MAN UAL 
OF 
THE MEDICAL OFFICER 
OF THE 
ARMY OF THE UNITED STATES. 
PART I. 
RECRUITING AND THE INSPECTION OP RECRUITS. 
BY 
CHARLES S. TRIPLER, M. D., 
Surgeon, U. S. A.; Fellow of the College of Physicians and Surgeons of the 
University of the State of New York. 
WASHINGTON: 
GOVERNMENT PRINTING OFFICE 
1866. MANUAL 
OF 
THE MEDICAL OFFICER 
OF THE 
ARMY OF THE UNITED STATES. 
PART I. 
RECRUITING AND THE INSPECTION OF RECRUITS. 
BY 
CHARLES S. TRIPLER, M. D., 
Surgeon, U. S. A.; Fellow of the College of Physicians and Surgeons of the Univer 
Bity of the State of New York. 
WASHINGTON: 
GOVERNMENT PRINTING OFFICE, 
1 866. ADJUTANT GENERAL’S OFFICE, 
Washington, August 1, 1858. 
This Manual is published by authority of the Department of War, 
as a guide to Recruiting and Medical Officers and Boards of Inspec- 
tors in the inspection of recruits. 
The standards herein proposed will govern as nearly as possible both 
in the enlistment and rejection of recruits. 
Disqualifications of rejected recruits will be. described in the Certifi- 
cates of Disability, as nearly as practicable, in the nomenclature and 
phraseology herein employed. 
To aid in the inspection, the following rules will be observed: 
1. Recruits will be washed before they are presented for inspection, 
that the concealment of defects may be thus prevented. 
2. Each rendezvous is to be provided from the Recruiting Funds 
with a tape measure for measuring the chest, &c. 
3. Blank forms to be used in inspecting recruits according to direc- 
tions herein will be furnished from the Adjutant General’s Office. 
They are to be filled up at the time of the first inspection for enlistment, 
and are to accompany the recruit as his personal description, and as a 
guide to the subsequent inspections. 
BV ORDER OF THE SECRETARY OF WAR : 
E. D. TOWNSEND, 
Assistant Adjutant General, PREFACE. 
The following pages have been prepared as the first part of a pro- 
jected Manual for the Medical Officers of the Army of the 
United States. The urgent want of some standard and guide in 
the inspection of recruits has induced their publication in advance of 
the remainder of the work. 
The Aide Memoire de l’Officier de Sant6 for the French Army has 
been taken as the basis of the work, and has been freely used in this 
part. It was the original intention of the Author simply to translate 
the French work for the use of his colleagues; but, upon a critical 
examination, it was found to contain so much that was redundant, and 
to be defective in so much that was essential for our own service, that 
this idea was abandoned, and it was determined to employ it as a basis 
only. At the same time, the arrangement of the French Manual 
appeared to be so judicious, it was considered best to adhere to that 
generally, which has been done. The works of others, however, as 
well as the experience and observation of the Author, have been drawn 
upon to make the work as useful as possible. Practical utility, rather 
than originality, has been the aim of the writer. MANUAL 
OF 
THE MEDICAL OFFICER 
OF THE 
ARMY OF THE UNITED STATES. 
CHAPTER I. 
GENERAL CONSIDERATIONS UPON THE RECRUITING OF 
THE ARMY. 
By the term “ Recruiting" is meant the operation by which the 
men who compose an army are raised. 
The military forces of the United States are made up of—1st, The 
Regular Army ; 2d, Volunteer Corps; 3d, Drafts from the Militia of the 
States. The term “Recruit” is, however, usually limited to men enlist- 
ing into the Regular Army. Still, for our purposes, all men offering 
for the military service may be considered as included in the general 
term “Recruit.” 
The laws and customs of the several States differ as to the modes of 
raising militia and volunteers, and as to the grounds of exemption of 
men claiming to be disqualified for the military service by reason of 
physical infirmity. But when a State is called upon to furnish its con- 
tingent for the service of the United States, the medical inspection of 
the men presented does not differ from that practiced in the case of 
the recruit offering himself for enlistment into the Regular Army. 
Drafted men and volunteers must be accepted or rejected upon the 
same principles as regular recruits; therefore, the standard adopted in 
the one case will also govern in the others. 8 
MANUAL FOR THE 
Section 1. 
Recruiting by Voluntary Enlistment into the Regular Army. 
“All free white male persons above the age of eighteen and under 
thirty-five years, being at least five feet four and one-half inches high, 
who are effective, able-bodied, sober, free from disease, and who have a 
competent knowledge of the English language, may be enlisted.”* 
It is not necessary that aperson desiring to enlist voluntarily into the 
army of the United States should be a natural-born or a naturalized 
citizen thereof. The United States insists upon the right of the foreigner 
to seek an asylum upon her shores; and, except in such cases where 
such foreigner may have fled from justice, and from countries with 
which we have made extraditional treaties including the crime with 
which the refugee is charged, the emigrant is entitled to and will 
receive the protection of our flag. He may offer himself for enlistment 
into the army, and, should he be found to possess the requisite moral 
and physical qualifications, he will be received. 
When enlisted he is to he taken before a civil magistrate or judge 
advocate,! and in his presence take the following oath or affirmation: 
“I, A. B., do solemnly swear or affirm (as the case may be) that I 
will bear true allegiance to the United States of America, and that I 
will serve them honestly and faithfully against all their enemies or 
opposers whatsoever, and observe and obey all the orders of the Presi- 
dent of the United States, and the orders of the officers appointed over 
me, according to the rules and articles for the government of the armies 
of the United States.”! 
When this oath is taken the enlistment is complete, and the recruit 
becomes entitled to all the immunities of a soldier in the army of the 
United States, whatever may have been the country of his birth. 
The only disqualifications, then, incident to the birthplace of the recruit, 
are crimes enumerated in treaties, and want of a competent knowledge 
of the English language. The former is a matter to be determined by 
the civil courts—the latter comes under the cognizance of the recruit- 
ing officer and th e inspecting surgeon. 
* Regulation Recruiting Service. 
t Sec. 3, act June, 12, 1858, authorizes any commissioned officer of the army to 
administer this oath when there is no civil magistrate in the vicinity. 
{ Rules and Articles of W ar, sec. 10. RECRUITING SERVICE. 
9 
In the examination of a recruit the surgeon must rely upon the man 
himself for information as to several important points in his medical 
history, (as will be seen hereafter;) and unless the recruit has sufficient 
knowledge of the English language to comprehend and to answer the 
necessary questions distinctly, we are of opinion he should be rejected. 
The recruit must not be less than eighteen nor more than thirty-five 
years of age. 
This regulation does not extend to musicians, nor to soldiers who 
may re-enlist after having served faithfully a previous enlistment in the 
army. A person under twenty-one years of age cannot enlist without 
the consent of his parent, guardian, or master, if he have either. 
But if the minor shall offer such written consent, the question then 
presents itself, whether so young a person possesses the vigor and phys- 
ical development necessary for the performance of all the duties of a 
soldier. 
The following remarks from the Aide Memoire de VOfficier de Sante 
upon this point deserve the most careful attention: 
“When young men of this age are well made and have a true apti- 
tude for the profession of arms, they are capable of making excellent 
soldiers. But it must not be lost sight of that there are few at this age 
fit for this profession. The body has not yet attained the necessary 
strength, the organs have not yet arrived at that stage of vigor which 
will permit them to pass rapidly, without a careful transition, from a 
state of repose to one of violent exercise ; and it must be borne in mind 
that by the term “organs” we do not mean only those of locomotion, 
as the expressions repose and exercise, we have just employed, might 
suggest; but Ve intend also to include the viscera themselves. Thus, 
at this age, the gastro-intestinal mucous membrane is too readily over- 
excitable—the lungs are too susceptible of morbid impressions. This 
is the epoch of. pulmonary congestions, of haemoptysis, of those obsti- 
nate bronchites the frequent occurrence of which leads almost inevita- 
bly to phthisis. At this age likewise the nervous system is far from 
having arrived at its maximum of functional development; its play is 
still most irregular. How, then, under so many disadvantages, is it pos- 
sible to encounter successfully the fatigues and accidents of war ? 
How, with an irritable stomach, accommodate oneself to food the most 
diverse and frequently the most indigestible ? How, with lungs so pre- 
disposed to disease, support such severe changes of temperature, heat, 
cold, moisture? How bivouac, how sleep in the mud, in the snow, 10 
MANUAL TOR THE 
without shelter, without fire ? How, with a nervous system still imma- 
ture, at least in its functional relations, find in oneself sufficient moral 
energy to contend successfully against all those elements of destruction 
which surround the soldier in campaign ?” 
‘ ‘ If we were, then, called upon to give our opinion upon this point, 
it would be an unfavorable one; and if we did not go so far as to reject 
it entirely, we should restrain its exercise within the narrowest limits, 
and reserve it for very rare contingencies, to be determined by special 
rules.” 
We cannot but assent entirely to the physiological objections so 
forcibly urged a gainst the enlistment of minors ; and, considering the 
annoyances and losses to which the service is so constantly exposed 
from this class of recruits, the perjuries, falsehoods, and forgeries they 
induce in the young and dissolute, the inconsiderable accession of 
force they bring to the ranks, we think they might profitably be for- 
bidden altogether. But so long as these enlistments are authorized by 
the Regulations of the army, the medical officer cannot summarily 
refuse to recognize them. He must confine himself to the investiga- 
tion of the physical qualifications of the individual recruit. 
Let him, then, institute a closer scrutiny into the condition of the 
thoracic and abdominal viscera of the recruit under age—learn if possible 
if he have any hereditary tendency to pulmonary or scrofulous disease— 
observe the degree of development of his muscular system, and be well 
satisfied that his osseous system is so well developed as to preclude all 
danger of distortion and the like from the severe fatigues the young 
soldier is sure to be called upon to encounter. 
The minhnum height of a recruit is fixed by the Recruiting Regula- 
tions of 1854 at five feet four and one-half inches. 
The minimum stature for a soldier has been frequently changed in 
our service. Sometimes it has been fixed by law, sometimes by regu- 
lation. The act of April 30, 1790, fixed it at five feet six inches. The 
act of March 3, 1795, recognizes the same standard. The act of July 
16, 1796, leaves both size and age to be determined by the President 
of the United States, or, in other words, makes these two qualifications 
the subject of regulations. 
The object of prescribing the lowest limit of the stature of a recruit 
is to exclude such as, from diminutive size, are supposed to lack the 
physical strength necessary to endure the fatigues of a campaign. Our 
standard has varied from time to time, and according to the exigencies RECRUITING SERVICE. 
11 
of the service, from five feet six inches to five feet three inches. 
During the late war with Mexico the standard was reduced to five feet 
three, for the purpose of filling the ranks with greater rapidity. It is 
plain that a degree of physical strength is required for the soldier in 
active service at least equal to that necessary in time of peace. It 
seems strange, then, that with a view to strength a higher stature 
should be required in time of peace than in time of war. We have 
already stated that men of all countries may be and are enlisted into 
our service. We require of a foreigner only that he shall have been ten 
days in the country, and that he shall understand the English lan- 
guage. It becomes interesting, then, to inquire what is the average 
stature of the natives of the different countries that contribute to our 
rank and file. 
From the records of the recruits received at Newport Barracks, Ky., 
(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 
Marshall quotes in his Military Miscellany a table communicated by 
W. B. Brent, esq., showing the comparative height of the soldiers in 
the British and French armies in proportions of 1,000. From this table 
it appears that in the French army there are 583 in 1,000 from five feet 
one inch to five feet four inches. In the British army none under five 
feet five inches. The British minimum for the regular service is five 
feet five and one-half inches. In the Anglo-Indian army it is five feet 
six inches. The statistics of this army show the average height of the 
Bengal native infantry to be five feet eight and one-quarter inches, 
the Madras native infantry five feet six and one-quarter inches. The 
minimum in the French army is five feet one inch and nearly one-half; 
but, as we have seen, recruits of five feet one inch are received. The 
proportion of men of this stature in the French army is sixty-two in one 
thousand. 
The experience of the late war in the Crimea has satisfactorily 
shown that the French soldier, though of less stature, is fully equal to 12 
MANUAL FOR THE 
the English in capacity of endurance. In the war with Mexico our 
own men of five feet three inches were certainly as seldom inmates of the 
hospitals as those of greater stature. 
What we want in a recruit is “shape, activity, stamina," and we feel 
sure that we more frequently meet with this combination in the man of 
five feet three than in the man of six feet three. 
If physical strength were admitted to be in proportion to height 
within certain limits, we could still afford to take a recruit of less stat- 
ure than the English; for the weight carried by the British soldier in 
marching order is not less than sixty pounds; whereas the weight of 
the equipment of the United States soldier, including ammunition and 
three days’ rations, is but forty-two to forty-three pounds. 
Vegetius remarks: “I know that great height was formerly very 
desirable in recruits, for none were admitted into the cavalry of the 
wings or the foot soldiers of the first legionary escorts but men of six 
feet, or at least five feet ten inches in height; but then we could choose 
from the large number of those who sought the career of arms, because 
civil employments had not yet attracted to themselves the choice of the 
youth of the States. But now, since we cannot do otherwise, we must 
have less regard to height than to vigor. Whoever is charged with the 
recruiting of troops should endeavor, above all things, to judge from the 
eyes, from the whole expression of the countenance, from the conforma- 
tion of the limbs, of those who are capable of making the best soldiers. 
There are as certain and as well-understood indications for judging of 
the soldierly qualities of men, as there are for ascertaining the value of 
a horse or a hunting dog. The young soldier should have lively eyes, 
the head erect, the chest large,, the shoulders square, a strong hand, 
long arms, the belly lank, a free, easy way, the legs and feet less bulky 
than muscular. When we find all these in a man we may dispense 
with height, for it is much more necessary that the soldier should be 
robust than tall.”* 
The Aide Memoire remarks upon this passage that it was written at 
a time when physical force was not counterbalanced by science and 
tactics. But now the system of war authorizes us to be less vigorous, 
and permits us to receive into'the ranks men who, in the time of Vege- 
tius, would have been excluded: “ In the present time, when the fate 
of battle is often decided by fire-arms, to which the hand of a man of six 
feet does not give more power than the hand of one of five, it is not 
* Aide Memoire. RECRUITING SERVICE. 
13 
easy to see the reason of the rule which so generally influences the 
choice of those who select subjects for the formation of armies. * 4 
* * It is evident to the common sense of every one that a body of 
men of unusual size presents an object of proportionably great volume 
to the marksman; and as it is generally known that such a body 
moves with little comparative celerity, it necessarily suffers a compara- 
tively great destruction from missile force before it can reach the point 
of attack. But besides the positive disadvantage of greater volume, and, 
from probable slow movement, comparatively long exposure to destruc- 
tion from fire-arms, before the superiority of bodily power, if any such 
exist, can be brought to bear, it is well known to those who have seen 
and estimated the effect of severe campaigns, that men of large size 
are ordinarily the first to fail under fatigue; and medical men know, 
from observation, that they commonly suffer from disease in greater 
proportion than others. These are facts that cannot be disputed; and 
if they be admitted to be true, it will not be attempted to maintain that 
bulky men are the best subjects for ordinary military service.”* 
Since the introduction of the Minie rifle the positive disadvantage of 
bulk is still more apparent, and can no longer be prudently neglected. 
Quickness of perception, enterprise, and intelligence certainly do not 
depend upon bulk of body, but are found comparatively much more 
frequently in men of small than in men of large stature. The bulky 
man, from a consciousness of physical force, due as much to weight as 
to nerve, may ordinarily possess more physical courage; but the quick- 
witted, active little fellow, who instinctively makes up,'‘by intelligence 
and address, for the difference in physical force, thus training and discip- 
lining his mind, however unconsciously, to meet and grapple with 
superior strength, will make the best and most reliable soldier. 
We think, then, the good of the service would be promoted by reducing 
the minimum standard height to five feet three inches, provided that 
shape, stamina, and activity are secured; it would give a greater range 
for selection, and we are persuaded that this stature will generally be 
found to unite sufficient physical strength with the other qualities indis- 
pensable in the soldier. 
The recruit must also be effective, able-bodied, and free from disease. 
“Inpassing a recruit the medical officer is to examine him stripped, 
to see that he has the free use of his limbs; that his chest is ample ; that 
his hearing, vision, and speech are perfect; that he has no tumors or 
* Jackson’s Formation, &c., of Armies. 14 
MANUAL FOR THE 
ulcerated or extensively cicatrized legs; no rupture or chronic cutane- 
ous affection ; that he has not received any contusion or wound of the 
head that may impair his faculties ; that he is not a drunkard; is not 
subject to convulsions; and has no infectious or other disorder that 
may unfit him for military service.”* 
The spirit as well as the letter of a regulation will always be carried 
out by the zealous officer. It is obvious to the professional man that 
there are many causes of disqualification not enumerated in the regula- 
tion above cited. That medical officer who should confine his examina- 
tion to the defects recited in the text, would but very imperfectly per- 
form his duty. The intention of the regulation is to exclude from the 
rolls all who are in any way, physically or mentally, incapable of per- 
forming the duties of a soldier; and the surgeon is required to certify 
that no such disqualification exists when he passes the man. 
The circumstances of the military service in the United States are so 
totally dissimilar to those in any other among civilized nations, that 
the suggestions and cautions deduced from their experience are but to a 
limited extent applicable to us. The motives to deceit with us are such 
as may enable the recruit to get into the ranks; whereas, in other nations, 
they are such as may aid him in escaping the conscription in one ser- 
vice or the life-thraldom of another. In the army of the United States 
the term of service is but fite years—the pay of the soldier is fully ade- 
quate to his wants or expectations. The man does not lose caste by 
enlisting ; and, under the beneficent legislation of Congress, if he pos- 
sess, or ha* the ambition and industry to acquire, such elementary 
knowledge as will fit him for the discharge of the duties of a commis- 
sion, he is eligible to and may receive one. It is, therefore, a matter 
of the first importance that the medical officer should carefully scru- 
tinize the physical and intellectual qualifications of the recruit. The 
ineffective man weakens the ranks he was intended to strengthen. He 
serves but to fill the hospitals, incumber the trains upon a march, con- 
sume supplies, and call for the services of the effective and able-bodied 
to minister to his infirmities when his own services are wanted in the 
field. Let the surgeon, then, bear in mind that it is the number of bayo- 
nets in the field, and not the number of names upon the rolls, that deter- 
mines the strength of an army, and he will be less anxious to pass num- 
bers of recruits than that those whom he shall have certified to be free 
* Reg. Med. Department, p. 32. RECRUITING SERVICE. 
15 
from defects shall not compromise his professional reputation by their 
failure in the hour of trial. « 
It is not any easy thing for the inexperienced surgeon to examine a 
recruit properly. Unless he pursue some systematized method, import- 
ant points will be apt to escape him. The British regulations prescribe 
the particular routine according to which the examination is to be 
conducted. Our own regulations give no such instructions, but leave 
the method of examining the recruit to the discretion of each individual 
medical officer. 
We shall first endeavor to point out the most important defects which 
demand the rejection of a recrilit, and then to sketch a method of con- 
ducting the examination, by which, if followed out, these blemishes 
can scarcely escape detection. 
We must, however, admit that in some instances the most careful 
and experienced observer will be deceived. The arts of the dissembler 
may cover up important defects for a time. He has every advantage, 
and he will unscrupulously avail himself of his knowledge. We meet 
with so many cases in which the baldest falsehoods are so pertina- 
ciously asseverated in order to carry out a premeditated imposition, 
that, harsh as it may appear, we must caution the surgeon and 
recruiting officer against relying at all upon the declarations of a recruit, 
when any other means of arriving at what we wish to ascertain can be 
commanded. 
When a knave succeeds in his scheme, his defect will probably dis- 
cover itself very soon, and then we have the means of discharging him 
before he shall have gained much by his frauds. 
“ All lank, slight, puny men, with contracted figures, whose develop- 
ment is, as it were, arrested, should be set aside."* 
It is evident such men cannot bear the fatigues of war. It is to 
effectiveness in war that we are always to look, for “war is the nor- 
mal state of the soldier; peace is for him the temporary and excep- 
tional condition.” Ever since the addition of Texas, New Mexico, and 
California to the territory of the United States, our soldiers have been 
constantly engaged in war of some sort. The privation and exposure 
necessarily incident to the occupation of new and uncultivated coun- 
tries, and the harrassing wars constantly carried on with the savage 
tribes that infest them, demand a higher standard of physical strength 
in the soldier than would be required in any war we could he engaged 
*Aide Memoire MANUAL FOR THE 
in with a civilized enemy. The diminutive, half-developed recruit is 
totally unfit for the service our soldiers have to perform. 
Intemperate habits are a positive disqualification in a recruit. 
Although ardent spirits have for many years been excluded from the 
regular ration of the soldier, and although sutlers are prohibited from 
keeping it in their stores, still, even in places the most remote from the 
settled parts of the country, the whisky-dealer hangs upon the flanks 
and rear of the camp ever ready to minister to the depraved appetite 
of the drunkard. The intemperate soldier is never to be relied on; 
first in a mutiny and last in battle, he is at once an example of insub- 
ordination and a nuisance to his comrades. 
It is difficult oftentimes to detect the habitual drunkard. We must 
rely, to some extent, upon the man himself for information upon this 
point. Men frequently present themselves who exhibit evident signs of 
a recent debauch. It is frequently impossible to say whether this is 
the habit of their lives, or merely a temporary lapse, induced, perhaps, 
by misfortune, disappointment, or youthful folly. To reject summarily 
in such a case would frequently lose to the service a good and efficient 
soldier. It is positively enjoined by the regulations that every man 
shall be sober when enlisted. In cases, then, where there is room for 
doubt, a suspension of a final decision should be resorted to for a suffi- 
cient length of time to enable the man to recover from the effects of a 
mere temporary debauch. 
But when the man has long indulged in habits of intemperance, it is 
almost sure to be indicated by persistent redness of the eyes, offensive 
breath, tremulousness of the hands, attenuation of the muscles, par- 
ticularly of the lower extremities, sluggishness of the intellect, and fre- 
quently an eruption of rum blossoms on the face and purple blotches 
upon the legs. Men presenting such signs of intemperance as these 
should be rejected. 
In addition to the personal observation of the recruiting officer and 
surgeon as to these indications of intemperate habits, the recruit should 
always be made to say distinctly whether he is a drunkard or not; and 
his answer should be recorded on the spot, (in the manner to be here- 
after indicated,) for purposes of accurate reference, should a drunkard 
succeed in imposing himself upon the service notwithstanding the 
careful observance of all the requisite precautions upon the part of both 
the recruiting and medical officers. 
The man should have also the free use of all his limbs. RECRUITING SERVICE. 
There are many causes preventing "a free use of the limbs, but, for- 
tunately, their effects may be readily recognized by the recruiting officer,' 
even without the assistance ef a surgeon. The most frequent of these 
causes are fractures, dislocations, anchylosis, paralysis, permanent con- 
traction of the flexor muscles, chronic rheumatism, enlarged bursa;, 
varicose veins, cicatrices of burns, ulcers or wounds, toes crowded, 
overlapping, redundant, or defective, ingrowing toe-nails, corns, bun- 
ions, splay foot, &c. We merely mention these things here,' reserving 
a more extended examination of them for another place. 
When a recruit is inspected he should be made to execute such mo- 
tions as will serve to point out any immobility of any of his joints. 
For this purpose various modes have been suggested. 
“ Many of the causes which impede the performance of the animal 
functions are visible to the eye, and may be estimated to the full extent 
a priori; others only discover themselves upon trial in great exertions. 
As it is only from uniformity of power under exertion that union of 
action can be assured, and as this is the point 'which essentially con- 
tributes to success in war, a standard for the measure of the powers of 
exertion among recruits is not less necessary in sound reasoning for the 
construction of a military instrument than a standard for the measure 
of the height of the stature. In order to ascertain this important point, 
the writer conceives it to be proper that every person who enters into 
the army should be brought to trial in walking, running, leaping, climb- 
ing hills, and traversing irregular and broken grounds. It may be 
fairly admitted that a full-grown person who is not capable of marching 
at the rate of four miles in the hour, with fire-lock and knapsack, is not 
eligible for a soldier destined for field service. If his wind fail in walk- 
ing briskly up hill, or if his joints be weak, so that he does not move 
with speed and safety over broken grounds, it would be unwise to enroll 
him on the lists of an active army.”* 
If it were practicable to institute this mode of examination into the 
integrity of the organs of locomotion, there can be no question its results 
might be implicitly relied upon. The improved methods of modern 
tactics, and the introduction of the severe drill of the chasseur a pied 
into our service, requiring a greater degree and more uniformity of 
physical power and activity, would seem to demand some such ordeal. 
