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in enlistment. The chances of the reverse pertain, and in the few cases likely to be presented affording appearances of fractured cranium, it would not be justifiable to run the risk.
Cicatrices on the head and prominent parts of the face are to be looked for and should receive special attention. It does not appear that much importance has been heretofore attached to these marks as possible indications of epileptic fits. Any notice of the varieties and symptoms of a paroxysm, feigned or real, is altogether irrelevant to the intention of these remarks ; nor is the subject calculated for further investigation than, as it happens, that this serious periodic disease sometimes exists in young lads who enlist, and that individuals so afflicted are quite inadmissible as soldiers for numerous reasons; hence all circumstances which can assist in discovering its prevalence are well deserving of observation.* Epileptics some mechanical means of protecting the brain could be procured. However, about two months after the receipt of the wound, while riding in the bazaar, my attention was attracted by a crowd of natives round a drunken soldier; on going closer, I was astonished to recognize my friend, who had escaped from hospital, and was, about noon, in the month of April, drunk, without the least covering on his head, his hair shaved off, and a small portion of the dura mater exposed to the direct rays of an Indian sun, offering to fight any number of the assembled natives. He was, as soon as possible, conveyed back to the hospital ; even from so great an exciting cause there did not follow the least ill effects.
* Nearly every experienced army medical officer has witnessed epileptic or other very similar convulsive seizures as happening to soldiers who have never previously been so influenced; such fits may occur once or twice or more frequently, and may not for a very long period or possibly never again appear, having produced only effects for the time being. The observance and recollection of such cases does not in the least diminish the serious objection to admitting epileptics into the army.
may be considered in two degrees, as the most concise means of clearly arranging and appreciating the subject, and a division adopted into confirmed epileptics and those who have had occasional fits at periods of different intervals between the attacks. But prior to these considerations, it may be well to ask the question--are there any distinctive characteristics anatomically arising, and externally appreciable, by which a man who has had fits is to be detected.
The attempt at a foundation on such premises could never be established, for the simple fact that though irregularities in the shape or size of the head are often observable in epileptics, and in such cases are most usually admitted to be intimately connected with the predisposing influence, still epileptic and other convulsive seizures are commonly known to occur in men in whom there are no anatomical derangements whatever; the presence of peculiarities in the shape or size of the cranium is to be remembered as possibly associated with this condition, and attract enquiry for further information, which may be possibly detected as effects either constitutionally or accidentally produced.
The appearance of a man subject to frequent attacks of epilepsy, generally speaking, bears traces of ill health; the features become enlarged and coarse, the eyelids swollen, lips thick, pupils dilated, and cheeks pale. Dr. Hector Gavin remarks, “to the attentive observer, the true epileptic is a man
quite different from every other. It is rare to find in him any trace of hilarity, spirit, or vivacity. Nature, or rather the disease, has imposed upon
his face a character which seems to be composed of sadness, shame, timidity, and stupidity.” It is to be recollected these are the evidences of confirmed epilepsy, and, as such, not likely often to be presented in a man about to enlist; however, the admission of men with modifications of these appearances has occurred, thereby requiring an examiner to be upon his guard. The examination of books on this malady, or the experience of medical men, does not elucidate the discovery of individuals who have only occasionally had fits, and in whom accidental causes might renew the disease or establish its permanency. In fact, the opinion of Mr. Marshall, and others, is that there are no positive symptoms by which one can usually decide in such cases. cially the instances we are called upon to discover, and no indications seem so determinate when unequivocally found, or at least so likely to assist, as cicatrices the result of falls.
I have frequently examined soldiers subject to occasional convulsive seizures, and in
instances without being able to detect a single valuable evidence beyond such marks; true, they may not always exist; but, when observable, they should be well considered, and in instances where suspicion is in the least excited, the most careful scrutiny is incumbent.
These are espe
Private B. A., — Regiment, has lately had three epileptic seizures, on two occasions when on guard. About a year before he had a fit of a similar nature while on sentry, and was accidentally discovered by a civilian. On carefully examining his head, countenance, and body, no reason can be discovered why he is epileptic; he is a good-looking smart soldier, twenty years
he denies ever having had a fit prior to enlistment, or to the occasion first referred to. His sister was subject to epilepsy. His fits are not on all occasions true epilepsy; they sometimes present the characters of epileptic vertigo; they are unquestionably genuine; which opinion has been formed by myself and corroborated by another. Were he to appear before a medical officer for examination on enlistment, the only possible guide appreciable for suspecting epilepsy, is the presence of three cicatrices on the head and two on the face; all of which have been received while in the service; one of those situated on the eyebrow is very large and the most recent.
“6.- Impaired vision, inflammatory affections of the eye
lids, immobility, or irregularity of the iris, fistula
Deformity or irregularity of the appendages of the eyes
is visible almost immediately, their importance is then to be determined. An encysted tumour may be situated in any part of the lids, superficial or beneath the muscles. If of any size or likely to
require interference for removal, it is inadmissible. Whether ptosis is to be accounted a disability, must depend on its origin and amount; if it does not result from paralysis, and is not so extensive as to impair vision, it could only be regarded as slightly disfiguring, and therefore obtain no importance. Ophthalmia tarsi, trichiasis, districhiasis, entropium, ectropium, or any affection calculated either to injure the eyeball or subject it too much to external influences, are disqualifying. Enlargement of the lachrymal glands, affections of the puncta, lachrymal ducts, sac, or nasal ducts, are likewise causes of rejection, as they are at all times troublesome, may be obstinate and end in various derangements, affecting the constitution or the organ of vision, or occasioning at least stillicidium lachrymarum. Conjunctival inflammation, though of slight degree, may degenerate to serious mischief. Uncertainty invests the most experienced in pronouncing the result of any case, and the well-known contagious nature of ophthalmia is to me, I admit, a source of grave apprehension ; such as can be fully appreciated, in relation to soldiers, only by those who have served in a regiment that has seriously suffered from this affection. Sometimes a few vessels only are observed ramifying upon the visceral layer of the conjunctiva; in these cases, if the lids are everted, very often a granular condition will be discovered
; an invariable disqualification. Slight redness of the conjunctiva is sometimes temporarily excited by