risk to approve a man with any degree of contraction of a portion of the chest, as it is to be recollected that this is a deformed condition, a sequece of disease where, without the opportunity of successive observation for some time, the determination of renewed integrity of the constitution is impossible, and the most usual result is an impaired state of health and predisposition to disease.

I have heretofore remarked upon these morbid states in the succession of the unlikelihood of their observance, and have stated the improbability of either dilated bronchial tubes or dilated air cells existing in recruits, and the much more frequent occurrence of contraction of the chest as a sequence of the absorption of pleuritic effusion. I will now advert to what I conceive to be the most common forms of pulmonary affections in such men ;* I allude to bronchitis and incipient phthisis. Extensive acute disease is not likely ever to be observed in these cases, as the organs of respiration are so vascular and their perfection so necessary to life, that at the invasion of acute disease pyrexia and depression are so considerable as to preclude the likelihood of a man's conceiving the idea of enlistment even if able to present himself. Although I have, on very many occasions, detected chronic disease; with the exception of

* The small number of rejections classed under the head of Pulmonary Diseases in the Statistics of Recruiting is accounted for by the likelihood of their being frequently included under the classes "Want of due capacity or malformation of the chest," and "Marks of medical treatment.

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incipient bronchitis, I have never met with the case of a man, with any acute pulmonary affection, offering himself for enlistment. As, however, such a case would be usually very evident, it requires no lengthened observation. It is not probable that an individual afflicted even with acute bronchitis of an extensive portion of both lungs would present himself, as it is manifest that such an amount of acute disease is usually accompanied by symptoms impossible to be concealed. Yet a less amount may be observed where the symptoms are not so prominent, and the slight nature of the febrile phenomena produce no inconvenience sufficient to occasion, in the commencement at least, a cessation of out-door employments. These cases, though possibly likely to yield to the ordinary means of treatment applicable in the less severe forms of sthenic bronchitis, are assuredly doubtful in two respects; they may be of uncertain duration, or increase to a more serious state. Wherefore the approval of a man so affected, is, in my belief, a dereliction of the intention of the instructions.

This affection may be present in a chronic form, engaging various portions of the mucous membrane of the lungs; it may be partial or more generally diffused, and is often more evident in some situations than others; even when generally prevailing in a mild degree, it may have existed for years, periodically decreasing, or almost totally disappearing and again recurring; these changes usually depend on

the liability to exposure during certain seasons of the year. The general health may be good, and very considerable muscular exertion may be undergone without appreciable dyspnoea; especially in the interval of freedom from a sub-acute attack, or in cases where the secretion in the bronchial tubes is of small amount. Although this may be the condition in youth, the disease seldom remains stationary; remissions become less marked, and permanent distressing symptoms at length supervene. When the bronchial tubes contain secretion, the perception of this condition, as a morbid state of the lungs, is easily recognizable by auscultation, though the actual diagnosis as regards complication may be more difficult. This is to military surgeons of secondary importance, since chronic bronchitis, unconnected with other associations, uncomplicated by phthisis, dilated bronchia, &c., ought to be as definitively objectionable in the enlistment of soldiers as a pleura full of fluid or a hepatized lung.

Dr. Williams remarks that phthisis "is the cause of nearly a third of the mortality in London, and not much less in Paris;" when it is borne in mind that the deaths in England, from all causes annually, are about one in fifty-one of the inhabitants, what a fearful malady this country is subject to, can be easily conjectured. I find in Mr. Marshall's book,* if those enumerated under the head "worn out" are ex

* Marshall on the "Enlisting, the Discharging, and Pensioning of Soldiers."

cluded, from January, 1825, to October, 1828, that pulmonic affections formed about a fifth of those for which men were invalided at Chatham; and it is to be observed that this return included men discharged from regiments abroad and old soldiers. Did this return solely apply to home service, it would doubtless be found that these diseases bore a much greater proportion both as to the discharges and deaths, since Dr. Cheyne, in his letter to Dr. Renny, observes, "when the number of deaths in the army from phthisis is considered, which exceeds one-third of the whole (if we take into account those who die of consumption after they are invalided), I am persuaded that the mortality from that disease in Ireland is nearly one-half, &c." The same writer then gives a return of deaths that occurred in the army serving in Ireland from January, 1818, to October, 1826; the total is 2127, of these 888 are consumption alone. Statistics relative to the causes of discharge of men under three years' service are not at present available,* but I have no doubt that affections of the lungs absorb a large proportion.

Dr. Cheyne likewise strongly urges the propriety of mediate auscultation in the examination of recruits. The cases most liable to be overlooked, or affording the most serious difficulty in detection, are those in which tubercle in the first stage is being developed. Symptoms or signs may not be appre

* These statistics are in course of preparation, and will be available for information very shortly.

ciable, and it requires practice, experience, and care, to detect the first recognizable indications in the incipient production of possibly a gradually advancing chronic disease. Here is experienced the value of accurate percussion, giving comparative or actual local results; here crepitus from irritation long before the existence of softened tubercle, is often discovered by the practical stethoscopist and recognised from peculiarity and localization, or tubercular deposition diagnosed by occasioning impediment to the vesicular murmur, modifying the amount, evenness, and rythm, or causing merely feeble respiration, or by producing changes in the vocal resonance, especially valuable in connexion with the left lung. There is no question, however, but that tubercular deposition may pertain to some degree when physical signs will not always manifest the mischief, much less declare an accurate diagnosis. Nevertheless, one of the causes of difficulty often consists not so much in the detection of actual abnormal signs in a lung as the precise specification of the disease; it is sometimes more a doubt in discrimination than an inability to discover a diseased condition.

The education that most medical men have received, and its practical application in large hospitals, will evidence to every thinking man the danger and uncertainty of these affections, and as he will have learned the means of investigation and induction, little more remains for me to add, than to strongly impress the facts, that the active duties of soldiers