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Section I, Chapter IX

Table of Contents

CHAPTER IX

ANALYSIS OF SPECIAL NEUROPSYCHIATRIC REPORTS

The neuropsychiatric statistics here considered were prepared with little reference to the number of men examined. In the following pages estimates as to this number are made, but these are merely estimates. Complete reports as to the number examined were not received. The reported total number of men with neuropsychiatric conditions who entered the military service can not be considered the correct number, as it has already been shown that the neuropsychiatric examination was not given to all of the first increments of drafted men reporting at the camps. Further, many officers and the majority of those who served in the Students' Army Training Corps and the National Guard were not examined. After a careful consideration of all the facts, the total number who underwent this special examination is placed at approximately 3,500,000.

CHART I.-Diagnoses of neuropsychiatric cases (home forces)

Unless otherwise stated, all percentages given in this chapter refer to the total number of neuropsychiatric cases considered-69,394. For example, as shown in Chart I, of the total number of neuropsychiatric cases identified in the Army in the United States and available for classification, 21,858, or 31.5 per cent, were of mental deficiency, and 11,443, or 16.5 per cent, were of psychoneuroses. In certain of the tables which have been prepared the statistics established how the different conditions were distributed and, referring to States, for example, the percentage given shows the proportion of any given condition of the total neuropsychiatric conditions found among the residents of the State. As concerns races, the percentage is in reference to the total of neuropsychiatric disorders found among the members of a race, whether American born or foreign born.

From the foregoing statements it is evident that such percentages can not be regarded as indicative of the actual frequency of a condition in the total


158

number of men examined or in the representatives of either States or races. Further, as concerns the drafted men of the Army, the neuropsychiatric examinations were made only of those men who had been passed by the local examining boards under the provisions of the selective service act.

The number of neuropsychiatric cases found among the quotas which arrived at the camps depended upon the thoroughness of the examination by local boards. The character of the examination varied with different boards, and also at different periods of the mobilization, with the changing orders which were issued from time to time relative to the standards for rejection and classification. In order that one may understand in what degree the number of diagnoses of certain conditions made by the neuropsychiatric officers in camps corresponded with the rate of rejections for the same conditions by the local boards in various States, Table 5 was prepared. This table was compiled from the statistics given in Defects Found in Drafted Men,1 and affords information in respect to a few of the more important clinical groups in which the classification adopted by the Provost Marshal General corresponds with that used herein.

TABLE 5.-Neuropsychiatric defects noted in the total number of men rejected (549,099) by local boards in the different States. Rates per 1,000

States

Mental deficiency

Epilepsy

Drug addiction

Constitutional psychopathic states

Alcoholism

States

Mental deficiency

Epilepsy

Drug addiction

Constitutional psychopathic states

Alcoholism

Alabama

8.04

1.99

0.05

0.08

---

New Jersey

6.14

2.63

0.20

0.07

0.21

Arizona

2.00

.95

.35

.09

---

New Mexico

10.52

2.76

.14

---

.20

Arkansas

6.36

2.58

.01

.07

0.01

New York

7.26

3.92

.48

.30

.18

California

6.35

3.54

.64

.22

.38

North Carolina

14.03

3.72

.05

.04

.01

Colorado

6.77

3.27

.20

.07

.07

North Dakota

7.61

2.03

.04

.14

.07

Connecticut

7.96

4.15

.16

.06

.26

Ohio

9.95

3.99

.09

.19

.10

Delaware

5.45

1.36

.27

---

.14

Oklahoma

9.24

3.08

.17

.04

.01

District of Columbia

7.24

2.78

.07

.28

.14

Oregon

6.55

2.40

.04

.04

---

Florida

7.53

2.78

.11

.14

---

Pennsylvania

8.04

3.55

.17

.18

.13

Georgia

8.40

2.17

.14

.09

.01

Rhode Island

13.44

6.03

1.05

.33

1.18

Idaho

4.91

2.12

.06

---

.06

South Carolina

11.18

2.76

.10

.02

.07

Illinois

7.01

3.03

.06

.27

.08

South Dakota

11.34

.79

---

.20

---

Indiana

9.51

4.01

---

.07

.03

Tennessee

15.32

3.36

.15

.14

.03

Iowa

12.13

3.55

.06

.12

.13

Texas

8.42

3.82

.14

.04

---

Kansas

6.93

2.31

.03

.05

.09

Utah

5.95

2.50

.31

.38

---

Kentucky

12.54

3.47

.10

.06

.03

Vermont

27.13

10.18

.10

.40

.30

Louisiana

11.89

3.44

.10

.10

.06

Virginia

13.72

4.25

.10

.13

.01

Maine

16.75

4.45

.12

.08

.08

Washington

6.94

2.96

.49

.04

---

Maryland

20.36

6.03

.23

.64

.14

West Virginia

6.84

2.59

.03

.12

---

Massachusetts

8.00

3.74

.09

.14

.39

Wisconsin

9.70

2.84

.03

.14

.20

Michigan

8.44

2.67

.06

.21

.09

Wyoming

2.40

.58

---

---

.08

Minnesota

9.01

2.53

.16

.11

.09

Total United States rate per thousand, draft boards and camps

14.45

5.15

.54

.55

.31

Mississippi

9.28

2.50

.02

.05

.06

United states average

8.94

3.29

.16

.15

.13

Missouri

9.27

3.49

.15

.12

.23

Montana

2.79

1.74

.05

---

.03

Nebraska

4.77

1.96

.10

.06

.02

Nevada

2.28

2.07

.21

---

---

New Hampshire

7.40

3.58

---

.15

.23


In general, a low rate of rejections by local boards corresponds with a small number of cases found at the camps. For example, in the examination of men from Florida, the neuropsychiatric distribution average for mental defect was far below that of most of the other Southern States. This might be explained by the Florida local boards being unusually on the alert for mental defect, thus leaving fewer cases to be detected at the camps. Such was not the


159

case, however, as both local boards and neuropsychiatrists reported a below-average of mental defect in Florida. On the other hand, such correspondence between the findings of the local boards and the neuropsychiatrists was not invariable. For example, Nevada, with a none per thousand local board rejection for alcoholism, showed the highest neuropsychiatric distribution average for alcoholism of any State (see Table 42), although the actual number of cases was small.

The totals in all tables refer to diagnosis exclusively. The diagnoses form the basis of the statistics quite independently of any recommendation or action affecting the status of the soldier. That is, any individual in whom a diagnosis of neuropsychiatric disease was made and reported on Form 90 M. D. (see p. 14) is considered in the discussion which follows, irrespective of whether he was discharged from, or retained in, the Army. In some of the tables herein, in which the information is discussed in detail under subheads, the totals are not always uniform for the reason that in some of the different items the total of information was not constant.

In the consideration of many items, such as family history, preexistence of venereal disease, and alcoholic habits, the information is based upon the answers the enlisted men gave to questions asked them. Whenever possible their statements, especially as to personal history, were verified by correspondence with institutions, family physicians, and relatives. The facts as given are regarded as substantially correct. Drafted men, as a class, seemed truthful; the motives for deception were not strong, and attempts to deceive could generally be foiled. Again, in dealing with such large numbers, misstatements tend to balance. The compilations of the statistics as they became available at different periods were quite uniform. Thus the percentages established when 600,000 men had been examined were practically identical with those which covered the examination of 3,500,000. Throughout, also, there was a remarkable uniformity of the information obtained by the examiners at different stations.

In general it may be said that the present study furnishes many facts hitherto unknown concerning nervous and mental disease and defect occurring in a large group of individuals, or in certain selected smaller groups, all among males of a given age period. The neuropsychiatric disabilities of volunteers and drafted men are compared; of white and colored; of several races, both foreign and native born. Important information is furnished as to the length of service to be expected from men suffering from the different defects; the date of onset of such defects; the family history, age, education, home environment, marital and economic conditions, and alcoholic habits of those under consideration. It must be borne in mind throughout that the cases are discussed as groups and that the facts and conclusions given apply only to the group under consideration.

