Much has been written about the rivalry among the allied forces in World War I to claim the "honour" of having killed Manfred Freiherr von Richthofen, the "Red Baron" (1892-1918). This issue is still being debated periodically in aviation and veterans' magazines 80 years after his death. Here I review the Red Baron's military medical record, which has been made available to me by approval of his next of kin. It raises the question of whether von Richthofen should have been allowed to fly after having received a head injury during aerial combat on July 6, 1917.

Cadet von Richthofen

Von Richthofen entered the cadet corps on April 18, 1903, aged almost 11 years. His previous medical record showed a history of measles, chickenpox, and rubella. Eyesight was examined yearly and remained 6/6 throughout his brief career.

The medical record for that period is unremarkable with the exception of an injury to the right knee on June 12, 1909, that required a stay in hospital until July 3, 1909. A swelling of his right knee led to another short stay in hospital 1 year later. Surgery was successful and there is no mention of further knee problems during the remainder of von Richthofen's life.  

Military service

Von Richthofen began active military service on May 1, 1911, and served as a cavalry officer; therefore he was later given the title of Rittmeister (literally, riding master), the cavalry term for Captain. 4 years later in May 1915, he switched to the newly established flying force with the explicit goal of becoming a pilot rather than an observer. No mention is made of a medical examination before entering the German flying service in the autobiographies of either von Richthofen or of Ernst Udet, another famous fighter pilot of the period. There did not seem to be any special requirements or medical examinations to obtain clearance for flight duty among the guidelines of that time for troop fitness.

In his book The Red Air Fighter, von Richthofen mentions how he received his first wound on Sept 4, 1915, while flying on a bombing mission. He was still in training and therefore sitting in the observer's seat of a bomber. When he tried to point out where the bombs had hit, he grazed the little finger of his right hand on the propeller. In his own words, "This did not increase my fondness for bombing planes". He was grounded for 8 days. The diagnosis in his medical record was "complicated fracture of the right little finger tip" (figure 1). After initial examination he was transferred to a nearby naval hospital, where he received tetanus immunisation and his finger was splinted. The healing process was unremarkable and he was released from hospital on Sept 10, and declared fit for flying duty.

Von Richthofen remained healthy until July 6, 1917. Up to that date he had been credited with bringing down 57 enemy planes, been decorated with the Pour le Mérite ("Blue Max"), and gained celebrity status in Germany and among the allied forces. On June 25, 1917, he was made commander of the flying unit Jagdgeschwader I (literally, hunting wing I), which had been created the day before (it exists to this day as Jagdgeschwader Richthofen ). At that time the most successful German ace to survive the war, Udet, was credited with six victories in air combat; he ended the war with 62 victories on his record.  

Wounded

It is interesting to compare the two available accounts of von Richthofen's crash after he had been shot in the head during aerial combat on July 6, 1917. There is the version that has been published in his autobiography and the story as recorded by the physicians in the medical file. In his book, von Richthofen describes how he was about to attack a Vickers "bomber" and had not even taken the safety catch off his gun when the bomber's observer started to fire at a range of 300 m, a distance that von Richthofen considered to be too far away for "real" combat. In his own words, "the best marksman just does not hit the target at this distance". Suddenly there was a blow to his head and he was totally paralysed and blinded. After a great effort he was able to move his limbs again while sensing that his plane was in a dive; still he could not see. When the darkness slowly lifted he first checked his altimeter, which showed 800 m, a drop of 3200 m within a few moments. He reduced his altitude to 50 m and made a rough landing, when he realised he was going to faint again. He was able to get out of the plane and collapsed remembering only that he had fallen on a thistle and had not been able to move from the spot. After a drive of several hours in a motorcar he was taken to a field hospital.

