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Chapter I

Medical Statistics of the United States Army, Calendar Year 1954

PART ONE

Analysis of the Health of the Army
and
Army Medical Service
Activities


DEATHS FROM DISEASE AND NONBATTLE INJURY, U. S. ARMY, 1819-1954


CHAPTER I

Summary

The year 1954 was characterized by two major circumstances which affected the health and medical care of the Army. First, it was a peacetime year in which the size of the Army and of the wartime medical load was declining; and second, it was a year of unprecedentedly low levels of morbidity and noneffectiveness due to disease and nonbattle injury. These two dominant themes, singly or together, were reflected in diverse measures—in the lowered number of hospital beds in operation, in the decreased number and rate of disability separations, in the lowered morbidity and mortality rates, in the diminution in the numbers of persons inducted into the Army, and in decreased numbers of Army Medical Service personnel.

Admissions

Army personnel were admitted for medical treatment in 1954 at a rate of only 325 admissions per 1,000 strength per year. This was 18 percent below the 1953 nonbattle admission rate—the lowest admission rate on record in a series of data extending back for 135 years. The rate was low both for disease and for nonbattle injury; there were, of course, no admissions for battle injuries and wounds in 1954. The disease admission rate dropped much more sharply (20 percent) than did the injury admission rate (7 percent), but the latter rate also reached an alltime low.

A major factor which contributed to the sharp decline of the disease admission rate was a 31 percent drop in the rate of admission for acute respiratory infections. These conditions, many of them relatively minor, account for a large proportion of the admission rate; in 1954 they caused about one-third of all disease admissions. Of the rates for the three groups of diseases which, after acute respiratory infections, are the largest components of the total disease admission rate, those for infective and parasitic diseases and diseases of the skin declined by about 15 percent, while the rate for the third, diseases of the digestive system, remained unchanged.

The 325 admissions to medical treatment on an excused-from-duty basis among each 1,000 average strength did not include any of the patients treated solely on an outpatient basis, whether or not these patients were carded for record only. About 60 percent of these admissions represented admissions to a hospital or infirmary, while the remainder were treated on an excused-from-duty basis in quarters or dispensary. This proportion was about the same


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as in 1953; thus the admission rate for patients treated both in hospitals and in quarters declined.

The admission rate was higher for enlisted personnel than for officers. It was higher among persons with less than 6 months of service, particularly among recruits with less than 3 months of service, than among more seasoned troops, although the rate gradually rose again with increasing length of service, after being lowest for the group with 6 to 12 months of service. Admission rates for female personnel in the Army were significantly higher than those for male personnel even after allowances had been made for certain conditions peculiar to women. The admission rates for Negro and for white personnel were substantially the same. The oversea areas generally experienced higher rates of admission than were recorded among troops in the United States.

Although some of the 1954 admissions had not been disposed of by the end of the year, it is possible to examine the total number of cases disposed of during the year (including some on hand at the beginning of the year) to determine what proportions of the final dispositions were returns-to-duty. Approximately 95 percent of all patients admitted to hospitals and infirmaries and about 97 percent of all admissions for any excused-from-duty treatment were returned to duty.

Outpatient Care

Army personnel received outpatient care at about the same rate in 1954 as in the preceding years (between 8 and 9 outpatient treatments per person, on the average). This reflects the counterbalancing effects of generally reduced morbidity, tending to lower the rate, and continued emphasis on the policy of treating cases on an outpatient basis when feasible (rather than on an excused-from-duty basis), tending to increase the rate. Since the strength of the Army was lower in 1954, the total number of outpatient treatments given to Army personnel was also reduced. Some increases occurred in the number of outpatient treatments which Army medical treatment facilities rendered to dependents and certain other categories of non-Army personnel. These increases were more than offset by the fact that there were, of course, no treatments administered to enemy prisoners of war, so that the total number of outpatient treatments given at Army medical treatment facilities was 8.6 percent lower in 1954 than it had been in 1953.

