FOR OFFICIAL USE.

ONl:i¥::-
File B 63/14
_ _ NON-CIRCULATING
AIR SERVICE INFORMATION CIRCULAR
(AVIATION)

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

Vol. III July 15, 1921 No. 237

AIR MEDICAL

l--
COMPILED BY THE MEDICAL DIVISION
OF THE AIR SERVICE

Ralph Brown Draughon

LIBRARY
MAR 2 8 2013
Non-Depoitory
Auburn University

WASHINGTON
GOVERNMENT PRINTING OFFICE
1921
 TABLE OF CONTENTS.

Page.
" The Flight Surgeon, a New Specialist in Medicine;" byW. L . Sheep, M. D., major, Medical Corps, U.S. Army . 3-5
"A Study of Low Oxygen Effects During Rebreathing;" -by Edward C. Schneider and Dorothy Truesdell, De·
partment of Physiology, Medical Research Laboratory, Air Service, U . S. Army .. .. .. . . . .. ... . .......... 6-25
"Psychological Research in Aviation in Italy, France , England,.a,nd the A'. E. F. ;" by F. C. Dockeray, Univer-
sity of Kansas, and Lieut. S. Isaacs, Air Service Medical Research Laboratory (former captain and first
lieutenant, Sanitary Corps, respectively) . .. .... . ........ . .. . . ... . . . . . ........ . ..... . ...... . ............ 26-37
"Psychological Effects of Deprivation of Oxygen. Deterioration of Performance as Indicated by a New Sub-
stitution-Test;" by H. J\L Johnson, captain, Sanitary Corps, U . S. Army, and Franklin C. Paschal, assistant
professor of psychology , University of Arizona ... ....... . . . .. . .. .. . .... . ...... . .............. , ....... . . 38- 72
"Why an Aviator is Examined by the Rebreathfng Method and How Often the Examination Should be Made;''
by Ve~ner T. Scott, first lieutenant, Medical Corps, Medical Research Laboratory of the Air Service, Mitchel
Fieid, Garden City, Long Island, N. Y ., Physiology Department . .. . ......................... . ....... . .. 73-74
' ' Studies on th e Responses of the Circulation to Low Oxygen Tension . Changes in the Pacemaker and in Con-
duction During Extreme Oxygen Want as Shown in the Human Electrocardiogram;'·' by Charles W. Greene
and N. C. Gilbert, form erly of the Medical Research Laboratory of the Air Service, Mitchel Field, Long
Island, -N. Y . ... . ..... .. .. . ...... ... . ...... . . . . . . ..... . ... . ... . . · ·.-· · . . ... .. .... .. . .. . . .. .. . . . .... . . 75-106
"A Record of :Experience with Certain Physical Efficiency and Low Oxygen Tests; '' by E.d ward C. Schneider,
Department of Physiology, Medical Research Laboratory, Air Service, U. S. Army . ... . .......... . . .. 107-ll2
"The Application of Certain Physical Efficiency Tests;" by Verner T. Scott, M. D ., captain, Medical Corps,
Air Service, Mitch el Field, Long Island, N. Y ..•... .. ..... . . ..... . , .. . .. . . . . . . .. . .. . . . ..... . . . . . . . . 113-115
' ' A Sphygmographic Study of the Pulse During the Reb:reather Test;'' by N. C. Gilbert, Chicago, Ill., and
Charles W. Greene, Columbia, Mo ., formerly of the Medical Research Laboratory of the Air Service,
Mitchel Fiefd, Long Island, N .. Y .... . .. . . .... . . . .... • . .. . .... . .... . ... . ...... : . . . . -..... .. . , .. ... . . 116-121
"A Study of the Influence of Various Circulatory Conditions on the Reaction to Low Oxygen of Rebreathing;"
by Edward C. Schneider and Dorothy Truesdell, Department of Physiology; Medical Research Laboratory,
Air Ser".ice, U. S. Army . .. . ..... . ..............•..... • .. ·...•............ . . . ... .. . ............ . ..... 122- .133
"A Brief Note on German J,iquid Oxygen Appa:ratus;' 'by Dr. George B. Obear, formerly captain, Sanitary
Corps, Medical Research Laboratory, Air Service, U. S. Army . . .... . ... . . . •. . . ..... . .. .. . . ... . .... .. 134-139
(2) .
 oC\o\
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AIR MEDICAL SERVICE. -t\
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IA L.'

THE FLIGHT SURGEON, A NEW SPECIALIST IN MEDICINE.

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___
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By w. L. SHEEP , M. D.-, Major, Medical Corps, ·u. s. Army.

The flight surgeon bears the-same relation to aviation as ·for the establishment on a permanent basis of the office of
does the specialist in preventive· medicine to mankind in the flight surgeon. Further, these pioneers rendered ':re~
general, in that the two are concerned with-the prevention ports of their observations and experiences which have
of disability and the maintenance of physical efficiency. beeri of great assistanc·e in formulating the present sy's tem
As a knowledge of diseases is essential in order to make in· of instruction pr escribed for medical officers w.ho desire to
telligent efforts for their prevention, so a knowledge of the qualify as ·flight surgeons.
special ailments to which the flier is subject is necessary in This instruction is given at the central Medical Research
order that they· may b e prevented or reduced to a · Laboratory, and consists of lectures, demonstrations, and
minimum. practical work in normal physiology of respiration and cir-
When the United States entered the World War and t):iere culation and in_the physiology of respiration and circula-
began an immediate and great increase in aviation activi- tion of the ,flier when exposed to high altitudes. The
ties, it early becarn,e apparent that after men had under- ability to differentiate the arrhythmias and all types of
gone a thorough and special physical examination an9 valvular heart disease is acquired from clinics and lectures.
were found fit to fly, the most important work of the Med" Methods of new and special examinations of. the ophthalmo-
ical Division of the Air Service was to keep these selected logic and otologic apparatus are taught, .and each student
men under constant supervision to see that they remained flight surgeon is required to make- a number of complete
fit to fly, and to remove from flying those who became unfit. examinations uf the ·eye and the ear. In psychiatry the
The necessity for such a procedure was made obvious by a general field is covered by lectures and clinical work, and
report from overseas that th e British, French, and Italians, special attention is devoted to the making of personality
by information derived from carefuUy compiled statistics, studies. In psychology the instruction consists of a study
had come to the. conclusion "that 90 per cent of aviation of elementary psychologic methods and the psychology of
cjl.Sualties was due to troubles with the fli ers, 8 per cent to av,:i.ation, a subject which has to do with the mental adapta-
defective-airplanes, and 2 PP" cent to the Huns ; further, bility of the flier ·to the work required of him. In physics,
that by proper medical supervision of fliers; the British in such matters as oxygen supply apparatus, aviat9rs' goggles,
two years reduced this 90 per cent of casualties· to 12 per and th~ rebreathing apparatus for the·detection of staleness
cent. and the clas.~ification of fliers are given study and practical
The!!e so-called "ti:oubles" of the fliers were-made the demonstration . The whole course of instruction requires-
subject of special study by competent experts. Medical three months of intensive work.
officers were assigned to duty at flying fields for the pur- After its completion, and. on being assigned to flying
pose of obtaining all possible inforn;i.ation concerning ills fields for duty, flight surgeons are encouraged to take flying
and accidents of fliers, research laboratories for stttdy and instruction and to qualify as air pilots. They can thus ~y
experimentation were established at certain of the fields, experience in the air comprehe_n d the psychology ?f flYflg.
frequent reexaminations Of fifers were·conducted, and all From the study of the sensations produced dunng flight
of the- knowledge acquired· thereby was assembled and put they gain a wealth of information of inestimable value m
~to shape for the training of medical officers who were to dealing with fliers under. their charge. They have a true
qualify for the special medical work required by the ,Air appreciation of the stress which at all times the flier under-
Service. Thus there evolved a new specialist in medi- goes, the symptoms brought on by flying at high altitudes,
cine-the flight surgeon. and the physical and mental · exhaustion incident to pro-
· The program for the.training of-many medical officers as longed flights . They may acquire a personal knowledge of
flight surgeons for assignment to overseas squadrons was the manifestations of flying ''staleness," that mostinsidiou11
interrupted by the signing of the armistice. The yv-ork of and dangerous ailment of fliers, which may exist when the
the pioneer flight surgeons who were on duty during the subjects themselves are not aware of it, but which the com-
war at Air Service stations in the Unite4 Stat;es was of great petent observer · usually detects without difficulty.
value. New to duties not clearly defined, their status not Further, they have 'a bond ii:\ common with their fellow
always urid_erstood, the importance of their services at first fliers, and it has been observed that on thisaccountgreater
not fully appreciated, they showed keen enthusiasm and confidence is reposed in them by the fliPrs.
marked intelligence in the performance of their tasks an:d, Of'the 40· flight surgeons now on duty at Air Service .
by pract-ical demonstration of their worth, paved -the way stations, 2_9 are, on flying status, which requires that,
(3)
 4
either as passengers or pilots, they take a minimum of standards required for the examinations of the eye, the ear,
10 flights a month. Oi these 29 there are 7 who are. and the nervous system.
qualified pilots a.nd 5 who are now taking instruction to The official status of the flight surgeon is prescribed in
qualify as pilots. the follqwing instructions, which have been issued by the
The duties of the flight surgeon are prescribed officially director of Air Service t0 commanding officers of Air
as folloV1-s: "The duty of the flight surgeon i.s to act as Service stations:
advi~er to the commanding officer of flying schools and 1. Commanding officers of Air Service stations where
squadron groups. Although under the pQst surgeon, he flying is bJ:ling ·c arried on will consu,lt with the flight sur-
has the freedom of independent initiative in all questions geon in all matters pertaining to the mental and physical
of flying fitness of aviators or cadets. Subject to. the fitnesA of the flying personnel of his command . The term
approval of the commanding officer, he is expected to "flying personnel" will include all who make aerial
institute such measures as ·periods.of rest, recreation, and flights, such as instructors, flying· officers, and individuals
temporary excuse from duty as may seem to him ad- undergoing flying instruction.
visable .. He takes sick call for aviators anl cadets and 2. Commanding officers will take full advantage of the
recommends a disposition of cases excused from duty. assistance that can be rendered by the flight surgeon of
He will visit such cases as may be in the hospital at the his field. Such matters as the amount and kind of
post and consult with the attending medical officer regard- physical exercise required by individuals engaged in
ing them. From time to time he will make routine flying, the state of fatigue of the indi~idual flier, the
reexaminations of aviators and cadets, also such special amount of sleep necessary, food problems,Ieexaminations,
examinations as he may deem advisable, being assisted and all field conditions affecting the welfare of the flyfog
therein by data furnished by tlie.Medical Research Labora- personnel will be made the subject of conference between
tory. He will live in as close touch.with the aviators and the commanding officer and the flight surgeon. Com-
cadets at his station as is consistent with the conditions. " mandjng officers should obtain the recommendation of the
The flight surgeon should be out on the line with the flight surgeon on applications for leaves or furloughs from
fliers during the:. hours that.flying is actively engaged in those engaged in flying when physical incapacity is made
The mechanicians look over the engine, the control gears, the basis of application.
the struts and the wings of the airplane before it is taken 3. The flight surgeon will bfl listed on any form for
oi:lt for flight; how much more important it is thl!,t the clearance in vogue .at an Air Service station, and no flying
flier, the ·'heart and brains of the whole apparatus," as officer or anyone undergoing flying instruction will be
one flight surgeon expresses it, should be talked with and transferred from a station without first obtaining a cle,ar-
critically, if but momentarily, observed before he is ance from the flight surgeon. On notification of transfer;
allowed to go up·into the air. the flight surgeon will forward to the flight surgeon of the
On recommendation of the flight surgeon, the command- new station the reexamination report and laboratory
ing officer of an Air Service station..may at any time remove rating chart of the individual being transferred.
a man from flying duty. While the most important part 4. Flight surgeons :will be encouraged in every way to
of the flight surgeon' s work is in instituting mi;-asures for take flying instruction. On completion of the prescribed ·
keeping fliers in good physical condition, it is worth while tests, flight surgeons will be rated in the same manner as
to state that of 1,500 fliers in the United States in 1919 of other flying officers. Applications for flying training
whom there is a record 808 were temporarily disqualified should be made through the surgeon to the station com-
for flying on account of physical disability and 30 were mander, and will b1:, accompanied by the necessary report
permanently disqualified. of physical examination.
The flight surgeon is required to prepare and sendin to 5. On recommendation of the surgeon, station com-
the .office of the chief surgeon, ,Air Service, at frequent manders will authorize medical officers of the command,
intervals, standardized reports on fliers . Several of these who are :physically qualified and make application, to
reports deserve special mention in that the information take flying instruction. This will enable one of these
they furnish gives an idea of the v'aluable st~tistics which . officers to take the place of the flight surgeon when the
the central office is enabled to compile. The " Crash" latter for any reason is not availz.ble for that duty:.
report, sent in from a station ·w henever there is an injury 6. · Unless an absolute necessity exists therefor, flight
to a flier or serious damage to an airplane, covers the date surgeons will not be diverted from their regular duties to
of beginning of training of flier, hours of dual and solo perform rcrutine post duties when this service can be per-
instruction, hours flown during past month, duration of formeg by other medical officers. Flight surgeons should
last flight, number of previous crashes, result of crash, devote all the time possible to the close an,d constant
cause of crash, type of airplane, etc. The "('.are of Flier" supervision over ·flying personnel.
report is submitted weekly from each station. . It gu,es 7. The flight surgeon of an Air Serv'ice station will not
the total number of fliers on duty at the station, the number be detailed as a member of a board of officers convened to
of hours of flying, number of fliers temporarily removed ·examine into the efficiency of a flying offi.c er when it can
from flying duty by the commanding officer on recom- be avoided. His services will be of more yalue when
mendation of the flight surgeon, cause of disability in each· called before a board as an expert witness to give testi-
case reported on, statement as . to whether physical ex- mony relative to physical fitness, etc., of the officer under
amination records are on file for all fliers at the station, investigation
etc. The "Physical Examination for Flying" report on The flight surgeon has come to stay. Inst.ances without
each flier is sent in semiannually and covers a ·thorough number of the practical value of his work coul4 be related.
and complete physical examination, embracing the new In an analysis of statistics of t,250 crash reports rendered
 5
by flight surgeons, which covers a period from July 1,
1918, to .January 1, 1920, and which includes reports on
crashes from all stations in the United States at which
flight surgeons were on duty, the cause of crash due to
physical impairment of fliers, when definitely ascertained
to have existe<l, is given as only 2 per cent. Forty-seven
per cent is reported as due to "poor judgment." It i,
{J
probable that a relatively small number of these crashes
were due to physical impairment, but for lack ot more
exact information were not placed in that class.
Undoubtedly the work of the flight surgeon has resulted
in the saving of many lives and much valuable property.
(By courtesy of the Journal of the American Medical
Association.)
 A STUDY OF LOW OXYGEN EFFECTS DURING REBREATHING.
By EDWARD C. SCHNEIDER and DOROTHY TRUESDELL, Depa1'tment of Physiology, Medical Research Laboratory , Air
Service, United States Army.
The original data of the Air Service, United States Army,
official altitude classification examination of all l),viators
who were given this test have been collected and filed in
th-e Medical Research Laboratory, at Mitchel Field, on
Long Isl~nd. · There are approximately 7,150 cases.
Fr<;>m these, 1,050 have been selected for an analysis of
the physiological responses. Some of the characteristic
features of the results are here discussed.
The so-called "official altitude classification examina-.
tion" is-a low oxygen te·s t in which the aviator is required
to rebreathe 52 liters of air .fro;n which the carbon dioxide
is removed by sodium hydroxide. The Henderson~
Pierce rebreathing apps.ratus (1) was. used in all the exam-
inations. In tiie routine test the pulse rate and arterial
pressure were determined once each minute and the res-
pirati_on .recorded on a kymograph. The kymograph
tracing is in reality a record of the movements of.. the
spirometer. This. not only records the volume of each
breath, but also the reduction in air volume a:!id the
oxygen consumed. Throughout the entire period of
rebreathing the aviator was busy with work directed by a
psychologist (2), whereby the condition of voluntary
coordination and attention was observed. The psycho-
logist determined the earlies_t effects on attention anq motor
coordination, the time of appearance of more marked
effects, and of total breakdown. The experiment was
terminated when the subject had reached the point of
complete mental inefficiency .or when the circulation
indicated oncoming syncope.
The stlbject of an experiment does not ordinariJy ex-
perience discomfort. Many of the men show some degree
of apprehension immediately prior to and .at'the beginning
of rebreathing. This is evidenced in various ways-by
an acceleration of the pulse, a rise in blood pressure, or
increased breathing. Once the experiment is well on
the evidence of apprehension usually quickly disappears.
The discomfort of the nose clip and mouthpiece bother
some men, but even these annoyances pass from the field
of consciousness as the low oxygen effects develop. The
subject, as a rule, is entirely unaware of any change in his
condition, even though he may have been carried to ui;t-
consciousness. A good reactor, who does not faint, may
fail first to attend _to one, then another, and finally all of
. the signals directed by the.psychologist and sit glassy-eyed,
deaf, and irresponsive to signals or questions; and yet,
when revived with fresh air, ask why h e was not carried
further . . He can not readily be convinced that he has
been unconscious. Even the subjects .who develop the
fainting reaction are not aware of their condition, and
unless they are actually allowed to faint often question
the saneness .of the observer. After effects, such as head-
(6)
ache, ''tightness of head," and lassitude, are sometimes
observed. When the subject is allowed to faint complete
recovery is, as a rule, rapid, but has been .slow in several
instances.
The degree of-oxygen deficiency tolerated shows a wide
range. Capt. J. E. Coover examined 2,279 prearmistice
cases as to final oxygen per c-ent and the time required to
reach it. The mean · for · the final oxygen per cent was
7.42±0.01, with extremes of 11 and 5.2 per cent. The
mean length of run was 24.65±0.05 minutes, with the
extremes 15 and 35 minutes.
THE CIRCULATORY REACTIONS.
The response of the circulatory mechanism to the gradual
steady decrease in oxygen has been considered by Schnei-
der (3), Lutz and Schneider (4), and Greene (5): We have
compiled what may be called the normal and, therefore ,
the most frequent type of reaction by calculating the
arithmetical means r,nd probable error of the mean for a
number of groups of selected cases. Since the curves that
show-the changes in the pulse rate, the systolic, diastolic,
and pulse arterial pressures are quite similar for. the several
groups, the results obtained f,rom one group are here
presented in detail. This included 148 cases of the non-
fainting type of reaction. The data for these experiments
were tabulated and the means -for the pulse rate and the
arterial pressures calculated for the standing posture, for
the seated 'position take_n from the preliminary observation
just before the re breathing was begun, again three minutes
after the rebreathing began, and then at the following
percentages ·of oxygen during the experiment: 18, 15, 13,
12, 11, 10, 9, 8, and 7. The last means calculated were
those for the first readings after the subject was taken ·off
and allowed to breathe fresh air. The results are s.,.'iown
graphically in figure 1 and are tabulated in table 1.
A second set of curves has been added as dotted curves
to figure 1 for purposes of comparison. These data are
compared diagraphically in figure 10. The data for these
curves were obtained ·from a group of 100 men who with-
stood the low oxygen of rebreathing down to 7 per cent or
less of oxygen. The lowest oxygen reached by members
of the group was 5.6 per cent. The distribution of all
cases with respect to final oxygen was as follows: 59 men
went to 7-6.6 per cent, 35 to 6.5--6·.l per cent, and 6 to
6-5.6 per cent oxygen. The means for the pulse and dias-
tolic pressure almost coincide with those of the corre-
sponding oxygen percentage in the 148 nonfainting cases .
The means for the systolic and pulse pressures do not fall
as close together,. but in no instance are they more :than 3
mm. apart. The time of appearance of and the degree of
compensatory change are practically identical iii both
 7

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0 - - - - 0 - - - 0 - - --- 0 Jl U\~"Toi,..,\C.

~---><-·--- ><---
tao

140

130

120

110

100

18

14

15

11

40 1T

30 l8

20 Jt

10

n n -n O 1 2 8 4 Q 6 7
TIME I~ MINUTES
FIG. 1.-A norn;al but composite compensation to low oxygen . 'l'he curves were established t,y Calculating the aritjµnetical means· for
148 cases.· First N , standing. Second N; seated. Continuous heavy oblique line=oxygen. Cont muous heavy vertical=mean
time!;at; end of test.
TABLE 1.
Means and probable error of mean in 148 nonfainting r.asts.

Arterial pressure in =· Hg..

0 bserva tion.
Pulse rate per Number
Systolic. Diastolic. Pulse. of cases.
minute.

Standing . .. ....... .. . .. ...... . 92. 92±0.69 116. 51±0. 61 81. 68±0. 47 35.32±0.62 148
Before rebreathing (seated) ... . 81. 83± . 62 121.19± .62 81. 48± . 38 40.32± . 57 148
3 minutes on rebreather ...... . 85.81± . 76 130.32± . 79 84. 94± ·. 42 46. 62± .69 148
18 per cent.O, ..... ..: ......... . 86.09± . 71 130.16±. . 79 84. 70± .44 46.08± .. 67 148
15 percent O, •......... . ...... 87.45± . 70 129. 7 ± . 77 '84.46± .44 45.67± . 66 148
13 per cent O, .. ....•..... . . ... 90.08± .66 129.38± . 73 87.88± . 39 45.95± .56 148
12 per cent O, .... .. .. . • .. . . . .. 91.13± .66 129. 70± . 73 83. 92± .43 46, 84± .58 148
11 per cent O, ........ .. . .. ... . 94.05± . 71 130. 46± . 75 . 83.38± . 40 48.'43± :61' ' 148
10 per cen.t O, ..... .. . ...... .. . 99.49± . 74 130; 50± • 75 81.82± .45 49.58± .. 6() 147

a:~:~i o,8::::::::::'.::::::::
7percent ...·... ..... .. . ,.-.
101.38± . 73
106.98± .83
110.74±1.04
131. 94± . 74
133.17± . 79.
137. 03± 1. 02
.80.38± .45
77. 73± . 47
74.63± .65
52. 58cj: . 64
56; 06± . ll,f
63.20±1...o2
145
127
· 70
First readin;; after ·off . .. : . ... . 86.43·± . 78 125. 48± .69 77.00± .47 48. 68± . 60 148
 8
groups. A closer parallelism could hardiy be expected. The uniformity with which the individual cases of a
It emphasizes the fact that the good -physiological response group make the ordinary circulatory responses to low oxy-
to the low oxygen of the rebreathing test is made in about gen is well illustrated by a frequency study. The data
equal degree and iu a similar manner by healthy normal for the group of 100 cases of men who tolerated to 7 p er
young men. cent or less of oxygen were tabulated as to frequency in
It is evident from these data that the. majority of all distrib_u tion for the pulse rate and the arterial pressures
men who undergo the low oxygen .rebreathing examina- for the same time intervals and oxygen percentages used
tion show a psychic reaction that is still in evidence at.the to established the curves of figure 1. The pulse rate fre-
third minute in each of the circulatory factors here studied. quency curves for six of these periods have been repro-
This psychic reaction is most conspicuous in the systolic duced in figure 2. They show that each man made a
pressure. The curves also show that if a decrease in oxy- good compensation as oxygen :want increased, in that there
gen down to 19 per cent has any influence upon these is a shifting of the c:ill'Ves to the right along the base line
circulatory factors, this response is obscured by the psychic on which the.pulse rate intervals have been marked. . The
reaction. limits, as well as the mode of each curve, shift at 12.9, 8,

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FIG. 2.-Pulse rate distribution curves oflOO cases who rea<;hed 7 per.cent or less of O,. The basEl,line shows the pulse rate intervals and ordinate
the· number of cases.

The composite curve shows that the pulse rate accelers and 7 per ·cent, respectively. The mean pulse rate for
ates almost from the first. This acceleration at the begin- the group at each of these points was 83.2, 86.4, 90.2, 100.1,
ning is slight and gradual,· but from 12 per cent down to 105.5, and 111, respectively. Each of these almost coin-
the end is more marked. There is a well-defined com- cides with the respective observation for the group pre-
pensation evidenced by the arterial pressures in the rise sented in figure 1.
in the systolic and the fall in the diastolic pressures While in the arterial pressures the case line for the
that begin at 12 or 11 per cent and continue to the close curves of· frequency becomes longer, due to scattering of
of the experiment. The changes in the systolic and dias- the cases, as the lower oxygen percentages are reached,
tolic pressure beginning· at 13 per cent cooperate to yet a similar shifting of the curves is present for e.ach factor
steadily increase the pulse pressure. el_l:cept the ~_ystolic pressure. For- the diastolic pressure at
Not all of the men endured to as low as 7 per cent of the preliminary reading at 3 minutes and at 12, 9, 8, and
oxygen. Of the 148 cases all reached 11 per cent, while 7 per cent the lower and upper ranges of the respective
147 went to 10 per cent, 145 to 9 per cent, 127 to 8 per cent, curves were 54-102, 58- 106, 66-102, 62-102, 58-98, and
and only 70 to 7 per cent. There were three cases that 38--94 mm. The respective µie.ans for the several curves
reached 6 and lesa-5.8, 5.8, and 5.6 per cent. were 80.9, 84.6, 84.3, 80.9, 79.1, and 72.9 mm. The dias-

tolic curves, as the oxygen decreases, shift to the left
instead of the right, because the pressure shows a fall .
The diastolic means recorded for this group will be found
to be almost identical with those of corresponding per- the ideal curve of response occur in each group of cases
centages in figure 1.
9
VARIETIES OF CURVES OF REACTION.
A .mmber of variations of greater or lesser degree from
that has been examined. These fall more or less sharply
into well-defined subgroups. Some of the outstanding
varieties of the curves of response have been assembled
in figure 3.
PULSE RATE CURVES.

The pulse rate response can be expressed by eight types

of curves, which in reality occur in four pairs, containing
a psychic and nonpsychic variation. In 2 (see fig. -3)
there is no initial psychic effect and the low oxygen accel-
e.Fation begins early, sometimes at once and in all cases
before three minutes have elapsed. Variety 2b is much
like 2, with an initial psychic rise which has a tendency
to disappear, but before its disappearance the low oxygen
11
effect has already begun and the pregressive acceleration
... starts at a higher level than in 2. In variety 3, where the
Ttrn ,,.Mu.. vru
/0 IS zo z ' psychic influence is lacking, the pulse rate does not
change until the oxygen has decreased to 15 per cent or
less. 3b is like 3 except that an initial psychic reaction
occurs which persists unabated until a late low oxygen
effect further -accelerates ·t he pulse rate. In varieties 4
and 4b the initial nonpsychic and psychic responses are
present as in 2 and 2b, but differ in that toward· the end of
the experiment, as the limit of endurance is approached,
the pulse rate retards, causing a slow or rapid terminal fall
in the curve. In variety 1 a temporary hiitial psychic
rise. is present, which apparently does not obscure the-
initial low oxygen acceleration. Curve lb is character-
ized by an initial psychic climb and a terminal drop.
Occasionally there. are cases in which the pulse rate,
with and without the initial psychic effect, shows no
zo clearly defined responses to the decrease in oxygen. An
analysis of the data from 300 aviators who underwent the
DIASTOLIC 70., Pf.RUNT rebrel!-thing experhnent gave the following distributions
among the pulse rate variety of curves:
Cases. Percent.

.I ,,---
,,......_ .
13
l._......... . ........... . . 98
lb . ........ . ·········... . 5
2 ..... . •.•....•.· •.. . ..... .37
32.7
1. '/
12.3
3-
,. 65
2b ..... . ··· · ··· · · ·· · ···· . . 21. 7

·- 15

"
-3 •••.•. • . •••.•••.•••• • • , . 48
3b ......... · ······ · ..... . 26
4 • . •···•········· · · . . ... . 4
16
8.7
1. 3
,," -!b ..... ···.· ··· ··· · ······ · · 7 2.3
,, No response ·or uncertain .. 10 3.3
liMt IN ~ IM\iTtS
,o Total. . . . . . . . . . . . . . . 300 = 100
~'Io. 3.-Curves illustrating the varieties of reaction for. each circula- SYSTOLIC PRESSURE CURVES.
tory compensatory factor. The diagonal line indicates the rate
of oxygen change. The varietie11 of curves for ihe systolic arterial pressure
can be grouped among the eight patterns, some of which
The pulse pressure frequency curves shift to the right are diagramed in figure 3. In variety 4 the systolic pres-
along the base line as the oxygen decreases. The lower sure remains constant with exception of irregular fluctua-
and upper limits of these, for the same periods used in the tions throughout the low oxygen experience. Variety
pulse rate an<:l diastolic pressure, were 18-82, 14-78; 26--82, 4b-differs from 4 in the presence of an initial psychic rise,
30-90, 30-86, and 34-~4 mm. The-modes for the respec- which after several minutes of rebreathing wholly disap-
tive periods were 42.4, 49.4, 48.6, 54.4, 57.4, and 63.4 mm. pears. In 5 there is also, as ·in 4, no evidence of compen-

sation, the systolic pressure remaining constant until to-
ward the end of the experiment, when it begins to fall
with different degrees of rapidity. In varieties 1, 2; 2b, 3,
and 3b evidence of compensation is found in the occur-
rence of a terminal rise, this rise occurring as early as 15
per .cent oxygen in-some cases but more frequently at a
lower oxygen. Variety 2 is without, while 2b has an
initial, temporary psychic rise. In 1 there immediately
occurs a sharp rise in · the systolic pressure that persists
throughout the rebreathing; toward the end there ia some
degree-of compensatory rise, but still later there is a fall,
which continues untU the subject faints or is given fre.sh
itlr. Varietie,s 3 and 3b corre,spond to 2 and 2b, .respec-
tively, with ,a difference in the terminaJ.part of the curve,
in which, after some degree of compensatory rise, the sys-
tolic pre,ssure falls more or less rapidly.
The distribution of 300 cases among eight varieties of
systolic pressure curves follows:
Cases. Per cent.
1........ .. . . ............ $0 26. 7
2. . .. ... .. . .. . . . . . . . . . .. . . 32 = 10. 7
2b ........ . .... . ....... ·•. 68 22. 7
3....... ...•.. ... ... ... .. 6 2
3b .. ." . . ........ . ........ . 14 4.7
4... .. . . . . . . . . . . . . . . ... . . 23 7. 7
4b..... . ............. ... . . 9 3
5 .... . ................ . .. 68 22.7
Total. ........... , . . 300 = 100. 2
DIASTOLIC PRESSURE CURVES.
'fhe diastolic pr!lssui'e changes- do not show as great a
variety of patterns as do the changes in pulse rate and
sys~lic pressure. There are :five types of curves (see
fig. 3) .that are found to fit all except very exceptional
cases. . A small proportion, variety 1, either with or with-
out a brief initial psychic rise in diastolic pressure, hold a
fairly constant level throughout the test, giving no evi-
dence of a compensation in this factor of circulation. _In_
2 and .2b occur the.majority of all cases. The.two curves
are .quite alike except in the initial phase; 2b does and 2
does not show a psychic rise at the beginning of the 'test.
In both tliere . is ordinarily present a middle period of
increased pressure, but-~he striking feature is the,gradual
cpmpensatory fall in the pressure, which usually begins
after· 15 per cent oxygen has been reached and continues ·
slowly falling in a controlled-manner to the end of the test.
In variety 3 the initial psychic rise is usually present in
-slight degree while the terminal fall is very marked, called
an uncontrolled drop. Variety 4 is one in which the dias-
tolic pressure mainta.ins the initial level until the low
oxygen effect apparently becomes overpowering, when,
without warning, it suddimly falls to a very low level as
the subject faints. It is evident from curve!! 2, · ~b-, 3,
and 4 that under the influence of low oxygen the diastolic
pressure ordinarily f~lls, the curves differing chiefly in
. the rate of fall.
The pulse pressure curves are, of course, ~etermined by
the changes that occur in the systolic and diastolic pres-
Stires and can, therefore, be visualized from these curves.
The curve for pulse pressure given in the-composite curve ·
in figure 1 is_typical for all the groups of cases studied.
10
In 300 cases the varieties of -diastolic re,sponses were
grouped as follows:
Cases. Per cent.
L . . ..... . .. .. .... ..... . . 18 6
2. __ .. . .... ...... .. ... . . . 93 = 31
2b. . ..... .. . . . . . . . . . . . . . . 77 25. 7
3 • . • .•.•...... • .. •••. . .. • 74 24.7
4... ... . . .. . . . . . . . . . . . . . . . 38 = 12. 7
Total. . . . ... . . . . . . . . . 300 == 100. 1
The curves as presented in ·figure 3 have been partly
smoothed. Often ·a n individual original curve is quite
saw-toothed· in appearance. Some of the variations that
give the irregularities are 888ociated with respiration,
others are undoubtedly influenced by mental conditions.
OccaRiona1ly a response does not conform to any of the
patterns; most of such cases havt> <tppeared to us to lack
physiologjcal significance. The demarcation of the varie-
ties is not always clear, one form of curve gradually chang-
. ing into another by action that may be called transitional.
RESPIRATORY CHANGES UNDER THE PRO-
GRESSIVE DECREASE OF OXYGEN.
In order to establish the ideal or composite curve of the
respiratory changes analyses have been made of two groups
of cases. In the first study the kymograph tracings of
136 cases were checked up as to the per-minute volume,
depth, ·a nd-rate -of breathing. in the second study of 60
cases (see Table 2) fa. which the volume of breathing was
recorded .by means of the Larsen respiration automatic
recorder and counter, for each minute of the period of
r~breathing the ideal curve and varieties of curves were
established. · For. each group the mean and probable error
were calculated for a sufficient number of the points to
establish the form of the curves. The composite curves
derived for the two groups appear in figure 4·and summaries
in Table 2. ·
PER-MINUTE: RESPIRATORY VOLUME.
Curve I ; figure 4, was prepared fram the group_of 60
cases. Unfortunately, the method of recording respira-
tion does not permit the determination of either a pre-
experiment no_rmal or the post-experiment recovery.
Therefore, it has not been possible to indicate the psychic
reaction, as was done for the circulatory studies. · Eleven
points in the curve, the same used for the circulatory data,
were calculated. The calculation of additional points,
which would be permitted by available data, would not
add definiteness to t'4e part of the curve that indicates
the beginning-of the low oxygen effect, since ,the-change
is at first. so slight that it is almost always debatable.
Interpretation and opinion are quite likely to be biased
as regarded what constitutes an increase. There are, no
doubt, two {Ji.ctors other than low oxygen effects that ,may
cause the upward trend·in the curve during the first three
or · more minutes. At, first the mental factor enters,
because o~ anxiety when the subject begins to breathe
the confined· air, 80 that-for a while both the ,rate and
volume of breathing may be greater than normal. The
·mental effect, ·as a. rule, subsides wholly or. partially within
three or four minutes., The second factor that may account
 11
for a part of the increase in the per-minute volume of per-minute volume of breathing steadily increases as the
breathing is the physical work :r:equired in attending ·and available oxygen decreases.
reacting to the psychologist's signals. Just how much Curve II (fig. 4) was derived from-the data of 136 Gases.
this work would increase metabolism has not been deter- 'fhe first two points determined for this curve were at
mined. However, as the work done remains constant approximately 19 and 16 per cent oxygen. The, per-
throughout the period of rebreatliing, its influence on the minute volume differs between the two points by only
per-minute volume of breathing would quickly reach and 30 cc. This confirms the observations in curve I. Be-

'1

,120 D

110 10

100 11

.00 12

80

'IO

00

40 1'1

80 18

10 II

10
•
0 11 " " 0 1 II 8 ( G O '1 8 9 10 11 , U 18 H '1G 18 1'1 18 19 20 21 lll 23 lK 25 !IO 87 28 11D BO 81 Ba 81
'tlHE .IN MINUTES
FIG. 4.-Composite respiration.cµrves obtained by computing the arithmetical means. I and I{, the per minute volume In deciliters of breathing
for 60 and 136 cases respectively; III, ·the depth of breathing (the ordinate on tM left should be multiplied by io to obtain \!Orrect volume in
00.). Continuous .oblique line;=oxygen percentage; ve,rtical-continuous 'line=length of rebreathing experioient. ·

maintain a level. The a.scent in curve 1, figure 4, up to
he third point, 18 per cent oxygen, an interval in time of
~lmost six minutes, represents an. increase of 440 cc. in .
the per-minute volume of breathing. Between 18 and 15
per cent, an intervaloffive minµtes, the increase in breath-
ing is· only 90 cc. It seems, therefore; that the increa.se.
up to 1-Sper cent of oxygen can not properly be attributed
· to the decrease in o:x;ygen. Down from 15 per cent the
tween 19 and 15 per cent there normally occurs a plateau
or maintained level i~ the volume of breathing. In both
curves I and II, from between 16 and 15 per cent oxygen,
the per-miµute ventilation : clearly begins to increase.
T,lie increas(;l at 7 per cent was greatest in the group of -136
cases, being 3,950 cc. for the grou_p of 60 ca.sea and 5,490 cc.
for the other.

12
It should be noted that some men begin very early to
respond to the decrease in oxygen. Schneider (3) reported
that "in a few men this increase in lung ventilation begins
with the first decrease in the oxygen percentages of the air
breathed and is a gradual proportional increase in inverse
ratio with the reduction in oxygen." Ellis (6) found in
a careful study of the problem that there waa an increase
in the respiratory volume at an average of 18.l per cent
oxygen in 23 of 29 subjects. Lutz and Schneider (7)
approached the problem by determination of the alveolar
air composition in carbon dioxide and oxygen, as well as
the per-minute respiratory volume; and found in .the
majority of cases a definite increase in ventilation at oxy-
gen tensions equally as low as those reporte!1 by Ellis.
.
oxygen of 329 cc., or 49.1 ·per cent- in the volume of each
breath. These means show that there is an early increase
in the depth of breathing before 16 per cent of oxygen is
readied. Not all the men gave the increase in depth of
breathing. Nine, 6.6 per cent, had a decrease in depth,
but increased the per-minute volume by increasing the
rate of breathing. All Qther cases, that is, 127, or 93.4
per cent, had the increase in depth. Of the 91 who·went
to le!!S than 8 per cent oxygen, 7 had a decrease in depth ~f
from 100 to 380 cc., average 130 cc.; and the other 84 had
an average increase in depth of 450 cc. The greatest in-
crease observed among these men was 1,660 cc. In this

TABLE 2.
Mean volume of respiration during rebreathing.
.
Group I. Group II. ''

Oxy- / Num- Per- Proba- Oxy- Num- Per- Proba-

gen per ber of minute ble gen per berof minute bk
cent. cases. volume. error. cent. cases . volume. error.
:~·,
' '
- - - - -- - - - - - - - - - - -- - - - - - - ..i \.. \
'
cc. cc. cc. cc. '
20.96
19.5
18
60
60
60
10,275
10,525
10,717
±200
±184
±204
18. 9
15.8
12. 7
150
150
150
l!),320 ± 137
10,353 ± 161
10,873 ± 178
! \.,. - ~ ~ ~-
15 60 10,808 ±219 10 . 146 12,226 . ± 211 1 f .! ! J. !~ J. i
13 60 11,117 ±250 8.4 112 13,759 ± 312
12 60 11,350 ±254 7 6 15,833 ±1;302
11 60 11,600 ±230
10 60 . 12,017 ±227
9 56 12,629 ±232
8. 44 13,234 ±198
.7 15 14,233 ±612
-
In group II there were 91 men who reached 8 per cent
or leBB of oxygen. The average increase in the per-minute
volume of ventilation was 4,990 cc.; the greatest was 21,400
cc., and the least was 450 cc. There were .37 men who
lasted only to between 10 and 8.1 per. cent; their average
increase was 340 cc., the largest 890 cc., and the smallest
100 cc. Not a man in this group of 136 cases wholly failed
to make a respiratory response. In group I, 60 cases,
there were 5 who failed to respond to the low oxygen,
while the greatest response was only 10,700 cc.
The largest per-minute volume of breathing observed
among 97 men who tolerated less than 8 per cent o;x:ygen I • I
was 39,500 cc., and the smallest 820 cc. 1'o.J1,-.."--.. •• .. llu ,.. u 1.!'•

By means of frequency curves the distribution of cases

as to per-minute volume of breathing at the beginning and
end of the rebreat:hing "test has been shown for a group of
160 cases in figure 5, the bottom curves. The curves
illustrate the normal shifting of the curves to the right as
compensation occurs. The mode moves from between
8,000 and 8,999 cc. for the "beginning curve," to between
11,000 and 11,999 cc. for the "end curve." The range or
limits of the curves also show a similar shift of position.
DEPTH OF BREATHING.
Not alone is compensation to low oxygen shown in the
volume of air breathed per minute, but the volume of
each individual breath also is usually increased. The
average increaae has been determined by calculating the
mean increase for 136 men and is plotted in curve III of
figure 4. These data are tabulated in greater detail in
table 3. They show an average increase at 8.4 per cent
Fm. 5.-Fr8'luency respiration curves at the beginning anµ end of
rebreathing. Above: Mean depth of breathing in cubic centimeter
for 138 cases. Below: Mean per-minute volume in deciliters for 136
cases.
caae the volume per breath during the first minute of
rebreathing was only 520 cc. The greatest volume per
breath observed during regular breathing was ooen in a
man who inspired 2,370 cc., but at the beginning of the
experiment.each breath was already 1,010 cc.
Frequency curves that show the distribution of ca_aes
as to volume of the individual breaths are given in figufe 5
(upper section) for 138 cases at 18.9 per cent oxygen, and
again at 8.4 per cent for the 100 who managed to go that
low. The ranges in the two curves show a definite upward
movement for the entire group that reached -the lower
oxygen . . At 18.9 per cent oxygen the smallest volume
per breath was· 380 cc., the maximum 1,160 cc.; at 8.4
 13
per cent the smallest was 460 cc. and the maximum portion. It is evident that the alveolar ventilation is
2,370 cc. greatest in the last, less in the second, and least in the
RATE OF BREATHING. first condition. A less adequate compensation, but never-
theless helpful in some a.egree, is that in which, although
Low oxygen influences the rate in two directions. In the per-minute volume does not increase, the depth of
the group of 136 cases the rate decreased in 75, or 55. 1 per breathing ie materially increased by virtue of a reduction
cent, increased in 43, or 31.6 per cent, and was unchanged in the rate.
in 18, or 13.3 per cent. The mean rate of breathing for
the group at 18.9 per cent of oxygen was 16.4 breaths VARIETIES OF RESPIRATORY CURVES.
per minute, at 15.8 per cent 16 breaths, at 12.7 per cent
15.9 breaths, at 10 per cent 15.5 breaths, and at 8.4 per As with the circulatory reaction, so it is with the breath-
cent 15 breaths. The influence upon rate may therefore ing, men do not all follow the same pattern of response
manifest itself by either an increase or decrease in men when reacting to the continuous decrea.se in oxygen
who react best to the low oxygen of rebreathing. Among _during the rebreathing test. There are five curves that
the 91 who went to below 8 per cent oxygen, there were urdinarily represent the varieties of response in the per-
32 who showed an increase and 59 a decrease. The minute volume of breathing. They have been drawn in
greatest increase in rate was 7 breaths per minute, the figure 6. Each curve was taken from a typical test and
average 2.8 breaths; and the greatest decrease was 11 has been smoothed. Respiration volume rarely runs a
breaths, average approximately 4.5 breaths. Increased perfectly smooth minute-by-minute course. The kymo-
rate of breathing may or may not be associated with an
increase in the depth of breathing, but a slowing in the °"R~ SPrR RTION
rate has -always had an increase in the depth of breathing
associated with it. By this m"eans a fair respiratory
compensation to low oxygen may be made without an
increase. or bu~ little increase. in the amount of air breathed
per minute .. By this method :more air paBBes the dead
space at each breath and the alveoli undergo better
ventilation. Several examples selected from the group
of cases unde1· consideration will illustrate this. In one
the rates at the beginning and end of the experiment
were 15 and 10, the per-minute volumes 8,900 and 9,700
cc., and the depth of breathing 590 and 970 cc. , respec-
tively. In another for the corresponding periods the
rates were 12 and 8, the per-minute voJume,s 9,150 and
9,750 cc., and the volumes per oreath 760 and 1,22o·cc.,
respectively.
5
TABLE 3.-Depth of breathing under iow oxygen.

Mean
Oxygen, Number volume Increase_ Rate per
per cent. of ca.ses. per over A. minute.
breath.
- - ---------- - - FIG. 6.-Curves illust.r ating the varieties in the per-minute volume
Cc. respiration response.
A 18. 9 138 670±10 .......... 16. 4
B 15.8 138 683±11 13±14 16.0 graph tracing for the early part of the test often shows an
C 12. 7 138 723±14 53±17 15. 9
D 10. 0 134 855±16 1 185±18 15. 5 occasional breath deeper than the average, and in the last
E 8.4 1001 999±25 329±26 15.0
minutes, when the oxygen is below 9 per cent, these increase
' Mean of A for these 100 ca.ses, 657 ± 12. in frequency and may become deep, sighing breaths.
Occasionally there are men who show a tendency to a type
In our group of 136 cases the slowest rate recorded of rhythmic breathing, quite like Cheyne-Stokes breath-
at the beginning of the test was 9 breaths per minute, at ing. Figure 7 is a photographic reproduction of char-
tne end 6; the most rapid rate a~ the beginning 26, and acteristic kymograph records· of rebreathing experiments:
at the end 27. In no instance was the rate of breathing The minute-by-minute volume of breath.ing shows such
very rapid. .-variations that as a regular laboratory procedure the
It is apparent from our data that the respiratory com- ,·eadings are averaged by the usual "smoothing" process
pensation to low oxygen may be accomplished in seve~l advocated in statistical methods. However, the volume
ways. Even when the per-minute volume of breathing of the firat and last minutes are plotted just as recorded
is increased by equal amounts in a group of cases, it does from the Laraen .autonu.tic recorder.
not follow that alveolar ventilation .is equally improved Curve 4, figure 6, represents the noncompensating
in each case. In 11ome instances the per-minute volume cases in which aslightpsychic initial response is frequently
increase has wholly resulted from an increase in the rate present. The noncompensator usually does not last'long
of breathing, in others the rate of breathmg has not changed Curve 3 is typical of a moderate respiratory compensation
but the depth has increased, and in still othera the rate which, not being sufficient, causes inefficiency or failure
has decreased while ·the depth increased. in greater pro- under 8 per cent oxygen. Variety 2 represec.ts the good
 14
response ._c ommon. among men who last to -a y_ery low was selected at random and afterwards more carefully
o~ygen, 7 to 6 per cent. Curve 1 illustrates the typic!).l scruntinized.
psychic initial large volume of breathing whi.-ch lasts The group contains a higher percentage of respiratory
from 1 to 5 minutes. After the psychic effect has subsided noncompensators than any other we have examined.
the curve of reaction. may show a good response to low Two cases have not been placed among the listed variety
oxygen.. Curve 5 il:lustratee a less. frequent variety of of responses. They showed a.large initial psychic effect
response in which there is an earlier anrl more rapid i11- which required two to four minutes to reach its maxhnum
crease in .the per-minute volume of breathing than ordi- volume. The psychic effect then only partially subsided;
narily, and later a decrease sufficient to hasten the.develop- after which the per-minute volume of breathing remained
ment of inefficiency or fainting. ..constant.
The 60 cases that furnished· the material for this variety
of curves were grouped as follows: TYPES 9F PHYSIOLOGICAL REACTION TO THE
1. Good compensation with initial psychic rise, 17 SLOW CONTINUOUS DECREASE IN OXYGEN.
cases, 28.3 per cent; average final oxygen 7.4 per cent;
The experience with rebreathing in the Air Service
laboratories hris clearly shown that the centra1 nervous
system is not affected in the same manner in all men.
Because of this it has been necessary to have the responsi-
bility of determining when the subject should be re-
turned to fresh air divided between two observers-the
psychologist, who observes attention and motor coor-
dination, and the clinician, who has the physiological
data as his guide. With some men the higher or psychic
centers are paralyzed before the vaso-motor, cardiac, and
respiratory centers. Most of these men can be carried
into unconsciousness, and for at least a few seconds will
continue to sit perfectly erect as the heart rate arid ,respira-
tion continue to increase. In several instances such
cases have been carried beyond unconsciousness until
twitching of the .a.rlll,'l and legs preliminary to a loss of
muscle tone appeared, and still the respiratory and cir-
culatory mechanisms continued compensatory effort.
This is called the nonfai'.nting type of reaction. In other
men the circulatory contrnlli'ng, and sometunes respira-
tory, brain centers begin to show evidences of incoor-
dination befl)re voiuntary attenti'on and motor coordina-
tion are markedly $1,ffected, o_r at least before their break-
down occurs. The evidence of impending circulatory
collapse is usually found in a· rapid fall in the diastolic
pressure, a drop 1n the systolic pressure, which :is later
supplemented by a .diastolic pressure fall, or in a slowing
of the heart rate. In eacl,i. of these the subject, if not
immediately restored to fresh air, rapidly passes into the
Fm. 7.-Kymograph records of the respiration.duringrebreathing.
typical syncope complex and faints. This type has been
called the fainting reaciion.
2. Good compensation, 25 cases, 41. 7 per cent; ·average A group <if 300 cases, who had taken the rebreathing
per-minute volume at the beginning 956 cc., at the end test unde.r the observation of a single physiologist, was
1,482, cc.; average final oxygen 7.3 per cent. selected for a detailed study of their reactions. These
3. Slight compensatiim, 5 cases, 8.3 per cent; average men ranged between 19 and :rn years of age, except three,
per-minute volume at· the beginning 900 cc., at the end who were•34, 39, and 41 years, respectively. The mean
1,100 cc_. ; average final oxygen 8.3 per cent. age for the group was 25.2 years. In weight they ranged
4. No compensation, 5 cases, 8.3 per cent; average per- from 110 to 194 poundp, their mean weight beh:ig 150.7
minute volume of breath 910 cc.; average oxygen_reached pounds. There were 160 .nonfainting and 140 faintiiig
8.6 per cent. type cases.
6. Compensation with terminal decrease, 6 cMes, 10 'l'he two types of reactors did not show a material differ-
per cent; fi.nal oxygen 8.1 per cent. In ·this group were ell{!~ as to low oxygeri reached or time required to reach it.
placed 3 cases in which the per-minute volume of breath- The ·nonfainting group became inefficient at oxygeJl
ing was very large from the beginning a.nd· quickly _in- percentages rangi.ng between 10.7 and 5.6. _ The meari
creased tounusual,amounts, 17,400 to 28,700 cc. Similar oxygenrei.ched was7.24·±0.05pereent. Thelengthofthe
cases have been reported -by students of metabolism and , period of rebreathing varied between 17 ·minutes 40 sec-
attributed to a psychic rather than physiological action. ·onds and ·32 minutes 45 se<:onds, the mean· period being
.They are occasionally encountered in the rebreathing 26.6±0.17 minutes. For the fainting group the final
work; but not in such-proportion as in this group, which oxygen ranged between·n.1 and 5.8 per cent, wiih a mean

of 7.81±0,06 per cent. This was only oneahalf of. 1 per
cent difference in the means of the final oxygen for the two
groups. The time.for the fainting group ranged between
17 minutes 17 seconds and 30 minutes 18 seconds, with a
mean of 25.07 ±0.16 minutes.
In figure 8 the composite- cmves have been plotted for
the circulatory data of the two gr9u-ps. The ,reactions of
the fainting type.group are shown in the curves with the
continuous heavy- black line and those of the nonfainting
group by dotted lines. In the minute-by-minute changes
of the pulse rate and arterial pressures the two types do not
'"
\
'" . / · ··························································· .. ······=·-·="·
'"
. mote clearly this difference, the mean diastolic pressure
\:
.•• ·--·---~ · - · - · - · 51$T_AtC
15
end of the test (fig. 10). An inspection of the two sets
of. curves (fig. 8) down to 8 per cent oxygen shows that the,
pulse rate curves of the two groups practically coincide.
The systolic pressure curves show a slight difference.
That of the nonfainting group is 2 mm. below that of the
fainting group until 10 per cent oxygen is reached, after
which it crosses the other curve and is above it at 8 per
cent of oxygen. The systolic pressure for the fainting
group fails to inci:ease down to 8 per cent of oxygen, while
that of the nonfainting .group has a compensatory rise of
4 mm. · The mean systolic pressure for the last determina-
tion just before -the termination of rebreathing was 134 mm.
for the nonfainting .and 121 mm. for the fainting group.
This indicates that, as a rule, in the- fainting group the
.. ' systolic pressure was falling rapidly at the time of the last
' reading and.that the men were about to faint. The com-
posite diastolic pressure curves are almost identical for
the two groups of cases down to 10 per cent oxygen; froi;n
thereon that of the fainting group .falls a little more rapidly
than that of the nonfainters. The last determination made
immediately before the. administration of fresh air shows
for the last reading being 74 mm. for the nonfainting and
68 mm. mr the fainting group. The difference between
" the first and last determinations of diastolic pressure dur-

" ing rebrea.thing was 7.5 mm. for the nonfainting and 13
,o
· - · - · - · 11.&.M

T,i,c 11, l'l1•vTu

IS ,o
."
. - . - - . - . . - P. .... 'Pw,_ mm. for the fainting group .
The pulse pressure curves that show the changes during
rebreathing are almost identical for the two groups. The
FIG. 8.-A comparison of the fainting and nonfainting groups.
· Solid ]>lack iines'-tainting. Dotted lines-nonfainting.
reason is found in the fa.ct that while the systolic pressure
rises for the nonfitinting the diastolic pressure does not
differ in a significant degree in any one of the four factors. fall as far . or as rapidly as it does in the fainting group.
The comparisons !_\re worth while to only 8 per cent oxygen, The pulse pressure at the last determina_tion was 60.8 mm.
because at 8 per cent oxygen 127, or 85.8 per cent, of the for the nonfainting and only _54.!:\ mm. for the fainting
nonfainting and 76, or 54.7 per cent, of the fainting type group. That of the nonfainting group tends to increase
men were still efficient; while at 7 per cent oxygen the to the end, while for the fainting group it decreases rapidly ·
fainting type cases were reduced. to as few as 18, or 13 as the fainting reaction gains in momentum.
per cent, which was only one-fourth a,s many as of the. In table 4 the means, with probable errors, l).ave been
nonfainters. AB is shown later, these 18 men of the fainting tabulated for the circulatory data obtained from 139 of the
type, who went below 7 per cent oxygen, made excellent fainting type cases. These data should be compared
responses to low oxygen and·wete in every way equal to with those of table 1, obtained from 148 no:cifainting type
the nonfainters to within a minute, or thereabouts, of the cases.

TABLE 4.
Fainting types.

Pulse. Systolic. Diastolic. Pulse pressure.

Obser;vation. -Number
of cases.
M. Pem. M. ;I'Em. M. PEm. M. PE m.
- -- - - - - -- - -- ---- - - - - -
139 69. 7 0.553 117.5 0.487 71.3 0.41'5 _4 7.3 0.45
~~i:.·.::::::::::::::::::
Exercise . . ....... . •.... . ....
1'39
139
91. 9
99.1
:788 .
• 77
117: 8
121.6
. 616
.686
82.8
81.2
.454
.48
35.8
40.9
.656
• 734
Rest . . •........ . ...... ...... 139 77.6 . 81 117. 7 .485 76:3 .619 41.9 . 674
Before rebreathing . . . •..• ... 139 82. 1 . 636 121. 9 . 635 -82. 2 . 289 40.3 .Ml
3 minµtes on rebreathing .... 139 81.6 .681 132 . 734 85.9 .459 47, 2 . . 667
18 per cent. .. . .. . . ..... : . . .. 139 86.1 . 706 132.1 . 710 85. 5 .449 47. 3 . 625
f5 percent . ... .. .. , .... . .... 139 ·87.8 . 683 131. 5 . 722 85. 8 . 432 46. 7 .604
13 percent . . . .. •. .... ..... .. 139 90.8 .ti4 . 131. 7 . 724 :·8 . 439 46.4 .615"
I2percent . •._... ... .. . . . ... . 139 92. 3 .62 131.8 • 71 .7 .438 47.5 .578
11 percent. .. . ... . .... •. . . .. 138 94.6 ,644 131. 7 :14 84, 4 .459 49 .616
10 percent . . : ..... . ........ . . 137 .--98. 9· .664 131.2 .819 81./1 49. 9 . 655
119 103.4 . 702 131 .94 79.3 f8 24 53. 1 . 731
a:~::~L::::::::::::::::: , 76 105. 8 .941
1. 228
131. 7
135.1
1. 267 75.8 . 746 57. 8
63.8
1. 036
1.868
18 108. 7 1.961 72 1. 34
U:f:~~::::::::::::::::::: 138 11J7.2 . 753 120.8 1.16 68. 1 .633 54.8 ; 973
l"il"3t off••••• • •••••• .• • ••• ••. 139 82. 6 .809 120.5 . 794 76. 2 . 501
I 44. 7 • 709
 16
In Table 5 are summaries of the low oxygen reached by tolerated to less than 7 p er cent oxygen, there were 45.2
the two groups and of the cases removed by the psycholo- per cent of the nonfainters who h eld out below that per
gist for mental inefficiency and by t he clinician for circu- cent. The psychologist stopped the experiment because
latory failure or other evidence of approaching syncope. of mental inefficiency for only 34.5 per cent of the fainters
There were 20 in the fainting and only 3 in the nonfainting and for 92.5 per cent of the nonfainters. Just why the
group who failed to compensate adequately down to 9 p er clinician removed some of the nonfainters is not clear in all
cent oxygen. While only 13 per cent of the fainters of the records; reasons given were heart ' irregularities or
TABLE 5.

Nonfainting group. Fainting group.

Final oxygen Inefficient. Inefficient.

per cent. Off by Off by Off by OfI b
psycholo- Ii . . psycholo- . . . y
N b gist. c rucian. N b gist. chrucian.
ori:'se;r Per cent. or'~':!'se~~ !'er cent.
1 - - - - - - -- -1 - - - - - - -- - - -- ---- - --- -------- ----

11+----··········· . . .·........................... ····--··-- 1 0. 7 1

10-10.9............. 1 0. 6 1 1 .7 1
9-9.9............... 2 1. 2 2 18 13.0 3 15
8-8.9 ........•.. _... 21 13. 0 12 9 43 30.9 11 32
7-7.9...... . .... .. . . 64 40.1 61 3 58 41. 7 25 33
Below 7. . . . . . . . . . . 72 45. 2 72 18 13.0 9 9

,,, I r-•. JI
• - • - • - • StS TOt.lC.
l'-0 • - • - • - 0 .DtA~OTOLI C , '"
A-•-A-•"J"11LSC "' 5
1so ._,._,,__ .. Put.5C
---------1i'cs1>1Ri'ITtON
Pirc:1o'!o.,,.~
'"
'"
"''
'"

"
"
/¥

15 ,;

5o

11

.,. -··
JO

,, 20 ,,"
"T, 11C 11' M•NIITf:5 :i11(. m /:111w11TC>
,.
s 10 1S 20 H s JO . IS 2S

]I[ o/oO o/oOz

¥

5
'"
,...
'/
5

,,.
...
. I ." ·---.......-----· -· ':---·"-.. !
/ ·.. _ ·t--·
: •
120 . / ,

,,
" ,,
•• "
'°
IS IS

,,
"
s JO
Tn,c; 11, 1'111,uTt:S
JS 20 u
." 10

s 10
TiflCtf'/1'1rrt11Y~S
16 .. .U
..
FIG. 9.-A selection of type cases. I. Systolic falls first: II. Diastolic falls first. III. Pulse falls first . IV. Systolic and diastolic fall together.

abnormalities, high systolic pressure, and color changes.
Among the fainters it often happened that the subject
would be working well and be attentive to the signals, but
would suddenly cease to do so concomitantly with the de-
velopment of the-circulatory syncope symptoms.
The data of Table 5 show dearly that some become
· mentally inefficient at only moderately low oxygen (11.5
to 9 per cent) because the compensations are inadequate.
The two types of reactors to low oxygen indicate that fail-
ure among aviators while flying at high altitudes may
result merely because the higher brain centers are inade-
quately supplied with oxygen or from fainting caused by
the paralyzing action of low oxygen on the vaso-motor and
cardiac centers.
VARIETY OF CIRCULATORY RESPONS E WITHIN THE TYPES.
An attempt has been made to find whether certain com-
binations of the varieties in circulatory responses deter-
mined the percentage of low oxygen the subject would
tolerate. The .nonfainting type was separated into two
subdivisions according to the variety of diastolic pressure
/ff
,, .,/;-=·;··· ....................... . ...............................;.... ···a;;.:,;;:;···
"'
" cl cases, to make a calculation of the means of value. The
• - - - . • - • - • SuToa..,c
e- • - • - • .Dt,uTeuc
•-•-•-•Pl.i1.11:
• - • - • - • "f\.._w Prts:1-S"•
,.
Fm. 10.-A comparison of the n onfainting group (solid black lines)
and a group of 100 cases who tolerated 7 per cent oxygen or less
(dotted lines) .
change3, those in which the pressure gradually fell in the
latter part of the test and those in which it maintained a
level to the close of the t est. The nonfainting gradual
diastolic fall included 148 and the maintained diastolic
only 12 cases. No clear advantage was indicated for either
of these. Of the 12 cases with a maintained level 3 failed
between 9 and 8 per cent, 7 between 8 and 7 per cent, and
2 below 7 per cent oxygen. This result when compared
with the summary in Table 5 does not show their tolerance
of low oxygen to differ materially from that of the entire
nonfainting group of 160 cases.
The fainting type was divided into four subdivisions ac-
cording to the first appearance of evidence of the oncoming
syncope. There were 61 cases in which the systolic and
diastolic pressures fell together, 45 cases in which the
diastolic pressure alone first began a rapid fall, 29 cases in
which the systolic pressure began a rapid fall before the
diastolic pressure, and 4 cases i.n which the beginning of the
faint was first evidenced in a slowing of the heart rate.
The means for the final oxygen reached by these groups
were close tQgether. It was 8.2±0.08 per cent for the
55314 0-31--i
17
group in which the systolic and diastolic preBBures fell
together and 7.66±0.08 per cent for that in which the dias-
tolic and 7.9±0.13 per cent for that in which the systolic
drop first appeared. While the means do not show a large
difference, they do give indication of a difference which
shows more clearly when the number of cases that failed
to reach 8 per cent oxygen is listed. In the group in
which the systolic and diastolic preBBures fell together 60
per cent, in the group of systolic fall first 48.3 per cent, and
in the group of diastolic fall first 33:33 per cent of all cases
failed to reach 8 per cent oxyg_en. In the nonfainting
group only 14.7 per cent of the cases failed before 8 per
cent oxygen was reached. Apparently in those cases
where the systolic and diastolic preBBures fall together the
effect of low oxygen is the more overpowering.
In figure 9 appear the plotted curves of four selected
CMes of the rebreathing test, which illustrate the above
four subdivisions of the fainting type of response to low
oxygen. Those selected cases indicate the nature of the
reaction better than the composite curves that were de-
termined by calculating the means for each group of the
four subdivisions. We have tabulated in Tables 6, 7,
~o, and 8 the means and probable errors obtained from three
''\.: of the groups. In Table 6 are collected the date. from 60
c:i.ses in which the systolic and diastolic pressures fall
t:Jgether, in Table 7 those from 45 cases in which the dias-
\
!,-"'
"
II
"
,,
t:ilic pressure began to fall first, and in Table 8 the results
from 29 cases in which the systolic pressure began to fall
'irst. The group in which the fainting reaction was first
indicated by a slowing of the pulse rate was too small, only
lata of these tables should be compared with those in
L'ables 1 and 4. The curves of reaction show differences
in the systolic and diastolic pressures, and they are most
"
marked for the group in which the systolic and diastolic
pre3sures begin to fall together.
The last determination made just before the reb:reathing
WJB stopped bring out the group differences more clearly
than the curves. Th€ mean for the last determination of
the systolic pressure was for the group in which the systolic
and diastolic preBBures fell together 110.3 mm., for the
group in which the diastolic pressure began to fall first
135 mm., and for the group in which the systolic fell first
132 mm . The difference between the first and last deter-
minations during rebreathing which indicates the degree
of the fall in pressure was 20 mm , for the group in which
the systolic and diastolic pressures fell t ogether, 3.5 mm.
for that in which the diastolic fell first, and 6.2 mm . for the
group in which the systolic pressure fell first. The final
diastolic pressure was 83, 87 and 86 mm., respectively, for
the three groups in the order in which they were listed
above. The difference between the first and last readings
showed a fall of 20 mm. for ..the group in which the systolic
and diastolic pressures fell together, 18 mm. for that in
which the diastolic pressure fell first, and only 11 mm. for
that in which the systolic preBBure fell first. The pulse
pressure as shown by the last determination did not in-
crease for the group in which th e systolic and diastolic
preBBures fell together; itincreased 15mm. for the group in
which the diastolic preBBure fell first and 5 mm. for the
group in which th~ systolic pressure fell first. The group
differences as brought out by the study of the last deter-
 18
mination of the pulse rate and the arterial pressures at the at the same time. ·This more acute condition requires
close of the rebre'l.thing period show that the circulatory prompt action on the part of the observer if actual fainting
me::hanism was more profoundly influenced i,n t _h e group is to be avoided.
in 'which the systolic and diastolic pressures began to fall

TABLE 6.
Fainting type-Systolic and diastolic fall together.

