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mation and increase of their size from exposure; they are likewise very often associated with a strumous habit.
Were cicatrices discoverable on the palate, or back of pharynx, they would indicate ulcers, most likely syphilitic or mercurial at some period, and the possibility of their re-appearance or of the occurrence of other symptoms elsewhere at a future time, more particularly if taken in connection with the slightest evidence of delicate health.
“9.—Impediment of speech."
An impediment of speech sufficient to incapacitate a soldier challenging on sentry, or repeating the orders delivered to him on his post, can be generally discovered without much trouble or ingenuity. To detect simulation is often a point of great difficulty, but to discover concealment of the disability by questioning, if persisted in, is not usually hard of accomplishment. “ 10.—Want of due capacity of the chest, or any other
indication of liability to pulmonic disease.” Deformities of the chest are always important, and when remarkable most usually indicate a weak constitution, the effect of rachitis, curvature of the spine, some injury, or the sequent of disease of the contents of the thorax, In any case they suggest great caution, as the importance of the contained viscera to sustain life under exercise requiring physical power or resistance to fatigue, admit of no compression curtailing the limit of any viscus, or impeding its complete action. Want of capacity is constantly congenital, and if of sufficient amount to be designated a malformation is referable to a weak constitution, as they are most commonly co-existent. Malformations usually consist of flatness of the ribs, laterally, with projection of the sternum in front, and sometimes curvature of the spine, or the lesser modification of simple chicken breast, which is a prominence of the sternum with a contracted chest. The mis-shape is occasionally the reverse of this, presenting a depression of the sternum to a degree sufficient to compress the viscera, and possibly an inversion of the anterior convexity of the ribs. A variety of mis-shape very commonly encountered is a flat thorax with diminished antero posterior diameter. Any of these deviations, when excessive, are rarely consonant with a healthy and robust frame, (though emaciation is not always an accompaniment), and the predisposition to discase in chests so shaped is very generally drawn.
When deformities of the chest are the result of any organic disease of the contained structures, likely to be met in a man offering himself for enlistment, I believe by far the most common is contraction of one side after an absorbed pleuritic effusion. This may vary from scarcely perceptible flatness to an amount which produces falling of the shoulder and a crooked figure. Extensive dilatation of one or both sides of the chest
from vesicular emphysema of the lungs, or flatness or depression of a portion of one side of the thorax from tubercular deposit are most improbable contingencies to be observed in such men. Projection over the cardiac region consequent on dilatation or hypertrophy of the heart is equally improbable. In all instances where these irregularities are extensive, the individuals should be rejected, and when even slight, though not associated with a delicate appearance, they ought to be approved with great caution.
Before the examination of the chest is deemed concluded, I would submit that in all cases observation be directed to the condition of its contents, as considerable muscularity and the appearance of health can be associated with different organic lesions of the lungs and heart; this is a fact indisputable, and familiar to all conversant with thoracic disease and pathological research. Without exploration of the chest itself, who can tell that a man, seen for the first time, without knowing anything whatever of his previous history, in whom disease has not produced any apparent constitutional derangement, or muscular tenuity, sufficient to attract attention ? Who can tell that rheumatism has not left an indelible alteration in the structure of the heart? The mitral or aortic valves may, at that moment, be yielding an abnormal bruit, or pericardiac adhesions, by irregular action, &c., may be laying the foundation of hypertrophy, or this disease may actually be pre
sent. Chronic bronchitis may exist, or even that protean disease consumption may have sown its deadly seeds.
The diagnosis of thoracic disease is determined by the association of physical signs and symptoms ; the collection and comparison of the greatest number of these features are the only certain grounds upon which the physician can ordinarily draw a conclusion. Let us reflect upon the position of a medical officer examining a recruit,—where is the possibility of comparison ? Where are the group
of symptoms affecting the individual relation of the diseased organ, or the phenomena of organic life? except whatever general effect may be produced on the outward appearance of the man, none; (and I am assuming instances where general effects are not very appreciable). If asked has he a pain, he will deny it has he a cough, he will deny it; does he suffer from dyspnea or palpitation, the answer will be the same; the pulse may declare nothing decisive; wherefore one is left without resources from symptoms or previous knowledge, and thrown altogether upon evidence derivable from the actual exploration of the organs themselves;* the object is to deceive, so that circumstances likely to militate against him are concealed. Fortunately, in the examination of recruits, a necessity for accurate diagnosis does not often exist; the detection of an abnormal state is most usually sufficient.
* It is probable that the spirometer might be of great advantage in determining the fitness of recruits. The possibility of testing the capacity of the lungs seems a valuable assistant.
The ordinary respiratory murmur and the normal sounds of the heart, when interfered with by disease, are variously modified, and afford to the practical stethoscopist a means of ascertaining the integrity of these organs, which is still further assisted by the signs derivable from percussion. Affections engaging much extent of the mucous membrane of the lungs, or the parenchymatous tissues, or the fibro-serous membrane, are always detectable through the modifications manifested by auscultation, including phenomena in respiration, vocal resonance, and percussion. Auscultation, then, is almost the only resource for discovering the state of the organs within the thorax in the examination of recruits. I believe it will always be found sufficient, except in the invariable detection of incipient tubercular deposition; however, it occasionally happens that, in these cases, there is no previous history, no symptoms; the invasion is so gradual, the developement so insidious, that some time may elapse before appreciable features are manifested.
It would be out of place here to enter into a consideration of acoustic signs, and what phenomena, at the present day, meriting particular notice, are likely to be met in the field of observation contingent to the practice of a regimental medical officer. Periodicals and books on the practice of physic treat of the subject, and together with the various mono