it was his opinion the subject was experiencing a reaction to fear. (3) Joseph W. Brown, who testified as a fellow passenger that the subject seemed to be "normal" throughout the voyage but became very much agitated and nervous on landing, acting like an entirely different person. f: ... 4. The subject constantly alternates between euphoria and deep melancholia indicating manic-depressive psychosis. n vrocurot po bed lo al 5. On the basis of our medical examination of (name) and the evidence presented to us and made part of the record of our proceedings, it is our conclusion that (manic-depressive psychosis). is mentally defective 6. The certificate issued with respect to (name) on April 15, 1949, and signed by Surgeon Robert A. Smith and Sr. Asst. Surgeon William D. Jones is affirmed. Name Title Name Title Name Title 48. The medical board shall submit to the Surgeon General a copy of its report of findings and conclusions. los ́ ́ ́ 49. Records, papers, affidavits, certificates, and other documents that belong to the Immigration Service shall be returned promptly to that Service following termination of the board. Documents properly belonging to the Public Health Service shall be filed in an orderly manner at the station concerned, and shall not be removed from the station except upon authority from the central office. Custody and Transfer of Aliens-United States Ports 50. The custody of aliens presented for examination, the duty of guarding them during the examination to prevent escape or evasion, and the transfer of such persons to and from places where examinations are made are not the responsibility of the Public Health Service; medical officers shall cooperate with those responsible for custody and assist them as far as possible. All orders relating to the detention, hospitalization, transfer, or release of aliens are issued by the immigration authorities. Acute, Communicable Disease 51. When the medical officer detects or suspects acute, communicable disease, he shall isolate the case and contacts. He shall immediately notify the health authority concerned and the presenting authority, and furnish suitable recommendations. Such cases shall be deferred pending recovery or release from the hospital. (See also sec. 34.12 of the regulations, regarding quarantinable diseases in the United States.) Promptness 52. Examinations and reports shall be made promptly. Of course, medical officers should not let the expediting of examinations interfere with the performance of careful work. Record of Examinations 53. Medical officers shall maintain records of all examinations. In the case of mental conditions certified, the record shall contain a statement of the personal and antecedent history of the individual as far as obtainable, a description of any physical abnormalities detected, and a detailed description of the mental signs and symptoms. When fits occur, they should be described; when psychometric tests are given, the record of performance should be kept. 1. Medical inspections of aliens shall be performed only at ports of arrival in the United States and its territories and possessions; when large numbers of aliens are to be examined in a limited time, the medical inspection procedure may be used. 2. Inspections should be made under good lighting conditions, in a place where the officer can get a clear view of the aliens. General 3. By medical inspection the officer screens out and passes, as speedily as practicable, aliens who have no obvious signs of disease or defect. The medical officer in charge should ensure, as far as possible, that the procedure used is thorough enough to discover the presence of diseases or defects of. consequence. a. When a medical officer performs the inspection, he may issue class B or C certificates on the basis of his findings or of the medical reports presented by aliens. When he suspects the presence of a class B condition but a diagnosis cannot be made at the place of inspection, he issues a medical hold to the immigration officer, referring the alien for intensive examination. When the medical officer suspects a class A condition, he issues a medical hold unless he can detain the alien and call in another medical officer to collaborate in making an intensive examination and diagnosis. b. Except as provided in paragraph c below, final diagnosis and certification of class A conditions shall never be accomplished on board ships, and shall be accomplished at airports only if the necessary laboratory, testing, and observation facilities are available. c. A class A certificate may be issued at the time of the medical inspection when a physician's certificate establishing the diagnosis of the class A condition is attached to the alien's visa, provided the visa, form 257 A, B, and D, shows that it was issued under authority of the 9th proviso of section 3, Immigration Act of February 5, 1917. In such cases medical holds should not be issued, since the aliens are admitted under bond for the purpose of receiving medical treatment; the class A certificate may be issued by a single medical officer, or by an inspection officer for the responsible medical officer. If safeguards are necessary to prevent the alien's travel from presenting a public health menace, the officer should so inform the immigration authority. d. When an inspection officer notes that the medical report presented by an alien gives a diagnosis of a class C condition, or of a class B condition of such a nature that the diagnosis is not likely to be contested, he transcribes the information to a medical certificate. e. When an inspection officer observes an obvious class B or class C condition (such as amputation or cicatrix) not mentioned in the alien's medical report, he issues a medical certificate for the responsible medical officer. f. In preparing a medical certificate, the inspection officer signs it as follows; ‚amut, yd bot vesta e1100rot leafl (Name of inspection officer), Quarantine Officer for (Name and title of responsible medical officer), U. S. P. H. S. I g. The inspection officer should obtain the advice of a medical officer when he: In (1) Observes that the alien's medical report gives a diagnosis of a class B condition of such a nature that the officer thinks the diagnosis is likely to be contested. (2) Suspects the presence of any condition that is not obvious and not mentioned in the alien's medical report. When the medical officer cannot make a diagnosis at the place of inspection, a medical hold should be issued. h. Medical officers should establish inspection, examination, and supervisory procedures so that a minimum number of medi |