■'■^p^y'^j^^/^g^; ■ atifara, Wfw ^nrk THE CHARLES EDWARD VAN CLEEF MEMORIAL LIBRARY mLL. ^< fe:^-^z,r::^?..4_<^::7.z^35as^. JO Cornell University Library RC 65.B28 A manual of instructions for enlisting a 3 1924 000 227 409 Cornell University Library The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924000227409 MANUAL OF INSTRUCTIONS FOR ENLISTING AND DISCHARGING SOLDIERS. ■WITH SPECIAL REFERENCE TO THE MEDICAL EXAMINATION OF RECRUITS, AND THE DETECTION OF DISQUALIFYING AND FEIGNED DISEASES. ROBERTS BARTHOLOW, A.M., M.D. ASS'T surgeon U.S. ARMT. SURGEON IN CHARGE OF MCDOUGALL GENERAL HOSPITAL. PROP. OF MIL. MED. JURISPRUDENCE, ARMY MEDICAL SCHOOL. ADOPTED BY THE SUEGEON-GBNERAL FOB ISSUE TO MEDICAL OFFICEES OP THE AEMY. PHILADELPHIA : J. B. LIPPI]:^COTT & CO. 1864. Entered, according to Act of CongreBS, in the year 1863, by J. B. LIPPINCOTT & CO., In the Clerk's Office of the District Court of the United States for the Eastera District of Pennsylvania. TO ^ BRIG.-GENERAL W. A. HAMMOND, mId. SURGEON-GENERAL U. S. ARMY, ETC., ETC., ETC. ill ^mi .oJ Ife ^$^s WHOSE ADMINISTRATION MARKS A NEW ERA IN THE MEDICAL DEPARTMENT OF THE ARMY, THIS LITTLE -VTORK:, WHICH OWES ITS EXISTENCE TO HIS FRIENDLY SXTaOESTlON, IS liESCPECTFULLY IJTSCIilSEQ BY THE AUTHOR. PREFACE. The need of a work on enlisting and discharging" sol- diers, written with especial reference to the wants of the military service, at the present time, renders an apology for the appearance of this book unnecessary. • Tripler's Manual, and Henderson on the Examination of Recruits, although very excellent, are scarcely complete enough to suit the present emergency in military aifairs. The deficiencies in these, the only American authorities, are not supplied by the works of foreign military medico-legal writers, — our military system differing in many material respects from the military systems of other nations. I have availed myself freely of the labors of such of these foreign writers as were accessible, whenever their material was suitable to my purpose, and have drawn upon my own observation and ex- perience, — which have not been inconsiderable. Much of the subject-matter of a work of this kind has necessarily been so long the common property of military medico-legal writers as to render it impracticable for me to credit it to the original authorities. I have endeavored to make suitable acknowledgment, as I went along, for the aid derived from others. The disqualifications for military service are very much the same in all countries. The lists given in this work are derived from the report of the Medical Board (of which I. was a member) convened at Washington to determine the 1* 5 t) PREFACE. ( . - mental and physical infirmities which should exempt under the Enrolment Act ; from the Aide-3I4moire medico-legal de-V Officierde Santi de I'Armee de Terre, &c., par F. O. Maillot ei J. A. Fuel; from the Mimoire sur le Choix des Soimmes propres au Service militaire dams V Armie de Terre, par^JJ. BcauprS ; from the Code des Officiers de Santi de T Armie de Terre, par P. A.JDidiot; and from the regulations of the English and Prussian Army Bledical Departments. I need hardly suggest a fact to the reader which he will readily see and appreciate for himself, — that this work is not intended for professional experts, but for such examining surgeons, medical officers, and recruiting officers as have not had, heretofore, an opportunity to become informed on these subjects. For the benefit of the last named, at the suggestion of a distinguished officer on duty in the War Department, I have appended a glossary of medical terms used in the work, — a glossary which indicates rather than explains the meaning of the terms. MoDouaALL General Hospital, Fort ScnnTLEE, N.Y., July, 1863. TABLE OF CONTENTS. INTRODUCTION., Q SECT. I.— REAL DISQUALIFICATIONS FOR MILITARY SERVICE. V Chap. I. — Mental iNFiRMnrES that Disqualify fob Military Duty 16 n. — Moral iNFntjnTiES that Disqualify for Miutary Duty 23 m. — Physical Infirmities that Disqualify for Military Duty 28 I. — General Disqualifications 26 n. — Special Disqualifications 42 First Class. — Organs of Special Sense and Accessory Appa- ratus 46 A. AfiFections of Auditory Apparatus 46 B. Affections of the Eye and its Appendages 48 C. Affections of the Olfactory Apparatus 52 D. Affections of the Mouth and Gustatory Appa- ratus 54 Second Class. — Head and Spinal Column 53 Third Class.— Neck and Contained Organs 62 Fourth Class. — Chest and Thoracic Organs 64 Fifth Class. — Abdomen and Digestive Apparatus 70 Sixth Class. — Genito-Urijaary Apparatus 72 Seventh Class. — Upper and Lower Extremities 75 A. Disqualifications common to both Upper and Lower Extremities 75 B. Disqualifications proper to Upper Extremities 77 C. Disqualifications proper to Inferior Extremi- ties ; 78 Eighth Class. — SMn and Appendages 84 SECT. II.— PRETENDED DISQUALIFICATIONS FOR MILI- TARY SERVICE. I. — General Considerations 86 g II.— Classes op Men Feigning, and Character of their Ailments 92 ,^ m.— Duties of Medical Officers in Relation to Malingerino — Diagnosis '■-■ AND Classification 99 First Class. — Feigned Diseases affecting Organs of Special k Sense and Accessory Apparatus 107 7 8 TABLE OF CONTENTS. Chap. HE., First CtASS,— Continued. FASH / .' A. Auditory Apparatua....r. 107 B. Affections of the Eye 109 C. Affections of the Nose 113 ,_ D. Affections of the Mouth 113 V;. Second Class. — Feigned Diseases affecting the Head and t: Spinal Column and the Cerebro-Spinal ^, NeiTOuB System 115 '^ Thikd Class. — Feigned Diseases affecting Neck and Con- '^ tained Organs 128 ,5* FouKTH Class. — Feigned Diseases affecting Chest and Tho- racic Organs 130 '- FifTH Class. — ^Feigned Diseases affecting Abdomen and Di- gestive Apparatus 134 Sixth Class. — Feigned Diseases affecting Genito - Urinary Apparatus.. 138 Seventh Class. — Feigned Diseases and Injuries affecting Upper and Lower Extremities 143 Eighth Class. — Feigned Diseases affecting Skin and Append- ages 148 SECT. III.— ENLISTING SOLDIEHS. I. — Methods of Recruiting an Army 149 II. — Examination of Recruits 165 III.— Qualifications of Recruits 175 SECT. IV.— DISCHARGING SOLDIERS. I. — General Considerations 209 II. — INTALID Corps 216 III. — Physical Infirmities that incapacitate Enlisted Men for Field-Ser- vll!e, but do not disqualify them for service in the "invalid Corps" „. 224 rv. — Physical Infirmities that disqualify Enlisted Men for Service in THE Invalid Corps 231 V. — Causes of Discharge on Surgeon's Certificate 253 Class First. — Organs of Special Sense, and Accessory Ap- ^ paratus 240 Class Second. — Head and Spinal Column, and Cerehro-Spinal Nervous System 243 Class Third.— Neck and Contained Organs 244 Class Fourth. — Chest and Thoracic Organs 245 Class Fifth. — Abdomen and Digestive Apparatus 246 Class Sixth. — Genito-Urinary Apparatus 247 1^ Class Seventh. — Upper and Lower Extremities 248 te^ Class Eighth. — Skin and Appendages 249 \,'a% TI.— Mode of Discharging 253 GLOSSARY 263 INDEX 272 ON ENLISTING DISCHARGING SOLDIEES. INTRODUCTION. In the formation of an army, upon the eflfi- ciency of which may depend the safety of the state, two principles of the utmost importance must be kept in view : one, that no man, a proper suhject for military duty, be exempted; the other, that the service be not encumbered with men unfitted for it by reason of Jnental, moral, or physical infirmities. It is the pur- pose of the recruiting officer in time of peace, when the strength of the army is maintained by voluntary enlistments, as it is of enrolment and conscription acts in time of war, to obtain the one and exclude the other. To promote 10 INTEODUCTION. the continued efficiency of the army, these principles must be constantly applied, render- ing it necessary, on the one hand, to use the utmost skill and ingenuity in detecting feigned, factijliious, aggravated, and exaggerated dis- eases, and, on the other, to discharge those disqualified by infirmities which escaped the observation of the examining surgeon, or who have become disabled by accidents or diseases incident to mihtary life. Upon the faithful- ness and' thoroughness with which the duties of enlisting and discharging soldiers are per- "formed, dqpend the numerical strength of the army, its health, its efficiency in battle, and especially its mobility. How far the success of military movements is influenced by these circumstances, is apparent enough. The mul- tiplication of armes de prScision has not sup- plied legs to armies or obviated the necessity for physical power in individual soldiers. War, in modern times, consists so much in the science of making men march for the purpose of striking an unexpected blow on the enemy, that the efficiency of soldiers depends greatly on their capacity for executing long marches with comparative ease. Marshal Saxe and General Foy, both of whom had great military experience, do not hesitate in stating that the INTRODUCTION. 11 secret of war lies in the power of marching, — namely, in the strength of the legs.* The successes of Napoleon's military opera- tions were due in no smalV degree to rapidity of combinations and celerity of movements, or, in other words, to the physical efficiency of his troops. Reverses began when the necessi- ties of the emperor and the exhaustion of the matured portion of the population required that the conscription be enforced with more rigor and the army recruited from a levy of conscripts under twenty years of age, less care- fully selected. The capacity to endure fatigue and long marches is not less a requirement now than it was to the Roman soldier, who marched, carrying a load of sixty pounds, twenty miles and more a day.f Railroad communications may and do powerfully assist in military movements ; but their aid is local and of limited application, whilst physical stamina is universally applicable. The ten- dency in these days is to decry the necessity for a high standard of physical efficiency in the constitution of an army, and to exaggerate the importance of improved arms. There is another aspect of the question, too * Marshall on Enlisting and Discharging Soldiers, page 10. •j- Tegetius i. 10 ; Liv. iii. 27. 12 INTRODUCTIOlsr. important to be disregarded, — the pecuniary. "To put a soldier in the field costs the G.pvernment nearly four hundred dollars ;"* to maintain him in the hospital costs not less than twenty-five dollars per month, besides his pay and allowances. The sick and the dis- abled, derived from any source soever, are serious encumbrances to the movements of an army : they cannot be abandoned ; they must follow the army or be removed to a general hospital ; and attendants and ambulance trains become necessary to their care and comfortable transportation. It follows, then, from the consideration of the military necessities and the pecuniary results, that the application of the second of the two propositions with which this chapter opens is more important to the interests of the Government. It is an unwise policy to restrict within doubtful limits the causes of exemption from military service. In a country like this, where the general standard of health and physical stamina is high, and the number of cases of incomplete or arrested development of chronic, incurable, and constitutional dis- eases are in small proportion to the whole * A Treatise on Hygiene: W. A. Hammond, Surgeon-General U.S. Army. INTRODUCTION-. 13 population, it becomes the less necessary to include in an enrolment or conscription cases admitting of reasonable doubt as to their suffi- ciency to fulfil all the requirements of tjte military service. :? Under the provisions of the "act for enroll- ing and calling out the national forces," ap- proved March 3, 1863, the determination of the physical and mental fitness for mihtary duty devolves upon the Board of Enrolment, whose decision is final. The importance of a rigid attention to the two great principles enunciated in this introduction will appear in the results of these examinations; for if, on the one hand, injudicious laxity shall be the rule, the army will be burdened with useless recruits ; on the other, if a wise discretion shall govern, and drafted men be exempted whose powers, mental and physical, are inadequate, the army wirll be fitted for the work in hand. The examining surgeon of a recruit for the regular army certifies on honor that he has carefully examined the recruit agreeably to the general regulations of the army, and that it is his opinion that the recruit is free from all bodily defects or mental infirmity which would in any way disqualify him for the performance of military duty. 14 IKTRODUCTION. The principal object of the surgeon, in the examination of recruits or drafted men, is not to select what is in every way good, but to reject what is absolutely unfit* In a general view of a nation, excluding the two extremes of age, it would appear that all men have the physical capacity for soldiers; but, when examined in detail, a large percentage are dis- covered with disqualifying defects fatal to their efficiency. A drafted man, wishing to escape the just obligation imposed by the Government, may feign or produce a disease to be exempted, and a volunteer may dissimu- late one to be accepted. The purpose of the examining surgeon, therefore, seems to be to discover disqualifying defects, and to deter- mine, negatively, the fitness of a man for the life of a soldier before he enters upon the con- sideration of the positive quahties of develop- ment, symmetry, and general aptitude. Whilst the French, as also the Prussian, regulations are calculated to obviate the simulation of defects, and the English to prevent fraud by the dissimulation of infirmities, ours should be directed to the accomplishment of both these objects. According to this view of the subject, it is obviously most proper to commence a feiai. * Jackson. Economy, Discipline, and Formation of Armies. 'Pi. INTRODUCTION. 15 treatise on enlisting and discharging soldiers with an account of disqualifying infirmities, whether mental, moral, or physical. A great deal of repetition is avoided by this arrange- ment; for a disqualification which would exempt a man from draft, or for which he would be re- jected if a recruit, or which he might simulate or dissimulate, is usually a cause, real or pre- tended, for discharge from service. Assuming this view to be correct, I shall consider — 1. Real disqualifications for military service, comprised in three classes : mental, moral, physical. 2. Pretended disqualifications; which will constitute a separate section on feigned diseases. 3. Qualifications of recruits, and enlisting soldiers. 4. Discharging soldiers. The list of diseases and infirmities which disqualify for military service, contained in the regulations of the Bureau of the Provost- Marshal General,* being an official ancf authori- tative statement on the subject, each of the diseases or infirmities therein enumerated will be placed at the head of the corresponding class in the following arrangement. * Regulations for the Government of the Bureau of the Pro- vostMarshal General of the United States Washington, 1863. SECTION I. REAL DISQUALIFICATIONS FOR MILITARY SERVICE. CHAPTER I. MENTAL INFIRMITIES THAT DISQUALIFY FOR MILITARY DUTY. MANIFEST IMBECILITY, OR IlSrSANITY. The disqualifications under this head, ex- cept as feigned diseases, rarely come under the observation of the examining surgeon, or Board of Enrolment. The more distinctive forms, as Acute Mania, Monomania, Melancho- lia, &c., are sufficiently well characterized ; but there are disqualifying mental states much more obscure, which require close ob- servation and knowledge of the signs, symp- toms, and pathology of insanity, to be detected with certainty, especially in the incipient 16 MENTAL INFIRMITIES. 17 stages. I need hardly observe that any of the forms of mental alienation mentioned above, as also Idiocy, Cretinism, Imbecility, and Dementia, constitute absolute disqualifi- cations for military service. Between these well-marked states and that degree of intelli- gence sufficient for the soldier there are nu- merous gradations and varieties. The term imbecility of mind is usually employed by writers on the subject of enlisting soldiers, and intended to apply to Idiocy, Imbecility, and Dementia, rather than to the higher types of Insanity. Idiocy is a congenital condition; Cretinism, although not to be diagnosed usually at birth, is hereditary; Imhecility is a minor degree of mental defi- ciency than idiocy; and Dementia is the result of diseased action supervening upon a healthy mental state, or a sequel of more acute forms of mental derangement. In the lower forms of idiocy the functions of animal and organic life are greatly impaired : the idiot is below the plant, and is scarcely alive to external impres- sions.* Cretinism is not frequently seen in this country ; and it is scarcely necessary to enter into a description of it. Hitherto it has ■ 9 * Manual of Psychological Medicine : Bucknill & Tuke, page 103. 2* 18 MENTAL INFIRMITIES. existed mainly in Switzerland, Valais, Savoy, Italy, and Piedmont, where it is endemic ; but it is also sporadic, "an occasional case being found, presenting the characteristics of' genuine Cretinism, in the cities of various countries." A very well-marked case is now in the Tort Schuyler General Hospital. Imbe- cility of mind is a term admitting of wide application. From the highest to the lowest order of mental soundness there are an infinite number of degrees of intelligence. The same variations are found in mental deficiency. It is not always easy, in a given case, to deter- mine whether the intelligence is, or is not adequate to the performance of military duty. In the lower forms, imbeciles produce nothing, and all their movements, both intellectual and moral, are aroused only by impulses from without. They reply correctly; but they must not be asked too many questions, nor required to make responses which demand reflection or are contrary to their habits.* Others display considerable shrewdness, and are constantly indulging in jokes : they pass for half-witted people, whose droll behavior and ready repar- tees create amusement."}" Imbeciles possessing * Esquirol. Maladies meutales, p. 452. t Bucknill & Tuke, op. cit. p. 118. MENTAL INFIRMITIES. 19 this degree of intelligence may perform the r duty of soldiers, as far as it is merely me- chanical, with exactness, but they are, of course, unfitted for any duty requiring dis- cretion or judgment. They are, moreover, peculiarly liable to insane impulses, to com- mit theft and other crimes, although com- petent to the performance of many of the ordinary duties of life and able to take care of themselves. Senile Dementia, occurring at a period of life when men cease to be employed in the mili- tary service, need not detain us. In its beha- vior it does not differ from the disease arising from other causes than the degenerations of age. Dementia is divided by Dr. Prichard* into several stages : 1st, loss of memory with- out impairment of the reasoning faculty; 2d, aboHtion of the reasoning faculty; 3d, the stage of incoherence; and, lastly, loss of in- stinct and volition. When primary, it is the first stage of the mental disease of the patient, and, without having any well-marked sign of alienation, he only gives evidence of loss of memory, power of attention, and executive ability. At this stage Dementia may escape * Treatise on Insanity, p. 88. Also article "Insanity" in Cyclopaedia of Practical Medicine, vol. i. p. 824. 20 MENTAL INFIRMITIES. detection by the examining surgeon, but it is positively disqualifying. Idiocy, Cretinism, Imbecility, and Dementia are, usually, easily enough, recognized by want of harmony and vacuity in the expression, obvious deficiencies of mind, imperfect development of body, ill habits, limited but imperious instincts, and various hallucinations and delusions. The various forms of Monomania, irregular in their manifestations, and consisting of per- version of the aflfections and disposition, with or without deprivation of reason, are sometimes exceedingly obscure. Suicidal Mania, Klepto- mania, Erotomania, Pyromania, and Dipso- mania belong to this class j but as all of them, except the last-named, occur rarely, they need not be considered in this treatise. Whenever present, they are disqualifying infirmities. Dipsomania is a more frequent form of mono- mania. The distinction between this, as a form of mental disorder, and the merely phy- siological condition of drunkenness, is not very clear. Cerebral disease, hereditary tendency, or some disorder of the nervous system, not due to the abuse of alcoholic stimulants, exists in the one case, whilst the other is a habit merely.* Chronic Alcoholismus is a causn for * Buoknill & Tukc, op. cit. p. 219. MENTAL INFIRMITIES. 21 rejection or exemption, but, as it is a purely ' physical condition, will be considered under '; that head. Nostalgia is a form of mental disease which comes more frequently under the observation of the military surgeon. "Nostalgia, when it is of long duration and resists the means of moral treatment, and has produced a profound alteratiorL'of the organism, is a case for reform."* Considered as a mental disease, — and there can be no doubt that the primary phenomena of this state are mental, — it belongs to the class Melancliolia. The extreme mental de- pression and the unconquerable longing for home soon produce a state of cachexy, loss of appetite", derangement of the assimilative functions, and, finally, disease of the abdomi- nal viscera, — in fact, the objective phenomena of the typhoid state. Young men, it is said, are the most usual subjects of this disease, especially young men belonging to races and people remarkable for their attachment to home and country ; but in our army mar- ried men of middle life are more liable to it, particularly those given to solitary vice or the victims of spermatorrhoea. As Nostal- * Didiot, Code des Officiers de SantS, &c., second part, p. 465. Paris, 1863. 22 MENTAL INFIRMITIES. gia is not unfrequently fatal, it is a ground for discharge if sufficiently decided and pro- nounced, but, obviously, as a condition inci- dent to service, cannot be considered a cause for exemntion. MORAL INFIRMITIES. 23 CHAPTER II. MORAL INFIRMITIES THAT DISQUALIFY FOR MILITARY DUTY. The standard of qualification in respect to moral character is extremely low. The military service, in time of peace, presents so few attractions that men of good reputation, having other means of earning a livelihood, avoid it, and the ranks are filled up from the idle, the dissolute, and the unfortunate. Fre- quently, indeed, amongst unthinking civilians, a good moral character is considered unneces- sary in a soldier, and a man is held to be fit for the military profession who is worthless for every useful purpose in civil life. No one at all familiar with the insubordination, discontent, and bad habits which one evil-disposed man may induce in a company, will question the propriety of some standard of qualification in this respect. An ordinance of the 21st of March, 1832, requires the substitute or volun- teer to produce a certificate of good character from the mayor of the commune in which he last resided before he can be admitted into the 24 MORAL IKFIRMITIES. French army. This measure had its origin in the necessity for preserving the morals of the young conscripts, of whom the army is princi- pally composed, from contamination by associa- tion with men of profligate character. In the act for the enrolment of the national forces, it is wisely provided that no man convicted of a felony shall be permitted to serve in the army ; that is, he is not exemjDted, as others are, by reason of mental or physical disqualifications, but is ignominiously debarred the privilege of serving the country. The conviction of a felony is, therefore, a ground of rejection under the enrolment act. If the fact were known, it would be a cause of rejection in the examination of a recruit for the regular army, but not for discharge from service. Desertion and mark of branding with the letter " D" are properly considered in connec- tion with the subject of moral character. It is the custom in the English service, and sometimes in our own, to brand deserters with the letter "D" under the arms in the axillary region, on the hip, and more rarely on the cheek. A man faithless to one flag will not be true to another; and hence evi- dence of this kind, of a want of principle or MORAL INFIRMITIES. 25 bad moral character, will be a cause for reject- ing a recruit enlisting in the regular service or an already organized volunteer regiment, but will not constitute an exemption from the draft. Under this head should be included obstinate, persistent, and incurable Malingering. The experience of all military surgeons is quite decided as to the disqualifying nature of this vicious habit. There are some simulators so resolute in maintaining their consistency in the character of invalids, so skilled in imitating the signs and symptoms of disease, and so thoroughly intractable, that nothing remains but to discharge them from the service. Ma- lingering is not a ground of exemption from the draft, but is a cause for rejection in the examination of recruits for the army and for an organized volunteer regiment, or in the examination for re-enlistment. No malingerer should be discharged unless all known means of inducing him "to give in" have failed. (See, on this subject, the chapter on feigned diseases.) 26 GENERAL PHYSICAL DISQUALIFICATIONS. CHAPTER III. PHYSICAL INFIRMITIES THAT DISQUALIFY FOR MILITARY DUTY. I. GENERAL DISQUALIFICATIONS. 7. Decided feebleness of constitution, whether natural or ac- quired, 8. Scrofula or constitutional syphilis, which has resisted treat- ment and seriously impaired the general health. 9. Hahitual aud confirmed intemperance and solitary vice, in degree sufficient to have materially enfeebled the constitution. 5. '■■■ '* * Cancer. * » * * These general disqualifications consist of imperfect or arrested development, feebleness of constitution, cachexies, extreme youth or old age, too great or too small stature, and insufficient or excessive weight. These are correlative subjects, which may be considered in their connected relations. Imperfect or arrested develo]3ment and feebleness of con- stitution are usually dependent upon some cachexy; youth and old age, too great and too small stature, and insufficient or excessive weight, either are accompanied by, or produce, feebleness of constitution. It has been the experience of all wars, that GENERAL PHYSICAL DISQUALIFICATIONS. 27 a man whose development is incomplete or arrested, either on account of youth or some inherited cachexy, so far from being useful, is only an encumbrance to an army. " Not only is he incapable of performing the duty re- quired of him, but his frequent attacks of in- disposition demand the services of others in taking care of him."* McLeod,-}" referring to the recruits who joined the army in the Crimea early in 1855, says, "Many of them were raw boys, ill-conditioned, below the standard age, undeveloped in body, uncon- firmed in constitution, and hence without stamina or powers of endurance. Often se- lected on account of their precocious growth, at once launched into the turmoil, unwonted labor, and hardships of a siege in which the strength of full-grown men soon failed, they were quickly used up. * * * ^j^^g ]^qq. pitals became filled with such unpromising patients, whose 'wizened look' of premature age was rernarked by the most casual ob- servers." During the last three years and five months of the Peninsular War — the period when the greatest activity prevailed — the mean strength of the British army amounted to * A Treatise on Hygiene. Hammond, op. cit. •j- Surgery of the Crimean AVar, p. 97. 28 GENERAL PHTSICAL DISQUALIFICATIONS. 61,511 men, and the sick to 13,815, being 22i per cent. There is, perhaps, little doubt that a large portion of the inefficient troops were unfit in consequence of inadequate physical strength more than from actual sickness. The mean ratio of inefficiency from wounds did not exceed IJ per cent.* Feebleness of constitution is one of the most frequent causes of rejection in the French army. The mean annual number of conscripts examined during the years 1831, '3.2, '33, amounted to 126,669, of which number 11,007 were exempted from serving on account of this defect, — nearly 9 per cent.f So great and constantly increasing evil did this become, that the Emperor addressed a letter, in 1855, to the Minister of War, calling his attention to the large number rejected on account of feebleness of constitution, and to the great loss which thereby resulted to the army and to the treasury. "I have had occasion to remark," says the Minister of War, in his instructions concern- ing the draft in 1835, "according to the ac- counts which have been rendered to me by the Inspectors-General, that many of the young \ ^ * Marshall, op. cit. p. 12. t Aide-M6moire, Medico-l§gal, p. 6. GENERAL PHYSICAL DISQUALIFICATIONS. 29 men included in the contingent were returned from the corps a short time after their incor- poration, because they were seized with infirm- ities contracted before they entered the ser- vice. The Councils of Revision will recognize, I hope, of how much importance it is to the treasury and to the army to put a stop to a state of things which has not even escaped the investigation of the Chambers. They cannot show too great a care and scrupulous- ness in the choice of young soldiers. They should, with reference to this, read the 13th article of the law, which says, Those whose in- firmities render them improper subjects for service are exempted. Now, it would be badly interpreting the laAV, it would be vio- lating its text and disregarding its spirit, to send under the garb of men those who bring upon the State useless expense, and who drag a miserable existence from hospital to hos- pital."* These quotations apply not only to im- perfect and arrested development due to tender age or disease, but also to a class, hap- pily not numerous in our country, which en- croaches on the border ground of disease but yet presents no evidence of constitutional 'taint * Aide-M6moire, op. cit. p. 41. 3® 30 GENERAL PHYSICAL DISQUALIFICATIONS. or chronic structural change, — men of seden- tary life and occupation, not positively ailing, but wanting in vigor of constitution and act- ivity of organic functions. These fall easy prey to the accidents and hardships of mili- tary life. When this feebleness of cojistitution is apparent and decided, notwithstanding suit- able age and height, it constitutes a caitse of rejection and exemption from draft. The cachexies which incapacitate for ser- vice include a wide range of constitutional and visceral diseases, — scrofula, cancer, scurvy, con- stitutional syphilis, malarial, lead, and mercu- rial poisoning, and the peculiar physical condi- tion induced by the abuse of ardent spirits. Scrofula, if well marked, accompanied by swelling of lymphatic glands, enlargement of joints, flabby muscles, languid circulation, and dull, lifeless complexion, renders a man unfit for service.* The rule for rejection on the ground of scrofula is not absolute. There are instances — not very numerous, however — of boys who have outlived the early impressions of that cachexy, and have grown up into able- bodied, effective men. Cceieris paribus, the appearance of cicatrices about the neck, or the * Aido-M6moire, op. cit. p. 120. Tripler's Manual, p. 108. Marshall on Enlisting and Discharging Soldiers, p. 121. GENERAL PHYSICAL DISQUALIFICATIONS. 31 evidence of scrofulous diathesis, should cause more thorough investigation, and in all cases of doubt it is better to reject or exempt. Gamier, or the cancerous cachexia, is so pal- palaly a cause of exemption, rejection, and for discharge from the service, that it is only- necessary to allude to it. Scorbutus will almost never be presented to the examining surgeon for rejection or exemp- tion. It may probably come up as a question of discharge from service; but, as it is readily curable by appropriate dietetic and medical treatment, if no permanent organic change has occurred, it is not a sufficient cause. Constitutional syphilis, the secondary and tertiary forms of syphilis, shown by eruptions of the skin and mucous membranes, and affec- tions of bones, muscles, and joints, constitute an absolute exemption from draft, or a cause of rejection; for, notwithstanding some cases are readily amenable to treatment, the consti- tutional infection is almost never cured, and will be surely roused into activity by the ex- posure and unfavorable hygienic conditions to which the soldier is subjected. The effects of the long-continued action of malaria, of mercu- rial or lead poisoning, provided the cachexy be well marked and the constitution thoroughly 32 GENERAL PHYSICAL DISQUALIFICATIONS. involved, will constitute a case for exemption from the draft. The exclusion on this ground for the regular service or for an organized vol- unteer regiment is more rigid. Habitual drimJcenness disqualifies a man for military service, and is a cause for rejection in the examination of a recruit for the regular army or for an organized volunteer regiment, but does not constitute a case for exemption under the enrolment act, unless accompanied by lesions of the digestive apparatus, liver, kidney, or brain. It is not an adequate cause for discharge from service except when so long standing and so habitual as to have induced serious structural changes. Drunkenness is the principal cause of most of the military offences of which soldiers are guilty and for which they are punished, and is the source of many physical disqualifications dis- abling them from duty and rendering a dis- charge from the army ultimately necessary. The examining surgeon should therefore look carefully to this as a disqualifying infirmity. The habitual drunkard is easily enough recog- nized by the obvious signs of that condition : congested watery eyes (ferrety), acne rosacea; loaded, tremulous tongue; tumid belly; im- pairment of the functions of animal life, shown GENERAL PHYSICAL DISQUALIFICATIONS. 33 by the unsteady gait, trembling hands, and atrophy of the muscles of the inferior ex- tremities; disorder of the digestive organs; piles ; and, finally, weakened intellect, limited power of attention, and spasmodic modes of utterance and expression. But there is a state of cachexy or discrasy produced by another vice, still more unfortu- nate than drunkenness, — masturhatioyi. In all of our general hospitals there are numerous instances of men reduced to a most pitiable state of physical weakness and mental imbe- cihty by this vice, — a large proportion of them married men, separated for the first time from their wives. If of long standing, maintained hy inveterate habit and accompanied with maras- miis, loss of memory and power of attention, it constitutes an absolute disqualification for mili- tary service. The external signs of this habit are so well known that it is not necessary to enter into a detailed enumeration of them. The chief marks by which an examining sur- geon may recognize it are, emaciation, mental feebleness, organs of generation small, ill de- veloped, and prepuce elongated. The frequent connection of masturbation with disordered intellect suggests the reflection whether, in- deed, it is not frequently a result rather than 34 GENERAL PHYSICAL DISQUALIFICATIONS, a cause of dementia. As it occurs in the army, however, it is due rather to the depriva- tion of regular and uniform sexual intercourse, to the interrupting an established habit, which nature resents by extraordinary periodical ex- citement of the genital organs. Extreme youth and old age, especially the former, have been adverted to as disqualifying conditions in connection with the subject of feebleness of constitution. Under the volun- tary system large numbers of boys of from four- teen to eighteen years, immature and feeble, have been admitted into the volunteer regi- ments, most of whom at no distant day found their way into the hospitals. The other ex- treme has been as frequently observed, — men of advanced age, many of sixty years and up- wards. The present Regulations of the Army fix the minimum at eighteen years of age and the maximum at thirty-five, exception being made in the case of musicians, who may be un- der the minimum, and soldiers re-enlisting, who may be over the maximum. In the British service the minimum is eighteen years of age ; in the French and Prussian, twenty years; and in the Autsrian, nineteen. The act for enrolling and calling out the national forces wisely fixes the minimum age at. twenty years. GENERAL PHYSICAL DISQUALIFICATIONS. 35 The impolicy of enlisting boys is not only evident during the immediate operations of the war, but in the subsequent life of the nation. In the wars of the First Empire, and in their after-influence upon the French popu- lation, both results were thoroughly shown. More than half of the conscripts drawn for the army for the campaign of 1809 were under twenty years of age. After the battle of Leipsic, Napoleon called upon the Senate to fill up the decimated ranks, to which they interposed some objections. "Shame on you!" cried the Em- peror. "I demand a levy of three hundred thousand men ; but I must have grown men : hoys serve only to fill the hospitals and encxhwher the roadside." The more important after-effects of this enrolment of the youths of the popula- tion were exhibited in the depreciation of the general stamina, height, and physical efficiency of the nation. Between 1816 and 1835, out of 5,818,944 young men called for, 1,076,130 were exempted either because of a defect of stature or diverse infirmities.* All French writers on this subject are quite emphatic in their opposition to a minimum age less than twenty ; and the practice of the French Gov- * Aide-M6moire, op. cit. p. C. a1e»,r.»