The history in his medical file is very similar, noting that he did not lose consciousness in the plane. "His arms fell down, legs moved to the front of the plane. The flying apparatus fell towards the ground. At the same time he had a feeling of total blindness and the engine sound was heard as if from a great distance. After regaining his senses and control over his limbs, he estimated that the time of paralysis lasted for only a minute. He descended to an altitude of 50 m to find an appropriate landing spot until he felt that he could no longer fly the aircraft. Afterwards he could not remember where he had landed. He left the plane and collapsed." His memory of his transportation to the hospital was blurred. Upon arrival von Richthofen immediately told his physician that he had only been able to retain control of the aircraft because he had had the firm conviction that otherwise he would have been a dead man.

The initial diagnosis on reaching hospital was "machinegun (projectile) ricocheting from head". The stay in hospital was uneventful after surgery to ascertain that the bullet had not entered the brain.

Figure 2: July 1917, von Richthofen with his nurse Sister Käte at field hospital No 76 in Kortrik, Belgium, after having received a head wound during aerial combat

Von Richthofen stayed in the field hospital for 20 days until July 25, 1917 (figure 2). He left because he wanted to take command of his wing again. The skull wound was not closed, and the bare bone was probably visible until his death. He was advised not to fly until the wound in his head had healed completely. There is a special mention of the fact that even the surgeon in charge held this opinion in the medical file. It was also recorded that "without a doubt there had been a severe concussion of the brain and even more probable a cerebral haemorrhage. For this reason sudden changes in air pressure during flight might lead to disturbances of his consciousness". The record ends with the statement that von Richthofen promised not to resume flying before he had been given permission by a physician.
 

In the sky again

Kunigunde von Richthofen, mother of the Red Baron, recorded no unusual signs of depression or self doubt when her son was on vacation at home in June, 1917.⁷ Von Richthofen returned to flying duty on August 18, 1917, and was credited with his 58th aerial victory the same day. He was almost sick during this first flight after the injury, and on August 27, 1917, another piece of bone was removed from the open wound that still had a size of 2·5×2·5 cm.

A new chapter of The Red Air Fighter was added in the spring of 1918, in which von Richthofen mentioned his depression and melancholy when he thought about the future. He describes a totally different von Richthofen than the one who wrote the first edition of The Red Air Fighter. He feels unwell after each air combat and attributes this feeling to his head injury. After landing he stays in his quarters and does not want to see or to talk to anybody.

He also mentions the fact that he had been offered a desk job by "highest order". Von Richthofen's biographer Rolf Italiaander also mentions this incident and emphasises that the Kaiser himself had expressed this wish. Oberleutnant Bodenschatz makes no mention of it in his wing diary even though, according to Italiaander, he gave the message from the Kaiser to von Richthofen. An inquiry at the archives of the former ruling house of Prussia did not turn up such a written order. Von Richthofen refused to leave his wing. It is interesting to note that more than 50 years later during the Cold War Yuri Gagarin and John Glenn were denied a second spaceflight by their countries' leaders because they were heroes whose lives should not be risked.

At the end of January, 1918, when on another visit home, his mother noted the change in her son: she describes him as taciturn, distant, and almost unapproachable. She thought that he had changed because he had seen death too many times. 

Fitness for flying duty

Since there were no special rules concerning fitness to fly a combat aircraft, a general view of the ability to perform combat duty has to be considered to determine von Richthofen's ability to serve after his head injury.

In the general rules for determining fitness for military duty that were drawn up in peacetime, a head injury or malformation made a person ineligible for duty only if he could not wear appropriate headgear such as a helmet or cap. Pictures of von Richthofen during parades show him wearing a cap with his dressed head wound, so the rule did not apply in his case. Taking a more serious look at suitability for duty of wounded soldiers was necessary after the war dragged on and new replacements became scarce. A series of medical conferences was held in the autumn of 1916 sponsored by the Prussian Ministry of War concerning the evaluation of fitness for military and combat duty of soldiers who had received injuries or wounds. Kurt Goldstein (professor of neurology from Frankfurt am Main) gave a lecture on brain injuries and concluded that fitness for combat duty would only be restored in rare cases and that a qualified evaluation of the course of disease was necessary to make such a determination. He pointed out that only 20% of patients with a skull wound and only 4% of those with a brain injury wound were deemed fit for combat duty again. According to those recommendations, von Richthofen should not have been allowed to return to active flight duty since he was diagnosed as having a concussion and cerebral haemorrhage. The physicians and surgeons who treated him knew this, as can be concluded from their strong recommendation to von Richthofen not to fly before his head wound had completely healed.  

