cal holds will be necessary, and so that intensive examinations will be made as soon as feasible when holds have been issued. Procedure از 4. The officer performing medical inspection on shipboard inspects the ship's medical reports on the back of form I-415, Manifest of In-Bound Passengers (Aliens), and on form I-442, Report on Diseases, Injuries, Births, and Deaths among the alien passengers. He also inspects the clinical record of all aliens treated during the voyage. At airports the officer checks the aircraft General Declaration for a report of illness, and questions the aircraft commander regarding the health of aliens on the aircraft. When possible, the officer should obtain a signed statement from ships' masters or aircraft commanders when they give information regarding class A conditions. 5. While the alien approaches for medical inspection, the officer looks for deformities, lameness, or other obvious defects. He is alert to detect irregularities in movement, due to ankylosed joints or shortened or deformed extremities, and to detect tabetic, steppage, hemiplegic, or spastic gaits caused by nervous system disorders. 6. The officer tries to gain an idea of the alien's alertness, reasoning ability, and general mental reaction. To accomplish this, when there is no language barrier the officer diplomatically questions the alien about such matters as his trip and his age; when it appears advisable, the officer may propound one or two simple problems in addition. (eg 2 7. Every effort is made to detect signs and symptoms of mental disease and defect. Any suggestion, no matter how trivial, that points to abnormal mentality is sufficient cause for detaining the alien for a thorough examination. 8. The alien's manner of appearing for inspection, his conversation, style, or dress, and any peculiar or unusual conduct on his part are all to be observed. The officer should take into consideration racial characteristics in physique, costume, and behavior.com a arbon S >. 9. During inspection, aliens with defective hearing, defective vision, or fever frequently assume peculiar attitudes and do strange things, which may be suggestive of mental abnormality. In such cases further examination may disclose the real condition. 10. The officer reviews the medical report on form FS-398, carried by aliens with immigration visas and by others medically examined abroad. J1 T 11. The officer reviews the chest X-ray film, when presented by the alien. a. Inspection officers should be trained in the elements of chest X-ray interpretation. b. When an inspection officer believes the film indicates a questionable pulmonary condition but the medical report shows essentially negative findings, he should obtain the advice of a medical officer and, if the condition warrants, should issue a medical hold. When the FS-398 reports a class B or C pulmohary condition, the inspection officer may transcribe the information to a medical certificate, lose Liramodera c. When an officer issues a medical hold on the basis of suspected tuberculosis or other chest condition, he furnishes the film to the medical examiner for comparison with subsequent X-rays. 12. When an alien subject to the X-ray or blood test requirement arrives without the required reports, the officer issues medical hold referring the alien for the necessary diagnostic work. (See par. 7a-e of ch. 1, 7a-e of ch. 1, this part.) AI* 13. The officer carefully observes; a. The eyes, to detect irregularities. Observance of one or more of the following signs may warrant intensive examination: opacities or inflammation of the cornea, opacities of the lens, nystagmus (an involuntary, rapid movement of the eyeball), squint, bulging eyes, the wearing of glasses, an effort to see clearly on the part of the alien, clumsiness, and uncertainty of gait. b. The face, to note its color, expression, nourishment, and any abnormal signs. This observation often affords a clue to the alien's general condition. Anemia and lung, cardiac, kidney, and mental disorders are often suspected from facial signs. Fever may be manifested by a flushed face and congested eyes. Fever in young children may be suspected from undue movement of the alae nasi during breathing. c. The scalp, to detect tumors, depressions, or signs of favus, ringworm, or psoriasis. d. The neck, to detect goiter, tumor, pulsating vessels, or other abnormality. e. The hands, to detect atrophies, contractures, deformities, clubbed fingers, diseased nails, athetoid movements, or absence of members. 14. As the alien departs, the officer observes the posterior aspect of the scalp, and again checks for deformities, lameness, and other obvious defects. 15. The officer should bear in mind the liability of organic disease to develop and become of serious import in middle-aged persons. 16. The officer shall be alert to detect cases of acute exanthema. 17. Children in arms should be carefully inspected, and required to walk if old enough. 18. When the officer detects or suspects acute, communicable disease, he shall observe the instructions in paragraph 51, chapter 1, this part. AND HOLDS Medical notifications and certificates Medical holds-United States ports Medical Notifications and Certificates Page . 1-3-1 I-3-4 I-3-4 I-3-4 1. Form.-Medical notifications are issued on form FS-398, MEDICAL EXAMINATION OF VISA APPLICANTS. Medical certificates are issued on form PHS-124 (FQ), CLASSMEDICAL CERTIFICATE. 2. Content.-a. All notifications shall give their class A, B, or C-in the body of the report. All certificates shall show their class in the heading. b. All notifications and certificates shall include specific identification of the disease or defect observed in the alien. They shall use accepted medical terminology; when this is not self-explanatory it shall be supplemented by a brief description of the condition, in layman's language. c. Class A notifications and certificates shall contain the exact term used in the regulations. (They shall also give the applicable detailed diagnostic term when the term from the regulations does not give specific identification of the disease or defect-for example, "Insanity-psychosis with cerebral embolism"; "Mental defect-psychoneurosis.") When a certified condition is in the category of "loathsome or dangerous contagious disease," this phrase shall be given together with the name of the disease-for example, "Syphilis, infectious stage-loathsome or dangerous contagious disease.' d. Class A and B notifications and certificates (except those for obvious defects such as missing limbs) shall include a brief notation of medical data supporting the conclusion. When appropriate, mention should be made of tests or special procedures used in making the diagnosis, and of their results. When the tests or procedures result in a score or other quantitative measure |