Monthly Archives: July 2010

History of (Naval) Aviation Medicine (Part 2)

The Naval Order of the United States, at its annual Congress will this year celebrate 100 years of U S Naval Aviation. Prompted by this event, I think it is well for us to observe something of the history of U S naval aviation medicine. Part one of these jottings (see below) discussed the experimentation and the best medical thinking that accompanied the earliest flights–ascents to ever higher altitudes–in balloons.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

The advent of flying machines–and the daring young men who flew them–would ultimately prompt a whole new level of medical interest in the effects of flight. But in the early days, both civilian and military aeronauts put their emphasis on developing reliable and safe machines. Thanks to the foresight of then Assistant Secretary of the Navy Theodore Roosevelt–who in 1898 recommended the appointment of naval officers as aviation observers–Naval authorities at least followed the progress of pioneering aviators and their machines. Ten years on, in September 1908, two navy officers observed flight trials of the Army’s first Wright airplane in an official status. A year later, Lieutenant George C Sweet became the first U S Navy officer to become officially airborne, in an Army machine piloted by Lieutenant Frank P Lahm.

1910 saw the beginnings of an aviation office under the Secretary of the Navy. The Navy designated Captain W I Chambers, USN, to that position, and appointed an officer each from the Bureaus of Construction and Repair, and Steam Engineering, detailed to investigate the subject of aviation, develop technical knowledge of airplanes, and report progress in the field to Captain Chambers. Late that year, Lieutenant T G Ellyson became the first Navy officer to undergo flight training at the Glenn Curtis Aviation Camp at North Island near San Diego California. 1911 saw the conception of a naval office of aviation, soon to be housed in the Bureau of Navigation, with Captain Chambers as its chief. The first funds–$25,000–were designated for “experimental work in the development of aviation for naval purposes”, and flights of A-1, the first airplane built specifically for the navy, took place in upstate New York. U S Naval aviation was now established.

Early heavier than air machines were capable only of straight level flight at relatively low altitudes, and as such, placed relatively few demands upon their pilots other than of daring and physical strength. However, it became apparent enough that flying called for special qualifications that the Bureau of Medicine and Surgery promulgated–in Circular Letter 125221, October 8, 1912–new physical standards for prospective naval aviators. These standards called for very careful evaluation of prospects’ vision (both acuity and color), hearing, balance and joint flexibility. In addition, the new standards stated “any candidate whose condition shows that he is inclined to any except [sic] that may disturb his mental balance or to alcoholism, should be rejected.” Other than specifying special uniform items for the protection of pilots in the new environment of air travel–helmet with goggles, leather coat with fur or wool lining, leather trousers, boots and life preserver–Navy authorities did little more along medical lines until World War I. In fact, from the flight of the Wright’s first airplane until the beginning of the War–11 years–on the subject of medical aspects of air flight, in the world, only 31 papers and one small book saw publication.

History of (Naval) Aviation Medicine–Part One

The Naval Order of the United States will commemorate the 100th year of (U S) naval aviation, and naval aviation medicine, at its 2010 Congress in October. This event got me to thinking about the history of aviation medicine, and led to what will be a series of short jottings on the topic.

Long before the invention of aircraft, men–landlubbers all: naval aviation will have to wait a few centuries to emerge–observed the human effects of altitude. J. A. de Acosta, a Jesuit, described as “mountain sickness” the hypoxia symptoms he experienced during his 16th century sojourn in the Andes mountains. Descriptions exist of mountain sickness symptoms suffered by Chinese traders during their journeys through the Hindukush and Karokorum mountains of Pakistan and Afghanistan 1600 years earlier still.

Robert Boyle (of Boyle’s Law of gases), through self-experimentation in a barrel-vacuum chamber of his own design, was able to establish some notions about altitude physiology in 1677. But it wasn’t until the 19th century that French physiologist Paul Bert, again by means of self-experimentation, laid down the foundation of modern altitude physiology and elucidated the cause of altitude and decompression sickness. Berg actually used his own altitude chamber to systematically chart the physiological effects of altitude up to 8800 meters.

The field of aviation dates its beginning from the first flight of de Rozier and Laurent, who ascended in a Montgolfier brothers balloon on 1 November 1783. They reached an altitude of 900 meters. An American physician, John Jeffries of Boston, is given credit for being the first true “flight surgeon” based on his undertaking a “full investigation of the nature and properties of the atmosphere which surrounds us” in his first ascent, 1784. This was only the beginning.

Jacques A C Charles reached >8200 m in a hydrogen balloon of his design, in 1783. From this flight we also have Charles’s description of ear pain caused by pressure change. Etienne-Gaspar Robert and M. Lhoest attained 7000 meters in 1803 and described tachycardia and general lethargy at altitude. A year later, Andreoli, Brasette and Zambeccary suffered frostbite, nausea and dizziness in their ascent to 7000 m, while in 1862 Glaisher and Coxwell rose to 8800 m, and despite fainting, lived to tell of the palpitations, difficulty breathing, cyanosis and difficulty reading their instruments as they ascended. Spinelli and Sivel, however, died from effects of hypoxia in an ascent to 8000 m in 1875; they carried oxygen with them, but not enough to support them during their flight. In 1901, German meteorologists Berson and Süring survived reaching the height of 10500 m. by breathing supplemental oxygen. These men reported that the oxygen relieved their difficulties in breathing, and their feelings of fear disappeared; yet Süring lost consciousness, and only by luck was Berson able to initiate their descent from danger.