«'1*-- 36 GENERAL PHYSICAL DISQUALIFICATIONS. ernment is at present in accordance with their opinions. Dr. Fallot* says, "Conscripts at the age of eighteen have not attained their full growth; and medical men are well aware that the complete development of the human body requires an exemption from great fatigue, abundance of healthy nourishment, undis- turbed sleep, and a tranquil mind, — a concur- rence of circumstances which never occurs in the army." Cochef is not less decided in the expression of his opinion "that recruits at eighteen years of age are commonly unfit for the duties of the army, not only in time of war, but even in a period of peace." " It was necessary, at the period of which we speak, to take conscripts at the age of eighteen years. These unfortunate children performed prodigies of valor at Lutzen and Bautzen, but they could not resist the fatigues and priva- tions inseparable from the work of an army. They soon overloaded the hospitals ; and then burst forth that terrible typhus which so cruelly mowed down the ranks of the army ."J * Memorial de I'Expert dans la Visite sanitaire des Hommes de Guerre. f De rOp6ration medicale du Reorutement et des Inspectione genferales. t Aide-M6moire, op. oit. p. 12. GENERAL PHYSICAL DISQUALIFICATIONS. 37 I add to these opinions on this subject the high authority of Surgeon - General Ham- mond :* — " Physiologically, there can be no doubt on the subject. The youth of eighteqii years is immature ; his bones are slender and deficient in the necessary amount of earthy matter to give them the proper hardness ; the epiphyses are not yet incorporated with the shafts of the long bones, and in the ribs are still cartilaginous ; the joints are undeveloped, not having yet expanded sufficiently to give firmness and strength to the limbs ; the mus- cles are soft, and have by no means acquired their full power, as is shown by the investiga- tions of Quetelet and others ; the chest has not attained its full capacity, and the con- tained organs have not yet reached the maxi- mum point of efficiency." The practical result of the loose system which has obtained in filling up the ranks of a company, during the past two years of the re- bellion, is shown in the considerable number of youths in the mihtary hospitals. Three boys, respectively fifteen, sixteen, and seventeen years of age, have been discharged from the Fort Schuyler Hospital by civil authority. The re are now twelve in that hospital from fourteen to * Treatise on Hygiene, op. cit. 38 GENERAL PHYSICAL DISQUALIFICATIONS. eighteen years of age, and ten have been dis- charged for infirmities mainly due to tender age. There can be no doubt as to the positive disquaH- fication of a minimum age less than twenty years. The Regulation of the Army fixing the maximum age at thirty-five is a judicious one ; but forty-five is the maximum established by the enrolment act. Any age greater than forty-five is a positive disqualification for mili- tary service. The number of men admitted into the hospitals, disabled by this cause, is an opprobrium of the recruiting service. It is not unusual to find them more than sixty years of age, toothless, almost sightless, rheumatic, and worn out, — suffering, indeed, from the fail- ure of their mental and physical powers, due to the near termination of life. Besides the actual, there is a premature old age, equally disqualifying, which I have already alluded to in connection with feebleness of constitution. The Regulations of the Ai-my fix the mini- mum stature at five feet three inches. A maximum has not been estabhshed thus far in any country. Indeed, the military authorities have -been most desirous of increasing the sta- ture of their soldiers ; and this spirit reached its culmination in the mania of Frederick for obtaining recruits for his tall battalions. Mon- GENERAL PHYSICAL DISQUALIFICATIONS. 39 strosities in this direction are scarcely more able to perform the duties of soldiers than the highest grade of dwarfs. Since the enrolment act and the recruiting regulations do not limit the stature as to height, the needful restrictions re- main with the examining surgeon ; for a greater stature than six feet three inches is usually accompanied by such obvious deficiencies of structure as to constitute a sufficient cause for rejection or exemption. Great height alone, especially if there is a corresponding develop- ment, cannot be considered a ground of ex- emption. The medium height is the standard by which the physical capacity of men should be judged, as it is the stature best fitted for all the purposes of military life. Very tall men are more or less deficient in energy, and inca- pable of enduring fatigue.* The preponder- ance in height has been obtained at the expense of the development of the chest and of the muscular system. They are easily exhausted, and subject to hernia, to varicocele, to a va- ricose condition of the veins of the inferior ex- tremities, and to intractable varicose ulcers. The rule of practice for the examining surgeon to be deduced from these observations is, to re- ject or exempt very tall men {six feet three inches, * Marshall, Aide-M6moire, op. cit. p. 3. 40 GENERAL PHYSICAL DISQUALIFICATIONS. and ibpwards) loliose cliests are narroio and coiv- traded, whose muscular systems are imperfectly developed, and who hetray a tendency to hernia or to a varicose condition of the veins* Allied to the question of stature is the scarcely less important one of weight. In the perfect man there is a complete correspondence between the weight and stature. All devia- tions in either way are departures from the normal standard, and constitute deformities, which, if excessive, become disqualifications. A greater weight than two hundred and twenty pounds, unless accomj^anied by corresponding height and muscular sufficiency, is a disquali- fication for the military service. Ordinarily, a man weighing more than two hundred and twenty pounds, or less than one hundred and ten, should be exempted or rejected in the ex- amination under the recruiting regulations. Gi'eat obesity constitutes an absolute disqualifi- cation for military service. On this subject Hutchison remarks, " All weight under eleven stone and a half (161 lbs.) does not interfere with the vital capacity, but, on the contrary, it increases with the weight up to this point ; but above this weight, so far as our table goes, * ConsuU on this subject the admirable r&umi in Surgeon- General Hammond's Hygiene, p. 26 et seq. GENERAL PHYSICAL DISQUALIFICATIONS. 41 viz., fourteen stone, the weight interferes with the vital capacity in the relation of rather more than one cubic inch to the pound." In addition to the statistics already given, which illustrate the questions arising in the first part of this chapter, I subjoin some others, derived from the records of the English and United States recruiting service, which show how far the principles advanced have received a practical application. Out of 13,949 town and country recruits examined at the central recruiting station, Dublin, 3032 were rejected for various dis- qualifications, 298 for unsound health, 123 for muscular tenuity, 16 for weakness of in- tellect, and 167 for various cachexies, of which scrofula was the chief. A very admirable series of statistics of the recruiting service in the United States is to be found in the Medical Statistics of the U. S. Army from ^1839 to 1855, compiled and ar- ranged by Assistant Surgeon (now Medical In- spector) R. H. Coolidge. Although the num- bers are not large, the definiteness and certainty of the returns give special value to them. Out of 16,064 examined in the year 1852, 13,338 were rejected for various disqualifica- tions, leaving 2726 only enlisted. In account- 42 SPECIAL PHYSICAL DISQUALIFICATIONS. ing for this result, the character of the material presenting for enlistment in our army in time of peace must be considered. Of this number rejected, 1806 were under size (imperfect or arrested development) ; 732 were too old ; 106 were rejected for moral disabihty, 1965 for intemperance, 630 for unsound constitution (cachexies), and 16 for mental disability. The experience of this rebellion is illustra- ting these questions on a more gigantic scale than any previous war. In a sferies of 10,991 discharges for all causes examined by me at the Adjutant-General's Office, with reference to this question, 860 were discharged for feeble- ness of constitution, scrofula and syphilis, — the former, whether due to age or disease, greatly preponderating over the two latter. II. Special Disqualifications. In entering upon the subject of the special disqualiucations for military service, it is necessary to premise that many of the diseases and injuries enumerated, for which men may claim exemption under the enrolment act, are also those which substitutes may dissimulate to be accepted, or which soldiers may feign, produce, aggravate, or exaggerate to procure a SPECIAL PHYSICAL DISQUALIFICATIONS. 43 discharge from the service. The chapter on feigned diseases contains an account, more or less complete, of that class of disabilities and the methods of detecting them : here I pro- pose to consider the physical disqualifications for military duty, without reference to the question of their reality. It is a principle from which it is neither just nor expedient to depart, that no man should be accepted or drafted who may be made eflScient by the performance of any consider- able operation, or by a long course of medical or surgical treatment. This principle is espe- cially applicable to our service, the enrolment being for the maximum period of three years. An important surgical operation may not only endanger a man's life, but during the course of the subsequent treatment he will prove a source of expense to the government, without any compensating advantage. A man enlisted or drafted should have the health and stamina for immediate service, without reference to some future time when he may become efficient. The surgeon, in examining recruits, drafted men, and especially substitutes, should bring all his mental acumen, habits of observation, and knowledge of diseases to the investigation. It will be far safer to assume the attempt at 44 SPECIAL PHYSICAL DISQUALIFICATIONS. deception in every case than to permit a genial view of human nature to modify the necessary severity of his judgment. His suspicions, confined to himself, should not interfere with the kindness of his manner, his patience, or the thorough performance of his duty. For the more convenient treatment of the special disqualifications for military service, I propose to arrange them in eight classes, — viz. : 1. Organs of special sense, and accessory ajp-pa- atus. 2. Head and spinal column, and cerebro-spinal nervous system. 3. Neck and contained organs 4. Chest and thoracic organs. 5. Abdomen and digestive apparatus. 6. Geni to-urinary apparatus. 7. Upper and lower extremities. 8. Skin and appendages. A different arrangement is followed in the latest French authority on this subject.* Vices of conformation, maladies or infirmities which unfit for the military service, are enumerated in Tableau No. 4 des Comptes rendiis du RecriJb- tement, — the nomenclature of which is founded * Didiot, op. oit. p. 462 et seq. SPECIAL PHYSICAL DISQUALIFICATIONS. 45 upon the ministerial instructions of the 14th of June, 1862. The disqualifications for mili- tary service are included in three great divi- sions, — 1st,. General maladies; 2d, Maladies of the tissues; and 3d, Maladies of regions, — all of which are subdivided into classes. The first division corresponds to the general dis- qualifications already discussed in this work ; but mental infirmities are included in class second of the affections of regions ; whilst the affections of tissues, contained in a separate class, are here treated of in connection with the locality in which they occur. Without expressing an opinion as to the com- parative merits of the two systems, of classifi- cation, it will suffice to say that the system followed in this work has the sanction of long usage in our service, and is, therefore, more con- venient to the purpose in view. 46 SPECIAL PHYSICAL DISQUALIFICATIONS. FIEST CLASS. ORGANS OP SPECIAL SENSE AND ACCESSORY APPA' EATUS. A. Affections of the Auditory Apparatus. 16. Complete deafness, ^ * purulent otoirlioea. Deafness, if real, constitutes a ground of exemption from the draft, and is a cause for rejection or discharge. A distinction must be made between deafness the result of disease of auditory nervous apparatus and the labyrinth, which is permanent and incurable, and a tem- porary and partial deafness from accumulation of cerumen, acute inflammation of the tonsils, and the affection of the throat not uncommon in habitual smokers (follicular pharyngitis). The latter is not a sufficient cause for exemp- tion unless associated with well-marked stru- mous diathesis. A modified degree of deafness, sequela of the exanthematoe due to thickening of the membrana tympani or closure of the Eustachian tube, but unaccompanied by any cachexia or of the evidence of ill health, should not be considered a reason for exemption under SPECIAL PHYSICAL DISQUALIFICATIONS. 47 the enrolment act, but is a cause for rejection under the recruiting regulations. Malignant disease, caries of tympanum, mas- toid cells, or labyrinth, inveterate chrotxic purulent otorrlioea, strumous or syphilitic, are absolute causes for exemption, rejection, and discharge. Otorrhoea dependent upon simple acute in- flammation should not be considered a ground for exemption or discharge.* Perforated memhrana tympani, if considerable in extent and greatly impairing hearing, is a positive disqualification ; but a slight perfora- tion is not incompatible with a sufficient use of the organ. Imperforate auditory canal, obliterate auditory canal, produced by a tumor, polypus, or syphi- litic vegetations, positively disqualify ; but a temporary closure due to acute abscess, not connected with caries or necrosis, and closure from the tumefaction of acute inflammation of the meatus, are not causes for exemption, re- jection, or discharge. Malformations, loss or defect of the external ear, sufficient in degree to seriously impair the hearing, are disqualifications for the military service. The most frequent malformation is an imperfect development of the meatus and * Aide-BI^moire, op. cit. p. 51. 48 SPECIAL PHYSICAL DISQUALIFICATIONS. auricle, the former being reduced to a narrow slit in the temporal bone, and the latter exist- ing only as a slight fold of the integument. The labyrinth in these cases is most frequently normal, and a certain amount of hearing is present : often it is so considerable as to enable the man to perform useful duties.* In the case of the latter the malformation would not constitute a cause for exemption or discharge, but would be sufficient for rejection in recruit- ing for the regular army or an organized vol- unteer regiment. Loss of external ear by violence, or sentence of a court, in so far as it is evidence of bad character, would be a ground for rejection under the recruiting regulations, but would not constitute a case for exemption or dis- charge. B. Affectiofs of the Eye and its Appendages. 13. Total loss of sight ; loss of sight of right eye ; cataract ; loss of crystalline lens of right eye. 14. Other serious diseases of the eye affecting its integrity and use ; e.g. chronic ophtl/almia, fistula lachrymalis, ptosis (if real), ectropion, entropion, &c. Myopia, unless very decided or depending upon some structural change in the eye, is not a cause for exemp- tion. * Article on Diseases of the Ear, by Ilinton, in Holmes's Sys- tem of Surgery. See also Toynbee, Diseases of the Ear. SPECIAL PHYSICAL DISQUALIFICATIONS. 49 "Ophthalmia, unless chronic, does not consti- tute a cause for exemption from the military service."* Purulent and gonorrhoeal ophthalmia, actively contagious and destructive in their effects, are absolute disqualifications. Chronic ophthalmia, complicated with either inversion or eversion of the lids, ulcers or per- forations of the cornea, staphyloma or purulent discharge, is a cause for exemption or rejec- tion, but not always for discharge. Pterygion, pinguecula, are benign growths not sufficient to disqualify for military service, unless in the exceedingly rare event of exten- sion across the area of the pupil. Encanthis, when malignant, is a disqualifica- tion. Conical cornea is an absolute disqualifi- cation. Opacities of the cornea, njehula, al- hugo, and leucoma, if upon the right eye, preventing useful vision, demand exemption from draft, or are causes for rejection or dis- charge; but not, if upon the left. Congenital defects of the iris of right eye sufficient to render vision uncertain; rheumatic or syphilitic iritis, adhesions of iris to the cap- side of the lens; staphyloma scleroiicce; cata- 7-act; loss of lens of right eye; glaucoma; loss * Aide-M6moire, op. cit. p. 50. 5 50 SPECIAL PHYSICAL DISQUALIFICATIONS. of an eye or the use of an eye, provided it be the right; hlindness roduced hy disease; salivary fistula; chronic enlarge- ment of the tonsils sufficient to interfere with deglutition or phonation, and hucco-nasal fis- tula. • SPECIAL PHYSICAL DISQUALIFICATIONS. 57 Loss, or impairment of, the distinctness, of the voice may be due to affections of the tonsils, uvula, or palate ; but aphonia, without evident affection of the health or disease of the larynx, is to be looked upon with sus- picion. Allied to these by contiguity of tissue, yet scarcely coming within the subjects included in affections of the gustatory apparatus, are — Great deformities of the face, and loss of sub- stance of the cheeTcs. These are causes for rejection under the recruiting regulations, but will not constitute grounds of exemption under the enrolment act, unless producing some impairment of function. 58 SPECUIi PHYSICAL DISQUALIFICATIONS. SECOND CLASS. HEAD AND SPINAL COLUMN. 13. Great injuries or diseases of the skull, occasioning impair- ment of the intellectual faculties, epilepsy, or other manifest ner- vous or spasmodic symptoms. 35. Excessive anterior or posterior curvature of the spine ; caries of the spine. Affections of tlie scalp will be treated of in Class 8, with the affections of the skin and ap- pendages. -Imperfect ossification of the hones of the cra- nium, recognizable hy the persistence of the fronto- parietal fontanelles, and sometimes separation and mobility of the sutures; Monstrosity in the volume of the head, and conr- siderable deformities resulting from fractures ; Serious lesions of the shull, derived from com- plicated waimds, considerable fractures, and the operation of trephining ; caries and exfoliations involving the whole thickness of the bone; and Fungous tumors of the dura tnater (Aide-M6- moire). Whilst a small blow on the head may be fol- lowed by serious results — exfoliation and ne- crosis — considerable loss of bone is not incom- SPECIAL PHYSICAL DISQUALIFICATIONS. 59 patible with complete restoration to health. Injuries of the cranium are so liable to pro- duce derangement of the faculties, apoplexy, and other nervous disorders, that they are usu- ally causes for rejection and exemption. As remarked by Marshall,* injuries of this kind are frequently succeeded by alleged dis- abilities of mind or body ; and it is often diffi- cult to decide whether these consequences are real or feigned. All cicatrices of the scalp should be carefully examined ; but a wound of the scalp, denuding the skull and causing ex- foliation of the outer table, is not a ground for exemption if the injury occurred at a date long anterior and was not followed by brain- complication. Complete recovery, after even a considerable or entire removal of the scalp, is a circumstance not unfrequently observed by medical officers of the army on the fron- tier. Syphilitic caries or necrosis of cranium is an absolute disqualification for military service. Injury of any of the cranial nerves, affecting their functions, is also usually a cause for re- jection or exemption. Caries of the spine ; spina bifida ; curvature of the cervical, dorsal, or lumbar region; lumbar * Marshall, op. cit. p. 21. 60 SPECIAL PHYSICAL DISQUALIFICATIONS. abscess. All of these, which are absolute dis- qualifications for military duty, are dependent upon some constitutional vice or cachexy, scro- fula or syphilis. Rickets, which also demands exemption or rejection, is not an affection of the spinal column alone, but frequently involves the bones of the extremities. In much the greater number of cases it is a disease of early life ; sometimes it is observed in adult life : in the former case, complicated with hydroce-^ phalus ; in the latter, very rarely. Angular deformity, which includes gibhositij (gibbosite) of the anterior and posterior part of the thorax, is, usually, a disqualification. Gibbosity unconnected with spinal disease is not a disqualification for exemption unless the deformity is sufficient to prevent the carrying of the knapsack or to interfere with the proper play of the thoracic organs ; but it is a cause for' rejection under the recruiting regulations. Shoulders of unequal height, and greater promi- nence and development of the right, — some- times congenital, and frequently due to occu- pation, — have no connection with spinal disease. The question of exemption or i-ejection turns upon the degree in which such a deformity is present, and whether sufficient to incapacitate a man for service. Fractures and dislocatiotis SPECIAL PHYSICAL DISQUALIFICATIONS. 61 of the spine, it is scarcely necessary to remark, positively disqualify for military duty. Certain diseases of the cerebro-spinal nervous system belong to this class, epilepsy, chorea, paralysis agitans, hemiplegia, paraplegia, ixira- lysis of any part of the body, all of which are adequate causes for exemption, rejection, or discharge from the service. I refer the reader to the chapter on Feigned Diseases for inform- ation as to the means of detecting the simu- lated diseases of this class. Neuralgia, if genuine, is an undoubted dis- qualification for military duty, but is so fre- quently and easily simulated that it should be looked upon with suspicion by the examin- ing surgeon, and thorough search made for all possible sources of the disease. Dr. Brown- S^quard* includes in the various causes which give origin to neuralgia, carious teeth, tumors pressing on a nerve, neuroma, incised and punctured wounds, injury of nerve, reflex ac- tion, &c. * Article on Diseases of the Nerves, in Holmes's System of Burgery, p. 876, vol. iii. 6 62 SPECIAL PHTSICAL DISQUALIFICATIONS. THIRD CLASS. NECK AND CONTAINED ORGANS. 18. » » * Permanent loss of voice. » » » 24, Tumors of neck, impeding respiration and deglutition ; fis- tula of larynx or trachea ; torticollis, if of long standing and well marked. Gliranic laryngitis, indwation and schirrus of epiglottis; polypus of the larynx, aphonia due to either of these causes, are all positive disqualifications for military duty. Aplwnia may be produced also by pressure upon or division of the recurrent laryngeal nerves, and is sometimes a sequel of diphtheritis or acute laryngitis, but, as a condition easily simulated, should not be accepted as real with out careful investigation. Dysphagia, if due to stricture of oesophagus or pressure from tumors or schirrus, is an un- doubted cause for rejection. Goitre, if large enough to interfere with respiration, to prevent the buttoning of the shirt or the collar of the coat, or osseous de- generation of the thyroid gland, disqualify. i A small permanent goitre not subject to peri- : odical enlargement is not a cause of rejection SPECIAL PHYSICAL DISQUALIFICATIONS. 63 or exemption, unless it may be made use of to avoid duty and to obtain admission into the hospital. Engorgement, scrofulous enlargement and ulceration or abscess of the lymphatic glands, due to constitutional cachexy, are absolute disqualifications for military service. Cicatrices from old abscesses, burns or scalds producing deformity, retraction of Jaw and oigidity, are causes of rejection, exemption, or discharge. Fistulous openings into larynx or trachea, re- sulting from surgical operatio^w or attempts at suicide, are grounds of exemption. Wry nech, permanent in character, due either to chronic rheumatism, disease of cervical spine, or contraction of cicatrices, is a positive disqualification ; but this state of the muscles must not be confounded with a temporary torti- collis, produced by exposure to cold or lying asleep in a constrained attitude. 64 SPECIAL PHYSICAL DISQUALIFKiATIONS. FOURTH CLASS. CHEST AND THORACIC ORGANS. 25. Deformities of the chest sufficient to impede respiration or to prevent the carrying of arms and military equipments ; caries of the ribs. 26. Deficient amplitude and power of expansion of chest. A man should not measure less than thirty inches in circumference im- mediately above the nipples, and should have an expansive mobility of not less than two inches. Malformation of chest, or hadly united fracture of ribs or sternum, sufficient to interfere with, respiration, caries or necrosis of ribs, defi- ciency in extent of expansive mobility, greatly diminished vital capacity, evident predispositioii to phthisis, phthisis pulmonalis, chronic pneu- morCia, chronic pleurisy aitd emphysema, chronic bronchitis and asthma, are all disqualifying infirmities. A man of the minimum height of the pre- sent army regulations — five feet three inches — should measure in circumference of the thorax not less than thirty inches, should have an expansive mobility of not less than ; two inches, and, as there is a correspondence I between the height and weight of a healthy SPECIAL PHYSICAL DISQUALIFICATIONS. 65 man, should not weigh less than one hundred and ten pounds. All men under this standard come within the definition of imperfect physi- cal development or predisposition to phthisis. Very tall, as well as very small, men are fre- quently deficient in respect to capacity of thorax. It is not only necessary that the chest should be ample, but that there should be no disproportion of its parts : an abnormal depression or bulging usually indicates serious organic mischief. This rule is not invariable, however ; for some occupations tend to increase the development of one side out of proportion to, and sometimes at the expense of, the other. It is of the utmost importance to recognize, in the examination of recruits or drafted men, any defect in the capacity, or any disease of the thorax. A man with ill-developed chest and diminished power of expansive mobility will very certainly, if admitted into the army, soon become an inmate of the hospitals. Oc- cupation, which has much to do with the development of tubercle, should not fail to be considered in connection with the question of admission or rejection. Moist or dry rales, without dulness on per- cussion or increased vocal resonance, indicate bronchitis, with or without fluid in the bronchi.^ 6* i 66 SPECIAL PHYSICAL DISQUALIFICATIONS. Dry rales, accompanying prolonged expirar tion, with unusual resonance on percussion, indicate emphysema. Harshness of the inspi- ratory murmur, prolonged expiration, and in- creased vocal resonance confined to the apex of the lung, indicate advanced phthisis or pneumonia. The latter lesion, commencing at or confined to the apex, is rare ; and hence these signs are diagnostic of phthisis. Circumscribed bronchophony or pectoriloquy, •with cavernous dry or moist rales, indicates a cavity. This may be dependent upon tuber- cular ulceration, a gangrenous abscess, or a bronchial dilatation. The first is generally at the apex, and the two last about the centre, of the lung. Total absenfce of respiration indicates a col- lection of fluid or air in the pleural cavity. In the former case there is diffused dulness, and in the latter diffused resonance, on percussion. Marked permanent dulness, with increased vocal resonance, and diminution or absence of respiration, may depend on chronic pleurisy, or thoracic aneurism, or on a cancerous tumor of the lung. The diagnosis between these lesions must be determined by a careful consideration of the concomitant signs and symptoms.* * Bennett's CliniQal Medicine, p. 592. SPECIAL PHYSICAL DISQUALIFICATIONS. 67 Organic disease of the heart and large arte- 'o-ies, hypertrophy, valvular insufficiency and aneurism, serious and protracted functional de- rangement, and dropsy, dependent upon disease of the heart, are absolute causes for rejection: or exemption. Disease of the heart being frequently pretended, it is of great moment to be able to diagnose the various diseased con- ditions with some certainty. Excited and even tumultuous action of the heart is not to be accepted as conclusive on the subject ; for almost all recruits, especially young men, will present this perturbed action of the heart when stripped for examination, although there may be no other evidence whatever, of disease. It must be remembered, also, that disease of the heart, not traceable to acute rheumatism, to violent gymnastic sports, or long-continued powerful muscular exertion, as in the case of acrobats, stevedores, porters, and others, or to some constitutional vice, as fatty degeneration, or constitutional syphilis, is extremely rare. A friction murmur synchronous with the heart's movements indicates pericardial or exo- pericardial exudation. A bellows murmur with the first sound, heard loudest over the apex, indicates mitral insufficiency. 68 SPECIAL PHYSICAL DISQUALIFICATIONS. A bellows murmur with the second sound, heard loudest at the base, indicates aortic in- sufficiency. A murmur with the second sound, loudest at the apex, is very rare ; but when present it indicates — 1st, aortic disease, the njurmur being propagated downwards to the apex ; or, 2d, roughened auricular surface of the mitral valves; or, 3d, mitral obstruction, where the murmur is double, or occupies the period of both cardiac sounds. A murmur with the first sound, loudest at the base, and propagated in the direction of the large arteries, is more common. It may depend — 1st, on an altered condition of the blood, as in anaemia; or, 2d, on dilatation or disease of the aorta itself; or, 3d, on stricture of the aortic orifice or disease of the aortic valves, — in which case there is almost always insufficiency also, and then the murmur is double, or occupies the period of both sounds. Hypertrophy of the heart may exist inde- pendently of valvular disease ; but this is very rare. In the vast majority of cases it is the left ventricle which is affected, and in. con- nection with mitral or aortic disease.* Functional derangements of the heart are * Bennett's Clinical Medicine, op. cit. p. 512. SPECIAL THYSICAL DISQUALIFICATIONS. 69 usually dependent upon some gastric or intes- tinal disease, upon the use of some stimulants, as tobacco, alcoholic beverages, or upon the practice di" masturbation. The question of exemption, rejection, or discharge will rather turn upon the extent to which the disease — of which the functional disorder of the heart is merely a symptom — impairs the man's efficiency or fitness for the military service. 70 SPECIAL PHYSICAL DISQUALIFICATIONS. FIFTH CLASS- ABDOMEN AND DIGESTIVE APPARATUS. 27. Abdomen grossly protuberant; excessive obesity; hernia, either inguinal or femoral. 28. Artificial anus ; stricture of the rectum ; prolapsus ani. Fistula in ano is not a positive disciualification, but may be so if extensive or complicated with visceral disease. 29. Old and ulcerated internal hemorrhoids, if in degree suffi- cient to impair the man's efficiency. External hemorrhoids are no cause for exemption. Chronic gastritis, chronic gastro-enteritis, chronic disease of liver or spleen, engorgement or tubercular infiltration of mesentery (marasmus) , chronic diarrhoea, chronic dysentery, tcenia, chronic peritonitis, with or without effusion, ascites, and obesity, are all causes for rejection or exemption, but not always for discharge. The extent, duration, and intractability of the diseases are questions influencing the decision in respect to discharge. Chronic diarrhoea and dysentery of long standing are so difficult of cure, and the mucous membrane so readily takes on diseased action after an apparent cure when the man is exposed again to the producing causes, that there can be no question as to the disabling nature of these two affections. Dyspepsia may be considered a disqualifying SPECIAL PHYSICAL DISQUALIFICATIONS. 71 disease when of long standing, accompanied by general emaciation, vomiting, or regurgitation after meals, obstinate constipation, and hypo- chondria. Hemorrhoids are disqualifying if large, in- ternal, bleeding, ulcerated, and painful; but external hemorrhoids are neither a cause for rejection, exemption, nor discharge. Malformation or stricture of the rectum, pro- lapsus ani, fistula in ano, and considerable fis- sures of the anus, are absolute disqualifications for military duty. Hernia in all situations is a ground for re- jection or exemption, but not invariably for discharge if an incipient inguinal hernia, or an ordinary reducible hernia without complication which may be retained in position by a well- fitting truss. A tendency to hernia or relaxed abdominal rings may be a cause for rejection under the recruiting regulations, but is not a sufiicient cause for exemption under the act for enrolling the national forces ; and certainly it is not a cause for discharge. Extensive cicatrices from incised wounds, with weakness of abdominal wall and tendency to hernial protrusion, constitute- a disqualification for military service. 72 SPECIAL PHYSICAL DISQUALIFICATIOKS SIXTH CLASS. GENITO-URINARY APPARATUS. 30. Total loss or nearly total loss of ponls ; epispadia or hypo- spadia at the middle or nearer the root of the penis. 31. Incurable permanent organic stricture of the urethra, in which the urine is passed drop by drop, or which is complicated by disease of the bladder ; urinary fistula. Kecent or spasmodic stric- ture of the urethra does not exempt. 33. Loss or complete atrophy of both testicles from any cause ; permanent retention of one or both testicles within the inguinal canal ; but voluntary retraction does not exempt. 34. Confirmed or malignant sarcocele ; hydrocele, if complicated with organic disease of the testicle. Varicocele and cirsocele are not in themselves disqualifying. Loss of tlie penis, absence of hath testicles from any cause, permanent retraction of one or hoth testicles vntTiin the external ring, are causes for exemption, rejection, and discharge. The power of voluntary retraction should not be mistaken for retention of the testicle in the ring. ,The term " absence of the testicle," in this connection, is meant to apply to the loss of them by accident or disease, and must not be confounded with non-appearance in the scrotum. The evidences of virility will establish the fact that their absence from the scrotum is due to . SPECIAL PHYSICAL DISQUALIFICATIONS. 73 not having descended. The retraction of the testicle is a cause for rejection because of the serious accidents to which the organ is exposed in its new position. Malignant disease, scrofulous or syphilitic sarcocele, hydrocele if large, and atrophy of testicles, are absolute disqualifications for mili- tary service. Varicocele and cirsocele, unless large enough to impede walking and to occasion a painful sense of weight and dragging, are not grounds of exemption, rejection, or discharge. Ordi- narily, as the disease is almost universally confined to the left side, and produces no more serious result than atrophy of the correspond- ing testicle, it should not be considered a dis- qualification for military duty under the enrol- ment act. At the same time, it should be remembered that serious hypochondria has been induced by the loss of virile power due to varicocele. Epispadias and hypospadias, when not far- ther from the root of the penis than its middle, urinary fistula, and permanent stricture are absolute disqualifications for military service. Incontinence of urine, and hoematnria, as dis- tinct affections, unconnected with any disease, are so frequently feigned and so uncommon 74 SPECIAL PHYSICAL DISQUALIFICATIONS. that they may be thrown out of consideration as disqualifications. Discharge of urine hy the umbilicus, eversion of the hladder and loss of substance of the hypo- gastric region, and hermaphroditism, are causes for rejection and exemption. Spermatorrhoea, whether due to masturba- tion, to an ill-cured gonorrhoea, or diseases of seminal vesicles, if so long continued as to have impaired the general health, is a disquali- fication. Chronic enlargement of the prostate, if suffi- cient to interrupt the passage of the urine and fgeces, is a cause for rejection or exemption. Stone in tlis bladder, chronic cystitis of long standing, closure of ureter by a calculus, abscess of the kidney, fatty degeneration of the Iddney (albuminuria), renal dropsy, and diabetes are all absolute disqualifications for military ser- vice. SPECIAL PHYSICA.L DISQUALIFICATIONS. 75 SEVENTH CLASS. UPPER AND LOWER EXTREMITIES. 36. Loss of an arm, forearm, hand, thigh, leg, or foot. 37. Wounds, fractures, tumors, atrophy of a limb, or chronic dis- eases of the joints or bones, that would impede marching or pre- vent continuous muscular exertion, 38. Anchylosis or irreducitile dislocation of the shoulder, elbow, wrist, hip, knee, or ankle joint. 39. Muscular or cutaneous contractions from wounds or burns, in degree sufficient to prevent useful motion of a limb. 40. Total loss of a thumb ; loss of ungual phalanx of right thumb. 41. Total loss of any two fingers of same hand. 42. Total loss of index finger of right hand. 43. Loss of the first and second phalanges of the fingers of right hand. 44. Permanent extension or permanent contraction of any finger except the little finger ; all the fingers adherent or united. 45. Total loss of either great toe; loss of any three toes on the same foot; all the toes joined together. 