NOMKNCLATUKK OF DISEA.sr,.S. 



expressious as "disease of the heart," "disease of the hings," "disease of the liver," 

 are specimens of the mode of reporting canses of exemption in man}- instances. A 

 careful examination of this class of returns, and some necessary correspondence relat- 

 ing- to them, made it evident tliat they were capable of being assigned to the two 

 groups of acute and chronic diseases of the organ. There still remained, however, a 

 small number of cases in which, although organic disease was in some manner indi- 

 cated, the ])articular organ affected had not been specified. Under the heading 

 " Unclassified " these form a group described as " Organic disease of internal organs." 

 Their number is only 183; but a French critic, unaware of the explanation just given, 

 has especially connnented upon this portion of our nomenclature in an article marked 

 by much ability but containing some errors and misapprehensions.' 



' I.c rccriitemciit (Imis Varmie fvclcraJe cics Jitnis- Viiis, ^iciidnnt la guerrv lie secession, par M. Ely, midedv-mppr dc Iro 

 rhissc. Ri'cneil de M(?iq. do iij^tlicino, (lu obirurgie et de i)l)aiiii:uie iiiilitaires, 3iiie scrie, tome xxii, p. 1, Paris, lHti9. 

 This article consibts of a review cf the "Final Eejiort of the Provost-Mart^hal-Geiieral," printed in ISfifi, and which, it 

 will be remembered, contained the first part of the statistical tables of which the present work forms the completion. 

 JI. Ely conmieuts with emphasis n|)on the harshness and severity that mnst have resulted from the enforcement of 

 tile rules as to exiniplion for physical disability, '• under which," he says, " the American surgeons were compelled to 

 leave none outside the ranks of the Army but men afflicted with incurable disease. Those whose maladies were suscep- 

 tible of cure might seek that cure in the tield. Men blind in the left eje, or in the first stage of phthisis; those snifer- 

 ing from osseous caries which happened to be stationary ; with unconipliealed anal fistula, or external hasmorrhoids, 

 and the like, were considered to be fit for service, as well as all those who were sutfering from diabetes, albuminuria, 

 &c., whose diseases had not as yet made them absolute invalids. The iujuuclions are formal, and the selected phrases are 

 underlined aud reiterated, such as manifest, r/rare, evident, or estahlished iucapacity." The writer also expresses his sur- 

 prise that myopia should not exempt, aud that liability to hernia from relaxatioi of the inguinal ring should not be 

 regarded as disqualifying. He proceeds to point out the different spirit of the French and English regulations, ucder 

 which it is the object of the surgeon to exclude from the army men even threatened with disease. Divested of their 

 rhetorical exaggeration, there is still some justice in these criticisms. The chief medical officer of the Bureau strongly 

 advised the making of certain alterations in the list of disqualifications, and among them the very obvious ones alluded 

 to by M. Ely. The pressure of ])ublic liusinoss, and other reasons not now needful to be detailed, retarded the design 

 until the collapse of the rebellion made it no longer necessary. Some of M. Ely's objections proceed from incorrect 

 translation, as where he supposes '-well-established recent insanity, with a liability to recurrence," to mean a case 

 where the service has recourse upon the man in the future. The emphatic terms, also, whose frequent use he criticises, 

 by no means apply always to the disease but more often to the proof of its existence : thus, in the case just alluded to, the 

 expression " well-estahlislied" refers to the evidence that insanity did recently exist, aud not, as M. Ely supposes, to the 

 degree of development of the disorder. 



M. Ely more than once expresses his astonishment that the use of anieslhetics should be allowed in cases of snj)- 

 posed simulation of disease. Yet the French code expressly permits their employment upon the soldier in hospital 

 who may be suspected of feigning disability for the purpose of obtaining a discharge.['] The drafted man was, with us, 

 held to be actually in the service from the moment the lot fell to his name ; if a disqualification were found to exist, it. 

 entitled him to his discharge, aud there seems to be no reason why ,a soldier, owing his whole period of service to the 

 Government, should not he subjected to the same scrutiny as he from whom a leniaiuder only is due. M. Ely errs in 

 stating that anaesthesia was eounuonly resorted to in the examinations; its aid was allowed only in cases of professefl 

 rheumatic contraction of joints when unattended with perceptible alteration of form or structure. As a matter of fact, 

 however, the length of time required in the process, especially for the applicatiim of iether, rendered the permission 

 nugatory when from forty to sixty men had to be examined each day. 



M. Ely asserts that the exigence with which men even partially diseased were compelled to take their places in 

 the ranks deprives the statistics of all value as regards the number of those exempted in relation to the population. 

 The inference which he wi.shes to make is, doubtless, that the figures representing the military aptitude of the nation, 

 if drawn therefrom, would be unreliable. To this it may be replied, generally, that the facts do not warrant his con- 

 clusions. It is true that the rulings of the medical instructions were curtly worded, but the examining surgeons were 

 men, selected for their experience and ability, who knew well that the object of the Government was to obtain men 

 able to endure the hardships of a jirolonged campaign, and that the degree of incapacity atteudaut upon any disorder 

 was left to their judgiuenf. They also knew that each recruit would ho rigorously re-examined at the camp of rendez- 

 vous by the surgeon in charge, and that if considered uutit for service he would be returned to his district with a repri- 

 mand, implied or expressed, to the medical officer who had approved him. That certain defects were not to be looked 

 upon as canses tor exenijition was, as already stated, a matter of regret ; but it is also true that these were mostly 

 defects of function, congenital or acquired, and not disabilities arising from disease. 



V ; 



['] Instruction pour scrvir dc fjuide aux orders de sante, &.C., p. 24, folio, I'uris, 1862. 