DISTRIBUTION OF CASES (OFFICERS AND ENLISTED MEN)

The distribution of the cases considered in this series among officers, candidates for commission, and enlisted men is shown in Table 6. Assuming 3,500,000 as the total number examined, it is found that about 20 out of every


160

1,000 were discovered to have some form of mental or nervous disease or defect. The distribution of the cases among the military personnel was:

Officers

533

Candidates for commission

587

Enlisted men

68,274

Total

69,394


OFFICERS AND CANDIDATES FOR COMMISSION

It was not possible to make accurate determinations of the number of officers and candidates for commission examined by neuropsychiatrists, except in officers' training camps which were in operation subsequent to the summer of 1917, no routine psychiatric examinations having been prescribed for this class of personnel. The high percentage of defects found among those attending the officers' training camps is startling. These conditions were discovered during the routine examinations conducted at certain of the officers' training camps. A greater number of candidates for commission were eliminated at these few camps by reason of neuropsychiatric disease than among the entire officer personnel throughout the United States. It is certain that if all candidates for commission had been subjected to a thorough neuropsychiatric examination before being accepted many would have been rejected with advantage to the military service. It was probably the outstanding defect of the neuropsychiatric service during the war that so many individuals were commissioned and given positions of military responsibility without a determination of their mental and nervous fitness therefor.

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

Diagnoses

Total

White

Colored, total

Total

Commissioned officers

Candidates for commission

Enlisted men

Mental deficiency

21,858

17,803

---

7

17,796

4,055

Imbecile

6,817

4,881

---

---

4,881

1,936

Moron

13,242

11,215

---

7

11,208

2,027

Border-line condition

880

846

---

---

846

34

Degree not determined

919

861

---

---

861

58

Psychoneuroses

11,443

10,343

166

124

10,053

1,100

Anxiety neuroses

89

88

3

1

84

1

Angioneuredema

3

3

1

---

2

---

Compulsion neurosis

2

2

---

---

2

---

Enuresis

497

466

1

---

465

31

Hysteria

3,648

3,220

22

18

3,180

428

Migraine

181

178

1

2

175

3

Neurasthenia

3,982

3,800

90

51

3,659

182

Psychasthenia

1,118

1,079

40

19

1,020

39

Stammering

1,343

993

---

2

991

350

Traumatic neurosis

219

175

1

---

174

44

Undiagnosed

361

339

7

31

301

22

Psychoses

7,910

7,354

148

71

7,135

556

Traumatic

51

38

1

---

37

13

Senile

12

12

7

---

5

---

With cerebral arteriosclerosis

4

4

2

1

1

---

General paralysis

530

487

17

12

458

43

With cerebral syphilis

44

33

2

2

29

11

With Hungtington's chorea

1

1

---

---

1

---

With brain tumor

1

1

---

---

1

---

With other brain or nervous diseases

2

2

---

---

2

---

Alcoholic

292

287

4

---

283

5

Drug and toxic

45

36

2

2

32

9

With pellagra

37

33

---

---

33

4

With other somatic diseases

109

92

8

3

81

17

Manic-depressive

1,385

1,304

64

26

1,214

81

Involution melancholia

3

3

2

---

1

---

Dementia prŠcox

4,738

4,433

24

15

4,394

305

Paranoia and paranoid conditions

52

48

3

1

44

4

With mental deficiency

113

100

---

---

100

13

With constitutional psychopathic inferiority

66

64

---

7

57

2

Epileptic

131

112

---

---

112

19

Undiagnosed

294

264

12

2

250

30

Nervous diseases and injuries

6,916

6,116

100

147

5,869

800

Arteriosclerosis

41

41

10

14

17

---

Ataxia:

(a) Friedreich's

4

4

---

---

4

---

(b) Marie's

4

4

---

---

4

---

Atrophy

55

52

---

2

50

3

Beriberi

1

1

---

---

1

---

Brain:

Abscess of

9

8

---

---

8

1

Tumor of

27

27

1

---

26

---

Chorea

264

252

---

---

252

12

Combined sclerosis

3

3

---

---

3

---

Dercum's disease

1

1

---

---

1

---

Ear disease

2

2

---

1

1

---

Erythromelalgia

1

1

---

---

1

---

Hemiplegia

258

210

5

2

203

48

Hematomyelia

3

3

---

---

3

---

Hemorrhage, cerebral

17

16

1

---

15

1

Herpes zoster

2

2

---

---

2

---

Hydrocephalus

13

12

---

---

12

1

Injury:

(a) Brain

337

245

3

2

240

92

(b) Spinal cord

39

33

1

---

32

6

(c) Peripheral nerve

178

150

3

---

147

28

Lateral sclerosis

24

21

---

---

21

3

Little's disease

2

2

---

---

2

---

MÚniŔre's disease

3

3

---

---

3

---

Meningitis

279

242

2

1

239

37

Multiple sclerosis

511

483

4

3

476

28

Myasthenia gravis

4

4

---

---

4

---

Myelitis

32

27

---

---

27

5

Myotonia congenita

17

17

---

---

17

---

Neuralgia

5

4

---

---

4

1

Neuritis

222

213

6

---

207

9

Neurofibromatosis

3

3

---

---

3

---

Paralysis agitans

18

16

---

---

16

2

Paramyoclonus multiplex

3

3

---

---

3

---

Paralysis

340

282

3

2

277

58

Paraplegia

34

28

1

---

27

6

Pes planus

23

22

---

---

22

1

Plumbism

13

12

---

---

12

1

Poliomyelitis

211

191

4

1

186

20

Progressive muscular atrophy

61

58

1

1

56

3

Progressive muscular dystrophy

15

14

---

---

14

1

Radiculitis

1

1

---

---

1

---

Retinitis

1

1

---

---

1

---

Raynaud's disease

8

8

---

---

8

---

Sciatica

137

127

5

---

122

10

Syphilis C.N.S.

2,462

2,161

26

50

2,085

301

Syringomyelia 

17

16

---

---

16

1

Tabes dorsalis

333

294

11

27

256

39

Tetanus

2

2

---

---

2

---

Tetany

1

---

---

---

---

1

Thrombosis cerebral

5

4

---

---

4

1

Tics

200

183

1

6

176

17

Torticollis

34

27

---

1

26

7

Tremor

243

212

---

4

208

31

Vagatonia

16

16

---

1

15

---

Undiagnosed

377

352

12

29

311

25

Epilepsy

6,388

5,273

9

14

5,250

1,115

Constitutional psychopathic states

6,196

5,941

65

168

5,708

255

Criminalism

323

306

1

---

305

17

Emotional instability

1,915

1,835

21

75

1,739

80

Inadequate personality

2,594

2,500

21

33

2,446

94

Nomadism

28

28

---

---

28

---

Paranoid personality

388

378

9

9

360

10

Pathological liar

28

27

1

---

26

1

Sexual psychopathy

190

171

2

4

165

19

Undiagnosed

730

696

10

47

639

34

Endocrinopathies

4,805

4,506

17

52

4,437

299

(a) Achondroplasia

2

2

---

---

2

---

(b) Adrenal

6

6

---

---

6

---

(c) Gonad

16

15

---

---

15

1

(d) Neurocirculatory asthenia

50

35

---

---

35

15

(e) Pituitary

205

186

---

2

184

19

(f) Thyroid

4,501

4,239

17

50

4,172

262

(g) Polyglandular

25

23

---

---

23

2

Drug addiction

2,020

1,823

20

---

1,803

197

Alcoholism

1,858

1,834

8

1

1,825

24

Grand total

69,394

60,993

533

584

59,876

a8,401


aAll enlisted men except 3, who were members of the Officers' Training Corps.

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

ENLISTED MEN

The predominance of mental and nervous defects among men who volunteered as compared with those who were drafted is shown in Table 7 and Chart II. The cases considered were collected from reports which showed definitely the number of men examined in each of the groups referred to, and how many of these had neuropsychiatric defects. While the number here considered is far less than the total, the results are regarded as typical for the entire series. In this connection it is noteworthy that many neurospychiatric patients who might otherwise have entered through the draft had already been sifted out by the local board examinations. No such preliminary elimination had occurred among those enlisting voluntarily.

Table 7 also shows the distribution of neuropsychiatric disorders among volunteers to be different from that in the Army as a whole. Those applying for voluntary enlistment show proportionately fewer mental defectives and drug addicts, and many more alcoholics.


