In 1816, Sir James McGrigor, Director General of the Army Medical Department, instituted a system of returns on the sanitary state, morbidity and mortality of troops serving on foreign stations. In 1822, Inspector of Hospitals John Hennen compiled the first annual report on the sanitary state of the Malta Garrison and of the convalescent depôt in Malta for the whole army in the Mediterranean, covering the period 21 December 1821 to 22 December 1822.
In Oct 1835, Secretary at War Lord Howick appointed Major Alexander Tulloch and Deputy Inspector General of Hospitals Henry Marshall, to inquiry into the
extent and causes of the sickness and mortality among the troops in the West Indies, so as to establish such measures as might appear likely to diminish the great loss of life annually experienced in these colonies. Tulloch and Marshall utilised the McGrigor series of returns to prepare their account on the sickness and prevailing diseases among the troops in the West Indies from 1817 to 1834.
Subsequently, in May 1836, Lord Howick directed for a series of returns to be produced for each foreign station. On Major Tulloch's retirement in 1836, it fell on Assistant Surgeon Thomas Graham Balfour and Henry Marshall to produce the statistical reports on the health of the troops serving in the United Kingdom and the colonies.
From 1860 onwards, reports on the health of the army were printed annually in Blue Books, and submitted to Parliament.