In the earliest days of flight there was little reason to think that the new science might also require new medical expertise. However, as soon as aircraft performance improved an entirely novel range of aviators’ symptoms presented that needed to be addressed. Among them were the effects of altitude, disorientation, vertigo, air-sickness and even g-forces. Furthermore, once war had broken out and the various armies needed to recruit aircrew by the hundred, the question of how best to select suitable trainees became urgent. Should they be different from ordinary soldiers? What qualities – both physical and mental – made a good airman? Having a private income and being able to drive a motor car might not, after all, be enough. Being fit and healthy was surely a good start, but even the fittest human body had its limitations when faced with conditions for which no terrestrial creature had evolved. Of these, the ill-effects of altitude had at least been long recognised.
The early balloonists had been much admired and even lionised for their daring, and few did more to earn their accolades than Victorian scientists like James Glaisher and Henry Coxwell. On 5th September 1862 these two gentlemen, clad in ordinary street clothes with tweed jackets, ascended in their basket without oxygen to some 32,000 feet or six miles (nearly 10,000 metres). This was as high as today’s transatlantic jetliners grazing the stratosphere and leaving their white contrails. At 29,000 feet the temperature had sunk below minus 21°C. Quite apart from the cold, both men had for some time been suffering the increasing effects of hypoxia. Their hands had turned black and now their vision was too blurred to take further readings from the barometer that was effectively their altimeter. Both men were losing control of their limbs and drifting in and out of consciousness, and the balloon was still rising. One of the pigeons they had brought with them was already dead. They would undoubtedly have died as well had not Coxwell somehow willed himself to climb up, seize the rope attached to the gas-release valve in his teeth and pull it open before slumping down beside his insensible companion. Once the balloon had descended and the temperature risen the men, like their remaining pigeons, recovered quickly. This was just as well because on finally landing they had to tramp several miles to the nearest house. It was not for nothing that such pioneers inevitably became known as ‘balloonatics’.
Elsewhere in Europe, and particularly in France, scientific studies were being carried out to discover the precise effects of high altitude on the body. Increased heart rate and respiration, headaches, blurred vision, intense weakness and finally unconsciousness: were these caused by the low pressure or lack of oxygen or by something else as well, such as changed blood chemistry? And were such symptoms made worse by subzero temperatures? A tough breed of scientists began setting up some very stark laboratory huts at remote sites on Europe’s highest mountains. Not only must they have been competent mountaineers but unafraid of sheer physical hardship as well. The French climber and natural scientist Joseph Vallot was the first, constructing his hut 14,320 feet up Mont Blanc in 1890. Three years later the Italian neurophysiologist Angelo Mosso built a similar hut 650 feet higher on Monte Rosa. In 1910 the German physiologist Nathan Zunz led an expedition to Tenerife, setting up his laboratory at 10,695 feet in the Rifugio Altavista del Tiede the Scottish astronomer Charles Piazzi Smyth had first built there in 1856.
It was not until 1911 that there was a fully scientific anglophone high altitude research trip. This was the celebrated Pike’s Peak expedition to the mountain in Colorado where there was already a comfortable hotel at 14,100 feet and, better still, a rack and pinion railway to reach it. Two leading British physiologists, J. S. Haldane and C. G. Douglas, together with two equally distinguished American colleagues, Yandell Henderson and E. C. Schneider, spent five productive weeks at the hotel. With classical thoroughness they had earlier taken their bodily measurements at sea level. They then did the same at altitude for over a month plus a final set of data back at sea level. Their findings were of unprecedented accuracy.
Even so, the French scientist Paul Bert had long been granted the honorary title of ‘the father of high-altitude physiology’ since the publication of his great treatise La Pression Barométrique in 1878. He had used animals in low-pressure chambers at his laboratory in the Sorbonne and established once and for all that the ill-effects of high altitude were caused by low concentrations of oxygen in the atmosphere. Given this finding, which was fully corroborated by all subsequent research, it is surely very odd that forty years later pilots flying above 12,000 feet or so did not automatically carry an oxygen supply once aircraft were powerful enough to manage the extra weight of the cylinder. RFC pilots flying Sopwith Pups in 1917, for example, quite frequently went to 20,000 feet for lengthy patrols. The main reason for flying so high was that by then the Pup was obsolescent and the only way it could defend itself against the German Albatros D.III was by its sole advantage of superior manoeuvrability at extreme height. But the effects of flying at that altitude for extended periods without oxygen were very severe, especially if the least effort was required. Arthur Gould Lee left a vivid description of having to answer a call of nature in his Pup at 20,000 feet:
I give my reluctant attention to a difficult expedient, with the hope that no Hun will come along at an inconvenient moment. My hands are completely numb, but I pull off my right gauntlet and fumble interminably at opening buttons, which takes quite a time because my fingers have no sense of touch. Then comes the task of finding the way through a barrier of obstinate underclothes. This achieved, there is the problem of where? The refined procedure is to have a funnel with a rubber tube running to a container on the floor of the cockpit, but most of us just aim at the joystick and hope for the best, the hope being strongest over Hun territory. Then comes the job of getting things back as they were. When it is all over and the gauntlet is replaced, the effort has exhausted me and I flop back in my seat panting for several minutes.138
It might have been even worse. Diarrhoea was a well-known affliction of those who flew aircraft – like the Pup – with a rotary engine that spewed out quantities of castor oil whose laxative mist airmen constantly inhaled. Supposed remedies included blackberry juice and brandy, flasks of which pilots sometimes carried. After a while many men acquired an immunity to castor oil and quite probably to brandy as well.
