REPORT OF THE 
MEDICAL OFFICER 
NEW YORK CITY HEADQUARTERS 
SELECTIVE SERVICE SYSTEM 
October 15, 1940 to May 8, 1945 (V-E Day) REPORT OF THE 
MEDICAL OFFICER 
NEW YORK CITY HEADQUARTERS 
ui, SELECTIVE SERVICE SYSTEM. 
y* 
October IS, 1940 to May 8, 1945 (V-E Day) Lithoprinted in U.S.A. 
EDWARDS BROTHERS, INC. 
ANN ARBOR, MICHIGAN 
1945 PREFACE 
This report comprises the activities of the Medical Division from the commencement of 
Selective Service to V-E Day, May 8, 1945. 
The Medical Officer Is assigned to a State Headquarters with Regulations outlining 
the duties of Local Board Examining Physicians, Medical Advisory Board doctors, and dentists. 
These Regulations and directives are specific as to the duties of these groups of medical 
professional personnel. 
The Regulations as to the specific duties of the Medical Officer are exceedingly 
meager. Hence it was obvious that he had to devise methods to set into operation a uniform 
set of procedures as to the duties of the professional staff, all of whom were volunteers 
working without pay, but it was also necessary for him to Improvise and develop his own field 
of work In regard to the responsitllitles of his office, along such lines as the local sit- 
uation In the area under the jurisdiction of the Headquarters to which he is assigned Indi- 
cated as necessary. The ensuing pages will give an outline as to how these situations were 
found, met, and generally handled In the New York City area. 
In the work of the Medical Division, innumerable conferences and coordinated endeavors 
often became necessary between the Medical Officer’and the Operations, the Legal, the Inspec- 
tion, and the Occupational Divisions. The excellent cooperation and helpfulness always ex- 
tended to the Medical Officer are gratefully acknowledged. To a large extent, whatever suc- 
cess has accrued to the Medical Officer in his tasks Is In no small measure to be traced to 
the fine cooperative spirit extended by the commissioned officers handling these divisions. 
National Headquarters, too. In Its various divisions has given inspiring direction. 
We In the New York City area have been most fortunate In the personality of the Regional rep- 
resentative of National Headquarters, Captain Ernest B. Erickson, USNR, who by his comprehen- 
sion of the complexity of the problems Inherent to a city like New York has been an unfailing 
source of helpful advice and counsel. We acknowledge our indebtedness to him in being mu- 
tually helpful In clarifying many difficult situations. 
To the paid clerical staffs also must go credit for their fine contributions toward 
coordinated cooperation. To the paid staff, and the staff of volunteer physicians working 
In the Medical Division, sincere thanks are also due. In their devotion to their jobs 
particularly the Medical Division paid staff - they often worked at a pace and in length of 
hours beyond what In ordinary times would have been considered the "wonted activities" of such 
jobs. They did this and stayed on their jobs despite pay-schedules less than any one of them 
could have earned In outside jobs. 
This picture, which I am endeavoring to describe In a few paragraphs, of devotion to 
assigned duties by commissioned officers assigned to a civilian agency far separated from the 
dramatics of war front service with Its essential high .. 1 of morale and indoctrination In 
the effective spirit of coordinated team work. Is without question due to the wise judgments, 
good counsel, and fine support the Medical Division has enjoyed at the hands of Colonel 
Arthur V. McDermott, the New York City Director. I can say without mental reservation that 
most of the varied and extended activities reported herein, most of which have had favorable 
receptions from the general medical profession of the city, from the colleges, and from the 
hospitals can be traced to the Inspiring leadership of the New York City Director. I freely 
acknowledge my Indebtedness to him for the privilege I have enjcyed In serving in the capacity 
of Medical Officer to his Headquarters, and the support I have had from him In various of our 
endeavors which were Improvised because they were not specifically covered In current regula- 
tions or directives. 
Samuel J. Kopetzky 
Colonel, MC 
Medical Officer, N. Y. City Headquarters 
Selective Service System 
May 8, 1945- TABLE OF CONTENTS 
Page 
General Background vli 
Introduction 1 
The Physical Examinations of Registrants 2 
The Local Board Physician 2 
How Physicians were Selected 2 
Procedures of the Local Board Physician in Relation to 
the Medical Advisory Board 3 
Test In Rehabilitation 4 
Preparations to Undertake Remedial Therapy On National 
Level 7 
Hospital Examining Teams 8 
The Psychiatric Advisory Committee 8 
Sex Variants 9 
Psychiatric Screening Under Medical Circular No. 4 9 
t 
Medical Survey Program Procedure 11 
The Validity of the School Teacher Appraisal and 
Social History (DSS Form 213 and DSS Form 212) 12 
Chart No. 1 13 
Chart No. II 14 
Chart No. Ill 15 
Salvage of Needles for Serological Tests 16 
Review of Registrants Classified in IV-F 16 
Cardiovascular Review 17 
Headquarters Master Psychiatric File 23 
Adjustments of Complaints and Errors 23 
Review of Physical Examination Forms (DSS Forms 200 and 
22l) and Approximate Estimates of Numbers Examined, 
Numbers Accepted, and Numbers Rejected, after correction 24 
Investigation of Physicians' Certifications of 
Registrants' Dependents' Disabilities 25 
Interim Physical Examination of Registrants ■ . 25 
Examination of Men Discharged with C.D.D 25 
Procurement of Professionals for Military Duty 26 
Classification of Registered Pharmacists 27 
Hospital Advisory Committee Activity ' 28 
Salvage of Manpower by Substantiation of Positive 
Serologicals • 28 
Anent Student Deferment 30 
V REPORT OF MEDICAL OFFICER 
Page 
Studies Undertaken of Source Material and Reported 31 
The Purpose of the Forms Noted In Text 32 
Report on Proposals Based on a Study of Rejections of 
Registrants In the New York City Area to Procure a 
Better Health Level ' 
Contents - Categories of Rejections 34 
1. Health Level of Adult Predicated on Child's Health 3^ 
2. School Physician 35 
3. Medical School History 36 
4. Medical Department In Industry 36 
5* Physical vs. Health Levels 37 
6. Need for a Centralized Agency on National Level 77 
7- State and Local Agency 38 
8. Executive Council 38 
9- Research 38 
10. Proposal Does Not Imply Socialized Medicine 39 
11. Voluntary Prepaid Medical Care* 39 
12. Diagnostic Facilities * 39 
13. Negro Health Levels 40 
Proposals Anent Procurement of Manpower for the Armed 
Forces 41 
1. Universal Military Training 41 
2. Recruitment of Manpower 42 
3- Procedures In Peace Time 42 
4. Technique for War Time 43 October, 1940 to V-E Day, May, 1945 
GENERAL BACKGROUND 
The New York City area over which this Headquarters exercises 
jurisdiction has irdierent differences from that of any other State 
Headquarters. 
All our registrants are within a five cent fare trip of the 
Headquarters. The City has an ample supply of medical facilities 
within easy reach of every registrant's home. There are approxi- 
mately 16,380 practicing physicians in the City. There are five 
Grade A Colleges of Medicine, two Colleges of Dentistry, and four 
Colleges of Pharmacy, and one hundred forty-six hospitals in the city. 
The population of the City comprises many foreign language 
groups consisting of many nationalities. Of a total population of 
7,454,993 in New York City, on April 1, 1$40 2,080,020 were classified 
by the U. S. Census as "white - foreign born." Of these, 62.4$ were 
counted as naturalized citizens. (Report by J. 0. Capt, Director, 
Bureau of the Census). This background must be kept in mind when noting 
the problems, many of which are peculiar to the city and its population, 
■which came before this Headquarters for clarification and decision. 
vil INTRODUCTION 
This report comprises the organization of the Medical Division and the types of its 
functions since the commencement of Selective Service activities to May 8, V-E Day. 
In outline, it is a chronological record of Local Board physical examinations. 
Medical Advisory Board functions, and medical matters pertaining to the procurement of man- 
power for the military forces, including review of all DSS Forms 200 and DSS Forms 221 to 
rectify clerical and other errors in classification based on medical reasons. 
It also outlines the medical aspects of procuring for the Armed Forces medical, den- 
tal, and veterinary officer personnel, in cooperation with the New York State Procurement 
and Assignment Service. On the one hand, the need of the Armed Forces for their professional 
personnel and on the other, care not to deplete the civilian medical facilities of the City 
all come into focus when considering the individual status. 
There also came under the consideration of this Division certain professionals whose 
individual status needed'study and report. These included registered pharmacists, registered 
male nurses, technical help on hospital staffs, embalmers and morticians, and medical, dental, 
and veterinary pre-professional and professional college students. 
The claims of dependents of registrants who alleged ailments and diseases which 
precluded them from engaging in gainful occupations to support themselves or the remainder 
of the registrants' families, brought most of the certificates of their physicians regarding 
their physical disabilities to this Division for investigation, report, and decision. 
Finally, when men discharged from military service with honorable discharges alleged 
recovery from the disability which caused their separation from the service, who thereupon 
volunteered for re-entry into the Armed Forces, it required that their disabilities be 
studied and if the situation which caused their separation from the service was corrected or 
the disease cured it was necessary to institute steps to permit them to return to military 
duty of their own free will. Other discharged servicemen were routed to agencies and facil- 
ities where therapeutic measures which they needed were placed at their service. 
In addition to the above, from time to time various studies and reports were made by 
this Division and forwarded to appropriate sections of National Selective Service Headquarters, 
These are listed and outlined herein. 2 
REPORT OF MEDICAL OFFICER 
THE PHYSICAL EXAMINATION OF REGISTRANTS 
Some time before Selective Service became activated the Medical Societies of the five 
counties of New York began to nominate doctors to serve on the Medical Advisory Boards and as 
Local Board Examining Physicians. Twenty-six Medical Advisory Boards were formulated and 
activated throughout the City. Each consisted of at least one of the following specialists 
In medicine; otolaryngologist, ophthalmologist. Internist, orthopedist, neuropsychiatrist, 
roentgenologist, surgeon, and dentist. Later, as the need arose, dermatologists■and 
urologists were added to the Medical Advisory Boards. As the burden of work became heavier 
and the need was shown, additional specialists were nominated to each Medical Advisory Board, 
and In some cases as many as four of each specified type of specialty were represented on the 
Medical Advisory Board. 
The Local Board Physician 
Two physicians were nominated to serve on each Local Board. The Local Board 
physicians examined registrants In accordance with criteria and standards outlined In Volume 
No. 6 of Selective Service Regulations.i It was entirely within the jurisdiction and judg- 
ment of the Local Board physician to qualify a registrant for general military service or 
limited service, or,totally to reject him for either. At that time the examination given by 
the Local Board physician was complete. Including a urinalysis. The examinations were 
made at the quarters of the Local Board. 
It Is to be remembered that the Local Board physician was not a member of the Local 
Board but was attached to the Medical Division and served as medical advisor to the Board in 
his specific capacity to examine the registrants and make notations as to acceptability or 
disqualification. 
How Physicians Were Selected 2 
Arrangements ,had been made with the local County Societies to take the’ responsibility 
of making nominations of qualified men for all these positions. The local County Medical 
Societies of the five Counties also had agreed that In view of a complaint of any Irregu- 
larity of conduct on the part of any of the physicians necessary disciplinary action would 
be taken by the Board of Censors of their County Society. It is with some pride that we can 
announce at the end of four years of service that no single case of disciplinary action has 
been found necessary. 
1 Volume No. 6, Selective Service regulations laid down the standards for acceptance for full or for 
limited military service and for rejections. 
2 During the period herein reported, there have been 2,l4l physicians serving as Local Board Examining 
Physicians and 436 on Medical Advisory Boards. 413 dentists served our Local Boards, and 21 served on 
the Medical Advisory Boards PROCEDURES OF THE LOCAL BOARD PHYSICIAN IN RELATION TO THE MEDICAL ADVISORY BOARD 
PROCEDURES OF THE LOCAL BOARD PHYSICIAN 
IN RELATION TO THE MEDICAL ADVISORY BOARD 
Where the Local Board physician had doubt regarding the diagnosis of a condition which 
a registrant presented or where he deemed It necessary that laboratory tests and procedures * 
be undertaken before it was possible to make a determination, the Local Board physician at 
that time referred the registrant to the Medical Advisory Board for further examination and 
for the necessary laboratory procedures. In addition, If the registrant did not feel that he 
had been properly and correctly rejected or accepted by the Local Board doctor, he had at 
that time^the right to take an appeal on the physical findings. He was then sent to the spe- 
cialist concerned with the type of disability which he was alleged to have for an Independent 
examination and a specialist's opinion and decision. 
The Medical Advisory Boards at that time were, under our Regulations, permitted to do 
any laboratory tests they thought necessary at rates to be charged to the Government, In 
accordance with a fee schedule drawn up by National Headquarters. In this area this fee 
schedule was recommended to National Headquarters by me based upon the fee schedule In force 
in the State of New York under the Workmen's Compensation Law. In determining the different 
rates to be paid for the laboratory procedures this fee schedule received the approval of the 
hospitals and It was so administered that the fee merely covered the cost of the materials 
and did not Include the service of the doctor. All medical or dental personnel serving 
Selective Service did so as a patriotic contribution, to the war effort and not for fees. 
Each Medical Advisory Board had one of Its members nominated as the Chairman and he 
was permitted part-time secretarial help, which was paid for. It was the duty of the Medical 
Advisory Board Chairman to see that the various cases were allotted to the proper specialists 
and to- make sure that the reports were returned to the Local Board, and the bills certified 
and sent to this Headquarters for processing for payment. 
In March, the work of the Medical Advisory Boards became so heavy due to appeals 
and the Increase in quota calls that the Medical Advisory Board Chairmen were advised to dup- 
licate specialists on their staff In order to facilitate 'the work. This was done with the 
cooperation of the five County Medical Societies. 
I have already alluded to the fact that the registrants were allowed to take an appeal 
from the medical findings of the Local Board Examining Physicians. This necessitated that 
their cases be sent to the Medical Advisory Board and the registrants be examined by the 
Medical Advisory Board for the determination of the questions under dispute. While this pro- 
cedure was in vogue the registrants continued telephoning to the various Medical Advisory 
Board doctors to discover the results of their determination. The Local Board doctors were 
therefore advised not to give any information to the registrants but to make a report only 
to the Local Boards, and to advise registrants to apply to their Local Boards for Information 
as to their status. It soon became apparent that any registrant who felt like It could 
appeal from the medical findings and that the procedure was too unwieldy. Regulations there- 
upon were amended and no further appeals on medical grounds were permitted. The findings of 
the Local Board physician or, as the case might necessitate, of the Medical Advisory Board 
physicians were final. 
In April, 1941 the Local Board Examining Physicians were doing complete physical ex- 
aminations but, there having been a liberalization of the standards regarding teeth. It became 
necessary to assign two dentists to each Local Board. The First and Second District Branches 
of the American Dental Association nominated competent men to serve In this capacity. 
In June, It was determined that Medical Identification cards were to be distrib- 
uted to the Local Boards. These cards were for the purpose of ascertaining whether the reg- 
istrant had at any time had a history of a mental Illness. The Local Board clerks filled out 
the card with the registrant's name, address, age, and names of relatives and Local Board 
numbers. They were sent to the New York State Department of Mental Hygiene In Albany for a 
check through their central file to determine whether or not the registrant had at any time 
had a commitment to a mental Institution in the State of New York. These cards were returned 
to the Local Board with a notation "Not Identified" or, there being a record of commitment to 4 
REPORT OF MEDICAL OFFICER 
some institution, the name of the institution was given. The cards of registrants who showed 
that they had a record of hospitalization or institutionalization were then forwarded to the 
Medical Advisory Board psychiatrist, who made an inquiry direct to the institution concerned 
for the purpose, of obtaining details regarding the commitment, namely, the diagnosis and 
prognosis. On the basis of this report the psychiatrist would make a recommendation to the 
Local Board as to whether the registrant should be rejected at Local Board level or whether- 
he should be submitted to the psychiatrist for further psychiatric examination. In cases 
where a registrant was examined by a psychiatrist, the psychiatrist would naturally make a 
recommendation to the Local Board - either of rejection or of the registrant's being qualified 
for military service. 
The assignment of psychiatrists and the procedures in regard to the processing of 
Medical Identification Card #1 and also the work of the psychiatrist was devised and worked 
out by' the New York City Medical Division in conjunction with the New York City and New York 
State Committee on Mental Hygiene. 
Test In Rehabilitation 
About July, 1941 a test In rehabilitation was undertaken in New York City. The North 
Atlantic District Branch of the American Association of Medical Social Workers volunteered 
their assistance and the Local Board Examining Physicians and the Medical Advisory Board 
doctors were apprised of the program, which consisted in having the Local Board go over the 
records of such cases as the medical social worker would consider as remediable. Through 
contact with the registrant or his family they were to endeavor to persuade him to go to one 
or other of the hospitals or other facilities where remedial therapy might be obtained. Miss 
Sadie Shapiro was assigned to supervise the work, and a secretary was assigned to her, paid 
for by her organization. These two social workers were given desk space at this Headquarters. 
I cannot say too much in praise of these social workers, who made contacts with pri- 
vate practicing physicians, dentists, clinics, hospitals, and Board of Health Stations in the 
interest of the registrants, and who followed up the cases, as much as it was possible. All 
personnel, with the exception of the secretary, did this work on a voluntary basis after 
their regular working hours. Through this..program 3>996 registrants were referred for re- 
habilitation on a voluntary basis. There were 9,634 registrants interviewed because the na- 
ture of their disability made it appear likely that remedial therapy would be helpful in- 
giving them at least a better health level in their civilian occupations if it failed to 
make them fit for limited or general military service. 
Arrangements had been made so that none should fall to receive medical care, if they 
accepted it, because of financial inability to pay for it. Both the medical profession and 
the hospitals were cooperating wholeheartedly to make the volunteer rehabilitation program a 
success. 
The nature of the referrals is pertinent. Thus, 1,020 were referred to medical 
clinics. I59 were sent to dental clinics. It was found that an additional 562 were already 
being treated in medical clinics and 21 were likewise being treated in dental clinics. The 
interviews with the rejected registrants further evidenced that 1,602 were under the care of 
their private physicians and were under the care of their private dentists. The inter- 
views demonstrated that of the 9,634 interviewed, only 507 reported that they could not 
afford to pay anything for medical care, and it developed that of these 396 were handicapped 
in paying for artificial teeth replacements, dental bridges, and dental plates. 