163

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

Number of neuropsychiatric cases

Number of men examined

Total cases

Mental deficiency

Psycho-
neuroses

Psychoses

Nervous diseases or injuries

Constitutional psychopathic states

Drug addiction

Alcoholism

Volunteer recruits

81,881

2,066

413

108

138

682

232

480

13

Drafted men

626,825

10,812

3,952

1,681

453

3,356

750

99

521

Total

708,706

12,878

4,365

1,789

591

4,038

982

579

534


METHODS OF DISCOVERING CASES

The neuropsychiatric cases which comprise the present series came under the observation of the neuropsychiatrist through five sources (Table 8): (1) During the routine examination of all men on their arrival at a mobilization camp; (2) reference by other medical officers; (3) reference by commanding officers of organizations; (4) reference by psychologists; (5) reference by a court-martial or in connection with delinquency.

More cases were detected by the neuropsychiatrists during the preliminary physical examination than in any other manner, 27,836 cases, or 40.1 per cent of the total number reported, having been discovered in this way. Cases referred by other medical officers are regarded as consultation cases.

The cooperation of line officers was generally secured through talks given to them by the neuropsychiatrists. Their attention was invited to those particular traits which might indicate mental abnormality; and they were requested to refer to neuropsychiatrists, men in whom such characteristics were noted, for special examination. The success attending these efforts is indicated in the 16,336 positive cases which came to light through this channel.

One of the striking features of Chart III is the small number of cases reported as referred by the psychologists. Several explanations may be offered for this. As the psychological group examinations were conducted after the physical examinations were completed the greater number of cases of mental deficiency were discovered before the psychological examination began. Another explanation is, that many of the soldiers who received low grades in the psychological tests were sent to the development battalions where they were given an opportunity to display their ability. If their service was unsatisfactory they were later referred to the neuropsychiatrists by the commanding officers or surgeons of the organizations to which attached. Final recommendations in such cases were made, not alone upon failure to be placed in a particular psychological group, but upon failure to get along properly under training as well.

Whenever possible a psychologist was assigned to duty with the neuropsychiatric board for the purpose of conducting individual psychological examinations of men referred to them by the neuropsychiatrists. Their services were highly esteemed. Psychological ratings were thereby established, and the time of medical officers was economized.


164

TABLE 8.-Methods of discovering neuropsychiatric cases

CHART III


165

DELINQUENCY 

The number of cases brought to the attention of neuropsychiatric examiners by reason of misconduct was small. Out of the total of 69,394 neuropsychiatric cases there were only 1,498 (see Chart IV) which were referred by reason of delinquency. So small a representation of misconduct from a group of disorders of which the symptoms are primarily behavioristic contradicts civil experience. This contradiction may be interpreted in two ways. The first is that at the entrance examinations the neuropsychiatric officers detected most of the mentally irresponsible who were likely to turn out to be "bad actors," and succeeded in having them kept out of the Army. Such an interpretation is borne out by the unexpectedly low delinquency rate reported throughout the Army, both in this country and overseas. But even this interpretation does not altogether account for the low delinquency rate found among the neuropsychiatric cases. The conclusion can not be avoided that more misconduct cases would have been identified had there been a more thorough neuropsychiatric examination of all offenders prior to their trails by courts-martial. Such a view is borne out by the fact that of the 1,498 cases of misconduct, 575, or more than one-third, were reported from the Fort Leavenworth Disciplinary Barracks. In other words, the true nature of one-third of these cases was recognized, not as it should have been, at the point where the offense was committed, but at the point to which the individual had been sent after court-martial, for reformation or punishment.

CHART IV

With only 923 reported from all mobilized troops, it is evident from all previous experience with delinquency and mental irresponsibility, that many irresponsible soldiers were treated as delinquents.


166

TABLE 9.-Delinquency cases in each clinical group

Clinical groups

Number of neuro-
psychiatric cases

Number of delinquent

Per cent delinquent

Clinical groups

Number of neuro-
psychiatric cases

Number of delinquent

Per cent delinquent

Psychoses

7,910

404

5.1

Epilepsy

6,388

53

0.8

Constitutional psychopathic states

6,196

272

4.4

Psychoneuroses

11,443

66

.6

Mental deficiency

21,858

633

2.9

Nervous diseases and injuries

6,916

19

.3

Alcoholism

1,858

24

1.3

Endocrinopathies

4,805

6

.1

Drug addiction

2,020

21

1.0

Total

69,394

1,498

2.2


CLINICAL CLASSIFICATION

The neuropsychiatric examiners were instructed by the Surgeon General to use the following diagnostic terms in reference to classification:a

CLASSIFICATION OF DISEASES, INJURIES AND DEFECTS

I. Mental deficiency:

Imbecile.
Moron.
Border-line condition.

II. Psychoneuroses:

Enuresis.
Hysteria.
Neurasthenia.
Psychasthenia.
Stammering.
Other forms (specify) .
Undiagnosed.

III. Psychoses:

In designating the mental disease on the statistical card, the group and type of the psychosis will be given whenever possible.

1. Traumatic psychoses.
2. Senile psychoses.
3. Psychoses with cerebral arteriosclerosis.
4. General paralysis.
5. Psychoses with cerebral syphilis.
6. Psychoses with Huntington's chorea.
7. Psychoses with brain tumor.
8. Psychoses with other brain or nervous diseases (specify when possible).
9. Alcoholic psychoses.

(a) Pathological intoxication.
(b) Delirium tremens.
(c) Acute hallucinosis.
(d) Korsakow's psychosis.
(e) Chronic paranoid type.
(f) Other types, acute or chronic.

10. Psychoses due to drugs and other exogenous toxins.

(a) Morphine, cocaine, bromides, chloral, etc., alone or combined (to be specified).
(b) Metals, as lead, arsenic, etc. (to be specified).
(c) Gases (to be specified).
(d) Other exogenous toxins (to be specified).

11. Psychoses with pellagra.

aThe classification of mental diseases is the one adopted in May, 1917, by the American Medico-Psychological Association, now the American Psychiatric Association.


167

III. Psychoses-Continued.

12. Psychoses with other somatic diseases (specify disease).
13. Manic-depressive psychoses.

(a) Manic type.
(b) Depressive type.
(c) Stupor.
(d) Mixed type.
(e) Circular type.

14. Involution melancholia.
15. Dementia prŠcox.

(a) Paranoid type.
(b) Catatonic type.
(c) Hebephrenic type.
(d) Simple type.

16. Paranoia and paranoid conditions.
17. Psychoses with mental deficiency.
18. Psychoses with constitutional psychopathic inferiority.
19. Epileptic psychoses.
20. Undiagnosed psychoses.

IV. Nervous diseases and injuries:

Abscess-

Brain (specify location).
Spinal cord (specify location).

Arteriosclerosis- 

Cerebral.
General.
Spinal.

Beriberi.
Bulbar palsy.
Chorea.
Combined sclerosis.
Ear disease.
Embolism and thrombosis.
Eye diseases.
Facial palsy.
Hemorrhage (specify location).
Herpes zoster.
Hydrocephalus.
Injury (specify kind)- 

Brain (specify location).
Spinal cord (specify location).
Peripheral nerve (specify nerve).
Lateral sclerosis.
Lumbago.
MÚniŔre's disease.
Meningitis- 

Cerebrospinal.
Tuberculous.
Other forms (specify).

Migraine.
Multiple sclerosis (disseminated sclerosis).
Myasthenia gravis.
Myelitis- 

Transverse.
Traumatic.

Myotonia congenita (Thomsen's disease).
Neuralgia (specify nerve).


168

IV.  Nervous diseases and injuries-Continued.

Injury (specify kind)-Continued.

Neuritis (specify nerve)-

Diphtheritic.
Multiple-

Alcoholic.
Traumatic.

Other forms.

Pachymeningitis cervicalis.
Paralysis agitans.
Paramyoclonus multiplex.
Pes planus.
Plumbism.
Poliomyelitis.
Progressive muscular atrophy.
Progressive muscular dystrophies.
Sciatica.
Syphilis of central nervous system.
Syringomyelia.
Tabes dorsalis (locomotor ataxia).
Tics.
Torticollis.
Tremor-

Chronic progressive.
Brain (specify location).
Spinal cord.
Peripheral nerve (specify nerve).

