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Chapter I



Manpower Selection and the Preventative Medicine Program

Gertrude G. Johnson*

The Surgeon General is responsible for establishing physical standards to prevent induction, enlistment, or commission of the physically and mentally unfit. The Physical Standards Division determines the standards and supervises their administration. The maintenance of these standards was not a function of the Preventive Medicine Service during World War II, but the effectiveness of physical and psychiatric screening had a highly important bearing upon preventive medicine and materially influenced the measures and procedures necessary to plan and carry out the prevention and control of the acute and chronic infections which condition the health of the Army and the loss of manpower and man-days in military operations.

The experience of the Army in World War I made The Surgeon General particularly aware of the necessity for strict screening against tuberculosis. The incidence of tuberculosis during World War I averaged 11 per thousand per year and before World War I was over, about 3,000 soldiers had died of tuberculosis. Throughout that war, tuberculosis had been a leading cause of disability discharges, accounting for 12.7 percent of these.1  At its end, the newly organized Veterans Administration had inherited a huge and costly program to provide medial care for these casualties.

World War I also pointed up the desirability for adequate psychiatric screening. About 122,000 men were hospitalized as neuropsychiatric patients during that war. It has been estimated that around 34 percent of these men had to be discharged.2  By 1941 the Federal Government had paid out well over 1 billion dollars for disability, compensation, and hospital treatment of neuropsychiatric patients who were World War I veterans.3

The objective of physical screening, therefore, was to eliminate the physically and mentally unfit who would not be capable of performing a useful

*Historical Unit, Army Medical Service
1The Medical Department of the United States Army  in the World War. Washington,  Government Printing Office, 1928,  vol.  XV, pt 2, Tables 46, 48, 54, and 82.
2Information furnished by Medical Statistics Division, Office of The Surgeon General, 9 Feb 54.
3Menninger, William C.: Psychiatry  in a Troubled World.  New York, The Macmillan Company, 1948, p. 267.


military function, and also those who might reasonably be expected to break down while on active duty. This would provide an Army most likely to withstand the physical strain and other exigencies of service and would also avoid inducting men who might shortly be discharged and thereafter be eligible for disability payments and hospital expenses by the Government.

The Available Manpower Pool

Both the needs of the service and the available manpower pool fluctuated from time to time. The Selective Service System made the initial classification of registrants, complying with current requirements set by Congress as to age, occupation, dependents, and education. The Army determined the number of men needed each month, specified the minimum physical and mental standards required for military service, and conducted the physical examinations.4

When mobilization was ordered in the fall of 1940, the basic aim was to get a group of 900,000 highly qualified men who would be trained for 1 year and who would then form part of a reserve pool. This was a relatively small number to take out of the manpower pool of registrants available at that time, which totaled about 17,000,000. It was, therefore, possible to select only those who would be able to enter immediately upon a period of intensive training and who could reasonably be expected to remain fit for a period of years thereafter. Consequently no reparative or therapeutic work was considered; standards were set high; and psychiatric screening was designed so as to exclude anyone who might not respond well to Army life.

After the United States entered the war, the picture changed radically. A large Army was needed immediately. About 3,800,000 men entered the Army during 1942, through inductions and enlistments. Physical standards had to be lowered to get the number of men needed, and limited service personnel were accepted at a fixed percentage of the quota.

Industry and agriculture also expanded to keep pace with the enlarged Army. A great effort was made to increase the available manpower pool. Women formed the greatest labor reserve in the United States and hundreds of thousands became industrial workers. Women's branches were formed, on a volunteer basis, for the Army, including Air Force, and for the Navy, including Marines and Coast Guard. Labor was also drawn from the previously unemployed group and from the older age brackets. There was a decrease in civilian activities and in self-employment. To make the best possible use of the labor available, the work week was lengthened to 48 hours.

