WAR DEPARTMENT, PROVOST MARSHAL GENERAL'S BUREAU, Washington, D. C., January 11, 1864. Surgeon J. H. Baxter, United States volunteers, having reported for duty in accordance with Special Order No. 5, Adjutant General's office, War Department, 1864, is hereby assigned to duty as chief medical officer. JAMES B. FRY, Provost Marshal General. Upon the receipt of the above order, which created the medical branch of this bureau, I immediately opened an office in quarters assigned for that purpose. Under the previous able administration of Lieutenant Colonel R. H. Coolidge, medical inspector United States army, all medical matters pertaining to your bureau had been conducted with rare skill and executive ability. A list of diseases and disabilities, for the government of surgeons of boards of enrolment, had been prepared by a medical board, of which Medical Inspector Coolidge was president, and medical questions in regard to the formation of the invalid corps had received his assiduous care and attention. I take this occasion to express my personal and official obligations to this experienced and patriotic officer, (whose recent death has deprived the medical corps of one of its most zealous and accomplished members,) for his valuable counsel so freely tendered me in the establishment of this branch of your bureau. By personal inspection of many boards of enrolment, and by correspondence, I acquainted myself with the difficulties under which surgeons of boards labored, and by circular letters and forms for medical record books and reports issued from this branch, a uniformity of action was established, which resulted not only to the good of the bureau, but rendered less onerous and more correct the performance of the duties devolving upon the surgeons of boards of enrolment. The record books are similar to those prescribed in the pamphlet issued by the Adjutant General entitled, "Instructions for Officers of the Adjutant General's department, and others of kindred duties," ie., "Letters Received," Letters Sent," and "Endorsement and Memoranda;" and the method adopted in keeping said books has not differed in any material point from that laid down in the work referred to, which is so universally followed that I do not deem it necessary to detail it in this report. The medical reports accumulated so rapidly, and were of such size, that it was thought necessary to open a separate book in which to record their receipt. This book is entitled, "Record of Medical Reports Received." Immediately upon the receipt of the mail from the office of "general and miscellaneous business," it was opened and examined by the chief clerk of this branch, and all letters pertaining to this office, or involving medical questions, with the exception of letters of transmittal of the regular "medical reports," properly endorsed and entered in the book of "Letters Received;" after which, those letters requiring the attention and action of the chief medical officer were submitted to him, and disposed of according to his direction. The "medical reports were first entered in the "record of medical reports received," submitted to the chief medical officer, or to one of the medical officers on duty in the branch, by whom they were examined as to the medical points involved, after which they were sent to the "examining room," where they passed through a thorough examination by a corps of competent clerks, and if no errors were detected after this second examination, they were placed in wrappers and filed by States and districts to be tabulated in future. If, however, the surgeon making the report had not complied strictly with instructions previously issued, the report was returned to him through the acting assistant provost marshal general of his State, with endorsement enumerating the errors, and with directions to either forward a new report, or the original carefully revised and corrected. The stated medical reports are of two kinds, viz: "monthly medical reports," and "reports of the medical statistics of drafts," (Form 58;) the former received monthly, and the latter at the close of each draft from each congressional district. The "monthly medical reports" were made by the surgeons of boards of enrolment upon blanks furnished from this office, being copied from the "medical record books" kept by the surgeons. These reports contained a complete and minute record of the physical examination of all recruits, substitutes, drafted, and enrolled men, during each month. The following data given in the case of each man examined, will show more clearly the value of these reports, viz: Date of examination; number ditto; name; age; height; complexion; color of eyes and hair; nativity; residence; occupation; measurements of chest; white or colored; married or single; physique; and result of examination; stating also the disease or disability for which the man was rejected or exempted. "Reports of medical statistics of drafts" were rendered at the close of each draft, and were also made upon blanks furnished from this office, (Form 58.) Each of these reports comprised a series of four tables. The first table exhibited the number of drafted men of each occupation physically examined; the number exempted for each distinct disease or disability, alphabetically arranged; the number appearing before the board; also the number of each occupation exempted under each section of paragraph 85 Revised Regulations Provost Marshal General's Bureau. The second table exhibited the total number of drafted men exempted under each section of the above-mentioned paragraph, and the ratio exempted under each section per 1,000 examined. The third table, by nativities, embraced the vital statistics of all men examined under the draft for which the report was rendered; and the fourth table being a consolidation of the third. The whole number of clerks employed or detailed for duty in this branch, from its organization