Almost as bad were the agonising pins and needles in the hands and feet when descending quickly to lower altitude, not to mention the splitting headache that would sometimes linger for days. The Germans, too, had long experience of these symptoms in their airships, and during the war Zeppelin bomber crews were often badly affected. The hours of slow flight by night to the English coast against the prevailing wind, temperatures of forty degrees of frost and a lack of oxygen rendered many men useless. They were obliged to give up flying altogether and return to the trenches. A German officer later recorded the example of one such Zeppelin, the L.44, making a raid on Harwich in May 1917. The crew were so incapacitated by hypoxia that ‘the ship drifted over the town completely out of control, and without a single engine running. It was not until they were well out in the middle of the North Sea that two of the engines were restarted, and the ship was able to return to its base.’139
What is strange about these examples is that despite all that had long been known to science about oxygen deficiency impairing performance, the various militaries were so slow to do something to alleviate it even though their airmen were being incapacitated as fighting men. Certainly the slight extra weight of oxygen cylinders would have been insignificant in an airship. Nor was it for lack of suitable equipment. Back in October 1904 Scientific American had carried an article on ‘The Guglielminetti–Draeger Respiratory Apparatus’ and it was clear that some medics with an interest in aviation were aware of this piece of equipment because in 1914 the British surgeon J. Elrick Alder wrote about its advantages. Among these was the pilot’s ability to control the flow of oxygen according to need. He simply wore ‘a mask communicating by a pipe with the vessel. This caused the aeronaut to avoid all effort in carrying to his mouth the vivifying gas.’140 Mr Alder knew all about the effects of altitude and had observed ‘cyanosis of the extremities: the fingers become purple. Wynmalem [the Dutch flyer and altitude record holder, Wyn Malem] who reached a height of 8,340 feet felt the blood pour from his nails into his fur gloves, and red pearls were on his lips.’ (This last phrase is pure Oscar Wilde.)
The particular example he quotes picked up yet another important characteristic of altitude sickness that any mountaineer recognised: that different people reacted very differently to it, and it was not just a matter of fitness. There seemed no way of knowing in advance who would be better able to resist hypoxia without subjecting each man to tests in a barometric chamber. A British aviation doctor who had studied under Haldane, Captain Martin Flack, recorded a series of thirty-five pilots he had examined while consultant to the Air Board in 1917. He listed them (together with the number of flying hours in their log books) to show the variation in their reactions to altitude:
No. 1 (28 hrs): Giddy above 4,000 feet.
No. 2 (10½ hrs): Giddiness and blurring of vision when flying at 6,000 feet.
No. 3 (140 hrs): Fainted twice in air above 8,000 feet.
No. 11 (300 hrs): Since crash, fainted twice in air at 8,000 feet and 10,000 feet.
No. 31 (400 hrs): At first all right, then on 3 occasions faint at 7,000 feet.141
Quite often pilots seemed to have no idea that they were affected by altitude. This is a familiar syndrome, which explains the later testing of military aircrew in decompression chambers to teach them how to spot the symptoms of hypoxia. Despite their own blue fingertips subjects may gradually lose consciousness without the least awareness of its happening. In the first air war men carrying out high observation recces over 15,000 feet would often return to earth quite unable to remember what they had seen, their reports sketchy or useless. Many had failed to take notes at the time because, either through hypoxia or cold, they couldn’t hold a pencil. Once back on the ground the effects of amnesia became obvious. The military doctor Lieutenant-Colonel J. L. Birley RAMC recorded how ‘One observer returned from a high photographic reconnaissance well pleased with his effort until it was discovered that he had taken 18 photographs on the same plate…’142 After the war Birley, who had co-authored reports for the new Air Ministry, confided to The Lancet: ‘It has always been my opinion that the paralyzing and insidious effects of oxygen-want had a far greater influence in determining the course of aerial operations than has yet been realized.’143
If it was odd that no air force did much to deal with this phenomenon until quite late in the war, stranger still was the resistance by many pilots themselves to the very idea of carrying oxygen. In fact, some British squadrons luckier than Arthur Gould Lee’s were being supplied – albeit patchily – with oxygen equipment at the exact moment he was describing. The chronicles of W. E. Johns’s own squadron, No. 55, mention it in July 1917 (exactly a year before Johns was posted to France), but the tone of the entry makes it clear that the crews were initially sceptical of its value. ‘[T]hough opinions differed at the time as to the real usefulness of this additional “gadget”, it proved that ultimately the pilot and observer who dispensed with it felt the effects of altitude flying very much more than they who had consistently used it, and also that the former were liable to a sudden breakdown, possibly in the air.’144 In a leading medical journal nine months later in 1918 an exasperated M.O. noted a continued resistance to oxygen: ‘Unfortunately, some pilots have an unreasonable prejudice against the use of oxygen, possibly bred of some irresponsible scoffer, and medical officers should therefore patiently explain in the mess or in individual talks the value of oxygen at high altitudes in preventing drowsiness and loss of rapid judgement…’145 The obvious assumption has to be that of sheer ignorance: many British aircrew must have understood so little of basic science and human physiology that they didn’t realise oxygen’s importance. This seems all the more extraordinary given that nearly every pilot who had flown high for any length of time had personal experience of the deadly effects of hypoxia and dreaded being caught by an enemy aircraft when his reactions were slow and his energy depleted, like this German:
Many a poor fellow who had carried out a long and successful flight far behind the enemy’s lines lost his strength before his sortie was over. Weakened and unable to concentrate, he would fall easy prey to some enemy fighter on his return flight. Others could not use their machine guns on account of frostbite. Defenceless, they succumbed to the enemy’s relentless attacks.146
What was more, pilots dreaded being injured at altitude because they knew that with increased heart rate and low barometric pressure bleeding was often severe despite the cold. This syndrome had been known about since at least 1812 when the French solo balloonist Sophie Blanchard suffered a severe and unstaunchable nosebleed at 22,800 feet. The pilot of one German two-seater, seeing his wounded observer was losing blood at a great rate, broke off a fight at altitude and dived as steeply as he dared to land beside a hospital.147 In a British squadron, leaving a combat because your observer was wounded could have looked suspiciously like ‘blue funk’ or a lack of ‘fighting spirit’. But since in a German two-seater the observer was usually also the officer in command, it may be that this particular pilot was simply obeying orders bellowed imperiously from the back seat.
