78th Congress, 2d Session 
House Document No. 452 
REPORT OF THE COMMISSION OF PHYSICIANS 
APPOINTED TO EXAMINE THE REQUIRE- 
MENTS FOR ADMISSION TO THE ARMY, 
NAVY, AND MARINE CORPS 
MESSAGE 
FROM THE 
PRESIDENT OE THE UNITED STATES 
TRANSMITTING 
THE REPORT OF THE COMMISSION OF PHYSICIANS 
APPOINTED TO EXAMINE THE REQUIRE- 
MENTS FOR ADMISSION TO THE ARMY, 
NAVY, AND MARINE CORPS 
February 29, 1944.—Referred to the Committee on Military Affairs 
and ordered to be printed 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1944 MESSAGE FROM THE PRESIDENT 
To the Congress of the United States: 
I am sending herewith for the information of the Congress the 
report of the Commission of Physicians appointed to examine the 
requirements of admission to the Army, Navy, and Marine Corps. 
In addition to this report there are three rather voluminous appen- 
dixes. These, of course, should be made available to Senators and 
Representatives and any other person wishing to obtain the informa- 
tion there. 
I think that this report and these studies will be of definite interest 
to all. 
Franklin D. Roosevelt. 
The White House, February 29,19^. 
1 REPORT OF THE COMMISSION OF PHYSICIANS APPOINTED TO 
EXAMINE THE REQUIREMENTS FOR ADMISSION TO THE ARMY, 
NAVY, AND MARINE CORPS 
To the President : 
The Commission of physicians, appointed pursuant to Public Law 
197 of the Seventy-eighth Congress, convened January 6, 1944. The 
law assigned the Commission the duty of examining the physical, 
mental, and moral requirements for admission to the Army, Navy, and 
Marine Corps, and of recommending any changes therein, especially 
the establishment of special standards for men to be inducted for 
limited service which might be made without impairing the efficiency 
of the armed forces and have the effect of delaying as long as possible 
the induction of men living with their families. The Commission 
obtained factual data, comments, and opinions regarding numbers of 
men potentially available for induction, the numerical needs of the 
armed services for manpower, the rates and causes for rejection under 
the present requirements for admission, the types of duty for which 
men are needed by the armed services, and the possible effect of the 
current requirements for admission on claims for post-service benefits 
from appropriate civilian and military agencies of the Government 
and examined the requirements for admission to the Army, Navy, and 
Marine Corps in the light of this information. 
The Director of the Selective Service System discussed the numbers 
of men potentially available for induction, the rates and causes for 
rejection under the current requirements for admission to the armed 
services, and similar pertinent matters, in substance as follows: 
Total living registrants 22,138, 000 
In the armed forces: 
Inducted 6, 540, 000 
Enlisted t 2, 430, 000 
Disqualified after physical examination 3, 357, 000 
In process of classification, examination, or induction 1, 090, 000 
Deferred: 
Occupational reasons 3, 834, 000 
Dependency reasons 4, 645, 000 
Other reasons 152, 000 
Unclassified and unknown 90, 000 
Distribution of registrants, ages 18-37, as of Dec. 1,1943 
The group in the foregoing table shown as “In process of classifica- 
tion, examination, or induction” includes 43,000 men who have been 
found qualified for induction for limited service under present require- 
ments but whose services have not been required by the armed forces 
in this status. 
In addition to the men listed above, approximately 1,200,000 men 
reach age 18 each year. It can be expected that 240,000 of these will 
have entered one of the three services prior to their eighteenth birthday 
by voluntary enlistment in classifications which require a higher de- 
3 4 
REPORT OF COMMISSION OF PHYSICIANS 
gree of physical fitness than is required for induction for general serv- 
ice. As a result, the best material in this group physically does not 
appear for induction. Of those who do not enlist about 156,000 enter 
agriculture, and from the remajpder not more than 600,000 can be 
counted on for induction, since the rejection rate has been 25 percent. 
For some months past approximately 6 percent of registrants classi- 
fied as available for induction have been rejected as unfit by the local 
boards and, of the approximately 375,000 per month delivered to induc- 
tion stations, over 40 percent have been rejected after examination. 
An increase in these rejection rates can be expected as men in older 
age groups, men living with their families, are called up for induction. 
The leading principal causes for rejection of those in class IV-F 
have been mental disease, educational deficiency, syphilis, musculoske- 
letal conditions, and cardiovascular defects which together have ac- 
counted for approximately half of the registrants currently in class 
IV-F. 
A recent study on selected cardiovascular rejectees in five cities re- 
vealed that approximately IT percent of those registrants who were 
reexamined were qualified for general military service as defined by 
Army physical standards. It is estimated that perhaps 6 to 8 percent 
of all registrants currently in class IV-F would be found qualified for 
general service should a review of the whole IV-F group be under- 
taken. A program for a complete review has been formulated but has 
been held in abeyance pending the report of this Commission. In 
general, it provides for review of the folder of each of these men by 
his local board, review by the examining physician with final action 
if the disqualification is obvious, reference to medical advisory boards 
if necessary in doubtful cases, and delivery to the induction stations 
of only those men who seem likely to be accepted. 
The Assistant Chief of Staff, G-l, discussed the numerical needs of 
the Army for manpower and the types of duty for which these men are 
required, in substance as follows: 
The total authorized strength of the Army is 7,700,000 individuals. 
As of December 31,1943, there were 7,482,000, a deficit of 218,000. Part 
of this deficit was caused by the fact that in the last 4 months of 1943 
alone, inductions fell 211,000 (31 percent) short of planned call of 
675,000. After the Army reaches its authorized strength, there will 
be a continuing need for from 75,000 to 100,000 men per month to 
replace losses, and the majority of these men must be qualified for 
combat service. 
Under the present standards for general service the quality of the 
men is lower than is desirable, but this situation has been met by care- 
ful attention to personnel assignment. Even so, during the period 
from Pearl Harbor to October 31, 1943, 474,000 enlisted men were dis- 
charged from the Army because of physical or mental reasons. Of 
these approximately 300,000 were discharged on certificate of disabil- 
ity for discharge, the rest being discharged for inability to measure m> 
to required Army standards. Samples of those discharged on certifi- 
cate of disability for discharge show 40 percent were discharged during 
the first 6 months of service, 40 percent during the second 6 months, and 
20 percent after a year or more of service. Other statistical analysis 
shows that of those discharged on certificate of disability for discharge 
during the second quarter of the year 1943,44.6 percent were discharged 
because of neuropsychiatric disabilities. REPORT OF COMMISSION OF PHYSICIANS 
5 
These discharges are largely from combat organizations, and the 
men required by the Army as replacements from now on should be 
of the best possible physical caliber since they will all be potentially 
front-line troops. Not more than 10 percent of the strength of the 
Army can be composed of men who meet only the present standards for 
limited service. At the present time there are already more than 
500,000 men in the Army in this category. Not more than 300,000 
limited-service men can be profitably used in the service commands 
in this country and the remainder must be used in headquarters and 
similar installations overseas. During the period of expansion of the 
Army as many as 20 percent of the men offered for induction were taken 
under the qualifications for limited service, but at the present time only 
5 percent are being taken in this status, and this should not be in- 
creased. 
Until recently the Army’s effort in this country has been directed to 
mobilizing and training new organizations for combat service. These 
organizations are now completing their training and are moving over- 
seas. During the training period it was necessary to maintain many 
camps and posts and a considerable number of limited-service men 
were used for clerical, upkeep, and other overhead duties. As the 
trained organizations move on and these stations are put into a stand-by 
status, many of these limited-service men must be moved to new assign- 
ments. In the face of the decreasing number of assignments available 
for these men in the Army in this country, there is a steadily increasing 
number of men already in the Army who through injury or inci- 
dents of active operations become unfit for general service but who are 
able to render valuable service in a limited-service status. Such men 
are far more valuable to the Army because of their training and ex- 
perience than are men newly inducted from civil life, and there seems 
to be a moral obligation to permit them to continue to serve. Since 
the Army is limited in its total strength, induction of men from civil 
life in number sufficient to fill all the places available for men qualified 
only for limited duty might necessitate the discharge of these service 
casualties. 
The Army has recently announced a policy of returning men who 
have served overseas for long periods to the United States for duty 
when practical. This policy cannot be effected unless there are places 
in which men can be profitably employed. This would not be the case 
were all possible assignments in the United States filled by men 
physically fit for only limited duty. 
The Army has been aware of the potential manpower that exists in 
the group who have been rejected for educational deficiency. Tests 
have been placed in use by which men, who have native intelligence 
and ability to learn but who have not had the benefit of formal educa- 
tion, may be separated from those whose educational deficiency reflects 
inability to learn. 
The Army has accepted men who have the ability to learn and has 
established special training centers to which they are assigned. In 
these camps the men are taught to read and write up to the average 
fourth-grade level. This degree of education is necessary for the man 
to complete basic military training and is completed before the man 
is started on his basic training. Thus the length of time required to 
fit one of these men for actual service is increased over the time re- 
quired to bring the literate recruit to the same stage of military train- 6 
REPORT OF COMMISSION OF PHYSICIANS 
ing by the amount of time spent in his education. The maximum time 
required for the educational effort is 12 weeks. Since last June 75,000 
illiterate men have been accepted by the Army. Of this number 68 
percent have successfully completed the educational course and have 
been graduated into basic training for general service; 8 percent have 
been discharged; and 34 percent are at present under training. Illit- 
erates must be carefully selected for educational training, however, 
since the incidence of physical defects is high in this group. 
The Assistant Chief of Staff, G-l, concluded by stating that, in 
view of— 
{a) Present large losses from physical defects. 
(b) The small number of remaining limited-service positions 
to be filled. 
(c) The necessity for high-grade combat replacements from 
now on. 
(d) The time loss in taking in too many illiterates. 
that the present physical standards could not be lowered without 
impairing the efficiency of the Army. 
The Chief of Naval Personnel discussed the numerical needs of the 
Navy and the types of duty for which these men are required, in sub- 
stance as follows: 
The Navy has not reached its maximum requirements for manpower, 
and estimates as to total future needs must be tentative since the need 
of the Navy for men is in direct relation to the shipbuilding program. 
Since December 7, 1941, the Navy has progressively been forced to 
acquiesce in lowered physical standards in order to obtain the numbers 
of men it requires from the decreasing manpower pool. The Navy 
has always insisted, however, that, granting it a high priority both 
as to quantity and quality of the manpower resources available to the 
armed forces, constitutes the most effective measure to shorten the war. 
The peculiar conditions and requirements of naval life at sea will 
always make it imperative that personnel be of the highest physical 
qualifications available. Living conditions on board ship are totally 
different from on shore and necessitate a higher degree of physical 
fitness if efficiency is to be maintained during extended periods of sea 
duty. In addition to being able to withstand the rigors of seagoing 
life, naval personnel must not be unduly handicapped in the event they 
become separated from facilities for medical attention, as may occur in 
any type of sea duty. 
Crews of combat vessels must be versatile not only in their ability 
to perform their ordinary and routine daily task but also in their 
ability to perform combat duties under conditions requiring a high 
degree of coordination and teamwork. Regardless of their regularly 
assigned duties, all men aboard ship are potential combat personnel 
under battle conditions. It may be that particular jobs at sea can 
be performed temporarily by men of lesser physical qualifications, but 
since the final and ultimate test must be made under battle conditions 
which will require the highest performance attainable by physically 
qualified men, the daily needs must be fixed by the requirements of a 
few brief moments. Anything short of perfect performance cannot 
be tolerated at such a time. Failure to be constantly mindful of this 
may entrust crews of combat vessels to the uncertain performance of 
individuals whose performance in an emergency is limited by physical REPORT OF COMMISSION OF PHYSICIANS 
7 
handicaps. The existing requirements for admission to the Navy 
cannot be lowered without impairing efficiency. 
Much thought has been given to the increased use in the Navy of 
men of physical qualifications comparable to those for limited service. 
It is freely admitted that in the shore establishment of the Navy in 
the continental United States many of the billets are of such a nature 
that no undue physical hardships are involved. Routine is less severe 
than on board ship, and regular medical attention is always available. 
If no other considerations were involved, these billets could be filled 
by men of lowered physical standards, but the Navy is limited in its 
authorized strength, and all such limitations on total numbers pre- 
suppose a high degree of flexibility in assignment between shore and 
sea duty. Of the enlisted personnel ashore at the present time, ap- 
proximately 58 percent are qualified for general service, the majority 
of these being men in training for duty aboard ships now building. 
It is estimated that when the present contemplated strength of the 
Navy is reached, there will not be more than 23 percent of the enlisted 
personnel of the shore establishment qualified for sea duty. The 
Navy’s program for rotation of its personnel between sea and shore 
duty imposes definite limitations upon the possibilities of using men 
qualified only for limited service in these billets. It is necessary that 
men who have served at sea for extended periods be relieved from time 
to time and given duty ashore, not because they arewmot physically fit 
to continue at sea but in order to give them a respite from the harass- 
ing conditions of present-day operations in combat areas and to pre- 
vent deterioration in their physical and mental vigor. 
It is the policy of the Navy to retain in the service personnel who, 
as the result of incidents of the service, are physically qualified for 
only limited duty. It is probable that the number of men in this status 
will increase as the war progresses, and places within the authorized 
strength of the Navy must be available for them. These men are con- 
sidered of far more value to the Navy because of their training and 
experience than would be men of the same physical qualifications in- 
ducted from civil life. 
The construction battalions (Seabees) do not afford a place where 
men qualified for limited service could be used at the present time. 
During the mobilization of these battalions, large numbers of men 
skilled in the various trades were accepted who, because of age or 
physical condition, were not qualified for service in the Navy afloat. 
These battalions have now reached their authorized strength. Their 
needs in the future will be for replacements for attrition, and it is not 
anticipated that this number will be of significance. 
The Navy has recognized the necessity of eliminating as early as 
possible those recruits who could be reasonably expected to become 
neurospychiatric causalties under the rigorous conditions of combat 
service and has established a procedure for psychiatric screening of 
recruits during their first days at the naval training stations while 
they are undergoing basic training. This screening procedure has 
been in operation since the early days of mobilization. Even with the 
psychiatric examination at the induction stations followed by this 
screening procedure mistakes of exclusion and inclusion will occur in 
individual cases. It is believed, however, that the early elimination of 
prospective neuropsychiatric casualties saves valuable time and money 
for the Navy and restores the individuals to civilian status where they 
can be utilized in the war effort. At the present time discharges for 8 
REPORT OF COMMISSION OF PHYSICIANS 
physical disability constitute 69.9 percent of the total monthly dis- 
charges from the service. Discharges for neuropsychiatric disabil- 
ities constitute 30.1 percent of the total, and 46.0 percent of these are 
among individuals during their first 6 months of service. In addition 
to these discharges, 3.5 percent of all recruits received at naval train- 
ing stations are discharged as a result of the reexamination procedure. 
The Navy is accepting men whose education is below the fourth- 
grade level and is providing special training for them. Literacy 
training in which they are taught the elements of reading and writing 
in order that they may be able to discharge their duties in the Navy 
is conducted in conjunction with the recruit training. There are 
very few jobs in the Navy which can be filled by a complete illiterate, 
and it has been necessary to provide educational training for these men 
at the expense of purely naval training in order that their services may 
be utilized. The majority of illiterates are anxious to overcome their 
handicaps, and the educational program gives promise of considerable 
success. The fact, however, that additional time and personnel are 
required for the training of these individuals and the probability that 
they could not be used for other than the most elemental tasks leads 
to the belief that an extensive program for education of illiterates 
after induction into the Navy would not be profitable. 
The Administrator of Veterans’ Affairs discussed the possible ef- 
fects of the current requirements for admission on claims for post- 
service benefits, in substance as follows: 
Hospitalization of veterans of present war, authorized by the Veterans’ Administra■ 
tion, December 1941 through Nov. SO, 1943 
Admissions 
Total 
Average 
hospital 
days 
35,681 
Total discharges > __ _ 
25, 512 
34.1 
Service-connected: 
2,198 
2,185 
103.8 
56.9 
1,575 
610 
64.8 
36.4 
Other 
2,370 
34.9 
6,753 
64.4 
Non-service-connected: 
694 
4, 572 
38.8 
27.9 
Neuropsychiatric ... . 
Psychotic- 
1,696 
2,976 
34.1 
24.6 
General medical and surgical 
13,493 
20.7 
Total non-service-connected _ 
18, 759 
23.1 
Total remaining,* Nov. 30,1943 - 
9,688 
Hospital: 
Pulmonary tuberculosis 
2,007 
4,691 
2,871 
119 
Neuropsychiatric-- . 
General medical and surgical 
Domiciliary I - 
1 Includes 388 admissions to domiciliary care. 
5 Includes 381 discharges from domiciliary care. 
3 Because of changes in classification, admissions minus discharges will not equal patients remaining. REPORT OF COMMISSION OF PHYSICIANS 
9 
The number of discharges for neuropsychiatric disabilities, particu- 
larly those occurring in the first 6 months of service, is a cause for 
concern. In these cases, however, there has been rather consistent 
agreement after study in the hospitals of the Administration with the 
diagnoses established in the armed forces. 
All defects existing at the time of acceptance for service should be 
recognized and recorded since such recorded defects are not pension- 
able, unless aggravated by service. This recording would be particu- 
larly necessary should special physical standards be established for 
men for limited service. 
The Administrator of Veterans’ Affairs concluded by stating that, 
based on experience up to this time, it is evident that any lowering 
of the requirements for admission to the armed forces could be expected 
to increase the admission rate to facilities of the Veterans’ Admin- 
istration. 
The Commission gave careful study to the large and increasing 
group of registrants who have been disqualified after examination as 
a possible source from which men might be obtained by revision of 
the requirements for admission. It was apparent that neuropsychi- 
atric disabilities constitute a problem both in the numbers rejected for 
these causes at the induction stations and in the number who must be 
discharged within a comparatively short time after induction. A 
study of the reasons for the high incidence of neuropsychiatric dis- 
orders was not within the purview of the Commission. Every reason- 
able effort is made to recognize these conditions at the induction sta- 
tions, but in the limited time available for examination it is not possi- 
ble to recognize any but the most obvious. It is believed that the 
effectiveness of the psychiatric examination at the induction stations 
would be greatly enhanced if a properly taken social-adjustment his- 
tory of each registrant were available to the examiners. It is highly 
desirable that these potential neuropsychiatric casualties be rejected at 
the induction stations. Although they are not temperamentally suited 
for service in the armed forces, they are in practically all cases capable 
of making a real contribution to the war effort in civilian activities. 
Both the Army and Navy are using every reasonable means to rehabili- 
tate the neuropsychiatric case for further service, but in view of the 
mission of the services to prosecute the war, there is a point beyond 
which they should not go in expending time of personnel and use of 
training facilities for the possible salvage of individuals of very doubt- 
ful future value to the services. 
It appears that there may be a lack of understanding of the signifi- 
cance of neuropsychiatric conditions which lead to separation from 
the armed services in relation to the discharged man’s place in civil 
life. In the majority of cases the man’s basic temperament and per- 
sonality traits have not been altered by his service, and there is no ap- 
parent reason why he should not be expected to follow as gainful an 
occupation as he followed prior to his service. There is no doubt that 
these men can make a more valuable contribution to the prosecution of 
the war in a civilian status than in the armed services. 
Those rejected for deficiency in education comprise another large 
group to which special attention was given. It is evident that the 
armed forces have already given this group consideration as a source 
of manpower. They are accepting as many at the present time as is 10 
REPORT OF COMMISSION OF PHYSICIANS 
practical in view of the time and special personnel required to fit them 
for service. This pool of manpower, however, undoubtedly contains 
many men physically qualified for general service who could be in- 
ducted should provisions be made for their education to at least the 
minimum level necessary for duty in the armed forces. 
Another seemingly potential source of manpower lies in the men 
who have been rejected for defects such as herniae which are usually 
remediable by surgery or other treatment. The feasibility of induct- 
ing men with such conditions subject to correction after induction was 
explored. Such a procedure would permit the acceptance of these 
men, but it is not believed that it would be a practical undertaking. 
At the present time the hospitals of the services are practically all 
at capacity. Inauguration of a program of corrective surgery for 
inductees would require additional personnel and facilities which are 
not now available. Furthermore, should individuals with such defects 
be inducted and later refuse to submit to the indicated procedures, the 
services would be faced with the necessity of discharging them and the 
individuals would have acquired the rights to hospitalization and other 
benefits which current law provides for all persons who have served 
in the armed forces. 
Some time ago the services lowered the requirements for admission 
to permit the acceptance of men with conditions not requiring surgery 
for correction. Under these standards men are accepted with defective 
vision of a degree which requires lenses to afford usable vision, and 
lenses are furnished if the man is not already equipped. Absence of 
teeth is no longer a cause for rejection and literally thousands of men 
have been furnished dentures after induction. Uncomplicated 
gonorrhea and early syphilis are accepted and are treated during the 
training period. 
Extension of this program for correction of physical defects after 
induction is considered inadvisable at this time. 
The Commission has carefully studied Mobilization Regulations 1-9, 
United States Army, dated October 15, 1942, and subsequent changes, 
which contain the requirements for admission to the Army, Navy, and 
Marine Corps in effect in the induction stations for the examination 
of all registrants. This publication is attached as appendix I. Guided 
by the comments and opinions of those who appeared before it and in 
the light of the professional judgment of its members, the Commis- 
sion determined that certain changes should be made in these regula- 
tions. These changes are set forth in appendix II. A complete state- 
ment of requirements for admission to the armed forces for both gen- 
eral and limited service, which includes the changes the Commission 
has determined should be made in the current regulations, is submitted 
as appendix III, It is recommended that this appendix be made the 
standard by which the fitness of registrants for induction will be 
determined. 
The Director of Selective Service made the following comment fol- 
lowing a careful study of the changes which the Commission deter- 
mined should be made in the requirements now in effect for admission 
to the Army, Navy, and Marine Corps: 
It is noted that there has been a clarification of wording which may aid in the 
interpretation and evaluation of the standards for acceptance, especially in the 
field of nervous and mental diseases and in the cardio vascular system. There are REPORT OF COMMISSION OF PHYSICIANS 
11 
many minor changes, some of which lower and others raise the actual physical 
standards. These deviations from the present standards are minor in character 
and do not permit an exact estimate of the number of men who will be affected 
by these changes. The most favorable estimate would be that the result in addi- 
tional numbers inducted would not be significant. Hence, the maximum to be 
hoped for under these changes would be improvement of selection qualitatively 
with little result quantitatively. 
CONCLUSIONS 
The Commission has reached the following conclusions: 
1. The physical requirements for admission to the armed services 
cannot be reduced below those contained in appendix III with- 
out impairing the efficiency of these services. 
2. The services have reached saturation for newly inducted men for 
limited service since the need for men in this category will be 
fully met by men already in service who as a result of incidents 
of the service are no longer fit for general service. 
3. It is evident that the urgent and increasing need of the services 
today is for men for general service and that this need will pro- 
gressively increase until the war is successfully concluded. 
4. It is apparent that these needs cannot be met by lowering the 
physical requirements for admission to the armed forces or by 
increasing the induction of men for limited service. 
5. In view of the needs of the armed services for men qualified for 
general service, which needs cannot be fully met from the pool of 
men now on hand in class I-A plus the annual increment of 
men coming of military age, it is apparent that the manpower 
required for the prosecution of the war cannot be obtained except 
by induction of men living with their families and recourse to 
all other available sources. 
Respectfully submitted. 
Ross T McIntire, 
Rear Admiral, Medical Corps, United States Navy, 
Norman T. Kirk, 
Major General, Medical Corps, United States Army. 
Dr. Frank H. Lahey, 
Dr. Edward Strecker, 
Dr. Alan C. Woods. 
Chairman. APPENDIX I 
MOBILIZATION REGULATIONS 
No. 1-9 
STANDARDS OF PHYSICAL EXAMINATION DURING 
MOBILIZATION 
WAR DEPARTMENT 
Washington, October 15,1942 
13 MR 1-9 
C 2 
STANDARDS OF PHYSICAL EXAMINATION DURING 
MOBILIZATION 
Changes 1 
No. 2 J 
WAR DEPARTMENT, 
Washington, February 23, 1943. 
MR 1-9, October 15, 1942, is changed as follows; 
45. Limited service.—a. Rescinded. 
d. Rescinded. 
order of the Secretary of War : 
[A. G. 381 (1-26-43).] (C 2, Feb. 23, 1943.) 
Gr. C. MARSHALL, 
Chief of Staff. 
Official : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
15 
9G050—44 2 Mil 1-9 
o i 
STANDARDS OF PHYSICAL EXAMINATION DURING 
MOBILIZATION 
Changes 
No. 1 
WAR DEPARTMENT, 
Washington, January 22, 1943. 
MR 1-9, October 15, 1942, is changed as follows: 
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. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
8. Nonacceptable. 
&. Active tuberculosis of any degree. 
g. Acute rheumatic fever or authentic history of recurrent attacks of rheumatic 
fever, chronic rheumatism and chronic arthritis. 
h. Active osteomyelitis of any bone or a substantiated history of osteomyelitis 
of any of the long bones of the extremities at any time. 
o. Hernia, except small umbilical hernia. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
17. Limited service. 
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 20/100 corrective to not 
less than 20/20. 
c. Rescinded. 
d. Rescinded. 
18. Nonacceptable.—Defects such as the following 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
q. Permanent or well-marked strabismus. 
r. Ptosis interfering with vision. 
s. Trichiasis. 
t. Chronic conjunctivitis. 
u. Chronic dacryocystitis. 
v. Pterygium interfering with vision. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
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 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 registrant and close one of his own ears in the same way as a control. The 
assistant will use a whispered voice produced by speaking with the lungs in 
a state of complete exhalation so as to assure as great uniformity of sound 
output as possible. The whisper will be plainly audible to the examiner and 
use will be made of numerals, names of places, or other words or sentences, 
17 18 
REPORT OF COMMISSION OF PHYSICIANS 
until the condition of the registrant’s hearing is evident. The acuity of hear- 
ing will be expressed as a fraction, the numerator of which is 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 a degree indicated by the fraction, that is, 
the registrant hears at 10 feet distant the words which the normal ear hears 
at 15 feet. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
23. General service.—a. Hearing in each ear of 8/15 or better. 
24. Limited service.—a. 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. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
6. Rescinded, 
c. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
25. Nonacceptable.—Defects such as— 
c. Perforation of the membrana tympani. 
d. Acute or chronic mastoiditis. 
e. Total loss of an external ear. 
f. Atresia of the external auditory canal, or tumors of this part. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
27. General service. 
c. Rescinded. 
f. Rescinded. 
g. Rescinded. 
h. Rescinded. 
i. Rescinded. 
28. Limited service.—a. Deviation of the nasal septum which moderately 
Interferes with nasal breathing. 
b. Hay fever, if moderate. 
c. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
29. Nonacceptable.—Defects such as— 
d. Tracheostomy. 
i. Nasal obstruction due to septal deviation, hypertrophic rhinitis, or other- 
causes, if sufficient to produce mouth breathing. 
/. Chronic laryngitis, 
m. Perforation of the hard palate. 
Stricture or other organic disease of the esophagus, 
o. Harelip. 
[A. G, 381 (1-20-43).] (C 1, Jan. 22, 1943.) REPORT OF COMMISSION OF PHYSICIANS 
19 
p. Perforation of the nasal septum associated with interference of function, 
or ulceration or crusting, and when due to organic disease. 
35. Limited service.—There are no skin ci’iteria to warrant initial selection 
for limited service. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
38. Limited service.—There are no head defects to warrant initial selec- 
tion for limited service. 
[A. G. 381 (1-20-43),] (C 1, Jan. 22, 1943.) 
41. Limited service. 
b. Rescinded. 
c. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
42. Nonacceptable.—Conditions such as— 
a. Tuberculosis, either active or healed. 
b. Osteoarthritis. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
44. General service.—a. Old or recent fractures which have healed normally 
with no resulting impairment of function. 
6. Rescinded, 
c. Rescinded. 
g. Rescinded. 
i. Stiff fingers of a degree not to interfere with function. 
j. 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. 
q. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
45. Limited service.—a. Loss of entire thumb of either hand. 
b. Loss of two entire fingers of either hand, not to include the right Index 
finger, provided the thumb remains. 
c. Webbed fingers or toes, if severe in degree. 
d. Rescinded. 
f. Rescinded. 
n. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
46. ISTonacceptable.—Defects such as— 
a. Loss of one or both thumbs. 
