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 FORM 75 
 (SECOND KDITION) 
 
 STANDARDS OF 
 
 PHYSICAL EXAMINATION 
 
 FOR THE USE OF 
 
 LOCAL BOARDS, DISTRICT BOARDS, AND MEDICAL 
 ADVISORY BOARDS UNDER THE SELECTIVE-SERVICE 
 
 REGULATIONS 
 
 PRESCRIBED BY THE PRESIDENT UNDER THE AUTHORITY VESTED IN EIM 
 BY THE TERMS OF THE SELECTIVE-SERVICE LAW 
 
 ISSUED THROUGH THE 
 OFFICE OF THE PROVOST MARSHAL GENERAL 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 
 19X8
 
 War Depabtment, 
 Washington^ September 27, 191S. 
 Under authority vested in liim by tlie act of Congress of May, 
 18, 1917, and the public resohitions and acts amendatory thereof, 
 the President of the United States prescribes the following Rules 
 and Regulations (jn this the second edition of the Standards of 
 Physical Examination) for the government of Local Boards, Dis- 
 trict Boards, and Medical Advisory Boards, and directs that they 
 be published for the government of all concerned, and that they 
 
 be strictly observed. 
 
 B. Crowt^ll, 
 
 Acting Secretary of Wa7\ 
 (2)
 
 SRLF 
 YRL 
 
 TABLE OF COXJENTS. 
 
 Page. 
 
 Important prefatory notice 4 
 
 I. Preliminary statement and rules 5-8 
 
 II. Order and method of examination 8-9 
 
 III. Eyes 9-15 
 
 IV. Ears 15-17 
 
 V. Mouth, nose, fauces, pharyBX, larj-nx, trachea and esophagus 17-19 
 
 VI. Dental requirements 19-20 
 
 VII. Skin 20-21 
 
 VIII, Head 21-22 
 
 IX. Spine 22-24 
 
 X. Scapulie 24 
 
 XI. The extremities 24-27 
 
 XII. Height, weight, and chest measurements 28-30 
 
 XIII. Abdomen 30-32 
 
 XIV. Neck 32-33 
 
 XV. Genito-urinary organs and venereal diseases 33-36 
 
 XVI. Mental and nervous diseases 3G-40 
 
 XVII. Lungs and chest wall 40-43 
 
 X\'IIT. Heart and blood vessels 43-48 
 
 XIX. General 48 
 
 XX. Temporary defects 48-49 
 
 XXI. Purposely caused physical defects 49 
 
 XXII. Notes on malingering 49-51 
 
 Appendix: Important sections of the Selective Service Regulations — Rules of 
 
 ProccduTe 53-70 
 
 (3)
 
 IMPORTANT PREFATORY NOTICE. 
 
 This second edition of Standards of Physical Examination, P.M. 
 G. O. Form 75, supersedes the first edition published June 5, 1918, 
 and the use of the latter must be abandoned at once and all copies 
 destroyed except a sufficient number to complete the permanent 
 reference files at State Headquarters and Local and District Boards. 
 
 This edition should be carefully studied for observation of 
 
 IMPORTANT CHANGES. 
 
 1. In the procedural rules (Selective Service Regulations, second 
 edition, see appendix hereof) a registrant no longer has the right 
 or privilege of applying to be sent to a Medical Advisory Board; 
 nor need a registrant, sent by a Local Board to a Medical Advisory 
 Board, be sent to or examined bj'' the entire Medical Advisory Board, 
 but may be sent to and examined by any member or members thereof 
 designated by the Local Board. 
 
 2. The changes in the Physical Standards proper are few, and 
 have been adopted mainly for the purpose of making available the 
 greater numJjer of registrants having remediable defects (Group 
 B) by transferring them to Group C for special or limited service. 
 When inducted and accepted at camps, the defects may be corrected 
 when convenient; meanwhile, the Army will have the benefit of the 
 services of these men. 
 
 3. Registrants who have heretofore, upon examination, fallen 
 into Group B (the deferred remediable gToup) but who now, under 
 the revised Form 75, have physical defects placing them in Group 
 C (as physically qualified for special or limited military service), 
 should at once be reviewed, reexamined if necessarj'', and recorded 
 in Group C, subject to call for special or limited military service. 
 
 4. The next most important change is that which cites certain 
 variations from Army physical standards in the assignment of in- 
 ducted men to the Navy and the Marine Corps. 
 
 5. Attention is called particularly to the following sections : 
 Section 4 (group changes). 
 
 Section 5 (Navy and Marine Corps standards). 
 
 Section 14 (prohibiting office examinations for Local Boards). 
 
 Section 20, last paragraph (eye examinations for Navy). 
 
 Sections 22, 43, 54, 72, 73, 74, 75, 87, 100, 101, 102 (transfers of 
 certain disabilities from one phj'sical group to another). 
 
 Section 171 (induction of malingerers). 
 
 Appendix (Selective Service Regulations, second edition, espe- 
 cially sections 128^ and 177, with notes, pages 61 and 64 hereof). 
 
 (4)
 
 STANDARDS OF PHYSICAL EXAMINATION. 
 
 FOR THE USE OF 
 
 LOCAL BOARDS, DISTRICT BOARDS, AND MEDICAL ADVISORY 
 BOARDS UNDER THE SELECTIVE SERVICE REGULATIONS. 
 
 I. PRELIMINARY STATEMENT AND RULES. 
 
 1. The purpose of the Standards of Physical Examination is to 
 secure greater efficiency and uniformity in the examination of regis- 
 trants and enlisted men. Medical examiners should consider the 
 standards as a guide to their discretion ; therefore they are not to be 
 construed too strictly or arbitrarily. The object is to procure men 
 who are physically fit, or who can be made so, for the rigors of field 
 service, or for special and limited service, and the determination of 
 these questions is left to the judgment and discretion of the exam- 
 ining boards, appointed under authority of the selective-service law, 
 and to the militar}^ examining surgeons at mobilization camps and 
 other army posts and stations. 
 
 2. As the physical standards established by these regulations apply 
 to voluntary applicants for enlistment, as well as to registrants, un- 
 der the selective-service act, the term " registrants," as used therein, 
 may be considered as including applicants for enlistment where such 
 interpretation is necessary to a proper application of the text. (See 
 Section 151, S. S. S.) 
 
 3. Voluntary applicants for enlistment who do not come within the 
 standards of acceptance for general military service as applied to 
 registrants under the selective-service act will be rejected for all 
 military service, unless the defects are waived by authority of The 
 Adjutant General of the Army. 
 
 4. Local Boards have original jurisdiction, subject to review on 
 appeal to District Boards, and may accept or reject registrants for 
 military service as follows: 
 
 {a) Registrants who on examination are found to present condi- 
 tions which fall vrithin the proper standards shall be unconditionally 
 accepted for general military service (Group A). 
 
 (5) Registrants who on examination are found to suffer from 
 
 remediable defects which fall within the proper standards may be 
 
 accepted for general military service in the deferred remediable 
 
 group (Group B). 
 
 (5)
 
 G-roup B is restricted to drug addicts, to those having deformities 
 which may interfere with the wearing of a uniform, and to a few special 
 conditions cited in the text. (See Section 128|, S. S. E.) 
 
 (c) Registrants who on examination are found to present defects 
 which fall within the projjer standards may be accepted for special 
 and limited military service (Group C). 
 
 (d) Eegistrants who on examination are found to present defects 
 which fall within the proper standards shall be unconditionally 
 rejected for all military service (Group D). 
 
 (See sec 128 J, Selective Service Regulations, pp. 61-63 herein.) 
 
 (e) Wliere conditions are temporarily disabling, but tend to a 
 spontaneous cure, induction should be delayed. 
 
 (/) When a registrant has some defect for which, under the standards 
 of physical examination, he would he unconditionally rejected, hut which 
 does not impair his health, he may he accepted for special or limited 
 military service, provided that he possesses qualifications which render 
 his induction desirable, and that such induction is specifically requested 
 hy military authorities. 
 
 5. Navy standards of physical requirements conform in the main 
 to those of the Army included under Group A. But registrants who, 
 on examination, present the following defects shall not he accepted for 
 service in the Navy or Marine Corps : 
 
 Eyes: (a) Vision less than three-quarters of the normal in either 
 eye. 
 
 (h) Colorblindness. 
 Skin: (a) Parasitic affections, including pediculosis, ringworm, 
 and scabies. 
 
 {h) Eczema. 
 
 (c) Psoriasis. 
 Genito-urinary organs and venereal diseases : 
 
 (a) Absence, atrophy, or non-descent of both testicles. 
 
 (h) Venereal disease, any type or stage. 
 Height : Over 74 inches, 
 
 6. Local Boards need not make complete physical examination of 
 every registrant. Upon discovery of a defect requiring uncondi- 
 tional rejection the physician of the Local Board need proceed no 
 further ; but in all other cases there must be a complete examination 
 as prescribed in section 182, Selective Service Regulations (pp. 65-66 
 herein). 
 
 7. Medical Advisory Boards have no power to determine finally 
 whether a registrant shall be accepted or rejected for militar}' service. 
 This power is placed by the Selective Service Regulations in the 
 Local and District Boards. The functions of the Medical Ad- 
 visory Boards are, as the name imports, to examine registrants re- 
 ferred to them by the Local Boards and State Adjutants Gen- 

 
 eral, and to return the result of their examinations, inserted at the 
 proper phaces in Form 1010 P.M.G.O., " Eeport of Physical Exami- 
 nation " (sec. 282, Selective Service Regulations, p. 227). The Medi- 
 cal Advisory Boards arc not required to make a complete examination 
 of every registrant. At any point in the course of the examination 
 when it is found that the registrant is physically or mentally unfit 
 within the standards of unconditional rejection, the examination need 
 jDroceed no further. After a Medical Advisory Board (or a member 
 or members thereof, to whom a registrant has been referred), has 
 completed the examination of the registrant, the chairman, or the 
 designated member of the Advisory Board, shall certify the result 
 in the proper space on Form 1010, and return the form at once in 
 triplicate to the Local Board through the mail or by messenger 
 other tlian the registrant. (See sec. 123, S. S. R., p. 58, herein.) 
 
 8. Medical Advisory Boards are maintained for the purpose of re- 
 examination of registrants concerning whose physical condition the 
 physicians of the Local Boards are in doubt. Local Boards should 
 feel free to ask the advice of the Medical Advisory Boards concerning 
 the mental and physical fitness of registrants. There should be cor- 
 dial co-operation between the Local Boards and the Medical xVdvisory 
 Boards. Co-operation ma}^ be made profitable and practical through 
 actual consultation and conference between the Local Boards and 
 Medical Advisory Boards when this is possible. In many districts 
 the members of the Medical Advisory Boards have the opportunity 
 to be in close touch with the Local Boards. In some large advisory 
 districts the opportmiity for frequent consultation and conference 
 may be infrequent and difficult. Through the medical aide to the 
 governor, ways and means for co-operation may be found. The 
 standard of efficiency of the personnel of Medical Advisory Boards 
 should result in the rejection of all registrants referred to Advisory 
 Boards or members thereof for examination who are physically and 
 mentally defective within the standards of unconditional rejection. 
 This is very important as a measure of economy and justice to the 
 Government, the Army, and the registrant. 
 
 9. Local Boards and Medical Advisory Boards should be especially 
 careful in the selection of registrants who suffer from defects of 
 vision; defects of hearing, and with chronic discharge from the ear 
 or ears; toxic conditions associated with abnormal conditions of the 
 thyroid gland; valvular disease of the heart; tuberculosis; epilepsy; 
 mental disease or deficiency ; and irremediable defects of the feet. In 
 other words, to make a good soldier the registrant must be able to see 
 well; have comparatively good hearing; his heart must be able to 
 stand the stress of physical exertion; he must be intelligent enough 
 to understand and execute military maneuvers, obey commands, and
 
 protect himself ; and must be able to transport himself by walking as 
 the exigencies of military life may demand. 
 
 10. District Boards have appellate jurisdiction over all decisions 
 of Local Boards, including the findings of Local Boards as to 
 physical qualifications; but in considering appeals as to physical 
 qualifications the District Board may not conduct any new physical 
 examination nor receive or consider any evidence which was not con- 
 sidered by the Local Board. (See sec. 126, Selective Service Eegu- 
 lations, p. 60, herein. 
 
 11. The Army medical officer detailed as Medical Aide to the Gov- 
 ernor should be the instrument of communication between the gov- 
 ernor or his Adjutant on the one hand and the Local and Medical 
 Advisory Boards on the other hand in all matters concerning ques- 
 tions relating to phj^sical examinations. (Sec. 29, S. S. R.) ' 
 
 12. Local Boards may not induct registrants accepted for general 
 military service who are in tlie deferred remediable group (Group B) or 
 for special or limited military service (Group C), until a special call has 
 been made by the Provost Marshal General's Office for these groups of 
 registrants. 
 
 13. The final decision as to the acceptance or rejection of inducted men 
 under these regulations rests with the military authorities at the mobiliza- 
 tion camps or other military stations to which the registrants are sent 
 upon induction into the military service. 
 
 14. No physical examination, nor any part thereof, shall be conducted 
 at the private office of a medical examiner for a Local Board. 
 
 15. Instructions for the special guidance of Local and Medical 
 Advisory Boards are printed in heavy type at the end of each chap- 
 ter and all specific directions to Local Boards and to Medical Ad- 
 visory Boards are printed in heavy type in the text. 
 
 16. In the appendix will be found general information and the im- 
 portant sections of the Selective Service Eegulations relating to 
 physical examinations and governing Medical Aides and Local, Dis- 
 trict, and Medical Advisory Boards, which Avill be found valuable in 
 connection with the Standards of Physical Examination. 
 
 XL ORDER AND METHOD OF EXA^IINATION. 
 
 17. The physical examination should take place in a large, well- 
 lighted room. A quiet communicating room should be used for the 
 examination of the heart and lungs. The temperature of the room 
 should be regulated in cold weather to prevent the registrant from 
 becoming chilled. The registrant should be questioned about his past 
 and his present physical condition. His mental characteristics and 
 speech should be observed. Malingering should be borne in mind 
 at all stages of the examination.
 
 18. No anesthetic may be given to a registrant without his vohin- 
 tary consent for the purposes of examination or to aid in the diag- 
 nosis of defects. 
 
 19. The following order of i^rocediire in examining a registrant 
 should be pursued, as a rule: 
 
 (a) Make tests of the vision. (See Chapter III.) 
 (h) Make tests of the hearing. (See Chapter lY.) 
 
 (c) Examine the scalp, face, mouth, teeth, fauces, and nose. (See 
 Chapters Y-VI.) 
 
 (d) At this stage of the examination have the registrant take off 
 all of his clothing. 
 
 (e) Make a thorough general inspection of the skin of the entire 
 body. (See Chapter VII.) 
 
 (/) Observe the conformation of the back, the chest, the abdomen, 
 the neck, buttocks, and the upper and lower extremities. (See Chap- 
 ters XI, XIII, XVI.) 
 
 (g) Carefully examine the abdomen for the bulgings of hernia. 
 (See Chapter XIII.) 
 
 (A) Palpate the testicles. 
 
 (i) Inspect the genitals and anus while the registrant is stooping 
 forward with the lower extremities separated. The registrant should 
 separate the buttocks with his hands to enable the inspection of the 
 anus to be made. (See Chapter XV.) 
 
 (j) Have the registrant vigorously exercise all of the joints of the 
 upper and lower extremities, and also move the head in all directions 
 to test the mobility of the joints. (See Chapter X.) 
 
 (k) Have the registrant bend the body forward, backward, side- 
 wise, and rotate the trunk upon the pelvis, to test the mobility of 
 the spine. (See Chapters VIII, IX.) . 
 
 (?) Especial attention should then be paid to the feet. (See Chap- 
 ter XL) 
 
 (m) Take the weight, the height, and the chest measurements. 
 (See Chapter XII.) ■ 
 
 (n) Have the registrant put on his drawers, trousers, stockings, 
 and shoes, then proceed to examine the chest. (See Chapters XVII, 
 XVIII.) 
 
 III. EYES. 
 
 20. Vision, — To determine the acuity of vision, place the person 
 under examination with his back to a window at a distance of 20 feet 
 from the test types. Examine each eye separately, without glasses, 
 covering the other eye with a card (not with the hand). The ap- 
 plicant is directed to read the test types from the top of the chart 
 down as far as he can see and his acuity of vision recorded for each 
 eye, with the distance of 20 feet as the numerator of a fraction and 
 
 83246°— IS 2
 
 10 
 
 the size of the type of the lowest line he can read correctly as the 
 denominator. If he reads the 20-feet type correctly, his vision is 
 normal and recorded 20/20; if he does not read below the 30-feet 
 type, the vision is imperfect and recorded 20/30; if he reads the 
 15-feet type, the vision is unusually acute and recorded 20/15, etc. 
 
 In examining for the Navy or Marine Corps, stand the registrant 15 
 feet instead of 20 feet from the chart. If he is unable at this distance to 
 read the 20-foot type, his vision is below the standard required for Navy 
 or Marine service. 
 
 21. Registrants who on examination are found to present the fol- 
 lowing conditions, who are otherwise mentally and physically fit, 
 shall be unconditionally accepted for general military service: 
 
 (a) Normal vision. 
 
 (5) Minimum vision of 20/100 in one eye and 20/40 in other eye 
 without glasses; or 20/100 in each eye without glasses, if correctable 
 with glasses to 20/40 in either eye. 
 
 (c) Conditions due to iridectomy or other operation upon the eye 
 if the condition for which the operation was performed has been 
 relieved and the vision is within or above the minimum standard 
 requirements. 
 
 (d) Slight nystagmus. 
 
 (e) Slight conjunctivitis. 
 
 (/) Chronic simple conjunctivitis occurring in regions where tra- 
 choma is not prevalent, and if easily remediable. 
 
 (g) Slight adhesion of the lids to the eyeball. 
 
 (A) Small pterygium. 
 
 (i) Slight injection of lids. 
 
 (j) Ptosis which does not interfere with vision. 
 
 (k) Strabismus which does not interfere with vision. 
 
 (7) Color blindness. (Color blindness should be indicated on Form 
 1010.) 
 
 22. Registrants who on examination are found to present the fol- 
 lowing defects, Avho are otherwise mentally and physically fit, may 
 be accepted for special and limited military service, unless the degree 
 of disability is obviously disqualifying. 
 
 (a) A minimum vision of 20/200 in one eye and 20/40 in other 
 (either right or left) without glasses, or 20/200 in each eye without 
 glasses if correctable with glasses to 20/40 in either eye. 
 
 (h) Blindness in one eye not due to progressive organic change, 
 with normal vision in other eje without glasses. 
 
 (c) Chronic conjunctivitis not trachomatous. 
 
 (d) Inversion of e3'elids. 
 
 (e) E version of eyelids. 
 
 (/) Ptosis interfering with vision. 
 (g) Trichiasis.
 
 11 
 
 (h) Epiphora. 
 
 (^) Chronic blepharitis. 
 
 (j) Extensive pterygium. 
 
 (k) Chronic dacryocystitis. 
 
 (I) Blepharospasm. 
 
 (m) Superficial corneal ulcer. 
 
 (n) Acute inflannnatory diseases of the eyeball. 
 
 23. Registrants who on examination are found with the following 
 defects shall be unconditionally rejected for all military service : 
 
 (a) Total blindness. 
 
 (h) Vision less than the minimum requirements for special and 
 limited military service. 
 
 (<?) Disfiguring cicatrices of eyes. 
 
 (d) Lagophthalmus. 
 
 (e) Pronounced exopthalmus. 
 (/) Chronic keratitis. 
 
 (g) Chronic recurrent inflammatory diseases of the globe. 
 (h) Deep ulcer of cornea. 
 
 (i) Any organic disease of the retina, choroid, or. optic nerve. 
 (j) Detachment of the retina. 
 (k) Marked nystagmus. 
 
 (1) Loss or disorganization of either eye wiih less than normal 
 vision in remaining eye. 
 (m). Glaucoma. 
 
 (n) Diplopia due to paralysis of the extrinsic ocular muscle. 
 (o) Abnormal conditions of eyes due to diseases of the brain. 
 (p) Malignant tumors of lids or eyeballs. 
 (q) Trachoma. 
 
 24. When the physicians of the Local Boards are not supplied with test 
 glasses and there is no opportunity for the Local Boards to secure an 
 examination of the registrants' eyes with test glasses, they should be 
 referred to Medical Advisory Boards, or a specialist member thereof. 
 
 25. Local Boards should encourage oculists and aurists to serve as vol- 
 untary assistants in the examination of the eyes and ears of registrants. 
 
 26. Local Boards shall refer all suspected cases of trachoma to the 
 Medical Advisory Board, or to a member thereof. 
 
 VISUAL TESTS FOR THE DETECTION OF MALINGERERS. 
 
 27. Malingerers may feign inability to open their eyes, total loss 
 of vision in one or both eyes, or impaired vision in one or both eyes. 
 Occasional!}^ an inflammation in the eyes will be produced by putting 
 sand or other irritating substance under the lids. 
 
 28. Malingerers who wish to evade military service by feigning 
 impairment of vision may be divided into two classes, as follows: 
 
 (a) Those who claim total loss of vision in one eye.
 
