History

Medical Statistics of the United States Army, Calendar Year 1954

CHAPTER II

Medical Care

A. Major Morbidity Indices

ADMISSIONS

In terms of admissions for disease and nonbattle injury, the year 1954 was the healthiest in the Army?s history. During this year fewer than one-third of the men in the Army were admitted to hospital or quarters?276 per 1,000 average strength for disease and 49 per 1,000 for injury, or a total of 325 admissions per 1,000 average strength for all causes. Between 1953 and 1954 the nonbattle admission rate fell 18 percent, with the component disease and nonbattle injury rates receding by 20 and 7 percent, respectively. Battle injuries and wounds, a factor in the all-causes rate in 1953, did not, of course, account for any admissions in 1954. Contributing conspicuously to the reduction in the nonbattle admission rate was the 31 percent drop in the admission rate for acute respiratory diseases.

In both text and source tables of this report the term ?admission? is used to refer only to instances of medical treatment given on an excused-from-duty basis. While the term has always meant substantially this, earlier Annual Reports (including the report for 1953) have arbitrarily used this term in a less restricted sense to include also those cases which were ?carded for record only,? a relatively small number of cases?largely cases of venereal disease?which, although treated on an outpatient basis, were nonetheless reported in the same manner as were the excused-from-duty cases. In line with changes in reporting procedures made in recent years, the group carded for record only has come to be excluded from the admission figures, so that the latter now represent those cases serious enough to prevent the patient from being returned to duty on the day first seen. These patients may have been treated in a hospital or infirmary bed or ?in quarters? (in a dispensary bed or in the person?s usual quarters). Admissions to hospitals or infirmaries constituted about 60 percent of all non-battle admissions in 1954. Slightly less than 60 percent of the total admissions for disease, and about two-thirds of the admissions for nonbattle injury, were cases admitted for treatment to a hospital or an infirmary.

It is important to note that the remarkably low admission rates reported for 1954 are not artifacts of this change in reporting procedures. It is still possible to examine admission rates computed as they were in earlier years

including the CRO cases, and when this is done the 1954 rate shows substantially the same proportionate decrease from 1953 and remains the lowest rate on record for any year. To facilitate comparison with earlier ?admissions? series, admission rates for the past five years are presented separately in table I. It is apparent from table I that the rates for disease are affected most by the inclusion or exclusion of CRO cases, whereas the rates for nonbattle injury are affected but little. Of the disease cases carded for record only in 1954, 80 percent were among the infective and parasitic diseases, chiefly venereal disease, and nearly 15 percent were among diseases of the urinary and male genital system, chiefly the urethritides.

TABLE I.?ADMISSIONS TO HOSPITAL OR QUARTERS, AND CRO CASES: NONBATTLE CAUSES, U. S. ARMY, BY YEAR, 1950-1954

(Rates expressed as number per 1,000 average strength per year)

Year	All nonbattle causes		Diseases		Nonbattle injury
Year	Admissions	Admissions plus CRO cases	Admissions	Admissions plus CRO cases	Admissions	Admissions plus CRO cases
1950	424	464	350	388	74	76
1951	488	543	415	468	73	75
1952	408	480	348	419	60	61
1953	396	476	343	421	53	55
1954	325	391	276	340	49	51

The most important cause of admission in 1954 continued to be acute respiratory infections, which accounted for nearly one-third of the disease admissions among Army active duty personnel. The second most frequent cause of admission was nonbattle injury, which accounted for about 15 percent of all admissions. The frequency of admissions in the various diagnostic classes is depicted in chart A.

About 1 percent of all admissions were readmitted during the year; that is, the number of cases which were admitted to treatment for a condition which had been previously treated and recorded in the Army medical statistics amounted to 1 percent of the number of new admissions. (See definitions in the appendix. Note that data on admissions in text and tables refer to new cases only.) There was considerable variation in this proportion, however, in terms of particular diseases and disease classes; for example, for neurological diseases and for diseases of the bones and organs of movement, the proportion of readmissions was about 5 percent, whereas for diseases of the skin and cellular tissue the proportion was 0.9 percent, and for acute respiratory infections only 0.05 percent.

During 1954 the rate of admission to hospital or quarters was 25 percent greater for enlisted personnel than for officers; admissions of enlisted personnel for disease exceeded those of officers by only 17 percent, but for injuries the

CHART A.?NONBATTLE ADMISSIONS, BY DIAGNOSTIC CLASS, TOTAL ARMY, 1954

rate was more than twice as high for enlisted personnel. The disease disparity is due, in large measure, to the higher rates among enlisted personnel for acute respiratory infections (enlisted rate, 93; officer rate, 67), diseases of the skin and cellular tissue (enlisted, 23; officers, 11), the infective and parasitic diseases (enlisted, 24; officers, 15), and psychiatric disorders (enlisted, 11; officers, 6). For some specific disease classes, however, the higher morbidity occurred among officers; for example, diseases of the digestive system (officer rate, 39; enlisted rate, 31), diseases of bones and organs of movement (officers, 16; enlisted, 11), and diseases of the circulatory system (officers, 14; enlisted, 9). To a large degree admission rates by rank vary according to age and factors related to age. Thus, enlisted personnel, who as a group are younger than officers, are more susceptible to the acute respiratory diseases and to certain infective and parasitic diseases. Officers, on the other hand, are more likely to develop the diseases that occur with advancing age, such as those of the digestive system, bones and organs of movement, and circulatory system.

During their first 3 months of service, Army active duty personnel in 1954 were admitted (for all causes) at a frequency about one and three-quarters times as great as that of their counterparts engaged in the second half-year (6-12 months) of service (chart B). With additional years of service, admissions

to hospital and quarters tended to rise. Again, variation from this pattern is noted for nonbattle injury admissions and for several of the disease classes. Comparison of chart B with admissions by age (see the 1953 Annual Report, chart A, page 7) reveals the similarity of the distribution of admissions by length of service and by age. This is hardly surprising, since length of service and age of personnel are closely interrelated.

CHART B.?ADMISSIONS FOR NONBATTLE CAUSES, BY LENGTH OF SERVICE, TOTAL ARMY, 1954

In terms of race, the admission rates during 1954 were virtually the same (whites, 324; Negroes, 326). Rates for disease admissions were the same (275), with a small difference in the injury admission rate (whites, 49; Negroes, 51). For some disease classes the admission rates for Negroes exceeded those for white personnel?infective and parasitic diseases (Negroes, 29; whites, 22), and diseases of the urinary and male genital system (Negroes, 23; whites, 11). However, in a number of other disease classes, admission rates for white personnel exceeded the rates for Negro personnel?acute respiratory infections (whites, 92; Negroes, 75), diseases of the digestive system (whites, 32; Negroes, 28), and skin diseases (whites, 23; Negroes, 19).

The admission rate among women in the Army during 1954 (581 per 1,000 average strength) was greatly in excess of the admission rate for men (322 per

1,000 average strength). The disparity lay entirely in the disease segment (532 for women as against 273 for men), since the injury admission rates, although qualitatively different, were at the same level (49 per 1,000 average strength).

As in 1953, the admission rates were higher overseas than they were in the United States. The rates for major geographic areas are illustrated in chart C. Between the two years, the nonbattle admission rate in the United States dropped by 20 percent, whereas the rate overseas receded 15 percent. With the end of the Korean Conflict, the nonbattle admission rate in the Far East dropped 20 percent. The Caribbean area, which had the highest admission rate of any major oversea area, exhibited no change in admission rate. The greatest change occurred in Alaska, where the admission rate fell 40 percent, largely because of the precipitous drop of 52 percent in the admission rate for acute respiratory infections.

During 1954 total incidence of nonbattle conditions exceeded total admissions by 19 percent; for disease and for nonbattle injury, incidence exceeded admissions by 18 percent and 27 percent, respectively. The differences between rates of admission and of incidence result from the inclusion in incidence data, as shown in source table 1, of secondary as well as primary diagnoses; that is, secondary conditions that existed at the time of, or developed subsequent to, admission for other causes are counted in addition to the primary diagnoses,

CHART C.?ADMISSIONS FOR NONBATTLE CAUSES, SELECTED AREAS, U. S. ARMY, 1954

resulting in a better indication of the incidence of specific disease or injury conditions than would be contained in data for primary diagnoses only.

Ninety-seven percent of all admissions having dispositions in 1954 (regardless of year of admission) were returned to duty. Of the cases admitted to hospital or infirmary, 95 percent were returned to duty.

OUTPATIENT CARE

In 1954 the Army Medical Service continued its policy of treating as many patients as feasible on a duty rather than on an excused-from-duty basis. In recent years application of this policy has been considerably facilitated by advances in therapeutic methods and the use of antibiotics and other new drugs. Such measures have made possible the adequate outpatient treatment of cases formerly requiring inpatient care, with resultant substantial savings in medical personnel and equipment and a marked decrease in loss of time from duty.

There were 15.6 million outpatient visits during 1954, requiring the performance of slightly more than 19 million outpatient treatments. In addition, Army medical treatment facilities worldwide performed over 1 million complete physical examinations (including flight physical examinations), over 10 million immunizations, and 146,000 specified periodic examinations or tests. The actual volume of outpatient care for these various categories is shown in table II. It should be noted that these data exclude all dental outpatient care.

The number of outpatient treatments during 1954 declined about 8.6 percent as compared with 1953. Most of this decrease resulted from the absence of enemy prisoners of war, who were included in the 1953 data. When this group is excluded from the outpatient treatment data for 1953, the number of outpatient treatments provided by Army medical treatment facilities worldwide during 1954 is but 1.5 percent less than that experienced during 1953. These 1954 data show a decrease of about 1 percent when compared with the total outpatient treatments (less enemy prisoners of war) given during 1952. (For purposes of comparison, in order to avoid distortion in ratios caused by sudden changes in population base, data for enemy prisoners of war are excluded throughout the remainder of this article.)