I). Loss of the right index finger or more than two entire fingers of one hand. 
c. Tuberculosis of a bone or joint. 
d. Old ununited fractures. 
j. 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 20 
REPORT OF COMMISSION OF PHYSICIANS 
the astragalus are disqualifying regardless of the presence or absence of sub- 
jective symptoms. 
r. Active osteomyelitis of any bone, or a substantiated history of osteomyelitis 
of any of the long bones at any time. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
56. General service. 
/. Healed intrathoracic primary tuberculous lesions, demonstrable in roentgeno- 
grams, but of slight extent. The following specifications of the limits of such 
lesions are intended to exclude persons with disease which is most likely to be in 
part caseous and therefore potentially hazardous. The limits are set arbitrarily to 
provide an objective basis on which the examiner may render a decision. All 
measurements refer to single, standard 14- by 17-inch direct projection roent- 
genograms. These lesions may consist of—. 
(1) 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 of such lesions does not exceed five. 
(2) Calcified lesions of the pulmonary parenchyma, provided the total 
number of these does not exceed ten. One of these may equal but 
not to exceed 1 cm in diameter, but none of the remainder may ex- 
ceed 0.5 cm in diameter. In the roentgenogram such calcified lesions 
should appear isolated, sharply circumscribed, homogeneous, and 
dense. 
The above arbitrary limits of calcified lesions are set on the assumption that 
large and numerous lesions are more likely to be partially unhealed, and there- 
fore a potential source of future recrudescence, than small lesions of limited 
distribution. It is recognized, however, that in some individuals calcified tuber- 
culous lesions exceeding these limits may be present which are so well healed that 
the possibility of future reactivation is remote. Further consideration may be 
given to the acceptability of persons with calcified lesions of this type when the 
state of health in all other respects clearly warrants the opinion that the lesions 
In question are healed. In such cases the history of the applicant and his age, 
as well as the character of the lesions as seen in X-ray films, provide criteria for 
estimating the probability of complete arrest of the tuberculous process. If there 
Is no history of active tuberculosis or symptoms which might be interpreted as evi- 
dence of this disease and if the applicant is more than 25 years of age, and if 
finally the calcified lesions seen are dense and discrete in character and not hazy 
or irregular in outline, such lesions may be considered as not prejudicial to future 
health. In these cases the applicant may be accepted provided the report of 
physical examination and the chest X-ray films have been reviewed and accept- 
ance has been recommended by a medical examiner specially qualified in the 
diagnosis of diseases of the chest. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
57. Limited service. 
6. Rescinded. 
[A. G. 381 (1-20-43).] (C I, Jan. 22, 1943.) 
58. Nonacceptable.—Disqualifying defects such as— 
a. Tuberculosis of the lungs or tracheobronchial lymph nodes except as defined 
In paragraph 56f and b below. REPORT OF COMMISSION OF PHYSICIANS 
21 
&. 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 a total area 
of 5 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 6 months. It must be rec- 
ognized 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 a greater likelihood of reactivation of a lesion that appears to he 
stable in persons under 25 years of age than in older persons. 
e. Chronic bronchitis. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
62. General service. 
0. A pulse x'ate of not lower than 50 per minute. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
68. General service. 
o. Rescinded. 
d. Rescinded. 
e. Rescinded. 
f. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
69. Limited service.—There are no defects of the abdominal organs or wall 
to warrant initial selection for limited service. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
70. Nonacceptable.—Defects such as—• 
0. Ulcer of the stomach or duodenum, if diagnosis is confirmed by the usual 
laboratory procedures or authentic medical history, also authentic history of 
gastric or duodenal ulcer. 
[A. G. 381 (1-20-43).] (C 1. Jan. 22. 1943.) 
72. General service. 
6. Rescinded. 
o. Mild albuminuria without casts which is proved by observation and repeated 
examination to be temporary in character or orthostatic in type. 
f. Rescinded. 
g. Rescinded. 
h. Rescinded. 
73. Limited service. 22 
REPORT OF COMMISSION OF PHYSICIANS 
c. Rescinded. 
d. Rescinded. 
[A. G. 381 (1-20-48).] (C 1. Jan. 22, 1943.) 
74. BTonacceptable. 
u. Undescended testicle which lies within the inguinal canal. 
v. Absence of one kidney. 
w. Amputation of the penis. 
[A. G. 381 (1-20-43).] (C 1. Jan. 22, 1943.) 
1943.) 
76. General service. 
c. Rescinded. 
d. Rescinded. 
e. Rescinded. 
[A. G. 381 (1-20-43).] (C 1. Jan. 22, 1943.) 
84. Limited service—There are no neurological disorders which warrant 
initial selection for limited service. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22, 1943.) 
91. Limited service.—a. Rescinded. 
[A. G. 381 (1-20-43).] (C 1, Jan. 22 
1943.) 
102. Bed wetting.—Bona fide enuresis substantiated by a physician’s affidavit 
or other acceptable documentary evidence is cause for unconditional rejection. 
[A. G. 381 (1-20-43).] (C 1. Jan. 22. 1943.) 
obdek of the Secretary of War 
G. O. MARSHALL, 
Chief of Staff, 
Official 
J. A. ULIO, 
Major General, 
The Adjutant General. REPORT OF COMMISSION OF PHYSICIANS 
23 
*MR 1-9 
1 
MOBILIZATION REGULATIONS 
No. 1-9 
WAR DEPARTMENT, 
Washington, October 15, 1942. 
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 31-33 
Till. Skin 34-36 
IX. Head 37-39 
X. Spine, scapulae, and sacroiliac joints 40-43 
XI. Extremities 44-47 
XII. Neck 48-50 
XIII. Lungs and chest wall 51-59 
XIV. Heart, blood vessels, and circulation 60-67 
XV. Abdominal organs and wall 68-71 
XVI. Genito-uriuary organs and venereal diseases 72-75 
XVII. Endocrine and metabolic disorders 76-78 
XVIII. Diseases of blood and blood-forming tissues 79-81 
XIX. Neurological disorders 82-86 
XX. Psychoses, psychoneuroses, personality disorders 87-93 
XXI. Purposely caused physical defects 94 
XXII. Malingering 95-103 
Index 45 
Section I 
INFORMATION AND INSTRUCTIONS 
Paragraph 
Purpose 1 
Publication 2 
Objective 3 
Physical classification 4 
Defects not specifically mentioned in these regulations and hospitalization 5 
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. 
(2) Prescribe permissible deviations from the general service standards 
for limited military service. 
(3) Describe deviations from the above standards which are not accept- 
able for any class of military service. 
*This pamphlet supersedes MR 1-9, March 16, 1942, including section V, Circular No. 92, 
War Department, 1942. 24 
REPORT OF COMMISSION OF PHYSICIANS 
6. So far as it applies to enlisted men AR 40-105 is superseded by these regu- 
lations. These regulations will apply to men in the following categories: 
(1) Men enlisted or reenlistgd 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. 
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 a 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 a guide to their discretion 
and not construe them too strictly or arbitrarily. The examination will be car- 
ried out with the utmost care in order that no individuals who are unfit for 
service will be accepted, only to be discharged within a 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 a registrant is accepted for 
general military duty but who, nevertheless, has a 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 gen- 
eral military service. Registrants will be recommended for assignment for gen- 
eral service if they meet the requirements therefor throughout the entire physical 
examination. 
b. Limited service.—Physically unfit for general military service, but fit 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 examina- 
tion will be recommended for assignment to limited service unless, because of 
multiple defects, the medical examiners recommend unqualified rejection as non- 
acceptable. Men recommended as nonacceptable will not be accepted unless spe- 
cific directions to that effect have been issued by the War Department. 
o. Nonacceptable.—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. 
5. Defects not specifically mentioned in these regulations and hospitaliza- 
tion.—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 REPORT OF COMMISSION OF PHYSICIANS 
25 
for general service or for limited service, as the case may be. A brief statement 
of the reasons for the rejection will be entered on the report of physical exami- 
nation. Lo far as practicable, however, the physical classification of individuals 
tvill conform to the specified requirements. 
h. Hospitalization for a period not to exceed 3 days for men whose physical 
fitness for military service cannot be determined without hospital study is au- 
thorized. Military or other Government hospitals will be used for this purpose 
when practicable. When military or other Government hospitals are not avail- 
able the use of civilian hospitals is authorized. Individuals idll not he hospital- 
ized ichen their 'fitness for military service can he 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 
General service 6 
Limited service 7 
Nonacceptable 8 
Paragraph 
6. General service.—a. Acute communicable diseases, provided acceptance of 
the individual is temporarily deferred until a final examination shows recovery 
without disqualifying sequelae. Individuals with uncomplicated venereal disease 
will not be accepted until instructions for their acceptance have been issued by 
the War Department. See paragraph 72a. 
b. Malaria, acute, or malaria, chronic, unless severe. 
c. Uncinariasis, unless severe. 
d. Remediable incapacity due to recent acute illness, surgical operation, in- 
jury, employment or environment in civil life, provided acceptance is deferred 
until recovery is complete. Following any major surgical operation an indi- 
vidual will be deferred for a sufficient period of time to insure complete recovery 
without sequelae. The minimum period of deferment following a major surgical 
procedure will be at least 3 months. The actual period of deferment* longer 
than 3 months will depend upon the condition for which operated and upon 
the discretion of the medical examiners. 
7. Limited service.—Temporary incapacity as cited in paragraph Qd, if not 
easily remediable to a degree compatible with general service but which is con- 
sidered acceptable for limited service. 
8. Nonacceptable.—a. Carcinoma or other malignant disease of any organ 
or part of the body. 
b. Active tuberculosis of any degree, either general or localized. 
c. Leprosy or actinomycosis. 
d. Late syphilis affecting the cerebrospinal or cardiovascular system or the 
viscera. 
e. Chronic metallic poisoning, except argyria. 
/. Mycotic infection of the lungs of other internal organs. 
g. Acute rheumatic fever or history of recurrent attacks of rheumatic fever, 
chronic rheumatism and chronic arthritis, if occurrence is verified and malin- 
gering is excluded. 
h. Active osteomyelitis of any bone or a substantiated history of osteomyelitis 
of any of the long bones of the extremities within the past 5 years. 26 
REPORT OF COMMISSION OF PHYSICIANS 
i. Filariasis or trypanosomiasis. 
j. Hodgkin’s disease. 
1c. Uncinariasis, if severe. 
l. Malaria, chronic, severe. 
m. Splenectomy for any cause, other than trauma or congenital hemolytic 
icterus. 
n. Leukemia. 
Section III 
HEIGHT, WEIGHT. AND CHEST MEASUREMENTS 
Table of standard and minimum acceptable measurements of height, weight, and 
circumference of chest 9 
Directions for taking height 10 
General service- 11 
Limited service 12 
Nonacceptable 13 
General considerations 14 
Paragraph 
9. Table of standard and minimum acceptable measurements of height, 
weight, and circumference of chest. 
Height 
Standard 
Minimum 
Weight 
Chest measure- 
ment at ex- 
piration 
Weight 
Chest measure- 
ment at ex- 
piration 
Inches 
Pounds 
Inches 
Pounds 
Inches 
60 
116 
31% 
105 
28% 
61 
119 
31% 
107 
29 
62 
122 
31% 
109 
29% 
63 
125 
32 
111 
29% 
64 
128 
32% 
113 
29% 
65 
132 
32% 
115 
30 
66 
136 
32% 
117 
30% 
67 
140 
33 
121 
30% 
68 
144 
33% 
125 
30% 
69 
148 
33% 
129 
31 
70 
152 
33% 
133 
31% 
71 
156 
34 
137 
31% 
72 
160 
34% 
141 
31% 
73 
164 
34% 
145 
32 
74 
168 
34% 
149 
32% 
75 
172 
35 
153 
32% 
76 
176 v 
35% 
157 
32% 
77 
180 
35% 
161 
33 
78 
184 
35% 
165 
33% 
10. Directions for taking1 height.—Use a board at least 2 inches wide by 
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 
square board of about 6 by 6 by 2 inches, best permanently attached to graduated 
board by a long cord. The individual should stand erect with back to the gradu- 
ated board, eyes straight to the front. REPORT OF COMMISSION OF PHYSICIANS 
27 
11. General service.—a. Those who fall within the requirements for height, 
weight, and chest measurement given in the table in paragraph 9. 
h. 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 circum- 
ference given in the table, who are otherwise mentally and physically fit, and who 
do not fall within the nonacceptable class may be accepted for limited military 
service. 
13. Nonacceptable.—a. Less than 60 inches in height. 
6. Less than 105 pounds in weight. 
o. A 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. Individuals of 76 inches or more in height 
will be studied for the possibility of gigantism or acromegaly. 
6. Examining physicians will use discretion and judgment in accepting regis- 
trants with variations in the ratio of height, weight, and chest measurements 
indicated in the table. 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 may be accepted, however, 
whose weight is less than 105 pounds. 
Section IV 
EYES 
Paragraph 
Vision 15 
General service 16 
Limited service 17 
Nonacceptable 18 
Visual tests for detection of malingerers 19 
Other methods of examination 20 
15. Vision.—Visual acuity will be determined by standard methods. Exam- 
ine each eye separately, without glasses, covering the other eye with a 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 a 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. For general military service in all arms and serv- 
ices.—Registrants whose visual acuity is not less than 20/200 in each eye without 
glasses, if correctible to at least 20/40 in each eye. The actual possession of 
suitable glasses by an individual is not required for his acceptance under these 
standards. 
b. 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. 28 
REPORT OF COMMISSION OF PHYSICIANS 
c. Nystagmoid movements if not persistent or pronounced and if true nystagmus 
Is excluded. 
d. Slight conjunctivitis. 
e. Chronic simple conjunctivitis, if mild. 
f. Slight adhesion of the lids to the eyeball. 
g. Small pterygium not encroaching on cornea. 
h. Strabismus which does not interfere with vision. 
i. Ptosis which does not interfere with vision. 
J. Color blindness. 
k. Exophthalmos, if not of such degree as to have led to or threatened corneal 
Ulceration and provided hyperthyroidism is excluded. 
l. Blepharitis marginalis, if slight. 
m. Blepharospasm, if mild. 
n. Superficial corneal ulcer, provided acceptance is deferred until ulcer is healed 
Without disqualifying impairment of vision. 
17. Limited service.—a. A minimum vision of 20/400 in one or both eyes 
without glasses if eorrectible with glasses to at least 20/40 in each eye. 
6. 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 eorrectible to not less than 
20/40. 
o. The following conditions, if mild: 
(1) Inversion and eversion of the eyelids. 
(2) Ptosis interfering with vision. 
(3) Trichiasis. 
(4) Strabismus interfering with vision. 
(•5) Epiphora. 
(6) Chronic blepharitis, 
(7) Pterygium encroaching on cornea. 
(8) Chronic dacryocystitis. 
(9) Diplopia due to paralysis of ocular muscles of one eye. 
(10) Blepharospasm. 
d. Conjunctivitis, chronic, simple, moderate. 
18. Nonacceptable.—Defects such as the following; 
а. Vision less than the minimum requirements for limited military service. 
б. Deformity of the eyelid or eyelids such as inversion or eversion of a degree 
that forcible closure fails to cover the eyeball or in which there is a resultant 
conjunctival inflammation, corneal irritation, or a restriction of the rotation of 
the eyeball. 
c. Disfiguring cicatrices of eyes. 
d. Lagophthalmos, if associated with signs of hyperthyroidism. 
e. Pronounced exophthalmos. 
f. Chronic keratitis. 
g. Chronic recurrent inflammatory disease of the globe. 
h. Chronic ulcer of cornea. 
i. Any active disease of the retina, choroid, or optic nerve. 
j. Detachment of the retina. 
k. Nystagmus. 
l. Glaucoma. 
m. Diplopia due to paralysis of extrinsic ocular muscle unless mild in degree. REPORT OF COMMISSION OF PHYSICIANS 
29 
n. Abnormal condition of eyes due to disease of the brain. 
o. Trachoma. 
p. Any tumor of the orbit. 
q. Permanent or well-marked strabismus of a severe degree. 
19. Visual tests for detection of malingerers.—a. Malingerers may feign In- 
ability 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. 
6. 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 a normal acuity of vision or may exaggerate a 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 be hesitant or 
evasive. Careful observation will be made of his conduct and every movement 
noted. The nature of the man’s answer will be taken into account and considered 
in the light of the kind of reply that is given when a nonmalingerer is being 
examined. 
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°. 
(8) Opthalmoscope (electric battery in handle). 
(4) Condensing lens. 
(5) Loupe. 
(6) Red and green letters on glass: 
(a) Letters varying in size. 
(ft) Spectacle frame containing red and green glasses. 
(7) Special test cards, one a duplicate, with letters reversed to use with a 
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 1% inches wide. 
(13) Three disks of polaroid 36 mm in diameter and 2 mm thick. 
e. The principle involved in the polaroid test is that light polarized in any 
given meridian by a 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 2 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 30 
REPORT OF COMMISSION OF PHYSICIANS 
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 a short period at a 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) A 6° prism, base down, is placed before the admittedly sound eye 
while the man looks at a 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) A 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. 
(3) The alleged “blind” eye is covered. A prism of 10°, with the apex up, 
is placed before the “seeing” eye in such a 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 indi- 
vidual to read a row of special red and green letters on glass through a 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 a low-plus 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 a ruler about lAA inches wide vertically midway 
between the two eyes at about 4 to 5 inches’ distance; direct the man to read 
from a printed page with lines at least 4 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 will be made: 
(a) Oblique examination.—A careful examination of the cornea will be 
made with the aid of a condensing lens and a loupe. 
(&) 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. 31 
REPORT OF COMMISSION OF PHYSICIANS 
h. To verify partial loss of vision in one or doth eyes.—(1) The most common 
manifestation of malingering takes the form of a statement that one eye is 
imperfect. Men pleading this disability may be divided into two classes: 
(a) Those who pretend to have a visual defect. 
(ft) Those who are aware they have a 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 a 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 20 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 a 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. 
'(6) 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 an individual to differentiate be- 
tween a dime and a penny, a cigarette and a pencil, a pen and a 
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 a trial frame upon the man’s face add put before 
the sound eye a high convex lens (+16D) and before the “weak” eye a plane or 
weak lens (0.25) which will not interfere with vision. If letters placed at a 
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 a report of his vision must 
be made, and then to postpone further examination until after the 
next few individuals have been examined. 
(5) 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 
9G050—44 3 32 
REPORT OF COMMISSION OF PHYSICIANS 
cannot be accounted for objectively and the vision is brought from 
20/100 to 20/50 or 20/30 by means of a low-plus or minus glass, the 
man is malingering. 
(9) Retinoscopy.—Look for corneal and lenticular opacities and estimate 
refractive errors. 
o. 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 be investigated with the appli- 
cation of the ordinary tests as if they were genuine and with every precaution 
taken to guard against a serious nerve lesion being overlooked. 
Section Y 
EARS 
Examination for disease 21 
Determination of auditory acuity 22 
General service 23 
Limited service 24 
Nonacceptable 25 
Tests for malingering in hearing 26 
Paragraph 
21. 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 
or by a 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 low conversational voice test. To determine the acuity of hearing, place 
the individual 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 individual cannot hear the words at 20 feet, the assist- 
ant will 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 individual and. close one of his own ears in the same way as a 
control. The assistant will speak in a low conversational voice (not a whisper), 
just plainly audible to the examiner, and will use numerals, names of places, or 
other words or sentences until the condition of the individual’s hearing is evident. 
The acuity of hearing will be expressed in a fraction, the numerator of which is 
the distance in feet at which the words are heard by the normal ear; thus 20/20 
indicates a normal hearing, 10/20 partial hearing of a degree indicated by the 
fraction, that is, the individual only hears at 10 feet distance the words which 
a 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 individual may be blindfolded and a watch used to determine the dis- REPORT OF COMMISSION OF PHYSICIANS 
33 
tance at which it can be heard, care being taken that the individual does not 
know the distance from the ear at which it is being held. The watch if used will 
be one whose ticking strength has been tested by determining the distance at 
which it can be heard by a normal ear. 
23. General service.—a. 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. 
b. Healed scar of mastoid operation without marked deformity and if hearing 
is not below requirements. 
24. Limited service.—a. Hearing in one or both ears less than 10/20 but not 
less than 5/20. Complete deafness in one ear if the hearing is not less than 
10/20 in the other ear. 
b. Loss of one or both external ears if the individuals have followed a useful 
vocation in civil life. 
c. Perforation of the membrana tympani provided there is a trustworthy 
history of no symptom of otitis media or disease of mastoid during preceding 
2 years. 
25. Honacceptable.—Defects such as— 
a. Hearing less than the minimum hearing prescribed under limited service. 
b. Chronic purulent otitis media with or without mastoiditis. 
26. Tests for malingering in hearing.—Individuals who are malingerers in 
regard to hearing usually claim magnification of slight imperfection on one side 
with a 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 a skilled assistant and 
all communications between them will be in a low, whispered voice. 
b. The assistant will stand at the back of the suspected malingerer pnd 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 a 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 a 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 he applied 
to the normal ear is occluded by clamping with a hemostat and the earpieces are 
placed in the ears of the blindfolded suspect. The examining physician speaks 
in a 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 a normal ear is tightly 34 
REPORT OF COMMISSION OF PHYSICIANS 
packed with absorbent cotton, it will still conduct sound waves to a limited degree, 
a loud-ticking watch even under these circumstances being heard about 1 or 2 
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 1 meter, he 
is malingering. 
i. The Chiman-Moos test is made with the C2 tuning fork. The vibrating tun- 
ing 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 perceive the sound of 
the fork when thus placed on the vertex of the skulk 
Section YI 
MOUTH, NOSE, FAUCES, PHARYNX, TRACHEA, ESOPHAGUS, AND 
LARYNX 
General service 27 
Limited service 28 
Konacceptable 29 
Use of diagnostic aids 30 
Paragraph 
27. General service.—a. Enlarged tonsils. 
6. Adenoids. 
c. Small benign tumors of the nasal and buccal mucous membrane. 
d. Deviation of the nasal septum or enlarged turbinates which do not seriously 
Interfere with nasal breathing. 
e. Acute primary sinusitis, provided the acceptance of the individual is de- 
ferred for reexamination until after a reasonable time has elapsed and the sinusitis 
has disappeared. 
f. Laryngitis manifested by hoarseness, laryngeal cough, and congestion of the 
Vocal chords as confirmed by laryngoscopy, unless tuberculous, syphilitic, or 
malignant in origin. 
g. Alleged stricture of the esophagus which is unattended by evidence of organic 
disease of the esophagus as shown by a fluoroscopic examination while the indi- 
vidual is swallowing a barium mixture. 
h. Perforation of hard palate which is not associated with a disqualifying dis- 
ease and does not seriously interfere with speech. 
i. Moderate deformity of the structures of the mouth which does not seriously 
interfere with mastication or speech. 
j. Hay fever, if mild. REPORT OF COMMISSION OF PHYSICIANS 
35 
28. Limited service.—a. Deviation of the nasal septum which markedly in- 
terferes with nasal breathing. 
6. Hay fever, if moderate. 
c. Nasal polypi, if mild or moderate and not accompanied by evidence of chronic 
sinus disease. 
29. Nonacceptable.—Defects such as— 
a. Deformities of the mouth, throat, and nose which interfere with mastication 
of ordinary food, with speech, or with breathing. 
&. Destructive syphilitic disease of the mouth, nose, throat, larynx, or esophagus. 
c. Laryngeal paralysis due to any cause. 
d. Permanent tracheostomy. 
e. Stricture of the esophagus. 
f. Chronic sinusitis of the accessory sinuses of the nose. (This diagnosis will 
be established by the presence of a chronic 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 of the larynx. 
i. Nasal polypi, if severe, 
j. Aphonia. 
k. Hay fever, if severe. 
30. Use of diagnostic aids.—Examining physicians will make use of laryn- 
goscopy, 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 diagnostic aids are 
indicated. 
Section VII 
DENTAL REQUIREMENTS 
General service 31 
Limited service 32 
Nonacceptable 33 
Paragraph 
31. General service.—a. Individuals who are well nourished, of good muscu- 
lature, are free from gross dental infections, and have a minimum requirement 
of an edentulous upper jaw and/or an edentulous lower jaw, corrected or cor- 
rectible by a full denture or dentures. 
6. Malocclusion.—When it is evident from the individual’s general physical 
condition that his malocclusion has not seriously interfered with the mastication 
of a 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 classifica- 
tion 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. 
6. Extensive loss of oral tissue in an amount that would prevent replacement 
of missing teeth by a satisfactory denture. 36 
REPORT OF COMMISSION OF PHYSICIANS 
Section VIII 
SKIN 
Paragraph 
General servi ce 34 
Limited service 35 
Nonacceptable 30 
34. General service.—a. Acute nonexanthematous and noncommunicable dis- 
eases of the skin which ordinarily run a temporary course. 
6. 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 of packs or by other military equipment.) 
(2) Anomalies of pigmentation. 
(3) Scars not extensive, disfiguring, nor incapacitating in character. 
(4) Warts. 
(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. 
(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. 
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 XXI. 
e. True alopecia areata, provided the existence of disqualifying endocrine, 
neurological, or other disqualifying conditions are excluded. 
35. Limited service.—Such conditions as chronic diseases of the skin of the 
type which disqualify for general military service, provided the individual has 
successfully followed a useful vocation in civil life. 
36. Nonacceptable.—Serious or incapacitating skin disorders such as— 
а. 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 a soldier 
or so disfiguring as to render the individual objectionable in common social 
intercourse. 
б. Actinomycosis. 
c. Dermatitis herpetiformis of long duration. 
d. Epidermolysis bullosa. 
e. Generalized dermatitis of long duration. 
f. Allergic dermatoses, if severe. 
g. Mycosis fungoides. 
Ji. Chronic pemphigus. 
i. Lupus vulgaris. 
j. Elephantiasis. 
k. Ringworm, if very severe and not easily remediable. REPORT OF COMMISSION OF PHYSICIANS 
37 
l. Scabies, if very severe anti not easily remediable. 
m. Cysts and benign tumors of the skin of such size and/or location as to inter- 
fere with the normal wearing of military equipment. 
n. Pilonidal cyst or sinus. (If there is only a simple dimpling of the skin or 
short simple sinus in the postanal region, the individual will be accepted for 
general service.) 
Section IX 
HEAD 
Paragraph 
General service 37 
Limited service 38 
Nonacceptable 39 
37. General service.—a. Moderate deformities of the bones of the skull such 
as depi’essions, exostoses, etc., unassociated with evidence of disease of the brain, 
spinal cord, or peripheral nerves and not preventing the individual from wearing 
military headgear. 
1). 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 3 months.) 
38. Limited service.—Osseous defects due to decompression or trephine of 
the skull, if asymptomatic and unassociated with bulging at the site of operation. 
39. Uonacceptable.—a. Deformities of the skull in the nature of depressions, 
exostoses, etc., of a degree which would prevent the individual from wearing 
military headgear. 
ft. Deformities of the skull of any degree associated with evidence of disease 
of the brain, spinal cord, or peripheral nerves. 
Section X 
SPINE, SCAPULAE, AND SACROILIAC JOINTS 
General service 40 
Limited service 41 
Nonacceptable 42 
X-ray examination 43 
Paragraph 
40. General service.—a. Lateral curvature of the spine of 2 inches or less 
from the midline if the mobility and weight-bearing power are good. 
6. Fracture of the coccyx. 
g. Prominent scapulae not interfering with wearing of uniform or military 
equipment. 
d. Complaint of disease of the sacroiliac and lumbo-sacral joints which is tm- 
associated 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 a useful vocation 
in civil life. 
41. Limited service.—a. Lateral deviation of the spine from the midline of 
more than 2 inches and less than 3 inches. 
6. Nontuberculous diseases of the spine which are unassociated with such 
rigidity or other symptoms that the registrant has been incapacitated for follow- 
ing a useful vocation in civil life. 38 
REPORT OF COMMISSION OF PHYSICIANS 
c. Disease of the sacroiliac and lumbo-sacral joints of a degree which disquali- 
fies for general military service, if the individuals have followed a useful vocation 
in civil life. 
42. ISJonacceptable.—Conditions such as— 
а. Tuberculosis, either active or healed. 
б. Osteoarthritis, partial or complete, if sufficient in degree to interfere with 
the following of a useful vocation in civil life. 
c. Healed fractures of the vertebrae or pelvic bones with associated disquali- 
fying symptoms. 
d. Lateral deviation of the spine from the midline of more than 3 inches. Cur- 
vature of the spine (kyphosis or lordosis) of a degree sufficient to interfere with 
the wearing of a uniform or military equipment or which has prevented the 
individual from following a useful vocation in civil life. 
e. Disease of the sacroiliac and lumbo-sacral joints which is of a 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. 
