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Section I, Chapter IX continued

Table of Contents

194

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

Diagnoses

Total

White

Total

Syphilis

Gonorrhea

Other venereal infection

Admitted

Denied

Admitted

Denied

Admitted

Denied

Mental deficiency

21,858

17,803

517

17,286

2,231

15,572

171

17,632

Psychoneuroses

11,443

10,343

446

9,897

1,860

8,483

114

10,229

Psychoses

7,910

7,354

640

6,714

1,409

5,945

163

7,191

General paralysis

530

487

255

232

159

328

19

468

Alcoholic

292

287

35

252

93

194

11

276

Manic-depressive

1,385

1,304

69

1,235

256

1,048

29

1,275

Dementia pręcox

4,738

4,433

205

4,228

752

3,681

83

4,350

Epileptic

131

112

2

110

18

94

2

110

Other forms

834

731

74

657

131

600

19

712

Nervous diseases and injuries

6,916

6,116

1,669

4,447

1,594

4,522

176

5,940

Chorea

264

252

11

241

35

217

3

249

Hemiplegia

258

210

26

184

45

165

4

206

Injuries to nervous system

554

428

23

405

79

349

4

424

Meningitis

279

242

4

238

32

210

2

240

Multiple sclerosis

511

483

16

467

88

395

1

482

Neuritis

222

213

5

208

35

178

2

211

Paralysis

340

282

15

267

52

230

5

277

Poliomyelitis

211

191

6

185

27

164

2

189

Sciatica

137

127

7

120

26

101

3

124

Syphilis C.N.S.

2,462

2,161

1,345

816

862

1,299

102

2,059

Tabes dorsalis

333

294

135

159

107

187

11

283

Tic

200

183

8

175

29

154

2

181

Tremor

243

212

22

190

38

174

7

205

Other forms

902

838

46

792

139

699

28

810

Epilepsy

6,388

5,273

182

5,091

819

4,454

69

5,204

Constitutional psychopathic states

6,196

5,941

360

5,581

1,142

4,799

117

5,824

Endocrinopathies

4,805

4,506

131

4,375

591

3,915

46

4,460

Drug addiction

2,020

1,823

390

1,433

847

976

74

1,749

Alcoholism

1,858

1,834

210

1,624

583

1,251

39

1,795

 

  Total

69,394

60,993

4,545

56,448

11,076

49,917

969

60,024


Diagnoses

Total

Colored

Syphilis

Gonorrhea

Other venereal infection

Admitted

Denied

Admitted

Denied

Admitted

Denied

Mental deficiency

4,055

949

3,106

1,846

2,209

166

3,889

Psychoneuroses

1,100

240

860

506

594

65

1,035

Psychoses

556

145

411

220

336

25

531

General paralysis

43

31

12

17

26

5

38

Alcoholic

5

2

3

3

2

---

5

Manic-depressive

81

9

72

33

48

4

77

Dementia pręcox

305

58

247

117

188

10

295

Epileptic

19

6

13

8

11

4

15

Other forms

103

39

64

42

61

2

101

Nervous diseases and injuries

800

349

451

404

396

39

761

Chorea

12

5

7

3

9

---

12

Hemiplegia

48

20

28

24

24

4

44

Injuries to nervous system

126

31

95

66

60

5

121

Meningitis

37

8

29

9

28

---

37

Multiple sclerosis

28

9

19

14

14

---

28

Neuritis

9

2

7

5

4

---

9

Paralysis

58

15

43

32

26

1

57

Poliomyelitis

20

6

14

13

7

---

20

Sciatica

10

2

8

5

5

---

10

Syphilis C.N.S.

301

188

113

153

148

23

278

Tabes dorsalis

39

30

9

22

17

2

37

Tic

17

7

10

6

11

1

16

Tremor

31

10

21

21

10

1

30

Other forms

64

16

48

31

33

2

62

Epilepsy

1,115

273

842

557

558

45

1,070

Constitutional psychopathic states

255

71

184

133

122

9

246

Endorinopathies

299

85

214

148

151

18

281

Drug addiction

197

75

122

112

85

16

181

Alcoholism

24

8

16

7

17

1

23

 

  Total

8,401

2,195

6,206

3,933

4,468

384

8,017


195

Table 26 shows that an almost equal percentage of the white and colored neuropsychiatric cases abstained from the use of alcohol, and that the ratio of moderate drinkers was also about the same. The ratio for the whites exceeded that for the colored in the number who were classed as intemperate. It will be observed that a little less than one-half of the individuals were reported as moderate drinkers.

No information is obtainable which might permit a comparison of the alcoholic habits of neuropsychiatric cases with similar habits in soldiers generally; but Table 26 permits of a comparison of the alcoholic habits among the different neuropsychiatric groups. There are noteworthy wide variations between the percentage of "abstinent" and "intemperate" in the various groups.

CHART XIV

TABLE 26.-Habits of neuropsychiatric cases as to alcohol

Diagnoses

Total

White

Colored

Total

Absti-
nent

Mod-
erate

Intem-
perate

Unascer-
tained

Total

Absti-
nent

Mod-
erte

Intem-
perate

Unascer-
tained

Mental deficiency

21,858

17,803

6,873

8,100

1,556

1,274

4,055

1,626

1,989

358

82

Psychoneuroses

11,443

10,343

4,824

4,554

541

424

1,100

522

470

84

24

Psychoses

7,910

7,354

2,383

3,102

1,278

591

556

183

261

76

36

General paralysis

530

487

81

244

121

41

43

12

20

8

3

Alcoholic

292

287

---

14

259

14

5

---

---

4

1

Manic-depressive

1,385

1,304

446

589

162

107

81

26

40

6

9

Dementia pręcox

4,738

4,433

1,586

1,914

603

330

305

105

138

42

20

Epileptic

131

112

40

28

18

26

19

10

9

---

---

Other forms

834

731

230

313

115

73

103

30

54

16

3

Nervous diseases and injuries

6,916

6,116

2,010

2,880

741

485

800

274

395

111

20

Chorea

264

252

141

98

6

7

12

5

4

2

1

Hemiplegia

258

210

101

76

16

17

48

21

25

2

---

Injuries to nervous system

554

428

189

181

31

27

126

46

54

19

7

Meningitis

279

242

129

84

12

17

37

21

14

1

1

Multiple sclerosis

511

483

173

218

38

54

28

11

12

5

---

Neuritis

222

213

82

93

29

9

9

6

2

1

---

Paralysis

340

282

125

124

12

21

58

15

33

9

1

Poliomyelitis

211

191

105

70

5

11

20

12

7

1

---

Sciatica

137

127

43

62

8

14

10

7

2

---

1

Syphilis C.N.S.

2,462

2,161

371

1,206

437

147

301

79

160

55

7

Tabes dorsalis

333

294

48

142

60

44

39

8

22

9

---

Tic

200

183

84

76

10

13

17

10

7

---

---

Tremor

243

212

96

89

15

12

31

10

17

3

1

Other forms

902

838

323

361

62

92

64

23

36

4

1

Epilepsy

6,388

5,273

2,245

2,274

343

411

1,115

501

525

66

23

Constitutional psychopathic states

6,196

5,941

2,186

2,548

913

294

255

91

114

46

4

Endocrinopathies

4,805

4,506

2,151

1,930

198

227

299

105

154

34

6

Drug addiction

2,020

1,823

567

838

319

99

197

72

100

22

3

Alcoholism

1,858

1,834

---

---

1,771

63

24

---

---

22

2

Total

69,394

60,993

23,239

26,226

7,660

3,868

8,401

3,374

4,008

819

200


196

MARITAL STATUS

Table 27 shows the marital status of the neuropsychiatric cases. Therein it is seen that 54,166, or 78 Percent, of the 69,394 neuropsychiatric cases were single, as compared with 89.5 Percent of the draft men (Class I) who were single.4 Marriages in both groups include widowed and divorced. There are several explanations for the excess in the percentages of married men among the neuropsychiatric cases: One was the tendency of the local boards to place in Class I men who had no families to support; another is the probability that some benedicts enlisted on account of domestic troubles, which are frequent among those handicapped by nervous and mental disease or defects.