 12 
 
 (h) Those wlio claim partial loss of vision in one or both e3'es. 
 Either group may have a normal acuity of vision or may exagr 
 gerate a defect actually present. 
 
 29. In testing for malingering the medical examiner should bear 
 in mind that detection is more likely to result \\hen the man is 
 allowed to believe that his case is regarded from the first as genuine 
 and tliat his story is not discredited. There is something indefinable 
 in the bearing of the malingerer which experience alone can detect. 
 lie may be self-assertive and overconfident; he may be hesitating or 
 evasive. Careful observation should be made of his conduct and 
 every movement noted. The nature of the man's answer should be 
 taken into account and considered in the light of the kind of reply 
 that is given when a genuine refraction case is being dealt with. 
 
 30. The following equipment is necessary: 
 
 Trial frame: blank; spherical lenses, +10, +3, -(-0.25, —3, —2, 
 -1, -0.2a. 
 
 Two prisms, one 6° and one 10°. 
 
 Ophthalmoscope (electric battery in handle). 
 
 Condensing lens. 
 
 Loupe. 
 
 Red and green letters on glass; (a) letters varying in size; (h) 
 spectacle frame containing red and green glasses. 
 
 Special test cards, one a duplicate, Avith letters reversed to use with 
 a mirror. 
 
 Special illiterate test cards. 
 
 Mirror, large enough to reflect test card.s. 
 
 One stereoscope with special card. 
 
 I\etinoscope (electric, with battery in handle). 
 
 Ruler, about 1{ inches wide. 
 
 METHODS OF KXA>[INAT10X. . 
 
 Class A. Total Loss of Vision tn One Eye. 
 
 31. (a) A 6° prism base downward is placed before the admittedly 
 sound eye, while the man looks at a distant light or candle. If he 
 sees two candles, binocular vision is proved. The examiner may 
 vary the test by placing the prism before the " blind "' eye, either base 
 up or base down. 
 
 (1) A prism of 10°, with base outward, is placed before the 
 "blind'' eye. If there is any sight in this eye, double vision will be 
 produced and the eye will be seen to move inward to correct it and 
 fuse the two images. 
 
 (e) The allegtMl "blind " eye is covered: A prism of 10°, with the 
 apex up, is placed before the " seeing " eye in such a position that its
 
 13 
 
 edge lies horizontally across the center of the pupil. This produces 
 monocular diplopia. The prism is then moved upward so as to be 
 completely in front of the good eye and at the same time the "blind '* 
 eye uncovered. If diplopia is produced or admitted there is sight 
 in the " blind " eye. 
 
 {d) Test with colored glasses and letters : This consists in directing 
 the individual to read a row of red and green letters through a red 
 and ffreen glass. The red letters will be invisible to the eve that has 
 the green glass, and vice versa, but if all the letters are correctl}' read 
 irrespective of their color there must be sight in the " blind " eye. 
 The proper illumination back of the chart must be observed. 
 
 (e) Test with trial glasses: A high-plus glass is placed before the 
 good eye and a low plus or minus before the " blind " eye. If the 
 distant type is read the vision in the " blind " eye is good. 
 
 (/) The stereoscopic test : This may be made with ordinary stereo- 
 scope, the printed matter so arranged that certam portions of it are 
 not present before one of the eyes. 
 
 {g) The bar test: Interpose a ruler about 1^ inches wide vertically 
 midwa}' between the two eyes at about 4 to 5 inches distance; direct 
 the man to read from a printed page with lines at least 4 inches long. 
 If able to read the lines, binocular vision exists. 
 
 (A) The action of the pupil must be carefully tested, there usually 
 being no movement to light stimulation when the eye is blind. If 
 the examiner is not satisfied, the following examination should be 
 made : 
 
 Oblique examination : A careful examination of the cornea should 
 be made with the aid of a condensing lens and a loupe. 
 
 Ophthalmoscopic examination : A searching examination with the 
 ophthalmoscope should be made, together with an estimation of the 
 refractive error. The pupil should be dilated if necessary. 
 
 Class B. — Partial Loss of Vision in One ok Both Eyes. 
 
 « 
 
 32. The most common manifestation of malingering takes the form 
 of a statement that one eye is imperfect. Men pleading this disability 
 may be divided into two classes: (1) Those who pretend to have a 
 visual defect; (2) those who are aware they have a visual defect and 
 exaggerate its effect. 
 
 No hard-and-fast tests can be prescribed for the detection of these 
 cases. Much depends on the alertness and ingenuity of the medical 
 examiner. 
 
 The tests with prisms are not applicable here, for there is not pre- 
 tended blindness in one eye, but simply an alleged diminution of 
 visual acuity.
 
 14 
 
 (a) If a room 30 or 40 feet long can be obtained for testing vision, 
 place the registrant suspected of malingering at 30 to 35 feet from 
 the test chart. Direct him to read the letters and note the result. 
 He should then be brought up to 20 feet from the card and retested. 
 If he reads the same line, he is malingering. 
 
 (5) Mirror tests with special test cards. 
 
 Test cards are used which are identical, one having letters re- 
 versed. The registrant is directed to read the letters on the chart 
 across the room, and then in a mirror beside it, which reflects reverse 
 letters that are placed over his head. The letters seen in the mirror 
 are located double the distance of the direct letters from the man 
 being examined. The malingerer is apt to read in the mirror the 
 line which he read on the first card, showing that his vision is twice 
 as good as he pretends. 
 
 In order to obviate the use of test letters in the mirror test various 
 common objects aj^^roximating the size of the 20/40 and 20/30 
 letters may be used by asking a registrant to differentiate ^between a 
 dime and penny, a cigarette and pencil, a pen and pencil, the num- 
 ber of spots on playing cards, or between the different aces, held on 
 either side of his head and reflected in the mirror at 20 feet distance. 
 
 Trial frame test: Place a trial frame upon the man's face and put 
 before the sound eye a high convex lens (-fl6D), and before the 
 "blind" eye a plane or weak lens (0.25) which will not interfere 
 with vision. If letters placed at distance of 20 feet are read, the 
 fraud is at once exposed. 
 
 (c) Oblique examination with condensing lens and loupe to deter- 
 mine corneal or lenticular opacities. 
 
 {d) Ophthalmoscopic examination: It is probable that the malin- 
 gerer will resist the ophthalmoscopic examination b}' frequent wink- 
 ing or rolling of the eyes. In this event it is best to caution the man 
 that a report of his vision must be made, and then to postpone 
 further examination until after the next few registrants have been 
 examined. 
 
 (e) Estimate the refractive error with the use of the ophthalmo- 
 scope. If no error of marked degree exists and the media and fundi 
 are normal, the relation between the alleged vision and the refractive 
 condition furnishes an important clue. If the error is about +4 or 
 —2, the visual acuity could be about 20/100, but when the defect can 
 not be accounted for objectively and the vision is brought from 
 20/100 to 20/50 or 20/30 by means of a low plus or minus glass, the 
 man is malingering. 
 
 (/) Eetinoscopy: Look for corneal and lenticular opacities and 
 estimate refractive errors.
 
 15 
 
 OCCUPATION. 
 
 33. The man's occupation in civil life may have been such that it 
 could not haA^e been followed without more vision than he claims. 
 
 In the absence of ocular defects, continuous and persistent blephar- 
 ospasm, the use of colored glasses, eye shades, or eye bandages should 
 be regarded with suspicion. 
 
 DIPLOPIA. 
 
 34. Cases of malingering are occasionally met with in which the 
 men complain that they see double. These must be investigated with 
 the application of the ordinary tests as if they were genuine, with 
 every precaution taken to guard against a serious nervous lesion 
 being overlooked. 
 
 IV. EARS. 
 
 35. Hearing. — Place the registrant facing away from the assistant, 
 who is 20 feet distant, and direct him to repeat promptly the words 
 spoken by the assistant. If the registrant can not hear the words 
 at 20 feet, the assistant should approach foot by foot, using the 
 same voice, until the words are repeated correctly. Examine each 
 ear separately, closing the other ear by pressing the tragus firmly 
 against the meatus; the examiner should face in the same direction 
 as the registrant and close one of his own ears in the same way as 
 a control. The assistant should speak in a low conversational voice 
 (not a whisper), just plainly audible to the examiner, and should use 
 numerals, names of places, or other w^ords or sentences until the con- 
 dition of the applicant's hearing is evident. The acuity of hearing 
 should be expressed in a fraction, the numerator of which is the 
 distance in feet at which the words are heard by the registrant and 
 the denominator the distance in feet at which the words are heard 
 by the normal ear; thus 20/20 indicates normal hearing, 10/20 par- 
 tial hearing of a degree indicated by the fraction. If an}^ doubt as to 
 the correctness of the answer is given, the registrant should be blind- 
 folded and a watch should be used, care being taken that the indi- 
 vidual does not know the distance from the ear at which it is being 
 held. The. watch used should be one whose ticking strength has been 
 tested by trial on a normal ear. 
 
 36. Registrants who on examination present the following condi- 
 tions, who are otherwise mentally and physically fit, shall be uncon- 
 ditionally accepted for general military service : 
 
 («) Normal hearing. 
 
 (5) Hearing in each ear of 10/20 or better. 
 
 37. Registrants who on examination present the following defects, 
 who are otherwise mentally and physically fit, may be accepted for 
 special and limited militarv service :
 
 
 \^a) Deafness in one ear with normal hearing in the other ear. 
 (b) Hearing in one or both ears less than 10/20 but more than 
 
 5/20. 
 
 {c) Perforation of membrana tympani without discharge, defi- 
 nitely determined by otoscopy. 
 
 {d) Loss of one or both external ears, if the registrants have fol- 
 lowed a useful vocation in civil life and the deformity is not too 
 greatly disfiguring. 
 
 38. Registrants who on examination present the following defects 
 shall be unconditionally rejected for all military service: 
 
 {a) Hearing in one or both ears of less than the minimum hearing 
 required for special and limited military service. (See 37 (5).) 
 {h) Chronic purulent otitis media, vvith or without mastoiditis. 
 
 39. The Local Boards shall refer to the Medical Advisory Boards, or to 
 a specialist member thereof, all registrants who are found giving a history 
 of chronic discharge, or have a chronic discharge of the middle ear or 
 ears, or whose hearing is in doubt. 
 
 TESTS FOR MALINGERING IN HEARING. 
 
 40. Individuals who are malingerers in regard to hearing usually 
 claim magnifications of slight imperfections on one side with a com- 
 plaint of past trouble. Exaggeration of defects in hearing extends 
 usually to declarations of total deafness on one side. 
 
 41. The following directions should be observed in examining 
 suspected malingerers : 
 
 {a) In making these examinations the observer should have a 
 skilled assistant and all communications between them should be in 
 a low whispered voice. 
 
 {!)) The assistant should stand at the back of the patient and 
 should at the direction of the examiner obstruct the ears of the sus- 
 pect as directed, by pressing the tragus firmly into the auditory 
 meatus. 
 
 {c) The suspected malingerer should be placed in the center of the 
 room, free from all obstructions. His eyes should be securely and 
 completely blindfolded. 
 
 {d) An accurate notation should be made of which ear is deaf as 
 claimed by the registrant. Then a critical examination of the auditory 
 canal, membrana tympani, and for the patulency of the Eustachian 
 tubes should follow. 
 
 (e) Then an accurate test of the normal ear should be made. Care 
 should be exercised not to allow the suspect to hear figures or other 
 signs as to the result of examination. 
 
 (/) If the suspect gives markedly conflicting statements when the 
 normal ear is tightly plugged as to the distance at which he hears 
 the voice or accumeter, it is fair to assume he is a malingerer.
 
 17 
 
 (g) The simplest and most available test for malingering is the 
 use of an ordinary binaural stethoscope. One earpiece, the one to be 
 applied to the normal ear, is packed tightly with a wad of absorbent 
 cotton, and the earpieces are placed in the suspect's ears. The exam- 
 iner speaks in a soft tone or counts into the bell-shaped chest portion 
 of the stethoscope, aild the suspect is told to repeat what he hears. 
 The tubes are removed from the ears, and the assistant is told to stop 
 the normal ear. The same words or numerals are again repeated. 
 The suspect will now claim failure to hear the words or numerals 
 which he had previously heard through the tube with the ear stated 
 to be deaf. 
 
 (h) Erhard's test is another simple method for malingerers which 
 requires no special apparatus. If the external auditory canal of a 
 normal ear is tightly packed with absorbent cotton, it will still con- 
 duct sound waves to a limited degree; a loud-ticking watch eVen 
 under these circumstances being heard about 1 or 2 meters. The 
 suspect has his ear which is stated to be deaf stopped, and then the 
 test is made with the hearing of the normal ear, the suspect being 
 told to count the ticks of the watch. The suspect's normal hearing 
 ear is then stopped and the testing is made with the supposed deaf 
 car. Under this test, if he claims failure to hear the watch under 1 
 meter, he is malingering. 
 
 (i) The Chiman-Moos test is made with the C2 tuning fork. The 
 vibrating tuning fork is held at equal distances from each ear. The 
 suspect may claim that he hears it better in the normal ear. The vi- 
 brating tuning fork is then, placed on the vertex of the skull. The 
 suspect hearing it equally well in both ears will at first hesitate and 
 then state he hears it better in the normal ear. In diseases of the con- 
 ducting apparatus he should hear it better in the diseased ear. If, 
 now the external meatus of the normal, ear is tightly closed and the 
 vibrating tuning fork is placed upon the vertext of the skull, the in- 
 dividual with the diseased ear will state he hears it better in tho 
 normal closed ear ; or, it may be impossible for him to decide in which 
 ear he perceives the tone better. The suspect, with the normal ear 
 tightly obstructed, will state that he does not perceive the sound of 
 the fork when thus placed or^ the vertex of the skull. 
 
 V. MOUTH, NOSE, FAUCES, PHARYNX, LARYNX, TRACHEA, 
 
 AND ESOPHAGUS. 
 
 42. Registrants who on examination are found to present the fol- 
 lowing conditions, who are otherwise mentally and physically fit, 
 shall be unconditionally accepted for general military service: 
 
 (a) Normal conditions of the mouth, nose, fauces, pharynx, larynx, 
 trachea, and esophagus. 
 
 83246°— 18 3
 
 18 
 
 (5) Enlarged tonsils. 
 (g) Adenoids. 
 
 (d) Small benign tumors of the nasal and buccal mucous mem- 
 brane. 
 
 (e) Deviation of the nasal septum Avhich does not seriously inter- 
 fere with nasal breathing. 
 
 (/) Acute primary sinusitis provided the acceptance of the regis^. 
 trant is temporarily deferred for reexamination, if after a reasonable 
 time the sinusitis has disappeared. 
 
 (g) Laryngitis manifested by hoarseness, laryngeal cough, and 
 congestion of the vocal chords, confirmed by laryngoscopy. 
 
 (A) Paralysis of the vocal chords, if it appears to be temporary in 
 character. 
 
 (i) Aphonia without objective findings by laryngoscopy or other 
 measures, and which in the opinion of the examiners is due to func- 
 tional nervous conditions. 
 
 (_/■) Alleged stricture of the esophagus which is unattended by 
 evidence of organic disease of the eosOphagus as shown by the passage 
 of a stomach tube or an esophageal bougie, or by a fluoroscopic exam- 
 ination while the regi&i:rant is swallowing a bismuth mixture. 
 
 43. Eegistrants who on examination present the following defects, 
 who are otherwise mentally and physically fit, may be accepted for 
 special and limited military service : 
 
 (a) Deviation of the nasal septum, though it markedly interferes 
 with nasal breathing. 
 
 (h) Paralysis of the vocal chords, and which does not appear tem- 
 porary in character, if it permits the registrants to follow a useful 
 vocation in civil life. 
 
 (c) Aphonia, with attendant conditions, which disqualify for 
 general military service, if they have followed a useful vocation in 
 civil life. 
 
 (d) Partial ankylosis of the lower jaw. 
 
 (e) Perforation of the hard palate. 
 
 (/) Moderate deformity of the structures of the mouth which 
 does not seriously interfere with mastication or speech. 
 
 44. Eegistrants who on examination present the following defects 
 shall be unconditionally rejected for all military service : 
 
 (a) Irremediable deformities of the mouth, throat, and nose which 
 interfere with the mastication of ordinary food, with speech,- or with 
 breathing. 
 
 (5) Tuberculosis of the structures of the mouth, larynx, fauces, 
 nose, or esophagus. 
 
 (<?) Cancer of the structures of the mouth, nose, throat, larynx, 
 or esophagus.
 
 19 
 
 {d) Destructive syphilitic diseases of the mouth, nose, throat, 
 larynx, or esophagus. 
 
 {e) Laryngeal paralysis, due to pressure from aneurysm or tumor. 
 
 (/) Permanent tracheostomy. 
 
 {g) Stricture of the esophagus. 
 
 {h) Permanent gastrostomy. 
 
 (^) Chronic sinusitis of the accessory sinuses of the nose. (The 
 diagnosis should be established upon chronic nasal discharge, pres- 
 ence of large nasal polypi, and other signs and symptoms rein- 
 forced by transillumination or X-ray plate, or both. 
 
 {j) Chronic atrophic rhinitis with offensive odor. (Ozena.) 
 
 45. When the Local Boards are in doubt concerning the physical fit- 
 ness of registrants who suffer from defects of the mouth, nose, fauces, 
 pharynx, larynx, or esophagus, they should he referred to the Medical 
 Advisory Boards, or to a member or members thereof. 
 
 46- Medical Advisory Boards should make use of laryngoscopy, tran- 
 sillumination of the head, and X-ray plates, when available, to determine 
 more definitely the physical fitness of registrants who have defects in- 
 volving the upper air passages, head, or esophagus. 
 
 VI. DENTAL REQUIREMENTS, 
 
 47. Registrants v^ho on examination are found to present the fol- 
 lowing conditions, if otherwise mentally and physically fit, shall be 
 unconditionally accepted for general military service : 
 
 («) Normal teetli. 
 
 (6) A minimum of three serviceable natural masticating teeth 
 above and three below opposing and three serviceable, natural in- 
 cisors above and three below opposing. (Therefore, the minimum 
 requirements consist of a total of six masticating teeth and of six in- 
 cisor teeth. All of these teeth must be so opposed as to serve the 
 purpose of incision and mastication.) 
 
 48. Registrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and physically fit, may 
 be accepted for special and limited military service : 
 
 (a) Dental defects which are greater than the minimum dental 
 requirements for general military service. 
 
 DEFINITIONS. 
 
 49. {a) The term " masticating teeth " includes molar and bi- 
 cuspid teeth, and the term " incisors " include incisor and cuspid 
 teeth. 
 
 (&) A natural tooth which is carious (one with a cavity) which 
 can be restored by filling is to be considered as a natural serviceable 
 tooth.
 
 20 
 
 (c) Teeth which have been (bee (5)) restored by crowns or 
 dummies attached to fixed bridge work, if well placed, shall be 
 considered as serviceable natural teeth, when the history and the 
 appearance of these teeth is such as to clearly warrant such 
 assumption. 
 
 (d) A tooth is not to be considered a serviceable, natural tooth 
 when it is involved with excessively deep pyorrhea pockets or when 
 its root end is involved with a known infection that has or has not 
 an evacuating sinus discharging through the mucous membrane or 
 skin. 
 
 50. Physicians and dentists of Local Boards and Medical Advisory 
 Boards are urged to advise and to aid registrants with remediable carious 
 teeth and infected dental roots and other dental defects, to have them 
 remedied pending- orders. 
 
 51. Instruct them that all hopelessly diseased teeth should be extracted. 
 Chronic focal infections involving the teeth and jaws should be eradi- 
 cated and all tooth cavities should be filled. This preliminary remediable 
 dental work will greatly assist the dentists of the cantonments in com- 
 pleting the routine necessary dental work. The correction of the focal 
 infection about the mouth will protect the registrants from possible 
 systemic complications which are liable to occur under the strain of 
 military training. 
 
 52. When the physicians of the Local Boards are in doubt concerning 
 dental defects of registrants, they should refer them to the Medical 
 Advisory Boards, or to a specialist member thereof. 
 
 VII. SKIN. 
 
 53. Eegistrants who on examination are found to present the fol- 
 lowing conditions, if otherwise mentally and physically fit, sliall be 
 unconditionally accepted for general military service: 
 
 (a) Normal skin. 
 
 (h) Acute diseases of the skin which ordinarily run a temporary 
 course. 
 
 (c) Diseases which are trivial in character and which do not inter- 
 fere with the general health and are not incaj)acitating. Among 
 these common and usually trivial diseases may be enumerated: 
 
 Acne. 
 
 Anomalies of pigmentation. 
 
 Scars not extensive, disfiguring, nor inCapaciting in character. 
 
 Condylomata which are not extensive. 
 
 Staphylococcic and streptococcic skin infections. 
 
 Acute eczemas. 
 
 Naevi which are not greatly disfiguring. 
 
 All forms of pediculosis. 
 
 All forms of ringworm.
 
 21 
 
 Scabies. 
 . Mild and not extensive psoriasis. 
 
 Warts. 
 
 The secondary syphilitic lesions of the skin. 
 
 Registrants who are accepted for general military service with tem- 
 porary remediable defects in the form of parasitic and other communi- 
 cable diseases of the skin should have this fact noted in Form 1010. 
 (See Section 5.) 
 
