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suspected, the assistance of a speculum will usually determine the matter at once.
"8.—Loss of many teeth, or the teeth generally unsound."
I am aware this is a most disputed point: different medical officers forming their own estimate of the extent intended to be implied. Yet it appears that such variety of opinion is hardly admissible, as by adhering even to the letter of the instruction, considerable latitude is allowed, and were a specification to a very confined limit intended, doubtless such would have been expressed. Having said thus much, it must at the same time be acknowledged, that the objections to unsound teeth are numerous and valid when judiciously applied. Many have stated that the loss of the incisors of either jaw incapacitate a soldier from effectually biting off the ends of cartridges when loading. This is unquestionably the case, as some force is requisite to tear the strong paper of which they are constructed; an act that could not be quickly accomplished if deficiency or decay of the incisors was extensive. A serious objection is likewise constituted in the fact that general unsoundness or loss of many teeth is commonly an indication of a delicate constitution, symptomatic of depraved health, or occasionally of the strumous diathesis; sometimes of the abuse of mercury, or the effect of mineral acids. The teeth are a most important provision in nature for the perfection of digestion; they serve as appreciable distinctions in classifying the animal kingdom; their peculiar shape, arrangement, and density differing, and evidencing not only the nature of the food, but how essential in some is accurate mastication to the accomplishment of digestion. The loss of many molars and bicuspids must tend to the production of dyspepsia, thereby alone injuring the general health or assisting the train of causes producing disease of organs where there pertains any peculiar idiosyncracy of constitution. Decayed teeth often create excessive suffering from head and tooth-ache; abscesses form in the gums, necrosis is sometimes induced, ulcers form on the tongue, and occasionally violent inflammation is produced in this organ and adjacent tissues. Decayed stumps are often most difficult of extraction, and the circumstance of men coming frequently to hospital on account of any of the very painful results of decayed teeth, which may admit of only tardy or temporary relief, should assist in deeming this a decided disability when extensive. Nevertheless, the fact of a recruit being otherwise eligible always deserves consideration, as mitigating the degree of many equivocal objections.
In the case of enlarged tonsils, certain contingencies are to be recollected; the estimation of which will cause this common affection to be regarded in a serious light. The difficulty of reducing the size of these glands when chronically enlarged, at times the impossibility is constantly experienced. An individual so situated is frequently subject to inflam
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 disease 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