CHART XV

CHART XVI

It will be noticed that the number of marriages among the colored exceeds that of the whites, the ratio more than double, and that there is a very slight increase in the ratio of divorces among the colored.


197

TABLE 27.-Marital status of neuropsychiatric cases

Diagnoses

Total

White

Colored

Total

Single

Mar-
ried

Wid-
owed

Divor-
ced

Unascer-
tained

Total

Single

Mar-
ried

Wid-
owed

Divor-
ced

Unascer-
tained

Mental deficiency

21,858

17,803

15,161

1,813

87

128

614

4,055

2,724

1,158

85

73

15

Psychoneuroses

11,443

10,343

7,882

2,062

56

131

212

1,100

670

381

21

21

7

Psychoses

7,910

7,354

5,989

932

69

115

249

556

359

160

11

8

18

General paralysis

530

487

322

105

16

27

17

43

26

14

1

---

2

Alcoholic

292

287

221

31

7

20

8

5

3

---

1

1

---

Manic-depressive

1,385

1,304

1,018

209

10

19

48

81

50

24

3

1

3

Dementia pręcox

4,738

4,433

3,798

440

29

35

131

305

201

87

3

3

11

Epileptic

131

112

86

19

---

2

5

19

11

7

1

---

---

Other forms

834

731

544

128

7

12

40

103

68

28

2

3

2

Nervous diseases and injuries

6,916

6,116

4,553

1,128

69

122

244

800

483

263

23

22

9

Chorea

264

252

199

46

1

3

3

12

5

6

1

---

---

Hemiplegia

258

210

170

32

2

4

2

48

35

10

2

1

---

Injuries to nervous system

554

428

316

83

1

6

22

126

71

42

5

4

4

Meningitis

279

242

191

44

1

3

3

37

26

11

---

---

---

Multiple sclerosis

511

483

382

67

3

8

23

28

21

7

---

---

---

Neuritis

222

213

161

40

3

3

6

9

4

5

---

---

---

Paralysis

340

282

228

43

1

---

10

58

37

18

1

2

---

Poliomyelitis

211

191

163

24

---

---

4

20

15

4

---

---

1

Sciatica

137

127

89

29

1

3

5

10

9

1

---

---

---

Syphilis C.N.S.

2,462

2,161

1,552

436

35

68

70

301

172

105

8

12

4

Tabes dorsalis

333

294

186

59

10

9

30

39

19

18

2

---

---

Tic

200

183

136

36

1

4

6

17

8

8

1

---

---

Tremor

243

212

167

33

3

2

7

31

18

9

1

3

---

Other forms

902

838

613

156

7

9

53

64

43

19

2

---

---

Epilepsy

6,388

5,273

4,009

926

47

68

223

1,115

662

420

18

12

3

Constitutional psychopathic states

6,196

5,941

4,857

803

31

83

167

255

162

89

2

2

---

Endocrinopathies

4,805

4,506

3,570

792

21

28

95

299

197

94

7

1

---

Drug addiction

2,020

1,823

1,367

355

20

41

40

197

125

66

4

2

---

Alcoholism

1,858

1,834

1,379

282

45

74

54

24

17

6

---

1

---

Total

69,394

60,993

48,767

9,093

445

790

1,898

8,401

5,399

2,637

171

142

52

HOME ENVIRONMENT-URBAN OR RURAL

Neuropsychiatric examiners were instructed to classify all places of 2,500 people or over as urban, in accordance with the classification used in the reports of the United States Census Bureau.

In the examination of the records of 200,000 selected registrants from urban and rural districts, 21.7 Percent of those from urban districts were rejected, while the rejections from the rural districts were 16.9 Percent.5 In other words, according to the Provost Marshal General, considerable physical advantage accrues to the boy reared in the country.5 Of the general population of the United States, 49 Percent of the whites and 73 Percent of the colored reside in rural districts.

Table 28, which shows the home environment of the neuropsychiatric cases during the World War indicates no striking difference between the percentage of white and colored population and the percentage of white and colored neuropsychiatric cases living in the urban and rural communities. A slightly higher rate of neuropsychiatric cases is to be found among people living in the cities, but in individual clinical conditions there is more variation as between urban and rural environments.


198

CHART XVII

TABLE 28.-Home environment of neuropsychiatric cases

Diagnoses

Total

White

Colored

Total

Urban

Rural

Unascer-
tained

Total

Urban

Rural

Unascer-
tained

Mental deficiency

21,858

17,803

6,081

11,022

700

4,055

1,088

2,944

23

Psychoneuroses

11,443

10,343

5,889

4,167

287

1,100

429

666

5

Psychoses

7,910

7,354

4,228

2,759

367

556

216

323

17

General paralysis

530

487

374

87

26

43

28

14

1

Alcoholic

292

287

209

63

15

5

2

3

---

Manic-depressive

1,385

1,304

800

438

66

81

24

54

3

Dementia pręcox

4,738

4,433

2,400

1,837

196

305

118

178

9

Epileptic

131

112

55

49

8

19

6

13

---

Other forms

834

731

390

285

56

103

38

61

4

Nervous diseases and injuries

6,916

6,116

3,703

2,127

286

800

406

385

9

Chorea

264

252

131

115

6

12

6

5

1

Hemiplegia

258

210

116

85

9

48

19

28

1

Injuries to nervous system

554

428

242

167

19

126

52

71

3

Meningitis

279

242

110

125

7

37

23

14

---

Multiple sclerosis

511

483

257

198

28

28

14

14

---

Neuritis

222

213

121

83

9

9

3

6

---

Paralysis

340

282

161

113

8

58

28

30

---

Poliomyelitis

211

191

115

72

4

20

6

14

---

Sciatica

137

127

72

49

6

10

5

4

1

Syphilis C.N.S.

2,462

2,161

1,510

565

86

301

178

120

3

Tabes dorsalis

333

294

196

69

29

39

20

19

---

Tic

200

183

107

68

8

17

10

7

---

Tremor

243

212

95

109

8

34

19

12

---

Other forms

902

838

470

309

59

64

23

41

---

Epilepsy

6,388

5,273

2,802

2,215

256

1,115

391

722

2

Constitutional psychopathic states

6,196

5,941

3,672

2,073

196

255

140

113

2

Endocrinopathies

4,805

4,506

2,502

1,917

87

299

123

176

---

Drug addiction

2,020

1,823

1,614

163

46

197

188

7

2

Alcoholism

1,858

1,834

1,470

305

59

24

20

4

---

Total

69,394

60,993

31,961

26,748

2,284

8,401

3,001

5,340

60


199

STATES OF RESIDENCE AND BIRTH (WITH GAIN OR LOSS FROM IMMIGRATION OR MIGRATION)

Table 29 shows the number of residents of each State included in the present series of neuropsychiatric cases. Table 30 shows the State of birth of neuropsychiatric cases. In reference to the occurrence of nervous and mental diseases or defect in the individual States, a question presents itself: Are the cases found among the residents of the State the State's own people? Table 31 shows, by States, the gains or losses of neuropsychiatric cases through foreign immigration and State migration. It will be observed that all but nine States have more cases living in the State than were born there. Table 31 shows in detail whether the problem for each State is one of foreign immigration or is of State migration of either the white or colored. Those interested may ascertain how immigration is related to the State problem in regard to any clinical group. For instance, as concerns mental deficiency in Connecticut and Rhode Island, the foreign-born mental defectives constituted about one-half of all the cases. In New York and Massachusetts about one-third of the cases were of foreign birth. In New Jersey, Pennsylvania, Michigan, California, and Washington the foreign-born equaled from one-fourth to one-fifth of the total. In many of the other States the ratios were from one-sixth to one-ninth of the totals.

Thus it may be determined in reference to any condition how many cases more or less were residing in the State than were born there. For instance, the residents of Alabama gave birth to 435 of the white and 711 of the colored mental defectives. The same State had only 397 of the whites and 656 of the colored mental defectives living there. In other words, the other States had among their mental defectives 38 whites and 55 colored which were received from Alabama (for which the latter State received 9 in return).