At the completion of the period of this test on rehabilitation it was found that 1,014 
had attained the maximum recovery attainable. In 823 the condition was stationary, and in 
191 the condition had been corrected, even before interview by the social worker. 
There were 1,230 who refused to sign the necessary waivers so that the social worker 
could study their physical examination records. In addition, 308, although they permitted 
study of the type of their disability, absolutely refused to have anything done about it. 
This program was a worthwhile endeavor. It proved that a rehabilitation program 
was feasible. Major surgery was done without untoward incident. Obviously, there was no 
authority to compel acceptance of remedial therapy. I asked for such authority because in 
war time I could not accept the condition that a man of military age could shield himself TEST IN REHABILITATION 
behind a remediable physical defect for which medicine or surgery held a cure, to avoid his 
military obligation as a citizen. Such authority, however was never given and the project 
was dropped. 
In the cases of registrants rejected for tuberculosis, the names of such were for- 
warded to the Bureau of Tuberculosis, New York City Department of Health. This was for the 
purpose of checking the reason for rejection and also to see that registrants in the in- 
fectious stage of this disease cane under treatment. This action was in compliance and in 
accordance with the New York City Sanitary Code. Often, registrants did not respond 
correspondence from the Chest Clinics and in such cases their names were given to the Local 
Board so that the Local Board could see to it that the registrant appeared at the Chest0 
Clinic for further examination. This procedure started in July, 1941 and is still going on 
in the Interest of the registrants' families to prevent them from being unduly exposed to 
tuberculosis, and also in the interest of the registrants themselves, who might otherwise not 
have come under treatment. Many of these men first found out they had a tubercular lesion 
in their chests when they were X-rayed either at the Local Board level or at the Armed Forces 
Induction Station examination. 
The question of venereal disease concerned us from the beginning. These men at that 
time were not accepted for duty with the Army. It disturbed me very much that these men 
should be allowed at large with an infectious venereal disease so in August,. 1941 through 
contact with the Bureau of Social Hygiene of the New York City Department of Health, each 
Local Board received a Directory of Venereal Disease Clinics. Moral suasion was exercised 
by the Boards so as to refer registrants rejected for venereal disease to the clinic nearest 
their residence. 
In September, 1941 National Headquarters revised the fee schedule for laboratory and 
medical work, and this was transmitted to all Local Boards in the City, 
Up to September, 1941 the result of the determination on physical examination was 
noted on a DSS Form 200, which Form carried the registrant's signature. However, when a 
registrant was referred to the Medical Advisory Board for a detailed specialist's examination, 
occasionally a different person would appear for this examination since the registrant was 
not known to the Medical Advisory Board doctor. In order to avoid substitutions, the Medical 
Advisory Board doctors were directed to have the registrants sign their names before them 
when they appeared for examination and the signature could be compared with the one already 
before the doctor on the Form 200. 
At this time the Local Board Examining Physicians were instructed to add the letter 
"Rn following their recommendations for classifying men in IV-F or I-B when in their medical 
opinion the registrant could be put in a higher classification if the deficiency found at 
examination were corrected by curative therapy, medical, surgical, or dental. This was done 
to help the volunteer rehabilitation program put in progress in this area. 
In November, 1941 National Headquarters advised that a change in procedures in regard 
to medical examinations was to be put in effect in January, 1942. The new procedure pro- 
vided for a complete and thorough examination of the registrants at the Armed Forces Induction 
Station. ‘ The Local Board Examining Physicians would merely do a screening procedure, weeding 
out registrants with obvious defects. These obvious defects were listed in DSS Form 220. At 
that time it was further determined that a change in regard to Medical Advisory Board 
physicians should take place, namely, that no case should be referred to the Medical Advisory 
Board physician prior to the examination at the Induction Station, and all laboratory ex- 
aminations were to be stopped in the New York City area. When any doubt existed as to a 
case, the man was to be referred to the Armed Forces Induction Station for determination. 
After January, 1942 registrants were sent to the Armed Forces Induction Station for a pre- 
induction examination, and if they were found acceptable for either general or limited 
service their induction took place from twenty to thirty days later. At this time the right 
to appeal physical findings was also dropped. 
Effective January 1, 1942 the criteria for examinations at Local Board level were 
revised. Local Board Release No. 66 became the standard for determining physical fitness at 
Local Board level. This Release consisted of Part I and Part II. Part I consisted of a 
list of physical defects which disqualified registrants for either general or limited service. 
Part II consisted of a list of defects which disqualified registrants for general service but 
qualified them for limited service. 6 
REPORT OF MEDICAL OFFICER 
The examinations of the physicians at the Local Board level now became "screening" 
examinations to determine whether a registrant had any of the physical defects listed in 
either Part I or Part II of Local Board Release No. 66, and there were no laboratory pro- 
cedures required or permitted. When there was any doubt as to a determination or where 
laboratory procedures were necessary, the registrants were forwarded to the Armed Forces 
Induction Station for processing. 
Up to this time, the blood for serological examinations was taken by the Local Board 
physicians. In order that the reports from the blood examinations should be returned In 
time, the examinations were usually held during the evening hours. At the completion of the 
examination one of tne team would take the serological to the nearest Police Station and, an 
arrangement having been made with the Commissioner of Police, the Board of Health Collecting 
Service would bring the specimen to the Board of Health laboratory the same evening, and 
within five days the report would be back at the Local Board. Selective Service Is greatly 
Indebted to the assistance which It received from the Police Department in this effort. 
The new procedure under Local Board Release No. 66 eliminated the taking of 
serologicals by the Local Board examining Physicians because the registrants, under the new 
procedure, would be given a blood test at the Armed Forces Induction Station and If it was 
found to be doubtful or positive the Local Board physicians would then only take an additional 
serological because two tests were necessary. 
The Report of Physical Examination and Induction was also revised so that the Local 
Board Examining Physician, after the registrant's screening, could answer the following two 
questions with either a "yes" or a "no": 
"Do you find that the above named registrant has any of the defects shown on Part I of the List 
of Defects (Form 220)? (if in doubt answer "no")." 
and 
"Do you find that the above named registrant has any of the defects shown on Part II of the List 
of Defects (Form 220)? (if in doubt answer "no")." 
As you can see this tended to lessen the work of the Local Board Examining Physician. 
The Medical Advisory Boards also found that their work was reduced to a minimum 
and they were advised to discharge their clerical help. Nevertheless, some Medical Advisory 
Boards were still In use to clear up doubtful cases after Induction Station examinations. 
Laboratory procedures were still kept at a very minimum. 
Quotas were becoming larger each month and It was anticipated that in spite of the 
lessened burden on the Local Board Examining Physicians because of these Increasing quota 
calls the work was still too burdensome for Local Board physicians to handle. Therefore, they 
were advised that if at any time they felt they could not keep up with the numbers of ex- 
aminations required of them they were to notify immediately this Division and additional 
physicians would be assigned to the Local Boards to cover this emergency. For this emergency 
several teams of doctors were formed., to be ready at a moment's notice to go to any Local 
Board in the City to make the required examinations. Fine cooperation was received both 
from the doctors and from the five County Medical Societies to carry out this idea. 
The Local Boards were advised that in the case of any registrants rejectee, with 
remediable defects the- classification was to be I-A-R. The Examining Physicians were advised 
to mark on the Form 200 any Information available regarding the registrant's mental condition 
and if In need of additional information, to write to the New York City Committee on Mental 
Hygiene. 
For the month of January, 1942 and the month of February, 1942, as previously stated, 
the Induction Station took the serologicals. However, It was found that with the increasing 
quotas, the facilities at the Induction Station were not adequate. Therefore, the Local 
Board Examining Physicians were advised that as of March 14, 1942 they would again be re- 
quired to take serologicals. 
In March, 1942 the system of examination was again revised, eliminating the pre- 
induction examination. This also called for the taking of serologicals by the Local Board 
Examining Physicians for all registrants to report for induction in March. Since at this 
time the quotas were high, the burden on the Examining Physicians was very heavy, for they PREPARATIONS TO UNDERTAKE REMEDIAL THERAPY ON NATIONAL LEVEL 
7 
had to complete examinations for registrants scheduled for Induction in April, and in addition 
take serologicals on the registrants for induction in April and those to go in March. In 
order to assist the Examining Physicians in this emergency, arrangements were made with the 
Department of Health local Clinics to take serologicals of registrants from Local Boards all 
over the City, where the Examining Physicians were unable to keep up with the quotas. 
Arrangements were made through this Division on receipt of a call from a Local Board. 
Preparations To Undertake Remedial Therapy On National Level 
At this time it was decided by National Headquarters that a Rehabilitation Program 
would be put into effect, making use of the Examining Physicians and dentists of the Local 
Boards. The first step was to establish a national roster of physicians and dentists who 
were to do the work. To accomplish this, application forms were sent to all the Examining 
Physicians and dentists assigned to the Local Boards to be filled out. The rehabilitation 
was to be done at a fixed rate according to a fee schedule to be published later. After the 
Examining Physicians and dentists assigned to Local Boards had applied, other doctors and 
dentists were to be permitted to do so. However, the collecting of applications was as far 
as this project ever went. The Selective Service System had made a decision that it did not 
want to be involved in a system of remedial medicine. After four years, because of the needs 
which predicate the call quotas for manpower for the Armed Forces and the stress in war 
industries for manpower, the question of instituting a system of surgical and medical 
therapeutical procedures under the supervision and control of the Selective Service System is 
again being considered. It seems doubtful that it will be undertaken. Were it undertaken, 
it is also doubtful that much manpower would be salvaged. 
Since the preinduction examination was eliminated, it became necessary for the Local 
Boards, with the aid of the Examining Physicians, to procure all evidence as to medical and 
mental conditions, so that this might be sent to the Induction Station for consideration. The 
information procured was insufficient regarding mental conditions, and therefore in May of 
in order to lessen the induction of psychiatric cases it became necessary to institute 
the following procedure; a social psychiatric worker was assigned to each group of ten or so 
Local Boards, approximating the grouping of the Local Boards coming under the jurisdiction 
of the Medical Advisory Board. Additional psychiatrists were assigned to each group of 
Local Boards. The Local Board Examining Physicians were instructed to have a brief, adequate 
conversation with all registrants in an endeavor to discover any suspicion of psychoneurosis, 
mental deficiencies, epilepsy, history of commitment or other mental or emotional conditions 
which would make a registrant unfit for Army duty. 
Registrants coming under the above outlined categories would then be referred to a 
psychiatric social worker who would take a history of the men referred to her. The report 
of the psychiatric social worker was then to be transmitted to the Local Board, who would 
turn it over to the Examining Physician. The Examining Physician would abstract it and put 
a summation on the Form 200 for the information of the Army Induction Examining Team. In 
cases where an actual examination by the psychiatrist would be deemed necessary, arrangements 
would be made for such an examination. 
In May 1942, National Headquarters advised that all registrants who were discharged 
from the Armed Forces prior to December 8, 1941 for physical disabilities could be re- 
processed for Induction, and the Local Boards were accordingly advised. 
In June, 1942 National Headquarters ruled that registrants should not undergo an 
interview by the psychiatric social worker before going for induction but that any information 
available should be noted on the Report of Physical Examination. However, the psychiatric 
social workers were still to aid the Local Boards in procuring such information. 
Up to September, 1942 the quota calls kept steadily Increasing so that it became 
evident that something would have to be done to facilitate the examination of the registrants. 
Aside from the fact that the doctors could not handle the required examinations because of 
time, the problem of space in the Local Board quarters came into the picture. The result was 
that "Examining Teams" were formed. 8 
REPORT OF MEDICAL OFFICER 
Hospital Examining Teams 
These Examining Teams served on an average of about six Boards each, and they held 
examinations about twice a week. These teams were composed of approximately thirty doctors 
each, and there were fifty-two such teams formed throughout New York City. One of the doc- 
tors on each team was designated as the Chief of the Team to coordinate the work, and in 
addition there was appointed a Supervisor over these teams, in each borough of the City. It 
was the duty of the borough Supervisor to straighten out any difficulties the individual 
teams might encounter, make arrangements for locations, set up the procedure to be followed 
in examining, and arrange for the dates of examination. 
In Brooklyn, where it was particularly difficult to set up these teams because of the 
distances Involved and the inconvenience in travelling for both the registrants and the doc- 
tors, it became necessary to set up a separate team for the purpose of .absorbing the overflow 
that the other Brooklyn teams were unable to handle. This team consisted of about fifty doc- 
tors and they functioned once a week. 
The large numbers of registrants to be examined by these teams brought up the problem 
of proper locations. For this purpose most of the city1s.hospitals offered their space and 
facilities. In some Instances they donated their personnel also to assist in handling 
clerical detail, drawing blood, and doing other services for the examining doctors. In addi- 
tion, a number of private hospitals did the same thing. For other locations it was necessary 
to call upon private companies and schools to secure space. In these cases, lay persons 
volunteered to assist the doctors with all the many details involved with this work. 
At the inception of this change all sorts of different problems arose. For one thing, 
as is usually the case with a new project, there were protests from some of the doctors that 
it couldn't be done and wouldn't work. However, as soon as the first team was set up properly 
and the protesting doctors saw how they worked, these protests were silenced. These same 
doctors then did all in their power to set up teams themselves that were as efficient and ran 
as smoothly as the model team, and they took great pride in their achievement. These doctors 
did all this examining without any remuneration whatsoever, taking precious time from their 
own very busy schedules, and paying their own expenses Insofar as travelling, telephones, and 
other incidentals were concerned. 
The maintenance of order at these hospital stations was a voluntary contribution by 
various Posts of the American Legion. These Legion Posts sent men in their Legion uniforms 
to help in clerical work, keep order, and be generally helpful. The USAAC organization of 
veterans of World War I, an organization which manned ambulances in France during the prior 
World War, also engaged voluntarily in this duty. Both the Legion and the USAAC thus made 
noteworthy contributions to the war effort, because this was a continuing service and took 
the leisure time of men engaged in their wonted occupations, after the day's work. All these 
teams worked evenings. 
The quotas kept steadily increasing at this time, until March of and. the strali 
upon all these people was tremendous. 
These examinations were mostly done at night. Naturally, there were occasions where 
registrants who did night work or theatrical work found it involved quite a loss for them to 
be examined at night. When these cases were brought to the attention of this Headquarters, 
special arrangements were made with individual doctors at their offices for the examination 
of these registrants, and, of course, there were always a few volunteer doctors on hand at 
this Headquarters to jump in and pinch-hit. All in all these large scale examinations which 
taxed the capacity of everyone Involved, brought out hidden talents. Ingeniousness, and 
limitless patience. The team examinations were a great- success. 
The Psychiatric Advisory Committee 
In the early part of because of the multiple problems concerned with psychiatric 
questions, there was set up in this area a Psychiatric Advisory Committee. The Committee 
consisted of the following; PSYCHIATRIC SCREENING UNDER MEDICAL CIRCULAR NO. 4 
Dr. Richard Brlckner, Chairman 
Dr. Marion E. Kenworthy 
Dr. Lawrence S. Ruble 
Dr. Robert ¥. Laidlaw 
Dr. Lawson G. Lowrey 
Dr. John Alfred P. Millet 
Miss Marian McBee 
Dr. George S. Stevenson 
Miss McBee and Dr. George S. Stevenson were from the National Committee on Mental Hygiene. 
This Committee met at frequent intervals, and discussed and advised on current prob- 
lems as they arose. The Committee was largely Instrumental in creating the favorable 
attitude among lay psychiatric social agencies and workers which resulted in recruiting the 
large force of psychiatric social workers who jo-ined our staff of voluntary help and accepted 
the assignments as Medical Field Agents to our Local Boards. 
I freely acknowledge Indebtedness to this group whose contribution to the war effort 
has been note-worthy. To them, and to Mrs. Ethel Glnsburg, who organized the original group 
of Medical Field Agents, we are deeply indebted. 
Those psychopaths who tell either Local Board officials or the medical examining 
physicians stories of psychosexual conditions, were for a time a problem at this Headquarters. 
Sex perversion is a legitimate cause for disqualifying a registrant at the Local Board level. 
Once the story spread through a given neighborhood that if the registrant told the doctor a 
story Implying sexual perversion he was disqualified, the numbers of such began to Increase. 
The news soon spread that a confession of disinclination for normal, and a habit of abnormal 
sex relationships would disqualify a registrant at the Induction Station. Here, too, the 
numbers of such rejections began to increase. Anonymous letters began arriving telling of 
boasts made of how easy it was to avoid military service by telling "tall tales" to the ex- 
amining physicians. 
Therefore, arrangements were made with Professor George Henry, an outstanding authority 
on sex variants, to undertake the clarification of this problem. He set up a clinic for the 
examination of such cases at his department at the New York Hospital - Cornell Medical Centre. 
All registrants claiming sex variations were referred to him for psychiatric examination, 
opinion, and report. At his clinic there exists a file of many thousands of names of such 
unfortunates. The confessed sex variant established his contact, whose name often was on 
record. Professor Henry's reports came to this Headquarters, and were routed from here to 
the Local Board for their information and guidance in classifying the registrant. 
Once this system became established, the "tall tales" ceased, and the numbers 
appreciably dropped, and there only remained the disclosure of legitimate cases of sex 
variants who thus were properly disqualified for military service. 
In the course of the work, the problem becoming less acute, the Psychiatric Advisory 
Committee to the Medical Division made representations to the Medical Division that they 
believed all the neuropsychiatrists on our staff should take part in this work. They stressed 
that any qualified psychiatrist was able to detect false claims of sex variations, and 
could diagnose correctly this condition. Furthermore, they pointed out certain conditions 
existing on Professor Henry's staff, which unfavorably affected these sickened individuals. 
Without entering into any partisan discussion of these Issues, and to relieve the heavy 
burden which Professor Henry had carried almost alone for two years, last Spring the pro- 
cedures were modified and the affected registrants were sent to the neuropsychiatrists on our 
panel for examination and opinion. The present procedure is working well. 
Sex Variants 
Psychiatric Screening Under Medical Circular No. 4 
There had been a test of psychiatric screening going on at this Headquarters for 
almost a year before Medical Circular No. 4 was issued by National Headquarters. Its 10 
REPORT OF MEDICAL OFFICER 
importance and the information received had demonstrated the great usefulness of the procedure 
This test was performed entirely upon a voluntary basis, and field workers, the New York 
Social Service Exchange, doctors, and institutions all cheerfully cooperated. Being upon a 
voluntary basis, the numbers investigated were not large. Only names regarding which the 
officials of Local Boards, or the Examining Physicians of these Boards, had reasons to make 
inquiry were submitted to the procedures evolved by the Medical Officer of this Headquarters. 