Vagotonia.
Undiagnosed.

Conditions secondary to other diseases-

Aphasia.
Bulbar syndrome.
Hemiplegia.
Jackson's syndrome.
Optic atrophy.
Paraplegia.

V. Constitutional psychopathic states:

Criminalism.
Emotional instability.
Inadequate personality.
Nomadism.
Paranoid.
Pathological liar.
Sexual psychopathy.
Other forms (specify).
Undiagnosed.

VI. Epilepsy:

Idiopathic.
Jacksonian.

VII. Endocrinopathies:

Achondroplasia.
Adrenal.
Gonad.
Neurocirculatory asthenia.
Pituitary.
Polyglandular.

VIII. Drug addiction.

IX. Alcoholism.


169

The number of cases concerned was so large that the assembled material may be accepted as representing every variety of nervous and mental disease or defect occurring in men in the given age period in the United States. Larger collections of statistics concerning individual conditions exist, but none dealing with the whole subject of neuropsychiatry are known which parallel the present series. They furnish a complete compilation, not only of disorders which affect conduct primarily, such as the psychoses and the constitutional psychopathic states, but also the organic and functional disorders which affect the nervous system in structure and function.

To divide the diagnoses into distinct groups was not difficult, and it is believed that the several groups represent essentially different conditions, not only in regard to origin, but also as to characteristics, management, and other factors. The fringes of each group overlap, observable especially in the merging into each other of such conditions as are without definite physical symptoms. Under such circumstances the diagnosis and group assignment were made on the basis of the major disability. There was some question as to the proper group assignment of the 292 cases of alcoholic psychoses. (See Table 6.) These disorders, being induced by alcohol, belong to the alcoholism group, but any discussion of the psychoses must also include them. So they belong to both groups. They are counted with the psychoses in the general clinical classification and in the tables; but in the itemized information concerning the psychoses and alcoholism, they appear in both places. Similarly there were placed under psychoses 45 cases of "drug and other toxic psychoses." Of these no further account is made. The numbers finally placed in each group are shown in Table 6. The order of arrangement established in Table 6 is the order followed throughout this chapter.

CHART V

LENGTH OF SERVICE

The neuropsychiatric examinations, except those made of the men of the first draft and the men in the National Guard and the Regular Army, were conducted eventually as a part of the routine physical examination given the men upon arrival at a mobilization camp. As a result of this system, most of the individuals who were rejected left the service before the Government had proceeded to any great length with their military training. Information as to how long the men of this series were in service prior to discovery was obtained


170

for all but 2,635 cases. (Chart V.) Of the number for which the data were obtained, 52.6 per cent of all cases were discovered before they had been in the service one month, and 74.7 per cent were discovered before they had been in the Army three months, 86.7 per cent of all cases were identified before the expiration of six months, which was the average training period before men went overseas.

The period of service for the entire group of cases would have been reduced considerably if the final perfected system of conducting neuropsychiatric examinations had been in operation at the time the first draft went to camp. The men who were not examined immediately were given neuropsychiatric examinations by special boards after their training was started; in some instances the delay reached three months. Eliminating the cases found in this delayed group, which numbered about 13,000, the conclusion that most neuropsychiatric cases can be found by experienced neuropsychiatrists in one month does not seem to be unreasonable.

TABLE 10.- Length of service of neuropsychiatric cases prior to discovery

Diagnoses

Total

White

Total

Under 1 month

1 to 3 months

4 to 6 months

7 to 12 months

Over 
1 year to 2 years

Over 
2 years

Unascertained

Mental deficiency

21,858

17,803

9,212

3,753

2,178

1,320

377

99

864

Psychoneuroses

11,443

10,343

4,516

2,510

1,403

1,039

411

209

255

Psychoses

7,910

7,354

2,522

1,773

1,099

895

435

293

337

General paralysis

530

487

299

56

38

28

9

42

15

Alcoholic

292

287

163

42

11

23

20

17

11

Manic-depressive

1,385

1,304

445

315

186

161

78

66

53

Dementia prŠcox

4,738

4,433

1,352

1,146

741

592

271

123

208

Epileptic

131

112

44

34

11

9

4

5

5

Other forms

834

731

219

180

112

82

53

40

45

Nervous diseases and injuries

6,916

6,116

3,312

1,114

554

500

214

185

237

Chorea

264

252

137

51

21

29

4

2

8

Hemiplegia

258

210

118

40

22

16

2

6

6

Injury to nervous system

554

428

226

73

51

37

18

12

11

Meningitis

279

242

77

37

34

54

31

3

6

Multiple sclerosis

511

483

313

76

36

26

10

11

11

Neuritis

222

213

62

54

35

32

15

8

7

Paralysis

340

282

146

68

29

16

11

6

6

Poliomyelitis

211

191

129

31

15

10

2

3

1

Sciatica

137

127

34

31

19

17

7

12

7

Syphilis C.N.S.

2,462

2,161

1,199

356

169

175

67

87

108

Tabes dorsalis

333

294

191

39

12

18

6

13

15

Tic

200

183

95

48

17

8

4

1

10

Tremor

243

212

155

31

13

3

1

3

6

Other forms

902

838

430

179

81

59

36

18

35

Epilepsy

6,388

5,273

2,624

1,363

548

343

145

65

185

Constitutional psychopathic states

6,196

5,941

2,246

1,484

908

701

294

133

175

Endocrinopathies

4,805

4,506

2,994

722

354

227

95

27

87

Drug addiction

2,020

1,823

1,165

254

139

74

41

28

122

Alcoholism

1,858

1,834

1,287

101

102

106

90

68

80

Total

69,394

60,993

29,878

13,074

7,285

5,205

2,102

1,107

2,342



171

TABLE 10.-Length of service of neuropsychiatric causes prior to discovery-Continued

Diagnoses

Colored

Total

Under 1 month

1 to 3 months

4 to 6 months

7 to 12 months

Over 
1 year to 2 years

Over 
2 years

Unascertained

Mental deficiency

4,055

2,496

781

438

120

29

19

172

Psychoneuroses

1,100

688

233

85

49

12

6

27

Psychoses

556

249

177

47

43

8

14

18

General paralysis

43

22

13

2

1

1

4

---

Alcoholic

5

4

1

---

---

---

---

---

Manic-depressive

81

35

28

7

6

1

1

3

Dementia prŠcox

305

138

90

28

31

5

6

7

Epileptic

19

8

7

3

---

---

1

---

Other forms

103

42

38

7

5

1

2

8

Nervous diseases and injuries

800

520

122

64

43

11

13

27

Chorea

12

11

---

1

---

---

---

---

Hemiplegia

48

36

8

1

---

---

1

2

Injury to nervous system

126

80

23

8

6

---

---

9

Meningitis

37

26

2

3

5

1

---

---

Multiple sclerosis

28

19

6

3

---

---

---

---

Neuritis

9

2

3

3

---

1

---

---

Paralysis

58

41

9

2

2

1

1

2

Poliomyelitis

20

15

2

---

2

---

---

1

Sciatica

10

5

1

3

---

---

---

1

Syphilis C.N.S.

301

182

47

25

23

7

9

8

Tabes dorsalis

39

26

7

2

2

---

1

1

Tic

17

13

2

1

---

---

---

1

Tremor

31

25

3

---

2

---

1

---

Other forms

64

39

9

12

1

1

---

2

Epilepsy

1,115

713

267

74

30

3

1

27

Constitutional psychopathic states

255

151

59

22

14

2

3

4

Endocrinopathies

299

241

39

3

7

1

---

8

Drug addiction

197

167

16

1

---

---

3

10

Alcoholism

24

20

2

---

1

---

1

---

Total

8,401

5,245

1,696

734

307

66

60

293


LINE OF DUTY

It appears, as far as the determination by medical officers is concerned, that 96.1 per cent of the cases discovered did not have a disability which arose in line of duty; that is, the disability was not due to service in the Army. In only 2.8 per cent was "in line of duty" established. (See Table 11.)

As most of the cases were considered as "not in line of duty" the date of onset of the disease is of little importance from a military point of view, but the records contain important clinical data, especially as to the essential chronicity of nervous and mental disorders.


