, heart disease, nervous, mental. 
Heart. Size 
Sounds 
Rate (I) at rest (II) after exertion 
(Ill) returning to normal 
Pulse. (I) Horizontal (II) Raise 
Thorax. Expansion 
♦Vital capacity 
Breath held (I) at rest 
*(II) after exercise 
- *Reasons for giving up 
Abdomen. Muscular tone : 
♦“Splashing” 
Nervous system. Deep reflexes 
Tremor, etc 
Mentality 
Summary Initials 
History 
Hearing R. ear D. ear i 
Membrane R L 
Teeth 
Pharynx 
Naso-pharynx 
Nose 
Muscle sense 
Nervous stability 
Vestibular stability 
Mentality 
Summary. Initials 
3. AURAL EXAMINATION. 
4. ASSESSING. 
Found: 
Fit as 
Unfit as . 
Temporarily unfit owing to . 
Signature , 
President A viation Candidates’ Medical Board. 
Date 
Royal Air Force. 
[F. S. Form 48.] 
[Envelope to contain the medical history of an officer, probationer, warrant officer, N. C. O. or man of the 
air force.] 
vra~„ /Official No. or \ 
JName [Date of Commission/ 
(Surname first.) 
Bank 
* These tests need only he applied in doubtful or special cases. 298 
AVIATION MEDICINE IN THE A. E. F. 
(1) This envelope is t(Tcontain the flimsy copies of F. S. Forms 35, 39, 40, 42, 44, and 46. 
(2) It is to be kept in the station office with other personal papers. It is to be treated as strictly 
confidential. 
(3) On the transfer of the officer or man whom it concerns to another station or hospital (whether Air 
Force, Naval, Military or Civil) it is to be forwarded with other personal papers to the commanding officer, 
of the station or hospital to which the transfer is made. 
Medical TT Station or Station or hospital transferred to— -p, t Date of 
category. hospital. or—inoculation or vaccination. forwarding. 
Entry Card, Royal Air Force. 
[F. S. Form 35.i 
Unit -. Date 
Squadron, wing, etc Height - 
Rank Official No. or date of commission 
Name 
Age , Weight Where recruited 
Residence (town and county only) 
Address of nearest relative. 
Body marks 
Vision: 
Right eye +2 
Left eye +2 
With glasses 
♦Color vision 
Physique 
Wounds and injuries .....' 
Surgical abnormalities 
Mentality 
Summary (surgical) 
♦Habits: 
Smoking v 
♦Alcohol 1 ." 
♦Any special athletic record 
Previous occupation (civil) 
Army: Period and unit Foreign service 
Illnesses 
♦Family history 
Heart: Size . 
Sounds 
♦Rate (see F. S. Form 36)—I *11 *111 
Pulse—*1 *11 
Thorax—expansion *Vital capacity 
♦Breath held—(i) At rest *(ii) After exercise 
♦Reasons for giving up 
♦Abdomen 
♦Nervous system: 
Deep reflexes 
♦Tremor 
♦Mentality , 
♦Summary (medical) 
Hearing 
Teeth 
Nose 
♦Muscle sense 
♦Nervous stability * 
♦Mentality 
Summary (aural) 
Signature of medical officer 
[F. S. Form 39.] 
Royal Air Force. 
[All Air Force cases except from expeditionary forces.] 
Discharge Card, U. K. 
Name of hospital or station 
Serial No. in admission list (F. S. Form 38).. 
Unit - 
Official No. of date of commission. , 
Squadron, wing, etc * 
Sank 
Grading . 
♦These items need not be filled up for ground duty candidates. AVIATION MEDICINE IN THE A. E. F. 
299 
Name ..V. ? 
Age Total service 
Date of arrival at hospital: 
(а) As an admission 
(б) Asa transfer (state where from) 
Date of discharge: 
To duty 
By change of disease 
As an invalid 
Date of death 
Date of transfer (state where to) 
Number of days under treatment 
Observations (to be filled in by the medical officer in charge of case): 
♦Disease . .* 
Operations 
Result of operation 
Complications in order of occurrence 
Signature of medical officer 
One of these cards is to be completed for every patient of Air Forces received into hospital, except those 
from expeditionary forces. 
Royal Air Force. 
[F. S. Form 40.] 
Discharge Card for Expeditionary Air Force Cases. 
Hospital or Station. 
State from which Force Serial No. in Admission! 
Unit ' 
OfficialNo. or Date of Commission , 
Squadron, Wing, etc 
Rank 
Grading 
Name : 
Age Total Service 
State Service with Field Force in Months 
(Last period only if more than one) 
(а) Date of arrival at hospital as an admission 
(б) As a transfer (state where from) 
Date of discharge to duty 
Date of discharge by change of disease , 
Date of discharge as an invalid 
Date of death 
Date of transfer (state where to) ' 
(Name of hospital to be given) 
No. of days under treatment 
Observations 
To be filled in by the medical officer in charge of case 
Disease (final diagnosis)* : 
Operations 
Result of operation 
Complications in order of occurrence 
Signature of medical officer 
One of these Red cards is to be completed for every Expeditionary Force patient of Air Forces received 
into hospital. Black cards for U. K. Air Force. 
Royal Air Force. 
[F. S. Form 44.] 
Report of Accident to a Flying Officer, Probationer or N. C. 0. (Flying). 
Unit Official No. or date of commission 
Squadron and wing 
Rank and grading • Age 
Name 
History of accident:—Hate Locality 
Name and type of machine 
Did machine catch fire? 
Was fire extinguisher fitted? 
Were telephones fitted? 
Exact position of airman when found 
Was he pinned by any part of machine? 
* To be in accordance with the official nomenclature. 300 
AVIATION MEDICINE IN THE A. E. F. 
Was there blood, hair, etc., on any part of machine? 
Was he pilot or passenger? 
Was any mishap observed? 
At what stage of flight did accident occur? - 
Helmet worn and type 
Goggles and type 
Belt and type 
Did belt cive way? 
Nature of injuries 
Nature of aid rendered 
Condition after accident, unconsciousness, etc 
Any headache? Any vomiting? - 
Signs of fracture of base 
Nightmare? ; 
No. of hours flying done 
Health immediately before accident 
Date of last special report 
If fatal, state exact cause (if thrown out, head struck, etc.) 
Chief injuries observed at post mortem 
Signature of medical officer 
[F. S. Form 35. 
Unit..; Date 
Squadron, wing, etc Height 
Rank Official number or date of commission 
Name 
Age Weight Where recruited 
Residence (town and county only) 
Address of nearest relative 
Body marks 
Vision {g; +2 With glasses 
♦Color vision 
Physique 
Wounds and injuries 
Surgical abnormalities 
Mentality 
Summary (surgical) .' 
*Habits—Smoking : 
♦Alcohol 
♦Anjr special athletic record 
Previous occupation (civil) 
Army, period and unit Foreign service 
Illnesses 
♦Family history 
Heart (size) 
Sounds 
♦Rate (see F. S. Form 36)—I *11 *111 
Pulse—*1 .*11 
Thorax—Expansion *Vital capacity 
♦Breath held—(i) At rest * (ii) After exercise 
♦Reasons for giving up 
♦Abdomen 
♦Nervous system—Deep reflexes 
* Tremor 
♦Mentality 
♦Summary (medical) 
Hearing 
Teeth 
Nose 
♦Muscle sense 
♦Nervous stability 
♦Mentality 
Summary (aural) 
Signature of medical officer. 
