H. STEWART .4, D=



MEDICAL DEPARTMENT

UNITED STATES ARAIY

IN WORLD WAR II
NOTE

This volume was written under the direction of Col. John Boyd Coates, Jr., MC, USA.

and Col. Arnold L. Ahnfeldt, MC, USA (Ret.), former Directors and Editors in Chief,

The Historical Unit, U.S. Army Medical Service.

Robert S. Anderson,

Colonel, Medical Corps.

Editor in Chief.
MEDICAL DEPARTMENT, UNITED STATES ARMY

PHYSICAL STANDARDS IN

WORLD WAR II

Prepared and published under the direction of

Lieutenant General Leonard D. Heaton

The Surgeon General, United States Army

Editor in Chief

Colonel Egbert S. Anderson, MC, USA

Editor for Physical Standards

Charles M. Wiltse, Ph, D., Litt. D.

OFFICE OF THE SURGEON GENERAL

DEPARTMENT OF THE ARMY

WASHINGTON D.C., 1967
PHYSICAL STANDARDS IN WORLD WAR II

Advisory Editorial Board

Colonel Arthur H. Nylen, MC, USA (Ret.), Chairman

Colonel Richard N. Fanes, MC, USA (Ret.)

Colonel' Arden Freer, MC, USA (Ret.) (Deceased)

Colonel Cornelius E. Gorman, MC, USAR

Colonel Harold E. Opsahl, MC, USA (Ret.)

Colonel Robert S. Anderson, MC, USA (ex officio)

The Historical Unit, United States Army Medical Service

Colonel Robert S. Anderson, MC, USA, Director

Charles J. Simpson, Executive Officer

Hazel G. Hike, Chief, Administrative Branch

Ernest Elliott, Jr., Chief, Editorial Branch

Roderick M. Engert, Chief, General Reference and Research Branch

Charles M. Wiltse, Ph. D., Litt. D., Chief, HistoriansBranch

Lieutenant Colonel Gilbert A. Bishop, MSC, USA, Chief, Information Activities Branch

Lieutenant Colonel Frederick Bell, Jr., MSC, USA, Chief, Special Projects Branch

Library of Congress Catalog Card Number: 67-60002

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D.C. 20402 Price $3
PHYSICAL STANDARDS IN

WORLD WAR II

by

Colonel William B. Foster, MC, USA (Ret.)

Ida Levin Hellman, M.Sc.

Lieutenant Colonel Douglas Hesford, MSC, USA

and

Captain Darrell G. McPherson, MSC, USA

MEDICAL DEPARTMENT, UNITED STATES ARMV

The volumes comprising the official history of the Medical Department of

the U.S. Army in World War II are prepared by The Historical Unit,

U.S. Army Medical Service, and published under the direction of The Surgeon

General, U.S. Army. These volumes are divided into two series: (1) The

administrative or operational series; and (2) the professional, or clinical and

technical series. This is one of the volumes published in the latter series.

VOLUMES PUBLISHED

ADMINISTRATIVE SERIES

Hospitalization and Evacuation Zone of Interior

MedicalService in the Mediterranean and Minor Theaters

Organization and Administration in World WarII

Personnel in World War II

CLINICAL SERIES

Internal Medicine in World War II:

Vol. I. Activities of Medical Consultants

Vol, II. Infectious Diseases

Neuropsychiatry inWorld War II

Vol. I. Zone of Interior

Preventive Medicine in WorldWar II:

Vol. II. Environmental Hygiene

Vol. III. Personal Health Measures and Immunization

Vol. IV, Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts

Vol. V. Gommunicable Diseases Transmitted Through Contact or By

Unknown Means

Vol. VI. Communicable Diseases: Malaria

Vol. VII. Communicable Diseases: Arthropodborne Diseases Other

Than Malaria
Surgery inWorld War II:

Activities of Surgical Consultants vol.

Activities of Surgical Consultants vol. II

General Surgery vol. II

Hand Surgery

eurosurgery. vol.

Neurosurgery vol. II

Ophthalmology and Otolaryngology

Orthopedic Surgery in the European Theater of Operations

Orthopedic Surgery in the Mediterranean Theater of 0perations

The Physiologic Effects of Wounds

Thoracic Surgery vol.

Thoracic Surgery vol. II

Vascular Surgery

Miscellaneous:

Blood Program in World War II

Cold Injury Ground Type

Dental Service in World War II

Radiology in World WarII

Veterinary Service in World WarII

Wound Ballistics
oreword

There is no subject more immediately pertinent for military planning than

physical standards. An Army is built of men who must be physically and

emotionally fit to withstand the rigors and hardships of combat in any part

of the world, from steaming jungle or blazing desert to the perpetual ice and

snow of the Arctics, and from sandy or rugged coastlines to craggy mountain

peaks.

The minimum qualifications will necessarily be established in terms of the

number of men required, with due consideration being given to the numbers

needed for essential backup roles in industry, agriculture, transportation, and

other supporting services. Within this broad framework, however, there is an

inescapable factor of judgment, exercised first by those who prepare the standards and second by those who apply the norm to the individual case. Disabling

physical conditions are frequently matters of degree and are almost always

function of assignment. The tanker, for example, does not need the sturdy feet

of the infantryman. The discriminating hearing required for radio communications is not essential for supply handling or computer programming. Visual defects that would be fatal to fighter pilot offer no bar to outstanding

performance in one of the supply services.

Although the development of physical standards for the guidance of local

draft boards was initially the responsibility of the Selective Service System,

they were worked out in close association with the U.S. Army Medical Department and were administered by Army medical examining boards. method

of classifying and easily describing physical capacities of individuals procured

by the Selective Service was needed to provide for equitable distribution of

available manpower among the Armed Forces. For this purpose, system of

physical profiling was devised. At later stage, men already in the Army were

classified under the Physical Profile Serial System according to their capacities

for various military assignments.

Not only are the changing standards themselves delineated in this volume of

the history of the Medical Department of the United States Army in World

ar IT, but also the evolution of the whole concept of physical standards, as

the war made deeper and deeper inroads into our manpower reserves, is explored. Col. William B. Foster, MC, and his collaborators have underlined for

us one of the most useful lessons of the war—in total conflict we must call upon

our total resources, human as well as material. We must assume, moreover, that

in the present era of intercontinental ballistic missiles we shall not have time

for the leisurely M-day contemplated in the mobilization plans that preceded

World War II. Instantaneous readiness becomes essential for successful response to future combat operations.

257-966'"—67
FOREWORD

It behooves us to be ready with standards flexible enough to fill and to

maintain at full strength the ranks of the Armed Forces, at the same time

allowing no important supporting service to suffer critical shortage of

personnel. The authors of “Physical Standards in World War II” have given

us pertinent and valuable guidelines. To disregard them for the future would

be to invite disaster.

Leonard I). Heaton,

Lieutenant General

The Surgeon General.
Preface

history of the U.S. Army Medical Department’s role in the development

and application of physical standards in 'World War II has been intermittently

in preparation for several years. Many individuals have participated—by

research, by writing drafts, by making available firsthand knowledge and

experience, and by providing the necessary support services. Those whose

contributions were extensive enough to qualify them as coauthors of the present

volume are Col. William B. Foster, USA (Ret.), Ida Levin Heilman, M. Sc., Lt. Col. Douglas Hesford, MSC, and Capt. Darrell G. McPherson, MSC.

(Colonel Foster, besides being an author of the volume, contributed to the

development of the standards themselves, as head of physical standards subdivision in the Surgeon General’s Office during the prewar mobilization period,

as chief of the Physical Standards Branch during the war, and as the senior

medical member of the Secretary of War’s Separation Board after midJanuary 1944. Among his responsibilities in the latter position, Colonel Foster

served as the chief adviser on matters pertaining to physical standards.) Also

deserving of special mention are Col. Esmond R. Long, MC, who wrote on

the tuberculosis problem, and Col. Richard II. Fanes, MC, formerly chief

medical officer for the Selective Service System. The manuscript was put into

its final form under the immediate direction of Dr. Charles M. Wiltse, Chief

Historian, The Historical Unit, U.S. Army Medical Service.

In addition to these various contributors, special thanks are due to the

members of the Advisory Editorial Board, who guided the project from its

early stages and reviewed its progress at every step; to Col. John Boyd Coates,

Jr., MC, Director of The Historical Unit during much of the time that this

history was in preparation; and to Lt. Col, William P. Chambers, MSC, who

served as project officer at critical time in the development of the volume.

Others whoread and commented upon one or more manuscript drafts are Lt. Col.

Ivan C. Berlien, MC, Maj. Paul E. Chevey, MC, Col. Santino J. Lerro, MC,

Col. John F. Lieberman, MC, Miss Elizabeth McFetridge, M.A., Col. Clark B.

Meador, MC, and Col. Raymond W. Waggoner, MC, The contributions of

each and all of these are gratefully acknowledged.

Thanks are also due to the successive chiefs of the Special Projects Branch

of The Historical Unit, who had large responsibilities in connection with tins

study. In chronological sequence, these were Col. Charles A. Pendlyshok,

MSC, Lt. Col. Matthew Ginalick, MSC, Lt. Col. Douglas Hesford, MSC, Lt.

Col. Frederick Bell, Jr., MSC, Lt. Col. Gilbert A. Bishop, MSC, and Lt. Col.

Harvey E. Meagher, MSC.
PREFACE XII

Neither should the services of the General Reference and Research

Branch, nor of the Editorial Branch be overlooked. Chiefs of the General

Reference and Research Branch who worked on the project were Mrs. Josephine P. Kyle, Mrs. Lucy W. Lazarou, Maj. Albert C. Riggs, Jr., MSC, and

Mr. Roderick M. Engert. In the Editorial Branch, Mrs. Marjorie G. Shears,

Editor (Printed Media), edited the manuscript, processed the artwork, and

prepared the index.

few words of further explanation are in order here. It will be noted that

the reprinting of key regulations as appendixes gives to the volume something

approaching documentary character. Only by including this appendix material

has it been possible to effect the degree of compression exhibited in the text.

By the same token, however, it is believed that the needs of future mobilization planning will be better served by these documents themselves than by

the extensive summaries of their provisions that would otherwise be necessary.

As it stands, “Physical Standards in World War II” is compact, succinct,

complete for all practical purposes, and it is believed more useful than more

detailed treatment would be.

Robert S. Anderson,

Colonel Medical Corps

Editor in Chief.
Prolog

The influence of physical stamina and mental attitude upon military

efficiency has been understood from the most ancient times. In the Old Testament of the Bible, for example, the Book of Judges tells how Gideon selected

300 men from more than 30,000, and how by daring, discipline, and “psychological warfare” this little band of picked warriors defeated vastly larger

force of Midianites. Strength, endurance, and the will to excel also were

stressed in the most successful armies of the pre-Roman world—the Persians,

the Spartans, and the Macedonians.

The Romans went further still, refining and reducing these qualities to

broadly applicable rules. According to Flavius Vegetius, 4th century commentator whose De Re Militari was still being studied in 15th century

Europe, the ideal soldier should possess “a lively eye,” carry his head erect,

and be broad of chest with muscular and brawny shoulders. His fingers should

be long, his arms powerful, his legs and feet rather “nervous than fleshy.” If

his waist was small and “his shape easy,” his height did not greatly matter to

this influential analyst of the art of war. It was of more importance to the

Emperor Valent in ian who established feet inches—above average for

Roman—as the most desirable height, judgment no doubt influenced by

Valentinian’s own battles against the taller Goths. In age, the Roman soldier

was normally between IT and 45 years, but he might be retained in the service

until the age of 65, if the need for troops were urgent.

Physical prowess alone, of course, was not the key to Roman military

might; the key lay, as it does today, in organization, discipline, mobility,

weapons, tactics, and leadership. Rome remained for thousand years the

world’s greatest military power because her armies were variously composed

of large or small units, of infantry or cavalry, of light-armed or heavy-armed

men, as the circumstances of the individual campaign required; and because

the arms at her disposal, ranging from the short, stabbing sword of the infighter

to the ingenious catapult for attacking walled cities, were superbly made and

excellently used. Strength and stamina were tempered by imagination, knowledge of the enemy, and technological skill.

Roman standards were not improved upon, and seldom equaled, until

very near to our own era. The language was less precise but the meaning was

the same when the Continental Congress in July of 1775 provided that all ablebodied effective men between 16 and 50 years of age be formed into militia

companies. Even more hazy were the standards applied in the Regular Army,

where lack of time and rapid shifts of battle made any kind of physical

examination almost an impossibility. Men were recruited in most instances
XIV PROLOG

“by judicious combination of emotionalism, martial psychology, and rum.”

The fierce desire of the recruiting officers to meet quotas, then as now, overcame

their judgment.

More successful was Baron von Steuben’s handpicked Corps d’Elite. Von

Steuben, in the spring of 1777, was an unemployed Prussian captain whose

services, despite proven ability of high order, had been turned down by

France, Austria, and the Margrave of Baden. Through the French minister

of war, he came to the attention of the American commissioners, Benjamin

Franklin, and Silas Deane. The Americans immediately recognized his potential value to their cause but realized also that as mere captain he would

have little impact. Von Steuben proved to be as good an actor as he was

soldier. Sponsored by Franklin and Deane, he arrived in Portsmouth, N.IL.

with suitable entourage, billed as lieutenant general in the service of the

King of Prussia. He quickly proved his worth at Valley Forge and, with

legitimate commission as major general in the Continental Army, was

appointed Inspector General by Congress at Washington’s request. The Corps

d’Elite, made up of robust and well-proportioned men of good military bearing,

generally between the ages of 20 and 30 years, was one of his innovations. So,

too, was the counterbalancing Corps of Invalids, composed of men physically

fit only for garrison duty, perhaps the first application of the idea of limited

service in this country.

set of physical standards for the U.S. Army and Navy was proposed

unofficially in 1808 by Dr. Edward Cutbush, whose observations, based on his

own experience as naval surgeon, were tailored to the society in which he

lived. He emphasized the necessity for recruiting men free from disease and

capable of undergoing “necessary fatigues inseparable from military life,”

preferably men from the country who were “generally accustomed to bear the

vicissitudes of the weather, to the carrying of burdens,” and were “more active

and sober” than the city dweller.

Doctor Cutbush recommended thatrecruits be inspected by medical officer.

Examination was to establish that the men were apparently sound, withperfect

limbs, and were free from ulcers and venereal disease. It was to reveal, also,

existence of rupture, the itch, or “scrophula.” He felt strongly that those who

appeared to be habitual drunkards always should be rejected. “The cost of men

of this description to the Government, who are generally subject to swelled and

ulcerated legs, besides being for long time unfit for service, is very considerable.” Observing movements of the body and the limbs in various positions was

stressed. He subscribed to the view that “compressed breast,” pale face, and

dulleves were indications of bad health.

Kriedberg, Marvin A., and Henry, Merton G. History of Military Mobilization in the United

States Army, 1775-1945. Washington: U.S. Government Printing Office, 1955. (DA Pamphlet 20-212.)

Fanst, Albert B. Inspector General Frederick William von Steuben. Steuben Society of America,

1927. Encyclopedia Americana. Americana Corp., New York, Chicago, Washington, 1957, vol. 25, p. 634.

Cutbush, Edward Observations on the Means of Preserving the Health of Soldiers and Sailors. Philadelphia Fry and Kammerer, 1808.
PROLOG XV

“constrained gait and bow legs” Dr. Cutbush found contrary to the requirements of military service. Swollen legs showed disposition to disease,

although this symptom might be transient and only the effect of fatigue. Difficulty of respiration, an habitual cough, ulcers, and scars from “the

scrophula”—all were reasons for rejection. “The mutilation of noble parts,

hernia, obstructions, etc.” were described as imperfections rendering man incapable of military service. Those with blindness in one eye, those lame or

hunchbacked, or those with “a disagreeable effluvia arising from his body,”

fistulous and watery eyes, loss of part of fingers or toes, “who is meagre in

the extreme,” or whose abdomen was very large—all were declared unfit for

service. Stuttering likewise was considered disqualifying imperfection.

In addition to choosing healthy men, Dr. Cutbush subscribed to choosing

good-looking men to the extent that “the figure, for the profession of arms,

ought not to be defective.” Recruits were to be active and courageous and their

character and temperament evaluated. The practice of identifying “the lively,

quick, and hardy” was recommended as means of identifying potential heroes.

Although his observations had no official standing, Dr. Cutbush was clearly

the inspiration for the first specific regulations governing the examination of

recruits, issued as an accompaniment of war in 1814.All “free” (this was the

customary language employed to exclude slaves) able-bodied men between the

ages of 18 and 35 years who were active and free from disease were welcomed

into the Army, but their healthiness had to be demonstrated. Recruiting officers

were expressly forbidden to accept any man having “ulcerated legs; scaled head,

rupture, or scurvy,” who was an habitual drunkard, or was known to have

epileptic fits or “other infirmity.” An officer enlisting such man and any surgeon who certified his fitness for service was subject to dismissal. Men being

examined were required to strip so that it could be ascertained that they had perfect use of every joint and limb and that therewere no tumors, diseased enlargement of bones or joints, sore legs, or rupture.

By 1841, these standards had become somewhat more detailed and included

for the first time mental qualification. Surgeons, Assistant Surgeons, and

private physicians examining prospective recruits were directed to—

cause each recruit to be stripped of all his clothes, and to move about and exercise

his limbs in their presence, in order to ascertain whether he has the free use of them; that

ids chest is ample; that his hearing, vision, and speech are perfect; that he has no tumors;

ulcerated or extensively cicatrized legs; rupture, chronic cutaneous affection, or other

disorder or infirmity, mental or physical, which may render him unfit for the active duties

of soldier, or be the means of introducing disease into the Army; and they will ascertain,

as far as practicable, whether the recruit is an habitual drunkard, or subject to convulsions

of any kind, or has received any contusions or wounds of the head, which may produce

occasional insanity. With any of these defects, the man will be rejected as unfit for service.

The Civil War saw little change in official standards in its early stages.

Both sides relied essentially upon the regulations of 1841, but neither followed

Military Laws and Rules and Regulations for the Army of the United States. Washington

Adjutant General's Office, 1814. pp. 257—258.

General Regulations for the Army of the United States, 1841.
XVI PROLOG

the standards rigorously. The system broke down completely for the North with

the early adoption of the draft. Any man called for service might, if he could

afford it, hire substitute, and apparently there was not even an attempt to

apply tests of physical fitness to these mercenaries. The South, relying largely

upon volunteers, did nothing until the supply grew scarce. The illness rate was

high because examination of recruits was lax, but the response was not to tighten

enforcement but to lower standards so far as to admit men blind in one eye, men

suffering from functional heart trouble, and even epilepsy. Northern standards,

as the war progressed, were not tampered with but were more and more

consistently ignored.

The need for physical fitness in officers and enlisted men seems to have become crystallized between the Civil War and the Spanish-American War. While

numbers of physically unfit men did enter the Army during the Spanish-American War, this did not occur nearly to the extent that it did during the Civil

War. Reasons for this were probably that service was completely voluntary because lesser number of men were required for military duty and that the procedure of hiring substitutes during the Spanish-American War was eliminated.

It is noteworthy that at this time, for the first time in the history of military

service in this country, physical examination was conducted on discharge.

The physical standards of the pre-World War period, as contained in

War Department General Orders No. 66, dated 18 April 1910, were relatively

severe. This was derived from the ability of the Army to maintain the authorized strength of the small regular force by voluntary enlistments. Moreover, it

was achieved without the necessity of accepting physically undesirable men. At

the time the United States entered the First World War in April 1917,no physical standards existed for classifying men who were drafted into theArmy. When

the Selective Service Act was passed, it was at once apparent that the physical

standards in force for the Regular Army must be materially lowered. These

standards were found to be prohibitive to obtaining sufficient manpower for

rapid expansion of wartime army. The ability to secure sufficient numbers

from age groups liable to the draft was the critical factor.

The first revision of prewar physical standards was prepared by The

Surgeon General in early summer of 1917. It was published by the Provost

Marshal General on July 1917 as “Regulations Governing Physical Examinations Under the Selective Service Act.” It should be noted that these revised

standards related to registrants under the draft act only. Higher prewar

requirements were still applicable to those applying for voluntary enlistment.

Unfortunately, causes for rejection, as stated in these regulations, were of

very general nature with regard to many defects. For example, the only cause

for rejection under the heading “mental” was “lack of normal understanding.”

“(1) Adams, George W.: Doctors In Blue. New York: Henry Schuman, 1941, pp. 11 and 43. (2)

Cunningham, Horace H.: Doctors in Gray. Baton Rouge, La. Louisiana State University Press, 1958,

pp. 163—165.

War Department General Orders No. 124, 20 Aug. 1898.

The Medical Department of the United States Army in the World War. Washington Government

Printing Office, 1923, vol. I, pp. 272-276.
PROLOG XVII

Subsequently, pamphlet entitled “Instructions for the Physical Examination of Drafted Men at National Army Cantonments” was prepared by The

Surgeon General. It was given to all medical officers in camps for their information and guidance. This pamphlet brought together under one cover various

memorandums which had been previously issued by The Surgeon General in

explanation and interpretation of published physical standards for the draft. It also included instructions and details of procedure to be applied to physical

examinations conducted at camps and other military stations as well as copy

of instructions issued by Selective Service to local boards.

The pamphlet reached mobilization camps shortly before the first registrants arrived to receive their final-type examination. Unfortunately, it had

not been furnished to examining physicians at local selective service boards.

Examining physicians at Army camps, thus, were aware of the criteria used

at local boards, while examining physicians at the latter were ignorant of

examining criteria used at Army camps.

Standards used by local boards were slightly higher for some defects, lower

for others, as compared to standards being used at mobilization camps. For

example, Army standards were more rigid in relation to defects of the spine,

teeth, lungs, and heart, but less so for the feet and weight requirements. Under

mental defects, registrants who showed that they Avere mentally deficient or had

mental disease, including psychopathic personality and psychoneuroses, were

to be rejected by camp medical examiners. At the same time, examining physicians at local boards were being guided by the term “lack of normal understanding” as basis for rejection. It naturally followed, therefore, that many

registrants judged acceptable and inducted by local boards were rejected and

sent home as unfit by examining physicians at mobilization camps.

second revision of physical standards for drafted men, published as

part VIII of Selective Service Regulations on November 1917, was designed

to eliminate these differences. Very few fundamental changes characterized this

revision, but it did bring local board standards into line with those used at

mobilization camps. It combined certain modifications and changes made since

the original publication of July 1917. In addition, certain physical requirements were more clearly defined and made more specific. Most significant,

however, was reference for the first time to the class of substandard men later

to be taken into the Army for“limited service.”

The revision of November 1917 was in effect only for short period.

subsequent revision, entitled “Revision of Physical Examination Requirements,

Selective Service Regulations, Change No. 3,” dated 28 January 1918, was

written by board of medical officers appointed by The Surgeon General.

novel feature of this change provided for unconditional acceptance of registrants having “remedial defects.” Army hospital facilities and personnel were

totally inadequate to accomplish the ensuing wholesale reclamation of unfit

men in the midst of war activities. For this reason the third change was not

considered success. Significantly, however, it made it unnecessary for physi-
PROLOG XVIII

cians at local selective service boards to make complete examinations of

registrants after disqualifying defect was discovered or after condition

was revealed that necessitated referring the case to medical advisory boards.

On 24 February 1918, the “Manual of Instructions for Medical Advisory

Boards” (Form 64, Provost Marshal General's Office) was published as guide

for this important function.

Change No. too was soon abandoned and, again, The Surgeon General

convened board of medical officers to compile workable revision. As result,

many changes were made, and more thorough and practicable revision was

published for immediate implementation. Induction of registrants with “remediable defects” ceased. Instead, they were classified as “deferred remediable

group” and were eligible for call when wanted. Also, with this revision, and

for the first time, the same standards were fixed for draftees and for voluntary

enlistees. few minor modifications and changes in these standards were made

in the summer of 1918. In general, however, it may be said that this latest

revision stood the test of inducting new men into uniform during the months

of greatest war activity. Basically, the combination of instructions contained

in the “Regulations Governing Physical Examination Under the Selective

Service Act” with later revisions, and the “Manual for Instructions for

Medical Advisory Boards,” constituted the physical standards until the end

of World War I, and established basis for the planning that preceded

World War II.
Contents

Page

FOREWORD IX

PREFACE XI

PROLOG XIII

Chapter

Development and Administration of Physical Standards

Historical Note

Organization

Regulations

Selective Service Coordination

Induction Procedure Developments 11

Conclusions 14

II Fluctuation of Physical Standards According to Manpower Needs: Higher

Manpower Requirements—Lower Entrance Standards 15

Introduction 15

Policy on Rehabilitation for Induction 17

Limited Service for Inductees 19

Dental Standards 21

Vision 24

Hernia 27

Venereal Diseases 27

Tuberculosis 30

Mental and Personality Disorders 36

Conclusions 42

III Mobilization Standards and Procedures for Officers and Special Categories 43

Officers’ Reserve Corps and National Guard 43

United States Military Academy 53

Officer Candidate Schools 53

Reserve Officers’ Training Corps 55

Female Components 56

Army Specialized Training Program 61

Army Specialist Corps 62

Conclusions 62

IV Personnel Classification and Retention Policies 65

Classification Problems 65

Limited Service for Enlisted Men 76

Redeployment of Personnel From Europe to Pacific Area to Engage in

War Against Japan 82

Reclassification of Officers 86

Civilian Personnel in the Army of Occupation 93

Conclusions 93
XX CONTEXTS

Chapter Page

Separations 97

Line-of-Duty Determination 97

Separation of Enlisted Personnel 100

Misuse of Medical Channels for Disposition of Personnel 108

Officer Disability Retirement 110

Physical Evaluation Upon Demobilization 117

Conclusions 125

Epilog 126

APPENDIXES

Mobilization Regulations No. 1-9, 31 August 1940 129

Mobilization Regulations No. 1-9, 19 April 1944 161

Army Regulations No. 40-105, 29 May 1923, and Army Regulations No.

40-105, Changes No. 5, 17 August 1940 209

Army Regulations No. 40-100, 16 November 1942 249

Army Regulations No. 40-110, December 1942 259

Tabular Summary of Physical Standards 275

INDEX 345

Illustrations Figure

Col. Joseph R. Darnall, MC

Col. William B. Foster, MC

Col. Cornelius E. Gorman, MC

Col. Richard H. Eanes, MC

President Roosevelt speaks at ceremony when first inductees are determined by

lottery, 29 October 1940

Inductees wait to be examined at Fort Douglas, Utah, March 1942 12

young inductee is examined at Camp Beale, Calif., November 1944 16

selective service enrollee gets his teeth examined at South Armory, Boston,

January 1941 22

Brig. Gen. Charles C. Hillman, MC 32

10 selectee receives chest X-ray as part of his physical examination at Fort

Douglas, Utah, March 1942 34

11 Col. Esmond R. Long, MC 35

12 WAAC enrollee being inoculated for protection against fever and disease in

future assignment 59

13 Individuals in service troops undergoing physical examination for combat

duty at the 619th Clearing Station, Saverne, France 66

14 An enlisted man receives his physical examination before being separated at

Camp Beale, Calif., November 1944 120
CONTEXTS XXI

Tables Number Page

Physical profile serial 69

Distribution quotas, expressed in percentages of totals available, to the three

major commands, May 1944 74

Enlisted men separated from the Army on certificates of disability for discharge

for disease, 1942-45 106

Enlisted men separated from the Army on certificates of disability for discharge,

1942-45 107

Charts

Typical wartime organization chart, Professional Service, Office of The Surgeon

General, August 1942

CHAPTER

Development and Administration

of Physical Standards

HISTORICAL NOTE

Any collection of regulations created to differentiate between various states

of physical or mental well-being or capacity and used to determine suitability

for acceptance or retention in the Armed Forces may be called physical standards. Such standards are sometimes very simple. When Ethiopia was faced with

aggression before World War II, the only physical requirement for the induction of men into the Armed Forces was that they be strong enough to carry arms.

Standards become much more complicated in large, modern countries when

they are pressed for manpower. For example, in 1911, the U.S. Army would

accept for limited service, men with minimum vision of 20/400 in each eye, without glasses, provided this be correctable to 20/40 in one eye and to 20/70 in the

other, or 20/30 in one eye and 20/100 in the other, and further provided that the

men pass the minimum requirements for all other anatomical parts and conditions of health, set forth in equally complicated combinations and subject in

each case to judgment of an examining physician or board (appendix B, p. 101).

The U.S. Army depended on physical standards during World War II to

provide the Nation’s defense system with the best qualified soldiers from the

available supply of manpower. When the Army is small or manpower is plentiful, standards may be very high. It is then possible to require that person be

completely free of almost all physical and mental defects if he is to be accepted

into the Army. As the need for men increases in time of war or national crisis, or

when the size of the manpower pool decreases, standards for vision, condition of

teeth, musculoskeletal defects, and many others must be lowered to allow the

induction of an adequate number of men. It is then that the standards must be

formulated and administered with greatest care. When standards are low, many

people with physical defects will be inducted, but if the standards have been

wisely devised and efficiently used, these people should be capable of making

valuable contributions to the Army, without risk that they may become medical

or financial burdens, or danger to the health of others.

The Army Medical Service has three-fold concern with physical standards: (1) Writing the standards to meet the needs of the country, (2) applying

the standards during entrance or separation physical examinations, and (3)

keeping personnel physically qualified to meet such standards between accept-
PHYSICAL STANDARDS

ance and separation through the application of modern principles of preventive

and curative medicine.

The development of physical standards in the United States has paralleled

the increase of knowledge in medicine and the growth of the Armed Forces.

Need for the establishment of and the enforcement of standards was recognized

as early as the American Revolution. It was emphasized during the Civil War

when, partly as result of inadequate entrance examinations, thousands of unfit

soldiers, many of them hired substitutes for draftees, overloaded hospitals and

clogged highways. As the country became more democratic, public opinion rejected the use of substitutes, and claims against the Government for disabilities

incurred in the service were more often recognized. Physical standards used in

induction and in separation examinations then became the basis for decision in

claim cases.

The Army had written complex aggregation of physical standards into its

regulations long before the United States became actively involved in World

War I, but no adequate method of administering mass inductions into the Armed

Forces had yet been devised. The selective service procedures used at that time

were born of necessity and were not perpetuated. This experience, however, had

reeemphasized the importance of physical standards in the medical selection of

personnel for the Army in peace or war. Standards were reviewed, organized,

incorporated into Army Regulations, and issued after World War as AR 40-

105, “Standards of Physical Examination for Entrance into the Regular Army,

National Guard, and Organized Reserves,” dated 29 May 1923 and Changes No.

5, dated IT August 1940; AR 40-100, “Standards of Miscellaneous Physical Examination,” dated 16 November 1942; and AR 40-110, “Standards of Physical

Examination for Flying,” dated December 1942. Over the next decade, they

became integral parts of the mobilization plans evolved under authority of the

National Defense Act of 1920. (Appendixes C, p. 209; D, p. 249; and E, p. 275.)

Mobilization plans were brought up-to-date late in 1932 with publication by

the War Department of MR (Mobilization Regulations) 1-5, “Standards of

Physical Examinations During Those Mobilizations for Which Selective Service is Planned,” on December. MR 1-5listed physical defects which an individual might have and whether these defects disqualified him for military service

as an enlisted man. The regulation also outlined examination techniques and

suggested means of detecting malingerers.

With war visibly approaching in Europe in the late 1930’s, mobilization

planning in this country assumed new urgency, culminating in the Selective

Training and Service Act of September 1940, the first peacetime draft in the

Nation’s history. The Surgeon General had anticipated the passage of this Act

and its called-for increase in manpower by having new mobilization physical

standards prepared. These standards were contained in an updated version of the

1932 Mobilization Regulations, retitled MR 1-9,“Standards of Physical Examination During Mobilization,” issued on 31 August 1940 (appendix A, p. 129).

The 1940regulation made provision for advances in medical procedures, but the
DEVELOPMENT AND ADMINISTRATION

physical requirements outlined were still relatively high, based on plans for an

Army far smallerthan events would soonrequire.

In addition to the new standards for enlisted men, MR 1-9 provided that,

in the event of mobilization, AR 40-105, which provided high standards for

most enlisted and officer personnel entering the Army before mobilization, was

to continue to govern selection of candidates for commission in the Army; AR

40-110 was to continue to apply to commission in the Air Corps; and AR 40-100

was to continue to govern appointment of Army nurses, warrant officers, and

candidates for the U.S. Military Academy. At the outset, the provisions of MR

1-9 were applicable equally to both selective service and Army examinations.

ORGANIZATION

The organization back of the creation of physical standards was located

in the Surgeon General's Office. In the years preceding World War II, responsibility for administering physical standards was assigned to the Professional

Service Division. Before mobilization, all work of this nature was portioned out

to subdivisions which had major responsibilities for related areas. Lt. Col. (later

Col.) Joseph R. Darnall, MC (fig. 1), had coordinating responsibility for the

Figure 1.—-Col. Joseph R. Darnall, MC.

For an excellent summary of mobilization activities, see Kreidberg, Marvin A., and Henry,

Merton G. History of Military Mobilization in the United States Army, 1775-1945, Washington

U.S. Government Printing Office, 1955. (DA Pamphlet 20-212.)
PHYSICAL STANDARDS

physical standards activity within the division. As the workload increased, physical standards and qualifications for the Regular Army were made the responsibility of one office element of the Preventive Medicine Subdivision, while

activity relating to the Reserve Corps was concentrated into second office

element.

To cope with the intensification and expansion of Reserve and induction

activities which came with mobilization, and with the tremendously increased

manpower demands as the war progressed, several reorganizations and name

changes within the Professional Service Division were instituted (chart 1). As

the Army was expanded, physical standards assumed new importance, and personnel assigned to create and refine the standards worked at various times in

subdivisions, divisions, and then in branches devoted primarily to physical

standards activity. Chiefs of the various elements concerned with physical

standards during World War II were Lt. Col. (later Col.) William P. Foster,

MC (fig. 2), Lt. Col. (later Col.) Patrick S. Madigan, MC, Lt. Col. (later Col.)

James B. Anderson, MC, Col. John F. Lieberman, MC, and Lt. Col. (later Col.)

Cornelius E. Gorman, MC (fig. 3). These were the men who had to resolve problems connected with the standards, such as matters of interpretation, application, determination of conditions for waiver, some aspects of claims for disability

and other special problem areas. They had to evaluate rejection rates and determine whether problems stemmed from induction and examination procedures

or from the standards themselves. Perhaps more important, when the country

was faced with manpower shortages, these were the men who had to weigh the

numerous factors involved, whether military, medical, administrative or political, before concluding which standards could be lowered and which procedures

changed to allow induction of therequired number of men. The matter of drafting men with certain disabilities or frailties to perform certain types of limited

or special duties was one of the many problems repeatedly coming up. better

estimate of the number and variety of problems facing these men can be ascertained when it is remembered that some 10,420,000 military personnel served

in the U.S. Army and Army Air Forces during World WarIT. To acquire this

number of people, the Selective Service and the Army had to examine many

millions more.

REGULATIONS

Examples of the actual physical standards regulations prepared in the

Surgeon General’s Office appear in the appendixes to this volume—standards

for enlisted men in appendixes and (pp. 129,161), and those for officers and

for special categories in appendixes C, I), and (pp. 209, 249, 259). Other ediFor complete discussion of the organization of the Surgeon General’s Office throughout the war

period, see Medical Department, United States Army. Organization and Administration in World War II. Washington U.S. Government Printing Office, 1963.

Williams, Mary H.; Chronology 1941-1945. United States Army in World War II. Special Studies. Washington U.S. Government Printing Office, 1960, p. 551. Report of Director of Selective Service, 1940—1941, Survey of the Selective Service System at Work in Peacetime, pp. 13-16.
DEVELOPMENT AND ADMINISTRATION

Selection

Standards Branch Nursing

Service Branch NURSING DIVISION

Chart

1.—

Typical

wartime

organization

chart,

Professional Service,

Office

of

The

Surgeon

General,

August

19.

$2

Animal

Service Branch Meat

Dairy

Hygiene

Branch Miscellaneous Branch VETERINARY DIVISION

CHIEF

OF

PROFESSIONAL SERVICE Dental

Service Branch Miscellaneous DENTAL Branch DIVISION

Sanitary

EngineeringBranch Occupational

Hygiene

Branch Medical

Intelligence Branch

PREVENTIVE MEDICINE DIVISION Venereal

Disease Control

Branch Laboratories Sanitation Branch Branch Epidemiology Branch

Adjutant

General's Liaison

Branch Physical

Standards Branch MEDICAL

PRACTICE DIVISION NeuropsychiatryBranch Procurement Advisory

Branch Surgery Branch Medicine Branch Nutrition Branch
PHYSICAL STANDARDS

Figure 2. Col. William B. Foster, MC.

tions and many numbered changes to these regulations, as well as numerous circulars, letters, and intermediate procedural directives were issued, which do not

appear in this volume. Chapters II and III discuss the more important problems

to which the changes responded. Some alterations resulted from understandable

errors of estimation or changes in the requirements of the war. Other changes

and reversals in policy were printed attempts to cope with and bring order to

the chaotic situations which were bound to develop when millions of individualistic physical and personality types were categorized by thousands of other

individuals who were unequally familiar with the intentions of the regulations

or the requirements of theArmy.

For purposes of background information, there follows brief general discussion of the groups responsible for applying the regulations as well as short

description of the changing process whereby enlisted men were brought into the

Army during World War II.

SELECTIVE SERVICE COORDINATION

Coordination between the Army and Selective Service was necessary not

only in the creation and evolution of physical standards but also in the utiliza-
DEVELOPMENT AND ADMINISTRATION

Figure 3.—Col. Cornelius E. Gorman, MC.

tion of the standards throughout the country during the induction process as

well. Authorized by Congress on 16 September 1940, the Selective Service

System began operation the following month. Col, Richard II. Eanes, MC

(fig. 4), Regular Army officer, became chief medical officer for the System.

Selective Service had year’s experience of peacetime operation before it was

called upon for the serious function of selecting young men for wartime

service (fig. 5).

The selective service organization consisted of national headquarters and

53 “State" headquarters. This number included, in addition to for each of

the 48 States, headquarters for Hawaii, Alaska, and Puerto Rico, and each for the city of New York and the District of Columbia. State headquarters

supervised and conducted registrations. Beneath the level of State headquarters,

examining physicians on 6,443 local boards made the first determination of

registrant's physical condition. The Selective Service System did not, in contrast to the operation for World War I, induct men into the service. Neither did it make the final decision, except for rejection in manifest cases, concerning

the qualifications of man for service. The selective service local board selected

See footnote 4, p. 4.
PHYSICAL STANDARDS

Figure 4.—Col. Richard H. Danes, MC

man as available for service by considering all aspects of civilian manpower

requirements. If the man was not considered essential to the civilian effort,

physician examined him for physical defects and then, if he was not indisputably disqualified under current procedures, he was sent to the Armed Forces

for further examination and induction. At Army induction stations, medical

examining boards made the final determination of registrant’s physical

qualifications. Advisory boards and appeal boards were also set up to assist

selective service and Army officials as well as registrants.

Following enactment of the Selective Training and Service Act of 1940,

interest in induction and physical evaluation procedures of World War was

intensified and studies which had been going on throughout the intervening

years were given priority. The Surgeon General sent memorandum to the

Assistant Chief of Staff, G-1, presenting plan, subsequently put into use,

for the organization and operation of Army medical examining boards at

induction stations.

Examining boards were to be located in centers of population, preferably

in or adjacent to military post or station, while at the same time reducing

Memorandum, Col. .Tames E. Baylis, MC, Executive Officer, for The Surgeon General, to the

Assistant Chief of Staff, G-l, subject: Physical Examination of Selectees Under the Provisions of the

Selective Service Act, 25 July 1940.
DEVELOPMENT AND ADMINISTRATION

Figure 5.—President Franklin D. Roosevelt speaks at ceremony in Washington, D.C.,

when first inductees are determined by lottery, 29 October 1940. Attorney General Robert

Jackson is being blindfolded by Col. C. R. Morris, USA (Ret.).

the distance traveled by registrants from their homes to the examining board.

It was determined that about half of these boards could be established at

military installations. Locations for boards were suggested by The Surgeon

General, but actual placement was to be left as matter for decision by corps

area commanders concerned.

An Army medical examining board was to consist of 11 medical officers

and dental officer, preferably reserves. The officer in charge, however, was

to have been on active duty for period of time sufficient to supervise preparation of the examining room and to check supplies and equipment. All boards

in given military area were to be supervised by Regular Army medical

officer. However, the shortage of Regular Army medical officers made this

impossible.

In addition to the officer in charge, the board was to consist of one general

surgeon, three internists, one orthopedist, two ophthalmologists, one otorhinolaryngologist, one neuropsychiatrist, one clinical pathologist, and one dentist.

To assist the board, it was considered necessary to have total of 22 enlisted

men or qualified civilians. This complement was to consist of two noncommissioned officers (preferably of the Medical Department), one stenographer, one
10 PHYSICAL STANDARDS

typist, two laboratory technicians, eight men to act as clerks, and eight men

to act as messengers and to perform general duties.

The examining procedure was predicated on examining men at the rate of

25 per hour during each 8-hour day. It was anticipated that men would be

introduced into the examining process at the rate of approximately one every

minutes. This schedule was established to provide 10-minute period at the

end of each hour to permit examining physicians to make further examinations

and to confer on more difficult cases.

Changes in medical science and procedures since World War allowed for

some reductions in personnel and increased speed of processing. For example,

questionable cases of tuberculosis were to be decided by X-ray examination

rather than by reference to special tuberculosis examiners. As result, it was

believed that one examining board would be able to average 200 examinations

per daj Thus, in period of 25 days, one board could examine 5,000 men.

On this basis, it was possible for 80 examining boards to examine 400,000 men in

25 days. Of this number, it was estimated that some 300,000 registrants would

be found acceptable. The proposed plan, however, provided for 94 boards

rather than for 80 to allow for any losses in effectiveness resulting from

geographical dispersion. At the same time, it was noted that additional boards

might be required, depending on local conditions.

Fundamental honesty and integrity were essential in all members of examining teams. Regulations for physical examination and physical standards

served as guides to accurate processing. careful system of check and doublecheck was necessary to prevent error, particularly with the speeds at which

work had to be performed. Constant supervision was necessary even with

well-trained personnel. All personnel had to be alert to changes in regulations

which frequently called for complete reversal of policy. Consequently, team

members had to be flexible and capable of assimilating and digesting changes in

standards and of applying them promptly and intelligently.

There were few diagnostic aids, except ophthalmoscopes, trial frames and

lenses, stethoscopes, and chest X-rays. Time did not permit detailed clinical

history, meticulous and prolonged physical examination, or many refinements

of diagnosis considered essential in civilian practice. Decisions had to be made

promptly and accurately, consultations reduced to minimum, and dispositions

made with fairness and justice to all concerned.

Many problems arose in the early phases of induction station operation,

but as personnel became more experienced, station operation became more

efficient and administrative complaints lessened. Meanwhile, the War Department maintained careful check on rejection rates. Rejections exceeded expectations and changes were made in examining procedures as well as standards, but

the basic Army examination plan remained in effect throughout the war.

Herpel, P. K.: Medical Examination at an Armed Forces Induction Station Observations of

Medical Examining Physician. Mil. Surgeon 94 345-350, June 1944.
DEVELOPMENT AND ADMINISTRATION 11

INDUCTION PROCEDURE DEVELOPMENTS

One aspect of induction procedure after the stait of the peacetime draft

resulted in so much protest from private and public sources that it had to be

changed. Some weeks or months after an initial examination at local selective

service boards, depending on induction quotas, potential inductees were sent to

Army examination stations for induction examinations. Those acceptable to

the Army were inducted immediately, making it necessary that everyone called

conclude his employment and personal affairs before reporting for the examination. Those failing to pass this second examination (from to 30 percent

depending on the relative experience of selective service versus Army examiners) faced the embarrassment and inconvenience of returning to their homes

and jobs after having made their farewells. This situation was changed shortly

before the United States actively entered the war by having all inductees

returned to their homes as civilians at the expense of Selective Service. These

persons remained at home, subject to orders for induction, without further

examination if their order numbers were reached within 90 days. This procedure lasted only short time after the United States entered the war. On

15 February 1942, the Army announced that it would again induct acceptable

men immediately upon examination. There was difference, however, from

the original procedure which had caused so much public protest. Registrants

found physically qualified after the induction examination were sworn in

immediately as members of the Army, but instead of being sent at once to

reception centers, they were transferred to the Enlisted Reserve and sent home.

Travel was at Army expense, and men were under orders to report to

designated reception center days later.

Within days following entry of the United States into war, new regulations were issued to provide uniform induction procedure to replace various

State selective service plans previously authorized. Under the new regulations,

the concept of two complete physical examinations (one by the Selective Service

and one by the Armed Forces) was abandoned (fig. 6). Beginning on January

1942, examining physicians at local boards were required to examine registrants

only for the more easily detectable defects which were disqualifying for general

service or for any military service. Physical standards established in MR 1-9

(appendix A, p. 129) were no longer used by Selective Service. Instead, the

Director of Selective Service issued DSS Form 220, which was “List of

Defects” to be used by examining physicians as guide. This form also identified the more easily detectable defects qualifying for limited service. Examining

physicians were not to take blood for serological testing except on request of

the Armed Forces. Moreover, medical advisory boards supported examining

(1) Memorandum, Lt. Col. John E. Dahlquist, GSC, for General Haislip, 13 Mar. 1941, subject:

Physical Examination of Selectees. (2) Letter, The Adjutant General, War Department, to Commanding

General, Third Corps Area, Baltimore, 23 Apr. 1941, subject: Revision of Induction Procedure.

257-966 —67
12 PHYSICAL STANDARDS

Figure 6.—Inductees waiting to be examined at Fort Douglas, Utah, March 1942.

physicians when the latter called for special examinations or tests in cases of

doubt.

Joint Induction

On December 1942, the President, by Executive Order 7279, directed

that volunteer enlistments of persons between 18 and 38 years of age be

terminated and that all male enlisted personnel needed by the Armed Forces

be obtained through Selective Service and distributed to the services on

ratio quota basis. Before this time, the Navy had satisfied its manpower

requirements by volunteer enlistments. Because they had no induction station

setup and in order to avoid unnecessary duplication and expense, it was decided

(1) For more complete discussion of the induction process and the role Selective Service played

in it, see the series of special historical monographs printed after World War II for the Selective

Service System in the U.S. Government Printing Office, Washington, D.C. Titles include: “Backgrounds of Selective Service,” “The Selective Service Act,” “Registration and Selective Service,”

“The Classification Process,” “Industrial Deferment,” “Agricultural Deferment,” “Dependency Deferment,” “Age in the Selective Service Process,” “Special Groups,” “Conscientious Objection,” “Quotas,

Calls, and Inductions,” “Reemployment and Selective Service,” “Enforcement of the Selective Service

Law,” “Physical Examination of Selective Service Registrants,” and “Problems of Selective Service

and Evaluation of the Selective Service Program.” (2) Other detailed information is available in

wartime Selective Service regulations, changes, and miscellaneous publications.
DEVELOPMENT AND ADMINISTRATION 13

that inductees for naval service would be handled through Army induction

stations already in operation. This necessitated some planning for joint induction procedures, and coordination of physical standards of the two services,

which differed in many respects. For instance, the Army had no restrictions

for color blindness, but the Navy did. Army standards for minimum and maximum height were from 60 to 78 inches, respectively, while those of the Navy

were 62 and 76 inches. Another difference occurred in the acceptability of

those with venereal diseases. In February 1943, the Navy would not accept

individuals with any venereal disease, while the Army would accept them to

the extent of local capacity for treatment provided no disabling complications

existed and the men were otherwise qualified. Some compromises were made,

and as time went on the standards of the two services were brought somewhat

closer together. 10

Volunteers for induction were permitted under joint procedures. Within

quotas, every effort was to be made to grant the requests of registrants for

assignment to either ground or naval forces. Priority was to be given to those

volunteering in advance of order number call, but no assurance of assignment

to either ground or naval forces was to be given to anyone before induction.

In January 1943, procedures permitted those inducted into the Army to elect

to proceed directly to reception center or to be transferred to the Enlisted

Reserve Corps for period of days, as discussed earlier. Registrants rejected

for military service were to be returned by Armed Forces recruiting and induction stations to the vicinity of the local board delivering them for induction

processing. Reports of physical examination on all registrants rejected were

to be sent to The Surgeon General of the Army.

Other Procedure Changes

Public Law 197 of December 1943 required that registrants expecting

induction momentarily be given preinduction physical examination on request.

Beginning in January 1944, examinations were to be given at Armed Forces

induction stations, and the results were to be accepted by selective service local

boards. Actually, the law was intended to cover only certain individual cases.

Selective Service, however, immediately began accepting preinduction examinations performed at Armed Forces recruiting and induction stations on

mass scale in lieu of the “physical inspection” they had been performing.

Consequently, by the end of January 1944, examinations by local board

physicians became very cursory in nature, except for special cases. Following

thorough preinduction physical examinations at Army examination stations,

10(1) Letter, The Adjutant General, War Department, Services of Supply, to Commanding General,

Each Service Command, 22 Jan. 1943, subject: Joint Induction Procedure of the Army, Navy, Marine

Corps, and Coast Guard. (2) Letter, The Adjutant General, War Department, to Commanding General,

Each Service Command, 27 May 1943, subject: Changes in Joint Induction Standards for the Army,

Navy, Marine Corps, and Coast Guard. (3) Letter, The Adjutant General, War Department, to Commanding General, Each Service Command and USAFPOA, 25 July 1945, subject; Joint Induction

Standards of the Army, Navy, Marine Corps, and Coast Guard.
14 PHYSICAL STANDARDS

those accepted were returned home to await call within 90 days. Then, they

were delivered to induction stations by local boards for less extensive physical

inspection after which they were inducted. The procedure was thus almost

reversal of that previously in effect on this point.11 The 1944 procedure did

not change materially for the remainder of the war.

Registrants appearing at reception centers more than 90 days after their

preinduction physicals were required to undergo complete new physical

examination. 12 Otherwise, they were given only physical check for contagious disease, apparent defects, and for intercurrent illnesses or injuries.

It was only under exceptional circumstances that registrants were rejected at

this point.13

From medical point of view, reception center responsibilities in 1944

involved physical profiling (ch. IV), blood typing, and immunizations. Apart

from the required physical inspections, these remained the principal medical

function at this stage of the process of bringing man from civilian life to

active service. The general physical examination was usually accomplished on

the first day of processing, while blood typing and immunizations were

accomplished on the second. Otherwise, determination of man’s capability

to serve, based on physical grounds, was normally an accomplished fact before

his arrival at reception centers. However, physical rehabilitation functions

such as treatment of venereal disease and dental defects, together with furnishing spectacles, all after induction, normally began at reception centers.

CONCLUSIONS

The Medical Department had its World War experience and its between

wars planning on which to base induction activities during World War II,

but only the press of mass mobilization could uncover most of the difficulties

which then arose. Procedures were amended as circumstances required, and

solutions were improvised when problems appeared. At the same time, every

effort was made to maintain the required steady flow of men into the Armed Forces, Not all problems could be resolved by procedural changes, however,

and when it became obvious that certain physical standards would not permit

manpower requirements to be met, some of the basic standards had to be reevaluated and changed.

11 Selective Service as the Tide of War Turns. Third Report of the Director of Selective Service,

1943—1944. Washington: U.S. Government Printing Office, 1945, pp. 56-57. 13 Memorandum, Brig. Gen. Russel B. Reynolds, GSC, Director, Military Personnel Division, Headquarters, Army Service Forces, for The Adjutant General, 19 May 1944, subject: Status of

Registrants Whose Pre-Induction Physical Examination Has Exceeded 90 Days.

13(1) Letter, The Adjutant General, War Department, to Commanding General, Each Service

Command, Alaskan Department, USAP in Central Pacific Area, Antilles Department, and Military

District of Washington, 19 June 1944, subject: Pre-Induction of Registrants. (2) Letter, The

Adjutant General, War Department, to Commanding General, Each Service Command, Alaskan Department, USAP in the Pacific Ocean Areas, Antilles Department, and Military District of Washington,

27 Nov. 1944, subject: Pre-Induction Physical Examination and Induction of Registrants.
CHAPTER II

Fluctuation of Physical Standards According to

Manpower Needs: Higher Manpower Requirements—Lower Entrance Standards

INTRODUCTION

When the United States moved toward war and an army of millions rather

than thousands was suddenly required, the struggle to supply the basic element

necessary to win the war—manpower—was on. In September 1940, there were

an estimated 1,024,789 men in the Armed Forces, 519,805 of whom were in

the Army. By December 1941, there were 2,296,086 in the Armed Forces, and

in November 1942, the strength had risen to 6,773,809. At this time, the size

of the Army had reached 4,932,469 men. Less than year later, the total

strength of the Armed Forces had risen to 10,425,916 and by October 1943,

Army strength had reached 7,333,474 men. Before the end of the war, more

than 10 million men in all served in the Army, the largest number at one time

being 8,291,336 in May 1945 (fig. 7).

Although the Army made changes in its physical and mentalrequirements

throughout the war, itwas during the first years that the most telling changes

had to be made to permit the induction of millions of men. After that period

steady increase in personnel continued, but the problem of keeping individuals

in the Army after they were inducted assumed new importance (ch. IV).

Before changing standards and procedures, the responsible personnel of

the Surgeon General’s Office had to consider such factors as (1) the contributions that could be made by persons with certain defects, (2) what the policy

should be on the physical rehabilitation of men to make them capable of

service, and (3) the merit or legal implications or both of calling in men with

physical defects, thereby inviting future claims against the Government.

In addition to finding and resolving procedural problems and helping to

make decisions about much publicized areas of complaint, such as the policies

on venereal diseases, the Surgeon General’s Office kept constant check on

trends in rejection rates as basis for manipulating standards, authorizing

(l) Selective Service in Wartime. Second Report of the Director of Selective Service, 1941-42.

Washington U.S. Government Printing Office, 1943, pp. 64—65. (2) The Army Almanac. Washington

U.S. Government Printing Office, 1950. (1) Selective Service as the Tide of War Turns. Third Report of the Director of Selective Service

1943—44. Washington: U.S. Government Printing Office, 1945, p. 551. (2) See footnote (2)
16 PHYSICAL STANDARDS

Figure 7.—A young inductee is examined at Camp Beale, Calif., November 1944.

waivers, and offering guidance on the interpretation of regulations. These rates

were gathered by selective service local boards and Armed Forces examination

stations; they were compiled by the National Headquarters, Selective Service

System, and by the Medical Statistics Division, Surgeon General’s Office.

For the period of November 1940 to August 1945, an estimated 17,954,500

men were examined for induction into military service, and 6,419,700, or 35.8 percent, were rejected. During the mobilization period before the United States

entered the war, total rejections for induction ran as high as 52.8 percent. It

should be noted, however, that this percentage included persons with physical

defects who were classified as acceptable for limited service. These men were

not drafted then because the Army at that time still demanded only individuals

qualified for general service who could undergo and complete training without

delay and then go into the Reserves. During the war, when limited service

personnel were drafted, overall rejection rates fluctuated from about 30 to

Egan, J. R., Jackson, L., and Eanes, R. H. Study of Neuropsychiatric Rejectees. J.A.M.A. 145:

466-469, 17 Feb. 1951. Medical Statistics Bulletin No. 2, National Headquarters, Selective Service System, Aug. 1943.
LOWER ENTRANCE REQUIREMENTS 17

50 percent. These rates were influenced by many factors—changes in standards

and induction procedures, reexaminations of previously rejected men, variation

in age groups being called, efficiency of examinations, manner of reporting

rates, and regional policies. Although these high overall rejection rates were

of grave concern to the Surgeon General’s Office, it was necessary to study

rejection rates for specific defects to determine the areas in which changes in

standards would bring the requisite number of new men into the Armed Forces.

The changes in physical standards which permitted the greatest introduc- tion of new men into the Army were those made for vision, teeth, and venereal

diseases. The establishment of rehabilitation program and the induction of

limited service men helped make these changes possible. Advances in medical

technology reduced the possibility of inducting tuberculars, but the problems

in the area of mental disorders and deficiencies remained serious throughout

the war.

POLICY ON REHABILITATION FOR INDUCTION

The treatment of remediable defects found in inductees and the induction

of defectives with the deliberate intention of later rehabilitation were serious

problems during mobilization. In 1940 and 1941, these problems were given

considerable study, but they remained major issues at the outbreak of war, only

to be pushed into the background by the rush of events. The problems were not

dormant for very long, however, because the number of men disqualified for

service exceeded all expectations while the need for manpower mushroomed.

The idea of rehabilitating men found physically disqualified for service

at the time of induction was not new one. For example, registrants with correctable defects were classified in World War as “remediables.” Because the

regulations were not always correctly interpreted by local boards or even by

medical advisory boards, many registrants with remediable and other defects

were inducted into the service only to burden existing Army hospital facilities.

This was especially true with respect to feet and hernias. At one time, about

10,000 men with hernia were in Army hospitals awaiting definitive treatment.

The problem was brought to head in 1918 when there was large and taxing

influx of respiratory and other communicable disease cases into Army hospitals.

Consequently, the correction of remediable defects was brought to halt as

matter of expediency due to lack of hospital and other medical facilities as

well as personnel.

As result of World War experience, it was apparent that any attempts

at rehabilitation should be executed on the basis of sound and complete informaMemorandum, Lt. Col. John A. Rogers, MC, Executive Officer, Office of The Surgeon General, for

the Secretary of War, Oct. 1941, subject: I. Selectees With Remediable Defects. II. Induction of

IndividualsWith Venereal Disease. [Both Colonel Foster and Mrs. Heilman used this document in their

work on earlier drafts of this volume, but the document has since become unavailable.-—C. M. W.

The Medical Department of the United States Army in the World War. Volume VI. Sanitation.

Washington U.S. Government Printing Office, 1926, pp. 463—470.
18 PHYSICAL STANDARDS

tion. It was equally apparent that program of this type should be under close

administrative supervision at all times. Therefore, when the question of correcting physical defects arose in World War II, commission on physical rehabilitation was created. Its membership consisted of six physicians and one

dentist who were charged with studying the most suitable methods and procedures for developing such program. In July 1941, the commission recommended that voluntary physical rehabilitation program be initiated and that

the costs be defrayed by the Federal Government. An alternative recommendation called for lowering of physical standards, with the understanding that

men subsequently inducted with remediable defects were to be subjected to

compulsory program of correction conducted by the Army. As long as the country was not actually at war, the Army was unwilling to modify its policy of high

physical standards. Neither did the Army wish to reverse its position on the

matter of not undertaking rehabilitation program within the service. In these

circumstances, voluntary rehabilitationappeared to be necessity.

On October 1941, the President called conference to discuss this problem. The next day, it was announced that the Selective Service System had been

charged with the responsibility of administering program for the rehabilitation of men between 21 and 28 years of age who had been found at induction

stations to have remediable defects. It was estimated that approximately 20 percent of the million men rejected up to that time, or some 200,000 registrants,

possessed remediable defects. The President’s plan called for the rehabilitation

of this number under program to be carried out through existing selective

service boards and with existing personnel. Corrective treatment was to be

given by the family doctor or dentist in registrant’s hometown, under the

supervision of Selective Service, and in conjunction with county medical and

dental societies. Professional work was to be accomplished at reasonable costs,

defrayed by Federal funds.

Part 661 of Selective Service Regulations, entitled “Physical Rehabilitation,” was developed and approved. Before it was made effective on nationwide

basis, however, pilot tests were conducted in the States of Maryland and Virginia. Results of the pilot tests were not wholly satisfactory, although cooperation given by physicians, dentists,and registrants alike, was considered excellent.

The success of the tests was viewed as something less than complete for the following reasons: (1) The number of cases which wereremediable without surgical

treatment was found to be small in comparison to those which could be so corrected, and (2) the many registrants previously classified as nonacceptable, but

with remediable defects, were inducted immediately after the outbreak of war.

This was because their original classification was made on the basis of the high

prewar physical standards which were lowered rapidly after December 1941.

Thus, many registrants scheduled for rehabilitation were already serving in the

Army.

There was, moreover, critical shortage of civilian physicians developing

during the early months of 1942, which led to some doubt as to whether
LOWER ENTRANCE REQUIREMENTS 19

rehabilitation program on nationwide basis could be properly stalled. These

and other factors led the Director of Selective Service to be relieved at his

own request of responsibility for the program. By August 1942, men were

being inducted into the Army for general and limited service on much broader

scale, even though they possessed remediable defects which previously had

been considered unacceptable. With, this turn of events, the approach was to

accept men in these categories with certain defects which could be corrected

by the Army after induction. This applied particularly to those with defects

involving venereal disease (p. 27),teeth (p. 21), vision (p. 24),or hernia (p.27).

LIMITED SERVICE FOR INDUCTEES

Before the United States entered World War II, enlisted men were not

inducted when physically evaluated as suited only for limited service. The

pressure for increasing the size of the Army and the need for replacements

as the war progressed, however, brought about an early change of policy.

On 26 June 1942, the War Department announced that effective on August

1942, selective service registrants not physically qualified for general military

service, but who had specified defects qualifying them for limited service could

be inducted. These individuals included—

1. Those who on examination had been found to present conditions not

within the accepted measurements for weight and chest circumference, as

shown in mobilization physical standards (MR (Mobilization Regulations)

1-9,“Standards of Physical Examination During Mobilization”) but who were

otherwise mentally and physically fit, and who did not fall within class IV

(unfit for military service).

2. Those with minimum vision of 20/400 in one or both eyes without

glasses, if correctable with glasses to 20/40 ineither eye.

3. Those with the loss of one eye, or blindness in one eye not due to progressive organic change, with vision in the other eye of not less than 20/200 correctable to not less than 20/40. 4. Those with hearing in one or both ears less than 10/20 but not less than

5/20. Complete deafness in one ear provided hearing was not less than 10/20 in

the other ear.

5. Those with loss of one or both external ears, if the individual had

followed useful vocation in civil life.

6. Those with unilateral atresia of the external auditory canal.

7. Those with insufficient teeth to qualify for class I-A under mobilization standards, but whose dental defect was correctable by artificial dentures,

provided there was no evidence of extensive areas of infection with multiple

abscesses, large cysts, or any other disease of the jaws and oral tissues, the

correction of which would require protracted treatment.

Letter, The Adjutant General, War Department, to Commanding General; Western Defense

Command, Caribbean Defense Command, All Corps Areas, and Hawaiian Department, 26 June 1942,

subject: Selective Service Registrants Acceptable for Limited Service.

257—966 67
20 PHYSICAL STANDARDS

8. Those with deviation of the spine from the normal midline of more than

inches but iess than inches.

9. Those with entire loss of thumb of eitherhand.

10. Those with entire loss of three fingers of either hand, including the

right index finger, provided the thumb remained.

11. Those with webbed fingers or toes, notwithstanding severity.

12. Those with moderate deformities of one or both upper extremities,

which did not or had not interfered with function to degree to prevent the

individual from following useful vocation in civil life.

13. Those with abduction and pronation of foot (knock-ankle), when the

condition was not associated with rigidity of the tarsal joints, deformity of

the foot, or excessive callosities.

14. Those with loss of great toe.

15. Those with loss of dorsal flexion of great toe.

16. Those with hammertoe with rigidity.

17. Those with other defects of the feet which would disqualify for general

military service, but which would not prevent the individual from wearing

military slice, and which had not prevented him from following useful vocation in civil life.

18. Those with moderate deformities of one or both lower extremities, but

which did not and had not interfered with function to degree as to prevent

the individual from following useful vocation in civil life.

19. Those with deformities of clavicle, ribs, or scapula, of degree disqualifying for general military service, but had not prevented the individual

from successfully following useful vocation in civil life.

20. Those with Frbhlich’s syndrome, if only moderate in degree.

Registrants with defects other than those just cited and who had previously

been classified under “limited service” were not to be accepted. Those who had

previously been classified for limited service and who upon reexamination had

been qualified for general military service were to be inducted.

When the need for manpower was greatest, the possibility of drafting all

men who were physically and mentally capable of making an effective contribution was seriously considered but the risk of future claims against the

Government and of other more immediate losses was felt to outweigh the

benefits. The proportion of limited service men who could serve in the Army had meanwhile been set at 10 percent of the total on active duty. When training

units were converted into combat outfits early in the war, it was found that

many men serving in training units did not qualify for combat duty and that

an excess of 10 percent was already in the Army. Limited service men for

whom suitable assignments could not be found could be discharged. The induction quota for limited service men was dropped to percent in February 1943.

In April 1943, induction of limited service men was suspended completely for

period of weeks, then resumed again at percent quota. During July 1943,

the War Department ordered the mandatory discharge of limited service men
LOWER ENTRANCE REQUIREMENTS 21

for whom suitable jobs could not be found. During this period, the War Department ordered that the classification, “limited service,” be discontinued. The

Army was to continue to accept, in controlled numbers, men who were not

physically qualified for general service, depending on their skills, ability, intelligence, and aptitude, but the term, “limited service,” was not to be permanently noted on service or allied records of men so accepted. Of course, physical defects

were still described in examination records, which could be temporarily tagged,

and defects were taken into consideration when assignments were made.

As physical standards were lowered to meet rising manpower needs, many

former limited service men qualified for general duty. This led to strange

situation in which some limited service men without appropriate jobs were

being discharged from the Army, while at the same time, others, sometimes

less physically qualified, were being drafted for general or limited service.

But by oue method or other, the number of limited service men was reduced

to the prescribed 10 percent by November 1943, and discharge of such personnel

was prohibited. In September 1944, their discharge was again permissible. Between the acceptable quota of 10 percent for limited service men and those

individuals inducted with defects under lowered standards, the overall total

of such men who served at some time in the Army was considerable. Some

183,000 limited service personnel were separated as not adaptable during the

war and others were separated with certificates of disability for discharge

when they acquired new disabilities or when their existing defects were seriously

aggravated by military service. Still others were separated “for convenience of

the Government” when appropriate assignments were not available.

DENTAL STANDARDS

Dental standards during the mobilization period before World War II

were high and were administered rigidly (appendix A, p. 129). For example,

to qualify for general service, registrant was required to have six serviceable

natural masticating teeth and six serviceable natural incisor teeth, all so opposed

as to serve the purpose of good incision and mastication. Persons with fewer

natural teeth, but who had suitable dentures, were classified as acceptable for

limited service, but were not to be inducted. Dental defects were the leading

cause for rejection at local boards and accounted for 17.7 percent of all rejections during the prewar training and service period. 10 About 8.8 percent of

(1) War Department Circular No. 161, 14 July 1943. (2) War Department Circular No. 176,

31 July 1943. (3) Letter, The Adjutant General, War Department, to Commanding General, Bach

Numbered Service Command, Alaska Defense Command, Hawaiian Department, Puerto Rican Department, 14 July 1943, subject: “Elimination of the Term ‘Limited Service’ With Reference to Enlisted

Men.” (4) War Department Circular No. 293, 11 Nov. 1943. (5) War Department Circular No. 370,

12 Sept. 1944.

(1) Monthly Progress Report, Army Service Forces. War Department, 31 Aug. 1946, Section

Health. [This report, used by Mrs. Heilman in the preparation of an earlier draft of this volume, is

now unavailable.—C. M. W.] (2) For discussion of procedures affecting limited service personnel

while in the Army, see ch. IV, p. 65. 10See footnote 4, p. 16.
22 PHYSICAL STANDARDS

all persons examined were rejected for dental reasons, although two-thirds of

these were qualified for limited service. Most frequently recorded disqualifying

defects were missing teeth, dental caries, malocclusion, and allied conditions

(fig. 8).

Mobilization Regulations 1-9, dated 31 August 1940, did not indicate

whether teeth replaced on removable bridges could be counted as serviceable

natural teeth or not. In March 1941, Selective Service Medical Circular No.

was issued, which explained that either fixed or removable bridges were

acceptable if supported at least in part by the remaining teeth. The details of

this information were ultimately incorporated into MR 1-9 when it was revised

and reissued in March 1942.

Selective Service Medical Circular No. also clarified other sources of

confusion in the regulation. For example, an error in the description of tooth

defects acceptable for limited service in MR 1-9 of 1940, resulted in disqualifying large numbers of registrants. The standards provided that registrants

be placed in limited service category when found with “insufficient teeth to

qualify for class I-A, if corrected by suitable dentures.” Selective Service

Medical Circular No. explained that the word “corrected” was intended to

Figure S.—A selective service enrollee gets his teeth examined at South Armory, Boston,

January 1941.
LOWER ENTRANCE REQUIREMENTS 23

mean correctable since it was not intended that individuals have corrective

dentures in their possession in order to qualify for limited service.

Standards Lowered

It was recognized in the Dental Division of the Surgeon General’s Office,

at an early date, that standards utilized in the prewar draft would not be useful

in the event of war and full mobilization. In May 1941, Brig. Gen. Leigh C.

Fairbank, Director of the Dental Division, estimated that large percentage

of men inducted into the Army would require extensive dental replacements as

the result of the effects of lack of dental care during the depression years, but

that this should not constitute disqualifying factor. 11 He warned that the

safety of the Nation should not be sacrificed just to maintain high dental standards. Consequently, action was to be taken to provide means for adequate corrective dentistry to care for those brought into the service in low states of dental

health. “The entire plan for dental service in time of mobilization has been revised to meet the conditions which we are certain will exist in every Army camp.”

At the outbreak of war and the start of full mobilization, dental standards

were drastically reduced. Under an interim circular, February 1942, registrants

were declared dentally acceptable for general service if they had no serious infection and had “sufficient teeth (natural or artificial) to subsist on the Army

ration.” revision of MR 1-9 followed in March, spelling out the minimum complement of natural or artificial teeth or both. At this time, malocclusion was to

be cause for rejection only when it interfered with the individual’s health or

resulted in damageto the soft tissue.

When MR 1-9 was again revised and reissued in October 1942, dental requirements for induction were virtually eliminated. From that point on, registrants need have no teeth at all to qualify for general service provided they had

or could be fitted for the necessary dentures. Criteria for limited service had

been dropped, while only the most serious defects were to be disqualifying.

Rejections for dental reasons went from 2.9 percent in April 1942 to about 0.1

percent in December 1942, and remained substantially unchanged for the

remainder of the war.

Rehabilitation

In the selective service pilot tests conducted in Maryland and Virginia, the

dental program operated along the lines previously discussed. It did so satisfactorily, but on small scale, during the short period of time that the experiment

was conducted. The rehabilitations accomplished were largely those of extracting infected teeth and replacing them with prosthetic dentures. The average

cost of dental rehabilitation was estimated at somewhere between $54.19 and

11 Medical Department, United States Army. Dental Service in World War II. Washington: U.S.

Government Printing Office, 1955, p. 200.
24 PHYSICAL STANDARDS

$78.00 per registrant. The average elapsed time, from certifying the individual

case as remediable to cured, was 38.5 days.

When the pilot tests ceased, the Armed Forces undertook the remedial work

within each service. This resulted in the operation of tremendous dental program. Approximately one-third of the practicing civilian dentists were taken

into the Army and the Navy. In the Army, most dental rehabilitation was done

during the basic training period at replacement training centers. The latter were

recognized as the most favorable place in which to concentrate dental facilities,

because it was the first location at which an inductee spent sufficient time to

permit extensive dental treatment. Here, dental service was organized for maximum efficiency with the most critical positions staffed by the best qualified dental

officers. Because many men went from replacement training centers to units on

duty overseas, it was absolutely essential that men leaving the centers meet

dental standards forforeign service.

The size of the dental rehabilitation program conducted by the Army between January 1942 and 31 August 1945 is reflected in the following tabulation

of dental corrections: 12

Type Number of corrections

Permanent fillings 68, 092, 479

Extractions 15,189, 936

Full dentures constructed 568, 669

Partial dentures constructed 1, 997,162

Dentures repaired 743,261

Fixed bridges constructed 206, 484

Teeth replaced 18, 306, 800

Dental prophylaxes performed 8,187, 932

The dental defects handled under the program, if left uncorrected, would

have been detrimental at least to the extent of interfering with mastication of

the Army ration. Without the program, it would have meant either the induction of untreated dental cripples, bringing with them into active service the

adverse effects of large number of physically incapacitated men, or their rejection for any military service. Either way, it would have resulted, substantially,

in the loss of the effectiveness of nearly million men, or the equivalent in

numbers of approximately 65 divisions.

VISION

Between 1940 and 1944, standards for vision were quite clear cut, even

though they underwent considerable revision. Diseases and conditions which

did or did not disqualify registrant for service were specific. Specifications

for the test to be given to assist the examining physician in arriving at

decision, however, were not so precise. Mobilization Regulations 1-9 prescribed

an examining routine which included only test for visual acuity and an

12 Medical Department, United States Army. Dental Service in World War II. Washington U.S.

GovernmentPrinting Office, 1955, pp. 247-254.
LOWER ENTRANCE REQUIREMENTS 25

inspection of the eyes, with the lids inverted, for evidence of disease, as well

as muscular and other defects. Examinations more extensive than this, including refractions, were to be made only when defects were revealed during the

routine examination.13

The Army-Navy Vision Committee of the Office of Scientific Research

and Development established Subcommittee on Procedures and Standards for

Visual Examinations. Serving as its chairman was the Chief of the Ophthalmology Branch of the Surgeon General’s Office. The subcommittee developed

manual of instructions for testing visual acuity aimed at establishing uniformity of equipment, lighting, and other conditions for conducting the tests.

Items such as the occluder used to shield the eye not being tested were described

in complete detail.

On 10 July 1945, the subcommittee recommended that the manual be used

by all the Armed Forces, and copy was submitted to the Physical Standards

Division of the Surgeon General’s Office. Members of the subcommittee were

of the opinion that both the Army and the Navy could employ comparable

visual-acuity tests. Moreover, for the first time, examinations given in all parts

of the country would be the same. The procedure contained in the manual was

not incorporated into the standards until August 1946, however.

Effects of Standards Changes

During 1940—41, eye defects were the cause of 12.2 percent of all rejections

and were the second leading cause for disqualification. 14 After standards were

lowered at the outset of the war, however, rejections for eye defects were

exceeded consistently by mental disease, by mental and educational deficiency,

and by musculoskeletal and cardiovascular defects.

After they were lowered, physical standards for the eyes even permitted

the induction of registrants with handicaps which would have prohibited their

engaging in certain civilian employment. Registrants with unilateral blindness, for example, were acceptable for limited service. With the possible

exception of those men with dental defects and venereal disease, more men were

made available for service by lowering standards for the eyes than was the

case involving any other part of the body.

Rehabilitation

The rehabilitation of men with eye defects principally involved the correction of vision by furnishing spectacles to those who could not meet the

standards without them and who did not already have them. This practice

did not originate with World War II. As early as the latter part of 1917, action

13 Medical Department, United States Army. Surgery in World War II. Ophthalmology and

Otolaryngology. Washington U.S. Government Printing Office, 1957, pp. 10, 27, 28, 29, and 453-455. 13 See footnote 4, p. 16.
26 PHYSICAL STANDARDS

to standardize on lens to be used in military service had begun, and by June

1918, spectacles were being furnished by the Army without cost to the individual. At the beginning of World War I, registrants requiring spectacles

were inducted, but no special provisions were made for supplying the spectacles. When the need was established by refraction, the individual was permitted to purchase spectacles through camp exchanges at reduced price. The

Army began furnishing spectacles without cost to the wearer as result of

public criticism of system which required an inductee to suffer the expense

of piece of equipment essential to the performance of his military duties.

Similarly, in 1940, the only provision for purchasing spectacles for military

men at Government expense was in connection with correcting visual defects

suffered as result of violence in line of duty. Men inducted during this

premobilization period were responsible for the purchase, repair, and replacement of their own spectacles. In June 1941, on the recommendation of The

Surgeon General, The Adjutant General directed that necessary arrangements

be made to supply spectacles to all Army personnel requiring them. With

this, the Army embarked on an enormous optical program. 15

When the World War II optical program was initiated, the basis of issue

of spectacles was one pair to each individual requiring spectacles, with another

pair provided upon embarkation for overseas. This was done so that the

individual’s efficiency would be maintained even in isolated areas overseas

while broken pair was being repaired or replaced. This plan, however, was

found to impose an impossible burden upon staging areas and ports of embarkation, as well as upon optical supply houses. Often, by the time the spectacles had been fabricated and delivered to the oversea staging area, the

individual had already moved on. True destinations were often obscure.

Delivery overseas presented insuperable obstacles, and glasses which had to be

discarded represented financial loss of at least two-thirds of their value, since

the lenses, which represented this proportion of the cost, were not salvageable.

To overcome this obstacle, each man requiring spectacles was issued two pairs

as early in the training process as possible, whether he was destined for oversea

duty or not. At the end of hostilities, the basis of issue was again made one

pair of spectacles to each person.

Arranging for contracts and the supply of spectacles presented some severe

administrative problems. The total problem was further complicated by the

necessity for furnishing spectacles which could be fitted into gas masks. In

addition, arrangements had to be made so that repair and replacement of

spectacles could be accomplished overseas. This problem was solved by the

design and construction of mobile optical repair units, which consisted of

specially designed van, complete with an initial load of supplies and the necessary tools, machinery, and technical personnel.

15 (1) Medical Department, United States Army. Surgery in World War II. Ophthalmology and

Otolaryngology. Washington U.S. Government Printing Office, 1957, pp. 28-31. (2) Medical Department, United States Army. Medical Supply in World War II. [In preparation.]
LOWER ENTRANCE REQUIREMENTS 27

By the end of the war, some 18 to 20 percent of all military personnel

were furnished with spectacles. An estimate of 10 percent was made at the

outset of the program. During the entire war, total of 2,250,000 pairs of

spectacles had been fabricated by civilian and military facilities and issued,

with nearly 1,500,000 of these being distributed in 1942 and 1943. These were

issued at rate of 522,000 pairs per annum, which included 30-percent per

annum replacement factor for personnel stationed in the Zone of Interior. In

addition, some percent ofall military personnel wearing glasses were furnished

gas mask inserts. These totals, of course, do not represent the number of men

who actually needed and wore glasses in the service, because some possessed and

maintained their own, while substantial portion of the total represented

replacements.

HERNIA

During the mobilization and early war period, only the simplest forms of

hernia were acceptable either for general service or for limited service, even

though hernia accounted for almost percent of all rejections within the

1940-41 period. 16 Military authorities were generally opposed to the induction

of men with hernia, except the small symptomless variety at the umbilicus.

This was based on the fact that part of the difficulty of the repair of hernia

under compulsion is the physical trauma resulting in painful scars and functional disability. Early in the war, however, the Navy accepted men with

hernia to be repaired in Navy treatment facilities after induction.

It was only after 200,000 registrants with the more complicated hernias

had been rejected that certain of these hernias were made acceptable to the

Army. In November 1943, the Army began to accept for limited service men

with inguinal hernia which had not descended into the scrotum. Afterinduction,

registrants with hernia either underwent surgery or were classified for limited

service and performed the appropriate limited duties. The overall contribution

to the buildup of the Army was not great, however, and was restricted mainly

to limited service personnel.

VENEREAL DISEASES

Tests

The initial Selective Service Regulations of 1940 required that each registrant be given serological test for syphilis. Local draft boards were to make

thorough investigation whenever registrant’s history or physical examination indicated the possibility of venereal disease. Additional examination and

laboratory tests were to be employed, as deemed necessary, to determine the

presence of disqualifying sequelae or of contagion. second test to be

given in all cases where the first test was positive.

16 See footnote 4, p. 16.
28 PHYSICAL STANDARDS

By June 1941, the U.S. Public Health Service had completed analysis of

over million serological tests of men examined for military service. 17 The

results showed that serological tests were positive on 1.8 percent of the whites

and on 24 percent of the Negroes examined. study based on the second million

reports of physical examinations received for the period from 16 April to

31 August 1941 showed that of 1,041,155 registrants tested for syphilis, positive

results were reported in 4.9 percent or 50,929 cases. Of this number, 756 had

shown suspicious early primary lesions. Test results of these were reported as

555 negative, 180 positive, and 18 doubtful. There were 41 cases whose report

of examination showed finding of primary and secondary lesions, but there

were no blood test dataavailable.

In November 1944, the Selective Service System, in its Medical Statistics

Bulletin No. 3, reported the incidence of syphilis occurring during the period

from April 1942 to December 1943 to be 50.2 registrants per 1,000 examined, the rate being 20.8 for white registrants and 214.7 for Negroes. The diagnosis

in both races was predominantly on the basis of positive serology with no

specified classification made as to the stage of the disease. As result of this

study, it was found that all forms of syphilis except neurosyphilis occurred

approximately 10 times as frequently among Negroes as among white registrants. The ratio of incidence of neurosyphilis between white and Negro was

to 4. Complications of syphilis, such as neurosyphilis and cardiovascular

syphilis, were recorded infrequently amongregistrants examined. Neurosyphilis

occurred in 1.8 registrants and cardiovascular syphilis in 0.2 registrants per

1,000 examined.

The Army Policy

Under the pre-July 1942 concept that persons classified for limited service

would not be inducted, men with venereal disease were bypassed by the draft

(appendix A, p. 129).18 This policy was questioned by the Director of Selective

Service in July 1941. In letter to the War Department, he expressed the belief

that acceptance of venereals would be necessary if an adequate supply of inductees for the Armed Forces was to be maintained. At the same time, public

opinion was beginning to manifest an objection to system which permitted

individuals with venereal disease to avoid service, while those without it were

compelled to serve. In reply, The Surgeon General agreed that it should be

possible to induct individuals with certain venereal infections. These were defined as (1) individuals with uncomplicated cases of gonorrhea, and (2) persons

17 Syphilis Among Selectees and Volunteers. Medical Preparedness. J.A.M.A. 116(26): 2859

28 June 1941.

18 (1) Mobilization Regulations No. 1-9, 31 Aug. 1940, as amended by War Department Circular Nos.

110. and 117, dated Oct. 1940, and 18 Oct. 1940. respectively. (2) Mobilization Regulations No. 1-9,

15 Mar. 1942. (3) For discussion of the overall venereal disease problem, see Sternberg, Thomas H.,

Howard. Ernest B., Dewey, Leonard A., and Padget, Paul: Venereal Diseases. In Medical Department,

United States Army. Preventive Medicine in World War II. Volume V. Communicable Diseases Transmitted Through Contact or By Unknown Means. Washington U.S. Government Printing Office, 1960, pp. 139-331.
LOWER ENTRANCE REQUIREMENTS 29

who had had syphilis, but who, following adequate treatment, had shown no

objective evidence of the disease for minimum period of year. 19

By March 1942, those with adequately treated syphilis were to be classified

as acceptable for general service, but the change resulted in the induction of

very few registrants so afflicted. The criteria of what constituted “adequate

treatment” was so rigid that few registrants with syphilis coidd meet it. The

official policy on gonorrhea was spelled out in September 1942, when theArmy

announced that only up to percent of persons drafted for general service could

be made up of men with uncomplicated gonorrhea. An increase in this percentage was to await the availability of more hospital and medical facilities for

treatment. Very few venereals were drafted forlimited service.20

real liberalization in the policy on induction of persons with venereal

diseases became possible before the end of 1942 by the use of the sulfonamides

and new treatment methods. In December, the War Department announced

that it would permit, without drastic artificial limits, the induction of men with

uncomplicated gonorrhea, acute or chronic, and syphilis, except the cardiovascular, cerebrospinal, and visceral types. Acceptable also were men found with

uncomplicated chancroid. 21 By this time, large backlog of men previously

rejected because of venereal disease was available for induction. For few

months, the scarcity of beds in hospitals and the new venereal disease treatment

facilities at reception centers continued to limit the number of such cases that

could actually be brought into the service, but by March 1943, some 7,000 men

infected with venereal disease (approximately 2,500 of whom had gonorrhea)

were inducted into the Army and subsequently treated in Army medical treatment facilities. In syphilis, it was not until after this date that larger numbers

so afflicted could be inducted, because of the continuing shortage of treatment

facilities. In some months of 1943, as much as one-third of the total Negro call

was made up of previously rejected syphilitics in order to achieve proportionate reduction in the backlog.

The induction of men with venereal disease reached its peak in the last

quarter of 1943, when approximately 12,000 were inducted each month. By the

end of the war, it was estimated that total of 200,000 registrants with venereal

disease had been inducted and treated in Army facilities, of whom 170,000 had

had syphilis. 22 These figures do not includeall persons who had gonorrhea when

first considered for induction because most of these were classified as acceptable

ia Letter, Lewis B. Hershey, Deputy Director, National Headquarters, Selective Service System, to

The Adjutant General, War Department, May 1941, subject: Induction of Yenereals. 21 National Headquarters, Selective Service System, State Director Advice (No. 77), 26 Sept. 1942,

subject: Acceptance of Certain Classes of Yenereals. 21 (1) Letter, The Adjutant General, War Department, to Commanding General, First Service Command, Services of Supply, 12 Dec. 1942, subject; Acceptance of Men With Venereal Disease. (2)

Letter, Lewis B. Hershey, Director, National Headquarters, Selective Service System, to State Director

Advice (No. 126), 17 Dec. 1942, subject: Acceptance of Yenereals. (3) Memorandum No. W40-2-43,

Maj. Gen. J. A. Ulio, The Adjutant General, War Department, The Adjutant General’s Office,

19 Jan. 1943, subject: Treatment of Individuals With Uncomplicated Gonorrhea on Duty Status. 22 Karpinos, B. D. Venereal Disease Among Inductees. Bull. U.S. Army M. Dept. No. 10, vol. VIII,

pp. 806-820, October 1948.
30 PHYSICAL STANDARDS

for general service but were deferred for induction until their condition became

asymptomatic. Short duration of the disease after treatment made induction

without long delay possible. Induction policies on registrants with the active disease later covered those who might have acquired the disease to avoid the draft.

TUBERCULOSIS

The number of rejections for tuberculosis was relatively small throughout

the mobilization and war periods, but the development of standards for the

disease was considered very important. The objective of physical standards

applicable to tuberculosis was to exclude all active cases and all those of doubtful stability that might have resulted in active disease or contagion during military service. Tuberculosis is apt to be progressive, but even in its minimal stage,

it is disease of unpredictable outcome, curable only with prolonged care. From

the military point of view, tuberculosisnot only requires personnel and facilities

for treatment but also creates liability to the Government in terms of lasting

compensation and other benefits to which disabled servicemen are normally

entitled.23

At the same time, it was recognized that tuberculosis of minor extent

frequently heals completely. For this reason, it would have been waste of

manpower to have rejected all persons showing traces of healed tuberculous

lesions. Some means had to be developed for differentiating small lesions of

definite stability, so that the individuals concerned could be accepted for service.

During World War I, standards were designed to exclude men with tuberculosis in active form. As basis of diagnosis, stress was laid upon the physical

signs characteristic of the disease. Most of the experience gained in World

War I, in this connection, was incorporated in MR (Mobilization Regulations)

1-5, “Standards of Physical Examinations During Those Mobilizations for

Which Selective Service is Planned,” December 1932. In the interval between

1932 and 1940, there was significant progress in the understanding of tuberculosis and enormous strides were made in the methods and techniques of

detection, not least of which were advances in radiology. By 1940,it was evident

to those concerned in the Surgeon General’s Office that technical developments

in the field of tuberculosis control called for drastic revision of the physical

standards contained in MR 1-5, and study of the problem was undertaken

at an early stage.

Requirement for X-ray

During the tense period before mobilization in 1940, many organizations and individuals were urging The Surgeon General to adopt routine X-ray

23 (1) Long, E. R.: Exclusion of Tuberculosis. Physical Standards for Induction and Appointment.

[Official record.] (2) For more information on tuberculosis, see Long, Esmond R.: Tuberculosis. In Medical Department, United States Army. Preventive Medicine in World War II. Volume IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts. Washington

U.S. GovernmentPrinting Office, 1958, pp. 259-279.
LOWER ENTRANCE REQUIREMENTS 31

examinations of recruits as more positive means of excluding those with

tuberculosis. These individuals included the managing director of the National

Tuberculosis Association and the chairman of the Committee on Military Affairs

of the American College of Chest Physicians. On June 1941, the National

Tuberculosis Association forwarded to The Surgeon General resolution

adopted by its board of directors advocating universal chest X-ray examination

of all those recruited into the military services. In April 1941, Time magazine

published an article captioned “TB Warning,” which stressed the importance

of chest X-rays in preventing the induction of men with pulmonary tuberculosis. This concern and the interest of professional societies, the press, and

individual members of the medical profession, as well as of the general public,

was regarded by The Surgeon General as helpful. Actually, the development of

chest X-ray program was already well underway in the Army. As early as

1935, routine X-ray examinations were given to oversea replacements at certain ports of embarkation. At the same time, The Surgeon General was on

record as favoring chest X-rays in the final physical examination for commission in the Regular Army, and for reservists applying for extended active

duty.24 In April 1939, chest X-ray examination was included as part of the

physical examination given to applicants before they could be commissioned as

officers. Standards were relaxed for the purpose of accepting officers for limited

service in other respects, but the requirement for negative chest X-ray was

not changed.25

While preparations for mobilization were being made in November 1939,

Col. (later Brig. Gen.) Charles C. Hillman, MC (fig. 9), then chief of the

Professional Service Division, Surgeon General’s Office, discussed the

experience with detecting early tuberculosis in recruits during World War I.

In memorandum to the Executive Officer, Surgeon General’s Office, he called

attention to the inadequacy of an ordinary physical examination of the chest

as means of detecting early tuberculosis in recruits and draftees. He pointed

out that X-ray examination was already practiced to limited extent on

recruits. Because of this, its application in the event of mobilization was being

considered to include all recruits and draftees. To further this effort, lie recommended that board be appointed to investigate and report on the feasibility

of making chest X-ray studies of all recruits and draftees.

Action on Colonel Hillman’s proposal was swift. On the day following its

submission, 14 November 1939, board consisting of Colonel Hillman, Maj.

(later Col.) Martin E. Griffin, MC, and Capt. (later Col.) Alfred A. De Lorimier, MC, was appointed by The Surgeon General, The board was to investigate

and report on the practicability and best method of making chest X-ray

24 (1) Indorsement, Col. E. R. Gentry, MC, Office of The Surgeon General, to The Adjutant General,

War Department. 20 Sept. 1938. (2) Indorsement, Col. C. C. Hillman, MC, Office of The Surgeon

General, to The Adjutant General, War Department, 21 Oct. 1939.

25 Letter, Col. John A. Rogers, MC, Office of The Surgeon General, to the Commanding Officer,

Stark General Hospital, 23 Mar. 1942, subject: Waiver of Physical Defects For Limited Service

Officers.
32 PHYSICAL STANDARDS

Figure 9.—Brig. Gen. Charles C. Hillman, MC.

examinations of all recruits and draftees, and to report on the estimated cost.

On 14 August 1940, the board had completed its work and submitted report

to The Surgeon General. It developed that the principal problem the board had

to deal with centered on the type of X-ray equipment it would recommend.

The Surgeon General reacted quickly to the report submitted by Colonel

Hillman’s board and, on 19 August 1940, he dispatched memorandum to

The Adjutant General entitled ‘‘Chest X-ray of Military Personnel.” In this

memorandum, he pointed out that large proportion of cases of early pulmonary

tuberculosis could be demonstrated only by X-ray examination. lie recommended that radiological survey of all men in the Army be made immediately

and that the chest X-ray be included later as part of the physical examination

performed on all selectees before induction.

The Adjutant General was highly receptive to the recommendations and

recognized the desirability of universal X-ray examination. At the time, however, mandatory X-ray examination was considered impractical. Instead, on

25 October 1940, he directed that chest X-ray examination be given at induction stations to all registrants in whom underweight, pallor, abnormal chest

findings, or suggestive personal or family history increased the likelihood of

the presence of pulmonary tuberculosis. He directed, also, that, insofar as
LOWER ENTRANCE REQUIREMENTS 33

existing roentgenological facilities at induction stations would permit, chest

X-ray be given to all other registrants, provided the examinations did not

impede the flow of selectees through the induction process. Induction stations,

located at other than Army installations, were authorized to arrange for use

of State or civilian roentgenological laboratories.

On 18 November 1940, the Secretary of the Navy, the Secretary of the

Interior, the Administrator of the Federal Security Agency, and the Administrator of Veterans’ Affairs made their X-ray facilities available to assist in the

induction examination process.26

On January 1941, The Adjutant General issued instructions that all

applicants for voluntary enlistment, or reenlistment in the Regular Army and

the National Guard of the United States, be given an X-ray examination of

the chest. When facilities were not immediately available, the chest X-ray

was to be given at the first station of assignment where facilities were available.

On June 1941, X-ray examination of the chest was finally made mandatory part of all physical examinations conducted at induction stations.27

more positive effort was to be made to exclude those individuals from service

who were afflicted with pulmonary tuberculosis and with other significant

intrathoracic defects (fig. 10),

Approximately 51 percent of all men sent to induction stations between

October 1940 and March 1941 received X-ray examinations. For the overall

war period, however, the percentage was greatly reduced. It was estimated

that approximately 10 million men had the benefit of an X-ray examination,

while hardly more than million enlisted men were accepted without it. Many of

these were later X-rayed at reception or basic training centers, where men

found to have active tuberculosis were discharged.

Development of Physical Standards

In working out more extensive use of chest X-rays, The Surgeon General

was assisted by committee on tuberculosis in the National Research Council.

The Committee on Tuberculosis consisted of Drs. Esmond R, Long (fig. 11),

its first chairman, J. Burns Amberson, Jr., who later became chairman, Bruce

II. Douglas, Herbert R. Edwards, Paul P. McCain, and James J. Waring.

The Committee’s first meeting on 23 July 1940 was also attended by representatives of the Army, the Navy, and the U.S. Public Health Service.

The principal outgrowth of the first meetings of the Committee on Tuberculosis was an urgent recommendation that X-ray examinations be made

routine part of the examination of registrants under the Selective Training

and Service Act of 1940. Moreover, the Committee recommended that mem28 Letter, Maj. Gen. E. S. Adams, The Adjutant General, to Commanding Generals of All Corps

Areas and Departments. 18 Nov. 1940, subject: Authorization for Use of Medical Facilities of Other

Federal Agencies in Induction Examinations. 27 Letter, The Adjutant General, War Department, to The Commanding Generals, All Corps Areas

and Departments, June 1941, subject: Routine Chest X-Rays on Induction Examinations.
34 PHYSICAL STANDARDS

Figure 10.—A selectee receives chest X-ray as part of his physical examination at Fort

Douglas, Utah, March 1942.

bership of examining boards include specialists in the field of tuberculosis and

that physical examination and laboratory study, where indicated, be used to

supplement the X-ray findings of chest X-ray film. Behind the urgency of

the recommendation was the consensus of those present that at least 75 percent

of early active tuberculosis could be discovered only by X-ray examination

and that approximately percent of the male population then of military age

were so aillicted.

substantial part of the recommendations of the Committee on Tuberculosis were included in MR 1-9 of 1940. Specifically, active tuberculosis of
LOWER ENTRANCE REQUIREMENTS 35

Figure 11.—Col. Esmond R. Long, MC.

any type was considered disqualifying. Tuberculosis of the lungs or tracheobronchial lymph nodes was considered disqualifying, with the exception of

certain types of stabilized lesions which were considered unlikely to break

down under military strain. The gravity of serofibrinous pleuritis in relation

to tuberculosis was emphasized. It was pointed out, as in previous standards,

that pleurisy, with or without effusion, is frequent manifestation of early

tuberculosis. Because of this, examining physicians were to exercise great care

in evaluating registrants who apparently had recovered from pleurisy. Specific

instructions were not issued at that time, however, with respect to excluding

men with history of pleurisy.

The first edition of MR 1-9 retained detailed instructions for examining

the lungs by palpation, by percussion, and by auscultation. Because it was not

possible, at that time, to make X-ray examination mandatory at all induction

stations, it was necessary to provide the best examination possible without

X-rays. Detail on the physical examination of the chest was much abbreviated

in later editions of MR 1-9, when instructions were expanded with regard to

tuberculous lesions of different types and degrees which might be found by

X-ray.
36 PHYSICAL STANDARDS

After roentgenography did come into widespread use at induction stations,

questions arose concerning the significance of large calcified lesions of arrested

primary tuberculosis. Ordinarily, such lesions are recognized as well healed.

Examiners at induction stations, however, encountered all grades of calcification, from barely perceptible nodules to huge incompletely calcified masses.

Although it seemed reasonable to expect that competent roentgenologists and

examining physicians could render decisions on the basis of combined clinical

and X-ray examination, in practice this proved not to be the case. Induction

was rapid, and there was relatively little time for careful weighing of clinical

and X-ray changes. Moreover, the roentgenologists at induction stations were

not all specialists in the field. These men frankly confessed their inability to

make decisions on the basis of judgment alone. It was this uncertainty that

prompted The Surgeon General to request the advice of the Committee on

Tuberculosis in solving this problem. Although some members of the Committee, when it met on 17 May 1941, opposed issuing rigid specifications on

the ground that clinical judgment might be subordinated to objective data, it

was finally agreed that the needs of the service demanded precision. The Committee then recommended specific limits for those types of lesions most likely

to be potentially hazardous.

The standards recommended later became the object of much criticism. It

was thought that their overrigid application at induction stations may have

excluded many obviously healthy men. In response to the criticism, The Surgeon

General pointed out that examining physicians were directed by section of

MR 1-9 to use the standards as “guide to their discretion and not to construe

them too strictly orarbitrarily.” In the case of calcified lesions, however, review

of the practices at individual induction stations revealed that, in many instances,

standards were applied very strictly, without recourse to the liberalizing provisions made in October 1942.Subsequently, Selective Service was to reexamine all

men who had been rejected for this cause alone.

MENTAL AND PERSONALITY DISORDERS

During the World War period of April 1917 to 31 December 1919, more than 97,000 Army patients were admitted to hospitals for neuropsychiatric

diseases.28 Nearly 50 percent of these individuals had to be discharged from

the service. Moreover, records showed that in the same period, more than half

million registrants were rejected by Selective Service because of mental disorders. By 1940, the Veterans’ Administration had paid nearly $642 million in

claims on neuropsychiatric cases arising out of World War I. This number

constituted almost one-fifth of the total number of beneficiaries to whom claims

were paid for all causes. Added to this was the cost of hospitalizing neuropsychiatric patients, which alone amounted to nearly $300 million between 1926 and

1940.

28 Circular Letter No. 19, Office of The Surgeon General, U.S. Army, 12 Mar. 1941.
LOWER ENTRANCE REQUIREMENTS 37

As result of this experience, the World War II planners considered it

imperative that standards for mental and personality disorders be aimed at

preventing neuropsychiatrics and potential neuropsychiatrics from entering

the Armed Forces. The record of World War 11 experience in this area proved

to be very much like that of World War I, however. During the mobilization

period before the United States entered the war, more than 10 percent of those

rejected were rejected for mental and nervous defects and 3.8 percent for

educational deficiency. 29 Although rejection rates by cause fluctuated during the

1042-45 period, mental illness was responsible for the greater number of

disqualifications. In all, an estimated 1,992,950 men, or more than 30 percent of

all rejections, were found by Selective Service to be unfit for general duty

because of mental and educational deficiency and neuropsychiatric conditions. 30

Of those who served in the Army during the war years, 1942-45, 379,486 were separated from the service for neuropsychiatric reasons. These accounted for 45 percent of all discharges for disability. An additional 356,000 were separated for inaptness, lack of required degree of adaptability, or enuresis.31

Standards

World War II standards stated that, to be effective in military service, an

individual must have the capacity for sustained duty in the face of separation from home, regimentation, lack of privacy, extremes of climate, hunger, exhaustion, and threat of bodily injury. basic premise was that an unstable individual forms weak point in the military organization. lie often breaks down

under stress, endangering the lives of others in his unit as well as the national

security. lie is often an inefficient soldier, occupies hospital beds, and requires

other personnel to care for him. Consequently, examining physicians were in- structed to judge the fitness of registrants with these premises in mind.

In the March 1942 version of MR 1-9, registrant was to be accepted for

general service if he had marginal intelligence provided this was compensated

for by better than average stability. moderate degree of stuttering and stammering was also acceptable, provided speech was understandable and the individual was otherwise physically, intellectually, and emotionally fit. When

MR 1-9 was revised in October 1942, those showing moderate degree of compulsiveness or obsessiveness, in addition to those who stuttered and stammered,

also were to be considered acceptable. Acceptability of the obsessive-compulsive

was short lived, because it was removed from the standards in January 1943.

With certain exceptions, standards for mental and personality disorders

underwent the most radical and constant change of any standards established

in the regulation. All activity was coordinated with Selective Service, which

made appropriate modification of its regulations to maintain consistency with

29 See footnote 4. p. 16. 30 See footnote 3, p. 16. 31 Health of the Army, Volume I. Report No. 2. Office of The Surgeon General, War Department

31 Aug. 1946.
38 PHYSICAL STANDARDS

those of the Army. From review of the standards in effect throughout the war,

however, it is apparent that there was less difficulty in stating the classifications

of acceptability or rejection than in applying them accurately to each individual

examined, in the face of the variety of adverse influences brought to bear on the

examining physician.

Examination of Registrants

The minimum psychiatric examination, included in Selective Service Medical Circular No. 1, dated Nov. 1940, and in MR 1-9, was created with the

understanding that the great majority of physicians making the psychiatric

evaluation would be general practitioners. The same documents carried warning about neuropsychiatric cases, stressing the fact that there was no place in

the Armed Forces for the psychopath, the feebleminded, or the insane.

In Circular Letter No. 19, issued on 12 March 1941, The Surgeon General

amplified the point. The Army, he stressed, was not in any sense social service

or curative agency to be considered as haven of rest for the wanderer or the

shiftless. Neither was it corrective school for the misfits, the ne’er-do-wells,

the feebleminded, nor the chronic offender. It was not to be considered either

as gymnasium for the training and development of the undernourished and

the underdeveloped, or as psychiatric clinic for the proper adjustment to

the emotional development of adulthood. There was no place in the Army for

the physical or mental weakling, the potential or prepsychotic, or the behavior

problem. The circular made it clear that if an individual was problem in

the civilian community, he would most certainly become more intensified

problem in the service. The examining physician was then cautioned that, while

these facts were brought to his attention, he was not to interpret them as

basis for lightly rejecting individuals for military service. They were rather

to be construed as points upon which to evaluate men being examined with the

view to eliminating the unfit and to retaining those capable of satisfactorily

performing the duties of soldier.

The procedure was tightened in 1942 by requiring that psychiatric examinations be given only at induction stations, where trained psychiatrists were

regular members of the examining teams. The general practitioners who served

as examining physicians at the local board level were instructed to reject for

mental conditions only those registrants about whom there could be no doubt.

Induction Station Problems

During 1941, and in the early part of 1942, constant effort was made to

improve neuropsychiatric screening at induction stations. Many factors were

operating to make this difficult task. The induction of large numbers as

rapidly as possible was an important factor. As result, the time allowed for
LOWER ENTRANCE REQUIREMENTS 39

accomplishing the examination was unrealistically short, routinely less than

15 minutes. Examining physicians were handicapped by lack of adequate

historical information on the registrants sent to induction stations by local

boards. To further complicate the problem, there were not enough adequately

trained neuropsychiatrists in many areas. As with other medical specialists, the

bulk of the workload in connection with neuropsychiatric selection was handled

by the civilian psychiatrists available in the respective areas. Most of these had

little or no military experience to assist them in deciding which person might

be expected to make satisfactory adjustment to military life. Moreover, local

boards, when hard pressed to till their quotas, would return for induction men

who had been rejected previously, sometimes more than once. In some instances,

even former mental hospital patients were sent for induction. There were also

instances of individuals who had been discharged from other services for

neuropsychiatric reasons being sent for induction into the Army without this

essential background information being made available to the induction board.

There was no test so perfect that it would detect all potential neuropsychiatric casualties. Many who would later crack made an excellent impression during brief examination, while others, already alHicted, managed to

conceal their histories and their existing conditions. If the screening was too

strict, the rejection rate would be unrealistically high; if it was not strict

enough, the Army and the entire war effort would suffer by the induction of

the mentally unfit. further problem was imposed by the physical and emotional immaturity not infrequently found in the 18- to 20-year-old age group.

Where the requisite specialists were not available to staff induction stations,

the Army tried, whenever possible, to fill the gap by assigning medical officers

who had had some psychiatric training. It was observed that, at induction

stations where neuropsychiatrists were utilized, the rejection rate, based on

psychiatric grounds, was higher than at those stations which were not so

supported, but even the well-trained psychiatrists were at disadvantage

because of their inexperience with military requirements.

The War Department and The Surgeon General issued directives and

instructions in continuing stream to all agencies in the field. These communications were aimed at clarifying and adjusting standards, and at calling attention to the need for careful examination. This was done with the realization

that, while regulations and directives could be issued and enforced, nothing

could substitute for sound professional judgment.

The medical history of each inductee was another area for special emphasis.

