there is noticeable deformity when the applicant is dressed (scoliosis, hyphosis, or lordosis).

(3) Fracture or dislocation of the vertebrae.

(4) Vertebral caries (Pott's disease). (5) Abscess of the spinal column or its vicinity.

(6) Osteo-arthritis of the spinal column, partial or complete.

(7) Fracture of the coccyx; spina bifida; spondylolisthesis; cervical rib.

(8) Active arthritic processes from any cause.

(9) Herniation of intervertebral disc (nucleus pulposus) or history of operation for this condition.

(n) The thorax. The following conditions are causes for rejection:

(1) Congenital malformations or acquired deformities which result in reducing the chest capacity and diminishing the respiratory function to such a degree as to interfere with vigorous physical exertion or to produce disfigurement when the applicant is dressed.

(2) Pronounced contractions or markedly limited mobility of the chest wall following pleurisy or empyema.

(3) Deformities of the scapulae sufficient to interfere with the carrying of equipment.

(4) Absence or faulty development of the clavicle.

(5) Old fracture of the clavicle where there is much deformity or interference with the carrying of equipment; ununited fractures, or partial or complete dislocation of either end of the clavicle.

(6) Suppurative periostitis or caries or necrosis of the ribs, the sternum, the clavicles, or the scapulae.

(7) Old fractures of the ribs with faulty union, if interfering with function.

(8) Benign tumors or cysts of the breast or chest wall which are so large as to interfere with the wearing of a uniform or of equipment.

(9) Unhealed sinuses of the chest wall.

(10) Scars of old operations for empyema unless the examiner is assured that the respiratory function is entirely normal.

(11) Pneumoconiosis, extensive pulmonary fibrosis or pulmonary emphy

sema.

(12) Acute or chronic pleurisy or empyema.

(13) Pneumothorax, hydrothorax, or hemothorax.

(14) Tumors of the lung, pleura or mediastinum.

(15) Chronic bronchitis, bronchiectasis, abscess of the lung, pulmonary infiltration of undetermined origin, asthma, cystic disease of the lung.

(16) Actinomycosis, nocardiosis, blastomycosis, coccidioidomycosis, aspergillosis or histoplasmosis if there is reason to suspect recent activity of the disease process.

(17) Sarcoidosis.

(18) Hydatid or echinococcus cysts of the lung.

(19) Disqualifying defects demonstrable by a roentgenographic examination of the chest, such as:

(i) Evidence of reinfection (adult) type tuberculosis, active or inactive, other than slight thickening of the apical pleura or thin solitary fibroid strands.

(ii) Evidence of active primary (childhood) type tuberculosis.

(iii) Extensive calcification of the pleura, lung parenchyma or hilum, if of questionable stability or of such size and extent as to interfere with pulmonary function.

(iv) Evidence of fibrous or serofibrinous pleuritis, except moderate diaphragmatic adhesions with or without blunting or obliteration of the costophrenic sinus.

(0) The heart and blood vessels. The following conditions are causes for rejection:

(1) All diastolic murmurs.

(2) Apical systolic murmurs, when persistent in both the recumbent and upright positions, when moderate in intensity, when transmitted to the axilla, and when not abolished nor significantly diminished in intensity by forced breathing.

(3) Harsh systolic murmurs, heard at aortic area, even of less than moderate intensity with diminished or absent second sound.

(4) Pulmonic systolic murmurs, blowing or rough, low pitched, of more than moderate intensity.

(5) All valvular diseases of the heart, congenital heart disease, or pathological

murmurs.

(6) Hypertrophy or dilation of the heart.

(7) History of evidence of pericarditis, endocarditis, myocarditis, angina pectoris, coronary occlusion, or coronary atherosclerosis.

(8) A heart rate of 100 or over, or of 50 or under, when these are proved to be persistent in the recumbent posture and on observation and reexamination over a sufficient period of time.

(9) Marked cardiac arrhythmia or irregularity, or an authenticated history of paroxysmal tachycardia, or auricular fibrillation or flutter.

(10) Arteriosclerosis.

(11) Arterial hypertension, essential hypertension (hypertensive vascular disease). In general, a persistent systolic blood pressure above 130, or a persistent diastolic blood pressure above 84, is cause for rejection.

(12) Aneurysm of any variety in any situation.

(13) Intermittent claudication. (14) Raynaud's disease, acrocyanosis. (15) Thrombophlebitis of one or more extremities, if there is a persistence of the thrombus or any evidence of obstruction to circulation in the involved vein or veins.