Entry Card, Royal Air Force. 
Sickness and inoculations (for use at air ministry only) 
N^1 Dor™[attl,nry Hospital or station. admission or Dd£°t 
jno. or mocmauon. inoculation. charge. 
* These items need not he filled up for ground duty candidates. AVIATION MEDICINE IN THE A. E. E. 
301 
Royal Air Force. 
[F. S. Form 42.] 
Special Report on a Flying Officer, Probationer or Other Flying Rank. 
Hospital or station Date 
A (i) Name (ii) Age (iii) Weight 
Rank and grading (official number or date of commission) 
(iv) Total number of hours flying (v)Maximum flying height (feet) 
(vi) Average flying height (feet) (vii) Average hours flying per week 
(viii) Nature of aerial work 
B Habits—(i) Smoking (ii) Alcohol 
C (i) Condition of lungs 
(ii) Respiratory rate and movement 
(iii) Time breath held in seconds (iv) 
(v) Time breath after exercise (vi) Expiratory force mm. Hg. 
D (i) Condition of heart and pulse 
(ii) Pulse rate at rest (iii) After regulated exercise 
(iv) Time of return to normal (seconds) 
(v) S. P D. P P. P 
(vi) Evidence of defective peripheral circulation 
E (i) Condition of muscles (generally) 
(ii) Condition of abdominal and respiratory muscles 
(iii) Condition of stomach (e. g. splashing) 
F (i) Knee jerks (ii) Other reflexes 
(iii) Tremor (fingers, eyes, tongue) 
Drawing line 
(iv) Sleep 
(v) Self-balancing (at rest) (vi) In action 
(vii) Vision 
(viii) Mentality 
G Fatigue test (U tube, etc.) ...— 
H Urinary system—(i) Albuminuria (ii) Glycosuria 
(iii) Venereal disease, history or signs of 
J (i) Condition of ears 
(ii) Condition of tonsils, etc 
(iii) Condition of teeth, etc 
(iv) Any special conditions of other systems 
K General opinipn 
Signature and rank of medical officer. 
f When used to report on a cadet or P. F. O. the other side should be used also.] 
[P. T. O.] 
WHEN USED FOE CADET THIS SPACE ALSO SHOULD BE FILLED UP 
Length of time under training 
Number of hours dual 
Summary of report by C. O. (temperament, suitability, etc.) 
Royal Air Force. 
[F. S. Form 37.] 
ROUGH NOTES OP MEDICAL OFFICER FOR FILLING UP ENTRY CARD F. S. FORM 35, WHEN 
USED FOR CANDIDATES FOR GROUND DUTIES ONLY. 
Unit ......... Date .... —. — 
Squadron, Wing, etc Height 
Rank Official No 
Name (surname first) - 
Age Weight Where recruited 
Residence (town and county only) 
Address of nearest relative 
Body marks 
Vision—R. E L. E With glasses 
Physique - 
Wounds and injuries 
Surgical abnormalities 
Mentality - 
Summary (surgical) 
Previous occupation, civil 
Army Foreign service - 
Illnesses - 
Heart—Size Sounds 
Thorax—Expansion 
Hearing - 
Teeth 
Summary 
Signature of medical officer - 302 
AVIATION MEDICINE IN THE A. E. F. 
Royal Air Force. 
[F. S. Form 41. 
ROUGH NOTES OF MEDICAL OFFICER FOR FILLING UP DISCHARGE CARD F. S. FORM 39 OR 40. 
Name of hospital or station 
Serial No. in admission list (F. S. Form 38). 
Unit Squadron, wing, etc 
Rank and grading Official No. or date of commission : 
Name (surname first) 
Age Total service 
Date of arrival—(a) as an admission 
(ft) as a transfer (state where from) 
Date of discharge to duty 
Date of discharge by change of disease 
Date of discharge as an invalid 
Date of discharge death 
Date of transfer (state where to) .* 
No. of days under treatment 
[To be fdled in by the medical officer in charge of the case.] 
Observations: 
Disease (in accordance with official nomenclature) 
Operations 
Result of operation 
Complications in order of their occurrence 
Signature of medical officer 
Royal Air Force. 
[F. S. Form 36.] 
ROUGH NOTES OP MEDICAL OFFICER FOR FILLING UP ENTRY CARD F. S. FORM 35 FOR 
CANDIDATES FOR AVIATION DUTIES. 
Unit Date 
Squadron, wing, etc.. Height 
Bank Official No .. 
Name (surname first) ... 
Age Weight Where recruited 
Residence (town and county only) . 
Address of nearest relative 
Body marks 
Vision ® |+2. With glasses 
Color vision 
Physique 
Wounds and injuries 
Surgical abnormalities ..' 
Mentality Initials of M. O. 
IT. T 
Habits. Smoking, cigttes. and pipes, p. d. Inhales. Alcohol] Moderate 
[Mod. B. B 
Any special athletic record 
Occupation, civil 
Army (period and unit) 
Foreign service{|^^;;:::::::::::::::;--:::::::::::::::::::;:::::::::::::::::::::::::: 
Illnesses 
Family history ....... 
Heart. Size 
Sounds , 
Rate I. At rest II. After exertion III. Returning to normal 
Pulse I. Horizontal II. Raised... 
Thorax. Expansion Vital capacity. 
Breath held—I. At rest II. After exertion 
Reason for ceasoning 
Nervous system. Deep reflexes 
Tremor, etc 
Mentality 
Summary (medical) Initials of M. O 
History (aural) 
±iearmgjM:ernl) R. ear L. ear 
Teeth 
Pharynx 
Naso-pharynx 
Nose .- 
Muscle sense 
Nervous stability 
Vestibular stability 
Mentality 
Summary (aural) 
Initials of M. O AVIATION MEDICINE IN THE A. E. E. 
303 
Royal Air Force. 
[F. S. Form 43.) 
ROUGH NOTES OF MEDICAL OFFICER FOR FILLING UP F. S. FORM 42, SPECIAL REPORT 
ON A FLYING OFFICER, PROBATIONER, ETC. 
Hospital or station Date 
A. (i) Name , (ii) Age (iii) Weight 
Rank and grading : Official No. or date of commission 
(iv) Total number of hours flying (v) Maximum flying height 
(vi) Average flying height (vii) Average hours per week 
(viii) Nature of aerial work 
B. Habits: (i) Smoking (ii) Alcohol 
C. (i) Condition of lungs 
(ii) Respiratory rate and movement 
(iii) Time breath held, in seconds (iv) Reasons for ceasing 
(v) Time breath held after exercise, in seconds (vi) Expiratory force mm. Hg. 
D. (i) Condition of heart and pulse 
(ii) Pulse rate at rest per minute 
(iii) Pulse rate after regulated exercise 
.(iv) Time of return to normal, seconds 
(v) Systolic pressure Diastolic pressure Pulse pressure 
(vi) Evidence of defective peripheral circulation 
E. (i) Condition of muscles generally 
(ii) Condition of abdominal and respiratory muscles 
(iii) Condition of stomach (e. g., splashing) 
F. (i) Knee jerks (ii) Other reflexes 
(iii) Tremor (fingers, eyes, tongue) 
Drawing line 
(iv) Sleep 
(v) Self balancing (at rest) 
(vi) Self balancing (in action) 
(vii) Vision (viii) Mentality 
G. Fatigue test (U tube, etc.) 
H. Urinary system: (i) Albuminuria (ii) Glycosuria, etc 
(iii) Venereal disease, history or signs of 
J. (i) Condition of ears 
(ii) Condition of tonsils, etc. - 
(iii) Condition of teeth, number requiring treatment, etc 
(iv) Any special conditions of other systems, skin, etc. 