The Army and the Navy (including Marine Corps and Coast Guard) competed for manpower through voluntary enlistments. The Army offered a choice

4Up  to January 1942, the main  medical examination was made by  the local boards of Selective Service and the Army's function was limited to the final physical examination.   After that date, however, the whole medical processing was taken over by the Army, and the function of the local boards was limited to elimination of the obviously disqualifying defects.


of assignment to the Ground, Air, or Service Forces as an inducement; most Army volunteers chose the Air Forces. Since the physical and mental standards for enlistment in the Navy and Army Air Forces were higher than the general requirements for induction, the result was that they were able to obtain men of better physical and mental caliber than were the Ground and Service Forces.5  Lack of control over the number of available men and the resultant inability to plan accurately laid an undue burden upon Selective Service machinery. President Roosevelt6 therefore, in December 1942, stopped all voluntary enlistments of men between 18 and 38. Registrants were thereafter processed through Selective Service and allotted to Army and Navy according to established quotas.

The manpower shortage seemed so acute by the end of 1943 that Congress directed the appointment of a commission to study requirements for the Armed Forces.7  It was hoped that some of the large group rejected for physical reasons (estimated at that time at 3,000,000) could be inducted, especially for limited service. The commission reported that existing physical requirements could not be reduced further without impairment of efficiency. The chief need, the report concluded, was for men for general duty.8  As a result, it became routine procedure to induct men with dependents; deferments for essential industries were more strictly scrutinized.

By the middle of 1944, the Army had attained the bulk of its procurement objective. With offensives on all fighting fronts, it urgently needed young men as replacements. Exemptions for those under 26 were rigidly screened; deferments in older age groups were liberalized. Men becoming of age for registration were the chief source of replacements for the Armed Forces. Concurrently many were being discharged, primarily for physical reasons, and became available as civilian labor. When once again the Army's mission changed after the defeat of Germany, it was possible to use more limited service personnel, and induction of such men was resumed.

Throughout the period of mobilization and war Selective Service maintained a continuous program of registering, classifying, and reclassifying. Registrants were not considered frozen in one category, but were constantly screened and reevaluated.

Physical Standards for Induction

Basic physical standards for induction were published in August 1940 as Mobilization Regulations (MR) 1-9 in anticipation of the passage of the Selec-

5Karpinos, B. D.: Evaluation of the physical fitness of present-day inductees. U. S. Armed Forces Med. J. 4: 415-430, Mar 1953.
6Executive Order 9279, 5 Dec 42.
7Amendment to Selective Training and Service Act of 1940, Public Law 197, 78th Congress, approved 5 Dec 43.
8Selective Service as the Tide of War Turns, The 3rd Report of the Director of Selective Service 1943-1944. Washington, Government Printing Office, 1945, p. 55.


tive Training and Service Act. The President declared them part of Selective Service regulations9 and they were used both by examining physicians of the local boards and by Army induction examiners.

Mobilization Regulations 1-9 went through several major revisions during the war and were also amended from time to time by War Department directive with respect to specific items. Although for some conditions very sharp lines of demarcation were drawn, the introduction to each of the published regulations stated that they were to constitute a guide to the medical examiner. It was expected that he would exercise his professional judgment. In many instances it was the degree of incapacity which led to classification for general or limited service, or for rejection. An analysis for rejection for cardiovascular disorders showed a particularly wide range of professional difference of opinion upon what would be disqualifying.10   If the examining physician believed that the general condition of the man would not allow him to perform satisfactorily, he could recommend rejection, even though no specific item was the cause.

