DUTCH
(Number classified, 328)

The Dutch come near the United States average in almost all groups. They drink more than they take drugs, but in both are below the United States averages. They have a few less neurotics and a few more of the other classified disorders, except mental deficiency, alcoholism, and drug addiction.

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ENGLISH
(Number classified, 9,092)

The English, like the Dutch, approximate the United States average in practically all groups. They are more inclined to drink than to take drugs, and have a slight excess of epilepsy, endocrine disturbances, and constitutional psychopathic states. They just reach the United States average for mental defect.

FRENCH
(Number classified, 941)

The French show rather a high total of inebriety, being above the average in alcoholism, and only a little below it in drugs, their total inebriety percentage being 6.8 per cent as compared with 4.1 per cent for English, and 4 per cent for the Germans. They also exceed the average in psychoneuroses, neurological conditions, and epilepsy. They are considerably below the average in endocrine disorders and constitutional psychopathic states, and are about equal to the United States average for mental defect. The excess of inebriety in the French may surprise many, as the French are said to be a wine-drinking people, and it is a common belief that wine-drinking people do not suffer from alcoholism. As a matter of fact, alcoholism depends more upon the amount of absolute alcohol imbibed than upon the form in which it is taken. If enough wine or beer or any other beverage with comparatively low alcohol content is taken, a person becomes alcoholic.

AMERICAN-BORN GERMAN
(Number classified, 4,164)

In spite of his reputed beer-drinking customs, the native German fails to reach the United States average in alcoholism, and is not much given to drugs. On the other hand, he exceeds, slightly, the United States average in psychoses, psychoneuroses, and constitutional psychopathic states, and by 3.6 per cent in endocrine troubles. He is slightly below United States average in mental defect.

FOREIGN-BORN GERMAN
(Number classified, 187)

The foreign-born German shows a much higher rate for insanity than the native born, and one considerably lower in endocrine troubles and mental defect.

GREEK
(Number classified, 281)

The Greeks are very low in inebriety, especially as concerns drugs, but exceed the United States average in epilepsy, the psychoses, and the psychoneuroses, an excess particularly noticeable in epilepsy and the psychoneuroses. They are well below the average in mental defect and constitutional psychopathic states.

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HEBREW
(Number classified, 1,314)

The American-born Hebrew shows a very striking contrast in his habits of inebriety as far as the choice of alcohol and drugs is concerned. The number of Hebrew alcoholics is almost negligible, while the percentage of drug addicts is more than double the United States rate. The Hebrew is also low in neurological conditions, epilepsy, endocrine disturbances, and mental deficiency. The low percentage of mental defect is particularly striking; the only classified races which show less being the Scotch. The Hebrew exceeds, on the other hand, the average representation in the conditions characterized by emotional instability. He is nearly 3 per cent above the United States average for insanity, and is very much above it in the psychoneuroses and the constitutional psychopathic states.

AMERICAN-BORN IRISH
(Number classified, 4,068)

The American-born Irish show the most pronounced tendency to inebriety of any racial group except the foreign-born Irish, and their intemperance relates to both alcohol and drugs. Inebriety constitutes 14.8 per cent of all their neuropsychiatric disorders. Although they are less than one-sixteenth of all the neuropsychiatric cases, the native-born Irish contribute more than one-fifth of all the cases of alcoholism identified by the neuropsychiatric examiners and more than one-tenth of all the cases of drug addiction. With the exception of inebriety, neurological conditions, and constitutional psychopathic states, they sink below all United States averages. They are so far below this average in mental defect that they confirm the general law of the incompatibility of alcoholism and mental defect. They also furnish an interesting example of a high distribution of alcoholism with an underaverage of mental disease. It would seem that if alcoholism were an important cause of insanity, one would find an excess of it, instead of an underaverage in a group so given to alcoholic intemperance as this one is. But in this connection it should be remembered that drafted men, as a class, were too young to have developed alcoholic insanity.

The Irish offer an interesting comparison with the English. They have more inebriety by 11 per cent and less mental defect by 8.2 per cent. The excess of alcoholism and the lesser amount of mental defect would show them to be a livelier, more excitable race than the English, which is rather borne out by their having a slight excess of constitutional psychopaths than the English.

FOREIGN-BORN IRISH
(Number classified, 394)

The foreign-born Irish have a distribution rate of mental defect 6.6 per cent lower than that for the native. They have also a lower distribution rate of constitutional psychopathic states and endocrine troubles. Insanity and inebriety are much higher among them than among those born in this country. Inebriety changes both in extent and in its own distribution. There is a lessened total rate of inebriety by 4.2 per cent among the native, and even a greater falling off in the distribution rate of alcoholism. Nearly one-half of the decrease

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in alcoholism is accounted for by an increase in drug addiction among the native born. It would seem at first sight that the lowering of the distribution rate for insanity among the native-born Irish was to be connected with the lowering of the alcohol rate, but it should be observed that a similar decrease in insanity distribution occurs in the German native born as compared with foreign born, with an increase in alcoholism, and a smaller decrease in insanity among Scandinavian native born, with a large decrease in the alcohol rate.

