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Section II, Chapter VII

Table of Contents

CHAPTER VII

IN THE ARMY OF OCCUPATION

Provisions were made at the very outset for a highly organized medical service of the army of occupation. In so far as the neuropsychiatric service is concerned, the division psychiatrist of the 42d Division, who had been consultant in neuropsychiatry for the First Corps, was assigned to duty as consultant in neuropsychiatry for the new army. Each division was already provided with a divisional psychiatrist. In some cases these officers joined their divisions at the time of the organization of the Third Army, others had served with their divisions during the period of active hostilities, were thoroughly familiar with their duties, understood conditions of actual warfare, and had established themselves in the esteem and respect of their officers and associates.

The officers and men of the Third Army had just come from the severest kind of fighting. Many of them were suffering (without fully appreciating it) from the effects of fatigue and prolonged emotional excitement. Their new duties were to be of a type decidedly different from their recent ones in active warfare; and although it was considered by every soldier an honor to become a unit in the army of occupation, there was, nevertheless, not a little feeling of envy and regret as they reflected that long after other divisions would have returned to their homes those constituting the Third Army would remain on duty on foreign soil. Favorable as living conditions were when compared with those in the field, still, new adaptations would be required, some of which might be rather difficult. In other respects the army of occupation constituted a miniature American Expeditionary Force and many of its medical problems were similar to those of the larger American Expeditionary Forces during the latter part of 1917 and the early months of 1918.

Under these conditions it was deemed wise to organize a neuropsychiatric service in the Third Army, at the earliest possible moment, capable of giving immediate and efficient treatment to officers and men suffering from mental and nervous disorders, of furnishing the divisions with a medical service for diagnosing and eliminating men likely to become useless for military service, and of providing adequate care for the evacuation to the United States of men not likely to be returned to duty after a period of hospital treatment. A hospital service of specialists was to be established in order to be prepared to meet these problems as they arose.

The task of organizing a neuropsychiatric service in the Third Army was assigned to the senior consultant in neuropsychiatry by the chief surgeon of the army. Certain officers, experienced in dealing with neuropsychiatric problems, were ordered to report for duty in the Third Army. With this personnel the consultant in neuropsychiatry for the Third Army organized his special service.

aThe statements of fact appearing herein are based on a report of the activities of the neuropsychiatric service, Third Army, made by Maj. S. W. Hamilton, M. C., consultant in neuropsychiatry, Third Army. On file, Historical Division, S. G. O.


424

NEUROPSYCHIATRIC ORGANIZATIONS IN GERMANY

During the period of advance into German territory only the field hospitals were available for the care of the sick. These hospitals evacuated their cases largely to Commercey, where there were two base hospitals (one with a neuropsychiatric ward), and to Souilly, where three evacuation hospitals still remained. Division psychiatrists examined patients coming under their observation during this period, but the number was very small. As soon as the troops arrived in the areas which they were to occupy psychiatric clinics were established at Coblenz and Trier. These were known, respectively, as Neuropsychiatric Unit No. 1, Evacuation Hospital No. 14, at Coblenz, and Neuropsychiatric Unit No. 12, at Trier. At Coblenz a fine private hospital conducted by a male religious order had the best available facilities for such a service and was requisitioned by the army. Although this building constituted a separate unit physically, it was attached administratively to Evacuation Hospital No. 14 and later to Evacuation Hospital No. 16. That part of it devoted to the care of mental and nervous patients was known as Neuropsychiatric Unit No. 1. It was opened on December 26, 1918. The building was an excellent three-story and basement structure of brick and stone about 20 years old but in a fine state of repair. The rooms and wards varied in capacity from 2 to 12 beds, making proper classification of patients easy. The special equipment of the hospital included a good hydrotherapeutic plant, a fair Zander installation for mechanotherapy, and a gymnasium which was converted into an excellent shop for occupational therapy. The hospital building, in addition to the psychiatric service, conducted a general medical service. Sometimes the admissions were so numerous that the neuropsychiatric patients overflowed into the general medical wards.

The buildings of Neuropsychiatric Unit No. 2 were barracks with a capacity of 1,500 which had been used previously by the Germans for hospital purposes. The neuropsychiatric service opened on the third floor of Building V, December 24, 1918. On January 22, the service was moved to Building III where special preparations had been made for the reception of nervous and mental cases. The first floor was used for neurological cases and the milder mental disorders. Quarters for the more serious psychoses were on the second floor. There were 57 beds and the construction of the building was such that the proper classification of cases was an easy matter. A room was set apart for hydrotherapy. This center received all neurological and mental cases originating in the military area around Treves. Early in April, 1919, it began to receive patients from the organizations farther south in the Luxembourg district, which formerly had evacuated their cases of mental and nervous diseases to our hospitals in France. Patients were received also by transfer from the more congested service established in Evacuation Hospital No. 14 (later Evacuation Hospital No. 16) at Coblenz.

