comes, the illnesses from which he has suffered, the stresses to which he has been exposed and the manner in which they have been borne, are of prognostic importance. Reliable impressions are also formed in many cases in the course of ordinary clinical examination, additional aid in arriving at a decision being afforded by the candidate's method of performing the various tests of the cardiovascular, respiratory and neuromuscular sys- tems. When deemed necessary the psychomotor reflexes may be measured.
After admission much devolves upon the medical officer in the way of careful supervision. As in other branches of the medical profession, the success of the medical officer in preventing breakdown from flying strain depends largely upon his mental aptitude for, and his attitude towards, his work. To the medical officer the flying officers under his care are so many human engines, and it is his duty to keep them as far as possible in fit condition, properly attuned, and to overhaul them periodically so that he can say whether they are wearing well or showing signs of strain, and, if the latter, to take necessary measures to prevent any disaster.
The medical officer should live as much as possible among the officers under his charge; by this means he acquires an intimate knowledge of their characters, which he may use sympathetically and confidentially as occasion arises. Each flying officer is, so to speak, an individual unit, and requires his own special study. Much of the medical officer's best work, therefore, is done in the mess, on the aerodrome, or at games. For example, indications of " fatigue " may be observed when a pilot, usually efficient, begins to land badly, or returns from a relatively simple flight unduly exhausted; when a moderate drinker begins to take more than is good for him; or when a sociable pilot prefers always to sit alone quietly reading in the corner. A little tact and sympathy on the part of the medical officer under such conditions may make all the difference between recovery and breakdown.
It should always be borne in mind that a certain number of pilots are liable to develop an " anxiety " in regard to their occupation, especially as the result of the stress of early training or of prolonged service in the air. The first symptoms of such anxiety are best detected by a medical officer knowing each of his pilots personally. Thus during the training stage much information can be gleaned by a quiet chat with an officer or cadet in regard to his sensations while in the air, either when receiving dual instruction or when learning to acquire pro- ficiency at aerial acrobatics. The stress of the first solo flight must always be borne in mind. It must be remembered also that a young officer is generally averse to showing any sign of what he fears may be deemed cowardice. Yet, during the stages of training, he is probably constantly repressing a tendency to be afraid, which is only natural. With such an individual a frank discussion of his fear with the medical officer will frequently improve his condition. It is a great help, from the pilot's point of view, to be assured by a medical officer in whom he has con- fidence that he is in good condition, or that he is not a coward, and that many other pilots who have eventually " made good " have been through the same stages of " wind-up." In gleaning information as to the " anxiety state," note should be made of such points as change of habits, restlessness, irritability, ten- dency to jump at any sudden noise, or inability to concentrate. Enquiry should be made as to sleep and the nature of dreams or nightmares. The " anxious " pilot is particularly liable to in- somnia, anxiety dreams and nightmares. In his dream or nightmare he is nearly always performing something connected with his daily duties, and failing in its performance. The importance of good refreshing sleep in a flying officer cannot be too strongly emphasized.
Periodic medical examination will also give indication of the onset of flying strain or fatigue, and if found, appropriate steps can be taken to prevent or mitigate it.
Attention has already been drawn to the great importance of the use of oxygen for flights at high altitudes or of long dura- tion, as well as to the great value of sports and games in promot- ing flying skill and bodily endurance in pilots. Periodic advice
by medical officers in respect of the ill effects of too much smok- ing or alcohol also play a part in the effective care of flying personnel. Advice may also be given in regard to the efficient protection of the body.
The intensity of the cold varies with the season of the year and with the height attained; it is accentuated also by the speed of the machine through the air. To prevent loss of body heat while flying, special suits have been designed, the cardinal principle of which is to keep the body surrounded by layers of warm air. In most cases this warmth is derived from the body, but the warming of clothing by electric means has also been tried. For warmth purposes, great thickness of clothing is by no means necessary. Underclothing should be loose-fitting; two thin garments of closely-woven texture, either of wool or silk, are better than one thick one. Research has shown that the warmth-giving power of clothing lies in the fineness of the mesh rather than in its thickness. Care should be taken to avoid orifices through which the outside air can permeate. Tight clothing should be avoided, particularly clothing which tends to hamper the movements of the chest and abdomen or to restrict the circulation of the limbs. Frequently, however, it is necessary to employ considerable additional protection for the legs, espe- cially for the feet, and for this reason care should be taken to provide suitable additional protection in the form of warm, loose-fitting stockings.
For the protection of the face, a fairly close-fitting head and face piece of non-absorbent and non-porous material may be made, the inner surface of which will not absorb the oil or grease with which it is advisable to anoint the face when severe cold has to be endured. Over such, a woollen balaclava may be worn, and then a flying cap of close-fitting design.
For the protection of the hands a series of suitable gloves may be employed; for instance, thin silk gloves covered by woollen gloves, the whole enclosed in a leather gauntlet, which can be easily removed for delicate work. Gauntlets provided with a specially adaptable finger muff are to be recommended. In certain cases electrically heated gloves have also been employed.
For the protection of the eyes well-fitting fur-lined triplex goggles should be employed. The fogging of goggles may be prevented by certain preparations which are on the market. Some pilots prefer to employ tinted goggles; this is especially necessary for flying in the tropics, otherwise the effects of glare are soon felt.
In regard to diet, gas-producing foods are best avoided, since altitude causes expansion of the gases of the intestines, but in practice there is little need for the healthy person to worry about the constitution of his diet. It is important, however, that no flying should, under any circumstances, take place upon an empty stomach.
Before long flights it is advisable not to partake of food of too fluid a nature or of too much liquid. By this means the desire to urinate in the air during a flight is avoided. On very long flights, a supply of liquid food, such as sweetened cocoa or malted milk, may be carried in special thermos flasks. In addition compressed food in the form of tablets or chocolate may be provided.
Finally if " flying strain " supervenes the treatment necessary is such as would be applied to the condition of " fatigue " arising in any other occupation. According to his chief symptoms the patient may pass for treatment of an anxiety neurosis to the neurologist or for the treatment of respiratory and circulatory symptoms to the general physician. But it is always to be remembered that the keynote of the effective care of flying personnel lies in prevention rather than cure. (M. FL.)
AFGHANISTAN (see 1.306). The visit of the Amir Habibulla Khan to India at the beginning of 1907 was destined to exercise a powerful and beneficial influence on the attitude of the Afghan ruler during the rest of his reign throughout periods of unusual crisis and strain. It gave him the opportunity of making acquaintance with British officials and Anglo-Indian society, and the result was a new development of friendship and mutual