Killed in action

On April 21, 1918, von Richthofen was shot dead while on a patrol flight. He died just 2 weeks short of his 26th birthday. He was the most successful ace of World War I, and credited with 80 aerial victories. Many attempts have been made to answer the question of whether he was killed by a bullet from the air or ground. Some historians believe that he was shot down from the air by Captain Roy Brown, a Canadian serving in the Royal Air Force, although a hit from the ground cannot be ruled out. On the evening of April 21, 1918, an inspection of the body by a Captain and a Lieutenant of the British Royal Army Medical Corps showed an entrance wound on the right side of the chest in the posterior fold of the armpit; the exit wound was situated at a slightly higher level nearer the front of his chest, about half an inch below the left nipple and about three-quarters of an inch external to it. On April 22, 1918, the consulting surgeon and the consulting physician of the British 4th Army made a surface examination of the body. They found the wounds as described above "and also some minor bruises of the head [and] face. The body was not opened--these facts were ascertained by probing from the surface wounds". Thus ends the available medical record for the Red Baron.  

Conclusion

After reviewing the available medical information on von Richthofen and the state of the art in neurology and psychiatry at the time, I believe that the Red Baron should not have been declared fit for duty after the head wound he received on July 6, 1917. It is most probable that after having been released from the field hospital under the instruction to fly only after getting permission from a physician there were no further medical checks.

The times were such that manpower was sparse. An experienced ace and hero such as von Richthofen could not be grounded against his wishes for public relations reasons. Furthermore von Richthofen's sense of duty and comradeship would not have allowed him to desert his fellow soldiers while he still felt capable of aerial combat. 

Epilogue

It was not until 1975 that von Richthofen's remains found a (hopefully final) resting place. After his death he was first buried in a village churchyard at Bertangles near Amiens, France, with full military honours by the Commonwealth forces. Later the coffin was transferred to a War Graves Commission cemetery. During the Weimar Republic, the Invalidenfriedhof in Berlin--the Prussian equivalent of the US Arlington National Cemetery--was to become his resting place by wish of the German government and veterans' organisations. On Nov 20, 1925, he was reburied there. The German President Paul von Hindenburg as well as the Chancellor with nearly the whole cabinet were among the dignitaries present. Von Richthofen's reburial was seen as a symbol of homecoming that was appreciated by the many people whose loved ones were buried in foreign soil or missing in action.

In 1961 when the Berlin Wall was constructed, the Invalidenfriedhof was at the very edge of the demarcation zone in the Russian sector. It was only possible to visit the cemetery with special permission. For this reason von Richthofen's surviving brother, Bolko, who had been in charge of the transfer of the remains from France in 1925, got permission from the East German government to rebury the remains in the family burial plot in Wiesbaden before his death in 1971. The reburial book place in 1975. The original grave marker is kept by the Jadgeschwader Richthofen in Wittmund, Ostfriesland.

I thank Herrn Manfred Freiherr von Richthofen (nephew of the Red Baron) for inviting me to his home and giving me the opportunity to review the medical record that stayed intact despite two world wars. I am indebted to the British government for providing me with copies of the records of von Richthofen's postmortem examinations. The German military archives gave me a list of records concerning fitness tables for military duty before and during World War I. The Jagdgeschwader Richthofen's former Kommodore D G H Nowalk checked the facts and corrected the military terminology. I thank all those who helped in creating this manuscript. I am especially indebted to my friend and colleague David J Keblish for his criticism and encouragement