172

CHART VI


173-174

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


175

RECOMMENDATIONS OF PSYCHIATRISTS AND DISPOSITION OF CASES

Table 12 gives in detail the final disposition of the cases. Ninety-nine deaths were reported; 27 cases were absent without leave. These 126 cases and the 10,893 cases represented as retained include 2,142 more cases than the number recommended for retention. Adding these 2,142 cases to the 6,498 (unreported) cases upon which no action was taken, it seems probable that

CHART VII


176 

8,640 cases were retained which were at one time recommended for discharge by the neuropsychiatrists. In other words, 8,640 cases of nervous and mental diseases discovered in the United States were retained in the service while, in the opinion of neuropsychiatric officers, they should have been separated from it.

Some light as to the wisdom of retaining cases of nervous and mental diseases in the Army, especially among troops destined to go overseas, is shown by the statistics of the nervous and mental cases reported from France.

Between the dates of January 1, 1918, and July 1, 1919, the total number of cases of nervous and mental disease occurring in France and evacuated home, passed through General Hospital No. 214, A. E. F.2 The total number of them was 8,772, which is close correspondence between the number that the neuropsychiatrists had recommended unavailingly to be prohibited from going to France. These figures do not include the cases which were treated in hospitals and returned to duty.


177-179

TABLE 12.-Recommendations and final disposition of neuropsychiatric cases

FAMILY HISTORY

Tables 13 to 17 gave details concerning the members of families having a history of nervous or mental disease, inebriety, and mental deficiency.

Tables 18 and 19 summarize information as to family history in the different clinical groups. Table 19 indicates the distribution throughout the nine


180

clinical groups of family history of nervous disease, mental disease, inebriety and mental deficiency in the 39,484 cases classified under these headings. Later in the chapter, for each clinical group an additional summary is made in accordance with disorder and relatives. The number of the classified cases which serves as a basis of this summary is small. The information is interesting but too much weight should not be given to it.

CHART VIII

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

Diagnoses

Total

White cases

Colored cases

Total

Family history of neuropathic taint

Total

Family history of neuropathic taint

Positive

Negative

Unascer-
tained

Positive

Negative

Unascer-
tained

Mental deficiency

21,858

17,803

6,624

8,103

3,076

4,055

1,598

1,430

1,027

Psychoneuroses

11,443

10,343

5,486

4,187

670

1,100

577

445

78

Psychoses

7,910

7,354

3,441

2,850

1,063

556

232

187

137

General paralysis

530

487

137

263

87

43

10

20

13

Alcoholic

292

287

116

122

49

5

2

3

---

Manic-depressive

1,385

1,304

652

484

168

81

31

33

17

Dementia prŠcox

4,738

4,433

2,143

1,675

615

305

137

93

75

Epileptic

131

112

52

33

27

19

12

5

2

Other forms

834

731

341

273

117

103

40

33

30

Nervous diseases and injuries

6,916

6,116

2,164

3,215

737

800

360

336

104

Chorea

264

252

162

78

12

12

7

5

---

Hemiplegia

258

210

72

116

22

48

17

27

4

Injury to nervous system

554

428

140

241

47

126

52

49

25

Meningitis

279

242

76

145

21

37

19

14

4

Multiple sclerosis

511

483

226

193

64

28

18

7

3

Neuritis

222

213

56

141

16

9

3

5

1

Paralysis

340

282

85

173

24

58

24

28

6

Poliomyelitis

211

191

55

120

16

20

14

5

1

Sciatica

137

127

36

77

14

10

4

6

---

Syphilis C.N.S.

2,462

2,161

692

1,188

281

301

135

124

42

Tabes dorsalis

333

294

75

149

70

39

17

15

7

Tic

200

183

89

72

22

17

11

6

---

Tremor

243

212

122

79

11

31

20

11

---

Other forms

902

838

278

443

117

64

19

34

11

Epilepsy

6,388

5,273

2,859

1,867

547

1,115

714

333

68

Constitutional psychopathic states

6,196

5,941

3,108

2,188

645

255

144

70

41

Endocrinopathies

4,805

4,506

2,549

1,645

312

299

180

100

19

Drug addiction

2,020

1,823

648

967

208

197

66

107

24

Alcoholism

1,858

1,834

608

999

227

24

18

5

1

Total

69,394

60,993

27,487

26,021

7,485

8,401

3,889

3,013

1,499



181

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

Diagnoses

Total

White

Number of cases

Number of relatives with nervous disease

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

3,456

2,967

686

1,542

79

1,419

376

11,427

3,409

Psychoneuroses

4,009

3,587

1,025

2,301

128

2,110

402

6,015

759

Psychoses

1,534

1,438

360

768

52

735

210

4,646

1,270

General paralysis

74

64

15

37

1

27

1

337

86

Alcoholic

38

36

6

11

1

19

4

198

53

Manic-depressive

294

282

77

140

7

170

53

815

207

Dementia prŠcox

927

873

211

485

38

420

127

2,804

756

Epileptic

32

27

10

12

2

21

7

50

35

Other forms

169

156

41

83

3

78

18

442

133

Nervous diseases and injuries

1,572

1,389

354

690

59

643

196

3,870

857

Chorea

129

124

32

69

5

81

27

113

15

Hemiplegia

48

44

8

21

2

18

8

145

21

Injuries to nervous system

94

71

24

39

3

29

3

309

48

Meningitis

62

56

7

33

3

25

8

160

26

Multiple sclerosis

176

169

41

83

7

85

23

234

80

Neuritis

34

33

4

12

1

23

10

160

20

Paralysis

71

56

12

25

2

19

12

202

24

Poliomyelitis

45

37

14

18

4

10

7

138

16

Sciatica

27

25

10

13

---

13

1

87

15

Syphilis C.N.S.

458

379

81

205

11

153

45

1,431

351

Tabes dorsalis

37

32

10

18

1

15

1

187

75

Tic

74

68

18

31

3

34

20

95

20

Tremor

110

93

39

41

7

44

7

107

12

Other forms

207

202

54

82

10

94

24

502

134

Epilepsy

2,036

1,525

432

875

111

1,251

395

3,083

665

Constitutional psychopathic states

1,616

1,535

394

947

59

839

192

3,611

795

Endocrinopathies

1,180

1,045

417

1,024

85

988

250

111

350

Drug addiction

266

239

53

106

7

99

25

1,321

263

Alcoholism

224

221

43

102

3

78

23

1,343

270

Total

15,893

13,946

3,764

8,355

583

8,162

2,069

35,409

8,638


Diagnoses

Colored

Number of cases

Number of relatives with nervous disease

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

489

110

196

32

399

139

2,383

1,183

Psychoneuroses

422

104

138

11

343

62

596

82

Psychoses

96

21

26

3

50

18

314

146

General paralysis

10

6

2

---

1

5

19

14

Alcoholic

2

---

---

---

2

---

3

---

Manic-depressive

12

---

4

---

9

2

49

20

Dementia prŠcox

54

10

14

3

23

8

175

76

Epileptic

5

2

2

---

4

3

9

5

Other forms

13

3

4

---

11

---

59

31

Nervous diseases and injuries

183

42

73

11

102

25

491

126

Chorea

5

---

3

1

2

---

7

---

Hemiplegia

4

1

2

1

3

1

40

4

Injuries to nervous system

23

5

8

1

10

2

70

33

Meningitis

6

1

3

---

3

---

27

4

Multiple sclerosis

7

2

3

1

2

1

17

4

Neuritis

1

---

---

---

1

---

7

1

Paralysis

15

5

6

3

4

5

40

3

Poliomyelitis

8

2

3

---

11

---

11

1

Sciatica

2

---

1

---

---

3

---

8

Syphilis C.N.S.