(16) An authenticated history of rheumatic fever or chorea within the past 5 years, or a history of more than one attack of rheumatic fever.

(17) Arterial hypotension if it is causing, or has caused, symptoms. (p) The abdomen. The following conditions are causes for rejection:

(1) Wounds, injuries, cicatrices, or muscular ruptures of the abdominal walls sufficient to interfere with function.

(2) Fistulae or sinuses from visceral or other lesions or following operation. (3) Hernia of any variety.

(4) Large tumors of the abdominal wall.

(5) Scar pain, if severe or causing persistent or recurring complaints.

(6) Chronic diseases of the stomach or intestine or a history thereof, including such diseases as peptic ulcer, regional ileitis, ulcerative colitis and diverticulitis.

(7) Gastric resection, gastro-enterostomy, or bowel resection.

(8) Chronic appendicitis.

(9) Ptosis of the stomach or intestines. (10) Acute or chronic disease of the liver, gall bladder, pancreas, or spleen. (11) Chronic peritonitis or peritoneal adhesions.

(12) Chronic enlargement of the liver. (13) Chronic enlargement of the spleen if marked.

(14) Jaundice.

(q) The perineum and the pelvis including the sacroiliac and lumbosacral joints. The following conditions are causes for rejection:

(1) Malformation and deformities of the pelvis sufficient to interfere with function.

(2) Disease of the sacroiliac or lumbosacral joints.

(3) Urinary fistula.

(4) Stricture or prolapse of the rectum.

(5) Fissure of the anus or pruritus ani.

(6) Fistula in ano or ischiorectal abscess.

(7) External hemorrhoids sufficient in size to produce marked symptoms; internal hemorrhoids, if large or accompanied by hemorrhage, or protruding intermittently or constantly.

(8) Incontinence of feces.

(r) The genito-urinary system and venereal disease.

(1) All candidates for the U. S. Naval Academy shall receive a serologic test for syphilis. This test shall be conducted at the time of the final physical examination.

(i) When albumin, casts, hemoglobin, or red blood cells are found in the urine, the applicant shall not be accepted unless further study proves such findings to be of no significance. Such further study, if desired, should include daily complete examinations of the urine for at least 3 days and such other tests as are necessary, unless the presence of albumin and casts is associated with enlargement of the heart, high blood pressure, or other evidence of cardiovascular disease of such degree that a diagnosis of renal disease may be made immediately. When albumin is constantly or intermittently present, the underlying pathological condition should, if possible, be determined and stated as the cause for rejection; but if albuminuria be present daily during a period of 3 days, it should

be regarded as reason for rejection, even if the origin cannot be determined.

(ii) If glucose is found in the urine, further observation is indicated, including an estimation of the 24-hour amount of urine and the employment of other tests to demonstrate the possible existence of diabetes. Blood-sugar values and blood-sugar tolerance tests must be normal if such an applicant is to be found qualified; the glycosuria must be shown to have been transient and not a persistent condition.

(iii) When the specific gravity of the specimen first examined is under 1.010, further observation of the applicant and repeated complete urinary examinations are indicated.

(iv) When serological test for syphilis is positive, the possibility of a false positive test should be considered. In view of the possibility of error in such a test, the candidate giving a positive reaction will have the opportunity for a physical reexamination subject to the conditions set forth herein under the heading "Physical Reexamination."

(2) The following conditions are causes for rejection:

(i) Acute or chronic nephritis; diabetes mellitus or insipidus, or glycosuria if accompanied by abnormal response to bloodsugar tests.

(ii) Blood, pus, or albumin in the urine, if persistent.

(iii) Floating kidney, hydronephrosis, pyonephrosis, pyelitis, tumor of the kidney, renal calculi, or absence of one kidney.

(iv) Acute or chronic cystitis.

(v) Vesical calculi, tumors of the bladder, incontinence of urine, enuresis, or retention of urine.

(vi) Hypertrophy, abscess, or chronic infection of the prostate gland.

(vii) Urethral stricture or urinary fistula.

(viii) Epispadias or hypospadias, except for minor displacements of the urethral orifice with no impairment in function of micturition, and no symptoms of irritation.

(ix) Phimosis when prepuce is adherent in whole or in part to the glands. (x) Hermaphroditism.

(xi) Amputation of the penis.

(xii) Varicocele, if large and painful, or hydrocele upon original appointment.