43. X-ray examination.—When examining physicians are in doubt concern- 
ing the cause and the extent of disease of the bones and joints an X-ray exami- 
nation will be made. 
Section XI 
EXTREMITIES 
Paragraph 
General service 44 
Limited service 45 
Nonacceptable 46 
General considerations 47 
44. General service.—a. Old or recent fractures which have healed normally 
with no resulting impairment of function. 
6. Paralysis of a muscle or group of muscles which does not interfere with 
function. 
c. Benign tumors of bone or defects due to their removal when the condition 
does not interfere with the function of the extremity or the joint involved. 
d. Recent injury of a 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 a period of time not less than 6 weeks for 
recovery before the final examination is made.) 
e. Webbed fingers and toes, unless severe in degree. 
A Loss of two entire fingers of either hand, except a combination of right 
index and middle finger. 
g. Loss of entire right index finger, provided right middle finger is present and 
normal. 
h. Scars and deformities of moderate degree of the hand or hands which do not 
Interfere with normal function. 
i. Stiff fingers of a degree not to interfere seriously with function. 
/. Pes planus unless accompanied by marked deformity, rigidity, or weakness, 
or of such degree as to have interfered with useful vocation in civil life. 
k. Hallux valgus, unless severe. REPORT OF COMMISSION OF PHYSICIANS 
39 
l. Clubfoot of slight degree if tarsal, metatarsal, and phalangeal joints are 
flexible, permitting the wearing of a military shoe and, in the opinion of the 
examiner, will not interfere with the performance of military duty. 
m. Slight claw toes not involving obliteration of the transverse arch and which 
do not interfere with the wearing of a military shoe. 
n. Hammertoe which is flexible and which does not interfere with the wearing 
of a military shoe. (Hammertoe usually involves the second digit and unless it is 
rigid is not a disqualifying defect.) 
o. Absence of one or two of the small toes of one or both feet, if function of the 
foot is good. 
p. Ingrowing toenails, unless severe. 
q. Individuals who have had cartilages removed from the knee joint will be 
accepted for general military service provided at least 6 months have elapsed 
since operation and there are no residual symptoms and provided further that 
upon careful examination no abnormal mobility is elicited. 
45. Limited service.—a. Loss of entire thumb of either hand. 
&. Loss of three entire fingers of either hand, including the right index finger, 
provided the thumb remains. 
c. Webbed fingers or toes, if severe in degree. 
d. Ganglion and other benign tumors of the hand or fingers, if they do not 
interfere greatly with function. 
e. Moderate deformities of one or both upper extremities which do not and have 
not interfered with function to a degree to prevent the individual from following 
a useful vocation in civil life. 
f. Internal derangement of the knee joint, if not severe enough to have pre- 
vented him from following a useful vocation in civil life. 
g. Abduction and pronation of the foot (knock-ankle) when this condition is not 
associated with rigidity of the tarsal joint or with deformity of the foot, 
Ji. Loss of great toe. 
i. Loss of dorsal flexion of great toe. 
j. Hammertoe with rigidity. 
k. Other defects of the feet which disqualify for general military service but 
do not prevent the individual from wearing a military shoe and which have not 
prevented him from following a useful vocation in civil life. 
l. Moderate deformities of one or both lower extremities which do not and 
have not interfered with function to a degree to prevent the individual from 
following a useful vocation in civil life. 
m. Adherent scars of the skin and soft tissues of an extremity, if not incapaci- 
tating and likely to break down. 
n. Old ununited fractures which do not interfere with good function. 
o. Healed disease or injury of wrist or elbow with resulting limitation of mo- 
tion, if not severe in degree. 
46. Nonacceptable.—Defects such as— 
а. Loss of both thumbs. 
б. Loss of more than three entire fingers of one hand. 
c. Tuberculosis of a bone or joint. 1 
d. Old ununited fractures which interfere with function. 
e. Old unreduced or recurring dislocations of any of the major joints. 40 
REPORT OF COMMISSION OF PHYSICIANS 
f. Disease of any bone or joint healed with such resulting deformity or 
rigidity that the function is impaired to a 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 a degree which seriously inter- 
fere with function. 
i. Varicose veins, if severe in degree or if associated with edema or with 
present or previous ulcer of the skin. 
j. Pes planus, if accompanied by marked deformity, rigidity, or weakness, or 
of such a degree as to have interfered with a useful vocation in civil life. 
k. Obliteration of the transverse arch associated with permanent flexion of 
the small toes (claw toes). 
l. Hallux valgus, if severe and associated with marked exostosis or bunion, 
especially when there are signs of irritation over the joint. 
m. Clubfoot, if marked in degree or which interferes with the wearing of a 
military shoe. 
n. Diseases of the bone or of the hip, knee, or ankle joint which interfere 
with function and weight-bearing power. 
o. Deformities due to fracture or other injury which seriously interfere with 
function and weight-bearing power. 
p. Sciatica which is apparently intractable and disabling to the degree of 
interference with the function of walking and weight-bearing power. 
q. Amputations of extremities in excess of those already cited. 
r. Active osteomyelitis of any bone, or a substantiated history of osteomy- 
elitis of any of the long bones within the past 5 years. 
47. General considerations.—It is important that individuals with defects 
of the feet which would prevent them from taking proper training will not be 
accepted for general military service. It is quite as important that defects 
of the feet which are not disabling will not be considered disqualifying for 
general military service. 
Section XII 
NECK 
General service 48 
Limited service 49 
Nonacceptable 50 
Paragraph 
48. General service.—a. Nonspastic contraction of the muscles of the neck 
which is not of great degree and will not prevent the wearing of a uniform 
or military equipment. 
6. Simple goiter unassociated with pressure symptoms, provided the enlarge- 
ment of the thyroid will not interfere with the wearing of a uniform or mili- 
tary equipment. 
o. Enlarged lymph nodes of the neck which are not a manifestation of sys- 
temic disease, do not apparently interfere with the general health, and are not 
large enough to interfere with the wearing of a uniform or military equipment. 
49. Limited service.—There are no neck criteria to warrant initial selection 
as limited service. 
50. Nonacceptable.—a. Exophthalmic goiter. See section XVII. REPORT OF COMMISSION OF PHYSICIANS 
41 
&. Thyroid enlargement from any cause associated with toxic symptoms. 
See section XVII. 
0. Carcinoma of the thyroid or other structures of the neck. 
d. Enlargement of the lymph nodes of the neck associated with leukemia or 
Hodgkin’s disease. 
e. Lymphosarcoma. 
f. Tuberculous lymph nodes. 
g. Nonspastic contraction of the muscles of the neck or cicatricial contraction 
of the neck to the extent that it interferes with the wearing of a uniform or mili- 
tary equipment or so disfiguring as to render the individual objectionable in 
common social intercourse. 
h. Spastic contraction of the muscles of the neck. 
1. 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 a uniform or military equipment. 
j. Simple adenomatous goiter. 
7c. Thyrolingual cyst. 
Section XIII 
LUNGS AND CHEST WALL 
Chest examination 51 
History 52 
X-ray examination 53 
Physical examination 54 
Other examinations 55 
General service 58 
Limited service 57 
Nonacceptable 68 
General considerations 59 
Paragraph 
51. Chest examination.—The chest examination will include a roentgeno- 
gram, as well as the usual methods of physical diagnosis. A pertinent history of 
past chest diseases will be taken. Because of its importance and frequency, special 
consideration must be given to the detection of tuberculosis. 
52. 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 unex- 
plained 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 a cause. It must be 
remembered, however, that pulmonary tuberculosis may exist in its earliest 
stages without producing any symptoms. 
53. X-ray examination.—Chest X-ray films made on individuals entering the 
military service are to serve as permanent records. Care will be exercised in 
processing these films to insure their keeping qualities and in marking them in 
order that they may always be accurately identified. Chest X-rays will be made 
on selectees and applicants for voluntary enlistment and reenlistment as indicated 
below. 
a. Selectees.—Chest X-ray will be made on selectees at the place of initial 
examination whenever practicable. Men who are not X-rayed at the time of the 42 
REPORT OF COMMISSION OF PHYSICIANS 
initial examination will be X-rayed upon arrival at reception centers and the 
films interpreted before induction. 
6. Applicants for voluntary enlistment and reenlistment.— (1) Applicants for 
voluntary enlistment or for reenlistment more than 3 months following discharge 
from previous Army service will have a chest X-ray prior to acceptance whenever 
facilities are available for this purpose. Army facilities will be used to the utmost 
but when these and the roentgen facilities of other Federal agencies are not 
available, competent civilian X-ray laboratories may be utilized. Applicants for 
reenlistment immediately following discharge from previous Army service will 
have had an X-ray made prior to discharge and in such cases reexamination by 
X-ray is unnecessary. 
(2) When it is not practicable to have chest X-rays made on individuals apply- 
ing for enlistment and reenlistment prior to acceptance, if otherwise qualified, 
they may be enlisted and a chest X-ray made at the first Army station to which 
assigned. Recruits and those not applying within 90 days for reenlistment whose 
X-ray of the chest is made subsequent to their acceptance and who are found 
to have disqualifying defects as a result thereof will be immediately discharged 
on certificate of disability. 
(3) In order to insure that all individuals are given a chest X-ray as provided 
in (1) and (2) above, the date and fact of chest X-ray examination will be 
recorded under the heading “Carrier Examinations” on page 1 of the individual’s 
Service Record. This information will be recorded upon the initiation of the 
service record of individuals whose enlistment or reenlistment examination has 
included a chest X-ray. For others it will be recorded upon completion of the 
chest X-ray examination. 
c. Identification.— (1) Identifying marks which are photographed on the film 
at the time of its exposure are most satisfactory. This may be accomplished with 
the special attachment which forms an integral part of the photoroentgenographic 
unit or by lead foil stencils for use with standard X-ray equipment. The indi- 
vidual’s identification tag is readily photographed upon the film. Its use when 
available will obviate the necessity for including the individual’s name and serial 
number in the stencil or adding it to the film as described below if stenciling 
equipment is not available. Such identifying data as cannot be photographically 
recorded at the time the film is made will be added as soon as practicable after 
processing of the film is completed. Experience has shown that a good grade 
of white ink, well shaken to form an even mixture, provides the best medium for 
writing on acetate films; ordinary black ink, for writing on paper films. If avail- 
able, a perforating machine making letters and figures of appropriate size may 
be used for recording additional data on films after they have been processed. 
Identifying marks other than those which are recorded photographically will 
be placed on the light portion of the film corresponding with the subdiaphragmatic 
area. Care will be taken that identifying words and figures are printed, perfo- 
rated, or written so that they are clearly legible. Data photographically recorded 
will be located in the upper right and left corners of the film. 
(2) For individuals being examined for entrance into the enlisted service, the 
minimum identifying data will include' the following; place of examination; 
date; the individual’s last name, first name, and middle initial; his home address; 
Army serial number, and in the case of registrants, their local board identifica- REPORT OF COMMISSION OF PHYSICIANS 
43 
tlon code number. Except for the Army serial number, these data will appear 
in the upper right and left corners of the film as follows ; 
Johnson, Carl D. 
Camp Forrest, Tenn. 1205 West Avenue 
February 28, 1942 Nashville, Tenn. 
48-037-005 
(The local hoard 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. 
d. Disposition of films made in continental United States and Puerto Rico.—«■ 
(1) Films made in the examination of men voluntarily enlisted or inducted into 
the service or discharged therefrom, after being carefully checked for proper 
identification, 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, D. C. All packages of films sent to the 
Veterans’ Administration will be labeled “Exposed X-ray Films” and will show 
the name of the Army organization making shipment. 
(2) All chest X-ray films of individuals who are rejected for any reason will 
be forwarded to the State Director of Selective Service at the State headquarters 
of the State from which the registrant is presented. Films forwarded to State 
directors will be sent in separate packages appropriately labeled as indicated 
below: 
(a) “Films of individuals recommended for reexamination in 6 months 
because of borderline tuberculous or other chest conditions.” 
(b) “Films of individuals rejected because of tuberculous or other chest 
conditions.” 
(c) “Films of individuals rejected because of other than chest condi- 
tions.” 
e. Disposition of films made in Hawaiian Department.—Chest X-ray films 
made on individuals in the Hawaiian Department will be held there for the 
present. 
54. Physical examination.—This will include inspection, palpation, percus- 
sion and auscultation of the chest. 
a. Structural abnormalities of the thoracic wall and striking rapidity, limi- 
tation, or inequality of the respiratory movements are to 5e noted. 
1). Abnormal physical signs in the lungs, pleura, or mediastinum will be care- 
fully checked to ascertain whether they persist or are only transitory. 
e. 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. A 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. 44 
REPORT OF COMMISSION OF PHYSICIANS 
d. It must be borne in mind that some tuberculous lesions may not produce 
abnormal physical signs. In other words, normal signs do not exclude tubercu- 
losis. 
e. The attention of examining physicians is particularly directed to the neces- 
sity of exercising great conservatism in their interpretation of physical signs 
over the apices. Misinterpretation of such signs as an indication of active 
tuberculosis would in many cases do the Government an injustice by leading 
to the exclusion of men who are fit for service. 
/. Certain signs which may arouse suspicion but, unless X-ray and other 
studies reveal definite evidence of disease, will be disregarded 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 disappear after a few deep breaths or coughs. 
55. Other examinations.—It may be necessary to postpone decision in some 
cases until special studies and adequate observation have been completed. For 
example, subacute bronchopneumonia in an upper lobe of the lung may simulate 
tuberculosis, but proper laboratory studies of the sputum and blood and another 
X-ray and physical examination after 3 or 4 weeks usually suffice to make the 
differential diagnosis. 
56. General service.—a. Acute bronchitis, provided acceptance is temporarily 
deferred until a final examination shows recovery without disqualifying sequelae. 
b. Acute or subacute pneumonia, provided acceptance is deferred until a final 
examination shows recovery without disqualifying sequelae. 
c. Scars of operation for nontuberculous empyema which have been healed for 
one year or longer, provided the function of the lung is good. X-ray and physical 
examination may show some fibrous thickening of the pleura but no evidence of 
any sacculation or other residue of the empyema. 
d. Acute or subacute fibrinous pleurisy, definitely nontuberculous in origin<, 
provided acceptance is temporarily deferred until a final examination shows 
recovery without disqualifying sequelae. Such pleurisy usually is suspected or 
demonstrated on physical examination, not on X-ray examination. 
e. Fibrous pleural scars and adhesions, revealed most often in the roentgeno- 
gram by isolated roughening or peaking of an interlobar fissure or of the apical 
pleura, provided there is no evidence of tuberculosis of the pulmonary paren- 
chyma beyond the limits defined in f below. 
f. (1) Apparently healed intrathoracic tuberculous lesions of slight extent 
demonstrable in the roentgenogram but producing no audible rales after the 
expiratory cough during physical examination. 
(2) The following specifications of the limits of such lesions are intended to 
exclude persons with disease which is most likely to be in part caseous and 
therefore potentially hazardous. The limits are set arbitrarily to provide an 
objective basis on which the examiner may render a decision. All measure- 
ments refer to single, standard 14- by 17-inch direct-projection roentgenograms. 
These lesions may consist of— r 
(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 of such lesions does not exceed five. REPORT OF COMMISSION OF PHYSICIANS 
45 
(&) Calcified lesions of the pulmonary parenchyma, provided the total 
number of these does not exceed ten; and one of these may equal 
but not exceed 1 cm in diameter; but none of the remainder may 
exceed 0.5 cm in diameter. In the roentgenogram such calcified 
lesions should appear isolated, sharply circumscribed, homogeneous, 
and dense. 
(3) The above arbitrary limits of calcified lesions are set on the assumption 
that'large and numerous lesions are more likely to be partially unhealed, and 
therefore a potential source of future recrudescence, than small lesions of limited 
distribution. It is recognized, however, that in some individuals calcified tuber- 
culous lesions exceeding these limits may be present which are so well healed 
that the possibility of future reactivation is remote. Further consideration 
may be given to the acceptability of persons with calcified lesions of this type 
when the state of health in all other respects clearly warrants the opinion that 
the lesions in question are healed. In such cases the history of the applicant and 
his age, as well as the character of the lesions as seen in X-ray films provide 
criteria for estimating the probability of complete arrest of the tuberculous 
process. If there is no history of active tuberculosis or symptoms which might 
be interpreted as evidence of this disease and if the applicant is more than 25 
years of age, and if finally the calcified lesions seen are dense and discrete in 
character and not hazy or irregular in outline, such lesions may be considered as 
not prejudicial to future health. In these cases the applicant may be accepted 
provided the report of physical examination and the chest X-ray films have been 
reviewed and acceptance has been recommended by a medical examiner qualified 
in chest diagnosis. 
g. Fracture of the rib or ribs, provided acceptance is temporarily deferred 
until a final examination shows recovery with or without deformity and pro- 
vided the residual deformity if any does not interfere seriously with respiratory 
movements. 
h. Benign tumors of the breast or of the chest wall, provided the mass does 
not interfere with the wearing of a uniform or military equipment. 
i. Small palpable lymph nodes of the axilla which apparently are not evidence 
of active disease. 
57. Limited service.—a, Deformity of clavicle, ribs, or scapula of a degree 
disqualifying for general military service but not preventing the individual from 
successfully following a useful vocation in civil life. 
b. Chronic bronchitis which is mild and not associated with emphysema. 
58. Nonacceptable.—Disqualifying defects such as— 
a. Tuberculosis of the lungs or tracheobronchial lymph nodes except as de- 
fined in paragraph 5of. 
b. Small fibroid lesions represented in the roentgenograms as sharply demar- 
cated strandlike or well-defined, small, nodular shadows not exceeding a total 
area of 5 square cm will be deferred until subsequent examination demonstrates 
that the lesion is stationary and not likely to be reactivated. The minimum 
period of time to determine this is 6 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 exer- 
cised in estimating the likelihood of reactivation. Experience indicates a greater 
likelihood of reactivation of a lesion that appears to be stable in persons under 
25 years of age than in older persons. 46 
REPORT OF COMMISSION OF PHYSICIANS 
c. Fibrinous or serofibrinous tuberculous pleurisy, and serofibrinous pleurisy 
of unknown origin. Inasmuch as pleurisy, with or without effusion, is a very 
frequent manifestation of active tuberculosis, all persons who have apparently 
recovered from pleurisy will be examined with the greatest Chronic fibrous 
pleurisy sufficient to cause marked retraction of the chest wall and of the mediasti- 
nal organs or to cause a density in the roentgenogram which completely obscures a 
considerable section of the pulmonary markings will be considered disqualifying. 
d. Empyema or unhealed sinuses of the chest wall following operation for 
empyema. 
e. Chronic bronchitis with emphysema. 
f. Bronchial asthma. 
g. Pulmonary emphysema with impairment of function. 
h. Cystic disease of the lung. 
i. Silicosis as represented in the roentgenogram by strandlike and nodular 
shadows or any other form of severe pulmonary fibrosis. 
j. Abscess of the lung. 
1c. Bronchiectasis. 
l. Active mycotic disease of the lung and residual cavitation due thereto. 
m. Tuberculosis of the ribs and other parts of the chest wall. 
n. Any malignant tumor of the breast or the chest wall. 
o. Tumor of the lung, pleura, or mediastinum. 
p. Spontaneous pneumothorax. 
q. Foreign body in the lung. A person may be accepted after a foreign body 
has been removed from a bronchus, provided examination shows recovery with- 
out disqualifying sequelae. 
r. Benign tumors 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. 
59. General considerations.—Examining physicians will not reject without 
confirmatory evidence persons who allege tuberculosis as a ground for exemp- 
tion or discharge. Some enlisted men may allege symptoms of tuberculosis 
with a view of securing discharge. Some persons may be expected to claim 
the existence of tubei’culosis as a ground for exemption and fortify their claims 
by certification of physicians. Such certificates will not necessarily be accepted, 
but examining physicians will satisfy themselves as to the physical qualifications 
by their personal examinations. There will be cases in which pulmonary tuber- 
culosis will have been previously diagnosed on the ground of subjective symp- 
toms and of physical signs which are without any pathological significance. 
It is necessary, therefore, that conclusions of examining physicians he based 
on their own findings and their own evaluation of the case. Statements of the 
individual as to symptoms will not be accepted as an indication of the exist- 
ence of tuberculosis unless supported by objective evidence. Roentgenograms 
of the chest made previously may be accepted as part of the objective evidence, 
provided their authenticity is satisfactorily established. On the other hand, 
men who desire to serve their country may conceal, from patriotic motives, 
symptoms of tuberculosis which they know or suspect to exist. Some tubercu- 
lous individuals may seek enlistment with a view of obtaining treatment and a 
pension. REPORT OF COMMISSION OF PHYSICIANS 
47 
Section XIV 
HEART, BLOOD VESSELS, AND CIRCULATION 
Paragraph 
History 60 
Procedure 61 
General service 62 
Limited service 63 
Nonacceptable 64 
Electrocardiogram 1 65 
X-ray 66 
General considerations 67 
60. 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. 
61. Procedure.—The following procedure will govern in the physical exami- 
nation of the heart. Only those findings need be recorded which are indicative 
of disease or anatomical defect (examples of findings which are usually not in- 
dicative of disease are extra-systoles and functional pulmonary systolic mur- 
murs). For the information of the examiners it is suggested that reference be 
made to the publication adopted and distributed by the American Heart Asso- 
ciation entitled “The Nomenclature and Criteria for the Diagnosis of Diseases of 
the Heart.” 
a. Location of apex impulse and determination of character. 
&. 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 its rhythm, and palpation of radial 
arteries for unusual thickening or high tension. 
e. 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, a statement will be appended as to the position of the subject at the 
time of measurement. 
/. Exercise test (stepping 12 times briskly upon a common chair) will be used 
in selected cases to bring out significant heart murmurs but this test in itself 
is not to be considered a 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 return for detailed reexamination. 
62. General service.—a. A heart will be considered normal when the apex 
impulse is within the left midclavicular line and not below the fifth interspace; 
96050—44 4 48 
REPORT OF COMMISSION OF PHYSICIANS 
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; when 
pulse rate is normal and regular and there is no unusual thickening of the arteries 
or significant elevation of blood pressure. 
b. A pulse rate of 100 or over which is not persistent and not due to paroxysmal 
tachycardia. '(A pulse rate of 100 or over may be temporary and due to excite- 
ment or to recent infection, such as pneumonia or local infections about the nose, 
mouth, and throat, or may be induced by drugs.) 
c. A pulse rate of 50 or under which is proved to be the natural pulse rate of 
the individual or to be temporary or due to the use of drugs. (If the bradycardia 
is physiological, the rate on exercise will rise to a higher level and then gradually 
return to the original slow rate; whereas when heart block is present the rate 
on exercise will either change slightly or not at all or sudden interruptions in 
the length of the heart cycle will be detected.) 
d. Sinus arrhythmia. (This consists in a quickening of the pulse rate during 
inspiration and a slowing during expiration and is best recognized with the 
individual recumbent and breathing deeply.) 
e. Elevation of blood pressure from excitement, proved to be temporary. 
f. Neurocirculatory asthenia, if very mild in degree. 
63. Limited service.—There are no cardiovascular criteria to warrant initial 
selection for limited service. 
64. Nonacceptable.—a. Circulatory failure evidenced by definite symptoms 
such as undue breathlessness, pain, or evidence of congestive failure (engorged 
neck veins, enlarged liver, edema, as well as dyspnea). 
b. 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 a heaving or diffuse character, or by X-ray evidence. 
c. A persistent heart rate of 100 or over when this is proved to be persistent 
in the recumbent posture and on observation and reexamination over a sufficient 
period of time. See also section XXI. 
d. Paroxysmal tachycardia. See also section XXL 
e. Heart block. 
f. 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 there is a 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 vari- 
cose veins, Raynaud’s disease, Buerger’s disease (thromboangiitis obliterans), 
erythromelalgia, and arteriosclerosis. In doubtful cases special tests should be 
employed. 
l. Aneurysm of any vessel. 
m. Pericarditis. 
n. Acute endocarditis. 
o. True angina pectoris. 
p. Coronary thrombosis. REPORT OF COMMISSION OF PHYSICIANS 
49 
q. Neurocirculatory asthenia (effort syndrome), unless very mild. Usual 
symptoms of this condition are exhaustion, breathlessness, heartache, and palpi- 
tation. 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 dis- 
ability of the individual. Cases of effort syndrome may be divided into four 
groups. (In some cases more than one of these factors is present.) 
(1) As an accompaniment of organic heart disease. 
(2) Following infections. 
(3) In individuals with poor physique or insufficient training for the work 
required. 
(4) Orthostatic hypotension or tachycardia.—The blood pressure and pulse rate 
will be taken with the individual in the recumbent position and after standing 
3 minutes. An increase in a normal recumbent pulse rate to 120 beats per minute 
or more when the individual stands or a decrease of a normal blood pressure 
(when the individual is recumbent.) to values less than 90 systolic and 60 diastolic 
when the individual stands may be considered evidence of a definite physiologic 
disturbance and in itself cause for rejection unless the condition is very temporary 
following an illness, operation, or exhausted state. 
65. Electrocardiogi’am.—The electrocardiogram is of great assistance in de- 
termining the nature of certain cardiac abnormalities, the most, important of 
which are the various arrhythmias, defects in conduction, and diseases of the coro- 
nary arteries. The electrocardiograph may be utilized in cases where such diag- 
nostic aid is especially indicated but will not be employed as a routine measure. 
66. X-ray.—In doubtful cases, fluoroscopy and teleroentgenography is ad- 
vised to determine the size and shape of heart and great vessels. Films taken 
for the study of the. lungs will also be viewed for cardiovascular defects. 
67. General considerations.—a. It is incumbent upon examining physicians— 
(1) To 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) To 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 
to create a pension problem. Therefore, all individuals with valvular heart 
disease are to be regarded as unfit for service and will be rejected. 
6. Men wrho desire to serve their country may, from patriotic motives, endeavor 
to conceal a 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 knowTedge 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 
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 symp- 50 
REPORT OF COMMISSION OF PHYSICIANS 
toms, the history, especially of rheumatic fever, may be a factor in the final 
decision. No statement, however, will be accepted as proof of the existence of a 
cardiovascular defect unless supported by objective evidence. 
d. It is the duty of examining physicians to protect the interest of the Govern- 
ment by preventing the entrance into the service of men whose circulatory sys- 
tems 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 devia- 
tions 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 68 
Limited service 60 
Nonacceptable 70 
General considerations 71 
68. General service.—a. Abdominal scars due to surgical operation or acci- 
dent which show no hernial bulging. 
ft. Scar pain when found not associated with any disturbance of function of 
abdominal wall or contained viscera. t 
c. Achylia gastrica, unless associated with a disqualifying disease. 
d. Complaint of “weak stomach,” indigestion, dyspepsia, constipation, belch- 
ing, vomiting, and various other types and degrees of abdominal discomfort un- 
less proven to have an organic basis by a carefully elicited history, physical 
examination, and such laboratory tests as may be employed or by a trustworthy 
medical record from a competent physician or clinic, provided neuropsychiatric 
examination reveals no disqualification. 
e. Blood in stools, if proved to be due to slight defects such as shallow fissures 
of the anus, small hemorrhoids, or superficial small ulcers of the rectum. 
f. Mild enlargement of the liver unassociated with other objective evidence of 
disease of the liver or other organs. 
g. Splenic enlargement of mild degree unassociated with evidence of other 
disqualifying disease. 
h. Small benign tumors of the abdominal wall. 
i. Intestinal parasites or their eggs in the stools. 
j. Internal and external hemorrhoids, if mild in degree. 
k. Relaxed inguinal ring provided there is no hernial sac present. 
l. Hernia, small umbilical (patent umbilical ring). 
m. History of cholecystectomy provided there are no residual disqualifying 
sequelae. 
69. Limited service.—Unless the degree of disability is obviously disquali- 
fying— 
а. Authentic history of gastric or duodenal ulcer, provided there is a trust- 
worthy history of freedom from activity during the past 5 years and provided 
that gastrointestinal X-ray made at the time of examination is negative. 
б. Large benign tumors of the abdominal wall. j ' 
c. Internal and external hemorrhoids, moderate. 
70. Nonacceptable.—Defects such as— REPORT OF COMMISSION OF PHYSICIANS 
51 
а. Hernia, inguinal, femoral or postoperative. Umbilical hernia, if moderate 
or large in size. 