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Even without the problem of oxygen deficiency, the sheer cold in an open cockpit with nothing but a minuscule windshield for protection from the slipstream’s freezing gale was an agony in itself. No-one was impervious to it, not even fit young men with excellent circulation. Despite leather garments with layers of clothing underneath, their legs enclosed in thigh-length sheepskin ‘fug boots’, exposed areas of the face smeared with foul-smelling whale oil and with a sinister-looking dogskin mask and goggles, the cold always got through. An inventive Australian pilot with the RNAS, Sidney Cotton, designed a one-piece suit he proudly named the ‘Sidcot’. It became officially adopted by the RFC at the end of 1917 and went on being used by the RAF until well after the Second World War.148 But good though it was, the Sidcot could do little to warm the extremities. Being roused by a batman at 4 a.m. on a dark and frosty winter morning in France to fly a dawn patrol clad in stiff and freezing leather in an open-cockpit aircraft – and usually on nothing more than a cup of tea and a slice of toast – must have demanded quite exceptional fortitude. Life in the trenches in winter with snow on the ground was no picnic; but the appalling cold at 15,000 feet or higher was another matter – further exacerbated as it was by the wind-chill of the slipstream, especially for the observer who had to stand up to man his gun. Even in summer, temperatures of minus 40°C were not unknown at altitude. Even the alcohol in the aircraft’s compass could freeze. Supposedly cold-resistant gun oil thickened to the point where weapons jammed and became unusable. Aircrew sometimes arrived back on the ground unable to climb out of their machines and in no fit state to fly again that day or even for weeks. ‘My face feels like one big bruise after the cold yesterday,’ admitted Lieutenant-Colonel H. Wyllie to his diary. ‘Mowatt rather badly frost bitten.’149
CASE 2 – Flight Sub-Lieut. M., aet 27. Returned from bombing raid of about two and a half hours’ duration. Face very swollen though not particularly painful. Next day the face was enormously swollen, the cheeks being almost in line with the tips of the shoulders, and in addition there was much redness and some vesication of the skin below the right angle of the mouth. This latter developed into a fairly superficial necrotic patch about the size of a crown piece.
Treatment consisted of keeping the face warm by wool and bandage, and dusting powder to the necrotic patch. Later a zinc oxide ointment dressing was applied to this latter. The swelling gradually decreased, and the slough turned black and separated, leaving a healthy base about the fifteenth day. The face was very painful for some weeks after this whenever exposed to the cold.150
Yet just as with oxygen, there was resistance on the part of some pilots and observers to the issuing of electrically heated clothing, some versions of which were introduced in early 1918. Like the electrical supply for wireless sets, the power came from a generator attached to a strut and driven by a small propeller that turned in the slipstream. One pilot noted the case of an Australian who refused both these aids to his well-being on the grounds that the small extra weight plus wind resistance ‘added to the burden put upon the engine, and so tended to deprive him of just that last ounce of power which makes all the difference when manoeuvring against the Hun’.151
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By now military doctors serving with all the combatants realised that a significant proportion of their aircraft accidents and losses was caused by the aircrews’ physical state rather than by enemy action. An example of this was recorded of a new officer who joined 20 Squadron in France in 1917:
He was a quiet and delightful man who had just been elected to the Fellowship of his college. A week or so later, he was under arrest for cowardice. On each of three occasions when his flight had been on reconnaissance patrol, he had joined the flight above the airfield, had begun to move off with them and then broke off and returned alone. He did not know why he had done this and did not even realize that he had until after he had landed. Heald [an RAMC captain, the squadron’s Medical Officer] examined him and found a chronic suppurating otitis media [middle ear infection] and a history of his having been awarded his wings without ever exceeding 1,000 feet. As he had to rendezvous at about 2,500 feet for his sorties he had obviously become dizzy and disorientated. Heald made a full report in writing and in person to the brigadier and the court martial was cancelled. The officer returned to his regiment with his honour unsullied.152
This reveals much about the standards of aircrews’ medical selection and training in the RFC at the time. It seems incredible now: a highly articulate young man with a chronic weeping ear infection and no experience of going above 1,000 feet who was nonetheless passed as suitable for combat flying in a war zone. Behind such cases lay an administrative absurdity: that despite all that was being recognised by aviation medics, RFC recruits were still given the standard army medical inspection designed to weed out obvious physical deficiencies such as bad eyesight or lameness, as well as infectious diseases like TB and VD. One army doctor wrote candidly of the inspection he was required to carry out as ‘a perfunctory examination calculated to exclude the one-legged, the hunch-backed, the man moribund of cardiac disease, and the blind’.153 To be fair, he was speaking of coping with the great rush of volunteers in the autumn of 1914. All the same, standards of public health in Britain were often so bad that in some units upwards of 20 per cent of men were found unfit for military service.
