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SECTION II.
CHAPTER XXI.
DIVISION OF AIR SERVICE MEDICAL.
Before our entrance into the World War no division having to do with aviation existed in the Surgeon General`s Office, but some thought had been given there to what should constitute the physical requirements for admission to the aviation service (fliers) and medical officers in that office had been in correspondence with other members of the medical profession who were interested in the subject. A partial study had also been made of the physical requirements for aviators formulated by Great Britain, France, Italy, and Germany. Preparation for war by way of a Medical Aviation Service had gone no further than this when war came in 1914. When we entered the war, not quite three years later, our Air Service consisted of 65 officers and 1,120 enlisted men.1 From these numbers the personnel increased by June 30, 1918, to the maximum strength of 14,230 officers and 124,767 enlisted men. 2 The number of men in or awaiting training for fliers increased from 100 to 18,000. 2 There were 4,872 officers and 46,667 enlisted men overseas. 2 The medical administrative problems comprised not only those common to all troops, viz, the sanitation and professional care of this considerable force located in many different stations of different types; but also the many special questions which arose in consequence of the fact that work in the air in war was the primary object of the service and that in this respect the Medical Department had no precedent to guide it through previous practical experience of its own.
ORGANIZATION OF AIR SERVICE MEDICAL.
In May, 1917, an officer of the Medical Corps was detailed, in addition to certain other duties, to take charge of the aviation work in the Surgeon General`s Office, which included the physical examination of all applicants for duty with the Aviation Section, Signal Reserve Corps. 3
Curiously enough the only authority for the organization of a separate medical service for aviation was a War Department special order assigning a medical department officer to duty as chief surgeon, Aviation Section, Signal Corps. 4
In July, 1917, prior to which time there had been no office for the chief surgeon of the Air Service Medical outside the Surgeon General`s Office, a room connected with the attending surgeon`s office at 1106 Connecticut Avenue was obtained for his use, with an office force of one soldier and one stenographer.: As the work increased the functions of the Chief of the Air Service Medical became akin to those of a department surgeon. It should be noted that this largely independent status existed in none of the divisions of the Surgeon General`s Office.
Owing to the necessity for more room to house the increasing personnel, at the end of August, 1917, the office of the Chief of the Air Service Medical
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was moved to the old Southern Railroad Building, 119 D Street NW., then the headquarters of the Aviation Section, Signal Corps;5 shortly thereafter it was again moved to 613 G Street NW., and later to 940 F Street NW., where it remained until June 15, 1918, when it was moved to the first floor of the first wing of Building " D " of the temporary office buildings at Sixth and B Streets NW. 5
Early in 1918 the office organization comprised the chief surgeon, an assistant, an executive officer, and five sections, as follows, each with an officer in charge: (1) Personnel; (2) property, supplies, and accounts; (3) hospitals;(4) reports and returns, including sick and wounded reports; (5) care of fliers. 6
On May 11, 1918, the appellation "chief surgeon" automatically ceased to exist officially through the relief of the chief surgeon, Aviation Section, Signal Corps, and his detail to duty in the Surgeon General`s Office in charge of the Division of Aviation,7 which was simultaneously created. 8 This order was revoked on May 23, 1918, the division being known thereafter as the Air Service Division" (commonly known as Air Service Medical). On May 24,1918, the Department of Military Aeronautics was established by order of the President. 10 The Air Service was thus completely separated from the Signal Corps; but at the instance of the director of military aeronautics, the Surgeon General directed that the work of the medical office continue as before;` that is, the administration of medical activities actually remained located and functioned in building " D," Sixth and B Streets NW. The officer in charge of the Division of Air Service Medical of the Surgeon General`s Office was then appointed chief of a Medical Section (Advisory). 9 The functions of this section as then prescribed were to handle all matters relating to medical personnel, equipment, supplies and all other medical questions concerning aeronautics. 9 The office continued to be known as the Division of Air Service Medical of the Surgeon General`s Office until after the armistice. On March 14, 1919, the division was abolished, 11 the medical functions of this service again being administered by a chief surgeon, Medical Division, Air Service, as had been the case in the beginning.
FIRST PROBLEM.
When war began, it was at once apparent that a large number of aviators must be secured for the Army in a very short time. The first medical problem, then, was to select thousands of men physically fit for fliers so that they might be placed in training immediately. New physical standards were required as well as new physical examination methods. The prescribed physical examination was promulgated by The Adjutant General in Form 609, in May, 1917. 12 Necessarily this was prepared hurriedly by the Medical Division, but it is worthy of note that the physical tests then required remained unaltered during the whole course of the war.
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PHYSICAL EXAMINATION OF APPLICANTS FOR DETAIL IN THE AVIATION SECTION, SIGNAL CORPS.
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PHYSICAL EXAMINATION OF APPLICANTS FOR DETAIL IN THE AVIATION SECTION, SIGNAL CORPS (continued)
The following instructions will govern the medical officers making the examination:
EYE DETERMINATION.