б. Chronic cholecystitis with or without cholelithiasis, if diagnosis is con- 
firmed by usual laboratory procedures or authentic medical history. 
c. Ulcer of the stomach or 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 5 years. 
d. Surgical operations for gastric or duodenal ulcer. 
e. Intestinal obstruction of any kind. 
f. Sinuses of the abdominal wall. 
g. Stricture of the rectum. 
h. Fistula in ano. 
i. Schistosomiasis. 
j. Enlargement of the spleen associated with leukemia, Hodgkin’s disease, or 
splenic anemia. 
k. Great enlargement of the spleen from any cause. 
l. Large internal and external hemorrhoids with or without prolapse of the 
rectum. > 
m. Megacolon, diverticulitis, and ileitis. 
71. General considerations.—a. When necessary to confirm a diagnosis, ex- 
amining physicians will avail themselves of fluoroscopy and roentgenography. 
&. 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 
rings, or at the site of a scar is not necessarily indicative of hernia. 
f. In cases of suspected gastric or duodenal ulcer every effort will be made 
to obtain a trustworthy history, including authentic medical records. 
Section XVI 
GENITO URINARY ORGANS AND VENEREAL DISEASES 
General service 72 
Limited service 73 
Nonacceptable 74 
General considerations 75 
Paragraph 
72. General service.—a. Gonorrhea, uncomplicated, acute or chronic; syphilis, 
except cardiovascular, 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.) C' 
b. History of bed wetting, unless substantiated by physician’s affidavit or by 
other acceptable documentary evidence. 52 
REPORT OF COMMISSION OF PHYSICIANS 
c. Mild albuminuria with or without casts which is proved by observation and 
repeated examination to be temporary in character or orthostatic in type. 
d. Absence of one testicle unless removed on account of malignant disease or 
tuberculosis, j 
e. Undescended testicle which lies within the abdominal cavity. 
f. Phimosis with or without adhesions of the mucous surfaces. 
g. Benign warts and other benign growths of the glans penis and of the 
prepuce. 
h. Amputation of the penis, if a sufficient amount of the organ remains so as 
not to interfere with the function of micturition. (Care will be taken to examine 
fully individuals for possible recurrence of a disqualifying disease for which the 
amputation may have been made.) 
i. Varicocele of moderate size. 
j. Hydrocele of moderate size. 
1c. Epispadias or hypospadias, if mild in degree. 
I. History of unilateral renal calculus with freedom from symptoms and if the 
X-ray is negative for calculi. 
73. Limited service.—a. Stricture of the urethra unless severe. 
6. Floating kidney. (Floating kidney is one which is freely moveable.) 
c. Undescended testicle which lies within the inguinal canal. 
d. Removal of one kidney, unless due to malignant disease, renal calculus, o* 
tuberculosis, the remaining kidney being healthy. 
74. Nonacceptable.—a. Acute or chronic nephritis. 
6. Stricture of the urethra, severe. 
c. Urinary fistula or incontinence. 
d. Gonorrheal arthritis. 
e. Surgical kidney with or without renal calculus, 
f. The presence of renal calculus, or a substantiated history of bilateral renal 
calculi at any time, j 
g. Chronic pyelitis. 
h. Hydronephrosis or pyonephrosis. 
i. Tumors of the kidney, bladder, or testicle. 
j. Chronic cystitis. 
7c. Amputation of the penis, if the resulting stump is insufficient to permit 
normal function of micturition. 
l. Hermaphroditism. 
m. Hypertrophy of the prostate gland. 
n. Epispadias or hypospadias when urine cannot be voided in such a 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. 
p. Bed wetting, if substantiated by physician’s affidavit or by other acceptable 
documentary evidence. 
q. Varicocele, if large. 
r. Hydrocele, if large. 
s. Granuloma inguinale. 
t. Lymphogranuloma venereum. 
75. General considerations.—a. Urinalysis.— (1) Routine urinalysis to in- 
clude 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 REPORT OF COMMISSION OF PHYSICIANS 
53 
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 a day on 2 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 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 a thorough study will be made to determine the 
underlying cause. 
(2) When it is deemed necessary, examining physicians will employ X-ray 
facilities to verify diagnosis of defects of the genito-urinary organs. 
ft. Serological test for syphilis.—(1) All applicants for voluntary enlistment 
and Selective Service registrants will be subjected to a serological test for 
syphilis. ; 
(2) All individuals giving a positive serum reaction for syphilis will after a 
minimum period of 5 days be subjected to another test to confirm a previously 
positive reaction. 
(3) In the case of applicants for voluntary enlistment the serological test for 
syphilis will be performed prior to acceptance whenever practicable. Individuals 
of this group on whom it has not been practicable to obtain a serological test for 
syphilis prior to enlistment will be subjected to this test on arrival at their first 
station. In order to insure that all individuals voluntarily enlisting will have a 
serological test for syphilis as indicated above the date of the test and the result 
will be recorded in the space “Carrier Examinations” on page 1 of the W. D., 
A. G. O. Form No. 24 (Service Record). 
Section XYII 
ENDOCRINE AND METABOLIC DISORDERS 
Paragraph 
General service 7 6 
Limited service 77 
Nonacceptable 78 
76. General service.—a. Simple colloid goiter, provided the enlargement of 
the thyroid will not interfere with the wearing of a uniform or military equipment. 
b. Frohlich’s syndrome, if mild in degree. 
c. Hypothyroidism, if mild. 
d. Acromegaly, if not severe or associated with symptoms other than the bony 
changes. 
e. Glycosuria, if transient in type, provided acceptance is deferred until the 
possible existence of diabetes mellitus and renal glycosuria are excluded. 
77. Limited service.—a. Frdhllch’s syndrome, if moderate in degree. 
b. Pellagra, beriberi, scurvy, and other nutritional deficiencies, if mild and 
remediable by diet and appropriate treatment. 
78. Wonacceptable.—a. Toxic goiter. (It should be remembered that ma- 
lingerers may use thyroid medication to produce many of the symptoms of 
thyrotoxicosis.) 
b. Simple goiter with definite pressure symptoms or so large in size as to inter- 
fere with wearing a uniform or military equipment. 54 
REPORT OF COMMISSION OF PHYSICIANS 
c. Cretinism with imbecility or dwarfism. 
d. Myxedema (with clinical manifestations and diagnosis not based solely on 
low basal metabolic rate). 
e. Gigantism or acromegaly, if markedly disfiguring or if associated with other 
symptoms of severe pituitary dysfunction. 
f. Frdhlich’s syndrome, if severe. 
g. Hyperparathyroidism and hypoparathyroidism when the diagnosis is Sup 
ported 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 cases the 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.) 
k. Renal glycosuria. 
l. Nutritional deficiency diseases (including sprue, beriberi, pellagra, and 
scurvy) which are severe or not readily remediable or in which permanent patho- 
logical changes have been established. 
m. Gout. 
n. Simmonds’ disease. 
o. Cushing’s syndrome. 
p. Hyperinsulinism when established by adequate Investigation and if regarded 
by the examiners as of sufficient degree to disqualify for military service. 
Section XYIII 
DISEASES OF BLOOD AND BLOOD-FORMING TISSUES 
Paragraph 
General service 79 
Limited service 80 
Nonacceptable 81 
79. General service.—Secondary anemia, mild, due to easily remediable 
causes. 
80. Limited service.—There” are no diseases of this group which warrant 
initial selection for general service. 
81. Ndnacceptable.—a. Hemophilia, 
ft. Thrombocytopenic purpura. 
c. Primary pernicious anemia. 
d. Aplastic anemia. 
e. Hemolytic ictero-anemia (hemolytic jaundice)# 
f. Splenic anemia. r 
g. Polycythemia vera. 
h. Leukemia, acute or chronic, of any type. 
i. Malaria, chronic, if severe. 
j. Sickle cell anemia. REPORT OF COMMISSION OF PHYSICIANS 
55 
Section XIX 
NEUROLOGICAL DISORDERS 
Methods of examination 82 
General service 83 
Limited service 84 
Nonacceptable 85 
Diagnostic criteria 86 
Paragraph 
82. Methods of examination.—a. In order to detect the presence of certain 
common neurological diseases, particularly epilepsy, post-encephalitic and post- 
traumatic syndromes, multiple sclerosis, drug addiction, and hysteria, informa- 
tion regarding the life history of the individual is essential. Therefore, exam- 
ination will be made concerning convulsions, fainting spells, attacks of un- 
consciousness, 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 a straight line at a 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, incoordi- 
nate 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 movement and muscle condition. Look for muscular atrophy or pseudo- 
hypertrophy, muscular weakness, limitation of joint movement and spine stiff- 
ness. As to pupils, look for irregularity, inequality, diminished or absent con- 
traction to light; movements of eyes, facial muscles, and tongue. Look for 
strabismus, 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 labora- 
tory tests and X-ray examinations will be made. 
83. General service.—These registrants present— 
а. A healthy nervous system as manifested by absence of signs of disease of 
the brain, spinal cord, cranial and peripheral nerves. 
б. Certain variations clearly within physiological limits such as minor tremors. 
c. Inconsequential paralyses resulting from old poliomyelitis or lesions of the 
peripheral nerves not likely to interfere with military duties. 
84. Limited service.—Individuals with local paralyses due to old poliomye- 
litis or nonprogressive disease of the peripheral nerves of such marked degree 56 
REPORT OF COMMISSION OF PHYSICIANS 
that they disqualify for general military service but have not prevented the 
individual from successfully following a useful vocation in civil life. 
85. Nonacceptable.—Any serious neurological disorder such as— 
a. Neurosyphilis of any form (general paresis, tabes dorsalis, meningo- 
vascular syphilis). 
b. The epilepsies. 
c. Paralysis agitans, post-encephalitic syndromes, athetosis, chorea, spasmodic 
torticollis, familial ataxia. 
d. Post-traumatic cerebral syndrome. 
e. Multiple sclerosis, encephalomyelitis. 
f. Diffuse muscular atrophies or dystrophies of any type (with the exception 
of extremely mild residuals of poliomyelitis). 
g. Chronic or recurrent neuritis or neuralgia of an intensity sufficient to prevent 
the individual from following a useful vocation in civil life. Multiple neuritis. 
h. Cerebral arteriosclerosis, vascular accidents of all types. 
i. Spina bifida, if associated with neurological manifestations. Meningocele, 
even if uncomplicated. 
j. Other chronic degenerative diseases of the brain and spinal cord. 
86. Diagnostic criteria.—The following brief summary of diagnostic criteria 
is intended as a general guide for examiners. It includes the common manifesta- 
tions 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 meningo-enr 
cephalitic 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 a schizophrenic or neurasthenic type. 
(2) Meningo-vascular or cerebrospinal syphilis.—The prominent diagnostic 
signs and symptoms are headaches, history of mood changes or convulsions, vary- 
ing 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. 
(8) Tabes dorsalis (locomotor ataxia).—Look for unequal, irregular, or slug- 
gishly 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. Epilepsies.—Look for deep scars on tongue, face, and head. Since no physi- 
cal findings are pathognomonic, it is necessary to discover if the individual 
has had spells of unconsciousness, convulsions, “fits,” “falling but” spells, “lapses,” 
“dizziness,” or “fainting.” The individual will be disqualified on a verified 
history of such 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 treat- 
ment with anticonvulsive drugs over a long period of time. Such a history will REPORT OF COMMISSION OF PHYSICIANS 
57 
be verified, if practicable, a confirmatory medical record from a trustworthy 
source. When a registrant is rejected for epilepsy a statement will he made l>y 
the examining hoard giving the basis for the diagnosis. In the absence of stig- 
mata or a verified history and diagnosis is based icholly on the registrant’s 
statement, it unit be so stated. 
c. Paralysis agitans.—Paralysis agitans is recognized by frozen facies, unwink- 
ing stare, rigidity of the muscles, stooped posture, slowness of movement, tremors, 
slow, monotonous speech, etc. It may be unilateral. A history of encephalitis or 
influenza is obtained in only about cne-half the cases. Even mild manifestations 
disqualify. , 
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. 
e. 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. A 
dull apathetic expression, slight nystagmus, fine tremors, vasomotor changes, 
abnormal sweating, etc., are confirmatory evidence. If the syndrome is definite, 
even though mild, the individual should be rejected. The presence of signs in- 
dicating a focal lesion, even though mild, is also cause for rejection. See 
paragraph 37. 
f. Multiple sclerosis.—A history of transitory weakness, numbness, ataxia of 
one or more extremities, transient diplopia, scotomata or bladder disturbances 
should arouse a suspicion of multiple sclerosis. The presence of optic atrophy, 
scotomata, definite nystagmus, corneal hypesthesia, absence or irregularity of 
abdominal jerks, exaggerated deep reflexes, a Babinski or similar signs, or ataxia 
and euphoria are common manifestations. 
g. 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. 
h. Chronic neuralgias.—-A history of severe constant or recurrent pain, con- 
fined to the area of distribution of a single nerve or segment, without objective 
changes, suggests this diagnosis. Clearly defined entities are sciatic and trige- 
minal 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, etc., and 
also hysteria and malingering must be considered in differential diagnosis. Evi- 
dence of previous treatment and the injection of procaine into the nerve pre- 
sumably affected are important diagnostic aids. 
i. Multiple neuritis.—This may be associated with the dietary deficiencies, in- 
fection, or intoxication. The symptoms depend upon 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 or diminution of reflexes. 
j. Cerebral vascular accidents.—Characteristically, the onset is acute, with or 
without unconsciousness. Almost any focal disturbance may result. Evidence 
or peripheral arterial disease may be inconspicuous. The diagnosis disqualifies. 58 
REPORT OF COMMISSION OF PHYSICIANS 
Section XX 
PSYCHOSES, PSYCHONEUROSES, PERSONALITY DISORDERS 
General considerations 87 
Routine procedure 88 
Minimum psychiatric examination 89 
General service 90 
Limited service 91 
Nonacceptable 92 
Diagnostic criteria 93 
Paragraph 
87. General considerations.—The detection of disorders of the personality 
is often most difficult and the general fitness of the individual for military life 
should he considered at the end of the medical investigation. At the time of ex- 
amination there may be no obvious defects such as present themselves in other 
pathological conditions. Each examiner will constantly be on the alert through- 
out 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 par. 26.) Every effort must be made to reject the mentally deficient and 
those showing evidence of nervous instability. The mentally deficient and 
unstable are always a detriment to the Army from the day they are accepted until 
they are separated from the service. Such men will under no circumstances be 
accepted. 
88. Routine procedure.—a. The diagnosis of most psychiatric disorders de- 
pends 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. 
6. Routinely, examiners will be on the watch for any of the following per- 
sonality deviations: inability to understand and execute commands promptly 
and adequately, abnormal negativistic attitude, abnormal anxiety, silly inap- 
propriate laughter, instability, seclusiveness, sulkiness, sluggishness, discontent, 
lonesomeness, depression, shyness, suspicion, overboisterousness, timidity, per- 
sonal uncleanliness, stupidity, dullness, resentfulness to discipline, a history of 
nocturnal Incontinence, sleeplessness, lack of initiative and ambition, sleep- 
walking, recognized queerness, suicidal tendencies either bona fide or feigned, 
and homosexual proclivities. 
c. 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 auto- 
nomic responses as might reasonably be expected under the circumstances. 
89. Minimum psychiatric examination,—a. Mental and personality difficul- 
ties 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 straight- 
forward professional inquiry coupled with real respect for the individual’s 
personality and due consideration for his feelings—which does not mean diffi- 
dence. 
6. The psychiatric examination will be made outside of easy hearing of 
other men. Matter of diagnostic significance is often concealed when the indi- report of Commission of physicians 
59 
vidual feels that he 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 a 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 cases one 
would not be able to suspect the presence of any morbid condition without some 
knowledge of the individual’s history. 
90. General service.—a. The range of personalities usually classed as “nor- 
mal.”—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, a job. 
6. Marginal intelligence, if compensated for by better than average stability. 
c. Men whose speech can readily be understood, even though there is a moderate 
degree of stuttering or stammering, if otherwise physically, intellectually and 
emotionally fit. 
91. Limited service.—a. Moderate degrees of compulsiveness or obsessiveness. 
6. Stuttering and stammering of a degree disqualifying for general military 
service but which has not prevented the man from successfully following a use- 
ful vocation in civil life. 
92. Nonacceptable.—Individuals who are found to have any serious mental 
or neurological disorder such as— 
а. Mental deficiency. 
б. Psychopathic personality. 
c. Major abnormalities of mood. 
d. Psychoneurotic disorder. 
e. Pre-psychotic, post-psychotie and schizophrenic personalities. 
/. Chronic alcoholism and drug addiction. 
g. Syphilis of the central nervous system. See paragraph 85a. 
h. Sexual perversions. 
i. Stammering to such a degree that the registrant is unable to express him- 
self clearly or to repeat commands. 
93. Diagnostic criteria.—a. Mental defect or deficiency.— (1) Manifested by 
lack of general information concerning native environment; inability to learn, 
to reason, to calculate, to plan, to construct, to compare weights, etc.; defect 
in judgment, foresight, language, output of effort; suggestibility, untidiness, 
lack of personal cleanliness, anatomical stigmata of degeneration, muscular 
awkwardness. History of school life, vocational career, and disciplinary report 
will assist materially; then classify according to psychometric standards. 
(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, 60 
REPORT OF COMMISSION OF PHYSICIANS 
but an approximate psychometric scaling will be listed as cause for rejection, as 
“mental age, eight years.” Elaborate psychometric estimation is not necessary 
and any accepted abbreviated method will suffice. 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 cir- 
cumstances. Illiteracy per se is not to be classified as mental deficiency. 
6. Psychopathic personalities.—In this ill-defined, more or less heterogeneous 
group are placed those individuals who, although not suffering from a congenital 
defect in the Intellectual sphere, do manifest a 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, truthfulness, decency, and considera- 
tion of their fellow associates. They are emotionally unstable, not to be de- 
pended 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 a decided influence upon his fellow associates and the morale of his organ- 
ization, for he will not conform himself to organized authority and he derives 
much satisfaction in cultivating insubordination in others. Quite frequently he 
presents a favorable impression, is neat in appearance, talks well, and is well 
mannered. However, under this veneer the real defect is evident by past ir- 
responsiveness to social demands and lack of continuity of purpose. Among this 
general group are to be placed many homosexuals, grotesque and pathological 
liars, vagabonds, wanderers, the inadequate and emotionally unstable, petty 
offenders, swindlers, kleptomaniacs, pyromaniacs, alcoholics, and likewise those 
highly irritable and arrogant individuals, so-called pseudoquerulents, “guard- 
house lawyers,” who are forever critical of organized authority and imbued with 
feelings of abuse and lack of consideration by their fellow men. 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 
such individuals ultimately may develop full-fledged psychotic states. 
c. Major abnormalities of mood (affective psychoses, manic depressive psycho- 
sis).—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 a morbid 
excitement or a depression will be rejected. r 
d. Psychoneurotic disorders.— (1) Symptoms.—These conditions, often having 
no objective signs, may easily escape notice. Such individuals may show— 
(a) Conversion symptoms such as hysterical fits, absences, trances, hys- 
terical deafness, blindness or loss of voice; hysterical paralyses or 
anesthesias, and vasomotor disturbances such as sweating, palpi- 
tation and dizziness, and other dysfunctions of internal organs. In 
evaluating all of these conditions, the history of interference with 
progress in civil life is of utmost importance. REPORT OF COMMISSION OF PHYSICIANS 
61 
(6) Excessive concern with minor or imaginary bodily ailments as mani- 
fested by multiple vague complaints, multiple operations for obscure 
disorders, unusual fatigability, vagiie pains, pressure feelings, dis- 
torted bead sensations, etc. 
(o) Obsessions, compulsions, phobic manifestations such as specific terrors 
of harmless objects or situations, food phobias, dirt and germ pho- 
bias, inflexible rituals of behavior about food, sleeping, dressing, 
compulsive acts, tics, obsessional thoughts, obsessional indecision, 
etc. 
(d) Emotional disturbances such as chronic depression, mild elation, ir- 
ritability and chronic or episodic insanity. 
(2) Physical disorders which may furnish important clues to psychoneurotic 
disabilities.—Neurotic tensions may be manifested not only by frank psychoneu- 
roses and behavior difficulties but also by manifestations of a variety of physical 
disturbances and organic disease processes. Such conditions as peptic ulcer, 
pylorospasm, mucous colitis, spastic constipation, neurociyculatory asthenia, par- 
oxysmal 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 a close relationship. 
e, Schizophrenic group.—(1) This category comprises the grave mental or per- 
sonality handicaps. Prepsychotic and postpsychotic personalities and those actu- 
ally suffering a schizophrenic (“dementia praecox”) mental disorder manifest 
their condition by obscurely motivated peculiarities of behavior and thought. Of 
these, the so-called deteriorated states are the most obvious. Here belong the 
numerous shiftless, untidy, perhaps morose, sometimes nomadic individuals, who 
have had what was regarded as quite a normal childhood. Somewhere between 
the ages of 12 and 25 they underwent a change, acute or insiduous, with dilapida- 
tion of their social interests and the habits in which they had been trained. They 
may or may nqt have received treatment in hospitals for mental diseases. 
(2) The paranoid personalities are 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. A morbid sus- 
piciousness of anyone who takes an interest in them is frequent. They may 
become tense and hateful when interrogated. An attitude of unusual cautious- 
ness or suspiciousness toward the examining physician or toward fellow individ- 
uals should suggest the possibility that the individual may be paranoid. 
(3) The catatonic and prepsychotic states may present great difficulty in 
diagnosis. Perhaps the only sign of these conditions is the impression of queer- 
ness which the person makes on anyone who seeks to get acquainted with him. 
The actual oddities of behavior or thought may be subtle; it may be difficult, 62 
REPORT OF COMMISSION OF PHYSICIANS 
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 a peculiar reaction which upon questioning may awaken a suspicion 
of a prepsychotic state. > These individuals frequently entertain unfounded con- 
victions 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. 
f. Chronic alcoholism and drug addiction.— (1) Chronic alcoholism.—An in- 
dividual will be regarded as a 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 a history, if obtained, 
should be verified. Look for suffused eyes, prominent superficial blood vessels 
of nose and cheek, flhbby, 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, prevarica- 
tion, suspicion, auditory or visual hallucinations, persecutory ideas. 
(2) Drug addiction.—An individual will be regarded as a drug addict if he 
is or has recently been a habitual user of any of the opium preparations, cocaine, 
or cannabis indica (marijuana). A 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, shoul- 
ders, buttocks, or thighs are very important evidence but are not always present. 
The condition of the pupils is not important in active addicts. 
g. Syphilis of the central nervous system.—See paragraph 85a. 
h. Sexual perversions— Persons habitually or occasionally engaged in homo- 
sexual or other perverse sexual practices are unsuitable for military service and 
will be excluded. Feminine bodily characteristics, effeminacy in dress or manner, 
or a patulous rectum are not consistently found in such persons, but where pres- 
ent 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 a 
record as a pervert he will be rejected. 
Section XXI 
PURPOSELY CAUSED PHYSICAL DEFECTS 
Report of apparently purposely caused defects- 
Paragraph 
94 
94. 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 examina- 
tion prescribed herein would render him disqualified for military service of any 
kind, a 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. REPORT OF COMMISSION OF PFIYSICIANS 
63 
Section XXII 
MALINGERING 
Paragraph 
Definition 95 
Differentiation 96 
Feigned medical diseases 97 
Feigned surgical conditions 98 
Feigned nervous or mental illness 99 
Simulated defects of vision 100 
Simulated defects of hearing 101 
Bed wetting ; 102 
General considerations 103 
95. 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 a particular end which is more satisfactory 
to him or of seeking an escape from a fear-infested situation. Malingering 
is encountered in a number of situations but most frequently during the pre- 
liminary examinations and early training periods of military service. The 
simulation of neuroses and of physical disorders includes a 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. A person gifted with histrionic talent and who has a 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. 
96. Differentiation.—a. For a disorder to be classed as true malingering, it 
must fulfill three conditions that— 
(1) No obvious or frank 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 a purpose to a preconceived result. 
6. When confronted with a case of malingering the observer will try to ascer- 
tain how much of what constitutes the total picture 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 a definite end by simulation of a 
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 a bluff and hopes to get away with it. 
(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 symp- 
toms of fatigue, etc. 
(3) Malingering as a manifestation of a psychopathic personality with a sug- 
gestion 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 psycho- 
pathic personality contain many persons having an irresistible tendency to 
96050—44 5 64 
REPORT OF COMMISSION OF PHYSICIANS 
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 a disability which on the surface appears to be a definite simulation, requires 
a special investigation. The confusion of hysteria with true malingering is not 
Infrequently made by those who consider nearly all hysterics as malingerers 
with symptoms that could be controlled voluntarily. Some of these psychoneu- 
rotics 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 a 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 a 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 a healthy person to feign disease 
than it is for a diseased person to simulate health and that a malingerer may be 
able to simulate and to accentuate single symptoms but be is practically always 
unable to feign the entire picture of the disease he has selected and thus the export 
can usually detect omissions, discrepancies, .and contradictions in the situation. 
97. Feigned medical diseases.—a. The detection and management of malin- 
gerers 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 a difficult matter. 
b. 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 a 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 hematemeses. 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. Crutches, spectacles, trusses, strappings, etc., may be used to create 
appearance of disability. 
98. Feigned surgical conditions.—Under this are included old scars and 
injuries of the bones, fractures, and orthopedic conditions. Men may have teeth 
extracted in an effort to evade military service. Others may shoot or cut off 
their fingers or toes, usually on the right side, to disqualify themselves for REPORT OF COMMISSION OF PHYSICIANS 
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. 
99. Feigned nervous or mental illness.—a. Psychosis.—Rarely feigned by 
individuals and then usually a 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 symp- 
toms usually accompanies types of pain of which complaint is made. Absence1 
of objective evidence of localized pains. Note behavior when the registrant 
believes himself unobserved. 
c. Anesthesia.-—Complaint of anesthesia itself creates a suspicion of malin- 
gering 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 pupilJ 
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 a soldier. 
f. Stiff back.—Stiff back is a frequent symptom of hysteria in mobilization 
among selected men. In cases of this kind, organic diseases of the vertebrae cart 
and will be excluded, if necessary by X-ray. 
100. Simulated defects of vision.—See section IV. 
101. Simulated defects of hearing.—See section Y. 
102. Bed wetting.—Enuresis either real or simulated may be a frequent com- 
plaint among individuals for military service, but it is not a cause for uncon- 
ditional rejection. Men claiming to be bed wetters may be placed in class 1-A,. 
unless enuresis is substantiated by a physician’s affidavit or other acceptable 
documentary evidence. 