The 42nd Territorial Division was nearly at full establishment when it left Britain, but when it arrived in Egypt in September 1914 the GOC, Sir John Maxwell, found 100 men technically blind, 1,500 riddled with vermin, one dying of Bright’s disease and ‘hundreds so badly vaccinated they could hardly move’. One officer concluded that the division had ‘picked up any loafer or corner boy they could find to make up the numbers’.154
For all that these men had volunteered, the result was like press-ganging all over again; and it scarcely helped that until May 1915 doctors were paid half a crown for every man they passed as fit: a system that practically guaranteed abuse. Both the French and the Germans were well aware of deficiencies in the health of their own potential recruits, but all evidence suggests that they were generally more thorough, and at an earlier date, than were the British, certainly when medically vetting their future airmen. Once he had passed the standard Army inspection a man applying for the RFC was usually deemed by implication to be fit to fly. Indeed, there were documented cases of men diagnosed as unfit for the trenches being recommended for transfer to the RFC, although it is probably safe to assume a degree of Army ill-will was operating here, and not just medical incompetence. This being noted, 1917 was also the year when the RFC formed its Special Medical Boards – much to the scepticism of the existing Army medical services. This was in direct response to casualty figures that had become quite unsustainable. In that year of Bloody April the air arm’s reinforcement demands were running at roughly 500 per cent per annum – a rate that implied a complete turnover of RFC personnel every ten weeks or so. More than half these casualties occurred in the first six weeks of training. The Special Medical Air Boards began applying much more rigorous selection standards and by autumn these were showing dividends. They halved the wastage of men and machines by weeding out early the obviously unfit, and disqualifying certain prospective flyers from even basic training. Even so, a further 10 per cent of recruits were eliminated during training as ‘unlikely to become efficient flyers’. It was yet another sign of the impending break of the Royal Flying Corps from the Army, which formally took place on 1st April the following year with the creation of the RAF. By now it had become evident that a particular sort of man was needed in the air, with quite different attributes to those of an infantryman. Inevitably, he would also be prone to a different set of ailments and injuries.
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The question of the best flying temperament had long been moot. It was all very well bluff types in flying club bars booming that anyone who could drive a motor car could learn to fly; but since at least the days of Blériot and his flying schools the question of whether there was a particular ‘type’ of person who made an ideal aeronaut had been much debated. The war only made this both more urgent and more problematic because men were no longer required just to be skilled aviators. They also had to be warriors; and ‘fighting spirit’ seemed to demand yet another kind of character. The idea was common then (and persisted into the 1930s among older officers in the RAF) that a good horseman made the best aviator. Sensitive hands, a good seat and an eye for country were thought to be essential requirements. It is perhaps too easy to scoff at this today. In fact, the light biplanes of the early days of flying never responded well to heavy-handed treatment and nor, for that matter, do modern aircraft. Once stable machines like the B.E.2c had been superseded by fighting aircraft deliberately designed to fly on the very edge of stability like the Sopwith Camel, it was not hard for an unwary pilot who was a little rough on the controls to tip his machine into a spin or a stall – either of which could easily prove fatal, as training airfields witnessed almost daily throughout the war.
A further reason for not scoffing at the perceived connection with riding has to do with class. In 1914 horses were ubiquitous and most well-to-do young men could ride, if only after a fashion. Such youngsters constituted the pool from which the British Army mainly drew its pilots in the early part of the war because by and large they were the middle-class men who had already learned to fly at their own expense in private aero clubs. Particularly in Britain, the type of man the military chose tended to self-select in conformity with the Army’s preconceptions. Yet the pressures of war soon obliged the RFC’s recruiting officers to look further afield. By late 1918 an RAMC doctor could report that ‘Flying is not now confined to the public school boy, the cavalry officer, or the athlete. We take many of our pilots at present from the lower middle classes and some from the artisan class.’155 Even so, at much the same time another doctor who had already spent eighteen months as the chief medical officer of various RFC and RAF training camps could write:
[O]ne would much sooner accept a well-educated nervous type as a pilot than one whose mental training has been very limited. For the nervous, pale-faced, introspective East End clerk with little or no experience of outdoor exercise and sport, whose habit of life almost compels him to think far too much of [i.e. about] himself, one would probably advise rejection; while for the university athlete, equally nervous but trained to ignore himself and to control his feelings, trained to act and think of and for others, of good physique and broad in mental outlook, one would on the whole advise acceptance.156
Here, a public school housemaster disguised in RAMC khaki has plainly had the last word. Clean-limbed, clear-eyed and sporty ’varsity boys versus weedy working-class townees? No competition. And after all, he was probably right. The one thing that upset this easy preference was the influx of pilots from the Dominions – Canada, Australia, New Zealand and South Africa – because they were more unreadable in class terms. They tended overwhelmingly to be country boys, and mostly far tougher and fitter even than Oxbridge men who rowed. Better still, thanks to lives lived in the great open spaces, they often had terrain-reading skills that seemed positively uncanny to their British instructors and proved less likely than their British counterparts to get lost in the air.
