296 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 



highly approved by Major General Gorgas, then Surgeon General, 

 and later by his successor, Major General Ireland. Prior to being 

 issued it had been submitted for revision to two of our most 

 eminent internists, Professor William P. Thayer and the late 

 Professor Theodore C. Janeway, both of Johns Hopkins Univer- 

 sity, but these authorities found only some slight changes to rec- 

 ommend and returned it to the Surgeon General's office with their 

 absolute approval. Its purpose was to standardize the methods of 

 examination in order to secure uniformity in the rejection or 

 acceptance of doubtful cases of tuberculosis. Bushnell well said : 



"Military examinations must differ from those in civil life in three respects: 

 (i) The statements of the men examined could not be taken at their face 

 value; the examinations must, therefore, be based on objective facts. (2) 

 Besides the interests of the individual, only considered usually in civil practice, 

 there must be borne in mind the interests of the Government. It was im- 

 portant, above all things, to obtain soldiers; men must, therefore, not be re- 

 jected on doubtful indications -the diagnosis upon which rejection was based 

 must be based upon positive, distinctly marked signs and symptoms. (3) 

 The examinations must be rapidly performed in order to clear the army of the 

 unfit at an early date for the army's sake, and examinations must be early to 

 prevent claims that the disabilities found had been incurred in line of duty 

 this for the sake of the taxpayer." 



Because of the scientific, practical, economic, historical, and 

 above all patriotic value of this circular, it will be well worth 

 while to reproduce here the essential parts of it. The circular was 

 issued on June 13, 1917, for the information of the medical officers 

 to be used in connection with examinations for pulmonary tubercu- 

 losis in military service: 



"The duties of the examiner are: 



" i. To exclude cases of manifest tuberculosis from the army. 



"2. To hold to service men who allege tuberculosis as a ground for exemp- 

 tion or discharge on the basis of insufficient or incorrectly interpreted signs 

 and symptoms. 



"3. To determine in the case of soldiers accepted for the military service 

 the existence of pulmonary tuberculosis, and to decide whether or not the 

 disease has been incurred in the line of duty." 



"The following signs will not be regarded as evidence of pulmonary disease 

 in the absence of other signs in the same portion of the lungs: 



"i. Slightly harsh breathing, slightly prolonged expiration over the right 



