THE 
BEST FORM OF REPORT 
OF 
DISEASES AND WOUNDS, 
REGARDED FROM A 
STATISTICAL STANDPOINT. 
BY 
JOSEPH R. SMITH, M.D., 
BREVET-COLONEL, LIEUTENANT-COLONEL AND SURGEON, U. S. ARMY. 
[Reprinted from the "Transactions of the Ninth International Medical Congress," Vol. II.] 
PRESS OF WM. F. FELL A CO., 1220-2* SANSOM AT., PHiUU. PA. THE BEST FORM OF REPORT OF DISEASES AND WOUNDS, 
REGARDED FROM A STATISTICAL STANDPOINT. 
LA MEILLEURE FORME D'UN RAPPORT SUR LES MALADIES ET LES BLESSURES 
POUR EN FACILITER LA STATISTIQUE. • 
DIE BESTE FORM EINES BERICHTES UBER KRANKHEITEN UND VERWUNDUNGEN VOM 
STATISTISCHEN STANDPUNKTE BETRACHTET. 
BY JOSEPH R. SMITH, M. D., 
Brevet-Colonel, Lieutenant-Colonel, and Surgeon U. S. Army. 
Military surgeons of most civilized nations make two different kinds of reports of the 
sick and wounded of the army. 
One kind of report is made daily: is for purely military purposes, and gives the 
number from the army unfit for duty on account of sickness, wounds and injuries. It 
merely furnishes data to aid the commanding officer in determining the effective 
strength of his army. 
This report is not here in question. The other kind of report, monthly, quarterly, or 
annual, is largely statistical, though more than numerical. It is called a ' ' Report of 
Sick and Wounded." 
Regarded merely from the statisticians' point of view, this report should supply data 
from which to ascertain, in a large number of healthy men in determinate conditions of 
life, the number and nature of diseases and injuries occurring, their results, and the 
amount of service and labor lost therefrom, computed in days. 
It should give : 1st. The number of men taken sick or injured. 
2d. The disease or injury in each case. 
3d. The disposition of each case, under the headings "Returned to Duty," which 
implies cure-"Transferred" - "Discharged from the Service for Disability" - 
' ' Deserted' '-" Died' '-and ' ' Remaining under Treatment. ' ' 
4th. The numerical strength of the army. As the facts thus recorded are also the 
data by which pensions and similar allowances are granted to the disabled, and to the 
widows and children of the dead soldier, they should be sufficiently full and accurate, 
on the one hand, to enable deserving beneficiaries to obtain without fail the allowances 
granted, and, on the other hand, to protect the government against the false claims of 
pretenders. 
The form of this report varies somewhat in different armies, and is occasionally 
changed. Now, what form is best for the attainment of its objects ? 
In all armies whose forms or regulations I have been able to examine, the forms are 
framed so as to include the headings before specified. In the Austrian, French, and 
Prussian armies, the report embraces officers and soldiers only, not referring to women 
and children. 
This is almost equally true of the British Army. In this army, at certain places, women's hospitals are provided for the authorized families of the soldiers, and these 
hospitals make their own report. But in the other reports of sick and wounded of the 
British Army, viz. : W. O. forms 294-294a-294b-298-464-516-517~823-893-893b-986, 
and the abstracts containing the tables in the annual reports of the Army Medical 
Department, women and children are only mentioned in two ; while in the printed 
form of " Annual Sanitary Reports " made by the principal medical officer (516-517) 
and which are the chief reports, the abstract of specific diseases contains the directions 
printed : "medical officers will be particularly careful that no diseases of women and 
children are included." 
The form in use by the United States Army Medical Department was only adopted 
in 1883, and is a bulky, awkward paper. Besides the statistics heretofore spoken of, it 
is arranged to contain the military history of the army ; statistics of sickness, deaths, 
vaccination, births and marriages among a greater or less number of civilians in the 
vicinity ; and statistics as to age, nationality, birthplace, and length of service of the 
sick soldier. 
Of course, these facts are valuable to the general statistician ; and the work of col- 
lecting them is suitable for a city office or bureau of statistics, where such facts may be 
hunted up, tabulated and analyzed ; but it is unsuitable in actual military service 
on the frontier. The central bureau has abundant space, sufficient time, and numerous 
clerks ; the military surgeon serving with troops generally has neither time, space, nor 
clerical aid. He must, therefore, delegate the preparation of these reports to unfit per- 
sons, and the more complicated the report is-the greater the number of subjects 
embraced by them-the more sure they are to be inaccurate. 