Noneffectiveness and Average Duration

The noneffective rate in 1954 was only 14; that is, on the average day there were 14 persons per 1,000 strength excused from duty due to disease, nonbattle injury, or battle injury or wound. Of this number, 11 were excused from duty because of disease and about 3 because of nonbattle injury; battle injuries and wounds accounted for only 0.26 persons excused from duty per 1,000 average strength. This noneffective rate of 14 was the lowest ever recorded for the United States Army. The 1953 rate was 18, with and 20 without the inclusion of battle injuries and wounds—on either basis the lowest rate recorded up to


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that year. The 30 percent decrease in the all-causes rate in 1954, as compared with 1953, was due partly to reduction in the battle casualty patient load, partly to decreased rates of admission for nonbattle injuries (to an even greater extent for disease), and partly to decreases in the average duration of the disease and nonbattle injury cases admitted.

The average duration of a nonbattle case was 16 days in 1954. This figure is based on only the cases which were admitted to excused-from-duty treatment; when cases carded for record only are included in the computation, the average is 14 days per nonbattle case. The comparable 1953 figures were 17 and 14, respectively. The average duration based on excused-from-duty cases thus decreased slightly. Disease cases averaged 15 days per case and nonbattle injuries 22 days per case, to make the combined average duration of 16 days for excused-from-duty nonbattle cases.

Mortality

The frontispiece, showing death rates in the Army during the past 135 years, by year, for disease and nonbattle injury causes, indicates how great the decline has been in this period. It also shows that this decline has been far greater for disease deaths, which throughout the first century of this period had exceeded deaths from nonbattle injuries; in recent years, nonbattle injury has caused many more deaths than disease.

There were about 2,100 deaths in the Army in 1954, less than half the number in 1953. Most of this decrease reflects the fact that 1954 was a peacetime year, whereas the deaths in 1953 included those due to battle injuries and wounds. However, both the numbers and rates of deaths due to nonbattle causes decreased. The death rate for disease dropped over 15 percent, and that for nonbattle injury declined 18 percent. As in other years, nonbattle injuries accounted for about three-fourths of the nonbattle deaths. This difference in relative fatality is seen to be more marked when it is recalled that nonbattle injury admissions made up only 15 percent of the admissions. About half of the nonbattle injury deaths, 759 out of 1,543, were due to motor vehicle traffic accidents. This constituted more than one-third of the deaths from all causes—far more than from all diseases combined.

Separations

The number of disability separations in 1954 was about 37 percent lower than in 1953. This reflects the decreased strength of the Army, with the concomitant decline in new accessions, as well as the further reduction in the number of battle injury and wound patients. Of the approximately 14,000 disability separations reported, only some 800 were due to battle causes, about 2,000 were due to nonbattle injuries, and about 11,000 were due to disease. While both absolute and relative numbers of separations for all causes declined sharply in 1954 as compared with 1953, the decline reflects a sharp drop in separations due to disease rather than in separations due to


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nonbattle injuries. More than half (7,424) of the 14,053 disability separations in 1954 represented separations without severance pay, due almost entirely to conditions which had existed prior to service. There were 2,695 permanent retirements, 2,448 persons were placed on the Temporary Disability Retired List, and the remainder (1,486) were separated with severance pay. About one-fourth of all the disability separations were due to psychiatric conditions (largely psychotic disorders) and about the same proportion were due to diseases of the bones and organs of movement (including many residuals of injury). Infective and parasitic diseases (largely tuberculosis) accounted for about 10 percent and diseases of the circulatory system for about 8 percent of the disability separations.

General Considerations

Most of the data in this report pertain to the health of the Army. These data represent the medical care experience of a population comprising, on the average, about 1.4 million persons, about 7 percent fewer than in 1953. This population was made up predominantly of young males; less than 1 percent of Army personnel were women. Over 60 percent of the total population fell in the age group from 20 to 24 years of age; 9 percent of the total population were officers. Negroes constituted 13 percent of the total population.

The report also presents data on a number of other related subjects. These include information on Army Medical Service personnel, dental care, veterinary care, medical care workload at Army medical treatment facilities, medical care provided to other than active duty military personnel, and the results of examinations given to Selective Service registrants. An appendix provides information concerning sources, definitions, and methodology.