require a respiratory system capable of sustaining animal heat under extensive vicissitudes of temperature, and of supporting the waste of great muscular exertion; wherefore, the free arterialization of the blood essentially necessary for these services is of serious importance. The well-known debilitating effects, mortality, and uncertainty of affections of the lungs, the impossibility of prophylactic measures, and the objection to soldiers spending their time in hospital, are all conclusive reasons for the necessity of the efficiency of these organs in this class of men. Thus the detection of any positive abnormal sign should be esteemed of serious consequence. Further remark is hardly necessary to strengthen so obvious a conclusion. Suppose a man presented himself in whose chest anteriorly mucous rales were detectable, were he young, robust, and healthy-looking, the presumption would be that they were caused by an attack possibly easily admitting of cure; yet who could state that such was the case? who could tell that they were not the commencement of bronchitis, that would in time engage the mucous membrane of every bronchial tube in the lungs, and lay the foundation for chronic bronchitis, dilated tubes, or Laennec's emphysema; this, on one examination, no one could veritably assert. Such, moreover, might be the first perceptible signs of phthisis, for in incipient disease the physical signs are common, there are none pathognomonic. Or it might be an affection eventually to lapse into consumption, for

despite Laennec's denial, phthisis so frequently succeeds to bronchitis, even in persons not hereditarily predisposed, that we must connect this affection with its occasional production, which probably Laennec would himself have admitted, had not his opposition to Broussais influenced his judgment. The subject of bronchitis would more than probably get well, still the chance remains that the amount of derangement sufficient to occasion mucous rales may tend to other serious disease, or lapse into chronic bronchitis; a serious disqualification to a soldier, likely to be continued and aggravated by night duty and ordinary exposure; and though never extending to more fatal structural change, a diseased pulmonary mucous system, endeavouring to sustain active exercise, will usually occasion the man's inefficiency. I might continue occupying more time and space than necessary connecting this or any sign indicative of deranged function with the several organic diseases of the lungs, but I conceive sufficient has already been remarked upon the subject.

Diseases of the heart are much less often met in recruits than affections of the lungs; this is dependant on the less frequency of the actual abnormal condition, and likewise upon its less frequent occurrence in youth than in a more advanced period of life, in proportion to similar conditions of the pulmonary organs at similar ages. Yet the prevalence of affections in this organ, in men offering themselves for recruits, is a fact familiar to army sur

geons; and, I believe, in a proportion exceeding that shown by "the Statistics," as doubtless many bearing "marks of treatment" over the cardiac region were included under that head. The seriousness of affections of the heart in the class of men usually enlisted bears an extra gravity from the fact that functional derangements are met with in a proportion much less than in the mass of the population, as experienced in civil practice; irregularities are to be esteemed most usually as organic, and here is at once seen how great the importance of detection. The origin may be referred to many sources, as acute rheumatism, inflammatory affections of the lungs and pleura, fevers, hereditary predisposition, besides many others chiefly associated with more advanced age; frequently no period or source is assignable. Acute rheumatism, however, is the great connexion, and its general prevalence throughout the system, is often the cause of the absence of marks of treatment over the cardiac region, from the affection of the heart haying escaped observation. It is generally stated that endocarditis, or pericarditis, or both conjoined, occurs in the majority of cases of acute rheumatism, and that the number of those so attacked whose hearts perfectly recover without any sequelæ remaining to lay the foundation of future aggravation is very small. The exact proportion would be difficult to determine, as years often elapse before symptoms and occasionally even signs are appreciable. And how almost certain are those symptoms

to increase where organic structural change has been produced, either connected with the valves or pericardium! Sooner or later they will appear, very rarely is there exemption; and when they do so, though gradually they completely incapacitate for active exertion. As they progress the dyspnoea palpitation and other effects are often followed by secondary diseases, all of which shorten life: such effects may speedily follow or be deferred for years. If valvular disease of the heart or pericardiac adhesions result from an acute inflammatory attack, irrespective of youth or other favourable circumstances, other structural derangements almost invariably follow. Hypertrophy, with dilatation or with some other abnormal condition, succeeds, and produces irreparable mischief.

From the foregoing remarks can be deduced the correctness of the observation previously made, that whenever marks of medical treatment are discovered over the cardiac region, the recruit should be rejected. Such marks point out that an affection of this organ has existed. The very great exception of perfect recovery, the difficulty where the pericardium alone has been engaged of determining that recovery is complete by physical signs or otherwise, the almost certainty of further derangement, in the form of structural change being induced where any morbid result remains, and the eventual unfitness of such a man for the duties of a soldier, all clearly verify the impropriety of passing such men when marks of

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treatment in this situation pertain, even though signs of persistent disease are not appreciable. Thus then it may be truly said that it is only where marks of treatment are not observable that the cardiac region requires exploration.

Similar reasons to those offered with reference to pulmonic lesions preclude my entering into detailed remarks upon cardiac diseases further than to observe that disease, to an amount capable of interfering with even ordinary occupations, may exist in the heart and totally escape observation, unless auscultation be resorted to; and that disease, to an amount sufficient in time to produce similar effects and shorten life, may exist unknown even to the subject of it, and be utterly impossible of detection by a medical officer by any other means than auscultation. I happen, at present, to have an instance under my observation bearing out the latter assertion of the existence of a cardiac derangement of which the man affected is totally unconscious. J G., a soldier in the 4th Light Dragoons, in November, 1851, suffered from a very severe attack of acute rheumatism, in the course of which endo-carditis was developed. He recovered with a permanent bruit de soufflet accompanying the systole, of so loud and prolonged a character as completely to mask the second sound; yet this man is capable of performing the most active duties of a dragoon, without the smallest inconveniThe great probability is, that urgent symptoms will eventually arise in this man, though for

ence.