 54. Registrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and physically fit, may 
 be accepted for special and limited military service : 
 
 (a) Simple ulcers or other defects of the skin which are curable. 
 (See Par. 75 (s).) 
 
 (h) Defects due to diseases of the skin, either acute or chronic, 
 which disqualify for general military service, if the registrants have 
 successfully followed a useful vocation in civil life. 
 
 55. Registrants who on examination present the following defects 
 of the skin shall be unconditionally rejected for all military service: 
 
 (a) Long existing skin diseases or long existing ulcers of the skin 
 which are so severe, or so disfiguring as to incapacitate the regis- 
 trant for the duties of a soldier, or so disfiguring as to render the 
 registrant objectionable in common social intercourse. 
 
 (5) Actinomycosis. 
 
 (c) Dermatitis herpetiformis of long duration. 
 
 {d) Epidermolysis bullosa. 
 
 (e) Forms of universal dermatitis of long duration. 
 
 (/) Glanders. 
 
 (g) Idiopathic multiple hemorrhagic sarcoma. 
 
 (h) Mycosis fungoides. 
 
 {!.) Pemphigus chronicus of long duration. 
 
 (j) Pemphigus foliaceous. 
 
 (k) Pemphigus vegetans. 
 
 (1) Cancer, including pigmented moles. undergoing degeneration. 
 
 (m) Lupus. 
 
 (n) Syphilitic lesions ulcerative in character showing much de- 
 struction of tissue which if healed would be unsightl}' or so scarring 
 as to incapacitate the registrants for military service. 
 
 56. When the Local Boards are in doubt concerning the physical fit- 
 ness of registrants who suffer from defects due to diseases of the skin, 
 they should refer them to the Medical Advisory Boards. 
 
 VIIL HEAD. 
 
 57. Registrants who on examination are found to present the fol- 
 lowing conditions, if otherwise mentally and physically fit, shall be 
 unconditionally accepted for general military service: 
 
 (a) Normal skull.
 
 22 
 
 (b) Moderate deformities of the bones of the skull of the char- 
 acter of depressions, exostoses, etc., and unassociated with evidence 
 of disease of the brain, spinal cord, or peripheral nerves, and which 
 would not prevent the registrant from wearing military headgear. 
 
 (c) Defects which are apparently temporary in character due to 
 recent injuries. (This includes contusions and other wounds of the 
 scalp and concussion. Registrants with these defects should have the 
 final examination temporarily deferred.) 
 
 58. Eegistrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and physically fit, may 
 be accepted for special and limited military service: 
 
 (a) Decompression operation of the skull unassociated with 
 marked bulging at the site of operation. 
 
 59. Registrants w^ho on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military 
 service : 
 
 (a) Deformities of the skull of the nature of depressions, exos- 
 toses, etc., of a degree which will prevent the registrants from wear- 
 ing military headgear. 
 
 (5) Deformities of the skull of any degree associated with evi- 
 dences of disease of the brain, spinal cord, or peripheral nerves. 
 
 IX. SPINE. 
 
 60. Eegistrants who on examination are found to present the fol- 
 lowing, conditions, who are otherwise mentally and physically fit, 
 shall be unconditionally accepted for general military service: 
 
 (a) Normal spine. 
 
 (b) Lateral curvature of the spine of 2 inches or less from the 
 normal mid line, if the mobility and weight-bearing power are good. 
 
 (d) Temporary defects in the form of recent contusions or sprains 
 of the spinal column. 
 
 (e) Pilo-nidal sinus (this usually presents itself in the region 
 between the coccyx and anus) if unattended with disease of the bone 
 as shown by an X-ray plate. 
 
 (c) Fracture of the coccyx. 
 
 61. Registrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and- physically fit, may 
 be accepted for special and limited militar}^ service : 
 
 (a) Lateral deviation of the spine from the normal mid line of 
 more than 2 inches and less than 3 inches. 
 
 (b) Nontuberculous diseases of the spine which are unassociated 
 with such rigidity that the registrant has been incapacitated from 
 following a useful vocation in civil life. 
 
 (c) Fracture of the spine or pelvic bones which have healed 
 without defects and which have not interfered with their following 
 a useful vocation in civil life.
 
 23 
 
 62. Registrants who on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military 
 service : 
 
 (a) Extensive disease of the vertebrse. 
 
 (b) Tuberculosis of any portion of the vertebral column. 
 
 (c) Abscess of the spinal column. 
 
 (d) Osteoarthritis, partial or complete, of the spinal column. 
 
 (e) Healed fractures of the vertebrse or pelvic bones with associ- 
 ated disqualifying rigidity. 
 
 (/) Lateral deviation of the spine from the normal mid line of 
 more than 3 inches. 
 
 63. When the Local Boards are in doubt concerning the physical fit- 
 ness of registrants who suffer from deformities and diseases of the spine, 
 they shall refer them to the Medical Advisory Boards, or to a member or 
 members thereof. 
 
 64. Eegistrants who appear for examination wearing a plaster jacket 
 should be referred to the Medical Advisory Boards, or to a member or 
 members thereof. The jacket should not be removed until provision shall 
 have been made for its reapplication. 
 
 65. When the physicians of the Medical Advisory Boards are in doubt 
 concerning the cause and the extent of the diseases of the vertebras, an 
 X-ray plate of the spine should be made. 
 
 SACRO-ILIAC AND LUMBO-SACRAL JOINTS. 
 
 66. Registrants who on examination are found to present the fol- 
 lowing conditions, if otherwise mentalh' and physically fxt, shall be 
 unconditionally accepted foi'' general military service: 
 
 (a) Normal sacro-iliac and lumbo-sacral joints. 
 
 (h) Complaint of disease of the sacro-iliac and lumbo-sacral joints 
 which is unassociated with objective signs and symptoms at the 
 first examination and which, on reexamination, after a reasonable 
 period of time, is again found negative. 
 
 67. Registrants who on examination are found to present the fol- 
 lowing defect, if otherwise mentally and physica^Uy fit, may be 
 accepted for special and limited military service : 
 
 (a) Disease of the sacro-iliac and lumbo-sacral joints of a degree 
 which disqualifies for general military service, if otherwise mentall}' 
 and physicall}" fit and if the registrants have followed a useful voca- 
 tion in civil life. 
 
 68. Registrants who on examination are found to suffer from the 
 following defect shall be unconditionally rejected for all military 
 service : 
 
 (a) Disease of the sacro-iliac and lumbo-sacral joints v.diich is of a 
 chronic type and is obviously associated with pain referred to the
 
 24 
 
 lower extremities, muscular spasm, postural deformities, and limita- 
 tion of motion in the lumbar region of the spine. 
 
 69. When Local Soards are in doubt concerning the physical fitness 
 of registrants who snl?er from disease or other defects of the sacro-iliac 
 or lumbo-sacral joints, they shall be referred to the Medical Advisory 
 Boards, or to a member or members thereof. 
 
 X. SCAPULAE. 
 
 70. Registrants who on examination are found to present the fol- 
 lowing conditions, if otherwise physically and mentally fit, shall be 
 unconditionally accepted for general military service: 
 
 (a) Normal scapulae. 
 
 ( h ) Prominent scapulae due to other causes than paralysis. 
 
 71. Registrants who on examination are found to present the fol- 
 lowing defect shall be unconditionally rejected for all military service : 
 
 (a) Prominent scapula? due to paralysis. 
 
 XL THE EXTREMITIES. 
 
 72. Registrants who on examination are found to present the fol- 
 lowing conditions shall be unconditionally accepted for general mili- 
 tary service: 
 
 (a) Normal upper and lower extremities with normal function. 
 (h) Ancient or recent fractures which have healed spontaneously 
 with no resulting impairment of function. 
 
 (c) Parah^sis of a muscle or group of muscles that does not inter- 
 fere with function. (See Section 128.) 
 
 (d) Benign tumors of bone or defects due to their removal when 
 the condition does not interfere with the function of the extremity 
 or the joint involved. 
 
 (e) Recent injury of a bone or joint with or without fracture or 
 dislocation which in the opinion of the examiners is only temporarily 
 incapacitating. (Registrants with these defects should be given a 
 period of time not less than six weeks for recovery before the final 
 examination is' made.) 
 
 (/) Defects of bone or joint due to healed tuberculosis when the 
 tuberculosis has not shown evidence of activity at any time during the 
 period of 10 years immediately preceding, the examination. 
 
 (g) Absent left thumb. 
 
 (A) Loss of one finger of either hand, with the exception of the 
 right index finger. 
 
 (i) Scars and deformities of moderate degree of the hand or hands 
 which do not interfere with normal function. 
 
 (j) Stiff fingers- of a degree not to interfere with function. 
 
 (k) A low or even absent longitudinal arch if tlie foot is otherwise 
 practically normal in shape, flexibility, and weight-bearing capacity.
 
 25 
 
 (l) Slight hallux valgus which is unassociatcd with exostoses or 
 bunion of any size. 
 
 (m) Clubfoot of slight degree if the deformity has been corrected 
 to the degree that the tarsus, metatarsus, and phalanges are flexible 
 and the condition permits the wearing of a military shoe. 
 
 (n) Slight claw toes not involving obliteration of the transverse 
 arch and which do not interfere with the Avearing of a military shoe. 
 
 (o) Hammer toe which is flexible and which does not interfere 
 with the wearing of a military shoe. (Hammer toe usually involves 
 the second digit and unless it is rigid is not a disqualifying defect.) 
 
 (p) Absence of one or two of the small toes of one or both feet 
 if the function of the foot is good. 
 
 (q) Ingrowing toenails. 
 
 73. Eegistrants who on examination present the following remedia- 
 ble defects, who are otherwise mentally and physically fit, may be 
 conditionally accepted for general military service in the deferred 
 remediable group : 
 
 (a) Ununited fractures if in the judgment of the examiners they 
 are remediable with resultiiig good function. 
 
 (b) Benign tumors of bone or joint which interfere with function 
 and wdiich in the judgment of the examiners are remediable. 
 
 (c) Other defects which in the opinion of the examiners are dis- 
 qualifying but remediable. 
 
 74.. Registrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and physically fit, may 
 be accepted for special and limited military service, unless the degree 
 of disability is obviously disqualifying: 
 
 (a) Loss of thumb or index finger of right hand. 
 
 (h) Loss of two fingers of either hand, including the right index 
 finger. 
 
 (c) Web fingers. 
 
 (d) Ganglion and other benign tumors of the hand or fingei's. 
 
 (e) Moderate deformities of one or both upper extremities Avhich 
 do not and have not interfered with function to a degree to prevent 
 the registrant from following a useful vocation in civil life. 
 
 (/) Internal derangement of the knee joint. 
 
 (ff) Abduction and pronation (knock-ankle) when this condition 
 is not associated with rigidity of the tarsal joints or Avith deforniit}' 
 of the foot. (This defect is remediable with proper foot exercises 
 and w^ith correct shoes.) 
 
 (h) Loss of great toe. • 
 
 (i) Loss of dorsal flexion of great toe. 
 
 (_/') Hammer toe with rigidity. 
 
 (k) Web toes. 
 83246°— 18 4
 
 26 
 
 (l) Other defects of the foot which disqualify for general mili- 
 tary service but do not prevent the registrant from wearing a military 
 shoe and which have not prevented him from following a useful voca- 
 tion in civil life, 
 
 (m) Moderate deformities of one or both lower extremities which 
 do not and have not interfered with function to a degree to j:) re vent 
 the registrant from following a useful vocation in civil life. 
 
 (n) Adherent scars of the skin and soft tissues of an extremity. 
 
 (0) Paralj^sis of a muscle or group of muscles that interferes with 
 function. (See Section 128.) 
 
 75. Registrants who on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military 
 service : 
 
 (a) Loss of both thumbs. 
 
 (h) Loss of more than two entire fingers of one hand. 
 
 (c) Extensive disease of long duration of one or more of the large 
 joints with or without sinuses. 
 
 (d) Tuberculosis of a bone or joint. (The diagnosis should be 
 based upon the presence of swelling, tenderness, muscular spasm, re- 
 striction of joint motion, and the evidence of bone destruction shown 
 by an X-ray plate.) 
 
 (e) A history of tuberculosis of a bone or joint when the tuber- 
 culosis has been active at some time during the period of 10 years 
 prior to the examination. 
 
 (/) Old, irremediable, ununited fractures or united fractures wi(h 
 deformity sufficient to interfere markedlj" with function. 
 
 (g) Malignant tumors. 
 
 (A) Extensive disease of long duration involving a number of 
 joints of the upper and lower extremities. 
 
 (i) Old, unreduced dislocations which have interfered with the 
 registrant following a useful vocation in civil life, 
 
 (j) Disease of the shoulder, elbow, or wrist with resulting limita- 
 tion of motion. 
 
 (k) Disease of bone or joint healed with such resulting deformity 
 that the function is disturbed to a degree that it will interfere with 
 military service. 
 
 (1) Muscle paralysis or contraction which disturbs function to 
 the degree of interference with military service. 
 
 (m) Excessive curvature of the bones of the forearm or arm which 
 would interfere with military drill. 
 
 (n) Excessive curvature of the bon^ of the leg or thigh. 
 
 (o) Excessive knock-knee. 
 
 (p) Excessive bow legs. 
 
 (q) Adherent scars of skin or soft tissue to a degTee which seri- 
 ously interferes with function.
 
 (r) Excessive varicose veins. 
 
 (.s) Varicose veins of any degree associated Avitli edema or ulcer 
 of the skin. 
 
 (t) Absent longitudinal arch of the foot associated with one or 
 more of the following conditions : 
 
 Limitation of dorsal flexion. 
 
 Eigid metatarsal and subastragaloid joints. 
 
 Rigid toes. 
 
 Marked pronation. 
 
 Prominent scaphoid associated with other disabling foot condi- 
 tions. 
 
 (u) Rigidity of the tarsus and metatarsus due to former infec- 
 tious processes, with or without flat foot. 
 
 (r) Obliteration of the transverse arch associated with permanent 
 flexion of the small toes (claw toes). 
 
 (w) Prominence of the plantar surface of the transverse arch 
 especially when associated with large callosities. 
 
 (cc) Abnormal flaccidity of the foot and toes when associated 
 with evident severely painful symptoms. 
 
 (y) Abduction and pronation (knock-ankle) when associated with 
 rigidity of the tarsal joints and painful symptoms. 
 
 (0) Hallux valgus if severe and associated with exostoses or a 
 bunion of any considerable size, especially when there are signs of 
 irritation about the joint. 
 
 (aa) Club foot, if correction of the condition has not been suffi- 
 cient to meet the standard requirements. (See par. 72 (m).) 
 
 (hh) Disease of tlie bone or of the hip, knee, or ankle joint which 
 seriously interferes with function and weight-bearing power. 
 
 (cc) Deformities due to fracture or other injur}' which seriously 
 interfere with function and weight-bearing power. 
 
 (dd) Sciatica, which is apparently intractable and disabling, to 
 the degree of interference with the function of walking and weight- 
 bearing power. 
 
 (ee) Amputations of extremities in excess of those already cited. 
 (See par. 4 (/).) 
 
 76. The selection of reg-istrants with defects of the feet for special or 
 limited military service must be left to the judgment of the physicians 
 of the Local Boards and Medical Advisory Boards. 
 
 77. It is extremely important that registrants with defects of the feet 
 which are not remediable by training and which prevent the inducted 
 men from taking proper training, should not be accepted for general 
 military service. It is quite as important that defects of the feet, which 
 are not disabling, should not be considered disqualifying for general 
 military service.
 
 28 
 
 XII. HEIGHT, WEIGHT, AND CHEST MEASUREMENTS. 
 
 78. Table of standard accepted measurements of height, weight, 
 and circumference of chest. (See Section 5.) 
 
 A. standard accepted measurements. 
 
 Height. 
 
 Weight. 
 
 Chest measure- 
 ment. 
 
 At ex- 
 piration. 
 
 Mobil- 
 ity. 
 
 Inches. 
 60 
 
 Pounds. 
 120 
 120 
 120 
 124 
 128 
 130 
 132 
 134 
 141 
 148 
 155 
 162 
 169 
 176 
 183 
 190 
 197 
 204 
 211 
 
 Inches. 
 31 
 31 
 31 
 31 
 32 
 32 
 32i 
 33 
 33} 
 33i 
 34 
 34} 
 34J 
 35} 
 36} 
 36| 
 371 
 37J 
 38} 
 
 Inches. 
 2 
 2 
 2 
 2 
 2 
 2 
 2 
 2 
 2i 
 2i 
 24 
 
 f 
 
 3 
 
 3 
 
 3i 
 
 3i 
 
 f 
 
 61 
 
 62 
 
 63 
 
 64 
 
 65 
 
 66 
 
 67 
 
 68 
 
 69 
 
 70 
 
 71... . 
 
 72 
 
 73 
 
 74 
 
 75 
 
 76 
 
 77... 
 
 78 
 
 
 B. The foUowing variations from the standard shoii-n in column A are per- 
 missible iohen the applicant is active, has firm muscles, and is evidently 
 vigorous and healthy. 
 
 Height. 
 
 Weight. 
 
 Chest measure- 
 ment. 
 
 At ex- 
 piration. 
 
 Mobil- 
 ity. 
 
 Inches. 
 60 
 
 Pounds. 
 110 
 110 
 110 
 116 
 120 
 120 
 120 
 120 
 121 
 124 
 128 
 133 
 138 
 143 
 148 
 155 
 161 
 108 
 175 
 
 Inches. 
 30 
 30 
 30 
 30 
 30 
 30 
 30} 
 30i 
 
 m 
 
 31 
 
 31} 
 
 31J 
 
 32} 
 
 .32J 
 
 33h 
 
 34} 
 
 34f 
 
 35} 
 
 35i 
 
 Inches. 
 2 
 2 
 2 
 2 
 2 
 2 
 2 
 2 
 2 
 2. 
 2 
 2 
 2h 
 2h 
 2J 
 2f 
 
 r 
 
 3 
 
 61 
 
 62 
 
 63 
 
 64 
 
 65 
 
 66 
 
 67 
 
 68 
 
 69 
 
 70 
 
 71 
 
 72 
 
 73 
 
 74 
 
 75 
 
 76 
 
 77 
 
 78 
 
 
 79. Directions for tahing, height. — Use a board at least 2 inches 
 wide by 80 inches long, placed vertically, and carefully graduated 
 to one-quarter inch between 58 inches from the floor and the top 
 end. Obtain the height by placing vertically in firm contact with
 
 29 
 
 the top of the head and against the measuring rod an accurately 
 squared board of about 6 by 6 by 2 inches — best permanently at- 
 tached to graduated board by a long cord. The registrant should 
 stand erect with back to the graduated board, eyes straight to the 
 front. 
 
 80. Registrants who on examination present the following condi- 
 tions, if otherwise mentally and physically fit, shall be unconditionally 
 accepted for general military service. 
 
 (a) Those who fall within the accepted standards (A) or mini- 
 mum requirements (B) for height, v.eight, and chest measurement 
 given in tables, paragraph 78. 
 
 (b) Those whose weight is greater than the standards indicated 
 for the height (A) provided the overweight is not so excessive as to 
 interfere with military training. 
 
 81. Registrants wdio on examination are found to present condi- 
 tions not within the accepted measurements for weight and chest 
 circumference and mobility given in the table, who are otherwise 
 mentally and physically fit, may be accepted for special or limited 
 military service. But no registrant may be accepted whose weight is 
 less than 110 pounds. 
 
 82. Registrants who on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military 
 service : 
 
 (a) Less than 60 inches in height. 
 (5) Less than 110 pounds in weight. 
 
 (c) With a chest measurement of less than 30 inches and chest 
 mobility of less than 2 inches. 
 
 (d) A height of more than 78 inches. 
 
 (e) Overweight which is greatly out of proportion to the height, 
 if it interferes with normal physical activity or with proper training. 
 
 83. Local Boards should refer to the Medical Advisory Boards the fol- 
 lowing registrants: 
 
 (a) Registrants who on examination are found to be apparently 
 slight!}' under the minimum requirements for weight and chest meas- 
 urements in their relation to the height; 
 
 (h) Registrants of 76 inches or more in height who should be 
 studied for the possibility of gigantism or acromegaly. 
 
 (c) Registrants who are obese. 
 
 (d) Registrants whose weight is slightly under the minimum with 
 respect to height, in whom the defect is due to recent illness or to 
 employment and environment of civil life and may be considered 
 remediable by camp life. 
 
 (e) Registrants whose chest mobility is less than 2, 2|, or 3 inches, 
 respectively, as per the table, that they may be further studied to
 
 30 
 
 ascertain if the lack of required chest mobility is due to ignorance or 
 to lack of practice. 
 
 84. Physicians of Local Boards and Medical Advisory Boards should 
 use discretion and judgment in accepting registrants with slight varia- 
 tions in the ratio of height, v/eight, and chest measurements indicated 
 in the table. Minimum and maximum height are absolute, but when the 
 weight is disproportionate and is believed to be due to some temporary 
 condition, proper allowance may be m-ade, provided it is the opinion of 
 the boards that the variation is correctable with proper food and physical 
 training. But no registrant may be accepted whose weight is less than 
 110 pounds. 
 
