Disqualifying Diseases

Medicine and Military Recruitment

Book excerpt

By: Theodoric Romeyn Beck

Date: 1823

Source: Theodoric Romeyn Beck. Elements of Medical Jurisprudence, Volume I of II. Albany, NY: Webster and Skinner, 1823.

About the Author: Theodoric Romeyn Beck was a nineteenth-century physician, medical professor, manager of a psychiatric facility (then called a lunatic asylum) and private school principal. He was active in the New York State Medical Society. He wrote and researched in several medical areas, particularly on issues concerning deaf-mutism and on psychopathology (the two were unrelated); his best-known body of work was the two-volume book text entitled Elements of Medical Jurisprudence, co-authored with his brother John Broadhead.

INTRODUCTION

During the late eighteenth and much of the nineteenth centuries, the general population of the United States did not have a cultural commitment to the pursuit of physical fitness, as everyday life was rigorous and physically demanding enough for most people—particularly those in rural and frontier areas, which comprised much of the country at that time.

During the Industrial Revolution and after the American Civil War (1861–1865), two major shifts in American life changed the nation's overall level of health and fitness: Developing technologies replaced many of the most labor-intensive jobs, so people didn't have to work as hard physically, and rural settlers moved to the cities for higher-paying jobs, shifting to an urban lifestyle that required far less walking and exertion. As a result, the general fitness level of the population declined considerably.

With America's entry into World War I in 1917, hundreds of thousands of men were drafted into the military. Conscription data indicated that nearly half of all deferrals, that is, those not accepted for active duty but reserved for call-up as needed, and one-third of all men drafted were considered to be "unfit for combat." Many were categorized as "highly unfit" prior to their military training. Of those draftees who received deferrals for possible service at a later date, the three most frequently cited reasons were large numbers of dental caries (commonly called dental cavities), flat feet, and venereal disease. After World War I, legislation was passed that required better school-based physical education programs.

In the World War II (1941–1945) draft, nearly half of all men registering were again either rejected for military service or given noncombat classifications. Since this conflict, like the previous World War, was a low-tech ground and air war, basic fitness for combat was necessary. During World War II, the primary categories for rejection were displayed symptoms of mental illness, chronic and life- or mobility-impacting physical illness, observable physical disabilities that interfered with mobility or weapons use, rashes and skin diseases, and stated homosexuality. During World War II, particularly, there was a social stigma in being and classified 4F (unfit for duty), and recruits often did not disclose chronic health conditions to examiners, or often sought assignment in stateside organizations that supported the war effort.

PRIMARY SOURCE

       Of disqualifications for military service.

In every state, however despotic, there are certain classes of individuals exempted from military duty. This is in fact deemed indispensable, even with those who consider the male population merely as the material for armies. There must remain some to renew the waste of war—some to support the females and children of the nation, and others to protect them from injury.

The Jewish lawgiver, in his statutes, mentions several classes who were exempted from this duty, and in particular, all married persons during the first year of their marriage. And similar provisions are to be traced in the laws or customs of all countries.

In the United States, by a law of congress, all persons under eighteen years of age and above forty-five, are exempted. The importance of this regulation in time of war is incalculable, since it prevents the destruction of such whose strength is not yet matured, as well as those who are already feeling the advances of age. It is also understood, that there are many diseases which disqualify and exempt from military duty. The law of the state of New York directs, that the age and ability to bear arms of every enrolled person, shall be determined by the commandant of the company, with the right of appeal to the commanding officer of the regiment; and it adds, what indeed must now appear superfluous, "that the certificate of a surgeon or surgeon's mate shall not be conclusive evidence of the inability of any person to bear arms."…

The military system of France being more perfect than that of any other nation, it might be expected that rules on this subject would be formed; and accordingly we find that such were promulgated at an early period after the revolution….