On October 18, 1943 Medical Circular No. 4 was Issued by National Headquarters. This 
Circular concerned what it described as a "Medical Survey." It changed the designation of the 
social and psychiatric social volunteer workers to that of Medical Field Agents. It covered 
a rather broad and comprehensive program under which information concerning registrants is 
gathered for transmittal to the Medical Officers of the Armed Forces Induction Stations for 
use in making determinations as to acceptance or non-acceptance for military service. 
About the beginning of January, 1943 definite plans were under way for what is now 
known as the Medical Survey Program. In New York City, the New York City Committee on Mental 
Hygiene was the organizing factor and paid for the services of Mrs. Ethel Glnsburg to head the 
program at this Headquarters, and two secretary-stenographers, and also assigned this per- 
sonnel to Selective Service. At the same time, arrangements were made with the numerous 
social welfare agencies in the City, both private and governmental, for the purpose of their 
submitting information regarding registrants, upon Inquiry from this Headquarters. 
These social workers, having been recruited, were asked to take a course of six lec- 
tures arranged by this Headquarters to be given them by Dr. S. Mouchly Small, one of the 
psychiatric staff of the New York Hospital. These lectures were subsequently published.3 
The prospective Medical Field Agents were thus indoctrinated as to their duties and respon- 
sibilities. It was stressed to them in their lecture series to approach all their problems 
anent Selective Service objectively and dispassionately. They were taught to avoid any ten- 
dency toward the adoption of a protective role when interviewing or contacting families 
under Medical Circular No. 4 procedures. 
At the same time the work began of assigning social psychiatric workers to each Local 
Board. Since all the social welfare agencies were aware of this program the response among 
the psychiatric social workers for volunteer work was very gratifying. At the beginning of 
this program the Local Boards were instructed to refer to these social psychiatric workers 
any registrant who seemed to present a special problem with regard to dependency questions, 
etc., or who had a history of hospitalization or commitment, or any registrant who gave any 
indication of not being normal. 
It was the aim of this program to have every registrant interviewed by a psychiatric 
social worker before he went to the Induction Station. However, in view of the particularly 
high quotas at this time, and the fact that the program was just being established, it was 
Impossible to do more than stated above. Each case referred to a psychiatric social worker 
took a great deal of time for it necessitated, first of all, an interview with the registrant 
which lasted from half an hour to over an hour. After that, the psychiatric social worker 
would have to write to any of the doctors the registrant might have mentioned and to any of 
the. institutions mentioned and wait for the information to be returned before she could 
begin to make her report. In dependency cases, she sometimes would find it necessary to 
interview the family of the registrant. 
The work at this Headquarters with regard to this program grew in leaps and bounds 
and it became necessary for the New York City Committee on Mental Hygiene to assign several 
part-time psychiatric social workers at this Headquarters, to assist Mrs. Glnsburg. Since 
this Headquarters was not quite prepared for the volume of work that would be entailed and 
the number of people necessary, there was not sufficient space nor equipment to meet the 
needs of this program. However, as quickly as it could be secured, additional equipment was 
had and additional space secured. 
The Local Boards, as can well be appreciated, were not too happy about this program 
3 'Symptoms of Personality Disorders" - Prepared for the use of Medical Field Agents in Selective Service 
Screening - by S. Mouchly Small, M. D. - Published by the Family Welfare Association of America, 122 East 
22 Street, New York City, N. Y. MEDICAL SURVEY PROGRAM PROCEDURE 
11 
for It only meant additional effort on their parts at a time when the quotas were Increasing 
so steadily as to make It almost Impossible for them to meet the demands. However, notwith- 
standing some "griping" here and there, after they once realized the Importance and the scope 
of the program, they became very interested and put all their resources at the disposal of 
this program. Local Boards had to remain open an extra night a week In order to arrange for 
the Interviewing to be done by the psychiatric social workers who did all this work, volun- 
tarily, after their regular working hours. This program has resulted In keeping many misfits 
out of the Army and thus saving the many millions of dollars which would be necessary to dis- 
charge these men - not to mention the pensions that were saved. 
Medical Survey Program Procedure 
Forms 210 are sent In by the Local Boards on all registrants being processed for In- 
duction. Forms 211 are sent In only on registrants who have attended secondary school within 
the preceding five years of the time when the registrant Is being processed for Induction. 
The Forms 210 are checked against the Bellevue-Klngs County file at this Headquarters. 
If any of the registrants for whom a Form 210 has been submitted Is positively Indentlfled, 
after checking with the Bellevue-Klngs County file, as having a defect listed In the DBS Form 
220, the Forms 210 for those registrants are Immediately returned to the Local Boards with a 
covering letter, advising the Local Boards to classify the registrants In IV-F at the Local 
Board level. 
The remaining Forms 210, for which there was no record In the Bellevue-Klngs County 
file, or where the Identification Is questionable, are sent to the Social Service Exchange 
for clearance. 
When the Forms 210 are returned by Social Service Exchange, those Identified and those 
not Identified are separated. On those Identified, form letters are sent to the agencies, 
courts and hospitals listed by Social Service Exchange, for more detailed Information. 
Where the Local Boards have Medical Field Agents, the Forms 210 are Immediately re- 
turned to the Local Boards after the letters have been sent out to the agencies. In these 
cases, an envelope addressed to the Medical Field Agent Is Included so that the agency re- 
ports are returned directly to the Medical Field Agents by the agencies. 
In cases where there ape no Medical Field Agents at the Local Boards, the Forms 210 
are held at this Headquarters and letters to the agencies, requesting Information, are sent 
out with return envelopes addressed to Mrs. Daniels, who Is the Medical Field Agent acting 
as advisor to the Medical Survey Program at this Headquarters. 
When the Medical Field Agents receive the reports from the agencies. If there is 
pertinent Information, they interview the registrant and make out a Form 212. 
In the cases where there are no Medical Field Agents at the Local Boards and the re- 
ports are returned to this Headquarters, on receipt of the reports at this Headquarters, 
appointments are made for registrants on whom pertinent Information has been secured. The 
registrants are interviewed at this Headquarters by a special group of Medical Field Agents 
who meet on Tuesday nights. Forms 212 are made out and then the Forms 210 and 212 are returned 
to the Local Boards in a Form 212-A. 
On Forms 210 not Identified, if an out of town address Is given, this Headquarters 
writes to the out of town Headquarters covering that address for Information regarding the 
registrant. In addition. If the registrant has made any statement on the Form 210 or Form 
211 which would Indicate further study, the case Is called to the attention of the Medical 
Field Agent by marking the Form 210 "Refer to Medical Field Agent" and returning It to the 
Local Board with a referral letter to the Medical Field Agent. 
Every year the secondary schools send to this Headquarters Forms 215 covering all 
students who' have enrolled, ages 17 to 18. 
The Forms 211 are checked against our file of Forms 213 and if a Form 213 is found to 
correspond to the Form 211, it is stapled to the Form 211 and both Forms are returned to the 
Local Board. 
If no Form 213 is found and the registrant has been in a secondary school within the 
past five years, a Form 214 Is sent to the last school mentioned, to be filled out. When the 12 
REPORT OF MEDICAL OFFICER 
Form 214 is returned, it is sent to the Local Board where it is examined by the Medical Field 
Agent for any possible clues as to pertinent information. 
The Local Boards send down to the Induction Station any Forms 210, 211, 212, 213, or 
214 they may have on a registrant. The Induction Station, after it has examined the regis- 
trants, returns all such Forms to this Headquarters, where they are filed for referral when a 
registrant is sent to the Medical Advisory Board for further examination or when a registrant 
is to be resubmitted for induction. 
The Validity Of The School Teacher Appraisal 
And Social History (DSS Form 213 And DSS Form 212) 
Considerable money has been allocated by the Federal Social Security Agency, and much 
time and effort on the part of the Selective Service personnel is devoted to assembling data 
on personality behavior patterns of registrants for the use of the Armed Forces to aid in 
the medical examinations and determinations at the Induction Station anent acceptability or 
rejection of selectees. 
To determine their validity and also to ascertain how they were being used by the 
Armed Forces Induction examination station in the New York City area, the study herein out- 
lined was undertaken. 
The Public School System and the Parochial School System of New York City have en- 
thusiastically cooperated in forwarding to this Headquarters the information required to be 
checked on Forms 213 for registrants recently graduated from the high schools. 
There are now approximately 23,000 such Forms filed alphabetically here. Of these, 
2,336 such Forms were selected for detailed study after they had been used by the psychiatrists 
at the Armed Forces Induction Station. 
The results are shown on Chart No. I. 
The difference in percentage between those accepted and those rejected after actual 
psychiatric examinations employing the Form 213 is shown in the third column. These 
differences would seem to the casual observer to be small. Projected against the 25,000 
individual registrants represented in our alphabetical files of Forms 213, these percentage 
figures would represent large numbers as being represented in each category. 
By withholding 284 Forms 213 from the Armed Forces Induction Station while the 
registrants represented by these Forms 213 were being examined at the Station, a sampling 
of adequate numbers was obtained to make a determination as to how the registrants would 
fare if no Forms 213 were available to the military examiners. 
The determinations made at the Armed Forces Induction Station are shown in Chart II. 
Summation; Contrasting Chart I and Chart II the following items are pertinent. With- 
out the use of Form 213, the Armed Forces Induction Station accepted more men whose teachers 
reported reduced ability to study than they rejected. The Armed Forces Induction Station 
accepted more men who were truants in school than they rejected. They accepted more men 
disinclined to physical activity, or who engaged in none, than they rejected. They accepted 
more men ignored by their classmates than they rejected. They rejected more students des- 
ignated "very cooperative" than they accepted. On the question of reliability, they rejected 
more marked "always cooperative" than they accepted. 
The preinduction examination accepted more youths marked -"moody," "suspicious," 
"deceptive," "having tantrums," more "strikingly Immature," "day-dreamers," than they rejected. 
Of those with physical defects known to their teachers, they accepted more having 
history of hay fever, history of heart trouble, than they rejected. 
In all these determinations, there were from three to six individual teachers' 
appraisals available on each registrant made by teachers each Independently of the other. 
Those rejected listed in Charts I and II, were all mentally disqualified. 
Conclusion: It is very evident that the Forms 213 are used by the psychiatrists at 
the Armed Forces Induction Station. The subsequent review of the registrants' forms in the 
light of either acceptance or rejection, leave no doubt as to the value of processing these 
forms and having them at the Armed Forces Induction Station for study before the registrant 
appears for examination. THE VALIDITY OF THE SCHOOL TEACHER APPRAISAL. ETC. 
CHART I 
From the Forms 215, the teachers' appraisal gives the following difference in per- 
centage of those rejected against those accepted. 
Accepted 
Rejected 
Difference 
Number 
of DSS Forms 215 
1174 
1162 
1 
Is his school work getting poorer: 
No 
82.5$ 
79.4$ 
3-1$ 
Yes 
8.7 
11.3 
2..6 
If "Yes" do you attribute this to 
Harder studies 
20.6 
17.6 
3 - 0 
Other interests 
33.9 
48.1 
5-8 
Reduced ability to study 
20.6 
29.O 
8.4 
2 
Is he a truant? 
No 
85-9 
82.4 
3-5 
Yes 
1.8 
3.9 
2.1 
3 
To what extent does he have diffi- 
culty In making up his mind? 
None 
52.6 
44.7 
7-9 
Moderately 
31-5 
33-2 
1.9 
Has much difficulty 
2.4 
5-2 
2.8 
4 
Participation In physical activi- 
ties 
Much 
9.1 
7-6 
1.5 
Average 
43-0 
38.4 
6.6 
None 
1.8 
6.8 
5*0 
5 
Response from classmates 
Accepted 
84.9 
80.5 
4.6 
Ignored 
5-3 
7-4 
1-9 
Disliked 
.6 
1.9 
1-3 
6 
Attitude toward teachers 
Very cooperative 
40.3 
38.3 
2.0 
Usually cooperative 
48.9 
48.1 
.8 
Uncooperative 
5.0 
8.4 
3-4 
7 
Dependability 
Always reliable 
37-7 
34.0 
3-7 
Usually reliable 
49.0 
49.1 
.1 
Unreliable 
4.8 
9-6 
4.8 
A breakdown of the uses the Station makes of the-Forms and the social histories, com- 
piled by our force of Medical Field Agents is appended, as Chart III. 
To be again noted is our procedure of forwarding only social and psychiatric histories 
which are considered pertinent. Futhermore, by using the Master Psychiatric File which we 
compiled and which now contains about 66,000 names of admission to the Psychiatric Pavilions 
of both the Bellevue/and the Kings County Hospitals, we are enabled to recommend classifica- 
tions of IV-F to those registrants found to have such hospital records. Finally, by using 
the Sex Variant file, of Professor George Henry, of the Payne-Whltney Clinic of the New York 
Hospital, sexual perversions are substantiated and classification of IV-F at the Local Board 
level is in order, under our Regulations. Thus, a large percentage of social histories need 14 
REPORT OF MEDICAL OFFICER 
CHART HO. II 
Forms 213 withheld from Armed Forces Induction Station, until preinduction examination 
had been completed. 
Accepted 
Rejected 
Difference 
Number 
of DSS Forms 213 
284 
284 
1 
Is his school vork getting poorer: 
No 
76.1$ 
81.7# 
5-6 
Yes 
10.9 
9-2 
1-7 
If "Yes" do you attribute this to 
Harder studies 
9-7 
15.4 
5-7 
Other interests 
67-7 
53-8 
13-9 
Reduced ability to study 
22.6 
23-1 
• 5 
2 
Is he a truant? 
No 
81.7 
84.6 
2.9 
Yes 
3.2 
1.1 
2.1 
3 
To what extent does he have diffi- 
culty in making up his mind? 
None 
54.2 
46.8 
7-4 
Moderately 
21.1 
33-1 
12.0 
Has much difficulty 
2.8 
3-9 
1.1 
4 
Participation in physical activi- 
ties? 
Much 
9-9 
4.9 
5-0 
Average 
39-8 
40.5 
•7 
None 
3-5 
4.9 
1.4 
5 
Response from classmates 
Accepted 
84.5 
83-5 
1.0 
Ignored 
5-3 
4.9 
.4 
Disliked 
• 7 
1.8 
1.1 
6 
Attitude toward teachers 
Very cooperative 
39-1 
47.2 
8.1 
Usually cooperative 
47.2 
38.0 
9.2 
Uncooperative 
5-3 
6.0 
• 7 
7 
Dependability 
Always reliable 
33.3 
41.2 
7-7 
Usually reliable 
49.3 
43.0 
6.3 
Unreliable 
8.8 
8.1 
• 7 
not be sent to the Armed Forces Induction Station, because these registrants are handled at 
the Local Board level. 
Conclusions: The social histories are pertinent and useful to the examiners at the 
Armed Forces Induction Station. 
During the last fifteen months of which detailed records have been kept,, 260,621 
registrants appeared at the Armed Forces Induction Station, for whom 12,816 social his- 
tories were forwarded, aggregating 4.92$ of those being examined. Of these 5,933 were 
found to be pertinent and 6,863 were found non-pertinent at the Armed Forces Induction 
Station but considered pertinent by our Headquarters staff. Wherever the history seemed 
borderline or equivocal, the doubt was resolved by forwarding the history. MOUTH 
SELECTEES 
SENT FROM 
CITY 
LOCAL 
BOARDS TO 
A.F.I.S. 
SOCIAL 
HIST. 
SENT 
FROM 
L.B . '3 
to 
A.F.I.S. 
BER- 
GEN- 
TAGE 
TOTAL 
SOCIAL 
HIST. 
SENT 
FROM 
L.B. 's to 
A.F.I.S. 
TOTAL PERT. 
SOCIAL HIST. 
SENT FROM 
CITY L.B.'a 
to A.F.I.S. 
PER- 
CEN- 
TAGE 
NON-PERT. 
SOCIAL HIST. 
SENT 
PERT. 
INFORMA. 
LEADING 
TO 
REJECTION 
PERT. 
INFORMA. 
LEADING 
TO 
ACCEPT. 
CONCUR 
WITH 
NEURO- 
PSYCH. 
DIAGNOSIS 
AT 
A.F.I.S. 
PERT. 
BUT 
NON- 
CON- 
CURR- 
ING 
PERT. 
TO 
OTHER 
DEPTS. 
(NOT 
NEURO- 
PSYCH). 
19^4 
PEB. 
47,851 
183 
.38 
183 
104 
56.83 
79 
21 
12 
26 
16 
15 
MAR. 
51,842 
3,595 
6.9 
3,595 
. 964 
26.82 
2,631 
40 
2 
364 
57 
287 
APRIL 
36,532 
2,028 
5.58 
2,028 
607 
29.93 
1,421 
26 
0 
133 
11 
227 
MAY 
26,466 
925 
3.49 
925 
457 
49.40 
468 
45 
3 
118 
6 
219 
JUNE 
11,135 
486 
4.27 
486 
304 
62.55 
182 
59 
8 
124 
10 
158 
JULY 
6,794 
495 
7.29 
495 
332 
67.07 
163 
122 
10 
200 
7 
145 
AUG. 
4,067 
280 
6.9 
280 
197 
70.35 
83 
85 
25 
120 
17 
75 
SEPT. 
4,473 
330 
7.03 
330 
267 
80.09 
63 
144 
55 
213 
31 
116 
OCT. 
4,311 
389 
9.04 
389 
271 
69.66 
118 
158 
77 
224 
31 
129 
NOV. 
3,810 
484 
12.70 
484 
337 
69.92 
147 
192 
118 
118 
248 
196 
DEC. 
3,409 
361 
10.59 
361 
232 
64.26 
129 
141 
82 
160 
65 
139 
SUB- 
TOTALS 
200,490 
9,516 
4.7 
9,550 
4,C72 
42.63 
5,484 
1,033 
392 
1,930 
312 
1,706 
1945 
JAN. 
10,999 
815 
7.40 
815 
531 
65.15 
284 
321 
207 
352 
165 
249 
FEB. 
11,780 
737 
6.25 
737 
376 
51.02 
361 
209 
167 
263 
113 
192 
MAR. 
