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Section II, Chapter XIV

Contents

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SECTION II.

CHAPTER XIV.

DIVISION OF NEUROLOGY AND PSYCHIATRY.

PRELIMINARY WORK.

The beginnings of what became the Division of Neurology and Psychiatry of the Surgeon General's Office were made in March, 1917, when three distinguished civilian neurologists a conferred with the Surgeon General with reference to the problem of nervous and mental diseases. Through the efforts of these specialists, with private financial support, and later with the assistance of the Rockefeller Foundation, inspections were made of the larger military hospitals at San Antonio and El Paso, Tex., and the United States Disciplinary Barracks at Fort Leavenworth, Kans., in order to determine the facilities of the Government with respect to mental and nervous diseases in the event of war. Upon the declaration of war the chairman of the National Committee for Mental Hygiene appointed a Committee on Furnishing Hospital Units for Nervous and Mental Disorders to the United States Government. The name was subsequently changed to War Work Committee. The activities of this committee continued throughout the war.            
           
First of all, on the authority of the Surgeon General,1 it set about recruitinga special personnel, circularizing the medical profession and special hospitals for this purpose. There were received in all 795 applications for commission in the Medical Reserve Corps. After considering the special fitness of the applicants the papers were forwarded to the Surgeon General's Office, with indications as to the aptitude of the candidates, and with recommendations as to rank, based on professional standing. 2 A total of 564 commissions were granted such applicants.

The committee also, in much the same manner, secured the names of nurses and attendants, and cooperated with the Surgeon General in regard to their induction into the service. It was from plans drawn by this committee that the type of neuropsychiatric pavilion for the camps was decided on.1

As the war proceeded, the committee continued to cooperate with the civil community. It assisted in making the arrangements by which recruits who became insane prior to or immediately after enlistment would be cared for by their own States, and prepared a classified list of State hospitals, showing their standards in reference to internes and care of patients.

ORGANIZATION OF DIVISION.       

As mobilization progressed the Surgeon General found it necessary to create in his office an administrative division for the conduct of this work. Accordingly, the Division of Neurology and Psychiatry was created.3

    a Dr. Stewart Patoin, of Princeton University; the I ate Dr. Pearce Bailey, of the Neurological Institute, New York City; and Dr. Thomas W. Salmon, medical director of the National Committee for Mental Hygiene.


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Prior to the organization of this division there was no neurological or psychiatric organization in the Office of the Surgeon General or in the Medical Department. The social and psychiatric department of the Fort Leavenworth Disciplinary Barracks had shown and was showing the value of psychiatry in relation to deliquency and disciplinary problems, 4 but no special examinations as to the mental fitness of volunteers had been made at recruit depots or recruit depot posts or of applicants for commission in the Regular Army. There was a small number of regular medical officers who were recognized as having a knowledge of psychiatry, obtained for the most part during detail at the Government Hospital for the Insane (St. Elizabeths Hospital, Washington, 1). C.).With the exception of the service at the Letterman General Hospital, however, the special equipment of these officers was utilized as it would have been had their professional leanings been in another direction. The creation of this division, therefore, began a new chapter in the history of the Medical Department. The functions of the division are shown in Chart XV.

Bulletin No. 4, W. 1)., February, 1918, covers the subject as follows: 5

Officers with special experience in nervous and mental diseases have been added to the Medical Department of the Army. Such officers are detailed at all base hospitals and with many divisions. Most base hospitals have also special nurses and therapeutic appliances for the care of nervous and mental diseases. The services of these officers and nurses are available, through their superior officers, for consultation in all matters pertaining to such diseases.

The first activities of the division consisted in classifying and "exempting"for special service the specialists whose applications were coming up daily in great numbers, in deciding upon assignments for them when commissioned, in recommending orders, and in attempting to coordinate its own activities, with those of other branches of the professional services.

With the reorganization of the Surgeon General's Office in the latter part of 1918, the Division of Neurology and Psychiatry ceased to exist as such, and became a section of medicine, under the direction and control of the chief of the Division of Internal Medicine. 6 (See Chart XXIV.)

PERSONNEL.

Four officers were always sufficient to administer the division and it was found possible to spare some of these from time to time to make consultation visits to hospitals and camps.