103. General considerations.—d. All men suspected of malingering will be 
immediately subjected to a thorough psychiatric survey which will include a 
careful history of their previous behavior and adjustment record and a complete ' 
physical, neurological, and laboratory evaluation. Observation in hospital may 
be required. If simple genuine malingering exists, the man will be confronted 
with the situation and given time to reconsider his attitude. Those malingerers 
whose past record is not unfavorable and who are otherwise acceptable willi 
not be rejected. Suspected malingerers found suffering from definite psycho- 
neuroses 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. 66 
REPORT OF COMMISSION OF PHYSICIANS 
INDEX 
A 
Paragraph Page 
Achylia gastrica 68c 28 
Acne 346(1) 14 
Acromegaly 76d, 78e 31,32 
Actinomycosis 8c, 366 3,14 
Addison’s disease 786 32 
Adenoids 276 12 
Albuminuria.- 72c,976 30,42 
Alcoholism, chronic 92/, 936,93/ (1) 37,38,40 
Allergic dermatoses 36/ 14 
Alopecia areata 34e 14 
Anemia: 
Aplastic 81d 32 
Hemolytic ictero . 81« 32 
Primary pernicious 81c 32 
Secondary 79 32 
Sickle cell - - 81/ 32 
Splenic 70/, 81/ 29,32 
Aneurysm i—' 641 26 
Angina pectoris 64o 26 
Ankle, disease of 46n 18 
Aphonia 29/ 13 
Application of physical standards 16 2 
Arteriosclerosis — 641: 26 
Cerebral — 856 34 
Arthritis 8g. 7id 3, 30 
Asthenia 93d(2) 39 
Asthma 58/ 24 
Ataxia, familial 85c 34 
Athetosis 85c, 86d 34,35 
B 
Deriberi. - 776,782 31,32 
Bladder, tumors of 74i 30 
Blepharitis 1 162,17c(6) 6 
Blepharospasm 16m, 17c(10) 6 
Blood: 
In stools 68e 28 
Pressure 6ie, 62e, 64; 25,26 
Bone, tumors of 44c 16 
Bradycardia - 62c 26 
Brain: 
Hernia of 396 15 
Other diseases of 85;, 966(5) 34,42 
Bronchiectasis 582: 24 
Bronchitis: 
Acute 56a 22 
Chronic 576, 58c 23,24 
Buerger’s disease 64fc 26 
Calculus, urinary: 
Bladder 74e,74/ 30 
Kidney 721. 73d 30 
Carcinoma 8a 3 
Of neck structures 1 50c 19 
Cardiospasm 1 93d(2) 39 
Cardiovascular system, history 60 25 
o REPORT OF COMMISSION OF PHYSICIANS 
67 
INDEX 
Cerebral: 
Concussion 376 15 
Syndrome, post-traumatic 85d, 86e 34,35 
Vascular accidents 856, 86j 34,35 
Chancroid 72 a 29 
Chest: 
Examination of 51, 53, 54, 55 19,21,22 
General considerations 67 27 
General service 62 25 
History.. 52 19 
Limited service .' 57 23 
Nonacceptable 64 26 
Physical examination procedure 61 25 
X-ray examination of, on whom made 53a, 536 19,20 
X-ray of 66 27 
Cholecystectomy 68m 28 
Choroid 1 18* 6 
Chorea 60, 85c, 86d 25,34,35 
Classification, physical 4 2 
Clavicle, deformity of 57a 23 
Clubfoot 44J, 46m 17,18 
Coccyx, fracture of 406 15 
Color blindness 16j 6 
Communicable diseases 6a 3 
Compulsiveness Ola, 93d(l)(c) 37,39 
Conjunctivitis 16d, 16e, 17d 6 
Constipation 93d(2) 39 
Convulsions 93d(2) 39 
Cornea, ulceration of ... 166, 16n, 186 5 
Coronary thrombosis 64p 26 
Cretinism 78c 32 
Cushing’s syndrome 78o 32 
Cyst: 
Pilonidal . 36n 15 
Thyrolingual 506 19 
Cystitis 74j 30 
Paragraph Page 
D 
Dacryocystitis ... 17c(8) 6 
Dementia praecox .a 93e 39 
Dental requirements 31,32, 33 13 
Dermatitis: 
Chronic 36e 14 
Herpetiformis 36c 14 
Diabetes insipidus 78/ 32 
Diabetes mellitus 76e, 78t 31,32 
Diagnostic aids 30, 43, 65, 66, 71a 13,16,27,29 
Diplopia 17c(9), 18m 6 
Dislocations 46e 17 
Diverticulitis 70 m 29 
Drug addiction 92/, 93/(2) 37. 40 
Dwarfism 78c 32 
Dystonia 86 d 35 
Ear: 
E 
Examination for disease ; 21 10 
External 246 11 
Ectropion 17c(l),186 6 
Eczema 346(8), 93d(2) 14,39 REPORT OF COMMISSION OF PHYSICIANS 
INDEX 
Paragaph Page 
Effort syndrome 62f, 64g, 93d(2) 26,27,39 
Elbow 45o 17 
Electrocardiogram - 65 27 
Elephantiasis --- 36./ 14 
Emphysema 676, 58e, 58j/ 23, 24 
Empyema.. - 56c, 58d 22,24 
Encephalomyelitis 85e 34 
Endocarditis. - — - 64n, 97a 26,42 
Entropion - 17c(l), 186 6 
Enuresis .... 726, 74p, 93d(2), 10 29,30,39,43 
Epidermolysis bullosa 36d 14 
Epilepsy ....... ...... ... 856, 866, 966(5), 99d 34,42,43 
Epiphora 17c(5) 6 
Epispadias. 72k, 74n 30 
Erythromelalgia. 64fc 26 
Esophagus, disease of 27g, 29e 12,13 
Exophthalmos --- - 16fc, 18e 6 
Extremities: 
Amputations of. 46? 18 
Deformities of.. 45e, 45g, 45k, 45e 46;, 46m, 46o 17,18 
Eye: 
Inflammatory disease of — - — 18? 6 
Operations on 166 5 
F 
Feet, defects 450, 45k, 47 17 
Feigned diseases: 
Medical 97 42 
Nervous or mental illness .• 99 43 
Surgical conditions 98 42 
Filariasis - - - 8i 4 
Fingers: 
Loss - - 44/, 44g, 45a, 456, 46a, 406 16,17 
Stiff - - 441 16 
Fistula: 
Inano 706 29 
Urinary 74c 30 
Fractures: 
Old or recent 44a, 44d 16 
Old ununited - 45d 17 
Frdhlich’s syndrome 766, 77a, 78/ 31,32 
a 
Gall bladder: 
Disease 706 29 
Operations on 68m 28 
Gastro-intestinal diagnostic aids. 71 29 
Qenito-urinary disease, use of X-ray in diagnosis 75a(2) 31 
Gigantism 78e 32 
Glasses, possession not required - 16a 5 
Glaucoma - 18i, 93(1(2) 6,39 
Glycosuria - 76c, 976 31,42 
Goiter: 
Adenomatous 506, 50j 19 
Exophthalmic - 50 a 18 
■ Simple - 486, 501, 76a, 786 18,19,31 
Toxic 78o 31 
Gonorrhea — 6a, 72n 3,29 
Gout 78m 32 
(Granuloma inguinale 74s 30 REPORT OF COMMISSION OF PHYSICIANS 
69 
INDEX 
H 
Paragraph Pag* 
Hallux valgus 44ft, 462 16,18 
Hand, deformity 446 16 
Hand or finger, ganglion and other benign tumors..*. 45d 17 
Hard palate, perforation 276 12 
Hay fever 2?j, 286, 29ft 12,13 
Hearing acuity: 
Determination 22 10 
General service 23 11 
Limited service 24 11 
Nonaceeptable 25 11 
Test for malingering 26 11 
Heart: 
Arrhythmia 62d, 64f, 65 26, 27 
Block... 64c 26 
Congenital heart disease 646 26 
Exercise test 61/ 25 
Hypertension 64i, 93d(2) 26,39 
Hypertrophy and dilatation... 646 26 
Hypotension 64g(4), 93d(2) 27,39 
Murmurs, functional 61, 67a(l), 67d 25,27,28 
Nomenclature and criteria for diagnosis 61 25 
Normal 62a 25 
Valvular disease 64g, 67, 97a 26,27,42 
Height 9 4 
Directions for taking 10 5 
Maximum 13c 5 
Minimum 13a 5 
Hemophilia - 81a 32 
Hemorrhoids 68c, 68;, 69c, 701 28,29 
Hermaphroditism — 741 30 
Hernia 68ft, 1, 70a, 71c 28,29 
Hip, disease.. 46n 18 
Hodgkin’s disease 8j, 50d, 70; 4,19,29 
Homosexuals. 936 40 
Hospitalization 56 3 
Hydrocele 72;, 74r 30 
Hydrocephalus 396 15 
Hydronephrosis 746 30 
Hyperinsulinism. — 78p 32 
Hyperthyroidism 18d, 50a, 6, 78a 6,18,19,31 
Hypospadias - 72ft, 74n 30 
Hypothyroidism 76c, 78d 31,32 
Hysteria ... - - --------- - ----- 93d, 966(4), 99c 38,42,43 
L 
Icterus, congenital hemolytic 8m 4 
Ileitis 70m 29 
Illiteracy 03a, 99a 37, 43 
imbecility 78c, 93a 32,37 
jmpotency-- --- 93 d (2) 39 
indigestion 68d, 97a 28,42 
intestinal obstruction 70« 29 
iridectomy 166 5 
I 
Keratitis 18/ 6 
Kidney: 
Floating 736 30 
Removal of one 73d 30 
Surgical 74e 30 
Tumors 74j 30 
K 70 
REPORT OF COMMISSION OF PHYSICIANS 
INDEX 
Knee joint: 
Internal derangement 45f 17 
Loose cartilages removed from 44q 17 
Other diseases 46n 18 
Knock ankle - 45ff 17 
Paragraph Page 
L 
Laryngitis 27/ 12 
Larynx; 
Paralysis 29c 13 
Tumors 29 h 13 
Leprosy 8c 3 
Leukemia 8n, 50d, 70j, 81 h 4,19, 29, 32 
Liver, enlargement 68/ 28 
Lung: 
Abscess. 68j 24 
Cystic disease 58h 24 
Foreign body in 685 24 
Mycotic disease 581 24 
Tumor 58o 24 
Lungs and chest wall: 
General considerations 59 24 
General service. 56 22 
Limited service 57 23 
Nonacceptable 58 23 
Tuberculosis 54d, 56f, 58a, 586, 58c, 58m, 59 22, 23, 24 
Lupus vulgaris 36* 14 
Lymph nodes: 
Of the axilla 56* 23 
Of the neck 48c, 50d, 60* 18,19 
Tuberculous : 50/, 56/, 58a 19, 22, 23 
Lymphogranuloma venereum 74f 30 
Lymphosarcoma ...... 50e 19 
Malaria 66, 81, 81i 3, 4, 32 
Malingerers: 
Definition 95 41 
Differentiation .... 96 41 
General considerations.. 103 43 
Hearing test for detection 26 11 
Visual tests for detection . I... 19 7 
Malocclusion 316 13 
Marijuana 93/"(2) 40 
Mastoid operation . 236 11 
Measurements 9 4 
Mediastinum, tumor 58o 24 
Megacolon 70 m 29 
Membrana tympani, perforation 24c 11 
Meningocele 85i 34 
Mental deficiency 92a, 99a 37, 43 
Diagnostic criteria 93a 37 
Metallic poisoning 8e 3 
Migraine ; ,.. 93d(2) 39 
Monstrosity 396 15 
Mood, abnormalities 92c, 93c 37,38 
Moron 93a 37 
Mouth: 
Benign tumors 27c 12 
Deformity 27i, 29a 12,13 
Mucous colitis 93d(2) 39 
M REPORT OF COMMISSION OF PHYSICIANS 
71 
INDEX 
Muscle: 
Atrophy 85/ 34 
Dystrophies 85/, 80? 34, 35 
Nonspastic contraction... 48a, 50y 18,19 
Paralysis.. 446, 46?, 83c, 84 16,18,33 
Spastic contraction 50A 19 
Tremors. 93/(l) 40 
Mycosis fungoides 36? 14 
Mycotic infections — 8/, 58/ 3,24 
Myxedema 78 d 32 
Paragraph Page 
Naevl - 346(7) 14 
Narcolepsy., 93d(2) 39 
Nasal septum, deviation 27d, 28a 12,13 
Nasal turbinates, enlarged - 27d 12 
Nephritis: 
Acute - 74a 30 
Chronic 74a 30 
Neuralgia — 85?, 806 34,35 
Neuritis 85?. 86/ 34,35 
Neurocirculatory asthenia 62f, 64?, 93d(2) 26,27,39 
Neurological disorders: 
Diagnostic criteria 80 34 
General service - 83 33 
Limited service - 84 33 
Nonacceptable... 85 34 
Methods of examination ; 82 33 
Nose: 
Benign tumors - 27c 12 
Deformities _____— 29a 13 
Polypi - - 28c, 29/ 13 
Nystagmus 16c, 18fc 6 
N 
o 
Objective of regulations 3 2 
Obsessiveness 91a, 93d(l)(c) 37,39 
Optic nerve, disease ...... : 18* 6 
Orbit, tumor 18p 7 
Osteoarthritis 426 16 
Osteomyelitis 8ft, 46r 3,18 
Otitis media 266 11 
Overheight 13c, 14a, 146 5 
Overweight 116, 13d, 146 5 
p 
Paralysis: 
Agitans 86c, 86c 34, 35 
Of larynx - 29c 13 
Of muscles 446, 45g, 83c, 84 16,18, 33 
Parasites, intestinal 68i, 71 d 28,29 
Parathyroid, conditions 78# 32 
Paresis 85a, 86a (1) 34 
Paroxysmal tachycardia 626, 64d 26 
Pediculosis 346(8) 14 
Pex.agra 776, 7SZ 31,32 
Pelvis, fracture 40e 15 
Pemphigus 366 14 
Penis, conditions 72h, 72k 74Z, 74n , 30 
Pericarditis 1 64 to 26 
Pes planus 44), 46) 16,18 
Phimosis 72/ 30 
Phobias 93d(l) 38 
Pigmentation 346(2) 14 72 
REPORT OF COMMISSION OF PHYSICIANS 
INDEX 
Paragraph Page 
Pilonidal cyst 36n 15 
Pleura, tumor . 68o 24 
Pleurisy... 56d, 56e, 58c 22, 24 
Pneumonia 65, 666 22 
Pneumothorax 58p 24 
Polycythemia. 81<7 32 
Post-encephalitic syndrome .... 85c 34 
Proctoscopy 71c 29 
Prostate gland, hypertrophy 74m 30 
Psoriasis 346(11), 93d(2) 14,39 
Psychiatric examination: 
General service 90 37 
Limited service ’ 91 37 
Nonacceptable 92 37 
Minimum 89 36 
Psychoneuroses 92d, 93d, 966(4), 103a 37,38,42,43 
Psychopathic personality 926,936, 966(3) 37,41 
Psychoses 966(5), 99, 103a 42,43 
Psychoses, psychoneuroses, personality disorders: 
Each examiner to report suspicious symptoms 87 36 
Examination of, routine procedure.. 88 36 
General considerations 87 36 
Psychotic disorders... 92e 37 
Pterygium 16gr, 17c(7) 6 
Ptosis 16t, 17c(2) 6 
Publication of standards. 2a 2 
Pulse, counting 61 d 25 
Purpose of standards 1 1 
Purposely caused defects. 94 40 
Purpura. 816 32 
Pyelitis 74p 30 
Pylorospasm 93d (2) 39 
Pyonephrosis 74 h 30 
Raynaud’s disease 64fc, 93d(2) 26,39 
Rectum; 
Examination 71c 29 
Stricture - - 70 g 29 
Ulcer.. 68« 28 
Renal glycosuria 76c, 78k 31,32 
Retina, disease — 18i, 18j 6 
Rheumatic fever - 8g, 60, 67a, 67c 3,25,27 
Rheumatism, chronic 8g, 97a 3, 42 
Rhinitis, chronic 29fl> 13 
Rib: 
Deformity 57a 23 
Fracture 56p 23 
Ringworm 346(9), 36fc 14 
R 
Sacroiliac disease 40d, 41c, 42e 15,16 
Scabies. 4 — 346(10), 361 14,15 
Scalp, contusions and other wounds... 376 15 
Scapula 40c 15 
Deformity 57a 23 
Sears: 
Abdominal wall 68a, 686 28 
Hand - 446,466 16,18 
Schistosomiasis 70 i 29 
Schizophrenia 92e, 93e 37,39 
Sciatica 46p 18 
Sclerosis, multiple 85«, 86f 34, 35 
s REPORT OF COMMISSION OF PHYSICIANS 
73 
INDEX 
Paragraph Page 
Scurvy,. 776, 787 31, 32 
Sexual perversion * 926, 936 37,40 
Silicosis 58i 24 
Siinmonds’ disease 78n 32 
Sinuses of abdominal wall .... 70/ 29> 
Sinusitis 29/ 13- 
Skin: 
General service 34 14 
Limited service . 35 14 
Nonacceptable 36 14 
Scars of 346(3) 14 
Ulcers of 34c 14 
Skull: 
Deformities 37a, 38, 39a, 396 15 
Osseous defects 38, 39 15 
Somnambulism 93d(2) 39 
Spina bifida . 85i 34 
Spinal cord, disease 85/ 34 
Spine; 
Curvature 40a, 41a, 42d 15,16 • 
Disease y 85/, 99/ 34, 43 
Fracture.. 40e 15 
Spleen, enlargement , 68g, 70/, 706 28, 29 
Splenectomy 8m 4 
Sprue. 781 32 
Stammering or stuttering. 90c, 916, 92i 37 
Stomach: 
Disease... 68d, 70c 28, 291 
Examination 716 29 
Strabismus '. 166, 17c(4), IS? 6, 7< 
Surgical operation, major 6d 3 
Symblepharon 16/ 6 
Syphilis 8d, 296, 36a, 74o 3,13,14, 30 
Central nervous system 85a, 86a(2), 92g 34, 37 
Serologic test for 756 31 
Tabes dorsalis 85o, 86n<3) 34' 
Tachycardia... - 61 g, 626, 64d, 64j(4), 93d(2), 976 25,26,39,42 
Teeth and associated structures: 
General service 31 13 
Limited service 32 13 
Nonacceptable 33 13 
Teleroentgenography - 66 27 
Testicle 72d, 72c, 73c 30 
Tumor 74i 30 
Throat, deformities 29a 13 
Thrombophlebitis 64/ 26 
Thyrolingual cyst - 50k 19* 
Thyrotoxicosis 50a, 506, 78a, 976 18,19, 31, 42 
Toes: 
Claw toes 44wi, 461 17,18 
Hammer toes 44m 17 
Ingrown nail 44p 17’ 
Loss of 44o, 45h 17 
Other defects 45c, 45i, 45p 17 
Tonsils - 27a 12: 
Torticollis 85c, 8Gd 34,35 
Tracheostomy — 29d 13 
Trachoma 18o 7 
Trichiasis 17c(3) 6- 
Trypanosomiasis 8i i. 
T 74 
REPORT OF COMMISSION OF PHYSICIANS 
INDEX 
Paragraph Pag* 
Tuberculosis..86,42a, 46c, 51, 52, 53d(2), 54c, 54d, 54c, 55, 56e, 66/, 58a, 686,58c, 58m, 59 3,16,17,19,21,22,23,24 
Tumors: 
Benign, of abdominal wall 686, 696 28 
Benign, of breast or cbest wall 666, 58n 33,34 
Benign, of neck 60i 19 
Kidney 74i 30 
Larynx 296 13 
Lung 58o 24 
Malignant 8a, 50c, 58n 3,19, 24 
Orbit 18p 7 
Testicle 74i 30 
u 
Ulcer: 
Anal 68e 28 
Corneal 16ft, 16n, 18ft 6 
Duodenal . _ 70c, 70d, 71/, 93rf(2), 97a 29,39,42 
Gastric 70d, 71/, 93d(2), 97a 29,39,42 
Rectal 68e 28 
Skin . 34c 14 
Uncinariasis J 6c, 8ft 3,4 
Underheight . 13a, 146 5 
Underweight. . , 12, 136, 146 5 
Urethra, stricture. 73a, 746 30 
Urinalysis 75 a 30 
Urinary incontinence 74c 30 
Urinary retention 98 42 
V 
Varicocele . . j. 72Z, 74f 30 
Varicose veins 46i, 64A; 18,26 
Venereal disease 6a, 72a 3,29 
Visual acuity; 
General service 16 6 
How determined 16 6 
Limited service 17 6 
Nonacceptable.. 18 6 
Warts 346(4) 14 
Webbed fingers and toes *. 44e 16 
Weight 9 4 
Minimum 136, 146 5 
Wrist 45o 17 
w 
X-ray films of chest: 
Army serial number to he recorded on 63c 20 
Disposition 63d 21 
Identification 63c 20 
Processing 63 19 
To be noted on service record 536(3) 20 
[A. G. 381 (9-18-42).] 
X 
ORDER OP THE SECRETARY OF WAR 
G. O. MARSHALL, 
Official ; 
Chief of Staff. 
J. A. ULIO, 
Major General, 
The Adjutant General. APPENDIX II 
CHANGES IN PHYSICAL STANDARDS AS PRESCRIBED 
BY MOBILIZATION REGULATIONS 1-9, WAR DEPART- 
MENT, WASHINGTON, D. C., DATED 15 OCTOBER 1942, AS 
AMENDED BY CHANGE 1, DATED 22 JANUARY 1943, AND 
CHANGE 2, DATED 23 FEBRUARY 1943, RECOMMENDED BY 
THE COMMISSION APPOINTED UNDER SECTION 4 (e), 
PUBLIC LAW 197, 78th CONGRESS. 
75 TABULATION OF CHANGES IN PHYSICAL 
STANDARDS 
Section I 
(Old) Par 4. Physical classification.—a. General service.—Physically quali- 
fied for general military service. Registrants will be recommended for assign- 
ment for general service if they meet the requirements therefor throughout the 
entire physical examination. 
(New) Par. 4. Physical classification.—a. General service.—Physically quali- 
fied for general military service. Registrants will be recommended for assign- 
ment for general service if they meet the requirements therefor throughout the 
entire physical examination. In those border-line cases, where a 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. 
(Old) Par. 4 b. Limited service.—Physically unfit for general military service, 
but fit 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 rejec- 
tion as nonacceptable. Men recommended as nonacceptable will not be accepted 
unless specific directions to that effect have been issued by the War Department. 
(New) Par. 4 b. Limited service.—Physically unfit for general military serv- 
ice, but qualified for limited military service. Individuals who fail to qualify 
for general service, and who do not fall below limited service requirements in 
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. 
(Old) Par. 4 c. Nonacceptable.—Physically unfit for any military service. All 
individuals who do not meet the physical reqiiirements of general service, or 
limited service will be recommended as nonacceptable. 
(New) Par. 4 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 accu- 
rately on the report of physical examination. The defects will be listed in 
the summary of the physical examination i-eport in the order of their importance. 
The irremediable, disqualifying permanent defect will be listed as number one 
and 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 be accepted unless 
specific directions to that effect have been issued by the War Department. 
INFORMATION AND INSTRUCTIONS 
77 78 
REPORT OF COMMISSION OF PHYSICIANS 
Section II 
GENERAL AND MISCELLANEOUS DEFECTS 
(Old) Par. 6. General service.—a. Acute communicable diseases, provided ac- 
ceptance of the individual is temporarily deferred until a final examination shows 
recovery without disqualifying sequelae. Individuals with uncomplicated ve- 
nereal disease will not be accepted until instructions for their acceptance have 
been issued by the War Department. See Paragraph 72a. 
(New) Par. 6. General service.—a. Individuals with acute pathological con 
ditions, including acute communicable diseases except venereal diseases, from 
which in the natural course of the disease recovery occurs without sequelae, will 
be deferred until a final examination shows recovery has occurred without dis- 
qualifying sequelae. 
(Old) Par. 6. General Service.—b. Malaria, acute, or malaria, chronic, unless 
severe. 
(New) Par. 6. General service.—b. Malaria, acute, or malaria, chronic, if 
mild. 
(Old) Par. 6. General service.—c. Uncinariasis, unless severe. 
(New) Par. 6. General service.—c. Uncinariasis, if mild. 
(Old) Par. 8. Nonacceptable.—g. Acute rheumatic fever or authentic history 
of recurrent attacks of rheumatic fever, chronic rheumatism and chronic 
arthritis. 
(New) Par. 8. Nonacceptable.—g. Acute rheumatic fever or verified history 
of single or recurrent attacks of rheumatic fever within the previous 2 years. 
(New, added) Par. 8. Nonacceptable.—h. Osteoarthritis or rheumatoid ar- 
thritis. 
(Old) Par. 8. Nonacceptable.—i. Filariasis or trypanosomiasis. 
(New) Par. 8. Nonacceptable.—j. Filariasis, trypanosomiasis, amoebiasis, or 
schistosomiasis. 
(Old) Par. 8. Nonacceptable.—k. Uncinariasis, if severe. 
(New) Par. 8. Nonacceptable.—I. Uncinariasis, if more than mild. 
(Old) Par. 8. Nonacceptable.—I. Malaria, chronic, severe. 
(New) Par. 8. Nonacceptable.—in. Malaria, chronic, if more than mild. 
(Old) Par. 8. Nonacceptable.—o. Hernia, except small umbilical hernia. 
(New) Deleted and rewritten. (See Section XV, par. G9 g, 70 a, 71 a.) 
SECTION IV 
EYES 
(Old) Par. 16. General service.—a. For general military service in all arms 
and services.—Registrants whose visual acuity is not less than 20/200 in each eye 
without glasses, if correctible to at least 20/40 in each eye. The actual possession 
of suitable glasses by an individual is not required for his acceptance under these 
standards. 
(New) Par. 16. General service.—u. 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. 
(New, added) Par. 16. General service.—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 (1) 20/40 in each eye, 
(2) 20/30 in the right eye and 20/70 in the left eye, or (3) 20/20 in the right eye 
and 20/400 in the left eye and provided the defective vision is not due to active or REPORT OF COMMISSION OF PHYSICIANS 
79 
progressive organic disease. The actual possession of suitable glasses by an indi- 
' vidual is not required for his acceptance under these standards. 
(Old) Par. 16. General service.—d. Slight conjunctivitis. 
(New) Deleted. 
(Old) Par. 16. General service.—g. Small pterygium not encroaching on 
cornea. 
(New) Par. 16. General service.—g. Small pterygium not encroaching on 
cornea so as to interfere with vision. 
(Old) Par. 16. General service.—/;. Strabismus which does not interfere with 
vision. 
(New) Deleted. (See par. 18 p.) 
(Old) Par. 17. Limited service.—a. A minimum vision of 20/400 in one or 
both eyes without glasses if correctible with glasses to at least 20/40 in each eye. 
(New) Par. 17. Limited service.—a. 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. 
(Old) Par. 17. Limited service.—6. 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 
20/100 correctible to not less than 20/20. 
(New) Par. 17. Limited service.—&. 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. 
(Old) Par. 18. Nonacceptable.—c. Disfiguring cicatrices of eyes. 
(New) Par. 18. Nonacceptable.:—Deleted. 
(Old) Par. 18. Nonacceptable.—d. Lagophthalmos, if associated with signs 
of hyperthyroidism. 
(New) Par. 18. Nonacceptable.—c. Lagophthalmos, if extreme. 
(Old) Par. 18. Nonacceptable.—g. Chronic recurrent inflammatory disease 
of the globe. 
(New) Par. 18. Nonacceptable.—f. Chronic recurrent inflammatory disease 
of the cornea or uveal tract. 
(Old) Par. 18. Nonacceptable.—q. Permanent or well-marked strabismus. 
(New) Par. 18. Nonacceptable.—p. Permanent and well-marked strabismus 
(over 30 degrees deviation). 
(Old) Par. 18. Nonacceptable.—t. Chronic conjunctivitis. 
(New) Par. 18. Nonacceptable.—s. Chronic conjunctivitis, other than mild, 
simple. 
Section V 
EARS 
(Old) Par. 23. General service.—a. Hearing in each ear of 8/15 or better. 
(New) Par. 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. 
(Old) Par. 24. Limited service.—a. Hearing in one or both ears less than 
8/15 but no less than 5/15 in either ear. Deafness in one ear if the hearing is 
not less than 15/15 in the other ear. 
(New) Par. 2i. Limited service.—There are no defects in hearing that war- 
rant initial classification for limited service. 
(Old) Par. 25. Nonacceptable.—Defects such as— 
a. Hearing less than the minimum hearing prescribed under limited service. 
(New) Par. 25. Nonacceptable.—Defects such as— 
96050—4.4 6 80 
REPORT OF COMMISSION OF PHYSICIANS 
a. Hearing less than the minimum hearing prescribed under general service. 
(Old) Par. 25. Nonacceptable.—b. Chronic purulent otitis media with or 
without mastoiditis. 
(New) Par. 25. Nonacceptable.—b. Purulent otitis media with or without 
without mastoiditis. 
(Old) Par. 25. Nonacceptable.—/. Atresia of the external auditory canal, or 
tumors of this part. 
(New) Par. 25. Nonacceptable.—f. Severe atresia of the external auditory 
canal. 
Section VI 
MOUTH, NOSE, FAUCES, PHARYNX, TRACHEA, ESOPHAGUS, AND 
LARYNX 
(Old) Par. 27. General service.—d. Deviation of the nasal septum or enlarged 
turbinates which do not seriously interfere with nasal breathing. 
(New) Par. 27. General service.—c. Deviation of the nasal septum or en- 
larged turbinates which do not interfere more than mildly with nasal breathing. 
(Old) Par. 28. Limited service.—a. Deviation of the nasal septum which 
moderately interferes with nasal breathing. 
(New) Par. 28. Limited service.—a. Deviation of the nasal septum or en- 
larged turbinates which do not interfere more than moderately with nasal 
breathing. 
(Old) Par. 29. Nonacceptable.—f. Chronic sinusitis of the accessory sinuses 
of the nose. (This diagnosis will be established by the presence of a chronic 
nasal discharge, large nasal polypi, and other signs and symptoms and confirmed 
by transillumination or x-ray examination or both.) 
(New) Par. 29. Nonacceptable.—■/. Chronic sinusitis of the accessory sinuses 
of the nose. (This diagnosis will be established by the presence of a chronic puru- 
lent nasal discharge, * * *. 