By similar means the integrity of the functions of the heart and lungs 
would also be ascertained, and many other advantages might be pointed 
* Jackson op. citat. 18 
MANUAL FOR THE 
out. But inasmuch as in cities and towns where most of our recruits 
are enlisted we have not the means of instituting so severe a test, we 
must content ourselves with a less perfect mode. The method pre- 
scribed in the Regulations of the British Army seeming to be as well 
adapted to the end in view as any we know of, we here transcribe them: 
Upon entering the inspection room the recruit is to walk a few 
times pretty smartly across the apartment, for the purpose of showing 
that he has the perfect use of his lower extremities. He is then to be 
halted and set up in the position of a soldier underarms, with the knees 
about an inch apart, and examined both in front and rear from head to 
foot. Should no material defect be discovered during this survey, the 
examination may go on. The recruit is then to perform, in imitation of 
the hospital sergeant, the following evolutions : To extend the arms at 
right angles with the trunk of the body, then to touch the shoulders 
with the fingers ; next to place the backs of the hands together above 
the head; in this position let him cough, while at the same time the 
examiner’s hand is applied to the rings of the external oblique muscles. 
Let the inspecting officer examine the spermatic chord and testes; then 
pass his hands over the bones of the legs. The recruit is next to be 
made to stand upon one foot and move the ankle joint of each extremity 
alternately ; when any doubt is entertained respecting the efficiency of 
this joint, or any part of an inferior extremity, he should be made to 
test his strength by hopping upon the suspended limb for a short period, 
and the size and aspect of the corresponding joint or part of the oppo- 
site limb should be accurately compared. He is next to kneel on one 
knee, then on the other, and subsequently upon both knees. Let him 
then stoop forward and place his hands on the ground, and while in 
this position it ought to be ascertained whether he is afflicted with 
haemorrhoids. 
‘ ‘ He is then to extend the superior extremities forward, for the pur- 
pose of having his arms and hands examined, and with this intention 
he is to perform flexion and extension of the fingers, and to rotate the 
forearm.” 
The systematic observance of this method of examination will enable 
the recruiting officer or surgeon to detect any impediment to the free 
use of the limbs and joints of the recruit, as well as to discover some 
other defects that may demand his rejection. 
To enable the inspecting officers to carry out the plan more readily, 
they should carefully instruct the recruiting sergeant in the regular RECRUITING SERVICE. 
19 
mode of performing the various motions required, and the recruit should 
be directed by the sergeant to imitate him in all the motions. The 
recruiting officer or surgeon will then be at liberty to observe the 
motions of the recruit both front and rear while the inspection is pro- 
gressing. 
To this list of motions to be executed should be added the vertical 
and lateral motions of the lower jaw and head, and extreme flexion of 
the wrist, hip, knee, and ankle joints. 
We may here observe that we have seen a few instances in which .|he 
recruit could not touch his shoulders with his fingers, and still the 
most rigid examination could detect no imperfection in any of the 
joints of that extremity. When any difficulty in touching the shoulders 
with the fingers is perceived, a more cautious inspection of all thejoints 
of the limb must be instituted, as the probabilities are that some defect 
exists. The elbow or wrist will generally be found to be the failing 
joint. 
We may again remark, that the order in which the several motions 
are executed is immaterial, provided they are all gone through with. 
Our own method is this: After the recruit has gone through with the 
walking and hopping, and has taken the position of a soldier, while 
questioning him as to any defect, injury, or disease he may have suf- 
fered, we percuss the chest, place the hand over the heart to ascertain 
the character of its motion, etc. We then feel the surface of the head 
carefully; then examine the ears, eyes, teeth, nose, throat, and motions 
of the jaws in succession; then extend the arms above the head, with 
the backs of the hands together, and in this position examine the rings, 
chord, and testes ; then cause the man to touch his shoulders with his 
fingers. We next inspect the elbow and wrist-joints, fingers, etc., being 
careful to require the fore-finger to be flexed and extended separately, 
while the other fingers are kept flexed and the thumbs are adducted 
across the palms of the hands ; then ascertain the presence of the vaccine 
or variolous cicatrix ; then cause the man to touch the floor in front of 
him with his fingers while the nates are kept elevated, so that the exist- 
ence of haemorrhoids, fistula in ano, or perineo, etc., can be observed. 
Then the man rises and we examine the urinary organs; next the inde- 
pendent motions of the ankle joints; then cause the man to kneel upon 
each knee separately; and, finally, to raise on his toes. 
It is evident that while these motions are being performed, the expe- 
rienced eye has abundant opportunity for observing every point of the 20 
MANUAL FOR THE 
man’s person front and rear, and will scarcely fail to perceive any devi- 
ation from the normal standard in the head, limbs, thorax, abdomen, 
spine, pelvis, etc. 
The chest should be ample. 
The limit of what may be considered an ample chest has never been 
definitely determined. The “ vital capacity" of the chest, as Mr. Hutch- 
inson terms it, will depend upon the integrity of the contained viscera. 
This author thinks that the vital capacity is commensurate with the 
range of mobility or thoracic movement, and that the mobility increases 
in arithmetical proportion with the height. Our own observations have 
led us to the conclusion that the mobility is rather inversely as the cir- 
cumference of the chest, than directly as the height of the person—as if 
increased mobility were designed to make up for less capacity as indi- 
cated by a less diameter; so that the quantity of air consumed does not 
differ greatly in different men with healthy lungs, whatever may be 
their relative stature or circumference of chest. And this, after all, we 
look upon as the essential condition of healthy respiration. The larger 
quantity of air that may be forcibly expelled, as shown by the spi- 
rometer, we consider as indicative of muscular vigor, rather than of the 
quantity of oxygen required or regularly used for vital purposes. 
The vital capacity, as measured by Hutchinson with his spirometer, 
gives some curious results. Mr. Hutchinson thinks the circumference 
and length of the chest have little influence in determining the quantity 
of air taken in at each inspiration, because the circumference increases 
with the weight, and the length of the chest varies but little in men of 
different statures. To the latter proposition we accede, to the former 
we do not. Mr. Hutchinson measures with a tape around the chest 
above the nipples. We think this may account for the different results 
of his measurements and ours. Mr. Ii. finds the mobility of the chest 
to average three inches, seldom reaching four. 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 margins of both the latissimus 
dorsi and pectoralis major muscles will be included as well as the fatty 
developments of the breasts themselves. This will give an increased 
measurement to the parietes of the chest, and when a forced inspiration 
and expiration are made, the swelling and relaxation of these muscles 
will give an apparent mobility greater than the real. We measure 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 RECRUITING SERVICE. 
21 
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 two and one- 
half inches, and seldom exceeds three; once only have we found it four. 
In this way, it seems to us, we may approximate more nearly to the 
solid contents of the thorax. We think the geometric solid represented 
by the thorax to be nearer a paraboloid of revolution than any other 
figure ; and if we consider the space occupied by the heart and the 
mediastinal spaces to be equal to that part of the cavity contained by 
the plane of the diaphragm and a horizontal plane passing through the 
lowest point of the attachment of the diaphragm to the sternum, we 
shall have a regular figure whoso solid contents are easily calculated. 
The spirometer of Hutchinson is not readily accessible to the army 
surgeon, and would be found both inconvenient and unnecessary in 
the examination of recruits. The tape measure will answer all practical 
purposes. 
Stokes found twenty chests that he measured to average thirty-five 
inches, and a maximum chest to measure forty-three inches and one- 
half. Taking thirty-five inches for a circumference, with a mobility of 
three inches, and the altitude of the figure we have described at seven 
inches, it will be found that fifty-nine cubic inches have been expelled 
at one expiration. This we consider to be near the truth. In regular 
breathing the quantity taken in at each inspiration is much less. Thus, 
Dumas and Coathupe, when they inspired sixteen times a minute, 
found they consumed at each inspiration twenty cubic inches, or 266.66 
cubic feet in twenty-four hours. From more recent experiments by Dr. 
Draper, the quantity consumed at each inspiration with the same num- 
ber of inspirations per minute, was found to be thirty-nine cubic inches. 
The circumferences of the chests of 150 recruits examined by us within 
a few weeks have varied from 29.5 inches to 38 inches, and their mo- 
bility from two to three inches. The mean circumference was 33.97 
inches. The height of the men ranged from five feet four and one-halt 
inches to five feet eleven and a half. The least circumference was in 
the tallest man, and the greatest in a man five feet eight and a quarter 
inches. Other men of five feet four and one-half and five feet four and 
three-quarter inches have measured 34 and 34.5 inches. The man meas- 
uring 29.5 was rejected for evident feebleness of constitution. We should 
then fix the lowest limit of thoracic circumference, measured as we 
have indicated, at thirty-one inches, with a mobility of two inches in a 
man of five feet six inches. A less “vital capacity,” in our own opin- 22 
MANUAL FOR THE 
ion, disqualifies the recruit. We have dwelt more upon this point be- 
cause it is one of great importance. A better judgment can be formed 
of the physical strength of a recruit from the development of the thorax 
than from any other single feature. Cruvelhier has well remarked 
that, “ in each individual, the capacity of the thorax is exactly propor- 
tioned to the volume of the lungs; and as in general voluminous lungs 
co-exist with a highly developed muscular apparatus, it follows that the 
size of the thorax is no equivocal sign of a vigorous constitution.” 
We have remarked that the figure of the thorax is nearly a paraboloid. 
This is of course not rigidly true—no section of it is a regular circle, 
but it will be found to be flattened in different directions in different 
places. For our purposes, the most important normal flattening is 
antero-posteriorly. Many variations, however, of the normal configu- 
ration, are met with; some compatible with health, others pathological. 
We will only mention in this place that— 
When the lateral exceeds the antero-posterior flattening, and the ster- 
num is prominent, the chances are that the subject is phthisical and 
should be rejected. 
When there is much curvature of the spine, so that the ribs are abnor- 
mally approximated on one side, the mobility of the chest will be sensi- 
bly affected and the vital capacity seriously diminished. Such men 
are neither physically nor physiologically fit for soldiers. 
The remaining points of examination being less general in their char- 
acter, will be treated of when we come to speak of the different organs 
and systems which may be the seats of special diseases of such a nature 
as to disqualify a man for the military service. 
We shall conclude this chapter with a few general remarks selected 
from various authors: 
“Reason dictates that none should be admitted to the military ser- 
vice but men endowed with a healthy and vigorous constitution. But 
the expression “ Strong constitution," when applied to a man remarka- 
ble only for great muscular development or predominance of the lympha- 
tic system, is sometimes deceptive. In fact, it frequently happens that 
this athlete, ■with a herculean form, presents organic affections which 
render him unfit for the military service, and which an attentive exami- 
nation alone can discover. We advise, therefore, that this class of men 
should be subjected to a more minute inspection. The employment of 
the stethoscope may then be a valuable assistance -when one is expert 
in the use of this instrument. This observation is particularly appli- RECRUITING SERVICE. 
23 
cable to very tall men, in whom the thorax is rarely in proportion to the 
other parts of the body.” 
“In general, men of small stature and otherwise well formed resist 
the fatigues of war better and are more active than those of tall stature ; 
and it was thus judicious that the last law upon the recruiting of the 
army reduced the standard of height for the military service.” 
There is still another constitutional condition which, far from being 
characteristic of perfect health, on the other hand, indicates that the 
subject presenting it is in a condition approaching disease, and is conse- 
quently unfit for the army. This is an excessive predominance of the 
sanguineous system, or a constitution plethoric to an extreme degree, 
in an individual of full habit, whose figure is short, thick-set, with a 
large head, short neck, countenance injected, veins prominent, and who 
can neither stoop down, wear a stock, hook his collar, nor wear a 
shako without his face becoming purple, and being threatened with 
an attack of apoplexy.”* 
“ All weight under eleven stone and a half (161 lbs.) does not inter- 
fere 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, (viz: fourteen stone,) the weight interferes with the vital capacity 
in the relation of rather more than one cubic inch to the pound.”t 
“ Besides height, beauty and symmetry of figure influence opinion 
and determine preferences in the choice of soldiers. * * * * 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. On the contrary, it is 
usually observed that cross-made persons—persons whose joints are 
large and prominent—possess great powers of action and long endurance 
of toil. The observation is true, and the reason of its truth is obvious. 
The form of body alluded to furnishes an advantageous lever for the 
action of muscles ; and on this ground bodies so constructed are patient 
of toil, inasmuch as their movements are effected with comparatively 
little effort. Hence, instead of grace and symmetry of form, a rosy 
color and delicate texture of skin, large joints, prominent bones, swell- 
ng muscles, rough and elastic integuments, are true military proper- 
ties. They are the real beauties of a soldier, as they are the surest marks 
of the capacity of enduring the fatigues of war. ****** 
* Aide Memoire. 
t Hutchinson. 24 
MANUAL FOR THE 
The duty imposed upon the surgeon is not to select what is in every 
way good, but to reject what is absolutely unfit.* 
“ It may be observed generally, that in the case of dwarfs or under- 
sized men, the upper part of the body is often sufficiently well developed, 
and it is in the lower limbs, or inferior half of the body, that the deficiency 
exists. In remarkably tall or overgrown men, on the other hand, we 
have the lower limbs for the most part unduly developed, and the 
trunk, particularly the chest, often defective.”! 
These general remarks are sufficient to indicate to the recruiting officer, 
as well as to the inexperienced medical officer, the points to which his 
attention should be specially directed in the inspection of recruits, 
and of which any intelligent officer is capable of judging. 
* Jackson’s Econ. of Armees. t Sir George BallingalL RECRUITING SERVICE. 
25 
CHAPTER II. 
SPECIAL AFFECTIONS OF PARTICULAR ORGANS THAT 
DISQUALIFY A RECRUIT, OR ARE JUST CAUSES FOR 
THE DISCHARGE OF AN ENLISTED MAN. 
Section I. 
The subject of this section is so ably and so fully treated in the Aide 
Memoire, that we shall do little more than translate the introductory 
remarks as they stand. Some alteration in their phraseology will be 
necessary to adapt them to our service. This we shall do freely, and 
add, whenever it may appear useful, our own observations and those 
of other writers upon particular points. In this way we hope to be able 
to include all that may be necessary to enable the inspecting surgeon, 
whether military or civil, to form a correct judgment in the several cases 
of the admission of recruits, of the discharge of soldiers for disability, of the 
admission or rejection of substitutes for drafted men, and of the exemption 
of drafted men from service on account of physical or mental infirmities. 
PRELIMINARY CONSIDERATIONS. 
“The appreciation of the different circumstances which give the 
right to exemption or discharge from the military service is left to the 
conscience, the judgment, and the experience of the medical officers. 
There neither is nor can be any fixed or invariable rule upon this sub- 
ject. The jurisprudence of the matter is very simple, and reduces itself 
to rejecting all persons who present vices of conformation, or other 
infirmities offering any real impediment to the exigencies of the different 
branches of the service. 
“ From this it may be readily perceived bow difficult it would be to 
include in any one catalogue all cases of incapacity. Two official docu- 
ments, emanating from the Minister of War, have been published at 
different times to regulate the proceedings of councils of revision; 
but it has been conceded that the table prepared by order of the Minister 
of War, and the old instructions of the inspectors general of the army 
medical service, are incomplete, and should no longer be consulted ex- 
cept as mere hints. 26 
MANUAL FOR THE 
“It must also be borne in mind that these tables were drawn up at 
a time of excessive severity upon the subject of exemptions ; at the time 
when the conscription was carrying off the whole of the French youth. 
But now, when we take but a part of the classes, (says the Minister,) 
councils of revision (surgeons and boards of inspection in our service) 
should reject from the army all those conscripts (volunteers or substi- 
tutes with us) who do not appear evidently capable of becoming good 
soldiers and of supporting all the fatigues of war.” 
“ Every decision of a council of revision which would admit into 
the contingent men evidently unfit to perform good service, would be a 
violation of its orders, and an inexplicable forgetfulness of the important 
duty confided to it.” 
These injunctions are of the greatest importance, and cannot be too 
strongly commended to the consideration of medical and mustering offi- 
cers charged with inspection of volunteers and militia who may offer for 
the service of the United States. 
When volunteers are called for, the commissions of the officers are not 
uncommonly made to depend upon their success in raising a certain 
number of men within a given time. Political aspirations too frequently 
induce the ambitious citizen to seek notoriety in the field. Entirely 
ignorant of the profession of arms, and with ideas of the nature of 
war derived from the annual militia muster of his vicinity alone, he 
receives eagerly anything that offers to fill his contingent; and thus, 
with mere apologies for men, heedlessly seeks the unequal strife with 
disease and death that too certainly awaits him in the field. A princi- 
pal cause of the mortality that has so frequently and fearfully deci- 
mated our volunteers, is the original unfitness of so many of their rank 
and file for the military service. Were the important duty of the pre- 
liminary medical inspection fearlessly and carefully conducted, this pro- 
lific cause of disease and death would be effectually removed. It 
appears to us to be doubly dishonest to receive an incapable volunteer— 
first to the service, in burdening it with a man who has no chance of 
ever being able to draw a trigger, and whose military history is sure 
to be found in the pension office instead of the field reports; and, next, 
to the man himself, in permitting him, from perhaps an impulse of 
patriotism, to proceed to the seat of war, there to be a burden to his 
comrades, and too often to finish a sad career by succumbing inglori- 
ously in bed. 
“I have had occasion to remark,” again says the Minister in his in- RECRUITING SERVICE. 
27 
stractions upon the call of 1S33, ‘ ‘ according to the reports made to me 
by the inspectors general, that many of the young men comprised in 
the contingent have been sent back from their corps, a short time after 
their incorporation, on account of infirmities contracted before their 
entry into service.” “Councils of revision. I hope, will bear in mind 
how important it is to the interests of the treasury and of the army to 
put an end to a state of things that can no longer escape the investiga- 
tion of the Chambers. They cannnot carry too much care and caution 
to the selection of young soldiers. In this respect, they should recol- 
lect that the law says: all those whose infirmities render them unfit for 
service shall be exempted. Now, it would be but wretched to so inter- 
pret this law as to violate its letter and to disregard its spirit; to send 
into the ranks men who only involve the State in useless expense, 
whose existence is dragged along from hospital to hospital, where they 
finish by perishing, if they are not immediately restored to their families. 
To point out such grave results to the councils of revision is, I hope, 
to put an end to them.” 
These remarks are to the full as applicable to our volunteer system as 
to the French conscription. No officer of experience can fail to see 
their force. 
What, then, are the infirmities which unfit men for the military ser- 
vice ? 
The term of enlistment of the regular soldier in the army of the United 
States is for five years only. Volunteers are called for different terms, 
varying, according to circumstances, from a few months to a year, or 
for the duration of an existing war. Militia or drafted men usually for 
three months. 
It might appear at first sight that a less rigid rule of exclusion might 
be observed in our service, on account of the short term of enrollment, 
than would be demanded in services where the enlistment is for a much 
longer period, and sometimes for life. But this view will not be sus- 
tained by the result of its practical application. 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 re- 
cruit is capable of this, he is as fit to be enlisted for life as for three 
months. 
But, as has been before remarked, there is no fixed rule upon the sub- 
ject. “ The appreciation of the facts is left to the sagacity of the sur- 
geon. The confidence reposed by the government in his honesty and 28 
MANUAL FOR THE 
in his judgment, imposes upon him responsibilities so much the more 
stringent.” 
Diseases or infirmities which render a man unfit for military service 
maybe real, simulated or dissimulated, (concealed,) provoked ox feigned- 
The surgeon cannot be too much upon his guard against the sources 
of error by which he is surrounded. He must be suspicious, incredu- 
lous, and, above all, most attentive. 
In treating in detail of each of these diseases or infirmities, we shall 
endeavor to furnish the means for detecting fraud. 
All those diseases or infirmities which impede the functions of one or 
more organs or members, all incurable diseases, or such as are curable 
only after a loDg time, when their seat is in an important organ, demand 
exemption, rejection, or discharge from the military service. Any chronic 
disease should reject a recruit for our army, (if seated in an important 
organ,) but a less rigorous rule should be applied in cases of discharge. 
A chronic hepatitis, or engorgement of the liver, for example, though of 
so light a grade as to admit of the performance of the ordinary duties 
of a soldier, will be availed of by the indolent recruit to enable him to 
evade duty and spend half his time upon the sick report, while it would 
scarcely be allowed to interfere at all with the duties of the veteran 
soldier. We would not pass a recruit with such a disease, nor would 
we grant a certificate for the discharge of a soldier for that reason. 
“We shall not occupy ourselves any further than we have already 
done with defect of height, as it does not constitute a disease, although 
it is a reason for exclusion from the service.” 
“ We shall examine, in their medico-legal relations, those infirmities, 
deformities, and diseases which present the characters pointed out above; 
and in this examination we shall follow the order of regions, as is done 
in the inspection of recruits. In fact, this examination being made by- 
regions, and successively from head to foot, we shall adopt the follow- 
ing order, wThich appears the most convenient and the most appropriate 
to the nature of this work : 
1st. The Head. 
2d. The Neck. 
3d. The Chest. 
4th. The Abdomen. 
5th. The Genital and Urinary Organs. 
6th. The Spinal Column. 
7th. The Superior Extremities. 
8th. The Inferior Extremities. RECRUITING SERVICE. 
These are the points upon which questions of rejection or discharge 
usually turn. But there are still others, which, although more rare, 
are often met with. Such as diseases of the cerehro-spinal nervous sys- 
tem ; diseases whose diagnosis should be well understood, because they 
are frequently simulated; scrofulous diseases, or a deterioration of 
the constitution by scurvy, by a cancerous diathesis, or by inveterate 
constitutional venereal disease ; chronic and extensive cutaneous dis- 
eases ; a puny constitution, or arrest of development. In this category 
is included a number of men, sometimes lymphatic to excess, flabby, 
spongy, wan; sometimes diminutive, spare, weak, narrow-chested, 
limbs without muscles; sometimes with a skin dry, dull, or shriveled, 
with prominent articulations and flaccid flesh; sometimes badly built, 
badly proportioned; finally, sometimes emaciated, worn out by long 
fatigues, or by antecedent disease. Such men should be excluded from 
the ranks of an army. “ The surgeon charged with the inspection of 
young men for the military service should keep himself constantly on 
his guard ; should maintain a perpetual distrust, as we have already 
said. One would risk nothing by inclining rather to the theory of simu- 
lation than reality. But while he should be circumspect, he should also 
be equitable, and neither omit nor neglect anything in order to base his 
decision upon just and substantial grounds.” 
“It is allowable, and sometimes necessary, to subject to experiment 
men whom we can compass in no other way; but these experiments 
should never present any danger, nor expose the subject of them to any 
untoward consequences. All violent measures should be rejected as 
illegal, cruel, and dangerous. They are at once inefficient and decep- 
tive, and can only furnish contradictory results. 
“The axiom that ‘ no man should be operated upon against his con- 
sent, ’ is too generally admitted to require that it should be maintained 
by an argument. 
“The law has not established, nor can it establish, any distinction 
between irremediable diseases and those that can be cured only by 
means of a surgical operation. It limits itself to conceding that every 
man affected with infirmities that disqualify for the career of arms, shall 
be exempted after professional men have been consulted. The law, then, 
requires that we take the man fit for service, and not him who must be 
subjected to an operation to tit him for the performance of his duties. 
