Of every 100 American soldiers and sailors who took part in the war with Germany, 2 were killed or died of disease during the period of hostilities.

In the Northern Army during the Civil War the number was about 10. Among the other great nations in this war, between 20 and 25 in each 100 called to the. colors were killed or died. To carry the comparison still further, American losses in this war were relatively one-fifth as large as during the Civil War and less than one-tenth as large as in the ranks of the enemy or among the nations associated with us.

The war was undoubtedly the bloodiest which has ever been fought. One possible competitor might be the Crimean War in which the casualty rate per 100 men was equally heavy. The British forces in the Crimean War lost 22 of every 100 men, the French 31, the Turkish 27, and the Russian 43.

More than four fifths of the losses were, however, deaths from disease, while in the recent war with Germany disease deaths were inconsiderable as compared with battle deaths. The forces engaged in the Crimean war were, moreover, much smaller.

BATTLE DEATHS IN ARMIES ENGAGED IN THE PRESENT WAR, 1914-1918

TOTAL ---- 7, 450, 200

The total battle deaths in the recent war were greater than all the deaths in all wars for more than 100 years previous. From 1793 to 1914 total deaths in war may safely estimated at something under 6,000,000. :Battle deaths alone from 1914 to 1918 totalled about 7,450,000. An estimate of the losses of the principal nations engaged is shown in Table 9. As the final records are not yet wholly complete, these figures are approximate in some

cases. Only deaths resulting directly from action are included. The total deaths from all causes is very much larger as some of the armies lost more heavily from diseases and privation than from battle. The table shows that Russia had the heaviest losses, in spite of the fact that she withdrew from the war after the fall of 1917. American losses are third from the bottom of the list. German losses were thirty-two times as great as the losses of the United States, the French twenty-eight times, and the British eighteen times as large.

For every man who was killed in battle, seven others were wounded, taken prisoner, or reported missing. The total battle casualties in the expeditionary forces are shown in Table 10. The number who died of wounds was only 6 per cent as large as the number who were wounded. The hospital records show that about 85 per cent of the men sent to hospitals on account of injuries have been returned to duty. About half the wounded were reported as slightly wounded and many of them would not have been recorded as casualties in previous wars. except for 297 who died all the prisoners shown in the table have now been returned.

BATTLE CASUALTIES IN THE AMERICAN EXPEDITIONARY FORCE.

'The number of men reported as missing has been steadily reduced from a total of 22~724, exclusive of prisoners, to the figure 2,913 shown in the table. This reduction has gone on without clearing any case as dead except on evidence establishing beyond doubt the fact of death. Only 22 per cent of those who were originally reported as missing in action have now been returned as dead. The results of clearing up the records of more than 19,000 cases are shown in diagram 52. The largest number have been found in hospitals, while a considerable number have returned to duty after being lost from their units.

The work of the Central Records Office of the American Expeditionary Forces in clearing up the cases of men listed as missing has been more successful than that done in any of the other armies hr in any previous great war. When the records are finally completed there will be very few American soldiers unaccounted for. The missing lists of the other nations still run into the hundreds of thousands.

The total number of lives lost in both Army and Navy from the declaration of war to May 1,1919, is 122,500. Deaths in the Army, including marines attached to it, were 112,432. About two-thirds of these deaths occurred overseas.

The next table shows the proportion which occurred in the United States and overseas, and also the proportion which disease-deaths bore. to battle- deaths.

Under "others" are included deaths from accident. There were 768 lost at sea, of which 381 are included under battle deaths, since their loss was the direct result of submarine activity. Almost exactly half the. losses were from disease. If the comparison between disease and battle losses is limited to the expeditionary forces, the battle losses appear more than twice as large as deaths from disease.

This is the first war in which the United States has been engaged that showed a lower death rate from disease than from battle. In previous wars insanitary conditions at camps and the ravages of epidemic diseases have resulted in disease deaths far in excess of the number killed on the battle field. The facts are shown in the next table. In order to make a fair comparison the figures used are the numbers of deaths each year among each 1,000 troops.

Since the time of the Mexican War a steady improvement has been made in the health of troops in war operations. The death rate from disease in the Mexican War was 110 per year in each 1,000 men; in the Civil War this was reduced to 65; and in the Spanish War to 26; while the rate in the expeditionary forces in this war was 19. The battle rate of 53 for the overseas forces is higher than in any previous war. It is higher than in the Civil War because all of the fighting was concentrated in one year, while in the Civil War it was stretched over four years. The rates of this war for the total forces under arms both in the United States and France from the beginning of the war to May 1, 1919, were 13 for battle and 15 for disease.

Some of the outstanding causes of the remarkably low disease death rate in the war against Germany are:

(1) A highly trained medical personnel,

(2) Compulsory vaccination of the entire Army against typhoid fever,

(3) Thorough camp sanitation and control of drinking water,

(4) Adequate provision of hospital facilities.

There were at the beginning of the war 2,089 commissioned medical officers, including the reserves. During the war 31,251 physicians from civil life were commissioned in the Medical Corps. This number included leaders of medical science who have not only made possible the application of the most recent advances of medicine in the prevention and cure of disease, but have themselves made new discoveries during the course of the war, resulting in great saving of life in our own and other armies. The intestinal diseases such as dysentery, the typhoids, bubonic plague, cholera, and typhus, have ravaged and even obliterated armies in the past.