The medical officer, more or less pressed by his proper work, cannot but regard these 
studies as foreign, and as interfering with his legitimate duty ; they must receive but 
perfunctory attention, and carelessness and indifference, thus engendered, renders sure 
the presence of inaccuracies. 
The frequency with which these reports are returned for correction (from the Surgeon- 
General's office in Washington) to the officer making them, testifies to the correctness 
of this view. 
For various reasons, it is desirable that these reports should be uniform in the dif- 
ferent armies ; and, as the simpler they are, the more probable their correctness, and 
the easier to secure the adoption of one form in all armies, it seems clear, that this uni- 
formity should be attained, not by complicating the more simple, but by simplifying 
the more complicated. 
Facts concerning women and children, surrounding nations, military movements, or 
current events of interest, should be given in special reports; the "Column of Remarks " 
in the " Report of Sick and Wounded " containing only information necessary to the 
understanding of the report itself. Such special reports as are ordinarily called " Report 
of Wounded," "Report of Surgical Operations," "List of Wounded after Action," "Re- 
ports on Secondary Hemorrhage, Tetanus and Pyaemia," are of the greatest value. But 
they are irregular as to periodicity, because, cases to be reported in them occur infre- 
quently, and in some commands never ; while cases to be reported in the paper I am 
discussing are constantly occurring. This report, to show the exact health and the 
percentage of diseases, etc., in the large body of men forming modem armies, should 
embrace every case of disease or injury occurring among the armies. 
It might be thought unnecessary to argue this point; but, in certain armies, the 
practice has prevailed of including only those cases admitted to hospital, while in 
the report of the United States Army Medical Department the rule is, to report those 
excused from duty on account of sickness or injury, and none, but those so excused by 
the surgeon. Obedience to this rule inevitably necessitates incomplete and imperfect 
statistics of diseases, because many cases, though occurring, will be unreported. Syphilis, gonorrhoea, and skin diseases frequently occur, whose successful treatment 
requires no excusing from duty, while, in even more serious cases of these diseases, 
officers and privates (both) will prefer to do their whole duty, rather than be excused, 
and thus have made public the malady from which they are suffering. So also occur 
parasitic diseases, tumors, ear diseases, even to unilateral deafness, never requiring 
excuse from duty, while phthisis, cancer and other diseases of the gravest character 
may be treated for a long time in their incipient stage without any excuse from duty, 
after which the subject may be discharged by termination of service, and the disease 
progress to death. The writer has known a company clerk, a soldier (ruptured himself), 
still perform his clerical duty, and be neither excused, nor reported as a case of hernia; 
while commanding officers will frequently excuse themselves and those directly under 
them from duty, the surgeon treating them, but never excusing them. This has fre- 
quently occurred under the writer's observation. 
Surely, enough has been written to show the inaccuracy of statistics from reports 
thus made. 
A few words will here be needed as to nosology. It seems better to have the names 
of the most frequently-occurring diseases printed on the form, on account of economy of 
labor, the work of printing names in an office being easier than that of writing them in 
active service. Besides, the order of enumerating diseases will thus be uniform, and 
not left to the discretion of each officer, the theoretical views of any one of whom may 
differ from that of his next neighbor. Probably the diseases thus named will vary in 
number between 150 and 200. 
No classification of diseases has been yet devised absolutely above criticism. A 
really philosophical one must be founded on either Etiology or Pathology; and our 
knowledge of these is incomplete and subject to modification. 
To illustrate, under the head of ' ' Parasitic Diseases, ' ' no one can say what diseases 
may not, in the near future, be included, considering our increasing knowledge of 
microbes, and their functions in disease production. 
By the classification in use in the U. S. Army, " Diseases and Injuries " are divided 
into five classes, viz. : 1st, Zymotic, 2d, Constitutional, 3d, Parasitic, 4th, Local, and 
5th, Violent Diseases and Deaths. 
The Zymotic Class is divided into the three orders, 1st, Miasmatic, 2d, Enthetic, 
3d, Dietic. 
The Constitutional Class into the two orders, 1st, Diathetic, 2d, Tubercular. 
The Parasitic has no sub-orders. 
The Local is divided into nine orders, such as Nervous System, Eye, Ear, Organs 
of Circulation, etc. 
The 5th Class, "Violent Diseases and Deaths," is divided into four orders, viz. : 
1st, Wound Injuries and Accidents, 2d, Homicide, 3d, Suicide, 4th, Execution of 
Sentence. 