The Surgeon General urged Selective Service to provide medical data on each

selectee sent to induction stations as means of giving added substance to psychiatric as well as to medical evaluations. The National Headquarters of the

Selective Service System, on 28 November 1941, did request local boards to furnish this information to examiners, but the desired records were in fact rarely

obtained. It was because of this inertia on the part of local boards that Selective
40 PHYSICAL STANDARDS

Service finally inaugurated its own medical survey program, outlined in Medical Circular No. of October 1943.

Under the procedure established, the State Director of Selective Service

assigned to each local board medical field agent who was made responsible

for seeking information about registrants from any source specified by the State

Director of Selective Service, Normally, information was obtained from personal or private physicians, social service exchanges, hospitals and clinics, public

or private social agencies of recognized standing, the U.S. Employment Service, present or former employers, public or private schools, and correctional

institutions or agencies. Great emphasis was placed on the need for accurate information, which was to be divided into medical, social, and educational, as

recorded in the secondary school records. The information was handled confidentially and was forwarded to the appropriate induction station without the

registrant’s knowledge. When it had served its purpose, it was returned to the

State Director of Selective Service.

Change in Approach to Evaluating Neuropsychiatric Disorders

As the war progressed and experience accumulated, strong evidence indicated that many individuals with minor personality disorders and mild neurotic

trends could still be useful in the Armed Forces. This fact, coupled with the

ever-increasing need for manpower, prompted change in approach in nenropsychiatric evaluation. In April 1944, the War Department issued TB MED

(War Department Technical Bulletin) 33 laying down new guidelines for the

induction station neuropsychiatric examination. The important change was

modified view of those with mild neuropsychiatric conditions. Rejection was

still to be based on findings of mental and personality disorders which findings

were to take into account the individual’s history as well as the examination

being given for induction, but all individuals having “reasonable chance,”

liberally interpreted, of adjusting to military life were to be admitted into the

armed services. Only definite indication of past or present, partially or completely incapacitating mental or personality disorder was to be considered as

cause forrejection.

Examining physicians were instructed at the same time to exercise care in

labeling registrant with diagnostic term which might in some way be injurious to him. Admittedly, both information and time were frequently inadequate

to establish an accurate diagnosis. For example, although symptomatology or

behavior might warrant disqualification of the registrant, the examiner was

warned that these might not be sufficiently well crystallized to permit diagnosis

of an actual disease entity. It was emphasized that each diagnosis must be based

upon adequate historical and clinical evidence. When the diagnosis was one not

included in the standards, separate terminology was prescribed to avoid

injurious language, but still identify the condition.
LOWER ENTRANCE REQUIREMENTS 41

Neuropsychiatric Screening Adjunct Test

To further the goal of detecting and eliminating registrants with certain

psychiatric disqualifications, the Neuropsychiatric Screening Adjunct test was

adopted in October 1944 for use at all induction stations. Because physicians

making the psychiatric examination saw every registrant, the amount of time

given to each one was necessarily limited. The screening test was designed to

extend the psychiatrists usefulness by enabling him to give more time to the

most difficult cases. It was not intended as substitute for psychiatric examination. As used in the induction stations, the Neuropsychiatric Screening Adjunct

test was to identify the group which were potential neuropsychiatric casualties.

When this was done, the individuals were referred to the psychiatrist for

individual diagnosis.

If the test results showed that the individual did not sutler maladjustments,

it was hoped that the examination by the psychiatrist could be perfunctory. In

fact, in situations when the rate of processing through the induction station was

unusually high, it was hoped that the examining psychiatrist could place full

reliance on the test.

The Neuropsychiatric Screening Adjunct test was adopted by the Army in

October 1944, although it had not been fully evaluated at that time. In July

1945, all induction stations in the United States were instructed to keep daily

record of the test scores of all men receiving preinduction physical examinations during the remaining months of 1945. Depending on the results, each man

was to be classified into one of seven groups, according to disposition. As it

developed, however, the pace of inductions slowed considerably during August,

because the war ended in that month. So far as is known, the Neuropsychiatric

Screening Adjunct test was not used to replace the individual examination of

the examining psychiatrist. The extent to which examining psychiatrists were

in favor of its use is not known, because the test was administered, principally,

by psychologists, and not enough experience was developed for total

evaluation.

Special Studies

During the war years, data were collected and studied by Fry and Rostow, 32

under the auspices of the National Research Council, concerning the performance in military service of men from Yale and Harvard Universities who were

treated for psychiatric difficulties while students at those institutions. The

diagnoses made while they were students ran the gamut from psychoneurosis and

sexual perversion to psychosis. These studies revealed considerable incongruity

between predicted and actual rates of failure in military service. great number who turned in creditable records, including many who served as officers,

32 Fry, C. C., and Rostow, W. G.: Reflections on the Problem of Psychoneuroses. Interim Report

to the Committee on Medical Research of the Office of Scientific Research and Development, 31 Oct.

1945.
42 PHYSICAL STANDARDS

would never have been recommended for military service by the psychiatrists

who saw them during their student years.

Another study reviewed the discharges of 174 enlisted Navy personnel who

had been rejected on neuropsychiatric grounds at least once but were later

accepted for service. Only 20, or 11.5 percent of the total, were discharged for

psychiatric reasons, including unsuitability and dishonorable. Of the remaining 88.5 percent, some were discharged for nonpsychiatric physical disabilities

incurred in the service; the others received routine honorable discharges.

study made after World War II at National Headquarters, Selective Service

System, under the supervision of the chief medical officer, revealed that of

2,054 men studied who were rejected at some time for neuropsychiatric reasons,

and who later served in the Army, 79.4 percent, or 1,630 of the total, rendered

satisfactory service. 33

All these studies, plus the records of rejections and separations for mental

causes, indicate that the Army’s standards on mental defects and deficiencies

were inadequate and ineffectively administered. Many who might have served

creditably were rejected at selective service local boards or at Armed Forces

induction stations, while others (more than one-third of million) who were

inducted were later separated from the Army for mental defects.

CONCLUSIONS

After the United States committed troops to battle in World War II, an

Army of 10 million men was mobilized. An Army of such size, if it was also

to exclude civilian force large enough to feed and equip it, was possible only

after changes to existing policies on physical and mental requirements were

made. The most significant changes included the decision to induct men with

certain defects, who could make positive contribution only after rehabilitation

or in specialized and limited assignments. The greatest numbers of additional

men came from groups that could function effectively only after dental work

had been accomplished, after spectacles had been furnished, or after treatment

for venereal disease.

Meticulous care was taken in creating standards on tuberculosis in order to

avoid the induction of tuberculars.

The greatest problem in the standards, however, was in those devised to

exclude mentally defective or deficient persons. Mental defects led the list of

causes for rejection during the war, yet they were also responsible for the

greatest number of discharges for disability.

33 See footnote 3, p. 16.
CHAPTER III

Mobilization Standards and Procedures for

Officers and Special Categories

Approximately one million officers served in the U.S. Army for some

time during World War II. These were gathered from various sources. On

27 August 1910, Congress authorized the President to order members and units

of Reserve components and retired personnel of the Regular Army into active

military service. Besides these Reserves (which included the National Guard)

and the Regular Army, the other primary sources of officer personnel were the

military training schools. These were the schools established for the sole purpose of training officers including the United States Military Academy, which

supplied officer personnel for the Regular Army; officer candidate schools for

eligible enlisted men; and the Reserve Officers’ Training Corps, established and

maintained in civilian institutions.

OFFICERS’ RESERVE CORPS AND NATIONAL GUARD

Examining Procedures

Examinations of Reserve officers were of three types: (1) Preliminary,

(2) final-type, and (3) terminal. Examinations were to be very much the same

for all categories, but in some instances, preliminary examination did not

include all the laboratory tests of final-type examination. Originally, Reserve officer ordered to active duty for an initial tour in excess of 30 days was

given preliminary examination not more than 90 days before entry on active

duty. This was to be as thorough as possible to avoid expense and inconvenience

to the individual and to the Government. If applicants lived near an Army

hospital or dispensary equipped with X-ray, electrocardiographic, and laboratory facilities, they were directedto report there for preliminary examination.

An examination by Regular Army medical officer was considered desirable,

but if this was not practicable, corps area commanders were to designate

medical officer of the Reserves to conduct it. Agencies issuing orders placing

Reserve officers on active duty in excess of 30 days were to advise commanding

officers of the Reserve officer’s first active-duty station whether or not finaltype examination had been given within 30 days of the effective date of

active-duty orders. In the absence of such notification, final-type examinations

were to be given when the officer reported for active duty.

Public Res. 96, 76th Congress, approved 27 Aug. 1940,

257—966 —67
44 PHYSICAL STANDARDS

If the preliminary examination did not disclose disqualifying defects, the

officer was ordered to active duty. When this examination did not definitely

disqualify, but indicated doubt in final qualification, the Reserve officer could,

if he desired, go to an Army hospital or other Army medical facility at his own

expense, where final-type examination could be accomplished.

In November 1940, information reaching the War Department indicated

that problems were arising out of differences in the results of preliminary and

final-type examinations. In some cases, Reserve officers receiving two examinations within the first 30 days after entry on active duty were being relieved

from duty because of different findings in the second examination. As result,

the War Department modified its instructions to provide that the results of

preliminary examinations be final, with respect to qualification for active duty,

if examining boards had been properly appointed and constituted. Recommendations of any succeeding examining boards were to be based solely upon those

parts of the second or final-type examination that were not within the scope

of the preliminary examination. Examples of these were given as chest X-rays,

electrocardiography, or serological tests. Finally, on 28 December 1940, the

War Department instructed that no second examination, except check for

intervening illnesses, was to be required if the preliminary examination was

of the final type. It was required, at that time, however, that the officer report

within 60 days of the original examination. Otherwise, another complete examination was called for. This interval fluctuated, but was finally stabilized at

90 days in March 1943.

Under procedures introduced in December 1940, examinations given before

actual entry upon active duty were to be at the option, and upon request of the

individual concerned. Because no funds were available for these purposes, such

examinations were to be given without expense to the Federal Government for

travel or pay.

Terminal examinations were given when Reserve officers were relieved from

active duty. They were to be identical to the final-type examination except that

serological tests for syphilis were not required.

Procedure Problems

Mobilization was still almost year away when the War Department, in

January 1940, pending revision of pertinent Army regulations, issued instructions governing physical standards and examination of officers of the Reserve

Letter, Maj. Gen. B. S. Adams, The Adjutant General, War Department, to Each Corps Area

and Department Commander; Each Chief of Arm and Service Chief of the National Guard Bureau

and Commanding General, Armored Force, Nov. 1940, subject: Physical Examinations and Waivers. Letter, Maj. Gen. E. S. Adams, The Adjutant General, War Department, to Each Corps Area

Bureau, 28 Dec. 1940, subject: Physical Standards and Physical Examinations.
OFFICERS AND SPECIAL CATEGORIES 45

components. These instructions were to supplement those already existing and

were to supersede them when appropriate. They provided that the same high

physical standards for officers of the Regular Army apply as well to those of

the Officers' Reserve Corps and the National Guard, except that visual standards

were to be lower. Specifically, visual standards were to be the same as those

prescribed for commission in the Medical Department and Corps of Chaplains

of the Regular Army. At that time, these visual standards were fixed at 20/200

in each eye, corrected to 20/20 in one eye, if myopia or myopic astigmatism;

and 20/50 in each eye, corrected to 20/20 in one eye, if hyperopia or hyperopic

astigmatism (appendixes C, p. 209; D, p. 249; E, p. 259).

Many discrepancies in policy and procedure were uncovered in 1940 and

1941, which enabled the Army to put them right before the country went to

war. For instance, before 22 May 1940, physical standards for retention of

members of the Officers' Reserve Corps in an active status were the same as

those for appointment. On that date, however, the War Department raised

physical standards for retention in an active status. On July 1940, standards

were raised also for appointment and, again, for retention in an active status.

In due course, retroactive changes to AR (Army Regulations) No. 40-100,

“Standards of Miscellaneous Physical Examinations” and AR 40-105, “Standards of Physical Examination for Entrance Into the Regular Army, National

Guard and Organized Reserves,” were made, principally with respect to vision.

As result, many officers fully eligible for retention on active duty on one

day, found themselves disqualified on the next. Many officers of the National

Guard were similarly affected. To correct this, the War Department nullified

the retroactive aspects of their instructions with respect to vision of National

Guard officers, but failed to give like consideration to members of the Officers’

Reserve Corps. Consequently, instructions were approved for dispatch on 18

March 1941 to equalize standards of visual acuity for both Reserve and National

Guard officers. These standards provided that Reserve officers appointed before

July 1940 could be retained in the active section of the Officers’ Reserve Corps

and that they could qualify for extended active duty, with vision of 20/200

in each eye, correctable with glasses to 20/20 in one eye, if no organic disease

of either eye existed. Xhicorrected visual acuity below 20/200, bilateral, was

not to be acceptable. These instructions, published on 22 March 1941, were

presented as an authority to waive visual requirements set forth in AR 40-100

rather than as an exception, or change, to the regulation itself.

Letter, Maj. Gen. E. S. Adams, The Adjutant General, War Department, to Each Corps Area

and Department Commander Bach Chief of Arm or Service; and to the Chief, National Guard Bureau,

30 Jan. 1940, subject: Physical Standfirds and Physical Examinations.

Memorandum, Brig. Gen. Wade H. Haislip, Assistant Chief of Staff, G-l, for the Chief of Staff,

Mar. 1941, subject: Physical Disqualification of Members of the Officers’ Reserve Corps.

Letter, Maj. Gen. B. S. Adams, The Adjutant General, War Department, to All Corps Area and

Department Commanders, 22 Mar. 1941, subject: Physical Standards of Reserve Officers Under

Paragraphs ISb, AR 40-105, and 16a (1), AR 40-100.
46 PHYSICAL STANDARDS

Confusion about the disposition of physically unqualified officers on active

duty persisted, however, until 17 April 1941. On that date, the Adjutant General’s Office issued directive that no officer of the Reserve component on

extended active duty was to be relieved because of any disability incurred or

disclosed after he had been found physically qualified for active duty, or found

physically disqualified and defects waived, except upon specific authority of

the Secretary of War. Corps area and department commanders were to continue

to relieve officers found physically disqualified at the time of physical evaluationfor active duty, of course.

Increased Manpower Requirements

Increased requirements for manpower quickly led to modifications in procedures and standards. On February 1941, the need for additional medical

officers was pressing. Consequently, The Surgeon General made recommendations to The Adjutant General, approved on 20 February 1941, which lowered

minimum requirements of height and weight to 60 inches and 105 pounds,

respectively, for appointment of officers in the Medical Corps Reserve.

By January 1942, an urgent necessity arose to increase strengths of officer

personnel in supply arms and services to handle the enormous material procurement demands of the War Department. War Department policy was changed

so as to approve for appointment, or extended active duty, individuals then

qualified only for limited assignments. Included were individuals with minor

physical defects which would disqualify them under existing physical standards

but would not interfere with satisfactory performance of noncombat duties.

These defects, however, were to be stationary in character and not likely to

be aggravated as result of active military service. In order that the provisions

of this policy were carried out in uniform manner, the Surgeon General’s

Office on 30 January 1942, issued list of defects considered acceptable for

limited service, supplemented by list of those that could be waived for general

service. 10 Such lists were revised and reissued periodically throughout the war

period.

Letter, Brig. Gen. J. A. Ulio, Acting The Adjutant General, War Department, to Bach Corps

Area and Department Commander, 17 Apr. 1941, subject: Physical Disqualification of Reserve

Officers.

Letter, The Adjutant General, War Department, to The Surgeon General, 20 Feb. 1941, subject:

Appointment in the Medical Corps Reserve.

Letter, Maj. Gen. E. S. Adams, The Adjutant General, War Department, to Each Corps Area and

Department Commander; Each Chief of Arm or Service; to the Chief, National Guard Bureau and

to the Commanding Officers, All General Hospitals, Jan. 1942, subject: Waiving of Physical Defects

for Limited Service Officers of the Supply Arms and Services. 10 Letter, Lt. Col. John A. Rogers, Executive Officer, Office of The Surgeon General, to The Surgeon,

Hawaiian Department, Fort Shatter, T.H., 30 Jan. 1942, subject: Waiver of Physical Defects for

Limited Service Officers. [Letter also sent to Surgeons, All Corps Areas and Departments, except

Philippine Department; Commanding Officers, All General Hospitals, except Sternberg General

Hospital; Chief, Medical Division, Office of Chief of Air Corps.]
OFFICERS AXD SPECIAL CATEGORIES 47

In the list issued on 30 January 1942, defects considered acceptable for

limited service were generally as follows:

1. Overweight to 25 percent above average weight for age and height, and

underweight to 15 percent below ideal weight, provided chest X-ray is negative

for pulmonary pathology and other chronic disease is carefully excluded.

2. Vision 20/400 in each eye, corrected with glasses in possession of the

examinee to 20/20 in one eye and to at least 20/40 in the other, provided no

organic disease of either eye exists.

3. Blindness, or vision below 20/400, in one eye, with vision 20/100 corrected with glasses in possession of the examinee to 20/20 in the other,provided

that there is no organic disease in the better eye and no history of cataract or

other disease in the more defective eye, which might be expected to involve the

better one; and provided in case one eye is missing, the individual is fitted with

satisfactory artificial replacement.

4. Complete color blindness.

5. Hearing 5/20 in each ear for low conversational voice, or complete deafness in one ear with hearing 10/20 or better in the other, provided the defect is

not due to active inflammatory disease and is stationary in character.

6. Chronic inflammation of the middle ear (otitis media) inactive, with

perforation of the eardrum, provided there is trustworthy history of freedom

from activity for the preceding years.

7. Old fracture of the spine or pelvic bones which has healed without

marked deformity, provided there is trustworthy history of freedom from

symptoms during the preceding years.

8. Loss of one hand, one forearm, or one lower extremity below the junction of the middle and lower thirds of the thigh, provided thatthe lost member

is replaced with satisfactory artificial limb.

9. Abnormally low or high longitudinal arches (pes planus, pes cavus),

or one form of clubfoot (talipes equinus), provided the condition is asympto- matic and does not interfere with normal locomotion.

10. History of bone inflammation (osteomyelitis) following fracture, provided X-ray indicates complete healing and there have been no symptoms of

the condition for the preceding years.

11. Joints fixed or limited in motion, provided the condition is the result

of injury and not symptom of disease.

12. History of excision of torn or detached semilunar cartilage of knee

joint, provided there is normal stability of the joint and period of one year

with complete freedom from symptoms has elapsed since the operation.

13. Residuals of anterior poliomyelitis, without marked deformity or loss

of function, originating years or more before examination.

14. Varicose veins, moderate, without edema or discoloration of skin.

15. History of gastric or duodenal ulcer, provided there is trustworthy

history of freedom from activity during the preceding years and provided

that gastrointestinal X-ray at the time of examination is negative.
48 PHYSICAL STANDARDS

16. Incomplete inguinal hernia.

17. Small asymptomatic congenital umbilical hernia.

18. Absence of one kidney, provided its removal has been necessitated by

other than tuberculosis or malignancy, and the other kidney is normal.

The following defects were considered unacceptable for any type of service

1. History of malignant disease within the preceding years.

2. Active tuberculosis of any organ and inactive pulmonary tuberculosis

except as described.

3. Syphilis, except adequately treated syphilis as described.

4. Old fracture of the skull with bony defect greater than cm. in longest

diameter or with history of accompanying mental or neurologic complications.

5. Instability of any of the major joints.

6. History of bone inflammation that has spread to organs, tissues, or other

nonbony parts of the body (metastatic osteomyelitis) with prolonged or recurrent drainage, regardless of duration.

7. Arthritis of the atrophic type (rheumatoid).

8. Any cardiovascular condition which disqualified for general service.

9. History of any of several types of intestinal operation (gastroenterostomy, gastric resection, intestinal anastomosis, or operation for intestinal

obstruction).

10. History of any of several types of prostate operation (prostatectomy

or transurethral resection of prostate, or of prostatic hypertrophy of any

degree).

11. Chronic endocrine disease, except mild hypothyroidism or mild genital

adiposity (Frohlich’s syndrome).

12. Certain forms of diabetes (diabetes mellitus of any degree of renal

glycosuria).

13. History of any psychosis.

14. History of severe psychoneurosis at any time, or psychoneurosis of any

degree if it has been recurrent or has shown symptoms within the preceding

years.

Defects recommended for general military service with waiver were the

following:

1. Minimal inactive lesions of primary or reinfection-type pulmonary

tuberculosis. These lesions may consist of—-

a. Calcified residues of lesions of the intrathoracic lymph nodes,

provided none of these exceeds an arbitrary limit of 1.5 cm. in diameter and

the total number does not exceed five.

b. Calcified lesions of any functional element of the lungs (pulmonary

parenchyma), provided the total number does not exceed 10, one of which may

equal but does not exceed cm. in diameter, but none of the remainder may

exceed 0.5 cm. in diameter. (Note: The lesions described in (a) and (b) just
OFFICERS AND SPECIAL CATEGORIES 49

cited should appear sharply circumscribed, homogeneous, and dense. Measurements refer to standard 14- by IT-inch direct project roentgenograms.)

c. Small tibrotic parenchymal lesions represented in the roentgenogram as sharply demarcated strandlike or well-defined small nodular shadows

not exceeding total area of square centimeters, provided that acceptance is

deferred until subsequent examination demonstrates that the lesions are stationary and are not likely to be reactivated. The minimum period of time to

determine this is months. It must be recognized that either progression or

retrogression of the lesion indicates activity.

2. Confirmed positive serological tests for syphilis with no clinical evidence

of the disease, with convincing histories of trustworthy diagnosis of syphilis,

or with reliable histories of treatment for the disease on serological or clinical

grounds provided—

a. That negative spinal fluid since infection and treatment had been

reported from trustworthy source.

b. That in infections estimated to be of less than years’ duration, at

least from 30 to 40 arsenical and from 40 to 60 insoluble bismuth injections or

their equivalent, with minimum total of 75 injections, have been given, with

approximate continuity (no rest periods or lapses) during the first 30 weeks of

treatment.

c. That, except as further qualified in infections estimated to be of over

years’ duration, at least 20 arsenical injections and from 40 to 60 insoluble

bismuth injections or their equivalent, with minimum total of 60 injections,

have been given in alternating courses, rest periods between consecutive courses

not exceeding weeks being allowable.

In infections of unknown duration, it shall be presumed for classification

purposes that infections of individuals under 26 years of age are of less than

years* duration, and that those of individuals over 26 are of more than years'

duration. (Note: For the determination of treatment, the signed statement of

acceptable treatment sources administering it, with total doses of each drug and

approximate calendar dates of administration and available laboratory and

clinical data, shallbe required as evidence.)

3. Overweight to 20 percent above average weight for age and height, and

underweight to 12.5 percent below ideal weight provided chest X-ray is negative for pulmonary pathology and other chronic disease is carefully excluded.

4. Insufficient incisor or masticating teeth, provided the mouth is free from

extensive infectious processes and the examinee is wearing satisfactory dentures.

5. Pilonidal cyst or sinus, provided there is no palpable tumor mass, no

evidence of purulent or serous discharge, and no history of previous discharge

or inflammation.

6. History of healed fracture with bone plates, screws, or wires used for

fixation of fragments still in situ, provided X-ray shows no evidence of osteomyelitis and no rarefaction of bone contiguous to the fixative materials; that such

fixative materials are not so located that they will be subjected to pressure from
50 PHYSICAL STANDARDS

military clothing or equipment; and that year has elapsed since their

application.

7. History of operation or injection treatment for inguinal or small ventral

hernia, provided that examination months or more following operation, or

following the last injection, shows satisfactory results.

8. History of kidney stones (unilateral renal calculus), provided the condition has been asymptomatic for the preceding years, urine examination is

negative, and roentgenological examination (flat plate) of both kidneys is

negative.

9. Absence of the spleen, provided its removal has been necessitated by

crushing injury.

10. History of removal of the gallbladder (cholecystectomy), provided

the condition has been asymptomatic for the preceding years.

By August 1942, considerable difficulty was being experienced in keeping

pace with demands for manpower,both officer and enlisted. 11 Commanding generals of service commands were advised that the possibility of having to discharge for disability some individuals after induction into the service, with the

further possibility of subsequent claims against the Government, was of minor

importance compared to the necessity of immediately inducting the maximum

number of qualified registrants into the Army. This and similar actions were

considered by the Surgeon General’s Office as part of constantly growing

demand to lower physical standards. Concern over the influence of these instructions on physical evaluation of officers could not be avoided. 12

In November 1942, revision of AR 40-100 was issued, which contained

complete list of defects for which waivers could be recommended (appendix I),

p. 249). This revision permitted officers, Army nurses, and warrant officers of

Reserve components with any of the defects listed to be accepted for limited

service. Conditions not enumerated, but similar to those given, and which were

borderline in nature, were to be evaluated on similar basis.

Waiver of Physical Defects

Before massive increases in manpower made it imperative that officers be

accepted for limited service, the rigid physical standards were being infringed

upon and lowered through grants of waivers for general service. The War Department instructions of January 1940 provided that waivers of physical defects

would be granted only by the War Department. Moreover, waivers granted

before that date would not be considered binding. This was in keeping with the

policy of that period that only the most highly qualified would serve on active

duty.

11 Memorandum, Col. Oscar B. Abbott, GSC, Director of Military Personnel, for The Adjutant

General, 10 Aug. 1942, subject: Recruiting and Induction Examination. 12 Memorandum, Brig. Gen. C. C. Hillman, War Department, for General Love, 15 Aug. 1942.
OFFICERS AND SPECIAL CATEGORIES 51

On July 1940, the Secretary of War approved recommendation of The

Surgeon General to permit commanding generals of corps areas to grant waivers

to underweight or overweight Reserve officers being ordered to active duty. 13

Corps area commanders were authorized to approve waivers for underweight to

12.5 percent below the ideal weight, provided chest X-rays were negative for

pulmonary pathology. Overweight could be waived to 20 percent above the

average weight for the respective height and age.

The policy on waivers was liberalized somewhat more in September 1940

when little more authority was given to corps area and department commanders,14 and then in November, the War Department instructed these commanders

to grant reasonable waivers where the interest of the Government or of the

military service would not be compromised. 15 The latter directive applied to

examinations given after entry upon active duty. Those delegated authority

to grant waivers were enjoined to exercise this authority when physical defects would not interfere with satisfactory performance of field duties and when the

nature of the defect was such that it was not likely to be aggravated to disabling degree as result of active military service.

Waivers were to be granted under the November 1940 instructions only

upon written request of the individual concerned. In National Guard officers,

waivers were to be granted upon recommendation of division or separate unit

commanders, made on the requests for waivers forwarded by the individuals

concerned. Each request for waiver was to be accompanied by an affidavit from

the individual acknowledging that waived defects had existed before entry into

active military service and were not the result of such service.

When the 28 December 1940 instructions on physical standards and physical

evaluation of Reserve officers were issued, corps area and department commanders retained the same authority to grant waivers as specifically delegated

by the War Department. These instructions were more or less summary of

those issued after 30 January 1940. On 11 January 1941, that portion of instructions dealing with the request for waivers was modified, and corps area and

department commanders not only were authorized to grant waivers submitted

on the initiative of individuals but also were further authorized to request individuals to submit requests for waivers. This applied in those cases where,

in the absence of request for waiver submitted on the initiative of the individual concerned, corps area or department commanders believed that waiver of

defect was appropriate. 16

13 Memorandum, Maj. Gen. E. S. Adams, The Adjutant General, War Department, for Assistant

Chief of Staff, <3—1, 29 June 1940, subject: Waiver by Corps Area Commanders of Underweight or Overweight Reserve Officers Called to Active Duty.

14 Letter, Maj. Gen. E. S. Adams, The Adjutant General, War Department, to Each Corps Area and

Department Commander; Each Chief of Arm or Service and to the Chief, National Guard Bureau,

Sept. 1940, subject: Physical Standards and Physical Examinations. 15 See footnote 2, p. 44. 16(1) See footnote 3, p. 44. (2) Letter, Maj. Gen. E. S. Adams, The Adjutant General, War Department, to Each Corps Area and Department Commander; Each Chief of Arm or Service; and to the

Chief, National Guard Bureau, 11 Jan. 1941, subject: Physical Standards and Physical Examinations.

257—966 —67
52 PHYSICAL STANDARDS

The finality of physical examinations given, to include waivers granted

therewith, was reemphasized in March 1942.17 Once an officer began active duty,

after proper examinations, evaluations, and approval, he was not to be reexamined or hospitalized unless ho was to be relieved from active military

service or his physical condition was such that he could not perform efficiently

in theposition to which he was assigned. Thus, by November 1942, when waivers

for limited service were included in All 40-100, the policy on waivers was

already fairly liberal toward the individual officer.

Disqualification and Appeals

War Department instructions of January 1940,covering physical standards

and physical examinations, required that reports of physical examination be

forwarded to The Adjutant General when an examination disclosed disqualifying defects. The War Department then took final action on the appointment

or discharge of the Reserve officer concerned.

On September 1940, the first definitive instructions were published concerning Reserve officers disqualified for service. 18 Reserve officer found

disqualified in final-type examination was accorded certain rights of appeal.

Otherwise, he was promptly relieved from active duty and ordered to his home.

If disqualifying defects were found in the preliminary examination, the officer

was accorded the right of reexamination. If lie declined the second examination, the report for the preliminary examination was to be forwarded to The Adjutant General for appropriate action.

When terminal examinations disclosed disability entitling the officer to

disability retirement benefits, he was ordered to an Army general hospital for

observation and treatment. On 28 December 1940, when revised instructions

on physical standards and physical examinations were published, 19 it was

emphasized that only the War Department and corps area and department commanders were authorized to adjudge an officer physically disqualified for

extended active duty. Consequently, only these authorities could authorize relief

from extended active duty for physical disqualification. An officer already on

extended active duty, who was found physically disqualified as result of

final-type examination, was to be retained on active duty if an appeal or request

for waiver had been initiated. Those found disqualified without waiver were

either to be placed in the Inactive Reserve or to be honorably discharged by

The Adjutant General.

When the War Department delegated authority to corps area and department commanders to make final determination of acceptance or rejection of

17 Letter, Maj. Gen, J. A. Ulio, The Adjutant General, War Department, to Commanding Generals

of All Armies, Army Corps. Divisions. Corps Areas, and Departments Chiefs of Arms and Services, Commanding Officers of Exempted Stations; Chief. National Guard Bureau; and to Commanding

Officers, All General Hospitals, Mar. 1942, subject: Physical Standards and Waivers for Physical

Defects. 18 See footnote 14, p. 51. 19 See footnote 3, p. 44.
OFFICERS AND SPECIAL CATEGORIES 53

Reserve and National Guard officers in uncomplicated cases, together with

certain authority to grant waivers, appeal boards were to be established to

satisfy the individual’s right to appeal. The revised instructions of 28 December

1940 also made the right to appeal retroactive to September 1940 for officers

who were then on an inactive status and had not been discharged.

Officers found with disqualifying defects were to be so informed by the

appropriate corps area or department commander. notice was to be furnished

the officer concerned, which was to include the specific defect or defects for

which the officer was disqualified. At the same time, the notice was to include

advice to the officer of his right to appeal. Those submitting appeals, whether

in the Active or Inactive Reserve, did so with the understanding that cost of

travel, pay, and subsistence in the hospital, if hospitalization was indicated

during the appeal examination, was to be at their own expense.

The medical appeal boards were to consist of two or more medical officers of mature experience and judgment; they were to be officers other than those

serving on examining boards making physical evaluations of Reserve and

National Guard officers.

Medical appeal boards were to limit their examinations to the disqualifying

defects reported by examining boards. Where practicable, the place of examination by medical appeal boards was to be hospital or dispensary other than

the one in which the officer making the appeal was originally examined.

Action on appeals by corps area or department commanders was to be final.

The one exception to this was the case of flying officers, action on whose cases

had been reserved by the War Department,

UNITED STATES MILITARY ACADEMY

Standards for the United States Military Academy, for practical reasons,

always had been maintained at high level. Physical standards for appointment

to the Academy were established in AR 40-100 (appendix I), p. 249) and, with

minor exceptions, were identical to those set forth in AR 40-105 (appendix C,

p. 209) for appointment in the Regular Army. The standards for eyes and vision,

ears and hearing, and dental were higher for appointment to the Academy

than those for Regular commission. The standards applied not only to

candidates for admission but also to applicants for enlistment who expected,

ultimately, to enter the Academy.

OFFICER CANDIDATE SCHOOLS

The first Army regulation covering the subject of officer candidate

schools, AR 625-5, “Officer Candidates,” was issued on 26 November 1942.

Before that time, series of War Department circulars had been issued which

established and governed operation of these schools, and by the time AR

625-5 was published, 18 such schools were in operation, training men to qualify
54 PHYSICAL

for commission in the Army of tlie United States. The age limits for officer

candidate school applicants were from 18 to 46 years, and mental score of

110 or higher in the Army General Classification Test was required for acceptance. All applicants were required to have final-type physical examination.

With certain modifications, physical standards by which officer candidates

were evaluated were to be those previously established for Reserve officers. The

initial exception was height, which was to be that established for selectees

under the first mobilization regulation. On 24 March 1042, further exception was made by War Department Circular No. 86, which lowered the dental

and visual requirements. Individuals were to be accepted with minimum of

three serviceable natural masticating teeth above and three below, together with

three serviceable natural incisors above and three below, so opposed as to serve

the purpose of mastication and incision during excursions of the mandible.

Individuals were to be accepted even though the teeth described were not in

actual contact when the mandible was at rest in centric occlusion. Instead of

this, individuals could be accepted with minimum of an edentulous ridge

in the upper jaw, corrected or correctable by full denture, provided they did

not otherwise show evidence of physical impairment, either from loss of masticatory efficiency or from ill health incurred from the pathological processes

which led to the loss of teeth. At the same time, individuals could be accepted

with minimum of sufficient number of natural lower teeth in proper position and condition to support partial denture. The denture was to be removable and easily replaced by the individual and was to be retained by

means of clasps with rests or by special provision attachments to abutment

teeth.

War Department Circular No. 86 permitted acceptance of individuals with

visual acuity below 20/100, but not below 20/200 in each eye, without glasses,

if correctable to 20/40 in each eye. Individuals thus qualifying were to be otherwise qualified and eligible for commission and duty with noncombat services.

On 14 October 1942, War Department Circular No. 345, establishing the

maximum age for candidates attending the Army Administration Officer Candidate School, was issued. Candidates for this school were to be accepted at

an age no greater than 50 years and months at the opening date of the class

for which selected. Candidates coming from the combat arms and services were

not to have attained the age of 36 on the opening date of the class for which

selected.

By 28 October 1942, the shortage of officer candidate material in the combat arms and the heavy demands being made on the latter prompted the release of War Department Circular No. 358. Circular No. 358 required that no

qualified enlisted man, under 35 years of age, assigned to the combat arms and

services, was to be enrolled in one of the basically administrative officer candidate schools. Specifically named were the Army Administration Officer Candidate School, the Quartermaster Officer Candidate School, the Medical Ad-
OFFICERS AND SPECIAL CATEGORIES 55

ministrative Officer Candidate School, and the Finance Officer Candidate

School.

When AR 625-5 was issued in November 1942, the standards for vision

were modified to the extent that the minimum visual acuity of 20/200 in each

eye, without glasses, had to be correctable to 20/20 in one eye, and to 20/40 in the other. This was applicable only to the noncombat services. Candidates

failing to meet these requirements for general military service under the provisions of MR (Mobilization Regulations) 1-9, “Standards of Physical Examination During Mobilization,” were still eligible for officer candidate

schools of the noncombat services.

War Department Circular No. 64 was issued in March 1943 after it was

revealed that certain enlisted men were being denied the opportunity to attend

officer candidate schools because of physical defects present at the time of their

enlistment or induction. These defects were not sufficient to disqualify the individual for general military service as an enlisted man. The Adjutant General

pointed out in this circular that any enlisted man qualified for retention on

active service was to be considered physically qualified to attend officer candidate schools of the noncombat services.

RESERVE OFFICERS’ TRAINING CORPS

Applicants for membership in ROTC (Reserve Officers’ Training Corps)

were required to be “physically fit to perform military duty, or will be so upon

arrival at military age.” Physical standards were to be those prescribed for

commission in the Officers' Reserve Corps (appendix C, p. 209). Deviations

in height and weight were permitted from the standard height and weight

table for students from 14 to 21 years of age. Existing physical disability, or

defects likely to exist at the time of graduation from the Reserve Officers’

Training Corps and which might not be waived for appointment in the Officers’ Reserve Corps, could not lie waived for enrollment or continuance in

senior division of the Reserve Officers’ Training Corps.

Before the war, students graduating from the Reserve Officers’ Training

Corps were enrolled in the Officers’ Reserve Corps. At the outbreak of war, only

senior division ROTC students were permitted to continue under the program

and, upon graduation, were enlisted in the Army, given basic training, and

sent to officer candidate school. Special provisions were made with respect to

physical qualification before commissioning former ROTC students graduating from officer candidate schools.20

Qualification of students for the Reserve Officers’ Training Corps had been

based on the higher physical standards contained in AR 40-105. Physical standards for entrance into officer candidate schools were but very little higher than

those for enlisted service. The War Department wanted to keep the higher quali20 Memorandum No. W145-2-43, Maj. Gen. J. A. Ulio, The Adjutant General, War Department,

13 Feb. 1943, subject: Appointment of ROTC Graduates.
56 PHYSICAL STANDARDS

fied personnel separate, so that they could be retained in the Officers’ Reserve

Corps after the war without depriving the Army of the services of others who

could qualify under the lower standards applicable. Consequently, theWar Department prescribed that advanced course KOTC students, physically qualified

for appointment in the Officers’ Reserve Corps under AR 40-105, were to be

considered physically qualified for attendance at any officer candidate school.

Upon graduation, they were to be considered physically qualified for commission in the Officers’ Reserve Corps rather than in the Army of the United

States in which officer candidate school graduates were normally commissioned.

Senior ROTC students not qualified under AR 40-105 could still attend officer

candidate schools if they qualified for general service under AR 625-5, but on

graduation, they were to be commissioned in the Army of the United States.

Senior ROTC students, not qualifying under these criteria for the arms, could

attend officer candidate schools of the services under lower criteria. Students not

meeting any of these standards could qualify for officer candidate schools of the

services if they met the physical standards prescribed in MR 1-9 for general or

limited service applicable to inductees.

Students not physically qualified under any of the criteria mentioned were

not to be ordered to officer candidate schools. Instead, their ROTC contracts

were to be terminated, and if they had been previously enrolled in the Enlisted

Reserve Corps, or inducted into the service, they were to be discharged. Regardless of the level of physical condition under which ROTC student qualified,

final-type physical examination was necessary before he departed for officer

candidate school. From this point on,requirements and procedures applicable to

ROTC students were thesame as those for other officer candidates.

FEMALE COMPONENTS

When the United States entered World War II, the only women in the

Army were nurses. During the war, components were created to include dietitians, physical therapists, physicians, surgeons, and members of the Women’s

Army Auxiliary Corps (later Women’s Army Corps). Nurses held positions of

relative commissioned rank which later was changed to full commissioned status

in July 1944. Before the war, physical therapy aides and dietitians on duty in

Army hospitals were civil service appointees. During the war, such personnel

were commissioned on the same basis as nurses, and by the end of the war, the

personnel involved was substantial. In the Women’s Army Corps, both officer

and enlisted personnel were involved. Physical standards for all women were

essentially those prescribed for Army nurses.

Army Nurse Corps

Standards in effect for the examination of Army nurses and applicants for

the Army Nurse Corps in 1940 were those set forth in AR 40-100. With the
OFFICERS AND SPECIAL CATEGORIES

large influx of women into the Army, however, more definitive physical standards for accurately evaluating the physical condition of females were required.

In September 1913, an entire section [Change No. 5] was added to the basic

regulation, embracing causes for rejection, pelvic examination, special qualifications for Women’s Army Corps, history of menses, and limited service. In addition to causes for rejection covered in All’s 40-105 and 40-100, common to both

men and women, IT causes for rejection peculiar to women were added to the

standards. In technical terminology, disqualifying conditions thus included

were pregnancy; marked endocervicitis; tuberculosis of pelvic organs or breasts

(a history of successful excision of the affected organ years or more before

date of application was not to be considered disqualifying); bartholinitis;

vaginitis, acute or chronic; salpingitis, acute or chronic; oophoritis, acute or

chronic; new growths of the external genitalia; cervical polyps; ovarian cysts;

new growths of the uterus (this was with the exception of fibroid, single subserous, asymptomatic, less than cm. in diameter, with no general enlargement of

the uterus); congenital abnormalities or lacerations of the birth canal, which,

in the opinion of the examining physician, were of such degree as to cause

incapacity; incapacitating menstrual disorders; menopausal syndrome manifested by more than mild constitutional or mental symptoms; new growths of

the breasts; acute mastitis; and marked chronic cystic mastitis (appendixes

and D).

Limited service was authorized for Army nurses, hospital dietitians, and

Medical Department physical therapy aides in the September 1943 change. Previously, AR 40-100 of 16 November 1942, with respect to females, had included

reference only to Army nurses.

Both the 1940 and the 1942 versions of AR 40-100 required that physical

fitness of Army nurses and applicants for the Army Nurse Corps be determined

by an examining board of not less than two medical officers. Individuals were to

be questioned carefully about their medical history and state of health atthe time

of examination. Examinations were to be thorough in order to eliminate those

not capable of performing duties required of an Army nurse. An X-ray examination of the chest was to be made, and full advantage was to be taken of all

other available diagnostic aids in detecting physical impairment.

Women’s Army Auxiliary Corps and Women’s Army Corps

The WAAC (Women’s Army Auxiliary Corps) and the WAC (Women’s

Army Corps) were created—the former for service with the latter for service

in, the Army of the United States. Establishment of the Women’s Army

Auxiliary Corps was authorized by an act of Congress approved 14 May 1942,21

21 (1) Women’s Army Auxiliary Corps Regulations (Tentative), War Department. Washington:

U.S. Government Printing Office, 1942. (2) Women’s Army Auxiliary Corps Regulations, War Department, 1943. (3) For more detailed discussion see Treadwell, Mattie E. The Women’s Army Corps.

United States Army in World War II. Special Studies. Washington; U.S. Government Printing

Office, 1954.
58 PHYSICAL STANDARDS

The purpose was to make available to the national defense, when needed, the

knowledge, skill, and special training of the women of the Nation. The total

strength of the corps was not to exceed 150,000. The Women’s Army Auxiliary

Corps was not organized as part of the Army, but in serving with it, was to be

utilized for noncombat service.

Enrollment in the Women’s Army Auxiliary Corps was to be voluntary.

Enrollees were to be of excellent character, in good physical health, and between

21 and 45 years of age. Medical care was to conform as near as practicable to

that given to personnel of the Army, including the use of Army facilities and

medical personnel. During any “line-of-duty” injury, illness, incapacity, or

death, members of the Women’s Army Auxiliary Corps were entitled to all

benefits prescribed for civilian employees of the United States, which affairs

were normally administered by the U.S. Employees’ Compensation Commission. In the absence of specific regulations to the contrary, the Women’s Army

Auxiliary Corps was to be administered in accordance with Army regulations.

Tentative WAAC regulations of 28 May 1942 required that enrollees be

given physical examination at Army recruiting stations similar to that given

to personnel of the Army (fig. 12). Chest X-rays and serological tests for

syphilis were to be given as routine part of the examination. Physical

standards for enrolled members (counterparts of enlisted men in the Army)

were to be those given in MR 1-9 for general service in the Army, with due

consideration of the difference in sex and height and weight.

In addition to the conditions listed in MR 1-9 as causes forrejection, other

causes for rejections included in the tentative WAAC regulations of May 1942

were pregnancy; infections or new growth involving female organs (the breasts

included) congenital abnormalities or lacerations of the birth canal, which,

in the opinion of the examining physician, were of sufficient degree to have

caused incapacity; incapacitating menstrual disorders (amenorrhea per se was

not considered to be cause for rejection when secondary to menopause, or

surgery which was performed for benign condition) and other gynecologic

conditions which, in the opinion of the examining physician, were disqualifying

for admission into the Women’s Army Auxiliary Corps.

The Women's Army Corps, established on July 1943 as component of

the Array of the United States, absorbed and superseded the Women’s Army

Auxiliary Corps. Strength of the corps was to be as directed by the President.

It was to exist for the duration of the war plus months. Women under 20 or

over 50 years of age were ineligible for enlistment or reenlistment. Enlisted and

officer personnel of the Women’s Army Corps assumed status identical with

that of like personnel in other components of the Army. Basic regulations governing the new corps were amplified in War Department Circular No. 289, dated November 1943. Physical standards, as before,

were to be those set forth in AR 40-100 for nurses. In addition to the causes

for rejection listed in that regulation, venereal disease was added as further

disqualification for enlistment in the Women’s Army Corps. At the same time.
OFFICERS AND SPECIAL CATEGORIES 59

Figure 12.-—A Women’s Army Auxiliary Corps enrollee being inoculated for protection

against fever and disease in future assignment. Others await turn.

deviations from normal physical standards were permitted. It was clearly

indicated, however, that such deviations were not to interfere with, nor prevent,

satisfactory performance of duties. Moreover, they were not to be of nature

likely to be aggravated by the type of military service contemplated.

In War Department Circular No. 132, dated April 1914, further modification authorized limited service for WAC officers on the same basis as that

previously established for female components of the Medical Department.

Limited service was not authorized for enlisted members of the Women's Army

Corps, but some standards for general service were quite low. For example,

dental requirements for enlisted women were to be the same as those contained

in MR 1-9, dated 15 October 1942. The minimum standards, as result, permitted acceptance in the Women’s Army Corps of those who were completely

without natural teeth, provided the condition was, or could be, corrected with

artificial dentures.

Ultimately, examinations given for commission or enlistment were to be

of the final type. Before March 1943, many enrollees in the Women’s Army

Auxiliary Corps had not received complete final-type physical examinations.
60 PHYSICAL STANDARDS

The requirement for thorough examination was particularly desirable in that

when this group was incorporated into the Army members became entitled to

compensation and retirement benefits if subsequently found disqualified for

service in line of duty.

The neuropsychiatric examination of WAC applicants at recruiting stations was spelled out by TB MED (War Department Technical Bulletin) 100

issued in October 1944. The enlistment procedure usually involved an interview

by the recruiting officer following completion of the WAC classification test.

At this point, recruiting officers might disqualify an applicant as being delinquent, promiscuous, or troublemaker. Following the interview, applicants were tested by means of the Cornell Selectee Index, 22 The results of the

latter and the recruiting officer’s evaluation were then furnished the psychiatrist. Whenever possible, the applicant’s name was to have been cleared with

State institutions for mental disease. Doubtful cases, for whatever reason, were

to be investigated.

Pregnancy and Maternity Care

The basic policy on pregnancy was the same as that for nurses and all other

women serving in the Army. Members of the corps becoming pregnant were to

be relieved or discharged from the service. Pregnancy was added to 40-100

as cause for rejection. Tentative WAAC regulations of 28 May 1942 required

that married members, certified as pregnant by medical authority, were to be

honorably discharged without prejudice. Unmarried members, similarly certified, were to be given “summary discharge” without delay. WAAC Circular

No. 3, issued on February 1943, provided that an enrolled member becoming

pregnant was to be discharged without the usual board proceedings. The “summary discharge” was to be used to separate member for convenience of the

Government when retention in the corps would not be in the best interests of

the service. WAAC regulations of June 1943 required that pregnancy be entered in daily sick reports as “not in line of duty.” However, the condition was

not to be construed as due to the member’s own misconduct because this would have resulted in forfeiture of pay and service time. Under the provisions of

these regulations, WAAC members becoming pregnant, likewise, were to be

honorably discharged. The same provisions applicable to discharge of enrolled

women were to apply to WAAC officers. When the Women’s Army Corps was

created on July 1943, subsequent regulations for the new corps incorporated

identical provisions with regard to pregnancy.

The basic policy on pregnancy for all Army women was amplified in No- vember 1943, when it was directed that—

1. Only honorable discharges were to be granted for pregnancy, without

distinction as to marital status.

22 psychiatric screening test issued as Cornell Selectee Index Form No. by the Technical Section, Classification and Replacement Branch of the War Department Adjutant General’s Office.
OFFICERS AND SPECIAL CATEGORIES 61

2. Pregnancy was to be considered as occasioned not in line of duty, but

was not to be considered dueto the member's misconduct.

3. Pertinent Army regulations were to be reworded so as to omit any reference to marital status in connection with discharge or hospitalization for

pregnancy. 23

Many factors influenced this decision to give honorable discharges to

women for pregnancy regardless of marital status. Foremost among them was

the lack of any legal basis for other than honorable discharge. There were

also, however, administrative difficulties in making just decision, in many

cases, and the harm accruing to the woman on her return to civil life with

misconduct discharge and record of illegitimate pregnancy. Moreover, members of the Army Nurse Corps, when relieved under other than honorable

conditions, were to be removed from the list of registered nurses, thus depriving the individual from earning living in her chosen profession. Similar disadvantages would have accrued to women of other components.

Policy with respect to disposition of female officers and warrant officers

of the Army of the United States who became pregnant was restated and further clarified in War Department Circular No. 404, dated 14 October 1944.

Normally, an officer or warrant officer was to be given an honorable discharge

when pregnancy was involved. If other conditions were also involved, individuals were to be retained for hospitalization and treatment, even though they

were pregnant. Illegal abortions, whether complete or incomplete, were to be

regarded both as misconduct and as incurred “not in line of duty.”

The basic administrative policy with respect to separation from the service

was that pregnant nurses, hospital dietitians, physical therapists, and women

physicians were to be relieved from active duty. Other women officers and warrant officers who became pregnant were to be discharged.

ARMY SPECIALIZED TRAINING PROGRAM

In December 1942, program was established to provide for the scholastic

training of specially selected Army enlisted men in certain civilian colleges and

universities. After July 1943, only those trainees assigned to medical, dental, and veterinary schools were to be admitted to the program without having completed the prescribed course of basic military training. Moreover, the individual

was to be selected on the basis of his prior academic record, and, as appropriate,

the record achieved during basic training. Trainees admitted to any phase of

the Army Specialized Training Program were to have the same physical qualifications as those required for commission in the Army of the United States

(appendix C, p. 209). At least 90 percent of the personnel selected for such training were to be qualified for general military service. The remaining 10 percent

2J Memorandum for Record, Brig. Gen. Russel B. Reynolds, GSC, Director, Military Personnel

Division, Adjutant General’s Office, to The Adjutant General thru the Acting Chief of Staff, G—1,

Nov. 1943, subject: Line of Duty Status of Pregnant Nurses, Dietitians, Physiotherapy Aides and

Wacs.
62 PHYSICAL STANDARDS

could be admitted to the program if physically qualified for limited service

under the same standards.

ARMY SPECIALIST CORPS

The Army Specialist Corps was established in March 1642 under Executive

Order No. 9078, dated 26 February 1942. The corps was to bring under control of

the Secretary of War those individuals with professional, technical, scientific,

administrative, and managerial skills who otherwise would not have been available to the service. This group was to include, also, those who were to perform

work incidental, subordinate, or preparatory to the work required of those occupying positions calling for such skills. Still others were to perform work as

artisans, normally part of trade or manual-skill occupation.

Members of the Army Specialist Corps were to be assigned on an Armywide

basis to relieve military personnel for combat and command duties. Members

of the corps were to be appointed as civilians, without the acquisition of civil

service status, but were to have relative rank ranging from corporal to major

genera], and were to wear the comparable Army uniform. Members were to

have no command function. Their duties were to be administrative supervisory

only.

Appointees were required to meet the minimal physical standards established for limited service under MR 1-9. This requirement was subject to two

basic provisions. The first provision specified that no individual was to be accepted who had physical defect which, in the opinion of examining physicians,

rendered the applicant unsuitable for the special work he was expected to perform. The condition, moreover, must be of nature not likely to be aggravated

during Federal employment, nor apt to become the basis of subsequent claim

against the Government. The second provision, covering exceptional cases,

permitted acceptance of an individual failing to meet standards for limited

service set forth in MR 1-9 with recommendation for waiver of defect. In such

cases, examining physicians were to be of the opinion that physical condition

would not be limiting factor in the special work the applicant was to perform.

CONCLUSIONS

Problems of physical standards and examination in the physical evaluation

of manpower were almost as diverse as the purposes for which it was needed and

the sources from which it was drawn. The Officers’ Reserve Corps, the officer

candidate schools, the United States Military Academy, the Reserve Officers'

Training Corps, and the National Guard were basic sources of male officer personnel. The National Guard was also the principal source of units which were

inducted during the first years of the war. At the outset of mobilization, standards were raised and examination procedures tightened, but as the need for

manpower became crucial shortly after theUnited States entered the war, stand-
OFFICERS AND SPECIAL CATEGORIES 63

ards were lowered through the acceptance of officers for limited service and

liberal policy on waivers for defects.

Female components posed special situation in connection with standards,

examination, and pregnancy. These were amplified with the creation of the

Women’s Army Auxiliary Corps and theWomen’sArmy Corps.

The Army Specialist Corps was formed to fill gap by capturing the skills

of men who would not otherwise be available to the military effort. By the time

the corps was abolished late in 1012, however, standards had been so far lowered

that some 85 percent of its members were able to meet the physical qualifications

for service in the Army of the United States. It was after the absorption of the

Army Specialist Corps in the Army of the United States that the Army Specialized Training Program, operating in civilian institutions, was inaugurated

to provide further source of potential officer material.

CHAPTER IV

Personnel Classification and Retention Policies

When large numbers of men were no longer available from outside the

Armed Forces, the Army had to turn within itself to retain and make better use

of the men on hand. Personnel managers in industry and government had long

recognized the monetary, material, and intrinsic waste, or loss, resulting from

high turnover rates. It was not simply matter of replacing one individual with

another and having the latterpick up where the otherleft off. There were losses

of skills, experience, time, and separation costs, to mention few. With the

drastic depletion of men capable of performing service in the Armed Forces

during World War II, it became even more important to keep and utilize the

men already serving (fig. 13). Success in doing this depended upon developing

workable policies on classification, reclassification, limited service, oversea

assignment, and redeployment.

CLASSIFICATION PROBLEMS

Procedures for the initial classification of those entering the Army as enlisted men were issued shortly before passage of the Selective Training and

Service Act of 1940, and in anticipation of it. This classification was process

by which pertinent dataconcerning the man'seducation, intelligence, aptitudes,

previous military experience, civilian work history, interests, hobbies, and

other qualifications were obtained and recorded. The information was to be

used as basis for an assignment in which man would be of greatest value to

the service by the most effective use of the skills he possessed.

There was very little in the regulations regarding the physical condition of

the man, except to state that men physically qualified only for limited service

would be assigned to noncombatant duties. The high physical standards applicable during the early mobilization period created situation wherein many

of the most physically qualified men were in service or support assignments

rather than in combat units of the Army Ground Forces, where the higher

physical capacities were needed. As the war progressed and physical standards

For more information on personnel procedures and problems, especially as they applied in the

Medical Department, see Medical Department, United States Army. Personnel in World War II.

Washington U.S. Government Printing Office, 1963.

Army Regulations No. 615-25, Sept. 1940.
66 PHYSICAL STANDARDS

Figure 13.—Individuals in service troops undergoing physical examination for combat

duty at the 619th Clearing Station, Saverne, France.

were lowered, it became increasingly difficult to find men just coming into the

Army who had the physical capacity to serve in combat units.

Both the Army and the Navy competed for the best men at induction stations. Moreover, within the Army, the Army Ground Forces, the Army Air

Forces, and the Services of Supply (later Army Service Forces) each competed

for the best of the manpower available. Particularly acute was the rivalry between the Army Ground Forces and the Army Air Forces, both of which had

combat missions.

As part of its promise to those volunteering for Army service at induction

stations early in the war, the Army offered choice of assignments. Most of

these “volunteers” chose the Army Air Forces. By establishing higher enlistment standards than those required for duty with other major elements of the

Army, the Army Air Forces were able to obtain much of the cream of the manpower brought into the Army (appendix D, p, 249). In addition, all men within

(1) Army Ground Forces Memorandum, Replacement Depot No. 1, for Commanding General, Army

Ground Forces, Nov. 1943, subject: Characteristics of Enlisted Replacements by Arms. (2) Tab D, Army Ground Forces Memorandum (S) for G—1, War Department, 21 Dec. 1943, subject: Utilization

of Available Manpower Based Upon Physical Capacity. [Both documents cited here were used by

Mrs. Heilman in her work on an earlier draft of this volume, but neither is now available in the

official files.—C. M. W.]
RETENTION POLICIES 67

the Army were eligible to apply for aviation cadet training. Men failing to

complete aviation cadet training successfully were not returned to the organization from which they had been drawn but were retained on duty with theArmy

Air Forces in some other capacity.

The distribution of men between the Army Ground Forces and the Army

Service Forces was not ideal. The former needed men in good physical condition,

while the latter needed men with previously acquired skills and occupational

training. Until 1944, there was no system for relating skills and capabilities

with physical capacity beyond the use of physical standards for induction.

The classification of men according to acquired skills tended to emphasize

this aspect in the process of making assignments. Consequently, the more highly

skilled were assigned to the Army Service Forces, while the remainder went to

the Army Ground Forces. As result, many of the more highly skilled, who

were also better physically qualified, were given noncombatant assignments,

much to the disadvantage of the effort to obtain sufficient qualified personnel

for combat units. Added to these difficulties was that all men were eligible to

apply for the Army Specialized Training Program, as in aviation cadet training. Personnel drawn from the Army Ground Forces in this manner not only

comprised more than proportionate share of the total but also represented an

even higher percentage of its better qualified men than was the case in the other

major Army elements.

Although the need for combat troops was rising steadily, approximately

600,000 able-bodied men were in overhead organizations in the Zone of Interior at the end of 1943. Early in January 1944, the War Department directed

that these men be reassigned in the course of the next months for oversea

duty. Their replacements were to come primarily from civilians, Wac’s, and

limited service men. The Army Ground Forces did reassign 42,000 of its own

troops included in the total, but little progress was made by either the Army

Air Forces with 400,000, or the Army Service Forces with 158,000. Only after

direct orders issued on 30 October 1944 to transfer men qualified for oversea

duty to the Army Ground Forces were any substantial numbers shifted between the two major commands. Between that date and the end of the war, the

Army Air Forces supplied 60,000 men for ground combat duty, the Army

Service Forces supplied 28,000, and other Zone of Interior sources supplied

12,500. The Army Ground Forces also received 73,000 men from the Army

Specialized Training Program.

Memorandum, Capt. W. F. Lentz, Chief, Statistics and Reports Executive Office, for Director,

Army Specialized Training Program, 21 July 1943, subject: Number of Men in ASTP Institutions

Supplied by Bach of the Three Forces.

(1) Palmer, Robert A., Wiley, Bell I., Keast. William R.: The Procurement and Training of

Ground Combat Troops. United States Army in World War II. The Army Ground Forces. Washington

U.S. Government Printing Office, 1948, pp. 80-82. (2) Minutes, War Department General Council,

27 Mar. 1944. (3) Memorandum, Maj. Gen. Ray E. Porter, Assistant Chief of Staff, G-3, for the

Commanding General, Army Ground Forces, 29 Mar. 1944, subject: Allotment of Personnel Released

by Army Air Forces.
68 PHYSICAL STANDARDS

The Adoption of “PULHES”

Early in 1944, the War Department recognized the need for some means

of classifying the physical capacities of men, as had been done in occupational

skills and intelligence levels, and then using these classifications to make an

equitable and realistic distribution of combat-fit personnel. After considering

several proposals, the Physical Profile Serial System, or “PULHES,” was

adopted,

The “PULHES” system was an adaptation of the Canadian “PULHEMS”

system. It differed from the Canadian system in that the latter embraced

closer relationship between physical capacity and specific military duties to be

performed. It must be emphasized that the Physical Profile Serial System was

applied to those men who already had been physically evaluated in induction

stations, according to the physical standards of MR (Mobilization Regulations)

1-9, “Standards of Physical Examination During Mobilization,” and found

acceptable for military service. Itwas to serve the purpose of determining, after

entrance into the service, the kind of military duty each man was capable of

performing in keeping with his skills and his physical capacity.

The “PULHES” system was based primarily upon the functions of various

organs, systems, and integral parts of the body. Since an analysis of the individual’s physical and mental status played an important role in his future assignment and welfare, clear and accurate description of his physical and

mental condition was essential.

In developing the system, the human functions were divided into six categories, which were designated by the letters P-U-L-H-E-S. The factors to

be considered, the parts affected, and the bodily function involved in each of

these categories are shown in table 1. The six categories created contained four

grades. Grades and represented level of physical fitness equivalent to the

induction classification of “general service,” Grade indicated the presence of

physical defects involving an impairment of function, which was qualification

equivalent to “limited service.” Grade represented the presence of defects

which were below the minimal standardsfor induction.

In complete profile, an individual received grade from to in each

of the six body parts or functions; that is, “P,” physical capacity or stamina;

“U”, upper extremities; “L”, lower extremities; “H”, hearing (including ear

defects) “E”, eyes; and “S”, neuropsychiatric. Thus, profile was basically

combination of six numerals from to 4, representing degrees of fitness and associated with the letters P-U-L-H-E-S. profile of P-1, U-l,L-l, H-l, E-l,

S—1, for example, indicated the highest level of physical proficiency.

Palmer, Robert R., Wiley, Bell I., and Keast, William R. The Procurement and Training of Ground Combat Troops. United States Army in World War II. The Army Ground Forces. Washington U.S. Government Printing Office, 1948, pp. 67—76.
RETENTK )N POLICIES 69

Table 1. Physical profile serial

Physical capacity

Degree

of fitness (physical capacity or

stamina)',

(upper extremities)

(lower extremities) (hearing;

ears) (vision; eyes)

(neuro

psychiatry)

Grade 1... Able to perform

maximum

sustained effort over extremely long

periods.

Bones, joints,

and muscles

normal.

Should beable

todo hand to

hand fighting.

Bones, muscles

and joints

normal. Must

be capable of

performing

longmarches

and continuous standing

over long

periods. No

defects which

disqualify for

running,

climbing, and

digging.

Hearing 15/15 in

one ear and

8/15 or better

in other ear.

Meets general

service standards of MR

1-9.

Emotionally

stable, and

those with

transient,

mild psychoneurotic

manifestations incident to

imminent

departure for

oversea

assignment.

Grade2-.. Able to perform

sustained effort over long

periods.

Slightly limited

mobility of

joints, muscular weakness,

or other musculoskeletal

defects which

donot prevent

hand to hand

fighting, and

do not disqualify for

prolonged

effort.

Slightly limited

mobility of

joints, muscular weakness,

or other musculoskeletal

defects which

donot prevent

moderate

marching,

climbing, running, digging,

or prolonged

effort.

Minimum hearing 8/15 bilateral or 15/15 in

one ear and

less than 8/15

in otherear.

No intermediate

grade, use 1.

Intermediate

grade, use 1.

Grade 3— Able to perform

sustained effort for moderate periods.

Defectscausing

moderate

interference

with function

yet capable of

sustained

effort for

short periods.

Defects causing

moderate

interference

with function

but capable of

sustained

effort for

short periods.

No intermediate

grade, use 2.

Below but

meets mini- mum standards forinduction under

MR 1-9.

Mild psychoneurosis

other than

aboveor

transient

phschoneurosis of

moderate

degree.

See footnotes at end of table.
70 PHYSICAL STANDARDS

Table 1. Physical profile serial—Continued

Iii assigning the numerical grades, it was emphasized that neither anatomical nor pathological defects were the sole basis of classification. The defects

as described in the physical standards of MR 1-9 were to be given consideration in accomplishing the profile. The factors of function and prognosis, regarding the possibility of aggravation in the light of the defect found, however,

were of primary importance in grading.

To assist examining physicians in making their analysis, brief guide to

the defects and the weight of grading applicable in each of the categories was

prepared (table 1). It was pointed out that this table was not complete, and

examining physicians were cautioned that because certain defects were not listed

it was not to be assumed that they should not be considered.

The important point made was that the basic principle of the physical profile serial was to provide an index to the individual’s functional capacity. The

function of the particular organ or system of the body, therefore, had to be

carefully evaluated in determining the proper grading, rather than the extent

of the defect per se. Meanwhile, other elements of the examination, such as

X-ray films, electrocardiograms, and other specific tests that gave concrete

results, were to be used as aids in making the evaluation.

Physical capacity

Degree

of fitness (physical (upper (lower 11 (hearing; S(neuro

capacity or

stamina) extremities) extremities) ears) (vision: eyes) psychiatry)

Grade 4... Below mini- Below mini- Below mini- Below mini- Below mini- Below minimum stand- mum stand- mum stand- mum stand- mum stand- mum standards for ards for ards for ards for ards for ards for

induction. induction. induction. induction. induction. induction.

Disqualifying Disqualifying Disqualifying Disqualifying Disqualifying Disqualifyexcept for except for except for except for except for ing except

those men those men those men those men those men for those

who havebeen who have per- who have per- who have per- who have per- men who

trained in and formed ade- formedade- formed ade- formed ade- have perhave per- quately in quately in quatelyin quately in formed adeformed ade- current current current current quately in

quately in

current

assignment.

assignment. assignment. assignment. assignment. current

assignment.

Factors to be considered: organic defects,

coordination,and similarfactors.

age, build, strength, stamina, height, weight, agility, energy, muscular

Initial profile will be based on anticipated performanceat completion of training; verified profile will be based upon observation of actual performance of duty, and medical inspection.

Factors to be considered: strength, range of motion and general efficiency ofupper arm, shoulder girdle and back,

including cervical thoracic and lumbar vertebrae.

Factors to be considered

Factors to be considered

Factors to be considered

strength, range of movement and efficiency of feet, legs, pelvic girdle, and lower back.

auditory acuity, and organic defects of the ears.

visual acuity, and organic defects of the eyes and lids.

Factors to be considered emotional stability, personality, and neuropsychiatric history.
RETENTION POLICIES 71

To facilitate assignment of individuals at reception centers and replacement training centers after they were given physical profile serial, the profiles

were grouped into three broad categories:

Category Profile serial limit and level of duty

Men whose profile was 211211, or better. (Fit for duty

in combat zones and for any strenuous work.)

Men whose profile was between 32231 and 211211. (Fit

for close combat support duties.)

Men whose profile was between 333231 and 32231. (Fit

for duty in lines of communications, or bases overseas, or in the continental United States.)

Men whose profiles came within the range of the broad categories and

were regarded as qualified for “general service” as defined in MR 1-9, while

those whose profiles qualified for category were considered qualified for

“limited service.” The concept of these categories, with respect to the range of

profiles, changed from time to time throughout the war, but the plan remained

essentially the same. In the “S” factor, such profiles were applicable only to the

evaluation of men for retention in the service, and not for induction.

To make the profile serial more informative, code letter, or combination

of code letters, was used as suffixes where applicable. Code letters used and their

meaning were, as follows:

—Indicates the individual had oversea service outside the continental United

States, or in Alaska, since December 1911, regardless of duration, or that,

although assigned in the United States, normal duties involved travel or duty

outside theUnited States, and cumulative time so spent has exceeded months

since December 1941.

R—Indicates the individual has remediable physical defect which does not

prevent his being assigned to oversea duty, but which, if corrected, would

improve his general health and welfare. Correction of the defect may or may

not result in change of the profile. It is not used in cases where the remediable defect prevents the individual from going overseas.

—Indicates that the individual has remediable defect which under current

instructions would temporarily prohibit his shipment overseas. Such defects must be of nature that when successfully corrected the individual will

be physically qualified for oversea duty, for example, an individual with

hernia but with no other defects. An “R” suffix is not to be used in this type

of case.

—Indicates the individual has defect which under current instructions is

permanently disqualifying for oversea service.

—Used only in the Army Air Forces, and indicates the individual is physically qualifiedfor aircrew, combat-type aircraft.

X—Used only by the Army Air Forces, and indicates physical qualification for

aircrew, noncombat-type aircraft.

Thus, an inductee with physical profile of 333231 was considered fit

for limited service, but was permanently disqualified for oversea duty.
72 PHYSICAL STANDARDS

The initial profile serial, ordinarily, was prepared by medical officer at

the reception center after the individual entered the service. Verification or revision of the profile serial, as necessary, was made at, or near, the completion of

basic training. Later, revisions could have been made at any time by profile

classification board. Such boards, normally, were to consist of the soldier's unit

commander, medical officer, and classification officer. In any event, 3-month

interval was required between classifications. An exception to this rule was illness or injury with marked physical deterioration which made an earlier review necessary. Meanwhile, when the profiling system was initiated, only inductees were involved. Profiling of men already in the service did not take place

until approximately yearafter its adoption by theArmy.

Profiling of Men in the Service

On November 1944, War Department Circular No. 431 was issued, of

which section VI required that all Army enlisted men in the continental United

States be profiled by February 1945. By this time, use of the physical profile

serial on inductees had progressed so rapidly that it was deemed essential to

profile all men in the service so as to expedite classification and discharge objectives. To achieve this objective by the deadline date, all unit commanders

concerned were directed to make immediate arrangements to complete the profiling ofall men undertheir control.

Previously, physical profile supplement to MR 1-9 of 22 May 1944, as

amended by Change No. 1, 19 August 1944, subject: “Physical Profile Serial,”

had been issued. Commanders were directed to use this supplement as guide.

Profiling was to be accomplished either by medical officers assigned to the organization or by those designated to hold sick call for it. To expedite completion

of the profiling in the time allotted, unit commanders were to furnish medical

officers certain information on each man to be profiled. This information constituted the unit commander’s evaluation of the individual and was to include

factors such as physical stamina, emotional stability, adjustment in the organization, general health, frequency of appearance on sick call, and report of

any known physical defects.

The men involved were then to be brought before the medical officer who

was to perform complete physical examination (rather than simple physical inspection) including an estimate of psychiatric stability. Wherever possible, the examination was to be accomplished by team of qualified specialists.

Routine chest X-rays, serological tests, and urinalyses were not to be included,

except where special circumstances indicated.

Obviously, there were certain circumstances under which delay for profiling would have had adverse effects on Army operations. Therefore, certain

conditions were identified under which profiling would not be necessary. These

were specified as (1) enlisted men at or under orders to proceed to oversea

replacement depots or ports of embarkation as individual replacements; (2)
RETENTION POLICIES 73

enlisted men in units under movement orders to depart for overseas before

January 1945; and (3) aircrew combat personnel, including those enlisted

men in training or awaiting training leading to assignment as aircrew combat

personnel.

At or near the completion of basic training, each enlisted man was given

physical inspection and his profile verified or revised as the findings warranted. complete physical examination was not given for this purpose, but

special examinations could be ordered by the responsible medical officer if the

need for one was indicated.

In addition to the profiling already mentioned, unit commander could

request profiling or reprofiling of man. In these instances, as in all profiling

actions, action was taken by profile classification board consisting of line

officer, medical officer, and classification officer. In mental cases, the classification officer was replaced by psychiatrist.

The initial profile serial, expressed as numerical grading and suffix only,

was recorded, dated, and initialed in the individual’s W.D., A.G.O. Form No.

20, “Soldier’s Qualification Card.” This was done when the profile was established initially and at any other time that it may have been changed.

Use of Profiles in Assigning Men

Each month, the Assistant Chief of Staff, G-l (personnel), established

and published an approved list of all specialties critically needed in the Army.

Enlisted men, processed through reception centers, who possessed the needed

skills were assigned in accordance with the instructions accompanying the list

and those issued in specific instances which covered the assignment of men

with certain skills withoutregard to profile.

With the exception of critically needed specialties, all enlisted men were

assigned, according to their profiles, to one of the three major commands—the

Army Ground Forces, the Army Air Forces, or the Army Service Forces.

Quotas for this purpose were established and published from time to time. If at

any time there was an excess of men with profile after all quotas had been

filled, the excess was automatically allotted to the Army Ground Forces. In

such instances, the number involved was deducted from the Army Ground

Forces’ quota of men with profile B. When there was an excess of men with

profile B, they were prorated among the three major commands. This was done

on the basis of fixed percentage of men in this category allotted to each command. Changes in the quotas were made by the Assistant Chief of Staff, G-l,

on the basis of his approval of recommendations submitted by each of the major

commands. The distribution quotas to the three major commands for May 1944,

for example, expressed in percentages of the totals available, are shown in

table 2.

War Department Memorandum No. W40-44, dated 18 May 1944.
74 PHYSICAL STANDARDS

The men available for assignment seldom permitted these allocations by

precise percentages established for the three profile categories. It was believed,

however, that if the prescribed percentage distribution was adhered to as

closely as possible, in the long run the desired results would be brought about.

Table 2.—Distribution quotas, expressed in percentages of totals available, to the three major

commands, May 1944

It was the responsibility of reception centers to fill the quotas established

in accordance with classification and assignment procedures. Every effort

was made to assign the best qualified men to the Army Ground Forces. Assignments to units and arms of the Army Ground Forces were made at reception

centers based on apportionment information furnished by the Commanding

General of the Army Ground Forces. If, for example, the quota for the latter

at reception center on given day was total of 100, then the Army Ground

Forces representatives attached to reception centers decided which of this

number were to be assigned to the Infantry, Field Artillery, and so forth.

Normally, the best physically qualified men were assigned to the Infantry

Replacement Training Centers and units. Army Ground Forces representatives

at reception centers had no part in the selection of men apportioned to them

but only indicated assignments within the command after apportionment had

been made. Interchange of personnel between the three major commands was

to be made only upon approval of the War Department.

Actual placement of man in job or duty was the responsibility of the

commanding general of each of the major commands. This was done on the

basis of the man’s general ability and physical fitness. Since minimum primary

profiles were established for arms or services within each of the three major

commands, it was incumbent on the commanding general to use the information from the profile serial in effecting assignment and reassignment within

his command. Evaluation of profiles was made at the end of the weeks’ basictraining period. Based on the results, assignments then were made within the

major commands.

Experience With the Physical Profile Serial System

Although the Physical Profile Serial System was not inaugurated until

February 1944, it met with some success. In June 1944, when the invasion of

Command Profile Profile Profile

Percent Percent Percent

Army Air Forces 10 50 40

Army Service Forces 40 40 20

Army Ground Forces 80 10 10
RETENTION POLICIES

the European Continent was launched from England, over half of the divisions

in the U.S. Army were overseas, while most of the remainder were preparing

for oversea movement. Profiling was not required for individuals on order for

shipment overseas. At the time the system went into effect, it must be evaluated

as effective to the extent that it permitted the proper distribution of the newly

inducted men who were the most physically fit. In addition, it caused the equitable reassignment of those more physically capable men who earlier had been

assigned to service-type units and installations, instead of to combat units.

An examination of the system revealed that, in application, the categories

A, B, and were too broad and not sufficiently discrete to be significant. For

example, an individual in category or could not perform every job within

his group. Moreover, there was no accurate means of measuring the degree of

any factor or qualification called for by the job, or possessed by the individual,

and relating these with physical capacity. The system, therefore, lacked precision in that it succeeded only in suggesting broad areas of employment in

which an individual might be expected to perform successfully on the basis of

physical capacity. In actual practice, unit commanders were able to influence the

profile ratings made by medical officers, depending on whether or not they

wished to retain in their units any individual under consideration.

Confusion arose concerning the use of the “T” suffix indicating temporary

deferment of man from oversea assignment until defect was corrected. Late

in 1944, it became evident that medical officers at all hospitals appeared to be

using it as temporary classification because of uncertainties of diagnosis. They

were doing so as stopgap, when they had no authority under existing instructions to limit service to the continental United States or to take discharge

action, but at the same time were reluctant to put the man in profile category

which would qualify him for oversea duty. This seemed to be especially true

in infantrymen with defects not readily diagnosed. In some of these cases,

many medical officers were under the impression that if they certified man as

being qualified for oversea duty, he would be trained and shipped out as

rifleman. This attitude, perhaps, was justified in some cases. It no doubt arose

because training in the Infantry had become so channelized that consideration

was not given to the possibility that man might be qualified in military

occupational specialty in the Infantry which was less physically exacting than

that of rifleman.

One value of the Physical Profile Plan was the comparison of the initial

profile with that assigned at the time of discharge or separation from the

service. This permitted the pinpointing of any physical defect sustained or

aggravated in the line of duty.

In final analysis, introduction of the Physical Profile Plan during World

ar II can be viewed as an experiment successfully applied in real situation.

Although it was not in existence long enough during the war years to accomCooke, Elliot Duncan: All But Me and Thee. Psychiatry at the Foxhole Level. Washington:

Infantry JournalPress, 1946, pp. 11-38.

25T-966' —67
76 PHYSICAL STANDARDS

plisli completely that for which it was designed, its evolution continued in

subsequent years.

LIMITED SERVICE FOR ENLISTED MEN

By late 1942, when large number of men in theU.S. Army were physically

qualified only for limited service, it became necessary to give careful consideration to their proper assignment (ch. II). Consequently, War Department Circular No. 327, dated 27 September 1942, stated that commanders at all echelons

had the obligation of making careful visualization of the physically limited

man and the duty he was to perform in their organization. As policy, it was

the duty of organization commanders to retain within their units all men

physically capable of filling position vacancies.

As general rule, limited service personnel were to be given initial assignments only to noncombatant duties. It was anticipated, however, that some men

would appear in combat units who did not measure up to the standards for

general service, as set forth in MR 1-9. In this event, unit commanders were

to give them special consideration in assignments. Moreover, if it was possible

through appropriate physical training and remedial measures, an attempt was

to be made to assign them for general service.

Screening Men in Combat Units

The early correction of dental defects and the fitting of glasses were routine. Greater attention, however, was to be given to the proper physical classification of individuals for the duties they were to perform. It was found that

many could be fitted into combat organizations, even though they had noncorrectable defects. For example, an individual with defective hearing might

function well as cook in combat unit, or one unable to march long distances

might be fully qualified as chauffeur.

Personnel in combat units getting ready for field service underwent

constant screening process in order to insure their complete physical fitness.

None, however, were recommended for transfer to noncombatant Zone of Interior organizations simply because they were physically unfit. They were retained if they could fill vacancy in the organization, without reducing its

efficiency as fighting unit. Age was not primary consideration. It is to be

noted that uncomplicated venereal disease was not to be considered cause for

transferring those so afflicted to noncombatant units.

If, as result of screening, man’s total capacity was judged to be below

that necessary for continued service in combat unit, he was classified for

limited service and assigned to noncombatant duties. Usually, such men were

capable of performing duties with units such as prisoner-of-war escort companies; permanent party personnel at posts, camps, and stations; fixed harbor

defense and antiaircraft units outside the combat zones; aircraft warning
RETENTION POLICIES 77

companies; special service companies; recruiting and induction stations; reception centers; port battalions; station and general hospitals, and so on, to include

rear echelon detachments or installations of combat divisions, corps, or armies.

The reclassification and transfer of limited service enlisted men from field forces was accomplished through the action of board of three medical officers.

When available, one member of the board was to be psychiatrist. Normally,

hospitalization to make final determinations was not necessary except in unusual cases.

When standards for general service were lowered in 1942, 1943, and 1944,

many limited service men qualified only for limited service then became qualified for general service and duty with combat units.

Problems in Assigning Limited Service Personnel to Medical Units and

Installations

The degree of usefulness of limited service personnel to the Army was

in direct proportion to the suitability of duties to which they were assigned.

Since the physical standards varied in accordance with the need for manpower, many problems arose in the process of making optimum assignments

in consideration of man’s skills and total physical capacity.

As an approach to this problem, it was the consensus of the Surgeon

General’s Office that as much as 50 percent of the personnel assigned to Zone

of Interior medical installations could be limited service personnel. If absolutely necessary, it was believed that this could be increased to 100 percent.

In numbered medical units employed in the communications zone, however,

this same opinion held that only 20 percent of the strength should be made

up of limited service personnel. This was based on the fact that medical units

in the communications zone were furnishing cadres for combat units, and therefore only minimum number of limited service personnel could be used.

Also, in September 1942, the Chief of the Personnel Service of the Surgeon

General’s Office suggested that Zone of Interior staffing of medical installations

with limited service men should not exceed 50 percent of the total. He suggested also that the Medical Department should accept and absorb such personnel on the same basis as the allotments made to other branches of the Army.

It was important that the Medical Department acquire personnel physically

qualified for general service sufficient for the formation and training of cadres

for Services of Supply units and installations, as well as for numbered Medical

Department units to serve outside the continental United States. With respect

to units designated for duty in combat zones, it was believed that all personnel

Memorandum, The Surgeon General, Office of The Surgeon General, to Training Division, Office

of The Surgeon General; Personnel Service, Office of The Surgeon General; Supply Service, Office of

The Surgeon General; and Professional Service, Office of The Surgeon General, 10 Sept. 1942, subject: Employment of Class I—B Personnel in Medical Department Units and Installations. [Mrs. Heilman

used this document in connection with an earlier draft of this volume, but it has since become

unavailable.—C. M. W.]
78 PHYSICAL STANDARDS

should be physically qualified for general service. The Chief of the Personnel

Service of the Surgeon General’s Office went on to state that it was just as important for Medical Department enlisted men to meet physical qualifications

for general service as it was for line soldiers assigned to combat units. Both

had to endure the same hardships and, therefore, should be on the same footing

from physical standpoint. 10

On 16 October 1942, The Surgeon General pointed out that an excessive

number of limited service personnel were being assigned to medical installations

in service commands. 11 This was the result of misinterpretation of War Department Circular No. 327 of 27 September 1942, covering the utilization of

limited service enlisted personnel and their transfer from field forces. Reception

centers were filling all personnel vacancies at medical installations in service

commands with limited service personnel and, at the same time, assigning an

additional 10 percent as overstrength. Medical units destined for theaters of

operations were receiving limited service personnel on the order of 50 to 90

percent of the authorized total. The Surgeon General noted that these conditions, particularly in medical units employed in combat zones, could result in

dangerous situation with respect to the unit’s training and function. In one

such unit with an authorized enlisted strength of 500 men, for example, out of

shipment of 436 limited service men assigned by reception centers, there were

16 illiterates; 131 with an IQ (intelligence quotient) below 70 (the average IQ for the 436 was 82) with hearing so defective as torequire the use of hearing

aid; many with partially immobile (ankylosed) and chronic arthritic joints;

and many with teeth missing. Many of these personnel were required to be

qualified in highly technical procedures, such as X-ray, laboratory, operating

room, pharmacy, and so forth. This could not be entrusted to mentally irresponsible persons without accepting an unwarranted and indefensible hazard

for the patient. Obviously, the training of such units presented an almost superhuman task. This training problem would have been intensified on the receipt

of oversea movement orders, when many would have been found physically

unfit for duty overseas and replacements would have required training.

The main difficulty was seen as the possibility of dangerous misinterpretation of the term “noncombatant” as used in War Department Circular No.

327. The basic policy expressed in that directive was that “in general, individuals physically qualified for limited service will be assigned initially only

to noncombatant duties.” The Surgeon General expressed the view that the

idea that Medical Department units with divisions in combat areas could

function effectively with limited service personnel was definitely fallacious.

Few tasks, if any, performed by any arm or service required more stamina and

10 Memorandum, Col. George F. Lull, MC, Chief, Personnel Service, Office of The Surgeon General,

for Training Division (Attn: Lt. Col. A. B. Welsh), 12 Sept. 1942, subject: Employment of Class I-B

Personnel in Medical Department Units and Installations. 11 Memorandum, Maj. Gen. James C. Magee, The Surgeon General, for Commanding General,

Services of Supply (Thru: Military Personnel Division), 1G Oct. 1942, subject; Limited Service

Personnel With the Medical Department.
RETENTION POLICIES 79

physique than was required by company aidmen and litter bearers. The job

of relieving combat elements of their wounded could not be accomplished by

any but the physically strong and mentally alert.

Another important point The Surgeon General brought out was that large

numbers of trained combat personnel, as result of battle wounds and disease, would be reclassified from general service to limited service while in theater

of operations. Such personnel would be ideally suited for assignment to medical

units, but not in excess of an effective balance between general and limited

service personnel. This would represent the most effective use of available personnel already overseas. In order to permit such reassignment, it was imperative that medical units be shipped overseas with only minimum number of

limited service personnel already assigned.

The proposals made to the Commanding General, Headquarters, Services

of Supply, by The Surgeon General were not adopted. Medical units assigned

to service commands continued to receive limited service replacements for

general service personnel up to 10 percent above the authorized strength. The

cadres for theatermedical units that service commands were required to produce

were to consist of available general service personnel. This was to be done with

the understanding that as the number of available general service personnel in

service commands was reduced, so the requirement placed on them to furnish

qualified cadres would be reduced.

The Director of Military Personnel, Headquarters, Services of Supply,

observed that limited service personnel had the skills, aptitudes, and educational qualifications in the same proportion to general service personnel. 12

test of the usefulness of limited service personnel, conducted atFort McClellan,

Ala., revealed that, with proper training, such men were capable of performing

full military duty in noncombatant organization.

Standards for Transferring Personnel to Oversea Destinations

Organizing, training, and equipping units for combat was the responsibility of each of the three major commands; that is, the Army Ground

Forces, the Army Air Forces, and, to limited extent, the Army Service Forces, Requirements for shipping such units overseas were met by these commands. Before departure of unit from its home station, personnel were given

physical examination. Those found physically or mentally unfit were cleared

from the units. These examinations were normally performed by medical personnel assigned or attached to the unit. Otherwise, examinations were accomplished through the assistance of the station surgeon. While waiting call from

the port commander, units at staging areas continued training with emphasis

on the physical condition of personnel. Before embarkation, personnel were

given physical inspection to determine whether any illness or physical

12 1st Indorsement [to Memorandum cited in footnote 11 ], Col. Russell B. Reynolds, GSC, Director

of Military Personnel, Headquarters, Services of Supply, to The Surgeon General, 28 Oct. 1942.
80 PHYSICAL STANDARDS

deterioration had occurred since the examination given before leaving the

home station.

During the mobilization period, it was contemplated that only personnel

qualified for general service were to be sent to active theaters overseas, but as

the demand for manpower grew, this policy was modified. When the induction

of limited service men was authorized, the problem arose of determining which

of these could serve in combat areas without adversely affecting the man or the

military mission. Many limited service enlisted men were sent overseas as qualified to serve in these areas. Complaints were received in the Surgeon General's

Office from commanding generals of oversea theaters, however, that men were

arriving with units or as replacements who did not meet the standards for

oversea service. One such complaint, received in August 1942, pertained to men

sent overseas with visual defects below the standard authorized for members

of combat units. This situation was clearly the result of careless examination

or the lack of attention to recording results and other administrative detail,

and the War Department emphasized the importance of correcting such

deficiencies. 13

In October 1942, the physical standards were lowered to allow the maximum number of men to be classified for general service, thus making them

available for assignment to combat units. Before the release of MR 1-9 of

October 1942, unit commanders, assisted by unit medical officers, were directed

to equate the enlisted man’s abilities and his physical capacity for the duties

he was expected to perform in the unit. Wherever possible, men with nonprogressive physical defects were to be assigned to appropriate duties and thus

release men without physical defects for the more physically exacting jobs

which were part of the unit's mission. Men were to be reclassified and transferred to noncombatant or Zone of Interior organizations only when they could

not fill position in unit or when transfer was recommended by hospital

commander after period of hospitalization.

It was the duty of all unit commanders to appraise their men constantly,

with the view to reclassifying enlisted men, when warranted, from limited service to general service. This required that both unit commanders and surgeons

familiarize themselves with the limiting defects of men in their units, so that

at monthly inspections both could give special attention to the possibility of

reclassification.

On introduction of the Physical Profile Plan in 1944, more than ever, the

assignment of enlisted men to combat units was based on physical capacity. At

that time, the criteria required that an enlisted man sent overseas had to be

physically qualified to perform the duties of his military occupational specialty

under field conditions. man was considered to have met this requirement

when he was found to be physically capable during his training period in

replacement training center or in unit. The unnecessary removal of trained

enlisted man from shipment immediately before departure for overseas was

13 War Department Memorandum No. W40-2-42, dated 17 Aug. 1942.
RETENTION POLICIES 81

considered flagrant waste of military manpower and training, destructive both

to the morale of the individual and to the efficiency of the unit. Oversea service

physical standards for enlisted men were established in War Department Circular No. 164, issued on 26 April 1944, and was revised by War Department

Circular No. 196, dated 30 June 1945. Defects which would disqualify personnel

for shipment overseas were, as follows:

1. Pronounced psychiatric disorders. Men with psychiatric disorders, except psychoneuroses that were mild and transient in character, were not to be

sent overseas with combat units or as casual replacements for the combat arms.

2. Hernia, except small incisional or umbilical hernias. Moderate impulse

produced by cough at the inguinal ring or at the site of scar was not to be

considered necessarily as an indication of hernia. Diagnosis of inguinal hernia

was to be based on the demonstration of hernial sac.

3. Class dental defects, except in those individuals whose only defect

was the need of prosthetic replacements, and provided that, despite the missing

teeth, they had been able to follow gainful occupation in civil life and their

histories indicated that restoration of the missing teeth was not essential.

4. Loss of either eye, with or without an artificial replacement.

5. Tropical diseases.—Individuals who had suffered from tropical diseases

causing residual damage or sequelae, or tropical diseases such as filariasis, which

would be liable to exacerbation or serious aggravation upon reinfection. This

was not to include uncomplicated malaria, except that individuals who had or

had had clinical attack of malaria, or in whose blood malaria parasites were

found, were not to be sent overseas until months subsequent to the date of

recovery, or of the disappearance of parasites from the blood.

6. Venereal disease.—Otherwise qualified enlisted men with venereal disease were eligible for oversea shipment except for those with the following

conditions:

a. Chancroid or undiagnosed penile ulcers.

b. Primary and secondary syphilis, unless two injections of an arsenical had been administered.

c. Sulfonamide-resistant gonorrhea as determined by failure to respond to one course of treatment.

d. Gonorrhea with complications, such as epididymitis, arthritis, and

severe acute prostatitis.

e. Granuloma inguinale or lymphogranuloma venereum. (When penicillin was available on transports, all individuals with gonorrhea could be

shipped except those with complications.)

7. Organic heart disease, including serious disturbance of cardiac rhythm,

persistent arterial hypertension with systolic pressure above 160 mm. Hg or

diastolic pressure above 100 mm. Hg.

8. Active peptic ulcer; chronic peptic ulcer, symptomatic within the

past years; history of peptic ulcer complicated by perforation, obstruc-
82 PHYSICAL STANDARDS

tion, bleeding, or surgical intervention; or history of gastric resection or

gastroenterostomy.

9. Active tuberculosis, bronchiectasis.

10. Allergic states, such as asthma, severe hay fever, or severe skin

sensitivity.

11. Thyroid enlargement with toxic manifestations, diabetes.

12. Perforated eardrum complicated by active disease, or when active

disease has been present within the past months.

13. Rheumatic fever or permanent organic sequelae from the condition, or

history of uncomplicated rheumatic fever until period of months had

elapsed.

14. Severe chronic skin conditions.

15. Uterine tumors, amenorrhea, menorrhagia.

16. Symptomatic flat feet, which during the period of training of the individual had prevented him from properly performing his duty.

17. Acute and chronic gonorrhea in women.

Enlisted men not meeting the standards requirements of War Department

Circulars Nos. 164 and 196 were to be removed from shipments before departure

from home stations rather than at staging areas. The examination of men at

staging areas was limited to necessary physical inspections to determine the

existence of communicable diseases, disqualifying venereal disease, and any

marked deterioration since the examination given at the home station.

The criteria applicable to the disqualification of an enlisted man for shipment overseas did not necessarily apply in the event of any reevaluation made

after arrival in the oversea theater. The existence of nonprogressive or remediable defect or disease was not to be considered sufficient reason for returning

man to the United States, provided the defect could be remedied at facilities

available in the oversea command, or if an assignment could be found that the

man could fulfill within his physical limitations.

REDEPLOYMENT OF PERSONNEL FROM EUROPE TO THE PACIFIC

AREA TO ENGAGE IN WAR AGAINST JAPAN

Following the defeat of Germany, existing procedures had to be reconsidered. Preparations had to be made for the intertheater movement of unit

equipment and personnel, whether to the Pacific area directly or through the

United States, and for the movement of personnel replacements between oversea commands. In this process, men were to be as carefully selected as they had

been on initial selection and induction for service in the Army. 14 Personnel

already overseas wore screened again, in accordance with the physical criteria

14 For full explanation of the “point score” system devised for selecting personnel for redeployment, see footnote 1, p. 65.
RETENTION POLICIES 83

which permitted their original shipment. This involved reexamination to

determine their physical and mental fitness for redeployment to still another

oversea theater.

As companion move to redeployment, reduction in the strength of the

Army was contemplated. The difficulties attending mobilization were met, in

part, by relaxing physical standards. On this basis, itmight have been supposed

that the reverse action—a tightening of standards—would have produced the

desired results. This was not the case, however, so that War Department standards previously in effect for oversea service were used for redeployment. It was

found that no military advantage would be served by more rigorous physical

selection of men from the Zone of Interior. Consequently, the same standards

were used in selecting men in the Zone of Interior for oversea service in the

Pacific area as had been applied, for the same purpose, to men already serving

in the European theater.

Unit commanders were not to be deprived of keymen on arbitrary or theoretical grounds. To insure positive implementation of this concept, the screening examination was to be performed by medical personnel organic to or serving

with the unit. This not only carried out the established policy but also assured

the efficient execution of the entire screening process. It seemed reasonable that

the special knowledge which the unit medical personnel had gained of the men

themselves, and the conditions of their service, would go far to insure that the

redeployment screening procedure would be of excellent quality and geared to

military fact.

Great care and considerable judgment were to be exercised in arriving at

decision that personnel were physically disqualified for further oversea service.

Those who had performed their duties satisfactorily, but who, ordinarily, would

have been disqualified under existing instructions, were to be permitted to

accompany their units. This was not to apply, however, when there were indications that the defect would be subject to complications or aggravation by

further oversea service.

The screening examination made on all individuals to be redeployed was

to be supplemented by appropriate special examinations and laboratory procedures when indicated by the medical history or physical findings. All personnel found physically or mentally unfit were cleared from their units. Those not

requiring hospitalization were not evacuated to the United States as patients

but were returned by ordinary means of transportation.

Neuropsychiatric Considerations

Although it was an extremely difficult field in which to exercise definitive

judgment at the unit level, the psychiatric evaluation derived particular benefit from knowledge of the men possessed by unit medical personnel.

257-966 —67
84 PHYSICAL STANDARDS

Redeployment directives 15 detailed the emotional qualifications for further

oversea service; these were an expansion of the standards troops serving in

theaters of operations had already been required to meet. Disqualifying conditions were—

1. Psychoses.

2. Marked degrees of psychopathic personality.

3. Marked mental deficiency.

4. Chronic, disabling, psychoneurotic disorders.

5. History of definite psychosis.

The borderline group (defects not disqualifying of themselves) included—-

1. Psychopathic personality.

2. Psychoneuroses of mild and moderate severity.

3. Definite history of the above conditions.

The criteria aiding diagnosis of the borderline group were outlined as

1. The severity and duration of symptoms.

2. The type and degree of external stress precipitating the symptoms (imminence of departure overseas, domestic difficulties, physical disorders, recent

debilitating physical disorders, and serious job misassignments).

3. The individual’s basic personality, strength, and nature of previous adjustmentand performance.

4. The actual impairment of the individual’s functional capacity.

All moderate or severe neurological disorders were to be excluded from

further oversea assignment. Inconsequential paralyses, on the other hand, such

as the residuals from mild poliomyelitis were not to be excluded. Neither were

lesions of the cranial or peripheral nerves which were not likely to interfere

with military duties or variations which were clearly within psychological

limits, such as minor tremors, to be excluded.

The “borderline group” was defined as those having psychoneurotic symptoms of mild to moderate severity. It was specified that an individual clinical

judgment was to be made in each case. This was to be accomplished on the

basis of severity and duration of symptoms, the type and degree of stress

precipitating the symptoms, the basic personality strength and adjustive capacities of the individual, and the actual impairment of his functional capacity.

Evaluating Infectious Diseases

Men who had recovered from acute and infectious diseases were generally

to be judged qualified to move overseas or to be redeployed. Men with complications or aftereffects which were likely to become aggravated, on the

other hand, were not to be considered qualified for oversea duty. This was to

13 Letter, Maj. Gen. J. A. Ulio, The Adjutant General, War Department, to Commanding Generals,

Army Air Forces, Army Ground Forces, Army Service Forces; to Commander-in-Chief, Southwest

Pacific Area; and to Commanding Generals, Theaters of Operations, Defense Commands, Alaskan

Department, Northwest Service Command, Military District of Washington, and Independent Commands under the War Department, Apr. 1945, subject: Inclosure No. (Preparation of Inter-Theater

Movements) to Annex “Redeployment Movements,” inclosure thereto.
RETENTION POLICIES 85

include, also, those in whom reinfection might be serious. An example of such

complications was given as the men who suffered from filariasis, wherein the

threat of repeated filarial infection carries the threat of permanent damage. An exception to this rule was uncomplicated malaria. The previous practice

had been to defer movement of those suffering from the disease until months

after the last attack, or until months after the parasites had disappeared

from the blood. For redeployment, or dispatch overseas, this criterion was

liberalized to the extent that simple malaria was to be treated as any other

acute infectious disease. If this had not been done, redeployment of troops,

especially from the Mediterranean theater, might have been unnecessarily

difficult. Some men might have been motivated to avoid taking suppressive

Atabrine (quinacrine hydrochloride) and thus permit manifestation of the

symptoms of malaria with which they were afflicted.

Remediable Defects

Steps were to be taken to correct any remediable defects found. Men with such conditions were not to be transferred from their units on this account

alone. Dental defects, for example, were to be corrected, insofar as possible,

before embarkation from the theater. Other minor defects were to be corrected,

also, in the theater or in the Zone of Interior assembly stations.

Recording Limiting Defects

An interesting feature of the examination to determine eligibility for redeployment was the recording of any real defects found, along with the physical

profile serial. This was to be entered on W.D., A.G.O. Form No. 20, “Soldier’s

Qualification Card,” and was to include statement of the limitations inassignment imposed by the defects. This step was an important aid when reassignment became necessary. Moreover, its value was enhanced by the fact that judgment of the man’s condition and his limitations was being made by the unit

medical officer, who had firsthand knowledge of both the physical condition of

the man and the kind of duty the unit was normally called upon to perform.

Screening Neuropsychiatrics and Individuals Recovered From

Cold Injury

Individuals diagnosed as having neuropsychiatric conditions and those

having recovered from cold injury represented two large groups of particular

interest in the redeployment screening process. When screening began, there

was no way of knowing just how large these groups would be. It was known

that many had been evacuated to the Zone of Interior for these and other

reasons. It was known, also, that some had been killed and that hospital admission counts contained duplication within and between the two groups. Even
86 PHYSICAL STANDARDS

with all due allowance for the reduction in the aggregate number of these

groups, the size of both was still formidable. In the European and Mediterranean theaters, there had been no fewer than 82,000 admissions involving cold

injury and 125,000 for neuropsychiatric conditions in 1941 and 1945 alone.16

In evaluating men in these groups for redeployment, two possible difficulties were apparent: (1) Men could have been pulled out of their units on these

grounds alone, which would have been incorrect; and (2) men could have been

cleared for shipment to the Pacific area, only to fail there under combat conditions—thus causing an injustice to the man, the service, and the Nation.

Obviously, errors of this kind are not compensating, but no definite solution

or guidance could be furnished. Consequently, reliance was placed upon the

judgment and experience of the unit medical officers performing the screening examinations, guided by broad War Department policy, to the end that,

from the military standpoint, the best possible determinations would be made

at that level.

Command and Medical Interests

It was perhaps natural for commanders to view with some anxiety the

impending redeployment screening process for the physical reevaluation of

their men. They were concerned about retaining the men they knew were best

qualified to aid them in performing unit missions. As it developed, however,

command interest was amply safeguarded in that (1) standards were the

same as those governing any oversea movement, (2) unit medical officers performed examinations insofar as practicable, and (3) men who had already

served usefully overseas were not to be removed from their units unless their

defects were subject to complications or aggravation by further oversea service. These factors made up the principle upon which redeployment standards

were based and applied. With this recognition of command interest, which in

the last analysis was identical to the medical interest, troops redeployed to

the Pacific area were physically and emotionally adequate for the mission.

RECLASSIFICATION OF OFFICERS

Reclassification Boards

On 25 August 1941, AR 605-230 (Tentative) covering the subject of reclassification of officers was issued, superseding AR 650-230, issued on June 1941.

The regulations were intended to conserve the commissioned manpower of the

Army and to provide means of eliminating officers who were found unsuitable.

The term “reclassification,” as it applied to an officer, was defined as those

procedures necessary to place the individual in the proper assignment or to

16 (1) Medical Department, United States Army in World War II. Cold Injury, Ground Type.

Washington U.S. Government Printing Office, 1958, p. 494. (2) Medical Department, United States

Army. Neuropsychiatry in World War II, Volume II. Overseas Theaters. [In preparation.]
RETENTION POLICIES 87

separate him from the service. Separation was to occur when there had been

lowering in efficiency, and retention in the service was viewed as undesirable.

The instructions were applicable to officers both in the Regular Army and in

theArmy of theUnited States.

Generally, reassignment was permitted when it was apparent that it would

result in better performance of duties. Normally, when unsatisfactory performance was noted in an officer by commander, action was to be taken to have the

officer relieved from duty. If unsatisfactory performance was not due to misconduct, habits, or traits of character, the commander was to report the matter

to the next higher commander having authority to appoint reclassification

boards, instead of taking action to cause the individual’s relief from active duty.

Reclassification cases were then to be referred to reclassification board.

Although medical question was not necessarily involved, an officer to be reclassified was directed to appear for physical examination, the results of

which were furnished to the president of the reclassification board.

Normally, reclassification boards consisted of not less than five officers, one

of whom was to be medical officer. Officers appearing before such boards were

entitled to counsel. As result of board action, recommendations were to be

forwarded to the convening authority, who was to recommend demotion, reassignment to suitable duty, demotion and reassignment, observation and treatment in an Army hospital, or other suitable action.

It was emphasized that reclassification proceedings were not to have been

initiated merely to accomplish reassignments. Normally, an officer’s services

were to have been rated unsatisfactory before reclassification proceedings were

initiated. Moreover, the proceedings were intended to insure that the rights of

the officer concerned were not prejudiced and were to assist in the preparation of

factual record of the case. Although AR 605-230 was reissued and changed

many times during the war, the basic procedures remained much as they were

when originally conceived. Numerous administrative modifications were made, however.

Disposition of Physically Incapacitated Officers

On 15 October 1911, War Department Circular No. 217 announced that

the determination of line of duty and fitness for all officers on active duty

would be as prescribed for officers of the Regular Army. An officer on extended

active duty was to be ordered before an Army retiring board when found

incapacitated for further active duty by line-of-duty board or disposition

board at general hospital (ch. Y). Such cases were to involve illness or injury

whether or not conditions were found to have been incurred in line of duty. If

the Army retiring board found the officer incapacitated for further duty, he

was to be relieved from active duty. Officers (Reserve and National Guard)

who previously had been relieved as result of physical disqualification without the benefit of the Army retiring board review were permitted to apply for

appearance before it.
88 PHYSICAL STANDARDS

Shortages of Officers Bring Changes

By March 1942, the need for officers for all purposes became so great that,

in addition to granting waivers for physical defects, 17 War Department Circular No. 83, dated 21 March 1942, directed the suspension of retirement board

proceedings on all officers except those who were too incapacitated to perform

even limited duty and those whose retirement was legally mandatory. The same

directive also contained the general authorization for the assignment of officers

in limited service status. Under this policy, the fitness of an officer was to be

determined more by his ability to do his work from day to day than by the

presence of certain defects. His discharge or retirement for physical reasons

alone was not to be considered as long as his daily work was satisfactory. On

this basis, then, general hospitals were authorized to reclassify officers from

status of “general service” to that of “limited service,” if the physical condition

so justified. If an officer was found qualified for limited service, he was returned

to duty. Thus, many officers who formerly would have been sent before retirement boards for possible separation from service were recommended for limited

duty by hospital disposition boards and were not considered for retirement

during the period when the need for manpower was greatest.

In October 1942, it was found that many former officers, whose commissions had been terminated solely by reason of physical disability, subsequently

had been drafted as enlisted men. When this was revealed, instructions were

issued in War Department Memorandum No. W605-14-42, dated 11 October

1942,providing for reappointment and return to active duty of such individuals, if they were otherwise qualified. Officers on duty who could meet the limited

service qualifications for enlisted men were to be kept on duty as officers.

Limited and General Service Classification

In War Department Circular No. 82, dated 24 March 1943, examining

facilities were cautioned that the Army should not be deprived of the services of capable officers already in the service. It was pointed out that officers who

in the course of routine examinations or during hospitalization were found to

have certain asymptomatic conditions, such as mild degrees of diabetes mellitus, arterial hypertension, nerve deafness, hypertrophic arthritis, and similar defects, might have service expectancy of several years.