The belated introduction of the Special Medical Air Boards ensured that the RFC’s doctors began to catch up with the more scientific approach of their Continental counterparts. However, anyone looking through bibliographies of the medical problems that early flying threw up will be struck by how few of the contemporary books are in English. Whether addressing aviation accidents, ear-nose-and-throat conditions, altitude sickness or the psychology of fliers, the majority of the texts are in French, German and Italian with only the occasional British or American book. It was not that Britain lacked scientists of J. S. Haldane’s calibre – or even first-rate doctors, come to that. As we know, the German and French army high commands were at first equally sceptical about an air war. But their scientists were clearly ahead of the game, the Germans being particularly advanced in aviation medicine thanks to their supremacy in airship technology (while nevertheless allowing at least some of their Zeppelin crews to fly without oxygen).
At any rate the RFC did eventually adopt physiological and even rudimentary psychological tests for airmen. These included measurement of reaction times (using French-designed apparatus), visual acuity tests and sometimes pressure chamber tests to weed out those abnormally susceptible to altitude. Yet even here a doctor writing in a British journal after the war could say: ‘On the Continent observations have been made upon the circulatory system in the air at different heights. I had hoped to carry out a series of similar observations myself as it does not follow that one would obtain the same results with British pilots.’157 Evidently he felt Britons were physiologically different from Continentals.
Some aviation doctors formed their own rule-of-thumb notions of how to spot a potential aviator that may well have had a modicum of validity:
I have noticed that if a man had a good ‘sense of projection’ he made a good aeronautist… This test seems to me to be almost decisive of a man’s fitness for flying. By ‘sense of projection’ I mean that a man having looked at a small object [at arm’s length] will afterwards be able quickly and accurately to touch it with the eyes closed.158
The real problem, of course, was that while it was theoretically possible by now to subject men to all sorts of physical tests to see if they were suitable for flying training, it was far more difficult to evaluate a man’s psychology or character in a way that would yield reproducible scientific data. Thus in the latter half of 1918 an American doctor could write:
While at a medical conference at the central recruiting office in England for [RAF] aviators, at which there was an exhaustive discussion of physical tests, I was surprised to note how little stress was laid on the psychological element. It was admitted that even the most experienced examiner could not predict how a flier would behave in action, or whether he would cease to be useful after he had met with an accident, or had had a narrow escape from death.159
This was hardly surprising, given that nearly a century later such things are still to some extent unpredictable, despite batteries of psychological tests and widely-held beliefs that the mechanics of the mind are today far better understood. At the time, RFC and RAF doctors had to rely on first impressions of each candidate as a suitable ‘character’. Their recorded assessments could then be matched up with those of the men’s first instructors – although in many cases it is hard to see how the wretched candidate was ever allowed to climb into an aircraft in the first place, even if he had been to the right sort of school:
Remarks of M.O. | Instructor’s Remarks |
7. All there – guts | Good – plenty of guts |
19. Uptake slow | Good but silly |
24. Slow uptake, no sports, clerk | Average – slow learning |
40. Dull and windy | Poor – sent to heavier machines |
42. Mentality very poo | Hopeless |
50. Quick but bumptious & over-confident | Good but objectionable |
72. Little stamina, clerk | Average |
89. Civil Service clerk | Poor – slow |
107. No physique – windy | Poor, windy and sick |
139. Charterhouse School, but slow, heavy | Poor, very slow160 |
‘Windy’ in this context meant timid and fearful, with unmistakable overtones of cowardice: the polar opposite of ‘guts’. Number 40 was probably not an ornament to the unlucky squadron (presumably bombers) to which he was posted.
It can be seen that predicting the sort of man who would make a good aviator in the RFC or RAF was, until late in the war, considerably a matter of personal prejudice on the part of the examiner, whether he was a doctor or a flying instructor. In the absence of more sophisticated medical tests this was not unreasonable, given that he would have formed his opinions by means of experience (in an instructor’s case experience that had probably come very close to killing him on several occasions). By September 1918 it seemed that something of a consensus had been reached in RAF medical circles about the qualities that made a good combat pilot:
The fighting scout is usually the enthusiastic youngster, keen on flying, full of what one might call ‘the joy of life’, possessing an average intelligence but knowing little or nothing of the details of his machine or engine; he has little or no imagination, no sense of responsibility, keen sense of humour, able to think and act quickly, and endowed to a high degree with the aforementioned quality, ‘hands’ [i.e. lightness of touch on the controls]. He very seldom takes his work seriously, but looks upon ‘Hun-strafing’ as a great game.161
A very British prescription, this, of the ‘playing fields of Eton’ variety. Apparently the requirement was for young men who were not very bright, pig-ignorant about the technicalities of their aircraft, and with a feckless enough sense of humour to view killing and being killed as just a game. Certainly this profile was very much at variance with the far better informed, professional and seriously accomplished airmen Robert Smith-Barry’s Gosport system was even then trying to train.
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By the end of the war active RAF units in France at last had their own medical officers rather than just a medical orderly, most of whom would have had a working knowledge of the particular ailments to which airmen were prone. They might not have been able to predict a newly posted man’s aptitude for war flying with any accuracy, but the attrition of Bloody April in 1917, the temporary reign of the German massed-Jasta ‘circuses’ and the ever-widening scope of air operations had made them practised judges of what today is known as Combat Stress Reaction. W. E. Johns’s first description of the fictional Biggles, quoted in the Introduction, is that of a pilot showing all the symptoms of ‘battle fatigue’ (although with artistic licence the often exuberant aerial adventures he went on to enjoy miraculously belie this). Dr Birley gives a still bleaker description of a pilot at the end of his combat usefulness:
To keep himself going he smokes to excess, or may even come to rely on alcohol. If he meets an enemy formation on patrol he either turns tail or attacks recklessly, too tired to think about manoeuvring. In the last stage the noise of engines on the aerodrome distresses him; he cannot bear to see a machine take off or land, and he even hates to hear ‘shop’ talked. Sooner or later he must give in. The career as a war pilot of an individual who reaches this extreme stage is irrevocably finished.162
The tragedy was that aircrew shortages meant such diagnoses were often ignored by station commanders desperate to keep their machines in the air. In some ways it was even worse that so many of these shattered men were sent back to Britain to act as flying instructors.