79

14

31

2

40

9

175

47

Tabes dorsalis

5

3

1

---

---

2

24

10

Tic

6

3

3

1

6

---

11

---

Tremor

17

5

8

1

14

---

14

---

Other forms

5

1

1

---

6

2

48

11

Epilepsy

511

82

166

30

362

94

525

79

Constitutional psychopathic states

81

17

39

6

41

16

120

54

Endocrinopathies

135

35

58

15

65

15

145

19

Drug addiction

27

2

16

1

7

2

40

30

Alcoholism

3

2

1

---

1

6

20

1

Total

1,947

415

713

109

1,370

377

4,634

1,720



182

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

Diagnoses

Total

White

Number of cases

Number of relatives with mental disease

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

2,855

2,146

353

403

194

650

972

12,252

3,405

Psychoneuroses

1,744

1,551

255

292

159

399

781

7,890

902

Psychoses

1,855

1,729

357

384

208

561

940

4,427

1,198

General paralysis

42

41

11

10

2

9

21

366

80

Alcoholic

40

40

8

10

3

14

24

195

52

Manic-depressive

390

373

86

102

41

119

176

736

195

Dementia prŠcox

1,182

1,101

222

221

128

371

612

2,625

707

Epileptic

27

23

7

3

5

5

17

57

32

Other forms

174

151

23

38

29

43

90

448

132

Nervous diseases and injuries

653

515

97

102

67

113

309

4,782

819

Chorea

34

33

9

6

6

7

46

200

19

Hemiplegia

26

24

2

3

3

4

11

157

29

Injuries to nervous system

53

34

6

4

3

6

16

345

49

Meningitis

34

24

2

4

2

6

16

196

22

Multiple sclerosis

61

50

10

12

4

9

24

353

80

Neuritis

19

17

4

1

---

6

7

178

18

Paralysis

26

20

3

6

3

1

12

237

25

Poliomyelitis

17

16

3

1

2

3

7

158

17

Sciatica

11

10

1

2

1

---

7

101

16

Syphilis C.N.S.

210

149

34

34

23

42

87

1,710

302

Tabes dorsalis

33

26

7

3

5

6

5

192

76

Tic

22

17

4

6

---

4

12

143

23

Tremor

37

30

3

9

4

6

20

165

17

Other forms

70

65

9

11

11

13

39

647

126

Epilepsy

1,035

747

110

181

114

198

357

3,745

781

Constitutional psychopathic states

1,061

999

206

248

123

268

586

4,111

831

Endocrinopathies

543

496

75

102

52

116

238

3,612

398

Drug addiction

177

149

26

29

15

45

87

1,417

257

Alcoholism

115

113

18

9

8

27

52

1,460

261

Total

10,038

8,445

1,497

1,750

940

2,377

4,322

43,696

8,852


Diagnoses

Colored

Number of cases

Number of relatives with mental disease

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

709

83

113

52

264

432

2,239

1,107

Psychoneuroses

193

18

22

23

62

121

826

81

Psychoses

126

28

23

10

45

64

292

13

General paralysis

1

---

1

---

---

---

29

138

Alcoholic

---

---

---

---

---

---

5

---

Manic-depressive

17

2

6

1

7

12

45

19

Dementia prŠcox

81

19

12

6

24

40

150

74

Epileptic

4

1

1

---

3

3

13

2

Other forms

23

6

3

3

11

9

50

30

Nervous diseases and injuries

138

23

11

19

50

73

529

133

Chorea

1

---

---

---

1

---

9

2

Hemiplegia

2

2

---

1

2

4

43

3

Injuries to nervous system

19

4

3

1

3

9

73

34

Meningitis

10

1

1

---

8

4

23

4

Multiple sclerosis

11

4

---

2

5

4

15

2

Neuritis

2

---

---

---

2

4

6

1

Paralysis

6

2

---

2

2

1

48

4

Poliomyelitis

1

---

1

---

---

---

18

1

Sciatica

1

---

---

---

---

1

9

---

Syphilis C.N.S.

61

6

6

10

14

33

184

56

Tabes dorsalis

7

2

---

1

5

6

22

10

Tic

5

---

---

---

5

1

12

---

Tremor

7

1

---

1

---

4

21

3

Other forms

5

1

---

1

3

2

46

13

Epilepsy

288

39

49

30

109

139

729

98

Constitutional psychopathic states

62

13

12

8

21

29

136

57

Endocrinopathies

47

2

6

9

17

27

233

19

Drug addiction

28

4

4

4

3

13

144

25

Alcoholism

2

---

---

---

1

1

21

1

Total

1,593

210

240

155

572

899

5,149

1,659



183

TABLE 16.-Neuropsychiatric cases giving a family history of inebriety

Diagnoses

Total

White

Number of cases

Number of relatives with inebriety

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

3,028

3,630

1,963

55

55

781

446

11,810

3,363

Psychoneuroses

1,566

1,434

926

18

68

337

334

7,917

992

Psychoses

1,403

1,326

988

27

45

358

240

4,745

1,276

General paralysis

63

61

49

---

7

21

17

340

86

Alcoholic

112

110

57

1

3

47

22

119

51

Manic-depressive

215

206

153

3

8

38

36

884

214

Dementia prŠcox

834

789

620

19

21

172

135

2,897

747

Epileptic

13

12

10

---

---

5

1

61

39

Other forms

166

148

99

4

6

75

29

444

139

Nervous diseases and injuries

970

822

559

15

25

254

153

4,454

840

Chorea

43

42

30

---

2

5

8

187

23

Hemiplegia

32

26

19

1

---

6

7

157

27

Injuries to nervous system

82

48

30

---

1

17

12

332

48

Meningitis

23

21

10

4

2

2

9

198

23

Multiple sclerosis

110

103

63

---

5

16

22

301

79

Neuritis

21

20

18

---

1

3

3

174

19

Paralysis

40

27

17

---

1

13

4

228

27

Poliomyelitis

21

14

9

---

---

10

4

159

18

Sciatica

16

13

9

---

---

7

10

97

17

Syphilis C.N.S.

402

349

240

5

5

121

42

1,496

316

Tabes dorsalis

33

30

26

3

1

11

10

187

77

Tic

19

17

16

1

---

5

2

140

26

Tremor

29

22

17

---

1

3

3

172

18

Other forms

99

90

55

1

6

35

17

626

122

Epilepsy

894

681

599

20

27

210

195

3,841

751

Constitutional psychopathic states

1,167

1,119

861

32

44

254

219

4,037

785

Endocrinopathies

737

675

462

12

23

129

152

3,451

380

Drug addiction

429

382

247

22

13

134

96

1,191

250

Alcoholism

542

531

355

18

17

183

116

1,077

226

Total

10,736

9,600

6,960

219

317

2,640

1,951

42,523

8,863


Diagnoses

Colored

Number of cases

Number of relatives with inebriety

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

398

248

18

8

196

87

2,463

1,195

Psychoneuroses

132

96

5

4

45

28

879

89

Psychoses

77

52

6

---

41

16

340

139

General paralysis

2

2

1

---

---

2

27

14

Alcoholic

2

1

1

---

---

---

3

---

Manic-depressive

9

3

---

---

3

4

53

19

Dementia prŠcox

45

32

3

---

29

9

186

74

Epileptic

1

1

---

---

---

---

15

3

Other forms

18

13

1

---

9

1

56

29

Nervous diseases and injuries

148

69

2

1

43

39

541

111

Chorea

1

1

1

---

---

---

9

2

Hemiplegia

6

5

---

---

2

---

38

4

Injuries to nervous system

34

5

---

---

5

6

77

15

Meningitis

2

1

---

---

1

---

30

5

Multiple sclerosis

7

2

---

---

1

8

20

1

Neuritis

1

---

---

---

1

---

7

1

Paralysis

13

4

---

---

7

2

42

3

Poliomyelitis

7

4

---

---

4

---

12

1

Sciatica

3

2

---

---

---

1

6

1

Syphilis C.N.S.

