Books and Documents

The
MEDICAL DEPARTMENT
OF THE UNITED STATES ARMY
IN THE WORLD WAR

VOLUME X
NEUROPSYCHIATRY

IN THE UNITED STATES
BY
COL. PEARCE BAILEY, M. C.
LIEUT. COL. FRANKWOOD E. WILLIAMS, M. C.
SERGT. PAUL O. KOMORA, M. D.

IN THE AMERICAN EXPEDITIONARY FORCES

BY

COL. THOMAS W. SALMON, M. C.
SERGT. NORMAN FENTON, M. D.

PREPARED UNDER THE DIRECTION OF
MAJ. GEN. M. W. IRELAND

WASHINGTON : U. S. GOVERNMENT PRINTING OFFICE : 1929

TABLE OF CONTENTS

PREFACE. 
    By Col. Thomas W. Salmon, M. C., and Lieut. Col. Frankwood E. Williams, M. C.

SECTION I.-IN THE UNITED STATES

INTRODUCTION.
    By Lieut. Col. Frankwood E. Williams, M. C.

CHAPTER: 

I. Organization.
        By Col. Pearce Bailey, M. C., Lieut. Col. Frankwood E. Williams, M. C., and Sergt. Paul O. Komora, M. D.

II. Personnel.
        By Lieut. Col. Frankwood E. Williams, M. C., and Sergt. Paul O. Komora, M. D.

III. Provisions for care of mental and nervous cases.
        By Col. Pearce Bailey, M. C.

IV. Detection and elimination of individuals with nervous or mental diseases.
        By Col. Pearce Bailey, M. C.

V. Observation and treatment.
        By Lieut. Col. Frankwood E. Williams, M. C.

VI. Delinquency.
        By Lieut. Col. Frankwood E. Williams, M. C.

VII. Disposition of mental cases.
        By Lieut. Col. Frankwood E. Williams, M. C.

VIII. Occurrence of neuropsychiatric diseases in the Army.
        By Col. Pearce Bailey, M. C., and Capt. Roy Haber, S. C.

IX. Analysis of special neuropsychiatric reports.  
        By Col. Pearce Bailey, M. C., and Capt. Roy Haber, S. C.

Section 1
Section 2
Section 3

LIST OF TABLES

Table:

1. Neuropsychiatric diseases. Admissions, officers and enlisted men (except native troops), in the United States and Europe (except North Russia), April 1, 1917, to December 31, 1919. Absolute numbers.

2. Neuropsychiatric diseases. Admissions, officers and enlisted men (except native troops), in the United States and Europe (except North Russia), April 1, 1917, to December 31, 1919. Rates per 1,000 per annum.

3. Neuropsychiatric diseases. Discharges for disability, officers and enlisted men (except native troops), in the United States and Europe (except North Russia), April 1, 1917, to December 31, 1919. Absolute numbers.

4. Neuropsychiatric diseases. Discharges for disability, officers and enlisted men (except native troops), in the United States and Europe (except North Russia), April 1, 1917, to December 31, 1919. Rates per 1,000 per annum.

5. Neuropsychiatric defects noted in the total number of men rejected (549,099) by local boards in the different States.

6. Diagnoses of nervous and mental diseases and defects among commissioned officers, candidates for commission, and enlisted men.