46. The great toe crossing the other toes, with great prominence of the articulation of the metatarsal bone and first phalanx of the great toe. 47. Over-riding or superposition of all the toes. 48. Permanent retraction of the last phalanx of one of the toes, so that the free border of the nail bears upon the ground ; or flexion at a right angle of the first phalanx of a toe upon a second, with anchylosis of this articulation. 49. Club feet, splay feet, where the arch is so far effaced that the tuberosity of the scaphoid bone touches the ground and the line of station runs along the whole internal border of the foot, with great prominence of the inner ankle; but ordinary, large, ill- shaped or flat feet do not exempt. 50. Varicose veins of inferior extremities, if large and nume- rous, having clusters of knots, and accompanied with chronic swellings or ulcerations. 76 SPECIAL PHYSICAL DISQUALIFICATIONS. 51. Chronic ulcers; extensive, deep, and adherent cicatrices of lower extremities. Disqualifications affecting the extremities are either common to both upper and lower or proper to one or to the other. A. Disqualifications common to both Upper AND Lower Extremities. Chronic rheumatism, with swelling of the joints, enlargement of the surrounding tissues, earthy deposits, contraction of tlie tendons, and wasting and loss of motion. Chronic disease of the joints, due to injury or constitutional disease, as scrofula, rheuma- tism, gout, syphilis, &c. Old or irreducihle dislocations, or false joints. Severe sprains, with or without displacement of the bones, followed by permanent deposit about the joint and impairment of mobiUty. Relaxation of the capsular or other ligaments of a joint, with abnormal mobility and volun- tary or involuntary luxation of the bones. Complete or partial anchylosis of an im- portant articulation. Sinuses communicating with the osseous cavi- ties, the articulations, and with the thickness of spongy hones. SPECIAL PHYSICAL DISQUALIFICATIONS. 77 Hydropsy of the articulations. Badly united fractures, suflficient to impede the proper motions of the limb, or otherwise to interfere with the performance of military duty. Defective or excessive curvature of the lo7ig hones, richets, caries, necrosis, exostosis. Atrophy of a limb ; paralysis of a limh. Extensive deep and adiierent cicatrices ; aneu- , risms. Contraction or permanent retraction of a limh or of a portion of a limh. Loss of a limh or of an essential part of a limh, all of which require exemption, rejec- tion, or discharge. B. DiSQUALIFICATIOKS PROPER TO UpPER EX- TREMITIES. Extraordinary size of the hands, proceeding from a natural lymphatic engorgement or a general varicose state of the venous capilla- ries, or from habitually ulcerated chilblains^ Fingers adherent or united, supernumierary, double, or branched ; permanent flexion or ex- tension of one or more fingers, except the little finger, and irremediable loss of motion of these parts. 7» 78 SPECIAL PHYSICAL DISQUALIFICATIONS. Loss of the first phalanx of the thumb of the right hand. Total loss of either thumh. Total or partial loss of the index finger of the o'ight hand. Loss of tlie first and second jphalanges of the fingers of the right liand. Total loss of any two fingers of same hand. Mutilation of the last phalanges of the fingers of either hand. Partial loss of index :^nger of right hand, although a ground of exemption or rejection, if it consist of l^ss of more than the last phalanx, is not a sufficient disability to jus- tify discharge; for a trained soldier will not thereby be much embarrassed in handling his piece. C- Disqualifications proper to Inferior Ex- tremities. Varicose veins, voluminous and multiplied, render a man unfit for military duty. If the varices are small, not numerous nor accom- ' panied by marks of ulceration, oedema or thickening of the integument, they are not disqualifying. If the deep-seated veins are involved, the varices ancient and voluminous, SPECIAL PHYSICAL DISQUALIFICATIONS. 79 and tlie man have long, thin, ill-developed legs, the disqualification is undoubted. Chronic ulcers. — In the French service, ulcers of the inferior extremities are not held to be causes of exemption, except in the follow- ing cases : those accompanied by great loss of substance, those with atrophy of the limb, those in which the general constitution is profoundly altered, those complicated with varicose veins.* There can be no doubt of the propriety of exemption, rejection, or discharge in either of these cases; but the exclusion is not sufficiently rigid for our service. All ulcers of the lower extremities of several months' duration, whether dependent upon some constitutional vice, upon plethora or de- fective assimilation, not promptly curable, and which would be increased by the use of the limb, should be considered a cause for exemp- tion or rejection, but not always for discharge from the service. These rules do not apply, of course, to factitious ulcers. Extensive adherent cicatrices, dark-colored and accompanied by evidences of former ulcera- tion, by evident marks of cachexy, by vari- cose veins, or produced by considerable incised * Aide-M6moire, op. oit. p. 106. 80 SPECIAL PHYSICAL DISQUALIFICATIONS. wounds penetrating to and involving import- ant muscles. Lameness, unless produced by obvious de- formity, unequal length, of the limbs, short- ening of femur by fracture, by disease of hip, knee or ankle joint, or affections of muscles, is not a ground of exemption or dis- charge. Fracture is not necessarily a cause for exemption ; but it is frequently made use of by a reluctant soldier to evade duty, and in this respect is an important subject. That degree of shortening of the limb which will disable a man from the performance of mili- tary duty is not easily determined ; but there can be no doubt that shortening of one inch and a half need not occasion an obvious halt- ing or imperfection of gait. An accidental fracture well united, occurring in a man in good health in whom there is no unusual fragility of bones, is neither a ground of ex- emption, rejection, or discharge. The cambering of one or hoth knees, carried to excess (knock knees, in-knees). This must be very decided, and accompanied by some other deficiencies of structure, to constitute a disability for exemption. Gluh feet and splay feet are always positive disqualifications. The splay foot, to constitute SPECIAL PHYSICAL DISQUALIFICATIONS. 81 a disqualification, consists of inclination in- wards of the internal malleolus, — arch being effaced, the tuberosity of the scaphoid bone touching the ground, and the internal border of the foot being in a line with the base of the heel and first metatarsal bone, the ligaments weakened, and the power deficient, because the axis of the leg does not fall upon the centre of the foot. This condition should not be con- founded with broad, flat, ugly feet, peculiar to some races and nations of the continent, in whom this conformation is not a disabling infirmity. The toes joined together, dovhle or hranching. That deformity in which tlie great toe crosses the other toes, and in which there is great promi- nence of the articulation of the great toe and first metatarsal hone. Over-riding and superposition of all the toes. Loss of a great toe ; loss of three toes of the same foot. Mutilation of the last phalanges of tlte toes of either foot. The retraction or inflexion of all the toes of the same foot or of two toes. The permanent retraction of tJie last phalanx of a toe in which the free border of the nail hears upon the ground, or flexion at a o'ight angle of 82 SPECIAL PHYSICAL DISQUALIFICATIONS. the second phalanx of the second toe upon the first, with anchylosis of the articulation. There can be no doubt of the disqualifying nature of all the above disabilities. Upon the soundness and efl&ciency of the lower extremi- ties depend, in great degree, the capacity of the soldier; and the examining surgeon, hence, should Jook carefully to the development and symmetry of the thighs, legs, and feet, — not the symmetry of the painter and sculptor merely, but the symmetry which delights the eye of the military surgeon, consisting of large joints, prominent bones, swelling muscles, and rough, elastic integuments. As is well said by that philosophical observer Dr. Jackson,* the graceful shape and form of perfect symmetry are seldom connected with power, activity^ and that inexplicable fund of endurance which supports toils and fatigues with constancy and firmness. The fetid sweat of the feet is sometimes a cause for rejection, if excessively offensive; but the question of rejection turns more frequently upon the condition of the integument which gives rise to it. Chilblains, old and ulcerated, and chronic engorgement and hypertrophy of * Formation, Discipline and Economy of Armies, op. cit. p. 22. SPECIAL PHYSICAL DISQUALIFICATIONS. 83 the sweat-glands, are usually tJie causes of the bad odor of some feet. This odor is less ob- jectionable in the military view than the soft- ness of the integument and the tendency to unpleasant and intractable ulcerations, parti- cularly exhibited on the march. 84 SPECIAL PHYSICAL DISQUALIFICATIONS. EIGHTH CLASS. SEJN AND APPENDAGES. 6. Inveterate and extensive disease of the skin, whioli will neces- sarily impair his efficiency as a soldier. It may be expressed in general terms that all cIiTonic and incurable or contagious shin- diseases, except scabies, are causes for rejection, exemption, and discharge. Diseases admitting such latitude of exemption, and ofttimes so difficult to assign to appropriate classes, require more than this summary statement of the ex- tent to which they may be regarded as dis- qualifications. Ghronic eczema; herpes circinnatus which is communicable;* herpes capitis when chronic; chronic pemphigus ; scabies, when of long stand- ing and herpetic in character, all of which belong to the class vesiculce, are positive dis- qualifications for mihtary service. To this list may be added the squatnce, — lepra, psori- asis, pityriasis, and ichthyosis. Lupus serpiginosus a7id lupus devorans, and >cheloid tumors, are causes of exemption and re- * Neligan, Diseases of the Skin, p. 89. SPECIAL PHYSICAL DISQUALIFICATIONS. 85 jection; but the latter is not usually a cause for discharge. Of the dermatophytce, porrigo (favus; tinea; scald-head), sycosis, are absolute causes of re- jection and exemption. All the Syphilides are positive disqualifications. Alo])ecia, whether due to any of the diseases mentioned in this class or to hereditary tend- ency, if extensive, or if the loss of hair be total, preventing a man wearing a military cap and exposing him to accidents from atmospheric vicissitudes or exposure to the sun's rays, is a reason for exemption, rejec- tion, or discharge ; but the temporary alopecia produced by an attack of acute disease is not a disquaUfying infirmity. To these diseases of the skin may be added certain congenital" deformities which authorize rejection, as ncevi, large, livid; hairy, and U7i- sightly spots when they occur on the face and render the man hideous and disgusting to his comrades; but these can scarcely be consi- dered causes for exemption under the enrol- ment act. 8 SECTIOIT II. PRETENDED DISQUALIFICATIONS FOR MILI- TARY SERVICE. CHAPTER I. GENERAL CONSIDERATIONS. The term "feigned disease," as employed throughout this treatise, is used in its general signification. Technically, there are distinc- tions, as will be shown further on, between feigned diseases proper, and the other forms of imposture included in this general term. As the voluntary system of raising a mili- tary force, previous to the passage of the act for enrolling and calling out the national forces, was alone employed, the attention of examining surgeons was directed to discover dissimulated or concealed diseases, rather than simulated or feigned. Early in the war, in 86 GENERAL CONSIDERATIONS. 87 the general enthusiasm awakened in support of the government, large numbers of men en- tered the ranks with concealed infirmities, which early required their discharge. Cap- tains, more solicitous about securing the requi- site number to form a company than the phy- sical capacity and stamina of the men com- posing it, wilfully overlooked, if they did not actually suggest, the dissimulation. Many men, influenced by the large bounties, and hav- ing no higher motive to influence them, con- cealed their disqualifying infirmities until after enlistment, when they made use of them to avoid duty or procure a discharge. Hitherto the war has not drawn so heavily upon the population as to induce the study of methods of deception. Neither has it been necessary to elaborate an ingenious imposture to procure a discharge from the service ; for the mere assertions and importunities of the man have too often succeeded in accomplish- ing his desires. In our country, indeed, the sources of information have been few. Here the professional beggar, whose artful portrait- ure of sickness and suffering awakens the sympathy upon which his support depends, .is rarely seen : he is not one of the " sights,j*as Charles Lamb styles the poor of London. Our 88 GENERAL CONSIDERATIONS. civil hospitals furnish few instances of malinger- ing, for outside the walls means of subsistence by labor or charity are rarely wanting. The few cases which have heretofore occurred were found in our penal institutions, where labor is imposed on the reluctant convict, in our courts, wliere justice is to be defeated, and in our army, where the avoidance of duty pro- cures ease and does not lessen pay and allow- ances. The necessary information has, there- fore, not been at hand to meet the wants of malingerers in our newly-created army. The varieties of feigned diseases have, consequently, been limited in number, if the men feigning are legion. The causes of feigning in the military ser- vice of the United States are to be found usu- ally in one or more of the following : — 1. An inaptitude or a positive disinclination for service, which has been overcome by pay- ment of bounties or the fear of being disgraced in public estimation by remaining at home. 2. The nature of the service, its dangers, exposure, and hardships. Laborious marches, fatigue-duty, night-watching, the discomforts of the camp, and the necessary rigor of mili- tary discipline, disgust the lazy, the spiritless, and the insubordinate. GENERAL CONSIDERATIONS. S9 3. Those uninfluenced by the privations, hardships, and dangers of the service, are in- terrupted in their attention to duty by small pique, disappointment as to promotion, and want of confidence in the character, conduct, and professional knowledge of their immediate superiors. Losing thus their interest in the service, and actuated by no higher motives than these personal considerations, they be^ gin the career of imposture by entering the regimental hospital for pretended ailments which rapidly acquire consistence and definite- ness. 4. The vice of malingering is further encou- raged by the conduct of the regimental medical officer. A desire to be popular amongst the men, many of whom are his friends and neigh- bors, renders the surgeon lenient in his judg- ment, and disposed rather to gloss over and hide impostures than to expose and bring the offender to punishment. 5. The transfer of sick and wounded soldiers to State hospitals, and the giving furloughs to!| sick, wounded, and convalescent more freeiy than to the well, contribute to the disccp- tent of the men, and dispose them to feign disease or disability to obtain the same iiidul- gences. ■ 8* 90 GENERAL CO^fSIDERATIONS. 6. The very large number of discharges on surgeon's certificate of disabihty powerfully contribute to the prevalence of malingering. The percentage of men discharged for incura- ble disorders, from which they soon after sur- prisingly recover, is not small : indeed, in every village there are one or more instances of the expertness or perseverance, of the mahngerer or carelessness of the surgeon. 7. The leniency of the military authorities in the treatment of malingering affords addi- tional encouragement to the practice. Besides the difficulty of demonstrating clearly enough to meet the objections of a military court the nature and character of this ofiense, the punish- ment will not, necessarily, be in proportion to the gravity of the crime. In the regular ser- vice there have been not a few instances of summary punishment upon proof of feigning, but not one instance, so far as I am acquainted, in the volunteer service. Having no fear of the law before his eyes, the simulator is not j^indered in the performance of any of his tricks or stratagems. The worst that can happen him is to be exposed and returned to duty, — to have an opportunity at no distant day to re- sume his old imposture and to deceive other credulous medical officers. GENERAL CONSIDEEATIONS. 91 8. Besides these causes, there can be no doubt that men sometimes feign disease with- out reason, — a species of monomania; and sometimes it arises in th^t state of mysterious mental sympathy known as " imitation." 92 CLASSES OF MEN FEIGNING, CHAPTER II. CLASSES OF MEN FEIGNING, AND CHARACTER OF THEIR AILMENTS. Our service should not be judged, in respect to the vice of malingering, by the standard of the French and English. Under the opera- tion of the conscript law, France is repeatedly drained of her able-bodied men, and the desire becomes wide-spread to avoid a service which entails such calamities upon families. The English army, maintained exclusively by volun- tary enlistment, is not popular amongst the middle and lower classes, and "hence recruits rarely enlist in consequence of a deliberate preference for military life, but commonly on account of some domestic broil, or from a boy- ,,ish fancy, sometimes from a want of work and its immediate result, great indigence. Per- haps nine-tenths of the recruits regret the step they have taken, and are Avilling to practice any fraud or adopt any means which promises to restore them to liberty and the socjety of AND CHAEACTEK OF THEIR AILMENTS. 93 their former acquaintance."* The same facts are true of our regular army in time of peace. But the gigantic army called into existence by the necessities of the present war is composed of very different material ; yet it need occasion no surprise that in the vast multitude of men who have taken up arms there are many who mistook zeal for the cause for aptitude for a military life. It is even less remarkable that there are not a few influenced by other consider- ations than patriotism in entering the ranks. Consequently it must be understood at the out- set that the social status of the soldier pre- vious to his enlistment has little to do with the determination of the question of feigning, in a given case. My own experience, how- ever, has given me a decided opinion on this point. I have very frequently observed, in- deed, that the malingerers in our hospitals are not derived from the class of well-informed educated soldiers, of whom there are quite a large number in the ranks, but from the class of workmen, laborers, and uneducated men. The appearance of the former amongst a flock of "hospital birds" is an anomaly which at- tracts immediate attention. * Marshall's Hints to Young Medical Officers on Examina- tion of Recruits, &c. (London, 1828), p. 89. 94 CLASSES OF MEK FEIGNING, One of the most important subjects under this head is the question of the nationality of the malingerers in our army. The army is composed mainly of representatives of three nationalities, American, German, and Irish ; be- sides these there are a few Scotchmen, French- men, and Italians, but they may be excluded from consideration, as insignificant in numbers as compared with the great masses of the others. It has happened me to observe a larger number feigning and fewer wounded amongst the Germans than the Americans or Irish. I think it may be assumed in respect to the Ger- man that the argumentum ad crumenam is the argument which determines the choice of some in this controversy. I say this whilst remembering the devotion of the German race to national unity and liberty, and their attach- ment to their adopted country; but they love ease and money not less,-— many of them more. Chronic rheumatism is the ailment which they most frequently feign or exaggerate ; next, in- , continence of urine and hgematuria, and, lastly, diarrhoea. '- The class of Americans who mainly simulate disease are the married men of mature age, — from thirty to forty, — mechanics or laborers by profession, who were induced to enter service, AND CHARACTER OF THEIR AILMENTS. 95 as I have already remarked, by a sudden zeal which had no foundation in a conviction of duty, or by the stimulus of large bounty. My observation inclines me to believe that much of the feigning practiced by them has its origin in nostalgia ; for, whatever may be our peripatetic habits as a people, there can be no doubt of the strong attachment to home felt by the inhabitants of the rural districts. Affections of the respiratory organs, of the urinary and genital organs, diarrhoea, dyspep- sia, heart-disease, and epilepsy, are the dis- abilities usually feigned by Americans. Contrary to the opinion of Mr. Marshall,* who is great authority on these subjects, the Irish have seemed to me to simulate less fre- quently than the Americans or Germans. I am quite prepared to assent to the dictum of Dr. Davies, quoted by Marshall, that "the poorer class of laborers" are those who usually feign disease. Sun-stroke, chronic rheumatism, and "pain in the back" are the favorite dis- eases of the Irish. Certain temperaments, as might be antici- pated, are more prone to malingering than others, e.g. the bilious and melancholic or hypochondriacal, the nervous, the lymphatic; * Hints to Young Medical Officers, &c. p. 91. "' 1 96 CLASSES OP MEN FEIGNING, whilst the sanguine is least of all disposed to it. The typical malingerer has dark brown or hazel eyes, dark hair, and dark complexion ; his face is stealthy, dogged, lowering; his eyes suspi- cious, furtive, restless; and his manner habit- ually constrained and exhibiting violent at^ tempts at composure. These last physiogno- mical characteristics become more evident when the malingerer is subjected to a rigid cross-examination. The diseases feigned by the various classes of malingerers are those which have either happened under their observation and with which they are therefore most familiar, or with which they are pretty thoroughly ac- quainted by report. It will be found, usually, that the diseases most feigned are those most prevalent in the army, provided they can be simulated with tolerable facility. This, then, is a measure of the varieties of simulated or factitious diseases which come under the ob- ^servation of the military surgeon. It is a H unfrequently the discontented sick or wounded, I who expose the malingerer because of envy of ^^ his success in evading duty which has fallen upon his more faithful comrades. To obtain the confidence of these men and secure their aid is an important part of the duty of the surgeon. The nurses cannot always be relied on to keep careful watch over and make faith- ful report of the conduct of the malingerers : 8» 02 DUTIES OF MEDICAL OFFICEKS et the surgeon must be compelled in a great majority of the cases to dejaend upon their dis- retion, intelligence, and willingness. If the malingerer preserve his general cha- acter as invalid successfully, the surgeon lay detect his imposture by carefully ques- oning him as to the circumstances under ^hich his disability occurred, in which he will robably disclose the motives of his feigning, r by encouraging him to relate his symptoms, 1 which he will probably assign to his dis- use symptoms that do not belong to it, or ive prominence to those of least importance, trange as it may seem, there are few mulators who are prepared with a set of ^mptoms at all appropriate to the peculiar ^sease or disability feigned, or who are even !ady to give a set of symptoms, or who can ilate, without hesitation and anxiety, the .anner in which the disease or disability ■iginated or occurred. Nevertheless, they ■e peculiarly liable to overact their parts, to Qpress the medical officer with the extent id reality of their sufferings.* But the pains ■ symptoms are usually not in harmony with le alleged disease or disability, or are wholly ; variance with it. * Cyclopasdia of Practical Medicine, vol. ii. p. 134. IN RELATION TO MALINGERING. 103 In making a diagnosis of a suspected case the surgeon will be greatly aided by chemical tests, by the microscope, by the ophthalmo- scope, and frequently by anesthetic agents. But above all he will find it necessary to use his own senses, his habits of observation, and that peculiar tact in detecting impostors which, whilst it seems an instinct with some, may be acquired by all who are willing to cultivate it. Begin* proposes the following rules for the diagnosis of feigned diseases : 1st. The appreciation of the moral situation of the subject and the motives which influence him to simulate, dissimulate, or provoke the malady of which he pretends himself to be the vic- tim. 2d. Comparison of this malady 'with the age, the sex, the temperament, the mode of life, of the individual. 3d. Attentive ex- amination of the affected parts, the local symp- toms which they present, and the impediments to the exercise of functions which result from - such lesions or which are attributed to'themi^ 4th. Careful comparison of these lesions with the development, the color, and the other general dispositions of the organism. 5th. Study of the causes to which the lesion, real or * Dictionnaire de M§decine et de Chirurgie, article Riforme. 104 DUTIES OF MEDICAL OFFICERS pretended, is attributed. 6th. Methodical ques- tioning of the subject relative to the circum- stances which accompanied the development of the disease, to the sensations, to the pains, to the hindrance of function, thereby produced. 7th. Proper employment of therapeutic mea- sures, suggested by the indications of the mor- bid state and the observation of the effects. 8th. Appropriate excitation, to distract the at- tention of the man whilst the affected parts are examined or made to move. Various systems of classification have been proposed for facilitating the study and descrip- tion of feigned diseases. Didiot* divides them into pretended, provoked, simulated, or dissimu- lated. The authors of the article in the Cyclo- paedia of Practical Medicinef arrange them in four groups : — 1. Feigned diseases, strictly so called, or those which are altogether fictitious. 2. Exaggerated diseases, or those which, ex- isting in some degree or form, are pretended by the patient to exist in a greater degree or different form. 3. Factitious diseases, or those which are wholly produced by the patient or with his concurrence. * Code, op. cLt. p. 461.- f Vol. ii. p. 133. IN RELATION TO MALINGERING. 105 4. Aggravated diseases, or which, originating in the first instance without the patient's con- currence, are intentionally increased by artifi- cial means. Fodere and Orfila adopt a similar classifica- tion. Gavin* founds his classification on the means of diagnosis; on the symptoms which are re- ferrible to the feelings of the patient, and those which are cognizable by the senses or acquired information of the physician. Each of these systems of classification has merit peculiar to itself: but none of them are applicable to the plan of this work. To secure uniformity, the arrangement followed in the description of real disqualification for military service will be ad- hered to in the description of the pretended. Feigned diseases, affecting — 1st. Organs of special sense and accessory apparatus ; i 2d. Head and spinal column, and cerebros spinal nervous system; 3d. Neck and contained organs ; 4th. Chest and thoracic organs ; 5th. Abdomen and digestive apparatus; 6th. Genito-urinary apparatus; * On Feigned Piseases, p. 54. 106 MALINGERING. 7th. Upper and lower extremities ; 8th. Skin and appendages. In treating the feigned disabilities peculiar to these classes, I shall have in view more especially the feigned, factitious, exaggerated, and aggravated diseases which are usually seen in our service. For obvious reasons, I shall not describe the means used by malin- gerers to feign or produce them. AUDITORT APPARATUS. 107 CLASS FIRST. FEIGNED DISEASES AFFECTING " ORGANS OF SPECIAL SENSE AND ACCESSORY APPARATUS. A. Avditory Apparatus. Deafness, of the disabilities affecting the ear, is most usually feigned in our service. The regulations of the Bureau of the Pro- vost-Marshal General require that this disabi- lity, before it shall be admitted as a ground of exemption, " shall be proved by the existence of positive disease or other satisfactory evidence." It is a malady which is often simulated, be- cause it can be done with facility, and the real deafness is not easily distinguished from the simulated.* In the French service, as in our own, it is not admitted as a cause of exemp-j tion unless established by satisfactory evidenc^ In 10,991 discharges on surgeon's certificate, for all causes, examined by me at the Adjutant- General's Office, 169 were for deafness. Tliere can be no doubt that many of the^e were either feigned or exaggerated. A modified de- gree of deafness, insufficient to constitute a * Aide-M6moire, op. cit. p. 55. 108 ORGANS OF SPECIAL SENSE. reason for exemption or discharge, is a not uncommon sequela of the exanthematas even after the otorrhoea has entirely disappeared. This "hardness of hearing" is frequently ex- aggerated. A temporary loss of function of the auditory nerve is sometimes produced by typhoid -fever, and is greatly exaggerated by soldiers to procure a discharge. Usually, how- ever, complete deafness is the lesion feigned. The malingerer in doing this overacts his part ; for complete abolition of the faculty of hear- ing rarely exists, except as a congenital con- dition. In feigned deafness the tone of voice habitual to the man is not altered, as it is in the real infirmity. There is a keen look of inquiry, an attentive, subdued manner, and low-toned voice, characteristic of the deaf man, ! not easily simulated. Real deafness is slow in " its progress, whilst the feigned is sudden in its •isaccess. If this lesion has occurred suddenly, .and there is no evident aifection of the audi- tory canal, membrana tympani, or Eustachian tube, the surgeon will have good reasons for a suspicion of fraud. By talking very loudly on some topic of in- terest to the malingerer and then suddenly and unexpectedly in a low tone, he will be very certain to betray his artifice; or he may be AFFECTIONS OF THE EYE. 109 surprised by sudden noises, by dropping money behind him on the floor, by being waked out of his sleep, or by being accused of some crime.* The natural but involuntary language of the countenance gives evidence that the impostor gains intelligence of what is passing around him through the organ of hearing. No case of deafness should be admitted as real until the surgeon has satisfied himself that there are lesions of the auditory canal, otorrhoea, perfo- rate membrani tympani, or disease of the nerve, and that no artificial means have been made use of to close the canal against the entrance of sound. B. Affections of the Eye. The afi'ections of the eye are feigned, exag- gerated, and aggravated. Ptosis is frequently feigned, usually of both eyes. A man has come under my observation who had escaped duty four months by a simple closure of the palpebrse. He was led to the hospital by a comrade. When I attempted to open the lids, the orbicularis violently resisted the effort I made, and there was no disease of * Gavin on Feigned Diseases, op. cit. ; Cyclopedia of Practical Medicine, art. Feigned Diseases ; Diotionnaire des Sciences M6dioale's, art. Simulation des Maladies. 10 110 ORGANS OF SPECIAL SENSE. any part of the globe. The imposture was ob- vious. He was privately informed that his case T^as thoroughly understood, and a galvanic shock through the temples effected a cure as sudden as it was complete. Nictitation is an affection of the eyelids oc- casionally feigned in our service. Sometimes it is a habit acquired early in life, sometimes a sign of disease in the deeper structures of the eye, and sometimes a purely factitious con- dition. When it consists of a habit of wink- ing merely, it is not a disqualifying infirm- ity, and when factitious is unaccompanied by lesions of internal parts of the eye. Before coming to a definite conclusion, the surgeon should use the ophthalmoscope. Myopia is frequently exaggerated, and in some instances, apparently, produced. It is |pot difficult of detection when merely fictitious. The appearance of the eye, and the manner and habits of the man not those of a near-sighted person, are points of diagnosis to determine the question. If produced, the detection is more difficult. By a habit of holding small objects close, to the eye, and by wearing glasses, a con- dition of the eye and a peculiarity of manner are induced not unlike myopia. Myopia ex- aggerated is not easily recognized. Short- AFFECTIONS OF THE EYE. Ill sighted persons do not look at the person with whom they are conversing, being attentive to the words only ; and in reading they hold the book obliquely towards their eyes. Their eyes are frequently prominent, and the cornea pre- ternaturally convex; the pupil is generally large, the eyeball firm, and the lids tender; the eyebrows are corrugated, and there are goose- foot wrinkles at the corners of the eyes. The internal structure of the eye, in a case of sus- pected myopia, should be examined with the ophthalmoscope; for in the worst cases there will be found some obvious lesions. The ex- perhnentum crucis, however, consists in the use of bi-concave glasses. A man is exempt under the French conscript law if he sees at a distance of 30 or 35 centimetres from his nose with bi-concave glasses Nos. 4 and 5, and -■ if he distinguishes clearly distant objects witii the No. 6 or 7.* Blindness, or loss of sight, in various degrees, is frequently feigned. It requires great tact and perseverance on the part of the malingerer to simulate loss of sight; and by watching him narrowly at all times he will be very certainly * Didiot, op. cit. p. 466 ; Aide-M6moire, loo. cit. ; Gavin, op. cit. ; Copland, Med. Diet. p. 1036 ; Cyclopedia of Practical Medicine, etc. 112 ORGANS OF SPECIAL SENSE. caught seeing. The manner and gait of a blind man are peculiar, and not easily imitated. Feigned amaurosis is easily detected by the employment of the ophthalmoscope, regard being had to the possible use of some agent to dilate the pupil and render it immovable. If the blindness be due to cataract, it may be diagnosed by the usual signs of that affection. The amaurosis induced by the use of certain drugs differs from the true disease in the ap- pearance of the eye, which is red, watery, and inflamed.* Patients in our general hospitals frequently simulate an obscure disease of the eye which they may happen to see placed upon the card of a comrade, and frequently also continue to pretend being affected with a disease the name of which an attending surgeon has incautiously placed upon their own cards. An instance oc- curred to me' not long since, in going around the wards of a hospital of which I am in charge, of a man feigning " retinitis," who produced, on my questioning him, a transcript of a card ap- pended to his bed many months before, in some other hospital. Hemeralopia, nyctalopia, and amblyopia, when temporary lesions, are due, * Percy and Laurent, in Diet, des Soi. Med,, art. SimuJation des Maladies. AFFECTIONS OF THE NOSE. 113 usually, to some impairment of the functions of the digestive apparatus. They are sometimes feigned, but are easily detected by the use of the ophthalmoscope. C. Affections of the Nose. The only feigned disease of the nose which it is necessary to mention here belongs to the class of exaggerated lesions. A small polypus is not a ground for exemption from military service, neither is it a cause for discharge; but the importance of it may be greatly exag- gerated by an unwilling soldier who wishes to avoid duty or procure a discharge. D. Affections of ih^ Mouth. Stammering is one of the affections occasion- ally feigned. The stammerer invariably ov^- acts his part. It is usually pretended to have occurred suddenly, and is so excessive as to justify suspicion. True stammerers rarely hesitate in repeating any thing they have com- mitted to memory, or in singing.* In aU cases of stammering, the organs of speech should be carefully examined by the surgeon. If they be well formed, the tongue not mutilated, of * Fallot, Memorial de I'Expert, &c. loc. cit. p. 94. - 10* 114 ORGANS OF SPECIAL SENSE. proper size, and capable of being protruded, and there be no deformity of the jaw or mal- formation,' the surgeon has just grounds for as- suming that the defect of speech is feigned. Dumbness has been feigned several times in my experience. As it usually occurs suddenly, without obvious cause and without evidences of congenital or acquired defects, it is not dif- ficult of detection. Paralysis of the tongue is sufficiently evidenced by the withered ap-- pearance of that organ and the difficulty of deglutition. In an ordinary case of paralysis, where loss of speech takes place, it can be seen that the patient moves his tongue with difficulty, that deglutition is difficult and takes i^a long time, and that, from the paralysis afiecting the muscles of the cheek and pharynx, the saliva issues from the mouth, and the pa- tient, in short, slavers incessantly.* * Gavin on Feigned Diseases, op. cit. p. 94. HEAD AND SPINAL COLUMN. 