Among the preliminaries necessary to obtain an exemption, are the following: Every conscript who pleads bad health or bodily inability, must appeal in the first instance to his municipal administration; and he is not entitled to present himself for this purpose, unless he brings a certificate from a health officer, that he is really affected with a disease which appears to him to authorise an application. He is then to be examined by a health officer in presence of the administration, if he is capable of attending, or in presence of a delegate from it, if he be totally unable to attend in person. Before any dispensation be granted, the commission of the executive directory must be heard; and he may, if any doubts be entertained, require a counter-examination. When the municipal administration consider any appeal to be without foundation, the conscript is obliged to join the army without delay. When they consider themselves incompetent to decide upon the appeal, the conscript is allowed to present himself immediately before the central administration, for their decision. And the municipal administration can only grant definitive dispensations in cases of palpable and notorious infirmities. They may allow provisional ones, not exceeding three months, when acute diseases or accidents prevent the conscript form presenting himself.

All the decisions of the municipal, must be sent to the central administration, for their approbation or rejection; and if they refuse to ratify them, the conscript must again be examined. Lastly, then they confirm a dispensation, it is sent to the minister of war, who forwards an exemption to the conscript, or annuls the dispensation….

The officers of health, in giving their opinion, are directed to regulate themselves by the following tables:

TABLE 1. Evident infirmities, implying absolute incapability of military service, and which are left to the decision of the municipal administrations of the canton.

1. Total privation of sight. 2. The total loss of the nose. 3. Dumbness; permanent loss of voice; complete deafness. If there be any doubt of the existence of these infirmities, or if they do not exist in a great degree, the decision is to be reserved for the central administration. 4. Voluminous and incurable goitres, habitually impeding respiration. 5. Scrophulous ulcers. 6. Confirmed phthisis pulmonalis, i.e. in the 2d or 3d degrees. Care should be taken to report the symptoms characterizing this state; and as they are but too evident, they ought to procure an absolute dispensation. But for commencing phthisis, asthma, and haemoptisis, the municipal administration ought to grant only a provisional dispensation, if the person is incapable of presenting himself before the central administration; the decision in these different cases being reserved to the latter. 7. The loss of the penis, or of both testicles. 8. The total loss of an arm, leg, foot, or hand. The incurable loss of motion of these parts. 9. An aneurism of the principal arteries. 10. The curvature of the long bones; rickets and nodosities sufficient evidently to impede the motion of the limbs. Other diseases of the bones, although great and palpable, are sometimes liable to doubt, and therefore are reserved for the judgment of the central administration. 11. Lameness (claudication) well marked, whatever be the cause; this must be precisely stated. The same is the case with considerable and permanent retraction of the flexor or extensor muscles of a limb, or paralysis of these, or a state of relaxation impeding the free exercise of the muscular movements. 12. Atrophy of a limb, or decided marasmus, characterised by marks of hectic and wasting, which should be stated in the report.

SIGNIFICANCE

The use of a selective service system, or military draft process, began during the American Civil War in both the Union and Confederacy. It was also employed during World Wars I and II, the Korean War in the early 1950s, and for the Vietnam War in the 1960s.

During the war in Vietnam, the draft lottery and selective service systems were used at different times. In both cases, it was relatively easy to obtain a deferment, simply by being a college student who received passing grades. In retrospect, some sociologists consider the deferment process used during Vietnam biased in favor of those who could afford higher education. Legislative reforms have made the current draft law considerably more equitable: college students are deferred only until the end of the current semester (seniors until the end of the academic year; local boards must be culturally, ethnically, and racially representative of the communities in which they were located; and a random lottery determines the order of call to duty). At present, there is no military draft system in active use in the United States.

Historically, induction centers have functioned similarly: an inductee receives a letter informing him of a time and place to appear for induction. The inductee must arrive at the designated time and place prepared to leave for basic training/"boot camp." Upon arrival, the inductee is given an aptitude test or interview, undergoes a physical examination, and is classified according to fitness for service. Because of the sheer numbers of people being moved through the system during a military draft, processes are streamlined as much as possible. The job of the staff at the induction center is simply to see whether the inductee is "fit" for military service; this designation generally extends for a period of two years. Prior to leaving for basic training, the inductee is given any necessary vaccinations or inoculations, and undergoes any other medical regimens necessitated by the assigned field of duty (deployment location and combat classification, or military job).