It was generally agreed that observers in two-seaters suffered more strain than pilots. Not surprisingly, any loss of confidence in his pilot’s skill greatly increased the observer’s anxiety. This could become extreme if, for instance, his usual pilot went off on leave or was injured and he was assigned a greenhorn straight out of flying school. Not only would he have no faith in the man’s flying ability until it was proved, but there was a lot to learn by bitter experience about surviving in the air over the front, and the first few weeks were crucial. Any experienced observer would have found this learning period agonising. Furthermore, an observer had far more to do in the air than did his pilot. Not only had he to keep a constant lookout for enemy aircraft that could appear in a split second as if from nowhere, especially from the blind spot beneath the aircraft, and be prepared to use his gun at an instant’s notice; he usually had to combine this with taking photographs or making pencil notes or drawings of enemy positions and movements he could see below. He might also have to tap out wireless messages in Morse. It became recognised on all sides that observers usually broke under the strain before pilots did, and to a more serious degree.
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One of the most intractable physiological difficulties to beset aviators became apparent almost as soon as the earliest aeroplanes encountered mist or cloud. It was commonly known as ‘pilot’s vertigo’ and medically as disorientation. That word (derived from the mediaeval ‘orienting’ of churches so as to face east) normally implied losing one’s sense of direction in the usual two earthbound dimensions. It was the addition of a third dimension that led to pilot’s vertigo. After some two million years’ evolution as a bipedal animal, our genus Homo has acquired a pretty reliable sense of balance when dealing with abrupt changes of direction, especially at running speeds (while hunting or being hunted), even though this can easily be disturbed – as any child knows who spins around fast enough to induce giddiness. But until humans flew powered craft they did not have to deal with abrupt changes of direction in three dimensions, and at undreamt-of speeds. Suddenly, human physiology was found wanting. The appropriate circuitry had never evolved because it had never been needed.
Early aviators commonly became lost in the conventional sense of compass bearings. But for what was surely the first time in human history they also found themselves not always knowing which way was up and which down. It is difficult to convey to someone who has never flown a light aircraft in thick cloud how astonishingly easy it is for the body’s sense of up and down to become completely fooled; and the longer this state of ‘blind’ flying lasts, the more disorientated a pilot can become. This is why a vital part of training is in instrument flying. Instruments are generally reliable; the fabled seat of one’s pants less so. Without instruments virtually nobody manages to blind-fly dead level for very long. It may sound hard to believe but there are instances on record of an aircraft emerging from a thick bank of cloud inverted, without the pilot having realised he has gradually turned upside down. It would be a considerable shock to burst suddenly into brilliant sunshine to find rivers and fields overhead.
One of the very first instruments in aircraft was the ‘slip bubble’. This was simply a sealed tube of liquid with either a bubble or a ball in it, much the same as a builder’s level but slightly curved. It was essentially an athwartships spirit level. If the aircraft’s wings were parallel to the horizon and its vertical axis in line with the earth’s gravity, the ball would remain in the centre. But this primitive gadget could seriously mislead a pilot flying blind in a cloud if the aircraft was in a banked turn and centrifugal force counteracted gravity. Not only could this cause the ball to remain in the centre despite the aircraft being tilted, but because the pilot felt his weight increase the turn could also give him the illusion that that he was in a climb. Seeing the slip bubble apparently registering level flight, he might be tempted to push the stick forward to descend or to pull it back hoping to fly out of the cloud. Obviously this could easily lead to disaster or at the very least to acute disorientation, as happened to Cecil Lewis one day in 1916, slowly climbing up through 2,000 feet of thick cloud and at last emerging into sunlight:
But what in heaven had happened to this cloud-bank? It wasn’t level. It was tilted as steeply as the side of a house. The machine was all right – airspeed constant, bubble central – and yet here were the clouds defying all natural laws! I suppose it took me a second to realize that I was tilted, bubble or no bubble; that I had been flying for the best part of fifteen minutes at an angle of thirty degrees to the horizon – and had never noticed it! 163
It might be thought that, a century on and with all the sophisticated electronic instrumentation and gadgetry available to modern military and civil aviation, disorientation would no longer be a problem. Yet an article in the May 2013 issue of Aerospace International entitled ‘Battling spatial disorientation’ shows this to be wishful thinking. It begins with a description of an onboard video recording made in the cockpit of an RAF Tornado while its two-man crew practised anti-missile evasive manoeuvres high above the North Sea. They began by
going to full afterburner and rolling the aircraft into a 60° nose-down descent through thick cloud… with the navigator calmly counting down the altitude from 17,000 ft. It was not until the cockpit low altitude voice warner could be heard saying ‘Pull up! Pull up!’ that the crew grasped the immediacy of the danger they were in and managed to recover the aircraft only 350 ft above the sea by pulling a 7G manoeuvre. The video was sent around all squadrons to show the danger of spatial disorientation (SD) and how it can occur even during routine missions.
