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SICKNESS AND MORTALITY IN THE ARMY.

BY JOSEPH R. SMITH, A. M., M. D., Brevet Colonel and Surgeon U. S. A., Medical Director, Department of Texas.

Has State Medicine progressed within the past four years? and has its progress been marked by a diminution of disease and death? It has struck me that some light might be thrown on these questions by a study of the figures from the SurgeonGeneral's office.

The figures analyzed represent the mean strength of the Army; the number of cases of men reported as taken on the sick list from disease alone (that is, excluding wounds, accidents, and injuries); and the mortality from disease alone.

These figures commence with the year ending June 30, 1871 (that is, the fiscal year beginning July 1, 1870); and this particular year has been chosen by me, because in July, 1870, new directions were published by the Surgeon-General, defining and changing the character of cases thereafter to be included in the monthly reports of sick and wounded made by attending surgeons. Previous to that date, reports of sick and wounded included cases at the discretion of the surgeon. Accordingly, if a soldier presented himself with, say, a tape-worm or a venereal sore, not, in the judgment of the attending surgeon, requiring for its treatment admission to hospital, or neglect of duty, he was by many medical officers reported. While on the other hand, if the soldier was excused, say, from evening parade, for awkward handling of his musket, due to slight soreness of the skin, disappearing in a few hours, many medical officers failed to report this as a case of disease.

In July, 1870, the Surgeon-General established a new standard for reports. He directed that all cases excused by the surgeon from any duty on account of disease, should be embraced in the monthly reports of sick and wounded, and those cases only. Every case of disease was to be excluded from these reports, if the sufferer was not excused by the surgeon therefor from some duty.

The reports for the year ending June 30, 1871, were the first made conformably to this rule, which has been observed in all subsequent reports.

In the table below, cases of disease alone are embraced; all cases and deaths from wounds, injuries, and accidents being excluded.

Further, each year, as reported in figures, is the year ending June 30th of the year designated by the figures.

The second and third columns give the number of cases taken on sick report per thousand of mean strength of white and colored troops separately, and the fourth column gives the same for the whole army.

The fifth and sixth columns give the deaths per thousand of mean strength for white and black troops separately, while the seventh column gives the same for the whole army.

The eighth and ninth columns give the number of deaths of white and colored troops, respectively, per thousand of cases of sickness reported, and the tenth column gives the same for the

whole army

The figures in the last three columns bear perhaps rather on therapeutic than preventive measures.

The eleventh column gives the mean strength of the army

each year.

During the years indicated, no epidemic prevailed among the troops to a degree sufficient to seriously affect the percentage of sickness or the death rate.

Nor does any constant relation appear in the figures between the exposure of the troops in campaigns or marches and the prevalence of disease, fatal or otherwise.

It is, of course, possible that a very close examination of the movements and history of each man might disclose some intimate connection ; but, so far as appears from a general surrey, the average exposure of the soldiers to such noxious causes as produce the disease and death here treated of, was about the same for each year included in this report. Their difficulties and facilities of living were about the same.

TABLE

SHOWING THE SICKNESS AND MORTALITY IN THE ARMY OF THE UNITED STATES

DURING THE YEARS 1871-'81, INCLUSIVE,

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Analyzing the foregoing figures, an examination of the second column shows that among the white troops a greater proportion were taken sick in the year ending June 30, 1871, than in any other year. In every thousand of mean strength, 1,863 were taken sick; that is, every white soldier in the army was taken sick almost twice.

In the year 1878, the smallest number were taken sick, namely, 1,270 per thousand of mean strength, and from 1871 to 1878 the decrease in the proportion of cases taken sick was constant and quite uniform. In 1879 the number increased to 1,505 per thousand, from which it scarcely varied in 1880 and 1881; and, indeed, the proportion of cases taken sick during the years 1874, 1875. 1876, 1877, 1879, 1880, and 1881 presents but slight variation.

