The principal object of the surgeon, in the examination of recruits or drafted men, is not to select what is in every way good, but to reject what is absolutely unfit.* In a general view of a nation, excluding the two extremes of age, it would appear that all men have the physical capacity for soldiers; but, when examined in detail, a large percentage are discovered with disqualifying defects fatal to their efficiency. A drafted man, wishing to escape the just obligation imposed by the Government, may feign or produce a disease to be exempted, and a volunteer may dissimulate one to be accepted. The purpose of the examining surgeon, therefore, seems to be to discover disqualifying defects, and to determine, negatively, the fitness of a man for the life of a soldier before he enters upon the consideration of the positive qualities of development, symmetry, and general aptitude. Whilst the French, as also the Prussian, regulations are calculated to obviate the simulation of defects, and the English to prevent fraud by the dissimulation of infirmities, ours should be directed to the accomplishment of both these objects. According to this view of the subject, it is obviously most proper to commence a * Jackson. Economy, Discipline, and Formation of Armies. treatise on enlisting and discharging soldiers with an account of disqualifying infirmities, whether mental, moral, or physical. A great deal of repetition is avoided by this arrangement; for a disqualification which would exempt a man from draft, or for which he would be rejected if a recruit, or which he might simulate or dissimulate, is usually a cause, real or pretended, for discharge from service. Assuming this view to be correct, I shall consider 1. Real disqualifications for military service, comprised in three classes: mental, moral, physical. 2. Pretended disqualifications; which will constitute a separate section on feigned diseases. 3. Qualifications of recruits, and enlisting soldiers. 4. Discharging soldiers. The list of diseases and infirmities which disqualify for military service, contained in the regulations of the Bureau of the ProvostMarshal General,* being an official and authoritative statement on the subject, each of the diseases or infirmities therein enumerated will be placed at the head of the corresponding class in the following arrangement. * Regulations for the Government of the Bureau of the Provost-Marshal General of the United States Washington, 1863. 1 SECTION I. REAL DISQUALIFICATIONS FOR MILITARY SERVICE. CHAPTER I. MENTAL INFIRMITIES THAT DISQUALIFY FOR MILITARY DUTY. MANIFEST IMBECILITY OR INSANITY. THE disqualifications under this head, except as feigned diseases, rarely come under the observation of the examining surgeon, or Board of Enrolment. The more distinctive forms, as Acute Mania, Monomania, Melancholia, &c., are sufficiently well characterized; but there are disqualifying mental states much more obscure, which require close observation and knowledge of the signs, symptoms, and pathology of insanity, to be detected with certainty, especially in the incipient stages. I need hardly observe that any of the forms of mental alienation mentioned above, as also Idiocy, Cretinism, Imbecility, and Dementia, constitute absolute disqualifications for military service. Between these well-marked states and that degree of intelligence sufficient for the soldier there are numerous gradations and varieties. The term imbecility of mind is usually employed by writers on the subject of enlisting soldiers, and intended to apply to Idiocy, Imbecility, and Dementia, rather than to the higher types of Insanity. Idiocy is a congenital condition; Cretinism, although not to be diagnosed usually at birth, is hereditary; Imbecility is a minor degree of mental deficiency than idiocy; and Dementia is the result of diseased action supervening upon a healthy mental state, or a sequel of more acute forms of mental derangement. In the lower forms of idiocy the functions of animal and organic life are greatly impaired: the idiot is below the plant, and is scarcely alive to external impressions.* Cretinism is not frequently seen in this country; and it is scarcely necessary to enter into a description of it. Hitherto it has * Manual of Psychological Medicine: Bucknill & Tuke, page 103. existed mainly in Switzerland, Valais, Savoy, Italy, and Piedmont, where it is endemic; but it is also sporadic, "an occasional case being found, presenting the characteristics of genuine Cretinism, in the cities of various countries." A very well-marked case is now in the Fort Schuyler General Hospital. Imbecility of mind is a term admitting of wide application. From the highest to the lowest order of mental soundness there are an infinite number of degrees of intelligence. The same variations are found in mental deficiency. It is not always easy, in a given case, to determine whether the intelligence is, or is not adequate to the performance of military duty. In the lower forms, imbeciles produce nothing, and all their movements, both intellectual and moral, are aroused only by impulses from without. They reply correctly; but they must not be asked too many questions, nor required to make responses which demand reflection or are contrary to their habits. Others display considerable shrewdness, and are constantly indulging in jokes: they pass for half-witted people, whose droll behavior and ready repartees create amusement. Imbeciles possessing * Esquirol. Maladies mentales, p. 452. |