PHYSICAL EXAMINATION FOR FLYING

[Music] e introducing the air surgeon Army Air Force medical cor General David NW Grant Aviation is one of the marvels of this century and yet has become commonplace in the brief period of about two decades people in all walks of life use this means for transportation and flying has become the profession of thousands of men military airplanes are now being built which can travel at more than 400 mph climb almost a mile a minute operate in the cold unfriendly environment of the stratosphere and remain alone for 20 or more hours the performance of these modern military machines exceeds the physiologic capabilities of man and yet with mechanical Aid the the man can still be made the master of the machine from very sad experiences in the early part of the last war it was found that every man could not be made into a military Aviator it was determined after a very high crash rate that men must be carefully selected on the basis of young maturity physical fitness High native endowment a normal sensorium and a stable emotional makeup when the examination of Pilots was based on this concept and carefully carried out by competent and conscientious examiners the crash mortality was greatly reduced and the problem of pilot selection was established on a firmer Foundation progress has been made in the past 20 years in the selection of suitable pilot material and the washer rate has been materially reduced however the number of failures at the Flying schools is still too high and fluctuates with the skill and care with which the examinations of the applicants for flying training are made the selection of the best potential pilot material available is an extremely important function of the medical division of the Army Air Forces if the job is has done well a large percentage of the men examined and selected will go on to become military aviators and there will be little wastage of men and public funds in the picture you are about to witness you will observe the procedure of the complete physical examination of candidates for flying training in the United States Army Air Forces the examination is long thorough and meticulous but is not ritualistic and each part of the eye ear nose and throat General physical and psychological examination in the film is conducted with no more care and detail and should be given by each individual examiner this film was taken in the examining rooms and Laboratories of the school of aviation medicine Randolph field this institution in developing many of the physical standards used in the examination of flying training applicants and in the training of the medical examiners for their roles continues to play an increasingly important part in now expanding defense activities the examination of the prospective candidate begins as he enters the door it includes his General appearance how he answers questions his mannerisms and how he gets along with the other boys that is the ago form 64 you see being typed it is used to record the findings on all flying Personnel take this and sit down over there please the eye examination is generally done first as good vision is of supreme importance many candidates have real or imagined defects and due allowance must be made for this observ ations on the mentality and stability of the candidate made during the various tests are an extremely important part of the entire Examination for flying does he comprehend and follow simple directions rapidly and well with reasonably good coordination or is he excitable careless and incapable of an even train of thought under stress the flight surgeon must be careful to standardize his technique so that in so far as possible the only variables are the candidates themselves obviously many diverse types are examined let us follow Smith and Jones as examples to illustrate these points each candidate is compared to a hypothetical average which The Examiner has established in his mind by his past experience Mr Smith please are you Mr Smith will you come with me please uhoh was that on purpose or not inspection of the eye is first a brief history is obtained at this time the BB Loop is best used here as it gives moderate magnification the eyelids Puna conjuctiva cornea and the Scara as well as the iris are closely examined now for the associated parallel movements watch the bead the examiner watches the bridge of the nose look for primary nagus first then in the extreme lateral positions where it is common and not disqualifying the bead moves in the cardinal directions as you see it is easier to detect abnormalities in the associated parallel movements by watching The Bridge of the candidate's nose rather than either eye this makes use of the peripheral visual fields which are especially sensitive in observing motion the pupilary reaction to light is next as the examinee faces the light the hands are placed over his eyes the contraction of the pupil when exposed to light is carefully observed a flash light in a darkened room is used when difficulty is encountered using this simple method the pupilary accommodation reflex is now observed look out there across the street now at the pin once more please The Reflex contraction of the pupil as the eyes look from a distant to a near point is observed the equality of the pupils is also examined the findings are dictated to the enlisted flight surgeon's assistant who types them directly on the worksheet were possible these findings are all normal read the second line of letters from the bottom backwards please this is the familiar test for visual Acuity which flight surgeons do almost exactly as shown the examinee is never allowed to cover one eye with his hand and peek between fingers or use any of the old and familiar Dodges remember that in combat a pilot's life hangs by a string perhaps the largest single thread of which is his visual Acuity a flight surgeon is not being a good fellow if he gets careless one eye is tested at a time squinting is not allowed here the projector chart is being used any visual acuity testing equipment is satisfactory provided snull and letters are used the illumination is around 7 to 10t candles and the candidate is at the proper distance 2020 on the right and 2020 on the left the spaces left blank are filled in if glasses are worn now for the depth perception test using the Howard dolman apparatus this tests for the presence of binocular single Vision with Fusion as you look down there you see two vertical rods against an illuminated background the rod towards your left is fixed and can't possibly move the one on your right