The examiner's rigid or liberal interpretation of existing standards, shifting with the need to fill a quota, in effect caused these to fluctuate. The most drastic changes in the regulations themselves were those relating to visual acuity and dental requirements. The first MR 1-9 in August 1940 set the minimum dental requirements at a total of 6 masticating teeth and 6 incisor teeth properly opposed. As soon as the first statistics were available, it was discovered that failure to meet these requirements had resulted in rejection of approximately 9 percent of those examined. If that standard had been maintained, it has been estimated that by the end of 1943 nearly 1,000,000 men who were inducted under the liberalized dental standards would have been lost to the service.11 Dental requirements were revised downward, and an extensive reparative program by the Dental Corps initiated, until in October 1942 a man completely edentulous could be inducted if his condition was corrected or correctable by dentures.12

In 1940 minimum visual acuity for general service was set at 20/100 in each eye without glasses, if correctable to 20/40 bilaterally. This was the second most important cause for rejection, and these requirements were progressively lowered. The lowest visual acuity requirements were reached in April 1944,13 when 20/200 in each eye, or 20/100 in one eye and 20/400 in the second eye (if correctable to 20/40 in each eye, 20/30 in the right and 20/70 in the left, or 20/20 in the right and 20/400 in the left), was sufficient for general

9Executive Order 8570, 18 Oct 40.
10Levy, R. L., Stroud, W. D., and White, P. D.: Report of reexamination of 4,994  men disqualified for general military service because of the diagnosis of cardiovascular defects. J. A. M. A. 123: 937-944, 11 Dec 43; and 1029-1035, 18 Dec 43.
11ASF Monthly Progress Rpt, Sec 7, Health, 31 Jan 44.
12MR  1-9, 15 Oct 42.
13MR 1-9, 19 Apr 44.


service. The registrant did not have to supply the corrective glasses himself; the Army furnished more than 2 million pairs of glasses.

In general, no registrant with an acute infectious disease, with the exception of venereal diseases which are considered separately, was to be inducted until he had recovered without disqualifying sequelae. Although intestinal parasites were not considered cause for rejection, such findings were to be noted on the record so that medication could be undertaken. Other parasitic infections such as filariasis, trypanosomiasis, amebiasis, and schistosomiasis were cause for rejection.

Tuberculosis.  The Subcommittee on Tuberculosis of the National Research Council, at the request of The Surgeon General, made recommendations regarding screening standards for tuberculosis. The aim was to exclude all men with active tuberculosis or tuberculosis of doubtful stability that might break down and lead to active disease during military service. At the same time it was recognized that tuberculous infiltrations of minor extent not infrequently heal completely, and it would be a waste of manpower to reject all persons showing any traces of healed tuberculous lesions.

The 1940 standards included detailed instructions on the physical examination of lungs by palpation, percussion, and auscultation although it was recognized that these methods were of less value than X-ray. The Subcommittee on Tuberculosis pointed out that at least 75 percent of early active tuberculosis can be discovered only by X-ray examination, and that about 1 percent of the male population of military age has active tuberculosis.14

Examination by X-ray was carried out wherever facilities permitted and in all doubtful cases. Approximately 1 million men were inducted without X-ray.15   Many of these however, were X-rayed after acceptance at reception or basic training centers and those found to have active tuberculosis were discharged. In March 1942 chest X-ray on all inductees became mandatory.16 The criteria for rejection were made arbitrary because induction was rapid and many of the roentgenologists used were inexperienced in the field. The average rejection rate for tuberculosis for the years 1942-45 was approximately 1 percent. The incidence rate of tuberculosis in the Army during those years was 1.24 per thousand, approximately one-ninth that of World War I.

A roentgenogram of the chest was made a routine part of the separation physical examination as well. Cases of active tuberculosis discovered averaged 1 per thousand. All those discovered at induction centers or on discharge were required to be reported to the soldier's State Board of Health, thus advancing the cause of tuberculosis control in the nation as a whole.

14Minutes of Meeting, NRC Subcommittee on Tuberculosis, 23 Jul 40.  HD: 040 (TB).
15Long, E.R., and Lew, E.A.: Tuberculosis in the Armed Forces.  Am J.  Pub.  Health 35: 469-479, May 1945.
16MR 1-9, 15 Mar 42.


