Auburn University Libra riPs

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File B 63/7

AIR SERVICE INFORMATION CIRCULAR

( HEAVIER-THAN-Al R)

PUBLISHED BY THE CHIEF OF AIR SERVICE, WASHINGTON, D. C.

Vol. I August 15, 1920 No. 99

AIR MEDICAL SERVICE

Compiled by the Medical Division of the Air Service

Ralph Brown Draughon

LIBRARY

MAR 27 2013
Non·Depoitory
Auburn University

I
WASHINGTON
GOVERNMEN f PRINTING OFFICE
1920
 CONTENTS.
Page.
1. OPERATION OF THE. MEDICAL DIVISION OF THE
AIR SERVICE SINCE THE SIGNING OF THE
ARMISTICE. By Col. Albert E. Truby, Med-
ical Corps, Chief Surgeon, Air Service, and
Maj. John Dibble, Medical Corps .. ... ......•
2. A NEW TYPE OF REBREATHER AND OTHER
RESPIRATORY APPARATUS. By Carl N·. Lar-
sen, formerly first lieutenant, Medical -Corps ..
3. THE PSYCHOLOGICAL EFFECT OF OXYGEN DE-
PRIVATION. By English Bagby, formerly
first lieutenant, Sanitary Corps ............. .
4. A CARDIO-VASCULAR RATING AS A MEASURE
OF PHYSICAL FATIGUE AND EFFICIENCY. By
Edward C. Schneider, formerly major, "Sani-
tary Corps ....• . ..........•.... . ...........
5. DARK ADAPTATION, WITH SPECIAL REFERENCE
TO THE PROBLEMS OF NIGHT FLYING. By
Capt. P. W. Cobb, Medical Corps ... . . ...... .
6. A CONTRIBUTION TO THE STUDY OF DARK
ADAPTATION. By Capt. P. W. Cobb, Medical
Corps .. ... .................. ..... ....•.•. . ..
7. THE MADDOX RoD AND SCREEN TEST COM·
BINED. By Pere Dolman, formerly captain,
Medical Corps • ....................••......••
8. RESPIRATORY VOLUMES OF MEN DURING SHORT
EXPOSURES TO CoNsTANT Low OXYGEN
TENSIONS ATTAINED BY REBREATHING.
l3y Max M. Ellis, formerly first lieutenant,
Sanitary Corps .•. . ........ . ......... .. ...•..
9. ALVEOLAR Arn, RESPIRATORY VOLUME AT Low
OXYGEN TENSIONS. By Edward C. Schnei-
der, major, Sanitary Corps, and Brenton R.
Lutz, first lieutenant, Sanitary Corps ....... .
Page.
110. COMPENSATORY REACTION!, TO Low OXYGEN.
By Edward C. Schneider, major, Sanitary
Corps; Brenton R. Lutz, first lieutenant,
Sanitary Corps; and Harold W. Gregg, second
3 lieutenant, Sanitary Corps .....•............ 62
11. THE REACTIONS OF THE CARDIAC AND RESPI-
RATORY CENT:ia:RS TO CHANGES IN OXYGEN
8 TENSION. By Edward C. Schneider, major,
Sanitary Corps, a.nd Brenton R. Lutz, first
lieutenant, Sanitary Corps ..........•....... 73
16 12. THE RELATION OF THE SIGHTING EYE TO THE
MEASUREMENT OF HETEROPHORIA. By Pere
Dolman, formerly captain, Medical Corps . .• .80
13. A CONSIDERATION OF SOME TESTS FOR DETER-
22 MINING THE SIGHTING EYE. By Pero. Dol-
man, formerly captain, Medical Corps. -- .. .. 83
14. THE MADDOX MULTIPLE RoD: A CONSIDERA-
27 TION OF !Ts OPTICAL DEFECTS. By Pere
Dolman, formerly captain, Medical Corps . ... 84
15. "A. NEW APPARATUS FOR TESTING ACCOMMODA-
39 TION. By Harvey J. Howard, formerly cap-
tain, Medical Corps ..•... . . .... . ..... . . . .....
16. A STEREOMICROMETER. By Harvey J. How-
42 ard, formerly captain, Medical Corps ....... . 90
17. JUDGMENT OF DISTANCE WITH SEMAPHORES
AND A. SCREEN AT ONE HUNDRED METERS.
By Harvey J. Howard, formerly captain,
Medical Corps . .. .......•.... . . ... ........... 94
45 18. A NOTE ON THE Low-PRESSURE CHAMBERS
INSTALLED IN THE MEDICAL RESEARCH LABO-
RATORY OF THE Arn SERVICE. By Capt.
G. B. Obear, Sanitary Corps ......... ...•. ... . 100
51
(2)

PART 1.
..s
OPERATION OF THE MEDICAL DIVISION OF THE AIR SERVICE SINCE TFIE
SIGNING OF THE ARMISTICE.1
By ALBERT E . TRUBY, colonel , Medical Corps, United States Army, Chief Surgeon,_Air Service, and
major, Medical Corps, United States Army .
When the distinguished president of this association
asked us to present a paper at this meeting it was decided
that the subject which would probably be of most interest
to former Air Service Medical officers would be a brief
review of the work which has been accomplished by the
Medical .Division since they left the service. We ·recall
the great interest and enthusiasm shown at the flight sm-
geons' meeting at Dallas, Tex. , 13 months ago. At that
tinie most of the flight surgeons were about ready to return
to civil life, and it is believed that all of you still maintain
great interest in the service. Since that meeting 'war
activities have been closed. The Great War army bas been
demobilized, and the forma,tion of a new peace-time
army, with its more deliberate and systematic procedures,
has begun . In all this the Medical Division -of the Air
Service has played an active part.
Shortly after the armistice was signed the Air Se-nice
was reorganized and a new Director was appointed . One
of his first steps was to request the Surgeon General to
transfer the Air Service Division of the Surgeon General's
Office to the Air Service. This request was .approved,
and tlre Medical Division of the Air Service was organized.
A Chief Surgeon was appointed by Air Service orders, and
-he was placed in ch a:rge of the Medical Division. The
necessity for this separate Medical Division for the Air
Service was therefore recognized, and its usefulness has
since that time been thoroughly demonstrated. We still
receive inquiries as to why the Air Service should have a
special Medical Division any more than other branches,
such as the Infantry, Cavalry, and Artillery. We have
been able to satisfy those concerned, however, by calling
attention to the splendid work which has made the flight
surgeon indispensable at flying fields, by the special work
done at t he Medical Research Laboratory at Mineola. and
by the requirements of the highly technical physical
examination for flying.
Personnel naturally demanded a great deal of attention
in the process of demobilization and reorganiZll,tion. At
the time of maximum activity there were 70 active Air
Servi ce.stations in the United States, all under the control
of the Director of Air Service, which required for their
medical care 971 m!)dical officers, 453 female n urses, and
3,752 enlisted men. This personnel was practically all
serving for the emergency only, and the reports of the
signing of the armistice were scarcely dry fl'Om the presses
before the Chief Surgeon's Office was bombarded with
requests and demands for immediate release from the
1 Read at the annual meeting of the Air Service Medical Association of the United States at New Orleans, La., Apr. 26, 1920• .-
(3)
~l ·v.
r
~
JOHN DIBBLE,
I service. When practicable "such immediate discharge
was granted those who applied for it. Others of the per-
sonnel expressed a willingness to remain in the service as
Ilong as they were needed, antl these, with a few Regulars
and those of the temporary personp.el who desired perma-
nent commissiGns in the Army, continued the work of the
Medical Division. As stations were closed the available
medical personnel was transferred to active stations, and
.by this arrangement all who desired prompt discharge
were gradually separated from the service. This applied
especially to officers and nurses. Enlisted men in all
instances were not so fortunate , but all applications for
discharge were given due- consideration and men were
released as rapidly as their services could be spared.
Urgent requests for discharge were always given prompt
consideration. As Air Service stations continued to be
closed, or became inactive, Medical personnel was redis-
tributed, some of it being released to the Office of the
Surgeon General when it was not req_uired. by the- Air
Service."
As reorganization of the · Regular Army progressed it
soon became apparent that the Air Service would particu- -
larly appeal to applicants for enlistment, and it has,
therefore, been possible to maintain the Air Service at its
full authorized strength ofapproximately 10,000 officers and
men. These are now scattered among the 33 active and
11 inactive stations of the Air Senice . Medical care is
furnished to aU of these stations by 98 officers, 38 nurses,
and 422 enlisted men of the Medical Department. A
recent order has placed the active flying fields under the
control of the department commanders. While this has
taken the Medical personnel at these stations from our
control to a certain extent,-it has in no way interfered with
the special work which this office is carrying on. Depart--
ment commanders and department surgeons have been
informed of the special functions of the flight surgeon, and
it has been ;i,rranged that they shall not be diverted from
their special dutles with Air Service troops. The flight
surgeon is recognized as a highly specialized Medical
officer and a very necessary adjunct to every military
flying field. It has been one of the big problems of this
office to sup ply Medical officers with proper qualifications
for this work. There were very few permanent officers of
the Medical Corps attached to the Air Service prior to the
signing of the armistice, and of the emergency men who
\ served as flight surgeons during this time practically all
I desired to return to their civilian work. This made it
 4
necessary to obtain permanent officers for this duty , and b eing simply to give the future flight surgeons a firm prac-
for this reason, the following circular letter from the tical foundation for their future work in selecting, classify~
Surgeon General's Office was published : ing, and caring for the fliers. Rigid examinations were
WAR DEPARTMENT, given in each subiect at the end of the course and those
OFFICE OF THE SURGEON GE NERAL, who passed t hem satisfactorily were given a certificate
Washington , A.pril25 , 1919. and ordered to the various flying fields. for duty. The
Circular letter No. 189. , scope of the flight surgeon's work has greatly increased.
. . , . ; clue to the conditions imposed by a peace status. There
Subject: . F Itght surgeons
. for the An Service. i are no 1onger any A v1ation· · p l1ysica
· 1 examimng
· · b oar d s,
1. 0 wma- to the discharO'c of a large numb er of t ern- ,1 . . . . .
porary Medical officers, th; Air Service n eeds a numb er physical cluectors , o_r speciall y orgamzed rnbreather um~s,
of Medical officers of the permanent establishment for the and all th e work formerly performed by t h ese special
position of flight surgeon. groups is now thrown on the should ers of the flight surgeon .
2. _This position i s one of r ecent d_eveiopm ent. The The importance of the flight surgeon's work and the recog-
Meclical officers who have served as fllD'ht sura-eons h ave ·t· hi h th fl' ht h · d b t b
been particularly active and efficient,"' so mu~h so that Ill 1011 w c . e ig s~rgeon a.s _recetv e . ca.n es e
the importance of t h eir work has been recoo-nized by the shown by the tollowmg cncular, which was issued by the
Air Service authorities, including the comm~nding officers Director of Air Service:
of the jlying fields. The Air Serv ice now requires that a WAR DEPARTMENT,
flight surgeon be detailed for duty at all of i ts active fields. OFFICE OF THE DIRECTOR OF Arn SERVICE ,
3. The duties of a flight surgeon are essentially as follows: Washingtmi, October 15, 1919.
He has full ch arge of everything connected with the CIRCULAR}
physical condition and ca.re of t h e flier . The fli ght sur- No . 123.
geon lives with and associates with the aviators constantly . 1. Commanding officers of Air Service stations where
In this way h e i s able to d etermine when any individual is flying is being carried on will consult with t he flight sur-
not in proper condition to fly. In order to do this h e must. geon in all matters pertaining to th e m ental and physical
be able , through tact and general efficien cy, to gain the fitness of the flying personnel of his command. The term
confidence of the fliers. F or ·the same reason .it has been "flying personnel " will include all who make aerial flights,
demonstrated that the flight surgeon ~hould take flying such as instructors, flying officers, and individuals und er-
training and actually become a licensed pilot. Authority going instruction.
has been granted Medical officers to take su ch t raining , an d 2. Commanding officers will take full advantage of the
when t hey qualify they are en titled to all th e rights an d assistance t hat can be rend ered by the flight surgeon and
privileges of aviators , including the " wings." and t h e 25 the physical director of his field . Such matters as the
per cent increase in pay from the time t raining is star ted. amount and kind of physical exercise required by indi-
J\~ed~cal officers who have been flight surgeons are enthu- viduals engaged in flying ; the state of fatigue of the indi-
~1astic over .t lus work. They have undoubtedlv saved vidual flyer ; the amount of sleep necessary; food prob-
many lives and much property . • lems ; reexaminations ; and a ll field conditions 'affecting
4. Medi cal officers below the gra.d e of lieutenant colonel the welfare of the flying p ersonnel will b e made the sub-
who d esire duty as outlined above should communicate ject of conferences between the commandin~ officer and
with t h e Chief Smgeon, Air Service, Washington, D. C. the flight surgeon or physical director. Commanding
Vacan ci es will be fi lled from among thmie who voiunteer officers should obtain the recommendation of the flight
in this way. surgeon on application for leaves or furloush from anyone
By direction of the Surgeon General: engaged in flying when physical incapacity is made t he
C. R. DARNALL, basis of t he application.
Co lonel, Medical Corps, U. S . A. , E xecutive Officer. 3. The flight surgeon will be listed on any form for
clearance in vogue at an Air Service station, and no flying
As a r esult of this letter approximately 30 m en applied officer or anyone undergoing flying instruction will be
transferred from a station without first obtaining a clear-
for detail as flight surgeon, 10 of whom were reject ed ance from that officer. Upon n otification of transfer, the
physically b ecause of the high standard required for flying flight surgeon will forward to the flight surgeon of t he
(609 examination) . In addition 20 t emporary officers who new station the reexamination report and laboratory
desired p ermanent commissions made similar applications, rating chart of the individual being transferred. This
This assured a sufficient supply of flight surgeons for p res- will be in addition to Form f\09, Record of examination
required to be forwarded to the flight surgeon of the new
ent n eeds. In order to standardize the work in this special station, by paragraph 4, Orders No. 31, 0. D. A. S., 1919.
field the accepted applicants were ordered to the Medical 4. F light surgeons will be encouraged in every way to
Research Laboratory, Hazelhmst Field, in groups of 5 i,o take flying instruction. Upon completion of the pre-
15 for a special course of instruction. scribed test, flight surgeons will b e rated in the same man-
ner as other flying officers. Application for flying train-
This course of instructiou required a period of two ing should be ma~e through the s~rgeon to the station
months for its completion and was t h oroughly systemati zed commander and will be accompamed · by the necessary
so that the time could b e put to the greatest advantage to report of physical examination.
fit the students for their n ew work. Classes were held 5. Upon recommendation of the surgeon, station com-
m anders will authorize m edical officers of the command ,
daily from 9 a . m . to 5 p . m., except Sundays. Systematic who are physically qualified and make applic.:ation, to
lectures were given by representatives of all department13 take flying instruction. This will ena.ble one of these
of the laboratory staff and their lectures were supplem ented officers to take the place of the flight surgeon when the
by practical work whenever possible. Abundant clinical latter for any reason is n ot available for that duty.
6. Unless a.n absolute necessity exists therefor, flight
material was available among the fliers returning from surgeons and physical directors will not be diverted from
overseas and who were b eing discharged at Mitch el Field theu regular duty to perform routine :post administrative
in large numbers; in the wards of the Camp Mills Hospital; duties when this service can be performed by another
and at the various h ospitals for the insane about New Y ork . medical officer. Flight surgeons and physical directors
should devote all the time possible to the close and con-
No attempt was made to give a compl ete course in all of stant supervision over flying personnel, as indicated in
the specialties represented at the laboratory, the object p aragraph 2.
 5
7. The flight ,surgeon and the physical director of an normal action of the extrinsic muscles of the eyes is abso-
Air Service station will not be demiled as a member of a lutely essential to safe flying. As a result, the tests of these
board of officers convened to examine into the efficiency muscles have been greatly amplified by the addition of
of a flying officer when it can be avoided. Their services
will be of more value when called before a board as an tests for muscle balance at 33 centimeters, power of prism
expert witness, to give t-estimony relative to physical divergence, and tangent curtain diagnosis. Other impor-
fitness, etc., of the officer under investigation. tant modifications of the eye tests have been made in the
By direction of the Director of Air Service: testing of each eye separately for color vision, perimetry
WM. F. PEARSON,
for both form and color a.nd a complete refraction. The
Colanel, A. S. A., Administrative Executive.
last is most important for the detection of latent hyperopia,
As stated above, the Air Service particularly appealed which condition, by reason of its tendency to become mani-
to applicants for enlistment in the Army, one reason fo1 fest under the fatigue and stress of flying, ·has proved dis-
this being the policy adopted by the Air Service of select- astrous in many instances.
ing cadets for training as pilots from among these enlisted The numerous cases of "staleness," neurasthenia,
men. All enlisted men are elig1ble for this training, neurn-circulatory asthenia, and psychoses generally, as
provided they can pass the preliminary examinations well as simple loss of confidence among fliers, has indicated
which df::oi!sist of a mental examination and a physical tlie necessity for a more careful selection of these men as
examination on Form 609, given by a board of officers, one regards their nervous stability. In -0rder that the inferior
of whom is the flight surgeon, who makes the physical along these lines might be eliminated the examination of
examination. He thus assumes the function of the avia- the nervous system was made to include a detailed per-
tion physical examination board. sonality study in addition to the usual tests for organic
The men who successfully pa<!s these examinations are nervous disorders.
assigned to either Carlstrom or March fields, which are The instructions for making this examination, as pub-
designated as Air Service pilot schools, and which are now lished in Special Regulations 65-c, are 1ninutely detailed so
the only stations at which pilot instruction is given. It that the examination can be standardiz2d wherever given.
thushappensthatatthesefieldsonly does the flight surgeon In addition a provision has been placed in these instruc-
have cadets to care for. If the cadet completes his course I tions that only medical officers designated in writing by

I
at these schools satisfactorily he is commissioned as a second I the Surgeon General are authorized to make this examina-
lieutenant, Air Service, Officers Reserve Corps, inactive, tion. Such authority has only been given to gmduates of
and is.then discharged o~ allow~d to continue on ~uty as the ~Iedical Research Laboratory who ~ave had inst:uc-
an e1:l~ ted_man of the A1r SerVIce, as_ he may desu_e. \ t~on rn the ~tan~ard methods of performmg the exa~na-
It 1s behev,ed that the system outlined above will not t10n. The mev1table personal element which enters rnto
yield a sufficient number of men suitable for cadet instruc- all examinations has by this means been still further di-
tion and to make up thisdeficiency,arrangementsare being minished. There are at present 40 officers on active duty
made to select a proportion of cadets direct from civil life. who have been so designated, 21 being permanent officers
The preliminary examinations for these men will be the of the Anny. Of these, 29 are now on flying status, 7 being
same as that of the enlisted men outlined above and will rated as pilots, 3 are receiving pilot instruction officially,
require a flight surgeon to make the physical examination. while 2 more are awaiting assignment to a pilot school for
As a result of the experience gained in examining ap- training.
proximately 25,000 men for flying training during the war And thus the flight surgeon plays his part in selecting
a careful analysis of the causes of disqualifications, the ex- the flier, which naturally leads us to his main function,
perience gained by observing fliers at the fields, and the that of caring for the flier.
researches :tnade at the Medical Research Laboratory at There is littie new to be said on this subject. His du-
Mineola, N . Y., it became evident that some changes in ties here remain practically the same as during the war.
the physical requirements for flying were necessary. Naturally they have been somewhat enlarged, as without
These changes, principally in the examination of the eyes au athletic director or nutrition officer the flight surgeon
and nervous system, were incorporated in the new edition is expected to see that their functions are still carried on.
of Form 609, A. G. 0. , Physical examination for fliers, One important detail in the care of the flier consists of
which is now in use. Special instructions for making this a careful checking up of ~he physical condition of every
exami!lation were also issued as Special regulations 65-c, pilot. Early in 1919 the Chief Surgeon's office discovered
W. D. the fact that a few officers had received flying.training and
The development of satisfactory apparatus for testing become pilots who had never taken the prescribed physical
depth perception at 6 meters has led to the adoption of this examination on Form 609 for fl.ying. This led to an in-
in pla.ce of the old hand stereoscope, which was quite arti- vestigation, which showed that there was no record of
ficial arid very generally a puzzle to the candidates. This physical examination for flying-for a great number of the
test was developed at the Medical Research Laboratory at officers who had received ratings as pilot<!. It was also
Mineola. The machine is very simple in construction and discovered that a few officers who had been physically
operation, and bas proved quite satisfactory in practical disqualified for flying by the War Department continued
use. Sufficient work has now been done with it to establish .flying training and were acting as pilot<!, in spite of tho
reliable standards for interpreting the results of the tests. fact that they were physically disqualified. The discovery
Practical work with aviators on the flying fields and at of these conditions led this office to the recommendat.ion
the front has led to 1manimity of opinion among all workers of orders which would place the subject of physical exami-
in aviation medicine, both in this country and abroad, that nations foi· flying on a systematic basis. Orders Nos. 4G
 -
6
and 52 were, therefore, issued by the Director of Air schools, Carlstrom and March fields . This work at Kelly
Service. From theee orders, supplemented by Special field has made fair progress but at the other stations has
Regulations 65-c, prepared in the Chief Surgeon's office been delayed due to lack of personnel. Enlisted men are
and issued by the War Department, it will be seen that being trained at the laboratory at Mitchel field to operate
every flier must be physically reexamined in January and the machines, and personnel will shortly be available for
July of each year. This is a full physical examination. this work. The great difficulty encountered so far has
reported on Form 609, the use of the shorter Form 694 been that with the one year enlistment period the men
having been discontinued. have been nearly ready for discharge by the time thay have
By these reexaminations, disqualifying conditions are shown their fitness for such special training and too late to
detected in their incipiency and proper corrective meas- receive the necessary instruction. So far very few of them
ures inetituted, thus conserving the flying personnel. have shown any inclination to reenlist.
Whenever disqualifying defects are. found on these reex- It is planned to classify every cadet passing through the
aminations the case is referred to a board of officers com- pilot schools according to his rebreather run. The classes
posed of the Chief Surgeon and chiefs of Air Service attheseschoolswillaverageabout l 50men,anditisplann¢
groups in the office of the Direct,r oi· Air Service. If the to complete the training of each class in about four months,
pilot's record is such as to indicate that he has attained a so that to make the ''runs" as planned it will be necessary
degree of skill in flying which is apt to compensate for his to take two men every day for five days a week throughout
defects, and the latter are slight, a waiver is recommended the courses. With the limited personnel available for the
and usually granted. No waivers are granted for defects work it will be seen that such a plan is quite ambitious.
found at original examinations of candidates for flying Ip addition to classifying the cadets it is hoped that in
training. Flight surgeons are not authorized to waive time every officer already in the service will be similarly
any defects; and this office refers all requests for waiver, tested . The records made during the war have all been
with proper recommendations, to the Surgeon General ot reviewed, andithasbeenfound thatonlyabout20p'ercent
the Army. of the present officer personnel has had the rebreather test.
With the present strength of the Air Service it is possible The remainder will be tested as opportunity presents it-
to ·check both original examinations and reexaminations of self. For this purpose a unit will b€ established at the
all fliers in the office of the Chief Surgeon. It is therefore Army Medical School at Washington and this, together
provided tliat Form 609 in every case be made in triplicate, with the other four units at Mitchel, Kelly, Carlstrom, and
one copy to remain permanently at the station where the March fields, should in a reasonable time catch all men
examination is made, one to accompany the flier whereve1 not already tested. l J,
he goes for duty, and one copy for file in the central fileE This covers the work of selecting, classifying, and caring
of the office of the Director of Air Service. Two copieE for the fliers as individuals. But the function of the Medi-
are sent in to the Chief Surgeon as soon as made and these cal Division of the Air Service does not stop here. There
are reviewed and the flier certified as qualified for flying. are many problems affecting fliers in general to be solved,
One of these is the Director's file copy and the other is re- and these can only be solved by statistical studi.es of the
turned to the flier's station as the copy for the flight sur- fliers en masse. For such study it is necessary that certain
geon 's file. facts regarding all fliers be collected in one place, the Office
In the case ofan original examination the candidate is not of the Chief Surgeon, and there consolidated and analyzed .
authorized to proceed with flying training until this certified The basis of these studies is found in the weekly "Oare of
report of examination has been received at this station, the flier" report, the "Crash report" and the "Statistical
and in the case of disqualification on reexamination. an report of fliers." The first two of these are old reports
order is issued by the Director of Air Service which re- which haive been greatly revised and enlarged. The last
lieves the flier from further duty as a pilot until his defect is a new report and will bring together data relating to the
has been remedied. fliers which is at present unobtainable at any central point,
A card index file has been prepared in the office of the but which will be of inestimable value in solving problems
Chief Surgeon with a card for every flier, and on this card which are now subject merely to speculation. Thus we
is noted the result of every physical examination with its must ascertain the age limits which shall be fixed for cadets;
date, the date of all crashes, the classification of the flier J we must determine the average period of usefulness as a
on the rebreather, and other important data. By these pilot; whether intensity of flying training shortens such
cards it is possible to make a quick check and see that all usefulness and why the pilot wears out when he does.
required examinations have been made and also to de- What types of planes are most dangerous, and what par-
termine exactly the physical fitness for flying of each flier ticular type of injury, if any, is more common with any
up to the time of his examination. particular type of plane? These and many other problems
Classification of the flier by rebreather examination was of a similar nature have been presented for solution, not
discontinued, except at the Medical Research Laboratory by theory but by demonstrable facts.
at Mitchel field, for a considerable period while demobili- This statistical work is as yet in an embryonic stage.
zation was going on. This was necessary because of the The work has been fairly well outlined, but not enough
discharge of personnel and the uncertainty as to the future material is as yet available to furnish much basis for re-
status of the various Air Service stations. liable conclusions: The data obtained as a result of the
With the adoption of a permanent training policy, how- transcontinental race has been carefully reviewed and
ever, it was possible to take this work up again, and branch made the basis of a full report to the Director of Air
laboratories have been set up at Kelly field and at the pilot Service. This report has led to comments which make it
 7
seem probable that such undertakings will not be made
in future without consultation with the Office of the Chief
Surgeon, ·and subject to some medical supervision. In
addition to this a complete statistical analysis of 1,250
crashes reported between May 1, 1918, and December 31,
1919, is about completed.
Research work in aviation medicine has been pushed
with undiminished vigor by those officers still on duty at
the Medical Research Laboratroy. Numerous original
articles have been contributed to the medical literature of
this country, and in addition there will be ready for issue
shortly an "Air Service Medical Bulletin," containing
14 original articles contributed by the laboratory staff. A
delay of almost a year in the publishing of these articles
has resulted because of the fact that the Senate Committee
on Printing failed to authorize funds for this work. Other
issues. will probably follow as the progress of the work war-
rants.
The great general interest taken in aviation medicint-
is indicated by the frequent editorials on the- subject
appearing in the various medical journals, together with
nmnerous abstracts of articles published in this country
and abroad. A library of all this work is being collected
in the office of the Chie.f Surgeon and additions to it will
be welcomely received. As articles appear in domestic
and foreign journals requests are made direct to the authors
to furnish copies of their reprints to this library and as a
return courtesy it is planned to give the new "Bulletin"
rather wide distribution. It¥! hoped that this manifesta-
tion of interest in their work on our part will lead many
authors to voluntarily forward such contributions as they
may have.
The work required of the Air Service in patrolling the
Mexican border and the general realization of the value of
commercial aviation has resulted in a great increase in the
amount of cross-country flying. Th.is work is especially
hazardous and has resulted in many crashes at remote
points which has served to c~eate new interest in the
possibilities of the aeroplane ambulance. None of the
types developed during the war were quite satisfactory
and the Engineering Division has undertaken to design
a fuselage especially suited to this work. Plans oi all
the ambulance planes already in use were-submitted to
the Engineering Division with the following remarks: .
" There should be room for .two passengers besides the
pilot. The ideal arrangement, from the medical stand-
point, would be a place for two Stokes Navy litters. Ar-
rangements should be made for a Medical officer to ride
out to the scene of accident in the plane with the pilot,
occupying the space for one of the patients. If there ate
two patients, both patients can be placed in the litters
and brought back. If one patient, he can be placed in
one litter and the Medical officer can accompany him
back. If practicable, a detachable seat, which can be
folded up out of the way when not in use, should be avail-
able for the Medical officer. Construction should be- so
arranged that it is possible for two men to load and unload
the litters. It is immaterial, from the medical po'int of
view, whether the patients are in front or behind the
pilot. Utters should be installed so that the patient's
head be slightly elevated. In the ordinary type of
plane it is believed this would be more readily obtained
if the patient rides feet first if he is located in front of the
pilot, and head first if he is located in the rear of the pilot.
If such a plane is not considered practical, then similar
arrangements should be made making provision for but
one patient. Provision should be ma'de so that the
Medical officer can ride out to the scene of the accident
with the pilot and attend to the patient. The Medical
officer, after loading the patient, can remain at the field
until another plane picks him up."
-Satisfactory progress is being made in this work and a
number of these ships should shortly be in commission
for work on the Mexican border.
The Ruggles orientator is likewise receiving its full
share of attention with a view to determining its actual
value in training aviators to overcome the effects of vertigo.
Machines have been installed at the pilot training schools
and a certain number of cadets designated to receive in-
struction and practice with them. The work is regularly
planned, beginning with a short seance using only one
control and gradually increasing as experience is gained .
So far this work has been very promising, the majority
of the men being able to compensate for any vertigo they
may have after about six lessons, totaling 25 minutes of
actual work in the orientator.
In carrying out the work outlined above jt is most
gratifying to be able to state that the Medical Division
has had the active support and cooperation of all de-
partments of the Air Service, as well as that of the Surgeon
General's Office. We are doing our very best under the
limitations of peacetime conditions to carry on the great
work that was so well started by the members of this
association and other medical officers connected with the
Air Service. You will, I am sure, be pleased to know
that we have prepared a list of all Medical officers who
served with the Air Service during the war, and that the
Surgeon General has authorized the reservation of this
officer personnel for duty with the Air Service in case· of
future emergencies requiring their service, provided that
they belong to the Reserve Corps or volunteer for service.
It is our sincere hope that you will continue to keep up
an active interest in the medical aspects of aviation, and
that you will lend us your invaluable advice and support.
(Read before the Air Service Medical Association of the
United States at annual meeting in New Orleans, April
26, 1920.)
-By courtesy of the " Military Surgeon."
 PART 2.

A NEW TYPE OF REBREATHER AND OTHER RESPIRATORY APPARATUS.

By CARL N. LARSEN, formerly first lieutenant, Medical Corps, Medical Research Laboratory, :Air Service.

The present article is particularly concerned with a n ew another flow meter, which has been calibrated in terms of
t.ype of closed rebraather and cei·tain accessory pieces of oxygen percentage after the two gases have been mixed.
apparatus which have been developed in connection with in the emergency mixing bag, and whose flow is controlled
I
the use of this rebreather in routine examination of men by a special valve. Since the flow through the bag must
in the Air Service. As ·a result, the experimental and I remain constant, ,30 liters per minute regardless of the
practical application of all these pieces of apparatus have 1 percentage of gas mixture, it will 1:}e necessary, if a loweref!i•
been to the aviation problem, although they preBent oxygen percentage is desired, to close the air-control valv.e
various possibiiities for other physiological researches. to the same extent as the nitrogen-control valve is opened.
Since the work of Paul Bert, 1878, the decrease in oxygen 1 F'rom the bag the gas nms through a rubber tube to a
or more correctly the decrease in partial pressure of tight-fitting face mask applied to the subject. The over-
oxygen has been considered the principal factor involved fiow gas escapes through a one-way rubber valve at the
in the mountain sickness and balloon problem, and base of the mask.
naturally with the advent of the airplane, in the aviation The accuracy of this apparatus depends upon the accu- -
problem. racy of the aneroid flow meter. Although the results
The reduction in partial pressure may be accomplished obtained by the use of this apparatus at the Medical
in several ways and for convenience the types of apparatus Research Laboratory of the Air Service, Mineola, N. Y.,
de-1,i sed for this purpose may be divided into three groups. have not been dependable, no doubt by the use of more
I. The method by which the barometric pressure is re- efficient flow meters some very valuable results may be
duced- low pressure chamber. obtained. While this apparatus has the advantage of
II . The method by which a current oi normal atmos-1 holding the subject at a given oxygen percentage indefi-
p.heric air is reduced to the desired oxygen percentage by \ nitely and of registering the 0 2 per cent directly, it does
a current of nitrogen-Dreyer apparatus. not furnish ariy other data regarding the gas exchange.
I
III. The method by which the oxygen _is gradually This, however, has been overcome by the Larsen respi-
I
reduced by the subject from an air-tight ch.amber and rometer and recorder, which records the rate and volume
the carbon dioxide removed by an absorbent-closed-cir- of respiration and makes it possible to take a sample of the
cuit pulmonary apparatus . expired air for gas analysis. The initial cost of the appa-
l. The low-pressure chamber in the Medical Research ratus and the cost of operation are considerably more for
Laboratory at Mineola; N. Y., consists essentially of a this machine than for any of the closed-circuit types of
cylindrical steel tank, 10 feet in diameter and 10 feet rebreathers.
high, standing on end. The barometric pressure is re- III . The closed-circuit pulmonary rebreather consists,
,·I uced by means of a motor-driven vacuum pump, placed in its simplest form, of an eleastic bag filled with air,
some distance away and on a separate base to minimize connected by a tube to one side of an absorbing can con-
the noise within the tank. In addition to the electric, taining caustic soda. A tube leads from the other side of
telephone, and oxygen connections it is also equipped the can to the mouthpiece. A clip having been placed on
with a carbon dioxide refrigeration apparatus by which the subject's nose and the mouthpiece in his mouth, he
the temperature can be lowered to -32° F. Ventilation breathes into and out of the bag, all of the carbon dioxide
and reduction of pressure is controlled by a valve on a being.removed while the air is passing through the caustic
3-inch pipe leading into the bottom of the tank . The soda. Inasmuch as part of the oxygen is removed by
entrance is through a door in the side, which is fitted with caustic soda, the volume of air in the bag gradualiy de-
a plate of aluminum for X-ray purposes. creases and the per cent of oxygen in the mixture grows
·while the above apparatus is the most complete of its progressively less.
kind and simulates very accurately pressure and thermal Apparatus of thi5 type constructed by Ludwig, Sanders-
Ezn, 1867 ; Zuntz and Rohrig, 1871; Regnard , 1879, and
condition of various altitudes, it dces not lend itself to ·
. . others are now more or less obsolete. The more recent
general use
• •
because
_
of
•
the cost. of • constn!ctlon
•
and marn-
• 1-orms are th ose b y H ald ane an d D oug,as,
, 19 32
: , K rogb ,
1
t~nance rn the pract.1ca. apphcat1on of routme examma- , l913; Hough, 191Q; and Henderson and its modification
t1on._ · . by Pierce. 1918.
II. The Pierce-Hanson modification of the Dreyer i ·The H;nderson-Pierce rebreather which is a ruodifica-
apparatus is supplied with an electric pump by means of tion of Haldane and Dono-las, has be~n in use in the Medical
which a uniform presm_e is.maintained in an air chamber. ; Resea.rch Laboratories a~d its bra~ch laboratories for the
Air pc!.ssing through the outlet pipe f-:rom the air chamber : purpose of testing and rating aviators and candidates for
is so controlled by a speciai valve that tlie flow meter . 1he Air ·service. A short. description and a, sketch of thi,,
registers 30 liters of flov,- per minute. In the pipe i.s ; apparatus follows:
(8)
 9

LA Q,5E. H --
R~ t:'1/l Di:. q

PIP!!
IJt .)£~TIO/I
I

Tlfl l.AllSlN - /)Av1.s REBIU.ATHe!Z

f"/G. L
l'w. 1.-A new type of rebreather. It is light, portable, iree o[ water supply and plumbing
systems, and permits direct re.acting of the oxygen level at any moment during the e.xperi-
ment.al procedure.

The ba,;e of the machine is a steel tank ~ 'l' or 60 litt;rs pipe and absorbing cartridge A at the right. The ,;alves
capacity. Air is inspired f,rom the tank through the pipe VV are one-way mica flutter valves, keeping the air
at the left, and is expired back into the tank through the stream flowing always in the same direction. In order to
maintain the contained air at approximately atmospheric
2 For illustration seep. 344, Ah" Service Medical, 1919. pressure and to allow for changes in v olume. a water
 .. ,
.'•·.
I
..
'•
UJ.1.E. y
WH E£J.

..

,_.
0

ll, 1
Fr;; ON T

FIG. E
FIG. 2.-Automatic recorder and counter, front and profile views. 'l'he dial must be coI)lputed for the volume of the individual spirometer to which it is attaclrncl.
 11
sprrometer S, carefully counterbalanced, is mounted on
the tank and communicates foeely with its interior through
a vertical pipe P. A stylus attached to the counterweight
records the move.ments of the spirometer upon the smoked
drum of the kymograph K. Water is admitted to the tank
through the valve E to replace the volume of the used
oxygen and also to flush out the tank after an experiment.
l oxyisen consumption determined.
t The frame oi the machine is made of 1-inch No. 10
! air tank consists of an upper immovable and a lower
JvrtJMAT/('
f"IG. JIL
FIG. 3.-Automatic respirometer adapted to measurement of tidal air
during variations in pressure of the air respired.
The water is drained away to the sewer by means oi the
valve F. Valve C affords a free opening to the atmosphere
for flushing the tank of the rebreathed air. The absorbing
cartridge is a cylindrical paper tube filled with solid
caustic soda, cast in thin shells, so as to expose a large
surface to the action of the gas. This cartridge is placed
in a metal tube of equal size, which is made air-tight by
a rubber ring and fastened with clamps. Samples of air
are taken from the tank at the termination of the experi-
ment and anal yzed by the Henderson-Orsat gas analysis
for carbon dioxide and oxygen content. The chief advan-
tages claimed by Henderson for this apparatus are sim-
plicity, ruggedness, ease of operation, and low operating
cost. For experiments which require only the final
determination of oxygen, the above apparatus is in the
majority of cases sufficient, but in the opinion of the
author only one of the many factors necessary for a satis-
factory experiment. Owing to the lack of better apparatus
the earlier wbrkers of this laboratory confined themselves
to such experiments as were possible on the Henderson-
Pierce rebreather, thereby practically disregarding the
time factor, which is of more importance than the final
oxygen determination. With this in mind a new form of
this type of apparatus was designed by the present writer
and N. S. Davis III.
The Larsen-Davis rebreather is now in operation as a
standard research apparatus in the Medical Research
Laboratory, Mineola, N. Y. It has the following advan-
tages over other forms of this type:
I. It is light and portable.
II. It does not require water and sewer connections
for operating.
III. It does not require gas analysis for the determina-
tion o_f the oxygen per cent.
IV. It does not depend upon the termination of the
experiment for a gaa analysis, which can be had during
the progress of the experiment.
V. The rate and volume of respiration can, by means of
the Larsen recorder and counter, be had directly, without
the necessary use of a smoked drum and kymograph,
though as a matter of fact the recorder is always a desir-
able check.
VI. The subject, by means of thti oxygen supply
apparatus, can be held for an indefinite length of time at
the desired oxygen per cent and at the same time his
DESCRIPTION OF THE APPARATUS.
angle iron, 5 feet 6 inches high and 18 inches square. The
movable portion, constructed of No. 16 galvanized iron.
The lower portion is a double cylinder with a common
base and open at the top, each 15 inches high and 14 inches
in diameter, respectively. Between the two cylinders is
a 1-inch space filled with water, acting as a seal for the
upper and .lower portions. A water gauge i.s attached at
the outer cylinder. The upper portion is a single cylinder
with a top and open at the bottom, 15 inches high and 15
inches in diameter. When the lower portion is raised,
the upper portion fits into the water seal of the lower one,
making an air-tight chamber, which can be varied in size
from 40 to 80 liters capacity. In the center of the top of
the tank is countersunk a well-balanced water spirom-
eter of 6 liters capacity opening into the air chamber.
To the right and left of the spirometer are openings into
the top of the tank for the inspiration and expiration
pipes. Each pipe contains a one-way mica flutter valve
by means of which the air stream is always kept flowing
· in the proper direction, also a three-way valve for the
purpose of starting the experiment without the subject
being aware of it. · On the exhalent tube just before it
enters the air chamber is a container for a paper cartridge
of many compartments of solid sodium hydroxide, the
absorbent for the exhaled carbon dioxide. Two !-inch
valves for the introduction of oxygeIJ. are inserted into
the top of the chamber. A fish line passes from the
spirometer to ita poise weight over the pulley wheel of
I
I

FIG. 0:
- - - - - -- - - - - -- -- - -
FIG. •!.-Oxygen supply apparatus as assembled for holding the oxygen per cent constant in an inolose<l air chamb~r.
 13
the automatic recorder and counter that gives the rate · Since the absorbent cartridge contains only sufficient
and total volume of respiration per unit of time. The sodium h ydroxide to remove the exhaled carbon dioxide
lower or movable portid;n of the air chamber is raised or of man for a period of three hours, a record of previous
lowered by means of two steel cables and ratchet pulleys. experiments during which a given cartridge has -been nsed
A scale indicating the capacity of the tank as well as the should be kept. When a n ew cartridge is introduced it
displacement of oxygen· is attached to the side of the should be tested by the operator for its resistance by blow-
upper portion of the c;hamber and a pointer on the lower ing through the expiration pipe. Should the resistance
one. All pipes of th~ machine leading to and from the be too great the cartridge is removed and pressed between
subject are from t to 1 inch in diameter. Where the the palms of the hands for the purpose of breaking up -any
corrugated rubber hose connects with pipes of the machine, solid layers of sodium h ydroxid e which may have formed.
a small container, lightly packed with absorbent cotton, If there is still too much resistance a new cartridge must
is placed to insure sanitary conditions. (Torrel. ) The be used, which is prepared by punching the paper in the
direction of the flow of air is from the air chamber to the bottom full of holes the size of a pencil ; the paper in the·
subject through the inspiration pipe on the left, and from top is removed entirely. Before inserting the cartridge a
the subject to the air chamber by the expiration pipe half-inch brass ring is fitted into its lo'wer end to keep it
and sodium hydroxide cartridge on the right. By the from collapsing and thereby partially closing the opening
up and- down movement of the spirometer the partially of the pipe. A round rubb er ring slips over the outside at
deoxygenated air from the subject is so well mixed with the same place to insure an air-tight connection when
the air in the chamber that a correction of 0.2 p er cent lastened to its base.
will cover all errors, including that due to improper mixing The determination of the oxygen percentage is simple.
within the pipes. At the beginning of an experiment the champer contains
a known quantity of air of a known oxygen percentage,
PREPARATION AND OPERATION OF THE and since the displacement of the oxygen consumed is
MACHINE. recorded by the upward movement of the lower portion
The machine must be properly calibrated and a con- of the chamber; the percentage of the remaining gases can
venient scale attached. From a small valve in the top of be calculately directly. It is not, however, always prac-
the air chamber a rubber hose is connected to one end of ti cable to compute the various percentages during the
a gas meter, while the other end is attached to a water- progress of the experiment, so a curve is plotted by which
suction pump. With the machine closed and the spirom- the percentages of the gases can be had immediately.
eter down, the position of the lower portion of the chamber Given the oxygen percentage, oxygen can be introduced
is noted and marked upon the upper portion. The lower at any time during the experiment by means of the auto -
portion is now raised until the spirometer is about three- matic oxygen supply apparatus and the subject kept at
quarters of its length above its water seal. The position this oxygen percentage for an indefinite period.
of the lower portion of the chamber is again marked on the The rate and volume of the respirations are recorded by
upper portion. With the gas meter at zero the valve to means of an automatic recorder and counter.
the machine is opened and the suction pump started . To begin an experiment the machine is prepared as
When the spirometer descends to its former position again heretofore descri bed and the air chamber set at a definite
the suction pump is detached immediately. The reading capacity, depending upon the desired length of the ex-
of the gas meter is the capacity of the portion of the tank periment. While the spirometer is down all valves are
represented between the two marks on its upper portion. closed and then the chamber is raised equivalent to a
The chamber being of uniform size throughout, the total ~pirometer capacity of 2 or 2.5 .liters- about 10 notches.
capacity is easily determined and scaled accordingly. Then the subject is seated in front of the machine facing
The wateT seal of the air chamber and the spirometer in the opposite direction and equipped with a universal
should always be kept at the same level as when the mouthpiece and nose clip. For experiments of long dura-
machine was calibrated . For this purpose a water gauge tion a nose plug of inflated rubber has been found more
is attached to the outer cylinder of the lower portion of convenient and comfortable than either a nose clip or
the tank. Best results were obtained with the water Benedict 's nose piece. After the subject has b een allowed
spirometer about one-half inch from the top. to breathe atmospheri c air for two or three minutes the
Proper flushing or' the machine before each experiment experiment is started at the end of inspiration by quickly
can be done in several ways, but the following method is turning the three~way valves so that the subject is shut off
simple and efficient. The entire machine is closed except from the room air,- but has free access to the air in the
the three-way valve in the inspiration and expiration chamber; lower portion of the chamber is immediately
pipes. The air chamber is reduced to its minimum capac- raised to allow more air in the spirometer from which to
ity, thereby forcing as much air out directly as possible. breathe. Since the subj ect started the experiment at the
Since the flow of the air stream is always in the same end of inspiration it is only necessary, in order to deter-
direction, the upward movements of the spirometer will mine the oxygen percentage during the experiment, to
cause atmospheric air to be drawi1 through tht> inspiration lower the lower portion of the air chamber carefully until
pipe·, while the downward movement will force air out of the spirometer touches the bottom at the end of inspiration
th e chamber through the expiration pipe. A repetition and read the amount of displaced gas on the scale attached
of this procedure for 10 or 15 times will entirely change the to the air chamber which corresponds on the curve to the
air in the chamber and pipes. oxygen percentages of the remaining gases in the chamber.
 14
Two per cent is added to allow for the capacity of pipes
and tubing. Although oxygen percentage can be deter-
l the smoked drum and kymograph without endless labor
mined in this way it is rarely done, except for the final
determination. Experiments are usually planned and the
desired oxygen percentage for the particular experiment
agreed upon beforehand. When this is done it .is only
necessary to raise the lower portion of the chamber from
time to time as the spirometer will permit until the corre_
sponding oxygen percentage is reached.
This machine in conjunction with the necessary appa-
ratus has been developed for the solution of the air prob.
lems peculiar to aviation. It is believed to be also readily
adapted to the study <if numerous clinical problems, espe.
cially the clinical question of metabolism.
LARSEN RECORDER AND COUNTER.
Of the various methods employed for obtaining the rate
and volume of respirations ;from the movem,:mts of a water
spirometer, the smoked drum and kymograph is the most
common, but of recent years attempts have been made to
construct a device which will give accurately the rate and
summation of the excursions directly. (Benedict, 1909-
1912; Gibbs, 1918.)
Detailed Description.
This apparatus consists of three 7-inch aluminium wheels
mounted on a common steel shaft 6 inches long. This
shaft is supported at its ends by two angle irons. A line
to which a spirometer is attached at one end and a counter-
weight at the other takes up the movements of each
respiration. On both sides of the second wheel B and
close to its outer edge are 1-inch concentric strips of felt,
while a quarter-inch strip of felt covers its circumference.
The third wheel, qr dial C, whose bearing is on the hub
of the second wheel, is held firmly against the felt of the
second wheel by means of a spring D, causing it to take
up the same movement as D. A sharp steel hinged lever
2 inches long with a spring for the pmpose of keeping it
extended j.s fastened to the pulley wheel on its inner side
one-half inch from the edge with the direction of the
pointer in the direction of the downward movement of
the spirometer. The distance between the first and second
wheels is a little less than 2 inches, allowing the pointer
to engage the felt of the second wheel when tW'Iling in
the direction of the downward movement. But when
turning in the opposite direction it merely slides over the
felt without imparting any motion to it. To prevent any
backward motion of the second wheel a one-way catch is
attached to the base of the apparatus below the rim of the
second wheel engaging the felt on its circumference.
A paper dial calibrated in accordance with the spirometer
is atf.a:ched to the third wheel. For the purpose of read-
ing the results for definite periods of time the dial can be
stopped by releasing the spring. A pointer E attached
to the base indicates the total volume. To the hub of the
pulley wheel is attached an electric clutch making and
breaking a circuit to an electric counter at each inspiration.
The apparatus is applicable to any spirometer or other
apparatus where a summation of movements is desired.
When properly constructed it will give accurate results
which are practically impossible to obtain by the use of
in measuring the individual respirations.
LARSEN AUTOMATIC RESPIROMETER.
The purpose of the apparatus is twofold: First, to record
automatically the rate and volume of respiration at con-
stant or varying barometric pressures; second, to record
the rate and volume of respiration in connection with the
Dreyer ;i,pparatus.
Description and Operation.
It ·consists essentially of an inspiration and expiration
pipe with one-way valve, water spirometer, electric con-
tact valve, spring magnetir. valve, and automatic recorder.
At the distal end of the expiration pipe is a hinged valve
A, so placed that it,closes the opening of the pipe by fore!)
of gravity. From this valve is a wire leading to the dry
cell B, while just above it is suspended a wire leading to
the magnetic valve C. This latter valve, consisting of
double magnet separated by a steel shaft upon which a
coil spring and circular iron disk is moveable, is so placed
that it controls the opening of the inspiration pipe. The
other pole of the magnetic valve is connected to the dry
cell. About 3 inches from the distal end of the inspira-
tion pipe is a T connection, the vertical portion of which
leads to the water spirometer D. The counterweight E,
suspended by a fishline over the pulley wheel of the
recorder F to the spirometer, is sufficiently heavy to
cause the spirometer to be drawn upward when the valve
of the inspiration pipe is open. Since the direction of the
air stream is changed during expiration and inspiration
they will be given separate consideration. The principle
of the mechanism is to measme the inspiration and utilize
the expiration only as a timer for the opening and closing
of the valve to the inspiration pipe. During expiration
the hinged valve at the distal end of the expiration pipe
is slightly raised to allow the air to escape, thereby making
contact with the suspended wire above and closing the
circuit to the magnetic valve. When no current passes
through the magnet the circular.disk is held by means of
the sprihg tightly against the opening of the inspiration
pipe, and when the contact is made the magnetic force
overcomes the force of the spring, pulling the disk away
from the opening of the inspiration pipe. Since the spi-
rometer is overbalanced by its counterweight, air is then·
drawn into it from the outside. Very little additional
weight is necessary to raise the spirometer if the inner
chamber is well polished and sufficient room is allowed
between the two chambers. The diameter of the inner
and outer chambers should be 6 and 8 inches respectively.
At the end of expiration the hinged valve by force of
gravity falls, breaking the circuit to the magnetic valve
whose force kept the inspiration pipe open to the outside
for the purpose of filling the spirometer with air at that
barometric pressure. By the force of the spring against
the circular disk the opening is closed and the direction
of fl.ow during the inspiration is now from the spirometer
to the subject. The rate and volume of respiration may
be obtained by the use of the automatic recorder and
counter.
 15
When to be used in conjunction with the Dreyer appa-
ratus it is necessary to construct an air-tight chamber-
tight-fitting wooden box-with an inlet and outlet over
the magnetic valve and opening of the inspiration pipe.
This chamber serves the same purpose as the mask of the
subject, since the flow of air from the apparatus passes
into it through the inlet pipe and the excess air escapes
through the one-way valve attached to the outlet pipe.
During expiration such mixture of air as is passing through
the chamber is taken into the spirometer and breathed by
the subject at the next inspiration. By means of a small
valve in ·the expiration pipe samples of expired air can be
had for analysis.
OXYGEN SUPPLY APPARATUS.
The purpose of this apparatus is to supply oxygen to the
·s ubject in proportion to his oxygen consumption regard-
less of the percentage of the mixture of gases breathed.
Description and Method of Operating.
The apparatus consists in part of" a spirometer, water
valve, recorder and oxygen tank with a reducing valve.
A water spiro)Ileter of 8 liters capllcity with two one-half
inch pipes leading into it and extending to the top of the
water line is carefully balanced by a ·weight and fish line
over the pulley wheel of the recorder. From one pipe is
attached, by means of a rubber hose, a small oxygen tank
equipped with a pressure-reducing valve. The other pipe
is attached to the long tube of the water valve. This
valve is an ordinary water valve or Turkish water pipe.
It consists pf a wide-necked glass bottle of 500 cubic
centimeter capacity one-third filled with water; if the
gas used contains carbon dioxide a .weak solution of sodium
hydroxide is substituted for water. Through two holes in
a tight-fitting rubber cork are inserted two one-half inch
glass tubes, one of which extends just above the leYel of
the water while the other opens below the surface. From
the shorter of the glass tubes is a connection to the c"hamber
of the rebreather. Oxygen from the tank forces the spi-
rometer upward, partly filling it with oxygen, when the
tank is shut off. The connection at the chamber pf the
rebreather is removed and the oxygen spirometer forced
down, thereby filling the. tubes and water valves with
oxygen. The connection is then made at the chamber of
the rebreather and all valves closed. The oxygen pipe
leading into the air chamber is supplied with a valve
preventing any oxygen from entering· until the desired
time. This pipe is placed close to the open.ing of the ex-
piration plpe for the purpose of replenishing the returning
air with oxygen.
To conduct experiments the subject is seated before the
Tebreatber equipped with a mouthpiece and nose clip, and
the experiment commenced as previously described for
conducting experilllents on the rebreather. When the
desired oxygen percentage of air in the chamber has been
reached, oxygen from the supply apparatus is admitted.
This is done by lowering the lower portion oftthe air
chamber until the spirometer of the rebreather just touches
the bottom at the end of inspiration and the valve to the
oxygen apparatus is then opened . The following expira-
tion forces the spirometer of the rebreather upward, but
since some of the oxygen was removed, less air is expelled
than is requir.ed for tj:ie following inspiration. The differ-
ence between the volume of expiration and the necessary
volume for inspiration is made up by oxygen drawn over
from the oxygen supply and the amount is measured by
an automatic recorder.
Although the rebreather"J:,as been referred to in t he
above description, it is not at all necessary to use so elab-
orate a device, except where varying gas percentages are
required, to determine th e oxygen consumption of an
individual.
 PART 3.

THE PSYCHOLOGICAL EFFECTS OF OXYGEN DEPRIVATION.

