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Friday, S ep tem b er 11, 1959

FEDERAL REGISTER

CODIFICATION GUIDE Con.

38 CFR

Page
6 __________________________ 7319
8__________________________ 7319

43 CFR

115-_______ - _______ _________ 7333
200______ --------------------------- 7334
Public land orders:
1974________ A ____ __ ___ ; 7334

47 CFR

7 ________________
7334
8 _______________ - __________ 7334

50 CFR

115________

7335

Reg. Docket No. 112; Amdt. 29-2

PART 29 PHYSICAL STANDARDS
FOR AIRMEN; MEDICAL CER
TIFICATES
Amendment of Medical Standards
Notice was given in Draft Release No.
59-1 24 P.R. 2257 th at the Adminis trator proposed to amend P art 29 of the Civil Air Regulations primarily by amending the medical requirements in 29.2 c1 and d, 29.3c and d, and 29.4 c and d to provide addition al specific standards relating to general physical condition and the nervous system.
As pointed out in the draft release, the Congress of the United States appro priated funds in 1956 to provide for an objective evaluation of current medical standards and their administration in light of the ever-increasing activity in the field of civil aviation. To accomplish this purpose, a contract was entered into between the Civil Aeronautics Adminis tration and the Flight Safety Founda tion, Inc., a non-profit organization, of New York City. Upon completion of its study, the Foundation made two final reports and a supplement. Report No.
2 March 31,1958 deals with the medi cal aspects of civil aviation. This report paakes recommendations as to changes J? medical standards in several areas.
Of these recommendations, the most im portant deal with three medical areas:
1 Individuals with an established diagnosis of diabetes requiring insulin or other h y p o g l y c e m i c agents for treatment;
2 Individuals with a history of myo cardial infarction or other evidence of coronary artery disease; and p / in d iv id u a ls with a history of an established diagnosis of psychosis, severe Psychoneurosis, severe personality abonuality, epilepsy, chronic alcoholism or drug addiction.
J h e Foundation recommends, in effect, mat existence of any of the conditions these three categories is an approprie basis for disqualification for any class j ipedical certificate. This recommennni!0n i s based on th e medical fact that , hese three conditions can be so cisely studied in the individual as to Provide assurance th at they will not fil er ere with the safe piloting of aircraft, reality, the likelihood of occurrence Partially or totally incapacitating
states directly attributable to these con ditions is so great, and the ability to pro vide acceptable medical assurance of non-occurrence of such states in any given individual is so inadequate, th at these conditions existing in airmen con stitute a definite hazard to safety in flight.
The recommendations of the Founda tion were made on the basis of consider ation of these conditions by leading pro fessional groups and individuals in appropriate medical specialties. Addi tionally, other professional groups were asked to comment on the Foundations recommendations and the proposed amendments. The comments reflected concurrence with the recommendations and agreement with the principles ex pressed therein, as more fully discussed hereinafter.
The Administrator agrees with these recommendations and on the basis of expert medical opinion believes that they are well founded in medical fact.
The following discussions abstracted from the draft release indicate the underlying medical reasons leading up to the conclusions th at the conditions de scribed should be disqualifying.
D iabetes M ellitus
7309
called by the Flight Safety Foundation in November 1957. The panel included members of major medical institutions, industrial organizations, a major sched uled airlines medical department, the American Medical Association, the Office of the Surgeon General of the Air Force, and the Medical Division of the former Civil Aeronautics Administration. The panel found th at myocardial infarction and coronary artery disease is the most serious problem among cardiac condi tions because of its frequency and the sudden incapacitation related to it. The panel recommended That anyone who has suffered a myocardial infarction or has angina pectoris or other evidence of coronary insufficiency which may rea sonably be expected to lead to myocardial infarction, should not be certified to pilot or co-pilot an aircraft.
The generalized processes of arterio sclerosis or atherosclerosis are the usual causes of myocardial infarction. These processes are rarely limited to a single location. Although medical knowledge has progressed substantially in the field of control of these diseases there is in sufficient data at this time to insure posi tive control or cure. Therefore, it must be considered that these diseases are pro gressive and irreversible in nature and a person who has suffered one infarction and survived may reasonably be expected to suffer further attacks.

The following statement was prepared by a panel of specialists in the fields of diabetes and aviation medicine called by the Flight Safety Foundation in Novem ber 1957. The panel included members H istory of P sychosis or S evere P sycho
neurosis , S evere P ersonality Abnor of the American Medical Association, mality , E pilepsy , Chronic A lcoholism the American Diabetes Association, the or D rug Addiction Office of the Surgeon General of the Air Force, the Medical Director of a large The Flight Safety Foundation devel scheduled air carrier, and the Medical oped recommendations for specific stand Division of the former Civil Aeronautics ards in the area of mental disturbances Administration.
by consulting individually with recog Any individual who takes insulin, Oriilase, nized psychiatrists who were familiar or any other hypoglycemic drug, is subject with the requirements of aviation. The to a decrease in concentration of sugar in Foundations report states:

the circulating blood. When the concentra tion of sugar falls below an average level of 70 mg. in each 100 ccs, a chain of reactions is set up. These involve the sympathetic nervous system, the parasympathetic nervous system and the central nervous system.
For the purposes of flight safety, we are interested, mainly, in the effects on the central nervous system. These range from loss of reasoning power, euphoria alternating with depression, blurred vision, and double vision, loss of memory, convulsions, and, ultimately, if not treated, complete uncon sciousness. The severe manifestations are easily recognized and, by themselves, in the ground crew, can be detected before damage is done. In-flight personnel, of course, may go into unconsciousness without detection.
What is most important, however, are the early, almost undetectable, changes th a t oc cur while the blood sugar concentration is decreasing. These are the changes mani fested by the personality alterations, lapses in memory, and lack of ability to coordinate muscular activity, and loss of reasoning power, muscular tremors and double vision-
the subject, himself, may fail to recognize this onset.
Diabetes, per se, does not alter the various nervous systems of the body; hence, th at type of diabetes which is amenable to proper treatment without the use of hypo glycemic agents, does not render a man incapable of flight via aeroplane.
C oronary H eart D isease
Coronary heart disease was considered by a panel of specialists in heart disease
The most common psychiatric psychotic disorders encountered are 1 schizophrenia and 2 affective disorders depressive states. In a high percentage of cases, schizophrenic reactions tend to recur while tendency of the depressive state to recur after remission is less. The precipitating factor in a recurrence cannot be predicted, neither can the. time of recurrence. Anyone with a his tory of schizophrenia definitely is dangerous and should not be certified as an airman.

The report classifies these psychiatric disorders into the following broad cate gories and recommends them as the basic policy for denial of medical certification;
1. Pyschotic disorders.
2. Psychiatric disorders with demon strable physical or toxic etiology or asso ciated structural changes in the brain.
3. Psychoneurotic disorders severe.
4. History of attempted suicide.
5. Personality pattern disturbance.
6. Mental deficiency and moronic states.
7. Any other psychiatric abnormality which in the opinion of the medical ex aminer would be likely to render the air man unable to perform safely the duties and exercise the privileges of the grade of airman certificate held or sought.
In addition to the purely mental dis orders, epilepsy and certain other dis turbances of consciousness including those due to unexplained causes were