115 CLASS SECOND. FEIGNED DISEASES AFFECTING THE HEAD AND SPINAL COLUMN AND THE CEREBKO-SPINAL NERVOUS SYSTEM. Headache (cephalalgia), neuralgia of the cranium, and vertigo, are frequently feigned. Pain of all descriptions, existing often without evident external sign, is peculiarly liable to be simulated, because difficult of recognition. Headache, unaccompanied by some obvious disorder of the general system, need not be- come a question. Neuralgia of the cranium and tic douloureux may be simulated to escape disagreeable duty, but will rarely be persisted in to procure a discharge from service. Not- withstanding very violent pain is not incom- patible with excellent general health, there'can be no doubt that long-continued neuralgia|will produce effects cognizable by the senses of the surgeon. Several cases of feigned vertigo have come under my observation, the alleged^; after- effects of coujp-de-soleil. There have been four instances of it in the Fort Schuyler General Hospital. In none of them were there any appreciable lesions or impairment of any of the ^16 HEAD AND SPINAL COLUMN, imctioiis or organs. All of them complained if strange sensations in the head, and vertigo. L singular expression was imparted to the ountenances of two of them by wearing a landkerchief around the head ; and a third i^ore green glasses. The striking discrepancy etween the professions of these men, and the otal absence of any physical or mental evi- ence of the truth of their assertions, was the nportant point in the diagnosis of these ases ; and their subsequent histories fully onlirmed the diagnosis. "Pain, whether simulating headache, neural- ia in any of its forms, rheumatism, lumbago, r affections of the muscles, bones, or joints, ! a symptom of disease so easily pretended lat it is not to be admitted as a cause for xemption unless accompanied with manifest erangement of the general health, wasting of limb, or other positive sign of disqualifying )cal disease."* Chronic rheumatism has the bad pre-emi- ence of being the disease most frequently signed. In a series of 8283 discharges, for 11 causes, for part of 1861 and 1862, examined dth reference to the comparative frequency * Eegulationa of Bureau of Provost-Marshal General, Wash- igton, 1863. AND CEREBROSPINAL NERYOUS SYSTEM. 117 of chronic rheumatism as a feigned ailment, I find 791 discharges for this cause alone. It became an evil of such magnitude that a General Order was issued by the War Depart- ment in 1862, prohibiting discharges for rheu- matism. In all convalescent hospitals a large number of rheumatics encumber the wards, a considerable proportion of whom present no evidence of disease. Our service is not alone in respect to the great prevalence of this feigned disability : although not so common, the cases are quite numerous in the English and the French services.* The circular of the EnglishArmy Medical Department of 2 2d January, 1830, states that these affections are a fertile source of fraud, and that so long as men: are discharged in consequence of.rheumatisnjf instances of imposition will frequently occi?^. It is a matter of great moment to determine whether a man be feigning who professealto be affected with chronic rheumatism in any of its forms and situations. Whilst it is true that a man may suffer severe pain without affording any external physical evidence of it, it is no less true that a long-continued neural- gic or rheumatic affection of a nerve or a set * Marshall, op. cit., and Percy et Laurent, Diet, des Sci. Med. op. cit. 118 HEAD AND SPINAL COLUMN, af muscles will produce some impairment of Function or nutrition ; so that a medical of- ficer is justified in assuming that to be a case Df i&posture in which a rheumatic disease of !ong standing has produced neither of these esions. " When the health is good and the seat of the alleged pain unaffected by swelling 3r increased temperature, a medical officer will orobably in nineteen out of twenty cases be safe in concluding that no material or, at any :ate, no permanent disease exists."* " In that jase in which the rheumatisnuis accompanied 3y permanent rigidity of articulations, by ivasting or atrophy of members, and against K^hich the usual therapeutic means are used .n vain, the man thus affected is a subject for jxemption or reform." f " If there is not an 3vident wasting of the limb said to be affected, it is not a sufficient cause for excusing from iuty or invaliding any class of military men."J It is fortunate that the treatment appro- priate to chronic rheumatism is that which mill be most likely to induce the malingerer ■' to give in," and that rheumatic pains un- accompanied with local or constitutional evi- , £1^^ * Marshall on Enlisting and Discharging Soldiers, p. 104. f Aide-M6moire, op. cit, p. 99. % Hennen, Military Surgery, p. 455. AND CEKEBRO-SPINAL NERVOUS SYSTEM. 119 dences of disease are not made worse by exer- cise, fatigue, police, or other military duty. It is not a little remarkable with, what forti- tude this class of malingerers will endure the application of counter-irritants, galvanic cur- rents, firing, and other remedies of this class. They seem to think that to gain their object it is only necessary to affirm that they have pain somewhere, to put on the appearance of suffering, and to affect loss of power in the limbs. The back, loins, and hips are the parts usually selected ; the knee, ankles, and superior extremities less frequently. The use of a crutch or a stick, and the ready submission to and apparent anxiety for the application of remedies, is considered by them an irrefragable^ proof of the reality of this alleged disability J* There is a class of malingerers who decline to fix the locality of their pains, who content themselves with the assertion that they suffer " all over," and who spend their time in bed or in lounging about the wards, and can with difficulty be induced to take exercise in the open air. They oppose a passive resistance to all the measures of relief proposejiffor their benefit, are dull, listless, and apparently ab- * Marshall on Enlisting and Discharging Soldiers, op. cit. p. 194. 120 HEAD AND SPINAL COLUMN, 3orbed in the contemplation of their sufferings. The points of diagnosis in these cases are as Follows. 1st. The discrepancy between the )bjective and subjective phenomena of the lUeged disability. 2d. The inconsistencies of :he patient observed when he supposes himself Tee from espionnage. For instance, a man in ;he Fort Schuyler Hospital who had gone for nonths in a semi-erect attitude suddenly straightened himself and threw up his arms ;o pull down the cape of his grea1>coat, which I gust of wind wrapped about his head. An- )ther instance : a man who had walked with. ;reat difficulty by the aid of a cane rushed to ;he steamboat^landing as the boat was pushing )ff, forgetting entirely his lameness. 3d. The ■ailure of remedies to produce any result in ;he case, and the indifference of the malingerer ;o changes in the temperature and hygrometric londition of tbe atmosphere. Paralysis, hemiplegia, paraplegia, and para- ysis of one or more extremities, are sometimes limulated. They are, usually, easily enough, ■ecognized. In feigned paralysis the man nay be surprised into the exertion of his will )y a little address on the part of the surgeon. in instance occurred to me not long since. ]n passing by a man in the hospital who pro- AND CEREBROSPINAL NERVOUS SYSTEM. 121 fessed to have paralysis of the left arm, I suddenly seized the paralyzed limb, without his being aware of my intention, and threw it up. Greatly surprised, and taken off his guard, lie exerted all Ms force to prevent my raising the arm. His imposture was at once declared. In feigned paralysis there is no wasting of the limb or impairment of nutrition or sensibility, as in true. Besides, the malingerer can give no consistent account of the manner in which the disability occurred and of the progressive steps in the gravity of the lesions. He usually pretends to have received a blow by a shell upon the spine, or to have been exposed to cold and wet, the paralysis immediately super- vening ; or he pretends to have had rheumatism which has produced loss of power. The most, usual form of feigned paralysis is loss of pow:6ir confined to one of the upper extremities. This is a disability occurring so rarely to adults without some obvious local injury to nerves, that there can be no difficulty in detecting the imposition. As in the case narrated above, there will be found, in these cases of partial paralysis, neither loss of substance, impair- ment of nutrition, nor loss of sensibility. It has happened me to see many cases of feigned ,M 11 .22- HEAD AND SPINAL COLUMN, laralysis ; but none of them presented any diffi- ulties in the diagnosis. The proportion of cases of epilej)sy dis- harged from the service since the rebellion, n the series of discharges examined by me at he Adjutant-General's Office, reached 22 per 000 discharges for all causes. There can be 10 doubt that many of these cases were suc- essfuUy feigned. The exact number I have 10 means of determining. Authorities are not agreed as to whether here is a physiognomy peculiar to epilepsy, ly which the existence of that disease in any ;iven case can be infallibly recognized. Gavin —who, it appears to me, knew little of feigned lisease by personal observation — says, " To the .ttentive observer the true epileptic is a man [uite different from every other. It is rare to ind in him any trace of hilarity, spirit, or ivacity. Nature, or rather disease, has im- )ressed upon his face a character which seems o be composed of sadness, shame, timidity, ,nd stupidity. * '•= * * * This )eculiar physiognomy of epileptic patients ;enerally renders the simulation of the disease rery difficult." This opinion is much too trongly stated. ,In my experience, there are mdoubted epileptics who do not present these AND CEREBRO-SPINAL NERVOUS SYSTEM. 123 physiognomical characteristics, nor, indeed, any evidences of disease whatever. Hence an ex- amining surgeon will be frequently deceived in cases of dissimulated epilepsy. Simulated epilepsy is easily enough detected. The malingerers in our service are not suf- ficiently well informed and skilful to produce an - exact portraiture of the epileptic parox- ysm. They overact the part, supposing, in- deed, that it is only necessary to fall down upon the ground in some convenient place, to act violent convulsions, to strike all who ap- proach them, and to struggle vehemently, in order to be believed. The milder type of epilepsy — the petit mal as distinguished from the grand mal of the French — is not feigned. Temporary loss of consciousness, unaccom- panied by convulsions, would not suit the purpose of the simulator. How exact and perfect soever may be the imitation of an epileptic paroxysm, there is a condition which cannot be imitated,-— total loss of consciousness, accompanied by involuntary discharges. " The signs of epilepsy," says the Aide-M6moire,* " are numerous and various. Some are characteristic, carrying with them 'if * Op. cit. p. 111. 124 HEAD AND SPINAL COLUMN, complete conviction and giving incontestable certitude. * * * * * ''The absolute loss of sensibility, the dilatation and the immobility of the pupil, are the charac- teristic signs of epilepsy. The other pheno- mena are variable in their intensity, as in their appearance : it is the constant presence of the first which renders them diagnostic of epilepsy." Each of the simulated cases of epilepsy which it has happened me to see was a most lame and impotent attempt, by men who had had no opportunity to study the disease and who knew of it only by report. The fits were nothing more than a series of violent struggles and contortions, without loss of consciousness. In each case the pupils contracted on exposure to light, and the eyelids moved involuntarily when the eyes were threatened with a blow. These evidences of consciousness are not to be counterbalanced by such non-essential phe- nomena as frothing at the mouth, clench- ing of the hands, and discharge of urine and faeces, all of which may be produced by the voluntary efforts of the malingerer or by artificial means. No man should be discharged on his own assertion that he is affected with epilepsy, or on the statements of others. "^Jv AND CEREBK03PINAL KERVOUS SYSTEM. 125 If a man claim a discharge on this ground, he may possibly, if requested to do so, give an exhibition of his infirmity ; but ordinarily the fits occur when the surgeon is not at hand or not easily procured, and recovery almost in- variably takes place before his arrival. The feigned epileptic selects his situation and op- portunities, when his fits will draw the largest audience and excite the widest sympathy; for he relies upon the pressure of various in- fluences upon the surgeon rather than upon his skill in imitating disease. The discharges for mental imbecility, in- sanity, and other forms of mental disease, amount to nine per one thousand discharges for all causes. During the first twelve months of the rebellion the discharges for this cause were 11 per 1000, and in the second year 7 per 1000 : so that it may be assumed that mental alienation is not one of the forms of disability feigned by our soldiers. These figures corre- spond to my own observation. I have seen few instances of feigned mental diseases, — not one instance: of mania. All of those observed by me were cases of dementia, fatuity, or mental imbecility. Mania is not easily feigned. In the attempt to produce conviction in the minds of his ii» 126 HEAD AND SPINAL COLUMN, superiors, the malingerer almost invariably overacts his part. This is not to be wondered at when we remember that almost all poets and novelists who have attempted the portrait- ure of insanity, except Shakspeare and Goethe, have succeeded in producing caricatures only. No one at all familiar with the appearance and manner of the insane could be deceived in a feigned case. Besides the difficulty of per- sonating the countenance, manner, and lan- guage of an insane man, the simulator cannot maintain the character for a long period with- out yielding to exhaustion. The simulator cannot feign sleeplessness for many nights in succession, and pass many days without food or drink, as the insane do. But the most flagrant instances of imposture occur in feigned cases of idiocy, imbecility, or dementia. These are the forms of imposture most usual in our service. Loss of memory, incapability of learning his military duties, listlessness, slovenly habits, and a passive immobility of manner, are the peculiar signs exhibited by the malingerer. To detect the imposture, it is only necessary to have the man under ob- servation at unexpected times, when he will betray his artifice, to study the evidences of intelligence and coherence in the expression AND CEREBRO-SPINAL NERVOUS SYSTEM. 12 ii I of Hs countenance, and to compare his pre vious history with his present symptoms. Deformity of the spine, crooked-back, and "weakness in the back" the alleged result of rheumatism or of injury, are among the mos' common feigned disabilities in our service. Th( extraordinary persistence of the malingerer who will pass months in the hospital bent ir the most> uhcomfortable attitude conceivable, is a remarkable circumstance. Injuries produced by the explosion of shells, or by lifting heavj weights, or by extraordinary exertion in making a bayonet-charge or in assaulting the enemj^s works or lines, are alleged as the circumstances under which the pretended disability occurred By a judicious cross-examination, it will usu- ally appear that the injuries were received early in the engagement. The contrast be- tween the general condition of the patient and the severity of his pretended symptoms, and the absence of any evidence of a local lesion, are the means of diagnosis in these cases. 128 FEIGI-raD DISEASES AFFECTING NECK THIED CLASS. i-EIGNED DISEASES AFFECTING NECK AND CON- TAINED ORGANS. Several cases of feigned aphonia have been )bserved in a hospital under my charge. The )atients professed to have lost voice suddenly, vithout obvious cause. Two occurred after their Ldmission into the hospital, and the others at a )eriod long anterior to their admission. With- lut- being able to assign any cause, and ap- )arently indifferent to the impression their )eculiar assumption might make, they con- ented themselves with the simple declaration if their inability to speak. If there be no evi- lence of local disease, or tumor, or aneurism iressing upon recurrent laryngeal nerves, or ,ifection of brain or cervical spinal cord, LO doubt can remain that the ^^honia is signed. This point being determined, it re- uains to induce the man to acknowledge his mposture and "give in." This has not J)een [ifficult in the cases I have seen, who regained heir voices by being daily assured by their urgeons that their impostures were detected AND CONTAINED ORGANS. 129 and that it was not worth while to continue to act them. A sudden alarm at night when asleep, or the inhalation of ether or chloroform, continued to the stage of excitement will betray the malingerer. Goitre is an exaggerated ailment. A simple*'; enlargement of the thyroid gland, not compli- cated with malignant disease or osseous degene- ration and deposit, is not a cause for exemp- tion. I have seen not a few instances of this condition greatly exaggerated by soldiers for the purpose of procuring a discharge. They usually complain of interruption of breathing by compression of the trachea, or of head- symptoms by pressure on the jugular veins. There can be no difiiculty in determining how far a goitre may interfere with these functions. Wry neck, although sometimes attempted, cannot be feigned successfully. There is a peculiar prominence and rigidity of the mus- cles in a long-standing case, which cannot be accurately imitated. A more definite and im- portant sign is the peculiar cast of the coun- tenance, induced by the efforts of the features to accommodate themselves to the changed relations of the parts. 130 FEIGNED DISEASES AFFECTING CHEST FOUBTH CLASS. i'EIGNED DISEASES AFFECTING CHEST AND THO- KACIO ORGANS. In a series of 10,446 discharges on surgeon's iertificate for all causes, I find 1564 discharges br phthisis alone, — a large number of them m "incipient phthisis." The simulated or 'actitious disability which bears a close re- lembldnce to phthisis in its incipient stage is me of the most usually and successfully feigned n the whole range of diseases. Many of he physical and sensible signs of phthisis may )e induced by cough maintained by habit. If o the cough be added bloody expectoration, he difficulty of diagnosis is increased. The )lood may be derived from the gums or pos- erior nares, or from some extraneous source. \. congested state of the throat and emacia- ion result from profuse tobacco chewing and moking (follicular pharyngitis) . A more com- aon set of symptoms simulating phthisis are )roduced by masturbation, — not always for the )urpose of feigning that disease, but any op- )ortunity for deception is gladly seized. Close AND THOEACIC ORGANS. 131 confinement in a hospital-ward, a large portion of the time in bed, chronic cough maintained by the efforts of the patient, haemoptysis, feigned or factitious, and low diet, eventually result in a condition which may be confounded by an incautious physician wititi;sincipient phthisis. Notwithstanding the great perfec- tion to which the science of auscultation has attained, there can be no quesition as to the extreme difficulty of diagnosing incipient phthi- sis with certainty. The morbid despondency of the patient produced by long confinement, deferred hope, and weakened general health is increased by nostalgia, rendering the detec- tion, as also the cure, of such a case, a matter of no little patience, skill, and tact. In 10,446 discharges — the same series men- tioned above — there were 629 for heart-disease. In 1131 discharges during the months of Janu- ary and February, 1863, there were 217 for the same cause. This extraordinary increase in numbers is due to the increased number of feigned cases. Two causes have been in opera- tion, — increased skill on the part of the malin- gerers, and ignorance or fraud on the part of the surgeons. The greater the number of , dis- charges for a given disease, the more frequent will be the attempts at imposition. 132 FEIGiS^ED DISEASES AEFECTING CHEST Functional derangement of the heart is pro- duced by various evil habits, — excessive to- bacco-chewing, indigestion, masturbation, long- continued confinement in hospital, much of the time being passed in bed, habitual and pro- longed reflection upon the condition of the heart, and, finally, nostalgia. Violent palpita- tion may occur at the time of the visit of the surgeon, excited by emotion, or it may be in- duced by sudden exercise. The malingerer invites attention to his heart, complains of pain in the cardiac region, violent palpitations, and difficulty of breathing. Before he forms an opinion, the surgeon should carefully compare the present symptoms with the history of the case. If the man have not .had acute rheuma- tism, or have not followed the profession of a circus-performer, or stevedore, or hotel-porter, it may be assumed that the heart-trouble is either entirely feigned or factitious. No man should be discharged for heart-disease until the character of the lesion is definitely ascer- tained. The persistent assertions of the .simu- lator should not stand in the way of tihiorough inquiry. Spasmodic asthma is imitated, but with slender success, by simply breathing hur- riedly at the time of the visit. Asthma unac- companied by emphysema, or disease of the AND THORACIC ORGANS. 133., ■I heart or large vessels, is a rare condition : ' hence there will be no difficulty in the diag- ^ nosis. ./ All the forms of thoracic disease, except incipient phthisis, simulated by soldiers,^should . be readily recognized. Discharges for phthisis should not take place until an uneqjHivocal diagnosis can be made. Diseases of the heart are recognized by specific signs, which can be easily enough discovered by the surgeon, if he will take the time and trouble to make the necessary investigation. I have elsewhere given rules to facilitate the. examination and,'' decision in these cases. 12 ■,..134 TEIGNED DISEASES AFFECTING ABDOMEN FIFTH CLASS. FEIGNED DISEASES AFFECTING ABDOMEN AND DIGESTIVE APPARATUS. Diseases of the digestive system, both real and simulated, furnish a very large proportion of all the cases ^admitted into the general hos- pitals. The simulated diseases of this class are feigned, factitious, aggravated, and exag- gerated. I have seen two instances of the power of vomiting at will. This power is witn difficulty distinguished from the vomiting of a diseased state. It will usually be seen, how- ever, that the vomiting is scarcely more than the act of regurgitation, that it occurs at the time of the visits and whilst the g-ttention of the surgeon is attracted to it, and that, although of long standing, it has produced >no visible emaciation and is without evidence of organic .change. Many cases of dyspepsia are prodi^ced by the evil habits heretofore mentioned as con- stantly in operation in lowering the general stamina and exciting real disease. Some men AND DIGESTIVE APPARATUS. 135 have the power of enlarging the abdomen at will, without apparent effort, bj filling the-i lungs, forcing down the diaphragm, and push- ing forward the spinal column. These men '^-'j go about, panting, with belly displayed in the most ostentatious manner, and pantaloons and drawers fastened together with cords, leaving large interspaces. A sudden blow upon the abdomen, or an emetic, will generally cause the phantom tumor to disappear; But sometimes the inhalation of an anassthetic will be re- quired. This peculiar factitious state^ must not be confounded with the enlargement of the abdomen in the convalescent stage of chronic diarrhoea or chronic dysentery. It seems a work of supererogation to repeat here, what I have so cotistantly insisted on, that no disease should be accepted as real, when the man has, a motive for deception, without proper examination and inquiry. Now, this is especially true of feigned diseases of the abdomen. Men are transferred 'from hospital to hospital on their mere assertion that they are afflicted with "liver-complaint," chronic-diarrhoea, chronic splenitis, or other diseases of the abdominal viscera. None of these should be admitted without evidence. A state of emaciation, melancholy, and disin- 13G FEIGNED DISEASES AFFECTING ABDOMEN clination for the performance of duty are not always evidences of diseased condition. But especially do all those cases admit of reason- able doubt in which the general health remains unimpaired. Diarrhoea, of all the diseases of the digestive system, is most frequently feigned. Men continue months in hospitals who profess to pass many liquid stools daily, without sen- sible diminution in weight or jjhysical vigor. These are objects of just suspicion. To detect them, it is only necessary to require the use of the close stool. But a liquid stool is not con- clusive evidence; for the discharge may be factitious. Two men were detected, not long since, in the General Hospital at Fort Schuyler, producing diarrhoea by means of " Wright's In- dian Vegetable Pills." One had a box wrapped in his shirt on his person, and the other a box concealed in his bed. Hemorrhoids is one of the most usual exag- gerated disabilities. External piles are not disabling. Internal hemorrhoids are some- times feigned. They are not disabling when real, except large, ulcerated, or bleeding. A man frequently claims a discharge or lounges in a hospital who has a single pile, neither large, ulcerated, nor bleeding. Serious symptoms not unlike those produced by hemorrhoids eiccom- AND DIGESTIVE APPARATUS. 137 pany fissures of the anus : hence a man should not be declared an impostor who believe^ himself the victim of the one, yet is really affected with the other lesion. 12» 138 FEIGNED DISEASES AFFECTING ;■' SIXTH CLASS. FEIGNED DISEASES AFFECTING GENITO-URINART APPARATUS. Diseases of this class are frequently simu- lated ; but the impostures are usually detected without difficulty. Hematuria has been feigned under my observation, and in one instance so successfully that the ward surgeon recom- mended the man for discharge. His symp- toms were these : he complained of pains in the back, and went about in a semi-erect at- titude, — of pain in making water, and passed bloody urine ; but his appetite, digestion, and general appearance were strikingly at variance with his expressions of suffering. This want of harmony between the alleged symptoms and the state of the health induced me to look closely into the case. The urine j)resented under the microscope no evidence of disease, except the presence of blood-globules. I sent for the man to pass his urine in my presence. This he professed to be unable to do; but thereafter he ceased to pass bloody urine. Blood in the urine may be derived from the kidney, bladder, or urethra. In the first case GENITO-UEINART APPARATUS. 139 it is more' intimately mixed with the urine ; in the second, the blood is rarely, if ever, the only morbid product present ; and in the third the : blood is less intimately, or not at all, mixed with the urine. In making a diagnosis the condition of the kidney and bladder should be definitely ascertained by the microscope and chemical tests, by examination with the ca- theter and the sound; and all the attendant circumstances should be carefully investigated. If the blood have not been injected into the bladder, but have been incorporated with the urine after it has been voided, the imposture may he detected by requiring the urine to be passed in the presence of the surgeon, or by the use of the catheter. Pains in the lumbar region, and "weak back" alleged to depend upon some obscure disease of the kidney, are amongst the most common causes of complaint with malingerers. There can be no doubt, I think, that lumbago, and hypersemia of the kidneys, with albumen in the urine, and sometimes oxaluria, are occa- sionally produced by sleeping on the damp ground ; but such cases are limited in number compared to the mass of those entirely ficti- tious. Foreign bodies are sometimes' produced and exhibited as "gravel," to give color to ex- 140 TEIGNED DISEASES AFFECTING pressions of disease. Not unfrequently the ^simulator contents himself with the assertion f'that he has "kidney-disease," and upon cross- examination will offer no other symptoms in proof of his statements than an increase in the quantity of urine and the frequency with which he voids it. Quite a number of cases of incontinence of urine it has happened me to see in the military hospitals. In the series of discharges heretofore frequently mentioned, I find 22 discharged for this cause alone. Incontinence of urine, unassociated with any other diseased condition, is an Igxtremely rare disease in the adult. In all the cases I have seen, the ma- lingerer made no pretence of any other ail- ment. Uncomplicated incontinence of urine occurs in. weak, sickly subjects who have ill- developed organs of generation. When com- plicated with disease of the bladder, paralysis, or calculus, there can be no difficulty in form- ing an accurate diagnosis. Men who feign in- continence do not always furnish the most easily prepared sign of the condition, — wet clothes ; and by examining them unexpectedly they may sometimes be detected by this over- sight. If the clothes be wet, the penis should be examined and the man required to make GENITO-URINARY APPAEATUS. 141 water, or the catheter should be introduceii. If these measures fail to expose the imposture, a large dose of opium may be administered, and the man waked up in the night to, empty the bladder. Stricture is sometimes feigned or exagge- rated by officers to procure a leave on surgeon's certificate. Some men possess athe po'v^er to prevent the introduction of the bougie or catheter without any effort that can be re- cognized, producing to the hand of the operator sensations not unlike those of stricture. In all cases of doubt, chloroform should be admin- istered before the introduction of the catheter. Varicocele and cirsocele are frequently ex- aggerated. In 10,991 discharges, for all causes, 116 were for varicocele alone. It may be assumed that a large proportion of these were discharged without adequate reason and for a degree of inconvenience not sufficient to con- stitute^a disability.. Varicocele is one of the most common infirmities to which men are subject; and if all recruits were rejected who presented themselves with it, many valuable men would be lost to the service. There can be no doubt that there may be some incon- venience - to the soldier in a varicocele of moderate extent j but the discomfort is usu- 142 FEIGNED DISEASES AFFECTING «■■' ally much exaggerated. Loss of virile power, which occurs when both testes are affected, produces a degree of despondency and physi- cal lassitude which justifies discharge ; but a double varicocele is rare. The most serious, result to be apprehended in ordinary cases is atrophy of the testicle. Hydrocele and sarcocele are frequently ex- aggerated in their early stage, when the incon- venience from their size and the pain expe- rienced would be insufficient to authorize a discharge. The judgment and experience of the surgeon must decide in each case the degree in which it disabtes a man from the perform- ance of military duty. Gonorrhoea is both feigned and produced. I have not seen instances of the former, but have had reason to believe that men have availed themselves of opportunities to contract it. The irritation of the glans penis pro- duced by retention under the prepuce of the cheesy secretion peculiar to that locality is sometimes aggravated, until a profuse discharge and swelling of the organ are brought about, or considerable ulceration of the glans. It may require some care and attention to distinguish such cases from gonorrhoea and chancre re- spectively. UPPER AND LOWER EXTREMITIES. 143 SEVENTH CLASS. FEIGNED DISEASES AND INJURIES AFFECTING UPPER AND LOWER EXTREMITIES. Some of the feigned diseases of the extre- mities have been discussed, — chronic rheuma- tism and paralysis, in connection with affections of the cerebro-spinal nervous system. I do not propose to add any thing to what I have already said on these diseases. Contraction of a joint, the alleged result of rheumatism or injury, is one of the most frequently feigned disabilities. The elbow, wrist, and knee are the joints usually alleged to be affected. The endurance of the malin- gerer is most extraordinary in submitting with- out a murmur to the violent measures proposed for his relief, and in maintaining a most un- comfortable position of a limb for many months. Contractions following gunshot wounds of soft parts are very frequently exaggerated, and aggravated by the persistent opposition of the patient to the means of cure. The nursing of the wounded limb is necessary in the first place to prevent motion and pain ; but subse- lil FEIGNED DISEASES AND INJURIES queritly the attempt to use the limb is resisted, and the patient obstinately keeps it contracted, to secure a discharge from the service, and a pension. The elbow, wrist, fingers, and knee are the joints usually contracted in this way. Numerous instances have occurred under my observation of this wilful aggravation of a slight wound. In some instances the contrac- tions are merely feigned, and no cause assigned for this result. In such cases, if the affected limb be manipulated by the surgeon, the volun- tary efforts of the patient to maintain the assumed position will become very apparent. His feigned cries of distress at every move- ment, and the trembling of the muscles of the limb when fatigued, are quite characteristic. Sometimes, indeed, the voluntary retraction has continued so long that the limb has wasted, as from disease, and the muscles have accommo- dated themselves to the new relations of the parts. This has occurred in a case now in a hospital under my charge, the man having carried his knee flexed upon the thigh for nine months. Such a case presents peculiar diffi- culties in the diagnosis. All doubtful cases should be submitted to complete anaesthesia. Although a man subjected to strict surveillance- may be detected, yet no testimony is so satis- OF UPPER AND LOWER EXTREMITIES. 145 factory or complete as the results of anaes- thesia. Lameness was given as a cause of discharge in 71 in a series of 10,991 discharges on sur- geon's certificate. Affections of the hip, knee, or ankle joint were probably the causes, real or pretended, of the lameness. Hip-joiht dis- ease is sometimes feigned. The patient can only simulate the objective phenomena of this disease successfully : he cannot counterfeit the evident marks of cachexy and suffering in the real disease. In a recent case occurring under my observation, there was no evidence of local disease, and the general health remained unimpaired, the posture and lameness of cox- algia only being assumed. Weakness of the knee or ankle joint is pretended, without other evidence of ailment than lameness. If there be no local or constitutional evidence of dis- ease, the surgeon is justified in assuming that the disabiUty is feigned, but is not justified in using unprofessional or unusually severe remedies. An old fracture is frequently exaggerated by the malingerer to justify limping, and as a cause for discharge. There can be no reason why a well-united fracture in a soldier should be followed by results not at all usual in a civilian. In regard to this lesion, as in gun- is 146 FEIGNED DISEASES AND INJURIES shot wounds, unwilling soldiers obstinately thwart the surgeon in the application of the means of cure, and persistently keep the limb out of use long after the necessity for quiet has ceased. Feigned and factitious injuries are not un- common. The cases of alleged contusion by the bursting of a shell, in which there is no local evidence of the injury, are so common as to be ludicrous. Mutilation of fingers is frequently seen. Whilst it is true that there are no inva- riable signs by which a self-inflicted wound may be distinguished from any other wound, it is equally certain that scarcely any man can give a satisfactory account of all the circum- stances attending the mutilation. A fragment of a shell is not unfrequently alleged to have made a clean cut of the index finger ; and it will be found frequently that the wound was received very early in the action. Varicose veins are exaggerated. In 10,991 discharges, there were 213 for varicose veins. There can be no doubt that many of these did not come within the description of the large, voluminous, deep-seated varices, in which the valves have lost their functions and the limb be- come oedematous and ulcerated, which are held to be a ground of exemption or discharge. or UPPER AIS^D LOWEE EXTREMITIES. 147 Superficial varices, in which the valves per- form their functions, and which do not cause swelling or ulceration of the limb or consider- able pain, are frequently exaggerated, to ob- tain exemption, to be excused from duty, or to be discharged from the service. In a hospital under my charge there were at one time not less than ten cases of swelling of one of the inferior extremities, which had existed in each of them for a considerable period. In some of them the swelling was hard, not pitting easily under pressure, and the integument rough and adherent, presenting the appearance of elephantiasis in its formative stage. None of these patients could assign a satisfactory reason for the occurrence of such a disability, although they usually ascribed it to lying upon the damp ground. Careful search at unexpected times, even at midnight, never disclosed the slightest trace of a ligature or pressure upon the veins. The swelling seemed to be produced by keeping the leg habitually crossed upon the other. For further informa- tion on the subject of disabilities from gunshot wounds, the reader is referred to the section on discharging soldiers. 