CHAPTER XI
Liaison Activities
The history of the Army's participation in standardization efforts and international cooperation in the medical statistics field is long and is a source of legitimate pride. One of its notable early phases is associated with the name and the accomplishments of a truly great member of the Medical Corps of the Army, Col. John Shaw Billings (p. 11), a man who, with no more than simple justice, has been called a 'medical genius of the nineteenth century.' In September 1894, Colonel Billings, who was then Deputy Surgeon General, represented the U. S. Army and served as chairman of an international commission in Budapest where military medical officers from England, Germany, France, Denmark, Belgium, Italy, Austria, and the United States developed and agreed upon a standard set of tabular formats for the annual publication of key elements of military medical statistical data by the Army of each of the signatory nations. These international tables were included in the annual reports of The Surgeon General of the U. S. Army for each year from 1894 until World War I.
In this past quarter-century, there has been a strong resurgence of the spirit of cooperation and awareness of the benefits and economies of standardization in this field which Billings had earlier done so much to foster. Toward the middle of World War II, the Bureau of the Budget, mindful of the gains in interagency comparability and interchange of data that might accrue, established a Committee on Morbidity Classification. The director of Medical Statistics in the Army Surgeon General's Office was appointed to this committee. Before a definitive resolution was reached by the committee, however, it was recognized that an alternative approach was available which offered a number of distinct advantages. This involved expanding the membership of the U. S. Committee on Joint
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Causes of Death, a group which, under State Department sponsorship, was drafting a proposal for the forthcoming 1948 revision of the International List of Causes of Death, which would make this international statistical classification suitable for morbidity as well as mortality coding. The Army, Navy, and Veterans' Administration representatives were appointed to this State Department committee, and the Budget Bureau group was disbanded. The work of the U. S. Committee on Joint Causes of Death was later formally recognized by a Lasker award, presented at the 1947 meeting of the American Public Health Association. Several of the committee members, including the Army representative, were appointed to the U. S. delegation to the 1948 Paris Conference, at which the sixth revision of the International Statistical Classification was officially adopted.
Late in 1946, acting on a recommendation made by President Harold W. Dodd of Princeton University, the Bureau of the Budget established the Interagency Committee on Medical Records, including permanent members from the U. S. Public Health Service, the Veterans' Administration, the Army, and the Navy. Dr. Harold Dorn, of the U. S. Public Health Service, the wartime director of Army Medical Statistics, was named chairman of this group, and the Army member appointed was the current chief of the Medical Statistics Division. The first major project of this group was the development of a family of three forms for use in physical examination and evaluation. These are now designated as Standard Forms 88, 89, and 90, the Report of Medical Examination, the Report of Medical History, and the Health Qualification Placement Record. These forms, intended for use by all Federal medical agencies, replaced a vast and confusing multiplicity of forms previously used by the several agencies for these purposes. In 1947 and 1948, the Interagency Committee undertook the design of a basic series of clinical record forms for use in all Federal hospitals. This series, adopted in 1948, included some 56 forms. Also in 1948, the committee, at the request of the Defense Department, started work on the design of a health record similar to the one in use by the Navy for many years to be used by the Armed Forces. Although complete implementation of this plan required several years, the health record is now in full use in
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the Departments of the Army, Navy, and Air Force. The Interagency Committee on Medical Records is still in operation. It designs new standard medical forms as necessary and carries out the task of effecting whatever revisions come to be required in the forms already promulgated.
The Secretary of Defense in 1947 appointed an ad hoc committee on Medical and Hospital Services, under the chairmanship of Dr. Paul R. Hawley, with the mission of 'making a thorough, objective and impartial study of the Medical Services of the Armed Forces with a view to obtaining at the earliest possible date the maximum degree of coordination, efficiency and economy in the operation of these services.' Among the many subcommittees named by the Hawley Committee to assist in accomplishing this mission, there were two on which the Medical Statistics Division chief served as Army representative; these were the Subcommittee on Diagnostic Nomenclature of Diseases, Injuries and Conditions, and the Subcommittee on Medical Forms, Recording and Reporting Procedures.
In 1949, the Secretary of Defense appointed a permanent Defense Department Committee on Standardization of Medical Forms, Recording and Reporting Procedures to replace and continue the activities of the two subcommittees just mentioned. One of the first acts of this committee was to forward for publication the Joint Armed Forces Statistical Classification and Basic Diagnostic Nomenclature, which has been used by Army, Navy, and Air Force since that time. It is at present (1958) being reviewed for revision.
Since its establishment, the Standardization Committee has met more than 250 times and has attained a number of important objectives. Among these are standardization of nomenclature and definitions for medical treatment facilities of the Armed Forces, standardization of terms and definitions relating to bed capacity and bed status in military hospitals, standardization of a system of summary statistical report forms, and standardization of collateral forms for the health record system. This committee, for which Medical Statistics Division provides the Army member, continues in full operation at the present time (1958).
The Paris Conference for the Sixth Decennial Revision of the International Lists of Diseases and Causes of Deaths in 1948
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recommended the proposal that all governments should establish national committees on vital and health statistics to study broadly the problems of producing satisfactory national and international statistics in the field of health. After its approval by the World Health Organization, the U. S. Department of State acted on this recommendation by requesting the Federal Security Administrator to form such a committee.
Early in 1949, the Surgeon General of the U. S. Public Health Service constituted the U. S. National Committee on Vital and Health Statistics with Dr. Lowell J. Reed, then vice president of the Johns Hopkins University, as its chairman. The chief of Medical Statistics Division was asked to serve as a member of this committee. In the period since 1949, he has served as chairman of two subcommittees of the national committee (the Subcommittee on Military Health Statistics and the Subcommittee on the Physical Impairment Code) and as a member of several ad hoc subcommittees.
The first International Conference of National Committees on Vital and Health Statistics convened under the auspices of the World Health Organization in London, England, in October 1953. The chief of Medical Statistics Division was a member of the U. S. delegation. When the Seventh Revision Conference on the International Statistical Classification of Diseases, Injuries and Causes of Death was held in Paris in February 1955, the chief of Medical Statistics Division was again one of the delegates from the United States.
The interest of those responsible for the medical statistics program in the Army in greater cooperation and increased coordination with others similarly engaged in health statistics activities has been strong and sustained. Since full and correct evaluation of an agency's own experience is so greatly facilitated by having appropriate norms and basis for comparison, the development of orderly and uniform methods for solving common problems in a common way is of incalculable benefit. Furthermore, the broadened scope of relationships and the increased understanding of other people and groups and their similar problems contribute to a clearer view and better balanced judgment to apply to the effective accomplishment of the task.