 XIII. ABDOMEN. 
 
 85. Registrants who on examination are found to present the fol- 
 lowing conditions, who are otherwise mentally and physically fit, 
 shall be unconditionally accepted for general military service: 
 
 (a) Normal abdominal wall and abdominal organs. 
 
 (b) Abdominal scars due to surgical operation or accident which 
 show no hernial bulging at site of scars. 
 
 (c) Scar pain when found not associated with any disturbance of 
 function of abdominal wall, stomach, or bowels. 
 
 (cZ) Jaundice when this is proved to be of a temporary character 
 and not associated with organic disease of the gall tracts or liver, by 
 observation and reexamination of the registrant over a period of 
 one month. 
 
 (e) Complaint of weak stomach, indigestion, dyspepsia, constipa- 
 tion, belching, vomiting, and various other types and degrees of 
 abdominal discomfort which are proven by examination not to be 
 associated with organic disease, by the absence of the usual objective 
 symptoms and signs and by such laboratory tests as may be employed. 
 
 (/) Blood in stools if proved to be due to slight defects, such as 
 fissures of the anus, small hemorrhoids, or superficial small ulcers of 
 the rectum. 
 
 {(j) Moderate enlargement of the liver unassociated with other 
 objective evidence of disease of the liver or other organs. 
 
 (h) Splenic enlargement of moderate degree unassociated with 
 evidence of other disqualifying disease. 
 
 {i) Moderate enlargement of the spleen due to malaria. 
 
 (j) Small benign tumors of the abdominal wall. 
 
 (/.;) Ptosis of the stomach and bowels unassociated with objective 
 evidence of disturbance of function of the gastrointestinal tract. 
 (Individuals who have ptosis of the stomach and bowels usually 
 complain of constipation, belching of gas, heaviness in abdomen after 
 meals, and numberless symptoms referable to the heart and nervous 
 apparatus.)
 
 31 
 
 (Z) Mucous colitis of simple character. 
 
 {m) Proctitis of simple character confirmed by proctoscopy, which 
 is not associated with ulceration of the mucous membrane. 
 {n) Intestinal parasites or their eggs in the stools. 
 {o) Internal and external hemorrhoids without prolapse of rectum. 
 
 86. Registrants who on examination are found to present the fol- 
 lowing remediable defect, who are otherwise mentally and physically 
 fit, may be conditionally accepted for general military service in the 
 deferred remediable group : 
 
 {a) Partial obstruction of the bowel not due to organic disease. 
 
 87. Registrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and physically fit, may 
 be accepted for special and limited military service, unless the degree 
 of disability is obviously disqualifying : 
 
 («) Hernia — inguinal, femoral, umbilical, and postoperative. 
 
 (5) Large benign tumors of the abdominal wall. 
 
 {c) Jaundice which persists beyond a period of one month and is 
 determined at the final examination to be remediable. 
 
 {d) Internal hemorrhoids with prolapse and hemorrhage. 
 
 (e) Proctitis associated with remediable ulcers. 
 
 (/) Amebic dysentery. 
 
 {g) Simple fistula in ano. 
 
 {h) Ptosis of the stomach and bowels associated with disqualifying 
 conditions for general military service, but which permit the regis- 
 trants to follow a useful occupation in civil life. 
 
 88. Registrants Avho on examination present the following defects 
 shall be unconditionally rejected for all militarj'- service : 
 
 {a) Inoperable hernia. 
 (5) Irremediable diseases of the stomach. 
 {c) Irremediable diseases of the bowels. 
 {d) Irremediable diseases of the liver. 
 (e) Irremediable diseases of the kidney. 
 (/) Achylia gastrica. 
 {g) Gastric succorrhea. 
 (h) Syphilis of the liver, 
 (i) Hydatids of the liver. 
 {}) Ulcer of the stomach or duodenum. 
 {h) Obstruction of the bowel due to organic disease. 
 (7) Chronic gastritis secondary to organic diseiise of other organs, 
 (m) Irremediable sinuses of the abdominal wall communicating 
 with the hollow viscera. 
 {n) Tuberculosis. 
 
 {o) Irremediable stricture of the rectum. 
 (/?) Multiple fistulse of the anus. 
 {(j) Schistosomum disease (blood flukes).
 
 32 
 
 (r) Enlargement of the spleen associated with leukemia, Hodg- 
 kin's disease, or splenic anemia. 
 
 (s) Great enlargement of the spleen from any cause. 
 
 (t) Large internal and external hemorrhoids associated with pro- 
 lapse of the rectum. 
 
 (u) Paralysis of the sphincter associated with incontinence of 
 feces. 
 
 89. When the physicians of Local Boards are in doubt concerning the 
 physical fitness of registrants who present defects of the abdominal wall 
 or abdominal organs, they shall refer them to the Medical Advisory 
 Boards, or to a member or members thereof. 
 
 90. When necessary to confirm a diagnosis. Medical Advisory Boards 
 should, when possible, avail themselves of fiuoroscopy and X-ray plates 
 when examining registrants with defects of the abdominal wall or ab- 
 dominal organs. 
 
 91. Wlien the Medical Advisory Boards, or their members, are able to 
 command hospital facilities and the necessary diagnostic appratus, they 
 should, within their discretion, use test meals and chemical and micro- 
 scopic examination of the stomach contents and stools- 
 
 92. Physicians of Local Boards and Medical Advisory Boards should 
 make use of digital rectal examination of defects referable to that region, 
 and when necessary proctoscopy should also be utilized. 
 
 93. Registrants who are found to have parasites or their eggs in stools 
 should have this condition indicated on Form 1010. 
 
 94. Moderate impulse produced by cough at the inguinal, femoral, 
 jll:^^ or umbilical rings, or at the site of a scar is not necessarily indica- 
 tive of hernia. 
 
 XIV. NECK. 
 
 95. Registrants who on examination are found to present the fol- 
 lowing conditions, who are otherwise mentally and phj'sically fit, 
 shall be unconditionally accepted for general military service : 
 
 (a) Normal neck. 
 
 (b) Nonspastic contraction of the muscles of the neck which is not 
 of great degree and will not prevent the wearing of a uniform or 
 militar}^ equipment. 
 
 (c) Simple goiter or benign thyroid tumors unassociatcd with 
 toxic symptoms provided the enlargement of the thyroid will not 
 interfere with the wearing of a uniform or military equipment. 
 
 (d) Benign tumors and cj'^sts of the neck which will not interfere 
 with the wearing of a uniform or military equipment, 
 
 (e) Small, benign tumors of the parotid gland which will not in- 
 terfere with the wearing of a uniform or military equipment.
 
 33 
 
 (/) Enlarged lymph glands of the neck vrhich apparently do not 
 interfere with the general health and which are not large enough to 
 interfere with the wearing of a uniform or military equipment. 
 
 96. Registrants who on examination are found to present the fol- 
 lowing remediable defects, who are otherwise mentally and phys- 
 ically fit, may be conditionally accepted for general militai*y service 
 in the deferred remediaJble group. 
 
 (a) Simple goiter or benign tumors unassociated with toxic symp- 
 toms but so large as to interfere with wearing a uniform or military 
 equipment. 
 
 (o) Enlarged lymph glands of the neck which are so hirge as to 
 interfere with wearing a uniform or military equipment. 
 
 (c) Benign tumors and cj^sts of the neck which are so large as to 
 interfere with the wearing of a uniform or military equipment. 
 
 (d) Large benign tumors of the parotid gland which, in the opin- 
 ion of the examiners, may be removed without permanent paralysis 
 of the seventh nerve. 
 
 97. Registrants who on examination are found to present the fol- 
 lowing defects shall be nncoriditionally rejected for all military service : 
 
 (a) Exophthalmic goiter. 
 
 (&) Thyroid enlargement from any cause associated with toxic 
 symptoms. 
 
 (c) Enlargement of the lymph glands of the neck associated with 
 all clinical types of leukemia and Hodgkin's disease. 
 
 (d) Lympho-sarcoma. 
 
 (e) Tuberculous glands. 
 (/) Malignant tumors. 
 (g) Myxedema. 
 
 (h) Xonspastic contraction of the muscles of the neck which is 
 disfiguring and unsightly or interferes with wearing a uniform or 
 military equipment. 
 
 (i) Spastic contraction of the m.uscles of the neck. 
 
 98. When Local Boards are in doubt concerning the physical fitness 
 of registrants who present defects of the neck, they should refer them to 
 the Medical Advisory Boards, or to a member or members thereof. 
 
 99. The physicdans of Local Boards and the Medical Advisory Boards 
 should reject all registrants who, after careful study, are proved to 
 suffer from thyroid toxic symptoms. 
 
 XV= GBNITO-URINARY ORGANS AND VENEREAL 
 
 DISEASES, 
 
 100. Registrants who on examination are found to present the fol- 
 lowing conditions, who are otherwise mentally and phj'sically fit, 
 shall be unconditionally accepted for general military service: 
 
 83246°— 18 5
 
 34 
 
 (a) Gonorrhea, acute or chronic, imcomplicatecl. (See Section 5.) 
 (h) Syphilis witli remediable manifestations. (See Section 5.) 
 
 (c) Chancroids and the resulting infection of the lymph glands of 
 the groin. (If, in the opinion of the examiners, registrants suffering 
 from this defect are in a condition which would make it unsafe to 
 themselves and to other soldiers in the cantonment, their induction 
 should be temporarily deferred until the condition is improved.) 
 (See Section 5=) 
 
 (d) Gonorrheal arthritis which is determined to be temporary in 
 character and not of itself disqualifying. (See Section 5.) 
 
 (e) Moderately movable kidney. (By this is meant a kidney which 
 upon deep inspiration may be palpated below the costal margins and 
 which is not loose within the abdominal cavity. 
 
 (/) Albuminuria with or without casts which is proved by observa- 
 tion and repeated examination to be temporary in character. 
 
 (g) Absence of one or both testicles due to removal or atrophy. 
 
 (A) Acute cystitis which has proved to be of a temporary char- 
 acter by observation and repeated examination over a period not to 
 exceed six weeks. 
 
 (^) Phimosis with or without adhesions of the mucus surfaces. 
 
 (_/') Benign warts and other benign growths of the glans penis 
 and of the prepuce. 
 
 (k) Amputation of the penis if a- sufficient amount of the organ 
 remains so as not to interfere with the function of micturition. 
 (Care should be taken to fully examine registrants who present 
 evidence of a recurrence of a disqualifying disease for which the 
 amputation was made.) 
 
 (?) Varicocele of moderate size. 
 
 (m) Hj^clrocele of modei^ate size. 
 
 (n) Undescended testicle which lies within the al^dominal cavity. 
 
 101. Registrants who on examination are found to present the fol- 
 lowing remediable defects, who are otherwise mentally and physically 
 fit, may be conditionally accepted for general military service in the 
 deferred remediable group : 
 
 (a) Cystitis, chronic, severe, which is remediable within the judg- 
 ment of the examiners. » 
 
 (h) Pyelitis which has been verified by cystoscopy and is deemed 
 remediable by the examiners. 
 
 (c) Hj'drocele of very large size. 
 
 (d) Chronic gonorrheal vesiculitis or prostatitis. 
 
 102. Registrants who on examination are found to present the fol- 
 lowing defects, who are otherwise mentally and physically fit, may 
 be accepted for special and limited military service: 
 
 (a) Stricture of the urethra. 
 
 (6) Renal or ureteral calculus verified by an X-ray plate and 
 ■with no evidence of disease of the kidneys.
 
 35 
 
 (c) Benign tumor of the testicles. 
 
 (d) Cystitis, subacute or chronic, of mild grade. 
 (6') Benign tumor of the bladder. 
 
 (/) Varicocele of large ^3izc. 
 
 (g) Hydrocele, unless of very large size, 
 
 (h) Floating kidney. (By floating kidney is meant one which' 
 is freely movable within the abdominal cavity.) 
 
 (i) Undescended testis which lies within the inguinal canal. 
 
 {]) Removal of one kidney, the remaining one being healthy. 
 
 (/t) Bed wetting. 
 
 103. Iveyistrants who on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military service : 
 
 (a) Chronic nephritis. (This should be evidenced by the presence 
 in the urine of albumin and casts Avith or without blood, over a 
 j)eriod of time sufficient to prove the persistency of the urinary find- 
 ings. The examiners should require the registrants to void the urine 
 during the period of the examination and in the presence of the 
 physicians.) When albumin and casts are found in the urine the 
 registrants should be reexamined not less than twice on separate 
 diijs. If the urine shows albumin and casts with or without blood 
 and this condition of the urine is associated with enlargement of the 
 left heart, high blood pressure, and other evidences of cardio-vas- 
 cular disease, the diagnosis of chronic nephritis may be made imme- 
 diately. If the presence in the urine of albmnin and of casts with or 
 without blood is proved to 1)e inconstant and if the condition is 
 unassociated with the cardio- vascular conditions mentioned, decision 
 should lie within the judgment and discretion of the examiners. 
 
 (h) Diabetes, evidenced by the presence of glucose in the urine. 
 (Reexamination of the urine of registrants which on the first ex- 
 amination is found to contain glucose should be made over a period 
 of two or three days. The registrants should void the urine in the 
 presence of the physicians.) 
 
 (<■) Irremediable stricture of the urethra. 
 
 (d) Urinarj^ fistula. 
 
 {'/) Gonorrheal arthritis which is of itself disciualifving. 
 
 (/) Surgical kidney with or Avithout renal calculus. 
 
 (fj) Irremediable pyelitis. 
 
 (h) Cancer. 
 
 (i) Hydronephrosis. 
 
 (j) Tumors of the kidney. 
 
 (/>■) Tuberculosis of the kidney, ureter, bladder, seminal vesicles, 
 or testicles. 
 
 (7) Acute nephritis which is proved by obserA'ation and reexami- 
 nation not to be temporary in chaiacter.
 
 36 
 
 (m) Chronic cystitis associated witli retention of urine caused by 
 stricture of the uretlira or by disease of the central nervous system. 
 
 (n) Amputation of the penis if the resulting stump is insufficient 
 to permit of normal function of micturition. 
 
 104. "When Local Boards are in doubt concerning the pli7/sical fitness 
 of registrants who present defects of the genito-urinary apparatus, they 
 shall refer them to the Medical Advisory Boards, or to a member or mem- 
 bers thereof. 
 
 " 105. When it is deemed necessary, Local Boards and Medical Advisory 
 Boards should take advantage of cystoscopy and X-ray examination to 
 verify diagnosis of defects of the genito-urinary organs. 
 
 103. Physicians of Local Boards and Medical Advisory Boards should 
 advise and aid registrants who suffer from gonorrhea, syphilis, and 
 chancroid and temporary remediable defects of the skin to secure proper 
 treatment pending induction. 
 
 XVI. MENTAL AND NERVOUS DISEASES. 
 
 107. Eegistrants who on examination show the following conditions 
 shall be unconditionally accepted for general military service : 
 
 (a) A normal nervous S3^stem. 
 
 (5) Who appear to have normal understanding, whose speech can 
 be understood, who have no definite signs of organic disease of the 
 brain, spinal cord, or peripheral nerves, and who are otherwise 
 mentall}' and physicall}- fit. 
 
 {c) Hysterical paralysis or hj^sterical stigmata and local mus- 
 cular spasms which do not cause mental or physical defects disquali- 
 fying for general military service. 
 
 {(I) Muscular tremors of moderate degree. 
 
 108. Registrants who on examination are found to suffer from the 
 following condition, who frre otherwise mentallj'' and physically fit, 
 may be conditionally accepted for general military service in the de- 
 ferred remediable group: 
 
 {a) Drug addiction, including the habitual use of opium and its 
 derivatives and cocaine. 
 
 109. Registrants who on examination are found to suffer from the 
 following defects of the nervous system, who are otherwise men- 
 tally and physically fit, may be accepted for special and limited mili- 
 tary service : 
 
 (a) Stuttering and stammering of a degree disqualifying for gen- 
 eral military service but wdiich has not prevented from successfully 
 following a useful vocation in civil life. 
 
 (5) Hysterical paralysis or hysterical stigmata of a degree dis- 
 qualifying for general military service but not of a character to 
 prevent the registrants from successfully following a useful vocation 
 in civil life.
 
 O' 
 
 (c) Tremors of such marked degree that they disqualify for gen- 
 eral military service but have not prevented tlie registrants from fol- 
 lowing a useful vocation in civil life. 
 
 110. Registrants who on examination are found (o suffer from the 
 following defects shall be unconditionally rejected for all military 
 service : 
 
 (a) Insanity. 
 
 (b) Epileps}^ 
 (e) Idiocy. 
 
 (d) Imbecility. 
 
 (e) Moron. (See Section 115.) 
 (/) Chronic alcoholism. 
 
 (g) Stuttering or stannnering to such a degree that the registrant 
 is unable to express himself clearly or to repeat commands or to de- 
 mand the countersign. 
 
 (h) Constitutional psychopathic state. 
 
 (i) Chronic essential chorea. 
 
 (j) Tabes (locomotor ataxia). 
 
 (k) Cerebrospinal syphilid. 
 
 (l) Multiple sclerosis. 
 
 (m) Paraplegia. 
 
 (n) S,yringoniyelia. 
 
 (g) Muscular atrophies and dystrophies wliich are obviously dis- 
 qualifying. 
 
 (p) Hysterical paralysis or hysterical stigmata so serious that 
 these defects are disqualifying for military service. 
 
 (q) Neuritis which is not temporary in character and which has 
 progressed to such a degree as to prevent the registrant from follow- 
 ing a useful vocation in civil life. 
 
 111. Ail registrants who suffer from defects involving the mental or 
 nervous system concerning: v/hich the Local Boards are in doubt should be 
 referred to the Medical Advisory Boards, or to a member or members 
 thereof. 
 
 112. The examiners may base their decisions as to mental and 
 nervous defects upon the following brief description of some dis- 
 qualifying defects : 
 
 113. Insanity. — All registrants should be considered insane who 
 are committed or v>ho have been committed to a licensed public or 
 private institution for the care of the insane. The examiners may 
 require proof in the form of verified records of commitment by the 
 proper State authorities to verif \' the statements of the registrants. 
 
 114. Epilepsy. — The registrant shall not be considered an epileptic 
 unless the claim is substantiated by characteristic scars on the tongue, 
 face, or head, or if the examiner is in doubt, by properly certified 
 proof o]:)tained by the registrant or by the Government Appeal Agent, 
 which shall be filed with Form 1010.
 
 115. Moron. — An in(ii^'idllal whose mental development is that 
 of a child not over eight jears of age, as measured by the Binet-Simon 
 test, is not competent to learn nor to perform th^ duties required of 
 a soldier. 
 
 118. Idiocy.— X registrant shall be declared an idiot who has been 
 so defective in mind from birth or from early age that he is unable 
 to guard himself against common physical danger. 
 
 117. Imbecility. — A registrant shall be declared an imbecile who 
 has been so defective in mind from birth or early age as to be in- 
 capable of earning a livelihood but at the same time is able to 
 guard himself against common physical danger. 
 
 118. Chronic alcoholism. — A registrant shall be declared a suf- 
 ferer from chronic alcoholism v\hen he presents a majority of the 
 following symptoms and signs: Suliused e^'es; prominent super- 
 ficial blood vessels of nose and cheek ; flabby, bloated face : red or 
 pale purplish discoloration of mucous membrane of the phar^mx 
 and soft palate; muscular tremor of the protruded tongue and 
 extended fingers ; tremulous handwriting. 
 
 The history or evidence presented that the registrant has been 
 frequently and grossly intoxicated is not of itself sufficient proof 
 lor the diagnosis of chronic alcoholism, 
 
 CLIMCAL J'OK-"\IS or IXSAMTV. 
 
 119. Dementia precox. — Look for indifference, apathy, withdrawal 
 from environment, ideas of reference and persecution, feelings of 
 the mind being tampered with, of thought being controlled by 
 hypnotic, spiritualistic, or other mysterious agencies, hallucinations 
 of hearing, bodily hallucinations, frequently of electrical or sexual 
 character; meaningless smiles; in general, inappropriate emotional 
 reaction and lack of connectedness in conversation. There may be 
 sudden emotional or motor outbursts. The history of family life 
 and of scliool, vocational, and personal career will usually show 
 erratic and more or less irrational conduct. 
 
 120. 3Imuc-depressive insanity. — Look for mild depression, with or 
 without feeling or inadequacy, or mild manic states with exhilara- 
 tion, talkativeness, and overactivity'. 
 
 ORGANIC DISEASES OF THE BRAIN, SPINAL CORD, AND 
 
 PERIPHERAL NERVES. 
 