All of the categories of outpatient care, with the exception of flight physical examinations, declined in 1954 as compared with 1952 and 1953. The largest reduction occurred in the number of immunizations. Approximately 13.2 million immunizations were performed during each of the two preceding years, as compared with 10.5 million immunizations during 1954, a reduction of about 20 percent. The number of specified periodic examinations or tests performed in 1954 amounted to less than three-quarters (71 percent) of the number for 1953, and slightly less than one-half (47 percent) of the number for 1952. Although the number of flight physical examinations given during 1954 increased by 2,500 (41 percent) over 1952 and 3,000 (52 percent) over 1953,

TABLE II.?OUTPATIENT CARE AT ARMY FACILITIES WORLDWIDE, BY CATEGORIES OF PERSONNEL AND TYPE OF CARE, 1954

Category of personnel	Visits	Treatments	Physical examinations		Specified periodic examinations or tests	Immunizations
Category of personnel	Visits	Treatments	Flight	Other complete	Specified periodic examinations or tests	Immunizations
All categories	15,616,707	19,237,269	8,619	1,024,217	146,286	10,556,549
Daily average^a	42,903	52,850	24	2,814	402	29,002
Active duty military personnel	9,469,513	11,912,326	8,403	862,434	52,342	8,620,177
Army	9,174,133	11,520,775	7,811	854,618	51,637	8,540,356
Navy and Marine Corps	77,142	95,846	26	1,323	236	12,446
Air Force	218,238	295,705	566	6,493	469	67,375
Dependents of military personnel	4,700,526	5,675,224	-	18,561	14,261	1,242,152
Army	4,001,896	4,853,160	-	16,631	13,969	1,086,128
Navy and Marine Corps	216,902	246,414	-	272	14	35,409
Air Force	481,728	575,650	-	1,658	278	120,615
Retired military personnel	92,172	109,533	-	417	62	2,035
All other^b	1,354,496	1,540,186	216	142,805	79,621	692,185

^aBased on 364 days in the report period.

^bPredominantly U.S. civil service employees.
SOURCE: Outpatient Report, DD Form 444.

complete physical examinations (other than flight) decreased by 268,000 and 292,000, respectively, from the numbers reported during 1952 and 1953.

The relative distribution of outpatient care by type of care was approximately the same during both 1952 and 1953. By comparison, outpatient treatments comprised a relatively larger proportion of outpatient care during 1954 than during either 1952 or 1953. This proportionate increase in outpatient treatments during 1954 was largely offset by a relative decrease in immunizations as compared with 1952 and 1953.

Of the 19.2 million outpatient treatments given by Army medical treatment facilities worldwide in 1954, approximately 11.9 million (62 percent) were received by active duty military personnel; 5.7 million (30 percent) were received by dependents of military personnel; and the remaining 1.6 million (8 percent) were received by ?all other? personnel (chiefly civil service, employees). As may be seen from table III, active duty Army personnel accounted for virtually all (97 percent) of the outpatient treatments given active duty military personnel of the Armed Forces. Dependents of active duty Army personnel received the largest proportion (about 86 percent) of the outpatient treatments given dependents of all military personnel.

With the exception of obstetrics, gynecology, pediatrics, and X-ray and radium therapy, the distribution by type of treatment among the various

TABLE III.?OUTPATIENT TREATMENTS AT ARMY FACILITIES WORLDWIDE, BY CATEGORIES OF PERSONNEL AND TYPE OF TREATMENT, 1954

Type of treatment	All categories	Active duty military personnel			Dependents of military personnel			All other^a
Type of treatment	All categories	Army	Navy and Marine Corps	Air Force	Army	Navy and Marine Corps	Air Force	All other^a
Total treatments	19,237,269	11,520,775	95,846	295,705	4,853,160	246,414	575,650	1,649,719
General medicine	9,524,668	6,527,526	43,206	124,691	1,722,892	63,224	163,224	879,905
Dermatology	846,355	581,946	7,840	25,859	147,026	7,014	21,519	55,151
General surgery	1,079,281	765,070	10,162	26,266	188,638	11,775	19,874	57,496
Surgical dressing room	1,610,795	1,163,462	5,356	21,114	140,325	4,915	13,999	261,624
Ophthalmology	1,089,116	819,063	8,575	24,806	151,617	6,922	15,053	63,080
Ear, nose, and throat	1,090,926	717,915	8,064	27,757	194,702	6,872	16,893	118,723
Neuropsychiatry	286,302	176,790	1,430	6,487	38,442	2,907	7,356	52,890
Psychological tests	56,552	33,263	199	986	5,214	359	1,624	14,907
Obstetrics	818,057	1,152	66	103	647,594	46,442	109,134	13,566
Gynecology	351,196	7,986	234	369	275,836	17,511	37,018	12,242
Pediatrics	1,422,672	-	-	-	1,178,643	70,561	147,783	25,685
Physiotherapy	1,040,962	720,160	10,240	35,817	155,607	7,234	20,145	91,759
X-ray and radium therapy	20,387	6,442	474	1,450	6,624	678	2,028	2,691

^aPredominantly U.S. civil service employees. Of the 1,649,719 outpatient treatments received by the "all other" group, U.S. civil service employees received 979,950. Also included in the total are 70,102 treatments administered to members of the civilian components of the U.S. Armed Forces on active duty for training, and 109,950 treatments given to retired military personnel.

SOURCE: Outpatient Report, DD Form 444.

categories of personnel shows that active duty military personnel received from 61 to 78 percent of the various other separate types of treatments; dependents largely accounted for the balance. In three instances (surgical dressing room, neuropsychiatry, and psychological tests), however, personnel other than dependents received a larger proportionate share of the balance. It is evident that the type of specialized care required at outpatient clinics will vary with changes in the proportion of active duty military personnel, dependents of military personnel, and other categories of personnel provided medical care. Quite aside from any variation that may result from changes in the proportionate distribution of the total population actually provided outpatient care, are variations which result from changes in the population eligible to receive outpatient care. For example, the annual numbers of outpatient treatments provided active duty Army personnel have progressively decreased from 1952 to 1954. However, when these separate numbers of outpatient treatments are related to the active duty average strength of the Army for each of these years, respectively, the 1954 annual outpatient treatment rate of 8,500 per 1,000 average strength is seen to be slightly higher than the corresponding rate of 8,200 per 1,000 for 1952, and about the same as the rate of 8,600 per 1,000 for 1953.

In comparing the number of outpatient treatments, by type of treatment, during 1954 with those of 1952 and 1953, it is seen that although a slight decrease occurred in both the number and proportion of general medicine outpatient treatments during 1954, this type of treatment still constituted about one-half of all outpatient treatments. Of the total numbers of outpatient treatments provided by the Army Medical Service worldwide during each of these three years, general medicine represented 51.7, 52.0, and 49.5 percent, respectively, for 1952, 1953, and 1954. During 1954, the largest part of the decline in general medicine outpatient treatments occurred among active duty military personnel; this reduction more than offset an increase in the number of general medicine outpatient treatments provided dependents of active duty military personnel in the same year.

Although the proportionate distribution of the various other types of treatments during 1954 was not markedly different from the proportions for corresponding types of outpatient treatments in 1952 and 1953, certain changes, nevertheless, occurred. For example, throughout this 3-year period, progressive increases occurred in the number of neuropsychiatry, psychological tests, obstetrics, gynecology, and pediatrics outpatient treatments; whereas the number of surgical dressing room, ear, nose, and throat, and X-ray and radium therapy outpatient treatments progressively decreased.

When increases occurred, these resulted largely from increased numbers of outpatient treatments provided dependents of active duty military personnel, which more than outweighed any reduction in the numbers of treatments provided active duty military personnel. For the three types of treatments which showed progressive decreases, the reductions in the numbers of

treatments provided active duty military personnel more than outweighed the increased dependent workload at these particular clinics.

AVERAGE DURATION

Data on average duration of patient stay in hospital or quarters are especially important in that they are utilized by the Army Medical Service in planning for provision of inpatient medical care. The number of hospital beds occupied and the number of beds which must be provided, as well as the amount of professional and ancillary personnel needed, are directly related to the numbers and types of patients requiring inpatient care, and to the length of stay that is likely to be entailed for particular diagnoses.

The data on duration of stay that are shown in this report relate to all cases having a final disposition during calendar year 1954, including cases admitted in prior years. Except where otherwise specified, these data exclude cases carded for record only (CRO), which involve no loss of time from duty. Since the 1953 report presented average durations computed on the basis of all cases, including cases carded for record only, table IV compares the two years on both bases. In evaluating these data on average duration of stay, it should be noted that the overall average for all nonbattle causes is affected by, among other factors, the relative proportion of nonbattle injury cases included in the total, since nonbattle injury cases have an average duration from one-half to about two-thirds greater than that for disease cases. The overall average is also based on the time lost in hospital and quarters due to single and multiple diagnosis cases combined. Because of the latter fact, the data on average duration provided in source table 16 are presented separately for single diagnosis cases and for single and multiple diagnosis cases combined.

Nonbattle cases disposed of in 1954 averaged 16 days in hospital or quarters, the lowest average duration in the last five years. Disease cases, representing 85 percent of all nonbattle dispositions in 1954, averaged 15 days in hospital or quarters; nonbattle injury cases averaged 22 days. During the previous four years (1950-1953) the relative proportions of disease and nonbattle injury cases included in the annual numbers of nonbattle dispositions remained relatively constant. Thus the decrease in the average for all nonbattle causes is not merely an artifact of changing composition of the type of case. This may be seen from chart D, which shows that the average duration of nonbattle injury cases has been reduced to a new low from the high point of 30 days experienced in 1952, and that the average duration of disease cases has been reduced to its current low level from the high averages of 19 days and 18 days experienced during 1950 and 1952, respectively.