however moves back and forth as I pull this right hand string it comes toward you see that if you relax on that string and pull on the other one it moves away from you now you see that the two rods are approximately straight across from each other your job is to set the rods exactly straight across from each other close your eyes a moment please now [Music] open here you see it all [Music] [Music] diagrammatically close your eyes a moment once again please this test is generally repeated from 3 to 10 times depending upon how consistent the candidate is in his ability to set the rods the deviations on the millimeter scale are noted and added together arithmetically the average is then taken and it must not be greater than 30 mm to be within qualifying limits if the average is greater than 30 mm the test is repeated on two successive days and the average of these daily readings taken the perometer or muscle balance test is of great importance here is a pilot suffering from anoxia while flying at a high altitude under these conditions the fusion reflex is impaired and lopia or double vision may occur the muscle balance test determines the load the fusion reflex has to carry the greater the imbalance the more susceptible the ocular neuromuscular mechanism becomes to such disturbing factors as anoxia and fatigue the fomer is the instrument used in this test this is the rizley rotary prism the thumb screw changes the Prism Power which with the direction of the the base is shown by the white line the unit of measurement is the prism diopter prism bends rays of light toward the base here we have a prism point and a source of light let us continue the line of the ray of light for 1 meter the amount of deviation of the ray from this Base Line measured in centim at 1 M distance is the strength of the prism and prism diopters the resl rotary prisms consist of two prisms of equal strength rotating about a common center turning the thumb screw changes the strength from zero to the sum of two prisms the rley prism and madx Rod are used like this to test the horizontal muscle balance both the rly prism and the madx rod can rotate in their mounts as you see this is the position they are to be used in testing vertical muscle imbalance the madx rod inhibits Fusion by changing the appearance of the spot of light seen by one eye making the similar images on the two retin the instrument must be level and at the right height everyone is either right or left-handed we also have a master or sighting eye the siding eye is determined quite accurately by using this method with both eyes open hold this board at arms length with both hands and find the light at the end of the room through this hole in the center do you see it now no do you see it now yes this candidate is left eyed these diagrams will illustrate the meanings of the terms to be used you will note that the maox rod is assumed to be used in front of the non- siding eye because it is only with Fusion inhibited by its use that the latent deviations of the visual axes can be brought out the multiple maox Rod changes the appearance of a point of light into a line perpendicular to the corrugations when Fusion is unimpaired reflex adjustments are normally made resulting in both visual axes intersecting the point of fixation with corresponding points and the retina being [Music] [Music] stimulated [Music] this is the sighting eye and this is the non- sighting eye the resl prism and the Matic Rod are placed in front of the non- siding eye as you look toward the end of the room you see a vertical line of light do you not now you see a spot of light now with both eyes open you see both a line of light as well as a spot of light I want you to turn this thumb screw slowly so that the line of light Cuts right through the center of the spot of light we are determining the horizontal balance vision is interrupted using the occluder this cuts down the tendency of the lion to wander the non sighting eyeball rotates till tonis equilibrium of the extraocular muscles is reached he has now placed the proper prism strength in the optical system to balance any deviation of his visual [Music] AXS the amount and direction of the deviation is determined by noting the location of the prism base and reading the strength of the rly prism base in is exoria base out is esophoria the scale at the edge shows the prism strength in diopters the test is repeated twice or more if necessary and the average taken esophoria of more than 10 diopters or exophoria of more than five diopters disqualifies for pilot training now for the vertical balance the ret prism is rotated 90° as is the Maddox Rod now you see a horizontal line of light I want you to turn the thumb screw so the horizontal line of light Cuts right through the spot of [Music] light [Music] this is repeated if the prism base is down there is right hyperphoria if up it indicates right hypophoria which is the same as left hyperphoria hyperphoria of more than one prism diopter disqualifies for pilot training findings are being typed on the 64 form as you see they are normal the prism Divergence test is next this determines the strength of the fusion reflex and its ability to carry the load imposed by any muscle imbalance you now see a single spot of light as I turn the thumb screw it will suddenly widen then separate into two sideways tell me as the light begins to widen just before it splits pay close attention now close your eyes please open them again this test is generally not repeated more than twice note that vision and fusion are not interfered with prism Divergence of less than three or more than 15 diopters disqualifies it must equal or exceed any esophoria that may be present the pris Divergence in prison diopters is now noted the red lens test determines the angular range of fusion it is convenient to have the red lens in a spectacle frame the light is held at ey level 75 cm away look at the light please what color do you see now red what color do you see now White NOW pink follow the light with your eyes as it moves further out one of three things will happen it will become all white or all red or most commonly split into a red and white light watch it closely and tell me when one of these things happens the thumb is merely the doctor's reference point to the primary position the light is moved in the cardinal directions corresponding to the main direction of pull of the extraocular muscle if diplopia or suppression of one of the retinal images takes place within 50 cm of the primary position it is disqualifying the red lens test and the angle