53

32

1

1

10

20

197

51

Tabes dorsalis

3

3

---

---

1

---

24

12

Tic

2

1

---

---

1

---

14

1

Tremor

7

4

---

---

7

---

24

---

Other forms

9

5

---

---

3

2

41

14

Epilepsy

213

116

---

---

104

35

806

96

Constitutional psychopathic states

48

29

4

---

17

35

153

54

Endocrinopathies

62

36

5

4

40

13

212

25

Drug addiction

47

24

3

1

20

11

125

25

Alcoholism

11

9

1

---

6

5

7

6

Total

1,136

679

43

18

512

269

5,525

1,740



184

TABLE 17.-Neuropsychiatric cases giving family history of mental deficiency

Diagnoses

Total

White

Number of cases

Number of relatives with mental deficiency

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

1,752

1,478

244

243

9

1,339

151

12,376

3,949

Psychoneuroses

84

34

21

23

8

190

91

9,406

967

Psychoses

307

280

42

53

3

232

89

5,644

1,430

General paralysis

7

5

---

1

---

3

2

390

92

Alcoholic

1

1

---

---

---

2

---

231

55

Manic-depressive

48

47

8

7

---

49

13

1,038

219

Dementia prŠcox

207

194

25

35

2

134

57

3,369

870

Epileptic

12

10

1

1

---

8

3

58

44

Other forms

32

23

8

9

1

36

14

558

150

Nervous diseases and injuries

125

89

5

5

4

69

35

5,248

956

Chorea

6

5

---

---

---

4

---

222

25

Hemiplegia

6

5

---

---

---

3

2

172

33

Injuries to nervous system

10

3

---

---

---

2

1

368

57

Meningitis

2

1

---

---

---

1

1

198

43

Multiple sclerosis

19

14

1

1

1

8

6

388

81

Neuritis

3

2

---

---

---

1

3

188

23

Paralysis

4

2

---

---

---

3

---

254

26

Poliomyelitis

4

4

1

1

---

3

---

170

17

Sciatica

6

5

1

1

---

4

4

104

18

Syphilis C.N.S.

31

19

---

1

2

17

9

1,809

333

Tabes dorsalis

3

1

---

1

---

3

---

212

81

Tic

3

3

---

---

---

6

---

155

25

Tremor

10

7

---

---

---

5

2

186

19

Other forms

18

18

2

---

1

9

7

695

127

Epilepsy

288

208

19

19

7

165

69

4,194

871

Constitutional psychopathic states

53

35

81

31

7

167

90

5,003

903

Endocrinopathies

165

152

7

8

3

93

21

3,907

447

Drug addiction

35

33

7

8

---

24

9

1,504

286

Alcoholism

8

8

1

---

---

4

3

1,512

314

Total

2,817

2,317

427

390

41

2,282

557

48,596

10,080


Diagnoses

Colored

Number of cases

Number of relatives with mental deficiency

Fathers

Mothers

Grandparents

Siblings

Collaterals

Denied

Unascer-
tained

Mental deficiency

274

32

36

3

292

52

2,535

1,246

Psychoneuroses

50

9

8

1

52

21

958

126

Psychoses

27

7

5

---

18

5

382

147

General paralysis

2

---

---

---

2

---

27

14

Alcoholic

---

---

---

---

---

---

4

1

Manic-depressive

1

---

---

---

1

3

58

22

Dementia prŠcox

13

5

3

---

7

---

213

79

Epileptic

2

---

---

---

2

---

14

3

Other forms

9

2

2

---

6

2

66

28

Nervous diseases and injuries

36

4

4

2

24

7

606

160

Chorea

1

---

---

---

2

---

9

2

Hemiplegia

1

---

---

---

1

1

47

---

Injuries to nervous system

7

1

2

1

1

2

81

38

Meningitis

1

---

---

---

3

---

30

6

Multiple sclerosis

5

1

---

---

3

1

19

4

Neuritis

1

---

---

---

1

---

7

1

Paralysis

2

---

---

---

2

---

42

14

Poliomyelitis

---

---

---

---

---

---

20

---

Sciatica

1

---

---

---

---

1

9

---

Syphilis C.N.S.

12

1

2

---

7

2

226

63

Tabes dorsalis

2

1

---

---

1

---

24

13

Tic

---

---

---

---

---

---

16

14

Tremor

3

---

---

---

3

---

24

4

Other forms

---

---

---

1

---

---

52

14

Epilepsy

80

8

11

2

79

15

909

126

Constitutional psychopathic states

18

2

4

---

1

11

165

72

Endocrinopathies

13

1

---

1

5

8

247

39

Drug addiction

2

---

---

---

2

---

175

20

Alcoholism

---

---

---

---

---

---

23

1

Total

500

63

68

9

470

119

5,970

1,931



185

TABLE 18.-Neuropsychiatric cases giving family history of neuropathic taint. Percentage distributiona

Family history of neuropathic taint

Total cases

Per cent of cases ascertained as to family history in each clinical groups

Number

Per cent

Mental deficiency

Psycho-
neuroses

Psychoses

Neurological

Epilepsy

Constitutional psychopathic states

Endo-
crinopathies

Drug addiction

Alcoholism

Positive

31,376

51.9

46.3

56.7

54.7

41.5

61.9

59.0

61.0

39.9

38.4

Negative

29,034

48.1

53.7

43.3

45.3

58.5

38.1

41.0

39.0

60.1

61.6

Total ascertained

60,410

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0


aThere were 8,984 cases of which the family history of neuropathic taint was unascertained.

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

Specified neuropathic taint in family

Cases with each taint

Per cent of cases with each specified taint among the total cases with ascertained family history in each clinical groups

Number

Per cent

Mental deficiency

Psycho-
neuroses

Psychoses

Neuro-
logical

Epilepsy

Constitutional psychopathic states

Endocrino-
pathies

Drug addiction 

Alcoholism

Nervous diseases

15,893

26.3

19.5

37.5

22.9

25.9

35.3

29.3

26.4

14.9

13.7

Mental diseases

10,038

16.6

16.1

16.3

27.6

10.7

17.9

19.3

12.1

10.0

7.1

Inebriety

10,736

17.8

17.1

14.6

20.9

16.0

15.5

21.2

16.5

24.0

33.3

Mental deficiency

2,817

4.7

9.9

.8

4.6

2.1

5.0

1.0

3.7

2.0

.5

Total neuropathic taints

39,484

65.4

62.5

69.2

76.0

54.7

73.7

70.7

58.7

50.7

54.5


AGE

In Table 20 it is possible to compare the ages of the white with the colored neuropsychiatric cases. This table shows the predominance of neuropsychiatric disorders among colored between the ages 20 and 24 years. There is little difference in the percentages for the other groups, except the colored naturally fall below the whites on account of the increase in the percentage for the colored in the age group from 20 to 24 years.

Table 21 summarizes information as to age in the different clinical groups.


186

CHART IX


187

TABLE 20.-Ages of neuropsychiatric cases

Diagnoses

Total

White

Total

Under 20 years

20 to 24 years 

25 to 29 years

30 to 34 years

35 years and over

Unascer-
tained

Mental deficiency

21,858

17,803

1,685

7,878

5,782

1,692

143

623

Psychoneuroses

11,443

10,343

445

4,200

3,962

1,331

242

163

Psychoses

7,910

7,354

334

2,551

2,694

1,158

382

235

General paralysis

530

487

4

37

158

165

110

13

Alcoholic

292

287

2

33

107

95

36

14

Manic-depressive

1,385

1,304

31

427

500

220

84

42

Dementia prŠcox

4,738

4,433

254

1,781

1,634

549

85

130

Epileptic

131

112

10

44

42

10

4

2

Other forms

834

731

33

229

253

119

63

34

Nervous diseases and injuries

6,916

6,116

184

1,831

2,264

1,171

480

186

Chorea

264

252

19

136

75

20

---

2

Hemiplegia

258

210

1

71

98

29

7

4

Injuries to nervous system

554

428

11

165

172

55

9

16

Meningitis

279

242

10

125

83

19

2

3

Multiple sclerosis

511

483

29

168

183

71

16

16

Neuritis

222

213

7

78

76

33

13

6

Paralysis

340

282

12

111

109

37

6

7

Poliomyelitis

211

191

7

107

50

19

2

6

Sciatica

137

127

---

40

55

21

8

3

Syphilis C.N.S.