K. General opinion: 
When used for a cadet: 
Length of time under training 
Number of hours dual 
Summary of report by commissioned officer (temperament, suitability, etc.) 
Signature of medical officer 
[P. S. Form 45.) 
ROUGH NOTES OP MEDICAL OFFICER FOR FILLING UP F. S. FORM 44, REPORT OF AN 
ACCIDENT TO A FLYING OFFICER, PROBATIONER, ETC. 
Royal Air Force. 
Unit Official No. or date of commission 
Squadron, wing, etc - - --------. 
Rank and grading Age 
Name (surname first) 
History of accident: Date Locality 
Name and type of machine - 
Did machine catch fire? Was fire extincteur fitted? 
Were telephones fitted? 
Exact position of airman when found 
Was he pinned by any part of the machine? 
Was there blood, hair, etc., on any part of the machine? 
Was he pilot or passenger? 
Was any obvious mishap observed? 
At what stage of flight did accident occur? 
Helmet worn and type 
Were goggles worn and type? 
Belt and type? Did belt give way? 
Nature of injuries 
Nature of aid rendered - 
Condition after accident, length of unconsciousness, etc 
Any headache? Any vomiting"? 
Any signs of fracture of base? Any nightmare? 
Number of hours flying done 
Health immediately before accident 
Date of last special report 
If fatal, state exact cause (if thrown out, head struck, etc.) 
Chief injuries observed at post-mortem 
Signature of medical officer 304 
AVIATION MEDICINE IN THE A. E. F. 
[F. S. Form 38.J 
Royal Air Force. 
List op Oases Admitted and State op Station (or Hospital) During Week 
Ending (Saturday Night) — 
I. Admissions, Inoculations, and Reinoculations, Vaccinations. 
Official Prob- 
q„rinl Rank No. or n t f Provisional able r>atp Num- 
No of Name and date of admit Whence diagnosis or dura- Remark:s of duL ber of 
No of Name. d. com_ admis- Whence inoculation tion of Remarks, of dis days 
case- ing. mis- S10n- etc. treat- cnarge. siok- 
sion. ment. 
For use at 
Air Ministry 
only. 
II. LIST OF CASES EXCUSED FLYING. 
III. CHANGES OF DIAGNOSIS DURING THE WEEK. 
NUMERICAL STRENGTH. 
Wt. N. C. Other 
Units at Ob- ts n Other officers O’s Other r M Total Total 
station. servers. officers, (fly- (fly- W.O’s. n',„ • en' officers, men. 
ing). ing). u s- 
STATE OF SICK QUARTERS OR HOSPITAL. 
Number of beds equipped 
Number of cases in sick quarters 
Number of Weather 
hours flying. weather. 
Sunday 
Monday 
Tuesday 
Wednesday 
Thursday 
Friday 
Saturday 
Weather and flying. 
Signature of medical officer in charge. 305 
AVIATION MEDICINE IN THE A. E. F. 
K. U. K. (Royal and Imperial) Army High Command, Chief of Air Service. 
AIR SERVICES OF THE CENTRAL POWERS. 
Health Report. 
Record No. 
PERSONAL HEALTH RECORD FOR THE AIR SERVICE. (AVIATORS, BALLOONISTS) OF 
Surname and Christian name 
Rank 
Age 
Last arm of service before applying 
Employed with the K. U. K. air forces since when 
As 
Date of examination 
Military Medical Examination Office for the Air Service. 
[Student pilots and observers, aircraft pilots and observers, airship personnel (captive and dirigible 
balloons).] 
K. U. K. MILITARY HOSPITAL NO. 1 IN VIENNA. 
Record or register number 
Place of appointment 
Purpose of examination (original examination, reexamination, confirmation) 
Surname and Christian name 
Rank ’ 
Birth date 
Last arm of service before applying. 
Employed with the K. U. K. Air Forces since when 
As 
Examination day 
A. PREVIOUS HISTORY. 
I. The answers to questions 1-29 are, so far as possible, to be filled out by the person being examined and 
affirmed by his signature. 
Questions 1-10 refer to the candidate for flying. 
1. Has there been any case of mental disorder, nervous diseases (epilepsy) among his parents, brothers, 
sisters, or other near relatives? 
Is there in his family any case of tuberculosis of the lungs or other organs? 
2. Has the applicant himself ever suffered from severe bodily sickness or nervous diseases: Such as uncon- 
sciousness, dizziness, cramps, nightmares, bed-wetting, etc? When and how long? 
Has the applicant suffered syphilitic infections and did it receive professional medical treatment? 
3. Has he as a boy or later engaged in athletic sports and which? 
4. Has he in connection with athletic sports or other activity suffered any accident? 
What bodily injuries, especially concussion of the brain and broken bones, resulted therefrom? 
Did" he have any nervous trouble as the result of such action? Of what nature and how long? 
5. Has he any tendency to dizziness (in swinging or dancing) or to sea or mountain sickness? 
Does he suffer from palpitation of the heart or colic? 
6. Has he, from examinations in school or later in connection with his work or from any other causes, 
exhibited occasional nervous symptoms (headache, uneasiness, lack of mental concentration, becom- 
ing easily fatigued, sleeplessness, melancholia, etc.) and how long? 
7. What was his civilian occupation before entering the air service or military service? 
8. Was he employed at the front before entering the air service and in what capacity? 
9. During this time, did he show symptoms of organic diseases, especially of the heart, lungs, and ears, 
or signs of nervous exhaustion (when and how long) and to what cause were they traced? 
Has he suffered from injuries or wounds? 
When? 
Describe them. (Hemorrhage.) What complications resulted and how long was treatment required? 
When did he begin service at the front again? 
10. Whv was he transferred to the air service? 
Questions 11-29 apply to active aviators or balloonists. 
II. Where, and by what medical commission, was his fitness for the Air Service determined? 
12. Date and report of this confirmation 
13 When and where was he trained as pilot or observer? 
14. To what aviation school does he belong? 
Is he a student pilot or observer? 
Is he pilot, observer, aircraft gunner, radio operator, or balloonist? 
15. Has he had any sickness during his education? What, when, and how long? 
171364—20 20 306 
16. During his training has he been involved in any special difficulties; for example, unlucky landing 
(break, crash), bad starts, etc., and did he thereby receive any bodily injury or contract any nervous 
trouble? 
Was he on that account obliged to give up flying for a time? Did his self-possession and confidence 
suffer? 
How long did these disturbances continue? ’ 
17. After how long a time and after how many flights, and how many flights alone, did he take the pre- 
scribed tests? 
When did he come to an aerodrome, to a flying division or to a combat or bombing squadron, etc.? 
18. Number of flights made up to date; average duration and altitude"? 
How does the candidate get along with flying in dense fog, clouds, or in the dark? 
Can he do the loop? 
19. How many flights or air trips, ascents in a captive balloon over the enemy lines, or how many tasks 
has he executed (air siege)? 
Were most of the flights made over high mountains or level land or the ocean? 
20. Was he frequently and successfully under Are and how did it affect his nervous system, his self-con- 
fidence, and how long did such disturbances last? 