The residents of the State of New York gave birth to 814 of the white and 12 of the colored mental defectives, and 412 of the whites came to the State from foreign countries. Deducting the last figure from the total whites, it is found that the State of New York received 45 white and 35 colored mental defectives from the other States.

Calculations similar to the ones made in the preceding paragraphs may be made by those interested for each of the different clinical conditions for every State in the Union. The results may be of no great practical value because of the inability to prevent neuropsychiatric individuals from going where they are taken by their parents. The information may prove useful, however, to those who wish to determine the localities that furnish more than their quota of neuropsychiatric conditions.


200-205

TABLE 29.-State of residence of neuropsychiatric cases


206-210

TABLE 30.-State of birth of neuropsychiatric cases


211

TABLE 31.-Gain or loss of neuropsychiatric cases resulting from immigration or migrationa

Total gain or loss

State migration

Foreign immigration

Total gain or loss

State migration

Foreign immigration

White 

Colored

White

Colored

Alabama

-211

-98

-120

+7

Nevada

+48

+35

+1

+12

Arizona

+98

+76

+6

+16

New Hampshire

+37

+4

---

+33

Arkansas

+2

-55

+53

+4

New Jersey

+782

+437

+37

+308

California

+1,223

+924

-26

+325

New Mexico

+30

+17

+4

+9

Colorado

+252

+198

-2

+56

New York

+3,769

+1,980

+117

+1,672

Connecticut

+438

+244

+4

+190

North Carolina

-133

-39

-99

+5

Delaware

+32

+7

+12

+13

North Dakota

+157

+106

-2

+53

Florida

+118

+87

+12

+19

Ohio

+1,079

+555

+103

+421

Georgia

-38

+42

-96

+16

Oklahoma

+778

+677

+80

+21

Idaho

+101

+86

+2

+13

Oregon

+130

+117

-19

+32

Illinois

+1,417

+693

+96

+628

Pennsylvania

+2,514

+1,321

+148

+1,045

Indiana

+137

+38

+17

+82

Rhode Island

+154

+75

+3

+76

Iowa

-114

-177

+13

+50

South Carolina

-100

-3

-99

+2

Kansas

-7

-32

-5

+30

South Dakota

+75

+49

-2

+28

Kentucky

-288

-251

-48

+11

Tennessee

-126

-151

+20

+5

Louisiana

+10

+19

-23

+14

Texas

+22

+2

-28

+48

Maine

+101

+42

---

+59

Utah

+28

+13

-1

+16

Maryland

+181

+87

+45

+49

Vermont

+11

-1

---

+12

Massachusetts

+896

+448

+7

+441

Virginia

+138

+117

+5

+16

Michigan

+1,033

+558

+36

+439

Washington

+354

+273

---

+81

Minnesota

+381

+201

+8

+172

West Virginia

+298

+215

+43

+40

Mississippi

-131

-42

-96

+7

Wisconsin

+233

+80

+2

+151

Missouri

+171

+1

+81

+89

Wyoming

+102

+80

+2

+20

Montana

+259

+200

+4

+53

District of Colombia

+111

+65

+29

+17

Nebraska

+16

-40

+9

+47


aData unascertained for 2,755 cases.

RACE

Table 32 shows the distribution of neuropsychiatric conditions among the races concerned. From it may be seen the distribution averages attained by the several races. Table 33 furnishes information in regard to the four foreign-born peoples of which the numbers were adequate. This table offers opportunity for comparing the occurrence of neuropsychiatric conditions between the native and foreign born in the four peoples.

The results as to the different races classified worthy of notice are summarized below.

AFRICAN (NEGRO)
(Number classified, 8,401)

A high distribution rate of mental defect and a low distribution rate of alcoholism is found in this race. The low alcoholic distribution exists in spite of the fact that the alcoholic habits of Negroes are about the same as of whites. From this comparison it appears that the Negro can be practically as intemperate as the white man without paying the same penalty for it. On the other hand, he has a higher ratio of venereal disease. (See Table 25.) By reason of this, it would seem that some modification might be made in the views of those who place alcohol as the chief factor in the spread of venereal diseases. A similar, though less marked, resistance to the invasion of the central nervous system by syphilis is shown by the Negro. Among neuropsychiatric patients the previous history of syphilis was more than three times as frequent in the colored as in the whites, but the invasion of the central nervous system was about equal in the two classes.


212

TABLE 32.-Races of neuropsychiatric cases

Diagnoses

Total

African (Negro)

American Indian

Armenian

Dutch

English

French

German

Greek

Hebrew

Irish

Italian

Mental deficiency

21,858

4,055

78

26

86

2,651

274

1,217

67

226

936

803

Psychoneuroses

11,443

1,100

6

11

49

1,501

174

761

70

331

662

443

Psychoses

7,910

556

5

10

43

1,070

95

552

39

196

524

237

General paralysis

530

43

---

---

3

74

4

36

3

6

56

12

Alcoholic

292

5

---

---

3

23

---

27

3

1

46

4

Manic-depressive

1,385

81

---

---

5

165

18

115

11

41

70

57

Dementia pręcox

4,738

305

5

8

22

705

59

332

20

128

288

133

Epileptic

131

19

---

---

---

8

3

3

---

6

6

7

Other forms

834

103

---

2

10

95

11

39

2

14

58

24

Nervous diseases and injuries

6,916

800

5

8

38

913

102

418

25

98

516

191

Chorea

264

12

1

---

3

43

6

14

---

2

27

3

Hemiplegia

258

48

---

1

2

23

8

10

3

5

13

3

Injuries to nervous system

554

126

1

---

3

61

6

40

3

10

31

15

Meningitis

279

37

---

---

1

40

6

18

4

2

23

7

Multiple sclerosis

511

28

---

---

4

74

11

35

---

6

41

10

Neuritis

222

9

---

2

3

40

5

16

---

2

14

13

Paralysis

340

58

---

---

2

45

5

19

---

9

13

10

Poliomyelitis

211

20

---

1

1

22

2

15

1

4

10

11

Sciatica

137

10

---

---

---

14

2

10

---

6

17

11

Syphilis C.N.S.

2,462

301

2

2

12

316

28

125

14

30

212

68

Tabes dorsalis

333

39

---

---

3

37

4

16

---

4

28

8

Tic

200

17

---

---

---

37

6

27

---

3

9

4

Tremor

243

31

---

---

---

33

3

17

---

---

18

4

Other forms

902

64

1

2

4

128

10

56

---

15

60

24

Epilepsy

6,388

1,115

9

7

34

813

102

321

38

93

366

315

Constitutional psychopathic states

6,196

255

11

6

33

975

75

433

23

203

497

228

Endocrinopathies

4,805

299

3

1

34

796

55

474

15

73

287

94

Drug addiction

2,020

197

4

---

5

171

25

70

1

88

222

131

Alcoholism

1,858

24

3

---

6

202

39

105

3

6

452

10

Total

69,394

8,401

124

69

328

9,092

941

4,351

281

1,314

4,462

2,452


Diagnoses

Japanese

Mexican

Filipino

Porto Rican

Scand-
inavian

Scotch

Slavonian

Spanish

Welsh

Other peoples

Mixed

Race unascer-
tained

Mental deficiency

---

257

3

1

296

72

915

31

13

237

6,490

3,124

Psychoneuroses

1

16

---

2

221

106

378

19

16

123

4,333

1,120

Psychoses

1

18

1

2

217

71

358

11

9

84

2,889

922

General paralysis

---

1

---

---

10

17

17

---

1

5

164

78

Alcoholic

---

---

---

---

5

1

14

---

---

2

120

38

Manic-depressive

---

6

---

---

31

11

63

---

2

13

535

161

Dementia pręcox

1

10

---

2

152

36

231

9

5

60

1,700

527

Epileptic

---

---

---

---

---

2

2

---

---

---

58

17

Other forms

---

1

1

---

19

4

31

2

1

4

312

101

Nervous diseases and injuries

---

22

---

3

127

96

181

16

16

62

2,406

873

Chorea

---

1

---

---

6

2

1

---

---

---

111

32

Hemiplegia

---

2

---

---

4

3

9

---

1

1

95

27

Injuries to nervous system

---

2

---

---

10

9

15

3

3

3

170

43

Meningitis

---

2

---

---

4

3

1

1

---

1

96

33

Multiple sclerosis

---

1

---

---

16

8

18

1

2

3

198

55

Neuritis

---

3

---

---

8

5

8

---

---

---

78

16

Paralysis

---

1

---

---

5

2

8

1

---

3

131

28

Poliomyelitis

---

---

---

---

4

3

4

2

---

3

91

17

Sciatica

---

1

---

---

1

3

6

2

---

1

47

6

Syphilis C.N.S.