148 FEIGNED DISEASES AFFECTING SKIN. EIGHTH CLASS. FEIGNED DISEASES AFFECTING SKIN AND APPEND- AGES. No feigned diseases of this description have come under my observation. Ulcers are pro- duced and exaggerated. There are no means of diagnosis between the genuine and factitious ulcer. In a suspected case the man should be closely watched, or he should be so constrained by a strait-jacket or other means as to j)ut it out of his power to irritate or to apply iri'i- tating substances to his ulcer. I have seen many cases which seemed to be produced or aggravated. The importance and the degree of suffering in various forms of cutaneous eruptions are occasionally exaggerated; but the severity of any specific pain- or suffering, or the extent of loss of function, is easily enough determined "by the surgeon. SECTION III. ENLISTING SOLDIERS. CHAPTER I. METHODS OF RECRUITING AN ARMY. In the United States service there are but two methods employed in raising an army, — voluntary enlistment of individuals, or a com- pulsory draft from the whole body of citizens. The Romans, who were a nation of warriors, required every citizen to enlist as a soldier when the public service required it, from the age of seventeen to forty-six ; nor at first could any one enjoy office in the city who had not served ten campaigns.* In certain wars and under certain commanders there was the * PolybiuB vi. 17; Liv. s. 25, xlii. 32. 13* 149 150 METHODS OF RECRUITING AN ARMY. greatest alacrity to enlist; but this was not always the case. Sometimes compulsion was requisite, and those who refused were forced to enlist by fines and corporal punishment.* Mutilations were sometimes practiced to escape service : hence pollice trunci, " poltroons." Ordi- narily, several causes of exemption from mili- tary service were permitted : — as age, if above fifty; disease or infirmity; office, being a magis- trate or a priest ; favor, or indulgence granted by the Senate or people; and, finally, for serving out the period of military tenure.-j- In sudden emergencies, or in great wars, none of these excuses were held to be sufficient. When the states of Italy were admitted into alliance, they were required to furnish a certain quota, and the Consuls, when about to make a levy, sent them notice of the number of men they were expected to furnish. Under the feudal system, levies pf troops were involuntary. Every chieftain called out his retainers whenever it suited his interests or his ambition to do so, or when the king or emperor required an army; but armies were in those times less an institution of the state than the followers and retainers of a number of independ,ent chieftains, who, whilst they * Liv. iv. 53. t Ibid, xxxix. 19. METHODS OF RECRUITING AN ARMY. 151 flocked to one general standard, yet held alle- giance to their immediate chief. The French were the first in modern times to organize an official body, to direct the civil administration* of an army. Francis I., having experienced the signal inconvenience of mer- cenary troops, essayed the formation of a na- tional army.* This innovation on the mili- tary feudal system was much improved during the reign of Henry IV. During the reign of Louis XIV. the military institutions rapidly approached perfection. The Revolution availed itself largely of all the improvements adopted or prepared in the last years of the monarchy, and substituted for the militia and voluntary enrolment the levy en masse and the military conscription. The law of 18 Fructidor, year 6, declared that the services of all citizens were due to the state. By the law of 1832, ex- plained and illustrated by the laws and minis- terial instructions of 1840 and 1857, numerous causes of exemption were admitted, substitutes authorized, and the bounty to volunteers with- drawn. At present the French army is re- cruited by conscription and by voluntary en- gagement.f The council of revision is the * Didiot, Code, &o. op. cit. p. 414. f HsW. p- 439. 152 METHODS OF KECEUITING AN ARMY. tribunal charged with the supervision of the recruiting service, to hear excuses, and to judge in public session the causes of exemption. The council is composed, 1st, of the prefect, or the councillor of the prefecture, as presi- dent; 2d, of a councillor of the prefecture; 3d, a member of the general council of the department; 4th, a member of the council of the district, — all of Avhom are named by the prefect; and, 5th, a general or superior officer designated by the Emperor. Besides these, a member of the intendance m ilitaire, who repre- sents the,, Government, has a consultative voice ; the sous-y)refet of the district, who keeps the reckoning of the young conscripts; and, lastly, the physician who makes the ex- amination and ascertains the case of infirmity. The commandant of the depot of recruits attends the council of revision at their circuit ; he takes note concurrently with the general officer and the scms-intendant of the aptitude, the height, profession, and physical constitu- tion, of the conscripts. The military surgeons who accompany the council of revision are chosen by the prefect, upon the indication of the division intendants, from among the physicians of corps or military METHODS OF RECRUITING AN ARMY. 153 hospitals, who can be diverted habitually for this service.* The decisions of the council of revision are fixed and irrevocable. The conscripts who are proclaimed free by the president are definitely liberated from that contingent, but may be- come the object of another decision by the council. The strength of the Prussian army is main- tained exclusively by involuntary levies. Every Prussian who has passed the age of twenty has been a soldier, or he is furnished with a medical certificate showing that he labors under an infirmity which disqualifies him for military duty. After a man has served three years in the standing army, he is transferred to the militia, a branch of the mili- tary force which is called out annually for a period of fourteen days. On reaching thirty- two years of a,ge, he is transferred to another class of militia (the landwehr), a branch of the militia which is never embodied except in case of emergency. The physical defects which disqualify for service in the Prussian army are in almost all respects the same as those given in that part of this work describing the disqualifications for service in our army. * Didiot, Code, &o. op. cit. p. 440 et seq. 154 METHODS OF RECRUITING AN ARMY. Distinctions are made as to tbe qualifications of recruits for different arms of the service. The standard for the infantry arm is the highest. Kecruits who are unfit for the general duties of the service are sometimes approved for garrison and veteran battalions. The British army is recruited by voluntary enlistment. The ranks of the army are filled up from the lowest orders of society, because there are no opportunities for promotion and therefore no inducement for men of good social position and education to enter. Some gratuity is necessary to induce men to enlist ; and for this purpose three kinds of remuneration are offered to the soldier : first, a sum of money to act as aii immediate inducement to enlist ; secondly, a daily rate of remuneration, as nearly as possible equivalent to the ordinary wages of labor ; and, thirdly, a prospective pro- vision after a fixed period of service.* Kecruits are enlisted either by a regimental recruiting party, or under the direction of the inspecting field-ofiicer of the recruiting district. The first are inspected by the medical officer in charge of the regiment or corps to which the * Treatise on the Administration and Organization of the British Army, &c., Fonblanque. London ; longman, Brown, Green, Longman & Roberts, 1858. METHODS OF EECRTJITING AN ARMY. 155 man belongs, whose decision in regard to the qualification of the recruit is conclusive. The recruits enhsted under the direction of the recruiting staflf are examined at the place where they engage, and subsequently by the staff surgeon of the district. No recruit is finally approved until he be examined and re- ported eligible by the medical officer in charge of the regiment or the depot of the corps in which he has enlisted.* Formerly the service of a British soldier was unlimited, or till legally discharged. At present the period of service is ten years for the infantry, and twelve for the cavalry and artillery. The system of voluntary enlistment does not draw forth the best material of the countryj and Englishmen begin to discuss the propriety of a conscription when the necessities of the state may require a large increase of their standing army. An able and earnest writer upon the subject of recruiting for the army has stated that "so strongly have the evils and dangers of this state of things impressed themselves on the minds of thoughtful men, that one hears it said on every emergency, even by those from whom such opinions were * Marshall's Hints, &c. op. cit. p. 55. 156 METHODS OF RECRUITING AN ARMY. least to be expected, that we must have a con- scription. "There are, indeed, but two possible modes of obtaining a good and efficient army and of keeping it permanently on foot. One is the method of conscription; the other, the method of making the army a desirable profession for rational men."* The bounty offered for enlistment has varied at different periods, according to the necessities of the nation. During the Peninsular War the bounty rose, for the best class of recruits,. for the unlimited service to £23 17s. 6d., and for the limited service to £18 12s. Qd. In 1856, before peace had been declared, the bounty was £7. In the following year it fell to £2; but it is now fixed at£3.f During the wars of 1812 in which the British nation was engaged, the military and naval forces reached the large number of one million of men, — about one- twentieth of the then population of the islands. As the recruits for this large army were drawn almost exclusively from the manual-labor por- tion of the population, it is obvious that the Government entered into competition with the agricultural, mechanical, and manufacturing interests. With the increase in bounty there * Quoted by Fonblanque, op. cit. p. 246. f Ibid. p. 247. METHODS or RECRUITING AN ARMY. 157 was a decrease in the standard of qualification. It was impossible to maintain a high standard when the number of recruits required bore so large a proportion to the whole body of the population.* I have elsewhere quoted the opi- nion of Mr. Marshall as to the character of the recruits who joined the army of the Peninsula. I have been thus minute in giving the Eng- lish experience in raising an army, beeause our own experience has been similar. The system of voluntary enlistment and the inducements of bounty and advance pay have been followed by the same results here : the ranks have been filled, but the quality of the material has not been commensurate with the expenditure. The recruiting service for the regular army is conducted by the Adjutant-General, under the direction of the Secretary of War. The general recruiting service is for the army at large, and the regimental recruiting service for each regiment. Field-offi-cers are, detailed to superintend the recruiting districts, and lieu- tenants to take charge of the recruiting parties. Kecruiting officers are instructed not to allow any man to be deceived or inveigled into the service by false representations, but to explain in pei'son the nature of the service, the length * Fonblanque, op. cit. 14 * 158 METHODS OF RECRUITING AN ARMY. of the term, the pay, clothing, rations, and other allowances to which a soldier is entitled by law, to every man before he signs the en- listment. If minors present themselves, re- cruiting officers are required to treat them with great candor, to ascertain the names and resi- dences of their parents or guardians, if they have any, who will be informed of the minor's wish to enlist, so that they may make their ob- jections or give their consent. The consent of the parent, guardian, or master must be given in writing and witnessed ; and no person under the age of twenty-one is to be enlisted without such written consent. No man having a wife or child can be enlisted in time of peace without special authority from the Adjutant- General's Office. After the nature of the service and terms of enlistment have been explained to the recruit, the officer reads to him and offers for his signature the annexed declaration, which is appended to each coj)y of his enlistment : — "I, , desiring to enlist in the Army of the United States for the period of five years, do declare that I am — years — months of age ; that I have neither wife nor child ; that I have never been discharged from the United States service on account of disability or by 'METHODS OF EECRUITING AN ARMY.. 159 sentence of a court-martial, or bj order before the expiration of my term of enlistment ; and I know of no impediment to my serving hon- estly and faithfully as a soldier for five years." The forms of declaration, and of consent in case of a minor, having been signed and wit- nessed, the recruit is then duly examined by the recruiting officer and surgeon, and, if ac- cepted, the 20th and 87th articles o£ war are read to him, after which he is allowed time to consider the subject until his mind appears to be fully made up, before the oath is adminis- tered to him. As soon as practicable, and at least within six days after his enlistment, the following oath is administered to the recruit : — "I, , do solemnly swear, or affirm (as the case may be), that I will bear true al- legiance to the United States of America, and that I will serve them honestly and faithfully against all their enemies and opposers what- soever, and observe and obey the orders of the President of the United States, and the orders of the officers appointed over me, ac- cording to the rules and articles for the govern- ment of the armies of the United States." (See regulations of the recruiting service.) In recruiting under the several calls for volunteers to make up the quotas of the re- 160 METHODS OF RECRUITING AN ARMY. spective States, too frequently regiments have been filled up without examination of the men, and with little reference to the requirements of the recruiting regulations. The regimental recruiting, however, has since conformed more nearly to the regulations ; for it was early seen that these regulations were founded in the ne- cessity and fitness of things, and that although unsuitable or disabled men may fill up the rolls they cannot be made to do the duty of soldiers. The large bounties offered by the State authorities and the General Government, increased by the patriotism of private indi- viduals, so far from elevating the standard of the recruit, became a bounty for fraud. This method of raising an army proved so expensive, and so little satisfactory as to the character of the material, that the draft became necessary. Under the provisions of "the act for en- rolling and calling out the national forces," approved March 3, 1863, the United States is divided into districts, of which the District of Columbia constitutes one, the Territories one each, and each Congressional district one. The act provides for a board of enrolment for each district, to be composed of a provost- marshal " and two other persons appointed by the President of the United States, one of METHODS OF lipCRUITIiVG AN ARMY. 161 whom sliall be a licensed and practicing phy- sician and surgeon." "The 'boards of en- rohnent' are required to divide the district into sub-districts of convenient size, if they shall deem it necessary, not exceeding two, without the direction of the Secretary of War, and to appoint, on or before the 10th day of March next, and in each alternate year there- after, an enrolling officer for each sub-district, and to furnish him with proper blanks and in- structions; and he shall immediately proceed to enroll all persons subject to military duty, and shall note their respective places .of resi- dence as they will be upon the 1st day of JTuly, 1863, their color, whether white or black, and their occupations, respectively." The national forces thus enrolled are divided into two classes : the first of which comprises all persons subject to do military duty between the ages of twenty and thirty-five years, and all unmarried persons, subject to do military duty above the age of thirty-five and under the age of forty-five ; the second class com- prises all other persons subject to do military duty. The second class are not to be called into service until the first class shall have been called. All persons drawn in the draft are notified i-t* 162 METHODS OF RECRUITING AN ARMY. of the same within ten days thereafter by a written or printed notice, to be served per- sonally or by leaving a copy at the last place of residence, requiring them to appear at a designated rendezvous to report for duty* Section 2 of the enrolment act "provides that the following persons be, and they are hereby, excepted and exempted from the pro- visions of this act, and shall not be liable to military duty under the same, to wit : such as are rejected as physically or mentally unfit for the service; also, first, the Vice-President of the United States, the judges of the various courts of the United States, the heads of the various executive departments of the government, and the Governors of the several States. Second, the only son, liable to military duty, of a widow dependent upon his labor for support. Third, the only son of infirm or aged parent or parents, dependent upon his labor for sup- port. Fourth, where there are two or more sons of aged or infirm parents subject to draft, the father or, if he be dead, the mother, may elect which son shall be exempt. Fifth, the only brother of children not twelve years old, having neither father nor mother, dependent upon his labor for support. Sixth, the father * Regulations of Bureau of Provost-Marshal General, op. cit. METHODS OF RECRUITING AN ARMY. 163 of motherless children under twelve years of age, dependent upon his labor for support. Seventh, where there are a father and sons in the same family and household, and two of them are in the military service of the United States, as non-commissioned officers, musicians, or privates, the residue of such family and household, not exceeding two, shall be consi- dered exempt. And no persons but such as are herein exempted shall be exempt." "The substitute whom any drafted person is authorized to furnish by section 13 of the enrolment act must be presented to the board of enrolment, and it shall be the duty of the board to examine him, and, if accepted, to place his name on the book of persons drafted, with explai^atory remarks." The commutation price for exemption au- thorized by the law is $300 ; but the discharge furnished by the board of enrolment releases the conscript from no further liabilities than "this particular draft." The object of these provisions of the en- rolment act, and the regulations of the Bureau of the Provost-Marshal General founded upon them, is to secure an efficient army with the least possible expenditure of the life of the nation. There can be no question, I think, 164 METHODS OF RECRUITING AN ARMY. that this object is closely approximated to, if not actually attained. It is obviously im- possible to frame a conscription act which shall bear equally upon all classes. In the present order of things, there must be those upon whom the defence of the state devolves more immediately as a personal effort whilst to others it becomes an expenditure of sub- stance and treasure. Moreover, as our ex- perience in great wars and internal convul- sions is limited, we must copy from those to whom great armies have become a necessity, satisfied if we may adapt their regulations to our own case with moderate success. EXAMINATION OF EECKUITS. 165 CHAPTER II. EXAMINATION OF RECRUITS. The governments of all civilized nations, especially those to whom large standing armies have become a necessity, are fully alive to the great importance of the judicious and careful examination of recruits. The importance of this examination has a twofold aspect, — as a pecuniary question and as a military necessity. The Austrian regulations say that "the duty of inspecting conscripts and recruits requires the utmost skill, impartiality, and circum- spection on the part of the medical ofl&cer." The Prussian regulations for the medical ex- amination of recruits set forth that "the duty of inspecting recruits and of determining whether they are fit or unfit for the military service of the country is one of the most dif- ficult and responsible a military surgeon has to perform. To enable him to execute it cor- rectly and with suitable promptitude, he would require more knowledge and experience than 166 EXAMINATION OF RECRUITS. is generally supposed : he must possess an in- timate acquaintance with anatomy, physiology, and pathology. A knowledge of these sciences is essentially required to qualify him to decide on the health and general efficiency of recruits, and to distinguish between defects that may be real from those that are only feigned." Dr. Fallot* says, "The duty of inspecting conscripts and recruits is not only an im- portant but a very difficult task, partly in con- sequence of the obscurity of the indications or symptoms of some disabilities. But to as- certain the existence or name of a disability is not the only difficulty a medical officer meets with : he has also to appreciate the disquali- fying degree of an infirmity, for the purpose of deciding upon the fitness or unfitness of a man for the army." It will be perceived from the abstract of the French regulations and the composition of the councils of revision, given in the preceding chapter, that the qualification of conscripts considered in respect to military as well as medical relations is made a subject of prime importance in the French military system. Paragraph 91 of the regulations of the bureau of the Provost-Marshal General says, * Memorial de I'Expert, &c., quoted by Marshall, op. cit. p. 37. EXAMINATION OF RECRUITS. 167 " The duty of inspecting men, and of deter- mining whether they are fit or unfit for the military service of the country, requires the utmost impartiality, skill, and circumspection on the part of the examining surgeon and board of enrolment ; for upon the manner in which this duty is performed will depend in very great degree the eflSciency of the army."' To insure the careful attention of the re- cruiting officer and examining surgeon, the re- cruiting regulations affix a pecuniary penalty for the negligent or careless performance of this duty. If a recruit be rejected, when he joins the depot or regiment, for a mental or physical defect which existed at the time of his enlistment, and which might have been discovered by proper care and diligence by the recruiting officer, or surgeon, they are held ac- countable for all the expenses connected with the enlistment. " The examination by the examining surgeon is to be conducted in the daytime, in the presence of the board of enrolment, and in a room well lighted and sufficiently large for the drafted man to walk about and exercise his limbs, which he must be required to do briskly."* * Par. 94, Reg. of Bureau of Provost-Marshal General. 168 EXAMINATION OF RECRUITS. " The man is to be examined stripped."* The recruiting regulations require that the recruit be sober when enlisted. He should be washed before coming into the inspection-room. The propriety of conducting the examination in daytime only is obvious, for at night many important defects might escape detection which daylight would reveal. The necessity for hav- ing recruits or drafted men stripjsed for ex- amination is so apparent that it would seem to be a work of supererogation to dwell upon it; but this regulation has been so frequently disregarded as to have become a gigantic evil. Early in the rebelUon, it happened to me to be present at the muster in of several regiments of volunteers, and to make the physical ex- amination of the men composing them. My duty consisted in walking through the ranks with the commanding officer, to point out those disqualified for military duty. I was not per- mitted to examine them stripped. During the progress of this hasty and most superficial ex- amination I saw not a few blind, some va- riously deformed, and others decrepit from old age, and found it necessary to reject so many that the commanding officer was constrained to expostulate vath me. " I know of several "" Par. 94, Beg. of Bureau of Provost-Marshal General, p. 95. EXAMINATION OF RECRUITS. 169 regiments," says Surgeon-General Hammond, "in which the medical inspection was per- formed by the surgeon walking down the line and looking at the men as they stood in the ranks."* I think it may be assumed that this was the usual practice when the first troops were raised in this war, as was also the case sometimes in the Mexican War.f Recruits or drafted men, actuated by motives of delicacy, may be disinclined to submit to an examination stripped. Such hesitation in a recruit may depend upon a concealed disqualifying infirm- ity, that he is unwilling to have exposed. In either case, the surgeon should inform the man that the practice of examining men stripped is invariable, that the ordeal will not last long, and that his secrets are kept inviolate. If the objection arises from timidity and deli- cacy alone, the surgeon should be kind in his manner, and patient, and not frighten a good recruit away by abruptness or indelicacy ; if it arise from supposed concealed defects, more thorough examination and scrutiny should be made. In practice it will be found more convenient to make the whole examination after the man * Treatise on Hygiene, op. oit. p. 19. f Examination of Recruits, Henderson, p. 79. 15 170 EXAMINATION OF RECRUITS. has been stripped. The clothes should be taken off in an apartment adjoining that ir which the examination is conducted. When- ever practicable, this room should contain facilities for bathing and washing, so that the recruit may present himself in perfectly cleanly condition. Whenever practicable, also, the examination of recruits, if in considerable numbers, should be conducted in three rooms en suite, — the first for disrobing and washing, the second for the examination, and the third for dressing. Whilst one is being examined, another may be got in readiness, and thus no confusion or interruption occur. It is import- ant that this first unpleasant experience of his new miUtary life may be rendered as little unpleasant to the drafted man as possible; that in undressing and dressing he niay not be exposed to the curious gaze of bystanders, and that he may feel that the persons whose duty it is to examine him do it in their official capacity in conformity to law. In the ordi- nary recruiting service the same precautions may be unnecessary; but kindness and deli- cacy are never expended in vain. The age, stature, and what may be styled' military aptitude of the recruit are determined by the military authorities. It becomes, then, EXAMINATION OF RECRUITS. 171 more particularly the duty of the surgeon to point out mental and physical disqualifications, real or pretended. To do this with certainty and success, he must have a uniform and pre- scribed course of examination, which shall de- velop latent defects of structure, deformities, or diseases. Uniformity of examination will promote facility and celerity, which are not unim- portant when large numbers of men are to be examined. But facility and celerity are less important than thoroughness. The duty must be well performed, if not quickly. When he enters the inspection-room, the recruit or drafted man should be required to walk briskly in a circuit around the room, increasing his speed with each turn, until he has made three or four rounds. He should then be halted, and made to hop the same circuit, first on one foot and then the other. In this way the surgeon will probably detect any defect of conformation or want of power of the inferior extremities. Immediately upon halting, the surgeon should place his hand upon the prsecordial region, to detect an ab- normal action of the heart which this exei-cise may develop. He should then be placed in -the position of a soldier under arms, with the 172 EXAMINATION OF RECRUITS. heels together and the .knees about an inch apart. "Whilst in this position, his head, ears, eyes, mouth, and nose should be examined, and the completeness of the performance of their respective functions carefully ascertained. His head should be examined for fractures, depressions, cicatrices, or diseases of the scalp. He should be tested as to the functions of hearing, of speech, and of sight, and as to the state of his intellectual faculties. The audi- tory canal should be looked into for foreign bodies, for discharges, for vegetations or tumors; the tongue, posterior fauces, palate, and teeth, for defects, loss of substance, mutilations, or tumors; the eye, for diseases of lid, of lach- -Tymal apparatus, of conjunctiva, of cornea, of iris, of lens, or of deeper structures. The whole contour of the head and the expression of countenance should be observed, to detect the physiognomy of epilepsy, imbecility, or insanity. Next the neck should be examined for goitre, or other tumors, for cicatrices of old abscesses or burns, and for the integrity of the larynx or trachea. Next, in imitation of the recruiting sergeant or examining surgeon, the recruit should be required to stretch out his arms at right angles with the trunk of his body, then to touch his shoulders with his EXAMINATION OF RECRUITS. 173 fingers and place the backs of the hands together over the head : in this position he should cough, whilst at the same time the surgeon's hand should be applied to the ab- dominal rings. The recruit Avill then extend his hands, and perform the motions of flexion and extension of the fingers, of pronation and supination of the forearm, the elbow being applied to the side, and the motion of circum- duction of the arm from the shoulder. The chest should, next, be explored with the utmost care ; its size, configuration, and expansive mobility should be noted, and search be made for diseases of the lungs, aneurisms or other tumors, and diseases or malformations of the heart. The abdomen should be examined for hernial protrusions, extensive cicatrices from incised wounds, for laxity of abdominal rings, for hypertrophy of organs, for tumors, or collec- tions of fluid in the peritoneal cavity. The testes and cords should be examined for chronic enlargements, varicocele, cirsocele, hydrocele, or sarcocele. The next step is to require the recruit to lean forward upon his hands and place his feet widely apart : whilst in this position, the sur- geon should separate the nates and examine 15* 174 EXAMINATION OF RECRUITS. for hemorrhoids, fissures of the anus, fistula in ano, or urinary fistula. The lower extremities should be examined with reference to extent of mobility or diseases of joints, for ulcers or old cicatrices, for nodes, caries, or necrosis, for aneurisms, for varices, or for malformations, deformities, or injuries of the feet. Each inferior extremity should be stood upon in turn, whilst all the joints of the other are being tested in all their motions; and the two extremities should, be compared as to size, length, symmetry, and mobility. An examination conducted in this way, if entered into with zeal, supported by a com- petent knowledge of anatomy, physiology, and pathology, can scarcely fail to expose all real and dissimulated infirmities and to develop the physical capacity of the recruit for the mili- tary service. QUALIFICATIONS OF RECRUITS. 175 ■CHAPTER III. QUALIFICATIONS OF RECRUITS. The standard of qualification for the mili- tary service varies usually with the necessities of the country. The limits of variation are, however, not very wide, for a certain degree of efficiency is absolutely essential to the sol- dier : below this none should be admitted ; whilst beyond, the qualities so much es- teemed, — good appearance, symmetry, and ele- gance of form, — although desirable, are by no means essential. The ideal which every ex- amining surgeon will probably form in his own mind, and by which, consciously -or uncon- sciously, he will judge the recruits who come before him, should not be formed after too complete a model. Under the operation of the enrolment act the same standard of effi- ciency may not be necessary as in recruiting for the regular armyj for in the one case the ser- vice may not last longer than one, two, or three years; whilst in the other it extends 176 QUALIFICATIONS OF BECEUITS. over five. Moreover, drafted men may be clas- sified, as is done in the Prussian army, and assigned to different arms of the service, ac- cording to the especial fitness of their physical qualifications. Dr. Tripler*is of opinion "that the only safe rule is to insist upon a sufficient integrity of all the organs to enable a man to endure the greatest hardships for a severe campaign ; and if the recruit is capable of this he is as fit to be enlisted for life as for three months." Whilst it seems to me this opinion is much too strongly stated, there can be no doubt that the lowest standard of physical efficiency required for military service is -not separated by many intermediate degrees from the highest. The examining surgeon of drafted men should reject all those who do not come up to the lowest standard; but the examining surgeon of recruits for the regular army may reject all who do not come up to the highest. For instance, the regulations of the army fix the minimum height of the recruit at five feet three inches; but neither the enrolment act nor the regulations of the Bureau of the Pro- vost-Marshal General have established a rule as to stature : hence, if a drafted man were pre- * Manual for the Recruiting Service, p. 31. QUALIFICATIONS OF RECRUITS. 177 sented five feet one inch in height, and other- wise physically capable, he must be accepted. The chief physiological characteristics to be attended to in the examination of recruits or drafted men are : a suitable age, a sufficient stature, and a just correspondence between weight and stature, a capacious chest, aptitude of the limbs, and a perfect condition of the organs of sense ; or, as they are tersely ex- pressed in the instructions of the Director- General of the British army, addressed to ex- amining surgeons, "a tolerably just proportion between the trunk and different members of the laody; a countenance expressive of health, with a lively eye ; skin firm and elastic ; lips red; teeth in good condition; voice strong; chest capacious and well formed ; belly lank ; limbs muscular; feet arched and of moderate length ; hands rather large than small."* Be- sides these physiological characteristics, there are certain other circumstances entering into the subject of the qualifications of recruits, as locality, occupation, race, — each of which affects either the health, stamina, or military aptitude. Age. — I have already discussed, in another section, the disqualifications due to youth or * Marshall, op. cit. pp. 4, 15. 178 QUALIFICATIONS OF RECRUITS. old age. The age for military service is fi;xed by the enrolment act for the minimum at twenty years and for the maximum at forty- five. Under the recruiting regulations the maximum age for a recruit is thirty-five and the minimum eighteen years. Marshall,* who had thorough knowledge of the qualifications of soldiers, derived from long experience in the British army, says, " The period during which a man's efficient service may be depended upon is limited to between twenty and forty years of age." There can be no doubt, I think, of the correctness of this opinion. When the draft comes to be enforced, the claims for exemption on the ground of age may prove a subject of great embarrassment to boards of enrolment. Paragraph 66 of the Regulations of the Bureau of the Provost- Marshal General says, " The board shall require the enrolling officers to judge of the ages of individuals by the best information they can obtain in each case, but always to make a decision as to whether the person in question is subject to enrolment, and, if so, in which class, and to enroll him accordingly. The board will decide questions of exemption on * On Enlisting and Discharging Soldiers, op. cit. p. 13. QUALIFICATIONS OF RECRUITS. 179 account of age, when brought before it under the law by the persons enrolled." Paragraph 83 further says, " The affidavit of the person claiming exemption must in all cases be re- quired to be supported by as much of the fol- lowing testimony as can be obtained or may be deemed requisite : — "1. By an authenticated extract from the legal registry of births, if there be any such registry. " 2. By any other authenticated documentary evidence tending to establish the fact of age. "3. By the affidavit of parents. "4. By the affidavit of such other respectable persons (not less than two), heads of families, as are most likely to be informed on the sub- ject." Circumstances may render such testimony difficult to be procured, or inadmissible from the character of the parties furnishing it.. Be- sides, in voluntary enlistments, in which testi- mony of this kind is not required, the ages of recruits may be concealed. In either event, the examining surgeon, as a professional ex- pert, may be required to judge of the age on physiological grounds. Are there any inva- riable marks by which a particular age may be distinguished? Adolescence is recognized by 180 QUALIFICATIONS OF RECRUITS. the size of the head, the straightness of the spinal column, the lack of d.eveloj)ment of the extremities, and the absence of the third molars, or wisdom-teeth. At puberty characteristic changes occur : the voice alters, the beard begins to appear upon the chin, and hair upon the pubes ; the body grows rounder and fuller ; the extremities become developed; and from seventeen to twenty-one the "wisdom-teeth" appear. This last characteristic is the most specific sign of adult age. The bones at this period become thicker, the joints stronger, the shoulders broader, and the muscles firmer and more expanded ; the fat of the cellular tissue increases, and, as life progresses, corpulency sometimes supervenes ; but frequently, also, the fat which had accumulated begins to dis- appear at the middle period of life. Frequently the extremities, face, and neck become thinner, and the abdomen protuberant. Wrinkles on the forehead, and " crows'-feet" about the eyes, are amongst the earliest indications of ad- vancing age. Further, the muscles become less plump, the skin is disposed in folds, espe- cially about the neck, the generative organs become more relaxed, the integument of the scrotum more distensible, and the hair about the temples begins to turn gray. The change QUALIFICATIONS OF RECRUITS. 