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ANNUAL REPORT THE SURGEON GENERAL UNITED STATES ARMY Fiscal Year 1959

Annual Report the Surgeon General United States Army Fiscal Year 1959

STANDARDS OF MEDICAL FITNESS

The multiplicity and complexity of medical fitness (physical) standards directives have long adversely affected the accomplishment of medical examinations and their administrative processing. In addition to the four Army regulations (AR 40-110, AR 40-500, AR 40-503, and AR 40-504) for which The Surgeon General is responsible, there are almost 200 other directives of various kinds which, in whole or in part, deal with physical standards matters. Fiscal year 1959 was marked by significant achievements in simplifying, clarifying, integrating, modernizing, and consolidating the principal directives in this field. Appointment, enlistment, and induction medical fitness standards were consolidated in AR 40-503, which concurrently established new distant visual acuity criteria. Retention medical fitness standards were clarified and extended to cover all Army personnel whether on active or inactive duty.

The most significant development in the field of physical standards was the initiation of a special project known as the Consolidated Medical Fitness Standards Project. Its purpose is to combine medical fitness standards directives into a readily accessible two-part regulation, completely indexed, and printed on 8- x 10-inch paper in a looseleaf binder form. Part I, dealing with the the various standards of medical fitness, has been drafted and is being reviewed and evaluated. Considerable progress has been made on Part II, which deals with the conduct and recording of medical examinations and with the preparation and disposition of reports of medical examination. In addition, present criteria for Army service are being evaluated as to their current and future appropriateness in the light of recent medical advances and the demands of modern warfare.

One problem has been the lack of factual statistical data upon which to base realistic standards, particularly in certain "gray areas," such as asthma, diabetes mellitus, herniated nucleus pulposus, myocardial infarctions and coronary occlusions, malignant tumors, otitis media, and peptic ulcer. A preliminary survey, conducted by Surveys and Research Corporation of Washington, D.C., and designed to study the gray areas, demonstrated that a larger survey of the medical aspects of the Army's personnel acquisition and retention standards in these areas is both desirable and feasible. This survey should provide detailed information on the medical cost, medical effects (as defined by days lost, hospitalization, and other medical factors), and duty performance of personnel with the conditions mentioned.

A second problem concerns the improvement of the quality of medical examinations and profiling at medical facilities and AFES. Pro-


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grams begun in previous years were intensified, including instruction of AMEDS personnel in basic courses at the Army Medical Service School, Fort Sam Houston, Tex., a special course for prospective AFES examiners, and instructional inspections, visits, lectures, and conferences (each of the 73 AFES's is inspected at least once every 2 years). In this connection, The Surgeon General recommended a revised schedule of instruction in profiling for use at the Army Medical Service School and a brochure to give guidance to installation commanders in training new medical examiners. Corrective procedures for AFES included the following: Improvement of facilities, equipment, and techniques; better scheduling of processing at AFES; and utilization of the necessary competent civilian physicians on a fee basis.

Other improvements included the introduction of or extension of the use of the Schiotz'tonometer, the audiometer, agents for testing urine content, the stereoscope for vision testing, the electrocardiograph, and the electroencephalograph; the last three for Army aviation medicine, particularly.

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