After the establishment of the Division of Neurology and Psychiatry, the War Work Committee in New York continued to forward applications of candidates for commission, but as the war proceeded the majority of such applications were passed upon directly in the Surgeon General's Office. Some officers who were already commissioned without being exempted for neuropsychiatry obtained special work in the field through their personal applications for trans-fer from other service; a few, too, requested transfer from neurology and psychiatry to other services. At first, many neurologists and psychiatrists hesitated about applying for commission at all for fear they would be detailed to other duties in the Army than those for which they were exclusively qualified. They were given such assurances as were possible under the circumstances, namely, that they would be used for work for which they were best fitted, and it was only under exceptional circumstances that they were detailed to other activities.


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Chart XV.–Division of Neurology and Psychiatry, Surgeon General’s Office, June, 1918.


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But, as was the case with other professional services, some who showed ability in administration were taken out of professional work for the purpose of acting as adjutants, mess officers, or in other nonprofessional capacity.

At the time of the creation of the division about 50 neuropsychiatric officers had been commissioned. Five months later there were 235, of whom16 were majors, 71 captains, and 149 lieutenants. At the time of the signing of the armistice there were 430 officers in this country and 263 overseas, making a total of 693. Of these there were 2 colonels, 2 lieutenant colonels, 84 majors,278 captains, and 307 lieutenants.7

At first great care was exercised in regard to the qualifications of physicians seeking commissions for the purpose of doing special neuropsychiatric work and for transfer thereto, for the latter estimates of qualifications were based, in the first place, on the recommendations of superior and commanding officers. When the pressure for specialists of this class became great, especially from France, the strictness in regard to qualifications was relaxed somewhat, and the average in professional excellence underwent a decline.

In general, the officers serving under this division were either psychiatrists or neurologists, although some few had been thoroughly educated in both branches. The psychiatrists were much more numerous and were drawn chiefly from the State hospitals.

The shortage of competent neuropsychiatrists for the Army brought to the attention of the division the marked defects in the educational opportunities for this important specialty. So far as psychiatry was concerned, few facilities had existed anywhere for the proper instruction of undergraduate students. A few clinical lectures were given, but the students were not afforded opportunity of sufficient practical work for these lectures to be of any great advantage to them. There were also few provisions for postgraduate instruction. Practically all the psychiatrists of the country were employees of State hospital systems and received their education through routine performance of their duties. Their experience was largely confined to institutional patients, and they had had little opportunity to observe the border-line cases, which, after all, constituted the real problem of the Army.

In neurology, educational conditions were no better. Practically the only clinical instruction that had been given was on out-patients. Bed services in connection with medical schools were practically unknown, and few hospitals had any bed set aside for neurological cases, and in few hospitals had neurologists ever had any real representation.

The Neurological Institute in New York received many students but had no amphitheater, and the teaching done there, while of high quality, was performed under the greatest difficulty. The enlisted personnel for nervous and mental cases was made up as far as possible from attendants who had had experience in State hospitals. They were assigned to neurology and psychiatry in some cases by orders, when already enlisted, and in others, by induction into the service, and were sent first, as far as possible, to a training camp. This special class was by no means sufficiently numerous to meet the demands, and was supplemented by men from the Medical Department at large. As few of these had had any special training, they were sent, when possible, for instruction to St. Elizabeths Hospital.


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The women nurses were also obtained in large part from State hospitals which had training schools, and became members of the Army Nurse Corps. Special women assistants, termed psychiatric aides,8 were taken into the Army after a course of training at Smith College.

The almost simultaneous opening of many camps in 1917 created so great a demand for neuropsychiatrists that it was rarely possible to send them to medical officers' training camps for preliminary military training. A few were ordered to these camps, and some officers detailed at these camps were accepted for neuropsychiatric service; but some neuropsychiatrists acquired their military knowledge by the actual performance of duty. It was found desirable, however, to provide additional professional instruction, and this instruction was generally furnished by the directors at special medical institutions at different points, the directors in question being commissioned or serving under contract and receiving the title of military director. 9 The military directors secured the collaboration of many other representative teachers of the vicinity, with the result that the courses provided the best special neuropsychiatric instruction ever given in America.b They were scheduled as of six weeks' duration, although not infrequently they were cut short by the pressing need for neuropsychiatric officers in the Army. Even when courses were not actually in progress there were usually some students left on special detail to profit from the usual clinical routine of the institution concerned. The course of study included lectures, clinics, demonstrations, and laboratory work. The fields covered were psychiatry, psychology, personality problems, serology, neurology, neuropathology, with collateral instruction in otology and ophthalmology. The student officers ordered to these schools were on duty status and between two and three hundred of them were given this opportunity of acquiring or perfecting neuropsychiatric knowledge.10

Interesting comments were submitted to the Surgeon General by the military directors. 10 From these it appeared that about 20 per cent of student officers could be considered, at the close of the instruction, as qualified in the specialty. The most promising students were neither the very recent graduates or the oldest men, but those who had been in active work for about 10 years. These latter showed the most energy and initiative and the keenest appreciation of the practical value of the opportunities offered them.