With 40 beds at Coblenz and 57 at Trier, the army of occupation had facilities for the reception, observation, and treatment of neuropsychiatric patients in the proportion of about 1 bed to 2,500 enlisted strength. In an American city approximately 60 per cent of the total population are adults. Not only was the proportion of beds available for neuropsychiatric patients


425

in the army of occupation greater than that which was provided at that time in the most advanced communities at home, but the personnel, medical officers, nurses, reconstruction aides, and enlisted men were very much above the average.

The neuropsychiatric unit at Evacuation Hospital No. 12, at Trier, received 249 patients during the period between December 24, 1918, and April 22, 1919, or about 4 per cent of the total number of admissions to this hospital. Of this number, 198 had mental disorders or were admitted for mental observation, and 51 showed symptoms of a neurological nature. One hundred and eighty-three patients, or 77 per cent of the total, were evacuated to base hospitals in France, and 37, or 16 per cent, were returned to duty. There were two deaths. The mental cases received included a comparatively small number of severe psychoses. The greater number had less serious mental disorders. The majority were cases of psychoneurosis. A systematic effort to eliminate mental defectives from the divisions constituting the army of occupation led also to the admission of a considerable number of such cases.

The operations of the neuropsychiatric service at Coblenz were more active than those of the above unit, since the hospital was more conveniently placed as far as transportation was concerned.

During the winter, the hospital services were very busy; in March a decline in admission rate began. The following table shows the number of patients received in both centers from December, 1918, to June, 1919, inclusive:

December

January

February

March

April

May

June

Total

Psychopathic cases:

Coblenz

24

106

174

201

159

115

73

852

Trier

16

50

34

21

21

23

9

170

36

156

208

222

180

138

82

1,022

Neurological cases:

Coblenz

11

31

39

35

24

24

9

173

Trier

1

26

21

14

19

7

3

91

12

57

60

49

43

31

12

264


These cases were grouped with respect to diagnosis as follows:

Psychiatric:

Defect and psychopathy

376

Psychoneurosis

263

Psychosis

190

Epilepsy

65

Alcoholism and drug states

69

Miscellaneous mental problems

59

1,022

Neurological:

Cerebrospinal syphilis (excluding dementia paralytica)

23

Paralysis

33

Neuritis

38

Neuralgia

27

Brain tumor

4

Miscellaneous problems of neurology and internal medicine

139

264



426

A few points concerning the mental group are noteworthy. The misfits-defectives and psychopaths-came to the hospitals in highest proportion in February and March. This was due to the attempted elimination of all but class A men from the army. Had not many been evacuated through other than hospital channels (replacement depots) the figures would be even higher. Most epileptics appeared in January and March. Psychoses almost held their incidence, and alcoholic states increased. Syphilis furnished 2.2 per cent of all our cases.

December

January

February

March

April

May

June

Defect and psychopathy

7

54

113

81

68

40

13

Epilepsy

4

17

7

18

10

7

2

Psychosis

13

23

28

35

30

28

27

Alcoholism and drug states

2

6

16

9

8

13

15


From the beginning it was the aim of officers in charge of these neuropsychiatric centers to have them serve as more than mere reception and clearing houses. Every effort was made to employ the therapeutic measures available in the best conducted hospitals in the United States. For the treatment of neurological patients, massage, baths, electrical and Zander apparatus were available. For mental cases, reliance was placed first upon individual treatment by the trained medical and nursing personnel. In the Coblenz center, there were 18 and in the Trier center 6 enlisted men who either had had nursing experience in State hospitals at home for several years or else had received previous training in the Army and were selected because of their special qualifications. Likewise, the nurses were chosen with reference to their previous experience and personal qualifications. Much use was made of the hydrotherapeutic apparatus at the hospital at Coblenz and at Trier; a special bathtub was always available for excited or agitated patients. Excellent laboratory facilities were available and in constant use.

A development of special importance both at Coblenz and at Trier was occupational therapy. This was started at Neuropsychiatric Unit No. 1, in a small room, by the commanding officer, with the aid of one enlisted man. A few weeks later three reconstruction aides who had been sent to the American Expeditionary Forces for work with neuropsychiatric patients were on duty at each center. Shops were finally established in commodious quarters and during working hours a very large proportion of the patients under treatment were assigned there. For patients who were physically infirm, or who were in an uncertain mental state, and so unable to go to the shop, occupational work was provided in the ward, and if necessary at the bedside of the patient. Valuable assistance was given by the orthopedic department in getting supplies for the occupational therapy department. Work with wood, brass, and copper was provided and all sorts of interesting and useful things were made. Other materials were used, for example, rings were made from silver, bags from leather or beadwork. Likewise, drawing and painting, braiding, and similar crafts were taught.