Approximately 14 percent of the cases included in the overall average duration for nonbattle causes in 1954 had more than one diagnosis. For the single diagnosis cases alone the average duration was 12 days (11 days for disease, and 14 days for nonbattle injury). The nonbattle cases with multiple diagnoses had an average duration of 44 days (44 days for disease and 45 days

TABLE IV.?AVERAGE DURATION OF STAY IN HOSPITAL OR QUARTERS FOR NONBATTLE CAUSES, U. S. ARMY, 1953 AND 1954,

Type of case	Including CRO cases		Excluding CRO cases
Type of case	1953	1954	1953	1954
All nonbattle causes	14	14	17	16
Nonbattle injury	25	22	27	22
Disease	13	12	16	15
Venereal disease	1	1	16	16
Other disease	15	15	16	15

SOURCE: Based on tabulations of individual medical records.

CHART D.?AVERAGE DURATION, NONBATTLE CASES IN HOSPITAL OR QUARTERS, BY TYPE OF CASE, U. S. ARMY, 1950-1954

for nonbattle injury). This effect of number of diagnoses on average duration must be kept in mind in making comparisons between individual diagnoses or groups of diagnoses.

When distinction is made between the average hospital case and the average quarters case, it may be seen that the average duration of stay for hospitalized cases was 25 days as compared with only 3 days for the average case treated on an excused-from-duty basis without being admitted to hospital, i. e., quarters case. Of the total days lost for the average hospitalized case, 22

days were spent in a bed-occupying status and the remainder (also, coincidentally, 3 days) in quarters, on leave, on temporary duty, etc. The averages, however, represent a combination of cases, some of the disposition being from hospitals outside continental United States and some from hospitals in the United States. The dispositions from hospitals in continental United States, in turn, represent a combination of cases, some originating in the United States and some being complicated nonbattle cases returned from overseas and treated in hospitals in the United States. The differences in average duration of hospitalization for these different classes of cases may be seen from the data presented in table V. Data for quarters cases show that 3.2 days were spent in quarters for the average case having a disposition outside the continental United States, and 2.6 days for cases having a disposition in the United States.

TABLE V.?AVERAGE DURATION OF HOSPITALIZATION (HOSPITAL ADMISSIONS ONLY), TOTAL TIME LOST,^a AND TIME IN BED-OCCUPYING STATUS, BY AREA OF ADMISSION AND DISPOSITION, U.S. ARMY, 1954,

Area of admission and disposition	All nonbattle causes		Disease		Nonbattle injury
Area of admission and disposition	Total time	Occupying bed	Total time	Occupying bed	Total time	Occupying bed
Total Army	25	22	24	21	32	28
Dispositions outside U.S.	17	16	16	16	20	20
Dispositions in U.S.	31	26	29	24	41	34
Admitted in U.S.	25	21	23	20	33	28
Admitted outside U.S.	170	141	158	134	224	177

^aIncludes time in quarters, on leave, on temporary duty, AWOL, etc., for hospitalized cases.
SOURCE: Based on tabulations on individual medical records.

Large differences in length of stay are observed when the cases are distributed by type of final disposition. Nonbattle cases returned to duty during 1954 averaged 12 days in hospital or quarters prior to final disposition, whereas nonbattle cases which resulted in death averaged 45 days. Separations from the Army for causes other than disability averaged 90 days in hospital or quarters prior to disposition in 1954. The longest average duration (155 days), however, occurred among those nonbattle cases which terminated in separation from the Army for disability, an average duration almost ten times that for all cases combined. There are many reasons why this is true, most of them having to do with the nature and severity of the cases from a medical viewpoint and the resultant kind and amount of treatment required. However, some of the reasons are related to the administrative processing required when persons are being separated for disability. The Army has long recognized that the disability separation cases comprise an important segment of the duration-of-stay pattern and has carried on an aggressive campaign to expedite administrative processing of these patients. The following duration-of-stay statistics

for cases separated for disability due to nonbattle causes show that the 1954 durations were markedly lower than the 1950 averages; for disease the duration is three-fifths as great, for nonbattle injury about one-half less:

Year of separation	All nonbattle causes	Disease	Nonbattle injury
1950	251	242	392
1951	116	110	279
1952	166	154	326
1953	169	158	297
1954	155	146	214

SOURCE: Based on tabulations of individual medical records.

The fact that many patients with certain conditions that formerly required inpatient care may now be satisfactorily treated as outpatients has undoubtedly resulted in savings in hospital beds and hospital costs, but, as might not be readily apparent, this has also tended to increase the overall duration. This paradoxical effect is the result of excluding from the computation of the average duration cases which would otherwise have contributed a relatively small number of days lost in proportion to their numbers, and would therefore have tended to reduce the overall average duration. That the overall average duration for all nonbattle causes has continued to decline during 1954 despite this paradoxical effect is one indication of the success of efforts on the part of the Army Medical Service to reduce bed-occupancy time and average duration of stay.

NONEFFECTIVENESS

Temporary incapacity from disease and injury among active duty personnel is of considerable military importance because it means that some men are not available for performance of assigned duties and because provisions for medical care must be made for them by the Army Medical Service.

A measure of time lost from duty attributable to personnel sick in hospital and quarters is the noneffective rate, derived by relating days lost due to admissions to hospital and quarters to average strength. This measure is usually represented as the average daily number of patients in hospital and quarters on an excused-from-duty basis per 1,000 average strength during the period being considered (See the appendix.)

Among Army personnel the noneffective rate due to disease and injury declined more than one-fourth during 1954, to reach a rate of 14 patients per 1,000 average strength per day?a rate which is lower than any reported for a previous year. Of these 14 patients, 11 had been admitted for a disease and 3 for an injury, the latter including a small proportion (2 percent of all non-effectiveness) admitted for battle wounds and injuries prior to 1954 (chart E). Considering only nonbattle admissions, the 1954 data show a 46 percent decrease in noneffectiveness from the high point reported for 1951 (a period of hostilities), from which the rate has steadily dropped in successive years to its present relatively low level.

CHART E.?PERCENT DISTRIBUTION OF NONEFFECTIVENESS, BY CAUSE, TOTAL ARMY, 1954

For 1954 the noneffective rate, a fairly comprehensive index of morbidity, shows that there was a continuing trend toward a higher level of health among active duty Army personnel. Favorable changes, such as greater effectiveness of preventive programs and improvement in therapeutic methods, together with the treatment on an outpatient basis of a greater proportion of cases, contributed to the declining noneffective rate. The influences of many such factors on the magnitude of temporary loss of manpower may be collectively appraised by examining the rate of admission and the average duration, variables from which the noneffective rate is derived. During 1954 the decrease in the rate of noneffectiveness from nonbattle causes was produced (1) by a one-fifth decline in the disease admission rate, in conjunction with a small decrease (6 percent) in the average time loss per case; and (2) by a 7 percent decrease in the injury admission rate, augmented by a larger proportional reduction in the average duration of injury cases (19 percent).

Although the reduction in noneffectiveness attributable to disease admissions occurred mainly through a substantial decrease in the rate of admission, the following are several specific disease categories for which decreases in average duration appear to have been more influential in reducing the manpower loss involved: tuberculosis, neoplastic diseases, diseases of the nervous system, dental diseases and conditions, and diseases of the digestive system and hernia.

Because older personnel are more frequently admitted for disease conditions which require longer periods of hospitalization, the rate of noneffectiveness for disease admissions was higher among older personnel. For noneffectiveness due to nonbattle injury the opposite was true, since lower admission rates among older personnel and smaller variation in the average duration with respect to age resulted in lower noneffective rates among older personnel. For personnel under 20 years of age a high disease admission rate more than offsets the shorter average duration per case, to produce relatively high noneffectiveness. The following table shows the effect of age of the patient at time of admission on the 1954 rates of manpower loss attributable to admissions for disease and nonbattle injury:

Age	Number noneffective daily per 1,000 average strength
Age	All nonbattle causes	Disease	Nonbattle injury
Total Army	13.91	11.12	2.79
Under 20	15.04	11.85	3.19
20-24	12.45	9.63	2.82
25-29	15.39	12.45	2.94
30-39	15.38	13.09	2.29
40 and over	23.81	21.65	2.16

The distribution of nonbattle noneffectiveness between admissions for disease and admissions for injury and among the various classes of disease was substantially the same during 1954 as it has been for the past four years, with the same disease groups contributing heavily to total noneffectiveness. It will be noted that the general reduction in noneffectiveness which occurred among the separate classes of disease does not necessarily apply to each disease category within these classes. For example, while noneffectiveness for the infective and parasitic disease class declined from a rate of 3.05 per 1,000 in 1951 to 1.94 per 1,000 in 1954, and noneffectiveness due to venereal disease was reduced from 0.25 in 1951 to 0.08 in 1954, noneffectiveness due to tuberculosis rose from 0.60 per 1,000 in 1951 to 0.78 per 1,000 in 1954.

Motor vehicle accidents, falls, and athletic activity caused more than one-half of the noneffectiveness due to nonbattle injury. About 424,000 mandays were lost by admissions attributable to motor vehicle accidents, and about 338,000 by admissions for injuries from falls and athletic activity.

The seasonal pattern of noneffectiveness for 1954, while reflecting a continuation of the trend toward lower rates, was influenced by the seasonal incidence of disease. The high rate for February corresponds to the peak incidence rate for acute respiratory diseases, whereas noneffectiveness declined during the warmer months as the incidence of these diseases fell to lower levels. Monthly data show that the regular decline in the rate of temporary loss of manpower due to nonbattle injury which occurred during 1953 began to level off during 1954 (chart F).

