years he may perform his duties. Still, even in this instance, were the hope of exemption from increasing effects more bright, exceptional cases are no arguments against the seriousness of admitting men with any form of abnormal condition of the heart into the service. Such instances likewise manifest that the effects and not the existence alone of diseases of important organs should subject soldiers to be invalided. Nevertheless, whenever organic diseases of the heart occur in regimental practice, the surgeon is almost invariably obliged to bring forward the subjects for discharge. I could adduce very many examples illustrative of this point, but the subject of invaliding soldiers is only admissible here as illustrating the importance of the question now under discussion; therefore, the following case, the most recent under my own observation, must suffice. A fine young soldier, aged 26, about three years ago, suffered from pleuro-pneumonia of the left side; the inflammation extended to the pericardium, as evidenced by frottement, &c. He apparently recovered, but, about two years after, decided symptoms of cardiac disease became apparent. The sequelae of the acute attack were at first supposed to be adhesions of the pericardium, and most probably the diagnosis was correct; latterly however, hypertrophy with dilatation of the left ventricle, was diagnosed; he was very nervous and distressed, continued exertion produced violent palpitation, irregular action of the heart and bleeding at the nose, as well as dyspnoea.

The usual signs and symptoms were present on ordinary occasions; his muscular developement was not impaired. After many attempts were in vain made by treatment to mitigate his symptoms so as to enable his being retained in the service, he was invalided. By these two cases another element in the examination of recruits was illustrated, namely, the necessity of auscultation for the detection of derangements of the heart. In the first there are no marks of treatment, a bruit de soufflet is the only evidence. In the latter, were there not marks of cupping, the man's muscular appearance might easily have deceived.

Attention in diagnosis is not infrequently requisite to determine in another species of cases, in which too great caution may arise; where a medical officer, aware of the unfitness of the subjects of cardiac disease, may too cautiously decide, and deem symptoms and signs associable with perfect health as dependent on structural alteration in the heart. I allude to the effect sometimes produced on the impulse and motions of the heart by the power of mental emotions while undergoing examination. Many feelings conduce to produce these effects; the importance of the step of enlistment, anxiety, the irrevocable act, &c., to which may be added the muscular exertions usually undergone during the routine of the investigation. Some such influences seem capable occasionally of increasing the frequency and impulse of the heart's motions, and may lead to the idea of

hypertrophy or other form of morbus cordis, when it is a mere functional and temporary effect of a perfectly healthy organ. A reference to this possible cause of mistake is alone sufficient; as allowing the recruit to stand aside for a few minutes before completing his examination, will usually manifest the temporary nature of this functional defect.

"11.-Debility of the hands or arms caused by palsy, old fractures, especially of the clavicle, contraction of joint, mutilation, extenuation, deformity, ganglions, &c. &c."

The detection in these situations of imperfections, either malformations, or the effects of injury or disease, is, generally speaking, unattended with difficulty; they are usually mechanical in their effects, and as it is not probable that any affection of the hand or arm would be symptomatic per se of constitutional derangement, without other obvious concomitant characters, such disabilities are consequently local as to cause and position; being thereby so apparent as that one thoroughly informed in the duties of a soldier, unless from an accidental oversight, ought rarely to make a mistake, either from omission or in estimating the extent of incapacity. For the furtherance of the examination, the different motions of the various joints included in the upper extremities are to be rigorously investigated, and their components so inspected as to provide for every portion being

brought under observation. The above remarks, as connected with the feasibility of a definite criterion, must be qualified however in connexion with one relation, namely, the actual amount of mutilation of a finger or fingers that preclude a man's entering the service.

The easiest way to comprehend this question appears to me to divide the consideration into mutilations that bonâ fide incapacitate a man from performing the duties of a soldier, and into those which may not in a certain arrangement incapacitate, but which in all cases without this provision it would not be prudent to approve. These considerations again involve the question as to whether the recruit is to serve in cavalry or infantry; the importance of this last point is highly essential, inasmuch as I conceive no mutilation whatever could be admissible in a dragoon; though to a slight degree such is not necessarily altogether incompatible with the duties of an infantry soldier. To a cavalry soldier in action the right hand is his sole means of destruction, possibly of defence. To wield a sword, or use a lance, the grasp must be perfect; his life and value as a dragoon may depend on his strength and dexterity in the command of his weapon. It is likewise to be borne in mind, that reasons similar to those requiring complete integrity of certain fingers in an infantry soldier, hereafter to be mentioned, apply here. With reference to the left hand, if one reflects how completely the fingers and thumb

are employed by the reins, it can at once be seen that no defect in any could be sanctioned.*

Regarding infantry, in this particular, a less restricted limitation can undoubtedly be assigned, as the bonâ fide essential indispensable for actual duty, since it does not appear that the motions necessary in the manual and platoon exercise, need uncompromisingly the separate use of all the fingers. It is essentially necessary, however, in every branch of the service, that the thumb and index finger of each hand must be perfect, they are requisite for grasping an object with firmness in every use of the hands requiring manipulation, and the index finger of the right hand is indispensable for the trigger. On the subject of mutilations of the fingers, I beg to introduce the remarks of Mr. Marshall" By the French code, a conscript is not to be exempted from service on account of a mutilation of a hand, unless he has lost a thumb or the fore finger of the right hand, or two other fingers of one hand. The loss of any finger of a hand should in general

* One side of the birdoon rein passes over the fore finger, between it and the thumb; the other passes round the outside of the little finger, the bite resting in the palm, except when a man rides on the birdooon; then one side of the rein passes between the little and ring finger of the right hand; an additional reason why the perfection of the right hand is necessary to a dragoon, as he may at any time have a horse he cannot ride on the bit. The bit reins pass, one side between the ring and little finger of the left hand, and the other round the outside of the little finger, the bite passing up the palm to be grasped by the thumb and fore-finger, thereby occasioning separately the use of the thumb and three fingers; the integrity of the middle is necessary in confining the reins, as likewise in completing the grasp of the carbine when firing from horseback.