17 In an effort to protect the Government from future claims relative to nonservice connected

defects or disabilities, individuals examined for appointment or for assignment to extended active duty

who had defects requiring waivers were to acknowledge the existence of the defects in an affidavit to accompany the physical examination report. However, if the Individual refused to sign this statement,

the report of physical examination was forwarded to the reviewing authorities without it. The

requirement, in the end, served little purpose for the legal authorities decided an individual could

not sign away any rights that he might possess as to possible future pension benefits. Section 105

of the “Servicemen’s Readjustment Act of 1944” (act of 22 June 1944 [S. 1767]) provided “no person

in the Armed Forces shall be required to sign statement of any nature relating to the origin, incurrence or aggravation of any disease or injury he may have, and any such statement against his own interest signed at any time shall be null and void and of no force and effect.”
RETENTION POLICIES 89

During- this period, when an officer was believed to have become physically

incapable of performing the duties of his office, his commanding officer was to

directthat board of medical officers perform complete physical examination,

unless one had been performed recently. As result of examination, an officer

could be ordered to the nearest general hospital. This was to apply whether

he had been initially rated as physically capable for general service, but later

considered physically incapable of performing such duties, or whether he had

been classified for limited service and was considered physically incapable of

doing his job. Hospitalization in both of these cases was to be for the purpose

of observation, treatment, and recommendation as to the type of duty, if any,

the officer was physically capable of performing.

An officer who had been ordered to active duty with waiver of defects

to qualify for limited service was not to be ordered later before retirement

board simply on the basis of defects which had been waived. If, however, there

had been marked aggravation of the waived defects, or the defects themselves

were the cause of hospitalization, then this prohibition was not to apply. An

officer believing himself incapacitated could initiate action on his own behalf

by submitting written statement to his commanding officer.

Evaluation by Disposition Boards at General Hospitals

Officers hospitalized for observation, treatment, and recommendation as to

the type of duty for which they were physically qualified were to appear before

the hospital disposition board. Such boards were to classify officers as qualified

either for general service or for limited service, or disqualified for any type of

military duty. Recommendations in those qualified for limited service were to

include statement as to the general type of duty the individual was suited to

perform.

An officer reclassified for limited sendee was released from the hospital

and returned to his unit, and his commanding officer was notified accordingly

and advised of his status. Officers recommended for appearance before Army

retiring boards were retained in hospital status pending appearance before

the board (ch. V). General officers were given dispositions issued separately in

each case by the War Department. All Air Force officers were assigned as

specified by the Commanding General of the Army Air Forces.

Change From Limited Service or General Service Status

An officer classified for limited service who had reason to believe that the

conditions causing this classification no longer existed could request physical

reexamination, provided he had served in that status for at least 90 days. Such

action could also be initiated by his commanding officer.

Reexamination was to have been made by board of at least two medical

officers, if available. Otherwise, one medical officer would suffice. thorough
90 PHYSICAL STANDARDS

examination was to be given and all medical records were to be reviewed. If it

was the board’s opinion that the officer was physically qualified for general

service, he was ordered to general hospital where he was again examined, and

recommendation was made as to his final status by the hospital disposition

board.

In July 1943, significant change in reclassification procedures was effected.

Instead of disposition boards at general hospitals making thefinal recommendation as to the reclassification of an officer from general service to limited service,

such men were to appear before Army retiring boards. All Medical Department

officers, exclusive of the Veterinary Corps, were excepted. Later, only Medical

Corps officers were excepted. Officers who had been classified for limited service

upon initial appointment were to appear before Army retiring boards only

when the limiting defect had become markedly aggravated, or when they had

been hospitalized for another defect which was permanently incapacitating

for general service. Disposition boards could recommend retention of an officer

on temporary limited service. This classification was to include officers who

were only temporarily incapacitated for general service. In such instances,

disposition boards were required to document in the board proceedings the date

the officer was to return to the hospital for determination of his qualifications

for general service or permanent incapacity.

The War Department issued separate disposition instructions in November 1943 18 for officers permanently incapacitated for general service but who

were recommended for retention in limited service status by Army retiring

boards. Officers so affected were to be relieved from active duty if they did not

desire to remain. Meanwhile, The Surgeon General was directed to include in

his review of each case recommendation as to whether the officer concerned

should be retained in limited service capacity. When The Surgeon General's

recommendation did not concur with that of the Army retiring board, the case

was to be referred to the Secretary of War’s Personnel Board. If The Surgeon

General concurred in the recommendations of the Army retiring board, or if

he did not concur and the Secretary of War's Personnel Board subsequently

recommended that the officer be retained in limited service status, The Adjutant

General was to endeavor to secure an appropriate assignment for the officer, if

the officer agreed to such retention.

If an officer was permanently incapacitated because of wounds received in

combat, and no suitable assignment could be found, assignment responsibility

was to be turned over to the major command to which the officer had been assigned before hospitalization. Officers not so incapacitated who were under 38

years of age also were assigned to the major command to which they had been

assigned before hospitalization, provided they met the minimum standards for

induction which were applicable to enlisted men. Officers over 38 years of age

18 Letter, The Adjutant General, War Department to Commanding General, Army Air Forces;

Commanding General, Army Ground Forces and Commanding General, Army Service Forces. Nov.

1943, subject: Instructions Relative to Retention of Officers on Active Duty for Limited Service.
RETENTION POLICIES 91

and those who, regardless of age, did not meet the physical standards for induction of enlisted men were to be relieved from active duty.

If the Army retiring board recommended retention of an officer in

limited service capacity and neither The Surgeon General nor the Secretary

of War's Personnel Board concurred, the officer was relieved from active duty,

provided the officer was over 38 years of age or was unable to meet the minimum

standards for induction of enlisted men. The reason for retaining officers under

38 years of age who met the minimum standards for induction was to preclude

their being drafted as enlisted men after relief from active duty as officers.

In February 1944, that portion of the instructions dealing with retention

of physically incapacitated officer in limited service capacity, provided he

agreed, was rescinded in regard to Medical Corps and Dental Corps officers

and to chaplains. If such officers were qualified for limited service, they were

to be retained, regardless of their individual desires to be relieved.

In April 1944, the War Department authorized the assignment of battlecasualty patients in temporary or permanent limited service status. This was

brought about because many officer patients were undergoing treatment as battle

casualties in general hospitals in the continental United States, These officers

required several months of additional treatment before they would be ready for

final disposition, but their physical condition and treatment did not interfere

appreciably with their ordinary daily activities. Moreover, if they were assigned

to staff and other headquarters duties, their services could be utilized with benefit to both the individual and the Government. Examples of such cases were

those with peripheral vascular disturbances and conditions requiring series

of operative procedures, especially plastic surgery (except for extensive facial

disfigurement).

Changes to Reclassification Instructions

On 14 October 1944, War Department Circular Xo. 403 was issued, which

dealt exclusively with the subject of physical reclassification of officers. Prior

instructions, issued from time to time in separate War Department letters, were

consolidated in this circular.

The physical standards for the evaluation of officers for general and limited

service were to be as prescribed in All 40-100 (appendix D, p. 249) and All

40-105 (appendix C, p. 209).

The instructions contained in War Department Circular Xo. 403 were

again changed on April 1945, when War Department Circular Xo. 109 was

issued. It was complete restatement of the instructions relative to the physical

classification of officers. In it, the hospitalization of officers overseas was covered.

It provided that reclassification in these instances was to be handled in accordance with the policies prescribed by the respective theater commanders. This

regulation was greatly expanded, but mostly in the area of administrative

procedures.
92 PHYSICAL STANDARDS

On 12 October 1945, War Department Circular No. 109 was rescinded and

replaced by War Department Circular No. 313, This regulation emphasized

liberal approach to the interpretation of regulations in connection with the

retention of officers in limited service capacity. Factors to be considered were

the individual’s age, grade, branch of service, and MOS (military occupational

speciality), as well as the record of his satisfactory performance of general

service over reasonable period of time.

There were several intervening directives issued during 1945, but all were

essentially administrative innature.

Oversea Assignment of Officers

On 19 October 1942,War Department Circular No. 349, section III, authorized oversea assignment of some officers who were physically qualified only for

limited service. These instructions as amended by War Department Circular No, 86, issued 27 March 1943, also authorized the use of officers of the Army

Specialist Corps who did not meet the standards for general service. Officers

who were classified for limited service could proceed overseas, provided the

physical defect causing thatclassification was of static nature, nonprogressive,

and not subject to the development of complications. Defective vision, defective

hearing, and static orthopedic conditions were in this category. Officers classified

for limited service with waiver of defect involving either cardiovascular,

genitourinary, gastrointestinal, psychoneurotic, or endocrine conditions were

not to be given oversea assignments.

The policy regarding the oversea shipment of limited service officers was

liberalized in War Department Circular No. 102, issued on 11 March 1944, with

concurrent lowering of the individual’s physical capacity for the duties he

was expected to perform. Limited service officers and warrant officers with mild

hypothyroidism and syphilis, other than tertiary, could be considered for

assignment overseas. Conditions which disqualified limited service officers and

warrant officers for shipment overseas were more carefully delineated at that

time, as follows:

1. Organic heart disease, including serious disturbance of cardiac rhythm,

persistent arterial hypertension with systolic pressure above 180 mm. Hg or

diastolic pressure above 100 mm. Hg.

2. Peptic ulcer, or history of gastric resection or gastroenterostomy.

3. Asthma which has been incapacitating anytime during military service;

also bronchiectasis.

4. Thyroid enlargement with toxic manifestation; diabetes mellitus.

5. Symptomatic prostatic hypertrophy; kidney stone condition

(nephrolithiasis).

6. Mental disorders of all types in which there was history of previous

incapacitating episodes or definite incapacitating symptoms currently.
RETENTION POLICIES 93

7. Rheumatoid arthritis; history of rheumatic fever within the last

months; residual damage or sequelae from tropical diseases; diseases such

as filariasis which were liable to exacerbation or serious aggravation upon

reinfection; tertiary syphilis (osseous, visceral, or neurosyphilis).

8. Hernia, except small incisional or umbilical.

War Department Circular Xo. 406, section VIII, 16 October 1944, announced that medical officers with inguinal hernia, if this was their only defect, could be assigned to numbered general or station hospitals, which normally

were placed in base sections far behind the frontlines.

In War Department Circular Xo. 196, dated 30 June 1945, existing instructions were amplified concerning the utilization of manpower based on physical

capacity. General principles were outlined, and the policy on both officers and

enlisted men was summarized. Instructions were made more specific concerning

physical standards applicable to the shipment of personnel overseas. There

was no change with regard to general service officers. For limited service officers,

the examination could be limited to determining whether the defects initially

resulting in the limited service classification were also disqualifying for oversea

service. In some exceptional circumstances, limited service officers, even though

disqualified for oversea duty, could have been authorized by the War Department to perform temporary duty overseas for periods not to exceed 90 days.

CIVILIAN PERSONNEL IN THE ARMY OF OCCUPATION

At the time when an army of occupation was being formed in Europe, and

troops were being redeployed to the Pacific area, it was seen as both necessary

and practical to send civilian work force to supplement the Army. The matter

of physical qualification for such service was regarded as important to civilian

personnel, if not to the same degree, as it was for the military. Consequently, in

November 1944, The Surgeon General developed appropriate standards for

later use in the physical evaluation of civilian personnel. As in the case of

physical Standards for inductees contained in MR 1-9, examining physicians

were advised not to construe the standards for civilian personnel arbitrarily or

rigidly, but to use them as guide to their discretion. 19

CONCLUSIONS

The process of evaluating personnel for retention in the Army was enormously important in solving the total problem of acquiring, training, and

employing sufficient manpower for carrying out the Army's mission. The

medical interest and responsibility in this problem, from the standpoint of

19 Memorandum, Col. J. F. Lieberman, MC, Director, Physical Standards Division, for Mr. Jacobson,

Oversea Branch, Civilian Personnel Division, Office of the Secretary of War, Nov. 1944, subject:

Standards of Physical Examination of Civilian Personnel for Duty in Europe.
94 PHYSICAL STANDARDS

evaluating physical capacity to serve, involved the Physical Profile Serial

System, reclassification, limited service, oversea assignment, and redeployment.

The Physical Profile Serial System, an adaptation of the Canadian system,

was method by which job assignment within the Army was to be made, based

on the physical capacity and the skills of the individual. The system was brought

about by the realization that the Nation’s manpower pool was being depleted

at an alarming rate and that better utilization of those already in the service was

necessary. Because it came rather late in the war, it must be viewed as being

only limited success. The system permitted better composite and total

evaluation of the individual’s proficiencies and capacities, but it failed to give

an adequate indication of the various levels of employment for which the respective degrees of capacity were suited. It was an experiment which paved the

way for future study, refinement, and use.

The term “limited service,” as used in the U.S. Army in World War II,

described broad category of physical capacity which included individuals

with certain physical defects but who were otherwise qualified for general

service. During the period of limited emergency preceding World War II, men

qualifying for limited service were not inducted into the Army. At the start

of World War II, manpower requirements were such that this luxury could

not be tolerated and limited service personnel were taken into the service to

fill out both the officer and enlisted ranks. At the same time, there was the urgent

consideration of taking any man into the service who was physically and

mentally capable of making an effective contribution, but the possibility of

future claims against the Government and other losses was ever present.

Consequently, attention and regulations were focused on, and directed toward, the category of limited service. For the most part, limited service men were

assigned to noncombatant duties. For this reason, large percentage of them

were assigned to medical installations at all echelons behind the combat zone.

In the combat areas, The Surgeon General insisted that medical personnel had

to be at least the physical equal of combat soldiers. In this, he met with only

limited success.

With the defeat of Germany, the shift of emphasis was back toward the

Pacific area. The redeployment of many thousands of seasoned combat and

service troops to that area from Europe for the war against Japan became

matter of urgent military necessity. In fairness to both the vital interests of the

Nation and the individual selection for redeployment from the medical standpoint was to be based on the then current physical standards for shipment

overseas. This applied whether individuals were shipped with units or individually as replacements and whether shipped directly from theater to theater, or

through, or directly from, the United States. The key to successful evaluation for this purpose in War Department policy rested on the judgment of the unit medical officer. Unit medical officers were in the best position to know the individual’s capacity to function efficiently in the unit mission. Men who had already

served usefully overseas were not to be transferred from their units unless their
RETENTION POLICIES 95

defects were subject to complications or aggravation by further oversea service.

The physical reclassification of officers embraced policy wherein officers

were to be retained if they possessed the capability and capacity to perform in

an available assignment. Toward this end, the procedures for evaluating all

officers—whether Regular Army, AUS, or National Guard—were standardized.

For the most part, the basis of decision wasreduced to purely medical question.

The shortage of officers was highlighted early in the war with the shortage

of qualified materiel procurement specialists in the supply arms and services.

By March 1942, however, this shortage had become general, and retirement

board proceedings were virtually halted. The criteria for retention became

matter of the individual’s fitness and ability to do his work from day to day,

rather than the existence of certain physical defects. Discharge or retirement

for physical reasons alone were not to be considered so long as the individual’s

daily work was satisfactory.

Officers were reclassified from general service to limited service and then

retained in the latter category with waivers of otherwise disqualifying defects,

if necessary. It must be said that the most liberal standards possible were made

applicable to officers. The only justifiable basis for release from the service was

complete incapacity due to physical or mental causes, excluding indifference,

inaptitude, or incompetence.

CHAPTER

Separations

All 'World War II and demobilization separations from the U.S. Army

involved the use of physical standards to help determine fitness. When it was

concluded that an enlisted man had become disabled in the line of duty or that

he had an existing defect which was seriously aggravated by military service, the man was entitled to treatment and certificate of disability for discharge

or both. The certificate of disability for discharge and accompanying description of the extent of defects became the basis for any Veterans’ Administration

pension or other benefit claims against the Government. disabled enlisted

man with 20 years’ service became entitled to retirement or pension benefits.

Officers (Reserve and National Guard as well as Regular Army) disabled in the line of duty and limited service officers whose defects were seriously

aggravated by service became eligible for disability retirement. Officers and

enlisted men who became disabled not in the line of duty were subject to

separation from active duty after treatment. Determinations of fitness or eligibility for discharge or retirement were made at any time an individual’s

physical condition so indicated or during the general demobilization at the end

of the war.

LINE-OF-DUTY DETERMINATION

Before an officer or enlisted man could be retired, or an enlisted man

discharged with certificate of disability, determination that defect did

exist and that it had been acquired in the line of duty had to be made in

accordance with current regulations.

The policies concerning line-of-duty determinations with regard to disability or injury were generally the same for officers and enlisted men. They

changed many times during the war, with each change being more favorable

to the individual than to the Government, Disabilities caused by wounds or

injuries were easily related to military service, as were impairment of vision

or hearing. Chronic and long existing diseases, and degenerative conditions

normally occurring with increasing age, however, presented far more difficult

problem. The crux of the case rested in the question: Is this the natural

progression of preexisting disease, or is the military service responsible for

The steps involved in the retirement and discharge processes are discussed in chapter IY and

on page 111 of this chapter. Line-of-duty determinations could be made by line-of-duty board or by

hospital disposition board and the local commanding officer, depending upon the situation.

(1) War Department Circular No. 217, 15 Oct. 1941. (2) War Department Circular No. 226.

27 Oct. 1941. (3) Memorandum, The Adjutant General, for the Assistant Chief of Staff, G-l, Sept.

1941, subject; Line of Duty.
98 PHYSICAL STANDARDS

the aggravation and progression? In 1941, the War Department established the

policy that, except when medical judgment or records indicated that defect had

existed before service, any diseases or injuries manifested more than months

after entry on active duty were to be considered “line-of-duty—yes.” Conditions appearing before that time were usually to be considered as not in the

line of duty unless there was definite service connection.

Determinations also had to be made as to whether or not disease or injury

which existed before acceptance into the service had been permanently aggravated thereby. In making this determination, consideration was to be given to

the usual course of the condition in question. Conditions normally expected to

deteriorate at the rate found were to be considered not in the line of duty.

Decisions were not to be influenced by any extraneous or contributory causes

peculiar to military service.

Injuries

In every case of injury, organization commanders were to take immediate

steps to help determine the line-of-duty status from all available evidence. In

the absence of corroborating evidence and when the line-of-duty status was in

doubt, the unsubstantiated statement of the individual was not to be considered

as conclusive evidence of the true circumstances under which an injury had been

incurred. Injuries considered to have been incurred in line of duty, provided

misconduct or gross negligence was not contributory factor, were (1) battle

casualties, (2) injuries incurred while operating or riding in government vehicles or airplanes, and (3) injuries sustained while on maneuvers or during

authorized athletic exercises or otherwise while engaged in the execution of

military duty.

Original Policy Liberalized

This rather strict policy, established in late 1941, was relaxed intermittently

in detail until May 1944, when in War Department Circular No. 205 it was

revised and materially liberalized. In general, all diseases and injuries were

then to be considered as service connected, unless

1. They were incurred as result of the individual’s own misconduct.

2. They were incurred while the individual was absent from duty without

official permission.

3. They were incurred as result of the individual’s activities in pursuing

private avocation or business, not of class specifically authorized and

encouraged by the War Department.

4. They grew out of the individual’s relations unconnected with the service.

5. They existed before the individual’s current active service and were not

aggravated by such service.

At that time, venereal disease was still to be considered the result of

misconduct unless satisfactory evidence could be produced to show it was

acquired innocently, as from the individual’s husband or wife.
SEPARATIONS 99

Under this new policy, length of service was no longer critical factor.

Except for deficiencies noted on the “Report of Physical Examination,” W.D.,

A.G.O. Form No. 63, prepared at the time of acceptance for service, member

was presumed to have been in sound condition. Even when so noted, there was

to bo an assumption of service aggravation unless specific findings of natural

progression of the disease or injury were heavily overriding. There was, however, clause which permitted exception to this basic rule when unmistakable

evidence indicated that the injury or disease, or the causative conditions, although not noted, existed at the time the individual entered on active duty.

Defects that were incapacitating because of certain diseases in which the

onset was insidious and progression was slow were not of themselves to be considered as evidence of increased disability. These were described as neoplasms;

most endocrine disturbances, except hyperthyroidism or diabetes mellitus;

epilepsy; arteriosclerosis; hypertrophic (degenerative) arthritis, commonly

designated as osteoarthritis; and other chronic and degenerative diseases of this

type. In this regard, it was established that such incapacitating defects might

arise as the natural consequence of preexisting conditions, and not be incident

to service or aggravated thereby, unless there was some pertinent local injury, or

an abrupt and sudden pathological development during active service.

Advancement of certain other conditions, on the other hand, was expected

to have been caused by the unusual exertion, exposure, or other adverse influence

of military service. Some of these were defined as peptic ulcer; rheumatoid

arthritis; diabetes mellitus; active pulmonary tuberculosis; and bronchial

asthma, not established as seasonal.

Other preexisting conditions were to be declared “line-of-duty—yes,” unless

they were clearly and unmistakably shown as having undergone no increase in

severity during active service. These were defined as acute infections, such as

pneumonia; acute rheumatic fever, even though recurrent; acute pleurisy;

acute ear disease; and other diseases such as hemoptysis, lung collapse, perforating ulcer, decompensating heart disease, coronary occlusion or thrombosis, and

cerebral hemorrhage.

Change in Policy for Venereal Disease

In War Department Circular No. 458, dated December 1944, another

significant liberalization of the policy was effected. All cases of venereal disease

were to be considered line of duty. One exception to this was when the individual

failed to comply with the instructions in Army regulations covering such cases.

Individuals involved were to report the disease and to receive treatment for it.

The only other exception was when the condition had existed before the individual's entry on active duty. In the absence of these exceptions, the acquisition

of syphilis, gonorrhea, chancroid, lymphogranuloma venereum, or granuloma

inguinale while in the Army was to be considered service connected. The same
100 PHYSICAL STANDARDS

evaluation was to be made for conditions thatwere unmistakably the results of

venereal infection, such as paresis, tabes dorsalis, and so forth.

Early Line-of-Duty Experience for Officers

substantial number of officers were separated from the service with disabilities that were not found to be service connected. Approximately 7,600 of

these separations were based on the original policy. In order to equalize treatment of all officers separated, the War Department appointed special Army

retiring board to review these earlier cases on the basis of the later more liberal

policy. The board functioned from about July until October 1914. During this

period, all 7,600 cases were reviewed, with the result that in approximately 10

percent of the cases, the disability was reclassified as in line of duty.

SEPARATION OF ENLISTED PERSONNEL

On 26 November 1942, AR (Army Regulations) 615-360, “Enlisted Men:

Discharge; Release From Active Duty,” was republished, replacing the regulations published on April 1935, and numerous War Department circulars.

Enlisted men were separated from the service as result of physical or mental

evaluation under one of three sections of these regulations. Specifically, these

were section II—Disability; section VIII—Inaptness or Undesirable Habits

or Traits of Character; and section X—Convenience of Government. Separations under the provisions of section II were commonly referred to as “CDD’s”

while those under sections VIII and were referred to, broadly, as

“administrative.”

Certificate of Disability for Discharge

Discharges under section II of AR 615-360 were granted to enlisted men

when CDD (certificate of disability for discharge) was issued. This document

certified that the individual had become unfit for military service because of

physical disability. Such discharges also were granted to enlisted men who

entered the service with defects qualifying for limited service, but who, subsequently, had acquired disqualifying defects. Italso included limited service men

whose existing defects had been aggravated by military service to the extent that

they were disqualifying under current standards for induction.

Separation under this authority, however, was not to take place if the

individual was capable of performing some useful service. Toward this end, full

use was to be made of the reclassification procedure.

(1) War Department Circular No. 161, 14 July 1943. (2) Memorandum No. W615-64—43, Maj.

Gen. .T. A. Ulio, The Adjutant General, War Department, The Adjutant General’s Office, 26 Aug. 1943,

subject: Discharge of Enlisted Men Under Section III, Circular No. 161, War Department, 1943.
SEPARATIONS 101

man becoming unfit for service because of physical disability was to be hospitalized in military hospital in the United States. There, lie was to be

treated in an attempt to improve his condition so that he could be returned to

duty. When this was not possible, and further hospitalization was required,

the man was given certificate of disability for discharge from the Army of

the nited States. He was then transferred if his disability was incurred in

line of duty to Veterans’ Administration hospital. Terminal cases, or those

whose life or recovery would have been endangered by such transfer, were

retained in the service while patients in hospital. Those incurring disability

determined to be not service connected, with the exception of neuropsychiatric

cases, could be retained in the Army up to months, unless sooner discharged.

If disability incurred not in line of duty required hospitalization beyond

months, special arrangements were possible for retention of the individual

in the Army hospital as discharged enlisted man. Men determined to have

neuropsychiatric disability which was incurred not in line of duty were placed in the custody of the nearest relative, or otherwise delivered to civilian authorities. Those with neuropsychiatric disabilities incurred in line of duty were

transferred to Veterans’ Administration hospital for further treatment, as

appropriate.

When it was determined that man was to be separated on certificate

of disability for discharge, W.D., A.G.O. Form No. 40, was initiated by his

commanding officer sufficiently in advance of the expected discharge date and

dispatched to the hospital commander. The commander then convened board

of medical officers consisting of three members who made critical examination

of the man. The results of the examination were entered on the W.D., A.G.O.

Form No. 40 with specific reference to the origin of the disability, together

with careful description of the disability, wound, or disease. This was to be

done because service connection was always the basis of claim for pension

and other benefits.

The broad authority to actually issue discharge under these conditions

was vested in the commanding generals of the service commands, but, depending

on the circumstances, this authority could be delegated to commanders of lower

echelons. "When action on W.D., A.G.O. Form No. 40 had been completed by

the board of medical officers, the hospital commander made the appropriate

disposition for execution of final discharge. Commanders were to exercise

extreme caution and to be assured that the disablement was permanent. Moreover, the certificate of disability for discharge was not to be used when the

individual, possessing the characteristics qualifying under section VIII, was

deemed mentally responsible for his actions. If he was not found to be mentally

responsible for his actions, then the CDD discharge could be executed. In this

connection, examining physicians were enjoined to be particularly careful in

evaluating the facts relative to service connection of the disability. W.D.,
PHYSICAL STANDARDS 102

A.G.O. Form No. 40 was to be forwarded to The Adjutant General. At the

same time, report of the case was to be made by the hospital commander to

The Surgeon General. When the facts suggested that the man might be entitled

to pension, assistance in preparing an application was to be given the individual by the unit commander or the personnel officer.

The form of discharge in such cases was to be an honorable discharge from

the Army of the United States (W.D., A.G.O. Form No. 55) unless the board

of medical officers had indicated otherwise. If it was determined that the

disability was incurred apart from line of duty due to the individual’s own

misconduct, the so-called “blue” discharge from the Army of the United States

was to be given. Misconduct in this case included any occurring during or before

the man’s current service if it was the cause of the existing disability. In such

cases of misconduct, an honorable discharge could be given if the disability had

been noted at the time of enlistment, or if the board determined that, by virtue

of honest and faithful service, the man was entitled to an honorable discharge.

Otherwise, in cases of misconduct occurring before service, the board was always

to examine the facts to determine whether or not fraudulent enlistment was

involved.

Section VIII Discharges

Section VIII discharges were granted to enlisted men who, while mentally

responsible for their actions, were inapt or unadaptable for military service.

These discharges applied, also, to those with bad habits and traits of character,

or physical defects caused by their own misconduct, which made their retention

undesirable.

When an enlisted man was believed to possess these characteristics, his commanding officer submitted report of the facts to the next higher commander.

Upon its receipt, the latter convened board of three officers, one of whom was

to be medical officer, to decide whether or not the man should be discharged.

Heavy reliance in these cases was placed on the testimony of psychiatrist, who

was to have examined the man.

Boards for this purpose operated strictly in accordance with rules of evidence normally applying to special court-martial proceedings, and all witnesses

were sworn. As result of board action, men were recommended either for

retention or for discharge. In the former case, recommendation as to the type

of duty the man was capable of performing was to be made.

Discharges for Convenience of the Government

Discharges for convenience of the Government were issued to persons

honorably separated for reasons other than physical disability, such as limited

service men for whom appropriate assignment was not reasonably available, and
SEPARATIONS 103

enlisted men graduating from officer candidate schools and who were commissioned in the Army of the United States. Also, some men were discharged for

convenience of the Government when they claimed they had not been physically

qualified for induction but were erroneously classified and drafted. Others were

discharged when their importance to the national health, safety, or interest was

considered overriding. The form of discharge issued in such cases was an

honorable discharge from theArmy of theUnited States.

Significant Changes to the 1942 Procedure

In April 1943, no man was to be separated from active service if he could

meet the then current standards for induction. man who did not recover

sufficiently to meet these standards, regardless of line-of-duty status, was to be

given CDD discharge and transferred, if practicable, to Veterans’ Administration facility, if further treatment was indicated. The administrative

procedure for consummating CDD discharge was amplified, and the major

responsibility was given to general hospital commanders. Boards of medical

officers were enjoined to regard the interests of both the Government and the

individual, with any questions of doubt resolved in favor of the individual.

Various changes in the disposition of reports and records were made to include

The Adjutant General, The Surgeon General, the Veterans’ Administration,

and the Selective Service, in order to achieve coordination on the status of each

man separated. In June 1943, boards convened by commanding officers to act

on section VIII cases were to recommend discharge when the man could not be

developed sufficiently to absorb military training or was unfit to associate with

enlisted men. Those recommended for retention were to be sent to special training units, as appropriate.

In December 1943, soldiers with service-connected neuropsychiatric disabilities were to be retained for further treatment in an Army hospital if medical judgment indicated that the man could be expected to return to duty in the

continental United States within reasonable time. Individuals with tuberculosis were to be discharged and transferred to the Veterans’ Administration,

unless they were terminal cases. Those nearing completion of 20 years’ service

could be transferred to the tuberculosis treatment center at Fitzsimons General

Hospital, Denver, Colo. Meanwhile, those with malaria were not to be separated unless the condition was accompanied by permanently incapacitating

sequelae, such as marked enlargements of the spleen (splenomegaly) or form

of physical and mentalretardation known as cachexia, Ivepeated relapse, alone,

was not to constitute cause for separation.

On January 1943, enuresis was given as specific cause for consideration

of disability discharge. It was announced at the time that it was the generally

accepted medical and psychiatric opinion that enuresis was not necessarily
104 PHYSICAL STANDARDS

habit, but rather may have been symptom of some underlying mental or

physical condition. Underlying causes of the condition were described as organic

disease, psychoneurosis, psychosis, mental deficiency, psychopathic personality,

or lack of proper juvenile training. Generally, if the case was studied completely, one of these diagnoses would be established. Consequently, the individual in each case was to undergo complete physical and mental evaluation

by qualified medical officers, and decision was to be made as to disposition.

When AR 615-360 was republished on 25 May 1944, individuals with

enuresis were to be discharged in accordance with section VIII proceedings,

rather than certificate of disability for discharge, when the individual's lack

of further usefulness had been established. Also, the board of officers convened

by the commanding officer under section VIII was to include member of the

Women’s Army Corps when member of that corps was to appear.

On 20 July 1944, section VIII of AR 615-360 was replaced by AR 615-368,

which covered undesirable habits or traits of character, and AR 615-369, which

covered inaptness, lack of the required degree of adaptability, or enuresis. On

25 October 1944, section of AR 615-360 was replaced by AR 615-365, which

covered limited service not adaptable for military service.

Disability Discharge Rates

The disability discharge rate for theArmy fluctuated early in the war more

from change in administrative policy than from the influence of combat or other

casualties. After considerable rise in 1941, associated with the induction of the

National Guard into Federal service, the disability discharge rate for enlisted

men declined in early 1942 to low point of about 1.3 discharges per 1,000

strength per month. In the fall of 1942, it began to increase rapidly, so that by

February 1943,it stood at 2.6, close to its peak for 1941.

When War Department Circular No. 161, 14 July 1943, was released, and

the term “limited service” was to be eliminated in any reference to enlisted

men, those so classified were to be reexamined. As result, individuals meeting

the then current minimum physical standards for induction were to be retained

on active duty. man not meeting the minimum standards was to be given

CDD discharge unless he was able to perform useful service.

During June and July 1943, men were being discharged for disability at

rate in excess of per 1,000 enlisted strength per month. This rate rose to

per 1,000 in August and to 11 per 1,000 in September. Then, in November,

the disability discharge policy was changed and men were to be retained as long

(1) Monthly Progress Report, Army Service Forces, War Department, 31 Apr. 1943, Section

Health. (2) Also affecting discharge rates were many other factors, including the number and competence of examiners, time allotted for examinations, quality of examining facilities, and the frequent

changes in standards.
SEPARATIONS 105

as they were useful with physical defects per se secondary consideration.

Disability discharge rates dipped to per 1,000 in December 1943.

The relatively low disability discharge rate achieved in December 1943

prevailed until September 1944, when War Department Circular No. 370 was

issued. This contained slight modification of the policy of “retain the man

and find the job that fits his capabilities” to “if job is available that fits his

capabilities, retain the man.” The effect of this change was to liberalize markedly what had been fairly strict discharge policy since November 1943. As

result, there was an immediate increase in the disability discharge rate. This

was tempered, however, by the release of Changes No. to AR 615-360,

republished on 12 September 1944. This change provided that an enlisted man

would not be discharged for physical reasons on the grounds that he was

incapable of serving in physically exacting position when he could render

adequate service in reasonably available and less exacting assignment. Failure

to meet induction standards was not to be sufficient grounds for discharge if

the man was satisfactorily filling an authorized position. When defects were

not sufficient to warrant disability discharge, but prohibited employment in

reasonably available assignment, the man was to be discharged for convenience

of the Government. As result, the total rate of discharge from the Army for

all causes was not materially affected, but the disability discharge rate was

lowered because many discharges previously given for disability were given

for convenience of the Government instead. In January 1945, War Department

Circular No. 370 was rescinded, and there was return to the stricter discharge

policy prevailing inAugust 1944.

During the war, about 1,312,000 enlisted men were separated from the

Army for reasons attributable directly or indirectly to physical and mental

defects. About 956,000 of these were separated on certificates of disability for

discharge. The remainder of some 356,000 men were separated for inaptness,

lack of the required degree of adaptability, or for enuresis. By the beginning

of 1946, of all enlisted men who had entered the service, approximately 12.8 percent had been separated for physical or mental defects. Disability separations

amounted to 9.3 percent, while separations for other physical and mental causes

amounted to 3.5 percent.

Table indicates the status of defects for which men were separated from

the Army on certificates of disability for discharge between 1942 and 1945. It

shows the trend in the number of men separated by cause of separation and the

same trend expressed as percentages of the total. The rise and fall of separations, previously mentioned, are clearly indicated.

Health of the Army. Volume I. Report No. 2. Office of The Surgeon General, War Department,

31 Aug. 1946.
106 PHYSICAL STANDARDS

Table 3.—Enlisted men separated from the Army on certificates of disability for discharge

for disease,

In addition to the effects of change in administrative policies on the

discharge rates in 1943 was the marked increase in the number of enlisted men

who had entered the Army in 1942. About 3,815,000 enlisted men came into

the Army in 1942, as compared to 1,341,000 in 1941 and 2,660,000 in 1943.

Moreover, the men inducted during 1943 were from the comparatively older

age groups from which larger percentage qualified only for limited service.

It was estimated, also, that the more liberal policy announced in War Department Circular No. 161 in August 1943, although short lived, resvdted in the

discharge of some 55,000 limited service men.

During 1944, there were fewer GDI) discharges than in 1943, mainly as

result of the decrease in the number of men entering the Army. The rise in

1945 resulted, primarily, from separations because of trauma, both battle and

nonbattle, rather than discharge policy. Trauma first reached substantial

figure in 1944, when it comprised 6.T percent of all GDI) discharges. In 1945,

this figure rose to 26.5 percent of the total (table 4).

Psychiatric disorders comprised the greatest bulk of all separations for

disease (table 3). About 380,000 enlisted men were separated during 1942—45

because of such disorders. Moreover, psychiatric disorders constituted 45 percent

of all GDD discharges granted for disease. Most of these separations were for

psychoneuroses and psychoses. The former made up 68 percent of all neuropsychiatric separations, while the latter accounted for 14 percent.

Next in order of magnitude were separations resulting from diseases of the

bones and organs of locomotion. These totaled 12.8 percent of all disability discharges for disease. More than one-half of these separations were for musculoskeletal defects. Arthritis was the primary cause of the 12.5 percent of separaCause of separation 1942--45 1942 1943 1944 1945

Number Percent Number Percent Number Percent Number Percent Number Percent

All disease 846,153 100.0 61,283 100.0 343,563 100.0 192,017 100.0 249,290 100.0

Infectious and general. 105,534 12.5 9,503 15.5 40,242 11.7 22,733 11.8 33, 056 13.3

Neuropsychiatric.- 379,486 45.0 26,373 43.0 138,609 40.3 98,293 51.2 116,211 46.7

Eye, ear, nose, and

throat. 58, 715 6.9 3,578 5.8 32,621 9.5 9,971 5.2 12,545 5.0

Respiratory... ... ... 50,291 5.9 4,040 6.6 21,184 6.2 11,519 6.0 13,548 5.4

Cardiovascular.. .. 52,588 6.2 5,171 8.4 25,057 7.3 12,103 6.3 10,257 4.1

Gastrointestinal 61,181 7.2 5,803 9.5 20,664 6.0 17, 734 9.2 16,980 6.8

Genitourinary 15,606 1.8 1,146 1.8 6,825 2.0 3,604 1.9 4,031 1.6

Bones and organs of

locomotion 108,495 12.8 5,669 9.3 57, 619 16.8 15,373 8.0 29,834 12.0

Miscellaneous 14,257 1.7 742 0.2 687 0.4 12,828 5.1

Based on individual reports of separation received from The Adjutant General. The total is about percent short

of the sum published by the Adjutant General’s Office.

Source; Health of the Army, Volume I. Report No. 2. Office of The Surgeon General, War Department,31 Aug. 1946.
SEPARATIONS 107

Table 4.—Enlisted men separated from the Army on certificates of disability for discharge,

tions for infectious and general diseases, while gastric and duodenal ulcers

accounted for most of the 7.2 percent of separations for gastrointestinal defects.

The large increase in 1943 over 1942 in the rate of disability discharges for

arthritis, eye, ear, feet, respiratory, cardiovascular, and general musculoskeletal

defects was directly traceable to War Department Circular No. 161. This was

because of the large number of men inducted earlier in the war who were borderline and substandard in these respects. Their induction occurred when emphasis

was placed on the acceptance of every man in the classes not otherwise deferred

who could be expected to perform military duty satisfactorily.

Until 31 August 1943, about 50 percent of the disability discharges granted

to members of the Women’s Army Corps were for neuropsychiatric reasons.

About 90 percent of these were with diagnosis of psychoneurosis. Second in

order of importance were discharges for gynecological conditions, which accounted for about 20 percent of the total. study of discharges by age at the

time of discharge indicated sharp increase with advancing age.

Enlisted Retirements and Veterans’ Administration Pensions

The basic Army authority for disability retirement was contained in

AR 615-395, “Enlisted Men: Retirement.” It was revised and republished on

June 1942, superseding the Army regulation published on 16 May 1938. An

enlisted man of the Regular Army or of the Philippine Scouts who had served

20 years or more and who had suffered physical disability in line of duty

which permanently incapacitated him for active service was to have been placed

on the retired list. Such men were to have been hospitalized for the purpose of

being examined by board of three medical officers. This board was to determine whether or not the man was incapacitated for active service and if so, the

cause of the incapacity, and the approximate date when the incapacity originated; it was to determine whether or not the disability leading to his incapaciMonthly Progress Report, Army Service Forces, War Department, 31 Aug. 1943. Section 7:

Health.

'257-906'’—67

19^2-45

Cause of separation 1942-45 1942 1943 1944 1945

Number Percent Number Percent Number Percent Number Percent Number Percent

All causes

Disease

Battle and nonbattle

injuries

956,232 100.0 61,990 100.0 348,964 100.0 205,901 100.0 339,377 100.0

846,153

110,079

88.5

11.5

61,283

707

98.9

1.1

343,563

5,401

98.5

1.5

192,017

13,884

93.3

6.7

249,290

90,087

73.5

26.5

Based onindividual reports of separation received from The Adjutant General.The totalIsabout percent of the sum

published by the Adjutant General’s Office.

Source; Health of the Army, Volume I. Report No. 2. Office of The Surgeon General, War Department, 31 Aug. 1946.
108 PHYSICAL STANDARDS

tation was incurred in line of duty, and whether or not it was permanent.

report of physical examination was to have been rendered and board proceedings were to have been recorded.

If the board recommended retirement, the hospital commander was to

forward the proceedings to The Adjutant General for final action by the

Secretary of War. Upon War Department approval, orders were to have been

issued placing the man on theretired list.

Under provisions of Public Law 140 of the 77th Congress, approved on

30 June 1941, man placed on the retired list was to be eligible for pension or

compensation under laws administered by the Veterans’ Administration. If he

elected to receive the latter, however, it was required that he waive receipt of

retired pay, an allowance to which he was normally entitled from the War

Department. To avoid concurrent payment, when an individual waived receipt

of retired pay in favor of pension or compensation from the Veterans’ Administration, the War Department was to notify the latter when the waiver was

received from the enlisted man concerned and to advise them also of the date

when retired pay was terminated. The same administrative coordination was

effected when man elected to waive Veterans’ Administration pension and

compensation infavor of Army retired pay.

An individual did not have to be eligible for retirement to qualify for

veteran’s pension, however. Any man honorably discharged who had incurred

disability in the line of duty or anyone with preexisting defect aggravated by

military service might qualify. Whether retired or discharged, the individual’s

entitlementto pension was matter of separate application.

Army Regulations Vo. 615-360, dated 26 November 1942, required that

organization commanders and personnel officers give assistance to enlisted men

undergoing discharge who wished to prepare an application for pension.

Changes were made number of times during the war to the exact procedures to

be followed in helping the men apply for pensions and infiling the applications.

Applications for pension were to be prepared on Veterans’ Administration

forms supplied by the field directors of theAmerican National Red Cross. Meanwhile, the approved certificate of disability for discharge was to be forwarded

to The Adjutant General, and report of the discharge was to be made to The

Surgeon General. Completed pension application forms were to be sent to the

Veterans’ Administration. In addition to unit commanders and personnel officers, field directors of the American National Red Cross were authorized to

assist in the preparation of pension applications, assisting the enlisted man and

working in cooperation with the commanding officer.

MISUSE OF MEDICAL CHANNELS FOR DISPOSITION OF

PERSONNEL

problem continuing throughout the war was the tendency of command

to abuse medical channels for the disposition of personnel when alternate means
SEPARATIONS 109

were not otherwise practicable. It required constant alertness on the part of

medical officers to prevent abuses in this respect. This had been as true in peace

as it was during war and applied to both officers and enlisted men.

An organization commander is primarily interested in unit which has

as few substandard members in its complement as possible. From commander’s

point of view, the simplest way of disposing of substandard men during World

ar II was often through medical channels. In many instances, the proper

disposition was an administrative separation rather than one for disability, but,

because of command pressure, the latter channel was utilized. There were two

disadvantages to this procedure: First, the unnecessary burden placed on

medical personnel and facilities at the expense of the primary mission; and

second, and more important, the possibility of establishing status for the

individual which ultimately might result in pension rights to which he was not

really entitled.

In this process, individuals were often reclassified, evacuated, and even

discharged for medical reasons on meager grounds. Medical means were used

to dispose of individuals who were merely ineffective and inefficient, and not

sick or physically disabled. There was widespread tendency to attribute

ineffectiveness to coincidental medical defects, while other factors influencing

effectiveness, such as lack of leadership and individual motivation and attitudes,

were not given sufficient consideration. The medical officer, especially one with

little military experience, often did not fully appreciate his professional responsibility to the individual and to the Government in this context.

The use of medical channels to discharge persons not wanted in the service

later cost the Government millions of dollars. One such instance arose when

the need for officers was at its peak during the war, and many enlisted men

were sent to officer candidate schools. Many who had been awarded their bars

but who were later considered unsuitable leaders by their superiors were found

to have service-connected disabilities of various degrees. Hundreds of these

men were discharged for physical disability. Enlisted men were not eligible

for disability retirement with less than 20 years’ service at that time. These men

were given “line-of-dnty—yes” evaluations as enlisted men in connection with

their disabilities if the disability had been incurred while they were enlisted

men, but “line-of-duty—no” evaluations as officers, thus making them ineligible

for disability retirement. claim was later made by one of these men that he

should have had “line-of-dnty—yes” both as an officer and as an enlisted man.

The man won his case, and the U.S. Comptroller General ruled that all such

men should be eligible for benefits as officers if they had been discharged in

that manner.

The War Department during the war, in various directives and in Army

regulations covering the disposition of personnel, emphasized the importance

of making the distinction between those unfit by reason of disability and those

Based on information furnished by Col. Harold Opsahl, MC.
PHYSICAL STANDARDS

to be separated because of unfitness for other reasons. Medical channels were

to be used only for the disposition of the sick and the wounded, after maximum

benefit had been obtained from treatment, but without sufficient improvement

to fit the individual for service.

If an officer had failed to demonstrate his adaptability to his assignment

and his psychiatric or physical condition did not warrant placing him before

an Army retirement board, prompt measures were to be taken either toreassign

him or to effect his reclassification and discharge. It was realized that there

would be some marginal cases among the noneffectives, whose disposition would

be difficult to determine. It was believed, however, that adequate study would

indicate the proper disposition.

OFFICER DISABILITY RETIREMENT

As with enlisted men, an officer’s state of health was compared, in some

way, with physical standards requirements number of times while he was

being processed for retirement—by examining boards after hospitalization, by

disposition boards, by retiring boards, and by review boards. It was not necessary that all these boards act on every retirement case, but some examination

plus retirement board action was always necessary. The standards used by the

various boards were very similar and usually the same as entrance standards.

Late in the war, special set of retention standards were in the process of being

developed, but these were not published until 1953.

On April 1939, Public Law 18 of the 76th Congress became effective

granting Reserve component officers the same retirement benefits as accrued

to officers of the Regular Army, providing their disability was incurred in line

of duty while on active duty. 10 The War Department, shortly after the passage

of this act, directed that the same physical standards apply to the Reserve as

to the Regular Army, and instructions were issued for more comprehensive

physical examinations to be made to protect the Government. The method of

separation of Reserve officers who were on active duty and relieved for physical

disability, and their entitlement to retirement benefits for disability, were then

essentially the same as those for Regular Army officers. 11

However, the act of April 1939 had not specified which agency of the

Government was to administer the equalized retirement benefits for Reserve

officers, so Executive Order No. 8099 was issued on 28 April 1939 to correct this

deficiency. The order provided that the Veterans’ Administration would be

responsible for administering the provisions of the act. The line-of-duty determination, however, was to be made by the Secretary of War or someone

(1) War Department Circular No. 81, 31 Mar. 1945. (2) War Department Circular No. 233, Aug. 1945.

In 1953 as Special Regulations No. 40-120-1, Oct. 1953, and later as Army Regulations

No. 40-504, 28 June 1955, and then as Army Regulations No. 40—501, Dec. 1960. 19 Statutory authority for the retirement of Regular Army officers for reasons of mental or physical

Incapacity had its origin in the act of Aug. 1861 (12 Stat. 289) and was carried over to the revised

statutes (par. SP.TGA 1943/9514, 14 July 1943 JAG 210.85, 14 March 1932 C.22399, 22 Nov. 1907). 11 See footnote 2(1), (2), and (3), p. 97.
SEPARATIONS 111

designated by him. Determinations were to be made in the same manner as for

personnel of the Regular Army.

Some of the procedures leading to retirement arc discussed under “Reclassification of Officers” in chapter IV (p. 86). After the officer had been

hospitalized and his ailment diagnosed to determine if it was permanent and

of degree to render him unfit for further military service, he was to appear

before hospital disposition board. If this board recommended retirement,

the proceedings were forwarded to the War Department where they were

reviewed by officers from the Surgeon General’s Office. If these officers recommended retirement and the War Department concurred, orders were issued for

the officer in question to appear before an Army retiring board. 12

The proceedings of the retiring board were sent to the War Department,

reviewed by The Surgeon General, and final action taken by The Adjutant

General for the Secretary of War, who acted for the President of the United

States.

Line-of-duty determinations were to have been initiated by medical disposition boards, but sometimes decisions on line of duty were difficult, especially

after so many changes in policy were effected. The War Department utilized

Army retiring boards as factfinding boards in cases where the medical disposition board could not come to satisfactory decision on an officer's fitness for

further military service or the line-of-duty status of the incapacity in question.

The final decision, however, was to rest with the War Department as to the

officer’s entitlement to benefits. If the final decision was favorable to the officer, certification was made to the Veterans’ Administration, from which agency

Reserve officer received his retirement pay. (Regular Army officers received

theirretirement pay from the War Department.)

On 15 October 1941, the War Department reaffirmed that line of duty and

fitness for active military service for all officer personnel on active duty for

periods in excess of 30 days were to be the same for officers of both the Reserve

and the Regular Army. 13 As result of retiring board hearings, officers physically or mentally disqualified were relieved from active duty on termination of

accrued leave and travel time, whether or not they ultimately received retirement benefits. Those found fit for further active service, however, were to be

returned to duty.

Due to the large number of officers on active duty and the pressing needs of

the war, it was found impracticable to make periodic examinations of officers

after they had once been examined and found qualified for active duty. Annual

physical examinations of officers of the Regular Army also were discontinued

early in the war. The same was true for physical examinations of officers of the

Reserve components for promotion. Usually an officer went before an Army retiring board because some disability was found upon his terminal physical

examination or during some period of hospitalization.

12(1) Army Regulations No. 605-245, 17 June 1941. (2) Army Regulations No. 605-250, 19 Jan.

1924, June 1943, and 28 March 1944. 13 See footnote 2(1), p. 97.
112 PHYSICAL STANDARDS

Some problems resulted during and after the war from the mechanics of

Army retiring board procedure, but these are not within the scope of discussion of physical standards. These boards operated under provisions of the

Revised Statutes and certain legal requirements had to be met for the findings

to be valid. The prime responsibility that the board meet legal requirements

rested with The Adjutant General, whereas it was customary for the Surgeon

General’s Office to review Army retiring board decisions and to note the recommendations, The function of the Surgeon General’s Office in reviewing the

recommendations of these boards was primarily to express an opinion whether

or not the cause for retirement could be considered adequate, whether or not the

line of duty had been correctly determined, and whether or not general policies

outlined by the War Department were being carried out in uniform manner

by all boards.

The Surgeon General’s Review

Army retiring boards were made up ofboth line officers and medical officers,

most of whom had little experience in such duties. Medical witnesses before

such boards seemed to be obsessed with the idea that any minor deviation from

the physical standards which governed appointment should be adequate reason

to recommend an individual for retirement. 14 The finding of some residual

defect, such as the scarring from an old duodenal ulcer, would in many cases

bring an individual before an Army retiring board, although the man might

have no residual symptoms and be well able to perform military duty. Aggravation might be found as incident to the service merely because preexisting

defect had again presented symptoms and the individual claimed some trauma

in the service. In many cases, claims could not be substantiated by any official

record of injury. Many board proceedings were received by the Surgeon General’s Office for review that showed long list of diagnoses as disabilities. Close

scrutiny often showed that these diagnoses were those made at the time the

individual had been originally hospitalized, and that at the time of appearance

before theretiring board the conditions no longer existed, or else had progressed

to degree of improvement that they no longer constituted reason for

retirement.

Typical of the actions taken as result of review of Army retiring board

proceedings in the Surgeon General’s Office were those taken during 23 July

1945 through September 1945.15 At that time, 2,344 Army retiring board cases

were reviewed. Of this number, only 49 were for Regular Army officers. Of

the 2,295 non-Regulars, 1,870 were cases appearing before the board for the

first time, while on 425 the board had been reconvened. All Regular Army

14 Based on information supplied by Col. William B. Foster, MC (Ret.).

15 Memorandum, Headquarters, Army Service Forces, for The Surgeon General, 20 July 1945,

subject: Officers Ordered Before Army Retiring Boards Who Are Not Retired for Disability, and

1st Indorsement, The Surgeon General, to the Director, MPD, ASF, 19 Sept. 1945. [This memorandum

was used by Lt. Col. Hesford in the course of his work on an earlier draft of this volume, but the

d»cument has since become unavailable.—C.M.W.]
SEPARATIONS 113

officers involved were found permanently incapacitated for active service by

the board and these decisions were concurred in by The Surgeon General. Of

the 2,295 cases involving non-Regular officers, 1,480 were found incapacitated

for active service. Of this number, 51 were the result of reconvened retiring

boards with which The Surgeon General did not concur. Of the 815 non-Regular

Army cases remaining, the retiring boards found that 19 officers were not

incapacitated for active service and returned them to general service, and in

41 cases recommended that the officers be placed on temporary limited service

for months. On the remaining 756 cases, the following actions were taken:

1. Returned through The Adjutant General to Army retiring boards were

235 cases appearing for the first time. In these cases, The Surgeon General was

of the opinion that the officer might well have been found not incapacitated

for active service and, instead, placed on temporary limited service for months.

This was based on the fact that the disease, injury, or infirmity was improving,

and sufficient time had not elapsed to determine the permanent residuals or the

question of permanent aggravation by service.

2. The Surgeon General did not concur in 35 cases on which retiring boards

had been reconvened. recommendation was made to The Adjutant General

that the officers concernedbe found not incapacitated for active service and that

they be placed on temporary limited service for months with reexamination

and reevaluation at the end of that time.

3. The Surgeon General did not concur with the line-of-duty determination

or aggravation findings in 151 cases. These were returned through The Adjutant

General to theretiring boards forreconsideration.

4. In 113 cases, The Surgeon General found the evidence submitted to be

insufficient to warrant retirement or to find the officer incapacitated for general

service. These cases, likewise, were returned to the retiring board, through

The Adjutant General, for reconsideration and clarification.

5. Similarly returned to retiring boards were 26 cases for reconsideration

and for inclusion of major defects in the findings which had been omitted.

6. There were 84 cases for which the clinical records or X-rays had been

requested of The Adjutant General because the diagnosis and line-of-duty

determination were questionable.

7. The findings in 46 cases were incomplete or not recorded as called for

in AR 605-250, “Commissioned Officers: Army Retiring Boards,” so they were

returned to retiring boards for correction.

8. Returned to The Adjutant General were 65 cases in which further

treatment was indicated, and it was recommended that treatment be completed

at the appropriate hospital.

Neuropsychiatric Cases and Psychoneuroses Main Cause for Retirement

Action

Neuropsychiatric and psychoneurotic cases presented unusual difficulty.

These constituted approximately 40 percent of all officers appearing before
114 PHYSICAL STANDARDS

retiring boards. Many of these officers had been returned to the United States

from oversea theaters and often afterarrival no longer presented any symptoms.

The history of such condition prevented hospitals from returning these

individuals to full military duty, with possible reassignment overseas, and if

they were returned to duty at all, it was for limited service. Many would refuse

limited service status and the regulations then in force would require their

appearance before an Army retiring board. This was especially true of

Air Forces personnel, for limited service classification prevented the individual from flying, and the Air Forces resisted reassignment of individuals

considered unfit for full military duty. The result was that many officers were

found physically disqualified for further military service by retiring boards,

with subsequent certification to the Veterans’ Administration forretirement pay.

In the majority of retirements for psychoneuroses, it was not possible to

predict whether or not the psychoneurosis would persist after the officer had

been retired and returned to civilian life. There was no provision in the

retirement law for the reexamination of any of these cases at later date to

determine if recovery had occurred, and even if there had been, it would have

presented difficulty. Experience had shown that in handling of such cases,

individuals would not admit improvement if such acknowledgment might result

in reduction of monetary or other benefits. Without doubt, many had so

little disability that they were not incapacitated in any way for their usual

civilian occupations.

The course of physical disabilities could be predicted with fair degree of accuracy, but as stated above, the rendering of prognosis for the psychoneuroses presented more of problem. Many of these psychoneurotic individuals

lost their disabilities immediately after discharge from the service and their

return to civilian life; others with medical assistance recovered promptly; and

others continued to profess disability. Many of these cases while considered

unfit for military service had no handicap for their civilian vocation.

Inequities

The provision at the close of the war for retirement pay and the large

number of officers coming up for retirement presented serious problem. The

retirement provisions at the time provided the same compensation for minor

incapacities as for major disabilities, and there was no provision forthe periodic

review of cases to determine permanency of the disability. The Surgeon General had recommended that the amount of retirement pay be graded to conform

to the extent of disability estimated for civilian life and that provision be made

for reviewing the degree of disability at stated intervals after retirement for

the purpose of adjustment of pay where indicated by changed degree of disability. 16 To correct the situation, change in the laws effecting retirement

1# Monthly Progress Report, Army Service Forces, War Department, 31 Dec. 1944, Section

Health.
SEPARATIONS 115

benefits was necessary. Some changes were made but not until 1949, when they

were included under U.S.C., title 10, chapter 61, sections 1201-1221, of the 81st

Congress. At that time, physical evaluation boards were established, review of

cases to determine permanency of disability was instituted, and disabilities were

rated by percentages which determined the amount of benefits which would be

tax free.

Disability Retirement of Nurses

Beginning on 10 July 1944, both Regular Army and Reserve Corps nurses

could be appointed as officers in the Army of the United States, withrights to

disability retirement the same as those for other officers. 17 Before that time,

although the Army Nurse Corps was component of the Medical Department,

its members were not commissioned officers of the Army, but held relative rank

to other officers. Special statutory provisions had covered the retirement of

nurses, both Regular Army and Reserve on active duty. An act of 13 May 1926

provided for the retirement of nurses for longevity of service. Statutory authority for the retirement of nurses for physical or mental disability came in

an act of 20 June 1930, amended by an act of IT October 1940.18 These provided

that nurse could be retired for physical disability if found by board of medical officers to be disabled in line of duty while performing the duties of nurse.

Board findings were to have been approved or disapproved by the head of the

military department concerned.

Disability Retirement Situation at the Close of the War

Much confusion existed during the war period concerning Army retiring

board procedures and interpretation of various directives concerning physical

reclassification of officers. Such confusion often required that retirement board

proceedings be returned number of times for correction and clarification of the

findings. Finally and rather belatedly, War Department Technical Manual 12-

245, “Physical Reclassification: Retirement and Retirement Benefits for Officers,' was released on October 1945. This manual was useful but failed to

serve its full purpose because of the late date on which it was issued. Also, the

document was loosely written and subject to varying interpretations, which led

to claims against the Government after the war.

During 1942, about 1,350 officers were retired or separated for physical

disability. In 1943, the number increased to nearly 4,300, and for 1944,the number was about 9,000. Because on the average some months elapsed between

the hospitalization of battle casualty and the time he was retired or separated

for disability, the battle casualties sustained in the invasion of France and the

Lowlands had not appeared in sizable numbers by the end of 1944.19 These

17(1) War Department Bulletin No. 16, 19 July 1944. (2) Army Regulations No. 40—21 27 Nov.

1944.18 (1) 44 Stat. 531. (2) 46 Stat. 790. (3) 54 Stat. 1192. 19 See footnote 16, p. 114.

257-966 —67——10
116 PHYSICAL STANDARDS

casualties began making their appearance before retiring boards in substantial

numbers in the early part of 1945, and during that year, more than 13,500 officers were separated or retired for physical disability.

The distribution of officer disabilities by cause was, in most respects, similar

to that of enlisted men, except that the older age composition of officers was

reflected in higher proportion of disabilities from cardiovascular disease,

arthritis, gastric and duodenalulcer, and tuberculosis.

Secretary of War’s Separation Board

On January 1944, the Secretary of War, Mr. Henry L. Stimson, established separation board, consisting of five general officers, at least three of

whom were from the Reserve components. This board acted for theSecretary of

ar on matters pertaining to commissioned and warrant officers (except general officers) on matters including separations and relief from active duty (other

than death, dismissals as result of court-martial, demobilization, and retirement) retention on active duty in limited service status after appearance

before retiring board; certain cases involving disability; and benefits under

Public Law 101 of the 78th Congress, approved 29 June 1943.

Maj. Gen. William Bryden was president of the board which began functioning on 19 January 1944. The board remained in operation until it was dissolved on February 1946, when its work was transferred to the Secretary of

ar’s Personnel Board. In one report of the board’s proceedings rendered on

29 November 1945, which covered the action completed on 40,000 cases, 22,100

of these had been approved for separation while 17,900 were disapproved.

Veterans’ Administration Pensions

If it was determined that an officer’s disability was insufficient to warrant

the finding of incapacity, the officer could still apply to the Veterans’ Administration for benefits under laws administered by that agency. In such cases, the

Veterans’ Administration evaluated the disability, rated it on fractional basis,

and awarded pension commensurate with the amount of disability found.

As for enlisted men under Public Law 140 of the 77th Congress, approved

30 June 1941, Public Law 314 of the 78th Congress, approved 27 May 1944,

provided that an officer receiving retired pay who was eligible to receive

pension or compensation under laws administered by the Veterans’ Administration could waive his right to receive retired pay from the War Department.

The amount of retired pay waived was to be equal to the amount of the pension

or compensation received from the Veterans’ Administration. Administrative

coordination between the Veterans’ Administration and the War Department

was the same as for enlisted men. Policies and procedures for the filing of

pension applications for officers also were the same as those described for

enlisted men.
SEPARATIONS 117

PHYSICAL EVALUATION UPON DEMOBILIZATION

Pilot Separation Centers

In 194-1, pilot separation centers were established at Fort McPherson, Ga.; Fort Sam Houston, Tex.; Presidio of Monterey, Calif.; Fort Sheridan, 111.; and Fort Dix, N.J. In September 1944, Col, Cornelius E. Gorman, MC, represented The Surgeon General on an Army Service Forces team established for

the purpose of visiting the pilot installations.20

Although the intent of the team was to confine its study to pilot separation

centers, it was apparent from the first that the activities of personnel center, of which separation centers were part, were so integrated that it was impossible to study separation centers without studying the personnel center as

unit. At the time the studies were made (September 1944), action was underway

to discharge certain enlisted men who did not meet the minimum physical

standards for induction. To afford each service command the means of handling

this load and to gain experience for separations following the end of the war,

the team recommended that separation center be established in each service

command.

It was found that, generally, the number and quality of medical personnel

assigned in the pilot centers were inadequate to accomplish good physical

examination, as were the physical plants in which examinations took place.

It was noted, also, that Veterans’ Administration pension application forms

were being filled out by various means—at one place by the American Nat ional

Red Cross, at other places by the Veterans’ Administration representative, and

at other places by the records branch. (This was to be done by the Medical

Administrative Section of the center, with the assistance of the other agencies.)

It was considered important that medical history interviewers be properly

trained and that they be males rather than females, except where female

personnel were to be examined. It was noted that in the examination, not

enough professional judgment was being exercised and too much reliance was

being placed on the letter of the physical standards regulations, which were

intended to be used only as guides.

recommendation resulting from the pilot tests, but never fully adopted,

was that medical personnel employed in separation center examinations be

assigned directly to the personnel center so that turnover could be kept to the

minimum. Above all, it was seen as imperative that particularly well-qualified

personnel be assigned to the examining teams. Another importantpoint was that

the Medical Administrative Section should operate under the chief medical

examiner.

20 Letter, to Director, Planning Division, Army Service Forces, 12 Sept. 1944, subject; Report on Visit to Pilot Separation Centers by Army Service Forces Visiting Team. [This report cited is no

longer available for examination. However, It was used by Lt. Col. Hesford in the preparation of an

earlier draft of this volume the correctness of the material based on it is attested by Col. Gorman,

who was The Surgeon General’s representative on the team.—C.M.W.]
118 PHYSICAL STANDARDS

At this early stage, it was found that some men who still required the care

of medical attendant were being sent to separation centers instead of being

separated at their home stations. Similarly, individuals arrived at the separation centers before their course of treatment was completed. Such cases were to

have been retained at the home station.

It was found that, for the most part, the physical examining facilities for

women were inadequate at all of the pilot stations.

This was the planning phase of the separation process. By this means,

many problems were corrected long before the surge of outgoing personnel in

1945, when 26 separation centers were in operation, and personnel were separated, although in smaller numbers, from other posts as well. Many more

problems were found when large-scale demobilization got underway, but most

of these resulted from the large numbers involved, fast turnover of operating

personnel, requirements for speed, inadequate facilities, and similar considerations. Only the completion of demobilization ended such problems.

Demobilization

In the traditionally accepted American fashion up to that time, demobilization was rapid after the war’s end in August 1945. After peaking in May 1945

at 8,291,366 men, total Army strength dropped to 6,487,053 in October and

was down to 4,228,936 in December, By August 1946, the total Army strength

had plummeted to 1,731,040 men, and year later it was 955,698. Thus, from

August 1945 to August 1947, over million men had been separated from the

Army; million of these in the first year. In February 1941, total strength of

the Army was just over 900,000 men, and it took until May 1944 to reach

strength of 7,900,000 men, or over years to induct the million men who were

demobilized in years.21

Of the 26 separation centers established throughout the country after the

Japanese surrender, were equipped to process both male and female personnel.

The procedures employed at separation centers ultimately were developed to

high level of efficiency, so that man’s separation from the service usually

was accomplished within 48 hours of his arrival at the center. The amount of

administrative detail was enormous, but all matters relating to personnel records, finance, travel, claims, and physical examination were processed as rapidly

as possible. In order to accomplish this, many center administrative activities

operated around the clock.

The procedures for the operation of separation centers were published in

War Department Technical Manual 12-222, “Separation Center Operations,” on

15 October 1944 and 20 September 1945, respectively. Upon arrival, separatees

were given cursory dental examination to determine if dental treatment was

needed and desired by the individual before separation. The incoming records

21 Statistical data were taken from the Army Almanac, Department of the Army. Washington:

U.S. GovernmentPrinting Office, 1950.
SEPARATIONS 119

of those expressing desire for such treatment were annotated, and an initial

appointment at the dental clinic was arranged.

Medical processing, in addition to an orientation talk, the dental examination, the physical examination, and liaison with the Veterans’ Administration,

included reporting cases of doubtful or positive serology to the U.S. Public

Health Service representative, report of physical examination establishing

fitness for service in the Enlisted Reserve Corps was also prepared. For this

purpose, all personnel separated at separation center on normal discharge

were considered physically fit, unless otherwise specified. Officer personnel being

separated were authorized to be commissioned in the Officers’ Reserve Corps.

If qualified, they were sworn in at the separation center. Commanding officers

of separation centers were authorized to grant waivers of certain physical

defects, as recommended by the center surgeon.

Terminal Physical Examination

War Department Technical Manual 8-255, “Terminal Physical Examination on Separation From Military Service,” was issued on 10 September 1945,

to establish standards and standardize medical procedures to be followed at

separation centers. War Department Technical Manual 12-235, “Discharge and

Release From Active Duty,” January 1945, dealt with discharge and release

from active duty at installations other than separationcenters.

The terminal physical examination at separation centers was required to be

thorough and complete physical examination (fig. 14). All physical defects

were to be recorded. The record included diagnosis, degree (such as mild, moderate, or severe), and the extent of any incapacitation found. Three days beyond

the usual time allotted for separation was authorized to permit study, observation, and special examination of those individuals whose physical and mental

status or both otherwise could not be evaluated. If more than days were found

necessary to permit proper evaluation and disposition, the man was hospitalized.

Essentially, the terminal physical examination given on separation beginning in 1945 was the same as that prescribed for officers in AR 40-100 (appendix

D, p. 249) and AR 40-105 (appendix C, p. 209), while for enlisted men, it was

the same as that prescribed in MR 1-9 (appendix B, p. 161). All examining

physicians were alerted to the need for detecting signs of psychiatric disorder

and to make proper notation of them. complete psychiatric examination was

not required unless indicated.

The examination was given within 72 hours of separation. Many officers,

however, had substantial terminal leave accrued, frequently in excess of 90 days.

Rather than repeating an examination or having the individual return to

military installation for examination at the end of terminal leave, the terminal

physical examination, given at separation centers before beginning terminal

leave, was to suffice for final separation. If the officer suffered minor illness or

injury while on terminal leave, report of the case was sent to the separation
120 PHYSICAL STANDARDS

Figure 14.—An enlisted man receives his physical examination before being separated at

Camp Beale, Calif., November 1944.

center to which the officer was assigned while on terminal leave. If the condition

was other than minor, the officerreported to the nearest Army medical treatment

facility for supplemental examination. The report of this examination was

sent to the separation center at which the terminal physical examination had

been given.

The examination given to female officers and enlisted women was the same

as that given for appointment or enlistment.

Separation Center Medical Boards

Medical examining boards were of five types. In addition to the board

established for the purpose of accomplishing the terminal physical examination, there was board to act on certificates of disability for discharge, disposition board, retiring board, and review board.

Physical examination board.—The board established for the purpose of

giving the separation physical examination consisted of chief medical ex-
SEPARATIONS 121

aminer and such other medical and dental officers, nurses, Medical Department

enlisted personnel, and civilian personnel deemed necessary for the efficient

functioning of the board. The chief medical examiner was responsible for the

proper operation of the board. The number of other personnel was flexible but

to be consistent with the requirements for efficient accomplishment of specified

professional and clerical duties.

Normally, the board consisted of chief medical examiner, dentists, surgeon, roentgenologist, an eye, ear, nose, and throat specialist, internists

(one experienced in tropical disease), laboratory officer, an orthopedic surgeon,

psychiatrist, medical officer (and assistants), Medical Administrative Corps

officers, and psychologist.

The enlisted complement normally consisted of noncommissioned officers

(for property and supervising enlisted personnel), stenographers, psychiatric

social worker, dental technicians, laboratory technicians, X-ray technicians, medical clerks, typists, messengers, orderlies, and other assistants as necessary.

For thepurpose of processing female personnel, gynecologist, nurse, and

other assistants could be added.

War Department Technical Manual 8-255 furnished guidance on the number of personnel required in relation to the average number of examinations

given in day. For example, if there were an average of 100 examinations

day, 14 officers and 19 enlisted men were the estimated requirement. For 200

examinations day, this was increased to 20 officers and 30 enlisted men, while

the figures for 500 examinations day were 39 and 60, respectively. Personnel

required to supplement existing staffs for the purpose of examining female

personnel were, for 30 examinations day, nurse and enlisted women. For

60 examinations day, the requirement was gynecologist, nurse, and 13

enlisted women.

Medical review board.—A review board of medical officers was established at each separation center to act on cases in which an individual claimed

disability from defects not considered incapacitating in character by the examining physicians or when there was disagreement among the medical officers

engaged in the examining process. In claims for disability where the examining

physicians and the members of the review board agreed that no disability

existed, an officer was separated without reference to retiring board, and an

enlisted man was referred to the board acting on certificates of disability for

discharge.

If there was reasonable doubt about the existence of defect causing

disability in an officer, action on the case was to be taken by retiring board.

Ifit involved an enlisted man, the case wasreferred to board for consideration

of discharge on certificate of disability. Reports of the proceedings of review

boards were prepared in each case and copy attached to the report of terminal

physical examination.
122 PHYSICAL STANDARDS

Review boards were appointed by the commanding officer of the separation

center and consisted of not fewer than three medical officers. list of alternates

was also designated. The number included sufficient medical officers with special

training in the various branches of medicine and surgery to insure that the

evaluation of defects in the individuals coming before the board would have

the benefit of the best informed opinion.

Certificate of disability for discharge board.—Certificate of disability

for discharge boards were appointed to pass on the eligibility of enlisted men

discharged on certificates of disability as covered inAR 615-361 “Enlisted Men:

Discharge; Medical,” November 1944. Normally, the individual was hospitalized only on direction of the physical examination board or the CDD board.

If individuals were separated from the service because of disability and had

not been hospitalized, the chief medical examiner was held responsible for the

transmission of all required records to the Veterans’ Administration,in addition

to the proper disposition of other required records and reports.

Disposition and retiring boards.—Enlisted men with more than 20 years'

service and officers whose cases required action by disposition board or

retiring board were transferred to general hospitals or other hospitals designated to function as general hospitals for this purpose. From such hospitals,

individuals were separated in the manner prescribed in the regulations. In this

procedure, however, individuals were first admitted to the local station hospital

before transferto the appropriate hospital facility.

When an officer demanded to appear before retiring board, even though

the medical examining team at the separation center had found no defect, he

was sent before the review board for consideration in accordance with their

normalpurpose and procedures.

Line-of-duty and limited service considerations.—Line-of-duty determinations were made in accordance with existing regulations. The individual’s

discharge or return to inactive status, however, was not delayed pending receipt

of information from other sources. To prevent delay in doubtful cases, and

where there was insufficient information for making line-of-duty determination, the individual’s affidavit and other available information were utilized to

make determination. If adequate information could not be developed by these

means, the line-of-duty status was recorded as “undetermined” in the report of

physical examination, together with the reasons why determination could not

be made.

Boards reviewing the results of examinations were required to make careful

evaluations of cases involving officers or enlisted men ordered to center for

separation who were classified for temporary limited service and in which the

time period limiting such service had not yet elapsed. In such instances, the

review board recommended disposition by separation, if the limiting defect

had improved sufficiently, or ordered the individual to hospital for evaluation

and proper disposition.
SEPARATIONS 123

Physical Classification

Separate physical classification groupings were created into which individuals were segregated as result of the separation physical examination and

evaluation. These consisted of three classes and were as follows:

Class A.—Individuals who conformed to the physical standards prescribed

for discharge without further examination or treatment.

Class B.—Individuals whose immediate separation was delayed because

special study and treatment or both was indicated before qualifying for class

or class C, in addition to cases which required action by separate board of

review.

Class C.—Individuals with defects requiring action by disposition board

and retiring board or both. Such action was applicable to officers and to enlisted

men with over 20 years’ service. Similar action was applicable to enlisted men

with less than 20 years’ service who were to appear before board processing

discharges on certificates of disability.

Men were placed in class and disposed of in accordance with current

directives (separation without further treatment) when they met one of three

general requirements: (1) They met the respective standards for appointment,

enlistment, or induction, as appropriate; (2) they entered upon extended active

duty in limited service capacity and had been able to perform such service

in satisfactory manner; and (3) they had no mental or physical defects, other

than nonincapacitating, clinically nonsignificant defects unlikely to interfere

with satisfactory performance of duties in civilian occupation.

Class consisted of men who were held for special medical study or

treatment in accordance with prescribed treatment policy. Such men had

defects which were considered either temporarily incapacitating or permanently

nonprogressive, or they had defects of progressive character.

Men placed in class with temporarily incapacitating physical or mental

defects included, also, those with history of tropical disease, venereal disease

in an infectious state, or inadequately treated syphilis. Permanent nonprogressive defects were not regarded as incapacitating. Moreover, it was provided

that such conditions be more extensive than those qualifying for class A, and

sufficient to prohibit man’s immediate discharge or transfer to the Officers’ or

Enlisted Reserve Corps. With respect to defects qualifying for class which

were progressive in character, the appropriate further study and treatment was

determined atthe time of evaluation. Upon complet ion of any study or treatment

given in connection with conditions originally qualifying for class B, the individual was evaluated for classification into either class or class C.

Separation classification contained individuals whose situation was

rather complex and diverse. Placed in class were individuals who were then

classified for limited service, but who were found incapable of performing the

specified limited duties because of permanent physical incapacity. Included,

also, were those incapable of performing any type of military duty, regardless
124 PHYSICAL STANDARDS

of whether serving in general service or limited service status. Officers who

had entered on active duty in general service capacity but were later reclassified by board action, other than an Army retiring board, as permanently fit for

limited service duties, only, also were placed in separation class C.

Many officers and enlisted men with over 20 years’ service previously retired

by reason of physical disability were recalled to active duty during the war. At

the time of separation after the war, such individuals usually were serving

with temporary appointment in grade higher than that in which originally

retired. In these cases, individuals were placed in class when there was aggravation of the physical defect for which the individual was previously retired, or

when an additional permanently incapacitating defect had been incurred. Such

individuals who entered retired status for reasons other than physical disability, and who were found with physical defect that was permanently incapacitating for the physical classification in which they were then serving,

were placed in separation classification C, also. At the same time, any officer

or enlisted man with over 20 years’ service who was not capable of performing

general service duties because of permanent physical incapacity, even though

he was then serving in general service capacity, was placed in class and

referred to disposition and retiring board for appropriate action. Enlisted

men with less than 20 years’ service, on the otherhand, who had definite permanent physical or mental defects which were incapacitating were given discharge for physical disability. This applied when the defects prevented successful performance in civilian occupation.

In making determinations of incapacity for military service, entrance

standards for officers and enlisted men were used as guide. In making determinations of incapacity to satisfactorily perform in civilian occupation, examining physicians were directed to rely on medical judgment.

Officers possessing undesirable habits and traits of character were recommended for reclassification under the regulations governing such action, All

605-230 “Commissioned Officers: Ileclassification,” dated June 1942. ATI

605-230 provided means for the disposition of officers who were inefficient or

otherwise unsuitable in their assignments. This was accomplished by reassigning

them to position that they were capable of handling efficiently, by demoting

them to grade commensurate with their qualifications, or by separating them

from commissioned service. Normally, an officer's services had to be rated

unsatisfactory before such proceedings were initiated. Action in such cases was

taken by reclassification board formed for this purpose.

Enlisted men possessing undesirable habits and traits of character were

disposed of in accordance with All 615-361 (p. 122).

Treatment Before Separation

Individuals with an acute or infectious disease, or with conditions which

were apt to endanger the life or the welfare of the individual or others in his
SEPARATIONS 125

environment, were not separated from the service until such treatment had

been given so as to render the individual's separation safe for himself as well

as others, or until some other disposition, such as transfer to the Veterans’

Administration, was arranged. Individuals with remediable defects incident

to the service or aggravated by the service, if incapacitating or likely to interfere with either military or civilian duties, were given appropriate treatment

if the individual so desired. Enlisted personnel who had actually been discharged and officers who had been relieved from active duty and who were no

longer on terminal leave were not eligible for treatment in Army hospitals.

If an officer was found with an incapacitating defect while on terminal

leave, and required treatment and appearance before disposition board or

both, he was transferred to the local station hospital for proper evaluation,

treatment, and disposition. lie was treated at the separation center station

hospital, or transferred to another hospital for specialized treatment ifindicated.

CONCLUSIONS

Personnel selection and elimination policies must be as sound as we can

make them, and must be tailored to the situation facing us at that time. While

they must be flexible they must not be capricious. Most of these difficulties in

World War II were due to constantly changing policies—changes in physical

standards and in psychiatric standards. We rejected men for service, only to

accept them later. Many were called up and rejected several times with consequent disruption of their lives and then later accepted. Likewise many were

separated at one period under the policies in effect, while others with the same

or worse conditions were retained in the service at other times under other

policies. Divisions which were ready to go overseas were decimated by relaxation of separation standards and tilled with replacements probably not as well

qualified as those separated. In retrospect, it is clear that policies were changed

on the current exigency, frequently without comprehension of the far-reaching

effects that would inevitably ensue. 22

All separations from the Army involved the utilization of physical standards. Generally speaking, if an individual left the Army with disability

incurred in the line of duty, or if he had preexisting defect made worse by

military service, he was entitled to some form of compensation—either pension

or retirement. Such entitlements involved millions of dollars, therefore emphasizing the importance of the effective administration of sensible physical

standards upon induction, the provision of thebest medical care during service,

and uniform policy in applying standards upon separation. Many physical

standards-related problems developed during the war, but the most costly of

these were the fluctuating policies on the utilization of limited service personnel,

22 'Speech, Maj. Gen. Silas B. Hays, Surgeon General of the Army, to the students at the Army

War College, Carlisle Barracks, Pa., 21 Jan. 1959, subject: “The Interrelation Between Military

Medicineand Command.”
126 PHYSICAL STANDARDS

the failure to establish effective psychiatric standards and treatment for mental

defects and problems until late in the war, and the constant vacillation in

retirement procedures and line-of-duty policies and physical standards in

general.

Demobilizing the Army from strength of over million to about 900,000

over period of years after the war ended was an enormous task, and in

many ways more difficult than the job of raising an Army of that size. Disability

determinations and the need to protect the Government against costly unwarranted claims complicated the task. Planning for demobilization began early

in 1943 and was carried on continually throughout the war. When the end of

the war was in sight, plans were refined and made more detailed and pilot testing

of separation centers carried out.

EPILOG

In an attempt to correct the weaknesses noted during World War II and

to avoid similar mistakes in the future, work on physical standards has continued since that time. The Army has published single regulation, AR 40-501,

“Medical Service: Standards of Medical Fitness,” December 1960, covering

requirements for general service for both officer and enlisted personnel.

AR 40-501 includes special physical requirements for service in certain geographical areas and for duties such as airborne, ranger training, and diving.

It also specifies standards for limited and total mobilization. Anotherregulation,

AR 611-201, “Personnel Selection and Classification Manual of Enlisted Military Occupational Specialties,” 15 June 1960, describes physical standards

requirements for certain enlisted occupational specialties. Refinement of the

physical profiling system has continued, but an opportunity to test its actual

application on scale that would demonstrate the extent of its effectiveness

has not come to pass. The draft has continued on limited scale also, permitting

the constant advantage of recent experience in induction procedures.

The history of the 1960’s attests to the fact that the age of missiles and

atomic weapons has not brought an end to manpower as the ultimate weapon.

As long as the necessity for manpower in war exists, system to determine

physical fitness—physical standards—will be required.

It is clear, however, from World War II experience, that standards must

be applied with flexibility and in context. The size of the Army required in

relation to total manpower will always be limiting factor. So, also, will be

the manpower requirements of essential supporting functions, such as industrial

production, agriculture, and transportation. There are many essential wartime

activities, both in the armed services and in the civilian economy, that may

be satisfactorily performed by men physically or emotionally unfit for combat, or by women. There are men fully equipped physically to serve in one climate

who would not be effective in another. There are situations, both military and

supportive, in which the resilience and vigor of youth are necessary, and others
SEPARATIONS 127

that may be better filled by men of greater maturity and judgment, even though

of less than standard physical qualifications. The problems for advance planning, if we are to be prepared for the next emergency, are problems of

classification—matching the man or the woman with the job; and of administration—devising system that will work smoothly and rapidly under all

conditions.

APPENDIX

MOBILIZATION REGULATIONS)

No. 1-9

WAR DEPARTMENT,

Washington, August 31, 1940

STANDARDS OF PHYSICAL EXAMINATION DURING MOBILIZATION

Paragraphs

Section I. Information and instructions 1-5

II. General and miscellaneous defects 6-8

III. Height, weight, and chest measurements 9-14

IV. Eyes 15-20

V. Ears 21-26

VI. Mouth, nose, fauces, pharynx, trachea, esophagus, and larynx 27-30

VII. Dental requirements 31-32

VIII. Skin 33-35

IX. Llead 36-38

X. Spine, scapulae, and sacro-iliac joints 39-42

XI. Extremities 43-46

XII. Neck 47-48

XIII. Lungs and chest wall 49-52

XIV. Heart, blood vessels, and circulation 53-60

XV. Abdominal organs and wall 61-64

XVI. Gcnito-urinary organs and venereal diseases 65-68

XVII. Endocrine and metabolic disorders 69-71

XVIII. Diseases of the blood and blood-forming tissues 72-74

XIX. Mental and nervous disorders 75-79

XX. Purposely caused physical defects 80

XXI, Notes and malingering 81-88

Page

Index 158

‘This pamphlet supersedes MR 1-5, December 5, 1932, including 1,July 29, 1938.
130 PHYSICAL STANDARDS

Section

INFORMATION AND INSTRUCTIONS

Paragraph

Purpose

Publication

Objective

Physical classification

Defects not specifically mentioned in these regulations

1. Purpose.—a. The purpose of these regulations is—

(1) To set forth the standards of physical requirements for men selected for general

service in the Army of the United States (class 1-A standards).

(2) To prescribe permissible deviations from the class 1-A standards for special and

limited military service (class 1-B standards).

(3) To describe deviations from the above standards which are not acceptable for any

class of military service (class 4).

ft. These standards are applicable only to individuals who are to be examined for induction or enlistment during periods of mobilization. In time of mobilization the standards

set forth in AR 40-105 will continue to govern the selection of candidates for commission in

the Army, and AR 40-110 will apply to commission in the Air Corps. Likewise AR 40-100

will continue to govern the appointment of Army nurses, warrant officers, and candidates

for the United States Military Academy.

2. Publication. —These regulations are published for the information and guidance of

medical examiners of the Selective Service Administration as well as for the medical

examiners used by the Army.

3. Objective.—The object is to procure men who are physically fit, or who can be made

so, for the rigors of general military service or for special and limited military service.

Therefore, examining physicians should consider these standards as guide to their discretion and not to he construed too strictly or arbitrarily. The examination will be carried out

with the utmost care in order that no individuals who are unfit for service be accepted, only

to be dischargedwithin short time on certificate of disability. All minor defects as well as

disqualifying defects will be recorded, in order to protect the Government in the event of

future claims for disability compensation. The likelihood of subsequent claims on account

of disability should be borne in mind by the examiners in considering the qualifications of

registrants with questionable defects. Whenever registrant is accepted for unlimited

military duty but who, nevertheless, has venereal disease or other physical condition

which requires medical treatment, the nature of the condition and the need for treatment

will be clearly stated on the report ofphysical examination.

4. Physical classification. a. Class 1-A.-—Physically qualified for general active military service. Registrants will be placed in class 1-A if they meet the class 1-A requirements

throughout the entire physical examination.

b. Class -B.—Physica11 unfit for general active military service, but fit for special

and limited military service. Registrants who fail to qualify for class 1-A and who do not

fall below class 1-B in any phase of the examination will be placed in class 1-B unless,

because of multiple defects, the medical examiners recommend unqualified rejection and

placement in class 4. Men placed in class 1-B will not be accepted unless specific directions

to that effect have been issued by the War Department.

c. Class —Physically unfit for any military service. All registrants who do not meet

the physical requirements of class 1-A or class 1-B will be placed in class 4.
APPENDIX 131

5. Defects not specifically mentioned in these regulations.—If any registrant is regarded

by the medical examiners as physically unfit for general military service (class 1-A) or for special and limited military service (class 1-B), by reason of physical or mental defects not

specifically noted in these regulations as causes for rejection, he will nevertheless be rejectedfor class 1-A or for class 1-B, as the case may be, and brief statement of thereasons

therefor entered on the report of his physical examination. Insofar as it is practicable,

however, the physical classification of registrants will adhere to the specified requirements.

Section II

GENERAL AND MISCELLANEOUS DEFECTS Paragraph

Class 1-A

Class 1-B

Class

6. Class 1-A.—a. Acute communicable diseases, provided acceptance of the registrant

is temporarily deferred until final examination shows recovery without disqualifying

sequelae. (Venereal disease in communicable stage and without incapacitating complications will be accepted. See par. 65a.)

h. Malaria, acute, or malaria, chronic, unless severe.

c. Uncinariasis, unless severe.

d. Remediable incapacity due to recent acute illness or injury or to employment or

environment in civil life.

7. Class 1-B.—Temporary incapacity as cited in paragraph d, if not easily remediable

to degree compatible with unlimited service, but which is considered acceptable for special

or limited service.

8. Class 4.—a. Carcinoma or other malignant disease of any organ or part of the body.

b. Active tuberculosis of whatever degree and whether general or localized.

c. Leprosy and actinomycosis.

d. Late syphilis affecting the cerebrospinal or cardiovascular systems or the viscera.

e. Irremediable metallic poisoning, except argyria.

/. Mycotic infection of the lungs or other internal organs.

g. Acute rheumatic fever or recurrent attacks of rheumatic fever, chronic articular

“rheumatism” and chronic arthritis, if occurrence is verified and malingering is excluded.

h. Osteomyelitis.

i. Filariasis and trypanosomiasis.

j. Hodgkin’s disease.

k. Uncinariasis, if severe. Section III

HEIGHT, WEIGHT. AND CHEST MEASUREMENTS

Paragraph

Table of standard and minimum acceptable measurements of height, weight, and

circumference of chest

Directions for taking height 30

Class 1-A 11

Class 1-B 12

Class 13

General considerations 14

9. Table of standard and minimum acceptable measurements of height, weight, and

circumference of chest.
132 PHYSICAL STANDARDS

10. Directions for taking height.-—Use board at least inches wideby 80 inches long,

placed vertically, and carefully graduated to inch between 58 inches from the floor and

the top end. Obtain the height by placing vertically, in firm contact with the top of the

head, against the measuring rod an accurately squared board of about by by inches

best permanently attached to graduated board by long cord. The registrant should stand

erect with back to the graduated board, eyes straight to the front.

11. Class 1-A. a. Those who fall within the requirements for height, weight, and

chest measurement given in the table (par. 9).

6. Those whose weight is greater than the standards indicated for the height provided

the overweightis not so excessive as to interfere with military training.

12. Class 1-B,—Registrants who on examination are found to present conditions not

within the accepted measurements for weight and chest circumference given in the table,

who are otherwise mentally and physically fit, and who do not fall within class 4, may be

accepted for special or limited military service.

13. Class 4. a. Less than 60 inches in height.

I). Less than 105 pounds in weight.

c. height of more than 78 inches.

d. Overweight which is greatly out of proportion to the height if it interferes with

normal physical activity or with proper training.

14. General considerations. a. Registrants of 76 inches or more in height should be

studied for the possibility of gigantism or acromegaly.

I). Examining physicians should use discretion and judgment in accepting registrants

with slight variations in the ratio of height, weight, and chest measurements indicated in

the table. Minimum and maximum height are absolute, but when the weight is disproportionate and is believed to be due to some temporary condition, proper allowance may be

Height (inches)

Standard Minimum

Weight Chest measurement

at expiration Weight Chest measurement

at expiration

60 __ ___

Pounds

116

119

122

125

128

132

136

140

144

148

152

156

160

164

168

172

176

180

184

Inches

31%

31

31%

32

32%

32%

32%

33

33%

33%

33%

34

34%

34%

34%

35

35%

35%

35%

Pounds

105

107

109

111

113

115

117

121

125

129

133

137

141

145

149

153

157

161

165

Inches

28%

29

29%

29%

29%

30

30%

30%

30%

31

31%

31%

31%

32

32%

32%

32%

33

33%

61

62 _._

63 _____

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78
APPENDIX 133

made provided it is the opinion of the examining physician that the variation is correctable

with proper food and physical training. But no registrant may he accepted whose weight

is less than 105 pounds.

Section IV

EYES

Paragraph

Vision lo

Class 1-A 16

Class 1-B 17

Class 18

Visual tests for detection of malingerers 19

Other methods of examination 20

15. Vision.—To determine the acuity of vision, place the person under examination

with his back to window at distance of 20 feet from the test types. Examine each eye

separately, without glasses, covering the other eye with card (not with the hand). The

registrant is directed to read the test types from the top of the chart down as far as he can

see, and his acuity of vision is recorded for each eye, with the distance of 20 feet as the

numerator of fraction and the size of the type of the lowest line he can read correctly

as the denominator. If he reads the 20-feet type correctly, his vision is normal and recorded

20/20; if he does not read below the 30-feet type, the vision is imperfect and recorded

20/30; if he reads the 15-feet type, the vision is unusually acute and recorded 20/15, etc.

16. Class 1-A.—a. Normal vision.

ft. 20/100 in each eye without glasses, if correctable with glasses to 20/40 bilateral.

c. Conditions due to iridectomy or other operation upon the eye, if the condition for

which the operation was performed has been relieved and the vision is within or above

the minimum standard requirements.

d. Slight nystagmus.

e. Slight conjunctivitis.

/. Chronic simple conjunctivitis occurring in regions where trachoma is not prevalent

and if easily remediable.

g. Slight adhesion of the lids to the eyeball.

h. Small pterygium.

i. Strabismus which interferes with vision.

j. Strabismus which does not interfere with vision.

k. Color blindness.

I. Exophthalmos if not of such degree as to have led to, or threatened, corneal ulceration, and provided hyperthyroidism is excluded.

17. Class 1-B. a. minimum vision of 20/400 in each eye without glasses, if correctable with glassesto 20/40 in either eye.

h. Loss of one eye or blindness in one eye not due to progressive organic change, with

vision in the other eye of not less than 20/200 correctable to not less than 20/40. c. Superficial corneal ulcer, provided acceptance is deferred until ulcer is healed without

disqualifyingimpairment of vision.

d. The following conditions, if mild

(1) Chronic conjunctivitis not trachomatous.

(2) Inversion of eyelids.

(3) Eversion of eyelids.

(4) Ptosis interferingwith vision.

(5) Trichiasis.

(6) Epiphora.

(7) Chronic blepharitis.

(8) Extensive pterygium.
134 PHYSICAL STANDARDS

(9) Chronic dacryocystitis.

(10) Blephrospasm.

(11) Diplopia due to paralysis of ocular muscles of one eye, if mild.

18. Class 4.—Defects such as the following

a. Vision less than the minimum requirements for special and limited military service.

b. Disfiguring cicatrices of eyes.

c. Lagophthalmus, if associated with signs of hyperthyroidism.

d. Pronounced exophthalmus.

e. Chronic keratitis.

/. Chronic recurrent inflammatory disease of the globe.

(j. Deep chronic ulcer of cornea.

h. Any active disease of the retina, choroid, or optic nerve.

i. Detachment of the retina.

j. Marked nystagmus.

k. Glaucoma.

l. Diplopia due to pai’alysis of extrinsic ocular muscle, unless mild in degree.

m. Abnormal conditions of eyes due to disease of the brain.

n. Trachoma.

19. Visual tests for detection of malingerers.—a. Malingerers may feign inability to

open their eyes, total loss of vision in one or both eyes, or impaired vision in one or both

eyes. Occasionally an inflammation in the eyes will be produced by putting sand or other

irritating substance under the lids.

b. Malingerers who wish to evade military service by feigning impairment of vision

may be divided into two classes, as follow's

(1) Those who claim total loss of vision in one eye.

(2) Those who claim partial loss of vision in one or both eyes.

Either group may have normal acuity of vision or may exaggerate defect actually

present.

c. In testing for malingering the examining physician should bear in mind that

detection is more likely to result when the man is allowed to believe that his case is

regarded from the first as genuine and that his story is not discredited. There is something

indefinable in the bearing of the malingerer which experience alone can detect. lie may

be self-assertive and overconfident; he may be hesitating or evasive. Careful observation

should be made of his conduct and every movement noted. The nature of the man’s answer

should be taken into account and considered in the light of the kind of reply that is given

when genuine refraction case is being dealt with.

d. The following equipment may be necessary

(1) Trial frame, blank, spherical lenses, +16, +3, +0.25, —3, —2, —1, —0.25.

(2) Two prisms, one 6° and one 10°.

(3) Ophthalmoscope (electric battery in handle).

(4) Condensing lens.

(5) Loupe.

(6) Red and green letters on glass

(a) Letters varying in size.

Spectacle frame containingred and green glasses.

(7) Special test cards, one duplicate, with letters reversed to use with mirror.

(8) Special illiterate test cards.

(9) Mirrorlarge enough to reflect test cards.

(10) One stereoscope with special cards.

(11) Retinoscope (electric, with battery in handle).

(12) Ruler about 1% inches wide.

(13) Three discs of polaroid 36 mm. in diameter and mm. thick.
APPENDIX 135

e. The principle involved in the Polaroid test is that light polarized in any given

meridian by Polaroid screen is selectively absorbed by an analyzing Polaroid screen

whose axis is at an angle to the axis of the polarizing screen. The test may be conducted

as follows: Three disks of Polaroid 36 mm. in diameter and mm. thick are required.

They are held in the ordinary trial frame with the handle corresponding to the polarizing

axis. One Polaroid disk is placed before each eye with the polarizing axis horizontal. The

patient is then asked to read the smallest possible line of letters on the test chart with

both eyes open. Immediately the third Polaroid disk is rotated so that the polarizing axis

becomes vertical for the length of time that it takes to read three or four letters. The

rotation of the third disk to the vertical position prevents the passage of any light, so that

if the reading of the test chart is continued during this time it is very evident that the

poor eye is functioning. The disk may be used with correcting spectacle lenses if necessary.

Care must be exercised to see that the poor eye is not closed while the Polaroid disk before

the other eye is at right angles. Also the good eye must be occluded by the opposed

Polaroid disk for only short period at time so that the registrant does not become

aware of the momentary elimination of visual acuity in that eye.

20. Other methods of examination. a. To verify total loss of vision in one eye.

(1) 6° prism, base downward, is placed before the admittedly sound eye, while the man

looks at distant light or candle. If he sees two candles, binocular vision is proved. The

examiner may vary the test by placing the prism before the “blind” eye, either base up or

base down.

(2) prism of 10°, with base outward, is placed before the “blind” eye. If there is any

sight in this eye, double vision will be produced, and the eye will be seen to move inward

to correct it and fuse the two images.

(3) The alleged “blind” eye is covered. prism of 10°, with the apex up, is placed

before the “seeing” eye in such position that its edge lies horizontally across the center

of the pupil. This produces monocular diplopia. The prism is then moved upward so as to

be completely in front of the good eye and at the same time the “blind” eye is uncovered.

If diplopia is produced or admitted, there is sight in the “blind” eye.

(4) Test with colored glasses and letters.—This consists in directing the individual to

read row of special red and green letters on glass through special red and green glass.

The red letters will be invisible to the eye that has the green glass, and vice versa, but if

all the letters are correctly read irrespective of their color there must be sight in the

“blind” eye. The proper illumination back of the chart must be observed. This test is not

applicable to individuals who are color blind to red and green.

(5) Test with trial glasses.—A high-plus glass is placed before the good eye and lowplus or minus before the “blind” eye. If the distant type is read, the vision in the “blind”

eye is good.

(6) Stereoscope test.—This may be made with ordinary stereoscope, the printed matter

so arranged that certain portions of it are not present before one of the eyes.

(7) Bar test.—Interpose ruler about 114 inches wide vertically midAvay between

the two eyes at about to inches’ distance; direct the man to read from printed page

with lines at least inches long. If able to read the lines, binocular vision exists.

(8) The action of the pupil must be carefully tested, there usually being no movement

to light stimulation when the eye is blind. If the examiner is not satisfied, the following

examination should be made:

Oblique examination.—A careful examination of the cornea should be made

with the aid of condensinglens and loupe.

(ft) Ophthalmoscopic examination.—A searching examination with the ophthalmoscope should be made, together with an estimation of the refractive error. The

pupil should be dilated if necessary.
136 PHYSICAL STANDARDS

b. To verify partial loss of vision in one or both eyes. (1) The most common manifestation of malingering takes the form of statement that one eye is imperfect. Men pleading this disability may be divided into two classes

(a) Those who pretend to have visual defect.

(b) Those who are aware they have visual defect and exaggerate its effect.

(2) No hard-and-fast tests can be prescribed for the detection of these cases. Much

depends on the alertness and ingenuity of the examining physician.

(3) The tests with prisms are not applicable here, for there is not pretended blindness

in one eye, but simply an alleged diminution of visual acuity.

(4) If room 30 to 40 feet long can be obtained for testing vision, place the registrant

suspected of malingering at 30 to 35 feet from the test chart. Direct him to read the letters

and note the result. He should then be brought up to 20 feet from the card and retested.

If he reads the same line, he is malingering.

(5) Mirror test with special cards.

(a) Test cards are used which are identical, one having letters reversed. The

registrant is directed to read the letters on the chart across the room, and then

in mirror beside it, which reflects reverse letters that are placed over his head.

The letters seen in the mirror are located double the distance of the direct letters

from the man being examined. The malingerer is apt to read in the mirror the

line which he read on the first card, showing that his vision is twice as good as

he pretends.

(b) In order to obviate the use of test letters in the mirror test, various common

objects approximating the size of the 20/40 and 20/30 letters may be used by

asking registrant to differentiate between dime and penny, cigarette and

pencil, pen and pencil, the number of spots on playing cards, or between the

different aces, held on either side of his head and reflected in the mirror at 20

feet distance.

(6) Trial frame test.—Place trial frame upon the man’s face and put before the

sound eye high convex lens (+10D) and before the “blind” eye plane or weak lens

(0.25) which will not interfere with vision. If letters placed at distance of 20 feet are read,

the fraud is at once exposed.

(7) Oblique examination.—This is conducted with condensing lens and loupe to determine corneal or lenticular opacities.

(8) Ophthalmoscopic examination.

(a) It is probable that the malingerer will resist the ophthalmoscopic examination

by frequent winking or rolling of the eyes. In this event it is best to caution the

man that report of his vision must be made, and then to postpone further

examination until after the next few registrants have been examined.

(b) Estimate the refractive error with the use of the ophthalmoscope. If no error of marked degree exists and the media and fundi are normal, the relation between

the alleged vision and the refractive condition furnishes an important clue. If

the error is about +4 or —2, the visual acuity could be about 20/100, but when

the defect cannot be accounted for objectively and the vision is brought from

20/100 to 20/50 or 20/30 by means of low plus or minus glass, the man is

malingering.

(9) Retinoscopy.—Look for corneal and lenticular opacities and estimate refractive

errors.

c. Occupation. (1) The man’s occupation in civil life may have been such that it

could not have been followed without more vision than he claims.

(2) In the absence of ocular defects, continuous and persistent blepharospasm, the

use of colored glasses, eye shades, or eye bandages should be regarded with suspicion.

d. Diplopia.—Cases of malingering are occasionally met with in which the men complain that they see double. These must be investigated with the application of the ordinary
APPENDIX 137

tests as if they were genuine, and with every precaution taken to guard against serious

nerve lesion being overlooked.

Section

EARS

Paragraph

Examination for disease 21

Determination of auditory acuity 22

Class 1-A 23

Class 1-B 24

Class 25

Tests for malingering in hearing 26

21. Examination for disease.—The external ears and mastoid region will be examined

by inspection and, if necessary, the mastoid region by palpation. The externalauditory canal

and membrana tympani will be examined by reflected light or by self-illuminating otoscope.

22. Determination of auditory acuity.—Acuity of hearing will be determined by the

low conversational voice test and by the audiometer when indicated. To determine the

acuity of hearing, place the registrant facing at right angles to the assistant, 20 feet distant,

with ear to be tested toward assistant, and direct him to repeat promptly the words spoken

by the assistant. If the registrant cannot hear the words at 20 feet, the assistant should

approach foot by foot, using the same tone of voice, until the words are repeated correctly.

Examine each ear separately, closing the other ear by pressing the tragus firmly against

the meatus; the examiner may face the same direction as the registrant and close one of

his own ears in the same way as control. The assistant should speak in low conversational voice (not whisper), just plainly audible to the examiner, and should use numerals,

names of places, or other words or sentences until the condition of the registrant’s hearing

is evident. The acuity of hearing should be expressed in fraction, the numerator of which

is the distance in feet at which the words are heard by the normal ear; thus 20/20 indicates

normal hearing, 10/20 partial hearing of degree indicated by the fraction, that is,

the registrant only hears at 10 feet distance the words which normal ear hears at 20 feet.

The duties of the examiner and assistant may be reversed by desire. If any doubt arises

as to the correctness of the answer given, the registrant may be blindfolded and watch

be used to determine the distance at which it can be heard, care being taken that the

registrant does not know the distance from the ear at which it is being held. The watch

if used should be one whose ticking strength has been tested by determining the distance

at which it can be heard by normal ear. The audiometric examination will be conducted

according to the method prescribed by the manufacturers of the instrument employed, and

the findings as recorded on the prescribed form will be forwarded for file with the

examination report.

23. Class 1-A. a. Normal hearing.

b. Hearing in each ear of 10/20or better.

24. Class 1-B. a. Hearing in one or both ears less than 10/20 but more than 5/20. b. Loss of one or both external ears, ifthe registrants have followed useful vocation

in civil life and the deformity is not too greatly disfiguring.

25. Class 4.—Defects such as—

a. Hearing less than the minimumhearing prescribed under class 1-B.

b. Chronic purulent otitis media, with or without mastoiditis.

c. Chronic perforation of membrana tympani.

26. Tests for malingering in hearing.—Individuals who are malingerers in regard to

hearing usually claim magnification of slight imperfection on one side with complaint

of past trouble. Exaggeration of defects in hearing extends usually to declarations of total
138 PHYSICAL STANDARDS

deafness on one side. The following directions should be observed in examining suspected

malingerers;

a. In making these examinations the observer should have skilled assistant and all

communications between them should be in low whisperedvoice.

1>. The assistant should stand at the back of the suspected malingerer and should, at

the direction of the examining physician, obstruct the ears of the suspect as directed, by

pressing the tragus firmly into the auditory meatus.

c. The suspected malingerer’s eyes should be securely and completely blindfolded.

d. An accurate notation should be made of which ear is deaf as claimed by the registrant. Then critical examination of the auditory canal, membrana tympani, and for the

patulency of the eustachian tubes should follow.

e. Then an accurate test of the normal ear should be made. Care should be exercised

not to allow the suspect to hear figures or other signs as to the result of examination.

/. If the suspect gives markedly conflicting statements, when the normal ear is tightly

plugged, as to the distance at which he hears the voice, it is fair to assume that he is

malingerer.

g. The simplest and most available test for malingering is the use of an ordinary

binaural stethoscope. The tubing leading to the earpiece to be applied to the normal ear

is occluded by clamping with hemostat, and the earpieces are placed in the ears of the

blindfolded suspect. The examining physician speaks in soft tone or counts into the

bell-shaped chest portion of the stethoscope, and the suspect is told to repeat what he hears.