CHART F.?NONEFFECTIVE RATES, BY MONTH, TOTAL ARMY, 1953 AND 1954

DEATHS

The number of deaths among U. S. Army personnel during 1954 was only 2,105, less than half the number of deaths in 1953. Most of the decrease came from the elimination of battle deaths brought about by the end of fighting in Korea, but there were also slight decreases in the death rates from nonbattle causes. The annual death rate from disease decreased from 46 per 100,000 average strength in 1953 to 39 in 1954, and the corresponding rate from nonbattle injuries decreased from 133 to 109. Two deaths were reported as ?killed in action? on Quemoy Island, but no other battle casualty deaths were recorded during 1954. (Note that death rates are shown here and elsewhere in this report in terms of the number of deaths during the year per 100,000?rather than per l,000?average strength of the Army.)

The Army death rate from disease is markedly lower than the disease death rate among U. S. male civilians aged 15-44 years; even after standardizing the Army rate on the basis of the age distribution of this segment of the total United States population, it is less than half as great. The death rates from nonbattle injury are about the same in these two populations. Even though practically all of the deaths during 1954 resulted from nonbattle causes, the many special characteristics of the Army population need to be considered in making any comparisons with the civilian population. Aside from age factors and obvious differences in sex composition, Army personnel represent a selected group because of the entrance examinations and the disability separations, which screen out some persons having serious chronic conditions. Moreover,

any Army-civilian comparisons of death rates are affected by the geographic distribution of Army strength, the activities of Army personnel, the availability of medical care in the Army independent of individual economic conditions, and many other factors.

From the frontispiece, which shows death rates in the U. S. Army for the period 1819-1954, it may be seen that there has been a great decline in the rates in the past 135 years. It is also apparent that the improvement has been much more pronounced for disease than for nonbattle injury deaths. Until about 1920, deaths from disease were far more numerous than deaths from nonbattle injury; then for about 20 years the two rates were approximately equal, and maintained a fairly constant level; since 1940 the disease death rate has been less than half the rate for nonbattle injury deaths. Both rates have shown a downward trend since the end of World War II. The chart serves to emphasize the increase in disease death rates during periods when the United States was at war, prior to World War II, during World War II, the introduction of antibiotic drugs helped to decrease the rate to a new low level.

The death rates from nonbattle injuries show wide fluctuations, especially in the early years when Army strength was small. It is possible that some of the low rates may reflect classification of certain deaths according to the terminal condition rather than by the underlying cause; that is, the disease deaths may include some which should have been attributed to the injuries which started the chain of causes eventuating in death. However, much of the difference from year to year results from the inclusion of a greater or lesser number of injury deaths resulting from skirmishes with the Indians. Thus in 1876, the year of Custer?s Last Stand, most of the year?s injury deaths occurred on a single day.

During 1954 the death rate from nonbattle injuries in continental United States was quite constant from month to month; however, for diseases, both in the United States and overseas, and for nonbattle injuries overseas, there was considerable variation among the months, the highest death rate being double the lowest. The variation is probably largely due to chance fluctuations where such small numbers are involved; there appears to be no definite seasonal pattern in the rates.

Substantial differences between areas may be seen when the death rates from nonbattle injuries are compared; the death rates from disease show somewhat less variation by area. The death rate from nonbattle injury was highest (169 per 100,000 average strength) in Japan, primarily because of a large number of drownings in a serious accident. (In September during a typhoon a ferry capsized, with heavy loss of life.). The relatively high rate of nonbattle injury deaths in the United States (117 per 100,000) reflects a higher proportion of motor vehicle traffic accidents. Nonbattle injury deaths occurred less frequently in Europe (rate of 84), but this area had one of the high disease death rates (46 compared with 38 for continental United States and 39 for the Army worldwide).

Deaths by Rank and Race

The disease and nonbattle injury death rates for enlisted personnel each declined by nearly 20 percent from their 1953 levels, while only one of the corresponding rates for officers decreased, the nonbattle injury death rate, which dropped only about 10 percent. Thus, the difference between officer and enlisted death rates, particularly for deaths from disease, was sharper in 1954 than in 1953. Most of this difference is due to the difference in the age composition of these groups, the officers being concentrated more heavily in higher age groups, which have higher disease death rates. In continental United States the nonbattle injury death rate for enlisted personnel continued to be more than 60 percent greater than the rate for officers, but overseas it dropped below the rate for officers.

The death rates for Negroes showed especially great reductions from the 1953 levels, both disease and nonbattle injury rates dropping about 30 percent. The rates among white personnel were also lowered but not to the same degree. The 1954 nonbattle injury death rate for Negroes overseas remained higher than that for white personnel, but for nonbattle injury deaths in continental United States and for disease deaths in both areas the rates for the two population groups were about the same. (See table VI.)

TABLE VI.?DEATH RATES BY RANK AND RACE, U. S. ARMY, 1954

Cause of death and area of admission	Rate per 100,000 average strength
	Total Army	By rank		By race
	Total Army	Officers	Enlisted	White	Negro
Nonbattle deaths, total	148	191	144	146	166
Continental U.S.	155	174	153	155	159
Overseas	140	217	133	135	173
Disease deaths, total	39	103	33	39	41
Continental U.S.	38	100	31	38	41
Overseas	41	107	35	41	42
Nonbattle injury deaths, total	109	88	111	106	124
Continental U.S.	117	74	122	117	117
Overseas	99	109	98	94	132

SOURCE: Tabulations of individual medical records.

Deaths by Cause

As in 1953, approximately two-thirds of the disease deaths in 1954 resulted from three broad groups of causes: diseases of the circulatory system, neoplastic diseases, and infective and parasitic diseases. The sharp rise seen in table VII in disease death rates for the older age groups, beginning at 30-34 years, is primarily a reflection of the death rates from diseases of the circulatory system, although neoplastic diseases contributed substantially to the high rates for the

ages 45 and over. Since these older age groups comprise only a small part of Army strength, the effect of their high death rates upon the rate for all ages combined is not great.

TABLE VII.?DEATH RATES FROM DISEASE: PRINCIPAL CAUSES BY AGE AND AREA OF ADMISSION, U. S. ARMY, 1954

Age and area of admission	Death rates per 100,000 average strength
Age and area of admission	All diseases	Infective and parasitic diseases (class I)	Neoplastic diseases (class II)	Diseases of the nervous system (class VI)	Diseases of the circulatory system (class XI)	Diseases of the digestive system and hernia (class XIII)	All other diseases
Total deaths	39.5	4.5	8.3	3.9	13.7	2.7	6.4
Age at admission:
Under 20	16.4	4.0	4.0	2.1	0.7	-	5.6
20-24	20.2	4.6	4.9	2.2	2.2	1.0	5.3
25-29	25.5	4.2	6.7	2.8	4.9	3.2	3.7
30-34	65.8	6.8	11.1	7.9	26.8	2.2	11.0
35-39	104.1	2.8	21.3	14.3	42.9	8.6	14.2
40-44	158.7	-	14.0	8.3	108.5	16.7	11.2
45-49	435.5	6.4	108.9	32.0	237.0	32.0	19.2
50 and over	717.6	26.0	130.5	39.2	430.8	65.1	26.0
Area of admission:
Continental U.S.	38.2	3.0	8.5	3.9	13.6	3.2	6.0
Overseas	40.9	6.3	7.7	3.9	13.6	2.5	6.9
Europe	46.1	3.9	8.7	5.7	19.3	2.6	5.9
Japan	41.0	5.2	6.6	4.0	14.6	4.0	6.6
Korea	39.9	9.6	6.7	2.0	8.8	2.5	10.3

Four-fifths of the nonbattle injury deaths can be accounted for by six types of traumatisms, as listed below:

Nature of traumatism	Death rate per 100,000 average strength per year	Percentage of total deaths from nonbattle injury
Skull fracture	28.7	26
Other head injuries	15.4	14
Internal injuries of chest, abdomen, and pelvis	16.0	15
Drowning	13.9	13
Multiple injuries	8.9	8
Poisonings	4.7	4
All other traumatisms	21.1	20
Total	108.7	100

Each of these categories except drowning showed a decrease from the 1953 rate, corresponding roughly to the decrease in the total death rate from nonbattle injuries The rate for drowning increased from 11.7 in 1953 to 13.9 in 1954, largely due to a serious accident already mentioned, the capsizing of a ferry near Japan during a typhoon.

TABLE VIII.?DEATHS FROM INJURIES, BY CAUSATIVE AGENT, DUTY STATUS, AND ACTIVITY, U. S. ARMY, 1954

Area of admission and causative agent	Number of deaths by duty status and activity
	Total	On duty status				On leave or AWOL
		Total	Related to-		Other activities on duty status
		Total	Scheduled training	Assigned duties	Other activities on duty status
All areas of admission:
Total deaths	1,543	746	86	417	243	797
Aviation accidents	90	74	11	60	3	16
Motor vehicle traffic accidents	759	213	8	175	30	546
Other transportation accidents	85	61	20	25	16	24
Machinery, tools, and related agents	69	48	4	31	13	21
Instrumentalities of war	245	165	28	32	105	80
Poisonings	64	31	2	6	23	33
Heat, cold, weather, and elements	54	51	6	45	-	3
Other and unspecified agents	177	103	7	43	53	74
Suicides	162	96	---	---	---	66
Homicides	82	43	---	---	---	39
Continental U.S.:
Total deaths	894	252	42	117	93	642
Aviation accidents	46	30	7	23	-	16
Motor vehicle traffic accidents	553	82	2	58	22	471
Other transportation accidents	27	14	6	5	3	13
Machinery, tools, and related agents	28	13	3	5	5	15
Instrumentalities of war	128	63	19	7	37	65
Poisonings	22	7	---	---	7	15
Heat, cold, weather, and elements	5	4	2	2	-	1
Other and unspecified agents	85	39	3	17	19	46
Suicides	90	39	---	---	---	51
Homicides	42	16	---	---	---	26
Overseas:
Total deaths	649	494	44	300	150	155
Aviation accidents	44	44	4	37	3	-
Motor vehicle traffic accidents	206	131	6	117	8	75
Other transportation accidents	58	47	14	20	13	11
Machinery, tools, and related agents	41	35	1	26	8	6
Instrumentalities of war	117	102	9	25	68	15
Poisonings	42	24	2	6	16	18
Heat, cold, weather, and elements	49	47	4	43	-	2
Other and unspecified agents	92	64	4	26	34	28
Suicides	72	57	---	---	---	15
Homicides	40	27	---	---	---	13

SOURCE: Tabulations of individual medical records.