21. Was his airplane (or balloon), his pilot (or observer) or he himself hit during these flights (ascents or 
trips), or did he see another aircraft near him fall, burn, or the like? 
Mention each occasion with date 
How did these incidents affect his nervous system, his self-confidence, and how long did the con- 
sequent disturbances endure? 
22. During his service at the front, did he experience forced landings, crashes and the like, or threatened 
disaster, although fortunately escaped, like plunging of the airplane with recovery, catching on fire, 
which was extinguished before landing, plunging into the sea, etc.? I 
Has he made parachute descents? Mention each instance of the above incidents with date and cause 
State whether or not injuries resulted 
How did these events affect his self-confidence, and how long did the consequent disturbances last? 
23. Did he get into difficulty during flights over enemy territory through stalling of the engine or strong 
head wind or shortness of fuel or other causes (squalls, thunderstorms, the sea)? 
How did these events affect his nervous system, his self-confidence, and how long did the consequent 
disturbances last? 
24. When did he first notice bodily or nervous disorders and in what form did they appear? 
(а) Disorders before flights or balloon ascensions (uneasiness, anxiety, palpitation of the heart, etc.) 
(б) Disorders during or immediately after flight in an airplane or captive balloon 
During rapid ascent (pressure in his ears, feeling of suffocation, etc.) 
During rapid descent (pressure on his ears, temples, forehead, headache, numbness, feeling of 
becoming dark before his eyes, shortness of breath, etc.) 
During steep spiral flight (dizziness, etc.) 
While remaining at high altitudes: 
At what altitude do the troubles begin and when do they disappear again? 
Did the high flights first have bad effects, after the appearance of other nervous troubles 
apart from flying (feelings of suffocation, numbness, sleepiness, anxiety, distress, 
heart trouble, dizziness, vomiting, etc.)? : 
Did the inhalation of oxygen always produce prompt results 
From escaping gas, oil vapor, etc. (headache, distress, vomiting, etc.) In which type of 
airplane or airship? 
From engine noise: (deafness, weakening of ability to distinguish, etc.) 
From wind and cold (frostbites, chafing from the goggles, irritation of the upper air 
passages, rheumatism, etc.) 
From the strong light (inflammation of the eyes, disturbances of vision) 
From physical exertions in steering, operating machine gun, etc. (pains and Cramps in 
the muscles, exhaustion of certain muscles, general exhaustion, etc.) 
Injuries on an airship 
(c) Troubles during periods of relief from flying: 
25. Since his training, has he had any illness? 
What, when, and how long? 
26. Has his mental activity during this time been influenced in any manner? 
27. When and how long has he already had furloughs or been under medical care and with what 
results 
. Did he regain his accustomed confidence as flyer after his furlough? 
28. Did the disorders come on gradually or by what circumstances were they hastened? 
What causes started the present disorders or increased them to such an extent that the examinee 
believes himself compelled to relinquish his occupation temporarily or permanently? 
29. Describe any other troubles not above enumerated 
AVIATION MEDICINE IN THE A. E. F, 
Signature of 
B. PRELIMINARY DOCUMENTS. 
What knowledge or observations of his superiors or of the Army doctor tend to official confirmation of the 
advisability of granting a furlough for recuperation or initiating proceedings for discharge? (Report 
of injury, doctor’s certificate, protocol, petition, etc.) 
C. REPORT OF EXAMINATION COMMISSION. 
Record No 
Position and movements of the eyes and lids. 
I. EYE. AVIATION MEDICINE IN THE A. E. F. 
307 
Condition of the lid edges, conjunctiva, and lachrymal organs 
Functioning of the muscles of the lid and eye (squinting and seeing double) 
Visual acuity: R with D. 
Visual acuity: L with D. 
Field of vision, perimeter (scotoma) 
Vision for distance [ 
Color vision: (Do any of his relatives have color blindness?) I. I." 11!!!"!!! ” 
Adaptation and night sight 
Eye fundi ” 
Signature. 
Mirror examination of nose, the nose-throat cavity (side cavities) 
Mirror examination of ears (residue of secretions of the middle ear) 
Obstructions of auditory canal 
Acuity of hearing: R ’’’ 
Acuity of hearing: L 
Ability to distinguish sounds 
High and low tones (hearing relief, according to Von Bezold) ” 
Rinnetest '. 
Schwabach test ’". ’ * 
Weber test ’" 
Testing sense of balance or equilibrium (static sense) 
Statements concerning subjective dizziness 
Spontaneous nystagmus •. ” 
Chair rotated to the R 
Chair rotated to the L 
Caloric reaction (most favorable positions) 
Galvanic reaction 
Hearings in space, sense of angular speed 
n. EAR. 
ni. SURGICAL SECTION. 
Signature. 
Residuum of healed wounds or injuries (adherent scars) 
Functional defects of the larger muscle groups (ankylosis) 
Signature. 
IV. PHYSICAL EXAMINATION—INTERNAL MEDICINE. 
Record No 
Ordinary bodily characteristics, appearance, condition (thymolymphatic status) bearing and gait 
Alcohol 
Tobacco 
Height - W eight 
Shape and mobility of chest (measurement expanded and contracted), breathing, lung capacity 
Condition of the respiratory organs 
Condition of the circulatory organs 
Size and form of heart (orthodiagram) 
Heart rhythm (liability) 
Pulse rate, in rest • 
Pulse rate after knee-bending 
Blood pressure, in rest 
Blood pressure, after knee-bending 
Functional or organic disorders of the heart.' 
Malaria 
Stomach-intestine-tract (colic) 
Urinalysis (was diabetes observed in the family?) 
Signature. 
Record No 
Neuro and psychopathic constitution 
Sense of power and muscular strength, of rest and motion (kinetic sense) 
Coordination (walking up an inclined plane with eyes closed) 
Reflexes - : 
Babinski 
Gordon 
Kernig 
Oppenheim • 
Rossolino, etc 
Sensibility (power of feeling) 
Noticeable symptoms of irritation (neuralgia, migraine, etc.) 
Psychopathic reactions 
Reaction time for hearing 
Reaction time for sight 
Reaction time for touch 
Reaction time for fright 
Effect of fright on respiration and circulation 
Attention 
Choice or decision (division of attention) 
Suggestibility . 
Will preparedness 
V. NERVES (PSYCHOLOGICAL EXAMINATION). 308 
AVIATION MEDICINE IN THE A. E. E. 
Fatigability 
Space perimeter 
Estimating distance 
Are there functional or organic disorders? 
Signature. 
The examined is, on the ground of official examination (recommended or not) to active air service, as 
pilot, observer, balloonist 
NET RESULT OF EXAMINATION: JUDGMENT. 
PROPOSAL. 
The examined is to be relieved from active air service until 
A furlough will be granted of The examined must present him- 
self for a new examination or confirmation. 
(date). 
Signature. PRESENT ORDERS ON THE PHYSICAL EXAMINATION OF 
FLIERS IN U. S. AIR SERVICE. 
[Regulations governing “Physical Examination for Flying” are contained in Special Regulations No. 65c.] 
War Department, 
Office of the Director of Air Service, 
Washington, September 29, 1919. 
Orders' 
No. 45._ 
1. Orders No. 31, 0. D. A. S., July 24, 1919, are rescinded and the following sub- 
stituted therefor: 
2. All applicants for heavier or lighter-than-air flying training will be subjected to 
a rigid physical examination before being authorized to proceed with such training. 