17,098 
878 
5.13 
878 
478 
54.44 
400 
246 
252 
359 
119 
309 
APRIL 
20,254 
830 
4.18 
830 
496 
59.75 
334 
265 
331 
359 
137 
328 
SUB- 
TOTALS 
60,131 
3,260 
5.4 
7,038 
2,949 
41.88 
1,379 
1,041 
937 
1,333 
534 
1,078 
TOTALS 
260,621 
12,776 
4.9 
16,588 
7,021 
42.3 
6,863 
2,074 
1,329 
3,263 
' 846 
2,784 
THE VALIDITY OF THE SCHOOL TEACHER APPRAISAL, ETC. 
15 
MEDICAL AND SOCIAL HISTORY STATISTICS 16 
REPORT OP MEDICAL OFFICER 
2,074 gave pertinent information leading to the registrant's rejection, while 1,329 
gave histories which substantiate acceptance. In 3,133 cases, the social history concurred 
with the neuropsychiatric diagnosis at the Armed Forces Induction Station. The Armed Forces 
Induction Station considered 1,033 social histories pertinent but did not concur with the 
social-psychiatric workers' (Medical Field Agents) findings. 
Finally, in 2,784 Instances, the social history while not pertinent to the 
psychiatric examiners was nevertheless found of pertinence to other medical specialty de- 
partments at the examination post. 
Salvage Of Needles For Serological Tests 
Due to the large quotas and the fact that it was becoming harder and harder to secure 
supplies at this time, the New York City Department of Health was forced to request that the 
doctors return the serological needles after they were used, so that they might be salvaged 
for further use. This request was met with the utmost cooperation. 
Revision Of DSS Form 220 
On January 30, 1943, the List of Disqualifying Defects, DSS Form 220, was revised 
so that it listed additional defects which would allow the Examining Physicians to dis- 
qualify a registrant at the Local Board level. These additional defects consisted mostly 
of chronlcitles which were obviously disqualifying. Among these were Addison's Disease, 
Chronic Alcoholism, Pernicious Anemia, Diabetes Mellitus, Hypoglycemia, Insanity without 
commitment when the registrant was actually in an institution for the treatment of such 
diseases. Mutism, Parkinsonian, repeated positive serologies, and active peptic ulcer, con- 
firmed by X-ray. This was done for the purpose of facilitating the work at the Induction 
Station and to save such obviously disqualified registrants the trouble of going to the 
Induction Station for an examination. 
Review Of Registrants Classified In IV-F 
In October of 1942, this Headquarters initiated an inspection of the cases which had 
been disqualified at the Local Board level to see whether any could be salvaged, and also 
for the purpose of checking on any possible errors. This Headquarters had always reviewed 
the Report of Physical Examinations of all registrants who were disqualified for service-, 
both at the Induction Station and at the Local Board level. However, there always were 
some Local Boards who did not send in these Forms immediately for review. 
A select group of twenty-five doctors was chosen to organize this work and as usual• 
they were both enthusiastic and cooperative in spite of their already heavy programs. 
Another specific reason for this review was the fact that in May, 1942 the standards 
had been liberalized so that some conditions which had previously been considered totally 
disqualifying were then made acceptable for limited service, or for general service. Among 
these were the following; 
Defect 
Now Acceptable For 
(Previously IV-F) 
Perforation of the membrana tympanl provided there Is a trustworthy 
history of no symptom of otitis media or disease of mastoid durlng- 
preceding two years 
Limited 
service 
(Previously Limited Service) 
Hernia, small umbilical (patent umbilical ring) 
General 
service 
(Previously Limited Service) 
History of cholecystectomy provided there are no residual dis- 
qualifying sequelae 
General 
service 
(Previously IV-P) 
Undescended testicle which lies within the Inguinal canal 
Limited 
service 
(Previously IV-F) 
Large benign tumors of the abdominal wall 
Limited 
service 
(previously IV-F) 
Internal and external hemorrhoids, moderate 
Limited 
service REVIEW OF REGISTRANTS CLASSIFIED IN IV-F 
17 
Defect Now 
Acceptable For 
(Previously Limited Service) 
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 
General 
service 
(Previously IV-F) 
Pellagra, beriberi, scurvy, and other nutritional deflciences, if 
mild and remediable by diet and appropriate treatment 
Limited 
service 
(Previously IV-F) 
Chronic blepharitis 
Limited 
service 
(Previously IV-F) 
Pterygium encroaching on cornea 
Limited 
service 
(Previously IY-F) 
Deviation of nasal septum which markedly Interferes with nasal 
breathing 
Limited 
service 
(Previously IV-F) 
Nasal polypi, if mild or moderate and not accompanied by evidence of 
chronic sinus disease 
Limited 
service 
(Previously IV-F) 
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 
Limited 
service 
(Previously IV-F) 
Individuals who are well nourished, of good musculature, are free from 
gross dental infections, and have a minimum requirement of an edentulous 
upper jaw and/or an edentulous lower jaw, corrected or correctable by 
a full denture or dentures 
General 
service 
The final results of this Inspection were available In June, and showed the 
following: of cases inspected, 3>507 were found doubtful and were ordered for re- 
examination at the Induction Station (approximately 4$). Of the cases submitted to the 
Induction Station, 171 were finally accepted, or .001$ of the total cases reviewed. 
As small as this percentage of cases finally accepted Is, it Is still smaller when 
one takes Into consideration the fact that most of the' cases accepted were the result of the 
change In standards as noted above, and not the result of errors of diagnosis. -These same 
standards were later changed back to what they had been originally, and most of the regis- 
trants accepted with perforated eardrums and undescended testicles were later discharged 
from the Armed Forces. The review did show that the percentage of error on the exam- 
inations was almost infinitesimal and for this reason alone it was worth the effort. 
Cardiovascular Review 
A pilot test' upon cardiovascular rejections by Local Board physicians and Medical 
Advisory Board specialists was made upon one thousand such in the New York City area in 
January, 1943. A report upon such tests, held also In Boston, Chicago, Philadelphia, and 
San Francisco was made by a national committee of heart specialists. This report and the 
findings at the special reexamining station established at the Presbyterian Hospital, 
Columbia University Medical Center, were submitted to me and upon the request of Colonel 
Rowntree, Chief Medical Officer of Selective Service, I rendered a report and critique at the 
meeting of Medical Officers in Washington, D. C., on June 6, 1944. 
The report is as follows: -- 
The reestlmatlon of registrants rejected both by the Medical Advisory Board physicians 
and by the Induction Station examiners undoubtedly was prompted by prevalent opinion among 
specialists In cardiovascular disease that the diagnosis of heart conditions and lesions by 
Loc'al Board physicians, and Medical Advisory Board specialists, made under the pressure and 
apparent hurry of the routine examinations were disqualifying large numbers of men for heart 18 
REPORT OF MEDICAL OFFICER 
murmurs, hypertension, enlargement of the heart, and neuroclrculatory asthenia, which upon 
a review hy a specially selected group of cardiovascular specialists might prove to lack 
diagnostic substantiation in many Instances. In other words, it was though that many were 
incorrectly disqualified for military service. 
It was hoped also that as a result of such review and reexamination a considerable 
salvage of manpower for the Armed Forces might be obtained 
In planning the pilot test Boston, Chicago, New York, Philadelphia, and San Francisco 
were selected as the cities where the reexamination should be made. These cities were selected 
in spite of the fact that in all these centers of large population aggregations, it was to be 
expected that competent and qualified physicians were available to the public, and also to 
Selective Service, to man the Medical Advisory Boards. 
In the New York City area, summarizing our experience, I find that of the 1,000 re- 
submitted to the pilot test 494 had been originally disqualified at the Local Board level. 
Of these rejected at the Local Board level, the rejection was substantiated in 378, leaving 
only 116 whom the special group of cardiovascular specialists recommended to be resubmitted 
to the Induction Station. There were 506 originally disqualified by the Army Induction Sta- 
tion examining specialists. Of these, only 77 were recommended by the special Medical Advisory 
Board of cardiovascular specialists to be resubmitted to the Army examining team. Thus, of 
the 1,000 selected from the New York City area to be reexamined only I93 were recommended for 
resubmlsslon. One additional registrant was resubmitted to the Induction Station before the 
special Medical Advisory Board report on him, and he was accepted for military duty. Of the 
193, when reexamined at the Army Induction Station and the examiners having before them the 
detailed report of the special Medical Advisory Board's findings, 140 were accepted for mil- 
itary duty, and 37 were again rejected. There was a further loss of 17 who, for various 
pertinent reasons, were given deferred classifications by their respective Local Boards. Sum- 
marized, this means that of the 1,000 registrants with prior rejections for cardiovascular 
disqualifications, 14$ were accepted after special review for Army, Navy, and Marine Corps 
service. 3*7$ were again rejected, and 1.7$ were deferred because of socio-economic reasons 
The prior diagnosis warranting a IV-F classification was substantiated in about 80.6$ of the 
1,000 registrants; namely, 807 of them. 
One other item needs notation. Of the 14$ accepted for military service (l40 regis- 
trants), I have received information up to date that 24 of them have been discharged for med- 
ical reasons, mostly because of heart conditions (exact diagnosis not available to me), leaving 
at this time only 11.6$ or 116 men of this group, still in the service. 
As a means of salvage of manpower for the Armed Forces, this review of cardiac rejec- 
tions in the New York City area has not yielded impressive results. 
To be noted is the factor already alluded to above, that the test was made in large 
city centers of population, where there are outstanding medical facilities available. Nat- 
urally, some of the very men who are serving on Medical Advisory Boards served on this special 
Medical Advisory Board; likewise, the heart specialists who, as civilians, serve at the In- 
duction Station examining teams as heart specialists are, in some Instances, physicians who 
previous to their appointment had served as examiners on Medical Advisory Boards. 
I hazard the assumption that had the places selected for the test been in areas or 
sections of the country less adequately supplied with cardiovascular specialists that a 
larger salvage of men for the Armed Forces might have been obtained. Please note that this 
is only an assumption on my part, for I have no substantiating data to permit rile to accept 
this assumption as an established fact. 
There is a factor at issue that needs consideration. In medicine one cannot set up 
a fixed level of diagnostic acumen, particularly where there is a large number of different 
examiners at work at the numerous stages and places of examination in the process of re- 
cruiting our manpower for the Armed Forces. Diagnostic acumen differs even among those 
rated by their fellows' as experts. Hence, the same individual presenting exactly the same 
symptoms and findings will receive a different diagnostic opinion from one or the other ex- 
pert who examines him. One is permitted, however, to establish certain yardsticks as guides, 
when acceptance or rejection for military service is at stake. Therefore, it is but natural 
to expect that there will be varying results within a given range between the different ex- 
amining teams in-differing localities and at different stages of examination for induction 
into our Armed Forces. CARDIOVASCULAR REVIEW 
19 
In reading the report published by Drs. Levy, Stroud, and White, of the Subcommittee 
on Cardiovascular Disease of the National Research Council, I can find very little difference, 
except In minor percentage figures, between Boston, New York, Chicago, and San Francisco. One 
may speculate how Interesting it might be to contrast findings of the large urban centers with 
those of men from,rural areas, where the medical profession has less access to electrocardio- 
grams, fluoroscopy, and X-ray technical assistance In their dally practices and there is a 
different level, perhaps, of detailed diagnostic acumen prevalent In the professions In these 
large cities than might be found to exist In rural centers. 
We can agree with the findings of the report made by the Cardiovascular Subcommittee 
of the National Research Council In regard to the following Important points. We are repeating 
them here briefly for the sake of emphasis, and In addition have added here and there some of 
our own experiences. 
1. The Differentiation of a Functional from an Organic Heart Murmur. A systolic murmur 
at the cardiac apex is commonly found In both health and disease. A murmur that was slight, 
but not very marked In the apex, which is either not transmitted at all toward the axilla or 
only partly heard on the line toward It, particularly If It Is late In Its timing, and when It 
Is found in the absence of evidence of cardiac enlargement or a diastolic murmur, or further- 
more, In the absence of a history of rheumatic fever. Is to be considered .as within normal 
limits. This Is the more so If the systolic murmur varies greatly, if the murmur disappears 
entirely with change In bodily posture or with a change In respiratory rate. This functional 
murmur gave our examiners in Selective Service the most difficulty and, as a matter of fact, 
there still Is not a settled opinion on the significance of even the Intensity of a heart mur- 
mur. The Committee believes that a loud apical systolic murmur Is generally to be considered 
a cause for rejecting the registrant. 
Aortic murmur signifying stenosis is always to be considered as cause for rejection. 
Slight sternal murmurs at the left lower sternal region of uncertain origin were encountered 
by the test examiners a few times and they also found pulmonary systolic murmurs when the 
subject lay on his back and which were heard distinctly upon expiration, particularly If loud 
and persistent. These were held as cause for rejection. 
The Local Board examiners rejected many cases In which there were extra cardiac scratch 
sounds or the so-called systole, which is sometimes termed the "systolic click," These men 
should be acceptable. 
2. Blood Pressure Levels. This presented a problem both to the Local Board examining 
physicians and to the test examiners. MR 1-9 lists 150 mm for systolic and 90 for diastolic 
as within normal limits for the majority of registrants at rest, but taking Into account the 
nervousness and excitement Incident to the examination Itself, 160 to even I70 could be con- 
sidered normal, provided the diastolic was not too high. If the diastolic was 95 It again 
brought Into question the acceptance or rejection of the registrant. Here It Is to be noted 
that many registrants indulged In an excess of liquor drinking before going to the examining 
post and this factor should be remembered when judging blood pressure levels. 
Mild hypertension attended by nervous tachycardia, where the elevation of the blood 
pressure was accompanied by a low heart beat rate or even an average pulse rate Is considered 
a serious condition and cause for rejection. 
3. Pulse Rate. In the absence of authenticated evidence of heart disease, thyrotoxi- 
coses, or physical ailment responsible for tachycardia or neuroclrculatory asthenia, a pulse 
rate of 110 with a range up to 120 would seem to be acceptable. It must be noted In passing 
that the pulse rate is the poorest criteria for estimating cardiovascular fitness. However, 
an authenticated history of tachycardia should be respected. 
4. The determination of the normal size and shape of the heart presents another dif- 
ficult problem to solve by any method of examination Including actual measurements on X-ray 
findings. The New York special Medical Advisory Board held the measurements made by the 
Hodges-Eyster formula as Inadequate to determine the size of the heart. The standard agreed 
upon was 1 cm for the upper normal limit greater than the transverse diameter calculated by 
the Hodges-Eyster formula. This group noted that men of unusual stature, rather short with 
wide chests and shoulders, which resulted In perfectly normal cardlothoracic ratios; l.e., 
the transverse diameter of the heart not being over 50$ of the Internal diameter of the thorax. 20 
REPORT OF MEDICAL OFFICER 
Such they consider as within normal ranges. Height and weight alone do not indicate variations 
In normal body build, and no criteria Is as yet at hand to make individual decisions as to the 
actual size of the given man's normal heart. 
5. There are Difficulties In Interpreting Electrocardiography. This Is also true when 
studying X-ray shadows In regard to heart size. The full range of the normal has not yet been 
satisfactorily established to the satisfaction of cardiovascular experts. 
Habitually X-ray technicians ask that patients take a long breath and hold same, with 
arms extended against the frame holdlpg the film. In estimating the size of the heart, in 
questionable cases, it is better technique to have the registrant take a casual inspiration, 
and take the film during the casual inspiratory phase of a respiratory act. Thus a picture 
more accurately approximating the actual relationship of heart size to chest size is obtained ’ 
than when the chest is expanded by a forced inhalatory effort. 
6. Neuroclrculatory Asthenia Presents Two Problems. The first one is concerned with the 
recognition of the condition itself, and the second with the acceptability of men with slight 
grades of this condition. The examiner must decide to reject men with various grades of this 
condition, and the examiners in the New York area decided to reject men with even the mildest 
form of this condition. The recognition of neuroclrculatory asthenia is extremely difficult 
in mild cases. The diagnosis rests at present on the history of symptoms. Sometimes it 
rests upon actual and prolonged testing rather than on physical signs; namely, pulse and 
blood pressure ratings. Let me add that if rectal temperature is elevated then it speaks 
for hyperthyroidism rather than neuroclrculatory asthenia. 
The syndrome includes, as you are well aware, a combination of dyspnea, usually 
accompanied with sighing, palpitation, heartache, and exhaustion on relatively little effort 
or excltment. In civil life it is generally attended by some definite psychoneurosis, par- 
ticularly of the anxiety type. 
In the New York City area we have had very few rejections for neuroclrculatory asthenlj 
This diagnosis was a cause for rejection in only 77 instances among the meny thousands of re- j 
jectlonsof our registrants. I hold this due to the efficient screening out of psychoneurotic 
cases. There are probably many not diagnosed as neuroclrculatory asthenia who had its 
symptoms. They were disqualified for service with a diagnosis of psychoneurosis, which I 
believe is correct. 
At the Signal Corps Station at Port Monmouth, New Jersey, the Squler Laboratory is 
carrying on a test project specifically studying neuroclrculatory asthenia. In a mutually 
satisfactory arrangement made with the Chief Medical Officer at the Station, a substation of 
his laboratory was established in the New York City area to study these 77 registrants,' who 
were invited to cooperate in this study. Thus far, however, only five have responded to the 
invitation and since we cannot direct them to go for the study, I do not believe much has 
been determined as yet. 
7. Rheumatic Fever. The exclusion of registrants simply on the ground that they pre- 
sent a history as having had an attack of rheumatic fever in childhood, or even more than one 
attack, in the absence of any physical evidence of heart damage, has seemed to me an un- 
warranted loss of manpower to the Armed Forces. On the other hand, the undesirability of 
accepting those with* an authenticated history of rheumatic fever within five years, even 
though the heart seems normal, I believe warranted the rejections which were made. 
8. The Exercise Tests. I do not hold to be more than a test of general fitness of 
the subject rather than an indication of the condition of his.heart. This is in accord with 
the opinion of the special Medical Advisory Board in the New York City area. 
In conclusion, it becomes obvious from this study, as well as from other matters hav- 
ing to do with selection of manpower for the Armed Forces, that there is a need for a con- 
tinuing study of medical problems with reference to selection of individuals for military 
service. This should be the assigned duty of some section of the Surgeon Generals' Depart- 
ments of- both the Army and Navy. This section should function not only in times of war 
emergency, but in times of peace also. 