By E N GLISH BAGBY, Ph. :p. , First Lieutenant, Sanitary Corps, Medical Research Laboratory

On October 18, 1917, the War Department authorized the I subject was required to grip the mouthpiece of the ·re-
appointment of a Medical Research 'Board "to investigate 1 breathing machine with bis lips and teeth precluded the
all phases of flying which bear direct relation to the mental use of an y psychological test involving a verbal response.
1
and physical equipment of the-flier ." Almost the first From this it will be seen that the subject's responses were
problem which came to the attention of the board was the limited to one hand and his two feet.
classification of all Army aviators according· to their fit- In view of the absence of pioneer work on the problem
ness for altitude work. From considerations of con- it was necessary'to face the possibility of deterioration, or
venience and simplicity, it was immediately decided to change, in any of the psychological functions. Conse-
use a form of the Henderson rebreathing apparatus,' quently, the tests· which were first tried involved practi-
wh.ich supplies the most deleterious feature of increasing cally all varieties of mental activity: Sensitivity, mus-
altitude, namely, decreasing oxygen tension. cular control, emotions, memory , attention, and the more
The preliminary investigation of the psychological I complex processes.
effects of low oxygen tension in rebreathed air, an d the It was the custom in the early work to vary the quantity
development of a standard test for resistance, was entrusted of a ir to be rebreathed in such a way as to provide suffi-
to Maj. Knight Dunlap and two assistants, Lieut. Schachne cient for any desired length of ''run" from 15 to 40 minutes.
Isaacs and Lieut. English Bagby. I When required for special purposes, oxygen was intro-
! duced into the reservoir and the run prolonged indefinitely.
1. · The method of introducing oxygen was also used in con-
PRELIMINARY STAGE OF THE INVESTIGATION. trols. When a given test performance was found to
deteriorate in successive trials, oxygen was supplied with-
The standard psychological test had to be adapted to out the subject's knowledge and observations were made
certain limitations imposed by the military emergency on the performance as it returned to normal.
and by the conditions of rebreathing. In the earliest stage of the investigation, almost every
1. Since it was considered imperative that all aviators subject was permitted to faint before being removed from
be very promptly classified it was necessary to limit the the machine. Later, as the symptoms of impending
time of each complete psychological examination to collapse became more fam iliar, the subject was released
approximately 30 minutes. This precluded a lengthy while sti.11 conscious.
period of practice in the test performance previous to the It did not seem practical to make a systematic study of
rebreathing examination. On the other hand an exami- each mental function . Instead , it was determined to u.se
nation procedure involving significant effects of practice selected tests to discover which functions were most
was regarded as impractical , sin ce the improvement inci- imp3.ired by oxygen deprivation. With this information,
dental to p ractice might be expected to obscur.e any an intensive study of these specific functions was to be
possible deterioration due to oxygen depletion. undertaken.
2. It was thought inadvisable to use graphic registra-
Description of the Preliminary Tests.
tions of performance. In the first place, considerable
time is required for record reading and statistical t reat- The psychological tests listed below were given at three-
ment. There is a second and more serio us objection. minute intervals throughout a number of 1'runs" and the
While errors may be readily registered , compensatory pc:rformance was studied for evidence of deterioration or
reactions by which errors tJ.re avoided can not be con- change . No effort was made toward absolutely accurate
veniently recorded . determinations since the early tests were used simply
3. It was necessary that the test performance be non- with the purpose of obtaining indications for further work.
fatiguing, as low oxygen effects and fatigue effects are The quantitative results of the tests do not constitute
liable to confusion. the sole source of information. Much data was also
4. In order to haV'e some constant check on the physical secured through incidental observations and the subj ect's
condition of the subject, pulse and blood-pressure read- description of his experience.
ings must be made at two-minute intervals throughout the
examination. This eiiminates the use of the left hand in 1. SENSORY TESTS.
the psychological work. In addition , the fact that the (a) Vision (lower threshold of visual acuity).- The
, A description of t h e Henderson rebreathing apparatus is to be found apparatus consisted of the I ves visual acuity test object,
on p . 169, " Air Service Medical. " as made by Bausch & Lomb Optical Co. It was found
(16)

that the commercial form of the Ives instrument is not
well adapted to rese~rch_, the scale of adjus~ment being too
coarse. Another ob1ect10n to the test as given was found
in the fact that acceptable settings for all subjects, even
under normal air conditions, varied between very wide
lim~ts. The use of special statistical methods is of little
avaiJ because of the small number of readings which can
be gotten during a stand~,rd "run." ·
With this test, as with all others that were used , there
was found to be a short period, just previous to the final
collapse, during which the performance was unmistakably
less efficient than under normal air. This period involves,
not simple deterioration in a sensory function, but a
partial failure of "yoluntary attention ," with inability to
cooperate fully . Effort is more or less spasmodic, and a
dazed attitude follows any unexpected stimulus. This
period, technically known as the.final stage of asphyxiation,
persists for an interval of from 15 to 90 seconds; occa·
sionall y longer.
Coincident with or immediately following the beginning
of the profound psychological disturbalfCe, a failure of
physiological compensation occurs. It is marked by a
failing vascular tone. In the close association of the
psychological "break" and the failure of physiological
compensation, there is some support for the conception of
the psychological processes as integrative, i. e. , as de-
pendent on the integration of the centr&l nervous system,
rather than on the action of specific parts of the system. 2
(b) Audition (lower threshdld of auditory acuity, and
threshold of pitch discrimination).-To determine the lower
threshold of sound intensity, Dunlap's acoumeter was
used. This instrument consists of a vertical metal reed
(256 d. v.), the upper end of which may be drawn from the
vertical position to any desired position by an electro-
magnet. When the current through the magnet is broken
the reed is released and vibrates. Since the position of
the core of the magnet may be varied, any desired ampli-
tude of vibration can be secured by adjustment of a milli-
meter scale attached to the magnet core.
No deterioration in the performance on this test was
observed before the final stage of asphyxiation, the stage
of failure of voluntary attention described above. Also it
was found that slight sounds arising from the necessary
manipulation of the rebreathing machine, and other
incidental noises, were sources of distraction tending to
invalidate the results.
An effort waa made to use the difference threshold of
pitch as an index of deterioration, but the results were
negative.
(c) Pressure (reaction time to change of pressu.r e).-All
fli.ers testify to the importance of sensations of pressure
arising from the buttocks and the posterior surfaces of the
thighs. These sensations, together with visual cues and
afferent processes from the inner ear, are involved in
leveling and properly banking a plane.
For testing purposes, a special apparatus was devised
by Maj . Dunlap. It consisted of a large solenoid magnet,
to the core of which was attached an upright brass rod
surmounted by a horizontal plate. The subject's left
thigh was placed upon this plate and the weight forced
'See Dunlap: An Outline of Psychobiology, 2 ed., p. 122.
1454-30- -2 0
17
Ithe core from its resting position in the magnet. A cer-
tain amount of upward pressure was thus exerted against
the surface of the leg, and this pressure could be increased
or decreased by changing the intensity of the current
flowing through the c.oil.
The apparatus control was not sufficiently good to per-
mit of the establishment of adequate thresholds.
2. MOTOR PERFORMANCE TESTS.
The tests selected involved a minimum of discrimina-
tory attention. Deterioration, due to low oxygen tension,
affects the speed of movements and causes tremor, inco-
ordination, and overdischarge.
(a) Aiming (steadiness). --Dunlap's modification of the
Whipple arrangement was used. This consists of graded
openings in a metal plate and a stylus. An attempt was
made to find the smallest opening in which the stylus
could be held for 20 seconds without contact. Trials were
made at intervals during the process of asphyxiation.
It was found that there is a constant but irregular de-
crease in steadiness during the preliminary stage of as-
phyxiation. This stage extends from the time of the
appear:l.nce of the first effects to the beginning of the final
stage of asphyxiation. In 272 standard examinations, with
the most favorabie conditions of observation, the earliest
appearance of psychological deterioration was in the sev-
enth minute, or at an oxygen tension of approximately
17.3 per cent (0.73 per cent of the 272 cases).
The aiming test was·not available for use in the standard
examination, because breathing is seriously interfered
with by the tendency of the reactor to hold his breath
during the trial. This tends to aggravate the effects of
low oxygen tension.
(b) Tapping (rapidity of motor discharge) .- A specia'.l
form of the tapping test was used. The apparatus con-
sisted of the usual form of stylus and two mounted brass
plates (2 by 2~ inches) separated by a narrow piece of
hard rubber. The plates are touched alternately. The
:i.dvantage of this arrangement over the usual form rests
in the fact that greater motor control is required and
tremors are less likely to be registered as taps. Each trial
lasted 15 seconds, and the number of taps electrically
recorded was taken as the record of the performance.
The number of taps made during each 15-second inter-
val remained fairly constant until:- the final stage of as-
phyxiation, at which time marked muscular incoordina-
tion appears. During the preliminary stage of asphyxia-
tion there is a significant increase in the energy of the taps.
It has been suggested that the rate of tapping is maintained
by this increase of energy. However, the energy increase
appears to be .a true low oxygen effect rather than a com-
pensation phenomenon.
(c) Knee-jerk (irritability ).- A rubber hammer hanging
freely on a pivot was permitted to fall against the sensitive
point of the subject's knee from various heights. In this
way the threshold of irritability was established. The
results were extremely variable, but showed ·no indication
of decreased irritability during asphyxiation.
3. MEMORY TESTS.
Three forms of memory tests .were used with immediate
or delayed recall.
 18
(a) Series of from fi_ve to nine consonants were orall) Low-oxygen tension does not seem to affect the speed
presented and the subject was required to,reprodu~e them of the performance until the final stage of asphyxiation is
in writing. The material used is shown below: reached. However, a§ rioted in the, tapping test, the reac-
RKZWT tion movements become progressively more energetic dur-
ing the preliminary stage of asphyxiation.
CXWNFZ
(b) Addition (Dunlap's material) .-This test involves
JLXBRVN the use of sheets containing 16 !,;nee of digit.'3, each line
NHBDZVCR containing 45 digits. A single line was presented to the
VJSRBLTMW subject with instructions to add the digits f;om left to
HRKGWMDPTL right until the sum equaled or exceeded some designated
ZXWDKTNVSHQ number (12, 13, 14, or 15). After the last number of a
group a line is dra.wn by the subject, and the difference
YPCQDKWZMTBJ
between the total and the designated number is inserted.
(b) Combinations of color :i;iames and numbers were No low-oxygen effect was observed before the final'stage
orally presented for reproduction,. Selections were made of asphyxiation.
from the following list: (c) Tactile di~crimination.-The subject was required tu
•
White ................ . 63 Ecru .................. . 81 sort cards containing diamond-shaped openings. Time
Russet ... ....•. ..... , . 84 Black .. . . ............ . 52 wa.s faken for a series of 50 cards .
Gray ..,. .. . ............ . 47 Green . . ........ ....... : 24 The results were entirely negative.
, ,Amber . . .. ... ......... . 28
Lilac ................ . 73 Summary.
Violet ................ . 96 Orange . .. . ...... .. .... . 35
Red . ..... ............ . 58Blue ...... . .. .. ...... . 74 This completes a review of the tests which were used to
,T an ................ .. . 14Buff .................. . 29 determine the general cha1·acter of the psychological
Rose .. ...... ..... .... . 95 effects of oxygen deprivation. '.rhe results of this pre•
Gold .... . . , ........... . 85
Drab ................. . 62 liminary work may be briefly summarized. The summary
Azure . .... ...... .. ... . . 46
Purple ................ . 79 includes not only the observations made on test perform-
Yellow . .. ........ .... . . 69
Crimson ............... . 13 ances but such additional data as was secured through
Scarlet ...... .... .. ... . 57
Straw ................. . 25 Slate ................. . 68 self-observations and incidental observations ·made by
Brown ................ . 18 Pink,. . ... ............. . 37 the experimenters.
Lavender ..... _. ...... . 36Indigo . . .. ............ . 92 1. Motor performance.-The most obvious effect of sub-
jection to a gradually depleted oxygen supply is the pro-
The performance was rated on the number of combina- duction of tremor, muscular incoordinati.on, and ,over-
tions which could be correctly reproduced. discharge. These effects become progressively more pro-
(c) Memory of position.-The apparatus consisted of nounced as rebreathing proceeds and are presumably re-
49 miniature lamps arr~nged in rows of 7, and mounted lated to a less and less complete integration of the central
on a vertical blackboard. A scattered group of from nervous processes.
three to seven lamps were lighted for three seconds and, 2. Attention phenomena.-Lovr-oxygen tension tends to
the subject was instructed to desiguate on a chart the, bring about a reduction in the abil:ity to carry on a number
position of the lamps which had been lighted. of discrete tasks simultaneously through rapid shifting of
The phenomena 0£ immediate and delayed recall were attention . This restriction of the general field of atten-
investigated with these three tests. No deterioration was tion operates in such a way as to lower the subject's dis-
found under low-oxygen tension during the preliminary tractibility. Hence, the attention directed to a simple,
stage of asphyxiation . However, it was noted that mate- relatively mechankal feature of a complex task ,is supe-
rial presented during the final stage of asphyxiation was rior tb the attention given to that feature under normal
not properly impressed (perceived). Nothing specific can air conditions. It is probable that the absence of low-
be said about retention during this stage. oxygen effects in the simple sensory and motor tests used
4. ATTENTION TESTS.
in the preliminary investigation is largely accounted for
by the progressive decrease of distra<:>tibility.
Deterioration in attention may take the form ,of con- I In the final stage of asphyxiation the subject is unable
fusion between stimuli, failure to react, diminution of to concentrate on any task in the normal way, and instruc-
attention-range, or distractibilit) . The following test, tions have to be given insistently and in a loud voice.
were used: 3. The condition of resting muscles.-Some data was se-
(a) Serial reaction.-The apparatus was a serial reaction cured thrpugh observation of the coDdition of the muscula-
boa.rd consisting of 24 miniature lamps, with correspond- ture of the left hand during various stages of the run. The
ing switches, in a semicircular arrangement. The series muscular condition, normally firm, was found to become
is started when the operator lights a lamp. The subject first relaxed, then tense, and finally twitchy.
reverses the corresponding switch, extinguishing the first 4. Removal of inhibitions.-In the final stage ofasphyxia-
lamp and lightiug a second, nnd so on to the end of the tion some subjects give expression to uncontrolled anger.
series. The wiring is so arranged that the lamps are Occasionally an attempt is made to break various parts of
lighted in irregular order, and the sequence is changed the apparatus or the mouthpiece is vigorously expelled.
afu,1 each trial. The time of the series of reactions is In milder forms of·the condition an attitude of resentment
taken with !l, stop watch. is taken toward all stimuli which are presented.

On the other hand, some subjects become silly, winking
and smiling at the apparatus and,at the experimenter.
Sometimes this is followed· by uncontrollable laughter,
which necessitates removal from the machine.
Such conduct represents a primitive, or emotional, form
of behavior, with a removal of inhibitions. The phenome-
non is perhaps related to the factors involved in decreased
distractibility, as previously described. The experimental
conditions lose their restraining value.
5. Self-observation.-Many : ubjects report that they are
able to "pull themseves together" for any brief task but,
upon its Completion, "want to rest."
This fact was substantiated by direct observations made
by the experimenters. In the latter part of the preliminary
stage·of .asphyxiation, after a very normal performance on
a short test, the subject may sink back into his chair with
eyes closed and quite inert. He is with difficulty aroused
for the next task but, when aroused, makes as good a per-
formance as before. This is called the "spurt phenome-
non."
Self-observations ma.de during the final -stage of asphyx-
iation are almost uniformly unreliable. When a subject is
removed from the machine after repeated efforts to arouse
him have failed, he may maintain that his work was effi-
cient to the end. This occurs even when complete uncon .
sciousness has not intervened.
The standard classification test, as adopted by the
Medical Research Board, is bas1ld on the consideration just
listed. It involves a continuous performance to avoid the
"spurt phenomenon," mentioned in 3. The inotor per-
formance is of such a sort that decrea.~ed mus_cular control is
at once detected. It includes three discrete tasks so as to
demonstrate increasing restriction of attention. The per-
formance is clinically observed rather than graphically
registered for the reasons mentioned in the discussion of
the limitations imposed by the. military emergency.
It is especially important to note that no claim is made
that the standard test determines the constitutional resist-
ance to low-oxygen tension. The physiological condition
of the subject at the time of the test may operate in such a
way as to affect the performance profoundly. Loss of
sleep, dissipation, and indigestion are believed to modify
constitutional resistance.
2.
THE STANDARD PSYCHOLOGICAL TEST FOR
RESISTANCE TO OXYGEN DEPLETION.
In order to complete this account of the work on low-
oxygen tension, the following description of the apparatus,
technique, arid prncedure of the standard test is appended.
The description, with minor textual corrections, is taken
from the Manual of the Medical Research Laboratory, first
edition, pages 170-177, as written by Maj. Knight Dunlap.
Apparatus for .the Standard Test.
The apparatus used for the psychological tests consists
of two groups, A ari.d B .
A. This group includes a number of pieces assembled the corresponding screw heaq. Do not touch the washer.
on a specially designed table, adjustable in height and
slope, and swinging on a sh:gle heavy post mounted on a
cast-iron base. This table is designed to furnish a suffi- the right hand) keep the ammeter at the designated marl:.
19
ciently rigid mounting and at the same time giving greater
convenience than could be afforded by a table with legs.
The apparatus mounted on this table forms three separate
units:
(1) There are 14 stimulus lamps (2 candlepower) ar-
ranged in two rows of seven each, with two similarly
arranged rows of contact buttons, each surrounded by a
washer. The contact buttons are rounded screw heads of
one-fourth inch diameter. In addition, there is a check
lamp and a red error lamp and a stylus with a hard-rubber
handle and metal tip. These parts of tlie unit are so
wired electrically that when· a stimulus lamp lights, the
cprresponding contact button is "alive" and if touched
with the metal tip of the stylus, the check lamp is lighted.
If the washer surrounding any of the buttons is touched
with the metal tip of the stylus at any time, the error
lamp is lighted.
(2) Two ammeters mounted on a metal arm above the
table top are connected in series with two rheostats, one
on the upper side of the table top at the edge near the
reactor, the other underneath, at the edge near the psy-
chologist. One ammeter faces the reactor, the other the
psychologist. A change in the resistance made by the
psychologist at his rheostat, causing a chap.ge in the amme-
ter reading, may be compensated for by a change in the
reactor's rheostat, by which the original ammeter reading
may be restored.
(3) A small electric motor mounted on the upper side
of the table top is connected in series with a third rheostat
underneath the table. A. two-way lever switch mounted
underneath the table at the edge next to the psychologist.
and a rocking pedal two-way switch on the floor under the
table, are connected with the rheostat ·by a three-wire
system, so that a part of the resistance of the rheostat can
be cut out (thus increasing the speed of the motor) by
either switch and again cut in (thus restoring the lower
motor speed) by either switch.
B. The second group of apparatus, on a small table in
any convenient part of the room, consists of an automatic
distributor which lights the stimulus lamps in selective
order and for a constant interval. During the -examina-
tion a stimulus light appears every fifth second and re-
mains for l! seconds.
Method of Conducting the Test.
The rebreathing machine-is adjusted by the physiologist
to give a "standard run, '' which will vary in time accord-
ing to the individual and his method of work, but which
will bring a reactor of the highest type to 7 per cent oxygen
in 25 minutes on the average. For this standard run the
quantity of air in the reservoir at the start is 53 liters.
The reactor, being seated in proper position before the
apparatus, is given the following instructions to read:
Instructions.
Read carefully.
You have three things to do:
1. 'Lights.
When a light flashes, touch with the stylus the top of
2. Ammeter.
Watch the ammeter and by adjusting the rheostat (using
 20
3. Motor. psychologist sharply notifies the responsible medical at-
Keep the motor at low speed by maintaining the proper tendant in order that the reactor may at once be given
positions of the pedal. When the motor speeds up reverse air and so prevented from undergoing-complete collapse.
the pedal and hold it in its new position until the speed The recognition of "complete inefficiency" is a matter
again increases. on which the psychologist must carefully train himself .
NOTES: In general it shows itself in a definite way, as described
(a) The lights are Qf first importance, i. e., if a lamp below, but may show in forms which are readily recognizad
lights when you are reading (or are about to react) to the by the trained observer but which are described with
ammeter band , react to the. light first and then go back to difficulty.
the rheostat. In many cases the medical attendant will find it neces-
(b) When you touch with the stylus the contact button cary to inter,rupt the test, because of cardiovascular
corresponding to a light, the movement of the hand and symptons, before psychological inefficiency is reached.
arm should be ' 'free' ' (neither hand nor arm should touch At the start of the rebreathing examination it is advisable
table , rheostat, or board). The hand may at other times to allow the reactor to react to the lights alone during the
rest on the slide of the rheostat. first minute and add successively the changes in the speed
(c) Do your work with accuracy, neatness, and promptness. of the motor and in the ammeter readings. He should be
Do riot bang, slam, or jab. busy with all three tasks by the middle of the third
While the reactor is reading the instructions, the psy- minute.
chologist is ready to explain any detail of the apparatus In observing, the psychologist needs to attend as con-
or method in which the reactor may show special interest; stantly as possible to the behavior of the reactor. The
and, after the re,i,ctor has finished reading, the psychologist labor, of recording must therefore be reduced to a mini-
further explains the procedure and verbally emphasizes mum. For this purpose and for the purpose of standardiz-
the important points in the instruction&. ing the method of observation the following symbols
'When the rebreathing machine is ready and the blood- have been adopted.
pressure recorder has secured the requisite preliminary SYMBOLS AND THEIR SIGNIFICANCE.
readings, the mouthpiece and nose clip being in place,
the external opening of the mouthpiece is closed by the First significll,nt effects on "voluntary muscular coor-
responsible clinician and the test CL1mmences. The psy- dination."
chologist and all others concerned in making the test start "Fumbling"; clumsiness; inaccuracy in touching the
their stop watches at this moment. contact b11ttons.
During the first three minutes of the test the psycholo- ? "Groping," approaching contact buttons with cor-
gist coaches the reactor if necessary and estimates his com- rective movements.
prehension oi the task and instructions, his power of atten- E "Effort," increase in the force of applying the stylus
tion , and his composure (freedom of excitement or nervous- to contact buttons.
ness), entering the words good, fair, or poor on his record 3 Decreased "effort."
sheet. He also notes the motor tendencies .of the reactor I Impulsive or uncontrolled movements.
as they fall into one or more of the following categories: a. On the movement to the buttons.
b. On the movement from the buttons.
Motor Tendencies. S Slowing of reactive movements.
Tremor. Slow . F Speeding of reactive movements.
Tense. Hesitant. ~ First significant effects on "attention."
Impulsive. Accurate. d I "Distraction" from lights, neglects lights.
Steady. Inaccurate . dl-v Neglects lights for ammeter.
Rapid. Restless. / Reactor delays initiating stylus movement so long that
In addition to these general tendencies, it is important he fails to light check lamp .
that the psychologi8 t take notice of other specific tend - // Reactor delays so long that he touches the button after
encies shown by the reactor, and if definite types of error the stimulus lamp has gone out.
are shown he must watch during the succeeding five or / / / Reactor starts movement after the light has gone out.
six minutes for improvements. In this way the "M', and dv "Distraction" from the ammeter dial, fails to note and
" A" determinations (described below) may be accurately adjust the position of the pointer.
noted as deterioration from the normal performance of the d n "Distraction" from the motor, neglects to control the
reactor, and not as failures with regard to an absolute speed of the motor.
standard of proficiency. This is important since the rating /cl I Confusion between rows of lamps. but finally touches
on these tests is valid only as an index of the effects of the right button
abphyxiation on a particular individual and not as an cl Confusion between columns of lamps, but finally
index of efficiency or inefficiency in any other respect. touches the right button.
The comprehension, attention, and composure, and the lwl [ Selects button in wrong row.
motor entries are, however, worth recording for purposes wi Selects button in wrong column.
other than oxygen rating. Wv Moves ammeter pointer in wrong direction.
Normally the test continues until the point of complete Wn Shift of pedal without change i11 motor speed.
psychological inefficiency is reached, at which point the <%> Two of the symptoIDB', 9, ?, I, and E repeatedly.

<f) Two of the symptoms, di, dv, dn, ///, cl, wl, and wv.
© "Inefficiency." Inability to control any of the three follows :
tasks. The reactor sometimes stares at the lights
without making an attempt to touch a button, or
makes a number of irrelevant touches. Completely
disregards the motor and the ammeter. Sometimes
severe tremors appear and jerkiness sets in finally.
* Breakdown. The reactor ·ceases to work and com-
mences to collapse ; qualitatively & more serious con-
dition than-
X Reactor released from the apparatus.
There are the following additional symbols for special
diagnostic purposes:
~ Tremor of the hand.
,vwJerkiness of the hand.
Swaying or drooping of the head.
~ r
Tapping buttons more than once.
R Rests hand or fingers in touching button.
K Keeps stylus on button after making touch.
THE BAGBY-ROSS RATING SCHEME.
'The aviator is rated, or classified, according to the
following scheme.
1. Take 25 minutes as the standard duration of a run.
If © or * appears before the end of 25 minutes, debit
point for each minute in case © or
minutes.
*
or credit 1. point for each minute. Similarly, credit 1
appears after 25
2. Assume,- as a standard altitude, 7 per cent of oxygen
for ©- Debit or credit 1 point for each one-tenth of 1
per cent.
3. As in the case of 1 above, take 25 minutes as the
standard time for the appearance of both of the diamondR.
Debit or credit 1 point for each minute.
4. Assume 15 minutes for the standard time· for the
appearance of the two arrowheads. Debit or credit one-
half point for each minute.
21
5. Add the debits and credits and assign to classes, as
+ n....... . ..................... ... .. . 0 Class A
0 .. . ... . ... .. .... .. . . ..... . ... . . . . .. - 12 Class A
- 12 .. . ........... . ... . ... ..... ..... .. . -30 Class B
-30 ................................... - n Class C
In case the run is interrupted before © is reached, a
computation, based on the above rating sch eme, can be
made assuming the missing symbols to have occurred
at the time of ().
At first glance the method of classification just described
seems to be based on time rather than on oxygen per-
centage. but this is only apparent. If every reactor were
run at the same rate (a rate of oxygen depletion at which
7 per cent oxygen would be reached in 25 minutes), it
would be immaterial whether -the oxygen percentages of
the times at which the s, <ff>, and © were reached should
be used in the rating, since there would be a fixed corre-
spondence between these. Since the rates of oxygen de-
pletion vary in accordance ·with the individual rates of
oxygen consumption, and since a faster rate enables the
reactor to reach a lower percentage, it is necessary to make
allowance for the variations in the rate of oxygen con-
sumption.
This can be done by computing in oxygen percentages,
and then making a correction for time; or, more simply,
as in the scheme actually employed, by ·computing in
times as if the oxygen change followed· a line of the same
slope in each case, and then correcting for deviation from
this slope in terms of the final p ercentages of oxygen
I reached.
At the present time the standard rebreathing test .has
, been administered to over 7,000 aviators. Almost a score
I of psychological observers have had opportunity to verify
the effect of oxygen depletion as revealed by the pre-
liminary investigation reported in part 1 of this report.
 PART 4.

A CARDIO-VASCULAR RATING AS A MEASURE OF PHYSICAL FATIGUE

AND EFFICIENCY.
By EDWARD C. SCHNEIDER, Ph.D., Physiologist, Medical Research·Laboratory .

The need of a measure for physical efficiency whereby an athlete and a sedentary worker, and there is reason to
degrees of fatigue, physical fitness, and health may be believe these functional differences vary to some extent
determined has been felt alike by the med~al profession as the health and fitness of the individual vary.
and educators in physical education and school·hygiene. The cardio-vascular changes during altered physical
Of late the newly awakened inter.e st in industrial efficiency fitness have been most studied, and it is these that are
has shown that we lack satisfactory and reliable tests of considered in tliis paper. The tests here discussed should
fatigue. Experience with the aviator during the war also not be confused with functional heart tests. We are con-
emphasized the need of some reliable physical efficiency cerned with the cardio-vascular changes only in so far as
test easy of application. Often the .aviator gradually they give evidence of fatigue and health changes in the
underwent physical and nervous deterioration, the result body.
of the wear and tear of his air work, or sometimes of dissi-
pation, which made him less reliable in handli~g the THE PULSE RATE AS A CRITERION OF HEALTH.
airplane and frequently ultimately led to a crash. These (a) The Postural Rates.
aviators at times developed a disinclination to fly but
Cook and Pembrey(2) while finding considerable varia-
• would not confess it because of the fear .of being considerer!.
tion in the pulse of different healthy individuals showed;
"yellow." To single out such men the flight surgeon
however, more frequently a slow rate in men trainea. for
needed the aid of a dependable test .
muscular work. Meylan(3) from his e·xtensive experience
Unquestionably the most satisfactory test for fatigue
concluded that a horizontal posture pulse rate between 40
and loss in physical fitness would be one that eliminated
and 80 beats and a vertical posture rate betwe.e n 50 and
the "personal equation" of the examiner and the anxietv
90 were favorable health signs. McCurdy(4) from a study
and dishonesty of the patient: Replies to questions co~-
of boy's passing through the adolescent changes decided
cerning symptoms and habits are often misleading because
that the heart rate serves as a fair indication of condition;
of a performed opinion by the examiner or because the
a high heart rate indicates poor condition, and a heart
patient i~ incapable of self-analysis and accurate descrip-
rate with wide variations between the horizontal and stand-
tion of his experiences. Furthermore, because some men
ing positions suggests a poor vascular adjustment. ·
for personal reasons would prefer to mislead the examiner
'!Jawson(5) during repeated periods of training of a
the test should not demand much in cooperation and
single subject found that training slowed the resting pulse
attention from the patient.
rate as much as nine beats per. minute and that this espe-
The functional changes of the body brought about by
cially influenced the noon and afternoop _pulse. Thus the
regular physical training give the basis for a number of
form of the diurnal curve was slightly altered. He also
physical ,efficiency tests. The attention of trainers and
found that while acute infection caused an increase in
athletes, as well as physiologists, has naturally been
the pulse rate, it was much less pronounced in the trained
directed to these. A brief review of .the conclusions-
than in the untrained.. man.
regarding these physiological changes which occur as r,,
In young men the normal average pulse rate has been
result of improved physical condition will suggest possible
reported ·to be 78.9 standing, 70.1 sitting, and 66.6 iying.
tests for degrees of health and fitness .
The continued practi:e of some form of exercise, such as
There exist differences between· active and iriactive
rowing, extending over a period of years, may progressively
animals which throw light on these functional variations.
lower the rate of heart beat. Thus Michell(2) found Hie
In England the 'w ild hare, which lives an active life in
average rate of the athlete's pulse was d-ruing the first
the open, and the wild rabbit, which lives an inactive
year, 69 ; second year, 64.5 ; and third year, 56.8. Accord-
life in seclusion and does not venture far from its burrow,
ing to .Lindhard(7) not only is the pulse less frequent,
have been ·compared by Dreyer of Oxford University(l).1
but the output of the heart per minute is slightly larger
The wild hare contains double the blood volume, 30 per
in the trained than in the untrained man.
cent more hemoglobin, and three times more heart muscle
All available evidence indicates that with improvement
than a wild rabbit of the same weight. The rate of heart
in physical fitness the heart beats less frequently and more
beat is for the wild hare about 68 and tlie wild rabbit
efficiently . It follows, ~herefore, that the pulse rates in
about 200 per minute. The rate of breathing for the hare
the reclining and · standing postures may at times give
is between 18 and 20 and the rabbit about 50 per minute.
useful hints as to the degree oCfitness and health. That
Furthermore, the meat of the hare io dark and of the rabbit
the altered physical condition may not be evidenced by
light in color. No doubt similar differences exist between
pulse rate changes in both postural positions was demon-
1 Number-in parentheses refers to the bibliograph at the end of the strated by Boney(8) who found in some tired, listless,
ar c;cle. depressed, and fatigued patients that the pulse rate was

(22)
 23
normal while lying down but was abnormally rapid during I It should be emphasized that while the several puls~
standing; in several the standing rate was as high as 130 rate criteria of fitness may all be found to occur in a single
and 140 beats per minute. individual not one or even any two of them is found to. be
an absolute test. In forming a judgment as to the physical
(b) Pulse Rate Increase on Standing. condition of a man it is best to consider the postural rates,
the increase on standing and after exercise, and the time
The difference between the standing and reclining pos-
required for the rate to return to normal after exercise.
ture pulse rates has been found to be a useful index of
physical fitness. According to Vierodt(9), the average THE ARTERIAL BLOOD PRESSURE AS A CRITERION
postural increase was from 12 to 14 beats. Crampton(lO) OF CONDITION.
reported that in vigorous subjects the heart rate may not
(a) The Normal Arterial Pressures.
increaae on standing while in wearied subjects it may
increase as much as 44 beats per minute. Meylan(3) Although the arterial pressures have re·ceived much
believes a -standing increase of not more than 16 beats is attention, the determination of the pressures for the indi-
. one of the favorable signs of physical efficiency. Par- vidual at rest offers little of value in estimating the phys-
kinson (ll) recently reported that 20 healthy soldiers gave ical condition of the young man. Meylan(3) considers
an average increase of 10 beats when the recumbent and systolic pressures for the horizontal posture between 110
-standing rates were compared. Geigel(l2) considers that and 140 millimeters and for the vertical position between
a_ variation of pulse rates above 30 between lying and 110 and 150 millimeters Hg. as favorable signs. Dear-
standing indicates weakened heart function. It is now born(l9) believes that adequate physical training raises
recognized that in states of debility the postural difference the blood pressure. He obtained an average of 114 milli-
may be as much as 30 to 50 per minute. meters in trained and 108 millimeters in untrained women.
·A slow horizontal and a slow vertical postural pulse rate Dawson(5) recently has shown that the effect of training
with a small difference between the two are usually signs on the resting blood pr.essure is neither striking nor con-
of excellent health. st:mt. Bainbridge(20) has written "The systolic arterial
pressure, according to most observers, is not higher during
(c) Exercise Pulse Rate. rest in trained than in untrained men."
According to Bowen(l3), the rapidity of the pulse during Opinion as to the value of the. diastolic and pulse pres-
sures is not as clearly crystallized as it is regarding the
exercise is chiefly determined by the (1) speed of move-
ment, (2) resistance encountered, (3) condition of the systolic pressure.
individual, and (4) age. He(l4) also pointed out that Hypotension in systolic or diastolic pressures occur in
pulse rate counts made after exercise are worthless for weak patients.
comparison unless the count is made at exactly the same (b) The Postural Changes in Arterial Pressures.
period in each case and the subject is placed in exactly the
same position and assumes the same degree of relaxation The hydrostatic effects of posture and the manner in
which the splanchnic vasomotor mechanism compensates
and repose.
for these is well known. _ Normally, when man changes
The pulse rate as a result of a certain amount of work
from the reclining to the standing position the splanchnic
increases more in an untrained than in a trained indi-
vasomotor tone overcompensates the hydrostatic effects
vidual. Hartwell and Tweedy(l5), comparing athletic
of gravity. In normal subjects the systolic blood pressure
and nonathletic women, found that running up and down
is about 10 millimeters higher in the standing than in the
stairs accelerated the heart rate an average of 10 beats
recumbent posture. Erlanger and Hooker(21) found that
more in the nonathletic women. Lewis, Cotton, and
on standing thera might be either a slight rise or fall in
Rapport(l6) believe that the average height to which the
the bracµial systolic pressure. According to Hill(22), any
pulse rate is raised at the cessation of effort may be taken
influence which weakens the splanchnic vasomotor mech-
as a gauge of the degree of distress produced and that the
anism interferes with the compensation. Sewall(23) has
amount of distress is determined by the degree of health .
shown that individuals in whom there is excessive gravita-
Similar conclusions have been reached by many students
tion of the blood in the limb sand splanchnic area on stand-
of the exercise acceleration of the pulse rate.
ing are victims of physical weakness and nervous insta-
(d) The Decline in Pulse Rate After Exertion. bility and often suffer from headache, dizziness, or tin-
nitus in the erect posture. That the systolic pressure falls
A widely recognized sign of conditio11 is the time re- in individuals weakened by dissipation; overwork, lack of
quired by the pulse rate to return to normal after effort. sleep, or disease was recognized by Crampton in his "blood
Flack and Bowdler(l7), from a study of the problems fol- ptosis test" for physical fitness. Crampton(lO) demon-
lowing stepping upon a chair five times in 15 seconds, strated that a subj_e ct might when standing show weakness
conclude that the rate of heart in the healthy subject by a decrease in the systolic pressure or by a large increase
should not increase more than 25 beats and should return in the heart rate.
to normal within 30 seconds. Meakins and Gunson(lS) Recently Sewall(23) has pointed out that a weakened
report that following a climb of 27 steps at·a brisk walk in patient on standing may fail to show the systolic drop, but
healthy subjects the pulse rate returned to normal within instead may have an inordinate rise in diastolic pressure.
one minute, while patients required as much as five He employs this rise in diastolic pressure and low levels of
minutes. pulse pressure as measures of fitness.
 24
The above observations on tlie cardiovascular changes
that occur with training and with weakness suggest means
of measuring fatigue, staleness, and weakness. A pulse
rate m-0re rapid than the average in the reclining and
standing postures, a large acceleration on ·standing and
after exertion, a slow return to normal after exercise, and a
systolic pressure that fails to rise but falls when the subject
3tands indicates fatigue or weakness.
In 1913 and 19'14 three physical efficiency tests were
reported that used some or all of these changes. Cramp·
ton's(lO ) " blood ptosis test" is a vasomotor efficiency
test, that is intended to show the beneficial or depressive
.effect of various conditions supposed to affect the health.
It takes account of the differences between the pulse rates
and the syst9lic pressures of the horizontal a~d vertical
postures. The usual raRge of systolic pressure variation
is from +10 to -10 and the heart rate increase from Oto 44.
It was determined that a decrease of 1 millimeter in sys-
tolic pressure was equivalent to an increase in heart rate
of approximately two beats. By statistically balancing
the ranges of systolic pressure and pulse rate and assigning
equal percentages to equal ranges a percentage scale of
fitness was established.
Meylan (3), although not attempting to evaluate, finds
that efficiency may be judged by (1) general condition
as shown in weight, color of skin, and general appearances,
such as firm, vigorous muscles ; (2) pulse rate in the hori-
zontal and vertical positions ;· (3 ) systolic blood pressure
in the horizontal and vertical positions; and (4) heart
reaction to the exercise of hopping 100 feet. Favorable
signs were considered to be a horizonal pulse rate between
40 and 80 beats, a vertical rate between 50 and 90, and a
standing increase of not more than 16 beats. A horizontal
blood pressure between 100 and 140 millimeters, a vertical
pressure between llO and 150 millimeters, with a difference
of 10 millimeters or more. An exercise increase. in pulse
rate of less than 100 per cent and a recovery of more than
80 per cent in a minute.
Foster's(24) efficiency test made use of the standing
pulse rate, the rate. immediately after running in plate
for exactly 15 seconds at the rate of 180 steps per minute,
and the rate 45 seconds after the work.ceased.
Crampton's test was employed with the aviators at
Hazelhurst field, but was found to be unsatisfactory
because of the fact that physical deteriorations may be
manifest in various ways in the cardio-vascular mechanism .
The test neglects fo ur of the available factors . A similar
criticism may be made of Foster's method. A statistical
study of several hundred cases led to the abandonment
of both these methods.
A Point System for Grading the Cardio-Vascular
Reactions.
It is difficult, when it becomes necessary to weigh data
from six sets of observations, properly to evaluate them
and to avoid giving undue weight to a single factor. If
it is true, as it seems to be, that weakness may show itself
differently in individual cases, then to center attention
only on the postural systolic blood pressure changes or
the amount of acceleration of the pulse rate in exercise
would result in the overlooking of some cases of weakness.
In order to avoid the disposition to stress one o:r two of the
factors that give evidence of physical deterioration and
to recognize equally the six factors we have used a system
of scoring the tests wherein each of the cardio-vascular
changes is rated according to a scale that evaluates the

TABLE 1.- Tabies of points for grading cardio-vascular changes .

(A) Reclining
pulse rate. (B) Pulse rate increase on standing.

50- 60= 3 pts. 0-10 beats= 3 pts. 11-18= 3 pts. 19-26= 2 pts . 27-34= i pts . 3H2= Opts.
61- 70= 3 pts. 0-10 b\)ats= 3 pts. 11-18= 2 pts. 19-26= 1 pts. 27-3i= opts . 35-42= - 1 pts.
71- 80= 2 pts. 0-10 beats= 3 pts. 11-18= 2 pts. 19-26= 0 pts . 27-34=-1 pts. 35--42= -2 pts.
81- 90= 1 pts. 0- 10 beats= 2 pts. 11-18= 1 pts. 19-26= -1 pts . 27-34= - 2 pts . 35-42= -3 pts.
91- 100;= 0 pts. 0-10 beats= 1 pts. 11-18= Opts. 19-26=-2,pts. 27-,34= - 3 pts. 3H2=-3 pts.
101-110=-l pts. 0-10 beats= 0 pts. 11-18= -1 pts. 19-26= - 3 pts. 27-34= -3 pts . 35--42= -3 pts .
'

(C) Standing
pulse rate. (D) Heart rate acceleration im.me.l.iatefy after a standard exercise.

60-- 70= 3 pts. 0-lObeats= 3 pts. 11- 20= 3 pts. 21-30= 2 pts. 3(-40= 0 pts. 41 -50= Opts.
71- 80= . 3 pts. 0-10 beats= 3 pts. 11- 20= 2 pts. 21-30= 1 pts. 31--40= opts. 41- 50- opts.
81- 90= 2 pts. 0-lObeats= 3 pts . 11- 20= 2 pts. 21-30= 1 pts . 31-40= opts. 41- 50= -1 pts.
91-100= 1 pts. 0-10 beats= 2 pts. 11- 20= 1 pts. 21-30= opts . 31-40= -1 pts . 41-50= - 2 pts .
101-110= 1 pts. 0-10 beats= 1 pts. 11-20= Opts. 21-30=-1 pts . 31-40= - 2 pts. 41-50= - 3 pts.
111- 120= 0 pts. 0-)0 beats= 1 pts. 11- 20=-l pts. 21- 30= -2 pts. 31--40= - 3 pts. 41-50= · - 3 pts.
121-130= 0 pts. 0-10 beats= Opts. 11- 20= - 2 pts. 21-30= -3 pts . 31--40= -3 pts. 41-50= -3 pts .
131-140= -1 pts. 0-!0beats= opts . 11- 20= -3 pts. 21-30= -3 pts . 31-40= - 3 pts. 41-50= - 3 pts.

(E) Return of pulse rate to s tanding no,mal after exercise. (F) Systolic pressure, standing compared with reclining.

~tirn~~~!t: ::::::: : : :::::: ::: ::: : ::::: ~ ~H:

2- 10 beats above, at 120 seconds . . , .. . ...... = Opts .
11- 30 b eats abm·e, at 120 seconds .. .... ...... = ....: l pts .
Rise of8mm.ormore .... . .. . .... . ......... = 3pts.
Rise of 2-7 mm ........ ..... ..... . . . .... ... . = 2 pts.
No rise ......................... . ....... ... . = 1 pts .
Fall of 2-5 mm ..................... ...... .. = 0 pts.
Fall of.6 mm. or more . : .......• . ........... = - ! pts.
 25
condition or change. 'l'he grading of performance must ing rate. The data in (b) are scored according to part E
of necessity be arbitrary and therefore is held by some of the table.
to be objectionable. Nevertheless, as was stated earlier, This system of scoring men as to physical fi tness is now.
the " personal equation ,;· of the observer often weighs. too being used by flight surgeons in their work among aviators
heavily where comparisons are made. A mathematical and is applied at the Medical Research Laboratory at
system of grading can in large measure eliminate the Mitchel aviation field on Long Island .
personal factor. · That there may be value in assembling the circulatory
The scoring scheme we have used recognizes that fatigue data under such a point system is indicated from an analy-
or derangement may be evidenced in the high heart rate sis of 54 cases of aviators who, when examined by the
during reclining; during standing; in the number of beats medical officers of the departments of the Laboratory ,
the heart rate increases when the standing and reclining were found to be ailing and physically below standard .
postures are compared ; in the acceleratio:, in the pulse The medical examinations included an overhaul by the
.rate after exercise ; in the time taken by the pulse to internist, neurologist, ophthalmologist, and ear, nose, and
return to normal ; and, lastly, in the rise or fall in the throat expert. The medical findings include a large
systolic blood pressure on standing. This scheme uses . variety of conditions, the majority being common to any
in part a plan proposed by Dr. J . H. McCurdy for rating 1 group of men and in no way characteristic of aviators.
infantry men in cardio-vascular and neuro-muscular · That which was of greatest interest in this analysis was
efficiency. The scores for each of the six items range from the final efficiency score of each patient. The cases were
+3 to -3. A perfect score, the sum of the value given distributed as follows:
to each of the six items, is 18. The values as assigned,
appear in Table 1, parts A, B, C, D, E, and F. In using Number Percent-
the table for scoring, parts A and B , ·also C and D, must Fitness score. of cases. age.
always be used together. Thus, if an individual has a
pulse rate increase of 15 beats (see part B) on standing, O or Jess ...... .. .. . ......... . ..... . .... . 2 3. 7
1 to 3 . ........ . ........................... . ... . 9 16 . 6
and his reclining rate was 60 (see part A), he is graded 3 4 to 6....•.•. • ... ••• •• • • • • . .• , .••..• • •.•• •. . . -- 15 27. 8
om his· standing increase. However, if his reclining rate 10 7 to 9 • .•....... • • •• •.•••. • . . • .. • . . ••••• . ••.. .• . 22 40. 7
to 12 ......... . ............... . ............. . 3 5. 6
had been 100, then a standing increase of 15 would have 13tol5 . . .. . ....... . ... . .. . ....... , ........... . 3 5.6
16 to 18....... . .. . .- . •• .. •• . . . .. • . . ... . . .•. . .... 0 0.0
been scored 0.
Total. .... . ...... .. . . .. . ... . . . . . ......... . . 100.0
THE PROCEDURE IN MAKING OBSERVATIONS.
1. The patient reclines for five minutes : Only six of the 54 cases had a score of 10 or bett'er, while
(a) The heart rate is then counted for 20 seconds. When 88.8 per cent had scores ranging betwe_e n nine and minus
two consecutive 20-second counts are the same this is mul- one. These figures seem to indicate that" a score of nine
tiplied by 3 and recorded . Score by part A of the table. or less is characteristic of physically unfit men .
(b ) The systolic blood pressure is next taken by auscul- On the assumption that a score of nine or less gives indi-
tation. Two or three readings being taken as a check. cation that the clinician may find something wrong with
2. (a) The patient stands at ease for one or two minutes the patient, we have listed all men among a group of 150
to allow the pulse to assume a uniform rate. When two men who had a low score. In this group there were 46
consecutive 20-second counts are the same multiply by who scored nine or less.
3 and record . Score by use of part C of the table. The The medical examiners working independently, and
difference between the standing and reclining pulse rates without the cardio-vascular data available to them, re-
is scored then by use of part B. corded abnormal conditions in 30 of the 46 men . Thus,
(b ) The standing systolic pressure is next taken. The wheii working independently, 65.2 per cent of the group
difference between this and th'e reclining systolic pressure of 46 with low scores by the cardio-vascular efficiency
is then scored by part F of our table. test were found by others to be below standard. Two of
3. The patient next, timed by a watch, steps upon a the men were unfit because of excessive smoking and one
chair, about 18 inches high, five times in 15 seconds. To had recently been on a drunk. The neurologist reported
make this uniform he stands with one foot on the chair five as stale and nervously unbalanced , the internist
at the count 1. This foot remains on the chair and is alone found five unfit, six were tonsil or local infection
not brought to the floor again until after the-count 5. At cases, and the remainder were found wrong by at least
each count -h e brings the other foot on the chair and at the two of the medical departments.
count " down " replaces it on the floor. This should be This point system of scoring men as to health and phy-
timed accurately so that at the 15-second mark both feet sical fitness by the cardio-vascular react~ons is easily
are on the floor . applied. It has the advantage of stimulating men to
(a) Immediately, while he stands at ease, the pulse attempt to improve the score by exercise and proper liv-
rate is counted for 15 seconds, multiplied by 4 and re- ing. It i~ suggested that a score of nine or l ess gives reason
corded. for an overhaul of the patient by a clinician. Aviators
(b) Count ing is continued in 15-second intervals for with a low score might well be called back for further
two minutes ; record being made of the counts at 60, 90 examination and observation. A poor score suggests a
and 120 seconds . 3earch for a cause. The cause may be disease or unhy-
The data from (a) will be scored by part D, taking the gienic living.
difference between this exercise pulse rate and the stand- -By courtesy of the Journal of American Medical Association.
 26
BIBLIOGRAPHY.
1. FLACK and Hµ,L: Text-Book of Physiology, 1919, 79.
2. CooK and PEMBREY: Journal of Physiology, 1913,
XLV, 438 ..
3. MEYLAN:. Amer. Phys. Edu. Rev., 1913, XVIII, 441.
4. McCuRDY: Amer. Phys. Edu. Rev., 1910, XV, 421.
5. DAWSON: Amer. Journ. Physiol., 1919, L, 443.
6. FLACK and HILL: Text-Book of Physiology, 1919, 216.
7. LINDHARil: Pfliiger's Archv. f. Physiol., 1915, CLXI,
233.
8. BONEY: Brit. Med. Journ ., 1916, II, 645.
9. VIERODT: Daten u . Tabellen f. Med ., 1906, 235.
10. CRAMPTON: Proc. Soc. Exper. Biol.. and Med., 1915,
XII, 119.
11. PARKINSON: Heart, 1917, VI, 317.
12. GEIGEL: Deutsch Archv. f . klin. Med. , 1906, XCIX,
1028.
13. BOWEN: Amer. Phys. Edu. Rev. , 1903, VIII, 8.
14. BowEN: Amer. Phys. Edu. Rev. , 1903, VIII, 232.
15. HARTWELL and TWEEDY: Journ. Physiol., 1913,
XLVI, IX.
16. COTTON, RAPPORT, and LEWIS: Heart, 1917, VI, 269.
17. FLACK and BowDLER: Repts. Air, Medical Invest1ga-
tions Committee, London, No. 2, 1918, 12.
18. MEAKIN and GuNSON: Special Rept. Medical ·Re-
search Committee, London, No. 8, 1918, p. 27.,
also Heart, 1917, VI, 284.
19. DEARBORN: Amer. Phys. Edu. Rev., 1915, XX, 337,
414.
20. BAINBRIDGE: Physiol. of Muscular Exercise; 1919,
142.
21. ERLANGER and HooKER : Johns Hopkins·Hosp. Rept.,
1904, XII; 145.
22. HILL: Journ. Physiol., 1895, XVIII, 15.
23. SEWALL: Amer. Jour. Med. Sciences, 1919, CLVIII,
786.
24. FOSTER: Amer. Phys. Edu . Rev., 1914, XIX, 632.
 PART 5.

DARK ADAPTATION WITH ESPECIAL REFERENCE TO THE PROBLEMS OF

NIGHT FLYING.

MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.

By PERCY W . Conn, captain , Medical Corps.

INTRODUCTORY. Nage!, 3 . with certain technical modifications. It consists

This work was urnlertaken with a view to designing a
method whereby the visual fitness of the aviator for night
flying might be tested. His absolute sensitiveness. for
light is one datum sought. Another is his rate of recovery
after the relative blinding following exposure to ligl:J.t for
short periods.
Researches heretofore made on dark adaptation have
shown that in the course of an hour spent in the dark the
sensitiveness of vision for light increases gradually, and
may. in the course of the· hour increase several thousand-
fold over its initial value; 1 or less according to the dura-
tion and the intensity of the light to which eyes have
been previously exp.osed; 2 until a point is reached beyond
which no further change is to be found.
The present work contemplated ex.posing the eyes of
the observer to light of a standard intensity for certain
measured periods of time, and subsequentry investigating
the course of his light sensitivity. Since from what has
just been said it appears that exposures of the eyes to
light prior to the time the observer comes under investiga-
tion may produce effects which do not completely wear
off in less than an hour, it was necessary, before beginning
the experiment proper, to make sure that the observer had
reached a standard and 'reproducible condition. The
obvious way to accomplish this was to measure his light
sensitivity from time to time, as he remained in the dark,
until a stage was reached beyond which no further increase
was noted . It was then assumed that his vision had
become completely dark-adapted, and was in a state
whfoh could, for the individual and for experimental
purposes, be taken ae a standard. The actual experim.e nt
began after this point had been reached .
APPARATUS AND METHODS.
The test of light-sensitiveness is, in the first instance,
the photometric brightness of a surface which is just
visible with certainty. The instrument by which such a
dimly bright surface- is maintained and its brightness
known is the adaptometer. The particular one used here
was design~d .on the fundamental principle proposed by
1 Piper, Ueber Dunkeladaptation, Zeitscb. f. Psychologic u. Physiol- could be shifted about slightly and then clamped.
ogie d . Sinnesorgane, XXXI. See also Lohmann, Disturbances of the
Visual Functions, Blakistons, .Philadelphia, 1914, Chapte1 V.
2 Nicolai, Zentralblatt f. Physiologie, XXI, vide Lohniann, Disturb-
ances of the Visual Functions, 1914, p. 71; and Rabinowitsch,"Zeitsch.°f. 9.2 cm. and P-MG 46.2 cm. approximately. The L _gnification is here
Augenbk., XIX.
(27)
of a box, made of one-half inch white pine, 29 inches
(73.6 cubic centimeters) long, 8· inches (20.3 cubic centi-
_meters) wide, and 7t inches (18.4 cubic centimeters) high,
inside m easurements. A one-half inch cross-partition
divides its length into two compartments 11 inches and
17i inches (27.9 and 44.4 cubic centimeters) long. (Fig.
IA.) At the outer end of the longer one of these compart-
ments a milk glass MG 5 inches (12.7 cubic centimeters)
square is attached to. cover a somewhat smaller opening.
The test pattern is projected upon the inside_ of this glass
by an optical arrangement which is in effect a miniature
stereopticon, consisting of a projecting lens P supported
in an opening i~ the cross-partition; and within the
smaller compartment a condensing lens C and an electric
lamp L, together with a "slide" .S 1 • This last is a thin
slip of brass in which openings are cut (Fig. 1, B), the
image of the openings projected on the translucent screen
MG, being the test pattern viewed by the subject.
The lamp is a 12 candlepower tungsten-filament auto
headlight lamp, rated at 6 to 8 volts, 2 amperes, with a
1~ inch spherical bulb. It was actually operated at 1.75
awperes to avoid too rapid . deterioration. The current
was supplied by a small storage battery and controlled by
rheostat and ammeter. The lenses are 11 inch ophthal-
mologists' trial lenses removed from their rims. 0 is of
18 diopters and P of 13 diopters power. The first focusses
the image of the lamp filament upon a slit, S 2 (Fig. IA),
the distances being such that a reduction in size as 5 :.3
takes place. That is, LC is 14.8 cubic centimeters and
CS 2 8.9 cubic centimeters approximately. The slit is
one-half millimeter wide by 10 millimeters high. The
amount of light entering the slit is reduced by a ground ·
glass GG and, by way of adjustment, may be further
decreased by mo,ing the glass farther from the lamp .
The last adjustme:µts as to the relative positions of these
parts were made without the ground glass in place, so that
t he image of the slide, Si, was accurately focussed upon
the milk glass, MG. 4 It was then determined just where
the image of the lamp filament fell, and the slit, was per-
manently placed at just the same distance from the cross-
partition. This was accomplished by mounting the lamp,
condensing lens, and slider (L, C, S1 ) in their proper
relative positions permanently on a small table which
.' Zeitsch. f. Augenbk., XVII, 3.
• The distances determining the size of the test pattern are 81-P
. as 1: 5. ·
 - - - -- MG
p ___---- ---- --- - ----
~-:.:...-:. _
- -- - - - - - - - - - ---
----
Sh

II
tv

,.
... -- -- ... .....
', '
00

I
,
/
' \

~ DD !
\
', ,'
' ' , . . .... ___- "

B
F I G- . I
FIG. 1.- T he adaptometer. A, plan of the instrument in section . See text for explanation . B, the slide, showing the test-pattern in the two positions.
The lace of the projection lens is indicated, for one i:iosition of the slide, by the dotted circle.
 29
The finer changes in the brightness of the test pattern,
necessary during the experimental procedure, were
brought about by an absorbing wedge, of which the .light
transmission varies by indefinite gradations in the ratio
of 29,100 : 1 between its extreme positions 100 millimeters
apart. This is mounted immediately behind the slit, be-
tween it and the projecting lens, and is provided with a
millimeter scale and a mechanism by which it may be
shifted from t he outside of the box. It was found by
photometric measurement that the brightness of the test
pattern was 0.0272 candles per square meter when the
wedge was set at zero of the scale. In such a wedge the
change in the amount of light transmitted is in a certain
constant ratio fm; each equal linear shift of the wedge.
In the wedge used each shift of 10 millimeters from 0
toward 100 millimeters was found to change the amount
of light transmitted by the factor dirr or 0.358 . The re-
lation between scale reading and brightness is best worked
out by logarithms and is as indicated in Table I. At 0
millimeter the brightness is 0.0272 candle. per square
meter, logarithm -1.5656. The logarithm diminishes by
0.44638 for each centimeter, or by 4.4638 for 10 centi-
meters. In the table the negative signs are dropped,
hence the figures are cologarithms from which brightness
may be directly found . As they stand in the table the
logarithms may be taken as expressing the grade of sensi-
tivity corresponding to the i:espective scale readings. 5
The test pattern it.self is in form a pair of bars of such
dimensions that they represent the remainder of a square
after its min.die third is removed. Two such patterns
were cut in the slide (fig. 1, B) 'in such a way that the
image might be shown in the horizontal or in the vertical
position . Each opening in the slide is 15 by 5 millimeters,
and the strip left between the two, in each pair, is 5
millimeters wide .
Directly above the test pattern and on a level with the
eyes of the observer is a fixation point (fig. 2) consisting
of a 4 to 6 volt, tungsten filament tail-light lamp operated
on one dry cell. The light from the lamp, operated so
much· below its rated voltage, was dim and reddish and
it was further dimmed by coloring the lamp with red dip
and by interposing layers of paper between it and a dia-
phragm (with an opening of about 6 millimeters diameter)
which is directly in front of it. The fixation point was
kept just bright enough to be located in the dark. Its
distance from the eyes of the observer was 52 centimeters.
The center of the test pattern is 12 centimeters below the
fixation point, and therefore 13 degrees below the center
of the visual field. The test pattern subtended about 8
degrees both horizontally and vertically in the visual
field. A sliding shutter (Sh., fig. 1, A) was arranged to
darken the test pattern completely except when actual
observations were being made.
D~ing the progress of the experiments in the dark all
light, except that from the adaptometer, that from the
fixation point, and that from a small reading lamp, was
excluded from the room. This last is a 4 to 6 volt tail-
light lamp , operated on a single dry cell. It was used in
recording the results and was always kept well shaded.
, This mode of expressing the grade of dark-adaptation is quantita-
tively different from that proposed by Best (Arch. f. Ophthal., LXXVI,
pp. 146-58) but t he same in mathematical principle.
Possible stray light from this and other sources was kept
from the observer by a black felt curtain.
PROCEDURE.
The subject was seated in darkness before the adapto-
meter with his forehead just touching a fixed support,
and fixated the red fixation point. (Fig. 2.) The shutter
was opened for approximately one second and he was
asked to state whether he saw the test pattern, and if so,
in what position . By repeated t rials the point on the scale
was found at which he was just able to report the position
of the test pattern correctly. The time was immediately
taken and entered in the record along with the scale
reading. This was repeated at intervals of about five
minutes, the subject resting in the mean time. Usualfy
the subjects had been spending the last hour or two,
before the room was darkened, in some part of the labora-
tory, and as a consequence the time required to ·r each a
constant threshold was less than an hour. In general, at
the end of 20 or 30 minutes it was found that two or three
readings had been taken which were in agreement to
within the limits of precision of the method .
When this point was reach ed a white screen was placed
before th~ eyes of the subject, leaning against the front of
·the adaptometer at a definite inclination; and the center
light of the room was turned on. The subj ect was in-
structed to maintain hi~ position and direct his eyes
toward the center of the screen. In preparation for what
was tcr follow, the test stimulus, set at a certain point, was
exposed by drawing the shutter. Five minutes from the
time the light was turned on the screen was quickly
removed and the light turned off after an interval of per--
haps one or two seconds, in which the observer could locate
the fixation point. He remained at this fixation until
the test stimulus, at first invisible owing to the five min-
utes blinding, became visible to him. The time required
for this to take place was noted. Suasequently readings
were taken as before, but somewhat more frequently,
until th e former absolute threshold was again reached.
Finally, the white screen was replaced and th e procedure
of the last paragraph repeated with 15 seconds exposure
to the white screen in an exactly similar way. From th e
time the subject entered the room until the end of this
third portion of the experiment the whole procedure
occupied from an hour to an hour and a quarter, according
to the speed of the subject in recovering his absolute
threshold.
The screen used for " blinding " the subject was a
sheet of white blotting paper·24 by 19 inches, mounted on
a light frame. Its angle of inclination and distance from
the eyes were such that it subtended, at the eyes, an angle
of 67° vertically and 70° horizontally in respective planes
through its center: It~ lower half was nearer the observer,
consequently including a larger angle, easily including
that part of the visual field occupied by the test-stimulus
and much more in every direction. The photometric
brightness of ·this screen averaged 13 candles pet square
meter by actual measurement.
RESULTS.
The various values for sensitiveness were plotted, each
against the time at which it was obtained. Thus each
 w
0

Flo. 2.-Genernl \'iew of t he ,1claptometer, the obsen·er (to the left) and the experimenter. 'l'he test-pattern appears on the square wh ite surface on the end of the instrument and is not visible except in the dark.
~bo\'e this is thl' fi xation point with t he 1.l ry l'ell attached. 'l'he white screen used for the purpose of "blindin g" the subject is below in the foreground . 'l'he experimenter holds the read ing light in his left hand.
 31
experiment yielded three ,curves as i n Figure 3. The
first of the three began -with the state of adaptation in which
the subject happened to be and was carried on until his
absolute threshold had been reached. This was taken as
one datum in his case .
The second curve represents his recovery after five
minutes blinding 6 by a surface of standard extent and
brightness. .Here the question was rather his rate of
return to dark adaptation than the ultimate point. The
first datum here, in the cbronological course of the experi-
ment, was the time required to see an initial stimulus,
already exposed when the room was darkened, as his dark
adaptation progressed and the sensitivity of his vision
grew sufficient to take account of it. At this stage the
increase in sensitivity is rapid, for which reason the technic
just described"' was made use of. The method was not
satisfactory in that the whole result depended upon a
single judgment of the observer . If for any reason he
failed in this, as happened on certain occaaions, there was
ho way of repeating without undue expenditure· of time.
The results so obtained are nevertheless given and are not.
on the whole, without significance.
I I
A I
y 7 -1
point, taken with the stimulus set and exposed on increas-
ing dark adaptation immediately after darkening the room,
is not strictly comparable with the ,late~ observations,
taken by a trial and error (perhaps better called a " bracket-
ing") method, with the stimulus darkened in the intervals .
In general a rapid method had to be used, since the quan-
tity measured was, for the most part, continuously chang-
ing; and a different and more rapid method had to be
used to get an index of the initial rapid rise within the
first minute or ·so.
A study of all the plotted curves led to the selection,
for the purpose of discussion, of a comparatively few data.
Some of these rest upon an arbitrary basis, but all the
possibilities are involved .
Those so selected are:
(1) The absolute threshold.
(2) (a) The time required to reach an arbitrary, rather
low degree of sensitiveness, obtained by noting the instant
that the test stimulus appears to emerge from the .darkness.
(b) The time required to reach an arbitrary level (70
millimeters on the scale) obtained by linear interpolation
from th.e curves of rise.
(c) The time required for the individual to reach a
point on the scale 15 millimeters short of his own absolute
threshold.