These examinations will be made only by such medical officers as are authorized in 
writing by the Surgeon General of the Army to conduct such examinations and will 
be conducted as prescribed in existing orders. 
3. A record of the examination, in triplicate, will be made on Form 609, A. G. 0. 
Two copies will be forwarded to this office direct, attention Chief Surgeon, Air Serv- 
ice, and the third copy retained by the Flight Surgeon at the station of the candidate. 
Upon receipt of the two copies of Form 609 at this office, they will be approved or dis- 
approved by the Chief Surgeon, Air Service, and one copy returned to the station 
from which received and one copy retained in this office for permanent file. 
4. Upon receipt back at the station of the copy of Form 609, the action of this office 
contained thereon will be transcribed to the retained copy of the form and the same 
certified as a “true copy”; candidates will not be allowed to proceed with their flying 
training until an approved copy of Form 609 in their case has been received back at 
the station. 
5. Whenever an individual is transferred to another station, the copy of Form 609, 
with the action of this office certified thereon, as provided in Par. 3 above, will be for- 
warded to the Flight Surgeon of the new station. The other copy of Form 609 will be 
retained at the station for permanent file. 
6. Commanding officers of Air Service stations will require the Flight Surgeon or 
Post Surgeon in the absence of the former, to investigate the physical examination 
records of all commissioned and enlisted personnel engaged in flying or under flying 
instruction. 
7. A report of this investigation covering the flying, personnel, as of November 1, 
1919, for all personnel for whom reports have not been submitted under the pro- 
visions of Par. 6, Orders No. 31, O. D. A. S. (rescinded by this order) giving name, 
rank, and organization and whether qualified or disqualified for flying status, as 
shown by the record on Form 609, will be forwarded through the commanding 
officer to this office, attention Chief Surgeon, Air Service. If the record on Form 609 
is not found, or is incomplete in any case, these facts will also be reported. 
8. In cases where the physical examination record is incomplete, unsatisfactory 
or missing, the commanding officer will immediately direct discontinuance in flying 
until the physical qualifications have been properly determined, recorded, and cer- 
tified, as required by this order. This restriction will not apply to officers who have 
309 310 
AVIATION MEDICINE IN THE A. E. F. 
already received either the reserve military aviator, junior military aviator, military 
aviator, observer, reserve military aeronaut, junior military aeronaut, or military 
aeronaut ratings. 
9. Officers making physical examinations will under no circumstances waive phy- 
sical defects. 
10. Reexaminations will be required from time to time, as deemed expedient by 
this office, or as considered necessary by commanding officers, to determine the phy- 
sical fitness of any one to continue on flying training or duty. Commanding officers 
are authorized, upon recommendation of the flight surgeon, to suspend the flying 
training of, or to relieve from flying duty, any individual considered physically in- 
capacitated, and to authorize the resumption of such training when the individual 
is found physically fit. Whenever such incapacity is not the result of a disability 
incurred as a result of participation in aerial flights, the individual will be relieved 
from flying status until the disability is removed. 
11. No rating as reserve military aviator, junior military aviator, military aviator, 
observer, reserve military aeronaut, junior military aeronaut, or military aeronaut 
will be given until the report of the board of officers received at this office has been 
furnished the Chief Surgeon, and same has been received back from the Chief Surgeon 
with a statement to the effect that the candidate is considered physically qualified 
for the rating recommended. A copy of the statement will be filed with the report 
of the board of officers on the candidate under consideration. 
12. Attention is invited to the provisions of G. O. No. 63, W. D., 1914. G. O. No. 13, 
W. D., 1917, Special Regulations No. 50, W. D. (Aviation Section, Signal Corps), 
and Circular No. 49, O. D. A. S., 1919, which should be studied in connection with 
this order in so far as the physical examination of applicants for flying training is 
concerned. 
By direction of the Director of Air Service: 
Wm. F. Pearson, 
Colonel, A. S. A., Administrative Executive. 
War Department, 
Office of the Director of Air Service, 
Washington, December 1, 1919. 
Orders'] 
No. 52. J 
1. The last sentence, paragraph 8, Orders No. 45, O. D. A. S., September 30, 1919, 
is rescinded. 
2. All officers and enlisted men on flying status, including observers, “heavier or 
lighter-than-air ” service, will be subjected to a physical reexamination on Form 609 
in January and July of each year. These examinations will be made only by such 
medical officers as are authorized in writing by the Surgeon General of the Army to 
make physical examinations for flying training, and will be conducted and recorded 
as prescribed in Orders No. 45, O. D. A. S., September 30, 1919. 
3. In cases where a 609 physical examination has been made since July 1, 1919, in 
compliance with Orders No. 31 or 45, O. D. A. S., 1919, a reexamination will not be 
required in January, 1920. 
4. When the Medical Division of this office reports either an applicant for Hying 
training or a flier as physically disqualified, the personnel division will issue an order 
definitely fixing the status of each individual case. 
5. All persons on a flying status prior to rating as reserve military aviator, junior 
military aviator, etc., will be reexamined physically by a properly authorized medical 
officer, and a report submitted to this office on Form 609 as a part of the proceedings 
of the examining board. AVIATION MEDICINE IN THE A. E. E. 
311 
6. A list of stations having medical officers authorized to conduct this examination 
will be furnished all commanding officers. At stations or places where the examina- 
tion can not be made, the commanding officer will communicate with the Director 
of Air Service, giving names of officers and enlisted men who require examination 
under the provisions of this order. 
7. Nothing in the provisions of this order will be construed to restrict commanding 
officers from removing a flier from flying duty whenever the physical condition of a 
flier warrants such action. Commanding officers are authorized to direct such other 
physical examinations from time to time as they may deem necessary. Whenever 
a flier has been removed from flying duty under the conditions mentioned in this 
paragraph, he will not be allowed to resume such duty until the flight surgeon, or 
the post surgeon in the absence of the flight surgeon, certifies that he is physically 
fit for flying duty. 
8. The physical examination required for ratings of aviation and balloon mech- 
anicians, by paragraph 310, Compilation of Orders, as amended by Changes No. 19, 
September 20, 1919, is not as complete a physical examination as is prescribed for 
fliers. No mechanician will, therefore, be allowed to take flying training or to pilot 
an airship until he has been found physically qualified by the prescribed physical 
examination for fliers (Form 609). 
9. When officers or enlisted men, including those who are physically disqualified 
as pilots, are required to participate in frequent and regular aerial flights in the per- 
formance of duties other than those of pilots, the provisions of paragraph 1269|, 
Army Regulations, will govern the question of increased compensation. Under no 
circumstances will they be allowed to take flying training or act as pilots if they are 
physically disqualified for such duty. 
10. Commanding officers of all Air Service stations are charged with the responsi- 
bility of enforcing the provisions of this order. 
By direction of the Director of Air Service: 
Wm. F. Pearson, 
Colonel, A. S. A., Administrative Executive. 
War Department, 
Office of the Director of Air Service, 
Washington, October 15, 1919. 
CIRCULAR) 
No. 123. J 
1. Commanding officers of Air Service stations where flying is being carried on 
will consult with the flight surgeon in all matters pertaining to the mental and physical 
fitness of the flying personnel of his command. The term “flying personnel” will 
include all who make aerial flights, such as instructors, flying officers and individuals 
undergoing instruction. 