It cannot be claimed that the examination for tuberculosis as conducted was perfect. A considerable number of men with small active tuberculous lesions escaped detection.17 But the general view of responsible authorities was that the screening process was a highly creditable one, that it eliminated the overwhelming majority of active cases sent to induction stations, and provided a body of troops so nearly free from tuberculosis that further infection from exposure in the Army was negligible.18

Venereal Disease.  According to the physical standards in effect in 1940,19  registrants with any form of venereal disease were not acceptable for general service. Registrants with acute or chronic syphilis, including latent syphilis, were classified as limited service. No limited service registrants were called for induction, however, until July 1942. Gonorrhea was considered a remedial defect, and registrants with this disease were temporarily deferred until a cure had been effected.

Several things happened to change this attitude. One was pressure of public opinion which produced a flood of letters of protest against a policy which seemed to penalize good conduct. It was soon obvious, also, that a number of men, otherwise qualified, were being lost to the services.20  After war was declared, and the limitations of American manpower became evident, regulations were reviewed. Some draft boards, particularly in the South, were hard pressed to meet their quotas because a high percentage of the Negroes in their districts were infected.

The treatment of uncomplicated venereal diseases was very much simplified by new therapeutic discoveries. In the summer of 194221 the Medical Department conducted an experimental program of inducting men with venereal diseases and curing them before they reported for active duty. Since successful results were achieved, induction boards were directed to accept infected men within the limits of facilities for their treatment. By March 1943, about 7,000 venereally infected men were inducted into the Army. About 4,500 of these inductees were infected with syphilis. The induction of men with venereal disease reached its peak in the last quarter of that year, when about 12,000 men with venereal disease were inducted each month. By the end of the first half of 1944, the backlog of all registrants previously rejected for venereal disease was completely rescreened and inducted. It has been estimated that with the liberalization of the standards regarding venereal disease the Army absorbed

17Myers, J. A.:  Failure to detect all tuberculosis on induction to military  service.  J. Lancet 64: 111-113,  Apr 1944.
18Long, E. R., and Hamilton, E. L.: A review of induction and discharge examination for tuberculosis in the Army. Am.  J. Pub. Health 37: 412-420,  Apr 1947.
19WD Cir 117, 18 Oct 40.
20Selective Service Med. Statistics  Bull. 1, 10 Nov 41. HD: 327.
21See footnote 11, p. 4.


during World War II somewhat over 200,000 registrants who had venereal disease.22

Psychiatric Screening.  During the first 2 years of the war great effort was made to screen out all men with actual mental disorders, also those with psychoneurotic traits which might make it difficult for them to adjust to Army life. But the speed of induction, lack of adequate social histories of the registrants, and shortage of trained psychiatrists made it very difficult to make a definitive appraisal.

The Army emphasized that men with psychoneurotic traits were a detriment to the morale of a unit, were likely to take up needed hospital beds, and would be a great expense to the Government if they had to be discharged as psychiatric patients.23 Complaints were received from combat officers who had in their commands some of the men who had been misclassified. One War Department directive stated: "There is no classification for duty of military personnel with such mental diagnoses as psychoneurosis. . . ."24

As a result of this Army attitude, it became the rule in many induction centers that if there were any doubt at all as to whether a registrant would perform satisfactorily, he should be rejected. If the candidate gave any suggestive evidence of emotional instability, such as nervousness at the time of examination, sweaty hands, or expressed fears, he was usually rejected.25

In April 1944, a War Department directive emphasized that accumulating evidence indicated that many individuals with minor personality disorders and mild neurotic trends could be of service to the Armed Forces. It was noted that, on the basis of previous directives, many such men were being rejected at induction stations. The acute need for manpower made it necessary to admit all individuals who had a reasonable chance of adjusting to military service.26  In order to aid the examiners, who frequently had 3 minutes rather than the planned 15 minutes for the psychiatric interview, a test, known as the Neuropsychiatric Screening Adjunct, was composed which was aimed at selecting those who needed further psychiatric study. This 23-question test was adopted in October 1944 and used in all induction stations.27