AMERICAN-BORN ITALIANS
(Number classified, 413)

The native Italians present a distribution of neuropsychiatric disorders which indicates a sluggish, backward mentality. As drug addicts they have a much larger percentage than the Jews, and like the Jews are little given to alcoholic inebriety. Some races, such as the Jews and the Irish, seem to be able to surpass the average in drug inebriety, and still, through the low percentage of other disorders which indicate racial backwardness, retain the characteristics of nimble-minded people. For example, the Irish, while they are excessive drug users, are more given to intemperance in alcohol than in drugs; and of the two, alcoholic intemperance seems to indicate a more active mentality than does the secret and solitary use of drugs. Both Irish and Jews, while exceeding the average for drugs, are far below it in mental defect. But the Italians make the poorer choice for the satisfaction of their inebriate tendencies; and in addition to that show their racial backwardness by a preponderance of those other disorders which must be accepted as indicative of inferiority. In mental defect the native Italians exceed the United States average rate by 4.7 per cent, but in epilepsy they fall below the United States average by 6.4 per cent. In respect to the distribution of neuropsychiatric defects in general, they manifest a remarkable correlation with the two primitive races, the Negro and the American Indians. All three have an excess of mental deficiency and are below the average in mental diseases. All these are low in endocrine troubles, and take drugs more than they drink.

FOREIGN-BORN ITALIANS
(Number classified, 2,039)

The foreign-born Italian shows considerable variation from the native in the distribution of neuropsychiatric disorders. The rate for epilepsy and psychoneuroses is much higher among the foreign born, but the rate for drug addiction is higher among the native, as in fact it is among all the native-born European races except the Germans, where the two percentages are equal.

MEXICANS
(Number classified, 384)

Of all the races classified the Mexicans have the highest rate for mental defect, 66.9 per cent. They exceed even the Negroes and American Indians. As all percentages are based on the total neuropsychiatric cases from each race, it is evident that when two-thirds of the total is taken up by a single condition the percentages of the other eight conditions must be low. So it is with the

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Mexicans. With the single exception of epilepsy, they are below the United States average in all other neuropsychiatric groups. There was not a single alcoholic among them, and only two drug addicts, as contrasted with 45 epileptics and 257 mental defectives.

MIXED RACES
(Number classified, 23,604)

The mixed races include those whose ancestors were of different races. This group, of course, includes most "Americans." The large number (almost one-third of the total cases) makes this group fundamentally important in the establishment of the United States average.

AMERICAN-BORN SCANDINAVIANS
(Number classified, 890)

Native Scandinavians (Norwegian, Danish, Swedish, Icelandic) show an excess of mental disturbances and endocrine troubles. They slightly exceed the United States average of psychoneuroses. They are well below the average in mental defect and in epilepsy.

FOREIGN-BORN SCANDINAVIANS
(Number classified, 366)

The foreign-born Scandinavians show much less mental deficiency than those born here, and, strangely enough, less endocrinopathy. On the other hand, they show an excessive percentage of alcoholism and insanity as compared with the American born.

SCOTCH
(Number classified, 579)

The Scotch exceed the United States average in all groups except that of mental deficiency. The mental deficiency rate is lower than that of any other race and is 16.8 below the United States average. The inebriety is high; but, as in all races which have a low mental-deficiency rate, alcoholism exceeds drug taking.

SLAVONIC
(Number classified, 2,474)

This racial classification includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, Ruthenian, Serbian, Slovak, and Slovenian. The Slays have a high mental-deficiency rate, in spite of which their inebriety is alcoholic rather than narcotic. Both varieties of inebriety are below the United States average. The comparative infrequency of epilepsy is worthy of remark, especially in view of the high mental deficiency. In spite also of the sluggishness indicated by the excess of mental deficiency, they have an emotional sphere of some activity, as is shown by the excess of psychoses among them.

