Physical Standard No. 2

(1) The medical examination and assessment will be based on the following requirements of mental and physical fitness– (a) the applicant shall be required to be free from such active or latent, acute or chronic physical disability, as would entail a degree of functional incapacity which is likely to interfere with the safe performance of the duties at any altitude throughout a prolonged or difficult flight; (b) the medical examination will include a full inquiry into the family and personal history of the applicant. The information obtained shall be given in a statement made and signed by him and will be taken into consideration by the medical examiner; (c) examination of the nervous system – The applicant shall have no history of significant or nervous trouble. He shall be required to be free from any mental impairment, or presumptive evidence of latent epilepsy. He shall be required to be free from any progressive disease of the nervous system and from any non-progressive disease of that system, the effects of which are likely to interfere with the safe performance of the duties. Cases of past or present insanity and cases in which syphilis, past or present, has Civil Aviation 179 affected the central nervous system will be assessed as permanently unfit. (2) As to injuries of the head– (a) cases of simple concussion, or simple fracture of the skull without associated intracranial injury will be assessed as temporarily unfit until such time as the medical examiner is satisfied that the effects of the concussion or fracture are no longer likely to jeopardise safety in flight. If the applicant has been incapacitated for a period in excess of one month the licence if renewed will be valid only for a period of two months in the first instance, thereafter its validity will be restricted to consecutive periods of two months until the medical examiner is satisfied that the after-effects of the concussion or fracture are no longer likely to cause a sudden incapacity in flight; (b) cases of head injury associated with intracranial injuries will be assessed permanently unfit if a local lesion of the brain or meninges persists; (c) cases of head injury in which there has been an operation on the skull with loss of bony substance involving the two tables of the cranial vault will be assessed as permanently unfit. (3) General surgical examination – (a) the applicant shall be required to be completely free from hernia; 180 Civil Aviation (b) cases of active disease of the bones, joints, muscles or tendons and all serious functional sequelae of congenital or acquired disease will be assessed as unfit. Cases of functional after effects of lesions affecting the bones, joints, muscles or tendons and certain anatomical defects compatible with the safe performance of the duties may be assessed as fit; (c) cases of sequelae of disease or surgical intervention on any part of the digestive tract and its adnexae, liable to cause sudden incapacity in flight, in particular any obstructions due to stricture or compression will be assessed as unfit; (d) cases of extensive mutilation of the chest wall with collapse of the thoracic cage and sequelae of surgical procedures resulting in decreased respiratory efficiency at altitude will be assessed as unfit; (e) cases of sequelae of disease or surgical procedures on the kidneys and the urinary tracts liable to cause sudden incapacity, in particular any obstructions due to stricture or compression will be assessed as unfit; (f) cases of compensated nephrectomy without hypertension or uraemia may be assessed as fit. An applicant who has undergone a major surgical operation on the biliary passages or the digestive tract or its adnexae, or the urinary system, which has involved a total or partial excision or a diversion of any of these organs will be assessed as unfit until such time as the medical examiner having access to the details of the operation concerned considers Civil Aviation 181 that the effects of the operation are not liable to cause sudden incapacity in the air. (4) General medical examination – (a) the heart shall not possess any abnormality, congenital or acquired, which is likely to interfere with the safe performance of the duties. Respiratory arrhythmia, occasional extra systoles which disappear on exercise, increase of pulse rate from excitement or exercise, or a slow pulse not associated with auriculo-ventricular dissociation may be regarded as coming within “normal” limits; (b) the systolic and diastolic blood pressures shall be within normal limits; (c) there shall be no significant functional or structural abnormality of the circulatory tree; (d) there shall be no acute disability of the lungs nor any active disease of the structures of the lungs, mediastinum or pleura. In the case of an examination for the first grant of a licence, radiography will form a part of the chest; (e) and similar radiographic examinations will be carried out as necessary thereafter; (f) cases of pulmonary emphysema will not be assessed as unfit unless the condition is causing symptoms; (g) cases of active pulmonary tuberculosis will be assessed as unfit. Cases of quiescent or healed lesions which are known to be tuberculous, or are presumably tuberculous in origin, may be 182 Civil Aviation assessed as fit. Cases of doubt about the activity of a lesion, where symptoms of activity of the disease are lacking, clinically, will be assessed as temporarily unfit for a period of not less