There was little difficulty in identifying men with serious mental disorders. The borderline cases posed the real problem. The psychiatrist at the induction center had no possible way of evaluating the four most important factors of influence on the adjustment of a soldier: the type of leadership he would receive;

22Karpinos, B. D.: Venereal disease among inductees.  Bull. U. S. Army  M. Dept.  13: 806-820, Oct 1948.
23SG Cir Ltr 19, 12 Mar 41.
24WD AG Memo W600-39-43, 26 Apr 43.
25 Menninger, op. cit., pp. 266-292.
26 WD  TB  MED 33, 21 Apr 44.
27WD AG Memo 40-44, 19 Sep 44.


the degree of motivation he would have to do his job; the type of job and unit to which he would be assigned; and the degree of external stress which might confront him.28

Functionally effective screening processes may reduce the number of psychiatric casualties during military service. But since a man's personality at time of induction is only one of the factors involved in breakdown, screening cannot be expected to eliminate all such breakdowns. It was also shown that many men at first rejected by psychiatric examiners were able to perform for long periods in a satisfactory manner.29

The Physical Profile Serial System

Throughout the major portion of the war there were only two physical classifications used: general and limited service. Classification for job placement was carried out by an extensive program of testing and interviewing. A real attempt was made to match the individual's training, experience, and aptitudes with his military assignment. However there was no simple system of assessing the man's physical stamina and including that as a part of the classification for job assignment.

The Canadian Army had evolved the PULHEMS system which indicated the physical and mental capabilities of the individual. The personnel division graded each job in terms of the minimum PULHEMS requirements necessary to carry it out. The United States observed the Canadian system and, after experimentation in this country, adopted in May 1944 a modified form known as the physical profile serial system.30

The initials PULHES represented six factors in an individual which were to be evaluated: P- general physical stamina and strength; U-upper extremities; L-lower extremities; H-hearing; E-eyes; S-psychiatric evaluation. Each of these letters had four potential grades, so that a man's profile might read 121121 for a general service man.31 The "M" in the Canadian PULHEMS which stood for mentality and intelligence was omitted from the American factors because it was considered adequately covered by the Army General Classification Test. A lettered code to represent certain combinations of grades in the various factors was adopted for statistical, assignment, and reporting purposes.32

The profile system proved to be a timesaver in choosing men for particular types of assignment, although the United States Army did not use it as ex-

28Menninger, op. cit., pp. 266-292.
29Eanes, R. H.: Standards used by Selective Service and  a follow-up on neuropsychiatric rejectees in World War II. In Selection of Military Manpower: A Symposium. Washington, National Research Council, 1951, pp. 149-156.
30WD Memo W40-22, 18 May 44.
31Developments in military medicine during the administration of Surgeon General Norman T. Kirk; preventive medicine and professional care. Bull. U. S. Army M. Dept. 7: 594-646, Jul 1947.
32 Supplement, 12 Jun 45, to MR 1-9, 22 May 44.


tensively as did the Canadian Army. It was particularly helpful when transfers of large numbers of troops were to be made from one type of unit to another since it was possible to check PULHES serial numbers quickly in order to determine who was physically capable of serving in the new assignment.

Physical Standards for Special Categories

The physical standards as given in MR 1-9 applied only to the induction or enlistment of enlisted men. Standards for commission as an officer or as a cadet in the United States Military Academy were embodied in AR 40-105, and were higher than those for enlisted men, particularly with respect to eyesight and physical stamina. The physical standards for all female personnel serving in the Army were adapted from the Army Nurse standards. To admit women of Oriental descent, adjustments were made in measurement requirements.