1. Question the candidate carefully regarding previous or present eye trouble, use of glasses, headaches, lachrymation, scotoma, and photophobia; also diplopia (muscae volitantes panorama symptoms), glaucomatous symptoms, night blindness or asthenopia when not wearing correcting lenses. Any one of the latter group disqualifies, and also of the former group if marked. Note findings.
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2. Stereoscopic vision is the ability to appreciate depth and distances by means of binocular single vision. Objects printed on the test cards furnished for use with the stereoscope arc drawn to scale; the distance between corresponding points of similar objects are equal, between dissimilar objects unequal. They are seen at different apparent depths, the result of superposition of each two similar images in space; the less the distance between the objects, the nearer they appear to the observer`s eyes; the greater the distance between, the farther away they appear. A normal eye can appreciate an apparent difference in distance between stereo scoped objects of 0.01 mm. Adjust the oculars of the stereoscope at their focal distance (15 cm.) from the glass stage and rotate by means of the milled edge on either ocular cup so that the interpupillary distance will be as great or greater than the distance between any two similar points or objects to be stereo scoped. With good illumination, have the candidate name the sequence of objects from front to rear as he sees them through the stereoscope. This should be done readily and without error, otherwise it is a cause for rejection.
3. Ocular movements are tested roughly by requiring both eyes of the candidate to be fixed on the examiner`s finger, which is carried from directly in front to the right, to the left, up, and down. The movements of each eye must be regular and identical.
4. Pupillary reactions should be regular and equal in each eye when responding to (1) direct and (2) indirect light stimulation and (3) to accommodation. Face the candidate and place a card as a screen before both eyes. Uncover one eye after a short interval and allow light to shine in this eye. The resulting contraction of the iris of this eye is called direct. Repeat, but now observe the shaded eye. This reaction is indirect or consensual of the shaded eye. Repeat for the other eye.
With both the candidate`s eyes open and uncovered, have him fix on a pencil held a few inches directly in front of him. Bring the pencil toward him until it nearly touches his nose. Both irides will contract, which is called the reaction to accommodation.
5.Intraocular tension is tested roughly by palpation. The candidate looking downward, palpate the eye through the upper lid with the index finger of each hand, and compare the tension with the other eye and with an eye believed to be normal. If not normal, it is a cause for rejection.
6. Any visible lesion of the eye is determined by having the candidate near to and facing a well-illuminated window and assisted by the use of a hand lens. The eyes should be free from disease, congenital or acquired, such as lesions of the cornea, iris, or lens, including affections of surrounding structures such as pathological conditions of the lachrymal apparatus, conjunctival deformities, or any other affection which would tend to cause blurring of vision if the eyes, unprotected by glasses, were exposed to wind or other unfavorable atmospheric conditions.
7. Ocular nystagmus is determined, and if it is rhythmical and occurs-(a) and (b)-on looking straight ahead or laterally 400 or less it is a cause for rejection.
(c) Spontaneous ocular nystagmus produced by extreme lateral sight, 500 or more, is not a cause for rejection, as it is found in the normal individual. It is usually manifested by a few oscil- lating lateral movements, never rotary, which appear when the eyes are first fixed in extreme lateral positions. Select a scleral vessel near the corneal margin as a point for observation.
8. Field of vision is tested separately for each eye. Place the candidate with his back to the source of light and have him fix the eye under examination (the other being covered) upon the examiner`s, which is directly opposite at a distance of 2 feet. The examiner then moves his fingers in various directions in a plane midway between himself and the candidate until the limits of indirect vision are reached. The examiner thus compares the candidate`s field of vision with his own and can thus roughly estimate whether normal or not. A restricted field of vision should be confirmed by the use of a perimeter, as it would then be a cause for rejection.
9. Color vision should be normal for red and green. A Jennings test set is preferred. If not available, then select a skein of any shade of red or green worsted and have the candidate select, in separate piles, all skeins containing red or green. If confusion, colored lights at 20 feet should be used as a test before rejecting.
10. Muscle balance at 20 feet.-A photometer, with spirit level, Maddox rod, and rotary prism attached, should be used to determine the presence or absence of a muscular imbalance. Adjust the phorometer close to and in front of the candidate`s eyes, at 20 feet distance from a point of light 10 mm. in diameter on the same level with eyes. Darken the room and arrange the prisms so that their bases are situated inward; two images of the light will then be seen displaced laterally. If on a level, there is a normal balance of the vertically acting extrinsic eye muscles or orthophoria; if not on the same level, there is vertical imbalance or hyperphoria, left if the left image is below,
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right hyperphoria if the right image is below. Read off on the scale the amount necessary to bring the images on the same level.
Repeat the tests with the prisms, one up and one down. If the images now are directly above each other there is no lateral imbalance, but if laterally displaced and on the same side with the eye seeing each image, there is homonymous diplopia due to a lateral imbalance called esophoria. If the images are crossed there is exophoria. Read off on the scale the amount necessary (prism diopters) to bring them in the same vertical meridian. If not more than 10 of hyperphoria and more than 20 of esophoria or exophoria, the test is satisfactory.
11. Visual acuity.-(a) Acuity for distance tested at 20 feet from a well-illuminated Snellen test card, if less than 20/20 in either eye, tested separately, disqualifies.