Pulse. Systolic. Diastolic. Pulse pressure.

Observation. ~f ~ 1- - -- -- --1-- - - -- - - 1 - - - - ~ - -- 1-- - ~~---1
M. II .
PEm. M. PEm. M. P.Em. M. PEm.
- - -- -- - ----- - - - - - - - -- ' - - - --- - - - - - - - - - - --
71. 2 117. 8 o. 726 , 71.8 0;532 47. 4
~<;~11;~;.:_: :: :::::: :::::: :::
Exercise . .............. . ....
60
60
60
94 9
100: 2 ·
0.83
-L 155
1.005
117. 9
120.0
1.021
1.119
-83.8
80. 7
. 743
• 788·
35.2
39.9
0. 752
1.092
1. 171
Rest ..... . ... . ........ ... ... 60 81.3 1. 215 117.6 • 745 78. 3 .937 39. 5 .971
Before rebreathing .. _. ~ .... _ 60 82.4 .928 120. 7 .946 81.8 .686 31!. 8 . 85
3 minutes on rebreather ... .. 60 85. .3 .969 130. 4 1.078 83.0 • 704 46. 4 1.012
18 per cent ................. . 60 85.9. .98 130. 5 1. 015 84. 7 • 715 46.3 .997
15 per cent ...........•. . .. . . 60 88. 1 .9 129. 7 1.007 85. 6 .7 42.9 . 883
13 per cent , . ....... , . : ...... 60 90.6, .891 . 129;-5 1.03 85.4 . 7l3 44.6 . 9'27
12 per ce,;it. . ............ . .. .. 60 92. 7 ..84 129. 4 .986 84.2 .684 4.5.9 -. 882
11 percent .. .. : . ... .. ... . . . . 59 94.8 .897 129.2 1.038 84.0 . 748 48.1 1.022
10 per cent ..... : . . ..... :: ... 68 99.2 . 968 128.3 1:36 81.0 .9 47.3 1.046
9 per cent ....... . ...... . . .. . 48 105. 6 1.054 127. I I . 78 77.6 . , 973 51. 7 ·I 223
8 per cent . . . .............. . . 24 111. 1 1. 369 2. 536 72. 0 1.689 56.0 1'. 82
Last on . .. ... ... ............ 60 107. 5 1.057 124.
110.361 1.645 63.4 1.06 46 2 1. 28
First off ........... . ... . . .. . 60 80.2 1.268 116..4 1.065 75.8 • 813 42.0 1.121

TABLE 7.

Fainting type-Diastolic /all first.

Pulse. Systolic. Diastolic. Pulse pressure.

Observation. Number
-of cases.
M. PEm. M. PEm. M. PEm. M. "PEm.
- - - - - - - - - - -- - - - - -- - -- - ---
Reclining ........ .. .... .. ... 45 67.9 0.982 117.6 0. 923 68.4 0. 57 48. 2 0.689
Standing ..... ... ...... . .... 45 89.9 ':L.445 119. 0 1. 019 82.6 .662 37. 2 . 952
Exercise __ ._ ..... .... _.. . ... 45 95.4 1.462 124. 2 1.093 81.5 . 819 43.0 1. 064
Rest ... . ... .. .. ....... . . . ... 45 '70. 2 .911 118. 0 . 866 71.8 . 91 47.0 .983
Before rebreathing ...-. . ..... 45 80.6 · .962. 124. 4 t 121 82. 9 • 765 42.0 .889
3 minutes on rebreather ..... 45 85.2 1.239 135. 1 1.308 87.4 . .848 49. 1 1.107
18 per cent . . . ............... 45 86.0 I.3M 135.6 1.278 86. 7 .835 49. 7 1.0
15 per cent ........... . ...... 45 85.9 1. 288 134. 8 1.35 86.6 . 745 49.0 1.049
13 per cent . . ................ 45 89.4 1.086 134. 8 1.309 84.8· • 737 48.4 .935
I2per cent. ................. 45 90.9 1.222 134. 6 1.,274 85. 5 . 779 49. 7 .995
11 per cent ........ . ......... 45 94.2 1. 011 134.4 t.187 85.5 . 788 49.9 . 954
10 per cent ...... . .... . ..... . 45 97.0 1. 211 134. 4 1. 22 83. 4 .905 51. 9 1.01
:Last
t:~ on.
~~t:::::::: :>::: :::
·. ... .. ..............
43
32
45
100. 5
102.8
106: 9
1.272
1.448
1. 341
t·5.5
131. 6
1.404
1.675
1.906
81. 0
77.9
68. 7
.935
.954
.902
54.4
58.0
63.9
1.U7
1. 398
1. 755
First off . .. .... .. . .. . . . . . ... 45 83.5 1.239 125.0 1.523 77.6_ .898 48. 5 1.113
I
TABLE 8.
Fainting type-Systolic fall first.

Pulse. Systolic. Diastolic. Pulse pressure,

0 bservatiou . Number
of cases.
M. PEm. M. PEm. M. PEm. M. PEm.
- -- - -- - -- - - - - -- - - - - - - - - --
Reclining ....... . ... . ... . ... 29 71.0 1.182 117.4 1.012 72.4 0. 856 45.9 0.936
Standing ............... .... 29 90.0 1.662 115. 4 1. 201 81.8 1.089 35.0 1.566
Exercise ... .... ...... .. . ... . 29 101. 0 1.688 121. 9 I. 445 82.2 .888 40.1 L846
Rest . .... .. ...... .... ...... . '29 80. 6 1. 728 118. 1 1. 041 80. 7 1.336 37. 9 1. 555
Before rebreathing ....... . ... 29 84.3 1.442 121. 3 1.335 82.5 . 725 39.4 1.232
3 minutes on rebreather ..... 29 87.6 1.498 132.1 1. 026 86. 3 .816 46.6 1.53
18 per cent. ..... ... ........ _ 29 87.2 I. 551 131.4 1. 47 85. 7 • 75 46.8 l_. 375
15 per cent ....... ... . . ..... . 29 89. 7 1.481 131.0 1;481 85. 3 . 788 46.3 1. 318
13 per cent . ....... . ....... . . 29 92. 9 1. 362 132. 6 1.533 87.4 . 747 47.2 1. 35
12 per cent ... .. ... . ... ..... . 29 93.8 1. 316 133. 7 1.556 85.4 . 856 49. l 1.348
11 per cent . . ... . .. •. . . ...... 1 Z9 96.5 1.332 138.1 l. 419 84. 3 .852 50.5 1.45 ·
10 per cent . . .. _....... .. ..... 2:1 101.1 1.346 132. 7 1. 691 81. 5 .952 52.1 1.486 '
9 p er cent .._.... _. ........... 24 104.1 1.589 133. 2 1. 892 80,2 .987 53.9 1.598
8 per cent. ...... , ... ... ..... 18 105. 3 2.129 133. 8 2.093 77.6 1.104 56.9 2.27
Last on ....... . . . . .. .. . ..... 29 108. 4 1.a84 125. 9 1.809 75. 4 .846 51. 7 1.988
I First off ... _,. .. . _..... ..... 29 86.3 2.06 121. 9 1.525 78. 3 1. 003 44.3 1. 572
 19
The percentage of oxygen and the time at which the fall
in the systolic and diastolic pressures and the slowing of
the pulse rate begin have been determined. A gradual
systolic pressure fall occurred in 63 cases. In all of these
after falling at the rate of 2, 3, and 4 mm. per minute there
was a sudden drop of as much as 5 to 58 mm. per minute.
If the fall is as much as 5 mm. in a minute the observer
must watch his subject very closely and be ready to restore
him to fresh air. Two examples will i_llustrate a common
experience, the systolic pressure in one case gradually fell
from 116 to 110 mm. in four minutes, falling to 104 mm. in
the next minute, and before another determination could
be made the man had fainted. Another case gave the fol-
lowing systolic pressures in five cons~utive minutes: 132,
130, 128, 126, and 120 mm., and he then fainted. A case.
in which quick action should have been taken gave the
following systolic pressures during the last minutes of the
test: 138, 138, 80, and 68 mm. If the observer is watchful,
ordinarily the subject can be restored without actually
fainting. In the 63 cases in which the systolic pressure
began to fall gradually, the fall was first observed between
the fifteenth and twenty-seventh minutes, the mean time
being 21.5±0.25 minutes. The rapid fall in the systolic
pressure appeared between the seventeenth and twenty-
ninth minµtes;- the mean was 23 .9±0.2. As a rule, then,
the obs@rver had a warning of what to expect for at least
two minutes. The oxygen at the time the gradual fall
began ranged between 12.9 and 7.5 per cent, with a mean of
10±0.09 per cent; and when the rapid fall appeared it
ranged between 11. 7 and 6.3 per cent, with a mean of 8.9±
0.7 per cent. The subgroups of the fainting type conform
with the larger group in the onset of the gradual and rapid
falls· in the systolic pressure. Among the fainting type
there were 101 cases in which a gradual diastolic pressure
fall occurred. This first appeared somewhere between
the thirteenth and twenty-seventh minutes and changed
to a rapid fall sometime between the fifteenth and twenty•
ninth minutes. The mean time for the appearance of th(l
beginning of the gradual fall was 20.8±0.22 and for that
of the rapid fall 23.5±0.18 minutes. A good exan:iple of
the diastolic fall is one in which the consecutive readings
made at minute intervals toward the end of the_test were,
respectively, 88, 86, 86, 84, 80, 78, 70, .60, and 40 mm. In
such cases the observer has an ample warning of approaching
syncope in the diastolic pressure. The gradual fall in the
101 cases began somewhere between 14.7 and 7.5 per cent
of oxygen and changed to a rapid fall between 11. 7 and 6.6
per cent oxygen. The mean oxygen for the onset of the
gradual fall was 10.5±0.09 and for the rapid fall 8.8±0.06
per cent. The diastolic on the average precedes the sys-
tolic pressure fall by about a minute. There were 148
cases of the nonfainting type of reactors that showed the
gradual diastolic pressure fall. The time of its onset was
between the eleventh and twenty-ninth minutes, with a
mean of 20.2±0.2 minutes. The fall began in these c11Bes
between 15.3 and 7.5 per cent of oxygen, the mean being
10.7±0.09 per cent. The means for the fainting and non-
fainting types are, therefore, practically the same. The
gradual diastolic pressure fall is in reality a measure of a
normal compe~tory reaction to the decreasing oxygen
supply .
A slowing of the pulse rate occurs in some men at the end
of the rebreathing low oxygen test. In the group of 300
men this occurred 23 times. It began at various times
between 10:5 and 6.9 per cent of oxygen. Gilbert and
Greene, in papers not yet published, have studied some
similar cases by means of the electrocardiograp)i and find
that the slowing of the hea'tt and heart irreghlarities do
not ordinarily appear until the stage of oxygen want is
insufficient ·to maintain the nervous system in conscious
activity . . They show that a cardiac crisis during low
oxygen is imminent at. the approach of unconsciousness.
They were not able to definitely determine whether the
slowing is a 'vagus inhibition due to action of low oxygen
on the cardio-inhibitor center, or whether it is a direct
oxygen want effect upon the heart pacemaking tissue.
In four of our . cases the heart b egan- to slow before other
evidence of syncope appeared . In each case the blood
pressure evidences of fainting quickly followed.
While, as a rule, warning of the approach of fainting is
given in the syst(!lic or diastolic pressure or in the,slowing
of the pulse rate, there do occur cas'ill! in which the observer
does not act quickly enough to prevent fainting. In the
group studied ·there were 14 cases of sudden development
of the fainting reaction. The data do not give satisfac-
tory evidences of its approach in any case. Usually a
fall of 5, mm. or more per minute in the diastolic pressure
indicates that fainting is impending, and if to this are
added a systolic -drop and a slowing of the heart rate the
subject must immediately be given fresh ah in order to
check the process of fainting, Even then the subject
soµietimes grows worse for a time, but the process is usually
completely checked and normal circulatory conditions are
rapidly restored. 1n- cases where the rapid diastolic fa! I
appears alone it is ordinarily safe to continue the experi-
ment a minute or two longer until the rate of fall becomes
very rapid.
The analysis of the 14 cases in which the fainting reac-
tion developed unusually quickly shows how completely
a close observer may protect the subject from losing con-
sciousness. Not one of these men actually fainted ; in
each the process was chocked by one or two deep breaths
of fresh air. In three of the cases the fall in the systolic
pressure had progressed so far that the subject was removed
before the diastolic pressure was determined. One case
gave the following systolic pressure readings in consecutive
minutes: 142, 144, 140, and 80 mm. One minute later,
after being taken. off, it was 120 mm, In .another the
pressures the last four minutes were 138, i38, 136, and
68 mm.; beginning two minutes after being taken off they
were 104, 114, and 122 mm. In 11 cases . the diastolic
pressure was also taken before the subject was restored by
fresh air. The rush character of the reaction is quite clear
in each. The pressure determinations during the last
four consecutive minutes in one case were systolic 134, 136,
134, and 108; diastolic 96, 94, 94, and 64 mm. Another
case ran as follows: Systolic 124, 120, 122, and 96; diastolic
80, 74, 74, and 46 mm. In this last case the return for the
first three minutes after receiving fresh air was as follows:
Systolic pressure 100, 104, and 108; diastolic 70, 78, and 80
mm. The final oxygen percentages for this group of 14
cases were 10.4, 1 case; 9 to 9.9, 4 cases ; 8 to 8.9, 5 cases;
7 to 7.9, 4 cases. The compensatory increase in pulse
rate and respiration was present in all. They did not show
a systolic pressure compensation. In five some diastolic
compensation occurred.
~ -

20
In the entire experience with more than 7,000 rebreath- Between 10 to'l.0.9 per cent 0 2 •• 6 cases, 3.0 per cent.
ing low oxygen tests, 'in which the effect of oxygen want Between 9 to 9.9 per cent 0 2 •• 1 case, 0.5 per cent.
was always carried either to_demoralization of voluntary The greatest pulse rate acceleration observed during
attention and motor coordination or until fainting w_as the test among the nonfainters was 57 beats per minute .
imminent, there has not bee11. an instance-of.injury to the The mean increase for this type was 27 .5 ± .0.6 beats. In
subject. There was one man; who was allowed to faint, the fainting type group ~he greatest acceleration was 62
in whom t "1e after effects persisted for six- hours. In no beats .pet minute and the mean increase 26.2±0.6 beats.
others have there be.en reasons for worry. Some men In-this the two types also fail to show a difference.
who b,ave been allowed to faint have. felt weak for ·awhile The systolic prE;Jssure responses of the fainting and non·
and unusually tired the rest of the day: A frequent after- fainting types do not generally follow-the same patterns.
effect is a frontal headache. While ordinarily it disappears The nonfainting -type cases all gave one or the other of
within a.few minutes or after getting out into fresh ait or in the systolic varieties labeled- 2, 2b, and ·4 (see fig. 3).
more persistent cases after taking a cup of coffee, in some The t erminal compensatory rise in pressure · clearly
instances a dull ache has been reported to continue as occurred in 93 cases; 58.1 per cent. :Men in whom the
much as two days. systolic pressure remained on a . level appeared to wit.h -
Comparisons have been made of- the c urves of reaction stand low oxygen equally as welf!),s those who gave the
of the pulse rate and the arterial pressures for the fainting compensatory rise . ·The initial psychic rise occurred in
and nonfainting types -with the varieties of curves given 112 cases, 63 :8 per cent. It usually was of brief duration,
in figure 3. The two types are distributed· in about equal but often persisted for four or five minutes. In a few
proportions as regards the variety of pulse rate response. eases it lasted throughout the test. Some of these will be
Among the nonfainters there was one man in whom tlie discussed later. The amount of psychic rise ranged up
rate of the heart did not increase who became mentally to as high as 34 mm. The amount and frequency of the
inefficient at 10.7 per cent 9xygen. Among those of the rise were as follows i 5-9 mm., 11 cases; 10-cl4 mm., 3g
fainting type there were five that gave no pulse rate in- cases; 15-19 mm., 19 cases; 20-,24 mm., 28 cases·; 25-29
crease under the.low oxygen. They failed at 11.1, 8.9, mm., 10 cases; and 30-,34 mm., 3 cases.
8.8, 8.3, and 7. 7 per cent of oxygeIJ., r.:ispectively. Among Among the 139 cases of the fainting type the variety of
both types there were some men whose pulse rate increased patterns· for the systolic curve was greater; in fact, each
for awhile as the oxygen . decreaeed, but finally ceased variety-of systolic .curve shown in figure 3 occurred. The
accelerating and then maintained .ii. level Among the curves most frequently found were 1 and 5. Of these 79,
nonfainters there wer.e i;tine such cases; the plateau began 57 .5 per cent, were variety 1; and 21, 15.1 per cent, variety
in one at 9:3 per cent of oxygen, _in the others later, while . 5. Only 35.3 per cent of the cases had the terminal com-
in three ·it occurred at le&B than 7 per cent oxygen. In pensatory systolic preBBure rise. The initial psychic rise
each. case mental inefficiency came on within two or three was present in all but 17 .3 per cent. The amount and fre-
mmutes after the pfateau was reached. There were 10 quency were about the same as in the nonfainting type.
among the fainting type cases whose pul.se rate reached a 1n one man this initial rise amounted to 38 mm.
plateau. The earliest to appear Wl\,S at 12.4 per cent The character of. the- diastolic changes gave the basis for
oxygen, while in all it began before 8 per cent was reached. our subdi'Vi.sion of the two .types, so need not be discussed at
In the tainting type, therefore, th'e limit ,of compensation length here , Varieties 3 and 4 (see fig. 3) are characteristic
iri pul.s e rate was reached earlier than -i n the nonfainting of the fainting type; although in a few cases, as where the
type c;iaes. f~inting-reaction begins with a systolic pieBB\Jl'e fall, the
Approximately 60 per cent of all cases had an initial diastolic pressure may follow varieties i or 2. An initial
psychic rise in pulse rate. In one man this amounted p_sychic rise occurred in approximately 55 per cent of
to an increase of 43 beats per minute. In the large major• all ca.sell_. This rise ranged up to 18 mm., but ordinarily
ity it was less than.15 beats. It ordinarily requires two to was under 8 mm. In about half of all cases in which the
four minutes for this psychic acceleration to disappear. rise was present it did.not exceed f> mm.
In about 28 per cent of all cases it persists so long that-it
RE&PIRATION.•
obscures the beginning of the low oxygen acceleration.
The percentage of oxy;;: ::. at -which the heart rate fir!!t
The respiratory reaction of the fainting and nonfainting
begins to accelerate in response to the low oxygen stimllli!,
types have been compared .as to the per-minute volume
tion can no.t be as accurate!y detetmined rn
an untrained
l)f breathing at the beginning and end of the experiment
group of men such as we have here as it was by Lutz and
and as to the variety of the curve of reaction. At the
Schneider (4) in men accuatomed to acting as subjects~
beginning the two groups showed approximately the S!IJlle
physiolQgical .experimellts. We have, however, note:!
range, distribution, and mean. For the fainting type
when the _acceleration first appeared .in ·200 of our cases
group this per-minutE;l volume of breathing ranged between
The results follow:
5,800 and. 16,200 cc., with the m<Me of the carve at ·8,000
Between 18 to 18.9 per cent 0 2 •• 16 cases,. 8.0 per cent. cc. and the mel!,n 9,162±103 cc. For nonfainting type
Between 17 to 17 .9 percenv0 2 •• 27 caees, 13;5 percent. groilp-.the.:range was 4,900 to 14;800, .the mode 8,000 cc.,
Between 16 to 16.9 per cent 0 2 • • 29 ca~, 11.;5 per~ent. and the mean 9,294±90 cc, At the end of the test there
Between 15 to l/>.9 percent 0 2 •• 29 eases, 14.5 p.e r cent. was no parallelism. F.or the fainting type group the per-
Between 14 to 14.9 percent 0 2 •• 30 ~ase!l., 15.0 per cent. minute volume of ,breathing ranged between 7,300 and
Between 13 to 13.9 percent 0 2 •• 28 cases, 14.U per cent. 19,900 cc. , with the mean 12,,()29±144 cc. For the non-
Between 12 to 12.9 per cent 0 2 • . 20 cases, 10.0 per cent. f8,inting group the range was 8,200 to 25,000 and the .mean
Between 11 to 11.9 -per cent 0,- .14 cases, 7.0 percent. 14,406±162 cc. At the end the lung ventilation of the

nonfainting group exceeded that of the fainting group by
1.8 liters. The fainting type had an average increase in
the per-minute volume of 3,467 cc. while ihe nonfainting
group had 5,112 cc. The d ifference in favor of the non-
fainting type explains why this group showed a mean
final oxygen of 7 .2, while that for the fainting type group
was 7.8 per cent, yet it would hardly account for the
appearance of the fainting reaction in one and not in the
other.
The distribution of the two types with respect to the
variety of the curve (see fig . 6) of respiratory reaction was
as shown in table 9. As was to be expected, the nonfainting
type followed the good compensation curves in larger
numbers than the fainting group.
TABLE 9.
N onfainting
group.
Cases. Per cent. Cases. Per cent.
- -- - - - -- - - - ! - -- - - - - -
1. og.ftfa,:;t~~~~ion··"'i·t·h·
2. Good compensation .......... .
46
84
29. 5
53.9
3. Slight compensation .......... . 20 12. 8
4. No compensation........... . . . l .6
5. Compensation with terminal
fall . .... .................... . 5 3. 2
- - -- - -- - ---~
Total . . .... . . . . . . . ... . .. . . . 156 100.0
EARLY FAILURE.
There were 24 out of 300 men who failed to go below 9
per cent of oxygen. Of these only 3 belonged to the non-
fainting type. There were 5 men in which there was first
a systolic fall, 2 in which there was first a diastolic fall ,
and -1~ in which the systolic and diastolic pressures began
to fall at the same time. The clinician's Teports of the
condition of the subjects prior to the test show nothing
abnornial in any case. The men were feeling well; 2
reported a slight cold and 3 a moderate loss of sleep.
The three nonfainting type .cases were removed py the
psychologist for complete inefficiency . One was removed
at 10.7 per cent oxygen. His first low oxygen effects on
voluntary attention and motor coordination appeared
unusually early, at 16.8 and 16 per cent, respectively, and
there was complete demoralization before he r~ched 11
per cent. Physiological compensation did not appear
until the last minute, when the pulse rate increased six
beats and the respiration, by mor,• rapid breathing, in-
creased 2 liters. The delayed reaction did not revive him
mentally. The other two men had respiratory response
to the low oxygen and failed at :l.4 and 9..3 per cent of ox-y--
gen. One of them showed a good pulse rate reaction in
which the acceleration began at 15.5 per cent oxygen and
reached a per-minute increase of 20 beats by the end of the
test. His per-minute volume of respiration, however,
fell off the last seven minutes and was only 7 .2 liters the
last minute.. The rate of breathing was then 15.
Among the 21 men who early failed because of the de-
velopment of the fainting reaction there were 10 who
appeared to be reacting by normal compensation and for
whom no explanation of the failure was apparent. Other
cues offered possible explanations of early failure.
There were 7 who showed early psychological effects; in
21
all but 2 of these the voluntary attention and motor
coordination were almost completely demoralized before
the fainting symptoms appeared. Physiologically the 11
men failed to show an increase in the per-minute volume
of breathing; 1, however, while decreasing the per-minute
volume increased the depth of breathing by decreasing
the rate. Most of the men showed at least a fair increa;ie
in tl;ie pulse rate. In 1 the pulse rate began to accelerate
at 17 per cent oxygen and continued to do so to the close
of the test, at which time it had increased as much M 30
beats per minute. He was a shallow rapid breather, rate
28 per minute, depth 300 cc. Three cases that failed at
11.1, 9.5, and 9.3 per cent of oxygen, respectively, did not
compensate in either the pulse rate or respiration.
The early failures point to respiration as a more impor-
tant factor than circulation in· compensation.
Fainting group. COMPENSATION TO 6 .9 PER.CENT OR LESS OF OXYGE N.
Seventy-one CMes of nonfainters who went down to less
than 7 per cent of oxygen have been examined to deter-
- - --- mine the importance of the various compensatory factors.
Assuming that the acceleration in the rate of heart beat
3'4
51
26.4
39.5 the increase in the per-minute volume of bre::tthing, ~
29 22.5 terminal rise in systolic arterial pressure, and a terminal
4 3.1
gradual controlled fall in the diMtolic pressure are com-
11 8. 5
pensatory responses to low oxygen, these factors enter
129 100. 0 into the reaction as follows:
A good response in the 4 factors, 24 CMes.
A good response in the 3 factors, 30 cMes.
A good response in the 2 factors, 14 cases.
A good response in only 1 factor, 3 cMes.
An increase of 20 beats in the pulse above the lowest
rate observed during rebreathing is considered good and
above 30 very good. A respiratory response in which the
increase in the per-minute volume WM 5 liters above the
lowest volume observed during the early half of the test
is considered a good response. A systolic pressure rise
of 8 mm. and a gradual diMtolic pressure fall of 10 mm.
are good averages. There were 7 cMes with a pulse rate
increase of less than 20 beats; 1 of these accelerated only
8 beats. In 13 the respiratory response was less than 5
liters; the leMt WM 2.6 liters. In 1 the diastolic fall was
absent and was less than 10 mm. in 19 more. There was
no systolic compensation in 20 and less than 8 mm . in 9
others. ·
Among the 30 cases with one factor somewhat deficient
the pulse rate was slightly below the required amount in
2, both having an acceleration of 18 beats per minute.
Respiration was deficient in 4, in 1 of which the increase
was only 2.6 liters. He, however, breathed less frequently,
so that the volume of each breath was increased from 75.0
cc. at the beginning of the test to 1,050 cc. during the last
two minutes. His heart rate accelerated 34 beats, and the
arterial pressures showed excellent compensation. In the
other cases the deficiency occurred in arterial pressure
changes. In 16 of these the respiration increMed con-
siderably ~ore than the normal amount, and in 18 the
pulse rate increase exceeded 30 beats. By the interplay
of the four factors, it appears that these 30 case§ are ac-
counted for as to sufficiency in compensation.
The deficiency in compensation for the 14 cases in which
two factors are below normal can be explained in all but
 22
4 by extraordinary respiratory and pulse rate increases. volume r!lSpiratory incr~e was unusually high, 6 and 8.2
In 1 the respiratory incre:ise was only 3.7 liters, but by a liters. The other 3 made go<)(! eompensations in all fac-
slowing in the rate of breJ.thing the tidal volume had just tors except respiration, irr which the per;mnute volume
double1 . The pulser.ate in thia case increased 24 beats, increase was 2.7, 3.2, and 3.2 liters, . respectively. The
the systolic pressure showed 6 mm. compensatory rise, man who gave an incre!llle of only 2.7 litera breathed very
and the diastolic pressure a gradual fall of 14 mm. An- deeply for the last four minutes of the test; during the !Mt
other man who reached 6 ..7 per cent oxygen had almost minute there were nine breaths, of which five ranged
no incre:ise in the systolic pressure, a gradual diastolic between 2.5 and 3.7 liters. One of the men, who in-
pressure fall of 10 mm., a pulse rate of 90 that increased creased 3.2 liters by a slowing of the rate, more than
to 98 during the last 8 minutes, and a respiratory increase doubled the depth of breathing, and the other case
of 4.7 liters. Mentally he held out unusually well. The throughout the entire experiment breathed very deeply,
third man had a gradual terminal rise of 6 mm. in the sys- with 11.5 liters per minute at the bo,,<>i.nning and much
tolic and a gradual fall of 14 mm. in the diastolic pressure, deeper breaths at the end .
a pulse acceleration of 30 beats, while· his respiration There wore 2 men whose compensations were not up to
in<'reased only 3.5 liters without a change in the rate of standard in two factors. One of these had a 7.2 liters
bre:ithing. The fourth man failed to have a systolic increase in the total per-minute volume of breathing, but
pressure rise, had very good i::ompensation in diastolic no increase in pulse rate beyond an initial peychic rise at
pressure and pulse rate, but only an increase of 4 liters in the beginning of the experiment. The pulse rate was 110
the respiratory per-minute volume. beats per minute. The last man showed up well in pulse
The 3 cases b elow normal in all but one of ·the com- rate and diastolic pressure compensation; he had an initial
pensatory factors showed unusually good respiratory com- · psychic rise of 16 mm. in systolic pressure at the beginning;
pensation. Their pulse rates increased 17, I8, and 19 which was maintained without change throughout the rest
beats, respectively. The systolic pressure did not in- of the test. His respiratory increase was only 3.2 liters,
cre:ise; in 1 the diastolic failed to respond, and in the but the per-minute volume at the start was 11 .5 liters and
others fell 8 and. 6 mm., respectively. In these 3 the the increase in depth was unusually large, or 240 per cent.
respiratory compensation appears to have spared the other All cases among the fainting type group that reached
factors. 7 or less per cent of oxygen appear, therefore, to have made-
There were 18 cases among the fainting type that went good or excellent compensations as judged by the available
(!own to 7 or less per cent oxygen. Eleven of these showed criteria.
excellent compensation in all four factors u~ until the In Table 10 are tabulated the laboratory ratings given
last minute, or two minutes in two cases, of the test, when by the physiologist and the psychologist for the individual
the evidence of circulatory collapse appeared. cases in each group of the fainting and nonfainting types
There were 5 men of the fainting type who showed and for the several subdivisions of the fainting group.
cleficient compensation in one of the factors. Of these, The physiologist's ratings were made according to the
2 had no rise in the systolic pressure; but the per-minute following:
TABLE 10.

Fainting.
Nonfainting.
Total fainting. Systolic fall first . Diastolic fall first. SystoJko and dias-
Rating. tolie fall together.

Number Percent. Number Per cent. Number Per cent. Number Per -cent. Number Per cent.
of cases. of cases. of cases. or cases. of cases.
- -- - --- ------ - - - - - - - - - -- - - -
Physiology AA .. . 43 29.05 5 3. 71 2 6.89 2 4.44 l 1.64
A .... . 70 47.29 39 28. 85 8 Zl.58 19 42.22 12 19.67
B .. . .. 31 20.94 77 57.08 '15 51. 72 24 53. 33 38 62.29
C..... 4 .2. 70 14 10.38 4 13. 79 0 10 16.39
Psychology A+ . . 76 51. 35 38 21.19 11 37.93 15 33.33 12 19.67
.A- .. 26 17. 58 31 22. 95 7 24.14 13 28. 88 11 18.03
B .... 37 25.00 45 33.35 5 17. 23 11 24.44 29 47.54
c ... .. 9 6.08 21 15.56 6 20.69 6 13. 33 g 14. 75
Total.. ... . .
- -148-- - - - -135- - - - - -29- - .- - - - -45-- - - - -61- - --
...... ....
··· ···· ··- ·····--· -· -···· · ··· · ··········

CLASS A.
Compensation must be maintained to 8 per cent oxygen
or less.
Systolic must increase or hold to 8 per cent oxygen or leas
and must r{;lmain below l55 mm. throughout the· greater
part of the run. A brief rise above-155 mm. is allowable
at the end of the run. The normal must not exceed
140=.
Dwswlw must increase, remain on level, or hold with af
controlled drop to 8 per cent oxygen. A fall of 5 mm. in a1
minute is suggestive of a weakening of the vasomotor'
control, and if this rate continues or is exceeded. in theJ
next minute the fall should be considered as uncontrolled,
Pulse must increase or hold to 8 per cent oxygen and·
must not exceed 125 beats per minute between. the fifth
minute and 10 per cent oxygen.
Respiration must increase 3 liten;i or more.
 23
CLASS B. first two classes be added together the two viewpoints used
in rating give fair agreement for the nonfainting group.
C<1mpensation must be· maintained to 10 per cent oxygen
The physiologist by usip-g the physiological compensation
or less.
rated 76.3 per cent of the cases high, 20.9 per cent fair, and
Systolic must.increase or hold to 10 per cent oxygen or
2.7 per cent low; while the psychologist on the basis-of
less and must remain below 155 mm. throughout the
mental efficiency rated 68.9 per cent high, 25 per cent fair,
greater p;ut of the run. The normal must not exceed·
and 6.1 per cent low. Qn the basis of the physiological
150 mm.
response the physiologist graded more of the nonfainting
Diastoli,c must increase, remain on leval, ·or hold with a
type men high than the psychologist did on the basis of
controlled drop to 10 per cent oxygen.
mental efficiency. This difference can be accounted for
Pulse must increase or hold to 10 per cent oxygen and
in the observation that in this type the physiological com-
.must not exceed 145 beats per minute between the fifth
pensations are maintained or even increased for awhile
minute and 12·per cent oxygen.
after unconciousness occurs.
Rupiratwn must-increase 1.5 Ii'ters or more.
In rating men of the fainting type the psychologist places
CLASS C. more of them in the high class than does the physiologist.
On considering all cases of the fainting type the physiolo-
Compensation must be maintained to 12 per cent oxygen gist w'as found to rate 32.6 per cent high, 57.1 per cent fair,
or less. and 10.3 per ·cent low; while the psychologist rated 44.1
Systolic must increase or hold to 12 per cent oxygen. per cent high, 33.4 per .cent.fair, and 15.5 per cent low.
Diastoli,c must increase, remain on level, or hold with a For the subdivisions of the fainting group the physiologist
controlled drop to 12 per cent oxygen. and, psychologist show even a greater disagreement._ For
Pulse must increase or hold to 12 per cent oxygen and the subdivision in which the systolic pressure begins to
must not exceed 150 beats per minute between the fifth fall first the physiologist found 34.5 per cent of the cases
minute and 12 per cent oxygen. high and the psychologist rated 62.1 per cent high. In the
Respiratwn may increase less than 1.5 liters. subdivision in which the diastolic pressure falls first the
CLASS D. physiologist rated 46. 7 per cent high, while the psychologist
found 62.2 per cent high . By both-methods of rating there
Circulatory collapse occurs before · 13 per cent oxygen. · are fewer men of the subdivision in which the systolic and
If doubt exists as to the final.rating, th_e candidate should diastolic pressures fall together that reach a high classifica-
he given the benefit of a rerun. · ·-. tion. The physiologist rated high only 2r.3 per cent and
the psychologist 37.7 per c.ent . . The disagreement btl-
TIME CORRECTIONS.
tween the ratings of the physiologist and psychologist of the
I. If the duration of the run is 20 minutes or less, 1 per fainting type of reactors suggests that the cortical centers
cent oxygen_ must be added to .the final analysis for the of -voluntary attention and coo~dinatiori are not necessarily
purpose of rating. The actual per cent of oxygen found immediately affected by changes of circulation and that a
by analysis, however, will be used in drawing the oxygen fair degree of mental efficiency may be maintained during
line on the chart ·th!) early changes of oncoming syncope .
2. If the duration of the run is. between 20 and 22 .The experience with the rebreathing altitude classifica-
minutes, ! per cent oxygen is to be added to -the final tion examination has shown that the final judgment re-
analysis for purpose of rating. garding a pai;ticular case can not safely be made exclu-
sively from the data of either the physiologist bor the
RESPIRATION.
psychologist. A man may be rendered unconscious by a
To determine the respira.tory response for the purpose ot low oxygen while his compensatory mechanisms are still
rating, the lowest per-minute volume of deciliters breathed responding to the stimulus of lack of oxygen in ever-increas-
before reaching 15 per cent oxygen is taken as the minimum ing .degree. On the other hand, he may in color and in
volume. The highest per-minute volume of deciliters the blood pressures and pulse rate show signs of fainting,
breathed 'the last three minutes oi-the run is taken as the while tis mind still remains capable of attending and re-
maximum volume. The difference between the minimum acting to stimuli. It waS' because of these facts that the
volume and the maximum volume is termed the respira- decision as to the final rating · of the· subject has been
tory response . made by concensus of opinion on the basis of the ratings of
The aviator was rated AA when the compe:nsatiol\B we_re each separate department, and it is ordina.--ily the lowest
good down to 7 per cent or less of oxygen. While the assigned-by any one of them.
scheme of rating debits the candidate for a high systolic
EVALUATION OF THE' SEVERAL COMPENSATORY
preBBure, yet in a general way +'..le grouping of cases agrees REACTIONS.
with that tabulated in Table 5. • The percentages of AA
and A men are inuch larger for the nonfainting -than for the While an inspection of many records of rebreathing ex-
fainting type cases. The subdivision of the ·fainting type periments-convinces one that the response to low oxygen
in which the systolic aml 'diastolic pressures fall together constitutes a definite physiological process, yet there are
has a greater proportion of B and C men than other sub- such differences in the d~gree and pattern of the response
divisions. · that it is often impossi::,,Ja to determine the relative value
The psychologist rated the men on their ability to main- of the several reactions. Therefore, a mathematical state-
bin voluntary attention and motor coordination during the ment of these relationships has been sought. The coeffi-
period of rebre1,thing. If, in both methods of rating, the cient of correlation, which measures the degree of scatter
--
24
or of concentw,tion of the data, has been determined for the
pulse rate increase, the systolic, diastolic, and pulse pres-
sure changes, and the respiration increase, with resp ect to
oxygen. For each of these correlations the sign of the
coefficient has been minus and thus has supported the ob-
servation that a decrease in oxygen is accompanied by an
increase in the physiological response. The degree of cor-
relation between the several cOQ:ipensatory reactions and
low oxygen .h as not been found to be high, but was found
to be present in significant degree and in somewhat differ-
ent measure for each factor . Hence it h_as been possible
to place a value on each response and to arrange t hem in a
scale of importance.
The interpretation of the degree of correlation has been
made on th e following basis: When the coeffici.ent of cor-
relation was less than -0.15 to -0. 20, the correlation has
been regarded as negligible or indifferent~ when it ranged
from -0.20 to -0.35, as present but low; and when it
ranged from -0:35 to -0.50or -0.60,.as markedly present
(8). In our problem - 1 would of course mean a perfect
correlation.
The coefficients of correlation for the physiologic re-
spouses to low oxygen have been tabulated in Table 11 for
our two groups of type cases. The degree of correlation
between the several physiological changes and low oxygen
agrees quite closely with the results obtained from our
study of other selected groups. Assuming, as we believe
we are justified in doing from our study of other groups, that
the nonfainting group represents the best compensation
to low oxygen, then it is cl_e.ar that the increase in the per-
minute volume of breathing is the compensatory factor of
first importance. There has been a disposition on the
part of clinicians who have been associated with ·the re-
breathing altitude classification examination to consider
that the circulatory reactions constitute the only trust-
worthy criteria of compensatory ability. The relation-
ship established by the statistical ·analysis places the -cir-
culatory adaptive changes in a position of secondary im-
portance. It indicates that a large increase in the breath-
ing is more frequently associated with the toleration of an
extremely low oxygen than is a large increase in pulse rate
The coefficient - 0.55 for the respiratory increase is fairly
high, while -0.34, that for the pulse.rate increas~, is some-
what low; but correlation is clearly present. . That the
diastolic pressure change should show an indifferent cor-
relation, -0.07, with the. low oxygen cwas somewhat of a
surprise. But as thiscoefficientofcorrelationisinvariably
small in all our groups for which.it h~ been calculated,
the degree of diastolic pressure fall must, for the present,
be regarded· as a factor of minor importance. In "five
groups of cases the correlation of .the systolic pressure
changes with oxygen has ranged between -0.28 and
-0.43, which shows that a part of the compensation to
low oxygen is accomplished by a rise in this pressure, and
that this factor should be re~rded' as of at lee.'!!t equal
importance with the increase in heart rate. The coetli-
cient of correlation for the pulse pressure change is.approx-
imately equal to that of the systolic pressure and has been
found to range between -0.26 and -0.44, which would
lead us to regard this faotor as of more importance than
has been our custom.
TABLE 11.- C~fficient of correlation with probable error fer
physiological responses to lov; oxygen,
Physiologic response. N onfalnting Fainting
gro~p. group.
Respiratory increase in deciliters ..... . .... . -0.5.5±0.04 -0.42±0.05
Pulse rate increase ....................... . - .34± . 05 -.35±.05
Systolic pressure rise ..................... . - .40±.05 - .43± .05
Diastolic pressure fall .. ..... . . ..... . ..... . - .07± 05 -.02±.06
Pulse pressure increase ............. , .... . . - .29± . 05 - .43± .05
Number of cases .... <·. -............ . .. .. . 160 139
Mean oxygen per cent . . ..... . ..._..... . . .. . 7.2 ± .05 7.8 ± . 06
A comparison of the coefficients of correlation obtained
for the nonfainting and fainting types (see Table 11) indi-
cates that t hese two groups differ materially in only two o
the factors ; that is, in respiration and the pulse pressure.
A closer study of the correlation computations, however
brings out other differences that will be presented briefly.
These differences are found in the arithmetical means and
in the standard deviation, which is another measure of
the ~ariability that includes the middle two-thirds of all
cases.
The mean increase in breathing as determined by the
per-minute volume at the end of the test was for the non
fainting type 5,120±135 cc. and the standard deviation
2,540 cc., for the-fainting type the increase was 3,500±127
cc. and the standard deviation 2,210 cc. It is clear, there
fore, that the per-minute volume of breathing was greater
in the nonfainting than in the fainting group.
The mean increase in the pulse rate for the nonfainting
group was 28.5±0. 6 beats and the standard deviation 11.3
bl)l\ts; for the fainting group it was 26.2±0.6 beats and
the standard deviation 10.3 beats. The differences be
tween the two groups of cases is too slight to be significant.
The systolic pressure changes gave for the nonfainting
group a mean rise of 12.7±0.6 mm., with a standard de-
viation of 11.5 mm., while for the fainting group there
was a mean fall of l±lmm. and a standard deviation of
17.7 mm. Hence, although the coefficients of correlation
for the relationship between systolic pressure change and
low oxygen were approximately equal, - 0.40 and - 0.43,
respectively, yet the nonfainting group had a considerable.
increase in systolic pressure, while the fainting group on
the whole showed very little change.
While the computations do not show the diastolic pres-
sure changes to correlate with the oxygen, yet the two
groups gave striking contrast in the arithmetical means
and standard- deviations, The mean diastolic pressure
fall for the nonfainting group was 7.5±0.4 mm. and the
srandard deviation 6.6 mm:; for the fainting group the
mean fall was 18.8±0.6 mm. and standard deviation 11 mm.
The pulse pressure mean in~rease for the nonfainting
group was 23.8±().6 mm. and the stand_a rd deviation 12
mm. ; foI the fainting.group the increase was only 14.2±0.8
mm. and the standard deviation 14.6 mm. These figures
point to the systolic pressure changes as more signific.a.nt
in the determination of the final pulse pressure than the
diastolic pressure. Just why the coefficient of correlation
for the nonfainting group should be less than for the
fainting has not as yet been determined.
By this mathematical study it has been demonstrated
that, as a rule, men of the nonfa.inting type increase their
 25
breathing more, have a greater rise in systolic pressure, a arterial pressure constitute an. excellent response to the
more moderate fall in the diastolic pressure, and a larger decrease in oxygen.
increase in pulse pressure than do the characteristic faint- The final oxygen percentage for all cases gave an arith-
ing type reactors. metical mean of 7.42±0.01, with extremes of 11.1 and 5.2.
The length of the rebreathing period in which 52 liters
SUMMARY. of air were used gave for all cases a mean of 24.65±0.05,
with extremes of 15 and 37 minutes.
A part of the.result.a from a study of 1,050 ~ s of re- We wish here to express our thanks to Mr. S. Isaacs and
breathing has been given. The normal, or UBUal, responses H:rs. R. G. Merriman for suggestions and help in handling-
in respiration, pulse rate, and the systolic, diastolic, and - the statistical data.
pulse pressures have been pre&ented by curves. Varia-
tions from the normal curve have also been illustra_ted. BIBLIOGRAPIIY.
An analysis of 300 cases showed that 140,. 46. 7 per' cent, 1. Henderson, Y., and Seibert: Journal of the -4-merican
belonged to the fainting and 160, 53.3 per cent; to the Medical Association, 1918, 71, 1382.
nonfainting type. Each of these types was found to pre- 2. Manual of the Medical Research Laboratory, War De-
sent several variet.ies of reaction that have . been briefly partmei:it, Washington, 1918, p. 212.
considered. Special examinations have been made of 3. Schneider: Journal of the American Medical Associa-
cases of early failure and of those who tolerated to less tion, 1918, ·71, 1384.
than 7 per cent of oxygen. Computations of the coeffi- 4. Lutz ~nd Schneider: American Journal of Physiology,
cients of correlation and the standard deviation. for the 1919'; 50, 228.
relationship between the compensatory factors and low 5. Greene: American Journal of Physiology, 1919, 49, 118.
oxygen have shown that the respiration constitutes the 6. Ellis: American Journal of Physiology, 1919, 50, 267.
primary and the circulatory changes the secondary factor 7. Lutz and Schneider: American Journal of Physiology,
in compensation. A large increase in the per-minute 1919, 50, 280.
volume and depth of breathing, an acceleration in the 8. Rugg: Statistical Methods applied to Education, New
pulse rate, a considerable rise in the systoiic and ·pulse York, 1917, p. 256.
pressures, and a moderate terminal drop in the diastolic (By courtesy of the American Journal of Physiology.)
PSYCHOLOGICAL RE.SEARCH IN AVIATION IN ITALY, FRANCE, ENGLAND.
AND THE A. E. F.
By F. C. DocKERAY, University of Kansas, and Lieut. S. lsAAcs, Air Service ;Medi,cal Research Laboratory.

Among the many demands for the appli<;ation of psy- sensation or perception of muscular effort, and equilib-
chology to practical problems, those presented by aviation rium, as well as the more distinctly physiological and
are of particular interest. In 1914; very little, if anything, medica,l aspects.
was known regarding the qualifications ,of an aviator, Simple reaction times with .visual and auditory stimuli
aside from the fact that it was assumed that he mulit possess were used in all the laboratories. Of 13,936 candidates ex-
an unusual amount of dare-devil spirit. As late asl917, it amined in 1918,. 247 were disqualified on the reaction time
was supposed, in this country at least, that the demands test. In the earlier report by Gradenigo the limit of
upon the aviator were totally different from those made by fitness .was .placed .at 0.200 sec . for the visual and at 0.170
any gther work. The qualifications in balance in the air, sec. for the auditory stimuli, with a variability not to
as contrasted . with balanc e . in walking, quickness in exceed an average of 0.030 sec.
reaction, emotional !ltability, and good 'judgment, were Saffiotti (p. 159) reports more in detail the methpd
supposed to be much superior to th9Be for a gunner, a Signal adopted at the. Turin laboratory. The purpose of the
Corps officer; or a lieutenant in the trenches. tests is stated to be the determination of the '' functioning
While it is doubtless true that we .have learned that 9f neuromuscular processes during a period of attention,
flying dpes not require the unique qqalities which mark the at which time an individual tends to show hia perceptive-
aviator ·as a superman, nevertheless great steps have been . motor reactions." Jie claims that the objection usually
taken in the direction of perfecting methods for the selec- made to simple reaction time tests-that is, that automa-
tiop. of those yo:ung men who give promise of learning this tism in the ·reactions arises-is Iiot founded. The fact
patticula.r type of performance most successfully. Thls tliat most of the series in all three laboratories consisted of
work has been performed by medical men, physiologists, . only 20 readings, preceded by a few preliminary practice
and psychologists. While in this country the work of reactions, would lend weight to his view.
these three groups has been kept quite distinct, the re- The reactions were recorded with a Hipp chronoscope,
search abroad has not been so definitely divided. arranged · for a break-make circuit with , the use of the
lower spring only, the cnirent passed through the upper
ITALIAN RESEARCH.
.coils. The average errors were 0.001 to 0.002 sec. The
Italy was the nrst of the Allies to take up extensively stimuli adopted were, for visual, a green diaphragm
research in aptitude for flying. This work W!IS carried on 1ighted by a 2 cp. lamp; for auditory; a lever falling frhm
at psychophysiological laboratories at Turin, Naples, and a fixed height striking a key. Having expla~ned the task
1
Rome, , under the general direction of Dr. Gieuseppe to the subject, the reacti'mis are taken until "a normal
Grader\igo. Here were developed a number of tests, and homogeneous group ·of 20 reactions" are secured. Usually
a mass of data gathered in routine examinations and in the subject reacted immediately with normal reactions,
intellflive research on seled;ed groups of aviators at the though occasionally it was necessary to spend some time
front as well as candidates for aviation instruction. to accustom him to the methoQ. The st.imuli in the
In prelimin.ary wor:;r , a number of tests were tried out series seemed to have fpllowed rather rapidly an,d no
upon pilots known to be successful aviators, upon another "ready" signal given.
group rate:! .mediocre, and upon a thlrd group of unsuccess- The values obtained range between 0.170 and 0.200 sec.
ful aviators. The conclusions reached were that "a good · with the visual stimulus, and 0.130 anrl 0.150 sec. with
airplane pilot is one who to a sufficient speed of perception auditory. Values above these are considered-slow and the
and to a notable degree of extension and distribution of individual is rejected. Saffiotti claimR there is no reason
attention, adds constancy, precision, coordinating ability for having placed the maximum limit of tolerance with the
of the psychomotor activity' and who possesses a sufficient auditory stimulus at 0.170 sec. as reported by Gradenigo,
inhibitory power of emotive reactions not to be .d isturbed but·he gives no definite reason for reducing the limit to
. in the above functionR on account of emotional stimulus." 0.150 sec. He suggests, however, that the elimination
In accordance with these conclusions, tests were sought should be on a 10 percentile distribution, rather than on
that would measure psychomotor activity, attention, and any fixed arbitrary standard. On this· basis the average
resistance to emotional stimulus. An account of this deviation of 0.030 sec. was con~idered the limit of varia-
work. is given in "Richerche biologiche sull' aviazione," bility.
'.Rome .(Tipografia Nazionale Bertero) 1919, pp. 235. Choice reactions were made with right or left hand in
These experiments covered studies in reaction times, either of four directions and combined reactions with
attention time of perception, emotional stability, muscular hand and foot. The technique of the latter is described
(26)