---

4

---

1

44

38

68

5

5

31

802

354

Tabes dorsalis

---

---

---

1

5

3

7

---

1

2

112

63

Tic

---

---

---

---

2

2

3

---

1

4

67

18

Tremor

---

1

---

---

3

2

5

---

---

2

76

48

Other forms

---

4

---

1

15

13

28

1

3

8

332

133

Epilepsy

---

45

2

---

85

54

163

13

5

61

2,046

701

Constitutional psychopathic states

---

15

---

---

105

62

247

12

11

73

2,347

585

Endocrinopathies

---

9

---

---

132

60

141

1

6

33

1,691

601

Drug addiction

---

2

---

---

24

27

29

4

1

10

870

139

Alcoholism

---

---

1

1

49

31

62

2

8

12

532

310

Total

2

384

7

9

1,256

579

2,474

109

85

695

23,604

8,375


 


213

TABLE 33.-Percent distribution of neuropsychiatric conditions among four different races, with comparisons between the American born and the foreign born

Race

Number classified

Percent of total of each nativity

Mental deficiency

Psycho-
neuroses

Psychoses

Neurological condition

Epilepsy

Constitutional psychopathic states

Endocrino-
pathies

Drug addiction

Alcoholism

Italians:

American born

413

33.9

13.6

11.6

6.5

2.2

10.9

1.0

19.1

1.2

Foreign born

2,039

32.5

19.0

9.3

8.0

15.0

9.0

4.4

2.6

.2

Scandinavians:

American born

890

26.7

17.8

15.4

9.1

6.6

8.3

11.0

2.1

2.8

Foreign born

366

15.8

16.9

21.9

12.6

7.1

8.5

9.3

1.4

6.6

Irish:

American born

4,068

21.6

14.7

10.9

11.6

8.2

11.6

6.6

5.4

9.4

Foreign born

394

15.0

15.7

20.1

10.9

7.9

6.6

4.8

1.0

18.0

German:

American born

4,164

28.1

17.6

12.3

9.6

7.3

10.1

11.0

1.6

2.4

Foreign born

187

25.7

15.5

21.4

10.7

8.6

7.0

7.5

1.6

2.1


TABLE 34.-Races of neuropsychiatric cases. Classification percentage

Race

Total classified

Percent of total of each race

Number

Percent

Mental deficiency

Psycho-
neuroses

Psychoses

Neuro-
logical

Epilepsy

Consti-
tutional psycho-
pathic states

Endocrin-
opathies

Drug addiction

Alco-
holism

African (Negro)

8,401

12.1

48.3

13.1

6.6

9.5

13.3

3.0

3.6

2.3

0.3

American Indian

124

.2

62.9

4.8

4.0

4.0

7.3

8.9

2.4

3.2

2.4

Armenian

69

.1

37.7

15.9

14.5

11.6

10.1

8.7

1.4

---

---

Dutch

328

.5

26.2

14.9

13.1

11.6

10.4

10.1

10.4

1.5

1.8

English

9,092

13.1

29.2

16.5

11.8

10.0

8.9

10.7

8.8

1.9

2.2

French

941

1.4

29.1

18.5

10.1

10.8

10.8

8.0

5.8

2.7

4.1

German

4,351

6.3

28.0

17.5

12.7

9.6

7.4

10.0

10.9

1.6

2.4

Greek

281

.4

23.8

24.9

13.9

8.9

13.5

8.2

5.3

.4

1.1

Hebrew

1,314

1.9

17.2

25.2

14.9

7.5

7.1

15.4

5.6

6.7

.5

Irish

4,462

6.4

21.0

14.8

11.7

11.6

8.2

11.1

6.4

5.0

10.1

Italian

2,452

3.5

32.7

18.1

9.7

7.8

12.8

9.3

3.8

5.3

.4

Mexican

384

.6

66.9

4.2

4.7

5.7

11.7

3.9

2.3

.5

---

Scandinavian

1,256

1.8

23.6

17.6

17.3

10.1

6.8

8.4

10.5

1.9

3.9

Scotch

579

.8

12.4

18.3

12.3

16.6

9.3

10.7

10.4

4.7

5.4

Slavonian

2,474

3.6

37.0

15.3

14.5

7.3

6.6

10.0

5.7

1.2

2.5

Spanish

109

.2

28.4

17.4

10.1

14.7

11.9

11.0

.9

3.7

1.8

Welsh

85

.1

15.3

18.8

10.6

18.8

5.9

12.9

7.1

1.2

9.4

Mixed

23,604

34.0

27.5

18.4

12.2

10.2

8.7

9.9

7.2

3.7

2.3

Other peoples

713

1.0

33.8

17.7

12.3

9.1

8.8

10.2

4.6

1.4

2.0

Race unascertained

8,375

12.1

37.3

13.4

11.0

10.4

8.4

7.0

7.2

1.7

3.7

 

Total cases

69,394

100.0

31.5

16.5

11.4

10.0

9.2

8.9

6.9

2.9

2.7


With the exception of mental deficiency and epilepsy, the Negro falls below all United States distribution averages. He is especially low in psychoses, constitutional psychopathic states, and alcoholism. In the psychoneuroses, the Negro presents distinct differences from the white man. He is more prone to hysteria than to neurasthenia, and stammering is nearly twice as frequent with him as is neurasthenia. The psychological mechanism of the disorder is simple, as these conditions in Negroes were identified more frequently by examining and discharging officers. In Negroes the psychoneuroses occurred more frequently in the younger age groups than in the whites. The Negro is given to early marriage, lives more in the country, and contends with especially unfavorable circumstances as concerns education and modern standards of' living.


214

AMERICAN INDIAN
(Number classified, 124)

The American Indian is primitive, like the Negro, and exceeds even the latter in mental deficiency. He is not so much below the average in alcoholism or drug addiction as the Negro, but is somewhat below him in epilepsy. In other neuropsychiatric conditions the Indian falls below all United States averages.

As concerns non-native races, it should be remembered that the information which follows stands by itself, and is not supplemented by any facts as to the circumstances of residence of these races in this country, nor as to the causes of their immigration or nature of occupation. There is no information as to whether these individuals are representative of the same races living at home.

Comparison can be made also between the native born and the foreign born of the different races given in Table 33. Certain definite variations are noticeable; for example, practically all native born are more addicted to the use of drugs than are the foreign born. The influence of this country seems to arouse a drug inebriety or to convert an alcoholic inebriety into a drug inebriety. Similarly, foreigners seem to undergo a decrease in insanity from residence in this country.