(xiii) Atrophy of both testicles or loss of both.

(xiv) Undescended testicle (acceptable if unilateral, abdominal and unassociated with hernia), infantile genital organs.

(xv) Chronic orchitis or epididymitis. (xvi) A persistently positive serologic test for syphilis.

(xvii) Syphilis in any stage, or a clearly defined history thereof.

(xviii) Any active venereal infection, acute or chronic, or any active infectious process resulting therefrom.

(xix) Reiter's disease.

(s) The extremities. The following conditions are causes for rejection:

(1) All anomalies in the number, the form, the proportion, and the movements of the extremities which produce noticeable deformity or interfere with function.

(2) Atrophy of the muscles of any part, if progressive or if sufficient to interfere with function.

(3) Benign tumors if sufficiently large to interfere with function.

(4) Ununited fracture, fractures with shortening or callus formation sufficient to interfere with function, old dislocations unreduced or partially reduced, complete or partial ankylosis of a joint, or relaxed articular ligaments permitting of frequent voluntary or involuntary displacement.

(5) Reduced dislocation or united fractures with incomplete restoration of function.

(6) Amputation of any portion of a limb (except fingers or toes if there is no interference with military activities), or resection of a joint.

(7) Excessive curvature of a long bone or extensive, deep, or adherent scars interfering with motion.

(8) Severe sprains.

(9) Disease of the bones or joints.

(10) Chronic synovitis, or floating cartilage, or other internal derangement in a joint (particularly of knee joint with history of disability).

(11) Varicose veins in an extremity when they cover a large area or are markedly tortuous or much dilated, or are associated with edema or hemorrhoids, or are accompanied by subjective symptoms.

(12) Varices of any kind situated in the leg below the knee, if associated with varicose ulcers or scars from old ulcerations; chronic edema of a limb.

(13) Chronic or obstinate neuralgias, particularly sciatica.

(14) Adherent or united fingers (web fingers).

(15) Deviation of the normal axis of the forearm to such a degree as to interfere with the proper execution of the manual of arms.

(16) (i) Permanent flexion or extension of one or more fingers, as well as irremediable loss of motion of these parts, if sufficient to interfere with proper execution of duties.

(ii) Total loss of either thumb.

(iii) Mutilation of either thumb to such an extent as to produce material loss of flexion or strength of the member.

(iv) Loss of more than one phalanx of the right index finger.

(v) Loss of the terminal and middle phalanges of any two fingers on the same hand.

(vi) Entire loss of any finger except the little finger of either hand or the ring finger of the hand not used in writing.

(17) Perceptible lameness or limping.

(18) Knock-knee, when the gait is clumsy or ungainly, or when subjective symptoms of weakness are present; bowlegs if so marked as to produce noticeable deformity when the applicant is dressed.

(19) (i) Clubfoot unless the defect is so slight as to produce no symptoms during vigorous exercise.

(ii) Pes cavus if extreme and causing symptoms.

(iii) Flatfoot when accompanied with symptoms of weak foot or when the foot is weak on test. Pronounced cases of flatfoot attended with decided eversion of the foot and marked bulging of the inner boarder, due to inward rotation of the astragalus, are disqualifying, regardless of the presence or absence of subjective symptoms.

(20) Loss of either great toe or loss of any two toes on the same foot.

(21) Overriding or superposition of any of the toes to such a degree as will produce pain when wearing the military shoe.

(22) Ingrowing toenails when marked or painful.

(23) (i) Hallux valgus when sufficiently marked to interfere with locomotion or when accompanied by a painful bunion.

(ii) Bunions sufficiently pronounced to interfere with function.

(iii) Hammertoes when existing to such a degree as to interfere with function when wearing shoes.

(iv) Webbing of all the toes.

(v) Corns or calluses on the sole of the foot when they are tender or painful.

(24) (i) Hyperidrosis or bromidrosis when present to a marked degree.

(ii) Habitually sodden feet with blistered skin.

(iii) Unusually large or deformed feet for which proper shoes cannot be readily obtained.

(25) Severe fungoid infection of nailbeds.

(t) The nervous system. The following conditions are causes for rejection:

(1) Neurosyphilis of any form (general paresis, tabes dorsalis, meningovascular syphilis).

(2) Degenerative disorders (multiple sclerosis, encephalomyelitis, cerebellar and Friedreich's ataxia, athetoses, Huntington's chorea, muscular atrophies and dystrophies of any type, cerebral arteriosclerosis).