The tubes are removed from the ears, and the assistant is told to stop the normal ear.

The same words or numerals are again repeated. The suspect will now claim failure to

hear the words or numerals which he had previously heard through the tube with the

ear stated to be deaf.

h. Erhard’s test is another simple method for malingerers which requires no special

apparatus. If the external auditory canal of normal ear is tightly packed with absorbent

cotton, it will still conduct sound waves to limited degree; loud-ticking watch even

under these circumstances being heard about or meters. The suspect has his ear which

is stated to be deaf stopped, and then the test is made with the hearing of the normal ear,

the suspect being told to count the ticks of the watch. The suspect’s normal hearing ear

is then stopped and the testing is made with the supposed deaf ear. Under this test, if he

claims failure to hear the watch under meter, he is malingering.

i. The Chiman-Moos test is made with the C2 tuning fork. The vibrating tuning fork

is held at equal distances from each ear. The suspect may claim that he hears it better in

the normal ear. The vibrating tuning fork is then placed on the vertex of the skull. The

suspect hearing it equally well in both ears will at first hesitate and then state he hears it

better in the normal ear. In diseases of the conducting apparatus he should hear it better

in the diseased ear. If now the external meatus of the normal ear is tightly closed and

the vibrating tuning fork is placed upon the vertex of the skull, the individual with the

diseased ear will state he hears it better in the normal closed ear, or it may be impossible

for him to decide in which ear he perceives the tone better. The suspect, with the normal

ear tightly obstructed, will state that he does not perceive the sound of the fork when thus

placed on the vertex of the skull.

Section YI

MOUTH, NOSE, FAUCES, PHARYNX, TRACHEA, ESOPHAGUS, AND LARYNX

Paragraph

Class 1-A 27

Class 1-B 28

Class 29

Use of diagnostic aids 30
APPENDIX 139

27. Class 1-A.—a. Normal conditions of the mouth, nose, fauces, pharynx, larynx,

trachea, and esophagus.

b. Enlarged tonsils.

c. Adenoids.

(I. Small benign tumors of the nasal and buccal mucous membrane.

e. Deviation of the nasal septum or enlarged turbinates which do not seriously interfere

with nasal breathing.

/. Acute primary sinusitis provided the acceptance of the registrant is temporarily

deferred for reexamination, if after reasonable time the sinusitis has disappeared.

g. Laryngitis manifested by hoarseness, laryngeal cough, and congestion of the vocal

chords, confirmed by laryngoscopy, unless tuberculous or malignant.

h. Alleged stricture of the esophagus which is unattended by evidence of organic

disease of the esophagus as shown by fluoroscopic examination while the registrant is

swallowing barium mixture.

i. Perforation of hard palate, if not associated with disqualifying disease.

j. Moderate deformity of the structures of the mouth which does not seriously interfere

with mastication or speech.

k. Hay fever, unless severe.

28. Class 1-B. a. Deviation of the nasal septum, which markedly interferes with

nasal breathing.

b. Aphonia, with attendant conditions, which disqualify for general military service,

if they have followed useful vocation in civil life.

e. Hay fever, if severe.

29. Class 4.—Defects such as—-

a. Irremediable deformities of the mouth, throat, and nose which interfere with the

mastication of ordinary food, with speech, or with breathing.

b. Destructive syphilitic diseases of the mouth, nose, throat, larynx, or esophagus, if

severe in degree.

c. Laryngeal paralysis, due to pressure from aneurysm or tumor. (I. Permanent tracheostomy.

e. Stricture of the esophagus.

/. Permanent gastrostomy.

g. Chronic sinusitis of the accessory sinuses of the nose, unless mild in degree. (The

diagnosis should be established upon chronic nasal discharge, presence of large nasal polypi,

and other signs and symptoms reinforced by transillumination or X-ray examination or

both.)

h. Chronic atrophic rhinitis with offensive odor (ozena).

30. Use of diagnostic aids.—Examining physicians should make use of laryngoscopy,

transillumination of the head, and X-ray, when available, to determine more definitely the

physical fitness of registrants who have defects involving the upper air passages, head, or

esophagus, when such diagnosticaids are indicated.

Section VII

DENTAL REQUIREMENTS Paragraph

Classes 1-A and 1-B 31

Class 32

31. Classes 1-A and 1-B. a. Class 1-A. (1) Normal teeth and gums.

(2) minimum of serviceable natural masticating teeth above and below opposing

and serviceable natural incisors above and below opposing. (Therefore, the minimum

requirements consist of total of masticating teeth and of incisor teeth.) All of these

teeth must be so opposed as to serve the purpose of incision and mastication.

257-966''—67 11
140 PHYSICAL STANDARDS

(3) Definitions.

(a) The term “masticating teeth” includes molar and bicuspid teeth, and the term

“incisors” includes incisor and cuspid teeth.

(b) natural tooth which is carious (one with cavity), which can be restored

by tilling, is to be considered as serviceable natural tooth.

Teeth which have been restored by crowns or dummies attached to bridgework, if well placed, will be considered as serviceable natural teeth when the

history and the appearance of these teeth are such as clearly to warrant such

assumption.

(d) tooth is not to be considered serviceable natural tooth when it is involved

with excessively deep pyorrhea pockets, or when its root end is involved with

known infection that has or has not an evacuating sinus discharging through

the mucous membrane or skin.

b. Class 1-B.—Insufficient teeth to qualify for class 1-A, if corrected by suitable

dentures.

32. Class 4.—a. Irremediable disease of the gums of such severity as to interfere

seriously with useful vocation in civil life.

b. Serious disease of the jaw which is not easily remediable and which is likely to

incapacitate the registrant for satisfactory performance of general or limited military

service.

c. Extensive focal infection with multiple periapical abscess, the correction of which

would require protracted hospitalization and incapacity.

d. Extensive irremediable caries.

Section YIII

SKIN

Paragraph

Class 1-A 33

Class 1-B 34

Class 35

33. Class 1-A. a. Normal skin.

&. Acute nonexanthematous and noncommunicable diseases of the skin which ordinarily

run temporary course. c. Diseases which are trivial in character and which do not interfere with the general

health and are not incapacitating. Among these common and usually trivial diseases may

be enumerated—-

(1) Acne.

(2) Anomalies of pigmentation.

(3) Scars not extensive, disfiguring, nor incapacitating in character.

(4) Condylomata which are not extensive.

(5) Staphylococcic and streptococcic skin infections.

(6) Acute eczemas.

(7) Naevi which are not greatly disfiguring.

(8) All forms of pediculosis.

(9) All forms of ringworm, unless severe and not easily remediable.

(10) Scabies, unless severe and not easily remediable.

(11) Mild and not extensive psoriasis.

(12) Warts.

d. Simple ulcers or other acute defects of the skin which are easily curable.

e. Pilonidal cyst or sinus if unattended with disease of the bone, as shown by X-ray.

/. Unusual skin defects should arouse suspicion of self-inflicted lesions (dermatitis

factitia).
APPENDIX 141

34. Class 1-B.—Such defects as chronic diseases of the skin, which disqualify for

general military service, if the registrant has successfully followed useful vocation in

civil life.

35. Class 4.—Serious or incapacitatingskin disorders such as—

a. Chronic skin diseases or chronic ulcers of the skin which are so severe or so disfiguring as to incapacitate the registrant for the duties of soldier or so disfiguring as to

render the registrant objectionable in common social intercourse.

b. Actinomycosis.

c. Dermatitis herpetiformis of long duration.

(I. Epidermolysis bullosa.

c. Forms of generalized dermatitis of long duration.

/. Allergic dermatoses if severe and not easily remediable

g. Mycosis fungoides.

b. Chronic pemphigus.

i. Lupus vulgaris.

j. Syphilitic lesions ulcerative in character showing much destruction of tissue which

if healed would be unsightly or so scarring as to incapacitate the registrant for military

service.

k. Elephantiasis.

Section IX

HEAD

Paragraph

Class 1-A 36

Class 1-B 37

Class 38

36. Class 1-A.—a. Normal skull.

b. Moderate deformities of the bones of the skull of the character of depressions,

exostoses, etc., and unassociated with evidence of disease of the brain, spinal cord, or peripheral nerves, and which would not prevent the registrant from wearing military headgear.

c. Defects which are apparently temporary in character due to recent injuries. (This

includes contusions and other wounds of the scalp and concussion. Registrants with these

defects should have the final examination temporarily deferred.)

37. Class 1-B.—Osseous defects due to decompression or trephine of the skull, if

asymptomatic and unassociated with bulging at the site of operation.

38. Class 4. a. Deformities of the skull of the nature of depressions, exostoses, etc.,

of degree which will prevent the registrants from wearing military headgear.

b. Deformities of the skull of any degree associated with evidences of disease of the

brain, spinal cord, or peripheral nerves.

c. Hernia of brain; monstrosity of the head or hydrocephalus.

Section

SPINE, SCAPULAE, AND SACROILIAC JOINTS

Paragraph

Class 1-A 39

Class 1—B 40

Class 41

Use of X-ray 42

39. Class 1-A. a. Normal spine and scapulae.
142 PHYSICAL STANDARDS

b. Lateral curvature of the spine of inches or less from the normal midline, if the

mobility and weight-bearing power are good.

c. Fracture of the coccyx.

d. Prominent scapulae not interfering with wearing of uniform or military equipment.

e. Pilonidal cyst or sinus (this usually presents itself in the region between the coccyx

and anus), if unattended with disease of the bone as shown by X-ray.

/. Normal sacro-iliac and lumbo-sacral joints.

(j. Complaint of disease of the sacro-iliac and lumbo-sacral joints which is unassociated

with objective signs and symptoms at the first examination and which, on reexamination

after reasonable period of time, is again found negative.

40. Class 1-B. a. Lateral deviation of the spine from the normal midline of more

than inches and less than inches.

b. Nontuberculous diseases of the spine which are unassociated with such rigidity that

the registrant has been incapacitated from following useful vocation in civil life.

c. Fracture of the spine or pelvic bones which has healed without marked defects and

which has not interfered with following useful vocation in civil life.

(I. Disease of the sacroiliac and lumbosacral joints of degree which disqualifies for

general military service, if the registrants have followed useful vocation in civil life.

41. Class 4.—Defects such as—-

a. Tuberculosis, either active or healed, of any portion of the vertebral column.

b. Osteoarthritis, partial or complete, of the spinal column if sufficient in degree to

interfere with following useful vocation in civil life.

c. Healed fractures of the vertebrae or pelvic bones with associated disqualifying

rigidity.

d. Lateral deviation of the spine from the normal midline of more than inches.

Curvature of the spine (kyphosis or lordosis) of degree sufficient to interfere with the

wearing of uniform or military equipment, or which has prevented the registrant from

following useful vocation in civil life.

e. Disease of the sacroiliac and lumbosacral joints which is of chronic type and is

obviously associated with pain referred to the lower extremities, muscular spasm, postural

deformities, and limitation of motion in the lumbar region of the spine, and if malingering

is definitely excluded.

42. Use of X-ray.—When examining physicians are in doubt concerning the cause and

the extent of the diseases of the vertebrae, scapulae, or sacroiliac joints, an X-ray examination should be made.

Section XI

EXTREMITIES

Paragraph

Class 1-A 43

Class 1—B 44

Class 45

General considerations 46

43. Class 1-A. a. Normal upper and lower extremities with normal function.

1). Old or recent fractures which have healed spontaneously with no resulting impairment of function.

c. Paralysis of muscle or group of muscles that does not interfere with function.

d. P>enign tumors of bone or defects due to their removal when the condition does not

interfere with the function of the extremity or the jointinvolved.

e. Recent injury of bone or joint with or without fracture or dislocation which, in the

opinion of the examiners, is only temporarily incapacitating. (Registrants with these defects

should be given period of time not less than weeks for recovery before the final

examination is made.)
APPENDIX 143

/. Web fingers and toes, unless severe in degree.

g. Absent left thumb.

h. Loss of two lingers of either hand, except combination of right index and middle

fingers.

i. Loss of right index lingers, provided right middle finger is present.

j. Scars and deformities of moderate degree of the hand or hands which do not interfere

with normal function.

k. Stiff fingers of degree not to interfere seriouslywith function.

l. Pes planus unless accompanied by marked deformity, rigidity, or weakness, or is of

such degree as to have interfered with useful vocation in civil life.

m. Hallux valgus unless severe.

n. Clubfoot of slight degree if tarsal, metatarsal, and phalangeal joints are flexible

and the condition permits the wearing of military shoe and, in the opinion of the examiner,

will not interfere with the performance of military duty.

o. Slight claw toes not involving obliteration of the transverse arch and which do not

interfere with the wearing of military shoe.

p. Hammer toe which is flexible and which does not interfere with the wearing of

military shoe. (Hammer toe usually involves the second digit and unless it is rigid is not

disqualifying defect.)

q. Absence of one or two of the small toes of one or both feet if the function of the foot

is good.

r. Ingrowing toenails.

44. Class 1-B. a. Loss of thumb of right hand.

b. Loss of three Angers of either hand, including the right index finger.

c. Web fingers or toes, if severe in degree.

d. Ganglion and other benign tumors of the hand or fingers.

e. Moderate deformities of one or both upper extremities which do not and have not

interfered with function to degree to prevent the registrant from following useful

vocation in civil life.

/. Internal derangement of the knee joint if not severe enough to have prevented him

from following useful vocation in civil life.

y. Abduction and pronation (knock-ankle) when this condition is not associated with

rigidity of the tarsal joint or with deformity of the foot. (This defect is remediable with

proper foot exercises and with correct shoes.)

h. Loss of great toe.

i. Loss of dorsal flexion of great toe.

j. Hammer toe with rigidity.

k. Other defects of the feet which disqualify for general military service but do not

prevent the registrant from wearing military shoe and which have not prevented him

from following useful vocation in civil life.

l. Moderate deformities of one or both lower extremities which do not and have not

interfered with function to degree to prevent the registrant from following useful

vocation in civil life.

m. Adherent scars of the skin and soft tissues of an extremity.

n. Ununited fractures which do not interfere with good function.

o. Benign tumors of bone or joint which do not interfere with function.

p. Healed disease or injury of wrist or elbow with resulting limitation of motion.

q. Other defects which, in the opinion of the examiningphysician, are disqualifying but

remediable, but which have not prevented the registrant from following useful vocation

in civil life.

45. Class 4.—Defects such as—-

a. Loss of both thumbs.

b. Loss of more than three entire fingers of one hand.
144 PHYSICAL STANDARDS

c. Chronic inflammatory disease of long duration of one or more of the large joints,

with or without sinuses.

d. Tuberculosis of bone or joint. (The diagnosis should be based upon the presence

of swelling, tenderness, muscular spasm, restriction of joint motion, and the evidence of

bone destruction shown by X-ray.)

e. Old ununited fractures which interfere with function or ununited fractures with

deformity sufficient to interfere with function.

/. Old unreduced dislocations which have interfered with the registrant following

useful vocation in civil life.

(j. Disease of any bone or joint healed with such resulting deformity or rigidity that

the function is impaired to degree that it will interfere with military service.

h. Muscle paralysis or contraction which disturbs function to the degree of interference

with military service.

i. Adherent scars of skin or soft tissue to degree which seriously interfers with

function.

j. Varicose veins, if severe in degree, or if associated with edema or ulcer of the skin.

k. Pes planus, if accompanied by marked deformity, rigidity, or weakness, or of such

degree as to have interfered with useful vocation in civil life.

I. Obliteration of the transverse arch associated with permanent flexion of the small

toes (claw toes).

m. Hallux valgus if severe and associated with marked exostosis or bunion, especially

when there are signs of irritationabove the joint.

n. Clubfoot if marked in degree or which interferes with the wearing of military

shoe.

o. Diseases of the bone or of the hip, knee, or ankle joint which seriously interfere

with function and weight-bearing power.

p. Deformities due to fracture or other injury which seriously interfere with function

and weight-bearing power.

q. Sciatica which is apparently intractable and disabling to the degree of interference

with the function of walking and weight-bearingpower.

r. Amputations of extremities in excess of those already cited.

46. General considerations.—It is important that registrants with defects of the feet

which are not remediable by training and which prevent the inducted men from taking

proper training should not be accepted for general military service. It is quite as important

that defects of the feet which are not disabling should not be considered disqualifying for

general military service.

Section XII

NECK

Paragraph

Class 1-A 47

Class 48

47. Class 1-A. a. Normal neck.

1). Nonspastic contraction of the muscles of the neck which is not of great degree and

will not prevent the wearing of uniform or military equipment.

c. Simple goiter or benign thyroid tumors unassociated with toxic or pressure symptoms,

provided the enlargement of the thyroid will not interfere with the wearing of uniform

or military equipment.

d. Enlarged lymph glands of the neck which are not manifestation of systemic disease

and which apparently do not interfere with the general health and which are not large

enough to interfere with the wearing of uniform or military equipment.

48. Class 4.—a. Exophthalmic goiter. (See sec. XVII.)
APPENDIX 145

I). Thyroid enlargement from any cause associated with toxic symptoms. (See sec.

XVII.)

c. Enlargement of the lymph glands of the neck associated with leukemia and Hodgkin's

disease.

d. Lympho-sarcoma.

e. Tuberculous glands.

/. Nonspastic contraction of the muscles of the neck or cicatricial scarring which is

disfiguring and unsightly or interferes with wearing uniform or military equipment.

g. Spastic contraction of the muscles of the neck.

Simple goiter unassociated with toxic or pressure symptoms, enlarged lymph glands

of the neck, benign tumors and cysts of the neck, large benign tumors of the parotid gland, if

the enlargement is of such degree as to interfere with wearing uniform or military

equipment.

Section XIII

LI NGS AND CHEST WALL

Paragraph

Class 1-A 49

Class 1-B 50

Class 51

General considerations 52

49. Class 1-A.—a. Normal respiratory system and chest wall

h. Acute bronchitis, provided acceptance is temporarily deferred until final examination shows recovery without disqualifying sequelae.

c. Scars of operation for empyema which have been healed for year or longer, when

the function of the lung is good.

d. (1) Arrested pulmonary tuberculosis consisting of lesions appearing in X-ray examination as small apical scars, small calcified nodules or localized fibrous strands, in no case

exceeding minimal extent as defined in the classification of the National Tuberculosis Association, and when, in addition, in the opinion of the examining physician, this lesion is not

likely to be reactivated under conditions of military service.

(2) Minimal pulmonary lesions are defined as slight lesions without demonstrable

excavation confined to small part of one or both lungs. The total extent of the lesions,

regardless of distribution, will not exceed the equivalent of the volume of lung tissue which

lies above the second chondrosternal junction and the spine of the fourth or body of the

fifth thoracic vertebra on one side.

c. Fracture of the rib or ribs, provided acceptance of registrant is temporarily deferred

until final examination shows recovery with or without deformity, and provided the

residual deformity, if any, does not interfere with respiratory movements.

/. Benign tumors of the breast or of the chest wall, provided the enlargement does

not interfere with the wearing of uniform or military equipment.

g. Small palpable lymph glands of the axilla which apparently do not interfere with

the general health.

50. Class 1-B. a. Deformity of clavicle, ribs, or scapula of degree disqualifying for

general military service but which has not prevented the registrant from successfully following useful vocation in civil life. &. Chronic bronchitis, bronchiectasis, or chronic asthma which is mild and which has

not prevented the registrant from successfully following useful vocation in civil life.

51. Class 4.—Disqualifying defects such as—

a. Tuberculosis of lungs or tracheobronchial lymph nodes, except as defined in paragraph 49.

1). Fibrinous or serofibrinous tuberculosis pleuritis, and pleurisy with effusion of unknown origin. (Inasmuch as pleurisy, with or without effusion, is very frequent mani-
PHYSICAL STANDARDS 146

festation of early tuberculosis, examining physicians should examine with the greatest

care registrants who have apparently recovered from pleurisy.)

c. Empyema, or unhealed sinuses of the chest wall following operation for empyema.

d. Chronic bronchitis with emphysema except as stated in paragraph 50.

e. Chronic asthma associated with chronic bronchitis and emphysema, except as stated

in paragraph 50.

/. Abscess of the lung.

g. Bronchiectasis, if moderate or severe.

h. Actinomycosis.

i. Tuberculosis of the ribs and other parts of the chest wall.

j. Tumor of the breast or of the chest wall of such size and location as to interfere with

the wearing of the uniform or military equipment.

7c. Tumor of the lung, pleura or mediastinum.

1. Spontaneous pneumothorax.

52. General considerations. a. The chest examination will include the usual methods

of physical diagnosis supplemented, whenever indicated, by radiographic and laboratory

studies.

h. Examining physicians should be extremely careful to reject registrants with pulmonary tuberculosis, except as defined in paragraph 49, for all military service; and to

accept for military service registrants who allege tuberculosis as ground for exemption

or discharge on the basis of insufficient or incorrectly interpreted signs and symptoms.

c. Men who desire to serve their country may conceal, from patriotic motives, symptoms

of tuberculosis which they know or suspect to exist. Some tuberculous individuals will

seek enlistment with view to obtaining treatment and pension. Some soldiers may

allege symptoms of tuberculosis with view to securing discharge. Some registrants may

be expected to claim the existence of tuberculosis as ground for exemption and fortify

their claims by certificates of physicians and by roentgenograms. Such certificates and

roentgenograms will not be accepted, but examining physicians will satisfy themselves

as to the physical qualifications of registrants by their personal examinations. There will

be cases in which pulmonary tuberculosis will have been previously diagnosed on the

ground of subjective symptoms and of physical signs which are without any pathological

significance. It is necessary, therefore, that conclusions of examining physicians will be

based only on their own examinations. Statements of the registrant as to symptoms will not

be accepted as indication of the existence of tuberculosis unless supported by objective

evidence.

d. The attention of examining physicians is particularly invited to the necessity of

exercising great conservatism in their interpretation of physical signs over the apices.

Interpretation of such signs as indicating active tuberculosis would in many cases do the

Government great injustice, leading to the exclusion of men who are fit for service.

e. The following signs may arouse suspicion, but unless X-ray and other study reveal

definite evidence of disease they will be disregarded.

(1) Slightly harsh breathing, slightly prolonged expiration over the right apex above

the clavicle anteriorly and to the third dorsal vertebra posteriorly; the same signs at the

extreme apex, left side.

(2) Same signs at second interspace right anteriorly near sternum (proximity of right

main bronchus).

(3) Increased vocal resonance, slightly harsh breathing immediately below center of

left clavicle.

(4) Fine crepitations over sternum heard when stethoscope touches the edges of that

bone.

(5) Clicks heard during strong respiration or after cough in the vicinity of the

sternocostal articulations.
APPENDIX 147

(6) The so-called rales at the apex during the tirst inspiration which follows deeper

breath than usual or cough.

(7) Sounds resembling rales at base of lung (marginal sounds), especially marked in

right axilla, limited to inspiration.

(8) Similar sounds heard at apex of heart on cough (lingula).

(9) Slightly prolonged expirationat left base posteriorly.

(10) Very slight harshness of respiratory sounds with prolonged expiration in the

lower paravertebral regions of both lungs posteriorly.

Section XIV

HEART, BLOOD VESSELS, AND CIRCULATION

Paragraph

History 53

Procedure 54

Class 1-A 55

Class 1-B 56

Class 57

Electrocardiogram 58

X-ray 59

General considerations 60

53. History.—Questions may be asked during the course of the examination concerning

past history of rheumatic fever, syphilis, and reaction of physical effort which may be

helpful in the interpretation of the findings, but reliance should not be placed on the history

alone.

54. Procedure.—The procedure following should govern in the physical examination of

the heart. Only those findings need be recorded which are indicative of disease or anatomical defect (examples of findings which are usually not indicative of disease are

extra-systoles and functional pulmonary systolic murmurs). For the information of the

examiners it is suggested that reference be made to the publication of the American Heart

Association entitled “The Nomenclature and Criteria for the Diagnosis of Diseases of the

Heart.”

a. Location and determination of character of apex impulse.

ft. Auscultation of the heart sounds over apex, lower sternum, and second and third

interspaces to right and left of sternum, noting accentuation of sounds and murmurs, and

rate and rhythm, and comparingapex findings with the radial pulse.

c. Inspection of root of neck and upper thorax and percussion of first interspace on

each side of manubrium forevidence of aneurysm.

d. Count of radial pulse, observation of its rhythm, and palpation of radial arteries

for unusual thickeningor high tension.

e. The blood pressure will be determined only in those cases in which it appears

indicated.

/. Exercise test (stepping 12 times briskly onto common chair) will be used in

selected cases to bring out significant heart murmurs, but this test in itself is not to be

considered reliable estimate of the functional capacity of the heart. Care will be taken

that registrants with heart lesions are not placed in jeopardy by overexercise.

g. If there is doubt as to the presence of cardiovascular disease the registrant should

return for detail reexamination.

55. Class 1-A.—a. Normal heart. (A heart will be considered normal when the apex

impulse is within the left midclavicular line and not below the fifth interspace; when

sounds are normal and there are no thrills or important murmurs; when there is no

abnormal pulsation or dullness above the base of the heart; ivhen pulse rate is normal and

257-966 —67——12
148 PHYSICAL STANDARDS

regular and there is no unusual thickening of the arteries or evidence of high blood

pressure.)

It. pulse rate of 100 or over which is not persistent. (A pulse rate of 100 or over

may he temporary and due to excitement or to recent infection, such as pneumonia or local

infections about the nose, mouth, and throat, or may be induced by drugs.)

c. pulse rate of 50 or under which is proved to be the natural pulse rate of the

registrant or to be temporary or due to the use of drugs.

d. Sinus irregularity. (This consists in quickening of the pulse rate during inspiration

and slowing during expiration and is best recognized with the registrant recumbent and

breathing deeply.)

e. Elevation of blood pressure from excitement, proved to be temporary.

/. Neurocirculatory asthenia, if mild in degree.

56. Class LB,—There are no cardiovascular criteria to warrant initial selection for

class 1-B.

57. Class 4. a. Circulatory failure evidenced by definite symptoms such as combination of breathlessness, cyanosis, and edema.

h. Hypertrophy and dilatation of the heart evidenced by displacement of the apex

impulse to the left of the midclavicular line or below the sixth rib, and of heaving or

diffuse character.

c. persistent heart rate of 100 or over when this is proved to be persistent in the

recumbent posture and on observation and reexamination over sufficient period of time.

(See also sec. XXI.)

d. Paroxysmal tachycardia. (See also sec. XXI.)

e. Heart block.

/. Any serious disturbance of rhythm, such as auricular fibrillation.

g. Valvular disease.

h. Congenital heart disease.

i. Persistent blood pressure at rest above 150 mm. systolic, or above 90 diastolic, unless

in the opinion of the medical examiner the increased blood pressure is due to psychic

reaction and not secondary to renal or other systemic disease.

j. Thrombophlebitis of one or more extremities if thereis persistence of the thrombus

or any evidence of obstruction of circulation in the involved vein or veins.

k. Other abnormalities of the peripheral vascular system, including large varicose

veins, Raynaud’s disease, Buerger’s disease (thromboangitis obliterans), erythromelalgia,

and arteriosclerosis of the leg vessels. In doubtful cases special tests should be employed.

I. Aneurysm of any vessel.

m. Pericarditis.

n. Acute endocarditis.

o. Angina pectoris clearly due to coronary insufficiency.

p. Coronary thrombosis.

q. Neurocirculatory asthenia (effort syndrome), unless mild.

58. Electrocardiogram.—The electrocardiogram is of great assistance in determining

the nature of certain cardiac abnormalities, the most important of which are the various

arrhythmias, defects in conduction, and diseases of the coronary arteries. The electrocardiograph may be utilized in cases where such diagnostic aid is especially indicated, but

will not be employed as routine measure.

59. X-ray.—In doubtful eases fluoroscopy is advised to determine the size and shape

of heart and great vessels. Such films as may be taken for the study of the lungs of the

registrants should also be viewed for cardiovascular defects.

60. General considerations. a. It is incumbent upon examining physicians—

(1) To accept for service men with accidental functional murmurs or other findings

which do not indicate disease and do not impair the individual’s ability to undergo severe

bodily exertion.
APPENDIX 149

(2) To exclude from active service in the Army any registrant affected with disease

of the heart or blood vessels which impairs his ability to undergo severe bodily exertion.

Although many men with compensated valvular heart disease are able to undergo severe

bodily exertion, the question of aggravation in service, especially by activation of rheumatic

carditis, is likely to arise and incidentally to create pension problem. Therefore, all

registrants with valvular heart disease are to be regarded as unfit for service and will be

placed in class 4.

h. Men who desire to serve their country may from patriotic motives endeavor to

conceal known valvular lesion which has given no symptoms. On the other hand, men

drafted for service may allege or feign symptoms to obtain exemption. Registrants may be

expected to present physicians’ certificates to substantiate the existence of valvular disease. Many of these may be given in good faith because of inadequateknowledge of the significance of certain frequent murmurs. Such certificates will not be accepted, but examining

physicians will satisfy themselves by their personal examinations as to the physical

qualifications of registrants.

c. It is necessary, therefore, that the conclusions of the examining physician in doubtful cases will be based on objective evidence in the widest sense, including both physical

signs, cardiac rhythm, measurement of blood pressure, and the observed effect of effort.

Nevertheless, in the presence of questionable signs or symptoms, the history, especially of

past rheumatic fever may be factor in the final decision. No statement, however, will be

accepted as proof of the existence of cardiovascular defect unless supported by objective

evidence.

(I. Since it is the duty of examiningphysicians to protect the interests of the Government by preventing men from entering the service whose circulatory systems may be

expected to break down under strain, and equally by preventing the exemption or discharge

of fit subjects because of unimportant deviations from the normal, it will be necessary for

them to exercise care in the interpretation of their findings and to bear in mind constantly

the murmurs and other departures from the supposed normal which may occur in perfectly

healthy hearts.

Section X\

ABDOMINAL ORGANS AND WALL

Paragraph

Class 1—A 61

Class 1-B 62

Class 63

General Considerations 64

61. Class 1-A. a. Normal abdominal organs and abdominalwall.

J). Abdominal scars due to surgical operation or accident which show no hernial

bulging.

c. Scar pain when found not associated with any disturbance of function of abdominal

wall or contained viscera, unless malingering is definitely excluded.

d. Achylia gastrica, unless associated with disqualifying disease.

e. Complaint of weak stomach, indigestion, dyspepsia, constipation, belching, vomiting,

and various other types and degrees of abdominal discomfort which are proven by examination not to be associated with organic disease, by the absence of the usual objective symptoms and signs and by such laboratory tests as may be employed, provided psychiatric

examination reveals no disqualification.

/. Blood in stools if proved to be due to slight defects, such as fissures of the anus, small

hemorrhoids, or superficial small ulcers of the rectum.

g. Mild enlargement of the liver unassociated with other objective evidence of disease

of the liver or other organs.
150 PHYSICAL STANDARDS

h. Splenic enlargement of mild degree unassociated with evidence of other disqualifying disease.

i. Small benign tumors of the abdominal wall.

j. Intestinal parasites or their eggs in the stools.

k. Internal and external hemorrhoids if mild in degree.

62. Class 1-B.—Unless the degree of disability is obviously disqualifying—-

a. Hernia-inguinal, femoral, umbilical, and postoperative.

b. Largebenign tumors of the abdominal wall.

c. Internal hemorrhoids moderately severe, if remediable.

63. Class 4.—Defects such as—

a. Inoperable hernia.

b. Hydatids of the liver.

c. Ulcer of the stomach or duodenum, if diagnosis is confirmed by the usual laboratory

procedures.

d. Obstruction of the bowel due to organic disease.

e. Irremediable sinuses of the abdominal wall communicating with the hollow viscera.

/. Irremediable stricture of the rectum.

g. Multiple fistulae of the anus.

h. Schistosomiasis.

i. Enlargement of the spleen associated with leukemia, Hodgkin’s disease, or splenic

anemia.

j. Great enlargement of the spleen from any cause.

k. Large internal and external hemorrhoids associated with prolapse of the rectum.

l. Paralysis of the sphincter associated with incontinence of feces.

64. General considerations. a. When necessary to confirm diagnosis, examining

physicians should, when possible, avail themselves of fluoroscopy and roentgenography when

examining registrants.

b. When examining physicians are able to command hospital facilities and the neces- sary diagnostic apparatus, they should, within their discretion, use test meals and chemical

and microscopic examination ofthe stomach contents and stools.

c. Examining physicians should make use of digital rectal examination of defects

referable to that region, and, when necessary, proctoscopy should also he utilized.

d. Registrants who are found to have parasites or their eggs in stools should have

this condition indicated on report of examination.

e. Moderate impulse produced by cough at the inguinal, femoral, or umbilical rings,

or at the site of scar is not necessarily indicative of hernia.

Section XYI

GENITOURINARY ORGANS AND VENEREAL DISEASES

Paragraph

Class 1-A (35

Class 1-B (30

Class 07 General considerations rq

65. Class 1-A.—a. Gonorrhea, acute or chronic.

b. Syphilis with remediable manifestations except cerebrospinal, cardiovascular, or

visceral syphilis.

c. Chancroids and the resulting infections of the lymph glands of the groin.

d. Bed wetting, if mild in degree.
APPENDIX 151

e. Albuminuria with or without casts which is proved by observation and repeated

examination to be temporary in character.

f. Absence of one testicle due to removal or atrophy.

g. Undescended testicle which lies within the abdominal cavity.

h. Acute cystitis which has proved to be of temporary character by observation and

repeated examination over period not to exceed weeks.

i. Phimosis with or without adhesions of the mucous surfaces, if remediable.

j. Benign warts and other benign growths of the glans penis and of the prepuce.

k. Amputation of the penis if sufficient amount of the organ remains so as not to

interfere with the function of micturition. (Care should be taken to fully examine registrants for possible recurrence of disqualifying disease for which the amputation was

made.)

l. Varicocele of moderate size.

m. Hydrocele of moderate size.

66. Class 1-B. a. Stricture of the urethra, unless severe and irremediable,

ft. Benign tumor of the testicles.

c. Cystitis, subacute or chronic, if deemed remediable.

d. Varicocele if large.

e. Hydrocele, if large and considered irremediable to degree which would qualify for

class 1-A, but would permit limited service.

/. Floating kidney. (By floating kidney is meant one which is freely movable.)

g. Undescended testis which lies within the inguinal canal.

h. Removal of one kidney, the remaining one being healthy.

i. Bed wetting if more than mild in degree.

67. Class 4. a. Chronic nephritis. This should be evidenced by the presence in the

urine of albumin and casts, with or without blood, over period of time sufficient to prove

the persistence of the urinary findings. Examining physicians should require registrants to

void the urine during the period of the examination and in their presence. When albumin

and casts are found in the urine, the registrants should be reexamined not less than twice

day on or more separate days. If the urine shows albumin and casts with or without

blood, and this condition of the urine is associated with enlargement of the heart, high

blood pressure and other evidences of cardiovascular disease, the diagnosis of chronic

nephritis may be made immediately. If the presence in the urine of albumin and of casts

with or without blood is proved to be inconstant, and if the condition is unassociated with

the cardiovascular condition mentioned, decision should lie within the judgment and

discretion of the examining physicians.

ft. Irremediable stricture of the urethra, unless of such slight degree as to be of no

pathological significance.

c. Urinary fistula or incontinence. (See par. 65 and 66i concerning bed wetting.)

d. Gonorrheal arthritis which is of itself disqxialifying.

e. Surgical kidney with or without renal calculus.

/. Irremediable pyelitis.

g. Hydronephrosis or pyonephrosis.

h. Tumors of the kidney or bladder.

i. Acute nephritis if moderately severe and persistent after month’s observation.

j. Chronic cystitis associated with calculi or with retention of urine caused by

stricture of the urethra or by disease of the central nervous system.

k. Amputation of the penis if the resulting stump is insufficient to permit normal

function of micturition.

J. Hermaphroditism.

m. Hypertrophy of the prostate gland of sufficient degree to cause retention of the

urine.
152 PHYSICAL STANDARDS

n. Epispadias or hypospadias when urine cannot be voided in such manner as to

avoid soiling of clothing or surroundings, or when accompanied by evidence of chronic

infection of the genito-urinary tract.

o. Cardiovascular, cerebrospinal, and visceral syphilis.

68. General considerations. a. When it is deemed necessary, examining physician

should employ X-ray facilities to verify diagnosis of defects of the genito-urinary organs.

I). Complications and sequelae of gonorrhea will be regarded by examiners as acceptable

or as disqualifying, depending upon the degree of seriousness in individual cases, and

registrants will be appropriately classified according to the best judgment of the medical

examiners.

Section XVII

ENDOCRINE AND METABOLIC DISORDERS

Paragraph

Class 1-A 69

Class 1-B 70

Class 71

69. Class 1-A. a. Goiter (enlargement of thyroid gland, diffuse or nodular) if unassociated with toxic or pressure symptoms, provided the enlargement of the thyroid will not

interfere with the wearing of uniform or military equipment.

b. Froelich’s syndrome, if very mild in degree.

c. Hypothyroidism without myxedema, if not severe or resistant to cure. d. Acromegaly if not severe or associated with symptoms other than the bony changes.

e. Pellagra, beriberi, scurvy, and other nutritional deficiencies, if remediable by correction of diet, and not severe.

/. Glycosuria, if transient or renal in type, provided acceptance is deferred until the

possible existence of diabetes mellitus is excluded.

70. Class 1-B.—Froelich’s syndrome, if moderate in degree.

71. Class 4. a. Toxic goiter or thyrotoxicosis. (It should be remembered that malingerers may by use of thyroid medication produce many of the symptoms of thyrotoxicosis.)

b. Goiter with definite pressure symptoms or so large in size as to interfere with

wearing uniform or military equipment.

c. Cretinism with imbecility or dwarfism.

d. Myxedema (with clinical manifestations, and diagnosis not based only on low

basal metabolic rate).

e. Gigantism or acromegaly if markedly disfiguring or if associated with other symptoms of severe pituitary dysfunction.

/. Froelich’s syndrome, if severe.

g. Hyperparathyroidism and hypoparathyroidism, unless mild in degree.

h. Addison’s disease.

i. Diabetes mellitus and diabetes insipidus. If sugar is found in the urine, further

specimens should he voided in the presence of the physician or authorized assistant, and

on more than one occasion to avoid the substitution of diabetic urine or the voiding of diabetic or glucose containing urine previously introduced into the bladder by catheter. In

doubtful cases the blood sugar should be determined. Before diabetes insipidus is diagnosed,

malingering (by drinking large quantity of water) should be excluded.

j. Avitaminoses (including spruce, beriberi, pellagra, and scurvy) which are severe

or not readily remediable, or in which permanent pathological changes have been established.

1c. Gout.

l. Simmond’s disease.

m. Cushing’s syndrome.
APPENDIX 153

Section XVIII

DISEASES OF THE BLOOD AND BLOOD-FORMING TISSUES

Paragraph

Class 1—A 72

Class 1-B 73

Class 74

72. Class 1-A. a. Secondary anemia, due to hemorrhoids or any other remediable

cause.

b. Purpura if symptomatic of remediable condition.

c. Sickle cell anemia, if not severe. d. Malaria, acute or chronic, unless severe and irremediable. (See also par. b).

73. Class 1-B.—Primary pernicious anemia in the absence of posterolateral sclerosis,

ifresponsive to treatment and not severe.

74. Class 4.—a. Hemophilia.

b. Thrombocytopenic purpura.

c. Primary pernicious anemia if severe, not responsive to treatment or with neurological complications.

d. Aplastic anemia.

e. Hemolytic ictero-anemia (hemolytic jaundice

/. Splenic anemia.

<j. Polycythemia vera.

h. Leukemia, acute or chronic, of any type.

Sectiox XIX

MENTAL AND NERVOUS DISORDERS

Paragraph

Class 1-A 75

Class 1-B 76

Class 77

Diagnostic criteria 78

Sequelae of organic neurological disease 79

75. Class 1-A. a. normal nervous system.

b. Registrants who appear to have normal understanding, whose speech can be understood, who have no definite signs of organic disease of the brain, spinal cord, or peripheral

nerves, and who are otherwise mentally and physically fit.

c. Muscular tremors of moderate degree, unless malingering is definitely excluded.

76. Class 1-B.—a. Stuttering and stammering of degree disqualifying for general

military service but which has not prevented registrants from successfully following

useful vocation in civil life.

b. Tremors of such marked degree that they disqualify for general military service

but have not prevented the registrants from following useful vocation in civil life.

77. Class 4.—Any serious mental or neurological disorder such as—-

a. Insanity.

b. Epilepsy.

c. Post-encephalitic syndrome.

d. Imbecility.

e. Drug addiction, including the habitual use of opium and its derivatives and cocaine.

/. Chronic alcoholism.

ff. Stammering to such degree that the registrant is unable to express himself clearly

or to repeat commands.
154 PHYSICAL STANDARDS

h. Psychoneuroses and constitutional psychopathic states providing the diagnosis is

clearly established and in the opinion of the medical examiner precludes the successful

performance of military duty.

i. Chronic essential chorea.

j. Syphilis of central nervous system.

k. Post-traumatic cerebral syndrome.

I. Multiple sclerosis.

m. Paraplegia or hemiplegia.

n. Syringomyelia.

o. Muscular atrophies and dystrophies which are obviously disqualifying.

p. Hysterical paralysis.

q. Neuritis or neuralgia which is not temporary in character and which has progressed

to such degree as to prevent the registrants from following useful vocation in civil life.

r. Brain tumors.

s. Cerebral arteriosclerosis.

t. Sexual perversion.

78. Diagnostic criteria.—In arriving at decisions concerning nervous or mental defects,

the following criteria may be of assistance

a. Insanity.—All registrants should be considered insane who are committed, or who

have been committed, to licensed public institution for the care of the insane. The

examining physicians may require proof in the form of verified records of commitment by

the proper State authorities to verify the statements of the registrants.

(1) Dementia praecox.—Look for indifference, apathy, withdrawal from environment,

ideas of reference and persecution, feelings of the mind being tampered with, or thought

being controlled by hypnotic spiritualistic, or other mysterious agencies, hallucinations of

hearing, bodily hallucinations, frequently of electrical or sexual character; meaningless

smiles; in general, inappropriate emotional reactions and lack of connectedness in conversation. There may be sudden emotional or motor outbursts. The history of family life

and of school, vocational, and personal career will usually show erratic and more or less

irrational conduct.

(2) Manic-depressive insanity.—Look for mild depression, with or without feeling of

inadequacy, or mild manic states with exhilaration, talkativeness, and overactivity.

(3) Paresis.—The diagnosis of paresis may be made when at the examination of the

registrant majority of the following signs and symptoms are demonstrated: ArgyllRobertson pupil, facial tremor, speech defect in test phrases and in the slurring and

distortion of words in conversation; writing defects, consisting of omissions and the

distortion of words; apathetic or depressed or euphoric mood. These registrants may show

memory loss or discrepancies in relating facts of life; the knee jerks may be plus, minus,

or normal.

1). Epilepsy.—The registrant will not be considered an epileptic unless the claim is

substantiated by characteristic scars on the tongue, face, or head, or if the examining

physician is in doubt, by properly certified proof.

c. Imbecility.—A registrant will be declared an imbecile who has been so defective in

mind from birth or early age as to be incapable of earning livelihood but at the same time

is able to guard himselfagainst common physical danger.

d. Chronic alcoholism. (1) registrant will be declared sufferer from chronic

alcoholism when he presents majority of the following symptoms and signs: Suffused

eyes; prominent superficial blood vessels of nose and cheek; flabby, bloated face; red or

pale purplish discoloration of mucous membrane of the pharynx and soft palate; muscular

tremor of the protruded tongue and extended fingers; tremulous handwriting.

(2) The history of evidence presented that the registrant has been frequently and

grossly intoxicated is not of itself sufficient proof for the diagnosis of chronic alcoholism.
APPENDIX 155

e. Tabes.—The diagnosis of this disease should he made when, at the examination of

the registrant, several of the following signs and symptoms are present: Argyll-Robertson

pupil; absent knee jerks; positive Romberg, attaxic gait (especially when the eyes are

closed) hypotonia; and anesthetic areas of the skin. The history of tabes is usually that

of slow progression, of failing sexual power, and pains in the legs or back which are often

described as rheumatism.

f. Cerebrospinal syphilis.—The prominent diagnostic signs and symptoms are headaches. varying deep and superficial reflexes, pupillary changes, ptosis, ocular palsies, facial

weakness; the mental state may be normal, dull, or apathetic. Comparative motor weakness

may involve one side of the body or one extremity.

y. Multiple sclerosis.—The diagnosis of this disease rests upon the following signs and

symptoms: Intention tremor, nystagmus, absent abdominal reflexes, increased tendon reflexes, and scanning speech; in cases of this kind the history obtained is not characteristic,

but sometimes there may be history of urinary disturbances.

h. Paraplegia.—The diagnosis of paraplegia from whatever cause will rest upon weakness of the lower extremities, associated with loss of or increased knee jerks, Babinski reflex, or disturbance of the sphincters of the rectum and bladder, with or without girdle

sensations. Sensory disturbance of the skin may or may not be present. Muscle sensibility

may be diminished.

i. Syringomyelia.—Syringomyelia is usually evidenced by more or less loss of power

and atrophy of groups of muscles of one or more extremities; disturbance of the sensations

of the skin, more especially in the form of analgesias, and diminution of the temperature

sense; if in the upper dorsal cord, often associated with stooped shoulder posture; if in the

lower dorsal, ith weakness in one or both lower extremities.

j. Muscular atrophies and dystrophies.—The signs and symptoms of muscular atrophies

and dystrophies are: Atrophies of the small muscles of the hand and of the muscle groups

of the shoulder; fibrillary twitching. The history of these defects rarely furnishes reliable

data, although it will usually be found that the registrant has shown evidences of awkwardness. There is never history of pain in the affected muscles.

k. Multiple neuritis—The chief manifestations are more or less pain in the course of

the affected nerves, with tenderness over the trunks of the nerves and of the muscles supplied by them lessened muscularpower of varying degrees more or less atrophy of muscles,

with or without contraction, and evidences of trophic changes of the skin. The reflexes,

deep and superficial, may be diminished or absent; the sphincters are not involved.

79. Sequelae of organic neurological disease.—Certain aftereffects of organic nervous

disease need not be causes forrejection, provided—

a. That the disease is no longer active and is not likely to recur.

b. That the effect left by it does not prevent satisfactory fulfillment of military duties.

Examples of such conditions are paralysis of few unimportant muscles following poliomyelitis, slight unilateral hypertonicity as result of an infantile hemiplegia in man now

robust, and various traumatic conditions.

Section XX

PURPOSELY CAUSED PHYSICAL DEFECTS

Paragraph

Report of apparently purposely caused defects 80

80. Report of apparently purposely caused defects.—Whenever it shall appear to an

examining physician that registrant is suffering from selfinflicted or purposely caused

physical defects which, under the standards of physical examination prescribed herein,

would render him disqualified for military service of any kind, full statement of the facts

and of the condition of the registrant and of the examining physician’s recommendation
156 PHYSICAL STANDARDS

will be prepared and submitted to the Director of Selective Service or other designated

authority for waiver of the physical defects, if recommended, so that the registrant may

be compelled to render military service.

Section XXI

NOTES ON MALINGERING

Paragraph

Types of malingerers 81

Feigned medical diseases 82

Feigned surgical conditions 83

Nervous and mental feigned illness 84

Simulated defects of vision 85

Simulated defects of hearing 86

Bed wetting 87

General considerations 88

81. Types of malingerers.—Malingerers may be divided into three general groups.

a. Real malingerers with nothing the matter with them, who injure themselves, or

make allegations respecting diseases or such condition as drug taking, or who simulate

disease with full consciousness and responsibility—all for the purpose of evading military

service. Many of these will have been coached.

h. Psychoneurotics who are natural complainers and try to get out of every disagreeable

thing in life; perhaps only partially conscious of the nature of the seriousness of what they

do and only partly responsible. In many the motives are not persistent and many can be

made into good soldiers.

c. Confirmed psychoneurotics with long history of nervous break-downs and illnesses

who behave like group above but more persistently and from whom not much can be

expected in the way of reconstruction.

82. Feigned medical diseases. a. The detection and management of malingerers simulating medical diseases depend upon the absence of positive findings in an individual

who presents the general characteristics of the malingerer. There is special need for the

physical examination to be thorough in this group. Some of the cardiac cases at first

regarded as malingerers may later be found to have mitral stenosis or bacterial endocarditis.

Similarly, proper tests may show the existence of peptic ulcers in those suspected of feigning

digestive abnormalities. The estimation of the reality of rheumatic pains is always

difficult matter.

ft. Tachycardia and thyrotoxicosis may be temporarily induced by ingestion of drugs,

such as thyroid extract. Egg albumin or sugar may be added to urine. Undiluted canned

milk may be made to simulate urethral discharge. Cantharides may be taken to cause

albuminuria. Digitalis and strophanthus may be taken to cause abnormal heart findings.

The skin may be irritated by various substances. Cathartics may be taken to bring about

purging or to stimulate chronic diarrhea. An appearance of hemoptysis may be produced

by adding blood, either human or that of animals, to the sputa. Sometimes merely coloring

matter is added. Those who can vomit voluntarily what they swallow use the same means

to create the appearance of hematemesis. Similarly, coloring matter may be added to the

stools. Mechanical and chemical irritants are made use of to cause inflammation about

practically all the body orifices. .Jaundice may be simulated by taking picric acid. Crutches,

spectacles, trusses, strappings, etc., are made use of to create the appearance of disability.

Artificial jaundice is recognized by demonstration of picric acid in the urine.

83. Feigned surgical conditions.—Under this are included old scars and injuries of

the bones, fractures, and orthopedic conditions. Men may have teeth extracted in effort to

evade military service. Others may shoot or cut off their fingers or toes, practically always

on the right side, to disqualify themselves for service. Some may put their hands under
APPENDIX 157

cars for this purpose. Retention of urine may be simulated. Substances may be injected

under the skin to create abscesses. Crutches, braces, strappings, or trusses may be used to

give the appearance of disability. Wounds are rarely self-inflicted when witnesses are

present: consequentlyit is almost impossible to be certain of malingering in some cases. 84. Nervous and mental feigned illness. a. Insanity.—Rarely feigned by registrants

and then of an extremely silly, foolish type. In case of doubt, hospital observation is necessary, with verified past records. Mental defects are frequently feigned, especially by illiterates. Organic diseases of the central nervous system cannot be simulated.

b. Pain and hyperesthesia.—The most frequent of all complaints. History inconsistent,

ordinary traces of suffering absent. Absence of other symptoms usually accompanies types

of pain complained of. Absence of objective evidence of localized pains. Note behavior when

the registrant believes himself unobserved.

c. Anesthesia.—Complaint of anesthesia itself creates suspicion of malingering as

most patients with anesthesia are ignorant of it.

d. Epilepsy —Men who have sustained head injury are very apt to claim tits. These

complaints may be in reference to grand mal or petit mal. Petit mal attacks are spoken ofas

fainting attacks. In grand mal attacks there is loss of pupil response to light, knee jerks

are lost, and the Babinski reflex may be present.

e. Hysteria. Not feigned in itself, but its existence creates confusion as to malingering. The question to be decided is whether the registrant is too seriously affected with the

neurosis to be useful as soldier. (See par. llh.)

f. Stiff back.—Stiff back is frequent symptom of hysteria in mobilization among

selected men. In cases of this kind, organic diseases of the vertebrae can and should be

excluded, if necessary, by X-ray.

85. Simulated defects of vision.—See section IV.

86. Simulated defects of hearing.—See section V.

87. Bed wetting.—Enuresis, either real or simulated, may be frequent complaint

among registrants for military service, but it is not cause for unconditional rejection.

Bed wetters may be placed in class 1-A or 1-B depending upon the apparent significance or

severity of the disorder.

88. General considerations. a. The surest means of detecting malingering is thorough

understanding by the examining physician of the types of people who actually do it, and

the way they behave. It is only in the feigned diseases of the eye and ear that special tests

are required. Observation in hospital is necessary in difficult cases. The vast bulk of malingerers are those who exaggerate some actual defect, and the problem for the examining

physician is to decide whether the defect complained of is sufficient cause for rejection for

service. Persons of intelligence and education have more difficulty in deceiving, as they are

bound to express themselves freely. If they are reticent in these matters they arouse suspicion by their reticence. Those who talk freely may be counted on to say things at variance

with the existence of the disease of which they complain.

b. Whenever it shall appear to an examining physician that registrant is endeavoring

to escape service by malingering, if otherwise mentally and physically fit, he will be

accepted. full statement of the facts will be prepared and forwarded to the Director of

Selective Service.
PHYSICAL STANDARDS 158

INDEX

Paragraph

Abdomen 61-64

Achylia gastrica 61d

Acromegaly 69d; 71c

Actinomycosis 8c

Addison’s disease 71

Albuminuria 65e; 67a

Alcoholism, chronic 77/; 78d

Anemia 72; 73; 74

Aneurysm 571

Ankylostomiasis 6c; 81c

Aortic insufficiency 57

Aortic stenosis 57

Apices, lungs 52d

Arrhythmia 55; 57

Arthritis 41c; 45

Asthma, bronchial 51c

Bed wetting 65; 66; 87

Beriberi 69c; 71/ Bladder- 65; 66; 67

Blood dyscrasias 72-74

Blood pressure 54c; 55c; 57

Blood vessels 53-60

Bradycardia 55c; 56e

Brain, organic diseases of 75-79

Bronchiectasis 506; 51

Calculi, vesical, renal, ureteral 65-68

Cancer 8a Cardiovascular system 53-60

Cerebrospinal syphilis 67o; 77; 78

Cervical region 47; 48

Chancre 6o; 656

Chancroid 6a; 65c Chest standard measurements Chest wall and lungs 49-52

Chiman-Moos test 261

Chorea 771 Chronic alcoholism 77/; 78d

Circulation 53-60 Classification 1-A, 1-B, or 4, according to physical

qualifications 1-5 Clubfoot 43«; 45« Coccyx 39c

Communicable diseases 6a

Congenital heart disease 57

Constitutionalpsychopathic state 77

Cretinism 71c

Cushing’s syndrome 71m

Cystitis 65A; 66c; 67/

Dementia praecox 77a; 78a

Dental requirements 31-32

Diabetes insipidus 711

Diabetes mellitus 711

Diplopia 17d; 181

Drug addiction 77e

Duodenal ulcer 63c

Paragraph

Ears 21-26

Elephantiasis 351:

Endocarditis 57

Endocrine disorders 69-71

Enuresis 65d; 661; 87

Epilepsy 776; 786

Erhard’s test 26A

Esophagus 276; 29e

Examinations; generalinformation and instructions. 1-5

Extremities.. 43-46

Eyes 15-20

Fauces 27-30

Feet 43-46

Feigned defects, notes on 81-88

Filariasis-.

Fingers 43-46

Flat feet._ 431; 451:

Fractures 39-46

Froelich’s syndrome 696; 70; 71/ See also Obesity 116

Gastric ulcer 63c

General information and instructions governing

physical examination 1-5

Genito-urinary defects 65-68

Gigantism 14a: 71c

Glaucoma 181:

Glucose in urine 71*

Goiter 47c; 48o; 69a; 71o,

Gonorrhea 6a; 65a

Complications and sequelae 686

Gout 71

Groups (classes) indicating physical qualifications-- 1-5

Hands 43-46

Hay fever 27fc; 28c

Head 36-38

Hearing 21-26

Heart 53-60

Height 9-14

Hemophilia 74a

Hemorrhoids 61 /; 621:; 631:

Hermaphroditism 67

Hernia 62a; 63a

Hodgkin’s disease 8/

Hookworm 6c;

Hydrocephalus 38c

Hydronephrosis 67

Hypertension, arterial 571

Imbecility- 77 d; 78c

Information and instructions 1-5

Insanity 77a; 78o; 84a

Joints:

Extremities 43-46

Spine 39-42
APPENDIX 159

Paragraph

Knees 43-46

Larynx.. 27-30

Legs 43-46

Leprosy 8c Leukemia 74 Lumbo-sacral joint 39-42

Lungs and chest wall.. 49-52 Lupus vulgaris 35i

Malaria 66; 72 Malignant tumors 8a Malingering:

Notes on 81-88 Hearing, tests to detect 26

Vision, test todetect 19-20

Measurements, directions and standards 9-14

Mental disorders 75-79

Metabolic disorders 69-71

Metallicpoisoning, irremediable

Mitralinsufficiency 57 Mitral stenosis. b7g

Mouth 27-30

Mycotic Infection of viscera 8e Myocardialdisease 53-60

Myxedema 71

Neck 47-48

Nervous disorders 75-79

Nephritis 65e; 67a,

Neurological defects 75-79 Nose 27-30

Obesity 116

Froelich’s syndrome 69-71

Osteomyelitis 86

Otitis 21-26

Ozena 296

Paralysis 75-79

Pediculosis 33c

Pellagra 69e

Pes planus.. 43-46

Pharynx 27-30

Phlebitis 57;;

Physical defects purposelycaused 80

Pilonidal cyst or sinus 33e

Pleurisy 516

Prostate 67

Psychoneuroses 75-79

Psychoses 75-79

Pulmonary Insufficiency b7g

Pulmonary stenosis b7g

Purposely caused defects 80

Rectum 61-64

Remediable incapacity 6-8

Respiratory diseases 49-52

Paragraph

Rheumatic fever

Rules, general 1-5

Sacro-iliac and lumbo-sacral joints 39-42 Scabies 33c Scapulae 39-42

Scurvy 69e, 71;

Self-inflicted defects 81 Sexual perversion 77;

Sinunond’s disease 7H Sinusitis 27/ Skin 33-35 Skull 36-38 Speech defects 76a; 77 Spine 39-42

Stammering .. 76a; 77

Strabismus 16;

Syphilis 6a; 656

Cerebrospinal, cardiovascular, or visceral 67o

Tabes 78e Tachycardia.- 556; 57c;

Teeth.. 31-32

Temporary incapacity 6a;

Throat 27-30 Thrombophlebitis 57;;

Thumbs 43^46 Thyroid... 47; 48; 69a; 71a

Toes 43-46 Tonsils 276

Trachea 27-30 Trachoma 18n

Treatment of nondisqualifying defects

Trypanosomiasis 8i

Tuberculosis, active 86

Inactive (see under organ or part affected).

Pulmonary; diagnostic considerations 52

Uncinariasis 6c; 8fc

Underheight 9-14

Underweight 9-14

Urological defects 65-68

Varicocele 65Z; 66d

Varicose veins 45;

Venereal diseases 6o; 656; 67o

Visual requirements 15-20

Weight 9-14

Froelich’s syndrome 696; 70; 71/

X-ray, use of in diagnosis:

Abdomen 64

Genito-urinary organs 68a

Heart 59

Lungs 52

Spine 42
160 PHYSICAL STANDARDS

[A.G. 381 (8-20-40)]

By order of the Secretary of War: G. C. MARSHALL,

Chief of Staff. Official:

S. ADAMS,

Major General,

The Adjutant General.
APPENDIX

MOBILIZATION REGULATONS

No. 1-9

WAR DEPARTMENT,

Washington 25, D.C., 19 April 1944

STANDARDS OF PHYSICAL EXAMINATION DURING MOBILIZATION

Paragraphs

Section I. Information and instructions 1-5

II. General and miscellaneous defects 6-8

III. Height, weight, and chest measurements 9-14

IV. Eyes 15-20

V. Ears 21-26

VI. Mouth, nose, fauces, pharynx, trachea, esophagus, and larynx 27-30

VII. Dental requirements 31-34

VIII. Skin 35-37

IX. Head 38-40

X. Spine, scapulae, and sacroiliac joints 41-44

XI. Extremities 45-48

XII. Neck 49-51

XIII. Lungs and chest wall 52-60

XIV. Heart, blood vessels, and circulation 61-68

XV. Abdominal organs and wall 69-72

XVI. Venereal diseases 73-76

XVII. Genitourinary organs 77-80

XVIII. Endocrine and metabolic disorders 81-83

XIX. Diseases of blood and blood-forming tissues 84-86

XX. Neurological disorders 87-91

XXI. Psychoses, psychoneuroses, personality disorders 92-98

XXII. Intelligence.-. 99-102

XXIII. Purposely caused physical defects 103

XXIV. Malingering 104-112

Page

Index 201

Section

INFORMATION AND INSTRUCTIONS

Paragraph

Purpose

Publication

Objective

Physical classification

Defects not specifically mentioned in these regulations and hospitalization

This pamphlet supersedes MR 1-9, 15 October 1942, including 1, 22 January 1943, 2, 23 February 1943; and

section I, Circular No. 137, War Department, 1943.

1. Purpose.—a. The purpose of these regulations is to

(1) Set forth the standards of physical requirements for men procured for

general military service.
162 PHYSICAL STANDARDS

(2) Prescribe permissible deviations from the general service standards for

limited military service.

(3) Describe deviations from the above standards which are not acceptable for

any class of military service.

b. So far as it applies to enlisted men AR 40-105 is superseded by these regulations.

These regulations will apply to men in the following categories

(1) Men enlisted orreenlisted in the Regular Army.

(2) Men for enlistment or reenlistment in the Regular Army Reserve, Enlisted

Reserve Corps, and Reservists on call to active service if they have been in the

inactive Reserve longer than 90 days.

(3) Men enlisted or reenlisted in the National Guard while in Federal Service.

(4) Enlisted men of the National Guard on induction into Federal Service.

(5) Men enlisted in the Army of the United States.

(6) Men inducted into the Army under the provisions of the Selective Training

and Service Act of 1940, as amended.

2. Publication. a. These regulations are published for the information and guidance

of all medical examiners who may be used by the Army.

6. Medical examiners should read every section of these regulations in order that they

may have broad knowledge concerning physical standards.

3. Objective.—The objective is to procure men who are physically fit for the rigors of

general military service or for limited military service. Therefore, examining physicians

will consider these standards as guide to their discretion and not construe them too

strictly or arbitrarily. The examination will be carried out with the utmost care in order

that no individuals who are unfit for service will be accepted, only to be discharged within

short time on certificate of disability. All minor defects as well as disqualifying defects

will be recorded in order to protect the Government in the event of future claims for

disability compensation. The likelihood of subsequent claims on account of disability should

be borne in mind by the examiners in considering the qualifications of registrants with

questionable defects. Whenever registrant is accepted for military duty but who, nevertheless, has disease or other physical condition which although not disqualifying requires

medical treatment, the nature of the condition and the need for treatment will be clearly

stated on the report of physical examination.

4. Physical classification. a. General service.—Physically qualified for general military service. Registrants will be recommended for assignment for general service if they

meet the requirements therefor throughout the entire physical examination. In those borderline cases, where question is raised as to whether an individual should be classified for

general or limited service, preference will be given to his initial classification for general

service if the chief medical examiner has reason to believe the man can perform general

military service duty.

b. Limited service.—Physically unfit for general military service, but qualified for

limited military service. Individuals who fail to qualify for general service, and who do

not fall below limited service requirements in any phase of the examination will be

recommended for assignment to limited service unless, because of multiple defects, the

medical examiners recommend unqualified rejection as nonacceptable.

c. Nonacceptable.

(1) Physically unfit for any military service. All individuals who do not meet

the physical requirements of general service or limited service will be recommended as nonacceptable.

(2) Care will be taken that all defects found will be recorded fully and accurately

on the report of physical examination. The defects will be listed in the summary

of the physical examination report in the order of their importance. The

irremediable, disqualifying, permanent defect will be listed as number one and
APPENDIX 163

the others in the order of their importance. The major disqualifying defect may

be physical or mental.

(3) Any individual recommended as nonacceptable will not he accepted unless specific directions to that effect have been issued by the War Department.

5. Defects not specifically mentioned in these regulations and hospitalization.—a. If

any individual is regarded by the medical examiners as physically unfit for military service

by reason of physical or mental defects not specifically noted in these regulations, he will

nevertheless be recommended as unsuitable for general service or for limited service, as

the case may be. brief statement of the reasons for the rejection will be entered on the report of physical examination. So far as practicable, however, the physical classification

of individuals will conform to the specified requirements.

b. Hospitalization for period not to exceed days for men whose physical fitness for

military service cannot be determined without hospital study is authorized. Military or

other Government hospitals will be used for this purpose when practicable. When military

or other Government hospitals are not available the use of civilian hospitals is authorized.

Individuals will not be hospitalized when their fitness for military service can be

determined otherwise.

c. All previous instructions in connection with physical standards which are in conflict

with these regulations are rescinded.

Section II

GENERAL AND MISCELLANEOUS DEFECTS

Paragraph

General service

Limited service

Nonacceptable

6. General service.—a. Individuals with acute pathological conditions, including acute

communicable diseases except venereal diseases, from which in the natural course of the

disease recovery occurs without sequelae, will be deferred until final examination shows

recovery has occurred without disqualifying sequelae.

6. Malaria, acute, or malaria, chronic, if mild.

c. Uncinariasis, if mild.

d. Remediable incapacity due to recent acute illness, surgical operations, injury, employment or environment in civil life, provided acceptance is deferred until recovery is

complete. Following any major surgical operation an individual will be deferred for

sufficient period of time to insure complete recovery without sequelae. The minimum period

of deferment following major surgical procedure will he months. The actual period of

deferment longer than months will depend upon the condition for which operated and

upon the discretion of the medical examiners.

7. Limited service.—There are no general or miscellaneous defects to warrant initial

selection for limited service which are not covered elsewhere in these regulations.

8. Nonacceptable.—a. Carcinoma or other malignant tumor or disease of any organ or

part of the body.

b. Active tuberculosis of any degree.

c. Leprosy or actinomycosis.

d. Late syphilis affecting the cerebrospinal or cardiovascular system or the viscera.

e. Chronic metallic poisoning, except argyria.

f. Mycotic infection of the lungs or other internal organs.

g. Acute rheumatic fever, or verified history of single or recurrent attacks of rheumatic fever within the previous years.

h. Osteoarthritis or rheumatoid arthritis.
164 PHYSICAL STANDARDS

/. Active osteomyelitis of any bone or substantiated history of osteomyelitis of any

of the long bones of the extremities at any time.

j. Filariasis, trypanosomiasis, amoebiasis or schistosomiasis.

1c. Hodgkin’s disease.

l. Uncinariasis, if more than mild.

m. Malaria, chronic, if more than mild.

n. Splenectomy for any cause, other than trauma or congenital hemolytic icterus.

o. Leukemia.

Section III

HEIGHT, WEIGHT, AND CHEST MEASUREMENTS

Paragraph

Table of standard and minimum acceptable measurements of height, weight, and

circumference of chest

Directions for taking height and weight 10

General service 11

Limited service 12

Nonacceptable 13

General considerations 14

9. Table of standard and minimum acceptable measurements of height, weight, and

circumference of chest.

10. Directions for taking height and weight.—a. The measuring rod should consist of

board at least inches wide by SO inches long, placed vertically, firmly fixed, with accurate

graduations of *4 inch between 58 inches and the top end. Obtain the height by placing

Height (inches)

Standard Minimum

eight Chest meas- urement at expirationeight Chest meas- urement at

expiration

60

Pounds

116

119

122

125

128

132

136

140

144

148

152

156

160

164

168

172

176

180

184

Inches

IK

31K

IK

32

32

32

32

33

33K

33K

33K

34

34K

34K

34K

35

35K

35K

35

Pounds

105

107

109

111

113

115

117

121

125

129

133

137

141

145

149

153

157

161

165

Inches

28

29

29K

29K

29

30

30K

30K

30K

31

IK

IK

IK

32

32

32

32

33

33K

61 _____

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78_
APPENDIX 165

horizontally, in firm contact with the top of the head, square against the measuring rod

hoard of about by (> by inches, best permanently attached to the graduated board by

long cord. The individual should stand erect with back to the graduated board, eyes

straight to the front. The shoes should be removed when the height is taken.

b. The weight should be taken with the clothing removed.

11. General service.—a. Those who fall within the requirements for height, weight,

and chest measurement given in the table in paragraph !).

b. Those whose weight is greater than the standards indicated for the height, provided

the overweight is not so excessive as to interfere with military training.

12. Limited service.—Individuals who on examination are found to present conditions

not within the accepted measurements for weight and chest circumference given in the

table (par. 9), who are otherwise mentally and physically fit, and who do not fall within

the nonacceptableclass may be accepted for limited military service.

13. Nonacceptable.—a. Less than 00 inches in height.

b. Less than 105 pounds in weight.

c. height of more than 78 inches.

d. Overweight which is greatly out of proportion to the height if it interferes with

normal physical activity or with proper training.

11. General considerations. a. Individuals of TO inches or more in height will be

studied for the possibility of gigantism or acromegaly.

b. Examining physicians will use discretion and judgment in accepting registrants

with variations in the ratio of height, weight, and chest measurements indicated in the

table (par. 9). When the weight is disproportionate and is believed to be due to some

temporary condition, proper allowances may be made, provided it is the opinion of the

examining physician that the variation is correctible with proper food and physical training. No individual will be accepted, however, whose weight is less than 105 pounds.

Section IV

EYES

Paragraph

Vision 15

General service 16

Limited service 17 Nonacceptable IS

Visual tests for detection of malingerers 19 Other methods of examination 20

15. Vision.—Visual acuity will be determined by standard methods. Except as otherwise noted, examine each eye separately, without glasses, covering the other eye with

card (not with the hand). The individual is directed to read the test types from the top

of the chart down as far as he can see, and his acuity of vision is recorded for each eye,

with the distance of 20 feet as the numerator of fraction and the size of the type of the

lowest line he can read correctly as the denominator. If he reads the 20-foot type correctly,

his vision is normal and recorded 20/20; if he does not read below the 30-foot type, the

vision is imperfect and recorded 20/30; if he reads the 15-foot type, the vision is unusually

acute and recorded 20/15, etc.

16. General service.—a. Binocular (both eyes open) vision of not less than 20/40 without glasses, provided the vision in the more defective eye is not less than 20/70 without

glasses and provided the defective vision is not due to active or progressive organic disease.

b. Registrants whose visual acuity without glasses is not less than 20/200 in each eye

or 20/100 in one eye and 20/400 in the second eye, if vision is correctible to either 20/40 in

each eye, 20/30 in the right eye and 20/70 in the left eye, or 20/20 in the right eye and

20/400 in the left eye and provided the defective vision is not due to active or progressive
166 PHYSICAL STANDARDS

organic disease. The actual possession of suitable glasses by an individual is not required

for his acceptance under these standards.

c. Conditions due to iridectomy or other operation upon the eye, if the condition for

which the operation was performed has been relieved and the vision is within or above the

minimum standard requirements.

d. Nystagmoid movements, if not persistent or pronounced and if true nystagmus is

excluded.

e. Chronic simple conjunctivitis, if mild.

f. Slight adhesion of the lids to the eyeball.

g. Small pterygium not encroaching on cornea so as to interfere with vision.

h. Ptosis which does not interfere with vision.

i. Color blindness.

j. Exophthalmos, if not of such degree as to have led to or threatened corneal ulceration and provided hyperthyroidism is excluded.

k. Blepharitis marginalis, if mild.

l. Blepharospasm, if mild.

m. Superficial corneal ulcer, provided acceptance is deferred until ulcer is healed

without disqualifying impairment of vision.

17. Limited service.—a. minimum vision of 20/400 in each eye without glasses, correctible to 20/40 in one eye and 20/70 in the second eye, or 20/30 in one eye and 20/100 in

the second eye.

&. Loss of one eye (anophthalmos) or any degree of defective vision in one eye from

below 20/400 to no light perception, if such defective vision is not due to active or progressive organic disease, with vision in the other eye of 20/100 without glasses, correctible to

20/20 with glasses.

18. Nonacceptable.—Defects such as—

a. Vision less than the minimum requirements for limited military service.

t>. Deformity of the eyelid or eyelids, such as inversion or eversion of degree that

forcible closure fails to cover the eyeball or in which there is resultant conjunctival

inflammation, corneal irritation, or restriction of the rotation of the eyeball.

c. Lagophthalmos, if extreme.

d. Pronounced exophthalmos.

e. Chronic keratitis.

/. Chronic recurrent inflammatory disease of the cornea or uveal tract.

g. Chronic ulcer or cornea.

h. Any active disease of the retina, choroid, or optic nerve

i. Detachment of the retina.

j. Nystagmus.

k. Glaucoma.

l. Diplopia due to paralysis of extrinsic ocular muscles, unless mild in degree.

m. Abnormal condition of eyes due to disease of the brain.

n. Trachoma.

o. Any tumor of the orbit.

p. Permanent and well-marked strabismus (over 30° deviation).

q. Ptosis interferingwith vision.

r. Trichiasis.

s. Chronic conjunctivitis, other than mild, simple.

t. Chronic dacryocystitis.

«.Pterygium interfering with vision.

19. Visual tests for detection of malingerers.—a. Malingerers may feign inability to

open their eyes, total loss of vision in one or both eyes, or impaired vision in one or both

eyes. Occasionally, an inflammation in the eyes will be produced by putting sand or other

irritating substance under the lids.
APPENDIX 167

&. Malingerers who wish to evade military service by feigning impairment of vision

may be divided into two classes, as follows:

(1) Those who claim total loss of vision in one eye.

(2) Those who claim partial loss of vision in one or both eyes. Either group may

have normal acuity of vision or may exaggerate defect actually present.

c. In testing for malingering the examining physician will bear in mind that detection

is more likely to result when the man is allowed to believe that his case is regarded from

the first as genuine and that his story is not discredited. There is something indefinable in

the bearing of the malingerer which experience alone can detect. He may be self-assertive

and overconfident; he may he hesitant or evasive. Careful observation will be made of his

conduct and every movement noted. The nature of the man’s answer will he taken into

account and considered in the light of the kind of reply that is given when nonmalingerer

is being examined.

d. The following equipment should be available.

(1) Trial frame, blank, spherical lenses: 16, +3, +0.25, —3, ~2, —1, —0.25.

(2) Two prisms, one 6° and one 10°.

(3) Ophthalmoscope (electric battery in handle).

(4) Condensing lens.

(5) Loupe.

(6) Red and green letters on glass

(a) Letters varying in size.

(& Spectacle frame containingred and green glasses.

(7) Special test cards, one duplicate, with letters reversed to use with mirror.

(8) Special illiterate test cards.

(9) Mirror large enough to reflect test cards.

(10) One stereoscope with special card.

(11) Retinoscope (electric, with battery in handle).

(12) Ruler about inches wide.

(13) Three disks of Polaroid 36 mm in diameter and mm thick.

e. The principle involved in the Polaroid test is that light polarized in any given

meridian by Polaroid screen is selectively absorbed by an analyzing Polaroid screen the

axis of which is at an angle to the axis of the polarizing screen. The test may be conducted

as follows: Three disks of Polaroid 36 mm in diameter and mm thick are required.

They are held in the ordinary trial frame with the handle corresponding to the polarizing

axis. One Polaroid disk is placed before each eye with the polarizing axis horizontal. The

individual is then asked to read the smallest possible line of letters on the test chart with

both eyes open. Immediately, the third Polaroid disk is rotated so that the polarizing axis

becomes vertical for the length of time that it takes to read three or four letters. The

rotation of the third disk to the vertical position prevents the passage of any light so that,

if the reading of the test chart is continued during this time, it is very evident that the

poor eye is functioning. The disk may be used with correcting spectacle lenses if necessary.

Care must be exercised to see that the poor eye is not closed while the polarized disk

before the other eye is at right angles. Also, the good eye must be occluded by the opposed

Polaroid disk for only short period at time so that the individual does not become aware of the momentary elimination of visual acuity in that eye.

20. Other methods of examination. a. To verify total loss of vision in one eye.

(1) 6° prism, base down, is placed before the admittedly sound eye while the

man looks at distant light or candle. If he sees two candles, binocular vision

is proved. The examiner may vary the test by placing the prism before the

“blind” eye, either base up or base down.

(2) prism of 10°, with base outward, is placed before the “blind” eye. If there

is any sight in this eye, double vision will be produced and the eye will be seen

to move inward to correct it and fuze the two images.
168 PHYSICAL STANDARDS

(3) The alleged “blind” eye is covered. prism of 10°, with the apex up, is placed

before the “seeing” eye in such position that its edge lies horizontally across

the center of the pupil. This produces monocular diplopia. The prism is then

moved upward so as to be completely in front of the good eye and at the same

time the “blind” eye is uncovered. If diplopia is produced or admitted, there is

sight in the “blind” eye.

(4) Test with colored glasses and letters.-—This consists in directing the individual

to read row of special red and green letters on glass through special red

and green glass. The red letters will be invisible to the eye that has the green

glass, and vice versa, but if all the letters are correctly read, irrespective of

their color, there must be sight in the “blind” eye. The proper illumination back

of the chart must be observed. This test is not applicable to individuals who are

colorblind to red and green.

(5) Test with trial (/lasses. —A high plus glass is placed before the good eye and

low plus or minus before the “blind” eye. If the distant type is x’ead, the vision

in the “blind” is good.

(6) Stereoscope test.—This may be made with ordinary stereoscope, the printed

matter so arranged that certain portions of it are not present before one of the

eyes.

(7) Bar test.—Interpose ruler about inches wide vertically midway between

the two eyes at about to inches’ distance: direct the man to read from

printed page with lines at least inches long. If able to read the lines, binocular

vision exists.

(8) Pupil action.—The action of the pupil must be carefully tested, there usually

being no movement to light stimulation when the eye is blind. If the examiner

is not satisfied, the following examination will he made

(a) Oblique examination.—A careful examination of the cornea will be made

with the aid of condensinglens and loupe.

{b) Ophthalmoscopic examination.—A searching examination with the ophthalmoscope will be made, together with an estimation of the refractive

error. The pupil will be dilated if necessary.

h. To verify partial loss of vision in one or both eyes.

(1) The most common manifestation of malingering takes the form of statement

that one eye is imperfect. Men pleading this disability may be divided into

two classes:

(a) Those who pretend to have visual defect.

(b) Those who are aware that they have visual defect and exaggerate its

effect.

(2) No hard-and-fast tests can be prescribed for the detection of these cases.

Much depends on the alertness and ingenuity of the examining physician.

(3) The tests with prisms are not applicable here, for there is not pretended

blindness in one eye but simply an alleged diminution of visual acuity.

(4) If room 30 to 40 feet long can be obtained for testing vision, place the

individual suspected of malingering at 30 to 35 feet from the test chart. Direct

him to read the letters and note the result. He should then be brought up to

30 feet from the card and retested. If he still reads only the same line and

does not read any of the smaller type, he is malingering.

(5) Mirror test with special cards.

(a) Test cards are used which are identical, one having the letters reversed.

The registrant is directed to read the letters on the chart across the room

and then in mirror beside it which reflects reverse letters that are placed

over his head. The letters seen in the mirror are located double the distance
APPENDIX 169

of the direct letters from the man being examined. The malingerer is apt to

read in the mirror the line which he read on the first card, showing that his

vision is twice as good as he pretends.

(ft) In order to obviate the use of test letters in the mirror test, various

common objects approximating the size of the 20/40 and 20/30 letters may

he used by asking an individual to differentiate between dime and penny,

cigarette and pencil, pen and pencil, the number of spots on playing

cards, or between the different aces, held on either side of his head and

reflected in the mirror at 20 feet distance.

(6) Trial frame test.—Place trial frame upon the man’s face and put before the

sound eye high convex lens (—101)) and before the weak eye plane or weak

lens (0.25) which will not interfere with vision. If letters placed at distance

of 20 feet are read, the fraud is at once exposed.

(7) Oblique examination.—This is conducted with condensing lens and loupe to

determine corneal or lenticular opacities.

(8) Ophthalmoscopic examination.

(a) It is probable that the malingerer will resist the ophthalmoscopic examination by frequent winking or rolling of the eyes. In this event, it is best to

caution the man that report of his vision must be made, and then to

postpone further examination until after the next few individuals have been

examined.

(&) Use the ophthalmoscope as an aid in estimating the refractive error. If

no error of marked degree exists and the media and fundi are normal, the

relation between the alleged vision and the refractive condition furnishes

an important clue. If the error is about +4 or —2, the visual acuity could

be about 20/100 but when the defect cannot be accounted for objectively

and the vision is brought from 20/100 to 20/30 by means of low plus or

minus glass, the man is malingering.

(9) Retinoscopy.—Look for corneal and lenticular opacities and estimate refractive

errors.

c. Occupation.

(1) The man’s occupation in civil life may have been such that it could not have

been followed without more vision than he claims.

(2) In the absence of ocular defects, continuous and persistent blepharospasm,

the use of colored glasses, eye shades, or eye bandages will be regarded with

suspicion.

d. Diplopia.—Cases of malingering are occasionally met with in which the men complain that they see double. These must he investigated with the application of the ordinary

tests as if they were genuine and with every precaution taken to guard against serious

nerve lesion being overlooked.

Section

EARS

Paragraph

Examination for disease 21

Determination of auditory acuity 22

General service 23

Limited service 24

Nonacceptable 25

Tests for malingering in hearing 26

21. Examination for disease.—The external ears and mastoid region willbe examined by

inspection and, if necessary, the mastoid region by palpation. The external auditory canal
170 PHYSICAL STANDARDS

and membrana tympani will be examined by reflected light or by self-illuminating

otoscope. Cerumen will be removed, if necessary, in order to visualize satisfactorily the membrana tympani.

22. Determination of auditory acuity.—Acuity of hearing will be determined by the

whispered voice test. To determine the acuity of hearing, place the registrant facing at

right angles to the assistant, 15 feet distant, with ear to be tested toward the assistant, and

direct him to repeat promptly the words spoken by the assistant. If the registrant cannot

hear the words at 15 feet, the assistant will approach foot by foot, using the same whisper,

until the words are correctly repeated. Examine each ear separately, closing the other ear

by pressing the tragus firmly against the meatus the examiner may face the same direction

as the egistrant and close one of his own ears in the same way as control. The assistant

will use whispered voice produced by speaking with the lungs in state of complete

exhalation so as to assure as great uniformity of sound output as possible. The whisper

should be plainly audible to the examiner and use will be made of numerals, names of

places, or other words or sentences, until the condition of the registrant’s hearing is evident.

The acuity of hearing will be expressed as fraction, the numerator of whichis the distance

in feet at which the words are heard by the normal ear; thus 15/15 indicates normal hearing,

10/15 partial hearing of degree indicated by the fraction, that is, the registrant hears at

10 feet distant the words which the normal ear hears at 15 feet.

23. General service.—a. Hearing in each ear of 8/15 or better, or 15/15 in one ear and

less than 8/15 in the other.

h. Healed scar of mastoid operation without marked deformity and if hearing is not

below requirements.

24. Limited service.—There are no defects in hearing that warrant initial classification

for limited service.

25. Nonacceptable.—Defects such as—

a. Hearing less than the minimum hearing prescribed under general service.

6. Purulent otitis media with or without mastoiditis.

c. Perforation of the membrana tympani.

(1. Acute or chronic mastoiditis.

e. Total loss of an external ear.

/. Severe atresia of the external auditory canal.

26. Tests for malingering in hearing.—Individuals who are malingerers in regard to

hearing usually claim magnification of slight imperfection on one side with complaint of

past trouble. Exaggeration of defects in hearing extends usually to declarations of total

deafness on one side. The following directions will be observed in examining suspected

malingerers:

a. In making these examinations the observer will have skilled assistant and all

communications between them will be in low, whisperedvoice.

1). The assistant will stand at the back of the suspected malingerer and will, at the

direction of the examining physician, obstruct the ears of the suspect as directed, by pressing the tragus firmly into the auditory meatus.

c. The suspected malingerer’s eyes will be securely and completely blindfolded.

d. An accurate notation will be made of which ear is deaf as claimed by the individual.

Then critical examination of the auditory canal, membrana tympani, and for patency of

the eustachian tubes will follow.

e. Then an accurate test of the normal ear will be made.

f. If the suspect gives markedly conflicting statements when the normal ear is tightly

plugged as to the distance at which he hears the voice, it is fair to assume that he is

malingerer.

(j. The simplest and most available test for malingering is the use of an ordinary

binaural stethoscope. The tubing leading to the earpiece to be applied to the normal ear
APPENDIX 171

is occluded by clamping with hemostat and the earpieces are placed in the ears of the

blindfolded suspect. The examining physician speaks in soft tone or counts into the

bell-shaped chest portion of the stethoscope and the suspect is told to repeat what he

hears. The tubes are removed from the ears, and the assistant is told to occlude the normal

ear. The same words or numerals are repeated. The suspect will now claim failure to hear

the words or numerals which he had previously heard through the tube with the allegedly

deaf ear.

h. Erhard’s test is another simple method for malingerers which requires no special

apparatus. If the external auditory canal of normal ear is tightly packed with absorbent

cotton, it will still conduct sound waves to limited degree, loud-ticking watch even

under these circumstances being heard about or meters. The suspect has his ear which

is stated to be deaf occluded with cotton, and then the test is made with the hearing of

the normal ear, the suspect being told to count the ticks of the watch. The suspect’s normal

hearing ear is then occluded with cotton and the testing is made with the unoccluded

supposedly deaf ear. Under this test, if he claims failure to hear the watch under meter,

he is malingering.

i. The Chiman-Moos test is made with the C2 tuning fork. The vibrating tuning fork

is held at equal distance from each ear. The suspect may claim that he hears it better in

the normal ear. The vibrating tuning fork is then placed on the vertex of the skull. The

suspect hearing it equally well in both ears will at first hesitate and then state he hears

it better in the normal ear. In diseases of the conducting apparatus he will hear it better

in the diseased ear. If now the external meatus of the normal ear is tightly closed and the

vibrating tuning fork is placed upon the vertex of the skull, the individual with the diseased

ear will state he hears it better in the normal, closed ear, or it may be impossible for him

to decide in which ear he perceives the tone better. The suspect, with the normal ear tightly

obstructed, will state that he does not preceive the sound of the fork when thus placed on

the vertex of the skull.

Section YI

MOUTH, NOSE, FAUCES, PHARYNX, TRACHEA, ESOPHAGUS, AND LARYNX

Paragraph

General service 27

Limited service 28

Nonacceptable 29

Use of diagnostic aids 30

27. General service.—a. Enlarged tonsils.

6. Adenoids.

c. Deviation of the nasal septum or enlarged turbinates which do not interfere more

than mildly with nasal breathing.

d. Acute primary sinusitis, provided the acceptance of the individual is deferred for

reexamination until after reasonable time has elapsed and the sinusitis has disappeared.

e. Hay fever, if mild.

28. Limited service.—a. Deviation of the nasal septum or enlarged turbinates which

do not interfere more than moderately with nasal breathing.

ft. Hay fever, if moderate.

29. Nonacceptahle.—Defects such as—-

a. Deformities of the mouth, throat, and nose which interfere with mastication of

ordinary food, with speech, or with breathing.

1). Destructive syphilitic disease of the mouth, nose, throat, larynx, or esophagus.

c. Laryngeal paralysis due to any cause.

257-966'—67 13
172 PHYSICAL STANDARDS

d. Tracheostomy.

e. Stricture of the esophagus.

/. Chronic sinusitis of the accessory sinuses of the nose. (This diagnosis will be

established by the presence of chronic purulent nasal discharge, large nasal polypi, and

other signs and symptoms and confirmed by transillumination or X-ray examination, or

both.)

g. Chronic atrophic rhinitis with offensive odor (ozena).

h. Malignant neoplasms.

i. Nasal obstruction due to septal deviation, hypertrophic rhinitis, or other causes, if

sufficient to cause mouth breathing.

j. Aphonia.

k. Hay fever, if severe.

l. Chronic laryngitis.

m. Perforation of the hard palate.

n. Stricture or other organic disease of the esophagus.

o. Harelip.

p. Perforation of the nasal septum associated with interference of function, or ulceration or crusting, and when due to organic disease.

30. Use of diagnostic aids.—Examining physicians will make use of laryngoscopy,

transillumination of the sinuses, and X-ray when available to determine more definitely

the physical fitness of individuals who have defects involving the upper air passages, head,

or esophagus when such diagnosticaids are indicated.

Section VII

DENTAL REQUIREMENTS Paragraph

General service 31

Limited service 32

Nonacceptable 33

General considerations 34

31. General service.—a. Individuals who are well nourished, of good musculature, are

free from gross dental infections, and have minimum requirement of an edentulous upper

jaw and/or an edentulous lower jaw, corrected or correctible by full denture or dentures.

h. Malocclusion.—When it is evident from the individual’s general physical condition

that his malocclusion has not seriously interfered with the mastication of normal diet,

provided that in the excursions of the mandible or with the mandible at rest, the teeth do

not impinge upon opposing soft tissues and that the malocclusion has not resulted in secondary pathological changes.

32. Limited service.—There are no dental conditions that warrant classification as

limited service.

33. Nonacceptable.—a. Diseases of the jaws and associated structures which are

irremediable or not easily remedied, or which are likely to incapacitate the individual for

satisfactory performance of military duty.

I). Extensive loss of oral tissue in an amount that would prevent replacement of missing teeth by satisfactory denture.

34. General considerations. —Examining dentists, to protect the interest of the Government and the individual, will exercise every care to indicate clearly the status of every

tooth, as well as those extracted, missing, or unerupted. The exact teeth replaced by

prosthetic appliance or bridge (with abutments) as well as the serviceability of the appliance will be recorded. Defects, infections (including pyorrhea) will be listed and classified

as to severity.
APPENDIX 173

Section VIII

SKIN

Paragraph

General service 35

Limited service 36

Nonacceptable 37

35. General service.—a. Acute nonexanthematous and noncommunicable diseases of

the skin which ordinarily run temporary course.

ft. Diseases which are trivial in character and which do not interfere with the general

health and are not incapacitating. Among these common and usually trivial diseases may

be enumerated

(1) Acne, mild or moderate. (Care must be taken to exclude individuals with

chronic severe acne, particularly when the face is involved to the extent of being

markedly disfiguring or the shoulders extensively involved, making it likely to

be aggravated by shoulder straps or packs or by other military equipment.)

(2) Anomalies of pigmentation.

(3) Scars not extensive, disfiguring, nor incapacitating in character.

(4) Warts, except plantar warts on weightbearing areas.

(5) Skin infections, if mild and considered of no significance.

(6) Acute eczema, if mild.

(7) Naevi which are not greatly disfiguring and are not so located as to be subject

to irritation or trauma by the normal wearing of military equipment.

S) All forms of pediculosis.

(9) All forms of ringworm, unless severe and not easily remediable.

(10) Scabies, unless severe and not easily remediable.

(11) Mild and not extensive psoriasis.

c. Simple ulcers or other acute pathological conditions of the skin which are easily

curable.

d. Unusual skin conditions should arouse suspicion of self-inflicted lesions (dermatitis

factitia). See section XXIII.

e. True alopecia areata, provided the existence of disqualifying endocrine, neurological, or other disqualifyingconditions are excluded.

36. Limited service.—There are no skin criteria to warrant initial selection for limited

service.

37. Nonacceptable.—Serious or incapacitatingskin disorders such as

a. Chronic skin disease, chronic ulcers of the skin, or cured syphilitic lesions which

are so severe as to incapacitate the individual for the duties of soldier or so disfiguring

as to render the individual objectionable in common social intercourse.

6. Actinomycosis.

c. Dermatitis herpetiformis of long duration.

d. Epidermolysis bullosa.

e. Generalized dermatitis of long duration.

f. Allergic dermatoses, if severe.

g. Mycosis fungoides.

h. Chronic pemphigus,

i. Lupus vulgaris.

j. Elephantiasis.

k. Ringworm, if very severe and not easily remediable.

l. Psoriasis, if other than mild.

m. Scabies, if very severe and not easily remediable.

n. Cysts and benign tumors of the skin of such size and/or location as to interfere with

the normal wearing of military equipment.
174 PHYSICAL STANDARDS

o. Pilonidal cyst or sinus. (If there is only simple dimpling of the skin or short simple

sinus in the postanal region, the individual will be accepted for general service.)

p. Plantar warts on weight bearing areas.

Section IX

HEAD Paragraph

General service 38

Limited service 39

Nonacceptable 40

38. General service.-—a. Moderate deformities of the bones of the skull such as depressions, exostoses, etc., unassociated with evidence of disease of the brain, spinal cord, or

peripheral nerves and not preventing the individual from wearing military headgear.

h. Abnormalities which are apparently temporary in character resulting from recent

injuries. (These include severe contusions and other wounds of the scalp and cerebral

concussion. Individuals with these conditions will have the final examination temporarily

deferred for months.) See paragraphs 90e and 91 h.

39. Limited service.—There are no head defects to warrant initial selection forlimited

service.

40. Nonacceptable.—a. Deformities of the skull in the nature of depressions, exostoses,

etc., of degree which would prevent the individual from wearing military headgear.

1). Deformities of the skull of any degree associated with evidence of disease of the

brain, spinal cord, or peripheral nerves. See paragraphs 90e and 917n

Section

SPINE, SCAPULAE, AND SACROILIAC JOINTS

Paragraph

General service 41

Limited service 42

Nonacceptable 43

X-ray examination 44

41. General service.—a. Lateral deviation of the spine of inch or less from the midline if the mobility and weight bearing power are good.

6. Fracture of the coccyx.

c. Prominent scapulae not interfering with wearing of uniform or military equipment.

d. Complaint of disease of the sacroiliac and lumbo-sacral joints which is unassociated

with objective signs and symptoms.

e. Fracture of the spine or pelvic bones which has healed without marked deformity

and which has not interfered with the following of useful vocation in civil life.

f. Spina bifida occulta providing it is asymptomatic, unassociated with objective signs

and symptoms and can be demonstrated by X-ray examination only.

42. Limited service.—Lateral deviation of the spine from the midline of more than

inch and less than inches.

43. Nonacceptable.—Conditions such as—-

a. Tuberculosis, either active or healed.

1). Osteoarthritis or rheumatoid arthritis, or chronic arthritis from any cause.

c. Healed fractures of the vertebrae or pelvic bones with associated symptoms which

have prevented the individual from following useful vocation in civil life.

d. Lateral deviation of the spine from the midline of more than inches, curvature

of the spine (scoliosis, kyphosis, or lordosis) of degree sufficient to interfere with the

wearing of uniform or military equipment or which has prevented the individual from

following useful vocation in civil life.
APPENDIX 175

e. Disease of the sacroiliac and lumbo-sacral joints which is of chronic type and is

obviously associated with pain referred to the lower extremities, muscular spasm, postural

deformities, and limitation of motion in the lumbar region of the spine.

f. Nucleus pulposus (herniation intervetebral disc) or history of operation for this

condition.

44. X-ray examination.—When examining physicians are in doubt concerning the cause

and the extent of disease of the bones and joints, an X-ray examination will be made.

Section XI

EXTREMITIES

Paragraph

General service 45

Limited service 46

Nonacceptable 47

General considerations 48

45. General service.—a. Old or recent fractures which have healed normally with no

resulting impairment of function.

&. Recent injury of bone or joint with or without fracture or dislocation which, in

the opinion of the examiners, is only temporarily incapacitating. (Individuals with these

conditions will be given period of time not less than weeks for recovery before the final

examination is made.)

c. Webbed fingers and toes, unless severe in degree.

d. Entire loss of little linger of either of both hands, or the ring finger of the left hand.

e. Loss of terminal phalanx of the right index finger; loss of the terminal and middle

phalanges of one finger, except the right index finger, on one or both hands; loss of one

phalanx of one or all fingers on one or both hands, provided the function of the hand is

ample to permit the performance of general military duty.

/. Scars and deformities of moderate degree of the hand or hands which do not interfere with normal function.

g. Stiff fingers of degree not to interfere with function.

h. Flat foot unless accompanied with symptoms of weak foot or when the foot is weak

on test. Pronounced cases of flat foot attended with decided eversion of the foot and marked

bulging of the inner border, due to inward rotation of the astragalus, and rigid flat foot

are disqualifying regardless of the presence or absence of subjective symptoms.

i. Hammertoe which does not interfere with the wearing of military shoe.

j. Hallux valgus, unless severe.

k. Absence of one or two of the small toes of one or both feet, if function of the foot

is good.

I. Ingrowing toenails, unless severe. 46. Limited service.—a. Loss of two entire fingers of either hand, except combination

of the right index and middle finger.

&. Webbed fingers or toes, if severe in degree.

c. Moderate deformities of one or both upper extremities which do not and have not

interfered with function to degree to prevent the individual from following useful vocation in civil life.

d. Abduction and pronation of the foot (knock-ankle) when this condition is not associated with rigidity of the tarsal jointor with deformity of the foot.

e. Loss of great toe.

/. Loss of dorsal flexion of great toe.

g. Clubfoot of slight degree if tarsal, metatarsal, and phalangeal joints are flexible,

permitting wearing of the military shoe and, in the opinion of the examiner, will not interfere with the performance of military duty.
176 PHYSICAL STANDARDS

h. Slight claw toes not involving obliteration of the transverse arch and which do

not interfere with the wearing of military shoe.

i. Other defects of the feet which disqualify for general military service but do not

prevent the individual from wearing military shoe and which have not prevented him

from following useful vocation in civil life.

j. Moderate deformities of one or both lower extremities which do not and have not

interfered with function to degree to prevent the individual from following useful

vocation in civil life.

1c. Adherent scars of the skin and soft tissues of an extremity, if not incapacitating

and not likely to break down.

I. Healed disease or injury of wrist or elbow with resulting limitation of motion, if

not severe in degree.

m. Internal derangement of knee joint—

(1) History of, providing disability has been mild and infrequent.

(2) Operation for, providing period of months has elapsed since operation with

freedom from symptoms.

Under (1) and (2) above, the knee ligaments should be stable in lateral and anteroposterior directions in comparison with the normal knee; the X-ray should be negative; the

thigh musculature not weak or atrophic enough to interfere with function and the full

active motion in flexionand extension is present.

47. Nonacceptable.—Defectssuch as—-

a. Loss of one or both thumbs.

h. Loss of more than two entire fingers of either hand,

c. Tuberculosis of bone or joint.

d. Old ununited fractures.

e. Old unreduced or recurring dislocations of any of the major joints.

/. Disease of any bone or joint healed with such resulting deformity or rigidity that

the function is impaired to degree that it will interfere with military service.

g. Muscle paralysis or contraction which disturbs function to the degree of interference

with military service.

h. Adherent scars of skin or soft tissue to degree which seriously interfere with

function.

i. Varicose veins, if severe in degree or if associated with edema or with present or

previous ulcer of the skin.

j. Rigid flat foot or flat foot when accompanied with symptoms of weak foot or when

the foot is weak on test. Pronounced cases of flat foot attended with decided eversion of the

foot and marked bulging of the inner border, due to inward rotation of the astragalus, are

disqualifying regardless of the presence or absence of subjective symptoms.

1c. Obliteration of the transverse arch associated with permanent flexion of the small

toes (claw toes).

I. Hallux valgus, if severe and associated with marked exostosis or bunion.

m. Clubfoot, if marked in degree or which interferes with the wearing of military

shoe.

n. Diseases of the bone or of the hip, knee, or ankle joint which interfere with function and weight-bearingpower.

o. Deformities due to fracture or other injury which seriously interfere with function and weight-bearingpower.

p. Sciatica which is apparently intractable and disabling to the degree of interference

with the function of walking and weight-bearingpower.

q. Amputations of extremities in excess of those already cited.

r. Active osteomyelitis of any bone, or substantiated history of osteomyelitis of any

of the long bones of the extremities at any time.
APPENDIX 177

s. Osteoarthritis or rheumatoid arthritis, or chronic arthritis from any cause.

t. Plantar warts on weight-bearingareas.

48. General considerations.—It is important that individuals with defects of the feet

which would prevent them from taking proper training will not he classified for general

military service.

Section XII

NECK

Paragraph

General service 49

Limited service 50

Nonacceptable 51

49. General service.—a. Nonspastic contraction of the muscles of the neck which is

not of great degree and will not prevent the wearing of uniform or military equipment.

b. Simple goiter unassociated with pressure symptoms, provided the enlargement of

the thyroid will not interfere with the wearing of uniform or military equipment.

c. Enlarged lymph nodes of the neck which are not manifestation of systemic disease, do not apparently interfere with the general health, and are not large enough to

interfere with the wearing of uniform or military equipment.

d. Healed tuberculous lymphnodes when few in number and densely calcified.

e. History of thyroidectomy for nontoxic goiter.

50. Limited Service.—History of thyroidectomy for toxic goiter with complete absence

of active manifestations for years.

51. Nonacceptable.—a. Toxic goiter.

b. Tumor of thyroid or other structures of the neck, including enlarged lymph nodes

and benign tumors of the neck, if the enlargement is of such degree as to interfere with

wearing of uniform ormilitary equipment.

c. Enlargement of the lymph nodes of the neck associated with leukemia or Hodgkin’s

disease.

(I. Lymphosarcoma.

e. Tuberculous lymph nodes, except as specified in paragraph 49 d.

f. Nonspastic contraction of the muscles of the neck or cicatricial contraction of the

neck to the extent that it interferes with the wearing of uniform or military equipment

or so disfiguring as to render the individual objectionable in common social intercourse.

(j. Spastic contraction of the muscles of the neck.

h. Simple goiter, if associated with pressure symptoms confirmed by X-ray, or if

enlargement is of such degree to interfere with wearing of uniform or military

equipment.

Section XIII

LUNGS AND CHEST WALL Paragraph

Chest examination 52

History 53

X-ray examination 54

Physical examination 55

Other examinations 56

General service 57

Limited service 58

Nonacceptable 59

General considerations 60

52. Chest examination.—The chest examination will include roentgenogram, as well

as the usual methods of physical diagnosis. pertinent history of past chest diseases will
178 PHYSICAL STANDARDS

be taken. Because of its importance and frequency, special consideration must be given to

the detection of tuberculosis.

53. History.—Inquiry will be made about previous and present symptoms of respiratory

disorders, particularly if abnormalities of the chest are discovered, if the weight is

below normal without other explainable cause, if there is unexplained fever, or if there are

indications of possible tuberculous lesions in other parts of the body, such as fistula in ano

or enlarged lymph nodes. The history of chronic or frequently recurring cough and expectoration, hemoptysis, pleurisy, or chronic laryngitis requires special investigation for

cause. It must be remembered, however, that pulmonary tuberculosis may exist in its

earliest stages without producing any symptoms.

54. X-ray examination.—Chest X-ray films will be made as part of the physical

examination of all selectees, applicants for voluntary enlistment of any type, and applicants

for reenlistment, and will serve as permanent records. Care will be exercised in processing

these films to insure their keeping qualities. It is imperative that these films be clearly

marked as outlined in paragraph below.

a. Identificationof films. (1) Identifying marks which are photographed on the film at the time of its

exposure are most satisfactory. When the photoroentgenographic method of

X-ray examination is employed, this may be accomplished with the special attachment which forms an integral part of the camera unit. With standard X-ray

equipment as much identifying data as possible should be recorded on the film

at the time of exposure by use of lead numbers, lead foil stencils, or other suitable

means. The additional identifying data required should be added in ink at the

bottom of the film. The Army serial number in most cases cannot be recorded

photographically at the time the film is made, as the examination precedes

acceptance. The serial number will be added as soon as practicable after the

film is processed, either in ink or with perforating machine making letter’s

and figures of the appropriate size, and is to be recorded on the light portion

of the film corresponding to the subdiaphragmatic area. Data photographically

x-ecorded will be located in the upper right and left corners of the film. It is

essential that the photographed identification be clearly legible without magnification. Photographing of the caption in such way that it may be read when

the film is viewed with the heart to the observer’s left is recommended.

(2) The minimum identifying data will be: place of examination; date; individual’s last name, first name, and middle initial; his home address; Army serial

number; age in years; weight in pounds; abbreviation for race; and, in the case

of Selective Service registrants, the local board identification code number. The

abbreviation for race will be W, X, or O, conforming with the specifications for

White, Negro, and other registrants in DSS Form 221. Except for the Army

serial number, these data can be photographed on the film at the time this is

made. They should appear in the upper corners of the film as indicated in the

following example;

Armed Forces Induction Station DOE, John D.

Philadelphia, Pa. 612 Lombard St.

28 July 1943 Philadelphia,Pa.

LB 32-050-612 31-W-156

(The local board identification code number will be found at the right side of

the local board stamp placed on DSS Form 221.)

(3) Since serial numbers are not given until men have been accepted for service,

all films of accepted men will be held at the home station of the Army examining

boards until individual serial numbers have been obtained and entered thereon.
APPENDIX 179

h. Disposition of films made in continental United States and Puerto Rico.

(1) Chest X-ray Minis made in the examination of men accepted for enlistment

or induction into the service, after being carefully checked for proper identiMcation, will be assembled in packages of appropriate size and mailed promptly

under penalty cover to the Veterans Administration, Kansas Avenue and Upshur

Street NW., Washington 25, D.C. All packages of Mims sent to the Veterans

Administration will be labeled “Exposed X-ray Films” and will show the name

of the Army organizationmaking shipment.