The courses, as a whole, set an example of how neuropsychiatry should be taught and how well it can be taught in this country. The many inquiries on the part of physicians who took the courses, as well as by those who did not, left no doubt as to the practical success attending postgraduate instruction of this kind. At the following places instruction was given: 10 Neurological Institute, New York City; Psychopathic Hospital, Boston, Mass.; Psychopathic Hospital, Ann Arbor, Mich.; St. Elizabeths Hospital, Washington, D. C.;Philadelphia General Hospital, Philadelphia, Pa.; Mendocino State Hospital,Talmage, Calif.; Phipps Clinic, Baltimore, Md.

The first assignments of commissioned personnel were made for the purpose of carrying on neuropsychiatric examinations in the new Army and to supply neurologists and psychiatrists to base and other hospitals. The attempt was also made to examine the National Guard in their armories before they

b For full details see volume on In truction and Training.


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went to the camps, but this was successful in but few instances because of the great confusion which existed in all branches of the service at the time. Examiners were sent later to all recruit depots.

Perhaps the most important piece of intensive work done at this time was the examination of candidate officers at the officers' training camps. It was not possible to send examiners to many of the first training camps, which closed August 1, 1917, although excellent pioneer work was done then at Fort Myer. At the second camps valuable service was rendered by specially selected contract surgeons.

In January, 1918, on the recommendation of the Division of Neurology and Psychiatry, the War Department created the position of division psychiatrist, with the rank of major, one for each tactical division. 11 The creation of this office, which was the first recognition in the Army Tables of Organization of the utility of specialists for troops in the field, proved of the utmost importance. These positions were filled as fast as divisions were formed. The official detail of each of these officers was to one of the field hospitals of the division concerned, but they were generally given desks in the office of the division surgeons, from which points they could operate most effectively. Being with and a part of a tactical division, they were able to exercise the preventive side of their specialty to the utmost advantage. It was their duty to keep in touch with the mental health of the command and to familiarize medical officers serving with sanitary troops with neurologic and psychiatric methods. During the training period they were available for all special examining boards, and they asked for the assignment of regimental surgeons to assist in the neuropsychiatric examinations of recruits. They supervised the preparation of special reports to the Surgeon General and saw to it that the recommendations of the neuropsychiatric examiners were promptly prepared for forwarding to general disability boards. They visited the regimental infirmaries and held informal conferences, from time to time, with regimental surgeons and com- pany commanders. They were generally available for consultation and established a satisfactory cooperation with judge advocates, by means of which the mental state of prisoners was established as a factor in their delinquency. Reports of the functioning of these officers overseas indicate that they assisted materially in maintaining the integrity of the commands to which they were attached and expedited the elimination of the unit. 2 Without them the prompt treatment of functional nervous disorders in the hospitals attached to the fighting armies, which practically eliminated "shell shock" as a military problem in our troops, would not have been possible.

As soon as circumstances demanded neuropsychiatric officers were assigned to the office of the surgeons of the ports of embarkation.

By December, 1917, it was realized in the office of the Chief Surgeon, American Expeditionary Forces, that the number of troops then in France, many of whom had sailed before the neuropsychiatric examinations had begun, rendered imperative the services of a director for nervous and mental diseases. Consequently, a neuropsychiatrist was ordered overseas as a casual, with recommendation, which was complied with on his arrival.13 After that assign- ments for service with the American Expeditionary Forces became increasingly frequent, being made to overseas base hospitals, evacuation hospitals, special


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hospital No. 117 for war neuroses, and as casuals and replacements.14 Some younger officers were assigned to the liaison officer in London for the purpose of studying the methods of management of the war neuroses in the English military hospitals.

