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Preface

Table of Contents

PREFACE

The subject matter of this volume is divided into two sections, the one dealing with neuropsychiatry in the United States; the other, with neuropsychiatry in the American Expeditionary Forces. This division naturally follows the differences which obtained in administering the neuropsychiatric service in both places, as the class of cases, generally speaking, with which the neuropsychiatrists had to deal.

The section of neuropsychiatry in the United States was quite largely prepared by Col. Pearce Bailey, M. C., who during the year preceding his untimely deathb gave a large proportion of his time to a careful study of the records of the division of neurology and psychiatry in the Surgeon General's Office. His material was completed and edited by Lieut. Col. Frankwood E. Williams, M. C., who was Colonel Bailey's chief assistant during the war, and Sergt. Paul O. Komora, M. D., who served in the offices of both Colonel Bailey in the United States and Colonel Salmon in the American Expeditionary Forces.

In the preparation of Chapters V and VI, material furnished by a number of neuropsychiatric officers was freely used. Mention is particularly made of the reports of Maj. A. J. Rosanoff, M. C., who was chief of neuropsychiatric service of the special hospital for war neuroses at Plattsburg, N. Y.; of Capt. Earl D. Bond, M. C., who was in charge of the neuropsychiatric activities in connection with the embarkation and debarkation of troops at Newport News, Va.; of Capt. Sylvester R. Leahy, M. C., who assisted in similar work at the port of Hoboken; and of Maj. Herman M. Adler, M. C., who made a special study of disciplinary problems in the Army in the United States.

In the preparation of Chapter IX jointly by Col. Pearce Bailey, M. C., and Capt. Roy Haber, S. C., who was on duty in the division of neurology and psychiatry, Surgeon General's Office, assistance in the editing of this chapter for statistical style and accuracy was given by Dr. Horatio M. Pollock and Miss Edith M. Furbush, statisticians, respectively, of the New York State Department of Mental Hygiene (formerly the New York State Hospital Commission) and the National Committee for Mental Hygiene.

This is the first time in the history of the country that it has been possible to study statistically such quantity of data in regard to neuropsychiatric disorders. Special study of neuropsychiatry had not reached an advanced stage during the Civil War, and the medical and surgical history of that war contains no discussion of this class of diseases. Such medico-military sta-

aFor the purposes of the history of the Medical Department of the United States Army in the World War, the period of war activities extends from Apr. 6, 1917, to Dec. 31, 1919. In the professional volumes, however, in which are recorded the medical and surgical aspects of the conflict as applied to the actual care of the sick and wounded, this period is extended, in some instances, to the time of the completion of the history of the given service. In this way only can the results of the methods employed be followed to their logical conclusion.
bDeceased Feb. 11, 1922.


tistics as had been compiled since that time have related only to a comparatively few men who had volunteered for military service.

Previous statistical studies have necessarily been confined to the records of various civilian institutions. These have not been possible on any large scale because of the lack of a uniform method of recording data in the various States and even in the several hospitals of the same State. Such studies have also lacked completeness for the reason that no State has made adequate institutional provision for mental diseases and practically no provision has been made at all for those who do not fall in the category of insanity. Therefore, individuals with psychoneuroses, constitutional psychopathic states, and the like have appeared only seldom in civil statistics.

The information obtained from this study will be of value to the Medical Department of the Army, in the event of future wars, in helping to make a correct estimate of the percentage of nervous and mental disabilities existing in the group of citizens liable for military service, and in estimating to what extent these conditions may be found among citizens of the different States and among people of different races and nationalities. Furthermore, authentic data will be available from which to fix definite standards of rejection for those examined at the time of entrance to the military service, and estimates can be made as to the different types of nervous diseases which will develop in the Army.