(2) All chest X-ray Mims of individuals who are rejected for any reason will

be delivered to the Selective Service System in accordance with agreements

entered into between the service command and the State Director of the Selective

Service System in the State from which the registrants are presented. Subject

to such local agreements, Mims of rejected individuals in general will be separated

and forwarded to State directors in appropriately labeled packages as indicated

below:

(a) “Films of individuals recommended for reexamination in months, or

other speciMed period, because of borderline tuberculosis or other chest

conditions.”

(6) “Films of individuals rejected because of tuberculosis or other chest

conditions.”

c) “Films of individuals rejected because of other than chest conditions.

c. Disposition of films made in Hawaiian Department.—Chest X-ray Mims made on

individuals in the Hawaiian Department will be held there for the present.

55. Physical examination.—This will include inspection, palpation, percussion, and

auscultation of the chest.

a. Structural abnormalities of the thoracic wall and striking rapidity, limitation, or

inequality of the respiratory movements are to be noted. &. Abnormal physical signs in the lungs, pleura, or mediastinum will be carefully

checked to ascertain whether they persist or are only transitory.

c. Particular attention will be focused upon the occurrence of pulmonary rales, which

may be elicited only after the expiratory cough. The subject will be instructed to exhale

completely with the mouth open, immediately to cough before inhaling, and then to inhale

deeply but quietly. Rales are heard most often at the beginning of inhalation after such an

expiratory cough. small patch of persistent rales at the apex, in the interscapular area,

or in some other part of the chest may be the only evidence of tuberculosis shown by

physical examination.

d. It must be borne in mind that many tuberculous lesions will not produce abnormal

physical signs. In other words, the absence of abnormal signs does not exclude tuberculosis.

e. Certain signs may arouse suspicion, but will be disregarded unless X-ray and other

studies reveal evidence of disease. These are—

(1) Slightly harsh breath sounds and slightly prolonged expiration over the right

apex above the clavicle and the third thoracic spine and/or the same signs at the

extreme left apex.

(2) Slight alteration of the breath sounds anywhere in the chest, without other

abnormal signs.

(3) Clicks or crepitations which disappearafter few deep breaths or coughs.

56. Other examinations.—It may be necessary to postpone decision in some cases until

special studies and adequate observations have been completed. For example, so-called

atypical pneumonia in an upper lobe of the lung may simulate tuberculosis, but proper

laboratory studies and another X-ray Mini and physical examination after months

usually suMice to make the differential diagnosis.

57. General service.—a. CalciMed residuals of primary tuberculosis in the pulmonary

parenchyma or hilum lymph nodes, provided the size, number, and character of such lesions

257—966 —67 14
180 PHYSICAL STANDARDS

are not such as to suggest the possibility of reactivation. Well calcified masses in adult

white subjects usually represent entirely healed lesions. Partially calcified and therefore

presumably partially caseous masses in younger subjects, particularly in persons of other

than the white race, are potentially hazardous. Clinical judgment is important in rendering

decision. In those cases in which decision cannot be made on roentgenological grounds

alone, it is essential that careful examination be made by an examiner with special

experiencein tuberculosis, taking into account the age of the subject, history, and the possible presence of nonpulmonary tuberculosis.

It. Fibrous pleural scars and adhesions, revealed most often in the roentgenogram by

simple thickening of the apical pleura, deformity of the dome of the diaphragm, or

visualization of an interlobar fissure, provided there is no evidence of disqualifying

tuberculosis of the pulmonary parenchyma.

c. Scars of operation for nontuberculous empyema which has been healed for year

or longer, provided the function of the lung is not significantly impaired, and provided

no residue of the empyema other than some fibrous thickening of the pleura is evident

upon X-ray and physical examination.

d. Healed fracture of the rib or ribs, provided the residual deformity, if any, does not

interfere seriously with respiratory movements.

e. Benign tumor of the breast or of the chest wall, provided the mass does not interfere

with the wearing of uniform or military equipment.

/. Small palpable lymph nodes of the axilla which apparently are not evidence of

disease.

g. The following conditions are temporarily disqualifying:

(1) Acute bronchitis, until final examination shows recovery without disqualifying sequelae.

(2) So-called atypical or other types of pneumonia, until final examination

shows recovery without disqualifying sequelae. Ordinarily resolution, as shown

by X-ray films, will be complete within months. Other cause of the shadow

in the X-ray film than pneumonia must be considered if complete clearing has

not occurred in months.

(3) Acute or subacute fibrinous pleurisy, definitely nontuberculous in origin, until

final examination shows recovery without disqualifying sequelae. Pleurisy of

this type is suspected or demonstrated on physical examination more frequently

than on X-ray examination.

(4) Recent fracture of rib or ribs, until final examination shows recovery

with or without deformity and provided the residual deformity, if any, does not

interfere seriously with respiratory movements.

(5) Scarred fibroid or fibrocalcific infiltrative tuberculous lesions of the lungs

represented in roentgenograms as sharply demarcated, strand-like or well defined,

small, nodular shadoivs not exceeding total area of square cm may be

accepted after deferment until subsequent examination clearly demonstrates

that the lesion is stationary and not likely to be reactivated. The minimum

period of time to determine this is months. It must be recognized that either

progression or regression of the lesion indicates instability. Clinical judgment,

taking into consideration other factors, including age and race, must be exercised in estimating the likelihood of reactivation. Experience indicates greater

likelihood of reactivation of an apparently stable lesion in persons under 25 years

of age than in older persons.

58. Limited service.—Deformity of clavicle, ribs, or scapula of degree disqualifying

for general military service but not preventing the individual from successfully following

useful vocation in civil life.

59. Nonacceptable.-—a. Tuberculosis of the lungs or tracheobronchial lymph nodes

except as defined in paragraph 57 and (5). Small infiltrative tuberculous lesions, unless
APPENDIX 181

of sharply defined linear or nodular appearance on roentgenograms, as described in

paragraph 57 (5), are disqualifying even though involving total area of less than square cm and apparently stable over period of months.

h. Fibrinous or serofibrinous tuberculous pleurisy, and serofibrinous pleurisy of un- known origin. Inasmuch as pleurisy, with or without effusion, is frequent manifestation

of active tuberculosis, all persons who have apparently recovered from pleurisy will be

examined with the greatest care. Authenticated history of pleural effusion of unknown

origin within the last years; chronic fibrous pleurisy sufficient to cause marked retraction of the chest wall and of the mediastinum or to cause density in the roentgenogram which completely obscures considerable section of the pulmonary fields.

c. Spontaneous pneumothorax, history of spontaneous pneumothorax within the last years or history of repeated spontaneous pneumothorax, authenticated by properly dated X-ray films.

d. Empyema: residual sacculation or unhealed sinuses of the chest wall following

operations for empyema.

e. Chronic bronchitis.

f. Bronchiectasis.

g. Bronchial asthma.

h. Bullous or generalizedpulmonary emphysema

i. Cystic disease of the lung.

j. Silicosis as represented in the roentgenogram by strandlike and nodular shadows any other form of severe pulmonary fibrosis.

k. Abscess of the lung.

I. Active mycotic disease of the lung and residual cavitation due thereto.

m. Foreign body in the lung. An individual may be accepted after foreign body has

been removed from bronchus, provided examination shows recovery without disqualifying

sequelae.

n. Tumor of the trachea, bronchi, lung,pleura, or mediastinum.

o. Any malignant tumor of the breast or chest wall.

p. Tuberculosis of the ribs or of other parts of the chest wall.

q. Benign tumor of the breast or of the chest wall of such size and location as to

interfere with the wearing of the uniform or military equipment.

60. General considerations. a. Tuberculosis. —An alleged history of tuberculosis will

not be considered cause forrejection unless supported by objective evidence substantiating

the claim. Examining physicians should make every effort to determine the validity of the

alleged history by requesting the individual’s X-ray films and summary of the clinical

record. This will be necessary only when the present chest X-ray film of an individual

alleging history of tuberculosis reveals no evidence of disqualifying defects. It should

be recognized that in some instances moderately extensive pulmonary tuberculosis may

resolve, leaving no residuals of disqualifying character or extent visible on X-ray examination. An authenticated history of active moderately or far advanced tuberculosis will be

considered as disqualifying. An authenticated history of active minimal pulmonary tuberculosis within the past years also will be considered as disqualifying. In those cases in

which pulmonary tuberculosis has been previously diagnosed on the ground of subjective

symptoms and of physical signs which are without pathological significance, the conclusions

of examiningphysicians will be based on their own findings and their own evaluation of

the cases.

h. Bronchiectasis.—Not infrequently routine chest X-ray examination will reveal no

obvious abnormalities even though bronchiectasis of marked degree is present. When the

history or physical examination suggests the possibility of bronchiectasis, individuals should

be held for study under the provisions of paragraph and 6.
182 PHYSICAL STANDARDS

Section XIV

HEART, BLOOD VESSELS, AND CIRCULATION

Paragraph

History G1

Procedure 62

General service 63

Limited service 64

Nonacceptable 65

Electrocardiogram 66

X-ray 67

General considerations 68

61. History.—Questions will be asked during the course of the examination concerning

past history of rheumatic fever, chorea, spells of rapid heart action, syphilis, and reaction to

physical effort which may be helpful in the interpretation of the findings, but chief reliance

will not be placed on the history alone.

62. Procedure.—The following procedure will govern in the physical examination of the

heart. For the information of the examiners it is suggested that reference be made to the

publication adopted and distributed by the American Heart Association entitled “The Nomenclature and Criteria for the Diagnosis of Diseases of the Heart.”

a. Location of apex impulse and determination of character.

h. Auscultation of the heart sounds over apex, lower sternum, and second and third

interspaces to right and left of sternum, noting accentuation of sounds, the presence of

murmurs, rate and rhythm. Compare the heart rate with the radial pulse rate.

c. Inspection of root of neck and upper thorax followed by percussion of first interspace on each side of the manubrium for evidence of aneurysm.

d. Count of radial pulse, observation of the rhythm, and palpation of radial arteries

for unusual thickeningor high tension.

c. The blood pressure will be routinely measured. It will be determined with the subject

in the sitting position. If orthostatic hypotension is suspected, the blood pressure will also

be measured while the subject is standing. If the blood pressure appears to be abnormally

high, it will be measured after the subject has rested in the recumbent position. When

measured in other than the sitting position, statement will be appended as to the position

of the subject at the time of measurement.

/. Exercise (stepping 12 times briskly upon common chair) will be used in selected

cases to bring out significant heart murmurs but tins test in itself is not to be considered

reliable estimate of the functional capacity of the heart.

g. If in doubt about an unexplained tachycardia, take the temperature. Fever that is

sometimes not very obvious can account for otherwise unexplained tachycardia.

h. If there is doubt as to the presence of cardiovascular disease, the individual will be

held for detailed reexamination.

63. General service.—a. heart will be considered normal when the apex impulse is

within the left midclavicular line and not below the fifth interspace; when sounds are

normal and there are no thrills or important murmurs when there is no abnormalpulsation

or dullness above the base of the heart; when pulse rate is normal and regular and there

is no unusual thickening of the arteries or significant elevation of blood pressure.

b. Given heart of normal size, responding normally to exercise, slight to moderate

pulmonary systolic murmur, louder in the recumbent position and on expiration and largely

or entirely abolished by deep inspiration, is the commonest of all murmurs and is to be considered physiological (functional). faint systolic murmur localized at the aortic area

without thrill and followed by normal second sound may be considered normal, but any

aortic systolic murmur of moderate intensity or louder probably indicates disease (for

example, aortic dilatation or stenosis), and demands further study. loud systolic murmur
APPENDIX 183

(usually with thrill), maximal at the left of the sternum in the third and fourth spaces, suggests the probability of congenital ventricular septal defect and is cause for rejection.

faint systolic murmur at the apex, varying in intensity, with forced respiration, less well

heard in the erect position than when recumbent and unattended by cardiac enlargement or

other evidence of heart disease, or by verified history of rheumatic fever, may be considered to be physiological (functional), but moderate or loud apical systolic murmur which

persists in all phases of respiration and body positions and is intensified by exercise is evidence of abnormality of the heart. Any diastolic murmur heard over any portion of the

cardiac area is evidence of disease. The presystolic (or middiastolic) murmur of mitral

stenosis may be confined to small area at or just within the cardiac apex and heard only

in the recumbent position (best in the left lateral decubitus and with the hell stethoscopic

chest piece) it is accentuated by exercise. slight aortic diastolic murmur, on the other

hand, may be heard only along the left sternal border, with the patient erect or leaning

slightly forward, best at the end of forced expiration; it is more easily heard with the

Bowles stethoscopic chest piece. Frequently, interpretation must be based on cumulative

evidence or number of relatively slight deviations from the normal.

c. pulse rate of 100or over which is not persistent and not due to paroxysmal tachycardia. (A pulse rate of 100 or over may be temporary and due to excitement or to recent

infection, such as pneumonia or local infections about the nose, mouth, and throat, or may

be induced by drugs.)

d. pulse rate of not lower than 50 per minute.

e. Sinus arrhythmia. (This consists in quickening of the pulse rate during inspiration

and slowing during expiration and is best recognized with the individual recumbent and

breathing deeply.)

/. Elevation of blood pressure from excitement, proved to be temporary.

64. Limited service.—There are no cardiovascular criteria to warrant initial selection

for limited service.

65. Nonacceptable.—a. Circulatory failure evidenced by definite symptoms such as

undue breathlessness, pain, and evidence of congestive failure (engorged neck veins, enlarged

liver, edema, as well as dyspnea).

&. Hypertrophy and/or dilatation of the heart evidenced by displacement of the apex

impulse to the left of the midclavicular line or below the sixth rib, and of heaving or

diffuse character, or by X-ray evidence.

c. persistent heart rate of 100 or over when this is proved to be persistent in the

recumbent posture and on observation and reexamination over sufficient period of time,

unless in the opinion of the medical examiner the increased cardiac rate is due to psychic

reaction and not secondary to any disease condition, including infection.

d. Paroxysmal tachycardia if recurrent and disabling. See also section XXIII

e. Heart block.

f. Any serious disturbance of rhythm such as auricular fibrillation.

g. Valvular disease.

7i. Congenital heart disease.

i. Persistent blood pressure at rest above 150 mm systolic or above 90 mm diastolic. If

the blood pressure reading is somewhat (16-20 mm) above 150 mm systolic on the first

reading, it should be repeated after hour’s rest recumbent.

j. Thrombophlebitis of one or more extremities if there is persistence of the thrombus

or any evidence of circulatory obstruction in the involved vein or veins.

k. Other abnormalities of the peripheral vascular system, including large varicose

veins, Raynaud’s disease, Buerger’s disease (thromboangitis obliterans), erythromelalgia,

and arteriosclerosis. In doubtful cases special tests should be employed.

I. Aneurysm ofany vessel.

m. Pericarditis.

n. Endocarditis.
184 PHYSICAL STANDARDS

o. True angina pectoris.

p. Authenticated history of coronary thrombosis, and/or myocardial infarction.

q. (1) Neurocircuiatory asthenia (effort syndrome). Usual symptoms of this condition are exhaustion, breathlessness, heartache, and palpitation. These symptoms may follow exertion such as would not produce them in healthy individuals.

These, and other symptoms such as dizziness or fainting, may arise without

evidence of organic disease sufficient to account for the disability of the individual. Cases of effort syndrome may occur—

(а) As an accompaniment of organic heart disease.

(б) Following infections.

(c) In individuals with poor physique or insufficient training for the work

required.

In some cases more than one of the above factors is present.

(3) It is important to observe that neurocircuiatory asthenia should not be confused with tachycardia alone or increased blood pressure alone or both together,

although such conditions may be present with neurocircuiatory asthenia. The

diagnosis must be clear and based on the symptom complex.

r. Orthostatic hypotension or tachycardia.—The blood pressure and pulse rate will

be taken with the individual in the recumbent position and after standing minutes. An

increase in pulse from normal in recumbent position to 120 beats per minute or more when

the individual stands or decrease of normal blood pressure (when the individual is

recumbent) to values less than 90 systolic and (iO diastolic when the individual stands may

be considered evidence of definite physiologic disturbance and in itself cause for rejection

unless the condition is very temporary following an illness, operation, or exhausted state.

s. Acute x-heumatic fever, or verified history of single or recurrent attacks of rheumatic

fever within the previous years.

66. Electrocardiogram.—The electrocardiogram is of great assistance in deciding the

nature of cei’taixx cardiac abnormalities the most important of which are various arrhythmias, defects of conduction, and diseases of the myocardium. The following electrocardiographic findings may be considered to be within the normal range: P-R interval and

QRS condxxction time not exceeding 0.20 secoxxds and 0.10 seconds respectively; axis deviation not greater than —15 degrees left or +105 degrees right; diphasic wave in Lead

and/or negative wave in Lead 3; waves not greater than mm in Leads 4R and

4F waves in Leads 4R and 4F not less than mm and 2.5 mm respectively; and elevation

of the RS-T segment in Leads 4R and 4F not to exceed mm.

67. X-ray.—In doubtful cases, fluoroscopy or teleoroentgenography is advised to

determine the size and shape of the heart and great vessels. Films should be taken at

distance of meters. The total transverse diameter of the heart is the most useful measurement in estimating cardiac size. If this exceeds the predicted transverse diameter (calculated according to the Hodges-Eyster formula), by more than cm, the heart is considered

to be enlarged. In the case of certain short, thickset men slightly greater figure may,

at the discretion of the examiner, be regarded as within the x’ange of normal, provided

no other signs of cardiovascular disease are present. Films taken for the study of the lungs

are not suitable for accurate estimation of the size of the heart.

68. General considerations. a. It is incumbent upon examining physicians to—-

(1) Accept for service men with functional murmurs or other findings which do

not indicate disease and do not impair the individual’s ability to undergo severe

bodily exertion.

(2) Exclude from active service in the Army any individual affected with disease

of the heart or blood vessels which impairs his ability to undergo severe bodily

exertion. Although many men with compensated valvular heart disease are able

to undergo severe bodily exertion, the question of aggravation in service,

especially by activation of rheumatic carditis, is likely to arise and incidentally
APPENDIX 185

to create pension problem. Therefore, all individuals with valvular heart

disease are to be regarded as unfit for service and will be rejected.

b. Men who desire to serve their country may, from patriotic motives, endeavor to

conceal known valvular lesion which has given no symptoms. On the other hand, men

drafted for service may allege or feign symptoms to obtain exemption. Individuals may

be expected to present physicians’ certificates to substantiate the existence of valvular

disease. Many of these may be given in good faith because of inadequate knowledge of

the significance of certain physiological murmurs. Such certificates will not be accepted

but examiners will satisfy themselves by their personal examinations as to the physical

qualifications of individuals.

c. It is necessary therefore that the conclusions of the examining physician in doubtful

cases be based on objective evidence in the widest sense, including physical signs, cardiac

rhythm, measurement of blood pressure, and the observed effect of effort. Nevertheless, in the presence of questionable signs or symptoms, the verified history, especially of rheumatic fever, may be factor in the final decision. No statement, however, will be accepted

as proof of the existence of cardiovascular defect unless supported by objective evidence.

d. It is the duty of examining physicians to protect the interest of the Government by

preventing the entrance into the service of men whose circulatory systems may be expected

to break down under the strain. It is also their duty to prevent the exemption or discharge

of fit subjects because of unimportant deviations from the normal. They will exercise

care in the interpretation of their findings and bear in mind constantly accidental murmurs

and other departure from the supposed normal which may occur in perfectly healthy

hearts.

Section XV

ABDOMINAL ORGANS AND WALL

Paragraph

General service 69

Limited service 70

Nonacceptable 71

General considerations 72

69. General service.—a. Abdominal scars due to surgical operation or accident which

show no hernial bulging.

b. Scar pain when found not associated with any disturbance of function of abdominal

wall or contained viscera.

c. Splenic enlargement of mild degree unassociated with evidence of other disqualifying

disease.

d. Small benign tumors of the abdominalwall.

e. Internal and external hemorrhoids, if mild in degree.

f. Relaxed inguinal ring provided there is no hernial sac present.

g. Hernia, small umbilical (patent umbilical ring).

h. History of cholecystectomy provided there are no residual disqualifying sequelae.

70. Limited service.—a. Hernia, inguinal, which has not descended into the scrotum;

femoral.

b. There are no other defects of the abdominal organs or wall to warrant initial selection for limited service.

71. Nonacceptable.—Defects such as—

a. Hernia, inguinal, which has descended into the scrotum; recurrent; postoperative;

ventral; umbilical, if moderate or large in size.

b. Acute or chronic cholecystitis with or without cholelithiasis, if diagnosis is confirmed by usual laboratoryprocedures or authentic medical history.

c. Ulcer of the stomach or duodenum, if diagnosis is confirmed by the usual laboratory

procedures or authentic history of gastric or duodenal ulcer.
186 PHYSICAL STANDARDS

d. Authenticated history of surgical operations for gastric or duodenal ulcer.

e. Authenticated history of true intestinal obstruction of any kind.

f. Sinuses of the abdominal wall.

g. Stricture or prolapse of the rectum.

h. Fistula in ano.

i. Enlargement of the spleen associated with leukemia, Hodgkin’s disease, splenic

anemia, or other disqualifying disease; great enlargement of the spleen from any cause.

j. External hemorrhoids sufficient in size to produce marked symptoms. Internal

hemorrhoids if large or accompanied with hemorrhage, or protruding intermittently or

constantly.

k. Megacolon, diverticulitis, ileitis, and ulcerative colitis.

l. Absence of one kidney.

m. Splenectomy for any cause, other than trauma or congenital hemolytic icterus.

n. Cirrhosis of the liver.

72. General considerations. a. When necessary to confirm diagnosis, examining

physicians will avail themselves of fluoroscopy and roentgenography.

5. When examining physicians are able to command hospital facilities and the necessary diagnostic apparatus, they will, within their discretion, use test meals and chemical

and microscopic examination of the stomach contents and stools.

c. Examining physicians will make use of digital rectal examination of defects referable to that region and, when necessary, proctoscopy will also be utilized.

d. Individuals who are found to have parasites or their eggs in stools will have this

condition indicated on report of examination.

e. Moderate impulse produced by cough at the inguinal, femoral, or umbilical ring, or

at the site of scar is not necessarily indicative of hernia.

/. In cases of suspected gastric or duodenal ulcer every effort will be made to obtain

trustworthy history, includingauthentic medical records.

Section XVI

VENEREAL DISEASES

Paragraph

General service 73

Limited service 74

Nonacceptable 75

General considerations 76

73. General service.—a. Gonorrhea, uncomplicated, acute, orchronic.

5. Syphilis, except cardiovascular, cerebrospinal, or visceral.

c. Chancroid, uncomplicated.

74. Limited service.—There are no venereal disease criteria to warrant initial selection

for limited service.

75 Nonacceptahle.—a. Stricture of the urethra, severe.

6. Gonorrheal arthritis.

c. Other complications of gonorrhea, including acute prostatitis, seminal vesiculitis,

and epididymitis.

d. Cardiovascular, cerebrospinal, and visceral syphilis.

e. Granuloma inguinale.

/. Lymphogranuloma venereum (active).

76. General considerations.—Examination for the detection of venereal disease will

include inspection of the skin and genitalia for lesions; cardiac and neurological examination to detect late complications of syphilis; blood serological test for syphilis, and in individuals with latent syphilis, spinal fluid tests.
APPENDIX 187

Section XVII

GENITO URINARY ORGANS

Paragraph

General service 77

Limited service 78

Nonacceptable 79

General considerations 80

77. General service, a. Mild albuminuria without casts which is proved by observation

and repeated examination to be temporary in character or orthostatic in type.

ft. Absence of one testicle unless removed on account of malignant disease or

tuberculosis.

c. Undescended testicle which lies within the abdominal cavity

d. Varicocele of moderate size.

e. Hydrocele of moderate size.

f. Epispadias or hypospadias, if mild in degree

g. History of unilateral renal calculus with freedom from symptoms and if the X-ray

is negative for calculi.

It. Phimosis.

78. Limited service.—a. Stricture ofthe urethra unless severe.

h. Floating kidney. (Floating kidney is one which is freely movable.)

79. Nonacceptable. a. Acute or chronic nephritis.

ft. Stricture of the urethra, severe. c. Urinary fistula or incontinence.

d. Acute or chronic infections of the kidney.

e. Absence of one kidney.

/. The presence of renal calculus, or substantiated history of bilateral renal calculi

at any time.

g. Chronic pyelitis.

ft. Hydronephrosisor pyonephrosis.

i. Tumors of the kidney, bladder, or testicle.

j. Chronic cystitis.

k. Amputation of the penis, if the resulting stump is insufficient to permit normal

function of micturition.

Z. Hermaphroditism.

m. Hypertrophy of the prostate gland with urinary retention.

v. Epispadias or hypospadias when urine cannot be voided in such manner as to

avoid soiling of clothing or surroundings, or when accompanied by evidence of chronic

infection of the genito-urinary tract.

o. Bed wetting, if substantiated by physician’s affidavit or by other acceptable documentary evidence.

p. Varicocele, if large.

q. Hydrocele, if large.

r. Undescended testicle which lies within the inguinal canal.

80. General considerations. a. Routine urinalysis to include determination of specific

gravity and the absence or presence of albumin and sugar will be done on all individuals.

Microscopic study of the urine will be done when indicated. Examining physicians should

require examinees to void the urine in their presence. It must be emphasized here that

prior to voiding the examinee must be examined for the presence of venereal disease.

When albumin and/or casts are found in the urine, urinalysis should be repeated not less

than twice day on or more successive days. If the urine shows albumin and/or casts

and this condition of the urine is associated with enlargement of the heart, high-blood
188 PHYSICAL STANDARDS

pressure, and other evidences of cardiovascular-renal disease, the diagnosis of chronic

nephritis may be made immediately. If the presence in the urine of albumin and/or casts

is proved to be inconstant and if the condition is unassociated with evidence of cardiovascular and/or renal disease, decision should lie within the judgment and discretion of the examining physicians. When blood is found in the urine thorough study will be made to determine the underlying cause.

h. When it is deemed necessary, examining physicians will employ X-ray facilities to

verify diagnosis of defects of the genito-urinary organs.

Section XVIII

ENDOCRINE AND METABOLIC DISORDERS

Paragraph

General service 81

Limited service 82

Nonacceptable 83

81. General service.—a. Simple colloid goiter, provided the enlargement of the thyroid

will not interfere with the wearing of uniform or military equipment. See paragraph 49e.

ft. Frdhlich’s syndrome, if mild in degree.

82. Limited service.—a. Frdhlich’s syndrome, if moderate in degree.

6. Pellagra, beriberi, scurvy, sprue, and other nutritional deficiencies, if mild and

remediable by diet and appropriate treatment.

83. Nonacceptable.—a. Toxic goiter. (It should be remembered that malingerers may

use thyroid medication to produce many of the symptoms of thyrotoxicosis.)

7>. Simple goiter with definite pressure symptoms or so large in size as to interfere with

wearing uniform or military equipment.

c. Cretinism.

(I. Myxedema, spontaneous or postoperative (with clinical manifestations and diagnosis not based solely on low basal metabolic rate).

e. Gigantism or acromegaly.

f. Frohlich’s syndrome, if severe.

g. Hyperparathyroidism and hypoparathyroidism when the diagnosis is supported by

adequate laboratory studies.

h. Addison’s disease.

i. Diabetes mellitus. If sugar is found in the urine, further specimens should be voided

in the presence of the physician or authorized assistant, and on more than one occasion.

In doubtful eases the fasting blood sugar should be determined. Consideration will be given

to authentic medical records indicating the existence of diabetes mellitus.

j. Diabetes insipidus. (Before diabetes insipidus is diagnosed, malingering by drinking

large quantities of water will be excluded.)

fc. Persisting glycosuria.

I. Nutritional deficiency diseases (including sprue, beriberi, pellagra, and scurvy)

which are severe or not readily remediable or in which the permanent pathological changes

have been established.

m. Gout.

n. Simmonds’ disease; Cushing’s syndrome; other diseases due to disorder of the

pituitary gland.

o. Hyperinsulinism when established by adequate investigation and if regarded by the

examiners as of sufficient degree to disqualify for military service.
APPENDIX 189

Section XIX

DISEASES OF BLOOD AND BLOOD-FORMING TISSUES

Paragraph

General service 84

Limited service 85

Nonacceptable 86

84. General service.—a. Secondary anemia, mild, due to easily remediable causes.

b. Malaria, acute or chronic, mild.

85. Limited service.—There are no diseases of this group which warrant initial selection for limited service.

86. Nonacceptable.—a. Hemophilia.

b. Thrombocytopenic purpura.

c. Pernicious anemia.

d. Aplastic anemia.

e. Hemolytic ictero-anemia (hemolytic jaundice).

f. Splenic anemia.

g. Polycythemia vera.

h. Leukemia, acute or chronic, of any type.

i. Malaria, chronic, if more than mild.

j. Sickle cell anemia.

k. Hodgkin’s disease.

Section XX

NEUROLOGICAL DISORDERS

Par.ngraph

Methods of examination 87

General service 88

Limited service 89

Nonacceptable 90

Diagnostic criteria 91

87. Methods of examination. a. In order to detect the presence of certain common neurological diseases, particularly epilepsy, postencephalitic and posttraumatic syndromes,

multiple sclerosis, drug addiction, and hysteria, information regarding the life history of

the individual is essential. Therefore, history will be obtained relative to convulsions,

fainting spells, attacks of unconsciousness, routine use of any medicines, hospitalization,

severe head injury, and educational and occupational history.

b. The neurological examination will be conducted as follows: The individual will be

examined stripped. He will walk straight line at brisk pace with his eyes open, stop,

and turn around. He will then return in the same manner with his eyes closed, stop, and

turn around. Look for spastic, ataxic, incoordinate or limping gait; absence of normal associated movements deviation to one side or the other; the presence of abnormal involuntary

movements undue difference in performances with the eyes open and closed. The individual

will then stand erect, feet together, arms extended in front. Look for unsteadiness and

swaying, deviation of one or both of the arms from the assumed position, tremors or other

involuntary movements. With eyes closed he will then touch his nose with the right and

then the left index finger. Look for ataxia, tremors, overshooting, particularly at the end

of the movement. Examine joint and spine movements and muscle condition. Look for

muscular atrophy or pseudo-hypertrophy muscular weakness, limitation of joint movement

and spine stiffness. As to pupils, look for irregularity, inequality, diminished or absent contraction to light; movements of eyes, facial muscles, and tongue. Look for strabismus,
190 PHYSICAL STANDARDS

ptosis, sustained nystagmus, tremors of retracted lips, asymmetry or tremors of face or

tongue. Sensation will be examined by pricking lightly each side of the forehead, bridge of

nose and chin, across the volar surface of each wrist, and dorsum of each foot. Look for

inequality of sensation right and left. If these sensations are abnormal, vibration sense

should be tested at ankles and wrists by tuning fork. With the eyes closed, he will run each

heel from the opposite knee to the ankle. Test sense of movement of great toes and thumb.

Look for diminution or loss of vibration and sense of position, and ataxia. Knee jerks and

plantar reflexes should be tested. When indicated, appropriate laboratory tests and X-ray

examinations will be made.

88. General service.—These registrants present—

a. healthy nervous system as manifested by absence of signs of disease of the brain,

spinal cord, cranial and peripheral nerves.

b. Certain variations clearly within physiological limits such as minor tremors.

c. Inconsequential paralyses such as those resulting from poliomyelitis or lesions of

the peripheral nerves not likely to interfere with military duties.

89. Limited service.—Individuals with local paralyses such as those due to poliomyelitis or nonprogressive disease of the peripheral nerves of such degree that they disqualify

for general military service but have not interfered with locomotion and have not prevented

the individual from successfully following useful vocation in civil life are acceptable for

limited service.

90. Nonacceptable.—Any serious neurological disorders such as—

a. Neurosyphilis of any form (general paresis, tabes dorsalis, meningovascular

syphilis).

b. Degenerative disorders (multiple sclerosis, encephalomyelitis, cerebellar and Friedreich’s ataxia, athetoses, Huntington’s chorea, muscular atrophies and dystrophies of any

type; cerebral arteriosclerosis).

c. Residuals of infection (moderate and severe residuals of poliomyelitis, meningitis

and abscesses, paralysis agitans, postencephalitic syndromes, Sydenham’s chorea).

d. Peripheral nerve disorder (chronic or recurrent neuritis or neuralgia of an intensity

which is periodically incapacitating, multiple neuritis, neurofibromatosis).

e. Residuals of trauma (residuals of concussion or severe cerebral trauma, posttraumatic cerebral syndrome, incapacitating severe injuries to peripheral nerves).

/. Paroxysmal convulsive disordersand disturbances of consciousness (grand mal, petit

mal and psychomotor attacks, syncope, narcolepsy, migraine).

g. Miscellaneous disorders (tics, spasmodic torticollis, spasms, brain and spinal cord

tumors, operated and unoperated,cerebro-vascular disease, congenital malformations, including spina bifida if associated with neurological manifestations and meningocele even if

uncomplicated, Meniere’s disease).

91. Diagnostic criteria.—The following brief summary of diagnostic criteria is intended

as general guide for examiners. It includes the common manifestations of the more usual

neurological disorders, but it is not intended to cover all diagnostic criteria or all neurological disorders.

a. Syphilis of central nervous system.

(1) General paresis or meningoencephalitic syphilis.—Look for unequal, irregular,

or sluggishly reacting pupils or Argyll-Robertson pupil; facial tremor; speech

defect in test phrases and in the slurring and distortion of words in conversation

writing defects consisting of omissions and distortions of letters; defective memory discrepancies in relating facts of life; inability to perform quickly and

accurately simple problems of addition and subtraction in mental arithmetic.

Knee jerks may be normal or overactive or underactive. The mood may be

apathetic, depressed, or euphoric; other psychiatric symptoms may be of

schizophrenic or neurasthenic type.
APPENDIX 191

(2) Meningo-vascular or cerebrospinal syphilis.—The prominent diagnostic signs

and symptoms are headaches, history of mood changes or convulsions, varying

deep and superficial reflexes, pupillary changes, ptosis, ocular palsies, and facial

paresis. The mental state is normal, dull, or apathetic. Motor weakness may

occur on one side of the body or in one extremity.

(3) Tabes dorsalis (locomotor ataxia). —Look for unequal, irregular, or sluggishly

reacting pupils or Argyll-Robertson pupil; absent knee jerks; positive Romberg;

ataxic gait, especially when the eyes are closed; hypotonia and anesthetic areas

of the skin. The history, usually of slow progression, may show failing sexual

power or sphincter disturbances and pains in the legs or back, usually an irregular series of short, identical attacks of pain coming at intervals.

b. Multiple sclerosis.—A history of transitory weakness, numbness, ataxia of one or

more extremities, transient diplopia, scotomata or bladder disturbances should arouse

suspicion of multiple sclerosis. The presence of optic atrophy, scotomata, definite nystagmus,

corneal hypoesthesia, absence or irregularity of abdominal reflexes, exaggerated deep

reflexes, Babinski or similar signs, or ataxia and euphoria are common manifestations.

c. Muscular dystrophies.—There is atrophy of the muscles in some forms, hypertrophy

in others and, in general, decrease or loss of muscle power. In the pseudohypertrophic form

some muscles are atrophied, others hypertrophied. In myasthenia gravis there is rapid

fatigue of muscle power, appearing first in the facial and extrinsic eye muscles and later

becoming generalized.

d. Athetosis, dystonia, torticollis, chronic chorea.—These are names given to various

types of irregular, intermittent, involuntary movements, affecting various parts of the

body, often associated with evidence of spastic paralysis. Simulation is possible and in

doubtful cases previous medical records should be sought. Even mild manifestations

disqualify.

c. Paralysis agitans.—Paralysis agitans is recognized by frozen facies, unwinking stare,

rigidity of the nmscles, stooped posture, slowness of movement, tremors, slow, monotonous

speech, and typical gait. It may be unilateral. history of encephalitis or influenza is

obtained in only about one-half the cases. Even mild manifestations disqualify.

/. Multiple neuritis.-—This may be associated with the dietary deficiencies, infection,

or intoxication. The symptoms depend tipon the cause and duration. They consist of pain,

various combinations of diminution or loss of motor power most marked in the distal part

of the extremities, sensory diminution or loss, tenderness of the muscles and nerves, loss

of diminution of reflexes.

g. Chronic neuralgias.—A history of severe constant or recurrent pain, confined to

the area of distribution of single nerve or segment, without objective changes, suggests

this diagnosis. Clearly defined entities are sciatic and trigeminal neuralgias. Less common

are suboccipital, brachial, and glossopharyngeal neuralgias. Neuralgias of other nerves

are extremely rare and the diagnosis will be made with extreme caution. Neuritis,

arthritis, bursitis, sinusitis, and also hysteria and malingering must be considered in

differential diagnosis. Evidence of previous treatment and the injection of procaine into

the nerve presumably affected are important diagnostic aids.

h. Post-traumatic cerebral syndrome.—A history of head injury followed by headache,

dizziness, loss of initiative, or change of personality is suggestive, but independent confirmation of such alterations should be sought if possible. dull apathetic expression,

slight nystagmus, fine tremors, vasomotor changes, or abnormal sweating, are confirmatory

evidence. If the syndrome is definite, even though mild, the individual should be rejected.

The presence of signs indicating focal lesion, even though mild, is also cause for rejection.

i. Paroxysmal convulsive disorders.—Look for deep scars on tongue, face, and head.

Since no physical findings are pathognomonic, it is necessary to discover if the individual

had had spells of unconsciousness, convulsions, “fits,” “falling out,” “spells,” “lapses,”

“dizziness,” or “fainting.” The individual will be disqualified on verified history of such
192 PHYSICAL STANDARDS

spells or of multiple attacks of loss of consciousness, especially with incontinence or

twitching, or of frequent momentary episodes of being dazed, or of uncontrollable outbursts of rage or irrational conduct, or fugues, or treatment with anticonvulsive drugs

over long period of time. Such history will be verified, if practicable, by confirmatory

medical record from trustworthy source. The electroencephalograph is of great assistance

in diagnosis, particularly in doubtful cases, but will not be used routinely. When registrant is rejected for epilepsy, statement will be made by the examining board giving

the basis for the diagnosis. When the diagnosis is based wholly on the registrant’s statement, in the absence of stigmata or verified history, it will be so stated. It should be

remembered that the epileptic may attempt to conceal his defect in order to gain entrance

to the military service.

j. Cerebral vascular accidents.—Characteristically, the onset is acute, with or without

unconsciousness. Almost any focal disturbance may result. Evidence of peripheral arterial

disease may be inconspicuous. The diagnosis disqualifies.

Section XXI

PSYCHOSES, PSYCHONEUROSES, PERSONALITY DISORDERS

Paragraph

General considerations 92

Routine procedure 93

Minimal psychiatric examination 94

General service 95

Limited service 96

Nonacceptable 97

Diagnostic criteria 98

92. General considerations.—The detection of disorders of the personality is often

most difficult and the general fitness of the individual for military life should be considered

at the end of the medical investigation. The key to the proper evaluation of each individual

is the knowledge that military life is rigorous and makes special demands on the individual.

To be effective, man must have the capacity for sustained duty in the face of separation

from home, regimentation, lack of privacy, extremes of climate, hunger, exhaustion, and

the threat of bodily injury, and should be judged with this in mind. Since experience has

shown that mentally defective and unstable individuals form weak points in the military

organization and often break down under stress, endangering the lives of others as well as

the national security, they will not be accepted. Each examiner will constantly be on the

alert throughout his contact with the individual to detect any sign of such disorders

and will promptly report suspicious symptoms he may note to the chief examiner. See

paragraph 2&.

93. Routine procedure.—a. The diagnosis of most psychiatric disorders depends in

the first place upon the examiner’s estimate of the person’s behavior and response to the

situation of the examination and in the second place upon an adequate history, supplemented if necessary by information gathered from the individual’s own physician, courts, hospitals, social service, or welfare agencies, etc.

I). Attention will he given to whether the individual wants to be in the Army and

thus may have tendency to minimize his defects or whether he wants to remain in

civilian life and thus may have tendency to exaggerate.

c. Routinely, examiners will be on the watch for any of the following personality

deviations: Inability to understand and execute commands promptly and adequately, abnormal negativistic attitude, abnormal anxiety, silly inappropriate laughter, instability,

seclusiveness, sulkiness, sluggishness, discontent, lonesomeness, depression, shyness, suspicion, overboisterousness, timidity, personal uncleanliness, stupidity, dullness, resentfulness
APPENDIX 193

to discipline, history of nocturnal incontinence, sleeplessness, lack of initiative and ambition, sleep-walking, recognized queerness, suicidal tendencies, either bona fide or feigned,

and homosexual proclivities.

d. Abnormal autonomic responses (fainting, blushing, excessive sweating, shivering,

or gooseflesh, excessive pallor, or cyanosis of the extremities) are also occasionally significant. Note also the lack of such normal anxiety or autonomic responses as might reasonably be expected under the circumstances.

94. Minimum psychiatric examination. a. Mental and personality difficulties are most

clearly revealed in the subject’s behavior toward those with whom he feels relatively at

ease. The most successful approach is often one of straightforward professional inquiry

coupled with real respect for the individual’s personality and due consideration for his

feelings, which does not mean diffidence.

ft. The psychiatric examination will be made outside of easy hearing of other men.

Matter of diagnostic significance is often concealed when the individual feels that lie

must be impersonal and give replies that will not impress listeners with his peculiarity.

c. Questioning will begin with something that is obviously relevant to the immediate

situation. One tries to elicit the difficulties which the individual has been experiencing in

his relations with others and himself in his work and in his spare time activities. The

examiner pays close attention to content and implication of everything said and to any

other clues and, in matter-of-fact manner, follows up whatever is not self-evidently

commonplace.

d. The probable presence of some types of psychiatric disorders, in particular the

major psychoses and marked degrees of feeble-mindedness, may often be suspected by

alert observation of the individual’s behavior if the examiner knows what to look for

and what to regard as significant. In other eases one would not be able to suspect the presence of any morbid condition without some knowledge of the individual’s history.

95. General service.—a. The range of personalities usually classed as normal. Evidence of ability to get along tolerably with family, friends, casual acquaintances, au- thorities in school or society, employers, and fellow workers. Conventional attitude toward

sexual problems. Sufficient intelligence to graduate from grammar school unless prevented by external circumstances. Sufficient stability and ability to obtain and keep, or

at least to seek, job.

&. Marginal intelligence, if compensated for by better than average stability.

c. Men whose speech can be readily understood, even though there is moderate de- gree of stuttering or stammering, if otherwise physically, intellectually, and emotionally

fit.

96. Limited service.—Stuttering and stammering of degree disqualifying for general military service but which has not prevented the man from successfully following

useful vocation in civil life.

97. Nonacceptable.—Individuals who are found to have any serious mental or neurological disorder such as—-

a. Mental deficiency.

b. Psychosis.

c. Psychoneurosis.

d. Psychopathic personality.

e. Alcoholism and drug addiction.

/. Primary behavior disorder of sufficient degree to indicate predisposition to more

serious disorders.

g. Syphilis of the central nervous system.

98. Diagnostic criteria.—a. Mental deficiency.

(1) Manifested by lack of general information concerning native environment;

inability to learn, to reason, to calculate, to plan, to construct, and to compare

weights defect in judgment, foresight, language, output of effort; suggestibility,
194 PHYSICAL STANDARDS

untidiness, lack of personal cleanliness, anatomical stigmata of degeneration,

muscular awkwardness. History of school life, vocational career, and disciplinary report will assist materially.

(2) Examiners will use extreme care and judgment in reporting their findings

on enlistment records. Such terms as “imbecile” and “moron” will not be used.

Elaborate psychometric estimation is not necessary. Intelligence cannot be definitely estimated and there is no test that is infallible. They are all only approximations and must be evaluated only in conjunction with accompanying

factors and circumstances. diagnosis of mental deficiency will be based on

the results of objective tests interpreted in the light of the above considerations. Illiteracy per se is not to be classified as mental deficiency.

b. Psychosis.

(1) Schizophrenia (dementia praecox).—This mental disorder is manifested by

obscurely motivated peculiarities of behavior and thought. Of these, the so-called

hebephrenic type is the most obvious. More difficult to identify is the simple type.

These are the numerous shiftless, untidy, perhaps morose, sometimes nomadic

individuals who have had what was regarded as normal childhood. Somewhere

between the ages of 12 and 25 they underwent change, acute or insidious,

with dilapidation of their social interests and the habits in which they had been

trained. They may or may not have received treatment in hospitals for mental

disease. The paranoid type is another large division. These persons cling to

fantastic beliefs in their overwhelming importance, and often feel that people

are persecuting them or otherwise interfering with their career or well-being.

Some of them believe that they are in communion with supernatural beings.

Others believe that they are victims of plots, secret organizations, spy rings, or

religious or fraternal groups. They are often plausible in supporting these delusions by clever misinterpretation of facts. Some of them are very evasive and

skillful at concealing the pattern of their disorder. morbid suspiciousness of

anyone who takes an interest in them is frequent. They may become tense and

hateful when interrograted. An attitude of unusual cautiousness or suspiciousness toward the examining physician or toward fellow individuals should suggest

the possibility that the individual may be paranoid. The catatonic states present

great difficulty in diagnosis. Perhaps the only sign of these conditions is the impression of queerness which the person makes on anyone who seeks to get

acquainted with him. The acutal oddities of behavior or thought may be subtle;

it may be difficult, in retrospect, to point to any particular instances of the

unusual. The most striking signs of these conditions may in fact come out in

connection with the physical examination. The physician, at some state of the

physical examination, may observe peculiar reaction which upon questioning

may awaken suspicion of prepsychotic state. These individuals frequently

entertain unfounded convictions as to bodily peculiarities or disorders which

they attribute to excessive sexual acts of one sort or another. These beliefs,

sometimes hard to elicit, are often medically incredible and bizarre. Questioning

them on intimate personal matters often leads to great embarrassment, confused

speech, or actual blocking of thought, so that they do not know what to say.

Get history of family life and of school, vocational, and personal career.

(2) Manic-depressive psychosis.—Major abnormalities of mood are shown by episodes of unreasonable elation or depression which have tended to recur without

obvious connection with events. People who are known to be so mercurial in their

reactions that their judgment is seriously impaired during the up or down swing

of their moods will be rejected. Individuals known to have received medical

or nursing care because of morbid excitement or depression willbe rejected.
APPENDIX 195

(3) Other types.—Psychosis of other types, involutional melancholia, toxic psychosis, paranoia, are encountered rarely at induction and will be rejected.

(4) History.—Reliable history of commitment to mental hospital will be cause

for rejection.

c. Psychoneurosis.—Individuals suffering from acute psychoneurosis at the time of

examination or with evidence of chronic psychoneurosis (neurotic personality) are to be

rejected. These individuals react inappropriately to difficulty. They may have done well in

civilian life but tend to be anxious, selfconscious, oversensitive, and emotionally dependent

on other people. In evaluating the signs and symptoms, particularly the psychosomatic

phenomena, it is important to keep in mind that sometimes they may be transient reactions

to the examination and concern over the likelihood of induction and Army service. Important factors in the diagnosis of clinical psychoneurosis are definite history of previous psychoneurotic episodes and/or the persistence of psychoneurotic reactions, which

were, at least, in some degree disabling to the individual in his civilian life.

(1) Types of signs and symptoms.—Signs and symptoms fall in the following

types:

(a) Anxiety, manifested by subjective and objective evidence of apprehension

and worry.

(ft) Neurasthenia, excessive concern with minor or functional bodily ailments

as manifested by multiple vague complaints, multiple operations for obscure

disorders, unusual fatigability, vague pains, pressure feelings, distorted

head sensations; excessive concern over health and function of bodily

organs.

(c) Hysteria, conversion symptoms such as hysterical fits, deafness, blindness,

or loss of voice; hysterical paralyses or anesthesias; dissociations such as

amnesia, absences, trances.

d) Psychasthenia, obsessions, compulsions, phobic manifestations such as

specific terrors of harmless objects or situations, food phobias, dirt and germ

phobias, inflexible rituals of behavior about food, sleeping, dressing, compulsive acts, obsessional thoughts and obsessional indecision.

(e) reactive depression is depression which may he severe, and with

suicidal trends and which is reaction to adverse and serious environmental

situations. It persists for fairly long periods of time and is definitely more

than “blue spell.” The patient is apt correctly to regard the disturbing

environmental situation as responsible for the depression.

(/) Mixed types.

(2) Physical disorders which may furnish important clues to psychoneurotic disabilities.—Neurotic tensions may be manifested not only by frank psychoneuroses

and behavior difficulties but also by manifestations of variety of physical

disturbances and organic disease processes. Such conditions as peptic ulcer,

pylorospasm, mucous colitis, spastic constipation, neurocirculatory asthenia,

paroxysmal tachycardia, vascular hypertension and hypotension. Raynaud’s

disease, fainting, convulsions, somnambulism, narcolepsy, migraine, glaucoma,

eczema, psoriasis, enuresis, cardiospasm, impotency, and asthenia may have

important emotional components and may therefore furnish important clues to

the neurotic aspects of the individual. The presence of such conditions, if not in

themselves disqualifying, should always lead to further study. Look for close

relationship.

d. Psychopathic personalities.—In this ill-defined, more or less heterogeneous group

are placed those individuals who, although not suffering from congenital defect in the

intellectual sphere, do manifest definite defect in their ability to profit by experience.

They are unable to proceed through life with any definite pattern of standardized activity.

They are unable to respond in an adult social manner to the demands of honesty, truthful-
196 PHYSICAL STANDARDS

ness, decency, and consideration of their fellow associates. They are emotionally unstable,

not to be depended upon; act impulsively with poor judgment; are always in difficulties,

have many and various schemes without logical basis, lack tenacity of purpose, are easily

influenced and oftentimes in conflict with the law. They do not take kindly to regimentation

and are continually at variance with those who attempt to indoctrinate them in the essentials of military discipline. Such an individual has decided influence upon his fellow

associates and the morale of his organization, for he will not conform himself to organized

authority and he derives much satisfaction in cultivating insubordination in others. Quite

frequently he presents favorable impression, is neat in appearance, talks well, and is

well mannered. However, under this veneer the real defect is evident by past irresponsiveness to social demands and lack of continuity of purpose. Among this general group are

three main types;

(1) Psychopathic personality with pathologic sexuality. This may include many

homosexuals and cases of sexual perversion. Persons habitually or occasionally

engaged in homosexual or other perverse sexual practices are unsuitable for

military service and will be excluded. Feminine bodily characteristics, effeminacy

in dress or manner, or patulous rectum are not consistently found in such

persons, but where present should lead to careful psychiatric examination. If

the individual admits or claims homosexuality or other sexual perversion, he

will be referred to his local board for further psychiatric and social investigation.

If an individual has record as pervert he will be rejected.

(2) Psychopathic personality with emotional instability. This includes the inadequate personalities. Those individuals who do not show the patterns of psychoneurosis or psychosis but do not have personality traits which enable them to

make satisfactory adjustment owing to introversion, eccentricity, impracticalness, or vagrancy.

(3) Psychopathic personality with asocial and amoral trends. This includes the

grotesque and pathological liars, petty offenders, swindlers, kleptomaniacs, pyromaniacs, alcoholics, and likewise those highly irritable and arrogant individuals,

so-called “guardhouse lawyers,” who are forever critical of organized authority

and imbued with feeling of abuse and lack of consideration for their fellowmen.

(4) All such men should be excluded from the service as far as possible, both

because of the difficulties which these symptoms themselves cause and because

of the fact that these individuals are predisposed to psychoneurotic and psychotic

states.

c. Chronic alcoholism and drug addiction.

(1) Chronic alcoholism. —An individual will be regarded as chronic alcoholic if

he habitually uses alcohol to the point of social or physical disablement, as

evidenced by loss of job, repeated arrests, or hospital treatment because of

alcoholism. Such history, if obtained, should be verified. Look for suffused eyes,

prominent superficial blood vessels of nose and cheek, flabby bloated face, red

or pale purplish discoloration of mucous membrane of pharynx and palate;

muscular tremor in the protruded tongue and extended fingers, tremulous handwriting, emotionalism, prevarication, suspicion, auditory or visual hallucinations,

persecutory ideas.

(2) Drug addiction. —An individual will be regarded as drug addict if he is or

has recently been habitual user of any of the opium preparations, cocaine,

or cannabis iudica (marijuana). history of arrests for narcotic law violation

is important; recent needle marks are suggestive; discolorations along the line

of blood vessels on the arms, or scars from needle abscesses on the arms, shoulders, buttocks, or thighs are very important evidence but are not always present.

The condition of the pupils is not important in active addicts.
APPENDIX 197

f. Primary behavior disorders.—These may or may not be cause for rejection depending

upon their severity. They are cause for rejection either because they indicate predisposition

to more serious mental disorder or because the symptom itself interferes with military

efficiency. These disorders fall into the following groups:

(1) Simple adult maladjustment.—These individuals show evidence of tension

and anxiety not serious enough to be classified as psychoneurosis and clearly

caused by situational difficulties.

(2) Neurotic traits.—Tics, habit spasms, somnambulism, overactivity, fears either

present at time of examination or in the individual’s history, though not in

themselves disabling may indicate predisposition to serious mental disorder on

exposure to stress.

(3) Enuresis.—This is cause for rejection if of sufficient degree to cause sanitary

difficulties for men living in close quarters. History of bed-wetting since childhood may indicate predisposition to psychiatric disorder. verified history will

be obtained. See paragraph 111.

(4) Emotional immaturity.—Certain individuals have no defect of personality but

are too inexperienced or too dependent on family ties to function effectively in

the armed forces.

(5) Stammering and stuttering.—Cause for rejection if of such degree that

registrant is unable to express himself clearly or to repeat commands.

Section XXII

INTELLIGENCE

Paragraph

General considerations 99

General service 100

Limited service 101

Nonacceptable 102

99. General considerations.—Minimum intelligence requirements for military service

are prescribed to insure that only men capable of absorbing training within reasonable

limits of time will be inducted. Factors of intelligence measured by prescribed Army tests

are not necessarily those measured by other tests of intelligence; therefore, intelligence

tests other than authorized Army tests will not be used. Concepts such as mental age and

intelligence quotient are not applicable to results achieved on Army tests, and will not he

used to describe the mental level of individuals being tested. Further, since intelligence,

rather than education, is the criterion used to determine the trainability of an individual,

references to the educational level attained by an individual are irrelevant when used

to describe the level of intelligence.

100. General service.—Individuals who are graduates of standard English-speaking

high schools are acceptable. Individuals who are not graduates of standard English-speaking

high schools will be given prescribed objective tests of intelligence. man achieving the

critical score or higher score on one or more of the authorized tests is acceptable for

induction.

101. Limited service.—There are no intelligence criteria to warrant initial selection

for limited service.

102. Nonacceptable.—Failure of nongraduate of standard English-speaking high

school to achieve score on one or more of the prescribed tests equal to or higher than

the critical score will be accepted as evidence of low intelligence. Such persons are

nonacceptable.
198 PHYSICAL STANDARDS

Section XXIII

PURPOSELY CAUSED PHYSICAL DEFECTS

Paragraph

Report of apparently purposely caused defects 103

103. Report of apparently purposely caused defects.—Whenever it appears to an examining physician that an individual is suffering from self-inflicted or purposely caused physical defects which under the standards of physical examination prescribed herein would

render him disqualified for military service of any kind, full statement of the facts and

of the condition of the individual and of the examining physician’s recommendation will

be prepared and submitted to the Director of Selective Service.

Section XXIV

MALINGERING

Paragraph

Definition 104

Differentiation 105

Feigned medical diseases 106

Feigned surgical conditions 107

Feigned nervous or mental illness 108

Simulated defects of vision 109

Simulated defects of hearing 110

Bed wetting 111

General considerations 112

104. Definition. —The malingerer is one whose complaints of bodily disorders and whose

behavior or acts are in simulation of some physical or mental disease for the definite purpose of attaining particular end which is more satisfactory to him or of seeking an escape

from fear-infested situation. Malingering is encountered in number of situations but

most frequently during the preliminary examinations and early training periods of military

service. The simulation of neuroses and of physical disorders includes wide variety of

problems which must be differentiated from the ordinary neuroses as well as from physical

illnesses. However, simulation is always in keeping with the extent of the knowledge

possessed by the individual regarding the particular disorder from which he pretends to

suffer and therefore constantly changes its methods and its maladies. person gifted with

histrionic talent and who has considerable degree of knowledge and skill at his command

may be able to simulate physical or mental conditions to such perfection that physicians may

sometimes be deceived.

105. Differentiation. a. For disorder to be classed as true malingering, it must fulfill three conditions that—•

(1) No obvious orfrank disease or personality disorder is present.

(2) The individual is consciously aware of what he is doing and of the motive

responsible for his attitude. (3) He is fixed in carrying out purpose to preconceived result.

h. When confronted with case of malingering the observer will try to ascertain how

much of what constitutes the totalpicture is well acted drama and consciously done and how

much is true in part and more or less unconscious. For practical purposes these reactions

may be divided into the following;

(1) Malingering for the purpose of attaining definite end by simulation of disease by one who has no past history of similar patterns of reaction but who

is making an attempt to escape in an emergency (temporary reaction) one

who feigns his symptoms as bluff and hopes to get away with it.
APPENDIX 199

(2) Malingering to the extent of exaggerating or “capitalizing” conditions or

symptoms that are present for the purpose of avoiding service. This includes

an enlargement on minor physical ailments or on relatively insignificant

diseases, emphasizing mild personality problems or neuroses, and overemphasis on symptoms of fatigue, etc.

(3) Malingering as manifestation of psychopathic personality with suggestion

or definite history of previous psychopathic behavior. In intelligence the

psychopath may be retarded, of average endowment, or superior but he is

incapable of adjustment under ordinary life conditions. The ranks of psychopathic personality contain many persons having an irresistible tendency to

alcoholism, drug addiction, sex perversion, and criminality, including numbers of cranks, extremists, eccentrics, hobos, and queer social misfits.

(4) The psychoneurotic suffering with hysteria, who believes in the reality of

disability which on the surface appears to be definite simulation, requires

special investigation. The confusion of hysteria with true malingering is

not infrequentlymade by those who consider nearly all hysterics as malingerers with symptoms that could be controlledvoluntarily. Some of these psychoneurotics exaggerate more or less unconsciously their symptoms to gain their

ends, thus emphasizing the questions of how much is neurosis, how much

is simulation, and how much is associated with change in personality.

(5) Malingering or reactions considered to be malingering may appear in those

basically psychoneurotic, insecure, and apprehensive, or physically ill as well

as in those suffering from psychoses, epilepsy, and organic brain disorders

where there has been definite change in personality. These reactions frequently confused with pure malingering may become much worse during

investigation or attempted correction.

c. Among these five groups the typical members are readily distinguished but intermediate and doubtful cases which resist differentiation do occur. It should be kept in mind

that it is even more difficult for healthy person to feign disease than it is for diseased

person to simulate health and that malingerer may be able to simulate and to accentuate

single symptoms but he is practically always unable to feign the entire picture of the disease

he has selected and thus the expert can usually detect omissions, discrepancies, and contradictions in the situation.

108. Feigned medical diseases.—a. The detection and management of malingerers simulating medical diseases depend upon the absence of positive findings in an individual who

presents the general characteristics of the malingerer. There is especial need for the physical

examination to be thorough in this group. Some of the cardiac cases at first regarded as

malingerers may later be found to have mitral stenosis or bacterial endocarditis. Similarly,

proper tests may show the existence of peptic ulcer in those suspected of feigning digestive

abnormalities. The estimation of the reality of rheumatic pains is always difficult matter. 1). Tachycardia and thyrotoxicosis may be temporarily induced by ingestion of drugs

such as thyroid extract. Egg albumin or sugar may be added to urine. Canned milk may be

utilized to simulate urethral discharge. Cantharides may be taken to cause albuminuria.

Digitalis and strophanthus may be taken to cause abnormal heart findings. The skin may be

irritated by various substances. Cathartics may be taken to bring about purging or to

simulate chronic diarrhea. An appearance of hemoptysis may be produced by adding blood,

either human or that of animals, to the sputa. Sometimes merely coloring matter is added.

Those who can vomit voluntarily what they swallow use the same means to create the

appearance of hematemesis. Similarly, coloring matter may be added to the stools. Mechanical and chemical irritants may be used to cause inflammation about practically all the body

orifices. Jaundice may be simulated by taking picric acid. Artificial jaundice is recognized

by demonstration of picric acid in the urine.
200 PHYSICAL STANDARDS

107. Feigned surgical conditions. —Under this are included old scars and injuries of

the bones, fractures, and orthopedic conditions. Others may shoot or cut off their lingers or

toes, usually on the right side, to disqualify themselves for service. Some may put their

hands under cars for this purpose. Retention of urine may be simulated. Substances may be

injected under the skin to create abscesses. Crutches, braces, strappings, or trusses may be

used to give the appearance of disability. Wounds are rarely self-inflicted when witnesses

are present, consequently it is almost impossible to be certain of malingering in some cases.

108. Feigned nervous or mental illness. a. Psychosis—Rarely feigned by individuals

and then usually silly, foolish type. In case of doubt, hospital observation is necessary,

with verification of past records. Mental deficiency is frequently feigned, especially by

illiterates.

b. Pain and hyperesthesia.—The most frequent of all complaints. History inconsistent,

ordinary indications of suffering absent. Absence of other symptoms usually accompanies

types of pain of which complaint is made. Absence of objective evidence of localized pains.

Note behavior when the registrant believes himself unobserved.

c. Anesthesia. —Complaint of anesthesia itself creates suspicion of malingering as

most patients with anesthesia are ignorant of it.

d. Epilepsy.-—Men who have sustained head injury may claim fits. These complaints

may be in reference to grand mal or petit mal. Petit mal attacks are spoken of as fainting

attacks. In grand mal attacks there is loss of pupil response to light, knee jerks are lost, and

the Babinski reflex may be present.

e. Hysteria.—Not feigned in itself but its existence creates confusion as to malingering.

The question to be decided is whether the individual is too seriously affected with the

neurosis to be useful as soldier.

/. Stiff back.—Stiff back is frequent symptom of hysteria in mobilization among

selected men. In cases of this kind, organic disease of the vertebrae can and will be

excluded, if necessary by X-ray.

109. Simulated defects of vision.—See section IV.

110. Simulated defects of hearing.—See section V.

111. Bed wetting.-—Bona fide enuresis substantiated by physician’s affidavit or other

acceptable documentary evidence is cause for unconditional rejection. See paragraph 98/(3).

112. General considerations.-— a. All men suspected of malingering will be subjected

immediately to thorough psychiatric survey which will include careful history of their

previous behavior and adjustment record and complete physical, neurological, and laboratory evaluation. Observation in hospital may be required. Suspected malingerers found

suffering from definite psychoneuroses and others in whom signs of mental disorders are

detected will be rejected for military service.

b. Whenever it appears to an examining physician that an individual is endeavoring

to escape service by malingering, if otherwise mentally and physically fit, he will be

accepted.
APPENDIX 201

INDEX

Paragraph

Abdominal wall, benign tumor of 69d

Hernia 71c

Scars 69a,

Sinuses of 71/ Abscess, pulmonary. 596

Brain, residuals of 90c

Acne 356(1)

cromegal y_ 83c

Actinomycosis 8c, 376

Acuity. See Hearing; Vision.

Addison’s disease 836

Adenoids 276

Adult maladjustment 98/(1)

Albuminuria, temporary 77o, 80

Orthostatic 77

Alcoholism 97c, 98c(l)

Allergy, diseases of:

Asthma, bronchial 59

Dermatoses 37/ Hay fever 27c, 286, 296

Alopecia areata 35c

Amputation.

Ear 25e

Extremities 45d, c, 6, 46a, c, 47o, 6,

Fingers, partial; complete 45d, c, 46a, 476

Penis 796-

Thumb 47a

Toes 456, 46c

Anemia, aplastic 86d

Hemolytic ictero-anemia 86c

Pernicious 86c

Secondary 84a

Sickle cell 86/ Splenic 71*, 86/ Aneurysm 65/

Angina pectoris 65o

Ankle, disease of 47

Deformity of 46d

Ankylosis (in general) —. 47/

Elbow 46/

Extremities 46c, 46/

Fingers 450

Foot 456

Wrist 46/

Anxiety neurosis 98c(l) (a)

Aphonia 29/ Argyria 8c

Arteriosclerosis 656

Cerebral 906

Arthritis, chronic 436, 47s

Gonorrheal 756

Gouty 83

Osteo 86, 436, 47s

Rheumatoid 86, 436, 47s

Asthenia, neurocirculatory 65?

Asthma, bronchial 590

Ataxia 906

Athetosis 906, 91

Atrophies, muscular 906

Auricular fibrillation 65/

Paragraph

Bedwetting 79o, 98/(3), 111

Behavior disorders 97/ Beriberi 826, 83/

Bladder, tumors of 79 Blepharitis, marginalis 166 Blepharospasm 16/

Blindness, color. 16*

One eye 176,19a, 6, 20

Blood disorders. 84 to 86

Bones, disease of 47c,/, n, Fracture of.. 45o, 47d

Osteomyelitis 8*, 47r Tuberculosis 47c Bradycardia 63d

Brain, abscess residuals 90c Disease of 90 Tumor of 90 Breast tumors 595

Bronchi, tumor of 59 Bronchial asthma 59 Bronchiectasis 59/, 606

Bronchitis, acute 570(1)

Chronic- 59e Buerger’s disease 656 Bunion 47

Calculus,renal, bilateral. 79/ Unilateral 77 Carcinoma

Cardiac. See Heart.

Central nervous system syphilis 97 Cerebellarataxia 906

Cerebral, arteriosclerosis 906 Syndrome, post-traumatic 90c, 916

Trauma, severe,residuals of 90e, 916 Vascular accidents 91/ Vascular disease 900 Cerebrospinal syphilis 91a Chancroid 73c

Chest, deformity of 68 Measurements

Tuberculosis of 59 Tumor of.. 59o,g

Cholecystectomy, history of 696 Cholecystitis 716 Cholelithiasis 716

Chorea, acute 90c Chronic 9id

Huntington’s 906 Sydenham’s 90c

Choroid,disease of 186 Cicatrices. See Scar.

Claw toes 466,476 Classification, physical 4a, 6, Clavicle, deformity of 58 Club foot 460, 47 Circulatory failure 65a Cirrhosis ofliver... 71

Coccyx, fracture of 416

Colitis, chronic.. 716

Color blindness iei

Commitment to mental hospital, history of 986(4)
202 PHYSICAL STANDARDS

Paragraph

Empyema, scars of operation for 57c

Sacculation, residual of 59

Sinuses following operation for 59<f

Encephalomyelitis 906

Endocarditis 65m

Endocrinedisorders 81 to 83

Enlargement. See organ or part concerned.

Enuresis 79o, 98/(3), 111

Epidermolysis bullosa 37d

Epididymitis 75c

Epilepsy 90/ Epispadias 77/, 79m

Erythromelalgia 65

Esophagus, disease of 29m

Stricture of 29e,

Exophthalmic goiter 50, 51, 83a

Exophthalmos 16/, 18d

Exostoses of skull 38a, 40a

Extremities- 45 to 48

Amputation 47

Deformities 45 to 48

Injuries, recent; temporary 456

Scars 466, 476

Eyes 15 to20

Adhesion of lids to 16/ Anophthalmos 176

Blepharitis 16fc

Blepharospasm 16

Blindness, one eye 176, 19, 20

Choroid, disease of 186

Color blindness 16i

Conjunctivitis. 16e, 18s

Corneal ulcer 16wi

Dacrocystitis 18f

Diplopia 18Z, 20d

Exophthalmos 16/, 18d

Glaucoma 186

Keratitis 18e

Lagophthalmos 18c Loss of one 176

Malingering, tests for 19

Muscles, paralysis of 18

Nystagmoid movements 16d

Nystagmus 18/ Operations 16c

Optic nerve, disease of 186

Pterygium 16?, 18m

Ptosis of lids of 166,18?

Retina, diseases of 186,

Strabismus 18p

Trachoma 18m

Trichiasis 18r

Tumors. 18o

Vision 16, 17a, 18

Eyelids:

Blepharitis 16fc

Blepharospasm 16Z

Deformity 186

Eversion 186

Inflammation 16e, 166, 18s

Inversion 186

Ptosis 166, 18?

Feet 45 to 48

Feet, flat 456, 47/

Paragraph

Communicable disease 6o

Concussion, cerebral 886

Residuals of. 90e

Congenital malformation 90?

Heart disease 65ft

Conjunctivitis 16c, 18s

Convulsive disorders. 90/

Coronary thrombosis 65

Cornea, inflammation chronic 18/

Keratitis- 18c

Pterygium 16?, 18m

Ulcer of 16m, 18?

Cretinism 83c

Cryptorchidism 77c, 79r

Cushing’s syndrome 83m

Cylinduria 80

Cyst, pilonidal 37o

Pulmonary 59

Skin. 37m

Dacryocystitis 18<

Deafness 24, 25a, 26

Deferment for recent disease; operation; illness 6a,

Defects not specifically mentioned

Deformity, chest 58

Extremities. 46c, /, 47/,

Eyelids 185

Hands 45/

Legs 4/0

Mouth, nose, and throat 29a

Skull 88a, 40a,

Dementia praecox 986(1)

Dental requirements 31 to 34

Dermatitis. See Skin.

Dermatoses, allergic 37/

Diabetes insipidus 83/

Mellitus 831

Diplopia 20d

Disease. See propername, organ, or part concerned.

Dislocations 47c

Diverticulitis 716

Drug addiction 97c, 98c(2)

Duodenal ulcer and history of 71c, d, 72/

Dystonia 91<f

Dystrophies, muscular 906, 91c

Ears;

Auditory canal, atresia of 25/

Drum, perforation of 25c

Examination of 21,22,26

External, loss of 25c

Hearing, acuity of 22, 23a, 25, 26

Mastoiditis 25<i

Meniere’s disease 90?

Otitis media 256

Eczema 356(6)

Effort syndrome 65?

Elbow, limitation of motion of 46

Electrocardiogram 66

Elephantiasis 37/

Emotional immaturity 98/(4)

Instability 98d(2)

Emphysema 596
APPENDIX 203

Paragraph

Feigned diseases. See Malingering.

Femoralhernia 70a

Fibrosis, pulmonary 59/

Filariasis

Fingers, amputation, complete; partial— 45(1, e, 46a, 476

Ankylosis of 45

Webbed 45c, 466

Fistula in ano 71A

Urinary 79c

Flat feet 45A, 47

Floating kidney 786

Fractures 45o

Coccyx 416

Extremities 45a

Pelvis 41c, 43c

Ribs 57d, 570(4)

Spine 41c, 43c

Ununited 47d

Friedreich’s ataxia 906

Frohlich’s syndrome, mild. 816

Moderate. 82a

Severe 83/

Gastric ulcer and history of. 71e, d,72/ Gigantism 83c

Glaucoma 186

Glycosuria 83i,

Goiter. See Thyroid.

Gonorrhea 73a, 75c

Complications of 756,

Gout 83

Granuloma inguinale 75c

Hallux valgus 45j, 47

Hammertoe 45

Hands, deformities and scars of 45/ Harelip 29o

Hay fever, mild 27e

Moderate. 286

Severe 296

Head... 38, 39, 40

Hearing, acuity of 22, 23a, 24, 25a, 26

Heart:

Angina pectoris 65o

Block 65c

Bradycardia 63d

Congenital disease of 65

Coronary thrombosis 65p

Dilatation of 656

Electrocardiogram 66

Endocarditis 65

Enlargement of 656, 67

Failure 65a

Fibrillation, auricular 65/ Hypertension 63/, 65i

Hypertrophy 656, 67

Hypotension 65r

Infarction, myocardial 65p

Measurements 67

Murmurs 636, 68o

Paroxysmal tachycardia. 65d

Pericarditis 65

Heart—Continued Paragraph

Rheumatic fever 80, 65

Sinus arrhythmia 63e

Tachycardia 63c, 65c, d, 65

Valvular disease 65

Height to 14

Hemolytic, ictero-anemia (jaundice) 86e Hemophilia 86a

Hemoptysis 53

Hemorrhoids, internal; external 69e, 71,

Hepatic cirrhosis 71n Hermaphroditism 79

Hernia, femoral 70a

Inguinal 70a, 71

Postoperative 71a

Recurrent 71a

Scrotal 71a

Umbilical. 690, 71a

Ventral 71o

History of. See Disease; Operation.

Hodgkin’s disease 8k, 86k

Homosexuality 98d(l)

Hospitalization,authority for 56, 112

Huntington’s chorea 906

Hydrocele Tie, 79q

Hydronephrosis 79

Hyperinsulinism 83o

Hypertension 63/, 65i

Hyperthyroidism 51o, 83a

Hypertrophy. See organ or part concerned.

Hyperparathyroidism 830

Hypoglycemia 83o

Hypoparathyroidism 830

Hypospadias 77/, 79

Hypotension, orthostatic 65

Hysteria 98c(l)(c)

Icterus, congenitalhemolytic

Ileitis 71

Illiteracy 98a (2)

Incontinence of urine 79c

Infection. See organ or part concerned.

Ingrown toe nail 45

Inguinalhernia 70o, 71a

Inguinal rings, relaxed 69)

Intelligence 99 to 102

Intelligence marginal 956

Internal derangementof knee 47«

Intervertebral disc, herniation of 43/

Intestinal obstruction 71e

Parasites 72

Involutional melancholia-.- 98 6(3)

Iridectomy 16c

Jaundicehemolytic 86e

Joints;

Ankle 47n

Ankylosis of 450, 46Z

Diseases of 47/

Knee 46m, 47

Tuberculosis of 47c

257-966'—67 15
204 PHYSICAL STANDARDS

Paragraph

Keratitis 18e

Kidney:

Absence of one 79c

Calculus, bilateral 79/ unilateral-- 77

Floating 786

Hydronephrosis 79ft

Infections, acute; chronic 79d

Nephrectomy 79c

Nephritis, acute; chronic 79a

Pyelitis chronic 79

Pyonephrosis 79ft

Tumors of 79/

Knee, internal derangement of 46m, 47

Knock ankle 46d

Kyphosis 43d

Lagophthalmos 18c Laryngeal paralysis 29c Laryngitis, chronic 29/, 53

Leprosy 8c Leukemia 8o, 86ft

Lip, hare 29o Locomotor ataxia 91a(3)

Lordosis 43d

Lumbosacraldisease 41d, 43e

Lungs:

Abscess of 59fc

Cystic disease 59/

Emphysema 59ft

Foreign body 59m

Infection, residuals of 57g(5)

Mycosis 59/

Pneumonia, virus 57//(2)

Pneumothorax 59c

Silicosis 59;

Tuberculosis 60

Tumor 59

Lupus vulgaris 37/

Lymph nodes, enlargement of 49c, d, 57/

Tuberculous 49d, 61c, 59a

Lymphogranuloma venereum 75/ Lymphosarcoma 51d

Malaria, acute 66

Chronic, mild 66

Chronic, moderate: severe. 8m

Malignancy. See Tumors.

Malingering 104 to 112

Malocclusion 316

Manic depressive psychosis 986(2)

Mastoiditis 25d

Scar following operation for. 236

Mediastinum, tumor of 59

Megacolon 71fc

Melancholia 986(3)

Membrana tympani, perforationof 25c

Meniere’s disease 90

Meningitis, residuals of 90c

Meningocele 90/?

Mental deficiency 97a, 98a

Metallic poisoning 8e

Migraine 90/

Mouth, deformities of. 29a

Paragraph

Multiple neuritis 90d, 91/ Mulitple sclerosis 906, 916

Murmurs, cardiac 636, 68a

Muscular atrophies 906

Dystrophies 906, 91c

Mycosis fungoides 37g

Mycotic infection, lungs, viscera 8/, 59

Myocardial infarction 65

Myxedema 83

Naevi 356(7)

Narcolepsy 90/ Nasal;

Deformities 29o

Obstruction 29/

Polypi 29/ Septum, deviation of 27c, 28a, 29/

Septum, perforationof- 29p

Neck:

Contraction of muscles of 49a, 51/,

Lymph nodes, enlargement of 49c, 51c

Tumor of 516

Nephrectomy 71/, 79e

Nephritis 79a

Nephroptosis 786

Neuralgia 90<f, 91g

Neurasthenia 98c(l)(6)

Neuritis, chronic 90d

Multiple 90d, 91/ Recurrent 90rf

Neurocirculatory asthenia 65j

Neurofibromatosis 90d

Neurologic residuals of infection 90c

Residuals of trauma 90e Neurotic personality. 98c

Neurosyphilis 90a

Nerve, peripheral, disease of 406

Injury to-. 88c, 90c

Nose. See Nasal.

Nucleus pulposus, herniated— 43/ Operation for 43/ Nutritional deficiencies 826, 83/

Nystagmoid movements 16d

Nystagmus 18;

Obstruction, nasal 29/

Operation, surgical;

Brain tumor 90

Cholecystectomy 69ft

Deferment for recovery from 6d

Duodenal ulcer 71d

Eye 16c

Peet 47

Fingers, amputation 45d, 46a

Gastric ulcer 71d

Hands, amputation 47

Intervertebral disc, herniated 43/ Iridectomy 16c

Mastoid 236

Meniscectomy 46m(2)

Nephrectomy 71/, 79e

Nucleus pulposus, herniated 43/ Orchidectomy 776

Recent, deferment for 6d
APPENDIX 205

Operation, surgical—Continued Paragraph

Semilunarcartilage removal 46m(2)

Spinal cord tumor.. 90

Splenectomy 8ra,71m

Thyroidectomy 49e, 50

Toes, amputation 45ft, 46e

Optic nerve, disease of 18ft

Orchidectomy 776

Orthostatic albuminuria 77

Hypotension 65r

Tachycardia 65r

Osteo-arthritis 436,47s

Osteomyelitis 47r

History of 8i

Otitis media 256

Ozena 29

Paralysis:

Agitans 90c, 91e

Laryngeal 29c

Local 89

Residual ofpoliomyelitis, etc 88c

Paranoia 986(3)

Parasitesintestinal 72d

Paresis, general 90a

Paroxysmal convulsive disorders 90/, 91*

Paroxysmal tachycardia 65d

Pathologic sexuality 98d(l)

Pediculosis 356(8)

Pellagra 826, 831

Pelvis, fracture of 41e, Jfic Pemphigus 37ft

Penis, amputation 79ft

Perforation, hard palate. 29m

Eardrum... 25c

Nasal septum 29

Peripheral nerve, diseaseof 406

Disorders of 90d

Injury of 88c, 90c

Pernicious anemia 86c

Pericarditis 65m

Personality, disorders of 92 to 97

Pes planus 45ft, 47/

Petit mal 90/

Phimosis 77 ft

Pilonidal sinus; cyst 37o

Plantar wart 356(4), 37

Pituitary disorders 83

Pleura. See Pleurisy.

Pleurisy:

Acute 57ff(3)

|! Adhesions, residual of.. 576, 596

Chronic 53, 596

Effusion, with 596

Fibrinous 596

Fibrous, chronic 596

Recurrent 53

Scars, residual of. 576, 596

Serofibrinous 596

Thickening, residual of 576, 596

Tuberculous 596

Pneumonia 57g(2)

pneumothorax 59c

Poliomyelitis, residuals of, mild 88c

Moderate 89

Severe 90c

Paragraph

Polycythemia vera 86 Polypi, nasal 29/ Post-encephalitis, syndrome 90c Postoperative hernia 71a

Post-traumatic cerebral syndrome 90e, 91ft

Prostate gland, hypertrophyof 79m Inflammation of 75c Psoriasis 356(11), 37f

Psychasthenia 98c(l)(d)

Psychiatric examination 92,93,94

Psychomotor attacks 90/ Psychoneuroses 97c, 98c Psychopathic personality 97d, 98c(2)d

Psychosis 976, 986 Pterygium I6g, 18w Ptosis of eyelids 16ft, I83 Pulmonary. See Lung.

Pulse rates 63c, d, e, 65c, /,

Purpura thrombocytopenic. 866 Pyelitis, chronic 79 Pyonephrosis 79 ft

Raynaud’s disease 65fc

Reactive depression 98c(l)(e)

Rectum, stricture of 71 Prolapse of 7lg

Renal. See also Kidney.

Calculi, bilateral 79/ Calculi, unilateral 77 Retina, detachment of I8i

Disease of 18ft

Rheumatic fever, acute; recurrent; historyof g, 65s Rheumatoid arthritis 436, 47s

Rhinitis, atrophic 29 Hypertrophic 29i

Ribs, deformity of. 58 Fracture of 57d, g(4)

Tuberculosisof 59p

Sacro-iliac, disease 41d, 43e Scabies 356(10), 37?

Scars, abdominal 69a, Extremities 46fc, 47ft

Scapula, deformity of. 58 Prominent 41c Schizophrenia 986(1)

Sciatics 47p

Scoliosis 41a, 42, 43d

Scurvy 826, 83

Self-inflicted defects 103 Seminal vesiculitis 75c Sexual perversion 98d(l)

Sickle cell anemia 86/ Silicosis 59/ Simmonds’ disease 83« Sinus arrhythmia 63e

Sinus, abdominal wall 71/ Chest 59

Pilonidal 37o

Sinusitis, nasal, acute 27d

Chronic 29/

Skin. 35,36,37

Acne 356(1)

Actinomycosis 376
206 PHYSICAL STANDARDS

Skin—Continued Paragraph

Acutedisease of 35o

Allergicdermatoses 37/ Alopeciaareata 35e

Chancroid 73c

Cysts of 37n,

Dermatitis factitia 35d

Dermatitis, generalized 37c

Dermatitis herpetiformis 37c

Eczema 356(6)

Elephantiasis 37/

Epidermolysis bullosa 37

Filariasis 8/ Infections. 356(5)

Lupus vulgaris 37/

Lymphogranuloma venereum 75/ Mycosis fungoides 37

Naevus 356(7)

Neurofibromatosis 90d

Pellagra 83/

Pemphigus 376

Pigmentation of 8c, 356(2)

Psoriasis 356(111, 37/

Purpura hemorrhagica.—. 866

Ringworm 356(9), 376

Scabies 356(10), 37

Scars 356(3)

Self-inflicted lesions of 35

Sinus, pilonidal 37o

Syphilis 736

Temporary disease of 35a

Tumor, benign 37

Ulcers 35c, 37a, 47/

Warts 356(4), 37p

Skull;

Abnormalities, temporary of 386

Contusions of 386

Exostosis 38a, 40a

Deformities 38a, 4Co,

Spasms 90

Spasmodic torticollis 90g, 91

Spinal cord:

Degenerative disorders of 906

Meningocele 90g

Multiple sclerosis 906

Poliomyelitis, residuals 88c, £9, 90c

Syphilis 90a

Tabes dorsalis 90o

Tumor 90

Spine, bifid 90g

Curvature of 41o, 42, 43d

Fracture 41e, 43c Limitation ofmotion of 43e

Osteoarthritis of 436

Tuberculosis of 43a

Spleen, enlargement of 69c, 71/

Splenectomy n, 71

Splenic anemia 71i, 86/ Sprue 826, 83/

Strabismus 18p

Stricture of rectum 71g

Urethra 75o, 78a, 796

Stuttering or stammering 95c, 96, 98/(5)

Syncope 90a

Syphilis 296, 736

Cardiovascular d, 75d

Central nervous system 91o

Syphilis—Continued Paragraph

Cerebro-spinal 8d, 75d, 91a(2)

LateMeningo-encephalltic 91a(l)

Meningo-vascular 90a, 91 (2)

Nervous system 90a

Paresis, general 90o Tabes dorsalis 90a, 91a(3)

Tachycardia 63c, 65c Orthostatic 65r

Paroxysmal 65d

Talipes 46g, 47m Teeth 31 to 34 Testicle:

Absence of one 776 Removal for tumor 776 Tumor 79/

Undescended— 77c, 791 Throat, deformities of 29o

Thrombo-angitis obliterans 656 Thrombocytopenicpurpura 866 Thrombophlebitis 65/ Thumb, amputation of 47 Thyroid;

Colloid goiter, simple 81a Cretinism 83c Enlargement, simple 496, 516, 83o,

Thyroidectomy fornontoxic goiter 49e

for toxic goiter 50 Thyrotoxicosis 51a, 83a Tumor 516 Tics 90g

Toes, amputation of 456, 46e

Claw- 466, 476

Flexion, loss of, in great toe 46/

Hammer. 451 Webbed 45c, 466 Tonsils, enlarged 27 Torticollis, spasmodic 90.a, 91d

Toxic psychosis 986(3)

Trachea, tumor 59» Tracheostomy 29d

Trachoma I8ra

Tremor, minor 886

Trichiasis I8r

Trypanosomiasis 8/ Tuberculosis 86, 52, 63, 55, 56, 57, 59, 60o

Active 86 Bones and joints 47c

Chest wall 59p

History of 60a Lymph nodes 49d, 51e, 59a Pleura 53 596 Pulmonary 57o, g(5), 59a, 60a Ribs 59p

Spine 43o X-rays, disposition of, in 546, Tumors;

Abdominal wall, benign 69d

Bladder 79 Brain 90g

Breast, benign 59,;

Bronchi 59

Chest wall, benign 57e, 59

Kidney 79i
APPENDIX 207

Tumors—Continued Paragraph

Lung 59n

Malignant

Mediastinum 59n

Neck, benign... 516

Orbit 18o

Pleura 59n

Pulmonary. 59n

Skin, benign 37

Spinal cord 90# Testicle 79i

Thyroid 516

Trachea 59n

Turbinates, enlarged. 27c, 28a

Ulcer, comeal 16m, 18<7

Duodenal and history of 71c, d, 72/ Gastric and history of 71c, d, 72/ Skin 35c, 37a, 47/

Umbilicalhernia.. 69g, 71

Ring, patent 69 Uncinariasis 6c,

Urethral stricture 75o, 78a, 796

Urinary fistula 79c

Incontinence 79c Urinalysis 80a,

Paragraph

Valvulardisease of the heart 65g, 68a(l)

Varicocele. 77d, 79p

Varicose veins 47i, 65 Venereal diseases... 73, 74, 75,76

Ventral hernia 71a

Vertebra, fracture of 41e,43c

Vesiculitis, seminal. 75c

Vision, acuity of. 15,16a, 6,17a, 6, 18a

Binocular... 16a

Diplopia 18f,20d

Malingering, tests for 19

Warts 356(4),37p

Webbed fingers; toes 45c, 466

Weight.. 9,10,11,12,13,14

Wrist, limitation of motion of 46?

X-ray films of chest:

Disposition 546,

Identification 54o

When required.. 54

[A.G. 300.8 (14 Apr 44).]

By order of the Secretary of War:

G. C. MARSHALL,

Chief of Staff. Official;

J. A. ULIO,

Major General,

The Adjutant General.

APPENDIX

ARMY REGULATIONS WAR DEPARTMENT No. 40-105 Washington,May 29,1923.

MEDICAL DEPARTMENT

STANDARDS OF PHYSICAL EXAMINATION FOR ENTRANCE INTO THE

REGULAR ARMY, NATIONAL GUARD, AND ORGANIZED RESERVES

Paragraphs

Section I. Preliminary 1-7 II. General instructions for examination 8-14

III. The eyes— 15-18

IV. The ears 19-22

V. General examination, including height, weight, and chest measurement. 23-32

VI. The skin 33-35

VII. The head 36-38

VIII. The face 39-41

IX. The mouth, nose, fauces, pharynx, larynx, trachea, and esophagus 42-44 X. The teeth 45-48

XI. The neck 49-51

XII. The spine 52-54

XIII. The chest 55-57

XIV. The lungs 58-62

XV. The heart and blood vessels 63-73

XVI. The abdomen 74—77

XVII. The pelvis, including the sacro-iliac and lumbo-sacral joints 78-80

XVIII. The genito-urinary system, including venereal diseases 81-87

XIX. The extremities 88-90

XX. The nervous system 91-95

Section

PRELIMINARY

Paragraph

Purpose of standards; how construed

Application of standards to candidates for commission

Fundamental qualifications of soldier

Rejection for causes not specially noted

Enlistment prohibited if rejected by medical examiner

Enlistment of former soldiers whose physical condition at date of last discharge was not good

Definition of term “applicant”

1. Purpose of standards; how construed. —The purpose of the standards of physical

examination is to secure the greatest efficiency and uniformity in making physical examNote.—This pamphlet supersedes AR 40-105, June 20,1921.
210 PHYSICAL STANDARDS

inations for entrance into the Army of the United States. Medical examiners and line officers

should interpret the standards with discretion and should not construe them too arbitrarily, the object being to procure personnel which is physically fit for the rigors of

military service.

2. Application of standards to candidates for commission.—a. The standards, as prescribed for candidates for commission, will apply uniformly to those seeking commission

in the Regular Army, in the National Guard, and in the Organized Reserves, except as

otherwise provided in these regulations.

?>. Candidates for commission for special service in the Organized Reserves (as contemplated in paragraphs 14ft and 16, S.R. No. 43) will not be required to conform strictly

to the standards as prescribed for other candidates for commission, but must be free from

any defect or pathological condition which would interfere with the performance of the

duty expected of them in the Army, or which would as result of military service be

especially liable to undergo progressive change or to become the basis of claim against

the Government in the event of call to active service.

When an individual who does not reach the physical standards required for service

with troops is recommended by medical examiners for commission for special service,

the action in respect to recommending waiver will be taken as directed in paragraph 13,

particular care being exercised to note in detail all defects or deficiencies and to state

specifically the character of military duty the candidate is able to perform and for which

he desires to be commissioned.

3. Fundamental qualifications of soldier.—Medical examiners should be especially

careful in the acceptance of applicants who suffer from defects of vision; defects of hearing chronic discharge from the ear or ears; toxic conditions associated with abnormal

conditions of the thyroid or other ductless glands; valvular disease of the heart; tuberculosis epilepsy; mental disease or deficiency; and irremediable defects of the feet. In

other words, to make good soldier the applicant must be able to see well and have good

hearing; his heart must be competent to stand the stress of physical exertion; he must be

intelligent enough to understand and execute military maneuvers, obey commands, and

protect himself; and he must be able to transport himself by marching as the exigencies of

military life may demand.

4. Rejection for causes not specially noted. —If any applicant for enlistment or candidate for commission is regarded by the medical examiner as physically unfit for the

military service by reason of condition not specially noted in these regulations as

cause for rejection, he will, nevertheless, be rejected, and full statement of the reasons therefor entered on the proper form. candidate for commission who is rejected under

the provisions of this paragraph will, if he so desires, be permitted to continue with the

mental and professional examination, the final decision as to physical fitness in each

case being made by the War Department.

5. Enlistment prohibited if rejected by medical examiner.—The enlistment of any

applicant who has been found physically disqualified by the medical examiner is prohibited unless such enlistment is specially authorized by the War Department after

report submittingall facts in the case has been considered.

6. Enlistment of former soldiers whose physical condition at date of last discharge

was not good.—No former soldier who was discharged on certificate of disability or whose

physical condition, as noted on last discharge, was other than “excellent” or “good” will be

enlisted without authority from the War Department. In requesting authority for the

enlistment of such former soldiers complete report as to the notations on last discharge and statement of his present physical condition will be submitted with the request.

7. Definition of term “applicant.”—Wherever the term “applicant” is used in these

regulations it will apply to applicants for enlistment and candidates for commission.
APPENDIX 211

Section II

GENERAL INSTRUCTIONS FOR EXAMINATION

Paragraph

Place

Care

Additional diagnostic procedures 10

Routine order 11

Applicants for enlistment 12

Candidates for commission and applicants for appointment as warrant officers 13

Special examination for flying 14

8. Place.—The physical examination should take place in large, well-lighted room.

An adjacent quiet room should be available for the examination of the heart and lungs.

The temperature of the rooms should be so regulated in cold weather as to prevent uncomfortable or dangerous exposure of the naked men undergoing examination.

9. Care.—The applicant or candidate will be carefully questioned about his past and

present physical condition, special inquiry being made regarding any serious illness, injury,

or operation he may have had. The examination will be carried out with the utmost care

in order that no applicants who are unfit for service he accepted, only to he discharged

within short time on certificate of disability. Where practicable the examination will he

conducted by several medical officers, under the supervision of the chief medical examiner.

Each officer will be definitely assigned to stated portions of the examination and will he

held responsible for the results obtained in that part of the examination made by him.

During the entire examination all examiners should be especially observant with view

to determining the mental characteristics of the examinee.

10. Additional diagnostic procedures.—The medical examiner will, if necessary, employ

every diagnostic procedure at his disposal, including the use of the microscope, the X-ray,

or other laboratory methods, with view to determining the true condition in doubtful

cases.

11. Routine order.—The order in which the physical examination is conducted must

he determined by the officer in charge, depending upon the facilities available. In general,

all procedures in the examination which can be conducted without the applicant being

stripped should be carried out first. Men should not be required to remain nude for

longer period than is absolutely necessary, and the number brought together in this

condition should be limited in order to spare the sensibilities of modest individuals.

12. Applicants for enlistment.—The physical examinations of applicants for enlistment

will be made by medical officers of the Army or by contract surgeons, unless special

authority for examination by civilian physician is granted by the War Department.

The results of the examination will be recorded on Form No. 22, A.G.O. (Enlistment

record). The examination will be thorough in every detail and the examiner may have

doubtful cases admitted to miltary hospital for study and observation during period

of not to exceed six days in order that definite conclusion may be reached regarding

their desirability as soldiers. Applicants unfit for service by reason of disease, not of

serious nature and which it is believed can be cured within short time, may be

admitted to military hospital for treatment with view to their enlistment upon recovery.

The physical examination will he made complete in each case, even though disqualifying

defect be discovered, in order to ascertain whether or not any other defects exist. Every

defect noted, whether or not it is disqualifying, will be entered on the proper form. No

applicant will he accepted for enlistment who does not conform to the standards set forth

herein. In the case of specially desirable applicants, who have some defect which in the

opinion of the examiner will not interfere with the performance of their military duties,

request for waiver of the defect may be made to The Adjutant General. In these

257-9(>6 —67 16
212 PHYSI CAL ST NBA

requests the nature and degree of the defect and the reason for recommending waiver

should be clearly stated. Men desiring to reenlist who have defects which would be cause

for rejection for original enlistment, but not such as to prevent the performance of the

duties to be expected of them, will be reported to The Adjutant General with request for

waiver.

13. Candidates for commission and applicants for appointment as warrant officers.—•

The physical examination of candidates for commission will he conducted by the medical

members of the examining board and will be recorded on Form No. 395, A.G.O. Each

candidate will be subjected to thorough and rigid physical examination. All medical

officers engaged in making these examinations are enjoined to exercise the greatest care

and diligence in this procedure and to assure themselves that all findings are fully and

accurately recorded. Sufficient time must be given to this examination to make certain

that every detail is thoroughly carried out. Each defect noted must be recorded in such

clear and complete manner that no question as to its character, degree, and significance

can arise when the report of the board is reviewed in the War Department. When

candidate is rejected, the cause must be clearly established and so definitely recorded as

to be conclusive regarding the propriety of the rejection. Symptoms of disease will not be

noted as causes of rejection if it is possible to arrive at definite diagnosis. In every

instance the disease or disability for which candidate is rejected will be entered in full.

candidate who does not conform to the standard of requirements will be rejected by

the medical examiners. If the members of the examining board believe that defect which

is classified in these regulations as disqualifying should be waived in any particular case,

recommendation to that effect may be submitted to the War Department. In making such

recommendations the nature and degree of the defect and the reason for recommending

waiver should be clearly stated. Candidates will not be accepted subject to the performance

of surgical operations for the removal or cure of defects. The same physical standards

will apply to all candidates for commission, regardless of the branch of service or grade

in which appointment is desired, except as otherwise provided in these regulations.

The examination of an applicant for appointment to the grade of warrant officer will

be that prescribed herein for an applicant for enlistment. Report of this examination will

be made on Form No. 395, A.G.O.

14. Special examination for flying.—Candidates for commission as flying officers of

the Air Service, and applicants for enlistment as flying cadets, will be given the additional

physical examination required by ATI 40-110, Standards of Physical Examination for

Flying. This examination will be conducted only by medical officers specifically authorized

to do so, in accordance with the provisions of AR 40-110, and will be recorded on

Form No. 609. A.G.O. (Physical examination for flying), Form No. 395, A.G.O. (Physical

examination for appointment in the Army), or Form No. 22, A.G.O. (Enlistment record),

also being prepared in these cases.

Section III

THE EYES

Paragraph

Inspection for disease 15

Determination of visual acuity 16

Standards for applicants for enlistment 17

Standards for candidates for commission 18

15. Inspection for disease. —Each eye will be inspected for evidence of muscular or

other defect and for disease, the lids being everted.

16. Determination of visual acuity.—To determine the acuity of vision, place the

person being examined with his back to window at distance of 20 feet from the test

types. Examine each eye separately, without glasses, covering the other eye with card
APPENDIX 213

(not the hand), or other suitable device, especial care being taken to see that the vision

in the covered eye is completely occluded. No pressure should be applied to the occluded eye.

The applicant or candidate is directed to read the test tyi>es from the top of the card down

as far as he can see, and his acuity of vision is recorded for each eye separately, with the

distance of 20 feet as the numerator of fraction and the size of the type of the lowest line

he can read correctly as the denominator. If he reads the 20-feet type correctly, his vision

is normal and is recorded 20/20; if he does not read below the 30-feet type, the vision is

imperfect and is recorded 20/30; if he reads the 15-feet or 40-feet type, the vision is recorded as 20/15 or 20/40, respectively, etc. In case he can read all the 20-feet type except

one or two, the vision is recorded as 20/20—1 or 20/20—2, etc. If he can read the 30-feet

type and one, two, or three of the 20-feet type, the vision is recorded as 20/30+1, 20/30+2,

20/30+3, etc. Any person having visual acuity less than 20/40 in either eye will be given

the necessary further examination (including refraction) to determine the exact cause

of the defect, especial attention being directed to the discovery of organic disease of the

eye. The correcting formula will be recorded as follows

VisionR.E. 20/30, corrected to 20/20 by +1.50 D. cyl. 180°.

Vision L.E. 20/100, corrected to 20/20 by —2.00 D. sph. with +0.50 D. cyl. 90°.

Special care should be taken to make certain that the candidate has not memorized

the letters on any line. Reading the lines backward or identifying certain letters when

the others are covered are methods of overcoming such attempts to deceive.

17. Standards for applicants for enlistment. a. minimum vision of 20/100 in each

eye, correctible to 20/40 in either eye, when no organic disease of either eye exists, is

required.

b. The following conditions are causes for rejection

(1) Trachoma, or xerophthalmia.

(2) Chronic conjunctivitis.

(3) Pterygium encroaching upon the cornea.

(4) Complete or extensive destruction of the eyelids, disfiguring cicatrices, adhesions of the lidsto each other or to the eyeball.

(5) Inversion or eversion of the eyelids, or lagophthalmus.

(6) Trichiasis, ptosis, blepharospasm, or chronic blepharitis.

(7) Epiphora, chronic dacryocystitis, or lachrymal fistula.

(8) Chronic keratitis, ulcers of the cornea, staphyloma, or corneal opacities encroaching on the pupillary area and reducing the acuity of vision below the

standard noted above.

(9) Irregularities in the form of the iris, or anterior or posterior synechiae sufficient to reduce the visual acuity below the standard.

(10) Opacities of the lens or its capsule, sufficient to reduce the acuity of vision

below the standard, or progressive cataract of any degree.

(11) Extensive coloboma of the choroid or iris, absence of pigment, glaucoma,

iritis, or extensive or progressive choroiditis.

(12) Retinitis, detachment of the retina, neuro-retinitis, optic neuritis, or atrophy

of the optic nerve.

(13) Loss or disorganizationof either eye, or pronouncedexophthalmus.

(14) Pronounced nystagmus, or permanent or well-marked strabismus.

(15) Diplopia, or night blindness.

(16) Abnormal conditions of the eyes due to disease of the brain.

(17) Malignant tumors of lids or eyeballs.

(18) Asthenopiaaccompanying any ocular defect.

18. Standards for candidates for commission.—a. For commission in all branches of

the Regular Army, except in the Medical Department and as chaplain, minimum vision

of 20/40 in each eye. correctible with glasses to 20/20 in one eye, when no organic disease
214 PHYSICAL STANDARDS

of either eye exists, is required. Color blindness for red, green, or violet is cause for

rejection.

b. For commission in the Medical Department and as chaplain in the Regular Army,

minimum vision of 20/200 in each eye, correctible with glasses to 20/20 in one eye, is

required when the refractive error is due to myopia, myopic astigmatism, or compound

myopic astigmatism; and minimum of 20/50 in each eye, correctible with glasses to 20/20 in one eye, when the refractive error is due to hyperopia, hyperopic astigmatism, or compound hyperopic astigmatism; provided in each case that no organic disease exists in either

eye. Color blindness for red, green, or violet is cause for rejection of applicants for the

Medical Department, but not for applicants for appointment as chaplains.

c. For commission in the National Guard, and for service with troops in the Organized

Reserves, minimum vision of 20/200 in each eye, correctible with glasses to 20/20 in one

eye, when no organic disease of either eye exists, is required. Color blindness for red, green,

or violet is cause for rejection.

d. In other respects the standards are the same as for applicants for enlistment.

Section IV

THE EARS

Paragraph

Examination for disease 19

Determination of auditory acuity 20

Standards for applicants for enlistment 21

Standards for candidates for commission 22

19. Examination for disease. —The external ears and mastoid region will be examined

by inspection, and, if necessary, the mastoid region by palpation. The external auditory

canal and membrana tympani will be examined by reflected light in the dark room or by

self-illuminating otoscope.

20. Determination of auditory acuity.—To determine the acuity of hearing, place the

applicant facing away from the assistant, 20 feet distant, and direct him to repeat promptly

the words spoken by the assistant. If the applicant can not hear the words at 20 feet, the

assistant should approach foot by foot, using the same tone of voice, until the words are

repeated correctly. Examine each ear separately, closing the other ear by pressing the tragus

firmly against the meatus; the examiner may face in the same direction as the applicant

and close one of his own ears in the same way as control. The assistant should speak in

low conversational voice (not whisper), just plainly audible to the examiner, and should

use numerals, names of places, or other words or sentences until the condition of the

applicant’s hearing is evident. The acuity of hearing should be expressed in fraction,

the numerator of which is the distance in feet at which the words are heard by the applicant and the denominator the distance in feet at which the words are heard by the normal

ear; thus 20/20 indicates normal hearing, 10/20 partial hearing of degree indicated by

the fraction, that is, the applicant only hears at 10 feet distance the words which normal

ear hears at 20 feet. The duties of the examiner and assistant may be reversed if desired.

If any doubt arises as to the correctness of the answer given, the applicant may be blindfolded and watch should be used to determine the distance at which it can be heard, care

being taken that the applicant does not know the distance from the ear at which it is

being held. The watch used should be one whose ticking strength has been tested by determining the distance at which it can be heard by normal ear.

21. Standards for applicants for enlistment. a. The acuity of hearing must be at least

15/20 in one ear and 20/20 in the other.
APPENDIX 215

ft. The following conditions are causes for rejection:

(1) The total loss of an external ear, marked hypertrophy or atrophy, or disfiguring deformity of the organ.

(2) Atresia of the external auditory canal, or tumors of this part.

(3) Acute or chronic suppurative otitis media, or chronic catarrhal otitis media.

(4) Mastoiditis, acute or chronic.

(5) Existing perforation of the membrana tympani following otitis media (not

to include traumatic perforations in which hearing is not below prescribed

standard, nor former perforations following otitis media when the continuity

of the drum has been restored by cicatrization.

22. Standards for candidates for commission.—a. For commission in the Regular Army

hearing in each ear must be 20/20. h. For commission in the National Guard, and for service with troops in the Organized

Reserves, hearing in one ear must be 20/20 and in the other not less than 15/20.

c. In other respects the standards are the same as for applicants for enlistment.

Section

GENERAL EXAMINATION, INCLUDING HEIGHT, WEIGHT, AND CHEST

MEASUREMENT

Paragraph

Facts determined by inspection 23

Evidences of maturity 24

Directions for taking height 25

Weight 26

Directions for taking chest measurements 27 Standards of height, weight, and chest measurement 28

Exercises 29

Results of exercises 30

Standards for applicants for enlistment 31

Standards for candidates for commission 32

23. Facts determined by inspection.—Examination will be conducted with the applicant

entirely nude. thorough general inspection of the entire body will he made, noting the

proportion and symmetry of the various parts of the body, the chest development, the

condition and tone of the muscles, the general nutrition, the character of the skin, the

presence of any deformities or of signs of immaturity. This examination frequently determines the fact of the applicant’s unfitness for military service; it may show him to be

undersized, underweight, undeveloped, pale and emaciated, poorly nourished with thin

flabby muscles, or manifestly lacking in stamina and resistance to disease.

24. Evidences of maturity.—Physical evidence of maturity may be summed up as

follows:

a. The wisdom teeth are sometimes but not always cut.