In July, 1918, the Chief of the Division of Neurology and Psychiatry was ordered overseas for the purpose of observing methods pursued there. A trip of three months gave him a better understanding of the care, management, and prevention of the nervous and mental casualties of the war, and enabled him on his return to cooperate more successfully with the American Expeditionary Forces.

NEUROSURGICAL SERVICE.

In the winter of 1918-19 officers specially experienced in organic neurology were ordered to certain of the general hospitals with the recommendation to the commanding officer that they be assigned to the surgical service. 15 This recommendation was necessary because organic injuries of the nervous system, although most of them had ceased to be surgical, were treated in the surgical services. That this great mass of neurological material, approximately5,000 cases, should have been retained under surgical control was not an altogether happy clinical arrangement, from the standpoint of the division, but it was inevitable in view of the circumstances.

The whole question of the proper organization for the care of this class of cases is so important to a modern military medical department that it is discussed here in some detail.

The attitude of the division in the matter will now be explained:

Battle injuries of the nervous system are primarily surgical, being associated not only with open wounds but also with fractures. The best clinical arrangement for this whole class of injuries at the front is in surgical hospitals which are staffed as far as possible with the neurosurgeons and neurologists. If neurosurgeons can not be supplied in sufficient numbers, the cases must be treated at the front by general surgeons. With the healing of the original wound the injury changes its type in the majority of cases. There are some cases which when they reach the hospitals in the zone, of the interior still require operation, but these cases are in the great minority. At this stage the spinal-cord injuries are hardly operable, some of the brain cases require secondary operations, and perhaps 15 per cent of the peripheral nerve palsies require surgical interference. But, with these exceptions, after the original would has healed, the majority have changed their clinical status, and, though primarily surgical, now actually present problems with which a medical officer who is a neurologist by experience and interest is best fitted to deal. Those who have sustained cerebral injuries have been left irritable and subject to various symptoms, which makes personality study necessary before they can be readjusted to civil life; and the cases of peripheral nerve injuries which give promise of spontaneous repair require exact diagnosis and treatment.

Thus, at the close of the surgical wound period, injuries of the nervous system become, as a class, neurological cases. But a change in the specialist in charge of this class of cases would have been difficult to recognize administratively. It was not done in the British medical service and it would have been


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impossible under the organization which obtained in our Medical Department. The original plan as devised in the Surgeon General's Office was that all these cases would be cared for in the United States in one or more special hospitals, under the Brain Section of the Division of Head Surgery.16 But when these cases began to be returned in so much greater numbers than had been anticipated, it was found that the provisions for their care in the special hospitals established for the purpose at Cape May and Colonia, N. J., were inadequate both as to the number of beds and as to qualified personnel. And, in addition, it was found that civil interests demanded a wider distribution than had been provided for. These patients, like most others, wanted to be somewhere near their homes. It accordingly became necessary to increase the hospitals designated for their special care. More than a dozen, geographically well separated, general hospitals were therefore designated for patients of this class on their arrival from overseas, the choice of the particular hospital being made with reference to nearness to the patient's home.18 The Division of Head Surgery, having so many of its officers overseas, could not expand its personnel to meet this situation, and as there was no special neurological service in the hospital organization of the Medical Department, the patients automatically fell to the Division of General Surgery, to which were assigned such neurologists and neurosurgeons as were available.

CONSULTANTS.

No authority was vested in the officers of this division, except on occasions of special detail, to make inspections, as all inspection duties were performed by officers of the Division of Sanitation, Surgeon General's Office (q. v.). Certain special inspections were actually made by members of this division, however; these were classed as consultations in reference to professional work. Some of the professional divisions of the Surgeon General's Office appointed officers known as consultants, who were assigned to different geographical regions for the purpose of consulting therein.17 This plan was not adopted by the Division of Neuropsychiatry for the reason that it was always possible to secure War Department orders designating an individual officer as a consultant, and it was deemed wiser and less expensive to use different officers for this purpose as the occasions arose. For example, when an officer assigned to some particular post developed a particularly successful system of treatment or management of patients or for making examinations, permission for his temporary relief was obtained from his commanding officer, and he was sent to posts in his neighborhood to consult with neuropsychiatric officers there, in order that they might benefit by whatever he had to tell them. Contract surgeons also were appointed for consulting purposes when they had special knowledge that would prove useful to neuropsychiatric officers on duty in their neighborhood. Practically all the officers detailed to this division, Surgeon General's Office, were ordered from time to time to make trips embracing special hospitals or camps for the purpose of ascertaining whether a more or less uniform and standard of performance of duty was being maintained. Consultations in Cali- ifornia were made by a member of the staff of Mendocino State Hospital.18 This method of consultation in professional matters proved highly successful. Visits from outside officers to officers working at another point invariably


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resulted in an increase of local interest, in the removal of any obstacles that may have existed, and in raising the standard of professional work.