181 in the color of the hair is the least decisive of these signs, for in some families, and as a result of disease or various excesses,- the hair becomes gray at a very early period, and there- fore is not always an indication of age. At about forty-five, and occasionally earlier, the arcits senilis appears in some subjects in one or both eyes. Some persons arrive at the maximum of development much sooner than others, although living under the same external conditions, due to original differences in constitution. They also decline earlier. Some youths are more mature at eighteen than many adults at twenty- one. The divisions into periods of life by the years of existence are, therefore, arbitrary. They do not admit of universal application. The examining surgeon will, consequently, be influenced by the physiological phenomena of evolution or decay in the formation of his opinion as to the qualification of a recruit, and will not depend entirely upon the number of his years. Stature. — The standard height has varied in our service from five feet six inches to five feet three inches : it is at present fixed by regu- lation at the latter. The question of stature is not at all considered in the enrolment act, — • w 182 QUALIFICATIONS OF BECEUITS. the determination of the physical capacity of the recruits being left to the judgment of the surgeon. This is, probably, wise. The stature to a limited extent only is a measure of the physical power of the soldier. Great stature, without corresponding weight and develop- ment, as well as diminutive size, is an abnor- mity. Uniformity of height, with lofty stature, are matters of great moment in European armies, especially in royal and household troops, where splendor of appearance is the most important part of their use ; and these pleasing externals of the military profession may be regarded in the selection of recruits for our permanent military establishment ; but necessity and efficiency are the only questions in connection with the height of drafted men. The standard for the British service — five feet five inches — is the highest adopted by any European nation. The French is five feet one inch (one metre, 56 millimetres). When the soldiers of the two armies were serving side by side in the Crimea, the French appeared equally if not more capable of enduring the almost unprecedented fatigues of that famous siege. In a series of 1439 town and country re- cruits examined in the London district, QUALIFICATIONS OF RECRUITS. 183 106 were from 5 feet 5 inches to 5 feet 6 inches. 658 il *^ 5 " 6 ' " 5 " 7 " 326 5 " 7 ' " 5 " 8 " 178 5 " 8 ' " 5 " 9 " 86 5 " 9 ' " 5 " 10 " 57 X_ _ -• -_ 5 "10 n ' " 5 " 11 " J -1 T • Twenty-eight were from 5 feet 11 inches to 6 feet 6 inches and upwards.* A stature less than 5 feet 5 inches does not appear on the above table, because no recruits are accepted in the British service below that height. In a seriesf of 1000 French soldiers there were 62 of 5 feet 1 inch. 156 " 5 " 2 inches. 187 " 5 " 3 " 178 " 5 " 4 " 152 " 5 " 5 " 107 " 5 " 6 " 69 of 5 feet 7 inches. 49 " 5 " 8 22 " 5 " 9 9 " 5 " 10 5 " 5 " 11 2 " 6 " The great superiority of the British army in respect to stature is clearly shown by the above tables ; but, as already intimated, the French soldiers are not therefore less efficient and en- during. The stature of recruits presenting for enlist- ment in our service, and of drafted men, will vary with the nationality, with the locality in which enrolled or enlisted, and with the occu- * Marshall on Enlisting and Discharging Soldiers, op. cit. p. 5. f Quoted on authority of M. Hargenvilliers, Hammond, op. cit. p. 28. 184 QUALIFICATIONS OF RECRUITS. pation. "From the record of the recruits re- ceived at Newport Barracks, Kentucky (the Western depot for recruits), for the years 1853, 1854, and 1855, it appears that the mean height of Feet. Inches. Americans enlisted was.... 5 8.06 Irish 5 6.92 Germans 5 5.15 Scotch 5 7.30 English 5 5.86 French 5 6.50* "The following table exhibits the mean height, in feet and decimals, of 1800 men, taken as they were entered upon the lists of recruits filed in the Adjutant's-General's OflSce. The results are given for one hundred men from each^ State":-]- — * Tripler's Manual, &c., op. cit. p. 12. t Medical Statistics of the United States Army, from 1839 to 1856, op. cit. p. 633. QUALIFICATIONS OF RECRUITS. 185 States. Indiana Kentucky..; Ohio Tennessee Maine Vermont and N.Hampshire Massachusetts and Conn't. North Carolina South Carolina Alabama Virginia New York Pennsylvania New Jersey and Delaware. Maryland Illinois Missouri Six Feet Mban Height. AND ( OVER. Feot. 5.7604 18 5.7729 18 5.7537 15 6.7779 18 5.7314 11 5.6951 6 5.6821 5 5.7814 24 5.7729 15 5.7647 17 5.7488 15 5.6505 4 5.6756 5 5.6509 6 5.7130 9 5.7696 17 5.7162 8 Greatest Height. Feat. Inches. 6 4i 6 3| 6 Si 6 6 6 6 6 6 6 6 6 6 6 6 6 6 3 2 1 3 3f 4 2 li 1 1 2 3 li Six hundred soldiers, in a general hospital under my charge, representatives of a large number of regiments, were measured as to stature with the following results : 568 were above the regulation standard, and only 32 below it. Of those above the regulation stand- ard there were 56 from 5 feet 3 inches to 5 feet 4 inches. 77 ft 5 " 4 it " 5 " 5 92 H 5 " 5 n " 5 " 6 109 n 5 " 6 *' " 5 " 7 87 a 5 " r il " 5 " 8 41 " 5 " 8 (( " 5 " 9 54 " 5 " 9 (t " 5 "10 33 it 5 "10 it " 5 " 11 15 " 5 "11 it " 6 " 4 " 6 " ti " 6 16* " 2 186 QUALIFICATIONS OF RECEUITS. The general average thus appears to be con- siderably above the average of stature in armies of Continental Europe. Notwithstanding this result, it is question- able whether our American soldiers are more physically capable of enduring the fatigues of war. "In general," says the Aide- Memoir e, "men not very tall, and otherwise well built, resist better the fatigues of war, and are more active, than the very tall." All medical officers who have served with troops in the field must have observed the superiority of men of middle height in respect to endurance and activity. The reason of this is obvious. Very tall men usually present evident defects of conformation. The increased height is produced by the undue development of the lower limbs, and is not accompanied by corresponding development of the chest, which is often narrow and con- tracted : rarely is there increased length of the body. Not Only is a man of great stature easily fatigued, because the levers he has to move are longer, and the muscles less developed, but he breaks down more readily under diminished supplies of nutriment, because he requires more for his subsistence than his smaller com- rade. I think it will be found as a rule that men of six feet two inches and upwards are QUALIFICATIONS OF RECRUITS. 187 more objectionable than men of five feet one inch, or even five feet. It is not uncommon to see in our volunteer regiments men of five feet who have undergone without flinching all the hardships of this war. The proportion of men of six feet and upwards in our hospitals suffer- ing from diseases — chronic dysentery and diar- rhoea, hemorrhoids, &c. — ^is much greater than men of medium height. The height of a recruit is determined by the recruiting officer. The real height often differs materially from the apparent. A small recruit, very anxious to enlist, may increase his height by artificial means, of which there are some curious instances on record; a drafted man may wish to diminish his real height so as to fall below the standard. By cutting his. hair close to his head, and removing the thick cuticle from the soles of the feet, by flexing the head forward a little, protruding the abdo- men, and slightly bending the knees, a man, without being detected, may lessen his appa- rent height a half an inch or more. When- ever there is a suspicion of fraud, the recruit ehould be measured extended on his back. In fifty-two recruits measured by Mr. Marshall with the same standard, with the view of de- termining how much the horizontal length of 188 QUALIFICATIONS OF EECRUITS. a man exceeds the perpendicular height, in 5 the horizontal length exceeded the perpen- dicular height i of an inch ; in 5 the hori- zontal length exceeded the perpendicular height f of an inch ; in 13 the horizontal length ex- ceeded the perpendicular height i of an inch ; in 14 the horizontal length exceeded the per- pendicular height i of an inch; in 15 there was no appreciable difference. In the examination of recruits or drafted men, height is to be considered in connection: with weight, muscular and osseous develop- ment, and capacity of thorax. Weight. — That weight which is at once an evidence and a measure of physical power must not be confounded with obesity, which is a diseased state. There should be a just corre- spondence and proportion between the age, stature, and weight of a recruit. A man at twenty years of age should weigh not less than one hundred and twenty-five pounds; and for every inch of height above five feet five inches his weight should increase five pounds (Ham- mond.) Neither the recruiting regulations, nor the regulations of the Bureau of the Pro- vos1>Marshal General, have established any rules as to a minimum or maximum weight. Within the limits already indicated, weight is QUALIFICATiONS OF KECRUITS. 189 a better standard of physical power than stature. Every recruit or drafted man pre-, sented for enrohnent, who does not evidently conform to a proper standard of weight, should be placed upon a platform scales, with which every recruiting rendezvous should be fur- nished. The minimum weight should be esta- blished by regulation. In recruiting under the enrolment act, there can be no question that a man vreighing less than one hundred and ten pounds, and five feet in height, should be exempted. Recruits for the regular mili- tary establishment, five feet three inches high, should not be admitted weighing less than one hundred and twenty pounds. Men reaching the regulation stature of less weight than this have either some constitutional tendency to disease, or have been exposed to depressing influences retarding growth and development. The preponderance of height of American soldiers is counterbalanced by deficiencies of weight. It is said that our national habit of tobacco-chewing is a potent cause of the na- tional leanness. It undoubtedly interferes with both primary and secondary assimilation. The use of tobacco is a most prevalent habit in the army. In a hospital under my charge, con- taining at present eight hundred and thirty- 190 QUALIFICATIONS OF RECRUITS, six patients, five hundred and fifty-eight use tobacco in some form, — many of them immode- rately. The dryness of the climate has some- thing to do with the thinness of Americans. Americans of medium height, and stoutly and compactly built, are undoubtedly better sub- jects for the military service than the tall. Besides the question of the physical qualifica- tion of men of small weight, there are certain mental phenomena due to size worthy of being considered. Small men, as a rule, are more cheerful, active, and enterprising than large men; to the extent of their capacity, they endure hardships and fatigue with more cheer- fulness, and recover with more promptness from the depressing influences of defeat. The maximum as well as minimum weight should be definitely fixed by law or regulation. Excessive obesity is contained in the list of disqualifications for military duty. Under or- dinary conditions of stature and development, no man weighing more than two hundred and twenty pounds is fit for active military ser- vice. "The expression 'strong constitution,'" says the Aide-Memoire, "is sometimes deceptive when applied to an individual who is remark- able only for predominance of the lymphatic and muscular systems. In fact, it often hap- QUALIFICATIONS OF RECRUITS. 191 pens that the athlete of herculean frame pre- sents organic affections which render him un- suitable for military service, and which an attentive examination only will reveal." Capacity of Thorax. — The vital capacity of the chest is one of the best indications of the physical power of an individual. A nar- row and contracted or malformed chest is usually associated with the strumous diathesis, with diseases of the contained viscera, or is an evidence of feeble constitution or want of stamina. The researches of Mr. Hutchinson,* who has furnished nearly all our information on this subject,, have developed some very curious and interesting results. His methods of investigation are too elaborate to be used in the ordinary examination of recruits ; but his conclusions are capable of a very valuable ap- plication. Every recruiting rendezvous should be supplied with a graduated tape, or one of Sibson's chest-measurers.f The spirometer of Hutchinson requires too much careful mani- pulation to make it useful; and the results determined by it are affected by the height and weight, by the manner in which inspira- * Article Thorax, in Cyclopaedia of Anatomy and Physiology, t Figured in Bennett's Principles and Practice of Medicine, and in Hammond's Hygiene. 192 QUALIFICATIONS OF EECKUITS. tion and expiration are accomplished, by the muscular force and other circumstances. The chest-measurer, or the simple graduated tape, will determine all the questions as to the capacity of the thorax necessary to be deter- mined by the. examining surgeon. A more convenient method consists in measuring the distance between the nipples with a pair of dividers, or a graduated rule, and multiplying the result by four (Hammond). If one side of the chest is to be measured for the purpose of comparison, one end of the graduated tape should be placed on the sternum midway be- tween the nipples, and the distance measured between this point and a spinous process of a vertebra on the same plane. The quantity of air which can be expelled from the lungs by a forcible expiration, after the deepest inspiration that can be made, is named by Mr. Hutchinson the "vital capa- city." He found that, at a temperature of 60° F., 225 cubic inches is the average vital capa- city of a healthy person five feet seven inches in height. For every inch of height above this standard the capacity is increased on an average by eight cubic inches j and for every inch be- low it is diminished to the same amount. The capacity of the chest is determined mainly by QUALIFICATIONS OF RECRUITS. 193 the mobility of the walls of the chest ; but why this mobility should increase in a definite ratio with the height of the body must be difficult of solution, since the height is chiefly deter- mined by the length of the legs, and not by the length of the body or depth of the thorax. This curious result arrived at by Hutchinson, and confirmed by Surgeon-General Hammond and various other observers, is called in ques- tion by Surgeon Tripler,* who says, "Our ob- servations have led us to the conclusion that the mobility is rather inversely as the circum- ference of the chest than directly as the height of the person, — as if increased mobility were designed to make up for a less capacity, as indicated by a less diameter : so that the quan- tity of air consumed does not difier greatly in different men with healthy lungs, whatever may be their relative stature." For every inch of height the minimum chests increase half an inch, the medium chests some- what more, and the maximum chests five- eighths. The extent of mobility of the thorax is a tolerably accurate measure of the respiratory power or vital capacity. To ascertain this, the * Manual, op. cit. p. 22. 17 194 QUALIFICATIONS OF RECEUITS. chest is measured — 1st, when expanded to its utmost capacity; 2d, when the air has been as completely as possible expired. The difference is the extent of mobility. The tape should be applied immediately above the nipples (Hutchinson) , or over them (Hammond) . Mea- sured at this point, the extent of mobility varies in healthy persons from two to four inches. Dr. Tripler* objects to this position of the tape. "Now, by passing a tape around the chest above the nipples, when the arms are extended above the head (as they ought to be), the mar- gins of both the latissimus dorsi and pectoralis major muscles will be included, as well as the fatty development of the breasts themselves ; this will give an increased measurement to the parietes of the chest ; and, when a forced inspi- ration and expiration are made, the swelling and relaxation of these muscles will give an apparent mobility greater than real. We mea- sure the circumference of the chest by passing the tape around it immediately at the point where the border of the latissimus dorsi springs from the trunk. The tape will then be found to fall generally below the nipple. In this way we find the mobility of the chest is usually * Manual, op. cit. p. 23. QUALIFICATIONS OF RECRUITS. 195 two and one-half inches, and seldom exceeds three. Once only have we found it four." I confess it does not seem to me clear how this mode of measurement can better ascertain the mobility of the chest, or produce results dif- ferent from those obtained by other observers. The average degree of mobility is three inches; and two inches should be considered the mini- mum for military service. Less than this indicates actual disease, or a decided tendency thereto. Hammond is of opinion that no recruit, in whom the circumference of the chest imme- diately over the nipples measures less than half the height, should be accepted. For the purpose of ascertaining the mean girth around the chest of men of different heights. Dr. Balfour, staff assistant surgeon, while he was acting in London as district sur- geon, measured 1439 recruits, and constructed the following very interesting table : — 196 QUALIFICATIONS OF EECEUITS. 1^ *s J r^ th CTJ CO o -^ CO o CO sg P o ■^ t-- 05 o 1—1 CO o CD ll fl s c4 M M cq* CO CO CO 0^ cq o CO CO 00 CO CO CO CO CO CO . t3 CO CO o X) CD iO cq cq o e4 O fl t* r- ^ 5 o ^ cq t— 00 o CI CO ^ i fl T-( CD CO 1— ( - ^ rH a ■« ^ s CD o CO CO t-- 1— < o o Oi « o o CO QO 1—1 1— ( iO 00 o o OS M V V £ a rd 4 csi oi CO* CO CO CO iO CO cq' « ■5 = CO CO CO CO CO CO CO CO CO tH . -« d fl o t* CO ^- CO CO cq 1-H 1-1 ^ 1 (d ; t^ -^ o t-^ to CD o C5 5^ -a fl CN c4 CO CO* CO co' CO CO cq" M CO CO CO CO CO CO CO CO CO o o 1^ M "S CO CO CO CD CO CO CO 1-* o .a cq CO o O C<) 1—1 CD (N 1—1 Ttl 1 ° O -* Oi CO 1-H Oi ''JH o o cq w p o iO 00 lO en o o (N ID d ^ ci w ci ci d" cq* CO cq' c^ ai ■5 " O CO CO CO CO CO CO CO CO CO ^ 'at d d CO C5 t^ a CO t- o 1-1 OS !=> « o 1^ M 1-- CO cq r-t o o CO w 00 Oi o 1—1 ^ S tj ^ IC >o o in o o la g QUALIFICATIONS OF RECRUITS. 197 In one hundred and fifty recruits examined by Dr. Tripler, the height ranged from five feet four and a half inches to five feet eleven and a half, and the circumference of the chest varied from 29.5 inches to 38 inches, and the mobility from two to three inches. The mean circumference was 33.97 inches. The least circumference was in the tallest man, and the greatest in a man five feet eight and a quarter inches. Assuming that the circumference of the thorax should equal one-half the height, a man five feet three inches should measure around the chest thirty-one and a half inches. In practice, this rule for ascertaining the rela- tive capacity will be found of great utility. For every inch of increase in height there should be an increase of half an inch in the girth of the chest. No man should be enrolled or enlisted having a less circumference of the chest than thirty inches. Besides the determination of the capacity, measurements should be directed to ascertain the symmetry and correspondence of the two sides of the thorax. Aptitude of the Limbs. — Aptitude does not necessarily include symmetry. The first de- pends upon development of bones and muscles, including bony and muscular prominences, fre- 198 QUALIFICATIONS OF EECKUITS. quently in striking contrast to the second. The lateral sections of the body are more sym- metrical than the inferior and superior parts. The right arm is usually thicker and more developed than the left in right-handed pei"- sons, — due of course to greater use ; but there is no appreciable difference, usually, in the in- ferior extremities. The inferior extremities are sometimes so large and cumbrous as to be out of proportion to the body and upper extre- mities, constituting a serious defect of conform- ation. It is especially important that the joints be mobile, and capable of performing all their functions. Without any obvious defect of structure, sometimes the hands and fingers have lost their mobility from long application to certain employments, as in shoemakers, day- laborers, &c. The same imperfection of motion results in the lower extremities in some em- ployments. Each joint should be carefully tested to determine its integrity, in the manner heretofore indicated. CojsrDiTio]sr of the Organs of Sense. — No point in the examination of recruits is more important than this. A good recruit will have in perfection the use of the organs of sight and hearing. If the right eye be free from defects, QUALIFICATIONS OF EECRUITS. 199 minor aflfections of the left may not be a cause of rejection or exemption from service. There are congenital irregularities and deficiencies of the iris unsightly enough to constitute a de- formity, yet not impairing function : these would not interfere with the usefulness of the man ; and hence that surgeon would ill dis- charge his duties who considered them dis- qualifications. But the eyes are organs so essential that the utmost care must be exer- cised in testing their integrity. This care is particularly necessary in determining exemp- tions for short or long sight. The function of hearing, though less import- ant than sight, should be unimpaired. A sol- dier needs to hear quickly as well as accu- rately. The examining surgeon should test this faculty by talking in a high and in a low tone, to ascertain the degree of sensitiveness and accuracy of the organs. The two func- tions of sight and hearing should in the perfect soldier have their fullest development. Expe- rience and use, but more than all necessity, educate these faculties; but the degree of per- fection which they may attain will vary in different individuals. The senses of taste and smell are much less important to the soldier. Their absence may 200 " QUAIJFICATIONS OF RECRUITS. indicate centric or eccentric lesions of nervous system of grave character, but otherwise would not be a subject for serious apprehension, ex- cept the consequent interference with some of the enjoyments of the soldier, or with his ability to discern certain kinds of injury to his health or constitution. There remains to be considered, under the head of the qualifications of recruits, the influ- ence of locality, occupaticm, race, upon the quality of the material offering for enlistment or becoming the subject of involuntary levies. In a country such as ours, having so great variety of climate and soil, numerous trades and professions, and representatives of many nationalities and races, these questions of lo- cality, occupation, and race have an immediate interest and importance to the subject in hand. Locality affects the question of the suitable- ness of a recruit in respect to the hygienic conditions to which he has been subjected, and the influence of these conditions upon his health and stamina. In the English service important distinctions are made between town and country recruits, preference being had for the latter, owing to their superiority in de- velopment. This superiority is exhibited, not in height, — for the great social statist M. Vil- QUALIFICATIONS OF RECRUITS. 201 lerm6 has shown that in this respect the in- habitants of cities are superior, — but in the development of the chest and extremities, and in power of endurance. Wherever large num- bers of human beings are crowded together in small spaces, as in cities, the general standard of health and physical efficiency be- comes lowered. " For the whole of France," say Maillot and Puel,* "the average of exemp- tions for feebleness of constitution is 189 per 1000; but for the sixth group [Champagne) it is 292, and 290 for the seventh [Lorraine- Alsace). It clearly results, therefore, that in those parts of the country where the popula- tion is very dense, the industrial interests act- ive, and the civilization has attained a high development, there are a greater number of individuals of weak constitution." The character of a given locality as to pro- ductiveness of the soil influences the physical development. Poverty and wretchedness stunt the growth and impair the strength and act- ivity. Abundant food, cceteris paribus, in- creases the size and stature. Luxuriance of living and idleness are as fatal to. the produc- tion of healthy men as poverty. The Gauls * Aide-M6moire, medico-legal, &c. op, cit. p. 7. 202 QUALIFICATIONS OF RECRUITS. (Belgge) and Teutonic nations were superior in stature and weight to the civilized Romans. Pastoral nations generally are more robust than manufacturing and mechanical. In the United States the influence of locality upon the physical qualities of recruits is seen more especially in malarious regions. Paludal poison, operating through several generations, lessens the reproductive capacity of a people, the size, weight, and stamina, and impairs the intellectual faculties. Goitre is becoming en- demic in some localities; and cretinism will appear at a period not very remote. Occupation comes more immediately to be considered than locality in the selection of recruits. Trades and professions requiring confinement in-doors, and the collection of large numbers of men in communities, have a very depressing influence upon the health and physical efficiency. Hence regiments raised from the cl'ass of artisans and mechanics are less efficient than those raised in the rural dis- tricts and composed of farmers. This is now witnessed on a large scale in our army, in the comparative endurance, stamina, and activity of regiments from different localities. The factories and workshops do not turn out such men as the lumbermen of Maine and Pennsyl- QUALIFICATIONS OF RECRUITS. 203 vania or the farmers of the Northwest. As a necessary corollary of lowered vitality we find less courage and enterprise. Men devoted to in-door occupations and to the peaceful arts are indisposed to face the dangers and are anxious to avoid the fatigues and hardships of war. Certain kinds of mechanics are ohjection- able, — tailors and shoemakers. Men who have followed these professions uninterruptedly for fifteen or twenty years, if they have entered them early in life, are commonly unfit for sol- diers. Permanent flattening of the thorax, and gibbosity, with diminished vital capacity, occur in these occupations. , Race.— The army of the United States con- tains representatives of many races and nar tionalities, differing widely in physical stamina and in aptitude for the military service. There are three principal types, — European or Cauca- sian, Negro, American ; the last-named in very insignificant numbers. The European type is composed mainly of the Saxon, Teutonic, and Celtic races, — usually variously commingled, and, after the lapse of several generations, forming a type distinctive pf the country. This is the type best fitted for warlike achievements, most intelligent, enduring, and having the 204 QUALIFICATIONS OF RECRUITS. highest standard of physical qualification. Moreover, the European has a capability of adaptation to climate greater than any other race. Besides the mixed European, which has gra- dually assumed national characteristics and is sometimes styled the American race, there are in our army many Germans, Irish, Scotch, and French, who preserve not only their native language and manners, but all the physical peculiarities of the races from which they have sprung. As far as my observation extends, the Germans are the least desirable recruits from this true foreign population. They are less capable of enduring fatigue, are more frequently the subjects of rupture, varicose veins, and deformities of the feet, and more addicted to malingering than either of the other races. Of all the soldiers presenting for enlistment in our service, the Irish are most capable phy- sically. Less in stature than Americans and less obese than Germans, they have usually greater muscular development, more capacious chests, tighter joints, and more abundant vi- tality than either of the others. The Scotch, of all the foreigners in our army, are the most efficient soldiers. They are not remarkable for considerable stature, weight, or QUALIFICATIONS OF RECRUITS. 205 symmetry, but for compact, sinewy, hardy frames, for contempt of fatigue and danger, and for steadiness and courage under fire, and impetuosity in a charge. The peculiarities of the French race, and their military qualities, have been so frequently alluded to in preceding pages that it is not necessary to enlarge upon them here. An estimate of the military qualities of the negro must necessarily be based upon his phy- sical and mental peculiarities. In the United States the pure African is rarely found. The mixture with the white elevates his intellectual power and gives symmetry to his form, but lowers his health and physical efficiency. Few negroes having admixture with white blood are free from scrofula, independently of locality. But, having a limited power of adaptation to climate, and being fitted by nature for a warm and humid atmosphere, he is unsuited to mili- tary service in cold latitudes, in which he soon falls a prey to scrofula, loses the power of re- production, and becomes extinct in a few years. Years of servitude, respect for authority, and the simplicity and enthusiasm of his nature, peculiarly fit the negro for habits of military discipline. He can be made a mechanical soldier to great perfection, skilled in the use 18 200 QUALIFICATIONS OF RECRUITS. of arms and the machinery of tactic, and, by reason of the obstinacy of his disposition and the depth of his passions, may become most powerful in a charge or in resisting the onset of an enemy. He can do httle of himself: he must have a head, which he at once fears and respects. In those military operations which require each individual to act for himself, the negro cannot be relied on. He is fitted for heavy infantry or for artillery, but not for light infantry, for skirmishing, or for outpost duty. In an examination of the physical qualifica- tions of negro troops, the surgeon's attention must first be directed to ascertain the degree in which admixture with white blood has lowered their health and stamina. The traces and evidence of scrofula must be examined into, if existing, and preference given, cceteris paribus, to the black. The aptitude of the limbs — especially the mobility of the fingers, the development of the forearm and of the calves of the legs, and the formation and condition of the feet — must be regarded. Splay feet and ill-developed calves are frequent in the negro. Convexity of the arch of the foot, decided in- ternal inclination of the inner malleolus, and turning out the toes, render many of this race unfit for service on foot. The rules given in QUALIFICATIONS OF KECEUITS. 207 foregoing parts of this Avork, for the rejection of recruits or drafted men for various disquali- fications, apply as well to the negro as to the white man. Besides the color of his skin, his prognathous jaws, shape of cranium, length of forearm, thinness of calves, and flatness of feet, there are no physical peculiarities making him him different from white men. The American race is represented to a most limited extent in our army, and the few found are half-breeds, semi-civilized. The Indians sometimes serve as allies j but their instincts and habits are entirely opposed to rules of war and discipline. The same physical results from the admixture of white and Indian races follow as in the admixture of the white and negro, — rapid degeneracy, and ultimately extinction. The pure Indian is greatly inferior to the white race in physical power, in weight, stature, and longevity. A considerable force of Spanish half-breeds was raised in New Mexico early in the rebel- lion, and I believe still continue in service. A more cowardly, mentally and physically inferior, and treacherous race can scarcely be found than this mixed Spanish-Indian population of New Mexico. Poverty, filth, disease, and here- ditary and slavish submission to their supe- 208 QUALIFICATIONS OF RECRUITS. riors have so far degraded the race as to render them unfit for military service. Their conduct at the only serious engagement into which they have thus far been led (at Valverde) justifies this opinion of their worthlessness. They have nothing in common, except language, with the illustrious conquerors of the New World from whom they are descended. An unprejudiced view of the various races and nationalities forming our army will disclose the fact, I think, that the fused European na- tionalities constituting what is now known as the North American race, and which begins to assume characters as distinct as those of the English, French, German, or Spanish races, is better fitted for military purposes than either or all of the representatives of foreign nations. Called out by involuntary draft, and sub- jected to a rigid inspection, which shall sepa- rate those too tall, the feeble, and those dis- qualified by infirmities, our army will present a splendor of physical appearance and develop- ment second to that of no other army in the world. SECTION IV. DISCHARGING SOLDIERS. CHAPTER I. GENERAL CONSIDERATIONS. Soldiers are discharged by reason of expi- ration of enlistment, on their own application after twenty years' service, by civil authority, by sentence of a court-martial, by order of the War Department or General-in-chief, or on surgeon's certificate of disability. Under the law of May 14, 1862, the Medical Inspector- General, or any medical inspector, has power to grant a discharge upon his own certificate, provided it is given after a "personal inspec- tion of the soldier and with the soldier's consent, and for a disability the nature, degree, and origin of which are correctly described in the certificate." By General Orders No. 137, War 18* 209 210 GENERAL CONSIDERATIONS. Department, May 18, 1863, "the power given the medical inspectors of the army to dis- charge soldiers for disability is suspended until their duties in this respect are defined by regulations, to be published hereafter.'' The giving a certificate of disability for dis- charge is one of the most important duties a military surgeon has to perform. Although his certificate is the ground of action, and not the authority to discharge, the military com- mander is governed in the exercise of his powers by the statements of the surgeon. The great importance of a correct and conscientious per- formance of this duty is sufficiently shown by the fact that up to May 9, 1863, there had been received at the Adjutanl^General's Office, Wash- ington, since the commencement of the rebel- lion, 143,303 certificates of disability. These were certificates upon which discharges had been granted in the usual way. But if to these be added the considerable number of irregular discharges, and those instances in which the certificgbtes have not been forwarded to the Adjutant-General, the aggregate of discharges on surgeon's certificate will probably reach the enormous number of 200,000. The magnitude of these results illustrates the great necessity for each surgeon to discharge his duty w ithf)ut GENERAL CONSIDERATIONS. 211 fear or favor ; for, although a disregard of his obligations may affect the aggregate result but slightly, there are a large number of surgeons with the same powers, the same temptations, and mayhap not a few with the same disre- gard of the duties and obligations of their office. The surgeon's first duty is to the United States ; his second, to the soldier. This is based upon the general principle that the welfare of a large number, of a conxraunity, or of a state is superior to the interests of individuals. When the rights of individuals conflict with those of the state, there can be no question as to which must be respected. Fortunately, in the discharge of soldiers for disability the respective interests do not conflict; for the right of a soldier to a discharge when disabled by wounds or disease is not less clear than that it is the interest of the United States to be rid of him. The formation of an^ Invalid Corps is seemingly opposed to this principle ; but in reality there is exact and equal justice in making those men useful who are not wholly disabled. They perform duties which would otherwise require the employment of sound men, for which they receive adequate 212 GENERAL CONSIDEEATIONS. pay, clothing, and subsistence, and are not the mere recipients of a public charity. Before giving a certificate of disability for discharge, the surgeon must decide upon three questions : — 1st. Does the alleged disability really exist? 2d. Is it incurable, or can it be cured within a reasonable period ? 