In classifying injury deaths by cause, the axis of causative agent can be used instead of the axis, type of traumatism. On this basis it is seen that motor traffic accidents caused almost half of all nonbattle injury deaths during 1954, an even higher proportion than in 1953. In fact, this causative agent more was more than three times as deadly as the group of purely military agents included in the category as ?instrumentalities of war.? The death rate from motor vehicle traffic accidents in continental United States was two and one?third times the rate for oversea areas. The problem of reducing these fatal accidents in the United States is complicated by the fact that 85 percent of them occurred while the person was on leave or AWOL. However, even for personnel in a duty status, motor vehicle traffic accidents were the most important cause of injury death, both in the United States and overseas.

For nonbattle injury deaths caused by agents other than motor vehicle accidents, the proportion occurring while the person was on leave or AWOL was 50 percent in continental United States but only 18 percent overseas. This of course represents a basic difference in the amount of leave available to troops in the United States and overseas, as well as differences in the type of activities while off duty in these two areas. Of the persons who were fatally injured while in a duty status, about two-thirds were performing assigned duties or receiving scheduled training. It is interesting to note that the accidents involving instrumentalities of war usually were not related either to scheduled training or to assigned duties.

The suicide rate of 11.4 per 100,000 average strength per year was about the same as in 1953, but the homicide rate decreased slightly to 5.8. There was no apparent relationship between age and the homicide rate, but suicides did tend to increase with age. There was considerable variation in these rates by area. Korea had relatively high suicide and homicide rates, while the suicide rate was lowest in Europe and the homicide rate lowest in Japan. All of the variations in these rates should be somewhat discounted because in many cases they are based on relatively small numbers. (See table VIII.)

Immediate Causes of Death

In statistical tabulations by cause of death, it is usual to tabulate deaths with multiple causes by the cause which initiated the chain of events which resulted in death, since this is the condition which would generally determine the preventive measures which might be taken. (All of the source and text tables on deaths in this report are presented in terms of the underlying cause except table X, which is specifically labeled otherwise.)

The immediate cause of death?that is, the final condition (other than purely terminal conditions such as hypostatic pneumonia or the mode of dying such as circulatory collapse) in the chain of events resulting in death?is also of interest. By means of data on these immediate causes it is possible to quantify and evaluate more readily the problems relating to anesthesia and therapeutic misadventures, gas gangrene and tetanus, air and fat embolisms, and other conditions which, while serious and important in themselves, usually

occur as sequelae or complications of some other underlying disease or injury. Prevention or better control of these conditions will contribute to reduction of the deaths among patients and thus to reduction in the overall death rate. Beginning with 1954, the statistical punch cards were coded so that the immediate cause of death as well as the underlying cause could be identified.

Of the 2,103 nonbattle deaths among Army personnel in 1954, 1,823, or 87 percent, were reported as having only one cause, so that the same condition was tabulated as both the underlying and the immediate cause. This proportion was especially high among deaths which were carded for record only (CRO) where the individual was not in a patient status at the time of death, but even among the deaths of persons who had been admitted to a medical treatment facility, almost three-fourths had only one cause reported. (See table IX.) The proportion having a single cause of death was higher for injury deaths than for disease deaths.

TABLE IX.?TOTAL DEATHS AND DEATHS HAVE ONLY ONE CAUSE REPORTED, U. S. ARMY, 1954

Underlying cause of death	Total deaths	Deaths having only one cause
Underlying cause of death	Total deaths	Number	Percent
Nonbattle deaths, total	2,103	1,823	87
Disease deaths, total	560	438	78
Admissions	397	284	72
CRO cases	163	154	94
Nonbattle injury deaths, total	1,543	1,385	90
Admissions	292	216	74
CRO cases	1,251	1,169	93

SOURCE: Tabulations of individual medical records.

There were 280 deaths in which the underlying cause and the immediate cause were different conditions (table X). In 55 cases, one cause was a disease and the other a traumatism, but the 28 disease-injury combinations were almost exactly offset by the 27 injury-disease combinations. Therapeutic misadventures, complications of surgical treatment, retained foreign bodies, and embolisms (air or fat) were the traumatisms listed as the direct causes of deaths having a disease as the underlying cause. Pneumonia (largely bronchopneumonia), diseases of the kidney (such as nephritis and nephrosis), diseases of the nervous system (cerebral hemorrhage and thrombosis, encephalitis and encephalopathy, etc.), and diseases of the digestive system (such as peritonitis) accounted for all but 4 of the diseases which were reported as the direct cause of deaths having a nonbattle injury as the underlying cause.

Table X shows the distribution of immediate causes which were not underlying causes of death. It should be noted that the immediate and the underlying cause may differ in terms of the detailed diagnostic code applicable

and yet be in the same broad classification. For example, in most of the 29 instances in which a neoplasm was the immediate cause of death, metastasis had occurred from a primary malignant neoplasm, the underlying cause of death. Similarly, of the 17 deaths having a circulatory disease as the immediate cause and a different specific disease as the underlying cause, many of the underlying diseases were also diseases of the circulatory system (e. g., coronary thrombosis and myocardial infarct). Among the 121 disease deaths in which the immediate and underlying causes were different, pneumonia was the most frequent immediate cause. Traumatic hemorrhage accounted for 38 percent of the total immediate causes (disease and injuries) which were not underlying causes.

TABLE X.?DEATHS FROM IMMEDIATE CAUSES WHICH WERE NOT UNDERLYING CAUSES, U. S. ARMY, 1954

Immediate cause of death	Total deaths from multiple causes	Underlying cause of death
		Disease		Nonbattle injury
		Admissions	CRO cases	Admissions	CRO cases
All causes	280	113	9	76	82
All diseases	121	88	6	23	4
Infective and parasitic diseases (class I)	3	2	-	1	-
Neoplastic diseases (class II)	29	29	-	-	-
Diseases of the nervous system (class VI)	20	15	-	3	2
Diseases of the circulatory system (class XI)	19	13	4	1	12
Diseases of the digestive system and hernia (class XIII)	12	8	-	4	-
Pneumonia	25	16	2	7	-
Kidney diseases	8	1	-	6	1
Other diseases	5	4	-	1	-
All injuries (class XXIII)	159	25	3	53	78
Traumatic hemorrhage	107	-	-	38	69
Traumatic hematoma	10	-	-	6	4
Prophylactic reactions and therapeutic misadventures	22	19	1	2	-
Other traumatisms	20	6	2	7	5

SOURCE: Tabulations of individual medical records.

SEPARATIONS FOR DISABILITY

During 1954, as in the preceding years since 1950, separations for disability continued to be accomplished in accordance with the provisions of Title IV of the Career Compensation Act of 1949. This act provides for uniform disposition of all members of the Armed Forces found unfit to perform their duties by reason of permanent disability. Such members may be either

retired (permanently retired or placed on the Temporary Disability Retired List), or separated with or without severance pay. Members are entitled to permanent retirement if they are found physically unfit and if their disability rating exceeds 30 percent, or if they have had 20 or more years of active military service, even though their disability rating is less than 30 percent. Members with less than 30 percent disability and less than 20 years of service who are found physically unfit are entitled to severance pay only. However, if the disability resulted from intentional misconduct or willful neglect, or was incurred during a period of unauthorized absence, or existed prior to the member?s entrance into the service and was not permanently aggravated by the service, the member is separated without severance pay; i. e., without entitlement to any benefits associated with the Career Compensation Act of 1949.

The same criteria that determine eligibility for permanent retirement apply to temporary retirements. This type of disability separation is used whenever the permanency or stability of the disability cannot be immediately established. Members are placed on the Temporary Disability Retired List (TDRL) for a period not to exceed 5 years. While on the list, such members are subject not less frequently than every 18 months to a physical examination for re-evaluation of their disability. A final determination of their disability can be made during any one of these periodic examinations, but such a determination must be made within the 5-year period. If a member on the TDRL is found unfit for further military service, he is either permanently retired or separated with severance pay according to the provisions stated above for such separations. If he is found physically fit for further military duty, a member on the TDRL may be either discharged from the service without disability compensation or returned to active status subject to his consent.

The determination of a member?s physical fitness or unfitness for further military duty is made in accordance with the physical standards prescribed by the special regulations ?Medical Standards of Fitness and Unfitness for Retention on Active Duty? (SR 40-120-1, 9 October 1953, now AR 40-504). These regulations were designed to secure maximum efficiency and uniformity in the evaluation of disabilities. They presumably had an effect on the 1954 separations for disability, from both a quantitative and a qualitative standpoint.