(3) Residuals of infection (moderate and severe residuals of poliomyelitis, meningitis and abscesses, paralysis agitans, postencephalitic syndromes, Sydenham's chorea).

(4) Peripheral nerve disorder (chronic or recurrent neuritis or neuralgia of an intensity which is periodically incapacitating, multiple neuritis, neurofibromatosis).

(5) Residuals of trauma (residuals of concussion or severe cerebral trauma, post-traumatic cerebral syndrome, incapacitating severe injuries to peripheral nerves).

(6) Paroxysmal convulsive disorders and disturbances of consciousness (grand mal, petit mal, and psychomotor attacks, syncope, narcolepsy, migraine).

(7) Miscellaneous disorders (tics, spasmodic torticollis, spasms, brain and spinal cord tumors, whether operated upon or not, cerebrovascular disease,

congenital malformations, including spina bifida if associated with neurological manifestations and meningocele even if uncomplicated, Meniere's disease).

(i)

(u) Dental (1) Standards. Every candidate shall be examined clinically and by dental roentgenography by a dental officer of the military services who shall make a separate report in each case of his findings and recommendations to the President of the Board of Medical Examiners.

(ii) A candidate for appointment as midshipman must have a minimum of 20 vital serviceable permanent teeth including (a) 4 molars. Of this number, 1 upper and 1 lower molar on the right side, and 1 upper and 1 lower molar on the left side must be in functional occlusion; (b) 4 incisors. Of this number, 2 should be in the maxillae and 2 should be in the mandible in such position as to enable the applicant to incise satisfactorily. A candidate should not be accepted who has teeth missing in the anterior part of the mouth which have not been replaced and which result in an unsightly space. Any deviation from normal occlusion should be minor, and good functional occlusion as well as absence of interference with speech must be demonstrable. Candidates should not be considered qualified for appointment when orthodontic appliances are attached to teeth for the purpose of continued treatment. Orthodontic retaining appliances such as are used after the completion of treatment are acceptable provided they are not an oral health hazard.

(iii) The teeth must be free from dental caries, restorations must be of high quality, and the peridontal tissues must be free from disease. A "Type 2" examination is necessary for the detection of interproximal caries. Definition of a "Type 2" examination is: Mouth mirror and explorer examination; adequate natural or artificial illumination; posterior bite-wing roentgenograms; periapical roentgenograms, when indicated.

(iv) Teeth should be free from calculus, all restorations of the highest standard, the oral soft tissue in a state of normal health, and the general appearance of the mouth indicative of the practice of strict personal hygiene. All required dental treatment, restorations,

and replacements must be obtained prior to entrance to the Naval Academy.

(2) Explanation of standards. (i) A vital tooth is a tooth containing a vital dental pulp.

(ii) A serviceable tooth is one which is free from disease, or if carious, can be restored satisfactorily without endangering the pulp; is adequately supported by normal tissue; does not have a faulty restoration or bridge attachment; and is fully effective functionally.

(iii) An opposed tooth is one that comes into functional contact with one or more teeth of the opposite arch.

(iv) Appointees as midshipmen must have had all carious teeth restored or extracted.

(v) A bicuspid may not be counted as a molar nor may a cuspid be counted as an incisor.

(vi) An abutment tooth (a natural tooth to which a bridge is attached) may be counted as serviceable only when the pulp is vital, the tooth is sound, supported by healthy tissue, is in useful occlusion, and the bridge attachment is well designed and in good condition.

(3) Disqualifying defects. (i) Edentulous spaces in the dental arch causing wide separation of the continuity of the incising and masticating surfaces shall cause rejection. Prosthetic appliances are not considered as substitutions for natural sound teeth, unless in excess of the 20 vital sound serviceable permanent teeth required. Unerupted teeth will not be included in the 20 vital sound serviceable permanent teeth required. Natural teeth supporting fixed or removable prosthetic appliances (crowns or dentures) will be considered as sound and serviceable only when they are vital, in normal healthy condition and supported by healthy tissue. Extraction is indicated for all carious teeth incapable of receiving treatment and restoration. (ii) The loss of teeth in excess of the standards noted in above paragraph.

(iii) Marked protrusion or retrusion of the mandible.

(iv) Marked deformity of the maxillae or mandible.

(v) Marked malocclusion.
(vi) Dento-facial deformity.

(vii) Lack of serviceable occlusion. (viii) Impingement of teeth of one jaw upon gingiva of the opposing jaw.