212 surgeons' reports — Massachusetts — sixth district. 



Loss of IcctJi. — Reference having aliendy heeii niacle to the fact that Americans snffor from 

 caries and couseijiient loss of tlie teeth earlier in life and to a greater degree than Europeans, and 

 a possible cause assigned therefor, no further comment is needed. That 48.7 ]ier 1,000 of the 

 enrolled population, otherwise able-bodied, should be found unfitted for military duty on account 

 of this disqualification, must certainly be regarded as a national calamity, the more so from the 

 irremediable nature ol fhe difficulty. 



Hernia. — 45.3 per 1,000 suffered fiom this inlirmitj'. A large proportion of the enrolled popu- 

 lation are, or have at some period in their lives been, engaged in laborious avocations iu which 

 there is a liability to contract hernia. * * * 



Shoemakers occupy the front rank. It must not, however, be too hastily inferred that the 

 occupation of shoemaking tends to produce hernia. Among the men examined, shoemakers were 

 much more largely represented than any other class of mechanics. As I learned by inquiry, a very 

 large proportion had formerly been otherwise employed, often in very laborious callings, iu w'hich 

 hernia was coutracted, and in consequence of which they were compelled to seek other employ- 

 ments. The same statement is applicable to clerks and other persons engaged in sedentary occu- 

 pations not requiring muscular exertion. In fact, the choice of such occui)afion in individual cases 

 may often have been determined by the existence of hernia. Hence no reliable deduction can be 

 drawn from the frequency of hernia occurring in those who follow a ])articnlar occtupation, except 

 the general one, that occui)ations which rc(juire lifting and straining are most liafile to cause this 

 disability. 



FeMcness of constitution, natural or acquired; general debility; permanent phusical disabiUt!/, 

 d'c. — 45.3 per 1,000 were rejected on ac^count of the above-named causes. In a region where con- 

 sumption, scrofula, and kindred diseases are rife, it must be expected that an indiscrimin:ite 

 enrollment will include many persons naturally of delicate and feeble constitution, and. therefore, 

 unfitted to endure the fatigues and hardships incident to military service. In every community, as 

 I have before observed, there will be found a class of persons who enjoy a species of health with- 

 out being able-bodied, but who are not more cakuilated to do good service in the field than sapling 

 pines for the ribs of a seventy-four. Others, originally robust, become debilitated from intemj)er- 

 ance, solitary vice, sedentary or unhealthy occupations, or from theefl'ects of wasting or protracted 

 disease, and are conse(]neutly unfitted for hard labor in or out of the army. To put such persons 

 into the ranks would be to impose a burden upon the Government, and to inflict cruelty and 

 injustice upon them. 



Diseases of the heart. — Diseases of the heart figure largely in the list of infirmities, for which 

 certificates of exemption were issued at this office; 37.6 per 1,000 of exemptions ou account of 

 permanent physical disability having been granted under this head. The number being so large, 

 a sus|>icion may arise as to the correctness of the diagnosis. It may be proper, therefore, to state 

 that the examinations in all these cases were very carefully made. Tiiose whicli seemed doubtful 

 were referred to the most reliable auscultators in the vicinity, and their opinions carefully com- 

 pared with my own, previously recorded. 



Subsequently to the first draft, it became my duty to re-examine, with reference to striking 

 their names from the lists, a majority of the drafted men examined thereunder, ou account of dis- 

 eased hearts. A good opi)ortunity was thus afforded for correcting or confirming my previous 

 diagnosis, with this result, that the parties re-examined were almost without exception drop])ed 

 from the enrollment. In the majority of such cases, altliough the [)hysical signs of disea.sed heart 

 were strongly marked, the constitutional .symptoms were not severe ; in others, the countenance was 

 strikingly expressive of organic disease, and the muscular system of the sufferei-s was weak and 

 flabby. Several of the parties exemi)ted deceased suddeuly before the term of n:y official service 

 had expired. 



The frequency of diseases of the heart in this district admits I thiidc of easy and satisfactory 

 explanation, arising, in my judgment, from the following causes: 1st. The prevalence of acute 

 rheumatism, and the frequency with which that disorder attacks and irreparably injures the val- 

 vular apiiaiatus of the heart; 2d. The mechanical and manufacturing interests largely predomi- 

 nating in the district, and affording a variety of what are termed "light" occupations, persons 

 prevented by diseased heart from earning a livelihood at hard labor naturally flock hither in search 