(p. 210) by Azzii of the Naples laboratory. In a frame
were arranged five. 16-cp, lamps-two upper, two lower,
and one in the center. Below each lamp was a small
lamp of the flashlight variety. Under this bank of lamps
was-a. table with two keys for the.hands, and on the floor
under the table, two keys for the feet. The subject wa!l
instructed to react with the right hand to the correspond-
ing upper lamp, and with the foot to the corresponding
lower lamp. He might be required to react to any two
lamps simultaneously. The small lamps lighted when
the subject reacted, thus indicating whether he reacted
correctly. A D'Arwnval chronoscope was used . The
following are given as the normal values :
Average reaction time._._ . ....... _. . 0. 500 sec.
Average deviation._. __ ... _.. __. . . . . . 0. 120 sec.
Coefficient gf variability . ............. 20
Percentage of e~ors.. . . . . . . . . . . . . . . . 8
The following were considered abnormal values and stand-
ards for rejection:
Average reaction time.... . . . . 0. 680-0. 700 Rec.
Average de'Viation........... . 0. 220 sec.
Coefficient of variability ....... 36
Percentage of errors.. . . . . . . . . 26
Gomelli states (p. 51) that the reactions with the left
hand, whether in isolation or simultaneous with another
member, are more prompt than the reactions with the
right hand.
The reaction apparatus used by Saffiotti (p. 182) and
by Roi:na.:,"Ila-Manoia (p . 212) consists -·of a vertical lever
which is grasped by the subject, as is the stick control of
the airplane, and which can be moved forward, back-
ward, or to either side 1 centiineter from the center. The
stimulus is given by a lighted arrow indicating the direc-.
tion of the movement, and by a negative command (not
described) to which- the subject must not react. The
results centralize between 0.350 sec. and 0.500 sec ., with
little \lifference in the various directions. The varia-
bility oscillates between 0.040 sec. and 0.070 sec., and
since from 0.070 sec. to 0:080 sec. there is a decided de-
crease in frequency, 0.070 sec. is considered the greater
limit of variability or standard of rejection. There were
no errors .in reaction, except for an occasional failure of
inhibition with the negative stimulus.
Romagna-Manoia, using the four-movement stick for
re.actions, btlt using four lamps, arranged above, below,
and on either side of a fifth lamp, as stimuli denoting the
direction of the reaction (the central lamp not to be re-
acted to), obtained the following results from 400 can-
didates (p. 217):
Coeffi-
Mean Extreme Mean cient of
Direction. (sigma). values. variation. varia-
bility.
- - - -- -11 - - - - -- - -- --- -
Forward .. . . . . .... 453 326-633 60. 20 13.28
Back\1'.ard . ....... . 478 34.µ)63 57. 97 12.12
Left ... . .. . ...... . - 491 356--009 58. 50 11.91
Right . . .. . . .. . . . . . 465 3-llH>59 55.10 11.1!4
In the cases of nervous exhaustion from service at· the
front, the simple reaction time method was applied by
Saffiotti "for purposes of study of the state of the nervous
system and the capacity of attention" (p. 183). These
27
series consisted of 150 to 300 reactionB with the visual
etimulus, and 100 to 200 with the auditory. Sa.ffiotti
claims to have been able by repeated tests "to follow the
manifestationB of the progressive renewal of normality
of the reactions in -comparison with the best physical and
psychic conditions." Two fundamental types appeared
from these tests-the type who slow up (exhaustion and
weakness), and the opposite type (E!xcitability and in-
stability). A study of the individual reactions shows
that the first type is characterized by a consistently
long reaction time, 0.220 sec. to 0.230 sec. with the visual
stimulus; the second type presents a lower reaction time,
0.lQO sec. to 0.190 sec., but an increased variability.
Emotional· reactions were studied by the ·changes in cir-
culation, respiration, and tremor of the hand, produced
by stimuli designed to c:reate an emotion. All the labora-
tories seem to have used the method described by Gra-
denigo and Gemelli (p. 45) in the selection of candidates
for aviation, though the standards of classification are
not reported further than to state that those who have an
exceBBive reaction are 'pronounced ineiigible. Of 13,936
candidates examined, 232 were rejected as "excessively
emotional." The general behavior of the pulse and
changes in blood pressure and volume and the duration
of the changes were observed. The following were re-
corded: the pulse of the· left forearm by means of an arm
plethysmograph, the pulse of the carotid, thoracic breath-
ing, the tremor of the right hand, and the "time in seconds.
The "emotive stimulus" was produced by a pistol shot,
automobile claxon, or the explosion of a firecracker.
Aggazzotti (p. 89) has reported more in detail the
results obtained in the Rome laboratory, though he also
fails to state how the tests were used in the selection of
candidates. He, however, presents interesting tables
of the r01:\Ults of the examination of 723 subj°ects. These
are classified into 10 groups according to their pulse rate
at the moment of stimulus, 'ranging from 55-59 in the
first group to 140-149 in the tenth. Following the stimu-
lus the reaction is divided .into three phases: first, the
effects of an inhibition of the vague with an acceleration
oI the pulse; second, an excitement of the vagus with a
slowing up of the pulse; and third, an excitement of the
aceelerator with a consequent acceleration. The first
phase is brief (4-5 pulsations), and manifests itself almost
immediately after the stimulus. I ts latent period is negli-
gible. The second phase is longer than the first {15-25
pulsations.). It manifests itself rapidly and also ceases
rapidly, to give place to the third .phase. The third
phase is the longest of the three. It appears rapidly and
ceases slowlz. These chronotropic reactions a.re always
accompanied by inotropic reactionB (strength of pulse) .
However, there is no relation in the degree of these two
Percent-
age of forms of the reaction, nor is there any relation noticed
error. in the activity of the heart and the inotropic reactions at
- - . the moment or stimulus. The inotropic reaction appears
0.85 in two phases: a negative phase of brief duration, 3-4
0.50
0.65 seconds, which appears in the first pulsations after the
0.72 stimulus; and a positive phaBe of greater duration, which
de-.elops gradually a.ftet the first negative phase has
ceased. The author does not discuss the relation between
the degree of the various reactions and the pulse rate at
the moment of stimulus, but an inspection of his Table A
(p. 91) indicates that as we go from those subjects with a
-
28
low to those with a high initial pulse, the decrea,se in
pulse rate in the second phase is more pronounced, but
the increase in the third phase (acceleration) is less pro-
nounced. The various reactions occur in more rapid
succession with the more rapid initial pulse rates. The
height of the systole also increases, but the proportional
change with stimulus is not significant.
The influence of an emotive state upon an elementary
process, such as reaction time, was studied by M. Camis
(p. 188). The technique was similar to that employed
in the other reaction time experiments, except that the
"emotive stimulus" was mtroduced between two series
of 20 or 30 readings with visual and auditory stimuli.
In every C!l,Se reported (12 cases) the average is longer in
the series following the emotive stimulus, ranging from
3.4 per cent to 30 per cent. These may be classified as
·«good" below 10 per cent, "medium" between 10 and 25
per cent, and "poor" or disqualifying above 25 per cent.
The deviations from the a-µerage were also taken into
consideration. These are presented in the form of curves
of the individual reaction times plotted with reference
to the abscissa representing the average. An inspe:ction
of these curves shows several types. The disturbance
may be violent but fleeting, producing a few extremely
long reaction times and quickly returning to normal, or
the effect may be more moderate and la.sting. A third
type shows a fairly large deviation which is constant
througho~t the series, both before and after the emotive
stimulus. The fourth and best type is characterized by
a relatively small deviation in both series.
Short series of observations were made on the effects
of the emotive stimulus upon choice reaction· times.
The results are uncertain. In the majority of cases the
average of the second series is lower than that of the first,
though the number of wrong reactions is gre!l,ter. The
author concludes that these facts lead him to believe
"that a moderate emotional state, as ·is that induced by
the methods of the laboratory, can frequently increase
the velocity with which the psychic process -develops.
That the difference, that is, the increase in velocity, is
to be ascribed to the superior psychic elements of this
complex function, is demonstrated by the fact that in the
psychomotor simple reaction, where the psychic func-
tions, M judgment and choice, do not enter into play,
one never has shortening but only lengthening of the
reaction times'' (p. 196).
Attention WM studied by various tests to determine the
extent, distribution, concentration, fluctuation, and in-
tensity of attention and the speed of perception.
The cancellation test devised by Saffiotti was used.
ThiA test consists of marking symbols arranged without
any connection and placed irregularly so that the influence
of the habit of reading is reduced to a minim.um. Account
is taken of the time required and the number of errors, the
limits being set at five minutes and five errors.
Gemelli (p. 56) also used the successive exposure of
small images at a rate sufficient for the subject barely to
gather the details. The subject must react to the passing
of each image and signal the passage of those images which
presented the predetermined peculiarity. No results
are given, but he states that the method "hM proved ex-
cellent in the singling out individuals unfit from the
point of view of the ability to concentrate attention for a
determined time."
Another method of meMuring attention WM devised
by Gallotti and Cacciapuoti (p. 207). Series of simple
figures of different colors were exposed successively and
the subject required to report immediately. The ex-
posures were made by means of a kymograph at the rate
of one figure every two and one-half seconds, each figure
remaining exposed one second . A record _:wM kept of
the number of figures reported and the errors regarding
form , color, and order. A figure omitted was counted
as two errors, one for form and one for color. With four
series of five figures each, it was found that the majority
of subjects tested (338 subjects) made 13 to 16 errors; a
minority, considered to possess insufficient attentive
capacity, made over 20 errors. An examination of 36
candidates who had been declared ineligible because of
"psychic nervous wear" demonstrated that 26 made
over 20 errors. The limit of 20 errors was, therefore,
considered a just standard of attentive capacity for re-
jection of candidates.
Both Herlitzka (p. 196) and Galeotti (p. 201) designed
methods to test the speed of perception. Simple figures,
such as circles, squares, and triangles , were exposed by
means of a falling shutter. The length of exposure wM
varied by adjusting the height of the fall or by adjusting
the size o~ the opening. In this way the minimum time
necessary to recognize the figures was determined. In
Herlitzka's test a screen was lighted by two projectors so
arranged that the falling shutter cut off the light of the
first at the moment that it opened the second, which
projected the figures upon the screen. In like manner
it reopened the first at the close of the exposure.
Both of these investigators obtained similar results, but
disagree in their interpretation. Herlitzka believes that
the individual variations in minimum time required for
recognizing the figures indicate that the test must measure
the psychic function. However, the time is too brief,
2-4.5 sigma, for such a mental process, and he is inclined
to believe that after all his method merely determines the
threshold or time of adequate stimulation of the retina.
Particular evidence of this is cited in the fac.t reducing
the distance between the subject and the screen from 2
m. to 80 cm. materially reduced the minimum time re-
quired. Galeotti, on the other hand, insists that their
results are the measure of the speed of perception, though
his evidence is not convincing. The fact that their
methods were slightly different, but their results approxi-
mately the same, which his data does not entirely sub-
stantiate, and also the fact that he himself was unable to
observe an after-image upon closing his ~ye immediately
after an exposure are evidence to him that .his test meas-
ures the psychic function and not merely the sensory
threshold. It should be observed that the field was
lighted only momentarily in his experiment. Herlitzka
is not willing to recommend the test, in its present de-
velopment, for the selection of aviators, and Galeotti has
apparently not so used it.
Perceptwn of muscular effort was studied on the assump-
Ition that one of the important factors in the control of an
I
airplane would be the recognition on the part of the pilot
of the pressure exerted upon the controls ,and the amount
of effort necessary to change their position a given amount.
IApparatus was designed by Galeotti (p. 143), which
required the subject, blindfolded, to hold a lever in a
specified position while the weight suspended from the
 29
lever varied irregularly from 2 to 12 kg. The movements was requirea to recognize simple figures exposed on a
of th{l lever were x:ecorded upon~ kymograph. The result BCreen as soon as he could gain the upright positior. This
are briefly summarized as follows: (1) Excellent curves · test also yielded negative results. The difficulties that
indicating excellent muscular aptitude. The curve would be encountered in such an experiment can be easily
remains in t he middle horizontal, zone of the tracing. understood. As the experiments we.re -performed it may
The principal oscillations are uniform and low with few be ·assumed that the tests were given after any effects upon
indentations al).d without jumps. (2) Mediocre curves, consciousness had ·disappeared. If the tests had been
ascending and decending with not very high nor very applied immediately after rotation, the lack of motor con-
uniform oscillations, but · many indentatio:ns. (3) Poor trol, particularly the tendency to eye movement, would
curves, which indicate .inaptit ude rightly to regulate tlie . have vitiated the results ..
muscular activity, those deformed with great indentations It will be recogrnzed . that the Italian investigators
and jumps .. attempted to use a great variety of tests and have undoubt-
Gemelli (p. 58) also tested muscular effort, though he edly acquired a great mass.of data. It is to be hoped that
does not adequately describe his method. Apparently definite correlations will be published, now that the-war
the s-ubject was required to move a handle against a fixed ·is over and opportunity fo~ such a study is possible. It
resistance any required distance. The tune required Jor should be remarked that the disqualification of a candidate
the movement and -the accuracy of the judgment of1 the did not rest upon the absolute results of any test or group
effort required were taken as measures, not of his motor of tests. These served only to present the most ·definite
ability, but of his attention ability. profile it was possible to-obtain. From these resuits com-
Equilibrium.-In the selection of candidates for the air pared with flying aptitude the following conclusions are
service the -Italians, like the Americans, placed a great presente<l :.
deal of emphasis upon the Barany tests. Gradenigo, 1. Pursuit pilots present a keen perception of position
president of the commission a-nd inspector of the labora- of body, low visual reaction times, choice reaction times,
tories, is hiIDEelf. an otologist. The technique and st1md- and low average deviation in reaction time. Nearlv all
ards of admission did not differ materially from those the best pul'Buit pilots were of the sensorial type in ;eac-
adopted in this country. However, Malan, an otology tion time tests. Resistance to emotive stimuli was not
specialist, expr~s the belief that while the Barany· necessarily great in all cases. Many of the best pilots.in
tests are necessary, they do not indicate the candidate's this group manifested low resistance to emotive stimuli.
sensitivity to balance or change of position. "To pOSEeBB 2. Nearly all the best pilots on slow machines, such as
an absolutely normal organism, to be iJnmune from exag- the bombing planes, were of the muscular type in reaction
gerated· manifestations of vertigo following rotation and time. Caproni pilots present considerable . resistance to
transcepha1ic galvanization are certainly indispensable emotive stimuli.
requisites to become a good aviator ; however, besides all
FRENCH RESEARCH.
this, the so-called static sense of oml"'i:i position and that of
the vertical must not be lacking" (p. 159). The interests of the French seem to have been limited
To test this sense of position, Malan arranged -a special to sim_p le reaction times and studies of emotional stabiiity.
cockpit which could be tilted. forward, backward, OF later- A prelimi;iary report of these experiments, '' Recherches
ally. The-aul;>ject, blindfolded, must report his position. sur l'aptititude a !'aviation" by· Camus and Nepper,. is
and at the same tiine place in the vertical position a rod in, present.ed in Bulletin de l 'Institut General Psycholo-
front of him .attached to a goniometer. About- 900 tests gique, Nos. 1- 3, 17e annee, 1917.
were made. with. i50 l;lUbjects. The results indicate that · In the simple reaction time tests the D 'Arsonval chrono-
an inclination in the lateral direction is more easily scope w-as used. It was found that the average reaction
recognized than. in the. forward or in the backward direc, times were 0. 190 sec. with the visual stimulus and 0:140
tions. Inclining the head forward at an angle of 30° sec: with the auditory and tactual stimuli, but the limit of
did not alter th-e results materially. The best results eligibility was set at 0.100 sec. above the averages. Only
were given by pilots of long experience and in good phy§.ica1 single illustra_tiv.e cases are reported. Unfor.tun~tefy,
condition. Sailor.a and -tight-rope walkers also gave good however, these cases seem rather conflicting. For exam-
results, especially in the lateral position. In aviators pie, one case is given to show that a single series of 10 reaca
suffering from nervous exhaustion, as a rule the errors tions is reliable as a measure of a candidate's reaction
were much greater, but, examined after a complete .JeSt 1 · times, as it remains constant even after a year at the front,
the errors were reduced to normal. No ;mention of the use where he was shot down by the artillery. The effect of
of the test for ~classification of candidates is made. Indi- morphine in one case was a slight decrease in reaction
vidual diffo~ence!l· anq standards that might be established times in nn~ examination, but four mo~ths later the test
are also omitted. a
was repeated showing decided increase. Still another
Bilanci~ni and Romagria-Manoia (p. 175) present a pilot who had been-shot down at the front is used to Hhis-
preliminary study of the state of consciousneBB in rotary trate the effect in lengthening his .reaction times. 'Ihese
vertigo. The tests are rather crude a.n;d -unsatisfactory:. are-only il!ola.ted cases, and it may _be assumed that they
The sirbject, blindfolded, is .required .to recogni2e simple were poorly chosen, for we learned that at the time of ;N ep-
objects placed in his hand befe>re and after turning with ~r's death thousands of aviators and candidates had been
head resting on-his knees. Naturally the~e is a good deal . tested by this method. It is to be hoped that a careful
of disturbancecdue io compensatory moyemenf.s as the sub_ stud_y of these results will soon be forthcoming.
ject attempts to sit up after rotation. However, when The emotional study was identical in every way with the
the object is, placed in his hand the time for recognitiott Italian work, with the exception that these results were
is not ·appreciably longer. In a. second series too subject compared carefully with the results of the reaction time
 30
experiments. Both the average times and the deviations every circle with a pencil as the tape passes the opemng.
from the average were considered. On the basis of these The rate of movement of the tape is gradually increased
two tests candidates were divided into five types; until a breakdown in the subject's reactions is secured.
1. Excellent pilots, who present normal reaction times 'he tape is then seored according to the following rules:
and who do not show excitability. Ten complete misses out of 20 constitute a breakdown at
2. Those who present normal reaction times but show a the particular rate at which this occurs. The rate imme-
slight er11otional reaction. diately preceding this breakdown is then assessed as
3. Those who present slightly irregular reaction times follows: plus 5 for a bull's-eye and minus 1 for a miss, 20
and show a slight emotional reaction; usually young men circles being counted . The fastest nominal rate is one, and
who are apprehensive of the examination. for this 100 marks are given; for rate three, 80 marks; for
These three types are considered acceptable for aviation. rate five, 60 marks, and so on. A simpler method of
4. Reaction times present large.deviations and the emo- marking was later adopted, in which two mark11 were given
tional reactions are greatly exaggerated. for a bull's-eye, one mark for touching the ..:ircle, and
5. Reaction times are very irregular, though they do not zero for a miss, 20 circles being counted at each speed.
show excessive emotional reactions. .T he results with the dotting machine indicate an im-
Types 4 1,J,nd 5 are considered ineligible for aviation. provement with administration of oxygen. Of nine
Since the report of Camus and N epper was published we cases, six deteriorated after flight without oxygen; after
learned, indirectly, that the use of the vaso-motor reaction flight with oxygen all made improved performance, and
test, as a means of determining the emotional fitness of in the cases where .there was previously a deterioration
candidates, was abandoned in favor of the regularity of the the previous performance was surpassed. Administration
reaction times. of oxygen to stale or mentally fatigued subjects increased
their performance 30 to 40 per cent.
BRITISH RESEARCH. The British laid great stress on simple motor coordina-
tion tests, such as walking a line heel~to-toe and turning
The British paid little attention to reaction times and
on one foot, standing on one foot for 15 seconds with eyes
the more elaborate studies of resistance to emotional
stimuli . The latter is included in an incidental manner opened or closed, balancing a rod on a flat board with eyes
in a motor-coordin:1tion test. ·T he principal application opened or c!ooed, and on indications of tremor.
of psychological tests by the British was in the deterrnina- Walking along a line heel-to-toe, turning on one foot, and
tion of the effects of altitude flying and in studies of'' stale- standing on one leg with the eyes closed was a test designed
ness'' in pilots, rather than in the routine examination of to determine "vestibular stability.'' But according to
candidate11. Their results are to be found in the reports of Head (Special Report Series, No. 28, "The Sense of Sta-
the Air Medical Investigation Committee, published by bility and Balance in the Air, " 1919) ''there is no evidence
the Medical Research Committee, London . The member- to show that any of these acts bears a dire.ct relation to the
ship of the Air Medical Investigation Committee consisted activity of the semicircular canals." Failure to ·pass
of Henry Head, chairman, Sir Walter M. Fletcher, M. the test is due to "clumsiness in action or slowness in
Greenwood, Leonard Hill, W. H . R . Rivers, C. S. Sher- comprehension." Likewise, the assumption that the
rington, C. E. Spearman, and Martin Flack. Most of the .ability to stand on one foot for 15 seconds with the eyes
experiments are concerned with physiological data, pulse, closed was a test of "muscle sense" was criticized by Head,
blMd pressure, vital capacity, etc. Some of these, how- who carried out tests to measure 'the power of recognizing
ever, present a psychological aspect. For ·example, the · that individuals who were unable to stand on one foot with
manometer tests involve a measure of volition, which has passi..-e movements of the lower extremities, and found
been recognized by . Birley and others. 'Ihe more dis- eyes closed did not lack the ability to recognize the passive
tinc:tly psychological experiments included the Mac- movement of the lower extremities. Failure to pass the
Dougall dotting test, studies of tremor and giddiness, and test is due to want of control and not to defective muscle
a study of temperament and service flying. sense. In a like manner he found that inability to balance
In the studies oft.h e effects of altitude flying the British a rod on a flat board was due not to defective muscle
did not make use of a low-pressure chamber or other se~, as assumed; but to "want of controi and clumsiness
apparatus for diminishing the oxygen supply, though late in action." Theinabilit·y to balance the rod is not due to
in .the war .Lieut. Col. George Dreyer had developed an tremor, as several failed who showed no eigns of tremor.
apparatus that promised to have certain advantages over The rod-balancing test is recommendeq. as a useful method
the rebreathing apparatus used in this country. 'The of testing states of exhaustion, flying stress, insomnia,
tests to determine tlie effects of altitude and the valµe of and other neuropathic and psychopathic conditions in the
use of oxygen were made before and after flights. Fh1.ck e~ly etages of development.
arid Head (Report No. 1, "Oxygen Needs of Flying Giddiness and nausea in the air are ascribed to two
Officers," Feb. 18, 1918) investigated the oxygen need at groups of ·causes: (1) temporary abnormality of the mid-
relatively low altitude by this method. The tests adopted dle ear, often due to a cold in the head and interference
were the pulse, blood pressure, the time the breath could with the free paeeage of air through one or both of the
be held, and the MacDougall test. The apparatus for the Eustachian tubes, producing an abnormal condition of
latter consists of a paper tape passed through a narrow ten9ion which acts on the vestibular apparatus; and (2)
slit by means of a . clockwork. Upon the tape are small failure to learn adaptation to disturbances of equilibrium,
circles, each with a dot in the center. The circles are which may be caused by lowered general resistance-due to
regularly spaced longitudinally; but are irregularly placed a physical or mental disturbance, such ae influenza, or
laterally. The subject endeavors to spot· the bull's.eye of strese of flying at the front, "anything which tends to
 31
lessen control over the reaction of the lower centers to sen- examination ,of candidates and pilots. An account of the
sory stimulation " In every caBe investigated in the latter test was furnished by correspondence by Prof. Spear-
group the subject had suffered in childhood from swinging man : "The candidate is asked to draw a 'line lightly an:d
and riding on the train. Most of them had suffered dis- deliberately acrosli the greater length oLa.sheet of fooliwap,
comforts in the first flights, but had become adapted to parallel to the border, with a leaded pencil, without the
changes in equilibrium by repeated flights , though some hand or arm touching the paper. The presence and de-
never completely overcame some discomfort. Rotation gree of tremor can be ~en, especially if a magnifying
produced no abnormal response but was accompanied glass is used. He is then asked to draw another line in
by exceBBive giddiness and nausea. It might be ex plained the same way. While he is doing 80 an unexpected loud
that the rotation test consisted not in the time of nystag- noise is made close to the ear with a Dalby'·s 'clacker,'
mus but in the re:iuirement that, after rotation, the subject which makes a loud noise and is easily manipulated and
should stand erect and walk forward . He at the same hidden. A perfectly sound man will often continue the
time reported the direction in which the room seemed to line without interruption, or a slight irregularity will
be turning. The degree of stagger and deviation in walk- appear in the line before it is again firmly continued .
ing were considered the measure of his reaction. The effect on a nervous man is either to produce a sudden
Fainting in the air, on the other hand, was never accom- dash and complete stop, or the line is co.n tinued in an
panied by any discomfort. None of the subjects examined increasingly irregular and shaky manner. He is then
had ever experienced any discomfort in flying. They asked to draw a third liiie, after being warned that the
seemed to posse3B the adaptability or power to control the noise will be made .at some point. If the nervousness is
effects produced on the vestibular app:uatus by changes under control, the iine will not be interrupted; if _not, t}le
of equilibrium. " But when the impulses of the semi- same hurried dash and complete stop is again seen, or the
circular canals bec,ame too violent to be held in check, rest of the line is drawn with increased tremor and irregu-
they expended themselves by producing a withdrawal of 'larity ."
consciousness." Fainting is described .as pleasant. It Lieut. Col. J. L; Birley (Report No. 4, "Temperament
begins with a narrowiµg of the field of attention and may and Service Flying,' ' Sept. 25, 1918) li,ae m1¥ie the attempt
culminate in complete oblivion. The reaction upQn rota- to determine the influence oI "temperament" upon the
tion of these pilots was characteri/!tic. The effect upon ability not merel!Y to fly but to do effective combat flying
those who were giddy in the air was, when rotated, exces- at the front. His method is that of the eiimination of _
sive reaction in the form of giddineBB and nausea, though the possibilities of physical causes of "staleness" by
their ability to exercise voluntary control was normal. On means of the regular physical .examinations. He makes
the other hand, of five who had fainted in the air, three no attempt to analyse temperament or detemi:ine the
suffered no discomfort of any kind when rotated. In two special ,t emperamental qualifications for service flying.
cases " everything went misty," and both repocted they . From a st udy' of the results of the- manometer tests (ex-
felt exactly as they did in the air. pira.tion force and time of sustaining a 40-mm. column· of
The presence and. degree of t remor, revealed by ·requir- ·mercury by blowing), blood preBBUre, and pulse rates,
ingthesubjecttostretchouthisarmsinfrontofhim, fingers from pilots and observers tran,sferred: to England for l'est
semiflexed and separated, and eyes closed, at the same ·from active service at the front on account of fatigue, he
time protruding his tongue, was carefully noted. Ac- C()ncludes that "temperamental an<f pl\ysical unfitnese
cording to Flack and Bowdler (Report·No. 2, III, ''Report . are not separate but closely allied 'things," and that "the
on the Examination of a series of sucCeBBful Pilots from temperamentally unfit is unstable physically." "Certain
the Point of'View -of Their Cardiovascular · and Nervous individuals are so constituted that they,react to strain by
Systeµis ," Mar. 23, 1918), a high correlation is found in altera~ion of their physical state; or, in other words\ that
the group which showed tremor with 'want. of aptitude •to by reasoµ of their temperament they will n:ecesearily
fly. Tremor is 'absent or slight in the good pilot_ Out of ·bec9me physically unfit when expo~d to strain . , This ·
54 candidates who were accepted in spite of "marked . la.ck of resistance appears to be a characteristic of the .
of
tremor," 14 did not qualify, a ratio of success to 'failure ,general '' make up' of the individual, and it must be
2.8 to l. Among 2,000 candidat.es who showed nQ abnor- -supposed that the lack of inhibition in the higher nervous
mal signs, 7.6 per ~nt only were ultimately rejected. It centers paves the way for a spread of nervous impulses;
is the conclusion of Head (op. cit.) that "tremor is not 80 this in turn gives rise to a variety of physical phenomena,
m,uch an.indication of a neuropathie temperament as of a the main·feature of which is overaction," which manifests
definite disturbance of -function.'.' A tremulous tongue itself in the · !!()matic system in various neuro-muscular
may be indicative of chronic indigestion or of alcoholic g'!()Ups, more especially· in the speecll mechaajsm, in the
excess. Tremor of the hands was always found to be asao- !l,Ufunomic system in rapid and disordered )lea.rt ·action, '
ciated with some- obvious cause,. as -Jl;lcoholie ex~, sweating, hyperacidity, raised blood pi;essure; and lOllS
excessive smoking; especially. the perpetual uiisuse of. of weight due to general increase in metabolism. ·
cigarettes, or as a sequel of malarial infection. It was AMERICAN 'RESEARCH -OVERSEAS.
found most commonly, however, .as .a sign,of stress of serv-
ice at the front, exhaustion, and states of · anxiety, and Sev~l papers concerning psychological . research in
was universally present in those officers ybo were ad- aviation .in this, coun~ ha\re appeared in. the American
0

nritted to hospital for some functional psy!!bOllis ("shell journals and .need no further mention. Some of the
shock"); '.Fhe "line drawing and .n ~ test" W&I! re- publi,ihed reporqi have been attempts merely to demon-
garded as a val~ble test and its uae recommended in the . .strat.e. a method, others have involved a ~ful atuµnpt
 32
to determine the degree of correlation of the results with
flying ability.' The results of the various lines of re-
search carried on by the psychology department of the
Air Service Medicai Research Laboratory are also about .
to be published.
The work of the Air Service Medical Research Labora-
tory in the A. E. F., before the signing of the armistice,
consisted principally in routine examinations of student
flyers as conducted at the various fields in this country.
As the number of these examinations was small com-
pared to the number at home and as no new or significant
data were presented, a discussion of these results will be
omitted in lieu of the forthcoming reports from the home
laboratory. After the signing of the armistice the officers
of the research laboratories at Isooudun and Tours under-
took a study, as well as conditions permitted, of those
flyers who had made excellent records at the front and
in the instruction centers. Three groups of flying officers
were examined, the moniteurs of the instruction center
at Issoudu:tl, chasso pilots from the front who returned
to Issoudun on their way home, and observers from the
front who returned to Toms. It should be stated that
only those pilots who had proved to be exceptional service
flyers were examined. The moniteurs examined were
declared by the commanding officer of the field to have
been selected and retained at the instruction center
because they were recognized by the training department
as possessing all the qualifications of good service flyers,
and would doubtless have distinguished themselves at.
the front, had they not been detained for instruction
purposes.
All of ihese subjects were first examined by the depart-
ments of medicine, physiology, ophthalmology, and
otology. Those diagnosed as unfit because of abnormal
pulse, blood pressur.e, respiration, or any other specific
reason that might influence their results in the psycholog-
ical tests have been considered separately. In addition
several who showed unmistakable signs of suffering from
exhaustion, nervousness, or recent excitement that might
render their results unreliable were also placed in the
group of unfit.
The psychological tests applied to the moniteurs and
chasse pilots consisted of the standard altitude test, or
rebreather, simple reaction times to visual, auditory, and
tactual stimuli, and a steadiness test. With the observers
at Tours, in addition to the altitude test, a new test of
speed, reliablility, and confidence of observation was
adopted,
1 i' Air Service Medical," Part II, Chap. VII; ''Manual of Medical
Research Laboratory," IV; "Psychology Department,"~. Gov-
ernment Printing Office, Washington, 1919.
Dunlap, K.: "Psychologic Observations and Methods," in "Medical
Studies in Aviation," Jour." Amer. Med. -Assoc.,- n, 1382-1400, Oct. 26,
1918.
Dunlap, K.: "Psychological Research in Aviation," Science, N. S.
49, 94-97, Jan. 24, 1919.
Henmon, V. A. C.: "Air Service Tests of Aptitude for Flying," Jour.
APP: Psych., 3, 103-1()9, June, 1919.
Stratton, G. M .: "Psycho-physical Tests of Aviators,'' The Scientific
Monthly, 8, 421,-426, May, 1919.
Thor.ndike, E . L.: "Scientific Personnel Work in the Army," Science,
N. S. 49, 53-62. Jan.17, 1919. •
Thorndike, E. L.: "The Selection of Military Aviators," U. S. _Air
Service, 1-and 2, Jnne, Aug., 1919; Jan., 1920; 14-17, 2&-32, 29.'ll.
Yerkes, R. M.: "Report of the Psychology Committee of the National
Research Connell.'' 3. "The Committee on Psychological Problems of
Aviation, including Examination of Aviation Recruits," The Psych.
Review, 26, 94-99, Mar., 1919.
REBREATHER TEST.
While the purpose_of the rebr:eathing test is primarily
for the altitude classification of the flyer determined by his
resistance to effects of low oxygen, it incidentaHy reveals
certain individual psychological characteristics involving
as it does the performance of a task requiring coordinated
and rapid movements and alert extensive attention the
det-0rioration of which is c2.refully noted during the ox~gen
diminution. An intensive study of this feature of the
rebreathing test on 5,000 pilots examined in the United
States is being prepared by Dr. J. E. Coover, formerly
captain, .Sanitary Corps, on duty with the Medical Re-
search Labo~tory, and a comparison with the results in_the
A. E. F. will be made upon its completion. This com-
parison is significant because the group in the _A. E. F.
was composed of advanced pilots from which all the in-
ferior or unsuccessful flyers had been eliminated, while
the group in the States contained many who were still in
training and subsequently proved unfit for flying. A pre-
li.minary examination of the data seems to indicate that
with the pilots in the A. E. F. there is a more decided
tendency to maintain effective attention longer after the
appearance of disturbance of motor coordination, than is
the Cll8e with pilots examined in the States.
REACTION TIME TESTS.
As the Fren·c h depended upon simple reaction time
solely in their psychological examination of candidates for
aviation, it was recommended by the Medical Research
Board that the psychology department investigate this
type of test as to its validity. The moniteurs and chasse
pilots afforded good material for this investigation, as they
were all men of proved ability. In addition we were able
to secure the rating of a large number of these men from
the traiajng department of the instruction center at Issou•
dun. The degree of correlation between their reaction
times and the training department rating should indicate
the value of the tests.
The attempt was made to reproduce as nearly as possible
the experimental conditions of the French methods as
developed by Dr. Nepper. The reaction times were
re~orded with the D' Arsonval chronoscope used by N epper,
with the exception that part oi the reactions to the auditory
stimulus was recorded with the. Hopkins chronoscope in
0.001 second. The D'Arsonval chronoscope was read in
0.005· second. The tactual stimulus was given with a
touch key, which was also used for giving the auditory
stimulus. The visual stimulus was the starting of the
hand oii the dial of the chronoscope. Though N epper re-
corded only 10 reactions with each stimulqs, claiming that
this number gave as reliable a mean as a larger, we made
it a rule to record 25. The results of our experiments do
not tend to confirm his view, though for c).inkal purposes
the variation with each succeeding 10 readings is not so
great· as to be very important.
Table 12 gives the results of the moniteurs and chasse
pilots combined, showing the mean (M) in sigma,.probably
error (PE) and the standard deviatlon of the mean (u) for
the -entire group based on the mean reaction times of each
individual tested, and also the mean probable error and
standard deviation of the coefficients of variation ofeach
individual from .his mean reaction time.
 33
TABLE 12. xiy, _ vl ) 1
r=
( z __
n i
nil
i
-
0"10"2
•

Num- l
Reaction time. I Coefficient of variation. 0. 6745(1-r2)
ber of PEr n .
cases . M. PE: M. PE. u.
"·
--- - - - - -- - -- --- ---
TABLE 14'.
Visual. .... . 148 197 17.9 ±0, 17 3. 0
Auditory ...
Tactual. ....
192 155 !~:: 19. 5
8.3
11.4 ±0.16 3.3 Correlation of training rlepartment rating with average reac-
90 143 ±1. 16 I 24. 7 13. 4 ±0.23 3.5
tion times (R. T, ) and coefficients of v·ariation (C.).
. .
The corresponding mean reaction times reported by the VISUAL REACTION TIMES.
French (Camus and Nepper, op. cit.) are 0.190 sec. for the
visual stimulus, and 0.140 sec. for the auditory and tactual Num- 1 R.T. C.
stimuli. They do not report definitely the amount of de- ber of 1--- - -- 1 - - - - - -
viation from these means, except to say that more than - - - - -- - - - - l-c-M_~_. _ r_._ ·_P
I
_ E_.y_. _ r_._ _P_E_.r_
0.10 sec. lengthening in reaction tiine was considered suf-
ficient to bar a candidate. They also apparently consid- Total. ............ ...... ..... , 110 0.051 ±0.064 0.098 ±0.053
Fit................... .. ..... 93 .113 ± .069 .073 ± .039
ered -6.10 sec. as the maximum deviation of an individual
from his own mean reaction time. It will be observed AUDI'l'O~Y REACTION TIMES.
that our means are somewhat higher than the French -and
that there is a wider deviation not only between individ-
uals but also in the separate reaction times of each indi-
Total. .. . .. . ................ ·I
Fit ..... , ........... ·.. : .... ..
148' 1 0.. 0951±0,0581 0.042 ,. ±0. 055
132 .132 ± .058 ·.188 ± .057
vidual.
In table 13, we have separated the results of moniteurs TACTUAL REACTION TIMES.
and chasse pilots. The chasse pilots are further divided
into the "fit" ap.d the " unfit" on the basis already ex-
plained. AJl of the moniteurs were.reported physica\ly fit.
Total. ......... .... ... .. . .....
Fit ......................... .
l 68
60
I 0.075 l±0.082 0. 011
.037 ± .087 - . 018
I I ±0.083
±0.058

Reactions to tactual stimulus are omitted from this table

owing to the few moniteurs and unfit chasse pilots that are
included.
TABLE 13.
Visual reaction time.
M. I PE. "·
- - - -- -- - - - - - - - - - - - - - - -
Moniteurs... ....... . 189 ±2. 98 23
Chasse, fit........... 197 ± 1.15 17
Chasse, unfit.. .... .. 205 ±4. 22 22
A further check upon the value of reaction times in the
selection of avirtors is the comparison with ratings in fly-
ing ability furnished by the training department. We
should not expect. too high a correlation, even though the
test is a good measure of aptitude in flying, for doubtless
the training depart~ent rating is frequently influenced
by other factors not actually related to flying_ ability.
Strict observance of military forms, sociability, etc., can
not be strictly eliminated from a rating of this sort made
by several different officers under diverse conditions. We
might expect, therefore, that a man might be misplaced
one or more classes in either direction due to these irrele-
vant factors.
It was desired f9r the convenience in handling the data
that the men be classified into 10 groups according to gen-
eral flying ability. Capt. Street , in charge of the training
department, using all the ·records available in his office,
performed this work for us. None of the men we exam-
ined fell in the last four group11, so there are practically six
grades cl&BBified. The results of correlation of these rat-
ings with reaction times and the coefficients of variation
are given in table 14. The coefficient of variation is given,
as it may be an index of stability -or emotional control, as
Nepper suggested. The Pearson correlation formula (Dav-
enport, C. B. : Statistical Methods, p. 45) was used:
55314 0-31- -3
I All the correlation values with reaction times are low,
but the fact that they tend in the same direction may have
some significance, noting that cqrrelations with visual
and a uditory reactions are somewhat higher when the unfit
Auditory reaction time. are eliminated. It is very doubtful, in our opinion, how-
ever, that the simple reaction time can be regarded as an
M. PE. "· adequate test in the selection of aviation candidates. It
-- is possible that more complex reaction experiments, such
153 ±1. 54 19 as those that involve discrimination of varying degrees of
157 ±1. 24 18 d'ffi ul . d d h d f · ·
158 ±2. 73 20 1 c ty, JU gment, an ot er mo es o assoc1at1on, may
· I yield important results. Such·experimentsin the A. E . F.,
I with t he limited _equipment_ and t~me at our. dis~l,
could not be earned. out sat1sfactonly. Experiments m
choice reactions were attempted, but the results are too
\ meager to be of value.
STEADINESS TEST.
Tlie appara:us for the steadiness test consisted of a
sheet of copper about -h of an inch thick and 6 inches
square, in which holes ·were drilled H, H, H, and H of
an inch in diameter. This plate was attached .by one
com er to the window sash and could be turned up or
down sufficiently to bring any hole on a level with the
eyes of the subject when he stood erect. It was con-
nected in series with a dry cell, stylus, and signal magnet,
adjusted to mark upon the smoked paper of a kymograph
revolving once in a little over one minute. The subject
was instructed to stand erect.with the right arm free from
the body, but 1n as easy a position as possible, and with
the stylus held horizontally between the thumb and
fingers as he would hold a pencil in writing. He was to
take his time in inserting·the stylus into the hole and_was
further informed that no record would be made until he
had fairly done so. He was to hold it in the hole without·
t<:mching the sides for a full minute. He w~ warned
against holding his breath, as this would interfere with
_. , . ,-~ --

34
his steadiness before the e1>d of the minute, and ·quite OBSERVER'S TEST.·
regular br~athing was recommended . The largest hole
was used first. AJter the subject had rested about half a Very little attention has been paid to the selet
minute the next smaller·lJ.ole was used, and the other two .' men best qualified for aerial observation, and
holes in _the same manner. ' .strongly impressed upon the olli.ten of the Medi
Unfortunately the fixi.ng solution used to preserve the search Laboratory at the observers school near T,
records was unsatisfactory; and the records were so badly _ which observers from .tbP. front were sent on th,
blurred beforP. vit:i could count the number of touches that . -home, that the aerial observer, froni the' special d
it was deemed advisable to give up the. attempt of such a made qpon him and the importance of his work,-1
quantitative study, Accordingly> the subjects, 128 in as carefully selected and as highly trained as the
number, were divided into five groups on the basis of the Of the various types of wo_rk required of the ~-
appearance of tremor as sho:wn by inspection of the records infantry and artillery liaison, bombing, pbotc
for .the smallest hole. Group 1 (table 15) includes those missions, sketching, and· visua.lreconnafasance, th
subjects whose records showed onl_y a few scattered coh- of especial interest to the psychologist. 'Ihe obst
tacts; group . 5, those showing practically continuoue a visual reconnaiRsance Jnisi'lion' must know his se<
tremor. fectly from a topographical point of view, and n
TABLE 15.
serve and report to the Intelligence Officer any
in the enemy troops and organization and in thE
1 troop-rest area, going to a depth of 50 kilometers
Group. Frequency.
the enemy lines. What is called" cloud reconnai1
a type of observation recommended, gives a sugg,
1 16
2 34 the intelligence and keenness required of the ci
3 38. Very often the clouds are low and form a solid
4 19
5
I 21 probably 1,000 or 2,000 meters. The . (lnemy· t:
vantage of t~e weather to move troops or conv
·The best 9 ill group ·2 were se1ected and added to.group they would not attempt on cleardays. To -det,
1, a.nd the poorest 4 in group· 4 were added to group 5, movements the observer climbs up through the
making 25 in each of the extreme groups. Of these, it was flies by compass until he arrives at the point h,
found that the training department could furnish ratings to observ{l, dives down through the clouds, get,
in aviation ability on 19 in group 1 and on 18 in group 5. informatio'l that he can, climbs up through th
_The distribution of' these ratings in the two groups is again, and goes to another point in the same
shown in table 16. When the observer dives through the clouds, he
TABLE 16. course, get his bearings and orient himself i1
besides ma.king accurate and detailed obse
Among the observatiolll! that he must make and J
. Rating.
Frequency.
I _are: (1) Movements along roads, behind the enem.1
Group 1. Groµp 5-1 troops, their location and direction, and an_esiimat
number; likti'WI.Se of tra:µsports, their na,ture, whe1
1 1 0 eral service wagop.s (rations, forage, supplies, etc.:
2 5 2 .and whether motor or hol'!!El drawn; also moveme;
3 9 3
4 2 5 ·.railroads, whether normal or ·abnormal; trains,
5
6
2
0
7
0 standard or -narrow-gauge, their location and (
7 0 0 and nu.. _ber of cars in the train; the nature of t
I I
8 0 1
whether trucks or·carriages, covered or uncovere,
or empty. (2) Dumps, materiai and ru;nmunit
To determine the relationship between the training: the .rolling stock at stations and in the yards. I
department rating and tremor; the Pearson cos II method increase or decrease in the size of the dumps, ·and
in a fourfold table (Rugg, N._ 0.: Statistic,a l Methods centration at railroad statioµs, itis pot!Sible to detei
Applied to Education, p. 294;, Whipple, C. M.: Manual intentions of the enemy in that .particular area.
of Mental and Physical Tests, I, p. 48) was used: Airdromes, increase in number_and.thefrJocation,
occupied or unoccupied,. and the activity as indi
~ ~ < M ~ L H ! ~ , ;(# tJrzo ~
~ ~= ~m ,~ ~ ~ ~ .P..&!l
men fa:&n.tf.newpomta·of'eoneen.tz:Btion, ay .noti'ng tzac
a=n umber csses po tremor (group 1) and high P!Jth11, smoke from kit;chens, and bonfires BB-signs·ofacti
rating (1, 2,.3) . .•... .......••.. .•...• • .. :: .•.... , 1~ ; ity. "· (5) Villages and t.owns located behind- the enem
b,;;,number cases marked tremor (group '5) &11d hi.gh · :JineB, noting such things as i1i_e number of'people loit,erin
rating........ >.....................·........... 5 a.bou't the street.s, t,o· def.ermine to what-ext.erit they ~
C=numbei_CIIBeB no tremor and low rating (4, 5, being used t.o station troopi,: (6) .Niw l)nes of delenBe,
etc.) ...· .-•.............. .• ....... ,.- .... ::'. ......_ 4 battery pol!itione, especi~lly before -th¢.r camouflage. lil
d=number cases marked tremor and low rating... . · -13 completed, trenches, gun emplacements, rai~ unde.l"
The.index of_conelation was found to be 0.725 ± 0.181, construction. must all be watched very closely. (7)
in very striking agreement with Head'~ statements regard- : Enemy aerial activity, t~e number of planes, their type,
ing the British findings in their studies of. tremor. insignia and marking~, location and altitude, and their
 35
aggressiveness; hostile balloons, and the exact position -by closing one of two keys as quickly as he . identified
of the balloon beds; and anti-aircraft artillery, their ac- each as the "sam·e" or "different" from the one he had
tivity, which is usually a good indication of the enemy's- learned. The time elapsing between }he ill~flatjon
intentiona. of the slides by the experimenter and the discrimination
With these deIIJ.ands on the observer in mind, it was -r ecognition reaction by the subject was measured in
desired to devise a laboratory test that might reveal indi one one-hundredth seconds by a. time marker on a kymo-
0

vidual differences in the quickneBB, accuracy, and cer- gra.ph.

tainty of the observation of a situation, requiring definite · In scorfug the results the accuracy was graded on the
study, especially of the nature and relation of parts in its basis of 100 for correct reproduction, debiting .Bl points
recall and in its recognition Whf n again presented . 'Ihe for each misplac!l(i disk, 81 points for each wrong indica-
teat here described was applied to about fifty observers tion of color, and 16i points for eJl.ch disk addi0, over the
returned from the front. Incidentally, the introspection correct numb~r six, which was the number on the slide .
many volunteered seemed to indicate that.it involved a The value of confidence was graded hy assigning 100 for
very similar mental performance .to that in actual condi- -correct report and judgment by the subject that he was
tions of visual reconnais _ance in aerial observation. A certain of his accuracy (A), or if incorrect and judged as
series of aluminum slides, 16 cm. square, each ruled off certain that it was inaccurate (C); assigning 50 for both
in 2-cm. squares, and with lioles 5 IllIIl,. in ·diametel', correct and incorrect report where the judgment made
drilled at six or seven of the 49 croBBlines, was prepared . was that he was uncertain as to his .accuracy (B); and
These hales were covered-with red, green, or white tiBBue aSBigning O where the . judgment was made as certainly
paper or gelatin. When a slide was inserted in the win- correct or certainly incorrect when the accuracy was the
dow of a lightbox and illuminated from·behind, the ho_les .opposite of the judgment. Where several trials were
appeared as colored lighted disks-of about equal brightneBB necessary before a. correct report .with confidence A was
on a black surface defined by a white border. 'Ihe mndow made, the totaltime to study, the total time to report, the
wa.s covered by a thin opensweave black cloth, and pro- average a.ccl!.l'acy, and· the average value of confidence
tected from side lights by a hood 14 cm. deep, .and when were calculated. The average results of the group of 47
unlighted tlie surface of the slide appeal'ed as a uniform observers returned from service on the front a.re given in
black area. The lightbox, on - a swivel base so that it table 17
could be swung around to the experimenter for changing TABLE 17.
slides outBide of the sul:Jject's view, was placed .on the
table at which the subject sat, about 1 meter in front of
him. A slide was inserted 1n: the window, illuminated, - - -- - ~~ - - - -,--- - ~ - "-
M.I I
FE,. Rim'.ge.

and the subject giyen instructions and practice in plotting Number of trials necessary , - -. - -- 3. 45 ±0. 19 1. 93 1 - 8
the arrangement, by noting their relation to the_border Total time to study, seconds_- -.. . 102. 45 ± 6. 02 61. 20 27. 0-319. 0
Total tima to report, seconds .. .. . 149. 04 ± 9. 33 97. 561 18. 0-434. 0
and to each other, and indlcati.ng the color of the disks on Average accuracy, per cent. -... - . 80. 96 ± 1. 25 , 12. 68 100. 0- 50. 0
a piece of coordinate paper ruled in l:cm. squares. When ·Average value of confidence, per
cent..... . ·•. . ...... - . -- . ·-- - -.• . 65. 00 ;.2.14 21.75 _100.0- 17. 0
the procedure was learned, the light was cut off, the prac-
tice slide removed and replaced by another. '.fhe subject
had at hand a telegraph key by which he could at will In the discriminative recognition reaction times com-
Jtght the box, and, by holding the key closed, keep it parison was made between the reaction times of.the sixth
lighted as long as he desired. He was instructed to turn and seventh slides in the series, the sixth being" Different' '
on the light an~ study the arrangement of tlia colored and the seventh being " Same," having. been preceded in
disks until he felt certain .he could map them accordingly the oroer: first, Different; second, Same; third, Different;
on the coordinate paper, and to . do this in the shortest fourth, Different; fifth, Same, the " Different" slides ·in
necessary t1me. The experimenter, at the side wh.ere he every case being different from each other as well. Forty-
could watch the work, noted on a stop-watch (1) the Gne ob~rvers returned from the front ·gave the average
ti'IIU to study ta.ken. When the subject indicated his results shown in table 180
readineBB·to map the slide by releasing the key·and dark- TABLE 18.
ening the box, he was given pencil and coordinate paper,
and (2) the iime to report the arrangement and.indicate the Reaction times tn 1/100 seconds.
colors was ·no~d. 'Ihe subject was . then . asked ·to say
how certain he was of the accuracy of his repo~ . . ,, c~- M. J?E11.
" C. 'Range.
tain that it is '.occura.te, ' ' '' Doubtful if accurate!' (indi- - - - ~- -- - 1- - - - - - - - - - - -1- - --
cating doubtful ru>ints by a. question mark), and ·"Ce,r- Different ..... .. .... ... __ 97. 92 ± 3. so 36. 10 o. 37 46, 0-m. o
Same....... . . . , __ , .. . ... 92. 55 ±3. 30 -31. 35 . 34 34. 0-159. o
tain that it is not correct," noted by the experimenter ~ -
under (3') COf\/iaence cif report a.s_A,, B, and C, respectively: . .
The "experimenter noted (4) the accuracy .ofrepart and•if ·The difference ·b etween the a.ve_ragea of the two reaction
incorrect, or if confidence B or C another· trial wa.s·.given times is slight and not significant (D=5.37 PED=±5.03
following the j!lime procedu,re, and (5) the number of trials although the variability ol the "different" reactiops is
neceesa.ry' for accuracy and CQnfidence A noted. When slightly more and the range greater than that of the
this ·pa.rt of the test was completed, the slide was re- "Sa.me.''
moved, and a dozen slides, a.mci~g which several times at An attempt WB.1:1 ma.de to determine the relation of the
random tnis slide which had just.been stµdied and 'lDapped performance in this test !,ti success as an observer
appeared, were . inserted in succeBBion, illuminated by Ra.tings 1, 2, and 3 (1 being the best) were ma.de of these
the experimenter, and the subject instructed_ to react observers by Ca.pt.lrln Cary, Marine Corps, at an interview
 36
which he held with each man, basing his estimate of the· could be obtained. Forpurposesohdequatelytestingthe
man's ability on a complex of impressions gained from test, such a rating would of course be necessary. Com-
his appearance, manner, attitude, report of his experience parison between two groups, . group I containing those
at the front, etc. Unfortunately no more objective meas- rated I, and group 2, those rated 2 and 3, are shown in
ure of the observer's success or failure at the front, and tables 19 and 20.
specifically as an observer on visual reconnaissance, ,
TABLE 19·.

Groui;, 1-24 cases. Group 2--23 cases. Group 1-Group 2.

Contaming rating 1. Contabili)g ratings 2 and 3.

M. . .PE,..
"· c. M. PE...
"· C. D. PE,;.

Numper of trials necessary•.••...... .. ......... ..•:. 3. 75· ± 0. 27 1.99 0;53 3.13 ± 0.26 1. 114 .0.59 0.62 . ± 0.38
Total time to study, seconds........ •. . . .•.... • .... 108. 75 -± 7.05 51. :Kl 95.85 ..± 9.51 67.80 12.90
Average time to study, seconds •......•............
Total time to report, seconds .•••.•.. . ... • ..... ·....
34.60 ± 2.29
162; 51 ,±14.26
16.17
103.83
:~
.63
37.~ ± 2.89
135.00 ±12.42
:Kl. 60
88.·50
• 71
.55
.66
'- 2.60
±11.84
± 3.68
27.51 ,±19.12
Average accuracy, per cent •••• . .. ••.........•.... ; 75.83 ± l.~ 13. :Kl , 17 SIi. 30 ± 1.33 9.46 .11 -11.30 ± 2.25
Average value ol confidence, ·per cent ...., •......••. all.17 ± 3.39 24.42 , 41 71.09 ± 2.39 16.33 .23 -11.92 ± 4.15

Inspection of table 19 does not seem to differentiate the
two groups in any striking way. Diffe);flnceli in the
ineans are present but not significant. The difference (D)
between two . means fu be significant should exceed 4l
times the value of the probable· error of. the difference
(PEn). In one case only we find a significant difference,
that in Average Accuracy, in favor of group 2. As to varia-
bility (C), group 2 is more variable in "totaltime to study,"
TABLE
while group 1 i!! more variable in "average value of confi-
dence." In the case of ''average accuracy," while the dif-
ference in means is in favor of group 2, the variability of
groupi is grP.ater, arid the coefficient.of correlation between
mting and accuracy in the total group was found to be
hign, 0.482±0.172 (Pearson's cos.,.. method).
Compa.risori of -the two .groups in discriminative recog-
nition time is shown in table 20.
20.

Group l-20cases. Containing rating 1. Group 2--21 cas~nia.ntaining ratings Gro1,1p 1-Group 2.

M. PE11. .... C. M. PE.11. . "· C. D. PE».

. ---- - - ------------ . .

w,
R831;ti~n time 1/lW sec,:
D11ferll!lt • . • . • • . . . . . . . . . . • . . . • • . • • 92. 00 ±5' 84 : 38. 78 0.42 98.32 ±4.61 31..40 0.32 - 6.32 ±7.42
"Same" ..-..... . ..................... 75.00 ±4.04 26.84 • 36 109. 30 :!,5. 19 35.30 .32 -34.30 ±6.58

It is seen that group I is decidedly quicker thtm group 2
in recognizing the slide that has been studied aµ.d mapped
(D=34.30, PEn=±6.58). The coefficient of correlation
was .found to be high between rating and quickness in
this recognition, 0;729±0.173.. This fact is interesting
when it is recalled how important suchrecognition is_in
·conditions· of actual aerial observation. Group I is quicker .
(18.5 per cent) in its identifying the "Same " than· the
"Different,!' while group 2 is ·slower (11.2 per · cent), the
difference in the means b~ing for group 1; 17 .00± 7.IO, for
group 2, -10.98±6.94.
PERSONALITY.
Aside from laboratory test methods of discovering the
qualifications that make the successful flyer the Medical
Research Laboratory sought to get an insight · i~to t~ ·
temperament and personality of these men .by systematic
interviews, and.more particularly in the arrangement made
by which one of the writers (Capt. Dockeray) completely
identified himself witn the flying personnel, taking the
R. M. A. training, al!.d being put on flying status. This
officer, when ass}gned to flying duty, ate at the flying
officers' mess, reported at formations, and in every way
possible conformed to the routine of flying training that
a student flying .officer undergoes.- Thus, in addition to
the experience in flying, he was able to meet more in-
tin).ately hundreds of flying officers, who talked much
more freely than when they came to the laboratory. in
this way the personality of the aviators, their habits of
recreation, manifesj;ations of staleneBB, and their flying
aptitude as observed on the field were studied , The gen-
eral impression gained was that flying demands and encour-
ages a degree of individualism · unknown in .any other
branch of the Army, somethi!}g which has been given full
recognition in the French, ·and especially in the British
service, but too often: not in that of the United States.
In learning to fly, as in the acquisition of any complex
act of skill, there are definite periods of ,lapse in improve-
ment dtie to certain difficulties in adjustment · of- tl).e
organism, and aleo to the change in attitude of the learner.
The former should be understood by the ruoniteurs and
others directly in charge of the cadet's .training, as it
would be of ll,BBistance in preventing accidents, as wen ·as
in judging the cadet's ability. The attitude of the cadet
is largely influenced by his success, but also by the physi-
cal conditions surrounding him, such as quality of food,
sleep, recreatio11, and .the relation to his superiors. There
are times when the aviator does not ''feel ·like flying," as
he says, not due to lack of willingness or desire to fly, but
due to an inability to "pull himself· together." It is a
common belief among aviators .that they should not be
compelled to fly at such times. There is no doubt that
 37
often this feeling can be overcome, especially during
emergency, but it is equally certain tliat it should always
receive due consideration during the first weeks of training,
and should be thoroughly understood by those in charge
of flying.
.As to the personality of the aviator, it seems that no
general rule can be laid down. Quiet, methodical men
were among the best flyers. What seems most needed by
the aviator is intelligence; that is, the power of quick
.!
adjustment to a new situation and good judgment. He
need not be so quick in rrwtor adjustments, provided he
thinks clearly or makes quick mental adjustments. The
nervous, high-strung individuals, or those bordering on
the temperamental, are the least reliable, for though they
often become good flyers, they are the most liable to
become psychotic under streBB.
(By courtesy of "The Psychobiology.")
PSYCHOLOGICAL EFFECTS OF DEPRIVATION OF OXYGEN-DETERIORA-
TION OF PERFORMANCE AS INDICATED BY A NEW SUBSTITUTION TEST.
By H. M. JOHNSON, Captain, Sanitary Corps, U.S. A., and FRANKLIN C. PASCHAL, Assistant Professor of Psychol.ogy,
· University of Arizona. ·

INTRODUCTION. material yielded · by themselves as well as by other sub-

. jects. 2 The material as presented in fragmentary form
In the routine classification tests of American military is not ·readily susceptible of analysis, and the conclusions
aviators according to their ability to resist . depletion of
drawn from it have not been .inanim:ously accepted.
their oxygen supp~y, the 'rating of their psychological
The J)re~ent type of experiment was selected for use 'in
performance is based on criteria which m~t be evaluated a part of this- investigation,. since it involved sustentation
by the psychological observer during tlie progre38 of the
of the visual function, attention, memory, and muscular
test. In this respect the criteria. of ch!,s~ification are in a '
coordinatfon during a longer ·period than can be included
measure "subjective " in character. Like all clinical
in an ordinary voluntary "spurt." Certain of the factors
data, they depend to some extent on the personal biases
_irivolved are also capable of being isolated for further
and different degrees of impre38ionability of the· observeta.
study by other methods.
A statistical investigation is now in progre38 at the Air
-Service Medical Research Laboratory for the purpose of THE METH()D EMPLOYED.
retimating the importance of the personal equation of the
psychologist in his weighing of tlie criteria. The results The task assigned the subject is the transliteration of a
obtained to date indicate a. definite influence, which tiuIJ1ber of sets of nonsense material into corresponding
usually ie not seriously. large, and · k probably capable of · codes, one of which is presented with each set of material.
being corrected for. · The codes are fro.ma group compiled by Capt. Joh:nson
From the earliest stages of the development of the with a view of insuring the closest practicable li.pproxi-
psychological studies of, the effects of deprivation , of ination to equality of difficulty. After a large number of
oxygen, it was recognized that a test which would furnhh 'systems for deriving them had been tried and rejected,
an "objective" measure of the extent of deterioration of ·a method , of satisfying this condition was found. The
behavior would have greater authority than the ''clinical» different sets of test material were derived by trans-
methods which were finally adopted. One difficulty !iterating a single set succeBBively into the several codes.
underlying the development of "objective" tests lje3 in Thus the several sets are also of approxim~tely equal
the fact that the efforts of the subject to compensate for difficulty. The.codes and thetestniaterialareI'eproduced
the deterioration in his responses by the expenditure of in the app_eiidix; with a brief description of the method of
greater energy· in " voluntary" control ar~ not readily preparation. ·
-recorded in an interpretable · manner. These data are Most o! the tests were administered by Dr. Paschal
folly as important as the variations in speed and accuracy, . according to the following method: The subject is seated
and in some cases are even more important. Unless they -in front of the Hendel"BO.h rebreathing apparatus, behind
are included in the record, or a.re at least considered, a an adjustable desk, to which a large ruled card is secured
mere inspection of the s_ubject's record of performance may b~low a rack -provided for reception of the test card.
give a very misleading impression. (Cf. appendix.).
A sample-test card is placed in the rack, and the subject
PURPOSE OF THE PRESENT EXPERIMENT. is instructed to print3 on the large ruled card the letters
presented in the ·given code tci be substituted for the
In its essential.features the test described belqw is one letters in the set of test material.
of several whi.ch were attempted early in 1918 and aban- The subject is informed that his performance depends
doned. In January, 1919, the original method was mate- on both time and accuracy, and is measured by the number
rially improved and used for another purpose than the of letters correctly substituted in.a unit ()f time.
original one, namely, as a part of a somewhat general
attempt to ascertain whether the more complex processes • Cf. Dunlap, Knight: "Psychological research in aviation." Science,
of behavior tend to deteriorate before, after, or simul- N. s. vol. 49, 1919, pp. 94-97.
• It w11s observed 4uting the exploratory work early in 19J8thathand-
taneously with the simpler processes. writing became more illegible than printing at advanced stages of oxy-
A definite impression regarding this question was made gen depletion, a fact which was later made the subject of a specialstudy
on the pioneer invretigators by a mass of observational by Maj. John B. Watson. In the opinion of Maj. Dunlap, who was in
charge of the earlier work, printing ·a s a substitute.for writing also
• From the Air Service M<\(}ica\ Research Laboratory, Mitchel tended to lessen the disadvantage of the more clumsy and excitable
Field, Long Island, N. Y. subjects. ·
(38)
 39
The subject is then .c onnected with the rebreather, and when the oxygen contends depleted to a point between
the work is started} 15 per cent and 12 per cent. In many subjects this dis-
In the actual experiment the following procedure is turbance is compensated for by an increase. of muscular
observed with respect to presentation of the material: activity. The compensation may be partial, as in No.
The test card is laid in the rack, face down. The suoject 6877; complete, as in No. 6864; or excessive, as in No.
is warned by the BP,oken words, "Reagy! Now!" and the 6924. In some subjects the tendency is not apparent.
face of the card is exposed. A.stop watch is started when Occasionally, as in No. 6889, the increase of "vofontary"
the .subject begins to print the. first substituted letter anp. effort-due to the diminution of apprehension, distraction
is stopped when the subject ta,ps on the -desk to indicate of surroundings, etc., and the increase of interest-is so
that the last substituted letter hJl.B been printed. To,guard great that the performance steadily improves in spite of
against the appearance . of certain spurious effects, the the deleterious effect of depletion of oxygen, . until the
several sets ·of test material are given in an-irregular se- subject approaches cardiovascular collapse.' . In this con-
quence, which is di.fferent for most of the 1;1ubjects. nection, it nui.y be remar\ed that one of the most fre-
quently noted effects of diminution (if.the oxygen supply
RESULTS OF THE TEST. -i s a constriction of the field of attention, ·which facilitates
the ·application of effort exclusively to the task in hand.
-Unsuccessful _tests were run on nine subjects before tlie IHhe task is sWficiehtly simple, improvement in perform-
method was sufficiently standatd.ized for i:!se. Due· to
&lice may .result. ·
failure of proper control of 'the appar~tus, three other A brie{ col)'.lment is presented with the graphic record
experiments were considered uilBatisfactory. These rec- ,1n each case, .and should assist materially 'in interpretation
ords are not inciuck,d among the resuits presented below. of the record.
'.fhe abscissa! values of the cutvea of psychological perc · The ·reader is e11rneatly_cautioned against drawing con-
formance represent the middle point of the temporal clusions froiii superficiai inspection of the graphs. Cox'i-
period of work on the given set of mat.eriaE At first trary_to tl!-e fir11t visuai impressions, the graphs do not give
attempts w~re made to maintain a constant· temporal a quantitative 1ndication of,the extent of deterioration of
interval, or "headway,,., betwwn the presentations of the. performance, Tliis-fact will be made clear by considera-
several sets, but the flµctuations of performance tendered tion of.the I.oilowing facts: ·
this impractfoable. Later· an attempt was made to main~ i . .It would be unfair to compare the performance of
tain a constant period ofrest between period.a of work, and ' subjects havi.ng different degrees of dexterity with a
this attempt was more nearly, though not compl_eiely, suc- uniform standard, ·
cessful, the principal source of variability being the ·2. Owing to the fact that the subjects are available for
necessary activity of the clinician. only a singie sitting~ it is l).Ot easy to establish a "normal''
The scale of ordinates was arbitrarily chosen fro~ the perfprmance for each one, with which the performance
standpoint of convenience in plotting. , Each ordinate rep- under · dimi.nished oxygen may b~ compared. As . was
resent~ five times the -average nUmber of.letters correctly pointed dut'i~bov~, the initial perfor~nce and also the
substituted per·minute. rate of improvement wfth. practice depena so largely oh .
variable and unconti'ollabl_e factors that the subject's .
DISCUSSiON OF GRAPHS.
·capability is not necessarily indicated. by them.
Most of the records show an important d.!)_gree of improve- 3.. The rate of deterioration can not be determined accu-
ment with practJ.Ce as compared with the in).iial perform- rately by the slope of the latter part of the cur:ve, as this de-
ance. The raie ·9f improvement varies widely with the pends in large part on the reJative excellence of perform-
different s_ubjects il.fid depends in large degree on their rela- ance before deterioration began. Also, all experiments
tive composure, distractibility, and i~terest. When the can iiot be terminated in the same phase of the·period ·of
mouthpiece is first inserted , (as indicated by an asterisk. work. _Indeed, not infrequently a sudden collapse QCCurB
on the graphs), a :lioticeab}e,,disturb!lnCe usually results, during a period of rest. Also; ' the· first appearance of
but this'is usuallfquickly'overcome. · symptoms' of profotiild deterioration is separated. from the
In those cases1n which-the rate o1 improvement is rapiJ, symptoms of impending collapse by a temporal interval,
the. curve of performance reaches a level rather quicldy; .which varies widely among different subjects. Therefore,
and such subjects usually show . a definite deteri9ration the till).e· of removal ·is often determined by considerations
of sarety of the subject, and it frequently occurs too early
· • In the earlier experiments the subjects worked up three sets of mate- in the work-period to permit of completion of the last set
riai before the 11'.l()llthpiece was inserted and two additionalsetsafterthe of material. The performance·during the last period being
mouthpiece was.inserted and before rebreathing was col'.Ill'.Ilellced. .In
these experiments the unmodified Henderson rebreather was used,.and integrated over only a short time, the value of the l!I.Bt
the duration of the experiments was in many cases shorter than was ordinate Dll\y be largely determined by fortuitous factors. ·
desired. Through a method devised by Capt. D. C. Rogers, of the sec- 4. The deleterious effects of depletion of oxygen may be
tion oi psychology, it qecame possible to increase the duratiOll of the run compensated for, for a time, by increased voluntary .effort,
as much as was desired, and to control, within reasonable lull.its, the
rate of consumption of oxygen. In these experiments the mouthpiece
and thus may fail of adequate representation in the graphic
was inserted and re breathing was started before the 11,rst set of material rec;ord. · .
was presented; but during the first thirteen minutes (in certain cases, With these precautions -in mind th!! graphs, atipple-
five minutes) all thi, oxygen consumed by the subject was replaced as mentecl'by clinical notes, are useful. ',rhe ~cip-1. reason
consumed, so that during that time the air was normal with respect to
fo~ presenting_ the results . in this form is that graphic
oxygen content; The position of the asterisk on the graph and the ,
accompany:ing note will indicate which type ofrebrll&thing was used in records; considered as wholes, are more -easily compre-
each case. . hended than tables. · ·
 40

Fm 11.
June 2, 1919. No. 6892. 2d lt., observer; a11e unknown; single; ranchman. 40.honrs' _flying.
Run was preceded by 13 minutes' rebreatbing during which the oxygen was replenished as consumed.
A distinct recovery from initial impairment followed by a steady dectedse in perfonnance, coincident with
a diastolic drop. Removed for inefficiency after failure to find the next letter in several attempts. Muscular
ineoordination with marked tremor durlng twentyaseventh minute.
 41

FIG. 12.
April 15, 1919. No. 6871. 2d lt., pilot; age 26; s1ngle; ban.li:er; 2 years college. 150 hours' flying; 180 ovl!E'
seas; 3 over lines. Suffering from loss of sleep.
Initla! performance, rapid, accurate. Greatly dlstrubed when mouthpi8C8 was inserted (set 5) but reoov-
8l"ed. Removed by cliniclan on account of h ~ murmur before deterioration of behavior occurred.
 42

Fm. 13.
April 28, 1919. No. 6880. 1st It., _observer; age 26; single; nurseryman. 110 how's' flying; 8 combats;
one crash; a poor fan.ding ; 18,500. feet for 10 mi.mites; pliysical condition good .
Run was preceded by 13 minutes' rebreathilig, during which the oxygen was replenished as consumed.
He attained high speed and accuracy, which· continued until the eighteenth minute, when he began to
be less accurate,,though speed did ncit , suffer. H<3 was prel"3turely removed at the. thirty-first minute by
the clinician. · ·
This case shows the stimulation that occurs upder low oxygen, the greatly incr01\5ed speed being at the
expense of accuracy. ·
 43

Fm.14,.

April 1s;·1919. No. 6863. 1st lt., pilot; age 26; married; mining engi11eer; college education; 300 hours' fly-
ing; see; suffering from cold; only. 4 horn:s' sleep previous night; stale; tired of flying; when taken. off was
troublll(l by insomnia.
Initial performance, accurate, fairly rapid. Steady improvement with practice. Deterioration expressed
in diminished speed, beginning in twenty-second to twenty-third minute, and accompanioo by controll!ld
fall in diastolic .]). P. No errors until last set. Letters. quite legible to the last.
 44

FIG. 15••
Ma'rch' U, 1919. No. 6653. 2d It., A. S., A.; age 24 years; single; mechanic; J year high school; 100
hours' flying; maximal altitude 18,000 foot ror 10 minutes; physical conditfon good.
Initial performance only fair, due to slowness; few errors; slight disturbance when mouthpiece was in-
serted. Considerable improvement from practice during first half'of test. Deterioration,due to impaired
muscular coordination, resulting in slowness.; began nt 21 to !2 minutes between 10 and 11 per cent 0:.
Greatly increased effort. Hard pressure with pencil from twenty-first minute, very tremulous at twenty-
sixth. Unable to form letters after Z1 minutes 13 seconds.
 --
45

FIG. 16.

April 22, 1919. No. 6866. 2d It., pilot; age 22 years; single; merchant; 5 years at Yale; 100 hours' flying,
all overseas; maximal altitude 12,000 feet for 15 minutes; suffering from chronic cough. ·
Slow and accl)rllte at start. Excited when ·mouthpiece w~q inserted (made 4 errors in set 4.) Improved
in snbsequent performance. Deterioration from seventeenth to eighteenth minute in both time and
accuracy. Impairment of performance accompanied by diminution of diastolic B . P.
 46

, Fm. 17.

, .April 21, 1919. No, 6879. 2d lt., pilc:it; age· 24; singie; bacteriologist; 250 hours' flying, 100 !,lours over
lines; several combats; 24,000 feet for 5 minutes without oxygen, and' 20,000 feet for 45 minut~; physical
·condition good.
Run was preceded by .5 minutes rebreathing, -during which .the oxygen was replenished as consumed.
He attained his maximal performance almost at the start and maintained it up to the fifteenth minµte,
when deterioration began and continued up to the end. He was tak~n , off by the psychologist at
25:23 8S iJ!.efflcient, when he had become very slow and Wli3 making numerous errors.
 47

FIG . 18.

Jlj:ay 13, 1919. No. 6882. 1st lieut. pilot; _age ' 27; single; personnel service; 100 hows' flying, noy.e
over lines; 1 crash;pQOr landing; physical,condition good . .
Run-was preceded by a minutes' rebreathlng;dnrlng which the oxygen was replenished as consumed.
The _performance was constant-until the twenty-second minute, when a retardation occurred 'accom-
panied by a.rise in respiratory ~ate and a pulse p'ressnre. The speed_of performance decreased and thll
number of errors increased until .the last minute, when he. almost ceased working altogether. He WSI
taken off by the psychologist at27:10fo£inefllciency. ·
 48

FIG.19.
April 23, 1919. No. 6589. 2d lieut ., A . S., A., pilot; age 28years; single; superintendent of public schools;
no service overseas; 130 hours' flying; maximal altitude 10,000 feet for 15 or 20 minutes; suffering from nasal
catarrh; condition otherwise good.
Well composed. No disturbance when mouthpiece was inserted. Considerable improvement with practice
during first half of test . Deterioration began in region of sixteenth to seventeenth minutes, 12 to 11 per cent
o, Completelyinefficientat twenty-sixth minute (6.8 per cent 0 1)
 49

FIG. 20,
May 26, 1919. No. 6887. 2d lieut ., observer; ag;e 25; single; ban.ker; ·75hours'·flying; maximal altitude
15,000 feet for 5 tninutes.
· Run was preceded by 13 minutes' re breathing, during which the oxygen was replenished as·consumed.
B!lth the speed and accuracy were somewhat low. Final deterioratfon. began at the eighteenth minute
coincfdent w1th the beginning of a controlled drop in diastolic B . P., reaching comp1ete inefficiency at
29:10, when he was taken off by the psychologist . · He was th.en deficient in motor control, and at the end
had superimposed four letters.
55314 0-31--4
 50

FIG. 21.

May 11, 1919. ~o. 6874. 2d lieut., pilot; age 23; single; clerk; 100 hours' flying, 30 overseas, none over lines; I
crash from forced landing; physical condition good, but slept poorly the night before.
Run was preceded by 5 minutes' rebre»,thing, during which tho oxygen was.-replellWled as consumed.
A rapid improvement over the initial performanc~ with a decided dro,1> when mouthpiece was introduced.
There was a steady im:'.)rovement up to the thirteenth minute, at which time a very high speed.- was attained.
From this point, coincident with a rise in pulse rate and pulse pressure, there was a drop to the level orthe
previous sets, and after the eighteenth minute a rapid decline of both speed and accuracy. At 26:25 l!e had
become inefllcient through deterioration of both attention and muscular coordination.
 51

FIG. 22.

April :a;, 1919. No. 6884. 2d lieut., A. S., observer; age 25; single: student; 5 years State normal; 2 years
basketball; 125 hours' flying,~ overseas; no records or combats or crashes ; maximal altitude 15,()()() feet for 120
minutes.
Initial performance, accurate, rapid . Disturbed by introduction of mouthpiece, but increased speed with
practice during the work in n_o rmal air. Significant disturbance a t 11 to 12 per cent oxygen in the .form of
decreased speed . This was more than compensated for by the exercise of greatly increa~ed effort, which later
ceased to be effective. Experiment terminated prematurely by clinician.
 52

·FIG . 23.

April 9,- 1919. No. 355. 2d lieut., A. S., A., pilot; age -24; married; student; returned as casual from
overseas; 76 hours of flying, 30 hours overseas, It hours over lines; maximal altitude 12,000 feet for 120
miputes; present health good.
Disturbed by insertion of mouthpiece before fifth set presented before rebreathing· began. (This ·is
plotted by mistake on the zero absscisal c_oordinate.) Recovery and improvement. Gradual deterio-
ration from si:i:teenth ])llllute, 11 to 12 per cent o,. .II\ fajnting .condition when removed. Inefficiency
concurred with circulatory break. Duration of test 28 minut.es 40 seconds.
 53

Fm. 24.

May·5, 1919. No. 687l 2d li~ut ., pilot;> age 27; single; man!lger·of store; 125hour-s• flyjng, 60.ov;erseas,none
overJi_il.es; no combats ot crashes;-physical condition good; -rated as stale. ·
-~ was preceded l!f 13 minutes' rebreathing,-during: -w ~ch the oxygen was r~plenish~ as coil3Uirled.
In1Cla!' performaneil fairly .rapii:l., accurate. '~ e d gl)Jle~I level of · performance in fifth ~.t• . General
ret~dation, witii not over 61?0r·cent em,~ fl"orn tw_ent:i:sixtiu\linut~. . . .
 54

FIG. 25.

