'Red Baron's' Fatal Fixation

Clinicians call it "perseveration," a brain dysfunction that causes people to persist in a task even when they know rationally that the chosen strategy is doomed and may even be mortally dangerous.

A new analysis suggests that perseveration caused by an earlier head wound is what led German pilot Manfred von Richthofen, World War I's fabled "Red Baron," to chase a British pilot into enemy airspace on April 21, 1918, allowing aircraft and ground fire to cut his red Fokker triplane to ribbons and kill him with a single bullet through the chest.

"He had target fixation and a mental rigidity," said University of Missouri clinical psychologist Daniel Orme. "He flew into a shooting gallery, violating all kinds of rules of flying -- rules from the manual that he himself wrote."

In a paper published in the autumn edition of the journal Human Factors and Aerospace Safety, Orme and co-author Thomas L. Hyatt, of Cincinnati's Veterans Administration Medical Center, describe how Richthofen's behavior changed after a British bullet dug a four-inch groove in his skull during a dogfight nine months earlier.

The authors, both of whom are retired Air Force clinicians, say Richthofen clearly suffered "traumatic brain injury." He brooded, behaved boorishly in public, and pulled childish stunts completely out of character for the careful predator whose 80 kills eclipsed those of all other World War I pilots.

"He said he had headaches, got sick when he flew and suffered fatigue," Orme said in a telephone interview. "Today the Air Force would have made him 'DNIF' -- Duties Not to Include Flying."

-- Guy Gugliotta

The Air in Smoky Taverns

The level of cancer-causing particles in the air is much higher in smoky bars and casinos than on truck-filled highways and city streets, according to the first-ever study comparing indoor air quality before and after a smoking ban.

The survey, conducted in a casino, six bars and a pool hall in Wilmington, Del., between November 2002 and January 2003, appears in the September issue of the Journal of Occupational and Environmental Medicine.

"This research clearly shows that it is far worse for your health to be a bartender or casino dealer in a smoking-permitted establishment than it is to be a turnpike toll collector," said James L. Repace, a visiting assistant clinical professor at Boston's Tufts University School of Medicine.

Workers in the establishments breathed 90 percent cleaner air after the ban was imposed to guarantee smoke-free workplaces, Repace said, adding that "ventilation measures are doomed to failure."

In the eight venues Repace surveyed before the ban, indoor levels of fine particles that can penetrate deep into people's lungs and cause respiratory problems were 20 times greater than the outdoors and 4.6 times higher than the level permitted under the Environmental Protection Agency's national ambient air quality guidelines. Hospitality workers were exposed to concentration levels that were 2.6 times higher than those Repace measured on Boston streets and Interstate 95 in Delaware.

After the ban, however, indoor air quality matched outdoor levels, with the exception of a concentration of chalk dust in the pool hall.

"Only a smoke-free workplace law can protect the health of these workers," Repace said.

-- Juliet Eilperin

Debate Over Removing Tonsils

Removing children's tonsils is not nearly as common in the United States as it was a few decades ago, as more doctors have come to the conclusion that the surgery's ability to reduce the frequency of throat infections had been overrated. But about 50 of every 10,000 U.S. children still undergo the surgery each year, and the rates in Europe are even higher -- evidence of lingering differences of opinion about the procedure's value.

To help settle the issue, doctors in the Netherlands randomly sorted 300 patients with chronic throat infections, ages 2 to 8, into two groups: one that had their tonsils and adenoids removed within six weeks, and another that did not.

After an average follow-up period of 22 months, those who had the surgery had tallied 0.56 throat infections per person per year, while those who did not have the surgery had 0.77 infections -- a difference that was barely significant by statistical analysis but which, in the opinion of the doctors, was not of notable medical significance.

The doctors found slightly greater benefit for children who had three to six infections in the previous year, compared with those who had fewer.

But they also warned that 6 percent of those operated on had complications, including two who had to undergo additional surgery to deal with bleeding.

The surgery, they concluded in Thursday's online issue of the British Medical Journal, "has little clinical benefit" for most children.

-- Rick Weiss

Manfred von Richthofen, the WWI pilot called the "Red Baron."