It would be contrary to every principle of humanity and justice to re- 
quire of an unfortunate man, whose infirmities are a sufficient reason 30 
MANUAL FOR THE 
for his discharge, that he should undergo a bloody operation in order 
to retain or admit him into the military service. And, moreover, 
every intelligent surgeon knows' that there is no surgical operation, 
however trifling it may be, that may not be followed by accidents ca- 
pable of compromising life.”* 
“ In the inspection of men called out bylaw, the surgeon, military 
or civil, occupies the position of an expert, who, knowing the nature of 
the service demanded, pronounces, after examination, upon the fitness, 
moral or physical, of the man before him to satisfy that demand. In 
cases of doubt, the opinion should always be in favor of the man as to 
whom it arises. This is the only way to reconcile all interests. There 
are a great many men who, too feeble to render good service, cause the 
State large hospital expenditures, and succumb miserably under the 
colors in time of profound peace. Yet, left at their own firesides, 
these men might have continued their occupations, and perhaps have 
completed a long and laborious career. By sending such men into the 
field we exact from them more than the law has required; for we sub- 
ject them to the manifest danger of death, while the law was never in- 
tended to exact from them the sacrifice of more than a portion of their life- 
time. Furthermore, how many debilitated men return to their homes ex- 
hausted—invalids, incapable of providing for their subsistence—a burden 
to themselves and others, who, had they been left at home, might have 
been useful citizens. The robust man, on the contrary, will become 
still more robust in the field; the army'will possess in him a soldier 
equally fit for work or battle. He will return capable of embracing or 
pursuing a laborious career, and of providing for himself and for his 
family. Thus will be solved the problem so important to the country— 
how to secure its defense in the best posssible way with the sacrifice of 
the least number of its citizens.”t 
These remarks have a peculiar significance in relation to the ac- 
ceptance of volunteers into the service of the United States, while their 
application to the case of drafted militia will be at once perceived. 
But while persons who are the true subjects of military disabilities 
should be rejected or discharged from the service, a different course 
should be taken with that class of men wrho, in order to evade a duty 
they are unwilling to perform, or to escape from an obligation they 
find more irksome than they anticipated, feign themselves the subjects 
of disqualifying disease. 
*Aide Memoire. 
f Bdgin. RECRUITING SERVICE. 
31 
“Among feigned diseases, some are expressed and announced to the 
surgeon by occult symptoms, of the nature of which he cannot judge by 
any external sign,” (affections of the kidney, for example;) “others 
present outwardly evident signs, which have been provoked by artifice, 
with the culpable design of creating a belief in their reality,” (e. g., 
ulcers, &c.) “ It is a studied, combined, premeditated imposture, in 
which, either alone or aided by the advice of others, the man repre- 
sents, with more or less fidelity and exactness, the disease with which 
he wishes to pass as being affected, with the view of evading duty, es- 
caping punishment, exciting commiseration, &c. Substitutes for con- 
scripts dissemble these infirmities in order to be received, while these 
last simulate them to escape service. And we are obliged to confess 
there are professional men who, from weakness, obsequiousness, or ava- 
rice, and forgetful of their obligations and their honor, do not hesitate 
to lend themselves to, and even to teach, these culpable manoeuvres. 
But the evil is done; the simulation of diseases has been reduced to 
principles—an art has been made of it. It is, then, to the interest of 
families and of consequence to the State to frustrate such designs; and, 
in order to do so, io is necessary to employ stratagem against strata- 
gem.”* 
We should, then, examine the suspected disease with so much the 
more circumspection and severity, in that the subject may have the 
greater interest as to whether his disease should be real, or should be 
considered to be real. The surgeon should ask himself whether the 
disease can be imitated or excited. In interrogating the subject, he 
should make his questions the more subtle in proportion as the mental 
faculties of the suspected malingerers may be the more developed. In 
this way he may be made to fall into contradictions, and to confess 
that he has symptoms incompatible with his disease. 
The general rules for detecting feigned diseases, as suggested in 
Guy’s Medical Jurisprudence, that may be profitably introduced here, 
are: 
“Inquire in all cases into the existence of motives for deception.” 
“ Inquire into the previous history of the patient, and the character 
which he bears among those who know him best, as his comrades or 
companions.” 
“Incases of feigned diseases, properly so called, consisting of as- 
semblages of several symptoms, we must examine minutely into the 
* Percey and Laureat. 32 
MANUAL FOR THE 
history and alleged causes of the disease. Compare the age, tempera- 
ment, and mode of life of the suspected person with the symptoms 
present. Watch narrowly the course of the symptoms, and contrast it 
with the known march of the disease itself.” 
“The suspected person should be visited at all hours of the day, and 
at times at which he does not expect to be seen. He should also he 
watched by those he is not likely to suspect.” 
“No questions should be put of a nature to instruct the patient as to 
what we wish to know; but our inquiries should he so directed as to 
lead him into incongruous statements. He should be thrown on his 
own invention, and allowed to talk in his own way. The suspicions 
■we entertain should be carefully concealed. We must ourselves become 
dissemblers, and meet the malingerer with his own -weapons.” 
B&gin says : “ The means proper for defeating fraud in the matter of 
infirmities or lesions of organs, reduce themselves to the following: 
“1. Consideration of the moral situation of the subject, and of the 
motives that may induce him to simulate, to conceal, to impute to 
another, or to have excited himself, the disease with which he pretends 
to be affected. 
“Comparison of the disease with the age, sex, temperament, and 
mode of life of the individual. 
“3. Attentive examination of the diseased parts, the local symptoms 
they present, the impediments to the performance of functions which 
result from their lesions, or which is attributed to them. 
“ 4. Careful comparison of these lesions with the development , the tint, 
and other general dispositions of the organism. 
‘ ‘ 5. Study of the causes to which the real or pretended lesion is at- 
tributed. 
“6. Methodical interrogation of the subject as to the circumstances 
that accompanied the development of the disease, the sensations, the pain, 
the impossibility of action it determines. 
“7. Suitable employment of the therapeutic means in relation to the 
indications furnished by the morbid condition and observation of their 
effects. 
* ‘ 8. Moral excitements calculated to distract the attention while the 
parts are being examined or set in motion.” 
Malingering, or “ scheming,” as it is usually called, with a view 
to obtain a discharge from the service, is not of very frequent occurrence 
in the Army of the United States. The culpable facility, if not complicity, RECRUITING SERVICE. 
of petty civil magistrates, affords the discontented and unscrupulous a 
much more speedy and less painful means of violating their contract 
with their country. But for the purpose of evading disagreeable duty, 
or affording opportunity for vicious indulgence, it is by no means unfie. 
quent. Sir George Ballingall remarks : “ There are to be found, both 
in the military and naval branches of the service, some worthless char- 
acters, who, instead of showing a commendable zeal in the discharge of 
their duty, are incessant in their attempts to impose upon the surgeon. 
And whenever they succeed in exempting themselves from duty, they 
throwr an additional burden on the willing and meritorious soldier, 
while at the same time every successful case of imposition becomes a 
focus whence other similar attempts emanate. This subject, therefore, 
possesses, in a national point of view, a much deeper interest than might 
at first be supposed, as it regards the efficiency of men for the public ser- 
vice, the protection of the real and innocent sufferer from suspicion, 
and the exemption of the good soldier from an undue proportion of 
duty.” 
Much tact is required in judging of these cases. Still, “this tact 
does not depend upon severity; for the most efficient surgeon will often 
doubt wdthout expressing his suspicions, and seem to be the dupe of a 
schemer that he may become his master.”* 
The young medical officer should be cautioned that this species of 
malingering is much more frequent where men are subjected to the ca- 
prices of an indiscreet or ill-tempered commander. Such will always 
exist while human nature remains as it is. We have ourselves known 
a commander much more ingenious in devising tortures for the sus- 
pected than encouragement for the meritorious. Where such is the 
case, men will always do duty reluctantly, and evade it if they can. 
When malingering, then, is frequent, the medical officer should observe 
carefully whether oppressive or arbitrary discipline may not have 
prompted the fault; and if so, he should (but always within the strict 
limits of his own province) interpose for the protection of the men. 
Such a course on his part is demanded alike by humanity and fidelity 
to the service. It is “a duty enjoined by an authority higher than any 
temporary authority to wffionr its performance may happen to be disa- 
greeable.”! 
* Marshall. 
tCyclopedia of Practical Medicine. MANUAL FOR THE 
Section II. 
Special investigation of the several organs that maij become the seat of dis- 
qualifying disease, real, feigned, or concealed. 
In the preceding section we have remarked how difficult it would be 
to prepare a complete catalogue of all the circumstances which consti- 
tute physical incapacity for military service. In the investigation we 
are about to make into the several diseases or infirmities that disqualify 
a man for the profession of arms, we shall endeavor to omit nothing 
important. We shall dwell more particularly upon the most common 
cases, or those which, from their importance, demand a more detailed 
examination. In other cases, we shall limit ourselves to a simple men- 
tion. 
1. Affections of the Head 
Alopecia, or the total or almost total loss of the hair, preventing a 
man from wearing the cap of a soldier and exposing him to the acci- 
dents resulting from exposure to the intense heat of the sun, or to the 
influence of other atmospheric vicissitudes, constitutes a case for rejec- 
tion or discharge. Alopecia may be simulated by the action of depila- 
tories, or it may be but transient—the effect of a recent and severe 
acute disease. It is, then, of course, no reason for either rejection, ex- 
emption, or discharge. 
Where it is old and real, it is characterized by a whitish, dull, and 
uniform tint of the hairy dermis—the bluish points corresponding to the 
hairy bulbs can no longer be distinguished. 
When the disease really exists, a substitute, in order to impose him- 
self upon the service, may attempt to conceal the defect by a wig. 
This would of course be detected in the manipulations always practiced 
upon the head of the recruit at the time of inspection. 
Alopecia so complete as to constitute a reason for the rejection of a 
recruit, will seldom present itself. A mere bald spot upon the crown of 
the head is of no consequence. Total loss of the hair is never seen, 
except as a sign of cachectic disease. "When this exists, rejection is 
imperative. 
Tinea Capitis.—The porrigo lupinosa of the English; the teigne 
faveuse and the teigne furfuracee of the French. 
These affections frequently result in alopecia. They are undoubt- RECRUITING SERVICE. 
35 
edly contagious, and being moreover unsightly and offensive, they de- 
mand the rejection of the recruit presenting them. Fortunately, they 
are very rare in adults. Where baldness is the result of this form of 
disease, it has characters that cannot be mistaken. Bald people, who 
have had tinea in childhood, usually remain pallid and puny. They 
are of spare habit, with a cachectic complexion. We may add that, in 
a man eighteen or twenty years of age, tinea is seldom curable, unless 
it is quite superficial, and characterized by but a small number of pus- 
tules. When the skin is deeply altered by numerous pustules, fur- 
nishing an abundance of purulent, fetid sanies; when the lymphatic 
glands are swollen; when the alopecia is complete, or nearly so ; when, 
in fine, there exists all the symptoms of a severe chronic disease, the 
discharge of the soldier should be recommended. 
Tinea, when it exists, is almost always an affection contracted in 
childhood ; it rarely breaks out after the age required for a recruit. We 
should, then, almost always find the characteristic signs of an invete- 
rate form of the disease. Thus, “ the skin of the head will be swollen 
and painful, with the obstinate heat and itching that accompany the 
almost constant tumefaction of the neighboring lymphatic glands; 
pustules and excoriations of the hairy scalp, from which oozes a viscid, 
reddish, or yellowish humor, very fetid, the desiccation of which forms 
upon the head crusts more or less thick, and under which an infectious 
sanies lodges that corrodes the skin and destroys the roots of the hair 
and the surrounding parts.”* 
Some attempts have been made to simulate tinea by dropping a few 
drops of nitric acid upon the head in order to destroy the hair. But it 
is scarcely possible to be imposed upon in this way; for, in true tinea, 
the head exhales the characteristic nauseating odor, the hair is thin, 
and the countenance exhibits the peculiar cachectic appearance. 
Imperfect ossification of the bones of the cranium, recognizable by the 
persistence of the fontanelles, and sometimes separation and mobility of 
the sutures. 
Monstrosity in size of the head, and considerable deformities, the con- 
sequence of fractures. 
Serious lesions of the skull, the consequence of complicated wounds, 
considerable fractures, and the operation of trephining; ulcerations with 
caries, followed by exfoliations, which have involved the entire thickness 
of the bones. 
Fungous tumors of the dura mater. 
* Coehe. 36 
MANUAL FOR THE 
When fractures of the skull have occurred requiring the removal of 
bone, according to the experience of the writer, if extensive within 
reasonable bounds, they are less liable to prove fatal, or to be followed 
by epilepsy, than if of very limited extent; but serious lesions of the 
mental faculties almost always result. Any exertion is apt to produce 
a degree of temporary insanity, and the subject is entirely unfit for the 
military service. Such a man should never be enlisted under any cir- 
cumstances ; and if the injury occur to a soldier, he should be discharged. 
If there be depression of a mere spicula of bone, epilepsy is a more 
common consequence. Such a recruit should be rejected ; but a sol- 
dier, the subject of such an accident, should not be discharged until 
convulsions have actually occurred. 
A wound of the scalp, denuding the skull and even causing exfolia- 
tion of a small portion of the outer table of the skull, is no reason for 
rejection or discharge. The caries of the entire thickness of the bones 
of the cranium that demands rejection or discharge, is the result of se- 
vere injuries, or of inveterate constitutional disease, and cannot be 
mistaken. These several lesions of the cranium will be apt to escape 
detection, unless the surgeon is careful to examine the head minutely, 
as Avell as to inquire particularly whether the man has, at any time, 
received any injury to the head whatever. If even a mere wound of 
the scalp is acknowledged, the cicatrix should be carefully handled and 
felt. 
Affections of the Auditory Apparatus. 
Loss or defect of the external ear, or malformations that interfere with 
the hearing. 
Obliterated or imperforate auditory canal. 
Tumors of any description that are incurable, except by an opera- 
tion, and that obstruct the free perception of sounds. 
Chronic otitis or otorrheea. 
Loss of the external ear, or a portion of it, may have been occasioned 
by sentence of a criminal court, by injuries received in private brawls, 
or by wounds received in battle. 
In the first cases, though the hearing may not be sensibly affected, 
still the disreputable character they indicate in the man should cause 
his exclusion from the ranks. In the last case, it is neither a reason for 
rejection nor discharge. RECRUITING SERVICE. 
37 
Imperforate or obliterated auditory canal constitutes an absolute cause 
for rejection or discharge. 
The tumors above noted are also absolute causes for rejection, but not 
for discharge, unless the loss of hearing is very decided. If these tu- 
mors are seen at all in enlisted men, it will probably be in those who 
have served more than one enlistment. These men will, in most cases, 
prefer an operation for the relief of the disability to being discharged. 
The alternative should be submitted to their choice. 
Otitis, or inflammation of the mucous membrane of the ear, is not a suffi. 
cient reason for exemption or discharge, unless it is chronic, and attended 
by a sensible diminution of the faculty of hearing. But it is a reason 
for the rejection of a recruit or a substitute; for it may go on to suppu- 
ration, and if in the internal ear, the matter may be discharged through 
a perforation in the tympanum by the eustachian tube, or by a fistulous 
opening in the mastoid process. The two last modes, according to 
Itard, are rare; nevertheless, we have seen one such case. 
Structural changes are another consequence—such as tumefaction, 
or entire or partial obliteration of the auditory canal, vegetations, or ex- 
crescences upon the tympanum or mucous lining of the canal, pustular 
eruptions or excoriations of the canal, and sometimes injury or destruc- 
tion of the bony or cartilaginous portions of the ear. 
Otorrhcea is another result of chronic otitis. This affection is gene- 
rally dependent upon a scrofulous constitution, and is sometimes ac- 
companied by caries of the bones. It is termed mucous or catarrhal, 
and purulent, according to the nature of the discharge. The latter in- 
dicates caries of the bone, while the former occurs in scrofulous habits, 
and its suppression is apt to be followed by engorgement of the lym- 
phatic glands of the neck, tumefaction of the testicles, affections of the 
eyes, porriginous eruptions on the scalp, (Itard,) paralysis of the nerves 
of the same side of the face, (Bell,) rheumatism and catarrh of the 
bladder, (Lallemand.) When either of these signs is perceived, at- 
tention should be directed to the ear; and if they are not of themselves 
considered cause for rejection, should they appear to depend even re- 
motely upon scrofulous otitis, rejection is demanded. 
Purulent otorrhcea being generally dependent upon caries of the 
bones of the ear, the cochlea, semi-circular canals, or mastoid cells, 
always impairs the hearing. It is a consequence of otitis, scrofula, or 
syphilis. Rejection or discharge in this case is absolute. Copland 
remarks that “all chronic discharges from, the ear, howrever slight 38 
MANUAL FOR THE 
they may seem, should be viewed in a serious light, not merely as they 
generally lead to deafness, but as they are also liable to be followed 
by fatal cerebral disorganization.” 
Otorrhoea is sometimes feigned. For this purpose some have intro- 
duced honey into the canal; others have employed the juices of herbs, 
the greenish hue of which they thought calculated to deceive an in- 
spector ; others again have used cheese mashed and diluted, for the 
purpose of giving the discharge the requisite foetor. Sometimes an 
attempt is first made to induce ulceration and inflammation of the canal 
by the introduction of epispastics, and then to counterfeit the dis- 
charge by a mixture of rancid fat, empyreumatic oil, asafeetida, etc. 
Wherever otorrhoea is assigned as a reason for exemption or discharge 
from the service, it is necessary to examine carefully the nature of the 
fluid contained in the auditory canal, to inspect the tympanum, to as- 
certain accurately the condition of the mucous lining of the canal and 
the other parts of the ear. The foetor of pus is readily distinguished by 
the experiened surgeon from that of any other substance likely to be 
employed. Should doubt still remain, the microscope will determine 
it. It is, moreover, rare that otorrhoea should exist for any length of 
time without being combined with certain organic changes, whose 
presence or absence will relieve any uncertainty that the local explora- 
tion may leave on the mind. 
When otorrhoea has been induced with a view of procuring a dis- 
charge, removing the means of keeping it up will generally be suffi- 
cient to repress it. This may be certainly effected by placing the man 
ir-der the surveillance of the chief of his squad, or by keeping him closely 
in the hospital for a few days. 
Deafness constitutes an absolute cause of rejection, exemption, and dis- 
charge. 
Deafness cannot be concealed, and, therefore, there is no risk of a 
recruit or substitute being received with this infirmity. 
But it is frequently feigned, because it is so easily simulated, and it 
is so difficult of detection. Individuals have been known to play the 
part of a deaf man with so much presence of mind, perseverance, and 
skill, as to lead one inevitably into error. Still, most of these knaves 
soon fall a prey to proofs or surprises that may be readily prepared for 
them. 
“ It is well known how numerous are the causes of deafness. Some 
are visible and palpable, others are profoundly hidden and equally inac- 
cessible to our instruments and cur so^es.” RECRUITING SERVICE. 
39 
Deafness may depend upon obstruction of the auditory canal. Hence, 
the simulation of this cause by the introduction of foreign bodies which 
resemble in some degree the caruncles or vegetations that are sometimes 
developed in the mucous lining of this canal. 
When deafness is kept up by the presence of a foreign body, as a 
pea or bean, or by the hardening or accumulation of the wax, it is re- 
cognized by means of the speculum, and readily yields to the extrac- 
tion of the foreign body that intercepted the sonorous wave. We may 
always detect these impostors if, not confining ourselves to a superficial 
examination, we have the perseverance to set snares for them day and 
night, into which they cannot help stumbling, unless, as in very rare 
instances, they have a presence of mind that never deserts them.* 
Bhgin suggests the following means of detection: “The first consists 
in questions addressed to the pretended deaf man. We should always 
distrust a man who perceives absolutely no sound, however loud one 
speaks to him. When one succeeds in making oneself heard, tbe con- 
versation should be continued in the same tone, feigning implicit confi- 
dence ; then, while exciting and keeping up strongly the attention of 
the subject, the voice should be gradually lowered to the ordinary tone. 
This method, adroitly employed, very often succeeds. When it fails, 
other means may be employed, such as waking the man up suddenly in 
the middle of the night, accusing him of some great crime; following 
him up in his intercourse with his comrades; letting fall behind him, 
when he believes himself unobserved, some pieces of money, etc. The 
skill of the observer must wrestle with the cunning of the knave, and 
it is seldom the truth will remain undiscovered.” 
A number of ingenious devices have been employed by medical offi- 
cers to detect this imposture. To recount them here is unnecessary and 
inexpedient; for there are few professional men whose minds will not 
suggest something of the sort, while the publication of such, in a work 
to which the impostor may find access, would be to furnish him with 
the means of defeating them. “When persons are really deaf, the 
expression of the countenance generally furnishes important indica- 
tions. They have a very peculiar physiognomy, in attempting to inn- 
ate Avhich the impostor makes only grimaces. 
Perforation of the Tympanum.—Where this exists it is a sufficient 
reason for rejection, because it exposes the subject to frequent attacks of 
violent otitis. But when it is made a question of discharge, the liability 
* Aide Memoire. 40 
MANUAL FOR THE 
to these attacks of otitis should be verified by observations befo’.e the 
discharge is granted. 
It may be recognized by the aid of a stylet or delicate probe diverg- 
ing into the cavity of the tympanum, or by causing the subject to close 
the mouth and nostrils accurately, and then to make a strong expira- 
tory effort; the air will pass out through the auditory canal. This is 
a precaution that should always be taken in the examination of a sub- 
stitute. 
Great deformities of the face—large, livid, hairy, unsightly spots—loss 
of substance of the cheeks—are so many reasons for rejection. Some of 
these lesions may in nowise hinder the functions of the several organs; 
but as they are calculated to excite aversion and disgust in others, 
they may prove prejudicial to the service by provoking discontent in 
the barrack room and by exposing the sufferer to cruel and irritating 
sarcasms and jests, that too often end in fatal quarrels 
Affections of the Face 
Affections of the Eye and its Appendages 
Chronic ophthalmia and its consequences, such as falling out of the 
eyelashes, chronic discharge from the lids, films upon or ulcerations 
of the cornea, staphyloma, etc. 
‘‘Ophthalmia does not constitute a case of exemption from military 
service except it is chronic. It moreover does not demand exemption, 
except when it has already produced in the apparatus of vision disor- 
ders permanently obstructing their functions. 
‘‘In the most simple cases, when this phlegmasia presents itself 
without the complication of a general morbid condition, such as scrofula, 
the disease is susceptible of cure by systematic treatment. When it 
depends upon the occupation of the individuals affected, it is almost 
always cured under the influence of a different mode of life. Neverthe- 
less, it must not be lost sight of that, in most cases, ophthalmia readily 
)elapses under the influence of the lightest cause; that young sol- 
diers affected with it are cured with difficulty, because, upon leaving 
the military hospital where ibis sort of disease is very common, they 
are exposed to the whole scries of causes that tend to reproduce it.” 
“ Chronic ophthalmia, with destruction of the eyelashes, which leaves 
the eye without defense against the action of a too brilliant light, or of 
bodies floating in the atmosphere—that which is complicated with RECRUITING SERVICE. 
41 
eversion or inversion of the lids, opaque spots, or perforat ion of the cornea, 
staphyloma, puriform palpebral flux—presents so many cases that de- 
mand exemption, rejection, or discharge from service.”* 
These observations are manifestly judicious and prudent, but in their 
application to our service they require some modification. Notwith- 
standing the amenability of a recent ophthalmia to treatment as a 
general rule, still it is frequently so traublesome, even where the patient 
is honestly desirous of being cured—it is so easily reproduced and kept 
up when the man wishes to avoid duty ; and it will, in so large a pro- 
portion of cases, occupy so much of the short term of enlistment in its 
treatment—we think no recruit should be approved who is thus affected. 
It will be better to let the man go and get cured, and then he may pre- 
sent himself again for examination. Should there be the slightest sus- 
picion or probability that the ophthalmia is the result of gonorrhoeal in- 
oculation, the rejection should be absolute. 
In cases of purulent ophthalmia, rejection is absolute, however recent or 
apparently mild the attack; for there is sufficient probability, to say 
the least, that the disease is contagious, to make it highly improper to 
introduce a case ef it into a barrack. 