3d. Is it sufficient to disable a man from the performance of military duty ? In many instances the surgeon will have to decide whether the disability is real. I have elsewhere treated at some length of the more usual forms of malingering in our service : it is not necessary for me to repeat what I have said on this subject; but I cannot repeat too often the injunction that no malingerer should be discharged on the ground of his pretended ailment. One case of successful imposture will increase by tenfold the number of men feigning. Simulators are too frequently suc- cessful by wearying the surgeon. When their own efforts fail, they bring to bear various influences, — the interposition and importunities of friends and relatives, and of company or regimental commanders anxious to be rid of troublesome men. I need hardly say that the surgeon cannot lend himself to the dig GENERAL CONSIDERATIONS. 213 charge of a man simplj because he feigns and will not do duty : he must certify to a physical disability sufficient to incapacitate for service, and this disability must have a real existence. The disease or disability must not only be real, but it must be either incurable, or cura- ble after so long a course of treatment as practically to deprive the Government of the soldier's services. The period for which a surgeon is justified in keeping a man in hos- pital rather than discharge him depends upon a variety of attendant circumstances : upon the length of his service, and upon his pro- ficiency in the drill ; upon the number of men required for military duty, and upon the facility with which men may be procured. If a man's period of service be nine months, and he have a disease or injury which will incapacitate him for service for six months, it will be better to discharge him, unless some special emer- gency may render his services necessary. The knowledge and experience of the soldier also affect the result; for, obviously, that man may be retained longer who can go from the hos- pital to the field without preliminary instruc- tion in the drill and in the duties of a soldier. The longer the period of service, the less numerous the voluntary enlistments, the more 214 GENERAL CONSIDERATIONS. thoroughly instructed are the men admitted into the hospital, and the more valuable their services to the Government. In the regular service, the period of enlistment being for five years, discharges should not be granted for curable diseases with the same facility as in the volunteer service. Ordinarily, in the regu- lar service certificates of disability should be given only for incurable disorders, injuries, or deformities. Is the disability sufficient to disable the man from the performance of military duty ? This is an important question, not easily decided. In a great variety of injuries, and in some obscure forms of disease especially, the deter- mination cannot be made with certainty, be- cause there are so many circumstances, whose precise importance cannot be estimated, influ- encing the result. These circumstances are the seat and character of the lesion, the degree in which the disability really exists, and the extent to which it is increased by the volun- tary efforts of the patient. In many instances there may be no difficulty whatever. The disease may be so well pronounced or so far advanced, and the wound or injury may be followed by such evident imperfections, de- formity, or loss of function, as in either case GENERAL CONSIDERATIONS. 215 to admit of no reasonable doubt of the soldier',s unfitness for military service. A disability completely disabling is more easily recognized than unfitness for field-service merely. In examining men for admission into the Invalid Corps, unfitness for field-service, and capability of performing the duty required of the Invalid Corps, are the questions to be determined. Previous to the organization of this corps, men unfit for field-service were almost inva- riably discharged. 210 INVALID CORPS. CHAPTER II. INVALID CORPS. Paragraph 10 of General Orders No. 36 of 1862, from the War Department, authorized the "chief medical officer in each city" (medi- cal director) "to employ, as cooks, nurses, and attendants, any convalescent, wounded, or feeble men who can perform such duties, instead of giving them discharges j" but this regulation, from causes which it is not neces- sary at this time to relate, proved to be inappli- cable, and was practically ignored. By Gene- ral Orders '69 of 1863, from the War Depart- ment, General Orders 36 of the previous year was modified as follows: — "At every U. S. general hospital, the feeble and wounded men unfit for field-duty, but not entirely disabled, instead of being discharged, will be organized and mustered in detachments under the charge of the officers acting as mili- tary commanders, who will assign men to them from time to time, on the reports of the sur- geons in charge of hospitals. From these INVALID CORPS. 217 invalid detachments the military commanders will make jjjetails for provost, hospital, and other necessary guards, for clerks, hospital attend- ants, nurses, cooks, and other extra-duty men. ****** " Should any of the men become fit for duty with their regiments, they will be immediately sent to join them." In these orders the formation of an Invalid Corps was foreshadowed ; but the separation of it from the company and regimental organiza- tion was not contemplated until the publica- tion of General Orders 105 of 1863, which authorized the organization of an "Invalid Corps," as follows : — " This corps shall consist of companies, and, if it shall hereafter be thought best, of batta- lions. The companies shall be made up from the following sources, — viz.: " First, by taking those ofBcers and enlisted men of commands now in the field (whether actually present or temporarily absent) that, from wounds received in action or diseases contracted in the line of duty, are unfit for field-service, but are still capable of effective garrison-duty, or such other light duty as m,ay be required of an invalid corps. 19 218 INVALID CORPS. " Second, by taking those officers and enlisted men still in service and borne on the rolls, but "who are absent from duty in hospitals or con- valescent camps, or are otherwise under the control of medical officers. :{: H: H< ^ ^ 4 " Third, by accepting those officers and en- listed men who have been honorably discharged on account of wounds or disease contracted in the line of duty, and who desire to re-enter the service." The officers and men of the first class must fulfill the following conditions : — "1. That they are unfit for active field- service on account of wounds or disease con- tracted in the line of duty," — this fact being certified by a medical officer in the service, after personal examination. "2. That they are fit for garrison-duty," — this fact being likewise certified by the medical officer, as above, after personal examination. "3. That they are, in the opinion of their commanding officers, meritorious and deserv- ing." This fact is certified on the rolls of such enlisted men or officers by intermediate com- manders. "The rolls of men for the Invahd Corps, prepared by commanders of convalescent INVALID CORPS. 219 camps, commanders of invalid detachments, and medical officers in charge of hospitals or depots of convalescents" (second source), "shall, as soon as made out, be forwarded to the ,Provost-Marshal General direct." (Gene- ral Orders No. 173, War Department, 1863.) The third requirement mentioned above is mainly applicable to officers. Obviously, the commander of a convalescent camp or depot of convalescents or general hospital has no means of arriving at accurate knowledge of the circumstances under which the wound or disabihty occurred, or of the meritorious cha- racter of the man. Men derived from the third source — viz.: "those honorably discharged on account of wounds or disease contracted in the line of duty" — must fulfill the following conditions : — " 1. The apphcant must produce the certifi- cate of the surgeon of the board of enrolment for the clistrict, that he is unfit for active field- duty on account of wounds or disease, and is not liable to draft, but is fit for garrison-duty. "2. He must furnish evidence of honorable discharge on account of wounds or disability contracted in the line of duty. "3. He must produce recommendations from the regimental, brigade, and division com- 220 INVALID CORPS. maiiders under whom he formerly served, that he is worthy of being thus provided for, and capable of returning adequate service to the Governnient." This requirement is intended to apply to invalid officers. "Enlisted men honorably discharged on account of disability, desiring to re-enlist in this corps, will present themselves to the board of enrolment for the district in which they reside, for examination by the surgeon thereof, who shall examine them and report the result to the board." If the applicant fulfill the conditions specified below, the board shall give him a certificate to that effect, viz.: — " 1st. That he is unfit for service in the field. " 2d. That he is fit for garrison-duty. " 3d. That he is meritorious and deserving. "4th. That he was honorably discharged from the service. " The acting Assistant Provost-Marshal General shall procure such evidence of service and good character as he may deem sufficient ; and, if satisfied that it is a meritorious case, and that the man is not intemperate, he will have him enlisted."* * Circular No. 21, Provost-Marshal General's Office, AVar Department, 1863. INVALID CORPS. 221 Garrison-duty, it will be seen, is the standard. Unfitness for field-service, acquired in the line of duty, and meritorious and deserving con- duct, are the conditions of admission. " Men enlisted in or transferred to the In- valid Corps will be subject to the' Articles of War, Army Regulations, &c., the same as other soldiers, and will be required to perform all duties within the limit of their physical capa- city, as laid down in the rules and regulations for that corps; but, for the convenience of service, they will be selected for two grades of duty. Those who are most efficient and able- bodied, and capable of using the musket, and performing guard-duty, light marches, &c. &c., will be assigned to companies of the first bat- talion. Those of a minor degree of physical efficiency, or who possess special qualifications as cooks, nurses, or clerks, and whose services are required in hospitals, will be assigned to the companies of the second battalion. "Companies of the first battalion will be employed mainly as provost-guards and garri- sons for cities, public buildings, and other im- portant points. They will be armed with muskets, and not liable to active campaigns with the field armies. " Companies of the second battalion will be 19» 222 INVALID CORPS. armed with side-arms only, and will be em- ployed in hospitals as cooks, nurses, clerks, orderlies, &c., and as guards to hospitals or other public buildings."* It is obvious that the second source of sup- ply for the Invalid Corps will be the principal one, — viz.: the general hospitals and convales- cent camps. " Medical inspectors, surgeons in charge of hospitals, military commanders, and all others having authority to discharge under existing laws and regulations, are forbidden to grant discharges to any men under their control who may be fit for service in the Invalid Corps." (General Orders No. 105, War Department, 1863.) By General Orders No. 173, War Department, 1863, General Orders No. 105 was so far modified as not to include officers in the prohibition to discharge any man on surgeon's certificate of disability who may be fit for service in the Invalid Corps. General Order 173 further requires that " hereafter, in giving discharges to officers and soldiers on account of disability, their discharge- papers must always state whether at the time of discharge the officer or soldier was or was not physically suitable to enter or re-enlist in * Extracted from General Order No. 212, 1863. INVALID CORPS. 223 the Invalid Corps." It will thus be seen that the surgeon has to determine the fitness of a man for the Invalid Corps as to his physical quali- ties : he has nothing to do with the question of the merits or demerits of the invalid. " The rolls of men for the Invalid Corps, re- quired by General Orders Nos. 105 and 173, current series from this Department, will state in each case the nature of the disability, and the battalion for which the men are qualified. " In all general hospitals and convalescent camps, these rolls will be prepared, and sent direct to the Provost-Marshal General, imme- diately after each regular muster. Convales- cents will be required to perform such hospital or military duty as they are capable of, until such time as the medical ofiicer in charge can decide finally whether they are fit for duty with regiments, for transfer to the first or second battalion of the Invalid Corps, or proper subjects for discharge on surgeon's certificate. " The physical examination of men for the Invahd Corps must be made by the surgeon in charge before they are reported to the Pro- vost-Marshal General."* * Extracted from General Order No. 212, 1863. 224 PHYSICAL INFIRMITIES NOT DISQUALIFYING CHAPTER III. PHYSICAL INFIRMITIES THAT INCAPACITATE EN- LISTED MEN FOR FIELD-SERVICE, BUT DO NOT DISQUALIFY THEM FOR SERVICE IN THE "IN- VALID CORPS." "In executing the provisions of General Orders No. 105, from the War Department, in' regard to the selection of men for the Invalid Corps, medical inspectors, surgeons in charge of hospitals, camps, regiments, or of boards of enrolment, military commanders, and all others required to make the physical examination of men for the Invalid Corps, will be governed in their decision by the following lists of qualifi- cations and disqualifications for admission into this corps :" — 1. Epilepsy, if the seizures do not occur more frequently than once a month, and have not impaired the mental faculties. 2. Paralysis, if confined to one upper extre- mity. 3. Hypertrophy of the heart, unaccompanied FOR SERVICE IN THE INVALID CORPS. 225 by valvular lesion. Confirmed nervous de- bility, or excitability of the heart, with palpi- tation, great frequency of the pulse, and loss of strength. 4. Impeded respiration following injuries of the chest, pneumonia, or pleuri^; incipient consuijiption. 5. Chronic dyspepsia, or chronic diarrhoea, which has long resisted treatment j simple enlargement of the liver or spleen, with tender or tumid abdomen. 6. Chronic disorders of the kidneys or blad- der, without manifest organic disease, and which have not yielded to treatment; incontinence of urine. Mere frequency of micturition does not exempt. 7. Decided feebleness of constitution, whether natural or acquired. Soldiers over fifty and under eighteen years of age are proper sub- jects for the InvaUd Corps. 8. Chronic rheumatism, if manifested by positive change of structure, wasting or con- traction of the muscles of the affected limbs, or pufl&ness or distortion of the joints. 9. Pain, if accompanied with manifest de- rangement of the general health, wasting of a limb, or other positive sign of disease. 10. Loss of sight of right eye ; partial loss 226 PHYSICAL INFIRMITIES NOT DISQUALIFYING of sight of both eyes, or permanent diseases of either eye affecting the integrity or use of the other eye, vision being impaired to such a de- gree as clearly to incapacitate for field-service. Loss of sight of left eye, or incurable diseases or imperfections of that eye, not affecting the use of the right eye, nor requiring i^edical treatment, do not disqualify for field-service. 11. Myopia, if very decided, or depending upon structural change of the eye; hemera- lopia, if confirmed. 12. Purulent otorrhoea ; partial deafness, if in degree sufficient to prevent hearing words of command as usually given. 13. Stammering, unless excessive and con- firmed. 14. Chronic aphonia which has resisted treatment, — the voice remaining too feeble to give an order or an alarm, but yet sufficiently distinct for intelligible conversation. 15. Incurable deformities of either jaw suf- ficient to impede, but not to prevent, mastication or deglutition. Loss of a sufficient number of teeth to prevent proper mastication of food. 16. Torticollis, if of long standing and well marked. 17. Hernia; abdomen grossly protuberant ; excessive obesity. FOE SERVICE IN THE INVALID CORPS. 227 18. Internal hemorrhoids ; fistula in ano, it extensive or complicated with visceral disease; prolapsus ani. 19. Stricture of the urethra. 20. Loss or complete atrophy of hoth testicles, from any cause ; permanent retraction of one or both testicles within the inguinal canal. 21. Varicocele and cirsocele, if excessive or painful ; simple sarcocele, if not excessive nor painful. 22. Loss of an arm, forearm, hand, thigh, leg, or foot. 23. Wounds or injuries of the head, neck, chest, abdomen, or back, that have impaired the health, strength, or efficiency of the sol- dier. 24. Wounds, fractures, injuries, tumors, atro- phy of a limb, or chronic diseases of the joints or bones that would impede marching or pre- vent continuous muscular exertion. 25. Anchylosis of the shoulder, elbow, wrist, knee, or ankle joint. 26. Irreducible dislocation of the shoulder, elbow, wrist, or ankle joint, in which the bones have accommodated themselves to their new relations. 27. Muscular or cutaneous contractions from 228 PHYSICAL INFIRMITIES NOT DISQUALIFYING wounds or burns, in degree sufficient to pre- vent useful motion of a limb. 28. Total loss of a thumb; loss of ungual phalanx of right thumb ; permanent contrac- tion or permanent extension of either thumb. 29. Total loss of any two fingers of the same hand. 30. Total loss of index finger of right hand; loss of second and third phalanges of index finger of right hand, if the stump is tender or the motion of the first phalanx is impaired. Loss of the third phalanx does not incapacitate for field-service. 31. Loss of the second and third phalanges of all the fingers of either hand. 32. Permanent extension or permanent con- traction of any finger, except the little finger; all the fingers adherent or united. 33. Total loss of either great toe ; loss of any three toes on the same foot ; all the toes joined together. 34. Deformities of the toes, if sufiicient to pi~event marching. 35. Large, flat, ill-shaped feet, that do not come within the designation of talipes valgus, but are sufficiently malformed to prevent march- ing. 36. Varicose veins of inferior extremities, if FOR SERVICE IN THE INVALID CORPS. 229 large and numerous, having clusters of knots and accompanied with chronic swellings. 37. Extensive, deep, and adherent cicatrices of lower extremities. ' Soldiers having nervous debility, or excita- bility of the heart, impeded respiration from curable causes, chronic dyspepsia, chronic diar- rhoea, chronic disorders of the kidneys or blad- der, incontinence of urine, aphonia, hemera- lopia, or other disease or infirmity not incurable, are not to be recommended for the Invalid Corps until they have been under medical treatment or observation a sufficient length of time to make it extremely probable, if not cer- tain, that they will not be fit for active field- service during any considerable portion of their period of enlistment. Soldiers who have lost an arm, forearm, hand, thigh, leg, or foot, may be discharged from the army on surgeon's certificate, if they so elect. None of the foregoing disabilities disqualify officers for service in the Invalid Corps; but some of them may be so aggravated or compli- cated as to unfit for any service : all such cases should be discharged. In all cases where the physical infirmities of officers or enlisted men come within the pro- 20 230 PHrSlCAL INFIRMITIES NOT DISQUALIFYING visions of the above list, they will be recom- mended for transfer to, or enlistment in, the Invalid Corps; but no one will be admitted into this corps whose previous record does not show that he is meritorious and deserving, and that he has compUed with the provisions of General Orders No. 105, War Department, Adjutant- General's Office, 1863, authorizing an Invalid Corps.* * Extracts from General Order No. 212, 1863. FOR SERVICE IN THE INVALID CORPS. 231 CHAPTER IV. PHYSICAL INFIRMITIES THAT DISQUALIFY ENLISTED ■ MEN FOR SERVICE IN THE INVALID CORPS.* 1. Manifest imbecility or insanity. 2. Epilepsy, if the seizures occur more fre- quently than once a month and have obviously impaired the mental faculties. 3. Paralysis or chorea. 4. Organic diseases of the brain or spinal cord; of the heart or lungs; of the stomach or intestines; of the liver or spleen; of the kidneys or bladder, so extensive and long-con- tinued as to have seriously impaired the general health, or so well marked as to leave no rea- sonable doubt of the man's incapacity for ser- vice in the Invalid Corps. Note. — This paragraph is intended to apply to incurable organic diseases of severe character, rendering a man use- less for any purpose in the military service, or organic dis- eases of equal severity, curable, but curable after so long a course of treatment as practically to render the man useless during his period of enlistment. * Extracts from General Order No. 212, 1863. 232 PHYSICAL INFIRMITIES DISQUALIFYING 5. Confirmed consumption, cancer, aneurism of important arteries. 6. Inveterate and extensive disease of the skin. 7. Scrofula, or constitutional syphilis, which has resisted treatment and seriously impaired the general health. 8. Habitual or confirmed intemperance, or solitary vice, suflQcient in degree to have mate- rially enfeebled the constitution. 9. Great injuries or diseases of the skull, occasioning impairment of the intellectual faculties, epilepsy, or other serious nervous or spasmodic symptoms. 10. Total loss of sight J partial loss of sight of both eyes, and perm.anent diseases of either eye affecting the integrity and use of the other eye, vision being so greatly impaired as to leave no reasonable doubt of the man's incapacity for service in the Invalid Corps. 11. Loss of nose, or deformity of nose, if sufficient seriously to obstruct respiration ; ozoena, if dependent upon caries. 12. Deafness. 13. Dumbness; permanent loss of voice. 14. Total loss of tongue, partial loss, and hypertrophy or atrophy, of tongue, if suflficiem FOR SERTICE IN THE INVALID CORPS. 23 O to make the speech unintelligible and prevent mastication or deglutition. 15. Incurable deformities of either jaw, whether congenital or produced by accident, which would prevent mastication or greatly injure the speech. 16. Tumors of the neck impeding respiration or deglutition; fistula of larynx or trachea. 17. Deformity of the chest, sufficient to im- pede respiration or to prevent the carrying of arms and military equipments; caries of the ribs. 18. Artificial anus; severe stricture of the rectum. 19. Total loss, or nearly total loss, of penis; epispadia or hypospadia, at the middle or nearer the root of the penis; stone in the bladder. 20. Incurable permanent organic stricture of the urethra, in which the urine is passed drop by drop, or which is complicated by dis- ease of the bladder ; urinary fistula. 21. Confirmed or malignant sarcocele; hy- drocele, if comphcated with organic disease of the testes. 22. Excessive anterior or posterior curvature of the spine ; caries of the spine ; lumbar ab- scess. 23. Anchylosis of hip-joint. 20« 234 PHYSICAL DISQUALIFICATIONS, ETC. 24. Irreducible dislocations of hip or knee joint. 25. Large chronic ulcers of lower extremi- ties. In all cases where the physical infirmities of an oflficer or enlisted man come within the provisions of this list, or where his previous record shows that he is not entitled to be re- 'ceived into the Invalid Corps, he will, if in service, be discharged ; and, if an applicant to re-§nter, his application will be disapproved. DISCHARGE ON SUEGEON's CERTIFICATE. 235 CHAPTER V. CAUSES OF DISCHARGE ON SURGEON'S CERTIFICATE. The disqualifications for service in the In- valid Corps, which are adequate causes for discharge, have been given in the preceding chapter. To form an intelhgent judgment, these disqualifications must be compared with the general and special disqualifications dis- cussed in Section I. of this work. A cause of exemption under the enrolment act, or for re- jection in the examination under the recruit- ing regulations, is not a cause sufiicient for discharge, unless it disqualifies for service in the Invalid Corps. The character, dui-ation, and gravity of dis- eases or injuries, and the extent to which they impair the health, strength, or eflSciency, re- quire further elucidation. Previous to the organization of the Invalid Corps, the importance of the ailments for which men were discharged from the service bore no fixed relation to the number of discharges. To 236 DISCHARGE ON SURGEOn'S CERTIFICATE. ascertain the relative frequency of tiie causes of discharge on surgeon's certificate, I examined 15,500 certificates as they were recorded in the Adjutanl^General's Office, Washington. There were discharged — For disqualifications due to age 388 " " " natural feebleness of constitu- tion 209 " " " mental infirmities 154 " " " cachexies 411 " " " moral character 44 " " general debility 1273 " diseases and injuries of organs of special sense and accessory apparatus 619 " diseases and injuries of head and spinal column and cerebro-spinal nervous system 1765 " diseases and injuries of neck and contained organs (the discharges for Aphonia amounting to 28) 45 " diseases and injuries of chest and thoracic organs 359S " " " " abdomen and digestive appa- ratus 2840 " " " " genito-uriuary apparatus 560 " " " " • upper and lower extremities.. 1361 " " " " skin and appendages 11 " gunshot wounds 1556 Injuries were received requiring discharge, but the locality and character of the injuries were not stated, in 595 For feigned disease 4 Unclassified 272 Total 15,500 The degree of disability was stated in 4588 " " " " not stated in 10,912 If the reader will refer to Section II. of this work, he will find that the statistics of dis- DISCHAKGE ON SUEGEON'S CERTIFICATE. 237 charges whicli have relation to the question of malingering have been given in that con- nection. I have had occasion to remark that those diseases were most frequently feigned which were most prevalent. The above nu- merical statement seems to support this view. The class containing the largest number of dis- charges contains also the diseases most com- monly feigned. Besides the feigned, these numbers represent a considerable proportion of cases curable within a reasonable period. Many of the cases discharged for "general debility" are of this character. Following the general plan pursued in other parts of this work, I have to consider the sub- ject of the extent to which diseases or injuries impair a man's capacity for military service : — 1st, The general physical disqualifications; and 2d, The special physical disqualifications, classi- fied according to the regions of the body in which they occur. Mental Infirmity. — The mental disease which is a ground of discharge is not the same as that condition of the intellect which justifies exemption or rejection. The insanity or im- becility must be manifest. This excludes the class of feeble-minded men not actually imbe- cile or insane, but who are nevertheless unable 238 DISCHARGE ON SURGEOn'S CERTIFICATE. to learn the drill and duties of a soldier. The 154 cases of discharge for mental disease in- cluded in the foregoing table contain several of this class. Discharges from the army should never take place for mental infirmity. Paragraph 169, General Kegulations of the Army, prohibits the discharge of insane soldiers, but requires "that they be sent under proper protection by the department commander to Washington, for the order of the War Department for their admission into the Government Asylum." Moral Obliquity cannot be held a legitimate ground of discharge on surgeon's certificate, notwithstanding the records of the Adjutant- General's Ofiice, as far as examined by me, show 44 discharges for this cause. Feebleness op Constitution. — This term includes extremes of age, cachexies, imperfect development, and the cases of general debility occurring after a great variety of ailments. The decision is to be made on three points : — Is the case curable ? does it unfit for field-service ? does it disqualify for service in the Invalid Corps ? Age, ordinarily, does not disqualify for ser- vice in the Invalid Corps; but it is obvious that a man may be so decrepit or so imper- DISCHARGE ON SUEGEON's CERTIFICATE. 239 fectly developed as to be unfitted for any duty. The cachexies (scrofula, cancer, constitutional syphilis, &c.), intemperance, and masturbation are causes of discharge, if the constitution be "materially enfeebled." The determination of the degree to which these cachexies and vices have unfitted a man for any duty in the mili- tary service must be made by the surgeon. Usually it will be found that these infirmities, except cancer, are not so severe as to prevent a man serving in some capacity in the first or second battalion of the Invalid Corps. If the lymphatic glands be suppurating, and if there be considerable emaciation and loss of power, the case of scrofula will justify discharge. Syphilitic affections of the mucous membranes, nodes and caries, severe syphilides, and wasting of the tissues, not amenable to treatment, and of long standing, render the subject of them unfit for either battalion of the Invalid Corps. Drunkenness and masturbation, — especially the former, — if confirmed habits, affecting the intellectual powers and producing serious or- ganic mischief, require discharge. In all these physical disqualifications the question arises as to the degree and extent, rather than as to the kind, of disability. For instance, " incipient phthisis" is not a disquali- 2i0 DISCHARGE ON SXJKGEON'S CERTIFICATE. fication for service in the Invalid Corps ; but, nevertheless, organic disease of the lungs, suf- ficient in degree to produce serious impairment of the health, strength, or efficiency, is a dis- qualification requiring discharge. CLASS FIKST. ORGANS OF SPECIAL SENSE, AND ACCESSORY AP- PARATUS. The principle I have enunciated in the last paragraph of the preceding section applies with equal propriety to the special physical dis- qualifications, and is especially true of Class First. The organs of special sense may be im- paired by the same disease, either to a very limited degree or wholly. Deafness requires discharge; purulent otor- rhoea disqualifies for field-service. The extent of loss of hearing is not easily estimated ; but to constitute an incapacity for any service it must be complete. The battalion of the Invalid Corps to which a deaf man may be assigned will be indicated DISCHARGE ON SUKGEOn's CERTIFICATE. 241 by the extent of his infirmity, — the more nearly complete use of the organ for the first bat- talion, and moderate deafness for the second : complete deafness requires discharge. The importance of the other disqualifying diseases of the ear must be estimated in the same w^y. Loss of sight from any cause. The right eye, being principally required by the soldier, must be perfect in all its functions. Minor defects of the left can scarcely be considered disquali- fications for field-service. Total loss of sight of left eye, or any- serious acute disease im- pairing its functions, would unfit a soldier for the performance of his whole military duty. The kind of service in the Invalid Corps to • which a man may be assigned will depend upon the degree of impairment of the function of sight. As a rule, it may be assumed that acute dis- eases and chronic diseases of a painful character require treatment in the hospital, and unfit for any kind of duty. Incurable diseases affecting the integrity and use of the eye require discharge from the ser- vice. The list of incurable diseases, in a literal sense, will be large or small according to the skill of the surgeon ; but the term " incurable diseases" is meant to include such lesions as 21 242 DISCHARGE ON SUEGEON'S CERTIFICATE. conical cotoea, opacities of the cornea prevent- ing useful vision, long-standing chronic ophthal- mia complicated with loss of lashes, entropion, ectropion, &c., the affections of choroid and retina known as amaurosis^ and others of like character and severity. The affections of the nose which unfit for every species of military duty are ozoena when due to caries, and such loss or deformity of nose as will "seriously obstruct respiration." These deformities include loss by malignant diseases, large polypi, or other tumors. The extent of interference in function, and the curability after a reasonable period, or incurability, enter into the question of discharge. The injuries and deformities of the mcmth which demand discharge consist of dumbness, loss of, or mutilation of, tongue, hypertrophy or atrophy of the organ, diseases or deformities of the jaw, whether the result of accident or disease, sufficient to make the speech unintel- ligible or prevent mastication or deglutition. Stammering, fissures of the palate, extensive loss of teeth, fistula, &c., which unfit a soldier for field-service, do not unfit him for the bat- talions of the Invalid Corps. The question of discharge is decided by the degree of inter- ference of these various lesions in the importr DISCHAEGE ON SURGEON'S CERTIFICATE. 243 ant functions of mastication, speech, and deglu- tition; for some of the causes of discharge above given may be so limited in degree as not to render a man unfit for every species of mili- tary duty. CLASS SECOND. HEAD AND SPINAL COLUMN AND CEREBRO-SPINAL NERVOUS SYSTEM. Those injuries and diseases of the skull re- quire discharge which have produced impair- ment of the intellectual faculties, epilepsy, or nervous disorders. The operation of trephining, considerable fractures, or loss of substance of the cranium, usually unfit for field-service, even if unaccom- panied by lesions of the brain, on account of the great probability of subsequent brain- trouble from exposure to the unfavorable hy- gienic conditions of the camp and field. Cur- vature of spinje dependent upon caries of the vertebrce, or abscess resulting from such disease, are undoubted causes for discharge. Gibbosity unfits, for field-service, but if uncomplicated with disease of the vertebrae does not disable 244 DISCHARGE ON SURGEON'S CERTIFICATE. a man for service in the second battalion of the- Invalid Corps. Fractures and dislocations of the vertebrae require discharge. Epilepsy which has impaired the faculties, whether the petit-mal or grand-mal, hemiplegia or paraplegia, and paralysis agitans, unfit a man for service in either battalion of the In- valid Corps, and justify discharge. Epilepsy oc- curring not more frequently than once a month unj&ts for field-service and disqualifies for the first battalion of the Invalid Corps, but not for the second. Paralysis of one upper extremity is not a disqualification for the second battalion ; but paralysis of a lower extremity requires dis- charge from service. Chorea, if severe, renders the subject of it unfit for any duty. CLASS THIRD. NECK AND CONTAINED ORGANS. Fistula of larynx or traxihea, and tumors impeding respiration or deglutition, require dis- charge. A goitre may produce these effects, if large enough, and if it have undergone osseous degeneration. Dysphagia, when a symptom of stricture of the oesophagus, not DISCHARGE ON SURGEON'S CERTIFICATE. 245 nervous or hysterical in character, and due to the pressure of tumors, to thickening of the mucous membrane, or to the contraction of cicatrices, disqualifies for service in any capa- city. Extensive cicatrices of the nech following injuries of any description, which produce retraction of the lower jaw and lip, and per- manent rigidity in degree sufficient to prevent mastication, unfit for service in the Invalid Corps, and are sufficient causes for discharge. CLASS FOUETH. CHEST AND THORACIC ORGANS. Phthisis and ^^ heart disease" are the most frequent causes of discharge, and are probably often feigned. " Incipient phthisis" does not authorize discharge : it must be "confirmed." The heart disease, to render a discharge neces- sary, must consist of valvular lesion. Other affections of the heart which incapacitate for field-service do not disqualify for service in the Invalid Corps. The injuries, deformities, or diseases of the thoracic walls for which a discharge may be accessary must be sufficient in extent to 21» 246 DISCHARGE ON SURGEON S CERTIFICATE. seriously impair the functions or prevent the carrying of arms and military equipments. Less important lesions unfitting for field-ser- vice will justify transfer to the Invalid Corps, rather than discharge. Dropsical accumula- tions dependent upon heart disease or aneurisms of important arteries require discharge. The lesions of the thoracic organs requiring discharge are comprised in paragraph 4 of the physical infirmities that disqualify for ser- vice in the Invalid Corps. This "organic disease" of the heart or lungs must be sufficient in degree to interfere manifestly and seriously with the proper functions of those organs and to have impaired the general health. CLASS FIFTH. ABDOMEN AND DIGESTIVE APPARATUS. All diseases of the abdominal viscera suffi- cient for discharge must consist of some struc- tural change so far interfering with- assimila- tion or producing such important local effects as to render a man useless. The abdominal diseases most prevalent in our army are chronic diarrhoea and dysentery. In the 15,500 dis- DISCHAEGE ON SURGEOn's CERTIFICATE. 