to the present date, is forty-two; greatest number employed at any one time, seventeen; average number employed per month, eight. A large proportion of the clerical force of this branch have been soldiers detailed from the Veteran Reserve Corps. A large majority of the citizen clerks had served in the Union army or navy previous to their appointment. Out of sixteen clerks on duty in this branch at present date, twelve have served in the army or navy, and have rendered a total of forty-two years and seven months' service, making an average of three years and six months, or an average of two years and eight months for the whole force. By a reference to schedule A, a list of all commissioned medical officers who have been on duty in this branch since its organization may be found; dates when each officer was detailed and relieved, to what duty assigned, &c. VIEWS IN REFERENCE TO THE LIST OF DISEASES AND INFIRMITIES FOR THE EXEMPTION OF DRAFTED MEN, AND CHANGES RECOMMended. The several sections of paragraph 85, in which are enumerated the diseases and disabilities for which drafted men should be exempted. have proved, as a general rule, acceptable, and but few cases have presented themselves deserving exemption which could not be classified under its requirements. Of course, no precise enumeration of all the particular diseases or disabilities which could disqualify drafted men for military service was possible, but paragraph 85 was given as a general guide, yet directing, as far as practicable, the judgment of examining surgeons. By rendering as definite as possible the list of disqualifying mental and physical disabilities, much trouble and annoyance were saved to surgeons of boards, and promptness of decision facili point out to him that the surgeon, in his decision not to exempt him from service, simply obeyed the instructions received from higher sources. Experience has proved some few alterations necessary, and I respectfully submit the following changes, which present themselves to my mind as desirable and worthy your consideration. For the purpose of making these changes the more readily comprehended, I write out in full the section as, in my opinion, it should read after all amendments: SECTION 1. No change. SEC. 2. No change. Paragraph 85. SEC. 3. Epilepsy. For this disability the statement of the drafted man is insufficient, and the fact must be established by the duly attested affidavit of a physician in good standing, who has attended him in the disease within six months immediately preceding his examination by the board, or in default of such evidence, the affidavits of at least three respectable citizens who have seen him in a convulsion within six months, and have personal knowledge of his being subject to repeated attacks. SEC. 4. Paralysis, general or of one limb or chorea; their existence to be adequately determined. Decided atrophy or hypertrophy of a limb. SEC. 5. No change. SEC. 6. No change. SEC. 7. No change. SEC. S. No change. SEC. 9. No change. SEC. 10. No change. SEC. 11. Chronic rheumatism, involving change of structure or distortion. SEC. 12. Total loss of sight of either eye; cataract of either eye; loss of crystalline lens of either eye. SEC. 13. Partial loss of sight of both eyes, vision being so greatly impaired as to leave no doubt of the man's inability to perform military duty. Serious permanent diseases of the eye or eyelids, so manifestly affecting the use of the eyes as to leave no doubt of the man's incapacity for military service. Nearsightedness does not exempt, unless excessive and confirmed. SEC. 14. Loss of nose; deformity of nose so great as seriously to impede respiration; ozaena with caries. SEC. 15. Decided deafness, dependent on organic change, or proved by other satisfactory evidence, so decided as to leave no doubt of the man's unfitness for military service. Chronic purulent otorrhoea. SEC. 16. Incurable diseases or deformities of either jaw, which greatly ímpede mastication or speech-anchylosis of jaw; caries of the bones of the face, if in progress; cleft palate, (bony;) extensive loss of substance of the cheeks, or salivary fistula. SEC. 17. No change. SEC. 18. Loss of tongue, or diseases thereof sufficient to interfere seriously with the use of that organ. SEC. 19. No change. SEC. 20. Loss of a sufficient number of teeth to interfere seriously with mastication. SEC. 21. Tumors or wounds of the neck, impeding respiration or deglutition. Torticollis, if of long standing and well marked. SEC. 22. Deformity of the chest, curvature of the spine, or caries of the spine, ribs, or sternum, sufficient to prevent the carrying of arms or military equipments. SEC. 23. Hernia, except small umbilical. SEC. 24. Artificial anus, stricture of the rectum, prolapsus ani, fistula in ano, if extensive or complicated. SEC. 25. Old and ulcerated internal or external hemorrhoids, if in degree sufficient to leave no doubt of the man's unfitness for military service. SEC. 26. Loss of penis; epispadias or hypospadias. SEC. 27. Chronic organic stricture of the urethra, which seriously impedes the passage of urine, or which is complicated with disease of the bladder, urinary fistula. Recent or spasmodic stricture of the urethra does not exempt. SEC. 28. Incontinence of urine, stone in the bladder, or gravel, ascertained beyond doubt, absolutely disqualifies. SEC. 29. Confirmed or malignant sarcocele; hydrocele, if complicated with organic disease of testicle. Varicocele is not disqualifying, unless excessive and severe. SEC. 30. No change. SEC. 31. No change. SEC. 33. Loss of right thumb. Loss of third phalanx of all the fingers of either hand. Loss of index and middle finger of same hand. Permanent extension or contraction of two fingers of either hand. All the fingers adherent. SEC. 34. Permanent defects or deformities of the feet, such as will necessarily prevent marching. SEC. 35. No change. I respectfully recommend that paragraph 87 should be amended to read as follows: The surgeon of the board of enrolment will keep three medical record books, in which he will record the following results of his examinations of all men he may inspect 1st. Of drafted men.