 121. Paresis (general paralysis). — The diagnosis of paresis may 
 be made wheji at the examination of the registrant a majority of 
 the following signs and symptoms are demonstrated: Argyll-Rol)- 
 ertson pupil or pupils, facial tremor, speech defect in test phrase?;, 
 and in the slurring and distortion of words in conversation; writing
 
 39 
 
 defects consisting of omi.^sions and the distortion of words, Apa- 
 tlietic or depressed or euphoric mood. The^e registrants may show 
 memory loss, or discrepancies in rehiting facts of life; the knee jerks 
 may be plus, minus, or normal. v; 
 
 122. Tabes {locomotor ataxia). — The diagnosis of this disease 
 should be made when, at the examination of the registrant, several 
 of the following signs and symptoms are present : Argyll-Robertson 
 pupil or pupils; absent knee jerk; Eomberg symptom; ataxia of 
 hands or legs (especially when the eyes are closed) ; hypotonia; and 
 anesthetic areas of the skin. The history of the locomotor ataxia is 
 usually that of slo\v progression, of failing sexual power, and pains 
 in the legs or back which are often described as rheumatism. j 
 
 123. C erehrO'S pinal syphilis. — The prominent diagnostic signs and 
 symptoms are headache, varying deep and superficial reflexes, jnipil-^ | 
 lary changes, ptosis, ocular palsies, facial weakness; the mental state 
 is normal, dull, or apathetic. Comparative motor weakness may; j 
 occur of one side of the body or of one extremity. 
 
 124. Multiple sclerosis. — The diagnosis of this disease rests upon 
 the following signs and symptoms: Intention tremor, nystagmus, 
 absent abdominal reflexes, increased tendon reflexes, and scanning" 
 speech ; in cases of this kind the history obtained is not characteristic, 
 but sometimes there may be a history of urinary disturbance. 
 
 125. Paraplegia. — The diagnosis of paraplegia from whatever 
 cauSe will rest upon weakness of the lower extremities, associated 
 with lost or increased knee jerk, Babinski reflex, or disturbance of 
 the sphincters of the rectum and bladder, with or without girdle 
 sensations. Sensory disturbance of the skin may or vcio^y not bo 
 present. Muscle sensibility may be diminished. 
 
 126. Syringomyelia, — Syringomyelia is usually evidenced by more 
 or less loss qi power and atrophy of groups of muscles of one or more 
 extremities; disturbance of the sensations of the skin, more especially 
 in the form of analgesias, and diminution of the temperature sense ; 
 if in the upper dorsal cord, often associated with stooj^ed shoulder 
 posture; if in the lower dorsal, with weakness in one or both lower 
 extremities. 
 
 12T. Muscular atrophies and dystrophies. — The signs and symptoms 
 of muscular atrophies and dystrophies are: Atrophies of the small 
 muscles of the hand and of the muscle groups of the shoulder; 
 fibrillary twitchings. The history of these defects rarely furnishes 
 reliable data, although it will usually be found that the registrant 
 has shown evidences of awkwardness. There is never a history of 
 pain in the affected muscles. 
 
 128. Multiple neuritis. — The chief manifestations are more or less 
 pain in tlie course of the affected nerves, with tenderness over the 
 trunks of the nerves and of the muscles supplied by them: les-
 
 40 
 
 sened muscular power of varying degrees; more or less atrophy of 
 muscles, with or without contraction and evidences of trophic 
 changes of the skin. The reflexes, deep and superficial, may be 
 diminished or absent ; the sphincters are not involved. 
 
 Existent organic nervous disease should always exclude. 
 
 For example, neuritis, of one or many nerves, while susceptible 
 of recovery without resultant defect, is none the less a cause for 
 rejection as long as it exists. 
 
 129. Certain after effects of organic nervous disease need not be 
 causes for rejection provided (1) that the disease is no longer opera- 
 tive and is not likely to recur, (2) that the effect left by it does not 
 prevent a satisfactory fulfillment of military duties. Examples of 
 such conditions are paralysis of a few unimportant muscles following 
 poliomyelitis, slight unilateral hypertonicity as a result of an infan- 
 tile hemiplegia in a man now robust, and various traumatic condi- 
 tions. (See Sections 72 (c) and 74 (o).) 
 
 XVII. LUNGS AND CHEST WALL. 
 
 130. Registi^nts who on examination are found to present the fol- 
 lov/ing conditions shall be unconditionally accepted for general mili- 
 tary service: 
 
 (a) Normal lungs. 
 (h) Normal pleura. 
 
 (c) Normal bronchi. 
 
 (d) Acute bronchitis. 
 
 (e) Hay fever. 
 
 (/) Scars of operation of empyema which ha^'e been healed for 
 one year or longer when the function of the lung is good. 
 
 {(/) Acute pleurisy with effusion, provided the acceptance of the 
 registrant shall be temporarily dcla^'ed for observation and re- 
 examination and there is finally established evidence satisfactory to 
 the examiners that the pleurisy and the effusion have entirely disap- 
 peared. (See Sec. 133.) 
 
 (h) Fracture of the rib or ribs, provided the acceptance of the 
 registrant is temporarily deferred until a final examination shows 
 recovery with or without deformit}'^, and provided the deformity, 
 if any, does not interfere v;ith respiratory movements. 
 
 (/') Benign tumors of the breast or of the chest wall, provided the 
 enlargement does not interfere with the wearing of a uniform or 
 militar}^ equipment. 
 
 {]) Small, palpable lymph glands of the axilla which apparently 
 do not interfere v/ith the general health. 
 
 (k) Syphilitic periostitis of rib or ribs, sternum or clavicle.
 
 41 
 
 131. Registrants who on examination are found to present the fol- 
 lowing remediable defects, who are otheiwise mentally and physically 
 fit, may be conditionally accepted for general military service in the 
 deferred remediable gi'oup : 
 
 {a) Typhoid i)eriostitis of rib or ribi5. 
 
 (b) Tumor of the breast or of the chest wall wnth such enlargement 
 as to intei-fere wath the wearing of a uniform or military equipment. 
 
 132. Registrants who on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military service : 
 
 {a) Tuberculosis of the lungs. 
 
 {h) Tuberculous pleurisy. 
 ■ (c) Unhealed sinuses of the chest wall following operation for 
 empyema. 
 
 {d) Chronic bronchitis with emphysema. 
 
 (e) Chronic asthma associated with chronic bronchitis and em- 
 physema. 
 
 (/) Fetid bronchitis. 
 
 {g) Bronchiectasis. 
 
 (A) Syphilis of the lung. 
 
 (/) Actinom3^cosis. 
 
 {]) Hydatid cysts. 
 
 {k) Restricted respiratory movements of chest due to deformity 
 of the chest as a result of fracture of ribs or other injuries. 
 
 (?) Tuberculosis of the ribs. 
 
 {m) Cancer. 
 
 133. When Local Boards are in doubt concerning the physical condi- 
 tion of registrants who present defects of the lungs, pleura, or bronchi, 
 they should be referred to the Medical Advisory Boards, or to a member 
 or members thereof. 
 
 134. Inasmuch as pleurisy, with or without effusion, is a very fre- 
 quent incidence of early tuberculosis, physicians of Local Boards and 
 Medical Advisory Boards should examine with the greatest care regis- 
 trants who have apparently recovered from pleurisy. 
 
 135. The following information concerning metliods of examina- 
 tion of the lungs and the interpretation of the findings are pre- 
 sented for the guidance of examiners : 
 
 136. The examiners should be extremely careful to reject regis- 
 trants with manifest pulmonary tuberculosis for all military service 
 and to accept for military service registrants who allege tuberculosis 
 as a ground for exemption or discharge on the basis of insufficient or 
 incorrectly interpreted signs and symptoms. 
 
 Men who desire to serve their country may conceal, from patriotic 
 motives, symptoms of tuberculosis which they know or suspect to 
 exist. Some tuberculous patients will seek enlistment with a view 
 to obtaining treatment and a pension. Some soldiers who have 
 volunteered may repent their action and allege symptoms of tuber-
 
 42 
 
 culosis with a view to securing discharge. Some registrants may bo 
 expected to claim the existence of tuberculosis as a ground for exemp- 
 tion, and may fortify their claims by certificates of physicians and 
 by radiograi)hs. Such certificates, etc., must not be acceptx'd. but 
 draft examiners must satisfy themselves as to Uie physical qualifica- 
 tions of registrants by their i)ersonal examinations. There will prob- 
 ably be many cases in which pulmonary tuberculosis will have been 
 diagnosticated on the ground of sul>jective symptoms and of physi- 
 cal signs which are normal or indicate unimportant and healed 
 lesions of some kind. 
 
 It is necessary, therefore, that conclusions of the examiner shall 
 be based only on physical signs, sputum examinations, and radio- 
 graphs. Statx^ments of the subject as to symptoms will not be 
 accepted as proof of the existence of tuberculosis unless supported 
 by objective evidence. 
 
 It is the> duty of examiners to protect the interests of the Government 
 by preventing men from entering the service who have manifest tuber- 
 culosis. It is equally their duty to prevent the escape from service on 
 the ground of tuberculosis of men who present slight or doubtful devia- 
 tions from the normal. It is therefore necessary to insist that recom- 
 nipcndations for dischargQ' for tuberculosis of otherwise apparently 
 healtliy and A'igorous men shall be based Only upon the presence of 
 (hiiiuito and i)laiidy marked signs of pulmonary lesions. 
 
 137. 'Jlio f(jllowing signs will not be regarded as evidence of pul- 
 monary disease in the absence of other signs in the same portion of 
 the lung^: 
 
 (a) SliglUly liarsh breathing, .slightly j^rolonged expiration over 
 the right apex above the clavicle anteriorly and to the thii'd dor.sal 
 vertebra posteriorly. The same signs at the extreme apex left side. 
 
 (6) Same signs second interspace riglit anteriorly jiear sternum 
 (proximity of right main bn^ichus). 
 
 (c) Increa.sed vocal resonance, slightly harsh breathing inniiedi- 
 ately below center of left crlavicle. 
 
 (d) Fine crepitations over sternum heard when stetho.scope touclies 
 the edge of that bono. 
 
 (e) Clicks heard during strong respirsttion or aftei- cough in the 
 vicinity of the sternocostal articulations. 
 
 (/) The so-called atelectatic n'des at the apex during the first 
 inspiration which follows a deeper breath thim iisiuil or a cough. 
 
 {(/) Sounds resembling rales at base of lung (uiargjnal .sounds), 
 especially nuirked in right axilla, limited to insiuration. 
 
 (A) Similar sounds heard at apex of heart on cmigh (lingula). 
 
 (i) Slightly prolonged expiration at left ba.se i:)osteriorly.
 
 43 
 
 (j) Very slight harshness of respiratory sounds Avith prolonged 
 expiration in the lower paravertebral regions of both lungs posteri- 
 orly, most marked at about angle of scapula, disappearing a short 
 distance above tliat point, equal on both sides, or slightly more 
 marked at the angle on one side, more frequently the left. 
 
 138. The apices. — The attention of examiners is particularly in- 
 vited to the necessity of exercising gi'eat conservatism in their in- 
 terpretation of physical signs over the apices. Interpretation of 
 such signs as indicating active tuberculosis would in many cases do 
 the Government great injustice, leading to the exclusion of men 
 who are fit for service. 
 
 The only trustworthy sign of active apical tuberculosis is the presence 
 of persistent moist rales. 
 
 139. Indications from X-ray negatives. — The X ray shows (1) 
 tuberculous disease confined to region of hilus in deep lung; (2) ex- 
 tension upward toward apex or downward and outward toward base, 
 confined to deep lung; (3) a fine line or two extending to apex with 
 or Avithout small focus or foci there — condition not determinable by 
 physical signs; (4) clouding of apex without marked lines from 
 hilus, probably largely pleuritic; (5) well-marked lines extending to 
 superficies of apex, usually, but not necessarily, with foci there — ■ 
 lesion accessible to physical examination; (6) lines extending toward 
 shoulder as well as apex — {a) if confined to deep lung ma}^ mean 
 early and now healed exacerbation — ijj) if extending to superficies 
 denote larger lesion and less immunity than 5; (7) more or less 
 widely dilfused spots, lines, and streaks through a considerable por- 
 tion of lower lobe approaching peripherj^ of lung, with few or no 
 auscultatory signs — deep peribronchial tuberculosis; (8) more exten- 
 sive streaked opacities involving greater part of one or both lungs 
 and extending to periphery'' with few or many phj'sical signs — fibro- 
 caseous tuberculosis, fibrosis preponderating in proportion to scanti- 
 ness of more or less rounded spots or dots. 
 
 Conditions as shown by 1, 2, 3, 4, and 6 («) are not causes for 
 rejection. Cases under 5 are to be determined by physical examina- 
 tion. Cases under 6 {l>), 7, and 8 are to be rejected. 
 
 XVIII. HEART AND BLOOD VESSELS. 
 
 140. The following procedure should govern in the examination 
 of the heart : 
 
 (a) Location and determination of character of apex impulse. 
 
 (h) Auscultation of the heart .sounds over apex, lower sternum, 
 and second and third interspaces to right and left of sternum, noting 
 accentuation of sounds and murmurs.
 
 44 
 
 (c) Inspection of root of neck and upper thorax and percussion 
 of first interspace on each side of manubrium for evidence of 
 aneurysm. 
 
 {d) Comit of radial pulse, observation of its rhythm, and palpa- 
 tion of radial arteries for unusual thickening or high tension. 
 
 (e) Exercise test: Hopping 100 times on one foot. At close count 
 heart rate with stethoscope over apex, listening for murmurs and 
 noting how long tachycardia and unusual dyspnea persist. After 
 two minutes neither should be marked. Examiners should use judg- 
 ment and discretion in applying the exercise test to registrants who, 
 in the preliminary examination, present evidence of incompetency 
 of the heart. Registrants should not be placed in jeopardy, but at 
 the same time the exercise test is an important factor in determining 
 the condition of the heart. 
 
 141. Eegistrants who on examination show the following condi- 
 tions, who are otherwise mentally and physically fit, shall be uncon- 
 ditionally accepted for general military service : 
 
 {a) Normal heart. (A heart shall be considered normal when 
 tlie apex impulse is within the left nipple line and not below the fifth 
 interspace, not heaving in character, with normal sounds, free from 
 murmurs, absence of pulsation or dullness above the base of the 
 heart, regular pulse of normal rate, no unusual thickening of the 
 arteries or evidence of high blood pressure, and a normal response to 
 the exercise test.) 
 
 {h) A pulse rate of 100 or over which is not persistent. (A pulse 
 rate of 100 or over may be temporary and due to a recent infection, 
 such as typhoid fever or local infections about the nose, mouth, and 
 throat.) 
 
 {c) A pulse rate of 50 or under which is proved to be the natural 
 pulse rate of the registrant or to be temporary or due to the use of 
 drugs. 
 
 (<:/) Sinus irregularity. (This consists in a quickening of the pulse 
 rate during inspiration and a slowing during expiration and is best 
 recognized with the registrant recumbent and breathing deeply.) 
 
 {e) Old thrombophlebitis of one extremity unassociated with any 
 evidence of persistence of the cause thereof or of obstruction in the 
 involved vein or veins. 
 
 142. Eegistrants who on examination are found to present the 
 following defects, if otherwise physically fit, may be accepted for 
 special and limited military service, unless the degree of disability is 
 obviously disqualifying. 
 
 {a) Intermittent claudication. 
 (?>) Raynaud's disease.
 
 45 
 
 143. Registrant who on examination are found to present the fol- 
 lowing defects shall be unconditionally rejected for all military service: 
 
 (a) Circulatory failure evidenced by definite symptoms such as a 
 combination of breathlessness, marked cyanosis or edema. 
 
 (h) Hypertrophy and dilatation of the heart evidenced by dis- 
 placement of the apex impulse to the left of the nipple line or below 
 the sixth rib, and of a heaving or diffuse character. 
 
 (c) A persistent heart rate of 100 or over when this is proved to 
 be persistent in the recumbent posture and on observation and 
 reexamination over a sufficient period of time. 
 
 (d) A persistent pulse rate of 50 or under proved te be due to 
 heart block. 
 
 (e) Complete irregularity of the pulse when this is found to be 
 due to auricular fibrillation. 
 
 (/) Valvular disease, as evidenced by characteristic murmurs, en- 
 largement of the heart, and a lack of the normal response to exercise. 
 
 (g) Arteriosclerosis and hypertension evidenced by a tense pulse, 
 persistent systolic blood pressure above 160 m. m., accentuation of the 
 aortic second sound when the registrant is in quiet recumbenc3^ 
 
 (h) Thrombophlebitis of one or more extremities if there is a 
 persistence of the thrombus or any evidence of obstruction of circu- 
 lation of the involved vein or veins. 
 
 (i) Aneurysm of tlie arch of the aorta or of any other large vessel. 
 
 144. When Local Boards are in doubt concerning the physical fitness 
 of registrants who suffer from defects due to conditions of the heart or 
 blood vessels, they shall refer them to the Medical Advisory Boards. 
 
 145. It is incumbent upon Local Boards and Medical Advisory 
 Boards: 
 
 (a) To accept for service men who have been recommended for rejec- 
 tion because of supposed defects which do not indicate disease and do not 
 impair the individual's ability to undergo severe bodily exertion. 
 
 (7j) To exclude from active service in the Army any registrant affected 
 with disease of the heart or blood vessels which impairs his ability to 
 undergo severe bodily exertion. 
 
 146. Men who desire to sem^e their countrj^ may from patriotic 
 motives endeavor to conceal a known valvular lesion which has given 
 no symptoms. On the other hand, men drafted for service may 
 allege or feign symptoms to obtain exemption. Registrants may be 
 expected to present physicians' certificates to substantiate the exist- 
 ence of valvular disease. Many of these may be given in good faith 
 because of inadequate knowledge of the significance of certain fre- 
 quent murmurs. Such 'certificates will not be accepted, but draft 
 examiners must satisfy themselves by their personal examinations 
 as to the physical qualifications of registrants.
 
 46 
 
 147. It is necessary, therefore, that the conckisions of the exammer 
 shall be based on objective evidence in the widest sense, including 
 both physical signs, cardiac rhythm, measurement of the blood pres- 
 sure, and the observed effect of effort. Nevertheless, in the presence 
 of questionable signs or symptoms, the history, especially of past 
 rheumatic fever, may be a factor in the final decision. No statements 
 of the subject, however, will be accepted as proof of the existence of 
 a cardio- vascular defect, unless supported by objective evidence. 
 
 148. Since it is the duty of examiners to protect the interests of the 
 Government by preventing men from entering the service whose circula- 
 tory systems may be expected to break down under strain, and equally 
 by preventing the exemption or discharge of fit subjects because of unim- 
 portant deviations from the normal, it will be necessary for them to 
 exercise every care in the interpretation of their findings and to bear in 
 mind constantly the murmurs and other departures from the supposed 
 normal which may occur in perfectly healthy hearts. 
 
 149. Principles of interpretation of symftoTns and signs referable 
 to the heart. — The following principles are laid down for the guid- 
 ance of examiners in their interpretation of abnormal signs and 
 symptoms : In many cases the interpretatidn must be purely individual 
 and based on the cumulative evidence of a number of relatively 
 slight deviations from the normal. It can not be too strongly in- 
 sisted on that, given a heart of normal size and responding nor- 
 mally to effort, any murmur that is heard should be considered ac- 
 cidental and insignificant unless it can be positively demonstrated 
 that it is a mitral or aortic diastolic murmur. It should also be 
 constantly borne in .mind that the excitement of the examination 
 may produce violent and rapid lieart action, often associated with 
 a transient systolic murmur, which conditions may erroneously be 
 attributed to the effects of exertion. They will usually disappear 
 promptly in the recumbent posture, but the examiner must be 
 shrewd to distinguish the excitable individuals and take measures to 
 eliminate psychic influences from the test so far as possible. 
 
 150. Hypertrophy and dilatation of the heart. — Impulse to the 
 left of the nipple line or below the sixth rib and of heaving char- 
 acter is cause for rejection. Its cause, either valvular disease or 
 hypertension in the majority of cases, should be sought for. It 
 should not be made a primary diagnosis unless careful examination 
 fails to reveal a cause. 
 
 151. Valvular diseases. — Cardiac murmurs are the most certain 
 physical signs by which valvular disease may be recognized and 
 its location determined, but murmurs are very frequent in the ab- 
 sence of valvular lesions and may occur in perfectly healthy hearts, 
 especially under the influence of excitement and exertion. Such
 
 47 
 
 accidental murmurs are always systolic in time. The most frequent 
 of these are : 
 
 (a) Those heard at the apex on excitement, especially when recum- 
 bent. 
 
 (h) Those heard over the second and third left interspaces during 
 expiration, disappearing during forced inspiration. These are par- 
 ticularly common in men with flexible chests, who can produce 
 extreme forced expiration and under such circumstances maj^ be 
 associated with definite thrill. 
 
 (c) Systolic accentuation of the respiratory murmur, especiallj' 
 on inspiration, heard near the apex or over the back. 
 
 Systolic murmurs as described in subparagraphs (a), (6), and (c) 
 are not indicative of defects which shall disqualify a registrant for 
 general military service.' 
 
 Systolic murmurs unassociated with enlargement of the heart, 
 alteration of the first sound, accentuation of the pulmonic second 
 sound, or abnormal response to exercise may also be considered as 
 without significance. 
 
 152. Other systolic murmurs : 
 
 (a) Loud systolic murmurs, audible at the apex and in the left 
 back, if associated with any enlargement of the heart, with snapping 
 first sound, or accentuation of the pulmonic second sound, constitute 
 a disqualifying defect. (See Section 142 (/).) 
 
