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Analysis of the Health of
Medical statistics pertaining to active duty Army personnel are available for a period of more than a century. Among the most frequently used measures of health of Army personnel are the admission rate and the noneffective rate. The former shows the relative number of admissions to medical treatment in the year; the latter indicates the relative number of persons excused from duty because of illness or injury on the average day in the year. On both of these bases the year 1953 was one of the healthiest on record for Army personnel.
Prior to 1900, admission rates in the Army had always been above 1,000 per thousand per year; in other words, admissions occurred at an average rate of something over one per man per year. The trend of the rate had been downward, however, with interruptions during periods of wars. In wartime, in addition to admissions from battle injuries and wounds, the rate of admission from nonbattle causes shows marked increases. This downward trend continued after 1900 and, during the latter part of the period between World Wars I and II, the rate reached new low levels of between 500 and 600 per 1,000 per annum. By contrast, the admission rate in calendar year 1953 was only 482 per 1,000 per annum for all causes, including a small component of battle injury and wound admissions (not quite 7 per 1,000).
The admission rates referred to above relate largely to the numbers of persons either patients in hospital or infirmary or else excused from duty as patients in a dispensary or in quarters. They do, however, include a small fraction of the cases who were treated as outpatients and were carded for record only (CRO), largely venereal disease cases in recent years. If CRO cases are excluded, the 1953 admission rates become only 396 per 1,000 for all nonbattle causes, 343 for all diseases, and 53 for all nonbattle injuries.
The 396 admissions of Army personnel per 1,000 average strength in 1953 were all treated on an excused-from-duty basis, some in hospitals or infirmaries, some in dispensary or quarters. Admissions to hospitals and infirmaries made up not quite 60 percent of the total Army nonbattle admissions to excused-from-duty treatment. This proportion is based on all nonbattle cases; it, of course, varies markedly with individual diagnoses.
The biggest cause of admission for Army active duty personnel was acute respiratory infections This group of diseases, largely common cold, acute
pharyngitis, and acute tonsillitis, accounted for nearly one-third (130) of the total 421 admissions per 1,000 average strength for all diseases. The second group, infective and parasitic diseases (see source table 1 for inclusions), had a rate of 91 per 1,000 strength, 65 of which was due to venereal diseases, almost entirely CRO cases. Diseases of the digestive system and hernia accounted for 32 admissions per 1,000 strength in 1953, of which the hernia component was 5. Diseases of the skin and cellular tissue (rate of 26 per 1,000) and diseases of the urinary system and male genital organs (24) were other important causes of admission. These five groups of diseases accounted for 303, or 72 percent, of the 421 admissions per 1,000 strength for all diseases.
Admission rates for Army personnel showed marked differences by geographic area. In general, oversea areas had higher rates of admission, both for disease and for nonbattle injury. In 1953, the admission rate for disease in continental United States was 380 per 1,000 compared with 463 for all oversea areas; the corresponding nonbattle injury rates were 47 and 64. Individual oversea areas varied considerably, with the highest rate for disease that reported for Japan (565), and the highest nonbattle injury rate that reported for Korea (73 per 1,000). This overall variation in disease admission rates was, of course, the result of many variations in separate diagnostic categories. Table 3 in the basic source tables shows the pattern of this variation for a great number of specific diseases and groups of diseases.
Noneffectiveness and Average Duration
The noneffective rate for Army personnel was only 18 per thousand average strength noneffective for all nonbattle causes on the average day in 1953. This is the lowest noneffective rate ever recorded for the Army. During the period from the Civil War to shortly before World War I, the nonbattle noneffective rate was generally around 50 per thousand, rising in periods of war. Between World Wars I and II, the rate was in the neighborhood of 30 per thousand, giving rise to the rule of thumb of “3 percent of the command noneffective from medical causes.” After going above 40 in World War II, the nonbattle causes noneffective rate dropped to 21 in 1949, rose following the outbreak of conflict in Korea to above 25 in 1951, and declined to a new low of 18 in 1953.
Battle injuries and wounds produced a noneffective rate of less than 2 persons per thousand average strength in 1953. Of the all-causes noneffective rate—approximately 20 per thousand—battle causes accounted for about 10 percent, diseases about 75 percent, and nonbattle injury 15 percent. The following five groups of diseases accounted for over 60 percent of the noneffectiveness due to disease: infective and parasitic diseases, acute respiratory diseases, neuropsychiatric conditions, diseases of the digestive system and hernia, and diseases of the bones and organs of movement.