(Old) Par. 29. Nonacceptable.—h. Malignant neoplasms of the larynx. 
(New) Par. 29. Nonacceptable.—Malignant neoplasms. 
Section VIII 
SKIN 
(Old) Par, 34. General service.—6. (4) Warts. 
(New) Par. 35. General service.—b. (4) Warts, except plantar warts on 
weight-bearing areas. 
(Old) Par. 36. Nonacceptable.—Psoriasis does not appear in old MR 1-9 as 
a nonacceptable skin disease but its nonacceptance is implied by par. 34 6 (11), 
if more than mild and if extensive. 
(New) Par. 37. Nonacceptable.—I. Psoriasis, if more than mild. 
(Old) Par. 36. Nonacceptable.—Warts not listed in old MR 1-9 as a non- 
acceptable defect. 
(New) Par. 37. Nonacceptable.—p. Plantar warts on weight-bearing areas. 
Section X 
SPINE, SCAPULAE, AND SACROILIAC JOINTS 
(Old) Par. 40. General service.—a. Lateral curvature ,of the spine of 2 
inches or less from the midline if the mobility and weight-bearing power are 
good. REPORT OF COMMISSION OF PHYSICIANS 
81 
(New) Par. 41. General service.—a. Lateral deviation of the spine of 1 inch 
or less from the midline if the mobility and weight-bearing power are good. 
(Old) Par. 40. General service.—Does not appear in old MR 1-9 in this sec- 
tion. (See par. 85 i.) 
(New) Par. 41. General service.—/. Spina bifida occulta providing it is 
asymptomatic, unassociated with objective signs and symptoms and can be dem- 
onstrated by x-ray examination only. 
(Old) Par. 41. Limited service.—a. Lateral deviation of the spine from the 
midline of more than 2 inches and less than 8 inches. 
(New) Par. 42. Limited service,.—Lateral deviation of the spine from the 
midline of more than 1 inch and less than 2 inches. 
(Old) Par. 42. Nonacceptable.—&. Osteoarthritis. 
(New) Par. 43. Nonacceptable.—6. Osteoarthritis or rheumatoid arthritis; 
or chronic arthritis from any cause. 
(Old) Par. 42. Nonacceptable.—c. Healed fractures of the vertebrae or pelvic 
bones with associated disqualifying symptoms. 
(New) Par. 43. Nonacceptable.—c. Healed fractures of the vertebrae or 
pelvic bones with associated symptoms which have prevented the individual from 
following a useful vocation in civil life. 
(Old) Par. 42. Nonacceptable.—d. Lateral deviation of the spine from the 
midline of more than 3 inches. Curvature of the spine (kyphosis or lordosis) of 
a degree sufficient to interfere with the wearing of a uniform or military equip- 
ment or which has prevented the individual from following a useful vocation in 
civil life. 
(New) Par. 43. Nonacceptable.—d. Lateral deviation of the spine from the 
midline of more than 2 inches. Curvature of the spine (scoliosis, kyphosis, or 
lordosis) of a degree sufficient to interfere with the wearing of a uniform or 
military equipment or which has prevented the individual from following a useful 
vocation in civil life. 
(Old) Par. 42. Nonacceptable.—Nucleus pulposus not in old MR 1-9. 
(New) Par. 43. Nonacceptable.—f. Nucleus pulposus (herniation interverte- 
bral disc) or history of operation for this condition. 
Section XI 
EXTREMITIES 
(New, added) Pax*. 45. General service.—d. Entire loss of little finger of 
either or both hands, or the ring finger of the left hand. 
(New, added) Par. 45. General service.—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. 
(Old) Par. 44. General service.—f. Loss of two entii’e fingers of either hand, 
except a combination of right index and middle finger. 
(New) Par. 6. Limited service—a. Loss of two entire fingers of either hand, 
except a combination of the right index and middle finger. 
(Old) Par. 44. General service.—j. Fiat foot unless accompanied with symp- 
toms 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. 82 
REPORT OF COMMISSION OF PHYSICIANS 
(New) Par. 45. General service.—h. Flat foot unless * * *, due to inward 
rotation of the astragalus, and rigid flat foot are disqualifying regardless * * *. 
(Old) Par. 44. General service.—I. Clubfoot of slight degree if tarsal, meta- 
tarsal, and phalangeal joints are flexible, permitting the wearing of a military 
shoe and, in the opinion of the examiner, will not interfere with the performance 
of military duty. 
(New) Par. 46. Limited service.—g. Clubfoot of slight degree * * *. 
(Old) Par. 44. General service.—m. Slight claw toes not involving oblitera- 
tion of the transverse arch and which do not interfere with the wearing of a 
military shoe. 
(New) Par. 46. Limited service.—h. Slight claw toes not involving * * *. 
(Old) Par. 44. General service.—n. Hammertoe which is flexible and which 
does not interfere with the wearing of a military shoe. (Hammertoe usually 
involves the second digit and unless it is rigid is not a disqualifying defect.) 
(New) Par. 45. General service.—i. Hammertoe which does not interfere 
with the wearing of a military shoe. 
(Old) Par. 45. Limited service.—h. Loss of twro entire fingers of either hand, 
not to include the right index finger, provided the thumb remains. 
(New) Par. 46. Limited service.—a. Loss of two entire fingers of either hand, 
except a combination of the right index and middle finger. 
(Old) Par. 45. Limited service.—j. Hammertoe wnth rigidity, 
(New) Par. 46. Limited service.—Hammertoe does not appear in limited 
service section in new MR 1-9. (See par 45 i.) 
(Old) Par. 45. Limited service.—Internal derangement of the knee joint 
* * * not in old MR 1-9. 
(New) Par. 46. Limited service.—m. Internal derangement of knee joint. 
(1) History of, providing disability has been mild and infrequent. 
(2) Operation for, providing a period of 6 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. 
(Old) Par. 46. Nonacceptable.—&. Loss of the right index finger or more 
than two entire fingers of one hand. 
(New) Par. 47. Nonacceptable.—6. Loss of more than two entire fingers of 
either hand. 
(Old) Par. 46. Nonacceptable.-—,;. Flat foot when accompanied with symp- 
toms 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. 
(New) Par. 47. Nonacceptable.—j. Rigid flat foot or flat foot * * *. 
(Old) Par 46. Nonacceptable.—I. Hallux valgus, if severe and associated 
with marked exostosis or bunion, especially when there are signs of irritation 
over the joint. 
(New) Par. 47. Nonacceptable.—I. Hallux valgus, if severe and associated 
with marked exostosis or bunion. 
(Old) Par. 46. Nonacceptable.—Not in par. 46 of old MR 1-9. (See par. 8 g.) 
(New) Par. 47. Nonacceptable.—s. Osteoarthritis or rheumatoid arthritis; 
or chronic arthritis from any cause. 
(Old) P'ar. 46. Nonacceptable.—Not in old MR 1-9. 
(New) Par. 47. Nonacceptable.—t. Plantar warts on weight-bearing areas. REPORT OF COMMISSION OF PHYSICIANS 
83 
Section XII 
NECK 
(Old) Par. 48. General service.—Not in old MR 1-9. 
(New) Par. 49. General service.—d. Healed tuberculous lymph nodes when 
few in number and densely calcified. 
(Old) Par. 48. General service.—Not in old MR 1-9. 
(New) Par. 49. General service,—e. History of thyroidectomy for nontoxic 
goiter. 
(Old) Par. 49. Limited service.—There are no neck criteria to warrant initial 
selection as limited service. 
(New) Par. 50. Limited service.—History of thyroidectomy for toxic goiter 
with complete absence of active manifestations for two years. 
(Old) Par. 50. Nonacceptable.—a. Exophthalmic goiter. (See Section 
XVII.) 
(New) Par. 51. Nonacceptable.—a. Toxic goiter. 
(Old) Par. 50. Nonacceptable.—b. Thyroid enlargement from any cause asso- 
ciated with toxic symptoms. (See Section XYII.) 
(New) Par. 51. Nonacceptable.—b. Not in new MR 1-9, because of redun- 
dancy. 
(Old) Par. 50. Nonacceptable.—c. Carcinoma of the thyroid or other struc- 
tures of the neck. 
(New) Par. 51. Nonacceptable.—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 a uniform or mili- 
tary equipment. 
(Old) Par. 50. Nonacceptable.—f. Tuberculous lymph nodes. 
(New) Par. 51. Nonacceptable.—e. Tuberculous lymph nodes, except as speci- 
fied in 49 d. 
(Old) Par. 50. Nonacceptable.—i. Simple goiter unassociated with toxic pres- 
sure symptoms, enlarged lymph nodes and benign tumors of the neck if the en- 
largement is of such degree as to interfere with wearing of a uniform or military 
equipment. 
(New) Par. 51. Nonacceptable.—h. Simple goiter if associated with pressure 
symptoms, confirmed by X-ray, or if enlargement is of such a degree to interfere 
with wearing of a uniform or military equipment. 
(Old) Par. 50. Nonacceptable.—j. Simple adenomatous goiter. 
(New) Par. 51. Nonacceptable.—Included in par. 51 b and 51 h. 
(Old) Par. 50. Nonacceptable.—k. Thyrolingual cyst. 
(New) P'ar. 51. Nonacceptable.—Not in new MR 1-9. 
Section XIII 
LUNGS AND CHEST WALL 
(Old) Par. 56. General service.—f. Healed intrathoracic primary tuberculous 
lesions, demonstrable in roentgenograms, but. of slight extent. The following 
specifications of the limits of such lesions are intended to exclude persons with 
disease which is most likely to be in part caseous and, therefore, potentially 
hazardous. The limits are set arbitrarily to provide an objective basis on which 
the examiner may render a decision. All measurements refer to single, standard 
14- by 17-inch direct projection roentgenograms. These lesions may consist of— 
(1) Calcified residues of lesions of the intrathoracic lymph nodes, provided 84 
REPORT OF COMMISSION OF PHYSICIANS 
none of these exceeds an arbitrary limit of 1.5 centimeter in diameter and the 
total number of such lesions does not exceed five. 
(2) Calcified lesions of the pulmonary parenchyma, provided the total number 
of these does not exceed ten. One of these may equal but not to exceed 1 centi- 
meter in diameter, but none of the remainder may exceed 0.5 centimeter in diam- 
eter. In the roentgenogram such calcified lesions should appear isolated, sharply 
circumscribed, homogeneous, and dense. 
The above arbitrary limits of calcified lesions are set on the assumption that 
large and numerous lesions are more likely to be partially unhealed, and there- 
fore a potential source of future recrudescence than small lesions of limited dis- 
tribution. It is recognized, however, that in some individuals calcified tubercu- 
lous lesions exceeding these limits may be present which are so well healed that 
the possibility of future reactivation is remote. Further consideration may be 
given to the acceptability of persons with calcified lesions of this type when the 
state of health in all other respects clearly warrants the opinion that the lesions 
in question are healed. In such cases the history of the applicant and his age, 
as well as the character of the lesions as seen in X-ray films, provide criteria 
for estimating the probability of complete arrest of the tuberculous process. If 
there is no history of active tuberculosis or symptoms which might be interpreted 
as evidence of this disease and if the applicant is more than 25 years of age, and 
if finally the calcified lesions seen are dense and discrete in character and not 
hazy or irregular in outline, such lesions may be considered as not prejudicial 
to future health. In these cases the applicant may be accepted provided the re- 
port of physical examination and the chest X-ray films have been reviewed and 
acceptance has been recommended by a medical examiner specially qualified in 
the diagnosis of diseases of the chest. 
(New) Par. 57. General service.—a. Calcified residuals of primary tubercu- 
losis 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 render- 
ing a decision. In those cases in which a decision cannot be made on roentgeno- 
logical grounds alone, it is essential that a 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. 
(Old) Par. 58. Nonacceptable.—a. Tuberculosis of the lungs or tracheo- 
bronchial lymph nodes except as defined in paragraphs $6 f and 58 b. 
(New) Par. 59. Nonacceptable.—a. Tuberculosis of the lungs or tracheo- 
bronchial lymph nodes except as defined in paragraphs 57 a and 57 g (5). Small 
infiltrative tuberculous lesions, unless of sharply defined linear or nodular appear- 
ance on roentgenograms, as described in paragraph 57 g (5), are disqualifying 
even though involving a total area of less than five square cm. and apparently 
stable over a period of six months. 
(Old) Par. 58. Nonacceptable.—b. Scarred infiltrative tuberculous lesions of 
the lungs, except that small fibroid or calcified lesions represented in roentgeno- 
grams as sharply demarcated strandlike or well-defined small nodular shadows 
not exceeding a total area of 5 square centimeters may be accepted after defer- 
ment until subsequent examination demonstrates that the lesion is stationary and 
not likely to be reactivated. The minimum period of time to determine this is 
G 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 REPORT OF COMMISSION OF PHYSICIANS 
85 
reactivation. Experience indicates a greater likelihood of reactivation of a lesion 
that appears to be stable in persons under 25 years of age than in older persons. 
(New) Par. 57. General service.—g. (5). Scarred fibroid or fibrocalcific in- 
filtrative tuberculous lesions of the lungs represented in roentgenograms as 
sharply demarcated, strandlike or well-defined, small nodular shadoivs not ex- 
ceeding a total area of five 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 
six 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 a greater likelihood of reactivation of an 
apparently stable lesion in persons under twenty-five years of age than in older 
persons. 
(Old) Par. 58. Nonacceptable.—c. Fibrinous or serofibrinous tuberculous 
pleurisy, and serofibrinous pleurisy of unknown origin. Inasmuch as pleurisy, 
with or without effusion, is a very frequent manifestation of active tuberculosis, 
all persons who have apparently recovered from pleurisy will be examined with the 
greatest care. Chronic fibroiis pleurisy sufficient to cause marked retraction of 
the chest wall and of the mediastinal organs or to cause a density in the roent- 
genogram which completely obscures a considerable section of the pulmonary 
markings will be considered disqualifying. 
(New) Par. 59. Nonacoeptable.—b. Fibrinous or serofibrinous * * * care. 
Authenticated history of pleural effusion of unknown origin within the last five 
years; chronic fibrous pleurisy sufficient to cause marked retraction of the chest 
wall and of the mediastinum or to cause a density in the roentgenogram which 
completely obscures a considerable section of the pulmonary fields. 
(Old) Par. 58. Nonaacceptable.—d. Empyema or unhealed sinuses of the chest 
wall following operation of empyema. 
(New) P'ar. 59. Nonacceptable.—d. Empyema; residual sacculation or un- 
healed sinuses of the chest wall following operations for empyema. 
(Old) Par. 58. Nonacceptable.—g. Pulmonary emphysema with impairment of 
function. 
(New) Par. 59. Nonacceptable.-—Bullous or generalized pulmonary em- 
physema. 
(Old) Par*. 58. Nonacceptable.—o. Tumor of the lung, pleura, or mediastinum. 
(New) Par. 59. Nonacceptable.—n. Tumor of the trachea, bronchi, lung, 
pleura, or mediastinum. 
(Old) Par. 58. Nonacceptable.—p. Spontaneous pneumothorax. 
(New) Par. 59. Nonacceptable.—c. Spontaneous pneumothorax, history of 
spontaneous pneumothorax within the last three years, or history of repeated 
spontaneous pneumothorax authenticated by properly dated X-ray films. 
Section XIV 
(New, added) Par. 63. General service.—6. Given a heart of normal size, re- 
sponding normally to exercise, a slight to moderate pulmonary systolic murmur, 
louder in the recumbent position and on expiration and largely or entirely abol- 
ished by deep inspiration, is the commonest of all murmurs and is to be considered 
physiological (functional). 
A faint systolic murmur localized at the aortic area without thrill and followed 
by a normal second sound may be considered normal, but any aortic systolic mur- 
HEART, BLOOD VESSELS, AND CIRCULATION 86 
REPORT OF COMMISSION OF PHYSICIANS 
mur of moderate intensity or louder probably indicates disease (for example, 
aortic dilatation or stenosis), and demands further study. A loud systolic mur- 
mur (usually with thrill), maximal at the left of the sternum in the third and 
fourth spaces, suggests the probability of a congenital ventricular septal defect and 
is a cause for rejection. A 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 
a verified history of rheumatic fever, may be considered to be physiological (func- 
tional) , but a 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 a 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 bell stethoscopic chest piece) ; it is accentuated by exercise. A 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. Fre- 
quently, interpretation must be based on cumulative evidence or a number of rela- 
tively slight deviations from the. normal. 
(Old) Par. 62. General service.—f. Neurocirculatory asthenia, if very mild 
in degree. 
(New) Par. 63. General service.—Not in new MR 1-9, this paragraph. (See 
par. 65 q.) 
(Old) Par. 64. Nonacceptable.—c. A persistent heart rate of 100 or over when 
this is proved to be persistent in the recumbent posture and on observation and 
reexamination over a sufficient period of time. (See also section XXI.) 
(New) P'ar. 65. Nonacceptable.—c. * * * over a 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. 
(Old) Par. 64. Nonacceptable.—d. Paroxysmal tachycardia. (See also sec- 
tion XXI.) 
(New) Par. 65. Nonacceptable.—d. Paroxysmal tachycardia if recurrent and 
disabling. (See also section XXIII.) 
(Old) Par. 64. Nonacceptable.—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. 
(New) Par. 65. Nonacceptable.—i. Persistent blood pressure at rest above 
150 nim. systolic or above 90 mm. diastolic. If the blood pressure reading is some- 
what (10-20 mm.) above 150mm. systolic on the first reading, it should be repeated 
after one-half hour’s rest recumbent. 
(Old) Par. 64. Nonacceptable.—n. Acute endocarditis. 
(New) Par. 65. Nonacceptable.—n. Endocarditis. 
(Old) P'ar. 64. Nonacceptable.—p. Coronary thrombosis. 
(New) Par. 65. Nonacceptable.—p. Authenticated history of coronary throm- 
bosis and/or myocardial infarction. 
(Old) Par. 64. Nonacceptable.—q. Neurocirculatory asthenia (effort syn- 
drome), unless very mild. 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 symp- 
toms 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 REPORT OF COMMISSION OF PHYSICIANS 
87 
may be divided into four groups. (In some cases more than one of these factors 
is present.) 
(1) As an accompaniment of organic heart disease. 
(2) Following infections. 
(3) In individuals with poor physique or insufficient training for the work 
required. 
(4) Orthostatic hypotension or tachycardia.—The blood pressure and pulse 
rate will be taken with the individual in the recumbent position and after stand- 
ing 3 minutes. An increase in a normal recumbent pulse rate to 120 beats per 
minute or more when the individual stands or a decrease of a normal blood pres- 
sure (when the individual is recumbent) to values less than 90 systolic and GO 
diastolic when the individual stands may be considered evidence of a definite 
physiologic disturbance and in itself cause for rejection unless the condition is 
very temporary following an illness, operation, or exhausted state. 
(New) Par. 65. Nonacceptable.—q. Neurocirculatory asthenia (effort syn- 
drome) * * * Cases of effort syndrome may occur—• 
(1) As an accompaniment of organic heart disease. 
(2) Following infections. 
(3) In individuals with poor physique or insufficient training for the work 
required. 
(In some cases more than one of these factors is present.) 
It is important to observe that neurocirculatory asthenia should not be confused 
with tachycardia alone or increased blood pressure alone or both together al- 
though such conditions may be present with neurocirculatory asthenia. The 
diagnosis must be clear and based on the symptom complex. 
(New) Par. 65. Nonacceptable.—r. Orthostatic hypotension or tachycardia. 
The blood pressure and pulse rate will be taken with the individual in the recum- 
bent position and after standing 3 minutes. An increase in pulse from normal 
in recumbent position to 120 beats per minute or more when the individual stands 
or a decrease of a normal blood pressure (when the individual is recumbent) to 
values less than 90 systolic and 60 diastolic -when the individual stands may be 
considered evidence of a definite physiologic disturbance and in itself cause for 
rejection unless the condition is very temporary following an illness, operation, 
or exhausted state. 
(Old) Par. 64. Nonacceptable.—Not in MR 1-9, this section. (See par. 8 g.) 
(New) Par. 65. Nonacceptable.—s. Acute rheumatic fever, or verified history 
of single or recurrent attacks of rheumatic fever within the previous 2 years. 
Section XV 
ABDOMINAL ORGANS AND WALL 
(Old) Par. 68. General service.—i. Intestinal parasites or their eggs in the 
stools. 
(New) Par. 69. General service.—Not in new MR 1-9, this section. (See par. 
8 }■) 
(Old) Par. 69. Limited service.—There are no defects of the abdominal organs 
or wall to warrant initial selection for limited service. 
(New) Par. 70. Limited service.—a. Hernia, inguinal, which has not de- 
scended into the scrotum ; femoral. 
b. There are no other defects of the abdominal organs or wall to warrant 
initial selection for limited service. 
(Old) Par. 70. Nonacceptable.—a. Hernia, inguinal, femoral or post-operative. 
Umbilical hernia, if moderate or large in size. 88 
REPORT OF COMMISSION OF PHYSICIANS 
(New) Par. 71. Nonacceptable.—a. Hernia, inguinal, which has descended 
into the scrotum; recurrent; post-operative; ventral; umbilical, if moderate or 
large in size. 
(Old) Par. 70. Nonacceptable.—1). Chronic cholecystitis with or without 
cholelithiasis, if diagnosis is confirmed by usual laboratory procedures or au- 
thentic medical history. 
(New) Par. 71. Nonacceptable.—b. Acute or chronic cholecystitis * * *. 
(Old) Par. 70. Nonacceptable.—c. Ulcer of the stomach or duodenum, if 
diagnosis is confirmed by the usual laboratory procedures, or authentic medical 
history ; also authentic history of gastric or duodenal ulcer. 
(New) Par. 71. Nonacceptable.—c. Ulcer of the stomach or duodenum, if 
diagnosis is confirmed by the usual laboratory procedures or authentic history of 
gastric or duodenal ulcer. 
(Old) Par. 70. Nonacceptable.—d. Surgical operations for gastric or duo- 
denal ulcer. 
(New) Par. 71. Nonacceptable.—d. Authenticated history of surgical opera- 
tions for gastric or duodenal ulcer. 
(Old) Par. 70. Nonacceptable.—e. Intestinal obstruction of any kind. 
(New) Par. 71. Nonacceptable.—e. Authenticated history of true intestinal 
obstruction of any kind. 
(Old) Par. 70. Nonacceptable.—g. Stricture of the rectum. 
(New) Par. 71. Nonacceptable.—g. Stricture or prolapse of the rectum. 
(Old) Par. 70. Nonacceptable.—i. Schistosomiasis. 
(New) Par. 71. Nonacceptable.—In par. 8 j of new MR 1-9. 
(Old) Par. 70. Nonacceptable.—j. Enlargement of the spleen associated with 
leukemia, Hodgkin’s disease, or splenic anemia. 
(Old) Par. 70. Nonacceptable.—k. Great enlargement of the spleen from any 
cause. 
(New) Par. 71. Nonacceptable.—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. 
(Old) Par. 70. Nonacceptable.—I. Large internal and external hemorrhoids 
with or without prolapse of the rectum. 
(New) Par. 71. Nonacceptable.—j. External hemorrhoids sufficient in size to 
produce marked symptoms. Internal hemorrhoids if large or accompanied with 
hemorrhage, or protruding intermittently or constantly. 
(Old) Par. 70. Nonacceptable.—m. Megacolon, diverticulitis, and ileitis. 
(New) Par. 71. Nonacceptable.—k. Megacolon, diverticulitis, ileitis, and 
Ulcerative colitis. 
(Old) Par. 70. Nonacceptable.—Not in old MR 1-9, this section. (See par. 
74 v.) 
(New) Par. 71. Nonacceptable.—I. Absence of one kidney. 
(Old) Par. 70. Nonacceptable.—Not in old MR 1-9, this section. (See par. 
8 m.) 
(New) Par. 71. Nonacceptable.—m. Splenectomy for any cause, other than 
trauma or congenital hemolytic icterus. 
(Old) Par. 70. Nonacceptable.—Not in old MR 1-9. 
(New) Par. 71. Nonacceptable.—n. Cirrhosis of the liver. 
Note.—Section XVI, Genito-urinary and Venereal Diseases of the old MR 1-9 
has been revised and separated into two sections in the proposed MR 1-9 and 
appears in Section XVI, Veneral Diseases and Section XVII, Genito-urinary 
Diseases. The comparison of the essential changes in these sections follows by 
paragraph numbers and subparagraph letters: REPORT OF COMMISSION OF PFIYSICIANS 
89 
(Old) Par. 72. General service.—a. Gonorrhea, uncomplicated, acute or 
chronic; syphilis, except cardiovascular, cerebrospinal, or visceral syphilis; un- 
complicated chancroid. (Acceptance of individuals with these conditions hy 
Army examining boards at the initial examination will be deferred until facili- 
ties have been provided for their care and instructions for their acceptance have 
been issued by the War Department.) 
(New) Par. 73. General service.—a. Gonorrhea, uncomplicated, acute or 
chronic. 
(New) Par. 73. General service.—6. Syphilis, except cardiovascular, cere- 
brospinal or visceral. 
(New) Par. 73. General service.—c. Chancroid, uncomplicated. 
(New, added) Par. 77. General service.—h. Phimosis. 
(New, added) Par. 74. Limited service.—There are no venereal disease cri- 
teria to warrant initial selection for limited service. 
(New, added) Par. 75. Nonacceptable.—c. Other complications of gonorrhea, 
including acute prostatitis, seminal vesiculitis, and epididymitis. 
(Old) Par. 74. Nonacceptable,—to. Amputation of the penis. 
(New) Par. 79. Nonacceptable.—k. Amputation of the penis, if the resulting 
stump is insufficient to permit normal function of micturition. 
(Old) Par. 74. Nonacceptable.—e. Surgical kidney with or without renal 
calculus. 
(New) Par. 79. Nonacceptable.—d. Acute or chronic infections of the kidney. 
(Old) Par. 74. Nonacceptable.—m. Hypertrophy of the prostate gland. 
(New) Par. 79. Nonacceptable.—m. Hypertrophy of the prostate gland with 
urinary retention. 
Section XYIII 
ENDOCRINE AND METABOLIC DISORDERS 
(Old) P’ar. 77. Limited service.—6. Pellagra, beriberi, scurvy, and other nu- 
tritional deficiencies, if mild and remediable by diet and appropriate treatment. 
(New) Par. 82. Limited service.—d. Pellagra, beriberi, scurvy, sprue, and 
other nutritional deficiencies, if mild and remediable by diet and appropriate 
t reatment. 
(Old) Par. 78. Nonacceptable.—c. Cretinism with imbecility or dwarfism. 
(New) Par. 83. Nonacceptable.—c. Cretinism. 
(Old) Par. 78. Nonacceptable.—d. Myxedema (with clinical manifestations 
and diagnosis not based solely on low basal metabolic rate). 
(New) Par. 83. Nonacceptable.—d. Myxedema, spontaneous or post-operative 
(with clinical * * *). 
(Old) Par. 78. Nonacceptable.—e. Gigantism or acromegaly, if markedly dis- 
figuring or if associated with other symptoms of severe pituitary dysfunction. 
(New) Par. 83. Nonacceptable.—e. Gigantism or acromegaly. 
(Old) Par. 78. Nonacceptable.—k. Renal glycosuria. 
(New) Par. 83. Nonacceptable.—k. Persisting glycosuria. 
(Old) Par. 78. Nonacceptable.—n. Simmonds’ disease. 
(Old) Par. 78. Nonacceptable.—o. Cushing’s syndrome. 
(New) Par. 83. Nonacceptable.—n. Simmonds’ disease; Cushing’s syndrome; 
other diseases due to a disorder of the pituitary gland. 90 
REPORT OF COMMISSION OF PHYSICIANS 
Section XIX 
DISEASES OF BLOOD AND BLOOD-FORMING TISSUES 
(Old) Par. 79. General service.—Not in old MR 1-9 in this section. (See 
Par. 6 6.) 
(New) Par. 84. General service.—b. Malaria, acute or chronic, mild. 
(Old) Par. 81. Nonacceptable.—c. Primary pernicious anemia. 
(New) Par. 86. Nonacceptable.—c. Pernicious anemia. 
(Old) Par. 81. Nonacceptable—i. Malaria, chronic, if severe. 
(New) Par. 86. Nonacceptable.—i. Malaria, chronic, if more than mild. 
(Old) Par, 81. Nonacceptable.—Not in old MR 1-9 in this section. (See par. 
8 j.) 
(New) Par. 86. Nonacceptable.—k. Hodgkin’s disease. 