2. Commanding officers will take full advantage of the assistance that can be rendered 
by the flight surgeon and the physical director of his field. Such matters as the 
amount and kind of physical exercise required by individuals engaged in flying; 
the state of fatigue of the individual flyer; the amount of sleep necessary; food prob- 
lems; reexaminations and all field conditions affecting the welfare of the flying 
personnel will be made the subject of conferences between the commanding officer 
and the flight surgeon or physical director. Commanding officers should obtain the 
recommendation of the flight surgeon on application for leaves or furlough from any 
one engaged in flying when physical incapacity is made the basis of the application. 
3. The flight surgeon will be listed on any form for clearance in vogue at an Air 
Service station, and no flying officer or any one undergoing flying instruction will be 
transferred from a station without first obtaining a clearance from that officer. Upon 312 
AVIATION MEDICINE IN THE A. E. E. 
notification of transfer, the flight surgeon will forward to the flight surgeon of the 
new station the reexamination report and laboratory rating chart of the individual 
being transferred. This will be in addition to Form 609, record of examination 
required to be forwarded to the flight surgeon of the new station, by Par. 4, Orders 
No. 31, O. D. A. S., 1919. 
4. Flight surgeons will be encouraged in every way to take flying instruction. 
Upon completion of the prescribed test, flight surgeons will be rated in the same 
manner as other flying officers. Applications for flying training should be made 
through the surgeon to the station commander and will be accompanied by the 
necessary report of physical examination. 
5. Upon recommendation of the surgeon, station commanders will authorize 
medical officers of the command, who are physically qualified and make application 
to take flying instruction. This will enable one of these officers to take the place of 
the flight surgeon when the latter for any reason is not available for that duty. 
6. Unless an absolute necessity exists therefor, flight surgeons and physical directors 
will not be diverted from their regular duty to perform routine post administrative 
duties when this service can be performed by another medical officer. Flight 
surgeons and physical directors should devote all the time possible to the close and 
constant supervision over flying personnel, as indicated in paragraph 2. 
7. The flight surgeon and the physical director of an Air Service station will not 
be detailed as a member of a board of officers convened to examine into the efficiency 
of a flying officer when it can be avoided. Their services will be of more value when 
called before a board as an expert witness, to give testimony relative to physical fit- 
ness, etc., of the officer under investigation. 
By direction of the Director of Air Service: 
Wm. F. Pearson, 
Colonel, A. S. A., Administrative Executive. 
Physical Examination for Flying. 
- Age 
(Surname.) (Christian name.) 
(Rank.) (Regiment or arm or corps or department.) 
EYE EXAMINATION. 
1. Visual acuity: R. E L. E 
2. Depth perception at 6 meters mm. 
3. Maddox Rod Screen Test at 6 meters: 
Eso Exo R. H L. H 
4. Maddox Rod Screen Test at 33 cm.: 
Eso A Exo 
5. Prism divergence 
6. Associated parallel movements 
Tangent curtain diagnosis 
Nystagmus 
7. Inspection 
Pupils: equality ; shape ; reaction 
8. Accommodation: R. E D. L. E D. 
9. Angle of convergence: PcB mm. Pd mm. Angle.... ° 
10. Retinal sensitivity 
11. Central color vision. R. E L. E 
12. Field of vision. Form: R. E L. E 
Color: R. E L. E 
13. Refraction (Homatropine). Tension 
R. E L. E 
14. Ophthalmoscopic examination: 
R. E 
L. E AVIATION MEDICINE IN THE A. E. E. 
313 
EAR EXAMINATION. 
15. History of ear trouble: 
(а) Ever have ringing or buzzing in either ear, earache, discharge or mastoiditis? 
(б) Ever have attacks of dizziness from any cause? 
(c) Ever been seasick? If so, how often 
and how long does it last? 
(d) Ever had a severe injury to head? 
16. (a) Appearance of external auditory canal: Right Left 
(6) Appearance of membrani tympani: Right Left 
(c) Hearing (watch, No. of inches; whisper, No. of feet). 
Right ...7 inches; /40(40/40normal) feet. 
Left inches; /40(40/40 normal) feet. 
NASO-PHARYNX. 
17. Condition ofnares (if obstructed, state degree, character and cause): 
Right 
Left 
18. Condition of tonsils and history of attacks of tonsilitis: 
Right 
Left 
19. Presence of adenoids 
20. Condition of eustachian tubes (if obstructed, state character and degree) after politzerization or per 
catheter 
21. Equilibrium (vestibular), head tilted forward 30 degrees. Eyes closed. Rotation nystagmus normal 
26 seconds, a variation of 10 seconds allowable: 
(а) Right- Applicant to be turned toward his right, 10 turns in exactly 20 seconds, horizontal nystag- 
mus to left for seconds. 
Left- Applicant to be turned toward his left, 10 turns in exactly 20 seconds, horizontal nystagmus 
to right for seconds. 
(б) Pointing tests: 
(1) Before turning: 
Right arm , left arm 
(2) After turning 10 times in 10 seconds to right: 
Right arm , left arm 
(3) After turning 10 times in 10 seconds to left: 
Right arm left arm. 
(c) Falling tests: 
(1) Turn to right, 5 turns in 10 seconds—Falls to 
(2) Turn to left, 5 turns in 10 seconds—Falls to : 
22. Caloric Test when 21 is unsatisfactory. 
Douche right ear. Douche left ear. 
Amplitude of eye movements. Amplitude of eye movements. 
After Min Sec. After Min Sec. 
Nystagmus. Nystagmus. 
Vertigo. Vertigo. 
Past-pointing. Past-pointing. 
Falling. Falling. 
Head back. Head back. 
Amplitude of eye movements. Amplitude of eye movements. 
23. Previous medical history. Date. Duration. Complication. 
(а) None - 
(б) Tonsilitis 
(c) Scarlet fever 
(d) Measles 
(e) Mumps 
(/) Pneumonia - 
(ff) Typhoid - 
(h) Lues 
(i) Gonorrhoea (acute) 
(i) Rheumatism, No. attacks 
(ifc) Asthma, No. attacks - — 
(l) Hay fever. No. attacks - 
(m) Malaria, No. attacks 
24. Temperature Height inches. Weight pounds. 
25. Chest measurement: Expiration inches. Inspiration inches. 
Waist measurement at umbilicus inches. 
26. Respiratory 
27. Bones and joints - 
28. Skin 
29. Vascular system - 
(а) Pulse: Rate (sitting) per minute; quality 
(б) Condition of arteries 
(c) Condition of veins ------ 
(d) Blood pressure (sitting): Systolic Diastolic 
(e) Heart - - 
1. Murmurs 
2. Arrhythmias 
(/) Hemorrhoids 314 
AVIATION MEDICINE IN THE A. E. F. 
30. Digestive system. 
Right. 
Left. 
Missing 
teeth. | 
Upper, 8, 7, 0, 5, 4, 3, 2, 1 
i Lower, 8, 7, 6, 5, 4, 3, 2, 1 
1, 2, 3, 4, 5, 6, 7, 8l 
1, 2, 3, 4, 5, 6, 7, 8-> 
(Strike out those that are missing.) 
31. Hernia 
32. Genito-urinary system 
33. Urinalysis: 
Specific gravity 
Reaction 
Casts 
Albumen.. 
Sugar 7 
NERVOUS SYSTEM. 
