376 surgeons' keports — Kentucky — sixth district. 



exempted? I have said " No" in luy ofiicial action, although tubercles evidently existed. Is the 

 commencing stage of softening what is meant "? or is it something between this and the tirst devel- 

 opment of crude tubercle? Only wbere the rational corresponded with the physical signs have I 

 exempted men for this disease. There should, however, as I believe, be a more accurate definition 

 of what is meant by the phraseology of the section. 



Section 11. Men with rhenmatism of long standing, the facts in each case made out in the clear- 

 est and established in the most satisfactory manner, have frequently come before me, in whom there] 

 was no " change of structure." The diathesis was so strong and overwhelming that the men were 

 snffering all the time ; they could not labor and had not for years, yet nutrition was good and 

 they looked well. "Though knowing theai to be worthless for any military purpose whatever, I could 

 not exempt them under this section, and they have been compelled either to pay the commutation 

 or to furnish substitutes. 



Section 20. This requires that twelrc teeth shall be toialli/ lost in either the uiiper or lower jaw be- 

 fore a jnan can be exempted for loss of teeth ; but he may only have eleven of the specified num- 

 ber out, and two or three of the back molars gone, or all the molars, front teeth, canines, and one 

 or more of the bicuspids may be missing; or he may have all the molars in both jaws out, and only 

 three, four, or five straggling teeth of all the remainder left, which do not come into apposition when 

 the mouth is closed. In such cases, and they are drawn from nature — from what I have seen — the 

 men cannot be exempted as the section now stands; but how can such mouths tear a cartridge or 

 masticate solid food? 



Section 22. Men are so dissatisiied who have curved spines, for which they are not exempted, that 

 I think what is meant by " excessive curvature" should be defined as nearly as possible by measure- 

 ment, to save the surgeon from undeserved ill-will, hatred, and abuse, and the board from being 

 regarded as a set of barbarous military tyrants. Besides, it is very hard to tell what is " sufficient 

 to prevent the carrying of arms and military equipments" in the cases of nnicillinrimen. The con- 

 struction of what is "excessive curvature of the spine" is regarded as wholly and purely nothing 

 but the opinion of the surgeon; but if a standard of measurement could be laid down, the judg- 

 ments of men, when exemption is refused in such cases, would be different, and the decision of the 

 surgeon and board would be satisfactory. 



If " caries of the spine, ribs, or sternum " is or ean be positireJii made out, whether "attended 

 with ulceration" or not, is not such a man of no military value whatever? 



Section 23. Hernia. — The surgeon should be allowed some discretion upon this subject. That 

 large numbers of men with hernia can perform good military service I am fully convinced. 1 

 have seen many men with small hernias who labored hard every day throughout the year, who 

 never suffered from them, never used trusses, and never believed there was anything the matter 

 with them until they were drafted. I have also seen men who had hernia when they went into the 

 service, who had fought and marched for three years without ever being in a hospital. They have 

 told me that they never suffered from their ruptures when marching or at any other time. If no 

 discrimination can be judiciously allowed, then such men should be held to guard fortifications, &c.; 

 otherwise many valuable soldiers, or men that would become such, are lost to the service entirely. 



Section 2o. I have seen men with external haemorrhoids who could walk only with difficulty, 

 and who could do no labor requiring considerable exercise. The parts were large, thickened, and 

 ulcerated, and the disease had been standing for years. Are such men of any use to the service? 



Section 29. It is more than questionable whether a man with an enormous varicocele can per- 

 form military duty or not. 



Section 32. Is not the bare fact of the dislocation of one of the large joints sufficient in itself to 

 exempt a man, whether it be reducible or not? If a man should be accepted with such a disloca- 

 tion, but not irreducible, tcho is to reduce it, and when is it to be done? Is it right to compel a 

 man to submit to the torture of reduction for the sake of putting liim into the Army ? If reduction 

 should be attempted and prove successful, would not the condition of the ligaments prevent him 

 liom being of any service for months, and perhaps years ? Sjirains of the ankle and knee joints 

 have often disabled men not only for months and years, but for life; would the case be any better 

 in dislocation of these joints when reduction was not made at the time of the accident? 



Section 33. Before I had any experience in the examination of injured and defective hands, 