REPORTS AND STATISTICS.

In order to secure uniformity in the reporting of neurological and psychiatrical cases, the specialists of the division were required to submit their reports on Forms 89, 90, and 91, Medical Department, which were especially prepared for the purpose. 19 These forms were devised and the system of reporting the cases was installed by the statistician of the New York Hospital Commission, who was loaned to the Surgeon General by the New York State Hospital Commission.

Form 89 gave the record of the neurological and psychiatrical examination, and contained instructions which, if followed in sequence, should have insured a systematic clinical history with all observations recorded in a uniform form and order. Form 90, the statistical data card, supplemented the medical history with statistical information of great social value. The data recorded on this form proved most useful for wide application, because the form was prepared so that nothing more than the underscoring or the writing of a few words was necessary for recording the data. Each officer concerned first submitted to the division a form which he had filled in; this was corrected and returned to him-a provision which insured the accuracy and uniformity regarding the data. Form 91, embodying a monthly summary of the work at the particular station, accompanied the monthly report which was required.

Mimeographic instructions relative to the preparation of the forms were mailed to each officer concerned at his first post of duty.20 They embodied a classification of the nervous and mental diseases, each case reported to be placed with appropriate specific designation under one of the general heads.

The special forms were returned to the Division of Neurology and Psychiatry through the camp surgeons, commanding officers of base hospitals, and post and department surgeons, as the case might be. They embraced camps, cantonment base hospitals, recruit depots, disciplinary barracks, general and post hospitals, and aviation fields. All reports of cases were filed temporarily in the office of the Division of Neurology and Psychiatry in alphabetical order.

The records of the cases (Form 89) were of immediate practical assistance to the medical officers on duty in the office of the Surgeon General in rendering opinions on special cases which were constantly being referred for comment by The Adjutant General of the Army, the Bureau of War Risk Insurance, and by Members of Congress. They further made it possible for The Adjutant General to furnish the States with information concerning the nervous and mental conditions of rejected recruits and discharged soldiers who required State care; an opportunity of which many States availed themselves.

In most instances the information recorded on the special forms was more definite and complete than that contained in the general medical records of the War Department. It will doubtless prove, in the future, of assistance in the detection of fraudulent claims against the Government and in settling controversies arising from disputed diagnoses.

In addition to the medical and statistical importance of the records which have now been explained in detail, they enabled the division to keep in close


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contact with the work being done in the field and to arrive at conclusions and form opinions as to the quality and amount of work done by officers there. The character of the reports and the promptness and manner in which they were rendered the division assisted in computing the ratings which formed the basis of promotion for these officers. It might seem at first that these forms, which were supplemental to those which were still required by the War Department, would have been regarded as an additional burden and would have been made out unwillingly. Such, however, was not the case. The officers concerned seldom complained of having to render Forms 89 and 90; on the contrary, many expressed satisfaction at thus being kept in professional touch with the central agency particularly interested in their work. The special forms also showed the division where the services of specialists were most needed; this was useful information, as the demand for services of this character always exceeded the supply.

Assistance was rendered the division in the examination of its various statistical data by the National Research Council, which furnished the services of a doctor for this purpose. Information of general value resulted from his researches, especially as concerns the statistical usefulness of clinical histories of the type collected. For example, he ascertained how difficult it was to assure the compliance of examiners with instructions as outlined in Form 89 and how rare it was for examiners to make complete examinations. He arranged a group of 76 examiners, which contained 16 majors and 25 captains, and of this group only one-third could be considered as having made and recorded satisfactory examinations. The others failed to follow the order of the instructions and left many points untouched. This led to the conclusion by the division that statistically clinical histories made under the plan allotted are of value only when they have been rigidly supervised and continuously checked up during the making, something that it was impossible to do with the large numbers involved. They otherwise would represent such an inchoate mass of incomplete and poorly assorted material as to be not worth the effort and expense involved in having them studied by experts. It was actually found that it would take an expert two years merely to read the histories recorded on Form 89, whereas the information on Form 90 was invariable and not only could be recorded rapidly but also could be rapidly reduced to statistical form.