In the French Army six General Divisions are made. 1st, General Diseases, 2d, 
Local Diseases, 3d, Wounds, excluding Suicides and Accidents, 4th, Suicide and 
Suicidal efforts, 5th, Accidental Deaths, 6th, Diseases not classified. 
The 1st General Division of ' ' General Diseases ' ' has five subdivisions. 1st, Fevers, 
2d, Virulent Diseases (Enthetic), 3d, Diathetic, 4th, Diseases from alteration of blood, 
5th, Diseases by poisoning. 
The 2d General Division, '1 Local " ' is very similar in subdivisions to the same class 
in the U. S. Army, having, however, ten subdivisions instead of nine. 
The 3d General Division, "Wounds," has no sub-orders, save as to site of wounds, 
and the 4th and 5th General Divisions are without formal subdivisions. 
On the British form (W. O. 516-517) diseases are classified into five great classes of 1st, Zymotic, 2d, Constitutional, 3d, Local, 4th, Developmental, 5th, Violence, Deaths or 
Diseases. 
The Zymotic class is subdivided into 1st, Miasmatic, 2d, Enthetic, 3d, Dietic, 4th, 
Parasitic. 
The Constitutional class into 1st, Diathetic, 2d, Tubercular. 
The Local class, almost as the former two described systems, save that the sub- 
divisions are eight. 
Developmental class is without sub-orders. 
Violence, etc., is divided into 1st, Accidental, 2d, Battle, 3d, Homicidal, 4th, Suicidal, 
5th, Executed, 6th, Punishments. 
The abstract of diseases, however, published in the British Army Medical Department 
Report for 1884, differs somewhat from the foregoing : the divisions are still five, but 
the headings are : 1st, General Diseases, 2d, Local, 3d, Debility, 4th, Poisons, and 5th, 
Injuries, while the class of General Diseases is divided into a Febrile Group and a 
Constitutional Group. 
In the Austrian Table, diseases are divided into 1st, General and Blood Diseases, 2d, 
New Formations, 3d, Diseases of Nervous System, 4th, Diseases of the Eye, 5th, Diseases 
of the Ear, 6th, Respiratory Organs, 7th, Circulatory Organs, 8th, Digestive Organs and 
Annexes, 9th, Urinary and Sexual, excluding Syphilis and Venereal diseases, 10th, 
Venereal and Syphilitic, 11th, Skin and connective tissue, excluding syphilitic forms, 
12th, Bones, excluding injuries, 13th, Joints, excluding injuries, 14th, Muscle, Tendons 
and Bursie, excluding injuries, 15th, Animal Parasites, 16th, Injuries, excluding Suicide 
and Self-mutilation, 17th, Poisoning, excluding Suicides, 18th, Attempts at Suicide and 
Self-mutilation, 19th, Malformations, 20th, Under observation, Simulated, Expectant, 
Other Cases. 
The Prussian Army subdivision of Diseases is into 1st, General Diseases (Poisoning), 
2d, Diseases of the Nervous System, 3d, Respiratory Organs, 4th, Circulatory Organs, 5th, 
Organs of Assimilation, 6th, Urinary and Sexual, excluding Venereal, 7th, Venereal, 8th, 
Eye, 9th, Ear, 10th, Integumentary, 11th, Locomotion, 12th, Mechanical Injuries, 13th, 
Other Diseases, including Self-mutilation, Attempt at Suicide, Simulation, General 
Debility of Body, Debility from Age, 14th, Under observation. 
In 1884 the Surgeon General of the U. S. Army proposed for the criticism of the 
medical officers, a nomenclature of diseases, with a classification, as follows : Diseases 
arranged in two great divisions : 1st, Dependent upon Morbid Poisons, 2d, Dependent 
upon Other Causes than Morbid Poisons. 
The 1st Division contained but one Class, subdivided into six Orders. 1st, Mias- 
matic, 2d, Diarrhoeal, 3d, Malarial, 4th, Zoogenous, 5th, Venereal, 6th, Septic. 
The 2d Division contained seven Classes, viz.: 1st, Parasitic, 2d, Dietic, 3d, Constitu- 
tional, 4th, Developmental, 5th, Local, 6th, Injuries, 7th, Illy-defined and non-specified 
Causes. 
The Local Class included more than forty sub-classes and orders, and the Class of 
Injuries was divided into General and Local. The other classes had no sub-orders. 
The classification was illy received and not adopted. 