General Findings

Considerably fewer individuals were separated for disability in 1954 than in 1953. The number of such separatees dropped from 22,347 in 1953 to 14,053 in 1954, a decrease of about 37 percent. This decrease may be attributed to several factors. It may be attributed in part to a decrease (about 7 percent) in Army strength and in part to the above-mentioned special regulations, which clarified the criteria for determining disabilities warranting separation. The relatively longer existing peacetime conditions and the decrease (expected with time) in the number of separations for battle injuries and wounds may also be counted as contributing factors. The most important

cause of this decrease, however, was apparently the decrease in relation to strength of new accessions in 1954.

In 1954, the relatively fewer losses in strength requiring replacements resulted in a lower ratio of new accessions to strength. The average monthly accessions in 1953 had constituted 4.2 percent of the strength, but then declined in 1954 to 3.0 percent. In 1954, as in other years, more than half of the disability separations were for conditions that existed prior to service, which of course were among the new accessions. Obviously, the smaller the ratio of new accessions to strength, the relatively fewer the disability separations that may be expected.

As a result of these changes, the total disability separation rate declined from 14.6 per 1,000 average strength in 1953 to 9.9 in 1954, a decrease of 32 percent. During the same period the separation rate for nonbattle disabilities decreased from 13.0 to 9.3, a decline of 28 percent. The differences between the two sets of figures represent the rate of separation for battle disabilities, which declined 62 percent, from 1.6 to 0.6, as shown in table XI. The table also reveals a somewhat greater decrease in the white than in the Negro rate.

The data in table XI show that about four-fifths of the disability separations in 1954 were due to disease. Nonbattle injuries and battle injuries and wounds accounted for 15 percent and 6 percent, respectively, of the total 1954 disability separations. By comparison with the rates for disability separations presented in the 1953 Annual Report (11.7 for disease and 1.3 for nonbattle injuries), the 1954 nonbattle rates appear to show somewhat different distributions for disease and for injuries. However, this difference may be only or largely an artifact of the processing procedures by which disability separations were classified in terms of broad cause of separation. These procedures were modified beginning with 1954, in order to more completely identify as due to injury certain separations in which the cause of separation

TABLE XI.?DISABILITY SEPARATION RATES, BY RACE AND BROAD CAUSE OF SEPARATION, U. S. ARMY, 1953 AND 1954

Broad cause of separation	Rates per 1,000 average strength per year
	Total		White		Negro
	1953	1954	1953	1954	1953	1954
Nonbattle, total	13.0	9.3	12.9	9.2	13.2	10.1
Disease	(^a)	7.8	(^a)	7.7	(^a)	8.8
Injuries	(^a)	1.5	(^a)	1.5	(^a)	1.3
Battle injuries and wounds	1.6	0.6	1.6	0.6	1.4	0.7
Total	14.6	9.9	14.5	9.8	14.6	10.8

^aProportions attributed to disease and to nonbattle injuries are not comparable with 1954 data. See text.

was a disease which was in turn due to an injury. For this reason it is emphasized that the comparisons of the two years? rates, while valid for all non-battle causes and for battle injuries and wounds, should not be made for diseases and nonbattle injuries separately.

Rank, Type of Separation, Age, and Length of Service

The general pattern in the differentials of the separation rates by rank, type of separation, age, and length of service remained about the same in 1954 as it was in 1953, although the decrease in the number of separations, coupled with the relatively greater utilization of temporary retirements in 1954, affected each of these groups or classifications somewhat differently.

The 1954 disability separation rate for officers (7.7 per 1,000) was lower than that for enlisted personnel (10.1). However, the difference by rank was not as large in 1954 as in 1953, since the decrease in separation rates for enlisted personnel was relatively greater than for officers. (See table XII.) In 1954 officers were primarily (about 75 percent) either permanently or temporarily retired, while the majority of enlisted personnel (about 55 percent) were separated without severance pay. This reflects the older average age and greater average length of service of officers; separations without severence pay are comprised almost exclusively of disabilities due to conditions that existed prior to service (EPTS), not service-aggravated. (In 1954 this classification also included 76 separations due to misconduct and similar factors not in the line of duty.)

TABLE XII.?DISABILITY SEPARATION RATES, BY RANK AND TYPE OP SEPARATION, U. S. ARMY, 1953 AND 1954

Type of disability	Rates per 1,000 average strength per year
	Total		Officers		Enlisted personnel
	1953	1954	1953	1954	1953	1954
Permanent retirement	3.3	1.9	4.5	3.6	3.1	1.7
Temporary retirement	1.5	1.7	1.6	2.2	1.5	1.7
With severance pay	2.4	1.0	1.2	0.5	2.5	1.1
Without severance pay	7.4	5.3	0.9	1.4	8.2	5.6
Total	14.6	9.9	8.2	7.7	15.3	10.1

By type of separation (table XIII), the greatest shift occurred in the proportion of temporary retirements. While in 1953 about 11 percent of the disability separations were temporary retirements, in 1954 these retirements constituted about 17 percent. The shift occurred primarily in separations for disease. As in previous years, separations without severance pay constituted the bulk (about 53 percent) of all disability separations.

TABLE XIII.?PERCENT DISTRIBUTION OF DISABILITY SEPARATIONS, BY BROAD CAUSE OF SEPARATION AND TYPE OF SEPARATION, U. S. ARMY, 1953 AND 1954

Type of separation	Percent distribution, by broad cause of separation
	Total		Disease		Nonbattle injuries		Battle injuries and wounds
	1953	1954	1953	1954	1953	1954	1953	1954
Permanent retirement	22.2	19.2	11.3	12.1	45.9	32.3	82.5	80.2
Temporary retirement	10.6	17.4	10.9	19.1	8.6	9.6	10.0	15.4
With severance pay	16.3	10.6	17.9	11.8	12.5	6.5	7.5	4.4
Without severance pay	50.9	52.8	59.9	57.0	33.0	51.6	---	---
Total	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0

By age (table XIV), the 1954 data indicate that, as in 1953, separation rates were high in the younger age groups, up to age 30, due chiefly to separation rates without severance pay. Again in 1954, as in 1953, there was a noticeable decrease in the separation rates throughout the 30-39 age group, but this was followed by an increase beginning with age 40, especially in those above 50 years of age, due to permanent retirements. By length of service (table XV), about 51 percent of the 1954 separatees, consisting primarily of individuals separated without severance pay, had less than 1 year of service.

TABLE XIV.?AGE-SPECIFIC RATES FOR DISABILITY SEPARATIONS, BY TYPE OF SEPARATION, U. S. ARMY, 1954

Age	Rates per 1,000 average strength per year
	Total	Retirement		Other
	Total	Permanent	Temporary	With severance pay	Without severance pay
All ages	9.9	1.9	1.7	1.0	5.3
Under 20	13.9	0.9	0.8	0.5	11.7
20-24	9.1	1.5	1.5	1.0	5.1
25-29	12.0	2.0	2.2	1.6	6.2
30-34	6.4	2.2	2.1	1.3	0.8
35-39	6.1	2.5	2.0	1.0	0.6
40-44	8.7	4.4	2.8	1.0	0.5
45-49	13.0	7.7	4.4	0.6	0.3
50 and over	47.0	35.4	10.2	1.0	0.4

TABLE XV.?PERCENT DISTRIBUTION OF THE VARIOUS TYPES OF SEPARATIONS, BY LENGTH OF SERVICE OF SEPARATEES, U. S. ARMY, 1954

Length of service	Percent distribution
	Total	Retirement		Other
	Total	Permanent	Temporary	With severance pay	Without severance pay
Less than 1 month	6.0	0.3	0.4	0.8	11.0
1-3 months	15.0	1.4	1.3	1.5	27.1
3-6 months	12.4	2.6	3.3	3.6	20.7
6-12 months	17.9	14.3	10.6	13.5	22.4
1-2 years	18.3	21.0	27.9	27.4	12.4
2-3 years	6.5	9.3	13.0	10.3	2.6
3-5 years	5.6	7.6	10.0	11.9	2.1
5-8 years	5.5	9.6	10.0	13.3	1.0
8-20 years	9.8	22.8	19.1	17.2	0.5
20-30 years	1.8	6.4	3.2	0.3	0.0
30 years and over	1.1	4.6	1.1	0.1	-
Unknown	0.1	0.1	0.1	0.1	0.2
Total	100.0	100.0	100.0	100.0	100.0

Disability Separations for Disease and Nonbattle Injuries

Three source tables (tables 20-22) have been prepared relating to the primary diagnostic causes of separation for disabilities due to disease and non-battle injuries.¹ Only one condition is presented in these tables as a cause of separation, referred to as the primary cause of separation. Whenever more than one condition causing disability is present, the condition having the highest ratable disability is given as the primary cause of separation.

The two leading primary causes of all disability separations for disease and nonbattle injuries were psychiatric disorders and impairments of bones and organs of movement, comprising 24.7 percent and 21.4 percent of all disability separations, respectively. This was generally true of permanent retirements and of separations with or without severance pay, except that in case of permanent retirements, separations for impairments of bones and organs of movement (32.4 percent) overshadowed those for disabilities due to psychiatric disorders (16.8 percent). Among the causes of temporary retirement, infective and parasitic diseases were predominant, the most important disease being tuberculosis.

Psychiatric disorders were chiefly responsible for separations in the younger age groups, whereas diseases of the circulatory system were the main cause in the older age groups. These age differentials were also reflected in the primary

¹The numbers of separations distributed by diagnosis, as given in source tables 20-22, are somewhat less than those given in source table 19, specifically in the number of separations without severance pay. (See footnote to source table 19.)

causes of separations by rank. Enlisted personnel, being principally of younger age, were separated primarily for psychiatric conditions, while officers, being largely of older age at the time of separation, were in large proportion separated for diseases of the circulatory system. Implicit in these age differentials are the differentials of length of service, since length of service will be shorter for younger age groups. Thus the primary cause of separation shifts from predominantly psychiatric disorders for separatees with short length of service to diseases of the circulatory system for separatees with longer length of service.