 (5) Systolic murmurs at the base, except as specified above, espe- 
 cially those heard in the second right intercostal space, require more 
 careful scrutiny. The}^ may be due to disease of the aortic valves. 
 In this case they should be harsh, conveyed well into the neck, asso- 
 ciated with an aortic diastolic murmur, with thrill, or w ith a marked 
 enfeeblement of the aortic second sound. They are more often due 
 to dilatation of the aorta, either syphilitic or arteriosclerotic. The 
 other signs of dilatation should then be sought — increased dullness 
 in the first and second interspaces to either side of the manubrium, 
 pulsation in this area, accentuation of the aortic second sound. In 
 doubtful cases X-ray examination and Wassermann test should be 
 made. 
 
 153. All diastolic murmurs, at apex or base, including presystolic 
 murmurs, shall be considered evidence of valvular disease. The 
 secondary signs should be sought for, viz, enlargement of one or 
 both sides of the heart, alteration of the first or second sound, par- 
 ticularly a snapping first sound and accentuated pulmonic second 
 sound in mitral disease, and the characteristic pulse of aortic insuffi- 
 ciency. In doubtful cases a definite history of rheumatic fever may 
 be given w^eight. The exact diagnosis should be noted on the record. 
 
 154. It should be borne in mind that the characteristic presystolic 
 murmur in certain cases of mitral stenosis may not be audible during
 
 48 
 
 rest. It is therefore important, in every doubtful case, that ausculta- 
 tion be made immediately after the exercise test and in both the erect 
 and the recumbent positions. On the other hand, many cases of tachy- 
 cardia or overacting heart present physical signs very suggestive of 
 mitral stenosis (sharp, tapping apex beat, sharp, loud first sound, 
 suggestion of apical thrill, etc.), and the diagnosis of mitral stenosis 
 should not be made unless a distinct presystolic or diastolic murmur 
 is heard. 
 
 XIX. GENERAL. 
 
 155. Eegistrants who on examination are found to present the fol- 
 lowing condition who are otherwise mentally and physically fit shall 
 be unconditionally accepted for general military service: 
 
 (a) Malaria, acute or chronic. 
 
 156. Registrants who on examination are found to present the fol- 
 lowing defects who are otherwise mentally and physically fit may be 
 accepted for special and limited military service: 
 
 {a) Secondary anemia, due to hemorrhoids or any other remedi- 
 able cause. 
 
 (h) Debility due to recent illness or to employment or environment 
 in civil life. 
 
 ((?) Hemophilia. 
 
 157. Eegistrants who on examination are found to suffer from the 
 following defects shall be unconditionally rejected for all military 
 service : 
 
 (a) Pellagra. 
 
 (b) Leukemia of all clinical types. 
 
 (c) Progressive pernicious anemia. 
 
 (d) Splenic anemia. 
 
 (e) Cancer. 
 
 (/) Tuberculosis. 
 
 (g) Irremediable metallic poisoning. 
 
 158. Registrants who are confined from injury or illness to their 
 homes, hospitals, or other institutions for the care of the sick shall be 
 examined and dealt with for the conditions or defects found, as indicated 
 in Chapters III to XXI, inclusive. 
 
 XX. TEMPORARY DEFECTS. 
 
 159. Registrants who are confined from injury or illness to their 
 homes or hospitals or other institutions for the care of the sick and 
 are found to suffer from temporary defects should be granted a rea- 
 sonable delay for the purpose of completing the" physical exami- 
 nation. 
 
 160. Eegistrants who are reported to the Local Boards or to the Medi- 
 cal Advisory Boards to be confined to their homes or to hospitals or in-
 
 49 
 
 stitutions for the care of the sick because of contagious, communicable, or 
 reportable diseases, should not be ordered to appear before Local Boards 
 or Medical Advisory Boards until they shall have been discharged by 
 health authorities having jurisdiction. 
 
 161. Eegistra,nts who are convalescent from diphtheria should not be 
 inducted into military service until three negative cultures in succession, 
 at intervals of three days, shall have been obtained from the throat. 
 
 162. When Local Boards or Medical Advisory Boards are unable to 
 command the facilities for making throat cultures of registrants recover- 
 ing from diphtheria, the cultures should be sent by mail to municipal 
 laboratories or to those of the State or of the "United States Public 
 Health Service. 
 
 XXI. PURPOSELY CAUSED PHYSICAL DEFECTS. 
 
 163. Whenever it shall appear to a Local Board or to a Medical Ad- 
 visory Board that a registrant is suffering from self-inflicted or purposely 
 caused physical defects which, under the Standards of Physical Exami- 
 nations, would render him disqualified for military service of any kind, 
 a full statement of the facts and of the condition of the registrant and of 
 the Board's recommendation shall be prepared and attached to Form 1010, 
 and one copy of Form 1010, with such statement attached, shall imme- 
 diately be sent by the Local Board to the Adjutant of the State to be 
 transmitted to the Provost Marshal General in order that the case may 
 be submitted to the Surgeon General and The Adjutant General of the 
 Army for a waiver of the physical defects, if recommended, so that the 
 registrant may be compelled to render militaiy se-vice. (See Note 2, 
 Sec. 128| S. S. E., p. 63, herein.) 
 
 XXII. NOTES ON MALINGERING. 
 
 164. Malingerers may be divided into three general groups : 
 
 (a) Real malingerers with nothing -the matter with them, who 
 injure themselves, or make allegations respecting diseases or such 
 conditions as drug taking, or who counterfeit disease with full 
 consciousness and responsibility; all for the purpose of evading 
 military service. Many of these have been coached. 
 
 (b) Psj^choneurotics, who are natural complainers and try to get 
 out of every disagreeable thing in life. Perhaps only partially 
 conscious of the nature or the seriousness of what they do and only 
 partly responsible. In many the motives are not persistent and 
 many can be made into good soldiers. 
 
 (c) Confirmed psychoneurotics with long history of nervous 
 breakdowns and illnesses who behave like class (a), but more per- 
 sistently, and from whom not much can be expected in the way of 
 reconstruction.
 
 50 
 
 165. The detection and management of medical cases depends tipon 
 the absence of positive findings in one who presents the general char- 
 acteristics of the malingerer. There is especial need for the physical 
 examination to be thorough in this group. Some of the cardiac cases 
 at first regarded as malingerers were pronounced later by the cardio- 
 vascular board tiO have mitral stenosis, and similarly proper tests 
 have shown the existence of gastric ulcer in cases which were under 
 susx^icion of fraud. The estimation of the reality of rheumatic pains 
 is always a difficult matter. 
 
 166. Suroical. — Under this are included old scars and injuries of 
 the bones, fractures, and orthopedic conditions. 
 
 Note. — For tlie detection of malingerers, in tests of vision and hearing, see 
 paragraphs 27 to 34, inclusive, 40, and 41. 
 
 167. Artifically created conditions. — Men shoot or cut off their fin- 
 gers or toes, practically always on the right side, to disqualify them- 
 selves for se]'vice. Sometimes they put their hands under cars for 
 this purpose. Many men have their teeth pulled out. Retention of 
 urine is simulated. Egg albumen is injected into the bladder or put 
 in urine. Glucose is added to urine. Digitalis, thyroid gland prepa- 
 rations, and strophanthus are taken to cause disturbance of the heart 
 and cantharides to cause albuminuria. The skin is irritated by va- 
 rious substances, which are also injected under it to create abscesses. 
 Various substances are taken to Ijring about purging. An appear- 
 ance of hemoptysis may be produced by adding blood, either human 
 or that of animals, to the sputa. Sometimes merely coloring mat- 
 ter is added. Those who can vomit voluntarily what they swal- 
 low use the same means to create the appearance of hematemesis. 
 Similarly, coloring matters may be added to the stools. Mechanical 
 and chemical irritants are made use of to cause inflammation about 
 practically all the body orifices. Jaundice may be simulated by 
 taking picric acid. Crutches, spectacles, trusses, strappings, etc., are 
 made use of to create the appearance of disability. (See sec. 165.) 
 
 168. Detection. — Wounds are rarely self-inflicted when witnesses 
 are present, consequently it is almost impossible to be certain of the 
 motive behind these. Artificial jaundice is to be recognized by the 
 demonstration of picric acid in the urine. 
 
 169. Bed ivettlng. — A frequent complaint among registrants for 
 military service but not a cause for rejection. 
 
 170. The surest means of detecting malingering is a thorough mider- 
 standing by the examiner of the types of people who actually do it — 
 and the way they behave. It is'only in the feigned diseases of the 
 eye and ear that special tests are required. Observation in hospital 
 is necessary in difficult cases. The vast bulk of malingerers are those 
 who exaggerate some actual defect, and the problem for the medical
 
 51 
 
 examiner is to decide Avhether the defect complained of is sufficient 
 cause for rejection for service. Persons of intelligence and educa- 
 tion have more difficultj'^ in deceiving, as they are bound to express 
 themselves freely. If they are reticent in these matters they arouse 
 suspicion by their reticence. Those who talk freely may be counted 
 on to say things at variance with the existence of the disease of 
 which they complain. 
 
 171. Whenever it shall appear to a Local Board or to a Medical Ad- 
 visory Board that a registrant is endeavoring to escape service by malin- 
 gering, if otherwise mentally and physically fit, he shall be inducted. 
 A full statement of the facts shall be prepared and attached to each copy 
 of Form 1010. (See Section 128^, Note 3, S. S. II.) 
 
 NEKVOUS AND MENTAL. 
 
 172. Insanity. — Rarely feigned by registrants and then of an ex- 
 tremely silly, foolish tj'pe. In cases of doubt, hospital observation is 
 necessary with verified past records. Mental defects are frequently 
 feigned, especially b}^ illiterates. Organic diseases of the central 
 nervous system can not be simulated. 
 
 173. Pain and hyi^eresthesia. — The most frequent of all complaints. 
 History inconsistent, ordinary traces of suffering absent. Absence of 
 other symptoms usually accompanj^ing types of pain complained of. 
 Absence of objective evidence of localized pains. Xote behavior 
 when the registrant believes himself unobserved. 
 
 174. Anesthesia. — Complaint of anesthesia itself creates a sus- 
 picion of malingering, as most patients with anesthesia are ignorant 
 of it. 
 
 175. Epilepsy. — Men w^ho nave sustained head injury are very apt 
 to claim fits. These complaints may be in reference to grand mal or 
 petit mal. Petit mal attacks are spoken of as fainting attacks. In 
 grand mal attacks there is loss of pupil response to light, loiee jerks 
 are lost, and the Babinsky reflex may be present. 
 
 176. Hysteria. — Not feigned in itself, but its existence creates con- 
 fusion as to malingering. The question to be decided is whether the 
 registrant is too seriously affected with the neurosis to be useful as a 
 soldier. Often, even when the physical symptoms are most pro- 
 nounced (paralysis) , cure is still possible, 
 
 177. Stif hachs.—Si'i^ back is a frequent symptom of hysteria in 
 the present mobilization among selected men. In cases of this kind 
 organic disease of the vertebra? can and should be excluded, if neces- 
 sary, by the X ray.
 
 APPENDIX. 
 
 IMPORTANT SECTIONS OF THE SELECTIVE SERVICE 
 REGULATIONS AND RULES OF PROCEDURE RELATING 
 TO PHYSICAL EXAMINATIONS, AND PERTAINING TO 
 MEDICAL EXAMINERS AND LOCAL, DISTRICT, AND 
 MEDICAL ADVISORY BOARDS. 
 
 Section 25. Correspondence rules of the Office of the Provost Marshal Gen- 
 eral. 
 
 Kule A. Except as specifically provided in these Regulations, all 
 communications intended for the Provost Marshal General concern- 
 ing the execution of the Selective Service Law within a State ema- 
 nating from individuals within the State or from Local and District 
 Boards or other officials engaged within any State in the execution 
 of the Selective Service Law. must be directed to the Adjutant General 
 of the State for reference to the Provost Marshal General. (See sec. 31.) 
 Correspondence sent in violation of this rule to the office of the 
 Provost Marshal General will be returned to the writer. 
 
 Note 1. — War Department rules governing correspondence require that all 
 communications be forwarded in duplicate. (Circular Letter, June 21, 1918.) 
 
 Section 29. Governor to District State and Recommend Appointment of 
 Members of Medical Advisory Boards. 
 
 Each State shall be carefully districted vfith due regard to com- 
 m-unication and hospital facilities for the erection of a nuhiber of 
 Medical Advisory Boards compacted with a view to the equitable and 
 practical distribution of the work of reexamination as provided 
 herein and to the convenience of registrants and economy to the Gov- 
 ernment in sending registrants before such boards. Members of 
 Medical Advisory Boards will be nominated by the Governor and 
 appointed by the President in accordance with instructions to be here- 
 after communicated to the- Governors. 
 
 A member of the Medical Corps of the Army will be 'assigned as 
 Medical Aide to the Governor of each State. Medical Aides will be 
 required to perform the following functions : 
 
 (a) To establish close relations with all examining physicians of 
 
 their States. 
 
 (52)
 
 53 
 
 (5) To recommend meetings of examining physicians for the pur- 
 pose of discussing the medical problems of the draft and for the 
 clearing up of doubtful points. 
 
 (c) To visit Local and Medical Advisory Boards; to observe these 
 at work; and to advise with examining physicians. 
 
 (d) To recommend to Governors the replacement of weak exam- 
 ining physicians; to arrange for additional examining physicians 
 where needed; to hasten the operations of physical examinations 
 where such are unduly slow or delayed. 
 
 (e) To study the causes of rejections at camps, with a view to the 
 detection of inefficiency in the physical examination of registrants. 
 
 (/) To perform such other duties in connection with physical ex- 
 aminations of drafted men as may be required of them. 
 
 Note 1. — Medical Advisory Boards in each State should be designated by num- 
 bers (consecutively, with no use of a general number and letters for divisions of 
 counties and cities). Each Board should be notified of the number assigned it 
 and should be required to use this number designation on all vouchers and re- 
 ceipts sent to the Office of the Provost Marshal General. (Circular Letter April 
 18, 1918.) 
 
 Note 2. — Appointments to and removals from Medical Advisory Boards can 
 not be made without reference to the President through the Office of the Provost 
 Marshal Genel-al. The Regulations require members of said Boards to be nomi- 
 nated by the governor and appointed by the President. (Circular Letter April 
 18, 1918.) 
 
 Note 3. — The Medical Ait4e to the Governor should be the instrument of direct 
 communication between the Governor or his adjutant general and the Local 
 Boards and Medical Advisory Boards in all matters concerning questions re- 
 lating to that part of the Selective Service Regulations which pertains to the 
 physical examinations of registrants. (Circ. Letter May 8, 1918.) 
 
 Note 4. — Class 1 registrants who are physically disqualified for general mili- 
 tary service but qualified for limited military service and also specially quali- 
 fied for such clerical and administrative work may be Inducted Into service 
 either as privates or in noncommissioned grades for clerical and administrative 
 work at States Headquarters and the Local, District, and Medical Advisory 
 Boards, such induction to take place under rules and regulations issued for that 
 purpose. (Telegram P,-2682, August 10, 1918, and Circ. Letter August 20. 1018.) 
 
 Note 5. — Officers of the Medical Corps ordered to report as Medical Aides to 
 Governors are assigned to duty subject to the orders of Governors to whom 
 they should Report for instruction. Such officers will be governed solely by 
 instructions from Governors and Adjutants General concerning all matters con- 
 nected with Medical Advisory Boards. (Telegram A-lOO, December 4, 1917.) 
 
 Note 6. — Draft Executives will supply Medical Aides with copies of all modi- 
 fications of regulations and with rules governing physical examinations. 
 
 Section 33. Status of members of Local and District Boards. 
 
 Section 6 of the Selective Service Law provides that : 
 
 * * * All persons designated or appointed under regulations prescribed by 
 
 the President, whether such appointments are made by the President himself or 
 
 by the governor or other officer of any State or Territory to perform any duty 
 
 in the execution of this Act, are hereby required to perform such duty as the
 
 54 
 
 President shall order or direct, and all such officers and agents and persons 
 so designated or appointed shall hereby have full authority for all acts done by 
 them in the execution of this Act by the direction of the President. * * * 
 Any person charged as herein provided with the duty of carrying into effect any 
 of the provisions of this Act or the regulations made or directions given there- 
 under who shall fail or«ieglect to perform such duty * * * or who, in any 
 manner, shall fail or neglect fully to perform any duty required of him in the 
 execution of this Act, shall, if not subject to military law, be guilty of a misde- 
 meanor, and upon conviction in the District Court of the United States having 
 jurisdiction thereof be punished by imprisonment for not more than one year, 
 or, if subject to military law, shall be tried by court-martial and suffer such 
 punishment as a court-martial may direct. 
 
 Under this autliority members of boards are as effectively drafted for 
 this duty as are registrants who are selected for military service and as 
 such are entitled and should be given deferred classification whenever 
 certified by the Governor of the State as necessary in the administra- 
 tion of the Selective Service Law. Appointments and changes in 
 membersliip of boards will be made by the President upon the 
 recommendation of the Governor. Applications for relief from such 
 appointments should be made to the Governor, . who should in- 
 vestigate the circumstances and recommend relief only in cases in- 
 volving hardship. Applications for such relief will be considered 
 only when submitted through the Governor. The telegraph should 
 be used in making these recommendations only in cases whose urgency 
 seems to justify the additional expense. 
 
 Note 1. — Responding to a request that the commissioning of medical members 
 of Draft Boards be discontinued for the present, except in instances where the 
 Provost Marshal General consents, the Surgeon General stated that every elfort 
 would be made to carry out the wishes of the Provost Marshal General, and 
 that local examiners for the Department of War would be requested in for- 
 warding the papers of 'applicants for appointment in the Medical Corps to 
 indicate whether or not the applicant is a member of a Local Board. (Ch-cular 
 Letter, August 23, 1918.) 
 
 Section 42. Additional examining physicians. 
 
 In addition to the licensed x^hysician wdio is a member of the board 
 or if no licensed physician is a member of tlie board, the Governor 
 or the Local Board shall designate and appoint additional examining 
 physicians, subject to removal by the Governor at his pleasure. 
 
 It shall be the duty of persons thus designated to act as examin- 
 ing physicians of the Local Board for which they are designated, 
 and they may be compensated at rates hereinafter prescribed. (See 
 sec. 196.) In addit-ion to the number of physicians that may be 
 thus designated and compensated under the above authority, volun- 
 teer physicians in any convenient number may be utilized for 'the ex- 
 amination of registrants upon appointment as aforesaid. 
 
 Examining physicians (unless actually appointed by the President 
 as members of. boards) are not to be considered as members of such
 
 55 
 
 boards. They should take the oath prescribed in section 14 of these 
 regulations. They shall have no vote on any question to be decided 
 by said board. (See sees. 122, 12i.) Their report on the physical 
 examination of a registrant is advisory only. 
 
 Note 1. — The services of volunteer dentists to aid in pliysical examination 
 of registrants by Local Boards may be utilized, but tliey are not members of 
 Local Boards and have no vote. ( See Form 75. ) 
 
 Section 43. Clerical Assistants for State Headquarters and for District, Local, 
 
 and Medical Advisory Boards. 
 
 (a) When authorized by the Governor on and after September 1, 
 1918, as prescribed in section 198 hereof, there may be employed the 
 necessary clerks for State Headquarters, District Boards, Local 
 Boards, and Medical Advisory Boards : Provided, That no clerk shall 
 be paid at a rate in excess of that fixed for clerks of Local Boards 
 in paragraph (c) of this section without specific authority of the 
 Provost Marshal General in each case. (For entire section, see 
 S. S. R., second edition.) 
 
 Section 44. Medical Advisory Boards. 
 
 There have been j)rovided in the various counties, cities, and other 
 localities throughout the United States, Medical Advisory Boards, 
 who will examine registrants sent to them by Local JBoards or State 
 Adjutants General for examination, and will advise such Local 
 Boards or State Adjutants General concerning the physical condi- 
 tion of such registrants. (See sees. 123 and 182.) 
 
 Note 1. — The personnel of the Medical Advisory Boards should be kept at all 
 times as full as efficiency demands. Members of these Boards who hold com- 
 missions in the Rledical Corps, when asigned by the Surgeon General to active 
 duty, automatically cease to be members of the Boards. Vacancies on the 
 Boards thus created may be filled as provided in section 29, supra. 
 
 Note 2. — In those States and localities where it is impossible to organize an 
 Advisory Board with a complete personnel of qualified specialists it is not ex- 
 pected that the Advisory Board will be able to carry out the complete directions 
 for the physical examination of those registrants who require it. In this emer- 
 gency the Medical Aid to the Governor, with the latter's authorization, should 
 make provision, if possible, for the registrant to be examined by competent 
 specialists who may not be members of Advisory Boards. The Advisory Boards 
 should, whenever practicable, examine registrants at the established head- 
 quarters of the Board, which by preference should be a general hospital. In 
 certain emergencies the registrant may be sent elsewhere for special examina- 
 tion, such as taking a roentgenogram, eye and ear tests, etc. 
 
 Note 3. — A dentist should be appointed as a member of every Medical Ad- 
 visory Board wherever possible. Membership of Medical Advisory Boards is 
 not limited as to number and dentists may be added to Boards already ap- 
 pointed. (Telegram A-189, Dec. 5, 1917.) 
 
 Section 46. Duties of lawyers and physicians generally. 
 