2,462

2,161

45

382

820

589

266

59

Tabes dorsalis

333

294

3

29

87

93

60

22

Tic

200

183

7

74

74

22

3

3

Tremor

243

212

1

67

88

48

3

5

Other forms

902

838

32

278

294

115

85

34

Epilepsy

6,388

5,273

358

2,383

1,790

497

57

188

Constitutional psychopathic states

6,196

5,941

537

2,438

1,960

745

174

87

Endocrinopathies

4,805

4,506

161

2,293

1,545

410

28

69

Drug addiction

2,020

1,823

12

665

845

238

28

35

Alcoholism

1,858

1,834

13

131

489

652

513

36

Total

69,394

60,993

3,729

24,370

21,331

7,894

2,047

1,622


Diagnoses

Total

Colored

Under 20 years

20 to 24 years 

25 to 29 years

30 to 34 years

35 years and over

Unascer-
tained

Mental deficiency

4,055

78

2,273

1,168

353

42

141

Psychoneuroses

1,100

34

569

365

110

8

14

Psychoses

556

9

227

216

70

15

19

General paralysis

43

---

8

19

9

5

2

Alcoholic

5

---

---

3

2

---

---

Manic-depressive

81

1

35

33

7

1

4

Dementia prŠcox

305

8

138

111

35

4

9

Epileptic

19

---

6

10

1

1

1

Other forms

103

---

40

40

16

4

3

Nervous diseases and injuries

800

7

310

315

138

17

13

Chorea

12

---

6

5

1

---

---

Hemiplegia

48

---

26

13

6

2

1

Injuries to nervous system

126

---

58

46

17

2

3

Meningitis

37

---

19

11

6

1

---

Multiple sclerosis

28

1

13

11

3

---

---

Neuritis

9

---

5

4

---

---

---

Paralysis

58

---

26

18

11

1

2

Poliomyelitis

20

---

8

11

---

---

1

Sciatica

10

---

5

4

1

---

---

Syphilis C.N.S.

301

1

91

133

63

9

4

Tabes dorsalis

39

---

11

14

13

1

---

Tic

17

1

9

6

1

---

---

Tremor

31

---

9

15

5

1

1

Other forms

64

4

24

24

11

---

1

Epilepsy

1,115

19

598

388

87

11

12

Constitutional psychopathic states

255

5

118

90

35

5

2

Endocrinopathies

299

6

163

90

36

2

2

Drug addiction

197

2

54

88

50

3

---

Alcoholism

24

---

3

12

7

2

---

Total

8,401

160

4,315

2,732

886

105

203



188

TABLE 21.-Ages of neuropsychiatric cases. Percentage distribution

Age on enlistments

Total with ascertained ages

Per cent distribution of ascertained ages in each clinical group

Number

Per cent

Mental deficiency

Psycho-
neuroses

Psychoses

Neuro-
logical

Epilepsy

Constitutional psychopathic states

Endocrino-
pathies

Drug addiction 

Alcoholism

Under 20 years

3,889

5.8

8.4

4.3

4.5

2.8

6.1

8.9

3.5

0.7

0.7

20 to 24 years

28,685

42.5

48.1

42.3

36.3

31.9

48.2

41.8

51.9

36.2

7.4

25 to 29 years

24,063

35.6

32.9

38.4

38.0

38.4

35.2

33.6

34.5

47.0

27.5

30 to 34 years

8,780

13.0

9.7

12.8

16.0

19.5

9.4

12.8

9.4

14.5

36.2

35 years and over

2,152

3.2

.9

2.2

5.2

7.4

1.1

2.9

.7

1.6

28.2

Total cases with ascertained ages

67,569

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0


Ages unascertained of 1,825 cases.

SCHOOLING

From the data which were compiled by the division of psychology of the Surgeon General's Office, reasonably accurate information was obtained as to the literacy of the men who made up the Army.3 The statements as to schooling, which were given by the men subjected to the psychological examinations, were not verified, and if there is any error it is probable that the facts were overstated by the men, as it is believed there was a general tendency for them to exaggerate their previous training.

From the entire group of men tested by the psychologists, about 80,000 records were carefully selected as a fair sample of the men in the Army. (Table 22.) The tabulation upon which the report of the division of psychology is based, is used herein for purposes of comparison.

The neuropsychiatric records are perhaps somewhat more accurate in reference to education than the psychological records, because of the opportunities for verification. Each case was personally interviewed by the neuropsychiatrist, and the records corrected if misstatements were found.

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

Schooling

White 
(per cent)

Colored 
(per cent)

None

3.2

13.5

Grades

75.2

76.0

High school

16.6

8.9

College

5.0

1.6

Total

100.0

100.0


Source of information. Report of division of psychology of the Surgeon General's Office.


189

CHART X


190-191

TABLE 23.-Schooling of neuropsychiatric cases

The facts clearly indicate that the neuropsychiatric cases did not measure up to the educational standards of the average soldier. This may be due to the large number of mental defectives included in the group of neuropsychiatric cases. Further comparisons will be made in the discussion of the different groups of neuropsychiatric cases.

ECONOMIC CONDITION

In compiling information on the economic condition, the cases were placed into two groups: Those in marginal and those in comfortable circumstances. (See Table 24.) Persons were considered as being in marginal circumstances who were not able to live without working for four months, without becoming objects of charity. This classification does not include "dependents" as the number of dependent men accepted by local boards was negligible. The table shows that 50,181, or 87 per cent of the whites and 8,005, or 97 per cent of the colored neuropsychiatric cases were in marginal circumstances.

The facts give no light on the question of whether poverty is the cause or the result of mental disease or defect. They do, however, show a close relationship


192

and agree with previous statistics, the best of which have been compiled by the New York State Hospital Commission, that neuropsychiatric disorders are relatively more frequent among persons in marginal circumstances.

CHART XI

TABLE 24.-Economic condition of neuropsychiatric cases

Diagnoses

Total

White

Colored

Total

Marginal

Comfortable

Unascertained

Total

Marginal

Comfortable

Unascertained

Mental deficiency

21,858

17,803

15,865

927

1,011

4,055

3,951

32

72

Psychoneuroses

11,443

10,343

7,992

1,901

450

1,100

1,037

37

26

Psychoses

7,910

7,354

5,777

1,053

524

556

493

38

25

General paralysis

530

487

362

88

37

43

38

3

2

Alcoholic

292

287

233

32

22

5

5

---

---

Manic-depressive

1,385

1,304

941

268

95

81

75

4

2

Dementia prŠcox

4,738

4,433

3,654

481

298

305

266

25

14

Epileptic

131

112

88

13

11

19

17

1

1

Other forms

834

731

499

171

61

103

92

5

6

Nervous diseases and injuries

6,916

6,116

4,618

1,035

463

800

739

41

20

Chorea

264

252

213

34

5

12

11

1

---

Hemiplegia

258

210

170

29

11

48

44

2

2

Injuries to nervous system

554

428

325

71

32

126

118

5

3

Meningitis

279

242

196

33

13

37

37

---

---

Multiple sclerosis

511

483

351

75

57

28

26

2

---

Neuritis

222

213

135

60

18

9

7

1

1

Paralysis

340

282

201

65

16

58

53

4

1

Poliomyelitis

211

191

155

27

9

20

18

2

---

Sciatica

137

127

91

30

6

10

9

---

1

Syphilis C.N.S.

2,462

2,161

1,698

313

150

301

277

14

10

Tabes dorsalis

333

294

190

65

39

39

36

3

---

Tic

200

183

144

30

9

17

15

2

---

Tremor

243

212

170

28

14

31

29

1

1

Other forms

902

838

579

175

84

64

59

4

1

Epilepsy

6,388

5,273

4,355

602

316

1,115

1,061

35

19

Constitutional psychopathic states

6,196

5,941

4,801

791

349

255

233

12

10

Endocrinopathics

4,805

4,506

3,567

704

235

299

290

8

1

Drug addiction

2,020

1,823

1,602

159

62

197

177

16

4

Alcoholism

1,858

1,834

1,604

138

92

24

24

---

---

  Total

69,394

60,993

50,181

7,310

3,502

8,401

8,005

219

177


VENEREAL DISEASE

Data on venereal infections at some time previous to entering the service were obtained from statements of the soldiers comprising this series. (See Table 25.) Verifications of the statements, being difficult, were not made except in such instances as required Wassermann examinations.


193

The usual motive for denying the existence of venereal disease did not exist in the Army, and neuropsychiatric examiners were impressed with the frankness with which soldiers spoke of their past life in this respect. The figures here presented must stand by themselves, as the Army statistics relative to venereal diseases refer only to the actual existence of them, not to past histories. It is impossible, therefore, to state how the neuropsychiatric individuals compared with soldiers in general as to a venereal history.

CHART XII

Table 25 shows the great predominance of history of preceding venereal infection in the colored cases.

CHART XIII


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