The translation of the civilian physician with his acquired contact with sick civilian ; 
does not necessarily qualify him to be able to make conclusive determinations of the regis- 
trant's acceptability or unsuitability for the Armed Forces. There is need for the education I CARDIOVASCULAR REVIEW 
21 
of a group of the medical personnel of both Army and Navy to fix the criteria of acceptance 
and rejection based on their knowledge of the demands which military life require from the 
personnel of the Armed Forces. Anything less can be construed as Improvisations by medical 
men in the hope of meeting current problems of war emergency. The problem of cardiovascular 
rejections and acceptances would fall naturally within the scope of such a study. The more 
leisurely procedures possible during peace time would permit a much better study with better 
periods of observations of the results of changes recommended. To do this during war time Is 
extremely difficult, and hardly satisfactory. 
We cannot escape the conclusion that we are wasting manpower to -some extent by re- 
jecting usable recruits and, to a larger extent, are drawing from Industry many who are unfit 
for Army life. The latter men break down in training camps, and thereupon become unfit to 
return to Industry. This breakdown and subsequent unfitness for work In industry after a 
disability discharge dates back to the mental attitude of these cardiacs. This test has 
shown that most of the men involved were well aware of their cardiac disability, and had so 
regulated their private lives that they were gainfully employed and functioned as useful 
members of their communities. On the other hand, others were told, year In and year out, not 
to take any exercise, to take things easy, etc., etc. Thus there was created In those having 
a functional murmur. Incorrectly estimated by their private physicians as an organic one, such 
a degree of phobia for anything approa.ching muscular exercise that It Is Indeed surprising so 
few broke down In service of the 140 accepted; namely, only 24 separated from the service to 
date, of which I have knowledge. 
One other factor needs notation. I differentiate between the standard of acceptability 
for military service and the usability of the recruit thus accepted. 
After the recruit reports to the Reception Center, he Is assigned to specified units 
in the Armed Forces - Infantry, Artillery, Transport, motorized units. Quartermaster Corps, 
etc., etc. 
To some extent there is fault in the assignments made. 
To some extent this assignment is predicated upon the aptitude tests and prior ex- 
perience In civilian life. I have never seen medical opinion correlated with the determina- 
tion of the assignment of recruits to active duty.4 I believe this Is a factor which needs 
consideration when the whole process and procedure of procuring manpower for the Armed Forces 
comes under review and revision in the post-war period when planning Is under way for the 
procurement of recruits for our peace time Armed Forces. From the study of procurement of 
personnel for the Army and Navy, the foundation should be made for the Inevitable expansion 
which war necessitates. Medical opinion should be Integrated with the opinions of the 
assignment officers, particularly in those cases having functional heart murmurs. 
Let It be said, however, that no Individual nor any one agency of Government Is solely 
responsible for the situation as It exists today. On this problem alone, and on the methods 
of procedure to correct the situation, a veritable thesis could be written. This Is neither 
the time nor place to present the Ideas Inherent In a plan which would tend to obviate the 
situation as It Is and as I see it. 
Suffice unto today Is the problem before us. I have sketched the outcome of the test 
as It affected the area under my medical jurisdiction. To do more at this time would lead 
me too far afield. 
In May of 1943, as a result of pressure by the Local Boards and registrants. It was 
determined to permit preinduction examinations for certain registrants. This was for the 
purpose of allowing registrants who had doubtful physical conditions an examination so that 
they would know whether or not to wind up their personal affairs and business, thus eliminat- 
ing financial loss and personal sacrifice. 
In June, 1943 the Local Boards were ordered to remove all registrants qualified, for 
limited service from a IY-F category and to resubmit them to the Induction Station for ex- 
anlnation. This was at a time when the Induction quotas were still at a very high peak and 
4 Memo. W-40-44 22 
REPORT OF MEDICAL OFFICER 
there were a great many positions which might be filled by men with limited service defects. 
In October, 1943 it became necessary to call upon the Medical Advisory Boards to help 
check on cases rejected by the Induction Station, which appeared doubtful to the Local Boapd 
because of the registrant's background, lack of medical verification, or because of complaints 
received. Naturally, with the large numbers of registrants being examined at the Induction 
Station it was Impossible for the Induction Station examiners to delve Into the registrant's 
background, etc.- As usual, the Medical Advisory Board was Immediately cooperative - although 
no laboratory procedures were permitted. 
Also due to the great number of limited service positions available at this time, the 
physical standards were liberalized so that an inguinal hernia which had not descended Into 
the scrotum, which formerly was rejected for either general or limited service, was made 
acceptable for limited service. Therefore, on November 30, 1943 an order was Issued to all 
the Local Boards that they review all their hernia cases and send them to the Induction Station 
for further determination. 
In January, 1944 this Headquarters was advised that beginning In February, 1944 pre- 
induction examinations at the Induction Station would be resumed and therefore, there would 
be no necessity for any further screening examinations by the Examining Physicians of the 
Local Boards. From the standpoint of the registrant this was very satisfactory for It gave 
him a more accurate decision as to whether or not he would be accepted at the Induction Sta- 
tion. However, It was modified so that if a registrant felt that he had an obviously dis- 
qualifying defect he, might request a Local Board examination and still be disqualified at the 
Local Board level if he had one of the defects listed In DSS Form 220. The preinductions were 
reactivated at this time probably because the Induction quotas had decreased at this point 
and the Induction Station was able to handle both preinduction and Induction examinations. 
Accordingly, a meeting was called of all the Chiefs of the Examining Teams to advise 
them regarding the discontinuance of the screening examinations. 
At this same time fathers and men In the older age brackets were being Inducted, which 
meant that a great many dependency cases came In for determinations. In many cases, the prime 
factor Involved was the health of one or the other of the dependents. This Headquarters had 
advised the Local Boards that the burden of the proof regarding the Illness of dependents 
rested with the registrant, but that if a determination could not be made by the Local Board 
on the basis of the certificates submitted this Headquarters would examine the dependent 
and render an opinion. The registrants were asked to submit certificates regarding the 
alleged physical conditions of their dependents. However, in a great many cases the Infor- 
mation secured was Insufficient or too vague, and In those cases the Local Boards were advised 
to submit the certificates to this Headquarters for an opinion. When It was deemed necessary, 
appointments were made for the dependents to come to the Medical Division for examination by 
a group of doctors who had volunteered to do this work at this Headquarters. It was found 
on examining these dependents that 50$ of the certificates submitted were exaggerated. 
The cases referred to this Headquarters had become so numerous that It was necessary 
to have four doctors on duty at this Headquarters. In spite of this, there were still more 
examinations than could be handled confortably. Therefore, when the screening examinations 
were eliminated the Local Board Examining Physicians were requested to do the examinations 
of these dependents for the different Local Boards. This they undertook to do. 
In February of 1944, the Medical Survey Program was in full operation. By this time, 
psychiatric social workers had been assigned to every Local Board, with few exceptions. To 
cover the Local Boards to which It was not possible to assign any paychlatric social workers, 
because of location, etc., a Headquarters unit of psychiatric social workers was established. 
This unit consists of about twelve psychiatric social workers who come in every Tuesday night 
and Interview the registrants from Local Boards not covered by psychiatric social workers 
specifically assigned to them. 
In the beginning of the program, since the quotas were quite high. It was Impossible 
for the psychiatric social workers to do more than Interview those cases which were especially 
referred to them by the Local Board personnel. However, as the procedure became more routinlzed 
and the quotas gradually decreased, the psychiatric social workers ’found time to Interview 
practically every registrant before he was sent down to the Induction Station for a preinduc- 
tion examination. ADJUSTMENTS OF COMPLAINTS AND ERRORS 
Headquarters Master Psychiatric File 
The Medical Identification Cards which were sent to the New York State Department of 
Mental Hygiene for clearance were discontinued in December of I945 because the New York State 
Department of Mental Hygiene was so flooded by the great number of cards arriving there every 
day that they were unable to keep up with the necessary checking. 
Since it was very necessary to have some check on the registrants as to previous 
admissions to hospitals for some mental condition, this Headquarters established what is now 
known as the Bellevue-Klngs County file. This file consists of an alphabetically filed card 
for every registrant within the draft age who at any time was committed or admitted either to 
Bellevue or to Kings County Psychiatric Divisions, giving the dates, diagnosis, etc. In order 
to establish this file it was necessary for volunteers to be recruited from this Headquarters 
and from the social service agencies to go to Bellevue Hospital and Kings County Hospital 
every night to copy the necessary information from the records. This work went on for about 
five months but it was the means of establishing a very vital part of the Medical Survey 
Program. The file is being kept up to date. 
Naturally, as this program progressed the staff assigned for this work Increased 
until at present there are eight clerks to do this work. Recently, the Social Service 
Exchange entered the program and now one of the representatives of this agency has been 
assigned to this Headquarters, and in addition, the names of all the registrants to report 
for preinduction are now cleared through the Social Service Exchange files, thus giving us 
further clues to the registrants' past history. 
Adjustments Of Complaints And Errors 
Fop some time registrants had been coming in to this Headquarters to complain regard- 
ing the examinations received by them at the Induction Station. Those who were accepted felt 
sure they had some defect which was disqualifying and for which they should have been rejected; 
and those who were rejected simply must get into the Army and were sure they had absolutely 
nothing wrong with them. 
These cases were given all the consideration possible, and if there did seem to be 
some basis for the complaint the case was taken up by this Division with the Chief Medical 
Examiner at the Induction Station. As a result of these conferences, which were held on an 
average of once a week, determinations would be made and the registrants would be advised 
either that they were to be resubmitted to the Induction Station for another examination, or 
that they had been correctly accepted or rejected, as the case may happen to be. Thus, many 
registrants who were formerly disgruntled with Selective Service became satisfied that every- 
thing possible was being done in their behalf. 
In July of 1944 the Induction Station ceased taking any men who were qualified for 
limited service, since there were no more available limited service positions to be filled. 
In November, orders came through from National Headquarters that all men who had been qualified 
for limited service only were to be reclassified in IV-F. 
The latest development at this time is that all IV-Fs who held essential positions 
and have left them without permission of the Local Board, after December 12, 1944, may be 
processed for induction in spite of their defects, and may be Inducted. 
In the foregoing there has been presented a running chronological account mostly 
concerned with the principal duty assigned to the Medical Division, namely matters concerned 
with the medical examinations of men, to select those physically and mentally fit for service 
in the Armed Forces, measured by the standards and criteria set for military service. 
The details in brief outline of ancillary functions carried out by the Medical 
Division also are noteworthy, and there follows the records made in these functions. 24 
REPORT OF MEDICAL OFFICER 
Review Of Physical Examination Forms And 
Approximate Estimates Of Numbers Examined, 
Numbers Accepted, And Numbers Rejected 
There have been Inducted from New York City, to May 7* 1945* 620,8o45 registrants Into 
the military services. Of these, 607,578 were inducted by the Local Armed Forces Induction 
Station, vh"’le an additional 15,426 of New York's registrants were inducted at Armed Forces 
Induction Stations outside the New York City area. 
Since the commencement of Selective Service, this Headquarters has processed and 
forwarded for examination l,104,8o6 registrants. 
The numbers rejected because they failed to qualify mentally or physically under the 
provisions of MR 1~96, both at preinduction and at Induction examinations amounted to 555*026.: 
In regard to these figures, it should be noted that when the figure for those rejected Is 
deducted from the total number examined the figure 484,002 will result. This figure Is 
150,976 more than the figure given for the number rejected. The difference is due to the 
fact that these 150,976 men were actually found acceptable for military service by mental 
and physical examinations, but were not Inducted because of reclassification by their Local 
Boards. 
Some also were qualified at the Armed Forces Induction Station at their prelnductlcn 
examinations but when they subsequently came up for Induction examinations they were dis- 
qualified. There are no figures available on the numbers to whom these happenings occurred. 
In the four years under report, the overall figures given herein are all that are available. 
The figures of those rejected at the Local Board level because they presented them- 
selves with obviously disqualifying defects which were listed In DSS Form 2208 are not 
available. 
The Medical Division scrutinized every Form 200 and Form 221 of all rejected regis- 
trants. There were 52,912 that denoted errors necessitating corrections. In the subjoined 
table the details of this activity of the Medical Division are shown from April 28, 1941 to 
May 8, 1945. 
TOTAL NUMBER FOR CORRECTION 52,912 100$ 
Inducted 6,810 20.7$ 
Rejected 14,285 45-4$ 
By Local Board Doctor 8,185 24-9$ 
By Induction Station 6,100 18-5$ 
Accepted, not yet Inducted 75 2$ 
Classified I-A-L. 81 2$ 
Other classifications 5*521 10.1$ 
Deceased 28 1$ 
Pending 4,405 15.4$ 
Technical errors corrected 1*556 4.1$ 
Conditions verified 2,575 7-8$ 
5 The actual figures of those In the Armed Forces, as of January 1, 1945, is approximately 800,000. The differ- 
ence between this figure and that in the text lies in the fact that the figures in the text comprise only 
those sent for Induction by Selective Service Local Boards and do not Include those who upon their own 
initatlve volunteered and entered the Armed Forces. 
6 War Department Standards of Physical Examination During Mobilization. 
7 This figure is only an approximation because there were necessarily duplications of examinations, because 
some registrants have been sent to the Armed Forces Induction Station examinations more than once. 
8 List of- Manifestly Disqualifying Physical Defects, Bureau of Selective Service, December 31, 1942. Revised 
January 16, 19^3* EXAMINATION OF MEN DISCHARGED WITH C.D.D. 
Investigation Of Physicians' Certifications Of 
Registrants 1 Dependents' Disabilities 
There have been claims asserting that hardship would result were certain registrants 
to be inducted into the Armed Forces because the registrant was necessary at home due to the 
inability of the registrant's dependent to engage in gainful occupation. 
In certain Instances, the certifying physician's statement of the condition was clear 
and definite. In many instances the Local Board's Examining Physician could and did make 
the determination to the satisfaction of the Local Board, who thereupon made the necessary 
adjustments of classifications. In a certain number of Instances, either the Local Board 
phycislan could not or did not make determinations, and in other Instances the Local Boards 
were not satisfied with the determinations made. It was necessary, therefore, to establish 
an examining team of doctors at Headquarters. This team was set up comprising four doctors 
of large general medical experience who gave their time and skill voluntarily. They were; 
Dr. William A. Rodgers 
Dr. E. Z. Epstein 
Dr. A. L. Goodman 
Dr. Edward L. Galnsburgh 
Dr. George B. Dorff 
Dr. D. K. Zongos 
Dr. L. Rau 
The entire staff of examining physicians, all of whom had regular appointments as 
Selective Service Examining Physicians, did not function during the entire period of this 
report. Dr. A. L. Goodman dropped out due to a severe Illness which still confines him to 
his home. Drs. Rau, Epstein, Zongos, and Dorff ceased functioning after the high peak load 
of inductions dropped to a level where so many physicians were not needed, and at the present 
Dr. Rodgers carries the main burden of the work, putting in a full work week, while Dr. 
Galnsburgh serves two half days weekly. 
There were 6,346 medical certificates reviewed and evaluated. Of these, 2,787 were 
substantiated. 3,339 were upon study found not to be substantiated and the claims made, based 
upon the alleged disabilities described in these medical certificates, were disallowed. 
In a number of cases, whore the doctors' certificates were so indefinite and a doubt 
existed, or because before a determination could be made, an actual physical examination was 
necessary, there were 2,434 such physical examinations of registrants' dependents made by the 
Headquarters staff of volunteer doctors. Of these 45$, or 1,095, were found able to be em- 
ployed, while 55$ or 1,339 were found to be physically disabled and hence unemployable. 
Interim Physical Examination Of Registrants 
After a screening examination by Local Board physicians and a complete physical and 
mental examination at the Armed Forces preinduction station, 1,188 registrants came in and 
presented medical certificates. X-ray films, or hospital records with the end in view to show 
that an error was made in the determination of their physical or mental condition. 
The Headquarters examining staff of volunteer physicians examined the medical evidence 
and where necessary made actual examinations of the men. 163 of such examinations resulted in 
recommendations being made that these be resubmitted for reconsideration and further evalua- 
tions of their acceptability for general military service, or where they had previously been 
accepted, for reconsideration because they had conditions or diseases which under MR 1-9 
should have resulted in their rejection. Of those reconsidered, 67 cases resulted in a 
change being made in their status. 
Lately men honorably discharged with certificates of disability who were anxiously 
desirous of returning to the Armed Forces necessitated-making 24 examinations upon such men. 
The results of these examinations became the basis for recommendations to Local Boards either 
to reprocess such as were found fit for service under MR 1-9* or to advise Local Boards that 
despite the voluntary effort of such discharged soldiers to re-enter the Armed Forces, the 
condition they presented when examined here was such that It precluded their acceptance under 
MR 1-9. Thus we were able to save time and wen hours at the Local Boards and at the Armed 
Forces examining posts. 
Examination Of Men Discharged With C.D.D. 26 
REPORT OF MEDICAL OFFICER 
The New York City Headquarters is deeply indebted for the fine service these volunteer 
physicians, headed by Dr. William A. Rodgers, have been donating to the Medical Division of 
the New York City Headquarters of Selective Service in particular and to the war effort in 
general. 
Procurement Of Professionals For Military Duty 
The procurement for military service of doctors, dentists, and doctors of veterinary 
medicine came partly to be the concern of Selective Service. Primarily based on memorandum 
from National Headquarters, that when considering the status in Selective Service of these 
professionals, inquiry should first be made of the New York State Procurement and Assignment 
Service as to whether or not the individual registrant under consideration was essential to 
his community in his civilian capacity. In the event that he was reported available for mil- 
itary service, the wonted regulations and procedures of our system anent him be brought 
into action toward inducting him. 
On the other hand. Bulletins from this Headquarters pointed out to Local Boards that 
the usual standards and criteria for estimating hardship and financial stress could hardly 
be applied to these professional men, because if they accepted the commissions which were 
available to them their pay and other financial allowances sufficed to cover their needs. 
Obviously, there must nevertheless be sacrifices involved, because some of even the younger 
group were definitely earning more money than what the Army or Navy pay provided. 
The joint purpose of both the Procurement and Assignment Service and ourselves was to 
furnish the Armed Forces the quota of professionals set for New York City, yet at the same 
time exercise care that the community would not be stripped of needed medical and dental per- 
sonnel to man our hospitals and Board of Health facilities, as well as the teaching staffs 
of our medical and dental schools. 