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

Country of birth

Number classified

Percent of total of each nativity

Mental deficiency

Psycho-
neuroses

Psychoses

Neuro-
logical

Epilepsy

Consti-
tutional psycho-
pathic states

Endo-
crino-
pathies

Drug addiction

Alco-
holism

Austria-Hungary

462

31.8

14.9

19.0

5.6

11.0

8.7

6.5

1.1

1.3

Canada

337

21.4

16.6

13.4

12.8

9.2

10.1

4.5

3.0

9.2

Denmark, Norway, Sweden

366

15.8

16.9

21.9

12.6

7.1

8.5

9.3

1.4

6.6

England, Scotland, Wales

323

9.3

24.5

12.1

12.4

8.4

15.2

5.0

3.1

10.2

France

49

20.4

16.3

10.2

24.5

14.3

8.2

2.0

2.0

2.0

Germany

187

25.7

15.5

21.4

10.7

8.6

7.0

7.5

1.6

2.1

Greece

242

24.0

23.1

15.3

9.1

14.5

7.4

6.2

.4

---

Holland

50

18.0

16.0

24.0

4.0

20.0

8.0

8.0

---

2.0

Ireland

394

15.0

15.7

20.1

10.9

7.9

6.6

4.8

1.0

18.0

Italy

2,039

32.5

19.0

9.3

8.0

15.0

9.0

4.4

2.6

.2

Poland

331

43.5

15.1

13.0

6.9

6.9

9.1

4.2

.3

.9

Russia

1,675

32.1

21.1

15.3

7.2

5.7

11.3

4.4

1.4

1.5

Switzerland

31

6.5

22.6

25.8

9.7

9.7

6.5

9.7

---

9.7

Others

772

28.9

17.5

17.2

9.5

9.6

11.1

3.6

.8

1.8


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.


215

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 Percent as compared with 4.1 Percent for English, and 4 Percent 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 Percent 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.


216

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 Percent 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 Percent 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 Percent and less mental defect by 8.2 Percent. 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 Percent 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 Percent among the native, and even a greater falling off in the distribution rate of alcoholism. Nearly one-half of the decrease


217

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 Percent, but in epilepsy they fall below the United States average by 6.4 Percent. 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 Percent. 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


218

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.


219

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.


220

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 Percent) 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 Percent) and the Italians (32.7 Percent) 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 Percent 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 Percent of the cases and the morons, or higher grades, sank to 50 Percent with 0.8 Percent 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 Percent of the mental defectives discovered were referred by medical officers, and 26 Percent 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


222

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 Percent, 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 Percent 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 Percent 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 Percent, 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 Percent) were recommended for limited service than whites (11.9 Percent). The proverbial freedom from physical illness of mental defectives is substantiated by the fact that only 76 cases (0.3 Percent) were retained in the hospital for treatment.

DELINQUENCY

Of the total number of mental deficiency cases, 562 white and 71 colored men, or 3 Percent, 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 Percent of the white and 64 Percent 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

Neuropathic taint in family

Number of cases

Number of relatives

Fathers

Mothers

Grandparents

Siblingsa

Collateralsb

White

Nervous disease

2,967

686

1,542

79

1,419

376

Mental disease

2,146

353

403

194

650

972

Inebriety

2,630

1,963

55

55

781

446

Mental deficiency

1,478

244

243

9

1,339

151

Total

9,221

3,246

2,243

337

4,189

1,945

Colored

Nervous disease

489

110

196

32

399

139

Mental disease

709

83

113

52

264

432

Inebriety

398

248

18

8

196

87

Mental deficiency

274

32

36

3

292

52

Total

1,870

473

363

95

1,151

710

Total, white and colored

11,091

3,719

2,606

432

5,340

2,655


aSiblings include brothers and sisters.
bCollaterals include uncles, aunts, and cousins.

FAMILY HISTORY

The information covering family history is open to the criticism that it was furnished by a class of patients less qualified to be accurate about such matters than most representatives of the neuropsychiatric group. (See Tables 13 to 17.) Mental defectives, when questioned about their forbears, may well be suspected of not having the knowledge that would enable them to give correct answers. They might and probably would know if members of the immediate family had been in an institution, but otherwise would be unaware of the existence of psychiatric conditions. This would be particularly the case for histories of mental deficiency itself which, in certain sections of the country, exists as a family characteristic and so would not be remarked by members of the family. This probably accounts for the relatively few instances of mental defect in forbears, as shown in Table 17. About four-fifths of the histories recorded data on these several points. Psychopathic inheritance existed in a little more than one-half of the whites and a little less than one-half of the colored.

Table 36 shows the large number of mothers among both the white and colored who had nervous diseases; also the large number of inebriates, chiefly alcoholics, among the fathers. Mental disease and defects are about equally balanced between fathers and mothers among both the white and colored.

The same table shows the large number of brothers and sisters-listed in the table as siblings-who were victims of nervous disease and mental defect. This appears to be true for both the white and colored. Mental diseases also ran high among the brothers and sisters of the colored mental defectives. The table also shows the small number of mental defectives and the large number of cases of mental disease among collateral relatives.


224

AGE

Relatively few of the colored cases were found to be under 20 years of age, the greater percentage being between the ages of 20 and 25 years. (See Table 20.) As already stated, of the men placed in Class I between the ages of 21 and 29 years, 62 Percent were between the ages of 21 and 24 and 38 Percent between the ages of 25 and 29. The corresponding percentages for the cases of mental deficiency are 59.4 and 40.6. The difference of less than 3 Percent would probably justify the conclusion that between the ages of 21 and 29 there is no difference of significance between the ages of a group of mental defectives and normal individuals.

When the ages of mental defectives are compared with the other groups of neuropsychiatric disorders, especially those which had a definite time of beginning, different conclusions appear. About 9 Percent of the white mental-deficiency cases were under 20 years of age, which percentage is the largest for any group, constitutional psychopaths and epileptics standing next in order of frequency. The percentage of white mental defectives over 30 years of age was smaller than for any other group except the endocrinopathies. The percentage of white epileptics over 30 was very slightly larger than that of the mental defectives. Among the other groups, the percentages of individuals over 30 years of age ran from 5 to over 50 Percent higher than the percentage for the mental defectives.

EDUCATION

Mental defectives, as might be expected, made the poorest showing in regard to education of any of the neuropsychiatric groups. (See Table 23.) The subject is best considered in connection with Table 22, prepared from certain selected examinations made by the psychological examiners, which indicates the results of their inquiries into the education of drafted men as a whole. One is struck, first of all, by the great difference between the education given the normal and that given the defective. In considering the disparity between the two, it should be borne in mind that the class here under discussion is composed of the higher grades of defectives, many of whom are, in certain respects, educable. Yet one-third of the whites and two-thirds of the colored had no education at all. No effort, apparently, was made to keep them in school. Fifty-nine Percent of the defectives had had some schooling, but only a small number reached high school, and the only college representatives were found in the officers' training camps.

The difference in the efforts at education of the Negroes as compared with the whites is conspicuous. The fact that such a large number of the negroes received no education may account in part for the large number reported by the psychologists as being defective.

ECONOMIC CONDITION

The numbers of the white and the colored mental defectives in marginal circumstances were larger than the numbers for any other group. (See Table 24.) This would be expected, since mental defectives have low earning power and lack ordinary prudence.


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HISTORY OF VENEREAL DISEASES

Table 25 shows that there were relatively few instances of preexisting venereal diseases among mental defectives. This corresponds with civil experience as concerns mentally defective males, as the sexual instincts are frequently dormant in these individuals. The rate of admission of the existence of infections of some kind was about four times as high among the colored as among white mental defectives. The rate of syphilitic infection being about eight times and that of gonorrheal infections about four times as high.

Among the mentally defective whites the percentage for all venereal diseases was lower than among any other group of neuropsychiatric disorders; for example, it was 12.8 Percent among white defectives and 54.2 Percent among white drug addicts; among the colored the percentage was lower than for any other group of colored except that of alcoholism, of which latter conditions the numbers were too small for the computation of rates.

The rate of syphilitic infections among the mentally defective whites was relatively low; it was equaled, however, in the endocrine group and was not much smaller than the rates for the epileptics and the psychoneurotics. Among the colored mentally defective the rate for syphilitic infections was lower than for any other group except that of the psychoneuroses. Gonorrheal infections were comparatively infrequent among the white mental defectives; among the colored the rate was higher for mental defectives than those for the groups of alcoholism and psychoses.

ALCOHOLIC HABITS

There is practically no difference between the white and colored cases of mental deficiency, in so far as alcoholic habits are concerned. (See Table 26.) The percentage of moderate drinkers for both white and colored mental defectives is slightly larger than the percentage for all neuropsychiatric cases. The mental defective group ranked sixth in order of frequency as to intemperance.