It is impossible to FEIGN films, palpebral inflammations, or ulcers; but 
it frequently happens that these lesions are provoked, by the application 
of irritating substances to the eyes. These applications, if kept up for 
any length of time, may occasion any shade of chronic ophthalmia; 
while plucking out the lashes, followed by cauterization of the bulbs, 
may produce ulceration of the free borders of the lids. When gon- 
orrhoeal matter is used for an irritant, the consequences may be fright- 
ful, and the self-inflicted punishment for the fraud severe. It would 
be impossible to distinguish in this case between the crime and the 
misfortune of the sufferer. But in other cases it will be found that the 
provoked disease is generally confined to the right eye ; that when the 
ophthalmia appears to be epidemic, the officers are not affected ; that it 
does not induce so much disorganization as the true disease; that the 
wrinkles in the lids, the relaxation of the lids, and the croicsfeet of 
chronic ophthalmia, produced by the constant winking, always a feature 
of the true disease, are wanting. On the contrary, the surface of the 
lids is more or less red, smooth, hot, and swollen. These signs are a 
sufficient indication that the disease is recent and acute. 
But if the subject is of a lymphatic or scrofulous habit, the lids tume- 
*Aide Memoire. 42 
MANUAL FOR THE 
fied as the consequence of an habitual inflammatory condition, their 
borders swollen, follicles ulcerated and furnishing an abundant secre- 
tion, these signs exclude all idea of fraud. 
A film upon the right eye may be simulated by the application of a 
weak solution of nitrate of silver to the cornea. We say the right 
eye, because it would be inconvenient for the malingerer to make the 
application to the left; and if even a genuine opacity should super- 
vene in that eye, it would be no reason for a discharge. It would not 
be worth his while to trifle with that eye if he could. 
When this cauterization is practiced, it produces a superficial whitish 
spot, confined to the external lamina of the cornea, irregular in outline, 
almost always large from the beginning, and which disappears in a 
short time without leaving any traces of the lesion. In such a case the 
fraud maybe detected, in the first place, by the characters already indi- 
cated ; and, secondly, by the absence of all those traces that inflamma- 
tion sufficiently intense and protracted to produce such alteration of the 
cornea seldom fails to leave in the whole appearance of the eye. 
When fraud is suspected, the subject should be deprived of the means 
of keeping it up; and the longer the time that shall have elapsed from 
the last cauterization, the more easy it will be to perceive that but a 
small scar exists, with a serrated margin that shrinks up and detaches 
itself, running through upon a small scale the different stages that are 
seen upon a larger scale when caustics are applied for the destruction 
of tissue. By the aid of a tolerably good lens all these changes are 
readily seen. 
Sir George Ballingall quotes a statement to this effect: Three hundred 
men being at one time affected with ophthalmia, accommodation for 
twenty-four men, the number quartered in one ward, was quickly pre- 
pared. The men in this ward were then aroused at midnight by the 
surgeon and commanding officer, and marched in a state of nudity to 
their new beds. The old ward was secured for the night, and upon 
carefully searching the beds the next day, a number of small parcels of 
corrosive sublimate were found concealed. The consequence was the 
rapid cure of two hundred and fifty of the cases of inveterate ophthalmia. 
Iu the British service handcuffs and thin masks have been resorted 
to in suspected individual cases to prevent the possibility of any appli- 
cation being made to the eye by the malingerer. 
Paralysis of the upper eyelid calls for rejection and also for discharge RECRUITING SERVICE. 
43 
when it is real and interferes sensibly with vision. It should, how- 
ever, be of the right eye to justify discharge. 
Bbgin suggests the following means of detecting a FEIGNED ptosis : 
“Falling of the upper eyelid may be feigned, but then there is no 
cedematous engorgement of the organ. If the subject is examined 
from above, it is perceived that the feigned diseased lid remains dropped 
only as an effect of contraction of the orbicularis muscle. If the atten- 
tion of the impostor is diverted by causing him to look briskly at 
some elevated object, the veiled eye is unveiled. Finally, paralysis of 
the levator muscle is generally accompanied by that of the other muscles 
supplied by the third pair of nerves, so that the eye is at the same time 
directed outwards and diverges from its normal rectitude.” 
Adhesion of one or both lids to the globe of the eye demands rejection 
or discharge. 
Spasmodic motions of the lids interfering with vision. 
This is a case that very rarely occurs, and is still more rarely a perma- 
nent affection. A case is, however, recorded in the Aide Memoire which 
resisted all modes of treatment. Even during sleep there was a convul- 
sive twitching of the lids. The iris was so much contracted as to render 
the pupil scarcely perceptible. Such a case evidently calls for rejection 
or discharge. Should an attempt be made to simulate it, there could 
be no difficulty in detecting the fraud. 
Affections of the iris.—The pupil may be permanently contracted, as 
in the case above mentioned, or from antecedent inflammation and ad- 
hesion of the iris to the capsule of the lens. This is a case for rejection 
if existing in either eye. Discharge is demanded only when the right 
eye is the seat of the disease. It of course cannot be simulated. Con- 
traction of the pupil from the effect of opium, alcohol, &c., being, from 
the nature of the cause, transient only, as well as always accompanied 
by well-marked constitutional signs, can scarcely be confounded with 
the organic contraction. 
The iris may be defective, either congenitally or as the result of acci- 
dent. The effect in this case will probably be a disturbance of the vis- 
ion of that eye. The extent of this disturbance, as well as the eye, 
whether the right or left that is affected, must govern as to the approval 
or rejection of the recruit. We have recently reinspected a recruit who 
had lost a portion of the iris in the upper and outer part of the right eye. 
This man’s vision was good and his judgment correct as to the objects 
placed before that eye, but he saw them of about one-half their linear 44 
MANUAL FOR THE 
dimensions. We did not think it a case calling for njection under the 
circumstances, though we should not have passed the man had we 
examined him originally. We have seen another case in which, from 
a blow from a stone, the lower border of the iris has been de- 
tached from its insertion, and it is now stretched as a chord across the 
pupil. The pupil is consequently but half a circle, while light is also 
admitted through the cornea below the detached border of the iris. In 
this case vision is not sensibly affected. The effect of the injury, then, 
as determined by experiment, must govern in each individual case. 
Iritis.—This disease always affects vision, and, when it exists, is an 
objection to enlistment. 
When the iris differs in color in the two eyes, or in one eye, it should 
be particularly examined into, lest iritis should be the cause of this dif- 
ference. It does not call for the discharge of an enlisted man, unless it 
shall have resisted treatment for a length of time. 
Large encysted tumors in the substance of the eyelids. 
Hy dr ophthalmia and exophthalmia. 
Cataract. 
Fistula lachrymalis, or tumefaction of the lachrymal sac. 
Loss of an eye or of the use of an eye. 
Blindness, or total loss of sight, whether congenital or accidental. 
These are all reasons for rejection. 
“ It is sometimes very difficult to verify the fact of blindness. When 
called upon to examine a case of feigned blindness, we should seem to 
have no doubt of the existence of the infirmity. Then, while examin- 
ing the eye, seize a cataract knife and suddenly direct it at the eye. 
The impostor will step back at once, and the cheat is discovered.”* 
Amaurosis or gutta sereua does not constitute a case for exemption or 
discharge from service by the French law, except when the right eye 
is the seat of the disease ; but with us the practice is different. With 
amaurosis of either eye the recruit or substitute would not be received. 
The disease is always apt to extend to the sound eye whatever may 
have been its cause; and though, when depending upon local irrita- 
tion, such as worms in the intestines, caries of the teeth, excessive 
venery, &c., it may be susceptible of cure, still we canuot rely upon the 
statement of the individual for the true history of the affection. Nor 
do we know of any means by which the temporary attack can be dis- 
tinguished from the permanent affection. 
* Aide Memoire. RECRUITING SERVICE. 
45 
When a discharge is solicited for this cause, the case is different, 
and we should not grant the certificate except the right eye be the seat 
of the disease. 
Amaurosis is sometimes feigned, with a view of procuring a dis- 
charge. The impostor asserts that he is blind of one eye—usually the 
right—and dilatation of the pupil is effected by the application of bella- 
donna, or some similar substance, to the affected organ. Total blind- 
ness or impaired vision of both eyes may also be feigned or even simu- 
lated by the internal use of the same substance. Detection in these 
cases is sometimes troublesome, but not very difficult or uncertain. 
“When an amaurotic individual enters your room, he walks in with a 
peculiar and undecided manner. He does not direct his eyes toward 
you, but stares with a vacant gaze. Very generally his eyelids are 
widely opened, but this is not constantly the case. The globes them- 
selves are more or less prominent. We almost always observe that the 
pupil is dilated, and that it contracts very slowly, if at all, under a 
strong light. On the other hand, we see it very small sometimes, yet 
equally inactive. The form also of the pupil may vary in many ways. 
Thus it is often very irregular, oblong or oval, and it is sometimes di- 
rected upwards and inwards. Its color also is often changed, so that 
we do not see the beautiful black color; but, instead of it, we look upon 
a dull, heavy, or clouded pupil, or a bright green one.”* 
“ In most cases the iris has no longer any mobility. Its circle is very 
much dilated, and sometimes almost effaced. The brightest light ex- 
cites no change in it. In some cases, however, it preserves its con- 
tractility, and that happens when the branches it receives from the third 
and fifth pairs do not partake of the lesion of those forming the retina. 
But this contractility is scarcely similar to that of a sound eye. In 
this the contraction excited by transition from darkness to light is 
prompt and durable. It alternates with dilatation as the light is ap- 
proximated to or withdrawn from the eye, and the diameter of the circle 
of the iris is never reduced to a mere linear trace. In the amaurotic 
eye, on the contrary, when this contractility exists, it is sluggish and 
not permanent, however bright the light may be, even that of the sun.”t 
When one eye only is affected, particularly if it be the right, the 
surgeon should be upon his guard. If contractility still exists in the 
affected eye, when really diseased, a comparison of the motions of the 
two irides "will show the fact. In the diseased eye the motion will be 
* Mackmurdo. t Dictionary of Medical Sciences. 46 
MANUAL FOR THE 
sluggish ; in the sound eye, prompt. In the affected eye the dilated 
state is soon resumed, though the light is still presented to it. In the 
sound eye the contraction remains as long as the light is kept up. 
When there is no amaurosis, both pupils contract and dilate equally 
and simultaneously under the same circumstances, unless some dilating 
substance has been employed. In this case the means of detection are 
that, in true amaurosis, the conjunctiva will have a natural appear- 
ance; in the feigned this tissue will appear irritated, congested, and 
tearful. But as the effect of these dilating agents is but temporary, it 
is plain that, by preventing the impostor from having access to them, 
(which is very easily done,) the cheat cannot be kept up long. 
The effects of belladonna will continue from four to seventy-two 
hours, and of hyoscyamus even longer, according to the time during 
which the application may have been kept up. Begin ascertained that 
when belladonna had been applied for several consecutive days, con- 
traction of the pupil was not observed until after seventy-two hours 
privation of the use of the drug. 
Myopia is an objection to a recruit. 
This is a very common affection, and one often assigned as a reason 
for exemption from military service. It is also very easily simulated. 
It may result from the habitual use of spectacles, the power of which 
has been gradually increased. Simulated in the beginning, it becomes 
real in the end. 
An individual is considered short-sighted if he reads at a distance of a 
foot with concave glasses, Nos. 3 and 4, and if he distinguishes distant 
objects with No. 5-J, and especially if he presents the characteristic 
signs of the myopic, such as wrinkles at the angles of the eyes, promi- 
nence of the eyes, and contraction of the pupils. 
If the eye is somewhat salient—if the cornea is convex—if the man 
when he is addressed winks in looking at one—if, when he is desired 
to read rather small print, he brings it briskly within a constant distance— 
if he walks with his head rather inclined forward, (a very common 
thing, however, with very tall men)—if he was born of myopic parents— 
the presumptions are strong in favor of myopia. To verify it, give the 
man plane glasses, telling him they are concave, and that if he cannot 
read with them he is not short-sighted. Or, the better to deceive him, 
the glasses may be made slightly convex. Afterwards we should pass 
to concave glasses, recollecting always that the eye can easily accom- 
modate itself to different foci, and can read with No. 2, 3, or 4, which RECRUITING SERVICE. 
47 
are very strong myopic glasses; but, in general, a true myope can read 
quite small print at a distance of eighteen or twenty inches; while a 
man wTio has acquired short-sightedness by practice can only read very 
near. Finally, take away the glasses, and require the man to read very 
small type at two and one-half inches from the eye. 
In spite, however, of all these precautions, a very cunning man, 
thanks to his drill, may embarrass the surgeon a good deal. It is, tljen, 
for the surgeon to redouble his vigilance; to examine the man re- 
peatedly, and at times when he least expects it.* 
Chrystalline lens—Loss of, by operation for cataract. 
We consider this an objection to a recruit, for it invariably affects 
the power of the eye to accommodate itself readily to vision at different 
distances. If it be the right eye, the objection is absolute. 
In persons wrho have undergone this operation, the anterior chamber 
of the eye will be found larger than natural, and the iris will present a 
concave surface anteriorly, due to the loss of the support of the lens 
and its appendages. And if the eye is inspected somewhat obliquely or 
crosswise, the aqueous humor will be found to have a tremulous mo- 
tion. 
Presbyopia.—This is rarely seen among recruits, and, unless very de- 
cided, can be no objection to their fitness for service. As a reason for 
discharge, it can be but one of the accidents of that period of life 
which, of itself, requires that the soldier should rest from his labors. 
Nyctalopia—night blindness.—The recruit seldom presents himself 
with this disease, nor can its existence be ascertained in any other way 
than by the confession of the man himself, as the inspection of recruits 
is habitually conducted by daylight. A man acknowledging the affec- 
tion would of course be rejected. 
It is ordinarily no reason for discharge, but it may sometimes be a 
sign of incipient amaurosis. It is not an infrequent affection in the 
field, particularly in southern climates; and for that reason, as well as 
the difficulty of verifying it, it is a favorite cheat with the malingerer. 
True nyctalopia is generally attended with more or less sluggishness 
of the motions of the pupil, and, after some days, with undue sensibility 
to light in the daytime. It is sometimes a concomitant of scurvy, and 
very commonly dependent upon defective nutrition, or some disorder 
of the digestive apparatus. It is very generally relieved by treatment 
in temperate climates in one or, at most, in two months ; but in hot 
* Aide Memoire. 48 
MANUAL FOR THE 
climates it lasts from four to nine months, and may even go on to total 
blindness. It must also be noted that in northern regions, during the 
prevalence of snow, it may also occur. 
Nyctalopia is not a valid reason for discharge, until a change of cli- 
mate, as well as a suitable course of treatment, shall have been tried 
unsuccessfully. When there is probable cause for suspicion that it 
is feigned to evade duty, doubling the sentinels—i. e., placing the sus- 
pected malingerer on post with a healthy sentinel—may be resorted to. 
Hemeralopia, or day blindness, is seldom seen, and we believe is never 
feigned. Should an attempt of the sort be made, its detection would 
be a very simple matter. 
Pterygium, if extending far over the cornea, may sensibly impede 
vision; and, in that case, would demand rejection. 
Encanthis, sometimes is of a malignant character, and demands rejec- 
tion or discharge. 
Strabismus, if seriously affecting the normal direction of the right eye, 
is generally admitted to be an insuperable objection to a recruit. But 
if either eye be affected, it should be carefully examined, for it will 
be sometimes found that the divergent eye is amaurotic. Macmurdo 
says he had two patients, a father and son, who had squinted slightly 
from childhood, though the strabismus was not congenital. In both in- 
stances it was discovered accidentally, during manhood, that the squint- 
ing eye was almost blind. 
Dr. Carron du Yillards communicated to the author of the Aide Me- 
moire the following facts and remarks upon this subject: 
“ Every man who squints much with the right eye is unfit for the 
infantry service. A foot soldier who cannot direct his musket accu- 
rately is an imperfect soldier. This imperfection is so much the greater 
in that he is often required to fire obliquely, and in the direction oppo- 
site to that of his infirmity; for, if in a direct fire, by closing the left 
eye, he can bring his right eye to a central direction for a few moments 
only; he can carry it no farther outward except with great difficulty.” 
‘ ‘ If from the foot soldier we pass to the horseman, we find that de- 
cided strabismus, either inward or outward, of the right eye, produces 
the same inconveniences. When strongly convergent squinting of the 
left eye exists, the soldier is obliged to use the right eye to replace his 
sabre in the scabbard. To do this he sways strongly to the left, and 
not only loses his alignment, but if his horse is at all sensible to his leg, RECRUITING SERVICE. 
49 
(sensible sur les aides,) he swerves briskly to the right, and crowds his 
neighbor on that side.” 
“As to the artilleryman, decided strabismus of the right eye presents 
the same inconvenience as in the infantry soldier, since it is with this 
eye that he directs his piece. The engineer with the same defect finds 
his work executed with the scale or graphometer continually inter- 
rupted by the necessity he is under of changing eye or place to record 
his observations.” 
The conclusion, then, from these observations, is that strabismus of 
either eye disqualifies for the cavalry service. Strabismus of the right 
eye disqualifies for all arms. 
Affections of the Olfactory Apparatus. 
Deformities of the nose disfiguring the face, sensibly altering the voice, 
and impeding respiration; 
Loss of the whole or a part of the nose; 
Purulent and fetid discharge from the nose, whether due to old and in- 
curable ulceration, or to any other lesion of the nasal mucous membrane ; 
Ozcena—fcetid breath ; 
Chronic swelling of the septum narium, obliterating the nasal fossae ; 
Polypus of the nose, incurable without an operation—are so many reasons 
for rejection or discharge. 
“ Obstruction of the respiration, dependent upon congenital or acci- 
dental deformity of the nose, when this disposition has been verified— 
chronic ulceration of the nasal mucous membrane, and polypus excres- 
cences, whether fleshy or vascular, gradually developed, and without 
having been provoked by the application of caustics—are so many 
reasons for exclusion from the service. It is not only the obstructed 
respiration, but also the foetor of the breath and the nasal voice that 
prompt the decision in these cases.”* 
Loss of the nose, due to syphilitic or scrofulous cachexia, disqualifies 
the recruit not only as an indication of constitutional disease, but also 
on account of the modification of the voice consequent upon the lesion, 
frequently to a degree that renders the man unintelligible. 
When the loss of the nose is congenital or due to accident, the same 
difficulty as to the voice presents itself; and the man, if enlisted, would 
be subjected to the impertinent jests of his comrades to his personal an- 
noyance, and to the prejudice of good order in his corps. 
* Aide Memoire. 50 
MANUAL FOR THE 
Ozoena, when depending upon syphilitic, scorbutic, scrofulous, or 
cancerous cachexia, demands the rejection or discharge of the subject. 
Not so, however, if the consequence of recent disease, as coryza, for ex- 
ample, or scarlatina, or erysipelas. Copland mentions a case occurring 
from an injury of the nose received in hunting, and which was followed 
by erysipelas. In such cases, as it is not certain that the disease will 
not become chronic, the recruit should be rejected; but discharge should 
not be recommended until it is ascertained that caries of the bone 
has taken place, or that there is no reason to hope for a cure within a 
reasonable time. 
Ozoena has been sometimes feigned, or rather provoked, by the use 
of some irritating agent. The surgeon should be upon his guard against 
this imposture. The foetor of the breath will be kept up in these cases 
by the use of a sponge saturated with old cheese or other foetid material, 
and retained in the nostril by means of a thread passed through the 
posterior nares behind the velum palati. An attentive examination can- 
not fail to discover the fraud. 
Ulceration may be produced and kept up by the repeated application 
of caustics. The feetor of the discharge will probably be wanting in 
these cases ; and this, with the absence of the usual constitutional ac- 
companiments of the genuine chronic ulcers, affords the means of de- 
tection. 
“ Some young men have attempted to escape military service by imi- 
tating polypus of the nose, by means of chicken’s testicles or rabbit’s 
kidneys introduced into the nasal fossa?,, and kept there by a sponge. 
But in these cases the natural conformation of the nose, which the 
4 schemers ’ cannot succeed in deforming, the natural condition of the 
mucous membrane, the nature and insensibility of the tumors, which it 
is easy to seize to draw out with forceps, or to cause to be ejected by 
sternutatories, soon discover the fraud.”* 
Affections of the Organs of Mastication, Deglutition, and 
the Voice. 
Hare-lip, sitnple, compound, or complicated. 
Loss of the whole or part of either lip. 
Unsightly mutilation of the lips from wounds, burns, or disease. 
Loss of the whole or part of either jaw-bone. 
* Aide Memorie. RECRUITING SERVICE. 
51 
Deformities of either jaw-bone interfering with mastication, speech, or 
the tearing of the cartridge. 
Anchylosis of the jaws. 
Loss of the incisor and canine teeth of both jaws. 
‘ ‘ To this catalogue we may add caries, or bad condition of a great 
many or most of the teeth. It is necessary that the soldier -should he 
able to chew his biscuit. If he has lost some of the molar teeth, the 
others should he sound, as well as the gums that support them. Other- 
wise the jaws are exposed to frequent irritations; to swellings under the 
influence of the slightest causes. In the inspection of substitutes we 
should be very severe upon this point.”* 
To pronounce absolutely upon the number or description of the teeth 
that may be lost without disqualifying the recruit, would be a very dif- 
ficult matter. All authors speak of this kind of defect, but always in 
rather indefinite terms. The British Regulations mention “loss of 
many teeth, or teeth generally unsound.” Sir George Ballingall speaks 
of “extensive deficiency, particularly of the front teeth.” The French, 
as above quoted, enumerate the loss of the whole of the canine and in- 
cisor teeth of both jaws. 
The soldier requires a sufficient number of teeth in good condition to 
enable him to masticate his food properly. Hard bread, tough beef, 
and salt pork require good molars for this purpose. The incisor and 
canine teeth are not adapted to this end; i. e., without the aid of some 
of the molars. The soldier must, again, have teeth of some description 
strong enough to tear his cartridge. This is usually done with the in- 
cisor and canine teeth ; but if the bicuspid and two of the molars in both 
j aws upon the right side remain and are sound, we think this may be 
done as conveniently as with the incisor and canine. The instructions 
for tearing the cartridge in the infantry tactics merely prescribe that it 
is to be put between the teeth, without specifying the particular teeth 
by which it is to be tom. 
If, then, the front teeth have been lost by accident, as sometimes hap- 
pens, we should not reject the man on that account, provided the double 
teeth, or a sufficient number of them, remain sound in both jaws, and 
upon the right side. But if the front teeth have been lost from caries, 
and the double teeth are unsound to any extent, the man should be re- 
jected. If the front teeth remain and the molars are gone, we think 
* Aide Memoire. 52 
MANUAL FOR THE 
rejection is again demanded, because the man is evidently incapable of 
properly masticating the food he must subsist upon in the field. 
“Foetid, breath" is sometimes a reason for rejection. If merely a sign 
of temporary derangement of the digestive organs or the like, it is of no 
consequence ; but if it depend upon extensive caries of the teeth, chronic 
ozoena, scorbutic, syphilitic, scrofulous, or mercurial cachexia, it de- 
mands rejection as well from its own offensiveness as from its being 
one of the indications of grave disqualifying disease. 
Hypertrophy or atrophy of the tongue. 
Obstinate or cancerous ulceration of the tongue. 
Mutilation or the partial or total loss of the tongue. 
Adhesion of the tongue to the parietes of the mouth 
Stammering or stuttering, if at all considerable. 
Adhesions of the buccal membrane, the sequel of salivation, or other ulce- 
rations of the mouth impeding the free motion of the jaws. 
Stammering may depend upon habit contracted in childhood, upon 
malformation of the tongue, malposition of the teeth interfering with 
the free motion of the tongue, undue length of the frenum, etc. A slight 
degree of stammering would not be considered a reason for rejection, 
but if the defect were more considerable it would. 
Of course there will be no difficulty in discovering the existence of 
this defect in the case of a recruit or a subsitute, but it may be feigned 
by drafted men, and, in that case, can be verified only by the testimony 
of those who have long known the man. Should there be no percepti- 
ble malformation of the larynx or tongue, or irregular disposition of the 
teeth, affidavits as to the fact should be required to justify exemption. 
Congenital fissure of the bones of the palate; 
Salivary fistulee; 
Chronic enlargement of the tonsils sufficient to impede deglutition, phona- 
tion, etc.; 
Lloss of the voice, or a manifest alteration of it by a bucco-nasal fistula, 
by schirrhous tonsils, by the division or loss of uvula, by induration of the 
epiglottis, etc.; 
Chronic laryngitis, aphonia; are so many valid reasons for rejection 
or discharge. 
