surgeons' reports MARYLAND SECOND DISTRICT. 349 



trouble, wlio scarcely know they had a heart, and who followed their daily occupations. Men 

 ciaJMiiii^ exemption from lieiirt-disease as tlieir cliieC j-iound were mostly suffering from functional 

 derangement, llysteria simulates all diseases; the heart simulates almost all the symptoms of 

 organic disease. Such cases might be termed " hysteria ot the heart." 



Physical disability Is not necessarily permanent ; when believed i)ennanent, it shoidd be so 

 designated. When a man is inciapacitated by recent disease, it should be marked " physical disa- 

 bility ;" if marked "permanent," the man's name shouldbe erased from the enrollment list. 



Teeth. — When the surgeon is satisfied that a man's teeth are so decayed as to reiuh-r him 

 incai)able of masticating his food, he should be discharged, as a mouth in sncli condition indicates 

 feebleness of constitution. The teeth in the upper jaw decay before those ot tlie lower jaw. 



Hcemorrhoids. — Old and irreducible external hieuiorrhoids unfit a man for any active employ- 

 ment. In such cases, some discretion should be allowed the sui-geon. 



Rheumatism. — Rheumatism often aliects the lumbar region and the sacrosciatic nerves, there 

 being na manifest evidence of the disease; there is, however, a radical physical defect. In such 

 cases, when i\n? proof is satisfactory that the man has been subject to these attacks, and has had 

 one within the last three months, which attack incapacitated him for days or weeks from following 

 his daily occupation, and had been brought on by undue exertion or exposure, he should be exempt. 

 Frecjuent attacks of acute rheumatism should not be disregarded, these attacks so frequently 

 involving the heart. 



Hernia. — Umbilical hernia is more frequent in the colored than in the white race. I have iiot 

 met a large nor a strangnlated umbilicial hernia in the male, althongh a man may have been a 

 laborer all his life, and have had Uiiibilical hernia. These hernias remain stationary, and are i)rob- 

 ably owing to a want of care in adjusting the umbilical bandage after birth. * * # 



Fifty men can be physically examined daily ; with this number, justice is more certainly done 

 to both Government and peo])le. 



Generally, there is uotiiing left undone on the part of the drafted man to deceive the surgeon. 

 The substitute will bear a great amount of temporary pain to get into the service. Chronic I'heu- 

 matism, consumption, and heart disease are most frequently claimed as grounds of exemption. Fee- 

 bleness of constitution is the nest most common plea. It has always been characteristic of con- 

 sumption that the patient could not be persuaded that he had the disease; when drafted, it was 

 impossible to persuade that consumi)tion was not present. " Like one of old, they could die in their 

 nest, but not in the tented field." When consumption was made the plea, it was considered as 

 almost conclusive of attempted fraud. Dr. Rush said only two classes admitted the presence of 

 the disease — the one was sailors, the other christians indeed. None of our cases were sailors; 

 if of the latter class, society is more christianized than is generally believed. 



Sciatica or lumbago were often used as a means to obtain a discharge, and such cases 

 were pressed with great earnestness. To do justice in these cases, it was often necessary to 

 examine witnesses, and scrutinize the testimony very carefully to prevent fraud. Drafted and 

 enrolled men seeking to escape usually come prepared with medical affidavits, certifying to 

 their diseased condition and total unfitness for military service. On ai)plication for these 

 certificates, questions no doubt would be asked by the physician about the disease and its symp- 

 toms, and, apt to learn what might greatly aid them in their designs, they became somewhat 

 acquainted with the symptoms and locality of the disease they wished to simulate. It is often 

 extremely ditHcult to diagnose disease with the patient honestly assisting you ; far more so when 

 the jtatient is designedly leading you into error, assisted, perhaps unwillingly, by his physician in the 

 contemplated fraud. If unsuccessful in his efforts, fault is found by the man and his fiiends with 

 the physician who gave the affidavit which was to bring success ; but all unite in abusing the 

 examining-surgeon. Frequently written complaints were made to the Secretary of War against 

 the surgeon, sustained by additional medical testimony as to the man's total unfitness for military 

 service. It is unpleasant to say, but it is nevertheless true, that these medical affidavits added gen- 

 erally very much to the labors and trouble of the examining-surgeon, and yielded very little aid 

 in his arduous and thankless duties. Substitute-brokers soon became familiar with disqualifying 

 causes, and instructed their men how to conceal (if iiossible) every cause of rejection. 



