Creation of the first Central Medical Establishment in World War II Published Aug. 31, 2017 AFMS History Office In the early days of World War II, Eighth Air Force Surgeon, Col. Malcolm C. Grow, grew concerned about the mental and physical well-being of aircrews within the command. To address these concerns, he first created a ‘Care of the Flyer’ section on his staff. Shortly thereafter, with the help of Col. Harry G. Armstrong, Grow stood up a medical research, development, and training facility in Great Britain to study additional ways to keep flyers in the air, eventually called the first Central Medical Establishment. Former Air Force Medical Service historian, Dr. James S. Nanney described the work done there in his book, Army Air Forces Medical Services in World War II1: In August 1942, when the air war over Germany began, the Provisional Medical Field Service School officially opened at High Wycombe, England, a small town northwest of London. The school's first task was to expand AAF understanding of the medical and psychiatric problems of combat aviators, and give aviation medical training to new arrivals in Europe. In 1942, about two thirds of the Eighth Air Force medical staff had no aeromedical training, and only ten percent of medics in tactical units had any training. Several bombers and their crews had already been lost because of the lack of trained medical officers. To make sure the training at High Wycombe was suitable, Colonel Grow added a medical board, altitude training unit, psychiatric unit, and research and development unit. As its first director, he appointed Col. Harry G. Armstrong, a prewar pioneer in aviation medicine. In November 1943, he renamed the whole facility the First Central Medical Establishment. A second central medical establishment was created in the Pacific, and a third was created in March 1944 for the Ninth Air Force, which moved from North Africa to Great Britain in October 1943 to support the ground forces invading France. The medical research program at High Wycombe concentrated on high altitude bombing and airplane ditching. Flying a series of bomb runs on Germany was one of the most dangerous and physically demanding tasks of the entire air war. Sortie rates were high because of AAF pressure to win an early aerial victory, and fighter escorts were not made available for the early missions. About one fourth of the returning bombers had sustained some form of battle damage. The normal maximum tour of twenty-five (later thirty-five) missions in a heavy bomber (the most dangerous) left a crew member with a less than fifty percent chance of escaping death or physical harm. Only one fourth of the crew members could expect to complete all twenty-five missions. Starting in 1942, prevention and reduction of these casualties became the focus of medical research at High Wycombe. Some form of personal armor soon looked promising against the German flak and 20 mm. cannon shells that began to ravage high-altitude bomber crews in 1943. A British firm, the Wilkinson Sword Company, produced a light armored suit of thin manganese plates to protect the chest and pelvic area. An improved helmet was soon added, and by January 1944 enough suits were available to equip every crewman in heavy bomber groups. The program worked. Armored crewmen had seventy-five percent fewer injuries and death from flak and cannon fire. There were many reports of the body armor's effectiveness. For example: A 20 mm. cannon shell exploded in the radio compartment of a B-17. A fragment of casing approximately 2 cm. by 1 cm. by 4mm. in thickness, struck the radio gunner in the left side of the abdomen. It spun him around but, being deflected by the armor, caused no wounds. The armor plate was bent but not penetrated. The gunner, slightly stunned by the impact, continued firing his machine gun throughout the action. Medics at High Wycombe also helped prevent anoxia deaths at high altitude. These deaths were caused both by inadequate training with oxygen equipment and by the faulty design of the first AAF oxygen masks, which often froze up at high altitudes (above 25,000 feet), shutting down the oxygen flow. Most anoxia deaths occurred among recently arrived crew members, whose lack of experience at high altitude sometimes caused their oxygen mask to disconnect from its hose. Training in proper use of oxygen equipment began in March 1943 at the school unit at High Wycombe. High altitude flights in training chambers were made available to almost everyone in the Eighth Air Force, including the medical staff. Especially valuable was exposure to the first stages of hypoxia (shortage of oxygen), emphasizing this silent danger that could kill quickly and unexpectedly. By September 1944 oxygen training was completely adequate. Meanwhile, designers improved the standard AAF oxygen mask by substituting a demand flow for a continuous flow system. And new