7
I

I
'r-
V Th e data indicated under (2) comprise two parallel
I
I
I I sets, the one following 5 minutes blinding, the other
following 15 seconds . It will be noted that while (a)

6() I
I

I'
I
o"v and (b) under (2) are data relative to fixed stimuli those
under (c) are relative to the subject's own standard and
will indicate his individual capacity, rather his individual

I
I
I rate of recovery than his competitive performance under

so
I
I
~
1
I
given external conditions. The data just described are
given in Table II. The arrangement of the observers
J I

1
~
I I
/5 .nt *)
I here in the upper block of the table is approximately in
the order of magnitude of the.absolute threshold , the third
40
JO.DO /I.fl/. ID m<n. 20 ao 40 /I.OD 10
column giving the same in terms of the adaptometer scale,
the fourth giving the corresponding logarithmic sensi-
fiG.J. tivity (the cologarithm of the brightness in candles per
FIG. 3.-Specimen plot of one experiment. The first curve was taken
square meter). The fifth gives the brightness itself in
without preparation-. In- this case the mean of the last three points hundred-millionths. The first valve in this column is
(79.5_mm.) was taken as the absolute threshold, and its location on the thus 0.00000134 candle per square meter.
plot is indicated by the horizontal interrupted line. The two blinding It will be seen that the variations here are quite large,
periods are indicated by the vertical interrupted lines. The return of
both .curves to the exact ,v alue of the mean absolute threshold is simply
134 and 995 hundred 0 millionths being the extremes, which
coincidence; usually there is some discrepancy. are as 1 to 7.4. On this account it seems more rational to
average these log~rithmically·, thus arriving at the geo-
It could not, of course, be predicted when the subject metric mean as has been done in columns three and four,
would reach a given degree of sensitiveness. Every than to average the numerical values - of column five.
exposure to the test stimulus seemed to blind the subject The following figures show the results of the two methods
slightly, especially in the later and more complete stages comparatively:
of dark adaptation where the disturbance might amount to
a number of millimeters on the scale. When, after a Geometric mean.
Arith-
waiting interval, the right point was hit upon, rather· by metic
accident, the stimulus might· be seen at a very low value; Cologa- Numerics mean.
rithms. X 10'.
whereas after severai. tr.ials by the t rial and error method
- - - - - - - - - - - - - - , -- - - - - - - - - - -
a new and larger value (lower on the scale) would be found ; -5.364 433 497
the subj~ct in the meantime being unable to repeat the it~:::::::,::::::::::::::::::::::::::::
±0. 201 ±218
initial. observation. It would seem then that the first Mean+m.v ...... . ....... .. . . .... . . . ... -5.163 687 715
Mean-m. v............................ -5. 565 272 7
, The word "blinding" is used here for want of a better and equally
short expression, meaning only that effect, due to which the subject is
relatively and temporarily blind to stimuli of the very low intensities The arithmetic method gives a larger result with a rangp
considered. of variation only slightly broader.
0.00000/-100 I

90
I ~- __ ..., -----· '. - ..L

80
1--w I I I. /(: ""c! 1'I IN

0.00001

70

w
I',:)

0.0001---t..w...+-+r----+-------+------~-----~

40

0.0() I - ~ - - - - - . . J . - - ~ - - - , . . - - - - l 1 . . - . . - - - - - : " = - - - - - - - ; : '

0 5 minutes /0 15 zo 0 5
FIG.4.
FIG. 4. -Four cases s)lowing typical courses of adaptation as to extent and rate: R, high sensitivity, slow recovery, Si, same, rapid recovery; Cr, low sensitivity, slow recovery, W, same, rapid recovery. On the
left, after 5 minutes blinding, on the right after 15 seconds blinding. The absolute thresholds, previously taken ,are indicated near the upper left angle of the figure.
 33
The remainder of the table consists of .the various data
just enumerated.
0.00000/ r-- -- - , - -- -- - - r - - -- - - , - - - - - ,
0.001OL-----!s=--m-,:-.n-.,-=-
,~-,- - ,~o,--- ----:,'=s- --'-- -;;':w
F,<;.5.
FIG. ,i .-Two types of adaptation curYe. R, "normal " or regulat
form. D, irregular fon_n showing a halt withir. the first five minutes
and subsequently a more rapid rise.
The meaning of the resuits will perhaps be more readily
apprehended from Table III. ·Here the results in each
column in the first section of Table II have been " rated "
in five classes, according to the theory of probability, in
such a way that out of an indefinitely large number of
cases, of which these 15 may b e considered a sample,
one-fifth showing the most favorable values would rate 1,
the next fifth 2, and so on, the lowest fifth rating 5. Thus
3 would be the rating of the-intermediate fifth of the whole
number, the group of one fifth .falling nearest the average.
DISCUSSION.
. This was done indepelildently for each column of results
(excepting the actual brightness, .column 5 Table II)
and the ratings are given in Table III. It was found that
those rating higher as to absolute threshold were, on the
whole, slower to return to within 15 mm. of that point
(" AT-15 mm."). Accordingly, the arrangement of the
observers in the table was based in these two consider-
ations and the same arrangement followed in constructing
Table II.
This fact, upon a few moments reflection, is not sur-
prising. The observer who has a very low absolute
threshold is taken farther from it, so to speak, in adapting
to the standard blinding brightness and might be expected
other considerations equalized , to be longer returning to it,
or to a point remote from it by an equal interval , and is
not necessarily slower in get6ng back to a given threshold .
For example L, rating 4 as to absolute threshold, rates
on the -whole almost, if not quite, as well as lt or Do in
point of his return to 70 or to 50 mm.
It is fortunate that this table exhibits in four individual
cases four types of adaptation. These are high and low
grade adaptation, each with rapid and slow recovery as
indicated:
1454- 30--3 0
- - - --~ -- -~ ----- - - -- - - - -- -- -
Absolute sens:tivity.
H :gh . Low .
S i 2, (1, 1) Cr 5, (1, 2)
R 1, (5, 5) W 4, (4, 5)
The plotted curves for these are reproduced in figure 4.
The curves for the other observers, drawn from the observa-
tions following the five minutes blinding, fall within the
•limits of these, except for one or two which intertwine with
om, of the extremes appearing in the figure, and except for
two special cases (which will be discussed later) in .which
the curve distinctly drops below the lowest one of the four.
It will be noted by comparison of the curves of R and Cr
showing, respectively, high absolute sensitivity with slow
recovery and the reverse, that Cr is somewhat more quick
than R in-reaching a given stimulus, up to the neighbor-
hood of 70 millimeters. The case is somewhat different if
we compare the curves of R and Cr , resulting after 15
seconds' blinding, as they appear in the right-hand portion
of the plot. Here Cr appears to be the slower, and this
would, in all probability, be shown more definitely if the
curves could have .been dr~wn from more abundant data
and more in conformity with the course of the absolute
threshold instead of being, as they are, simply broken lines
joining rather widely -separated points.
Examination of all the curves points to a possibility of
dividing the course of adaptation, for the technical purpose
of studying and testing individuais, into two portions-the
early abrupt rise out of the relatively blinded state and the
late, slow approach to the absolute threshold . The tenta-
tive limits of these are indicated in the plots (fig. 4) by tl}e
dotted lines- in the case of five minutes blinding all obser-
vations after five minutes and aboye 70 millimeters on th~
scale (within_the dotted right angle) being classed in the
latter portion of the curve, the corresponding limits being
21 minutes and 76 millimeters in the case of 15 seconds'
blinding. All this, of course, is tentative and is to be taken
in connection with what is subsequently to be said in regard
to the practical phase of the subject and the photometric
conditions which the vision of the aviator has to meet in
actual flying.
Examination Qf Table III , column headed 70, shows that
the first seven observer~ having the.lowest absolute thresh-
old return to the point 70 on the scale in better time, on the
whole, than the average-, and the last seven observers ii1
slower time. The point 70 millimeters therefore reflects
on the whole rathe~ the absolute threshold than the indi-
vidual's speed of recovery . Under the head 50 ± the dis-
tribution of ratings is seen to be more even, regardless of
the two individual factors. These latter results (time to
reach 50 ±) are, however, less complete and less trust-
worthy than the former. It can only be said that a
selected point on the scale, taken as the sole basis of rating
;i,nd reflecting on the a.verage neither the absolute thresJ-i-
old nor the individual rate of recovery (that is, giving
equal weight to both), would have to be chosen somewhat
below. 70 millimeters on the present scale .
 34
Si:x. minute. interya/s.
FiG. 6.
FIG. 6.-The course of adaptation after 5 minutes blinding in 15 different subjects . The vertical line in each case is the zero ordinate for the
corresponding curve, indicating the instant the blinding period came to an end and the dark-adaptation began, These ordinates are
arbitrarily plotted 6 minutes apart.
The degree of uniformity with which results may be
reproduced in successive experiments is indicated by the
figures in the lower blocks of Tables II and III. In the
cases of !Io and R the ratings are either identical or, in
some cases, one stage apart. The wide d_ifference inthe·case
of W is accounted for. In the experiment upon him of
November 9. the usual order of experimentation was
reversed, in that 15 seconds' blinding was carried out first,
then 5 minutes. The outstanding feature of the result is
that in the case of November 9 the subject rates high after
15 seconds' period and low after the 5 mi_n utes, whereas on
January 18 with the usual order of experimentation his
ratings for the two cases are more consonavt. The like is
true, less markedly, in the case of M (upper portion of
tables) upon whom also the experimental order was
reversed . !le shows especially under the head 70 milli-
meters a disparity of rating for the two different periods of
blinding which is unusual, and in every case he rates higher
after the 15 seconds' blinding than after 5 minutes. It is
also true that these two (Wand M) show in the same experi-
ments (after 5 minutes' blinding where this was preceded
by the 15 seconds' period) curves which drop below and
somewhat outside of. the limits indicated by the four types
of figure 4. This would indicate that in these two cases, at
least, the return after the shorter blinding period is more
rapid, owing to its not having been more or less immedi-
ately preceded by an experimental blinding period, while,
per contra, the rise after a longer blinding period is delayed
by reason of a foregoing blinding. This with reference to
the general results of the usual order of experimentation as
a standard. A further conclusion is that the general result
in the bulk of the cases is influenced in a similar way, and
the general rate of recovery after the short blinding period
is delayed, owing to a residual effect of the prior blinding.
If this be true, the rise after 15 seconds' blinding should,
under equal preceding conditions, ensue with greater
relative speed than the average results would indicate.
It is possible that the sudden onset of the rather bright
light, after complete dark adaptation, may, so to speak,
surprise the visual apparatus into more profound changes
than would ·b e induced by the same exposure to light
applied with gradual onset under similar conditions.
Aside ·from the changes in the size of the pupil there are
two anatomic factors undoubtedly concerned in dark
and bright adaptation: The exhaustion and regeneration
of the visual purple (or possibly other unknown photo-
chemical substance); and the m,igrati•n of the pigment of
the hexag,mal choroidal cells. This latter may be a pro-
tective device that acts fairly 'promptly, and has the
effect -of inclosing the retinal rods and by its own light-
absorbing qualities reducing the amount of light absorbed
by the individual rods. It is conc\livable that a sudden
flash of light might anticipate this action and produce a
strong destruction of the photochemical material in a
short time; before the pigment cells have had time to
react, while with gradual onset of light the time is ade-
quate for the pigment cells effectively to assume this
protective function.
Some of the curves strongly suggest two factors playing
a part in dark adaptation. In figure 5 one of these is
shown together with a typical smooth curve. Any
attempt to smooth .out D's curve here would have to

10 0
10
0 00 0 0
"N
~
c 0
~ 0
tr
cti._10
{;
1::1
~
BO mm.
I s ..3 ;,
11/Jsolule Threshold.
FIG.
7.-Relation between dark-adaptstion and shade-perception, the latter taken with the DeWecker and Masselon " light sense" chart. In the
figure on the left the abscissae are absolute threshold, iii millimeters of the scale aborn the line and in millionths of one candle per square
meter below. This unit i_s equal to 100 of those used in colunm 5, Table II.
proceed on the assumption of large experimental errors
at the second and third stations ; or else the results would
have to be interpreted as arising from t"o more or less
independent mechanisms one of ,,..-hich overtakes the
other, in effect, at the end of about four minutes. Such
terrace-like .irregularities, which may be interpreted as
a halt in the progress of dark-adaptation, are present in
14 out of s, total of 52 adaptation curves taken, and are
suggested in four others. The results obtained after five
minutes blinding irre plotted for all 15 observers in figure
6 to show the great variety of forms the curves may take.
It will be evident from the foregoing. discussion of the
experimental results that tha time required for adapta-
tion to progress to the point of visibility of any test-
stimulUB is a function of the individual's optimum and
also of his rate of recovery from the effect of disturbing
light; with one or the other of these of predominant effect
according to the magnitud e of the test-stimulus selected.
No single rating derived from time and stimulus magni-
tude would necessarily be valid as an index of the
efficiency of th~ same indi".idual with _respect to sti~u'.i
of other magmtudes. Agarn, the ratmgs of two md1-
viduals, taken in this way, might, by the arbitrary
selection of the test-stimulus, be so made as to place
either one of the indi viduals above the other. Ob-
viously such a me thod of estimating the efficiency of
night vision can not be considered valid.
By way of outlining a method for testing night vision
there is little to be stated in detail until definite data are
at hand (1) as to exactly what, photometrically consid-
ered, the aviator must necessarily be able to see in night
flying, and (2) what transient light conditions he may
meet which tend to make him blind relatively to such
35
/0 0 0
/I)
© @
0 0
0 0
.s
10
0
90
I 5 1 '3 fl. I
ll<icyitd.tzon 3/'eed, Class
FIG. /.
visual objects. The former might afford a basis for the
rational selection of a test-stimulus, the latter a basis for
standardizing· the duration and intensity of the exP,eri-
mental blinding.
As far as is known to the ,•niter, photometric meastire-
ments of the brightness of the sky and the earth's surface
and the objects upon it have never been made under
natural illumination at night. Such measmements would
~how whether the requirements of vision at night are
mor~ lenient than those demanded at the absolute thresh-
old in the experimental dark room, or equally exacting:
and whether the rate of recovery is more important, for
practical purposes, than the. value oi the absolute thresh-
old. In short, 1iuch data, taken in connection with data
such as those of the present work, would show which
portion of the adaptation curve is the more worthy of
intensive study from the present viewpoint- the early,
abrupt rise, out of the relatively blinded state, or the
slow approach to the absolute threshold.
In connection with the foregoing some experiments
I were undert~ken i:n_ shade perception to dete min~ what,.
7
if any, relat10n ex1:sts b etween the percept10n of small
brightness-differences at fairly high levels of illumination
on the one hand and the facts of dark-adaptation on the
other.
The test object used for testing shade perception is a
chart composed of 10 rows cf eight white letters each, on
gray backgrounds ranging from very dark to .very light.7
The various gray b·ackgrounds, each bearing a. row of
letters, are 4 by 18.3 centimeters, with a white interval
1.8 centimeters between. The row on the darkest gray
, Plate v of De wec:,er et Masselon, Echelle Metrique pour lfcsurcr
L'acuite Visuellc. o. Doin et fils, Paris.1914.
 36
is marked L 1/10, the n ext 2/10, and so on, the lightest In Figure 7 the shade-perception readings are plotted (a)
being L 1. The letters are of the gothic style and approxi- against the absolute threshold and against the speed-rating
mately 7.6 millimeters high, designed to subtend five (AT-15, Table II!). The numerical designation of the
minutes angle at 5 meters, and would thus represent 20/20 last line that the subject attempted to read was plotted,
vision if printed in black and white. The chart was disrBgarding the few letters missed, since there was no
illuminated by a 40-watt vacuum tungsten filament lamp, way of appraising the significance of the latter. In so f3:r
with reflector, from approximately 80 centimeters dis- as any correlation is shown, the sensitiveness to shade
tance, the room otherwise being in darkness. difference relates itself in an inverse sense with the abso-
The results are given in Table IV, where following the lute threshold (a, Fig. 7), and in a direct' sense with the
observers' designations are given (1) visual acuity with- I speed of recovery (b, Fig. 7) . These results are unsatis-
out correction, when glasses are worn. (2) Vision as ap- factory. A more appropriate and less ambiguous form of
plying to the experiment, corrected in case glasses were test chart (or other apparatus) for measuring the sensitive-
worn at the time. (3) The absolute (dark-adapted) n ess to small brightness-differences, and further investi-
threshold (millimeter scale). (4) The rating with respect gation, are necessary for definite conclusions.
to speed of recovery of the sa·me (AT-15, Table III). Plotting the shade-difference results against visual
(5) The performance with the De Wecker et :M:asselon acuity, measured by means of the Snellen chart, either
chart, light-adapted . (6) The same, dark-adapted. with or without the usual correction, showed even less
Investigations with this chart are unsatisfactory, prob- correlation than when the former were plotted against the
ably arising from the fact that the letters upon it are, dark-adaptation results, as in Figure 7.
with respect to size, too near the visual acwty threshold.
It would have been desirable to have a chart in which the SUMMARY.
former was put out of consideration by having the letters
so large that visual acuity, in the usual ophthalmologic (1) Upon investigation of 15 subjects it appear&that the
sense, could be ruled out. limit of vision in dark-adaptation (absolute threshold);
The chart was actually used at 5.1 meters distance. In measured by the least brightness at which gross form may
the case of observer L, the distance was slightly less, 4.8 be recognized, is variable within extreme limits expressed
meters, due to a purely fortuitous circumstance. In the by the ratio of 7.4 to 1. These limits lie between 1 and 10
case of Hn it was 3.4 meters, owing to the fact that this millionths of one candle per sqµare meter.
observer could not read even the first line at a greater (2) The rate of recovery, after dark-adaptation is dis-
distance. No relationship is known by which these read- turbed by a standard exposure to light, is also variable as
ings could be corrected so as to be strictly comparable between individuals and by no means always in a sense
with the others. corresponding with the value of the absolute threshold.
Another difficulty with this chart is the fact that the The extremes of variation between individuals as to time
observer is frequently able to read several lines, except- of recovery are as 4.5 to 1 and as 2.5 to 1 for a longer and
ing, in each line, an approximately equal number of let- shorter period of blinding, i::espectively. Recovery, as here
ters. That is to say, there is more divergence in visi- used, means the individual's return to a definite multiple
bility between letters of the same line than between one (by the factor 4. 7) of his own absolute threshold.
line and the next. (See observers G, 90, W, Tabltl JV.) (3) The time of recovery to the point of distingwshing a
The shade-perception readings under the head " l:ight- test object of standard brightness is to be looked upon as
adapted" were taken either just before the dark-adaptation a function of both. of these, the one or the other preponder-
experiment, or in some cases at another time. Those in ating in effect according to the test stimulus chosen. For
the next column, headed "dark-adapted," were taken at a test stimulus 4. 7 t'mes the (geometric) mean absolute
the close of the dark-adaptation run, immediately upon threshold of all observers, the extreme variations in time
the turning on of the light. The latter gives in most are expressed as 8. 7 to 1 and 2. 75 to 1 for a ionger and a
cases a somewhat poorer indication, usually by a few let- shorter period of blinding, respectively.
ters only, occasionally by as much as a line . In one- or (4) The times of recovery are less diverse after a short
two cases the reverse is noticed (0, G), i:,ometimes plainly blinding (15 seconds, 13 candles per square meter) than
the result of memory of the chart and of practice. (Com- after a longer one (5 minutes, same), and in the former
pare Co, W, under " light-adapted," with G.) The chart case recovery takes place, on the average, in about one-
was difficult and uncertain to -work with, and the effect third the time, or probably less when all antecedent con-
of dark-adaptation, to which a slight falling off might in ditions are equalized.
some cases be attributed, was very transient aud soon (5) The occurrence, in the course of dark-adaptation, of
wore off or became masked as the observer studied the more or less definite arrests in the decrease of the threshold
chart and became familiar with it. In what follows the suggests the independent working of two physiologic
effect of the state of adaptation upon shade-perception mechanisms. 'rhese halts occur, more or less definitely,
will be ignored, and for each observer his best reading will in 18 out of 52 courses of dark-adaptation investigated,
be used, for comparison with the extent and speed of his and appear as more or less definite "terraces" on the
darksadaptation. rising slope of the curve.
 37
(6) A definite photometric knowledge of the minimum TABLE I.
light conditions under which the flier may be called upon The ph otometric brightness of the test pattern, in candles per square
to use his vision is ne cessary before a test method can be meter, for each centimeter of the adaptometer scale. The cologarithm of
the same wi th the difference fo~ each millimeter division, from O to 10 ..
intelligently proposed or further investigation advan-
tageously carried on. Candles per square meter. I Scale. Colog.
(c. p.
sq. m.).
P roportion a l parts .
Mm. Dill
.
(7) The relation- between the limit and speed of dark-
adaptation on the one hand and sensitivity to shade- 272X10- 4 •• -· ·--- --- -· -- _____ •
973X10 - ' _. ___ . --- -- __ ______ _
0 1. 566 0 0. 000
1 2.012 I 0.045
difference under relatively high illummation on the other 348 ___ - - ----- - - -- - - -- -- - - -- -- _ 2 2.458 2 0.089
is not clear. It would appear that sh ade-difference 102 ___ -- -- _- - -- ----- - ... . . . . . . 3 2. 905 3 0.134
446 X l0-• _.. _. --· . . ... ·-· . _.. 4 3.351 4 0.179
sensitivity is related to absolute (dark-adapted) sensitivity 159 __ . _. __ . _. _. _____ . __ . _. _. _. 5 3. 798 5 0.223
57GX 10 - ; -----·-···-- ----- --- 6 4.244 6 0.268
in an inverse sense and to the speed of recovery of dark- 204 __ ·_·- ... -· .. · - ...... ·--- -- _ 7 4.690 7 0. 312
730X 10- ' .. _. _. . ____ . · -· .. _. . 8 5.137 8 0.357
adaptation in a doubtful , possibly direct sense; but the 261 ......... ... · -· -·- . ... -· - - _ 9 5. 583 9 0.402
results are such af! to leave these conclusions in doubt. 935X l0- 9 - • • • · - . -- •••• -· - · - - - 10 6.029 10 0.446

TABLE TI. The :results of the dark adaptation experiments.

The absolute threshold is s tated (1) in t erms of the scale reading, (2) as the cologarithm of the brightness of the test-pattern, and (3) as that bright-
ness itself in hundred millionths of one candle per square meter . -
•- · under "A T - 15" i s given t h e t ime of r eturn of the individual to a threshold 15 mm . below his own absolute threshold on t)le scale (wbitb
is p)lotometrically 4.7 times as brigbt).
Similarly, under "70 mm." and "50 mm.", tbe times of return to these respective points on t)le scale, a s described in t)le t ext. T)lese two
pJintsare, respectively, of 0.0000204 and 0.000159 candles per square m eter brightness.
The lower b lock of t)le table gives the comparative results of repetition of the same experiment upon each of three observ er s, except in the
case of W, in wh ose case the order was reversed and 15 second s blinding given first.
The sam e was the fact in th e case of observer M, in the upper block of the table.
In the last column the asterisk (*) indicates that the course of adaptation was too rapid to permit of taking the time as the first point (50
mm. ±) was reached .

AT- 15 mm. 70mm. 50mm.±

Absolute thresh old.
Date. Obs. 1- -- ~ ~- - - ~ - - - -1 Sec. after blinding. Sec. aft er blinding. Sec. after blinding.
Scale, c p. sq. m
e. p ~qo.·,
m m. m . colog. X _ 5 min. 15 sec. 5min. 15 sec. 5min. 15 sec.

Nov. 7, 1918 ...... . - ·-- -· ··· ·· -··-- -· -- · · R .. ·-·-· 96.5 5.873 134 300 106 151 76 30 12
Dec. 20, 1918. _. ___ •. . _...... _. _.. _. _..... Do . . ... . 91. 5 5 ..650 224 :J85 84 79 66 37 10
Jan. 6, 1919 .. .. .. .. _.. . - - - .. . • .. . .. . . .. - . 0 _. - . . . . 88. 5 5. 516 305 15 82 213 72 48 15
Jan. 7, 1919 ..... ·-···------- · ---·-·-·-· · · Sh . . .... 88.0 5.494 321 , 91 236 48
Jan.17, 1919.·-· ·- ··-·--- --- · -·- ··· -· · ··· G.·-··-· SRO 5.494 321 160 76 142 66 30 5
Oct. 31,.1918 ._ . _.. . . .. . - ·- · -·---·-·-····· Ho_· ·· - · 87.0 5. 449 356 140 127 10
Nov.4, 1918 .... - .• ·· · · - · - · - · - ··-· · -··--· SL._ ____ 89.0 5.539 2S9 86 43 .52 36 20 10
Jan. 17, 1919 .... · -···- · -· · ··· · · · · ···· ····
Jan. 18, 19Hl . ... . _... _. _. ....... . . . ......
Co ... ·-·1
W ..... _.
86.0
83 ..'i
5.405
.5. 293
394
509
204
281
87
95
170
307
83
99
43
50
12
13
Jan. 8, 1919 . . .. _. .. _. _. _. _............ ... B ....... 81. 5 5. 204 625 300 63 405 75 62 5
Jan. 3, 1919 . . ...... . . . .. . . . ..............
Jan. 17, 1919 . . . ... ... . ......•• . . . . . . · -- ··
L .. . . .
Du .. . -..
··1 82 5
81.0
5 248
5 182
so.,
658
135
129
61
70
151
291
56
87
32
25
16
8
Nov. 13, 1918 ....... . - · -··--·---·-·-· ···· Hn .. . ·- 79 5 5 114 769 192 70 542 87 30 25
Nov. 26,1918 .... - .. - -·-·-·-·· · ·········· M . .. _._. 77.0 5. 002 995 212 44 390 60 20 *
Jan. 14, 1919 .. ... _. _. _. _. _. _. _..... _.... . C' r. ...... 77. O 5. 002 , 995 86 56 230 82 25 20
1
Mean . . .. .. _._._ .. . .. . . . .• •... . ........... . . . .. . . . ·
M . V . ...... ... . .. . .... _. . . .. ___ . _..... _. . . . . . . . . . .
I 8.5. 1
4. 5
5. 364 1
. 201 1
497 1·
218
214
78
71 j
16
233
103
73
12
34
11
I 12. 6
4. 4
Nov. 7, 1918 ..... .. . ... . . ... . ... .. · · · - · · · · }R { 96. 5 5_ 373 134 300 106 151 76 30 I 12
Jan. 15, 1919 .... .... . . _.. .. . . . .. . .. ... .. . ······· 92.0 5.672 21 3 265 98 148 74 20 10
Oct. 31, 1918 ... -........ . ... .. . · · · · · ···· ·}Ho ..... . { 87. 0 5.449 356 140 127 10

raFJ. mt.::::::::::::::::::::::::::: }w....._. {

87. 5 5.471 338 177 117 15
80.5 5.159 693 259 44 662 52 55 *
83.J 5. 293 509 281 95 307 99 .50 13

TABLE III.
Similar to Table II (q. v.), giving ratings instead of .e,q,erimental values. T.h e ratings are 1 to 5 in order of super:orit y, 3 indicating the
average cl~ss.

D ate. AT- 15, AT- 15, 70 mm., 70 mm., 50 1nm.± 50 mm . ±

Obs. A.T. 5 min. 15 sec. 5 min. 15 sec. 5 min. 15 ser.
- - - - - - - - - - - - -- - - - -- - - - -1- - - - - -- -- -- - --- - - -- - - - - -- - - - - - -
Nov. 7, 1918 ..... . -·-· '· ························ ·· ···· ·· · ····· R.- .... . 1 5 5 z 3 2 3
D ec. 20, 1918· -··- · · ·· ·· ··· · ····· · · · ·· ·· · ··· · ·· · · - · · · ·· · ·· · ·· - · ·Do---·· · 1 5 4 1 2 3 2

fFn: r~.~mi: : : : ::: : : ::: ::::::::: :::::: ::::::::: :: : i~:::: :

Oct. 31, 1918 ... . ... . ... . _. _...... . _. . . . . . . . . . . . . . . . . . . . . . . . . . . Ho._ .. . .
2
2
2
2
.5
4
2
2
3
4 3
.3

2
2
3

2
5
5
2
l
4

~~\t mt::::::::::::::::::::::::::::::::::::::::::::::::: ~~.· ::::: 3

2 1
3
1
4
l
2
1
4
l
4
2
3

f
5 4 3

!?nitNm;;; 1/ i i;~;;;;;;\(\(\ t\1;; ;; ;; ;; ;; ;~ ;~ tt;; it\(;; t /111 /

4 4 5 5
4 5 2 5 3 5 I
4 2 1 2 1 3 4
4 l 3 4 5 2 2
5 3 3 5 5 2 5
fs'ri\~·111f.·.: :'.: :: '.: ;_:::::::::: :: :: ::::::::::::::::::::: :: i·.:::::: 5
.5
3
l
1
2
5
3
2
4
1
2 5
•
,f~~.1~, mt·.:::::::::::::::::::::::::::::::::::::::::::::::: }R ·-·-· ··1 5
4
2
5
5
2
2
2
3
3
2
1
3
2
1 ··-·· -· ·· ·
Oct. 31, 1918 ........ . .... . .......... - · · · · - · · · · · · - · · · · · · - · - · · - · }Ho

EFJ.mt:::::::::::::::::::::::::::::::::::::::::::::::::}w.~:: :~
2 1 1
4
4
5
4
1
5
5
5
*
3
 38
TABLE IV.
The res ults of the sh,dc·pcrco ption experiments, compared with the dark.adaptation res ults : (1) absolute threshold and (2) individual speed
of recovery. In the · latter the ch ss-nuinbers a re plotted, cf. Table Ill. The shade-perception chart was u sed at 5.1 meters except as specified.

Vision. Dark a daptation . Shade perception .

Obs. 1-----,-- ---+----.......,-----+----,-----, Remarks.
Uncor. AT cxpt. AT= · Speed class. Lt. adpt. Dark adpt.

R . . .. . . ... ... . ....... . 20/15- 94. 2 5/5 1/10- 4 ·-·-·· ·· ·- · -

20/15- 92.0 1/10- 3
0 .... . .... . . . 20/15 88. 5 5/4 9/ 10- 1 9/10+2
20,15
Sh ..... .. . 20/ 15 88.0 4/ - 7/10-2 6/10-2
20/20
0 ......... . ........ . 20/20- 20/15+ 88.0 2/3 5/10- 2 6/10-1
20/20- 20/15+ ······ · -- --- 7/10-4
Ho ............. . . . . . 20/30 20/10- 87. 2 2/ - 9/10+ 4 --------- -- -
20/20- 20/10- -- - -· -·· ··· ·
Co ... . .. • ..• • . • . • . .• ••• • • . . ••... • 20/200- 20/15 - 4 86.0 3/4 5/10-1 6/10+4
20/200- 20/15- 4 --·-········ - ·········· ti/10-2 ············
L ........ . . . ............ . ..... . ... ·................... . 20/30 20/ 10- 82. 5 2/1 ... . ........ 9/ 10- 1+3 At4.8rp
20/20 20/10- ·-·········· .
W .. . ... . . •..... • .•. • . • . . . .. • . . . • .•... . ... •• •..... • •. . 20/200 20/15- 83. 5 4/5 7/10- 1 ........... .
20/200 20/15 ------·----- 8/10- 1 ........... .
9/10 - 3 ........... .
\v ......... . ... ...... .. ..... .. .. . ............ . .. .. .. . . 82.0 9/10 + 0 ············
Du ..... . . .... . ..•.... . ...... . . .•.. : . . . . .. . . . ... . . . . . . 20/70 20/15 81. 0 1/3 10/10-3 10/10- 7
20/70 20/15 -·-··· · ·· · · ·········· --······--··
Hn . ................. . ................... .. ........... . 20/30 - 2 79. 5 3/3 9/10-1 ........ . ... At 3.4 ID.
20/30
Cr .. .. . . 20/ 15
20/15

TABLE V.
(The observers : age, vision , and refraction.]

Re(rnction. During exp't;

Obs. Age.
Vision w1 correcte.d. - -Vision Glasses Vis.ion.
Correction or remarks. corrected. worn .

R ....... . ...... . 46 0. D. 20/ 15- ..... . + 0.75 sph .............. . . . . . . ... . . . . . . .. .. .. . . ... . . . ... . ...... . ..... . . No . . .. . 20/15-
0. S. 20/15- ..... . + LOO sph ........ , ...................... ... .. . .. . ............... . ............. . . . 20/15-
Do . . .... . .. .... . 37 0 . D. 20/30- .. . .. . + LOO sph+ l.00 cyl. .... . ............... . .............. .. , 20/15 Yes ........ 20/15
_ax. 95°.
0. S. 20/30- ...... + LOO s ph + l.00 cy} 20/15 20/15
ax. 85.
0 . ...... . . .. . ... . 24 0. D. 20/15 ... . .... Slight marginal blepharitis . . ... .. ............... . . ....... . ........... No ....... . 20/15
Sh .. ......... .
G .......... . . . : lli~~:\:::: :~)~j~~~~~_:~~~)/)::\::\~:\ \:\::\::\ (: :\\ ::::\:::( :::i~'.i) :~!)(::((
O.
8
- 0.75sph+~.'&J /;L..................... ... ... ......... ..
s. 20/20- ..... , . 20/15+ . .. ... . ... . .
20/15
20/15
20/20
20/15+
20/15 +,
· · ax. 95°.
Ho .............. . 39 0. D. 20/30 ........ + 1.37 s ph+~!: fo':,L. .... .. ..... ... .. .......... .... 20/10- Yes ...... . 20/10-
0. S. 20/20- ....... + I.17 sph+0.62 cvl. . . .... ... . ~- .................. . . 20/10- ........... . 20/10-
1 ax. 110°
Si . .. . . ......... . 27 0. D . 20/20 ........ + 0.62 s ph + 0.!2cyJ- ......... . ... .. . . . . .. . . ..... . . . . . ................. No ....... : 20/20
ax. 90.
0. S. 20/20 ... . . . .. . +0.75 cyl.. . . . ..... . ..... . ........................ . 20/20
ax. 90°.
Co ....... . .....• . 47 0. D. 20/200- .... . - 2.75 sph - 0.62 cvl.. ........ . . .... . ... .. . . .. . . . .. .. . ..... . 20/ 15- 4 Yes ... . .·.. 20/15-'1
ax. 5°.
0 . s. 20/200- . . ... . - 1.75 sph - 0.62 cvl.. . . .. • .. .. . .. .. ............. . ....... . . 20/15- 4 20/15-4
ax . 175 °.
W .. . . . . .. . .. • .. . 39 0. D . 201200 ..• •• - 2.50 s ph-0.50 cy l.. ...... . ........ . ... . .. .. .... . .. . .. . .. . 20/ 15 Yes .... . . . 20/ 15
ax. 100°.
s. 1
o. 201200 • ••• : •• - 2.75 sph-0.75 cyl.. ... . .. . . ... . . . . . ..·. . ... ..... ..... . , . . . .
ax. 100°.
20/15 .20/15
ll .. .. .. . . . ... ... . 41 0. D. 20/20 - 1.. .. . + 1.00 sph-0.37 cyl.. ..................................... . 20/15 1 Yes ...... . 20/15 1
ax. 100°
O. s. 20/20-3.. .. . + 1.00 s ph- ~1_7 8c1 f . ::::::::::::: ::::::::::::::::::::::::: 20/ 151 20/15 1
L . ... . ... . .. . . .. . 55 0. D. 20/33 . . - 0. 75 sph+l.50 cyl.. .... . . . . ..... . ........ ..... -, ....... _.. 20/10- Yes ...... . 20/10-
ax. 48°.
0 . s. 20/25 ... - 0.75 sph+l.62 cyl.. ... 20/10- 20/10-
- ax. 92°.
Du ..... . 25 0. D. 20/7Q ....•.. - 2.00 s ph- 0.25 cyl.. . ........................ . . . ........ . 20/15 Yes ...... ., 20/15

Hn . . .. . .. . .... . . 49 .
21 ax. 120°
~-.s:. ~:?:::: ::::: =i:~ ~~fax: isii•::::: ~:::::: ::::::::::::::::::::::::::::: ~;~t2 ·y;;::: ::::
20/ 15
20/30- 2
M .... . 36 0 . D. 20/20-1.. .... :-: ·.
0
50 ~:.1: .~x: ~~~~:::::::: :: :::::: :::::::::::::: :::::::: ::: ...~'.~? ..... No::::::::
0. S. 20/20 + 4. .. ........................................ . .... .. ...................... ·. ·. · · . · · · · · · · · · · ·
20/30
20/20- 1
20/20 -f4
Cr •......... 23 0. D . 20/15 .... , ... {Possible s ligh t snow.tJindness from flying over rnow fields }· .......... No ... ... . . 20/15
0. S. 20/15 . ....... , some months previously .. . ................... :.......... . ... .... ... . .......... . 20/15

1 Glasses worn by B conta ined correction for slight presbyopia. Vision was thereby scmewhat fogged at 20 feet, but presumably equivalent to
20/ 15 a.t the distance used, 52 rm.
- By courteS'!f of PS'!fchological Review.
 PART 6.
A CONTRIBUTION TO THE STUDY OF DARK ADAPTATION.
MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.
By PERCY W. COBB. captain , Medical Corps.
Vision under ordinary conditions and v1s10n under
extremely low intensity of light present quite different
sets of phenomena. The latter phase of vision has hereto-
fore been of interest from the diagnostic standpoint, and
has been investigated and discussed as a problem in visual
physiology. · roar of his engine would make this impossible, even though
This problem has related itself mainly to the demon-
strable anatomic changes corresponding with exposur-e of
the eyes to light or darkness, notably the presence or
absence in the rods of the light-fugitive visual purple,
the variations in the shape of the pigme'ii.t cells and in the
distribution of their pigment, and the possible shift in
the position of the cones. Of these, the phenomena con-
nected with the visual purple have been correlated w:ith
certain experimental changes in the vision of light arid
color chatacteristically related to the change between
high -and low light levels, and have given rise to the
theory of dual function. Stated briefly, this theory
assumes that sensations of color are due entirely to changes
resulting from the incidence of light on the visual cones.
Colorless light sensation mediated by the cones is also
admitted; but sensitiveness to color is denied the rods
which are held to give only light impressions undiffeten-
t:ated in color, and to be capable of extreme enhance-
ment in sensitiveness after a period of removal from strong
light. The changes in function that take place in normal
vision in transition from high (daylight) to low (twilight
or night) intensities of light can be enumerated briefly:
l. Color as a visual quality disappears. Objects are
seen as lighter or darker, but not as of different colors.
2. Concomitantly a shift of sensitiveness, w1.th relation
to the position in the spectrum, takes place. The bright
spectrum presents all the rainbow colors, and has its
brightest part in the yellow. The dim spectrum is devoid
of color. At its red end it has ceased even to be luminous,
and its brightest point is found to be of shorter wave length
(i.e., farther toward what was the green) than the brightest
part of the daylight spectrum.
3. An enormous enhancement of the absolute sensitive-
ness to light takes place. This is progressive and when
measured is found to be rapid at first, then slower, and is
found to become stationary in an hour's time or less.
It is the increasing sensitiveness of the darkened eyes,
or dark adaptation, which concerns us here. This phenom-
enon has long interested the student of visual physiology
and has been investigated as a possible aid in the diagnosis
of certain conditions involving the retina. Further than
this it has not had technical importance. In times of
peace it is a simpler expedient to provide light than to
(39)
try to see in the dark. The way of warfare is diffei:ent,
and to choose for the enemy unfavorable natural conditions
which one himself has learned to meet is a part of good
strategy. To orient himself with reference to terrestrial
objects the aviator can not depend upon hearing. The
otherwise· he is not .too far away. The experiment of
foeling his way is unintentional because it is usually
fatal. Both with respect to objects on the earth and to
other airplanes the aviator must rely upon his vision
alone. When night flying became a part of military
strategy the classification of aviators on the basis of night
vision became a problem worthy of study .
In attempting to find the lowest limit of light sensitive-
ness we at once encounter the fact that the light threshold
is, apart from irregular variations, a variable quantity.
The subject, taken into a dark room, at first requires an
amount of light which is many times that necessary a few
minutes later. Exact researches have shown that the fac-
tor may easily be several thousand. In coming from bright
daylight into the dark room the threshold has been Shown
in normal individuals to be 1,500 to 8,000 times that ob-
tained an hour later, the subjects in the meantime remain-
ing in the dark.
It has also been shown that the rate at which the thresh-
old amount of light decreases is not always the same for the.
same individual, but depends upon the duration and in-
tensity of the light to which the subj ect's eyes have been
exposed during a (perhaps indefinite) period just prior to
the experiment. The present work proposed investigating
the quantitative relations regarding this last point, as well
as determining the ultimate light-sensitivity of individuals
and their characteristic mode and rate of recovery from
the partial and temporary blinding due to light. The
aim was to arrive at some idea ef individual variations in
these respects as preliminary to the devising of a practical
·and valid method of .testing.
The detailed procedure used in conducting the experi-
mental work at present under consideration will appear
in another place. An outline of the essential facts will
be given here.
The subject coming into the experimental room is
seated facing the adaptometer. (Fig. 2.') On a.J.evel with
his eyes, and 52 centimeters away, is a small red light,
dimmed as far as is consistent with certain fixation upon it
in the dark . The test pattern is in the same vertical plane
as the fixation point, its center 12 centimeters directly
\ 1 Figure numbers refer to illustrations in Part 5.
 40
below the latter. The test pattern is best described as a
square, 7.5 centimeters on each side, from which the mid-
die third is removed , leaving two parallel rectangles·, 7.5
by 2.5 centimerers, with a dark space 2.5 centimeters wide
separating them. The center of the pattern is 13° below
the point of fixation, and its extreme limits subtend
about 8° horizontally and vertically in the visual field
This pattern is projected upon a sheet of milk glass, from
the side away from the observer,. by a device which is
essentially a small stereopticon. The latter is inclosed
in a ligh t-tight box, the milk glass being a window set in
one end. The amount 6f light projected, and hence the
brightness of t.h e test pattern, was controlled and m.eas-
ured by means of a gelatin smoke wedge, , The form of
the pattern is determined by openings in a thin slip of
brass, which represents the "slide" in the stereopticon.
Two pairs of openings were used, one with the two rectan-
gles in the vertical position, the other in the horizontal,
and the change was made by a horozontal shift of the
slide.
(1) As soon as possible after the subject entered the
room the latter was darkened and his threshold was taken.
This was repeated with approximately 5-minute intervals
of rp,at. In 20 or 30 minutes it was found that his threshold
had reached a limit, and had become constant to within
what could be called the margin of experimental error.
(2) When this WM assured by the re.suits, the first part
of the experiment proper began, involving a meMured
amount of " blinding." A white screen was set up ob-
liquely before the subject, and the center light of the room
was turned on. The screen subtended 67° vertically and
70° horizontally in his visual field, and its brightness av-
eraged 13 candles per square meter. The subject wM
instructed to look at the central part of the screen, with-
out especial effort to fixate. At the end of 5 minutes the
light was turned off and the screen removed. In the
meantime the test pattern had been set at a certain rather
high level of brightness, and the time elapsing betwe·en
the darkening of the room and the first visibility of the
pattern WM taken. After that the threshold WM taken
as before, but with. somewhat shorter intervals, until it
had reached its former final value.
(3) When this had taken place the white screen was re-
placed and the procedure repeated M under (2), with 15
seconds' exposure to the screen instead of 5 minutes.
This procedure wa,s planned with the idea that the first
portion would serve two purposes, to give a value for the
abs'.llute threshold of the subject and at the same time to
bring him to a standard and reproducible state (that of
complete dark adaptation) :pefore subjecting him to :i
standard amount of blinding. Obviously this latter would
mean nothing unless the effects of previous light exposures
had come to an end, and there seemed no way of making
certain o.f this but to follow the subject's threshold to a
constan t value. ·There seems to be some evidence that
even this, as done here, is not adequate. In two cases,
th~ experimental order was varied, parts (2) and (3) of the
experiment being transposed in order. Comparison of
these results with the bulk of the results seemed to indi-
cate that whichever stage (2 or 3) of the experiment was
conducted last was subject to ·a residual effect from the
blinding of the foregoing part, in spite of the fact that the
subject had, in the meantime, come back to his first ulti-
mate threshold. This was evidenced by a somewhat
more rapid recovery in these two cases than was to be
expected in part (3) when this took second place in
order, and by a slower recovery in part (2) when this
took third place .
A study of the results yielded a set of numerical values
which are summarized in Table I . From this it will be
seen that the individual variations are quite large on
every point. For example, · in different individuals the
absolute threshold was found as high as 9.95 and as low as
1.34 millionths of one candle per square meter. The
mean value for all subjects was 4.97 with a mean devia-
tion of 2.18 millionths, or 44 per cent of the me.an.
A specimen of the course of adaptation is shown graphi-
cally in Figure 3, the three curves being the graphs of
parts 1, 2, a,nd 3 of the experiment, as described, and the
intervals of measured blinding being indicated by the
vertical dotted lines. The ordinates of the plot indicate
the position of the wedge, by which the intensity. of the
light was cut down. The relation between the shift of
the wedge and the brightness of the test pattern is a
l logarit.hmic one, such that the brightness is reduced by a
constant fraction for equal linll3,f ahifts of the wedge.
With the wedge at 0.0 millimeter the brightness is 0.0272
candle per square meter, which is in effect divided by
2.79 for each 10 millimeters shift of the wedge. The rela-
tion between these readings in millimeters and the
actual brightness of the test pattern, in decimals ,of one
candle per square meter, is shown b y the comparative
scale of ordinates in Figure 4. The decimal scale alone
appears in Figure 5, ~nd in these two figures the hori-
zontal lines indicate the intervals of a tenfold change in
brightness.
Returning to Ji'igure 3, the absolute threshold is indi-
cated at the height of the first curve by a horizontal
dotted line. It is placed at the mean of the three pointf
indicated. The relation between amount of blinding and
the rate and mode of recovery app,ear from consideration
of the next two curves. For a blinding period of five
minutes the curves show characteristic differences, as
exhibited in Figure 6, where the results for all 15 subjects
are plotted for comparison. These show the various
heights of sensitiveness which different individuals ulti-
mately reach, and also show in certain cases quite definite
temporary · arrests in the progress of adaptation (Do . B,
Du, Hn Fig. 6). Out of a total of 52 adaptation curves
plotted, 14 showed this halt in the rise of sensitiveness
very definitely, while in four others it is suggested. To
emphasize this the first two curves shown in Figure 6
are plotted toget.her in Figure 5, with their common
origin at the point where adaptation b egin s and with the
time scale enlarged fourfold.
In considering the rate of adaptation, that is, the indi-
vidual rate of recovery of the sensitiveness temporarily
lost in the process of blinding, it is to be said that great
variation was found, but the most interesting fact is that
the time of return to a fixed point in the scale of sensi-
tivity (estimated from the plotted curve) bears no very
definite relation to ultimate degree of sensitiveness which
the individual may show .• There is perhaps a general
trend, as might be expected, in the sense that a subject
 41
with a low absolute threshold reaches a given level of threshold an d his rate of recovery as indicated under (3).
sensitivity more quickly and vice versa, but the excep- For a constant test stimulus 4.7 times the (geometric}. mean
tions to this are more noteworthy than the rul e. In Figure absolute threshold of all subjects, the extreme variations
5 are plotted the results from four types illustrating this. in time are expressed as 8.7 to 1, and 2.75 to 1 for the
Subj ects R and Si have low absolute threshold"s (high longer and shorter blinding periods, respectively.
sensitivity), but R is slow and Si rapid in recovery. Simi- (5) The times of recovery are less diverse after a short
larly in .the case of W and Cr, wh ose absolute threshold blinding (15 seconds at 13 candles per square meter) than
is, however,, high. By examining the steep parts of the after a longer one (5 minutes, same), and in the former c-ase
curve it will be noted that Cr at first recovers·more rapidly recovery takes piace on the average in about one-third the
than R, who is by far the more sensitive later on in the time, or probably less when all antecedent conditions are
course of adaptation. equalized.
As to the general difference in the rate of recovery, as (6) The occurrence, in the course of dark-adaptation , of
dependent upon the duration of the previous blinding, more or less definite arrests in the increase of sensitivity
it is to. be said that recovery is about three times as fast suggests the independent working of two physiologic mech-
following the 15 seconds blinding as it is following the 5 anisms. These halts occur more or less definitely in 18
minutes blinding. The course is shown graphically in out of 52 curves studied, and appear, when distinct, as
the right hand plot, Figure 4,. for the same four subjects. "terraces" on the rising slope of the curve.
Owing to the rapid.i ty of recovery the data are not as (7) The practical usefulness of data, such as the present,
explicit as in the case of slower recovery. will depend upon a definite photometric knowledge of the
The s tudy of dark-adaptation with reference to the minimum light conditions under which the subject may
practical use of the eyes at night involves a point of view be called upon to use his vision.
different from that involved in the study of dark-adapta-
tion for the purpose of solving physiologic or diagnostic TABLE I.
problems, and a question arises here, with especial refer-
ence to the aviator. In rating h im, shall we consider his A'l'- 15mm. I 70mm.
I 50mm.±
ultimate sensitivity, or shall· we rate him in the basis of
Abso-
his speed of recovery after blinding? In other words, lute Recovery time, seconds, after
thresh- blinding for-
from this standpoint , which portion of the curve deserves old.
the more exhaustive investigation? It would seem an
5min. 15sec. 5min. 15sec. 5m in. 15sec.
obvious answer to this to say that the part of the curve to
investigate is that which , 'in general, best represents the
Largest value ... . ... . .. 9. 95 385 106 542 99 62 25
illumination conditions existing under nat ural ligh t at SmaUe, t value .·- . ..... 1. 34 86 43 62 36 10 5
night. The photometric study of such conditions will be 214 11 233 34 126
Mean· ··· :··:· · · ··- ~
a relevant and interesting topic. Mean dev1at10n. . .. , .... 2. 18 78 16 103 73
12 1 11
44
SUMMARY OF EXPERIMENTAL CONCLUSIONS.
GENERAL RESULTS OF THE DARK-ADAPTATION
(1) Upon investigation of 15 subjects it appears that EXPERIMENTS.
tlw limit of vision in dark-adaptation (the absolute thresh-
old), measured by the least brightness at which gross The absolute threshold is stated in millionths of 1 can-
form may be recognized, is variable within extreme dle per square meter.
limits expressed by the ratio of 7.4 to 1. These limits lie The next two columns give times of recovery, in seconds,
between 1 and 10 millionths of one candle per square of sensitivity corresponding to 4.67 times the subject's
meter. absolute threshold ("AT- 15 mm. "), for the 5 minutes and
(2) The rate of recovery, after dark-adaptation is dis- for the 15 seconds periods of blinding, respectively.
turbed by a standard exposure to light, is also variable as Similarly, the next two columns ("70 mm." ) give the
between individuals, and by no means always in a sense times of recovery to the point of visibility of a stimulus
corresponding with the value of the absolute threshold. 4.67 times the (geometric) mean absolute threshold. This
(3) Recovery to the point of visibility of a test stimulus is 4.33)(4.67=20.4 millionths, represented by 70 millime-
4 .7 times the indi vidual's absolute threshold is in general ters in scale .
slower the lower the absolute thresh old . This seems to Under " 50 mm.±," correspondingly, the times of recov-
be the consequence of the simple fact that the test stimu- 1 ery to it threshold of about 159 miilionths the initial r~ult
!us, so chosen , is necessarily the farther below the level of parts (2) and (3) of the experiment as described in the
of brightness of the blinding surface the lower the abso- text.
lute threshold. The extreme individual variat ions in time The times given under "AT-15 mm." and under "70
for this relative degree of recovery are as 4.5 to 1, and as m'm." were estimated from, the plotted curves, such as
2.5 to 1 for 5 minutes and 15 seconds, resl?ectively . figures 4 and 5.
(4) The time of recovery to the point of di~tin guishing - By courtesy of the Transaction of the American Ophthal-
a test object of standard brightness is to be looked upon mological Society, 1919, and the Archives of Ophthalmology,
as a function of two variabl%; the individual's absolute XL VIII, 1919.
 PART 7.

THE MADDOX ROD AND A SCREEN TEST COMBINED.

MEDICAL RF..SEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.

By PERC DOLMAN , ·B . S. , M. D .. captain, Medical Corps.