April 30, 1919. No. 6864. 1st lieut., A. S., A.; age 22; single; undergraduate student; 500 hours' flying, 450
overseas, 100 over lines: no crashes or combats reported.
Run was preceded by 13 minutes rebrtathing, during which the oxygen, was replenished as consumed.
Initial performance rapid, accurate. Improvement from seventh minute under diminution of 0 2 • Confused
at beginning of set presented in seventeenth minute; made several errors, which he paused to correct. Next
performance improved . Inaccuracy manifested from twenty-third· to twenty-fourth minute and increasing
slowness from twenty-sixth to twenty-seventh. Removed ·by clinician before reaehing complete psycho-
logical breakdown. ·

...
 55

FIG. 26.
April 17, 1919. No. 6869. 2d It., piiot; age ·23; single; automobile business; 2 years high school; 200 hours
flying, all overseas; physical condition gooC:, but rated as stale.
Initial performance, slow, accurate; considerable improvement with practice. Deterioration from eighth
to ninth minute, due. to decreased speed. When removed, subject was superposing one printed letter on
another, his work in the last set being almost illegible. This effect preceded diminution of B. P.
 56

~o. '}{I,

April 25, 1919. No. 6865. 1st lt., A. s.: pilot; ·age 26; single; salesman;· high school educatioµ ; rootblill'team, ,
1912-13; 500 hours flying; 425 overseas, none over Unes; no. ere.shes,
· Slightly disturbed by insertion or meutbpiece. U1;mstially.slow from begib.)\ing;· accurate; speeil increased
slovly with practice. Deterioration began in neighborhood or 11 per cent oxygen, In form of slowing or
responses. Subject attempted to compensate by greatly increased effort. Experiment terminated prema-
turely by clinician.
 57

FIG. 28.

May 10, 1919. No. 6877. 1st It ., obser=; age 28; single; civil engineer; 75 hours flying, with 40 over lines;
8 crashes, 3 from poor landings and 5 from forced landings; physi,;al condition good, but had little sleep· the
night before examination.
Run was preceded by 5 minutes' rebreathing, during which the oxygen was replenished as consumed.
A high speed was soon attained, somewhat at the expense of accuracy. There was a decrease in speed at
the eleventh minute' to a rate which remained constant to the twenty-second minute, when the final slowing
up began. Hewastakenoffby the psychologist at 27:49·.for inefficiency, three· letters having been superim-
posed at the end and a number of mistakes had preceded. A controlled drop in the diastolic B. P . occurred
during the last series.
 58

FIG.29.

May 16, 1919. No. 6891. 1st lt., pilot; age 77; single; lawyer; physical condition good; 40 hours flying, none
over lines; no crashes ·or combats.
Run was preceded by 13 minutes' rebreatbing, during which the oxygen was replen.shed as consumed.
There was a tendency. toward increase in performance lewl until the last two series were reached, being
partly due to decreased Bttfilltion to the legibility of his writing and partly to an attempt to increase speed.
When removed be had become unable to make correct substitutions, this being coincident with a sudden
drop In diastolic B. P.
 59

FIG. 30.

May 1, 1919. No. 6827. 2d lt., A.S.A.; age 25; single; draftsman; 175 hours flying, 140 homs overseas, none
over lines; no combats or crashes; present condition good; rated as "stale." ·
iuttial performanct' rather rapid, few errors. Effects of early practict' inconsistent. Accurate and fairly rapid.
Slight deterioration at about fifteenth minute, compensated for by increased effort. Deterioration began in
twenty-fourth minute between 10 and 11 per cent o,, due first to inaccuracies and later to l~s ot speed. Re-
moved prematurely by psycholosist. Record interesting as e.'ICample of result of compensatory effort.
 60

FIG. 31.

May 8, 1919. No. 6876. 2d lt., pilot; age 30; single; electrical engineer; 350 hours flying, 11.ll..overseas; no
crashes or combats; 24,000 feet or 20 minutes; ·physica} cgndition good.
Run was preceded by 5 minutes' rebreathing, during which the oxygen was replenislied as consumed.
This work was quite rapid and accurate; with an initial impairment cofncident with a fall in diastolic
B . P . at 19 minJ)tes and the final deterioration began at 23 minutes accoxnpanied by anotl:er fall in tl:e dias-
tolic. A sudden broo,k in the latter caused the clinician to take him off just before complete inefficiency was
reached, but not-until he h~ shown a distinct deterioration in speed and legibility and had made many
errors and repetitions. ·
 61

Fm. 32.
June 5, 1919. No. 6894. 2d lt., pilot; age~; single; ranch manager; 100 hours flying; 1 crash;
physical condition ·good, but had a slight headache.
Run was
consumed.
preceded by 13 minutes' rebreathing, 'during which the pxygen was replenish!l(l as
·
Only moderate speed but quite accurate. In the fourteenth minute he showed distinct initial
impairment of muscular coordination and attention. After the eleventh series he showed p>"ogres-
sive decrease in both speed and accuracy until the end. He was taken off for inefficiency at 37:4/L
He was still making some correct substitutions, but was finding the operations, in'cluding the
writing, very slow and difficult. A controlled drop of diastolic B, P. was occurring during the
last few s,eries.
 62

Fio. 33.
Ma)'" 14, 1919: Ng. 687S. fst It., observer; age 34; married; stockbroker; lOO ·hours flying, 30-hours
over lilies; 3 oonibata, 2 credits; .w as shot down once; 18,000 feet for 2 hours; physlcal llOllditioti gond.
Run was preceded by 13 minutesrrebreathing, during which the oxygen was replenished as con-
sumed. · ·
Mouthpiece In place at-start. A steady Increase In speed was shown during the first 13 minutes of
the ·run, when a stllSdy decline began. He was taken off at 23:32 by the clinician, when both the
systolic and diastolic blood pressures fell. While ~ was still fair. a fall in the i:ate of substi-
tution had accompanied the !all in blood pressure.
 63

FIG. 31.

May 15,1919. No. 6875. 2dlt., pilot; age 29; married; merchant; 300 hours' HyiJ1g, l-75overseas,none
over lines; one.crasq due to forced landing; physical condition good; machine.set for 2S-minute run .with
!>-minute normal period.
This was a sjo;v, steady performance, sho.vmg a s!Ight. duninution of accuracy in the sixteenth and
seventeenth minutes and a pronounced retardation with still grl!!lter .inaccuracy·in the last series.
This was accocnpai;ied by a fallin the diastolic blood pressure. At the end he ceased working quite
suddenJy, with but slight preliminary deterioration of either 'the motor·or attention pr~es. As the
subject apparently made little effort and at no time made a :good performance, the pregrtl68 of deteri-
oration is not clearly marked .
 64

FIG. 35.

June-a, 1919. No. 6893. 2d It., pilot; age 27; single; mecqanical engineer; 100 hours' flying, none over lines;
physical condition good, ·but had lost sleep the night before examination.
Run.was preceded hy 13 minutes' rebreathing, during which the oxyge_n was replenished as consumed.
A mo:lerately fast and accurate performance up to the last series, when he became Inefficient at the-time of
a break in systolic and-diastolic B. P. and pulse rate. He had been holding to his performance level by increased
effort under low oxygen.
 65

Fm.36.
June 6, 1919. No. 6895. 1st It., pilot; age 26; single: chemical engineer; 300 hours' flying overseas, 100 over lines;
l crash, night landing; 20,000 feet for 1! hours; 15 combats, 3 credits; physical condition good.
Run was preceded by 13 minutes' rel;>resthing, during which the oxygen was replenished as consumed.
Slight il!itial impairment at thirteenth minute. Deterioration began at 11 per cent oxygen., but compensation
took ,the forlil of increased effort. T!tjs effort became greater as time passed, hut muscularincoordination.and a
large number· of errors appeared at the end of the last series. He was taken off the machine st the end of the
series;as he was becommgineffieient so rapidly that he could probably not have started the next series.
55314 0-31--5
 66

~ s ~ ~ ~ l l U H r . . ..C..n~,1,m._ .,..,~~u;.;j 2:J,5.t,ll..- .- .

T,·pc: 'of W
Btbtc&thing . _ __ .. Dora1i00 3f> n,mutcs.. __:;.4._~ - ~
pi,,..:"""1 ...... of...._~~.r -_9 1;.L g! hoa~1 ...L~1WM'."-=-". - f i l ~
1 ~ ~.ii~. ~ o l ~ -- ·;~
4

-~:!t~~Dlei~----~;.,,:---·--:::~~Ff- '

FIG. 37.

June 4, 1919. No. ·~ . 2d It. , observer; age 25; married; structural engineer; 260 hours flYing,
with veryltttle over lines. Physicai condition: Just out of h03pita·1 following gener~l nervous
breakdown, but .was feelin g fit at tj me ofexamin_ation. ·
Run was · preceded by 13 minutes' · breathing; duung which the oxyge:ri. was replenished as
consumed.
The compensation in this case was through increased effort, following the appearance of aniilitial
impairmen tin the eighteenth minute. ':iJnder further diminution of oxygen he greatiy increased 'ins
perfomance, but·it declined steadily after the· twenty-seventh minute. He wi,s taken off by the
psychologisht the moment ofa JlSYChologicaJ break. .
 67

r. :,:.a~~< Pl::•~r:M..,,llep.t.,Tcc~On•tlyer
T)l'fof~
-,-~ ~ - 9., 19,~,?..... "'"" lC :3!)
_____ ,1&1',i.4lr--:--~ - --- - - D.u"raoon _____ ;3:_2_ -- ~'. __minutt~ __
Pht~·<:On~ ar time of ttsL - - , ·. __ __ :..___Q: co_O. ·---·:----- ··---: _: -----.- _-
5'2 ' _. sc;.:om~~.

;{/;~ i t ~ fl:! ''."!;-'j ;'- .'.·f.Y~o\ic:;...ku~,cioutl._: - -_- - - · · _

~ -~ ~01~~;:=~~~~~~:~:;~2P~-:=;i:~-~~-~-:~.:
' !f ~tl.:i;:).?..W..O;._._'.- PkittM by-..f.Y.l .a. __L2l,::ey
~~ _0 1 ~ . -. _ ; _ . ~ Pu1W"
, ' 0.,. ~ st.ir.t-il~-- riui5h..~.2.
RFfP, in dccil. per mio. 1 ~ Syst. B. P.
•- - - Oiast. B. R A«om. in mm. · C'C"rm!rgmce in mm.
PD cholo e rft1r"'8.Ace ·

l'IG. 38.

June 9, 1919.· No. 6928. Private, Med. Dept._; age 20; photographer; nonflyer; three-quarters hour in air as
passenger.
Run was preceded by 13 minutes' re breathing, during which the oxygen was replenished as consumed.
Had previously transliterated allthe material once under. normal conditions, hence there is little improve-
ment with practire.
Performance showed a slight and gradual decline in the early stages with subsequent steady improvement
due to increased effort. Deterioration began in the twenty-fourth and twenty-fifth mmutes between 11 per
cent and 12 per-cent oxygen, arid increased rapidly until the experiment was terminated by the clinician
The changes in the systolic B. P. present an mteresting parallel to the fluctuations in performance. The
reading in the seventh minute was made during a penod of rest.
 FIG. 39.
May 7, 1919. No. 6925. 1st It., Sanitary Corps; single; age 30; psychologist; 'nontlyer; one hour in air
as passepger.
Rtih was preceded by 13 minutes'rebreathing, dnring which the oxygen was replenished as consumed.
Had previously transliterated all the material once under normal conditions. Hence little improve-
ment over initial performance was shown.
A shght and transient impairment. occurred during the fift~tb and sixteenth minutes and partially
overcome by increased effort. Compensation was effective for ·o nly a . short time. l'ubject was near col-
lapse at time of removal.
 69

~if Hih MJor~,·lllfA.a.~1Nol\-~t.1¥,T~ "'_s..Jlu__,.~"a lllile1'14"-•

~ - • ·. ,
11, --_,_ :_ 2..:"
•C, ,. .
_, .1. )
, ,- '"
_:.._ ,/

'.f~1Mot1W · _- "· ae))r••UU,M' _ , _ , · · ~ ~ ~ §_..;.,__....m1n111a.,:-w., "7_ ,,.., .. ·:.~ ,

PIIYt,.~11~of~~ f:..:....·~ .Ji.QfOHL ·<_: .-, :,'· - . _> --~ :.-~>~.--- _'. ; _,·:<.'>""< ,J_
~~:+~__:t~j~~-::x!:':~ ~ir_c:iuor~:- ·
.~~W~ ;L ·- · •· . ·.· .· ·- - •. - .

FIG. 40.

July 7, 1919. No. 6921. MaJ., M . C.; age 29; married; flight surgeon; nonflyer: physical condition good.
Run was preceded by 13 minutes' rehreathing, durmg .which the oxygen was repleni.s hed is consumed.
Very slow but very accurate, reaching level quite early. An initial effect; in the form of retardation,
appeared in the seventeenth and eighteenth minutes, but was overcome until 11 per cent oxygen was
reached, at which point a controlled drop in diastolic B. P. began. Compensation then took the form ofin-
creased effort, and O\\ing to the type of the early performance this· was rr.ore than snfficien t to overcome
the deteriorating effects of low oxygen, with the result that his performance was higher at the end of the
run than at any previous time. He was tal,en off by the clinician when making his best performance
because of a sudden drop in t:ne diastolic blood ::iressure, whi·ch indicated that circulato_ry failure was
impending. ·
 70

FIG. 41.

Jime3, 1919. No. 6889. 2d lt., -bomber; ·age 26; single; construction engineer; 60 hours' flying, none over
lines; physical condition good.
Run was preceded by 13 minutes' rebreathing, during which the oxygen was,replenished as consumed.
Owing to the low speed and the only fair accuracy, a steady increase in performance was shown until the
later stag'es of the run. Increase of effort compensated, for impairment until the final series. When t h e
experiment was terminated he had reached the point where he was repeating two letters over and over
again and was on the verge of fainting. (The cardiovascular failure occurred after the.last systolic B. P.
reading was recorded .)
 71
The writers believe that any work test, made under the now employed in the classification of aviators, although
limiting conditions which apply to the present case, is the detection of initial and intermediate disturbances is
open to the same objections, so that a reliable case record not quite as easy as in the official test. Its simplicity
is indispensable. recommends it highly for exploratory work under external
The heavy ordinate drawn through the breaks of the or physiological conditions which produce an effect of
curves at the right of the graphs indicates the time pf ter- considerable magnitude in a relatively short time.
mination of the experiment. The straight line drawn
CONCLUSION.
fro:n abscissa! zero to this ordinate approximates the rate
ofqxygen depletion. Only the initial and final precentage The results of the tests indicate that the simpler sen-
being given, the actual rate can not be accurately repre- sorimofor reflexes, as a rule, do not exhibit noticeable
sented. The abscissa! value to which the curve of psy- impairment until deterioration of the more highly organ-
chological performance is continued by a broken "line ized responses has reached an advanced stage. Perhaps
represents the estimated point at which complete break- an- adequate hypothetical explanatio~ is that the delete-
down would have occurred. rious influence of low oxygen on the subject's responses
is largely, if not principally, due to interference at the
INTERPRETATION OF RESULTS. synapses. On such .an hypothesis one would expect that
The assertion has been made that in some early experi- the processes which first sliow impairment are those which
5

menbl with this type of test the perlormance seemed to be involve 6the highest gegree of organizatipn of neurommicu-
mod,ified . to an important extent by disturbances of lar arcs.
accommodation and of oculomotor adjustment. APPENDU.
We were-not successful, in the work reported in this The 20 sets of codes and test material used in the fore-
paper, in obtaining evidence in support of this view. A going work are reproduced below. A word regarding their
supplementary experiment was made by Capt. Johnson genesis may be useful, as a very large amount of material
for the purpose of measuring disturbances of vision due to wiµi assembled, tried, and rejected for important irregular-
these factors. The results are not yet ready for publica- ities in the distribution of difficulty before the method of
tion, but are entirely negative, The characteristics of compiling this material was developed. The first original
the records obtained indicate that the disturbances were. attempt at compilation of work material which is free
more probably attentional than sensory. A similar uncer- from ·this ob3ection will probably sutprise the student by
tainty exists regarding a.11 the rest of the work done directly itl3 difficulty.
on sensory process as affected by low oxygen. The following rules were adopted for the construction
One of the present authors has repeatedly reacted in of the codes. They were strictly followed, except for a
experiments on the effects of oxygen deprivation, and few errors due .to inadvertailce, the correction of which
has not~d · that as collapse approaches there is a great necessitated a few min'o r deviations rather than recompi-
depression of vision; but_it is manifested, not in the blur- lation of a large part of the material.
ring of outlines of objects, but in a general. darkening of 1. No code is systematically derived from another.
the visual field and an intermittent cessation of all visual. 2. Every letter in the alphabet shall be. represented
experiences (including that of darkness) together. This by a different letter in the code. ·
is especially marked in tests in wly.ch ·pure nitrogen is 3. No letter in the code is to be substitJited for its imme-
breathed instead of air, as the effect occurs very quickly diately preceding 1etter in the alphabet.
and is clearly noticed; and the duration of the test being
·, The authors do not regard this evidence.as conflicting with the early
very short, the effect is ;more readily appraised afterwards diplopia reported by Dunlap as having been observed on himself and
than in the case of longer experiments. The other author other subjects. (Cf. reference cited in footnote 2.) Dunlap's observa-
has reacted in fewer experiments, but his experience is tio~ has received ample corroboration under the conditions under which
very similar. A number of other subjects report a similar ·it was made.
In.._the ~ork reported in this paper aU the subjects were free from
observation; and records made in a continuous, self-record-
phorias or oculomotor imbalance, or possessed-th<JSe defects in negligibly
ing .test of visual acuity show the same tendency. small degree. They probably ha<t a slighter tendency toward develop
In the substitution test subjects were frequently ob- ment of diplopia under asphyxiation than Jess highly selected subjects
served to sta,re at the test card for several seconds before might have.
Besides the question of individual differences is the fact that in the
they initiated the recording movements, but the delay
official test thesu):>ject'_s responses are made to stimuli outside his control,
suggested muscular inhibition more strongly than any- irregular as to order an<i time of appearance, limited as to duration,
thing else. The increased time required for performance variable as to position in all three planes, and having a rather wide
in the later stages of the experiment is due largely to loss separation. Adequacy of response therefore depended on a more highly
of mu.s cular control. In several cases the subject was re- · coordinated type of eye movement than was demanded by the conditions
of this experiment.
moved from the experiment for the reason that he was un- In the experiment made directly on vision the subjects, even in ad-
able to form a letter, in other cases because he was unable vanced stages of oxygen deprivation, had little difficulty in maintaining
steady fixation and accommodation through periods of three minutes.
to put the pencil to the paper. These observations being made monocularly, diplopia did not enter.
In the opinion of the writers, the test has considerable One would suspect that the maintenance of fixation on a single sta-
usefulness as a means of qualitative demonstration of the tionary object, or the a\ternation of fixation between two stationary
objects in a relatively unlimited time, is less likely to induce and to
effects of low oxygen and of drugs. In experienced hands exhibit diplopia than tbe more trying conditions of the official test,
it might be an acceptable substitute for the routine tests While we do not contend that tendencies toward jmpairment of accom-
modatiori, convergence, and muscular balance were absent in the present
'Manual of Medical Research Laboratory; Washington, Government test, we obtained no evidence, either from the subjects' description or
Printing Office, 1918; p. 181. Also:· Air Service Medical; W asbington, behavior, that tb'lSe fact.ors w~ro open1tive in producing the results
Government Printing Office, 1918; p. 311. obtained,
 72
4. Habitual sequences (e.g., OK,·QU, etc.) are to be (9)

avoided, as are also sequences tending to form considerable ABCDEFGHIJKLMNOPQRSTUVWXYZ

parts of words. Q L .J V·I NW CSR HUY ET o · Z K DX PB MF O A
· 5. A given letter·is not t'o be substituted for the same GTYSHAREUQ WINZPLDJCK MOVFXBDWPI
KQEFRV°tMZU OCGLXHBDSA
letter more than twice in the··20. codes.
Subject to these limitations, the i!~uence of letters in (10)

each code was d~tennined by a pack of shuffled cards, ABCDEFGHIJKLMNOPQRSTUVWXYZ

The first set of w'ork material was prepared by. shuffling GEVOZSDCPUJIHFYLKTMXNAQRWB
a pack of 52 cards containing two complete alphabets, and . wx·oDCQKIPZ MSEAGUVRJH YTBNFLVMGS
HZINKBOYAP TJWUFCLVDQ
using the sequence of letters· c:Yetermined in this way.
The original set of material was then transliterated into (11)

code 1, arid the result into ·code 2, etc. The last two ABCDEFGHIJKLMNOPQ~STUVWXYZ
letters of each set were discarded. EDtBMTQZGXAPOFWLSCUYJRNIHV
In the earliest of the experiments descri,bed in this QRYOVKJPL· B HMZGDNATUC. WXEFSiAHDM
CB ·P F J E Y W G L XU Q NS VI A O K
report some of the subjects discovered that the material
presented with one code became after transliteration the (12)

m'l.terial presented with the next code. This discovery ABCDEFGHIJKLMNOPQRSTUVWXYZ

proved distracting, as the subject was tempted to compare JGMVKELNABUHTSXZFOWRQCYPDI
his performance by the card, to the neglect of the task. SCHWR.AXLPD Z 0--V QB FEY J K .NIMTU GEZBO
KD LT X MH N 'QP IJS FU ROE WA
For this reason the various sets were thereafter given in
shuffled order, and tli.is sburce of disturbance disappeared. (13)

The several sets of material are presented below as shown ABCDEFQHIJKLMNOPQRSTUVWXYZ '
on the cards actually used. The alphabet is given in the OTMGZXKAPEDFBVJHINBOYQSUWL
first line, the code in the second, and the material to be WMNYOJPHZV IXCFGEKDBU SATRQLKIG-X
UVHRPTNSFZ ABWEQOLKYJ
transliterated, below.
(1) (l4)
-A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A B C D E F G H I J K L M N O P Q R S 'i' U V W X Y Z
P X G Z D K M B T F _0 E A Q L U Y J V H N I R C S W N A Y M X R V J O W H U Q I F T E G Z K D S P B L C
D J E A-S RN U M V P X HY IT G L Z W O KC Q F B G_PIX SB V W J E HAL Q PU M X K Z D GT Y RO C N.I FD PK U
WVUQNCEOYM KZDTFSBGAR YQANHCVRXL OTSZIJFDWE
(2) (15)
ABC DEF G HI J KL MN OP QR STU V W X Y Z ABC DEF Q. HI J KL MN OP Q ~ST .UV W X Y Z
QVTWYNFOUXPZJLACIERDSGBHKM XZVKRMTOLUYCIWSNBFJQEAHDGP
ZFDPVJQNAI UCBSTHMEWR LOGYKXMU_TC ZASPWXJNUE TDQBHCMVKL GFYIORMTHD
RINYQGDLSA OWZHKVXMPJ LENIJYSGBU FKZCOWR:MPX
m oo
A B C D E F G H I J K L M N O P Q R S T U V W X -Y Z A B C U E F G. H I J K L M N O P Q R S T U V W X Y Z
Z O A R H S J M F D V G T X N B W L K E QC Y P I U H Y G Q L Z X D- C V O J F K W A s· M E B J; U T .N R ·p
M N WC G XI L Q U S TV R D O J YB E _Z A F KP HJ S D 'I' PX J NH DUWE R Q K B Z O V I A Y C TM,G LS FI Q OK
E UL KIF W ZR Q AB M-0 P G HJ OX C R .W LUG J T Z E MY P VS II, FIND
00 ~
ABCDEFGHIJKLMNOPQRSTUVWXYZ ABCDEF G HIJKLMNOPQRSTUVWXYZ
XZBGSDYUMTVOKWIFNLHJPRECAQ LEYTB~ZRDWSOGPXK~IHVMFVNAQ
TXY AJPFGWQ KECLRNDIOH UZSVBMDKRE A NV KD QI'.[' L M SO YPWUCHR G B F -XJE ZCSWO
HQGVFSYULW ZOTNBJMDAP GMTJIX _VBPL F ·RAUEDZCKQ
(5) (18)
ABCDEFGHIJrLMNOPQRSTUVWXYZ ABCDEFGHIJKLMNOPQRSTUVWXYZ
JHZQYAOTBSUXWIGEVMCRL~DKPF VNALHUOSRZfrYWQJDCPXMKEIFBT
JC AXT F DYEN VSB O LWG MIU PQHR-ZKGVLS LPFSTJDVO.O HXAKUMYRIZ ECNWBQYIJUX
UNYRDHAPOE QIJWZTKGXF ZGVWDNFEKO CILM:STQ.YSJ
(6) (19)
ABC D "E F G .HI J KL MN OP QR STU V W X Y Z ABC DEF G. H l_J KL. MN OP QR STU V W X Y Z
SL X Z Q V CG BMW KUT EH YA JP FOR IND K. MT AX BP L_· E G F Q J Z Y VU H W NC SI OD R
SZJKRAQPYI NCH GXD-0 WB L E VTMFUONXC YDU X MZLE JO . SFVGKWBPRT B ·AQINCB SK 1''
LIPMQTJEGY VBSD .FRUOKA TOEILQUHGJ ARY-WNMCBX-Z
. (7) (20)
A B C D E F G H ·I J K L M N O P Q R S T U V W X Y Z A B C D E F G H I J K L M N O P QR S T U V W X Y Z
W SQ L V. HR NY IC JU AF MK PX G Z DB TEO DP RAJ T Q_ W -K bl" Y C XV M. I B Z FE O H ·S LG U
JDMWASYHNB TXGCIZERLK Q.OPUVFET.IX DACOJRQXGY WBSPFIMVHN LKUEZTMWFB
KBHUY-P .MQCN OLJZyAFEWS NYXEQUCLPG KHDIZJTMOR
(R)
Correct iransliteration of (etl).
ABCDEFGHIJKLMNOPQRSTUVWXYZ
USKXROWBGCMTVEhJZNQIYDHAPF ADRMNZBLQG SPFITKXH;WV CYOJUEXSTP
VGLJBORCIQ YWAKUNEXMZ
BWXENAS GTRQYOVPJC KFMZDHVGYT
CSNZEMUKQA FJIODWHVBX (By courtesy of "The Psychobiology.")
WHY AN AVIATOR IS EXAMINED BY THE REBREATHING METHOD AND
HOW OFTEN THE EXAMINATION SHOULD BE MADE.
By VERNER T. ScoTT, First Lieutenant , Medical Corps, Medical Research Laboratory of the Air Service, Mitchel Field,
Garden City, Long Island, N. Y.; Physwlogy Department. ·

Two of the questions most frequently .asked by those liters of afr the average subject will reduce the oxygen
not familiar with aviation medicine are: "How do re- t.o 7 per cent in· 30 minutes.
breathing conditions simulate high altitudes?" and "How A . comparison of the analysis of alveolar ait found at
can you determine an aviator's limit in altitude by exam- different levels of rarefied air with that on the reb_reather
ining him on a rebreather machine at sea level?' '. with their corresponding partial pressures will be of in-
A brief statement concerning altitude physiology is terest. ·
necessary t.o appreciate the principle 'of the rebreather.
LOW PRESSURE CHAMBER.•
ft was Paul Bert in 1878 who first found that it was the
decrease in. thet>artial pressure of the oxygen of respired
air that caused the symptoms of mountain sickness. Since , Barometric pressure. Alveo'.ar air. Alveolar partial
pressure.
that tirrie it has ·been clearly proved that a decrease in the
partial preBEure of the oxygen of respired air regardless of 760 mm. . . . . . . . . . . . . . . . . . Oxygen, 14.5 per cent .. .. (760-40)= 104. 80
the method of reduction 'pr9duces the symptoms appear- Sea level. . . . . . . . .. .. . . . . . CO,, 5.5..... . ... , ...•.... (760-40)= 39. 60
560mm ... . .. •: .. . .. , . ... Oxygen, 14.0percent .... (560-40)= ·72. 80
ing at hig.Ji altitudes. 10,000 ft.... . ..... . . . . . . . . co,, 7.0.... • . •. •..••.••• . • (560-40)- 36. 40
There are three methods used at the medical research 350 mm. . .. . . . . . . . . . . . . . . Oxygen, 13.0 per cent .... . (350-40)= 40. 30
20,000 rt. . . . . . . . . . . . . . . . . . _
co,,. 10.5. .. : .......... .. . (350-40)- 32. 55
.laboratory_·(Air Service, Mitchel Field, Long Island)' to
reduce the p:µ-tial pressure of oxygen: (1) the rebreather
REBREATHING MACHINE.
machine, (2) the low•pressure chainber 1 and (3) the nitro-
gen dilution apparatus (Air Service Medical, 1919).
The low-pressure chamber is a cylindrical steel tank 21.96 per cent O,......... Oxygen, 14.5 per cent,. . . (760-40)= 104. 40
Sea level............. . ... CO,, 5.5 per cent.. .. ..... (760-40)- 39. 60
with a capacity sufficient to hold six people; The reduc- 10,000ftce1_1t
14.2 per 0 2 •••••• • : . • . Oxygen, 10.0 per cent . ... (760-40)- n. 00
.... . . . . ....... : .. CO,, 4.5percent ........ (760-40)= 32.40
tion of pressme is brought about by means of a motor-driven 9,7 per cent o, . .. .. . . . . . . Oxygen, &.6 p~r, cent .. . .. ·· (760-40)= 40. 32
vacuum pump capable of rarefying the atmospheric pres- 20,1l00 ft........... .... . ... CO,, 4.5 per cent..... .. . (760-40)- 32. 40
sure ·equal t.o that found on any altltude flight. ' 1 Lutz and Schneider; American Jonr. Physiology, Vol. L, No.3, Dec.,
Unfortunately, there are some who still believe tliat 1919.
Partial pressure of alveolar air= barometric pressure minus vapor
altitude sympt.oms are produced by the effect of the low- tension (40Y py per cent of gas.
ered ·barometric pressure on the surface of the body.
Schneider, working in this laboratory, confirmed the- work Whereas in altitude flights the partial pressure of 0 2 is
of Paul Bert by a number of experiments Ile placed reduced by a lowering of barometric pressure, so it i~ seen
two men in the low-pressure chamber, one supplied with that the same thing is accomplished on th!l rebreather
oxygen· an·d one without oxygen. The subject "taking machine by decreai,ing. the percentage of oxyge_n.
oxygen during the experiment remained as comfortable Classification of the a,'iator by t~e rebreathing method
and as efficient as at sea level, while the subject without clearly defines the altitude or low oxygen tension which
oxygen experienced an increase of pulse and' respiration he can tolerate and still remain mentally and physically
and became cyanotic and mentally inefficient. In fact, efficient.
this point is demonstrated daily. The clinician who ac- Providing he is in good physical condition at the time of
companies every subject in the low-preesure chamber is the test, the subject will not be able to raise his limit by
supplied with oxygen through a rubber tube with a wooden repeating the rebreathing test. Practice on the rebreather
nipple. He holds this nipple in his mouth ·in the same · does not increase one's tolerance _ for low oxygen. This
manner a cigar is held, and during the experiment he re- has been demo:nstrated by the men connected with the
mains perfectly comfortable and efficient, while the sub- Medical Research Laboratory. There· have been some
ject undergoes the compensatory reactions inddent t.o who, for experimentalpurposes, having taken the test
reduced partial pressure of oxygen. two or three times a week for months have found their
The rebreathel' machine is used for the official classifi- last test -no -lower in. oxygen than some earlier ones.
cation· ·of aviat.ors because of its simplicity and ease of Just as some men are more resistant to disease than
operation. An aviator :rebreathes into a metal tank by others, so do we find some men more re3i.stant to low
means of a mouthpiece and two corrugated rubber tubes. oxygen·than others.
The carbon dioxide is removed by a caustic soda con- Different aviat.ors in good condition vary in ~eir !',bility
tainer in the expiration pipe. The oxygen percentage in to reach low oxygen. Some reach 6 per cent, others 8 per
the mixture grows progressively less. Starting with 52 cent oxygen.
(73)
 74
Subjects in poor condition will.range from 13 per cent to
9 per. cent. The _causes which ·lower the "ceiling" of
airmen are acute and chronic disease3, stalene38 and · lack
of exercise plus loss of sleep, plus excesse3. The import-
ance of physical exercise3 and regular habits to the airman
i~ apparent. At one time there was a tendency to under-
e3timate the value of the rebreathing classification,because
there were occasions when a man who, being limited to a
certain ·altitude, exceeded this limit and.returned without
unpleasant experiences.
There are two reasons for this.: Either (1) his "ceiling"
was established when not in very good condition and his
flight taken when -in better condition, or else (2) he wa8
within the safety margin. He is given an altitude within
which he will remain his best. He may at times exceed
this limit but not within danger.
In view of our increasing knowledge :i.nd experience in
aviation medicine, we heiieve an , aviator's tolerance for
low oxygen should be established in all ca!;es before he is
permitted to fly, at least once a year thereafter, and always
after any serious physical or mental illness.
(By courtesy of "The Military Surgeon.")
STUDIES ON 11-IE RESPONSES OF THE CIRCULATION TO LOW OXYGEN
TENSION.
CHANGES IN THE PACEMAKER AND IN CONDUCTION DURING EXTREME OXYGEN
WANT AS SHOWN IN THE HUMAN ELECTROCARDIOGRAM.
By CHAS. W. GREENE and N. C. GILBERT.

Asphyxiation in the normar man can safely be carried ·. boratory recorded in the Air Service Medical (6) tend to
to the stage of unconsciousness when produced by the confirm the view that these problems of altitude a.re not
proceBB of continuous a11d gradual reduction of the oxygen so much the effects of decrease in barometric preBBure, or
in the air breathed. The respolliMclB of the body to the . of temperature changes, but are primarily due to oxygen
gradual oxygen reduction are compensatory to a certain want.
limit. The crisis appears promptly when the compensat- The cardiac accelerations of rate due to progreBBive
ing limit is reached ·for any particular person and set of oxygen want have been described by Bert (7) in the
experimental conditidns, until in rapid siicceBBion the experimental production of low atmospheric pressure in
following states are passed: (1) Decrease and. lQSS of e.tten- the low-pressure chamber. Bert showed also that these
tion; (2) loss of voluntary control of muscles; and (3) rate accelerations were removed on giving oxygen. The
complete unconsciousness, but with a degree of reflex changes in rate are given in fuller detail, with numerous
control of voluntary muscles. The heart beat and re- illustrations both for the low-preBBure chamber and the
spiratory movements persist through these three cycles. rebreather, by Schneider (8), by Whitney (9), and ll}Ore
The degree of circulatory efficiency which persists at the fully in the Air Service Medical. Coincident changes in
onset of unconsciousness is adequate for the moment; but blood pref¥!ure and in respiratory volume and alveolar air
the circulatory systeip: is assumed in general to be rapidly have been compared by Lutz and Schneider (10) and by
failing. Gregg; Lutz, and Schneider (11). The sumll}arized facts
We ha:ve applied the method of the electrocardiograph and interpretative ~ews may be categorically stated for
to the study of the changing function of the human heart the heart as follows: The heart rate augments during
through all stages of the symptoms of low oxygen from the. oxygen re,duction. It· ~s slight and very grad~l in the
normal to the stage of unconsciousneBB . and collapse. early stage of reduction, becomes more pronounced at
Obser'Vations on 21 cases are recorded in this naper. from 15. to 12 per cent oxygen and very profound at the
Physiology of the human at higli altitude has received lower limits 9f enduranc~ by ·the individual, wliich ni.ay
consideration for the last half century, and the literature reach 7 or even 6 per cent, 53 to 45 mm. partial preBBure,
is now rather definite and in harmony as toseausal explana- in men of ·the highest oxygen resistance. Heart · strain
tions. The reader is referred to the phenomena described with dilation, circulatory collapse and fainting Me de-
as mountain sickness by · mountain climbers, or altitude scribed and emphasized by Whitney as a terminal condi-
sickneBB of balloon men, and to the corresponding symp- tion to be avoided (11) .
toIIlB detailed by those who have investigated the problem Of the points summarized the variations in heart ·rate
of low-preBBure chambers or of airplanes. The• work of may be accepted without question. The seven thousand
Paw ·Bert (1) published in a series ·of scientific papers at and more records of official tests of aviators substantiate
intervals from 1871 to 1874 (1) and in book form in 1874 these facts. Ori the other hand, the cardiac dilation
and exhaustively in 1878 (2), of Mosso (3), of Zuntz (4), assumed on the basis of percussion has been more and
and the' more exhaustive ·P ike's Peak studies of Douglas, more strongly questioned as the tests have accumulated.
Haldane, Hen,derson, and Schneider .(5) Ii.ave given the The determination of relative cardiac volume, minute by
facts in the physiological responses of the· body in great minute, is in fact fraught with great difficiilty. The usual
detail. This accumulated . altitude physiology became of palpation and perCUBBi.on methods are scarcely accurate
i=ediate practical value with the development of the enough to decide the--point,at iBSue. The X-ray method
aviation program of the United States and served 11.B the yields results that must be correlated with the ·phases -of
scientific basis for the establishment cif the Medical Re- both the cardiac cycle ~nd the respiratory movement,
search Laboratory of the Air Service. which for the moment vary the size of the heart. Majors
Instances of unconsciousneBB developed in tp.e a:ir are · Turrel and Le Wald (12) have applied ingenious devices
related by men in the Air Service. Many aviation to secure photographs at corresponding phases of the heart
fata\ities are thought to be due to this cause. There are cycle and the respiratory cycle in their X-ray studiElS of
instances of unconsciousness or partial unconsciousneBB the size of the heart during progressive low .oxygen induced
with physical distreRB developed at high .altitudes with by the rebreather method, They find little evidence of
recovery on descent to lower atmospheric levels. The change of heart volume. This finding accords with the
exparimerital obs~rvations of the Medical Research La- measurements of the circulation volqme by Schneider
(75)
 76
and Sisco on Pike's Peak (13), data from which the con- instances even beyond the point of complete loss of
clusion was drawn that the heart volume does not change efficiency of the central nervous system.
with the increase of rat_e up to the altitude of Pike's Peak, Loss of continuous attention ·and of 'Voluntary motor
Le., 14,110 feet. However, 14,000 feet does not reach the coordination are the usual signsfor terminating an official
straining ·limits of compensation for the ·average vigorous rebreather test. Heart and circulatcry compensations
man. From 20,000 to even 30,000 feet must be reached continue to take place for a period of several seconds
to produce the extreme vaacular changes. Turrel and longer, i. e. , certainly until complete unconsciousness
Le Wald describe one case of unconsciousness at the occurs. This statement covers the rule. In exceptional
moment of an X-ray exposure. This heart was not d.i lated. cases circulatory fail)!re of compensation rather than fail-
On the contrary, its outlines and volume: were notably ure of nervous coordination termitj.ates official rebreather
less than -those shown by pictures ta-ken at eatlier stages t~st. These latter -cases are types that may and often cto
of oxygen want from the same officer. fail at relatively high percentages of oxygen.
The usual official psychological and ocular tests in use _
THE ELECTROCARDIOGRAPHIC METHOD. at the central laboratory at this time were abandoned as
Electrocardiograms -offer an added approach to the unnecessarily complicating for this research. In judging
state of the heart und·e r oxygE)ll want. 'Phe method can the safe terminal limits of endurance for each man tested;
not lay claim to even a probable solution to the problem. reliance was placed on the recorded evidences of respira-
Still it ought to yield facts of value in the interpretation tory volume compensations, the .coincident heart rate a11d
of the physiological state of the heart under extreme blood preBBure measurements, and the general clinical
o:,t.ygen streBB and the possible source of the collapse· in signs of distress. The men who take this test even to the
the circulatory system. limit of unconsciousneBB recover very promptly after one
The electrocardiographic method is the present reliance or two inhalations of ordinary air. Th'e delay is only a
for the determination of the following points in heart question of a few seconds, and the subject tested can not
physiology: believe that he has not been continuously conscious. In
1. The place of origin of the automatic excitation the friendly but keen rivalry ·among the men taking the
process. test at Lakewood they generally protested because they
2. The state, rate, and direction of conduction of the felt that they had not yet reached their oxyg(;ln-want
excitation over the heR;t. limits.
3. The degree . coordination of different. parts of the ELECTROCARDIOGRAPHIC 'RESULTS.
heart. Measurements of the different complexes of the cardio-
4. The character of extra s)'.stoles of d~ve~se~types. · grams are presented in tabular form for the periods re-
The oxygen want test WM given to 21 mdivid~als frolil corded during the test. All the cases examined are tabu-
whom electrocardiogram~ were taken at stated mtervals lated. The time of the -average pulse is measured by the
during the tests. The experiments were ma-de at the_.. duration of the R-R interval. The .conduction time and
United States Ar~y General Hospital No. 9, at Lakewo?<1, , the duration of the ventricular complex are measured by
N. J., Mar.ch 5 to 12, 1919. All the necessary re?reathmg . the P-R and R-T intervals, respectively . The ampli-
apparatus was taken to the Lakewood H~_tal from · tudes of the ai.fferent deflection waves are given in mm.,
Hazelhurst Field. T~is se.c~ed to.us the faci~ties of th~ . i.e., 10-• amperes, since the instrument was standardized
excellent electrocard1ograpl).1c station at Ho'.31ntal Nu. 9. to 1 centimeter per milliampere of current.
The procedure was, in brief, to give the ofliclal reb:eather Profound changes are revealed in the physiology of the
teat on the Larsen-Pier_.ce type of rebreather. nurmg the heart in several extreme tests that will -be discussed in
test the systolic and diastolic blood pre~ures, the. heart • detail below. But take it all in all the entire series shows
rates the respiratory movements, the respll'R~ory mmute- a wonderful. amount of endurance to oxygen want on the
vohn~es, and the clinical state of the individual w:re all part of the human heart. Rarely does any serious inter-
taken as described in the statement of methods m the ference with the normal cardiac· behavior occur up to the
various paper~ from the meg.i.cal researc~ laboratory· stage which marks the_ bordedand between loss of effi-
Electrocard1ogram~ wer~ taken for p~nods . of about 20 ciency and complete unconsdousness. . _
seconds each at 5-mmute intervals dur~ng the rebreather The R-R interval iA of coursA a function of the heart
test until the critical period of final failure of compensa- rate. The rate augments during the low-oxygen test, at
tion approached. In most test~ the i~terval was reduc~d first slowly and then more rapidly. This is the relation of
to two minutes after the twentieth ~1.13:u~e. At th_e cnt- fact previously well established as a typical compensatory
i cal moment and on signal from the clim<nan a contmuous response of the heart during the official aviation test to low
electrocardiogram was taken until.the end of the test. A oxygen. .
final tracing, taken after one or two minutes and w~ile The eo-.called sinus arrhythmia is accentuated durmg
recovery was in progress, .completed the series. Occasion- the· early period of the altitude test. This fact makes it
ally, due to the rapid onset of oxygen-want sym~toms, ~he difficult to select at random individual pulses.in any two
terminal tracing was nrissed, or the last asphyxia-I tracmg periods under .comparison 'that represent exactly the same
was extended across to the recovery period. Through the phase in the sinus variations. On _the whole, the_ cycles
hearty cooperation of the enlisted personnel of the ~ake- chosen for measurement vary in fan agreement with the
wood Hospital splendid rebreather tests were obtamed. increases in rate noted in the radial counts by 20-second
These carried to the limits of consciousneBB and in 11everal intervals which served to compute the rates per minute
1 Acknowledgement to be inserted. presented in the clinical test charts. The per cent of
Plate I. L. Corp!. H. B. Donaghy. Final Oxygen, 6.7 per cent. Series I. Greene-Gilbert-Clough.
 .,ill, l, Nor_mal, pure air

-- -4-· - ---- - -- • ---- • - • - -----· · --;-· . ·-.-.- -- ..

.'i M·.......,~
--~ ---· ____ j ·-~ ..: _ _ ·,.::. __ • --·- _:__

~- : ~:J
~~----·-,_J_. ;-,-- ' . Ti
~
-~~L-~·-:·-~rd·~r--~:~~ ~ ' -·~=~:~- i~ • -~~-=-· -•- :--i_:.:: • i~
0

Fia.:J ·10' minute~, .15.8 <>J<Yllen

Fl~.~ Cuntiuuntion of Fit, 7

Plate JI. F. J. D. Final oxygen, 8.1. Series I. u. S. Hospital No. 9.

 79

Plate III. J. ·F . Final oxygen, S.4. Series I. lJ. s'. Hospital No, 9._
 00
0

Plate IV. ').' . F. K. F.inal oxygen, 7.1. Series I. U.S. Hospital No. 9.
Plate V. W. C. M. Final oxygel), 5.9. ~erie~ 1.• 'U. $. j{ospitslNo.. 9.
 - - - --- --- ··---
. ,. - .l
-
. -· . -- J__._· . --- . ..
- -- ---- - --- . . . . L:~ ·,.;,,;,. ,,,..,.,,,_ -., ,,,,,.,,. ~ . -:-· •• ·-c---
_.,/~-../\~.~.,,~~1!s,;i .·
- - -·-- ---- ,. .:· - -
- -- -· -
'· . .

L -~:. ~ ~ •

- - . -·-;-- - --~ .
. ---- . -- . .
.~~~~~~.;.\~N,;
. .

Plate VI. T . B. M. Fine.I. oxygen, 7.6. Series I. U.S. Hospital No. 9.

Plate VII. D. W. 0. Final oxygen, 8.5. Series I. U. s. Hospital No. 9.
 84
oxygen at each time of taking an electrocardiogram is also
given in the· table, the per cent being computed from the
oxygen curve as ordinarily graphed. The details of va.ri-
ation are to be gathered from the tables, the salient points
of which in each test may be emph~zed as follows:
CASES TESTED.
Pvt . N. W. A .; oxygen'."efJfhed 9.7 per cent; time 21 min-
utes .W seconds.-Thia test showed a s~t shortening in
the P-R or conduction time and of Jhe ventricular com-
plex as oxygen want came on. The cb-ange in the P-R
interval is-from 0.228 secon<l. in the -normal to 0.200 second
at 10.5 per cent oxygen. In this case the-return to, the
normaJ was ,not prompt Jn the after period. The R-T
interval showed-little change. In the twentieth-minute
TAnLE
period there are at least three ectopic beats. The seventh
and seventeenth p,ulses are introduced by P-R intervals
of 0.120 and 0.130 secQnd. The thirteenth pulse shows
simµltaneous P and R. The P-P intervals are constant
and the p-.:R intervals following the premature complexes
are compensating, showing that we are dealing with pre-
mature v1intricular contr-actions. No premature ventric-
ular systoles occur in the recov:ecy period.
The record shows little change- i.n the amount of the
vari,ous deflectipns except·in the T'wave. This deflection
slightly increases during the fimt 10 minutes, then sharply
·fallil off in the twenty-fifth µnnute period and in the after
period. Thi.a tY}?e of c;b.ange in the T wave occurs com-
paratively coll!Jtantly throughout 'the entire series, in fact
is :the most constant phenomenon noticed.
21.

Trace Amplitude in llllQ.

and Time Qxygeil
pulse (min.).
(per 1-+-'-----~-----1-- - - - - - - - --- - - - - - - 1 Remarks.
No. cent) ,. R-R. P-R. R-T. ]!. Q. R. s. T.
- - - - , - - - - .- - - - --. - - - - - - - - ~ - - -·- - .- - - - - -- - ·1- - -- -- - - -- 1
1 Normal. 21. 0 0.•720 p.228 0.300 1.. 2 None. 3.,0 4.5 2. 5 Tracing uniform.
2 5 18,.3 . 732 . :rn· . 300 1. 2 None . 3.5 4.0 ~ .• 6
.240 . 320 t. 0 :!:,one. 3.5 4.Q 3.0
3
4
5
10
15
20
15. 7
13.1
10.5 .616
.220
. 200
:·i:J
• 320
.300
J.O
0.8
NQ!J.e .
NoM .
3.0
2.. 5
4.0
4.,0
2.6
2.-0 Ectopic beats.
6 Recovery. 21. 0 . 652 .200 .240 1,3 ').'r~ce. 3.0 4. 5 1. 8 No ectopic beats in the re-
covery period.
5-6
5 20
Contraction.
10; 5
·····:531i· ····':200· ···· ·:300· ······o:s" ····Nonr· ···~··is· ·· ····4:0· ······io·
5-7
5-12
5-13
Contraction.
Contraction.
Contraction.
. 704
. 440
. 808
. 120
..220
None.
. 280
. 280
. 280
O. 8
1. O
(1)
I Trljcii;-
Trace.
'T-)
2. 5
3. O
3. 5
4. 0
4. O
3. 0
2.,0 ·Ectopic beat.
2.2
2. 3 ·{'{!:ctopic beat introduced by
. ' simultaneous P. and R.
~---'--- - - ----4-- I

Pfc. H,. J. C.; final oxygen 10 per cent; tim~ 22 minutes
SO seconds.-Durirlg the firstl$ mfo.utes of the test the h"3-rt
rate increased and there was -~ corresponding deer-ease in
the total length of the individual _pul8es represented by
the R-R iniervaia. However, very little change is sho:wn
in either the conduction time or. in the ventricular com-
plex, thQugh a slight deetell.86 in dur11,tion of each. The
amplitudes of .t he deflecti~ va:ry considerably and c;on-
TAJ3LE
stantly. The S wave chan~ ir.o~ 2.5 mm . to 2 mm.
Tp.~ T wave varies from 6 mm. toil mm., less than the usual
decreas.e in amplitude. During the twentieth-minute
interval a. decided slowing of the heart rate occurs, the
detail of which introduces 1,10 ,new deviations except the
lengthening of the oycfe. Extraneous currents lead to
very irregular records both in. the twentieth minute and
in the i:ecovery period.
22.

f Trace Oxygen
Duration in.secs. .Amplitude in mm.
and Time

~1
pulse (min.) . (per Remarks.
No. cent). · R- R. P-R.• 'R-T. P. -Q. R. T-.
- - -~ -~--
1 Normal. 21.0 ():712 0.176 . 0.304 1.4 Trace. 12. 5 2..5 6.0 P small and T large during
2 6 18. 5 .692 ' .184 .320 1.2 1.0 14.0 iO s.o whole tracing.
3 10 16.1 • 640 . 176. .312 1.0 1. (l 12.0 2.-0 li;O ·aegu1ar except for sinus
4 15 13: s ,592 • ltJO .300 1.2 1.0 13-.0 ;.o 4:.ji Jrrhi!hniia.
5 20 11. 2 .940 • Jfl/l .340 .·5 1.0 16.0 io ~-P :Rates ow and irregular. dur-
6 Recov&y. 21.0 · • 880 • ~60 •.332 1.-.2 .8 13.0 2.·0 4.8 Ing entire tracing .

Sgt. H.B. D.; oxygim 'r':eCLChed 6.7 -per cent;, time 27 min-
utes 20 seconds.-The physiological and clinical responses
recorded minute by minute .t hrough 'the entire test are
presented in the accompanying chart. 'l'he ch11,rt shows
very good compensations t'hrough to the end of the twenty-
sixth minute. During the twenty-'1!0venth minute the,
systolic blood pressure !-ell sharply, from 152 mm. to 126
mm., and to 111 mm. -1\t the fust blood•pressure reading
after the experiment. In.th:41 .interim the systolic presi1ure
had tmdo}lbtedly been lowez, as indicat.ed by the further
rise of pressure to 134 mm. ~ the third reading of the re-
covery period.
Tlie ·heart gave a bell,tltirul c01;npensatoryincrease of rate
io the twenty-seventh minute. The clini.cal chart indi-
cates a gradual and normal rettltn to the. preexperiment
level. However, the electrocardiogram taken after .the
twe;nty-seventh minute.and just befpre the close of the test
shows a rate of only -70. This rate il,ropped to 68 at the
beginping of the recovery electrocardiogram (fig. 42, E. R.).
This ¢lectrocardiographic rate occurred between the last
 85
clinical test period and the first recovery clinical rate re-
corded. The true curve, therefore, shows a sharp fall to
the marks E. R. and then a tise of 22 mm. to the clinical
recovery rate. It is assumed that the fall in systolic blood
pressure and in heart rate are in fact simultaneous.
The respiratory minute volume varied greatly during the
test, between 54 and 81 deciliters per minute to the twenty-
third minute, an average between 65 and 70 deciliters-
:'.:>uring the last three minutes the volume ran up to 103
deciliters, which in itself is good but not full compensa-
tion for the reduction in proportionate oxygen volume.
V
·'
FIG. 42.
During the first seven records, i. e., from the iiormal
through and including the twenty-fourth minute, the
electrocardiograms show the typical variations. The usual
increase ·in heart rate occurred with a corresponding de-
crease of the t-0tal time of the individual beats. There
was a decided sinus arrhythmia. The extreme variations
during the arrhythmia are indicated by the pairs of meas-
urements in the tenth, fifteenth, twentieth, twenty-
second, and twenty-fourth minutes. In the twentieth
minute, with an oxygen of 10.5 per cent, the sinus arrhyth-
mia varied from 0.548 'to O. 784 second per single beat, i. e.,
theoretical rates of liO and 70 beats per minute, respec-
tively. These variations occur within the time between
the sixth and sixteeiith beats in the trace.
During these extreme changes in rate there is practically
no change in the P-R interval. The figures show a maxi-
mum variation of 0.008 second. The theoretical accuracy
of measurement is from 0.004 to 0.008 second. On the
other hand the R-T interval shortens coincident with the
acceleration of rate, i.e., as the oxygen decreases. Appar-
ently it is the latter factor that is involved, since in the
shorter beat given for the normal 0.628 second the R-T
interval is 0.320 second, whereas in the twentieth-minute
beat the total pulse of 0. 784 second duration shcrws an R-T
interval of 0.300 second.
In the amplitudes of the deflections the P wave is com-
paratively constant. The negative Q which is presen.t in
this case is relatively constant, though it tends to decrease
with the onset of low oxygen. The R wave also decreases
in amplitude. The S wave varies through a wide range.
The T has diminished by at least half and is generally
somewhat shorter in the pulses of shortest duration.
When the test reached 6.8 per cent oxygen in the twenty-
seventh minute, decided changes occurred in the character
of the electrocardiogram, These changes are of greatest
importance in tl).e tracing of the onset of cardiac asphyxi-
ation. They did not come on until the approach of uncon-
sciousneBB, which in this experiment was coupled with
intense clonic muscular spasms at the close of the test.
 86
These clonic spasms are in themselves of special signifi-
cance, since Sgt. D. Wllj! a vigorous neuro-muscular type
and in the best of physical condition. The significance
of this point will be more fully discuBBed later.
A short cardiogram was obtained just before the experi-
ment ended. The heart rate had slowed down to between
75 and 80 per minute from a previous rate of 111 in the
twenty-sixth minute. The ventricular complexes are
of the normal conducting tissue type. Although the
presence of extraneous currents destroyed the regularity
of the record, it is fairly conclusive that the P wave is
absent. It is unfortunate that we did not secure a con-
tinuous record through the twenty-sixth to the twenty-
seventh minute. It is apparent that in this unrecorded
interval the P wave had dropped out. In other words the
s1.no-auricular pacemaking region no longer gives evidence
of functioning. The normal ventricular complex shows
that the auriculo:ventricular pacemaker controls the
rhythm. This is a case of suppreBBion of the sino-auric-
ular beat, similar to Lewis's experiment on the cat
heart.
The alternative hypothesis would &BBUm() that the P
wave is buried in some part of the R-8--T complex. The
type of ventricular·complex of this record is like the norlnal
in amplitude .and duration. A careful comparison· of this
record with the normal for the individual gives no sugges-
tion of a superimposed P wave,occu:rring in llJlY portion oi
the ventricular complex, although Ws does not preclude
the possibility of such an inclusion. If we &BBume that
the P wave is completely suppreBBed, then we would
have at the same tke to accept the deduction that re-
versed conduction from the A-V node is alijo suppressed.
TABLE
This point can not be proven from this particular experi-
ment, but a suppression of conduction does seem to occur
in the test of Cpl. F. J. D., in whom there is dissociation
of auricular and 'ventricular rhythms. A full discussion
is reserved for data to be presented later.
In the record of the after period the first three ventric-
ular complexes are not associated with P waves. In the
fourth contraction there is a P wave with a short P-R
interval of 0.060 second. Table 23 presents the series of
measurements for the first 10 contractions and the nine-
teenth or last of the series. In the first, se.cond, and third
there is no evidence of an auricular contraction. In the
fourth beat the P wave appears 0.064 second in advance
of the R wave. In the fifth it is increased to 0.128 second,
and in the succeeding sixth to the eighteenth beats the
intervals are again normal, 0.140 second. During this
rnries of auricular irregularities the ventricular cotnpleJI.
is normal in type. It is constant in duration, namely,
0.320 second, and is of the conducting tissue type. A
rather striking point is the acceleration of the rate with
the reappearance of l!ino-auricular control of the contrac-
tion. The rate accelerates through the equivalent rates
of 68, 69, 72, 74, 81, 81, 86, 95, 94; then slows to 68, 71, 68, 68,
68, 70, 70, 69, 69, during the reestablishment of the normal
relations. The gradual recovery of the pacemaking function
in the a,scending direction is indicated. During the sup-
pression of the P wave the origin of the beat is in the A-V
nodal tissue, In the foUrth and fifth beats it is higher up,
and on and after the sixth it apparently occurs in the S-A
.node as indicated by the normal conduction time. The
slower rate introduced at the tenth beat is indicative of
returning vagal control of the rhythm.
23.

Trace Duration in secs. Amplitude in mm.

and Time. Oxygen
pulse (min.). (per Remarks.
cent).
No. R-R. P-R. R-1'. P. -Q. R. -s. T.
- - - - - - - - - - - - - - - ·- - -· - --
1- 5 Normal. 21. 0 0.828 0.140 0.320 1.5 2.0 16.0 4. 0 3.5 Sinusarrhythmiashown by
1-21 Normal. 21. 0 .628 .uo , 320 2.0 2. 0 16.g 2. 0 4.0 variation of R-R.
2-1 5 18.4 .540 .140 • 320 1. 8 2.0 14. 2.5 2.5 Arrhythmia slow and
marked.
3-1 10 15. 7 .800 , 140 . 320 1.4 1. 2 15.0 3.0 2.8
3-7 10 15. 7 .612 .144 .a20 1.6 l.~ 13.0 2.0 2.4
4-5 15 13.1 , 776 .144 ,300 4.6 1. 0 15. 5 !LO 2.0
4-1 15 13.1 .560 .136 . 312 2.0 2.0 14.0 3.'0 2.2
5-6 20 10.5 . 784 .144 .300 1.6 1. 3 16.5 4. 5 2. 0 Long perio<hrrhyl;bmia.
&-16 20 10. 5 .548 .136 .292 1.6 1.0 13. 0 2. 0 1. 8
~ 22 9.5 • 760 .136 .300 1.5 1.0 16.0 4. 0 2.0
6-16 22 9.5 .520 .144 .292 2.Q 1. 4 12. 5 2.0 1.8
7-1 24 8. 4 .648 .144 .300 1.8 1.3 14.5 3.0 2.0 Sinus arrhythmia.
7-7 24 8.4 •.504 .136 .304 1.8 1. 2 13. 0 2.5 2.0
8-1 26 7.4 .540 .140 .296 1.0 1. 6 13.0 4. 0 2.2
9-1 'IT 6.8 .760 None. .300 Nime, 2.0 16.0 1.0 3.0 Clonic spasms at end of ex-
periment. P not evident,
10-2 Recovery. 21.0 ,868 None. • 320 None . 2.0 18. 0 2.0 3,4
10-3 Recovery. 21.0 • 832 None . . '320 None. 1.6 15. 0 2.0 3.2
10-3 Recovery. 21 . 0 . 812 None . , 320 None. 1.0 rn.o 2.0 3.0
10-4 Recovery. 21,, 0 • 760 .064 ,320 1,2 o.o 17.0 2,0 3.2
10-5 I Reeovery. 21. 0 . 760 .128 • 320 2. 0 1. 2 14.'5 2:5 3.6 The initial complex meas-
lo-6 Recovery. 21.0 • 700 .144 .328' 2,0 1.0 14.0 2.5 4.0 ured.
10-7 Recovery. 21.0 .560 .140 • 320 2.0 1.0 14.0 3.4 4. 2
10-8 Recovery. 21.0 .640 .144 .320 1.8 .6 14.0 3.0 4.0
10-9 . Recovery. 21.0 .888 .140 ,·320 2.0 .6 13. 5 3.0 4.0
10-18 Recovery. 21.0 .872 .128 . 320 1.6 1. 0 15. 0 3.0 4. 5
10-10 ••••• •• •• r •• 68.0 .88 .14 .32 ······ ···· ······· ······ ···· ··· ...... - .. -· ········
~

10-11 71.0 .84 .14 .32

······· ·· · ... ....... ··········
J
········· ·· · ··-·· ·---- ··········
10-12
10-13 ······· ···-· 68.0
68. 0
.88
.88
.14
.14
.32
.30
----------..
·· -······· ......... ··· .......
... ··· ··· ···..· ··········
·- ··· ·· ........
·· ···· ······ ··-···-··· ······ ····
10-14
10-15 .············
.............
68.0
70.0
. 88
.86
.14
.15
.32
.32
---- ------
··-····· "· ...... ·· ········ ...... .... ······ ·· ··
.. ....
10-16 ··· ·· ·-····· 70.0 .~ .14 .32
··--·----·
··--···-·· ···· ·-····
··
.. ····
.....···· ······ ··· · ··
... .......... ·· -- ·· · ·
.......... 1
10-17
10-18 ···
.... ·..-········
. .......
.6 9.0
69.0
.f!T
. f!T
.13
.13
. 32
.32 1.6 ···To ... 15. 0 . ......... 3.0
-·-·· ·····
4.5,
 87
Corpl. F. ,J. D.; oxygen 8.1 per cent; time 24 minutes 26 The normal time of contraction was 0.920 second in the
seconds.-The clinical sheet of Corp. D. shows compensa- twenty-second minute, the last contraction of figure 6,
tions .of the circulatory systein to 10 per cent oxygen Plate I. The time of the beat was 0.716 second. Little
(fig. 43). The heart rate was augmented to 96 during the change occurred in the time of the ventricular complex,
twenty-second minute, th~n fell sharply during the but there was a slight shortening· of the interval. The
twenty-third and twenty-fourth minutes. The systolic conduction time was exceptionally long, 0.344 second in
blood pressure was sustained to the end of the experiment, the normal tracing, which is two and a half times the
but diastolic pressure broke at 21 minu"tes. The electro- standard average.
cardiogram in the twenty-fourth minute shows the onset I No striking changes occurred in the amplitudes of the
of complete heart block. This is coupled with slow I different deflections. However, the entire series of
Cpl. F.J' .D. _ _M_a=r~c=h~9~·.,.,1=9=1=9'-c,-,--------
<N-> (Dale...rBaalj
~ teotE:.!!.1?.L~~.11:!.11.r.•E.l.!!.1:.."t.r.iw.ar_a,111.~tioD . . 24
of "'"'__ _e_Q.....- - . .
Phys. anid. at time of teo, ____g__._~. but · clinical histo~y of~he=u=r~t~b._.l=o-c_k~------
-,-------·-----------

=~ ·-·····"·-·····-·------J:;!_~-~!.!t~.~-;-~~;.i.£.!!nmtlZ-~tlL- -
Buct .:onditioo at cloee of tat verY cyanotig but c-onscioµs

---------~"-e~ig_h__,t_l~5"""0~lb~a-'~- Height 70 inches -·- --- - -

-----··--
Oboonen: Maj.Greene , Pb,a.111nj.G1lbert Clla.Sgt,Greiat ,B ,F Lt.Clough ;i;:c",
O..macbineSgt.Jaffa 1'1ottedb7-Yt,Brown o,1' atart.3.-1..... flaioh B,I
wend ---0,'I'• ·•··· •···• ···• Palae 11.esp.ia decil. per. mia. Syat. B. P.
----Diast. D. P. Pulse Pressure Aecom: ia mm.. COoveramce 3n mm.
tllO 1'0
I
40
.......
180

- r>~ -

"'"
r---..
uo ....
I V"'- V [./

10
v\' ~ i,--...v ~
/
V
·I/
I

100
\ 0
/v
11

IIO
I\ I\ ft /
V
ill/" ·A 11

\ J 1 /\ V
......· ···II\ ,---..~
ao I

. .. \- 1-t··.. ....•. .•...•.. ....... ., •• J Vi I'\ ) _i..... . IV"

..)~:-: ~-
20
11- I I/
:V" >-----'" .... ~
- RI \
'; ·"i -.
I\& II
I

IO
I V 11
I/ '
40 1

V
- 18

It
/ '
I

10
)
/ .
0
• n
/
ft o 1 2 a 4 5 6 7 s i ro . 11 ~ a 14 ~ a 1118 tu~ n ~ ~ ~ 2, ~ n ~~ oo" a• •
TIME nr MINUTES

Fm. 43.-No striking changes occurred in the amplitudes of the different deflections. However, the
entire series of records show diphasic T wave. In some portions a distinct U wave also occurred:
for example, xx in Plate II, figure 1, also in figure 3. The lo)lg conduction time is suggestive of
some possible pathological lesion in the conducting tissue with corresponding delay in the process.

ventricular rate. It is interesting that the systolic pressure records show diphasic T wave. In some portions a
was maintained for a few moments in the presence of distinct U wave also occurred, for example, in Plate II,
both slow heart rate and sharp diastolic break. figure 1, also in figure 3. The long conduction time
There was complete failure of compensation in respira- is suggestive of some possible pathological lesion 'in
tion. The very large minute volume of air breathed in the conducting tissue with corresponding delay in the
the sixth and seventh minutes was due to a series of deep process.
sighing inspirations. In fact the respiratory record was In the twenty-fourth minute, just at the conclusion,
extremely irregular in tidal volume throughout. a change occurred in the rhythm which admits of som0
Eight el'ectrocardiograms were secured. Only slight discussion. The entire record secured at 8.1 per cent is
changes in the form of the cardiogram occurred during presented in figures 7 and 8, Plate II. Inspection of
the first 22 mi:r;mtes. There was a shortening of the this record shows that complete dissociation occurred.
P-R time associated with the increase in heart rate. The first P-R interval of the record is slightly less than
 88
the normal for .the individual, and each BUcceeding in- of Plate II the recovery tracing shows that the normal
te_rvaJ is decreased in time. At the same time there is relationship has returned as regards the sequence. · We
lengthening of the P-P interval, evidencing auricular do feel that a depression of the rhythmicity of the sino-
slowing, while the R-R interval remains substantially auricular node is shown in figure 10. In itself the record
the same or does not increase in proportion. Two possi- is insufficient to wholly justify this conclusion; but when
bilities suggest themselves: First, that in the preceding compared with suppression of rhythm in the auricles of
unrecorded interval conductivity had depressed, and other _hearts to be described later and with the added
that the dissociation is due to a complete internodal evidence that in routine Air Service examinations a
block; second, that the dissociation is due to the depression decrease in rate .was frequently observed in acute oxygen
of the pacemaking function of the sino-auricufar node to want, we feel that our conclusion is warranted.
a point below the rate· of its stimulus production inherent The variations of rate during the period of dissociation
in the A-V node at that time, allowing the A-V node to are noted, but no explanation is suggested at this time
assume an independent rhythm. since we have other data 'yet to present bearing on this
Whatever its etiology, dissociation clearly occurs. In phenomenon. It is not impossible that in some cases
Ghia record the P wave is seen to move through the ven- the auricular impulses found - a ventricular response, as
tricular comp_lex four times, which argues against A-V in the fourteenth beat, where it will be o.bserved that .
control of the auricular rhythm. Table 25 shows a record the P-P interval is about normal and the R-R interval
of the measurements for the entire tracing. In figure 9 is shortened.