Section XX 
NEUROLOGICAL DISORDERS 
Section XXI 
PSYCHOSES, PSYCHONEUROSES, PERSONALITY DISORDERS 
Section XXII 
INTELLIGENCE 
Section XXIII 
PURPOSELY CAUSED PHYSICAL DEFECTS 
Section XXIV 
MALINGERING 
Note.—Just prior to the meeting of the Commission, the Neuropsychiatry Di- 
vision, Surgeon General’s Office, U. S. Army, had completed a proposed revision 
of the sections of Mobilization Regulations 1-9, dated 15 October 1942, relating 
to neuropsychiatric standards (Section XIX, Neurological, Disorders : Section 
XX, Psychoses, Psychoneuroses, Personality Disorders ; Section XXI, Pur- 
posely Caused Physical Defects; Section XXII, Malingering). This revision 
made no significant changes in the standards themselves but provided more 
suitable instructions for conducting the examination and interpreting the exam- 
iner’s findings, and coincidentally provided a better arrangement and designation 
of sections. After slight modification of this revision, it was approved and 
incorporated in the accompanying draft of revision of Mobilization Regulations 
1-9. To avoid adding length and bulk to this report, the above designated sec- 
tions of the old Mobilization Regulations 1-9, and those of the proposed revision 
are not transcribed herein. APPENDIX III 
STATEMENT OF REQUIREMENTS FOR ADMISSION TO 
THE ARMED FORCES FOR BOTH GENERAL AND 
LIMITED SERVICE (INCLUDING CHANGES THE COM- 
MISSION HAS DETERMINED SHOULD BE MADE IN 
THE CURRENT REGULATIONS) 
91 *MR 1-9 
1 
MOBILIZATION REGULATIONS) 
No. 1-9 J 
WAR DEPARTMENT. 
Washington 25, D. C. 
STANDARDS OF PHYSICAL EXAMINATION DURING 
MOBILIZATION 
Section I. Information and instructions 1-5 
II. General and miscellaneous defects 6-5 
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. Genito-urinary 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 
Paragraphs 
Page 
Index.. 
Section I 
INFORMATION AND INSTRUCTIONS 
Paragraph 
Purpose 1 
Publication 2 
Objective 3 
Physical classification 4 
Defects not specifically mentioned in these regulations and hospitalization 5 
This pamphlet supersedes MR 1-9, 15 October 1942. 
93 94 
REPORT OF COMMISSION OF PHYSICIANS 
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. 
(2) Prescribe permissible deviations from the general service standards 
for limited military service. 
(3) Describe deviations from the above standards which are not accept- 
able for any class of military service. 
&. So far as it applies to enlisted men AR 40-105 is superseded by these regu- 
lations. These regulations will apply to men in the following categories; 
(1) Men enlisted or reenlisted 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 Array 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, 
I). Medical examiners should read every section of these regulations in order 
that they may have a broad knowledge concerning physical standards. 
3. Objectives.—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 a guide to their discretion 
and not construe them too strictly or arbitrarily. The examination will be car- 
ried out with the utmost care in order that no individuals who are unfit for 
service will be accepted, only to be discharged within a 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 a registrant is accepted for 
military duty but who, nevertheless, has a 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 gen- 
eral military service. Registrants will be recommended for assignment for gen- 
eral service if they meet the requirements therefor throughout the entire physical 
examination. In those borderline cases, where a 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 exam- 
iner has reason to believe the man can perform general military service duty. 
ft. 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. REPORT OF COMMISSION OF PHYSICIANS 
95 
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 nouacceptable. 
(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 the others in the order of their importance. The major disqualifying defect 
may be physical or mental. 
(3) Any individual recommended as nouacceptable will not be accepted unless 
specific directions to that effect have been issued by the War Department. 
5. Defects not specifically mentioned in these regulations and hospitaliza- 
tion.—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. A 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 a period not to exceed 3 days for men whose physical 
fitness for military service cannot be determined without hospital study is au- 
thorized. 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 ivill not be hospitalized 
tchen 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 6 
Limited service 7 
Nonacceptable 8 
6. General service.—a. Individuals with acute pathological conditions, includ- 
ing acute communicable diseases except venereal diseases, from which in the 
natural course of the disease recovery occurs without sequelae, will be deferred 
until a 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 a sufficient period of time to insure complete recovery without 
sequelae. The minimum period of deferment following a major surgical pro- 
cedure will be 3 months. The actual period of deferment longer than 3 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. 
9G050—44 7 96 
REPORT OF COMMISSION OF PHYSICIANS 
6. 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. 
/. 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 2 years. 
h. Osteoarthritis or rheumatoid arthritis. 
i. Active osteomyelitis of any bone or a substantiated history of osteomyelitis 
of any of the long bones of the extremities at any time. 
j. Filariasis, trypanosomiasis, amoebiasis, or schistosomiasis. 
k. 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 
Table of standard and minimum acceptable measurements of height, weight, and 
circumference of chest 9 
Directions for taking height 10 
General service 11 
Limited service 12 
Nonacceptable 13 
General considerations 14 
Paragraph 
9. Table of standard and minimum acceptable measurements of height, 
weight, and circumference of chest. 
Height 
Standard 
Minimum 
• Weight 
Chest measure- 
ment at expira- 
tion 
Weight 
Chest measure- 
ment at expira- 
tion 
Inches 
Pounds 
Inches 
Pounds 
Inches 
60 
116 
si % 
105 
28% 
61 
119 
31% 
107 
29 
62 
122 
31% 
109 
29% 
63 
125 
32 
111 
29% 
64 
128 
32% 
113 
29% 
65 
132 
32% 
115 
30 
66 
136 
32% 
117 
30% 
67 
140 
33 
121 
30% 
68 
144 
33% 
125 
30% 
69 
148 
33% 
129 
31 
70 
152 
33% 
133 
31% 
71 
156 
34 
137 
31% 
72 
160 
34% 
141 
31% 
73 
164 
34% 
145 
32 
74 
168 
34% 
149 
32% 
75 
172 
35 
153 
32% 
76 
176 
35% 
157 
32% 
77 
180 
35% 
161 
33 
78 
184 
35% 
165 
33% REPORT OF COMMISSION OF PHYSICIANS 
97 
10. Directions for taking height and weig’ht.—a. The measuring rod should 
consist of a board at least 2 inches wide by 80 inches long, placed vertically, 
firmly fixed, with accurate graduations of *4 inch between 58 inches and the top 
end. Obtain tiie height by placing horizontally, in firm contact with the top of 
the head, square against the measuring rod a board of about 6x6x2 inches, best 
permanently attached to the graduated board by a 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 9. 
6. 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 circum- 
ference given in the table, who are otherwise mentally and physically fit, and who 
do not fall within the nonacceptable class may be accepted for limited military 
service. 
13. Nonacceptable.—a. Less than 60 inches in height. 
b. Less than 105 pounds in weight. 
c. A 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. Individuals of 76 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 reg- 
istrants with variations in the ratio of height, weight, and chest measurements 
indicated in the table. 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 correctable with 
proper food and physicial 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 18 
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 a 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 
a 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 im- 
perfect and recorded 20/30; if he reads the 15-foot type, the vision is unusually 
acute and recorded 20/15, etc. 98 
REPORT OF COMMISSION OF PHYSICIANS 
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 lessr 
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 (1) 20/40 in each eye, (2) 20/30 in the right eye and 20/70 in the left 
eye, or (3) 20/20 in the right eye and 20/400 in the left eye, and provided the de- 
fective vision is not due to active or progressive 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 condi- 
tion for which the operation was performed has been relieved and the vision is 
tvithin or above the minimum standard requirements. 
d. Nystagmoid movements, if not persistent or pronounced and if true nystag- 
mus is excluded, 
e. Chronic simple conjunctivitis, if mild. 
/. 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. 
;. 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.—aA 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. 
6. 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 with- 
out glasses, correctible to 20/20 with glasses. 
18. Nonacceptable.—Defects such as the following: 
a. Vision less than the minimum requirements for limited military service. 
b. Deformity of the eyelid or eyelids, such as inversion or eversion of a degree 
that forcible closure fails to cover the eyeball or in which there is a resultant con- 
junctival inflammation, corneal irritation, or a 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 of 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. REPORT OF COMMISSION OF PHYSICIANS 
99 
p. Permanent and well-marked strabismus (over 30 degrees deviation). 
q. Ptosis interfering with vision. 
r. Trichiasis, 
s. Chronic conjunctivitis, other than mild, simple, 
t. Chronic dacryocystitis. 
u. 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. 
6. 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 a normal acuity of vision or may exaggerate a 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 be hesitant or 
evasive. Careful observation will be made of his conduct and every movement 
noted. The nature of the man’s answer will be taken into account and considered 
in the light of the kind of reply that is given when a 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. 
(b) Spectacle frame containing red and green glasses. 
(7) Special test cards, one a duplicate, with letters reversed to use with a 
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 1M inches wide. 
(13) Three disks of pollaroid 36 mm. in diameter and 2 mm. thick. 
e. The principle involved in the Polaroid test is that light polarized in any 
given meridian by a 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 man in diameter 
and 2 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 100 
REPORT OF COMMISSION OF PHYSICIANS 
very evident that the poor eye is functioning. The disk may be used with cor- 
recting 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 
a short period at a 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) A 6° prism, base down, is placed before the admittedly sound eye while 
the man looks at a 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) A 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. 
(3) The alleged “blind” eye is covered. A prism of 10°, with the apex up, is 
placed before the “seeing” eye in such a 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 indi- 
vidual to read a row of special red and green letters on glass through a 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 
a low-plus 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 a ruler about inches wide vertically midway 
between the two eyes at about 4 to 5 inches’ distance; direct the man to read 
from a printed page with lines at least 4 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 will be made: 
(a) Oblique examination.—A careful examination of the cornea will be 
made with the aid of a condensing lens and a 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. 
6. To verify partial loss of vision in one or both eyes.— (1) The most common 
manifestation of malingering takes the form of a statement that one eye is 
imperfect. Men pleading this disability may be divided into two classes: 
(a) Those who pretend to have a visual defect. 
(b) Those who are aware that they have a 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. REPORT OF COMMISSION OF PHYSICIANS 
101 
(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 a 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 20 
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. 
(а) 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 a 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 th$ first card, showing that his vision is 
twice as good as he pretends. 
(б) 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 an individual to differentiate between 
a dime and a penny, a cigarette and a pencil, a pen and a 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 a trial frame upon the man’s face and put before 
the sound eye a high convex lens (+16D) and before the “weak” eye a plane or 
weak lens (0.25) which will not interfere with vision. If letters placed at a 
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 a report of his vision must 
be made, and then to postpone further examination until after the 
next few individuals have been examined. 
(b) 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 20/50 or 20/30 by means of a low-plus or minus glass, the 
man is malingering. 
(9) Retinoscopy.—Look for corneal and lenticular opacities and estimate re- 
fractive 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. 102 
REPORT OF COMMISSION OF PHYSICIANS 
d. Diplopia.—Cases of malingering are occasionally met with in which the 
men complain that they see double. These must be investigated with the appli- 
cation of the ordinary tests as if they were genuine and with every precaution 
taken to guard against a serious nerve lesion being overlooked. 
Section Y 
EARS 
Paragraph 
Examination for disease 21 
Determination of auditory acuity 22 
General service 23 
Limited service —1 24 
Nonacceptable 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 
external auditory canal and membrana tympani will be examined by reflected 
light or by a 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 regis- 
trant 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 registrant and close one of his own ears in the same way as a control: 
The assistant will use a whispered voice produced by speaking with the lungs 
in a 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 a fraction, the numerator of which is 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 a 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. 
6. 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. 
&. Purulent otitis media with or without mastoiditis. 
c. Perforation of the membrana tympani. 
d. Acute or chronic mastoiditis. 
e. Total loss of an external ear. 
f. 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 a complaint of past trouble. Exaggeration of defects in hearing extends REPORT OF COMMISSION OF PHYSICIANS 
103 
usually to declarations of total deafness on one side. The following directions 
will be observed in examining suspected malingerers: 
а. In making these examinations the observer will have a skilled assistant 
and all communications between them will be in a low, whispered voice. 
б. 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 a critical examination of the auditory canal, membrana 
tympani, and for patency of the eustachian ttibes 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 a malingerer. 
g. The simplest and most available test for malingering is the use of an ordi- 
nary binaural stethoscope. The tubing leading to the earpiece to be applied to 
the normal ear is occluded by clamping with a hemostat and the earpieces are 
placed in the ears of the blindfolded suspect. The examining physician speaks 
in a 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 a normal ear is tightly 
packed with absorbent cotton, it will still conduct sound waves to a limited 
degree, a loud-ticking watch even under those circumstances being heard about 
1 or 2 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 wfith cotton and the testing is made with the unoccluded sup- 
posedly deaf ear. Under this test, if he claims failure to hear the watch under 
1 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 per- 
ceive the sound of the fork when thus placed on the vertex of the skull. 
Section VI 
MOUTH, NOSE, FAUCES, PHARYNX, TRACHEA, ESOPHAGUS, AND 
LARYNX 
Paragraph 
General service 27 
Limited service 28 
Nonacceptable 29 
Use of diagnostic aids 30 104 
REPORT OF COMMISSION OF PHYSICIANS 
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 de- 
ferred for reexamination until after a 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. 
6. Hay fever, if moderate. 
29. Nonacceptable.—Defects such as— 
а. Deformities of the mouth, throat, and nose which interfere with mastication 
of ordinary food, with speech, or with breathing. 
б. Destructive syphilitic disease of the mouth, nose, throat, larynx, or esophagus. 
c. Laryngeal paralysis due to any cause. 
d. Tracheotomy. 
e. Stricture of the esophagus. 
f. Chronic sinusitis of the accessory sinuses of the nose. (This diagnosis will 
be established by the presence of a 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 laryn- 
goscopy, 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 diagnostic aids 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 muscula- 
ture, are free from gross dental infections, and have a minimum requirement 
of an edentulous upper jaw and/or an edentulous lower jaw, corrected or cor- 
rectable by a full denture or dentures. 
b. Malocclusion.—When it is evident from the individual’s general physical 
condition that his malocclusion has not seriously interfered with the mastication 
of a normal diet, provided that in the excursions of the mandible or with the REPORT OF COMMISSION OF PHYSICIANS 
105 
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 classifica- 
tion 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 satisfactoi'y performance of military duty. 
&. Extensive loss of oral tissue in an amount that would prevent replacement 
of missing teeth by a satisfactory denture. 
34. General considerations.—Examining dentists, to protect the interest of 
the Government and the individual, will exercise every care to clearly indicate 
the status of every tooth, as well as those extracted, missing, or unerupted. The 
exact teeth replaced by a 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. 
Section YIII 
SKIN 
Paragraph 
General service 35 
Limited service 36 
Nonacceptable 37 
35. General service.—a. Acute nonexanthematous and noncommunicable dis- 
eases of the skin which ordinarily run a temporary course. 
6. 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 weight bearing 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. 
(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. 
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 disqualifying conditions are excluded. 
36. Limited service.—There are no skin criteria to warrant initial selection 
for limited service. 
37. Nonacceptable.—Serious or incapacitating skin 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 a soldier 106 
REPORT OF COMMISSION OF PHYSICIANS 
or so disfiguring as to render the individual objectionable in common social 
intercourse. 
b. Actinomycosis. 
c. Dermatitis herpetiformis of long duration. 
d. Epidermolysis bullosa. 
c. 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. 
Z. 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 in- 
terfere with the normal wearing of military equipment. 
o. Pilonidal cyst or sinus. (If there is only a simple dimpling of the skin or 
short simple sinus in the post-anal region, the individual will be accepted for 
general service.) 
p. Plantar warts on weight-bearing areas. 
Section IX 
HEAD 
General service 38 
Limited service 39 
Nonacceptable : 40 
Paragraph 
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. 
6. 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 3 months.) See paragraph 90 e 
and 91 h. 
39. Limited service.—There are no head defects to warrant initial selection 
for limited service. 
40. Nonacceptable.—a. Deformities of the skull in the nature of depressions, 
exostoses, etc., of a degree which would prevent the individual from wearing 
military headgear. 
b. Deformities of the skull of any degree associated with evidence of disease 
of the brain, spinal cord, or peripheral nerves. See paragraph 90 e and 91 h. 
SPINE, SCAPULAE, AND SACROILIAC JOINTS 
Section X 
General service 41 
Limited service 42 
Nonacceptable 43 
X-ray examination 44 
Paragraph 
41. General service.—a. Lateral deviation of the spine of 1 inch or less from 
the midline if the mobility and weight-bearing power are good. 
6. Fracture of the coccyx. REPORT OF COMMISSION OF PHYSICIANS 
107 
c. Prominent scapulae not interfering with wearing of uniform or militany 
equipment. 
d. Complaint of disease of the sacroiliac and lumbo-saeral joints which is un- 
associated with objective signs and symptoms. 
e. Fracture of the spine or pelvic bones which has healed without marked de- 
formity and which has not interfered with the following of a useful vocation in 
civil life. 
f. Spina bifida occulta providing it is asymptomatic, unassociated with objec- 
tive 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 1 inch and less than 2 inches. * 
43. Nonacceptable.—Conditions such as— 
а. Tuberculosis, either active or healed. 
б. 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 a useful vocation in civil life, 
d. Lateral deviation of the spine from the midline of more than 2 inches. Curva- 
ture of the spine (scoliosis, kyphosis or lordosis) of a degree sufficient to inter- 
fere with the wearing of a uniform or military equipment or which has prevented 
the individual from following a useful vocation in civil life. 
e. Disease of the sacroiliac and lumbo-sacral joints which is of a 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 intervertebral 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 
General service 45 
Limited service 46 
Nonacceptable 47 
General considerations 48 
EXTREMITIES 
Paragraph 
45. General service.—a. Old or recent fi’actures which have healed normally 
with no resulting impairment of function. 
6. Recent injury of a bone or joint with or without fracture or dislocation 
which, in the opinion of the examiners, is only temporarily incapacitating. (In- 
dividuals with these conditions will be given a period of time not less than 6 weeks 
for recovery before the final examination is made.) 
c. Webbed fingers and toes, unless severe in degree. 
d. Entire loss of little finger of either or 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 a 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 108 
REPORT OF COMMISSION OF PHYSICIANS 
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 a 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. 
l. Ingrowing toenails, unless severe. 
46. Limited service.—a. Loss of two entire fingers of either hand, except a 
combination of the right index and middle finger. 
b. 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 a degress to prevent the individual from 
following a 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 joint or with deformity of the foot. 
e. Loss of great toe. 
f. Loss of dorsal flexion of great toe. 
g. Clubfoot of slight degree is tarsal, metatarsal, and phalangeal joints are 
flexible, permitting wearing of the military shoe, and, in the opinion of the ex* 
aminer, will not interfere with the performance of military duty . 
h. Slight claw toes not involving obliteration of the transverse arch and which 
do not interfere with the wearing of a military shoe. 
i. Other defects of the feet which disqualify for general military service but do 
not prevent the individual from wearing a military shoe and which have not pre- 
vented him from following a useful vocation in civil life. 
j. Moderate deformities of one or both lower extremities which do not and 
have not interfered with function to a degree to prevent the individual from 
following a useful vocation in civil life. 
k. Adherent scars of the skin and soft tissues of an extremity, if not incapacitat- 
ing and not likely to break down. 
l. Healed disease or injury of wrist or elbow with resulting limitation of mo- 
tion, 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 a period of 6 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. 
47. Nonacceptable.—Defects such as— 
a. Loss of one or both thumbs. 
b. Loss of more than two entire fingers of either hand. 
c. Tuberculosis of a bone or joint. 
d. Old ununited fractures. 
e. Old unreduced or recurring dislocations of any of the major joints. 
f. Disease of any bone or joint healed with such resulting deformity or rigidity 
that the function is impaired to a 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 a degree which seriously interfere 
with function. REPORT OF COMMISSION OF PHYSICIANS 
109 
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 de- 
cided 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. 
k. Obliteration of the transverse arch associated with permanent flexion of the 
small toes (claw toes). 
l. Hallux valgus, if severe and associated with marked exostosis or bunion. 
m. Clubfoot, if marked in degree or which intereferes with the wearing of a 
military shoe. 
n. Diseases of the bone or of the hip, knee, or ankle joint which interfere with 
function and weight-bearing power. 
o. Deformities due to fracture or other injury which seriously interfere with 
function and weight-bearing power. 
p. Sciatica which is apparently intractable and disabling to the degree of inter- 
ference with the function of walking and weight-bearing power. 
q. Amputations of extremities in excess of those already cited. 
r. Active osteomyelitis of any bone, or a substantiated history of osteomyalitis 
of any of the long bones at any time. 
s. Osteoarthritis or rheumatoid arthritis; or chronic arthritis from any cause. 
t. Plantar warts on weight bearing areas. 
48. General considerations.—It is important that individuals with defects of 
the feet which would prevent them from taking proper training will not be classi- 
fied for general military service. 
Section XII 
NECK 
Paragraph 
General service 49 
Limited service. 50 
Nonacceptable 51 
49. General service.—a. Nonspastie contraction of the muscles of the neck 
which is not of great degree and will not prevent the wearing of a uniform 
or military equipment. 
6. Simple goiter unassociated with pressure symptons, provided the enlarge- 
ment of the thyroid will not interfere with the wearing of a uniform or military 
equipment. 
c. Enlarged lymph nodes of the neck which are not a manifestation of sys- 
temic disease, do not apparently interfere with the general health, and are not 
large enough to interfere with the wearing of a uniform or military equipment. 
d. Healed tuberculous lymph nodes 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 two years. 
51. Nonacceptable.—a. Toxic goiter. 
6. 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 a uniform or military equipment. 
c. Enlargement of the lymph nodes of the neck associated with leukemia or 
Hodgkin’s disease. 
d. Lymphosarcoma. 
e. Tuberculous lymph nodes, except as specified in 49 d. 110 
REPORT OF COMMISSION OF PHYSICIANS 
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 a uniform or 
military equipment or so disfiguring as to render the individual objectionable 
in common social intercourse. 
g. 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 a degree to interfere with wearing of a uniform 
or military equipment. 
Section XIII 
Paragraph 
Chest examination 52 
History : 53 
X-ray examination 54 
Physical examination 55 
Other examinations 56 
General service 57 
Limited service 5S 
Nonacceptable — 59 
General considerations 60 
LUNGS AND CHEST WALL 
52. Chest examination.—The chest examination will include a roentgenogram, 
as well as the usual methods of physical diagnosis. A pertinent history of past 
chest diseases will 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 un- 
explained 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 a 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 a below. 
a. Identification of films.— (1) Identifying marks which are photographed on 
the film at the time of its exposure are most satisfactory. When the photo- 
roentenographic method of X-ray examination is employed, this may be accom- 
plished 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 a perforating 
machine making letters and figures of appropriate size, and is to be recorded on 
the light portion of the film corresponding to the subdiaphragrnatic area. Data 
photographically recorded 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 a way that it may REPORT OF COMMISSION OF PHYSICIANS 
111 
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; indi- 
vidual’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, N, 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. 
612 Lombard St. 
Philadelphia, Pennsylvania Philadelphia, Pa. 
Lb 32-050-012 
28 July 1943 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. 
ft. Disposition of films made in continental United States and Puerto Rico.— 
(1) Chest X-ray films made in the examination of men accepted for enlistment 
or induction into the service, after being carefully checked for proper identifi- 
cation, 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, D. C. All packages of films sent to the Veterans’ 
Administration will be labeled ‘’Exposed X-ray Films” and will show the name 
of the Army organization making shipment. 
(2) All chest X-ray films of individuals who are rejected for any reason will 
be delivered to the Selective Service System in accordance with agreements en- 
tered 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, films of rejected individuals in general will be sepa- 
rated and forwarded to State directors in appropriately labeled packages as 
indicated below: 
(a) “Films of individuals recommended for reexamination in six months, 
or other specified period, because of borderline tuberculous or other 
chest conditions.” 
(6) “Films of individuals rejected because of tuberculous 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 films 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, limita- 
tion, or inequality of the respiratory movements are to be noted. 
6. Abnormal physical signs in the lungs, pleura or mediastinum will be care- 
fully checked to ascertain whether they persist or are only transitory. 
96050—44——8 112 
REPORT OF COMMISSION OF PHYSICIANS 
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 in- 
structed 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. A 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 examina- 
tion. 
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 disappear after a 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 film 
and physical examination after two mouths usually suffice to make the differen- 
tial diagnosis. 
57. General service.—a. 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 reactiva- 
tion. 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 a deci- 
sion. In those cases in which a decision cannot be made on roentgenological 
grounds alone, it is essential that a careful examination be made by an examiner 
with special experience in tuberculosis, taking into account the age of the sub- 
ject, history, and the possible presence of nonpulmonary tuberculosis. 
b. Fibrous pleural scars and adhesions, revealed most often in the roentgeno- 
gram by simple thickening of the apical pleura, deformity of the dome of the 
diaphragm, or visualization of an interlobar fissure, provided there is no evi- 
dence of disqualifying tuberculosis of the pulmonary parenchyma. 
c. 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. 
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 a uniform or military equipment. 
f. Small palpable lymph nodes of the axilla which apparently are not evidence 
of disease. 
g. The following conditions are temporarily disqualifying.— (1) Acute bron- 
chitis, until a final examination shows recovery without disqualifying sequelae. 
2. So-called atypical or other types of pneumonia, until a final examination 
shows recovery without disqualifying sequelae. Ordinarily resolution, as shown REPORT OF COMMISSION OF PHYSICIANS 
113 
.by X-ray films, will be complete within two months. Other cause of the shadow in 
the X-ray film than pneumonia must be considered if complete clearing has not 
occurred in three months. 
(3) Acute or subacute fibrinous pleurisy, definitely nontuberculous in origin, 
until a 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 a rib or ribs, until a 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 shadows not exceeding a total area of five 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 six months. It must be recognized that either progres- 
sion or regression of the lesion indicates instability. Clinical judgment, taking 
into consideration other factors, including age and race, must be exercised in esti- 
mating the likelihood of reactivation. Experience indicates a greater likelihood 
of reactivation of an apparently stable lesion in persons under twenty-five years 
of age than in older persons. 
58. Limited service.—Deformity of clavicle, ribs, or scapula of a degree dis- 
qualifying for general military service but not preventing the individual from 
successfully following a useful vocation in civil life. 
59. Nonacceptable.—o. Tuberculosis of the lungs or tracheobronchial lymph 
nodes except as defined in paragraphs 57 a and 57 g (5). Small infiltrative tuber- 
culous lesions, unless of sharply defined linear or nodular appearance on roent- 
genograms, as described in paragraph 57 g (5), are disqualifying even though 
involving a total area of less than five square cm and apparently stable over a 
period of six months. 
6. Fibrinous or serofibrinous tuberculous pleurisy, and serofibrinous pleurisy 
of unknown origin. Inasmuch as pleurisy, with or without effusion, is a fre- 
quent manifestation of active tubermilosis, 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 five years; chronic 
fibrous pleurisy sufficient to cause marked retraction of the chest wall and of 
the mediastinum or to cause a density in the roentgenogram which completely 
obscures a considerable section of the pulmonary fields. 
c. Spontaneous pneumothorax, history of spontaneous pneumothorax within 
the last three years, or history of repeated spontaneous pneumothorax, authen- 
ticated by properly dated X-ray films. 
d. Empyema; residual sacculation or unhealed sinuses of the chest wall follow- 
ing operations for empyema. 
e. Chronic bronchitis. 
f. Bronchiectasis. 
g. Bronchial asthma. 
h. Bullous or generalized pulmonary emphysema. 
i. Cystic disease of the lung. 
J. Silicosis as represented in the roentgenogram by strand-like and nodular 
shadows ; any other form of severe pulmonary fibrosis. 
k. Abscess of the lung. 
Z. Active mycotic disease of the lung and residual cavitation due thereto. 114 
REPORT OF COMMISSION OF PHYSICIANS 
m. Foreign body in the lung. An individual may be accepted after a foreign 
body has been removed from a 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 tuber- 
culosis will not be considered a cause for rejection unless supported by objective 
evidence substantiating the claim. However, examining physicians should make 
every effort to determine the validity of the alleged history by requesting the 
individual’s X-ray films and a summary of the clinical record. This will be neces- 
sary only when the present chest X-ray film of an individual alleging a history 
of tuberculosis reveals no evidence of disqualifying defects. It should be recog- 
nized 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 five 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 examining 
physicians will be based on their own findings and their own evaluation of the 
cases. 
b. Bronchiectasis.—Not infrequently a 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 sec- 
tion I, paragraph 5 a and b. 
