Now all roads lead to France and heavy is the tread
Of the living; but the dead returning lightly dance.
Edward Thomas, Roads

Friday, March 8, 2019

The Need for Flight Surgeons in World War I

By Lewis Barger, Office of Medical History, U.S. Army

Equilibrium testing for an aviation candidate,
19 March 1918. Early tests tried to replicate
aerobatic stresses. Courtesy National Archives
The Army’s association with heavier-than-air flight began on 10 February, 1908, when the Army signed a contract with the Wright brothers for an airplane. It was four years before the War Department published instructions, drafted by Surgeon General George H. Torney, directing the medical examination of pilot candidates attending the Signal Corps Aviation School. By April 1914, the particular physical demands of aviation were becoming better known, and two future Brigadier Generals, ophthalmologists Theodore C. Lyster and W.H. Wilmer, outlined new specifications for aviators: “Vision, ocular muscle balance, and the effect of refractive errors, were particularly considered.”

It wasn’t until April 1917, that the Medical Service for the Aviation Section was created. Newly promoted Lieutenant Colonel Lyster was put in charge of aviation issues in the Surgeon General’s Office and was responsible for the physical examinations of all those seeking to serve in the Air Service. In two month's time Lyster organized 67 examining units at sites around the country. He also incorporated the specifications he had worked out with Wilmer into the physical standards for pilot candidates, but he recognized that the standards were based more on common sense than actual analysis.

Aviator's Oxygen Mask in Position,
Ready for Use.  From Wings of War
by T.M. Knappen, 1920
Meanwhile aviation cadets were dying at a horrific rate in training accidents, leading Lyster to call for a research program to determine what type of person would best be suited for aviation duty. In September, Lyster was made Chief Surgeon of the Aviation Section, Signal Corps and promoted to colonel. He immediately set to work organizing an Aviation Medical Research Board, which the War Department gave the authority to:

* Investigate all conditions which affect the efficiency of pilots.
* Institute and carry out experiments and tests to determine the ability of pilots to fly at high altitude.
* Develop and test systems to supply pilots with oxygen at high altitudes.
* Act as a standing medical board for the consideration of all matters relating to the physical fitness of pilots.

One of the board’s first actions was to create the Central Medical Research Laboratory. The laboratory was created with departments of otology, cardiovascular medicine, physiology, psychology and neurology, and ophthalmology, and opened on 19 January 1918 at Hazelhurst Field in Long Island, with Colonel Wilmer as director. By that summer, 20 branch laboratories had been set up at flying fields throughout the United States and Wilmer was on his way to Europe to establish a Medical Research Board for the American Expeditionary Force. All this expansion was driven by the high rate of non-combat deaths, which would continue to drive research after the war ended.

Brigadier General Theodore C. Lyster
In May 1919 the first eight-week course of instruction for flight surgeons was given by the Central Research Laboratory at Hazelhurst Field. By 1922 the laboratory had been renamed the School of Aviation Medicine and in 1926 was moved to Brooks Field in San Antonio. That same year COL Louis H. Bauer published Aviation Medicine, the first textbook on the subject. 

Although Surgeon General Torney recognized the need for standards of fitness for military fliers relatively early, losing 59% of the fliers killed in France to non-combat accidents provided the War Department with the impetus to create research facilities to study the unique environment and demands of flight. Once the Medical Department was adequately resourced, they moved rapidly to the forefront of research and education on the subject and made significant contributions to the field of aviation medicine.

Source:  "The Beginnings of Aviation Medicine," The AMEDD [Army Medical Department] Historian, Summer 2014

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