FAINTING AND FLYING<subtitle>AN ANALYSIS OF 500 CASES OF IMPAIRMENT OF CONSCIOUSNESS IN PILOTS AND AIRCREW</subtitle>

Abstract

1. Five hundred consecutive cases of impairment of consciousness among pilots and aircrew have been classified into three groups, neurogenic, cardiovascular, and emotional. 2. The three groups are ill defined and merge into one another, so that it is often difficult to say which is the predominant factor in any given patient. In 17 instances there was so much doubt that classification was impossible. 3. The neurogenic group comprised just under a quarter of the total, about half of them cases of epilepsy. The influence of fear as a causative factor of epileptic attacks seemed to be of more importance than is commonly supposed. 4. The cardiovascular group comprised rather over a quarter of the total. It was made up of a number of small groups in which cardiovascular inefficiency was the main element, either acting alone or in association with infection, fatigue, or with poor reaction to raised temperatures. 5. The importance of hypotension in relation to aviation medicine is discussed. While considered to be no certain bar to flying duties it is an indication for caution. 6. Rather under half of the cases were classified as emotional in origin, ranging on the one hand from the acute panic states to hysteria and simulation on the other. 7. An electroencephalogram was done on 299 of the patients. In the neurogenic group nearly 50 per cent. of the electroencephalograms pointed to an epileptic basis for the attack; in the other groups 15 per cent. were positive. A change in the electroencephalogram when repeated occurred in 11 instances. 8. The importance of obtaining a full history in all candidates for flying duties is stressed. 9. Hasty decision in recommending withdrawal from flying duties is to be deprecated. In many instances a period of observation in a ‘ground category’ does no harm, may assist in arriving at a definite diagnosis, and may eventually allow a return to flying. The greater part of the work on which this analysis has been based was done by the officers who worked at the Central Medical Establishment during the latter part of the war and to all of these I am deeply grateful. In particular I should like to thank Air Commodore H. L. Burton with whom I have discussed the subject many times both before and during the war, Wing Commanders N. S. Alcock and K. Latter for special help from the neuropsychiatric point of view, Wing Commander D. Williams for helpful criticism and for assistance over the electroencephalographic side of the analysis, and Squadron Leader W. K. Stewart of the Royal Air Force Physiological laboratory for help with decompression and ‘black-out’ tests. I should like also to thank the airmen and airwomen of the office staff, especially Warrant Officer J. A. Patchett, Sergeant J. R. Dean, Corporal G. G. James, and Corporal J. S. Young who have done so much to ensure that no cases should be missed and that medical records and documents should always be available for study.