INTRODUCTION. ~y even slight departures from a correct position led to

the idea of a double prism * * * like two thin prisms
The Maddox rod in some form is given a place in almost joine<t at their bases but made of one piece of glass.
every modem trial case. It is also a part of the equipment · * * * Owing to the imperfect manufacture of the
of most of the new combined phorometers. When testing double prism * '° * the ridge had a rounded instead
the. eyes for muscular i.'Ilbalance in the primary position, of a sharp edge and this caused the appearance of a faint
it is reasonably safe to say that the Maddox rod is em- band of light joining the two false images. It was this
ployed by the great majority of American ophthalmolo- band of light which led to the thought of a glass rod to
gists. This wide distribution of the Maddox rod and its produce a more pronounced streak of light."
1
very·general use is explained by Stevens(l) who says: Maddox continued his experiments and determined that
"The rod test of Mr. Maddox, of Edinborough, is a beau- the "reatest amount of li"ht was admitted through the
tifill device, having the virtue of ~xtreme ~implicity, pupil by a piano-convex c;lindrical lens with a radius of
being perfectly portable and, what 1s not urumportant, J curvature of 10 millimeters. With hi.is lens he claimed
it is very cheap." 1
that the light of a star could be used to test the equilibrium
Jackson(2) years ago wrote of the Maddox r?d test-. of the eyes.
"For the recognition of heterophoria at .a d1st:i,nce. ~Is The single Maddox rod requires very accurate placing
proved with me the most satisfactory test. Its ~=pl:c1ty before the eye to enable the patient to see the line of light.
makes the application easy even with the least mtelhgent It was soon found that several rods fixed close y side by
patient. While it does depend on the patients' observa- side give more latitude in the choice of position before
tion, the simplicity of the observation required and the the eye. This type of multiple rod, however, exhibits
low grade of intelligence necessary to make it render the breaks in the line of light caused by the minute spaces
result uniform and satisfactory for all sorts ?f P.atients." separating the rods. Jackson(4) and others made sug-
One looks in vain for similar peans of praise 1~ th~ later gestions for eliminating the break in the line but the final
literature. On the contrary, much condemnation l~ ?e- solution of the problem arrived only with the manu-
ing heaped upon the Maddox rod, and a settled op1mon facture of a multiple rod out of a single piece of glass, with
prevails among a number of writers that the test should be the red formation on one side and a plano surface on the
greatly restricted in use if not entirely eliminated. In other.
the measuremlmt of esophoria and exophoria particularly THE TEST CRITICIZED.
the test is condemned as unreliable and inaccurate.
These are the most serious objections that can be. raised Keeping pace through the years with this evolution in
against any scientific test, and, if they are true, the the form of the Maddox rod is the growing mass of criticism
Maddox rod should be cast into the office junk pile. directed against its use . These objections should be con-
The experimental study, detailed in this paper, was sidered for a. moment in detail.
begun at the Medical Research Laboratory, Mineola, Steven's(!) tribute, already quoted, is modified some-
N. Y. , because of this growing condemnation and the fact what by a statement in the same article that the tendency
that the majority of ophthalmologists still have faith in of the line to fuse with the light is so great that ortho-
the beautiful device of Mr. Maddox and continue to phoria is shown often where heterophoria ex.i~ts. Duane(,5)
report the results of examinations made with it. savs that test is not as reliable nor as accurate in his hands
as· the screen and parallax tests. He finds it is apt to
DEVELOPMENT OF THE MADDOX ROD. indicate an excess of esophoria and. a tendency in som,
patients to [use the light with th( line. In a later paper(6)
The discovery which led to the use of the glass rod as he repeats this criticism and estimates the excessive
an ophthalmological test is so unique that it deserv~s a esophoria shown at about one degree . Howe(7) , in his
secure place among. the classics of our ophtbalmological elaborate study of the eye muscles, places the Maddox
literature. It is best told in the words of Maddox(3). rod thi.r<l in the list of tests arranged according to their
Speaking first of the Graefe test he says: clinical value . Savage(8 and .9) objects to the use of th.e
" The difficulty ofensuring that a prism is strictly base Maddox rod in all tests of the recti muscies and declares
up or down and the considerable inaccuracies introduced it has i ts legitimate use . only in the measurement of
1 Number in parentheses refers to t he bibliograph y at the end of the
cyclophoria. Weymouth(JO ), on the basis of some com-
article. parative tests, thought the rod showed an excessive
(42)
 43
amount of esophoria. In routine tests of the eyes of
aviators at the Medical Research Laboratory the Maddox
rod was· discarded ·because of a growing belief that the
measurements made with it wei:.e unreliable.
In. addition to these epecific .criticisms, attention .has
been called tq the fact_that some patientR can not be made
_ to see the line of light projected by the rod. Other
patients observe that the vertical line of light "wavers."
They see it in a constantly varying relation with the
light.
AH these criticisms. are based on the use of the Maddox
rod in the determination of heterophoria in the primary
position at 20 feet. They can be grouped readily under
four heads.
1. The inability of some patients to see the line pro-
jected by the Maddox rod .
2..The tendency to fusion of the line and light.
3. The instability of the relation between the li,nt and
the light.
4. The tendency of the test to show too much esophoria.
APPARATUS AND CONTROL TESTS.
In the analysis of these several objections the Maddox
rod test and several variations of it were made on a group
of 50 men at the Research Labotatorv. They were
chiefly flyers ·with normal visual acuity and good ocular
muscle balance. The apparatus used was a De Zeng
phorometer fitted with both a .Maddox multiple rod and.
a rotary prism before each eye cell. '..Che prism correc-
tion was invariably placed before the eye -:overed by the
Maddox rod_.
The necessity for control tests was met by obtaining
accurate screen and parallax findings in ~ach case.
CRITICISMS ANALYZED.
The first of these objections 1s of minor importance.
Inabiiity·to see the line of light may be due to malposition
of the rod before the patient's eye. If the vision is
greatly reduced in one eye, the Maddox rod should be
placed before the eye with the better vision . The room
in which the test is made should be darkened and the
spot light at which the patient looks should be small and
bright. When these precautions are obssrved, few pa-
tients will have any difficulty in seeing th,e line of light.
The tendency -of the line and light to ' fuse lias been
noted by a majority of observers but usually in relation
to the measurement of esophoria and exophoria. 'l'his
fusion tendency must be admitted. It exists in spite of
the dissimilarity in form of the line and light and prob-
ably because of the fact that, under the conditions of
the test, a spot of light and a line of light are the only two
outstanding sources of visual stimulation observed by the
patient. As the line is observed solely by one eye and
the light solely by the other, it is not unreasonable to
admit the tendency to fusion when one considers that
fusion is the lifelong habit of the eyes. It has been ob-
served by Jackson(2) and Stevens(ll) that tests of this
character should be carried on in a darkened room with
no figures on the wall nor lines in the vertical and hori-
zontal directions. If lines running in these directions
are seen by the patient near the light, the tendency to
fusion is greatly increased.
In seeking a means to comhat this fusion tendency,
a method suggested by Duane(5) years ago was tried.
He found that the test gave him a more accurate result
if, with the rod in place, he covered one eye f~r a few
moments, then withdrew the cover and made the test
before the patient had a chance to fuse or separate the
double images. This method was used in the present
experiments and found to possess many advantages in
addition to the obvious one of doing away with the fusion
tendency. A more detailed account of the use of the
cover or screen in combination with the Maddox rod is
given in the succeeding paragraphs.
A study of the tendency to instahility of the relation
between the line and the light during the test proved
most interesting. This wavering of the line is observed
by the patient chiefly during test<' for esophoria and
exophoria, although some patients observe it'in the hyper-
phoria tests. It exists independently of the tendency to
fusion. The covering of one eye after the manner just
described naturally does away with this objectionable
wavering of the line in relation to the light by p~rmitting
the patient to see the two together only for an instant on
uncoverir.g.
The experiments made with the screen and Maddox roct
combined give some unexpectP.d results, and the technique
used in obtaining them is detailed rather _fully for thi~
reason. The patient is seated behind the phorometer and
the Maddox rod swung into place before the left eye so as
to give a vertical line of light. The rod and left eye are
then covered with a card. The patient is cautioned to
fix intently the light 20 feet away. After a moment of
such fixation, the card or screen is quickly removed and
the patient asked to indicate the position of the vertical
line with respect to the light' at the instant of first seeing
it. A typicalreply is that the line is to the right of the
light or perhaps to the left, but that it jumps qu1ckly
toward the light. This quick jump is a manifestation of
the fusion tendency. After covering and uncovering the
Maddox rod with the screen two or three times, the patient
is able to tell definitely on which side of the light the line
is first seen and about how far away it is each time. The
rotary prism of the phorometer is now swung into position
before the Maddox rod and rotated to correct the devia-
tion, the screen being applied over both rod and prism
and withdrawn for an instant. Guided by the patient's
directions, the prism is rotated until the line is seen to
fall directly through the light whenever the eye is uncov-
ered. 'I'he amount of correcting prism is read off thel'lcale
and entered on the patient's record as esophoria or exo-
phoria and a note made of the eye before which the Mad-
dox rod and the screen were placed during the test.
Then, with t.he Maddox rod still in place before the left
eye, the screen is held beJore the right eye and the patient
told to fix the line intently. Allowing a moment for this
fixation, the screen is removed as before and a correcting
prism determined which causes the line and light to fuse.
This test usually takes more time than the one where light
fixation is employed. Some patients seem unable to keep
the line and light fused for more than one uncovering, no
matter what correcting prism change is made.
The results of these two tests, one made with light fixa-
tion and the other with line fixation, the Maddox rod being
before the left eye, do not a,,<>Tee in the majority of cases ..
Checking•thein Qoth against screen and parallax findings,
made at the same time, the.light-fixation measurements
are found to approximate closely those of the two control
tests. The results of the line-fixation tests show an .aver-
age of from one to four prism diopters more esophoria or
less exophoria than the other tests. Three of these tests,
scree!)., parallax, and light fixation, can be considered as.
giving correct measurements in this·series of cases oecause
of their general agreement. The. line fixation measure-
ments then must be false in those cases showing less exo-
phoria and more esophoria than given oy the other tests.
This type of error indicates the influence of some factor
favoring convergence . There is a good deal of evidence
to prove that the factor is a stimulation of accommodation
during the act .of line fixation. The full investigation of
this phase of the problem will be .made the subject of a
later report, but experiments to date indicate that the
patient usually sees the line made by the Maddox rod at
some indefinite and ·v arying place between the eye and
the source of light 20 feet away.. The line of light is a
false image made by the rod, out of focus with.the retina,
and capable of being projected anywhere at the fancy of
the patient. The limiting sense suggested by the :walls
of the room confine the location of the projected line to a
range extending from the eye to the light. · Patient.'l fre-
quently make the statement that they see the line "in
front" of the light. On questioning, they are apt to say
that the line appears to be several inches from the eye or
perhaps a few feet away. Not many patients can be made
to see the line as far away as the source of light.
The tendency of the Maddox rod test to show more eso-
phoria than actually exists at 20 feet has its explanation
doubtl ess in the facts just consid·e red. When the test is
made in the usual way without a screen before either eye
the amount of lateral deviati.on will vary as the patient
concentrates his attention firet upon the light and then
upon the line, the element of esophoria entering into the
findings through the more or less constant line fixation.
The~ several objections to ·the use of the Maddox rod
as a test for muscular imbalance in the primary positions
no longer are valid when a screen over one eye is used as
suggested by Duane. It is necessary, however, to go a
step further and stipulate that the screen,be placed always
over the eye that is covered by the .Madd-0x rod. There
are exceilent reasons for ad vising that the correcting prism,
used in connection with the test, be placed always before
the ~addox rod and never, before the light-fixing eye.
This phase of the problem and one other concerning the
choice of right or left eye for light fixation during the test
will be made the subject of later reports.
IMPERFECT MADDOX RODS.
One other source of error is.found not infrequently in the
construction of the Maddox multiple rod. Most •of the
rods of this type are made from glass supplied in the form
of ruby "cane.". This "cane' ' is a drawn or molded glass
tube, smooth inside, and, having the well-known corruga-
tions on the outside. It is cut down the side and, under
the influence of heat, spread out into a flat sheet from which
pieces of suitable size are cut and made up into commercial
.m ultiple red rods. Some manufactur.ers finish the smooth
side to an optical piano, but the corrugations are not
reshaped . Much criticism can be directed against the
character of the line formed by these molded· multiple
rods. It is frequently of irregular width, wavy in appear-
ance, without sharp edges, and marred- by an excess of
diffused light through the glass. Breaks in the line may
sometimes be noticed. .
Many of these rods also contain a prismatic element
which acts at a right angle to the direction of the line of
light. Such a prism causes the rod .to give a false reading,
just as a prism from the trial case would if it wen! held in
front of the Maddox rod so as to displace the liiie in the
same way. A simple way to detect such a pris~ is to 1?,old
the Maddox rod before the eye so as to see the hne of hght
·extending horizontally. Note the_positiqn of the line in
relation to the light. Then rotate the rod through 180
degrees, just as a cylinder is rotated in a trial frame. The
line is ·again horizontal and should extend exactly where
it did before, on the same side of the light and at the same
distance from it. If the line passes dire<;:tly through the
light in the first position, it should do so in the second.
The . multiple rod should be made from optical glass
with the corrugated side ground and finished by accurate
tools. The plano side should be carefully ground and
finished without a prismatic element. Such rods are-now
manufactured for use in the best grade of phorometers.
They project a line of light that is of uniform width, with
sharp e~ges, a minimum of diffused light, and no breaks in
contmmty.
CONCLUSIONS.
1. The Mad do~ rod test, because of its easy application
and the simple nature of the observation required of the
patient. bas a popularity and widespread use among
ophthalmologists.
2. Studies of heterophoria based wholly or in part on
Maddox rod findings are constantly being reported in our
ophthalmic literature in ·spite of the serious criticisms
directed against the test.
3. The test is <;ondemned chiefly because it has been
found to give variable and inaccurate results.
4. The chief causes of inaccuracy are the tendency to
fusion and the phenomerut based on the false projection
of the light seen as a line through the rod.
5. A screen placed over the Maddox rod during the test and
withdrawn for an instant enables a measurement of lateral
imbalance to be made that is accurate and free from any of the
several objections made against the t,est.
6. Every Maddox multigle rod in use should· be. tested
to determine the character of the line of light projected
by it and to guard against the presence of any prismatic
element which modifies the result of the test.
. BIBLIOGRAPHY.
1. STEVENS: An Examination of Some of the Means for
the Determination of. Heterophoria. Ophthalmic
Record, 1892, p. 125.
2. JACKSO N: Tests for Heterophoria and their Compara-
tive Value. Medical News XIII, 1893,,p, 454.
3. MADDOX : Tests and Studies of the Ocular Muscles.
1898, p. 353.
4. JACKSON: Note on the Rod Test. Ophthalmic Review.
1894, p. 21.
5. DUANE : What Routine Shall we Adopt in the Exami-
nation of Eye Muscles. Ne.w York Medical Journal,
May 25, 1901, p. 890. _
6. DuANE: The Practical Application and the Relative
Value of the Tests Used in Examining the Eye
Muscles. Annals of Ophthalmology, April, 1905,
p. 308.
7. HowE: The Muscles of the Eye. Vol. 1, p. 238.
8. SAVAGE: Ophthalmic Myology. 1911, p. 147.
9. SAVAGE: Heterophorias .and their Treatment. Oph-
thalmic Record, November, 1914.
10. WEYMOU1:H: An Experimental Comparison of Three
Common Methods of Measuring Heterophoria.
Ophthalmic Record, June, 1916, p . 271.
11. STEVENS: The Motor Apparatus of the Eye. 1906,
p . 275.
- By court,esy of Transaction of the American Ophthalmo-
logfcal Soriety , 1919, and Archives of Ophthalmology.
 PilRT 8.
RESPIRATORY VOLUMES OF MEN DURING SHORT EXPOSURES TO CON-
STANT LOW OXYGEN TENSIONS ATTAINED BY REBREATHING. 1
MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.
By ?YIAx M. ELLIS, formerly first lieutenant, Sanitary Corps.
Various writers have shown in experiments on men,
both with rebreathers and in pneumatic chambers, that
an increase in the per minute respiratory volume accom-
panies rather rapid reduction of the oxygen tension in the
air breathed by the subject. Hough(l910, 19U-)2 found
that the continued rebreathing of a small quantity of air
(20 to 30 liters) without the removal of the carbon dioxide
produced by the subject, caused a marked increase in the
depth of respiration and in the resp1iratory volume:
Twenty-three of his twenty-five cases showed an increase
of r1Jspiratory depth from the start of the rebreathing test,
and the increase in the depth of respiration was most
marked iu those cases in which there was some decrease
in the rate of respiration. Haldane and Poult~(l908),
using a rebreather which removed the carbon dioxide
produced by the subject, observed great hyperpnoea when
the oxygen in the air breathed was reduced from 10 to 5
per cent in a few minutes. Schneider(l918), reporting
on rebreather tests of 25 to 30 minutes duration, states
that more than 50 per cent of the men examined gave an
increase in respiratory volume when the reduction of
oxygen had proceeded to 16 to 14 per cent. Lutz(l919)
noted an increase in the respiratory volume of men in
the low pressure chamber :rt a pressure equivalent to
4,000 feet altitude; when the pressure was reduced at a
rate equivalent to a rise of 1,000 feet per minute. Lutz
and Schneider(l919), in a series of expetiments both in
the low pressure chamber" and with the Dreyer nitrogen
apparatus, found that the onset of increased breathing
occurred at about 656 millimeters mercury pressure
(about 4,000 feet altitude ) when the reduction in oxygen
tension had been made at a rate equivalent to a rise of
1,000 feet per minute. They also state that 9 out of 14
subjects gave a maximum ventilation during the first 10
minutes at 20,000 feet, and that following this period
there was a distinct falling off in the per minute volume.
The data which follow afford comparisons of the per
minute respiratory volume of 29 men during exposures
of ·10 to 30 minutes to various constant oxygen tensions
lower than the tension of sea level air, with the volumes
breathed at sea level and during the reduction of the
oxygen tension by rebreathing. Additional data are of-
ered on the increase in respiratory volume during the re-
duction of oxygen tension by rebreathing. Th!)se ob-
1 Abstract, in part, ii1 Proc. American Soc. Physiologists, Amer. Jour- · in the rebreather had been reduced could be read at any
nal Physiology, p. 119, for April, 1919, by authority from S. G. 0., dated
April 23, 1919.
• References refer to bibliography at the end of the article.
(45)
servations were made as parf of the general study of avi-
ation physiology at the Medical Research Laboratory of
the Air Service, during the fall and winter of 1918- 19.
The writer is indebted to Lieuts. H:. Fried, C, N. Larsen,
and B. R. Lutz for assistance during the experimentation.
The rebreather desigiied by Larsen and Davis(Larsen,
1919). was used in these tests. This machine is a portable
modification of a dosed rebreather in which the carbon
dioxide pn;is:Iuced by the subject whil~ rebreathing a
given volume of air, _is removed by a scdium hydroxide
cartridge. The rebreather tank contained 54 liters of
sea-level air at the beginning of each experiment, a volume
which the average subject could reduce from 21 per cent
oxygen to 9.8 per cent oxygen (equivalent to 20,000 feet
altitude) in 20 to 25 minutes. While holding the subject
at sea level or at a given oxygen ttneion, oxygen was
supplied automatic3lly to the subject by his own respira-
tory movements from a balanced oxygen spirometer.
The general plan of each experiment may be summarized
as follows: The subject, either sitting or reclining, was
connected with the rebreather through a rubber mouth-
piece and standard rubber gas-mask tubes. The re-
breather spirometer was set at zero and the valves to the
subject .opened at the end of an inspiration. In this way
the spirometer was raised by the volume of one expiration
minus the carbon dioxide which was removed as the air
passed in through the sodium hydroxide cartridge. One
or two inspirations sufficed to lower the re breather spirom-
eter to zero again, and as the water seal on the oxygen
spirometer was brokeri each time the rebreather spirom-
eter reached the zero level, a volume of oxygen equal to
that used by the subject during the last inspiration, entered
the rebreather tank, before the water seal of the oxygen
spirometer again closed. (See Larsen, 1919.) The sub-
ject continued this phase of the experiment, using air of
sea level oxygen tension until 10 to 15 minutes of normal
breathing had been recorded. The oxygen valve was
then quietly closed, and without any change in the re-
sistance of the apparatus the subject began the rebreathing
of the 54 liters of air in the rebreather tank. The loss of
air volume due to the absorption of oxygen by the subject
and the correlated absorption of carbon dioxide by the
sodium hydroxide cartridge was offset by raising the
movable bottom of the rebreather. By means of a scale
on the rebreather the per cent of oxygen to which the air
time and- thC;) equivalent altitude determined. The-
composition of the gas in the rebreather was also checked
 46
by analyses with a Henderson-Orsat apparatus. When I RESPIRATORY VOLUME DURING SHORT EXPO-
the subject had reached the desired oxygen tension the I SURES TO CONSTANT LOW OXYGEN TENSION.
oxygen_ valve was again opened and the oxygen tension Table 5 summarizes the comparisons of the respiratory
maintamed 3:8 at sea level. The respir~tor? vo_lume was volumes of the subjects while breathing air of a constant
read each mmute from the Larsen respiratwn mtegrator oxygen tension lower than the tension of sea-level air,
(La:sen, 1919). The blood press~res and pulse of the after reaching these oxygen tensions by rebreathing, with
subject were taken every other mmute as checks on the the volumes moved at sea level and during the reduction
subject's c~ndition. . by rebreathing.
The subjects for these exp~runen:s, drawn from the Thirty-two of the 36 subjects breathed a greater volume
A1;
~abooodratorhy sltahff and fro3m the Service, were young men per minute during the first 10 minutes at a constant lo. w
m g ea t , 20 to O years O age. oxygen level than at sea level. These various oxygen
RESPIRATORY VOLUME DURING THE REDUC- tensions were equivalent to altitudes of 5,000 to 21,000
TION OF OXYGEN TENSION. feet. The four men who were held at a constant low
oxygen level for 20 minutes and the one man who was
Because of the minute to minute variation in the respira- held for 30 mir.. utes in low oxygen, each continued to
tory volume readings they have been averaged for the breathe more air per minute throughout their sojoW"ns in
first 5 minutes of oxygen redu ction, for the first 10 minutes, low oxygfm than at sea level.
and for the remainder of the reduction period. The grouping of the cases if the respiratory volume at
From Tables 1 and 2 it may be seen that 23 of 29 subjects the reduced oxygen level is compared with the respiratory
who began the reduction of oxygen tension at sea level volume during the reduction of oxygen by rebreathing, is
showed an increase in the respiratory volume during the not so uniform. Seventeen of the thirty-six subj ects had a
first 5 minutes of rebreathing, and that 25 of the 29 gave an lower per-minute respiratory volume during the firnt 10
increase dufing the first 10 minutes. Of the four remain- minutes in low oxygen of a constant tension than during
ing cases three increased the respiratory volume during the period of rebreathing which preceeded this exposure.
the second IO-minute period. Of the five men who were held in low oxygen for more than
By plotting the oxygen reduction as .a straight line (the 10 minutes four gave a lower respiratory volume for the
current usage of the laboratory, verified by analyses made second 10 minutes of the exposure than for the first 10
at different stages of rebreather tests-see Air Service minutes.
Medical, 1919) the approximate per cents of oxygen reached The average depth of respiration of the subjects during
by each of the 29 men during the fust 5 and 10 minutes of these exposures to constant low oxygen was greater than at
re breathing were obtained. (Table 3.) These figmes sea level in 15 of 20 cases. The respiratory rate was th e
show that the increase in respiratory volume appeared same as or lower than the sea-level rate in il of 20 cases.
very soon after the red·uction of oxygen began, as 22 of the
29 subjects had not reduced the oxygen in the rebreather DISCUSSION AND SUMMARY.
tank air below 18.1 per cent, at the end of the fifth minute. The increase in respiratory volume during the reduction
The lowest per cent reached by any individual at the end of the oxygen tension found in these experiments agrees
of the fifth minute was 15.6, and the average of all cases with previous work of other writers who reduced the
was 18.1, equivalent to an altitude of about 4,000 feet. oxygen tension of the air breathed by their subjects at a
The average per cent reached at the end of the tenth fairly rapid rate. The increase here discussed can not he
minute was 15.2. ascribed to the resistance of the apparatus (which was
A comparison of the seven cases which began the reduc- practically negligible) as the subject respired through th e
tion of oxygen in the air breathed ;:t second time, after apparatus during all phases of the experiment, i.e ., during
remaining at a level of reduced oxygen tension for some the sea-level normals as well as during the reduction by
minutes, gives an increase in the respiratory volume rebreathing and during the exposure at low-oxygen levels;
during the transition period from one level of reduced nor is it the result of an accumulation of carbon dioxide in
oxygen tension to a still lower level. Considering all cases, the rebreather as check analyses of the gas in the re breather
the reduction of oxygen tension was accompanied by .an were made by the Henderson-Orsat gas· apparatus. This
increase in respiratory volume in 32 of 36 cases, regardless increase in respiration does, however, accompaRy the
of the initial oxygen tension, and this increase in the reduction of oxygen tension and begins very early in the
respiratory volume was initiated in less than 10 minutes of reduction phase of the ex:pitri'ment. Haldane, Meakins,
re breathing. and Priestley (1919) offer an explanation of his response
A correlation.of the rate of respiration with the respira- by stating that the first result of tbe diminution of the
tory volume in 20 cases indicates that there was little percentage of oxygen is an increase in the depth of respira-
change in the rate of respiration during the first 10 minutes tion owing to a lowering of the threshold of exciting value
of rebreathing. (Table 4.) Only 3 of these 20 cases, of carbon dioxide. This explanation if applied to the
however, failed to show an increase in the average depth present experiments would call for a change in the carbon
of respiration during the first 10 minutes. From this it is dioxide threshold very early in the rebreathing reduction
evident that the increase in respiratory volume was the of oxygen, as the tables show tliat most of the subjects had
result of an increase in the depth of the individual respira- responded with an increase in respiration by the end of the
tions. fifth minute- and to an average oxygen per cent of 18.1.
 47
Although the individual minute-to-minute data for respira-
tory volume can not be given here, they showed when
plotted as eurves, a distinct upward trend in every case
after the first or second minute of rebreathing, suggesting
that the actual increase in respiratory volume began earlier
than the fifth minute and at an oxygen per cent higher than
18.1. If the response to reduction of oxygen tension by
increase in respiratory volume began above 18.1 oxygen,
it might have been so small as to be easily masked by other
factors and escape notice on the rebreather. That there is
a progressive increase in the magnitude of this increase in
volume response as the reduction of the oxygen progresses
is suggested by a comparison of the per-minute volume
during the first 10 minutes of the rebreathingreduction with
the per-minute t'llspiratory volume during the second 10
minntes of rebreathing, the volume in the second pe6od
being higher in the majority of cases.
Considering the average of 18.1 per cent oxygen as the
point at which a definite .increase in respiratory volume was
found , the responses of 29 subjects examined came earlier
a
in the rebreathing reduction, i. e ., at higher oxygen per
cent, than in the cases given by Schneider (1. c. ), but at
almost exactly the same level as that given by Lutz and
Schneider (1. c.) for the onset of increased respir(1,tory
volume in theiilow-pressure chamber and Dreyer nitrogen
apparatmi experiments. It is· interesting to note that they
found the alveolar carbon dioxide tension definitely low-
ered at 656 millimeters of mercury pressure, which is ap-
proximately equivalent to 18.1 per cent oxygen.
The larger respiratory volume moved per minute by sub-
jects during short exposures to low oxygen after a rather
rapid reduction in oxygen tension by rebreathing, as com-
pared with their sea.-level per-minute respiratory volvmes
might be expected in the light of the increase in respiratory
volume at 18.1 per cent oxygen. The fall in per-minute
respiratory volume during the first 10 minutes of these
exposures to constani..low oxygen, to a volume lower than
that moved during the reduction of oxygen by re breathing,
in 17 of 36 cases, presents an interesting example of rapid
compensation to low oxygen. Lutz and Schneider (1. c.)
found a similar fall in the per-minute respiratory voume
in 9 of 14 cases held at 20,000 feet in the low-pressure
chamber, and state that they believe this fall in respiratory
volume to represent a temporary improvement in the sub-
ject 's condition. That this fall in respiratory volume does
indicate more or less compensation to the new conditions
of low oxygen and an improvement in general condition of
the_ subject is suggested in the present experiments by two
comparisons. . "·
If the 36 subjects are divided with regard to the per
cent of oxygen in the air in which they were held during
the exposures to constant low oxygen, i. e ., the line of
equivalent altitude·, 10 of the 36 cases were held at. ten-
sions equivalent to altitudes varying from 5,000 to 10,000
feet, inclusive. Of these 10 cases S had lower respiratory
volumes during the first 10 minutes at constant low
oxygen levels than'dnring the reduction of oxygen; and
the other two cases, although maintaining a higher per
minute volume during 1,the first 10 minutes at the new
oxygen level , decreased.<their per .minute volumes during
the second 10 minutes of the exposure to constant low
•
oxygen, to volumes lower than those breathed during the
reduction of oxygen. These cases held at comparative
low altitudes, or comparatively high oxygen per cent.a, con-
stitute half the cases in group 1 of Table V. If the per
cent of oxygen in the air breathed during these exposures
to low oxygen may be taken _as a gross index of the severity
of the conditions to which the subjects were attempting
compensations, the lower the oxygen per cent and the
higher the equivalent altitude, the greater the task of
adjustment. That the subjects exposed to the less severe
conditions did show this fall in respiratory volume during
the first 10 minutes in constant low oxygen, does therefore
favor the view that the fall in respiratory volume (pulse
and blood pressw-e remaining good) is associated with
compensations to reduced oxygen tension, which enable
the body to maintain itself without so great a per minute ·
respiratory volume.
As shown by the blood pressure and pulse records,
subject " K" was approaching a collapse during his sojourn
at 21,000 feet, i.e ., he was not maintaining nor improving
his condition at that level of low oxygen. His per minute
respiratory volume did not fall during the 10 minutes he
was held at 21,000 feet, but on the contrary continued to
increase above the volume breathed during the first,
second, and third 10-minute periods of rebreathing. This
case gives the respdnse in respiratory volume of a subject
exposed to conditions of low oxygen obviously too severe
for his compensatory complex at the time of this particular
experiment. The response of subject "K" also indicates
that the fall in respiratory volume of suhjectR under less
severe conditions was correlated with advantageous com-
pensations.
Although the respiratory volume during exposures to
constant low oxygen tension was greater than the respira-
tory volume at sea level, the return to sea-le'vel air was
accompanied by a very prompt return to the sea-level
respiratory volume . To check by quantitative methods
the general observation made on all subjects, subjects
"AA," ":\.C, " and " AD" were carried through a fourth
phase of experimentation. After completing the exposure
to low oxygen the valves were opened and the subject
allowed to breathe pure, unmixed , sea-level air through
the rebreather tubes fqr two minutes. This change to sea
level was instantaneous, and it was presumed that the
lungs of the subject were fairly well ventilated by breath-
ing outside air tor- two minutes. At the end of two min-
utes the rebreather valves were again closed and the sub-
ject's per minute respiratory volume while breathing pur(l
sea-level air was obtained as at the beginning of the exper-
iment fodm additional 10 minutes.
The average per minute respiratory volume of "AA"
returned to within 250 cubic centimeters of his original
sea-level respi.ratoryvolume, during this 10-minute after-
period at se7t level, although his increase in respiratory
volume at the low oxygen level was 4 .520 cubic centi-
meters. The respiratory volume of " AC" fell during the
10-minute afterperiod at sea level 120 cubic centimeters
and that of " AD" 500 cubic centimeters below .the sea-
level respiratory volume taken at the beginning of the
experiments. The increases in respiratory volumes at the
 48
low oxygen levels were 870 cubi_¢ centimeters and 920 still greater than the sea-level respiratory volume. These
.cubic centimeters, respectively, for these two men. 17 cases include all but one of the cases held at .oxygen
One correlation of tne pos\tion ol the subject during the levels equivalent to 10,000 feet or'less.
te.s t with the increase in respiratory volume during the 6. This fall in respiratory volume during 1:he first 10
reducti9n of oxygen by rebrea.thing seems worthy of note. minuMs of exposure to constant low-oxygen tension was
The per cent of increase in the.respiratory volume at the correlated apparently with compensations to low oxygen
end of the tenth minute of rebreatliing was higher for the advantageous to the subject.
·. . . . . . . 7. The return to sea-level o~ygen tension was followed
sitting subJects than for the rechmng subJects. As thlB \ by a prompt return to the sea-level respiratory v-0lume.
may be a function of the relative metabolic rate in the · ·
two positions, it may be added that Emmes and· Riche 1?rnLIOGRAPHY.
(1911) found the rate of metabolism in sitting subjects to Arn SERVICE MEDICAL, 1919, War Dept., Div. Military'
be 7\ 6 per cent higher than in reclining subjects, as shown Aeronautics, Gov. Printing Office, pp.1-446.
EMMES and RICHE, 1911, The Respiratory Exchange as
by th~ir oxygen consumption. affected by body position, Amer; Journal Physiol.,
1. The respiratory volumes of 29 men. during the reduc- Vol. XXVII, pp. 406-413.
tion of oxygen tension by rebreathing and during short HALDANE, MEAKINs, and PREISTLEY, 1919, Journal
exposures to constant low oxygen tension following the Physiol., Vol. LII, PP· 420. ·
HALDANE and PoYLTON, 1908, Effects of want of oxygen
period of re breathing were studied in copnection -with the on respiration, Journal Physiol., Vol. XXXVII, pp.
sea-level respiratory v-0lumes. 390-407.
2. An increase in the respiratory volume was noted at HouGH, 1910, The Influence of increase of alveolar ten-
sim;i of oxygen on the respiratory rate and volume of
tlie end of the fifth minuJe of rebreathing, at an average air respired while breathing a confined volume of
of 18.1 per· cent oxygen (approximately equivalent to air, Amer. Journal Physiol., Vol. XXVI, pp. 156---168.
4,000 'feet altitud~) in 23 of the 29 subjects. HouGH, 1911, Variations in the response of healthy men
3. The minute-to-minute respiratory · volumes sugge~t. to the dyspnek conditions produced by breathing
that this increase
. may occur even earlier in the rebreathii.l,.,"' · confined volumes of air, Amer .. Journal Physiol.,
Vol. XXVIII, pp. 369-390.
period. · LARSEN, 1919 (Descriptions of new apparatus perfected
4. The respiratory volume during the first 10 minutes at · the Medical Research Laboratory), Air Service
of the exposure to constant low-oxygen tension, varying Medical, in press.
LuTz, 1919', Abstract, Proc. Amer. Physiol. Soc., in Amer.
from 5,000 to 21,000 feet equivalent altitude, was,.greater Journal Physiol. for April, p. 119. ·
than the sea-level volume. in 32 of the 36 cases. LUTZ and SCHNEIDER, 1919, .Alveolar Air and Respiratory
5. The respiratory ·volume of 17 of the 36 cases fell Volume at Low Oxygen Tensions, Amer. Journal
during the first 10 minutes of the exposure to constant Physiol., in,press.
SCHNEIDER, 1918, Medical Studies in Aviation (in part),
-low-oxygen tension to a volume lower than that moved Journal American Medical Assoc., Vol. LXXI, pp,
during the reduction of oxygen by rebreathing, althoug,b 1382-1400.
TABLE !.-Average per mi:nute respiratory volume in cubic centimeters--Subject sitting.
Initial IO-minute \ Rebreathmg
period. . penod
. volumes. I ,
At rednced 0 2 level.
Time
Subject. o - Tenth Equiva- of reduc-
1 1 10
per cint. Volume.\ m~tes. mi~tes I O
minute Volume. per c~nt lent alti- tmn.
- -- - - - - - - - - - - - - - - - · l- - - - - - -- i- -- - - - · toend. - -- - - - ~
1
AX................. . ... . ................ .. ....... 21 6,IDQ 5,840 5,720 5 600 J.7 4 1'/xio .Mmutes9

~~~::: :::: :: ::.:::::: :,:: :.:::: :: :::.:::::: :::: :: :.

D ................. .. . ....... .. ............... . ...
~:
21
-~:6,620
~fo 1
~:~gg
9,ooo
:~:9,460
~: 9,500
1
~: 1: :f i f ~
1'100 15· 4 3'000
n
10
AF,........ . .... . .... ............. . . .......... .. .. 21 7,830 7,800 9,530 10,900
11:100 15.4 R'ooo
1
15
1
10, 350 ······ ..... • •• • •
4, 400 . "i,;i,:io· ··:·1;880·. ··1;850··.
•• - · · · · · · · - · - · - · ••• • •• • ••••••••••
B.. . ....... . . . . . ................ . ..... ... ... .. .... 21 7, 010 14.8 9,000 14
AB ................ . . . . .. . .. .. .. .. ... ........... . . . 21 9,070 10,750 12,590 12,913 12,540 14. 3 10,000 17

~ ~: ~: ~:
2

AG ......... .. .................. -· ........ - . - ... . .. : : : : : ::.: : : : :~: : : : :~,:~~~: : : :: ~'. : : : : ~; ;1:6::,:r990~ ; : ; /l:,44;·.~3;; : : :11;oO;,,·ooo0;00:;: 1; ; ;: ;;;-;i1;2:
0

AA ..... . ......... _. . . ..... . . ... ... . . . . _. _........ - .. · ·2i · .. · .. i2; :i10· ·· -.ifi)oo· · .. iii;-i-io · · .. ii;i;oo·
• 12, 720
17. 4 13, 690 ... i6;54o· ::: :::::: :::::::::: - -i-i;soo· · ····i:i::i····10;000· ·········5
!t:::::::::::::::::::::: :::::::::::::::: :: :::::::: 21 6,380 6,300 6,950 6, 957 7,250 13 ..7 11,000 17
AD ....... _. . - ........ _. . _. _, . _. : ... ___ .. .. . . .. _.. . 21
• 6,260
s.390 ·· ··r,;:ioo· -· .. 1:coo· · ..
i;i-io· .. . :6;:iio· .... . ia:1· ···ii,ooo· ··· ··· ii,
• 4;890
AH, . ....... . ..... _._ ........... - ... - ... .... ..... - .. 21 5,250 .. . s;i110· ... 6:960· .... (i20· .... s;s20· ... ·i:i:1 · ... ii;ooo · ··· ··· · is
AQ ...... ....... : ... ............. . ................ . 21 6,600 6,700 6,690 7,070 7;760 12.7 13,000 20
R ... ........ ..... . .......... .. .. .. .... .... ....... · · ... :ii" . . .. s;ii:io· .... ii,ooo· ... i2;oro· ... iz;il-io·
27,590
1:i,210 .. ... 1·2·.: s· ·· ·.i_i,:00· o· ··· - ··· 2· 0
AJ. .. ..·................................. .......... 21 7,750 8,900 9_,.030 9,633 8,340 11 3 1" 000 13
AAIE.. . . . ....... _.. .. .... . .. ... . __ . ... . .. . ... •. ..... , .....
, ......................... ·. ... .. .................
zi' ..... ooo· ....
14. 3
io;
14, 800
iJ;i;oo· - ... ii; 230 .... io; 833.
5 17,600 17,500
2
i:m ....·1·.11·.':~l· .. "1·o~',·',ooo'fXl·o-o··1·.. ... -.i8i.
1

AF;,.•................................. ·. .. . .........
AH, ....... : . ........ .. .......... ·. . ..... .. .... . ....
15.4
13.7
11,100
5, 820
',.12v',,666S66 13,600
4,180
0
1 1
10.4
1
18,300 6
AK ...... .. ........ .. . , . .. . . .. . ..... _.... - _. . . . .. . 21 6, 100 1, 460 8,~o_so _ __s~,_53_5_ _~ _ _ _~rn
8,'-4_20_ _ _9_._4 _.:__2_1'-,o_oo
L Average eleventh to fourteenth minutes. inclusive.
'Average eleventh to twentieth minutes , inclusive.
, A".erage twenty-~rst to thirtieth minutes, inclusive.
•. Average for 10 .=1:1utes at .sea lev_el oxygen tensio':' at th~ end of the experiment; 2 minutes elapsed between the last reading at low oxygen
tension and the begillJ?lng of ~his 10.mmut~ penod. durmg which 2 mmutes the subject was breathing sea-level air outside of the rebreather.
• Average first to s1xtb mrnutes,mclus1ve.
Su bnumerals in this table and in Tables 2 and 4 refer to successive sections of one experiment.
 49
TABLE 2.-Average per minute respiratory volume in cubic centimeters-Subject reclining.

Initial 10-minute Rebreatbing period volumes. At reduced 0 2 level.

period.
Time
Subject. of r ed uc-
Tenth
~flt ~
tion.
o,
per cent.
Volume. 1· 5 l-10
minutes. minutes. minute Volume. O,
to end. per cent. tude.

Feet. Minutes.
1. ...... •....... .. .-.. ................... ........ .. . 21 6,590 7,980 8,330 10,190 12,770 13. 7 11,000 18
J..... .. .. .. ... . .............. . .... ... ............ .. 21 14,050 15,000 15,180 16,100 16,100 13.7 11,000 17
G,...... .. ....... .. . .. ... .. .. . . .. . ... ..... .... ...... 21 13,480 12,200 13,560 13,550 14, 390 12. 6 13,000 12
N,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 11 , 040 12, 000 12, 200 12, 215 10,960 13. 3 12,000 19
~;.-:::::::: :::::: ::::: ·:::: ::::::::::::::::::::: :::
L....... . . .. . .. ....... . .... . . . . ... ..... .. ... .. ... . .
iL
21
}&:~
9,050
tgti;; ... ~
10,500
1
·.~:~ ....... . . . .
11, 525 11, 492
12, 600
15,270
12,450
13. 3
12. 3
12. 3
12,000
14,000
14,000
8
2
17
F... ... . . . ..................... ... . . . . . ...... .. .. . . 21 11,320 12,650 13,015 13,030 12, 880 12. 3 14,000 18
°'· ············ ·· ····· · ··· · ········ ······· · ······ ·· 21 11,950 12,320 13,860 14,210 12,520 11. 8 15,000 20
P...... ...... ...... ... . ..... . .... ..... .. . ..... . .... 21 11,980 11, 900 11,820 14,700 12,300 11. l 16,700 15
o, .... ...... .. ·· ·· ·· ·-· ··· ···· ··· ····· ····· ··· ... .
G,........ .. ......... ....... ....... . ............. . ..
11. 8
12.6
12,520
14, 390
12,866
15,633
. . .. .. ... . • · ·· ······
......... . . .... .... .
13, 305 JO. 4 18, 300 3
18,300 10. 1 19,000 3
M.. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 13, 010 14, 560 18, 840 . . . ...... . 17, 370 10.1 19,000 10
H...... . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . 21 11 ,360 12, 000 12,400 13,155 16,540 10.1 19,000 21
K...... . .... . .. . . .. .. . . . ... ... .. .. .... .. . . ...... ... . 21 8,550 9,200 9,980 10,870
•• • • • . • . • . • • •••••. • • • ,a .• . ••.. •••• . • • .•• 110,400 -· ·i2;1:ior-- ··gx ···2i;i100" ........ :ii

1 Average twenty-first t o t hirty-first m i nutes,inclusive.

TABLE 3.-Approximate oxygen levels of subjects at the end of the fifth and tenth minutes of rebreathing.
SUBJECT SITTING.

Percent
0 2 per cent O,percent change in
Subject. at end of at end of r espiratory W ei1;htof
filth t enth volumedur- subject.
min ute. min u te. ing first 10
minutes.

Pounds.
AX . ........ . . ...... .... .. ........ . . . ... . . . . . .... . . .. .. . . . .. . ..................... . ..... .... . . 19.0 17. 4 5- 140
AE ............... .... . .... .. . ... . ..... .. .... . ... . . . ... .. .. .. ..... .. .... . . . . .. . . . .. .. .... ... . . 19.2 17.4 61+ 175
c .... ...... .. .. ............................................. , .... ... . ... ... ......... .. ....... . 18. 2 15. 4 74+ 168
D . •. .... . ... . .............. . ...... .......... . . . ...•... ................. . .................. .... 19. 1 17. 3 43+ 140
AF .. ... .............. .... .... .... . . .................... ...... .. . .. .. . ....... ........ ..... ... . 19.1 )7.3 21+ 133.
B ........... ... . . .. ...... .. .. ....... .. .. .. . . . . .... .. • . . ........ .. ....... . . ..... ... . . ... ... .... . 18.8 16:5 75+ 110
AB .. . ...........•. . .. . ... .. . . ... ........ .. . . .. . . .. . . ...... . . . .. . ... . .. ... . . ..... ...• . . .. .... . 19. 0 17. 4 39+ 140
AG .......•...• . ••••• •.. . . ... .....•....................... .... .•. .......... • .. : ...•..... ...... 18.8 16.5 36+ 150
AA ..... . .................. . .... . ... ....... . . .......... . .......... .. .. .. . ... .. ... .. . ......... . 18.1 15. 3 32+ 160
AC .. .. . .. .. . .............. ......... . ............................. . ................. .... ...... . 19.2 17.4 9+ 140
AD ..... . . . ... .. . .. .. ...... .......... . .. .. . ...... , . . .............. .... .............. . ...... .. . 18.6 16.2 31+ 140
.AH ..... ... .. . . . . .. . .. . . . .. • . . ....... ....... . .. . • . . .. . . . . . ... .. . . .. . . . . .. • . .......•...... . . ... 18. 6 16. 2 33+ 160
AQ ... ... . • •. . • .• • . .. ..... . ........•............. , . .....•..... . .. . .....•. . . . . . ...... .... . ....• 18.8 16.6 l+ 150
R . . . ... .... ................. .. ... ... . . ........... .. .... .. . ..... • .... ... ... .. ....... ..... ...... 18.9 16. 7 35+ 165
AJ .. .................. . ..... . . . .. . ... .. .. . . . ............... . ... • ............................·.. 17. 5 13. 9 17+ 165
AI.. ............... . ...................... . .................... .. ... ... . ... .. . . . . . . ....... . .. . 18.4 15. 9 8- 224
AK .. ... .. .. .. ..... . . . . .. ... .. ................... .. ... ....... ..... .. . .. . ...... . . .. .. ... . ..... . 17. 8 14. 6 21+ 163
SUBJECT RECLINING.

t):\( ; ~;:; ~ ~ )\\~) ~; \) ;;;:::::;::: ~~:: : ~ ~ ~:);:):::: :(::::: : ~: :\ :~) ~:: : J

19.0 17. 1 26+ 144
18. 9 16. 7 8-+: 110
17. 5 13.9 7- 170
18. 7 16.8 11+ 160
P......................... . ..... . .......... . ..................... . ..... .......... ... . 17.6 14.3 1- 190
K ..... ..... .... , ................. . ....... ... ................... . ......... ... . 19.1 i'7.3 16+ 160
N ................ .. ... ... .... ...•.•. • ... ... •.... . . . .• •. . . . . .. •. .... . . •..•.... .. . • . ..• . ....... . 19.0 17. 1 11+ 160
Q . .. ...... ..•. .. . . . .. .....• . . ... .. . •• • . . • . , . . • .. . . ..•.. . ... . •........... . .... • • . .... . . . . .. 16.1 13. 2 R+ 130
L . ..... . .. .. . . . . . . . .. .. . . .. , ... . .. . . •. .. ....... .......... .. . .. .. . ........ 18. 4 15. 9 27+ 160
F ..... . ..... ...... ......... .. ··· · ·· ········· · ··············· · ·· 18. 5. 16.1 15+ 12ii
M.... ·············· ········ ·· ········ 15. 6 10. 3 43+ 123
H..... .... . . . ..... ··· ··· ······ .. ... . . .. . . . .. ... . ... . ... . ...... .. ... . ...... . .. . 18.4 15.9 9+ 144

1454-30--4 0
 50
TABLE 4.-Average per minute rate of respiratory and average depth of respiration in cubic centimeters.

Sea level. During reduction of 0 2• At reduced 0, level.

Eqniva-
Subject. First 10 minutes. Second 10 minutes. First 10 minutes. lent.
alt itude.
Depth. R ate.
Depth : / Rate. Depth. Rate. Depth . Rate.

Feet .
AX ..... • ..•. • . ... . .. .. . .. . . . • • .. .. . • • . . . . . . , .. .... 381 16 396 14.4 ... .. i2··· 1 350 16 5, 000
AF,..... ...... .... .. .. ..... . ....................... 524 13 .768 12. 4 · · ··· ·ilos· 925 12 8,000
AQ . . .... . . . . . .. .. .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 413 16 446 15 471 15 485 16 ·13,000
R . .... . .. .... . . . . . . . .. . . .... .. . . ... . . . . . . . .. . .. . ... 539 16.6 726 16.6 779 16.6 799 16 14, 000
AF, ... . .. .. .. . . .... .. . ..... . .. . . .. . .. • . . ..... ... .. ....... ... .... ...... 1, 005 12. 6 ···--·· · · · ·· · · ··· ·-- 1, 152 11. 8 16,"700
AK, . . ..... . .. ......•..... . .... . .... . .. . ... . . ... 698 9.6 824 9.8 888 9.6 1,005 8 21,000
I
L ...... ......... .. ... . .. . .... .. . .... . . .. . . .. .. .
J ... . .. . . . . .. . . . . . . ... • .. . ... . . .... . . . . •. . . . ....
366
878
1,225
18
16
11
I 438
766
19
19.8
509
894
20
18
751
947
·l, 182
17
17
11. 000
11; 000
13,000
g:::::::::::::: ............ .. .... .. .':::::::::::
P ....... . . ........ .... . . .. . .......... . . , . .. . .. .
949
798
12.6
15
1, 013
976
n2
12. 4
14. 2
16.6
1,1 27
1, 000
865
12
14. 2
17
963
707
12
13
17. 4
15,000
6, 700
0, . . ..... . . .. . .. . .. . . . . .. . . .. . . .. . . .. . . .. . ... ....... ···· ······ . .... . .. . . 989 13 · ·- · ·· ··· - 924 14.4 18, 300
G, ...... ....... . . . ... . . .. .. ·· ·· · · ···· · ·· ··- · - 1,182 13 ...... 724 . .. . 1, 800 10.3 19,000
K....... .... ......... .... . .. . . ...... . 655 15 15 909 14 21,000
743 I 14 ....... . ... . ....... . - ·-··· · · · ·
N,...... .......... . ....... . . . . . .. . ..... . . .. . . ······gj;i" . .. .. ii:ii° .... i;ioiJ ...... ii .. . 1,018 12 13. 7 12,000
r~.·.·.: ·.·.::·.·_
·_
······:::::::::::::::::::: ········-······· tm rn
800
1· ,:005i·
~·~· · · · · · · • 9~· · · . ...·i; i49. ···-- io··· 1, 075
1, 296
14
9.6
14, 0()()
14,000
F......... .... ...... ..... ... 1 1,627 8 1,150 8.5 1,842 7 14, 000
M......... .. . . . .. ... . . . . . . . . . .. . . . . . . . . . 1 1, 00-~ 17 ..... ·092· 1,022 17 19,000
B;...... .. .. . ......... . . .... .. . . .. . . . . . .. . . . ...... .. 728 1,5. 6 689 18 19 863 18 19,000
1 1

' Twenty-first to thirty-first m inute.• inclnsive.

TABLE 5.- Comparison of the per minute respiratory volumes dµ.ring the three phases of the experiment.

Subject Subj ect

sitting. reclining. Total.
- -- - - - - - - - - - - - - - - - - - - ------ - - - - - - -- - -- -- - - -- - - - - - - - - -- - - - -
Respiratory volume during first 10 minutes at low oxygen level less than r espiratory Yolume during reduction of
oxygen but gr eater than sea level respiratory volume. Group 1. ... ..... , ...... ... . _. __ ......... . ........ . ..... . 13 4 17
Respiratory volume during first 10 minutes a ~low oxygen level gr eater than respiratory volume during reduction
of oxygen and at sea level. Group 2 .... ... ............ ..... ...... .. ..... _. . _...... _... ... ......... .. . ... .. ..... . l 5 2 10 15
Respiratory vohune during first 10 minutes at low oxygen level less than the respiratory volume dilling r eduction
of oxygen and at sea level; r espiratory volum e during reduction of oxygen greater than that at sea level. Group 3 2 3
Respiratory volume decreased throughout the experiment .. . ... .... . ... . ... _... _ _.... ..... . ............. . ...... . 1 . . ... ........ ...... .
Cases . . ... ... ........... . • .. ... -. ... -. -..... . ...... -·· ·· ·· · · ·· · · ·· ·· · ·· · · · · · · - ··· ··· ······· · ·· · ···· ······ 1 21 15 36

1 Two of these 5 cases gave a respiratory volume less than the respiratory volume during the reduction of oxygen during the second 10 minutes
at low oxygen level.
'One of these 10 cases had exactly the same r espiratory volume during the first 10 minutes at th e low oxyg@ level and the last 10 minutes
during the oxygen reduction.
-By courtesy of American.Journal of Physiology.
 PART 9.
ALVEOLAR AIR AND RESPIRATORY VOLUME AT LOW OXYGEN TENSIONS
MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA . LONG ISLAND, N. Y.
By EDWARD C. ScHNECDER, formel"ly major, s ·a nitary Corps; BRENTON R. LuTZ, formerly first lieutenant, Sanitary
Corps.
'.\fodern warfare has not only created a need for quick
ascents to high altit ud e for brief periods, but has mad e it
necessary fre1uently for pilots and observers in recon-
naissance to remain one or two hours at 15,000 feet or
higher. In the ligh t of data recently published(l ) 1 from
this laboratory it seems clear that during expos ures of a n
hour or more relatively permanent factors may relieve the
more temporary means of compensation which come into
play when the ascent is made at the rate of 1,000 feet per
minute. In connection with experimental work along
these lines there was an opportunity to determine the
alveolar air and respiratory volume under c~nditions which
simulated , so far as time and pressure were concerned , an
ascent in an airplane to 18,000 or 20,000 feet . Many of
the subj ects were maintained at these levels for periods
varying between 20 and 127 minutes, during which the
alveolar air or the respiratory volt1me was fo llowed .
Few observations have been made under th e conditions
mentioned above. Haldane and Poulton(2) report great
hyperpnoea when the oxygen in the inspired air is red need
from 10 per cent to about 5 per cent in a few minutes.
When the reduction was made more slowly from about
12 per cent to 9 per cent in 30 minutes, there was no
noticeable hyperpnoea . The alveolar air fell to values
between 3.9 and 4.3 per cent. Schneider(3) reported an
increase in lung ventilation, beginning as soon as the
oxygen per cent had been reduced by the rebreathing
miithod to 16 or 14 per cent, when the rate of reduction
was about eqnivalent to an ascent of 1,000 feet per minute.
Lutz( 4) has reported that at this rate of ascent the onset
of increased breathing may come as early as 656 millimeters
(4,000 feet) in the low-pressure chamb er.
Many investigators have shown that the lung ve ntilation
is increased at low oxygen levels when the low level is
reached after some delay . Loewy(5} reported that the
volume of air breathed began to increase at a reduction of
pressure to 580 millimeters (7,000 feet). Loewy and
Zuntz(6) found a 4 per cent increase in ventilation when
the pressure was reduced to 448 millimeters (13,800 feet) .
Boycott and H aldane(7) found that when the atmospheric
pressure was diminished, the alveolar carbon dioxid e re-
mained constant until the air pressure fell to 550 milli-
meters (14 per cent oxygen at 760 millimeters), or until
the alveolar oxygen tension was lowered to about 62
millimeters. At lower air pressures the carbon dioxide
tension fell with increasing rapidity. In th ese exposures
the reduction of the barometric pressure to 350 millimeters
covered a period of two hours or longer.
' Number in parenthesis refers to the bibliography a t t he end or the pressure chamb er, and second by the rebreathing method
article.
Al veolar air tensions found by observers on mountains
of moderate h eigh t show cha nges similar to those found in
low-pressure chamber work. Haldane and Priestley(8)
report their alveolar carbon dioxid e tensio_ns taken at
Oxford and on Ba11 Nevis (4,406 feet) . That of J. S. H .
fell from 39.6 millimetern to 37 millimeters, while that of
J . G. P . dropped from 44.5 millimeters to 42 .4 millimeters .
This change of a little more than 2 millimeters was not
ascribed to low p ressu re bl!t to the effects of fatigue,
since ~he subj ects walked up the mountain. \Vard(9 )
compared his alveolar air values at London, Zermatt
(5,315 .feet) , and Monte Rosa (14,965 feet). The entire
ascent was mad e during a period of days, during which his
alveolar carbon dioxide tension fell from 37 .7 millimeters
at London, to 34.2 millimeters at Zermatt, and then to
28.5 mi)li.meters at the summit of Monte Rosa. Such a
fall means a marked i_ncrease in ventilation. Douglas,
Haldane, Henderson , a nd Schn eider(lO) found a fall of
alveolar carbon dioxide from abo ut 40 millimeters to 27
millimeters. The ascent from Manitou (7 ,485 feet) to the
summit of Pikes Peak (14,110 feet) was-made on the rail-
road in about an hour and a half. One subj ect, E. C. S.,
showed a fall to 33.5 millimeters just after arriving; an-
other, Y. H. , gave 33.4 millimeters. Determinations were'
not made on C. G. D. and J. S. H. u ntil nearly an hour
after their arrival. The former gave 32.2 millimeters , the
latter 31.6 millimeters. FitzGerald(ll) d etermined 1he
alveolar air on persons living permanently at various alti-
tudes up to 14,000 feet and fo und the carbon dioxide ten-
sion already lowered at 700 millimeters (2,200 feet) . Has-
selbalch and Lindhard(l2), however, report that in steel-
chamber experiments in wh ich the barometer was lowered
from 756 millimeters to 541 millimeters (10,000 feet) in
three or four days, little change in rate or volume of breath-
ing occurred. Mosso(l3) did not find a ny clear cut in-
crease in ventilation at high altit ud es .
It can not be doubted that there is a lowering of the
alveolar oxygen and c_arhon dioxide tensions at reduced
atmospheric pressures. A lowering of the carbon dioxide
tension, other things being equal , signifies increased ven-
tilation. However, the changes in the alveolar air and
ventilation wh"ich QC<::ur when the individual is subjected
to conditions comparable, so far as pressure is concerned ,
to rapid airplane ascents and reconnaissance have not
been clearly described.
METHOD.
Low oxygen tension was produced by t'wo methods:
First by reducing the barometric press ure i n a low-
in which the subject gradually reduces the oxygen in a
(51)
 52
grven volume of air, the carbon dioxide being removed by
sodj.um hydroxide. The majority of the experiments re-
ported in this paper were conducted "in the low-pressure
chamber. A number were made with the rebreather for
comparison.
The construction of the chamber is described else-
where(l4). While reduction was going on or while a re-
duced pressure was being held, sufficient ventilation could
be maintained to prevent an · accumulation of carbon di-
oxide or oxygen in the respired air. The rate of reduction
was uniform and equivalent to an ascent of 1,000 feet per
minute.
Alveolar air samples were taken in the following manner:
After a period of normal breathing ending with an expira-
tion, a quick forced expiration was made into a Henderson
alveolar air sampling tube(l5). This is esBentially a modi-
fication of the Haldane-Priestley method of taking an
expiratory sample, since the last 75 cubic centimete:r:a of
the forced expiration remain in the tubes. Samples for
analysis were drawn directly into a Henderson-Orsat
analyzer(l6), in which a 1 per cent solution of sulphuric
acid in 56 per cent ethyl alcohol was substituted for the
1 per cent acidified water ordinarily used. It was found
that such a solution hastened drainage and prevented
droplets from standing on the inside of the gas burette,
thereby increasing the accuracy as well as the rapidity
with which an analysis could be roade. Although the
method used-for taking air samples probably gives slightly
higher oxygen and carbon dioxide than more elaborate
indirect methods (17), it is pointed out by Pearce (18, 19)
that the Haldane-Priestley method is less likely to give
high results for the carbon dioxide than for tlie oxygen.
Certain practical considerations influenced the choice of
alveolar air sampling. First, the samples had to be taken
quickly while· the pressure was being reduced; second, a
technique requiring. the measurement of air volumes by
ordinary spirometers is subject to error in low-pressure
chamber work when the pressure is being changed. The
volume of breathing was determined by two methods.
UsUll.lly a continuoi.is record of the volume breathed per
minute was obtained. In the first method the subject
wore a part ot'an American Tissot gas mask and inspire·d
through an American light meter No. 5. This meter had
a resi.s tance of 3 inches of water to a 20 meter per minute
flow. Coi;,.trols, made at sea level for periods up to 111
minutes, showed no effects either on the volume per
minute or the rate. In the second method a spirometer
devised by Larsen(20) was used_. In this apparatus the
resistance is negiigible. I_t consists of a- calibrated
spirometer from which the subject inspires through a
mouthpiece, a clip being placed on the nose. Each
expiration operates an electric valve which opens the
spirometer to the low-pressure chambj'lr during the ex-
.piration and thus prevents a difference in air pressure
inside and outside of the spirometer, which would make
the readings valueless.
ALVEOLAR AIR CHANGES DURING GRADUAL
DECREASE IN BAROMETRIC PRESSURE.
In 24 cases in which the subjects were taken to 352
millimeters (20,000 feet) at a rate equival~nt to 1,000 feet
per minute the alveolar tensions were determined for 760
millimeters, 6/i(i millimeters, 560 millimeters, 480 milli-
meters, 410 millimeters, and 352 millimeters, or sea level,
4,000 feet, 8,000 feet, 12,000 feet, 16,000 feet, and 20,000
feet, respectively. The alveolar air tensions are given in
Table L The average figures shown at the bottm,n of the
rable are shown graphically in Figure 1. The average
f'
g
fl.
'" /
/
~% ('Pz
/
/
/
./
41 7
.s
5 15 zo
71,4
7/Me
~o '18D '"
:ZD'-----,.-L----.,___, _ __ . _ - . . - - - ~
, ~ ·-110 ssz
Fro. 1.-Average alveolar air changes in 24 men taken to 352 mm.
(~,000 feet) in a low pressure chamber at a ratil equivalent to 1,000. feet
a minute.
alveolar oxygen tension. at sea level was 103 millimeters,
and for 352 millimetei;s it was 34,8 millimeters, thus
showing a· fall of about 68 millimeters, or 66 per cent.
The maximum fall wall from 107 millimeters to 27 .8
millimeters, or 79.2 millimeters (74 per cent). The
minimum change was from 87.8 millimeters to 32.9 milli-
meters, or 54.9 millimeters (63 per cent). The average
I' alveolar carbon dioxide tension for 760 millimeters was
39.6 millimeters, and for 352 millimeters it was 30 milli-
meters, thus showing a fall of 9.6 millimeters, or 24 per
cent. The maximum fall was from 44.8 millimeters to
26 millimeters, or 18.8 millimeters (42 per cent). The
minimum change was from 39.5 millimeters to 35.6 _milli-
meters, or 3.9 millimeters (10 per cent).
These dat.a. show a fall in both oxygen and carb.o n dioxide
tensions present at 656 millimeters (4,000 feet). The fall
in carbon dioxide tension was a little more than 2 milli-
meters at thie pressure, which corresponds to the drop of
a little more tha,n 2 millimeters in the alveolar carbon
dioxide determinations of Haldane and Priestley(8) taken
at Oxford and on Ben Nevis (4,406 feet), and which
 they did not ascri.be to low oxygen. The lowered carbon
dioxide indicates that an increase in lung ventilation had
already begun at this low altitude, although it is difficult
to determine this slight in.crease b y measuring the volume
of air breathed per minute, as will be seen from data pre-
sented later in this paper. This early response to low
oxygen, which has been quickly produced , is interestino-
when it is compared with FitzGerald 's work(ll), which
shows a fall in alveolar carbon dioxide present in men
living permanently at 700 millimeters (2 ,200 feet).
Individual curves show the early fall in alveolar carbon
dioxide tension just as strikingly as the average curves.
J. B. D. (Fig. 2) was taken to 352 millimeters on two
"'" N9,
100
fP
,,
7•
~.
'\
5o
,. ::.,
I
44111
Fm. 2.-Alveolar air tensions of J .B. D. taken to 352
in a Jow pressure chamber. Dotted lines on 8/14/18 at a rate of 1,000 feet
a minute. Solid lines on 8/21/18 at a rate of 500 feet a minute. The carbon
dioxide tension of 8/14/18 is plotted l= · lower than the actual value.
different days a week apart. On the first day the pres-
sure was reduced at a rate equivalent to 1,000 feet p er
n:.inute, and the reduction was made in 20 minutes.
Alveolar air samples were taken every fo ur minutes. On
the second day the pressure was reduced half as fast and
samples were taken every five minutes. On the ·first day
the oxygen fell from 105.5 millime_ters to 37 millimeters,
68.5 millimeters, or 65 per cent. The carbon dioxide fell
from 42 millimeters to 28.2 millimeters, 13.8 millimeters,
or 32.9 per cent. On the second day the fall i:::J. oxygen
was 67 .5 per cent, and in carbon dioxide it was 32.7 per
,cent. On both days a definite fall in carbon dioxide
tension (2 to 2.5 millimeters) was present at 656 milli-
meters (4,000 feet). That both th e alveolar oxygen and
carbon dioxide tensions are quickly lowered and quickly
returned with rapid reduction, brief exposure, and rapid
increase of barometric pressure is shown in four experi-
ments ill Table II, the first of which, E . L. B. , is seen
Igraphically in Figu~e _3. In these cases ~be barometer
was lowered to 428 millimeters (15,000 feet) m 15 minutes,
held at that level for 5 minutes, then increased to 700
millimeters (2,200 feet) at the same rate and h eld at this
new level for 5 minutes, when the ascent was resumed.
The reduction of pressure was repeated three times in
succession. The fact that the carbon dioxide tension
changed so readily with the pressure ind icates that there
was little permanent disturbance in the carbon dioxide
level, although it should be noted that the carbon dioxide
tension did not entirely return to the starting level each
time that 700 millimeters was reached.
ALVEOLAR AIR IN THE REBREATHING AND IN
THE LOW-PRESSURE CHAMBER METHODS.
In six ;men the alveolar air t ensions in the low-pressure
chamber and in the rebreathing m ethod were compared.
The subjects were first taken on the rebreath er. Alveola1
air samples were taken by means of a special three-way
mouthpiece, about every four minutes during the run ,
with a final sample just as the experiment was stopped.
From the percentage of oxygen reached the corresponding
barometer was computed and later the subjects were taken
in the low-pressure chamber to th e calculated barometric
pressure at a rate corresponding exactly to the reduction
of oxygen t ension b y the rebreathing m ethod. Alveolar
air samples were again taken at corresponding times.
The data presented in Table III and the case of R. M. B .
in Figure 4 show that the two methods of producing low
oxygen partial pressure are essentially th e same so far as
the effects on alveolar tension are concerned. In one case
the alveolar air tensions were d etermined in a man taken
to 10 p er cent oxygen in 20 minutes b y th P, Dreyer nitrogen
dilution method(21). In this case the oxygen tension
fell from 102.5 millimeters to 32.8 millimeters, and the
carbon dioxide pressure from 38.7 millimeters to 33.3
millimeters. Both of these methods emphasize that baro-
('4~ 11/21/111 metric pressure in itself is not a causative factor in the
'('o_.. 8/1'4/III
responses to low oxygen t ension except as a means of
ZIIOOJI
producing low oxygen t ension.
=· (20,000 feet)
ALVEOLAR AIR DURING MAINTAINED LOW
OXYGEN PRESSURE.
The alveolar air t ensions immediately on ascending to
428 or 380 millimeters (15,000 or 18,000 feet) indicate that
an increasi) in ventilation has occurred. There is no doubt
that if men stayed long enough at these altitudes they
I would become mountain sick. But they may tolerate
these altitude for one or two hours and feel lit tle or no
ill effect after the flight. The course of th e alveolar
tensions during p eriods of low oxygen level of from 30 to
120 minutes was followed in the low-pressure chamber in
14 cases, by taking alveolar samples every 5 or 10 minutes .
In five subjects taken to 428 millimeters (15,000 fee t) in
15 minutes and maintained at that pressure for periods
varying from 30 to 90 'minutes, four showed a fall in carbon
dioxid e t ension during the ascent present at 560 milli-
m~ters (8,000feet ). This fall varied from 1.6 millimeters
to 4.3 millimeters and averaged 3.1 millimeters. All
showed a drop in carb on dioxide tension which averaged
6.7 millimeters (7.3 per cent) after having been at 428
mi1lin,eters for five minutes. The average alveolar oxygen
I
I

I
.Jlf4

ALVEOI..AII. 0.z. Tf:NSJOII

"!ao

<14-6 ,- - \
~UOMl!.T!:R..
,- -~
I I
ao
"'°
49 I
I \

,,
I
I
Sto I \
I
I \
I
5z
Ot
~
t,o

I
Jo I
I
t.1 I
I
I
I \
(.4
I
1.,1,, ~ 1
I
{,j I

701> I I i
.._ - _J .J