During World War II the Army did little to devise special testing for specific jobs or climates. More emphasis was placed upon adapting the environment to the man, that is, on developing uniforms and equipment. The Army Air Forces, however, carried out considerable experimentation to arrive at valid tests for determining physical aptitude for aircrew training. To predict success in only three aircrew jobs-pilot, bombardier, and navigator-it was found that a battery of 20 tests was required. Each of these tests contributed significantly to the prediction of success in at least one of these specialties.33  Followup studies of bomber and fighter pilots in the European theater showed high correlation between aptitude scores and performance in the field.34

Special physical standards were devised for officers and enlisted men engaged in training and service in marine and simulated marine diving and in the use of rescue apparatus.35  In October 1943, physical qualifications for parachute duty for both officers and enlisted men were adopted.36 Requirements for cardiovascular condition and blood pressure level were higher than under induction standards; many orthopedic conditions were disqualifying for this type of service.


Selection of military manpower during World War II was essentially a negative process; the unfit were to be excluded. It was assumed that all men in the Army should be able to fight, regardless of assignment, should the exigency arise. Screening was set up to eliminate rather than to classify in-

33Selection of Military Manpower: A Symposium. Discussion by Dr. John C. Flanagan, pp. 215-224.  Washington, National Research Council, 1951.
34Grant, D. N. W.: The medical mission  in  the Army Air Forces. In Fishbein, Morris: Doctors at War. New York, E. P. Dutton & Company, Inc., 1945, pp. 275-302.
35AR 40-100, C 4, 22 Jul 43.
36AR 40-100, C 6, 12 Oct 43.


dividuals and did not take into full consideration the related demands upon the country's total manpower pool.

Physical standards were written so that commanders would have the best manpower available to carry out their missions. The Army wanted to induct only men who would not increase pension or retirement costs to the taxpayer except where disease or injury was incurred in line of duty. It was also considered necessary to select men who would not burden the Medical Department, during critical periods, because of foreseeable physical or mental health breakdowns.37

Physical standards were originally set high and were progressively lowered as manpower resources became depleted. Manpower needs of the Army Service Forces, once that element had been organized, were rather stable; the Ground Forces suffered relatively higher casualty rates and required more replacements for combat troops. Thus, when physical standards were lowered, less fit men were assigned to the combat forces. It may be argued that this desire to retain men in jobs for which they have been trained is a reason that, from the outset of mobilization, the less fit should be inducted as well as the best.38

The physical selection of personnel was of great importance not only to the Army, but to the health of the whole country. By exposing the physical defects of the large groups of rejected individuals, it provided a unique opportunity to correct many health deficiencies in the civilian population.39

The physical standards for selection for Army service established and administered by the Physical Standards Division were effective in screening out those unfit for military service. Psychiatric screening was found to be less effective. Both influenced preventive medicine planning and practice, the former by reducing the reservoir of infectious disease and possibly eliminating a part of the most highly susceptible; the latter by screening out those less well able to understand and absorb health training and to withstand the rigors of military service under conditions of unaccustomed stress. Data on causes for rejection were important indices of the status of health of the United States manpower pool, and formed the basis for further preventive medicine planning for health protection when it became necessary to utilize personnel who could not meet the original high standards. Consideration of these data also greatly influenced the trend of research under the Office of Scientific Research and Development and the National Research Council as to the development of the best practices for full utilization of all segments of the manpower pool.

37Stone, W. S.: Measuring men for useful assignment.  In Selection of Military Manpower: A  Symposium. Washington, National Research Council, 1951, pp. 79-84.
38Bill, R. A.: Medical screening (physical standards) and its relation to service requirements and to retirement. In Selection of Military Manpower: A Symposium.  Washington, National Research Council, 1951, pp. 84-103.
39Simmons, J.S.: Preventive Medicine in the Army. In Fishbein, Morris: Doctors At War. New York, E. P. Dutton & Company, Inc., 1945, p. 142.


The administration of the medical aspects of selection was, without question, a proper function of clinical medicine. Evaluation of the World War II experience, however, also leaves no question of the importance of selection to preventive medicine and unequivocably established that clinical and preventive medicine must work in close coordination in establishing standards and studying the physical and mental defects of prospective candidates for military service in order that the most effective health and medical programs can be established and the most economical use be made of a not inexhaustible manpower pool.