COLONEL GEORGE E. BUSHNELL, M.C., U.S.A. 299 



larger lesion and less immunity than 5. 7. More or less widely diffused spots, 

 lines, and streaks through a considerable portion of the lower lobe approaching 

 periphery of lung, with few or no auscultatory signs deep peribronchial 

 tuberculosis. 8. More extensive streaked opacities involving greater part 

 of one or both lungs and extending to periphery with few or many physical 

 signs -fibrocaseous tuberculosis, fibrosis preponderating in proportion to 

 scantiness of more or less rounded spots or dots. 



"Conditions as shown by i, 2, 3, 4, and 6(a) are not causes for rejection. 

 Cases under 5 are to be determined by physical examination. Cases under 

 6(6), 7, and 8 are to be rejected." 



Concerning the reception of this circular by the examiners of 

 the army, Colonel Bushnell said in an address, delivered before the 

 National Tuberculosis Association on March 6, 1918: 



"These were novel ideas for our examiners, but they grasped them soon and 

 carried them out loyally. The attempt to standardize indications was per- 

 haps a bold one. Naturally, the ideas advanced in Circular No. 20, though 

 before its publication it had received the approval of some of the leading in- 

 ternists in the country, did not fail to arouse some opposition, which cannot be 

 said to be overcome even now. Almost any statement concerning a disease 

 with regard to which such divergent views are held, as is the case with tubercu- 

 losis, will meet with some dissenters. Still I think it may be said that, though 

 imperfect, a standard is better than no standard, under the conditions of this 

 examination." 



It was the writer's privilege to see the methods of examination 

 indicated in Circular No. 20 put into practice at Camp Platts- 

 burg, and it was indeed astonishing to see how much could be 

 accomplished and how reasonably sure one could be of not having 

 made a serious mistake by following the directions given by order 

 of the Surgeon General through Colonel Bushnell. The following 

 figures certainly will give food for thought: During the mobiliza- 

 tion period of the war in 1917-1918 the draft boards rejected 

 62,000 men because of tuberculosis. The examinations, as a rule, 

 were made by civilian practitioners. All men sent to camps and 

 cantonments as fit for military service and free from tuberculosis 

 were again examined by military surgeons according to the indi- 

 cations in Circular No. 20, and as a result 25,000 more were re- 

 jected on account of tuberculosis, which had escaped the exami- 

 ners at the draft boards. 



Colonel Bushnell's activity while at the head of the tuberculosis 