pressurized oxygen systems succeeded in sustaining operations above 43,000 feet. From November 1943 to November 1944, oxygen programs reduced the anoxia accident rate by eighty percent and the anoxia fatality rate by sixty-eight percent. Cold injury was another worry. Frostbite casualties were caused by the extreme cold and wind blast in AAF bombers at high altitude. Unheated sections of bombers were sometimes minus 60 degrees Fahrenheit, and the open waist-gunner windows were especially dangerous. Yet less than one fourth of the aircrews arriving in Great Britain knew how to prevent frostbite at high altitude. Extreme cold often hampered first aid efforts. One ball-turret gunner wrote: At 26,000 feet the tail gunner had both cheeks of his buttocks torn by a 20-mm. shell. We had him lie face down and put a dressing on as well as possible. Bleeding continued so we put a 140-pound ammunition box directly over the wound. The pressure seemed to stop the bleeding. He rested comfortably but was almost frozen because his heated suit was torn and we had no blankets available. In response to these cold and oxygen problems, the Eighth Air Force in March 1943 made a ground officer in each unit the ‘personal equipment officer.’ His main duty was to maintain cold weather clothing, protective gear, and oxygen equipment in perfect condition, and to train crews in its proper use. Personal equipment officers were ground officers, because pilots, navigators, and bombardiers were usually too busy with their standard duties to do such work properly. New personal equipment officers were trained at High Wycombe. Laboratories in the States helped the technicians in Great Britain devise better electrical heating for flying suits, gloves, boots, and casualty bags. Engineers reduced wind blast by structurally altering the aircraft. By March 1944, for instance, they closed the waist windows. Most of the training problems were solved by June 1944, and equipment improvements reduced the rate of cold injury during late 1944 and 1945. Another problem in 1942 and early 1943 was the lack of an effective AAF air-sea rescue program for crews who ditched in the North Sea or English Channel. There was an urgent need for smarter ditching procedures and faster rescue responses to support an expanded AAF role in the war. Fortunately, the Royal Air Force's Air Sea Rescue Service was already able to save about one third of the British crews who landed in the water. The British therefore helped the Americans at High Wycombe work out better ditching procedures and demonstrate them to Eighth Air Force crews and Air Sea Rescue units. New ditching and rescue procedures were established by Lt. Col. (Dr.) James J. Smith of the First Central Medical Establishment. In 1943 alone, these improvements saved the lives of about 650 Eighth Air Force men (about forty-three percent of those who ditched). Eighth Air Force medical researchers also had to tackle a special aviator's disease known as aero-otitis, an inflammation of the middle ear caused by an inability to adjust between its internal pressure and that of the surrounding atmosphere. Aero-otitis was prevalent in all theaters because the cabins of most AAF planes had no pressure systems. It was especially troublesome among heavy bomber crews in Europe, and there was no agreement in the first two years of the war on how to treat the problem. A research program on aero-otitis was started in May 1944, concentrating on heavy bombardment crews in the Eighth Air Force. It soon became clear that the main cause was multiple descents after long flights at high altitude. Respiratory disease could also contribute to the ear inflammation. Some improvement was available from radium treatment of the lymphoid tissue around the eustachian tube opening, but no single prevention or cure was discovered. The non-effective rate from aero-otitis fell during the war, partly because of a fall in the rate of respiratory disease. There was no meaningful change in protective equipment, preventive measures, or indoctrination to cope with the problem. Fortunately, many other aeromedical problems were effectively confronted before the invasion of France. Highly successful throughout the war, CME personnel contributed to a significant reduction in flak-related injuries and deaths. Their training programs increased an airman’s chances of survival when ditching at sea, taught air and ground crews how to properly use and maintain equipment, and substantially reduced deaths due to issues caused by anoxia. Additionally, their dedication and attention to detail solved many of the problems that led to frostbite injuries, thus keeping hundreds of men from harm. These efforts, and many others, saved thousands of lives and helped the Allies remain fit to fight. 1Book (U), James S. Nanney, “Army Air Forces Medical Service World War II,” Air Force History and Museums Program, 1998, pp 19-24.