~~~---------'·:J··
30 I l,.. -
ALY[OLA~ co._ Tf:I\SlbK
I
7zo
1-10 ,,
I'I

,,o 10 l'o .t.o 'f~ 40 g11> liio 70 o 10 111>0 11

• ,c
Fm. 3.- Alveolar air tensions of E. L. B., 5/14/18, taken three times to 428 mm. (15,000 feet) at a rate of 1,000 feet a minute.

tension had fallen from 100.4 millimeters to 41.5 milli-
meters at this time, an average drop of 58. 9 millimeterE,
or 58.6 per cent. In four cases the oxygen tension main-
tained its low level as the experiment proceeded. In
these cases the carbon dioxide tension maintained its
new level with little variation. In one case, vV. 0. K .,
which lasted 90 minutes, there was a d efinite rise in oxygen
tension during the last 40 minutes, and the carbon dioxide
tension fell to 24..4 millimeters toward the encl . It was
evident from these experimen ts that these men tolerated
428 millimet3rs with little discomfort , since the respira-
tion increas ed moderately and maintained its new level.
That the men at 428 millimeters were not under stress
is shown also by the normal alveolar a ir taken within 20
minutes after 760 millimeters had been reached. The
carbon dioxide tension of w. o. K. returned only to 34.6
millimeters while the others showed a complete recovery
to the former t ension.
Nine men were taken to 380 millimet ers (18,000 feet)
and maintained at that level for from 50 to 120 minutes.
At this altitude m ore profound changes than those shown
at 15,000 feet were expec ted. The c~ta obtained from
this series are presented in Table I V. Since alveolar ai r
samples were usually taken every fiv e minutes at the
desired level , the figures present ed represent, for the
8 that is. about 20 minutee after his exposure to 380 milli-
,.
/7!E.~._'.:O.- -Z
~ -.,~ -".__/l.__,.._"_ _./z_- -/.L+- -,."".-
4U_. 7UC Mf"f t,(. Z f ufl-
Fw. 4.-Alveolar air tensions of R. M. B. , 4/18/18, taken on the re-
breather to 10.3 per cent oxygen ( dotted line). 4/19/18, taken to 365 mm.
in the low pressure chamber at the same rate.
most part, the average of two samples taken during the
period indicated in the table. The average oxygen ten-
sion at 760 ,millimeters was 104 milli meters. It fell t0
36.4 millimeters, 67 .6 millimeters or 65 per cent, b efore
55
the subjects had b een at :~80 millimeters for lO minutes.
The average figure had fallen to 34.9 millimeters 20 to 30
minutes later. The average carbo n dioxid e tensio n at
760 millimeters was 38.7 millimeters. It fell to 30.4
. millimeters. 8.3 millimeters or 21.4 per cent, shortl y after
' the subjects had reached 380. millimeters. but before 10
mi.mites at that altitude. Twenty to th irty minutes later
the average figure had risen to 31. The more profound
the effects of 380 millimeters over 428 millimeters are shown
in the percentage of d ecrease in the alveolar ai r pressures.
For the ox ygen it was- 58.6 per cent and 65 per cent for
428 millimeters and 380 millimeters, respectively. As
might be expected the ~ore striking effect is shown in
the carbon dioxide. The percentage d ecrease was 17 .3 and
21.4 for 428 millimeters and 380 mi.llimetei:s, respectively.
The alveolar carbon dioxide pressures showed tliree
general t ypes of curves during these experiments. In
one case it fe ll and continued to fall- B. M. L. In two
cases it fell and maintained. its low level- R. S. S., and
A. W. L. In six cases i"t fell markedly, then rose for a
time and ei ther maintained this later level or fell toward
the end-N . E . F .. Figure 5. The majority of cases there-
fore showed a period of low carbon dioxid e tension just
afte1, the altitude was reached , followed b y a more or less
permanent rise. In two of the six cases the low point
was coincident with the arrival at 380 millimeters. This is
inte,preted to mean that the ventilation increases with the
ascen t and shows i.ts maximum value shortly after the
ascen t is reached. Follo,ving this period there is a ten-
d ency toward more quiet breathing. This point will be
discussed later in this paper when the data on the volume
of breathing are presented .
The after effects of exposures to a constant low oxygen
level are shown in the sea-level alveolar airs which were
taken just after the subject reached 760 millimeters again;
met ers. In only four cases did it return to i ts previous
average normal of 38.7 millimeters, the average normal
after th e experiment being 34.5 millimeters. This is
shown particularly well in H . M.. T. a nd B. R. L. in Table
V. Both of these men respond ed by deep breathing and
maintained an alveolar oxygen tension from 7 to 15 milli-
meters higher than the average. The slow return of the
carbon dioxide tension was pointed out by Boycott and
Haldane(7), by Schneider(22), and by Douglas, Haldane ,
H enderson , and Schne.ider(lO). Sclmeicler followed the
carbon dioxid e t ension of H. H. R . who had lived on.Pike's
P eak for about six ~onths. The level did not return to
normal for nearly one month and a half and was accom-
panied by a change in the composition of the ·blood.
THE RESPIRATORY VOLUME DURING REDUC-
TION OF BAROMETRIC PRESSURE.
Alveolar air d eterminations during th e reduction of
-/.L/J--Z.L0 - - pressure at a rate equivalent to 1,000 feet per minute
<' 6 t.
indicate that an increase in ventilation takes place early
and becomes most marked just after the sub jects reach
428 or 380 millimeters. The volume per minu te of breath-
ing was therefore investigated. The per-tninu te volume o[
breathing was measured with a Larsen spirometer in men
reduced to pressures of 395 millimeters, 380 millimeters, 365
millimeters (17,000 , 18,000, and 19,000 feet, respecti vely).
The data are shown in Table V. The su bjects all showed
 5G

r
8A40/IIJ!.TE~ ~811 /If.It .
-
I
8o
I
I

fo
I I
,,,, 1 I
11
~" II
I
Z# ' I
T//,/1!! " N 2JJ ~q
.,." 511 e" 7'
FIG. 5.-Alveolar tensions of N. E. F., 6/7/18, taken to 380 mm. (18,000 feet ) in 18 minutes and maintained at that level. Note the
low carbon dioxide tension just after the low harometr.ic pressure was attained.

a considerable increase in breathing, varying · between
1.8 and 9.3 liters, or 34 and H>3 per cent. The average
amount breathed per minute at 760 millimeters was 7.49
liters. Just as soon as the reduction started the average
figure went to 7.94 liters, due nq doubt to anxiety of some
of the subjects. By the third minute it had fallen to
7.61 liters. The readings thereafter showed a progressive
increase ,until at the nineteenth minute the average
figure was 11.59 liters, an increase of 54. 7 per cent. It will
be seen both from the average figures and from the individual
cases that the onset of increased breathing started usually
between the fourth and sixth minutes, or between. 656
and 605 millimeters; that is, 4,000 and 6,000 feet. This
confirms the alveolar air findings reported above. The
onset of increased breathing due to low oxygen produced
by the rebreathing meth-0d was reported by Schneider(3)
to begin in some cases as early as 16 per cent oxygen, cor-
responding to about 7,000 feet or 580 mill!meters and by
Ellis/23) before 17.5 per cent oxygen was reached .
Schneider(3) found in the rebreathing test that the rate
remained unchanged for many men, but the majority
increased the rate by two to four breaths per minute.
The depth of breathing he found increased from 20 to 128
per cent when at 8.5 to 6 per cent oxygen.
THE RESPIRATORY VOLUME DURING MAIN-
TAINED LOW BAROMETRIC PRESSURE.
In the majority of alveolar air determinations the lowest
carbon dioxide figure was found shortly after the reduced
barometric pressure was attained. Thereafter, the carbon
dioxide level either rose slowly or was maintained. Exper-
iments in which the volume per minute of breathing was
 57
~
'O)

"'"'
~ -:,,
,!180 ,_._,.._ :8J#ROMl!TE1<
~
-1"4
~-
/~

f' ·"I ',.. ..>P.J'.8. V~LVM!!.

....
8- ~
1 ,, (8

W. #. G. WI. VM£.
""
/
~
/.5 ~/, ; '• I. M. Yl)tVM£
6 1.,1
,~ <
.....1,/,.' .
4 4&/
J./J
3 'io

z 8
1
~

,: t / .\I.. "''
'
- - -........P...r.
1
,,,
.
B ~17.e
'. . .... w.H.tr. JZAre
"
1

's •·, .....

J ,.- II

Fm. 6.-The respiratory_per-minute volume of four cases in liters, taken to 380 mm. (18,000 feet) in 18 µtinutes and maintained at that level.
Note the decrease in ventilation after the maximum is reached. This corresponds to the alveolar CO 2 tensions under similar conditions shown
in Fig. 5.

measured during a reduction of pressure to 380 millimeters
at the usual rate and during the following 48 to 84 minutes
of the maintained low barometric pressure are tabulated in
Table VI. Control experiments at 760 millimeters, using
the mask and meter, are also shown. The figures given are
the three-minute averages in liters. All of the 11 subjects
showed an increase in lung ventilation, usually most
marked within 10 minutes after 380 millimeters was
reached. Seven showed a reduction of ventilation there-
after, continuing until the end of the experiment. Two
showed a reduction followed by a terminal rise, which in
the case of A. F. H. 2 was very marked. Two cases showed
a very slow rise, which tended to be maintained until the
end . The usual type of response is shown in Figure 6,
in which the cases of I. M., W. H. G., P . S. B., and E . A. R.
are plotted. In three subjects taken to 380 millimeters at
the same rate and held from 59 to 81 minutes the Larsen
spirometer was used. Two showed this type of response
and in one the increase in respiration continued until the
end.
The typical response seen in 9 cases out of 14 in which
the volume of breathing was measured corresponds to
that observed in 6 of the 9 cases in which the alveolar air
te)lSions were followed under similar conditions . In one
case the subject was taken to 12.5 per cent oxygen in 17
minutes by the rebreatbing method and held at that
level for 68 minut~s. The response was similar to the
typical low-pressure chamber experiment. His per-
-minute ventilation increased from 8.3 liters to 10.4 liters
at the fourteenth minute. It held a level at about 9.2
liters· from that time until the fortieth minute, when it
gradually fell to 8.4 liters at the eighty-fourth-minute.
Several subjects taken to 10 per cent oxygen in from 17
to 20 minutes by the Dreyer method showed similar
responses. In these cases the ventilation was indicated
by a Fitz pneumograph and the average amplitude times
the rate per minute was taken as a figure to indicate the
per-minute ventilation. I. M. increased from 90 to .252
at the seventeenth minute and then fell to 154 at the
ninetieth minute. This is a picture similar to that of
I. M. in Table VI and Figure 6. C. L. S. in a similar
experiment went from 192 to 360 at the seventeenth
minute and then fell to 128 at the. ninety-fifth minute.
The rate of breathing was reported in seven cases during
the reduction of pressure and the holding period in the
low-pressure chamber. In four cases it fell from two to
five breaths per minute as the experiment proceeded.
The rates of W. H . G. and P . S. B. are plotted in Figure 6.
One showed no change in rate . Two showed an increase,
one, N. E. B., from 13 per minute to 15 at 380 millimeters
and then to 19 at the eighty-second minute, when the low
_pressure was maintained . The other, A. F. H., showed
no increase until the fifty-eighth minute, when the rate
per minute .started to rise from 17 to 38 at the seventy-
seventh minute. The per-minute volume of breathing
increased markedly, as will be seen in Table VI.
The tidal air has never been observed to decrease in
the low-pressure _chamber. The majority of subjects
responded to .the low oxygen exposures by deep, slow
breathing, although frequently Cheyne-Stokes breathing
has been observed.
DISCUSSION.
The relation of respiration to low oxygen tension pre-
sented in this paper is, in a general way, in acc_ord with
most of the literature. The early response to decreased
oxygen tension and the tendency of the breathing to
return toward the normal during maintained low oxygen,
which we find under the conditions of our experiments,
may appear at first sight to be contrary to the views
which have been presented by Haldane and othera
 58
Haldane and Smith(24) in 1903 found ·marked hyper-
pnoea when the oxygen was reduced to 12-per cent, the
carbon dioxide being removed. They write "the fact
that any hyperpnoea sbould have been caused by a reduc-
tion of oxygen to 12 per cent may seem at first sight to be
hardly consistent with our former conclusions that hyper-
pnoea caused by vitiated air is entirely due to carbon
dioxid e.1' They explain that in the former carbon
dioxide and low oxygen experiments the increased supply
of oxygen brought about by the crabon dioXlide h yper-
pnoea prevented an extra hyperpnoea due to want of
oxygen from developing. Haldane and Poulton(2) in
1908 report experiments in which the subjects reduced
25 liters of air from 9 or 10 per cent oxygen to 4 or 5 per
cent in less than 10 minutes. They found marked hyper~
pnoea which they believed was not due to the direct
effect of oxygen want but to lowering of the threshold of
the respiratory center to carbon dioxide which has not
had time to escape. In their experiments, how13ver, the
alveolar carbon dioxide fell to between 3.2 and 4 per
cent. In another group of experiments the oxygen per
cent in the inspired air was reduced to about 9 per cent
in from 15 to 23 minutes. In these " no noticeable hyper-
pnoeal' is reported, although the alveolar carbon dioxide
fell to between 3.9 and 4.3 per cent, which indicates that
a considerable increase in ventilation must have occurred.
Haldane, Meakins, and Priestley(25) in 1919 conclude
from exposure to low oxygen of about 10 per cent, lasting
about six minutes, that the first result of diminution in
the percentage of oxygen is an increase in the depth of
respiration owing to a lowering of the threshold exciting
value of carbon dioxide . This is followed by a period
of periodic breathing due to the much quicker action of
want of oxygen as compared with that of increase of
carbon dioxide. Further reduction of the oxygen per-
centage showed the periodicity replaced by very rapid
shallow breathing . They write "Want of oxygen in the
inspired air causes shallow breathing which in turn in-
tensifies the anoxhemia. -!' The point of view taken by
these authors 'is that after the first period during which
the threshold is lowered to carbon dioxid e, oxygen want
acts as a paralyzing agent on the respiratory center:
We believe that one is not justified in drawing too gen-
eral conclusions regarding the effects of oxygen want
from experiments of extreme degree and short duration .
We shall show in a later paper the quick respiratory and
circ ulatory responses to the breathing of pure nitrogen.
At the other extreme in the well-known ascent of the
Duke of the Abruzzi in_the· Himalayas to 24,580 feet. In
quick extreme anoxhemia respiratory and circulatory
factors respond quickly and to their greatest capacity.
If the exposure to low oxygen is slow and long continued
other factors have time to..assist in the compensation. We
feel, therefore, that the rate of exposure as well as the
degree is an important condition when considering the
effects of oxygen want. The lack of recognition of this
fact brings about confusion. We have never seen a case
of shallow breathing and only two cases of increased rate
under the conditions of our experiments. They are,
however, quite different from those of Haldane, Meakins
and Priestley. The decrease in the respiratory per
minute volume which occurs in our experiments after
the preliminary increase with the reduction of pressure,
takes place during exposures of from 30 to 120 minutes.
rather than during expos\ll"es of from 6 to 10 minutes.
We do not believe it to be a sign of failing respiratory
center, but an indication of improvrm\mt in conditions as
will be pointed out in another paper.
SUMMARY.
1. Twenty-four men were- taken to 352 mi-llimeter
pressure in a low-pres3ure chamber at a rate equivalent to
an ascent of J,000 feet per minute. In these cases the
average alveolar oxygen tension fell 66 per cent, and the
alveolar carbon dioxide fell 24 per cent.
2. The average carbon dioxide tension was definitely
lowered at 656 millimeters (4,000 feet) which indicates
that the onset of increased breathing had occurred.
3. Alveolar ten~ions taken during a reduction of pres-
sure to 380 millimeters (18,000 feet) at the usual rate, and
during the subseq uent 30 to 120 minutes while the low
pressure level was maintained, showed that after the
preliminary fall in carbon dioxide tension there was a
tendency for this tension to rise for a time although it
remained low during the holding period. After 760
millimeters had been reached again, within 20 minutes,
the carbon dioxide had not recovered its former level in
the majority of cases.
4. The lowest carbon dioxide tensions occurred about
five minures after 380 millimeters was reached, when the
reduction was equivalent to an ascent of 1,000 feet per
minute. In some cases this latent period did not occur
and the maximum breathi:ug was coincident with the
arrival at 380 millimeters.
5. Tensions taken while the pressure was maintained at
428 millimeters (15,000 feet) did not show the same pro-
found effects. The carbon dioxide tension did not fall so
far and maintained a level.
6. Both oxygen and carbon dioxide alveolar tensions
responded quickly to rapid successive reductions of baro-
metric pressu.re to 428 millimeters.
7. The per-minute volume of breathing was determined
for each minute during a reduction of pressure at the usual
rate to 395, 380, and 365 millimeters. The ma,jority of
cases showed a definite increase in ventilation taking place
betweeii. 656 and 605 millimeters(4,000 and 6,000 feet).
This final iJicrease amounted to an average of 54.7 per cent.
Individual cases varied from 43 to 103 per cent increase.
8. The per-minute volunie of breathing was determined
during a reduction of pressure to 380 millimeters at the
usual rate, and during a period of fro!h 48 to 84 minutes
while the low level was maintained. In 9 out of 14 cases
the maximum ventilation occurred within 10 minutes after
380 millimeters was reached. Following this period there
was a distinct falling off in the per-minute volume. These
cases correspond to the 6 cases out of 9 in which the alveolar
carbon dioxide showed a rise after the preliminary fall .
9. The decrease in the per-minute volume of breathing
after the first maximum value, as 380 millimeters was
reached, was also found in cases in which the low oxygen
tension was produced by the rebreathing method and by
the Dreyer nitrogen dilution method.
10. The partial return of the respiration toward the nor-
mal is believed to indicate a temporary improvement in
condition.
 59
11. Alveolar air tensions taken during a reduction of the 11 . FITZGERALD: Philosophical Trans ., Royal Society of
oxygen partial pressure by the rebl'eathing method or the London, 1913, B, CCIII, p. 319. •
nitrogen dilution method corresponded to those taken 12. HASSELBALCH and LINDHARD : Biochemisch e Zeit-
schrift, 1915, LXVIII, p. 265.
under reduced barometric pressure. 13. Mosso: Life of Man on the High Alps, London, 1898, l.
14. MANUAL of the MEDICAL RESEARCH LABORATORY,
War Department, Air Service, 1918, l?· 212 .
15. HENDERSON and MORRISS: Journal of Biological Chem-
1. GREGG, LuTz, and SCHNEIDER: American Journal of istry, 1917, XXXI, p. 217.
Physiology. 16. HENDERSON: Journal of Biological Chemistry, 1918,
2. HALDANE and POULTON: Journal of Physiology, 1908, XXXIII, p . 31.
XXXVII, p . 390 . 17 . PEARCE: American Journal of Physiology, 1917,
3. SCHNEIDER: Journal of the American Medical Associa- XLIII, p. 73.
t ion, 1918, LXXI, pp. 1382-1400. 18. PEARCE: American Journal of Physiology, 1917,
4. LuTZ: Proceedings of the American Physiological XLIV, p. 369 .
Society, April, 1919, p. 119. 19. PEARCE: American Journal of Physiology, 1917,
5. LoEwY : Untersuchungen uber die R espiration u . s. w., XLIV, p . 391.
1-915, Berlin . 20. LARSEN: American Journal of Physiology.
6. LoEwY, LoEWY and ZuNTS: Pfluger's Archives, 1897, 21. DREYER: R eports of the Air Medical Investigation
vol. 66. Committee, England, .1918, No. 2, p. 8.
7: BOYCOTT and HALDANE : Journal of Physiology : 1908, 22. SOHN.EIDER: American Journal of Physiology, 1913 ,
XXXVII, p. 355. XXXII, p. 295 .
8. HALDANE and°PRIESTLEY: Journal of Physiology, 1905, 23. ELLIS: Proceedings of the American Physiological
XXXII, p . 225 . Society, April, 1919, p. 119.
9. WARD: Journal of Physiology, 1908, .XXXVII, p. 378 . 24. HALDANE and SMITH: Journal of Pathology and Bac-
10. DOUGLAS, HALDANE, HENDERSON, and SCHNEIDER: teriology, 1893, I, p . 168.
Philosophical Trans., Royal Society of London, 25. HALDANE, M"EAKINS, and PRIESTLEY : Journal of
1913, B, CCIII, p . 271 . Physi-0logy, 1919, LII , p. 420.
TABLE I.~ Alveolar air tensions in men during reduction of pressure to 352 mm. (20,000 feet) at a rate equivalent to 1,000 jut
per minute.

760 mm. 6.56mm. 560 mm. 430 mm. 410 mm. 352 mm.

o, co, O, I CO, o, CO, o, co, O, co, o, co,

1..... . . .. . . . . . . . . . 109.1 40. 3 87.1 i 37. 7 68. 2 36. 4 60. 2 31. 7 43. 6 34 . •5 39. 9 28. 0

!~J ~j :::)t \:::··;:_.:. :··:if :::::iii ~j HJ ···::::~: : : <It ~u \ ~t

L\)\\\\\\):\:
l)\\\\\))) :~:i ~J · ··1r · · ·1r1·- ··~1 ·····1rr :.::·iii : : ·:~ii~ ~n f&J ··-··in · ··--~J
6...... . .. . . ..... .. 99.1 36.2 ····· · ···· . . .. . ..... 64: 6 32.3 49. 3 31.3 40.7 27.9 .... . ~ :·~· · ·- - --~~:.;
7 . ... . ....... ... ... 97.0 1 41.6 81.6 I 37. 7 69.3 36.2 ........ .. ..... . . ... 43. 6 27.7 35.l ! 24.7

1 1 I 1

12............. . . . . .
13. __ . ..... ..... • ...
14 ...... . . . . . •. • ....
103. 4
98. 5
109. 9
39. 5
38. 4
92 5
86. 4
32 5 .. ...... .. \..... . . . .
45. l . . . . . . . . . . . . . . . . . . . •
37 • l
62 . 6
72 9
41. 2
35 8
I 56 8
48 9
54. l
31.
38. o
35. l
50. l
43. 2
42. s
28. 6
V
1
33~· 66 j
36. 3
33~. ·. 26
29. 3
3393 . 84
15 ....... .. . .. . ..... 104.1 41.3 83 4 38.9 70. 3 35.6 1 57. 6 359 45.0 34. l 34. 8 32.2
16.. . . ........ . .. ... 94. 2 40. 5 71 8 37. 9 58 5 35 l .. ...... .......... 36. 6 32: 2 ................... .

lL:::::::::::::::: m:~ iH :::::

20.. . ...... . ....... . 104.9
8
~:~: :::::~~: ~:
37. 4 .. ..... .. . . . .. . . . ..
··~rr ·····~nl ···gg:~ ·tr .....:i:~- .....~:
71.4 32.9 57.l
1
29.0 48.6 1 28.l
. .:::.;.......:;:.:
36.6 28. 0
21..... .. . . .. . . ... . . 93. 5 44. 0 79. 7 42. 2 66. 7 36. 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36. 3 32. 3
22 ...... . .. .. .. . .. .. 107. 0 39.6 91.4 33.4 71. 8 33.f 52.4 33.2 43.9 27.9 33. 9 28.~
23..................
24.. ...... . . .... .... 107.-8
104.9 _ 38.7
39. 5 · ·· · ······
80. 4 ·· · ···35.
· · 8·· ··········1··········
62.l 52.4 .......
37. 6 .......... 33.2
... 41. 84 I
41. 32. 4 ,_
29.2 38. l
33.2 30.4
3.5.6

Average . ..... . . 103.2 1 39.7 1 83.71 37. 0 66.0 36. 2 1 53.3 1 33.6 1 42.6 1 31.3 1 34.8 30.0

TABLE !!.-Alveolar air tensions- Repeated rapid reductions in pressure in the low-pressure chamber.

Time , minute s.

0
I 8
I
15
I 20
I
28
I I I
35 40 48
I
55
I
60
I
68
I
i5
I
80
I I I I I
88 95 100 108 115

Barometer, mm. H_g.

I 428
760
"" I ~•m -'"
- - - - - --- --
I '"' -,oo-
-~
556 428
~ 1 572
700 700 556
- - - - - - -------
42s ' 585 , 760

E . L . B. 5/14/18: I
02 tension ... _._. ----- 102. 0 ~7 U6 UI B6 ~O B5 61. 0 44.8 43.8 61.9 81. l 88.5 62.0 41. 7 39. ~ 6~.5 1 100.0
CO, tension ... ....... .. 40.3 ~ 4 ~6 ~9 ~2 •5 •B 35. 2 31. 0 32. 0 35.6 36. 1 37. l 34. 7 33 . 8 32. o 3o. 4 37. 4
C,N. 5/14/18:
O, tension . . ...... 104.4 60. 7 39. 7 41. 0 52. 0 90.5 87 . 0 62 ..0 42. 5 36-. 8 70. 0 84. 5 -·-· ·· 73.0 41.3 35.3 65. 2 98. 4
CO,. tension ....... ::: : 41. 7 39. 7 40. 3 37.4 44. 2 43 . 5 43. 5 42.3 38.2 39.4 39. 8 43.5 ---· ·· 39.9 37. 0 40. 5 42.0 41. 2
I. M. 5/13/18:
0, tension .. . ... .... . . . 106. 0 1 69. 5 . 49. 2 52.5 75. 5 93.0 99.0 ·- -·-- 44.4 48. 3 70. 7 99.·5 91. 7 70.G 46. 9 48. 0 65. 5 95.0
CO, tension. : . ..... _... 41.0 34.8 31.1 27. 3 32.1 I 34. 8 33.2 ...... 33. 8 29.6 32. 2 35. 2 37.3 35. 3 32.2 28. 7 33. 5 40. 5
I
 60
TABLE IL-Alveolar air tensions-Repeated rapid reductions in pressure in the low-pressure chamber-Continued.
Time , minutes.
0 10 15 21 28 35 40 48 55 65 85 93 I 102

Barometer mm. Hg.

760 510 425 430 595 700 I 700 540 425

I
425 425 570 760

A.F. H. 5/21,18:
O, tension .. .. . . .. . .. .... .... .. . )06. 4 59.3 47.0 43.1 65.2 86.4 91. 0 58.5 41. 2 38.6 37. 5 58. 2 93.5
CO 2 tension ... . ... . . . . .. ... . . . . 38.9 31. 2 30.6 31. 7 35.2 35.2 34. 8 33.8 31. 6 30.1 27. 9 34.3 36. 7

TABLE III.
· Rebreath~r. Low-pressure chamber.

Name. I Alveolar air. Per Finai Alveolar air. Per Final Ot

Date. cent per Date. cent ba.- partial
1· de- cent de- rome,. pres-
760 j Final. crease. 02. 760 Final. crease. ter. sure.

I. M ............... . .. . ............. 4/10/18 o, .... 100.2 41.8 58. 1 9. 7 4/17/18 02 .... 103.2 37.1 64.0 350 73.5
co, ... 38.8 32.6 16.0 CO, ... 40.0 30.4 24.0 ....... . ........
W.O.K'. ..... . . ... . .... . .......... 4/22/18 o, .... 97.5 36. 1 63.0 9. 0 4/27/18 o, ... . 104.5 32.4 69.0 325 68.0
co,. ,. 43.1 34. 5 19.9 co, ... 39.5 30.3 29.0 ---- --------
···- 368
H.F.P . ..•.... . .......... . ...... . . 4/20/18 0, .... l.02. 3 38. 6 62.1 9. 8 4/30/18 0, .... 107.5 37.9 64.8 74.~
co, ... . 40.4 32.3 20.1 co, ... 38.8 30.2 22.2 ------- - --------
S. M. J. . • . ..... .. . ....•. ... . ... . ... 4/30/18 j)7.5 0, ....
gb",:::
o, . ....
45.2
108.0
37.0
34.1
62.0
24. 8
65.2
9.0 5/ 1/18
CO, ...
107.0
37.6
105.2
33.6
26. 7
69.5
29.0
325 68.0
........ --------
R.M.B ............................ 4/18/18
CO, ...
0, . . ..
43.0
37.5
39.4 8.4
10.3 4/19/18
gb",:::
o, ....
39. 7
33.0
34.2
68.6
13.8
365
····a65· ·· ··1i;:5
76.5
E.L.B . . . ......................... 5/14/18 105.0 34.3 67.4 10.3 5/15/18 102.0 34.6 66.0
co, ... [ 38.3 3!;.2 8.1 co, ... 40.3 32.6 19.1 ······· · ······· -

TABLE IV.-Alveolar air tensions in the low-pressure chamber.-Subjects taken to 18,000jeet (380 mm.) in 181r1-inutes and
held at that level.
Barometer.
760
I 540
I 380
I 380
I 380
I 380
I 380'
I 380
I 380
I 380
I 380
I 540
I 760

Minutes.
0 8-10 18 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 I
N. E.F. 6/7/18. 0, ............... 106.6 65. 2 41.5. 39.4 37.0 35.2 33.6 34.1 32. 3 38.1 50.1 ... . ... .
co, .... ... ... ..
... .. ... ····w:o
9 39. 1 35.8 30.0 28. 7 32.0 33.3 34.4 33.2 33.8 33 . 7 39.0
R. s. s. 0, .. ... ..... ... ..
6/10/18. 97.8 .--- ----- ------ -- 32. 7 33.2 30.5 32.1 32.2 -------- --------
CO, . ..... .. ..... 38.8 32. 7 33 .5 33.9 32.4 34.2 ... ..... ---··--- --- ----- 39.0
M.G.B. 6/11/18. 0, . ...... . . .. . .. 101.6 1···55:1· ···as:!i· 35.3 29.8 29.7 30.2 28.8 29.0 34.1 30.3 ------ -- 82.6
co, ... ......... 39.'5 39. 2 30.4 28.6 32.5 31.5 32.4 31. 2 31.3 31. 5 32.5 35.8
H.M.T. 6/14/18. 0, ...... . . ... .. 109.0 75.5 1 38.4 47.3 47. 7 43.6 43.0 38.2 44. 3 -------- -------· 60.8 113.0
CO, .. , .. . ...... 38.2 29.1 28.6 21. 9 27.8 23.8 26.0 24.2 -------- ··------ 58.1 27. 4 27.6
B.M.L. 6/17/18. o, .... .... ..... : 25.68 1
CO, ............
A.W.L. 6/18/18. 0, .. ... .. .... . .
109.0 1········
37.0 ········
101. 3 54.5
35.8
33.6
31.3
32.0
32.9
;!2.0
31.8
33.0
30.9
30.
33.8
29.6
31. 9
31.1
30.3
32. 4
30.3
30.1
--· -·-·· ........
··-···· · ··· ·--- -
·--soj· 34 . 3 ... ... . . 66.8 108. 2
··-- --- - 31.8
107.4
30.5
co, ........... . 42. 7 I 40.5 34.8 34.5 33. 7 34.4 33.4 34. 3 33.5 30. 7 ........ 30.4 35.0
G.C.W. 6/25/18. 0, ...... . . . .... 98.5 .... . ... 36.2 29. 7 30.4 29.0 31. 8 31.6 27. 3 . ..... .. ·-·--··· 47.6 97.0
co, ..... .....·..
W. B.M. 6/28/19. 0, .. . .. . .......
CO, ............
B. R .L. 8/5/18. 0, ...............
co, ... .......... .
37.1
99.5
38.6
107.3
···~:r\I
75. 0
29 . 6
42.0
32.0
44.1
32. 7
37.6
32.1
42.2
32.3
32.3
33.6
44.0
31. 2
36. 5
34.4
50.0
23.1
38.2
31. 9
22.4
32.2
32.8
48.0
26.4 ·· ······ ·· ······
----- --- ········ ........
-- ----·-
50.4
--··· ···
43.2
·-··-···
46.6
40. 8
47.6
37.8.
73.0
40.6
98.0
40.0
113. 0
37. 3 30.9 27.4 29.6 25.0 21.0 22.9 19.8 23. 4 21. 6 22.3 23 . 8

TABLE V.-Experiments in the low-pressure chamber with the Larsen respirometer. Subjects taken to 18,000 feet (380 mm.)
in 18 minutes arid held. Respiratory volume in liters.
Barometer.
760 656 560

Minutes.
0 1 2 3 4 _ j_ _ 5 _
__ 6 7 8 9 10
---- - - - -- - -- - - - - -- - -- - - -
E.C. S. 4/29/19 ....... . ....... 5.82 5.82 8.3 6.66 7.'78 9.57 6.27 8.50 8.06 7.17
K . O.N. 4/30/19 ........ .. .... 5.27 4.59 5. 04 4.26 5.60 i 5.49 4. 71 5. 71 5. 71 5. 15 6. 27
N . E:B . 5/6/19 ......... . .... . 4.98 5.60 5.26 5.04 5.49 I 4.93 4. 71 5.37 5.49 5.15 5.37
B. R. L.1 5/29/19 ............. 7. 06 7. 39 6.16 : 6.04 7.39 I 8.28 8.96 7.95 I 8.96 10.93 9.07
K.O.N.l 5/29/19 ............. 7.06 8.95 9.96 ' 8.74 8.95 i 8.95 9. 75 11.0 10.3 10. 7 11.5
E. C. S. 6/29/19 ............... 8.40 10. 1 10.1 10.3 8.62 7. 95 8.40 8.51 7.84 8.28 8.28
G.M.l 5/29/19 .......... . ..... 9. 07 9.07 10.4 8.17 7. 50. 9. 74 8. 51 6.84 8. 74 8.85 8. 74
B. B. J.2 5/31/19 ... . . . . . . . .... 11.0 10.2 9.86 11.4 11. 2 11.3 9.52 10.4 12.0 10.4 9. 86
B. R. L.2 6/2/19 .... . ...... . .. 8. 74 7. 61 7.17 6.27 7. 72 5. 71 7. 72 7.95 9. 85 9.07 10.3
Average . . .... .. ....... ........ 7.49 7. 94 7. 75 7. 61 7.68 7. 79 7.98 7. 78 8. 60 8.44 8. 51
I
1 'raken to 19,000 feet in 19 minutes and h eld. 2Taken to 17, 000 feet in 17 minutes and held.
 61
TABLE V.-Experiments in the low-presS'J,tre chamber with the Larsen respirometer. Subjects taken to 18,000 feet
(380 mm.) in 18 minutes and held. Respiratory volume in liters-Continued.

Barometer.

480 410 395 380 365

Minutes.

_ _ _ _ _ _ _ _ _ _ __ _1_1 u \ _ _ 1_3_ ___1_4____1_5 ____1_6_ _ _1_1_ _ _1_8_ _ _1_9_ ~

_ __ _ _ _2_1_

E. C. S. 4/29/19 . •.........•... 7.95 7.39 6. 27 7.61 8.17 77. 50 7.05 7.17 8.28 7.50
K. 0. N. 4/30/19 •••..•........ 5.83 5.94 5.38 5.60 6.16 6. 94 4.82 6.05 6.05 7.06
N. E. B. 5/6/19 . . . . . . •.. .... .. 5.49 6.05 6.05 5.60 5.94 5.82 5.37 6. 72 6.27 5. 71 5.82
B. R. L.l 5/29/19 . • ........•.. 9.40 9.85 9.63 11.2 10.6 12.3 11.9 13.0 13.3 12. 7 13. 9
K. 0. N.1 5/29/19 .....•..... . • 11. 6 11.2 11. 5 11. 6 11. 1 12.2 11.8 11. 9 14.6
E. C. S. 5/29/19 . ..........• . •. 8.85 ~.51 9.96 10.3 9.07 11.4 11.6 11. 6 12. 8 11.0 11. 9
G. M.l 5/29/19 .. . •.• .•. ....... 8.96 8.51 10. 5 11. 9 9.52 10.1 9. 74 12. 2 18.4
B. B. J.• 5/31/19 .... . .• . •.. ... 10. 7 11.5 11.8 12.5 13.2 12. 7
B. R. L.• 6/2/19 •••.•• . . .. . . .. 8.51 9. 74 10.6 11.0 11. 9 14.0 13. 1 15.1 .... i4T :::::::::: ::::::::::
Average .• .................... . 8.59 8.85 9.07 9. 70 9.18 10.5 9.84 10.5 11. 6 . . . . .. ............. .

1 Taken to 19,000 feet in 19 minutes and held. • Taken to 17,000 feet in 17 minutes and held.

TABLE VI.
EXPERIMENTS WIT HGAS MASK AND METER. SUBJECT SITTING. RESPIRATION IN LITERS PER MINUTE . CONTROLS
. AT 760 MM.

Minute.

_ _ _ _ _ _ __ _ _ _ __ _ _ 0 _ __
1
3 ___
6 ___9_ 12 \ 15 ~
C.R. S. 6/18/18... . ...................... •.•... 5. 8 5.2 4. 6 5. 0 1 5.0 4, 2 5.3 4.8 4.6 4.8 4.3 4.9 4.1 4.8 4. 7
W.H. G. 7/10/18.......... . . ....... ............ 6.3 7. 6 8.2
J. J. G. 7/11/18 . .•. . ... .... _•.• .........•.. . ..•.. 9.2 9.9 9.2
6.9
9.2
5.7
9.3
6.9
9.0
6.3
8.7
6. 4
9. 0
6.2
8.8
6.7
8.7
6.4
9.0 I 8.4
7.5 6.4 6.9
9.71 8.4
5.7
8.5

EXPERIMENTS IN THE LOW-PRESSURE CHAMBER. SUJ:Jii:s TAKEN TO 18,000 FEET (380 MM.) IN 18 MINUTES AND

Minute.

48 51 54 57 60 63 ! 66 69 72 75 78 81
84~
7 1
I 90
8

4.4 4. 4
C. R . S. 6/18/18.. .. ......................... . . . .
W. H .. G. 7/10/18.. . ...................... . .....
J. J. G. 7/11/18 . • . .. . •••••....... • ...••.......• .
4. 2
7.5
9. 1
7.0
8. 7
6.6
8.8
5.0
6. 9
8.3
.~::'.. :::::: ::::::,::::::
8. 1 I 8. 3 s.5 8.4
::::::
8. 5
:::::: :::::: :::::: ::::::
8.5 \ 9.8 10. 0 8.6
:::::: ::::::
8.9 I 8. 1

EXPERIMENTS IN THE LOW-PRESSURE CHAMBER. su:i~i:s 'l'AKEN TO 18,000 FEET (380 MM.) IN 18 MINUTES AND

I I
I 9.2
I. M. 7/1/1&. ....... ......... . .. . ....... . ........
E.W. B . 6/30/18 .. . . .. ........................ .
B. F. 7/2/18 ... .. .. ........ ....... . ,. ............
D .. T. R. 7/3/18. ... .... . . .... . ....... . ....... - ..
5.4
8.6
7.8
7.4
6.6
7. 7
8.9
7.3
6.3
8.9
9 ..4
6.8
6.7
8.9
8.5
6.9
5. 7
8.1
8.1
7. 4
6.3
8.6
8.3
7.3
6.7
9.3
8.2
7. 3
.?~.U:~.
7. 6 7.3
6.5

8. 0
5.7
8.9
.. i:i.
9.6 .. 9:4· .. gj· ...ii
7.0 ··.,:s· ··1:2·
. ..,j
H.J.M. 7/5/18 .. . ... ........ . ·· ········ · ··· . . ...
A. F.H. (1) 7/8/18 ... . ..... . .... .. ...... . .... . .
5.8
8.8
5.9
8.2
5. 0
7.9.
5.8
7.2
6.4
7.0
6. 6
7.5
6.6
8.8 7. 8 .. .,:a: .·., :i. ......
6.3
. ... . . -·-·· · ·····- ......
5.8 4.9 6.0 ......
P. S. B. 7/9/18........... .. .................... . 8 . .3 8.6 8.6 8.5 7.8 8.3 7.3 8.4 8.2 9.5 8.6 8. 7
W.H.G. 7/10/18 .. .............................
A. F.H. (2) 7/15/18 ..... . ..... ........ . . . . .....
E.A.R. 7/13/18.............. . . . ...... . ... . . . ..
6. 8
7. 6
7.9
i:: I..u
u ~:'..
6. 5
9.0
8.2
6.5
11.4
8.1
7.0
13.8
6.6
15.5
6. 8
16. 5
8.2
6.6
19.8
6.8
19.'l
5.9 6. 4
.. .,T --····
6.0 6.7
...... ..... .
6.9

w.c.w. 7/16/18 ........•..... . .. . . . . . ... . .. . ..

8. 7 7.7 8.2 8.0 9.2 ----- - ----·· ·-----
6. 7 6.5 7.4 6.1 6.4 6. 7 6.4 6.8 6.2 6.5 6. 7 7.1 -- ---- ...... ......

I
I. M. 7/1/18 ..... . ....... ... ..... ..... . . . .
E.W.B . 6/30/18 . .... . . .. ..........•.. .•.
5.5
8. 1
4.4
9. 5
5.1
8.7
5.4
8.3
5.8
8. 3
6.4
8.6
7.1
9.2
7. 4
11.0
fi.9 1 7.3
8.0 9.3
7.9
8.6
7.1
9.2
7.5
7.9
6.9
8.4
6.9
9.0
I 6. 7
8.1
B.F. 7/2/18 .. , ... . . ······ · ········•··· · · ·
D.T. R. 7/3/18 .. ··········••·•· •····· ···
H.J.M. 7/5/18 . . .. ...••. .... .... -.. .... ...
8.5
-----
5.4
-
8.2
7.2
5. 7
7.6
7.7
5.9
7. 9
8.3
4. 6
I 8.1
7.3
5.9
8.6
7.8
5.7
8.9
7.8
5.6
9. 8
9.3
6. 7
9.4
7. 6
6.0
8.9
8.1
6.2
9.1
7. 7
6.1
8.9
8. 4
6.4
8.8
7.4
5.6
8. 7
7.8
6.9
9.2
6.9
6.3
8. 1
7.9
5.6
A. F.H. (1) 7/8/18.... . . . .. .... . ... •... .. 6. 7 6.8 5.4 4.9 6.2 8.4 9. 1 9. 4 9.0 9.1 10.2 9.2 8. 9 9.4 8.3
P . S. B. 7/9/18 .......................... . 6. 7 6.8 7.1 6.9 7.2 7.5 8. 1 9. 0 8.3 8. 1 8. 1 8.4 8.6 8.0 8.0 8.9
W .H.G. 7/10/18..................•...... 5. 7 6.6 6.3 7. 1 6.6 6.9 7, 0 8.1 6.5 7. 8 7.2 7.6 7.0 7. 6 6.6 6.8
A. F. H. (2) 7/15/18 . . .. ........ . . ..... .. . 7. 8 7.6 7.9 7.8 7.4 7. 7 8.2 9. 7 9.3 8.7 9. 2 8.9 9. 5 9.0 1 10. 2 7. 8
E. A. R. 7/13/18 ......................... 7.8 7.6 7.5 8. 8 8.3 9.8 8.8 10. 1 8.2 9.6 8.8 9.9 8.8 10. 0 9. 1 8. 7
w.c.w. 7/16/18 ............. . .... .. . .. . 6.6 6.2 6.1 6.1 6.9 5.9
I 6.0 7.0 6.5 6.6 6. 9 6. -9 7. 6 7. 6 7.0 6. 7

-By courtesy of American Journal of Physiology.

 PART 10.

COMPENSATORY REACTIONS TO LOW OXYGEN

MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y

13y EDWARD C. SCHNEIDER, formerly major, Sanitary Corps-; BRENTON R. LUTZ, formerly first lieutenant, Sanitary
Corps; and HAROLD W . GREGG,_forrp.erly second lieutenant, Sanitary Corps.
In earlier papers we have dealt separately with the s10ns. Men differ in sensitivenes9 to lowered ox:ygen and
blood, circulatory, and respiratory changes induced by in the power to make physiological adaptations which
short periods of exposure to lowered oxygen tensions. It will, from a decr(jased supply, provide sufficient oxygen-
was shown that men responded with definite adaptive to maintain tissue and body efficiency. In some there
physiological changes when subjected to gradually decreas- is.an immediate or at least an early response to a decreas~
ing oxygen partial pressures which reached values be- in oxygen, in others the response occurs much later and
tween 76 and 51 millimeters Hg, corresponding to baro- may be less adequate. Some men make excellent com-
metric pressures of from 360 to 240 millimeters (19,200 to pensations to low-oxygen tensions, while others show in-
29,000 fe~t), and also· when kept for from 30 to 130 minutes sufficient compens:itions at only moderately low oxygen.
at oxygen partial pressures of .from 88 to 80 millimeters, Individuals differ also in the use of the several ways of re-
corresponding to barometric pressures of from 425 to 380 sponding to the decrease in oxygen. The majority of men
millimeters (15,000 to 18,000 feet). In approximately 78 appear to make a well-balanced use of the three mechanisms
per cent of all men examined the erythrocytes and h::emo- for supplying oxygen . The ventilation of the lungs, the
globin increased in a unit volume of blood. This increase rate of blood flow, and the percentage of red corpuscles and
did not occu·r immediately, but usually required between haemoglobin are definitely increased. Some meet the new
40 and 60 minutes to become d efinite. About 13 per cent conditions largely by increased respiration and others de-
of all cases showed a well-defined increase in h::emoglobin pend almost entirely upon an increased blood flow. In
within 26 minutes (1 ). 1 many individuals, during the early period of exposure to a
The heart responded to slight changes in oxygen tension decreasing oxygen, the burden of compensation is borne
by an acceleration in the rate of beat. Some men gave the wholly by the circulatory and respiratory mechanisms,
first response at an oxygen partial pressure of 137 milli- but later the blood changes relieve one or both of these
meters, barometric pressure 656 millimeters (4,000 feet) ; mechanisms from a part of the burden. Our data show
but in the majority the acceleration began between an interdependence and an interplay of the adaptive
oxygen partial pressures of from 113 to 128 millimeters, mechanisms when a subject is held under a constant low-
barometric pressures of from 610 to 542 millimeters (6,000 oxygen tension. Schneidet (4) has reported briefly several
to 8,800 feet ). Evidence of an increased rate of blood cases in which the interplay was present.
flow was found in the acceleration of the heart rate, and The majority of the experiments which have been pre-
in a fall in the diastolic blood pressure, which resulted in sented in part in our earlier papers were conducted in the
an augmented pulse pressure. When a constant level of low-pressure chamber. The barometric pressure was low-
oxygen was maintained, the heart reached the maximum ered to 425, 395, or 380 millimeters (15,000, 17,000, or
rate after a lapse of a period of variable length. It 18,000 feet ) 11t the rate of 1,000 feet per minute and held at
continued at the maximum rate for some time, after that pressure for periods varying from 30 to 130 minutes.
which the rate retarded somewhat. The evidence indi- In a smaller number of e..xperiments the subject breathed
cated that a marked and progressive increase in the atmospheric 11ir d1luted with nitrogen by the Dreyer
rate of blood flow occurred during the reduction and method. Starting with undiluted air, 20.96 per cent
early holding period, after which there followed a period of oxygen, the nitrogen was a_d ded gradually in greater and
more or less constant rate of flow. Later, in many sub-1 greater proportion, so that at the end of 20 minutes the
jects, as shown by the heart rl)tardation and the rise in mixture contained only 10 per cent oxygen., This percent-
the diastolic pressure, the flow of blood in some degree age of oxygen was then maintained for from 30 to 90 min-
approached the normal rate (2 ). utes. Thus the subject was kept under low oxygen for a
The per-minute volume of breathing showed a definite ,period of from 50 to 112 minutes.
increase between 656 and 605 millimeters (4,000 and 6,000 In the low-pressure experiments the observers were given
feet). In the majority of cases the maximum ventilation oxygen by means of a tube held in the mouth. It was
occurred .w ithin 10 minutes after 380 millimeters was therefore necessary to determine whether oxygen accumu-
reached . · Following this period there was a distinct falling lated within the chamber during the period of experimen-
off in the per-minute volume (3 ). tation. In the majo~ity of ex:peri~ents sa~ples of air were
In the present paper we propose to consider the re,l ative taken three to five times durmg t?e _e xperrment and la_ter
values of the compensatory reactions to low-oxygen ten- analyzed for oxygen a~d cargo~ d10x:1de. The exhaustion
pump was kept working contn,uously throughout an ex-
, Number in parentheses refers to bibliography at end of the art;P.Je. periment, so that sufficient ventilation was maintained to
(62)
 63
prevent an accumulation of carbon dioxide. Often there barometric pressure of 380 millimeters was attained.
was.come accumulation of oxygen, but it was fo und to reach About this time, the twenty-fifth minute, th e blood flow,
quickly a constant level. With such data a corresponding as judged from the pulse rate and p ulse pressure, reached
correction for altitude was so metimes made. We have, its maximum. Coincident with this the pre-minute ven-
however, many experiments in which no accumulation tilation of the lungs was greatest as indicated by the
occurred, arid we l;lave ·u sually omitted the correction carbon dioxide, which at this time was onl y 28 .7 milli-
when the accumulation was slight and the oxygen percent- meters. The circulatory conditions remai ned abo ut the
age remained constant during the holding period. We are same during the next 10 minutes but the breathing, as
satisfied that the interpretation of our data is not vitiated judged from the carbon dioxide, was lessened. Both the
by this accumulation. As shown in our earlier papers, the. circulation and th e ventil~tion of the lungs fell off from
effects upon the blood, circulation, and respiration were _this time up to about th e sixtieth minute, after which they
the same under the three methods used for providing low- remained constant to the end of th e experiment . It should
oxygen tensions . Since this was fo und to be the case, we be noted that· the haemoglobin had begun to increase at
have deman<j.ed only a constant oxygen tension during the twenty-fifth minute and continued until the close of
the holding pe..i-iod. the exp_e riment. Coincident with this increase in hae-
moglobin there was a retardation in th e ·pulse rate and a
THE LOW-PRESSURE CHAMBER EXPERIMENTS. decrease in th e breathing. The inter play of compensatory
The interplay of the three adaptive responses has been factors .for this case is shown graphically in figure l.
studied in 47 experiments. For convenience of discussion R. S.S. , June 6, 1918.- Barometric pressure 380 millimeters.
we have divided the reactions observed during th e periorl
at which the barometric pressure remained constant into Minute.
four groups : (a) Cases in which the pulse retarded after
maintaining a high rate for a period of variable length , and 0 5 10 35 45 75
the haemoglobin percentage of the blood increas~d ; (b)
cases in which the-pulse maintained th e new level after an P ulse .............. 70 74 76 80 94 90 95 88
increase in rate, and the percentage of haemoglobin in- Syst olic ... . ...... . 118
Diastolic . .......... ZO
.... ....
. .... . . . . .
114 11.4
64 54
110
48
106
44
100
42
creased·; (c) cases in which the pulse rate remained con- !?J~~fu~e6s,U.re. '.::: : i~.
. .. . . . . . . 50 60 62 62
8 .. . ... ...... . .. . 32. 7 33. 2 32. 1
stant and the haemoglobin did not increase; (d) a few Alveolar CO,.. .... 38. 8 .. . . . . . . . . .. . . 32. 7 33.5 32. 4 34. 2
58
32. 2

cases in which the pulse rate retarded and th e haemoglobin Haemoglobin . . .. .. . 102 .... . .... l ..... 104 104 106 106

did not increase. The variations in respiration have been

determined for each of the groups. In this subject th ere was a progressive increase in the
rate of blood flow, as shown by the pulse rate and pulse
(a) Retardation of the Pulse Rate During the Holding pressure, which reach ed the maximum at the forty-fifth
Period with an Increase in Haemoglobin. minute. The pulse rate reach ed its maximum 10 minutes
There were 26 cases in which an increase of haemoglobin earlier. We believe that this illustrates that the pulse
seemed to favor the h eart and sometimes the respiration. rate alone did not determine the maximum compensation
The beneficial cardiac effect, as we interpret th e dat&, was in circul ation . The fall in diastolic pressure with the n,-
sulting increase in pulse pressure is considered evidence
manifested by a slowing of the pulse rate and frequently
of vaso dilatation in the systemic circ ulation. Judging
by a decrease in the blood flow by a rise in the diastolic
by the increase in pulse rate and in pulse pressure, th e rate
pressure and a correspondin~ d ecrease in the pulse pres- of blood flow began to slow at about th e fifty-eigh th minute .
sure . No two cases ·were exactly the same. The inter- The respiration attained i ts maximum soon after a pressure
dependence of the three comp ensatory responses can best of 380 millimeters was reach ed, and then maintained a
be shown b y a detailed study of a few individ ual cases. fairl y 'constant p er-minu te volume of ventilation until the
N . E. F ., June 7, 1918.- B arometr·ic _pressure 380 millimeters end of the experiment. The haemoglobin showed a slight
increase at the twenty-fifth minute and reach ed i ts maxi-

1I~
Minute. mum concentration at about th e fiftieth minute. In this
experiment the circu1ation seems to have been favored by
the concentration in haemoglobin while the increase in
0 5 10 15 125 35 55 75 83
respiration was.maintained throughout.
Pulse ....... ... . .... .. 73 I
Systolic.. . ..... . . . ... : 114
75 75 79 79 82
76
102 104 100
112 ...... . . . . 100
72 B . M. L., June 1"7 , 1918.- Barometric pressiire 380 rnill-i
Diastolic. . . . . . . . . . . . . 70 72 . . . .. .. . . . 56 meters.
Y~;!~f;;~~~:::::::: ;~ 40
·65::i ·,iij
·58
44
58
tt4
46
54
46
37.0 33. 6 32.3 ·-··
Alveolar CO,.. ..... .. 39. 1. . ... 35. 8 30. O 28. 7 32.0 34.4 33.8 .... Minute.
Haemoglobin .... .. .. . 94 ... .. . . . ..... . . 96 96 97 100
0 5 I 10 115 25 75
This subject was in good condi.tion up to the eighty-fifth
minute when blood was drawn from a vein. It will be Pulse .. .. . .... . . .. . 68 69 70 78 89 91 87 85
Systolic ......... . 102 .. .... ... . .. . . . ... 102 102 102 102
observed that during th e period of ascent the pulse rate Diastolic ...... ... . 68 ........ . . . , .. . ... 52 48 46 46
Pulse p ressure ... . . . 34 ...... .. . . .... ... . 50 54 56 56
accelerated and the alveolar carbon dioxide tension fell Alveolar o, ...... . 109 . . . . . . 35. 8 32. 0 31. 8 31. 9 32. 4
Thus the burden 'of compensation_ to decreasing oxygen Alveolar CO, ...... . 37 1. . . .. . 36. 6 32. 9 33. O' 31. 2 30.:l
Haemoglohin .... . . . 96 .. ... . 96 199 106 104
was at first borne by the circ ulation and respiration. The I
pulse rate reached its maximum four minutes after the 1 Fortieth minute.
 64

r,o' (0
ffo

{OD

~A3o~er~R._ ~eo____"'·.'!_·
I
- ...