The degree to which neuropsychiatric defects were shown to prevail was unexpectedly large. The great predominance of those little understood conduct disorders embraced under the clinical classifications of psychoneuroses and constitutional psychopathic states was particularly surprising. It had always been believed that the psychoneuroses were the important forms of neuropsychiatric disorder, but from a study of the Army neuropsychiatric examinations it must be concluded that the psychoneuroses greatly surpass them in numbers. Hitherto these conditions have not been regarded socially as serious, but in the future it is apparent that every effort must be made by all citizens interested in the welfare of the country to salvage this great class of people in order that the man power of the country may be maintained at its maximum, as well as for other economic reasons.

In the preparation of Section II of this volume, the editor, Col. Thomas W. Salmon, M. C.,c who was senior consultant in neuropsychiatry, A. E. F., was assisted by Sergt. Norman Fenton, M. D., who served during the World War as assistant in psychology at Base Hospital No. 117, A. E. F. (the special hospital for war neuroses), and who for several years after the war was engaged in a noteworthy study of the subsequent histories of men who had suffered with neuropsychiatric conditions in the Army.

The effects of modern war upon the human mechanism have bearings upon problems of health nearly as important in some of their practical aspects now that the war is over, as when the success of the war itself depended upon the preservation of the health and morale of troops at their highest possible level. In the belief that it might be useful and at the same time not detract from the value of this volume as a record of events, the relation that methods of management of the war neuroses and of mental disorders in the American

cDeceased Aug. 13, 1927.


Expeditionary Forces bear to the solution of problems of mental health in civil populations has been commented upon from time to time.

While the actual neuropsychiatric work in the American Expeditionary Forces covered many different fields, there was, in almost every instance, an individual officer who was more directly responsible than anyone else for a particular activity or more fully informed regarding it. Therefore, the main divisions of neuropsychiatric activities are dealt with in separate chapters prepared in most cases by the officer who came in most intimate contact with the work described. As director of psychiatry and later senior consultant in neuropsychiatry, the editor of this section had an unusual opportunity to view the neuropsychiatric work as a whole. For this reason, accounts of the general conceptions upon which neuropsychiatric plans were based, the general narrative and an account of the administrative mechanism by which the work was conducted, as well as an evaluation of the results and the significance of what was accomplished have been contributed by the editor.

The account of neuropsychiatry in divisions, corps, and armies, in Chapter II of this section, was prepared by Lieut. Col. Edwin G. Zabriskie, M. C., consultant in neuropsychiatry in the 3d Division, 3d and 5th Corps, and First Army; Lieut. Col. John H. W. Rhein, M. C.,d who at different times was consultant in neuropsychiatry with the Second Army and commanding officer of Neurological Hospital No. 1; Maj. Edward A. Strecker, M. C., Maj. Samuel Leopold, M. C., Maj. Mortimer W. Raynor, M. C., and Capt. Harry A. Steckel, M. C., who served as division psychiatrists in the 28th, 4th, 79th, and 26th Divisions, respectively. Chapter III, which deals with the army neurological hospitals. was prepared by Lieut. Col. John H. W. Rhein, M. C., and Maj. Roscoe W. Hall, M. C. Chapter IV, dealing with the special base hospital for war neuroses at La Fauche (Base Hospital No. 117), was prepared by Lieut. Col. Frederick W. Parsons, M. C., commanding officer of that unit. Chapter V was prepared by Maj. Sidney I. Schwab, M. C., medical director of this hospital, and Sergt. Norman Fenton, M. D., who also prepared the bibliography and made the study of a group of discharged men who had war neuroses. Chapter VI was prepared by Lieut. Col. Michael W. Thornton, M. C. (section on psychiatric collection station), and Lieut. Col. Sanger Brown, II, M. C. (history of Base Hospital No. 214). Chapter VII, dealing with neuropsychiatry in the army of occupation, was prepared by Maj. Samuel W. Hamilton, M. C. (who was consultant in neuropsychiatry for the Third Army).

It is impossible to give full credit for all the other assistance given in the preparation of this volume, for many officers have contributed their own observations and data.

dDeceased.