of convergence tests also indicate the strength of the fusion reflex this is a normal range the angle of convergence test now to be done has two parts first the inter pupilary distance is measured with a millimeter scale look at my open eye please the doctor measures from the nasal side of one pupil to the temporal side of the other here it is in diagram the inter pupilary distance is 64 mm in this instance a mark is placed 11 1/2 mm and interior to the cornea the end of the rule is placed at this point the bead is brought toward the eyes while the candidate watches it here you see it in diagram note that there are 25 mm from the end of the ruler to the center of rotation of the eyeballs the point at which either one or both eyes rotate outward as the beat approaches the eye is measured 25 mm are of course added to this to get the distance from the point of convergence to the Baseline which joins the centers of rotation of the two [Music] eyes [Music] [Music] e [Music] on the scale the bead was at 36 mm and adding 25 mm to this makes a total of 61 mm which is the PCB the actual angle can be obtained by chart as the enlisted assistant is now doing the angle of convergence must equal or exceed 40° it is 55° the accommodation test determines the near point of Vision on this card you see two lines of letters pay attention only to the upper line and read it aloud as soon as you can don't say who stop or there but actually begin reading d p c once again please e lb [Music] VZ the reading is made on the dioptric scale close to the edge of the ruler 10.3 on the right 11.2 on the left the unlisted assistant Compares this to the dway table of normal accommodation for each age group if the accommodation Falls below three diopters less than the average for his age the candidate is [Music] disqualified collar vision is tested using the ishihara or similar plates good daylight is essential and the plates held about 20 in away perpendicular to the line of vision read the numbers you see on these plates ples please 25 12 28 57 2 six about 2 seconds per plate is the proper time to allow if longer time is allowed some men will be able to remember the correct number to say rather than the incorrect one which they see they are not normal even though they recite the correct number the last few plates show a wavy line which the candidate Tres I want you to trace the line from this x to this one without quite touching the paper with the [Music] pointer some plates are not well seen by the normal and likewise some lines cannot usually be traced the collar vision defective usually traces these with ease he is unable to trace the normal ones however if the examiner feels that the candidate has memorized the tracing he can turn the book [Music] around at present if more than 1/4 of the plates are missed the candidate is disqualified the plate numbers and the candidate's responses are recorded on the 64 in this case this one is normal to ishihara the visual field is next I want you to keep your one eye closed by pressing downward on the eyelashes as you see me doing now keep your open eye fixed right on my open eye even though you watch my eye you can still see this bead moving around I want you to tell me the instant you first notice it come in your field of vision as I move it now now now now the nasal Superior and inferior fields are compared directly to the examiner's fields the lateral field extends out to approximately 90° and this is estimated as closely as possible both eyes are open here which makes this part easier to do now hold your right eye closed and with your left eye keep looking at my open eye again tell me when you first notice the [Music] bead the visual fields of both eyes are taken of course when a defect in the field is discovered or suspected more accurate determinations are made using the standard perimeter or the smaller hand perimeter and the results recorded on the parametric form in the usual manner these are attached to the 64 [Music] form they are recorded as normal while Smith is going on to other parts of the examination let's go back and watch Jones's responses hold [Music] it this shows the test for visual Acuity again in the beginning it was pointed out that the doctor should standardize his technique of examination so that the only variables will be in the candidates themselves watch these differences now for the depth perception test your job is to set the two rods exactly straight across from each other don't move your head please while you do this [Music] test does he ceh hand and follow simple directions now listen carefully I'll explain it all over [Music] [Music] again there it is watch for that marginal note that the doctor is writing on the side of form 64 it is very important later for the refraction which usually comes at the very end of the entire examination cycloplegia is obtained using one drop of 5% homatropine solution instilled into each eye at 5 Minute intervals for three drops after about 1 hour the refraction is begun which is similar to the procedure in any opthalmologist office the perometer frame is most generally used to hold the lenses a small set of lenses that the examine holds is considered satisfactory for this purpose here the one ey is being occluded and the plus one and half diopter working lens is inserted in the rear cell of the other side retinoscopy is done in the usual manner to determine the true refractive [Music] error the working lens is now removed and and the correction required to read 2020 determined if more than a plus or minus one and a half diopter correction is required in any Meridian it is disqualifying of this not more than one half diopter can be a cylindrical error he reads 2020 with a plus 50 sphere on the right and a plus 50 sphere on the left [Music] the retina is examined with the opthalmoscope at this time the dis macula and also the extreme peripheral portion of the retina are examined with care any defect which indicates underlying disease or interferes with function is disqualifying both retina are examined of [Music] course the anterior portion of the eye is routinely examined with the hand spit lamp the BB Loop is again used for the moderate magnification it gives the cornea anterior chamber Iris L and even part of the vitus chamber can be examined quite closely by this means the large slit lamp and corneal microscope are used where pathology is detected and when they are available this part of the examination is concluded by recording the opthalmological findings on form 64 also the correction required to read 2020 under [Music] cyclopia