After long experience and careful consideration, I am of the opinion that the 
"Table of Diseases" arranged in the Prussian service is most suitable in military 
service, and, with confidence, I submit for adoption the following form. It is not 
claimed that this form is perfect; but it is simple, compact, easily understood, easier 
to make out than any form known to the writer, and contains all the data necessary to 
determine the proportion of cases of disease or injury occurring in an army, and the 
results thereof; besides all the data needed to enable proper conclusions to be reached 
in regard to pensions and similar allowances. In connection with the foregoing, I offer 
to the Section, for adoption, or otherwise, the following propositions :- 1st. The main object of a " Report of Sick and Wounded " for an army, is to give 
the diseases and injuries; their number ; their proportions occurring among the 
troops, and the results thereof; all other objects being incidental and secondary, or 
better effected in certain cases by Special Reports. 
2d. For purposes of convenience this Report should be monthly. 
3d. It is desirable that, for comparison and study, the form of this Report should 
be uniform for all armies, and as simple as may be. 
4th. No nosological arrangement can now be made which commends itself to every 
one, and which all will agree on as the only one compatible with scientific knowledge; 
and, therefore, that nomenclature and arrangement of diseases should be adopted in this 
Report, which is most convenient for use in the exigencies of military service. 
5th. In view of the great desirability of an uniform " Report of Sick and Wounded ' ' 
by all armies, and in the absence of any other form better fitted to fulfill the ends for 
which this Report is made, this Section recommends the adoption of the subjoined form 
in the Medical Department of all armies. MONTHLY REPORT OF SICK AND WOUNDED. 
This Report will be sent to the Medical Director, and a copy to the Surgeon- 
general direct, by the fifth of each month. Separate Reports are to be made for 
white and colored troops. 
Station Month _18 
Mean Strength of the Command: Officers..... Enlisted Men Total Strength 
TABULAR LIST OF DISEASES. 
The names of diseases not printed below, and 
the number of each occurring during the month, 
will be written under the class to which they be- 
long. Each day that a soldier fails to perform 
duty on account of disease or injury, is a " day's 
service lost." The addition of the number of days 
thus lost by all sick with the same disease makes 
the sum to be entered in the last column. 
R TREAT- 
1 MONTH. 
K. OR WOUNDED 
THE MONTH. 
CS 
M p 
EETURNED TO DUTY. 
iSFERRED TO ANOTHER 
5PITAL OR COMMAND. 
1RGED FOR 
ABILITY. 
WHILE UNDER 
ATM ENT. 
C 
5 
M 
Q . 
Z Eh 
P z 
0 s 
Z E- 
2 M 
64 
64 
Q 
S 
QQ 
" 2 
o 
as 
M 
CQ 
s 
p 
z 
1 remaining unde 
| MENT FROM LAST 
TOTAL TO 
ACCOUNTED 
TAKEN SIC 
0 
Z 
2 
A 
« 
Q 
9 
S 
tn 
S 
DESERTED 
W 
g 
2 
d 
1st 
GENERAL DISEASES (POISONING). 
Div. 
Yellow Fever. 
Smallpox. 
Etc. 
2d 
DISEASES OF THE NERVOUS SYSTEM. 
Div. 
Epilepsy. 
Inflammation of the Brain. 
Etc. 
3d 
DISEASES OF RESPIRATORY ORGANS. 
Div. 
Acute Bronchitis. 
Inflammation of Lungs.  
4th 
Div. 
DISEASES OF CIRCULATORY ORGANS. 
Hypertrophy of Heart. 
Aneurism. 
Etc. 
5th 
Div. 
ORGANS OF ASSIMILATION. 
Dyspepsia. 
Etc. 
6th 
Div. 
URINARY AND SEXUAL ORGANS (EXCLUD- 
ING VENEREAL). 
Retention of Urine. 
Etc. 
7th 
Div. 
VENEREAL DISEASES. 
Primary Syphilis. 
Etc. 
8th 
Div. 
DISEASES OF THE EYE. 
Cataract. 
Etc. 
9th 
Div. 
DISEASES OF THE EAR. 
Otorrhiea. 
Etc. 
10th 
Div. 
INTEGUMENTARY DISEASES. 
Boil. 
Etc. 
11th 
Div. 
DISEASES OF ORGANS OF LOCOMOTION. 
Anchylosis. 
Etc. 
12 th 
Div. 
MECHANICAL INJURIES. 
Gunshot Wounds. 
Etc. 
13th 
Div. 
Other Diseases, including, in the order here 
named, Self-mutilation, Attempted Sui- 
cide, Simulation, General Debility of 
Body, Debility from Old Age. 
14 th 
Div. 
Under Observation. 
TOTAL. 
VACCINATIONS DURING THE MONTH. 
NUMBER OF 
CASES. 
