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Section I, Chapter VIII

Table of Contents

CHAPTER VIII

OCCURRENCE OF NEUROPSYCHIATRIC DISEASES IN THE ARMY

The reports received in the Office of the Surgeon General concerning the occurrence of neuropsychiatric diseases in the Army were of two entirely distinct classes. The first was the report card of sick and wounded (Form 52, Medical Department) which is forwarded for every officer or soldier admitted to sick report. In the second group were the special reports, required by the division of neuropsychiatry, which will be referred to at greater length in the following chapter.

The statistics compiled from the report cards of sick and wounded for all diseases are given in full in Volume XV, Part II, Medical and Casualty Statistics. From these statistics certain facts pertaining to the occurrence of neuropsychiatric diseases are recorded in Tables 1, 2, 3, and 4 below.

In Tables 1 and 2 every admission to sick report is considered. The only possible duplication would be that an individual may have been admitted more than once with the same diagnosis. This did not occur in any great number of instances, and the fact that it did occur among all the classes tabulated would tend to equalize the percentage of occurrence for purposes of comparison.

Table 2 shows for the following conditions a relatively higher degree of incidence among officers than enlisted men: Encephalitis, locomotor ataxia, apoplexy, neurasthenia, "shell-shock," neuritis, general paralysis of the insane, psychasthenia, psychoneurosis, and manic-depressive psychosis. The inclusion in this group of many of those indefinite functional disorders which usually are placed under the general term of psychoneuroses is of special interest. On the other hand, certain conditions occur much more frequently among the enlisted personnel. The marked preponderance in this respect of epilepsy, enuresis, constitutional psychopathic states, mental deficiency, and dementia pręcox is striking.

Table 2 shows, also, the higher incidence rate among officers serving abroad than among those in the United States. Further, it is seen readily that while for the total Army the percentage of neuropsychiatric diseases existing among officers was higher than among enlisted men, among those serving in Europe this disproportion was even greater.

As noted before, the special neuropsychiatric examination was not given as a routine to commissioned officers of the Army. This fact readily explains the higher percentage of this type of defect existing among officers and also why this percentage was increased among those serving in Europe. (When neuropsychiatric surveys of troops were made, officers were seldom required to undergo the special examination.) Ordinarily, we would expect a considerably lower rate of neuropsychiatric disease among the type of men included in the officer group than in the general type representing the enlisted men. The failure of this corollary to hold true is explained by the elimination of a


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large percentage of men, suffering from this class of disease, from the enlisted forces as a result of the efforts of the neuropsychiatrists.

A comparison of the ratio of these diseases occurring among enlisted men in the whole Army and among those serving in the United States and in Europe shows a much lower percentage for practically all neuropsychiatric diseases among the enlisted men in Europe. This marked reduction in the noneffective rate for this class of disease among the troops abroad is undoubtedly evidence of the efficiency of the neuropsychiatrists in detecting this type of defect before the soldiers had finished their period of training in this country. The general statement made above with reference to enlisted men as a whole applies similarly with reference to white and colored troops when considered separately.

In a comparison of the occurrence of neuropsychiatric diseases among white and colored troops, Table 2 discloses that the following diseases were recorded proportionately more often in white soldiers: Encephalitis, multiple sclerosis, neurasthenia, neurosis, "shell-shock," chorea, constitutional psychopathic state, dementia pręcox, psychasthenia, psychoneurosis, alcoholic psychosis, and manic-depressive psychosis. The following diseases occurred in a higher ratio among the colored soldiers: Simple meningitis, locomotor ataxia, apoplexy, facial paralysis, paraplegia, epilepsy, Jacksonian epilepsy, enuresis, neurocirculatory asthenia, hysteria, neuralgia, neuritis, defective speech, general paralysis of the insane, and mental deficiency and malingering. In general, the ratio of occurrence of neuropsychiatric diseases in white and colored troops corresponds for the whole Army-the Army in the United States and the Army in Europe.

A comparison of Tables 3 and 4 with Tables 1 and 2 shows a smaller number discharged on certificate of disability than might have been expected for defects of this character. It must be remembered, however, that a certain number died, some remained in hospital, and disposition at the final date included, in the statistics, a considerable number who were regarded as fit for the performance of some military duty and who were retained in the service; an appreciable number, after the signing of the armistice, were discharged upon the demobilization of their organizations who, if the war had not ended, would have been discharged for disability.


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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.


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TABLE 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


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TABLE 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.


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TABLE 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 

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