TABLE 24.

,-
T race
and Time Oxygen ·
Duration in secs. Amplitude in mm.
pulse (min.). (percent). Remarks.
No. p.:p. R - R. P-'R. R - T. P. -Q. R. -S. T.

1-1 Normal.. •. 21. 0 0. 920

- -- - -- - - -
0.920 0.344 0.344
- -- -1. 3
- -
None.
- --
10.0 2.5 '+0.6 .t o -0.2 T==difchasic, In some pulses+
2-2 5~ - - .. -- - - - 18. 4 • 828 .824 .308 .360 1.5 None. 9.6 2.0 + . 7 to - .6 0.6 o -0.4 and more.
3-2 10. - . • ••.•• 15.8 .800 .804 . 320 .360 1. 4 0.3 9.4 2.0 + .6to- .7
4-6 15 •.•... -- . 13. l • 748 • 744 . 316 .344 1.6 .3 9.0 3.0 + .6to- .4
5-1 20 . • ··•···• 10. 5 .soo . 792 .296 +.328 l. 2 .8 0.2 3.0 +.2to- ·.8
6-2 -22 .•••• • , •. 9.4 • 728 • 716 .296 . 336 1.8 .4 9. 0· 3.2 + .6t.o -.8
7-1 24 "otl" ... ·s.1 . 680 .680 . 308 . 336 1.0 Trace . . 9.0 3.0 -f .7to- .2 Complete block developed.
g.. Last pulse. 21.0 • 712 • 712 .314 .342 2. 0 None. 9.0 3. 0 - .2 to .-(?) See Table V, T==diphamc.
7-1 )Five s_uc- .680 . 308 .336 1.0 Trace. 9. 0 3.0 +.7to-.2 T low and Indeterminate.
7-2 cess1ve . 728 .680 .288 .'344 1. 5 0.4 9.0 3.0 + .8
7-3 pulsesin 8.1 : 784
r80 .692 .212 .320 ]. 5 Trace. 8. 0 2.4 + .6
7-4 the 24th .896 , 716 • 112 . 320 1.6 ·Trace . 8. 0 3. 0 + .4 P follows R, reversed conduc-
7-5 min. . 960 . 740 +.048 • 340 1.6 None . 8. 0 3.0 1.2 tion .

TABLE 25. Sgt. M. D. F .; final oxygen, 7.3 per cent; time, 33 minutes
Giving the auricular intervals, P-P, and the ventricular, R-R, and 7 seconds.-This degree of asphyxiation was not BUfficient
the time from the beginning of theauricularcomplex to the next succeed- to produce any marked physiological changes in the
ing ventricular complex. The series includes all the beats during the heart so far as was revealed by thE! electrocardiogram.
twenty-fourth minute, 'i. e,, from the beginning of complete block ti> the
end of the test. The block appeared at 8.1 per cent oxygen. The heart tate increased from a. normal of 73 per minute
.t o over 90. There was no change in duration of either
Intervals in seconds. Computed rates, the P-R or the R-T intervals. Very little change oc-
Ventric-
ular curred in .the amplitude of the deflections with the ex-
contrac- ception of the T wave which was reduced in amplitude
tion P-P R-R P-R Auric- Ventric-
serial No. ular. ular. _as usual. The total reduction a.mounted to 40 per cent.
- - - - - - - -- --- The duration of the test was long in Sgt. F. 's case, the
1 0.680 0.680 0.28 88 88 initial allowance of air being· too great for his weight of
2 . 728 .680 .26 82 88
3 -184 .692 .20 76 87 132 pounds. However, that does not in general influen·c e
4 .896 • 716 .10 67 84
5 . 740 ....... ... 81 the degree of low oxygen endured. In fact, the slightly
6 . 960 .644 .64 62 93 longer teat may l)e considered tp.e more accurate. With
7 . 768 .36 64 78
8 .800 .21 61 75 this in mind, the test has the more significance in that the
9
10
11
!.... ~~--.880
.808
.804
.898
.00
.......... ····-·-·--
• 74
65
68
75
75
57
time intervals in both the conduction and ventricular
complexes are absolutely· uniform. The slight excep-
12 .880 • !JJ8 .68 68 75
13 .880 .620 .60 68 97 tions are ~holly within the error of-measurement.
I 14
15
16
17
.824
.856
.920
---···-·-·
. 748
• 748
• 732
.732
.34
.24
.12
---------- ------ 71
----
73
70
65
80
82
82
82
Pvt. J. F.; final oxygen 8.4 per ·cent; total time 21 minutes
56 3econds.-The clinical chart of-this test is of peculiar in-
18 .840 . 732 .68 82 terest as a type showing sudden collapse at a compara.tiveiy
19 .860 .616 .52 70 97
20 . 760 . 696 .32 79 86 high per cent of oxygen, bet"l'l'een 8 and 10 per cent. There
21 . 740 .700 .22 81 86 ill a elinical lj,istory diagnosed a.s N. C. A. The blood
22 .800 .692 .20 75 86
23 .940 . 704 .05 64 85 pressures, both systolic and diastolic, steadily fall to 9.5
24 • 720 .. .. ...... ......... . 83
25 .920 .664 .56 65 90 per cent oxygen when collapse began. There was no
26 .960 · • 716 .30 63 84 respiratory compensation during the entire run.
 89
TABLE 26.

Trace Duration in secs. Amplitude in mm.

and Oxygen
pulse Time (min.). (per
No. cent). R-R. P--R . R-T. P. -Q. R. -S . T.
- - - - - - - - -- - -- - - - - - --------
1-2 Normal. 21.0 0.824 0.160 0.320 1. 2 0. 5 18. 0 3. 0 3.5
2-2 5 18. 9 . 748 .168 . 320 1. 2 .2 18. 0 2. 5 3.4
3-3 10 16. 9 .664 .168 . 320 1. 5 .6 16.5 2.0 3. 2
4-1 15 14.8 . 704 . 172 .320 1. 4 .3 17.5 2.0 3. 5
5-2 20 12. 7 . 712 .168 .320 1. 0 .4 16. 5 1. 5 3. 2
&-1
7-2
8-2
22
24
26
11. 9
11.1
10. 2
I .680
. 696
.664
.168
.168
.168
.320
.324
.320
1. 5
1. 0
1. 2
.4
.5
.4
18.0
16. 0
16. 0
1. 5
vs
1. 0
3.2
3.0
3.0
9-2 28 9.4 .664 .168 . 320 1. 0 .4 16.0 1. 0 3. 0
10-3 30 8.6 .648 .168 .320 1.0 .4 15. 5 2.0 2.8
11-3 32 7.8 .640 . 168 .324 .6 .5 16. 0 1. 4 2.2
12-4 35 recovery. . . ... . . ..... . 740
I .168
I .320 .8 1. 0 18. 0 2.0 3.0

Pvt.J.P. March 10 · 1919

(N-) (Da<eoadlloar)
Type ol teot...llJl.lu:....•....E.J.ac.lr.ru::a.t:.d.agr.aph_1>antia. ........... 2l ..... miDa~---56.._...,.,nds
Phys. coDd. at time of teot_Q-,_K~,- - - - ·
-····--··- ··--··----·-·······--··------- -·····-······-···-··
Bsact condition at cla&e of test Very CY80Pti C spoke 1 D J 5 88CQ.r!ru!____ __ _ _ __

!:'~': ::::::::::: : : :::::::::::::~J~~;E~ l32 __lbs ... Hei~ 68 inches. convalescent N,C.A~

iol>Rrv~: 1.1a1,Greene Phy,JJa.l,.GiJbert am. Sgt Greist BP, T.t Clough Ecg_ _
on mocliiaeSgt • Jaffa l'lotted by Pvt ,Braim o,fia"'tart-...2.l ..... f'uois~
Lca~nd - - - 0 1 S ........-_. Palae ci II o " ,o Jteap.in decll. per. min. Syst. B. P.
- - - Diast. D. P. ?ulsc Pressure Aecom in mm. Conver.-euce in mm.
1oor--.--r--.---r--..---.,--.-...,..-...---r--.--,,--....,.--r--r--r---,.-....,.-....,.,,~o,
1<01--+--+-+-+--+--ll--+--+-+-+--+--l--+--+-+--+--11--+--I

-----
,ao ' /

Ja0t----t--+-+-+--+--1l--+--"l-o,:::,......._-1_--+_=-+---+/r--+--t----t--+-+--t---i
/
111of--4--+---ll----l,---l---+--4--1----+---i,---l-,-,',4
/'+--+--+--4--+---i--+-~10
.... /
..··/
Wt-:-""l--t---t---t--t--11--t---t--+'~"t:--t--ir-:---t--t---t--t--t---t-~U
:i\·-.. .. ,. ,..··· ..... _.....·· .,····/ '
I
,or--:
+--.:J\~~~~~::+i~~'~t<:tf:+r~~-1-+-+~
~ / . V ..... )I../ '\_;Y\ ~ _.)/ 14

OOt---+--+--+--t---+--+--h'"-+--+-"--il---+--l'r,;,-o-+-_,-
. /++---+--+--+--'11----115

......--i--+---l--+--+---iho'/--+---l---+--+--+---il-1-1-+e
· -~+---l--+--l--+--114
V \
/
/
aot---+-+-+--l--:~/+--+--t---+--+-+-+--+---l--+--+-+-+---if---118
V
V
• • "
/
o 1 2 a , G a 1 e e 10 u 1a 1s 14 1s 1a 11 1s 19 . 20 21 :. 28 M 2'5 20 27 28 29 30 a1 ~
"' TIMB IN llINUTI!S

FIG. 44.

The heart rate incre1¥3ed from a minimal of 69 to a max- stage and just before the first clinical record the heart had
imal of 105 in the nineteenth minute. In the last minute slowed to an equivalent rate of 50 in the fourth beat, ER
the rate fell from 102 to 63 at the last clinical count. The of t est (fig. 3 and fig. 7 of Pl. III ).
last electrocardiogram during the test occurs at the twenty- The clinical record is interesting as showing lack of com-
first minute, showing a rate of 68 (fig. 6, Pl. III). pensatory elasticity in the neurocirculatory aesthenia
In the electrocardiogram taken: in the early recovery type. Th!l test was not carried to the complete limit of
 90
endurance. The usual changes in the electrocardiogram experiment ended and to 50 per minute during the re-
with reduced oxygen appear only in the T wave. The covery. The sudden slowing of the rate just at the close
P-R and R-T intervals are constant. of the experiment is another instance of the effect of
The chief interest in this test lies in tlie sudden reduction oxygen want in slowing down stimulus production at the
of heart. rate in the twenty-first minute. The slow rate crisfu.
continued throughout the recovery record after pure air. There were indications of approaching un.consciousness
The electrocardiogtam is normal in form, although the at the moment of .e nding the experiment, but F. spoke 15
heart rate was reduced to 68 per minute just before the seconds after beginning to breathe pure air.
TABLE 27.
I
Trace Duration in secs. .Alnplitude in mm.
and Time Oxygen
pulse (min.) . (per Remarks.
No.' cent). R-R. P-R. R-T. P. -Q. R. -s. '.l'.
--- - - - ------ - - - - --
1-2 Normal. 21. 0 0.668 0.140 0.206 l. 4 None. 9.0 0. 7 4.0 Effort ·syndrome case.
2-2 5 18.1 • 760 .144 .308 1.0 None. 9.5 1•. 0 2.8
3-4 10 15. 3 • 700 : 148 .304. 1.0 None. 9.0 l. 0 3. 0
4--2 15 12.4 .616 .144 .296 l. 4 None. !1.0 .6 2.4 Slig),it sin,us, arrhyth-
mia.
5-2 20 9.5 . 560 . 140 .292 1. 4 None. 10.5 .4 1.6
6--4 21 8.9 1. 052 .144 , 300 .6 None. 10.5 None. 2. 5 Failing heart.
7- 2 Recovery. 21.0 1.104 .144 .320 1.0 Noue. 10.5 None. 3. 4 Spoke within 15 secs.

Pfc. A . H. G.; oxygen 8.1 pe:r cent; time 29 minutes 92
seconds.-The chief change in the electrocardiogram was
in the amplitudes. There was a slight decrease in the
amplitude of the R lasting through the recovery stage.
There was no S wave. The T wave was reduced from
TABLE
2 mm. normal deflection to about 0.2 mm. in the last
stage of the experithent. The T was small throughout
the experiment. Toward the approaGh of oxygen 'asphyxi-
ation it was reduced to a very small deflection present
only toward the end of the ventricular interval.
28.

Trace Duration in secs. Amplitude in mm.

and Time Oxygen
pulse (min.). (per Remarks.
No. cent). R-R . P-R. R-T. ,P. -Q. R. -S. T.
-- - - -- - - - - - - - -- ---------
1-1 Normal. 21.0 o. 720 0.160 0.320 1. 4 1. 0 13: 0 None. 2.0 £
Electrocardiogr a h i c
type with very ow T
and nos.
·2--4 5 18. 8 :100 .160 . 320 1. 6 1. 3 14. 5· None. 2.0
3-,2 10 16.6 :616 .152 .300 1. 3 1.0 13.0 None. 2.0 Sinas arrh:ythmia .
4--4 15 14.5 . 680 ' .148 . 302 1.2 .5 15.0 None. 1. 8 Arrhythmia.
5-2 20 12. 3 . 644 .152 . 308 1. 2 1.0 13.0 None. 1. 4
6--10 22 11.4 . 628 .148 .312 1. 2 1; 5 13.0 None. 1.4
6--29 22 11.4 .920 .144 l. 0 .6 12. 5 None. 1.6
7- 12
7-2
24
24
10. 5
10.5 -
.608
. 832
.144
.140
:~
.320
1. 6
1. 2
l. 2·
.6
13. 0
13.0
None.
None.
.4
.6
8-1 26 9.6 .560 .140 ' .280 1. 4 l. 0 12.0 None .._ 1. 0 Average pulse, 0.600 sec:
!ki
9- 1
26
28
9. 6
8.8
. 680
.575
.140
.140
. 300
. 300 l.
1.
i 1. 2
1. 0
12.0
12. 0
None.
None.
.8
.2
10-4 Recovery.- 21.0 .668 . t40 . 280 1. 2 1.0 12. 0 None. .4

Pfc. T . H. K .; final oxygen 7.1 per cent; total time 27
minutes 9 seconds.-The ·clinical ' chart is of interest be-
cause of the partial coll.apse of the heart and fall of the
blood pressure without loss of cons<,iousness. The sys-
tolic blood pressure rel)lllfllB constant. to 8.2 per cent, then
it drops suddenly and rapidly. The diastolic pressure
also remains constant at 80 mm. to 9. 7 per ·cent, then
0
rapidly falls through five minutes to 44 mm. The heart
rate of 80 per minute increases to 90 at the twenty-ninth
minute, then rapidly to 116 at the last reading. The elec-
trocardiograms ,how that this rate dropped to from 63 to
55 and became vety irregular ,(Pl. IV, figs. 9 and 10) dur-
ing the interval between the last clinical pulse reading
and the first recovery reading.
The record shows only slight . changes in the electro-
cardiogram through to the twenty-sixth minute. There
was no important change in the conduction time and only
very slight shortening of the R-T interval as the usual
augmentation of rate came on. K. was of strong mus-
cular type and was taken off because of beginning general
clonic tremors. Muscular clonus lasted for 20 seco;nds,
though he recovered . control after the first few normal
inspirations. Fortunately we have a long tracing. of 32
heart beats taken at the close of the experiment and durin.g
the early recovery stage.
This record shows again a complete dissociation of the
auricular snd ventricular rhythms. Already in the pre-
ceding tracing at 7.7 per cent oxygen the rate had slowed,
though the sequence wa_s still normal. In the unphoto-
graphed interval the pacemaking function of the S-A
node slowed below the critical point of .stimulUB produc-
tion in the A-V node.. In fact the change proceeded to
the point of independence. Thisis:shown l;>y the irregu-
larity of the P-P interval, where it can be determined,
and by the evidence of varying site of stimulus production
in the ~uricle as evidenced by both direct and inverted
form and varying amplitudes of the P waves.. In addition
we have tlle increase of ventric'\llar muscle irritability as
shown by two premature ventricular beats. In fact, this
feature of the record suggests that of digitalis poisoning
or the type of hyperirritability observed in the electro.1
cardiograms of eJLperimental animals after chloroform.
 91
Ptc,T,B K, March 9, J 9] g·
' (N. . . ) (11•1"""4-)
Type of - Re~.r.........!ll,,!!s.:t!'..Q,9..~.L<!.l!lK!:',fM_ DaratiOll-,,,,,,1?,1. __ ,. ,,.. ,.min--,~-~,- - -
Phya. coDd. at time of te1t .-.O.•.L... _.Mua.c.ula.r_i.!Jle.--~rcm,,.,., before en] 1 sting,

.;;;~d.it·i~~...~;-;~- of~iusCUiar-treiiiOrS··1ncrafisin'g io c1onus 1 tor. 10-20 saooniie

&pftry u:1,_u ____~«i.!!.IL..i!l.!!Pi.r.!\.t l.Jm....tl!mJl.~.§lid...mLr.11,egyer;v was then proomt,
-..b, .W.~.1Bb.1.....l.~Q:.,P.Q.1ID~ll~---.JW.ahli.-&L..IL.J.~,,, ,
a.i.n-: ¥Ah Greeno Ph,.. ¥A3-, , Gilbert cu,,. Sgt.· QteisW Lt. Clougb, Ecp~_
Oaaac:biae Jlaj, Jaffa l'lou.dby Jtvt, Bromi 0 ,11, ltl!'t,-- ~J,- P•im 7,1 ,
Lec,,nd 0,11o •··--- • Pnbe ·aeop.ln d,cll. per. aw,. - 8,at. B. P.
----Diu1. D. P. Pllloe Pnuare Aecom In mm. ~ - - In mm.
tlO 1r

'° V '
llO

llO

IO
- ~ ~
'/
~

~ r---. ,-r - - -fv 'p,'\

V .. :,• I::..
I /,-....
8

'
10

100
V . ./ \I. -,
00
.. V ..... } _
II
.•·····.,. \l,/
..,, , .. .. ··•· ·-.... ...: ..-J I>-- V ,,
90
... ..... 7 ··---·· II

/\ lX V;- \ J I\ "
_

"
I'-- i"I..
'~ \.." ·\
. /
.
'° '
'/ .. 1$

• V \
6
II
V '\
IT

• V 8

• I/ "-
10
V
0 . . . ·IV
0 1
TIO IN MINUTES,
••• • 0 8 I 10 11' : 18 .. llS IITIIIIIOUIOIONUIOHIOIO.UalO -
Fm. 45.

TABLE 29.

Trace
and
pulse
Time
(min.).
·Oxygen
1
(per
I Duration in secs-. Amplitude In mm.
Remarks.
No. cent).· R- R . P-'R. R-T. P. -Q. R. -s. T.
- - - - - - - - - - -- ---- ---- - - - - ----
1-7 ·Normal. 21.0 0.840 0.160 0. 340 1.0, None. 16.0 None. 3.0 Trembling.
2-li j; 18. 4 . 868 • 168 .360 1. 0 None . 16,5 , None. 3.5 Arrhythmia group.
2-1 5 18.4 . 760 . 168 .352 1.2 None. 1g-5 None. · 3.0
3-2 10 15, ,9 .69_6 .168 .332 1. 6 None. 1 .5 None. 2.4
4-2 15 13.3 . 748 . 160 .336 1.0 None: 15.,0 None. 2.0 Sinus arrhythmia.
4-6 15 13.S ..672 . 160 .336 1. 3 None. 16:0 None . 2.0
f>-2 20 10. 7 .640 .160 .32() 1. 5 None. 16.0 None. 1. 8
6- 2 22 9. 7 .576 .152 .300 1. 6 None. 16. 0 None. 1.6
7-2. 24 8. 7 . 544 .160 .312 1. 5- 1. 4 i.7.0_ None. ±0.4 T very fl.at.
8-7 26 7. 7 . 548 .148 .300 1. 5 2.0 16. 0 N6ne. ±0. 4
9 Recovery.• 21.0

1 See, Table 30 for irregular boats in recovery peri9d.

 92
TABLE 30.

Pulse · Duration In secs. Amplitu<le In mm.

trace9
during Remarks.
there-
cove:-! R-R. P-R. , R-T. P. -Q. R. -s. T.
perio .
------ - - -- - - ~

1 0.952 0.500 0.360 -2.0 None. 18.0 None. 3.4

2 .528 .620 .340 -2.0 None. 19.0, None. 3.0
3 .940 .200 .328 -1;6 0: 5 18.0 None. 2.5
4 .944 .100 . 340 -2.0 0.6 18.5 None. 1.5
5 .944 .340 .360 +0.5 1. 6 19. 0 None. 2.0
6 ; 752 None. .360 None. 0.5 20.0 None. 2.0
7 .940 .180 .320 +1, 2 0.6 19.0 None. 1.8
8 .504 None. .360 ·None. 1. 0 20.0 None. 2.0
9 .940 :240 .320 .+2,0 None• 18.5 None. 3. 2
10 . 968 None. .360 -N one. 1.0 18.5 None. 3.2
11 .944 - . 144 .340 None. 1.0 18.5 None. 2.0 P follows-R.
12 • 528' No,ne . .320 None. 1.0 18. 0 None. 0.5
13 ,900 .220 .320 -1.0 None. 17.0 None. 2.0
14 .960 -.050 .360 . -2. 0 None. 20.0 (?) 3. 0 -P su,Perlm~sed on the
15 . 484 None. .360 None. None. 19. 0 None. 2.0 lower limbo R.
16 ;928 .240 .320 1.8 None. 16. 5 None. 2.6
IT .512 None. .380 None. None. 19. 0 None. 4.5 Combined +T and +P.
18 .948 .240 .320 P+T None. 17.0 Nohe. 2. 0
19 .480 None. ,360 None. 0.5 lQ. O No:ne. 3.5
20 ; 920 .240 .380 -1.5 None. 10. 0 None. -? Ventricle complex ectopic.
21 .480 None. .372 None. 0.5 18.5 None. 3.0
22 .824 .320 .380 ..:7 None. 10.0 None . 3.0
17.0 .
23
24
25
1.080
.972
.472
.064
.050
None.
-~
.348
',360
+1.0
+1.0
None.
None.
None.
None.
19.0
19.0
None.
None.
None.
3.0
2.5
3.0
26
27
28
.920
1.000
1.000
-~
.1
-.160
.336
.360
. 360
-1±
+I
+t
None.
None.
I
10.0
18.0
19.0
1.0
None.
None•
4. 0
2. 0
2.,0
29 . 488 None. . • 360 None. None. 18. 5 None. 2. 8
30 .928 . • 220 . 320 +1 ' None. 16.5 None. 2.5
31 l.012 . 140 . 360 +l I 17.5 None. 2. 5
32 ·········· -.140 .360 +I None. 16.0 None .• 2.2

Sgt. H. -K.; final oxygen 6.5 per cent; total time SO min-
u.tu t7 aeconda.-The electrocardiogram gives a good ex,
ample of a heart very resistant to the stress of low oxygen.
The experiment showed little or no change in the P-R
interval coincident with the uaual augmentation of heart
rate. On the other hand, the contraction time for the
ventricle, represented by-the R-T interval decreased 12.5
per cent toward the end of the experiment, 0.280 second as
against the normal of 0:320 second. A small Q wave
appeared after 7T oxygen was reached and persisted in the
recovery period. The T wave was reduced in amplitude
but not so much as usual. Six and a half per cent of
oxygen was seldom reached in our series without some
striking evidence showing in the cardiac reactions.
That the degree of asphyxiation endured by an indi-
vidual may be .to some extent a factor of practice is sup-
ported by the fact that Sgt. K. is an expert diver.

TABLE 31.

Trace Duration In secs. Amplitude in mm.

and Oxygen.
pulse Time (min.). (per Remarks.
cent). p
No, R-R P-R R-T -Q R -S T
- - - - - - ---- - - ---------
1-3 Normal. 21. 0 o. 780 0.140 0.320 1.4 None. 11.5 2.5 3.6 Muscular trembling.
2-1 5 18.5 . 720 .148 .320 1.5 None. 12.0 3.0 2.6
3-1 10 16,2 • 740 .140 .320 .4 None. 12. 5 2. 5 2. 6
4-3 15 13. 7 • 752 .140 .320 1,2 None. 12.0 2.4 2.8
o-2 17 12.8 • 720 .148 . 324 1.0 None. 13.0 2.0 3. 0
6-5 19 11.9 • 708 .148 . 328 1. 0 None. 12. 5 3.0 3. 0 Muscular tremors have
about disappeared.
7-2 21 11.0 • 720 .140 .328. 1. 3 None. 13.0 2. 5 2.8
8-3 23 10.0 .664. .140 .320 1. 2 None. 12.5 2.5 2.2
9-1 25 9.1 .664 .148 .300 1.0 None. 11.0 1.5 2.3
10-2 27 8.1 • 5!l4 ; 140 .300 1.0 Trace. 13.0 2.0 2; 2
11-1 29 7. 7 .540 ,'136 .296 1.4 1.0 11.5 2.0 1. 8
12-1 30 6. 7 .560 .136 ,288 I. 2 0.6 13. 5 2.0 2. 2
it1
13-H
After period.
After period.
After period.
21.0
21. 0
21. 0
.616
. 860
. 960
. 140
.140
. 148
,280
.300
.320
I. 4
1. 0
1. 0
1.0
0.5
1. 0
14. 5
11. 5
13. 5
2.0
2. 0·
2.0
3.0
2. 8
4. 0

Corpl. W. D. L.; final oxygen 6.9 pet cent; total time £9
minutta 18 se.conda.-There is only one unusual feature in
the electrocardiogram. Corp!. L. rune the usual course
of an accelerated heart rate, a constant P-R interval, a
rather strongly decreasing R-T interval, and a decrease in
amplit-ude of the T wave. In the fifteenth minute there
were occasional short R-R intervals compensated in the
I next.succeeding beats. These are introduced by the P-R
I intervals longer than the average, i. e., 0.180 second, as
compared with 0.144 second of the normal. They seem to
be associated with an over-active type of sinus arrhythmia,
that will be discussed in a later paper of this series.
The subject remained conscious to the close of the test.
He was reported as having a clinical history of nodal
 93
rhythm and premature ventricular systoles. Neither acceleration of rate produced under the stress of low
appeared dUl'ing our test. Low oxygen might be expected Oxygen. During the last low oxygen record,. the twenty-
to augment conditions leading to nodal rhythm. How- eighth minute, the T wave is very small and diphasic.
ever, extra ventricular systoles disappear during the

TABLE 32.

Trace Duration in secs. Amplitude in mm.

and Time Oxygen Remarks.
pulse (min.). (percent.)
No. R-R. P-R. R-T. P. -Q. R. -S. 'I'.
- - - - - - - - - - - - - - - - - - -·- -.-
1-2 Normal. 21.0 0. 816 0.144 0.328 1. 0 None. 13. 0 2.0 2.4
2-3 5 18.6 • 768 .148 .324 1. 2 N~e. 12.5 2.5 2. 5 Every third and fourth
3-10 10 16.2 . 744 .140 .320 1.4 Noe. 12.5 2.0 2.0 beat shorterand com-
4-4 15 13. 8 • 584 .156 .320 1.3 None . 12.0 2.5 2.0 i::ansated in next
4-.5 15 13.8 .872 .180 . 320 2. 0 1.0 13.0 2.5 2.0 t. The short.beats
4-6 15 13.8 . 736 . 148 .320 1. 6 None. 13. 0 2.0 1.8 are introduced by a
t~
7-3
20
22
24
11.4
10.4
9.4
. 632
.588
.600
.144
.148
,144
. 320
.304
. 300
1. 2
1.4
1. 8
None.
None.
None.
11.5
12.0
10. 5
2.0
3. 0
3.0
1.5
1.4
1. 2
lonJ P-R interval,
an the R's are
always taller.
8- 2 26 8.4 . 544 .144 .280 1.5 None . 13.0 3.0 0.6
9-4 28 7.5 .496 .144 .240 1.0 1. 0 9.0 2. 0 1: l Diphasic.
10-1 Recovery. 21.0. . 528 .144 .260 1.0 None. 12.0 2.5 2.2 Do.
10-17 Recovery. 21. 0 . 700 .148 .280 1. 5 N.one . 11.5 3; 0 0. 5

Sgt. E. 0. McC.; final oxygen 8.3 per cent; total time 23
minutes 5 seconds.-There was only slight increase in
·heart rate, no change in either the P-R or R-T intervals,
and the usual decrease in the amplitude of the T wave,
which in this case fell off more than one-Mlf. Otherwise
TABLE
this is a perfectly normal record in every way, expressing
the normal resistance of the healthy heart to low oxygen
tension in an experiment in which the extreme cardiac
I endurance to asphyxiation was not reached at an 8.3
per cent oxygen
33.

Trace Duration in secs. Amplitude in mm.

and Tune Oxygen
pulse (mln;). (per
No. cent). R-R P-R. R-T. P. -Q. R. -S. T.
- - - -~- - - - - - -.- - - - - - - - - - - - -
1-2 Normal. 21.0 1.012 0. 160 0.320 1, 2 None. 12.0 2.5' 5. 0
2-1 5 \8. 2 • 944 .160 .340 1. 2 No,ne. 12.0 2.0 4. 5
3-1 10 15.5 .916 .160 .336 1.4 None. 12;0 2.5 3.-8
4-4 15 12. 7 • 784 .160 .320 1.3 None. 11.0 2.0 3. 5
4-6 1.5 12. 7 1 . .008 .160 •.336 1.0 None. 11.5 2.0 4. 0
5-1 20 10.0 . 812 .160 .328 1.0 None. 10.0 2. 0 3.0
6-3 22 8.9 • 700 . 160 .320 1. 2 10:0 2.5 2. 7
7-2 Recovery. 21.0 . 892 .160 .320 1.0 N:J:t
N e. 12.0 2.0 2.2
7-20 Reoovery. 21.0 .944 .180 . 336 1.2 None. 10.0 2.5 4. 0

Pfc. A. H. McD.; final oxygen, 7.5 per cent; total. time, f4
minutes 15 seconds.-The rate was sharply augmented
without change in the P-R interval but with a decrease in
the R--T interval. Both the Sand the T waves decreased
in amplitude with the progress -0f the test and the T was
slightly diphasic. In the twentieth and twenty-second
minutes the T wave exhibited an unusual form. It began
as an isoelectric wave, to end in a sharp positive deflection
without the usual quick recovery'; . This gave the T wave
a stair-step form . The auricular CQmplex varied from the
normal type during ,low oxygeu' fo that the negative ph¥e
of the P wave continued until the :onset of the R . · This
was most marked in the twenty-second,minute at 8.8 per
cent oxygen.

TABLE 34.

Duration In secs. Amplitude in mm.

Traeeand Time Oxygen
pulse No. (mftl.), (per Remarks.
cent). R-R. P-R R-T. P. -Q. R. -8. T.
------------ - ----- ---.-
1-2 ... ..... Normal. 21.0 0. 768 0.140 0.320 1.0 None. 10.0 2.0 2. 0
2-3 .... . ... 5 18.2 • 760 .140 • 320 1.0 None. 8.5 2.0 1. 6
3-3... ... .•. 10 15.4 .892 .H4 . 300 1. 2 None. 9.0 2.0 1.4 Slow arrhythmia.
3-10 . ... ... 10 15.4 .824 .140 .320 1. 3 None, 9.0 1.5 1. 2 T-Flat except last
moment.
4-3 .. ... . . . 15 12.6 .588 .180 .280 1.2 None. 9.0 1.8 0. 5 Tslightdiphaslc,shelf-
o-1. ... ..•• 20 9.'8 .492 .140 .292 1. 4 None. 9.0 1. 0 1.0 Ulte.
6-L .....• 22 8.8 .476 .140 .280 1. 4 None. 9.5 1.0 1.0
7-6 .•.....• Recovery. 21.0 .468 .180 .280 1. 6 None. 8.5 1.5 1.0
Last pulse. Recovery. ·21.0 • 728 .152 .300 1.6 None. 9.6 1.5 1.4
 94
Sgt. W. C. M.; final oxygen 5.9 per cent: total time 23 min-
utes 48 seconds.-The physiological and clinical chart of
Sgt. M. (fig. 46) is unique.in several features. He reached
59 per cent oxygen, an equivalent altitude of 31,500 feet.
He made good compcmsations, but not in the typical way.
Instead of the, usual early gradual cardiac acceleration
preBBure slowly increased until the very last minute, when
it suddenly broke 20 mm.
The effect of prolonged athletic activity is manifest in
Sgt. M.'s excessive respiratory minute volume. This
began at 17 liters in the first minute, dropped to just
under 10 liters at 10 rrunutes, and increased rapidly after

Sgt.w.c.y.

IOO

180

180

1,0

1110

lllO

140

10

11

80 II

8D 18

"
.
• 1S

17

ao 18

00 19

10 00

FIG. 46.

beginning about the fifteenth minute, his heart rate ran
very uniform until the last two minutes. The rate then
augmented from 84 in the twenty-second to 150 in the
24th minute just before the close.
The ·systolic preBBure was over 150 mm. from the start,
but remained constant to the twelfth minute. From this
time it increased steadily for eight minutes, then sharply
the last two minutes to a total of 194 mm. The diastolic
the seventee~th minute to the enormous volume of
26.8 liters during the twenty-third or last full minute.
Qompensations are primarily due to augmentation of
respirartory volume and of blood preSBure. These
meet -the , strain to 7 per cent oxygen, when cardiac
acceleration was added. At the moment of unconscious-
neBB the .break in diastolic and in respiration had already
begun.
 95
Sgt. M. was physical director at Lakewood at the time -
he took the low oxygen test. He is a man of exceptional
muscular development and physical endurance. There
was a lively competition among the men at Lakehurst in
an attempt to exceed the record of Sgt. M., and the sergeant
himself entered into the spirit of this competition.
Notwithstanding the large volume of air breathed, he
became very cyanotic during the la.st five minutes. The
clinician did not terminate the ti)st until the onset of
unconsciousneBS. Immediately the mouthpiece wa.s .re-
moved. ConsciousnetJB reappeared after the first inhala-
tion of pure air. Muscular control was not lost and the
sergeant protested that he had not yet reached'his limit.
The heart rate wa.s very constant, and the cardiograms
show that there was no change m the P~R interval until
the twentieth minute, and then only in the short beats
of the arrhythmia periods. The R-T intervals became
shorter beginning on the twentieth minute. The char-
acter of the electrocardiogram wa.s abnormal. in only one
feature. The R wave was short and bifurcated. The U
wave was present in many of the cycles.
TABLE
The effect of oxygen want on local cardiac mechanisms
appears only in the recovery tracing, which was taken at
practically the moment of the removal of the mouthpiece
'(fig. 8, PL V). The .fifth beat in this figure shows a very
slight negative P wave. The·sixth has n:ow:.a well-defined
negative P. The inverted P wave . continues through
seven succeBBive· contractions. On the eighth, i. e., the
twelfth beat of the figure, the negative we:ve is reduced in
amount, and on the next beat the normal ppsitive ·p
appears and continues until the end of the photograph.
During the period of inverted P waves'the rate is reduced
slightly llB compared with the rate preceding and following
·the group, i. e., 167 to. 157 to 166 per minute. We consider
.this a splend,id example of jl,ll!t beginiliDg.. displacement of
-origin of the sino-auricular rhythm. The point of origin
of the rhythm i8 evidently fr6m a new BOtlrCe below,.
or from a lower point in the normal_·pacemaking centet.
It ls the initial stage of the oxygen want on the heart
in which the most advanced . stages are represented
by the terminal electrocardiograms of
Sgts. T. B.. M. and
:p.w. o.
35.

Duration In secs. Amplitude ln ~ -

·Trace and Time Oxygen
pulse No. (min.). (per Remarks.
cent). R-R. P- R . R-T. P. -Q. R. -8, T.
- - - - - - - - - - -- - - - - - - - - -
1-1. . . . . ... Normal. 121. 0 0.812 0.160 0.320 1.5 None . 7.0 None. 2.0 i,ome ,arrhythmia.
Z-2 .... .. .. 5 17.8 -.580 .160 . ·320 1..0 Trace. 7.5 None. 1.2 Do.
3-1. . . ...... 10 14.6 • 680 • 160 .320 1.0 None . 7.5 None . 1: 2
4-2 .. . . , ... 15 11. 5 .680 . 160 . 320 .8 None . 7.5 None. 1.0
5a-l.. - . .. . 20 8. 3 .656 .16() • 312 ..8 0.6 7. 0 None . 1.0·
5b-3.. ..... 20 8. 3 .632 .144 .300 .8 1.0 6.5 None. 1. 0
6-1. .. . .... 22 7.0 .504 .160 .260 1.2 1.0 9.0 None. 1.0
2d from - ...........
~ 7. 0 .468 . • 136 . 256 1.0 2.0 7.0 None. .6 Momentary uncon-
last. scionsness .
7-3 ........ Recovery. 21. 0 • 700 .144 .300 1.0 l.li 7.0 None. . i.6
Last pulse Recovery. 21. 0 . 740 .• 160 • .292 .6 •l ."O 8.0 None. 2. 0

Sgt. '.f. B. M.; final oxygen 7.6 per-' cent; total time 25
minutes 54 seconds.~Sgt. M:'s physiological and clinical
chart (fig, 47) shows poor compensations. His slow
heart rate in the late electrocardiograms is ~xplairied by
the clinical coliapse during the la.st. two minutes' of his
test. It is true that the heart increased in rate begin-
ning on <the tenth . minute. -The increase amounts to
about 25 beats during the last five minutes.' It ends. in a
drop from a rate of 117 to 75 in the last minute. ·The
electrocardiogram (fig. 8, PL VI) taken during the twen-ty-
fifth minute (apparently later. in the mip.ute than the
clinical rates recorded) shows the new slow rate, wluch
.had fallen to 62 per minute in the first beatphotogravhed.
In the early recovery period the rate varied·froni ,61 to 64
and wa.s fairly' constant.
Although unconscious at the last it is obvious that M.'s
heart rate w!l,B in itself sufficient to maintaui.an adequate,
circulation. The failure in compensation was due to
the inadequate blood preBSure. B.oth systolic and di!l,B-
tolic preBSures fell froµi the beginning, but the fall was
marked and more rapid after the eighteenth .minute, as
the chart shows. Respiration also failed to make ade-
quate compensation. The highest minute volume reached
,was only 10 litera.
The whole. clinical picture is that .of a strong muscular
type with a circulatory apparatus adequate only to .resist
the effects of a moderate reduction of oxygen. · As 8
per 'c ent was approached, coll!'pse of the peripheral vascu-
lar mecha:nism.and of the heart occurred. · Recovery was
slow, due. no doubt not so much _to the heart as to'the
fa.Bure of the peripheral blood vessels to regain their
tone, as.ahown in the low diastolic preBSure in the recovery
period.. .·
Figure 47 . Sgt. M. was carried to the ·stage of uncon•
sciousness iii a few seconds short of 26 minutes. He re-
covered a degree of consciousness in 20 seconds but" did
not talk ior .1 minute and 10 secoµds. He remained pale
'and perspired freely for several minutes.
The electrocardiograms show the usual ' progreBBive
acceleration of pu~ as indicated by the decrease in the
time of the cycle through to the twenty-fourth minute:
There was -a decrease of the conduct~g interval from 0.140
to0.120 second at 8,6 .per cent oxygen. The R-T interval
is also slightly decreased in length. Both these changes
are well-known functions of rate acceleration after exercise,
.etc. The amplitude of the deflections w.aaconstant except
for the diminution of the T wave, in this case from 3.2 mm.
, to 0.4 mm. in the twenty-fifth minute; that is, just at the
final stage of the experiment .and while the oxygen was
8.1 per cent.
Profound changes occurred in ' the character of the
terminal , cardi_ogram, changes that do · not . ~ppear
through the short recovery record obtained. The impor-
t \~t fact is the entire disappearance of any evidence of
 96
the P wave. The loBB of the P is associated with a coin-
cident marked diminution in the pulse rate, from 128 to
63 ·per minute. In this period (fig. 8, Pl. VI) .t here is a
record of 14 ventricular complexes, 9 of which are ideally
recorded, but not one is introduced by any evidence of
auricular activity. None of the nine complexes are
complicated by extraneous currents and all are regular
an~ clean of type. Table 37 presents the measurements
of allthe complexes in figure 8. The R 's do not present
amplitude changes that indicate inclusion of the P waves.
It is evident that we are again dealing with :i, rhythm of
nodal origin. We have no evidence recorded in the trac-
.FIG. 47.
ings of an auricular inhibition, the possibility of which
we have considered in relation to the cause of the dis-
sociation. The dissociation evidently 0<;curred between
figures 7 and 8. Against the theory that the dissociation
is due to inhibitory block is the evidence of the other
similar cases and the fact that the conduction time
decreased during the early stages of the experiment as
oxygen want increased and the pulse accelerated.
The condition shown in the tracing at the moment
before the removal of the mouthpiece and the admission
of pure air (fig. 8) is carried over in part in the tracing
immediately after the admission of pure air during what
we have called the recovery tracing (fig. 9, Pl. VI). The
rhythm does not yet begin in the S. A. node as shown by
the inverted P and the short P- R interval, the first eight
contractions show an inverted P wave, no P appears during
the next five contractions, and the P then reappears in the
last three contractioµ.s. The first eight P- R intervals are
progressively shorter, from 0.092 to 0.016 second. When
they reappear after five beats they become progressively
longer, from 0.040 to 0.100 second. It suggests an origin
of the · auricular contraction from points progressive!
lower in the rhythmic system until the P either
in the R or disappears entirely. The P then reappears,
showing that the rhythm moves progressively back toward
the normal pacemaker. These facts show that we have a
lighter degree of interference with the mechanism than that
shown in figure 8. Apparently The first inhalation of pure
air gave enough oxygen to only partially remove the degree
of oxygen want which suppressed the rhythmicity in the
normal controlling center an'.d released activity in a lower
portion of the system, as indicated by the inverted P at
the beginning of the tracing. In the interval before the
next inhalation of fresh air there was return of the low
oxygen level which suppressed activity in the auricle, as
indicated by the total ~ppearance of the P wave. The
 97
progreBBive type of recovery in the inverse direction wa.s continued during a few more heart beats it would have
produced rapidly by the influx of oxygen following the revealed a complete and permanent recovery of the
next respiration. It shows the return of the pacemaker sino-auricular control.
toward its normal location. If the record could have
TABLE 36.

Trace Duration in secs. Amplitude in mm.

and Time Oxygen
pulse (min.) .
(per Remarks.
eent).
---
No.
---
R - R. P- R.
- - -
R- T .
- --~
P. -Q.
- -
R.
- -- - - -
- S.
I T.

1-1 NoTI1Jal. 21: 0 0.852 0. 140 0.310 1. 0 1. 0 18. 5 2.5 3. 2

2--3 5 18. 4 . 760 . 132 . 328 1. 0 1.0 19.0 2.5 2.0
3-1 10 15.9 .652 .144 .320 1. 0 1.0 19. 0 3.0 1. 5
3-11 10 15. 9 . 840 . 140 .320 1. 0 1.0 20.0 2. 5 2.5
4-10 15 13.3 . 520 .132 . 280 2:0 1. 5 19.0 1. 0 1. 5
4-1 15 13. 3 . 672 .140 .340 1. 4 2.0 20.0 2.0 1. 4
5-4 20 10. 7 . 520 .132 .. 308 1. .3 1.0 18.0 2. 0 1. 0
5-11 20 10. 7 . 696 .148 .280 1.0 1. 0 '20.0 2. 0 1. 0
6-15 • 22 9.6 .60! . 128 . 312 2. 0 2. 5 19.0 3.0 1. 0
6-1 22 9. 6 . 628 . 136 •.300 2.0 1.5 21. 0 3. 0 1. 0
7-5 24 8. 6 .472 .120 ::m 1. 5 1,0 18. 0 2.0 0.4
7-1 24 8. 6 . 512 .132 .320 2. 0 2. 0 19.0 2. 5 0. 5
8-1 25 8. 1 .944 None. . 320 None. 1. 4 19.0 2. 0 2.0
9-1 R ecovery. 21. 0 . 920 092 . 348 -1.0 1. 3 20. 5 2.41 2. 8 See special tables 22
and 23.

TABLE 37.

Trace' Durati~D in secs. Amplit ude in mm .

No.~
oxyg_ Remarks.
l t
-1--
~;n~'.: R-R. P-R. R - T. P. -Q. R. -S. T.
pulse.

1 0. 944 None. 0.320 None. 1. 4 19. 0 2.0 2.0

2 .944 None. , 300 None. 1.0 19. 0 2. 0 2.0
3 . 952 None. ; 320 None. 1.0 18. Q 1.5 2.0
4 . 936 None. . 320 None. LO 19. 0 2. 0 2. 0
5 . 948 None. . 312 None . l. ·2 21. 0 1.5 1. 6
6 . 948 None. . 320 None. 1.0 21.0 1.0 2.2
7 .952 None. . 320. None. 1.0 19.j) 2. 0 2. 0
8 . 948 None. . 320 None. 1.0 18.0 2. 0 2.5
9 .940 . None. . 304 None. 1.3 21.0 2. 0 2. 0 Irregular.
10 . 944 None. .320 None. 1.0 18.0 2. 0 2.3
None . . 300 None. ··-- ---·-- 19. 0 2.0 2.0
l
11 . 948
12 . 948 None. .312 None . 19. 0 2.0 2.5 Do.
13 .932 None. . 320 None. 1.0 1
1.2 18.5 2. 5 2. 0 Do.

TABLE 38.

Trace Duration in secs. Amplitude.in mm.

No.9-
recov-
ery ' Remarks.
21 per R-R. P- R. R-T. P. - Q. R. -S. T.
cent o,
- pulse,
- -- - - - - - - --- - - - ---- - - ---
1 0.920 0.092 0. 348 - 1.0 1.3 20. 5 2. 4 2. 8
2 .920 , 096 . 360 -1. 0 19.0 2. 5 3.5
1 3.
4
.920
.928
.088
.088
.380
. 360
- 1.0
.- 1.0
1.5
1. 0 1
1. 0
20.0
23.0
1.0
1..5
3.2
3. 2
5 .928 .052 . 380 - 1. 0 ,1.0 21. 0 L5 3.2
6 .928 .048 . 372 - 0. 8 1 22. 0 1.0 3.0
7
8
.928
.924
. 024
.016
. 376
. 360
-1.0
- (?)
12.0
<
2.0
· 22. 0
21.0
2.0
2. 0
3. 2
3.5 P and Q coincide.
19 .928. None. . 360 None . 1. 6 19. 0 2.0 3. 5 External · · negative wave
through 8, 9, 10.
10 . 928 None. . 360 None. Ls 20.0 2.0 3.5
11 . 936 None . . 380 None. i. 5 20.5 1. 2 3, 0 ,
12 . 928 None. . 380 None . 2: 0 21.0 (?) (?) Shift during T .
13 . 928 None .. .360 None. 1. 8 20. 5 1.0 3. 4
14 . 928 . 040 (?) -0.8 1.0 21. 0 1.0 ' (? )
15 .912 . 080 . 360 - 1.2 1.0 22. 0 1. 5 3. 0
16 . 900 . 100 .352 - 1.0 1.5 20. 0 2. 0 3.0

' Pis negative i.zl. preceding beats, and absent or buried in '.l-8 interval here. In the thirteenth Pis added to Q; in the fourteenth it is present
P negative in entire record. ·
55314 0 -31- -7
 98
Sgt. D. W. O.final oxygen8.5 per cent, total time 25 minutes
8 seconds.--'The clinical chart of Sgt. D. W. 0 . (fig. 48),
shows that his respiratory, and circulatory responses are
c.oncompensating. There is a fall of diastolic blood pres-
sure and an even ·systolic pressure until the critical oxygen
limit is reached, then collapse occurs promptly. Tlie
initial heart rate is _high and sustained with only the
slightest. acceleration during the test. The cardiogram
'taken in- the last minute of the test shows a very 'slow
heart, around 50 per minute. This and the fall of dias-
t.olic pressure explain the unconsciousnes s that occurred.
auricle were strong, an amplitude of from 2 to 2.6 IµIll. of
the P wave, which continued to 8.6 per cent oxygen.
The T wave was lower and broader in type than the av~r-
age. As the oxygen want progressed a sharp negative wave
apIJeared at the terminal portion o.f the T wave.
Sgt. 0 also became unconscious at the crisis of the ex-
periment, though he retained reflex control of his muscles,
-eyidenced by sitting erect as if asleep . Only a-short trac-
ing of seven ventricular contractions was obtained at this
critical moment (fig. 10, ;Fl. VII), 8.5 per cent oxygen.
Reference to the eleetrophotogram shows complete obliter-

sgt.n,w. o. :March 7 Hl9

(-) (Dolooad&m)
T1Peot-1!ebr., Eleotrocaz;di.Q£l'..(lllh_ Dmatioa-..... _.?.l2 ····--- - --··il···---Dds.

=...
Pb,a. ooDd.ottimeof - P,K, ----------------
&act ~ition at doae of taaYery pfilebut-not·wotic · UDCODB<!io.us_m.l1scl eS___
coordini,. ted . ·
-·- -·--··-·-···-~{~fi5it'T~6%~~~.~ti~~h~! D.1l~---·- - -
. Very -)21iform ·and regular respirati ons . _
oi..na.: Maj .Greep!! PJ,y;;:Jdaj .Gilbert ai,,.S~t.Greiet ,B.P Lt.CloughEcg. -
oamadliaeSgt.Jaffa Plotted by Sgt.1olorath 0 .,r, itart..31.._ liai.i.8 ;-5
~end ~ . S •••••e•••• Pa1ae ..--i,-o Jl.elp_Ul~pcr. mi.n. - S y s t . B. P.
- - - Diut. D. P. Pulae Preuure Aecom ia mm. Convergmce in mm.
IIO

uo •
_),;-......
•
/ I I/
I/ "'
JJO ' '-
'( ·7 v
I
•
110
''II l \ I
\ V V
\/ ~ 10

[/- .\A
1eo

GO
..· ... ... ... .. .. . .. ..... ,. .... ..... ..
.<:.... . ·1'· · ·
....·· ··•···
V ·.
.,,. - 11

- V
-- "' '\.
__..-r....
• ' '- V
1./'-..
,
1S

It
Ill

- V
:
:
.,,.
-· V ' . /.,.
'

7 "
• 17

• I/ 18

• V
10
I/ .••
0 ... V 0118($f71tltllDUltUltl7ltUIOUDDN~•n•••n••
Tin llf MINUTES
ll

FIG . 48.

The clinical sheet classifi e_s Sgt. 0. in a group well known
in the Medical Research Laboratory as the noncompensat-
ing type. Th()S~ men ~ndure the test to a certain limit
without any compensation, then without' premonition er
warning they collapse completely, usually at a compari-
tively high oxygen level, though not universally so: We
are fortunate to have the electrocardiogram as giving new
light on what occurs in the heart of this type at the critical
moment of collapse.
Sgt. 0. began the test with the normal high rate of 94
per mi1,mte and increased only to 108 during the 25 min-
utes. The usual falling off in the-time of the R-T interval
occurs from 0.320 to 0.280 second. There was also the
usual decrease in the T wave. The contractions of the
ation of the P wave. and a strong, well developed R- T and
a weak T of the ventricular complex. Except for the
strong R the electrocardiogram was as nearly isoelectric
as in any experiment of the -entire series. Figure 10 was
during the unconscious stage. The heart rate had dropped
to 57 per minute, and undoubtedly the circulation was
very inadequate (see table 40 for the measurements).
Recovery occurred promptly, as shQwn in figlll/;l 11 of
the recovecy period. There was a return of ·the P wave
with normal amplitude and normal length of the P-R in-
terval. The T wave slowly recovered its initial ampli-
tude. The rate remained slo.wer than at the beginning of
the experiment, but recuperated from the depressed rate
at the cl0se of the- test.
 99
TABLE 39.

Trace I 0 Duration in secs. Amplitudain mm.

;:~e Time (min .). f;!ren , -- -- - - - - - - -, - - - - ~ - - - ~ - -~ -- --,--
I No. cent) . R-R. P-R. R-T . P. -Q. R -s. T. I
l--9 Normal.. . ... 21 0.640 0. 140 0.320 2. 2 1. 0 20. 0 4.0 1.0
2-1 5 . . . . .... . ... 18. 5 .600 . 144 . 412 2.6 1. 5 18.0 4. 5 1. 2
3,-8 ro ... .... .. :. 16.0 .656 .148 .320 2. 6 1. 3 18.0 4.4 1.2
4-4 15 .. .. . .. .. . : 13. 5 . 632 .148 . 312 2.2 1. 2 17. 5 4.0 .8
5 17 ... ... : .. .. 12.6 .612 .152 .320 2.0 1.3 16.0 4.0 .4
6 19 ... ·-······· 11. 6 .608 .160 .304 2.0 i: 4 16.0 3.8 .5
7 21. .. : .... . .. 10.6 . 592 148 .260 1.5 1.5 18.5 4.0
23 . . ..•. .. . . .
8
9
10-1
25 . . •·••···•·
25 • . .. • .....•
9.6
8.6
8.5
.580
.564
1.052
.140
. 140
None. I
.280
. 280
. 240
2.0
2.0
None.
i.8
2. 0
1.0
19. 0
20.0_
17.0
-4.0
3.4
2.5
=J.4
11-2 Continued 21.0 .·868 .140 .340 l.4 19. 4 3.2 .6
recovery . 1. 21

1 To include negative deflection only.

TABL E 40.

Trace Duration in secs.

: Amplitude in mm.
l~xy-
gen 8.5 Remarks.
percent-
pulse. R-R. P-R. R- T. P. -Q. R. -S . T-.
--- - -- - -- - - - - -- ~ ---
1 1.052 None. 0.240 None. 1. 0 17. 0 2.5 0.4 Tdiphasic.
2 1.040 None. . 280 None . 1. 0 19.0 2.6 .5
3 1. 080 None. .240 None. 1.0 18.0 2.6 .2
4 1.108 · None. (?) None. 0.8 17. 0 (?) None. Extrinsic interference.
5 1. 132 None. .240 None. 1.5 20.0 3.0 (?)
6 1.140 None. .260 None. 0.5 18. 0 2.5 0.3

Sgt. N. S. P.; final ·oxyge:n 6.7 per ce:nt;-- total time 34 ipg the P-R interval remained constant notwithstanding
minutes 12 seconds.-In thi_s test 6. 7 per cent_oxygen was the acceleration of rate. The R-T interval only slowly di~
reached during the relative long period of 34 minutes 12 sec- minished, from Q.340 to 0.300 second . The deflections are
onds. There was .a splendid augmentation of rate, practi- without significance except that there was only a slight
callydoubletheinitialnormal. Throughouttheentiretrac- diminution in the T wave, a type occasionally observed.

TABLE 41.

ITrace and
.pulse No.
Time
(min.).
Oxygen
(per
Duration iµ secs. Amplitude in mm.
Remarks.
cent). R-R . P- R. R- T . P. I -Q. R. -S. T.
---- -- --- ---- - - ---
1-1 Normal. 21.0 0. 924 0.160 0.340 1. 2 0. 4 11. 0 5. 0 2. 7
I 2-1
2-3
5
5
18. 9
18. 9
. 716
.924
.156
. 160
.336
.344
1.6
1.5 None.
.5 10. 0
10.6,
3. 5
4. 0
2. 8
3. 0
2-9 5 18. 9 .968 .'160 .360 1.4 1.0 10. 5 4.0 3.0
2-16 5 18. 9 .840 . 160 .360 1.2 .4 11. 0 4.0 2. 8
I 2b-5
3-3
5
10
18. 9,
16. 8
.880
.904
.160
.160
. 360
.360
1. 2
1. ll
None.
.3
10.0
11.0
3. 5
3. 5
2.6
2.4 Trace of arrhythmia .
4-i 15 14. 7 .928 . 152 .360 1.2 .6 11.0 4.0 2.5 Very slow arrhythmia.
4-10 15 · 14. 7 .868 . 160 .360 1. 4 .5 10.5 3.5 2.5
4-15 IS 14. 7 . 748 .152 .360 1. 2 .5 10.0 (?) 2.4
&-1 20 12. 7 . 880' .160 . 344 1. 3 .3 9.5 3. 0 2.2
3, 5 2.3
6-1
7-4
S--1
25
Z1
29
10.6
9. 7
8.9 ·
. 776
· . 732
.668
.152
.160
.160
J:
.340
1 1. 3
1. 5
1. 2
.5
.4
.3
9.5
9.0
8.5
2.5
3:5
2. 2
2.0
Ve~slight arrhythmia.
Slig. t sinus arrhyth-
m1a.
9-4 31 8.1 .652 .152 .320 1. 0 .4 8.5 3. 5 2.0
10-1 '33 7.2 .584 .156 .320 1. 2· .6 9.0 3.0 2.0 Difficult to read; tre-
mors.
Last beat. 33 7. 2 .536 .160 .312 1. 5 .8 10.0 3.2 I. 6
11-3 34 6.9 . 544 . 160 . 300 1. 4 .8 io.o 3.5 - 2.0
12-1 R 009very. · 21.0 . 728 . 152 .320 1. 4 .2 8. 0 3. 0 2.8 Sinus arrhythmia re-
appears.
12--2d from
last.
..... .. .....
, ,
21.0 . 848 . 160 . 340 I 1. 4 Trace . 9. 0 3. 5 3. 0
I
Sgt. F . J . P .; final oxygen, 6.8 per cent; total time, 281 bility in the R amplitude; otherwise little or no chan!J€
minutes 2 seconds.-There is only the usual slight reduc- in the electrocardiogram is sh own.
tion in the amplitude of the T wave and a degree of varia- I
 100
TABLE 42.

Trace Oxygen
Duration in ·secs. Amplitude in mm.
and Time (per
pulse (min.) .
No. cent). R-R. P-R . R-T. -P. Q. R. I - S. T.
- -- - - - - - - - - -- - - - - - - - -
1-1 Normal. 2LO 0.680 0.180 0.304 1.6 2.0 22. 0 2.(\ 3.5
2-1 5 18.8 . 624 .176 .300 1.5 2. 5 20. 0 2. 5 3.2
3-5 10 16:6 . 688 .200 .320 1.2 2.0 21. 0 2.0 3. 6
5-1 15 14.5 . 636 .200 .292 2.0 2.0 21, Q 2.5 4.0
6-3 17 113.6 . 740 .200 .280 2.0 2.4 19.0, 2. 0 4. 0
7-1 19 12. 7 .688 . 200 .300 2.0 2. 0 21.0 2.0 3. 6
8-1 21 ll.8 . 692 .w2 .308 2. 0 2.0 20.5 2.0 4. 0
~1 23. 11.0 .676 . 212 .312 2.0 2. 5 20.0 . 1.8 3.6
10-3 10.1 .632 . 200 . 300 2.0 2. 5 18.1 2.0 3.5
11-7
12-2
13-3
I
Recove~.
27
25
9.2
8. 8
21. 0
.624
.628
. 704 .
.200
.200
.200
.304
. 300
. 296
2.0
2.4
2. 3
2.4
2.0
2.0
19.0
18. 0
· 20. 0
1. 0
1.5
2.0
3. 0
3.0
3. 2
'
1, Unusually regular rhythm in the seventeenth minute, but the rhythm became very i:rteguJar in the twenty-third
minute, lasting to the end.

Sergt. W. A. R .; oxyge:n reached, 10.5. per ce:nt;·time, 22 min- Respiratory volumes were augmented after the seven-
utes 5.0 secolids...:._During the test the heart rate was fairly teenth minute. Unconsciousness was imminent at the close.
constant to the twelfth minute. It then increased rapidly . Little change occurred in the conduction, but there was
with a total acceleration of 45 beat& per minute at the Bhortening of the R-T, from 0.360 to 0.280 second: The T
close of the experiment. The systolic pressure remained de.creased in amplitude from 2.0 to 1.4 . : Recovery was
constant to the twentysfirst minute, then fell sharply. prompt except that Sergt. R. remained pale for some
The diastolic pressure broke at the nineteenth ~ute. minutes.
TABLE 43.

Duration in secs. Amplitude i'! mm.

Trace
and
pulse
Time
(min.).
Oxygen
(per
I Remarks.
No. cent). R-R. P-R. R-T. -P. Q. R. -S. T.
- .- - - - - - - -- - ------------ - -
1-2 Normal. 21 0.960 0.200 0.360 1.0 0.5 15.0 1.5 2.0
2-4 5 18. 6 .872 .192 . 360 ]. 0 None. 19.0 1.5 3.0 Sinus arrhythmia .
3-2 10 16.4 .820 .200 .360 1. 0 .8 14.0 1.5 2.6 Arrhythmia, short beats,
0-.628 second, long 0.880
second.
4-1 15 14.0 . 792 .208 .360 '1. O· 1.0 !5.0 1. 5 2.4
5-2 20 11.8 . 656 . 200 .320 1. 0 .5 15.0 1. 4 1.8 T-diphasic .
6-4 22 10.9 .648 .172 .280 1. 2 1.3 15.5 1.5 1. 4
7-1 Recovery. 21.0 .572 . 184 .280 1.2 1.0 14.5 .5 1.5
-32 Recovery. 21.0 . 8.52 . 200 .280 1. 2 1. 0 16. 0 1. 0 1.6

Sergt. B. S.; final oxyge:n, 10.8 per ce:nt; total time, 24 min-
utes.-There is no constant variation in either the P- R or
R- T intervals, nor are there any irregular amplitudes
except the usual decrease in the T wave with the onset of
diniinished oxygen.
The only striking phenomenon observed was the pro-
found sinus arrhythmia. Variations in heart rate com-
puted on the basis of individual beats show the wide
TABL E
extremes of the arrhythmia. These variations ' are par-
ticularly strikiµg in the recovery tracing. Of all . the
arrhythmias observ.ed, this is the most extreme. It is
suggested that the phenomenon depends upon the hyper-
sensitiveness of the medullary vagus apparatus, . but ·we
intend to discuss the significance of this phenomenon in
a later paper.
44.