34. Family history of insanity or other nervous diseases 
35. Intemperance: Tobacco Alcohol Drugs 
36. Syphilis Epilepsy Dizziness 
Fainting.. Headaches Stammering 
Enuresis Somnambulism Insomnia 
Dreams 
37. Memory Will grasp Phobias Worries 
Anxieties 1 Conflicts 
Complexes Irritability 
Apathy Elation Depression 
38. Pupillary reactions Secondary dilatation (Normal) : 
(Prolonged) 
39. Station 
40. Patellar reflexes Tic Tremor 
41. Psychomotor tension: Normal Peripheral circulation: 
Increased (Normal) 
Decreased (Relaxed) 
42. Is the candidate physically qualified for flying? 
If not, reason for disqualification 
(Place.) 
(Date!) 
Medical Corps, U. S. A. 
1. Physical examinations for flying will be made only by such medical officers as are authorized in writing 
by the Surgeon General of the Army to conduct such examinations and will be conducted as prescribed in 
Special Regulations Nos. 65 and 65c. 
2. Officers making physical examinations will, under no circumstances, waive physical defects. 
3. A record of the examination, in triplicate, will be made on this form. Two copies will be forwarded 
directly to the office of the Director of Air Service, attention Chief Surgeon, Air Service, and the third copy 
retained by the flight surgeon at the station of the candidate. Upon receipt of the two copies of this form, 
they will be approved or disapproved by the Chief Surgeon, Air Service, one copy retained for permanent 
file, and one copy returned to the station from which received. 
4. Upon receipt back at the station of the copy of this form, the action of the Chief Surgeon, Air Serviee, 
contained thereon will be transcribed to the retained copy of this form and the same certified as a “true 
copy.” 
5. An applicant will not be allowed to proceed with his flying training until an approved copy of this form 
in his case has been received back at the station of the applicant. 
6. Whenever an individual is transferred to another station, the copy of this form with the action certified 
thereon, as provided in paragraph 3 above, will be forwarded to the flight surgeon of the new station. The 
other copy of this form will be retained at the station for permanent file. 
INSTRUCTIONS. INDEX. 
Accidents, aviation: Page. 
Acrobacy 228 
Air conditions, relation to 238 
Clouds 239 
Holes 239 
Winds 239 
Altitude, relation to 226, 228 
Avoidable., 242 
Boards 27, 28 
Blanks 47,270,272,299,303 
Casualties, zone of advance 217 
Causes of 220,240, 265 
Collisions 239 
Combat 29 
Department of administration, responsibility of 246 
Department of engineering, responsibility of 243 
Department of training, responsibility of , 244 
Distribution of 205, 214 
Fatalities— 
At front... 207 
At training school 206 
Comparative chart t 210 
Relation to hours of flying 213 
Total in American Air Service 217 
Flier, as cause of: 
Confidence 222 
Excesses 225 
Familiarity with planes. 223 
Fatigue flying 225 
Fitness 224 
Foolhardiness 235 
Fright in relation to flying 
Hedge hopping 237 
Indispositions, temporary 225 
Inexperience 228 
Intemperance 225 
Overcautiousness 236 
Poor judgment 224 
Recklessness 235 
Staleness 225,226 
Training 224 
Flying as cause of: 
Bad 221 
Formation 228 
Forced landings 238 
Investigation of 241 316 
INDEX. 
Accidents, aviation—Continued. Pag€. 
Motor dead, turning with 236 
Morale, relation to 240 
Nonfatal, need for investigation 242 
Number of, in A. E. F 205 
Number of, in U. S. A 214 
Oil 222 
Records of 242 
Rules governing flying fields 230 
Aerodromes 23 
Air Medical Service: 
Development of 15 
Organization of 15 
Responsibility of 243 
Airplanes: 
Adaptability of 222 
Condition of 222 
Familiarity with 223 
Imperfection of 221, 223 
Mechanical fitness 221 
Nieuport 20 
Production 243 
Propellor, accidents to 240 
Upkeep of 221 
Windshields of. 25 
Airships 11 
Altitude : 
Adaptation to 63 
Breathing at high 68 
Circulation at high : 68 
Classification examination 67, 69, 70 
Effects of 59 
Effect of, on the eye 174 
Headache due to 62 
Hearing, impairment of, at high 61 
Intellect, impairment of, at high 61 
Judgment, impairment of, at high 61 
Muscular weakness of, at high 62 
Relation to aviation accidents 226 
• Symptoms— 
While in air ; 60 
After landing 62 
American Air Service 217 
Apparatus, eye, new 193 
Aviation medicine: 
Future of 264 
School of 52, 267 
Study of more important medical problems 52 
Aviators: 
Aerial gunner— 
Duties of 11 
Physical requirements for ~ 28 
Alcohol for, use of 127 INDEX. 
317 
Aviators—Continued. Page. 
Attitude of, toward hygiene 104 
Bomber, day, duties of 10 
Bomber, night, duties of - - H 
Desirable personality for 127 
Desirable qualities for 126 
Monitor— 
Examination of 53 
Qualification for 12 
Psychological examination of 113 
Observer— 
Duties of 10,128 
From the front, conferences with 56 
Classification of occupations of 57 
Physical requirements for 28 
Prerequisites for 57 
Psychological examination of 114 
Report of Capt. Cary on 56 
Test for, description of 128 
Results of test for, treatment of 130 
Pilots— 
Chasse, duties of 9 
Night, chasse, duties of 10 
American combat, conferences with 55 
Physchological examination of 114 
Ferry, duties of H 
Report of Majs. Patton and Hyde on 55 
Psychological examination of 113 
Psychological factors during training of 125 
Student fliers, type of 22 
Tester— 
Examination of 53 
Qualifications for 12 
See Fliers. 
Aviation: 
Attraction of 8 
Casualties of British 3 
Fields, outlying 20 
Hygiene in 192 
Medical problems of 32 
Requirements for 3, 9 
Rules and regulations of flying. - 27 
Science of flight 223 
Balloons: 
Captive 
Free 11 
Blind angles: 
Of aeroplanes 135 
Of goggles 191 
Blood pressure 31 
Low oxygen effects on 69, 72 
Postural 95 
Blood volume 31 318 
INDEX. 
Page. 
Breath holding 75, 76, 79 
British Air Service: 
American unit attached to 247 
Report by Maj. Beverly 251 
Report by Capt. Cary 262 
Report by Maj. Constantine 250 
Report by Maj. Gallagher 260 
Report by Capt. Garber 249 
Report by Maj. Hyde 261 
Report by Maj. Ingersoll 247 
Report by Maj. McCombs 255 
Report by Capt. Powers 250 
Report by Capt. Trumbull 262 
Circulatory efficiency test 91,97 
Crampton’s vasotone index 92,96 
Demobilization: 
Classes of 30 
Elimination board 30 
Dyspncea, 61 
Ear, inner: 
Hypersensitiveness to motion 134 
Normal response to motion 135 
Subnormal response to motion 147 
See Labyrinth. 
Efficiency: 
English, R. A. F. tests for 74,101 
Oxygen, to maintain at high altitude 110 
Tests 74,91,97,102 
Equipment of ophthalmological department. Third Aviation Instruction 
Center 204 
Examination, altitude classification 67, 70 
Examination forms: 
British Air Service— 
Discharge card : 298 
Discharge card, notes of medical officers for 302 
Discharge card, for Expeditionary Air Force cases 299 
Envelope 297 
Entry card 298 
Notes of medical officers for 302 
Entry card, R. A. F 300 
Notes of medical officers for 301 
Examination candidates, R. A. F 297 
List of cases admitted, etc 304 
Report of accidents to flying officers, etc 299 
Notes of medical officers for 303 
Special report on flying officers, etc 301 
Notes of medical officers for 303 
Central Powers, health report air service 305 
French Air Service, medical record 273 
Italian Air Service— 
Pointing test 278 
Aviation examination 279 INDEX. 
