4. Diagnosis of Syphilis by the General Practitioner. Joseph Earle Moore. 5. Diagnosis and Treatment of Syphilis-A Handbook for Physicians. Pub- 6. Management of Chancroid, Granuloma Inguinale and Lymphogranuloma Venereum in General Practice. Federal Security Agency, Public Health Service, Supplement No. 19 to Journal of Venereal Disease Information, United States Government Printing Office, Washington, D. C., 1943. This monograph is valuable for its description of diagnostic procedures and clinical course of the minor venereal diseases, although with the recent application of streptomycin, aureomycin, and chloromycetin it has become outdated in certain aspects of therapy. 1. Obviously it is impracticable to prepare a list of all diseases and defects in the category of class B conditions. 2. As with other classifications, uniformity of practice, so far as possible, is highly desirable. 3. Officers should be careful to avoid certifying as class B conditions diseases and defects that should be certified as class C. Such improper classification not only results in a lack of uniformity but also may work a serious injustice to the immigrant involved. Examples 4. Deformities and defects.-Attention must be given to the numerous malformations and deformities, whether congenital, developmental, or acquired. a. Clubfoot, clubhand, spina bifida, or loss of a leg, arm, foot, or hand should be certified as class B. b. Other deformities and defects shall receive careful consideration, and should be certified as class B when the responsible medical officer deems them substantial departures from normal physical well-being. Among the many conditions to be given consideration are dislocation of joints and loss of parts of the body. Special mention must be made of hernia, which is quite common and in many cases tends to grow worse, especially under the strain of a laborious occupation. c. Aliens may also be observed with markedly defective skeletal and muscular development. This should receive careful consideration, and the exact condition should be discovered by a complete examination with the alien divested of clothing. - 5. Senility. a. Senility is the feebleness of body and mind incident to old age. A certificate for senility shall be issued when the aging process has progressed to the point where there is a substantial departure from physical well-being. The diagnosis of senility should not be based on chronological age. b. When the aging process has progressed to an unusual degree in a comparatively young person so that there is a substantial departure from physical well-being, the condition may be certified as "premature senility." c. When degenerative change is associated with senility, a certificate should be issued for the specific condition for example, arteriosclerosis-as well as for senility. 6. Tumors. Both malignant and benign tumors may be certified as class B in most cases. 7. Diseases of the blood.-Such conditions as leukemia and the anemias are usually certifiable as class B. 8. Diseases of the circulatory system.-a. Particular mention must be made of the various forms of heart disease that are common and disabling. Medical officers should routinely examine the heart carefully during intensive examinations. Certification shall rest upon definite evidence of organic lesions and not on the mere presence of adventitious cardiac sounds. When indicated, X-ray or electrocardiogram should be obtained if facilities are available. b. Varicose veins should be certified when so marked as to give rise to disabling symptoms. 9. Diseases of the nervous system. This category includes a number of seriously disabling diseases. In examination of aliens suspected of having such conditions, effort should first be directed to the detection of any mental conditions certifiable as class A. 10. Diseases of the locomotor system. Among these are various forms of myositis, chronic diseases of the bones, and affections of the joints, such as arthritis. Many of these conditions are chronic, incurable, and disabling. 11. Diseases of the skin.-In addition to the skin diseases certifiable in class A there are a number that may be certifiable in class B. Many of these conditions are chronic, require prolonged treatment, and are disabling. At times they may be certifiable as class B on the basis of being repulsive. A typical case of this kind is psoriasis, when at all marked. 12. Infections.-Numerous conditions may come up for consideration under this heading. These include infections by bacteria, viruses, fungi, protozoa, and metazoa. a. Examples of such infections are various types infections, intestinal parasites, and malaria. of pyogenic NOTE.—At Mexican border stations, medical officers should give careful consideration to the possible presence of malaria in aliens; when malaria is suspected, officers shall make a microscopic examination of the blood sufficient to establish the diagnosis of the disease. When an alien is certified for malaria, and admitted by the Immigration Service, the medical officer shall immediately notify Division of Foreign Quarantine headquarters, giving pertinent details regarding the alien's identification, destination, and history and the methods and findings of the examination. b. Perhaps conditions that will prove more difficult of determination are infestations by the metazoan parasites. It is sometimes difficult to determine whether helminthic infestation should be classified as class B or class C. Much depends on circumstances, and especially the likelihood and degree of constitutional disturbance incident to the infestation. For example, clonorchiasis without constitutional disturbance is classified as class C, but with constitutional disturbance is regarded as class B. 13. Oral conditions. The following should be certified as class B: a. Malignant tumors. b. Deformities of the jaws (congenital or acquired) (1) Ankylosis of temporomandibular joint. (2) Cleft palate. (3) Loss of all teeth, when uncorrected by prosthetic appliances. (4) Nonunion or malunion of fractures of the jaws. c. Oral foci of infection: (1) Periodontal disease. d. Acute infectious diseases. e. Stomatitis from any cause. 14. Diseases and defects of the eyes.-The following should be certified as class B: a. Blindness in one or both eyes. b. Defective vision in one or both eyes due to disease processes of progressive nature and likely to result in blindness. c. Myopic vision of 20/400 or less in one or both eyes, regardless of what the corrected vision may be. Other refractive errors that cannot be corrected to 20/40 in the better eye should be certified as class B. d. Defective vision due to opacities of the cornea, when the field of vision is definitely limited or the corrected visual acuity is less than 20/40 in the better eye. e. Strabismus, if the corrected vision in the better eye is less than 20/40. 15. Diseases and defects of the ears.-The following should be certified as class B: a. Deafness without mental abnormality. b. Chronic suppurative otitis media, involving one or both ears. c. Chronic or subacute mastoiditis. d. Hearing of 5/20 low voice, or less, in both ears. It is well to examine the auditory canal and tympanic membrane with an otoscope in all cases of suspected ear defect. An X-ray examination may reveal structural, bone disease destructive of hearing. 16. Other conditions.—Some of the other categories of diseases that may be certifiable as class B are listed below, with some examples of each: |