247 charges on surgeon's certificate there were 1210 for these diseases. They undoubtedly unfit for field-service, but not necessarily for the Invalid Corps. Chronic diarrhoea and dysentery of long standing, acconipanied by great emaciation, unfit for any kind of duty. The question is one of severity and extent of the disease. The same principles apply to all other forms of disease of the abdominal viscera. Some are absolutely and others relatively disabling. The absolutely disabling obviously require discharge J the relatively disabling must be assigned to the battalions of the Invalid Corps according to the degree of their eflBciency. To the former belong artificial anus and severe stricture of the rectum ; to the latter, dyspepsia, chronic gastritis, chronic gastro-enteritis, chronic diarrhoea and dysentery not too far advanced, and other diseases of like character. CLASS SIXTH. GENITO-URINARY APPARATUS. The absolute disqualifications of this class consist of those lesions of the penis and urethra 248 DISCHARGE ON SURGEON'S CERTIFICATE. in which the passage of urine takes place so near to the body as to soil the person and clothing at each discharge {loss of penis, hypo- spadia, and epispadia), of those lesions of the urethra — usually complicated with disease of the bladder, and sometimes with fistulous open- ings (urinary fistula) — which prevent the flow of urine except drop by drop (permanent organic stricture) , of stone in the bladder, and of certain organic diseases of the testes (confirmed and malignant sarcocele, hydrocele if complicated with disease of the testes). CLASS SEVENTH. UPPER AND LOWER EXTREMITIES. But few of that large list of injuries and diseases of the extremities which disqualify for service in the field unfit for service in the Invalid Corps. The only infirmities of the latter are of the lower extremity, — viz. : an- chylosis of hip joint, irreducible dislocations of knee or hip joint, and large chronic ulcers of lower extremities. Loss of either and upper or lower extremity does not disqualify; but if a man so elect, he may be discharged. Artificial DISCHARGE ON SURGEOJST's CERTIFICATE. 249 limbs are now made with such skill and adap- tation of means to the end that a maimed soldier provided with one is capable of very useful service in the second battalion. CLASS EIGHTH. SKIN AND APPENDAGES. Affections of the skin demanding discharge must be "inveterate and extensive." These adjectives are meant to apply to incurable skin- diseases not only extensive, but repulsive and accompanied by serious affections of the or- ganism. Gunshot Wounds. — The proportion of dis- charges for gunshot wounds amongst the dis- charges for all causes has been, in the statistics I have examined, 10 per cent. The extent to which these lesions disabled varied greatly, ranging from the loss, of a little finger to the loss of a lower extremity at the upper third. Gunshot wounds of the head involving the cranium usually require discharge ; for serious impairment of the faculties, or nervous and spasmodic symptoms, frequently follow such 250 DISCHARGE ON SUBGEON's CERTIFICATE. lesions. "Wounds of the chest, not implicating the organs, do not disqualify for service in the invalid battalions, and if flesh wounds merely do not disqualify for field-service. Gunshot fracture of clavicle, and fracture of ribs, followed by necrosis, unfit for field-service. Wounds of the lungs disqualify for field-ser- vice and for the first battalion of the Invalid Corps, but not for the second, unless followed by collapse of lung, empyema, or similar im- portant lesions. Gunshot wounds of muscular wall of the abdomen, if considerable in extent, require admission into the invalid battalions. Pene- trating or perforating wounds with lesion of the intestine, although usually fatal, are not invariably so. They require discharge. Wounds of genital and urinary organs are disqualifying according to the extent of injury. Loss of both testes unfits for field-service. Injuries of urethra producing epispadia or hy- pospadia, or loss of more than half of the penis, require discharge. Simple flesh-contusions and wounds of upper and lower extremities are apt to result in " muscular contraction, and consequent loss of use and power in the arm, resulting from the patient's keeping the wounded limb in one DISCHARGE ON SURGEON'S CERTIFICATE. 251 particular position for months. This system of nursing their wounded limbs is brought about by trying at first to save themselves pain on any attempt at motion being made, and also from an idea that if they are in- valided for a wound received in action they will be granted a higher pension than for any other disability."* These remarks are applicable in their fullest significance to the wounded in our service. Previous to the organization of the Invalid Corps, large numbers of discharges were granted for these muscular contractions. At pre- sent many of these cases require admission into the Invalid Corps, or discharge ; but before going beyond the control of the surgeon they should be subjected to the very excellent plan of treatment recommended by Williamson. f Wounds involving the bones are much more serious. In addition to the muscular contrac- tions, there is the impairment of use and motion due to loss of substance of the bones. The character of service to which these men may be assigned in the invalid battalions, as well as the question of discharge, will be determined by the extent of the injury and the degree in * Williamson, Wounded from the Mutiny in India, p. 51. Churchill, London, 1859. t Ibid- 252 DISCHARGE ON SURGEON'S CERTIFICATE. which it impairs the use or functions of the part. I have entered into this subject of the causes of discharge from the military service, considered relatively to the degree in which they incapacitate for service, in a very cursory manner, because in the first section of this work the disqualifications for military service, in that proper and enlarged sense in which this term, is used, have been fully given, and because the Invalid Corps — a creation of the present war, not yet complete in the details of its organization — may have no permanent place in the military establishment. Moreover, the General Orders of the War Department, so freely quoted in this part of my work, present in very full and complete expression the details of this subject, rendering it the less necessary for me to enlarge upon it. MODE OF DISCHARGING. 253 CHAPTER VI. MODE OP DISCHARGING. There is a very prevalent and mischievous theory abroad that a man otherwise a proper subject for discharge may, if he feel so inclined, refuse his discharge, and continue to draw his pay and allowances without rendering an equivalent to the Government. If the case be a suitable one for the exercise of his power, it is not less clearly the duty of the surgeon to recommend the discharge than it is his duty not to make his certificate until he have posi- tively ascertained the existence of the disabil- ity. The necessity of ascertaining the willing- ness of a man to be discharged is devolved, by the law of 1862, only upon the Medical In- spector-General and medical inspectors. With regimental and staff surgeons it is only a ques- tion of the good of the public service. If there be those in the general or regimental hospital unfit for further military service in any capacity, there can be no question as 22 254 MODE OF DISCHARGING. to the imperative duty of the surgeon to recom- mend the discharge. Those not provided for in the Invalid Corps have claims to pension under the laws. In the regimental and small post hospitals the surgeon in charge has immediate and per- sonal knowledge of each case ; but in the large general hospitals he must rely in great part upon the action of his subordinates. In every general hospital, on a form for that purpose, the surgeon in charge of a ward in which there is, in his opinion, a case suitable for dis- charge, should enter all the particulars of the case, describing fully and clearly the disease or injury, and the circumstances, as far as appreciable, under which it occurred. This statement of the case should be presented with the man to the surgeon in charge, who should proceed to verify by a personal examination the assistant surgeon's diagnosis and prognosis. The propriety of this examination by the sur- geon in charge is obvious enough when the terms expressed in the certificate which he signs are recalled. A case requiring an un- usual amount of study and prolonged examina- tion before a decision can be made may be submitted to the arbitrament of a board of ofl&cers; but their decision must be verified by MODE OF DISCIIAEGING. 2oo a personal examination. Less than this will not acquit the senior surgeon of the obliga- tions imposed by the certificate. The surgeon's certificate must be made upon the printed blanks furnished from the Adju- tant-General's Office,— no written form being valid. " Whenever a non-commissioned officer or soldier shall be unfit for the military service in consequence of wounds, disease, or infirmity, his captain shall forward to the commander of the department, or of the army in the field, through the commander of the regiment or post, a statement of his case, with a certificate of his disability signed by the senior surgeon of the hospital, regiment, or post, according to the form prescribed in the Medical Regula- tions."* The '•'statement" of the company com- mander consists in the narration of all the facts known to him concerning the cause of the disability, the time, place, manner, and all the circumstances under which the injury occurred or disease originated or appeared. Where the facts are not known to the company com- mander, the certificate of any officer, or affidavit of other person having such knowledge, will * Revised Regulations, edition of 1861. 250 MODE or DISCHARGING. be appended.* In the general hospital this statement may be made and signed by the surgeon, if he have the necessary data. The surgeon certifies to the nature, extent, and degree of disability. The degree is a numerical statement of the extent to which a man is prevented earning a subsistence by manual labor. The wound, or disease, or injury must be described with great particu- larity and precision. The trade or profession of the soldier has, it will be perceived, no con- nection with the degi-ee of disability or amount of pension. The decision of the surgeon must be made upon the ability of the soldier to earn his subsistence by manual labor. If this prin- ciple be kept in view, the difficulty of deter- mining whether a man is disabled, one-half, one-third, one-sixth, &c., will be greatly light- ened. When the certificate has been approved by the medical director, it wall be acted upon by the military commander, to whom the author- ity to discharge men has been specially dele- gated. After having been thus acted upon, the certificate will be returned to the regimental or detachment commander, who will, if the * Revised Regulations, edition of 1861, p. 325. JIODE OF DISCHARGING. 2.0 i discharge is authorized by the necessary en- dorsement, sign the soldier's discharge, the last certificate on the " certificate of disability for discharge," and forward the certificates direct to the Adjutant-General of the army at Washing- ton. The certificates of disalaility are under no circumstances to be given into the hands of the soldier. The final statements — i.e. the state- ments of pay due, of clothing account, of re- tained pay, of bounty, &c. — are made up from the company records and signed by the com- pany commander. The papers given to the soldier at the time of his discharge consist of the "discharge," signed by the commander of the regiment, post, or detachment, and dupli- cate final statements, signed by the company commander. This is the mode of discharging soldiers on surgeon's certificate. To recapitulate, the prin- cipal points are : — 1st. The statement of the company com- mander as to the circumstances connected with the occurrence of the disease, injury, or dis- ability. 2d. The certificate of the surgeon showing the nature and extent of the disability, and his numerical estimate of the degree in which 22* 258 MODE OF DISCHARGING. it prevents the man earning his subsistence by manual labor. 3d.. The approval of the medical director of the corps, district, or department ; and 4th. The order of the military commander authorizing the discharge. Special regulations have been made govern- ing the discharges from general hospitals ; but the above principles lie at the foundation of them all. These regulations have varied from time to time. General Orders No. 36 of 1862 author- ized a chief medical officer (medical director), to whom all the general hospitals in a city may be intrusted, and who is required to cause certificates of disability to be made out for such men as in his judgment should be discharged. He is responsible that the certificates are given for good cause and made out in proper form, giving such medical description of the case, with the degree of disability, as will enable the pen- sion-officer to decide on any claim for pension which may be based upon them. The certificate of disability, thus prepared and signed by the chief medical officer, are acted upon by the military commander of the city, who is given the authority to discharge. The final statements and discharge-papers MODE OF DISCHARGI^■G. 259 are made out under the supervision of tlie mili- tary commander and signed by him. If no descriptive list of a man a fit sub- ject for discharge has been received, the mili- tary commander is authorized to call on the company commander, in the name of the Secre- tary of War, promptly to furnish the military history of the man, and his clothing, money, and other accounts with the Government. Where the descriptive list cannot be procured from the company commander, the medical officer is required to apply to the Adjutant- General for such account of the man as his records furnish. To this partial roll the medi- cal officer will add the period for which pay is due the man since the date of muster previous to his entry into hospital. If the descriptive list cannot be procured, either of the company commander or Adjutant-General, the order authorizes the discharge, and transportation to be furnished by the Quartermaster's Depart- ment. General Order 36 was modified by Cir- cular No. 2 of 1863, Surgeon-General's Office, to read as follows : — " The final statements and all the discharge-papers will be made out under the supervision of the military commander and signed by him, when the soldier is not in a United States hospital or under the charge of a 260 MODE OF DISCHARGING. United States surgeon. But if he is under a United States surgeon or in a United States hospital, the surgeon will in either case make out and sign the discharge and final statements after the military commander has endorsed the authority to discharge the soldier upon the usual certificates of disability." The term "United States surgeon" here used is meant to apply to medical officers of the regular army, and the staff surgeons and assistant surgeons of volunteers. The surgeon in charge of the general hospital, under these orders, has the same relation as post or regimental commander, in addition to his duty as surgeon. 1st. He makes the certificate of disability, and, if he is cognizant of the facts, signs the statement of the company commander. 2(^. He forwards the certificate through the medical director to the military commander. 3d. When the authority for the discharge, endorsed on the certificate, is received, he causes to be made out and signs the discharge and final statements. 4th. If no descriptive list can be procured, he enters on the final statements the date of the soldier's entry into the hospital, and that he has no descriptive list, and calculates the MODE OF DISCHARGING. 261 pay due from the date of the muster previous to his admission. 5th. The certificates of disability, having the date of discharge entered (which the sur- geon signs) and the soldier's address added, are forwarded to the Adjutani^General, and a notifi- cation of the discharge is sent to the commander of the company to which the man belonged. When a soldier is discharged hy reason of toounds received in hattle, he is entitled to a cer- tain bounty. Medical officers are accordingly directed (Circular No. 8), in making out the papers of soldiers discharged for this cause, to endorse upon hoth the final statements and the discharge the fact that tlie disability is hy reason of wounds received in hattle, and to sign such endorsement ivitJi their official signature. "Hereafter, in giving discharges to officers and soldiers on account of disability, their dis- cljiarge-papers must always state whether at the time of discharge the officer or soldier was or was not physically suitable to enter or re- enlist in the Invalid Corps."* The great importance of this subject, and the frequency of errors of greater or less mag- nitude, must be my apology for so much repeti- * Circular No. 8, 1863, Surgeon-General's Office. 262 MODE OF DISCHARGING. tion. These minute details are important, because a want of attention to them results in great inaccuracies, and consequent loss to the Government or to the soldier. Besides, the soldier deprived of his just dues is embittered against the Government, and prejudices those who might otherwise be induced to enter the military service. In addition to these reasons for accuracy there are personal considerations not to be lightly regarded. The surgeon is responsible for all payments made over his signature, and may be called upon at any future time to make good losses accruing to the Gov- ernment by his ignorance or carelessness. But, more than all, there is the higher obligation which every right-minded surgeon will not forget, — the obligation to do his duty, in small things as in great, with a single eye to the PUBLIC GOOD. GLOSSARY TECHNICAL TERMS USED IN THIS WORK. Abdominal rings. — Openings, bo called, in the abdominal wall, through ■which the spermatic cords pass to the testicles, and through which a loop of intestine may descend, consti- tuting one, and the most frequent, variety of hernia. Acne rosacea. — Rose spots on the face and forehead, vul- garly called "drunkard's blossom.'' Albuminuria. — A disease of the kidneys in which albumen is present in the urine, and general dropsy appears. Albug^O. — An opacity of the cornea, — usually the white opacity of a cicatrix. Alopecia. — Baldness. Amaurosis. — A term applied to loss of vision from a variety of causes. Anaesthesia. — Abolition of sensibility, produced by inhala- tion of chloroform, or ether, or other agents. Anchylosis. — Rigidity and loss of motion of a joint. Aneurism.^Dilatation of one or more of the coats of an artery into a pouch. There are several varieties. Aphonia. — -Loss of voice. Artificial Anus- — An opening into the intestine through which the faeces flow, instead of through the natural outlet. Ascites. — Dropsy of the abdomen. Asthma. — Laborious breathing occurring in paroxysms, 263 264 GLOSSARY OF TECHNICAL TERMS. either spasmodic, or produced by organic disease of heart or lungs. Atrophy. — Loss of substance, wasting, diminution of size. Auricle.— The external ear. Auscultation. — The science of diagnosing diseases of the chest by the sounds heard in respiration. B. Bronchophony. — Bronchial voice; a sound heard in aus- cultating the chest. c. Cachexy. — 111 health ; a low state of the system produced by a chronic disease. Calculus. — A urinary concretion. Canine teeth. — The third from the median line, on both sides, next the incisors. Caries. — Ulceration of bone. Cataract. — An opacity of the crystalline lens or its cap^le. Cerebro-spinal nervous system. — The brain and spinal cord, and connected nerves ; the nervous system of animal life, as distinguished from the sympathetic or nervous system of organic life. ^ Chorea. — St. Vitus' Dance. A nervou^i disease, the principal sign of which consists of involuntary muscular movements (jactitation). Cirsocele, — Enlarged veins of spermatic cord. Cleft palate. — Fissure of the palate, usually congenital, and present with hare-lip. Cranium.— The bony wall of the head. Cystitis. — -Inflammation of the bladder, acute or chronic. D. Deglutition.— The act of swallowing. GLOSSARY OF TECHNICAL TEEMS. 265 Dementia. — A form of mental imbecility. DermatophytsB. — A class of skin-diseases, due to the pre- sence of a parasitic plant. Diathesis. — A peculiarity of constitution, in which there is a predisposition to one kind of disease and not to another, — as the scrofulous diathesis, rheumatic diathesis, &c. Diabetes. — A disease of the kidneys, characterized by an extraordinary flow of urine containing sugar. DipMheritis. — An unhealthy inflammation of the throat, with exudation of false membrane and ulcerations. Dipsomania. — An insane desire for strong drink. Discrasy. — A low state of health, produced by animal, vegetable, or mineral poison, in which the blood is mainly involved. Dorsal. — The region of the back. Dorsum. — The back, as the dorsum of the hand, -&c. Dysphagia. — Difficulty of swallowing. E. Ectropion. — Eversion of the eyelid. Eczema. — A skin-disease. Emphysema. — A dilatation of the air-cells of the lungs ; one of the forms of the so-called asthma. Encanthis.— 'A tumor at the inner angle of the eye. Engorgement, — Distension of the vessels of a part. Entropion. — Inversion of the eyelid. Epiphora,— Overflow of the tears upon the cheek, due, usually, to closure of the duct, or disease of the lachrymal sac. Epiglottis. — Valve, situated at the base of the tongue, which closes the larynx in the act of swallowing. Epispadia. — An opening on the dorsum of the penis, per- mitting the urine to escape. Erotomania. — Madness caused by love or desire. Esophagus. — Gullet ; the canal which conveys the food to the stomach. Eustachian tube. — Canal extending between pharynx (back part of mouth) and tympanum. 23 2u6 GLOSSARY OF TECHNICAL TERMS. Exfoliation. — The removal by necrosis of a superficial plate of bone. Exostosis. — Outgrowth of bone ; a tumor of bone. Exanthematse. — Eruptive fevers : e.g. measles. P. Favus. — An intractable skin-disease. Fistula Lachrymalis. — A fistulous opening communicating ■with the lachrymal sac, permitting a constant flow of tears. Fistula in Ano. — An opening by the side of the anus, usually communicating with the gut. Fistula, Buceo-nasaL— Fistulous communication between nose and mouth. Fistula, Salivary. — Fistulous opening in the cheek commu- nicating with duct of parotid gland or mouth, permitting the escape of saliva. Follicles. — Crypts, or depressions, in skin or mucous mem- brane, lined by secreting cells. Follicular Pharyngitis. — An inflammation of follicles of pharynx, in which they are enlarged and irritable. Fungous tumor. — A variety of cancer. G. Gastritis. — Inflammation of stomach. Gastro-Enteritis. — Inflammation of stomach and intestinal canal. Gibbosity. — Hump-backed. Glaucoma. — An obscure disease of the eye. Goitre. — An enlargement of the thyroid gland, endemic in certain localities. H. Hematuria. — Bloody urine. Blood in the urine is fre- quently a symptom of serious organic mischief. GLOSSARY OF TECHNICAL TEEMS. 267 Hemeralopia.— Night-blindness. Hemiplegia. — Paralysis of one-half of the body. Hemorrhoids. — Piles. Hermaphroditism, — Union of the two sexes in the same individual; more properly, confusion of sex. Herpes. — A vesicular skin-disease. Herpes Capitis. — Applied to the disease when it attacks the scalp. Herpes Circinnatas. — Ringworm. Hydrocele. — An accumulation of water in the sac of the scrotum. Hypertrophy. — An abnormal increase in size. Hypogastric region, — A term applied to a region of the abdomen beneath the navel. Hypospadia. — An opening into the urethra on the under part of the penis, permitting the urine to escape. In epispadia the opening is on the upper part of the penis. They are trou- blesome in proportion to their nearness to the root of the organ. Ichthyosis. — A scaly skin-disease. Incisors. — The front teeth. Inguinal CanaL: — A canal in the groin through which the testicle descends into the scrotum, and Which contains the spermatic duct and vessels. Iris. — The movable vail suspended between the anterior and posterior chambers of the eye, variously colored in different individuals. Iritis. — Rheumatic or syphilitic forms of inflammation of the iris. K. Keratitis. — Inflammation of cornea. Kleptomania. — A form of emotional insanity, characterized by an irresistible impulse to the commission of theft. 268. GLOSSARY OF TECHNICAL TERMS. L. Labyrinth. — A part of the internal ear. Laryngitis. — Inflammation of larynx. Larynx.- -Organ of the voice, forming a projection in the throat known as Pomum Adami (Adam's apple). Lesion. — Injury or change of structure. Leucoma, — A ■n'hite opacity of the cornea. Lumbar region. — Region of the back immediately above the buttocks. Lumbar abscess. — Abscess of lumbar region ; usually con- nected with diseased spinal column. Lupus, — Spreading and unhealthy ulcerations of the skin, chiefly about the nose and face. Lupus devorans and Lupus serpiginosus are varieties. Luxation. — Dislocation. Lymphatic Glands. — Glands connected with lymphatic system, existing in clusters in certain localities, as in neck, groin, &c. M. Malingering — from Malingre — is a term applied to feigning disease.' Marasmus. — Emaciation. More frequently applied to the general emaciation produced by disease of mesenteric glands. Mastoid cells. — The mastoid process is a prolongation of the mastoid portion of temporal bone. Thi? portion contains the cells ; the process lies behind the ear. , Masturbation. — Onanism. Self-abuse. Maxilla. — Superior and inferior. Jaw-bone. Meatus. — A passage or -canal. Mesentery. — Folds of the lining membrane of the abdo- minal cavity, containing glands. Metacarpal bones. — Bones of the hand next the wrist joint. Metatarsal bones. — Bones of the foot next the ankle joint. Myopia. — Near-sfghtedness, GLOSSARY OF TECHNICAL TEEMS. 269 N. Nares. — The nasal passages. Nasal fossse. — Cavities extending from before backward, communicating with anterior and posterior nares. Nebula. — Opacity of the cornea, less dense than leucoma. Necrosis. — Death of bone. Normal. — Natural, healthy. Noli me taugere. — Lupus of the face. (See Lupus.) Nostalgia,^Homesickness. Nyctalopia. — Day-blindness. O. Oedema. — Dropsical effusion into cellular tissues underneath the skin. Ophthalmia. — Purulent, GonorrJiceal, Catarrhal. Forma of inflammation of the eye. Ossification. — The conversion of a tissue into osseous sub- stance. Otorrhoea. — Discharge from the ear. Ozoeua. — Ulcerations, accompanied by discharge from the nose. Paralysis. — Loss of power in a part. Paralysis agitans. — Shaking palsy. Paraplegia. — Paralysis of the upper or lower half of the body. PectorilO0[ny, — An abnormal sound heard in certain states of disease of chest. Pemphigus. — A vesicular skin-disease. Phalanx. — A small bone of the fingers or toes. Phonation. — Function of speech. Pityriasis. — A skin-disease. Pneumonia. — An inflammation of the lungs. 23» 270 GLOSSARY OF TECHNICAL TERMS, Polypus. — A tumor, usually pear-shaped, growing from a pedicle or stem. Porrigo. — A skin-disease. Prolapsus Ani. — Protrusion of the bowel through the anus. Prostate Gland. — A gland situated at the neck of the bladder. Psoriasis. — A scaly skin-disease. Pterygion. — A fleshy growth on the globe of the eye. Phthisis. — Pulmonary consumption. Ptosis. — A falling of the eyelid, with loss of voluntary con- trol over it. Ptyalism.— Salivation. Purulent. — Containing pus (matter). Bales. — Abnormal sounds heard in the examination of the chest. Hectum. — Lower bowel. Recurrent laryngeal nerves. — Nerves supplying larynx. Renal dropsy. — Dropsy dependent upon disease of' the kidneys. Rickets. — Constitutional disease, affecting the quantity of earthy matter in the bones. s. SarCOCele. — Enlargement of the testicle. Scirrhus. — Hard cancer. Scorbutus.— Scurvy. ' Sinus. — A cavity, or a canal. Spina bifida. — Congenital deficiency of lower portion of spinal column. Spermatorrhoea. — involuntary seminal emissions. Squamae. — A class of skin-diseases (scaly). Staphyloma. — A protrusion on the anterior surface of the globe of the eye : e.g. staphyloma of the iris. GLOSSARY OF TECHNICAL TEEMS. 271 Sternum. — ^Breast-bone. Strabismus. — Squinting. Strumous, — Scrofulous. Sutures. — Stitches. T. Taenia. — Tape-worm. Tympanum, — Drum of the ear Torticollis,— Wry-neck. _ Trichiasis. — Eyelashes growing inward, u. Ureter, — The canal leading from the kidney to the bladder. Uretlira, — The canal through which the urine is discharged. Urinary fistula. — Fistula communicating with the bladder or urethra, through which the urine flows. Uvula. — The pendulous body suspended from the palate, in the posterior part of the mouth. V. Valvular insufficiency. — Condition of the valves of the heart, permitting the regurgitation of the blood. Varicose veins, — ^Veins enlarged, prominent, and clustered in knots. Vesiculse. — ^A class of skin-diseasea. INDEX. A. Abdomen and digestive apparatus, af- fections of, 70. cicatrices of, 71. AbsceBS, lumbar, 59, 233. Age of recruit, 177. Albugo, 49. AlcoholismuB, 20. Alopecia, 85. Amaurosis, 51. Anchylosis, 76, 227, 233. Aneurism, 77, 232, 246. Anus, artificial, 233, 247. fissures of the, 81. Aphonia, 57, 62, 226. Arteries, diseases of, 67. •Ascites, 70. Asthma, 64. Auditory apparatus, affections of, 46, 240. canal, imperforate, 47. obliterate, 47. B. Bladder, eversion of, 74. Blindness, 50. Bones, long, defective or excessive curva- ture of, 77. caries of, 77. exostosis of, 77. necrosis of, 77. Bounties for enlisting in British Army, 156. Brain, organic affections of, 231. Bronchitis, chronic, 64. C. Cancer, 31. Capacity of thorax, 191. Cataract, 49. Causes of discharge on Siurgeon's cer- tificate, 235. Cheeks, loss of substance of, 57. Ciieloid tumors, 84. 272 Chest and thoracic organs, afifections ot, 64, 225, 233. deficient expansive mobility of, 64. diminished vital capacity ofi 64. Chorea, 61. Cicatrices, 79, 229, 245. Cirsocele, 73, 227. Club-feet, 80. Condition of organs of sense in recruits, 198. Contractions, muscular or cutaneous, 227. Cornea, conical, 49. opacities of, 49. Craniimi, afi'ections of, 243. imperfect ossification of, 58. Cretinism, 17. Cystitis, 74. Deafness, 46, 231, 241. Degree of disability, 256. Dementia, 17. senile, 19, Dermatophytse, 85. Desertion, 24. . Diabetes, 74. Diarrhoea, chronic, 70, 225, 247. Dipsomania, 20. Discharge-papers, 258. Discharging soldiers, 209. general considerations on, 209. Dislocations, old or irreducible, 76, 227, 233. Dropsy, cardiac, 67, 246. renal, 74. Drunkenness, habitual, 32, 232. Dumbness, 232. Dura mater, fungous tumors of, 68, Dysentery, chronic, 70, 247. Dyspepsia, 70, 225, 247. Dysphagia, 62, 224. INDEX. 273 E. Ear, external, loss of, 47. malformations of, 47. malignant disease of, 47. Eczema, chronic, 84. Emphysema, 64. Encanthis, 49. .^nlisting soldiers, 149. in British, Army, 153. in French Array, 151. in Prussian Army, 153 in Roman Army, 149. Enrolment act, IGO. Epiglottis, induration of, 62. scii'rhus of, 62. Epilepsy, 61, 224, 231, 244. Epiphora, 50. Epispadias, 73, 248. Erotomania, 20. Examination of recruits, 1G5. Extremities, affections of, 75, 248. Eye, affections of, 48, 241. loss of, 50, 225. loss of lens of right eye, 49. Eyelids, adhesions to globe, 51, encygted tumors of, 51. F. Face, deformities of, 57. Feebleness of constitution, 30, 238. Feet, fetid sweat of, 82. Feigning, character of ailments of men, 92. classes of men, 92, duties of medical officers in rela- tion to, 99. general causes of, 88. Feigned diseases, diagnosis and classi- fication of, 99. amaurosis, 112. amblyopia, 112. * aphonia, 128. asthma, 132. back, weakness of, 127. blindness, 111. cephalalgia, 115. cirsocele, 141. contraction after wounds, 143. of a joint, 143. coup-de-Boleil, 115. cranium, neuralgia of, llf . cutaneous diseases, 148. , deafness, 107. difurhoea, 136. Feigned dumbness, 114. dyspepsia, 134. epilepsy, 122. eye-diseases, 109. fissures of the anus, 137. fracture, old, 145. goitre, 129. gonorrhoea, 142. hsematuria, 138. head and spinal columu, affeo- tions of, 115. headache, 115. heart, functional derangement of, 132. hemeralopia, 112. hemiplegia, 120. hydrocele, 142. imbecility, 125. incipient phthisis, 130. incontinence of urine, 140. insanity, 125. lameness, 145. lumbago, 116. mania, 125. mouth, affections of, 113. myopia, 110. neuralgia, 116. nictitation, 110. nose, affections of, 113. nyctalopia, 112. pain, 116. pains in lumbar region, 140, paralysis, 120. of tongue, 114. paraplegia, 120. ptosis, 109. retinitis, 112. rheumatism, 116. sarcocele, 142. spine, deformity of, 127. stammering, 113. swelling of leg, 147. tic doulom-eux, 115. ulcers, 148. varicocele, 141. Taricose veins, 146. vomiting at will, 134. Felony, conviction of, 24. Final statements, 259. Fingers, adherent or united, 77. loss of,'78, 228. mutilation of last phalanges of, 78. permanent flexion or extension of, 77, 228. 274 INDEX. Fingers, supernumerary, 77. Fistula, bucco-nasal, 56. in ano, 71, 227. lachrymalis, 50. of larynx, 63, 233, 244. of trachea, 63, 233, 244. salivary, 56. urinary, 73. fracture, 80, 227. G. Gastritis, chronic, 70, 231, 247. Gastro-enteritis, chronic, 70, 231, 247. Geuito-urinary apparatus, affect .ons of, 72, 247. Gibhosity, 60, 243. Glaucoma, 49. Goitre, 62, 244. Gunshot wounds, 249. H. Hematuria, 73. Hands, extraordinary size of, 77. Hare-lip, 55. Head, affoctions of, 58. monstrosity in the volume of, 58. Heart, aneurism of, 67. diseases of, 67, 231, 245. functional derangement of, 67. hypertrophy of, 67, 224. Hemeralopia, 50. Hemiplegia, 61. Hemorrhoids, 71, 227. Hermaphroditism, 74. Hernia, 71, 226. tendency to, 71. Herpes capitis, 84. circinnatus, 84. Hydrocele, 73, 233, 248. Hydropsy of the articulations, 77. Hypogastric region, loss of substance of, 74. Hypospadias, 73, 248. Ichthyosis, 84. Idiocy, 17. Imbecility, 17, 231. Incontinence of urinej 73, 225. Insanity, 16, 231. Invalid corps, 216. formation in, 217. Iri^ adhesions of, 49. Iris, congenital defects of, 49. Iritis, rheumatic, 49. syphilitic, 49. J. Jaws, anchylosis of, 55. retraction of, 63. rigidity of, 63. , Joints, chronic diseases of, 76, 233. false, 76. relaxation of ligaments of, 76. K. Kidney, abscess of, 74. fatty degeneration of, 74. Kleptomania, 20. Knock-knees, 80. L. Labyrinth, caries of, 47. Lachrymal duct, closure of, 50. distension of, 50. Lameness, 80. Laryngitis, chronic, 62. Larynx, polypus of, 62, Lead poisoning, 31. Lepra, 84. Leucoma, 49. Limb, atrophy of, 77. cicatrices of, 77. contraction of, 77. loss of, 77, 248. paralysis of, 77. retraction of, 77. Lip, loss of, 55. Liver, chronic disease of, 70. Locality of enlistment, 200. Lupus devorans, 84. serpiginosus, 84. » M. Malaria, 31. Malingering, 25. Mania, acute, 16. suicidal, 20. , Marasmus, 70. Masturbation, 33. Maxilla, deformities of superior or In- ferior, 55. loss of superior or inferior, 55. ununited fracture of, 55. Melancholia, 16. Membrana tympani, perforated, 47. INDEX. 27o Mfintal infirmity, 16. as a cause of discharge, 237. Mercurial poisoning, 31, Mesentery, disease of, 70. Mode of discharging, 253. Monomania, 16. Moral infimiities, 23. obliquity, 238. * Mouth, affections of, 5i, cancer of, 55. deformity of, by burns, 55. erectile tumor of^ 55. malignant ulcer of, 55. syphilitic ulcerations of, 56. Mutism, 56. Myopia, 50, 226. N. Nsevi, 85. Nebula, 49. Keck, abscess of lymphatic glands of, 63. and contained organs, affections of, 62. cicatrices of, 63. engorgement of lymphatic glands of, 63. scrofulous enlargement of lym- phatic glands of, 63. Nerres of cranium, injury of, 59. Neuralgia, 61. Nictitation, 51. ' Noli-me-tangere, 52. Nose, affections of septum of, 52. deformities of, 52, 232. loss of, 52,232. polypus of^ 53. Nostalgia, 21. Nostril, occlusion of, 53. Nyctalopia, 50. O. Obesity, 40, 70. Occupation of recruit, 202. Old age, 34. Olfactory apparatus, affections of, 62. Ophthalmia, acute, 49. chronic, 49. gonorrhoeal, 49. purulent, 49. Orbit, chronic abscess of, 51. OtoiThoea, chronic purulent, 47, 226. Btrumous, 47. Otorrhoea, syphilitic, 47. Ozoena, 54. P. Palate, fissure of bones of, 56. Paralysis, 61, 224, 231. agitans, 61, Paraplegia, 61, Pemphigus, chronic, 84. Penis, loss of, 72, 248. Peritonitis, chronic, 70. Phthisis pulmonalis, 64, 245. predisposition to, G4. Physical disqualifications, general, 26. special, 42. Physical infirmities incapacitating for field-service, 224. Physical infirmities incapacitating for Invalid Corps, 231. Pinguecula, 49. Pityriasis, 84. Pleurisy, chronic, 64. ^ Pneumonia, chronic, 64, Porrigo, 85. Presbyopia, 50. Prolapsus ani, 71. Prostate, chronic enlargement of, 74. Psoriasis, 84. Pterygion, 49. Ptosis, 50. Pyromania, 20.. ^ Qualifications of recruits, 175. E. Race of recruit, 203. Recruiting service, 157. Rectum, malformation of, 71. stricture of, 71, 233. Rheumatism, chronic, 76, 225. Ribs, caries of, 64. fracture of, 64. necrosis of, 64. Rickets, 60, 77. S. Sarcocele, 73, 233, 248. Scabies, 84. Scalp, cicatrices of, 59. Scorbutus, 31. Scrofula, 30, 232. 276 INDEX. Sight, loss of, 50, 232, 211. Sinuses, 76. Skin and appendages, aflFectiODS of, i 232, 249. Skull, caries of, 58. exfoliations of, 58. serious lesions of, 58, 232. syphilitic disease of, 59. Spermatorrhoea, 74. Spina bifida, 59. Spinal column, affections of, 58, 2-13. Spine, caries of, 59. curvature of, 59, 233. dislocation of, 60. fractures of, 60. Splay feet, 80. Spleen, chronic disease of, 70, 231. Sprains, 76. Stammering, 56, 226. Staphyloma sclerotica, 49. Stature, maximum, 39. minimum, 38. of recruits, 181. Sternum, fracture of, 64. Stone in the bladder, 74. Strabismus, 51. Stricture of the rectum, 233, 247, urethra, 73, 227, 233 248. Surgeon's certificate, 255. Sycosis, 85. t^jrphilis, constitutional, 31. T. Tseuia, 70. Teeth, caries of, 55. Teeth, loss of, 55. Testicles, absence of both, 72. atrophy of both, 73, 227. malignant disease of, 73. retraction of, 72. Thorax, diseases and injuries of, 60,245. Thumb, loss of, 78. Tic douloureux, 115. Toes, diseases and injuries of, 81. Tongue, diseases and injuries of, 56, 232, Tonsils, chronic enlargement of, 56. Trephining, 243. ' Trichiasis,' 51, Tympanum, caries of, 47. V. Ulcers, 79, 233. Umbilicus, discharge of urine by, 74. Ureter, closure of, 74. Urethra, stricture of, 73, 227, 233, 248, Urinary fistula, 248. Varicocele, 73, 141, 227. Yaricose veins, 78, 146, 228. Vertigo, 115. Vomiting at will, 134, W. Weight, 40, 188. Wounds, 227. Wry neck, 63, 129, 226. Y. Youth, extreme, 34. THE END. » i« AUTHORIZED MEDICAL BOOKS. 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