Bluntly put, a highly trained combat pilot and his navigator had come within an ace of flying their £9.4 million aircraft straight into the sea at supersonic speed, instruments or no instruments. In fact, spatial disorientation has recently been blamed for 20 per cent of all fatal mishaps in military aviation and has been named as a factor in many high-profile civil accidents.164
In the First World War most army doctors would probably have understood little enough about the sense of balance and how the vestibular system works. However, it was clear that many trainees as well as experienced pilots were being killed by losing all sense of their aircraft’s attitude. Nor was this just a matter of flying into the ground. In many aircraft, including the Sopwith Pup, it was easy to stall or spin simply by not flying straight and level at the right airspeed, and neither slip-bubble nor compass was reliable enough to ensure safety in all circumstances. Once again Arthur Gould Lee describes it well:
Ordinarily you keep on an even keel, both fore-and-aft and laterally, by reference to the horizon, to which you continuously and unconsciously adjust the controls. In a cloud there is no horizon, and you use the air speed indicator for fore-and-aft checks – increased speed means you’re going down, and vice versa – and the bubble, like a carpenter’s level, a joke as an instrument, for lateral angles. Wind on the side of the face means you’re side-slipping. You keep straight by holding to the bearing on your compass, but this is another joke, for the slightest jerk of the rudder sends it spinning, and it needs a longish spell of smooth, straight flying to settle down again – and this you can’t do in a cloud.165
Compasses were notoriously easy to ‘topple’ by even quite mild aerobatics, and after a dogfight surviving pilots often found themselves completely lost, especially if there was a wind and they had drifted during the battle. On a grey day without sun and with a uselessly whirling compass, a pilot might find himself heading further into enemy territory instead of homeward.
It was at Tramecourt that I was sent my first NCO pilot, who I am sorry to say did not last very long, for apparently he got lost in the air and was last seen flying east into enemy country. We never heard of him again. No doubt this sounds incredible to the uninitiated, but it was astounding the number of new pilots who were lost in this way.166
This was presumably where certain Australians and Canadians had an advantage by allegedly being better able to ‘read’ directions from such things as rivers and by having a more developed memory for terrain than many of their British comrades.
From December 1917, under the aegis of the Special Medical Air Boards, cadets applying for commissions went for medical examination at the newly established RFC Central Hospital at Mount Vernon in Northwood, Middlesex, and standards became more demanding. Many of the tests were based on those already used by the French Air Force, such as d’Arsonval’s chronometer for measuring reaction times. There were tests for heart and eyesight and co-ordination, as well as for balance and disorientation. Among the test equipment favoured by French aviation doctors was the Bárány chair. This was a device designed by the Hungarian physiologist Robert Bárány as part of his work on the balance mechanisms of the inner ear that had earned him a Nobel Prize in 1914. The blindfolded subject sat in the chair which was then spun. When it stopped the blindfold was removed and the subject asked to point at something in the room. Measurement could then be made of how wide of the mark his aim was.
There is evidence that the British never took such things quite as earnestly as did other nations even though the Bárány chair tests showed that Dr McWalter had been fumblingly along the right lines when he looked for a ‘sense of projection’ in prospective fliers. Still, such tests were being used by RFC doctors at least by the autumn of 1916, if in a somewhat perfunctory manner. When Billy Bishop, the future Canadian air ace who had hitherto been flying as an observer, applied to re-train as a pilot in September that year he recalled his physical examination as having been less than rigorous:
After the doctor had listened to your heart and banged your lungs and persuaded you to say ‘aah’ and ‘ninety-nine’, you were put into a swivel chair, spun around, and suddenly invited to spring to attention. If you did not fall flat on your face it was presumed that you were a healthy individual and fit to fly. You also did things like walking a chalk line with your eyes shut. That was about all there was to it.167
By contrast an article in The Lancet of 8th September 1917 makes it clear the American Army took such tests as the Bárány chair very seriously indeed, and that the standards of the medical examination undergone by prospective aviators in the United States were high, much more so than those of the equivalent British examination. (The Bárány chair is still used in research departments worldwide today.)
British would-be aviators were also quizzed about their personal habits, especially drinking and smoking, as well as their family histories. So also was any airman admitted to Mount Vernon as an in-patient. When in 1918 the establishment became the RAF Central Hospital, Dr H. Graeme Anderson noted that a patient ‘was asked to give as complete account as he is able of his family: their ages, nationalities (particularly as to any Celtic or Hebrew blood), and habits…’168 W.B. Yeats’s Irish airman foreseeing his own death probably did well not to wind up in Mount Vernon. Yet despite the great step forward that the Central Hospital’s more thorough testing represented, the official attitude towards its true value – as The Lancet ruefully admitted in September 1917 – was still the familiar one of ‘We must wait and see. We don’t yet have enough data.’ It was an attitude that had served (and still serves) Britain long and well in its instinctive refusal to commit itself to anything much other than cautious fence-sitting, especially if it might cost money. Certainly in aviation medicine in the last two years of the First World War the British did sometimes give the impression they believed they were a race apart physiologically; that ‘Continental’ medical ideas were all very well for Continentals (not to mention Celts and Hebrews), but such things needed to be taken with a pinch of salt when testing British subjects.