MARITAL STATUS

Including the widowed and divorced, 15.7 Percent of mental defectives were married, which is a slightly higher percentage than that (13.2 Percent) found among the total of Class I men, and a lower percentage than that of neuropsychiatric cases generally, 19.1 Percent. (See Table 27.) The percentage of marriage was about three times as great among the colored defectives as among the white, but even in them the percentage was smaller than for any other colored group, except alcoholism.

As a class, defectives show less matrimonial inclinations than any other neuropsychiatric individuals. This is in contradiction to the common theory that lack of general intelligence is the chief factor in early marriage. Inasmuch as the mental defectives married relatively less than the other neuropsychiatric groups, and groups in which temperamental instability is conspicuous, it would seem that the explanation of early marriage would be found in the sphere of the emotions rather than in that of the intelligence. The relative number


226

divorced among defectives was also lower than for any other group, except the endocrine group, although among Negro defectives it was higher than that for the group of epilepsy, endocrine disorders, drug addicts, insane, or constitutional psychopathic states.

HOME ENVIRONMENT-URBAN OR RURAL

While 51 Percent of the population of the United States resides in communities of 2,500 or more (United States Census, 1920), only one-third of the mental defectives of the Army came from such urban communities. (See Table 28.) The rate of mental defectives from rural environment is higher among the colored than among the whites. This is accounted for by the excess of rural residence of the former.

Of all the neuropsychiatric conditions, mental defect was the only one for which the percentage of cases coming from rural districts exceeded the percentage of the population residing in rural districts. The general explanation is that the great flocking to the cities, so characteristic of modern times, is a movement carried out by the more progressive of the community.

STATE OF RESIDENCE (WITH GAIN OR LOSS FROM IMMIGRATION OR MIGRATION)

Among the whites for the entire United States mental deficiency constituted 29.2 Percent of all neuropsychiatric disorders. (See Table 37.) In 19 States (Table 38) the percentages are larger than for the United States as a whole.

TABLE 37.-State of residence ofmental defectives. Percentagesa

State of residence

White

Colored

State of residence

White

Colored

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Alabama

397

36.0

656

66.4

New Hampshire

36

27.7

---

---

Arizona

18

15.0

1

16.6

New Jersey

393

27.6

13

21.0

Arkansas

384

43.7

231

62.4

New Mexico

210

61.2

---

---

California

377

22.0

5

14.3

New York

1,271

19.8

47

29.2

Colorado

120

24.8

---

---

North Carolina

651

46.7

154

40.8

Connecticut

163

26.7

6

46.2

North Dakota

101

38.5

---

---

Delaware

21

22.8

15

37.5

Ohio

901

23.9

57

33.5

Florida

152

31.1

15

11.5

Oklahoma

398

33.3

95

57.9

Georgia

511

33.3

141

31.7

Oregon

55

18.1

---

---

Idaho

44

26.7

---

---

Pennsylvania

1,522

27.0

119

42.0

Illinois

791

19.9

60

41.1

Rhode Island

65

29.2

4

40.0

Indiana

417

23.3

14

32.6

South Carolina

318

43.4

219

40.0

Iowa

239

25.3

3

12.5

South Dakota

101

333.1

---

---

Kansas

197

21.6

11

21.6

Tennessee

570

43.0

501

71.8

Kentucky

771

41.1

67

38.5

Texas

414

25.5

114

33.4

Louisiana

275

28.7

332

48.3

Utah

31

20.5

---

---

Maine

202

51.5

---

---

Vermont

38

33.6

1

100.0

Maryland

396

44.9

319

74.4

Virginia

656

45.5

280

48.6

Massachusetts

400

25.7

7

33.3

Washington

115

26.1

2

100.0

Michigan

623

29.2

15

32.6

West Virginia

469

38.6

30

37.5

Minnesota

262

22.2

1

9.1

Wisconsin

363

27.0

1

25.0

Mississippi

308

35.4

328

44.6

Wyoming

25

21.7

---

---

Missouri

922

33.8

68

24.4

District of Columbia

26

16.1

48

52.7

Montana

45

16.7

1

25.0

State unascertained and others

901

---

73

---

Nebraska

125

25.1

1

9.1

United States

17,803

29.2

4,055

48.3

Nevada

11

18.3

---

---


aPercentages are based on the total neuropsychiatric cases of each color from each State.


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TABLE 38.-Percent distribution of neuropsychiatric conditions in 19 States in which the rates for mental deficiency exceeded the United States rate of 29.2 Percent

State of residence

Mental deficiency

Psycho-
neuroses

Psychoses

Neuro-
logical

Epilepsy

Constitutional psycho-
pathic states

Endo-
crinopa-
thies

Drug addiction

Alcoholism

United States

29.2

17.0

12.1

10.0

8.6

9.7

7.4

3.0

3.0

Alabama

36.0

20.1

11.8

9.9

9.3

7.3

4.0

1.2

.5

Arkansas

43.7

21.0

9.1

7.2

8.4

6.4

1.4

2.6

.2

Florida

31.1

18.4

14.5

9.2

11.2

8.8

3.5

2.9

.4

Georgia

33.3

13.0

13.4

11.5

7.9

11.8

6.1

2.5

.7

Kentucky

41.1

14.0

6.9

11.8

8.8

9.4

4.2

1.2

2.6

Maine

51.5

13.0

7.7

5.4

9.2

8.9

.5

1.3

2.6

Maryland

44.9

13.3

10.4

7.6

4.5

10.7

4.4

1.6

2.5

Mississippi

35.4

23.2

9.8

8.3

10.9

6.7

2.1

3.1

.6

Missouri

33.8

15.9

8.5

11.4

6.3

9.4

8.5

3.0

3.3

New Mexico

61.2

7.0

5.5

7.3

8.5

6.1

3.5

.3

.6

North Carolina

46.7

17.7

8.0

6.6

9.6

3.9

6.1

.7

.6

North Dakota

38.5

14.1

12.6

9.2

8.0

10.3

3.8

.4

3.1

Oklahoma

33.3

15.6

11.8

12.7

6.7

6.7

4.0

7.4

1.9

South Carolina

43.4

19.6

7.0

8.2

8.9

4.1

6.1

1.9

.8

South Dakota

33.1

14.4

10.5

12.8

6.6

3.9

16.1

.3

2.3

Tennessee

43.0

14.3

9.6

11.9

8.0

3.8

5.1

3.5

.8

Vermont

33.6

16.8

13.3

10.6

8.8

10.6

3.5

---

2.7

Virginia

45.5

12.1

9.2

7.0

5.8

7.4

10.9

1.2

1.0

West Virginia

38.6

12.6

8.2

9.1

6.3

7.8

15.7

1.1

.7


While all but four of these States are southern, the percentages refer to white cases only. The high degree of mental defect known to exist in the South is commonly laid to the door of the Negro. The preceding figures indicate plainly that among the southern white population mental defect is more general than among the population of the United States as a whole.

It is possible to form some idea as to the incidence of this condition in any State by comparing the rate of rejection by local boards of the State with the number of cases from that State found at camps by the neuropsychiatric examiners.

Table 5 gives the rate of rejections for mental defect per 1,000 men examined by the local draft boards of the different States. By comparing these rates with those of the neuropsychiatric identifications at camps, it will be observed that a high rate of rejection for mental defect at local boards did not mean necessarily a low rate of cases found at camps. On the contrary, it will be seen that, with the exception of Arkansas and Missouri, the high rejection rates by local boards were in the States in which a high degree of mental defect was found by the neuropsychiatric examiners. The local boards of Vermont rejected proportionately more than those of any other State (27.13 per 1,000), but even that large number of rejections was not sufficient to bring Vermont below the United States average of 29.2 Percent as determined by the neuropsychiatric examinations.