7. Neuropsychiatric cases found among volunteers at recruit depots, and drafted men, by clinical groups.

8. Methods of discovering neuropsychiatric cases.

9. Delinquency cases in each clinical group.

10. Length of service of neuropsychiatric cases, prior to discovery.

11. Time of onset of neuropsychiatric disorders-line of duty.

12. Recommendations and final disposition of neuropsychiatric cases.

13. Neuropsychiatric cases giving a family history of nervous disease, mental disease, inebriety, or mental deficiency.

14. Neuropsychiatric cases giving a family history of nervous disease.

15. Neuropsychiatric cases giving a family history of mental disease.

16. Neuropsychiatric cases giving a family history of inebriety.

17. Neuropsychiatric cases giving a family history of mental deficiency.

18. Neuropsychiatric cases giving a family history of neuropathic taint. Percentage distribution.

19. Family history of principal neuropathic taints among neuropsychiatric cases.

20. Ages of neuropsychiatric cases.

21. Ages of neuropsychiatric cases. Percentage distribution.

22. Schooling of 80,000 soldiers as determined by psychological examinations.

23. Schooling of neuropsychiatric cases.

24. Economic condition of neuropsychiatric cases.

25. Neuropsychiatric cases admitting and denying venereal infection previous to entering the Army.

26. Habits of neuropsychiatric cases as to alcohol.

27. Marital status of neuropsychiatric cases.

28. Home environment of neuropsychiatric cases.

29. State of residence of neuropsychiatric cases.

30. State of birth of neuropsychiatric cases.

31. Gain or loss of neuropsychiatric cases resulting from immigration or migration.

32. Races of neuropsychiatric cases.

33. Per cent distribution of neuropsychiatric conditions among four different races, with comparisons between the American born and the foreign born.

34. Races of neuropsychiatric cases. Classification percentage.

35. Foreign-born neuropsychiatric cases by countries of birth.

36. Classification of family neuropathic taints among mental defectives, according to disorder and relatives.

37. State of residence of mental defectives. Percentages.

38. Per cent distribution of neuropsychiatric conditions in 19 States in which the rates for mental deficiency exceeded the United States rate of 29.2 per cent.

39. Per cent distribution of neuropsychiatric conditions among six races in which the mental deficiency rate exceeded the United States mental deficiency white rate of 29.2 per cent.

40. Per cent distribution of neuropsychiatric conditions in 24 States in which the rate for psychoneuroses exceeded the United States rate of 17 per cent.

41. State of residence of cases of psychoses.

42. Per cent distribution of neuropsychiatric conditions in 21 States in which the rate for psychoses exceeded the United States rate of 12.1 per cent.

43. Nine races in which the distribution rate for psychoses exceeded the United States white rate of 12.1 per cent.

44. Per cent distribution of neuropsychiatric conditions in 21 States in which the rate for epilepsy exceeded the United States rate of 8.6 per cent.

45. Per cent distribution of neuropsychiatric conditions in 18 States in which the rate for constitutional psychopathic states exceeded the United States rate of 9.7 per cent.

46. Per cent distribution of neuropsychiatric conditions in 17 States in which the rate for endocrinopathies exceeded the United States rate of 7.4 per cent.

47. Family history of neuropathic taints among cases of drug addiction.

48. Classification of family neuropathic taints among cases of drug addiction according to disorder and relatives.

49. State of residence of cases of drug addiction.

50. Per cent distribution of neuropsychiatric conditions in 12 States in which the rate for drug addiction exceeded the United States rate of 3 per cent.

51. Per cent distribution of neuropsychiatric conditions in 17 States in which the rate for alcoholism, including alcoholic psychoses, exceeded the United States rate of 3.5 per cent.

LIST OF CHARTS

CHART:

I. Diagnoses of neuropsychiatric cases (home forces).

II. Ratio of neuropsychiatric cases found among volunteers and drafted men examined by neuropsychiatrists.

III. Number of neuropsychiatric cases discovered by different methods.

IV. Diagnoses of disciplinary cases reported by neuropsychiatrists.

V. Length of service of 66,759 neuropsychiatric cases (home forces).

VI. Time of onset of disease before entering service.

VII. Recommendations and final dispositions of neuropsychiatric cases.

VIII. Family history of 60,410 neuropsychiatric cases.

IX. Age groups of 67,569 neuropsychiatric cases.

X. Schooling of neuropsychiatric cases, compared with that of other soldiers.

XI. Economic condition of 65,716 neuropsychiatric cases.

XII. Ratio of neuropsychiatric cases admitting and denying venereal infection.

XIII. Neuropsychiatric cases admitting and denying syphilitic and gonorrheal infection.

XIV. Alcoholic habits of 65,326 neuropsychiatric cases.

XV. Marital status of neuropsychiatric cases, compared with that of the men placed in Class I.

XVI. Marital status of 67,444 neuropsychiatric cases.

XVII. Home environment of 67,050 neuropsychiatric cases, compared with population of the United States in 1910.

SECTION II.-IN THE AMERICAN EXPEDITIONARY FORCES

INTRODUCTION
        By Col. Thomas W. Salmon, M. C.