These experimenters chronicled the serious symptoms of breathlessness, lethargy, cognitive difficulty and other effects of hypoxia. Clearly, the advancing science of physiology needed to be applied to the study of the effects of altitude, and means of preventing altitude sickness found if safe flight was to become a possibility. Austrian physiologist von Schrötter was an important early contributor to our scientific knowledge, and in 1894 started a series of balloon studies at high altitude using oxygen equipment of his design; he also developed the first oxygen mask for aviation use. Other scientific efforts–like the 1911 Pikes Peak (4300 m) Expedition led by Oxford scientists C Gordon Douglas and J S Haldane and Yale trained researchers Yandell Henderson and Edward Schneider–with systematic examination and documentation of the physiology of altitude adaptation, would add to this essential knowledge.

To be continued. My references for this little exploration are the chapter on the history of aviation medicine by Viktor Harsch in Principles and Practice of Aviation Medicine, Claus Curdt-Christiansen, Jörg Draeger and Jürgen Kriebel, Eds., and Aviation Medicine from the Aeronauts to the Eve of the Astronauts, an exhibit at the National Library of Medicine, 7 Feb – 18 May 1979.

On Giving Ships the Female Gender and a Loss of Historicity in Medicine

I subscribe to the H-Maritime listserve. A recent string of correspondence there concerned an historian’s inquiry about the origin of the “female gendering” of ships. One reply noted that the Romans adopted the convention, and others that the Russians, uniquely, did not. One correspondent offered that ships were as mothers to sailors–providing succor and solace, and this naturally lead to their feminization. Others noted that sailors sometimes referred to their ship as “bitch” or “whore”; they deplored the feminization because it permitted such excoriation. Opinion tended toward the notion that such gendering of ships was inappropriate in nowadays, just as we’ve “de-gendered” (or more accurately, “bi-gendered”) hurricanes.

As I followed this string, it occurred to me that we have a natural tendency to anthropomorphize “large” things in order to make them understandable. The Greeks did it to their gods; Christ gives a literally human face to a distant and inscrutable Jewish God. This is also true with mechanical things. Just read Richard McKenna’s poetical description of a ship’s machinery in his novel San Pebbles to appreciate how intimate, how “human” the sailor-machinery relationship can be. Men are often heard to refer to their favorite cars as “she”. (I don’t know if women refer to their transport in male terms–help me out here, readers!)

As for ships as feminine entities, when I told my wife about the H-Maritime string and my comment that I still thought of the ship I served in as a “good and stolid old girl”, rather than resenting the allusion, Gina offered this additional notion: ships–at least Navy ships–are sleek, and powerful. Like the women we know. See; it just seems “natural” to anthropomorphize. As I thought more about it, I found myself a bit saddened by our tendency to “un-humanize” our ships, and other big things in a time when we probably need a good dose of “re-humanizing”, in this our technical world.

Here’s the history of medicine connection: there is also a trend to “un-humanize” diseases and syndromes; that is, to disassociate them from the men (usually) who first described or discovered them. Thus, “Addison’s Disease” becomes “adrenal insufficiency”, etc. In an effort to appear more scientific we are losing a sense of the long and often glorious history of discovery and progress in medicine. We lose an opportunity to be reminded of the hard work, the genius, and sometimes the suffering (I think for instance of how Semmelweis was ignored and even hated for his attempts to evangelize the importance of cleanliness in preventing perinatal infections) that went into the advance of our knowledge and our art.

Ironically we are in both spheres (and likely more) “de-humanizing” in a world that cries out for much more “humanity”.

“War Surgery” and Democracies in War

Society for the History of Navy Medicine member Leo van Bergen recently published a paper with the above subject in the journal Medicine, Conflict and Survival. He posts these comments about the paper:

For centuries pictures of the dead and wounded have been part and parcel of war communications. Often the intentions were clear, ranging from medical instructions to anti-war protests. The public’s response could coincide with or diverge from the publisher’s intention. Following the invention of photography in the nineteenth century, and the subsequent claim of realism, the veracity of medical war images became more complex. Analysing and understanding such photographs have become an ethical obligation with democratic implications.

We performed a multidisciplinary analysis of War Surgery (2008), a book containing harsh, full-colour photographs of mutilating wounds suffered by soldiers in the Iraq and Afghanistan wars. Our analysis shows that, within the medical context, this book is a major step forward in medical war communication and documentation. In the military context the book can be conceived as an attempt to put matters right given the enormous sacrifice some individuals have suffered. For the public, the relationship between the ‘reality’ and ‘truth’ of such photographs is ambiguous, because only looking at the photographs without reading the medical context is limiting. If the observer is not familiar with medical practice, it is difficult for him to fully assess, signify and acknowledge the value and relevance of this book. We therefore assert the importance of the role of professionals and those in the humanities in particular in educating the public and initiating debate.

If you wish to read van Bergen’s paper, email me at tlsnyder@history-navy-med.org, and I’ll send you the link.