True permanent aphonia is. a very rare disease. Temporary loss of 
voice is not uncommon. It is usually the effect of irritation of the 
laryngeo-tracheal mucous membrane, induced by catarrhal inflamma- 
tion or tonsillitis ; hut it may be caused, and that suddenly, by injury RECRUITING SERVICE. 
53 
of the vocal organs or nerves. A division of the recurrent nerves will 
always produce it, and so paralysis of those nerves or tumors pressing 
upon them may cause it. The aphonia in these cases is permanent, 
or sufficiently so to call for the discharge of the man. 
When permanent, then, except in cases of injury of the vocal organs, 
it is a difficult matter to verify; and cases have occurred where the ma- 
lingerer has had sufficient control of himself to resist for a long time all 
the trials that could be devised for his detection. I had such a case 
some years ago. The man asked for his discharge. I could detect no 
lesion of any kind. Auscultation revealed no abnormal sound. There 
were no tumors in the course of the recurrent nerves. Discharge was 
refused, and the man placed upon duty that did not require the use of 
the voice. Finding his case hopeless, he deserted. 
“In doubtful cases, after an attentive examination of the neck, the 
pharynx, etc., and a trial of sternutatories, nothing more remains than 
to try the effect of sudden impressions. An exclamation, or a word 
uttered under these circumstances, is sufficient to expose the im- 
posture.”* 
Mutism is to be considered after the same manner. When congenital, 
it is always associated with deafness. It may, however, be accidental; 
but in these cases the injury that caused it may always be verified. 
It is by no means certain that partial or total loss of the tongue will 
produce it. Certain sounds require the aid of the tongue for their articu- 
lation ; others do not. However, as any considerable mutilation of the 
tongue would demand exclusion from the service, this is of no practical 
importance. But when the tongue is well formed—not atrophied or hy- 
pertrophied—when it can be protruded from the mouth without much 
difficulty and moved freely, if the mute is not also deaf, he is an im- 
postor. 
Affections of the Keck. 
Goitre, if large enough to interfere iciih respiration, to prevent the wear- 
ing of a stock, or the hooking of the collar of the coat; 
Osseous degeneration of the thyroid gland; 
Engorgement of the lymphatic glands of the neck; 
Scrofulous inflammation or ulceration of these glands; 
The violet-colored, rugous, adherent cicatrices of these ulcerations; 
constitute so many causes of rejection. 
* Aide Memoire. 54 
MANUAL FOR THE 
In the examination of substitutes the surgeon should firmly reject 
any man thus affected, even to a very inconsiderable extent. Substi- 
tutes are almost invariably worthless in character, and ever ready to 
avail themselves of the slightest pretext to evade the duties they have 
assumed, not for patriotism, but for a price. 
In the inspection of recruits, unless the tumors or cicatrices were 
more than two or three in number, combined with other indications of 
a scrofulous habit, we would not reject the man for them. For the other 
causes above enumerated, rejection is absolute. 
B&gin says that these cicatrices and ulcers have been attempted to be 
imitated by means of caustics more or less active; but that the pecu- 
liar complexion of the subject, the state of the conjunctiva, the thick- 
ness of the lips, the soundness of the limbs, and the want of firmness of 
the flesh, are so many circumstances which, even supposing the ap- 
pearance of the parts themselves should leave any doubts as to their 
character, would not permit the presence of scrofula to escape recogni- 
tion, and the absence of which would leave no doubt as to the fraud. 
Fistulous openings into the larynx or trachea are also causes for re- 
jection or discharge. 
Affections of the Chest. 
Malformation of the chest sufficient to embarrass respiration, or in any 
wise to impede it; 
Predisposition to phthisis : 
Chronic pleurisy with existing effusion, or when effusion has existed 
and has been absorbed ; 
Caries of the ribs; 
Phthisis pulmonalis; 
Badly united fractures of the ribs, leaving a salient angle at the point of 
injury; are absolute causes of rejection. 
In a former chapter we have given, at some length, the signs which 
indicate a healthy chest, or the reverse; but as the subject is of great 
importance, particularly as regards the acceptance of volunteers and 
the approval of substitutes, we cannot help quoting in this place the 
remarks of Begin, which we find in the Aide Memoire. They point 
particularly to what may be considered predisposition to tubercular dis- 
ease. 
“Charged with two important and unceasingly active functions, the 
thoracic viscera constitute a double apparatus, the vigor and integrity RECRUITING SERVICE. 
55 
of which are so much the more essential to the soldier, as he is required 
to make more violent and more frequently repeated exertions. The 
thorax should be full and prominent, the ribs regularly and sweepingly 
arched, the shoulder blades well kept in and covered with muscles that 
completely fill their cavities. We should distrust subjects whose chests 
are thrust forward while the cartilages of the ribs are straight, instead 
of prolonging the graceful curvature of these bones. These chests, 
which are called * chicken-breasts,’ are seldom strong enough or 
roomy enough to permit the lungs to have free play in them. The 
same judgment should be formed of those marked and sometimes very 
considerable depressions of the lower part of the sternum and ensiform 
cartilage, the rather that the heart more than the lung has to suffer 
from this vice of conformation. Every one knows of how unfavorably 
portent, in relation to the integrity of the respiratory organs, are 
1 winged shoulder blades,’ as they are called. 
“ Some physicians maintain this doctrine, that before pronouncing in 
favor of exemption, it is indispensable to fix with precision the kind of 
organic lesion of the lung or heart with which the individual is affected. 
So extreme a pretension is inadmissible ; and in this connection we may 
remark in our clinics, surrounded with every means of investigation, 
and assisted by experience and profound science, how much difficulty 
the most skillful professors often experience in establishing the diagnosis 
of these lesions, and how many mistakes are revealed by their autopsic 
examinations. This is also a proper place to remark, that no important 
viscus can suffer for many years, or be the seat of grave lesions in its 
tissue, without the whole constitution partaking of its suffering, and 
presenting an alteration easy to recognize. 
1 ‘ When the chest is narrow and elongated, the countenance pale, or 
with merely a brilliant point upon the cheeks, the voice husky, articula- 
tion short, quick, interrupted almost every moment for want of breath, 
the skin presenting a fineness of texture, a whiteness or straw-colored 
tint, with abnormal dryness—when the limbs, more or less long, are thin, 
furnished with soft and emaciated muscles—these characters suffice to 
announce a weakly thoracic constitution, a manifest disposition to 
phthisis, and to demand exemption. When to these characters one en- 
deavors to add the results furnished by auscultation or mensuration, we 
cannot but applaud this searching investigation. 
“ Dullness of a considerable portion of the chest, absence of the respi- 
ratory murmur, and its various modifications, the development or flat- MANUAL FOR THE 
tening of one side of the thorax, will serve to confirm the judgment 
based upon first impressions, or to remove any doubt their insufficiency 
may have left in the mind. When there is, moreover, chronic catarrh, 
an old pneumonia, pleurisy with effusion, numerous and suppurating 
tubercles, the physician should undoubtedly push his investigations 
even to the appreciation of every particular of the pathological condi- 
tion ; but an exact knowledge of these is not of absolute necessity. It 
is sufficient to require exemption that the chest should be ill-formed, 
that its structure should appear to be too weak, and that the other- 
parts of the organism should be stamped with signs of debility and suf- 
fering. 
“In proceeding upon these extended views, it is true we run the 
risk of rejecting men who may afterwards become very robust, and 
who, by a long and successful life, may contradict the prognosis we 
may have pronounced in their cases. But look over the necrology of 
our hospitals, inquire of the inspectors general of our armies, attend the 
quarterly reviews of our military establishments, and you will be aston- 
ished at the number of men who, received because no determinate lesion 
of the thorax was recognized when they were inspected, succumb after- 
ward w'ith phthisis, or whom it was necessary to send back to their 
families with broken health after their strength had been exhausted. 
This is the plague of the army. I have already said that a feeble man 
left at home may become strong; but send him into the ranks, and he 
perishes almost certainly. Betwixt these two rocks neither the physi- 
cian, the officer, nor the magistrate can hesitate an instant.” 
The practical good sense of these observations must command the 
assent of the intelligent medical officer. But we must go further and 
remark, that a decided predisposition to phthisis may exist without any 
striking defect in the development or conformation of the chest. 
Phthisis is a constitutional disease, and will frequently be shown by 
constitutional signs before any tubercles can be discovered in the lung, 
and, in all probability, before they exist in that organ. Before there is 
any cough or spitting of blood, or abnormal sound upon percussion or 
auscultation, emaciation begins, shown by absorption of the fatty de- 
posits in the orbits, the cheeks, the limbs, &c.; then in the muscular 
tissue ; loss of physical strength succeeds ; the man is less active than 
usual—has a disinclination to work—and, finding his occupation irk- 
some, for this very reason is induced to offer himself to enlist. He is 
not conscious of any local disease, and probably, as yet, has none; RECRUITING SERVICE. 
57 
but the vigilant surgeon will detect the phthisical aspect. When, 
therefore, evident emaciation exists, though but in an inconsiderable 
degree, unless it can be accounted for by antecedent and recent acute 
disease, the case is suspicious. The man will acknowledge an unusual 
sluggishness of feeling if questioned closely, and further inquiry will, 
in many cases, satisfy the examining surgeon that he will soon have 
tubercles, though no present sign of them can be detected, and though 
he may have a well-developed chest. 
Haemoptysis is always reason for rejection, but not always for dis- 
charge. 
There are instances in which it may be considered accidental, but 
generally it is habitual, and then demands discharge as w-ell as rejec- 
tion. Sir James Clark has remarked, that it is occasionally idiopathic, 
or dependent upon a temporary plethora or congestion of the lungs, 
especially when it is a consequence of suppressed sanguineous dis- 
charges. It is sometimes a sign of disease of the heart, and usually of 
the left side, due probably, in this case, to some mechanical obstacle to 
the return of the blood from the lungs. It is sometimes a consequence 
of enlargement or congestion of the liver or spleen. It is sometimes a 
consequence, but not a cause, of tubercle in the lung. Pollock says it 
is a valuable indication of tubercle, but that it must be collated with 
the physical signs and other symptoms. He himself had a case of 
injury of the lung from fractured ribs, in which hoemoptysis occurred 
at short intervals for many months, but without any sign or symptom 
of tubercle. 
When discharge is sought for on account of hoemoptysis, the case 
should be carefully investigated before granting or refusing a certificate. 
When it depends upon a cause that may be removed within a reasona- 
ble time, or a pathological condition that will not be aggravated by the 
duties of the soldier, the discharge should not be granted. 
Hoemoptysis is sometimes feigned. The man complains of weak- 
ness of stomach and spitting of blood. Sometimes mechanical means 
are resorted to to induce a discharge of blood from the several parts of 
the primse viae within reach. Sometimes stimulants to the salivary 
glands are used, and various coloring matters employed to redden the 
secretion thus induced. These, however, are clumsy contrivances, and 
readily detected. True hoemoptysis is thus concisely defined by 
Copland: 
“ After a sense of pain and heat in the chest, and titillation in the 58 
MANUAL FOR THE 
throat, the rejection of florid, frothy, or pure blood from the bronchi or 
lungs, with a hawking or short cough.” 
When the blood is ejected in small quantities in the true disease, it is 
florid, frothy, and containing air bubbles, or mixed with muco puriform 
matter. Auscultation reveals a bubbling rale in the larger branchiae, or 
in the smaller branches, with absence of respiratory murmur. 
Begin remarks, that the true access always leaves after it a pallor 
and debility that artificial means never produce. The Aide Memoire 
observes: “ It is easy to recognize the imposture by making them spit 
without coughing; for then the saliva will be colored red as well as if 
they had coughed. We should also make them rinse the mouth with 
water and vinegar, and see if the coloring matters of which we have 
spoken will not be found in this liquid.” 
“ Furthermore, recent hoemoptysis, without signs of organic altera- 
tion of the pulmonary parenchyma, being no reason for exclusion from 
the military service, the most perfect imitation of this symptom is of no 
advantage to simulators in attaining their ends.” 
Structural or serious functional diseases of the heart constitute absolute 
cases of rejection or discharge. 
From the experience of the writer, he is persuaded that too little atten- 
tion is given to this important organ in the inspection of recruits. The 
surgeon should constantly bear in mind that the inducement to enlist is 
not unfrequently a sense of inability in the recruit to labor at his trade. 
In these cases the heart is as often the failing organ as any other. The 
hand should in all cases be placed firmly over the prsecordial region, for 
the purpose of ascertaining whether there be any abnormal action of 
the heart; and if the least should be detected, the investigation should 
be pushed to certainty as to the existence of any disqualifying disorder. 
The circumstance of being stripped and examined will frequently ex- 
cite disturbed action of the heart, and there may exist palpitation from 
slight functional disorder that may be readily remedied. Such cases, of 
course, are of no consequence; but when structural disease or serious 
functional disturbance exists, the man is plainly unfit for service. 
To facilitate the investigation of these cases, we shall here give a 
resumes of the principal points of diagnosis, chiefly condensed from 
Copland’s articles on auscultation and diseases of the heart. 
The physical means of investigation are palpitation, auscultation, 
and percussion. 
The impulse of the heart varies in different individuals, and is modi- RECRUITING SERVICE. 
59 
fied by the emotions, by repose, or exertion. It is synchronous with 
the first sound of the heart. If a second impulse is felt with the second 
sound, it will be slighter than the first—deeper and more tremulous— 
and it is indicative of hypertrophe with dilatation. A strong, heaving, 
and prolonged impulse indicates thickening of the ventricular walls. 
We have said that emotion may induce increased impulse; but when 
this impulse is morbid, it is persistent, and exists when the number of 
pulsations is not increased. 
Diminished impulse, if marked, is sometimes an effect of depressing 
passions or diseases ; but it is generally due to thinning of the walls of 
the ventricles, congestion of the heart or lungs, asthma, and the like. 
In health the impulse is chiefly felt under the cartilages of the fourth, 
fifth, sixth, and seventh ribs. If felt beyond this, the existence of dis- 
ease of the heart, lungs, liver, or spleen, effusions into the pleura or 
pericardium, or adhesions of these membranes, may be suspected, and 
should be inquired into. * 
Sometimes a deep-seated purring tremor will be felt when the hand 
is firmly pressed upon the prsecordial region. This, when an indica- 
tion of disease, will be accompanied with abnormal sounds. 
The sounds of the heart also vary in different individuals. They are, 
if otherwise normal, inversely as the impulse. Impulse being in pro- 
portion to the thickness and sound to the thinness of the walls of the 
ventricles, they can never both be present in a marked degree in health. 
The sounds of the left side are heard at the junction of the cartilages 
of the fourth, fifth, sixth, and seventh ribs with the sternum. The 
sounds of the right side, under the sternum and toward its right edge. 
The sphere of the sounds is more extensive than that of the impulse, 
particularly in narrow-chested and spare men. The sphere and loud- 
ness of the sounds are both increased by the affections above enume- 
rated as increasing the impulse. 
If exaltation of sound is accompanied by increased frequency of pulse, 
disease may not exist; but if an increased degree and range of sound be 
accompanied by a natural or slow pulse, disease may be inferred. 
In health the sounds are strongest in the left anterior part of the chest; 
next in the sternal part; then the right anterior; then the left posterior; 
then the right posterior. If there be any alteration or deviation from 
this order, disease exists. 
The abnormal sounds are the bellows, saw, rasp, and friction sounds. 
They must be considered, for our purposes, as always signs of disease; 60 
MANUAL FOR THE 
for though sometimes produced by functional disturbance, they are 
generally the result of organic changes; and as in the examination of 
recruits time is not afforded for determining the fact, rejection must be 
pronounced when these morbid sounds are present. When the ques- 
tion is as to the discharge of a soldier, there is of course opportunity for 
thorough investigation. 
The friction or creaking sound is always dependent upon structural 
change 
Palpitations or other perturbations of the heart’s action require care- 
ful investigation. They frequently depend upon excesses of various 
kinds that may be controlled and remedied. But tumultuous action of 
the heart is almost always indicative of organic disease. Long con- 
tinued palpitation frequently produces in time undue prominence of the 
praecordial region, and is due to hypertrophy 
Percussion—In health, the dullness over the heart is about two inches 
square in extent. If it exceed this at all, disease probably exists. If 
the excess be considerable, disease certainly exists. 
A florid complexion, with increased action of the heart, pulsation of 
the jugular veins, irregularity of the pulse, b:ueness of the lips, a sallow 
cachectic hue of the skin, are so many important features of heart 
disease; and where they are present the examining surgeon should 
critically investigate the condition of this organ. 
Affections of the heart are sometimes simulated for the purpose of 
procuring a discharge. The excessive use of tobacco, tea, or coffee, 
and sometimes of garlic, may induce irregular and even tumultuous 
action of the heart. But if organic disease exist, some of the other 
signs afforded by percussion and auscultation will be present and decide 
the matter. 
Asthma is a sufficient reason for rejection, whatever may be its char- 
acter or degree ; but when uncomplicated, there are no known means 
of detecting its existence during the intervals of the paroxysms. If of 
long duration, the lesions of the respiratory organs and heart it induces 
would reveal it, and of themselves, independently of the primary affec- 
tion, would demand rejection. 
Simple spasmodic asthma, without pulmonary or cardiac complica- 
tion, is not a sufficient reason for discharge. RECRUITING SERVICE. 
61 
Affections of the Abdomen. 
Chronic inflammation of the gastro-intestinal mucous membrane, with 
marasmus, diarrhoea, or dysentery ; 
Chronic hepatitis, or splenitis; 
Engorgement of the mesenteric glands; 
Chronic peritonitis, with or without effusion; are so many reasons for 
rejection. 
When they are found to be incurable, or not likely to be cured within 
a reasonable time, they also justify discharge. 
Men from districts in which malaria is rife, with systems thoroughly 
saturated with the poison of intermittent fever, are frequently driven to 
enlist from utter inability to go on with their work. Laborers upon 
canals and railways, upon newly opened farms, upon fresh water rivers 
in the middle, western, and southern portions of the country, are often 
affected in this way, and in many cases it is a difficult matter to decide 
whether they should be received or not. If the wants of the service 
would admit of such men being assigned to duty in departments free 
from malaria, this difficulty would in a great measure cease; but as 
the recruit may be sent to a district equally malarious with that from 
which he has fled, it is obvious that, in this event, he will be likely to 
pass more time in the hospital than in the ranks. 
If, therefore, the recruit present marked signs of malarial cachexia, 
with emaciation, sensible enlargement of the liver or spleen, with color- 
less lips, or the slightest tendency to oedema, he should certainly be 
rejected. 
Certain symptoms dependent, when real, upon the class of diseases at 
the head of this section, are sometimes FEIGNED; such as jaundice, 
vomiting, hamatemesis, tympanitis, &c. 
Jaundice has been attempted to be simulated by coloring the skin 
with infusions of various roots, seeds, &c. Soap and water readily 
discover such silly frauds. The lack of color in the conjunctiva in these 
cases would of itself be sufficient to expose the trick. 
“ Carbo-azotic acid possesses the property peculiar to itself of giving 
a yellow color to the skin, as if the person were suffering from jaundice, 
when taken for three or four days. * * * * This coloration would 
be easily distinguished from jaundice by any medical man.”* 
* London Lancet. 62 
MANUAL FOR THE 
“ The salts of this acid crystallize very readily, and all explode -when 
heated. When they are placed in contact with lime and green vitriol, 
blood-red solutions are formed.”* 
Moreover, jaundice, if real, would be of no consequence in this rela- 
tion, except as a sign of chronic disease of the liver or duodenum ; and, 
therefore, if discharge were demanded, it would be for the organic diffi- 
culty, and not for the jaundice. 
Vomiting.—Some persons succeed in acquiring the power of ejecting 
the contents of the stomach at will, and have been known to avail 
themselves of this power to procure discharge or exemption from mili- 
tary service. 
When this vomiting is pathological, emaciation and cachexia accom- 
pany it. The matters ejected by the malingerer generally consist of 
nothing more than the food recently swallowed, and that digested in 
proportion to the time that may have elapsed since the meal. 
Hcematemesis is simulated by swallowing blood and afterwards vom- 
iting it in the presence of others. Begin remarks, in relation to this : 
“ Error will be avoided by observing, 1st, that blood recently exhaled 
into the stomach is ordinarily vomited in a fluid form, while that which 
has been swallowed is coagulated; 2d, that the fluid ejected in a mor- 
bid state is voided in variable quantities at a time, but continues for 
some length of time, and if it escapes in abundance, all the signs and 
results of internal haemorrhage are speedily manifested ; but in artificial 
bloody vomiting the whole mass is rejected without effort in a few 
gulps, and is quickly exhausted without the malingerer experiencing 
the slightest debility; 3d, in true chronic hsematemesis the general 
health is impaired, contrasting strongly with the external signs of good 
health impostors always present.” 
Tympanitis has been successfully simulated by swallowing large 
quantities of air. Percy relates such a case. It must be very rarely 
that such a thing can be done. Injecting air per anum might be more 
readily practiced. These impostures present no difficulty in their de- 
tection. A chronic disease of the digestive organs, that could be pro- 
ductive of a sufficient degree of tympanitis to call for discharge or ex- 
emption from military service, would manifest itself by plainer signs 
than this. 
Stricture of the rectum. 
Prolapsus ani. 
* Turner’s Chemistry. RECRUITING SERVICE 
63 
Artificial anus. 
Fistula in ano. 
Haemorrhoids. 
With regard to the four first of these infirmities, there can be no doubt 
as to their being positive disqualifications for the military service under 
all circumstances whatever. With’regard to the last, the case is not so 
clear. 
Haemorrhoids are a very common affection. To exclude all men so 
affected, without regard to degree or extent, would be equally unjust to 
the recruit and to the service. We have no doubt that many able- 
bodied, effective men have been lost to the service by a blind adherence 
to the notion that haemorrhoids always disqualify. 
When haemorrhoids are old, ulcerated, painful, or the source of fre- 
quent haemorrhages, there can be no doubt; but when recent, appear- 
ing only occasionally, causing no discharge, or such only as may be 
readily relieved by ordinary means, they seem to us to be no objection 
to a recruit. Between these extremes there are many degrees, and these 
cases ought to be left entirely to the discretion and judgment of the in- 
specting surgeon. While a neglect to inquire into the existence of the 
disease would be culpable dereliction of duty on his part, the fact of his 
passing a man with piles, after a deliberate exercise of his best judg- 
ment, should not subject him to censure. 
Haemorrhoids are not enumerated in our Regulations among disquali- 
fying causes, unless it be under the general expression, “ tumors." In 
the British Regulations they are enumerated, but with the qualifica- 
tion, ‘ ‘ when they exist to such a degree as will immediately, or in all 
probability may, at no distant period, impair a man’s efficiency.” In 
the Aid Memoire they are mentioned only as one of the causes of ever- 
sion or falling of the rectum, and then as old and ulcerated. Still, we 
have seen cases where only two or three very small pedunculated 
haemorrhoids have totally incapacitated an officer from riding on horse- 
back, and sometimes from taking any exercise at all. In two of these 
cases we have removed the tumors with immediate and permanent re- 
lief. In other cases a considerable growth of these excrescences has 
produced little or no inconvenience. We have met with instances 
where the subjects were not aware they had anything of the sort until 
a military inspection has revealed them. 
The disqualification caused by haemorrhoids does not depend upon 
their development within moderate limits ; and they ought not, in our MANUAL FOR THE 
opinion, to exclude from service, except they exist to such a degree as 
to “impair the man’s efficiency.” How is this to be determined? 
By inspection, it is plain that haemorrhoids existing above the sphincter 
cannot be discovered, except they be ulcerated and furnish a constant 
purulent discharge, or while bleedipg is going on from them. When 
they are external to the sphincter, they are of course seen, and the expe- 
rienced surgeon will have little difficulty in judging whether they are 
old or recent. If recent, they can probably be readily cured without 
a surgical operation, and need not disqualify the man. If old, and not 
ulcerated, nor very extensive, the only means of ascertaining how far 
they “ impair the man’s efficiency,” must be derived from the affirmation 
of the man himself. If he asserts positively that they do not interfere 
with his activity, he should not be rejected. Should the event prove 
that he practiced deception, he should not be discharged or excused 
from duty, but the tumor should at once be removed by operation. 