CHAPTER:

I. General view of neuropsychiatric activities.
        By Col. Thomas W. Salmon, M. C.

II. Division, Corps, and Army neuropsychiatric consultants.
        By Lieut. Col. Edwin G. Zabriskie, M. C., Lieut. Col. John H. W. Rhein, M. C., Maj. Edward A. Strecker, M. C., Maj. Samuel Leopold, M. C., Maj. Mortimer W. Raynor, M. C., and Capt. Harry A. Steckel, M. C.

III. Army neurological hospitals.
        By Lieut. Col. John H. W. Rhein, M. C., and Maj. Roscoe W. Hall, M. C.

IV. Hospital for war neuroses (Base Hospital No. 117).
        By Lieut. Col. Frederick W. Parsons, M. C.

V. War neuroses as a medico-military problem.
        By Maj. Sidney I. Schwab, M. C., and Sergt. Norman Fenton, M. D.

VI. The care and disposition of cases of mental disease.
        By Lieut. Col. Michael J. Thornton, M. C., and Lieut. Col. Sanger Brown, II, M. C.

VII. In the Army of Occupation.
        By Maj. S. W. Hamilton, M. C.

VIII. Study of case histories of a typical group of war neuroses.
        By Sergt. Norman Fenton, M. D.

IX. A post-war study of a typical group of war neuroses cases in 1919-20 and 1924-25.
        By Sergt. Norman Fenton, M. D.

LIST OF TABLES

Table:

1. Comparison of ages of patients of Base Hospital No. 117, with ages furnished by 3,683,124 applicants for war risk insurance on basis of incidence of each age per 2,653.

2. Rank order of States from the standpoint of percentage of urban residents related to percentages of the total Army enlistments and of Base Hospital No. 117 patients from those States.

3. Rank order of States from the standpoint of density of population related to the percentage of the total Army enlistments and of the patients of Base Hospital No. 117 from those States.

4. Rank order of States from the standpoint of their percentage of foreign-born population related to the percentage of the total Army enlistments and of Base Hospital No. 117 patients from those States.

5. Rank order of States from the standpoint of their percentage of males 10 years and over engaged in agricultural work related to the percentage of the total Army enlistments and of the patients of Base Hospital No. 117 from those States.

6. Comparison of distribution of types of occupation of Base Hospital No. 117 patients with certain other groups.

7. Comparison of the 1919-20 follow-up group and the total Base Hospital No. 117 service in regard to physical classification.

8. A. E. F. physical classification of 1919-20 follow-up group in relation to condition in 1919-20.

9. Frequency of usage of diagnoses and physical classifications of psychoneurosis cases discharged from Base Hospital No. 117.

10. Comparison of the 1919-20 follow-up group and the total population of Base Hospital No. 117 in regard to diagnosis.

11. Condition in 1919-20 in relation to diagnosis in France.

12. Condition in 1919-20 in relation to diagnosis and physical classification.

13. Rank order of diagnoses on the basis of the percentage of those carrying on in civilian life in 1919-20.

14. Ages at hospitalization in France of follow-up group in relation to condition in 1919-20.

15. Distribution of cases within the normal, neurotic, fatigued, and disabled groups according to age.

16. Distribution of cases within each age group according to condition in 1919-20.

17. Family and personal histories (positive and negative) in relation to condition in 1919-20, numbers and percentages.

18. Family and personal histories (positive and negative) of follow-up cases compared with 1,000 unselected cases from Base Hospital No. 117, numbers and percentages.

19. Relation of pre-war occupation to condition in 1919-20.

20. Relation of 1919-20 condition to pre-war occupation.

21. Rank order of percentage of men of each occupation of the 1919-20 follow-up group now able to work.

22. Comparison of physical classification in the American Expeditionary Forces and the 1919-20 condition of the follow-up group, arranged so as to show cases discharged from the hospital before the armistice and during the armistice.