(b) Near point or acuity for near vision is determined separately for each eye by requiring the candidate to read in a good light the Jaeger No. 1 test type, first gradually bringing the card toward the uncovered eye until the nearest point to the eye at which the test type still remains distinct is reached. The distance of this point from the anterior surface of the cornea, measured in centimeters, is the near point. Greater than 11 cm. at 20 years of age, greater than 13 cm. at 25 years of age, or greater than 15 cm. at 30 years of age disqualifies.
12. Ophthalmoscopic findings.-Drop one drop of a 5 per cent solution of euphthalmin in each eye. Have the candidate keep his eyes closed. After 15 minutes repeat the drops; then examine 15 minutes later. A pathological condition of the fundus, active or quiescent, is cause for rejection.
EAR DETERMINATION.
13. Abnormalities are cause for rejection.
14. Hearing should be normal for each ear. To determine this both the whisper and watch tests are used. After examining both external auditory canals and membrana tympani by means of a speculum and a good light (first removing any wax if present) for abnormalities such as small and tortuous opening, presence of pus, perforation, scars, retraction, or other evidence of pastor present inflammation, which are causes for rejection, the candidate is required to stand at 20feet from the examiner and facing away from him. An assistant closes the ear not under examination with his moistened index finger pressed firmly into the external auditory meatus. The examiner facing the back of the candidate exhales and then, with his residual air, whispers numbers, words, or sentences which the candidate should repeat. If unable to hear, the examiner will approach until the candidate does hear, the distance being recorded in feet. If less than 20 feet, it is a cause for rejection. A quiet r6om is essential.
The watch test is preferably made with a loud-ticking watch, such as the ordinary Ingersoll, which, while variable, should be heard at about 40 inches. Any watch used should have been previously tried out on at least five normal persons and the distance heard made a matter of record. The number of inches in distance heard by the candidate, eyes closed and opposite ear occluded, is taken as the numerator and the distance the watch should be heard as the denominator. This should be the equivalent of 40/40, otherwise disqualifies.
NASOPHARYNX.
15-18. This region should be carefully examined. If defects can be removed by operation, this should be required prior to completing the examination. If nonoperable or operation refused, it is a cause for rejection.
STATIC TESTS.
19. The position should be maintained for one minute without marked swing. Eyes closed
EQUILIBRIUM (VESTIBULAR TESTS).
20.The nystagmus. past-pointing and falling, after turning, are tested. The turning chair must have a headrest which will hold the head 300 forward, a foot rest, and a stop Pedal.
(a) Nystagatus.-Head 300 forward; turn candidate to the right, eyes closed 10 times in exactly 20 seconds. The instant the chair is stopped click the stop watch; candidate opens his eyes and looks straight ahead at some distant point. There should occur a horizontal nystagmus to the left of 26 seconds` duration. Candidate then closes his eyes and is turned to the left; there should occur a horizontal nystagmus to the right of 26 seconds` duration. The variation of eight seconds is allowable.
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(b) Painting.-(l) Candidate closes eyes, sitting in chair facing examiner, touches the exam- iner`s finger, held in front of him, raises his arm to perpendicular position, lowers the arm, and attempts to find the examiner`s finger. First the right arm; then the left arm. The normal is always able to find the finger. (2) The pointing test is again repeated after turning to the right, 10 turns in 10 seconds. During the last turn the stop pedal is released, and as the chair comes into position it becomes locked. The right arm is tested, then the left, then the right, then to the left until he ceases to past point. The normal will past point to the right three times with each arm. (3) Repeat pointing test after turning to the left.
(c) Falling-Candidate`s head is inclined 900 forward. Turn to the right, five turns in 10 seconds. On stopping candidate raises his head and should fall to the right. This tests the vertical semicircular canals. Turn to the left, head forward 900; on stopping the candidate raises his head and should fall to the left. Unless each test is normal it is a cause for rejection.
Special Regulations No. 50, Aviation Section, Signal Corps, 1917, War Department, and Circular No. 2, War Department, November 1, 1916, and the physical requirements of recruits will govern 22 to 32, inclusive.
Immediate efficiency and ultimate economy were the controlling influences, from a physical standpoint, in determining the selection of personnel for training for fliers. The great number of applicants made facile the maintenance of high physical standards. It had been demonstrated already by our fliers that careful physical selection offliers would minimize the expenditure of time and money, as it would avoid training large numbers of prospective fliers who, through physical handicaps, could not possibly render efficient service as aviators. In a word, the primary responsibility of the Air Service Medical, in the selection of fliers, was that no aviator should fail in his mission because of discoverable physical defects. With the determination of attributes other than the physical, the Air Service Medical was not concerned.