The dissolution of the Third Army on July 2, 1919, found the number of troops in Germany already much decreased. Further embarkations of troops


427

going home occurred at frequent intervals. On July 15, Neuropsychiatric Unit No. 2, at Trier, was closed; Neuropsychiatric Unit No. 1, at Coblenz, was transferred to Evacuation Hospital No. 49 temporarily. On July 28, Neuropsychiatric Unit No. 1 was moved to its permanent quarters in what had been the garrison hospital of Coblenz but which was then Evacuation Hospital No. 27. The service was located in a building equipped with excellent hydrotherapeutic and electrotherapeutic installations. Some confusion was caused by the fact that all the trained enlisted men were released shortly afterwards, before recruits could be placed under training. In consequence the neuropsychiatric medical officers for a time were handicapped in their work.

ACTIVITIES IN ARMY, CORPS AND DIVISIONS

With the cessation of hostilities, new problems replaced those of controlling war neuroses; for example, medico-legal activities now became, in a large way, a psychiatric problem. Many men had been placed under arrest during the few months preceding the armistice, charged with different types of military offenses, but had not been brought to trial during active operations. In consequence the judge advocate's department was exceedingly busy during the early part of the period of occupation in disposing of these men. In some divisions it was the custom of the judge advocate to request a mental examination of prisoners accused of any serious crime. In others, such an examination was requested only if circumstances connected with the offense, or a rough estimate of the mentality of the prisoner, indicated the possible presence of an abnormal mental condition. In still other divisions, such examinations were not employed unless mental unsoundness had been definitely advanced in defense of the prisoner.

On January 11, 1919, an order was issued by general headquarters, Third Army, for the appointment of boards in all organizations of that army to pass upon and eliminate all soldiers physically or mentally unfit. Division psychiatrists were made members of such boards. Patients from organizations other than divisions were referred to the army consultant, if of neurological or psychiatric importance. The policy of the different divisions as to the elimination of men differed somewhat. A division soon to return to the United States referred fewer of its personnel than a division which had to remain in Germany for several months. Cases so referred were considered by the division psychiatrists and their opinions of men alleged to be mentally unfit were seldom challenged. In most cases the recommendations were for the evacuation of men found to be mentally defective, of marked psychopathic tendencies, or suffering from psychotic or psychoneurotic reactions. Such men were transferred to the neuropsychiatric centers at Coblenz and Trier and thence to base hospitals in France. This process was not intended to obstruct the evacuation of neuropsychiatric cases through hospital channels and did not.


428

CLINICAL OBSERVATIONS

The following table gives an idea of the distribution of diseases among the 1,286 patients received at the centers at Coblenz and Trier:

Psychopathic cases:

Mental deficiency and psychoses 

566

Psychoneuroses

263

Epilepsy

65

Alcoholism and drug addiction

69

Psychiatric conditions not involving definite disorders

59

Total

1,022

Neurological cases:

Cerebrospinal syphilis (exclusive of general paresis)

25

Paralysis

33

Neuritis

38

Neuralgia

27

Brain tumor

4

Miscellaneous neurological and internal medical conditions

139

Total

264


The largest proportion of patients with mental deficiency and constitutional psychopathic states came to the hospital in February and March due to the efforts to eliminate unsuitable men referred to above. Had many of these men not been evacuated through other channels the admissions at Coblenz and Trier would have been considerably higher. It is noteworthy that during a period of seven months a military population which averaged approximately 200,000 officers and men contributed 5 psychopathic patients and 1.5 neurological patients per 1,000 strength.

The results obtained with many of the cases treated were excellent. Although the number returned to duty was small this is because it seemed expedient, even after recovery, especially in the case of the lighter depressions, not to return a soldier to duty again. Such cases were almost invariably sent to France to be returned to the United States. In many cases the course of the disease was very favorably influenced by the possibility of early treatment. It is doubtful whether mental cases which occurred in any similar population have ever been received so quickly and with so little legal or administrative formality as they were in these neuropsychiatric units of the army of occupation.

The number of suicides that occurred in the army of occupation was very small. Not one of these suicides occurred in a patient who was under observation for mental disorders or in the wards at neuropsychiatric centers. This result is significant, because of the fact that at all times among these patients and in the wards states of depression were more frequently seen than any other psychotic manifestations.

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