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Powered flight had revealed yet another phenomenon for which evolution had not equipped humans but which, as aircraft improved, pilots suddenly had to deal with. This was g-forces. What is believed to be the first recorded case of someone losing consciousness because of ‘g’ occurred in 1903 when the American-British inventor, Sir Hiram Maxim, was testing his ‘Captive Flying Machine’. He had designed this as a ride for an amusement park in London’s Earl’s Court. It consisted of a central revolving pole with metal arms attached at right angles from which hung individual seats. As it sped up the seats were flung outwards under centrifugal force. Maxim himself dismissed it as nothing more than a ‘glorified merry-go-round’, but its derivatives survive to this day in amusement parks the world over. While trying out the Captive Flying Machine Dr A. P. Thurston blacked out under 6.87 g, which surely testified to the machine’s sturdy construction as well as to Dr Thurston’s. The Medical Research Council’s 1920 report ‘The Medical Problems of Flying’ cited a test pilot in a Sopwith Triplane who, ‘flying a 4.5 g banked turn, experienced “characteristic darkening of the sky which was preliminary to fainting”’.169 The truth was that this sort of thing had long been familiar to combat pilots everywhere. ‘I zoom up violently, pressure pushes me into my seat, my sight goes for a second…’170 It was practically an everyday event in single-seat fighters.
Since the phenomenon was transient (even if it could momentarily incapacitate a pilot at a crucial juncture), no test had yet been devised that would reveal the exact moment of positive g at which a pilot’s vision blacked out as the blood drained from his brain, or of negative g at which he ‘redded’ out. In Britain, Dr (then Colonel) Martin Flack already had his subjects blow up a column of mercury as a test of their heart and lungs’ ability to deal with the lack of oxygen at high altitudes. Evidently he also saw this as a reliable indicator of the subject’s susceptibility to g. ‘It has been estimated that the centrifugal force of a vertical turn may amount to as much as four times that of gravity,’ he observed, concluding that if the heart wasn’t strong enough it could lead to ‘anaemia of the brain and insensibility’. He noted that ‘turning chairs’ (i.e. Bárány chairs) were used in the USA to test every prospective pilot but that in Britain this had not been thought necessary because ‘a heart that can support the height tests is found able to meet the demands of centrifugal force’.171 This is odd because it suggests Dr Flack had completely mistaken the purpose of Bárány chairs. They were designed to test disorientation and vestibular illusion, not the ‘g’ effects of centrifugal force. To do that, the chairs would have had to tilt at the end of the arms of a centrifuge.
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If today it seems that, overall and for much of the war, the principal combatants’ air forces appeared to do surprisingly little to protect their own aircrew, it must have been partly because as the war progressed aircraft were recognised as a new weapon rather than as a mere vehicle for observers. The priority of weapons in a war is that they be deployed to inflict maximum discomfiture on the enemy, while the safety and well-being of those sent to deploy them are very much secondary considerations. As we have seen, even aircrew themselves were often reluctant to adopt protective measures.
Aircraft designers, too, could seem comfortably distanced from the consequences of their designs. To take an example at random: the radiator of the German Albatros D.III, the bane of the RFC in early 1917, was initially placed over the centre section immediately above the pilot’s cockpit. If it was holed in flight the pilot could be suddenly drenched in boiling water. One would have thought this foreseeable, and in time the radiator was indeed moved off to starboard along the top wing. But then, it wasn’t designers who flew combat missions. On the other hand military doctors undoubtedly became much more experienced at treating the conditions and injuries associated with flying, especially crash injuries. Even by early 1916 the British Medical Journal could draw up a short list of some of the commoner problems medics might need to deal with:
1. Head and neck injuries in crashes caused by violent deceleration when the pilot is strapped in.
2. Eye injuries from loose nuts or bolts blown back from the engine.
3. Frost-bite of the face at high altitudes.
4. Partial anaesthesia by petrol vapour.
5. Exhaust gases causing headache and drowsiness.
6. ‘Aeresthenia’: the suggested name for the inability of flying students to achieve hand-eye co-ordination.172
To these might have been added the permanently stiff and sore neck (to become known in the Second World War as ‘weaver’s neck’) caused by constantly looking all around the sky for enemy aircraft. It was the chafing, rather than a wish to cut a sartorial dash, that led so many fighter pilots to wear silk scarves. Still, amid the urgent pressures of war stiff necks, frost-bite and the rest were thought of more as occupational hazards than as matters requiring remedy.
Added to which, certain types of injury recurred with certain designs of aircraft. A good deal depended on whether the crashing aircraft was of the ‘tractor’ type (with the engine in front) or the ‘pusher’ type with the engine behind and the aircrew in the boat-like nacelle that formed the aircraft’s nose. Obviously this form offered the least protection. It was common for the occupants to survive the impact but immediately to be crushed by the hot engine tearing loose from its bearers behind them.
Fractures of the upper or lower jaw and nose were very frequent in crashes when the pilot’s face hit the cockpit edge or the instrument board or – as so often – the butt-ends of the machine guns that protruded into the cockpit. Many of these injuries could have been avoided with a safety belt and shoulder harness combined, but as will be seen in the next chapter this would probably have been thought namby-pamby as well as carrying risks of its own. Following crash-landings, fractures of the talus (the ankle bone), very seldom seen in civilian life, became common enough in the air war to be thought of as aviators’ fractures. Such injuries led to all sorts of new orthopaedic procedures at which the surgeons at Mount Vernon became increasingly skilled.
Terrible injuries could also be caused on the ground by men carelessly walking into turning propellers. Decapitation was not uncommon. Even swing-starting aero engines was hazardous, especially in the case of a backfire. Anybody brought up in the era when most motor mowers came with a starting handle and all cars still had one for emergency use was taught never to grip the handle with the thumb wrapped around it, but always with the thumb on top because otherwise a backfire could dislocate it. Similarly, the technique of how not to swing an aircraft propeller had to be learned, otherwise broken limbs or worse might easily follow.
The whole mysterious business of why so little was done to protect valuable aircrew better – and why it was the men themselves who so often resisted it – is the subject of the following chapter.