Early in 1917 the Aviation Board, created in 1916,13 meeting in Washington, D. C., passed on practically all candidates for commission in the Aviation Section, Signal Corps. This board was unable to cope with the vast increase in the number of examinations incident to the expansion of the Aviation Section, and as a result other boards were appointed at various places throughout the country, the number ultimately being 67.14 To perfect the standard of physical requirements tests were made universally the same. A medical officer from the Air Service Medical in Washington was sent to each of 35 cities in the United States to establish physical examining units for the examination of candidates for commission in the Aviation Service and to explain to members of each unit so established the requirements of the physical examination. 15 Specialists, experts in their various specialties, were selected as members of these units, and they were at once given intensive training for the purpose of establishing and maintaining a uniform technique. By the methods adopted, within a few months the character of the examination was made exactly the same in all physical examining units.
To save time existing institutions, such as large hospitals and State universities, with their equipment, were utilized as centers for establishment of the various physical examining units.17 In each case medical examining staffs made up largely of volunteers recruited from the ranks of eminent civilian consultants practicing near by were then organized. Some of these doctors were commissioned in the Medical Section, Officers` Reserve Corps, while others continued to serve as volunteers. This plan worked so well that within a few days after the arrival of the organizing medical officer from Washington the
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physical examining unit concerned would be actually at work examining candidates. By this method of decentralization the physical examination of thousands of candidates was made possible in a minimum of time. Once it was assured that a physical examining unit was equipped and capable of carrying on the physical examination according to the standards established full authority was vested in the officer in charge relative to its operation, but every effort was made to assist all units by occasional visits of inspection and by bringing to their attention from time to time pertinent information acquired as the result of further experience. Later, a military unit was organized in each of the 32 divisional camps to make the physical examination of enlisted candidates thereat.18 By far the majority of applicants were civilians, however, and the 35 original physical examining units in the cities, each examining from 10 to 60 applicants a day, soon provided almost all of the thousands of men required.
A vast amount of professional service was rendered without pay by the civilian members of the physical examining units. These civilian doctors included many of the foremost specialists in the United States. In addition to serving as examiners they gratuitously performed many hundreds of surgical operations to enable candidates to qualify physically for the examination.
Members of the physical examining units organized in the cities also performed many other patriotic services of importance. They were instrumental in the calling of the public meetings under the auspices of the medical profession in each city concerned. While there was no lack of desire on the part of the young men of the country to enter the flying service, there was a striking need of authoritative information regarding the nature of the service and how to proceed to enter it. Enlightenment was afforded through the public meetings and otherwise by the members of physical examining units. Thus an adjuvant activity of their establishment was the stimulation of public interest in the flying service in all of the cities in which they were located. The interest aroused by work in the physical examining units also resulted in bringing into the Air Service Medical a large number of specialists whose training in the physical examination of candidates for aviators fitted them for a larger sphere of usefulness later in the care of the flier.
To one not familiar with the organization for examining candidates for fliers some confusion will inevitably result in respect to the duties of examining boards and physical examining units, respectively. It may be explained that the examining boards were constituted much as are such boards in the Army generally. They had a president, the senior officer, and two other members. One member was the representative of the Air Service and one a medical officer. According to the usual practice of such a board, the medical board would make all physical examinations of candidates, but in the present instance this would have involved special knowledge of ophthalmology, otolaryngology, neurology, and of the cardiovascular and respiratory systems. As it was manifestly impossible to find highly developed special knowledge in all of these fields in any one individual, the physical examining unit was substituted for the medical member of the board. Candidates were referred by the examining board to the physical examining unit and the final decision of the board as to the acceptability of each applicant was made only after receiving a complete medical report from the proper examining unit.
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It has been noted that 67 physical examining units were finally established. 17 There was, of course, a like number of examining boards. 17
The selection of fliers from the physical standpoint and the placing of them into training for fliers proved more complicated than is indicated from what has already been said. This was due to the fact that all men fitted for flying are not fitted for all classes of such duty. This being the case, the importance, from a military standpoint, of careful classification of fliers was thoroughly appreciated in the Air Service Medical. The work of the Medical Research Laboratory demonstrated that of each 100 carefully selected fliers only 61 are mentally and physically capable of attaining an altitude of over 20,000 feet with safety and 25 out of each 100 are physically and mentally unsafe above 15,000 feet, and 14 out of each 100 are physically and mentally unsafe at altitudes above 8,000 feet. 18 Translated into military requirements, this meant that 61 in 100 could do any type of air work, that 25 might do bombing, and that 14 should be limited to reconnaissance or night bombing. Physical classification in accordance with these facts was therefore carried out. 19
PERSONNEL.
Medical officer personnel for the Air Service was obtained by request from the Chief of Air Service Medical to the Surgeon General. Such requests were of two classes, either for the commissioning of doctors whose names had already been selected by the Air Service Medical previously or for a certain number of unspecified medical officers. In the former case original commissions were issued to the doctors concerned and they were assigned immediately to an Air Service station as their first assignment. In the latter, medical officers already in the Army were transferred to an Air Service station. Medical officers once assigned to duty with the Air Service were not diverted from that service unless released by the Air Service Medical. Orders relating to such personnel were initiated in the Air Service Medical and on subsequent recommendation of the Surgeon General`s Office. As practically no medical officers secured for the Air Service had previous military experience, classes of instruction for them were essential at air stations. Classes of instruction for medical officers and for enlisted men were conducted at all such stations save at very small ones where there was only one medical officer, but even at these instructions for the enlisted force was systematically afforded. Enlisted men and nurses for the Air Service were obtained in the same way as medical officers.