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CORRELATIONS OF NEUROPSYCHIATRIC WITH OTHER CLINICAL CONDITIONS

In the following pages, in which the nine different clinical groups are described in detail, it appears that a certain "antagonism" exists between some of the different clinical conditions. That is, where a given condition exists in excess, other conditions vary in a way that can not altogether be explained by the variations inevitable in a method of distribution percentage average of the preponderance on one condition over another. For example, the variations between mental defect and alcoholism are constant: Where one rises, the other falls. With these two this relationship or antagonism is constant as concerns States' populations and native and foreign born races. It is believed that the connections of these two conditions have a certain significance as to the environmental condition, perhaps of the traits of character of the peoples concerned. Drug addiction, the psychoses, and endocrinopathies showed a similar disharmony with mental defect, though not so conclusively as with alcoholism. Efforts to establish correlations between the psychoneuroses and constitutional psychopathic states have been less successful. There seems to be no correlation of symptoms between the psychoneuroses and the endocrine group. The character of epilepsy in this respect is that it so nearly corresponds in both states and races with the United States average. This matter will be considered in more detail below under the separate captions.

MENTAL DEFECT

The outstanding features in regard to mental defect, as revealed by the statistics herein, are its wide distribution throughout the United States, with an especial excess in the Negro and the American Indian; its apparent antagonism to alcoholism, in that in the communities and races where it exceeds the United States distribution average, alcoholism falls below it, and vice versa.

It is a definite clinical entity, classifiable and distinct from insanity or any other of the different neuropsychiatric conditions, and is a result of a failure of development of the mentality up to a capacity which, as we are dealing only with adults, we may call adult capacity. Among its chief characteristics are lack of initiative, undue suggestibility, and lack of ability in meeting new situations.

The distribution of mental deficiency is postulated as an index of general intelligence, because where it is widely distributed the average intelligence can hardly fail to be lowered thereby. The standard of intelligence is lowered not only by the actual mental defectives, but by the number of dull people which the existence of mental defect implies. The standard of mental defect employed in the Army-i. e., a mentality not exceeding that of a child of 8 years⁶-implies a degree of incompetency so profound that the individual, whatever his race or surroundings, could not be counted on to take care of himself. Such a degree of inferiority is found in only a relatively small number of any race or people, but its occurrence has a direct bearing on the general intelligence and educability of the people in whom it occurs. It is probable that for every case of mental defect of the 8-year-old mentality standard, there are at least 10 cases of backward or retarded mentality.

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In addition to the lowering of the general intelligence through a high proportion of mental defectives, together with the dullards which go along with them, the quality of the general intelligence is further impaired by the reduction in the chances of the existence of persons of superior intelligence.

The significance of a high proportion of distinctly inferior persons in a community becomes apparent when different countries, and especially when different races, are compared. For example, as concerns mental defect, the American Indian presents a distribution rate of more than double, and the Negro a rate little less than double, that of the rate among whites over the whole United States. This in itself is enough to explain the inability of the two races to compete with the average American. The Mexican living in the United States presents an even higher rate for mental defect (66.9 per cent) but for them, as in fact for all races which may have immigrated here within recent years, we can draw no such general conclusions as we can for the indigenous Indian and Negro. The most that can be said for the foreign races which present a high distribution rate for mental defect, such as the Slavs (37 per cent) and the Italians (32.7 per cent) is that the ones living here now are distinctly below the average United States intelligence. It would be impossible to infer that these races at home present the same degree of mental inferiority.

The extreme dissemination of so disabling a condition as mental defect throughout men of military age marks this subject as the most important department of public mental hygiene. The combined totals of the draft and camp examinations shows that it existed to such an extent that the individual was unfit as a soldier in 12.06 out of every 1,000 men examined. There were registered 10,101,506 men between the ages of 21 and 31 years, and the ratio of 12.06 per 1,000 gives for this number 121,824 unfit from mental defect, in this registrant class.

The ratio considered above includes only men who were rejected for military service. In addition there must be considered the number who were discharged on this account after they had entered the Army. This number was 10,648, or a ratio of 2.60 per 1,000.

If mental deficiency ran uniformly among persons of all ages and of both sexes, there would be, on the basis of 100,000,000 population, 1,218,000 mental defectives in the United States. This number would be an understatement, however, because, while the distribution of mental defect in the two sexes is about equal, many defectives die before reaching the age period on which the estimates are based. Also, inasmuch as the standard of rejection in the Army was low, and as for every rejection there were accepted, without question, several dull, stupid, border-line type recruits, it is easy to see that the figures of 1,218,000 must be multiplied several times before the full significance to the country of the condition is realized.

The general disadvantages of having mental defectives in an army are obvious. Their inability to learn and understand orders interferes with the training of normal recruits. Their lack of judgment makes them unfitted to accept responsibility. Their failure to reach normal standards and their undeveloped sense of obligation is a constant source of difficulty and frequently

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brings them into the military courts. Of the disciplinary cases reported by neuropsychiatrists 42.3 per cent were mental defectives.