Disability Separations for Battle Injuries and Wounds

As already indicated, the number of separations for disabilities caused by battle injuries and wounds decreased in 1954. A total of 838 individuals were separated for these reasons during this year (table XVI).

The 1954 separations for battle disabilities were distributed by primary cause of separation in essentially the same manner as those of the preceding years. About two-thirds of these separations involved disabilities due to impairments and diseases of the bones and organs of movement, among which amputations of the lower extremities were the leading single cause. Next in magnitude as primary cause of separation, comprising about one-fifth of all separations for battle disabilities, were impairments and diseases of the nervous system, the predominant single cause being peripheral neuropathy.

The distribution of these disabilities by type of separation reveals the following differences. While impairments and diseases of the bones and organs of movement were mainly responsible for the permanent retirements, impairments and diseases of the nervous system, chiefly peripheral neuropathy, were responsible for the bulk of the temporary retirements. The latter fact might have been expected, since such disabilities often require longer periods of observation for evaluating their ultimate effects.

As shown in table XVI, 7,895 individuals were separated for battle disabilities during the entire period 1950-1954. It will be noted that about 85 percent of these individuals were permanently retired, about 6 percent were placed on the Temporary Disability Retired List, and about 9 percent were

TABLE XVI.?SEPARATIONS FOR DISABILITIES DUE TO BATTLE INJURIES AND WOUNDS, BY TYPE OF SEPARATION, U. S. ARMY, 1950-1954

Type of separation	Total 1950-1954		Number of separations, by year
Type of separation	Number	Percent	1950	1951	1952	1953	1954
Permanent retirement	6,728	85.2	110	1,323	2,587	2,036	672
Temporary retirement	479	6.1	1	14	89	246	129
With severance pay	688	8.7	3	93	370	185	37
Total	7,895	100.0	114	1,430	3,046	2,467	838

separated with severance pay. (Corresponding percent distributions of the 1953 and 1954 disability separations are shown in table VIII.) Except for 105 World War II cases, these separations were for disabilities incurred in the Korean Conflict. At the end of 1954 only 52 individuals were still hospitalized for the treatment of battle disabilities.

Distribution of Permanently Retired by Overall Disability

The current standards established by the Veterans Administration in the ?Schedule for Rating Disabilities? (1945), as amended, are used by the Army in rating disabilities. The ratings are expressed as percentages, and

TABLE XVII.?PERCENT DISTRIBUTION OF PERMANENT RETIREMENTS, BY PERCENTAGE RATING OF OVERALL DISABILITY AND BY BROAD CAUSE OF SEPARATION AND RANK, U. S. ARMY, 1954

Percentage rating of overall disability, and rank	Percent distribution by broad cause of separation
Percentage rating of overall disability, and rank	All causes	Disease	Nonbattle injuries	Battle injuries and wounds
Officers and enlisted	100.0	100.0	100.0	100.0
100	23.4	34.8	17.1	7.3
90	4.2	3.3	4.2	6.0
80	9.8	9.2	7.6	13.1
70	8.9	5.7	9.8	14.1
60	14.4	11.9	14.6	19.2
50	9.6	6.9	11.9	12.9
40	14.9	9.3	22.4	18.5
30	13.6	16.8	12.0	8.9
Less than 30^a	1.2	2.1	0.4	-
Officers	100.0	100.0	100.0	100.0
100	15.5	17.7	14.6	1.8
90	5.1	4.8	7.3	5.4
80	13.6	13.1	7.3	21.4
70	9.8	9.7	4.9	14.3
60	19.2	20.1	12.2	17.9
50	10.0	9.1	17.1	10.7
40	13.0	11.0	19.5	21.4
30	9.8	9.9	12.2	7.1
Less than 30^a	4.0	4.6	4.9	-
Enlisted	100.0	100.0	100.0	100.0
100	25.2	41.5	17.3	7.8
90	4.0	2.7	4.0	6.0
80	8.9	7.7	7.6	12.3
70	8.7	4.2	10.1	14.1
60	13.4	8.7	14.8	19.4
50	9.6	6.0	11.5	13.1
40	15.3	8.7	22.5	18.2
30	14.4	19.4	12.0	9.1
Less than 30^a	0.5	1.1	0.2	-

^aIncluding unknown or no rating.

each disability is rated separately. However, if more than one disability is present, the combined, or overall, disability rating is not a direct summation of the various disability ratings. The overall rating is calculated in accordance with the ?Combined Ratings Table? of the Veterans Administration rating schedule and in such a manner that no person can be rated as having more than 100 percent disability.

Percent distributions of overall disability for permanent retirements are presented in table XVII. The range of these distributions is from ?less than 30 percent" to ?100 percent? disability, inclusive. Disability ratings of ?less than 30 percent? apply mainly to individuals who have had the minimum length of service required for retirement, in association with the disability. (As indicated in the table, they include cases of unknown disability or of no disability rating.)

In terms of broad causes of separation, retirements due to disease show much larger proportions of overall disability in the higher disability ratings than either retirements due to nonbattle injuries or those due to battle injuries and wounds. For instance, about 35 percent of individuals for whom a disease was the primary cause of retirement were rated as having 100 percent disability, while only 17 percent of those for whom a nonbattle injury was the primary cause were so rated. Among persons for whom a battle injury or wound was the primary cause of retirement, only slightly over 7 percent were rated as having 100 percent disability.

These differences in the disability ratings by broad cause of separation are graphically shown in chart G in terms of cumulative percent distribution. Whether or not the 1954 experience with respect to these differences in distribution by overall disability may be taken as generally representative of the past is, of course, a matter of conjecture. It should be noted, however, that the 1954 experience with respect to battle-incurred disabilities is likely to be somewhat unrepresentative, since no short duration case could be included.

By rank, the 1954 separation data indicate that for enlisted personnel there was a greater concentration in the higher percentage ratings of overall disability than for officers (table XVII and chart H)

Ultimate Disposition of Persons on TDRL

With the increasing proportion of individuals placed on the Temporary Disability Retired List, the ultimate disposition of such cases and their effect was of separation for disability become important. According to available data, in 1954 final dispositions were accomplished for 910 temporary retirement cases These cases were distributed as follows: 32.3 percent were permanently retired; 9.7 percent were separated with severance pay; and 58.0 percent were found fit for further active duty and discharged. (In addition to the 910 cases mentioned above, 58 individuals who died were eliminated from the TDRL.)

With respect to final disposition, the 1954 TDRL cases do not differ appreciably from the TDRL cases disposed of prior to 1954, after the Career Com-

CHART G.?CUMULATIVE PERCENT OF PERMANENT RETIREMENTS, BY PERCENTAGE RATING OF OVERALL DISABILITY AND BY BROAD CAUSE OF SEPARATION, U. S. ARMY, 1954

pensation Act had become effective. Therefore, should the current final dispositions of those on TDRL be taken as indicative of what could generally be expected of future final dispositions, the 1954 ultimate disability separation rates might be as follows: permanent disabilities, 2.4 per 1,000 average strength per year; separations with severance pay, 1.2; separations without severance pay, 5.3; and the total separation rate, 9.0. Thus the rate for permanent disability separations might be increased by about one-fourth (1.9 to 2.4); that for separations with severance pay, increased by about one-fifth (1.0 to 1.2); for those without severance pay, unchanged; and the total disability separation rate lowered (since between one-half and two-thirds of the persons on TDRL recovered from their disability) by about one-tenth (9.9 to 9.0).

B. Health Among Women in the Army, 1950-1954

Since the establishment of the Army Nurse Corps in 1901 and the Women?s Auxiliary Army Corps in 1942, women have been performing in unified organizations having official status with the U. S. Army. In 1943 and 1944 full military status and rank were accorded women, and from that time they have

CHART H.?CUMULATIVE PERCENT DISTRIBUTION OF PERMANENT RETIREMENTS, BY PERCENTAGE RATING OF OVERALL DISABILITY AND BY RANK, U. S. ARMY, 1954

had complete membership in the Army.¹ During the period 1950-1954 women comprised 1.1 percent of the total Army strength, and female officers represented 5 percent of all officers. One-third of the women in the Army, all officers, were in the Army Nurse Corps and the Women?s Medical Specialist Corps, with some few in the Medical Corps and the Medical Service Corps during this period. The rest (about 90 percent of whom were enlisted personnel) were in the Women's Army Corps.

In terms of factors potentially affecting health, and apart from those related strictly to physical sexual characteristics, differences between the male and female components of the Army are considerable. The male segment is comprised of younger personnel, many of them inducted into the Army through Selective Service, mainly engaged in or being trained for relatively strenous outdoor activity; the female segment is a volunteer group, selected on the basis of higher physical standards, assigned in larger proportions to sedentary occupations, and containing a much higher proportion of older and professional personnel.

¹Treadwell, Mattie E., U. S. Army to World War II, The Women?s Army Corps, Office of the Chief of Military History, Department of the Army, Washington, D. C., 1954, pp. 5-6.

