limbs are now made with such skill and adaptation of means to the end that a maimed soldier provided with one is capable of very useful service in the second battalion.

CLASS EIGHTH.

SKIN AND APPENDAGES.

AFFECTIONS of the skin demanding discharge must be "inveterate and extensive." These adjectives are meant to apply to incurable skindiseases not only extensive, but repulsive and accompanied by serious affections of the organism.

GUNSHOT WOUNDS.-The proportion of discharges for gunshot wounds amongst the discharges for all causes has been, in the statistics I have examined, 10 per cent. The extent to which these lesions disabled varied greatly, ranging from the loss of a little finger to the loss of a lower extremity at the upper third.

Gunshot wounds of the head involving the cranium usually require discharge; for serious impairment of the faculties, or nervous and spasmodic symptoms, frequently follow such

lesions. Wounds of the chest, not implicating the organs, do not disqualify for service in the invalid battalions, and if flesh wounds merely do not disqualify for field-service. Gunshot fracture of clavicle, and fracture of ribs, followed by necrosis, unfit for field-service. Wounds of the lungs disqualify for field-service and for the first battalion of the Invalid Corps, but not for the second, unless followed· by collapse of lung, empyema, or similar important lesions.

Gunshot wounds of muscular wall of the abdomen, if considerable in extent, require admission into the invalid battalions. Penetrating or perforating wounds with lesion of the intestine, although usually fatal, are not invariably so. They require discharge.

Wounds of genital and urinary organs are disqualifying according to the extent of injury. Loss of both testes unfits for field-service. Injuries of urethra producing epispadia or hypospadia, or loss of more than half of the penis, require discharge.

Simple flesh-contusions and wounds of upper and lower extremities are apt to result in "muscular contraction, and consequent loss of use and power in the arm, resulting from the patient's keeping the wounded limb in one

particular position for months. This system of nursing their wounded limbs is brought about by trying at first to save themselves pain on any attempt at motion being made, and also from an idea that if they are invalided for a wound received in action they will be granted a higher pension than for any other disability."*

These remarks are applicable in their fullest significance to the wounded in our service. Previous to the organization of the Invalid Corps, large numbers of discharges were granted for these muscular contractions. At present many of these cases require admission into the Invalid Corps, or discharge; but before going beyond the control of the surgeon they should be subjected to the very excellent plan of treatment recommended by Williamson.† Wounds involving the bones are much more serious. In addition to the muscular contractions, there is the impairment of use and motion due to loss of substance of the bones. character of service to which these men may be assigned in the invalid battalions, as well as the question of discharge, will be determined by the extent of the injury and the degree in

The

* Williamson, Wounded from the Mutiny in India, p. 51. Churchill, London, 1859. † Ibid.

which it impairs the use or functions of the part.

I have entered into this subject of the causes of discharge from the military service, considered relatively to the degree in which they incapacitate for service, in a very cursory manner, because in the first section of this work the disqualifications for military service, in that proper and enlarged sense in which this term is used, have been fully given, and because the Invalid Corps-a creation of the present war, not yet complete in the details of its organization-may have no permanent place in the military establishment. Moreover, the General Orders of the War Department, so freely quoted in this part of my work, present in very full and complete expression the details of this subject, rendering it the less necessary for me to enlarge upon it.

CHAPTER VI.

MODE OF DISCHARGING.

THERE is a very prevalent and mischievous theory abroad that a man otherwise a proper subject for discharge may, if he feel so inclined, refuse his discharge, and continue to draw his pay and allowances without rendering an equivalent to the Government. If the case be a suitable one for the exercise of his power, it is not less clearly the duty of the surgeon to recommend the discharge than it is his duty not to make his certificate until he have positively ascertained the existence of the disability. The necessity of ascertaining the willingness of a man to be discharged is devolved, by the law of 1862, only upon the Medical Inspector-General and medical inspectors. With regimental and staff surgeons it is only a question of the good of the public service. If there be those in the general or regimental hospital unfit for further military service in any capacity, there can be no question as