P/.f.r Tt>L I ('

/,#£MO (;LDLJ/N
- - -..-
- - _.,.----

So
- -' - -

%i~:-:w.:::;~.'.o:----(l)~-- ---::;z~o:------,3i
='ll~--- -47o~-- -5-=6-=--- - -.,~6-:------...,,7li..,i,---- 8...."- -
Fm.1.-N. E. F., J~ 7, 1918. Taken to 3~ mm. (18,000 feet) in 18 minutes in the low-pressure chamber and maintained at that level.
This case illustrates the interrelation of the pulse rate, respiration, and oxygen-carrying capacity of the blood.

In this case the systolic pressure remained constant tmggests a relationship between the haemoglobin and the
throughout while in the cases of N. E . F . and R. S .. S. it pulse rate. The increase in breathing is also a factor that
fell. The increase in pulse pressure, as in the case of. may have permitted a slowing of the heart rate.
R. S. S., is again definite and is determined wholly by a
fall in the diastolic pressure. The rate of blood flow K. 0 . N., April 30, 1919. -Barometric pressure, 380 mm.
reached its maximum at about the thirty-fifth minute Minute.
which was approximately the time of maximum pulse
-25-I-35-
10 15 55 75
rate. From this ti..rne the pulse rate fell gradually about 0 1-5-
Pulse .. '. ........... 89 94 102 98 95 92
9 per cent, while the pulse pressure remained high and Systolic ............ 122 1 120 116 116
increased slightly, with the result that the rate of blood Diastolic .... . . . .... 1~ [: : t : 64 58 56 54
Pulse pressure ..... 48 •..... 58 62 60 62
flow was presumably reduced. The respiration increased
Minute.
early and then maintained a level until the fiftieth minute,

;J\_;~~1.;~ 1_:~ ;:1\.~ 1,;~1.~ J;~1.:~ 1_:~~

2 2
after which it increased gradually until the end of the
experiment. The ha, moglohin did not begin to increase Resp. v olume ........ 7 9 7 5
Hoomoglobin ......... ,1
until between the twenty-sixth and fortieth minutes. The
1 Twenty-seventh minute. ' Seventy-fourth minute .
pulse rate increased until the thirty-second minute. This 2 Fifty-second minut.e.
 65

Hb.
120 110
,,. ......,
,,
li>IJ

(07
(DI,
fi>5
/1,#E.·MO(it.()~/lf

____...,..,""'-,..__/',,,..., ..,.._..,,,..... ______ , ,..._.,,.. \

VOLVM t' PC: Q M tl/VTe.
//,..,
/ '-....
°"" 4/lOM£T£R 380 '"' · "< ·
_,,,,-.-..-__...- ,..,,.. ....

PVL./'e
.... __ - --
PllE./'. /' //lle

-- ---
.,,,,,,
/
-- __....._ ___ .

0 {5 20 2.5 JO 35 40 80 8 5
Fm. 2.-P. S. B., July 9, 1918. Taken to 380 = : (18,000 feet) in 18 minutes in the low-pressure chamber: Th \s case illustrates the inter-
play of compensatory factors, part:cularly the blood flow and the oxygen-carrying capac;t y.

In this case we determined the per-minute volume of the relationship between the increase in hremoglobin
breathing in liters and took the alveolar air occasionally and the retardation in the pulse rate. We believe that
to compare with the volume. The blood flow and ,respira- this group of.cases represent s the usual reaction when th e
tion each reached the maximum at once on arriving at 380 transition from normal oxygen tension t o low oxygen
millimeters. The pulse rate then held u ntil the thirty- is made gradually and at a moderately rapid rate.
fifth minute, wh en it fell slowly until the fall was 12 per
cent at the end. The respiratory volume fell slowly until (b) Maximum Pulse Rate Maintained with an Increase
the forty-second minute, after which it held at a volume in Hremoglobin.
slightly above the normal ventilation. The hremoglohin There were nine cases in this group, four of which are
was just beginning to concentrate at the twenty-Beventh presented here.
minute. It reached its maximum by the fifty-second
minute. In this case the circulatory and respiratory G. C. W., June 25 , 1918.- Barometric pressure, 380 mm.
mechanisms seemed to have been relieved somewh at by
the increase in hremoglobin. I Mint:te.

--------ll-
In Figure 2 the data for P. S. B ., July 7, 1918, has been

~l I~
plotted. Th e p ulse rate and diastolic pressure changes 0

indicate that the blood flow reached i ts maximum d uring -1--a-· _:__
the early part of the holding period, and also that to~ard Pulse.... . . . . .. .. .. .. f 60 62 64 70 78 78 78 821. .. ..
Syst31ic .. ........... 'J' OO . ....... 120 120 ll8 ll4 ... ..
the end it increased markedly. The decrease occurred Diastolic. . .. .. .. .. . .. 60 64 58 48 48 ... ..
Pulse pre3sure ....... ·. 40 .. . .. .. .. . . .. . 56 62 70 66 .... .
when the hremoglobin had increased. The respiration Alveolar 0 2 .. . . . . . . • .. 98. 5 .. . .. .. .. 36. 2 29. 7 30. 4 31. 8 . .. ..
was not benefited ·b y the increase in hremoglobin. The Alveolar co, .... .... . 37. 1 ......... , 29. 6 32. 7 32. 3 23.·1 .. .. ..... .
Hremoglobin ......... 98 .. . . .. . .. .. .. . .. . .. .. . .. 100
remaining 21 cases in this group show in a similar manner
1454-30- -5 0
 66
In this case first the pulse, then the systolic pressure, The rate. of blood flow undoubtedly increased markedly
and then the diastolic pressure each in turn aided in up to the thirty-fifth minute. The pulse rate rose early
naintaining an increased rate of blood flow. The subject to a first high point (100), then held on a plateau until the
appeared to be compensating satisfactorily, but his reac- thirty-ninth minute, after which it again accelerated until
tions seemed to be insufficient in that the circulatory and the forty-sixth minute, when it held more or less constant
respiratory reactions continued to increase even toward until the end. A slight lowering appeared at the ninety-
the end of the experiment. The. pulse rate was higher fifth minute. The respirati!)n increased during the ascent
after the seventieth minl).te than at any time before. The and attained its maximum .at the twenty-third minute.
respiration increased gradually but not so much as·in the It held this level · until the thirty-sixth minute, after
average case, until the forty-fifth minute, when a marked which the per-minute volume fell and maintained a new
ncrease in ventilation took place, iowering the carbon
1evel until the eighty-eighth minute. During the interval
dioxide from 31.2 millimeters to 22.4 millimeters. The ·
fact that the respiration increased markedly without from the thirty-sixth to the forty-second minutes, while the
affecting the pulse rate shows that the demand for oxygen respiration was being reduced the pulse rate rose. to its
was not sufficiently cared for. The increase in h:cemo- second high point (105). The hremoglobin showed con-
lobin was slight and not in evidence until the end. centration at the twenty-ninth minute. In this experi-
g ment the respiration seems to have been spared by the
W. C. W., July 16, 1918.-Barometric pressure, 380 mm. increase in hremoglobin. An interplay between circula-
tion and respiration was present during the middle period,
Minute. from the thirty-sixth to the forty-sixth minutes.

0 5 lG 15 25 25 55 75 N. E. B., May 6, 1919,-Barometric pressure 380 mm.

--------------
Minute.
Pulse . . .. ·......... . 66 69 72 75 88 86 82 90
Systolic .. .. ... .. .. 104 ------ 106 104 102 104 104 102 0 5 10 15 25 35 55 75
Diastolic ...... . ·10 ------ --···· -····· 52 44 64 60 - - -- - - - 1- - - - - - - - - - - - --- - -
Pulse pressure . .. . 34 ----·-
------ --- --- .50 60 40 42 Pulse.............. .
Systolic . • •.... . ....
74 74 76 79 86 85 85 84
108 112 106 104
Diastolic .... .....•. 76 70 70 66
I M~ute. Pulse pressme ..... . 32 42 36 38
1- ~- -- - - c -- c ---c---c- .,-----,---
0 Minute.
- - - - -- 1 -- - --- ------ - - -- - - -- 18 8
Resp. volume... 6. 6 6. 2 6. 2 6. 9 6. 9 7. 6 7. 0 7. 4 6. 5 7. 1
Hremoglobin . . . 98 . . . . . . . . . . .. . .. . . . .. .. . .. . . . . . . . . .. 1 10'1 2 104 . .-. -. .-. -. . ,- : -0 1- :-4 1- :~-9 .1-6--01-:-.6- 1- 6~-: 1--:-.7
R_oo_p_._V_o-lu_m_e-.-. .-.-
Raemoglo bin. . . . . . . . . . . . . . 100 . . . . . . . . . . . . 1 108 • • • • . . 2 O ••.•..
1 Si,:ty-fourth minute. 2 Seventy-eighth minute .. 1 Forty.second minute. 2 Seventy-sixth minute.
The heart rate at the twentieth minu.te was 90. It then The pulse rate and blood flow reached the maximum
varied markedly for the next 40 minutes, but at. the together about the twenty-first minute. The per-minute
sixty-fifth minute it reached 90 once more, and showed a volume of breathing had increased, by the twenty-third
tendency to go higher, reaching 95 at times. The respira-
minute, to the volume which was maintained throughout
tion reached its maximum per minute volume at about
the holding period. The increase in haemoglobin did not
the thirty-sixth minute, and maintained it until the
fifty-fourth · minute, · after which it decreased slightly. favor either the circulation or respiration.
The h remoglobin had increased definitely by the sixty- We believe that some members of this group failed to
fourth minute. In this experiment, if the hremoglobin show an interplay between the haemoglobin, circulationr
exerted any sparing action it was shown in respiration. and respiration because they were too near their critica,
Compensation seemed to be somewhat inadequate. low oxygen limit. The compensations were just able to
meet the demand of the tissue for oxygen.
E. C. S., April 24, 1919.- Barometr,.ic pressure, 380 mm.
(c) Maximum Pulse Rate Maintained Without an In-
crease in Haemoglobin.
Minute.
There were eight cases in this group. Several. of the
10 15 25 53 55 75 95 experiments will be discussed in the study of repeated
cases. It was to oe expected that a failure in compensa-

.. '. ... ~- .. 84 ·I 100 tion by one mechanism might cause the others to hold. a
:: :::::::::: iii62 I1,·.--·
Pulse . ............... . 6 98 108 105 102
128 134 126
~;;~i~\t;:
Pulse pressure ....... . 46 .......... 1
................... ·····. 62
66
58
76 ......
58
68
constant level when they had responded sufficiently to
meet the demands of the body for oxygen. The following
I
case is typical of the group.
Minute.
A. W. L., June 18, 1918.-Barometric pressure 380 mm.
0

----1----
11 25 33

Resp. volume . . . . . . . . 5. 8 7. 4 8.5 8.5 7.4 7.6 7.2 6.6

41

.6
Hremoglobin....... . . 100 .... . 1108 ..... 2107 .... · ,'109 ·........ ..
I 56 81 88 99 ·

- -- -- --1--0___
Ii,-
Pulse..... . . . . . . . . . . 93
~-

93
5_ ' ~
96
Minute.

98 98 100
1~
101 101

•1 Twenty-ninth minute. 2 Fifty-seventh minute.

~~i~ii.;:::::::::::
Pulse pressure. . ....
i~i42 ::~~: ::~;~: ::~;;: i~ i;; \ 1iio v
i~
a Seventy-<,eventh minute.
 67
A. W. L., June 18, 1918 .- Barometric pre~su re 380 ·mm.- H. J. M., June 20, 1918.-Barometric pressure 380 mm.
Continued. I
Minute.
!
I I
I 15 I 25 I 35
Minute. 0 5 10 55 63

0 10 ' 15 25 I 45 55
_ _ _ __ _ _ _ ,___ __ _ _ _,_ _ _ _ !_ _ _ __
I
65 1 75 85
-- · --
I I I Pulse . . .............
Systolic . ... ........
80 83 89 93 100 ! 97 92 100
108 112 114 . . ....
Alveolar 0 2••••••••• • • 101. 3 54. 5 31. 3! 32. 0 29. 61 30 j l 30. l , 30. 5: 34. 0
Alveolar CO, ......... 42 7 40. 5 34. 8! 34 . 5 34 4 33. 4 34 4 33. 5j 30. 7
Diastolic ........ ...
Pulse pressure .....
64.
44 ······1
······ 48
64
48 ......
66 ......

' Minut e.

I I
The rate of blood flow appeared to have reached a !
maximum about the fifty-fifth minute and then main-
0 18 21 24 33
I
42 57 66
I I I
tained the new level. The respiration, also, after reaching
Resp. Volume .... ··] 5.4 1 5 6 1 6. 7
its maximum value at the twenty-fifth minute remained Haemoglobin .......
6. o 6. 3
No change.
6.3 5.81 6.6 I I
fairly constant urrtil about the eightieth minute when it
increased once more. There \Vas no evidence of interplay A definite fall in the pulse rate began at the forty-sixth
of compensatory mechanisms throughout this experiment. minute and lasted. until the fifty-sixth minute, after
which it gradually accelerated again. There is nothing
(d) Retardation in the Pulse Rate During the Holding
Period with no Increase in Haemoglobin. that accounts for this fall in pulse rate. The arterial
pressures were not taken often enough to make an inter-
There were four cases in this group and the data for pretation of the blood flow changes.
these is given below: V\le believe that our data accounts, in three out of four
of the cases, for the decrease in pulse rate that occurred
F. C. P., December 8, 1918.-Barometer 428 mm. during the holding period. The interplay in these cases
was between the respiratory and circulatory compensa-
Minute. tions to low oxygen.
I
[o 5 10 u \ 25 u jn lw n REPEATED EXPERIMENTS ON ONE INDIVIDUAL
Five men served as subjects from two to five tim"ls (:Jach .
Pulse ........ . .. ... _
... I n 72 74 78 . 80 77 1 78 1 75 74 The data in four cases are complete enough to make
Alveolar 0 2 •• ········ · 197._l .... . 58. 1 44.21. 44.6 . •... 38.6 49.3 38.6
Alveolar CO 2 • ........ 39.7 .... . 36.7 32.81 30.3 ····· 131.9 25 . 5 31.4 comparisons worth while.
W. H. G., May 24, 1918.-Barometric pressure 428 mm:
This experiment was conducted at a barometric pressure t Minute.
of 428 millimeters (15,000 feet ). The breathing as shown
1
by the alveolar carbon dioxide was variable. The carbon i o 25 35 55
dioxide tension was lowest at the twenty-fifth and fiftieth
minutes. The high alveolar oxygen tension at the fiftieth
I

- - - - - - - - - i-
Pulse. ···· . ······ · ··· · ··· · \ 76
- --1-- -
821
5

85
10 15

94 93 91 90
Sl_'stolic..... . . . . . . . . . . . . . . 100 102 102 102 104 104 100
minute was sufficient to account for the falling off in pulse
rate .
Diastolic... .. .......... . ..
Pulse press ure . . . ........ ·I 66 . . . . . . . . . . . .
34 . . . . . . . . . . . .
60
42
62
42
66
38
68
32

Minut e.
C. P. C., December 13, 1918.-Barometric pressure 428 mm.

Minute.
o I 10 15 25 35 45 65

Alveolar o, .. ............. 19~- 8 72. 5 1 ?O. 8 i 45. 2 48 8 46. 7

0
__5_ 1~ . 1~ ~ l~ -4~ 58 Alveolar CO 2 •••••• • •••••• 3, .3 , 33. 0 30 4
Haemoglobin........ . .... 96 . . . . .. 103
I
31. 7
106
28.9
106
43. 7 1 28. 3
31.1
105 105

Pulse............ . .. 84
Ah-eolar o, .... .... 96.0 8488o 1 56940 1 41.986 . .. 95
. - 1-- 92 . 88
-- 48 4 W. H. G., J uly 10, 1918.-Barometric pressure, 380 mm.
Alveolar CO, .. . . ... 32. 2 22. 6 23 . 3 20 4 18. 7
I I Minut e.

The respiration increased throughout the entire period o I5 j 10 15 i 25 I 35 I 55 75 95

which probably accounts for the slowing of the pulse rate .
F . D., January 13, 1919, was subjected to a barometric Pulse........ 78 94
Systolic ... . . . . . . . . . . . 110 llO
pressure of 395 millimeters (17,000 feet) in an experiment Diastolic . . . . ... _. . .. . 70 64
Pulse pressure. . . . . . . . 40 44
which lasted 100 minutes. The haemoglobin did not
increase. The pulse rate accelerated from 72 to 99 by the Minute.
fifteenth minute. It held this rate for three minutes, was ,
90 at the twenty-fifth minute, and 78 at the seventieth o 6 12 21 27 I 39. 42 \ 60 75 I 102
minute, where it remained until the close of the experi- 1
ment. The respiration was not measured, but the observer Resµ. volume ... 5. 7
! I
6.6 1 6. 5
and the subject noticed that the subject's breathin g Haemo"lobin
~ ·· ·· °8
"
6. 3 6. 6 8.1 7.8 17.6
· · · · ·\ · · · · · · · · · · · · · · · I'
101 2
6. 8
101
6. 7
I 3 104
increased, and became labored at the twenty-fifth minute, 1-- - -,-F-o-r-t y--s-i'-x-t h- mrn
-'--_-_u- t-'-e-. - - - -,-N
- i_n_e_t)----fi-
ft_h_mrn
__-u-te~.- - -
and remained so until the end. , Sixty-fifth minute.
 68
In both experiments the blood flow, as showh by the that in each experiment the compensation was made at
pulse rate and the pulse pressura, reached its maximum first by the circulation and respiration, but later it was
immediately after the low barometric pressure was at- borne wholly by the respiration and haemoglobin, in that
tained. An increase in haemoglobin was·observed in each the pulse rat~ slowed to normal or subnormal.
experiment when the pulse rate began to i:etard . The A. F. H. served as,a subject four times and did not
respiration in the experiment in which the barometric tolerate the low oxygen tensions equally well each time .
pressure was 428 millimeters increased during the ascent, The data are summarized in the following protocols.
then maintained a level. In the experiment at 380 milli
meters the respiratory per-minute volume was increased A. F. H., July· 8, 1918.-Barometric pressure, 880 mm.
rom 5.7 to 8.1 liters during the ascent. It then decreased
slowly to 6.6 liters at the forty-second minute, after which Mfnute.
it remained constant. In the first experiment the in-
crease in haemoglobin spared the circulation: in the sec- 0 5 I 10 15 25 35 55 7b

ond both circulation and respiration shared the gain.

B. R. L. was taken twice to 380 millimeters. The Pulse ....... ...... . n n n' n 88 n
Systolic ........... .
results are tabulated· below. Diastoli c .......... . :~ ::::::::::::!::::::I~::::::::::: :66 I·····
..... 4
B . R . L., Aug. 5, 1918. Minute.

Minute.