[1. Officers and soldiers excused from duty because of 
vaccination will bo entered on Register with vac- 
cina. 2. Note kind of virus used and general char- 
Vaccinated successfully. 
acier oi lesions produced tnereuy. Kemarks.j 
Vaccinated unsuccessfully. 
Undetermined. 
Revaccinated successfully. 
Revaccinated unsuccessfully. 
Undetermined. Discharges on Surgeon's Certificate, and Deaths, for the month of....., 18 
NOTE.-Discharges on surgeon's certificate, and deaths occurring among those not on Sick 
Report, will also be reported, but separated from the others by a double line drawn across the page. 
The remarks will, in each case, specify the manner in which the disease originated, when it is 
known. 
In every case of the death of an officer, whether on duty or not, a special report is to be made to 
the Surgeon-general. 
In every case of discharge or death, it should be stated whether the disease originated in the 
line of duty. 
NO. 
NAI 
SURNAME. 
IE. 
CHRISTIAN 
NAME. 
RANK. 
REGIMENT. 
CO. 
DISEASE OR 
WOUND. 
DATE OF DIS- 
CHARGE FROM 
SERVICE. 
DATE OF 
DEATH. 
ORIGI- 
NATED 
IN THE 
LINE OF 
DUTY. 
f REMARKS. 
DIRECTIONS.-Here make any necessary explanations, and communicate any matters of inter- 
est with regard to prevailing diseases or the sanitary condition of the troops. Interesting cases and 
autopsies should be communicated in full, in an accompanying letter. In case a hospital is opened 
or closed during the month, it should be stated by whose order, and on what day. When the com- 
mand is moving, the station on the first and last of the month and the route should be given. 
I certify that the above Report is correct and true, to the best of my knowledge and belief. 
-Surgeon . 
(To be signed by the medical officer in charge, with the name and rank in full ) 
MONTHLY EEPOET 
OF 
SICK MD WOUNDED, 
Station : 
Month:, 18 . 
FORWARDED BY 
Surgeon 
(Here give legibly the name and rank.) 
COMMAND. 
(Here specify legibly the name of 
the regiment and the letters of the 
companies comprising command, 
with the brigade, division, corps, and 
army or department in which it is 
serving.) 
DIRECTIONS. 
I. In filling the first pages of this Report, enter, opposite the name 
of each disease, the number of cases remaining, taken sick, etc., using 
ordinary numerals. 
II. Patients sent on furlough while under treatment will be con- 
sidered as still " Remaining under treatment," and when they return 
will not be reported as new cases. Should a patient die or desert 
while on furlough, the fact will be reported in the columns of" Died " 
or "Deserted." 
III. No arrangement is made on this blank for reporting secondary 
diseases or complications. Should these be in any case interesting, 
the facts are to be stated on the fourth page, under the head of " Re- 
marks." 
IV. When a soldier, reported during one month as " Taken sick " of 
any given disease and, still on sick report, dies during a subsequent 
month of another entirely distinct disease, the death will be entered 
in the proper column, opposite the name of the disease which was the 
cause of death, but no new case will be entered to correspond. In all 
such instances the facts are to be set forth in the " Remarks," and 
the necessary statistical corrections will be made in the Central Office. 
V. Separate reports will, in all cases, be made for white and colored 
troops. In the case of colored troops, the first page of this Report will 
present only the diseases of colored men. The name and rank of 
sick white officers of colored regiments, with disease and its termina- 
tion, will be placed on the fourth page of the report of colored troops, 
under the head of "Remarks." 
VI. The "Mean strength of the command " is to be ascertained as 
follows: The total strength present on each day of the month, as ob- 
tained from the commanding officer, are to be added together and 
divided by the number of days. This is to be done for officers and 
enlisted men separately; the nearest whdle numbers are to be used, 
and not decimals or fractions. No mean strength is to be reported in 
the case of general hospitals, or of such post hospitals as regularly 
receive their sick from the several commands, the medical officers of 
which, of course, make monthly sick reports. In all other cases, 
when patients are transferred, the name, rank, company, regiment, 
and disease or injury of each, w'ith the date and place of transfer, 
will be entered in the " Remarks." 
VII. When the command represented by the Report is moving, the 
station on the first and last of the month, and the route, should be 
given in the "Remarks." 
divided by the number of days. This is to be done for officers and 
enlisted men separately; the nearest whdle numbers are to be used, 
and not decimals or fractions. No mean strength is to be reported in 
the case of general hospitals, or of such post hospitals as regularly 
receive their sick from the several commands, the medical officers of