The third column gives the number per thousand taken sick among the colored troops, and a marked difference appears between this column and the second. Among the blacks the proportion of sick appears the least in 1871, being but 1,137 per thousand, or less than reported among the whites for any one year. The maximum among the blacks, not quite as great as that reported in 1871 among the whites, occurred in 1877, and equaled 1,821 per thousand.

From 1871 to 1877 the number of cases of sickness among the colored troops, instead of decreasing with considerable regularity as among the whites, increased with much regu

* For whole period of eleven years.

larity, while among the blacks less uniformity than among the whites exists as regards the number of sick in the latter years embraced in this table.

During the period of eleven years here considered, the number of sick per thousand among the colored troops was slightly less than among the whites; the number among the blacks being 1,498, among the whites 1,551 per thousand.

Turning now to the fifth column, it appears that the number of deaths from disease per thousand of mean strength of white troops was greatest in 1871, being 12.36 per thousand, and decreasing, like the figures in the second column, with considerable regularity until 1878, when but 5.82 deaths per thousand are reported. The proportion of deaths occurring in 1878, 1879, 1880, 1881, varied but slightly, and is decidedly less than in the first seven years of the table.

The minimum of deaths per thousand reported in the sixth column, among the colored troops, was 7.23, and is reported for 1877, which year, by the third column, appears to have been the year when the greatest number of cases were taken on sick-report among troops of African descent. 18.25 (eighteen and a quarter) per thousand is the maximum of deaths reported among the colored troops, and for the year 1873.

The proportion of deaths among the colored troops, in different years, varied more than among the whites; but upon the whole was considerably less in the last six years than in the first five of the time here reported upon. The mortality among the whites was less than among the blacks, during these eleven years, in the proportion of 845 to 1,104.

The eighth and ninth columns give the number of deaths per thousand of cases treated. These figures show that less sick were cured among the blacks, and more cases died. The proportion of such deaths among the whites to those among the blacks was as 545 to 761. Among the white troops the number of such deaths in the years 1871 and 1872, was, respectively, 6.63 and 6.65 per thousand of cases treated; and from 1872 the proportion quite uniformly diminished until 1880. In this year the number of such deaths was 3.75, and in 1881 the number was 4.06 per thousand. Among the colored troops the maximum number of deaths per thousand of cases treated, namely, 14.97, is reported in 1872; while the minimum, 3.97 per thousand, is reported in 1877.

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While the mortality among the colored troops, as shown in this column, was very uneven in different years, still it was perceptibly less in the latter than in the former half of the period.

The fourth, seventh and tenth columns refer to the army as a whole: The figures in the fourth show, that from 1,804 per thousand in 1871, the number of cases taken on sick report steadily decreased, with considerable but not unvarying regularity, to 1298 per thousand of mean strength in 1878,—and that this number increased to a little more than 1,500 per thousand for the year 1879, 1880 and 1881.

The figures in the seventh column show the mortality per thousand of mean strength to have with remarkable regularity decreased during these eleven years—from 12.23 per thousand (1,223 per 100,000) in 1871 to 6.64 per thousand in 1881.

The steady decrease in the mortality per thousand of cases treated is also manifest during these years from 6.78 in 1871 to 4.32 in 1881.

It will be seen that these figures, as here reported, show nothing as to the character of the diseases prevailing, and doubtless they did differ somewhat in character during these

different years.

In one year may have occurred more diseases tending to recovery, and in another more diseases tending to a fatal result.

Neither do I here comment on the imperfections inherent in the reports themselves, whether from the greater or less competency of different observers, or the restrictions under which the reports were made.

At some future day I hope to offer some comments on these themes.

It may, however, quite fairly be argued that any such imperfections were continually in action, and any consequent error would be the same or similar in each year, so that, as among themselves, comparison between each year's figures are perfectly fair.

Not adopting, however, unreservedly any conclusions from the figures of this table, I may still say that, as far as they go, these figures seem to show an advance in army sanitation and therapeutics in the past eleven years. Fewer men in proportion are now taken sick. Fewer men in proportion now die, than were taken sick and did die eleven years ago.

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