 The selection and classification of men for military service is an 
 undertaking that should be regarded as a systematized effort of the
 
 56 
 
 citizenry of tlie whole Nation organized and compacted to meet the 
 present emergency. Every citizen has a duty to give his best en- 
 deavor to the success of this undertaking according to his qualifica- 
 tions and talents. All lawyers and physicians should regard it as 
 their duty to identify themselves with the Advisory Boards provided 
 for in sections 44 and 45, and freely and without compensation to 
 give their best service to the Nation. It is inconsistent with this 
 duty for lawyers to seek clients for the purpose of urging and advo- 
 cating individual cases in any other way than as disinterested and 
 impartial assistants of the Selective Service System,^ 
 
 Lawyers and physicians w^ll render a most valuable assistance by 
 giving their services to Local Boards and to the Medical Advisory 
 Boards provided in section 44 hereof. They should be scrupulously 
 careful in making affidavits and furnishing other proof of a medical 
 cha.racter to registrants in support of claims of physical disqualifi- 
 cation and respecting physical condition or infirmities of dependents. 
 
 Section 122. Physical examination 
 
 Beginning on such date or dates as the Provost Marshal General 
 shall hereafter fix for the beginning of the physical examination of 
 all or any number or proportion of registrants, and after a registrant 
 has been placet! in Class I by a Local Board (regardless of any 
 appeal) the Local Board shall mail to the last known address of any 
 registrant placed in Class I a notice (Form 1009, p. 226, sec. 281) 
 to appear for physical examination at a time and place to be desig- 
 nated in said notice (which time shall be five days from the date of 
 the mailing of the notice, unless otherwise ordered by the Provost 
 Marshal General), and shall enter the date of mailing of said notice 
 in column 19 of the Classification List. 
 
 Upon appearance of the registrant he shall be examined as provided 
 in Part VIII hereof and in Form 75, and the date of his examination 
 shall be entered in column 20 of the Classification List. The examin- 
 ing physician shall immediately enter his report and recommendation 
 in triplicate on the report of physical examination (Form 1010, p. 227, 
 sec. 282). 
 
 The same procedure as to physical examina^tion provided in these 
 regulations for registrants in Class I shall also apply to all regis- 
 trants who have been placed in a class more deferred than Class I, 
 so soon as the immediately preceding or earlier class has been ex- 
 hausted by calls into the military service and not before, except as 
 provided in sections 128, 149, and 150. 
 
 Note 1. — Whether the examining physician of the Local Board is in doubt or 
 not as to the physical qualification of a registrant for military service, he shall 
 nevertheless definitely report the registrant either as qualified or disqualified, 
 and if he is in doubt as to such qualification or disqualification, he may request 
 
 1 The provisions of the last sentence apply with equal force to physicians.
 
 57 
 
 to liiive the registrant sent before a Medical Advisory Board or a nieiijier or 
 members thereof a.s prescribed in section 123. 
 
 Note 2.— Registrants io Classes II, III, and IV will not be psyslcally exam- 
 ined except upon general order issued by the Provost Marshal General, ov when 
 special call is made for the induction into military service of registrants in such 
 classes, imless under the provisions of section 128. 
 
 NpTE 3.— The entry by the registrant on, the Questionnaire of the claim for 
 physical disqualification is not to be construed as a clalnr from which an appeal 
 lies to the District Board on account of the refusal of the Local Board to classify 
 the registrant in Class .5-G. Appeals from classification on physical grounds 
 may be made as provided in sections 122 to 128, inclusive, and not otherwise. 
 (Telegram A-2142, Jan. 3, 1918.) 
 
 Note 4. — See sections 141, 142, and 143 for provisions relating to transfer of 
 physical examination, physical examination of registrants residing abroad, and 
 physical examination of mariners actually employed on the Great Lakes. 
 
 .Section 123. Sending doubtful cases to a Medical Advisory Board. 
 
 If the examining physician is in doubt as to whether the registrant 
 is to be held for military service, or if the Government Appeal Agent 
 or two members' of the Local Board are dissatisfied with the finding 
 
 to 
 
 of the examining physician, the examining physician. Government 
 Appeal Agent, or members of the Local Board, may apply to the 
 Local Board to have the registrant sent before the nearest IMedical 
 Advisory Board or any member or members thereof (provided in sec- 
 tions 29 and 44 hereof) for a. further examination.^ Such application 
 shall be made by entering it in the place provided in Form 1010 (p. 
 227) . Thereupon the Local Board shall, linless it decides by imanimons 
 vote that the case is one in which there is no room for reasonable 
 doubt, immediately send the registrant before such Medical Advi.sorv 
 Board, or some member or members thereof, forwarding to the Medi- 
 cal Advisory Board, or such member or members thereof, the examiu; 
 ing physicians report (Foriji 1010, p.227) in triplicate and, where nec- 
 essary, furnishing the registrant with transportiition and meals and 
 lodging tickets for the time during which he will be before such Medi- 
 cal Advisory Board, or member or members thereof, in no case to ex- 
 ceed three days. 
 
 If the registrant is held to be physically disqualified by the examin- 
 ing physician, the Local Board shall, unless it decides by unanimous 
 vote that the disqualification is such as to leave no room for reason- 
 able doubt, send the registrant before such Medical Advisory Board, 
 or some member or members thereof, in the manner just provided. 
 
 Upon reference of a case from a Local Board as just provided, the 
 Medical Advisory Board, or the member or members thereof, to whom 
 such registrant has been sent, shall examine the registrant, record its 
 or their findings in triplicate on Form 1010 (p. 227), and return all 
 
 ^A registrant no longer h;is the right or privilege of applying to be sent to a Medical 
 Advisory Board.
 
 58 
 
 three copies of Form 1010 (p. 227) to the Local Board, with the coii- 
 chision and recommendation in the case. 
 
 Note 1. — Circular letter, January 9, 1918, prohibiting issuance of transporta- 
 tion requests for more than one way for sending of selected men to camps does 
 not nullify section 123, which provides for the sending of men to Medical Advisory 
 Boards. In these cases the Local Board will issue two transportation requests, 
 one each way. This rule is made necessary to prevent the possibility of unau- 
 thorized use of Government transportation other than for selected men or for 
 men being sent to Medical Advisory Boards, or a member or members thereof. 
 (Circular letter, Jan. 21. 191S.) 
 
 Section 124. Finding by Local Board as to physical qualification. 
 
 Upon receipt of the re^^ort and recommendation of the Medical 
 Advisory Board as provided in section 123, or, if the case has not been 
 sent to the Medical Advisory Board, or a member or members 
 thereof, then upon the receipt of the report of the examining physi- 
 cian, the Local Board shall make its decision as to the physical quali- 
 fication of the registrant. If the registrant is found physically dis- 
 qualified for general military service, the Local Board shall can- 
 cel the cross mark (X) or cipher (0) which has already been en- 
 tered in a classification column by drawing a red-ink line through 
 such cross mark or cipher and shall enter the classification of the 
 registrant in Class V, column 12. (See sec. 102.) If the registrant 
 is found to be physically disqualified for general military service, but 
 qualified to perform special and limited military service (see sec. 
 128|), his place in the classi£cation column shall not be changed, but 
 the Local Board shall, with red ink, inscribe a l^old circle around the 
 cross mark (X) or cipher (0) in such classification column. (See 
 sec. 188, Part Vin.)i 
 
 Note 1. — Once in 6very month the Local Board shall send one copy of Form 
 1010 for each case covering a registrant who Jias been finally classified in V 
 (G) and not theretofore so sent, to the draft executive, who shall assemble these 
 and transmit them to the Surgeon General of the Army, Washington, D. C. 
 The draft executive shall keep a nominal check list of such cases. 
 
 While men found disqualified for general military service but qualified 
 for special and limited military service are not placed in Class V, they 
 are subject to induction into military service only when a specific call for 
 men qualified for special or limited military service only is made. 
 
 If the finding of the Local Board is not in accord with the recom- 
 mendation of the Medical Advisory Board, and an appeal is taken to 
 the District Board from the decision of the Local Board as to 
 the physical qualifications of the registrant, the Local Board shall 
 make a special report to the District Board of its reason for reject- 
 ing the recommendation of the Medical Advisory Board. 
 
 The Local Board shall, on the day of its decision as to the physical 
 qualification of any registrant, mail to such registrant a notice (Form 
 1011, sec. 283, p. 231) of the result of such decision and shall enter 
 
 1 See section 1281 foi" deferred remediable group. •
 
 59 
 
 the date of such mailing in Golunin 21 of the Classificatoin List (Form 
 1000, p. 188.) 
 
 NoTK 1. — See section 12Si concerning deferred remediable group. 
 Section 125. Appeal from finding of Local Board as to physical qualification.s. 
 
 Within five days after the date of the notice prescribed in section 
 124 any registrant may make a cLaim of appeal to the District Board 
 from the finding of the Local Board as to his physical qualification 
 for military service. Claim of appeal shall be made by entering the 
 claim in the place provided for that purpose on all three copies of the 
 physical examination report (Form 1010, sec. 282, p. 227). The 
 Government Appeal Agent may make a claim of appeal on behalf 
 of the United States at any time. 
 
 Immediately upon filing of an appeal from the decision of the 
 Local Board as to physical qualification, the Local Board shall trans- 
 mit to the District Boai'd all three copies of the record of physical 
 examination (Form 1010, p. 227) in the case, together with any addi- 
 tional evidence as to physical qualification which may have been 
 submitted to the Local Board, and shall enter the date of forwarding: 
 such record in column 22 of the Classification List and in the place 
 provided on the Cover Sheet. 
 
 Note 1. — The entry of the registrant on the Questionnaire of a claim of 
 physical disqualification' is not to be construed as a claim from wliic-h an 
 appeal lies to the District Board from the refusal of the Local Board -to 
 classify the registrant in Class V (G). Appeals from classification on physical 
 grounds may be made as provided in sections llii* to 1:28, inclusive, and not 
 otherwise. (Telegram A-2142, Jan. 3, liJlS.) 
 
 Section 126. Action by District Board upon appeal as to physical qualification. 
 In considering a case appealed on the ground of physical qu^ilifica- 
 tion, the District Board shall neither conduct an}^ new physical 
 examination nor shall it receive or consider any evidence which was 
 not considered by the Local Board, but shall, upon consideration of 
 the record sent to it as prescribed in section 125, either aflirm, modify, 
 or reverse the decision of the Local Board and promptly enter its 
 finding on all three copies of Form 1010 (p. 227), and imnijediately 
 return the same to the Local Board. 
 
 Section 127. Procedure of Local Board on return of physical examination 
 record from District Board. 
 
 If the action of the District Board on appeal as to physical quali- 
 fication changes or affects the classification of the registrant (see sec. 
 124), the Local Board shall make the necessary changes in the Classi- 
 fication List. Whether the action of the District Board changes or 
 affects the Classification by the Local Board or not, the Local Board 
 shall mail to the registrant a notice (Form 1011, sec. 283, p. 231) of 
 the result of the decision by tlie District Board, and shall enter the 
 date of mailing of such notice in column 23 of the Classification List.
 
 60 
 
 Section 128. Physical examination of persons not in Class I. 
 
 Local Boards may, upon the application of registrants in Classes 
 II, III, or IV, examine such registrants physically, pass upon their 
 physical qualifications, and, if they are found to be permanently 
 disqualified, to classify them in Class V. (See sec. 79.) This is not 
 a right of the registrant, but it is a privilege that may be accorded by 
 the Local Board where the according of the privilege will not inter- 
 fere with the prompt and orderly execution of the Selective Service 
 Law. 
 
 Section 128 '/2. Grouping of registrants. 
 
 The Regulations governing physical examinations prescribe a 
 standard of unconditional acceptance and a standard of uncondi- 
 tional rejection. Certain cases found, upon physical examination by 
 a Local Board, falling between these two standards may be referred 
 by the Local Board to the Medical Advisory Board or to some mem- 
 ber in the same manner as other cases that are required or authorized 
 by these Regulations so to be referred. Cases so referred as falling 
 between these two standards, and cases referred to Medical Advisory 
 Boards, or member thereof, under the other provisions of these Regula- 
 tions, shall be examined by the IMedical Advisory Boards or such 
 member or members thereof, who shall advise the Local Boards to : 
 
 (a) Accept the registrant as physically qualified for general mili- 
 tary service; or 
 
 (h) Accept the registrant as physically qualified for general mili- 
 tary service when cured of (naming remediable defect for 
 
 which acceptance is authorized) ; or 
 
 (c) Accept the registrant as' pln^sicalb/ qualified for special or 
 limited military service in a named occupation or capacity ; or 
 
 (d) Reject the registrant; 
 
 and shall record their finding in the proper spaces provided on Form 
 1010. 
 
 Local Boards shall find a registrant physically qualified for gen- 
 eral military ser\dce (Rule a above) only when he falls within the 
 standard of unconditional acceptance as prescribed in sections 182 
 to 188, inclusive, as further explained and amplified by the Standards 
 of Physical Examination, including cases of slight remediable defects 
 not included under foregoing Rule h. 
 
 Local Boards shall find a registrant physically qualified for gen- 
 eral military service when cured of a remediable defect (Rule h above) 
 only in those cases when such acceptance is specifically authorized; 
 namely, when a registrant is found to fall within the "Deferred 
 remediable gTOup." 
 
 AVhen a Medical Advisory Board, or a member or members thereof, 
 to whom a registrant has been sent determine tlnit a registrant 
 fchould be accepted for general military service when cured of such
 
 61 
 
 remediable defects (Rule h above) the Medical Advisory Board, or 
 such member or members, shall insert in ink in the space provided 
 on page 2 of Form 1010, under the general heading, " Physical ex- 
 amination by Medical Advisory Board," and the following words: 
 " Physically qualified for general military service," the words " when 
 
 cured of " followed by the name or diagnosis of the remediable 
 
 defect, which name or diagnosis is to be followed by a circle in 
 black ink. Upon return to the Local Board of the record (Form 
 1010, p. 227) in such a case, and if the finding of the Medical Ad- 
 visory Board, or such member or members thereof , is confirmed by the 
 Local Board, the registrant's place in the classification column shall 
 not be changed, but the Local Board shall, with black ink, inscribe 
 a bold circle around the cross mark (X) or cipher (0) in such classi- 
 fication column; and such registrant shall be inducted into military 
 service after his order number is reached, but only at such time as 
 may be designated by a call issued by the Provost ]\Iarshal General. 
 
 Eegistrants shall be found " physically qualified for special or 
 limited military service" (Rule c above) onh' in those cases de- 
 scribed in the Standards of Physical Examination, and in such cases 
 the Boards shall designate the occupation or class of service for 
 which such persons are physically qualified in the space provided on 
 Form 1010 (p. 227) after the words " physically qualified for special 
 or limited military service as ," and the same- shall be indi- 
 cated on the Classification List as provided by section 124. 
 
 Registrants shall be found as physically deficient and not physi- 
 cally qualified for military service (Rule d above) only when they 
 fall within the standards of unconditional rejections as prescribed in 
 sections 182 to 188, inclusive, as further explained and amplified by 
 the Standards of Physical Examination. 
 
 When a Medical Advisory Board or a member or members thereof 
 delay the examination of a registrant on account of temporary de- 
 fects, it or they must return to the proper Local Board Form 1010 
 (p. 227), with a statem.ent attached thereto (but not written thereon) 
 stating the reason for delay and fixing a definite period of time 
 witliin which the registrant ma}^ be sent back to it or them. At the 
 end of said period, or earlier, if it believes the temporary defect is 
 removed, the Local Board shall send the registrant back to the 
 Medical Advisory Board, unless the Local Board believes that the 
 examination should be further delayed or that further refertnce to 
 tlie Medical Advisory Board, is unnecessary, and may proceed Avith- 
 out further reference. 
 
 Local Boards may aocei^t a registrant as physically qualified for 
 special or limited military service in a named occupation or capacity 
 without reference to the Medical Advisory Board. 
 
 Note 1. — The foregoing regulations clearly indicate the foiu- groups into 
 whicli registrants should be grouped by Local, District, and Medical Advisory
 
 62 
 
 Boards as a result of the physical examinations in accordance with the Manual 
 of Standards of Physical Examination. 
 
 In other words, Group A shall contain registrants found to be qualified for 
 general military service within the standards of unconditional acceptance, 
 including registrants with slight remediable defects. 
 
 Registrants with slight remediable defects shall be held physically qualified 
 for general military service, if not remedied pending orders. 
 
 All registrants coming within the foregoing definition and as 
 specifically indicated in the instructions in the Manual are to be 
 included in Group A and reported as physically qualified for 
 general military service in the place indicated on' Form 1010 
 (p. 227). 
 
 Group B shall contain registrants who are found to be phys- 
 ically qualified for general military service when cured of some 
 remediable defect which is of such a character that it must be 
 remedied or cured before the registrant can be ordered into service. 
 
 Group C shall contain registrants who are found not to be within 
 the standard of unconditional acceptance on account of defects which 
 are not remediable nor sufficiently incapacitating to bring them 
 within the condition of unconditional rejection. This is the group 
 of registrants who may be found to be qualified for special or limited 
 military seiwice. 
 
 Group D shall contain all registrants coming within the standards 
 of unconditional rejection and includes all cases not included in 
 Groups A, B, and C. Such registrants must be reported on Form 
 1010 (p. 227) as " Physically deficient and not physically qualified for 
 military service by reason of '• (the reason for the disqualifica- 
 tion to be stated in the blank provided). 
 
 In arriving at their decisions concerning the physical qualifications 
 of registrants Boards must be governed, as to the grouping of regis- 
 trants, by the specific instructions contained in Manual of Standards 
 of Physical Examinations. 
 
 Note 2. — Whenever it shall appear to a Local Board or to a Medical Advisory 
 Board that a registrant is suffering from self-inflicted or purposely caused 
 physical defects which, under the Standards of Physical Examinations, would 
 render him disqualified for military service of any kind, a full statement of 
 the facts and of the condition of the registrant and of the Board's recommenda- 
 tion shall be prepared and attached to Form 1010 (p. 227), and one copy of 
 Form 1010, with such statement attached, shall immediately be sent by the 
 Local Board to the Adjutant of the State to be transmitted to the Provost 
 Marshal General in order that the case may be submitted to the Surgeon Gien- 
 eral and The Adjutant General of the Army for a waiver of the physical defects, 
 if recommended, so that the registrant may be compelled to render military 
 service. 
 
 Note 3. — When in the opinion of the Local Board the registrant is believed 
 to be feigning disease or illness or physical defect, which can not be detected 
 l)y careful examination, the Local Board shall note on Form 1010 its opinion 
 that registrant is feigning in order to avoid service. (See sec. 171, Form 75.)
 
 63 
 
 Note 4. — The foregoing sections 122 to 12Si, inclusive, and sections 141-143 
 reliite to the procedure concerning pliysical .examinations. For rules and 
 standards as to physical qualifications governing examining physicians, see 
 Part VIII, sections 182 to 188, inclusive, and Foi-ni 75, " Standards of Physical 
 Examination." 
 
 Note 5. — Great care must be taken in observing the difference in the standards 
 of physical examination as between registrants to be inducted into the Army 
 and those to be inducted into the Navy. 
 
 Section 177. Disposition of registrants rejected or discharged from military^ 
 service at a mobilization camp. 
 
 When any selected man, prior to acceptance, is rejected at a mobi- 
 lization camp, the commanding officer thereof shall promptly notify 
 his Local Board of the fact, canso (stating at length the details), and 
 date of rejection, on Form 1020-A, and the Provost Marshal General, 
 on Form 1029-B. When any selected man is, subsequent to accept- 
 ance, discharged at a mobilization camp, the commanding officer 
 thereof shall similarly notify the Local Board, using Form 1029-C, 
 and the Provost Marshal General, using Form 1029-D. (Sec. 305, 
 p. 254.) 
 
 Immediately upon receipt of i\otice of the rejection or discharge 
 of any selected man, the Local Board shall reclassify the registrant 
 in accordance with his status as determined by the action of the 
 militar}^ authorities in rejecting or discharging him and shall then 
 proceed in the following manner : 
 
 (a) If the rejection or discharge was because of j)hysical disquali- 
 fication, the Local Board shall reclassify the registrant in class I and 
 shall direct him to aj^pear before it for further physical examination, 
 and if, after thorough physical reexamination, the Local Board dis- 
 covers the physical defect found by the examining surgeon at the 
 mobilization camp, the classification as determined b}^ the command- 
 ing officer of the mobilization camp shall stand. If, after thorough 
 physical reexamination, the Local Board does not discover the dis- 
 qualifying defect, it shall refer the registrant to a Medical Advisory 
 Board or a member or members thereof for exhaustive reexamina- 
 tion, advising the Medical Advisory Board or such member or mem- 
 bers of the fact that the registrant has been rejected at the mobiliza- 
 tion camp and specifically stating the jcause of rejection as reported 
 by the commanding officer. The Medical Advisory Board or such 
 member or members shall make an exhaustive examination of the 
 registrant, particularly as regards the physical disqualifications as 
 found by the examining surgeon at the mobilization camp and shall 
 report its findings to the Local Board. The Local Board' shall pro- 
 ceed to a decision as to the physical qualifications of the registrant 
 and shall forward the record to the District Board for approval or 
 disapproval of its findings. Upon the return of the record from the
 
 G4 
 
 District Board the Local Board shall reclassif}^ the registrant in 
 accordance with the findings of the District Board. 
 
