Preface
The medical statistics program of the Army has had a profound impact not only on military personnel and policies but on civilian programs as well. It is a rare and fortunate event when the major evolution of an important program can be put into the historical record by one who has played a vital role in it. General Love's first association with the Medical Records Section was when he had a tour of duty in the Surgeon General's Office from 1910 to 1914, and in 1917 he was assigned to duty as officer in charge of the section. In the subsequent 40 years, whether in the capacity of a responsible administrator or of an observer, he has maintained a keen interest in the work of this unit. This monograph by General Love and his coauthors is a welcome and important contribution to the annals of medical statistics.
The function of medical records is twofold, to provide for the care of the individual and to yield statistical information which will guide administrative policy leading to improved health conditions. Both of these principles are well known in the medical records of civilian hospitals and in the medical statistics collected by health departments. But in neither of these areas do we have an opportunity for these functions to be as fully exploited as in the military services where the population served is known, the medical services are more uniformly available, and the various medical records of the individual can be brought together.
This monograph traces the development of medical records of the Army in their individual service function, in their compilation as medical statistics, and in their analysis leading to new knowledge. The account documents the early history of the medical records to show that, even when they furnished only primitive statistical material, this was used by the Surgeon General of the Army to convince the military authorities and the Government of administrative moves needed to improve the health of the soldiers. It is an excellent record of the evolution of medical statistics in effective use, rather than as statistics gathered for their own sake.
The knowledge accruing from the statistical analyses has been applicable not only to the military service but often to general populations as well. One evidence of General Love's wisdom when he administered the Medical Records Section was his use of the International List of Causes of Death and similar decisions to harmonize the military system with that of the general population rather than to set it apart. In addition he saw and capitalized on the potentialities of data gathered on a population base and with opportunity for followup for answering a variety of physiological and medical questions which have made a unique scientific contribution.
Another distinct development traced by the authors of the monograph is that of mechanical methods for handling large volumes of records. Although the Army made a very early trial of the Hollerith machines when they were in an experimental stage, it was under General Love's administration that this mechanical tabulating system (later as the IBM) was established as the essential method of tabulating the medical records of the Army. We thus have a historical record of the early hand-tabulating systems and the transition to the development of modern systems written by a person who was active in these developments. General Love shows a warm appreciation for the individuals involved in all these changes, including the long-term employees who accepted innovation reluctantly but worked loyally to make the new system a success.
In the present period of rapid electronic equipment, this whole historical background is especially timely. We are apt to lose sight of the fact that the basic ideas for modern recordkeeping and high-speed computing were well understood by those early workers and that it was only the speed limitation of the initial equipment which prevented their full realization.
The Army is to be congratulated for the way it has, over its history, made use of medical records for individual and statistical purposes. The medical-statistical world will be grateful to General Love and his coauthors for making this history a matter of permanent record and to Surgeon General Hays for initiating the writing of this volume.
Shelburne, New Hampshire, LOWELL J. REED.
April 1958
