graphs, have hardly left a deficit in this fascinating study; fascinating it must be, when it is recollected what a mass of original and argumentative matter has been written since first Avenbrugger's neglected remarks on percussion were given to the world. When marks of medical treatment are perceptible, they point decidedly to an organ affected at some period, and suggest inquiry; yet it appears to me that recruits, even though free from such evidences, are not thoroughly inspected unless the chest is subjected in some degree, varying from circumstances, to exploration; and despite the extended range of a man's professional acquirements, he omits one of his greatest assistants, both as regards easy application and importance, if he neglects auscultation.

The forms of pulmonic disease most likely to be met with during the examination of recruits are certainly incipient disease or chronic forms, where the lesion is not an extensive organic change. Extensive results of permanent chronic disease are very seldom presented, yet by reference to the published opinions of the most experienced authorities on pulmonary affections, it may be understood that alterations in structure of a chronic character and permanent condition, particularly when they are the gradual products of disease, and originating in youth, are not always connected with an appearance of depraved general health; but the degree of the abnormal change must exercise an important influence in such an association.

Neither dilated bronchial tubes, nor vesicular emphysema, are states of the pulmonary structure that could often be presented; yet there are no reasons why such might not occasionally be the case. When dilated bronchial tubes are the sequelæ of pulmonary disease in youth, and of small amount, symptoms are by no means constantly severe, and deleterious effects, however certain, may not seriously arise until a more advanced period of life, should not the ordinary exciting causes have been much submitted to. Laennec says, "In cases even of the most extensive dilatation, the symptoms rarely indicate the severity of the disease; most commonly there is neither fever (at least continued) nor emaciation; and if the patient is not obliged to undergo severe bodily labour, he is scarcely sensible of any diminution of strength." Surgeons of the present day generally esteem dilated bronchial tubes a more serious disease and tending to more fatal effects than Laennec has described; still if this condition of a bronchial tube were limited, with the provisions previously specified, there does not appear any reason to render it impossible for a man so circumstanced to offer himself for enlistment. All medical officers who have served in the manufacturing districts and have been in the habit there of examining recruits, must be aware of the numerous instances and various forms of pulmonary diseases met with in such men.

Vesicular emphysema, or dilatation of the air

cells, must be included as a permanent chronic alteration of the structure, which, when prevailing to a limited extent, is occasionally seen in persons sufficiently robust not to attract any attention from appearances of ill health; and though, as previously remarked, not often likely to be discovered in recruits, the possibility is by no means equivocal. A little time back I witnessed this state in two young soldiers of the 31st Regiment, one died from subacute bronchitis, induced by some exposure, his disease becoming complicated with passive effusion into the serous cavities. The other, about a year after joining, was admitted into hospital; his general appearance, when dressed, was that of a robust man ; he complained of cough with scanty expectoration and inability to endure the tightness of his belts and jacket buttoned, or the pressure of his leather stock. On stripping him, phenomena became much more apparent; the chest was greatly dilated, nearly forty inches round the upper part; the sterno-mastoid muscles, the pectorals, intercostals, and abdominals, were engaged in ordinary respiration. Nevertheless, with this great muscular action, the motion of the thorax was diminished, the chest was clear on percussion, the respiratory murmur nearly everywhere very feeble, and in some places indistinct; as he was a well-grown man, and when free from an accession of bronchitis, to which he was very liable, displayed no very marked symptoms, he was retained under treatment for a lengthened period. Any excess of

duty, or the complication of even a slight attack of bronchitis, so completely compromised his efficiency that he was eventually discharged. I have no doubt that both these men suffered from dilated air cells on enlistment, when possibly the absence at the time of bronchitis renders it more easily understood how the diseased condition escaped detection.

Much more frequently than either of the disqualifying states just adverted to is the observance of the effects of pleuritis in the form of flattening or falling in of some portion of the chest. Although this has been previously alluded to when the causes and importance of the deformities of the chest were under consideration, I think some further remarks are here required. The degree of contractions of the chest, the sequelæ of pleuritis, is very various, and usually, ceteris paribus, directly connected with the severity of the attack. When occurring in youth the state of contraction is often removed, and when occurring in adult life is occasionally observed to produce little or no impediment to the exercise of arduous avocations. A man, at present in the 4th Light Dragoons, suffered from pleurisy with extensive effusion into the left side of the chest in the early months of 1851, he recovered with a contracted side; the left shoulder has dropped considerably, and the anterior portion of the ribs from their angles is much flattened; the respiratory murmur in this side is in every situation apparent but feeble; there is some comparative dulness on percussion.

This man has done all his duties as a dragroon since the summer of 1851. Those who are practically aware of the fatigue of riding without stirrups, &c., will bear me out in the conclusion that his lungs must be fully capable of supporting no trifling continued exertion. A fine young soldier, in the 31st Regiment, recovered from pleurisy with effusion of right side, the termination was incomplete expansion of the inferior half of right lung, with flattening of the ribs. Two years after the acute attack, this portion of the chest afforded a dull sound on percussion, and the respiratory murmur was very indistinct; for some time it was puerile in the remainder of the lung. He grew a stout healthy fellow, and on all occasions did his duty without complaint. Here are two instances where the other functions were sustained in health sufficient to endure fatigue by a pulmonary system, whose area for respiration was reduced by disease, but in which the disease ceased, leaving only a mechanical impediment to which the system gradually accommodated itself.

Such complete exemption from all ill consequences where contraction of the side results from pleurisy with effusion, is far less frequently met than an opposite condition, yet may be recognised as, under favourable circumstances, extenuating the total exclusion of every instance of small amount. Nevertheless, except where the presence of very undoubted characteristics of strength and health are fully apparent, it would assuredly be a dangerous