6. There should be some beard upon the face, hair under the arms, and full growth

of hair around the genitals extendingupward on the abdomen.

c. The skin of the scrotum has lost its soft texture, smooth surface and pinkish hue,

and is assuming wrinkled surface with darker tint.

25. Directions for taking height.—Use board at least inches wide by 80 inches long

placed vertically and carefully graduated to one-quarter inch. The applicant will be placed

against the measuring board with his feet together, the weight being thrown on the heels

and not on the toes nor on the outside of the feet. He must be made to stand erect without
216 PHYSICAL STANDARDS

rigidity, and with the heels, calves, buttocks, and shoulders touching the board, the

chin being depressed sufficiently to bring the head into natural upright position. Obtain the

height by placing horizontally, in firm contact with the top of the head and against the

measuring board, an accurately square board, which should preferably be attached permanently to the measuring board. The height will be recorded in inches and parts of an inch

to the quarter.

Where measuringrod is arranged on the scales this may be used.

26. Weight.—The applicant will be weighed on standard set of scales which are

known to be correct. The weight will be recorded in pounds (fractions of pounds will not

be recorded).

27. Directions to taking chest measurements.—The applicant will be made to stand

erect with his heels together and arms hanging loosely at the sides. The measuring tape

will be carefully adjusted around the chest, with the upper edge of the tape just below

the lower angles of the shoulder blades behind and the nipples in front. The tape should

be approximately horizontal. The applicant will then be directed to take several deep

breaths, followed by complete exhalation, in order to verify the maximum and minimum

measurements. Care must be taken not to displace the tape and to avoid muscular contortions, which frequently cause greater inspiratory measurement than the actual lung

capacity warrants. Great patience and care are often necessary to obtain correct results

in these measurements, as many men do not know how to expand the chest correctly and

must be taught the proper method. The chest measurement at inspiration and expiration

will be recorded in inches and fractions of an inch to quarters. The mobility is the difference

between the measurements recorded at inspiration and expiration.

28. Standards of height, weight, and chest measurement.

a. Standards for all applicants except Filipinos.

A. Standard accepted measurements B. The following variations from the standard shown in column are permissible when the applicant is active, has firm muscles, and is evidently vigorous and healthy

Height Weight Chest measurement Height Weight Chest measurement

At expiration Mobility At expiration Mobility

Inches Pounds Inches Inches Inches Pounds Inches Inches

64 128 32 64 120 30

65 130 32/ 65 121 30

66 132 32/ 66 122 CO h\V* 67 136 33 67 124 30/ 68 141 33/ 2/ 68 126 30

69 148 33/ 2/ 69 128 31

70 155 34 2/ 70 130 31/ 71 162 34/ 2/ 71 133 313/ 72 169 343/ 72 138 32/ 2/ 73 176 35/ 73 143 32/ 2/ 74 183 36 74 148 33/ 2/ 75 190 363/ 3/ 75 155 34/ 2/ 76 197 37/ 3/ 76 161 34/ 2/ 77 204 373/ 77 168 35/ 78 211 38/ 78 175 35/
APPENDIX 217

b. Minimum standards for Filipino applicants only.

29. Exercises.—The applicant will be put through series of movements similar to

those described below, which will bring into action the various joints and muscles of the

body. This purpose is best accomplished by requiring the applicant to follow the movements

as made by the examiner or an assistant.

a. The elbows should be brought firmly to the sides of the body and the forearms extended to the front, palms of the hands uppermost; extend and Ilex each finger separately;

bring the tips of the thumbs to the base of the little fingers; close the hands, with the thumbs

covering the fingers; extend and flex the hands on the wrists; rotate the hands so that

the finger nails will first be up and then down; move the hands from side to side. Extend

the arms and forearms fully to the front and rotate them at the shoulders; flex the forearms on the arms sharply, striking the shoulders with the fists. Extend the anus at right

angles with the body; place the thumbs on the points of the shoulders; raise and lower

the arms, bringing them sharply to the sides at each motion. Let the arms hang loosely by

the sides; swing the right arm in circle rapidly from the shoulder, first to the front and

then to the rear; swing the left arm in the same manner. Extend the arms fully to the

front, keeping the palms of the hands together and the thumbs up; carry the arms quickly

back as far as possible, keeping the thumbs up, and at the same time raise the body

on the toes. Extend the arms above the head, locking the thumbs, and bend over to touch the

ground with the hands, keeping the knees straight.

b. Extend one leg, lifting the heel from the floor, and move all the toes freely; move

the foot up and down and from side to side, bending the ankle joint, the knee being

kept rigid; bend the knee freely; kick forcibly backward and forward; throw the leg out

to the side as far as possible, keeping the body squarely to the front; repeat all these

movements with the other foot and leg; strike the breast first with one knee and then with

the other; stand upon the toes of both feet; squat sharply several times; kneel upon both

knees at the same time (if the man comes down on one knee after the other there is reason

to suspect infirmity).

c. Take the position to “fire kneeling”; stand erect, present the back to the examiner,

and then hold up to view the sole of each foot; leap directly up, striking the buttocks

with both heels at the same time; hop the length of the room on the ball of first one foot

and then the other; make standing jump as far as possible and repeat it several times;

run the length of the room several times.

30. Results of exercises.—While the exercises prescribed may cause some breathlessness and accelerated throbbing of the blood vessels, they should not cause manifest exhaustion or great distress in healthy man. Lack of ability to perform any of these

exercises indicates some defect or deformity that should be investigated further.

Height Weight Chest measurement at expiration Height Weight Chest measurement at expiration

Inches Pounds Inches Inches Pounds Inches

59 100 28/ 65 110 30

60 101 28/ 66 113 30/ 61 102 29 67 118 30/ 62 103 29/ 68 124 30/ 63 105 29/ 69 127 31

64 107 29/ 70 130 31/
218 PHYSICAL STANDARDS

31. Standards for applicants for enlistment.—a. No applicant except Filipinos will

be accepted who is less than 64 inches in height or weighs less than 120 pounds, or has

chest mobility of less than inches.

ft. The standards as to the relationship between height, weight, and chest measurement given in the tables in paragraph 28 relate to young men between 20 and 25 years of

age, and in general an applicant will not be accepted whose weight and chest measurement

are not proportionate to his height, as prescribed in the tables in paragraph 28. In

special cases when the applicant is active, has firm muscles, and is evidently vigorous and

healthy, variations to the extent noted in column of table in paragraph 28 may be

allowed. No applicant will be accepted who falls below the requirements laid down in

column of the table.

c. Variations in weight above the standard are disqualifying if sufficient to constitute such obesity as to interfere actually or potentially with normal physical activity, as

may be evidenced by high blood pressure, beginning nephritis, breaking down of the

arches of the feet, or other defects incident to such condition. No applicant will be accepted

for Cavalry service whose weightis in excess of 180 pounds.

d. The following conditions are causes for rejection, except as provided for in paragraph 12;

(1) Any deformity which is repulsive or which prevents the proper functioning

of any part to degree interfering with military efficiency.

(2) Obesity when so marked as to interfere with marching or military duties.

(3) height of more than 78 inches.

(4) Deficient muscular development.

(5) Deficient nutrition.

(6) Evidences of physical characteristics of congenital asthenia. The physical

characteristics of congentital asthenia are slender bones, weak ill-developed

thorax, nephroptosis, gastroptosis, constipation, the “drop” heart, with its peculiar attenuation and weak and easily fatigued musculature.

(7) All acute communicable diseases.

(8) All diseases and conditions which are not easily remediable or that tend to

physically incapacitate the individual, such as

(а) Chronic malariaand malarial cachexia.

(б) Severe uncinariasis.

(c) Tuberculosis, of whatever degree and whether general or localized.

Leprosy and actinomycosis.

(e) Pellagra and beriberi.

(/) Recurrent attacks of rheumatic fever, chronic articular rheumatism,

and chronic arthritis.

Cellulitis and osteomyelitis.

Malignant disease of all kinds in any location.

Hemophilia and purpura.

Leukemia of all types.

(7c) Pernicious anemia.

(7) Splenic anemia.

(m) Filariasis and trypanosomiasis.

Diabetes mellitus or insipidus.

(o) Acromegaly, gigantism, myxoedema, cretinism, Addison’s disease, and

other endocrine diseases.

(p) Chronic metallic poisoning.

32. Standards for candidates for commission.—The same as for applicants for

enlistment.
APPENDIX 219

Section VI

THE SKIN

Paragraph

Examination for disease 33

Standards for applicants for enlistment 34

Standards for candidates for commission 35

33. Examination for disease.—The skin will be inspected for eruptions and for signs

of anemia, jaundice, and other symptoms of disease, for hypodermic and other scars, and

for pediculi. In consideration of disease of the skin as cause for rejection, particularly

scabies and pediculosis, special attention should be given to the provisions of paragraph

12 in regard to placing applicants in hospital with view to their cure and subsequent

enlistment. As general rule, applicants extensively infested with vermin and filthy in

person and clothing should be rejected as probably being unsuited for the military service

by reason of habits, character, or mental deficiency.

34. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Eczema of long standing or which is rebellious to treatment

b. Chronic impetigo, pemphigus, lupus, or sycosis.

c. Actinomycosis, dermatitis herpetiformis, or mycosis fungoides.

d. Extensive psoriasis, or ichthyosis.

e. Acne upon face or neck which is so pronounced as to amount to positive deformity

/. Elephantiasis.

y. Pediculosis or scabies. See paragraphs 12 and 31

h. Carbuncle.

i. Ulcerations of the skin not amenable to treatment, or those of long standing, or of

considerable extent, or of syphilitic or malignant origin.

j. Extensive, deep, or adherent scars that interfere with muscular movements or with

the wearing of military equipment, or that show tendency to break down and

ulcerate.

k. Naevi and other erectile tumors if extensive, disfiguring, or exposed to constant

pressure.

I. Obscene, offensive, or indecent tattooing on portions of the body subject to exposure.

35. Standards for candidates for commission.—The same as for applicants for

enlistment.

Section YII

THE HEAD

Paragraph

Examination for defects 36

Standards for applicants for enlistment 37

Standards for candidates for commission 38

36. Examination for defects.—The head will be carefully inspected for stigmata of

degeneration. The scalp will be examined for pediculi. Every portion of the cranium will be

palpated for evidence of former injury, depression from any cause, and for other deformity.

37. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Tinea in any form. See paragraphs 12 and 33.

I). All tumors which are of sufficient size to interfere with the wearing of military

headgear.

c. Imperfect ossification of the cranial bones, or persistence of the anterior frontanelles.
220 PHYSICAL STANDARDS

d. Extensive cicatrices, especially such adherent scars as show tendency to break

down and ulcerate.

e. Depressed fractures or depressions, or loss of bony substance of the skull, unless

the examiner is certain the defect is slight and will cause no future trouble.

/. Monstrosity of the head, or hydrocephalus.

g. Hernia of the brain.

h. Deformities of the skull of any degree associated with evidence of disease of the

brain, spinal cord, or peripheral nerves.

38. Standards for candidates for commission.—The same as for applicants for enlistment.

Section VIII

THE FACE

Paragraph

Examination for disease 39

Standards for applicants for enlistment 40

Standards for candidates for commission 41

39. Examination for disease.—The face will be examined by inspection and, if necessary, by palpation.

40. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Extreme ugliness.

h. Unsightly deformities, such as large birthmarks, large hairy moles, extensive

cicatrices, mutilations due to injuries or surgical operations, tumors, ulceratons, fistulae,

atrophy of part of the face or lack ofsymmetrical development.

c. Persistent neuralgia, tic doloreux, or paralyses of central nervous origin.

d. Ununited fractures of the maxillary bones, deformities of either maxillary bone

interfering with mastication or speech, extensive exostosis, caries, necrosis, or osseous cysts.

e. Chronic arthritis of the temporo-maxillary articulation, badly reduced or recurrent

dislocations of this joint, or ankylosis, complete or partial.

41. Standards for candidates for commission.—The same as for applicants for

enlistment.

Section IX

THE MOUTH, NOSE, FAUCES, PHARYNX, LARYNX, TRACHEA, AND ESOPHAGUS

Paragraph

Methods of examination 42

Standards for applicants for enlistment 43

Standards for candidates for commission 44

42. Methods of examination.—These parts will be examined by inspection and palpation.

complete examination by reflected light in the dark room will be made of the anterior

and posterior nares, the nasopharynx, and the pharynx, and when necessary of the larynx.

When considered necessary, transillumination and studies by the X-ray will be employed.

43. Standards for applicants for enlistment.—The following conditions are causes

for rejection:

a. Harelip, loss of the whole or large part of either lip, unsightly mutilations of the

lips from wounds, burns, or disease.

1). Malformation, partial loss, atrophy or hypertrophy of the tongue, split or bifid

tongue, or adhesions of the tongue to the sides of the mouth, provided these conditions

interfere with mastication, speech, or swallowing, or appear to be progressive.
APPENDIX 221

c. Malignant tumors of the tongue, or benign tumors that interfere with its functions.

d. Marked stomatitis, or ulcerations, or severe leukoplakia. See paragraph 12.

e. Ranula if at all extensive, or salivary fistula.

f. Perforation or extensive loss of substance or ulceration of the hard or soft palate,

extensive adhesions of the soft palate to the pharynx, or paralysis of the soft palate.

g. Loss of the nose, malformation, or deformities thereof that interfere with speech

or breathing or extensive ulcerations.

h. Perforated nasal septum, if progressive, or if respiration is accompanied by noticeable whistling sound. Before accepting any applicant with perforated nasal septum the

possibility of syphilitic infection will be excluded.

i. Nasal obstruction due to septal deviation, hypertrophic rhinitis, or other causes, if

sufficient to produce mouth breathing.

j. Acute or chronic inflammation of the accessory sinuses of the nose, or hay fever.

k. Chronic atrophic rhinitis, if marked and accompanied by ozena.

I. Malformations and deformities of the pharynx of sufficient degree to interfere with

function.

m. Postnasal adenoids interfering with respiration or associated with progressive

middle-ear disease.

n. Chronic enlargement of the tonsils sufficient to interfere with speech or swallowing.

o. Chronic laryngitis from any cause.

p. Paralysis of the vocal cords, or aphonia.

q. Tracheostomy.

r. Stricture or pronounced dilatation of the esophagus.

44. Standards for candidates for commission.—The same as for applicants for

enlistment.

Section

THE TEETH

Paragraph

Requirements for acceptance 45

Definitions of terms used 46

Standards for applicants for enlistment 47

Standards for candidates for commission 48

45. Requirements for acceptance.—The teeth will be thoroughly examined by dental

surgeon, if one is available. No applicant or candidate will be accepted unless he has

minimum of three serviceable natural masticating teeth above and three below opposing,

and three serviceable natural incisors above and three below opposing. Therefore, the

minimum requirement consists of total of six masticating teeth and of six incisor teeth,

all of which must be so opposed as to serve the purpose of incision and mastication.

46. Definition of terms used. a. The term “masticating teeth” includes molar and

bicuspid and the term “incisors” includes incisor and cuspid teeth.

&. carious tooth with one or more cavities which can be restored by filling is to be

considered as “a serviceable natural tooth.”

c. Teeth which have been satisfactorily restored by crowns or replaced by dummies

attached to bridge work will be considered as “serviceable natural teeth,” when the history

and appearance clearly warrant such assumption.

d. tooth is not to be considered “a serviceable natural tooth” when it is involved

with excessively deep pyorrhea pockets, or when its root end is manifestly affected with

an infection that has or has not an evacuating sinus discharging through the mucous

membrane or skin, or when it fails to enter into serviceable occlusion with the opposing

tooth.
222 PHYSICAL STANDARDS

47. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. The loss of teeth in excess of the standardnoted in paragraph 45. I). Marked pyorrhea alveolaris.

c. Gross prognathism or irregularity which interferes with serviceable occlusion.

48. Standards for candidates for commission.—The same as for applicants for enlistment.

Section XI

THE NECK

Paragraph

Significance of cervical adenitis 49

Standards for applicants for enlistment 50

Standards for candidates for commission 51

49. Significance of cervical adenitis.—The neck will be examined by inspection and

palpation. Cervical adenitis must he given careful consideration with view to determining

its cause. If the condition is of benign origin, such as dental caries or pediculosis, it is not

cause for rejection. Adenitis in the submaxillary, parotid, and auricular region is usually

of benign origin; in the clavicular and lower carotid regions it is frequently tubercular.

The presence of adenitis should always be borne in mind as possible symptom of syphilis.

50. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Cervical adenitis of other than benign origin, including cancer, Hodgkin’s disease,

leukemia, tuberculosis, syphilis, etc.

b. Adherent and disfiguring scars from disease, injuries, or burns.

c. Extensive or progressive goiter interfering with breathing or with the wearing of

military clothing.

d. Exophthalmic goiter, or myxedema.

e. Thyroid enlargement from any cause associated with toxic symptoms.

/. Benign tumors or cysts which are so large as to interfere with the wearing of uniform or military equipment.

g. Torticollis.

51. Standards for candidates for commission.—The same as for applicants for enlistment.

Section XII

THE SPINE

Paragraph

Examination for disease 52

Standards for applicants for enlistment 53

Standards for candidates for commission 54

52. Examination for disease.—The spine will be examined by inspection and palpation.

The mobility wil he observed while the applicant is performing the exercises directed in

paragraph 29. When necessary, X-ray examinations willbe made.

53. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Lateral deviation of the spine from the normal midline of more than inches

(scoliosis).
APPENDIX 223

&. Curvature of the spine of any degree in which function is interfered with, or in

which there is noticeable deformity when the applicant is dressed (scoliosis, kyphosis, or

lordosis).

c. Fractures or dislocations of the vertebrae.

d. Vertebral caries (Pott’s disease).

e. Abscess of the spinal column or its vicinity.

/. Osteoarthritis of the spinal column, partial or complete.

g. Fracture of the coccyx.

54. Standards for candidates for commission.—The same as for applicants for enlist

merit.

Section XIII

THE CHEST

Paragraph

Study of conformation 55

Standards for applicants for enlistment 56

Standards for candidates for commission 57

55. Study of conformation.—The chest contains the vital organs of circulation and

respiration; it is therefore essential that it he well developed and justly proportioned to

the other body measurements. Any marked deviation in form, either flattening of the

chest or more especially persistence of the round or infantile type, is an element of weakness. Abnormal development, such as pigeon breast, funnel chest, or rachitic chest, is also

to be regarded with suspicion, as such conditions usually coincide with somewhat enfeebled constitution and predisposition to disease of the lungs. Hence, any anomaly in

the shape of the chest must be given careful consideration, especially in connection with

the results found in the examination of the contained organs and of other parts of the body.

56. Standards for applicants for enlistment.—The following conditions are causes for rejection:

a. Deficient expansion of the chest.

6. Congenital malformations or acquired deformities which result in reducing the

chest capacity and diminishing the respiratory functions to such degree as to interfere

with vigorous physical exertion, or that produce disfigurement when the applicant is

dressed.

c. Pronounced contractions of the chest with adhesions following pleurisy or empyema.

d. Deformities of the scapulae sufficient to interfere with the carrying of military

equipment.

e. Absence or faulty development of the clavicle.

/. Old fracture of the clavicle where there is much deformity or interference with the

carrying of military equipment, ununited fractures, or partial or complete dislocation of

either end of the clavicle.

g. Suppurative periostitis or caries or necrosis of the ribs, the sternum, the clavicles,

or the scapulae.

h. Old fractures of the ribs with faulty union, if interfering with function

i. Tumors of the breast or chest wall which interfere with the wearing of uniform

or of military equipment.

j. Unhealed sinuses of the chest all following operation.

k. Scars of old operations for empyema unless the examiner is assured that the

respiratory function is entirely normal.

57. Standards for candidates for commission.—The same as for applicants for

enlistment.
224 PHYSICAL STANDARDS

Section XIY

THE LUNGS

Paragraph

General considerations 58

Interpretation of physical signs 59

Certain physical signs not sufficient for rejection 60

Standards for applicants for enlistment 61

Standards for candidates for commission 62

58. General considerations.—The lungs will be examined by inspection, palpation, percussion, and auscultation of the chest. When desirable, radiographic studies and laboratory

methods, including examination of sputum, will be used. In the inspection and interrogation

of applicants the following points should lead to suspicion of pulmonary tuberculosis:

Apparent undue prominence of the clavicle on one side, caused by deepening of the

hollow above and flattening of the space beneath wasting of the muscles of the shoulder

girdle on one side, as evidenced by apparent excessive prominence of the shoulder and

scapula; history of recent loss of weight, especially if associated with long and severe

cough and night sweats. In suspected cases observation, with complete record of temperature, pulse, and respiration, may be of assistance. As pleurisy, with or without effusion,

is very frequent incidence of early tuberculosis, examiners will examine with the greatest

care applicants who have apparently recovered from pleurisy. Distinction must be made

between active and inactive pulmonary tuberculosis. In this connection conservatism must

be exercised in the interpretation of physical signs over the apices of the lungs.

59. Interpretation of physical signs.—Each applicant should be required to exhale his

breath, cough, and immediately breathe in. The chest should be auscultated during this

process. All men who show moist sounds during cough or during respiration should be

classed as doubtful cases. All cases should be also classed as doubtful in which there is

well-marked dullness on percussion, well-marked increased transmission of voice, harsh

respiration, and ell-marked prolonged expiration, even though there be no rales present.

Men under weight or with sunken or deformed chests should be considered with special

care, and if the conditions are marked should be classed as doubtful, even though definite

signs of tuberculosis are not detected. Doubtful cases, even in the absence of positive

diagnosis, should normally be rejected.

60. Certain physical signs not sufficient for rejection.—The following signs will not

be regarded as evidence of pulmonary disease in the absence of other signs in the same

portion of the lungs

a. Slightly harsh breathing or slightly prolonged expiration over the right apex above

the clavicle anteriorly and to the third dorsal vertebra posteriorly. The same signs at the

extreme apex on the left side.

t). Same signs in second interspace, right, anteriorly near sternum (proximity of right

main bronchus).

c. Increased vocal resonance or slightly harsh breathing immediately below center of

left clavicle.

d. Fine crepitations over sternum heard when stethoscope touches the edge of that

bone.

e. Clicks heard during strong respiration or after cough in the vicinity of the

sternocostal articulations.

f. The so-called atelectatic rales at the apex during the first inspiration which follows

deeperbreath than usual or cough.

g. Sounds resembling rales at base of lung (marginal sounds), especially marked in

right axilla, limited to inspiration.

h. Similar sounds heard at apex of heart on cough (lingula).
APPENDIX 225

i. Slightly prolonged expiration at left base posteriorly.

j. Very slight harshness of respiratory sounds with prolonged expiration in the lower para-vertebral regions of both lungs posteriorly, most marked at about angle of scapula,

disappearing short distance above that point, equal on both sides, or slightly more marked

at the angle on one side, more frequently the left.

61. Standards for applicants for enlistment.—The following conditions are causes for rejection:

a. Active pulmonary tuberculosis.

1). Inactive pulmonary tuberculosis, if extensive.

c. Acute or chronic pleurisy, or empyema.

d. Pneumothorax or hydrothorax.

e. Chronic bronchitis, chronic pneumonia, pulmonary emphysema, asthma, or

bronchiectasis.

/. Actinomycosis, hydatid cysts, or abscess of the lung.

g. Tumor of lungs, pleura or mediastinum.

62. Standards for candidates for commission.—a. No candidate with inactive pulmonary tuberculosis will be accepted for commission in the Regular Army.

b. In other respects the standards are the same as for applicants for enlistment.

Section XV

THE HEART AND BLOOD VESSELS

Paragraph

Methods of examination of heart and blood vessels 63

Examination after exercise 64

Consideration of blood pressure 65

Interpretation of abnormal signs and symptoms 66

Hypertrophy and dilatation 67

Interpretation of murmurs 68

Accidental murmurs 69

Systolic murmurs 70

Diastolic murmurs 71

Standards for applicants for enlistment 72

Standards for candidates for commission 73

63. Methods of examination of heart and blood vessels. a. General.—The applicant

should stand before the examiner with direct light falling upon his chest. He should stand

at ease, with the arms relaxed and hanging by his sides. The examiner should not permit

the applicant to move his body from side to side or twist it in an endeavor to assist in

the examination, as these maneuvers may distort landmarks and increase muscular resistance of the chest wall. The heart should he examined by the following methods: Inspection,

palpation, percussion, auscultation, and when considered necessary by mensuration. Bloodpressure readings and palpation of the pulse are required for candidates for commission

and for applicants for enlistment when considered necessary.

b. Inspection.—Begin from above downward, with especial reference to the following;

Condition and color of skin and mucous membranes, eyes for arcus senilis; visible pulsations of the vessels of the neck; enlargement of the thyroid gland; the shape of the chest

for any malformation which might change the normal relations of the heart; pulsations

in the suprasternal notch, and in the second interspaces to right and left of the sternum;

character of the precordial impulse, and the location and character of the maximum

impulse, epigastric pulsations or pulsations in the hepatic region, and any pulsations or

retractions in the back.
226 PHYSICAL STANDARDS

c. Palpation.—Palpate first for the detection of thrills over the carotids (aortic stenosis), thyroid gland (exophthalmic goiter), suprasternal notch (aneurysm), apex of heart

(mitral stenosis), and at the base (aortic stenosis). Use palms of hands in palpating and

use light pressure, as hard pressure may obliterate thrill. To locate the maximum cardiac

impulse, have the applicant stoop and throw shoulders slightly forward, thus bringing

heart into the closest possible relation with the chest wall. Palpate both radials at the

same time for equality in rate and volume. Run the finger along the artery to note any

changes in its walls. Place the palm of one hand over the heart and fingers of the other

over the radial to see if all ventricular contractions are transmitted. Palpate to determine

the degree of tension or compressibility of the pulse, the finger nearest the patient’s hand

compressing the artery and preventing any impulse reaching the middle or palpating

finger from the deep palmar arch. The middle finger is the palpating finger, and the third

is to make gradually increasing pressure upon the artery to obliterate the pulse wave and

estimate its volume. In estimating pulse rates, the excitement of undergoing physical

examination must be considered and rate of 90 may be considered normal, provided the

heart responds normally to the exercise test. rate of 50 or below should excite suspicion

of heart block and be made the subject of further investigation. Rates of 100 or over should

be investigated with view to the exclusion of heart lesions and hyperthyroidism.

d. Percussion.—Light mediate percussion should be used. The right and left cardiac

borders, as well as the diameter of the transverse arch may be determined by percussion.

In doubtful cases where it is important to determine the actual cardiac boundaries, X-ray

pictures should be taken and also cardiac mensuration made.

e. Mensuration.—Draw line down the midsternum, from the suprasternal notch to

the tip of the ensiform cartilage. Measurements are made at right angles to this line, at

the second interspace (aortic dullness), at the fourth interspace to the right for any

increase in the right border, and at the fifth interspace to the left for any increase in

the left border.

The following measurements may be considered normal for the average young adult: From midsternal line to right border at fourth interspace, cm.

From midsternal line to left border along fifth interspace, cm.

The normal aortic dullness at the second interspace to the right and left of the

midsternal line is cm.

/. Auscultation. —In auscultating the heart, the examiner should bear in mind the

four points where the normal sounds of the heart are heard with maximum intensity, viz: (1) Aortic area, second interspace to right of sternum. Here the second sound

is distinct.

(2) Tricuspid area, at the junction of the fifth rib with the sternum. Here the

first sound is distinct.

(3) Pulmonic area, second interspace to left of sternum. Here the second sound

is most distinct.

(4) Mitral area, fifth interspace to left of sternum. Here the first sound is most

clearly heard.

In doubtful cases the examiner should make inquiry into the use of alcohol or tobacco,

overindulgence in athletics, habitual use of coal-tar derivatives, or narcotic drugs. He

should also ascertain whether the applicant has had any of the following diseases: Scarlet

fever, chorea, diphtheria, measles, rheumatic fever, tonsillitis, influenza, typhoid fever,

syphilis, gonorrhea, tuberculosis, chronic focal infections, etc.

64. Examination after exercise.—Examiners will use judgment and discretion in

applying the exercise test to those who present evidence of incompetency of the heart.

An exercise test is required in order to determine the efficiency of the heart muscle. Have

the applicant hop 100 times on one foot, clearing the floor about inch at each hop, or

engage in an equivalent exercise. Take pulse rate before exercise, immediately after com-
APPENDIX 227

pletion of test, and two minutes later. heart muscle may be said to be efficient if the

pulse rate taken two minutes after the above exercise approximates the initial rate.

Example of normal response

Before exercise, SO.

Immediately after, 120.

Two minutes after, 84.

Immediately after the exercise auscultation should be repeated with particular reference to the detection of murmurs previously inaudible. Note should be made of the degree

of dyspnea and other symptoms of circulatory failure, such as cyanosis.

65. Consideration of blood pressure.—In considering the blood pressure, due regard

must be given to the age of the applicant and to physiological causes, such as excitement,

recent exercises, and digestion. The condition of the arteries, the tenseness of the pulse,

and the degree of accentuation of the aortic second sound must be taken into consideration,

as will also the relation between the systolic and diastolic pressure. No applicant will be

rejected as result of single reading. When the blood pressure estimation at the lirst

examination is regarded as abnormal, or in case of doubt, the procedure will be repeated

twice daily (in the morning and in the afternoon) for sufficient number of days to enable

the examiner to arrive at definite conclusion.

66. Interpretation of abnormal signs and symptoms.—The following principles are

laid down for the guidance of examiners in their interpretation of abnormal signs and symptoms. In many instances the interpretation must be purely individual and based on the

cumulative evidence of number of relatively slight deviations from the normal. It should

be strongly emphasized that, given heart of normal size and responding normally to effort,

any murmur is to be considered functional and insignificant unless it can be positively

demonstrated that it is mitral or aortic diastolic murmur, or unless definite history of

rheumatic fever or other acute infection or evidence of chronic focal infection is obtained.

It should also be constantly borne in mind that the excitement of the examination may produce violent and rapid heart action, often associated with transient systolic murmur,

which conditions may erroneously be attributed to the effects of exertion. These conditions

usually disappear promptly in the recumbent posture, but the examiner must be careful

to distinguish the excitable individuals and take measures to eliminate psychic influences

from the test so far as possible.

67. Hypertrophy and dilatation.—An apex beat located at or beyond the left nipple

line, or below the sixth rib, and of heaving character, indicates an enlargement sufficient

to disqualify for military service. Its cause, either valvular disease or hypertension in the

majority of cases, should be sought for. Enlargement should not be made primary diagnosis unless careful examination fails to reveal cause.

68. Interpretation of murmurs.—It is most important that cardiac lesions be correctly recognized, and that accidental or functional murmurs or defects which do not

indicate organic disease be not misconstrued and considered as cause for rejection. Ordinarily no murmur should be declared organic unless secondary physical signs can be

demonstrated. In questionable cases the history, especially of past rheumatic fever or

other acute infection, or chronic focal infection, should be carefully elicited.

69. Accidental murmurs.—Cardiac murmurs are the most certain physical signs by

which valvular disease may be recognized and its location determined, but murmurs are

very frequent in the absence of valvular lesions and may occur in perfectly healthy hearts,

especially under the influence of excitement and exertion. Such accidental murmurs are

always systolic in time. The most frequent of these are—

a. Those heard at the apex on excitement.

h. Those heard over the second and third left interspaces during expiration, disappearing during forced inspiration. These are particularly common in men with flexible chests,

who can produce extreme forced expiration,and under such circumstances may be associated

with definite thrill.
228 PHYSICAL STANDARDS

c. Systolic accentuation of the respiratory murmur, especially on inspiration, heard

near the apex over the back.

d. Cardio-respiratory murmurs occasioned hy movements of the heart against residual

air in part of the lung overlapping the heart. These are usually increased on inspiration

and decreased on expiration, and at times disappear completely on holding the breath.

e. Murmurs which appear to depend on the position of the heart for their production;

that is, appearing in the standing and disappearing in the recumbent position, or vice versa.

/. Murmurs which are present before exercise and disappear after exercise, owing to

the increased tonicity of the heart muscle caused by exercise.

g. Prolongation of mitral first sound, miscalled murmurs.

h. Systolic murmurs over the base occurring during the course of acute infections and

in all likelihood due to relaxed tone of the heart muscle.

i. Pleural and pericardial friction rubs which usually disappear when the applicant

holds his breath and are accompanied hy other physical signs.

70. Systolic murmurs.—a. Systolic murmurs unassociated with history of rheumatic

fever, or other acute infection, with enlargement of the heart, with alteration of the first

sound, or with abnormal response to exercise may also be considered as without significance.

6. Loud systolic murmurs, audible at the apex and in the left back, if associated with

any enlargement of the heart, with snapping first sound, or accentuation of the pulmonic

second sound, indicate organic disease, disqualifying for military service; also harsh and

blowing murmurs, and ones persisting throughout systole, transmitted to the axilla or back,

if associated with history of rheumatic fever, or other acute infection, or with poor or

dubious response to exercise.

c. Systolic murmurs at the base, except as specified above, especially those heard in the

second right intercostal space, require more careful scrutiny. They may be due to disease

of the aortic valves. In this case they shouldbe harsh, conveyed well into the neck, associated

with an aortic diastolic murmur, with thrill, or with marked enfeeblement of the aortic

second sound. They are more often due to dilatation of the aorta, either syphilitic or

arteriosclerotic. The other signs of dilatation should then be sought, viz, increased dullness

in the first and second interspaces to either side of the manubrium, pulsation in this area,

and accentuation of the aortic second sound. In doubtful cases, X-ray examination and

Wassermann test shouldbe made.

71. Diastolic murmurs.—a. All diastolic murmurs, at apex of base, including presystolic

murmurs, should be considered suggestive of organic disease. The soft, low-pitched diastolic

murmur of aortic insufficiency may be audible to the ear when not heard through the

stethoscope. The secondary signs should be sought for, viz, enlargement of one or both sides

of the heart, alteration of the first or second sound, particularly snapping first sound and

accentuated pulmonic second sound in mitral disease, and the characteristic pulse of aortic

insufficiency. In doubtful cases definite history of rheumatic fever or other acute infection may be given weight.

I). It should be borne in mind that the characteristic presystolic murmur in certain cases

of mitral stenosis may not be audible during rest. It is therefore important in every doubtful case that auscultation he made immediately after the exercise test and in both the erect

and the recumbent positions. On the other hand, many cases of tachycardia or overacting

heart present physical signs very suggestive of mitral stenosis (sharp, tapping apex beat,

sharp, loud, first sound, suggestion of apical thrill, etc.), and the diagnosis of mitral stenosis

should not be made unless distinct presystolic or diastolic murmur is heard. presystolic

thrill when present at or near the heart’s apex is practically pathognomonic of mitral

stenosis.

72. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. All valvular diseases of the heart.

1). Hypertrophy or dilatation of the heart, as indicated in paragraph 67.
APPENDIX 229

c. Pericarditis, endocarditis, myocarditis, or anginapectoris.

d. heart rate of 100 or over, or of 50 or under, when these are proved to be persistent

in the recumbent posture and on observation and reexamination over sufficient period of

time.

e. Marked cardiac arrhythmia or irregularity.

/. Arteriosclerosis.

g. Hypertension evidenced by persistent systolic blood pressure above 150. In persons

under 25 years of age persistent systolic pressure above 140 is cause for rejection.

h. Aneurysm of any variety in any situation.

i. Intermittent claudication.

j. Raynaud’s disease.

k. Thrombophlebitis of one or more extremities, if thereis persistence of the thrombus

or any evidence of obstruction to circulation in the involved vein or veins.

73. Standards for candidates for commission.—a. No candidate with systolic murmur

at the apex which is transmitted to axilla or angle of scapula will be accepted for commission in the Regular Army.

ft. In otherrespects the standards are the same as for applicants for enlistment.

Section XVI

THE ABDOMEN

Paragraph

Examination for disease 74

Observation for uncinariasis and malaria 75

Standards for applicants for enlistment 7G

Standards for candidates for commission 77

74. Examination for disease.—The abdomen will be examined by inspection and if

necessary by palpation and percussion. When indicated, X-ray examinations and laboratory

tests will be made. Examination for inguinal, femoral, and ventral hernia will be made

by both inspection and palpation.

75. Observation for uncinariasis and malaria.—Applicants accepted from regions in

which uncinariasis or malaria is prevalent, and who present symptoms of anemia or enlargement of the spleen, should be placed under observation for these diseases (examination of feces and blood). This applies also to the dysenteries, especially the entamebic form.

76. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Wounds, injuries, cicatrices, or muscular ruptures of the abdominal walls sufficient

to interfere with function.

ft. Fistulae from visceral or bony lesions or following operation.

c. Hernia of any variety.

d. Large tumors of the abdominal walls.

e. Scar pain, if severe.

f. Chronic diseases of the stomach and intestines.

g. Gastroenterostomy for relief of gastric or duodenal ulcer.

h. Blood in the feces unless shown to be due to unimportant causes.

i. Ptosis of the stomach or intestines.

j. Chronic appendicitis.

k. Chronic diseases of the liver, gall bladder, pancreas, or spleen.

l. Chronic peritonitis or peritoneal adhesions.

m. Chronic enlargement of the liver.

n. Chronic enlargement of the spleen, if marked.

o. Jaundice.
230 PHYSICAL STANDARDS

p. Proctitis or stricture of the rectum.

q. Hemorrhoids. (See Section XVII.)

r. Fistula in ano. (See Section XVII.)

s. Incontinence of feces.

t. Uncinariasis, if attended with marked anemia or other evidence of grave constitu

tional disturbance.

77. Standards for candidates for commission.—The same as for applicants for

enlistment.

Section XVII

THE PELVIS, INCLUDING THE SACROILIAC AND LUMBOSACRAL JOINTS

Paragraph

Examination for disease 78

Standards for applicants for enlistment 79

Standards for candidates for commission 80

78. Examination for disease.—The pelvis will be examined by inspection and if necessary by palpation. To inspect the anal region the applicant will be directed to bend forward from the hip and to draw apart the buttocks with both hands. Digital examination

of therectum and proctoscopy will be used if necessary.

79. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. Malformation and deformities of the pelvis sufficient to interfere with function.

b. Disease of the sacro-iliac or lumbo-sacral joints.

c. Urinary fistula.

d. Stricture or prolapse of the rectum.

e. Fissure of the anus or pruritis ani.

/. Fistula in ano or ischio-rectal abscess.

g. External hemorrhoids sufficient in size to produce marked symptoms. Internal

hemorrhoids, if large or accompanied with hemorrhage, or protruding intermittently or

constantly.

80. Standards for candidates for commission.—The same as for applicants for

enlistment.

Section XVIII

THE GENITOURINARY SYSTEM, INCLUDING VENEREAL DISEASES

Paragraph

Methods of examination 81

Procedure when albumin or casts are found 82

Procedure when specific gravity is abnormally low 83

Procedure when glycosuria is detected 84

Wassermann test 85

Standards for applicants for enlistment 86

Standards for candidates for commission 87

81. Methods of examination.—The genito-urinary organs will be examined by inspection and palpation. Evidence of venereal disease or malformation will be searched for. The

glans-penis and corona will be exposed and the penis stripped. Both sides of the scrotum

will be palpated, as will also the inguinal glands. When necessary, further examination

by the X-ray, by urethral instrumentation, and by laboratory methods will be conducted.

The urine of all applicants for enlistment will be examined for albumin and specific gravity,

and if the latter is over 1025 will also be tested for the presence of sugar. Urinalysis, includ-
APPENDIX 231

ing tests for albumin, specific gravity, and sugar, and microscopic examination of the

sediment, will be made in the case of all candidates for commission, the urine being voided

in the presence of one of the examiners.

82. Procedure when albumin or casts are found.—The term “albuminuria” will not

ordinarily be used as cause for rejection, nor does its presence alone justify diagnosis

of nephritis. When albumin or casts are found in the urine the applicant will be retained

under observation and daily complete examinations of the urine will be made for at least five

days, unless the presence of albumin and casts is associated with enlargement of the left

heart, high blood pressure, and other evidence of cardio-vascular disturbance to such

degree that diagnosis of chronic nephritis may be made immediately. When albumin is

constantly or intermittently present the underlying pathological condition must, if possible,

be determined and stated as the cause for rejection, but if albuminuria is present daily

during period of six days it should be regarded as reason for rejection, even if the origin

can not be determined.

83. Procedure when specific gravity is abnormally low.—When the specific gravity of

the specimen first examined is abnormally low, further observation of the applicant and

repeated complete urinary examinations are indicated.

84. Procedure when glycosuria is detected.—If glucose is found in the urine at the first

examination, further observation is indicated, including an estimation of the 24-hour

amount of urine and the employment of more than one test to demonstrate the possible

existence of diabetes. When considered necessary, blood sugar estimations should also be

made.

85. Wassermann test.—The Wassermann test will be required on all candidates for

commission in the Regular Army only. Whenever doubleplus reaction is obtained, another

specimen will be examined after lapse of one week. The Wassermann test will not be

employed as routine measure of examination for applicants for enlistment, but should be

used as an aid to diagnosis in doubtful cases.

86. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

а. Acute or chronic nephritis, or diabetes mellitus or insipidus.

б. Blood, pus, or albumin in the urine, if persistent for six days.

c. Floating kidney, hydronephrosis, pyonephrosis, pyelitis, tumors of the kidneys, or

renal calculi.

d. Acute or chronic cystitis.

e. Vesical calculi, tumors of the bladder, incontinence of urine, enuresis, or retention

of urine.

f. Hypertrophy or abscess of the prostate gland, or chronic prostatitis,

g. Urethral stricture or urinary fistula.

h. Epispadias or hypospadias when the urine cannot be ejected in such manner as

to avoid soiling of clothing or surroundings, or when accompanied by evidence of chronic

colon bacillus infection of the genito-urinary tract.

i.Phimosis when prepuce is adherent in whole or in part to the glans.

j. Hermaphroditism.

k. Amputation of the penis if it interferes with micturition.

l. Varicocele, if large and painful, or hydrocele if large.

m. Pronounced atrophy of both testicles or loss of both.

n. Undescended testicle when the organ is in the inguinal canal or when outside the

canal and lying against the pubic bone. Infantile genital organs.

o. Chronic orchitis or epididymitis.

p. Syphilis in any stage.

q. Gonococcus infections, acute or chronic (including gonorrheal arthritis), chancroids,

or buboes.
232 PHYSICAL STANDARDS

87. Standards for candidates for commission.-—a. No candidate who is found to have

double plus Wassermann reaction on two occasions (see paragraph 85) will he accepted for

commission in the Regular Army. In such cases, if no other evidences of syphilis can be

found, the cause of rejection will be recorded not as syphilis but as “Double plus

Wassermann.”

ft. In otherrespects the standards are the same as for applicants for enlistment.

Section XIX

THE EXTREMITIES

Paragraph

Examination for defects 88

Standards for applicants for enlistment 89

Standards for candidates for commission 90

88. Examination for defects.—The extremities will be carefully examined for deformities,

old fractures and dislocations, amputations, partially flexed or ankylosed joints, impaired

functions of any degree, varicose veins, and oedema. The feet will be especially examined, for

flat foot, corns, ingrowing nails, bunions, deformed or missing toes, hyperidrosis, bromidrosis,

and clubfoot. When any degree of flat foot is found, the strength of the feet should be

ascertained by requiring the applicant to hop on the toes of each foot for sufficient time

and by requiring him to alight on the toes after jumpingup several times.

89. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

a. All anomalies in the number, the form, the proportion, and the movements of the

extremities which produce noticeable deformity or interfere withfunction.

1>. Atrophy of the muscles of any part, if progressive or if sufficient to interfere with

function.

c. Benign tumors if sufficiently large to interfere with function.

d. Ununited fractures, fractures with shortening or callous formation sufficient to

interfere with function, old dislocations unreduced or partially reduced, complete or partial

ankylosis of joint, or relaxed articular ligaments permitting of frequent voluntary or involuntary displacement.

e. Reduced dislocations or united fractures with incomplete restoration of function.

f. Amputation of any portion of limb, except fingers or toes, or resection of joint.

g. Excessive curvature of long bone or extensive, deep or adherent scars interfering

with motion.

h. Severe sprains.

i. Diseases of the bones or joints.

j. Chronic synovitis, or floating cartilage, or other internal derangement in joint,

k. Varicose veins in an extremity when they cover large area or are markedly tortuous or much dilated, or are associated with oedema, varicocele, or hemorrhoids, or are

accompanied by subjective symptoms.

I. Varices of any kind situated in the leg below the knee if associated with varicose

ulcers or scars from old ulcerations.

m. Chronic oedema of limb.

n. Chronic and obstinate neuralgias, particularly sciatica

o. Deviation of the normal axis of the forearm to such degree as to interfere with

the proper execution of the manual of arms.

p. Adherent or united fingers (web fingers).

q. Permanent flexion or extension of one or more fingers, as well as irremediable loss

of motion of these parts, if sufficient to interfere with proper execution of the manual of

arms.
APPENDIX 233

r. Total loss of either thumb.

s. Mutilation of either thumb to such an extent as to produce material loss of flexion or strength of the member.

t. Loss of more than one phalanx ofthe right index finger.

u. Loss of the terminal and middle phalanges of any two fingers on the same hand.

v. Entire loss of any finger except the little finger of either hand, or the ring finger

of left hand.

w. Perceptible lameness or limping.

x. Knock-knee when the applicant is unable to take the position of soldier, when

the gait is clumsy or ungainly, or when subjective symptoms of weakness are present.

y. Bowlegs if so marked as to produce noticeable deformity when the applicant is

dressed.

z. Clubfoot unless the defect is so slight as to produce no symptoms during vigorous

exercise.

aa. Pes cavus if extreme and causing symptoms.

ah. Flat foot when accompanied with symptoms of weak foot or when the foot is weak

on test. Pronounced cases of flat foot attended with decided eversion of the foot and marked

bulging of the inner border, due to inward rotation of the astragalus, are disqualifying regardless of the presence or absence of subjective symptoms.

ac. Loss of either great toe or loss of any two toes on the same foot.

ad. Webbing of all the toes.

ae. Overriding or superposition of any of the toes to such degree as will produce

pain when wearing the military shoe.

af. Ingrowing toe nails when marked or painful.

ag. Hallux valgus when sufficiently marked to interfere with locomotion or when

accompanied with painful bunion.

ah. Bunions sufficiently pronouncedto interfere with function.

ai. Hammer toes when existing to such degree as to interfere with function when

wearing the military shoe.

aj. Corns or callous on the sole of the foot when they are tender or painful.

ak. Hyperidrosis or bromidrosis when present to marked degree.

al. Habitually sodden feet with blistered skin.

90. Standards for candidates for commission.—The same as for applicants for

enlistment.

Section XX

THE NERVOUS SYSTEM

Paragraph

General considerations 91

Methods of examination 92

Resume of the more common abnormal conditions 93

Standards for applicants for enlistment 94

Standards for candidates for commission 95

91. General considerations.—The detection of mental and nervous diseases is perhaps

the most difficult part of the examination of applicants. At the time of examination there

may be no obvious defects such as present themselves in other pathological conditions.

Each examiner should constantly be on the alert to detect any sign of such disorders in

the applicants and should promptly report suspicious symptoms he may note to the chief

examiner, or to the officer conducting the neuropsychiatric portion of the examination,

who should if possible be skilled specialist. Every effort must be made to reject the

mentally deficient and those showing evidence of serious nervous affections. The importance and value of thorough and effective examination of the applicants’ mental suit-
234 PHYSICAL STANDARDS

ability for Army service cannot be overestimated. Morons and those mentally deficient are

always continuous source of weakness and detriment to the Army from the day they are

accepted until they are separated from the service. Such men should under no circumstances be accepted for enlistment.

92. Methods of examination. —The applicant will be required to stand erect with the

inner borders of the feet together, arms horizontal, hands extended, fingers apart, and eyes

closed, and will be examined for tremors and nervous instability (Romberg sign). The

pupillary reactions to light and distance and the knee jerks should always be tested, and

in doubtful cases the other reflexes. When desirable, laboratory tests will be made.

93. Resume of the more common abnormal conditions. —The brief summary regarding

certain stigmata of degeneration, drug addictions, and nervous and mental diseases which

follow is intended as general guide for examiners. In estimating the value of the various

marks of degeneracy, the occurrence of very few in any individual case would not justify

classification of the case as defective. The presence, however, of numerous stigmata indicates probable instability in the nervous organization that is disqualifying for the

military service.

a. Anatomical stigmata of degeneration.—Cranial abnormalities in outline, capacity, or

dimensions; excessive development of the occipital protuberance and ridges, the frontal

eminences, and the mastoid processes; reduction of the facial angle; asymmetrical facial

development; lower jaw disproportionately large and prognathic; hard palate sharply

vaulted; dental arches narrowed or angular; teeth defective or misplaced; ears disproportionate in size or malformed; extreme refractive anomalies and strabismus; deviation of

the nose septal deformities harelip, cleft palate, remnants of branchial clefts spina bifida,

sacral growths of hair; deep sternal furrows and concavities disproportion between thorax

and abdomen; upper and lower limbs disproportioned to each other or to the trunk;

abnormality in size of hands or feet; tendency to left-sided overdevelopment; deformities

of the fingers; syndactyly; excessive length or shortness of the fingers; undersize of the

ring and little fingers; genitalia undeveloped; hypospadias; epispadias; scrotal fissure;

albinism melanism multiple naevi; defective development of hair and nails. The degenerate

physique as whole is often marked by diminished stature and inferior vigor; males may

present the general body conformation of the opposite sex, with sloping narrow shoulders,

broad hips, excessive pectoral and pubic adipose deposits, with lack of masculine hirsute and

muscular marking.

6. Functional stigmata of degeneration.—Defective mental qualities; moral delinquencies, such as willfulness, deceitfulness, indecency; stammering; urinary incontinence;

regurgitation and rechewing of food; color blindness; perverted tastes and cravings leading

to alcoholism and drug habits, sexual perversion.

c. Chronic alcoholism.—Suffused eyes; prominent superficial blood vessels of the nose

and cheek; flabby, bloated face; reddened aspect of the face; red or pale purplish discoloration of mucous membrane of the pharynx and soft palate; muscular tremor of the

protruded tongue and extended fingers tremulous handwriting.

d. Drug habit.—Peculiar pallor and dryness of the skin; needle marks and scars on

skin of arms and thighs; in opium users, contracted pupils; in users of cocaine, widely dilated

pupils.

e. Dementia praecox.—Indifference, apathy, withdrawal from environment, ideas of

reference and persecution; feelings that the mind is being tampered with or that thought

is being controlled by hypnotic, spiritualistic, or other mysterious agencies; hallucinations

of hearing; bodily hallucinations, frequently of electrical or sexual character; meaningless

smiles; in general, inappropriate emotional reaction and lack of connectedness in conversation. There may be sudden emotional or motor outbursts. The history of family life

and of school, vocational, and personal career will usually show erratic and more or less

irrational conduct.
APPENDIX 235

/. Manic-depressive insanity.—Mild depression, with or without feeling of inadequacy;

mild manic states with exhilaration, talkativeness, and overactivity.

g. Paresis (general paralysis).—The diagnosis of paresis may be made when at the

examination of the applicant majority of the following signs and symptoms are demonstrated Argyll-Robertson pupil or pupils; facial tremor; speech defect in test phrases, and

in the slurring or distortion of words in conversation writing defects, consisting of omissions

and the distortion of words; apathetic, depressed, or euphoric mood. These applicants may

show memory loss or discrepancies in relating facts of life; the knee jerks may he plus,

minus, or normal.

h. Tabes dorsalis (locomotor ataxia). —The diagnosis of this disease should be made

when at the examination of the applicant several of the following signs and symptoms are

present: Argyll-Robertson pupil or pupils; absent knee jerk; Romberg sign; ataxia of

hands or legs (especially when the eyes are closed), hypotonia, anesthetic areas of the

skin. The history of locomotor ataxia is usually that of slow progression, of failing sexual

power, and of pains in the legs or back which are often described as rheumatic.

i. Cerebrospinal syphilis.—The prominent diagnostic signs and symptoms are headaches, varying deep and superficial reflexes, pupillary changes, ptosis, ocular palsies,

facial paresis. The mental state is normal, dull, or apathetic. Comparative motor weakness

may occur on one side of the body or in one extremity.

j. Multiple sclerosis.—The diagnosis of this disease rests upon the following signs

and symptoms: Intention tremor, nystagmus, absent abdominal reflexes, increased tendon

reflexes, and scanning speech. In cases of this kind the history obtained is not characteristic, but sometimes there may be history of urinary disturbance.

k. Paraplegia.—The diagnosis of paraplegia from whatever cause will rest upon weakness of the lower extremities, associated with lost or increased knee jerk, Babinski reflex,

disturbances of the sphincters of the rectum and bladder, and sometimes girdle sensation. Sensory disturbance of the skin may or may not be present. Muscle sensibility may be

diminished.

I. Syringomyelia.—Syringomyelia is usually evidenced by more or less loss of power

and atrophy of groups of muscles of one or more extremities with disturbance of the sensations of the skin, more especially in the form of analgesias and diminution of the temperature sense. If in the upper dorsal cord, it is often associated with stooped shoulder

posture; if in the lower dorsal, with weakness in one or both lower extremities.

m. Muscular atrophies and dystrophies.—The signs and symptoms of muscular atrophies and dystrophies are atrophy of the small muscles of the hand and of the muscle

groups of the shoulder, associated with fibrillary twitchings. The history of these defects

rarely furnishes reliable data, although it will usually be found that the applicant has

shown evidences of awkwardness. There is never history of pain in the affected muscles.

n. Multiple neuritis.—The chief manifestations are more or less pain in the course of the affected nerves, with tenderness over the trunks of the nerves and of the muscles

supplied by them; lessened muscular power of varying degrees; more or less atrophy of

muscles, with or without contraction; and evidences of trophic changes of the skin. The

deep and superficial reflexes may be diminished or absent; the sphincters are not involved.

history of recent infectious disease or of exposure to poisons such as alcohol, lead, or

arsenic is of importance.

o. Mental deficiency and moron state.—Mental deficiency is that state in which the mind

has failed to attain normal development. The term “moron” is applied to an individual

with defective mentality, but who possesses greater degree of intelligence than the imbecile and the idiot. In all cases where there is any question as to the degree of mental

development of the applicant, he will be given the Stanford revision of the Binet-Simon

test; no applicant will be accepted who by this test shows mental age of 10 years or less.

p. Constitutional psychopathic states.—There is large group of individuals, who,

though not necessarily suffering from epileptic, psychotic, or psychoueurotic symptoms,

257—066 —67 -17
236 PHYSICAL STANDARDS

alcoholic or drug addiction, or feeble-mindedness in the strict sense of the term, are nevertheless incapable of attaining satisfactory adjustment to the average environment of civilized society. This group is very heterogeneous, yet there is much evidence, in family and

personal histories and in clinical manifestations, to show that the various conditions comprised in it are in some way related to one another and to other neuropathic conditions.

study of the individual’s past life readily shows psychopathic makeup, if one exists.

The types are—

(1) Inadequate personality,

(2) Paranoid personality.

(3) Emotional instability.

(4) Criminalism.

(5) Pathological lying.

(6) Sexual psychopathy.

(7) Nomadism.

q. Psychoneuroses: Hysteria, neurasthenia, and psychasthenia.—These conditions being

functional, often with no objective signs, may escape notice. Such individuals show emotional disturbances, have hypochondriacal complains, undue fatigability, and general nervous instability. The history of these conditions and of interference with progress in civil

life is important.

r. Epilepsy.—History of dizziness (without definite cause), many severe headaches,

and undue muscular tire in early morning are often due to epilepsy. Unexplained scars on

tongue, chin, or face given reason to suspect epilepsy. Epileptics often refer to seizures as

“fainting fits” or “spells of dizziness.”

s. Head injuries.—History of severe head injuries must be fully investigated and persistent symptoms referable to trauma should be carefully considered. Change in disposition

or shifting occupational history, following accident, should be regarded as disqualifying.

t. Peripheral nerve injuries.-—These conditions are manifested by history of injury

with localized motor or sensory disturbances. Any such case with an incomplete regeneration is poorrisk.

u. Endocrinopathies.—Functional disturbances of ductless glands are very important

in the production of neuropsychiatric conditions. The applicant should be closely observed

for evidences of such functional disturbances as goiter, exophthalmos, tremors, tachycardia, acromegaly, myxoedema, cretinism, smooth glassy skin, brittle nails, absent or

unnatural hair distribution, faulty skeletal development, infantile or hypertrophied genitals, scanty and downy beard, female figure, and vaso-motor disturbances.

94. Standards for applicants for enlistment.—The following conditions are causes for

rejection;

a. Insanity, epilepsy, or convulsions of any character, or history thereof.

h. Idiocy, imbecility, mental deficiency, or moronism (an applicanthaving mental age

of 10 years or less).

c. Constitutional psychopathic states.

d. Chronic alcoholism or drug addiction.

e. Locomotor ataxia, paresis, or cerebrospinal syphilis.

/. Multiple sclerosis, syringomyelia, paralyses, paraplegia, monoplegia, hemiplegia, or

hemiparesis.

g. Psychoneurosis, neurasthenia, psychasthenia, hysteria, hysterical paralysis, or hysterical stigmata.

h. Chorea or marked muscular tremors.

i. Somnambulism, or history thereof.

j. Neuritis, beriberi, or severe neuralgia.

1c. Muscular atrophies and dystrophies.

I. Stuttering or stammering of such degree that it would interfere with performance

of military duties.
APPENDIX 237

rn. Unequal or irregular pupils, unless cause is definitely determined to be other than

neurological.

n. Brain tumors.

o. History of having been committed to an institution for the care of the insane.

p. History of injury to skull, with secondary symptoms, or any evidence of impaired

nervous function.

q. History of excessive nervousness, or depression to an undue extent.

r. Endocrine disturbances that can be diagnosed by ordinary examination.

s. Injuries involving peripheral nerves which result in impaired function to an extent

that would interfere with the performance of military duty.

t. Other organic or severe functional diseases of the nervous system.

95. Standards for candidates for commission.—The same as for applicants for enlistment, except as to mentality, which will be as prescribed in other regulations.

[A.G. 300.33 (4-27-23).]

order of the Secretary of War

JOHN J. PERSHING,

General of the Armies,

Chief of Staff. Official

ROBERT C. DAVIS,

The Adjutant General.
238 PHYSICAL STANDARDS

INDEX

Abdomen: Paragraph

Examination of 74 Fistula. 76r Standards for applicants for enlistment 76

Standards for candidates for commission 77

Tumor of 76rf

Wounds of 76

Abscess, ischio-rectal 76,79/

Acne 34c Acromegaly 31d

Actinomycosis- 31d, 34c, 61/ Acuity ofhearing 20, 21, 22

Acuity of vision 16 Addison’s disease 31d

Additional diagnostic measures 10 Adenitis cervical 49

Adenoids, postnasal 43m Albuminuria 82, 866

Alcoholism, chronic 93c

Amputations 89/ Anemia 31d

Pernicious 31d

Secondary 31d

Splenic 31d

Aneurysm 72ft Angina pectoris 72c Ankylosis of joints 89d

Anus:

Fissure of. 79c Fistula in 79/

Hemorrhoids 76q, 79;

Pruritis of 79e Aphonia 43p

Appendicitis, chronic 76;

Applicant, definition of term

Applicants forenlistment:

Admission to hospital for observation 12 All defects to be noted 12 Examination of, by whom made 12

Examination of, to be complete 12

Rcenlistments 12 Results recorded on Form No. 22, A.0.0 12 Waivers for physical defects 12

Arrhythmia 72c

Arteriosclerosis 72/ Arthritis (see Diseases of bones and joints), Gonorrheal 86g

Articularrheumatism 31d

Asthenopia- 176

Asthma 61e

Astigmatism 186

Atrophy of muscles 896

Beriberi 31d, 94;

Binet-Simon test 93o

Bladder 86c

Cystitis 86d

Tumorsof 86

Blepharitis 17e

Blepharospasm 176

Blindness, night 176

Blood: Paragraph

Examination of, for malaria 75

In feces 75 Wassermanntest (see Wassermann test) 85, 87a

Blood pressure;

Consideration of 65 Estimation to berepeated 65 Rejection for increased 65, 72

Bones;

Disease of 89i

Excessive curvature of long bones 89 Fractures of. 89

Osteomyelitis 31d

Bow legs 89# Bradycardia 63, 72 Bromidrosis 89ak

Bronchiectasis 61e

Bronchitis, chronic 61e

Buboes 86

Bunion. 89aft

Calculi:

Renal 86c Vesical.. 86e

Callous, soles of feet 89 aj

Cancer. (See Malignant disease.)

Candidates for commission 13 Defects to benoted 13 Examination of, by whom made 13 Recorded on Form No. 395, A.G.O 13 Record to be complete 13 Thoroughness of examination 13 Waivers of defects 13 Carbuncle 34ft

Care in examination

Caries, vertebral 53 Cartilage, floating. 89;

Caution to examiners

Cellulitis 3id

Cerebrospinal syphilis 93i, 94 Chancroids 86c Chest 55-57 Abnormal development 65 Anomalies in shape 55 Deformity of 55 Developmentof 55 Deviation in form 55 Expansion of 31,56a Mobility of 31a Scars 56fc

Sinus of. 56;

Standards for applicants for enlistment 31,56 Standards for candidates for commission 32,57

Tumors of 56i

Chest measurements: Directions for taking 27

Requirements for applicants for enlistment 31 Requirements for candidates forcommission 32 Table of standards 28

Chorea 94

Choroiditis 176

Chronic alcoholism 93c, 94d
APPENDIX 239

Paragraph

Cicatrices of head. 37d

Claudication,intermittent 72* Clavicle:

Absence of.. 56e

Faulty development 56«

Fracture of.. 56/ Periostitis of 56 Clubfoot 89

Coccyx, fracture of 53

Coloboma 17 Color blindness 18 Communicable diseases 31d

Conjunctivitis 176

Constitutional psychopathic state. 93p, 94

Convulsions 94d

Cornea;

Opacities of 176

Ulcers of. 176

Corns 88,89 aj

Cretinism 31d

Cystitis 86d

Dacryocystitis 176

Deformity 31d

Dementia praecox 93e, 94

Depressed fractures of skull 37e

Dermatitis herpetiformis 34c

Diabetes:

Insipidus 31d, 86

Mellitus 31d, 86

Diagnostic measures, additional 10

Diseases:

Communicable 31d

Of long duration 31d

Diplopia 176

Dislocations:

Loss of function following. 89

Unreduced 89

Disqualified applicants, enlistment prohibitedDoubt as to rejection

Drug habit 93d, 94d

Ears 19-22

Deformity of 216

Determination ofacuity of hearing 20

Examination 19

Loss of 216

Standards for applicants for enlistment 21

Standards for candidates for commission 22

Eczema. 34a

Elephantiasis 34/ Emphysema 61e

Empyema 56k, 61c

Unhealed sinus following 56

Endocarditis 72c

Endocrine diseases 31d, 93m

Enuresis 86e

Epididymitis 86o

Epilepsy 93r,94a

Epiphora 176

Epispadias 86

Examination, general instructions for 8-14

Examination:

Assignment of examiners

Examination—Continued Paragraph

By whom made 12-13

Past history ofapplicant

Records of 12-13

Responsibility for

Rooms for

Routine order of 11

Special, for flying 14 Stripping ofapplicant 11 Temperatureof examining room Exercises:

Exhaustion following 30

Inconnection with examination of heart 64

Lack ofability to perform 30 Suggested movements for 29 External auditory canal:

Atresia of 216

Tumorsof 216 Extremities 88-90 Anomalies of 89 Examination of 88

Standards for applicants for enlistment 89

Standards forcandidates for commission 90 Tumorsof 89c Eyelids;

Adhesions of... 17 Cicatrices of 176 Destruction of 176 Eversion of 176 Inversion of 176

Eyes 15-18 Examination of 15 Standards forapplicants for enlistment 17

Standards for candidates for commission 18

Testingof acuity of vision 16

Face 39-41

Atrophyof 406

Deformity of 406

Examination of 39

Standards for applicants for enlistment 40

Standards for candidates for commission 41

Ugliness 40a

Fauces 42-44

Examination of 42

Standards for applicants for enlistment 43

Standards for candidates for commission 44

Feces:

Blood in 76

Incontinenceof 76

Feet;

Bromidrosis 89a fc

Club. 89z

Flat. 89a6

Hyperidrosis 89afc

Sodden 89a

Filariasis 31d

Fingers:

Amputation 89

Loss of 89

Loss of function of 89

Loss ofphalanges 89

Missing 89

Web. 89
240 PHYSICAL STANDARDS

Paragraph

Fistula:

Abdominal 76

In ano 76r, 79/ Lachrymal 176 Salivary. 43e Urinary 79, 86 Fits. (See Convulsions.)

Flat foot:

As cause ofrejection 89a6 Strength of 88 Flying, special examination for:

By whom made 14

Form used as record 14 Fontanelles, persistence of anterior 37c Foot. (See Feet.)

Fractures:

Interfering with function 89d

Of skull 37e Ununited— 89

Gall bladder 76 Gastroenterostomy 769

General examination 23-32 Instruction regarding 23 Results obtained from 23 Genito-urinary system 81,87

Examination of 81 Standards for applicants for enlistment 86 Standards for candidates for commission 87 Gigantism 31d

Gians penis, examination of 81

Glaucoma 176

Glucose, in urine 84 Goiter:

Simple 50c Exophthalmic 50d

Gonococcus infection 86

Gonorrhea 869 Gonorrheal arthritis 869

Hallux valgus 89ag

Harelip 43a Hay fever 43/

Head 36-38

Cicatrices of 37e Deformity of skull 376 Examination of 36 Imperfect ossification of cranial bones 37c

Monstrosity 37/ Standards for applicants forenlistment 37 Standards forcandidates for commission 38 Tumorsof 376 Hearing:

Acuity of 20 Recording of 20

Rules for determining 20

Standards for applicants forenlistment 21

Standards for candidates for commission 22 Heart 63-73 Apexbeat 63,67 Consideration of murmurs 66-71 Dilatation of 67,72 Distinction between functional and organic

defects 66-71 Examination of. 63-64, 67-71

Heart—Continued Paragraph

xaminationafter exercise 64

Hypertrophy of 67,726

Intermittent claudication 72i

Standards for applicants for enlistment 72

Standards forcandidates for commission 73

Height 23-32

Directions for taking 25

Maximum 31d

Minimum 31a

Relation toweight and mobility of chest 28,316

Standards for applicants for enlistment 31 a-d

Standards for candidates for commission 32

Table of standards 28

Hemophilia 31d

Hemorrhoids 76?, ~9g

Hermaphroditism 86

Hernia 76c

Hodgkin’s disease 50a

Hydatidcysts 61/ Hydronephrosis 86c

Hydrothorax 61d

Hyperidrosis 89a

Hyperopia 186

Hypertension 65,720

Hypospadias 866

Hysteria 939,94

Hysterical 94s Paralysis 94 Stigmata 94p

Ichthyosis 34

Idiocy 946

Imbecility 946

Immaturity, evidence of 24

Impetigo 346

Insanity 93,94a

Intestines, diseases of 76/ Iris:

Colobomaof 176

Irregularity of form of 176

Iritis 176

Ischio-rectal abscess 79

Jaundice 76o

Joints:

Ankylosis of 89d

Disease of 89i

Dislocation of 89«

Resection of 89

Sprain of 896/

Keratitis 176 Kidney:

Absence of 86

Diseases of 86 Floating 86c Tumors of 86c Knock-knee 89r

Kyphosis 536

Lachrymal fistula 176 Lagophthalmus 176 Lameness 89
APPENDIX 241

Paragraph

Laryngitis 43o

Larynx 42-44

Examination of 42

Standards for applicants forenlistment 43

Standards for candidates forcommission 44

Lens:

Cataract 176

Opacities of. 176

Leprosy 31d

Leukemia 31d

Leukoplakia- 43d

Limping 89

Lips;

Disease of 43

Harelip 43a

Mutilations of 43a

Liver:

Diseases of 76

Lordosis 536

Lumbo-sacral joint 796

Lungs. 58-62

Abscess of 61/ Actinomycosis of 61/

Examination of 58, 59

Hydatid cysts of 61/ Pleurisy --- 58

Standards for applicants forenlistment 61

Standards forcandidates for commission... 62

Tuberculosis 58-62

Lupus 342

Malaria:

Chronic 31

Malarial cachexia. 31d

Observation for 75

Malignant disease 31d

Manic-depressive psychosis 93/, 94

Mastoiditis 216

Maturity 24

Maxillary bones;

Caries of 40d

Deformity of 406

Fracture of 40d

Necrosis of 40d

Osseous cysts of 40d

Membrana tympani, perforation of 216

Mental deficiency 93o, 94

Metallic poisoning 31d

Military Academy, application of standards to candidates for

Moron 93o

Mouth 42-44

Examination of 42

Standards forapplicants for enlistment 43

Standards forcandidates for commission 44

Multiple neuritis 93n, 94

Multiple sclerosis 93/, 94

Murmurs;

Cardiac 66-71

Diastolic 71

Systolic 69, 70, 73

Muscles, atrophy of 89

Muscular atrophies and dystrophies... 93m

Mycosis fungoides 34

Paragraph

Myocarditis. 72

Myopia 18

Myxoedema 31d, 50

Naevi 34fc

Nasal septum:

Deviation of 43i

Perforation of 436

Neck 49-51

Adenitis 49, 50a

Cysts of 50/ Examination of 49

Scars of 506

Standards for applicants for enlistment 50

Standards for candidates forcommission 51

Torticollis 50g

Tumors of 50/

Nephritis 82, 86a Nervous system 91-95

Examinationof 91,92

Importanceof examinationof 92

R6sum6 of certaindiseases of 93

Standards for applicants forenlistment 94

Standards for candidates forcommission 95 Neuralgia 40c, 89n, 94

Neurasthenia 93?, 94/ Neuritis 94

Neuritis, multiple 93n, 94

Night blindness 176

Nose 42-44

Accessory sinuses of 43/ Deformities of 43

Examinationof 42

Loss of 43g

Obstruction of 43*

Standards for applicants for enlistment 43 Standards for candidates forcommission 44

Ulceration of 43d

Nudity 11

Nystagmus 176

Obesity 31c,

Objects ofphysical standards

Oedema 89m

Oesophagus 42-44

Dilatation of 43r

Examination of 42

Standards for applicants for enlistment 43 Standards for candidates forcommission 44

Stricture of 43r

Orchitis 86o

Order of examination 11

Ossification, imperfect, of cranial bones 37c

Osteomyelitis 31d

Otitis media... 216

Palate:

Adhesions 43/ Paralysis of 43p

Perforation of 436

Ulceration of 43

Pancreas, diseases of 76
242 PHYSICAL STANDARDS

Paragraph Paragraph

Reenlistment of soldiers previously discharged in

poor physical condition

Rejection:

For causes not specificallynoted

Of applicants not conforming to standards 12

Of applicant rejected by medical examiner

Rheumatic fever 31

Rheumatism, chronicarticular 31 Rhinitis:

Atrophic 436 Hypertrophic. 43fc

Ribs:

Fracture of 56

Periostitis of 56

Room for examination

Routine of examination 11

Sacro-iliac joint 796 Salivary fistula 43 Scabies 34^ Scapula, deformities of 56d

Scars 34

Sciatica 89m Scoliosis 536

Scrotum, examination of 81 Septum, nasal:

Deviation of 43 Perforation of 436

Sinusitis 43 Skin... 33-35 Admission to hospital of applicants with diseases

of.. 33 Examination of 33

Standards forapplicants for enlistment 34 Standards for candidates for commission 35

Skull:

Deformities of 37

Depressions of 37e

Fractures of 37e Loss of bony substance of 37e Somnambulism 94*

Spine 52-54

Abscess of 53e Curvature of 536

Dislocations of 53c Examination of 52r

Fractures of 63c

Lateral deviation of 53a

Osteoarthritis of 53/ Standards for applicants for enlistment 53 Standards forcandidates for commission 54

Spleen, diseases of 76n

Splenic anemia 31d

Sprains 89ft

Stammering 94Z

Stanford revision of Binet-Simon test 93o

Stigmata of degeneration 93a,

Stomach, diseases of 76

Stomatitis 43d

Strabismus 17d

Stricture:

Of rectum. 76p

Urethral 863

Stuttering 94Z

Sycosis 346

Symptoms not to be recorded as cause of rejection.. 13

Paralysis:

Hemiplegia. 94/ Hysterical 940

Of central origin 40c

Of facial muscles 406

Of vocal cords 43

Paraplegia 936,94/

Paraplegia 936 94/

Paresis 93g, 94e

Pediculosis 33,34(7

Pellagra 31d

Pelvis... 78-80

Deformities of 79

Examination of 78

Malformation of 79

Standards for applicants for enlistment 79

Standards forcandidates for commission 80

Pemphigus 346

Penis, amputation of 866

Pericarditis 72c

Peritonitis 76

Pernicious anemia 31

Pes cavus 89aa

Pharynx 42-44

Deformities of 431

Examination of 42

Malformaton of 43

Standards for applicants for enlistment 43 Standards for candidates for commission 44

Phimosis 86*

Pigment, absence of in iris 17

Pleurisy 56c, 58, 61c

Pneumonia 61e

Pneumothorax 61d

Pott’s disease 53d

Preliminary considerations 1-7

Prepuce, adherent 86*

Previous history

Proctitis 76 Prognathism 47c

Prostate gland:

Abscess of. 86/ Hypertrophy of 86/ Prostatitis 86/

Psoriasis 34 Psychasthenia 93?, 94d Pterygium 176

Ptosis 176

Pulse:

Character 63

Rate 63, 72 Purpose ofphysical standards

Pyelitis 86c

Pyonephrosis 86c

Pyorrhea, alveolaris 46d,476

Qualifications for good soldier

Ranula 43e

Raynaud’s disease 72/

Record of examination 12-14

Rectum:

Prolapse of 79d

Strictureof 76,79d
APPENDIX 243

Paragraph

Synechia 17

Synovitis 89j

Syphilis:

Adenitis as symptom of. 50a As cause of rejection 86p, 87a Cerebrospinal 93i,94e

Wassermann test for 85 Syringomyelia 93/ 94/

Tabesdorsalis 936,94

Tachycardia. 63-72 Tattooing, obscene or offensive 34f

Teeth 45-48

Bridge work 46c Crowns. 46c Examination by dental surgeon 45 Incisors 46a

Masticating 46a

Minimum requirements 45 Occlusion.. 47e

Prognathism 47c

Serviceable natural 46d

Standards for applicants for enlistment 47

Standards for candidates for commission 48

Temperatureof examining room

Temporo-maxillary articulation:

Ankylosis of 40e

Arthritis of 40c

Dislocation of. 40c

Testicle

Atrophy of 86m Loss of 86m

Undescended 86w

Thrombophlebitis 72 fc

Thumb:

Loss of 89r

Mutilation of 89s

Thyroid gland, enlargement of 50e

Tic doloreux 40c

Tinea 37a

Toes:

Hammer 89ai

Loss of 89oc

Overriding 89ae

Webbing of 89ad

Tongue:

Adhesions of 436 Loss of 436

Malformation of 436

Split —. 436

Tumors of 43c

Tonsils, enlargement of 43

Torticollis 500

Trachea 42-44

Examination of. 42

Standards forapplicants forenlistment 43

Standards forcandidates for commission 44

Tracheostomy 43,9

Trachoma 17

Treatment of applicants in hospital 12

Tremors, muscular 946

Trichiasis 176

Trypanosomiasis 31d

Tuberculosis:

As cause of rejection 31d, 61,62

Certain signs not regarded as evidence of 60

Tuberculosis—Continued Paragraph

Examination for 59

Signs of. 58 Tumors:

Of abdominal wall 76 Of bladder. 86

Of chest wall 56*

Of externalauditory canal 216

Of extremities 89

Of eyes 17<f

Of face 406

Of kidney 86c Of skin 34

Of tongue 43c

Ugliness 40a Ulcers of skin 34i

Uncinariasis 31d, 75,76

Urinalysis 81

Urinary fistula 86 Urine:

Albuminin.. 82,866

Analysis of 81-82

Blood in 866

Enuresis 86e Incontinence of 86e

Pus in 86c

Retention of 866

Specific gravity of. 83 Sugar in 84,86

Varices 891

Varicocele 861

Varicose veins 89

Vermin, applicants infested with 33

Vision:

Determining acuity of. 16

Standards for applicants for enlistment 17

Standards for candidates for commission 18

Vocal cords, paralysis of 43/

Waiver:

For applicants for enlistment 12

For candidates for commission 13

For reenlistment 12

Wassermann test;

As cause ofrejection 87

Confirmation of 85, 87a

Not required on applicants for enlistment 85

Required on candidates for commission 85

Web fingers 89p

Web toes 89ad

Weight:

How recorded 26 Limit for Cavalry 31c

Maximum 31c

Minimum 31a

Relation toheight and chest measurement 28, 316

Standards forapplicants for enlistment 31

Standards for candidates for commission 32

West Point, application of standards to candidates

for

Xerophthalmia 176

257-966 —67—18
244 PHYSICAL STANDARDS

STANDARDS OF PHYSICAL EXAMINATION FOR ENTRANCE INTO THE REGULAR

ARMY, NATIONAL GUARD, AND ORGANIZED RESERVES

Changes!

No.

WAR DEPARTMENT,

Washington, August 17, 1940.

AR 40-105, May 29,1923, is changed as follows

2. Application of standards to candidates for commission.—a. The standards, as prescribed for candidates for commission, will apply uniformly to those seeking commission

in the Regular Army, in the National Guard of the United States, and in the Officers’

Reserve Corps, and to those seeking Federal recognition as officers of the National Guard,

except as otherwise provided in these regulations.

[A.G. 702 (2-6-40).]

6. (As changed by 4, Feb. 12, 1936). Candidates for commission must be free from

any defect or pathological condition which would interfere with the performance of the duty

expected of them in the Army, or which would as result of military service be especially

liable to undergo progressive change or to become the basis of claim against the Government in the event of call to active service. For action in respect to recommending waiver of

physical defects, see paragraph 13.

[A.G. 702 (11-13-35).]

12. Applicants for enlistment. a. General.—The physical examination of applicants for

enlistment will be made by medical officers of the Army or by contract surgeons, unless

special authority for examination by civilian physician is granted by the War Department.

The results of the examination will he recorded on W.D., A.G.O. Form No. 21 (Enlistment

Record, Regular Army). The examination will be thorough in every detail and the examiner

may have doubtful cases admitted to military hospital for study and observation during

period of not to exceed days in order that definite conclusion may he reached regarding their desirability as enlisted men. Applicants unfit for service by reason of disease,

not of serious nature and which it is believed can be cured within short time, may be

admitted to military hospital for treatment with view to their enlistment upon recovery.

The physical examination will be made complete in each case, even though disqualifying

(defect is discovered, in order to ascertain whether or not any other defects exist. Every defect noted, whether or not it is disqualifying, will be entered on the proper form. No

applicant will be accepted for enlistment who does not conform to the standards set forth

herein. In the case of specially desirable applicants who have some defect which in the

opinion of the examiner will not interfere with the performance of their military duties,

request for waiver of the defect may be made as provided in paragraph 19, AR 600-750.

9. Applicants expecting to enter the United States Military Academy.—Every applicant

who is known to be enlisting with the expectation of entering the United States Military

Academy at any time after enlistment will be examined according to the standards prescribed

in paragraph 1,AR 40-100.

[A.G. 702 (11-13-35).]

13. Candidates for commission and applicants for appointment as warrant officers.—

The physical examination of candidates for commission will be conducted by the medical

members of the examining board and willbe recorded on W.D., A.G.O. Form No. 63 (Report

of Physical Examination), except for flying officers, whose examination will be recorded on

W.D., A.G.O. Form No. 64 (Physical Examination for Flying). Each candidate will be subjected to thorough and rigid physical examination. All medical officers engaged in making

these examinations are enjoined to exercise the greatest care and diligence in this procedure

and to assure themselves that all findings are fully and accurately recorded. Sufficient time

must be given to this examination to make certain that every detail is thoroughly carried out.

These changes supersede 4, February 12, 1936.
APPENDIX 245

Each defect noted must be recorded in such clear and complete manner that no question

as to its character, degree, and significance can arise when the report of the board is

reviewed in the War Department. When candidate is rejected, the cause must be clearly

established and so definitely recorded as to be conclusive regarding the propriety of the

rejection. Symptoms of disease will not be noted as causes of rejection if it is possible to

arrive at definite diagnosis. In every instance the disease or disability for which

candidate is rejected will be entered in full. candidate who does not conform to the

standard of requirements will be rejected by the medical examiners. If the members of the

examining board believe that defect which is classified in these regulations as disqualifying should be waived in any particular case, recommendation to that effect may he submitted to the War Department. In making such recommendations the nature and degree of

the defect and the reason for recommending waiver should be clearly stated. Candidates

will not he accepted subject to the performance of surgical operations for the removal or

cure of defects. The same physical standards will apply to all candidates for commission,

regardless of the arm or service or grade in which appointment is desired, except as otherwise provided in these regulations.

The examination of an applicant for appointment to the grade of warrant officer, except

warrant officer, Army Mine Planter Service, will be that prescribed herein for an applicant

for enlistment. The examination of an applicant for appointment as warrant officer, Army

Planter Service, will be that prescribed for candidate for commission. Report of examination will be made on W.D., A.G.O. Form No. 63.

[A.G. 702 (6-24-38).]

14. Special examination for flying.—(As changed by 4, Feb. 12, 1936). Candidates

for commission as flying officers and applicants for enlistment as flying cadets will be

given the physical examination required by AR 40-110. This physical examination for

flying will be conducted only by medical officers specifically authorized to do so in accordance with the provisions of AR 40-110, and will be recorded on W.D., A.G.O. Form No. 64.

This form, in the case of both candidates for commission as flying officers and applicants

for enlistment as flying cadets, will be prepared in triplicate (in quadruplicate for National Guard candidates), one copy being retained by the flight surgeon making the physical

examination, and the other copies to accompany the report of the board conducting the

examination for appointment. In the case of an applicant for enlistment as flying cadet,

the medical officer conducting the physical examination for flying will at the same time

make complete physical examination in accordance with the provisions of these regulations and will record the result on W.D., A.G.O. Form No. 21. This form, when completed,

will be given to the applicant by the medical officer who makes the examination, with

instructions to present it to the recruiting officer to whom he applies for enlistment. If

submitted within period of months from the date of its accomplishment, this report of

physical examination on W.D., A.G.O. Form No. 21 will be accepted by the recruiting officer

in lieu of any further examination, provided the applicant appears to be in good physical

condition and gives no history of serious illness in the interim between the examination

and the time he applies for enlistment. If period of time in excess of months has elapsed

since the original examination, the recruiting officer will cause the applicant for enlistment

as flying cadet to be reexamined at the recruiting station, in order to determine if he

still meets the physical requirements prescribed in these regulations. If the candidate was

reported as physically qualified on the original examination and is considered as physically

disqualified on the second examination, the reports of the two examinations will be forwarded to the War Department with recommendation for rejection, or for waiver of the

defects noted.

[A.G. 702 (11-13-35).]

18. Standards for candidates for commission.—a. For commission in all arms and services of the Regular Army, except in the Medical Department or the Corps of Chaplains,
246 PHYSICAL STANDARDS

minimum vision of 20/40 in each eye, correctable with glasses to 20/20 in one eye and to

20/30 in the other eye, when no organic disease of either eye exists, is required.

ft. For commission in the Medical Department or the Corps of Chaplains in the Regular

Army, and for commission in all branches of the National Guard of the United States and

of the Officers’ Reserve Corps, and for Federal recognition as officers of the National Guard,

minimum vision of 20/100 in each eye, correctible with glasses to 20/20 in one eye and to

20/30 in the other eye, when no organic disease of either eye exists, is required.

[A.G. 702 (2-6-40).]

c. Color perception.

(1) Impairment of the sense of color perception in pronounced degree is cause

for rejection. The minimum requirement for general qualification shall consist of the

ability to distinguish and identify without confusion the color of an object, substance,

material, or light that is uniformly colored pure red; and of an object, substance, material or light that is uniformly colored pure green.

(2) For commission in the Medical Department of the Regular Army impairment

of the sense of color perception forred and green is cause forrejection.

d. In other respects the standards are the same as for applicants for enlistment.

[A.G. 702 (10-2-37) (1-28-38) (2-0-40).]

22. Standards for candidates for commission.—a. For commission, hearing in each ear

must be 20/20. ft. In other respects the standards are the same as for applicants for enlistment.

28. Standards of height, weight, and chest measurement.

a. Standards for all applicants except Filipinos. (As changed by 3, Nov. 15, 1932.)

Chart 1A

[A.G. 201.6 (10-14-32).]

31. Standards for applicants for enlistment/ a. (As changed by 4, Feb. 12, 1936.)

No applicant except Filipinos willhe accepted who is less than 64 inches in height or weighs

less than 115pounds, or has chest mobility of less than inches.

Height, inches

Weight (pounds) Chest measurement at expiration (inches)

Standard Minimum Standard Minimum

64 128 115 32% 30% 65 132 117 32 30% 66 136 121 32% 30% 67 140 125 33 31

68 144 129 CO CO h\ 31% 69 148 133 33/2 31% 70 152 137 33% 31% 71 156 141 34 32

72 160 145 34% 32% 73 164 149 34/ 32% 74 168 153 34% 32% 75 172 157 35 33

76 176 161 35% 33% 77 180 165 35% 33% 78 184 169 35% 35%
APPENDIX 247

b. (As changed by 4, Feb. 12, 1930.) The standards as to relationship between height,

weight, and chest measurement given in the tables in paragraph 28 relate to young men

between 20 and 25 years of age, and in general an applicant will not be accepted whose

weight and chest measurement are not proportionate to his height, as prescribed in these

tables. In special cases when the applicant is active, lias firm muscles, and is evidently

vigorous and healthy, the minimum weight and chest measurements noted in the tables

in paragraph 28 may be allowed. No applicant will be accepted who falls below the

minimum requirements laid down in these tables.

[A.G. 702 (11-13-35).]

c. Variations in weight above the standard are disqualifying if sufficient to constitute

such obesity as to interfere actually or potentially with normal physical activity, as may be

evidenced by high blood pressure, beginning nephritis, breaking down of the arches of

the feet, or other defects incident to such condition. No applicant for original enlistment will

be accepted for Cavalry service whose weightis in excess of 170 pounds.

[A.G. 702 (9-2-39).]

32. Standards for candidates for commission.—The same as for applicants for enlistment with the exception that the weight for height for age and the permissible variation

therefrom will be in accordance with the standards for officers in paragraph 11, All 40-100.

[A.G. 702 (8-2-39).]

48. Standards for candidates for commission.-—The same as for applicants for

enlistment.

[A.G. 702 2-6-40).]

62. Standards for candidates for commission.—a. Chest roentgenograms will be required

of every candidate for commission in the Regular Army. No candidate with roentgenological

evidence of reinfection (adult) type pulmonary tuberculosis, active or inactive, will be

accepted for commission in the Regular Army, and no candidate with roentgenological

evidence of primary (childhood) type pulmonary tuberculosis will be accepted if the

degree or extent of the involvement appears to be of present or future clinical significance.

Chest roentgenograms will not be made routinely in the examination of applicants for commission in the National Guard of the United States or the Officers’ Reserve Corps or in the

case of those seeking Federal recognition as officers of the National Guard; however, the

conditions stated in the preceding sentence, if disclosed, will be considered disqualifying

for appointment in the National Guard of the United States and the Officers’ Reserve Corps,

and for Federal recognition as officers of the National Guard.

b. In other respects the standards are the same as for applicants for enlistment.

[A.G. 702 2-6-40).]

73. Standards for candidates for commission.—a. No candidate with systolic murmur

at the apex which is transmitted to axilla or angle of scapula will be accepted for

commission.

b. In other respects the standards are the same as for applicants for enlistment.

[A.G. 702 (2-6-40).]

81. Methods of examination.—The genito-urinary organswill be examined by inspection

and palpation. Evidence of venereal disease or malformation will be searched for. The glanspenis and corona will be exposed and the penis stripped. Both sides of the scrotum will be

palpated, as will also the inguinal glands. When necessary, further examination by the

X-ray, by urethral instrumentation, and by laboratory methods will be conducted. The urine

of all applicants for enlistment will be examined for albumin and specific gravity, and if the

latter is over 1025 will also be tested for the presence of sugar. Urinalysis, including tests

for albumin, specific gravity, and sugar, and microscopic examination of the sediment,

will be made in the case of all candidates for commission, the urine being voided in the

presence of one of the examiners, except that in the case of candidates for appointment in
248 PHYSICAL STANDARDS

the Officers’ Reserve Corps microscopic examination of the urine will be required only

when the history, physical examination, or other urinary findings indicate the necessity

therefor.

[A.G. 702 (4-1-40).]

85. Serological tests.—A Kahn precipitation test or Wassermann test will be required

of every candidate for commission in the Regular Army. The Wassermann test will ordinarily be used only as confirmatory test in the presence of doubtful or positive precipitation reaction. Whenever doubtful or positive Wassermann reaction is obtained, another

specimen will he examined after lapse of week. Serological tests will not be employed

routinely in the examination of applicants for enlistment, but should be used as aids to

diagnosis in doubtful cases.

[A.G. 702 (2-G-40).]

86. Standards for applicants for enlistment.—The following conditions are causes for

rejection:

c. (As changed by 1, August 31, 1926.) Floating kidney, hydronephrosis, pyonephrosis, pyelitis, tumors of the kidney, absence of one kidney, or renal calculi.

[A.G. 062.11 (8-25-23).]

87. Standards for candidates for commission.—a. No candidate who is found to have

positive Wassermann reaction on two occasions (see par. 85) will be accepted for commission in the Regular Army. In such cases, if no other evidences of syphilis can be found,

the cause of rejection will be recorded not as syphilis but as “Positive Wassermann.”

Serological tests will not be made routinely in the examination of applicants for commission in the National Guard of the United States or the Officers’ Reserve Corps, or in

the case of those seeking Federal recognition as officers of the National Guard; however,

positive Wassermann on two occasions, if disclosed, will be considered disqualifying for

appointment in the National Guard of the United States or in the Officers’ Reserve Corps,

and for Federal recognition as officers of the National Guard.

6. In other respects the standards are the same as for applicants for enlistment.

[A.G. 702 (2-6-40).]

order of the Secretary of War:

G. C. MARSHALL,

Chief of Staff. Official

E. S. ADAMS,

Major General,

The Adjutant General.
APPENDIX

ARMY REGULATIONS] WAR DEPARTMENT,

No. 40-100 Washington, November 16,19^2.

MEDICAL DEPARTMENT

STANDARDS OF MISCELLANEOUS PHYSICAL EXAMINATION

Paragraph

Physical examination for admission to the United States Military Academy

Physical examination of officers and warrant officers of the Regular Army for

permanent promotion

Physical examination, duty involving flying

Physical examination of officers and warrant officers for retirement

Physical examination of officers and warrant officers prior to resignation, discharge,

or dismissal, and of cadets prior to separation from the United States Military

Academy

Physical examination of Army nurses and of applicants for the Army Nurse Corps

Physical examination of deserters

Physical examination of enlisted men prior to discharge or retirement

Physical examination of retired officers and retired warrant officers prior to detail

to active duty

Physical examination of enlisted men selected for detail to attend service school 10

Physical inspection of military personnel prior to transfer for service outside the

United States 11

National Guard and National Guard of the United States 12

Reserve Officers’ Training Corps 13

Standards of physical examination during mobilization 14

Limited service; officers, army nurses, and warrant officers of Reserve components

for extended active duty, and original appointment of other than graduates of officer

candidate schools 15

1. Physical examination for admission to the United States Military Academy.—a.

Standards.—The standards prescribed in AR 40-105 for candidates for commission in the

Regular Army, as modified by the variations prescribed below, will apply to candidates for

admission to the United States Military Academy and to applicants for enlistment who

expect to enter the United States Military Academy.

*This pamphlet supersedes AR 40-100, September 10, 1940 section II, Circular No. 4, section II,

Circular No. 55, section II, Circular No. 72, section I, Circular No. 79, and paragraph 10, Circular

No. 221, War Department, 1941; and section I, Circular No. 17, section III, Circular No. 31, and

section II, CircularNo. 54, War Department, 1942.
250 PHYSICAL STANDARDS

(1) Physical proportions for height, weight, and chest measurement for all candidates

except Filipinos.

(a) Medical examinerswill recommend rejection of individuals who show poor

physical development and those who appear to be undesirable candidates

because of excessive fat, even though their measurements may come within

the limits stated in the above table. In such instances, the report will show

in detail the findings upon which recommendation for rejection is based.

(b) Recommendations for waiver of excessive weight will be made in cases in

which the general appearance, conformation of the candidate, and the rest

of the examination clearly indicate that he is of the robust type and there is

no tendency to obesity, endocrine imbalance, cardiovascular disease, or other

defect which is likely to shorten the period of useful active service normally

expected of an Army officer.

(2) Teeth.

(a) The teeth will be thoroughly examined by an officer of the Dental Corps.

On the dental chart of W.D., A.G.O. Form No. 0164 (Report of Physical Examination of Candidate for Admission to the United States Military Academy,

West Point, N.Y.) all missing natural teeth will be marked out with an “x,”

whether or not they are replaced by artificial appliances; all prosthetic dental

appliances will be entered, and teeth replaced will be indicated.

(b) No candidate will be accepted unless he has minimum of six serviceable

vital masticating teeth (bicuspids and molars) above, and six below, serviceably opposing, and also four serviceable vital incisor teeth (incisors and

cuspids) above and four below serviceably opposing. (See (c) below.) In

cases in which insufficiency of teeth may be remedied by the eruption of third

molars, an X-ray of the third molar region will be taken. If normal third

molar properly positioned and developed is shown, it may be assumed that it

will have normal eruption and the candidate may be credited with possession of this tooth. In such cases the report of physical examination will carry

an appropriate remark such as “X-ray shows normally developed and

erupting (specify tooth or teeth). In doubtful cases duplicate

of the X-ray films will be forwarded with the physical examination report.

Height, inches Weight

Minimum

pounds

Maximum

Minimum chest measure at expiration, inches

66 120 170 30. 50 67_ 124 176 30. 50

68_ 128 181 31. 00

69 132 185 31. 50

70 136 187 32. 00

71- --_ 140 189 32. 00

72- 144 192 32. 50

73__ 148 195 32. 50

74 152 198 33. 00

75_ 156 201 33. 00

76_ -- 160 204 33. 50

Note.—Fractions greater than J-3 inch in height will be considered as an additionalinch but candidates must be at

least 66 inches in height. Height to be taken without shoesand weight without clothes.
APPENDIX 251

(c) Vital teeth properly filled with permanent fillings or well crowned will be

considered serviceable, if otherwise acceptable. single tooth replacement

by standard method of fixed bridgework will he acceptable in lieu of

serviceable vital tooth when the abutment teeth are otherwise acceptable and

the bridge is well constructed.

d) tooth willnot be considered serviceable if— 1. It fails to enter into serviceable occlusion with an opposing tooth.

2. It has an unfilled cavity.

3. It supports defective filling or crown.

4- It is nonvital.

5. There is destruction of the supporting tissues of the tooth, resulting

from gingivitis, periodontoclasia,etc.

(e) Causes forrejection are 1. Failure to meet the standard of minimum requirements outlined in

(6) above.

2. Loss of three adjoining masticating teeth in either side of upper or lower

jaw.

3. Disfiguring spaces between anterior teeth.

4- Marked irregularity of the teeth.

5. Marked malocclusion.

(f) Plaster casts will be made of both the upper and lower teeth when conditions listed in (e) 3, 4, and above are causes for rejection. pencil mark

will be drawn across both casts to denote rest occlusion, and the candidate’s

name will be placed on each cast. X-rays will be made when destruction of

the supporting tissues of the teeth or nonvital teeth are causes for rejection.

Casts and X-rays will be forwarded direct to The Surgeon General, who will

be informed of such action by letter.

(g) Each candidate otherwise meeting the above dental requirements, whose

examination discloses dental caries or other dental defects of progressive

nature, will be given memorandum specifying in detail the conditions

found. copy of the memorandum of defects furnished the candidate will

accompany W.D., A.G.O. Form No. 0164. Pie will be informed that he cannot

be finally accepted until he has had the defects corrected and has reported

such fact in writing to The Adjutant General. This report will include

certificate from reputable dentist that all carious teeth have been restored,

without loss of vitality, by the placement of proper permanent fillings. Authority for the candidate to proceed to the United States Military Academy

willnot be granted until the report has been received.

(3) Eyes and vision.

(a) Visual acuity as determined by the official test types (without cycloplegic) must not be less than 20/30 in either eye without glasses, correctihle

with glasses to 20/20 in each eye, when no organic disease in either eye

exists. In all cases the actual vision of each eye, and the correcting lenses if

required, will be reported. Careful inquiry will be made by the board for

symptoms of asthenopia, and any symptoms elicited will he recorded. When

indicated, the board will determine the refractive error by cycloplegic

examination. Errors of refraction, if considered by the board to be excessive,

may be cause for rejection even though the visual acuity falls within

acceptable limits. Total hyperopia of more than two diopters or total myopia

of more than three-quarters (0.75) diopter in any meridian in either eye is

cause forrejection.

(6) Muscle balance of the eyes will be determined by the Maddox rod screen

test at 20 feet. Esophoria of more than 10 prism diopters, exophoria of
252 PHYSICAL STANDARDS

more than prism diopters, and hyperphoria of more than prism diopter

are causes for rejection.

(c) Both eyes must be free from any disfiguring or incapacitating abnormality and from acute or chronic disease.

(4) Ears and hearing.—Hearing must be normal (20/20) in each ear for the low

conversational voice. Existing perforation of the membrana tympani from any

cause whatever is disqualifying. Both ears must be free from any disfiguring

or incapacitating abnormality and from acute or chronic disease.

(5) Elares.—Nasal obstruction due to septal deviation, hypertrophic rhinitis, or

other causes, if so marked as to interfere materially with breathing, is cause

for rejection.

(6) Skin.—Psoriasis is cause for rejection.

(7) Heart and blood vessels.—The examination of the heart and blood vessels will

be conducted and the findings interpreted in accordance with the provisions of

AR 40-105. All questionable findings will be thoroughly investigated over

sufficient period of time to determine their significance. Any evidence of organic

heart disease will be considered as cause for rejection. When candidate is

found to have systolic blood pressure of 140 millimeters or more, or diastolic

blood pressure of 90 millimeters or more, series of readings will be taken

over period of or more days in order to determine whether the arterial hypertension is constant, and if possible the cause thereof. persistent systolic blood

pressure of 140 millimeters or more, or persistent diastolic blood pressure of

90 millimeters or more, or an unstable blood pressure, is cause for rejection.

(8) Serological tests.—A serological test for syphilis will be required for all

candidates. The test will be that prescribed by The Surgeon General. negative

report will be accepted as satisfactory evidence of freedom from syphilis in the

absence of history of, previous treatment for, or clinical signs of syphilis.

positive or doubtful report in the absence of history will be rechecked by such

tests as The Surgeon General may prescribe on an additional specimen or specimens. Confirmed positive serological tests will be cause for rejection.

(9) Genito-urinary system.—If albumin or casts are found in the urine the cause

will be determined, if possible. Urine containing albumin or casts will be examined on successive days. Persistent albuminuria or the persistence of casts in

the urine is cause for rejection, even though the cause thereof cannot be determined. The following are also causes for rejection: phimosis, epispadias or

pronounced hypospadias, amputation or deformity of the penis, atrophy or maldevelopment of both testicles, or undescended testicle of any degree.

(10) Pes planus.—Suitable exercises will be employed to determine the strength

of the arches of the feet. Weak or painful feet are causes for rejection regardless

of whether or not the arch is flattened. In reporting the presence of flat feet

careful estimate of the degree of flattening, as first, second, or third degree, will

be made and reported, as well as other abnormalities, such as eversion, rotation,

callosities, etc.

6. Report of examination.

(1) The result of the examination in each case, whether the candidate is accepted

or rejected, will be fully recorded, in typewriting when practicable, on W.D.,

A.G.O. Form No. 0164, and will be forwarded direct to the War Department.

When it is necessary to send blood to distant laboratory for the serological

test, the board will not forward Form No. 0164 until the report from the laboratory has been received and the results of the tests entered on the form. Delay

in completing and forwarding reports of physical examination will be avoided.

(2) If candidate does not fulfill all the requirements laid down in these regulations and in AR 40-105 as prescribed for candidates for commission in the Regu-
APPENDIX 253

lar Army, he will be reported by the medical examiners as physically disqualified. Medical officers are not authorized to waive defects or to vary from the

established standards, but may recommend that defects or variances be waived

by the War Department.

(3) The result of the physical examination, except in preliminary examination

as described in below, will be regarded as confidential and will not be disclosed to the candidate or other interested parties.

c. Preliminary examination.

(1) The presentation by candidate of his letter of conditional appointment, or

by prospective candidate of letter signed by Member of Congress stating

that the bearer is to be candidate for cadet appointment, and request by the

candidate that he be physically examined will be sufficient authority for an

Army medical officer at any military station to make the desired physical

examination.

(2) Upon completion of this examination the medical officer will inform the candidate of the result, and in case disability is found will inform him whether

such disability is believed to be permanent and disqualifying for military service,

or whether it is believed to be of temporaryor remediable nature.

(3) This examination is to be regarded as preliminary and advisory only, and in

no manner is to affect the decision of the regular medical examining board.

(4) No report of preliminary examination need be made.

d. Examination subsequent to original admission.—The physical standards applying to

cadets at the United States Military Academy and to candidates for readmission after

discharge therefrom will be those prescribed in AR 40-105 for candidates for commission

in the Regular Army, except that vision less than 20/20 will be correctible to 20/20 in each

eye by proper glasses, and the standards of height, weight, and chest measurement will

be those prescribed in (1) above.

2. Physical examination of officers and warrant officers of the Regular Army for permanent promotion.—a. Standard.—In the absence of specific instructions to the contrary, the

physical requirements will be those prescribed in AR 40-105 for candidates for appointment,

except the serological test for syphilis, but the provisions thereof will not be so strictly

interpreted as in the case of applicants for original appointment.

b. Form to be used for report.-—The report will be rendered on W.D., A.G.O. Form No,

63 (Report of Physical Examination).

3. Physical examination, duty involving flying.—SeeAR 40-110.

4. Physical examination of officers and warrant officers for retirement. a. General.

All officers and warrant officers will be physically examined prior to retirement. declaration regarding the existence of any physical incapacity will be obtained in all cases not

appearing before Army retiring boards. See also AR 605-250.

b. Form to be used for report.—The report will be rendered on W.D., A.G.O. Form

No. 63.

5. Physical examination of officers and warrant officers prior to resignation, discharge,

or dismissal, and of cadets prior to separation from the United States Military Academy.—

Same as prescribed for enlisted men prior to discharge or retirement (par. 8), except that

W.D., A.G.O. Form No. 63 will be used instead of W.D., A.G.O. Form No. 38 (Report of

Physical Examination of Enlisted Men Prior to Discharge or Retirement).

6. Physical examination of Army nurses and of applicants for the Army Nurse

Corps.—a. For admission to Army Nurse Corps.

(1) Where and by whom made.—The applicant’s physical fitness for appointment

will be determined by board of not less than two medical officers. She will be

questioned carefully about her medical history and her present health. The examination will be thorough in order that only those will be recommended for acceptance who are physically able to perform the duties required of an Army nurse.
254 PHYSICAL STANDARDS

The medical examiners will take full advantage of all available diagnostic aids

to detect any physical impairment, including in all eases an X-ray examination of

the chest.

(2) Standard.—In general, due consideration being given to difference in sex, the

standards prescribed for commission in AR 40-105 will apply, except as regards

those pertaining to height, weight, and chest measurement. The following table

gives the average weight for age and height for applicants for and members of

the Army Nurse Corps

(a) The permissible variation below the standard for age is 15 pounds, with

the exception that no applicant will be accepted whose weight is less than

105 pounds.

(ft) The weight for each height for the age group 26 to 30 is the ideal one to

maintain thereafter. In applying the percentage variation, fractions of less

than pound will be dropped; those of pound or more will be counted

as an additional pound.

1). Prior to discharge.—Upon receipt of orders directing her discharge or relief from

active service, and prior to her departure from her proper station, an Army nurse will be

given thorough physical examination.

c. Reports; form used; to whom rendered.—Reports of the examination required by

and above will be rendered on W.D., A.G.O. Form No. 63 direct to The Surgeon General.

7. Physical examination of deserters. a. Physical examination of deserter upon return

to military control will be made to determine physical fitness as prescribed in MR 1-9.

I). Report to he furnished commanding officer.—The medical officer making the examination will furnish the commanding officer report thereof on page of W.D., A.G.O.

Form No. 22 (Enlistment Record, Regular Army), modified as necessary, including therein

the nature and cause of any mental or physical disability found.