When, after the war, disabled ex-soldiers came under the charge of the Bureau of War Risk Insurance, the mental defectives had almost disappeared as hospital inmates. The explanation for this may be that they did not require hospital care, or that they had gone back to work for their families, chiefly on farms, or that they lacked the enterprise to request hospitalization.

CLASSIFICATION

In the classification of the mental defectives discovered in the Army, conventional terms were employed (see Table 6); an imbecile was considered as one capable of guarding himself against common physical danger, but incapable of earning a living; a moron as one capable of earning a living under favorable circumstances, but incapable of competing on equal terms with his normal fellows.

No idiot came under the observation of the neuropsychiatric officers, and, among the whites, morons constituted approximately two-thirds of the mental defectives and imbeciles one-third. The negroes showed a higher percentage of grave defects, as among them the imbeciles constituted 47.7 per cent of the cases and the morons, or higher grades, sank to 50 per cent with 0.8 per cent border-line cases. Of the cases rejected at local boards, as reported in the report of the Provost Marshal General, no classification as to mental grade was made. The present statistics refer to a definite group, and so it is not possible to compare the classification derived from them with classifications obtained in civil life.

METHODS OF DISCOVERING CASES

Twenty-eight per cent of the mental defectives discovered were referred by medical officers, and 26 per cent by line officers, notably company commanders. (See Table 8.) They were referred chiefly because they could not understand or learn. These two percentages disclose the satisfactory cooperation that existed between the specialists and the officers of the Army as a whole. As far as medical officers were concerned, any doubt that may have existed in their minds as to the nature of the diagnosis was relieved by the consultation, so that they could proceed confidently to the necessary steps for discharge on account of disability. Hospital beds were thereby relieved.

In connection with examinations made of members of the Army by the psychologists, all men falling into the lowest group as a result of the psychological examinations were to be referred to the psychiatrist as suitable for discharge. Information as to the exact number of cases so referred has not been obtainable. Partial reports of the section of psychology of the Surgeon General's Office give the number as 4,555 from the examination of 1,147,829 men. If a man was considered unfit for service after receiving a psychiatric examination he was recommended for discharge by the psychiatrist and the case was reported to the Office of the Surgeon General on Forms 89 and 90 Medical Department, from which the statistical data of this study have been compiled. According

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to the available records, specific recommendations were made by the psychiatrists on only 936 of the cases referred. Of this number, 175 cases, or 18.7 per cent, were found to be not mental defectives. These 175 cases were diagnosed as follows: Psychoneuroses, 45; psychoses, 28; constitutional psychopathic states, 26; nervous disease and injuries, 29; endocrinopathies, 23; epilepsy, 22; and drug addiction, 2.

LENGTH OF SERVICE PRIOR TO DISCOVERY

Prior to the expiration of the average training period, 18,858, or about 86 per cent of the total number of mental defectives, had been identified. (See Table 10.) There were 1,475 mental defectives recorded at Base Hospital No. 214, the one central receiving point for such cases in the American Expeditionary Forces.² Many of these probably were border-line cases. Of the 1,475 reported as admitted to Base Hospital No. 214 as mental defectives, only 762 reached the ports of the United States under that diagnosis. Many of the others may have been put back on a duty status, after treatment in hospital and subsidence of the reactionary episode-so common among the feebleminded under strain and excitement-that caused their admission.

A higher percentage of colored cases than of white ones was discovered in the first three months and a lower one after the first six months.

RECOMMENDATIONS FOR DISPOSITION

Table 12 shows that only 206 cases, or 1 per cent of those identified, were recommended for full duty. Mental defect was one of the neuropsychiatric conditions for which limited service was allowable, and 2,791, or 12.8 per cent, such recommendations were made. Labor battalions were regarded as organizations where the Negro, for limited service, could do well, and so a higher percentage of Negroes (16.4 per cent) were recommended for limited service than whites (11.9 per cent). The proverbial freedom from physical illness of mental defectives is substantiated by the fact that only 76 cases (0.3 per cent) were retained in the hospital for treatment.

DELINQUENCY

Of the total number of mental deficiency cases, 562 white and 71 colored men, or 3 per cent, were referred to the neuropsychiatric officers for opinion as to the causes of misconduct. Mental deficiency heads the list of neuropsychiatric conditions found among the men tried for military offenses, constituting 40.5 per cent of the white and 64 per cent of the colored. But a larger percentage of constitutional psychopaths and insane were delinquent than of mental defectives.

Mental deficiency was not so frequent among the neuropsychiatric prisoners at Fort Leavenworth as it was among delinquents in the camps. This fact may indicate that the mental defectives are in general the petty offenders and the individuals who commit chiefly misdemeanors.

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