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The following States equaled or fell below the United States neuropsychiatric average for white mental defectives:

Percent

Percent

Arizona

15.0

Colorado

24.8

District of Columbia

16.1

Nebraska

25.1

Montana

16.7

Iowa

25.3

Oregon

18.1

Texas

25.5

Nevada

18.3

Massachusetts

25.7

New York

19.8

Washington

26.1

Illinois

19.9

Idaho

26.7

Utah

20.5

Connecticut

26.7

Kansas

21.6

Pennsylvania

27.0

Wyoming

21.7

Wisconsin

27.0

California

22.0

New Jersey

27.6

Minnesota

22.2

New Hampshire

27.7

Delaware

22.8

Louisiana

28.7

Indiana

23.3

Michigan

29.2

Ohio

23.9

Rhode Island

29.2


In these States, there is again a general, though not absolute, agreement between the results of the neuropsychiatric examinations and those of the local boards. For example, in Arizona, which is lowest on the list, only 2 per 1,000 were rejected by home boards, whereas in Rhode Island, which is highest on the foregoing list, there were 15.18 such rejections per 1,000.

When the colored alone are considered, Table 5 is not of use. The Provost Marshal General's report, upon which this table was based, did not distinguish between colored and white mental defectives.

The United States distribution average of mental deficiency among the colored neuropsychiatric cases was 48.3 Percent. The following States exceeded this rate of 48.3 Percent for colored:

Percent

Percent

Vermont

100.0

Arkansas

62.4

Washington

100.0

Oklahoma

57.9

Maryland

74.4

District of Columbia

52.7

Tennessee

71.8

Virginia

48.6

Alabama

66.4


It is to be noted that Maryland, Tennessee, and Arkansas were also high in mental defect among whites. (See Table 37.)

The States for which the distribution percentages equaled or were less than the percentage for the United States colored were as follows:


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Percent

Percent

Minnesota

9.1

Massachusetts

33.3

Nebraska

9.1

Texas

33.4

Florida

11.5

Ohio

33.5

Iowa

12.5

Delaware

37.5

California

14.3

West Virginia

37.5

Arizona

16.6

Kentucky

38.5

New Jersey

21.0

Rhode Island

40.0

Kansas

21.6

South Carolina

40.0

Missouri

24.4

North Carolina

40.8

Montana

25.0

Illinois

41.1

Wisconsin

25.0

Pennsylvania

42.0

New York

29.2

Mississippi

44.6

Georgia

31.7

Connecticut

46.2

Indiana

32.6

Louisiana

48.3

Michigan

32.6


This list is peculiar in that Florida and Georgia are well below the United States average for white mental defectives. 

Table 39 shows five races in which the distribution of mental defect exceeded the United States mental deficiency average of 29.2 Percent.

TABLE 39.-Percent distribution of neuropsychiatric conditions among six races in which the mental deficiency distribution rate exceeded the United States mental deficiency white rate of 29.2 Percent

Race

Number classified

Mental deficiency

Psycho-
neuroses

Psycho-
ses

Neuro-
logical conditions

Epi-
lepsy

Constitu-
tional psycho-
pathic states

Endocrin-
opathies

Drug addiction

Alcohol-
ism

United States (white)

60,993

29.2

17.0

12.1

10.0

8.6

9.7

7.4

3.0

3.0

African (Negro)

8,401

48.3

13.1

6.6

9.5

13.3

3.0

3.6

2.3

.3

American Indian

124

62.9

4.8

4.0

4.0

7.3

8.9

2.4

3.2

2.4

Armenian

69

37.7

15.9

14.5

11.6

10.1

8.7

1.4

---

---

Italian

2,452

32.7

18.1

9.7

7.8

12.8

9.3

3.8

5.3

.4

Mexican

384

66.9

4.2

4.7

5.7

11.7

3.9

2.3

.5

---

Slavonic

2,474

37.0

15.3

14.5

7.3

6.6

10.0

5.7

1.2

2.5


NATIVITY

Two thousand and sixty-one, or 9.5 Percent of the ascertained white cases of mental deficiency were of foreign birth. Using all the neuropsychiatric cases for the purpose of comparison, it is found that 10.5 Percent were foreign born. As this percentage does not differ greatly from the percentage for mental defectives alone, the conclusion seems warranted that mental deficiency did not exist to a disproportionate extent among the foreign born.

CORRELATIONS WITH OTHER CLINICAL CONDITIONS

Throughout the present material mental deficiency presents significant correlations with the other clinical conditions, and these correlations may be taken as throwing some light on the extent and quality of the intelligence of the people concerned.


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As regards psychoses or mental disorders, it might be assumed that these would be less apt to occur when there was a high rate for mental deficiency. The existence of a mental disease implies a developed intelligence of a character that would possess imagination, ideas, and a certain quickness in mental processes. As is well known, distinct types of mental diseases are practically unknown in childhood, the period before the intelligence is fully developed. The hypothesis that mental disease implies a developed intelligence and is less frequent among people where the intelligence is under-developed is borne out by the tables. Nineteen States (Table 38) exceeded the mental deficiency distribution rate of 29.2 Percent, and showed among themselves an average distribution of mental defect of 39.3 Percent. But the insanity distribution rate for these States was below that for the United States, being particularly low in the States with high distribution of mental defect, viz, Arkansas, Kentucky, Maine, New Mexico, North Carolina, Tennessee, and Virginia. This same correlation holds true for the five classified native-born races (Table 39) which exceeded the distribution rate of 29.2 Percent for mental defect (with the exception of the Slavonic), namely, for the Negroes, American Indians, Italians, and Mexicans.

The converse of the above correlations between mental defect and insanity will be shown to hold true when the distribution rate of insanity is above the average.

Between mental deficiency and alcoholism there seems to exist a very definite antagonism, in that the two conditions do not exist in great abundance in the same communities and people. Where the rate for one rises, the rate for the other falls. Of the 19 States with an excess distribution of mental deficiency, only two have an excess of alcoholism, and in these 19 States the average distribution of alcoholism, including alcoholic psychoses, is 1.6 Percent as compared with 3 Percent-the United States distribution average. (Table 38.)

This same antagonism is observed in the different races. None of the five races which exceeded the United States distribution rate for mental deficiency attain the alcoholic distribution rate of 3 Percent. Similar conditions prevail in the foreign-born races classified. The converse will be shown to hold good when the correlations of alcoholism are stated.

As concerns epilepsy, in the States in which the distribution of mental deficiency was over average, there is practically no change; in the races there is a slight increase.

As concerns the psychoneuroses, States and races with an above-average rate of mental deficiency show a decrease. Constitutional psychopathic states which are akin to mental disorders, have a lower distribution average in both the States and the races which show an excess distribution of mental deficiency.

There is a tendency in some States for endocrine disturbances to sink when mental defect rises, and vice versa. Correlations exist between mental deficiency and drug addiction similar to those mentioned as existing between mental deficiency and alcoholism. Of the 19 States over average as regards mental deficiency, only three, Mississippi, Oklahoma, and Tennessee, exceeded


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the average distribution rate for drug addiction. Of the five races in which mental deficiency is over average, only two, namely, the American Indian and the Italian, exceed in drug addiction. (Table 39.) Of the four foreign-born races (Table 33), the Italian is the only one which exceeds in mental deficiency.

It would seem, therefore, that an excess of mental deficiency in a people assures a below average amount of alcoholism, insanity, psychopathic states, and drug addiction; the converse, still to be shown, is that when the latter conditions are in excess mental deficiency recedes.

PSYCHONEUROSES

The information as to the psychoneuroses obtained by the compilation of the reports of the neuropsychiatric examinations throws some light on certain important points concerning them. In the first place, the numbers alone were surprising. While physicians realized that there were many complaining people in hospitals, in dispensaries, and in the world generally, whose symptoms could not be associated with any definite pathological condition, few realized that there were so many young men in the country in whom functional nervous disease reached a point to constitute a definite disability. But when more than 11,000 of them were identified in the camps alone, it is evident that these conditions demand the serious attention of a government which hopes to conserve its man power.