than three months from the date of the medical examination. At the end of the three-month period, a further radiographic record will be made and compared carefully with the original. If there is no sign of extension of the disease and there are no general symptoms nor symptoms referable to the chest, the applicant may be assessed as fit for a period of three months. Thereafter, provided there continues to be no sign of extension of the disease as shown by radiographic examinations carried out at the end of each three-month period, the validity of the licence will be restricted to consecutive periods of three months. When the applicant has been under observation under this scheme for a total period of at least two years and comparison of all the radiographic records shows no changes or only retrogression of the lesion, the lesion will be regarded as “quiescent” or “healed”; (h) cases of disabling disease with important impairment of the functioning of the gastro- intestinal tract and its adnaxae will be assessed as unfit; (i) cases of significant metabolic nutritional or endocrine disorders will be assessed as unfit. Proven cases of diabetes mellitus will be assessed as permanently unfit: doubtful cases will be assessed as unfit until the condition is proven to be non-diabetic; Civil Aviation 183 (j) cases of severe and moderate enlargement of the spleen persistently below the costal margin will be assessed as unfit; (k) cases of significant localised and general enlargement of the lymphatic glands and of diseases of the blood will be assessed as unfit; those due to a transient condition may be assessed as temporarily unfit; (l) cases presenting any signs of organic disease of the kidneys will be assessed as unfit; those due to a transient condition may be assessed as temporarily unfit. The urine shall contain no abnormal element considered by the medical examiner to be pathological. Cases of affections of the urinary passages and of the genital organs will be assessed as unfit; those due to transient conditions may be assessed as temporarily unfit; (m) an applicant who has a personal history of syphilis shall be required to furnish evidence, satisfactory to the medical examiner, that he has undergone adequate treatment. An applicant showing any clinical signs of active syphilis will be assessed as temporarily unfit for a period of not less than three months from the date of the medical examination. At the end of the three month period, provided the applicant furnishes proof, satisfactory to the medical examiner, that he has undergone adequate treatment in the interim and that the serological reaction for syphilis is negative, he may be assessed as fit but where a licence is granted or renewed in these circumstances it will be valid only for a period of three months in the first instance. Thereafter, provided serological reactions for syphilis continue to 184 Civil Aviation be negative at the end of each three month period, the validity of the licence will be restricted to consecutive periods of three months. When the applicant has been under observation under this scheme for a total period of at least three years and the serological reactions have continued to be negative, the restriction on the period of validity of the licence may be removed. In cases where the serological reaction for syphilis remains persistently positive, examinations of the cerebrospinal fluid at the end of each period of six months with negative results may be accepted in lieu of negative serological reactions at the end of each period of three months; (n) applicants of the female sex who have a history of severe menstrual disturbances that have proven unamenable to treatment and that are likely to interfere with the safe performance of the duties will be assessed as unfit; (o) in the event of pregnancy, the applicant will be assessed as temporarily unfit until at least, after the pregnancy has been terminated. After confinement or miscarriage the applicant will not be permitted to exercise the privileges of the licence until she has undergone a medical examination and been assessed as fit. Cases of applicants of the female sex who have undergone gynecological operations will be considered individually. (5) Eye examination - The functions of the eye and its adnexae shall be normal. There shall be no active pathological condition, acute or chronic, of either eye or adnexae which is Civil Aviation 185 likely to interfere with its proper function to an extent that would jeopardise safety in flight. (NOTE: The details of the Visual Requirements are specified in regulations 200 to 204 and those for Colour Perception in regulations 205 and 206 of these Regulations). (6) Ear Examination - There shall be – (a) no active pathological process, acute or chronic, of the internal ear or middle ear cleft; (b) no unhealed (unclosed) perforation of the tympanic membranes except that a dry perforation of non-infectious origin need not render the applicant unfit; (c) no permanent obstruction of the Eustachian tubes; (d) no permanent disturbances of the vestibular apparatus. (NOTE: The details of the Hearing Requirements are specified in regulations 207 to 210 of these Regulations). (7) Nose, throat and mouth examination – There shall be free nasal air entry on both sides. There shall be no serious malformation nor serious, acute or chronic, affection of the buccal cavity or upper respiratory tract. Applicants with significant defects of speech will be assessed as unfit.