Certificates of disability should never be granted for this affection if 
external. 
Abdominal or crural hernia, single or double, reducible or irreducible, 
constitute absolute cases of rejection. 
We think there is no other safe rule than to reject in all cases of 
hernia. Marshall is of opnion that the umbilical and ventral varieties 
are of little consequence ; that they seldom incapacitate a man for duty. 
This is no doubt true, and the same may be said of an imperfectly de- 
veloped inguinal hernia. Nevertheless, when a man is loaded with his 
arms, knapsack, &c., upon a march, or inaction, grave inconveniences 
are very apt to occur, and even fatal results may be suddenly induced. 
As war is the “normal state” of the soldier, no recruit should be re- 
ceived who is not fully able to encounter all its hazards. “It is true 
that all soldiers affected with hernia do not incur the same disasters, 
and that many, in spite of their infirmities, make a number of cam- 
paigns without any sort of accident occurring; but if it is true that a 
single one has to dread them, is it not demonstrated that all those pre- 
senting this infirmity are physically unfit for all activo military ser- 
vice ?”* 
The Aide Memoire deduces from these and similar observations, that 
all cases of hernia demand rejection, and most of them discharge ; but 
that an incipient inguinal hernia, or an ordinary hernia without compli- 
cation, and easily retained by a veil-made truss, is not sufficient reason 
* Memories of Military Medicine. RECRUITING SERVICE. 
for the discharge of a soldier, particularly in the cavalry, where hernias 
are generally very numerous. 
In these opinions we concur. Men with ordinary hernia may be 
made useful in various ways, particularly during peace. They are fully 
competent to perform the duties of nurses in the hospitals, of cooks in 
the company’s kitchens, of herdsmen upon the frontiers, &c.; and 
unless there be some complication, or some peculiar circumstance to 
justify it, a certificate for discharge should not be given in these cases. 
In examining a recruit in relation to hernia, it is not sufficient to 
make the man cough while his hands are extended above his head, or 
even to place the hand upon the external ring while this is being done. 
The incipient or imperfectly developed hernia will frequently escape 
observation in this way. While the arms are extended above the head, 
the surgeon should carry a fold of the scrotum upon the point of the 
forefinger into the external ring, and as far up the inguinal canal as 
practicable, and then cause the man to cough. This is to be done 
upon both sides in succession. 
Though crural hernia is a rare occurrence in men, still an examina- 
tion of the crural ring should never be neglected. 
A “ tendency to hernia" is mentioned by some authors among the dis- 
qualifying affections of recruits. “Observe relaxed abdominal rings, 
as they indicate a tendency to hernia.”—(Henderson.) “Hernia, or 
a tendency to that disability from preternatural enlargement of the 
abdominal ring.”—(British Instructions.) 
This language appears to us to be very loose and indefinite, and cal- 
culated to exclude numbers of effective men from the service in its ap- 
plication by the inexperienced surgeon, as well as to give rise to differ- 
ences of opinion among the several medical officers who examine the 
recruit before he is finally enrolled. 
Men who present themselves for enlistment are almost always such 
as have led laborious lives, and who, if a tendency to hernia is to be 
recognized from the size of the external ring, ought to have contracted 
that infirmity long before. They are not likely to be called upon to 
make any more violent exertion as soldiers than they have been making 
for years as laborers. It is possible that a relaxed external ring may 
predispose to the direct or internal hernia; but this form of hernia is 
comparatively infrequent. Cloquet found it to occur in but 86 cases, 
while he met with the external hernia in 203 cases. It is through the 
internal ring that the mass of inguinal hernise we meet with protrudes. 66 
MANUAL FOR THE 
An imperfect closure of the upper part of the inguinal canal undoubt- 
edly predisposes to this form of hernia; but this is independent of the 
external ring. Hernia seldom occurs from this cause, except another 
be superadded in the form of violent exertion; and this not in the erect, 
but in a flexed position of the body—such as approximates the two 
rings, while the supporting power of the abdominal muscles is dimin- 
ished, and the protruding power of these and their associate muscles is 
increased. 
It may be merely accidental, but by far the greater number of herniae 
that have fallen under our observation have occurred in comparatively 
robust, thick-set men—just the men who rarely have a relaxed external 
ring. 
Bdgin remarks, that “there are subjects not affected with hernia 
who have the inguinal canal, as well as the corresponding portion of 
the abdominal wall, weak and relaxed, forming above the fallopian 
ligament an oblong and elongated outlet from the pubis toward the an- 
terior spine of the ilium—an outlet that increases under the influence of 
coughing or violent exertion, and appearing to constitute a sort of ru- 
dimentary hernia. When this condition is well marked, exemption 
should be conceded. When it exists even in a slight degree, the sub- 
stitute that presents it should be rejected.” 
This is an intelligible “tendency to hernia,” or, rather, it is a rudi 
mentary hernia, and of course must be recognized as a valid objection 
to a recruit. 
We conclude, then, that the term “tendency to hernia,” as indi- 
cated by the character of the external ring, should be excluded from the 
catalogue of military disqualifications. 
Hernia cannot well be simulated. It is, however, sometimes “ dissimu- 
lated.” 
“ To succeed in dissimulating a hernia, the tumor being inconsidera- 
ble, they reduce it, remain for some time in bed, apply over the di- 
lated opening cold and astringents, and then present themselves for 
inspection—the tumor appearing neither spontaneously nor as the effect 
of a cough, which the dissemblers are careful shall not be very strong.”* 
This fraud will be detected by the mode of examination we have sug- 
gested above. In these cases the finger can be carried completely tip 
to the internal ring, and then the nut-like protrusion will be felt if tho 
man is made to cough strongly. ' 
* Aide Memoire. RECRUITING SERVICE. 
67 
Affections of the Genital or Urinary Organs. 
Epispadia or liypospadia at or leyond the middle of the penis ; 
Permanent stricture of the urethra; 
Loss of the penis from any cause; 
Permanent retraction of one or loth testicles within the external ring; 
Absence of both testicles from any cause; are valid objections to a re- 
cruit. 
Stricture can be ascertained only from the confession ©f the man him- 
self, or by instrumental exploration. To the latter there are serious 
objections. Many valuable recruits would be lost to the service, were 
this exploration insisted on, from natural unwillingness to submit 
to it. When a recruit acknowledges he has some obstruction to the 
free passage of his urine, catheterism should be resorted to, of course. 
We have frequently ascertained in this way that no permanent stricture 
existed, and have thus saved to the service men that, upon their own 
statement merely, must have been rejected. But when no such objec- 
tion is acknowledged, we must rest satisfied with the declaration of the 
man. 
Loss of both testicles, either from extirpation, atrophy, or natural de- 
fect, constitutes an absolute case of rejection. 
The absence of both testicles from their natural situation does not 
necessarily imply the loss of them from either of these causes, for they 
may never have descended into the scrotum. In this case the usual 
signs of virility wrill resolve the doubt. Moreover, if the organs have 
been extirpated by accident or design, the cicatrix of the wound will 
reveal the fact. If they have disappeared from atrophy, some rudiment 
will still remain to show that they had descended. 
When the testicles have never escaped from the pelvis, it is a matter 
of some importance to ascertain their situation. If they occupy any 
portion of the inguinal canal, they incapacitate the man from their lia- 
bility to be followed by hernia, and particularly from their exposure to 
painful injury and to strangulation. This remark is also applicable to 
those cases in which only one testicle is present in the scrotum. The 
other may be interrupted in some part of the inguinal canal, and be fol- 
lowed by the consequences above noticed. 
I have remarked in the cases of this kind that have fallen under my 
observation, the missing testicle has always been the right. I do not 
know whether this fact has been confirmed by the observation of others. 68 
MANUAL FOR THE 
Some men have the faculty of retracting the testicle even within the 
external ring. These cases must not be confounded with those in 
which the organ has never passed that aperture. 
We conclude, then, that complete castration, atrophy, or congenital 
deficiency of both testicles, or permanent retention of both testicles in 
the inguinal canal, demands the rejection of the rec.'uifc. 
Sometimes we meet with an irregular semi-elastic mass appended to 
the inferior extremity of the testicle. It is frequently as large as the 
testes itself.. It is insensible, and presents no pathological indications. 
These tumors have frequently been mistaken for third testicles. It is 
probable they are fibrous tumors attached to the tunica vaginalis, or 
encysted hydroceles. Mr. Curling mentions instances of both. The 
latter would be an objection to a recruit. It may be distinguished, like 
other hydroceles, by transmitting light through it in a darkened apart- 
ment. 
It is possible, also, that this appendage to the testicle may be the 
thickened parietes of the tunica vaginalis, remaining after the curb of 
an old hydrocele or hernia. 
Sarcocelc, and even a chronic engorgement of the testicle that cannot 
be cured without extirpation of the organ, are absolute cases of exemp- 
tion.—(Aide Memoire.) 
In this dictum we concur. Even if the enlargement be not inconve- 
niently great, it will be made a pretext for evading duties, if the man 
be enlisted. 
It must be borne in mind, however, that these organs differ much in 
size iu different individuals, and sometimes in the same individual. 
In the latter case the left is usually the larger. The average dimen- 
sions of the organ are: 
Length, two inches. 
Breadth, one inch. 
Thickness, two-thirds of an inch. 
Weight, (according to Meckel,) half an ounce. 
Weight, (according to Sir Astley Cooper,) one ounce. 
For the purposes of this work, all the different species of chronic swell- 
ing, to which the body of the testicle is subject, may be included under 
this head. Such of them as are specific or malignant in their character, 
as scirrhous or sarcomatous degeneration, or scrofulous or syphilitic 
swelling, are, of course, more objectionable than the simple enlarge- 
ment. RECRUITING SERVICE. 
Hydrocele, if sufficient in size to be at all readily observed, is also 
cause for rejection. 
In both sarcocele (non-malignant) and hydrocele the question of 
discharge must be determined by the positive impediment they offer to 
the man’s activity. In our service they will seldom be found of suffi- 
cient size to call for a certificate of disability. 
Hydrocele has sometimes been attempted to be imitated by insuffla- 
tion of the scrotum. There can be no difficulty in recognizing this 
fraud. Sometimes water has been injected into the cellular tissue of 
the scrotum. This might be confounded with anasarca of the sac, but 
it is to be remarked that this “ affection never exists alone, and it is al- 
ways accompanied by general organic characteristics, easily distin- 
guished.”—(Aide Memoire.) 
Varicocele and cirsocele. 
“ Dilatation of the veins of the scrotum, (varicocele,) and that of the 
veins of the spermatic chord, (cirsocele,) when they have attained a 
size sufficient to impede progression, also constitute cases of exemption 
and discharge. These affections carry with them a constant sense of 
weight and painful dragging, that heat and fatigue augment.”* 
There exists among medical officers considerable difference of opinion 
as to the validity of these objections to a recruit. They are enumerated 
among the disqualifications in the British instructions under the same 
limitations as in the French. Out of 5,000 rejections in our service, 
877 were for varicose veins and varicocele, (cirsocele?) Hendefson 
says: “ If not large, and if unconnected with a varicose diathesis—that 
is, varicose veins in the lower extremities—the recruit may be passed.” 
He adds, that he never had a man report sick from this cause, and he 
quotes a remark of Marshall to the same effect. We can say the same 
thing, and by reference to the Army Vital Statistics, by Dr. Coolidge, 
it appears that in the whole Southern country, where these affections 
would naturally give most trouble, there were but sixty cases of all 
sorts of disease of the urinary and genital organs, exclusive of the vene- 
real diseases and their consequences, in sixteen years. Some degree of 
cirsocele is very common, and if men are to be rejected for this affection 
indiscriminately, our rendezvous might almost as well be closed. We 
have known persons in civil life to submit to an operation for the cure 
of cirsocele; not, however, because it interfered with their activity in 
their ordinary pursuits, but from a notion that it interfered with the 
* Aide Memoire. 70 
MANUAL FOR THE 
special function of the testicle. A cirsocele must be quite large that 
can incapacitate a man for the performance of military duty. There 
should be some standard by which these cases should be judged, or one 
surgeon is constantly liable to have his judgment reversed by another, 
and to incur censure for carelessness in his inspections because a re- 
cruit is rejected at a regimental examination who had been approved at 
a rendezvous. We suggest, then, the following as a safe rule: If the 
testicle upon that side is atrophied, whatever may be the volume of the 
cirsocele, or if the volume of the latter exceed that of the former, the 
recruit should be rejected. 
Occasionally a very eligible recruit presents himself with this affec- 
tion. In such a case, if the man were willing to submit to an opera- 
tion for the cure of the disease, we have received him and operated 
upon him at once. The operation of Vidal is so easily performed, so 
effective, and so rarely, if ever, followed by untoward consequences, 
that, with this method at our command, we should be very unwilling 
to lose a decidedly eligible recruit on account of a cirsocele. But, as a 
general rule, recruits with large cirsoceles are not, in other respects, de- 
cidedly eligible, and, therefore, within the limits above indicated, 
should be rejected. 
Cirsocele is almost invariably confined to the left side. We have 
seen but one instance of it upon the right, and then it was double. The 
mechanical obstacles to the venous circulation upon the left side are the 
causes. The left spermatic vein entering the emulgent, and passing 
also under the sigmoid flexure of the colon, the course of the blood 
through it is obstructed by both circumstances, and hence the dilata- 
tion of the vessel. Sometimes the right spermatic vein also empties 
into the emulgent, and this may account for the rare instances of cirso- 
cele upon that side. 
Stone in the bladder demands both rejection and discharge. 
It can only be detected by sounding ; so, of course, the surgeon must 
rely upon the veracity of the recruit in examining on this point. A 
very long prepuce may suggest a more searching inquiry as to the ex- 
istence of this disability. 
Haematuria.—This affection being frequently a sign of grave disease, 
such as urinary calculus, organic disease of the kidney, bladder, or 
prostrate gland, scorbutus, etc., if known to exist, will require rejec- 
tion ; but the question of discharge will depend upon the fact of its 
being actually a sign of chronic disease in the individual presenting it. RECRUITING SERVICE. 
71 
An accidental haunaturia, from the exhibition of certain remedies, from 
an injury that may be recovered from, etc., would not justify a dis- 
charge. 
It is sometimes feigned and sometimes simulated by the presence 
of bile, purjiurine, uric acid, etc., in the urine. 
Malingerers sometimes inject blood into the bladder. In this case 
the fraud is detected by washing the bladder out well, and then con- 
fining the man under surveillance for a few hours. Upon drawing off 
the recently secreted urine, it will be free from blood. Should any 
other than human blood have been used by the malingerer, the micros- 
cope reveals the fraud at once. 
Pariset’s test for the detection of blood in the urine is to “ boil the 
urine and filter it. Brown coagula of hsematosin and albumen will be 
left on the filter: pour on these liquor potassm, and if hsematosin be 
present, a greenish solution will pass through, from which hydrochloric 
acid will precipitate white coagula of protein.” 
Purpurine “is distinguished by not being affected in color or trans- 
parency by a boiling heat.” 
Uric acid “is distinguished by not being affected by heat, and by 
the microscopic character of the deposit.” 
Bi e, or its coloring ingredient, is thus detected : 
1. “ Pour on a white plate a small quantity of the urine or other 
fluid, so as to form an exceedingly thin layer, and carefully allow a 
drop or two of nitric acid to fall upon it; an immediate play of-colors, 
in which green and pink predominate, will, if bile be present, appear 
around the spot where the acid fell.” 
2. “ Add to a few drops of the suspected fluid, on a white plate, a 
little strong sulphuric acid ; when the mixture becomes hot, add a drop 
of a saturated solution of sugar. The mixture will immediately assume 
a fine purple color if bile exist.”—(Pettinkoffer.) 
“Hsematoxylon will often, by the red color it communicates to the 
urine, lead to an unfounded suspicion of the existence of hsematosin— 
distinguished by the dark precipitate produced by sulphate of iron, 
and by an absence of coagulation by heat.”* 
Heat and Pariset’s test will readily demonstrate the absence of hsema- 
tosin, when the use of the pareira or chimaphila may have colored the 
urine. 
The microscopic characters of the blood corpuscles afford the most 
*Bird on Urine. 72 
MANUAL FOR THE 
certain means of detecting the presence of blood when the instrument 
is at hand. “Whatever are the modifications presented by the blood 
corpuscles in urine, their non-granular surface, uniform size, and yel- 
lowr color under the microscope, will always be sufficient to identify 
them.”—(Bird.) 
Urinary fistula is a positive disqualification. 
Incontinence of urine is a positive disqualification. 
This affection is seldom seen. I have met with but one instance. 
Percy and Laurent remark, that they had seen but two cases of real 
incontinence, though the number of pretended cases that had come be- 
fore them was very considerable. It is as a FEIGNED disease that it 
becomes important to the medical officer. 
Sometimes incontinence is due to mechanical lesion of the organs 
concerned, and then it is readily verified ; hut if due to pathological 
changes, in their nature obscure, the diagnosis is more difficult. Upon 
this point we shall translate literally the remarks of the Aide Memoire: 
“Whatever may be the cause of this infirmity, it may he, 1, complete. 
Then the discharge of the urine is constant. It is made drop by drop. 
Then also the penis, particularly the glands, is pale, and, as it were, 
macerated. These parts are constantly bathed in the urine. 
“ It is said to be, 2, incomplete, when the excretion of this fluid is in- 
voluntary only at different times of the twenty-four hours. It is in the 
night, and during sleep, that this phenomonon most usually manifests 
itself. This condition is almost always accompanied with great wast- 
ing, pallor of the face, flaccidity of the limbs and of the genito-urinary 
organs; and, finally, all the characteristics of general debility. The 
bodies as well as the clothes of individuals affected with true inconti- 
nence emit a very strong ammoniacal odor. 
“To recognize this disease, the orifice of the urethra should be dried 
with a piece of cloth, and if the affection is real, the urine will soon be 
seen to flow drop by drop. If the reverse, nothing will escape, and we 
shall easily perceive by the action of the abdominal muscles, by the 
suspension of the respiration, and by the urine expelled in jets, that 
the knave is trying to produce a little of this fluid. Simulation of this 
disease is again recognized by ascertaining, by means of the catheter, 
the presence of a considerable quantity of urine in the bladder. But 
it is important to take the precaution beforehand to make the pretended 
patient swallow in the evening a sufficient dose of opium to produce RECRUITING SERVICE. 
73 
narcotism, in order that the simulator may not discharge his urine vol- 
untarily during the night.” 
Affections of the Vertebral Column. 
Curvature of the cervical, dorsal, or lumbar portion of the vertebral 
column. 
Gibbosity of the anterior and posterior parts of the chest. 
Arching of the back, with flattening of the anterior part of the chest. 
Gibbosity, or what is vulgarly called “broken back," is always a 
positive disqualification. 
Curvatures of the spine and round shoulders, with flat chests, dis- 
qualify when they exist to such a degree as to impede respiration, or 
to interfere with the action of the heart. 
Curvature of the spine is, moreover, an indication of scrofulous ca- 
chexia, and is significant in that respect. At the same time the muscles 
upon the interior aspect of the curve are impaired in force, and the phy- 
sical vigor of the subject proportionately diminished. 
The round-shouldered and flat-chested man will have the “vital ca- 
pacity” of the lungs seriously diminished, and to an equal degree will 
be incapacitated for a march or the active exertion demanded in battle. 
He is, at the same time, no ornament to the ranks, and with the addi- 
tional prominence given to his back by his knapsack, he renders it im- 
possible for his covering file to preserve his alignment. 
When, therefore, either of these affections exists to a degree that is 
recognized as a deformity, the recruit should be rejected. 
Curvature of the spine may be simulated to escape a draft when militia 
are called for. These cases may always be recognized by the follow- 
ing characteristics: 
1. The curvature is always in the lumbar portion of the column. 
2. The skin lies in folds in the concavity of the curve. 
'3. There is but one curve in the spine. 
4. There is neither gibbosity, torsion of the vertebrre, nor abnormal 
deviation of the bones of the pelvis.—(Guerin.) 
In the antero-posterior curvature, Begin suggests that “ an excellent 
means of straightening the subject is to lay him on his back upon a 
horizontal solid plane, with the most convex part of the gibbosity rest- 
ing on the table or the floor, the shoulder and head remaining more qr 
less elevated. In this position the abdominal and mastoid muscles, 74 
MANUAL FOR THE 
which are the principal agents in the simulation, soon become fatigued, 
and the subject finishes by extending himself completely ” 
Wry Neck.—“This is an affection in which the head, twisted to one 
side, cannot be brought back to its natural position. It is an absolute 
disqualification. It may be the effect of rheumatism, of wounds, of a 
fall, of inflammation of the subjacent cellular tissue, of convulsions. It 
may depend upon abnormal conformation, and it may also be very 
readily imitated. 
“When the disease is real, the mastoid muscle of the opposite side is 
not usually in a state of tension, while it is always so when the case is 
simulated. Moreover, it is difficult for the impostor to turn his eyes 
toward the side opposed to the curvature, which is not the case in the 
true disease. In cases of fraud a few slight efforts are sufficient to 
bring the head to its natural position.”* 
Men frequently present themselves for inspection with shoulders of 
unequal height. This is generally the result of habit, and of no conse- 
quence, unless connected with true curvature of the spine. The degree 
of this curvature, where it exists, will determine the eligibility of the 
recruit. Whenever shoulders of unequal height are seen, attention 
should of course be directed to the spinal column. 
Spina bifida; 
Fractures and dislocations of the certcbrce ; 
Rickets; are absolute causes of rejection. 
Affections of the Extremities. 
Disqualifying defects of the extremities relate to the articulations, to 
the bodies or shafts of the bones, or to the muscles and tendons con- 
cerned in the motions of the limbs. 
It is a matter of primary importance that the soldier should have the 
perfect use of all his limbs, and that the completeness and integrity of 
these organs should be in nowise impaired. A careful inspection of 
the limbs, even to the most minute detail, will never be neglected by a 
surgeon who feels a proper interest in the good of the service, or in his 
own reputation. It is necessary not only to put the man through the 
prescribed motions, but also to handle every important joint, or the sur- 
geon may be deceived. A fracture badly united may extend into a 
joint, produce no apparent deformity nor defective motion, and still in- 
*Aide Memoire. RECRUITING SERVICE. 
terfere essentially with the functions of the limb. Such a case has ac- 
tually occurred to myself very recently. 
With regard to some of the minor defects, as of the fingers and toes, 
for example, differences of opinion may exist; but still any deviation 
from the normal standard should be observed and carefully considered 
before it can be properly determined to constitute an objection to the 
fitness of the man for service. We are of opinion, moreover, that such 
defect should always be noted upon the descriptive list of the recruit, 
if passed, to show that it did not escape observation, though it may not 
have been considered of sufficient importance to exclude the man from 
service* Such a precaution would show that, however an examining 
surgeon may have erred in judgment, the passing of an objectionable 
recruit was not due to carelessness in the inspection. 
Many of the lesions and deformities of the limbs that disqualify a re- 
cruit are common to both the upper and lower extremities. Others are 
■proper to the one or to the other. 
The common lesions are— 
1. Chronic rheumatism, with swelling of the joints, or the neighbor- 
ing tissues, earthy deposits, etc., causing any impediment to the per- 
formance of the normal motions. 
Sometimes rheumatic pains are feigned with a view of procuring a 
discharge; and Percy and Laurent mention an instance in which a 
soldier succeeded in obtaining his discharge for rheumatism and conse- 
quent contraction of the knee-joint after having undergone the inflic- 
tion of blisters, moxa, and cups, and courses of mineral waters for four 
years. When he had attained his object, he put his wooden leg in the 
fire and boasted that he had successfully imposed upon every medical 
man who had had charge of him for all that time. Such a case could 
not occur in our service, for an eighth part of the time would have de- 
termined the question of discharge; but it show-s that a determined 
man may succeed in deceiving the most experienced and learned sur- 
geon. * 
In our service we think we would not grant a certificate for a rheu- 
matism about which there could be any doubt. Mere pain, without 
swelling of the joint, though accompanied with contraction, would not 
be sufficient. Anaesthesia with chloroform would immediately resolve 
the question of contraction. There could be no objection to its use 
from heart complication; for if this complication existed, the reality of 
the rheumatism would be decided Neuralgia or syphilitic pains may MANUAL FOR THE 
be verified by the coexistence of other signs, particularly those of de- 
fective hsematosis and atrophy of the affected limb, where they shall 
have existed a sufficient length of time, for the question of discharge to 
be entertained at all. 