Pulse. . . . . . . . . . . . . . . . 84
5

85 85
10 15

88
25

9086
35

84
55 ~
82
,~
83
~:i;;,~J~J.·.:: 6iJ .~:: ..~: ..~: ..~: .. tiil .~:~.,.I~ .:
' 1
. • ~o
Systolic . ..•..... ..... ,104 102 100 102 .........• 92 98 102 1 Fortieth minute. 'Sixtieth minute. • Eighty-sixth minute.
~~~
0
tr~~e::::::: :I ~ ::::: ::::: ~6 ::::: ::::: ~ ~ ~
Alveolar 0, .......... 1107. 31····· 75. 01 44.1 142. 2 44.0 48.0 50.0 43.2 A ...F, H., July 15, 1918.-Barometric pressure, 880 mm.
Alveolar CO 2 .•••••••• 37.3 ..... 30.9, 27.4 29.6 25 0 22.91 19.8 23 4
Haemoglohin .... .. ... 107 ....... . . · · \· ·· . . .... . 1111 112 , 112 • 116 i' 1 Minute.
1 Forty-filth minute. • One hundredth minute.
i Sixtieth minute. • One hundred and forty-second minute.
0 5 10 15 25 35 55 75

B. R. L., 'Jfay 12, 1919.

Pulse .... . . ....... . 69 69 72 72 78 81 79 72

Minute.
Systolic ........... .
Diastolic .......... .
Puls~ pressure ... . .
1()6
70
100 98 98
36 .. . ... ······· ..... .
I
1~ ::t\:~~~: 108
72
36

0 5 10 ~ 1~ 25 35 55 66 Minute.

e l M oo l 66 1n
Pulse .............. . . 85 88 86 88 88
~ 1~
94 94 86 82 1
Systolic . ... . ........ . 110 , ... ................. 110 ..... 112 ... . .
Diastolic ... .. . ...... . 70 ..... 70 ..... 68 .... .
o f ~ I IB n
Pulse pressure ... ...... 40 . . . . . 40 . . . . . 44 .... .
R es p.volunie . ....... 1 7.61 7.7 8.2 9.71 9·3t0.2 7.8 8.711 ;4115. 5}9.1
Haemoglobm .. .. ....,. 94 .. ..... . , .. .. . . . . 95 ... . .... 9o .. I 98
Minute.
1 Fortiet h minute. ' .Seventy-eighth minute.
i u
_ _______ ____ !__
o I 5 ' 23 • w
A. F: H., July 80, 1918.-Barorrwtric pressure, 380 mm.
Alveolar o•. .. ... ... 1 104. 4 90.0 49.3 1 48.3 51.6 52.0
Alveolar ci"i,.... .... 39. 1 33.6 31.4 19.5 18.3 18.3 Minute.
Haemoglobin. . . . . . . 100 . . . . . . . . 1 106 ' 106 • 107 • 107

1 Twenty-fifth :minute. a Eighty-eighth minute. 0 5 10 15 35 55 65

2 Forty-third minute.. • Ninetieth minute.
Pulse ......... .. . ... 78 81 81 86 86 87 90 93
The two experiments, while separated by nine months, Systol~c ....... ..... 112 112 108 108 108 96
Diastolic ....... .. .. 68 62 70 72 62 58
were quite similar and unusual in several respects. In Pulse pressure ..... 44 50 38 36 I 46 38
both the pulse reached its maximum rate quickly and I
returned to normal or subnormal before the close bf the Respiration not taken.
Haemogiobi.n, no change.
experiment. The respiratory increase was more marked
than in the usual case, in that the carbon dioxide instead A. F. H. apparently tolerated a barometric ·pressure of
of falling to the average figure of 31 mil.lim,eters reached 380 millimeters better on July 8 than during the later
19.8 millimeters in the first and 18.3 millimeters in the exposures. During the first experiment the pulse reached
secon\i experiment. A good increase in ventilation oc- its maximum rate, 90, at the eighteenth minute. It
curred during the ascent, and it continued to increase for slowed at about the time the haemoglobin increased. The
some time after the barometric pressure was maintained at per-minute volume of breathing showed an early and
380 millimeters. The haemoglobin increased 8.4 per cent marked increase, which reached its maximum at th.e
in one and 8 per cent in the other. It should be noted twenty-fourth minute and held until the forty-second,
 69
after which it returned to the pre-experimeptal volume .
The respiration especi~lly and the circulation slightly
seemed to have been favored by the increase in haemo-
globin toward the latter part of this experiment.
In the second experiment the demand for oxygen was
met by an entirely different compensatory reaction. The
pulse reached its maximum rate slowly, at the thirty-first
minute, and then remained more or less constant·until the
fifty-ninth minute, when it decreased almost to the pre-
-experimental. rate as the respiration increased . The res-
piration reached a first high point at the twenty-first
minute, which it held until the forty-second minute. It
then decreased for six minutes. At this time a great and
progressive increase in breathing ):>egan, which finally
changed the per-minute volume from 7.6 to 19.8 liters.
The;~ ffi.O_ciation of the pulse rate and the respiration was
conspicuous in this experiment. The part played by the
haemoglobin is obscured by the respiratory response .
In the third experiment, July 30, the respiration wag
not recorded. The hoomoglobin did ·not increase, and
the pulse rate gradually accelerated from 78 to 93, through-
out the period of experimentation. This subject had made
frequent ascents in the low-pressure chamber. He felt
more uncomfortable this time than in any previous experi-
ment. He noticed a blurring of vision which had never
occm:red before.
On May 21 , 1918, this subject was taken to a barometric
pressure of 425 millimeters in 15 minutes, held there for
4 minutes, taken down to 700 millimeters, held there for
about 5 minutes, then taken again to 425 millimeters and
kept there for 30 minutes. In this experiment the res-
piratory volume increased and decreased with the barom-
eter. The pulse acceletated in the first ascent from 74
to 96, then dropped to 70 and accelerated to 82 in the
second . The hoomoglobin increased from 94 to 98,
4.3 per cent.
These four experiments with A. F. H . show clearly that
an individual does not necessarily use the three com-
pensatory mechanisms in equal degree each time he
encounters low-oxygen tension. It is evident that the
burden of compensation may be met · adequately in
several - ways. It appears a113o that the oom;::ensatory
changes at a particular pressure may be adequate on some
occasions and inadequate at other times. It is probable
that A. F . H., if held a little longer at 380 millimeters,
would have developed a tYJ?ical case, of altitude sickness.
W. B . M. served as a subject five times. In the first'
experiment he was taken to a barometric pressure of 425
millimeters and in the others to 380 millimeters. At
425 millimeters the pulse accelerated from 63, reaching
its maximum rate, 80, seven minutes after 425 millimeters
was attained . It held that rate until the sixty-eighth
minu.te when it decreased to 76 and remained constant.
The hoomoglobin gave_no evidence of concentration up
to the fifty-fifth minute, but from the fiftJ -fifth to the
seventy-fifth minutes it increased from 104 to 110 p er cent.
The alveolar air showed that the maximum ventilation
of the lungs was reached at the fifteenth minute, after
which it toqk a lower level which was maintained until
the end . The compensations were good in this experi-
ment and the interplay of the compensatory f~ctors was
evident.
At 380 millimeters, in the experiments of June 12, 28,
and July 31, the pulse after re.aching a maximum rate did
not fall definitely . The pulse rate in each of the cases
showed fluctuations lasting from 5 to 10 minutes. In these
the rate retarded at first and then accelerated to the
previous high level. The hoomoglobin increased during
the experiments of June 12 and 28 but did not spare either
the respiration or the circulation. In both cases the res-
piration responded slowly, requiring 42 and 70 minutes to
·reach the maximum . In the experiment of July 31 the
respiration was not studied. The hoom~globin ,failed to
. show concentration. The pulse rate and the blood flow
reached their maxima shortly after 380 millimeters was
reached and then maintained that level for 56 minutes, or
uritil the end of the experiment. This subject was again
under observation at 3_80 millimeters about five months
later, December 27. His pulse at this time accelerated
from a rate of 69 at the beginning to 110 at the twenty-
eighth minute, then quickly retarded to 100 arid from
this point fell slightly toward the end of the experiment.
The pulse showed the same fluctuations in rate as were
observed in the earlier experiments with this subject.
The hoomoglobin increased 8.8 per cent_. We are inclined
to believe that a pressure of 380 millimeters was too low
for this subject. At 428 millimeters his compensations
were adequate and gave opportunity ·for an increase in
hoornoglobin to spare the other factors. At 380 milli-
meters slight movements caused a temporary upset in
the balance of the compensatory factors .
The data presented show clearly that on exposure to a
decreasing barometric pressure the circulatory and · res-
piratory mechanisms are both stimulated to increased
activity. Thus far we have been unable to determine
which of these two mechanisms is most sensitive to the
change . In many men the heart responded by an accel-
eration in the rate of beat, and the per-minute volume of
breathing increased at about the same time and at baro-
i:netric pressures that corresponded to relatively low
altitudes (4;000 feet). Usually the first evidence of
response occurred at a higher altitude. Sometimes the
pulse rate accelerated before the breathing increased, and
vice vetsa. The degree of response made by these two
mechanisms is shown to vary with 'individuals. Thus,
,during the ascent to 380 millimeters, the pulse rate accel-
erated from 5 to 30 beats. The volume of breathing also
showed corresponding differences.
When a desired pressure was reached and maintained,
these mechanisms continued to show differences. The
ventilation of the lungs in some men became maximal
during the ascent, in others a few minutes after the arrival
at the constant pressure, while in a few it increased slowly
throughout the entire period. The maximum ventila-
tion was likewise maintained for a few minutes, a con-
sidei·able portion of the time, or for the entire period of
the constant pressure. Often after a period of maximal
breathing the per-minute ventilation of the lungs was
somewhat reduced. In one experiment with A. F. H.
it r!)turned to the pre-experiwental volume." The pulse
rate and blood flow showed a similar variety of changes.
The hoomoglobin always increased slowly. In some
men no increase could be detected, in others it increased
as much as 10 per cent. In a few men the increase began
 70

- - - - - - ----- -

'---=---':-- -+:----+- -<-- +---+--~>----+--~- I

' I I I 'I I I
a"
'"
T INJ: () $ fl1 fS Z IJ ZS :!14 :!IS 4 4 -IS •4 ,rs ~s 7" 7s 'JS
FIG. 3.-W. A. B ., May 31, 1918. Taken to 10 per cent oxygen (19,400 feet) in 21 minutes by the nitrogen dilution method. The interplay ol
blood Uow, respiration, and h ,emoglobin is shown. Compare with Figs. 1 and 2.

as early as 25 minutes, usually between the fortieth and
sixtieth minute, sometimes as late as th e seventy-fifth
minute. Usuall y the pulse rate decreased while the
hremoglobin increased . Sometimes the pulse rate and the
breathing decreased, and in a few instances only the
breathing decreased as the hremoglobin concentrated .
The data presented show that the early compensations
are ~ade exclusivel y by the circulatory ana respiratory
mechanisms. Later the increase in red corpuscles and
h remoglobin shared the burden with the ·circulatory and
tained. The h remoglobin changes were studied in seven
experiments. Three of these gave no increase in· hiemo-
globin and also failed to show a falling off in puike °';ate
during the period of maintained constant percentage of
oxygen. The cases in which an increased h remoglobin
occurred are discussed below.
G. B . H., May 28, 1918.- To 10per cent oxygenin20minutes.
Minute. .l.

respiratory mechanisms. When the early compensation ·, -

1·- 75
was adequate, as it appears to have been in most cases, 0 5
I
10
I 15 25 I 35 55
the increase in hremoglobin caused a falling off in the
I I 103 I 102

.·~\JI'~ 1JllJ
activity of either the circ ulation or the respiration, or Pulse . . ............ 88 oo 92 95 98 102
Systolic ............ 110 110 104
both. When the compensation was not adequate, the Diastolic ........... 70 62 54
increase in hremoglobin failed to relieve the other mech- Pulse pressure .... . . 40 48 50
Hremoglobin ....... 100 '100 2104
anisms to any extent.
That an individual may make equal use of the adaptiv .. 1 Seventieth minute.
mechanisms during several exposures to low barometrk 2 Eighty-second minute.
pressures is indicated b y the repeated experiments on
The respfration was reconled by means of a Fi t7.
W. I-I. G., B . R. L., and W. B. M. As illustrated in the
pneumograph. It showed a definite increase at the
fou~ experiments with A. F. I-I. t~e responses may d~ff~r eighteenth minute with a. progressive increase to the
durmg two ascents. These experiments show that 1t 1s thirt _ ·gh th minute and then a plateau until the forty-
. "bl d" . h y el '
rmfo~: ~ t°upre 1ct 71t exactness _just how a given I eighth minute. After this a definite falling off in respira-
m 1v1 ua '_¥1 react to ow oxygen durmg exposur~s from tion occurred. The pulse rate accelerated until the
30 to 120 mmutes.. The three f_act~rs of compensat10n are twentieth minute and then maintained a. more or Jess con-
capab1e of a vanety of combmat1ons._ The normal _i'e- stant level. The blood flow as judged from the pulse
sponse to low oxygen makes use of the cuculatory, respua- ressure reached its maximum about the thirty-fifth
tory and blood chan"es. p. . · ·
·' " mmute and then held. The mcrease m hremoglobm came
EXPERIMENTS AT ATMOSPHERIC PRESSURE late. The dimini1tion in respiration began before the
WITH 10 PER CENT OXYGEN. concentration in hremoglobin was d etected. Hence the
evidence of an interplay of compensatory factors is
In this group of experiments the subjects breathed uncertain.
atmospheric air diluted with nitrogen. Starting with W. A. B. , gave an excellent response. His data have-
undiluted air the nitrogen was added gradually until the been plotted in Figure 3. The pulse rate reached its
proportion gave a mixture that gave 10 per cent oxygen at maximum about the twentieth minute, which was the
the end of 20 minutes. This percentage was then main- period of maximum blood flow as indicated by the pulse

pressure. The respiration, which was recorded by means
of a pneumograph, reached its m axi.mum at about the same
ti.me, the twenty-fifth minute, and held there until the
thirty-eighth minute. After this the per-minute volume
of breathing decreased somewhat. The h::emoglobin had
begun to increase at the twenty-second minute. In this
case the concentration in h::emoglobin appears to be
definitely related to a diminution in respiration and a
decrease in pulse rate.
W 0. K., June S, 1918.-To 10 per cent oxygen in20 minutes.
Minute.
---------0~_:_ ~~1~~
Pulse .... ___ __. __ ..
Systolic .. _________ _
72
110
75
!08
78
108
78
112
78
108
112
Diastolic ______ _____ 78 80 80 78 80
Pulse pressure._____ 32 28 28 34 28
Hremoglobin .. . .... JOO - --· - - ------ 102
' Thirty-ninth minute.
' Fiftieth minute.
The respiration as shown by a pneumograph trncing was
somewhat excessive at the start. It quieted later and
maintained a constant level until the forty-eighth minute
when it suddenly became labored. The dept:q at this
time.,increased to three ti.mes its former value while the
rate remained unchanged. There was no evidence of an
interplay of the compensatory factors in this experiment.
Ten per cent oxygen was too low for this subject, since he
fainted at rtie fifty-first minute. In a low barometric
pressure experiment, at 428 millimeters, his pulse main-
tained its maximum rate throughout even t hough there
was a progressive increase in lung ventilation. There was
no evidence of an interplay of factors in the experiment.
E. A. R. in an experiment similar to those just described
gave a 5 per cent increase in h::emoglobin which b1;gan
about the twentieth minute. The pulse rate accelerated
from 68 to 78 in 32 minutes and then held. The respira-
tion was not. recorded. Interplay between the h::emo-
globin and the circulation was lacking unless it be con-
sidered that the early concentration of h ::emoglobin made
it unnecessary for the pulse rate to increase as much as in
the other cases. In a low barometric pressure experi-
ment, 380 millimeters, this subject showed a greater in-
crease in the pulse rate. It accelerated from 72 to 93
and later retarded to 86. His per-minute ventilation
increased from 7.8 to 10 liters and then decreased as the
hremoglobin concentrated.
We are of the opinion that these experiments were made
at too low an oxygen percentage to obtain the optimum
response. Ten per cent oxygen, which was maintained
during the holding period , is equivalent to an altitude of
19,400 feet. Few men could remain long at such an alti-
tude and escape .altitude sickn ess. Under these circum-
stances the response made b y W. A. B. gives striking con-
firmation to .the view that the effects of low barometric
pressure and low percentage of oxygen are due to the same
cause, namely, a low partial pressure of oxygen. It also
proves that an interplay of the compensatory factors may
occur in men subjected to low percentages of oxygen.
71
We shall not enter here into a discussion of the mecha-
nisms by which the changes observed in these expe°riments
are produced . We desire to point out how the reactions
which we have been studying differ from those that occur
in men residing at high altitudes. The acclimatization
to oxygen want seen in men Jiving at high altitudes in-
volves the same mechanisms that we find in the compensa-
tion during a rapid lowering of oxygen tension and com-
paratively short exposures to low oxygen. Ordinarily on
ascending a mountain passively, by railway or automobile,
the respiratory response is the first to ·appear, beginning
during the ascent or almost immediately after the summit
is reached . It requires, however, several weeks for the
76
78
112
~ 86
114
respiration to increase to the volume that is normal for
the new altitude (5). The blood do es not show immediate·
ly the increase in h ::emoglobin and red corpuscles. Just
when these changes begin has not been determined , but
78 70 68 usually within 24 hours a marked increase in both can- be
34 42 56
' 106 2
108 observed. They require five or more weeks to reach their
greatest concentration. The pulse also does not ordinarily
acceletate immediately , but the rate increases slowly dur-
ing a period of several days. The changes in the breath-
ing and in the blood are permanent in character and do
not diminish during a protracted residence at the high
altitude. The .changes in the pulse rate and in the rate
of blood flow are of a less permanent character. With
acclimatization the pulse rate returns somewhat toward
the normal mte at sea level. It has been shown also
that the longer the period of sojourn at a high altitude the
more enduring are the after effects when the subject
again descends to a low altitude. The permanence of
these changes has been attributed to diminished alka-
linity of the blood, to permanent alteration in the excit-
ing threshold of blood reaction for the kidneys, or to· other
changes of a more or less permanent character.
The compensations which we have presented in this
paper are quick to develop and temporary in character.
They disappear at once, or at least quickly, when ordi-
nary atmospheric pressure and oxygen tensions are re-
stored. That they were never quite sufficient at a baro-
metric pressure of 380 millimeters was indicated by the
fact that while cyanosis often improved when a low oxygen
level was maintained, it never disappeared entirely. Fur-
thermore some men who appeared to be compensating
well lost gradually in mental efficiency or become abnor-
mally sleepy. It should also be noted that as experience
on mountains has demonstrated, if the experiments had
been continued several hours longer, the majority of our
subjects would have developed typical cases of altitude
sickness. Headache and fatigue were often observed as
after effects.
The differences in the responses observed under these
two different conditions of exposure to low oxygen depend
no doubt upon a suddenness with which the low barometric
pressure and low oxygen percentage have been decreased
and upon the exteJ?.t to which they were lowered. In
I very slow and moderate changes it is possible that no re-
sponse may be evoked. Possibly the respiratory center,
l by virtue of greater sensitiveness may react so much to
the stimulus that the increase in respiration for a time
I cares adequately for the oxygen requirement of the body.
 72
In the more rapid decrea1:1e w oxygen tension the respira-
tory and cardiac .centers and very 1ikely the vasomotor
centers are stimulated at higher oxygen tensions and at
about the same time. Consequently under the condi-
tions of our experiments these two mechanisms served al-
most equally to care for the oxygen need·of the body.
SUMMARY.
l. During a period of gradual reduction in oxygen par-
tial pressure at a rate approximately 5 millimeters per
minute the respiratory and cardiac centers are ordinarily
stimulated by about the same fall in the oxygen pressure.
In some subjects the first response · began at an oxygen
partial pressure.of 147 millimeters, in the majority between
128 and 113 millimeters.· In some men the circulation
responded -before _the respiration, and in others the order
was reversed. 'l'he compensations during the · period of .
reduction, -which lasted 15 to 20 minutes, ,rnre made en-
tirely by the circulation and respiration.
2. The compensations during an exposure to a constant
low oxygen tension were classified as follows: (a) 'I.'hose in
which the pulse, after maintaining a high rate for a while,
r_e tarded slowly and the percentage of hremoglobin in-
creased; (b) those in which the pulse after a primary rise
maintained a constant rate while the hremoglobin in-
creased ; (c) those in which the pulse rate after the primary
rise remained constant and in which the hremoglobin did
not increase; (d) those in which the pulse rate .after a
primary rise retarded and the hremoglobin did not in-
crease. The compensations were distributed among these
groups as follows: (a) 55 per cent; (b) 19 per cent; (c) 17
per cent; (d) 9 per cent.
3. During aR exposure of 30 to 145 minutes to low oxy-
gen tension the percentage of hremoglobin usually in-
creased in 20 minutes or more. When this occurred, and
when the compensation which had been made by the
respiratory and circulatory systems was adequate, the cir-
culation or the respiration, or both, decreased as the
hremoglobin increased . In several cases the sparing ac-
tion of the hremoglobin restored the pulse rate to nor-
mal- that is, the preexperimental rate-and in one case
the respiration returned to normal.
4. The interdependence of the three compensatory reac-
tions was shown also in a few cases in which an increase
in breathing, following a period of equilibrium in circula-
tion and respiration, resulted in a retardation in pulse rate
and blood flow.
5. Several ·individuals compensated in the same µi'a'n-
ner and in about equal degree in two or more experirrtents. ,
One man C'ompensated differently in each of four experi-
ments.
BIBLIOGRAPHY.
1. GREGG , LUTZ, and SCHNEIDER: American Journal of
Physiology, 1919, 1 216 .
2. LuTz and SCHNEIDER: American Journal of Physiology,
1919, l 228.
3. LuTz and SCHNEIDER: American Journal of Physiology,
1919, 1 280. "
4 SCHNEIDER: Journal of the American Medical Associa-
· tion, 1918. vol. 71, p. 1386.
5 _ DOUGLAS , HALDANE, HENDERSON , and SCHNEIDER
Philosophical Transactions of the Royal Society of
London , B. 1913, vol. 203, 185.
-By courtesy of American Journal of Physiology.
 PART 11.
THE REACTIONS OF THE CARDIAC AND RESPIRATORY CENTERS TO
CHANGES IN OXYGEN TENSION.
MEDICAL RESEARCH LABORATORY., AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.
By EoWAIW C. SCHNEIDER, formerly m3,jor, Sanit!l.ry Corps, and BRENTON R. LUTZ, formerly first lieutenant, Sanitary
Corps.
The-fact that the medullary centers of the brain in man
are very sensitive to changes in available oxyi,e n became
apparent early in the re breathing and low-pressure experi-
ments conducted at the Medical Research Laboratory of
the Air Service, Mineola, N. Y. We(l) 1 have shoW-ll that
the respiratory and cardiac centers are stimulated to in-
creased activity in some men when the atmospheric oxygen
tension is decreased from 159 to 137 Inillimeters Hgin about
four minutes. The respiratory response at first is an increase
in the depth but not in the rate of breathing. The cardiac
response is shown by an acceleration in the pulse rate.
Because these responses developed before the organism
appeared to come under stress from lack of oxygen we
became interested in attempting to deterinine how quickly
and to what extent the breathing and the rate of heartbeat
will respond to sudden changes in oxygen tension.
In the past, ii,sphyxia and low oxygen effects have been
studied in animals in considerable detail. Paul Bert(2)
working with man and animals showed in 1878 that, when
oxygen 1 was adininistered at a low barometric pressure
in a pneumatic cabinet, the pulse rate retarded soon aft.er
the inhalation of oxygen was begun. Traube(3) in 1863
investigated the action of asphyxia upon curarized rabbits.
The earlier experiments did not distinguish clearly
between the effects due to lack of oxygen and those due
to the accumulation of carbon dioxide. The complete
separation of the two conditions by the use-of such gases
as hydrogen, nitrogen, or carbon monoxide has proved
that the initial effect of oxygen lack on the medullary
centers is clearly stimulating(4). Loevenhart has writ-
ten, "The striking symptoms of asphyxia, however pro-
duced, are the following: .Increase in the rate and depth
of the respiration, rise of blood pressure, slowing of the
pulse, cessation of respiration, general convulsions fol-
lowed by paraly,Sis, marked and progressive fall in blood
pressure, death." Gasser and Loevenhart(6) found that
decreased oxidation stimulates the medullary centers in
the following order: Respiratory, vasomotor and cardio-
inhibitory, and that on further decrease in oxygen the
centers become depressed and finally paralyzed in the
order named. I,,oevenhart has omitted from his list of
symptolll8 of asphyxia the acceleration of the heart which
has often been recorded . Lewis and Mathison(7) observe
that the heart accelerates within two or three Ininutes of
the onset of asphyxia.
1 Number in parentheses refers to the bibliography at the end ol the
article.
The majority of researches have dealt in detail only with
th-e late and more acute conditions ol the reactions to as-
phyxia and anoxheinia. Gasser and Loevenhart(6), how-
ever, have determined the la.t ent periods for the action of
decreased oxygen on rabbits, dogs, and cats by the admin-
istration of carbon monoxide_and sodium cyanide. The
latent periods calculated from the beginning of the admin-
istration ranged tor the respiratory center between 4 and
14.5 seconds, averaging 6' or 7 seconds, and for the cardio-
inhibitory center between 15 and vO seronds,
In our experiment.'3 we have studied men and have con-
fined our attention to the early effects on the heart rate and
on the respiration of a reduced oxygen supply. We have-
also-studied the opposite condition in which either oxygen
·or normal air was given after the individual showed clearly
the effects of oxygen want"and we have recorded the heart
rate and respiration under these conditions.
METHOD.
The effects of anoxhemia and the restoration of normal
oxygen tension on the pulse rate and respiration were
studied by having men breathe pure nitrogen. Nitro-
gen, saturated with water vapor at room temperature, was
supplied through Larsen's spirometer from a rubber bag
Containing about 80 liters. In a few cases the subjects
inspired directly from the bag and exhaled into the room.
The Larsen apparatus was used, however, because it gi;tve
an opportunity to measure the volume ot each breath.
Before the experiment the subject sat quietly with a
mouthpiece in place but breathing through his nose.
Simultaneous records of the pulse and respiration rate
and amplitude were taken by means of a Mackenzie
polygraph to which a Fitz pneumograph was c,mnected .
After sufficient normal record had been secured, with the
apparatus still recording, the nose clip was put on and the
spirometer opened at the same time so that the subject
began to breathe nitrogen without interrupting the
record. When the pulse and respiration became markedly
increased and the subject began to appear ashy pale, the
pupils dilated, and unconsciousness impending, fhe nose
clip was remov~d and the spirometer closed so that the
subject breathed atmospheric air without interrupting
the pulse and respiratory record which was continued in
most cases until the normal was resumed . No cases of
fainting occurred, but it was evident when the method
was being tried out on ourselves that unconsciousness could
come on without fainting, and few· of our sq.bjects were
taken to this· point.
(7,3)
 74
From the continuous record the pulse was counted for
five-second periods throughout. The length of each
respiration was measured in seconds and recorded as the
rate per minute. The amplitude of each respiration was
measured in millimeters. The volume ·of each breath of
nitrogen was read in deciliters from the dial of the respirom-
eter. Unfortunately the return of the per-minute vol-
ume, when air was given, could not b e followed with
the apparatus, but the amplitude of each breath during
this period was recorded. In the pulse studies in the low-
pressure chamber a continuous pulse tracing was taken
with the polygraph covering the ·period before, during,
and after the taking of oxygen from the tube. In cases in
-which the effect of oxygen on respiration at low oxygen
tension was studied, the Larsen spirometer was used in
the low pressure chamber, and at the desired moment
oxygen was allowed to fill the spirometer.
The excitability of the medullary centers to changes in
the partial pressure of oxygen was determined in two ways,
first by a reduction in available oxygen, and second by a
sudden increase in the-oxygen obtained by returning the
subject quickly to atmospheric air or by the administration
of pure oxygen. By the first method the centers were
stimulated and by the second their activity was di-
minitihed.
For the determination of the latent period the second
method was found to give more uniform results than were
obtained by decreasing the oxygen supply. The nitrogen
experiments gave the best illustration of this difference.
Many of our subjects showed anxiety which was mani-
fested in a high pulse rate and slightly increased breathing.
These conditions naturally masked the onset of the
stimulating action of the lowered oxygen tension. A
. further cause for the variation in the length of the latent
period was found in the depth of breathing. In passing
from the breathing of ordinary atmospheric air to pure
nitrogen the depth of breathing was usually so shallow
that the amount of nitrogen that passed the dead space
of the lungs was comparatively small. It frequently
reguired two or three. breaths to alter profoundly the
alveolar oxygen. "\-Vhen the lungs were well filled with
nitrogen, the breathing became deep and rapid. Under
these circumstances-when oxygen was given or the subject
was returned to atmospheric air, the first breath because
of its depth carried a large amount of .oxygen into the
alveoli, and smce the breathing was also more rapid, a
second large influx of oxygen quickly followed the first.
PULSE RATE.
The pulse rate data for the nitrogen experiments have
been tabulated in Table I. In order that the pulse
counts for the entire period might be presented, we have
recorded the rate in one-second intervals. From the
polygraph tracings we have taken as our unit 5 second$
rather than 10 seconds. The latent period has been
caiculated from the beginning of the administration of
nitrogen in the study of the effects of decrease in oxygen,
and from the time the subject was returned to atmospheric
air or given oxygen for the determination of the time of
beneficial effects of oxygen. In each case the interpre-
tation consisted of determining in which five seconds the
puls0 rate had definitely changed in the proper direction,
and then of recording the interval that had elapsed up to
this 5-second period as the length of the latent period.
The following are typical experiments with nitrogen in
which the pulse rate is recorded in intervals of five seconds.
Before N. Nitrogen on. Nitrogen off. Time on.
J. D. 6,6,6, 7,6, 7 7,8,9,9,9,9,9,9 9,9, 7, 8,6,6,7,6 42ser.
W . .B. 6,7,6,6,6,6 6,7,8,7, 8,9,10, 11, 10 11 , 10,9,8, 7,8, 7, 6,6 45 sec.
C. L. 8, 8, 8, 8, 9, 8 8, 8, 8, 9, 9, 11, 11, ll, ll 12, 11, 10, 9, 8, 8, 8 46 sec.
The latent period for the stimulating effect of a decrease
in oxygen during the breathing of nitrogen ranged between
5 and 55 seconds. Approximately 44 per cent of all cases
gave a latent period of not more than 10 seconds, and 22
per cent gave one of 15 seconds. Thus a total of approxi-
mately 66 per cent of all experiments showed a latent
period of 15 seconds or less.
The latent period determined for the opposite action,
namely, an increase in oxygen percentage in which the
pulse rate was retarded, ranged between 5 and 30 seconds.
In about 45 per cent of all cases the latent period was 10
seconds or less, and in 41 pet cent between 10 and 15
seconds. A total of 86 per cent showed that the activity
of the cardiac medullary center was diminished in 15
seconds or less by an increase of the oxygen in the respired
air.
Experiments cond ucted with 10 men in the low press.ure
chamber in which the subject was held at a barometric
pressure of 380 millimeters (18,000 feet) gave latent
periods similar to those obtained with nitrogen. The
oxygen was administered in these cases through a rubber
tube held in the mouth. It was customary to give oxygen
until the pulse had returned to about the normal rate and
then to withdraw the oxygen for five minutes, or until the
pulse rate had l!,gain accelerated after which o,xygen was
given once more. The following cases in which the pulse
rate was recorded for intervals of five seconds are typical:
Before O,. O,given.
B. B. J. (1) 8, 8, 8, 8, 8, 8 8,8, 7, 7, 7, 7, 7,7,6, 7, 6, 7
(2) 8,8,8,9,9, 9 8, 8, 6, 7, 7, 7, 7, 6, 7, 6, 7, 7
B. R.L. (1) 10, 9, 9, 9, 9, 9 9,9,8, 7,8, 7,8, 7, 7;7,8, 7
(2) 9, 9, 9, 9, 9;8 9, 9,8,8, 7, 7,8, 7,7,7, 7, 7
With one exception the 10 men reacted to the oxygen
administration by a slowing of the pulse rate which was
definite within from 5 to 15 seconds. The exceptional
case in two trials gave a latent period of 45 seconds.
The total acceleration of the pulse rate in the nitrogen
experiments varied between 6 and 72 beats, although it
was usually in the neighborhood of 30. The return to
normal when th e subject was restored to atmospheric air,
was made in from 10 to 15 seconds. It should be noted
that in the nitrogen experiments we did not, as a rule,
continue the breathing of nitrogen until the subject
became unconscious. Jn the low pressure chamber the
return to normal spmetimes required two or three minutes
of oxygen .administration. In s.ome cases the rate became
subnormal.
The above reactions of the heart to changes in oxygen
,tension bring to mind the discussion of the mechanism by
which the observed changes are produced. Gasser and
Loevenhart(6) have pointed out that the views on the
effect of decreased oxidation on the medullary center~
may be classified as ·tollows: (a) A decrease in oxidation
can not cause stimulation; (b) decreased oxidation may
. cause stimulation, but only indirectly by increasing the
 75
stimulating effect of carbon dio4.ide, or by causing the
formation and acc·umulatibn of acid metabolic products;
and (c) decreased oxygen per se under proper conditions
will stimulate _:;, ese centers. They support the third
view by proving that the responses of the respiratory and
the vaso constrictor centers occur too rapidly to be at-
tributed to the accumulation of acid products. Our own
data on the acceleration and retardation of the h eart beat
give a reaction time that is also too short to lend support
to the acid theory or to the idea of accumulation of meta-
bolic products.
If it be admitted that the variations in oxygen in them-
selves stimulate and d epress the medullary heart center
the question of what constitutes th e accelerator mechanism
is still unsettled. It is well recognized that the h eart
may be accelerated in at least four different ways: (a) By
a d ecrease in vagal tone , (b) by stimulation of the acceler-
ator center, (c) by secretion of adrenin, (d) by an increase
in the temperature of the blood(9) . That the low oxygen
effect is not the result of a decrease in vagal tone seems
unlikely, since the first action of oxygen want is a stimu-
lating one. Mathison(8) found in animals in which the
vagi are intact that irregular slowing occurred frequently
during ii..sphyxia. This he attributed to the stimulation
of the cardio-inhibitory center. Gasser and Loeven-
hart(6) also found, in animals under low oxygen produced
by the use of carbon monoxide or sodium cyanide, that
the latent period for the stimulation of the cardio-inhibi-
tory center varied between 15 and 50 seconds. This
period , they find, is often obscured by the rapid onset of
the depressive effect of low oxygen on this center. The
reaction with which we have dealt in our experiments
does not find a ready explanation in decreased vagal tone
because the response occurred before the cardio-inhibitory
center would have been affected by oxygen want.
Since the first effect of low oxygen on the medullary
center is stimulating, it is natural to attribute to thE
accelerator center the increase observed in exposure t c
low oxygen of rebreathing and low barometric pressure.
Nolf and Plumier(lO) believe that in the dog they found
evidences of increased tonus in the accelerator cardiac
nerves during asphyxia. Mathison(ll), on the other
hand , demonstrated that the acceleration which im-
mediately preceded heart-block during asphyxia was not
due to stimulation of the accelerator center. After sec-
tioning the upper part of the spinal cord to remove the
influence of the accelerator center, he still obtained -ac-
celeration of the heart. That low oxygen may lead to
stimulation of the adrenals has been demonstrated by
Kellaway(l2). He observed a dilatation of the pupils
during such an exposure. We have seen a dilatation of
the pupils of some of our subjects during the last part of
the period while breathing nitrogen. Meek and Eyster(13)
have shown that the action of adrenin is twofold. It
accelerates the heart by direct stimulation and inhibits it
reflexly through the vagus, the acceleration occurring first.
That an increase in temperature is not the cause of the
acceleration follows from the briefness of the nitrogen
experiments in which the acceleration was evident within
5 to 15 seconds.
We believe that the acceleration which we have reported
in this paper and in our study of low pressures and low
oxygen percentages, occurs before the cardio-inhibitory
effects observed b y Gasser and Loevenhart and by Mathi-
son. It is not the same acceleration that Gasser and
Loevenhart found after the depression of the inhibitory
center. That it is a result of a stimulating action on the
accelerator heart center seems to us the most satisfactory
explanation. "\Ve have, however , no experimental proof
for this explanation.
The beneficial or quieting effect of oxygen on the heart
rate has been observed by Benedict and .Higgins(l4) and
by Parkinson(l 5). In normal individuals at sea level the
breathing of oxygen rich mixtures slowed the rate appre-
ciably. Schneider and Sisco(l6) working on Pike's Peak
(14,110 feet) administered oxygen to si x subj ects and ob-
s(ll"ved a reduction in the pulse rate which varied between
7.4 and 28 .8 per cent, while in Colorado Springs (6,000
feet) the breathing of pure oxygen caused a slowing of
2.5 to 8.8 per cent.
RESPIRATION.
The response of the respiratory m echanism to changes in
oxygen tension has been studied b y the same methods and
at the same time as the pulse-rate changes were und er ob-
servation. The respiration was recorded by means of a
pneumograph and a Mackenzie polygraph. In some cases
we have also measured the volume of breathing by means
of the Larsen spirometer. From the polygraph tracing the
height of the curve of each respiration has been measured
to determine a factor which would give relati ve data on the
change in volume of each respiration. The rate of breath_
ing has been determined by noting the tim e taken for each
breath.
A summary of the results obtained with nitrogen is
given in Table II. In Table III the results of six experi_
ments are presented in d etail. In the nitrogen experi-
ments we dealt with opposite conditions, a reduction in oxy-
gen tension and an, increase in oxygen tension. In the
presentation of the pulse-rate changes it was shown why
the latent period as determined for the effects of decrease in
oxygen would be longer than that for the effects of increase
in oxygen. In addition to the influence of the depth
of breathing, the rate of blood flow may account for the
shorter latent period that ·uccurred when the subject was
returned to normal atmospheric air. During the -early
stages of asphyxia, Mathison(ll) found in animals that
the systolic output per beat gradually increased, reaching
a maximum in about 30 seconds. Since the effects of the
oxygen changes are brought about through the action in the
medullary centers the shorter latent period at the return
to air or oxygen is explained in part by the increased blood
flow.
When anoxhemia was produced b y breathing nitrogen,
the latent period for change in volume of breathing as esti-
mated by the height of the respiratory curve ranged be-
tween 4 and 35 seconds. The average was 14.5 seconds.
About 32 per cent of all cases h:ave a latent period of 10
seconds or less, while fo 29 per cent it was between 10 and
15 seconds. In the determinations of the volume of each
breath by t he Larsen spirometer the latent period ranged
between 4 and 25 seconds, averaging 12.4 seconds. In al-
most all cases the latent period as estimated by this met.hod
was slightly less than that determined by the height of the
respiratory curves.
 76
The volu.m e of breathing diminished quickly when the/ same manner and in about the same short time as Gasser
subject was restored to atmospheric air. The latent period and Loeve.nhart found in animals. The shortness of the
as determined by the height of the pneumograph curve . latent periods, both when oxygen is withdrawn and when
I
ranged between 3 and. 34 seconds, averaging 6.9 seconds. it is administered, suggest that the oxygen effects are.
A large nutnber, 89.3 per cent, had a latent period of 10 immediate and determined only by the time required for
seconds or less. This would indicate that the respiratory the blood to pass from the lungs to th'e .medullary centers.
center, with respect to the volume of each breath re- These data appear to lend support to the view that oxygen
sponds to oxygen changes slightly earlier than the cardiac llJl'<l;c,T certain ·<.,-onditions pe:r se determines .the condition
center. of activity of the respiratory and other medullary centers.
The rate of breathing is increased by anoxhemia when In this connection the observations of Lindhard(l7) are
the fall in oxygen has become marked. On administering interesting because he found that an excess of oxygen
nitrogen the latent period for the increase in tlie rate of diniinisheu ""l1he excitability of the respiratory center.
breathing ranged between .8 .a nd 80 seconds, averaging 35.5 Kaya and Starling(l8) made chloralized animals breathe
seconds. The normal rate of breathing ranged between 8 a mixture of nitrogen and oxygen and found that a diminu-
and 26 breaths per minute, and at the height of anoxhemia tion of the oxygen fro:iµ 20 to 14 per cent had, as a rule,
it ranged between 11 and 46 breaths. . The rate of breath- no effect on ili.e rhythm or depth of respiration, but that
ing decreased more rapidly when the anoxheniia was a1le- oxygen of 8 to 10 per cent increased the amplitude and
viated than it increased during the withdrawal of oxygen. rhythm of the respiratory movements. The short latent
The latent period for rate on the return to air ranged be- period that we obtained withnitrogenandinourrespiration
tween 3 and 31 seconds, averaging 9.5 seconds. The studies in the low-preBBure chamber and in rebreathing(l )
.respiratory stimulation due to low oxygen with respect to indicate either that a man is more sensitive to changes in
rate and depth passed away completely within from 10 to oxygen or that chloral alters the excitability of the respira-
53 seconds after returning to atmospheric air. tory center.
In a few cases which werl:l kept at 380 millimeters in the The quick responses made by the heart and the respira-
low-preBBure chamber we have determined the volume tion to changes in the oxygen tension of the respired air
change when oxygen was administered. The per minute make it appear that the oxygen has a direct influence on
volume of breathing was recorded in these experiments, the excitability of the medullary centers which control the
and the data are given in the table. It will be observed rate of heart beat and the breathing. Whether oxygen
that the per minute volume of breathing was much re- acts indirectly by increasing .and decreasing the stimulat-
duced even during-the first minute of oxygen administra- ing effects of carbon dioxide or whether oxygen itself, by
tion. A fall in rate was also present in four cases. the variations in partial preBSure or in the rate of oxidation,
is a stimulus to the medullary centers still remains ·a n
E . C.S . B.R.L. K.O. N.
unsettled q,uestion.
Min. Vol. Rate. Min. Vol. Rate. Min. Vol. Rate.
SUMMARY.
------ - - - -- --
16 11. 4 13 16 12.3 10 11.5 18 1. The cardiac and respiratory medullary centers in
17 11. 6 17 11.9 11 11 11.6 ..
18 11. 6 18 13.0 12 11.2 man respond quickly to changes in the pa,rtial pressure of
19 12. 8 19 13.3 12 13 11.5 16 oxygen. A decrease in oxygen stimulates while an in--
20 11.0 20 12. 7 14 11.6 ..
21 11. 9 21 13. 9 ' 12 15 11.1 crease in oxrgen inhibits the action of these centers.
22 11.6 14 22 15.1 ... 16 12. 2 is 2. The heart accelerated in from 5 to 55 seconds in re-
Oxygen on. Oxygen on. 17 11. 7 ..
23
~ f
8.3
18: i2
23 · 10. 9
24
25
5.8
6.0
I
11
I
18
19
11. 9
14.6
Oxygen on.
19
sponse to a decrease in oxygen. In 66 per cent of all cases
the acceleration began within 15 seconds or less. Admin-
26 4. 8 11 26 6,84 9 20 8. 74
istration of oxygen slowed the heart within 'from 5 to 30
~ g i2
27
28
8. 4
4.25
I
..
..
21
22
I 23
7.61
6.72
6.95
16
16
seconds. In 86 per cent of the cases the retardation ·began
24 9.06 within 15 seconds.
+5 8. 06 17
3. · Changes in the partial pressure of oxygen in the re-
spired air have a twofold action on the respiration; the
G.S. M. B.B. J. B.R.L. rhythm and the depth of breathing may be altered. In
a gradual and comparatively slow reduction in oxygen
Min. Vol. Rate. Min. Vol. j Rate. Min. Vol. I only the depth of breathing was usually increased. With
- - ~ - - -
I a sudden decrease in oxygen the depth of breathing was
14 11. 9 12 · 12 .. 15 11.9
15 9.51 · 13 11.5
11. 6 1 16 14.0 first increased ·and later the rate .
16 10. 1 14 12. 5 17 13.1
17 9. 75 15 9.18 18 15.8 4. The latent period for the increase in the d6pth of
18
19
12, 2
18.4
Oxygen on.
12 16
17tn
Oxygen on.
23
I 22
19 14. 1
Oxygen on.
20 8.4
breathing in anoxhemia ranged between 4 and 35 seconds,
·averaging 14.5.seconds. The latent period for the increarn
20 14. 0 18 9.51 21 5. 61
in breathing ranged between 8 and 80 seconds, averaging
I
21 13. 3 19 6.26 22 3.82
22 11. 3 n 20 8.28 15 23 3. 36 · 35.5 seconds.
23 12.3 21 9.06
24 10. 7 22 6.16 15 5. When the subject was retmned to atmospheric air,
25 10. 6 23 7.39
the latent period for reduction in the volume of breathing
varied between 3 and 24 seconds, averaging 6.9 seconds;
Our data obtained from a study of men indicate that the for the rate of breathing it varied between 3 and 31 seconds,
respiratory center responds to a decrease in oxygen in the averaging 9.5 seconds.
 77
6. In all subj ects at a barometric pressure of 380 milli- 9. GASSER and MEEK : American Journal of Physiology,
meters (18, 000 feet) administration of oxygen reduced the 1914, XXXIV, p. 48.
volume of breathing, and in some cases the rate also was 10. NOLF and PLUMIER: Journal de Physiologie et de
Pathologie Generale, 1904, VI, p. 241.
decreased. 11. MATHISON : Journal of Physiology, 1910-11, XLI, p. 416
BIBLIOGRAPHY. 12. KELLAWAY : Journal of 'Physiology, 1919, LII, p.
1. LUTZ and SCHNEIDER : American Journal of Physiology. LXIII-V.
2. BERT: La Pression Baroriietrique, 1878. 13. MEEK and EYSTER: American Journal of Physiology,
3. TRAUBE: Allge. Med. Ctrblt., 1863, V. 1915, XXXVIII, p . 62.
4. MATHISON: American Journal of Physiology, 1911, 14. BENEDICT and HIGGINS: American Journal of Physiol-
XLII, p. 283. ogy, 1911, XXVIII, p . 25.
5. LoEVENHA.RT: The Archives of Internal Medicine, 15. PARKINSON: Journal of Physiology, 1912, XLIV, p. 54.
1915, XV, p. 1059. 16. SCHNEIDER and Sisco: American Journal of•PhysioJ.
6. GASSER and LOEVENHART: Journal of Pharmacology ogy, 1914, XXXIV, :p. 29.
and Experimental Therapeutics, 1913- 14- V, p. 239. 17. LINDHARD: Journal of Physiology, 1911, XLII, p. 337.
7. LEWIS and MATHISON: Heart, 1910-11, II, p. 47. 18. KAYA and STARLING: Journal of Physiology, 1909-10,
8. MATHISON: Heart, 1910-11, II, p. 54. XXXIX, p. 346 .
TABLE !.-Effects of breathing nitrogen on the pulse rate. Rates calculated from JO-second period13 on the sphygmogram.
[First black figure indicates time on, second black figure t ime off.J

No. 10 20 30 10 20 30 40 50 60 70 80 90 100 no 120 Time

130 on.

L..---1
2-----·
72
78
73
72
72
72
78
84
72
72
84
72
72
84
84
78
90
84
78
96
96
84
96
120
90
102
126
102
96
138
114
96
120
90
18
96
90

90 ----78-
72 72 ······ ·
-- --78-
71
68
3 ..... - , 84 58
4_ --- -- 90 84 96 108 96 108 114 102 114 108 114 114 72 72
5 ..... . 90 84 90 90 90 102 102 96 102 108 114 114 120 108 96 90 87
6---- - -1 96 96 102
I 96 102 120 132 138 126 102 96 . . . . . . . .... . . . ··- · ·· · · ·-· ·· · 47

: : ~f:::::
7 ____ -- 78 84 78 72 78 78 90 90 102 108 108 90 64
- ----
89 -______ 96 96 102 102 102 ll4 120 126 132 108 102 96 46
78 72 72 72 90 102 126 126 114 90 90 72 42
10- .. . . . 102 108 114 114 126 126 132 132 126 114 108 108 102 102 102 ·· ·· -· · 39
11.. •. .. 84 84 96 84 96 102 114 ll4 114 102 96 96 90 ····· ·- ·· ··· · · · · · · · · · 57
12 .•.. • . 102 108 108 102 114 108 108 108 108 108 108 96 80 ······ · -- -· · · · ... .. .. 80
13 ...•. .
14 ..• .. .
15 . . . ...
108
72
78
lU
78
102
114
78
95
120
90
90
132
108
102
144
108
108
144
108
114
150
108
114
144
90
114
144
72
102
126
78
90
12J
84
108 ·· ···· · · ······
··· ····1 (()
42
16 ...•.. 90 90 84 90 ll4 108 108 114 114 108
· · · ·- ·· ···· ·· · 48
84 102 90 60
17 .... • . 84 78 78 84 84 84 96 102 120 108 90 84 ··· ·· ·· [ 46
18 ...... 72 72 72 66 72 66 72 72 78 84 84 90 90 84 · · ·· · · · • • • • • •• j 88
19 . . •. -- 66 72 66 72 72 66 66 78 84 84 96 96 96 84 --- --·· 83
20 . ... . . 90 102 96 96 90 108 114 120 108 104 ·- ---·· --- -· ··- · ···· ·· .. ..... ···
84 ··· ·
· · · · ·· · 38
21. •.... ··· · ·· ·· 96 90
114
96 114 126 --- --- -- 132 · ······- · · · ··· ·· . . .. .... ..... .. . . . . ... . .... .. · ·- ·· ·· · ··· ·· · 30
22 . •.... 102 108 120 138 138 ···· · · · · 126 .. ... . .
23 . . .•. . 90 90 96 102 108 108 102 102 108 114 .... iii;"
114
· -···
96 90 90 ... . ....
30
66
24 . • .... 90 96 102 108 114 114 108 108 120 114 102 90 90 84
25 ... . . . ·-······ 90 96 96 96 108 114 114 108 108 102
· · ···· - · · ···· · 59
84 84 · · · ··- · 63
26 . . • • . . 84 84 9.6 102 114 120 126 120 114 102 90 84 78 84 52
······ ·
27 .••...
28 • . ••••
102
84
96
90
102
96
108
96
96
102
108
114
108
114
114
l~O I·....... 114 102
114
96
102
96 ·· ·· · ·· ···· ·· ·
96 90 90 90
·--····
· · - · · ··
47
45

TABLE I I.-Effects of breathing nitrogen on respi7:ation . . The latent perio~ for the initial response in both rate and depth
when nitrogen is on and off are given.
R ate. Height. Volmue.

No.
On,
laten t Normal
Maxi- Off , latent
mum riod in secon s.
rs· Oil,
latent
Off laten t pe- On ,
riod in seconrls. laten t
Deciliters per
breath.
p er
period min- per - -- - - - ormal Maxi-
period Nmm. mum period
in sec- ute. min- Begin. Com- in sec- mm. Com- m sec-. Begin. Maxi-
Begin . plete.
onds. ute. plete. onds. onds. mum.
1. ... ... • • . • . .. . . ..•.•. • • .. • • •. - ...
2 .•........... . .... • .... . .. • ·-···· ·
3 • ••••• • ••• • •• · -·······- · · ·· ··· · · ··
32
60
50
13
14
16 ~23 I··......
. . ~ . ~- . .
· · ··· ·· · 19

4
8
5
4
4
26·
20
9
,
4
IB ~
4 5. 60
t: :} H.8
4 ••••••••••• . • . ••••.•.••••• • •. . •..• 26 16 Z7 7 7 4 22 5 7 6. 70 26.3
5 . . ... • . , • • •.. •. · • • •· • ·• · •· • · • ·· -·· 8 17 26 5 4 5 21 lg it 4 3. 90 8. 95
6.•••.••. •·••·••·•••••••·•·• • ••· • •• ·
7 ... . .... . .. . .............. .. ..... .
55
20
16
18
29
24
7
12
20
12
22
20
4
6
16
14 3 ~ ~: rJ
1
8 .•• . •. • • •• •• .••••• • •.•••.• • • .. - • ••
9 .•.•••••••••• . • •• . •• • · · •· • • •••·· · •
10 ... • . . .•...• . .• . ....... · -· · · · ·····
45 .
33
20
17
15
14
30
17
29
11
4
31
25
17
31
13
21
22
5
14
4
22
25
8 24
~
31
fr 1
6
~ ~::
3. 90
Jr
7. 84
11. •.•. •. ......•.....•..•.• . . .... • .. 27 12 17 . .. -- . - · · ·· · ···
~
35 5 10 .. -- . . . . .. .. . . . . 23 8. 40 13. 4
12 .•...•.•.•.• . .... • ...•.•.. . . . . : •. • 31 18 ;JO 6 11 15 4 13 3 11 15 4. 50 10. 8
13 ..• . • •. • . •.•.. . •••... •. ••• • .. . ... • 26 20 50 ····· ·· - ..... . .. 18 4 17 15 25 15 2. 80 7. 80
14 ••...•.••••• . .. _•. . .•. . ... . ....•.. 32 15 25 11 32 12 3 25 5 21 4 1. 12 12. 2
15 . • . ·· · · · ······-· · · · ·-···- ·· ·· · · · · · 41 18 21 .. . . . .. . . ...... . 9 4 28 5 10 9 6. 72 19. 1
16 ..... . ........ . ..... ........ . ..... . 48 18 Z7 · · ······ 7 4 30 .. . .. . ....... . -- 7 2. 24 22. 4
17 .•.•.. .. .....• . • . ..•... • .• . .. .. •.. 61 15 23 4 13 25 3 17 8 23 25 2. 24 7.84
i8 . . .. . ... . . . .. . . _. .. . .... . ........ . 80 26 38 ··-·· ·· · ·-··· - ·- 17 3 10 7 17 ···· · · · · . .. . ... . ---- · ···
19. •·•·• . ..... _. • ... ••. .... .• . .... _. 48 8 15 ·-·--··· · · ··· 25
· ·· 28 9 16 10 .. . .. -- ... . .... .. .... . . . •..•.. . .
20 . • ...•... • ......... . .... . • . ..... - . 48 9 11 12 6 12
25 13 37 9 20 12 30
10 18 25 2 ·'--·io"I 10 7 25
21 13 23 7 ····· · ·· 12 6 13
ti i:1111111:;1;i )\)\\iiiii\iiiiiiii! 25
34
14
15
35
20
3
15 ::::::::i 12 1
4
8
15
27

,! i 1t>
12

········ •••····· .......

· ······.
26 .. .. .• . . •• . . . . . . ..... • . •. . • ... . • . • 22 17 20 22 5 17
........
I
27 ..••. · • •· •· ·•· •• ·• · •• ·•· •• • •··· ... 47 18 25 3 10 5 16
28 • •• •• • • •• • •••• - • .•. ••• • •. . • •. •. •••
29 . .•• ... .••. •... . . . . • •. • . •... ... . . •
25
18
21
23 30
46 I 8
19 --·.m 10
5 I
9
7
22
20
6
3
5
21
26 · •· · ·•·· · ••··• •·
48 • • ••··• • •.• .. •••
. • . •. . . .
· •· ·· • ·•
30 .• • .. • ·•· •· . . • . · • · ·· • ••·•· • • · · • •• • 48 10 27 7 13 I 6 20 6, 53 · · ·····• · · ···•·· ....•. . .
 78
TABLE lll.-Data for the respiratory response to the breath T ABLE III. - Data for the respiratory response to the breath-
ing of nitrogen as taken from the polygraph tracing ·anr.
the Larsen spirometer. · I ing of nitrogen as taken from the polygraph tracing and
the Larsen spirometer-Cont inued.
J.E. J.
I S. I.

Number
of resp.
Length,
sec.
IRate
min.
per Heigh t,
.m m .
Volume,
decil.
I Nu mber Length, Rat~ per Height, Volume,

--3.-5- ,-
I
- 1-7-
- ~ - - - -1 I of resp. sec. mi,µ .
--- ----
mm. decil.
--

T"~T'
0 4
0 2. 5 24 5 ... .... ...
1 4.0 3 1.12
Nitrogen on.
2 4.0 1 4. 0 15 4 3. 36
15 3 2. 24 2
3 4.0 15 3.3 18 5 2. 80
4 I 3. 36 3 2. 6
4 4.0 1.5 3 I 5. 60
23 5 I. 68
5 4. 2 4 3.1 19 5 5.04
14 6 I 5.60 5 2. 8
6 4.2 14 9 i 21 5 3. 90
6. 72 6 3. 0 20
7 4. 0 15 9 6. 72 6 3. 90
10 i j
4. 2 7 3. 0 20 7 5.04
8 14 6. 72 8 3. 0 20
9 3. 8 16 12 7.84 6 5.60
10 3.8· 9 2. 8 21 6 4. 48
16 13 8. 96 10 2. 7
11 3. 6 17 13 22 6 3.36
7.84 11 2. 7 22
12 3. 8 16 16 11.2 6 6. 16
13 12 4. 2 14 7 5. or
3. 6 17 17 10:1
14 3. 2 13 2.5 24 8 4.12
19 18 10. 1 I
14
15 3.4 18 2. 5 24 9 5. 60
18 11. 2 15 2. 2 27
16 3.0 20 19 10 6.16
17 2. 6 23 20
·-··- ---- -
11. 2
16 2. 2 27 11 5. 04
18 17 2.2 27 11 6. 72
2.8 21 21 10.1
19 2. 4 18 2.5 24 11 5. 60
25 24 12. 2 19 2.2 27 12
Nitrogen off. 6. 72
20 2.4 20 2. 2 27 13 6. 72
25 23 --- --- ---- 21 2. 2 27 13 7.R4
21 2.4 25 25 ·-------- - 22 2. 1 28 I I
I
22 2. 4 25 19 15 6. 72
23 2.4
·· --- ---- · Nitrogen off.
25 12 ------- -·· 23 2. 2 27 17
24
25
2.4
3.4
25
18
17
13
-.. . - -- --- 24 2.2 27 14
--- -·-····
·--- -··-· -
26 3. 4 18 10
·····--· ·· 25 2.2 27 15 ---- ·-· -··
···---·· · · 26 2.4 25 15 · -· ··· ·· -·
27
28
3.43
4.0
18
15
8
5
--- ------- 27 2.8 21 15 -- -· -··- ··
29 3. 6 28 2. 8 21 12 --- --- ---·
17 5 29 2. 2 27
30 3.8 16 5
15 --········
31 4.0 30 2.2 27 11 ------·-· ·
15 5 31
32 4. 0 15
1. 8 38 5 ----· -····
5 -- - -- -·· ··1

W . B.
E . C. S.

Number
' Length, Rate per Height
Number
of resp.
Length, Rate per Height, Volume,
Voh1mP, sec. min. mm. decil.
of res p. sec. min. mm. decil.
- -- - -- - - -
I --- ---
0 4. 3 14 3 1----- --- --
I 0
l
4.3
3.8
14
Nitrogen on.
16
3
4
··- ----- -·
2. 80
l
2
3. 2
2. 7
Nitrogen on.
39
22
4
5
-----3.90
-- ---
2 4. 2 14 4 3. 90 3 3. 7 16 4 6. 16
3
4
I 4. 6
4. 5
13
13
6
5
5.60
2.80
4
5
4. 2
3.0
14
20
5
5
4. 48
4: 48
5 7.5 8 7 5.04 6 2.5 24 5 5.60
6 4.2 14 9 6.16 2. 8 21 7 4. 48
7 4.8 12 9 7.84 8 2.8 21 7 6. 16
8 4. 6 13 11 7. 84 9 2.8 21 7 6. 72
9 4.3 14 9 8. 40 10 2. 5 24 7 6. 72
10 4. 4 14 11 7: 84 .11 2. 6 23 7 7.27
11 4. 4 14 12 8. 40 12 2.5 24 7 6. 72
12 4.3 14 14 12.89 13 2.4 25 9 7.84
13 4. 3 14 14 11.20 14 2.3
14
15 I 3.8
3. 6 I 16
17
15
20
15. 68
14. 57
I 15 2. 2
26
27
Nitrogen off.
8
7
7.84
7. 84
Nitrogen off.
15 .
16 2.2 27 7 ..........!I
16
17 3.
2. 95 17 1 ---- -- ---- 17 2. 2 27 7
21
"20
17 -- ---- ---- 18 2.1 29 7 --- -·· ·· ··
18 3.0 15 ---- --- --- 19 2.3 26 8 ---- ··· · -·
19
20
3.0
2. 9
20
21
13
9
-- -- -- ---- 20 2. 1 29 6 ··· ··-----
21
22
3.0
2. 7
20
22
I 7
4
· ··· · ·· · --
---- ----- -
21
22
23
I. 6
2. 6
2.4
37
23
5
5
5
·· ····--·-
···- ·· ·· -·
..........
23 2. 4 25 I 4
·· ··· ·-·-·
........ .. 24 2.3
25
26 6 · · ······- -
24 3.0 ---- --- ---
20
I 3 25
26
'}:J
2.2
2.5
2. 7
27
21
22
8
7
6
---······ ·
· ----··· ··
·· ···-····
28
29
2. 1
2. 2
29
27
6
6
----- -----
30 4.0 15 3
· ·· -····
..... ··
... ..
.... .. ... .
31 3.6 17
I 3
 79
TABLE III. - Data for the respiratory response to the breath- TABLE III.-Data for the respiratory response to the breath-
ing of nitrogen as taken from the polygraph tracing and ing of nitrogen as taken from the polygraph tracing and
the Larsen spirometer-Continued. the Larsen spirometer-Continued. ·
C. l\f. L . K.O.N.

Number
of resp.
Length,
sec.
Rate per
miil.
Height, II Volume, Number·
,:.,,''°j Ro<, "" H.,,M, M=o,

- - - --1-
mm. decil. of resp. sec. min. mm. decil.
- - - - - - -- -
0 2.6 23 5 . .... . ... . 0 3. 7 16 4 . . . . . •. . ..
Nitrogen on. itrogen on.
1 3.2 19 4 4.48 1
I 6 6. 72

'j "
2 2. 7 22 4 6.16 2 3. 66
3. 17
17 7 6. 16
3
4
5
3.3
3. 3
3.6
18
18
17 !
I 4
4
6
3.90
4.48
5.60
3
4
5
3.2
2. 9
19
21
10
14
8.40
9.52
15 14.0
6 3. 3 18 7 8.40 6 3.2 19 19 14.60
7 3.2 19 i 7 7.27 7 3. 9 15 20 26.30
19 I
I
8 3. 2 10 7. 84 8 3. 5 17 19 22.40
9 3.2 19 10 11. 20 9 3.2 19 19 16.80
10 :p 26 7 10.80 10 2. 9 21 20 24. 60
11 2.6 23 7 5.60 11 2. 2· 27 20 19.10
12
13
2. 7
2. 6
22
23
24 I
I 9
9
10.80
10.80
12 2.2 27
itrogen of
20
···· ·· ··· ·
14
15
2. 5
29 I
9 8.95 13 2. 5 24 I 22 ......... .
2.1 13 8.40 14 2.5 24 19 ------- ---
16 2. 0
Nitrogen off.
30 13 ·········-
18
23
2. 3
2.4
26
25 I
21
17
----------
---·-···-
17 2. 0 ...... . .... . . ........-
18 2. 0 I 30
30
11
7 --------·-
29
32
2.4
2.8
25
21
16
11
19 2.5 24 9 ------
-----------
--.-
35 2. 7 22 9
1···: ......
20
21
22
2.8
3. 4
3.1
I 21
18
19
6
5 -----·····
36
27
2.8
2. 7
21
22
9
9 --- -------
23 3. 6 17
5
5 ··········
.. .......... I
24 3. 4 j 18 5 ------ ----I -By courtesy of American Journal of Physiology.

THE RELATION OF THE SIGHTING EYE TO THE MEASUREMENT OF
HETEROPHORIA. (A PRELIMINARY REPORT.)
MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.
By Capt. l'ERC
When the eyes are alternately covered and uncovered
in the screen test, one eye is frequently seen to make a
greater excursion of redress than the other. Occasionally
a careful observer during the parallax test notices that the
image jumps farther when the screen is moved in one
direction than when it is moved iri the other. Such ob-
servations are common in the experience of ophthalmolo- ·
gists who employ these two excellent tests and some con-
fusion not infrequently arises in trying to select a prism
that will neutralize both mo_vements, In the interest
of accurate procedure it is necessary to determine which
of these two unequal eye movements indicates the true
deviation of the visual axes.
It is evident from the technique of the screen test that
the two unequal degrees of deviation d epend upon the
fact that the role of fixation is given to each eye in turn.
The stimulus received by the retina of the eye fixing the
test object determin es the direction of both visual axes
when the other eye is screened . A study of the problem
in hand , therefore, depends upon an investigation of the
effects of right and left eye fixation on the measurement
of heterophoria.
The screen test is not easily adapted for making the
measurements desired in this investigation. The tech-
nique advocated in this test is to place prisms of con-
stantly increasing strength before one eye until the direc-
tion of movement of the eye is observed to be reversed.
From this amount of prism (2)(A) 1 is deducted and the
result called the measurement of the original movement(!).
This procedure is practical for clinical use but is subject
to a possible error of one prism diopter(l), an amount too
high for the purpose of this investigation where small
amounts of heterophoria must be exactly measured.
The parallax test gives an exceedingly exact result but,,
being sub.jective in character, its success depends upon the
ability of the observer to see the apparent movement of
the test object when the eyes are alternately screened.
The fact that some observers are unable to see this move-
ment limits the l\pplication of the test.
Other tests for heterophoria in common use are not
readily available for this purpose because their technique
is such that fixation of the test object by one or the other
eye is not under the control of the examiner.
1 Number in parentheses refers to the bibliograph y at the end of the
11rticle.
PART 12.
DOLMAN, Medical Corps.
I It was not until the Maddox rod screen test(2) had been
in use in this laboratory for several weeks that a means
was recognized for making the desired measurements in
a simple and accurate manner.
Either eye in this test may be selected for light fixation,
the other being covered by the Maddox rod. The fixing
eye throµghout the test is kept in the natural primary
position, uninfluenced by any prism, screen, or other de-
vice . The Maddox rod before the other eye is covered by
a screen which is removed for an instant and replaced,
allowing a brief view of the line of light. If the line does
not pass through the spot of light, a rotary prism is placed
in front of the Maddox rod and rotated while other brief
exposures of the line are made until finally a degree of
prism is obtained that causes the line to pass through the
light every time the screen is removed. This prism is the
measure of the deviation of one eye in relation to the other
which fixes the light. Itis obvious that a second measure-
ment can be obtained i;'y selecting the opposite eye for
the role of light fixation.
This test has been made on both eyes of 100 observers,
50 of whom were aviators and medical officers connected
with the Air Service. The remaining 50 were patients
in several New York ophthalmological clinics. The
apparatus used in the Medical Research Laboratory was a
DeZeng phorometer-trial frame equipped with ·a pair
of Maddox multiple rods and a pair of Risley rotary prisms.
The phorometer attachment of thi13i apparatus was not
used. In the clinics the tests were made with a trial case
multiple red rod, held in position by a trial frame, measure-
ments being made by trial case prisms or a portable rotary
prism. The sighting or dominant eye of each observer
was ascertained by having him locate a distant light
through a hole in a large card held in both hands.
In the first half of the appended table are grouped the
aviators and medical officers. The aviators were ·com-
paratively free from refractive errors which might in-
fluence the test. The medical officers were tested while
wearing their refractive corrections. The second half
of the table contains the data concerning the clinical
patients. The visual acuity recorded for this group is
not as high as for the first one. Those who wo:re glasses
were tested with the glasses in place. The rest were free
from the suspicion of having more than a moderate amount
of refractive error. All individuals having a marked
inequality of vision of the two eyes were excluded from
I both groups.
(80)
 81
[Abbreviations: Esophoria, S; exophoria, X; right hyperphoria, RH; left hyperphoria, LH. Measurements are in prism dioptries J
Maddox rod Maddox rod
Visual acuity. measurements measurements
Sight- when light is Visual acuity.
Number. Age. Sex. fixed by- Sight- when light is
mg Number. Age. Sex. i ng fixed by-
eye. eye.
R.E. L. F,. R.E. L.E. R.E. L . E. R. E. L.E.

1. .........
2 . . ······· ·
3 ... . ......
25
21
34
21
M
M
M
20/15
20/20+2
20/20
20/15
20/15
20/20+5
.~1g~: 83
X2
... do . . 82
82
81
83
52 . . . ·······
53 • . . •......
54 •. . .......
11
30
31
M
M
F
20/20'!-4
20/3o+4
20/20+3
20/20+6
20/30+4
20/20+4
.~1g.t .
Left .. .
S2t
X2
X3
I Slf
Xt
X3
4 . . ··· · ···· M 20/15+4 20/15+5 .. . do .. 82 St
X3 55 • . · •··· · ·· 34 F 20/20+4 20/20+3 Right. {817 89!
5 .......... 24 M 20/20+3 20/20+3 ... do.· { LH2
X4 LH2 LHl
LH! 56 • . •· ··· · · · 36 F 20/20+2 20/20+ 1 . .. d o .. 81 81
6 . . · ···· ·· · 22 M 20/15 20/15 Left . . . Sl t 82 57 . . .. .... . . 20 F 20/20
52 M 20/15+3 20/20 . . . d o .. X7 X5
7. ··· ······· 20/15+3 Right. 82 81 58 .. · ···· · ·· 14 M 20/15 20/15 . . . d o .. X2 Ortho.
8 .......... 22 M 20/15 20/20+2 Left ... {Sl }ortho. 59 .. . ·· · ···· 16 M 20/20 20/20+3 . .. d o .. X2 X2
LHt
9 .......... 24 M 20/1.5 20/15, Either X2 Xl 60 . . ········ 10 F 20/20 20/20 .. . do .. {86 }84
10 ..........
11. .........
20
23
M
M
20/20
20/15
20/20
20/15
Right. 83
·Left. .. 82
s~
82
61. ......... 16 F 20/30 20/30 Left ... X27
RH! RHO
X9
12 . . .. ...... 62 . . . ······· 16 M 20/20+2 20/15 Either 81 83
22 M 20/15 20/ 15 . .. do .. Xl SI 63 .. . ....... 10 M 20/20
13 ...... . . .. 25 M 20/20+4 Right. Ortho. Ortho.
20/20 20/20 Right. 81 Ortho. 64 . . . ····· .. 9 M 20/20+2 20/20+4 ... do .. 81
14 .......... 21 M 20/15 20/15 Left ... Slt Do.
Sl t 65 .. ········ 19 M 20/20+4 20/15 ... do .. 82 St
15 .. . ....... 23 M 20/15 20/15 Right. Ortho. Ortho. 66 . ....... . . 16 M 20/20+ 1
16 ..... • • . .. 29 M 20/20+1 ... do .. X3 Xt
20/15 20/15 ... do .. X9 X5 67 .. .. .... . . 11 M 20/20 20/20+4 ... d o . . X3
17 .......... 36 M 20/15 20/15 ... do .. Ortho. Ortho. , 68 .. ·· ····· · X I!
18 ...... .... 8 M 20/30+5 20/20 Left ... XIO XS
27 M 2Q/15 20/15 ... do .. 84 82 4& F 20/30 20/30
69 .. . · · ·· · ·· Right. Slt Ortho.
19 ... . ...... 30 M 20/15 20/20+6 Left .. . {Sl 82 70 .. · ··· • ··· 13 .M 20/20 20/20 ... do .. 82 81
LHt LH2 X4
20 ..... . •... 25 M 20/20 20/20 ... do .. 84 82! 71. ....... . . 16 M 20/20+2 20/20+1 Left ..• {X2z
21. ......... 21 LH! LH!
22 ..... : ....
23 .. ····· ·· ·
22
24
M
M
M
20/30
20/20
20/30
20/30
20/20
20/30+4
.~1g.t:
Left .. . St
Ortho.
Do.
Ortho. 72 . .........
Do. 73 . .........
21
18
F
F 1 20/20+
20/20 1 20/30+4
20/20+4
Right. 84
Left . .. X3
82
X4
Sit 74 ....... . .. 11 M 20/20+2 20/20+2 Right. X2 Ortho
24 .... . .. . ..
25 . . ........
26 .... . .....
22
22
25
M
M
M
20/20+7
20/15
20/15
20/20+7
20/15
20/15
.~1g.t:
... do . . 84
X2
83}
X!
82
83
75 ... . ... . . .
76 ... ·······
34
10
M
M
20/30+6
20/20
20/20
20/20
Left ..• SU
Right. X2
814
X!
15
l 77 . .. ······ · M 1 20115 20/20+5 Left Ortho S2z
27 ....... . .. 27 M ' 20/15 20/15 d 1{84 82 78 .. ········ 10 F 20/20 20/30+4 Either Do. Ortho
. . . o .. RH! RHt 9 M 20/20 1
28 .... ... . .. 26 M
79 .. . · · ····· 20/20+2 , Left ... 82 83
20/15 20/15 ... do . . Sit S! 80 ... · ··· ··· 14 F 20/30+4 20/20 ... do . .. 84
29 .. ···· ···· 23 M 20/15 20/15 Le ft .. . St 82 83
81. . . .... ... 49 F 20/30 20/30+2 Right. XS! X7
30 .. . . ····· 25 M 20/20+5 20/20+4
.~1g.t: ~
St 82 ... ······· 13 M 20/20+4 20/15 Left . .". ~
31. ....... .. 23 M 20/20+6 20/20+6 St 16 M 20/30+ 4 X3
83. · · ······ · 20/30+4 Either 5 X3
32 ...... ....
33 .... ... . ..
34 ........ ..
26
21
23
M
M
M
20/15
20/15+2
20/20+6
20/20+6
20/15+1
20/20+7
Left ... St
.. . do . . XI
84
SU
X3
Slf
84 ....... . ..
85 •.. . . ... . .
11
10
M
¥
20/20+2
20/20+2
20/20
20/20+4
Right ·. {]Ortho
[. .. do •• . S2
I}Sl
Ortho
35 .... .... ..
36 .... . . . ...
37 ........ . .
26
29
26
M
M
M
20/20+1
20/15
20/20+7
20/20+3
20/15
20/20+7
.~~~.t .. 82
.. . do . . X2
... do .. 83
81
Xt
82
86 . . · ·· · ····
87 .. ········
19
19
F
F
20/20+ 1
20/20+5
20/20+1
20/20+2
I Either {X7
Left ... 85
RH!
LH4
I
RHO
X2
LH2t
86
38 ... ······ · 26 M 20/20 20/30+5 Left ... Ortho. Ortho. 50 M 20/20
39 ...... . .. . 26 M 20/15 20/15 Right. X4
88 . . . ······· 20/20+ 1 1· . .do ... X3 X5
X2! 89 .....• . ... 18 M 20/30+5 20/30+5 Either X2 X2
0 . ......... 25 M 20/15 20/15 .. . do .. {Sl
RHt
}s 1
RH}
90 ..........
91. . . .......
17
29
M
F
20/20+4
20/30+6
20/15
20/30+6
Right. 83
. . . do ... 810,
82
4 I. ......... 88
33 M 20/15 20/15 .. . do .. 81
42 .... . ..... 28 M 20/15 20/15 .. . do . _ X3
81
Xt 92 .. . ....... 40 M; 20/20+2 20/15 f .. . do . . .{Xt
RHl
X3
RHl!,
43 .... · • ··· . 21 M 20/15 20/20+4 .. . do .. 84 83 93 .. . . ······· 35 M 20/15 20/20+5 I Left . . . S! S2
44 . . .... ... 25 M 20/ 15 20/15 ... do .. 85 82 94. . ........ 14 F 20/15 20/20+3 ' . . . do ... 82 S4
45 .......... 24 M 20/15 20/15 Either 81 S2t 95 . . ....... , 13 M 20720 20/20+2 1. .. d o ... 81 82!
46 .......... 27 M 20/20+6 20/20+6 Right. Slt 81 96 . . . · ·-· · ·· 20 M 20/15 20/15 , Right. 81} Ortho
7 .. ·· · ····· 24 M 20/20+7 20/20+7 ... do .. X3! XH X2
97 .......... 13 M 20/20 20/20+2 ... do ... {X3

l
8 .. ···· · ·· · 25 M 20/15 20/15 ... do. . 81! Slf RHl RH!
9 .......... 30 M 20/15 20/15 Left ..• { Ortho. ?2 98 .......... M 20/20+2 20/20 Left .. . Ortho Ortho
Hl 99 ... •. .. . .. 15
18 F 20/20 20/20+2 I Either x2, Xlt
50 ... ······• 22 M 20/15 20/15 Right. 81! 81! 100 ....... . . 31 F 20/20+4 20/20+3 . . . do ... X3 X3}
51. ..... . .. . 30 F 20/20+1 20/20 Left . .• 88 88
1 II ''
The test for the sighting eye demonstrates that 61 ob- fixes the light. Of th e 26 left-eyed observers, 19 exhibit
servers (61 per cent) use the right eye, 30 (30 per cent) the the greater amount of error when the left eye fixes th e
left and 9 (9 per cent) sight with either the right or left light. The table indicates that when the sighting eye is
eye without showing a decided preference for either. used to fix the light.during the test, the greater amount of
Attention is called to the fact that 81 per cent of these heterophoria is exhibited by 66 per cent of the observers,
observers give two different measurements of the same the lesser amoant by 7 per cent and the same amount by
type of heterophoria as a result of :fixation of the ligh t by 17 per cent.
each eye in turn. This percentage is very much higher Further analysis of the data does not help determine
than experience with the screen test has i ndicated. whether the greater or lesser amount of error represents
The data concerning the amount of esoph9ria, exophoria the true condition of th e eyes. If the purpose of the hetero-
and hyperphoria measured when each eye is used to fix phoria. test is to measure the maximum error, then the
the light, may be rearranged for the purpose of studying greater amount revealed by giving the sighting eye the role
several different phases of the subject of heterophoria. of fixation indicates a practical method of performing the
This report, however, is concerned only with the relation test. This will give the greater amount of error in 66 per
of th e sighting eye to the measurement of heterophoria. cent of the tests and be accurate in 17 per cent more where
Out of 61 right-eyed observers, 47 exhibit the greater the same amount of error is recorded for each eyll. It is
amount of some form of heterophoria when the right eye possi ble then in 83 per cent of the tests for heterophoria
1454-30- -6 0
 82
made by the Maddox rod-screen method to measure the nearer the trial case. The role of light fixation should be
maximum error by having the sighting eye fix the light. given to the eye that is used habitually for sightin in the
In criticism of these percentages it should be stated th a tordinary visual acts of life.
the measurements obtained in testing some of the observers
are not free from the influence of small refractive errors. BIBLIOGRAPHY.
It was not possible in this series to refract every observer 1. FucHs-DuANE. Text-book of Ophthalmology. Sixth
as a preliminary to the test. The influence of slight turn- Edition, p. 767.
ing movements of the head is not entirely eliminated from 2. DuANE, ALEXANDER. The Practical Application and
the findings although head movements were guarded the Relative Value of thf,l Tests Used in Examining
against as much as possible without actually fixing the the Eye Muscles. Annals of Ophthalmology, April,
head. 1905, p. 304.
The hundred observers reported here are not enough to 3. DOLMAN, PERc. The Maddox Rod Screen Test.
bring this problem to a definite solution. Meanwhile, Archives of Ophthalmology. September, 1919.
pending the reporting of further tests, no mistake will be 4. DOLMAN, PERC. A Consideration of Some Testa for De-
made if the Maddox rod is always placed before the non- termining the Sighting Eye.
sighting eye instead of before the one that happens to be - By courtesy of American Journal of Ophthalmology.
 PART 13.

A CONSIDERATION OF SOME TESTS FOR DETERMINING THE SIGHTING EYE.

MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.

By Capt. PERC DouIAN, Medical Corps .

There is considerable literature devoted to the subject : test each observer for his sighting eye. Experiments were
of the sighting eye, but references to specific test.s for deter- I made with various tests and a conclusion reached that the
i
mining which eye is habitually used for sighting are diffi- possible influence of either hand would be greatly reduced
cult to find. This is probably explained by the fact that · by holding the first test object in both hands. A rn by 20
the act of sighting or aligning two objects is such a common I centimeter card with a 3-centimeter round hole in the
ex_rerience in life that tests may easily be borrowed from I center was employed instead of the customary pencil or
tms ~ource. Few of these tests, however, meet the exact ' poioter. The use of such a card compels the selection of
reqmreme1~ts of rese~rch _work. . . one or the other eye for sigliting through the hole, thus
. The possible coordmat10n between t~e s1ght~g eye ~nd eliminating a certain percentage of negative results which
nght or lef~ handedness must be considered m s~lectm_g are. obtained when the first and second test objects are
a test.. .Senous attempts have. been made to e3tabhsh. this a 11gne . d wi·th some porn
· t b et ween th e t wo eyes.
association between the dommant eye and the domman t "'h t t . f d b h · th b th
· · f h f h · ·
h an d m spite o t e act t at no anatomica1 re 1at10n can e h b .1 e es is per orme y avmg e o server grasp e
d Of h d · h b0 h h d d · · I 1
demonstrated. Until our knowledge on the subject is in- s ort e~ s · t e c~r wit . ~ an s an raise its_ ow Y
creased by scientific experiment, the possible influence of at arm s ~ength while_ lookmg mtently at a spot of hght G
either hand should be eliminated from the adopted proce- meters distant .. He is mstructed to _keep both eyes open
<lure. Tests made by pointing with either forefinger or with and locate the !1ght throu~h the ~ole ~ the card. The eye
a pencil held in either hand or by sighting through a ring selected for this purpose is the s1ghtmg eye.
held in either hand are open to criticism :or this reason. This test has been made repeatedly on the same ob5erv-
In another form of test the observer approaches a sta- ers with intervals of several days between trials. The eye
tionai:y object such as a vertical rod and aligns it with that was selected the first time-, whether the right or left,
another object located some distance away. This proce- was invariably selected at the later tests.
dure is free from the-influence of either hand but it fre- The apparatus required for the test just described is both
quently happens that, in walking toward the first object, simple and convenient. It does not permit the selection
the nonsighting eye is carried in line with the two test of a sighting point situated between the two eyes but forces
objects by a mere accident of head position. Such a test is the use of one or the other eye for th<y act of sighting. The
unnecessarily inconvenient in addition to being unreliable. possible influence of the right or left hand on the test is
During a recent investigation of the influence of fixation greatly lessened by having the card held in both hands.
on the measurement of heterophoria, 1 it was necessary to The results obtained with it are consistent in repeated
1 Dolman, Pere. The Relation of the Sighting Eye to the Measure- trials with the same individual.
ment of Heterophoria. - B y courtesy of American Journal of Ophthalmology.
(83)
 PART 14.
THE MADDOX MULTIPLE RED ROO: A CONSIDERATION OF ITS OPTICAL
DEFECTS.
MEDICAL RF.SEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.
By Capt. PERC DoLMAN, Medical Corps.
During the course of a series of experiments made for the
purpose of investigating the accuracy of the Maddox rod
test, it was discovered that the line of light often appears
No.
nea.rer than the light which is located 6 meters away.
The statements of a number of observers have repeatedly
