« PreviousContinue »
for the purpose of pointing out the grave objections that exist to the admission of recruits into the service, in whom it can be determined that rupture prevails or even a decided predisposition to this disease, which is not infrequently fatal to life, and which usually compromises the efficievcy of a soldier.
Hernia, as a general rule, is gradually progressive in origin. Soldiers can rarely specify the exact period of being ruptured, they usually say its appearance was gradual about a certain time; the peritoneum, the fascia propria, the transversalis fascia, the margin of the internal oblique, and the cremaster muscle, all yield in their turn as they are met by the sack and its contents, some to descend, others to be displaced ; yet, when this change is incipient, it may happen that no examiner could discover it. Were a decided laxity of the rings or canal when the individual coughed, detectable by sight or manipulation, he should be rejected. It seems more than probable that there, very frequently, pertains a weakness of tissues sufficient to predispose to rupture, independently of any want of apposition of the sides of the internal ring. Were even an evident enlarged condition of the external ring detected by manipulation, disapproval would no doubt be justifiable, as the presumption might be usually fairly drawn of the association with some similar condition of the canal or inner ring, the first to be overcome; also an anterior resistance being removed, of course the posterior obstructions are weakened. A protrusion, if small, may not be perceptible until it presents in the groin, having escaped from under the inferior margin of the internal oblique and occupied the canal, or even passed through the external abdominal ring. Nevertheless, in the great majority of cases, deviations are detectable; wherefore a strict examination of the hypogastric and inguinal regions is, in every instance, requisite. Femoral hernia is much less frequently encountered than inguinal, but is equally inadmissible. Ventral herniæ are usually small, and may be of little consequence. Umbilical ruptures may also be trifling; still they frequently occasion derangements of the bowels, and are generally prone to gradual increase ; from these, and other reasons, I would not pass a man so affected into the army.
“ 14.-A varicose state of the veins of the scrotum or sper
matic chord, sarcocele, hydrocele, hemorrhoids, fistula in perineo.
A varicose condition of the veins of the scrotum is not often met with, and is usually associated with other affections, which, however slight, seriously add to its importance; if extensive, it should generally be inadmissible as tending to increase, and allowing but unsatisfactory means of treatment.
Varix of the spermatic chord is commonly seen per se, often of small amount. It is said to be sometimes “much more evident at one period than at another*;" hence, if it exists in a minor degree, engaging a portion of the veins of the chord, it may escape detection during the time of the examination. When observable, it can hardly be mistaken. I have frequently seen this affection in soldiers, when of small amount, continue for years without occasioning any inconvenience; nay more, if a number of men in the ranks be examined, a considerable proportion will be found to have enlarged veins of the chord, who on enlistment were free from this affection ; and unquestionably it is a disease very rarely requiring treatment in soldiers. Yet the admission into the service of the subjects of varicocele is a question for careful reflection, and most certainly should obtain only conditional approval. In two respects it suggests consideration ; in the first as to the very great frequency of the observance of some degree of this condition in recruits, and the loss to the service that would accrue, were all such excluded. And in the second, how far or under what circumstances it disqualifies a soldier. The first question seems to me to sufficiently establish its claim to reflection, from the fact of its recognition; all medical officers who have been in the habit of examining recruits, must be aware how very frequently they have detected varix of the chord. The fact of the so frequent prevalence of this condition in soldiers, and of its being so very rarely a matter of complaint, or requiring treatment, is a valuable practical answer to opinions based upon any other foundation than experience; but here it is to be recollected, that from the strict examination recruits undergo, and in obedience to the positive wording of the instructions, it is very probable that extensive states of this condition seldom prevail in men when passed into the service. From the number and variety of the serious operations that have been suggested for this disease, by surgeons in private practice in all parts of the world, there can be no doubt but that extensive degrees present serious features; that when this state is extensive there must be great obstruction to the local circulation; the disease, moreover, sometimes extends to the testis and affords a varicose mass, destroying its functions, producing enlargement of the neighbouring parts, most inconvenient from its locality.
* Depending probably on whether the man had been taking exercise, or on the contracted or relaxed state of the scrotum.
The conclusion I would wish to draw, is, that in cases where the veins of the chord are only slightly engaged, and that the general characters of vigorous health are manifest, in otherwise eligible recruits, this common deviation should not produce disapproval, which experience does not warrant. But that when the degree of varicocele is greater, where the veins are in the condition of a large plexus, affording the feel as if of a collection of worms, I believe the admission into the service of men so afflicted, to be attended with considerable hazard; and that in instances where the testis is engaged, whether for cavalry or infantry, the subjects are unfit. There is a vastly greater prevalence of varicocele of the left than of the right chord. Most writers upon the subject have remarked this peculiarity, and attribute it generally to the difference of the anatomical arrangement of the left from the right side, occasioning in the former more impediment to the return of the blood into the vena cava ascendens.
Affections of the testicles from the pendent position of these organs and their great liability to inflammation, synchronous with gonorrhea, or its sudden disappearance, or from injury, are not infrequently discovered, and are, unless of trifling amount, to cause rejection, as their nature may be uncertain, and they constitute a liability to secondary inflammations, which may tend to more serious complaints. Sarcocele seems here intended to imply all increase in size of these glands.
Absence of the testicles from the scrotum, atrophy, or imperfect developement, are other conditions requiring mention. It occasionally happens that one or both testicles are not to be found in the scrotum, and nearly always the absence is dependent on congenital mal-position of these organs; they have not descended, and are retained either in the abdomen or arrested in their transit in the inguinal canal or immediately below the external ring. When placed in the inguinal canal, or just external to it, no possible question could arise against the invariable rule of rejecting such men, as