Throughout the four years herein reported, an excellent spirit of cooperative endeavor 
was enjoyed between Dr. Henry Cave, the Chairman of the Second Service Command Area, and Dr. Joe 
R. Clemmons, New York State Chairman, and Commander William McGill Burns, USNR, the Executive 
Officer of the Regional War Manpower Commission, Procurement and Assignment Service and our- 
selves. Likewise with the Medical Officer Recruiting Board at 39 Whitehall Street, and the 
Office of Naval Officer Procurement at 33 Pine Street, New York City. The officers at these 
posts gave wholehearted support and cooperation. 
Of the 7,013 cases of professionals who were registrants in Local Boards in our jur- 
isdiction, 137 came to see me for personal interviews. These and the remainder were eventuall 
handled through correspondence which went two ways namely, to the Local Boards and to our 
Washington Headquarters, 
The detailed breakdown, as of May 8, 1945, is as follows: 
Commissioned In Armed Forces and/or U. S. Public Health Service 1179 
Disqualified physically for commission In Army or Navy 4255 
Unlicensed, hence ineligible for commission 15 
Allens, ineligible for commission 80 
Inducted by Local Boards with our approval 17 
Over 38 years of age, not subject to Selective Service induction. ...!!!!!!! 558 
Declared Essential by Procurement and Assignment 365 
Out of town or country - not in our jurisdiction 262 
Declared Available - Local Board classified. III-D ’ ’ 16 
Declared Available - Classified IV-F - Rejected by Army Induction Station 59 
Discharged from Army or Navy 39 
Disqualified for other than physical reasons . 7*5 
Classified I-A-L 5 
Classified IV-E \ 
Classified IV-C . . 
classified ii-B !.!.!!!!!!!!!!!! 
Deceased 
Classified I-A - Father -No action, to be inducted when others 
in this group are inducted 2 
Pending . !!!]!!!! 82 
TOTAL 7013 CLASSIFICATION OF REGISTERED PHARMACISTS 
27 
The large numbers of drug stores in the City of New York is obvious to any one walking 
any of our streets. Some of these are glorified general stores, and some are really small 
restaurants. The number of drug stores in existence could not, therefore, be considered an 
index of the essential numbers of registered pharmacists who warranted being recommended for 
deferment because of essential pharmaceutical needs of the civilian population. The New York 
State Board of Pharmacy in a statment submitted to us, maintained that to maintain adequate 
public health services, the ratio of pharmacies to the civilian population should be 1 to 
1,500. The ratio of pharmacists in New York State, in March, 1943, was 1 to 2,064 population, 
while in New York City, the area under our jurisdiction, the ratio was 1 to 1,150. From 
these figures it was evident that we in New York City had more drug stores than were needed, 
and yet had probably fewer pharmacists than we "comfortably" needed, particularly should the 
city be visited by an epidemic disease. 
Under Occupational Bulletin #44, (Health and Welfare Services), authority was pro- 
vided for serious consideration to Local Boards for occupational classifications to pharmacists 
considered doing essential work. 
There was established at this Headquarters a Pharmacy Advisory Committee comprising 
the following: 
Classification Of Registered Pharmacists 
Mr. Robert R. Gerstner 
Mr. Marty H. Sasmor 
Dean Charles W. Ballard 
Dean Hugo H. Schaefer 
Mr. William deNeergaard 
The composition of this Committee was such that on it were a representative of the New 
York State Board of Pharmacy, Mr. Robert R. Gerstner, two Deans of Colleges of Pharmacy, 
namely Dean Charles W. Ballard of the Columbia University College of Pharmacy, and Dean Hugo 
H. Schaefer, of the Brooklyn College of pharmacy. Long Island University, and the others were 
representatives of practicing pharmacists and owners of non-chain, ethical drug stores. 
This Committee met weekly and made recommendations anent pharmacists under considera- 
tion for classification by their Local Boards. 
The following is the summary of the cases and the type of recommendations submitted to 
Local Boards. 
TOTAL NUMBER OF CASES CONSIDERED 877 
Deferment Recommended 578 
Owners 239 
Co-owners 44 
Chain store asst, mgrs 38 
Chain store mgrs ,. . 27 
Clerks 215 
Chain store clerks 7 
Non-practicing pharmacists 8 
No Deferment Recommended 299 
Owners 33 
Co-owners 18 
Chain store asst, mgrs . . j ' 10 
Chain store mgrs i 5 
Clerks 209 
Chain store clerks 8 
Non-practicing pharmacists 16 
The Committee performed a noteworthy work and built a bridge of good will between 
Selective Service, Its Local Boards, and the organized Pharmaceutical Associations. Our 
Indebtedness to them is here acknowledged for their contribution to the war effort. 28 
REPORT OF MEDICAL OFFICER 
Hospital Advisory Committee Activity 
The War Manpower Commission, Procurement and Assignment Service, had jurisdiction over 
the professional personnel of the hospitals but there was no specific agency extant to give 
expert advice on the essentiality or availability for military service of the technical staffs 
as well as the maintenance staffs of the city's hospitals. 
The New York Association of Hospitals officials were Intensely concerned that their 
hospital technical and maintenance staffs should not* be depleted to an extent which would 
affect the efficiency of their institutions in the needed services for the civilian population. 
It was therefore determined to establish a Hospital Advisory Committee to make recommendations 
as to the essentiality or avllablllty for military service of such hospital personnel whose 
classification status presented problems to Local Boards. 
The Committee consisted of the following hospital executive officers (Superintendents), 
and of Dr. Edward M. Bernecker, the Commissioner of Hospitals of New York City; 
Mr. Berger E. Foss 
Mr! John J. Kelly 
Dr. Joe R. Clemmons 
Mr. Bernard McDermott 
Mr. 'William B. Seltzer 
116 cases were sent to this Committee through the Medical Dlvlson by Local Boards. 
Of these, 99 were recommended for deferment and in 17 cases no deferment was recommended. 
Our appreciation for the work performed by this Committee is hereby expressed. It is 
true enough that more were deferred than were recommended for Induction, yet the fact that 
this Committee represented the actually sick of the city's hospital population made such de- 
cisions warranted under the circumstances. 
Salvage Of Manpower By Substantiation 
Of Positive Serologicals 
On September 16, 1944, there was completed a study of registrants rejected and class- 
ified in IV-F because of positive serological tests made by means of the Kline test. The 
following is the report. 
1. There is a provision of the New York City Sanitary Code which requires that cases of 
syphilis when found by a physician practicing in the city shall be reported to the New York 
City Department of Health. This provision was invoked to report to the New York City Depart- 
ment of Health the names of registrants who were found upon examination at the Armed Forces 
Induction Station to have two positive serological reactions to the Kline test. 
•2. It was, of course, realized that the Kline test was not definitely determining. In 
many cases an actual Wasserman test, either upon a blood specimen or a cerebrospinal fluid 
specimen, was necessary to clarify the registrants' status as to acceptability or to warrant 
positive rejection from military service. 
3. The situation was altered somewhat after the Armed Forces changed their criteria for 
acceptance of the registrants, who gave a positive serological test. After that time mili- 
tary hospital facilities to handle a percentage of these cases became available, and regis- 
trants with positive serological tests were tentatively accepted. 
4. The control of the registrants with positive serological tests rejected by the Armed 
Forces Induction Station was made possible by the fine cooperation of the Bureau of Social 
Hygiene of the New York City Department of Health and its Social Hygiene Clinics throughout 
the city. 
After conferences held between the Director of the Bureau of Social Hygiene and some of 
his staff and myself, a plan was evolved which, based upon the Sanitary Code on the one hand 
and -on the cooperative efforts of the personnel of the Local Boards on the other hand, con- 
stituted a threefold program. 
a) The Local Boards counselled the registrants voluntarily to report in person to the 
Social Hygiene Clinic nearest their homes for a recheck of their serology to verify or con- 
tradict the findings at the Armed Forced Induction Station examinations. 
b) The Bureau of Social Hygiene placed one of its public health representatives at the 
Armed Forces Induction Station to "talk" to men rejected because.of positive serolbglcal SALVAGE OF MANPOWER BY SUBSTANTIATION OF POSITIVE SEROLOGICALS 
findings and Induce them to accept remedial therapy. This was further enhanced by the proce- 
dures instituted at the Social Hygiene Clinics. Wherever the Clinics substantiated the find- 
ings of the Armed Forces Induction Station, the personnel of the Clinic, in the registrant's 
behalf, stressed to him the need to accept therapy not only for the sake of his future health 
but because if treatment was accepted and taken, he, - the registrant, - might be resubmitted 
to the Induction Station and if he had no other disqualifying defects he might be enabled to 
have a classification other than IV-F. 
It is to be noted that it is the medical profession's oft expressed opinion that were 
medical facilities placed at the very door step of our people there always would be some who 
would not accept the proffered aid. There were 4,637 who refused to cooperate and accept any 
therapy. 
Because the Department of Health, under the New York City Sanitary Code, has control 
only of persons in the communicable stage of syphilis, there was no procedure either under 
the Health Department's Code or under the Selective Service System to Induce these 4,637 
registrants to accept the therapeutical help they so evidently needed. 
c) The third endeavor comprised this Headquarters' concern over the question as to the 
possible manpower salvage that our plan would bring about. This was the paramount reason for 
our directing and supervising this activity. 
5. In this report no purpose would be accomplished by detailing the steps in the proce- 
dures to effect the results that were our aim. Suffice to make record of the wholehearted 
cooperation of the 280 Local Boards of this city. 
In this effort 6,624 registrants were brought to reexamination and those requiring and 
accepting it were brought under treatment. In addition, it was found that 4,325 undertook 
treatment in the various clinics of the city's hospitals and 923 came under the care of their 
own private physicians. To a large extent these figures constitute a group who otherwise might 
never have gone to the Board of Health, or to any hospital clinic, or to their private phylclan 
to get the medical care either they obviously needed or to have determinations made that proved 
they were not syphilitic. 
It became evident at reexamination at the Department of Health's Clinics, after detailed 
examinations, that' 4,155 actually were not syphilitic persons and as far as the question of 
syphilis was concerned, they were available for military duty. 
6. The large number of registrants whose original serological reaction to the Kline test 
was positive and who, upon subsequent examination by more specific tests were proven to be 
non-syphilitic, needs a note of explanation. 
The Kline test, the one used in the routine serological testing at both the Local Board 
and at the Induction Station examination, is too sensitive, and sometimes gives a positive 
result in persons not suffering from syphilis. The incidence in the patient's medical history 
of yaws, plnta, leprosy, malaria, and infectious mononucleosis among other conditions, vitiates 
the validity of the test for syphilis, unless these lesions have been ruled out definitely. 
Especially among itinerant Negroes, Mexicans, Portugese, and South and Central Americans is 
the application of the Kline test apt to be misleading. 
An additional factor needs to be recorded. Among the 4,155 registrants who presented 
equivocal Kline tests, leaving the question of syphilitic involvement undetermined, the 
reexamination and specific tests by the Department of Health Clinics clarified their status. 
This number was found not to have the disease. This information was an intense mental relief 
to many of these registrants, and in some cases, to their parents who had come into this 
Headquarters much perturbed by having had their sons inform them of the reason for their fail- 
ure to be accepted for military duty because of the finding of a positive Kline test. 
Of the registrants who accepted treatment from their private physicians and at the 
various Out-Patient Departments of hospitals located in this city, many had not been re- 
ceiving treatment before the- Medical Division at this Headquarters started these procedures 
in its efforts at manpower salvage for military service. 
7. Our compilations are in three categories. First, those under consideration from Octo- 
ber, 1940 to August, 1941. In this group, in which no ages are on record, 548 were found 30 
REPORT OF MEDICAL OFFICER 
correctly disqualified. In the second category, viz., those 18 through 25 years of age, 
were found correctly classified in IV-F; while in the older age group, - the third category, - 
4,435 were found who were correctly classified in IV-F. 
The whole number of those classified in IV-F for reasons other than syphilis is 5,755. 
These nevertheless had positive serological reactions. Their other disqualifying defects 
were of more significance than was the finding of a "truly positive" serology. These needed 
much more and additional therapy than treatment of their luetic condition. 
The number with actual neurosyphilis in the registrants under review was relatively small, 
vis., 525. Among those in the age groups younger than 25, the incidence of neurosphills was 
very small, viz., only 24. These figures bear out our general experience with figures anent 
rejections in the New York City area as regards physical defects. The age groups from 18 
through 25 years show less rejections than any other group. 
8. This activity on.the part of Selective Service and the New York City Department of 
Health in cooperation has resulted in the accomplishment of two objectives. 
1) It has caused the reconsideration of classification of 4,925 registrants. In the 
figure 8,508 whose records show that they were inducted or enlisted, some of this group is 
undoubtedly included. It is impossible with the technical staff at my disposition to make a 
more accurate estimate of the manpower salvage attained. 
2) It has brought under remedial anti-luetic therapy approximately 7*709 registrants. 
These figures are reached by adding those contacted for treatment, those that had the minimum 
treatment completed under the supervision of the Department of Health, and those under treat- 
ment by .hospital clinics and privately practicing physicians. 
Appreciation is expressed to Dr. Theodore Rosenthal, Director of the Bureau of Social 
Hygiene, and Mr. George Kirchener, Statistician of the Bureau of Social Hygiene, New York City 
Department of Health, not only for their fine cooperation in clarifying the undertermlned 
cases, but also for the copies of their work-sheets, and other details which they furnished me 
to make this report possible. 
Anent Student Deferment 
The student body in the Colleges of Medicine, Dentistry, and Veterinary Medicine came 
under scrutiny and recommendations emanated from the Medical Division concerning their 
classification. 
In the early days of Selective Service activities, many men who had been graduated with 
B.S. and B.A. degrees from colleges and who thus possessed the premedical or the predental 
scholastic requirements to qualify for admission to the professional schools, engaged in occu- 
pations having no relation whatsoever to either dentistry or medicine. They were carrying on 
business careers in many types of non-professional occupations. The war ensuing, and their 
disinclination to be selected by their Local Boards for military service, caused on the part 
of a nunjber of these immediately to enter any medical or dental school which would accept 
them as students. The advice given to the Local Boards in regard to these was that they did 
not, in our opinion, warrant deferment. The exact numbers of such were not kept and exact 
figures of this group are not available. 
For a considerable time, under the Regulations in force, the continuance of deferment 
for a given student was predicated upon the presumption that the student was progressing 
satisfactorily in his courses, and there was a reasonable chance of his graduation with the 
degree of M.D., DDS, or D.V.M. Hence, when any of the colleges sent notice of the failure 
of any student in his professional studies or failure of progressive advance with his class 
toward graduation, he lost his right to deferment. Where Local Boards requested opinion, no 
deferment was recommended for such. 
Latterly, all these Regulations were superseded, and a document called a Form 42A 
(Special) was required to be submitted by the college for bona fide students below the age 
of 26 years, upon which the Medical Officer placed a recommendation for exemption from 
induction under the provisions of State Director Advice No. 255- For older students, a 
Form 42A was submitted to Local Boards and determinations made either at the Local Board level 
or at the Local Board after an opinion was expressed by the Medical Officer, either recom- 
mending or not recommending deferment. STUDIES UNDERTAKEN ON SOURCE MATERIAL 
Our files at the Medical Division give the following: 
Deferment recommended. 1047 
No deferment recommended 131 
No Actions 16 
TOTAL 1194 
Since a new procedure is in vogue since April 1, 1943* which Involves the use of the 
new Form 42A (Special-Revised) which needs no approval by State Headquarters, regarding the 
deferment of students this Headquarters has no further figures. These Forms now go directly 
to the Local Boards. 
Studies Undertaken On Source Material 
During the last year particularly there were many important questions discussed with 
various officers of National Headquarters. The views and opinions of the Medical Officer of 
New York City Headquarters were casually asked, and it was suggested that he forward a 
memorandum presenting his views for detailed study and consideration by Divisions of National 
Headquarters. Thus, on November 8, 1944 there was submitted a memorandum entitled "Proposals 
Anent Procurement of• Manpower for the Armed Forces," This proposal contained.suggestions for 
the handling of manpower in the event that universal military training is put into effect in 
peace times, as well as changes in the method of handling manpower which the experience of 
four years of Selective Service would seem to justify. A copy of this memorandum 
is appended. 
The number of registrants rejected is a matter of deep concern. Even though the re- 
jections are based upon a criterion or standard of physical and mental health based upon 
fitness and suitability for military service only, it is a challenge to the medical profes- 
sion, in particular, and the community that future generations should show much improved con- 
ditions. This is of importance not only when a part of the community is measured by the stan- 
dards which qualify for military service, but as a means for procuring for more individuals a 
fuller, healthier and better living 'level, and an occupational effectiveness. A memorandum en- 
titled "Proposals Based on a Study of Rejections of Registrants in the New York City Area to 
Procure a better Health Level" was submitted to National Headquarters dated September 28, 1944. 
It is listed in the attached. 
Another study, sponsored by me, was undertaken by Mr. Oscar Halper, the senior 
psychiatric social' worker at that time attached to the Medical Division. This entailed "A 
Study in Psychiatric Cases Based Upon Examinations to Determine Fitness for Military Service 
of a Sample of 696 Cases from the New York City Selective Service Area." This study was com- 
pleted September 15, 1944 and forwarded to National Selective Service Headquarters. It was 
subsequently published in War Medicine, Vol. 6, No. 6, December, 1944, under the.title 
"Validity of Psychiatric Criteria for Rejection for Service with the Armed Forces. Study of 
the Cases of 696 Registrants with Psychiatric Diagnosis from the New York City Area." 
To study the needs for rehabilitation of men rejected for, or discharged from the 
Armed Forces for neuropsychiatric disabilities, the Medical Division assisted the New York 
City Committee on Mental Hygiene of the State Charities Aid Association in the study. The 
Medical Officer joined the Advisory Committee on the study. 
The Chairmen and the Clerks of ten Local Boards cooperated in providing source material 
Local Boards Nos. 4, 50, 52, 57, 70, 78, 91, 136, l4l, and 239 were selected so that they 
represented a range of distribution representing differences in incidence and type of neuro- 
psychiatric disabilities. Six of these Boards had rates of rejection above the average, and 
three had rates below the average for the city. One of the Boards selected' was concerned 
almost wholly with Negro registrants. Thanks for wholehearted cooperation is extended to the 
Chairmen and Clerks of these Boards. 
This study, which will be published by the New York City Commmttee on Mental Hygiene 
of the State Charities Aid Association, has already shown some significant findings. The 
following is quoted from their report. 
9 No action waa necessary because of I-C or TV-F classifications. 32 
REPORT OF MEDICAL OFFICER 
"Socio-economic factors have a direct relationship to the proportion of neuropsychiatric rejectees. 