Summary

During the 5-year period 1950-1954, there were about 50,000 admissions of Army active duty female personnel to medical treatment facilities on an excused-from-duty basis. Morbidity in this component of the Army occurred at an average annual rate of 676 admissions to hospital or quarters per 1,000 average strength. Of these 676 admissions, 618 were due to disease and 58 were attributed to nonbattle injuries (table XVIII). For this period the yearly admission rate for females ranged from a high of 716 per 1,000 in 1951 to 590 per 1,000 in 1954.²

TABLE XVIII.?ADMISSIONS, DEATHS, AND NONEFFECTIVENESS FOR DISEASE AND NONBATTLE INJURY AMONG FEMALE PERSONNEL, TOTAL ARMY, 1950-1954

Period	Admissions^a		Deaths		Noneffective days
Period	Disease	Injury	Disease	Injury	Disease	Injury
	Number
1950-1954	45,915	4,275	39	36	605,280	73,660
1950	6,930	845	5	4	84,385	14,575
1951	11,430	985	11	9	138,875	16,985
1952	10,775	1,080	8	12	151,005	19.495
1953	9,760	725	7	5	132,780	14,285
1954	7,020	640	8	6	98,235	8,320
	Rate^b
1950-1954	618.44	57.58	0.53	0.48	22.32	2.72
1950	594.96	72.54	0.43	0.34	19.85	3.43
1951	659.02	56.79	0.63	0.52	21.94	2.68
1952	615.79	61.72	0.46	0.69	23.58	3.04
1953	660.49	49.06	0.47	0.34	24.62	2.65
1954	541.00	49.32	0.62	0.46	20.74	1.76

^aIncludes small numbers of cases treated in outpatient status and carded for record only (CRO). During 1954, the only year for which these CRO cases were separately tabulated for women, they constituted 1.5 percent of the 1954 admissions shown in this table. The 1954 rates, excluding the CRO cases, are 532.52 and 48.94, for disease and injury, respectively.

^bFor admissions and deaths, the rate is expressed as numbers per 1,000 average strength per year; the noneffective rate is expressed as the average daily number of women noneffective due to disease or injury per 1,000 average strength.

On the average day of this period, 25 of every 1,000 women were sick in hospital or quarters, 22 due to disease and 3 due to injuries. The time spent by female patients in medical treatment facilities during 1950-1954 averaged approximately 2 weeks per admission. Average duration was greater for injury

²In referring to ?admissions? in this section on health among women in the Army, it was necessary to include small numbers of outpatient cases which were carded for record only (CRO), since for the years 1950-1953, they were not separately identified in the tabulations. In data for 1954, cases carded for record only, constituting 1.5 percent of the morbidity shown here for women, raised the ?admission? rate of 581 per 1,000 (shown elsewhere in this volume) to 590 per 1,000.

admissions (17 days per admission) than for disease admissions (13 days per admission).

Among female personnel, 75 deaths due to nonbattle causes (39 due to disease, 36 due to injury) occurred during this 5-year span. The average annual mortality rate was 1 per 1,000 average strength. For the entire period, about 15 in every 10,000 admissions terminated in death.

During 1950-1954 nearly 5,700 women were separated from the service because of physical disability or physical disqualifications; approximately 300 were retired for disability; 4,900 were physically disqualified because of pregnancy; and 500 were physically disqualified for other reasons, including more than 300 for conditions which existed prior to service.

In terms of the admission rate and the noneffective rate, data for the calendar year 1954 reveal it to be the lowest one in the 5-year period for the female component of the Army. The admission rate for disease among women was almost one-fifth lower in 1954 than it was in 1953, due largely to decreases in the admission rates for acute respiratory infections and psychiatric disorders.

Morbidity

A comparison of gross morbidity rates?that is, without any adjustment for the effect of certain differences between the male and female segments of the Army?shows that the female admission rate for disease during 1950-1954 exceeded the male admission rate by 52 percent. If one excludes from consideration diseases of the breast and the genital organs, deliveries and complications of pregnancy, and pregnancy, uterine, not delivered, the admission rate for women was only 33 percent higher than the comparable rate for men. However, in the male component the strength ratio of enlisted men to officers was 10 to 1 during 1950-1954, while for women this ratio was 10 to 7. In both components, the morbidity rate was considerably higher among the enlisted group. After adjustment for this difference in the distribution of personnel by rank, the female admission rate (with the same diagnostic exclusions previously noted) exceeded the male rate by 53 percent.

Certain selected categories of conditions peculiar to women?namely, diseases of the breast and female genital organs; deliveries and complications of pregnancy, childbirth, and the puerperium; and pregnancy without abnormal symptoms?as a group constituted 15 percent of all female ?disease? admissions during 1950-1954. A large proportion (about two-fifths) of this selected group of admissions were due to disorders of menstruation. The average length of stay in medical facilities for the entire group of selected conditions cited above was relatively short (10 days per admission); therefore, these admissions accounted for only 12 percent of the female noneffectiveness due to disease admissions. During 1950-1954 there were no deaths due to this group of conditions.

Admissions for the 5-year period by diagnostic class are shown in table XIX. In comparing morbidity among women in terms of specific categories of disease with that in the male component of the Army, large differentials

TABLE XIX.?ADMISSIONS AND AVERAGE DURATION OF STAY FOR FEMALE PERSONNEL, U. S. ARMY, 1950-1954

Cause of admission	Admissions^a		Average days per case
Cause of admission	Number	Rate^b	Average days per case
All causes	50,190	676.02	14
Infective and parasitic diseases	2,605	35.09	29
Neoplastic diseases	1,135	15.29	30
Allergic, endocrine system, metabolic, and nutritional diseases	1,000	13.47	23
Diseases of the blood and blood-forming organs	90	1.21	40
Mental, psychoneurotic, and personality disorders	2,430	32.73	36
Diseases of the nervous system	595	8.01	20
Disease of the eye and adnexa	395	5.32	13
Diseases of the ear, nose, and throat	1,375	18.52	12
Acute respiratory infections	13,850	186.56	4
Other diseases of the respiratory system	290	3.91	29
Diseases of the circulatory system	1,015	13.67	27
Dental diseases and conditions	470	6.33	4
Diseases of the digestive system and hernia	4,325	58.25	11
Diseases of the urinary system	990	13.33	14
Diseases of the breast and female genital organs	4,905	66.08	8
Deliveries and complications of pregnancy, childbirth, and pueperium	1,220	16.43	13
Diseases of skin and cellular tissue	1,635	22.02	13
Diseases of the bones and organs of movement	1,520	20.47	35
Congenital malformations	175	2.36	51
Symptoms and ill-defined conditions	1,800	24.24	7
Special admissions	2,705	36.43	7
Accidents, violence, and poisonings	4,275	57.58	17
Other admissions without disease	1,390	18.72	14

^aSee footnote a, table XVIII.
^bExpressed as number per 1,000 average strength per year.

between admission rates are observed for neoplastic diseases, psychiatric disorders, acute respiratory infections, diseases of the nervous system, diarrhea and dysentery, allergic disorders, diseases of the endocrine system, rubella, and venereal disease. For 1950-1954 the venereal disease morbidity rate among women was only one-twentieth as high as that among males. For the other above-specified categories, after adjustment for the difference in distribution by rank, the female admission rate was on the average about twice as high as the male admission rate.

Almost one-half of the female admissions for injuries during 1950-1954 were caused by abrasions, contusions, and blisters (18 percent), and sprains, strains, and dislocations (30 percent). Fractures accounted for 15 percent and wounds for 6 percent of the female admissions for injuries. About 11 percent of the female admissions for injuries during the five-year period were due to prophylactic reactions and therapeutic complications. Thus the proportion of major injuries was smaller among women than among men; the frequency of fractures and wounds among men was almost twice as great as among women and that of compound fractures about six times as great. The difference in the severity of injuries is reflected in a lower daily noneffective rate for injury admissions among females (2.72 per 1,000, compared to 4.40 per 1,000 for males), due to the loss of fewer days per admission for women (17 days, compared to 26 days for men); and also in a lower case fatality rate for women (0.8 percent, compared to 2.3 percent for men).

The female admission rate for injuries was about 7 percent lower than the corresponding rate for males; however, after adjustment for the difference in the distribution by rank, the female rate for injuries was 13 percent in excess of that for males. During 1950-1954 the trend has been toward a general decrease in the annual rate due to injuries among women, paralleling the decrease seen for the male component of the Army.

Mortality

Table XX shows that 14, or more than one-third, of the disease deaths among women were due to malignant neoplasms. In these cancer deaths, the fatal malignant neoplasm was located as follows: 3 in the intestines, 4 in the breast, 2 in the cervix uteri, 2 in the lower extremities, 1 in the pancreas, 1 in the brain, and 1 in the ovary. Of the 36 deaths due to injuries which occurred among females in the Army during 1950-1954, 18 resulted from motor vehicle accidents, 4 were caused by machinery, tools, and related agents, 3 were due to poisonings, 3 resulted from aircraft accidents, 3 were due to drowning, and the remaining 5 were caused by suffocation (2), a fall (1), a fight or a brawl (1), and some other agent (1).

Because of the low numbers involved, the fluctuation in the yearly mortality rates in table XVIII should be used with caution, and the relationship of the rates should not be regarded as necessarily indicative of actual changes in mortality from one year to another during the period covered.

TABLE XX.?DEATHS AMONG FEMALE PERSONNEL, U. S. ARMY, 1950-1954

Cause of death	Number	Rate^a
All causes	75	101.0
Tuberculosis, all forms	2	2.7
Meningocococcal infections	1	1.3
Malignant neoplasms	14	19.0
Leukemia and aleukemia	1	1.3
Benign neoplasms and neoplasms of unspecified nature	3	4.0
Diseases of blood and blood-forming organs	2	2.7
Vascular lesions affecting central nervous system	6	8.1
Arteriosclerotic and degenerative heart disease	2	2.7
Other diseases of heart	2	2.7
Hypertension with heart disease	1	1.3
Diseases of digestive system	4	5.4
Congenital malformation of circulatory system	1	1.3
All other diseases	--	--
Fractures, head injuries, and internal injuries	23	31.0
Laceration and open wounds	1	1.3
Burns	3	4.0
Effects of poisons	4	5.4
All other and unspecified effects of external causes	5	6.8
Homicides^b	1	1.3
Suicides^b	4	5.4

^aExpressed as number per 100,000 average strength per year.
^bIncluded above in categories of specific injuries.