Section XIY 
HEART, BLOOD VESSELS, AND CIRCULATION 
Paragraph 
History.* 61 
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 m'ay be helpful in the interpreta- 
tion of the findings, but chief reliance will not be placed on the history alone. 
62. Procedure.—The following procedure will govern in the physical examina- 
tion 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. 
b. 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. REPORT OF COMMISSION OF PHYSICIANS 
115 
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 its rhythm, and palpation of radial 
arteries for unusual thickening or high tension. 
e. 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 posi- 
tion, a statement -will be appended as to the position of the subject at the time 
of measurement. 
f. Exercise (stepping 12 times briskly upon a common chair) will be used in 
selected cases to bring out significant heart murmurs, but this test in itself is not 
to be considered a 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 tachy- 
cardia. 
h. If there is doubt as to the presence of cardiovascular disease, the individual 
will be held for detailed reexamination. 
63. General service.—a. 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; when 
pulse rate is normal and regular and there is no unusual thickening of the arteries 
or significant elevation of blood pressure. 
Z». Given a heart of normal size, responding normally to exercise, a 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). A faint systolic 
murmur localized at the aortic area without thrill and followed by a normal sec- 
ond sound may be considered normal, but any aortic systolic murmur of moder- 
ate intensity or louder probably indicates disease (for example, aortic diliation or 
stenosis), and demands further study. A loud systolic murmur (usually with 
thrill), maximal at the left of the sternum in the third and fourth spaces, sug- 
gests the probability of a congenital ventricular septal defect and is a cause for 
rejection. A faint sytolic murmur at the apex, varying in intensity, with forced 
respiration, less well heard in the erect position than when recumbent and un- 
attended by cardiac enlargement or other evidence of heart disease, or by a verified 
history of rheumatic fever, may be considered to be physiological (functional), but 
a moderate or loud apical systolic murmur which persists in all phases of respora- 
tion 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 a 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 
bell stethoscopic chest piece) ; it is accentuated by exercise. A slight aortic dias- 
tolic 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. Fre- 
quently, interpretation must be based on cumulative evidence or a number of 
relatively slight deviations from the normal. 
c. A pulse rate of 100 or over which is not persistent and not due to paroxysmal 
tachycardia. (A pulse rate of 100 or over may be temporary and due to excite- 116 
REPORT OF COMMISSION OF PHYSICIANS 
ment or to recent infection, such as pneumonia or local infections about the nose,, 
mouth, and throat, or may be induced by drugs.) 
d. A pulse rate of not lower than 50 per minute. 
e. Sinus arrhythmia. (This consists in a quickening of the pulse rate during 
inspiration and a slowing during expiration and is best recognized with the indi- 
vidual recumbent and breathing deeply.) 
64. Limited service.—There are no cardiovascular criteria to warrant initial 
selection for limited service. 
f. Elevation of blood pressure front excitement, proved to be temporary. 
65. Nonacceptable.—a. Circulatoi’y 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). 
ft. 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 a heaving or diffuse character, or by X-ray evidence. 
c. A persistent heart rate of 100 or over when this is proved to be persistent 
in the recumbent posture and on observation and reexamination over a 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 includ- 
ing infection. 
d. Paroxysmal tachycardia if recurrent and disabling. See also section 
XXIII. 
e. Heart block. 
f. Any serious disturbances of rhythm such as auricular fibrillation. 
g. Valvular disease. 
i. Persistent blood pressure at 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 one-half hour’s rest 
recumbent. 
h. Congenital heart disease. 
j. Thrombophlebitis of one or more extremities if there is a 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 (thromboangiitis obliterans), 
erythromelalgia, and arteriosclerosis. In doubtful cases special tests should be 
employed. 
I. Aneurysm of any vessel. 
m. Pericarditis. 
n. Endocarditis. 
o. True angina pectoris. 
q. Neurocirculatory asthenia (effort syndrome). Usual symptom's of this con- 
dition are exhaustion, breathlessness, heartache, and palpitation. These symp- 
toms may follow exertion such as would not produce them in healthy individuals. 
These, and other symptoms such as dizziness or fainting, may arise without evi- 
dence of organic disease sufficient to account for the disability of the individual. 
Cases of effort syndrome may occur : 
p. Authenticated history of coronary thrombosis, and/or myocardial infarction. 
(1) As an accompaniment of organic heart disease. 
(2) Following infections. 
(3) In individuals with poor physique or insufficient training for the work 
required. 
(In some cases more than one of these factors is present.) REPORT OF COMMISSION OF PHYSICIANS 
It is important to observe that neurocirculatory asthenia should not be confused 
with tachycardia alone or increased blood pressure alone or both together, although- 
such conditions may be present with neurocirculatory 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 a decrease of a normal blood pres- 
sure (when the individual is recumbent) to values less than 00 systolic and 60 
diastolic when the individual stands may be considered evidence of a definite 
physiologic disturbance and in itself cause for rejection unless the condition is 
very temporary following an illness, operation, or exhausted state. 
s. Acute rheumatic fever, or verified history of single or recurrent attacks of 
rheumatic fever within the previous 2 years. 
66. Electrocardiogram.—The electrocardiogram is of great assistance in 
deciding the nature of certain 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: a P-R interval and a QRS conduction time not exceeding 0.20 
second and 0.10 second, respectively ; axis deviation not greater than —15 degrees 
left or +105 degrees right; a diphasic T wave in Lead 2 and/or a negative T wave 
in Lead 3; Q waves not greater than 3 mm. in Leads 4R and 4F; R waves in 
Leads 4R and 4F not less than 4 mm. and 2.5 mm. respectively; and elevation of 
the RS-T segment in Leads 4R and 4F not to exceed 2 mm. 
67, X-ray.—In doubtful cases, fluoroscopy or teleroentgenography is advised 
to determine the size and shape of the heart and great vessels. Films should be 
taken at a distance of 2 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 for- 
mula), by more than 1 cm., the heart is considered to be enlarged. In the case' 
of certain short, thick-set men a slightly greater figure may, at the discretion of 
the examiner, be regarded as wtihin the range 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— 
(1) To accept for servicemen 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) To 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,, 
to create a pension problem. Therefore, all individuals with valvular heart 
disease are to be regarded as unfit for service and will be rejected. 
h. Men who desire to serve their country may, from patriotic motives, endeavor 
to conceal a 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 mur- 
murs. Such certificates will not be accepted but examiners will satisfy themselves- 
by their personal examinations as to the physical qualifications of individuals. 118 
REPORT OF COMMISSION OF PHYSICIANS 
c. It is necessary, therefore, that the conclusions of the examining physician 
in doubtful cases he 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 a factor in the final 
decision. No statement, however, will be accepted as proof of the existence of a 
cardiovascular defect unless supported by objective evidence. 
d. It is the duty of examining physicians to protect the interest of the Govern- 
ment 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 sui>- 
posed normal which may occur in perfectly healthy hearts. 
Section XV 
Paragraph 
General service 69 
Limited service 70 
Nonacceptable 71 
General considerations 72 
ABDOMINAL ORGANS AND WALL 
69. General service.—a. Abdominal scars due to surgical operation or accident 
which show no hernial bulging. 
6. 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 abdominal wall. 
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. 
&. There are no other defects of the abdominal oi'gans or wall to warrant 
initial selection for limited service. 
71. Nonacceptable.—Defects such as— 
a. Hernia, inguinal, which has descended into the scrotum; recurrent; post- 
operative ; ventral; umbilical, if moderate or large in size. 
&. Acute or chronic cholecystitis with or without cholelithiasis, if diagnosis is 
‘Confirmed by usual laboratory procedures 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. 
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. REPORT OF COMMISSION OF PHYSICIANS 
119 
j. External hemorrhoids sufficient in size to produce marked symptoms. In- 
ternal hemorrhoids if large or accompanied with hemorrhage, or protruding inter- 
mittently 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 a diagnosis, ex- 
amining physicians will avail themselves of fluoroscopy and roentgenography. 
&. 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 a scar is not necessarily indicative of hernia. 
f. In cases of suspected gastric or duodenal ulcer every effort will be made 
to obtain a trustworthy history, including authentic 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 or chronic. 
&. 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. Nonacceptable.—a. Stricture of the urethra, severe. 
&. Gonorrheal arthritis. 
c. Other complications of gonorrhea, including acute prostatitis, seminal vesicu- 
litis and epididymitis. 
d. Cardiovascular, cerebrospinal, and visceral syphilis. 
e. Granuloma inguinale. 
f. Lymphogranuloma venereum (active). 
76. General considerations.—Examination for the detection of venereal dis- 
ease will include inspection of the skin and genitalia for lesions; cardiac and 
neurological examination to detect late complications of syphilis; blood sero- 
logical test for syphilis, and in individuals with latent syphilis, spinal fluid tests. 
Section XVII 
Paragraph 
General service , 77 
Limited service 78 
Nonacceptable 79 
General considerations 80’ 
GENITO URINARY ORGANS 120 
REPORT OF COMMISSION OF PHYSICIANS 
77. General service.—a. Mild albuminuria without casts which is proved by 
observation and repeated examination to be temporary in character or ortho- 
static in type. 
It. 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. 
h. Phimosis. 
78. Limited service.—a. Stricture of the urethra unless severe. 
I). Floating kidney. (Floating kidney is one which is freely moveable.) 
79. Nonacceptable.—a. Acute or chronic nephritis. 
6. Stricture of the urethra, severe. 
0. Urinary fistula or incontinence. 
d. Acute or chronic infections of the kidney. 
e. Absence of one kidney. 
f. The presence of renal calculus, or a substantiated history of bilateral renal 
•calculi at any time. 
g. Chronic pyelitis. 
h. Hydronephrosis or pyonephrosis. 
1. Tumors of the kidney, bladder, or testicle. 
j. Chronic cystitis. 
k. Amputation of the penis, if the resulting stump is insufficient to permit nor- 
mal function of micturition. 
l. Hermaphroditism. 
m. Hypertrophy of the prostate gland with urinary retention. 
n. Epispadias or hypospadias when urine cannot be voided in such a 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. Urinalysis.— (1) 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 a day on 2 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 pressure, and other evidences of cardiovascular-renal dis- 
ease, the diagnosis of chronic nephritis may be made immediately. If the pres- 
ence 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 physi- 
cians. When blood is found in the urine, a thorough study will be made to deter- 
mine the underlying cause. 
(2) When it is deemed necessary, examining physicians will employ X-ray 
facilities to verify diagnosis of defects of the genito-urinary organs. REPORT OF COMMISSION OF PHYSICIANS 
121 
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 a uniform or military equipment. 
(See paragraph 49 e.) 
b. Frolich’s syndrome, if mild in degree. 
82. Limited service.—a. Frohlich’s syndrome, if moderate in degree. 
b. 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 malin- 
gerers may use thyroid medication to produce many of the symptoms of thyro- 
toxicosis.) 
b. Simple goiter with definite pressure symptoms or so large in size as to inter- 
fere with wearing a uniform or military equipment. 
• c. Cretinism. 
d. 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 sup- 
ported 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 unauthorized assistant, and on 
more than one occasion. In doubtful cases 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. 
l. 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 a 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. 
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. 
6. Malaria, acute or chronic, mild. REPORT OF COMMISSION OF PHYSICIANS 
85. Limited service.—Thei’e are no diseases of this group which warrant 
initial selection for limited service. 
86. Nonacceptable.—a. Hemophilia. 
6. Thrombocytopenic purpura. 
c. Pernicious anemia. 
d. Aplastic anemia. 
e. Hemolytic ictero-anemia (hemolytic jaundice). 
/. 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 
Methods of examination 87 
General service 8$ 
Limited service 89 
Nonacceptable 90 
Diagnostic criteria 91 
Paragraph 
87. Methods of examination.—a. In order to detect the presence of certain 
common neurological diseases, particularly epilepsy, post-encephalitic and post- 
traumatic syndromes, multiple sclerosis, drug addiction, and hysteria, informa- 
tion regarding the life history of the individual is essential. Therefore, a history 
will be obtained relative to convulsions, fainting spells, attacks of unconscious- 
ness, routine use of any medicines, hospitalization, severe head injury, and educa- 
tional and occupational history. 
6. The neurological examination will be conciliated as follows: The individual 
will be examined stripped. He will walk a straight line at a 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, incoordi- 
nate or limping gait; absence of normal associated movements; deviation to one 
side or the other; the presence of abnormal involuntary movements; undue dif- 
ference 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 stiff- 
ness. As to pupils, look for irregularity, inequality, diminished or absent con- 
traction to light; movements of eyes, facial muscles, and tongue. Look for 
strabismus, 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 oppo- 
site 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 REPORT OF COMMISSION OF PHYSICIANS 
123 
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. A healthy nervous system as manifested by absence of signs of disease of 
the brain, spinal cord, cranial and peripheral nerves. 
6. 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 diseases of the peripheral nerves of such degree 
that they disqualify for general military service but have not interfered with loco- 
motion and have not prevented the individual from successfully following a use- 
ful vocation in civil life are acceptable for limited service. 
a. Neurosyphilis of any form (general paresis, tabes dorsalis, meningovascular 
syphilis). 
90. Nonacceptable.—Any serious neurological disorders such as— 
b. Degenerative disorders (multiple sclerosis, encephomyelitis, 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, post-encephalitic syndromes, Syden- 
ham’s chorea). 
d. Peripheral nerve disorder (chronic or recurrent neuritis or neuralgia of an 
intensity which is periodically incapacitating, multiple neuritis, neurofibroma- 
tosis). 
e. Residuals of trauma (residuals of concussion or severe cerebral trauma, 
post-traumatic cerebral syndrome, incapacitating severe injuries to peripheral 
nerves). 
f. Paroxysmal convulsive disorders and 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 mal- 
formations 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 a general guide for examiners. It includes the common manifesta- 
tions 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 meningo- 
encephalitic 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 re- 
lating 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 a schizophrenic or neurasthenic type. 
(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 slug- 
gishly reacting pupils or Argyll-Robertson pupil; absent knee jerks; positive 124 
REPORT OF COMMISSION OF PHYSICIANS 
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. 
ft. Multiple sclerosis.—A history of transitory weakness, numbness, ataxia of 
one or more extremities, transient diplopia, scotomata or bladder disturbances 
should arouse a suspicion of multiple sclerosis. The presence of optic atrophy, 
scotomata, definite nystagmus, corneal hypoesthesia, absence or irregularity of 
abdominal reflexes, exaggerated deep reflexes, a Babinski or similar signs, or 
ataxia and euphoria are common manifestations. 
e. 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. Simula- 
tion is possible and in doubtful cases previous medical records should be sought. 
Even mild manifestations disqualify. 
e. Paralysis agitans.—Paralysis agitans is recognized by frozen facies, un- 
winking stare, rigidity of the muscles, stooped posture, slowness of movement, 
tremors, slow, monotonous speech, and typical gait. It may be unilateral. A 
history of encephalitis or influenza is obtained in only about one-half the cases. 
Even mild manifestations disqualify. 
f. Multiple neuritis.—This may be associated with the dietary deficiencies, in- 
fection, or intoxication. The symptoms depend upon 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 or diminution of reflexes. 
g. Chronic neuralgias.—A history of severe constant or recurrent pain, con- 
fined to the area of distribution of a single nerve or segment, without objective 
changes, suggests this diagnosis. Clearly defined entities are sciatic and tri- 
geminal neuralgias. Less common are suboccipital, brachial and glossopharyn- 
geal neuralgias. Neuralgias of other nerves are extremely rare and the diag- 
nosis 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 pre- 
sumably 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. A dull, 
apathetic expression, slight nystagmus, fine tremors, vasomotor changes, or ab- 
normal sweating, are confirmatory evidence. If the syndrome is definite, even 
though mild, the individual should be rejected. The presence of signs indicating 
a 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 has had spells of unconsciousness, convulsions, “fits,” “falling 
out,” “spells,” “lapses,” “dizziness,” or “fainting.” The individual will be dis- 
qualified on a verified history of such spells or of multiple attacks of loss of con- 
sciousness, especially with incontinence or twitching, or of frequent momentary 
episodes of being dazed, or of uncontrollable outbursts of rage or irrational con- REPORT OF COMMISSION OF PHYSICIANS 
125 
duct, or fugues or treatment with anticonvulsive drugs over a long period of time. 
Such a history will be verified, if practicable, by a confirmatory medical record 
from a trustworthy source. The electroencephalograph is of great assistance in 
diagnosis, particularly in doubtful cases, but will not be used routinely. When a 
registrant is rejected for epilepsy a 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 a 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 
Eoutine procedure 93 
Minimum psychiatric examination 94 
General service 95 
Limited service 96 
Nonacceptable 97 
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, a 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. Bach 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 par. 2&.) 
93. Routine procedure.—a. The diagnosis of most psychiatric disorders de- 
pends 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 agen- 
cies, etc. 
&. Attention will be given to whether the individual wants to be in the Army 
and thus may have a tendency to minimize his defects or whether he wants 
to remain in civilian life and thus may have a tendency to exaggerate. 
c. Routinely, examiners will be on the watch for any of the following per- 
sonality deviations: Inability to understand and execute commands promptly 
and adequately, abnormal negativistic attitude, abnormal anxiety, silly inappro- 
priate laughter, instability, seclusiveness, sulkiness, sluggishness, discontent, lone- 
someness, depression, shyness, suspicion, overboisterousness, timidity, personal 
uncleanliness, stupidity, dullness, resentfulness to discipline, a history of noc- 
turnal incontinence, sleeplessness, lack of initiative and ambition, sleepwalking, 
recognized queerness, suicidal tendencies either bona fide or feigned, and homo- 
sexual proclivities. 126 
REPORT OF COMMISSION OF PHYSICIANS 
d. Abnormal autonomic responses (fainting, blushing, excessive sweating, shiv- 
ering or gooseflesh, excessive pallor or cyanosis of the extremities) are also occa- 
sionally 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 difficul- 
ties 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 straight- 
forward professional inquiry coupled with real respect for the individual’s per- 
sonality and due consideration for his feelings—which does not mean diffidence. 
6. 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 he 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 a matter-of-fact 
manner, follow up whatever is not self-evidently commonplace. 
d. The probable presence of some types of psychiatric disorders—in particular 
the major psychoses and marked degree 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 cases one would 
not be able to suspect the presence of any morbid condition without some knowl- 
edge of the individual’s history. 
95. General service.—a. The range of personalities usually classed as “nor- 
mal”.—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 grad- 
uate from grammar school unless prevented by external circumstances. Suffi- 
cient stability and ability to obtain and keep, or at least to seek, a job. 
c. Men whose speech can readily be understood, even though there is a moder- 
ate degree of stuttering or stammering, if otherwise physically, intellectually, 
and emotionally fit. 
6. Marginal intelligence, if compensated for by better than average stability. 
96. Limited service.—a. Stuttering and stammering of a degree disqualifying 
for general military service but which has not prevented the man from success- 
fully following a usefrd vocation in civil life. 
97. Nonacceptable.—Individuals who are found to have any serious mental or 
neurological disorder such as— 
a. Mental deficiency. 
I). Psychosis. 
c. Psychoneurosis. 
d. Psjmhopathic personality. 
e. Alcoholism and drug addiction. 
f. Primary behavior disorder of sufficient degree to indicate predisposition 
to more serious disorders. 
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, untidiness,' lack of personal 
cleanliness, anatomical stigmata of degeneration, muscular awkwardness. His- 
g. Syphilis of the central nervous system. REPORT OF COMMISSION OF PHYSICIANS 
127 
tory 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. A diagnosis of mental deficiency will be based on 
results of objective tests interpreted in the light of the above considerations. 
Illiteracy per se is not to be classified as mental deficiency. 
ft. Psychosis.— (1) Schizophrenia (Dementia Praecox).—This mental disorder 
is manifested by obscurely motivated peculiarities of behavior and thought. Of 
thes,e, 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 a 
normal childhood. Somewhere between the ages of 12 and 25 they underwent a 
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 impor- 
tance, 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 plausi- 
ble in supporting these delusions by clever misinterpretation of facts. Some of 
them are very evasive and skillful at concealing the pattern of their disorder. 
A morbid suspiciousness of anyone who takes an interest in them is frequent. 
They may become tense and hateful when interrogated. 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 actual oddities of behavior 
or thought may be subtle; it may be difficult, in retrospect, to point to any par- 
ticular instances of the unusual. The most striking signs of these conditions 
may in fact come out in connection with the physical examination. The phy- 
sician, at some state of the physical examination, may observe a peculiar reaction 
which upon questioning may awaken a suspicion of a 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 embarrass- 
ment, 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 a morbid excitement or a depression will be 
rejected. 
(3) Psychosis of other types, involutional melancholia, toxic psychosis, par- 
anoia, are encountered rarely at induction and will be rejected. 
96050—44 9 128 
REPORT OF COMMISSION OF PHYSICIANS 
(4) Reliable history of commitment to a 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 per- 
sonality) are to be rejected. These individuals react inappropriately to dif- 
ficulty. They may have done well in civilian life but tend to be anxious, self- 
conscious, oversensitive, and emotionally dependent on other people. In evaluat- 
ing 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 a clinical psychoneurosis are a definite 
history of previous psychoneurotic episodes and/or the persistence of psycho- 
neurotic reactions, which were, at least, in some degree disabling to the individual 
in his civilian life. 
(1) Signs and symptoms fall into the following types— 
(a) Anxiety, manifested by subjective and objective evidence of apprehen- 
sion and worry. 
(6) Neurasthenia, excessive concern with minor or functional bodily ail- 
ments as manifested by multiple vague complaints, multiple opera- 
tions for obscure disorders, unusual fatigability, vague pains, pres- 
sure feelings, distorted head sensations; excessive concern over 
health and function of bodily organs. 
(c) Hysteria, conversion symptoms such as hysterical fits, deafness, blind- 
ness, or loss of voice; hysterical paralyses or anesthesias; disso- 
ciations such as amnesia, absences, trances. 
(d) Psychasthenla, obsessions, compulsions, phobic manifestations such 
as specific terrors of harmless objects or situations, food phobias, dirt 
and germ phobias, inflexibile rituals of behavior about food, sleeping, 
dressing, compulsive acts, obsessional thoughts, and obsessional in- 
decision. 
(e) A Reactive Depression is a depression, which may be severe and with 
suicidal trends and which is a reaction to adverse and serious en- 
vironmental situations. It persists for fairly long periods of time and 
is definitely more than a “blue spell.’’ The patent is apt correctly to 
regard the disturbing environmental situation as responsible for the 
depression. 
(f) Mixed types. 
(2) Physical disorders which may furnish important clues to psychoneurotic 
disabilities.—Neurotic tensions may be manifested not only by frank psycho- 
neuroses and behavior difficulties but also by manifestations of a variety of 
physical disturbances and organic disease processes. Such conditions as peptic 
ulcer, pylorospasm, mucous colitis, spastic constipation, neurocirculatory asthe- 
nia, paroxysmal tachycardia, vascular hypertension and hypotension, Raynaud’s 
disease, fainting, convulsions, somnambulism, narcolepsy, migraine, glaucoma, 
eczema, psoriasis, enuresis, cardiospasm, impotency, and asthenia may have im- 
portant 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 a close 
relationship. 
d. Psychopathic Personalities.—In this ill-defined, more or less heterogeneous 
group are placed those individuals who, although not suffering from a con- 
genital defect in the intellectual sphere, do manifest a definite defect in their REPORT OF COMMISSION OF PHYSICIANS 
129 
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, truthfulness, decency, and considera- 
tion 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 in- 
doctrinate them in the essentials of military discipline. Such an individual has a 
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 pre- 
sents a favorable impression, is neat in appearance, talks well, and is well 
mannered. However, under this veneer the real defect is evident by past ir- 
responsiveness 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 occa- 
sionally engaged in homosexual or other perverse sexual practices are unsuita- 
ble for military service and will be excluded. Feminine bodily characteristics, 
effeminacy in dress or manner, or a patulous rectum are not consistently found 
in such persons, but where present should lead to careful psychiatric examina- 
tion. If the individual admits or claims homosexuality or other sexual perver- 
sion, he will be referred to his local board for further psychiatric and social 
investigation. If an individual has a record as a 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 a satisfactory adjustment owing to introversion, eccentricity, imprae- 
ticalness, 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 individ- 
uals, so-called “guardhouse lawyers,” who are forever critical of organized 
authority and imbued with feeling of abuse and lack of consideration for their 
fellow men. 
(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. 
e. Chronic alcohol ism and drug addiction.— (1) Chronic alcoholism.—An indi- 
vidual will be regarded as a 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 a 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 a drug addict if he is 
or has recently been a habitual user of any of the opium preparations, cocaine, 
or cannabis indiea (marijuana). A history of arrests for narcotic law violation 130 
REPORT OF COMMISSION OF PHYSICIANS 
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. 
f. Primary behavior disorders.—These may or may not be cause for rejection, 
depending upon their severity. They are causes 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 a 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. A verified history 
will be obtained. See Sect. XXIV, Par. 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 are cause for rejection if of such a degree that 
registrant is unable to express himself clearly or to repeat commands. 
Section XXII 
INTELLIGENCE 
Paragraph 
General considerations 9f> 
General service 100 
Limited service 101 
Nonacceptable 102 
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 aye and intelligence quotient are not 
applicable to results achieved on Army Tests, and will not be 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 deserbe the level of intelligence. 
99. General considerations.—Minimum intelligence requirements for military 
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. A man achieving the critical score or a 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. REPORT OF COMMISSION OF PHYSICIANS 
131 
102. Wonacceptable.—Failure of a nongraduate of a standard English-speak- 
ing high school to achieve a 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. 
Section XXIII 
PURPOSELY CAUSED PHYSICAL DEFECTS 
Report of apparently purposely caused defects 103 
Paragraph 
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 exami- 
nation prescribed herein would render him disqualified for military service of 
any kind, a 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 
Definition 104 
Differentiation 104 
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 
Paragraph 
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 a particular end which is more satisfactory 
to him or of seeking an escape from a fear-infested situation. Malingering is 
encountered in a 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 a wide variety of problems which 
must be differentiated from the ordinary neuroses as well as from physical ill- 
nesses ; 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. 
A person gifted with histrionic talent and who has a considerable degree of knowl- 
edge 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 a disorder to be classed as true malingering, it 
must fulfill three conditions that— 
(1) No obvious or frank 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 a purpoose to a preconceived result. 
6. When confronted with a case of malingering the observer will try to ascer- 
tain how much of what constitutes the total picture 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; 132 
REPORT OF COMMISSION OF PHYSICIANS 
(1) Malingering for the purpose of attaining a definite end by simulation of 
a 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 a bluff and hopes to get away with it. 
(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 symp- 
toms of fatigue, etc. 
(3) Malingering as a manifestation of a psychopathic personality with a sug- 
gestion 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 psycho- 
pathic personality contain many persons having an irresistible tendency to alco- 
holism, 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 a disability which on the surface appears to be a definite simulation, requires 
a special investigation. The confusion of hysteria with true malingering is not 
infrequently made by those who consider nearly all hysterics as malingerers with 
symptoms that could be controlled voluntarily. 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 a 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 a definite change in personality. These reactions frequently con- 
fused with pure malingering may become much worse during investigation or 
attempted correction. 
c. Among these five groups the typical members are readily distinguished hut 
intermediate and doubtful cases which resist differentiation do occur. It should 
be kept in mind that it is even more difficult for a healthy person to feign disease 
than it is for a diseased person to simulate health and that a 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. 
106. Feigned medical diseases.—a. The detection and management of malin- 
gerers 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 a difficult matter. 
b. 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 a chronic diarrhea. 
An appearance of hemoptysis may be produced by adding blood, either human REPORT OF COMMISSION OF PHYSICIANS 
133 
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 hematameses. 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. 
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 fingers 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 appear- 
ance 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 a silly, foolish type. In case of doubt, hospital obser- 
vation is necessary, with verification of past records. Mental deficiency is 
frequently feigned especially by illiterates. 
h. 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 objec- 
tive evidence of localized pains. Note behavior when the registrant believes 
himself unobserved. 
c. Anesthesia.—Complaint of anesthesia itself creates a suspicion of malinger- 
ing, as most patients with anesthesia are ignorant of it. 
d. Epilepsy.—Men who have sustained head injury may claim fits. These com- 
plaints 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 a soldier. 
f. Stiff hack.—Stiff back is a 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 a 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 
immediately subjected to a thorough psychiatric survey which will include a 
careful history of their previous behavior and adjustment record and a 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. 
h. 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.