verified this fact.
When the line is in sharp focus, it is seen as a bright
bmid of light, of uniform density, with sharp, clean-cut
edges. Such a line appears to be located at the same
distance as the light. When the line is not in focus, it
is seen as a wider band, of unequal brightness, with hazy,
irregular edges. The general effect is that of indistinct.
ness. The line then appearn to be located often only
a few feet from the eye.
The influence on the Maddox rod test of this false
localization of the line is in favor of the measurement of an
excessive amount of esophoria. 1 The appearance of the
line of light, therefore, has a direct bearing on the accuracy
of the test.
The same indistinct appearance of the line may be
caused by certain optical defects in the Maddox rod. An
examination of the several rods which were being used
at the time, disclosed such a high percentage of defects
that a special investigation was begun to determine the
optical qualities of other Maddox rods in general use.
The results ol that investigation form a part of this report.
Twen~y multiple red rods were ex~ined. ~ome of
them were in use in the laboratory, others were found in
nearby clinics, and a few were obtained from dealer's
stock. The defects found in these rods are of two types,
· involving (1) the character of the line of light, and (2)
the presence of prism acting to deflect the line of light
from its true position.
The prism is readily det11cted by holding the rod before
one eye so that a horizontal line of light is seen while the
other eye ·1ooks at the light. The position of the line in
relation to the light is observed. Then the rod is rotated
through 180 degrees just as a cylinder is rotated in the
trial frame. The line is again horizontal and, if no. prism
is prtisent, will be in exactly the same position in relation
to the light as at the first observation.
The following table summarizes the data obtained from
an inspection of these rods. No prism, less in amount
than one-half prism diepter, is recorded.
1 Dolman, Pere, The Maddox Rod Screen Test. Archives of Opthal- ·
mology, September, 1919.
(84)
Inspection of Maddox multiple red rods.
Amount
of prism
Character of line. deflecting
line.
1 Good ... . . ..........• . ........ ...... . •.•.... ... •... One-half.
2 Indistinct .. . ..... . ... . . ... .... ...... ............. . Do.
3 Good ... .. .. . .................................... . None.
4 Indistinct ....................... .. .. ... ... . . ..... . One-half.
5 Good ........ .. .. ........... . . ...... ..... .. ... • . ... None.
6 Indistinct . .. .... . ........ .. .. ... .. ... .. ... .. .. . .. . One-half.
7 ....• do ..... .. . ................................... . One.
8 Good .................... . .. ........ ... ........ . . . None.
9 .•.•• do . ......... .. . ... ... .. . .. ..... .... .. . .... .. . . One-half.
10 Indistinct ....... ....... ... . ........... .... . .... .. . None.
11 ....• do . .......... . ... . . . .. ...... . . . . . .... ........ . Do.
12 Good ........................................ ·· ... . One-half.
13 Indistinct .. .. ..... ....... .................... .. .. . Do.
14 . . •• • do .............................. . ... . ........ , None.
15 ..... do .... . ............. . ... . . .. .... ...... ...... . . One.
16 Good ......... . ........ .. .. . ............. . ....... . One-half.
17 .• ..• do ............ . ........... ....... ... . ........ . None.
18 Indistinct ......... .. ..... . ...................... . . One-half.
19 Good .... .................... .. ......... .. ........ . None.
20 .•••• do ... . . ... ..... ... . . .. . . ... ..... . ............ . Do.
It will be seen bv reference to the table that 10 multiple
red rods (50 per c;nt) formed a line of light defective in
character and apt for this reason to give an inaccurate
result in the test. Eleven rods (55 per cent) contain an
amount of prism ranging from one-half to one prism diopter.
Six rods (30 per cent) were found to be free from all defects.
Ten single clear glass. rods were inspected and all but
one found to form a line of light of acceptable character.
The one exception formed an indistinct line, variable in
width .and of unequal density . No priRm deflecting the
line was found in any of these single rods.
An inquiry into the manufacture of multiple red rods
was made for the purpose of learning why the product
shows such a high percentage of defects. The varioua
steps in the process are so little known outside the trade
that the facts are briefly presented here.
Multiple red rods are manufactured from "ruby cane"
which is supplied by the glass factory in strips 18 to 24
inches long, seven-eighths of an inch wide, and about one-
fourth of an inch thick. The strips are made by a process
of drawing and pressing which forms the well-known corru-
gations on one side and leaves the other flat. Red-pot
glass is not used in making "ruby cane" beeause the
variable thickness of the glass due to the corrugations
would givB a line of light of uneven red color. The glass
factory has solved the problem by making "ruby cane" of
clear glass which is flashed on the corrugated side. By
 85
this process the corrugations are covered with a thin film The accuracv of the Maddox rod test is affected by the
of red glass which gives the line of light a nearly uniform prism only when its base is so located that the line of
red color. light is deflected at a right angle to its direction.
Pieces cut from the strips are optically ground and pol- The manufacture of multiple red rods involves several
ished on the flat side and edged to size before being highly technical processes and the finished product is
mounted . The corrugated side of the rod can not be probably as good as can be expected. It should be pos-
po!-ished ?r finished in ~ny w~y without remov~ng the sible to suppl y them free from any prism but the removal
thi_u flashmg from t~e hig~ pomts, thu~ destroymg the of optical defects from the corrugated surface is a problem
unif~rm color ?f the hue ~flight. For tlus reason, _all sur- , that will not be easily solved. Some of the responsibility
I
face ~mperfect10ns, res ultmg from the_ crude clrawmg and for the condition exposed in this report may be shifted to
J:'.ressmg proce~ses are allowed to rem~n on the c?1-rugated the popular demand for a colored multiple rod. The test
side of the fimsh ecl Maddox rod. It is to these imperfec- . · d
ti. ons ch"iefl v th
. a t th e d e fec ti" ve ch arac t er of th e 1inc
. of Ii" ht can be accurately made with a. clear
. . glaRs multiple
. rod .an
is clue. • " ~ colo_red glass may be used w1th 1 t if a colored line of light
The prism that is found in so many rods of this type is is desired.
a result of imperfect workmanship during the proceEs of Clear glass multiple rods are being manufactured from
finishing the flat side. The pieces of "ruby cane" are optical glass blanks, \\ith the corrugations cut by a lap
mow;i.ted with hot"pitch, corrugated surface downward, on instead of being shaped by pressing and drawing. These
a stock or holder and then ground and polished on the rods are free from prism and form a line of light that can
flat side. If the corrugated side is not mounted in proper not be criticized. They offer th e best solution of the
contact with the stock, the rod when finished will contain problem under discussion.
some prism.
 PART 15.

A NEW APPARATUS FOR TESTING ACCOMMODATION.

MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND; N. Y.

By Capt. HARVEY J. HoWARD, Medical <Jorps.

Of all the eye test.'3 performed by a number of exammers, viewpoint an apparatus should be so constructed that it
the one producing results subject to the greatest variation will automaticall y require a standard position in respect
is the test for the near point of accommodation. These to the subject before a test can be accomplished. In the
discrepancies may be caused by any one or more of several first plac , it should not be required to be h eld in position
different factors: by the examiner; it should either be set in a head rest or
1. Difference 1n the size of the test objects. held firm ly in a fixed position by the subject. By such
2. Difference in the speed of approach of the test object. an arrangement several of the disturbing factors alread y
3. Difference in the illumination and legibility of the mentioned would be eliminated. But as long as the test
test letters. is applied subjectively, just so long will results still be
4. Difference in th e place of contact and the angle of inaccurate and incomparable wh en dealing with candi-
the measuring rule . dates required· to pass a high standard. When dealing
5. Difference in the position from which the reading is with office patiilnts, the problem is an entirely different
c_omputed. one. From them the examiner expects the full est co-
6. Difference in the instructions to the subject. operation and generally receives it. Unde'r such cir-
7. Difference in the personal equation oi the examiners. cumstances th e ·a pproximation method , referred to below '.
8. Difference in tlie personal equation of the subject, should give consistent results if t-h e other disturbing factors
e. g., the motive of the examination. are eliminated.
In the examination of applicants for the United States If it is necessary to make the test objective, then letters
Aviation Service a test for the near point of accommodation or figures must b e used . Furth ermore, the test card must
has been made in every case. A comparison of the data, first be h eld so close to the eye that the letters are unrecog-
however, must convince one of the utter unreliability of nizable, and then carried slowl y away until th ey first
the figures recorded. In the first place, the test was made become legible. This is called the recession or obj ective
subjectively, i.e., the applicant was required to indicate, method . Unless the subject has learned the letters prior
while the test card was approaching his eye, the first blurr- to the t est, it must obviously be considereq an objective
ing of a letter. When we recall that the applicants were result the moment he reads them correc tly . The usual
all endeavoring to make as good a showing as possible, it method of examination is to bring the test card slowl y
is easy to understand why many of the findings were toward the eye and require the sub;ect to state when th e
absurdly small. Of all the factors referred to above as test object shows its first blurring. This is called th e
the cause of the great variation in the results obtained by approach or approximation method , and gi ves subjective
medical examiners, the personal equation of the applicant results. This brings up the question as to the comparison
is probably the most important. At the same time it is between results obtained by approximation and re<'ession
quite likely that all the other factors operated as well. methods.
If the Air Medical Service is offered no alternative but The approximation method calls for th e location on th,·
to disregard the data on accommodation already recorded , diopter mev.s uring ·rul e of the first ·blurring .of a letter cir
it is also placed in the undeniable position either of dis- object. Jf the card is gradually brought further in , th e
continuing further test.'3 or of devising a test which will letter_s fin ally become illegible. The result accepted quite
give more consistent results. The importance of a good generall y by this subjective metho'd is not the point of the
first illegibility but the point of the first blurring noticed.
power of accommodation on the part of a flyer is so gener-
The recession method requires the card to b e held close
ally accepted that it seems unworthy to drop the matter
to the eye at the beginning and carried slowly away until
summarily. The other alternative then must be accepted.
the letters become legibl~ The position on the rule
Our problem therefore is to devili<l a test which will where this first legibilit:,- occurs is not the same as the
both compel the adoption of a uniform method and pro- point of illegibility by the approximation method . But as
duce objective results. The apparatus used at present a matter of fact, attest ed b y a number of experiments, th e
consists of a. Prince rule and a card of small letters or the point on the rule indicating th e first legibility by the reces-
Duane disk. Tests with this apparently should give very sion method is the-same or practicall y the same point as that
consistent anli eomparable results if carried out by one indicating the first blurring by the approximation method.
careful examiner under the same conditions. The appa- The difference in the t -,;-o y-as found to b e astonishingl y
ratus is simple and inexpensive . Perhaps its chief fau lt small, in some individuals less than 1 millimetu of actual
is that, in being so simple, it lends itself readily to very L,' _.u ement. Witn th ese results before us our problem
different and careless m ethods of use. From an ideal is made .-asier.
(86)
 87

Fl(j 1
Fm. !.-View of the hood in cross section from above.

no-n
\\\ ~
---\:~
/'
,/I
~ '/
:::::----.:::::;.,

Fu:; Z
:Fm. 2.-View of the hood from behind as the subject sees it.

The only other requirement is that the letters will be so
arranged or manipulated that their order can not pre'lliously
b e ·learned. To meet all the requirements indicated
above, an apparatus to b e d escribed below was designed .
The apparatus consists of four essential parts:
1. A hood ·with an observation aperature for one eye.
2. A rule attached" to the hood , measured oft in milli-
met ers and diopters.
3. A t est object carrier.
4. A set of test letters and t est objects.
The following is a description of the essential parts in
detail :
1. The hood (figs. 1 and 2) js a combination of two
three-quarter face masks. The cut-out in the left half is
for the nose when th e right eye is looking at the t est
objects through the circular opening; the cut--0ut in the
right half is for-the nose when the left eye is looking through
the circular opening in the center of the hood . The hood
is made of aluminum and of sufficient size for the largest
face: In front of the aperature is a slot for holding lenses.
Figure 1 represents the shape of the hood as one looks at
it from above. Figure 2 represents the shape and appear-
ance of the hood looked at from behind , i.e., as th e subject
views it prior to adjusting it to his face . From these
figures it is noticed that there is a bulging of the mask in
the middle section below the circular opening. Into this
section is set the measuring rule. This bulge is so form ed
that when the mask is adjusted to the face, and the rule
is held in a horizontal position in respect to the vertical
position of the head , it fits snugly against the malar bone
which forms the lower anterior part of the orbit.
2. The measuring rule (figs. 3, 4, and 5) is made of
wood and is 2.5 centimeters wide- and a little more than
50 centimeters long. One end is set into the hood (fig. 2)
so that its median line is exactly beneath the center of the
aperture. The left side of the rule -(fig. 3) is marked off
in centimeters and millimeters. Zero on this scale is
17 .5 millime ters from the end of the rule where it butts
against the malar bone. From a series of measurements
on a number of individuals it was found that the average
distance from the malar bone, at a point directly below
the pupil of the eye to a perpendicular line drawn tangent
to the conea, was 6 millimeters. Inasmuch as all measure-
Iments of accommodation should be made from the anterior
focus, which is 11.5 millimeters in front of the cornea.
Zero on the scale must be located 17.5 millimeters in
front of the facial end of the rule.
The right side of the rule (fig. 3) is marked off in diopters
and fifths of dioptere so that the-decimal system may b e
used . Extending the length of the rule (except for the
first 4 or 5 centimeters of the facial end ) on its upper
surface and located in a median line is a rack composed
 a~ ~- -- -
T t

t
~ ~ ~'-
...... ...... ~
...... .......' - - ~ ~- ~
O"_ j Fl" 3

~,-·~J •••••. • · ·~}' ·"

- ::___ ~
•••••
-·-
·:~ 1:'ft~ <
fS-!:¥!1111.u.i.i111111 • ......... ~ --· -· . ~
~ ~ '.!'

Flq 4
~.

f"', It· u
r,
00
1'I'''' 00
l,11
1,,,
. 111

~
s
:. : ·. ,::
~\I) ~ ,ii1,,./
'"

FIC. 5
T
I
1 I----...;
r4cm
.- .::J.

r--
~
11,. ---, "" _j_

FIG 6
Noi·e : -
A, 0 C,t. D front Windows 4 , 5"1m,
FI G 7
.Secf-,on aa E": E. ' F f\e.o r W,ridow.s 6x5 mm
oJt., ,de D1omder vf Cog Wheel 4!i ,t1 m~
Ovt.,1d• D1ametc::r of 1J, U,,~ 4J.6 mm

FIG ..3.-The rule divided into millimeters and diopters. FIG. 4.- The rule showing handle and rack. FIG. 5.-Cross section of the rule. FIG. 6.~Test object carrier show-
ing drum which carries the test letters. FIG. 7.-Accessory test object carrier.
 89
of metal cogs about 3 millimeters high. Attached to the
E. A B C D F lower side of the rule 4 or 5 centimeters from the facial
D D E E end is a handle. In place of the handle there may be
X X Ill substituted a steel rod which can be fastened to a table
"' clamp in case it is found desirable to make the apparatuJ3
0 0 3 3 stationar} as a'head rest.
R R Ill Ill 3. The test object carrier (Fig. 6) consists of a box of
light metal containing a metal barrel which rotates about
M M Ill Ill
a central axis. The barrel is divided into two equal parts,
B B 3 3 left and right, by a circular rack of cogs, which coincide
with those of the rule. Attached to t he box beneath is a
L L Ill Ill
flat holder to be grasped by the thumb and forefinger. By
p p
this means the box may be propelled back and forth along
V V the rule and the barrel made to rotate. The box may be
propelled either by the subject or by the examinl;lr. In
s 5
y
.y
the front partition of the box at its horizontal center are
two small double windows lettered A, B, C, and D, in fig-
ure 6. By the addition of a metal slide only one of these
T T
windows may be open at one ti:rp.e. In the back partition
D D 1 of the box are also two windows. As the barrel rotates,
letters or other test objects appear in succession b efore
H H
these windows. The windows in front permit test objects
p p to be vtewed by the subject when he looks through the
X )( aperture tn the hood. The windows behind are made for
the examiner, who sees letters or test objects in the same
0 0
series as the subject sees them. Figure 7 represents an
E E ordinary test object carrier which may be used when the
figure 6 carrier is not required . A Duane accommodation
R R
disk or any card of small test letters may be carried in this
M M holder and the UJ3ual subjective test applied. The slot for
carrying the t est card should be flush with the front edge
(] s s 3 of the carrier, so that the reading on the diopter scale may
X 6 B Pl be facilitated.
4. The test letters and test objects are represented dia-
0 V V
E grammatically in figure 8. The test objects are engraved
~ L L Ill on heavy white cardboard in two sizes. B and C, which
~'J y y
Pl appear before windows B and C, figure 6, are 0.8 milli-
meters high, and A and D, which appear before windows
g 0 0 E A and D, are 1.2 millimeters high. The actual length of

' Ill
)( X the card is 140 millimeters. In each row there are 40
letters or objects which recur every 3.5 millimeters.
d R. R Rows E and F, which are only diagrammatically shown
A T T in the figure, i,,re made as large as possible. They
appear to the examiner at the windows E and F
~
' of the bux. The opportunity is given to use either
A. letters or the conventional E . The primary object
.l of the letters thus arraJJ.ged is to employ them as an
objective test. The test carrier therefore must be started
Q as close to the eye as possible and pushed slowly away until
H the subject is first able to read a letter or distinguish cor-
rectly the position of an E . The examiner who stands so
d that he can see the objects appearing at one of the windows
X in the back of the b_ox, is able to verify the statements of
the subject because the letters or objects which each
0 of them sees occur in the same series. To the subject the
:3 test objects go up behind the window, while to the exami-
ner the test objects come down. If more than one reading
}::j is desired, the t est carrier may be pulled off the rule and
w set back again in a different position, so that at the same
distances from the subject's eye different letters will
FI Cj. 8
I
FIG. 8.-Diagrammatic representation of the test letters and test objects.
appear from those previously seen.
-By courtesy of Archives of Ophthalmology.
 PART 16.

A STEREOMICROMETER. 1

MEDICAL RF.SEARCH LABORATORY, AIR SERVICE, MINEOLA, LONG ISLAND, N. Y.

By J apt. HARVEY J . How ARD , Medical Corps.

Stereoscopic pictures of figures viewed through a stereo- suggestions in formulating the final plans for the
scope produce an illusion of solidity or depth which instrument. 3
simulates one of our most common visual experieRces,
viz , true depth perception. The effect produced is DESCRIPTION OF THE INSTRUMENT.
merely an illusion, because, in reality, the two pictures are Figure 1 represents a photograph of the completed
in the same reference plane ; i. e., there is no difference instrument. Roughly it is about 9 inches high, 6 inches
in distance . The phenomena of depth and depth differ- wide, and 5 inches deep.
ence are produced by employing the principle of the Figure 2 shows the hood and the box containing the four
binocular parallax. Objects are made to appear rela- test objects which are small wires tightly drawn and
tively nearer or farther awa;y from the observer simply enameled black. The pair of wires on each side in the
by varying the lateral separation between identical objects completed instrument are 1.375 millimeters apart, which
or points in the two pictures. For instance, let us select gives them an angular separation from the center of
two pairs of identical points in the two pictures. If we the lens of exactly 1 centrad. This angle was decided
find the lateral separation between one pair is 63 milli- upon because in experiments with an apparatus at 6
meters and between the other pair 64 millimeters the meters and another at 100 meters, the centrad separation
point represented by the fusion of the two more widely of the test objects had always been use.d. From this
separated points will appear farther away than the point standpoint, therefore, the results of all three forms of/
represented by the fusion of the two less widely sepa- apparatus should be comparable. The lenses (fig. 3) are
rated points. as carefully made and adjusted as are those in a pair of
Whilew:orkingupon thesubjectofjudgmentofdistance 2 field binoculars. Each lens has a focal length of 137.5
with an apparatus employed at a distance of 6 meters, one millimeters.
of my coworkers, Capt. Percy W. Cobb, suggested that I At the right side of the instrument is a micrometer screw
adopt the same form of test objects in a hand stereoscopic which has a lateral movement of exactly 0.5 millimeter
instrument of precision for the purpose of producing any for each revolution. Attached to the axis of the screw is
degree of depth illusion desired. In the 6-meter appa- a drum with its peripheral surface marked off into 100
ratus two black rods, with a light surface background, were equal parts. Each division on this scale represents a
viewed through the -window of a box, the purpose being to lateral shift of the screw of 0.005 milfuneter. Attached
learn the smallest depth difference discernible by different to the axis of the screw there is also a double turnmg knob,
individuals. The binocular parallax was found to be Fixed in a horizontal position at right angles to the drum
the essential factor in the resultant determinations. The is a metal plate marked off into a 0.5-millimeter scale.
respective depth judgment ability of individuals was Within the box (fig. 6) the micrometer screw butts firmly
reckoned according to their minimal binocular paral- against the long end of a lever. With a leverage of five
lactic angles, which were computed from interpupillary to one, the short end is attached to a bar which holds in
distances and depth difference thresholds. position the right-hand wire. To take up all slack and
In the hand stereoscopic instrument suggested there lost motion a spring is fixed, one end to the ·movable bar
would be two pairs of vertical lines or objects to be fused. and the other end to a position inside the instrument.
To produce a sense of depth the only other essential would The other three wires are maintained independently of
be to effect a different lateral separation l;>etween the pairs the fourth and in fixed positions. The effect of the five
of fused objects; i. e., the binocular parallax would be to one 'ieverage is to reduce the lateral movement trans-
applied directly and not indirectly as is the case with mitted through the micrometer screw to the right-hand
the nonfused objects of the 6-meter apparatus. · wire to one-fifth that of the screw. One division therefore
In addition to Capt. Cobb, I am indebted to Mr. Max on the micrometer scale represents a lateral movement of
Poser of the Bausch & Lomb Optical Co. for valuable that wire of 0.001 millimeter or one micron.
1

2
An instrument of precision for measuring stereopsis. I• Authority to mak~ according to specifications granted February,
"A test for the Judgment of Distance," Trans. Am. Ophth. Sreiety, · 1919, to the Bausch& Lomb Optical Co., by the Supply Department,
1919. Hazelhurst Field, Mineola, Long Island, N. Y.
(90)
 91
Fir. . !.-Photograph of the compl eted insu ument.
Attached t.o th e hottom of the meta l stereoscopic box
is a base plate oi metal upon ;which the box can be tilted
and fix ed by a set screw in any position from 90° to 180° .
ln t he upper edge of the base plate is set an opaque milk
glass to giYe an indirect lllliform light background for the
wires aboY e it.
Behind the lenses is a shutter which is attached to a
wire leYer protruding through the upper right-hand side of
the box. By manipulating the wire lever the examiner
or the subject himself is able to produce practically an in
stantaneo us Yiew of the ,Yires, "·hich effect was found to be
so valuable in the experiments of the 6-meter apparatus.
MATHEMATI CAL PRINCIPLES INVOLVED !N THE
USE OF THE INSTRUMENT.
Let p=interpupi llar? Jicitance of lenses;
and m=t he binocular parallax produced by turning t he
micrometer scre,r:
and d=the focal length of the lenses, or the distance to thP,
apparently nearer wire:
 '
I

i - I
I
I
I
I
I
I
J..'
\

l'ig. 3 Fig. 2

$-

BA~Soc:!:.L~-~N~.CR 16458
STERl!O MICRQME'TE~
A'SSEMBL-Y
A SECTION A-A
LOOKING IN OIRE!CTION OJI' ARROW .., FULL S IZI! .,a;.......,oc•
Fig. 6 Fig. 5 Fig. 4 OR. av
TR. BV
CM. B Y
'-""'"
~-Ii 11

Fms. Z-6.- Mechanical drawings of the instrument.


FIG. 7.-Diagrammatic representation ol the binocular parallax.
and D=the imaginary distance to the apparently farther
wire.
Angle 1-angle 2=angle 3, the binocular parallactic angle. and D-d=l42.85-137 .5=5.35 millimeters.
For any small angle, like angles 1, 2, and 3, the tangent
and the angle in radians are practically equal with negli- parallactk angle of l') then by a similar method of com-
gible error.
Then tap. angle 3=r (angle in radians).
m parallactic angle of 15") then D-d=0.0215.
But tan angle 3=d
m parallactic angle of 1.5") then D-d=0.00215 ~illimeter.
then r=d
or m=rd.
If for example we let the binocular parallactic angle
(3)=1 ° then 1° in radians=0.01746 (which is an established
mathematical equation). If also d=l37.5 millimeters, the
focal length of the lens, then m=rd=0.01746Xl37.5=2.4
millimeters. If 2.4 millimeters therefore represents the
binocular parallax when we know the focal distance of the
lens to be 137 .5 millimeters and the binocular parallactic
angle to be 1 °, we can readily tabulate binocular parallac-
tic measurements representing any number of binocular
parallactic angles desired, as
1° = 2.4 mm.
l' = 0.04 mm.
l"= 0.00066 mm.
1.5" = 0.001 mm.
But it was planned that one division on the st.ereomi
crometer scale would represent a lateral movement of the
right-hand wire of 0.001 millimeter. Therefore each divi-
sion on the scale also represents a binocular parallactic
angle of 1.5".
When the distance to the apparently nearer wire and
the binocular parallax from the reading on the scale are
i
known, then the formula r= may be applied directly, e.g.
when
m=0.001 mm. then by substitution
r= .001 =0.00000727
137.5
But 0.00000727 radian=l.5".
If again we desire to know the apparent depth differ-
ence (D-d) represented by any binocular parallactic
measurement which is read off directly in microns from
the micrometer scale the results are computed as follows:
Tan angle 1=£
m
Tan angle 2=·a
Tan angle 3=}}
93
p p m p-m
then n=a:-a=- d-
D d
or - = -.--
p p-m
andD=~
p-m
But p=64 mm. And d=l37.5 mm.
If m=2.4 millimeters (the parallax of a binocular paral-
actic angle of 1 °), then by substitution
64Xl37.5
D 64-2.4 =142.85
When m=0.04 millimeter (the parallax of. a binocular
putation D-d=0.084 millimeter.
When m=0.01 millimeters (the parallax of a binocular
When m=0.001 millimeter (the parallax of a binocular
CONCLUSION.
The test is made by requiring the subject to set the
wires into what he thinks is the same reference plane;
i. e., equidistant from his eyes. After a number of such
trials the average error 1epresents his binocular parallactic
angle threshold. This threshold is computed in seconds
by adding 50 per cent to the reading on the scale repre-
senting his average error. For example, if the scaJe read-
ing is 10 divisions from the zero mark, th~n his minimal
binocular parallactic angle is 15". With such an instru-
ment it is possible to classify individuals according to
their respective degree of sterropsis. With those who
have the ability of fusing stereoscopic objects ; e. g.,
nearly all those having binocular single vision, thfa classi-
fication should represent their respective ability to judge
distance. This instrument should offer a far more satis-
factory test of stereoscopic vision than the ordinary hand
stereoscope which has been used almost universally in
testing candidates for aviation service.
The instrument perhaps offers a more direct application
in testing and classifying candidates for the naval and
artillery services, where according to recent communica-
tions the men may be required t o use stereoscopic range
finders. During the war it was k]J.own that the Central
Powers used stereoscopic range finders almost exclu-
sively. The Entente Powers, on the other hand, used
various forms of coincidence range finders, but toward
the end of the war the United States authorized the
manufacturn in this country of a number of stereoscopic
range finders. The comparative results with the two
forms of range finders will depend very largely upon the
selection of the men using them . By means of the
stereomicrometer it should be possible to select only those
who possess the highest degree of stereopsis or judgment
of distance. This group should show such a remarkable
ability with the stereoscopic range finde1 that its use may
eventually be adopted in plac·e of the ordinary coinci-
dence type.
 PART 17.

JUDGMENT OF DISTANCE WITH SEMAPHORES AND A SCREEN AT 100

METERS.

MEDICAL RESEARCH LABORATORY, AIR SERVICE, MINEOLA. LONG ISLAND, N. Y.

B y HARVEY J. HoWARD , captain, Medical Corps.

Since aviation became a science the term " judgment of Research Laboratory for the purpose of finding out, first,
distance," or, as some will call it, "stereoscopic vision," what the factors are that make men individually different
has come to have a new bearing. It takes such a slight in their ability to judge distance, and, second, to devise an
error in judgment, especially in landing a plane, in order apparatus which would eliminate all irrelevant factors
to produce disaster that the subject quite naturally has and test only the factor or factors which represent the
aroused serious attention. To learn to fly is like learning individual.
to walk. It is a new expei-ience and i t takes time to adapt In a previous report 1 it was shown that the representa-
one.self to new requirements. But unlike learning to tive personal factor which is important from the stand-
walk, one fall may end it all. For this reason and others point of aviation requirements is the binocular parallax.
anything that may be done to properly choose those who It was shown by the use of an app:i,ratus which required
can meet the requirements and to eliminate those who are tests to be made at 6 meters that it was possible to examine
physically unable to meet them is worth while. In other the binocular parallactic ability alone and to classify men
words, it must be regarded as a select game, not open to according to their skill with this factor. In that paper it
alL This is even more true when we are called upon to was stated what seemed to constitute normal findings.
deal with flying from the military standpoint. In order to supplement the experiments done with the
There has been a doubt in the minds of some, which 6-meter apparatus, it was suggested that an outdoor test
has extended into cocksure opinions on the part of others, be devised for use at 100 meters or more. In order to
that certain tests applied to applicants for flying service make the outdoor test comparable to the conventional
are unnecessary From the outset, then, any attempt to indoor test it had to meet the following requirements :
exclude men from the opportunity of learning to fly is A void shadows, reflections, and linear perspective; also
looked upon in some quarters as an "outrage." the test objects must maintain approxin1ately ' the same
Confidence in oneself is a good trait, but it may lead to visual angle irrespective of the difference in their distances
an overestimation of one's ability. For instance, if a man from the observer. In this way the binocular parallax
has always been defective in certain ocular functions, he could be tested and the subjects thus examined be graded
has not had the opportunity to develop that conscious according to the resultant binocular parallactic angles.
understanding of what an individual with perfect ocular
functions in comparison with himself can do. Therefore, APPARATUS EMPLOYED.
he may be firmly convinced that h e is "as good. as the The apparatus finally decided upon consisted of the
next man. " It is a common experience to find an appli- following parts:
cant trying to argue with and wheedle the examiner into (1) A set of four circular disks or semaphores painted
" letting him by, " when , e. g., he can not read 20/20 or I
white and each attached to a wooden dowel of small
can not show good stereopsis. For these reasons and diameter. The semaphores ranged from 12 to 13.3 centi-
meters in width. In order to render the dowels invisible
others it is well for the examiner first to be sure he is right
and then go ahead. He should have real convictions why they were painted brown to match the color of an outdoor
certain men should be excll!ded from flying and he should field.
have faith that the test he applies actually performs what (2) Tripods to hold in an upright p osition a piece of
it calls for. galvanized iron piping with a bore just large enough to
If we a.s examiners are convinced that any test fails to
receive a dowel.
measure up to the purpose for which it was intended, it (3) A board screen 1 meter high and 2 meters wide tc:
behooves us to check it up with other tests or to discard be set upright a short distance in front of the semaphore,
it if something better is found. in order to cut off all view of the tripods and avoid lineal
perspective.
THE PROBLEM. The apparatus was set up using two semaphores at a
In view of a somewhat widespread criticism of the hand time, the nearer one being exactly 100 meters from an
stereoscope as a test for the judgment of distance, it was 1 "A Test for the Judgment of Distance," Trans. American Ophthal.
11
suggested that research be undertaken at the Medical Society, 1919.
I (94)
 95
observer and the other, which was a trifle larger in dia- interpupillary distance; d=the distance BO to the near
meter, at a greater distance away. The lateral separa- object, and D=the distance BO' to the far object. Also
tion of the two semaphores was 1 meter, i. e., the angle let angle l=angle AOB, angle 2=angle AO'B, and angle
ef separation from the position of the observer was 1 3=angle OAO'.
centrad. This was the same as the angle between the According to figure 2, which furnishes a diagrammatic
rods in the 6-meter test. Figure 3 represents a set-up representation of the two distances D and d, the _depth
of the apparatus with the sunlight shining upon the sema- diff1prence is D-d or t.. Also angle 1 minus angle 2 equals
phores in line with the intended observation. angle 3, which is the binocular parallactic angle repre-
sented by the depth difference D - d.
For small angles like angles 1, 2, and 3, the sine, the
tangent, and the angle in radians may be considered equal
with negligible error.
But the tan of angle l=f

and the tan ·of angle 2 =£-

If we let r=angle 3 in radians,
p p D-d
FIG. 1.-Truerepresentation of two objects O and 0' atunequaldistances then r=a:-n=p Dd ·
from the eyes A and B. Therefore, when p=0 .060 meter, d=lOO meters and
p= interpupillary distance A B.
d= distance to near object. D=l03 meters, by substitution.
D= distance to far object. 3
D-d= difference in distance or the depth difference. r=.060 lOO XlOS .00001747 which represents the bin-
Angle 1-angle 2=angle of the binocular parallax. ocular parallactic angle in radians. In order to convert
radians to degrees of arc we must multiply radians by
THE TEST APPLIED.
180
, and then this result by 3600 to reduce the result in
One operator and one assistant were required to test 71'

each observer. The latter was required to stand at the
100 meter station with his back to the apparatus. The
operator adjusted the semaphores and gave the signal
"ready" to his assistant who was standing beside the
observer. The latter upon receiving the message turned
around, focused Iris eyes upon a spot near the bottom of
the board screen and then suddenly lifted his gaze to
observe the rods. In this way he was able to secure a
sudden impression which was found. to be so important
in the 6-meter test. He was also urged to keep as still as
possible while making an observation.
The observer was required to state which semaphore
was nearer to him, the right or the left. His judgments
were taken first at the 6-meter depth-difference station,
then at the 5, 4·, 3, 2t 2, lt and 1 meter stations, or until
it became apparent by the proportion of wrong judgments
that he was merely guessing. With a few exceptions
20 judgments were taken at each station.
It was accepted that an observer's threshhold had been
passed when he failed at any station to make less than 75
per cent of his judgments correct. Seven of the ten sub-
jects had already' been tried with the 6-meter indoor
apparatus, so a comparison of the results of the two
methods is possible.
Before proceeding with the discussion of the results ob-
tained it may be well to consider the elements entering
into the binocular parallax.
PRINCIPLES INVOLVED IN THE BINOCULAR
PARALLAX.
Figure 1 represents an observer viewing two objects, 0 11
and' O', at unequal distances from him. If O' be 'b rought
into a line with O a,nd one eye B as in figure 2, the re-
sultant diagram will give a more graphic idea of ,t he angles
and distances involved . In this figure let p=A B, the
degrees to seconds. Therefore, 0.00001747 radian=3.60",
which happens to be the binocular parallactic angle of
observer No. 2, as recorded in Table II.
On the basis of the above formula the binocular paral-
lactic angles were computed for various interpupillary
distances and for depth differences ranging from 1 to 12
meters. Table I , therefore, contains all the possible
parallactic angles of the 10 men of this series.
FIG. 2.-Diagra=atic representation of Fig. 1.
D-d= ~. the depth difference.
Angle 1-angle 2=angle 3, the binocularparallactic angle.
METHOD OF ELIMINATING THE RETINAL IMAGE
AS A FACTOR.
It is stated earlier in the paper that the test objects
should maintain approximately the same visual angle
irrespective of the difference in their distances from the
observer. This was necessary in order to rule out the
size of the retinal image as a possible factor in aiding
judgment. I stated "approximately the same" beca)lSe
.it is not required that they maintain exactly the same
angle in order to appear the same size.
There were four semaphores available, two of which
were used at a time. One was 12 centimeters, one 12.3
centimeters, one 12.6 cent1meters, and the other 13.3
centimeters in diameter. The 12-centimeter semaphore
 96
FIG. 3.-A CIOSll-UP view of the apparatus.
was always set at the 100-meter distance from the observer.
The other semaphores were used at the more remote sta-
tions, i. e., 101, 102, 103 meters, etc. As a matter of fact
another 12-centimeter semaphore would have sufficed, be-
cause if one of that size had been placed at the 105-meter
station, for example, the difference in size of the visual
angles at 100 and 105 meters, respectively, would have
been less than the minimal visual angle that is perceptible.
In this instance it would have been 11.8", which is less
than the minimal visual angle threshold I found in any of
10 men, a record of whom has already been reported.
Among these 10 I found one _whose l.iast visual angle
perceptible was 13;211, while the average of the 10 was over
15.5". However, in order to avoid any possible error I
used the larger semapho'res for the longer distances and
therefore reduced the difference in visual angle to 4.6" at
the mast.
In Table III has been recorded the size of the visual
-angle subtended by a 12-centimeter semaphore when. it
ranges
. from 100 to 112 meters from an observer • At a
dIStance of 100 meters the semaphore subtends an angle
I ·
of 4.125 . Table IV is a computation showing the diameter
or a semaphore required to maintain a visual angle of
4.J:25' at a distance also ranging from 100 to 112 meters.
r
SOME THEORETICAL CONSIDERATIONS.
In a previous report mentioned elsewhere in this paper
the results of experiments with an apparatus at 6 metern
were recorded. While examining men for the purpose of
finding and establishing a normal binocular parallactic
angle, a number were found whose tl)reshold angles were
lees than 2.0". The smallest angle found was 1.80",
which represented an interpupillary distance of 63 milli-
meters and a depth difference of 5 millimeters when the
nearer object was 6 meters away and the lateral separation
of the two objects was l centrad.
Inasmuch as one writer, Eaton, 2 has made the statement
that our "fusion sense," or the sense of depth or solidity
afforded by binocular vision "can not play any part at
• "Factors lil stereoscopic vision and In the visual estimation of dis-
tance," Brit. 1our. of Ophtl' v u1. ur, No. 2, 1919, p. 63. ·
 ~)7
distances greater than 120 yards," it will be interesting .to distance? It must be that distance at W:e.ich his visual
find out what the observer with a binocular parallactic axes make an angle equal to his minimal binocular paral-
angle of l.8 11 should theoretically be able to do at different lactic angle. Then angle 2=0 with its vortex at infinity.
distances. For instance, what would b e the least depth Therefore,
difference perceptible when the near-object is not 6 meters, angle l=angle 3=~ radian.
but 100 meters away, and also l kilometer, 2 kilometers,
etc. , away. .k ewise
L 1. . t h e rormu
. 1a ""=P D - d whi ch 1s
Del, · the reduced
If the parallactic angle remains constant while the
HJ
distance increases, the depth difference varies approxi- form of r= -7r15 , becomes
mately as the square of the di stance to the first object.
This, however, is true only when the dep th difference is r=~ when D equals infinity. Then by substitution
relatively small . For a distance to the first object of 100 63
0.00000874= o:~ or
meters there is an error of only 1 centimeter. But for
distances over 100 meters this approximate method of 0.063
d --0.00000874 7,~-108 ( meters )·
computation produces an error which increases greatly
with the increase of distance. To be exact, the depth In brief, the distance at which the nearer object must
difference increases as the product of the two distances, theoretically be, for this .individual to perceive it as
i.e. , according to the formula already referred to nearer than one at infinite distance, is 7,208 meters; i. e.,
D- d his depth. perception theoretically is limited to this dis-
r=p-- Dd , where, if rand p are constant, tance. Beyond that, angle 1 itself is less than his minimal
D-d binocular parallactic angle of 1.8011 •
Del must also be constant. Therefore, in the case of this
For observer No. 1, in Table II, whose minimal binocu-
observer, lar parallactic angle is 3.37(1, the binocular parallax, as a
D-el 0.005 ( h h h d. . positive factor, is limited to a much shorter distance. For
Del = 6 _OOOX 6 . 005 w en t .e s orter IBtance 1s 6 him the equation would read thus :
meters).
Likewise, if the shorter distance el=lOO meters, we have 0.067
d= _ 4,100 (meters).
0 00001634
D-100 0. 005
100 D = 6. OOO X 6. 005 DISCUSSION OF RESULTS.
D-d Ten Air Service officers were examined by this out-
But for the formula r=p- IR: previously employed, we
door apparatus. The examinations took considerable
can find the value of D (and therefore also of D-d) when time and required great care to always maintain the
the other factors are known, as they are in this case. operation of but the one factor, the binocular parallax.
Then r Dd=pD -pd or The assistant proveu to be of great value in aiding the
D (p-rd)=pd or operator to secure a uniform h eight and illumination of
pd the semaphores before the signal was given to the observer.
D= P-rd Photometric readings with a Maclleth apparatus were
Therefore, when D=lOO meters, p=0.063 meters, and taken before and after several of the ex periments. The
r=0.00000874 radians (1.8011 ), by substitution average of three readings taken at the beginning of one
0. 063 X l00 test at 11 a . m . showed the illumination on a horizontal
D=0.063 - (0.00000874 X l00) lOl.4 plane to be 5,500 foot-candles and on a vertical 4,800. At
12 noon, when the experiment was finished , an average of
Therefore,
three readings showed a horizontal illumination of 6,300
D-d=lOl.4-100=1.4 (meters)
foot-candles and a vertical of 7,300. At 2.30 p. m. that
Similarly, results may be obtained when d=l,000, same· day the horizontal readings showed 4,200 foot-candles
2,000 meters, etc., and the ability of the observer in and the vertical 9,980. And at 3.30 p . m, the horizontal
question may be tabulated as follows: readings averaged 2,030 and the vertical 6,500 foot-candles.
The vertical readings were taken parallel to the line of
Inter- Binocular Distance Depth. sight when viewing the semaphores. The illumination
pupillary parallac- to first distance during the other experiments compared very favorably
distance. tic angle. object. required.
with the two examples above, so the results of the tests are
Meters. .
Meters. Meters . all comparable from the standpoint of good visibility.
0.063
"
1. 80 16 0. 005 By consulting Table II, it is noted that observer No. 1
..063 1.80 100 1.4
.063 1. 80 1,000 161. 6 had a d epth-difference threshold of 2.5 meters, which
.063 1. 80 2,000 768. 0 represents a binocular parallactic angle of 3.37//. His
.063 1. 80 3,000 2, 138.0
.063 1. 80 4,000 4,989.0 vision was 20/10- in each eye. He had perfect muscle
.063 1. 80 5,000 11,321.0
. 063 1. 80 6, 000 29,795. 0 balance and his interpupillary distance was 67 milli-
. 063 1.80 7,000 235,308. 0
I meters, which was the widest of the 10 men examined .
The next two men, whose depth-difference thresholds
Again, for- this same individual, what must be the dis- were 3 · meters each, and whose binocular parallactic
tance of the first object when the more remote is at infinite angles were 3.6011 and 3.73'1, respectively, also had excel-
1454-30- -7 0

lent visual acuity and perfect muscle balance. The other
seven subjects, with c.ne exception, showed slight muscle
imbalance, but very good visual acuity. Their thresholds
varied from 4 to 6 meters· and their mID.ll)'.lal parallactic
angle1:1 from 3.8811 to ·7.5311 • The average threshold for
the 10 was 4.15 meters and the average binocular paral-
lactic angle was 5.1911 •
Seven of the observers had previously been examini:id
with the 6-meter apparatus. A comparison of tlie results
as recorded in Table II show a very consistent uniformity
with the exception of the last case. The average minimal
binocular parallactic angle obtained by the indoor test
was 5.9311 as against the 5.1911 obtained by the outdoor
method. Ten cases are admittedly too small a number
from which to make very positive deductions or to try to
establish the normal limit of the binocular parallax, but
in view of the opportunity for comparison with the more
convenient 6-meter test, it seemed worth while to record
the results, especially since they corroborated quite faith-
fully the findings of the other test and gave support to the
principles upon which the latter test was based.
It should also be of interest to learn the results of an
examination made ,vith observer No. 8 the day following
his first trial. On the second day there was low visibility
on account of a moderately heavy fog and a cloudy sky.
His depth-difference threshold the first day was 5 meters,
while ·o n the second day it was 11 meters. That is, his
binocular parallactic angle was 12.6711 , or more than twice
that of the preceding day.
98
CONCLUSIONS.
1. The binocular parallax, even when acting alone, is
capable of great depth-perceiving power.
2. The binocular parallactic · angle is computed from
the depth differences 9f objects looked at, and from one's
i,nterpupillary distance. The minimal binocular parallac-
tic angle varies greatly with individuals and seems to
have a physical basis. From data collected it seems to be
dependent Upon visual acuity, visual S)(Illmetry; and
musde balance to a large extent.
3. Subjects examined with the 100-meter ap_paratus
showed binocular parallactic angles ranging from 3.3711 to
7.5311, with an average of 5.1911 •
4. The findings with the outdoor test coincide very
closely with those of the 6-meter indoor test, but do not
warrant its substitution for the latter.
5. The si~e of the visual angle or the retinal image has
nothing to do with the binocular parallactic angle. It is
wrong, therefore, to associate the visual angle with bi-
nocular discrimination of distance. The visual. angle
threshold is often stated as being about one minute,
whereas the binocular parallactic angle threshold has been
found to be as small as 1.8011 •
6. Our '.'fusion sense,'' or our binocular depth per-
ceiving abilit y, theoretically is ·of value up to a distance of
several thousand meters. Practically it is less, because
we are limited by our visual acuity.

TABLE !.-Binocular parallax in seconds of arc.

(Depth differences when the shorter distance is 1()0 meters; e.g., 1 meter represents the second object at 1()1 meters.)

Interpupillary dis-
tance in milli- 1 1/i 2 2! 3 4 5 6 11 12
meters.

59 ... ... . .. . ... ...•..

60 ....•. .••••••.• ... .
1. 21
1. 23
1. 80
1. 83
2.39
2.43
2.97
3.02
3.55
3.61
4.68
4. 76
5. 80
5.90
6.89
7~00
1too
12. 'Z1
I 13.04
13.26
62. ·•··· · ····· · ·····. l.'ZI 1.81! 2.51 3.12 3. 73 4. 92 6.09 7.24 12. 67 13. 70
64.5 .•............ . ... 1. 32 1. 97 2.61 3.25 3.88 5.12 6.34 7.53 13.18 14.26
65.5 .............. . . .. 1.34 2.00 2.65 2.30 3.94 5.20 6.43 7.64 13.39 14.48
67 .... • ... . . .. ... • . .. 1.37 2.04 2.71 3.37 4.26 5.32 6.58 7.82 13. 70 14. 81
 99
TABLE IL-Judgment of distance in terms of the binocular parallactic angle.
(One semaphore at 100 meters with screen in front; the second semaphore at 101, 102 meters, etc.)

Percentage of correct judgment at the following Comparison between

depth dist ances (meters)- results of-
r
Inter-
Muscle N.P. N . P . pupil- 100 Test me- 6 Test
No. Name. Age. Vision. bal- Ac- Conv. lary me- bino- ters
ters bino-
ance. com. dis- cular depth cular
depth
tance. 1 ll, 2 2i 3 4 5 6 differ- r,aral- differ- para!-
ence actic ence lactic
I
thres- angle thres- angle
of. hold. of.
I hold.

Mil-
Me- lime-
" ters.
------ ...." ..
ters.
1 J . H·....... . 30 R. 20/10- ... . Orth .. 130 80 67 48 60 76 80 75 100 3.37
L. 20/10- . . .. · · ··- · ---··· 2!
2 H . T . . ...... 33 R. 20/15 . . . ... Orth . . 150 90 60 40 60 80 80 100 100 3.60
L. 20/15 . •.... ··· ···· ····· · 3 10 3.44
3 H.L.L . . ... 31 R.
L.
20/10- .. ..
20/10 . . . ...
Orth .. 125 96 62 58 --- --- 47 65 85 95 100 . .. .. . 3 2. 73 10 3.55
4 P.W.C ..... 46 R. 20/15 .. . ... Exo t . 325 100 64:5 40 60 70 ····· · 90 80 90 100 3 3.88 10 3. 69
L. 20/15 . ... .. L. H. i
5 P . D . . ..... . 43 R.
L.
20/10 . . . . . . ,
20/10 .. .. . .
Exo 2. 185 55 65. 5 50 55 45 . ..... 70 90 90 100 4 5.20 ······ ---- --
6 H.J . H . .. . . 39 R. 20/10- . : .. Esoi . . 145 70 59 50 60 58 ------ 60 64 80 100 5 5. 80 15 5.06
1 L. 20/10- . . ..
7 N. B . L . . . .. 26 R. 20/15 .. .. .. Exo!,.I 130 88 62 50 ...... 60 50 40 65 80 100 5 6. 09 20 7. 08
L. '2/J/15 ..... .
8 C.R ...... .. 46 R.
L.
20/15 . .. ...
20/15+ .. ..
Orth .. 275 55 62 60 80 40 ·--- ·- 60 70 90 100 5 6.09 ······ ... ...
9 B.L. W .... 56 R. 20/15+ .. .. E so4 .. 310 75 67 50 ---· -- 70 56 25 65 90 100 5 6.58 20 7.65
L. 20/15+ .. ..
10 F.W. H . . .. 28 R. '2/J/15 . ..... Exol. 135 67 64.5 --- --- . . .. . . 60 ..... . 35 55 70 95 6 7.53 30 11. 0
L. 20/15 .... . .
- -- - - - - - --- - - - - - - - - - - - - - - - - - -
Average. 37.8 0 . U .,20/15+ . Orth .. 191 77.6 63.4 50. 7 63. 7 55 61.4 62. 5 74 89 99.4 4.15 5.19 16.4 5. 93

TABLE III.- Var- TABLE IV.-Di-

iations in the ameter of sema-
visual angle sub- phore required to
tended by a 12 maintain a vis-
cm. semaphore ual angle of
at di.fferent dis- 4. 125 minutes at
tances. the following dis-
tances.
I
Size of
Distance Angle in
in meters. meters.
IinDistance
meters.
sema-
_phore
mcm.

100: 0 4.125 100.0 12. 00

101. 0 4.084 101. 0 12.12
101. 5 4.064 101.5 12.18
102.0 4.044 102.0 12.24
102.5 4.024 102.5 12. 30
103.0 4.005 103.0 12. 36
104.0 3. 966 104.0 12.48
10.5.0 3.928 105.0 12.60
106.0 3.891 106.0 12. 72
107.0 3.854 107.0 12. 84
108.0 3.820 108.0 12.96
109.0 3. 748 109.0 13.08
110.0 3. 750 110.0 13. 20
111.0 3. 716 111.0 13.32
112.0 3.683 112.0 13.44

-By cou rtesy of American Journal of Ophthalmology.

 PART 18.
A NOTE ON THE LOW-PRESSURE CHAMBERS INSTALLED IN THE MEDICAL
RESEARCH LABORATORY OF THE AIR SERVICE.
By Capt. G. B . 0BEAR, -head of Department of Physics and Engineering.
INTRODUCTION.
For many years the physiological and other effects of
reduced atmospheric pressure, and consequently, low
oxygn tension upon the animal mechanism havl;l been
under investigation.
Before 1914 the progress in air navigation bad been so
great that the war found the airpla1fe sufficiently p erfected
as to be of great use to the combatants. Coincidentally
with the suddenly increased importance of the airplane
came the call for increased study of th e effects of high
altitude on the flying man .
,A.-fuong those who have prosecuted investigations in
this general field of study, mention should be first made of
PaJl Bert of France. Probably Bert was the :first in-
vestigator to study the physiological effects of reduced
atmospheric pressure upon living animals and human
beings. He began his work in 1878 and continued it
until his lamented death about a year ago. At first Bert
made use of bell jars and experimented with mice.
Later he constructed a small chamber and carried on
numerous investigations upon human beings. 1
A small chamber which will accommodate two men has
been built by Siebe and Gorman of England. II.sing this
chamber in the Lister Institute Haldane, Priestley, and
others have made many investigations on the physiological
effects of low oxygen tension(2) .
Lindhard of Sweden has constructed a chamber of his
own design in ,vhich he has lived for a period of two
-weeks (3).
During the war the Medical Research Laboratory of
Hazelhurst Field was represented in France by a group
of investigators under the command of Col. W. H . Wilmer,
M. C. This group took with it the smaller of two cham,bers
which had been constructed in America. The termination
of the war prevented extended use of this chamber. Ox-
ford University purchased it and under the direction of
Dr. Dreyer high-altitude inveatigations are being made.
The first low-pressure chamber used in the Medical Re-
search Laboratory was at the time of its installation the
largest one of its kind in the world. This chamber was
put in operation in February, 1918. By the use of this
chamber extensive investigation has been pursued on the
physiological effects of high-altitude conditions. In the
early winter of 1918 a larger and more elaborate chamber
was installed. A description of these two chambers is
the object of this note.
• Number in parentbP.sis refers to the bibliography at the .end of the power Western Electric motor. The pump is connected
artic!P.
(100)
SMALL LOW-PRESSURE CHAMBER.
During the early days of the Medical Research Labora-
tory when it was situated in the American University at
Washington. the need was felt for some apparatuswhich
would simulate high-altitude conditions and lend itself
to greater variety of application thap. the Henderson re-
breathing apparatus already in use . Plans were there-
fore set in motion to obtain a suitable chamber from which
the air could be pumped in order to reduce the atmos-
pheric pressure and also the oxygen tension. Dr. Yandell
Henderson first suggested the plan. He and his col-
leagues took the matter in hand and in due course of time
the chamber arrived at Ha:,;elhurst Field , Mineola, the
new station of the laboratory.
The chamber was designed to accommodate several
persons. It is la1:ge enough to pennit the use of such
testing apparatus as reaction time apyaratus, the Barany
chair, and others.
In structure, the chamber is a circular cylinder of steel
one-half inch in thickness. The top and bottom are con-
vex outward. (See fig. 1). The lateral wall is of one
piece with riveted seam. The to_p and bottom are
1·iveted to the lateral wall. All the seams are calked .
The construction is siinilar to that of ,a boiler. The in-
side diameter is i feet 11 inch es and the height along
the central vertical axis is 8 feet 9 inches. Riveted
to the inside of the wall and lying in two parallel hori-
zontal planes are two L bealilS for rein orcement. Later
developments have proved that this precaution was un-
necessary. The chamber wall contains three circular
windows whose diameters are 6 inches each, placed at
0·0° around the wall. These windows are all the same
distance above the floor. The entrance to the chamber
is 3 feet wide and 5 feet 4 inches high. Near 1he top of
. the wooden door are two rectangular windows 13 inch es
by 5 inches. The -glass in all the windows is 1 inch thick.
When the chamber is in operation a rubber gasket fitted
into a channel extending completel y around the entrance
makes an air-tight seal between the door and chamber.
The chamber is supported by three legs riveted to the
wall at places 120° apart. These legs rest on concrete
pedesfals. The chamber bas a grating floor made of wood.
This floor is divided into sections in order that a part may
be removed m case of necessity. The headroom in the
chamber when the floor is in plac€ is 7 feet 4 inches.
The evacuation of the chamber is effected by the use of
a Nash hydrotmbine pump, belt conuected to a 10-horsc-
. by a 3-inch pipe to a port in the top of the chamber. At
 104

1:,,;_ .-,.

this. point" in the pipe line a check valve prevents ai1 The electric-moto r contrnl and the oxygen-supply control
frnm being drawn back into the chamber. At a place in valves arc also at the hand of the operator. The oxygen
the line conYenient to the hand of the operator is a regu I supply is furnished from large steel cylinders containing
lating vahe. Jn this line also a large muffler is installed . oxygen gas und er a pressure of about 150 atmosph eres.
to dimini~h th e noise of exhaust. Still fur ther to lessen The gas passes [rnm the cylinder throu1!11 a reducing Ya.Ive,
the sound effects the chamber is lined with hair felt l} ; and thence through suitable piping to a fitting fixed in
in ches in thich1css. Another 3-inch pipe enters a port , the top of th e chamber. Passi ng thrnugh this fitting the
in the bottom of the chamber. By this means it is possible ' gas flows to a battery of stop cocks. Rubber tubes for th e
to ventilate the chamber and to Yary the air pressure. , use of those in the chamber depend from these. Those
In this line a valn, for the regulation of the amount of air I who are conducting the experiment use the supply of
entering the chamber is placed conveniently at the hand : oxygen furnished by this equipment, since it is necessary
of the operator. A third line of 3-inch pipe form s .a by- : that they maintain their normal physiological condition.
pass arnund the chamb er and allows the continuous In extremely rare . cases, however, it is administered to
I
operation of t he pump while the vacuum remains at any , the individual under observation. A valve which com-
given value. For the proper operation of the pump, a , municates directly with the outside air is placed inside
continuous supply of water is necessary . This is obtained I the chamber for us~ in case anything should happen to
through a one-half-inch pipe. In this pipe line a valve the ventilating valve on the outside of the chamber.
i
which controls the supply of water is within reach of the Fixed to the wall of the chamber and near the operator
operator, who sits so that he may have a view of the inside I is- a. mercury manometer. The scale of this manometer
of the chamber through the round window seen in figure 1. I is graduated in thousands of feet and also in centimeters
 105

1454-:30--8 0
 106
of mercury. During operation, this manometer shows
at a glance the altitude which is being simulated in the
chamber. Inside another similar manometer enables
those- conducting the experiment to ascertain the altitude.
Placed over the door is a gauge which also indicates the
degree of vacuum in the chamber. In order that the oper-
atc1r may communicate with those conducting the experi-
ment, a telephone system has been installed. The wires
of this system pass into the chamber through a tube which
is hermetically sealed. Electric wires enter the chamber
through an air-tight tube and offer facilities for lighting
and other aide.
The operation of the chamber is very simple. As soon
as everything is arranged for the experiment the officer in
charge gives a signal and the door is closed . The operator
starts the motor and immediatilY turns on the water for
the pump. At first the exhaust and ventilation valves
are open. As he gradually closes the ventilation valve
more air is drawn out than goes in, and a reduction of
pressure is realized . With proper manipulation of this
valve, he governs 1lhe rate of diminution of preBSUfe inside
the chamber. With careful operation of this ventilation
valve it is possible to maintain a given altitude for one-
half hour or more at a time. A rate of ascent of 1,000 feet
pee minute has been found to offer ·no discomfort to those
in the chamber. After a little practice the operator can
easily bring about this condition with the help of the
mercury manometer and a clock. The descent from any
altitude is accomplished by reversing the primary opera-
tions and opening the ventilation valve gradually enough
to produce a fall of 1,000 feet per minute. A fall of much
over 2,000 feet per minute is liable to cause unpleasant
sensations in the ear.
At one time there was a strong contention, which still
exists to some extent, that the potent factor in bringing
about physiological changes at high altitudes was the
reduction of barometric pressure and not oxygen want.
Much investigation with the chamber has pointed strongly
to the fact that low oxygen tension consequent to high
altitudes is the really important factor. Studies carried
out on blood pressure, heart action, and reaction time are
connected with the research on tolerance of low oxygen.
The chamber has been•of use in studies with the Barany
chair and the excited phenomenon .of nystagmus. Im-
portant studies in alveolar air have also been accom-
plished (4).
LARGE LOW-PRESSURE CHAMBER.
The ·vacuum chamber which has just been described
met with such success that plans for a larger and more
elaborate one were put into effect, resulting in the con-
struction and installation of a chamber with a refrigeration
attachment. It has always been recognized that the
three great factors in the physiology of aviation are high
altitude, low temperature, and wind. From the outset
of the work done at the Medical Research Laboratory, the
importance of these factors has been appreciated. It was
therefore decided to put into service a chamber which
would combine the altitude and low-temperature factors.
This chamber is of the same general form as the other and
weighs about 6 tons. It is cylindrical with saucer-shaped
top and bottom riveted to the lateral wall of the chamber.
This lateral wall is made of two pieces of one-half inch steel
lap jointed. All the joints are riveted and calked. Upon
the top of the chamber is fixed a dome 1 foot in diameter
and 3 feet high. When this dome is properly filled, it acts
as a muffler to subdue the noise of the exhaust. At the
lowest point of the bottom is an opening to which a drain
pipe is attached. In this pipe a check valve prevents
drainage and air from entering the chamber. The inside di-
ameter of the chamber is 9 feet, and the maximum height
from top to base is 9 feet 9 inches . When the floor is
in place, there is a head room of about 8 feet 5 inches.
The free head room is diminished somewhat by the con-
nection for the oxygen supply. There are three circular
glass windows situated in the lateral wall of the chamber
at 90° from each other. Two have their centers 4 feet 3
inches from the floor, the other, which is the operator's
window, is 5 feet 6 inches above the floor. These windows
are 1.0 inches in diameter. The entrance to the chamber is
5 feet 6 inches high and 30 inches wide. It is closed by a
hinged door of one-ll.alf inch steel. A rµbber gasket makes
an air-t,i.ght joint between door and entrance. The door
contains two windows. The upper window is of the shape
seen in figure 2, the larger dimension being 19 inches and
the shorter 10 inches. All the glass windows are 1 inch
thick. In the lower part of the door is an aluminum win-
dow used for X-ray work. The dimensions of this window
are 14! by 17 inches. In the lateral wall there are 12
openings, 8 of which admit I-inch pipes, the others, l}-inch
pipes. Two of the latter openings are used for the brine
pipes. Of those remaining, one is for the recording ther-
mometer No. 6, figure 2, one for the manometer No. 4, one
for the telephone No. 5, and another is an open pipe con-
nectingthemanometerinside the chamber with the outside
air which is at normal pressure. All but two of those re-
maining have hermetically sealed into them groups of wires
which permit of electrical connections of various sorts.
The other two are left blank and are closed with iron caps,
to be used for purposes which may arise later. On the top
of the chamber are four similarly fitted pipes placed at 90°
from each other, One of these is used for the oxygen sup-
ply tube No. 3. This tube term;inates inside the chamber
in a pipe, bent into a circular form, to which are attached
several stopcocks with rubber tubing. This pipe is
mounted upon a wooden frame fastened to the inside top
of the chamber. To this frame are also attached 8 lamp
sockets properly wired. Into some of them lamps are
placed for the illumination of the chamber. The others
serve various electrical purposes. The leading-in wires for
this electrical supply come through one of the pipes pro-
jecting into the top of the chamber. Still another of these
pipes is connected to an emergency valve, inside the
chamber, which serves the same purpose as that in the small
chamber. Into the ftrurth pipe severnl wires are sealed l-
which may be used for electrical connections.
In figure 2, No. 8 is the suction pipe w4ich connects
the chamber directly to 'a Nash hydroturbine pump. In
 107
this pipe are two valves. Near the entrance of the pipe
into the dome mufiier a check valve prevents aii from
being drawn back into the chamber. Near the hand of
the operator is a regulating valve. Pipe No. 7 is the•
ventilation pipe with a regulating valve conveniently
placed . This pipe is connected to the tank No. · 15,
figure 6. The other end of this pipe terminates at the
inside of the chamber near the top in a circular pipe
extending around the chamber Holes· are bored in the
under side of this pipe through which the ventilation air
passes'. No. 9 is the water supply for the pump. In
addition to the above. there is a by-pass which is operated
at the third valve in the row. Pipe No . 10 terminates just
above the ceiling of the laboratory and is connected with
No . 7 through a butterfly valve. In pipe :No. 7 there is
another butterfly valve through which the air passes before
it reaches the rl\gulating valve mentioned above. These
two butterfly vaTves are rigidly connected by a rod and
are eo arranged that when one is opening- the-- other is
closing. By this means it is posaible to mix warm air
coming from the ceiling with the cold air coming from the
refrigeration apparatus, in varying quantities, to give the
entering ventilation air a considerab4, range of tempera-
ture. The operator can control all these processes from
his station just in front of the circular window, seen in
figure 2. All the valve controls, motor control, water
control, oxygen control. and the telephone are within easy
reach. The recording thermometer giving the tempera-
ture inside the chamber as a continuous 24-hour record is
also conveniently near. The mercury manometer scale,
which shows at a glance the altitude simulated in the
chamber, is clearly in view. Through the window the
operator has an unrestricted view of the inside of the
chamber.
The chamber is so insulated as to be protected from two
factors, shock nd heat. Four legs at intervals of 90°· are
0
riveted to the bottom of the chamber. Thes_e legs rest
upon an annular concrete foundation, but are separated
from the foundation itself by a layer of cork. The foun-
dation is ins1ilated from the concrete floor of the laboratory
by a 2-inch sand joint. The laboratory floor is separated
from ' the refrigeration room floor by another 2-inch sand
joint. The partition between the laboratory and refrig-
eration room is lined with a sound-proof material. A
channel about 3 feet deep and 3 feet wide, covered by
iron plates, extends tangentially from the chamber
foundation into the refrigeration room. The near end of
this channel, the cover of which is shown in Figure 3,
connects with the inner space of the annular foundation.
All the pipes leading from the chamber to the refrigeration
room pass along this channel, which is filled with granu-
lated cork to insulate the pipes from external effects.
The space under the chamber is likewise filled with
insulating cork material. The chamber itself is covered
with 9 inches of cork. This depth is made up ·of cork
sheets 1 inch thick, 3 feet long, and 1 foot wide, so. arranged
tp.at the joints of one layer are covered by the next. The
door of the chamber is also covered with the same depth
of cork. To prevent the glass windows from becoming
frosted by deposits of moisture from the outside air, they
are protected by dead air spaces. These spaces are formed
by three parallel glass plates sealed into the window ports.
Ea.ch space contains a vessel carrying a hygroscopic
medium. As a :finishing _coat, all the cork work on the
chamber is covered with one-half inch of cement painted
battleship gray. The ventilation pipe, No. 7, Figure 2,
is covered with a 3-in::h corkinsulation. The two brine
pipes, No. 12, Figure 3, are covered with 2 inches of cork.
All pipes or ·electrical conduits are painted according to
the accepted code with a few necessar) variations for more
complete identification. By observing the color of the
pipe it is possible to learn its function.
The refrigeration room adjoins the low-pressure chamber
room. Besides the pump and motor for use with the
chamber, and the compressed air unit, this room contains
a complete refrigeration outfit of an accepted type. The
apparatus is the 3-ton carbon dioxide safety system of the
American Carbonic Machinery Co. In the system installed
in the laboratory two refrigerants are used; expanding
carbon dioxide is the primary and calcium chloride brine
the secondary refrigeran_t. The chamber itself is cooled
·by the brine.
In Figure 6; No. 16, is the compressor, No. 17 the con-
denser, in front of which, near the floor, is the "liquid
container. No. 15 is the air cooler and No. 14 the brine
cooling tank. No. 18 is the pump which forces the brine
around the system. In the upper left-hand corner is the
gauge board, on which are indicators giving the suction ,
discharge, and stuffing-box pressures.
The production of low temperature in the low-pressure
chamber is effected in the following manner: Taking some
epoch during the cycle of operations, we may assume that
the gas, after having done useful work, is just entering the
compressor. Here the gas is compressed, becoming heated
in the process. It then passes into the condenser, which
consists of a system of coaxial tubes, through one of which
cooling water flows. The gas is liquefied and collects in
the liquid container shown near the floor. From the
container the carbon dioxide passes through the pipe
shown on the surface of No. 15 to an expansion valve,
concealed from view. The expanding gas passing through
this valve enters a coaxial system of piping immersed in a
tank containing calcium-chloride brine. In this particular
coaxial system of piping the brine circulates and becomes
cooled by contact with the t11bes containing the carbon
dioxide. During its expansion the carbon dioxide takes
up heat from the brine. This chilled brine collects in the
brine storage tank No. -14 and :is used as the secondary
circulating refrigerant. Under the action of the pump,
No. 18, the brine is forced into two different coils of pipe
connected in parallel. · One of the these coils is in tank No.
15. Here the ventilation air from out of doors enters
through a duct. The air, restricted by baffle plates during
its passage, flows over the coils containing the circulating
brine, becomes chilled, passes out through a 3-inch pipe
in the channel, and enters the chamber through pipe
No. 7, Figure 2. In this pipe there are two thermometers,
one at the air exit in tank No. 15 and the other just above
the regulating valve, as seen in Figure 2. This second
thermometer gives the resultant temperature of the venti-
lating air. There are two thermometers placed in the
brine line, so as to give the temperature of the incoming
and outgoing brine.
 108
Another portion of the brine is carried by means of insu-
lated pipes, running in the channel, to coils of tubing
located inside the low predaure chamber. Pipes No. 12,
figure 3, are the brine pipes. The coils in the chamber
are shaped to conform to the inner surface of the chamber
and are placed close to it. These coils and the circular
termination of the ventilation pipe are h oused by tin
sheeting to harness the incoming air. This causes the
ventilating air to pass downward under the floor, come
up through the grating floor and pass _out· through the
central exit in the top of- the chamber. During its down·
ward path, the air comes in cont3ct with the cold pipes
containing the circulating brine. By this means the
air in the chamber is additionally coo'ied . It i.i there-
fore possible to attain a temperature of between -25° C.
and - 30° C.
A special feature of this chamber enables investigators
to study th e effects of high _altitude on th e heart by means
of the Roentgen ray. To this end the door of the chamber,
as above stated, is eq uipped with an aluminum window
one-half inch in thickne~s. (See fig. 4.) This window is
bolted in place between rubber gaskets in a manner
similar to that in which th e glass windows are secured.
Just inside the chamber and in line with the window, is
placed the chair sh own in Figure 5. The subj ect sits in
this chair with his back to the window. In front and close
to his chest is the cassette containing a sensitive photo·
graphic plate, the cassette heing h eld in place by th e
holder seen in figure 5. In figure 4 the X-ray tube
(Coolidge) is shown"in the position for taking a radiograph.
Through a tube in the wall of th e chamber electrical con-
nection is made between a timing device inside and the
generating apparatus out in the laboratory. This arrange-
·ment enables the X-ray operator in the chamber to have
con trol of the exposures.
Aside from th e considerable a mount of work done on
radiography of the h eart by members of the Cardio-vascular
Department, use has been made of this chamber for an
extended piece of research by a member of th e Psychology
Department. In virtue of circumstances, the physiolo-
gists have done th e larger part of their work in the smaller
chamber. Now that the .large chamber has been rein-
stalled in its new station on Mitchel Field, it will very
soon be in active operation again.
It would be very difficult to give proper credit to all
who took part in the development of th e two chambers
herein described, yet a'mong others the name of Mr. Pierce
deserves mention. E. H . 0. has earned my gratitude for
valuable help in_the preparation of this note.
BIBLIOGRAPHY.
(~) BERT: La Pression Barometrique.
(2) BOYCOTT, DAMANT and HALDANE, Journal of Hygiene,
1908, vol. 8, p. 377.
(3) K . A. H"ASSELBACH and J. LINDHARDT, Biochemische
Z-eitscnrift, about vol. 67, 1914.
(4) LUTZ, SCHNEIDER, American Journal of Physiology,
vol. L, No. 3, Dec., 1919.
GREGG, LUTZ, SCHNEIDER, ibid.