It was realized by the Chief of the Air Service Medical early in the war that in order to develop its efficiency to the maximum extent possible it was essential to study conditions affecting it in the theater of war and to profit from the experience of our allies there. Two medical officers therefore accompanied the then commanding general, Air Service, to France on a temporary duty status.20 More specifically, the purpose of this visit was to obtain all available information relating to air medical service of our allies, largely as observed in actual operation at the front, and then to link this with the plan of the commanding general, American Expeditionary Forces, for an air service. Furthermore, their mission was to bring back to the United States all they had learned that this might be given practical effect in the way of preparation
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for service abroad. These observations had a potent influence on the development of our own air medical service. Other medical officers were sent to England, France, and Italy to acquire what they could for our service from practical experience.
Specialization of work went on among air medical officers until the personnel of a large field comprised a post surgeon; flight surgeon; a laboratory expert; an operating surgeon; eye, ear, nose, and throat specialists; internists; an orthopedist; and a sanitary engineer, in the majority of cases a sanitary officer; and a physical director. 21 This general plan of organization was ex-tended to all fields where such extensive specialization was necessary, but naturally at the smaller fields, with only two or three medical officers, it was not possible to carry specialization far. Specialization, as exemplified by the large aviation fields, was identical with that practiced by the Medical Department generally during the war for aggregations of troops of like strength, save that the aviation fields because of their special function had flight surgeons and physical directors.
SUPPLIES.
The Air Service Medical maintained no supplies of its own, its supplies coming from sources common to the Army as a whole. 22 Requisitions for supplies from air stations were sent to the office of the Chief of the Air Service Medical. It was found expedient in the Air Service Medical to add wire cutters, axes, and fire extinguishers to the standard equipment of boxes for surgical dressings carried by ambulances. 23 The creation of auxiliary landing fields led to the adoption of aeroplane ambulances. 24 On the creation of the office of flight surgeon in May, 1918, these officers were furnished with a special standard equipment, 25 including such items as the Jones-BarAny chair, the Maddox rod and phorometer, the Jennings color chart, and other special diagnostic apparatus.
SELECTION OF SITES FOR NEW FIELDS.
Upon our entry into the war, flying fields existed at San Diego, Calif.; Mineola, Long Island; and at Essington, Pa. 26 Shortly thereafter sites were leased at Hampton, Va.; Mount Clemens, Mich.; Belleville, Ill.; and Rantoul,111. 26 Early in the war no medical officer was detailed on any board for the selection of sites for new fields. 27 In conformity, however, with action taken by the Aircraft Production Board, July 31, 1917, 28 a board, consisting of two Air Service officers and one medical officer, made a comprehensive study of the entire country with a view to the appropriate location of more flying fields. This board located fields at Millington, Tenn.; 27 Dallas, 27 San Antonio, 27 and Houston, 27 Tex.; and at Lake Charles, La., 27 and inspected the fields in the Middle West where construction had already been started. The board also visited a Canadian field at Camp Borden, Canada. 27 Three fields were located in the neighborhood of Fort Worth, Tex., 27 for the use of Canadians during the winter of 1917-18. In all, 20 fields were located by the above-mentioned board, 27 and about the same time 10 fields were selected without the advice of medical officers, but in no case was a field selected by a board against the advice of its medical members. 27
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HOSPITALIZATION.
The Air Service usually required hospitals of its own because its fields were far separated from other Army hospitals, 29 but at such stations as San Antonio and the divisional camp at Waco, Tex., the Army hospitals in the vicinity were also utilized very largely. 30 A hospital was recommended for Kelly Field near San Antonio in August, 1917, but the Hospital Division of the Surgeon General`s office decided that no hospital was necessary here, as the sick could be taken care of at the base hospital at Fort Sam Houston. 31 In consequence, the only hospital facilities at Kelly Field during 1917-18 was the very small hospital on Field No. 2 (about 40 beds); in addition, a number of barracks had been converted into receiving wards for patients to be sent to Fort Sam Houston. 32 So of necessity thousands of patients had to be sent to Fort Sam Houston. At one time the Kelly Field command had a strength of approximately 35,000 men. In December, 1917, a 64-bed hospital was authorized for Kelly Field and was opened early in 1918. The new guardhouse here was converted into hospital wards in March, 1919. 33
No medical officer was consulted regarding the plans for the early hospitals, and those adopted after an inspection of Camp Borden, Canada, were faulty, as the hospitals were entirely too small for their commands. 34 Originally intended for 40 patients, they proved adequate for only 24 when a minimum of floor space per patient was established by the Surgeon General`s office. Hospitals of this type were built at Selfridge Field, Chanute Field, Hazelhurst Field, and at the two Wilbur Wright Fields. All these hospitals had to be enlarged later. 35 Forty-bed hospitals with adequate floor space for this number of patients were then built at Kelly Field No. 2, Dallas repair depot, and at Call, Rich, Park, Love, Carruthers, and Taliaferro Fields.