319 
Examination forms—Continued. 
United States Air Service— Page. 
Accident . 47 
Envelope 270 
Low oxygen tension examination, A. E. F 272 
Physical examination for flying, A. E. F ,» 268 
Physical examination for flying, present Form 609 312 
Present orders— 
Circular 123 311 
Order No. 45 309 
Order No. 52 310 
Reexamination of flier 46 
Reexamination of flier, A. E. F 269 
Expiratory force 76,77,79 
Eye, the: 
Accommodation. 179,183,193,198 
Alcohol, effect on the 182 
Altitude, effect of, on the— 
Accommodation , 179 
Convergence 179 
Color vision 176 
Motion perception 178 
Muscles - 176,185 
Retinal sensitivity 178 
Stereopsis 177 
Visual acuity 175,185 
Visual fields 178 
Apparatus, new— 
Accommodation and convergence, testing fatigue of 193 
Accommodation testing inertia of adjustment 198 
Ergograph modification of 193 
Head fixation of 193 
Perimeter, device for changing colors 198 
Reaction time, shutters for recording 195 
Binocular vision, defects of 169 
Blind spot, enlargement of 174,199, 202 
Classification of fliers with respect to 171 
Color vision 166,176,183,185 
Convergence 179,184,193 
Dark adaptation 168,185 
Dazzling of 173 
Difficulties of, secondary to nonocular infections.. 169,174 
Drugs, effect of, on 182,187 
Examination routine in fliers 169,173 
Examination, special, of aviators 183 
Goggles „ 187 
Infections, nose and throat effects of, on 199 
Blind spot, enlargment of 199 
Case histories 200 
Diagnoses, ophthalmological 199 
Muscles 203 
Master eye 184 
Mental strain, effect of, on 169 
Muscle balance 167,176,184,185, 203 320 
INDEX. 
Eye, the—Continued. Page. 
One-eyed man in flying 166,169 
Oxygen deficiency, effect of, on 171 
Perception of motion by 178 
Poor fliers, defects of, in 169 
Problems needing further consideration 184 
Reaction time, visual 168,187,195 
Refractive error of, correction in fliers 166,190 
Retinal sensitivity 178 
Slight affections of, in flying 169 
Stereoscopic vision 167,177,184 
Tobacco, effect on 182 
Treatment of ordinary troubles of 173 
Vision impairment of, at high altitude 61 
Visual acuity 165,175,183,185 
Visual fields 178,187,191,198 
Fainting 62 
Falling reaction, improved method of timing and recording 159 
Fatigue 62,106 
Tests for 76, 77, 79, 86, 92, 97,101 
Fliers: 
Board recommendations, summary of 37 
September, 1918 37 
October, 1918 38 
November, 1918 39 
December, 1918 41 
January, 1919 43 
Care of 35 
Carsick 22, 25 
Classification examination of 36 
Examination of, French 54 
Food and nutrition of 26 
Hypersensitive-to-motion type 54 
Investigations relating to 35, 52 
Monthly reports of 37 
Physical standards for 28 
Record blanks of 46 
Reexamination of 36 
Selection of i 35 
Student 27 
Types of 28 
Valuation of tests utilized in studying the 53 
See Aviators. 
Flight surgeons 15 
Flight surgeons, A. E. F 21, 25 
Assignments of 48 
Commendation of 48 
Duties of 48 
Lecture to 48 
Need of 51 
Qualification of 47 
Request for 24,47 
Value of 50 INDEX. 
321 
Flying: Page- 
Nausea, vomiting, and vertigo as a result of 54 
See Aviation. 
Goggles: 
Blind angle of 191 
Field of vision with 187,191 
Fliers’ dependence upon 187 
Ffosting of 193 
Material of 191 
Nonshattering 190 
Sinuses, protection of . 192 
Tinted 199,193 
Heart, rate influenced by low oxygen 68 
Italian Air Service 220 
Instruction center, Third Aviation, A. E. F.: 
Condition of personnel at 18 
Examination of French and British aces at 32 
Examination of monitors and testers at 13 
Exercise schedule of 22 
Need of 22 
Compulsory 32 
Hospital at 18 
Leaves, need of 21 
Main laboratory 19 
Officers’ meetings at 21, 22, 24, 27, 28 
Labyrinth: 
Conclusions on sensitiveness of labyrinthine reactions under varied con- 
ditions ;.. 157,159 
Hypersensitiveness to motion 134,146 
Types 158,159 
Normal response to motion 135,137 
Otological study of 149 
Past pointing 137 
Reactions in American aces 156,157 
Reactions in “monitors” 148,149 
Reactions in “staleness” 153,156 
Response after practice.. 137,150,151,152,153 
Role in flying efficiency 133,157 
Subnormal response to motion 147,159 
Labyrinth and flying 157,164 
Labyrinthine reactions, effect of practice on 137,150,151,152,153 
Medical Research Board: 
Equipment of 17 
Formation and duties of 15 
Location of 17 
Oversea units 16 
Recommendations of 37 
Medical Research Laboratory 267 
Organization of 15 
Medical Research Laboratory, A. E. F.: 
Main and branch laboratories 19 
Second Aviation Instruction Center at 29 
War functions of 51 
171364—20 21 322 
Page. 
Nystagmus, effect of practice on 137,150,151,152,153 
Oxygen: 
Altitude and use of 53 
Blood circulation under a decreasing supply of 63, 69 
Breathing under a decreasing supply of 63, 68, 7.1 
Low, effects on vision, hearing, intellect, and judgment 61 
Low, tests for power of adaptation 64 
Tests of, in plane 30 
Value of 33,109 
Orientator, Ruggles 22,23 
Personnel: 
Distribution of 206 
Flying at front 218 
Physical condition 105 
Psychological tests: 
Comparisons of, in United States and France 115 
French, explanation of 117 
French, results of 119 
Nature of 114 
Observers of 1 128 
Steadiness for— 
Explanation of 122 
Results of 123 
Spearman test 124 
Pulse rate: 
After standard exercise 96 
Under decreasing oxygen supply 63, 68 
Postural 94 
Reaction time, visual 31,168,187,195 
Rebreathing: 
Apparatus 94 
Classification examination 67, 70 
Respiration: 
Periodic 61 
Response to low oxygen 68 
Shallow 71 
Respiratory tests for oxygen want and staleness 67, 72, 74, 80, 83 
Respiratory reserve factor 75, 77, 84 
Seaplanes 12 
Sleepiness at high altitude 61 
SoCIETE SciENTIFIQUE POUR l’EtUDE MEDICAL AeRONAUTIQUE 34 
Staleness: 
Clinical findings in 86 
Circulatory tests for 91, 97 
England’s R. A. F. tests for 74,101 
Rebreathing test in 72, 88 
Training 228 
Essential to fitness - 224 
Schools of A. E. F 205 
Rate of 238 
Vision. See Eye, the. 
Vital capacity 31, 75, 77, 79, 83 
INDEX. V c£' V^^Jga 
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