8. Physical examination of enlisted men prior to discharge or retirement.-—a. When

made.—Every enlisted man not discharged for physical disability (AR 615-360 or 615-395)

Height, inches Weight according to age period

21-25 26-30 31-34 35-40 41-45 46-50 51 and over

60 114 117 120 123 126 128 130

61 117 120 123 126 129 131 133

62 120 123 126 129 132 134 136

63 123 126 129 132 135 137 139

64 127 130 133 136 139 141 143

65 131 134 137 140 143 145 147

66 135 138 141 144 147 149 151

67 139 142 145 148 151 153 155

68 143 146 149 152 155 157 159

69 147 150 153 156 159 161 163

70 151 154 157 160 163 165 167

71 155 158 161 164 167 169 171

72 159 162 165 168 171 173 175

Note.—Height and weight tobe takenwithout shoes and withsurgical gown or sheetin lieu of dress.
APPENDIX 255

will execute on W.D., A.G.O. Form No. 38 declaration of his physical condition, after which he aa ill be required to undergo thorough physical examination by medical officer within period of 72 hours prior to his discharge or retirement from active Federal service. When medical officer is not available the examination will be omitted, unless the enlisted man, in his own opinion or in the opinion of his commanding officer, has physical disability, in which event civilian physical! will be employed to make the examination. ft. Requirements.—The nature and location of any defect, wound, injury, or disease

found to exist will be stated in the report, together with the opinion of the medical officer as to whether or not the wound, injury, or disease

(1) Is likely to result in death or disability.

(2) Originated in the line of duty in the military service of the United States. c. Form to he used forreport.—The report will be rendered on W.D., A.G.O. Form No. 38,

d. Board of review.

(1) When required.—If the declaration required by above is at variance with the findings of the medical examiner, the enlisted man will he examined by

hoard of review, convened by the commanding officer, whenever the required number of medical officers is available at the station. The board will consist of not

less than two nor more than threemedical officers, one of whom may be the medical officer making the examination required by above. The board of review will be

dispensed with only when the required number of medical officers is not available.

(2) Requirements.—Same as above.

(3) Form to he used forreport.—Same as above.

e. When discharged on account of sentence to confinement hy civil court.—In such

cases the execution of the declaration of physical condition on W.D., A.G.O. Form No. 38 will

be dispensed with, and no physical examination is required even though disability is claimed

orbelieved to exist.

9. Physical examination ofretired officers and retired warrant officers prior to detail to

active duty.—a. Prior to the detail of retired officer or retired warrant officer to active

duty he will be required to undergo thorough physical examination by medical officer.

ft. Waivers may be recommended for defects which, although disqualifying for original

appointment or reappointment to the active list, will not, in the opinion of the medical

examiner interfere with the proper performance of the duties required by the detail. No retired officer or retired warrant officer will be assigned to active duty unless the medical

examiner will certify that in his opinion he has no disability (including dental conditions)

which is likely to incapacitate him for the duties which will be required of him while on

active duty, or which will necessitate medical or dental treatment in the near future.

c. Form to he used for report.—Report of the physical examination will be rendered

on W.D., A.G.O. Form No. 63.

10. Physical examination of enlisted men selected for detail to attend service school.

a. Standard.

(1) The standard of physical examination for enlisted men selected for detail to

attend service schools, other than officer candidate schools, West Point preparatory schools, and other schools for which special physical standards are or may be

prescribed, will be freedom from any abnormal physical condition which is likely

to interfere temporarily or permanently with his pursuit of course at the school.

(See also AR 350-110.)

(2) Applicants for West Point preparatory schools must meet the physical requirements for admission to the United States Military Academy.

(3) Applicants for officer candidate schools for general military service must

meet the same standard of physical fitness as that required for commission in
256 PHYSICAL STANDARDS

the Army of the United States (AR 40-105) except as indicated in (a) and (6)

below:

Standards of height, weight, and teeth will be the same as those prescribed in MR 1-9 for induction for general service.

(&) Applicants whose visual acuity is not less than 20/200 in each eye without

glasses and is correctible to 20/20 in one eye and 20/40 in the other eye and

who are otherwise physically qualified will be eligible for commission in the

Army of the United States for duty with the Medical Administrative Corps,

Quartermaster Corps, Finance Department, Ordnance Department, Chemical

Warfare Service, The Adjutant General’s Department, and Army Air Forces

administrative installations.

(4) Individuals who do not meet the physical standards set forth in (3) above,

but who meet the standards for induction set forth in MR 1-9, including class

1-B standards, will be considered physically qualified for officer candidate

schools for appointment for limited service.

5. Report.—-The physical examination will be recorded on W.D., A.G.O. Form No. 63,

in duplicate. If the final type physical examination reveals minor disqualifying defects,

the applicant may request waiver of the defects by letter to the commanding general

of the service command or department under whose jurisdiction he is serving or to the

Commanding General of the Army Air Forces or such officer or officers of the Army Air

Forces as he may designate. Where local conditions prevent complete final type physical

examination being accomplished, the applicant if accepted may be sent to the school and

have the examination completed there, provided such physical examination as is possible

locally does not reveal disqualifying defect.

11. Physical inspection of military personnel prior to transfer for service outside the

United States. —Prior to transfer for service outside the United States, all military personnel

will be given careful physical inspection at their home stations, and again at the port of

embarkation if more than 48 hours have elapsed since the inspection at the home station

or if the presence of communicable disease in command warrants additional investigation at the port of embarkation. With the exception of female personnel, they will be inspected with all clothing removed. Those whose inspection warrants additional physical

study will be given such examinations as may be indicated. See also AR 615-250.

12. National Guard and National Guard of the United States.—The physical standards

for Federal recognition and for retention of Federal recognition of officers in the National

Guard, for appointment, reappointment, promotion, and retention of officers in the National

Guard of the United States will be the same as those prescribed for appointment, reappointment, promotion, and retention of Reserve officers in the Active Reserve. For other regulations governing the physical examination of members of the federally recognized National

Guard and the National Guard of the United States, see AR 40-105 and 130-15.

13. Reserve Officers’ Training Corps.—For regulations governing the physical examination of applicants for, and members of, the Reserve Officers’ Training Corps, see AR

145-10.

14. Standards of physical examination during mobilization.—Standards of physical

examination prescribed for mobilization are covered in MR 1-9.

15. Limited service; officers, Army nurses, and warrant officers of Reserve components

for extended active duty, and original appointment of other than graduates of officer candidate schools.

a. In periods of national emergency and of long-continued war effort it may become

necessary to accept for limited service officers, Army nurses, and warrant officers of the

Reserve components for extended active duty and applicants for appointment in the Army

of the United States who do not fully meet the physical standards for general military

service. For such limited service as officers. Army nurses, or warrant officers, waiver may

be recommended for defects which are mild in degree and nonprogressive in character.
APPENDIX 257

ft. As an aid to uniformity in the recommending of waivers for limited service as

officers, Army nurses, or warrant officers, the following conditions are listed as being

acceptable for limited service: (1) Overweight in excess of that prescribed in AR 40-105, provided the individual

is not markedly obese, and provided that because of his special training in civil

life he is peculiarly fitted to fill particular technical assignment in the Army;

and underweight to 15 percent below ideal weight, provided chest X-ray is negative for pulmonary pathology and other chronic disease is carefully excluded.

(2) Any degree of uncorrected vision provided it is corrected with glasses in

possession of the examinee to 20/20 in one eye and to 20/40 in the other, provided

that no organic disease of either eye exists, and asthenopia is not present.

(3) Blindness or corrected vision below 20/40 in one eye with minimum vision of

20/200 corrected with glasses in possession of the examinee to 20/20 in the

other, provided that there is no organic disease in the better eye and no history of

cataract or other disease in the more defective eye which might be expected to

involve the better one, and provided that in case of ophthalmosteresis the individual is fitted with satisfactory prosthesis.

(4) Complete color blindness.

(5) Hearing 5/20 in each ear for low conversational voice, or complete deafness in

one ear with hearing 10/20 or better in the other, provided the defect is not due

to active inflammatory disease and is stationary in character.

(6) Chronic otitis media, inactive with perforation of membrana tyrnpani, provided

there is trustworthy history of freedom from activity for the preceding years.

(7) Old fracture of the spine or pelvic bones which has healed without marked deformity, provided there is trustworthy history of freedom from symptoms

during the preceding year.

(8) Loss of one hand, one forearm, or one lower extremity below the junction of

the middle and lower thirds of the thigh provided that the lost member is replaced with satisfactory prosthesis.

(9) Pes planus, pes cavus, or talipes equinus, provided the condition is not more

than mildly symptomatic, does not interfere with normal locomotion, and has

not interfered with the individual’s vocation in civil life.

(10) History of osteomyelitis following fracture, provided X-ray indicates complete healing and the condition has been asymptomatic for the preceding years.

(11) Joints fixed or limited in motion, provided the condition is the result of injury

and is nonsymptomatic.

(12) History of excision of torn or detached semilunar cartilage of knee joint,

provided there is normal stability of the joint and period of year with complete freedom from symptoms has elapsed since the operation.

(13) Hypertrophic arthritis not more than mild in degree and asymptomatic.

(14) Residuals of anterior poliomyelitis, without marked deformity or loss of function, originating year or more prior to examination.

(15) Varicose veins, moderate, without edema or discoloration of skin.

(16) History of gastric or duodenal ulcer, provided there is trustworthy history

of freedom from activity during the preceding years and provided that gastrointestinal X-ray at the time of examination is negative.

(17) History of intestinal anastomosis or operation for intestinal obstruction, provided the operation was not necessitated by the presence of regional ileitis or

malignant disease, there is trustworthy history of freedom from symptoms

for the preceding years, and current X-ray studies indicate normal function.

(18) Incomplete inguinal hernia, unilateral or bilateral.

(19) Small asymptomatic congenitalumbilical hernia.
258 PHYSICAL STANDARDS

(20) Absence of one kidney, provided its removal has been necessitated as result

of trauma and provided the other kidney is normal.

(21) Arterial hypertension not in excess of 160 systolic or 95 diastolic, provided

the cardiovascular and renal systems are otherwise negative.

c. The following conditions are not considered acceptable for limited service

(1) History of malignant disease within preceding years.

(2) Active tuberculosis of any organ and inactive pulmonary tuberculosis except as

described as acceptable for general service in MR 1-9.

(3) Asthma of any degree. History of asthma other than in childhood, with trustworthy history of freedom from manifestations during the preceding 10 years.

(4) Syphilis.

(5) Old fracture of the skull with bony defect greater than centimeters in longest

diameter or with history of residual mental or neurologic complications.

(6) Instability of any of the major joints.

(7) Active osteomyelitis of any bone, or substantiated history of osteomyelitis of

any of the long bones within the past years.

(8) Arthritis of the atrophic (rheumatoid) type, hypertrophic arthritis which is

either symptomatic or more than mild in degree, or history of recent or recurrent

attacks of rheumatic fever.

(9) Spondylolisthesis; herniated nucleus pulposus or history of operation for

same.

(10) Any cardiovascular condition which disqualifies for general military service,

other than mild hypertension as described in I) (21) above.

(11) History of gastroenterostomy or gastric resection.

(12) History of prostatectomy or transurethral resection of prostate, or of prostatic hypertrophy of any degree.

(13) The presence of renal calculus, or substantiated history of bilateral renal

calculi at any time.

(14) Chronic endocrine disease except mild hypothyroidism or mild Froehlich’s

syndrome.

(15) Diabetes mellitus of any degree or renal glycosuria.

(16) History of any psychosis.

(17) History of severe pyschoneurosis at any time, or psychoneurosis of any

degree if it has been recurrent or has shown symptoms within the preceding

years.

d. Determination as to acceptability for limited service of individuals with borderline

conditions not listed above will be made in conformity with the policies set forth in relation to those enumerated.

[A.G. 702 (8-29-42).]

order of the Secretary of War

G. C. MARSHALL,

Official Chief of Staff. J. A. ULIO,

Major General,

The Adjutant General.

Distribution

A; E.
APPENDIX

ARMY REGULATIONS WAR DEPARTMENT

No. 40-100 Washington, December 3, 1942.

MEDICAL DEPARTMENT

STANDARDS OF PHYSICAL EXAMINATION FOR FLYINC

Paragraph

Section I. General provisions 1-8

II. Records 9-10

III. Examination 11-21

Section

GENERAL PROVISIONS

Paragraph

Purpose

Definitions

Examinations, general

Restrictions until physically qualified

Reexamination physical incapacity

Examination, where made

Examination, by whom made

Waivers

1. Purpose.—a. These regulations set forth standards to determine an individual’s

fitness for flying duty. For appointment, personnel of the Army Air Forces will he subject

to the same physical standards and examinations that are given to personnel of other arms

and services, as provided in AR 40-100 and 40-105.

&. The purpose of these regulations is to conserve life and materiel by—-

(1) Selecting for the various flying duties only those individuals who are physically

and mentally fit for such duties;

(2) Maintaining standard of physical fitness required for duties in the air; and

(3) Reclassifying into lower brackets, grounding, or removing promptly from

flight status those who, because of physical or mental defects, become temporarily

or permanently unfitted for such duties.

2. Definitions. —For the purpose of these regulations, the following terms will be

euqfioyedonly within the meanings given

a. Flying.—Moving in the air in an aircraft.

&. Flying status.—A status in which an individual has been ordered legally and by

proper authority to participate regularly and frequently in aerial flights.

c. Grounding.—The prohibition of an individual from flying, usually for reasons of

temporary or minor nature.

d. Relief from flying status.—Issuance of legal order by proper authority terminating

the participation of an individual in regular and frequent flights. This may he of

permanent or temporary nature.

*This pamphlet supersedes AR 40-110, April 1, 1940; section II, Circular No. 119, War Depart

ment, 1940 section II, Circular No. 36, paragraph 2, Circular No. 65, paragraph 12, Circular No. 221,

War Department, 1941 and section III, Circular No. 6, War Department, 1942.
260 PHYSICAL STANDARDS

e. Serious illness or injury.-—In relation to flying, any major illness, however short,

and any illness or injury that requires major surgical procedure or absence from full military duty for period of month or more; fractures, and especially fractures involving

the cranium or vertebral column; injuries or interference with function, or diseases of the

eye; neurological, mental, or neuropsychiatric conditions; cardiovascular and renal conditions of an organic nature; encephalitis lethargica or any condition accompanied by

diplopia or lethargy syphilis malaria paroxysmal tachycardia recurrent attacks of any

of the rheumatic group; renal calculus; pneumonia, typhoid, and any other debilitating

disease.

3. Examinations, general.-—a. The physical examination prescribed herein will be

given—

(1) Applicants for flying training and individuals undergoing flying training.

(2) Officers of the Regular Army, Reserve Corps, Army of the United States, or

warrant officers applying for transfer to or detail in the Army Air Forces as

flying officers.

(3) Rated command pilots, senior pilots, pilots, service pilots, aircraft observers,

technical observers, balloon pilots, senior balloon pilots, balloon observers, navigators, bombardiers, glider pilots, liaison pilots, and flight officers.

(4) Other officers, Army nurses, and warrant officers of the Army Air Forces

authorized by competent authority to perform duties in military aircraft.

(5) Officers of other arms and services of the Army detailed by competent authority

to duty involving flying.

(6) Enlisted personnel assigned to flying duty.

(7) Air Corps Reserve officers holding an aeronautical rating, ordered to active

duty.

&. Applicants for appointment as commissioned officer of the Air Corps must meet

the basic physical requirements as provided in AR 40-100 and 40-105. The physical examination will be of the final type and signed by at least three medical officers. This report of

physical examination is normally recorded on W.D., A.G.O. Form No. 63 (Report of

Physical Examination) however, W.D., A.G.O. Form No. 64 (Physical Examination for

Flying) will be used whenever the applicant is also being considered for an aeronautical

rating.

c. Applicants for air crew training must meet the basic physical requirements for

commission as provided in AR 40-100 and 40-105, with the added requirements of class

visual acuity and normal color vision as prescribed in paragraph 11a(3). This examination

need not be final type examination. However, when facilities are available, X-ray of the

chest and an approved serological test for syphilis will be done on all applicants. Whenever the necessary equipment and services of flight surgeon or aviation medical examiner

are available, report of physical examination for applicants for air crew training will be

accomplished on W.D., A.G.O. Form No. 64. Qualified applicants will meet class standards.

This physical examination record (Form No. 64) will be signed by at least one aviation

medical examiner or flight surgeon.

d. The basic physical requirements are the same for all individuals who perform duty

in the air in any capacity. Because of the relationship between vision and hearing and the

performance of flying duties, individuals who are to perform the various technical duties

in the air in accordance with their professional qualifications are further classified into

three classes according to the findings of the examination of their eyes and ears. For duty

involving regular and frequent participation in aerial flights, the following personnel are

required to meet the physical standards of these classes

(1) Class 1.—Applicants for flying training, individuals undergoing flying training,

rated senior pilots, pilots, flight officers, aircraft observers, balloon pilots, senior

balloon pilots, balloon observers, service pilots, navigators, bombardiers, glider

pilots, and liaison pilots.
APPENDIX 261

(2) Class 2.—Rated senior pilots, pilots, flight officers, aircraft observers, balloon

pilots, senior balloon pilots, balloon observers, service pilots, liaison pilots, glider

pilots, individuals undergoing training as navigators and rated navigators.

(3) Class 3.—Rated command pilots, technical observers, aircraft observers, nonrated observers, Army nurses, and officers of other arms and services detailed

by competent authority to duty involving flying. Service pilots who cannot meet

the physical standards of class or 2, but whose defects are within the limits

prescribed for class 3, provided their training and experience, in the opinion of

the Commanding General, Army Air Forces, are such as to compensate for the

lower physical standards of class 3, may be qualified in this class.

4. Restrictions until physically qualified.—a. Individuals will not he assigned to duty

involving regular and frequent participation in aerial flights until they have successfully

passed the physical examination prescribed herein for their respective class, and until they

have received official notification from the Commanding General, Army Air Forces, or such

officer or officers of the Army Air Forces as he may designate to pass on the physical

requirements for such duty.

1). Those who fail to pass the physical examination prescribed in these regulations for

si)ecific duty in the air will be relieved from such duty and will not be placed thereon until

they are able to pass such physical examination, or have received waivers for their

physical defects.

5. Reexamination; physical incapacity.—a. Whenever flight surgeon finds an individual on flight status physically incapacitated for such duty he will promptly inform

the commanding officer of his station in writing, submitting appropriate recommendations

at the same time. Upon the receipt of such notification from the flight surgeon, the commanding officer will at once ground or suspend the flight status of any individual reported

physically incapacitated. When the individual, following physical examination, is again

reported by the flight surgeon as physically fit, the commanding officer may, if the flight

surgeon so recommends and the incapacity was for slight or temporary disability, authorize

resumption of such duty or training without reference to the Commanding General, Army

Air Forces.

I). Reexamination and report on W.D., A.G.O. Form No. 64 will be made on any rated

officer or rated enlisted man after hospitalization or serious illness, or injury in relation

to flying; after grounding or relief from flight status, for cause other than minor illness or

injury; after return from sick leave; and after head injury with actual or suspected

intracranial damage. Such individuals will not be allowed to resume any duty in the air

until the flight surgeon reports them physically qualified and action has been taken by the

Commanding General, Army Air Forces, or such officer or officers of the Army Air Forces

as he may designate.

c. Aviation cadets, officers training in grade, and enlisted men training in grade who

have been relieved from flight duty for serious illness or injury that requires major surgical

procedure or absence from full military diity for period of over month will not be

allowed to resume any duty in the air until authorized by the commanding general of the

Army Air Forces training center having immediate supervision of their training. Such

cases will not be referred to the Commanding General, Army Air Forces, or to the Air

Surgeon, HeadquartersArmy Air Forces.

d. Following an aircraft accident, and particularly after any head injury, careful

examination will be made to determine the presence or absence of intracranial damage.

Apparently trivial head injuries are often attended or followed by serious consequences,

and period of observation may be necessary before the possibility of permanent intracranial damage can be excluded. Such individuals, even though not necessarily hospitalized

or placed on sick report, will be given careful examination so that decision as to their

physical fitness for duty in the air may be reached. report of such examination will be

rendered on W.D., A.G.O. Form No. 64.
262 PHYSICAL STANDARDS

6. Examination, where made.—With few exceptions, all stations of the Army Air Forces

have the personnel and equipment necessary for the performance of the examination for

flying. Certain other stations have similar facilities. Information concerning the location

of these stations may be obtained from the Commanding General, Army Air Forces, the

headquarters of service commands, and service command recruiting stations.

7. Examination, by whom made.—Because of their highly technical character and

importance, these examinations will be made only by flight surgeons and aviation medical

examiners who are authorized by the Commanding General, Army Air Forces, to conduct

such examinations.

8. Waivers.—a. Personnel who do not meet the basic physical requirements for flying

duty, as established by these regulations, will require waiver granted by the Commanding

General, Army x\ir Forces, or other authorized authority before being allowed to perform

such flying duty. In such cases, formal request for waiver by the individual concerned is

not required unless called for by proper authority. It is apparent that extensive flying

experience usually compensates for the normal physical deterioration commensurate

with age.

h. The commanding general of an Army Air Forces training center who has immediate

supervision of the individual’s training may, upon recommendation of the staff surgeon,

grant waivers for minor physical defects. These waivers are to apply to duty involving

flying provided the defect is not considered dangerous to the individual or hazardous to

materiel.

c. Waiver for physical defects of enlisted personnel of combat crews undergoing training or previously trained may, upon recommendation of the senior flight surgeon, be granted

by the station commander or commanding officer of the unit concerned.

Section II

RECORDS

Paragraph

Record required, action, disposition

Transfer of record 10

9. Record required, action, disposition.—a. record of the physical examination for

flying prescribed in these regulations will be made in each case on W.D., A.G.O. Form

No. 64 in triplicate.

1). In the case of rated personnel and personnel undergoing flying training, three

copies of this form will be forwarded through medical channels to the authorized medical

reviewing authority for action and disposition of forms.

c. The original report of physical examination (W.D., A.G.O. Form No. 63 or 64) of

qualified applicants for air crew training will he forwarded with allied papers to the

commanding general of the service command. One copy of this report on all applicants,

both qualified and disqualified, will be forwarded to the Air Surgeon, Headquarters Army

Air Forces, Washington, D.C. The remaining copy will he retained by the medical examiner

for record.

d. Whenever rated personnel become ill at any station other than their home station,

the senior flight surgeon will have prepared clinical abstract in brief at termination of

treatment which will he forwarded to the senior flight surgeon of the individual’s

permanent station.

e. Outside the continental limits of the United States, two copies of the form prescribed

in above will be forwarded direct to the senior flight surgeon who has been delegated

authority by the Commanding General, Army Air Forces, to certify as to the physical

qualifications for flying on all flying personnel within his department or theater of operations. One copy of physical examination indicating the action taken will be forwarded to
APPENDIX 263

the station or unit concerned, and the remaining copy will be forwarded to the air surgeon

for final confirmation and tile.

10. Transfer of record. a. When an individual is transferred to another station, the

complete flight surgeon’s record, together with other pertinent data, will he forwarded to

the flight surgeon of the new station. An individual, prior to departing for new station,

will he required to present copy of his orders to the flight surgeon so that the exact

mailing address of his new station will be known. These orders will be appended to the

above file prior to mailing to the individual’s new station.

h. When the individual is transferred outside the continental limits of the United

States, the complete flight surgeon’s record and other pertinent data will he forwarded

direct to the Air Surgeon, Headquarters Army AirForces.

Section III

EXAMINATION

Paragraph

Visual efficiency 11

Accommodative power 12

Depth perception at 20 feet 13

Ocular muscle efficiency 14

Inspection of eyes 15

Refraction 1G

Ophthalmoscopic examination 17

Ear examination 18

Nose and throat examination 19

General physical examination 20

Nervous system 21

11. Visual efficiency.—a. Central vision.

(1) Acuity at 20 feet.

{a) Scope.—A central visualacuity at 20 feet will be determined on all examinations. Each eye will he tested separately. Visual acuity of each eye will

be recorded as 20/15, 20/20, 20/30, etc. Any additional letters read will also

be recorded in the following manner: 20/20+2, 20/30+4, etc.

h) Interpretation of findings.—For class 1, the minimal requirement for

visual acuity for each eye is 20/20 without correction. If two or three letters

are not read correctly on the 20/20 line, but an equal number are read correctly on the 20/15 line, the acuity will he recorded as 20/20. For class 2,

the minimal requirement without correction for each eye is 20/40, provided

it is correctible for each eye to 20/20, and that such correction is worn when

flying. For class 3, the minimal requirement without correction for each eye

is 20/100, provided it is correctible to 20/20 and that such correction is worn

when flying.

(2) Acuity at 13 inches.—Central visual acuity at 13 inches (near vision) will he

determined on all examinations. Each eye will be tested separately. The near

visual acuity of each eye will be recorded as “J-l-13,” “J-2-13,” etc.

(3) Central color perception.—Applicants for appointment as commissioned officers

in the Army of the United States will be required to meet the basic requirements

of All 40-105. Efficiency of binocular central color perception will be determined

on all original applicants for flying training, with either the American Optical

Company’s compilation of pseudoisochromatic plates or Ishihara color test plates.

Applicants for flying training, who correctly interpret all the plates of the test

books mentioned above will be recorded as having “normal” central color vision.

Those who correctly interpret less than 75 percent of the plates in the test books
264 PHYSICAL STANDARDS

will be recorded as, “fails Ishihara” or “fails A.O.” and are disqualified for any

type of flying training. Applicants for flying training who incorrectly interpret

to 25 percent of the plates in the color vision hooks will he recorded as, “misses

A.O.” or “misses Ish.,” referring to the number of plates missed and the

book used.

Aviation cadets undergoing classification and personnel, commissioned or

enlisted, undergoing flying training in grade who are found to have defective

binocular central color perception, as indicated by having incorrectly interpreted

more than 25 percent of the plates in the color vision test book, will be subjected

to further color vision tests as directed by the Commanding General, Army Air

Forces, to determine whether they are considered to be “safe” or “unsafe” will

be eliminatedfrom further flying training.

h. Peripheral vision for form (visual fields).

(1) Scope.—Peripheral vision for form will be determined on all examinations.

The confrontation test will be employed, using centimeter white sphere, but

if visual field defect is found, complete examination will be accomplished

with the perimeter and the findings recorded on the prescribed forms. These

forms will be attached to and forwarded with the report of physical examination.

(2) Interpretation of findings—The normal field for form extends temporally

90° or more; superiorly 50° nasally 55° interiorly 65°. Any contraction of the

visual field for form of 15° or more in any meridian disqualifies for flying unless

the contraction is the result of the anatomic conformation of the examinee’s

face. Other pathological changes of the visual field disqualify for flying

(scotomata, nasal contraction, etc.). If scotomata are suspected, they will be

mapped on tangent screen. Scotomata other than the normal blind spot are

disqualifying. This standard applies to all three classes.

12. Accommodative power.—a. Scope.—The power of accommodation will be determined on all examinations when the examinee is below 45 years of age. Each eye will be

tested separately. The power of accommodation will be recorded in diopters. The following

table gives the mean values of accommodation in diopters from 18 to 45 years of age:

Table of mean value of accommodation power (Duane)

b. Interpretation of findings.—Accommodation may be considered as within normal

limits provided it is not more than diopters below the mean for the examinee’s age, in either

eye. For class the examinee will be disqualified if his accommodation falls more than

diopters below the mean for his age, but before an examinee is disqualified his accommodation must be taken on successive days and an average of the three findings determined. For classes and 3, examinees are qualified with accommodation below diopters

regardless of age, provided they actually wear their correction for near vision while flying

Age Diopters Age Diopters Age Diopters

18 11. 26 9. 34 7.

19 11. 27 9. 35 7.

20 ___ 11. 28 9. 36 7.

21 11. 29 9. 37 6.

22 10. 30 8. 38 6.

23 10. 31 8. 39 6.

24 10. 32 8. 40 5.

25 10. 33 8. 45 3.
APPENDIX 265

and their correction while worn enables them to read Jaeger test letters No. at 20 inches

(50 cm.).

13. Depth perception at 20 feet. a. Scope.—Depth perception efficiency at 20 feet will

be determined on all examinations. Five trials will be given and the average of these trials

will be recorded in millimeters.

b. Interpretation of findings.—For class 1, an average error of more than 30 millimeters

disqualifies. For class 2, an average error of more than 35 millimeters with correction worn

disqualifies. For class 3, the depth perception test is omitted. An average error beyond the

qualifying limits may be waived in the case of aviation cadets applying for or undergoing

training as navigators, and rated navigators.

14. Ocular muscle efficiency.—Horizontal muscle balance (esophoria, exophoria)

vertical muscle balance (right hyperphoria, left hyperphoria) fusion power (power of

convergence (near point), power of divergence (prism divergence), field binocular rotation

(red lens test)).

a. Equipment.—A phorometer trial frame equipped with Maddox rod and rotary

prism or other prisms; spotlight centimeter in diameter. Horizontal and vertical muscle

balance and power of divergence will be determined at 20 feet. Ocular muscle efficiency will

be determined on all examinations.

h. Interpretationof findings.

(1) Horizontal muscle balance at 20 feet.—For classes and 2, esophoria of more

than 10 prism diopters or exophoria of more than prism diopters disqualifies.

For class 3, esophoria of more than 12 prism diopters or exophoria of more than

prism diopters disqualifies. Heterotropia (manifest muscle imbalance) of any

variety disqualifies for all three classes.

(2) Vertical muscle balance at 20 feet.—For classes and 2, hyperphoria of

more than prism diopter disqualifies. For class 3, hyperphoria of more than

prism diopters disqualifies. Muscle imbalance beyond the qualifying limits of

classes 1, 2, and may be waived in the case of aviation cadets applying for or

undergoing training as navigators, and rated navigators, provided binocular

single vision is maintained in the primary position and in all cardinal directions

of vision.

(3) Fusion power.

(a) Power of convergence.—For classes and 2, the distance from the base

line to the near point of convergence (Pc B) must not exceed the interpupillary distance by more than 25 millimeters. Test is omitted in class 3.

I) Power of divergence (prism divergence).

1. This test is accomplished with the spotlight at 20 feet and with prisms

placed immediately in front of the eye.

2. For classes and 2, power of divergence of more than 15 or less than

prism diopters disqualifies. When an esophoria exists, prism divergence

in diopters must be equal to or greater than the diopters of esophoria.

(c) Field of binocular rotation (red lens test).

1. Primary position is point 75 centimeters directly in front and on level

with both eyes.

2. Where diplopia occurs within 27.30 centimeters of the primary position,

the test will be completed by recording on tangent screen or blackboard

the exact points at which diplopia occurred. The distance from the primary point where diplopia first occurs will be measured in centimeters.

3. For classes and 2, diplopia within 50 centimeters in any meridian

disqualifies. For class 3, the test is omitted routinely. In command and

service pilots where diplopia is suspected and if diplopia within 27.30

centimeters in any meridian is found the examinee is disqualified.
266 PHYSICAL STANDARDS

15. Inspection of eyes.—a. Scope.-—In process of examination of the eyes, the following

conditions will be noted

(1) Globes.—Changes from the normal position of the globes, as changes in the

direction of the visual axes (squint), exophthalmos or enophthalmos.

(2) Lids.—Ptosis, blepharitis, trichiasis, entropion, ectropion, symblepharon,

chalazion, or hordeolum.

(3) Lacrimal apparatus. —Dacryocystitis, acute or chronic, dacryoadenitis, or

imperfect drainage or epiphora from any cause.

(4) Conjunctiva and sclera.—The lids are to be everted and the palpebral conjunctiva and fornices exposed. The following conditions are to be noted:

congestion, conjunctivitis, acute or chronic, evidence of trachoma, contractures,

cicatrices circumcorneal injection, evidences of episcleritis or scleritis, and chalklike meibomian concretions.

(5) Cornea.—Keratitis, opacities, vascularization, pterygium, deposits on posterior surface, irregularity of corneal surface due to trauma, or retained foreign

bodies.

(6) Pupils.—Note size, shape, inequality, direct and consensual reactions to light,

and reaction to accommodation.

(7) Iris.—Synechiae, anterior and posterior, evidence of past or present iritis,

congenital anomalies, any sequelae of trauma or minute pigmented neoplasms.

(8) Anterior chamber.—Abnormality in depth or any evidence of alteration in

normal character of aqueous humor, retained foreign bodies.

(9) Lens. —Opacities or anomalies.

(10) Vitreous.—Opacities or anomalies.

(11) Intraocular tension.-—Taken by palpation and recorded as normal increased,

or decreased. When there is question of increased intraocular pressure the

tonometer will be employed and the results recorded with the type of tonometer

employed.

b. Interpretation of findings.—Distinction will be made between defects considered as

being of temporary or of permanent nature, and notation made as to interference with

function. Any evidence of acute inflammation of the eye or adnexa is temporarily disqualifying. chalazion which is nonirritating and does not interfere with the normal function of the lid is not disqualifying but will be recorded. hordeolum will be considered as

temporarily disqualifying condition and consideration given to refractive error as its

possible cause. Well-healed corneal opacities which in no way interfere with vision are

not disqualifying, but will be recorded as to position, size, and density. An inactive pterygium

encroaching on the cornea more than millimeter is disqualifying. One that is definitely

progressive, as evidenced by marked vascularity and thick elevated head disqualifies. Any

evident increase or decrease in intraocular pressure disqualifies. Nystagmus in primary

position disqualifies, but nystagmoid movements which are noted only at extreme limits of

the normal ocular movements are of no significance and must be differentiated from true

nystagmus. If anisocoria exists, further attention will be given to the tests of visual fields

for form, pupillary reaction to light, blood serology, and history of syphilis. Abnormal

pupillary reaction to light is disqualifying if caused by organic disease. Any defect, disease,

or abnormality that materially interferes with the normal ocular function disqualifies for

all three classes. Evidence of past or present iritis will be given particular attention, and is

disqualifying when found to be other than traumatic in origin.

16. Refraction. a. Scope.—Refraction under cycloplegic will not be done as routine

procedure, but will be done when deemed necessary by the examiner. Except in presbyopia,

corrective lenses will not be prescribed unless complete refraction has been done under

cycloplegic.

b. Interpretation of findings.-—When refraction is accomplished on the original examination, the examinee is disqualified if he requires more than 1.5 diopters correction in any
APPENDIX 267

meridian in order to read 20/20, each eye, with accommodation paralyzed, or if he requires

cylindrical correction of more than 0.50 diopter, in any meridian, whether plus or minus,

in order to read 20/20 with accommodation paralyzed. Aviation cadets undergoing training

as navigators, and rated navigators, may be qualified in class with waiver, regardless of

the amount of correction required to correct vision to 20/20.

17. Ophthalmoscopic examination. a. Scope.—An ophthalmoscopic examination will be

conducted on all examinees. mydriatic will be employed, if indicated.

ft. Interpretation of findings.—Any abnormality discovered by the ophthalmoscopic

examination that interferes with the normal ocular function disqualifies for all three classes.

In case condition of the fundus is found in which it cannot be immediately determined

whether the lesion is pathological, the applicant will be reexamined at later date to determine whether there has been any change or progression of the condition. Attention is

directed to the fact that pathological conditions of the retina and choroid are most frequently indicative of extraocular or systemic diseases. Particular attention will he paid to

the ophthalmoscopic examination of individuals past midlife, where arteriosclerosis may

be suspected or where there is history of rheumatic or of focal infection, such as dental

foci and chronic disease of the nasal accessory sinuses. In rated flying personnel, repeated

ophthalmoscopic examination is indicated following head injury with fracture, concussion,

or period of prolonged unconsciousness. Any abnormality found will be classified and described accurately, and where possible, substantiated by objective tests (confrontation test

and tangent screen test). Lenticular opacities will be described as to appearance, location,

and interference with function.

18. Ear examination. a. Scope.-—An ear examination will be conducted on all examinees, and will consist of an objective and subjective examination. Hearing will be tested

by the whispered voice test and when found defective the spoken voice test and the audiometer, if available, will be used. The audiometer record will be attached to and forwarded

with the report of examination.

ft. Interpretation of objective findings.—On original examination the following conditions are causes for injection

(1) Evidence of serious post inflammatory process interfering with the auditory

or vestibularfunctions.

(2) Existing perforation of the tympanic membrane.

(3) Acute otitis media or externa temporarily disqualifies until the condition is

cured with no existing disturbance of function.

(4) Marked retraction of the tympanic membrane with limitation of its mobility

or if associated with occlusion of the eustachian tube.

(5) Persistent tinnitis aurium disqualifies for any class on original examination.

Tinnitis aurium is temporarily disqualifying for classes and for rated

personnel and personnel undergoing flying training.

c. Interpretation of subjective findings.

(1) Voice test.—On applicants for air crew training and applicants for original

aeronautical rating, hearing must be 20/20 in each ear for whispered voice. For

trained flying personnel to be qualified in class 1, the hearing must be 20/20 in

each ear for low conversational voice. For class 2, the hearing must not fall

below 15/20 for low conversational voice. For class 3, the hearing must not fall

below 8/20 for the low conversational voice.

(2) Audiometer.—Findings willbe reported in decibels of hearing loss. For class 1,

the average hearing loss must not be more than 20 decibels. For classes and 3,

no qualifying standards are set, but qualifications will be based on the results of

low conversational voice test.

19. Nose and throat examination. a. nose and throat examination will be conducted

on all examinees. Except as modified below, the examination of the nose and throat will

be governed by the provisions of AR 40-105. Transillumination and the X-ray will be

257-966 —67 19
268 PHYSICAL STANDARDS

employed when such procedures are indicated. In addition, the following conditions, either

of temporary or permanent nature, disqualify

(1) Congenital or acquired stenosis of the nares or choanae disqualify permanently,

if not correctible.

(2) Atrophic rhinitis.

(3) Hypertrophic rhinitis, if severe or associated with polypoid degeneration

(4) On the original examination nasal polyps disqualify. In rated personnel, nasal

polyps are disqualifying until corrected.

(5) Any irremediable defect or abnormality that materially interferes with the

respiratory or olfactory function or with phonation.

6. Certain other conditions which may be considered temporary or transient in nature

will disqualify until removed or improved by treatment: (1) Acute and chronic tonsillitis. Hypertrophied tonsils will not be cause for

rejection unless history of frequent sore throat is obtained or there is evidence

of septic absorption.

(2) Deviation of the nasal septum resulting in an estimated 50 percent or more

obstruction.

(3) Marked septal spur formations which impinge on the inferior turbinate and

interfere with the normal drainage of the accessory sinuses.

(4) Occlusion of one or both eustachian tubes.

(5) Acute or chronic sinusitis.

(6) Ulcerated condition of the nasal mucosa.

(7) Any acute condition of the nose, nasopharynx, mouth, tongue or larynx that

seriously interferes with normal function.

20. General physical examination.—Except as herein modified, the general examination

will be governed by the provisions of AR 40-100 and 40-105.

a. History.—History of the following will disqualify original applicants for air crew

training and flying personnel on subsequent examinations for flying:

(1) Encephalopathy following acute encephalitis or any illness accompanied by

diplopia or lethargy.

(2) Paroxysmal tachycardia.

(3) Arthritis of the atrophic (rheumatoid) type, hypertrophic arthritis which is

either symptomatic or more than mild in degree, or history of recent or recurrent

attacks of rheumatic fever.

(4) Sydenham’s chorea.

(5) Syphilis.—History of syphilis on original applicants for air crew training will

disqualify unless applicant is able to produce acceptable documentary proof that

all the provisions of treatment as contained in existing War Department instructions have been fulfilled. In all such cases, the documentary proof aforementioned will be presented through military channels to the Commanding General,

Army Air Forces, with request for waiver.

(6) Presence of kidney stone.—A substantiated history of repeated attacks of renal

or ureteral colic, due to calculus, will disqualify for air crew training. Individuals

undergoing flying training or those holding an aeronautical rating will not be

disqualified, provided X-ray of the kidney, ureter, and bladder shows no evidence

of urinary concretions; excretory urography indicates ho evidence of congenital

or acquired anomaly; and the function of both kidneys is normal.

(7) Malaria.—A history of malaria disqualifies original civilian applicants for air

crew training unless such individuals can present acceptable proof that they

have been free of symptoms for months. Original applicants in the military

service must present proof from officials records that their peripheral blood has

been free of parasites for period of 30 days. In either case blood examination
APPENDIX 269

must indicate the absence of parasites in the peripheral blood at the time of

examination.

(8) Asthma of any degree.—History of asthma other than in childhood with

trustworthy history of freedom of manifestations during the preceding 10 years.

(9) Hay fever.—Hay fever is disqualifying, unless the examiner is satisfied it is

mild in degree.

(10) Mastoid.—History of simple mastoidectomy is disqualifying for original

applicants unless period of year has elapsed since operation, during which

time there have been no symptoms or sequelae and there exists no disturbance of

function.

(11) Otitis media.—History of recent acute otitis media on original applicants is

disqualifying, unless period of weeks has elapsed since recovery and function

is in no way affected.

(12) Head injury.—Applicants for air crew training with history of cranio-cerebral injury will he temporarily disqualified pending final action by higher authority. In all such eases, the medical examiner will cause to have assembled

hospital records, statements by attending physicians, X-ray films and other

documentary evidence pertinent to the case, which will be forwarded with the

report of physical examination to the Air Surgeon, Headquarters Army Air

Forces, for final decision. After review of such cases by the air surgeon, the

various allied papers will be returned with final action to the examining board

concerned.

h. Height and weight.—Except as herein modified, this phase of the examination will

be governed by AR 40-105. On the original examination for air crew training no applicant

will he accepted for flying training who is less than 60 inches or greater than 76 inches in

height, or whose weight falls below the minimum for age and height, or exceeds 200 pounds

in any case. The average weight for height and age with the permissible variations therefrom will be in accordance with the standards as outlined in AR 40-105.

c. Cranio-cerebral injury. Reference to history of cranio-cerebral injury is made in

above. Individuals undergoing air crew training who sustain severe cranio-cerebral

injury will be disqualified for period of year after which time reconsideration may be

recommended. In cases of rated flying personnel who sustain cranio-cerebral injury, final

action will be taken by the Commanding General, Army Air Forces.

d. Body measurements, posture, frame, skin, head, face, neck, chest respiratory system, abdomen, gastro-intestinal system, genito-urinary system, endocrine system, bones,

joints, and extremities. The standards for examination will be in accordance with AR

40-105.

e. Cardiovascular system. Except as herein modified, the examination of the heart

and blood vessels will be governed by AR 40-105. An electrocardiogram will be made on

annual or special examinations on all rated Air Corps personnel who have reached 40 years

of age. Any abnormalities will be fully described and the tracing will be submited with

the report of physical examination.

(1) Blood pressure. —No examinee will be disqualified as the result of single

reading. When the blood pressure estimation at the first examination is regarded

as abnormal, or in ease of doubt, the procedure will be repeated (morning and

afternoon) for sufficient number of days to enable the examiner to arrive at

definite conclusion. When the blood pressure requires rechecking, this will

be done with the applicant in sitting position and all readings taken will be

recorded. Systolic blood pressure, if examinee is 25 years of age or under, will not persistently exceed 140 millimeters. low diastolic pressure will suggest

the presence of aortic insufficiency. diastolic pressure of 95 millimeters or

over in itself disqualifies. In the case of applicants for flying training, persistent systolic blood pressure of 135 millimeters or more or persistent dias-
270 PHYSICAL STANDARDS

tolic blood pressure of 90 millimeters or more, or an unstable blood pressure

disqualifies. In recording the pulse rate and blood pressure systolic and diastolic, under paragraph 27, W.D., A.G.O. Form No. 64, both the prone and

standing findings will be entered in the following manner: Pulse rate, 75-80;

B.P.: 108-112, 76-80.

(2) Schneider Index.—This test will be performed in all examinations for flying.

O) The index will be used as check of the physical condition of the examinee in connection with other findings. candidate will never be disqualified on the index alone, but an index of less than will cause the

examiner to have the candidate return for further observation.

(&) Points of grading cardiovascular changes (Schneider Index)

A. Reclining, pulse rate

B. Pulse rate increase on standing

Oto 10 beats 11 to 18 beats 19 to 26 beats 27 to 34 beats 35 to 42 beats

Points Points Points Points Points Points

50 to 60

61 to 70 -1

71 to 80 -1 -2

81 to 90 -1 -2 -3

91 to 100 -2 -3 -3

101 to 110 -1 -1 -3 -3 -3

C. Standing, pulse rate

D. Pulse rate increase immediately after exercise

to 10 beats 11 to 20 beats 21 to 30 beats 31 to 40 beats 41 to 50 beats

Points Points Points Points Points Points

60 to 70

71 to 80

81 to 90 -1

91 to 100 -1 -2

101 to 110 -1 -2 -3

111 to 120 -1 -2 -3 -3

121 to 130 -3 -3 -3

131 to 140 -1 -3 -3 -3 -3

E. Return of pulse rate to standingnormal after exercise F. Systolic pressure standing compared with reclining

Points Points

to 30 seconds Rise of millimeters or more

31 to 60 seconds Rise of to millimeters

61 to 90 seconds rise

91 to 120 seconds Fall of to millimeters

After 120 seconds; to 10

beats above normal.. __

After 120 seconds; 11 to 30

beats above normal

-1

-2

all of millimeters or more -1
APPENDIX 271

(3) On the original examination definite diagnosis of vasomotor instability

or neurocirculatory asthenia disqualifies.

f. Teeth, gums, and mouth.—The teeth, gums, and mouth will be thoroughly examined by an officer of the Dental Corps, when available. Original applicants for air crew training

are acceptable who are well nourished, of good musculature, are free from gross dental

infections, and meet the following minimumrequirements

(1) In the upper jaw.—Edentulous, if corrected or correctible by full denture.

(2) In the lower jaw.—A minimum of sufficient number of natural teeth in

proper position and condition to stabilize or support partial denture which

can be removed and replaced by the individual and which is retained by means

of clasps with or without rests, to stabilize or support the denture.

Interpretation of the above is that candidates must have at least two natural

teeth in the lower jaw, one on each side in such position that they would

serve as support or attachment for partial denture. The teeth may be cuspid,

bicuspid, or molar teeth, but not incisors.

(3) Malocclusion.—When it is evident from the individual’s general physical

condition and his occupation in civil life that malocclusion has not seriously

interfered with the mastication of normal diet, then he is acceptable for air

crew training provided that in the excursions of the mandible or with the

mandible at rest, the teeth do not impinge upon opposing soft tissues and

that the malocclusion has not resulted in secondary pathological changes. If

the malocclusion is considered severe and disqualifying, and if in the opinion

of the board the individual’s experience and ability are such that his acceptance is recommended, dental casts will be made and forwarded to the headquarters, Army Air Forces, Washington, D.C., for decision as to his qualifications.

21. Nervous system.—The examiner will carefully study the provisions of AR 40-105

and MR 1-9, and in addition, special attention will be given to and below. On the

original examination careful medical history will be taken. When the applicant has

been found to have definitely permanent disqualifying physical defect or abnormality

such history will not be necessary. On examination subsequent to the original one the

examiner will be guided largely by his personal knowledge and observation of the

examinee, particularly in arriving at conclusion relative to abnormal findings of

nervous or mental nature.

a. (1) Family history.—Inquire for psychotic and psychoneurotic manifestations in the

record, and if such are found, examine carefully for degenerative modifications

expressing transmitted taint. However, if the candidate is found normal, then

the isolated occurrence of mental disturbance in ancestors will be deemed negligible the examiner will not overvalue the influence of direct heredity but duly

weighall considerations pertinent to the situation.

(2) Personal history.—The infantile period will be searched for evidence of retardation, and particular study made of the factors which obtained during the

formative years and which determine the personality trend. To this end study

will be made of the family life, play life, sex life, school and college life, trends

of thought, athletic tendencies, degree of manual dexterity, personal and family

attitude toward flying, reactions concerning the ordinary stresses of life, and

particularly the probable reactions under the special stresses incident to flying.

h. Neuropsychiatric and psychological.—The personal history will be searched on

the points mentioned below in order to develop and complete the balance of the examination.

(1) Gait.—To be observed and interpretation of abnormalities to be stated clearly.

(2) Coordination.

(a Equilibratory.
272 PHYSICAL STANDARDS

(b) Nonequilibratory.—Any disturbances or ataxias will be interpreted and

carefully recorded.

(3) Reflexes.

(а) Superficial.

(б) Deep.

(c) Pathological.—Abnormalities will be interpreted as to cause and effect,

Any pathological reflexes will be noted and opinion as to cause stated.

(4) Spontaneous or auxiliary movements.

Tremor.—State whether fibrillary, fine, or coarse. Name part or parts

affected, and state whether of the intention or continuous type. Interpretation of abnormalities will be clearly stated.

(/;) Tics.—Name part or parts affected. Either organic or functional tics disqualify on original examination and demand searching inquiry as to cause

and effect in rated flying personnel. In the latter case, if found to interfere

with performance of flying duties, such tics disqualify.

(5) Muscle status.—The volume and contour will be carefully observed. Any

atrophies or hypertrophies with their location will be noted.

((>) Sensory disturbances. —These have either psychogenic or organic basis and

are sufficient cause for rejection and, because of their etiology, disqualify.

(7) Cranial nerves.—The cranial nerves will be appropriately tested and all abnormalities noted and recorded.

(8) Vertigo.—Vertigo other than that of transient nature disqualifies.

(!)) Psychomotor tension.—To be interpreted in terms of ability or inability voluntarily to relax. The examiner notes if the general attitude of the examinee is

one of composure and relaxation or of agitation and tenseness. Increased tension

is present in staleness, may be present in organic nervous disease, and may

be indicative of psychoneurotic coloring.

(10) Peripheral circulation.—Examine for flushing, mottling, and cyanosis of

face, trunk, and extremities. Note the presence of localized sweating (axillae

and palms) and cold extremities.

(11) Tobacco.—Its moderate use is permissible. Excessive use requires examination for deleterious effects and significance as nervous habit.

(12) Alcohol.—Excessive use disqualifies.

(13) Drugs.—Having eliminated drug addiction, inquire whether there is habitual use of medicines for ailments, either mild or severe. Such habitual resort

to medicines for any condition fancied orreal disqualifies.

(14) Sleep disturbances.

Insomnia.—When persistent, disqualifies on original examination and is

cause for grounding the flyer.

b) Pavor nocturnus.—To be duly weighed in association with related factors.

(c) Somnambulism.—Somnambulism is disqualifying providing the history

indicates definite somnambulistic tendencies and warrants the diagnosis

of somnambulism. It will be cause for rejecting all original applicants for

flying training and for grounding of flying personnel.

(15) Headaches.—An occasional mild headache may be considered negligible, but

if of frequent occurrence or ofmigraine type, disqualifies.

(16) Fainting.—History of repeated fainting without reasonable and adequate

cause disqualifies.

(17) Head injuries.—History of severe head injuries must be fully evaluated with

specialreference toresiduals.

(18) Amnesia.—Amnesia may be partial or complete, of psychogenic or organic

etiology. Cause and type will be recorded. Discovery of pathological memory

defects will disqualify on original examination. Amnesia following head in-
APPENDIX 273

jury is disqualifying in student flyers; however, in the case of rated pilots

and observers and others on flying status, history of amnesia, following

head injury, may receive consideration for waiver. Distinction must he made

between amnesia and unconsciousness.

(lb) Epilepsy.—Major or minor seizures disqualify. The most searching investigation will be made of the entire life record, not only for history of seizures,

either major or minor, but for those equivalents indisputedly establishing the

epileptic background. Sufficient preponderance of such equivalents with or

without seizures disqualifies.

(20) Obsessions and phobias.—Obsessive doubts, indecisions, and vacillations

may be of remarkable variety and apparent absurdity. Phobias are of the

most diverse variety. Care will be exercised in differentiating between mere

aversion and dislike on the one hand and morbid, unreasonable fear or dread

on the other. When obsessions or phobias motivate conduct in directions interpreted as odd and peculiar it expresses fundamental instability and disqualifies.

(21) Speech defects.—A definite history of stammering or stuttering disqualifies

on original examination. If either develops in the flyer it is cause for grounding

for further observation. If the difficulty is in articulation, that is, if the speech

musculature or its innervation is impaired, due consideration will be given it

as being cause for disqualification.

(22) Temperament.—Temperament is complex factor very difficult of definition however, it will be considered as the fundamental and prevailing life

mood peculiar to the individual personality, and will especially be noted in

the examinee as to irritability, apathy, elation, or depression. If these are

found in such degree as to be pathological on the original examination, they

disqualify. In flying i>ersonnel they are cause for grounding either temporarily

or permanently, depending on the result of further observation to determine

the etiology, diagnosis, and prognosis.

(23) Anxiety trends.—Deeply seated worries approximating the anxiety type,

and anxiety neurosis, or history of inadequate handling of past mental stresses

disqualifies on original examination. If found in the pilot or others on flying

status, they are cause for temporary disqualification, depending on the outcome

of competent observation and diagnosis.

(24) Instability.

(a) Nervous. —Inability to maintain uniformity and continuity of con- sciousness disqualifies unless there is some reasonable explanation for it.

(b) Emotional.— Undue fluctuation in mood disqualifies on the original examination, and is cause for grounding the flying personnel temporarily or

permanently.

(c) Mental.—Inability to keep the selective motive dominant and to make

coordinated effort disqualifies on the original examination, and is cause for grounding the flying personnel temporarily or permanently.

Cardiovascular.—Undue fluctuation of blood pressure or pulse rate disqualifies on the original examination, and is cause for grounding temporarily or permanently.

(25) Reaction time.—Slow reaction time as disclosed by such tests and in excess

of such limitations as may be prescribed by the Commanding General, Army Air

Forces, from time to time disqualifies on original examination.

(26) Reality adjustment.—In the study of the examinee review is made of his

total experience. Each candidate will be found to have met with situation difficulties requiring solution. The extent and type of these difficulties will, of

course, vary with the individual. The manner in which he has met Avorries,

handled conflicts, and sublimated complexes is an indication of the degree to
274 PHYSICAL STANDARDS

which he can adjust himself to his environment. The study will determine

whether he is inherently stable or unstable.

(27) Estimated adaptability for military aeronautics.—Required on original examination for flying training, thereafter only when specially indicated. Predetermination of ability to qualify as military aviator, of any type, is difficult.

The examiner will therefore utilize all aid available in arriving at conclusion.

These aids will include the examinations set forth in these regulations, as well

as such neuromuscular, coordination, and psychological examinations of whatever nature, as may be authorized by the Commanding General, Army Air

Forces. These examinations when considered as whole and woven into complete pattern will establish the fitness, stability, and endowment which make

for success in training and performance in the air. No one individual will show

all favorable reactions and traits and no unfavorable ones, but predominance

of one or the other will determine qualification or disqualification. The assessment of the adaptability will l>e expressed as satisfactory or unsatisfactory,

supported by rated scoring as authorized. If unsatisfactory, the reason therefor will be clearly stated.

[A.G. 702 (8-29-42).]

order of the Secretary of War

G. C. MARSHALL

Chief of Staff. Official

J. A. ULIO,

Major General,

The Adjutant General.

Distribution

A.
APPENDIX

Tabular Summary of Physical Standards

Note.—The 20 tables that make up this Appendix were originally prepared by Mrs.

Ida Heilman. The material was checked, rearranged, and set up in final form by Mrs. Claire

M. Sorrell, Historian, of the General Reference and Research Branch, The Historical

Unit, ably assisted by Mrs. Dreama E. Black and Mrs. Cavell B. Lo Presti, of the Administrative Branch, The Historical Unit.—C.M.W.

2o7-906 —67 20
276 PHYSICAL STANDARDS

Table

1.

—General and

miscellaneous

defects

Acceptability

Time

period

in

effect

31

Aug.

1940

-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

General

service...

Acute

communicable diseases,

provided

acceptance

of

the

registrant is

temporarily

deferred

until

final

examination shows

recovery without

disqualifying sequelae.

Individuals

with

acute

pathological

conditions

including

acute

communicable

diseases

except

venereal

diseases,

from

which

in

the

natural

course of

the

disease

recoveryoccurs

without

sequelae,

will

be

deferred

until

final

examination

shows

recovery

has

occurred

without

disqualifying

sequelae. Uncinariasis,

it

mild.

No

change.

No

change

Remediable incapacity

due

to

recent

acute

illness

or

injury

or

to

employment

or

environment

in

civil

life.

All

above

entries

deleted

and

the

following

substituted

defects

will

be

regarded as

causes for

rejection

until

there

has

been

recovery without

disqualifying

sequelae.

Medical

examiners

will

reject

all

men

who

are

in

need

of

hosp

italization,

and

all

those

who

by

reason of

physical defects

are

considered

unfit

for

early

participation

in

training

activities

(WD

Cir.

110,

Oct.

1940).

Remediable incapacity

due

to

recent

acute

illness,

surgical

operation,

injury,

employment or

environment

in

civil

life;

provided

acceptance is

deferred until

recovery

is

complete.

Following

uncomplicated appendectomy

registrants should

be

deferred

for

months

before

acceptance. Following remediable hernia

repair,

individuals should

be

deferred

for

months.
APPENDIX 277

Limited service...

Temporary

incapacity as

cited

in

genNo

change...

There

are

no

general

miscellaneous or

defects

to

warrant initial

selection

for

limited

service

which

are

not

covered

elsewhere

in

these

regulations.

No

change. Nochange. Nochange. Nochange. Nochange. Acute

rheumatic fever,

or

verified

history

of

single or recurrent attacks

of

rheumatic fever

within

the

previous

years. Filariasis,

trypanosomiasis, amebiasis

or

schistosomiasis. No

change. Uncinariasis,

if

more

than

mild.

No

change. Osteoarthritis or rheumatoid arthritis.

Nonacceptable

eral

service,

if

not

easily

remediable

to

degree

compatible

with

unlimited

service,

but

which

is

considered

acceptable

for

special

or

limited

service.

Carcinoma or

other

malignant

disease

No

change

of

any

organ

or

part

of

the

body.

Active

tuberculosis

of

whatever

degree

No

change...

and

whether

general

or

localized.

Leprosy

and

actinomycosis

No

change

Irremediable metallic

poisoning, exNo

change

cept

argyria. Mycotic

infection

of

the

lungs

or

other

No

change

internal

organs.

Acute

rheumatic fever

or recurrent attacks

of

rheumatic fever,

chronic

articular

“rheumatism”

and

chronic

arthritis,

if

occurrence is

verified

and

malingering

is

excluded.

Filariasis and

trypanosomiasis

Acute rheumatic fever or

history

of

recurrent

attacks

of

rheumatic fever,

chronic rheumatism and

chronic arthritis,

if

occurrence is

verified

and

malingering

is

excluded.

No

change.....

No

change No

change

Hodgkin’s disease.

No

change....

Uncinariasis,

if

severe.

No

change.. Splenectomy

for

any

cause..

Splenectomy

for

any

cause,

other

than

trauma or

congenital

hemolytic

icterus.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual

concerned

for

general

military

service

1-9

15

Mar

1942,

par.

4a(2)(a).
278 PHYSICAL STANDARDS

Table

2.

Height,

weight,

and

chest

measurements

Standard

Minimum

Standard

Minimum

Height

Height

Chest

Chest

Chest

Chest

Weight

measurement

Weight

measurement

Weight

measurement Weight

measurement

at

expiration

at

expiration

at

expiration

at

expiration

Inches

Pounds

Inches

Pounds

Inches

Inches

Pounds

Inches

Pounds

In<hes

60

116

31.

25

105

28.

75

70

152

33.

75

133

31.

25

61

119

31.

50

107

29

71_

156

34

137

31.

50

62

122

31.

75

109

29.

25

72

160

34.

25

141

31.

75

63_

125

32

111

29.

50

73

164

34.

50

145

32

64_

128

32.

25

113

29.

75

74_

168

34.

75

149

32.

25

65_

132

32.

50

115

30

75

172

35

153

32.

50

66

136

32.

75

117

30.

25

76

176

35.

25

157

32.

75

67

140

33

121

30.

50

77

180

35.

50

161

33

68_

144

33.

25

125

30.

75

78

184

35.

75

165

33.

25

69

148

33.

50

129

31

Time

period

in

effect

Acceptability

31

Aug.

1940

19

Apr.

1944

General

service.

Those

who

fall

within

the

requirements for

height,

weight,

and

chest

measurement

given

No

change.

in

the

above

table.

Those

whose

weight

is

greater than

the

standards

indicated

for

the

height,

provided

the

No

change.

overweight

is

not

so

excessive as

to

interfere

with

military

training.

Limited serviceRegistrants who

on

examination

are

found

to

present

conditions not

within

the

accepted

No

change.

measurements for

weight

and

chest

circumference given

in

the

table

who

are

otherwise

mentally

and

physically

fit,

and

who

do

not

fall

within

nonacceptable may be

accepted

for

special

or

limited

military

service.

Nonacceptable.

Less

than

60

inches

in

height

No

change.

Less

than

105

pounds

in

weight

No

change.

Over

78

inches

in

heightNo

change.

Overweight

which

is

greatly

out

of

proportion

to

the

height

if

it

interferes

with

normal

No

change.

physical

activity or

with

proper

training.

'Mobilization Regulations No.

1-0,

ited

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.
VPPEXDIX 279

Table

3.

—Defects

of

the

eye

Acceptability

Time

period

in

effect

31

Aug.

1940

1-14

Mar. 1942

15

Mar

-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr.

1944

19

Apr

-7

Sept.

1944

Sept.

1944

General

In

each

eye

20/100

with

For

general

military

Reg

strants

whose

visRegistrants whose

visual

Binocular (both

eyes

No

change.

service.

out

glasses,

if

correctservice

in

all

arms

ual

acuity

is

not

less

acuity

is

not

less

than

open)

vision

of

not

less

able

with

glasses

to

and

services.

—Regthan

20/200

in

each

20/200

in

each

eye

withthan

20/40

witnout

20/40

bilateral.

istrants

whose

visual

eye

without

glasses,

out

glasses,

if

correctaglasses,

and

provided

Per

WD

Cir.

43,

12

Feb.

acuity

is

not

less

than

if

correctable

to

at

ble

to

at

least

20/40

in

the

defective

eye

is

not

1942:

Registrants whose

20/100

in

each

eye

least

20/40

in

each

eye.

each

eye.

less

than

20/70

without

visual

acuity

is

below

without

glasses,

if

Per

AG

Letter

effective

glasses

and

provided

20/100

but

not

below

correctable

to

20/40

Feb. 1943

to

CGs,

Svc

the

defective vision

is

20/200

in

each

eye

within

each

eye.

Comds,

22

Jan.

1943:

not

due

to

activeor

out

glasses

if

correctable

For

general

military

Minimum

vision

of

progressive organic

to

20/40

in

each

eye.

service

in

all

noncom20/70

in

one

eye

and

in

disease.

batant

services.

—Regthe

other

eye

at

least

Registrants whose

visual

Registrants whose

visual

istrants

whose

visual

20/25

without

glasses.

acuity

without

glasses

acuity

without glasses

acuity

is

below

20/100

Per

AG

Letter

effective

is

not

less

than

20/200

in

is

not

less

than

20/200

but

not

below

20/200

June

1943

to

CGs,

Svc

each

eye

or

20/100

in

one

in

each

eye,

if

vision

in

each

eye

without

Comds,

27

May

1943;

eye

and

20/400

in

the

is

correctable to

20/40

glasses,

if

correctable

inimum

visual

acuity

second

eye,

if

vision

is

in

each

eye,

and

proto

20/40

in

each

eye.

of

20/70

in

one

eye

and

correctable

to

either

vided

the

defective

in

the

other

eye

at

least

20/40

in

each

eye,

20/30

vision

is

not

due

to

or,

20/40

with

both

eyes

in

the

right

eye

and

active or

progressive

open

without

glasses,

20/70

in

the

left

eye,

or

organic

disease.

The

provided

vision

is

not

20/20

in

the

right

eye

actual

possession

of

below

20/70

in

either

and

20/400

in

the

left

suitable glasses

by

an

eye,

and

provided

that

eye

and

provided

the

individual is

not

rethe

defective vision

is

defective vision

is

not

quired

for

his

acceptnot

due

to

an

organic

due

to

active or

proance

under

these

disease.

gressive

organic

disease.

standards.

The

actual

possession of

suitable

glasses

by

an

individual

is

not

required

for

his

acceptance

under

these

standards.

See

footnotes

at

end

of

table.
280 PHYSICAL STANDARDS

Table

3.

—Defects

of

the

—Continued eye

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

16

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr.

1944

19

Apr

-7

Sept.

1944

Sept

1944

General

Conditions

due

to

iridecNo

change

Conditions

due

to

iridectomy

or

other

operation

upon the

eye,

if

the

condition

for

which

the

operation was

performed

has

been relieved and

the

vision

is

within

or

above

the

minimum standard

requirements. No

change. Nochange. Nochange. Nochange. Nochange. Nochange.

service Continued

tomy

or

other

operation

upon the

eye,

if

the

condition

for

which

the

operation

was

performed

has

been

relieved and

the

vision

is

within

or

above

the

minimum standard

requirements. Slight

nystagmus

Nystagmoid

movements No

change--

tomy or

other

operation

upon the

eye, if

the

condition

for

which

the

operation was performed

has

been

relieved and

the

vision

is

within

or

above

the

minimum standard

requirements.

Per

AO

Letter

effective

Feb. 1943

to

CGs,

Svc.

Comds,

22

Jan.

1943:

Acuity

of

vision

of

20/25

with

both

eyes

open,

without

glasses,

provided

the

vision

in

the

worse

eye

is

not

less

than

20/70.

Slight

conjunctivitis

if

not

persistent or

pronounced and

if

true

nystagmus

is

excluded. No

changehronic

simple

conjunchronic

sim

pie

conjuncNo

change

tivitis

occurring

in

regions

where

trachoma

is

prevalent

and

if

easily

remediable. Slight

adhesion of

the

lid

tivitis,

if

mild.

No

change

No

change

to

the

eyeball.

Small

pterygium

Small

pterygium not

encroaching on

cornea.

Small

pterygium not

encroaching on

cornea

so

as

to

interfere

with

vision.
APPENDIX 281

Ptosis

which

does

not

inNo

change..

No

change.

terfere

with

vision.

Strabismus

which

does

No

change. ..

not

interfere!

with

vision.

olor

blindness.. L.

No

change..

No

change. Nochange.

Exophthalmos, if

not

of

such

degree

as

to

have

No

change

No

change

No

change

led

to,

or

threatened, corneal

ulceration,

and

provided

hyp'erthy-‘

roidism is

excluded.

Blepharitis

marginalis,

if

slight.

No

change...

No

change

No

change.

Blepharospasm, if

mild..

Superficial

corneal ulcer,

provided acNo

change

No

change

No

change. Nochange.

No

change

No

change

«|T<r O'J

ccptance

is

deferred

until

ulcer

is

healed

without

disqualifying impairment of

vision.

Limited

minimum

vision

of

No

change

No

change...... ..

No

change

No

change.

service.

20/400

in

each

eye

without

glasses,

if

correctable

with

glasses

to

20/40

in

either

eye.

20/400

in

each

eye

without

glasses,

correctable to

20/40

in

one

eye

and

20/70

in

the

second eye,

or

20/30

in

one

eye

and

20/100

in

the

second

eye.

Loss

of

one

eye

or

blindNo

change

No

change

Loss

of

one

eye

or

blindLoss

of

one

eye

(anophNo

change.

ness

in

one

eye

not

due

ness

in

one

eye

not

due

thalmos) or

any

degree

to

progressive

organic

to

progressive

organic

of

defective vision

in

change,

with

vision

in

change,

with

vision

in

one

eye

from

below

the

other

eye

of

not

less

the

other

eye

of

not

less

20/400

to

no

light

perthan

20/200

correctable

than

20/100

correctable

ception,

if

such

defecto

not

less

than

20/40.

to

not

less

than

20/20.

tive

vision

is

not

due

to

active or

progressive organic

disease,

with

vision

in

the

other

eye

of

20/100

without glasses, correctable to

20/20

with

glasses.

See

footnotes

at

end

of

table.
282 PHYSICAL STANDARDS

Table

3.

—Defects

of

the

—Continued eye

Acceptability

Time

period

in

effect

31

Aug.

1940

-14

Mar.

1942

15

Mar

.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr.

1944

19

Apr

.-7

Sept.

1944

Sept.

1944

Limited service Continued

Superficial

corneal

ulcer

provided

acceptance is

deferred

until

ulcer

is

healed

without

disqualifying

impairment

of

vision. The

following

conditions if

mild: Chronic

conjunctivitis not

trachomatous. Inversion

and

eversion

of

eyelids.Ptosis

interfering

with

vision. Trichiasis Epiphora-... Chronic

blepharitis.Extensive

pterygium

Chronic

dacryocystitis.Blepharospasm... Diplopia due

to

paralysis

of

ocular

muscles

of

one

eye,

if

mild.

The

following

conditions

if

mild: Conjunctivitis, chronic,

simple,

moderate. No

change.. No

change... No

change Nochange NochangePterygium

encroaching on

cornea. No

changeBlepharospasm, unless

mild. Diplopia due

to

paralysis

of

ocular

muscles

of

one

eye.

Strabismus

interfering

with

vision.

The

following

conditions

if

mild:

No

change Nochange Nochange Nochange Nochange... Nochange Nochange... NochangeBlepharospasm.. Nochange Nochange
APPENDIX 283

NonacceptaVision

less

than

the

minible.

mum requirements for

special

and

limited

military

service. Disfiguring cicatrics

of

eyes.Lagophthalmos, if

associated

with

signs

of

hyperthyroidism.Pronounced exophthalmos.

No

change

No

change. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange.

Lagophthalmos, if

extreme. No

change Nochange

Chronic

recurrent inflammatory

disease

of

the

globe. Deep

chronic

ulcer

of

cornea. Any

active

disease

of

the

retina,

choroid,

or

optic

nerve. Detachment of

the

retina..

Chronic recurrent inflammatory

disease of

the

cornea

or

uveal

tract.

Chronic ulcer

of

cornea..

No

change- ...

Diplopia due

to

paralysis

of

extrinsic

ocular

muscle,

unless

mild

in

degree. Abnormal

conditions

of

eyes due

to

disease

of

the

brain.

See

footnotes

at

end

of

table.

No

change
PHYSICAL STANDARDS 284

Table

3.

—Defects

of

the

—Continued eye

Acceptability

Time

period

in

effect

31

Aug.

1940

'-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct

1942-21 Jan

1943

22

Jan.

1943

-18

Apr.

1944

19

Apr

-7

Sept.

1944

Sept.

1944

Nonaccept- able—

Con.

Trachoma

No

change

No

change. Nochange. Nochange. Nochange. No

change. Nochange. Chronic

conjunctivitis. No

change. Nochange. Adhesion

of

the

lids

to

the

eyeball.Blepharospasm.

Any

tumor

of

the

orbit—

Permanent or

wellmarked

strabismus

of

severe

degree.

Deformity of

the

eyelid

or

eyelids

such

as

inversion

or

eversion

of

degree

that

forcible

closure

fails

to

cover

the

eyeball or

in

which

there

is

resultant

conjunctival

inflammation,

corneal

irritationor

restriction of

the

rotation of

the

eyeball.

No

change

Permanent and

wellmarked

strabismus (over

30°

deviation).

No

change Ptosis

interfering

with

vision. Trichiasis Chronic

conjunctivitis Chronic

dacryocystitisPterygium interfering

with

vision.

Chronic

conjunctivitis, other

than

mild,

simple.

No

change Nochange

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.1942.

Changes

No.

2,

MR

1-9,

Sept. 1944.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual

concerned

for

general

military

service.

MR

1-9,

15

Mar.

1942,

par.

4a(2)(a).
APPENDIX 285

Table

4.

—Defects

of

the

ear

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.

-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

M8

Apr.

1944

19

Apr.

1944

General

service..

Hearing

in

each

ear

of

10/20

or

better.

Hearing

in

each

ear

of

10/20

or

better;

5/20

in

one

ear and

15/20

in

the

other;

0/20

in

one

ear

and

20/20

in

the

other.

Hearing

in

each

ear of

8/15

or

better. Effective

Feb. 1943

per

AO

Letter

to

CGs,

Svc

Comds,

22

Jan.

1943:

Hearing,

normal,

15/15

in

each

ear

as

tested

by

the

whispered

voice.

Hearing

in

each

ear of

8/15

or

better,

or

15/15

in

one

ear

and

less

than

8/15

in

the

other.

Healed

scar

of

mastoid

operation

without

marked

deformity

and

if

hearing

is

not

below

requirements. Hearing

in

one

or

both

ears

less

than

10/20 but

not

less

than

6/20.

Complete

deafness

in

one

ear

if

the

hearing

is

not

less

than10/20 in

the

other ear.

No

change. There

are

no

defects

in

hearing

Limited service..

Hearing

in

one

or

both

ears

less

ban

10/20 but

more

than

5/20.

Hearing

in

one

or

both

ears

less

than

8/15

but

not

less

than

5/15

in

either

ear.

Deafness in

one

ear

if

the

hearing

is

not

less

than

15/15

in

the

other ear.

that

warrant

initial

classification

for

limited

service.

See

footnotes

ears,

if

the

registrants have

followed

useful

vocation

in

civil

life

and

the

deformity

is

not

too

greatly

disfiguring. at

end

of

table.

Unilateral

atresia

of

the

external

auditory

canal.

Perforation of

the

membrana

tympani

provided

there

is

trustworthy

history

of

no

symptoms of

otitis

media

or

disease

of

mastoid

during

preceding

years.
286 PHYSICAL STANDARDS

Table

4.—

Defects of

the

ear

Continued

Acceptability

Time

period

in

effect

31

Aug. 1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

43

22

Jan.

1943

M8

Apr.

1944

19

Apr.

1944

onacceptable...

Hearing

less

than

the

miniNo

changeNo

change

change. Purulent otitis

media

with

or

without

mastoiditis. No

change. Severe

atresia

of

the

external

auditory

canal.

No

change. No

change.

mum

hearing

prescribed

under

limited

service.

Chronic

purulent

otitis

meNo

change

No

change

dia,

with

or

without mastoiditis. Chronic

perforation of

memNo

change

Perforation of

the

membrana

tympani.Atresia

of

the

external

auditory

canal,

or

tumors

of

this

part.

Acute

or

chronic

mastoiditis,.

Total

loss

of

an

external ear

brana

tympani.

Atresia

of

both

external

auditory

canals.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise indicated

Changes

No.

1,

MR

1-9,

15

Oct.

1942.
APPENDIX 287

Table

5.

—Defects

of

the

mouth, nose, fauces,

pharynx,

traches,

esophagus,

and

larynx

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

M8

Apr.

1944

19

Apr.

1944

General

service-.

No

change

No

change.

No

change ..--

No

change.

Small

benign

tumors of

ihe

nasal

and

buccal mucous

membrane. Deviation of

the

nasal

septum

or

enlarged

turbinates which

do

not

seriously

interfere

with

nasal

breathing. Acute

primary

sinusitis,

provided

the

acceptance

of

the

registrant is

temporarily

deferred

for

reexamination, if

after

reasonable time

the

sinusitis

has

disappeared.

Alleged

stricture

of

the

esophagus

which

is

unattended by

evidence

of

organic

disease

of

the

esophagus

as

shown

by

fluoroscopic

examination while

the

registrant

is

swallowing

barium

mixture.Perforation of

hard

palate,

it

not

associated with

disqualifying disease.

No

change

Deviation of

the

nasal

septum

No

change

or

enlarged

turbinates which

do

not

interfere

more

than

mildly

with

nasal

breathing. No

change.

Perforation of

hard

palate

which

is

not

associated

with

disqualifying disease

and

does

not

seriously

interfere

with

speech.

See

footnotes

at

end

of

table.
288 PHYSICAL STANDARDS

Table

5.

—Defects

of

the

mouth,

nose, fauces,

pharynx,

traches,

esophagus,

and

larynx

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.

-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

MS

Apr.

1944

19

Apr.

1944

General

service Continued

Moderate

deformity

of

the

structures

of

the

mouth

which

does

not

seriously

interfere

with

mastication or

speech.Laryngitis manifested

by

hoarseness,

laryngeal

cough,

and

congestion

of

the

vocal

chords,

confirmed

by

laryngoscopy,

unless

tuberculous or

malignant.

Laryngitis manifested

by

hoarseness,

laryngeal

cough,

and

congestion

of

the

vocal

chords

confirmed

by

laryngoscopy, unless

tuberculous,

syphilitic,

or

malignant

in

origin.

No

change---

No

change.

Limited service-- Deviation of

the

nasal

septum

which

markedly

interferes

with

nasal

breathing.

Deviation of

the

nasal

septum

or

enlarged

turbinates which

do

not

interfere

more than

mildly

with

nasal

breathing. No

change.

Nonacceptable

Aphonia,

with

attendant conditions,

which

disqualify

for

general

military

service,

if

they

have

followed

useful

vocation

in

civil

life.

Irremediable deformities of

the

mouth,

throat, and

nose

which

interfere

with

the

mastication

of

ordinary

food,

with

speech, or

with

breathing.

Nasal

polypi,

unless

severe

and

irremediable.

Nasal

polypi,

if

mildor

moderate and

not

accompanied

by

evidence

of

chronic

sinus

disease.

Deformities of

the

mouth,

No

change

No

change.

throat,

and

nose

which

interfere

with

the

mastication

of

ordinary

food,

with

speech,

or

with

breathing.
APPENDIX 289

Destructive syphilitic

diseases

of

the

mouth, nose, throat,

larynx,

or

esophagus,

if

severe in

degree.

Laryngeal

paralysis, due

to

pressure

from

aneurysm or

tumor.

Destructive syphilitic

disease

of

the

mouth,

nose,

throat,

larynx,

or

esophagus.

Laryngeal

paralysis

due

to

any

cause.

No

change.

No

change

No

change.

Tracheostomy..

No

change.

No

change

No

change.

Chronic

sinusitis

of

the

accessory

sinuses

of

the

nose,

unless

mild

in

degree.

Chronic

atrophic

rhinitis

with

offensive

odor.

Chronic

sinusitis

of

the

accessory sinuses

of

the

nose,

if

of

marked

severity.

Chronic

sinusitis

of

the

accessory

sinuses

of

the

nose.

No

change Nochange

No

change. Nochange.

Malignant

neoplasms

of

the

larynx. Nasal

polypi,

if

severe and

irremediable.

No

change.

Nasal

polypi,

if

severe

Nasal

obstruction

due

to

septal

deviation,

hypertrophic

rhinitis, or

other

causes, if

sufficient

to

cause

mouth

breathing. No

change

No

change. Nochange.

No

change....

No

change.

Chronic

laryngitis

Perforation of

the

hard

palate.

Stricture or

other

organic

disease

of

the

esophagus.

HarelipPerforation of

the

nasal

septum associated with

interference of

function,

or

ulceration or

crusting,

and

when

due

to

organic

disease.

No

change. Nochange. Nochange. No

change. Nochange.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual

concerned

for

general

military

service. MK

9,

15

Mar.

1942,

par.

4a(2)(a).
290 PHYSICAL STANDARDS

Table

6.

—Dental

defects

Acceptability

Time

period

in

effect

31

Aug.

19401-14 Mar.

1942

15

Mar

.-14

Oct.

1942

15

Oct.

1942

General

minimum

of

serviceable

natural

Individuals who

are

well

nourished,

Individuals who

are

well-nourished,

of

service.

masticating

teeth

above

and

beof

good

musculature, are

free

from

good

musculature, are

free

from

low

opposing

and

serviceable

gross

dental

infections,

and

have

gross

dental

infections, and

have

natural

incisors

above

and

below

the

following

minimum requireminimum

requirement of

an

edenopposing.

(Therefore, the

minimum

ments:

tulous

upper

jaw

and/or an

edenrequirements consist

of

total

of

In

the

upper

jaw;

Edentulous, if

tulous

lower

jaw

corrected or

masticating

teeth

and

of

incisor

corrected or

correctable

by

full

correctable

by

full

denture

or

teeth.)

All

of

these

teeth

must

be

so

opposed

as

to

serve the

purpose of

incision

and

mastication. Definitions; The

term

“masticating

teeth”

includes

molar

and

bicuspid

teeth,

and

term

“incisors”

includes

incisor

and

cuspid

teeth. natural

tooth

which

is

carious

(one

with

cavity),

which

can be

restored

by

filling,

is

to

be

considered

as

serviceable

natural

tooth.

Teeth

which

have

been

restored by

crowns

or

dummies attached to

bridgework,

if

well-placed,

will

be

considered as

serviceable

natural

teeth

when

the

history

and

the

appearance of

these

teeth

are such

as

clearly

to

warrant

such

assumption.

denture. In

the

lower

jaw:

minimum

of

sufficient

number

of

natural

teeth

in

proper position

and

condition to

stabilize

or

support

partial

denture

which

can be

removed and

replaced

by

the

individual

and

which

is

retained by

means of

clasps,

with

or

without

rests,

to

stabilize

or

support

the

denture.

dentures.
APPENDIX 291

tooth

is

not

to

be

considered

serviceable natural

tooth

when

it

is

involved

with

excessively

deep

pyorrhea

pockets, or

when

its

root

end

is

involved

with

known

infection

that

has

or

has

not

an

evacuating

sinus

discharging

through

the

mucous membrane or

skin. Per

WD

Circ.

43,

12

Feb.

1942;

Individuals with

the

following

defects,

formerly

classified as

limited

service,

will

be

regarded as

suitable

for

general

service and

acceptable

for

service

as

indicated

below;

Registrants who

lack

the

required

number

of

teeth

when,

in

the

opinion

of

the

examining

physician,

they

are

well-nourished,

are

of

good

musculature, are

free

of

gross dental

infections, and

have

sufficient

teeth

to

subsist on

the

Army

ration.

Malocclusion.

—When

it

is

evident

Malocclusion.

—When

it

is

evident

from

the

individual’s

general

from

the

individual’s

general

physical

condition

and

his

physical

condition

that

his

maloccupation

in

civil

life

that

his

occlusion

has

not

seriously

intermalocclusion

has

not

seriously

fered

with

the

mastication of

interfered

with

the

mastication of

normal

diet,

provided

that

in

the

normal

diet,

provided

that

in

the

excursions

of

the

mandible

or

with

excursions

of

the

mandible or

with

the

mandible

at

rest,

the

teeth

the

mandible

at

rest,

the

teeth

do

do

not

impinge

upon

opposing

soft

not

impinge

upon

opposing

soft

tissues

and

that

the

malocclusion

tissues

and

that

the

malocclusion

has

not resulted in

secondary

has

not

resulted in

secondary

pathological

changes.

pathological

changes.

See

footnote

at

end

of

table.
292 PHYSICAL STANDARDS

Table

6.

—Dental

defects

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

‘-14

Mar.

1942

15

Mar

.-14

Oct.

1942

15

Oct.

1942

Limited

Insufficient teeth

to

qualify

for

general

Insufficient teeth

to

qualify

for

general

There

are

no

dental

conditions

that

service.

service

if

corrected

by

suitable

service

if

the

defect

is

correctable

warrant classification as

limited

dentures.

by

artificial dentures,

provided

service.

NonacSerious

disease

of

the

jaw

which

is

there

is

no

evidence

of

extensive

areas of

infection

with

multiple

abscesses,

large

cysts,

or

any

other

disease

of

the

jaws

or

oral

tissues,

the

correction

of

which

would

require

protracted treatment.

Diseases of

the

jaws

and

associated

Diseases of

the

jaws

and

associated

ceptable.

not

easily remediable and

which

is

structures

which

are

irremediable

structures which

are

irremediable

likely

to

incapacitate

the

registrant

or

not

easily

remedied, or

which

are

or

not

easily

remedied, or

which

are

for

satisfactory

performance

of

likely

to

incapacitate

the

individual

likely

to

incapacitate

the

individual

general

or

limited

military

service.

for

satisfactory

performance

of

for

satisfactory

performance

of

Extensive irremediable

caries.

Extensive focal

infection

with

general

or

limited

military

duty.

Extensive focal

infection

with

military

duty.

Extensive loss

of

oral

tissue

in

an

multiple

periapical

abscess,

the

multiple

periapical

abscesses,

the

amount

that

would

prevent

correction

of

which

would

require

correction

of

which

would

require

replacement of

missing

teeth

by

protracted

hospitalization

and

protracted

hospitalization.

satisfactory

denture.

incapacity. Irremediable disease

of

the

gums of

such

severity

as

to

interfere

seriously

with

useful

vocation

in

civil

life.

Mobilization Regulations No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.
APPENDIX 293

Table

7.

—Defects

of

the

shin

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

General

service...

Acute

nonexanthematous

and

nonNo

change..

No

change. Diseases which

are

trivial

in

character

communicable diseases

of

the

skin

which

ordinarily

run

temporary

course. Diseases

which

are trivial

in

character

Diseases which

are

trivial

in

character

Diseases which

are

trivial

in

character

and

which

do

not

interfere

with

and

which

do

not

interfere

with

and

which

do

not

interfere

with

and

which

do

not

interfere

with

the

general

health

and

are

not

inthe

general

health

and

are

not

inthe

general

health

and

are

not

inthe

general

health

and

are

not

incapacitating.

Among

these

are:

capacitating.

Among

these

are:

capacitating.

Among

these

are:

capacitating.

Among

these

are:

No

change. No

change.

Anomalies

of

pigmentation.

No

change. ..

Scars

not

extensive,

disfiguring,

nor

incapacitating

in

character.

Condylomata

which

are not

extensive

Staphylococcic

and

streptococcic

skin

No

change... Condylomata

which

are

not

extensive

and

are

not

syphilitic.

Skin

infections,

if

mild

and

considerNo

change.

No

change.

infections.

ed

of

no

significance.

No

change. Nochange.

Naevi

which

are

not

greatly

disNaevi

which

are

not

greatly

disNo

change.

figuring. All

forms

of

pediculosis

figuring

and

are

not

not

so

located

as

to

be

subject

to

irritation or

trauma

by

the

normal

wearing

of

military

equipment.

No

change. Nochange. No

change. No

change. Warts,

except

plantar

warts

on

weight

bearing

areas.

No

change.

All

forms

of

ringworm unless

severe

and

not

easily remediable. Scabies,

unless

severe and

not

easily

remediable. Mild

and

not

extensive

psoriasis

No

change.... No

change. Nochange.

No

change... No

change... ...... No

change

See

footnotes Simple

ulcers

or

other

acute

defects

of

the

skin

which

are

easily

curable.

Pilonidal cyst

or

sinus

if

unattended

with

disease

of

the

bone,

as

shown

by

X-ray.

at

end

of

table.

No

change

No

change
294 PHYSICAL STANDARDS

Table

—Defects 7.

of

the

skin

—Continued Time

period

in

effect

Acceptability

31

Aug.

1940

»-14

Mar.

1942

15

Mar

.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

eneral

Service- Continued

Unusual

skin

defects

should

arouse

suspicion

of

self-inflicted

lesions

(dermatitis

factitia).

No

change.

True

alopecia

areata,

provided

the

True

alopecia

areata,

provided

the

No

change.

existence

of

syphilis,

disqualifying

existence

of

disqualifying endocrine,

endocrine,

neurological or

other

disneurological, or

other

disqualifying

qualifying

conditions

are

excluded.

conditions

are

excluded.

Limited service...

Such

defects

as

chronic diseases of

the

skin

which

disqualify

for

general

military

service,

if

the

registrant

has

successfully followed

useful

vocation

in

civil

life.

Such

defects

as

chronic

diseases of

the

There are

no

skin

criteria

to

warrant

Pilonidal cyst

or

sinus.

(If

there

is

only

simple

dimpling

of

the

skin

or

short

simple

sinus

in

the

postanal

region,

the

individual

should

be

accepted

for

general

service.)

skin,

which

disqualify for

general

military

service,

if

the

registrant

has

successfully

followed

useful

vocation

in

civil

life.

Rescinded, per

C-l,

MR

1-9,

15

Oct.

1942.

initial

selection

for

limited

service.

Nonacceptable...

Chronic

skin

diseases

or

chronic

ulcers

of

the

skin

which

are

so

severe or

so

disfiguring

as

to

Incapacitate

the

registrant for

the

duties

of

soldier

or

so

disfiguring

as

to

render

the

registrant

objectionable

in

common

social

intercourse.

Chronic

skin

disease,

chronic

ulcers

of

the

skin,

or

cured

syphilitic

lesions

which

are

so

severe

or

so

disfiguring

as

to

incapacitate

the

registrant for

the

duties

of

soldier

or

so

disfiguring

as

to

render

the

registrant

objectionable

in

common social

intercourse.

No

change

No

change.

Dermatitis

herpetiformis

of

long

No

change.

duration.

No

change.

Forms of

generalized

dermatitis

of

Generalized

dermatitis of

long

duraNo

change.

long

duration.

tion.

Allergic dermatoses if

severe and

not

easily remediable.

Allergic

dermatoses, if

severe

No

change.
APPENDIX 295

•1

No

change

No

change.

No

change

No

change.

No

change

No

change.

No

change,..

No

change.

Syphilitic

lesions

ulcerative

in

character

showing

much

destruction of

tissue

which

if

healed

would

be

unsightly or

so

scarring as

to

incapacitate

the

registrant

for

military

service.

Ringworm,

if

very

severe and

easily

remediable. Scabies,

if

very

severe and

easily

remediable. Cysts

and

benign

tumors

of

the

skin

of

such

size

and/or

location

as

to

interfere

with

the

normal

wearing

of

military

equipment.

No

change Nochange Nochange Pilonidal cyst

or

sinus.

(If

there

is

only

simple

dimpling

of

the

skin

or

short

simple

sinus

in

the

postanal

region,

the

individual

will

be

accepted

for

general

service.)

No

change. Nochange. Nochange. Nochange. Plantar warts

on

weight-bearing

areas.

Psoriasis, if

other

than

mild.

MR

(Mobilization Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant acceptance

of

the

individual

concerned

for

general

military

service,

mk

1-9,

Ifi

Mar.

1942,

par.

4a(2)(a).
296 PHYSICAL STANDARDS

Table

8.

—Defects

of

the

head

and

skull

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

General

service.__

No

change...

No

change, Nochange.

of

the

character

of

depressions, exostoses,

etc.,

and

unassociated

with

evidence

of

disease

of

the

brain,

spinal

cord,

or

peripheral nerves,

and

which

would

not

prevent

the

registrant

from

wearing

military

headgear.

Defects which

are

apparently

temporary

in

character

due

to

recent injuries. (This

includes

contusions

and

other

wounds

of

the

scalp

and

concussion.

Registrants with

these

defects

should

have

the

final

examination

temporarily

deferred.) Osseous

defects

due

to

decompression or

trephine

of

the

skull,

it

asymptomatic and

unassocated

with

bulging

at

the

site

of

operation.

Deformities of

the

skull

of

the

nature

of

depressions,

exostoses,

etc.,

of

degree

which

will

prevent

registrants from

wearing

military

headgear.Deformities

of

the

skull

of

any

degree

associated

with

evidences

of

disease

of

the

brain,

spinal

cord,

or

peripheral nerves.

Hernia

of

brain;

monstrosity

of

the

head

or

hydrocephalus.

Abnormalities which

are

apparently

temporary in

character

resulting

from

recent

injuries.

(These

include

severe contusions and

other

wounds

of

the

scalp

and

cerebral

concussion.

Individuals

with

these

conditions

should

have

the

final

examination

temporarily

deferred for

months.)

Limitedservice...

Osseus

defects

due

to

decompres

sion

or

trephine

of

the

skull,

if

asymptomatic

and

unassociated

with

bulging

at

the

site

of

operation.Rescinded, per

C-l,

MR

1-9,

15

Oct.

1942.

Nonacceptable

No

change

warrant

initial

selection

for

limited

service.

No

change. Nochange.

No

change Nochange...

Mobilization Regulations No

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.
APPENDIX 1- 297

Table

9.

—Defects

of

the

spine,

scapula,

and

sacroiliac joint

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

15

Mar.-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943 M8

Apr.

1944

19

Apr.

1944

General

service.. Lateral

curvature

of

the

spine

of

inches or

less

from

the

normal

midline,

if

the

mobility

and

weight-bearing power

are

good.

No

change.. ..

Lateraldeviation of

the

spine

of

inch

or

less

from

the

midline

if

the

mobility

and

weight-bearing power

are

good. No

change.

No

change

Prominent scapula

not

interfering

with

wearing

of

uniform

or

military

equipment. Complaint

of

disease

of

the

sacroiliac and

lumbosacral joints

which

is

unassociated with

objective

signs

and

symptoms

at

the

first

examination

and

which

on

reexamination, after

reasonable

period

of

time,

is

again

found

negative.

Pilonidal cyst

or

sinus

(this

usually

presents

itself

in

the

region

between

the

coccyx and

anus),

if

unattended

with

disease

of

the

bone

as

shown

by

X-ray.

No

change

No

change.

Complaint

of

disease of

the

sacroiliac

and

lumbosacral joints

which

is

unassociated with

objective

signs

and

symptoms.

No

change

No

change.

Fracture

of

the

spine

or

pelvic

bones

which

has

healed

without

marked

defects

and

which

has

not

interfered

with

the

following

of

useful

vocation

in

civil

life.

No

change

No

change.

See

footnotes

at

end

of

table.
298 PHYSICAL STANDARDS

Table

9.

—Defects

of

the

spine,

scapula,

and

sacroiliac joint— Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

*-14

Mar.

1942

15

Mar.—14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr.

1944

19

Apr.

1944

General

service Continued Limited service-- Lateraldeviation of

the

spine

from

the

normal

midline

of

more

than

inches

and

less

than

inches.

Non

tuberculous

diseases

of

No

change

Spina

bifida

occulta

providing

it

is

asymptomatic, unassociated

with

objective

signs

and

symptoms

and

can

be

demonstrated by

X-ray

examination

only.

Lateraldeviation of

the

spine

from

the

midline

of

more

than

inch

and

less

than

inches.

Nontuberculous diseases of

No

change.

the

spine

which

are

unassociated with

such

rigidity that

the

registrant

has

been

incapacitated from

following

useful

vocation

in

civil

life.

Diseases

of

the

sacroiliac

the

spine

which

are

unassociated with

such

rigidityor

other

symptoms

that

the

registrant has

been

incapacitated

from

following

useful

vocation

in

civil

life.

onaccep

table...

and

lumbosacral joints

of

degree

which

disqualifies

for

general

military

service,

if

the

registrants have

followed

useful

vocation

in

civil

life.

Fracture of

the

spine

or

pelvic

bones

which

has

healed

without

marked

defects

and

which

has

not

interfered

with

following

useful

vocation

in

civil

life. Tuberculosis,

either

active or

No

change

Tuberculosis, either

active

or

healed.

No

change.

healed,

of

any

portion

of

the

vertebral

column.
APPENDIX 299

257-966' —67 21

Osteoarthritis,

partial

or

complete, of

the

spinal

No

change. ...__

Osteoarthritis,

partial

or

complete,

if

sufficient

in

Osteoarthritis or rheumatoid arthritis, or

chronic

column

if

sufficient

in

degree

to

interfere

with

arthritis

from

any

cause.

degree

to

Interfere

with

the

following

of

useful

following

useful

vocation

vocation

in

civil

life.

in

civil

life.

Healed

fractures

of

the

No

change.

vertebrae or

pelvic

bones

vertebrae or

pelvic

bones

with

associated diswith

associated

symptoms

qualifying rigidity.

which

have

prevented

the

individual

from

following

useful

vocation

in

civil

life.

Lateraldeviation of

the

spine

from

the

normal

midline

of

Lateraldeviation of

the

spine

from

the

midline

of

more

more

than

inches.

Curvathan

inches.

Curvature

of

ture

of

the

spine

(kyphosis

the

spine

(scoliosis,

kyphosis

or

lordosis)

of

degree

or

lordosis)

of

degree

sufficient

to

Interfere

with

sufficient

to

interfere

with

the

wearing

of

uniform

the

wearing

of

uniform

or

military

equipment, or

or

military

equipment or

which

has

prevented

the

which

has

prevented

the

registrant from

following

individual from

following

useful

vocation

in

civil

life.

useful

vocation

in

civil

life.

No

change.

lumbosacral joints

which

is

lumbosacral joints

which

is

of

chronic

type

and

is

of

chronic

type

and

is

obviously

associated with

obviously

associated with

pain

referred to

the

lower

pain

referred to

the

lower

extremities,

muscular

extremities,

muscular

spasm, postural deformities,

spasm, postural deformities,

and

limitation

of

motion

in

and

limitation

of

motion

in

the

lumbar

region

of

the

the

lumbar

region

of

the

spine,

and

if

malingering

spine.

is

definitely

excluded.

Osteomyelitis or

substantiated

history

of

osteomyelitis

if

active

within

the

past

years.

Nucleus

pulposus

(herniation

intervertebral

disc)

or

history

of

operation

for

this

condition.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

Initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.1942.
300 PHYSICAL STANDARDS

Table

—Defects 10.

of

the

extremities

Acceptability

Time

period

in

effect

31

up.

1940

i-14

Mar.

1942

15

Mar.

-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

M8

Apr.

1944

19

Apr.

1944

General

service..

Old

or

recent fractures

which

No

change...

No

change.

have

healed

spontaneously

with

no

resulting impairment

of

function. Paralysis

of

muscle or

group

of

muscles

that

does

not

interfere

with

function.

Benign

tumors

of

bone

or

deNo

change...

fects

due

to

their

removal

when

the

condition

does

not

interfere

with

the

function

of

the

extremity

or

the

joint

involved. Recent injury

of

boneor

No

change. ......

No

change. No

change.

joint

with

or

without

fracture

or

dislocation which,

in

the

opinion

of

the

examiner,

is

only

temporarily

incapacitating.

(Registrants with

these

defects

should

be

given

period

of

time

not

less

than

weeks

for

recovery before

the

final

examination

is

made.)

Web

fingers

and

toes,

unless

No

change.......

No

change.

severe in

degree.

Absent

left

thumb.

Loss

of

two

fingers

of

either

No

change....

Entire

loss

of

little

finger

of

either

or

both

hands,

or

the

ring

finger

of

left

hand.

hand,

except

combination of

right

index

and

middle

finger.
APPENDIX 301

Loss

of

right

index

finger,

No

change

Loss

of

terminal

phalanx

of

the

right

index

finger;

loss

of

the

terminal

and

middle

phalanges of

one

finger,

except

the

right

index

finger

on

one

or

both

hands;

loss

of

one

phalanx

of

one

or

all

fingers

on

one

or

both

hands,

provided

the

function

of

the

hand

is

ample

to

permit

the

performance of

general

military

duty.

No

change. Nochange. Flat

foot

unless

accompanied

with

symptoms

of

weak

foot

or

when

the

foot

is

weak

on

test. Pronounced cases

of

flat

foot

attended

with

decided

eversion

of

the

foot

and

marked

bulging

of

the

inner

border,

due

to

inward rotation of

the

astragalus,

and

rigid

flat

foot

are

disqualifying regardless

of

the

presence or

absence

of

subjective

symptoms.

No

change.

provided

right

middle

finger

is

present.

Scars

and

deformities of

No

change

No

change

moderate

degree

of

the

handor

hands

which

do

not

interfere

with

normal

function. Stiff

fingers

of

degree

not

No

change

__

No

change

to

interfere

seriously

with

function. Pes

planus

unless

accomNo

change

Flat

foot

unless

accompanied

with

symptoms of

weak

foot

or

when

the

foot

is

weak

on

test.

Pronounced

cases

of

flat

foot

attended

with

decided

eversion

of

the

foot

and

marked

bulging

of

the

inner

border, due

to

inward

rotation

of

the

astragalus, are

disqualifying

regardless of

the

presence or

absence of

subjective symptoms.

panied

by

marked deformity,

rigidity, or

weakness,

or

is

of

such

degree

as

to

have

interfered

with

useful

vocation

in

civil

life.

Hallux

valgus

unless

severe... No

change

No

change

Clubfoot

of

slight

degree

if

No

change

......

No

change..

tarsal,

metatarsal,

and

phalangeal joints

are

flexible

and

the

condition

permits

the

wearing

of

military

shoe

and,

in

the

opinion

of

the

examiner,

will

not

interfere

with

the

performance

of

military

duty.

See

footnotes

at

end

of

table.
302 PHYSICAL STANDARDS

Table 10.— Defects

of

the

extremities

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943 2-18

Apr.

1944

19

Apr.

1944

General

service—

Slight

claw

toes

not

involving

obliteration

of

the

transverse arch

and

which

do

not

interfere

with

the

wearing

of

military

shoe.

Hammer toe

which

is

flexible

No

change

No

change

Continued

No

change. Nochange. Nochange.

and

which

does

not

interfere

with

the

wearing

of

military

shoe.

(Hammer

toe

usually

Involves

the

second

digit

and

unless

it

is

rigid

is

not

disqualifying

defect.)

Absence

of

one

or

two

of

the

No

change...

small

toes

of

one

or

both

feet

if

the

function of

the

foot

is

good.

Ingrowing

toenails

Ingrowing toenails

unless

severe. Individuals who

have

had

Limited service.

Loss

of

thumb

of

right

hand....

cartilages removed from

the

knee

joint

should

be

accepted

for

general

military

service

provided

at

least

months

have

elapsed

since

operation

and

there

are

no resultant

symptoms and

provided

further

that

upon

careful

examination no

abnormal

movement

is

elicited.

either

hand.

either

hand.

Rescinded per

C-2,

MR

1-9,

15

Oct.

1942.
APPENDIX 303

Loss

of

three

fingers

of

either

hand,

Including

the

right

Loss

of

three

entire

fingers

of

either

hand

including

Lossof

two

entire

fingers

of

either

hand,

not

to

Loss

of

two

entire

fingers

of

either

hand,

except

index

finger.

the

right

index

finger,

provided

the

thumb

remains.

Include

the

right

index

finger,

provided

the

thumb remains. Rescinded per

C-2,

MR

1-9,

15

Oct.

1942.

combination

of

the

right

index

and

middle

finger.

Web

fingers

or

toes,

if

severe

in

degree.

No

change.

Ganglion

and

other

benign

Ganglion and

other

benign

Ganglion

and

other

benign

tumors

of

the

handor

tumors

of

the

handor

tumors

of

the

handor

fingers.

fingers

if

large

or

progressive nature.

fingers,

if

they

do

not

interfere

greatly

with

function.

No

change.....__

No

change.

or

both

upper

extremities

which

do

not

and

have

not

interfered

with

function

to

degree

to

prevent

the

registrant from

following

useful

vocation

in

civil

life. Internal

derangement of

the

knee

joint

if

not

severe

Internal

derangement of

knee

joint

enough

to

have

prevented

(1)

History

of,

providing

him

from

following

useful

disability

has

been

mild

vocation

in

civil

life.

and

Infrequent. (2)

Operation

for,

providing

period

of

months

has

elapsed

since

operation

with

freedom

from

symptoms. Under

(1)

and

(2)

above,

the

knee

ligaments

should

be

stable

in

lateral

and

anteroposterior directions

in

comparison

with

the

normal

knee;

the

X-ray

should

be

negative;

the

thigh

musculature

not

weak

or

atrophic

enough

to

Interfere

with

function and

the

full

active

motion

in

flexion

and

extension

is

present.

See

footnotes

at

end

of

table.
304 PHYSICAL STANDARDS

Table

—Defects 10.

of

the

extremities

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

M4

Mar.

1942

15

Mar.-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943 M8

Apr.

1944

19

Apr.

1944

Limited service—

Abduction

and

pronatlon

(knock

ankle)

when

this

condition

is

not

associated

with

rigidity of

the

tarsal

joint

or

with

deformity

of

the

foot.

(This

defect

is

remediable with

proper

foot

exercises

and

with

correct

shoes.)

Lossof

great

toe

No

change. Nochange. Nochange.

Continued

Lossof

dorsal

flexion

of

great

toe.

Hammer toe

with

rigidity

No

change

Other

defects

of

the

feet

No

change. Nochange. Nochange.

which

disqualify

for

general

service

but

do

not

prevent

the

registrant

from

wearing

military

shoe

and

which

have

not

prevented

him

from

following

useful

vocation

in

civil

life.

Moderate deformities of

one

No

changeor

both

lower

extremities

which

do

not

and

have

not

interfered

with

function

to

degree

to

prevent

registrant from

following

useful

vocation

in

civil

life. Adherent scars

of

the

skin

Adherent scars

of

the

skin

and

soft

tissues

of

an

extremity.

and

soft

tissues

of

an

extremity,

if

not

incapacitating

and

likely

to

break

down.
APPENDIX 305

do

not

interfere

with

good

function. Benign

tumors

of

bone

or

joint

which

do

not

interfere

with

function. Healed disease

or

injury

of

wrist

or

elbow

with

resulting limitation

of

motion. Other

defects

which,

in

the

opinion

of

the

examining

physician, are

disqualifying

but

remediable and

which

have

not

prevented

the

individual

from

following

useful

vocation

in

civil

life.

which

do

not

interfere

with

good

function.

Healed

disease or

injury

of

wrist

or

elbow

with

resulting limitation

of

motion,

if

not

severe in

degree.Other

abnormalities which,

in

the

opinion

of

the

examining

physician, are

disqualifying but

remediable

and

which

have

not

prevented

the

individual

from

following

useful

vocation

in

civil

life.