When the Medical Section of the Air Service was organized there was no separate division for hospital construction. When such a division was finally established in January, 1918, 36 the problem of enlarging the old type of 24-bed hospitals to 50 beds was carefully considered, and solved by adding an isolation wing of 10 beds and a 17-bed ward wing. Early in February, 1918, it was decided to adopt plans for a standard 50-bed cantonment hospital of the so-called gridiron type, comprising essentially a corridor with wings at right angles on either side. 36 Hospitals of this type were erected at nine fields. A standard 100-bed hospital of similar plan was then designed. 36 This was the type built at post fields and at the Army Balloon School, Arcadia, Calif. Infirmaries of 8 to 10 beds were also designed and constructed, as well as other hospitals varying in accommodation from 40 to 250 patients. 37 Standard plans for nurses` quarters, to accommodate 6, 12, or 30 nurses each, were also prepared. 37 Those of the six-nurse type for single unit fields were never authorized by the Secretary of War, so that nurses at these fields had to be quartered in hospital wards or in officers` quarters. Nurses` quarters of the large type were constructed at various fields. At Eberts Field the Red Cross built a nurses` dormitory at its own expense. Barracks for Medical Department enlisted men, varying in capacity from 30 to 200, were also built at a few fields when it became necessary to increase the capacity of their hospitals, this being done, of course, by removing the men from the hospital and quartering them in barracks con-
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structed for them. 37 Separate buildings for morgues were erected at 25 fields and separate medical research laboratories at 15 fields. On the recommendation of food experts, plans were also prepared for an ice-cold storage building at each of the southern fields. Only one of these buildings was erected; this was at Eberts Field. 38
Early in the winter of 1917-18 it became evident that it would be necessary to provide for the recuperation of Air Service personnel who had gone "stale" or who had become otherwise physically or mentally unfit. While many people living near aviation fields opened their homes to officers and men for this purpose, it was soon found that it was not advantageous thus to separate them from military and medical supervision. Special hospitals therefore were established for the care of such cases. 39 The Mary I. Bassett Hospital, at Cooperstown, N. Y., was opened for such patients in November, 1918; this was used extensively for overseas convalescents. Another place, more in the nature of a rest camp, was established at Warners Hot Springs, Calif. This was a substation of Rockwell Field, San Diego, and was also used for March Field, Riverside.
MEDICAL RESEARCH BOARD AND MEDICAL RESEARCH LABORATORY.
In the first year of the war it was found by the British air service that65per cent of all air casualties were due to the physical unfitness of fliers. 40 By careful study of the causes of accidents this percentage was reduced to 30 percent in the second year of the war and to 12 per cent in the third year. 40 The causes of physical deterioration were various, but the chief was found to be the effect of altitude. The oxygen requirements of aviators were also found to vary. The anti-aircraft guns of the Germans necessitated flight to such altitudes as 16,000 to 20,000 feet, and as few aviators could be acclimated to such heights an artificial supply of oxygen became an absolute necessity. In consequence of these experiences, it was recommended by the chief surgeon, Air Service, that a board be appointed, with discretionary powers to investigate all conditions affecting the physical efficiency of pilots, to carry out experiments and tests at different flying schools, to provide suitable apparatus for the supply of oxygen, and to act as a standing organization for instruction in the physiological requirements of aviators. Following this suggestion, the Medical Research Board was established in October, 1917, 14 with the following departments: Cardiovascular, otological, physiological, psychological, ophthalmological, and psychiatric, each department being represented by a specialist in the given field. Plans were prepared for a central research laboratory at Hazelhurst Field, Mineola, Long Island, and its construction was completed in January, 1918. 42 Fifteen branch laboratories were finally established at the different flying fields. 43
INSPECTIONS.
Inspectors from the office of the Medical Division of the Air Service conducted frequent medical inspections of the aviation stations. 44 These included all matters of Medical Department interest. The special objects sought were: (1) To instruct the post surgeons in general methods regarding administrative procedure, with a view to coordinating these methods and to procure uni-
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formity in all stations; (2) to note the quality and the condition of the personnel at the various stations, being constantly on the lookout for men with particular qualifications, and to see that the personnel was being used to the best possible advantage; (3) to get the views of commanding officers in regard to medical personnel, to take into consideration their recommendations, explain the purpose in the special care of flying personnel, and to coordinate the work of the Medical Department with the executive branch of the Air Service in every possible way.
As occasion arose, regular sanitary inspections of Air Service stations were also made by the sanitary inspectors of the Surgeon General`s Office. 45
DEMOBILIZATION.
On November 11, 1918, as already stated, the medical department of the Air Service was being operated by the Air Service Division, Surgeon General`s Office. At this date special medical boards were active at the different camps for the physical examination of applicants for aviation. At the 70 Air Service stations, 971 medical officers, 453 nurses, and 3,752 enlisted men were on duty., 46 Flight surgeons were under training for overseas duty, the medical research laboratory at Mineola was in full swing, and at several fields branch laboratories had been established for the classification and reexaminations of fliers. Demobilization began promptly after the signing of the armistice 46 with immediate discharge of aviator applicants when practicable. The medical work, now much reduced, was carried on by a few regular officers on duty with the Aviation Service and by such of the temporary commissioned medical personnel as desired to remain in the Army. As stations closed their medical personnel was transferred to active stations. Monthly progress in demobilization, from December, 1918, to December, 1919, inclusive, is shown in the following table : 46
[table]
PERSONNEL. a
(April, 1917, to December, 1919.)