The more native white, the more home ownership, and the higher the rent paid in the population of a 
Local Board's registrants, the smaller is its proportion of examined men who are rejected, and the 
smaller its proportion of rejected men who have neuropsychiatric dlsahllltles." 
The examination of the known background data of neuropsychiatric rejectees and dis- 
chargees, and other registrants from Selective Service Boards studied gives the following 
facts: 
1. In most social characteristics, the neuropsychiatric group resembles the population 
as a whole. 
2. Neuropsychiatric rejectees tend to be older than Inductees. 
3* Men with neuropsychiatric disabilities are apt to have had less than twelve years of 
schooling than men without such handicaps. 
4. The neuropsychiatric rejectee and dischargee are found in unskilled occupations more 
frequently than other men. 
5. There was more unemployment previous to induction or rejection among the medically or 
psychlatrlcally unfit than among others. 
6. Both neuropsychiatric rejectees .and dischargees asked for fewer deferments than did 
the non-neuropsychlatrlc group. 
7. The proportion of married men was smaller in the neuropsychiatric groups than in the 
others. 
The final report will be published by the New York City Committee on Mental Hygiene 
of the State Charities Aid Association. 
The Medical Division published six Bulletins anent the causes for rejections in the 
early days of Selective Service Activity. These were Medical Bulletins #1 to #6 inclusive. 
Subsequently, National Headquarters published all further statistical data on causes for 
rejection. 
The Purpose Of The Forms Noted In Text 
DSS Form 200 - Report of Physical Examination (Discontinued 11/9/42) 
DSS Form 221 - Report of Physical Examination and Induction 
DSS Form 220 - List of Defects - for disqualification at the Local Board level (in use at 
present) 
Local Board Release No. 66 - List of Defects for which a registrant could be disqualified at 
Local Board level. (in use from January, 1942 to August 15, 1942). 
Medical Circular No. 4 - Outline of Medical Survey Program procedure 
DSS Form 210 - Identity Verification card sent in by Local Board for clearance with regard to 
the Medical Survey Program 
DSS Form 211 - Educational Verification card sent in by Local Board for clearance of registrant 
school record (Medical Survey Program) 
DSS’ Form 212 - Medical and Social History - report to be filled out by Medical Field Agent 
(Medical Survey Program) 
DSS Form 212-A - Envelope for Form 212 
DSS Form 213 - Cooperative School Report form sent out by this Headquarters for registrants on 
whom schools have not sent in report (Medical Survey Program) 
DSS Form 214 - Special School Report 
MR 1-9 - War Department Standards of Physical Examination During Mobilization 
C.D.D. - Certification of Disability Discharge 
Form 42A (Special) - Affidavit - Occupational Classification - for registrants under 26 years 
of age. THE PURPOSE OF THE FORMS NOTED IN TEXT 
Form 42A (Special-Revised) - Affidavit - Occupational Classification - for registrants under 
• 30 years of age. 
State Director Advice No. 255 - State Director's Recommendation for occupational classification 
of registrants 18 through 25, other than agricultural. 34 
REPORT OF,MEDICAL OFFICER 
REPORT ON PROPOSALS BASED ON A STUDY OF REJECTIONS OF 
REGISTRANTS IN THE NEW YORK CITY AREA 
TO PROCURE A BETTER HEALTH LEVEL 
September 28, 1944 
The major causes for rejection because of physical defects may be divided Into the 
following four categories: « 
I. Developmental defects such as congenital deformities, mental 
deficiencies, and defective vision. 
II. Neglect - failure to employ available medical aid, resulting in 
chronically discharging ears, underweight. Insufficient and ulcerated 
teeth and other mouth conditions. 
III. Traumatic causes, the result either of athletics, types of employment, or of 
automobile accidents, which resulted In hernias, flat feet, enlarged but 
not diseased hearts, or lung conditions due to the inhalation of sand 
dust (silicosis). 
IVV Diseases as yet not conquered by medicine, such as rheumatic fever, val- 
vular heart disease, essential hypertension, and the results of infantile 
paralysis and pulmonary tuberculosis. 
A number of general observations are pertinent. The war came upon us just after about a 
decade of economic and mental stress due to the overall economic situation with Its con- 
comitant large unemployment problem and with the economic level of large numbers of our 
people lowered due to the prevailing economic depression. 
Underweight, malnutrition, and neglect to avail themselves of medical facilities which 
are ample In the New York City area accounts for some of the findings. 
It must be remembered that low wages, and bad housing are intimately interwoven In the 
problem. The provision of more medical facilities In this community would hardly change the 
picture. Better living quarters, full time employment, and a higher wage scale, coupled with 
a continuing and persistent educational compalgn would do more to lessen and perhaps obviate 
a number of physical defects found than any Increase In general medical facilities In this 
community. 
There Is very little medical evidence In this group to show that acute Illnesses have 
left permanent bad after-effects upon these Individuals due to an absence of medical care 
during the acute Illness. Summarizing the entire study of those accepted for military duty. 
Including those accepted for or designated for limited service only, one may conclude, after 
surveying the divers causes for rejection, that the health of the city's population Is 
good. 
We should not be satisfied, however, with the present level of health. It should 
and can be bettered. 
Leaving out of account that an Improved economic level with better living quarters, 
more and varied foods, and generally Improved sanitary and hygienic conditions which would 
ensue therefrom, nevertheless, a general health program should be the first step In a campaign 
of prevention, so that in future times similar figures of rejection would not be found In our 
population. 
This should be Instituted not only for Its value to produce a larger number of men 
fit for any subsequent military service, but also for Its effects In peace time, to produce 
healthy Industrial workers, and In fact a better health for future generations. 
The Health Level Of The Adult Is 
Predicated Upon Children's Health 
It Is known to students of the problem that one can predict the health of the man- 
from the medical findings among the childhood of the nation. I say this, among other things, 
on the basis of the Hagerstown, Maryland, study. THE SCHOOL PHYSICIAN 
Unfortunately, only In rare Instances are consecutive and continuing childhood health 
studies carried on and medical records kept continuously on the Individual Infant and child 
and carried along with him through school and college career, or where he enters Industry 
from his school days, brought to the medical departments of the larger Industrial plants and 
larger selling organizations which he then joins. 
The School Physician 
In the schools In most of the areas of this state, a physician is in attendance. His 
present duties are mostly concerned with contagious disease quarantine. He separates contacts 
with contagious diseases from the school's population. 
In this city his duties are mostly concerned with the same item.10 In many schools 
there is also a graduate trained nurse on duty. Primarily, she has the functions of a public 
health nurse and does little more than advise parents of children found undernourished or 
apparently deafened or apparently with lessened visual acuity, or she renders first aid and 
advice to the school children who happen to become ill while at school. In other words, she 
handles the obvious medical problems which are brought to her. She has no function to 
initiate or carry out public health and physical health education in the school except in a 
most desultory manner. 
In my opinion, the school physician should have a full time job. He should actually 
be a medical school officer. He should start and keep a continuous and continuing record of a 
series of complete physical examinations of the school's population, which is under his care. 
It should be his duty to see that records and all methods of prophylactic immunization in all 
established categories are carried out either by the child's private physician or himself. 
His office should be at the school and he should be supplied with a adequate staff. 
The school physician's medical staff should contain, along with the necessary tech- 
nical laboratory help, a trained nurse and dietitian, a dentist, an expert on problems con- 
cerned with behaviorism (either a psychiatrist or a psychologist), and a physical training 
expert. The very names of these medical staff associates connote the type of duties falling 
within the scope of their activities. 
In the special schools, such as the School for the Deaf, either the school's medical 
officer should be a qualified otologist or such a qualified individual should be on the 
school's medical officer's staff. 
This staff should be obligated to both examine each in his proper domain and also 
treat such cases among the school's population as were found not to have a private physician 
and who. In their professional opinion, require the correction of minor defects which are 
remediable. 
Thus, teeth could be conserved, cavities discovered when small, -maladjusted behavior 
problems handled, and programs for general physical training carried out in full cooperation 
with the educational departments. In the matter of physical training, the adjustment of 
such to the capacity of physically handicapped children would entail cooperative planning by 
the school medical officer and the physical trainer. 
The larger number of rejections for various types and degrees of psychiatric disabil- 
ities makes it necessary to begin the adjustment of the maladjusted child as early as possible 
and thus stop the further enhancement of anti-social and unpredictable behavior and the 
emotional instability found In the young adult. 
Where major medical conditions are discovered, liaison with the parents, the family 
physician, or where it Is discovered that the family Is unable to provide such, with the 
public or voluntary hospital serving the neighborhood should be undertaken to provide 
remedial therapy. 
The educational campaign carried out In the school, not only among the school pop- 
ulation but aimed also at the Parents' and Teachers' Associations, should stress the dogma 
10Since writing the above, I have been informed that in the whole City of New York, about b High Schools, 
mostly vocational, actually have a medical school physician who does more than the work outlined in the text. 
It still is not the type of service that I would envisage to cover the type of medical supervision which 
I believe required for the school aged population. 36 
REPORT OF MEDICAL OFFICER 
that no member of the community has an Inherent right to remain unfit physically or mentally, 
while the community has ample facilities, and Medicine, the means and methods to correct the 
deficiency. 
There Is nothing of such paramount Importance to the state as the health of Its 
citizens. 
Since the health of the adult Is, in most Instances, predicated upon the health of 
the community's children, the goal of still better health of the community Is reachable by 
remedial therapy rendered when the disabilities are just becoming apparent. 
In regard to the deviations from the normal, both physical and mental, discussion and 
study of available records demonstrates that some of the mental deviations from what Is con- 
sidered normal become apparent at the earliest school age. 
Preliminary discussions with competent school authorities reveal. In a very casual 
survey of the material on file, that correction of these behavior deviations needs attention 
from two angles: (l) correction of possibly existing rigidity of primary school curricula; 
and (2) psychiatric direction In leading back toward normal behavior the child whose conduct 
denotes a trend toward adnormallty. 
On this aspect of the problem concerned with the attainment of a better health and 
physical fitness level, statistical material Is on file In various agencies dealing with child 
guidance. Under the auspices of the National Joint Committee on Physical Fitness and Health, 
further studies are under way, and the general acceptance of Improved criteria for establish- 
ing determinations In estimating deviations will undoubtedly be evolved. Subsequently these, 
coupled with the indicated amendments to rigid school curricula, will provide another step 
toward the goal aimed at; viz., better health and better fitness. 
Our records of rejections have shown that the lower the age group studied the less 
the defects found per thousand in the population. The older the age group studied the larger 
the number of defects which a given individual shows, and the greater the gravity of some of 
them. 
The Medical History 
The medical history of the school child should follow his educational phases. It 
should go to the grammar school, then to the high school, and to the college If he elects to 
take a college career. If, on the other hand, he enters business or Industry this medical 
history should be made available to the medical officer of the business or plant where the 
Individual begins Work. 
Medical Departments In Industry 
Industry changes also are needed to attain a better level of general health. There 
should be a medical officer on full time duty in each plant. A nurse also should be on duty 
at each plant, and particularly there should be a qualified psychiatrist or psychologist. A 
dentist, too, should be established In each plant. 
The duties of this medical department. In addition to rendering such medical aid and 
assistance as may be necessary for those who are unable to pay for It, should be to teach 
medical hygiene and observe and study the Industrial health hazards to which the worker is 
exposed, as regards the particular plant where he is employed. The medical officer of the 
plant should recommend such changes as may lessen Industrial health hazards. Records of 
periodic complete physical examinations should be kept, and minor defects, as soon as 
discovered, should be brought into contact with facilities for remedial thqrapy. 
The psychiatrist at such a plant has an important job. The maladjusted workman who 
cannot adequately function in the group of his fellows eventually deteriorates and gradually 
goes on the downgrade for quite a length of time, until eventually he becomes an unemployable. 
These unemployables are a serious problem in the community. Anything which lessens their 
number adds to a better living level of their dependents and consequently also to a better 
health level In the community where these dependents and they themselves live. 
With a health record and the history from the elementary school until the time the 
youth goes to work, the medical officer of the plant will have a better Idea as to the NEED FOR A CENTRALIZED AGENCY ON NATIONAL LEVEL 
workman's "useablllty" and also he will have a knowledge of his acquired physical handicaps. 
His assignment to specific work obviously should be such as not to Increase this physical 
handicap. 
The tendency of organized labor not to permit a physical examination at the time a 
workman Is hired Is based upon false thinking. The disclosure to employers of a physical 
handicap does not, and should not preclude hiring, but It will lessen the awards for In- 
dustrial accidents and thus save taxpayers' money. It should not In any way prejudice a just 
claim for.injuries incurred In Industry any more than a physical examination of a recruit 
accepted under a waiver for some minor physical defect noted at the time of his examination 
prejudices his compensation or pension when he Is honorably discharged from service after a 
disability incurred In the service. 
Physical vs Health Levels 
In some states preliminary steps along these lines have already begun. The matter lags 
because of the undue stress on muscular development. Physical training has become enhanced. 
Muscular development and muscular strength developed by exercise Is not necessarily synonymous 
with health. 
Our studies of the rejected registrants have given us too many athletes who were found 
physically and mentally unfit for military duty. Some of these became problem cases because 
of their place In the public eye due to their athletic prowess In some particular sports 
field. 
.Need For A Centralized Agency 
On National Level 
The program halts also because there Is no central coordinating authority to embrace 
the entire national overall coverage of national health. As a matter of fact, it Is almost 
Impossible to locate sections of bureaus and departments scattered In various government 
agencies In Washington. The U. S. Public Health Service Is in the Federal Security Agency. 
The Children's Bureau Is In the U. S. Department of Labor. Many other Instances might be 
cited. 
The medical profession has long been cognizant of this situation and have upon various 
occasions advocated a Cabinet Officer heading a national department concerned with all matters 
pertaining to the health of the people. In this Cabinet department each and every bureau and 
subd.lvIson which deals with health questions should be assembled and their particular work 
reviewed. If they are In the process of performing a worthwhile service, that should be con- 
tinued. The U. S. Public Health Service, now under the Federal Security Agency, Is actually 
perhaps the largest and best known health agency of the national government. In the future, 
with the natural contracture of the world's surface because of aviation, and the interchange 
of people from the tropics to our temperate zone, a great Intensity of vigilance will fall on 
this agency to protect us from the insidious tropical diseases heretofore found only In the 
more remote quarters of the world. 
This agency should not be concerned with planning, maintaining, or providing for hos- 
pitals In the community as some are now proposing. A section of the proposed Federal Depart- 
ment of Health should have this obligation. 
The Federal Government and its agencies are considerably handicapped under existing 
conditions when they have problems dealing with health and physical fitness. They find them- 
selves almost invariably forced to handle the given problem not with a duly qualified person 
of top rank In a governmental department, or a Cabinet Officer, but with some subordinate, 
often on a secondary or subdlvisional level of a government agency. The top executive of 
this agency Is primarily concerned with matters totally devoid of any connotations with either 
health or physical fitness problems. This Is true even In sections and divisions of the 
governmental department concerned with education. There Is no divisional department head In 
charge of health and physical problems which would naturally come under the consideration of 
those concerned with education as it affects health and physical education I cite this as 
only one example of an urgently needed change. REPORT OF MEDICAL OFFICER 
For another example, the Federal Government, by and large, because of the absence In 
Its set-up as regards medical questions generally. In other words, a medical man of Cabinet 
rank, deals mostly with the United States Public Health Service. It Is assumed that this 
department of the Federal Security Agency is competent "to speak" for Medicine generally. 
This Is so evidently a fallacy that it often results In proposals becoming broadly publicized 
before the consensus of competent med-i-cal opinion Is obtained, or, for that matter, even a 
discussion or a thinking through by competent medical men on a given problem Is even started. 
The organized medical profession is a democratically constituted organization reaching 
down into every county of the country below the State level, and all reputable'practitioners 
hold membership in it, or they can if they desire to. The officers and Board of Trustees of 
the American Medical Association can only express the opinions of the entire profession as 
formulated, considered, and acted upon. They have established sections In every special 
branch of medicine, and have facilities and means to carry on any specific studies desired. 
The Federal Government should more fully avail Itself of the opinions and facilities 
of this organization whenever an expert opinion on a given problem Is wanted. The average 
general medical man's opinion is that the U.S.P.H.S. Is gradually endeavoring to intrude Itself 
Into the practice of medicine generally, rather than keep to its public health functions. 
That this is not necessarily true, does not mitigate the generally held opinion among the 
country's practitioners of medicine. 
In this outline the definition and limitation of scope of the U.S.P.H.S. Is not nec- 
essary. I am only outlining the difficulties encountered In setting up proposals to reach a 
better health level for our people, and underlining two outstanding examples of the necessity 
for a medical man of Cabinet rank to head this division and make the necessary coordinations 
and reorganizations to attain that result. 
The State And Local Agency 
Because a Federal Cabinet Office is suggested Is no reason to presuppose that states 
rights are to be over-ridden. In carrying out all projects which reach State level these 
should be handled at State levels by State officials. -The Cabinet Officer concerned with 
health problems coordinates, initiates, and stresses to the State set-up the goal In view in 
each particular instance. Carrying out of the necessary procedures falls under the states' 
authority and jurisdiction. In many Instances It must be carried out by local community 
efforts even below the state level. 
The Executive Council 
The proposed Cabinet Officer should have an Executive Council to serve him as ex- 
perts . 
On such a Council the Surgeon Generals of our Armed Forces, as well as the Surgeon 
General of the U.S. Public Health Service should serve. Additionally, there should be repre- 
sentatives of the academic branches of scientific medicine, each representing Its specific 
specialty on this Executive Council; for example, the American Academy of Otology and Rhlnology 
the American Heart Association, the American Academy of Orthopedic Surgery, the American 
Academy of Radiology, the American College of Surgeons, the American Neurologic Association, 
the American Association of Plastic Surgeons, etc., etc., and to represent the general medical ■ 
profession at large, a representative of the American Medical Association. 
Medical teaching should be represented by a representative of the American Association 
of Medical Colleges. The dental profession, the nursing profession, and the social service 
agencies should also be represented. Likewise, an Association of Scholars Interested In re- 
search problems should be represented. 
Research 
Our public Is amazed at the medical advances made during the war. It Is a sad 
commentary that the most wasteful, destructive thing that man has devised, namely, war, should 
be the background from which these advances emanate. 
