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is not to be conducted on the probability of every deviation becoming a formidable disability. Medical officers ought not to be supposed to be infallible; since though diligence and care are exercised with intelligence, mistakes will occasionally occur. Our decisions must be from inferences purely practical, and our assumptions supported by probability and the confirmation of frequent occurrence under similar circumstances. Nothing more conduces to understanding disease, its prophylactics and remedies, than a fair and probable view of cause and effect, so far as they can be truly applied, and the arranging as far as possible diseases or disabilities into causes assignable to exciting and predisposing influences. It is from the result of such a principle applied in a more or less extended sense, that for different employments arrangements are usually made. If we allow ourselves to be guided by such a rational means of discrimination, and provision for difficulties, the simplest, safest, and least liable to erroneous results; the course to follow in the selection of soldiers is obviously to be fully aware of the duties, the habits, the influences, and enervating causes incidental to their position, by which it can be comprehended that individuals deficient in certain physical proportions, although not of depraved health, cannot perform such duties or resist such enervating circumstances as they may possibly be subjected to; and the exciting causes of disease can also be easily understood, rendering more plain what are to be es
teemed the predisposing causes most liable to be aroused to actual disease by such exciting influences.
A man with enlarged veins of the legs, or even a decided tendency to this affection, is not a fit subject of selection for an infantry soldier, to engage in possibly harrassing marches, sustaining considerable weight, and requiring the exercise of muscles and endurance; the effect must be the developement of varicose veins, deranged circulation, and debility, which increasing, of itself becomes a cause of extension and accumulation. Nor should a man with a narrow sunken chest be subjected to carry a heavy knapsack, occasioning compression and fatigue, or be submitted to the influence of cold night air and want of rest; he is from his conformation most likely predisposed to pulmonary disease, or at least is of a delicate habit, and these causes will assuredly create or invoke the assumption of epidemic or casual disease. General debility without organic or local predisposition is open to similar objections, as it is an established law that such habit absorbs morbific poisons far more readily than a vigorous constitution similarly exposed.* The greatest diffi
. culty is often experienced in separating the intimate connexion between the exciting and predisposing causes of disease, in fact it is sometimes impossible;
Any predisposing cause liable to develope disqualifying disease as the effect of continued submission to the exciting influence, must, as a mat of course, be not only condemnatory in individuals of an herwise doubtful appearance, but is likewise applicable where the frame is in its general characters robust.
knowledge is only derivable from experience, or rather comparison of numbers subjected to the same influence, and it may be argued that predisposition as a remote cause of disease may often pertain, and not be appreciable; yet that idiosyncracy, by constitution or the arrangement by natural formation, may actually exist, but to a degree not discoverable. Select a number of cavalry soldiers, expose them to similar duties, some become ruptured, the very great majority escape. It appears a rational inference that the few in whom similar causes produced dissimilar effects, were predisposed, by congenital or accidental anatomical arrangement, to hernia, though a weakness of tissue or a laxity of the rings was not appreciable. Still such an argument is only referable in regard to universal application, and if a predisposition be discoverable in the majority, or even in a very great minority, its value and importance as a guide to selection must be immense. Incipient or chronic disease, also, when limited, not developed by constitutional, sympathetic, or local derangements, frequently escapes detection, and men so affected gain admission into the service. After a time, active duties or exposure developes most usually by increase, the unobserved condition. Such a state of things must always exist, even if we look with certainty to vast improvement in diagnosis. In instances of hereditary or constitutional tendency, there is more than likely no actual disease; and were the prophylactics of climate, occupation, and other circumstances attended to, such disposition would, in human probability, often be replaced by a habit associable with perfect health. However difficult this discrimination may be, still assuredly it is frequently much less confusing and not so problematical ; for turning to the converse where symptoms or signs, or the general characters traceable not to positive local disorganization exist(though its advance may be determinate hereafter) -how often may such assistance be derived by the power or frequency of the pulse, by emaciation, by feeble muscle or traces of strumous habit; or still more, referring to local derangement; how often is structural delicacy discovered in the lungs by auscultation, or a predisposition to fatigue by the shape of the feet, or a tendency to rupture by a laxity of the rings. The value of the detection of a predisposition to disease, or to any formation, which from certain similar appearances, repetition, and comparison, have been established as ill-suited for the duties of a soldier; are but to us appreciable for selection, as the discovery of causes, the effects of which would be objectionable in a man so situated ; it is, therefore, unnecessary in any other relation to consider the subject here.
We are directed, and it is our duty, to reject those predisposed to disease; such is contemplated by the instructions. The knowledge that disabilities may
present by predisposition, though not decidedly so as regards extensive organic change-should
always be borne in mind, and it should not be forgotten, that experience and a scientific education, by assembling and separating facts, will often form a diagnosis when the mere application to an organ, per se, for evidence of extensive disease might be made in vain. Nevertheless even here a great difficulty is presented; the assistance derivable from the evidence of the individual is not available; he is in the position of a dissimulator, he has a disability, he endeavours to conceal it. The effect of this is often to induce scepticism in cases not meriting it, which however is a fault of less frequent occurrence than the reverse; still such scepticism may easily be carried too far. Prejudice is too often dominant in the selection of recruits, maxims are occasionally inculcated and received by young medical officers entering the service as absolute, which when taken in a universally definite sense, are precepts the result of less extended views than seem to be the intention.— E. g., some hold that in all cases where marks of medical treatment are detectable, the man is unfit; others are similarly influenced if a slight lateral curvature of the spine exists, yet it is obvious that bleeding, leeches, or a blister, may have been resorted to as treatment for acute disease or injury, which very possibly is completely cured, leaving no derangement, sequela or even trace, save the evidence of treatment; and slight lateral curvature may exist in a robust man, produced by a particular employment, occasioning neither actual nor disfiguring unfitness.