Lyster, T. C., Brig. Gen., M. D)., chief.
Truby, Albert E., Col., Al. C., chief.
a In this list have been included the names of those who at one time or another were assigned to the division during the period, April 6, 1917, to December 31, 1919.
There are two primary groups-the chiefs of the division and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequency of service.
501
Crabtree, G. H., Col., M. C.
Gapen, Nelson, Col., M. C.
Wilmer, W. H., Col., M. C.
Bauer, Lewis H., Lieut. Col., M. C.
De Loffre, S. M., Lieut. Col., M. C.
Dreyer, G., Lieut. Col., R. A. M. C. (British Army).
Jones, Isaac H., Lieut. Col., M. C.
Lewis, E. R., Lieut. Col., M. C.
Seibert, E. G., Lieut. Col., M. C.
Sheep, W. L., Lieut. Col., M. C.
Butler, C. S., Maj., M. C.
Cleave, J. W., Maj., S. C.
Hitch, Edgar T., Maj., S. C.
Joseph, Don, Maj., M. C.
Martel, F. J., Maj., S. C.
Roby, A. A., Maj., S. C.
Dennis, F. L., Capt., M. C.
Nugent, E. T., Capt., S. C.
Todd, Wm., Capt., S. C.
Wharton, C. M., Capt., Air Service.
Wayland, Thomas A., First Lieut., M. C.
Knauss, Roy A., Second Lieut., S. C.
Stoddard, Charles J., Second Lieut., S. C.
REFERENCES.
(1) Report of the Director of Military Aeronautics, United States Army, to the Secretary of War 1918, 4. Government Printing Office, Washington, D. C.
(2) Ibid., 12.
(3) Letter to the Surgeon General from Maj. T. C. Lyster, M. C., April 28, 1917. Subject: Placing an Officer of the Medical Corps in General charge of Physical Examination of all Applicants for Duty with Aviation Section, Signal Reserve Corps. First indorsement by the Surgeon General, April 30, 1917. On file, Record Room, S. G. O., 140868 (Old Files). S. O., No. 109, par. 2, W. D., May 11, 1917.
(4) S. O., No. 207, W. D., September 6, 1917, par. 4.
(5) Correspondence. Subject: Assignment of Rooms. On file, Record Room, Office of Chief of Air Service, General Files, 029.21 (Assignment of Rooms).
(6) Letter from Col. Theodore C. Lyster, M. C., to the Inspector General, April 30,l91S. Subject: Organization of Medical Department Attached to Aviation Service. On file, Chief Surgeon`s Office, Air Service, 321.6.
(7) S. O., No. 111, W. D., May 11, 1918, par. 253.
(8) Office order, No. 33, S. G. O., May 11, 1918.
(9) Office order, No. 42, S. G. O., May 23, 1918.
(10) G. O., No. 51, W. D., May 24, 1918.
(11) Office order, No. 135, S. G. O., March 14, 1919.
(12) Copy of Form 609 (Physical examinations of applicants for detail in the Aviation Section. Signal Corps). On file, Office of Chief Surgeon, Air Service, 315 (General .
(13) S. O., No. 246, W. D., October 20, 1916.
(14) Letter from Maj. Theodore C. Lyster, M. C., attending surgeon, to the Surgeon General, April 28, 1917. Subject: Examining Boards, Aviation Section, Officers` Reserve Corps. On file, Record Room, S. G. O., Correspondence File, 140868-R (Old Files).
(15) S. O., No. 109, W. D., May 11, 1917. S. O. No. 155, W. D., July 6, 1917.502
502
(16) Letter from chairman Medical Reserve Board, to Surgeon General of the Army, November 13, 1917. Subject: Selection of Examiners. On file, Chief Surgeon`s Office, Air Service, 334 (General).
(17) List of physical examining units with examining boards, with location, given in Air Service, Medical, pages 44 to 54, inclusive. War Department, Air Service Division of Military Aeronautics. Washington, Government Printing Office, 1919.
(18) Memo. from Examining Board Section, Office of Chief Signal Officer, to chief surgeon, Aviation Section, January 14, 1918. Subject: Examining Boards at Divisional Clamps. On file, Chief Surgeon`s Office, Air Service, 334 (General).
(19) Air Service Medical, page 24. War Department, Air Service Division of Military Aeronautics, Washington, D. C. Government Printing Office, Washington, D. C.
(20) Confidential orders, No. 92, W. D., October 11, 1917, pars. 10 and 11.
(21) Memo. No. 79, S. G. O., Air Service Division, June 3, 1918. Subject: Duty of Personnel at Aviation Stations in Classifications and Care of Flier. On file, Chief Surgeon `s Office, Air Service, 321.6 (General).