!frace Duration in secs. Amplitude in mm.

and 'rime Oxygen
pulse (min.). (per Remarks.
cent).
No. R-R. P-R. R-T. -P. Q. R. -s. T.
- - - - - - - - - - -- - - -- - - - --
f-10 Normal. 21.0 0.680 0. 180 0.300 1.5 1.0 17. 0 1.5 2.2
2-1 5 18.9 . 800 .180 .312 1.0 .8 17. 0 2. 5 3. 0
3-1 10 116. 7 • 788 . 180 . 320 1.4 .5 18.5 1.5 2. 7 Ar~thmia. P much
t er during the ·ra,pid
periods than - dunng
the slow.
4-2 12 15. 9 .900 .180 . 308 1. 2 .6 18. 5 2.0 2.8
~ 12 15. 9 .648 . 180 .300 1.8 .4 15.0 2.8 2.0
5-2 14 15..0 . 768 .176 .308 1. 2 .6 16. 0 3. 0 2.4
6-1 16 14.2 . 720 . 176 .312 1. 4 1.0 17. 0 2.5 2.0
7-2 18 13. 4 . 748 .176 . 304 1. 5 .6 18. 0 2.0 2. 4
8-5 20 12.5 • 712 . 180 . 304 1.3 .5 19.0 2.0 2.2
9-3 22 11.6 . 684. .180 .312 1.6 •8 18.0. 2.2 2. 0
10-3 24 10. 8 .600 .176 .312 2. 0 1.0 15.0 3. 0 1. 6
11-2
-8 24
Normal.
10.8
21.0
• 776
. 776 . 180
176 I .292
.312
1.4
1. 0
.6
.8
17. 0
16.0
2. 0
2. 6
1.~
2.0
-5 Normal. 21. 0 1. 180 .180 .300 1. 0 .4 18.5 2. 0 2.2

1 A case of extreme sinus arrhythmia.

 101
Corpl. L . D. S-.; .final oxygen 10.9 per cent; total time 20 its of measuremen,t '. No special change occurred other
minutes 20 seconds.-Corpl. S. showed the characteristic than the usual decrease in the T wave. The one point
increase 41. heart rate, but variations in. the conduction to which attention is called is the development of ar-
time and the ventricular complexes were within the lim- rhythmia.

T ABLE 45.
I

Trace
and .Time . Oxygen
Duration in secs.
. AnlpliiudeinJillll. I
J)ulse
No.
(min. ). (per
cent), R-R. P-R.
-
R-T. '-P. Q. I ·R ,. -8. T.
I Remarks,

--- - . -- - -- - - - - -- --- - --
1-1 Normal. 21.0 0.836 0. 160. 0.340 0.4 None. 7. 0 3. 5 1. 4 Arrhythmia.
-4 Normal. 21.0 .940 . 160 . .340 .4 None. 7.0 3. 0 1. 5
Z-2 (Mean) _2 20. 0 .928 ._176 · • 344 1. 5 None. 6.5 a. o LS Do.
3'-1 5 18.5 .864 . 180 . 340 .8 None . 7.0 3. 0 1,8 Do.
-~ 10 1~.o • 776 .168 • 332 1. 0 None. 7. 0 3. 0 1. 7 Extraneous currents .
5-3 12 15.0 • 792 .180 .340 1. 2 None. 7.0 3. 0 1.5 Very slight sinus arrhyth-
mia, . .
6-1 14 14.0 , 776 • 168 .320 1.0 None . 7.0 2;5 1.3 Do.
7-1 16 13. 0 .696 • .180 .320 1.0 None. 6. 0 1. 3 1.0 Trace ofsinus arrhythmia.
JJ
8-2 18 12.0 .680 . .160 . 300 .8 None, 6.0 2.2 1. 0 Vef¥ slow sinus arr_hyth-
lllla .
'·· 9-1 19t 11, 2 .'640 .176· .304 1. 0 None. 6..0 2.6 .8
'l
10-2
-7
Recovery.,
Recovery.
21, 0
21. 0
. 736
. 832
• 168
. 176
. 312 .
.3_20 I 1.6
1. 4
None.
None.
7.5
7.2_
2. 6
2.8
1. 3,
1.3 Rate slowed during first
five beats.
•.

!'vt. W. V. T.; ji:~l oxygen 8.11 _per cent; total time ~4 , the test but, disappear~d with the onset of low oxygen.
-minutes.9 seconds.-Smus anhythrma was present early m There was no other special feature shown. .

T A BLE 46.
'
Trace Duration in secs. Amplitudeinmm.
" and Time Oxygen
J)ulse (min.). (per Remarks.
No. cent). R-R. P-R.. R-T. -P. Q. R. - 8. T.
- - - - - -- - - - -- - - - - - - - - ·- - --
1-3 Normal. 21.0 0.584 0.168 0.320 2. 2 2.0 17. 0 None. 1;5 S)celetal muscie move-
ments.
Z-1 5 18.3 . 588 .172 . 288 2.0 1. 5 17.0 None . 2.0
-3-1 10 15. 7 . 768 :154 • 296 2.• 2 1.6 18.0 None . 1. 8 Sinus ·arrhythmia.
4-4 15 13. 0 . 912 . 172 • 296 2. 0 1.0 20.0 None·. 2. 3
..:g . 15 13.0 .592 • loO .296 1.4 1.2 18.0 None. 2.0
V
5-3 19 10.9 .568 .168 • 300 2. 4 1.4 19. 0 None . 1. 4 Q and P increase during
a the rapid rate periods.
6-2 21 9. 9 . 544 . 172 • 300 2.-0 1. 5 16.5 None . 2.0
' 7- 2 23t
Recovery.
8.5 .512 . 160 .280 2.2 1. 8
1. 5
18.0
17. 5
None.
None.
1. 0
2.0
Arrhythmia now slight.
Arrhythmia.
8-2 21.0 ·.620 . 160 .296 2.0

TABLE 47 .

I. Summary of cases with electrocardiograms during the low oxygen test .

T rminall Height, .
Name. Time. oiygen; Weight, .Clinical remarks.
per cent. pounds. incpes. •
---
Mlnutu. sect>'lld3.
.J
Atherton; Pvt. N. W . ..• . .... 21- 40 9. 7 . .. .. 124 "'"0-2 · · ·
. Cain, Pfc. H . J. .·... •_. . . . .•.• .
DonnaghyC Co!'f.l. H.B .. ... . .
Drennan, orp . F. 1 :. : ... . ..
22
'J!T .
24
30
20
26
10. 0
6. 7
1\,1
145
150
69!
70
Pale, no irregularities of the heart.
Clonic muscular spasms; pale after 5 minutes.
Cyanotic, not unconscious.
Fogarty:{, Serr., M. D .. . ... .. . 33 13 7. 3 132 70 .
_Frisco, vt. . .. . .• ·... . . ... . . . 21 56 8. 4 132 68 Very cyanotic; spoke in 15 seconds; N. C. A. case.
Goate; Pfc. A.H ... •.. .. . . ... 29
Kline, PJc. 'l',_ F ... ... . . . ..... Z1
32
9
8..J.
7. 15
124
160 ffl Called off at beginning of muscular tremors; clonus
severe for 20 -seconds; prompt recovery after deep
inspiration.
Kolda, Serf· H ... ... ........ 30 'J!T 6.55 140 67 Expert diver.
Lane, Corp . W. D ........ . .. . 29 13 6. 9 143 69i Clliiical history of premature ventriculars, none dur-
ing test; conscious to end.
Monaihan, Sergt. W. C. .. ... . 23 48 5.9 212 73 Momentary unconsciousness at end.
Murp y, Sergt. T. B . •• . . . .... 25 54 7. 6 134 67 Unconscious; muscles of neck relaxed; recovered in
26 seconds; talked in !l6 seconds; pale, drowsy, and
,perspiring 5 minutes I ater.
Meer~ Sergt. E . o ..... .. . 23 5 8.3 166 71!
McDo , Pfc. A. H ... , ..... 24 15 7. 5 138 65!
Osborne, Sergt. D. W .. . . . . ... 25 3 8.5 130 68! Unconscious at end, but retained reflex control of
muscles; prompt recovery.
Parsons, Sergt. N. S .. ... ... . . 34 12 6. 75 138 70
Pittsley, Sergt. F. J .. ... . . .. . 28 2 8. 8 130 68
Roberts, Sergt. W. A . ... . .... 22 50 10. 5 146 62! Dazed if not unconscious at end . pale after 3 minutes.
Stacey, Serr- B .. .... . ....... 24 00 10.8 135 68 Extreme arrhythmia.
Stage, Corp . L. D .. . .-.. ...... 20 20 10. 9
Thorne, Pvt. W. V ...... .... .. 24 9 8.07 135 69
 102
CHANGES IN THE TYPE OF THE ELECTROCAR- show corresponding decrease in the time of the ventric-
DIOGRAM WITH THE ONSET OF OXYGEN ular complex with ar.celeration of rate, 2 cases show no
WANT. change, and all show decreases in the amplitude of the
COMPARISON QF CASES. T wave. There is no constant associati6n of the change
in total time of the cohduction, and the duration of the
The heart effects of extreme low oxygen in the air ventricular complex in the same individual, though~
breathed as revealed by the el~trocardiograms in our series ciation is the ·rule. The length of the P-R interval 1s
of 21 cases are varied and extreme. The degree of oxygen only very slightly influenced by oxygen want up to 'the
want endured by the majority, 13 cases, without visible crisis, i. e., until the onset of unconsciousneBB is iuiminent.
deleterious effects on the heart is surprising. At least 10 There is an appreciable acceleration of the P- R interval at
of the cases reached 10 per cent oxygen ·and.less with no the lower oxygen levels. This amounts, in H , J.C., to
drastic changes in the electrocardiograms. Of these, 5 ran 6 per cent acceleration; N. S. F., 12; T. B. M., 7 per cent,
to 8 per cent oxygen and 2 to less than 7 per cent. Our etc. These decreases,of from 6 to 12 per cent in conduc-
series illustrates the fact well established by the general tion time are representative. It is by no means a constant
experie~ce of the Medical R esearch Laboratory of the phenomenon. It is uncertain whether .this is .a direct
Air Service that the limit of endurance to low oxygen cardiac effect of low oxygen. It is probably bound up
covers the rather extreme range of froin 6 per cent or leBB in the factors which cause the acceleration in rate. The
to 10 per cent and more among apparentiy vigorous and stimulus that augments the pacemaking process also
well-developed individuals .. The men in the series ·re- hastens conduction. It. is as legitimate to. assume that
ported now were t 'lsted to as low as 5.9 per cent and taken the result is an indirect nerve influence over the heart
off as hj.gh as 10.9 per cent. · as tliat it is ·a direct muscul~r ef:ect. The point can not
There are 6 of the 21 cases that show distwbances of be settled at the present moment. .
normal heart function varying from slight and evanescent The RrT interval or ventricular complex.is also slightly
changes to the mOflt profound and vital interference with shortened before the crisis is ·reached. For example, in
normal rhythm and conduction. The extreme dianges H. B. D.'s electrocardiogram the normal R-a-T · of 0:-320
· occurred at the crises of low oxygen effects: H.B. D., ~.7 second is reduced to 0.300 and 0.292 second in the twen-
percen:t; F. J . D. , 8.1 percent;.J. F. , 8.4 per cent; T . H . K., tieth minute, or 9,5 per.cent oxygen. It is 0.300 second in
7.1 percent; W. C. M., 6.9 perc_e nt; T ._B. M., 7.6percent; the twenty-seventh·. minute., or 6.8 per cent oxygen, and
and D. W. 0 ., 8.5 per cent. Two of the six had severe promptly returns to 0.320 second on breathing pure air.
clonic muscular spasms, which tended to mask symptoms This recovery of the normal time of heart muscle contrac-
which are the usuaLsigns of impending loss of conscious- ·tion takes place even betore the normal S-A rate is rees-
. ness. The one clear case in which unconsciousneBB was tablished in control of the rhythm. The change in. ~on-
not reached out of the six showing heart irregularities was . traction time is not profound. It amounts in the case of
that of F . J. D. at 8.1 per cent oxygen. He developed T. F. K. to a drop of from 0.340 second in the normal to
complete dissociation , but with persistence of rather 0.300 second in the twenty-six.th minute at 7.7 per cent
regular auricular and ventricular rhyth)ns. Four of. the oxygen . This record shows an e,llgmentation in the RrT
six cases with extreme heart irregularity were clearly interval a,t the fifth minute. However, the low T wave
unconscious. In one, Sgt. W. C'. M., at 6.9 per cent, the and the occasional uncertainty of J.ts exact'-terniination in
unconscious stage was brief at1d momentary only, as -was lead II compels us to lay less streBB on the slight.differences
also the heart irregularity (see his protocol; tab}e 23, and as they appear in tabulation.
fig. 8 ·of Pl. XV). 1n:· the remai_n ing three the cardiac In the instance of H . K. the electrocardiogram is clear
disturbances were more profounp., as was al_so the general cut and the m~asurements Il}ore certain. The table shows
evidence of oxygen asphyxiation of the nervous system. a very regular .s hortening in the R-T .time with the de-
Even casual examination ·shows that circulatory changes crease in oxygen. _H. K. was taken off while still giving
during the ~ebreather test are slight during the first two- norIIJ.al general reactions. His R- T intervals in the first,
thirds of the test. In the last third the changes come on fifth, and fourteenth contractions of the recovery record
rapidly until the onset of what we have calJed the crisis. are 0.280, 0.300, and 0.320 second, respectively. Th:i,s is
If the test is pushed still furth er, unconsciousness occurs. a very pronipt and definite return to the original normal.
Then the disturbances of the heart are rapid, ·profound, The precrisis decrease in R.:.T time is coincident with the
and vital. Twenty seconds at this crisis may suffice to accelerated rate, and is doubtless due to the same reactive
drop the heart rate from its maximum compensating.high changes. Acceleration in he!ut rate is primarily at the
rate to the profound condition of dissociation observed in expense of the quiescent phase of the heart cycle. This
F . J . D. or the suppreBBed aur1cular slow heats of D : W. 0. is approximately the isoelectric phase between the T and
The details are further disCUBBed under two·headings, one P waves. -Our measurements show that during accelera-
presen:ting the.general precrisis changef,! leading up to the
tion of rate produced by oxygen want the cardiac proc-
crisi11 or crest of the c.o mpensating adjustments, and tlie
esses both of conduction and contraction are hastened.
other local and intrinsic changes at an,d following the crisis ..
The acceleration of conduction amounts to 6 to 12 per cent
GENER.U, OR PRECRISIS CHANGES IN THE TYPE and more, and of contraction to 8 to 12 per cent in some
OF .T HE ELECTROCARDIOGRAM. cases, while the rate is accelerated by 30 to 70 per cent.
The constant electrical change observed throughout the
The primary changes in the general type of the electro- ·series is in the chara~ter and amplitude oj the T wave.
cardiogram with the · onset of low oxygen are not pro- The T decreased with low oxygen to the point of complete
nounced and not uniformly constant. A fair proportion, obliteration in some cases but always by 50 to 75 per cent
9 cases, show decrease in. the time ol the conduction, 13 of the amplitude of the normal. The chief change is a
 103
simple diminution of amplitude. However, the type form nine ventricular complexes are ideally recorded in which
of the complex also altered. The normal Tin lead II, used the evidence is clear cut and decisive. (Pl. VI, fig. 8.)
by us throughout, is a positive deflection. It is slowly The momentary partial recovery of an inverted P and Us
developed and a symmetrical curve. As·extreme oxygen subsequent loss and:Second reestablishment shown in Sgt.
want approaches it becomes-much flatter in the ascending T . B. M.'s recovery tracing gives a happy confirmation of
limb of the deflection and more abrupt in the negative the fact that there are two fundamental effects of cardiac oxy-
phase; or the deflection may be delayed until the very gen ina<leguaciJ, i. e., loss of rhythm, production in the S'--A
end of the :ita:T interval. In a few cases the T wave was node and block in the conducting tissv,e. An in':erted P for
terminal, slight in amplitude, and sharply diphasic, i.e ., a few beats followed by its-disappearance is explained by
a short positive follows ·by a:n abrupt and slrort negative, . our hypothesis of oxygen want. The tissue at this moment
as in the case of D. W. 0. (Pl. VII, figs. 8 and 9). The is just trembling on the threshold of functional capability;
variations observed among normals as to the character of a little less oxygen and it fails- completely to fmiction, a
the Tare obscure· and problematic in the.iµterpretati.on, little more arid it functions normally. It is exactly the
hence it seems superfluous to offer theoretical discussions phenomenon observed in Sgt. W. Q.-M. al; the corresP.ond-
of the facts presented here. However, perhaps without 'ing state. In the latter only the stage of an inverted P
a-ny too great justification, it has seemed to us that the ~ave and a-foreshortened P-R interval was reached . In
change in the T is aBSociated to a great extent with the the fomer the record catches the shift in the point of origin
mechaniC¥ s~ress -of increasing blood pressure and accel- of the beat jiIBt at the extreme displacement reached by
eratingrate to:wa~d the climax of the test. Sgt. W. C. M. and carries the asphyxiation to the degree of
INTRINSIC 'CARDIAC CHANGES AT THE CRISIS complete suppression of function of all rhythmic tissue
above the A-V node. II). both instances the complete
OF QXYGEN WANT. cycle from the initial state through that of depr~ssed func-
The chang~~ in tlie heut at· the crisis of oxygen want tional activity back to the original state .is secured in the
o·c cur rapi_dly and are retrggrade _in, character. - They are electrocardiograms and is presented in the corresponding
interpreted as direc:t and asphyxia! in the six special cases figures. The actual measurements are given in Ta.hies 17
previo1.1sly given in detail, The simplest and least. com, and 18.
'plicated change of this type is the development of com- The -displacement of the locus of rhythm production is-
plete heart block in Corpl. T. J,--D. This heart has a hi&, shown in the shortening P-R interval before the disap-
tory <;if block. At the time of the oxyge,11-want test con- peara.nce of the P wave and by-the corresponding incre!}Be
duction was regular but the time was slow,-0.32 secoJid - in the P-R :interval during . the recovery stages of Sgt.
as against the normal average of0.12 to 0.16 second, At T. B, M, If any doubt still persists as to the complete
_8.1 per cent oxygen complete block \leveloped > · The crit- --asphyxiation of the sino-.auricular node, it ought to be dis-
ical period -of' oneet is fortunately recorded .in the electro- pelled by figure 10, Plate VU ; at the stage of 8.5 per cent _
cardiogram-, Plate H, figures 7 !'nd 8. Dissoci.lltion per- oxygen in the test of Sgt. W. C. 0. Thl.l electrocardio-
si!ited for the-remainder .(jf the test, and, what is of the gram shows as nearly complete suppr~sion ofheart func-
greatest importance, disappeared promptly on breathing tion as one can safely produce in m:an . The heart is sloW',
pure air. The weakest link fu this heart is the conducting about 51 compa~ed with a rate of 83 a. few momenta earlier.
system. The dissocia.tion is definite evid,e nce that The Tis low and :(fat and the P wave can not ·be detected.
extreme oxygen 'l!)anl i.1J,. man t'endss to suppress the process -of · The progressive acceleration of heart rate fu the precrisis
conduction .i n the ca.rdiac conduet'infJ system. The tes-t period argues against 31).y"itihibitory effects through pos-
developed another unusual phenomenon. It is that of sible vagus ac:tion, -It ffeems scarcely possible. that the
a ~ t e d heart. ryhthm -in which· the auricular rate . medullary vague center should become suddenly active
i:8 swwer than .the iventricitlar. .T he P wave is clearly just when the respiratory center ceaiies to function. The
- traceable and well defined except fot two evident buried recovfry of sequence_contractions with the P wave of nor-
beats. The ventricular ·complexes are noaa:1 types. '.l'he mal type but .of reduced amplitude and the P-R interval
complete 161!1! of function iii the conducting tissue makes of normal duration takes place in the after period. The
possible th& comparison of lack of oxygen on the two pace- deduction seems inevitable that the slowed rau and sup-
making ·centers under identical condition&. The -slowBr .pressed P wave are indicati've of asphyxi.atwn of the pacemak-
_auricular rhythm evidently demonstrates a IJ(eater 'Sensitive- ing tissue of the _sino-auricular no<le and assumption of that
ness ·o f the S-'A pacernaf{ng tissue to laclc of oxygrn. The . function by the auriculo-ventricular no<le.
P waves that occur are of the normal erect S-A type. In The terminal electrocardi{>gi'ams of T. W. K. are of a
9ther cases t-he S-A rhythm entir~ly disappeared. very much more complicated type. Th.e initial record is
The Pwa..vewaa suppressed in thetest~f Co.rpl. H.B. D. normal in type. Only the usual changes in conduc.tion
during the tw~nty-s!lventh minute at 6.8 per cent oxygen. - and in amplit'1:de and form of the T wave occur through
. The P wa~ absent for the first three beats of the recovery to the 7.1 per cent oxygen stage. i. !l-, almost to· the enci
tracing, but the ·rest of the electroca"l'diograII). shows co,m~ .-at 7 .1 per cent oxygen. In the tradng of the after
plete recovery. This is a simple and uncomplicat;ed case period, started appli.reµtly before' recovery occurred, there
of disappearance of the pacemalp.ng function ofthe sirio- :is.profound upsed.n the reactions of the intrinsic cardiac
auricular ncde. mechanism. Heart block is shown in the majority of
Howe-Ver, the very best. illustration of asphyxiation of beat.s, evid~ntly- complete. The P wave is present in por-
ihe sino-auricular rhythmic tissue ill that. of Sgt; T. B . M. tions of th~ record, but irregularl1 spaced. The auricular
At 8.1 per cent oxygen his electrocardiogram shows a. long rate, as in F. J. D ., is slower than the. ventricular rate.
series of· nodal ventricular compJexe,s without -a vestige of There is no sign of a P wave in relation to many of the ven-
the p wave. The protecol, p~e ---:-, states tbe fa.ct that ~cle compleiee. If buried in·the complex, it can not be
 104
shown. Two contractions of muscular origin complicate Eyster and Meek (1.,7) produced displacement of the
the irregularity. These facts are easily understood on pacemaking function from the S-A node to the A-V node
the theory of suppression of fonction of the conducting tis- by anatomical isolation, by crushing, and by applying
sue and partial but varying origin of rhythm production in chemicals to the S- A node. Their evidence was that
the sino-auricular node or its vicinity. rhythm under these conditions never arises outside the
parts of the heart containing specialized tissue.
DISCUSSION OF THE LITERATURE BEARING ON Meakins (18) says that "the new rhythm has its origin
OXYGEN WANT IN THE HEART. some distance above the division of the main stem of the
We do not find any references in the literature dealing auriculo-ventricular bundle, " He was able to produce
with the eJectrocardiographic method applied to the normal ventricular forward block in the dog by compressing the
human during asphyxiation. The nearest approach to bundle with a specially devised heart clamp applied after
the subject is in the very few cases photographed during the establishment of A- V rhythm by cooling.
the agonal stages of death. Lewis and Cotton (19) determined an almost constant
The latest of this type is 'the study by Halsey (14) of a acceleration of conduction in man as an immediate effect
case of broncho-pneumonia. Halsey secured a series of of exercise sufficiently strenuous to produce a considerable
electrocardiograms through to the termination in ven- acceleration of the heart rate and labored breathing. Such
tricular fibrillation. His figure 4 is more or less typical of a acceleration of conduction does not occur when the
heart agphy:nally embarrassed but still beating with a acceleration of ra.te is induced by direct stimulation of the
nol_'IIlal sequential rhythm. The halving of the rate and of auricles by the application of induction shocks, a fact
conduction time, that is, "double the time in the earlier previously shown by Lewis and Oppenheimer (20).
record," has never occurred in our tests. Whatever Acceler.ation of conduction would seem to be a function
happens to the rate, there has never been a multiple of the reflex reactions of the accelerator nerve induced
lengthening of the conducting time of this type. The
by the stimulus of exercise, or in our tests by the condi-
unexpected phenomenon shown in Halsey 's case is the
tions of reduced oxygen. Lewis and Cotton's conduction
great slowing of conduction time, with at the same time
time was accelerated by 0.01 to 0.03 second. Their normal
maintenance of a strong .p wave. The phenomenon is
conductions were reestablished in from three to five
not typi~l of simple oxygen want. In our experiments
minutes and before the normal rates were .reestablished.
the carbon dioxide was removed but is certainly present
Similar changes in conduction time have been observed
in excess in the dying heart in pneumonia. The gap
in.. patients after exercise. Our highest acceleration . in
between Halsey's figUl'es 5 and 6 is unfortunate, since it
b evident that the P waves ceased during the time of that conduction was' 0.048 second. The accelerations in rate
which we observed all occurred in the precrisis period,
gap in which he h1¥1 lost the most crucial part of the change
and du.ring this time conduction was quickened. The
in function. The single P in the fourth beat of figure 6
suggests that Halsey is dealing in this figure with sup- shorter P-R intervals observed at o,: after the crisis are
pression of the S-A nodal rhythm, i. e., by asphyxiation due to the displaced locus of rhythm production,
with. or without complications. Cohn (21) restudied the physiology of the cardiac vagus
Robinson (15) made electrocardiographic studies of pathways, showing that the right and left vagi, in dogs at
the mode of death of the human heart. Four out of seven least, do not exercise the same influence on the heart.
cases showed ventricular activity from 1.5 to 18 minutes The tight usually exerts a greater control over stimulus
after evidence of auricular activity had ceased. Two production, while the left vagus has a profound effect on
auricles outlasted the ventricles. In one case the auricle conduction. Rothberger and Winterberg (22) had sug-
and ventricle stopped together. In three cases complete gested earlier that the right vagus and cardiac accelerator
dissociation occurred. In five cases there was some delay nerves are distributed mainly to the S-A node and the left
seen in the conduction. In two cases the auricles ceased to the ·A- V node. Cohn and Lewis (23) examined the in,
before there was any evidence of impaired conduction. fluence of the vagi m delaying conduction and in pro-
There .was always a marked slowing during independent ducing heart block. They showed that the left vagus
ventricular rhythm, the ventricle contracting from 14 to 47 usually had the greater effect on conduction, but that the
times per minute. There was no auricular but one ventri- the difference was quantitative rather than qualitative.
ular fibrillation. He observed interference with . both Lewis (16) showed that when the A-V rhythm controls
rhythm and conduction, though his published records do the beat the vagus then acts at the A-V node and its
not show the onset of tli.e changes in the symptoms. The vicinity to produce reversed block. The point is used by
slowing of the ventricular rates observed by Robinson are Lewis to support the inference that the vagus acts dif-
confirmed by the slowing obtained by us when the evidence ferentially on the conducting tissue above the A-V nvde.
of auricular contraction disappears. Our rates .are aj, a He also observed that in complete heart block in the cat
higher level, but we have not carried the degree of oxygen the auricular rhythm of S-A origin completely drops out
want to the extreme represented by a heart in the agonal on asphyxiation.
stage during death from infectious disease. Eyster and Meek (24) present electrocardiograms of the
Lewis and- coworkers in investigations on the lower disordered action of the heart produced by morphine,
mammals have shown that both the S-A rhythm and the Auricular systoles are slowed aBd even suppressed, or the
conduction can. be delayed and even suppressed. Lewis conduction is partially or completely blocked.. Cohn
(16) used local cooling to study the development of the dis- (25) found that after morphine conduction was blocked
placed beat. Cooling of the S- A node is followed by slow- and sometimes reversed, as shown by R-P intervals. He
ing of the rhythm. His electrocardiograms show that the asserts that inhibition is the primary picture of morphine
new ce}lter of rhythm production is iP. the A-V node. action if the right vague only is intact, while disturbances
 105
of conduction predominate with intact left. vagus. Cohn is attributed to depression of the pacemaker, the A-V node
states that there is complete parallelism between morphine continuing to control the movements of the ventricle."
disturbances and right or left vagal stimulation, and that Mathison (28) did not observe h eart-block with an excess
the heart is released from 111orphine by atropine or by of carbon dioxide, but when he produced asphyxia by ni-
freezing the vagus. The,se observations are very sug- trogen containing only 1 or 2 per cent oxygen , thus pre-
gestive as showing the complexity of the problem. How- venting an excess of carbon dioxide in the tissues, he
ever, to explain our terminal heart slowing and loss of observed heart-block as "a regular occurrence during
auricular beats on the hypothesis of vague stimulation- is asphyxia-in dogs." Block occurred when the vagi were
to admit the occurrence of a sudden vagus activity at the cut. He attributes the block to want of oxygen alone on
close of a long period ot increasing heart acceleration the cardiac tissues.
associated with evidence of disappearance of normal vagal Most of the investigations in this field have dealt with
activity. asphyxia produced in the usual way by cessation of respira-
Robmson and Auer (26) state in their papers on ana- t-0ry exchange. Both an increase of carbon dioxide and a
phylactic shock that in 22 out of 24 anaphylactic rabbits decrease of oxygen takes place. Mathison has excluded the
marked changes occurred in heart activity whether the carbon-dioxide factor. In certain series of experiments the
vagi were cut or not. In the dog "these cardiac changes added factor of local cooling occurs, which adds to the com-
consist of disturbances in conduction of the heart impulses, plexity of experimental conditions .. The rebreather method
abnormalities in the ventricular contractions, and. other eliminates the carbon dioxide by absorbing it from the ex-
unusual disturbances of the mechanism of the heart beat.'' haled air. There is, indeed. a reduction of the degree of
They find inversion of the P wave, shortening of the P- R saturation of carbide dioxide in exhaled air during the aug-
interval showing displacement of the pacemaker, and mentation stage ofrespiration. We therefore attribute our
varying degrees of dissociation. The relationship between human observations to simple oxygen want produced by
auricular and ventricular activity beco_mes disturbed, gradual and progressive reduction of the available oxygen
"as shown by the abnormal proximity of the P and R in the blood and body tissues to a level below which normal
waves, figure ' 15. " Their figure shows a P-R time of function ean no longer occur. In the human heart rythm
0.033 as against the preexperimental time of 0.08 second. · production is decreased and lost and dissociati_on and block
They say "it probably represents a change at the point at occur, and both the factor of rythm and of conduction are
which the stimulus of the heart arises." This, view sensitive to extreme oxygen want in the descending direction.
coincides very well with the observed changes in our Further discussion of the significance of these changes
recovery charts for T. B. M., D. W. 0., and J. D., also will be given in a paper giving the results of a second
for W. C. M . Robinson and Auer interpret the changes series of electrocardiographic experiments.
in the form of the ventricular complex in anaphylaxis as
peripheral and local. SUMMARY.
Lewis, White, and Meakins (27) studied the effects of
asphyxiation on conduction in the heart of the cat by the 1. The general changes in the type of the electrocardio-
method of first cooling the S-A node and· then allowing gram with progressively induced oxygen deficiency in the
asphyxiation to dev~lop by stopping artificial respiration:, air breathed are slight until .a certain critical stage or
also by the method of simple asphyxiation without cool- crisis is reached, then fundamental intrinsic changes in
ing. These methocls make possible the study of asphyxia! cardiac mechanism begin.
effects on conduction during the normal S-A rythm in 2. The general and precrisis changes in the electro-
contrast with conditione during the A-V rythm. Their cardiogram are: (1) There is a decrease or shortening of the
facts are developed by splendidly executed electrocardio- time of the P-R interval, a change in 'Conduction time
grams. The conclusions emphasized by the authors ar!): well known to be coincident with augmentation of heart
"(1) Asphyxia produces a gradually increasing forward rate from exercise, etc., to which must now he added
heart-block in the cat's heart beating from the S-.i\ node." oxygen want. This augmentation is not universally
"(2) It produces a gradually increasing reversed heart-block observed. (2) There is a decrease in the total time of the
when the heart chambers respond to the A-V node." R-T interval similar in type and reaction frequency to
"(3) The·main defect is in the portion of the functional the change in conduction time but not always associated
system lying at a higher level (nearer the auricle) than the in the same test. (3) There is ·a marked decrease in the
actualseatofimpulsedischargein theA-V rythm." ;,(4) amplitude of the T wave with a retardation toward its
The A-V node or tissue in its immediate vicinity is the most · terminal phase· of the moment at which the· maximum
susceptible tissue in respect of changes in the A-V con- deflection appears. Sometimes the T wave becomes
duction." "(5) In the cat, so asphyxiated that there is diphasic at or near the crisis.
a complete functional break between A-V node and auricle, 3. The precrisis electroca.rdiographic changes are asso-
the application of cold to the S-A node brings about stand- ciated with the compensating reactions to oxygen waJ1t,
still of the whole of the auricular tissue." "(6) The effects reactions that are expressed in the general increase in
of the vagal stimulation in the automatic ventricle, as heart rate and blood pressure and in the respiratory aug-
reported ·by Van Angyan, are regarded as the effects of mentation in minute volume of air breathed.
vagal stimulation upon the A-V rythl'n, for in the complete 4. The chief post-crisis changes in the heart from ex-
block of asphyxia the dissociated ventricle is controlled by treme oxygen asphyxiation are a great slowing of rate,
theA-Vnode." "(7) When at the end of simple asphyxia displacement of the pacemaker or rhythm production, and
of the cat the auricular contractions disappear abruptly interference with normal conduction leading to disso-
during the stage of complete A-V dissociation, the change ciation.
 106
5. Th~ post-~risi's heart rate rap~dly drops to a slow 110. Lutz and S<;!hneider: Am. Jour. Physiol., 1919, L, 228,
rhythm m a :r;runute or less, often m a.few seconds. It 280, and 327.
decroasea from 120 or 130 to 50 or 60 per minute, a drop of 11. Gregg, Lutz, and Schneider: Am. Jour. Physiol.,
50 per cent and more. . This _change is associated with 1920, L, 302.
the development of a tllythin of auriculo-ventricular 12. Turrell and Le Wald: Manuscript in press.
origin_:six cases, The sino-auricular·rhythm was slowed 13. Schneider and Sisco: Am. Jour. Physiol., XXXIV, 1.
coincidently and disappeared altogether in extreme ; 14. Halsey: Heart, 1915, VI, ,67.
tests- three cases. Recovery of 8-A rhythm was prompt 15, Robinson: Jour. Exper. Med. XVI, 291.
on breathing atmospheric air. . 16. Lewis: Heart, 1914, V, 247.
6. In the ·post-crisis stage conduction was suppressed, J.7. Eyster and Meek: Heart, 1914, V, 119, 227.
leading to complete dissociation with maintenance of ; 18. Meakins. Heart, 1914, V, 281.
auricular beats-two cases. Complete suppression of ' 19. LewiP and Cotton: Jour. Physiol. 1913, XLVI, Pro-
sino-auricular rhythm and · conduction occurred or was- · c<iedings LX.
suspected in cases of absence of the P wav{!--three cases. . 20. Lewis and Oppenheimer: Quart. Jour. Med., 1910,
7. Suppression of.function during the post~crisis stage IV; 145.
of oxygen want occurred in the descending direction and 21. Cohn: Jour. Exper. Med. 1912, XVI, 732.
recovery in tbe reverse direction, both as rogards rhythm, : 22. Rothberger and Winterberg: Arch. f. d. ges. Physiol.,
production and conduction. -· 1913, CXXXV, 559.
8. Experimental tests have never been carried_to the 23 .. Cohn and Lewis: Jour. Exper. Med., 1913, :XVIII,
point of complete suppression of· the rhythm of the A-V 739.
node or of the conducting system connecting that node . 24. Eyster and Meek: Heart; 1912, IV, 5S-.
with the musculature of the ventricles in man. · i 25. Cohn: Jour. Exper. Med., .1913, XVIII, 715.
26. Robinson and Auer: Jour. Exp. Med., 1913 1 XVIII, ·
BIBLIOGRAPHY. . 556.
27. Lewis, White and Mee.kins: Bea.rt, 1914, V, 289.
L. Bert: A series · of -i3 .articles published from 1871 t0c
28. ·Ma.thiso~: Heart, 1910, II,~'
1874. Comptes rendu des Seances de l' Academie
des Sciences·, 1871, LXXIII, 213, 503_; 1872, LXXIV, 1. P-ublished by permission of the Surgeon General of
617 ; LXXV, 29, 88, 491, 543; 187.3, LXXVI, 443, the United SJ;a.tes Army. · .
578, 1276, i.493; LXXVII, 5.31; 1874, LXXVIII, 911. 2.-The experiment.a,! data on which thti present article
2.. Bert: La Presai.on Ba.rometrique etc., Paris 1874 and is based w~ obta.ine<f in a special study executed under
Paris 1878, , the orders , of the Surgeon Genera.l's Office, Division of
3.. MOllBO: Life of Man on the High Alps, London, 1898. Aeronautics. The writers are UI).der particular obligation
·4._ Zuntz, Loewy, Mtiller, and . ·Caspari:· H'ohenklima to the commanding officers of the Medical Research
·und Bergewa.nderuµg, etc_., 1Berlin, 1906. . Laboratory and of the U.S. General Hospit,a.l No. 9. We
- 5. Douglaa, Haldane, Henderson, and Schneider; Phil, a're. un~er personal · obligation to Lieut. Harry Clough,
· Trans. Royal Society, London, ·Series K, 191~, who had charge of the hospital cardiographic station and
CCIII, 271. under whose skill the excellent electrocardiograms were
If. Air Service Medical: U.S. Wa.rl)epa.rtment; Govern- made. To the .men who ·took the tests to the extreme
ment Printing Office, 19I9. . limits of safety and to the noncom.missioned office:r:s who
7, Bert: Comptes rendu, H!74, LXXVII, 911. assisted in ~e.exanriliations we ·expreBFI appreciation and
-8. Schneider: Jour. Am. Med. Assn., 1918, LXXI, 1382, aclpiow~edgments.
9. Whitney: Jour. Amer. Med. Aasn:, i91_8, LXXI, 1389. (By.courtesy of' 'The .Archives of Internal Medicine.'')
A RECORD OF EXPERIENCE WITH. CERTAIN PHYSICAL EFFICIENCY AND
LOW OXYGEN TESTS.
By EDWARD C. Sim.NEIDER.

The student of aviation medicine has been confronted The tests gre)V in number with experience, and the
with the problems of P,rotecting the flier . 'aga.irist the application .of them w&s extended to detect flying stress
effects of phySical deterioration and the effects of altitude, · and fatigue. · More recently Fla~k· has stated that he
low harometri~ pressure, and ·deficiency of. oxygen. · believes them to be of use in determining the physical
The .call for a measure· of health and physi.cal fitness •efficiency of an individual. He emphasizes that .these
comes from the fact that the aviator has need of all his ' tests are not designed to supplant the work of the clinician
physical energy . and intelligence. Flying requires an ~ ·any way, and ~heti a man is reported as physically
active, well-balanced, decisive .~nd and s~nd, quick, unfit on these tests it does not mean tliat the work of the
reflex actions. The aviator must be able to recognize at physician is finished, but that it is beginning.. If the sub-
once the slightest difficulty with . his machine. His ject does not come up to standards then the neurologist,
senses µmst give him accurate information of changes .in cardiologist, or general physician will find something is
the rhythm of his motor, of the sing of air across the wire!! wrong with him. The tests,· it is believed, give indica-
of the machine, and ofhis position in space. He 1D.ust be tions for such overhaul.
master of his impre3Bio:ns and · ready to make . prompt
decisions in a calm, cool manner. It is now clearly .recog- ALTITUDE AND, PHYSICAL EFFICIENCY TESTS
nized that the aviator's reactions to stimuli are slowed USED IN THE ROYAL AIR FORCE IN ENGLAND.
down or· disturbed by disease, worry, fatigue, . excessiv~ In a complete physiological examination seven distinct
use of alcohol and other excesses. Such influences may sets of observations are made upon the pilot. -These in-
caue,e·a delay of a second or part of a secohd in correcting. elude (1) the response of the pulse to ·a standard exercise,
an error in difficulties ihthe air or i,nlanding, which may (2) time the breath is held in s~conds after a fyll expira-
mean the difference between a cra~h and safety. The tion and full inspiration, (3) time the breath is held after
medical adviser requires tests that will-reve,a l the degree the standard exercise, (4) vital capacity, (5) extrarespira-
o1 loss in e'ficiency in_· order that h\;l may intelligeb.tly tory reserve as represented ·by the factor respiration. rate
83.Y when.the.tyiator should not fly. . multiplied }>y ventilation per minute_divided by the vital
. The ability to endure altitudes -well and without ioss capacity, (6) expiratory force, and (7) the "fatigue" test.
in e'ficiency_is dependent u.pon the eaee and quickness The valu~ of the tests depends on all being carried out
with which certain . adaptive adjustments are made. .in the same w~y·on all occasions.
There are marked individual diffete'!lces in this respect.' The technique and interpretations of five of the tests
Some nien adjust so well. that they are not dist11rbed by . may be summarized as-follows: · ·
heights which render the averag<;i person quite ine'fici1mt. 1. In holding the breath the sea~ subject is instructed
A few men fail entirely to respond to altitude and become to expire once as deeply a_s possible, then inspire fully and
inefficient at_i:elati vely low altitudes. The flight surgeon . hold the breath as.long as possible. · The subject is watched
finds it advantageous to have the fliers under his .super- to determine the degree of suffusion and color of the face.
vision classified as to their ability to compensate to .the _The reason for giving up is carefully noted. It is claimed
effects of altitude. 'that the breath holding shows whether there is "oxygen
In this paper we . shall report the results of a study of want,~· and thereby whether the individual is likely to do
12s· aviators who were .subjected to the· official.altitude weli at high-altitudes. If dizziness, blurred vision, etc.,
classification examination used by Air· Service S'ection of occur under 40 ~econds the candidate is debarred from
the U. S. Army; to five of the standard respiratory tests flying. Good pilots.manage 60 sitconds, and it _is main-
used by the Royal Air Force in England, and to a car!)ful tained that all should be able to hold a minimum, in three
overhaul by a neurologist, internist, ophthalmologist, and times, of45.seco:nds. .
otologist. The clinical exa~tions showed :n ;of these 2. In measuring the vital capacity the subject is asked
or
aviators to be stale physically below par. to fill-his chest and blow he.rd through a meter, takingpre-
In England, in the Royal Air Force, under the guidance· cautions against overblowing the meter. _ The minimum
of LieuC CoL Martin Flack (n (2); a set of simple 1· vital ' capacity, is' fixed ·at 3;000 c. c. It appears that no
physiologic tests was devised to indic'ate subjects who account is taken ofthe size.of the man. It is maintained
were likely :° ~uffer f~m _discomforts in t~e. air, sll:ch as that a capacity below 3,400 c. c. and inabil~ty_to hold !he
headache, g1ddmess, famtmg, nausea, vorrutmg, pressure breath for more _than 45 seconds contra-md1cates high
in the head, blooq rushing to the temples, palpitatiop. of flying.
the heart, etc., symptoms .which might .be due to la<ik of. 3. Bazett (3), who formulated the respiratory reserve
a
proper oxygenation of the blood mid likely to render the factor, suggested that inen with large vital capacity, a
man unfit for flying. - lowconsumption of air per minute, and a slow respiratory
(107)
 108
rate tolerate high altitudes better than othem. He found group there were 31 men found to be sfale or physically
that the average figure for the good type of flyer is 24.1, for below par by clinical examiners .
the bad 46.3, and for the uncertain 36.8 . A figure of 30 has
TABLE 48 .
been taken as the 1standard, those above this being rela-
tively bad for high altitudes.
Correla-
4. For the deteormination of the expiratory force a U-tube Num- Arith- Frob- Correlation tlon with
manometer, filled with mercury, is used. Tlie subject is ber of metical able with oxygen
cases. mean. err-0r. oxygen. consump-
asked to blow the column steadily as high as possible, and tlon rate.
not to swing it up by the momentum of the mercury. It is --
believed that this is a measure of fitness and of the tone of Final oxygen percent-
age . ················ · 128
the abdominal wall . The average normal is about 105 inm. Length of run in min-
Hg. It was found that pilots-suffering from flying streBEI utes ................ . 128 24.15 ± .14 -0. 51±0. 04 ..•.. . .• • .
Vital capacity in liters. 128 l!. 33 ± ,36 -' . 06± . 06 o. 20±0. 06
can often only blow 40 IJ?.Ill· "If the test is about 80 the Breath held in secoQds. 127 67. 84 ±1. 22 - .18± . 06 - .03± .06
pilot is considered suitable for only low flying, and if much ".Fatigue" test in sec-
onds.•.....• . ......... 122 52. 20 ± . 84 - • 12± . 06 ;13± . 06
below is probably in need of a rest from flying altogether. Expiratory force · in
mm.Hg .... ........ . 123 123. 01 ±1. 82 ~ .11± , 06 .10± . 06
5. The fatigue test is another with the U-tube manom- Extra respiratory re-
eter. The subject is asked to empty the lungs, take a deep serve factor ......... . 126 · 40. ss \± . 78 • 025± . 06
breath, blow the mercury to the height of 40 mm., and
hold it there without breaking for as long as possible. THE RELATION OF THE ABILITY TO HOLD THE
According to one hypothesis the test is an indication of the BREATH AND THE ENDURANCE OF LOW OXY-
tone of_ the respiratory center. The average normal time GEN.
of many cases is 50 seconds. Below 40 seconds is consid-
ered unsatisfactory and indicates that probably the sub- If the time the breath can be held should prove to be
ject is fit only for limited flying or is in need of a rest. an index of ability to respond to the influence of low _oxy
It is not claimed that each test is capable of rigid applica- gen, itwould serve as a simple means of classifying aviators
tion, but that it is the combination of the tests that is im- for altitude flying.
Flack has state.cl his opinion of the breath•holding test
portant.
as follows: "The test was originally designed to show
ALTITUDE CLASSIFICATION EXAMINATION. whether there was 'oxygen want,' and I still believe the
test does show the subject who would suffer from 'oxygen
The altitude test for the classification of aviators that want.' From my experience I found that people who.
has been used by the U . S. Army is described in the Manual were likely to imffer from. 'oxygen want' would give up
of the Medical Research Laboratory (p. 215). In this test after a very short time in holding the breath and would
the aviator rebreathes, for a period of 25 to 30 minutes, alm~st invariably return an abnormal answer. A-norma
through the Henderson rebreathing apparatus, 52 liters answer would be that the subject 'had to give up,' 'felt he
of air from which the carbon dioxide of the expired air is would burst'; an abnormal answer that 'the blood rushed
removed by an absorbent. As the oxygen gradually and to his head,' 'things became blurred,' etc.''
progressively decreases, the subject is under· observation We have determined that the coefficient of correlation
by a . physiologist, psychologist, and clinician. The between the time the breath was held and the,lowest per
physiologist determines the rate and volume per -minute centage of oxygen tolerated by 127 men was only -0.18
of breathing, the pulse frequency, and the systolic and ±0.06. This no doubt indicates that the compensation
diastolic arterial pressures. The psychologist records to a gradually decreasing -oxyg_e n supply is dependent
changes in attention and motor coordination until the upon other factors that exert a more profound influence
subject reaches the point of complete ~efficiency or until than conditions that obtain during breath-holding, and
the clinician finds that the condition of the circulation that the power to hold the breath is at the best of only
makes prolongation of the test undesirable. A few sub- minor importance as a measure of ability to endure low
jects exhaust the oxygen to 6 per cent or a little lower, oxygen.
many reach 7 per cent, while poor subjects may become The average time for holding the breath was 6.8 seconds
mentally inefficient, or faint, at considerably higher per- ·the longest time was 128 seconds, and the shortest 30
cent;l.ges, 9 to 12. A majority of all men examined gave seconds. '
the first physiological evidences of compensation to the There were 10 men who managed to hold their breath
reduction in oxygen at between 16 and 14 per cent of only 45 seconds or less, the minimum allowed by the
oxygen. English standard, and, of these, 6 remained fairly efficient
Our data for the 128 aviators have been examined by down to 7.5 per cent of oxygen; l even reached 6 per cent
statistical methods and these are summarized in Table 48 Four of the men failed between 9.8 .and 8.4 per cent
The' averages as determined in England by the exam- oxygen.
ination of healthy pilots in the Royal Air Force were: Two groups of cases .of 13 aµd 12 each iilustrate well the
Vital capacity, 3,800 c. c.; breath-hold, 66 seconds; ex- distribution with respect to the ability to compensation to
pi.ra,tory force, llO mm.; and "fatigue" test breath-holding low oxygen.and breath holding. There were 13 men who
while sustaining by blowing a column of mercury at 40 managed to hold the breath between 6.0 and 65 seconds; o
mm., 52 seconds. It will be seen that our American group these, 2 became inefficient in the rebreathing altitude
averag~d above the English group in vital capacity, ex- test before reaching 9 per cent of oxygen, 3 did not reach
piratory force, and breath-holding; while 1.n the "fatigue" 8 per cent, 4 failed betweeIJ. 8 and 7 per cent, while the
test the two groups ·were the same. In the American last 4 held 011 to between 7 and 6 per cent. The group of
 109
12 that held the breath for from 70 to 75 seconds became
inefficient as follows: Two before reaching 9 per cent, 3
between 9 and 8 per cent, 3 between 8 and 7 per cent, and
4 between 7 and ~percent of oxygen. It should be noted
that these two groups show almost identical distribution
in spite of the fact that one group could hold the breath
longer than the other.
There were two aviators who fainted at 11.3 and 11.1 per
cent of oxygen. The first, who held his breath 91 seconds,
was suffering from ethmoiditis and was not fit; the other,
who held his breath for 59 seconds and reported breath-
lessness at moderate altitudes, was found to be stale by the
neurologist.
Two other ca.ses are of interest because of early failure in
the rebreathing test. The first held his breath 99 seconds,
but-showed a circulatory failure at 10.7 per cent oyxgen.
He was found to be physically fit by the clinician but had
never flown higher than an altitudeof 10,000 feet. The next
man held his breath 68 seconds and became inetficient at
10.3 per cent of oxygen. He was a heavy smoker and com-
plained of being tired after flights at more than moderate
altitudes.
There were 12 men who managed to hold the breath for
from 100 to 128 seconds _and these, with one exception, who
reached 8.3 per cent, remained efficient to 8 or less per
cent of oxygen.
The correlation of breath-holding with the rate of oxygen
consumption was only -0 .03±0.06. An analysis of the
comparison of these ·two conditions fails to bring out as
close relationship as the ability to hold the breath and the
percentage _of oxygen reached.
If, as we _believe, the rebreathing low-oxygen examina-
tion gives sati_sfactory evidence as t6 how well a man com-
pensates to low oxygen and high altitudes; then our data
that indicate the breath-holding test alone would not
suffice as·a_means for grading Dien for altitude flights.
VITAL CAPACITY AND LOW OXYGEN.
In the Royal Air Force all candidates with a vital
capacity below 3,000 c. c. are rejected and all below 3,400
c. c. aro viewed with suspicion. If a person requires a
large volume of air per minute it is evident that he may
find a large vital capacity useful. In th.is group of 128 men
when seated the average volume of air breathed a minute
was 6.7 liters, and when under the influence of a low oxy-
gen of 7.6 per cent it was 10 liters, or there was an increase
of 3.3 liters in the totallung ventilation each minute. The
vast majority of men when breathing air that contains
from 8.5 to 6 per cent of oxygen inspire at each breath from
600 to 1,250·c . c., while theii normal volume per breath of
normalatmospheri~ airisbetween360and 640c . c. (4). We
ha,ve found a 'few men when under the influence of 7 or 6
per cent oxygen who breathed 2,000 to 2,400 c. c. of air pei;
breath. _It is obvious that a man of small chest might be
limited to rapid rather than deep breathing in order to
secure sufficient ~entilation of the lungs when at altitudes
comparable :to such oxygen tensions as these.
Among .the 128 men the vital capacity of the chest
averaged 4,330 c. c., th'e smallest was 3,090 c. c.,and the
largest 6,620 c. c. The coefficient of correlation between
vital capacity and compensation to a gradually decreasing
supply of oxygen was exceedingly small, only -0.06
±0.06. This sug'gests that vital capacity, when taken
alone, is almost a negligible factor in the process of making
the compensations necessary to supply the oxygen needed
by the tissues during exposure to a decrease in oxygen that
is comparable to ascending in altitude at the rate of ap
proximately 1,000 feet per minute.
There were 5 men among our group of 128 who had a
vital capacity of 3,400 c. c. or less. They responded to the
low-oxygen altitude test as follows: (1~ Capacity 3,090 c·. c.
endured to 8.5 per cent of oxygen, (2) 3,180 c. c. reached
8 per cent, (3) 3,-200 c. c. reached 8.9 per cent, (4) with a
capacity of 3,380 c. c. went to 8.4 percent, and (5) 3,400 c. c.
remained efficient to 7.6 per cent of oxygen. These men
reacted as well to oxygen want as many men of greater
vital capacity. They did not, however, reach the very
low oxygen of some of our cases. Two mel). with a vital
capacity of only 3,900 c. c. compensated well to 6 and 6.2
per cent oxygen.
The four men who become inefficient early-at 11.3,
11.1, 10. 7, and 10.3 per cent oxygen, percentages that are
tolerated well by the vast. majority of men-had vital
capacities of 4,680 c.c., 3,"900 c.c., 4,800 c.c., and 3,830
c.c., respectively.
The man who had the largest vital capacity, 6,620 c.c.
became completely inefficient at 9.4 per cent oxygen
and would have fainted had he not been restored tQ air
immediately.
It appears from the data cited above that the vital
capacity, when taken alone, does not give reliable evidence
aB to a subject's ability to respond to low oxygen and
altitudes. Our experience, unfortunately, does not
include men who at the same time had a small vital
capacity and a limited ability to hold the breath.
THE EXPIRATORY FORCE IN RELATION TO LOW
OXYGEN.
Unquestionably the expiratory force test is a measure of
the power of the abdominal and other expiratory muscles.
That the strength of these muscies should be of impor-
tance in making the necessary responses_ for providing
oxygen from an atmosphere deficient in this gas does not
appear a necessary or even likely correlation. Our data
gave a coefficient of correlation for the relationship
between the expiratory force and compensation to fo.v
oxygen of -0.11 ±0.06. This is slightly above the cor-
relation between vital capacity and low oxygen and not
equal to that between the power to hold the breath and
low oxygen. All are too low to be significant.
The coefficient of correlation has been calculated for
120 caBes for the relationship between expiratory force
and the power to hold the breath and vital capacity.
The correlation for expiratory force and -the breath-hold
a
was 0.48 ±0.05, which is fairly high and quite significant
coefficient of · correlation. The correlation between
expiratory force and vital capacity was 0.24 ±0.06,
which presents a decidely lesser degree of correlation,
but which, nevertheless, is .considerably higher than our
correlations for these tests with the low-oxygen com-
pensation.
Among our group of cases subjected to the iow oxygen
altitude test there were three men who gave only 70 mm.
in the expiratory force test. They compensated to low
oxygen down to 8.4, 6'.3, and 6 per cent, respectively.
On the other hand, the four men who made a poor showing
 110
~n the low-oxygen, test, failing at 11.3, U.l, 10. 7, and 10.3 In table 49 are given the data for seven cases of early
per cent of oxygen, registered 140, 178, 88, and _110 mm., failure in the rebreathing low-oxygen test. It should be
respectively, in the expiratory force test. Not one of them noted that two of these cases stand well in each of the
was below 80 mm., the minimum for normal. These respiratory tests and that the others a:re only below the
cases here cited are · all exceptional, but .they clearly minimum normal allowed by the English standards in
show why :the coefficient of correlation . for expiratory one or two tests, the extra reserve factor and the "Jatigue"
force ~nd low oxygen compensation is so decideldy low. test. The combination of the respiratory tests does not
appear to single out men incapable of compensating to
"FATIGUE" TEST. low oxygen any better than did the individual tests.
This is a form of breath-holding in which the subject· TABLE 49.
by expiratory effort sustains a. column of n;iercury at 40
I
mm. during the period that he holds his breath. It Inefficient Vital Breath Expirat_ory " Fatigue" Extra
No. at oxygen; capaeity,
a
requires considerable amount ,of effort and, t,herefore, per cent. inc. c.
held, in force, in test; in reserve
second~. · mm. hg. seconds. factor .
for the majority of men ,shortens the period that the
breath can be held. Since the test is a modified breath- 1 9.4 6,620 55 138 55 18.9
2 9.9 3,950 60 122 45 32.8
holding, i,t was to be expected, as was proven, that its 3 10.0 4,220 52 96 42 36.5
coefficient of correlation with compensation to low oxygen, 4 10.3 3,830 68 110 63 35. 0
5 10. 7 4; 800 99 88 32 37.2
which was -,-0.12 ±0.06, would be about equal. to that 6 11.1 3,900 59 178 36 33. 5
7 11.3 4,680 91 140 61 24.0
for the breath-holding test.
Our men in the ''fatigue" test averaged 92.2 secondfl.
The highest record was 97 seconds, made by a _man who A COMPARISON OF THE TESTS AND CLINICAL
compensated down to 7.9 per cent of oxygen. The FINDINGS.
minimum record of ~3 seconds was made by a man who
Among the men considered in this paper there were 31
compensated well to an extremely low oxygen, 6 per cent.
who were found to be below par by clinical departments of
Six JOOn who reacted poorly to the rebreathing low-
the laboratory. Each man was examined by an internist
oxyge:a test may be cited to furt!ier show the lack of
neurologist, ophthalmologist, and ear, nose, and throat
correlation of these tests. They faHed at the following
specialist. We shall now briefly show how these men
percentages of oxygen: 11.3, 11.1, 10.7, 10.3, 10.0, and
responded tQ the several respiratory tests.
9.9. Their respective "fatigue" tests were : 61, 36, :fa,
63, 42, and 45 seconds. THE REBREATHING LOW OXYGEN EXAMINATION ,AS A TEST
OF PHYSICAL F ITNESS.
THE ElTRA RESPffiATORY RESERVE FACTOR.
There were many incidents observed among aviators
For 126 of our men the coefficient of correlation for this that seemed to indicate that the man who had "_gone stale"
reserve factor and compensation .to low oxygen was sur- was very sensitive to low oxygen and particularly liable
prisingly low, only 0.025 ±0.06. According to Bazett to syncope when flying. In the laboratory we have seen
(3) ~low figure for the-reserve factor, under 30, indicates -men with temporary indispositions, such as may follow a
that the man is a good type for high altitude flying; such bad cold, recent illness, lack of sleep, alcoholic excess,
a man should, therefore, compensate well to low oxygen. etc., do poorly · in the rebreathing examination who at
Among our subjects there were many striking exceptions. some other time when feeli'ng fit had compensat~d very
One man with a reserve factor of 41 compensated to 5. 7 welL In view of these .occasional findings, the reactions
per cent oxygen, another with a factor of 40 reached 6.2 of the 31 s_tale or ailing men was not what might have been
per cent oxygen, and a third with a factor of 45 remained expected. They compensated to low oxygen as follows:
efficient tp 6.5 per cent oxygen. 11 to as low as between 5.5 and 7 per cent, 12 to between
There were 52 of 126 cases who had an extra reserve 7 and 8 per cent, 7 to between 8 and 9 per cent, and 1 to
factor of leBB than 30. These men compensated to low 9.9 per cent oxygen. From this data it appears that
oxygen as follows: 17 to betwe~n 6 and 7 per cent, 24 to among men who are physically below par some may reacr
between 7 and 8 per cent, 6 to between 8 and 9 per cent, very well to the action of low oxygen as judged by theit
4 to between 9 and 10 per cent, and 1 to only 11.3 per cent physiologic and psychologic responses and efficiency.
oxygen. The average low oxygen reached by our 128 The rebreathing low-oxygen test was perfected to de-
c11Bes WM 7.6 per cent. Of this group of 52, with a low termine the ability of the human organism to respond to
figure for the extra reserve factor, 11 failed to reach 8 per the decreasing oxygen tensions of high altitude. Some
cent oxygen and, therefore, could not b\l claBSed high in men compensate well, others inadequately, and others not
compensation to low oxygen and altitude. at all. The test should be employed for searching out
It appears from the above data that any one of the five those unfit for flying by reason of inability to respimd to
respiratory tests when taken alone does not give a reliable altitude and also for approximating -the altitudes safely
index as to how well a man may compensate to altitude tolerated. Physical fitness it appears must be measured
and low oxygen. by other tests.
 111
PHYSWAL FITNESS AND THE SIMPLE RESPIRA- Birley (6), working with English aviators at the front,
TORY TEST. found that pilots.-and observers whose condition warranted
their transfer to England for a rest preserved a compara-
The determinations for the 31 temporarily unfit men are
tively high degree of physical fitness as judged by the tests.
tabulated below.
H-e believes that they afford valuable information in
BREATH·HOLD . asseBBing temperament and susceptibility and reaction to
shock. He found that they did not prove lJ!ieful in search-
30-3-9 seconds .. ....... . 1 90-99 seconds ...... ... . 2 ing out psychopaths, individuals who never fee1 confident
40-49 seconds .. ..... .. . 0 100-109 seconds ....... . 1
50-59 seconds ...... . .. . 4 110-119 seconds . .. .... . i in the air and sooner or later reach the hospital with well-
60-69 seconds .. . ...... . 9 developed anxiety neurosis.
70-79 seconds ......... . 5 Total.. ...•..... . .. 31
80-89 seconds .. ... .... . 8 PRACTICE EFFECTS.
EXPIRATORY FORCE. In order -to determine the effects of practice and ex-
perience on the five respiratory tests, em>en m{ll! were asked
80-89 mm............. 1 150-159 mm .......... . 0
90-99 mm......... . ... 1 160-169 mm .......... . 1 to repeat the tests every day for a week. The results
100- 109 mm... . . . . . . . . 3 170-179 mm ... ....... . 1· obtained with five of the men are given in Table 50. The
110-119 mm.... . .... . . 10 180-189 mm .......... . 4 data for the -two men not recerded here show similar
120-129 mm. . . . . . . . . . . 5 variations. It sh9uld be -noted that the men followed
130-139 mm........... 3 Total.............. 31
140-149 mm.......... . 2 their regular daily routine of living during the period,
:.nd that no environmental conditions, habits of living,
VITAL CAPACITY. or sickneBB were- -recorded that might account for the
0- variations and improvement. Eacli m,11,_n cooperated to
3,000-3,499 c. C! ••• -·.. 1 5,500--5,999 C. C .••.•••
3,500-3,999 C. C •• _ . • • • 7 6,000-6,499 c. c .... , .. 1 the best of hi.Ii ability, so we may conclude that the differ-
4,000-4,499 C. C. . • • . • • 11 ences recerded are the results of practice and the fortunes
4,500---:4,999 C. C. • . . • . • 5 Total....... .. . ... . 31 of the details of coordinatfon and position.
5,000-5,499 c. c . .. . ... 6 ln breath-holding not a man held hi~ ·breath the same
"FATIGUE" TEST. length of time in any two trials. Each showed a con-
siderable amount of variation. Six of the men improved
20-29 seconds...... . . . . 1 70-79 seconds ....... . . . 4 the time of the hold with practice from 18 to 51 seconds.
30-3~ seconds ... , .... ,.. 5 80-89 seconds ......... . O Holding the breath requires will .power. If a man deter-
40-49 seconds ..... ". . . . 7
50-59 seconds ....... , . . 12 Total.. ............ 31 mines to hold the breath until discomfort is profound, it
60--69 seconds..... . . . . . 2 can be done, or he may give up with the first feeling of
effort. Private Ha. by effort increased his power of hold-
EXTRA RESPIRATORY RESERVE FACTOR.
ing the-breath from 31 seconds, which is below the mini-
10-19............. .... 3 60-69 ....... ......... . 0 mum for .normal, to 64.seconds, which was within 4 seconds
20:-29................. 11 70-79 ..... ...... ·..... . 2 of·the average for our group of 128 a.via.tors.
30-39........ .. . . . . .. . 5
40-49 ..... . .... , ...... 3 Total.......... . ... 27 TABLE 50.-Practice effect.
50-59...... .. ... . .. •. . 3
Only 1 of these-unfit men held his breath lef$B than 45
1st
day. 2d
day. I 3d
day.
4th
day.
5th
day.
6th
day.
seconds, the minimum for normal established in England; ---- --
1 had a vital capa.tity of 3,180 c. c., which was below the Sergt. L-.. R .:
minjinum of 3,400 c. c.; 6 held the breath in the "fatigue" Breath hold, seconds ... 71
50
95 \00
72
80 122
160
.-·----
... .. .
Expiratory force, mm .• 68 68
test for leBB than the 40 seconds, the minimum for normal; Vital capacity,'" c ..... 5,560 5,400 5,~ 5,200 5,700 .. ....
" Fatigue," seconds •... 3() 50 64 93 --- ··-
14 showed up unusually well in the extra reserve factor; Co~K.:
while only 8 made a very poor record, and not one ~ reath hold, seconds, .. 65 67 63 58 76 ......
Expiratory force, mm •. 80 92 138 811 78 ... ...
below th.e minimum normal atlowed in the expiratory yital_capa!'ftY, c. c •. _.. 4,300 4,180 4,100 4,400 4,ioo ------
Fatigue, secon!ls •... 36 55 52 51 55 ------
force fust. There were 11 cases that-did not fall _below the Pvt. I.:
minimum for nonn~l in .any one of these five respiratory Breath hold, seconds ... 50 60 49 43 75 ......
Expiratory force, mm .. 120 140 180 116 160 .. ....
tests, w:hile only 2 men fell below the minimum normal in y~al!l'lpa~ty,c.c. , . .. . 4,000 3,900 3,720 4,000 3,~ ... . ..
atigue, sec .... ... .. 4(i 55 40 . .....
three of the tests. Pvt. Ha.:
In the breath-hold 171:Vere above the average, 68·seconds; Breath hold, seconds ... _31 57 64 59 56 ......
Expiratorv force, mm . . 134 140 I30 120 136 ..... .
in the ''fatigue" test 14 were above the average, 52 seconds; yital.cap~ty, c. c ..... 4,170 4,190 4,000 3,970 4,500 ......
FatJ.gUe, seconds , . .. 40 48 65 54 49 --- --·
in the respiratory force 14 above 123 mm., the average; Pvt.Hu.: ·
and 15 had a vital capacity greater than the average, Breath hold, soconds ... 62 65 85 81 75 82
Expiratory force, m:m . . 60 54 70 96 94 104
4,330 c. c, Vital capacity, c. c . ... . ·3,700 3,890 3,650 3,660 3,760 3,690
' ' Fatigue,'' seconds . . .. 51 51 63 53 53 67
Our experience with these respiratory tests is similar to
that of White (5) in the United States Base Hospital
No. 6, in France, in which he trie d out the value of the In the ' 'fatigue " test, .which _is 'also a breath-holding
breath-holding, vital capacity, expiratory force, and .the ·test, some skill is. required in sustaining the column of
"fatigue" test on convalescent gaBSed cases. He con- -mercury at 40 mm., and a proper set of the fips will ap-
cluded that they were tests of the stability of the nervous preciably ease the performance. All of our men also
system rather than of cardiac and puhnonary condition. showed improvement with pnt,ctice in this test. Sergt.
 112
L. R. increased his performance each day so that on the often depends upon the ability to coordinate the contrac-
fifth day he held 63 seconds longer than on the first tion of chest and abdominal-muscles.
day. The coefficients of correlation for the power of breath
The expiratory force test practice effect shows improve- holding, vital capacity, "fatigue" test, expiratory force,
ment in five of the seven inen. One subject, whose com- and extra respiratory reserve factor with compensation to
plete data are not here given, raised the mercury column low oxygen werefound to be of such low value that the sim-
to 1~2 mni. on the first day and to 218 mm. on the seventh ple respiratory tests could not be accepted as aids in <;l.eter-
day. mining fitness for high altitude flying.
The data on vital capacity do . not show that practice The .d egree of physical fitness it appears, as shown by an
gives an increase in the record. examination of 31 temporarily unfit men, can not be
measured either by the .simple respiratory tests or by the
CONCLUSIONS AND SUMMARY. low oxygen of the rebrea thing test.
Seven men were able to improve their records in the
Certain criticisms may be offered against the simple
respiratory tests by p:i;actice.
respiratory tests. They require too much voluntary atten-
tion and hearty cooperation on the part of the patient. BIBLIOGRAPHY.
The results are not capable of physiological interpretation
unless they represent the best effort the patient can put 1. Flack: Lancet, 1919, I, p. 210.
into each test. Indifferent subject and listless observer 2. Anderson : The Medical and Surgical Aspects of Avia-
both vitiate the results. If the patient wishes a vacation, tion, London, OxfordFress, 1919, p. 55.
knowing that a poor showing in the tests indicate.I! fatigue 3. Bazett: Reports of the Air Medical Investigation Com-
and need of a rest, he can -easily imitate the '' all in'' man. mittee, London, No . 6, 1918, p . 7.
The tests are in some respects psychological, since ·if a man 4. Schneider: Journal of the American Medical Associa-
determines to hold his breatp. until discomfort is pro- tion, 1918, 71, p. 1386.
nounced it can be done, or he may give up with the first 5. White : American Journal of the Medical Sciences,-1920,
· feeling of effort. CLIX, p. 866.
To .sustain the mercury column 'in ·th(l "fatigue" test 6. Birley: Reports of the Air Medical Investigation Com-
reqUires some skill, and a proper set of the lips may ease the mittee, London, No. 3, p. 25.
performance so much that 20 or more seconds ar!J added (By courtesy of ''The American Journal of the Medical
to the. length of the hold.. The expiratory force test, if Sciences.")
well done, requires great effort, and the height of the blow

.
 THE APPLICATION OF CERTAIN PHYSICAL EFFICIENCY TESTS. 1
By VERNER T. ScoTr, M. D., Capwin, M. C., Air Service, Mitchel Field, Long Island, N . Y.
There appeared last year in the Journal of the American meet the requirements of our needs-Crampton 's 3 and
Medical Association a description of a physical efficiency Schneider's. These two tests were applied to men who
rating scheme, devised by: Edward C. Schneider.' It is were candidates for the flying status.
the purpose of this article to give applications of the test From a study of 410 of these cases, in which the men
and the reasons for its adoptio~ by the Medical Division were subjected to Schneider's test (recorded in the accom
of the Aii Service. panying chart), the mean score was found to be 11. The
In aviation we deal more with temporary than with ·lowest scor , -3, was made by a man who was diagnosed as
permanent ailments, · because men with serious physical having n•,nrocirculatory asthenia . . Only four men mad
defects are weeded out before they reach the stage of a score of 18, which is the highest possible under the
flying. As in industry, so in aviation, we encounter system of rating. Forty-seven made a score of 13.
that condition .known as "staleness"; and whereas in
the industrial world· it means lowered phy£ical efficiency, A COMPARISON OF SCHNEIDER'S AND CRAMP.
TON'S TESTS.

t
To learn the :r:elative merits of the two tests, the data
4-IOCA.sES
were checked against the official examination for flying.
MEAN==II.OT8 Two hundred of these cases have been analyzed and the
Plf'(JM81.EU~/J results tabulated in Table 51.