Because there is no draft for service in the armed forces of the United States as of January 2006, military enlistment is considered voluntary. When an applicant is being considered for military duty, the three primary areas examined are: aptitude for military service, background screening and evaluation (also called a background investigation), and physical qualifications. The overall medical standards are the same across all branches of service for enlisted, appointed, inducted, or accessed (reservists) troops, and they appear in Military Entrance Processing Station (MEPS) Regulation 40-1.

Essentially, they state that the recruit neither actively has nor is a carrier for a communicable disease, is physically and psychologically able to meet the demands and hardships of basic training, is sufficiently adaptable to relocate wherever s/he is sent by the selected branch of the service, can adapt to the environmental, physical and geographic demands of deployment location, and can carry out all of the requisites of military duty and troop assignment without significantly aggravating or worsening any pre-existing deformities, conditions or defects.

There is an extensive list of disqualifying medical conditions, many of which can be recommended for an official waiver by an examining physician at the time of the military induction physical. The (examining) physician must belong to the branch of the service to which the recruit has applied; each waiver is individually determined, based on the recommendation of the medical profile (MEPS) officer, the specific situation, and the current needs and mandates of that particular service branch.

In discussion of most chronic or inherited systemic diseases, disorders, or the consequences thereof, the questions to be considered pertain to whether the condition is progressive; could be worsened or aggravated by military service; might preclude satisfactory completion of required training and subsequent duty assignment; and could potentially constitute an undue hazard to the recruit or to others, particularly in time or place of combat.

All potential military applicants must complete an aptitude and placement test called the CATASVAB (typically unless they are recruited for a specific medical service position type such as physician, nurse, psychologist, or social worker); meet height and weight standards; pass vision and hearing examinations; undergo urine and blood tests, obtaining results that fall within normal limits; have clean drug and alcohol screening tests; successfully complete visible muscle group and joint range-of-motion maneuvers (in undergarments); and have a satisfactory physical examination and health history interview. Female applicants are also given a pregnancy test.

In terms of actual numbers of individuals processed through induction centers during the major conflicts of the twentieth century, a total of 2,810,296 American men were inducted into military service during World War I; 10,110,104 men during World War II; 1,529,539 draftees were processed into the armed forces for the Korean War; and the Vietnam War saw 1,857,304 men drafted, processed, and inducted into military service.

For the most part, although modern military conflicts are technologically oriented and involve less physical combat, that possibility always exists, so an overall high level of health, fitness, and physical agility are still required for entrance into military service.

FURTHER RESOURCES

Books

Rice, Emmett A. A Brief History of Physical Education. New York: A.S. Barnes, 1926.

Web sites

Department of Defense Instruction Number 6130.4. "SUBJECT: Criteria and Procedure Requirements for Physical Standards for Appointment, Enlistment, or Induction in the Armed Forces." 〈http://www.dtic.mil/whs/directives/corres/pdf2/i61304p.pdf/〉 (accessed November 28, 2005).

Office of the Surgeon General. "Office of Medical History: Infectious Diseases & General Medicine." 〈http://history.amedd.army.mil/booksdocs/wwii/internalmedicinevolIII/frameindex.html〉 (accessed November 28, 2005).

United States Army Regulation 40-501. "Medical Service Standards of Medical Fitness." 〈http://usmilitary.about.com/gi/dynamic/offsite.htm?site=http://www.usapa.army.mil/pdffiles/r40%5F501.pdf〉 (accessed November 28, 2005).

Veterans for Peace. Military Draft. 〈http://www.veteransforpeace.org/Military_draft_102403.htm〉 (accessed November 29, 2005).

World War II History. African-Americans in World War II. "Physical Fitness." 〈http://www.world-war-2-history.com/books/1/11〉 (accessed November 28, 2005).