2. Chronic inflammation of the ligaments or lining membrane of the 
ioints, the consequence of external injuries or constitutional disease, such 
as scrofula, rheumatism, gout, syphilis, &c. 
When there is even a slight degree of a soft, doughy-elastic, color- 
less swelling, especially if interspersed with blue veins about a joint, 
with wasting of the limb, chronic inflammation of the joint may be con- 
sidered to exist. These appearances are more frequently see# about 
the knee and elbow joints, but sometimes also in others. Such men 
should always be rejected, no matter how perfect the apparent move- 
ment of the joints may be. They frequently seek the service for a hos- 
pital, and desert as soon as they are cured. 
3. White swellings of the joints. 
4. Atrophy of a limb from any cause. 
5. Caries, necrosis, spina ventosa. 
C. Exostosis, occasioning any impediment to the motion of a limb. 
7. Old or irreducible dislocations or false joints. 
The shoulder joint is especially liable to chronic dislocation. Some 
men have the faculty of dislocating it at will, and can in this way 
evade duty whenever they desire. Should an apparent relaxation of 
the joint lead to a suspicion that it may have been frequently dislo- 
cated, in addition to a searching inquiry as to the fact, the man should 
be made to swing by that arm from a hook or pole above his head. 
8. Important fractures. 
Whether fractures are, per se, disqualifying accidents, is an unsettled 
point. When they produce shortening of limbs, unsightly deformities, 
impediments to the free motions of joints, paralysis, atrophy of a limb, 
and the like, there can be no doubt; but when none of these accidents 
are present, is every fracture an objection to a recruit J We think not, 
unless from the concurrence of several fractures in the same individual, 
or the peculiar circumstances attending the occurrence of even a single 
fracture, there may be reason to infer a special constitutional liability 
to that lesion. Where a fracture has occurred, an inquiry should 
always be instituted into the cause of the injury. Sometimes fractures 
are followed by neuralgic pains, becoming aggravated at times, and 
thus disabling the man from work. If atrophy of the limb is present in RECRUITING SERVICE. 
% 
these cases, as frequently happens, the disqualification is at once recog- 
nized, and rejection is absolute. But if there be no atrophy of the limb, 
the surgeon must rely upon the man himself for information upon this 
point. 
9. Severe sprains, with or without complete displacement of the bones. 
Sprains properly treated seldom result in permanent injury. But in 
the class of men who usually offer themselves to the recruiting officer, 
such accidents, when they occur, are very frequently neglected, and 
leave chronic inflammation of the ligaments that is sure to induce 
lameness when the man is called upon to march or drill at light infan- 
try. Hence, this injury should be borne in mind when inspecting the 
ankle joints, its most frequent seat. A similar injury to the wrist is of 
less consequence, but is not to be neglected. If any of the bones com- 
posing the joints are displaced, the man should be rejected, though he 
may give the strongest assurances that he suffers no inconvenience from 
the deformity. 
10. Dropsy of a joint. 
11. Relaxation of the capsular or other ligaments of a joint, with abnor- 
mal mobility, or voluntary or involuntary dislocation of the bones. 
12. Fistulce penetrating into the joints or any part of the bones. 
13. Defective or excessive curvature of the long bones. 
“ Bow legs," as they are termed, if within any reasonable limits, are 
no objection to a recruit, but are rather indicative of activity and 
strength. To the cavalry soldier they are a decided advantage ; still, 
the curvature may be so excessive as to constitute a serious impedi- 
ment to progression, and to point to a scrofulous habit for its cause. 
14. Complete or partial anchylosis of an important articulation. 
Injuries of the flexor muscles from gun-shot or other wounds, ab- 
scesses, &c., sometimes prevent complete extension of a limb without 
anchylosis, This result almost invariably follows a gun-shot wound, 
but is not necessarily nor usually permanent. Though a cause for the 
rejection of a recruit, it is not ordinarily sufficient reason for the dis- 
charge of a soldier. The simple operation of tenotomy remedies it at 
once, and is not usually attended with any danger. 
We sometimes meet with cartilaginous or bony formations in the course 
of some of the tendons that may or may not interfere with the complete 
flexion or extension of a limb. I have recently reinspected a recruit 
with such a body in the tendon of the biceps flexor cubiti near the elbow 
joint. It obstructed complete extension of the arm, but did not impede 78 
MANUAL FOR THE 
its flexiffn. I should have rejected this man had I inspected him before 
his enlistment; but having been enlisted, and, upon a careful inspection 
by a board, it being established that sufficient freedom of motion 
remained for the handling of arms, it was decided to retain him. We 
think, however, that there is great risk in receiving such men; for 
although, when enlisted, they may give every assurance that they have 
never suffered any inconvenience from this cause, and it may be found 
that the extent of motion in the neighboring joint is sufficient for all 
military purposes; still, so soon as duty becomes irksome, they seize 
upon the defect as a pretext for evading it. 
Incomplete anchylosis is sometimes FEIGNED, with a view of procuring 
a discharge. Anaesthesia detects the imposture at once; but sometimes 
it may be inconvenient or injudicious to resort to this. In such cases 
the following remarks of Begin will serve as a guide in forming the 
decision: 
“Incomplete anchylosis is one of those affections that young men 
believe they can most readily simulate. When it is real we may almost 
always discover in the articulation, which is its seat, some traces of 
the inflammation or fracture that has occasioned it, and which is want- 
ing when feigned. Invariably, in true anchylosis, the motions, free 
within the limits permitted by the lesion, cease suddenly at that point, 
as if a hard and inert obstacle there put an end to them, and without the 
intervention of muscular action of any sort. These motions, moreover, 
are not painful, and their extent never varies. When simulated, on 
the contrary, the subjects ordinarily complain of acute pain. When 
the joint they pretend to be diseased is put in motion, they stiffen the 
limb, the motion of which is arrested, sometimes sooner, sometimes later, 
iu a gradual manner, and by the action of the muscles—a fact recog- 
nized by the swelling and hardening of these organs, as well as by the 
tension of the tendons. These signs leave scarcely any doubt of fraud.” 
15. Weakness, difficult or total, and incurable loss of motion of a limb. 
16. Paralysis of a limb. 
17. Extensive, deep, and adherent cicatrices. 
It is only when these cicatrices impede the free motion of the limbs 
that they are absolute causes of rejection. As consequences of burns, 
and sometimes of ulcers, they are of this nature; but when seated on 
other parts, as, for example, the head or trunk, they are not in themselves 
objections to a recruit. As indications, however, of constitutional 
cachexia, such as the scrofulous or syphilitic, or as signs of habitual RECRUITING SERVICE. 
79 
intemperance, they are important, and in such cases will require rejec- 
tion. 
18. Loss of a limb, or an essential part of a limb. 
19. Deep depressions, inequalities, distortion or shortetiing of limbs, 
the consequences of simple or compound fractures badly united, violent 
sprains or luxations neglected or badly treated. 
20. Contraction or permanent retraction of a limb, or a portion of a 
limb. 
21. Aneurisms. 
Special Lesions of the Superior Extremities. 
1. Fractures of the clavicle. 
Fractures of the clavicle are rarely cured without deformity. Dr. 
Hamilton has carefully collated thirty-nine cases of fracture of this 
hone, and of these seven only have united without shortening; and in 
several of the latter there was still deformity, such as “fragments of 
bone displaced in direction of diameter of bone half an inch “a slight 
displacement forward,” &c. Dr. Henderson quotes Marshall, to the 
effect that “men, whose clavicles have been once fractured, should 
almost invariably be rejected.” But he dissents from the applicability 
of this dictum to our service, for the reason that our term of service is 
shorter. “ Yet,” headds, “ if thebonebe badly united, or callus forms 
a tumor, it may be that the man is not able to bear his knapsack 
strapped, and should be rejected.” 
We have before remarked that, in our opinion, a man who is fit for a 
service of one campaign is fit for a life service. Muskets are to be 
handled, fatigue duties performed, and knapsacks strapped during the 
shortest term of service, and if a fractured clavicle disqualifies a man 
for the performance of these duties, he will be as sure to fail in five 
years as in fourteen. 
Dr. Hamilton has shown that the badly united clavicle is the rule— 
the perfect, the exception; and such we apprehend will be the testimony 
of every candid surgeon who has not a hobby in some favorite appa- 
ratus for its treatment. We think, therefore, that Marshall’s opinion is 
the true and only safe one, and confidently pronounce that a fractured 
clavicle, with a resultant shortening or displacement, is a positive ob- 
jection to a recruit. 
2. Fractures of the coracoid or acromion processes. 
These fractures are rare. If they have occurred, and bony union has 80 
MANUAL FOR THE 
taken place, leaving no deformity and no impediment to the free mo- 
tions of the shoulder joint, they are no objections to a recruit. 
3. The fingers adherent or united. 
4. Redundant, double, or split fingers. 
5. Permanent flexion or extension of one or more fingers, as well as 
irremediable loss of motion of these parts. 
6. Loss of the first phalanx of the thumb of the right hand. 
7. Total loss of either thumb. 
8. Total or partial loss of the index finger of the right hand 
9. Loss of the first and second phalanges of the fingers of the right hand. 
10. Total loss of any two fingers of the same hand. 
11. Mutilation of the last phalanges of the fingers of either hand. 
“All these defects constitute absolute cases of exclusion from the 
military service.”* 
With one or two trifling exceptions we cannot hesitate to adopt these 
rules. We frequently meet with permanent partial flexion of the little 
finger of one or both hands, due to the effect of some particular varie- 
ties of labor. These flexions do not disqualify, as they in nowise 
interfere with the prompt and effective handling of arms. The perma- 
nent flexion of any other finger does, and should, exclude from service. 
We have recently seen a man who had received an incised wound in 
the course of the flexor tendons of the forefinger. This man, when 
directed to flex his fingers, would do so without perceptible difficulty. 
Sometime after his enlistment he was observed upon drill to keep tho 
forefinger extended. When asked the reason, he said he could not flex 
that finger without first extending the others, and then flexing all to- 
gether. This appears to be anatomically impossible; but it serves to 
show how astute an indolent man is in availing himself of the slightest 
pretext to evade his duties when he is once enlisted. 
Partial loss of the index finger of the right hand may be prudently 
considered as an absolute cause for rejection, but not for discharge. The 
instructed soldier will not find this defect any serious impediment in 
using his musket. The next finger soon learns to replace the first. 
Redundant fingers are not always objections to a recruit. If the 
redundant finger is upon the ulnar border of the hand, it is not usually 
in the way, and particularly if it be the left hand. We think, unless 
this appendage were more developed than we have ever seen it, we 
should not regard it in the inspection of a recruit. 
* Aide Memoire. RECRUITING SERVICE. 
Special Lesions op the Inferior Extremities. 
1. Varicose veins. 
It is a very rare thing to find a young man with varicose veins to a 
degree sufficient to attract attention. Men of thirty, and thence on to 
the limit of eligibility, more frequently present them; but even in these 
cases they are usually a sign rather of intemperate habits, or feebleness 
of constitution, than the result of mechanical causes. Generally, they 
should direct attention to the investigation of the former, and if the 
result of this investigation be satisfactory, any moderate prominence of 
the veins need not be regarded. 
But it must be borne in mind that the tendency of this affection is to 
become aggravated, particularly in tall men, and upon long marches 
with knapsacks and arms. 
The character, then, of the veins should be well noted. Sometimes 
the minute superficial branches only are enlarged, and of themselves 
are of no consequence; but when clusters of knots are seen, or one or 
more single knots, large, and with thin walls, or a net-work of enlarged 
branches about the ankle, the back of the foot, the calf of the leg, the 
ham or thigh, the man should be rejected. In all cases of varix, when 
there is chronic tumefaction or oedema of the limbs or marks of ulcera- 
tion, rejection is demanded. 
2. Chronic ulcers. 
“ Ulcerated or extensively cicatrized legs” are enumerated among 
the cases of absolute rejection in the 32d paragraph of the Medical 
Regulations, and “ulcerated legs” in the 24th paragraph of Recruiting 
Regulations. The intention of these provisions is to exclude men who, 
from the cachexia induced by intemperance, syphilis, &c., have been 
the subjects of chronic ulcerations of the lower extremities. In these 
men the slightest irritation is sufficient to reproduce the ulcers, and 
they are, of course, utterly unfit for soldiers. We have in the preceding 
article alluded to cicatrices combined with varicose veins. To these We 
now add cicatrices large, irregularly shaped, with discoloration of the 
integument, or with adhesion to the hones. Cicatrices non-adherent, 
white and smooth, resulting from an incised or lacerated wound, or a 
burn, not involving lesion of the subjacent organs, are not causes for 
rejection. We may say, generally, that the ulcerations demanding re- 
jection are those combined with great loss of substance; with atrophy 82 
if AN UAL FOR THE 
of the limb; with general constitutional disorder, or with varicose 
veins. 
Ulcers of the limbs are frequently excited and kept up by malingerers 
to procure their discharge or to evade duty. It is not necessary to enu- 
merate the means employed, nor, for reasons already stated, would it 
be prudent to do so. The means of detecting the fraud are of more im- 
portance. Chronic, inveterate ulcers, we believe, never occur unac- 
companied by unmistakable signs of constitutional disorder. General 
cachexia and atrophy or tumefaction of the diseased limb are always 
combined with the local affections. In the feigned as well as in the 
genuine ulcer we may have discoloration of the surrounding integu- 
ment ; but in the cachectic ulcer this discoloration gradually blends 
itself with the healthy skin, while in the fraudulent ulcer its margin is 
defined and readily recognized. Percy and Laurent remark that, “if 
the patient has a good complexion, is not emaciated, has good teeth, no 
engorged glands in the neck, if the borders of the ulcer are round, 
brown-colored, the bottom of it hot and violet-colored, the surrounding 
tissues inflamed, with spots, blisters, or pustules upon them, fraud may 
be inferred; for men attacked with obstinate ulcers are cachectic, their 
skin dry and scurfy, and the affected limb is almost always atrophied.” 
The Aide Memoire concludes that “ulcers of the lower extremities 
are not sufficient' reason for the exemption of a conscript, except they 
are accompanied with great loss of substance, where there is atrophy of 
the limb, where the general constitution is deeply altered, and where 
the ulcers are complicated with varices.”. 
When fraud is suspected a number of means have been devised by 
military surgeons to prevent tampering with the ulcers during the 
treatment. The object of all of them is to render it impracticable for 
the man to irritate the sore without detection, or to make it impossible 
for him to touch it at all. If, in such a case, for the sake of example, 
severe measures should be considered necessary, perhaps the least 
painful, most accessible, and most efficient would be to confine the man 
in a straight-jacket, and to apply a splint to the ulcerated leg to prevent 
flexion of the knee joint. 
3. Lameness. 
Perceptible limping, to whatever cause it may be due, demands the 
rejection of a recruit. 
It is sometimes exceedingly difficult and even impossible to ascer- 
tain the cause of the limping; and in the case of a recruit desirous of 83 
RECRUITING SERVICE. 
enlisting, no assistance in this respect is to be expected from the man 
himself. It is not necessary,, however, to be able to point out the 
particular lesion that causes the limping. If sufficient inequality of 
step, to be called a limp, exists, the man should be rejected. 
Lameness is sometimes feigned. Begin says: “ The simulation most 
frequently employed to create a belief in its existence, is the shortening 
of one of the limbs, attributed to an old fracture, a dislocation, a fall, to 
convulsions, &c. The most certain means of recognizing the fraud, 
is to place the subject upon his back, and to measure both sides from 
the most salient point of the crest of the ilium to the external malleolus, 
passing the tape exactly in front of the great trochanter. Whatever 
may be the position of the pelvis, the distance between these points 
should not vary, and whenever this distance is equal in both limbs, the 
simulation will be manifest.” 
4. Knock-knees. 
This deformity sometimes, though rarely, is carried to such an excess 
as to unfit a man for military service. In these cases it is impossible 
for the man to take the position of a soldier, and he is mechanically 
disabled from performing a long march. But it is not easy to fix a 
limit to this deformity as a cause for rejection. Much must be left to 
the discretion of each inspecting surgeon, and differences of opinion in 
such cases are to be expected. We would say, generally, that if a re- 
cruit cannot bring the inner borders of the feet, from the heel to the ball 
of the great toe, within three inches of each other, without passing the 
inner condyles of the thigh bones, respectively, in front of and behind 
each other, he is unfit for service. 
5. Club-feet are always positive disqualifications. 
6. Splay-feet. 
Large, ill-shaped, flat feet, with scarcely a trace of the tarsal arch, 
may exist without disqualifying a man for the military service. It 
seems to be almost the normal foot of many of the Continental nations ; 
i. e., among their laboring population. Some inconvenience is apt to 
he experienced among these men for a while after enlistment, from the 
abrasion of the inner malleolus, caused by the stiff shoe worn by sol- 
diers. This, however, soon disappears, and the men are capable of 
becoming very good soldiers. 
But there is a splay foot that disqualifies from marching, and demands 
re jection. It is thus graphically discribed in the Aide Memoire : 
“The foot that renders a man unfit'for service is that in which the 84 
MANUAL FOR 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 bor- 
der of this organ. Then the internal malleolous is salient, the astragalus 
is inclined inwards, and the axis of the leg does not fall upon the centre 
of the foot. From this disposition it results that the inner side of the 
tibio-tarsal articulation is prominent, that the corresponding lateral 
ligaments are elongated and weakened, and that, during long marches, 
with heavy burdens, this part, strained and wearied, becomes painful, 
and the man is obliged to fall behind. Carried to this point, this vicious 
conformation of the foot constitutes a case of exemption from the mili- 
tary service.” 
7. All the toes joined together—the toes double or branching. 
8. The great toe crossing the other toes with great prominence of the 
articulation of the metatarsal bone and first phalanx of the great toe. 
9. Overriding or superposition of all the toes. 
10. Loss of a great toe. 
11. Loss of any two toes of the same foot. 
12. 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 (usually the second toe) upon the 
second, with anchylosis of this articulation. 
14. Ingrowing of the nail of the great toe, usually upon the inner side 
of the toe, if deep and accompanied With signs of irritation, inflammation, 
or ulceration. 
These are all objections to a recruit, and are too frequently neglected. 
They invariably cause lameness upon a march, and frequently dis- 
qualify a man from undergoing the drills necessary for his instruction. 
When a man walks upon the nail, as it is termed, during a march, 
sand and other foreign bodies find their way between the nail and the 
skin, producing severe pain and irritation ; and even if this is escaped, 
the .constant pressure upon the free border of the nail is felt through - 
put its whole surface of adhesion, and develops there, and sometimes 
in the matrix of the nail, insupportable pain and inflammation. In 
the case of the anchylosed phalanges, the constant friction of the shoe 
upon a march soon obliges the man to give up and take to the wagons. 
Men with such infirmities are of no use whatever as soldiers. 
15. Stinking feet. 
It is very rare to meet with men whose natural secretions are so 
offensive as to be disgusting to -their comrades. Offensive secretions RECRUITING SERVICE. 
85 
from the feet, due, as they are in most instances, to neglect of personal 
cleanliness, may be remedied. But sometimes a man is so unfortunate 
as to emit the most offensive odor from his feet in spite of every atten- 
tion to personal neatness. Such men must be rejected; their presence 
in a barrack room would lead to the most injurious discontent. 86 
MANUAL FOR THE 
CHAPTER III. 
Affections of the Cerebro-spinal Nervous System. 
1. Epilepsy. 
Kejection is absolute in all cases of epilepsy. 
It is impossible in many instances for the inspecting surgeon to de- 
tect the existence of this disease in the recruit. If the seizures occur 
at long intervals, or the disease is of recent development, it may, as 
yet, have left no impress upon the features of the subject by which it 
can be recognized. In these cases we are compelled to rely upon the 
honesty of the man himself. His answers, when questioned upon this 
point, should be recorded, that there may be no evasion of the fraud he 
may have perpetrated, by a denial that he was ever “ asked the ques- 
tion,” when he is detected. 
But the recruit, when asked if he “ has ever had fits,” will sometimes 
say, “ Yes; he had been told he had had one or more in childhood or 
youth,” or he may have had one or, perhaps, tico seizures at some par- 
ticular period of his life, that may or may not have been true epilepsy; 
i. e., dependent upon alteration of the cerebro-spinal nervous centres. 
Still they are known, as is epilepsy, to the individual, under the general 
name of “jfits." How are these cases to be dealt with? 
If there be any reasonable doubt as to the true nature of these con- 
vulsions, so as to lead to the apprehension of the least probability of 
their recurrence, rejection is the only safe course. When such cases 
present themselves, if the man be of a strumous habit—if he be the 
subject of syphilitic, mercurial, or scorbutic cachexia—if he have received 
any injury of the head or spine, or have any disease of either—if his 
ancestors have been the subjects of epilepsy—if he be very plethoric or 
very anaemic—or if he have either functional or organic disease of any 
of the important viscera—or if his confessed convulsion have occurred 
within jive years' time—he should be rejected. 
In the habitually epileptic, however, the expression of the counte- 
nance,'cicatrices upon the head from wounds received in falling, upon 
the tongue from wounds by the teeth during the paroxysm, wearing 
away of the teeth from grinding during the fit, etc., furnish important 
means of defeating an attempt at imposture. RECRUITING SERVICE. 
87 
Epilepsy is feigned sometimes to procure a discharge from service; 
and although it would seem that our means of detection were sure, still 
it must be admitted that the malingerer does occasionally succeed in his 
design. It is, then, a matter of great importance to fix, if possible, the 
signs by which true epilepsy may be distinguished from feigned. 
“ Absolute loss of sensibility, dilatation, and immobility of the pupil, 
are the characteristic signs of epilepsy.”* 
“In true epilepsy the eyes remain half open in such a manner as 
that the whites only are seen; the eyelids are at the same time agitated 
by winkings that art can scarcely imitate without exposing the iris, or 
the eyes are wide open and either fixed or turning in their orbits in a 
frightful manner.”—(Marc.) 
These phenomena with regard to the eyes are generally true, but not 
always. Sometimes the pupils are natural, sometimes contracted, but 
immobility or very sluggish mobility still obtains, so that the value of 
the sign resolves itself into the general anaesthetic condition. Bearing 
in mind, then, the varying condition of the pupil, but its fixity in that 
condition, this sign claims the first attention upon the part of the ob- 
server when fraud is suspected. If, then, upon exposure to a bright 
light of either the sun or a candle, normal contractility of the pupil is 
observed, the epilepsy is feigned. 
Hennen’s remark upon this point is more strictly correct than that of 
the Aide Memoire. He says: “But it is from the eye that we are best 
enabled to form our judgment. In the impostor it is movable, and the 
iris sensible to the impressions of light. In the real epilepsy the eye is 
fixed, and the iris does not contract on the application of light.” 
But the unfailing test of true epilepsy is the absolute insensibility of 
the surface that always exists. Devergie remarks that “the insensi- 
bility of the skin is so complete that the patient supports, without expe- 
riencing the slightest impression, the application of a red-hot iron to 
any part of the body. Thus this means has been recommended as a 
test in doubtful cases, selecting the insertion of the deltoid for the point 
of application.” 
Henderson has adduced two cases to invalidate the reliability of this 
est. But we think that something more is required than a mere as- 
sertion that a convulsion was pronounced epileptic to prove that it was 
actually so. There is no point in diagnosis upon which writers are more 
entirely agreed than upon this. Even in apoplexy, unless paralysis 
* Aide Memoire. 88 
MANUAL FOR THE 
have already supervened, the sensibility of the skin is preserved, as 
may be readily seen by tickling the feet; and so in the hysteric con- 
vulsion that more closely simulates the epileptic than any other, sensi- 
bility is only obscured—never lost entirely. 
