17. Casualties-Diagnosis of.

Only the R.M.O. or the medical orderly under his instructions "will fill in the Tally Ticket. In all cases the R.M.O. will himself sign it. "In the case of sick he will see that the diagnosis is in accordance, with the" Nomenclature of Diseases."

In the case of injuries other than wounds, it will state whether these are battle 'casualties or accidental.

• (i) Gassed Cases.

  Gassed cases must be diagnosed as "wounded," i.e., Battle Casualty, or "sick," i.e., accidental.

  A case is a battle casualty if it arises from our own gas when it is being used in action against the enemy. It is accidental when arising from leakage of our own gas from its containers, either during transport to or storage in the line: provided that such leakage is not directly due to enemy action, as an enemy shell striking a container.

  Cases in which it is not known whether the gassing is accidental or a battle casualty, or whether the man has been gassed at all will be diagnosed "N.Y.D. (? gassed)."

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  It must also be definitely stated on the Tally of each gassed case whether the gas was. Shell, Drift (i.e., Cloud), or Mine gas.

  A diagnosis would appear thus: "Gassed—wounded—shell."

  Cases of conjuctivitis arising from gas are diagnosd as "Gassed."

• (ii) Shell Shock, Shell Concussion. Neurasthenia, Inability to stand Shell Fire.

  These terms are not to be used under any circumstances. The diagnosis will be written "N.Y.D.N." (The last "N" stands for "non-effective").

  The R.M.O. will procure all the information he can from the immediate associates of the patient as to the circumstances under which the condition has developed, e.g, undue proximity to an explosion, being buried, etc. He will also make a note of his physical condition, and state his own opinion on the case. This information will be forwarded in a closed cover to the medical unit to which the soldier is next evacuated. He must not express his opinion to the patient, but should assume an air of optimism and encouragement in handling his case:

• (iii)"P.U.O." or "P.O.U.O." (" Pyrexia of uncertain origin ").

  This is a permissible "diagnosis" in febrile cases, where the symptoms and signs are not sufficiently developed to enable the M.O. to make a definite diagnosis before evacuating the patient. While preserving the M.O. from the necessity of making a diagnosis on insufficient data, it must not be considered to completely satisfy the demands of medical science, or indications for treatment. It should therefore not be used for cases of definite disease, e.g., pleurisy, broncho-pneumonia, etc. Particularly, the M.O. must be assured that it is not covering an early case of some infectious disease, e.g, scarlet fever or C.S.M. It will be particularly used.for such cases as influenza and trench fever.

  Trench fever must not be diagnosed as such; but if suspected, as "P.U.O. (? trench fever)," as it is not possible to be sure of one's diagnosis till after a few days' observation.

• (iv) Mental and N.Y.D. (? Mental) Cases.

  The R.M.O. will forward with the patient to the Field Ambulance to which he is evacuated a report page 11stating fully:—

  1.	Facts observed by himself.
  2.	Facts observed by others.
  3.	His own opinion as to the nature of the case.

  This report will be sent by hand in a closed envelope, marked "Confidential." Under no circumstances will it be handed over to the patient for transmission.

  G.R.O. No. 2485 of 31-7-17, defines Battle Casualties and reads as follows:—

  "The following instructions will be observed when reporting casualties:—

  1.	All casualties caused by enemy weapons are Battle Casualties, i.e. the men concerned are reported simply as Killed in Action, or Wounded. Cases of shell shock will only be reported as "shell shock (wounded)" when the D.A.G., 3rd Echelon, has notified the unit in the Field that this should be done. See G.R.O. 2384 (iv).
  2.	All casualties caused by British or Allied weapons ('including poisoning by lethal or mine gas) which are in action against the enemy, will be reported as battle casualties, i.e., the man concerned will be reported simply as killed in action or wounded.
  3.	In every case where, accidents are strictly flying accidents, and death or injury to an officer or man flying on duty results, the casualty will be recorded in precisely the. same way as a casualty which occurs in action.
  4.	All casualties, other than self-inflicted, caused by British or Allied weapons which are not in action against the enemy, will be reported as accidental, thus:— Killed (accidently). Wounded (accidently).
  5.	All cases of mine gas poisoning will be supported by a certificate signed by the Officer i/c of the unit concerned and attached to A.F.B. 213, sent to D.A.G. 3rd Echelon weekly, stating that the casualty was not due to neglect or disobedience of orders. Casualties of this nature caused by neglect will be reported as "accidental."
  6.	All self-inflicted casualties will in the first instance be reported as wounded (self-inflicted). When the case has been investigated, the final classification will be-notified by the G.O.C. of the Army concerned to the D.A.G., 3rd Echelon. page 12
  7.	For the purposes of these instructions, the word 'weapons' will be held to include gas, liquid fire, high-tension currents, and enemy barbed-wire, as well as all other instruments used in fighting. In reporting casualties the special nature of the casualty will be indicated thus:— Killed (gas). Wounded (gas). Killed (liquid fire). Wounded (liquid fire). Killed (electrocuted). Wounded (electric shock). Wounded (barbed wire). If the casualty is accidental, the word 'accidental' will be added.
  8.	When an officer or other rank who is both 'wounded and missing,' and has been previously reported (l) missing, (2) wounded, the second notification should read:— (1) Wounded and missing, previously reported missing. (2) Wounded and missing, previously reported wounded. In the case where an officer or other rank is reported ' wounded and missing,' and it is desired to correct the report of wounded as well as of mising, thus:— (1) Cancel report wounded and missing, now reported wounded. (2) Cancel report both of wounded and of missing.