During the Spanish-American War typhoid fever alone caused 85 per cent of the total number of deaths. In the War with Germany these diseases have been practically eliminated as causes of death. Diagram 55 shows the relative proportion of death caused by principal diseases. During the entire war up to May 1, 1919, a total of only 2,328 cases of typhoid fever have been reported and only 22l deaths from this cause. The result is due to the compulsory vaccination of every man who entered the Army and to excellent sanitary conditions. The other intestinal diseases are similarly of little effect as causes of death or have not occurred at all. It was to be expected that with careful control exercised, epidemics of these diseases could be avoided in the United States; but in the Expeditionary Forces, where troops were quartered in temporary camps, billeted with civilians, or actively engaged in pro longed battle, the reduction of these diseases is a notable achievement in sanitary control. It is evident from the diagram that pneumonia has been the greatest cause of death. More than 40,000 died of the disease. Of these, probably 25,000 resulted from the influenza-pneumonia pandemic which swept through every camp and cantonment in this country and caused thousands of deaths in the expeditionary forces. Up to September 14, 1918, only 9,840 deaths from disease had occurred in the Army, and the death rate for the period of the war up to that time was only 5 per year for each 1,000 men. During the eight weeks from September 14 to the 8th of November 316,089 cases of influenza and 53,449 of pneumonia were reported among troops in this country. The explosive character of the epidemic is shown in diagram 56. The. curve. in the diagram shows the weekly death rate for each l,000 troops in this country during the year 1918. The curve starts to rise sharply during the third week in September. It reached its high point the second week in October when 4 out of each 1,000 troops under arms in this country died. The rate subsided at the end of October but during the succeeding months remained somewhat higher than it had been previous to the epidemic.

DEATHS BY PRINCIPLE DISEASES

Two other diseases which offered difficult for the medical force were measles and spinal meningitis. Measles was prevalent during the first year of the war and was particularly dangerous as the predecessor of pneumonia. After vigorous efforts to control it the number of cases was greatly reduced. Meningitis has caused nearly 2,000 deaths, ranking next to pneumonia as shown in diagram 55 Both of the contagious diseases were largely the result of bringing numbers of men together in the confinement of camps and cantonments where the control of contagion is difficult. In the case of measles, men from rural communities who had not been immunized by previous exposure were particularly susceptible.

VENEREAL DISEASE.

Great success has also been experienced in the control of the. venereal diseases. A compre- hensive program of education, together with medical prophylaxis, has produced unusual results. While these diseases have continued to be the most frequent cause of admissions to the sick report, and the greatest source of non-effectiveness in the Army. A large proportion of the cases were contracted before entering the. Army. A special study of all new cases of venereal diseases reported at five large cantonments, Lee, Virginia.; Dix, New Jersey; Upton, New York.; Meade, Maryland.; and Pike, Arkansas, during the year ended May 21, 1919, shows that of 48,167 cases treated, 96 per cent were contracted before entering the Army and only 4 per cent after. The record for the forces overseas has been particularly note worthy. There, few fresh recruits entered the Army from civil life, and hence the conditions more accurately the effects of the Army control exercised. Up to September, 1918, there was steady reduction of non-effectiveness from venereal diseases in the Army overseas. At the beginning of that month there was less than one venereal patient in hospitals among each 1,000 men.. While the relative number of patients has increased since hostilities stopped, the record is still excellent. Regular weekly inspections, covering about 85 per cent of the total number of troops overseas, have disclosed during six months since the armistice less than one new case in each thousand men examined weekly. The .actual average was one new case each week among each 2,630 men examined.

At the beginning of the war what was then considered an extravagant program of hospital construction was entered upon with the intent that in no case should the Army lack facilities for the care of its sick. The table summarizes the hospital construction in the Untied States.

ARMY HOSPITAL CONSTRUCTION IN THE UNITED STATES

The figures are exclusive of very numerous small hospitals already in Army use. In addition more than 200 hospitals were put in operation overseas.

On December 1, 1919 there were available in Army hospitals 399,510 beds, or 1 bed to every 9 men in the Army. Of these, 2871290 were overseas and 112,220 were in this country. The hospital capacity was exceeded in this country only during the influenza epidemic, when it became necessary to take over barracks for hospital purposes. The overseas record was even better. Except during two weeks in October at the height of the at tack on the Hindenburg line, the number of patients did not exceed the normal bed capacity of the hospitals, and at that time there were approximately 60,000 unused emergency beds.

Over 130,000 patients have been evacuated from the expeditionary forces to hospitals in this country. They have been distributed to hospitals in this country in accordance with a twofold plan permitting the specialization of hospitals for the most efficient treatment of the various kinds of cases and placing the convalescents near their homes.

1. Of 100 American soldiers and sailors who served in the war with Germany, two were killed or died of disease during the period of hostilities.

2. The total battle deaths of all nations in this war were greater than all the deaths in all the wars in the previous 100 years.

3.Russian battle deaths were 34 times as heavy as those of the United States, those of Germany 32 times as great, the French 28 times, and the British 18 times as large.

4. The number of American lives lost was 122,500, of which about 10,000 were in the Navy, and the rest in the Army and the marines attached to it.

5. In the American Army the casualty rate in the Infantry was higher than in any other service, and that for officers was higher than for men.

6. For every man killed in battle seven were wounded.

7. Five out of every six men sent to hospitals on account of wounds were cured and returned to duty.

8. In the expeditionary forces battle losses were twice as large as deaths from disease.

9. In this war the death rate from disease was lower, and the death rate from battle was higher than in any other previous American war.

10. Inoculation, clean camps, and safe drinking water, practically eliminated typhoid fever among our troops in this war.

11 Pneumonia killed more soldiers than were killed in battle. Meningitis was the next most serious disease.

12. Of each 100 cases of venereal disease recorded in the United States, 96 were contracted before entering the Army and only 4 afterwards.

13. During the entire war available hospital facilities in the American Expeditionary Forces have been in excess of the needs.