Perhaps under the emotional stress of war man may be and Is forced to think signifi- 
cantly and produce thoughts which, carried over into peace time, would be helpful to the DIAGNOSTIC FACILITIES 
situation and prolong human life. In peace time, thinking and research to conquer diseases 
and conditions as yet beyond therapeutical help should be nationally supported. A division 
of the proposed Federal Department of Health should be obligated to carry out this function. 
The Council suggested need not meet too often. It should be allowed to delegate its 
authority to an executive gro.up which it would elect. 
Were such a Cabinet Officer in being at the present time and the highest quality of 
the medical profession's opinion voiced by this officer, then the public educational campaign 
to carry out the necessary evolutionary changes to acquire a better health level of our 
people would be focussed and significantly pointed. The spokesman for medical opinion should 
have the necessary prestige to Impress everyone concerned. 
Like the Army and the Navy, this Cabinet position and its Council and its departments 
should be entirely apart and severed from all political activities. It should serve the nation, 
and have no political party affiliations. Its function is national health, which never should 
be a political question at any time. 
Proposal Is Not Socialized Medicine 
It will be claimed that this is socialized medicine. It is neither socialized medicine 
nor prepaid medicine nor compulsory medical Insurance. Most preventive and prophylactic meas- 
ures are not community concerns, and are handled by local Health Departments. No one considers 
these socialized medicine in the form to which, by and large, the medical profession objects. 
In the proposed set-up, wherever any of its projects to render therapy to individuals can be 
paid for, no government should Intervene to pay the costs; but no citizen should continue to 
have Inferior health because of inability to personally finance his recovery or his Improvement 
in health, because health is not an individual's problem. As shown above, one workman's low- 
ered health level affects his whole family and when "one" is multiplied by "many," the commu- 
nity is affected. On the other hand, sickness affects Individuals who must seek recovery. 
This they can procure from privately practicing physicians and at the hospital facilities in 
their community. 
Voluntary Pre-Pald Medical Care 
In .the ensuing post-war period we should see a further great development of the vol- 
untary pre-pald hospitalization plans, and continuing educational campaigns should be en- 
couraged to further the development of such plans. 
In Industrial plants and large selling organizations the medical departments should be 
Integrated Into the pre-pald hospitalization plans and freely employ the available hospital 
facilities in the community in which they are located. 
The one great obstacle to an even level of medical service in this country is the 
political obstacle which Federal grants in aid entail. Sections of our country are richer in 
medical facilities than are others. If the overall authority desires to grant medical fa- 
cilities to the states which are too financially handicapped to provide them, then it usually 
happens that the money is voted on a population-pro-rata basis. The richer communities thus 
having much get more. Actually they may not need any more. 
It should become political dogma that funds should be given for specific facilities 
and not on a population-pro-rata basis. Here, too, the citizens' better comprehension of the 
factors at issue will not result in reactions harmful to the political career of those members 
of Congress who voted help to the less rich states and none to the richer ones, so as to im- 
prove ■ specif1c facilities to procure better health levels of the people and equalize the level 
of medical facilities throughout the country. 
Diagnostic Facilities 
The proposal to establish diagnostic laboratories and consultant services to the 
communities which are poor in these resources is a step in the right direction. The handicap 
which the pending proposal carries is that it seems to the profession as if this is to be a 
Board of Health job locally, or one under the U.S. Public Health Service. I think the pro- 
posal is excellent, but it should be, since it is a new project about to be started, set up 
in an overall framework of the proposed Federal Department of Health. 40 
REPORT OF MEDICAL OFFICER 
Health Level Of Negroes Needs Improvement 
The larger number of physical defects and deficiencies among the negroes as compared 
to the whites Is a matter of grave concern. Basically, It rests upon the fact that there are 
too few Grade A medical schools, training schools for negro nurses, and social worker training 
centers for negroes. In existence. 
The problem can be handled In one or two ways, or a combination of them. Since these 
citizens' health Is as much a concern of the state as that of any other element of our pop- 
ulation, either all Grade A medical schools, nurses training schools, etc., should be Induced 
to accept a set quota of negroes in the regular college classes or separate schools should be 
set up for such to supply medical facilities for our negro citizens. In those states which 
local adverse public opinion against a mixture of the white and negro races. In such colleges 
the separate school should be the planned procedure. PROPOSALS ANENT PROCUREMENT OF MANPOWER FOR THE ARMED FORCES 
November 13, 1944 
The proposals concerned with the procurement of manpower for the Armed Forces take on 
many pertinent aspects. Necessarily it presents an entirely different facet in peace than it 
does under the stress and hurry incidental to war time expansions to meet the Inherent needs of 
the situation as determined by the General Staff. 
From the experience which the country has had both in World War I and the present con- 
flict, it may be premltted to recommend changes which, in the writer’s opinion, might not only 
make the selection of manpower more efficient, but also effect changes in the assignment of 
recruits to service units. Finally, by adopting the proposed changes it would be-possible to 
salvage what seems a degree of wastage of manpower under the present system. 
Making this report, it is assumed that as a result of the situation in which our 
country found Itself in some form of military service will be enacted. I prefer to hoj,e 
this will take the form of a universal military service law for all youths between the ages of 
18 and 21. 
Universal Military Service 
.It is presumed that our public and our legislators will have learned the bitter lesson 
that a nation unprepared militarily for war does not prevent wars from engulfing even a sin- 
cerely peace-minded nation. Likewise, with the inevitable contracture of the earth's surface 
because of aviation, no nation any more can rely on bordering oceans as a means of protection 
against aggressive assult. Further developments of the so-called Robot Bomb, and its succes- 
sors, whatever they turn out to be, will only add strength to this argument. 
Military training in peace time is therefore a proper concern at this time while the 
war time experiences are still fresh in mind. Military training has great advantages for our 
youth.. Among other things to be noted is that it Inculcates discipline and character build- 
ing into our youth, at their most adaptable age. The forces it would provide to study the 
physical status ana health of our youth cannot be overemphasized. The opportunity to 
therapeutically remedy minor physical and mental deficiencies before they become grave and 
serious would tend toward a better health level in our population,11 
The great chance that the assembly of our young men in a military community gives to 
have racial groups learn to comprehend one another, and become America conscious in lieu of 
race and class conscious, is something which is a desired intangible absolutely necessary in 
the further progress and development of a really democratic country. General military train- 
ing would give all our youth a pratriotlc focus upon pur country, lessen local community prej- 
udices, and tend toward the attainment of a better citizenry. 
During military training many crafts and skills are taught. General military training 
will bring such crafts and skills to many youths who have natural aptitudes toward them. In 
such, the stimulus of the militarily taught crafts and skills will incite their intellectual 
curiosity in many Instances to perfect themselves subsequently in one or other of such crafts 
and skills. Thus, for large numbers the opportunity which military tralnlhg gives will open 
doors which they otherwise would hardly even approach. 
The literacy level of the country is very uneven. From some sections of the country 
youths do not read or write our language. During World War I, after the Armistice, I started 
my officers teaching reading and writing to the illiterate enlisted personnel. Illiteracy 
should not prevent acceptance for duty in the peace time army. Part of the military training 
period should be utilized to remove the illiteracy. The benefits from this to the individual 
and the community are obvious. 
Lastly, general military training would remove from the civilian community boys at the 
very age where, in many Instances, they become community problems due to juvenile delinquency. 
In New York City between 3,200 and 3,500 youths reach their 18th birthday every month. 
This should be the age at which they should be obligated to give at least one year of military 
service. I would also recommend that between the ages of 18 and 21 years, the youth have the 
option to select the year. Some youths are too immature at 18 years to profit by the training, 
a fact that must be kept in mind. 
H 59 men In every thousand in age groups 18 to 21 years rejected could he salvaged hy remedial therapy had these 
determinations been made during peace time and provision made to remedial therapy to improve the 
physical health of these young people 42 
REPORT OF MEDICAL OFFICER 
What I have in mind in making the above recommendations is to utilize for military 
training the period betveen the termination of high school education, and the commencement of 
college training, or the beginning of his selected vorklng career if college education is not 
what the youth will undertake-. 
The military training as I envisage it should be universal, vlth no exceptions. Even 
those physically handicapped can be utilized, and at least given training in discipline, 
character-building, and taught some military craftsmanship or skill.12 
Nor vould I grant exemption to medical or other professional students. These too 
vould profit from military training. The man vho had dedicated himself to a medical, dental, 
or engineering career, should be trained in the enlisted personnel of these departments of 
the armed forces. True, it may prolong his professional training an additional year, but on 
the other hand he gains something in intangibles and in maturity vhlch vill more than com- 
pensate for the time spent in military training. What he learns, for example, vhile serving 
under military doctors, or military engineers in various engineering categories, vill enhance 
his Interest in the profession he has elected for his life's vork. On the other hand it may 
serve to demonstrate to him that the respective profession he has selected for himself, knov- 
ing now from actual contact with it, that he finds himself unsuitable for it, and that it is 
not vhat he conceived it to be, and actually he can decide on the basis of experience that he 
does not vant to undertake it as his life's vork. 
In conculsion, the country vould not only benefit from the Insurance to its safety 
implied by its providing itself vlth the nucleus of an armed force capable of expansion to 
the degree necessary to meet national emergencies, but it vould provide opportunity for many 
types of tests concerned vlth the proper selection and assignment of manpover for the armed 
forces. Likewise it would open the way for properly selected youths to enter and make military 
careers their life's work. 
Recruitment Of Manpower 
In the set-up of the personnel, and the procedures, certain general considerations 
need study nov. 
1 believe there vould be a great advantage in complete separation of all questions 
involved in socio-economic problems and the questions as to the physical and personality es- 
timations to determine acceptability for military service. These are tvo separate and dis- 
tinct preliminary processes vhlch should not be Interlocked. 
Procedures In Peace time 
There Is little need for the elaborate Local Board procedures In vogue invar time for 
use during peace. If a universal military service lav is enacted, in the peace time procedure 
there vould be, in New York City, a need for only one central office for each of the five 
Boroughs of the City of New York. At this office the youths should be intervleved, the forms 
filled out, medical certificates presented by private physicians recorded and evaluated, and 
any other preliminary procedures carried out as might be in the-regulations. 
Here the school history, DBS Form and the DBS Form 212 should all be sealed to- 
gether and attached to the Form 221 and sent to the Station vhere the physical examination 
takes place. The individual is then forvarded on his ovn recognizance to a training and ex- 
amination center. 
At this training and assignment center the complete detailed physical examination. 
Including psychiatric and profile estimation, is to be made, inquiry and tests as to aptitudes 
and all other procedures to estimate the prospective recruit as an individual, carried out. 
Since in my conception of universal military training all youths reaching their 18th 
birthday, or soon thereafter, shall undergo training, the criteria at the examining post should 
be a very much liberalized standard for acceptance during peace time. Some training should be 
given to all, so arranged that it vill not enhance any physical disability vhlch is found to 
exist upon medical examination. This is somevhat a-.nev idea but if the reader vill refer to 
12 The details as to how physically handicapped individuals are to he handled is outlined in another section of 
a report, not included herewith. WARTIME PROCEDURES NEED IMPROVED TECHNIQUES 
the section of this report on universal military training and note the advantages accruing to 
the youth If the Federal Government adopted the procedures suggested therein, citizenship, 
responsibility, and trades and skills, should be given to youths with such minor disabilities 
as, under the regulations In force at one time would have put them In what was then designated 
as I-A-L. 
Wartime Procedures Need Improved Techniques 
The present method of assigning recruits to military units leaves much to be desired. 
They go to the Reception Center, are processed as to necessary Immunological procedures, 
uniformed, and equipped. They have Interviews as to aptitudes and, more recently, are sur- 
veyed from the physical standpoint according to the so-called Profile Procedure. They then 
are assigned to units of the armed forces for training. 
There Is little chance In the present procedure to find a man thus assigned transferred 
to a different type of unit because he failed to make good In the place of first asslgnmnent 
without having to send him through hospitals and other cumbersome procedures which eventually 
result In his discharge from the service. 
The men are put, for the most part. In a general pool and are assigned to units upon 
requisition for needed men to fill replacements, or for additional manpower because the unit 
Is below Its requirements under the Tables of Organization. 
Too often such men are assigned without regard to their prior occupational trades or 
skills. Even the aptitude tests by which they demonstrate their abilities are disregarded. 
Their desire for a given service becuase they believe themselves fitted for It Is also mostly 
disregarded. This feature of the program of recruiting for the armed service Is not In the 
best Interests of all concerned. The following proposals are suggested as providing Im- 
provements . 
1. That the physical examining, classification, and training centers are to be estab- 
lished as separate units, constituting the lowest echelon of a separate command, under the 
control, supervision, and command of a general officer serving under the Chief of Staff, sim- 
ilarly as the Chief of Artillery, or Cavalry, or of the Air Corps serves. This separate 
command Is to have all the necessary subordinate echelons down to the Commanding Officer of 
the examining, classification, assignment, and basic training units. The basic training unit 
Is to be the first military Installation at, which the recruit appears for service. 
In war time the following changes In the present set-up of such a service are recom- 
mended : 
In contrast to the draft law of World War I, a step in the right direction was made 
when the medical examination was separated from all other activities of the Local Boards. 
In World War I, the Local Board physician was a member of the Local Board. In this war, the 
Local Board physician was not a member of the Board. His separation was a distinct Improve- 
ment over the World War I procedure. So therefore, the following might be a continuation of 
Improved procedures, predicated upon the same philosophy which resulted In the Improved 
situation just mentioned. 
2. Complete separation of the medical examination of recruits for the armed forces, 
including registrants who are selected by Local Board machinery to be Inducted, from all 
questions of social economic employment and essentiality in civilian occupation. These 
questions should be the prime concern of Selective Service, and the machinery of Selective 
Service should function entirely apart from any question of physical fitness, or with service 
In the armed forces. Selective Service should be concerned only with the selection of an 
Individual on the basis of his socio-economic and occupational availability. 
3. The recruit, or selectee, having been found to meet the requirements of availability 
by the Local Boards should be sent directly to the Reception Center to be examined, processed, 
and outfitted, and should then be sent to units for basic training, and eventually for as- 
signment to duty with'troops. He should not be sent to specified divisions, or units either 
of garrison or combat troops, but kept during the entire period of basic training In a train- 
ing unit, under the command of officers specifically selected for service with the various 
echelons of the training command. The Reception Center should include Army training battalions. 
For the Navy, there should be Navy training units. These units are to be entirely separate 
and apart from any combat, or general troops, or active Navy units. REPORT OF MEDICAL OFFICER 
During the stay of the new recruit in the training battalions he is to receive basic 
taining and is to be under the observation of aptitude experts, and Army technical personnel, 
and competent medical officers, vho evaluate the man and his capacities for various types of 
military duty. They determine, while he is in these battalions, whether he rates as capable 
of duty in the Air Force, or in the Ground Forces, or whether he will do better in Ground 
Combat Forces, or in garrison duty. They decide whether or not he has aptitude, and both 
physical and mental qualifications capable of acquiring higher technical skills; also whether 
or not he has the characteristics to be considered officer material. 
In the determinations made during the period of basic training the Medical Officer 
assigned to the training center should take part in both the study of the men and have a voice 
in the recommendations as to their assignment to specific units, based on their mental and' 
physical status. 
Having been studied during the period of the basic training program which, as far as 
possible, should be common to all soldiers and sailors, the assignment' to service is made, and 
the recruit joins his assigned unit not as a raw recruit but as a trained addition to the com- 
pany with which his future military career will be concerned. 
The present type of medical examination, which is predicated upon a list of physical 
and mental criteria as set forth in M31-9, can never be made to evaluate the finer distinctions 
which would be possible under the suggested period of medical and psychiatric observation. 
For example, two men from an entirely different level of civilian life both easily pass the 
MR 1-9 test, yet one may have inherent weaknesses in some particular, not determinable by 
either physical or mental examinations under the criteria as set forth in MR 1-9- The differ- 
ence would be apparent during the training period, and with the advice and recommendation of 
an alert Medical Officer the assignment to duty with troops would be so set that both would 
be used in the armed forces at their highest physical and mental capacity, and with only a 
minimum chance of a physical or mental breakdown during the subsequent period of advanced 
training with the field units to which they eventually were -assigned. 
V. When and if a soldier or sailor, after reaching the assigned unit, is found phys- 
ically or mentally unfit to continue with such unit. Instead of hospitalizing him for a ODD 
with various diagnoses such as inaptitude, maladjustment, etc., the Commanding Officer of his 
unit should declare him unfit physically or mentally for further duty with his unit to which 
he was assigned. He should not be discharged from the service but sent back to the training 
unit from which he came for another assignment more within his mental and physical capacity 
as would be shown on the report of his prior Commanding Officer when returning him to the 
training battalion for re-assignment. 
Much manpower for the armed forces would be salvaged by the outlined procedure and 
there would be fewer pension rolls for men discharged under a CDD who never saw battle-front 
duty and some not even garrison duty. 
Finally, those injured during maneuvers, if after hospitalization it is thought they 
still have a. degree of physical handicaps due to injuries Incurred in the line of duty, be- 
fore they are discharged and during the period of the war, should be sent back to the training 
centers from ..hich they originated for re-assignment in some unit where they, as veterans of 
battles or manouvres, may be useful either as instructors or for the sake of moral building 
among the newer recruits. 
Finally, records in regard to personality, physical and mental examinations, DSS Forms 
212 and 213 all are available at the Reception Center from whence the man came. Subsequently, 
when returned to the Center because of unsuitability for the unit to which he was assigned, 
judgments could be made based upon these records which are available to the Medical Officers 
concerned with his reassignment. If it is at all possible, the man should be assigned to 
another unit. In the event that no place can be found where he is suitable for duty, then 
only his discharge from service should be in order. 
The proposed plan entails changes in set-up from the General Staff down to the local 
recruiting Service Command. If such a recruiting and manpower procurement service were es- 
tablished, during peace, it would provide an excellent experimental situation for the training 
both of Medical 'Officers and Line and Staff personnel in the work of recruiting and assignment 
Such a unit and Command would naturally carry on continuing studies to evolve Improvements, WARTIME PROCEDURES NEED IMPROVED TECHNIQUES 
45 
particularly in xhe realm of assignment. In the end, the officer staff would become experts 
in the questions concerned with procurement, selection, and assignment of manpower for the 
armed forces. 
In the event of war, this trained staff would be the cadre from which the necessary 
expansions would result to meet the needs of the services, under the war conditions as they 
would be determined by the General Staff.