No

change. Clubfoot

of

slight

degree

if

tarsal,

metatarsal,

and

phalangeal joints

are

flexible,

permitting wearing

of

military

shoe

and,

in

the

opinion

of

the

examiner, will

not

interfere

with

the

performance

of

military

duty.

Slight

claw

toes

not

involving

obliteration

of

the

transverse

arch

and

which

do

not

interfere

with

the

wearing

of

military

shoes.

No

change.

Nonacceptable...

Loss

of

the

right

index

finger

or

more

than

two

entire

Angers

of

one hand.

tire

fingers

of

one hand.

Chronic

inflammatory

disease

of

long

duration of

one

or

more of

the

large

joints,

with

or

without

sinuses.

No

change

fingers

of

either

hand.

arthritis, or

chronic

arthritis

from

any

cause.

See

footnotes

at

end

of

table.
306 PHYSICAL STANDARDS

Table

—Defects 10.

of

the

extremities

—Continued

Acceptability

Time

period

in

effect

31

Aug. 1940 ‘-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943 2-18

Apr.

1944

19

Apr.

1944

Nonacceptable—

Tuberculosis

of

boneor

No

change. Nochange. Nochange. Nochange. No

change. No

change

Continued

joint.

(The

diagnosis

should

be

based

upon

the

presence

of

swelling,

tenderness,

muscular spasm, restriction

of

joint

motion,

and

the

evidence

of

bone

destruction

shown

by

X-ray.)

interfere

with

function or

ununited

fractures

with

deformity

sufficient

to

interfere

with

function.

Old

unreduced dislocations

interfere

with

function.

Old

unreduced

or

recurring

dislocations which

have

interfered

with

the

individual

following

useful

vocation

in

civil

life.

Old

unreduced

or

recurring

dislocations of

any

of

the

major

joints.

which

have

interfered with

the

registrant following

useful

vocation

in

civil

life.

Disease

of

any

boneor

joint

healed

with

such

resulting

deformity or

rigidity that

the

function

is

impaired

to

degree

that

it

will

interfere

with

military

service.

Muscle

paralysis or

contraction

which disturbs

function

to

the

degree

of

interference with

military

service.

Adherent scars of

skin

or

soft

tissue

to

degree

which

seriously

interferes

with

function.
APPENDIX 307

257-966 —67——22

Varicose

veins,

if

severe in

degree,

or

if

associated with

edema or

ulcer

of

the

skin.

Pes

planus,

If

accompanied

by

marked

deformity, rigidity,

or

weakness,

or

of

such

degree

as

to

have

interfered

with

useful vocation

in

civil

life.

Obliteration

of

the

transverse

arch

associated with

permanent

flexion

of

the

small

toes

(claw

toes).

Hallux

valgus,

ii

severe and

associated with

marked

exostosis or

bunion,

especially

when

there

are

signs

of

irritation

above

the

joint.

Clubfoot

if

marked

in

degree

or

which

interferes

with

wearing

of

military

shoe.

Varicose

veins,

if

severe in

degree

or

if

associated with

edema or

with

present or

previous

ulcer

of

the

skin.

No

change...

No

change.

Flat

foot

when

accompanied

Rigid

flat

foot

or

flat

foot

with

symptoms

of

weak

foot

or

when

the

foot

is

weak

on

test.

Pronounced cases of

flat

foot

attended

with

decided

eversion

of

the

foot

and

marked

bulging

of

the

inner

border,

due

to

inward

rotation of

the

astragalus

are

disqualifying regardless

of

the

presence or

absence of

subjective symptoms. No

change

when

accompanied with

symptoms

of

weak

foot

or

when

the

foot

is

weak

on

test.

Pronounced cases

of

flat

foot

attended

with

decided

eversion of

the

foot

and

marked

bulging

of

the

inner

border,

due

to

inward

rotation of

the

astragalus,

are

disqualifying regardless

of

the

presence or

absence

of

subjective

symptoms.

No

change.

No

change

Hallux

valgus,

if

severe and

No

change

associated with

marked

exostosis or

bunion.

No

change.

No

change

No

change.

hip,

knee, or ankle

joint

which

seriously

interfere

with

function

and

weightbearing

power.

Deformities due

to

fracture

or

other

injury

which

seriously

interfere

with

function

and

weightbearing

power.

No

change

No

change.

See

footnotes

at

end

of

table.
308 PHYSICAL STANDARDS

Table

10.-

—Defects

of

the

extremities

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

M8

Apr.

1944

19

Apr.

1944

onaceeptabieContinued

Sciatica

which

is

apparently

intractable

and

disabling

to

the

degree

of

interference

with

the

function

of

walking

and

weight-bearing power.

No

change__

No

change

No

change

No

change.

Amputations

of

extremities

in

excess of

those

already

cited.

No

change.

No

change.___

change

No

change.

Osteomyelitis

Active

osteomyelitis

of

any

bone, or

substantiated history

of

osteomyelitis

of

any

of

the

long

bones

within

the

past

years.

No

change__._

Active

osteomyelitis

of

any

bone, or

substantiated history

of

osteomyelitis

of

any

of

the

long

bones

at

any

time.

No

change. Plantar warts on

weightbearing

areas.

MR

(Mobilization

Regulations) 1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance of

the

individual

concerned

for

general

military

service.

MR

1-9,

15

Mar.

1942,

par.

42(2)

(a).
APPENDIX 309

Table

11.

—Defects

of

the

neck

Acceptability

Time

period

in

effect

31

Aug.

1940 ‘-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

General

service,.

Nonspastic

contraction

of

the

muscles

of

the

neck

which

is

not

of

great

degree

and

will

not

prevent

the

wearing

of

uniform or

military

equipment.

Simple

goiter

or

benign

thyroid

tumors No

change .. Simple

goiter

unassociated

with

pressure No

change Nochange

No

change. Nochange.

unassociated

with

toxic

or

pressure

symptoms, provided

the

enlargement

of

the

thyroid

will

not

interfere

with

the

wearing

of

uniform

or

military

equipment.Enlarged

lymph

glands

of

the

neck

symptoms,

provided

the

enlargement

of

the

thyroid

will

not

interfere

with

the

wearing

of

uniform or

military

equipment. Enlarged

lymph

nodes

of

the

neck

which

No

change

No

change.

Limited service...

which

are

not

manifestation

of

systemic

disease

and

which

apparently

do

not

interfere

with

the

general

health

and

which

are

not

large

enough

to

interfere

with

the

wearing

of

uniform or

military

equipment.

[No

standards]

are

not

manifestation

of

systemic

disease,

and

which

apparently do

not

interfere

with

the

general

health,

and

which

are

not

large

enough

to

interfere

with

the

wearing

of

uniform

or

military

equipment.

There are

no

neck

criteria

to

warrant

No

change...

Healed

tuberculous

lymph

nodes

when

few

in

number

and

densely

calcified.

History

of

thyroidectomy

for

nontoxic

goiter

with

complete

absence

of

active

manifestations

for

years.

History

of

thyroidectomy for

toxic

Nonacceptable See

footnotes

initial

selection

for

limited

service.

goiter

with

complete

absence

of

active

manifestations

for

years.

Toxic

goiter.

Tumor

of

thyroid

or

other

structures

of

the

neck,

including

enlarged

lymph

nodes

and

benign

tumors of

the

neck,

if

the

enlargement

is

of

such

degree

as

to

interfere

with

wearing

of

uniform

or

military

equipment.

Thyroid

enlargement

from

any

cause

associated with

toxic

symptoms.

at

end

of

table.

No

change.

No

change...
PHYSICAL STANDARDS 310

Table

11.

—Defects

of

the

neck

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

>-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

Nonacceptable— Continued

Enlargement of

the

lymph

glands

of

the

neck

associated with

leukemia

and

Hodgkin’s disease.Lymphosarcoma ..__

No

change. Nochange.Tuberculous

lymph

nodes,

except

as

specified

for

general

service.

No

change. change. Simple

goiter,

if

associated with

pressure

symptoms

confirmed

by

X-ray,

or

if

enlargement

is

of

such

degree

to

interfere

with

wearing

of

uniform

or

military

equipment.

No

change...

Nonspastic

contraction of

the

muscles

of

the

neck

or

cicatricial

scarring

which

is

disfiguring and

unsightly or

interferes

with

wearing

of

uniform

or

military

equipment. Spastic

contraction

of

the

muscles

of

the

neck. Simple

goiter

unassociated

with

toxic

or

pressure

symptoms,

enlarged

lymph

glands

of

the

neck,

benign

tumors

and

cysts

of

the

neck,

large

benign

tumors

of

the

parotid

gland,

if

the

enlargement

is

of

such

degree

as

to

interfere

with

wearing

uniform

or

military

equipment.

Nonspastic

contraction

of

the

muscles

of

the

neck

or

cicatricial

contraction

of

the

neck

to

the

extent

that

it

interferes

with

the

wearing

of

uniform

or

military

equipment or

so

disfiguring

as

to

render

the

individual

objectionable

in

common social

intercourse.

Simple

goiter

unassociated

with

toxic

pressure

symptoms,

enlarged

lymph

nodes

and

benign

tumors

of

the

neck

if

the

enlargement

is

of

such

degree

as

to

interfere

with

wearing

of

uniform

or

military

equipment. Simple

adenomatous goiter

...

No

change.

Carcinoma

of

the

thyroid or

other

structures

of

the

neck.

No

change.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance of

the

individual

concerned

for

general

military

service.

MR

1-9,

1.5

Mar.

1942,

par.

4a(2)(a).
APPENDIX 311

Table

—Lunas 12.

and

chest

wall

Time

period

in

effect

Acceptability

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-

14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-

18

Apr.

1944

19

Apr.

1944

General

service.-

Acute

bronchitis,

provided

No

change

No

change

No

change. Scars

of

operation

for

nontuberculous

empyema which

has

been

healed

for

one

year

or

longer,

provided the

function

of

the

lung

is

not

significantly

impaired,

and

provided no residue of

the

empyema other

than

some

fibrous

thickening

of

the

pleura

is

evident

upon

X-ray

and

physical

examination. Recent fracture

of

rib

or

ribs,

until

final

examination shows

recovery with

or

without

deformity

and

provided

the

residual

deformity,

if

any,

does

not

interfere

seriously

with

respiratory

movements. No

change.

acceptance

is

temporarily

deferred until

final

examination

shows

recovery

without

disqualifying sequelae.Scars

of

operation

for

empyema Scars

of

operation

for

nonNo

change

which

have

healed

for

year

or

longer,

when

the

function

of

the

lung

is

good.

Fracture of

the

rib

or

ribs,

tuberculous

empyema which

have

been

healed

for

year

or

longer,

provided

the

function

of

the

lung

is

good.

X-ray

and

physical

examination

may

showsome fibrous

thickening

of

the

pleura

but

no

evidence

of

any

sacculation

or

other residue of

the

empyema. No

change

No

change

provided

acceptance of

registrant is

temporarily

deferred

until

final

examination

shows

recovery with

or

without

deformity, and

provided

the

residual

deformity,

if

any,

does

not

interfere

with

respiratory

movements. Benign

tumors

of

the

breast

No

change

No

change

See

footnotes

or

of

the

chest

wall,

provided

the

enlargement

does

not

interfere

with

the

wearing

of

uniform

of

military

equipment, at

end

of

table.
312 PHYSICAL STANDARDS

Table

12.

—Lvngs

and

chest

wall

—Continued Time

period

in

effect

Acceptability

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-

18

Apr.

1944

19

Apr.

1944

General

service

Small

palpable

lymph

nodes

of

the

axilla

which

apparently

do

not

interfere

with

the

general

health.

Small

palpable

lymph

nodes

of

the

axilla

which

apparently

are not

evidence

of

active

disease. Acute

or

subacute

pneumonia,

provided

acceptance

is

deferred

until

final

examination

shows

recovery without

disqualifying

sequelae.

No

change. So-called

atypical or

other

types

of

pneumonia,

until

final

examination

shows

recovery

without

disqualifying sequelae.

Ordinarily resolution, as

shown

by

X-ray

films,

will

be

complete

within

months.

Other

cause

of

the

shadow

in

the

X-ray

film

than

pneumonia

must

be

considered

if

complete

clearing

has

not

occurred

in

months. No

change.

Continued

pleurisy,

definitely

nontuberculous

in

origin,

provided

acceptance

is

temporarily

deferred

until

final

examination

shows

recovery without

disqualifying sequelae.

Such

pleurisy

usually

is

suspected

or

demonstrated

on

physical

examination,

not

on

X-ray

examination.
APPENDIX 313

Fibrous

pleural scars and

adhesions, revealed most

often

Fibrous

pleural scars and

adhesions, revealed most

often

in

the

roentgenogram is

isoin

the

roentgenogram by

simlated

roughening or

peaking

pie

thickening

of

the

apical

of

an

interlobar

fissure or

of

pleura,

deformity

of

the

dome

the

apical

pleura,

provided

of

the

diaphragm,

or

visualthere

is

no

evidence

of

tuberization

of

an

interlobar

fissure,

culosis

of

the

pulmonary paprovided

there

is

no

evidence

renchyma beyond

the

limits

of

disqualifying tuberculosis

defined

in

table

13.

of

the

pulmonary

parenchyma.

Healed

fracture

of

the

rib

or

ribs,

provided

the

residual deformity,

if

any,

does

not

interfere

seriously

with

respiratory

movements.

Limited service,.

Deformity

of

clavicle,

ribs, or

scapula

of

degree

disqualifying

for

general

military

service,

but

which

has

not

prevented

the

registrant from

successfully

following

useful

vocation

in

civil

life.

Chronic

bronchitis,

bronchiectasis,

or

chronic

asthma

which

is

mild

and

which

has

not

prevented

the

registrant

from

successfully

following

useful

vocation

in

civil

life.

No

change.

Chronic

bronchitis

which

is

mild

and

not

associated with

emphysema.

No

change

Nonacceptable—. Empyema, or

unhealed

sinuses

No

change

No

change

Empyema: residualsacculation

or

unhealed

sinuses

of

the

chest

wall

following

operations

for

empyema.

of

the

chest

wall

following

operation

for

empyema.

Chronic

bronchitis with

emChronic

bronchitis with

emNo

change

Chronic

bronchitis.

No

change.

physema

except

as

stated

in

physema.

limited

service. Chronic

asthma

associated with

Bronchial

asthma.

No

change.

chronic

bronchitis

and

emphysema, except

as

stated

in

limited

service.

No

change

No

change.

See

footnotes

at

end

of

table.
314 PHYSICAL STANDARDS

Tabe

12

—Lungs

and

chest

wall

—Continued Time

period

in

effect

Acceptability

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-

18

Apr.

1944

19

Apr.

1944

Nonacceptable— Continued

Bronchiectasis, if

moderate or

severe.

No

change. Nochange. No

change. Tumor

of

the

trachea,

bronchi,

lung,

pleura,

mediastinum. or

Spontaneous

pneumothorax, history

of

spontaneouspneumothorax within

the

last

years

or

history

of

repeated

spontaneous pneumothorax,

authenticated by

properly

dated

X-ray

films.

Bullous or

generalizedpulmonary

emphysema.

No

change. Nochange.

Active

mycotic

diseases

of

the

lung. Any

malignant

tumor

of

the

breast or

the

chest

wall.

Active

mycotic

disease

of

the

lung

and

residual cavitation

due

thereto.

chest

wall

of

such

size

and

location

as

to

interfere

with

the

wearing

of

the

uniform

or

military

equipment.

Tumor

of

the

lung,

pleura, or

mediastinum.

Pulmonary

emphysema

with

impairmentof

function.

Cystic

disease

of

the

lung

Silicosis as

represented in

the

roentgenogram by

strandlike

and

nodular

shadows

or

any

other

form

of

severe

pulmonary

fibrosis.
APPENDIX 315

Foreign

body

in

the

lung.

No

change

No

change. No

change. Nochange.

person

may

be

accepted

after

foreign

body

has

been

removed from

bronchus,

provided

examination

shows

recovery without

disqualifying

sequelae.

Benign

tumors

of

the

breast or

No

change...

Tuberculosis

of

the

ribs

and

of

the

chest

wall

of

such

size

and

location

as

to

interfere

with

the

wearing

of

the

uniform or

military

equipment. No

change...

No

change

other

parts

of

the

chest

wall.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Change

No.

1,

MR

1-9,

15

Oct.

1942.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual concerned

for

general

military

service.

MR

1-9,

15

Mar. 1942,

par.

4a(2)(a).
316 PHYSICAL STANDARDS

Table

13.

Tuberculosis

Acceptability

Time

period

in

effect

31

Aug.

194

2-14

Mar.

1912

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

3-18

Apr.

1944

19

Apr.

1944

General

service-.

Arrested

pulmonary tuberculosis

consisting

of

lesions

appearing

in

X-ray

examination as

small

apical scars,

small

calcified

nodules or

localized

fibrous

strands,

in

no

case

exceeding

minimal

extent

as

defined

in

the

classification

of

the

National

Tuberculosis

Association,

and

when,

in

addition,

in

the

opinion

of

the

examining

physician,

this

lesion

is

not

likely

to

be

reactivatedunder

conditions

of

military

service.

Apparently

healed

intrathoracic

tuberculous

lesions

of

slight

extent demonstrable in

the

roentgenogram but

producing no audible

rales

after

the

expiratory cough

during

physical

examination.

No

change

Healed

intrathoracic

primary

tuberculous

lesions,

demonstrable

in

roentgenograms, but

of

slight

extent.

Calcified residuals of

primary

tuberculosis

in

the

pulmonary

parenchyma or

hilum

lymph

nodes,

provided

the

size,

number,

and

character

of

such

lesions

are

not

such

as

to

suggest

the

possibility

of

reactivation. Well-calcified masses in

adult

white

subjects

usually

represent entirely

healed

lesions.

Partially

calcified

and

therefore,

presumably

partially caseous

masses in

younger subjects,

particularly

in

persons

of

other

than

the

white

race,

are

potentially hazardous.

Clinical

judgment is

important

in

rendering

decision.

In

those

cases

in

which

decision

cannot

be

made

on

roentgenological grounds

alone,

it

is

essential

that

careful

examination

be

made

by

an

examiner

with

special

experience

in

tuberculosis,

taking

into

account

the

age

of

the

subject,

history,

and

the

possible

presence of

nonpulmonary tuberculosis.
APPENDIX 317

Minimal

pulmonary lesions

The

following

specifications

of

No

change

No

change

are

defined

as

slight

lesions

the

limits

of

such

lesions

are

without demonstrable cxcaintended

to

exclude

persons

vation

confined

to

small

with

disease

which

is

most

pan

of

one

or both

lungs.

likely

to

be

in

part

caseous

The

total

extent

of

the

and

therefore

potentially

lesions,

regardless of

distrihazardous.

The

limits

arc

bution,

will

not

exceed

the

set

arbitrarily

to

provide

an

equivalent

of

the

volume

of

objective

basis

on

which

the

lung

tissue

which

lies

above

examiner may render

the

second

chondrosternal

decision. All

measurements

junction and

the

spine

of

refer

to

single,

standard

14-

the

fourth or

body

of

the

by

17-inch

direct-projection

fifth

thoracic

votebra

on

roentgenograms. Those

one

side.

lesions

may consist

of—

(a)

No

change

of

the

intrathoracic

lymph

nodes,

provided none of

these

exceeds

an

arbitrary

limit

of

1.5

cm.

in

diameter and

the

total

number

of

such

lesions

does

not

exceed

five.

(b)

Calcified

lesions

of

the

(b)

No

chance

(b)

Calcified

lesions

of

the

pulmonary

parenchyma,

pulmonary

parenchyma,

provided

the

total

number

provided

the

total

number

of

these

does

not

exceed

ten;

of

these

does

not

exceed ten.

and

one

of

these

may

equal

One

of

these

may

equal

but

but

not

exceed

cm. in

not

to

exceed

cm.

in

diameter; but

none of

the

diameter, but

none of

the

remainder may exceed

0.5

remaindermay exceed

0.5

cm.

in

diameter. In

the

cm.

in

diameter.

In

the

roentgenogram such

roentgenogram such

calcified

lesions

should

calcified

lesions

should

appear

isolated,

sharply

appear

isolated,

sharply

circumscribed,

homocircumscribed,

homogcnoous, and

dense.

geneous, and

dense.

Sec

footnotes

at

end

of

table.
318 PHYSICAL STANDARDS

Table

13.

Tuberculosis

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

M4

Mar. 1942

15

Mar.

-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

3-18

Apr.

1944

19

Apr.

1944

General

service

In

the

case

of

lesions

as

deThe

above

arbitrary

limits

of

The

above

arbitrary

limits

of

Continued

fined

above

and

below,

the

calcified

lesions

are

set

on

calcified

lesions

are

set

on

history

should

not

reveal

the

assumption

that

large

the

assumption that

large

any

previous definite

sympand

numerous lesions

are

and

numerous lesions

are

toms

or

clinical

evidence

of

more

likely

to

be

partially

more

likely

to

be

partially

active

pulmonary tuberunhealed,

and

therefore

unhealed,

and

therefore

culosis.

In

no

case

is

perpotential source of

future

potential source of

future

son

acceptable

if

there

is

recrudescence, than

small

recrudescence, than

small

evidence

of

active

inflamlesions

of

limited

distribulesions

of

limited

distribumatory

tuberculosis

process

tion.

It

is

recognized, howtion.

It

is

recognized, howor

evidence

of

past

or

presever,

that

in

some individuever,

that

in

some individuent

tuberculosis cavitation.

als

calcified

tuberculous

leals

calcified

tuberculous

leSmall

fibroid

lesions

represions

exceeding

these

limits

sions

exceeding

these

limits

sented

in

the

roentgenomay

be

present

which

are

may

be

present

which

are

grams

as

sharply

demarso

well

healed

that

the

posso

well

healed

that

the

poscated

strandlike or

wellsibility

of

future

reactivasibility

of

future reactivadefined,

small,

nodular

tion

is

remote.

Further contion

is

remote.

Further conshadows

not

exceeding

sideration

may

be

given

to

sideration

may

be

given

to

total

area

of

sq.

cm.

prothe

acceptability of

persons

the

acceptability of

persons

vided

that

acceptance is

dewith

calcified

lesions

of

this

with

calcified

lesions

of

this

ferred

until

subsequent

extype

when

the

state

of

type

when

the

state

of

amination demonstrates

health

in

all

other

respects

health

in

all

other

respects

that

the

lesion

is

stationary

clearly

warrants

the

opinclearly

warrants

the

opinand

not

likely

to

be

react!-

ion

that

the

lesions

in

quesion

that

the

lesions

in

quesvated.

The

minimum

period

tion

are

healed.

In

such

tion

are

healed.

In

such

of

time

to

determine this

cases

the

history

of

the

apcases the

history

of

the

ap-
APPENDIX 319

is

months.

It

must

be

recplicant

and

his

age,

as

well

plicant

and

his

age,

as

well

ognized

that

either

progresas

the

character

of

the

leas

the

character

of

the

lesion

or

regression of

the

lesions

as

seen in

X-ray

films

sions

as

seen in

X-ray

films,

sion

indicates

instability.

provide

criteria

for

estimatprovide

criteria

for

estimatClinical

judgment, taking

ing

the

probability of

coming

the

probability

of

cominto

consideration

other

facplete

arrest

of

the

tubercuplete

arrest

of

the

tubercutors

including age and

race,

lous

process.

If

there

is

no

lous

process.

If

there

is

no

must

be

exercised

in

estihistory

of

active

tubercuhistory

of

active

tubercumating

the

likelihood of

relosis

or

symptoms

which

losis

or

symptoms

which

activation.

Experience inmight

be

interpreted

as

evimight

be

interpreted

as

evidicates

greater likelihood

dence

of

this

disease

and

if

dence

of

this

disease

and

if

of

reactivation of

lesion

the

applicant

is

more than

the

applicant

is

more

than

that

appears

to

be

stable

in

25

years

of

age, and

if

final26

years

of

age,

and

if

finalpersons

under

25

years

of

ly

the

calcified

lesions seen

ly

the

calcified

lesions

seen

age

than

in

older

persons.

are

dense

and

discrete

in

are

dense

and

discrete

in

character and

not

hazy

or

character

and

not

hazy

or

irregular

in

outline,

such

leirregular in

outline,

such

lesions

may

be

considered

as

sions

may

be

considered

as

not

prejudicial

to

future

not

prejudicial to

future

health.

In

these

cases

the

health.

In

these

cases, the

applicant may

be

accepted

applicant may

be

accepted

provided

the

report

of

physprovided

the

report

of

physical

examination

and

the

ical

examination

and

the

chest

X-ray

films

have

been

chest

X-ray

films

have

been

reviewed and

acceptance

reviewed and

acceptance

has

been recommended by

has

been recommended by

medical

examiner

qualimedical

examiner spefied

in

chest

diagnosis.

cially

qualified

in

the

diagnosis

of

diseases

of

the

chest.

See

footnotes

at

end

of

table.
320 PHYSICAL STANDARDS

Table

—Tuberculosis 13.

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

M4

Mar.

1942

15

Mar.-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

3-18

Apr.

1944

19

Apr.

1944

General

serviceContinued

The

following

condition

is

temporarily

disqualifying;

Scarred

fibroid

or

flbrocalciflc

infiltrative

tuberculous

lesions

of

the

lungs

represented in

roentgenograms as

sharply

demarcated,

strand-like or

well

defined,

small,

nodular

shadows

not

exceeding

total

area

of

square

cm.

may

be

accepted

after

deferment

until

subsequent

examination

clearly

demonstrates

that

the

lesion

is

stationary

and

not

likely

to

be

reactivated. The

minimum

period

of

time

to

determine this

is

months.

It

must

be

recognized

that

either

progression

or

regression of

the

lesion

indicates

instability.

Clinical

judgment,

taking

into

consideration other

factors,

including

age

and

race,

must

be

exercised

in

estimating

the

likelihood

of

reactivation. Experience indicates greater

likelihood

of

reactivation of

an

apparently

stable

lesion

in

persons

under

25

years

of

age

than

in

older

persons.
APPENDIX 321

Limited service-_

[No

standards]

[No

standards]

[No

standards]

[No

standards]

[No

standards]

Nonacceptable...

Tuberculosis

of

lungs or

tracheobronchial

lymph

nodes,

except

as

defined

in

general

service.

No

change

No

change

Tuberculosis

of

lungs

or

tracheobronchial

lymph

nodes,

except as

defined

in

general

service and

below.

Scarred infiltrative

tuberculous

lesions

of

the

lungs,

except

that

small

fibroid

or

calcified

lesions

represented

in

roentgenograms as

sharply demarcated strandlike

or

well

defined,

small,

nodular

shadows

not

exceeding

total

area

of

square

cms.

may

be

accepted

after

deferment until

subsequent

examination demonstrates that

the

lesion

is

stationary

and

not

likely

to

be

reactivated. The

minimum

period

of

time

to

determine this

is

months.

It

must

be

recognized

that

either

progression

or

regression of

the

lesion

indicates

instability.

Clinical

judgment, taking

into

consideration

other

factors,

including

age

and

race,

must

be

exercised

in

estimating

the

likelihood

of

reactivation. Experience

indicates

greater

likelihood

of

reactivation of

le

sion

that

appears to

be

stable

in

persons under

25

years

of

age

than

in

older

persons.

Tuberculosis

of

the

lungs

or

tracheobronchial

lymph

nodes

except as

defined

in

general

service.

Small

infiltrative

tuberculous

lesions,

unless

of

sharply

defined

linear

or

nodular

appearance

on

roentgenograms, as

described

in

general

service

paragraph, are

disqualifying

even

though

involving

total

area

of

less

than

square

cms.

and

apparently

stable

over

period

of

months.

See

footnotes

at

end

of

table.
322 PHYSICAL STANDARDS

Table

—Tuberculosis 13.

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

-18

Apr.

1944

19

Apr.

1944

Nonacceptable— Continued

Fibrinousor

serofibrinous tuberculous pleuritis,

and

pleurisy

with

effusion

of

unknown

origin.

(Inasmuch

as

pleurisy,

with

or

without

effusion,

is

very

frequent

manifestation

of

early

tuberculosis,

examining

physicians

should

examine

with

the

greatest

care registrants

who

have

apparently

recovered from

pleurisy.)

Fibrinousor

serofibrinous tuberculous pleurisy,

and

serofibrinous pleurisy

of

unknown

origin.

Inasmuch

as

pleurisy,

with

or

without

effusion,

is

very

frequent

manifestation

of

active

tuberculosis, all

persons who

have

apparently recovered

from

pleurisy

should

be

examined

with

the

greatest

care.

Chronic

fibrous

pleurisy

sufficient

to

cause

marked retraction of

the

chest

wall

and

of

the

mediastinal organs

or

to

cause

density

in

the

roentgenogram which

completely

obscures

considerable

section

of

the

pulmonary

markings

should

be

considered

disqualifying.

No

change

No

change

Fibrinousor

serofibrinous tuberculous pleurisy,

and

serofibrinous pleurisy,

of

unknown

origin.

Inasmuch

as

pleurisy,

with

or

without

effusion,

is

frequent

manifestation

of

active

tuberculosis,

all

persons

who

have

apparently recovered

from

pleurisy

will

be

examined

with

the

greatest

care.

Authenticated

history

of

pleural

effusion of

unknown origin

within

the

last

years; chronic

fibrous

pleurisy

sufficient

to

cause

marked retraction of

the

chest

wall

and

of

the

mediastinumor

to

cause

density

in

the

roentgenogram which

completely

obscures

considerable

section

of

the

pulmonary fields.

Extracted from

MR

(Mobilization

Regulations) No.

1-9,

section

XIII,

“Lung

and

Chest

Wall.”

Mobilization Regulations No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.
APPENDIX 323

Table 14.

—Defects

of

the

heart,

blood

vessels,

and

circulation

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr.

1943

19

Apr.

1944

General

service_.

pulse

rate

of

100

or

over

which

is

not

persistent.

pulse

rate

of

50

or

under

which

is

proved

to

be

the

natural

pulse

rate

of

the

registrant or

to

be

temporary

or

due

to

the

use

of

drugs.

pulse

rate

of

100

or

over

which

is

not

persistent

and

not

due

to

paroxysmal tachycardia.

No

change.

pulse

rate

of

not

lower

No

change.

than

50

per

minute.

No

change

No

change.

Elevation of

blood

pressure

from

excitement,

proved

to

be

temporary. Neurocirculatory

asthenia,

if

mild

in

degree.

There are

no

cardiovascular criteria

to

warrant

initial

selection

for

limited

service.

Circulatory

failure

evidenced

by

definite

symptoms,

such

as

combination

of

breathlessness,

cyanosis and

edema.

at

end

of

table.

No

change

No

change.

No

change

Limited service.- Nonacceptable... See

footnotes

No

change.

Heart

murmurs slight

to

moderate deviations from

the

norm. Interpretation must

be

based

on

cumulative

evidence.

No

change.

Circulatory

failure

evidenced

by

definite

symptoms,

such

as

undue

breathlessness, pain,

or

evidence

of

congested

failure

(engorged

neck

veins,

enlarged

liver,

edema

as

well

as

dyspnea).

No

change.
324 PHYSICAL STANDARDS

Table

14.

Defects

of

the

heart,

blood

vessels,

and

circulation —-Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

»-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr.

1943

19

Apr.

1944

Nonacceptable Continued

Hypertrophy

and

dilatation

of

the

heart

evidenced

by

displacement of

the

apex

impulse

to

the

left

of

the

midclavicular

line

or

below

the

sixth

rib,

and

of

heaving

or

diffuse

character. persistent

heart

rate

of

100

or

over when

this

is

proved

to

be

persistent

in

the

recumbent

posture

and

on

observation

and

reexaminationover

sufficient

period

of

time.

Hypertrophy

and/or dilatation

of

the

heart

evidenced

by

displacement of

the

apex

impulse

to

the

left

of

the

midclavicular

line

or

below

the

sixth

rib,

and

of

heaving

or

diffuse

character, or

by

X-ray

evidence.

No

change. persistent

heart

rate

of

100

or

over

when

this

is

proved

to

be

persistent

in

the

recumbent posture

and

on

observation

and

reexamination

over

sufficient

period

of

time,

unless

in

the

opinion

of

the

medical

examiner,

the

increased

cardiac

rate

is

due

to

psychic

reaction and

not

secondary

to

any

disease

condition,

including

infection. Paroxysmal

tachycardia,

if

recurrent and

disabling.

No

change. Nochange. Nochange. Nochange.Persistent

blood

pressure at

Any

serious disturbance of

rhythm such

as

auricular

fibrillation. Persistent

blood

pressure

at

No

change

No

change

No

change.
APPENDIX 325

rest

above 150

mm. systolic,

or

above

90

mm.

diastolic,

unless

in

the

opinion

of

the

medical

examiner

the

increased

blood

pressure

is

due

to

psychic

reaction and

not

secondary

to

renal or

other

systemic

disease.Thrombophlebitis

of

one

or

more

extremities

if

there

is

persistence

of

the

thrombus

or

any

evidence

of

obstruction

of

circulation in

the

involved

vein

or

veins.

Other abnormalities of

the

peripheral vascular

system,

including

large

varicose

veins,

Raynaud’s disease,

Buerger’s

disease

(thromboangiitis obliterans)

erythromelalgia,

and

arteriosclerosis of

the

leg

vessels.

In

doubtful

cases

special

tests

should

be

employed.

No

change

rest

above 150

mm. systolic

or

above

90

mm.

diastolic.

If

the

blood

pressure reading

is

somewhat (10-20

mm.)

above 150

mm.

systolic

on

the

first

reading, it

should

be

repeated

after

Vi

hour’s

rest

recumbent. No

change.

No

change

No

change.

No

change

No

change

No

change.

No

change

No

change

No

change.

No

change

No

change___

Endocarditis.

Angina

pectoris

clearly

due

to

coronary insufficiency.

True

angina

pectoris

clearly

due

to

coronary

insufficiency. No

change

No

change

True

angina

pectoris.

No

change

Authenticated history

of

Neurocirculatory asthenia

(effort

syndrome),

unless

mild.

Neurocirculatory

asthenia

(effort

syndrome),

unless

very mild. Orthostatic

hypotension or

tachycardia.

No

change

coronary

thrombosis, and/or

myocardial

infarction.

No

change. Orthostatic

hypotension or

tachycardia. Acute rheumatic fever,

or

verified

history.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.

digest

of

discussion found

in

source

document.
326 PHYSICAL STANDARDS

Table

—Defects 15.

of

the

abdominal organs and

wall

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

15

Mar.

-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

M8

Apr.

1944

19

Apr.

1944

General

service,.

No

change. Nochange.

surgical

operation or

accident

which

show

no

hernial

bulging. Scar

pain

when

found

not

associated with

any

disturbance

of

function

of

abdominal

wall

or

contained

viscera,

unless

malingering

is

definitely

excluded. Achylia

gastrica,

unless

associated

with

disqualifying

disease. Complaint

of

weak

stomach,

indigestion, dyspepsia,

constipation,

belching,

vomiting,

and

various

other

types

and

degrees

of

abdominal

discomfort which

are

proved

by

examination not

to

be

associated with

organic

disease,

by

the

absence of

the

usual

objective

symptoms and

signs

and

by

such

laboratory tests

as

may

be

employed,

provided

psychiatric examination revealsno

disqualification. Scar

pain

when

found

not

associated with

any

disturbance

of

function

of

abdominal

wall

or

contained

viscera. Complaint

of

“weak

stomach,”

indigestion,

dyspepsia,

constipation,

belching,

vomiting

and

various

other

types

and

degrees

of

abdominal

discomfort unless

proved

to

have

an

organic

basis

by

carefully

elicited

history,

physical

examination

and

such

laboratory

tests

as

may

be

employed

or

by

trustworthy

medical

record

from

competent

physician or

clinic,

provided

psychiatric

examination

revealsno

disqualification.

Complaint

of

“weak

stomach,”

indigestion,

dyspepsia,

constipation,

belching,

vomiting,

and

various

other

types

and

degrees

of

abdominal

discomfort unless

proved

to

have

an

organic

basis

by

carefully

elicited

history,

physical

examination,

and

such

laboratory

tests

as

may

be

employed

or

by

trustworthy

medical

record

from

competent

physician or

clinic,

provided

neuropsychiatric examination

revealsno

disqualification.
APPENDIX 327

Blood in

stools,

if

proved

to

be

due

to

slight

defects,

Blood

in

stools,

if

proved

to

be

due

to

slight

defects,

such

as

fissures

of

the

anus,

such

as

shallow

fissures

of

small

hemorrhoids, or

the

anus,

small

hemorsuperficial

small

ulcers

of

rhoids, or

superficial

small

the

rectum.

ulcers

of

the

rectum.

Mild

enlargement

of

the

liver

unassociated

with

other

objective

evidence

of

disease

of

the

liver

or

other

organs.

Splenic

enlargement

of

mild

degree

unassociated

with

No

change.

No

change.

evidence

of

other

disqualifying

disease.

Small

benign

tumors

of

the

abdominal wall.

No

change

No

change.

Intestinal

parasites or

their

eggs

in

the

stools.

No

change.........

Internal

and

external

hemorrhoids

if

mild

in

degree.

No

change

No

change

No

change.

Relaxed inguinal

ring

provided

there

is

no

hernial

No

change.

sac

present. Hernia,

small

umbilical (patent

umbilical

ring).

No

change.

History

of

cholecystectomy provided

there

are

no

No

change.

residual

disqualifying sequelae.

Limited service.. Unless

the

degree

of

disability

Unless

the

degree

of

disability

Unless

the

degree

of

disability

There

are

no

defects

of

the

Hernia-inguinal,

which

has

is

obviously

disqualifying:

is

obviously

disqualifying:

is

obviously

disqualifying:

abdominal organs

or

wall

not

descended into

the

Hemla-inguinal,

femoral,

Hernia-inguinal,

femoral,

Authentic

history

of

gaswhich

warrant

initial

selecscrotum;

hernia-femoral.

umbilical,

and

postumbilical, or

posttrie

or

duodenal ulcer,

tion

for

limited

service.

There

are

no

other

defects

of

operative.

operative,

if

remediable

provided

there

is

trustthe

abdominal organs

or

Large

benign

tumors

of

the

by

surgical

treatment.

worthy

history

of

freewall

to

warrant

initial

abdominal wall.

Large

benign

tumors

of

the

dom

from

activity

during

selection

for

limited

service

Internal

and

external

abdominal wall.

the

past

years and

prohemorrhoids

moderately

Internal

and

external

vided

that

gastrointestlsevere, if

remediable.

hemorrhoids,

moderately

severe, if

remediable. Single

fistula

in

ano

if

careful

examination excludes

the

presence

of

tuberculosis.

nal

X-ray

made

at

the

time

of

examination

is

negative. Large

benign

tumors

of

the

abdominal wall.

Internal

and

external hemorrhoids,

moderate.

See

footnotes

at

end

of

table.
328 PHYSICAL STANDARDS

Table

15.

—Dejects

of

the

abdominal organs and

wall

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

*-18

Apr.

1944

19

Apr.

1944

Nonacceptable...

Inoperable

hernia

No

change...

Hernia,

inguinal,

femoral or

postoperative.

Umbilical

hernia,

if

moderate or

large

in

size. Surgical

operations

for

gastric

or

duodenal ulcer.

Ulcer

of

the

stomach

or

No

change

Hernia,

inguinal,

which

has

descended into

the

scrotum;

recurrent,

postoperative; ventral;

umbilical,

if

moderate

or

large

in

size.

Authenticated

history

of

surgical

operations

for

gastric

or

duodenal ulcer.

No

change.

Ulcer

of

the

stomach

or

Surgical

operations

for

gastric

duodenal ulcer.

Operations

on

the

gall

bladder

and

operations

for

intestinal

obstruction. Ulcer

of

the

stomach

or

No

change... Ulcer

of

the

stomach

or

duodenum, if

diagnosis

is

confirmed

by

the

usual

laboratory

procedures.

Obstruction

of

the

bowel

due

duodenum, if

diagnosis

is

confirmed

by

the

usual

laboratory

procedures or

authentic medical

history.

No

change

duodenum, if

diagnosis

is

confirmed

by

the

usual

laboratory

procedures or

authentic medical

history;

also

authentic

history

of

gastric

or

duodenal ulcer

with

activity

within

the

past

years.

Intestinal

obstruction

of

any

duodenum, if

diagnosis

is

confirmed

by

the

usual

laboratory

procedures or

authentic medical

history;

also

authentic

history

of

gastric

or

duodenal ulcer.

No

change...

Authenticated history

of

true

to

organic

disease.

Irremediable sinuses

of

the

Irremediable sinuses

of

the

kind. Sinuses

of

the

abdominal wall.

No

change....

intestinal

obstruction

of

any

kind. No

change.

abdominal

wall

communicating

with

the

hollow

viscera. Irremediable stricture

of

the

abdominal wall.

No

change

Stricture or

prolapse

of

the

rectum. No

change.

rectum. Multiple

fistulae

of

the

anus...

Schistosomiasis .........

No

change

No

change

No

change....
APPENDIX 329

Enlargement of

the

spleen

associated with

leukemia,

Hodgkin’s

disease,

or

splenic

anemia. Great

enlargement

of

the

spleen

from

any

cause.

Large

internal

and

external

hemorrhoids associated

with

prolapse

of

the

rectum. Paralysis

of

the

sphincter

associated with

the

incontinence

of

feces.

Enlargement of

the

spleen

associated with

leukemia,

Hodgkin’s

disease,

splenic

anemia, or

other

disqualifying

disease;

great

enlargement

of

the

spleen

from

any

cause.

No

change...

Large

irremediable

internal

and

external

hemorrhoids with

or

without

prolapse

of

the

rectum. Megacolon,

diverticulitis,and

ileitis. Chronic

cholecystitis,

with

or

without

cholelithiasis

if

diagnosis is

confirmed

by

usual

laboratory

procedures

or authentic medical

history.

No

change

External hemorrhoids

suffiNo

change...

cient

in

size

to

produce

marked

symptoms. Internal

hemorrhoids

if

large

or

accompanied

by

hemorrhage,

or

protruding

intermittently

or

constantly.

Megacolon, diverticulitis, ileitis,

and

ulcerative

colitis.

Acute

or

chronic

cholecystitis

with

or

without

cholelithiasis,

if

diagnosis is

confirmed

by

usual

laboratory

procedures or

authentic

medical

history.

Splenectomy

for

any

cause

other

than

trauma or

congenital

hemolytic

icterus.

Cirrhosis

of

the

liver.

Hydatids

of

the

liver

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual

concerned

for

general

military

service.

MR

1-9,

15

Mar.

1942,

par.

4a(2)(a).
330 PHYSICAL STANDARDS

Table

—Defects 16.

of

the

genitourinary

organs

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

2-18

Apr. 1944

19

Apr.

1944

General

service..

Bed

wetting,

if

mild

in

degree.

Albuminuria

with

or

without

History

of

bed

wetting,

unless

substantiated by

physician’s

affidavit or

by

other

acceptable

documentaryevidence. Mild

albuminuria with

or

No

change

No

change. Nochange. Nochange.

casts

which

is

proved

by

observation

and

repeated

examinations to

be

temporary

in

character. Absence

of

one

testicle

due

to

without

casts

which

is

proved

by

observation

and

repeated examination

to

be

temporary

in

character or

orthostatic

in

type.

Absence

of

one

testicle

unless

No

change

removal or

atrophy.

Undescended testicle

which

removed on

account

of

malignant

disease

or

tuberculosis. No

change.....

lies

In

the

abdominal

cavity.

Acute

cystitis

which

has

proved

to

be

of

temporary

character

by

observation and

repeated examination over

period

not

to

exceed

weeks.Phimosis with

or

without

Phimosis with

or

without

No

change

Phimosis.

adhesions

of

the

mucous

surfaces,

if

remediable. Benign

warts

and

other

adhesions

of

the

mucous

surfaces. No

change..

benign

growths

of

the

glans

penis

and

of

the

prepuce.

Amputation

of

the

penis

if

sufficient amount

of

the

organ remains so

as

not

to

interfere

with

tire

function

of

micturition.

No

change.....
APPENDIX 331

257-966 -—67 23

Varicocele

of

moderate

size

Hydrocele

of

moderate

size

Limited service..

Stricture

of

the

urethra,

unless

severe and

irremediable. Benign

tumor

of

the

testicles..

Cystitis,

subacute or

chronic,

if

deemed remediable. Varicocele, if

large...

No

change Nochange Nochange Nochange Nochange Nochange Nochange Nochange

Epispadias or

hypospadias,

if

mild

in

degree.

History

of

unilateral renal

calculus

with

freedom

from

symptoms for

the

past

years and

if

the

X-ray

is

negative for

calculi.

History

of

unilateral renal

calculus

with

freedom

from

symptoms and

if

the

X-ray

is

negative

for

calculi.

Stricture

of

the

urethra,

unless

severe. No

change......

No

change Nochange

Cystitis,

subacute,

if

deemed

remediable.

Hydrocele,

if

large

and

considered

irremediable

to

degree

which

would

qualify

for

general

service,

but

would

permit

limited

service. Floating

kidney...

Hydrocele,

if

large

..__

Undescended

testis

which

lies

within

the

inguinal

canal.

Removal of

one kidney,

the

remaining one being

healthy. Bed

wetting,

if

more

than

mild

in

degree.

Nonacceptable...

Chronic

nephritis

No

change

No

change

Removal

of

one kidney

unless

due

to

malignant

disease,

renal

calculus, or

tuberculosis,

the

remaining

kidney

being

healthy.

No

change

No

change...

Irremediable stricture

of

the

urethra,

unless

of

slight

degree

so

as

to

be

of

no

pathological

significance.

See

footnotes

at

end

of

table.

No

change

Stricture

of

the

urethra,

severe.
332 PHYSICAL STANDARDS

Table

—Defects 16.

of

the

genitourinary

organs —Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

1-14

Mar.

1942

15

Mar.

-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943 M8

Apr.

1944

19

Apr.

1944

onaceep table

Urinary

fistula

or

incontinence. Surgical

kidney

with

or

without renal

calculus.

Irremediable pyelitis

Urinary

fistula

or

incontinence

due

to

organic

disease.

No

change

Urinary

fistula

or

incontinence. No

change

No

change

No

change.

Continued

No

change

of

the

kidney.

No

change. Nochange. Nochange. Nochange. Nochange. Nochange. Hypertrophy

of

the

prostate

gland

with

urinary retention.

Hydronephrosis or

pyonephrosis. Tumors

of

the

kidney or

bladder. Acute

nephritis

if

moderately

severe and

persistent

after

month’s

observation. Chronic

cystitis

associated

with

calculi

or

with

retention

of

urine

caused

by

stricture

of

the

urethra

or

by

disease

of

the

central

nervous

system.

Amputation

of

the

penis

if

the

resulting stump

is

insufficient

to

permit

normal

function

of

micturition. Hermaphroditism

No

change

Tumors

of

the

kidney,

bladder or

testicle.

Acute

nephritis,

if

persistent

after

month’s

observation. No

change______

Hypertrophy

of

the

prostate

gland

of

sufficient

degree

to

cause retention of

the

urine.

Hypertrophy

of

the

prostate

gland.
APPENDIX 333

Epispadias or

hypospadias

when

urine

cannot

be

voided

in

such

manner

as

to

avoid

soiling

of

clothing

or

surroundings,

or

when

accompanied by

evidence

of

chronic

infection

of

the

genitourinary tract.

No

change. Nochange. Nochange. Nochange. Nochange. Nochange. Nochange.

Bed

wetting,

if

substantiated by

physician’s

affidavit or

by

other

acceptable documentary

evidence. Substantiated

history

of

unilateral

renal

calculi

in

preceding

years

or

bilateral

renal

calculi

at

any

time.

The

presence

of

renal

calculus,

or

substantiated

history

of

bilateral

renal

calculi

at

any

time.

No

change Undescended testicle

which

lies

within

the

inguinal

canal. Absence

of

one

kidney,,

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise Indicated.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance of

the

individual

concerned for

general

military

service.

MR

1-9,

15

Mar.

1942,

par.

4a(2)(a).
334 PHYSICAL STANDARDS

Table

—Venereal 17.

diseases

Acceptability

Time

period

in

effect

31

Aug.

1940

2-14

Mar.

1942

15

Mar.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

General

service.-.

Venereal disease

in

communicable

stage

and

without

incapacitating

complications

will

be

accepted.

Gonorrhea,

acute

or chronic

Gonorrhea,

uncomplicated,

acute

or

Gonorrhea,

uncomplicated, acute

or

Gonorrhea,

uncomplicated, acute

or

Deleted

and

substituted

therefor:

chronic.

(Acceptance of

individuals

chronic;

syphilis,

except

cardiovaschronic.

Venereal disease

without

contagious

or

disabling

manifestations.

WD

Cir.

110,

Oct.

1940.

Syphilis

with

remediablemanifestations

except

cerebrospinal,

cardiovascular, or

visceral

syphilis.

Chancroids

and

the

resulting infections

of

the

lymph

glands

of

the

groin. All

above

entries

deleted

and

the

following

substituted;

defects

deleted

...

will

be

regarded as

causes

for

rejection

by

Army

medical

examiners

until

there

has

been

recovery

without

disqualifying

sequelae.

Medical

examiners

will

reject

all

men

who

are

in

need

of

hospitalization

and

all

those

who

by

reason

of

physical

defects

are

considered

unfit

for

early

participation

in

training

activities. WD

Cir.

110,

Oct.

1940

and

WD

Cir.

117,

18

Oct.

1940.

with

uncomplicated

gonorrhea by

Army

examining

boards

at

the

initial

examination

will

be

deferred

until

facilities

have

been

provided

for

their

care and

instructions

for

their

acceptance

have

been

issued

by

the

War

Department.) Syphilis,

adequately treated

cular,

cerebrospinal, or

visceral

syphilis;

uncomplicated

chancroid.

(Acceptance of

individuals

with

these

conditions

by

Army

examining

boards

at

the

initial

examination

will

be

deferred until

facilities

have

been

provided

for

their

care and

instructions

for

their

acceptance

have

been

issued

by

the

War

Department.)

Syphilis,

except

cardiovascular,

cerebrospinal, or

visceral.

Chancroid,

uncomplicated.
APPENDIX 335

Limited service.. Nonacceptable

Added per

WD

Cir.

117,

par,

2d

dated

18

Oct.

1940:

Acute or

chronic venereal

diseases,

including

latent

syphilis,

except

cardiovascular, cerebrospinal,

and

visceral

syphilis.

ases

of

gonorrhea

with

complications,

chancroid

infection,

granuloma inguinale

and

lymphoma

granuloma

venereum. Syphilis

other

than

adequately treated

cases

of

syphilis

as

set

forth

in

general

service

and

cardiovascular,

cerebrospinal,

and

visceral

syphilis.

[No

standards.]

There are

no

venereal

disease

criteria

to

warrant

initial

selection

for

limited

service. No

change. Nochange. Nochange.Lymphogranuloma venereum (active).

Other

complications

of

gonorrhea, including

acute

prostatitis,

seminal

vesiculitis,

and

epididymitis.

disqualifying.Cardiovascular,

cerebrospinal,

and

visceral

syphilis.

Late

syphilis

affecting the

cerebrospinal

or

cardiovascular

systems

or

the

viscera.

No

change.. ....

The

data

comprising

the

first

three

columns

of

this

table

were extracted

from

the

section

entitled

“Genito-Urinary

Organs

and

Venereal

Diseases,” in

the

source

documents.

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Radiogram, TAG

to

all

Svc

Comds,

dated

10

Dec.

1942,

directed

the

acceptance

of

these

individuals

to

the

extent

of

local

facilities.

Certain

disqualifying

defects which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual

concerned

for

general

military

service.

MR

1-9,

15

Mar.

1942,

par.

4a(2)(a).
PHYSICAL STANDARDS 336

Table

18.-

—Defects

of

the

endocrine

and

metabolic

systems

Acceptability

Time

period

in

effect

31

Aug.

1940

>-14

Mar.

1942

15

Mar-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

*-18

Apr.

1944

19

Apr.

1944

General

service..

Goiter

if

unassociated

with

pressure

or

toxic

symptoms, provided

the

enlargement

of

the

thyroid

will

not

interfere

with

the

wearing

of

uniform

or

military

equipment.

Simple

colloid

goiter

provided

the

enlargement

of

the

thyroid

will

not

interfere

with

the

wearing

of

uniform or

military

equipment.

No

change

No

change

No

change.

Frohllch’s syndrome,

if

very

mild

in

degree.

Hypothyroidism

without myxedema,

if

not

severe

or

resistant

to

cure. Acromegaly

if

not

severe

or

associated with

symptoms

other

than

the

bony

changes.

Glycosuria,

if

transient or renal

in

type,

provided

acceptance

is

deferred

until

the

possible

existence

of

diabetes

mellitus

is

excluded. Pellagra,

beriberi,

scurvy, and

other

nutritional deficiencies,

if

remediable by

correction

of

diet,

and

not

severe.

Deleted

and

the

following

substituted;

defects

will

be

regarded as

causes for

rejection

by

Army

medical

examiners

until

there

has

been

recovery without

disqualifying

sequelae.

Medical

examiners

No

change Hypothyroidism,

if

mild..

No

change.._ Glycosuria,

if

transient

in

type,

provided

acceptance

is

deferred

until

the

possible

existence

of

diabetes mellitus

and

renal

glycosuria is

excluded.

No

change Nochange Nochange Nochange

No

change..

No

change.
APPENDIX

Limited service

will

reject

all

men

who

are

in

need

of

hospitalization,

and

all

those

who

by

reason

of

physical defects

are

considered

unfit

for

early

participation

in

training

activities.

WD

Cir.

110,

Oct.

1940.

Frohlich’s syndrome,

if

moderate

in

degree.

No

change......

No

change.. ......

No

change.

Pellagra,

beriberi,

scurvy, and

other

nutritional

deficiencies,

if

mild

and

remediable by

correction

of

diet.

Renal

glycosuria, provided

the

renal

character

of

the

condition

has

been

clearly

shown

by

appropriate

laboratory

tests.

No

change..

Pellagra,

beriberi,

scurvy,

sprue, and

other

nutritional

deficiencies, if

mild

and

remediable by

diet

and

appropriate treatment. No

change. Nochange.

onacceptable.

Goiter

with

definite

pressure

symptoms

or

so

large

in

size

as

to

interfere

with

wearing

uniform

or

military

equipment.

Cretinism

with

imbecility or

dwarfism.

Simple

goiter

with

definite

pressure

symptoms

or

so

large

in

size

as

to

interfere

with

wearing

uniform or

military

equipment.

No

change..

No

change..

Myxedema,

spontaneous or

postoperative. Gigantism or

acromegaly.

No

change. Nochange. No

change.

Gigantism

or

acromegaly,

if

markedly

disfiguring

or

if

associated

with

other

symptoms

of

severe pituitary

dysfunction.

No

change

No

change

Hyperparathyroidism

and

hypoparathyroidism, unless

mild

in

degree. Addison’s

disease ...

Hyperparathyroidism

and

hypoparathyroidism when

the

diagnosis

is

supported

by

adequate

laboratory

studies.

No

change._

No

change...

No

change.. ......
PHYSICAL STANDARDS 338

Table

—Defects 18.

of

the

endocrine

and

metabolic

systems

—Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

15

Mar.

-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

-l

A.pr.

1944

19

Apr.

1944

Nonacceptable— Continued

Diabetes

mellitus,

diabetes insipidus.Avitaminoses

which

are

severe

or

not

readily

remediable, or

in

which

permanent

pathological

changes

have

been

established.

No

change. Nochange. Nochange. Simmond’s

disease. Cushing’s

syndrome;

other

diseases

due

to

disorder

of

the

pituitary

gland.

No

change. Persisting

glycosuria.

Nutritional

deficiency

diseases

which

are

severe

or

not

readily

remediableor

in

which

permanent

pathological

changes

have

been

established.

Cushing’s

syndrome

Hyperinsulinism

when

established

by

adequate

investigation

and

if

regarded by

the

examiners

as

of

sufficient

degree

to

disqualify

for

military

service.

No

change... Renal

glycosuria

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

Changes

No.

1,

MR

1-9,

15

Oct.1942.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance

of

the

individual

concerned

for

general

military

service.

MR

1-9,

15

Mar.

1942,

par.

4a(2)(a).
APPENDIX

Table

—Diseases 19.-

of

the

blood

and

blood-forming tissues

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

15

Mar

.-14

Oct.

1942

15

Oct.1942-18 Apr.

1944

19

Apr.

1944

General

service.--

Secondary

anemia,

due

to

hemorrhoids or

any

other remediable cause.

Malaria,

acute

or

chronic,

unless

severe and

irremediable. Purpura

if

symptomatic

of

remediable condition.

Secondary

anemia,

mild,

due

to

easily remediablecauses.

Malaria,

acute, severe

or

malaria,

chronic,

unless

severe.

No

change

No

change. Malaria,

acuteor

chronic,

mild.

Malaria,

acute, or

malaria

chronic

unless severe.

Limited service... Nonaccep

table

All

above

entries

deleted

and

the

following

substituted:

defects ... will

be

regarded as

causes for

rejection

by

Army

medical

examiners

until

there

has

been

recovery without

disqualifying

sequelae.

Medical

examiners

will

reject

all

men who

are

in

need

of

hospitalization,

and

all

those

who

by

reason

of

physical defects

are

considered

unfit

for

early

participation

in

training

activities.

WD

Cir.

110,

Oct.

1940.

Primary

pernicious

anemia

in

the

absence

of

posterolateral

sclerosis,

if

responsive to

treatment

and

not

severe.

Malaria,

acute, severe

or

malaria,

chronic,

unless

severe.

There

are

no

diseases of

this

group

which

warrant initial

selection

for

limited

service.

No

change...

No

change. Nochange.

No

change.....

No

change.

Primary

pernicious

anemia

if

severe, not

responsive

to

treatment or

with

neurological

complications.

No

change....

Pernicious

anemia.

No

change..

No

change.

Hemolytic

ictero-anemia (hemolytic jaundice)

No

change......

No

change.

No

change

No

change....

No

change.

No

change

No

change.

No

change

No

change.

Malaria,

chronic,

if

severe and

not

easily remediable.

Malaria,

chronic,

if

more

than

mild

No

change.

No

change

Hodgkin’s disease.

MR

(Mobilization Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise indicated.

Certain

disqualifying

defects

which

might

be

remediable and

which

if

corrected

would

warrant

acceptance of

the

individual

concerned

for

general

military

service.

MR

1-9

15

Mar.

1942,

par.

4a(2)(a)
340 1'IIYSICAL STANDARDS

Table

20.

—Mental

and

nervous

disorders

Acceptability

Time

period

in

effect

31

Aug.

1940 !-14

Mar.

1942

15

Mar.2-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943 MB

Apr.

1944

19

Apr.

1944

General

service..

Registrants who

appear to

have

normal

understanding, whose

speech

can

be

understood,

who

haveno

definite

signs

of

organic

disease

of

the

brain,

spinal

cord,

or

peripheral nerves,

and

who

are

otherwise

mentally

and

physically

fit.

healthy

nervous system as

manifested

by

absence

of

signs

of

disease

of

the

brain,

spinal

cord,

cranial

and

peripheral nerves.

Certain

variations

clearly

within

physiological limits

such

as

minor

tremors.

Inconsequential

paralyses resulting

from

old

poliomyelitis or

lesions

of

the

peripheral nerves not

likely

to

interfere

with

military

duty. The

range

of

personalities usually

classed

as

“normal”.

Evidence of

ability

to

get

along

tolerably

with

family,

friends,

casual

acquaintances,

authorities

in

school

or

society,

employers

and

fellow

workers.

Conventional

attitude

toward

sexual

problems.

Sufficient

intelligence

to

graduate

from

grammar school

unless

prevented

by

external

circumstances.

Sufficient

stability

and

ability

to

obtain

and

keep,

or

at

least

to

seek,

job.

No

change. Nochange. Nochange. Nochange.

degree,

unless

malingering

is

definitely

excluded.
APPENDIX

Marginal

intelligence

if

compensated

for

by

better

than

average

stability.

Men

whose

speech

can readily

be

understood,

even though

there

is

moderate

degree

of

stuttering or

stammering,

if

otherwise,

physically,

intellectually,

and

emotionally

fit.

No

change

No

change. Nochange.

Limited service..

Stuttering

and

stammering

of

degree

disqualifying

for

general

military

service

but

which

has

not

prevented

registrants from

successfully

following

useful

vocation

in

civil

life.

Tremors

of

such

marked

degree

that

they

disqualify

for

general

military

service

but

have

not

prevented

the

registrants from

following

useful

vocation

in

civil

life.

No

change

No

change.

Individuals

who

present muscular

tremors or

local

paralyses due

to

old

poliomyelitis

or

nonprogressive disease

of

the

spinal

cord

or

peripheral nerves of

such

marked

degree

that

they

disqualify for

general

military

service

but

have

not

prevented

the

individual

from

successfully

following

useful

vocation

in

civil

life. Moderate

degrees

of

compulsiveness or

obsessiveness. Neurosyphilis

of

any

form

(general

paresis,

tabes

dorsalis,

meningovascular

syphilis).

Individuals with

local

paralysis

due

to

old

poliomyelitis

or

nonprogressive disease of

the

peripheral nerves

of

such

marked

degree

that

they

disqualify for

general

military

service

but

have

not

prevented

the

individual

from

successfully

following

useful

vocation

in

civil

life.

There

are

no

neurological

disorders

which

warrant

initial

selection

for

limited

service.

Individuals with

local

paralyses

such

as

those

due

to

poliomyelitis or

nonprogressive

disease

of

the

peripheral nerves of

such

degree

that

they

disqualify

for

general

military

service

but

have

not

interfered

with

locomotion

and

have

not

prevented

the

individual

from

successfully

following

useful

vocation

in

civil

life

are

acceptable

for

limited

service.

onacceptable... See

footnotes

Syphilis

of

central nervous

system. at

end

of

table.

No

change.
342 PHYSICAL STANDARDS

Table

20.

—Mental

and

nervous

disorders —Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

*-14

Mar.

1942

15

Mar.*-14

Oct.

1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

-18

Apr.

1944

19

Apr.

1944

Nonacce

ptable— Continued

Paroxysmal

convulsive disorders

and

disturbances

of

consciousness

(grand

mal,

petit

mal

and

psychomotor

attacks,

syncope, narcolepsy,

migraine).Residuals of

infection

(moderate

and

severe residuals of

poliomyelitis, meningitis

and

abscesses,

paralysis

agitans,

posteneephalitis syndrome,

Sydenham’s chorea). Residuals of

trauma

(residuals

of

concussion or

severe

cerebral

trauma,

posttraumatic

cerebral

syndrome,

incapacitating

severe injuries

to

peripheral

nerves).

Degenerative disorders (multiple

sclerosis,

encephalomyelitis,

cerebellar

and

Friedrich’s ataxia,

athetoses,

Huntington’s

chorea,

muscular

atrophies,

and

dystrophies

of

any

type;

cerebral

arteriosclerosis).

Chronic

essential

chorea

..

Paralysis

agitans,

postencephalitic

syndrome,

athetosis,

chorea,

spasmodic

torticollis,

familial

ataxia.

No

change...

Postencephalitis syndrome

Posttraumatic cerebral syndrome. Multiple

sclerosis..

Multiple

sclerosis,

encephalomyelitis. Diffusemuscular

atrophies or

dystrophies of

any

type

(with

the

exception

of

extremely

mild

residuals of

poliomyelitis).

Muscular

atrophies and

dystrophies

which

arc

obviously

disqualifying.

No

change..

No

change...
APPENDIX 343

No

change

vascular

accidents

of

all

types. Other

chronic

degenerative

diseases of

the

brain

and

spinal

cord.

Chronic or

recurrent

neuritis

or

neuralgia

of

an

intensity

sufficient

to

prevent

the

individual

from

following

useful

vocation

in

civil

life.

Multiple

neuritis. Spina

bifida,

if

associated

with

neurological

manifestations.

Meningocele,

even if

uncomplicated.

Neuritis or

neuralgia

which

is

not

temporary

in

character

and

which

has

progressed

to

such

degree

as

to

prevent

the

registrants

from

following

useful

vocation

in

civil

life.

No

change...

Peripheral nerve

disorder

(chronic or

recurrent neuritis or

neuralgia

of

an

intensity

which

is

periodically

incapacitating, multiple

neuritis,

neurofibromatosis)Miscellaneous disorders (tics,

No

change Nochange------

spasmodic

torticollis, spasms, brain

and

spinal

cord

tumors,

operated

and

unoperated, cerebrovascular disease,

congenital

malformations,

including

spina

bifida

if

associated with

neurological

manifestations and

meningocele

even if

uncomplicated,

Meniere’s disease). No

change. Nochange.

Psychoneuroses and

constitutional

psychopathic states

providing the

diagnosis

is

clearly

established and

in

the

opinion

of

the

medical

examiner

precludes

the

successful

performance

of

military

duty.

Sec

footnotes

at

end

of

table.
344 PHYSICAL STANDARDS

Table

20.

—Mental

and

nervous

disorders

—-Continued

Acceptability

Time

period

in

effect

31

Aug.

1940

i-14

Mar. 1942

15

Mar.

-14

Oct. 1942

15

Oct.1942-21 Jan.

1943

22

Jan.

1943

-18

Apr.

1944

19

Apr.

1944

Nonacceptable— Continued

Major

abnormalities of

mood..

Hysterical

paralysis.

No

change.

Psychoneurosis. Psychosis.

Paraplegia or

hemiplegia

Prepsychotic,

postpsychotic

and

schizophrenicpersonalities. Chronic

alcoholism

and

drug

addiction.

No

change...

No

change....

Alcoholism

and

drug

addiction.

Primary

behavior disorder of

sufficient

degree

to

indicate

predisposition to

more

serious

disorders.

Drug

addiction,

including

the

habitual use

of

opium

and

its

derivatives and

cocaine.

Stammering

to

such

degree

that

the

registrant is

unable

to

express himself

clearly

or

to

repeat

commands. Insanity..........

MR

(Mobilization

Regulations) No.

1-9,

dated

as

per

initial

date

of

each

column

head

unless

otherwise

indicated.

As

of

15

Mar.

1942,

the

section

of

the

published standards relating to

the

examination

of

registrants for

menial

and

nervous

disorders

was divided

into

sections

entitled

“Neurological

Disorders’’ and

“Psychoses,

Psychoneuroses, and

Personality

Disorders.” To

simplify

the

comparison

of

standards

the

two

sections

were combined

to

compile

this

table.

Changes

No.

1,

MR

1-9,

15

Oct.

1942.
INDEX

Act of 13 May 1926, provided for retirement

of nurses for longevity of service, 115

Act of 20 June 1930, statutory authority for

retirement of nurses for physical and

mental disability, 115

Act of April 1939, equalized retirement

benefits for Reserve officers, 110

Act of 17 October 1940. amended act of

20 June 1930—115

Active Reserve, 53

Adaptability, separations for lack of required degree of, 37,105

Adjutant General, The, 26, 32, 33, 46, 52, 55,

90. 102, 103, 108, 111, 112, 113

Adjutant General’s Office, 46

Administration of physical standards, 1-14

Administrative policies, effect of, on dischargerates, 106

Administrator of Federal Security Agency,

33

Administrator of Veterans’ Affairs, 33

Admissions for—-

cold injury, 86

neuropsychiatric conditions, 86

neuropsychiatric diseases in World War

1—36

Advisory board,

Air Forces, 114

Alaska, 7, 71

Allergies, 82

Amberson, J. Burxs, Jr., 33

Amenorrhea, 82

American College of Chest Physicians, Committee on Military Affairs of, 31

American National Red Cross, 108,117

American Revolution,

Axderson, Lt. Col. James B.,

Armed Forces, 1, 2, 8, 11, 12, 14, 15, 17, 25,

28, 38, 40, 65

dental program in, 24

strength of, 15

Armed Forces recruiting and induction stations, 13

Armed Services, 126

Army Administration Officer Candidate

School, 54

Army Air Forces, 4, 66, 67. 71, 73, 79, 89

Army General Classification Test, 54

Army Ground Forces, 65, 66, 67, 73, 74, 79

Army induction stations, inductees for naval

service handled through, 13

Army Medical Service,

Army-Navy A’ision Committee, Office of Scientific Research and Development, 25

Army Nurse Corps, 56-57, 61,115

Army of the United States, 54, 56, 61, 63, 87,

05,101,102,103,115

Women’s Army Corps established as component of, 58

See also U.S. Army.

Army Regulations;

No. 40-100, September 1940—15, 57 No. 40-100, 16 Nov. 1942—2, 3, 50, 53, 56, 57, 91,119

No. 40-100, C5, September 1943—56, 57, 58, 60

No. 40-105, 29 May 1923—2, 3, 45, 53, 57, 91,119

No. 40-105, C5,17 Aug. 1940—2, No. 40-110, Dec. 1942—2,

No. 40-501, Dec. 1960—126

No. 605-230 [Tentative], 25 Aug. 1941—

86, 87

No. 605-230, June 1942—124

No. 605-250, 28 Mar. 1944—113

No. 611-201,15 June 1960—126

No. 615-360, 26Nov. 1942—100,108 No. 615-360, 25 May 1944—104

No. 615-360, Cl, 12 Sept. 1944—105

No. 615-361, Nov. 1944—122,124

No. 615-365, 25 Oct. 1944—104 No. 615-368, 25 July 1944—104

No. 615-369, 20 July 1944—104

No. 615-395, June 1942—107

No. 625-5, November 1942—53, 55, 56 No. 650-230, June 1941—86

Army Service Forces, 66, 67, 73, 79

team from, for visiting pilot installations, 117

Army Specialist Corps, 62, 63, 92

Army SpecializedTraining Program, 63, 67

physical qualifications for trainees admitted to, 61

Arsenical injections, in treatment of syphilis,

49

Arterial hypertension, 88

Arteriosclerosis, 99
346 PHYSICAL STANDARDS

Arthritis, 81, 106, 107, 116

hypertrophic, 88, 99

rheumatoid, 48, 93

Assistant Chief of Staff, G-l—8, 73

Asthma, 82, 92, 99

Astigmatism:

hyperopic, 45

myopic, 45

Atabrine, 85

AUS. See Army of the United States.

Bartholinitis, 57

Bismuth injections, in treatment of syphilis,

49

Blindness:

color, 47

one eye, 17, 47

unilateral, registrants with, 25

Board(s);

advisory,

CDD, 120, 122

disposition, 89,120,122

medical, 8, 9, 53,120-122

physical evaluation, 114

physical examination, 120-121

reclassification, 86-87

retiring, 87, 90, 91, 111, 112, 113, 114

Section VIII—102, 103, 104

separation, 116

Bones:

disease of, 47, 48, 49

fracture of, 47, 49

Bronchial asthma, 99

Bronchiectasis, 82, 92

Bryden, Maj. Gen. William, 116

Cachexia, 103

Calculus, renal, unilateral, 50

Canadian “PULHEMS” system, 68, 94

Cardiovascular defects, rejections for, 25

Cardiovascular disease, 116

Cartilage, semilunar, 47

CDD. See Certificate of disability for

discharge

CDD board, 120,121

Cerebral hemorrhage, 99

Certificate of disability for discharge, 97,

100-102, 104, 108

Cervical polyps, 57

Chancroid, 29, 81, 99

Chest, examinationof: physical, 35

X-ray, 33, 47, 57, 58

“Chest X-ray of Military Personnel,” 32

Chiefs of Personnel Service, Surgeon General’s Office, 77, 78

Cholecystectomy, 50

Circular Letter No. 19, 12 Mar. 1941—38 Civil War,

Civilian physicans, shortage of, 18

Civilian roentgenological laboratories, Army

use of, 33

Classification:

limited and general service, 88-89

personnel, 65-95

physical, 123-124

problems in, 65-76

Clavical, deformities of, 20

Clubfoot, 47

Cold injury:

admissions for, 86

screening individuals recovered from, 85,

86

Color blindness, 13

Combat units, screening men in, 76-77

Commanding General(s)

Army Air Forces, 89

Army Ground Forces, 74 Headquarters, Services of Supply, 79

Commission on physical rehabilitation, 18 “Commissioned Officers Army Retiring

Boards,” AR 605-250-113

“Commissioned Officers: Reclassification,”

AR 605-230-86, 87, 124

Committee on Military Affairs of the American College of Chest Physicians, 31

Committee on Tuberculosis, National Research Council, 33, 34

Congress (es), 6, 43, 57

77th—108, 116

78th—116

81st—114

Continental United States, 72, 75, 91

Cornell Selectee Index, 60

Coronary occlusion, 99

Coronary thrombosis, 99

Corps of Chaplains, 45

Cranial nerves, lesions of, 84

Cyst, pilonidal, 49

Darnall, Lt. Col. Joseph R., De Lorimiek, Col. Alfred A., 31

Deafness, 19

Defect(s)

acceptable for limited service, 47

dental, 21, 24, 81, 85

disqualifying personnel for shipment

overseas, 81

eye, 25-27
INDEX 347

Defect (s) —Continued

feet, 20

incapacitating, 99

limiting, recording of, 85

physical, waiver of, 50-52

qualifying registrant for limited service,

19-21

remediable, 17,18,19, 85

Deformities of—-

clavicle, 20

extremities, 20

feet, 82

ribs, 20

scapula, 20

Demobilization:

physical evaluation upon, 117-125

planning for, 126

statistics on, 118

Demobilization separations, use of physical

standards in, 97

Dental defects, 25

treatment for, 14

Dental Division, Surgeon General’s ()flice, 23

Dental rehabilitation, 23-24

Dental rehabilitation program, size of, 24

Dental standards, 21-24

Determination, line-of-duty, 97-98, 111, 122

Development(s)

in induction procedure, 11-12

of physical standards, 1-14

Diabetes, 82

Diabetes mellitus, 48, 88, 92, 99

Diagnosis;

of inguinal hernia, 81

of syphilis, 49

Diagnostic labeling, of rejected registrant,

40

Dietitians, 56, 57

Director of Dental Division, 23

Director of Military Personnel, Headquarters, Services of Supply, 79

Director of Selective Service, 11, 19, 28

Disability, service-connected, 109

Disability discharge(s), for—-

disease, 106

gynecological conditions, 107

neuropsychiatric reasons, 107

Disability discharge policy, 104, 105

Disability discharge rates, 104-107

for neuropsychiatric reasons, 37

Disability retirement: of enlisted men, 107-108

of nurses, 115

officer, 110-116

situation at close of war, 115-116

Discharge(s)

“blue,” 102

by certificate of disability, 21, 97, 100-102,

103,104, 106,108

for convenience of the Government, 60,

102-103

honorable, 61, 102,103

of limited service men, 20,104

Section VIII—102

“Discharge and Release From Active Duty,”

TM 12-222—119

Discharge rate(s)

administrative policies on, 106

for neuropsychiatric diseases in World

War 1—36

Disease(s)

cardiovascular, 116

endocrine, 48, 99

infectious, 85

malignant, 48

tropical, 81

venereal, 13, 15, 19, 25, 27-30, 34, 44, 49, 58,

81, 82, 92, 93, 98, 99,100

Disorders:

mental and personality, 36-42, 92

neurological, 84

neuropsychiatric, 40

psychiatric, 81,106

psychoneurotic, 84

Disposition:

of personnel, misuse of medical channels

for, 108-110

of rejected registrants, 13

Disposition and retiring boards, 122

Douglas, Bruce II., 33

DSS Form 220, “List of Defects.” II

Duodenal ulcer, 47,107,112,116

Fanes, Col. Richard H.,

Ear(s), 53

disease of, 99

hearing acuity of, 19

loss of, 19

Eardrum, perforated. 47, 82

Edema, 47

Educational deficiency, rejections for, 25

Edwards, Herbert R., 33

Endocervicitis, 57

Endocrine diseases, 48, 99

England, 75

“Enlisted Men: Discharge; Medical,” AR

615-361—121,124

“Enlisted Men: Discharge; Release From

Active Duty,” AR 615-360—100, 104, 105,

108

2,57-966—67 24
348 PHYSICAL STANDARDS

Enlisted men, limited service for, 76-82

“Enlisted Men: Retirement,” AR 615-395

107

Enlisted personnel, separation of, 100-108

Enlisted Reserve, 11

Enlisted Reserve Corps, 13,119,123

Enlisted retirements, 107-108

Enlistments, volunteer, terminated by executive order, 12

Enuresis, 37,103,104,105

Epididymitis, 81

Epilepsy, 99

Equipment, for mobile optical-repair units,

26

Ethiopia,

Europe, 2, 93, 94

redeployment of personnel from, 82-86

EuropeanContinent, 75

European theater, 83

admissions for cold injury and neuropsychiatric conditions in, 86

Examination (s)

chest, 33, 35, 47, 57, 58

eye, 25

final-type, 43. 44

lung, 35

neuropsychiatric, 40, 60

preinduction, 13,14

preliminary, 43

psychiatric, 38

roentgenological, 50

terminal, 44, 119-121

X-ray, 10. 31. 35, 36

Examining boards, locations for. 8.

Executive Order:

No. 7279, Dec. 1942—12

No. 8099. 28 Apr. 1939—110

No. 9078, 26 Feb. 1942—62

Extremities:

deformities of. 20

loss of. 47

Eye(s)

defects of;

effects of standards changes for, 25

rehabilitation of men with, 25-27

rejections for, 27

inspection of, 25

loss of. 81

physical standards lowered for, 25

refraction of, 25

test for visual-acuity of, 24

vision of, 19

Fairbank, Brig. Gen. Leigh C., 23

Federal Government, 44

Federal Security Agency, administrator of,

33

Federal Service, 104

Feet:

defects of, 20

deformity of, 20

Hat, 82

Female components of U.S. Army, 56-66

Fever(s):

hay, 82

rheumatic, 82, 93

Field Artillery, 74

Filariasis, 81, 85, 93

Finance Officer Candidate School, 55

Finger(s)

loss of, 20

webbed, 20

Fitzsimons General Hospital, 103

Flat feet, 82

Foot, abduction and pronation of. 20

Form(s)

DSS Form 220—11

W.D., A.G.O. No. 20—73, 85

W.D., A.G.O. No. 40—101. 102

W.D., A.G.O. No. 55—102

W.D., A.G.O. No. 63—99

Fort McClellan, Ala.. 79

Forts. Sec Military installations.

Foster. Lt. Col. William B.,

Fracture(s)

of skull, 48

of spine, 47

Frohlich’s syndrome, 20. 48

Fry, C. C., 41n

Gallbladder. 50

Gastric ulcer, 47.107.116

Gastroenterostomy,48. 82. 92

Germany, 82. 94

Glycosuria, 48

Gonorrhea, 81, 82, 99

induction of men with, 29

official Army policy on. 29

Gorman, Lt. Col. Cornelius E., 4. 117

Granuloma inguinale, 81, 99

Griffin, Col. Martin E., 31

Guidelines for neuropsychiatric examination. 40

Hammer toe, 20

Hand, loss of, 47

Harvard University, 41
INDEX 349

Hawaii,

Hay fever, 82

Headquarters, Services of Supply, 79

Hearing, acuity of, 19, 47

Heart disease, 19, 81, 92

Height, 54

Hemoptysis, 99

Hernia, 17,19, 27, 81, 93

inguinal, 27, 48

umbilical, 48

ventral, 50

Hillman, Col. Charles C., 31, 32

Historical note on physical standards, 1-3

Honorable discharge,61,102,103

Hyperopia, 45

Hypertension,81

arterial, 88

Hypertrophicarthritis, 88. 99

Hypothyroidism, 48, 92

Inactive Reserve, 53

Inaptness, 37

Incidence:

of neurospyhilis, 28

of syphilis, 28

Incisor teeth, 49

Index finger, right, loss of, 20

Inductees;

for naval service, 13

limited service for, 19-21

Induction;

of limited service men, 17

of men with venereal diseases, 29, 30

policy on rehabilitation for, 17-19

total rejections for, during mobilization

period, 16

Induction policy, on registrants with

gonorrhea, 30

Induction procedure, developments, 11-12

Induction station problems, 38—40

Induction stations:

advisory boards at,

appeal boards at,

examiners at, 36

medical examining boards at, 8,

Neuropsychiatric Screening Adjunct test

adopted at, 41

roentgenography at, 36

roentgenologists at, 36

Infantry, the, 74, 75

Infantry Replacement Training Centers, 74

Infection, venereal, 100

Inguinal hernia, 48, 50, 81

Injuries, line-of-duty status of, 98

Instructions of War Department:

concerning physical standards and physical examination of Reserve Officers, 52

concerningReserve officers disqualified for

service, 52

governing physical standards and examination of officers of Reserve components,

44, 45

on physical standards and physical evaluation of Reserve officers, 51

Japan, 82, 94

Joint Induction procedures, 12-13

coordination of physical standards for, 13

planning for, 13

volunteers permitted under, 13

Joints, fixed or limited in motion, 47

Kidney(s)

absence of one, 48

roentgenological examination of, 50

Kidney stones, 50

Knee joint, semilunar cartilage of, 47

Laboratories, roentgenological, 33

Lesions:

of cranial nerves, 84

of peripheral nerves, 84

parenchymal, 49

Lieberman, Col. John F.,

Limited service:

definition of, 94

for inductees, 19-21

for enlisted men, 76-82

for officers, 88-89

Limited service personnel, assignment problems, 77-79

Line-of-duty determination, 97-98, 111, 122

“List of Defects,” DSS Form 220—11

Long, Dr. Esmond, R., 33

Loss of—-

ear, 19

eye, 81

fingers, 20

hand, 47

lower extremities, 20

right index finger, 20

thumb, 20

Lower extremities;

deformities of, 20

loss of, 47

Lung(s):

calcified lesions of, 48

collapse of, 99

examination of, 35
350 PHYSICAL STANDARDS

Lymph nodes:

intrathoracic, 48

tracheobronchial, 35

Lymphogranuloma venereum, 81, 99

McCain, Paul, P., 33

Madigan,Lt. Col. Patrick S.,

Malignant disease, history of, 48

Malaria, 81, 85, 103

Manpower;

fluctuation of physical standards according

to need for, 15-42

requirements for, 46-50

Medical Administrative Officer Candidate

School, 54, 55

Medical Administrative Section, 117

Medical appeal boards, 53

Medical Circular No. 4, October 1943—40

Medical CorpsReserve, 46

Medical Department, 14, 45, 59, 77, 78, 115

Medical review board, 121,122

“Medical Service: Standards of Medical

Fitness,” AR 40-501—126

Medical Statistics Bulletin No. —28

Medical units and installations, problems in

assigning limited service personnel to,

77-79

Mediterranean theater, 85

admissions for cold injury and neuropsychiatric conditions in, 86

Mental and personality disorders, 36-42

Mental defects, 42

Mental deficiency, 84, 104

Mental disorders, 92

Mental illness, 37

Military installations: Fort Dix, 117

Fort McPherson, 117

Fort Sam Houston, 117

Fort Sheridan, 117

Mobile optical-repair units, 26

Mobilization period:

dental standards during, 21-24

total rejections for induction during, 16

Mobilization Regulations:

No. 1-5, Dec. 1932—2, 30

No. 1-9, 31 Aug. 1940—2, 3, 11, 22, 23, 35,

38, 55, 56, 58, 62, 68, 71, 76

No. 1-9, March 1942—23, 37

No. 1-9, October 1942—23, 24, 36, 37, 59, 80

No. 1-9, 19 Apr. 1944—93, 119

No. 1-9, 22 May 1944—72

No. 1-9, Cl, 19Aug. 1944—72

Musculoskeletal defects:

rejections for, 25

separations for, 106,107

Myopia, 45

National Defense Act of 1920—2

National Guard, 33, 43-53, 62, 95,104

National Headquarters, Selective Service

System, 16, 42

National Research Council, 33, 41

National Tuberculosis Association, 31

Navy, the, 13, 33, 66

Neoplasms, 99

Nephrolithiasis, 92

Nerve deafness, 88

Neurological disorders, 84

Neuropsychiatric conditions: in European theater, 86

in Mediterranean theater, 86

Neuropsychiatric diseases, admission for, in

World War 1—36

Neuropsychiatric disorders, evaluation of, 40

Neuropsychiatric examination: at induction stations, 40

at recruiting stations, 60

Neuropsychiatric screening:

at induction stations, 38

for redeployment, 85, 86

Neuropsychiatric Screening Adjunct test, 41

Neurosyphilis, incidence of, 28

Nurses, disability retirement of, 115

Office of Scientific Research and Development. Army-Navy Vision Committee of, 25

Officer(s)

assignment of, 92-93

classification of, 88-89

eligible for disability retirement, 97

psychoneuroses as cause for retirement of,

113-114

reclassification of, 86-93

waiver of physical defects in, 50-52

Officer candidate schools, 43, 53-55, 62,109

age limits for applicants to, 54

Army regulation covering subject of, 54

physical standards for entrance into, 53,

54, 55

“Officer Candidates,” AR 625-5—53, 55. 56

Officer disability retirement, 110-116

Officers’ Reserve Corps, 43-53, 55, 62, 119,

123

Oophoritis, 57

Ophthalmology Branch. Surgeon General’s

Office, 25
INDEX 351

Optical program;

administrative problems in. 26

supply and issue of spectacles in, 26

Optical-repair units, mobile, 26

Organic heart disease, 81, 92

Organization, of physical standards activity,

3-4

Osteoarthritis, 99

Osteomyelitis, 47, 49

metastatic, 48

Otitis media, 47

Oversea destinations, standards for transferring personnel to, 79-82

Oversea service, emotional qualifications for,

84

Overweight, 47

Pacific area, redeployment of personnel from

Europe to, 82-86

Paralyses, 84

Paresis, 100

Penicillin, 81

Peptic ulcer. 81, 99

Peripheral nerves, lesions of, 84

Personality disorders, psychopathic, 84

Personnel classification, 65-95

“Personnel Selection and Classification:

Manual of Enlisted Military Occupational

Specialties,” AR 611-201—126

Personnel Service, Surgeon General’s Office,

77

Pes cavus, 47

Pes planus, 47

Philippine Scouts, 107

Physical classification, 123-124

Physical defects in officers, waiver of. 50-52

Physical disability, officers separated or retired for, 115

Physical evaluation: boards for, 114

upon demobilization, 117-125

Physical examinations, preinduction, 13-14

Physical examination board, 120-121.122

Physical Profile Plan. 75, 76, 80

Physical profile serial, 69-70, 72, 85

Physical Profile Serial System, 94

adoption of, 68-72

experiencewith, 74—76

“Physical Reclassification: Retirement and

Retirement Benefits for Officers,” TM 2-

245—115

Physical rehabilitation: commission on, 18

results of pilot tests for, 18

Physical standards;

definition of,

development and administration of, 1-14

fluctuation of, according to manpower

needs, 15-42

for evaluation of officers, 91

for oversea service, 81

for retirement, 110

in separations, utilization of, 125,12G

Physical Standards Division, Surgeon General’s Office, 25

Physical therapy aides, 56, 57

Physicians, civilian, shortage of, IS

Pilonidal cyst, 49

Pilonidal sinus, 49

Pilot separation centers, 117

Pilot tests for physical rehabilitation, results

of. 18

Pleurisy, 35, 99

Pleuritis, serofibrinous, 35

Pneumonia, 99

Policy(ies)

basic, on pregnancy, 60-61

change in, for venereal disease, 99

concerning line-of-duty determinations, 97

on rehabilitation for induction, 17-19

retention, 65-95

Poliomyelitis, 47, 84

Polyps, cervical, 57

Pregnancy, 57

basic policy on, 60-61

Preinduction physical examination, 13,14

President of the United States, 12, 18, 43. 58,

111

plan of, for rehabilitation of men with remediable defects, 13,14

Presidio ofMonterey, 117

Problems:

at induction stations, 38-40

of classification, 65-76

Professional Service Division, Surgeon General’s Office, 3, 4,31

Profiles, use of. in assigning men, 73-74

Prostatitis, severe acute, 81

Psychiatric disorders, 81,106

Psychoneurosis (es), 48. 81, 84, 104, 106, 114

disability discharges for, 107

in officers, main cause for retirement action, 113-114

Psychoneurotic disorders, 84

Psychopathicpersonality, 84,104

Psychoses, 48, 84,104

Public Law 18. Apr. 1939—110

PublicLaw 101, 29 June 1943—116
352 PHYSICAL STANDARDS

Public Law 140, 30 June 1941—108, 116

Public Law 197,December 1943—13

PublicLaw 314, 27 May 1944—116

Puerto Rico,

“PULHEMS” system, 68

“PULHES,” adoption of, 68-72

“PULHES” system, 68

See also Physical Profile Serial System.

Pulmonary tuberculosis, 32, 48, 99

Quinacrine hydrochloride, 85

Reception centers, 78

responsibilities of, 14, 74

spectacles furnished at, 34

venereal diseases treated at, 14

Reclassification boards, 86-87

Reclassification instructions, changes to, 91-

92

Reclassification of officers, 86-93

Reclassification procedures, change in, 90

Recruiting and induction stations, 13

Redeployment;

neuropsychiatric screening for, 85, 86

of personnel from Europe to Pacific area,

82-86

policy of War Department on, 86, 94

Registrants:

psychiatric examination of, 38

rejected:

disposition of, 13

for mental disorders, in World War I—-

36

with defects, inducted for limited service,

19-21

with unilateral blindness, 25

Regular Army, 4, 31, 33, 43, 45, 53, 87. 94, 307,

311

Regulations, Army, covering—-

inaptness, lack of required degree of

adaptability or enuresis, 104

limited service not adaptable for military

service, 104

reclassification of officers, 86, 87

undesirable habits or traits of character,

304

See also specific Army Regulations.

Rehabilitation:

of men with eye defects, 25-27

policy on, for induction, 17-19

Rehabilitation program, establishment of, 17

Rejection(s)

for cardiovascular defects, 25

for dentalreasons, 21, 23

Rejection(s) —Continued

for eye defects, 25

for mental and educational deficiency, 25,

37

for musculoskeletal defects, 25

for tuberculosis, 30

pregnancy as cause for, 60

total, for induction during mobilization

period, 16

Rejection rates, factors influencing fluctuation of, 16

Remediable defects, 85

induction of men with, 19

President’s plan for rehabilitation of men

with, 18

Renal calculus, unilateral, 50

Renal. See also Kidney.

Replacement training centers, dental rehabilitation in, 24

“Report of Physical Examination,” W.D.,

A.G.O. Form No. 63—99

Requirements:

changes in physical and mental, 15

for increased manpower, 46-50

higher manpower, 15

Reserve Corps,

Reserve officers, examinations of, 43-44

Reserve Officers’ Training Corps, 43, 55-56,

62

Reserves, the, 16, 43

Results:

of pilot tests for rehabilitation, 18

of serologic tests, 28

Retention policies, 65-95

Retirement(s)

enlisted, 107-108

for psychoneuroses, 114

officer disability, 110-116

procedures leading to, 111

Retirement benefits, changes in laws affecting, 114

Retirement provisions, inequities of, 114

Rheumatic fever, 82, 93, 99

Rheumatoid arthritis, 48, 93, 99

Ribs, deformities of, 20

Roentgenography, widespread use of, 36

Roentgenological examination of kidney, 50

Roentgenological laboratories, 33

Roentgenologists at induction stations, 36

Rostow, W. G., 41n

ROTC. See Reserve Officers' Training Corps.

Salpingitis, 57

Scapula, 20
INDEX 353

Screening, neuropsychiatric, at induction

stations, 38

Scrotum, 27

Secretary of the Interior, 33

Secretary of the Navy, 33

Secretary of War, 46, 51, 62, 108,110, 111 Secretary of War’s Personnel Board, 90, 91,

116

Secretary of War’s Separation Board, 116

Section II, AR 615-360, discharge under provisions of, 100

Section VIII, AR 615-360, discharge under

provisions of, 100,102

Section VIII hoards, 102,103,104

Section VIII discharges, 102

Section X, AR 615-360, discharge under provisions of, 100

Selective Service. See Selective Service

System.

Selective Service Medical Circular No. 1,

Nov. 1940—38

Selective Service Medical Circular No. 2,

March 1941—22

Selective Service Regulations, “Physical Rehabilitation,” 18

Selective Service System, 4, 7, 11, 12, 18, 28,

36, 37, 39, 40,103

authorized by Congress,

chief medical officer for,

coordination between the Army and, 6-10

Director of, 11,19,28

headquarters for,

medical survey program inaugurated by, 39

National headquarters of, 16, 39

State Director of, 16, 39

Selective Training and Service Act of 1940

2, 8, 33, 65

Separation(s), 97-127

for disease, 106

line-of-duty determination in, 97-98

of enlisted personnel, 100-108

treatment before, 124—125

utilization of physical standards in, 125,

126

Separation center(s)

medical boards at, 120-122

pilot, 117

“Separation Center Operations,” TM 12-

122—118

Serological tests, 72

for syphilis, 58

Services of Supply, Headquarters, 66

Commanding General of, 79

Director of Military Personnel of, 79

Sexual perversion, 41

Skin, 82

Skull, fractures of, 48

“Soldier’s Qualification Card,” W.D., A.G.O.

Form 20—73, 85

Spectacles, 26

for wear with gas masks, 26, 27

furnished at reception centers, 14, 26

issue of, 26

repair and replacement of, 26

supply of, 26

Spine, 20

fractures of, 47

Spleen, 103

absence of, 50

Splenomegaly, 103

Standards for—-

applicants to—

Army Nurse Corps, 56

officer candidate schools, 53-55

Reserve Officers’ Training Corps, 55

appointment in—

Officers’ Reserve Corps, 55, 56

Regular Army, 53

United States Military Academy, 53

commission in—

Army of the United States, 53, 54, 56

Officers’ Reserve Corps, 56

Regular Army, 53

“Standards of Miscellaneous Physical Examinations,” AR 40-100—2, 3, 45, 50, 53, 56,

57, 58, 60, 91,119

“Standards of Physical Examinations During Mobilizations,” MR 1-9—2, 3, 11, 22,

23, 24, 35, 36, 37, 38, 46, 55, 56, 58, 59, 62,

68, 71, 72, 80, 93,119

“Standards of Physical Examinations During Those Mobilizations for Which Selective Service is Planned,” MR 1-5—2, 30

“Standards of Physical Examination for Entrance into the Regular Army, National

Guard, and Organized Reserves,” AR

40-105—2, 3, 45, 53, 56, 57, 91,119

“Standards of Physical Examination for

Flying,” AR 40-110—2,

State Director of Selective Service, 40

State roentgenological laboratories, Army

use of, 33

Statistics on—-

demobilization, 118

enlisted men separated from the Army, 105

officers retired or separated for physical

disability, 115
PHYSICAL STANDARDS 354

Statistics on—Continued

optical programs, 27

venereal disease, 28, 30

Stimson, Henry L., 116

Strength:

of Armed Forces, 15

of Army, 15, 118

Subcommittee on Procedures and Standards

for Visual Examinations, 25

“Summary discharge,” 60

Surgeon General, The, 2, 8, 9, 13, 26, 28, 31,

32, 33, 36, 39, 46, 51, 78, 79, 90, 91, 93, 102,

108, 111, 112, 113, 117

Surgeon General’s Office, 3, 4, 15, 17, 30, 46,

50. 77, 80, 111. 112

Dental Division, 23

Medical Statistics Division, 16

Opthalmology Branch, 25

Personnel Service, 53, 54

Physical Standards Division, 25

Preventive Medicine Subdivision,

Professional Service Division, 3, 4, 31

Syndrome, Frohlich’s, 20. 48

Syphilis, 29. 48, 81. 92. 93, 99.123

serological tests for. 27-28, 44, 49, 58

statistics, 28

treatment for, 49, 81

Tabes dorsalis, 100

Talipes equinus, 47

“TB Warning,” Time magazine,April 1941

31

TBMED. See War Department Technical

Bulletin.

Teeth, 17.19, 49

“Terminal Physical Examination on Separation From Military Service,” TM 8-

255—119,121

Test(s)

Army General Classification, 54

Cornell Selectee Index, 60

for visual-acuity, 24, 25

Neuropsychiatric ScreeningAdjunct, 41

serological, 72

for venereal diseases, 27-28, 44. 49,58

WAC classification, 60

Thumb, loss of. 20

Thyroid, enlargement of, 82

Thyroid gland, enlargement of, 92

Time magazine, 31

Toe(s):

hammer, 20

loss of, 20 webbed, 20

Trauma, 106,112

Treatment:

before separation, 124-125

corrective, of remediable defects, 17

of venereal diseases, sulfonamides in, 29,

49, 81

Tropical diseases, 81

Tuberculars, 17

Tuberculosis, 30-36, 48, 82,103,116

of lungs, 35

of pelvic organs or breasts, 57

of tracheobronchial lymph nodes, 35

pulmonary, 32, 33, 48, 99

Tuberculosistreatment center, 103

Tumors, uterine, 82

Ulcers:

duodenal, 47 gastric, 47

peptic, 92

perforating. 99

Umbilical hernia, 48, 81

Underweight, 47, 49

United States, 2, 63, 94

United States Military Academy, 3. 43, 62

physical standards for appointment to, 53

Upper extremities, deformities of, 20

Urinalysis, 50

U.S. Army, 1, 4. 75, 76

demobilization of, 126

female components of, 56-66

officers in, 43

strength of. 15,118

U.S. Comptroller General. 109

U.S. Employees’ Compensation Commission,

58

U.S. Employment Service, 40

U.S. Military Academy. See United States

Military Academy.

U.S. Public Health Service, 28, 33

positive serology cases reported to, 119

U.S.C., title 10. changes in retirement benefits included under, 114

Vaginitis, 57

Varicose veins, 47

Venereal disease(s), 13. 15, 19, 25, 27-30, 58,

81. 82, 98,123

Army policy on. 28-29

change in policy for, 99

tests for. 27-28

treatment of, at reception centers. 14

See also specific diseases.

Venereal infections, 100
INDEX 355

Ventral hernia, 50

Veterans’ Administration, 36, 103, 108, 110,

111, 114, 116, 119, 122, 124, 125

pension application forms sent to, 108

transfer of patients to hospital of, 101

Veterans’ Administration pension, 97, 107-

108,116

application forms for, 117

Vision, 17. 19, 24—25

acceptable for limited service, 1, 47

effects of standards changes for, 25

standards for, for limited service, 19

Visual-acuity:

manual of instruction for testing, 25

tests for, 24, 25

Volunteers, under joint induction procedures, 13

WAAC regulations (tentative), 28 May

1942—58, 60

WAAC regulations of June 1943—60

WAAC. See Women’s Army Auxiliary Corps.

WAC classification test. 60

WAC. See Women’s Army Corps.

War Department, 2, 10, 19, 28, 39, 44, 45, 46,

50, 52, 53, 55, 67, 68, 74, 80, 83, 89, 90,

91, 93, 98, 108, 109, 110, 111, 112, 116

final decision by, on officer’s entitlement to

benefits, 111

instructions of, on—-

physical standards and examination of

officers of Reserve components, 44, 45

physical standards and physical evaluation of Reserve officers, 51

physical standards and physical examination of Reserve officers, 52

Reserve officers disqualified for service,

52

orders discontinuance of “limited service,”

21

policy of;

in evaluating men for redeployment, 86

on selection of individuals for redeployment, 94

on waiver of physical defects, 50-52

proceedings of retiring board sent to, 111

special Army retiring board appointed by,

100

War Department Circular—

No. 64, March 1943—55

No. 82, 24 Mar. 1943—88

No. 83, 21 Mar. 1942—88

No. 86, 24 Mar. 1942—54

War Department Circular—Continued

No. 86, 27 Mar. 1943—92

No. 102,11Mar. 1944—92

No. 109, Apr. 1945—91

No. 109,12Oct. 1945—92

No. 132, Apr. 1944—59

No. 161,14 July 1943—104, 107

No. 161, August 1943—106

No. 164, 26 Apr. 1944—81, 82

No. 196, 30 June 1945—81, 82,93

No. 205, May 1944—98

No. 217, 15 Oct. 1941—81

No. 289, Nov. 1943—58

No. 313, 12 Oct. 1945—92

No. 327, 27 Sept. 1942—76, 78

No. 345,14 Oct. 1942—54

No. 349,19 Oct. 1942—92

No. 358, 28 Oct. 1942—54

No. 370, September 1944—105

No. 370, rescinded January 1945—105

No. 403,14 Oct. 1944—91

No. 406, 16 Oct. 1944—93

No. 431, Nov. 1944—72

No. 458, Dec. 1944—99

War Department Memorandum No. W605-

14-42, 11 Oct. 1942—88

War Department Technical Bulletin

TB MED 33, 21 Apr. 1944, on induction station neuropsychiatric examination, 99

TM MED 100, October 1944—60

War Department Technical Manual—-

8-255, “Terminal Physical Examination

on Separation From Military Service,”

119, 121

12-222, “Separation Center Operations,”

118

12-235, “Discharge and Release From Active Duty,” 119

12-245, “Physical Reclassification Retirement and Retirement Benefits for Officers,” 115

Waring, James J., 33

W.D., A.G.O. Form No. 20, “Soldier’s Qualification Card,” 73, 85

W.D., A.G.O. Form No. 40-101,102

W.D., A.G.O. Form No. 55—102

W.D., A.G.O. Form No. 63, “Report of Physical Examination,” 99

Webbed fingers, 20

Webbed toes, 20

Weight, 49

Women’s Army Auxiliary Corps. See

Women’s Army Corps.
356 PHYSICAL STANDARDS

Women’s Army Corps, 56, 57-60, 63, 104, 107

dental requirements for enlisted women in,

50

neuropsychiatric examination for applicants for, 60

physical standards for, 58

policy on pregnancy in, 60

status of enlisted and officer personnel of,

58

strength of, 58

World War 1—2, 7, 8,14, 17, 26

admissions to hospitals for neuropsychiatric diseases in, 36

claims paid by Veterans’ Administration

on neuropsychiatric cases arising out of,

36

cost of hospitalizing neuropsychiatric patients in, 36

World War I—Continued

cost to Government of mental diseases in,

36

discharge rate for neuropsychiatric diseases in, 36

experience with tuberculosis in, 30, 31

experienceon spectacles in, 26

“remediables” in, 17

X-ray examination, 10, 35, 36

requirement for, 30-33

Yale University, 44

Zone of Interior, 67, 77, 80, 83, 85

spectacles, replacement of, for personnel

stationed in, 27

U.S. GOVERNMENT PRINTING OFFICE: 1967


History of the Medical Department, U.S. Army in World War II

DISTRIBUTION LIST

PHYSICAL STANDARDS IN WORLD WAR II

Active Army:

OSD (1)

OSA (1)

OUSofA (1)

ASA (FM) (1)

ASA (I&L) (1)

ASA (R&D) (1)

USAS (1)

DASA (1)

DCSPER (2)

ACSI (1)

DCSOPS (2)

DCSLOG (2)

ACSFOR (2)

AOSRC (1)

CARROTC (1)

CofF (1)

CINFO (1)

CNGB (1)

CLL (1)

CRD (1)

CMH (1)

TAG (1)

TIG (1)

TJAG (1)

TPMG (1)

CofCh (1)

Tech Stf, DA (1)

TSG (30)

MedBds (1)

USCONARO (2)

ARADCOM (1)

OS Maj Comd (2)

except

USAREUR (4)

SHAPE (2)

OS Base Comd (1)

Log Comd (2)

MOW (1)

Armies (3)

Corps (1)

Bde (1)

Div (2)

SFGp (1)

Med Gp (2)

Med Bn (1)

USATC (1)

USMA (3)

Svc College (2)

Br Svc Sch (1)

MFSS (5)

Med Spec Sch (2)

USAMEDS VSch (1)

Med Sec 6ENDEP (OS) (1)

MedDep (OS) (1)

Gen Hosp (5)

Named Army Hosp

(4)

USA Hosp

25-100 Beds (1)

100-500 Beds (2)

500-750 Beds (4)

MedCen (1) except

WRAMC (5)

BAMC (5)

WRAIR (5)

AFIP (5)

Def Log Spt Ceu (1)

Def Med Spt Oen (1)

USAPERSCEN (1)

USA Trans Tml Comd (1)

Army Terminal (1)

PG (1)

Med Lab (1)

USA Med R&D Units

Lab (1)

AFES (1)

Arsenals (1)

Med Fid Maint Shops (1)

DB (1)

Disp (1)

USA Corps (1)

MAAG (1)

Mil Msn (1)

JBUSMC (1)

Units under following

TOE’s:

8-500 Team AH (1)

8-510 (1)

8-551 (5)

8-581 (1)

Historical Unit, USAMEDS (900)

NG: State AG (1) Div (1).

U8AR: Log Comd (1) Div (1) TOE’s 8-500 Team AH (1) 8-510 (1) 8-551 (1) Med

Gp (2) Bde (1) USA Hosp (1).

Request copies remaining on hand after initial distribution be returned to The Historical Unit, U8AMED8, Forest Glen Section, Walter Reed Army Medical Center, Washington,D.C. 20012.

U.S. GOVERNMENT PRINTING OFFICE: 1967