(22) Letters from the property officer, Air Service, to the Property Division, S. G. 0. On file, Chief Surgeon`s Office, Air Service, 444 (General).
(23) List of medical equipment for aero squadron, October 17, 1917. On file, Chief Surgeon`s Office, Air Service, 444 (General).
(24) Letter from Director of Military Aeronautics to commanding officers of flying fields, July 23, 1918, Subject: Ambulance Plane. On file. Record Room, Office of Chief of Air Service, General Files, 452.1 (Ambulance Planes). (2.5) Memo. from Lieut. Col. S. M. De Loffre, M. C., to the Property Division, S. G. O., May 28, 1918. Subject: Equipment for Flight Surgeons. On file, Chief Surgeon`s Office, Air Service, 444 (General).
(26) Memo. from Director Military Aeronautics to Historical Branch, War Plans Division, General Staff, dated April 1, 1919. Subject: Record of Training Section of the Air Service. On file, Historical Branch, Army War College, A. W. C. 76-2421.
(27) Memo. from Col. George H. Crabtree, M. C., to Lieut. Col. W. S. Shields, March 8, 1919. Subject: Selection of Sites for Aviation Fields. On file, Chief Surgeon`s Office, Air Service 201 (Crabtree, George H.).
(28) Memo. to Captain Edgar, August 1, 1917. Subject: Resolution Passed by Aircraft Production Board, July 31, 1917. On file, Record Room, Office of Chief of Air Service, General Files 686 (Miscellaneous Aviation Fields and Stations).
(29) Data concerning individual flying field hospitals. On file, Record Room, Office of Chief of Air Service, General Files 632 (General).
(30) Report on hospitalization Air Service, by Lieut. Col. S. M. De Loffre, M. C. On file, Historical Division, S. G. O.
(31) Telegram from department surgeon, Southern Department, to the Surgeon General, October.10, 1917. On file, Record Room, Office Chief of Air Service, General Files, 632.
(32) letter from commanding general, Fort Sam Houston, Tex., to commanding general, Southern Department, April 1,1918; and indorsements thereto. On file, Record Room, S. G. O., 632 (Kelly Field) (B).
(33) Telegram from director military aeronautics to commanding officer, Kelly Field, February 3, 1919. On file, Record Room, Office of Chief of Air Service, General Files, 627. (Kelly Field.)
(34) Extracts from Reports of Sanitary Inspections Made During the World War, 182-213 (Hospital Construction). On file, Record Room, S. G. O., 721.1.
(35) Memo. from Lieut. Col. Nelson Gapen, M. C., to Lieut. Col. G. H. Crabtree, M. C., November 13, 1917. Subject: Hospital Facilities at Certain Flying Fields. On file, Chief Surgeon`s Office, Air Service, 632 (General).
(36) letter from Chief Signal Officer to The Adjutant General, April 16, 1918, and indorsements thereto. Subject: Authority for Construction and Alteration to Various Hospital Buildings. On file, Chief Surgeon`s Office, Air Service, 632 (General Plans). On file, Plans Division, Construction Service (Quartermaster Corps).
(37) Correspondence on infirmaries. On file, Record Room, Office Chief of Air Service, General Files, 632 General).
503
(38) Letter from officer in charge of supply division, office of the Director of Military Aeronatics, to the officer in charge of construction, June 5, 1918. Subject: Ice-Cooled Refrigerator Plant. On file, Record Room, Office Chief of Air Service, General Files, 673 (Eberts Field).
(39) Memo. from Chief of Operations Section, office Director of Military Aeronautics, to Lieutenant Benham, Air Service, September 16, 1918. Subject: Rest Camps for Aviators. On file, Record Room, Office Chief of Air Service, General Files, 632.B (Hospitals).
(40) Air Service Medical, 95.
(41) S. O., No. 243, W. D., October 18, 1917, par. 113.
(42) Memo. from Maj. F. G. Seibert, M. C., Medical Research Board, to Chief Signal Officer, December 19, 1917. Subject: Medical Research Laboratory. On file, Record Room, Office Chief of Air Service, General Files, 702.3 (Hazelhurst Field).
(43) Memo. from Maj. Edward Burns, supply section, office of Director of Military Aeronautics, to Air Service Division, S. G. O., September 24, 1918. Subject: Construction of Sublaboratories. On file, Chief Surgeon`s Office, Air Service, 632 (General).
(44) Memo. from Brig. Gen. Theodore C. Lyster, M. D., Chief, Air Service Division, to Col. George H. Crabtree, M. C., August 17, 1918. Subject: Medical Inspections. On file, Chief Surgeon`s Office, Air Service, 333.1 (General).
(45) Report of sanitary inspections made by Surgeon General`s Office. On file, Record Room, S. G. O., 721.1 (Name of Station) (B).
(46) Report on demobilization of medical personnel assigned to Air Service, from Col. Albert E. Truby, chief surgeon, Air Service, to the Surgeon General, February 10, 1920. On file, Chief Surgeon`s Office, Air Service, 321.6 (General).