The extremely favorable admission rates and noneffective rates experienced in 1953 doubtless result from numerous factors. In addition to advances in
therapeutic medicine and in the area of preventive medicine, there has been increased emphasis on expeditious disposition of patients and increased use of outpatient treatment in instances where patients might otherwise have been excused from duty. Many of these effects cannot be measured precisely as to their contribution to the observed reductions. However, some related measures give an indication of the effect. Thus, the outpatient treatment rate has increased considerably during the last few years; it was 1,850 per thousand average strength per year in 1953, more than 15 percent higher than a few years earlier. To some extent, the increase in this rate reflects patients being treated as outpatients rather than as excused-from-duty patients. Another index, relevant to the noneffective rate, is the average duration, or length of stay, of the patient. The noneffective rate is a function of the admission rate and the average duration. There has been some decrease in the average duration per case in recent years and this too has contributed to the reduced noneffective rate.
Data on average durations vary greatly with the group of cases studied. Thus, disease cases have an average duration approximately one-half that of injury cases, and cases separated for disability have an average duration approximately twelve times that of cases returned to duty Similar differences are observable as one further refines the group studied; thus, for example, the average duration of cases of acute gastroenteritis was three days per case; of schizophrenia, 149 days per case; and of all forms of tuberculosis, 299 days per case.
The noneffective rates that have been quoted relate to all noneffectiveness resulting from persons being excused from duty for medical treatment; thus, they represent the total time lost due to disease or injury. While most of the time lost represents a period while the person was an excused-from-duty patient at an Army hospital or infirmary, a portion of this total noneffective rate (less than 10 percent) represents time lost as an excused-from-duty patient in quarters only, or in dispensary. In other words, the hospital noneffective rate based on all patients remaining in hospital on the average day was 18.2, compared with the 19.8 total noneffective rate. Even this lower rate, it should be recognized, is not produced solely by patients occupying beds in hospitals or infirmaries, but includes patients who are on leave from hospital as well. If a noneffective rate for patients occupying beds is computed for 1953, the rate is still further lowered to 15.7 per thousand strength.
Only about one-fourth of the nonbattle deaths occurring among Army personnel in 1953 were due to disease. Nonbattle injury produced just over 2,000 deaths in the year, compared to about 700 due to disease. Motor vehicle accidents accounted for nearly half of these nonbattle injury deaths. There were some 200 deaths among battle casualties admitted to medical treatment facilities. When killed in action, prisoner deaths, etc., are considered, the total
number of battle casualty deaths becomes more than 2,000. Although the fighting ceased in July, battle causes accounted for the largest number of deaths during the year. The death rate for nonbattle causes was higher in the United States than overseas, due largely to the higher rate of deaths from nonbattle injuries (146 per 100,000 in the United States, compared with 119 overseas).
Separations for Disability
Not quite 22,500 persons were separated for physical disability during 1953. Of these, nearly 20,000 were separated for nonbattle causes and about 2,500 for battle causes. The basic tables present data on age, rank and race, length of service, and specific diagnostic cause of disability separation for the disability separations reported to the Office of The Surgeon General. They also show that about 7,500 retirements for disability took place with two-thirds of them being permanent retirements and one-third being placements on the temporary disability retired list.
The data in this report pertaining to the health of the Army reflect the experience of a group comprising, on the average, one and one-half million persons. This population was distributed throughout many parts of the world. The population was predominantly male (99 percent) and about two-thirds of the persons were between 20 and 24 years of age. Less than 2 percent were 45 or more years of age. Negroes constituted about 15 percent of the total population; officers made up about 10 percent. The strength remained relatively stable through the period; there were roughly three-quarters of a million accessions, balanced by about the same number of separations.
The experience of this year is, of course, somewhat unique in that it represents a year in which combat occurred for a part, but not for all, of the period. This had an effect on the morbidity experienced due to nonbattle as well as to battle causes. Other events related to the fighting, e.g., the exchanges of prisoners that took place also affected the experience in this period. There were no outstanding peculiarities of the year as far as morbidity experience was concerned. Disease incidence of respiratory conditions was relatively high in comparison with recent years. Various conditions which have, from time to time, presented unusual problems of incidence (psychiatric conditions, malaria, venereal disease, infectious hepatitis, for example) were not particular problems in this year.
Other portions of this annual report present data on a number of subjects related to Medical Department activities. These include treatment provided battle casualties, medical treatment facilities workload by type of patients, Army Medical Service personnel, dental care, veterinary care, results of examinations given Selective Service registrants, and medical care provided non-Army personnel. An appendix provides information concerning sources, definitions, and methodology.