23. Comparison of the 1924-25 follow-up group and the total Base Hospital No. 117 service in regard to physical classification.

24. Physical classification of the 1924-25 follow-up group in relation to condition in 1924-25.

25. Comparison of the 1924-25 follow-up group and the total population of Base Hospital No. 117 in regard to diagnosis.

26. Condition in 1924-25 in relation to diagnosis in France.

27. Rank order of diagnoses on the basis of the percentages of those carrying on in civilian life in 1924-25.

28. Ages of follow-up group in relation to condition in 1924-25.

29. Distribution of cases within the normal, neurotic, fatigued, and disabled groups, according to age.

30. Distribution of cases within each age group according to condition in 1924-25.

31. Family and personal histories in relation to condition in 1924-25.

32. The follow-up cases (1924-25) compared with 1,000 unselected cases from Base Hospital No. 117.

33. Relation of occupation (1924-25) of follow-up group and total patients of Base Hospital No. 117 to working capacity.

34. Relation of condition in 1924-25 to occupation in 1924-25.

35. Rank order of percentage of men of each occupation of the 1924-25 follow-up group now normal.

36. Rank order of percentage of men of each occupation of the 1924-25 follow-up group now either neurotic or fatigued.

37. Direct comparison of physical classification in France and condition in 1924-25 of the follow-up group.

LIST OF FIGURES

Figure:

1. Map showing the locations of army neurological hospitals during the Meuse-Argonne operation.

2. Plan of psychiatric group at Bazoilles hospital center, A. E. F.

3. Plan of psychiatric clinic group at Savenay hospital center, A. E. F.

APPENDIX:

A bibliography of American contributions to war neuropsychiatry. By Norman Fenton, Ph. D.

Letter from Pearce Bailey, M. D., Stewart Paton, M. D., and Thomas W. Salmon, M. D., April 12, 1917, to the Surgeon General, United States Army.

The Care and Treatment of Mental Diseases and War Neuroses ("Shell Shock") in the British Army. By Maj. Thomas W. Salmon, M. C.

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LETTER OF TRANSMISSION

I have the honor to submit herewith Volume X of the history of the MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE WORLD WAR. The volume submitted is entitled, "NEUROPSYCHIATRY."

                                    M. W. IRELAND,
                        Major General, the Surgeon General.

The SECRETARY OF WAR.

Lieut. Col. FRANK W. WEED, M. C., Editor in Chief.
LOY MCAFEE, A. M., M. D., Assistant Editor in Chief.

EDITORIAL BOARD

Col. BAILEY K. ASHFORD, M. C.
Col. FRANK BILLINGS, M. C.
Col. THOMAS R. BOGGS, M. C.
Col. GEORGE E. BREWER, M. C.
Col. W. P. CHAMBERLAIN, M. C.
Col. C. F. CRAIG, M. C.
Col. HAVEN EMERSON, M. C.
Brig. Gen. JOHN M. T. FINNEY, M. D.
Col. J. H. FORD, M. C.
Lieut. Col. FIELDING H. GARRISON, M. C.
Col. H. L. GILCHRIST, M. C.
Brig. Gen. JEFFERSON R. KEAN, M. D.
Lieut. Col. A. G. LOVE, M. C.
Col. CHARLES LYNCH, M. C.
Col. JAMES F. MCKERNON, M. C.
Col. S. J. MORRIS, M. C.
Col. R. T. OLIVER, D. C.
Col. CHARLES R. REYNOLDS, M. C.
Lieut. Col. G. E. DE SCHWEINITZ, M. C.
Col. J. F. SILER, M. C.
Brig. Gen. W. S. THAYER, M. D.
Col. A. D. TUTTLE, M. C.
Col. WILLIAM H. WELCH, M. C.
Col. E. P. WOLFE, M. C.
Lieut. Col. CASEY A. WOOD, M. C.
Col. HANS ZINSSER, M. C.

^aThe highest rank held during the World War has been used in the case of each officer.