The most important question of all in regard to the psychoneuroses, their essential character, can not at present be decided. Intensive investigation, the need of which the present study makes plain, must decide as to the essential characters of these disorders. The evidence accumulated throughout the World War, both in this country and in France, indicates plainly that the behavior of psychoneurotics is more strongly motivated by impulses looking toward an improvement of their own personal situation than is observed in most people. For the most part their symptoms fluctuate in direct ratio with the unpleasant features of the situation. In the camps, a rumor of overseas orders would bring about an increased flow of applications for admission to the hospitals; overseas, the universal employment of the term "shell-shock" acted as a kind of moral contagion in creating these cases; during the armistice, more than one came out frankly and said he thought his paralysis, or whatever the disability was, would cause him no further trouble if he could be discharged from the Army.

But while these "selfish" trends in the psychoneurotic, in the Army as in civil life, are unmistakable, it is yet to be shown in what proportion of the patients they are really outside personal control. It is certain that many have been labeled psychoneurotics when they should have been recognized as suggestible, credulous, uninformed young men, who really were ready to carry on if they knew how. Both in the home camps and in the American Expeditionary Forces numerous instances were recorded of timid, immature, frightened youthful soldiers who really thought they were ill or "shell-shocked," yet who, under the benefits of rest, explanation, and kindly encouragement, forgot all their symptoms and settled down to their work like real men. The symptoms most


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frequently complained of which could be explained away were those referred to the gastrointestinal, cardiovascular, and sexual systems. The patients had often worried about them long before the war. In combat areas, recovery from such symptoms became much more assured when beds were set aside in field hospitals for these patients. These individuals, badly frightened, shaken up, or even slightly wounded, were returned to their organizations, instead of being sent, as they would have been sent, under other arrangements, to the rear. This phase of the subject-the phase having to do with psychotherapeutic reconstruction-touches primary education very closely and will be less acute when education becomes more generalized, and especially when educational programs include character up-building and world contact, as well as scholastic performance.

The association of the psychoneuroses with organic diseases is of importance. It is quite possible that many conditions were denominated psychoneurotics when they should have been denominated in terms of some organic condition. The superficial reaction was considered as primary, when it should have been recognized as secondary to a more serious organic disability.

The statistics show the psychoneuroses as more frequently associated with alcoholism and less frequently with poor economic conditions than in the case of the other neuropsychiatric conditions.

A problem for the future is the determination of the relationship between endocrine disorders and the psychoneuroses. From examinations of individual cases of these "situation neuroses" there is good ground for believing that they are often associated with some disharmony or defect in the function of the endocrine glands. The statistics in this chapter can hardly be utilized in support of such theory.

The question of the association of psychoneuroses with mental defect, while not elucidated by the present statistics, is one of importance. It was remarked in our hospitals, as well as in those of other countries, that many of the functional nervous cases presented inferior intelligence. This seemed to be particularly the case in hysteria, especially in the variations presenting paralysis and other somatic symptoms. It is to be noted that the negro, in whom mental defect is more prevalent than in the white, had a higher proportion of hysteria than that of other psychoneurotic conditions.

CLASSIFICATION

The 11,443 classified cases of psychoneuroses were distributed as shown in Table 6. There may be some question as to the propriety of including enuresis in this group, as probably some of these cases were mental defectives, others were endocrinopaths. The number of stammerers is notable. The clinical histories indicated the essentially psychoneurotic character of this disability.

The percentages of neurasthenia and psychasthenia were much higher among the whites than among the colored, while those of hysteria and stammering were much lower among the whites. The latter conditions comprised 70.7 Percent of the colored psychoneurotics.


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METHODS OF DISCOVERING CASES

The neuropsychiatrists apparently found some difficulty in identifying cases of psychoneuroses at the routine examinations. (See Table 8.) Perhaps the cases of psychoneuroses required some time for the symptoms to come to the front. More negroes, 47.8 Percent, as compared to 35.2 Percent of the whites, were identified immediately. That the psychoneuroses are more conduct disorders than certain of the other groups is shown by the fact that a considerably higher percentage of them, 25.3 Percent, than of endocrine troubles, alcoholism, or even drug addiction, were referred by organization commanders. Forty-five cases were referred by psychologists and 12 cases as a result of delinquency.

LENGTH OF SERVICE PRIOR TO DISCOVERY

Although not easily identified at first, these cases broke down promptly, 44.8 Percent of the white and 64.1 Percent of the colored being recognized in less than one month. (See Table 10.) Since a relatively larger proportion of colored were identified immediately, and a larger proportion of them broke down so early in training, it would seem that the mechanism of the psychoneuroses in the colored was a simpler affair than in the whites. Of the whole group, 84.5 Percent had been detected before the expiration of six months, leaving 15.5 Percent to break down when the situation became more acute, as it did in this country when overseas orders came.

TIME OF ONSET

Before entering the service 95.1 Percent of the cases had had symptoms of their disorder. (See Table 11.) In this respect there was practically no difference between the whites and the colored. Only 556 cases developed after entering the service. Of these, about half developed before the expiration of six months.

RECOMMENDATIONS FOR DISPOSITION

Nine thousand one hundred ninety-seven, or 80.4 Percent, of the cases were recommended for discharge-the smallest percentage for any one group. (See Table 12.) A comparatively large number were recommended for limited service, especially among the colored cases. Only 1.4 Percent were recommended for duty.

In the American Expeditionary Forces, the distribution percentage average of the psychoneuroses had increased. It became 30 Percent as compared with the mobilization distribution average of 16.5 Percent. After the war, when the patients had become beneficiaries of the Bureau of War Risk Insurance (March, 1921), the distribution average dropped to 20.2 Percent-lower than it was in France, but still higher than in the home camps. These distribution averages, shifting about in this manner under different circumstances, are quite in accord with the idea of the pscychoneurosis being a situation neurosis. The situation at home, acute enough as it was, and becoming worse as the war showed no signs of ending, became much more acute when the troops reached the country where the fighting was actually going on,


234

where many of them even had to engage in it. With the advent of peace some of these cases recovered, almost over night; most of them showed a steady improvement in all symptoms. In some of those left to be hospitalized by the Bureau of War Risk Insurance, the symptoms had doubtless become fairly well fixed, and others, in much the same way that litigants in personal injury suits maintain their symptoms, sought hospitalization for the purpose of being idle and to secure the compensation accruing to service disability.

DELINQUENCY

Of the misconduct cases, 66, or 4.4 Percent, of the total were cases of psychoneuroses. This number is 0.58 Percent of the total group of 11,443 cases-a percentage very low when compared with 5.1 Percent for the insane and 4.4 Percent for the constitutional psychopaths.

FAMILY HISTORY

Evidence in support of the theory that the psychoneuroses develop especially in neurotically predisposed individuals is shown in Tables 13 to 17. Of the ascertained cases, 57.7 Percent, with little difference between the white and colored, gave a family history of neurotic taint, being exceeded only by epilepsy, endocrine disturbances, and constitutional psychopathic states. In this respect the percentage for the psychoneuroses exceeded that for alcoholism and for drug addiction by about 17.

The psychoneuroses showed relatively the highest proportion of histories of family nervous diseases (37.5 Percent) and, after alcoholism, the largest proportion of mental deficiency (0.8 Percent). History of inebriety was also relatively low in these cases.

AGE

The psychoneuroses followed approximately the age distribution of the drafted men of the Army as far as the group between the ages of 25 and 29 years was concerned. (See Table 20.) They fell below the distribution in the 20-24 years' period and rose in the group over 29. This may be an indication of the psychoneuroses being somewhat more common among volunteers. The colored psychoneurotics inclined to younger age periods than the whites.

EDUCATION

The psychoneurotic group contained persons above the neuropsychiatric average of education (see Table 23), so far as high school and college are concerned. On the other hand, a relatively higher proportion of them had no schooling, than of the insane, neurological cases, constitutional psychopaths, endocrine cases, drug addiction, and inebriety.

ECONOMIC CONDITION

A larger percentage (17.7 Percent) of psychoneurotics were in comfortable circumstances (see Table 24) than any other group. This would indicate that nutrition and similar factors in the prevention of disease were less important in the psychoneuroses than in other neuropsychiatric conditions.


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