The command frequently attained by the impostor over all external 
manifestations of sensibility is so complete as sometimes to render ne- 
cessary an application of the cautery to decide the question. Threats 
of a resort to this test, and even the approximation of the hot iron to 
the surface, have sometimes been resisted by a determined man. Such 
a case actually occurred at Fort Monroe some years ago under the ob- 
servation of Assistant Surgeon Archer. The man confessed to the 
doctor, after his discharge, that he was upon the point of yielding when 
the iron was withdrawn. Of course no surgeon would use so painful 
an expedient until all other means of detecting a supposed impostor had 
failed. 
Besides this fact of absolute insensibility, there are other signs of true 
epilepsy that it is not easy to feign. Such are the conditions of the 
circulation, of the countenance, of the respiration, etc. In true epi- 
lepsy, “ the pulse is often quick and small, but it is felt with difficulty, 
and is usually irregular, becoming more distinct, slower, and more 
languid towards the close of this stage. The action of the heart is loud 
and vehement or tumultuous, and that of the carotids much in- 
creased.”—(Copland.) 
In true epilepsy, during the convulsive stage, the countenance is 
swollen, languid, sometimes almost black; the veins on the forehead 
full and prominent; and then, at the termination of the paroxysm, a 
sudden pallor pervades the whole surface. It would appear to be im- 
possible to simulate both these phenomena. 
But in asthenic epilepsy the countenance is not always turged or livid 
in the convulsive stage. This form of the disease, however, occurs in 
debilitated constitutions, in pale or sallow emaciated men, such as are 
not likely to be found in the ranks. 
The respiration, upon the accession of a paroxysm of epilepsy, is in- 
terrupted by the closure of the larynx, according to Marshall Hall, so 
as to make the efforts at expiration violent and ineffectual, until some- 
times a partial asphyxia is induced. 
In epilepsy the fingers, thumbs, and toes are usually violently and 
permanently flexed, so that it requires considerable force to extend 
them; but the fists once open, they remain so, until a new exaceiba- RECRUITING SERVICE. 
89 
tion supervenes to close them again. The simulator, on the contrary, 
will almost always close his fists again as soon as the extending force is 
withdraw-n. 
Henderson remarks, that “ these voluntary efforts made by the simu- 
lator are so violent as to produce perspiration, which is not the case in 
epilepsy.” This is erroneous. Toward the close of the convulsive 
stage of epilepsy, perspiration very commonly appears, and in the third 
or stage of exhaustion it is frequently profuse. 
“The true epileptic is, to the attentive observer, a man altogether 
different from any other. It is rare to perceive in him an air of cheer- 
fulness or vivacity. Nature, or rather disease, has impressed upon his 
features a character that appears to partake equally of sadness, of 
6hame, of timidity, and of stupidity, particularly if the paroxysms are 
frequent, and if the physical alteration and impression they make upon 
the features and physiognomy have not time to become effaced in the 
intervals of the paroxysms.”* 
2. Chorea; 
3. Paralysis of any portion of the boa’y; are absolute disqualifications 
in a recruit. 
Paralysis is sometimes FEIGNED. 
A careful investigation of the case should generally lead to a satis- 
factory solution of the question of the reality of the affection, though 
•vve cannot agree with Coche that “the simulation of the disease is 
simply ridiculous.” 
Paralysis of one side of the body, (hemiplegia,) we think, cannot be 
counterfeited, because the pathological condition upon which it de- 
pends will give other unmistakable indications of its existence. But 
sometimes the paralysis complained of is confined to a single limb. In 
this case the indications are not so clear; but in adults this form of the 
disease very rarely occurs. I once saw a case in a child of eleven 
years of age in which the left arm was paralyzed as a consequence of 
hooping-cough. All remedies that could be devised by myself or 
others proved ineffectual; but I believe such an affection never occurs 
suddenly, or without an ascertaining cause adequate to the produc- 
tion of the lesion of the nerves or nervous centres upon which the pa- 
ralysis must depend. The history of the case, then, and the progress of 
its accession, will determine the question. When the paralysis has 
existed for any length of time, emaciation of the affected limb will 
* Die, de Science Med. 90 
MANUAL FOE THE 
occur and assist in the solution of the doubt. Other means of detec- 
tion have been resorted to in particular cases. Powerful electric shocks 
(a proper remedy in true disease) have proved too much for the stoicism 
of the malingerer. “Mr. Hutchinson detected an imposition of this 
kind in a sailor, by administering a dose of opium to the patient, and 
then tickling his ear during sleep. To relieve the irritation the para- 
lyzed hand was instantly raised to the ear, which he rubbed with no 
small degree of force, and then turned upon his left side, dragging the 
bed-clothes over him with his heretofore useless arm.”* 
When one leg is the seat of the palsy, tickling the feet may excite 
movements of the limb, and yet the disease be real. These motions 
are automatic, and may be induced even when there is loss of sensa- 
tion as well as motion, through the influence' of reflex action. But I 
confess I should look with great suspicion upon such a case; because, 
if the paralysis depended upon spinal lesion, both limbs would proba 
bly be affected. If upon lesion of the nerves of the limb itself, reflex 
excitation would not be likely to be transmitted. 
Paraplegia is another form of paralysis that is feigned, and, when 
recent, it is very difficult of detection. Men will bear cupping, blis- 
tering, and the repeated application of the moxa in these cases without 
flinching. This has occurred more than once under my own observa- 
tion. 
Paraplegia, unless from mechanical injury to the spine, and perhaps 
from cold, never comes on suddenly. Pressure upon the chord from 
effused blood, tumors, disease or displacement of the vertebrae, or effu- 
sion of serum within the spinal canal, inflammation of the invest- 
ing membranes, or softening of the medulla, are its pathological condi- 
tions. It may be a consequence of cold, intemperance, or masturbation. 
It is to an accurate investigation of its history that the surgeon must 
resort for a sound judgment as to its reality. 
A sudden invasion of paraplegia, as we have already said, can be 
accounted for only from the infliction of mechanical injury or from 
cold. Malingerers are always, or nearly always, attacked suddenly ; 
but when the case is presented for decision, are there any signs by 
which its reality may be verified independent of its history ? Motion 
of the paralyzed extremities may be induced in real cases from excita- 
tion of afferent nerves, provided the seat of the spinal lesion is suffi- 
ciently removed from the cauda equina to leave a heaithy portion of 
* Cyclop. Practical Med. RECRUITING SERVICE. 
91 
medulla sufficient to permit a transmission of impressions. This is, 
therefore, not reliable as a positive test, but may be of value as a nega- 
tive one; for if automatic movements cannot be excited, the paraplegia 
is most probably real. 
The most reliable sign of the reality of the paraplegia at a reasonably 
early period of its existence, will be found in the character of the urine. 
In the real disease, this secretion will become ammoniacal, alkaline, 
turbid, and loaded with mucous. Watson emphatically and judicously 
says: * ‘ Do not forget the important fact that in many, nay, in most 
cases of paraplegia, the urine at length becomes 'ropy, alkaline, and 
stinking.” So important an affection cannot exist long without ex- 
hibiting signs of constitutional disturbance and suffering that will 
materially aid in the decision, and, in the course of a month or so, 
atrophy or oedema will take place in the limb. 
Imbecility and madness are absolute reasons for rejection or discharge. 
It is impossible that acute mania should escape recognition in the 
examination of a recruit. But a sufficient degree of imbecility to de- 
mand rejection, or even some forms of monomania, may elude observa- 
tion, unless the medical officer is careful to keep this fact before his 
mind during his inspection. The questions that should always be pro- 
pounded to a recruit by the surgeon, as to his age, occupation, parent- 
age, medical history, etc., combined with an attentive observation of 
the countenance, its characteristic expression, the shape of the head, 
and the like, will hardly fail to elicit some fact calculated to direct 
special attention to these forms of mental disqualification when they 
exist. 
Maniacal affections are sometimes feigned. BSgin remarks that, 
“among the characteristics of monomania and of true mania, there are 
two to which the attention of the physician should be principally di- 
rected. The first is, that aside from the subject of their delusion, 
monomanics, and most maniacs, are sufficiently rational, and answer 
questions justly proposed to them. The second consists in the almost 
absolute privation of sleep the true maniac generally experiences. Now, 
the simulator is very rarely capable of either limiting or extending 
sufficiently the field of his pretended madness, and his brain not under- 
going in reality the excitement under which that of the true maniac 
labors, he is obliged, as others are, almost at his accustomed hour, to 
yield to the demands of sleep.” Impostors are deficient in the presiding 
principle, the ruling delusion, the unfounded aversions and causeless MANUAL FOR THE 
attachments which characterize insanity. They are unable to mimic 
the solemn dignity of characteristic madness, or to recur to those 
associations that mark this disorder ; and they will want the peculiarity 
of look which so strongly impresses an experienced observer. The 
pretended monomaniac openly obtrudes his assumed delusion, and 
strives to make it square with other notions with which it has more or 
less relation. The real monomaniac, on the other hand, does not solicit 
attention, and takes no pains to reconcile his many contradictions. 
The open display and searching after effect of the one contrasts 
strongly with the reserve, the taciturnity, and the indifference of the 
other. The ungovernable fury which opposition and argument excite in 
most monomaniacs, is also a very striking character of the real affec- 
tion.”* 
“ The peculiar cast of Countenance of the imbecile is extremely diffi- 
cult to imitate. The dull, stupid, vacant, and wondering look, so 
characteristic of this state—the strange want of connection in the 
ideas—the submissive and pusillanimous behavior, with sudden and 
transient gusts of passion, are difficult to assume. In the less strongly 
marked forms of imbecility, shrewdness and stupidity are displayed, 
as it were, indifferently on all points; but, in an assumed case, the im- 
postor is shrewd on all points involving his interests or the success of 
his scheme, and displays his stupidity only in matters of indifference. 
All his conversation tends to exculpate himself; that of the real imbe- 
cile, on the contrary, tends to criminate himself.”t 
In true mania, it will be generally found that, Jn addition to the per- 
sistent wakefulness before mentioned, the patient will be obstinately 
costive, sluggishly answering to the impressions of active medicines, 
even emetics and narcotics, indifferent to the sensations of cold of 
hunger, and, in acute cases, rapidly emaciating. 
CACHECTIC DISEASES. 
1. Scrofulous Diathesis. 
Subjects of this form of cachexia caunot resist the influence of cold, 
humidity, defective nourishment, impure air, etc., in a sufficient degree 
to enable them to endure the usual vicissitudes of a soldier's life. 
When this constitution is well marked, the recruit should be rejected. 
Sometimes a scrofulous child, upon arriving at puberty, has his con- 
stitution so modified as to become quite vigorous, and though, when 
* Guy’s Med. Jurispr. tlbid. RECRUITING SERVICE. 
full grown, he may present traces of early scrofulous disease, he can- 
not be considered as other than an able-bodied effective man. But 
when we find narrow chests, flabby muscles, a dull, lifeless complex- 
ion, languid circulation, with chronic tumefaction or ulceration of the 
lymphatic glands, sometimes like a string of beads around the neck m 
the submaxillary region, or in the course of the large vessels, the man 
should be set aside as unfit for service. 
2. Scurvy. 
It is seldom that this form of cachexia presents itself to the recruiting 
officer, but it may sometimes constitute a question of discharge. When, 
from accidental circumstances, the disease has progressed so far as to 
have induced organic alterations of important viscera, or of the bones, 
discharge would be proper and necessary. A mere swelling or bleed- 
ing of the gums, or the existence of maculae upon the body or limbs, is 
not sufficient reason for either rejection or discharge. 
3 Cancer. 
“ Cancer and, a fortiori, the cancerous cachexia, which is but the re- 
petition of cancer in different parts of the body, totally disqualifies for 
the military service. To mention these facts is sufficient. They need 
no demonstration. Every one understands them, and perceives at 
once their bearing.”* 
4. Constitutional Syphilis. 
Constitutional syphilis disqualifies for the military service, and no 
recruit presenting signs of the secondary or tertiary accidents of syphilis 
should be approved. However amenable to treatment many of these 
accidents may be considered to be, it must be recollected that they 
are very liable to reappear, particularly under the unfavorable hygienic 
influences to which the soldier is exposed. 
But it is not always easy to determine whether several of the erup- 
tions that are seen upon the bodies of men are syphilitic or not. Vidal 
remarks, that “ the syphilitic eruptions present a physiognomy that 
cannot be mistaken, when the attention has once been fixed upon them 
This physiognomy consists in the color, form, chronicity, and marks 
which they leave behind.” He says, “ the color of these eruptions— 
*Aide Memoire 94 
MANUAL FOR THE 
the ham color of Fallopius, the copper color of Swediaur—has always 
arrested the attention of observers, and that it is still regarded as the 
most characteristic feature, that on which the differential diagnosis of 
these eruptions is based, that which distinguishes them from simple 
eruptions, or those of any other nature.”* 
Erasmus Wilson, however, says that “ reddish brown" is the true 
color of these eruptions, and that the copper color is the sign of their 
declining stage. The copper-colored eruption will most frequently 
present itself to the inspecting surgeon for obvious reasons; but the 
color of the earlier stages of these “ syphilitics" should be borne in mind. 
Cicatrices.—“The cicatrices left by syphilitic eruptions generally 
present the following characters: They are circular and more or less 
depressed. When recent, they have a brown color, and sometimes 
their tissue is slightly prominent. Beneath the epidermis we see the 
superficial vessels slightly broken. At a later period these become 
effaced, and a kind of internal absorption seems to be established. 
They lose their violet tints, become white and more depressed. Their 
surface, of a dull white color, is also tense or corrugated, shining or 
swollen, and sometimes furrowed with hard and prominent bands. 
Under certain circumstances they are white from the first, but of a 
bluish white. They are then surrounded by a coppery areola, which 
tends constantly to diminish, and the color of which is gradually lost in 
the surrounding skin.”t 
Cicatrices of buboes that have suppurated are no indication of con- 
stitutional syphilis. Taken alone, indeed, according to Eicord, they ex- 
clude the idea of constitutional taint. Whether this opinion be true or 
not, such cicatrices do not justify rejection. 
The other syphilitic accidents that indicate important constitutional 
infection, are principally certain forms of alopecia, distinct from the 
senile, caries of the bones, ulceration of the mucous membrane of the 
nose, throat, and anus, mucous tubercles, exostosis, periostosis, the 
venereal testicle, and iritis. These are enumerated that the inspecting 
surgeon may keep them in mind while conducting his examination. 
We do not consider the primitive accidents of syphilis as any insu- 
perable objection to a recruit. Were the man otherwise decidedly eli- 
gible, we should not reject him on this account. 
A simple recent gonorrhoea or balanitis is no objection to an other- 
wise good recruit; but repeated attacks of gonorrhoea, besides implying 
* Blackman’s Vidal. f Ibid. RECRUITING SERVICE. 
95 
a degraded moral sense, sometimes result in induration and contraction 
of the corpus spongiosum, rendering erections painful, and exposing 
the man to serious inconvenience from the irritation excited in march- 
ing, riding, &c. We have seen instances of this kind, and consider 
them as decided objections to the recruit. 
5. Chronic and Incurable Diseases of the Skin. 
We have already spoken of some of these affections as existing in 
particular regions, such as tinea capitis, &c. It would be impractica- 
ble in such a work as this to enumerate all the chronic cutaneous dis- 
eases that disqualify a recruit. We can only say, in general terms, 
that “chronic cutaneous diseases of a specific character, such as imply a 
constitutional taint, or such as are chiefly marked by chronic inflamma- 
tion of the vessels secreting the cuticle, producing morbid growth of 
this structure, and generally dependent upon debility of the system,”* 
are insuperable'objections to a recruit—such, for instance, as the vari- 
ous forms of lepra, elephantiasis, psoriasis, (palmaris, inveterata, and 
diffusa.) 
Itch may be so inveterate, as to demand not only rejection, but dis- 
charge. “When it has altered the constitution, and has assumed the 
aspect of an herpetic affection, as sometimes happens, it constitutes a 
case for exemption or discharge. Experience has in fact shown that it 
then resists with obstinacy the action of all therapeutic means.”! 
As a general rule a recruit, the subject of itch, should be rejected, 
that so disgusting a disease should not be propagated in barracks ; but 
if circumstances should admit of the complete isolation of the man 
during the cure of the disease, and he is in other respects decidedly eli- 
gible, this rule may be departed from. 
6. Feebleness of Constitution. 
“It is impossible, in our opinion, to convey the idea we wish to ex- 
press in any other language. There is no disease—to all appearance 
there is nothing more than defective development of organization. 
Nevertheless, several writers, and among them M. Coche, entertain a 
different opinion. They insist that a man should neither be exempted 
nor discharged for feebleness of constitution. One must, according to 
them, be able to recognize and point out some special disease. It is 
* Plumbe, or Diseases of Skin. t Aide Memoire. 96 
MANUAL FOB THE 
necessary, in short, that there be, in the case under consideration, 
some affection of one of the principal viscera enclosed in the splanchnic 
cavities. But it is evident that this mode of reasoning is quite errone- 
ous. In fact, let any one examine the class of subjects of which we 
are speaking, and he will find in them every organ sound and without 
any lesion. There is simply feeble development, and the play of the 
functions responds to the weakness of the mechanism. Thus it is that 
the stomach can bear only a certain kind of nourishment; the pulsa- 
tions of the heart are feeble ; the lungs furnish but a slight' animalized 
haematosis. These men partake more or less of the constitution of a 
woman, as well in the development of their organs as in the resultants 
of the functions. There is about them no particular disease or patho- 
logical condition; there is simply a less active vitality—a mode of ex- 
istence not in harmony with their sex. But it is in vain to examine, 
to feel of them. We find sound organs, though but feebly developed— 
an arrest of development—a feebleness of constitution, which is a suffi- 
cient reason for their exclusion from the military service.”* 
We frequently see men wThose constitutions may or may not have 
been originally feeble, but who, from unfavorable hygienic circum- 
stances, have aggravated or acquired this feebleness, debility, or general 
unfitness. There is partial or general emaciation, mental sluggishness, 
a listless air, a torpor of all the faculties, absence of activity, indiffer- 
ence to all their surroundings. Too lazy or too feeble to wrork, they 
seek the service as an asylum only, without the least notion of ever 
performing their duties. Such men are cases for absolute rejection. 
We have now concluded the subject proposed in this chapter, and it 
is believed every important defect ordinarily met with has been noticed, 
and its value as a disqualifying sign determined as accurately as the 
nature of the subject will admit. Of course other deviations from the 
normal standard than those to be found in these pages will sometimes 
he met with. The varieties of lesions to which the body is liable are 
too multiform to make a perfect catalogue of them a possible thing. 
But we believe that very few cases are likely to occur that will not 
find their analogues in the foregoing list, and that may not be fairly 
decided upon the principles therein enunciated. If, however, such 
* Aide Memo ire. 97 
RECRUITING SERVICE. 
cases should present themselves, and the examining surgeon is of 
opinion that the defect may, by any possibility, under any circum- 
stances, interfere with the perfect use of either faculty or limb, his duty 
will be to reject the man. 
In addition to the cause of rejection we have pointed out, one re- 
mains to be mentioned, viz: brands, with indelible ink or hot iron on 
any part of the person. 
Deserters and drunkards are frequently branded with the letter “ D,” 
or, in the case of the latter, with the letters “HD," in indelible ink, 
usually upon the left hip, sometimes elsewhere. In the British service 
the letter is sometimes placed upon the side of the thorax, under the 
arm. We have known deserters, in very aggravated cases, branded 
with the letter “ D” with a hot iron upon the cheek. Wherever this 
brand may be found, or with whatever instrument it may have been 
affixed, rejection is absolute. 
When men have been thus marked, they frequently resort to very in- 
genious devices to conceal it Elaborate designs, with various colored 
inks, to include the letter, are imprinted upon the person by some clever 
artist, and so well executed as etfectually to hide the brand, unless they 
are very carefully scrutinized. It is, however, difficult, if not impossible, 
to obtain an ink of precisely the same shade as that used in the brand, 
and thus a minute inspection reveals the trick. Whenever, therefore, 
these designs are observed upon the person of a recruit, a careful ex- 
amination should be made to ascertain if the letter “ D” is not enclosed 
within them. It will be well, in cases of apparent branding, to try if 
the ink cannot be washed off. A man may sometimes mark himself in 
this way with common ink, between his inspection at a rendezvous 
and that at a depot or regiment, with a view to be rejected. 
Mode of Examining a Recruit. 
The room in which the examination is conducted should be well 
lighted, and large enough to admit of the men being walked about 
freely, that every organ concerned in locomotion may be subjected to 
inspection. For obvious reasons, none others than they whose presence 
is absolutely required should be admitted to the room. 
The person of the recruit should be washed clean before he is pre- 
sented to the surgeon for inspection. It is impossible for the medical 
officer to ascertain the existence of certain defects that absolutely dis- 98 
MANUAL FOR THE 
qualify, when concealed, as they effectually may be, and sometimes 
are, by incrustations of filth a month old. 
We have remarked that certain defects can be ascertained only by 
questioning the man himself; and that, in order to avoid all subsequent 
evasions, the answers to these questions should be recorded on the 
spot. We shall now suggest a method of effecting this object, as well 
as of making it sure that no important part shall escape inspection 
through any slip of the memory. 
The following printed form is to be furnished, upon which the ob- 
servations of the inspecting surgeon are to be recorded as they are 
made: 
Recruit A. B. 
Age years 
Occupation . 
Bom in . 
Presented by . - * 
1. Have you ever been sick ? 
When and of what diseases ? 
2. Have you any disease now ? (such as as diarrhoea, cough, and 
the like.) 
3. Have you ever had fits ? 
4. Have you ever received an injury or wound upon the head ? 
5. Have you ever had a fracture, a dislocation, or a sprain ? 
6. Are you in the habit of drinking ? Or have you ever had the 
“ horrors ?” 
7. Are you subject to the piles? 
8. Have you any difficulty in urinating ? 
9. Have you been vaccinated ? or had the small-pox ? 
Head: 
Ears: 
Face: 
Eyes and appendages: 
Nose: 
Organs of mastication and voice : 
Neck: 
Chest: 
Abdomen: 
Genital and urinary organs: RECRUITING SERVICE. 
99 
Vertebral column: 
Superior extremities: 
Inferior extremities: 
Remarks 
(Approved or rejected, as the case may be.) 
Date . 
Rendezvous —. 
Inspecting Surgeon. 
The questions should be asked and the man’s answers recorded be- 
fore he is stripped. 
He is then to be divested of all his clothing, and the examination 
proceeded with systematically, in the order of regions, as indicated in 
the “ Form.” 
The surgeon is to note every peculiarity or deviation from the normal 
standard in each particular region. For example : if the man has re- 
ceived at any time a blow upon the head a resulting cicatrix or 
slight depression, let it be noted thus : “ Cicatrix and slight depression 
upon the right parietal protuberance.” 
Scars upon any part of the person should be noted, and the cause 
assigned by the man recorded. It is not uncommon to find marks 
of free cupping upon the chests of Germans, without there being any 
indication of disease. These, however, should be noted. 
If, upon inspection, the man be found to have a cirsocele, though not 
sufficient to disqualify, let it be noted under the proper head; and so of 
haemorrhoids or any other affection. The vaccine scar and its position 
should be noted, and whether vaccination has been practiced at the 
rendezvous or depot. 
Under the head of “Kemarks,” constitutional syphilis or other ca- 
chexise will find a plhce. If an interpreter is required during the 
inspection, that fact should be recorded. Men sometimes speak English 
very well when first examined, who, from after considerations, are 
entirely ignorant of the language when re-examined, and sometimes 
succeed in obtaining a discharge in this way. 
By this means an accurate description of the whole person is ob- 
tained sufficient to settle questions of identity, should such be subse- 
quently raised; and if there be any defects about which a difference of 100 
opinion may exist, the fact that such defects were not overlooked by 
the first inspecting surgeon will be apparent. 
It will frequently happen that an “absolute disqualification” will be 
discovered before completing the examination. Such a defect may be 
detected at any stage of the inspection. In such cases, it will of course 
be unnecessary to proceed any further. 
The above Form when filled up, should be sent with the recruit to 
the depot, where he is to be finally inspected, and thence transmitted to 
the regiment to which he may be assigned. 
Defects discovered at the depot upon reinspeetion should be indorsed 
upon the Form and signed by the surgeon In case of rejection, the 
document thus completed should be transmitted, with the proceedings 
of the Board of.Inspection, to the headquarters of the army. 
MANUAL FOR THE