I
With Schneider's test, of those who made a score of
8 or higher, 149 were qualified and 4 disqualified on the
official examination; and, on the other hand, of those
with a score 0f 7 or lower, 7 were qualified and 40 were
disqualified. On this basis we can say with a fair deg'!ee
of accuracy that those who make a score of 8 or more will

\~\
be. qualified on the physical examination, and those with
a score of 7 or less will be disqualified.

TABLE 61.-Results of physical examination for flying.

Quslified. Disqualified.

" '-:_:;,.:.:;z-:.~,-:o:.-:,:-.-:z:-,-:-..,.~5::--::,,.....,.T,....,..8""!J::--:IO:::-!,,~M!:-/.~:J:-l+""""'JS,,.....,,r,,::-..I
-SrN,YD-.$ /NDEJ( N~~,,P
Schn-ei-d e_r'_s_in_d_ex
_: - - - - - - --
8 and above..... . ...... .. ....
7 and less. . ... .. ..... . . . .....
of cases.

149
7
---
97. 4
14. 9
----i---
Numl>er Per cent Number/Per cent
· of cases.

4
40
·

2. 6
85.1
Crampton's index:
51 and aboye . . . ............. . 118 86.-0 19 14.0
50 and below .... . .. ... . .. . .. . 37 58. 7 26 41.3
40 and above.- . ........ . .... . 142 80.0 20.0
FIG. 49.
39 and below ... . .. . ..... . . .··I 15 42. 9
23
20 57. 1

i11 aviation it means all of that plus risk of life and de-
struction of airplanes. With Crampton's test we obtained no dear line of
demarcation, such as occurs in Schneider' s rating. We
A physician skilled in neuropsychiatry and cardiovascu-
took those with a score of 51 and above, and found that
lar work can make a diagnosis of "staleness," but he can
118- ·were qualified and 19 disqualified; while of those
not determine the _degree of fatigue. Schneider, by the
with a score of 50 and below, 37 were qualified and 26 dis-
use of arbitrary numbers, has made the best ~ffort in this
direction. . qualified. Finding more men qualified than .disqualified
During the war we realized the ·necessity for a short, at 50 and below; we shifted the line to 40, and found that
· with a score of 40 and above, 142 qualified and 23 dis-
simple test as a measure of physical efficiency. There
have been only two cardiovascular tests ~hat appeared to qualified, and those of 39 and below, 15 were qualified
and 20 disqualified. There is no material advantage,
1 From the Medical Research La)>oratory. therefore, in taking lower limits.
1 Schneider, E. 'C.: A Cardiovascular Rating as a Measure of Physical
Fatigue and Efficiency; J. A . M.A . 74: 1507 (May 29), 1920. • 9iampton: Proc. Soc. Exper. Biol. & Med. 12: 119, 1915.
553140-31--8 (113)
 114
The higher correlation of the former test with the fie<l. We would say from the point of view of the physical
official physical examination is due to the incorporation examination for flying that a score of 7 or less indicates a
of other well-known physiologic factore omitted from the physical condition that makes flying unsafe.
latter, namely, the pulse rate increase after exercise and The manner in w.hich the 200 cases were distributed is
the time required for the pulse rate to return to normal. shown in Table 52.
Whereas Crampton rates a man on his pulse rate, increase
on standing, and the difference between the systolic pres- TABLE 52.-Distribution of 200 cases examinedfor flying.
sures of the reclining and standing postures, Schneider
rates the man on his reclining pulse rate, standing rate.
pulse rate increase on.standing, increase in the pulse rate I~ - - Number or CS§es.

after exercise, time required for the pulse rate to return to :Qualified. DiJ2~~1i- Total.

\---1 ---0 ---1

normal after exercis_e, and the difference -between systolic
pressures of the reclining and standing positions.
The major portion of the disqualifications were made
Sch~t~~~~-_i-~-~-~~-'.-..-.-..-.-..-.-..-.-..-.-..-.-..-..
on neuropsychiatry fin<lings, such as increased psycho- 17.. .. . .. . . • . . • . . . . . . . . . . . . . . . . .. . . • 5 0 5
16.... .... ......... ... . . . . . . . . . . . . . . . 10 0 10
motor tension, prolonged secondary diiatation of the 15. .. . . . .. . . . • . . . . . . . . . . . .•. . . . . . . . . 16 0 16
14 . ... . .. . . . . . . . .. . .. . .. . . . . . . . . . . . . 16 -0 16
pupils, relaxed peripheral circulation, tics and tremors. 13 .. . ..... ······ •·· · ···· · ·· · ···· ·· ·• 26 0 26
It is the opinion of the neuropsychiatry department that 12.-... ........... . ••. .. . . ; .. . .•. .. . . 12 0 12
11. .. •.• .. ... . . . . . . . .. . . . . . . . . . .• . .. . 13 2 15
these signs are manifestations of fatigue and that three of 10 .... ·· · ·· · · · ··· · · · · · · · ·· · · · · · ····· 19 0 19
9 . .. . . . . . .. .... •. . • . •. .... . . ·• ••·. . 13 0 13
these appearing together give a sufficie.nt reason for a tem- 8 ..... ... .. . • .... . .. •.• ..... . . .-. . . . . 18 2 20
porary disqualification. It is an interesting fact to note 7 .. .. . ... . .. . . . . . . . . . .. . . . . . . . . . . . . 5 7 12
6 . . . .•••. ····• · •· · • • · · • · ·•• ••• • ••• · 2 9 1L
that these symptoms are often associated with exagger- 5·. ····· · ···················-···· ·· · · 0 7 7
ated responses of the ci.rculatory system to exercise and 4 . . . · · · ·· · ···· ·· · · ······ · · ····· · ··· 0 6 6
3 .. ·· ·· · ········ · · ··· · ·· · ··· · ·· · · · · 0 5 5
postural changes of the body. Wit.lJ.._ a Schneider index 2 ... · ······· · ·· ······· ··· ··· ···· ··· 0 2 2
1. .. · ···· · · ···· · ·· · ········ ·· ·· · · ·· 0 3 3
score of 7 or less, we can safely predict that at least-three of 0............................... .... 0 0 0
the neurologicsigns will be found by a competent examiner. -1. ..... . ············ · · · · ···· · · •· ·· · 0 0 0
-2 . .. ·· ·· ·· ·· · · · ··· · ··· ·· ······ . . ... 0 1 1
"It is readily seen that a s1.--ore of 7 is the dividing line Total ... . .... ..... .. .. , .. . .. . .. . 156 44 200
of those qualified and. disqualified. Of those with an index
of 8, 18 were qualified aqd 2 disqualified; on the other h,i,nd';
of those with an index of 7, 5 were qualified and 7 <lisquali-

TABLE 53- Effects of physical exercise.

~I t ·
I!~
.;, i:l Blood
0

Name. Date. """" .""

'3 :.~
.,-o
.; .,.:
~
i~ +->"' i:l - --
pressure,
systolic.
~ Comment.
~~
°;··$

!i
o;- ~
... ~ ~ ~;; .ci ih.. 'C1.
p::
i
P-1 P-1
·a""'
.... i
P-1
"'3 cl ~a g g.9 .S.9
P-1 P-1 p:: P-1 p::
i:lbO .9

~
"'
00
i i;..
- - - - - - - --- - - -- ---
Lt. E ....... 7/31/19 96 1 99 1 3 1 117 1 80 2 116 - 114 0 6 Disqualifi!i<J; diagnosed as staleness by neuropsychia-
try; sent to recreational camp. .
9/23/19 - 80 ll 90 2 10 3 108 2 80 2 124 126 2 13 Returned from camp; found normal.
Lt.W . ..... 12/10/19 93 1 111 0 18 0 123 1 60 3 120 118 0 3 Disqualified by neuropsychiatry; long office hours li
12/31/19 98 1 105 1 18 1 114 1 45 3 116 124 3 10 A t : s·
e of 2 hours daily; improvement found.
Pvt. B ..... 11/29/19 75 2 87 2 12· 2 108 1 75 2 126 128 2 11 A few symptoms of staleness found by neuropsychiatry.
12/ 4/19 78 2- 93 1 15 2 114 0 60 3 114 112 0 8 Looding trucks for one _week.
12/ 6/19 84 1 87 2 3 2 129 1 25 3 124 102 1 6 Loafing since last time examined.
12/ 8/19 93 1 96 1 3 1 135 1 120 1 118 126 3 4 Gqard duty all night. .
2/ 2f}IJ 72 2 87 2 15 2 79 2 60 3 126 130 2 13. Ran 2i miles every morning before breakfast for 27 days;
fo~ualified br neuroEsychlatry.
Lt.M .. .. . . . l/12f}IJ 87 1 111 0 24 0 120 1 60 3 132 112 1 4 Disq · ed as sta eness y neuropsychiatry; indoor
work. .
lf}IJf}IJ 90 1 117 0 27 1 117 1 50 3 134 122 1 3 Continued .indoor work.
1/0f}IJ 90 1 123 0 27 2 126 1 132 120 1 1 Do.
7/ 6f}IJ 69 3 99 1 30 0 105 02 r 60
20 3 116 106 1 8 B ~ ~ g golf; outside work.
10/1Z'20 781 2 99 1 21 1 120 0 60 3 122 130 3 10 Q · found; outdoor work.
~

To show the advantage of a test that will measure the to the fact that the 'Work was too strenuous for his condi-
degree of physical efficiency or fatigue, I present a few tion. Loafing did not help matters, nor did his all-night
c11Bes in the form of case reports in Table 53. Lieut. E. guard duty; but when h e was given his choice of any
and Lieut W. came back to a~erage physical condition form of physical exercise, he returned a month later in
as measured by the index in a comparatively ·short time, fairly good physical condition. The case of Lieut. M. is
the former by full-=time recreation, the latter by shorter worthy of thought, because it shows Jiow long it takes a
office hours and two hours of daily hiking. man to come ·back to normal after being out of condition
Pvt. B. is interesting, in that he had one week of out- for a long time.
door exercise, which lowered his index. This was due

PROTOCOLS.
LOSS OF S.LEEP PLUS EXCESSES.
Lieut. N.:
12/9/19; index 5; average of 2 hours' sleep for two
nights.
12/11/19; index 13; 8 hours' sleep.
Sergt. V.:
7/1/20; index 3; worked all night on airplane for Alaskan
trip.
7/3/20; index 10; had 8 hours' sleep.
A loss of sleep does produce a drop in the index
ACUTE INFECTIONS.
Capt. P.:
8/24/19; index 15; feeling normal.
10/9/19; index 7; acute rhinitis.
12/5/19; index 14; feeling normal.
12/17/19; index JS;· feeling normal.
Maj. T.:
8/7/19; index 7; diarrhea; feels weak.
8/23/19; index 14; feeling normal.
12/10/19; index 10; headache; 6 hours' sleep iast night. use with aviators and athletes, this is the best test so ·far
12/17/19; index 17; feeling normal.
HOSPITAL CASES.
Pvt L.:
1/12/20; index 5; diagnosis, Vincent's angina; fourth
day in hospital; not confined to bed; no rise of t~m-
perature.
2/25/20; index 10; throat better.
2/28/20; index 14; feeling normal.
3/8/20; index 7;- detailed on kitchen police duty for a
day.
3/9/20; index 10; removed from kitchen police yester-
day, because he complained of feeling weak.
3/15/20; index 7; feels normal.
3/20/20; index 6; feels normal; discharged from hospital.
Total number of days in hospital, 71.
Pvt. W.:
2/25/20; index O; diagnosis, unilateral tonsillitis.
2/27/20; index 3; temperature,.99 F,
3/2/20; index 14; patient up walking around.
3/3/20; index 13; complains of other tonsil feeling sore.
3/5/20; patient too sick to take index; other tonsil in-
fected.
3/9/20· index 4; patient confined to bed.
3/11/20; index 13; feels normal; walking around.
3/12/20; inde:ii: 17; discharged from hospital.
Total number of days in hospital, 17.
In the case of Pvt. L., the index was highest on the
fifty-first day of his stay in the hQspital, when his infection,
if not completely gone, was at a very low ebb. Kitchen
poiice duty produced a lower index, because the work
was too strenuous; he should have worked up to it gradu-
ally. His index was a little higher the next day, and then
gradually declined during the rest of his stay. It is rea-
sonable to assume that if this man had been given gradu-
115
ated exercises from the time his infection ceased he would
have left the hospital in good physical condition.
In the case of Pvt. W., the index rose rapidly after he
got rid of his toxins. This supports the opinion that a
person in good condition can repel a disease better and
recuperate more quickly than a man in poor condition.
Incidentally, lwill cite a case in support of the value of
daily systematic exercise, which is applicable alike to
civilians and aviators. Last year in preparation for the
transcontinental airplane flight, 25 aviators flew in from
other flying fields and were given the index from one to
two hours·after landing. With the exception of one man,
they all showed effects of fatigue. .The average index was
9. This one man made a score of 17. In taking the usual
history as to how many hours sleep, amount of exercise,
etc., we found that this man devoted a little time each
day to systematic exercise.
SUMMARY AND SUGGESTIONS.
_Schneider's testdoes not supplant, but should be used
in conjunction with a through physical examination. For
offered for measuring physical efficiency and fatigue.
The practitioner of preventive medicine, and physical
director, of schools and colleges will find this test a valu-
able aid in determining the amount of exerciEe necessary
.for physical fitness in each individual ca.Ee. There )]lay
be overtraining and undertraining of an individual.
Although we find that a score of ·7 or less is an indication
of improper functioning of the neurocirculatory apparatus,
we believe that a man who can only make a score of 9
should b!l given a thorough physical examination to
detennine whether his condition is due to ·diEeaEe or to
insufficient exercirn.
The conditions that we find that lower the. index are
aviation fatigue, loss of sleep, lack of physical exercise,
alcoholic and Eexual excesses, and acute infections.
We have encountered ·two conditions in which this test
or any other test baEed on pulse rate will not reveal the
true condition of the man. Bradycardia on account of the
low pulse rate gives a better rating than the condition
warrants, and those who are disturbed psychically by a
physical examination will get a lower rating than they
deserve on account. pf high pulse rate. But the latter
condition can be allayed by a tactful nurse or physician.
The_index gives the true condition at the time of the
test. When it comes to qualifying or disqualifying an
aviator for flying, or to determining the amount of exerciEe
needed by an athlete, it is best to determine the index on
three succe:!Bive days. If the man has not lost sleep or
dissipated, his index will not vary more than 1 point.
The reason for not relying on one index is that one may be
getting his average physical condition plus loss of sleep
or dissipation.
(By courtesy of the Journal of the American Medical
Association.)
A SPHYGMOGRAPHIC STUDY OF THE PULSE DURING THE REBREATHER
TEST.
By N. C. GILBERT, Chicago, Ill., and CHARLES W. GREENE, Columbia, Mo.

In the examination of candidates to be placed upon a
flying status and in the reexamination of aviators, it has
occasionally happened that sufficient weight has been given
to the occurrence of irregularities in the pulse to disqualify
the subject for a flying status, or to give him a lower rating
than that to which he would otherwise be entitled. Some
apprehension has also been expressed in regard to the de-
velopment of arrhythmias at lowered oxygen tension.
The work in this paper was to determine what, if any,
were the effects of lowered oxygen tension upon the rhythm
The subjects were all given a preliminary physical ex-
a,mination before the low-oxygen test was made. The
test was made on the type of rebreathing apparatus in use
in the. United States Army for the examination and classi-
fication of aviators. This apparatus has been fully de.-
scribed elsewhere (1). In the test by the rebreather
method the respiratory system of the subject is p~rt of a
closed circuit of known capacity, so that as oxygen is con-
sumed at llach respiration a lowered percentage results in
the air chamber from which the subject breathes, the ex-

FIG. 1i0.-A typical responsff to lowered oxygen tension during a rebreather test. S. Systolic
pressure. D. Diastolic pressure. R. Pulse rate. The broken line shows the respiration in
decilitres per minute; the straight unbroken liue the oxygen p ercentage.

of the heart, as determined by means of the sphygmo-
graph. The tests were done at the Medical Research
Laboratory of the Air Service, at Hazelhurst Field, Min-
eola, Long Island, N . Y. The subjects were for the most
part aviators appearing for discharge, after va~ying periods
of service. These were supplemented by a few from the
laboratory perso:'l.Ilel. In a body of men of as carefully
selected physical type as found in the Air Service, our
work W.11,B necessarily confi.ned to subjects with very nor-
mal cardiovascular mechanisms.
(116)
pired air is freed of carbon. dioxide by passing through a
sodium hydrate cartridge on its return to the air chamber,
the oxygen percentage is estimated from the air remaining
in the tank at the close of the test, and from this the oxygen
is estimated . A Mackenzie ink polygraph was attached to
the left arm of the subject. Tracings were taken for one
minute duration at five-minute intervals, or in about one-
half of the cases taken almost continuously, periodic inter-
ruptions being necessary to adjust the instrument follow-
ing movements of the subject, and to permit the taking of
 117
Roentgenograms for cooperative work done by Majs. Tur-
rell and Lewald (2) to show the variations in size of the
heart under decreased oxygen percentage.
The pulse rate and the systolic and diastolic pressures ·
were taken at 2-minute intervals for the first 15 minutes,
and subsequently every minute. The respiration was
recorded by means of a spirometer, and the minute volume
of air estimated in decilitres, as desoribed elsewhere (3).
EXPERIMENTAL RESULTS.
The reaction of the pulse .rate to decreased oxygen ten-
sion has been described by Maj. Schneider (4) and by the
writers in preceding paper of this series (5). The present
work has brought nothing new in that relation, except
where the _rate was taken almost continuously by means of
a polygraph, the increase in rate showed an evenly-rising
curve, without the periodic variations in rate observed in
curves plotted from the rate as estimated by taking the
pulse at the wrist for 20-second periods each minute.
In general, there was a slight ani very gradual increase
in rate until the latter part of the test. As tl;le oxygen
want was more acutely felt, a marked acceleration began,
and increased 813 the test progressed. A terminal fall in
rate occurred in i<ix cases. The mechansim and signifi-
cance of this fall h813 been considered by us in another
paper, based upon an electrographic study of the pulse
during the rebreather test (5).
The systolic and diastolic pressures followed the same
general course as described by Maj . Schneider. Figure
50 shows sypical curves of pulse rate, blood pressure, and
deciliters of air per minute.
Because of the lal"ge part played by mechanical factors,
it is not felt that any great stress can be placed on the
contour of pulse tracing or that any detailed attempt can
he made to correlate it with the pre~sure curve.
DICROTISM.
Dicrotism of varying degree was frquently· present
throughout the entire test, but bore no relation to the
efficiency of the caraiac response or to the altitude reached.
When not present at the beginning of the test, it frequently
appeared during the latter part of the test and 813 the s:-s-
tolic pressure rose. It was almost invariably present at the
last few minutes of the test,. when the syRtolic pressure
was elevated or rising and the peripheral resistance was
decreasing, as evidenced by a falling diastolic pressure and
a decrease in the intensity of the second aortic tone.
:!'he increase of dicrotism with increased pulse pressure
gives further evidence that a dicrotic pulse is not clini-
cally of a decreased pulse tension or a lowered cardiac
response, a view that one occasionally hears~ressed.
The degree of dicrotis increases (a) with increased ar-
terial tension, (b) with decreased peripheral resistance.
As stated by Mackenzie (6), "The presence of a dicrotic
wave is evidence of the retention of an important amount
of arterial tension.'' When the cardiac response decrea£es,
the dicrotic wave disappears. (Fig. 51.)
Hyperdicrotism appeared under identical conditions
when the pulse accelerated during the dicrotic pulse.
Hyperdicrotism is under these conditions a direct func-
tion of the rate, as shown bv Mackenzie. This is illusc
trated in the tracing in ffg~e 52, where it tends t~ dis-
appear as the pulse ebows in expiration. The presence
or absence of diocrotism did not correlate in any way with
the final result, as expressed in altitude reached.
Traube-Hering waves appeared in several cases during
the second half of the test, becoming more pronounced
as the test progressed, and disappearing as the -respira-
FIG. 51.-(a) '!'racing at '1:1 minutes, showing dicrotism. Subject
responding well. (b) Tracing taken just as subject was taken off of
test because of impending unconsciousness. Dicrotic wave has
disappeared.
tion returned to normal after itsconclusion(Fig. 53). Ina
few instances they were present throughout the test, but
increased in height.as the test progressed and the respir-
atory response increased. They had no bearing upon
the altitude reached. Mayer curves, reported in cases of
asphyxia, were not observed.
FIG. 52.-Dicrotic waves become hyperdicrotic as pulse accelerates
during inspiration, at 17 minutes.
SINUS ARRHYTHMIA.
· Allofthe81subjectsonwhomtracingsweretakenshowe:i
some degree of sinus arrhythmia, both before and during
the entire test (Fig. 54). The difference in length between
the longest and shortest beats in a given period, measured
in hundredths of a second, was taken as an index of the
FIG. 53.-Traube-hering waves.
degree of the sinus arrhythmia during that period. This
was measured in the prelimin11,ry tracing before the test
and at five-minute intervals during .the test, an:d charted
with the pulse rate at the corresponding period.
FIG. 54.-Sho.wing_sinus arrhythmia at 8 minutes.
Of 73 cases thus charted, 41, or 56 per cent, showed
an increase in sinus arrh)'ihmia as the respiratory response
increa.sed in the earlier portion of the test. This increase
in the degree of the sinus arrhythmia continued while
the heart was accelerating moderately, but as the pulse
acc~lerated -more markedly in the latter part of the test
the degree of sinus arrhythmia decreased to about its
initial value or less. There was no fixed rate at which
this decrease began, and in different individuals it was
found at different rates between 62 and 96.
 118
In 15 cases there was a decrease in the degree of sinus 66, one at 17 minutes, with a rate of 69, and one at 20
arrhythmia upon the commencement of the test, and a minutes, with a rate of 76. The pulse accelerated to 94,
further decrease in degree as the test progreBBed and the with no further ectopic beats.
rate ar:celerated. In 14 cases there was ·no change in the The other cases are showll in the following tables,
degree of the sinus arrhythmia until the pulse accelerated where the premature· ventricular contractions are givell in
in the latter part of the test, when the degree decreased . percentages, with the time at which they occurred. The
In two. cases t;here was an increase in the degree of sinus preliminary tracing before the test is indicated by "Pr.,"
arrhythmia .in the first part . of the test, and no further and the time at which the tracing was taken when the
change. In one of these (Case 12) the increase waa slight, premature ventricula- contractions were observed is indi-
and the pulse did not accelerate beyond a rate of 75. The cated. The incidence of ithe premature ventricular con-
other (Case 74) .also showed' a slight increase in the degree tractions is expre&:1ed as the percentage of the total number
of sinus arrhythmia, with a rapid pulse rate throughout of beats for the period observed. "Off" indicates the ter-
the test, beginning at 104 and finishing the test with a mination of-the test, after which another tracing was taken
rate of 116. O.ne case only showed no change in the during the recovery period. ·
degree of sinus arrhythmia at all (Case 45), but in this-
case the pulse rate did not accelerate over 70 at any time TABLE 54.
during the test.
In general, then, sinus arrhythmia showed a tendency
Per cent Per cent
to increase ,as the respiratory response increaBed, due prtima- prema-
Time. ture ven- Pulse tureven- Pulse
presumably to effects operating on the vagal mechanism. tricular rate. Time. trlcular rate.
This was followed by a decrease in the degree of sinus: contrac- . contrac-
ti<ms. tl9ns.
arrhythmia as the pulse accelerated in the latkir part of the
test. Insomeinstances, observed during the routine exami- Lt. N .: Lt. L.: ')
nation of aviators, before the present series was run, seriee of Pr.... 2 70 Pr.... 11.1 57 )
5. . .. . 3 71 5.. .... 12 70
10.... 4 70 · 10..... 11.6 68
18 . . ··' 2 78 15..... 12, 71 .68
24 .'... 1 82 20..... 9._8 75.
28. .. . . 2 88 25..... 12 90
~ff::: .....~ ...........~. ~ff:::: ......9~ ........ ~~--
33.... 0 M .. 33 ..... · 56
FJO. 55.-Showing a few slightly alternating beats just before the test Sgt. S.: Sgt. W.:
was terminated at -30 minutes, because of impending unconsci1>us. Pr.... 9.4 61 Pr.... 4.6 74
6:30... 0 66 3...... 50 84
ness. 8..... 21.5 65 7...... 50 84
12.... 1. 25 80 11-..... liO 90
sinus arrhythmia were seen so marked aa to present a very 18. : .. 0 80 18..... 45.3 86
22.... 0 92 24..... "41. 6 88 -
irregular pulse, where the respiratory phases were difficult 25.... 1-.4 102 ZT..... 21.6 93
27.... 0 108 28 ... :, 0 102 -
or impossible to detect and where there was a possibil1ty Off ..-..... , ......... ·...... 211 .. _.. 20.5 98 )(
of . confusion with a more serious arrhythmia. In all 32.... 13. 8 72
I
these cases the arrhythmia improved or disappeared as
higher altitudes were reached and the pulse rate acceler-
Sgt. W. was the only· case showing any oardi~ pathol-
ated. ogy. He gave a history of tonsillitis yearly, usually two
The appearance and character of the sinus arrhythmia
or three attacks each year, until .April, 1918, when a ton-
were checked against the altitude reached, the minute
sillectomy was performed while in the Army. Since this
volume of respiration, respiratory irregularities, and the
time he has felt much better, and has gained 15 pounds
depth of respiration, but all _without any apparent correla- in weight. He had influenza. in France in December,
tion.
1918. He has had at no time any symptoms referable to
PREMATURE VENTRiCULAR CONTRACTIONS. the heart. The heart was found to be slightly enlarged
on physical examination. There was a presystolic thrill
Premature ventricular _contractions were observed in and murmur at the apex, with an accentuated mitral first
only two aviators before taking the rebreather test, out tone and an accentuated· pulmonic second. Extra sys-
of a total of 78 on whom graphic records were obtained toles were present at examination for entrance into the
with the polygraph, or about 2.6 per cent. Both were Army, and later while in service he was referred to a
normal men without any demonstrable cardiac pathology, special board -because of them, 1:iut was passed for duty.
and each maq.e a normal response to lowered oxygen ten- In this case the premature ventricular systoles reappeared
sion. Four others showed one or more premature contrac- a~ 28:40, and were still present at 29:30, when the test was
tions during the test. In addition, three men from the terminated by unconsciousness.
laboratory personnel who were known to have frequent Capt. 0 . of the laboratory personnel, showed2.2 per cent
premature ventricular contractions volunteered to take of premature ventricular contractions in the preliminary
the test. Of the aviat-0n< who developed premature tracing before the test, at a rate of 60, and at all times when
ventricular contractions during the test, one showed one previously examined has shown the same ectopic beats, in
such beat only at 12 minutes, with a pulse of 64, one at 12 varying degrees of frequency. With the beginning of the
minutes, with a pulse rate of 90, and one showed one test they disappeared at a rate of 75, and only one such
interpolated beat after the conclusion of the test, with a beat was found during the test, at 8 minutes, at a rate of 84.
pulse rate of 84. The other subject showed one premature We had a similar experience with Capt. 0. during a
ventricul_a r contraction beat at 12 minutes, with a rate of test in an electrocardiographic series, yet to be reported.
 119
From the cases shown it will be observed that there is
a tendency for the incidence of the premature ventricular
contractions t.o increase as the tei,c progresses and the re-
spirat.ory response increases, but only in the earlier periods
of the test, as the. pulse accelerates the incidence decreases,
and they finally disappear. Th'e exception of Sgt. W., in
whose caae there was reason to assume a pathological basis.
In a series of several hundred cases given the official low-
oxygen test from October 4, 1918, to May 7, 1919, where one
of us either examined the cases personally or was in imme- ·
diate touch with the examination through his associates,
no case of ectopic beats was observed in which the extra
systoles· did not disappear before the termination of the
rebreather test.
It is not felt that premature ventricular contractions
are of -themselves of pathological significance. They tend
to disappear as the heart ·responds in rate to the increased .
demands upon it, and as the nonrefractory ·period is de-
creased is redu.ce<l by this increase in rate, just as in eX:er-
cise. Prematwe ventricular contractions should not of
themselves be a ·basis for rejection in examination .for a
flying status or used as a basis .for a lowered rating in the
classification. That such extrl!, systoles have little influ-
ence in reducing the mechanical efficiency of thJ he.art
has been recently shown experimently by Eyester and
Swarthout (7).
PULSUS ALTERNANS.
Pulsus alternans was watched for with especial care, and
more particularly just before the test was terminated be-
cause of impending unconsciousness, when there might be
reason to expect that the heart rate was out of proportion
to its strength. In one case a few alternating beats were
observed at a rate o{ 95. :The difference in height of the
waves is very slight, as shown in the accompanying fig-
ures, (fig. 56) . One other case was observed. The phys-
.iqlogist taking the blood pressure at one-minute intervals
in all of the routine cases examined had an,. excellent op-
portunity t.o detect alternation of the pulse, and the fact
that cases have not been ob's erved at any time in taking
~·m: 53.-Showing sinus arrhythmia at 8 minutes .
the pulse and · systolic pressure would indicate that it is
a rare phenomen at best.
The writers wish to make acknowledgment to Lieut.
Col. L. H. Bauer, officer in charge of the Medical Rtisearch
1''m. 57.-Showlng a fe N slightly alternating beats just beforethetes
was terminated at 30 minutes, because.of impending unconsciousness,
Laboratory, for his cooperation and assistance, and to Capt.
Britten and Capt. Powers for taking many of the tracings.
(By courtesy of "The Archives of Internal Medicine.")
LITERATURE.
l. Henderson, Yandell, and Seibert;, E . G.: Jo~n.A. M. A.
1918, 71, 1382.
2. Larsen. .
3. Schneider, Edward C.: Journ. A. M. A. 1918, 71, 1382.
4. Greene, O. W.,. and Gilbert, N: C.
5. Mackenzie, James: "The Study of the Pulse." New
York, 1902. .
6,. Eyster, ,J . A. E., and Swarthout, Edith C:: Arch. Int.
Med. 1920, 25, 317. .

. .

Pulse rate and the 'degree of sinus arrhythm_ia, in the preliminary tracing, in the four quarters of the test, at the
point of termination uf the test, and in the :recovery period.

Rate. Sinus arrhythmia.

No. Age. Per
cent. Time.

~ ,_ 1 _ . _ ~ _ 3_. _ _ _4_. _ ~ ~ ~ - 1-· - ~ - 3---~~,~

1 26 6.8 72 74 82 86 84 78 63 22 36 38 38 . 36 ,40 25
15 ·········
2
3 ... 2f ....ii:a" 84
63
90
78
76
76
82
. 78
99
82 94
60 75
63
05
10
25
20
.25
40
25
40 15
15
10
10 •.·
20
31 . • ..
4 ... 30. 62 66 66 75 75 90 57 25 25 40 20 10 05 20 30
5 ····1:4· 67 72 82 87 108 1\2 60 20 15 15 10 05 02 20 28:15
50
6
7
8
25
21
23
6.9
7.2
5.\1
57
58
74
70
65
82
68
68
80
68
68
84
90
74
102
78
90 ~ ... . - .
56
75
·78
25
25
15
25
30
20
30
20
60
40
10
:1 .... os·
05
10
20
60
40
20
30
39:18
Z1
.9
IO ·····
- 24· ... T2· 72
84
72
84
81
88
81
88
90
90
108
96
84
-84 .
25
20
25
25
25
25
15
25
10
20 IO
20 Z1
15 ......... .
11 ...... . 60- 75 78 96 120 ··· ···· 66 25 30 35 15' 05 ··· 20 .. 31.....
12 · ····- · ·
.......... '66 72 66 75 ....96. 60 05 15 20 20 . ...····
...
.. .. io· .... 05. 25
13 ······ ....ii:a' 66 66 81 84 84 72 40 35 40 20 20 Zl:30
1' ···24· 72 84 84 87 96 105 90 10 15 20 10 10 20 28
15 22 IO.!! 66 96 96 108 25 10 10 .... io'
16 23 IO. 5 78 84 80 84 ... io2'. ....... 84
84 2(j 23 . 25 20
05
-····· ·
20
20
23:50
24
17
18
Z1 6. 7 81
72
75
54
90
72
96
78
108
102
.... 00. 7.8
66
35
20
30
20
20 10 10
-05 .. .. os· 40
55
25
35:Z'/
19 ... is" .... s:2· 30 20
20
21
Z1
22
6.5
8. 5
63
66
69
67
66
70
69
69
72
65
81
72
65
84
78
81
102
84
60
72
72
45
20
10
45
20
10
50
20
10
60
35
IO
45
20
10
~I
05
30
40
10
36
28
30:45
22 23 11. 9 75 75 75 78 84 15 69 . 20 25' 20 20 20 10
23 25 6.3' 72 68 78 78 81 1.02 84 05 25 25 10 05 00 20 31
24 23 6.2 70 71 78 82 88 96 56 40 40 40 40 25 05 40 30
2a 25 7.8 78 78 81 90 gg 105 90 20 20 15 10 00 00 25
26 29 8.4 74 90 81 87 93 96 90 35 30 ,35 25. 25 15 20 26
Z1 28 11.4 87 ·78 84 90 90 66 56 25 2.5 lC 10 10 30 22
28
Z1
28
29
26
22
24
Z1
7.9
7. 7
7.5
7.2
66
68
86
62 :1
102
86
78
76
96
86
68
80
87
66
93
108
90
78
110
ll4
J20
8'
90
74
84 '
60
25
25
20
20
30
20
25
20
40
20
30
20
40
15
30
20
10
05
10
10
00
05
05
10
25
20
20
20
32:55
32:11
' 30:14 ·
34:17
 120
TABLE 56.
Pulse rate and the degree of sinus arrhythmia, in the preliminary tracing, at five-minute intervals during the
test, at the p<1int of termination of the test, and in the recovery period.

Rate. Sinus arrhythmia.

No. Age. c!;~. Time.
Pr. 7. 12. I 17. 22. 27. I 32. T. R. Pr. 7. f 12. 17. 22. 27. 32. T. R.

32 30 10. 4 52 54 56 58 56 54 j _- -- - - 51 50 25 35 30 15 20 35 - - - - - . 35 40 29:20
33 21 7. 8 80 88 90 90 90 891 - ----- 110 84 20 25 15 10 IQ 10 - - - - -- 05 20 31 .
34 22 6. 7 90 78 88 92 100 102 108 130 68 25 20 25 15 10 05 00 00 40 31:48
~ ~ - g 1i ~ ___ 80___ ~ ~! ~ :::::: ;:g : ~g20 25~ --·lio- :35 :20 ---20- ::::: : rn :840 -30:i5--
37 24 5_2 14 16 82 87 96 108 128 15 10 ______ 05 34,05
~
40
---23-
40
~j ;i r? : ~: ~6
5.8 63 88 90 82 88
94
s4
·--80- ---84-
110 110
~t ~ ?g ?g ig ~i
84 25 20 15 20 10
00
-·-io·
oo oo
·-·ao- ~ ~
20
~rg~
32
41 27 8. 9 78 86 90 80 98 - 75- 30 30 20 25 10
43
42 34
31
13.1
11.6
86
60
88
66
90 • __
__ - · 10
__ --·-:: :·:-::
:::: __:::: __ _:_:__
·--!io-
60
90
60
10
25
10
20
oo ____________ :::::: :::::: ---oo·
20 ______ ______ _____ _ 20
---io-
20
-ii·----
44 25 9. 1 72 72 ---78 78 84 oo ----- · ______ 75 10 25 ---20- 35 20 o5 ----·- --·-- - 30 27:30

~
47 22
~! ~:6.2
:84 rn~
78
ii~81 1i~78 --~~- --~~~- :::::: --~~~-
96 ----·- ·-----
1
96
:66 ~10 :10 ~~ I ~20 ---~- ---~~- :::::: ---~~-
JO -----· -----· 10
~g ~1
20 29 1
48 24 6.8 86 78 84 96 102 120 -·----- ---•-- 88 25 10 10 05 - 20 27
"<.V
49 ··- ··· -·---·- 60 63 64 66 86 96 -···-- 116 66 50 30 30 25 35 -·-40- ::::: . """io" 45
50 ... . . . -·-- - ·- 62 63 64 68 72 82 ·--··- 90 62 40 45 40 45 35 25 --·-·- 20 30
~i :::::: ::::::: : : i! : i~ ··iii-:::::: 1i~ 1: ~g ~ ~ ii ii ·--oo· :::::: gg ~ ~= 15
53 84 ------ --·- ·· JOO ·60 55 60. 60 I 30 ----·· ------ 50
:i -36:26--
68 68 72' 72 45 10 25:20
~ :::::: ::::::: : ii ~ ~ rs ---87° :::::: I~ ~ ~ f:l ~g : gg -- -20' ·- ---· gg
56 --·-·-· -·-···- 66
~ :::::: ::::::: : I ~
72 69 78
: i'fi ·-;~-
: ::_::: ::::::: : ii ~: : : --·84· ---00- 1~ -~ ?a ig ~g
·-;~f
20
~ ::::~~:::::::--;if
20 25
~
10 --·--- - ··- -- : :::: : ---··- --- -·- _,_: ___ _
i~ ig ---~~- :::::: ~ ~ ;f!~
ro ~ ·--20- ---20· ig ~ ~:55
61 ··---- -·•·- -- 102 90 !02 JOO U4 114 126 126 96 20 20 20 15 15 10 00 00 20 32:25
62 - ----· · - ----- 70 76 76 76 84 9.3 ·---·- 93 66 30 20 20 20 20 10 ·-·--· 0~ 20 30
63 ---··- ··--- · - 70 72 72 74 7S 96 ---··- 96 90 20 20 20 20 15 15 ---··- 10 20 29
64 ··--·- ·-- --·- 72 84 84 90 94 90 --···- 90 66 15 20 20 20 20 20 ----·- 20 20 34
~ :::::: ::::::: :84
67 ______ _______
~
90
~! 84 --- --- ------ ------ ·-- ---
·--oo· ---oo- ··i0'2- :::::: --i02-
~
12
:
10
___ :<!_
20 ____ __
: ~i ____ .. ------ ------ --···- 30rn
zs ··-io- ·--oo· :::::: ···oo·
~
'IT
6S --··-- ----·-- 80 82 84 90 102 --- -·- · · · ·- - -····· 78 20 20 20 20 10 ··-·-- ··- -·· ··-·- - 20 29:40
69 ··-··· - ·· -·- · 104 102 ····-·· 116 -····· ····-- ··-·-- -·-·- ------ 15 20 -··-·· 20 -- ----· -- --- - ------ ------ ------ ------·-
78 --·--· -- - - ---
71 -··--- ------ -
66 ------ ------ -·---·
96 96 100 96
84
108
--·---
114
--··-· 102
126 ------ 102
84 35 ·----- ---·-- --·---
15 15 15 10
10
10 r~ -32:23--
-·-or ··-oo- ---~~-
~ : : : : : : : * ~ ; e 5J--~~:---~:- --;:- ---~-
72 -·---- --·--·· 78 90 90 90 84
1
-··--- ------ 102 96 30

~
20 20

: ! ~
20 25

1; :::~~: :::~: ; ··-=- -:;::--1

10 -·-- - - 10 30 ··· · ·-··
 The following article supplements the preceding article.

BLOOD PRESSURE AND ELECTROCARDIOGRAPHIC CHANGES IN THE DOG DURING

EXTREME OXYGEN WANT.
By CHAS. W. GREENE and N . C. 0ILB.ERT.

Before the last annual meeting we reported cases of may mean a lower origin of beat, then became reversed
marked changes in the electrocardiograms of normal young and finally disappeared. The terminal reversed beats
men taking the rebreather test for low oxygen. These gave progressively longer R-P intervals indicative of
showed a shift in the point of origin of the beat and in the diminishing rate of conduction. In this man the ventric-
character of conduction through the Purkinje system. Iri ular complexes were all of normal type until recovery.
extreme cases the P wave entirely disappeared along with We have used dogs under the rebreather test, wit):i re-·
a marked slowing of the rate but with retention of the spiratory, blood pressure·, and electrocadiographic records
normal ventricular type of complex . We concluded then to determine if possible the nature of the mechanism
that the P wave was absent, not buried in the ventricular through which the slow rhythm and dissociated beats were
complex. Wilson has shown that under certain ci.l!cum- induced. Dogs give precriskresponses pel'fectly compar-
stances the electrocardiogram gives no evidence of the P able to those observed in man. At the breaking point and
wave, while the venogram shows the presence of the auric- in the postcrisis there occur in rapid order, but overlapping
ular contractions occurring simultaneously with the ven- in time, decrease in oxygen consumption, slowing and
tricular contractions. Two instances were reported by us stopping of respiration, fail in blood pressure, slowing of
showing great disturbances of the conduction with com- the heart rate. In a typkal case the slowing was from 156
plete dissociation. · to 44 per minute and less by more or less abrupt steps.
We report now an extreme case in which the details The electrocardiogram changes from the.normal sequen-
shown by the electrocardiogram are more concise. Lieut. tial type through various stages showing inverted and sup-
A. was tested to 7.1 per cent oxygen, 28,000 feet elevation; pressed P waves, shortened P-R intervals, stages of partial
gave normal circulatory and respiratory compensating re- or complete block,sometimes reversed rhythm; and ectopi-
sponseB in the precrisis period. At the crisis the heart beats. ·
rate was 136 peT minute and respiration more than doubled If when the changes are advanced the vagus nerves are·
the minute volume. The following changes in cardiac cut in succession, then partial recovery occurs when the
physiology appeared in rapid succession in a.n interval of first vagus is cut, either right or left, and compleie·recovery
a.bout 28 seconds: (a) The blood pressure sharply and when the second vagus is cut. The heart a.t once beats in
abruptly fell with nerve muscle collapse ending in uncon- rapid rhythm and with normal sequential beats. In con-
sciousness; (b) the heart rate dropped from 136 to 44 per tinued asphyxiation the normal beats progressively slow
minute; (c} the chanies shown in the electrocardiogram in rate and stop after three or four .µiinutes. At any time
a.re: First inversion of the P wave, then reversal to the post . during the postcrisis two or three brea.th,i of normal air are
R position with ventricle-auricle sequence, and finally dia- followed by quick recovery.
appearance of the P wave altogether. Conduction measured (By courtesy of the American J ourna.l of Physiology.)
by the P-R interval decre&Bed at first by 10 per cent, which
(121)
A STUDY OF THE INFLUENCE OF VARIOUS CIRCULATORY CONDITIONS ON
THE REACTION TO THE LOW OXYGEN OF REBREATHING.
By EDWARD C. SCHNEIDER and DOROTHY TRUESDELL, Depq,rt:ment of Physiology , Medical Research Laboratory, Air
· Service, U.S. Army.
The altitude classification examination (1) as applied in
the Air Service of the ·u . S. Army is somewhat elaborate
-and long. The desirability of having some simple test
that could be easily applied as a substitute for such an
examination is self-evident. That available simple re-
spiratory tests do not serve such a purpose has been proven
in a recent statistical study (2). · We have now attempted·
to determine whether certain circulatory factors.do or do
not influence the ability of compensating to thelow oxy-
_gen of the altitude clllBllification rebreathing experiment,.
in which 52.liters of air are rebreathed · until the subject
becomes inefficient beC1J.11se of the reduction in oxygen.
Many of the aviators who have been given the rebreath-
ing test have first been subjected to circulatory o~rva-
tions in which the pulse rate and arterial pressures were
determined in the reclining, standing, and . sitting pos-
tures, immediately after a standard exercise, .and again
two minutes later. With these postural circulatory data
as a basis for choice, we have selected froni 2,000 men 10
groups of cases. These groups included men with unu:
sually high and low systolic arterial pressm:es, high and
low diastolic pressures, large and small . pulse pressures,
rapid and slow p_ulse rates, and men in. whom the systplic
pressure rose and others in which it fell in the standing
position. A tota,l of 554 cases . w11:5 included in these
special ex"minations.
· For each of these lO groups we have determined the
character of the response to low oxygen by calculating the
mean value for pulse rate and arterial pressures for each of
the preliminary observations and for 11 pt>rcentages of
oxygen during the rebreathing test. From the means so
established we have plotted the curve for each factor 11,nd
have assembled the results for ea<;h pair of groups in a
sin_gle chart in order to facilitate comparisons.
The groups have also been cqmpared with respect to the
mean respiration- volumes at the beginning and end of the
experiment. This ought· to bring out any group differ-
ences that may be prese11t in the respiratory compe"Q.sa-
tions.
LOW AND IDGH SYSTOLIC PRESSURE.
It is genetally recognized that the systolic blood pres-
sure is a measure of vascular and heart strain. There also
is reason to believe that for each person a certain sy$lic
blood pressure is the optimum for the .efficiency of circula-
tion and the adequate supply of nutriment and oxygen to
the tissues. If it be assumed tl).at the average blood pres-
sure of a large group of men represents the optimUDi, then
men with a preBl!ure much above or ·below this may repre-
(122)
sent an abno~al and detrimental condition. A high sys~
tolic pressure has 9ften been associated with danger of nip-
ture of the blood vessels and with heart strain. A low
systolic pressure may mean that the nutriment supply. to
the tissues is inadequate. In view of these possibilities
we have selected for special study from the group of 2,000
men all cases, ·26 in number, in which the systolic pres-
sure in the .reclining posture was 98 mm. or less- and 40
cases .in which the reclining pressure was 138 mm. or more.
Some df,Jviation from the average or normal was present ·
in both groups. (See tables 56 and 57 for each of the sev-
eral_ circulatory factors here considered.) · The group se-
lected because all of the members had a systolic arterial
blood pressure below the average (table 56) had a heart
Nte about four beats less than the average, a systolic pr~s-
sure at least 14 mm., a diastolic pressure·approximately 9
mm., and a pulse pressure approximately 7 mm. below the
average. These differences were maintained with only
slight variations throughout the compensation to the low
oxygen of the rebreathing experiment. The groµp thai
had a high arterial systolic'pressure (table- 57) was above
the average in all factol"!!-"-the pulse rate about 11 beats,
the .systolic pres&ure about 25 mm., diastolic pressure 3
mm., and the pulse pressure 23 mm; They also showed a
disposition to maintain the high condition tJiroughout.all
experiences, such as changes in posture and in the com-
pensatio11, to low oxygen.
A suggestion that there was. a difference in the nervous
s~bility of the two groups is found in the psychic responses
that were still evident during the third minute of the
rebreathing. The members of the low systolic pressu,re
· group showed in the pulse rate, systolic pressure, and
pulse pressure a Biilaller psychic increase than the members
of the high systolic group. This. i'ncreaae was in the pulse
rate, three beats for the low and eight for the high systoli<!;
or the systolic pressure, 6 mm. in the low and 13 mm. in
the high ; for. the pulse pressure, 2 mm. in the low and 10
mm. in the high. The diastolic pressure-differences were
not signifi<;.ant, the low group having an average increase
of 3-and the high 2 mm.
The compensations to the low oxygen of rebreatliing
appeared to be equally good in each of these groups. The
graphic presentation of the compensatory changes as shown
in figure 58 reveals several differences in the reactioll8 of
the two groups. Toward the end of the rebreathing period
there occurred .in the .diastolic pressure a more rapid and
greater fall for the members of the high than for those of
the low systolic group. The difference is beet seen at 8
per cent oxygen when the diastolic· pr~e had fli.Ilen
 123
15.5 mm. for the former and only 5. mm. for the latter. In mm. at three minutes and 113 mm. at 8 per cent oxygen.
the high group the systolic pressures down to 8 per cent The group with the high systolic pressure showed the
oxygen showed a. gradual fall, it dropping from 157 mm. largest inc:rease in the pulse pressure; at 8 per cent oxygen
at three minutes to 147 mm. at 8 per cent, while in the low i! was 16.3 mm. as against 9.2 mm. for the low group.
group the systolic pressure maintained a level, being 114

5Y!>TOt..tC

&------- I ~Y5TOLIC li1c;H

'PuL 5 E Ji. SYHOL1C Lov<

I------
ll• ..• •. .•• ••• •••••.• ~-
"'PuLSC hf. ~5UR(
r -··-··-··-··- · ·

1'0
Sr- - _
, . ..:.,
SI-..:.-- - '
, __
/WJ

.
1zo

/01
~. ·- - - -- - - - - - --
,:, ~
"'
'

fo
.
"iy,
7~ ~ -
~# - -· , ...-..- ••
,1

?i"'if-.o-._ • . , . . , . - · - · - · - · - · - ,,
.

Fm. 58.-Comparison of high and low systolic groups.

TABLE 56.-Systolic low.

Pulse. Systolic._ -Diastolic. ·Pulse pressure.

Num-
ber of
cases. M. Pem. M. Pem. M. Pem. M. Pem.
- - - - - - - - - - - - - -- - -- - - - - - -

if=~:::::::::::: :::::
26 68.3 1.495 96.2 0.47 61.2 1.03 33.2 0.937
26 89.2 1.33 101.1 . 74 71.5 .918 28.9 1.065
26 96. 7 1.595 106.9 1.31 70.6 . 75 35.5 1. 542
Rest ................ . ..... 26 81. 3 1. 89a 100 .847 69. 1 1.145 30 1.401
Before rebreathlng ... . .. • . 26 79.2 1. 716 108.3 1.058 73.2 .864 36.3 • 90.5
3 minutes on rebreather . . -. 26 82.2 1.836 114.2 1. 05 76.5 . 781 38. 6 1.037
18 per cent ........... . .... 26 82.4 1. 78 114. 9 1.198 75.1 • 741 38.9 1.123
15 per cent . ............... 26 83 1. 818 113.7 1.229 76 .966 37.5 1.306
13 per cent ..... , ........... 26 84.8 1. 715 115.5 1.131 74 .928 39. 7 1.108
12 pen~ent .. .•.• . ••••• .• c. 26 87.5 1.625 116 1. 037 75. 1 .858 41.'7 1.099
11 per cent .. .. .. .......... 26 90 1.696 115. 7. 1.191 74 .92 42.9 1.856
lOpercent ................. 25 92. 3 1.659 115. !! 1.099 73.6 1.05 42. 4 1. 253
llpercent ...·...... .. .. .. ,. 25 96.1 1. '723 11s:1 1.169 71.8 1.029 42.6 1. 338
8 per cent . ................ 22 102.4 2.037 113.1 1.577 68. 2 1.429 45.5 1,528
117. l .976 73. 7 1.884 44 1.441
U:t :.~::::::::::::::::: 26
7 98.2
101.3
2.585
1.925 111.2 1. 545 63.1 1. 38 44 1,328

I First off .. ................ . 26 83.2 1.847 104..7 1.246 64.2 1.15-3 40.8 1.269
 124
TABLE 57 .-Systolic high.

Pulse. Systolic. Diastolic. Pulse pressure.

I
Num-
berof I
cases. M. Pem. M. Pem. M:. Pem. M. Pem.
- - - - - - - -- --- --- --- --- - -----
Reclining ... . ..... ... .. . ... .. . . ...... 40 SUI l.Z8 143.9 0.561 79. 2 1.048 65:8 1.0
Standing . . . .......... ... ...... .. ..... 40 96.6 1.328 146.3 l.013 86.3 1.158 60.6 1.115
Exercise .... . . ........ ... . . . . .... . ... 40 107.4 1.358 154.5 1.06 82.l 1.296 73.9 1 . 18
Rest .............. .. .......... ... .... 40 90.6 1.385 143.'3 . 672 85.9 1. 071 58.3 . 97
Before rebreathing . .. .... .. . .... . .... 40 91. 7 1.356 145.8 .868 85.9 1.089 60. 5 .891
3 min. on rebreatber ..... . . . . . . . . . . ... 40 99 . 4 1. 77 157.3 1.078 67. 6 1.4Q3 70. 6 1 .52
18 per cent . .... •. .. ..... . .. ... ...... . 40 98. 9 1. 76 156 . 759 87.6 1.37 69.4 1.339
15 per cent ...... ... .... , .......... ·... 40 98.5 J.591 154.3 1.005 87.2 1.322 67.8 J.241
13 per ce!).t . .... . . . .. .. .. . . .. . . .•. ..... 40 100. 9 1.551 153. 7 1.022 86. 3 1.311 67.6 f.178
12 percent ........................... 40 103.4 1.665 152. 7 1. 012 85. 3 1.305 68.3 J.23
11 percent ..... ............ ..... . .... 40 105 1.604 152.4 1.098 83. 9 1.499 69. 3 1.46
lOper cent ..... . .. • ... . ......•....... 40 ·109. 1 1.592 152.8 . 948 82.3 1.41 71. 2 1.434
9percent ...... . .. . . ....... . . • . .. .... 37 113.9 1.552 180. 5 1.124 76. 4 l.69 75 1. 678
8 per cent.. ...... . ..... . . .. .... .. ..... 33 117.6 1.622 146. 7 1.422 70.4 1.998 76.8 1.833
7 per cent . .... . ... .. ........... ..• . . . 12 118.3 2. 799 154 3.132 72. 7 2.684 82 3. 72
Last on • . ...... . ........... . . . . .. ... . 40 120.4 1.675 145. 2 1.89 64.8 1.985 82.6 2.101
First off . . ............ .. ... . ....... ... 40 95 . 3 1. 781 1, 719
I 137.6 67.5 1. 76 70.8 1.801

A comparison of the compensatory curves for these two
groups with the normal curves of reaction presented in our
earlier paper (3) shows that the compensatory reactions
followed the usual course in all factors except the arterial
systolic preBBure. In the nonfainting type of response a
slight or ·moderate rise in the systolic preBBure .occurs
during 'the last six or eight minute.~. In neither of these
two selected groups. waa the rise usually present. Seven,
17.5 per cent,.of the 40 men with a high systolic pressure
showed a terminal systolic preBBure rise of from 2 to 10 mm;
while there were eight, 32.5 per cent, of the group of 26
cases of low systolic preBBure who showed a slight rise
toward the end. As a rule, men with a high systolic
pressure make the compensations to low oxygen without
further increasing the vascular strain by a compensatory
rise. To prevent such an increase there occurs a greater
vaso dilatation than ordinary, as is evidenced by the
diastolic pressure fall.
The percentage of oxygen at which the men became
inefficient or fainted has been tabulated in Table 58.
TABLE 58.
Low systolic pressure group.
Failed
at- Num- Per Off by Off by Num- l Per Off by Off by
ber of cent of er.I;;.
.cJ,in- ber of cent of
cases. cases. gist. 1cian. cases. cases. gist. 1C1an.
10. 9-lO... 1 3. 9 .. _.... 1 . . . . . . . . • . . . . . . . . •• . . . . . . . . . .
per cent, of the fainting type; while among those with a
high systolic preBBure 11, or 27.5 per cent, be1.onged to the
nonfainting and 29, or 72.5 per cent, to the fainting type.
Here again it is evident that the systolic pressure does
not determine what type .of reaction will be made to low
oxygen.
There were only two men in whom.the systolic preBBure
remained at 100 mm. 9r less during the entire rebreathing
experiment. fhey compensated to 7.4 l!,Ild 7.9 per cent
of oxygen, respectively. The lowe"Bt systolic preBBure
observed in a seated subject was 93 mm., and this man
reached 7.4 per cent oxygen. Two men with the systolic
pressure constantly above 160 mm. compensated to 6 and
7.7 per cent oxygen.
The question of increased strain has been further con-
sidered . Prior to the beginning of rebreathing, as the men
were seated before the machine, the E1ystolic pressures of the
40 with high systolic ranged from 134 to 160 mm. As has
been shown, only seven of the group showed a final ter-
minal rise, while they all showed some degree of psychic
rise, which was maintained in part by the majority of the
cases. So it might be assumed that the pressures met by
the heart were extraordinary in some men. In this
High systolic pressure group.
group the laat determinations of the systolic pressui'e
taken just before rebreathing was stopped ranged between
llO and 182 mm. The highest pre.'lStlres were as follows:
J:~r;;. _c),in- 160-169 mm., 3 cases; :i.70-179 mm., 5 cases; and 184 nup..,
1 case. The man with a final pressure of 184 mm. went to
exactly 6 per cent oxygen. He was 26 years old, and his

fff ···· ~r .... T

9. 9-9 . .. . . o 3 7 5 3 preBBure was not above 170 mm. until the last four minutes.
f.tL::: 1~ ... 2f ~g 11 lg The oldest man in thiti group had just passed 32 years.
6.9-5.8 . . . _ _1___26_
. 9___1__
· ·_··_··_· _ _
12___3_~_ __10___ _2 The pressures observed in this group ought to be tolerated
Total. 26 100.0 22 4 40 100. 0 22 18 for short periods of time without injury to the heart and
blood veBBels of young men. The· 40 cases here discussed
From these data it is evident that the height of the were the only ones out of 2,000 men that showed a uni-
arterial systolic pressure does not give an indication of how . formly high pressure throughout all observations.
well a mart may compensate to low oxygen. Approxi- The evidence considered does not indicate that the
mately an equal percentage of men with a low and a high circulatory mechanism is subjected to inordinate strain
systolic pressure went down to leBB than 8 per cent of under'the conditions of rebreathing used in the Air Service
oxygen. altitude classification examination. Furthermore, it ap-
The members of each group have been classified as to pears that the low systolic pressures here considered suf-
whether they belonged to the fainting or nonfainting type fice to keep the brain as well supplied with metabolism
of reactors. Among those having a low systolic preBBure necessities during the conditions of the low oxygen of re-
9, or 34.6 per cent, were of the nonfainting and 17, or 65.4 breathing as do higher systolic preBBures.

