248 surgeons' reports — new york — eighth district. 



excessive aucl long-coutiiiued irritation ; it is said to bo cotuuion iu artilleryuieu, from tlie firing of 

 heavy cannon. It often conies on gradually ami spontaneously. * * * 



Personal deformity is often congenital, the result of accidental injury, and oftenest, as in caries 

 and curvature of spine and other bones, the result of a scrofulous cachexia, [rachitis and osteo- 

 malacia.) The same may be probably affirmed of 2)htMsis puhnonalis, andof thej;%6ic«i clisabiUfy, 

 to be hereafter alluded to, associated with simple (or compound) hypertrophy of the heart, with 

 tendency to haemoptysis, which constitutes, in my experience, a frequent cause for exemption and 

 rejection, as disqualifying from the fatigues and exposures of a military life. * « * 



Paragraph 85, as a whole, appears to me compreheDsive and ably and accurately constructed. 

 Iu spite, however, of the clearness of expression and definition which pervades it, there is still, 

 and there must be, much left to the judgment of the surgeon. His duties are twofold : to himself, 

 as a conscientious man and as desirous of being just to the applicant for examination ; and to the 

 country which employs and confides iu him. 



It was not my lot to hold to service any drafted man ; but in examiniug men prior to the draft, 

 and with a view to their being removed from, or retained upon, the enrollment-list, I never knew 

 what amonut of responsibility I should incur iu case any of those refused exemption, and held by 

 me to service should, on subsequent reexamination at headquarters, be deemed unfit for service ; 

 and I tkinlc this should he explained. In a circular I received, I was told that my decision was 

 " final ;" I do not perfectly understand the meaning of this, further than that if I refuse a drafted 

 man exemption, he must be enlisted, equipped, and sent forward. But what responsibility do I 

 incur if that man, whom, in the exercise of my best judgment, I have held to service, be rejected 

 as unfit fty oi/iers— possibly less qualified than I am myself to decide 1 Do the same rules apply as 

 in the enlistment of a recruit? 



Another circular informs me that " ttiere must be no doubt existing as to a man's total unfitness 

 for military service." ShoiM it not sny, of any Icind? No language could then be stronger. * * * 

 The difiQculty seems to me to be to exempt a man at all, unless for some palpable and indis- 

 putable disqualification, as blindness, lameness, deafness, or the like. Many apply in person to the 

 surgeon, who, in many respects, yet not in all, come under sections .|J and 9 ; ailing men, yet not 

 totally incapacitated for some kind of military service, say of the Invalid Corps. These men, if held, 

 would make very poor soldiers, and might ultimately be discharged ; if refused exemption, they 

 would, many of them, procure substitutes. What is the responsibility incurred by holding them? 

 The difQculty consists in the question of the totality of the incapacitation. Who, in reading sections 

 5, 8, 9, and 10, and comparing them with the men before him, shall be able to decide upon the 

 exact amount of disease under either which totally incapacitates ? What two medical men would 

 agree upon this point in some cases'? This must, then, it seems to me, be left to the judgment of 

 the examining-surgeon, who is cautioned, however, in regard to section 9, not to abuse his privilege. 

 For myself, I can only say that a clearer understanding on this head would be more satisfactory. 

 Whether I .should have held more, or refused more, 1 cannot now determine. 



The words ^^ equally lahorious occupation,''^ in section 5, if read to the applicant, instantly sug- 

 gests to him a doubt whether there can be any duties equally laborious as the military, which he 

 so eagerly endeavors to avoid. 



Section 3. Epilepsy. Many have epileptic fits who do not see a physician within six months. 

 I suggest that in such cases other testimony sufdce, if reliable. 



Section 5. Many men, oftenest young ones, present themselves, bringing certificates of the 

 existence oi phthisis iu their cases from their family-physician; they speak of repeated hemoptysis, 

 cough, sense of fatigue, shortness of breath, emaciation, «S:c., and the subjects are deemed, perhaps 

 justly, to be incapable of active military service. In such cases, the lungs are often sound, the 

 heart is simply hypertrophied, its apex striking one or two inches below the proper spot, and its 

 pulsations, on exercise, plainly visible and audible all over the prjecordium. Few of these persons 

 can i)ursue any very laborious occupations, and they present an amount of " permanent physical 

 disability" which, when well marked, should, iu my opinion, more than most other ailments, dis- 

 quali y the drafted man or recruit from service, and exempt the enrolled. 



Section 6. If, as I suppose, section 6 refers to phthisis pulmonalis, rather than to any other 



