The health of the Navy: the changing pattern.

190-201. Statistical data relating to the health of the Navy are usually unreliable prior to 1830. Sir Gilbert Blane used the ratio of those sent to hospital in all parts of the world' to the numbers voted by Parliament for the Navy' as a yardstick to assess the health of the Fleet. This ratio varied only from 1:3 to 1:4 between 1782 and 1795 but fell dramatically to 1:11 by 1813, by which time, however, conditions had improved so that more men were treated on board, which casts some doubt on the absolute validity of his case. Even in 1830, Blane still grouped the main causes of morbidity and death under the very broad headings of the fevers', the flux', the scurvy, and wounds', the nomenclature used since the 17th century. Annual Statistical Reports on (or of') the health of the Navy were published subsequently for the years 1830-1936, with only three gaps when publication was suspended. The case rates, invaliding rates, and death rates per 1,000 strength were tabulated from the outset to provide a clear picture of the changing pattern of disease. Since publication of the Reports was suspended in 1936 a revised system of medical documentation and the World Health Organization's International Statistical Classification of Diseases, Injuries, and Causes of Death have been adopted by the British Armed Forces, and from 1953 onwards domestic statistical reports on the health of the Navy have been circulated to Government departments. The main trends for the period 1953-1963 are discussed. Between the 1860s and the 1960s there was more than a four-fold decline in the annual case rate for the Total Force and a 15-fold decline in the death rate. The incidence of infectious diseases, with the notable exceptions of venereal disease and acute infections of the respiratory and gastro-intestinal tracts, was greatly reduced, and neuropsychiatric illness emerged as a major cause of lost working days and of discharge from the Navy. Degenerative vascular diseases of the heart and brain and neoplastic disease replaced phthisis, fever, dysentery, yellow fever, and inflammatory diseases of the lungs as the most prominent causes of death. In the 1960s deaths due to accidents and injuries were nearly twice as numerous as all the deaths due to diseases combined.