PERSONNEL. b

(April, 1917, to December, 1919.)

Bailey, Pearce, Col., M. C., chief.

Woodson, T. D., Lieut. Col., M. C., chief.

Williams, Frankwood E., Maj., M. C., chief.

Salmon, Thomas W., Col., M. C.

Brown, Sanger, II, Lieut. Col., M. C.

King, Edgar, Lieut. Col., M. C.

Adler, Herman, Maj., M. C.

    b In this list have been included the names of those who at onetime or another were assigned to the division during the period, April 6, 1917, to December 31,1919.

There are two primary groups--the chiefs of the division and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.


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Hutchings, Richard H., Maj., M. C.

Boring, E. G., Capt., S. C.

Haber, Roy, Capt., S. C.

Kinney, Kenneth W., Capt., M. C.

Sandy, W. C., Capt., M. C.

Pollock, H. M., First Lieut., S. C.

REFERENCES.

(l) Correspondence. On file, Record Room, S. G. O., 169005 and 183231 (Old Files).

(2) Letter from the Surgeon General of the Army to the National Committee for Mental Hygiene, June 11, 1917. Subject: Applications of Psychiatrists for the Reserve Corps. On file, Record Room, S. G. O., 169005 (Old Files).

(3) S. O. No. 166, W. D., July 19, 1917, par. 137. Annual Report of the Surgeon General of the Army, 1919, Vol. II, 1079.

(4) Correspondence. On file, Record Room, S. G. O., 198175 (Psychiatric Examinations) (Old Files); and 730 (Neuropsychiatry), U. S. Disciplinary Barracks, Fort Leavenworth (N).

(5) Bull, No. 4, W. D., February 7, 1918, par. 5.

(6) Office Order No. 97, S. G. O., November 30, 1918. On file, Record Room, S. G. O., 024.17. (Section of Neuropsychiatry.)

(7) Semiannual report, Division of Neurology and Psychiatry, January 2, 1918. On file, Record Room, S. G. O., Weekly Report File.

(8) Assignment psychiatric aides. On file, Record Room, S. G. O., 231 (Reconstruction Aides). (9) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1079.

(10) Semiannual report, Division of Neurology and Psychiatry, January 2, 1918. On file, Record Room, S. G. O., Weekly Report File. Correspondence. On file, Record Room, S. G. O., 3.53 (Training Neuropsychiatrists) (Boston, Mass., New York City, N. Y., Philadelphia, Pa., Baltimore, Md., Washington, D. C., Ann Arbor, Mich., Talmage, Calif.) (F).

(11 ) Letter from The Adjutant General to the Surgeon General of the Army, January 12, 1918. Subject: Assignment of Neurologists to Tactical Divisions. On file, Record Room, S. G. O., 210.3 (Assignment).

(12) Annual Report of the Surgeon General, United States Army, 1918, 372.

(13) Confidential Order No. 128, W. D., November 22, 1917, detailing Maj. Thomas W. Salmon, M. R. C., to duty overseas. On file Personnel Division, S. G. O. (Personal Report File).

(14) Report of the consultant in psychiatry to the chief surgeon, A. E. F., by Col. Thomas W. Salmon, M. C. On file, Historical Division, S. G. O.

(15) Correspondence. On file, Record Room, S. G. O., 210. 31-1 (Neuropsychiatry) Assignments.

(16. Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1095 and 10 6.

(17) Memo. from Brig. Gen. T. C. Lyster to the Surgeon General, August 28, 1918. Subject: Consultants. Approved by the Surgeon General. On file, Record Room, S. G. O., 211 (Consultants).

(18) S. O. No. 214, W. D., October 16, 1917, par. 59, and S. 0. No. 58, W. D., March 11, 1918, par. 47, detailing Contract Surg. Robert L. Richards to duty as consultant in Neuropsychiatry.

(19) Form 89, Records of Neurological and Psychiatric Examinations; Form 90, Statistical Data Card; Form 91, Report of Completed Neurological and Psychiatric Examinations. Copies on file, Record Room, S. G. O., 702.3 (Neuropsychiatry).

(20) Instructions to Examiners in Neurology and Psychiatry relative to the Preparation of Statistical Data. On file, Record Room, S. G. O., 702.3 (Neuropsychiatry) 1917.