-Date of examination, number, name, where drafted, (town or county,) age, nativity, occupation, height, weight, color of eyes, hair, and complexion, chest measurements at inspiration and expiration, married or single, white or colored, and result of examination. He will also record under head of remarks, if exempted, the disease or disability for which exemption was granted; if not exempted, the disease or disability for which exemption was claimed. 2d. Of carolled men the same, except "where enrolled" (town and county,) in place of "where drafted." If stricken from the enrolment lists, state under head of remarks the particular disease or disability for which the enrolled man was found unfit. If not stricken therefrom, the disease or disability for which he claimed unfitness. 3d. Of recruits and substitutes.-Date of examination, number, name, age, nativity, occupation, height, weight, color of eyes, hair, and complexion, chest, measurements at inspiration and expiration, married or single, white or colored, recruit or substitute, and result of examination. Under remarks, if rejected, state the reason why; if accepted, record some mark or scar which may be on his person by which he may hereafter be identified. The surgeon of the board of enrolment will also forward a monthly medical report of the drafted and enrolled men and recruits and substitutes he has examined. This report will be a copy of the medical record books above enumerated, and will be forwarded in duplicate the first day of each month; one copy direct, and one copy through the acting assistant provost marshal general. Immediately on the completion of a draft in any district, the surgeon of the board of enrolment will compile and forward to this office the statistics of the causes of exemption on account of physical or mental disability from such draft pro ment of such other facts as may be of scientific importance to the medical fession. This report will also be forwarded in duplicate, one copy direct, and one copy through the acting assistant provost marshal general. In the keeping of his records and preparation of reports, the surgeon of the board will be entitled to a clerk, whenever the services of one may be necessary. MEDICAL EXAMINATION OF MEN FOR MILITARY SERVICE AND FRAUDS TO BE GUARDED AGAINST. The medical examinations of men for the military service were made in a large, well-lighted room, where they could be exercised briskly, and with the windows so arranged that the light fell equally upon every portion of it. Upon entering the room the recruit, substitute, or drafted man was directed to divest himself of all his clothing. This was usually done in the presence of the surgeon, for this reason: that he was not then expecting to be noticed, and should he feel disposed to conceal any existing defects, as stiff joints, &c., he. would in this way be thrown off his guard, and the attempted fraud at once detected without further examination. He was first questioned in regard to his name, age, nativity, occupation, his general health and that of his family, whether any hereditary taints existed, and if he had ever suffered from any disease or accident, and if so, what; thus endeavoring to obtain all the information possible concerning him, and at the same time enable the surgeon to judge of his mental as well as his physical qualifi cations. He was then placed under a stationary measuring rod, directed to stand erect, while his height was accurately noted, and a graduated tape was passed around the chest over the inferior angles of the scapula, and directly over the nipple, and the measurement taken both at inspiration and expiration. After this the color of the eyes, hair, and the complexion were noted, and a general inspection of the whole body was now made, noticing the muscular development and general appearance, at the same time looking carefully for any tumors, ulcers, varicose veins or chronic swellings of the extremities, or any defect that could disqualify him for the service. The head was then examined for any depressions or irregularities that might exist; the eyes, eyelids, ears, nose, teeth, palate, and fauces, carefully noticed. The chest was then inspected, respiration and the action of the heart observed, and anything that could be discovered by inspection, auscultation or percussion, noted. He was next directed to stand erect, place his heels together, and raise his hands vertically above his head, the backs together, and was told to cough and make other expulsive movements, while the abdomen, inguinal rings, and scrotum, were examined for hernia; the penis was then examined for epispapadia, hypospadia, and venereal disease; the groin for glandular enlargements, and the testicles for atrophy, induration, or other diseases. He was then directed to bend over, the fingers touching the floor, the legs straight and widely distended, and separating the nates, the fissure, for hemorrhoids, fistula, prolapsus, or any disease of the anus, was carefully inspected; and while in this position, firm pressure was made on different portions of the spine to discover any disease or tenderness, if such existed. Next he was directed to extend his arms straight from the body, and then bring them together on the same level, behind and in front, pronate and supinate them rapidly, strike-out from the shoulder, flex the arm upon the shoulder, and the forearm upon the arm, and open and close the fingers rapidly. In this way almost any defect of the upper extremities were discovered. He was then told to walk rapidly, and then to run around the room several times, hop first on one foot and then on the other, with his heels together to |