 {h) If the rejection or discharge at the mobilization camp was 
 because of any reason other tha.n that of physical disqualification the 
 Local Board shall proceed to an investigation of the case, and if in 
 the opinion of the Local Board an error was made in the rejection or. 
 discharge the entire record shall be referred to the Adjutant General 
 of the State, who, if he approves the findings of the Local Board, 
 shall refer the record to the commanding officer of the mobilization 
 camp for his consideration, recommendation, and return through the 
 Adjutant General of the State to the Local Board. 
 
 In all cases so referred to the commanding officer of the mobiliza- 
 tion camp and not returned by him within a reasonable time, or 
 returned by him without recommendation, or returned by him with a 
 recommendation disapproving the findings of the Local Board, the 
 Adjutant General of the State shall, if in his opinion the same be 
 necessary, forward the entire record to the Provost Marshal General 
 for instructions as to further procedure.^ 
 Section 182. Preliminary statement. 
 
 In view of the contemplation of a further investigation and classi- 
 fication of registrants physicall}^ qualified for special and limited 
 military service who have not the physical qualifications for general 
 military service, and in view of the decision to accept some regis- 
 trants for general military service with remediable defects, who are 
 otherwise physically and mentally qualified for military service, the 
 following new regulations for the physical examination of regis- 
 trants by the physician of the Local Board becomes necessary : 
 
 Local Boards can accept registrants for general military service 
 only, when they come within the standards for unconditional accept- 
 ance, with or without remediable defects. 
 
 Local Boards can reject registrants for general military'- service 
 onl}^ when the registrant comes within the standards of uncondi- 
 tional rejection. 
 
 Local Boards may accept registrants for special and limited mili- 
 tary service, but must refer all doubtful cases to the Medical Ad- 
 visory Board or a member or members thereof. 
 
 Physicians on the Local Board are not required to make a com- 
 plete examination of every registrant. The moment the physician 
 on the Local Board finds a mental or a physical defect placing the 
 registrant within the standards of unconditional rejection the phy- 
 sician on the Local Board shall indicate this in Form 1010 (sec. 282, 
 p. 227), after "physically deficient and not physically qualified for 
 
 ^ If any doubt arises as to rejected men, their cases may be talcen up directly with the 
 camp commander, or the facts communicated to this office, as may be most expedient.
 
 65 
 
 military service by reason of," and shall in the space following, 
 write the disqualifying defect. 
 
 In all other cases the Local Board shall make a complete examina- 
 tion of registrants; and, when the physician of the Local Board finds 
 a defect which docs not come within the standards of unconditional 
 rejection but does take the registrant out of the class within the 
 standards of unconditional acceptance, he shall proceed to make a 
 complete examination and may then, if in doubt, refer the registrant 
 to the Medical Advisor}^ Board, or a member or members thereof, 
 reporting the result of the complete examination, including a report 
 of the defect or defects on Form 1010 (p. 227). 
 
 Registrants ca,n not be declared physically qualified for general 
 military service (see Form 1010, sec. 282, p. 227, S. S. R.) until the 
 complete examination has been made by the physician on the Local 
 Board, with the finding that the candidate comes in everv instance 
 within the standards of unconditional acceptance with or without 
 remediable defect. Then, it is so noted and recorded on Form 1010 
 (sec. 282, p. 227, S. S. R.), and if there is a remediable defect this is 
 also recorded after " physically qualified for general military service." 
 
 Section 183. Place, order, and method of examination. 
 
 For material, see Form 75, " Standards of Physical Examination." 
 
 Section 184. Causes for rejection. 
 
 For material, see Form 75, " Standards of Physical Examination." 
 
 Section 185. Dental requirements. 
 
 For material, see Form 75, " Standards of Phj^sical Examination." 
 
 Section IBG. Degree of deficiency for disqualification. 
 
 In these regulations the standards for unconditional rejection 
 which place the registrant in the class physically deficient and not 
 physically qualified for military service are clearly defined. When 
 the Local Board is in any doubt, the registrant should be referred to 
 the Medical Advisory Board, or a member or members thereof. The 
 attention of Local Boards and examining physicians is called to sec- 
 tion 123. 
 
 Section 187. Temporary defects. 
 
 Registrants confined to their homes or hospitals, or who present 
 themselves with some temporary defect, the result of an acute disease, 
 injury, or operation, or Avho are waiting for operation, should be 
 granted a reasonable delaj^ for completing the physical examination. 
 
 All of these cases should be thoroughly investigated by the physi- 
 cian 6n the Local Board. 
 
 Registrants with contagious, communicable, reportable diseases 
 should not be ordered before the Local Board for examination until 
 they are discharged by the boards of health.
 
 66 
 
 Eegistrants recovering- from diphtheria should not be ordered to 
 the cantonments until three negative cultures at intervals of three 
 days have been obtained from the throat and nose. In localities 
 where there is no provision for this bacteriological v^'ork, consult the 
 municipal or State health authorities, or United States Public Health 
 Sei-^ace. 
 
 Section 188. Special and limited military service. 
 
 In view of the importance of a thorough investigation and classi- 
 fication of registrants belonging to this group, Local Boards are re- 
 quired to refer to the Medical Advisory' Boards, or some member or 
 members thereof, all such registrants concerning whose qualifications 
 there may be doubt. 
 
 The physician of the Local Board is urged to consult with the Medical 
 Advisory Board about this group and to familiarize himself with the 
 specific regulations concerning special and limited military service. 
 
 Note 1. — See section 177 ami Form 75, " Standards of Physical Examination." 
 Note 2. — For rules of procedure couceruing physical examinations, see sections 
 
 122 to 12SJ and 141 to 143, inclusive. 
 
 Note 3. — Great care must be talien in observing the difference in the standards 
 
 of pliyslcal examination as between registrants to be inducted into the Army 
 
 and those to be inducted into the Navy. (See sec. 5.) 
 
 Section 196. Examining physicians — Rate of pay. 
 
 It is the duty of any physician who is a member of a Local Board 
 to make ph3sical examinations, and additional examining physicians 
 should be compensated only where acceptable gxtttuitous service can 
 not be obtained, and where, in accordance with section 42, the com- 
 pensation of an examining physician in addition to the physician 
 member of the board is authorized. 
 
 Physician members of Local Boaras and examining ph3^sician3 
 not members of Local Boards may receive compensation at the rate 
 of $1 per hour for each hour that they are actually present at the 
 office of the Board and fully engaged in the duties of making 
 l^hysical examinations, but not in any case to exceed $7.50 for any 
 single day or $150 for any single month. 
 
 Note 1. — The compensation provided in tlie above section for physician mem- 
 bers of Local Boards is in addition to that provided for their services as mem- 
 bers of Local Boards under section 195 of these regulations, subject, however, 
 to the provisions of note to section 190 of these regulations. 
 
 RULES OF PROCEDURE FOR MEDICAL ADVISORY BOARDS. 
 
 (1) Read carefully the Selective Service Regulations (S. S. R.), 
 particularly the following sections: 26, 29, 33, 42, 43 (<?),44, 46, 122 to 
 128i, 177, 182, 186 to 188, 196. For ready reference all of these sec- 
 tions are reprinted in this appendix.
 
 67 
 
 (2) Medical Advisory Boards shall consist of tlii-ee or more phy- 
 sicians. The desirable miniinuiii consists of one each of the following? 
 Specialists: Internist; ej'.e, ear, nose, and throat; orthor)edist ; sur- 
 geon ; psychiatrist ; radiographer ; dentist. Additional Medical Ad- 
 visory Boards ma}^ be formed. The membership of existing boards 
 may be increased as necessity may indicate, but should not exceed 10 
 members. (See sec. 29, S. S. R.) When a Medical Advisory. Board 
 believes that other boards should be created, or additional members 
 added to existing boards, it should recommend the same to the gov- 
 ernor through the Medical Aide. 
 
 (3) Each board should select one member as chairman, one as vice 
 chairman, and one as secretary. Sessions will be held only when 
 necessary for the conduct of general business. 
 
 (4) Request to the governor for authority to employ clerical as- 
 sistance and incur other expenses should be made only when abso- 
 lutely necessary. Do not incur any expense mitil authorized b}^ tlie 
 governor. (Se« sees. 43(a), 198, 204, and 208, S. S. E.) Stationery 
 will be supplied by the Adjutant General. 
 
 (5) No communications concerning the business of Medical Ad- 
 visory Boards should be addressed to any department or official in 
 Washington. Except for their communications with Local Boards 
 and Medical Aides, Medical Advisory Boards must address all offi- 
 cial communications of every character, whether reports, recom- 
 mendations, or requests for instructions or for interpretations to tlic 
 Adjutant General of the State, who will either respond thereto or 
 transmit the same to the proper authoritv. (See sec. 29, Note 3, 
 S. S. R.) 
 
 (6) A place will be salected as headquarters of the board where 
 sessions may be held and physical examinations conducted. This 
 should be preferably a hospital or similar institution, where proper 
 and careful examinations can be made. It ought not to be necessary 
 to ]Day rental for such headquarters; but in the event that no free 
 quarters can be obtained, application must be made througli the 
 Adjutant General of the State to the governor for authority to incur 
 expense for rent. Physical examinations should be conducted at 
 headquarters of the board when practicable; exceptionally, Avhen 
 necessity for prompt action exists, an Advisory Board member may 
 conduct his part of the examination at his office. 
 
 (7) A majority of the board shall constitute a quorum. The board 
 shall decide all disputed questions by vote. The chairman need not 
 vote except to break a tie. 
 
 (8) It shall not be necessary for all or a majority of a board to be 
 present at or to participate in the examination of a registrant. Such 
 registrant may be referred to the appropriate member or members, 
 whose opinion is desired.
 
 68 
 
 (9) Any member of the board can sign Form 1010, reporting tlie 
 result of ph3^sical examination by the Medical Advisory Board, des- 
 ignating the signer as follows : " Chairman," " vice chairman," " sec- 
 retar3^" or " member." 
 
 (10) Form 1010 will be promptly completed by the Medical Ad- 
 visory Board, or by the member or members who have examined the 
 registrant, and will be at once returned in triplicate to the Local 
 Board by which issued. If registrant has been examined at the re- 
 quest of the Adjutant General, Form 1010, when completed by the 
 Medical Advisory Board, shall be returned in triplicate to the Adju- 
 tant General. (See sec. 13T, S. S. E.) 
 
 (11) If clerks are employed they are to be on duty at place of 
 meeting dail^'^, except Sundays and legal holidays, from 9 a. m. to 
 5 p. m., and shall keep all records and conduct all correspondence 
 under the direction of the board. 
 
 (12) No permanent record is required to be kept by Medical Ad- 
 visory Boards except a minute book, which shall contain a list of reg- 
 istrants whose examination has been completed, and another list of 
 those Avhose examination is delayed on account of temporary defects. 
 The following, or substantially ecjuivalent form, which is not sup- 
 plied but must be written or typewritten, will be entered in the book 
 as a record of formal meetings. 
 
 Date of meeting Convened M. Adjourned M. 
 
 Present (members of board). • Arrived. Left. 
 
 Business Transacted. 
 
 Names of cases referred by the Local Board 
 
 Number finally acted on 
 
 Names of cases referred by registrar or Appeal Agent 
 
 Number finally acted on 
 
 Names of cases referred by The Adjutant General 
 
 Number finally acted on 
 
 Names of cases transfei'red from Local Boards 
 
 Number finally acted on 
 
 (13) Medical Advisory Boards must conduct all their proceedings 
 in strict accordance with the Standards of Physical Examinations 
 and the Selective Service Regulations. 
 
 (14) xVll inquiries, requests for interpretations, reports, and com- 
 munications of every character (except those with Local Boards)
 
 69 
 
 must be addressed to the Governor or State Adjutant General, 
 thrcugli the medical aid to the governor. When necessary, such 
 communications will be forwarded through proper channels to the 
 Provost Marshal General. (See sec. 25, S. S. E.) 
 
 (15) Definite and explicit instructions with respect to headquar- 
 ters, expenses, correspondence, and standards of examinations will 
 be found in the text of Form 75 and the Selective Service Eegulations. 
 
 (16) When registrants referred to the Advisory Board present 
 themselves with some temporary defect, the result of a recent acute 
 disease, injury, or operation, the Local Board should be advised to 
 grant a reasonable time for recovery before the final examination by 
 the Medical Advisory Board is made. 
 
 (17) When Local or Advisory Boards can not command the facili- 
 ties at the hospital headquarters for making throat cultures of regis- 
 trants recovering from an attack of diphtheria as directed in section 
 187 in the Regulations for Local Boards, the cultures from the 
 throats of such registrants may be sent by mail to municipal labora- 
 tories or to those of the State or of the United States Public Health 
 Service. 
 
 (18) The Medical Advisory Board may employ section 187, S. S. R., 
 "Temporary Defects," when they desire to grant the registrant a 
 reasonable delay for completing the ph3'sical examination when it is 
 difficult or impossible to come to a definite conclusion when the regis- 
 trant first presents himself to the ^ledical Advisory Board. 
 
 (19) Whenever possible examinations should be completed within, 
 one day. Medical Advisory Boards in those districts in which the 
 registrants must be sent from a distance should suggest to their Local 
 Boards to hold registrants under section 187, S. S. E., for a reasonable 
 time until the examination can be so completed.
 
 INDEX. 
 
 I References are to sections. See also index to appendix on page 73.] 
 
 Sections. 
 
 Abdomen, concerning , S5-94 
 
 Alcoholism, chronic 110, 118 
 
 Anemia, progressive, pernicious, secondary, splenic 156-157 
 
 Anesthetic, use of, in diagnosis 18 
 
 Apices, lungs 138 
 
 Blood vessels, concerning 140-146 
 
 Brain, organic diseases of 121-129 
 
 Cancer, concerning 157 
 
 Chest, standard measurements 78-S4 
 
 Chest wall, concerning 130-132 
 
 Chronic alcoholism 110, 118 
 
 Clinical forms of insanity 119, 120 
 
 Debility, concerning 156 
 
 Dental requirements 47-52 
 
 District Boards, jurisdiction and powers of {see Appendix) 10 
 
 Drug, addiction to, concerning 108 
 
 Ears, concerning 35-41 
 
 Epilepsy, concerning '110, 114 
 
 Esophagus, concerning 42-46 
 
 Examinations, order and method of 17-19 
 
 Extremities, concerning 72-77 
 
 Eyes, concerning 20-34 
 
 Fauces, concerning ^ 42-46 
 
 Feet, defects of 72-77 
 
 Fingers, concerning 72-75 
 
 Genito-urinary organs, concerning 100-106 
 
 Groups indicating physical qualifications (sec. 1281, S. S. R. ) 4 
 
 Hands, concerning 72-75 
 
 Head, concerning 57-59 
 
 Hearing, concerning 35-41 
 
 Heart, concerning 140-154 
 
 Height, standard measures-! 78-84 
 
 Hemophilia 156 
 
 Idiocy, concerning 110, 116 
 
 Illness and injuries confining to home, etc., concerning 158 
 
 Imbecility, concerning 110, 117 
 
 Injuries, confining to home, etc.. concerning 158 
 
 Insanity : 
 
 Concerning 110. 113 
 
 Clinical forms of 119. 120 
 
 Larynx, concerning 42-46 
 
 (70)
 
 / 
 71 
 
 Sections. 
 
 Local Boards, jurisdiction powers (see Appendix) 4-10 
 
 Lumbo-sacral joints, concerning GG-69 
 
 Lungs and cbest wall, concerning 130-139 
 
 Malaria, acute or chronic, concerning I55 
 
 Malingering : 
 
 Notes on 16i-177 
 
 Hearing, test to detect 40, 41 
 
 Vision, test to detect 27-34 
 
 Marine Corps, requirements for 5, 20 
 
 Measurements, directions and standards 78-S4 
 
 Medical Advisory Boards, concerning (see Appendix) 7-lG 
 
 Medical Aide, concerning {see Appendix) 11 
 
 Mental diseases, concerning : 107-129 
 
 Metallic poisoning, irremediable 3 57 
 
 Military authorities, powers of 13 
 
 ]\routh, concerning 42-4G 
 
 Murmurs of heart, concerning 140-154 
 
 Navy, requirements for 5. 20 
 
 Neck, concerning 95-99 
 
 Nerves, peripheral, organic diseases of , 121-129 
 
 Nervous diseases, concerning 107-129 
 
 Nose, concerning 42-4G 
 
 Order of examination 17-19 
 
 Organic diseases, brain, spinal cord, peripheral nerves 121-129 
 
 Pellagra, concerning 157 
 
 Peripheral nerves, organic diseases of 121-129 
 
 Pharynx, concerning 42— 4G 
 
 Plurisy, concerning 130-137 
 
 Kules, preliminary and general 1-lG 
 
 Sacro-iliac and lumbo-sacral joints . 66-G9 
 
 Scapulas, concerning • 70-71 
 
 Skin, concerning 53-5G 
 
 Spinal cord, organic diseases of 121-129 
 
 Spine, concerning ^ 60-G9 
 
 Standards of physical examination : 
 
 Purpose and use of 1 
 
 To whom applicable 2-3 
 
 Temporary defects, concerning 159-162 
 
 Teetli, definitions, etc 47-52 
 
 Thumbs, concerning 72-75 
 
 Trachea, concerning 42^G 
 
 Tuberculosis : 
 
 Diagnosis of, in general ■ 132-139 
 
 X-ray, uses of 139 
 
 Venereal diseases, concerning 100-lOG 
 
 Weight, measurements, standards 7S-S4 
 
 X-ray plates, use of 46, 65,. 90, 105, 152
 
 INDEX TO APPENT3IX. 
 
 [References are to pages.] Page. 
 
 Clerical assistance, appointment, expenses, etc. (sec. 43, S. S. R.) 55 
 
 Correspondence rules (sec. 25, S. S. R.) • 52 
 
 District Boards : 
 
 Appeals to (sec. 125, S. S. R.) 59 
 
 Powers and duties (sec. 126, S. S. R.) 59 
 
 Status of (sec. 33, S. S. R.) 53-54 
 
 Grouping of registrants as to pliysical qualifications (sec. 12S^, S. S. R.)_ 60-G2 
 
 Local Boards : 
 
 Appeals from findings (sec, 125, S. S. R.) 59 
 
 Powers and duties (sees. 122-128^, S. S. R.) 56-57,00-62 
 
 Procedure as to returned records (sec. 127, S. S. R.) 59 
 
 Registrants grouped by (sees. 12SA, 182, S. S. R.) 00-62,04-65 
 
 Status of (sec. 33, S. S. R.) 53-54 
 
 Jledical Advisory Boards : 
 
 Appointments, etc. (sec. 29, S. S. R.) 52-53 
 
 Clerical assistance for (sec. 43, S. S. R.) 55 
 
 Dentists on (sees'. 42, 44, S. S. R., notes) 55 
 
 Duties and personnel of (sees. 44, 123, S. S. R.) 55, 57-58 
 
 Rules of pi-ocalure for 66-69 
 
 State districts under (sec. 29, S. S. R.) 52-53 
 
 Medical Aide to Governor : 
 
 Appointment (sec. 29, S. S. R.) 52-53 
 
 Duties of (sec. 29, S. S. R.) 52-53 
 
 Physical examination : 
 
 Appeals from finding of Local Boards (sec. 125, S. S. R.) 59 
 
 Disqualification, degree of deficiency for (sec. 186, S. S. R.) 65 
 
 Doubtful cases sent to Medical Advisory Board (sec. 123, S. S. R.)___ 57-58 
 
 Finding by Local Board (sec. 124, S. S. R.) 58 
 
 Grouping of registrants after (sec. 1284, S. S. R.) 60-62 
 
 Persons not in class 1 (sec. 128, S. S. U.) 59 
 
 Powers and duties of District Boards (sec. 126, S. S. R.) 59 
 
 Powers and duties of Local Boards (sees. 122-128J, S. S. R.)— 56-57, 60-62 
 Powers and duties of Medical Advisory Boards (sees. 44, 123, 
 
 S. S. R.) 55,57-58 
 
 Procedure governing (sees. 122-128^, S. S. R.) 56-57,60-62 
 
 Qualifications (sees. 128*, 182, S. S. R.) 60-62,04-05 
 
 Reexamination of rejected and discharged registrants, when (sec. 
 
 177, S. S. R., note) 03-04 
 
 Physit'fil qualifications : 
 
 Concerning (sees. 128^, 182, S. S. R.) -. 60-62,64-65 
 
 Degree of deficiency disqualifying (sec. 186, S. S. R.) 05 
 
 Special and limited military service (sec. ISS, S. S. R.) 66 
 
 Temporary defects (sec. 187, S. S. R.) 65 
 
 Physicians., examining : 
 
 Additional, appointment and duties (sec. 42, S. S. R.) 54-55 
 
 Duties generally (sec. 46, S. S. R.) 55-56 
 
 Pay of, rate of (sec. 196, S. S. R.) 66 
 
 Registrants, how grouped (sees. 1284, 182, S. S. R.) 60-62 
 
 Rejected or discharged men, disposition of (sec. 177, S. S. R.) 63-64 
 
 Rules of Proce<lure for Medical Advisory Boards 66-69 
 
 Special and limited military service (sec. 188, S. S. R.) 66 
 
 (72) 
 
 o