LOW AND IDGH DIASTOLIC PRESSURE.
The diastolic pressure, in that it is a measure of periph-
era.I resistance to the circulation, is commonly regarded as
an index of vasomotor tone. During rebreathing in most
men the vascular resistance gradually decreases from
about 13 per cent of oxygen to the limit of low oxygen
toleration. Often, as shown in__earlier papers, the vaso-
motor center is so overpowered by oxygen want that the ·
resistance decreases very rapidly, thus causing fainting.
We became interested in other phases .of the diastolic
pressure, in the influence of unusually low and high dias-
tolic pressures on the toleration of low oxygen. It is
SY ST OLIC
I- - --------
Ji - - - - - - -
,. __ ___
'"·- - - - -
'"PUL '::IL PRt S~RE.
.:t - · · - ·· - · · -· -- · ·
=· -•- •-• · o- •
/1,o
/'lo
Ji',
Sr - -
;~
/00
80
~.-
bo
~
D
z
011,..._.,.o:___..,.;;:.::...._......__,,,__....,...._____......______....___~-~----_....._____,,,
Fm. 59.-Comparison of high and low diastolic groups.
recognized that the diastolic pressure supplies the force
that fills the coronary arteries. There must, therefore,
be a critical pr€8Sure below which the heart will suffer
from the lack of an adequate supply of oxygen and nutri-
menui. It appeared that in men who normally had a low
diastolic pressure the toleration of the low oxygen of re-
breathing might be less adequate and lend to early failure
because of the ·direct action of oxygen want on the heart.
We have, therefore, selected for comparison two groups
of a few cases of low and high diastolic pressures. For
the low diastolic group the reclining posture pressure
ranged between 40 and 56 mm., in standing between 48
and 60 mm.; for the high group it ranged between 90 and
98 reclining, and 90 to 110 mm. standing.
125
The mean or average circulatory reactions for these two
groups have been plotted in the curves of figure 59. The
means and probable errors are given in Tables 59 and 60.
It will be observed that the pulse rate curves are close
together, both slightly higher than the average, but show
the usual and normal response to the low oxygen. Also
the pulse pressure curves are nearly· the same and about
that of out nonfainting group. The pulse presslJie chan_ges
during rebreathing also follow the usual course. By se-
lecting cases of low and high diastolic pressure, we obtain
two gtoups of wide difference- in the systolic pressure·.
The low diastolic group (see TabJe 59) showed a systolic
pressure 12 to 20 mm. below the average and the high
I DIA'i>TOLIC HIG~
]I DIR'STOLIC LO'-
Sr
,,
DI
7,
rli: ····· • · • •·· · · · ·
/
_.,, --- ::- ..
/
-·· "
11
·- ·- --·- ·-;=·:=·:=~ ~~
/l
"
..
T,,.,E OF R UN IN M,,...,r£ :s
diastolic groJ!p (see Table 60) a systolic pressure 18 to 26
mm. above the average. So by these s.elections we again
bring into contrast the reaction of low and · high systolic
pressures. The low diastolic pressure group, however,
had a diastolic pressure, as much as 15 to 18 mm. lower
than our low systolic group.
There appears to be no ouuitanding difference in the
reaction of the two groups to low oxygen of rebreathing.
Failures from the development of the fainting reaction
were more-common among the men having a high than
among those with a ·low diastolic pressure. For the six
cases with a low diastolic pressure the final oxygen was
8.3, 8.1, 7.6, 7.4, 7.1, and 7 per cent, respectively. None
failed u,nusually early nor tolerated to an extremely low
 126
oxygen. Five of the men were removed by the psycholo-
gist at the appearance of complete mental inefficiency.
It appears then that, as a rule, the higher brain centers
suffered from oxygen want before the circulatory centers
were much affected. This fact also shows that the low
diastolic pressure here observed does not jeopardize
heart function. The failure in these cases, as appears to
he the ca!je in a large proportion of men, was due to the
action of low oxygen on the cortica.l centers of the brain.
I

--1-~,
TABLE 59.-Dwtolj,c-Low.

Pulse. Systolic. Diastolic. Pulse 'pressure.

, - - - - - - - - ~ - - -- --,-- - ~
Number
of cases. -I -

Pero.
l- - - - - , - - -

~ Pero.
1

~ Pero. _ _M_._
-1

Pero.

Reclining. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 77 2. 061 101. 3 1. 642 52 1. 533 52 1 1. 682

Standing. . . .. .. . . .... .......... ..... . 6 98 3. 319 104 · 2. 975 56 1. 099 44 2. 619
Exercise .. . . . ..... . ... . ...... .. .... : . 6 · 104 3. 699 109. 3 2. 668 54. 5 1. 169 54. 5 1. 598
Best. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 85 2. 061 99. 3 1. 938 56. 7 1. 534 44 2. 118
B efore rebreathing . . . . . . . . . . . . . . . . . . . 6 85 2. 969 102. 5 2: 493 57. 3 1. 068 48. 7 2. 931
3 minutes on rebreather. . . . . • . . . . . . . . 6 95 3. 453 110. 7 2. 82 58 1. 382 54. 7 3. 941
18 per cent.......... . ............ . . .. 6 95. 5 3. 719 110 2. 819 58. 7 1. 219 52. 7 4. 059
15 per cent... . .................... . .. 6 96. 5 3. 311 110 2. 591 58 • 868 52 3. 299
13 per cent • 6 98 2.. 671 108 2. 688 57. 3 . 795 50. 7 3. 207
12 per cent::::::::.:::: :::: :: : ::~ :::: ·5 100 2. 593 108, 7 2. 648 57-3 . 819 52. 7 3.382
11 per cent. . . . .. . . . . . . .. . . . . . . . . . . . . . 6 101. 5 3. 209 110 2. 668 56 L 098 56. 7 3. 729
10 per cent-. ........ . . ...... ... . ...... 6 105. 5 2. 299 110 2. 674 54. 5 1. 338 56 3. 589
9 per cent . . .. ... .. . •... .... . . : . . . . . . . 6 112 2. 665 109. 3 3. 392 52. 7 2. 231 57. 3 4. 249
8percent ............. ..... .. .. . ..... 4 117 2.462 115.1 5.557 51.l 2215 64 7.725
Last on .... ... . .... . . . ..... . . .. . . ....
First off..... . . . . . . . . . . . . . . . . . . . . . . . . .
·6
6
114. 5
86
I
7 per cent . . . ... .-: ... . . .. .... . ... .... .... . ....... ... . •. •. . . . . . ..... . .. . .. .. . . ...... .. . , ............. . ................. .
2. 837
2. 129
104. 7
100
5. 435 44
3. 591 _ 46. 5 · 2. 491
1. 68 · 60. 7
52. 7
5. 662
1. 847

TABLE 60.-Diastolic-High.

Pulse. Systolic. Diastolic. Pulse pressure.

Number
of cases.
M. P ero. M. Pero. M. Pero. M. Pero.
I
------ --------- --- - -- ---
10 82.5 I 2. 622 126 2,135 90. 8 1.428 38 1.538
~~Jfnt:::::: :::::::: :::::::::::::
Exercise . .....•.... .•.....•..... .....
10
10
100. 2
113.4
3.039
3.56
134. 4
142
1. 532
2.982
98.4
98
l . 278
1. 439
36.8
45. 2
1. 415
2.375
Rest .•. . .... .. ... .. .. . . . .. . . ......... 10 96.6 3. 521 128 1.618 97. 2 1.372 36.8 1.263
Before rebreathing : ... . . ... .. . ....... 10 92. l 2.1 145.6 1.49 94. 8 1.378 52 , 1.423
3 minutes on rebreather .. .... . .... , . . 10 97. 8 2.61 156.4 2.16 102 1. 536 55.6 1.998
18 per cent ....... . .. . ................ 10 '97.5 2.564 155. 6 2. 168 102 1. 388 54.4 1. 565
15 per cent.·. .... ... ......... . .. . ..... 10 98. 7 2.652 156. 4 2.429 102.4 1. 518 55.2 2. 571
13 per cent . .... ••.. . . .. .••.. .... • ... . 10 100. & 2.462 156.6 2.457 101. 2 1. 138 54 1. 757
12 per cent .... . ••.. . . . ... . •... . .••... 10 102. 9 2.482 158.4 1. 955 99.2 1.467 58 1. 712
11 per cent.:......................... 10 103. 5 2. 764 155.6 2.36 99.2 1. 365 57. 2 1.668
10 per cent. .. ....... . .. ....... . _. ... . 10 lQS.9 2.842 153.6 2. 76 -97.6 1. 478 57. 2 2.635
9 pe, cent ......•.......• . .... . . ..... . 9 111. 7 3..548 l.55.6 1. 958 92 1.609 64.9 1. 8(\8
8 per cent . ..... ...... ........... . .... 7 111 l. 293 154.3 2.295 89. 7 2.022 65. 7 2.022
7 per cent ........... . ................ 5 118. 8 2.185 153.6 3.115 82.4 3.115 71. 2 2.892
Last on .......... . .....•......... : .. . 1(} 120. 9 2.97 154. 8 2.019 81. 2 1.945 76 1. 763
First off .. ... . .. . .. . . .. . . ... . . ...... : . 10 102. 9 5.075 .142.8 3.432 85.6 1. 913 59.6 2. 931

The case with the lowest disatolic pressure throughout
the test.had a pressure of 50 mm. in the Preliminaries, and
it did not rise above 52 mm. during rebreathing and was
only' 40 mm. at the end, 8.1 per cent oxygen. In the
case that tolerated to i per cent oxygen the diastolic
pressure in the preliminaries was 58 mm.; this was main-
tained until toward the end of the test, when it gradually
dropped to 48 mm.
Among the high diastolic pressure group there were three
cases in which the pressure-exceeded 100 mm ..· In one, in
whom the preliminaries were 103 nim., the pressure rose
to 113 during the first half of the period of rehreathing,
then gradually fell to 100 mm. to end, 6.3 per cent oxygen.
In the second case the diastolic pressure rose from 103 to
108 mm, during the first 10 minutes -of the test, then slowly
fell to 88 mm. This man tolerated to only 8.5 per cent
oxygen. The third m_a n had a pressure of 100 mm. at the
start, which increased to 108 mm., then slowly -decreased
to 98 mm. until the last minute, when it dropped to 78 mm.
He had to be restpred. to fresh air at 8.1 per cent oxygen.
A comparison of the five special cases just cited shows that
no advantage in the response to low oxygen is obtained by
either a high or low dia,stolic pressure and that in neither
will-the reaction be Jniformly or unusually poor.
LOW AND HIGH PULSE PRESSURE.
Another circulatory measure of the nutritive supply to
the tissues is the pulrn pressure. It appeared probable
that in case of a low pulse p:r:essur.e the brain, as well as
other tissues, might be more quickly affected by the
decrease in the oxygen of the rebreathing experiment
than when the pulse pressure is high. We have, therefore,
Eelected 14 cases with the lowest and 19 with the highest
pulse pressure for a comparison of the rebreathing test
reactions. In the low -g roup the pulse pressure for the
reclining posture ranged between 26 and 32 mm., in
standing between 20 and 28 mm., and for the high group
between 62 and 84 for both postures.
The typic;d picture of the response of each of th_ese two
groups to the rebreathing test has been determined by
calculating the means for 11 percentages of oxygen.
These data are given in tables 61 and 62 and have been
 127
plott.ed in figure 60. The mean pulse rate was a little average, while that of the high group was between 4 and
above average and almost the same for each group, and the 10 mm. below the average. The compeilsatory diastolic
responses ran parallel until 12 per cent oxygen was reached, pressure fall during the latter part of the rebreathing
after which down to 8 per cent those with high pulse pres- period was largest in. the high group. This greater dias-
sure showed a greater increase in the rate of heart beat than tolic fall, along with a better maintaining of the systolic
those with the low. The mean systolic pressure of the low · pressure, gave a greater pulse press1,1.re compensation for
group (see table 61) was about 6 mm. below, while that the high than the low group. In all groups with a high
of the high group (see table 62) waB from ·18 to 28 mm. systolic pressure (see figures 58, 59, and 60) the diastolic
above the average.- These differences were maintained pressure fall under the influence of low oxygen haa been
throughout the rebreathing period. The mean diastolic found to be greater than among men having a lower
pressure of the low group· was that \letermined to be the systolic pressure.

SYSTOLIC.
I.----------
.:ii. _ _ _ _ _ _ _

I -PULS[ ·--P'f\t':i~URE HIGH

r _IJIR5TOLlt
__ _
" - - = - - --
"f>ULS[
·------
ll ; . . . . . ... . ... .... . . . .
'PULS[ r!RE:iSURE
:I-··--·--·-··-· ·
'IC ·- ·- ·-·-·-·

I l,O

- _.... - Si
----- - - -- -- --- --
SI-----""
,.
IZ --- ,,

ID

,,
-----·-'-·-·----~-
zo
?PI-.,
•--...._ .---·-·-··- _.,,,,,.• / ,9

TIME. OF "R"'"' ' fN N .1NVT£S.

Flo. 60.-Com_parison of high and low pulse pressure groups.

TABLE 61.-Pulse pres,ure-Low.

Pulse. Systolic. Diastolic. Pulse pressure.

Number, _ _ _ _ __ , _ _
of cases.
~ - - - 1--- -- -- ,------,
M. Pem. M. Pem. M. Pein. M •. Pem.
l - - ' - ' - - - - - - - - - - - - -1-- - - - - - -- - - - - - - - - - ----1-----l----
Reclining .... . . . ... .,_... .. ... .... . . .. 14 119. 6 1.405 101; 7 1.455 77. t 4.62 31.4' 0.253
Standing..... .. . .. ..... . .. . .. . . . . .. .. H 92.1 2.,!2 109.4' 1.111 8".6 1.36 25.1 .505
Exercise. . . . . ... ... . . . . .. .... .. . .. ... H 102.6 2.028 113. 4' 1.077 85.1 · 1.~ 30 . 529
Rest ... . .... ... . .. .. . .. ..... . ... . . ; .. H 88.3 2.27 107.1 1.285 84- ).307 24.9 .78
Beforerebreathing .... . .. . . . . . .,..... H 87.i 1.981 113. 7 1.686 79.t 1. 7« 34.6 .845
3 minutes on rebreather. ...... . . . ... . 14 93 1. M 124. 11 1. 791 85.1 1. 602 4'1.1 1. 07
18percelitt ...... . ..... . . . . . ... .. . . ... H
H 93 8
95. 2.6"6
2. 32 122.6
121.4' .1.603
1,316 83.7
8". 3 1.668
1.6 311.14'
37; 1.062
1.111

!lilrpe:~r.~c;it:_:. :. :_ :. :.:.·:_:.:_:_:_ :. :. :. :_:.:. :.. :. :.:_.:. :_.:· :·:·

_
f!
14
::n u:. m:~
101.8, 2.H2 122.6·
tk- ::~
1.482
81.4
t~
1. 78 n.• t~
:J 1.68
lOpercent.. .. ..... . . . . . .. ... . .. ... .. 14 lOli. 2 2.,1,!2 120. 6 1.633 80.6 1.909 .0.6 ~-
9percent. . . . .. . .. .. .. ... ... .. . . . . ... 14 100.3. 2. 568 118.9 1.986 78 1.886 ,!2 £508
8pereent... . . . .. . ..... .. ........... . 12 113 2.µ62 117 2.'305 72. 3 1.652 "5, 7 ·
u:~~~:::::::::::::::::::::::::::: ..... ir· .. iiiT ..ii:aii··· ··iio:9·· ··if ......10:r· .. flif
Firstoff_..... . . . .... . . . . . ....... . ..... H 89.8 1.917 106.9 1.994 68.3 ·
··-:t:f ··fl~·-
 128
TABLE 62.-P11.lse pressure-High.

~1
Pulse. Systolic. Diastolic. Pulse pressure.
Numbert--- ~- - 1- - -- - - 1- - - ~- - ,- - - - -- -1
,-~ - - - - - -- - ---,-o_r_cas_
· _es_. ~ Pem. Pem. ~ Pem. ~ Pem.

Rec!inirig.. .. . . . . . . . . . .. . . . . . . . . . . . .. 19 19. 7 1. 76 141. 5 1. 067 68.4 1.169 71.6 1.022

Standing.. .. .. .... . . .. . . . .. . .. ... .. .. 19 93.3 2. 10 144 1.392 71.8 1.301 70.3 1: 12:i--
ExerciSe. . ... .. .. . ... . . . . . . . . . . . . .. . . · 19 105. 9 2. 222 149. 7 1. 338 ll6. 9 1. 375 81.1 1.151
Rest . ........... . ..... . . '., . .... . .... . 19 92.2 2. 672 141. 5 1.097 14. 5 1.166 65. 9 1.26
l;leforerebreathing .. , . .... . .. . . .. . . : . 19 85.4 2. 081 139. 8 1.277 77. 1 1. 185 ti3.8 . 839
3minutesonrebreather. .. .. . . . .. . .. . 19 92.1 2. 451 151. 8 1.768 78. 1 1.48.: 74. 7 2. 23
1:~:~~:t::::::::::::::::::::::::::
13percent .. . . . . . . . . . .·..... ..... .... .
1i
19
iu g:
95.2
2.273
11i:i
147.4
U~
1.41
~t ~
77. 3
UM
1.287
~J 1.573
Ut8
70. 5
12percen(... .. , •. .. . .• . . . . . . . . . . . . .. 19 96.9 2.5 147. 8 l.467 76.6 1.141 71.8 1.674
llpercent.... . . . ... . ......... . . .... . 19 99. 6 2.37 146.1 2.04 73. 3 ·1.332 73.5 1.97
lOpercent...... . . . ..... . .... . .. . .... 19 103.6 2.72 145.9 1.99 72.6 1. 648 73.5 2.354
~~=~~:L:::::::::::::::::::::::::: 11 g:;· 9 u~ 4
1:~· tm 1
~:1 t~ :u tm
u:u~~::::::::::::::::::::::::::::
F iratoff ............ . , .... . .... .. . . ....
1i
19
1~·
90. 2
uig
2.756
}!g t~
132.2 2.454
~.l
59. 8
t~ 1.963
~.6
73.5
tm
2. 60Jl

In final oxygen .reached there were 36.9 per cent of all gained by high pulse preBBure, neither does a low pulse
CllBeB of the high pulse pressure group that went to 7 per · pressure appear to be disadvantageous. The cortical
cent Qr leBB, while in the low group Qilly 14.3 per cent went centers of voluntary attention and coordination remain as
as iow in oxygen. Nevertheless, it is found that when the efficient under low .oxygen in men with a low as with a
individual. cases are considered no clear advantage is high pulse preBBure.
h.e ld by the man with a low or a liigh pulse pressur_e. ·A
Relection is given below .of five. cases with the lowest and RAPID AND SLOW RATES OF HEART BEAT.
five with. the hig_hest pulse preBBure to illustrate this.
The ·numbers give the pulse pressures at regular i,ntervals On the -basis of the belief that a high heart rate indicates
. throughout the test. a poor physical condition and that men trained for mus-
1. 25-30-28-30-~8-2!i-30-32-36-30; final oxygen, 7.6 cular work, and therefore presumably physically fit, show
·per cent. a slow rate we selected two groups of men to determine
2. 28"'46-40-32-31-30--'32-:-36-32; final oxygen, 7.9 per what influence the heart rate has on the ability for com-
cent. pensating to low oxygen. One of the groups, with rapid
3. 31-36-cSS-36-38-37~33-32-40-52; final oxygen, 6.2 pulse, comprised 123. men whose rates were in the reclining
per cent. posture 87 and above and in the standing position 108
4. 31-42-38-36-40-40-38-44-46-62; final oxygen, i.9 and above. In the other group, with slow pulse, there
per cent.. were 95 men whose rates in tht: reclining posture were 60
5. 33-30-32-24-28-c30-30-36-34-32; final oxyg~J?,, 7.3 and less and when standing 75 and leBB. The circlllatory
per cent. reactions have been compared for the postures and for
1. 7~104-88-80-82- 82-92-108-112; final oxygen, 8.2 the compelll!ations to the low oxygen of rebreathing by a
per cent. study of ideal curves obtaine!l by calculating the arith-
2. 71-106-104-106-101-100-100-102-122-136; final oxy- metical mealll! and are given in tables 63 and 64, The
gen', 7.4 per cent. curves .plotted from these means are shown in figure '61.
3: 71-76-66-70-76-80- 72-80-96-88; final oxygen, 7.4 The blood preBBure postural and exercise changes as
per cent. .given in figure 61 show that the two groups react.in almost
4. 68-80-82-83-80-83-86-90-106-108-112; final oxygen, an identical manner and ·that selection on the b~ .of
6.9 per cent. pulse rate does not isolate groups that differ in vaso-
5. 67-70-69-67-62-64-65-64-68-70-74; final oxygen, 6.8 motor circulatory reactions. The respective systolic
per cent. pressures for the reclining, standing, and seated postures
The.first number in each case is in millimeters of pulse for the high pulse rate group were 118.2, 118, and 124.8
pressure for the subject when seated just before the re- , mm. and for the low 117.2, 120.8, anu 125.2 mm. The
breathing was begun. T!ie second number gives the pres- higher systolic preBBure for the seated position ·in each.
sure during the third minute of rebreathing and registers group is exp1ained by the fact that at the time · these
the psychic increase. The last four or five numbers bring determinations were made the subjects were seated before
out the low-oxygen e·ffect. the machine just ready to undergo the rebreathing test.
The . numbers of fainting 11,nd nonfainting t,Ype cases , Some psychic response is likely to be in evidence at the
were almost equally distributed in the two gi:oups. In ~e. The diastolic pressures were also almost identical
the low pulse pressure group 71.4 per cent gave the fainting for the two groups. T4ey were-for the reclining, standing,
and28.6percentthenonfaintingtypeo.frea.ction. Among and seated postures in the high pulse rate group 73.1,
the high group there were 68.4 per cent of the fainting and ·80.1, and 78.1 mm. and in the low 72.9, 80.5, and 79.6
31.6 per cent of nonfainting type. mm., respectivecy. ·
We may conclude from the available data that within The pulse rate changes of postw:e (see tables 63 and 64)
the limit.a of pulse pressures that were found in our cases, showed some group differences. The . respective mean
no material advantage in compensating to low o~ygen .is _ pulse rat.es for the reclining, standing, and' sitting pdBitions
 129
were in the high rate group 93, 116, and 99 and in the
slow 51, 70, and 73. There was an increase on standing of
23 beats for the first and only 13 for last. While sitting
just before the beginning o( rebreathing the high rate
group showed a slower rate than .when stat:\ding, while.
the slow rate group showed a rate a little more rapid than
that of the standing position. Thus, when seated, the
pulse rates for the two groups were more nearly the same
than for other postures.
Tlirou~hout the entire period of rebreathing the sys-
tolic, diastolic, and pulse pressure changes (see figure 61)
were almost identical for the two groups and quite like
that of the average run of cases, The pulse rate curves
are also similar but on different levels. When sitting,

5'1'5TOL\C.
:;. - - - - - - - - - -
.Ji. - - -- - - - I -PULS E H IG H
D I R'5TOl. \C.
,----
, ______
.a:-- - - - -

:Ji •••• • • • • •••• ••• • ••• . •

IT "PULSE L DvJ

°PllL'5£ "'PR[ M, \IR£.

1 - ··- ··-·· - ··- ··

/0
/60

/'lo
s,
s ._ =---= =-- - - - - - - - - - - =---=- - -- - - - -
/l o

/ 00

Ko

:;~ ~-==
..····· ·· ... .. ..····· _

Go
'?;: , •

,r

/9

Zo
zo

0 5 /0 I S"

FIG. 61.--Com parison of high and low pulse groups.

T ABLE 63.-Pulse- Rapid.

Pulse. Systolic. Diastolic. Pulse p r essure.

Number -
of cases.
M. Pem. M. Pem. M. Pem . M. Pem.
- -- - -- - -- - - - - ------ - - - --

151::::::::::::::::::::::::::::
123 93.4 0.392 118.2 o._661 73. l 0.6()t! 49. 3 0.68
123 115.5 . 442 118 • 739 80. l .635 41.6 . 707
123 123. l . 537 127.3 .828 78.6 .687 49. 4 . 834
Rest . .. .. ....... ...... . . . .. .. . . . .. ... 123 109.8 • 78 119.3 . 658 79.3 .605 41 .707
Before rebreathinj;- ....... . ....• . • .. . 123 98. 9 • 774 124. 8 .914 78. l .521 47. l .968
3 Min. on r ebreat er . . .......... . .... 123 104. 9 . 863 136.4 .933 82. l . 542 54.3 • 772
1~13 ~: ~:t :~::: :: :: :::: :::: :: ::::::-:
per cent . . . . .. . ............. . . . . .. .
123
123
123
105.3
105. 4
-107.2
.922
• 797
• 771
135.5
134. l
153. 9
. 938
. 866
.896
82.4
81. 9
81. 7
.554.
.564
.592
53.6
52.6
53.3
.757
. 689
• 712
12percent ......... ·- ··· · ···· · ······· 123 100. 5 • 746 134. 9 .874 80. 7 .559 56. 7 .695
11 per cent . .. .. .. .. .. .. . . ...... . .... . 123 111.3 . 795 134. 7 . 84· 79.5 .566 55.3 .697
10 per cent ... .. . . . . . . . . . ... ... . ··- . . • 121 114.8 .82 133. 5 . 929 77. 4 . 665 56. 4 • 739
~ E! ~:!::::: :: ::::: ::: :: :: :::::: :::
7percent ... . ....... ... .. ...... . .. ...
118
101
46
118.4
122.3
127. l
• 915
.992
1.675
132. 3
131.1
131,4 -
.962
1.128
1.699
74
69. 9
68. 2
• 696
• 733
1. 013
58. 9
62. 4
63. 7
l
• 721
l. 347
Last on ....... . . ...... . ... . . .. ... ~ . . • 123 122.8 1. 044. 125. l 1.226 63.5 .828 62: .986
First off . .. .. .. .. .. .. . . .. . . ... . ... ... . 123 102. 8 1. 012 121.5 1.,()56 66.1 . 801 55.6 .881
I
55314 0-31--9
 130
TABLE 64.-Pulse- Slow.

Numberi- ~
Pulse.
~ II
Systolic.
~i - ~
Diastolic.
~
Pulse pressure . I
of cases.

·1~
M. Pem. 1· M. Pem. M. Pem. M. Pem .

Reclining ............................ -~
Standing........... . .. . ........ ... .. . 95
~ 69. 6
o.247
. 342 120. 8
o..
. 751
~ ~ 80. 5
o.59
. 568
44. 5
41.1
o.623
. 699
Exercises.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 80. 1 . 591 : 126. 3 . 805 78. 2 • 644 49. 1 . 796
Rest . .. ... .. ....... . .....·.......... . . 95 66. 9 • 568 118. 7 • 646 79. 3 . 685 40: 1 . 66
Before rebreathing ... .. .... ... .... : . . 95 72. 9 . 629 125. 2 • 653 79. 6 . 557 45. 5 . 706
3 Min. on re breath ,r. . . . . . . . . . . . . . . . . 95 76. 3 . 822 134. 8 . 941 82. 6 . 581 51. 9 • 761
18 per cent ...... . ........... ·-. . ... .. 95 75.1 . 841 134. 5 • 965 83. 8 . 576 51. 6 . 801
15 per cent ........... . . . :.... . .. ..... 95 76. 9 . 769 134. 3 . 936 83. 3 . 564 51. 5 • 832
13 per cent. . . . . . . . . . . . . . . . . . . . . . . . . . . 95 78. 8 . 706 132. 5 • 690 82. 3 . 588 52. 2 . 752
12percent .. ... ..... .. ...... .. ... _... 95 81.6 .765 133.! .927 81.6 .591 51:1 .747
11 per cent.... ... ...... . .... .. ....... 95 83. 6 . 781. 133. l . 964 80. 9 . 597 52. 9 • 8ll
10 per cent. . . . . . . . . . . . . . . . . . . . . . . . . . . 95 88. 2 . 822 132. 9 • 987 79. 3 • 678 54. 3 • 785
9percent............................ 92 92.1 .864 13/.l 1.078 75.5 .7 57.6 .923
8 per cent 66 97. 8 1. 039 132. 2 1. 226 72 • 906 61. 4 1. 094
7 p , r cent:::::::: : :::: ::: :::::: : :::: : 35 100. 4 2.140 134. 6 1. 951 69. 4 1. fi03 56. 3 2. 044
Last on .... , .... .,............ ....... 95 97. 3 1. 203 126. 2 1. 375 63. 9 •.799 63. 2 1.13
First off. .. .. ......... ... ............. 95 75. 3 1. 005 120. 5 I. 154 68. 5 . 801 52. 5 1. 078

just prior to the commencement of rebreathing, the rate '.l'HE INFLUENCE OF POS'FURAL SYSTOUC PRES-
for the rapid pulse group was 99 and for the slow 73; at SURE CHANGES ON COMPENSATION TO LOW
9, 8, and 7 per cent of oxygen during the re breathing the in-. OXYGEN.
crea6e in the number of beats in the pulse .rate was for ihe
former 20, 23, and 28 and for the latter 19, 25, and 28 beats, Another seleetion of cases for special study was made
respectively. A more equal degree of response collld on the basis of the systolic arterial blood pressure changes
scarcely be expected orr any other basis of choosing cases. that occur with the taking of the reclining and standing
So far then as the curves of response are concerned, postures. Normally whe:q a man changes from the
the selection of men according to whether the heart rate reclining to the standing position the splanchnic vaEO-
is slow or rapid gives no differe)lce in the character of motor tone overcompensates the hydrostatic effects of
reaction to low oxygen. gravity, with the result that the sys.tolic blood pressure
An inqufry to determine how low in oxygen the mem- is higher in the st&nding than in the recumbent posture.
bers of each group went brings out an apparent advantage It is assumed that any influence which weakens the
in favor of the rapid pulse group. In this group 82 per splanchnic vasomctor mechaniem will also interfere with
cent of the men tolerated to less than 8 per cent oxygen, this compensa·tion. A systolic pressure fall on standing
while only 69.5 per cent with sl(?w pulse went as low. may then re3ult, and this is .regarded as evidence of
However, of those who tolerated to less tha~ 7 per cent physical weakness and .unfitness. lt was because of
oxygen the two groups showed equal proportions. There these opinions that a study of the possible influence of
were 46, or 37.4 per cent, of the first, and 35 cases; or 36.9 good and poor splanchnic vasomotor compensations on
per cent, of the second, who went below 7 per cent oxygen. the responses-to low o~ygen were studied.
A further inquiry was made concerning the number of The selection was made from 2,000 cases of such men
fainting and .nonfainting type cases in each group. The as showed a systolic arteriai pressure in the recumbent
prJportion of fainting type cases was higher in each group position within the limits of llO to 122 mm. Hg. Among
than in 300 unselected men, reported on in a former these were 104 men who showed a compensatory postural
paper, in which 46. 7 per cent belonged to the fainting rise of 12 mm. or more and 117 who showed a fall of 8 mm.
and 53.3 per cent to the nonfainting type. In the rapid and more. The two groups were studied by the same plan
pulse group 65.8 per cent were of the fainting and 34.2 followed for the other groups. These data appear in
per cent the nonfainting type. In the slow pulse group Tables 65 and 66.
there were 70 .5 per cent of the fainting and 29.5 per cent From the observations made prior to the rebreathing
of -the n onfainting type. Among·the first, over half of experiment, certain differences in the two groups are
the men , 56.8 per cent, showed the variety· of fainting seen to be,present. The mean rate for the reclining pulse
in which the systolic and diastolic pressures fell together, was about the same in each, being· 75.8 beats for the sys-
while in the second only 29.9 per cent gave this more tolic rise and 74 for the systolic fall group. On standing,
fapid type of fainting. In this latter group 58 per cent however, the mean increase in the pulse rates was only
of the fainters were of the variety in which the diastolic 13 beats for the former, while it was 23 for the latter.
pressure gives the first evidence of oncoming syncope. When the men were sitting quietly just before re breathing
The circulatory differences observed in the comparison the mean pulse rates for the two groups were again equal,
of these two groups of men, chosen because of the rate of 85.4 and 86,. respectively. Throughout the period of
the heart beat, ate not of such clear-cut importance as to rebreathing the pusle rates remained at approximately
indicate that the rate of the heart beat gives eviden~e of the same levels, but with that of the systolic rise group a
the manner in which the response will be- made nor of little more rapid and showed nearly the same amount of
the capacity of the individual to respond to the low compensatory increa.se throughout the decrease in the
exygen of the rebreathing experiment. oxygen.
 131
TABLE 65.- Systolic- Rise .

Nwnber
P~e. Systolic. Diastolic. I Pulse pressure. II

I
of cases.
M. Pem. M. i Pem. M. Pem. I M. i Pem ..
- - - - - -, - - - - ---1--
I
i~E~!::::::::::::::::: : : :::::::
Rest .. ... ....... .... ...... . ... . .. . .. .
104
104
104
104
75. 6
88. 8
102. 4
86. 1
o. 605
• 721
. 737
• 713
116. 5
131. 8
138. 1
124
o. 259
. 368
. 705
. 477
12. 2
83. 3
79. 3
83. 3
o. 566
. 587
. 636
. 539
44. o I o. 521
48. 7
59. 7
41. 2
. 558
. 844
• 629
Befo.re rebreathing ...•••....... . . . . : .
3 minutes on re breather ..... . .... .. .. .
104
104
85. 4
92
• 731
. 919
I 123.4
139. 4
.64
. 884
79. 6
85. 6
. 568
, 533
47. 8
54. 1
.67
. 671
rn13 E: ~:~!:::::::: :: :::::::: ·::'::: ::
per cent.: •............ . ...........
104
104
104
92. 2
92. 8
9c. 3
. 865
. 814
. 793
138. 6
137. 7
13s. 1
. 754
• 786
. 832
85. 8
84. 8
84. 1
• 552.
• 538
. 552
53. 2
53
53. s
. 639
. 651
.
111
12 per cent . ........... ... .... . ....... . 104 97 . 161 131. 6 • 852 83. e . 573 54. 3 I . 697
11 per cent ..... . .. . ... • . . ... . . . ... . .. 103 101. 2 . 86 137, 4 • 836 82. 5 . 539 55. 6 . 728
10 per cent .. . ......... .. ..... . ....... · 103 105. 3 . 876 137. 8 . 832 80. 2 . 589 57. 8 . . 468
9 per cent ......... . ........... . .... . . 102 1~. 4 . 913 135. 4 . 896 76. 4 . 633 60. 2 . 778
~E:~ ~:~t:: :::::::: :: :: :::::: :: :::::
Last on ... . . ..... . .................. .
88
.28
104
115. 5
119. 5
116. 3
1. 114
2. 11
1. 1
135. 8
136
132
1. 132
1. 617
1. 108
71. 4
65. 4
66. 7
. 796
1. 435
• 776
64. 3
66. 4
65. 6
. 76
1. 563
1. 009
First off .... . .. .. . ..••......... . .... .. 103 94 3 1. 348 121. 6 1. 236 66 • 815 56. 3 1. 06

TABLE 66 .-Systolic-Fall.

Pulse. Systolic. Diastolic. Pulse pressure.

Nwnber, _ _ _ _ _ _ _ ,_ _ _ _ _ _ _ , _ _ _ _ __ _ _ _ _ _ _ __
I 1

1_-
1
- -- - - -- - - - - -,, -o_f _ca_s-es_. - ~ Pein . ~ Pein. ~ I Pem. ~ Pem.

i~~!:::::::::~::::::::::::::::::
Rest ....... .... ... . . .... . .. . .........
120
120
130
120
74
98.8
105. 5
85. 9
0.522
.508
. 745
955
117. 1
105.1
113.3
111. 9
0.23
.378
. 484
.474
69. 3
76
74.8
74.4
0. 423
. 507
.594
. 515
47. 7
30.6
39.3
57.4
0.525
. 532
. 708
.666
Before rebreathing .... . .............. 117 86 . 722 116.8 .574 82.6 . 514 40.1 .497
3 minutes on reb reather • . .•. . ........ 117 89. 1 .695 126 .86 81 I .662 46.1 . 534
18 per cent .......... .. . . ............ . -117 89. 5 ,80,'I 125. 9 .663 83.4 .482 45.9 1 .622
15 per cent ..... . ..... .. . .... .. ....... 117 91.1 I . 762 125.2 .617 80. 3 . 503 45.6 .627
13 per cent . .. . . . .. . .. . . .. . . . ... . ... .. 117 94 . 763 125. 1 .634 80 .506 45. 7 . 399
12 per cent .. . . .......... . .... . ....... 117 95.6 . 771 125.2 . 627 79.1 . 512 46.5 .65
11 per cent .. . ........... .. ........... 117 98.6 . 773 125.1 .619 79. l . 443 47.1 .652 '
10 per cent .... .... . ... . ......•....... 115 l():?. 4 .808 12-5. 3 . 651 77.1 . 55 49.1 .665
9 per cent ... .... , . . . ..... . .. • . . ... .... 106 106.4 .816 122:8 .864 72.4 .662 51. 4 · . 761
8per cent . . .. •....... . ....... . ..... 80 111. 8 . 957 123. 3 .942 69.4 .868 . 851
7 per cent . ........ ... ... .......... . .. 35 113. 9 1. 723 127.6 1. 79 71.6 1. 595 1. 398
Last on ...•. ... . . ..... . • ... . ... .. ... . 117 111. 9 . 877 116. 2 1. 123 63. 3 . 771 ~~- 9 , . 925
50.6
First off ............ . .... .. .... . . . ... . 117 fl8. 6 .855 111. 5 . 935 67.1 . 855 42.2 . 752
I I

The mean systolic. arterial p~e~snres ?f. the groups

were about the same 1n the reclinrng pos1t1ons, berng 116.5
tw? I what greater in the systolic rise than in the systolic fall
group,. It was 16 mm. for the first and 9 mm. for th e
and 117.1 mm., respectively . During standing there was se~ond group. Hence, at the start tp.e systolic pressures
a big difference, the mean systolic "pressure was for the for the two groups were more widely separated tha11 for th e
systolic "rise group 131.8 mm. and for the systolic fall sitting posture observations. But having so separated ,
group 105.1 mm. Thus the average increase for the first that deg:ee of ~eparation "'.as m~intained throughout th e
was 15.3. mm. and the fall for the second 12 mm. In the rebreathi:ag period·. The drnstohc pressure curves ;emain
sitting position the two showed, as might be expected , a parallel down to 8 per cent of oxygen, but thereafter th e
diastolic curve of the systolic fall group does not fall as
tendency to approach a common level of pressure. For
rapidly as that of the oth er. The pulse pressure curves
the former the systolic pressure was less for the sitting than
are parallel throughout the whole period. 'I'he striking
the standing posture, and for the latter the pressure was thing about the pairs of curves of these comparisons is
higher. However, the mean systolic pressure for the that the differences present at the beginning of rebreathing
sitting postures was higher in ~he systolic rise than in the are maintained throughout the compensatory changes .
systolic fall group, being 123.4 mm. for the former and
116.8 mm . for the latter. T ABLE 67.
The postural diastolic pressure differences for the two
Systolic rise group. Systolic fall group.
groups were more uniform than ,those of the systolic pres- Lowest
sures, the systolic rise group averaging as much as 3 to·5 oxygen
mm. higher .
reached,
per cent.
Nwnber I Percent- Number
of cases .
Percent-
age oi
of cases. ~:~'. cases.
The pulse pressure reflected the systolic pressure changes
and so in this, as in others of our groups, the systolic pres-· - -- ---
sure changes were chiefly responsible for observed pulse
pressure chan<?,es.
11.. .....
10. !t-10 . .
9. .9-9 ....
....... 1.J....1~ ... .
1
2
9
1. 7
7. 7
s. ·0-8 . ... 14 13. 4 26 22. 2
The ideal or' type responses of each of these two groups to 7. !t-7 .. . . 60 57. 7 45 38. 5
6. !t-5. 8 .. 28 26.9 35 29. 9
the rebreathing experiment have been plotted in figure - - -- - - - - -- - -
62. The two groups show differences at the start that are Tota.I. 104 100 117 100
maintained with surprising uniformity throughout the I
rebreathing as the responseR to low oxygen are made. As to final oxygen percentages reached, the members of
The i nitial psychic systolic pressure response was some- the two groups were distributed as shown in table 67. ·

A higher percentage of the men who showed a systolic
blood pre3sure fall when standing failed before reaching
9 per cent und er the low oxygen than did members of the
opposite group. While 84.6 per cent of the systolic rise
group as against 68.4 per cent of the systolic fall group
tolerated to less than 8 per cent of oxygen, y et the two
showed up about equally well in the percentage of men
who went to less than 7 per cent oxygen. An examination
of the 35 cases of the systolic fall group that went to less
than 7 per cent oxygen showed that all but six of them
began rebreathing with a systolic pressure within 2 or 3
mm. of their standing posture pressure. However, the
six cases that maintaned the low systolic pressure ap-
:;: ____ _____
5'iS TOL IC _
- ------- I S 'i5TOLIC B15E
D IASTOLIC
"PUL5E JI. S 'i5TOLIC TALL
;q_·········-·········· ·
/1,0
14-0
s~
ieo
loo
&o
'f
zo
Fm. 62.-Comparison of group in which the systolic rose on standing witl) the group in which the systolic fell .
peared, in spite of this, to react equally as well to the
low oxygen as others and reached just as low percentages
of oxygen.
While the group with the standing postural systolic
pressure fall does not, as a whole, show up as well as the
systolic rise group under the low oxygen test, neverthe-
less the mere factthat the systolic pressure falls on stand-
ing does 'not necessarily indicate that the subject will
compensate poorly to low oxygen.
The frequency of fainting cases was not materially
different in the two groups; both showed something over
6,5 per cent of this type of reaction. As regards the variety
of the onset of the fainting reaction, the systolic fall group
showed a slightly greater tendency to have a sudden and
132
rapid development of the process. There were among
the systolic fall group 57 per cent of the fainting type in
which the systolic and diastolic pressure began to fall at
the same time, while only 41 per cent of the fainting
cases of the systolic rise group gave this variety of
reaction.
The mean value for the final oxygen percentage, deter-
mined by chemical analyses at the close of the rebreath-
ing period, was calculated for each group, The results
showed a striking uniformity, varying between 7.2 and
7. 7 per cent. The mean value for the final oxygen in a
group of 2,279 cases was 7.4 per cent. So we find that each
of our 10 groups, selected because of a divergence from the
IO
- - - - -· - - - - - ,e
- - - -- --- -- -----
-·-·--
.-·-· -
.- ·
/7
·-·- ,r
If
z.o
TiME orRuN IN J\i1NUT£S
average in some one circulatory factor, corresponded very
closely to the majority of all men in abilit.y to compensate
to the low oxygen of rebreathing. 'rhe me·a n time taken
by our 10 groups to reach the final oxygen ranged between
22.3 and 25.2 minutes. This also is close to the mean
time found for 2,279 cases, which was 24.7 minutes.
The mean increase in the per minute volume of breath-
ing for each of the groups was also very nearly the same,
except in the high systolic pressure group. This increase
as registered for the last minute of rebreatbing ranged
between 3,300 and 3,700 c. c. For the high systoli'c
pressure group, the mean respiratory increase was 4,300 c. c.
per minute. These findings confirm our ~ther data, which
show that the circulatory factor basis of selection does not
 133
separate men that differ in ability to compensate to low appeared to place the heart or the nervous system under a
oxygen. handicap not ,present in av(;lrage conditions of the several
SUMMARY. circulatory factors ·studied. It was shown that the rise
in systolic preBSure is not, at least eo far as the-men here
Ten Bpecial groups were eelected from 2,000 cases for a considered were concerned, great enough to place the heart
study of the influence of various circulatory factors on the under a dangerous strain.
power of coQ'.lpensating to low oxygen. These included (By courtesy of The American Jo,urnal of Physiology.)
lligh and low systolic pressures, high and low diastolic ·
pressures, large and small pulse pressures, rapid and slow BIBLIOGRAPHY.
pulse rates, and cases of systolic pressure rise and fall ·on
standing. A total of 554 cSBes were examined. The 1. Air ·service Medical, 1919,· p : 345. ·
postural and exercise. differences are striking in some .of _2, Schneider: 'Journal of the American -Medical Sciences,
the groups. NevertheleBB, all of the groups responded in, 1921.
a similar manner and compensated to equally low per- ;3. Schneider and Truesdell: .Americr,n Journal of Physi-
centages of ox~. None' of the conditione studied ology, 1921.
 A BRIEF NOTE ON GERMAN LIQUID OXYGEN APPARA.TUS.
By Dr. GEORGE B. 0BEAR, formerly captain, Sani.tary Corys, U. S_ Army.

It is, of course, well known that during nb.e Great War Figures 64, 65, and 66 are photographs of three different
there came into rather wide use an instrument for the instruments received at the Medical Research Laboratory.
feeding of oxygen to aviators. 1 The complete equipment The 'iru;truments shown in figtires 64 and 65 .a re practically
was fairly heavy, as the outfit necessarily 1.ncluded a identical. In figure 64 three knobs attached to the
storage· vessel for the oxygen gas. This vessel, which was spherical vessel form its stand. In figure 65 the trelliswork
called upon to withstaud a pressure of over 2,000 pounds
per square inch, _had to be of sufficient strength, and there-
fore possessed considerable weight. These containP.rs
carried an amount of oxygen gas for only comparatively
short flights. When altitude flights are carried out,
during which the. highest possible ceiling is desired, any
unnecessary weight is a hindrance. To attain these
higher altitudeff it is necessary to carry enough oxygen
to last for the duration of the flight. This means that at
least two of the ordinary containers, suitably connected
to the instrument, should be taken in the airplane, a beavy
equipment thereby resulting. Extra weight, especially
in an airplane, is undesirable. It· may have come as a
realization of this that we have the development of an
oxygen supply apparatus which is considerably lighter
than those. used by the Americans, British, and French
during the war. It seems that we should accord to the
Germans the credit of devising and using more or less
successfully th'e first oxygen-supply apparatus for aviators
where the active fluid is primarily in the liquid state.
It .is thought the Allies first became acquainted with
the German apparatus through its capture from German
airplanes such as the . G.otha. From the dates shown on
the name plates of the apparatus evidence is submitted
that these instruments were in use at least as early as 1917.
+he object of this note is to describe the apparatus and
to show, if possible, some of its advantages and disadvan-
tages in respect to the apparatus in which the primary
fluid is in the gaseous state.
The general principle of the German apparatus may be
briefly stated-as follows: The active fluid-liquid oxygen
or liquid air-is stored in a vacuum-protected vessel
where it is constantly tending to vaporize. The accumu-
lating vapor exerts a pressure ,on the liquid surface and
forces portiollil of the liquid upward through a system of
tubing and two evaporating chamqers. Durj.ng the
passage of ·the fluid through this system it becomes more
and more gaseous until upon reaching the. mouthpiece
it has become completely vaporized ai.ld to a large extent.
warmed. The vaporization of the liquid oxygen is
accomplished by supplying it heat energy from the ,
surrounding atmosphere, which _is at all times relatively JiiG. 63.-Ahrendt & Heylandt. Liquid, oxygen apparatus
Fabrik No . 845 .
hot compared to the temperature of the liquid. The
apparatus is seen to be simply a liquid _oxygen boiler, base is the stand. On the instrument in figure 65 no
the fire· under it ·being the heat energy contmned in the suspension lugs were discovered and no place where they
enveloping atmosphere. seem to have been broken off. The apparatus in figure 66
1 A Note on Oxygen Supply for Aviators, Capt. o.· B. Obear, Air differs somewhat in construction from those shown in
Service Information Circular, Vo,. I, No. 3, Mi:-r. 15, 1920. figures 64 and 65. The vaporizing chambers are of different
. (134)
 135
construction and gifferently placed. These chambers
instead of being cylindrical in shape with corrugated
lateral surfaces resemble somewhat the frustum of a
circular· cone, divi,ded into two parts and grouped about
the base of the neck where it joins the spherical vessel.
The tubes from the two chambers lie along the surface
of the spherical vessel coradial with it. Some of these
tubes can be distinguished just behind the trelliswork.
.p ending from C1 are tubes of varying length which are in
FIG. 64.-Ahrendt & - Heylandt. Liquid oxygen apparatus.
Fabrik No. 845.
A £tee-hand .schematic picture of the apparatus shown
in figure 64 is found in figure 67. V is a spherical vessel
t erminating in a long neck which may be .closed by the
screw cap N. Surrounding this' inner vessel and coaxial
with it-is the envelope E. · The neck of V is fastened to
the neck of E by means of an air-tight seal 1, 1. The SJ?aCE:
between V and E is a very good vacuum. After the
vacuum is formed the sealing-o .i tube is inclosed in a
hollow cup-shaped eleqient which, in cimnection with
two others, form the 'legs u.pon which the instrument, in at
least one of th1a designs, stands. The function of the
vacuum is to shield the liquid oxygen content from e:"Iects
of external h eat energy, thereby preventing too rapid
evaporation. Still further to protect the fluid, the outer
surface of V and the inner surface of the envelope E are
polished . An acceptable method seems to be to silver-
plate these surfaces and then burnish them. To the
lower outer·surface of V and within the vacuum space is
attached a perforated metal cup W· containing charcoal.
The role played by the contents -of this cup is the iin-
provement of the vacuum between V and .E. When the
liquid oxygen is· poured into V, it and the cup are cooled
to the temperature of the liquid . The effect of the cold
on the molecular sttucture of V seems to be th~t increased
intei:molecular separation results, allowing some traces of
gas to enter the vacuum space. This tends to break
down the vacuum. The function of th€ charcoal is that
mad.e use of by Sir James Dewar and tends to·nnprove the
quality of the vacuum by absorbing any residual gases
~ft in the vacuum space. As this action heightens the
vacuum, the quality of the thermal insulating property
of the space between V and E is made better than it would
be otherwise.
In figure 5 t 1 is a tube extending nearly to the bottom of
V, its lower portion being continually immersed in the
liquid ,oxygen; t, is an extension of t, and consists of a
coil connecting t 1 with a vaporizing element C1 • De-
communication with C,, their lower ends being closed.
The vessel C, is in communication with ,C., a similar
· Fm. 65.-Abrendt & Reylandt . . Liquid oxygen apparatus.
Fabrik No. 1777.
vessel , through a tube t 6 • 0 2 is similar in construction to
C1 .,and performs a similar function. , Tubes t 4 and t 5 are
series coils which connect C2 with the regulll,ting valve R
and subsequently with the outlet connections for pilot,
observer, and a breathing bag. The tegulating valve R
is of the needle type of construction and can be set for
0
"zu" (closed), "offen" (open); '' one per/lon, " " two
persons." On some of the instruments the .graduations
 136
are in liters delivery. The tube from the regulating valve
has a_ three-way opening. The function of two of them
has been pointed out. The third is for the attachment
of a breathing bag about 230 mm. square uninflated.
The bag is made of some flexible gas-tight material-for ex-
ample, a rubberized fabric-and Gan be inflated by the oxy-
gen gaB. Th~ function of the bag.is presumably that of a
re~ervoir. Pos,ibly its a-::tio.n may be similar to that of a
flywheel of an engine, tending to cause a steady flow of
gas to the aviators. A pressure gauge is placed in com-
munication with the inner vessel V by means of the tube
t3 • For purposes of security, a safety valve S JS placed in
this line of tubing. The apparatus is inclosed in a lattice
(_trellis) work of metal, for the purpose of protecting the
FIG . 66.-Abrendt & Heylandt. Liquid oxygen apparatus.
Fabrik No. 6627.
aviator from the intense cold should he happen to come
into contact with the instrument.
The action of the instrument may be outlined as follows:
In virtue of the heat energy which enters V at the unpro-
tected region 1,1 of the neck, and finds its way to the main
part of the vessel V, the liquid oxygen contained in V
tends to vaporize, the gas collecting in K registering its
pressure on G and exerting a downward force on the sur-
face of the liquid remaining in V. This effect caµses the
liquid to flow up the tube t, into t, and 0,. The process
of vaporization and drying now begins. As the active
fluid reaches these portions of the instrument it hi presented
·to a large evaporating surface. The fluid flowing into 0 1 ,
a ~essel whose lateral surface is corrugated, allowing of
some expansion, finds its way into tubes D,, w:here heat
absorbed from the atmosphere tends to vaporize the
liquid. The action here is similar to that of a water-tube
boiler. In the partially vaporized state the oxygen
passes over to 0 2 , th.rough tube t 6 , where it is again sub-
mitted to a new heating surface, and where it therefore
becomes more thorough1y vaporized. From the .second
evaporation chamber the fluid, which at this stage is
nearly all vapor, but which probably contains traces of
the liquid, passes through tubes t 4 and t 5 • The passage
of the fluid through these tubes tends to warm it further
and to remove whatever particles of liquid·remain. In
other words, the gaB is dried and warmed when it reaches
this stage. By the time the fluid reaches the regulating ·
valve it is thoroughly vaporized and brpught to a tempera-
ture which renders it breathabJe by the aviator. In the
above manner, then, the liquid. oxygen is changed to a
breathable ga,s by the vaporization of the liquid, this
-vaporization being effected by the heat energy taken up
by the fluid from · the surrounding atmosphere. The
temperature of the atmosphere is always much higher
than that of the liquid oxygen an:d therefore relatively
hot: Eve~ if the atmosphere was -at a temperature of
-30 6 C. it would still-be rather hot-compared to -185° o.;
the boiling point of liquid oxygen.
It will be readily understood from a consideration of
the abo'le that the gaB delivery of the instrument is pro-
portional to the amount of liquid forced up the tube t 1 ,
which will in turn be proportional to .the vapor pressure
in the neck K. It is possible for j;hIB pressure to vary
widely owing to various causes independent of outside
temperature-for example, orientation and change of
atmospheric. pressure. It is important, therefore, to
have a means of re.,oUl.ating this pres~ure. To obtain the
desired result; a tube t 3 puts the neck.K in communication
with a pressure gauge G graduated from O to 1.5 kg. per-sq.
a
ems. Into this tube the~e is inserted safety valve_s.
The control of the supply to the ii.pparatus is accomplisbed
by the adjustment of this valve. When evaporation of
the liquid oxygen takes plaee under normal conditions,
the.counter pressure of the gas in 0 1 is approximately equal .
to the oxygen vapor pressure in K minus the head of
liquid oxygen in the length of the tube t 1 • It would be
equal if there were no flow-of,the liquid th.rough t,. The
effect of this small flow in unbalancing hydrostatic con-
ditions is negligible. The pressure in 0 1 is that '.Vhtch
regulates the average :i.mount of flow through the vapor-
izers and tubing. If an increased volume of gas be taken
-from the apparatus, the counter pressure in 0 1 will be
momentarily diminished. This conditiorr increases the
pressure difference between the vapor contained in K
and that iriclO!led in 0 1 . The increase in pressure will
accelerat.e the supply of liquid in 0 1 where, in virtue of
evaporation, the counterpressure will be raised until an
approximate equilibrium is restored. By virtue of the
continual evaporation which must take place in V, the
pressure at K rises slowly and · continuously until the
maximum _value allowed by the release valve ~ reached .
I tis then that the apparatus gives its maximum supply
The difference in pressure dP denoted by the pressure
gauge G is that between the pressure.at K and :the atmos-
phere. The difference of pressure dp between the pres-
sure at 0 1 .a nd the surrounding-atmosphere causes the
 137
oxygen gas to enter the mouthpiece. dP-dp is equal this vol1Jme would be somewhat less than the volume of
to the difference in pressure between the vapor in K and the apparatus used by the Germans and would, therefore,
0 1• The former counterbalances the difference in level occupy less space in an airplane. Furthermore, the former
of the liquid in V and the point of\inlet at 0 1• This same can be so arrang8d as to occupy distributed space, (In the
difference of pre~ure also forces the liquid oxygen from case of the outfit including the Prouty instrument, the
V into 0 1 • This is of small value, however, compared instrument itself could be conveniently fastened to the
with the pressure normally recorded by the pressure instrument board and the gas tank stored on the floor of
gauge. In practice the reading of G indicates the supply the fuselage.) In regard to weight, the German apparatus
pressure. has a great advantage. The instrument errlpty weighA
In the normal functioning of the apparatus there is a about 10 pounds. When fully charged· it weighs about
certain amount of wastage of the gas. This must of 15! pounds. The inner vessel V has a volume such that
necessity take place in virtue of the conditions existing it could receive sufficient liquid oxygen to form about
in the instrument. If the regulating valve R is close'd , 1,800 liters of gas at 0° C. and sea-level barometric pressure.
any liquid oxygen forced into 0 1 wili soon set up such a If the instrument was filled with liquid air, the oxygen
pressure on that side that further flow of liquid through gas derivable therefrom would.be about 1,250 liters, pro-
tube t 1 will be stopped. Under these conditions the con- viding the liquid air contained 70 per cent oxygen.
tinual slow vaporization inside V causes a gradual rise
of pressure and a consequent steady escape ·of gas through
the valve S. Even if the regulating valve R ia open, .
and the apparatus ia working at a pressure above the release
pressure of valve S, a similar effect to that above occlll'B.
In i"eference to this loss of gas through escape at valve S,
it has to be kept in mind that wherE! pure liquid oxygen is
not employed, but only liquid air rich in oxygen, the sub- R

stance that evaporatedrom the mixture is almost wholly

nitrogen, the boiling point of which is a little lower than
that of ·-oxygen. In· this particular case, therefore, the
action of the valve in getting rid of the unbreathable -gas
ia beneficia1 rather than otherwise.
If for any reason the safety valve S fails to work, the
reading of the pressure gauge would· reveal it. In this
event the screw cap N may be unscrewed a little. This
diminishes .t he pressure gradually and assures the safety
or' the instrument, so far as this particular condition is
concerned. If the above procedure is omitted, there is a ·
tendency for the contained liquid oxygen to be forced
into the vaporizing chambers with explosives results.
From all that seems to have been discovered, the gas i8
fed to the aviators through flexible rubber tubes terminat-
ing in curved mouthpieces much the shape of pipestems. E
On one of the instrhments at the Medical Research Labore
atory two iron projecting pins attached to the trelliswork
incl9sing the instrument. proper were found. These, as
well as -the trelliswork, are shown in figure 64. These
pins are use<). to support the instrument in some sort Of
cradle bearing which would allow it to 03cillate in a verti- w
cal plane. The object of this method of suspension is Fm. 67.-General plan of German liquid oxygen supply apparatus.
evidently to maintain the instrumep.t in an upright
position should the airplane assume a position other than The delivery of gas from the instrument possesses a
that in straight flying. The arrangement is obviously a feature which the writer never observed in his wol'k on
precautionary measure to prevent the cold liquid from oxygen supply instruments, such as the Dreyer, Clark, or
coming into contact with the instrument at .the region K Prouty, using oxygen gas as the primary agent. lt has
of the neck. Such an occurrence would pe ol;>jectionable. ·been found that the delivery falls off in volume as the
First, the normal functioning of the apparatus would cease; altitude increases. The peculiarity just mentioned is
second, the intense cold which would be experienced at clearly shown in figure 68, which is a reproduction of the
K would cause severe mechanical strains at the soldered delivery curve of one of these instruments. This effect
joint between the neck Kand the envelope Eat the region is appare:ttt with every type of apparatus in which the
1, 1. This strain might be of sufficient magnitude to pressure head controlling the delivery is maintained con-
cause the joint to break, thus destroying the vacuum stant. The phenomenon seems to be c;lue to the faH in
between V and E. This would put the instrument out density of the gas in the delivery tube dtte to the decrease
of commission. of pressure in the outside atmosphere.
If we take the combined volume of the parts of an oxygen Experiments have brought out the fact that the German
supply apparatus using oxygen gas as the primary agent, instrument may become dangerous under certain con-
55314 0-31--10
 138
ditions. It has been found that if an armor-piercing bullet
actually pierced both the charcoal receptacle W and the
liquid oxygen vessel V, permitting the liquid oxygen to
come into contact with the charcoal, the charcoal defla-
grated with explosively violent results, setting on fire
inflammable material in its neighborhood. If the char-
coal receptacle is not pierced, however, armor-penetrating
ammunition of itself causes no conflagration, but a stream
of oxygen would flow out through the bullet hole. Never-
theless, if an incendiary bullet strikes inflammable
material in the neighborhood which is within the range of
the stream of escaping oxygen released by the previous
hit, a fire is started.
about 150 per cent greater in the German than in the
Allies' type. For example, the German instrument will
yield about 1,800 liters of gas as against a possible 1,000
liters for a two-aviator equipment of the Allies' type, or
about 500 liters for the one-aviator outfit.
4. The apparatus is a unit in itself and does not consist
of parts, as does the complete arrangement used by the
Allies. Centralization in this case might be regarded as
an advantage.
Some features of the German apparatus which-are obvi-
ously disadvantageous are as follows:
1. The absence of automatic control and supply seems
to be a serious drawback.

FIG. 68.-Plot of supply curves. Relation of supply and latitude.

On account of the novel feature i:r;itroduced into oxygen- 2. The supply diminishes as the altitude increases.
supply work by the Germans, a comparison of this instru- . Since the aviator needs more oxygen as he increases his
ment with those which have been used by the Allied altitude, this defect.is notable. Figure 6 gives an idea of
forces becomes instructive. Some of the advantages of the variation of the oxygen delivery as a function of the
the German type are stated in what follows: altitude. It is clearly shown that the delivery starts to
1 For two aviators the weight of the instrument is about lessen l\fter an altitude of 1,500 m. has been reachea' and
8 kilograms, as against 40 or more kilograms for' the type continues to do !!Q. The table at the right gives a numeri-
used by the Allies. cal picture of this peculiarity of the action of the instru-
2, Under working conditions the maximum pressure in . ment. It will be noticed that the curve for one-man-
the German instrument is very much less than that in the delivery is somewhat better than that for two men. Yet
other type of apparatus. This is of considerable advan- in both cases the marked drop in the higher altitudes is
tage, as there is much less risk of leakage and an elimina- noted.
tion of other inconveniences encountered in high-pressure 3. The instrument may become an explosive element;

•
apparatus. the danger from the instrument is especially present if it
3. If pure liquid oxygen is used, the gas capacity is is inside the fuselage.
 139
4. The instrument, compared with some of the Allies'
instruments, occupies a larger concentrated volume than
the total distributed volume of the latter.
5. Danger may result if _the instrument is upset.
6. The supplying of liquid oxygen-involves establishing
special plants at air ba.ses. Specially-designed vessels are
necessary for the transportation of the fluid.
7. There is considerable wastage of the oxygen in the
natural functioning -of the apparatus.
-The instrument in the state of development as received
at the Medical Research Laboratory has promise. Sev-
.eral inherent defects are present, however, the elimination
of which would probably place the instrument in the front
rank of oxygen-supply appar.a tus. One direction in
wliich the instrument would prove its superiority is _prob-
ably in the case of long flights in two or three eeaters
where the considerable weight of the high-yressure type
is a handicap. It· would seem poa11ible to increase the
capacity of the liquid-oxygen type so as to meet all rea-
sonable requirements ·without so great an increase in
weight as would be necessary in the other type. With
the increase in capacity the question of wastage would
become secondary.
It can hardly be said that any one type of apparatus is
completely s11tisfactory at the present stage of develop-
0
ment. Experts in France, England, the United States,
and perhaps other countries are working on the problem.
The subject of. the liquid-oxygen apparatus offers a seem-
ingly fertile field. From documents consulted · by the
writer it has been learned that the British have been
working on the elimination of the defects of the German
apparatus and may have at the present writing con-
structed an instrument using liquid oxygen.which can be
used satisfactorily in an airplane. The United States is
also working on the problem of determining the best type
of such apparatus. For some time-past the writer has had
in mind an instrument for oxygen supply whose function-
ing would depend on features not embodied in present-
day instruments. Some of the ideas for tliis model were
already on paper before the writer left the Army. He
hopes to continlj.e the work at his present station.
In the preparation of this note, free use h~ been. _made
of certain articles which were received at the Medical
Research Laboratory. No originality is claimed for the
· substance of the note. The aim of,the writer was to place
in a concise whole certain facts in regard to the German
type of apparatus and to offer them for consideration.
The above-mentioned articles were in the form of letters
a.nd reports, some of which were in French.
 ._ . ·.

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