Books and Documents

The
MEDICAL DEPARTMENT
OF THE UNITED STATES ARMY
IN THE WORLD WAR

VOLUME X
NEUROPSYCHIATRY

IN THE UNITED STATES
BY
COL. PEARCE BAILEY, M. C.
LIEUT. COL. FRANKWOOD E. WILLIAMS, M. C.
SERGT. PAUL O. KOMORA, M. D.

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IN THE AMERICAN EXPEDITIONARY FORCES

BY

COL. THOMAS W. SALMON, M. C.
SERGT. NORMAN FENTON, M. D.

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PREPARED UNDER THE DIRECTION OF
MAJ. GEN. M. W. IRELAND

The Surgeon General

WASHINGTON : U. S. GOVERNMENT PRINTING OFFICE :1929

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TABLE OF CONTENTS

PREFACE. 
    By Col. Thomas W. Salmon, M. C., and Lieut. Col. Frankwood E.Williams, M. C.

SECTION I.-IN THE UNITED STATES

INTRODUCTION.
    By Lieut. Col. Frankwood E. Williams, M. C.

CHAPTER: 

I. Organization.
        By Col. Pearce Bailey, M. C., Lieut.Col. Frankwood E. Williams, M. C., and Sergt. Paul O.Komora, M. D.

II. Personnel.
        By Lieut. Col. Frankwood E. Williams,M. C., and Sergt. Paul O. Komora, M. D.

III. Provisions forcare of mental and nervous cases.
        By Col. Pearce Bailey,M. C.

IV. Detection and elimination of individuals with nervous ormental diseases.
        By Col. Pearce Bailey, M. C.

V. Observation and treatment.
        By Lieut. Col. Frankwood E. Williams,M. C.

VI. Delinquency.
        By Lieut. Col. Frankwood E. Williams,M. C.

VII. Disposition of mental cases.
        By Lieut. Col.Frankwood E. Williams, M. C.

VIII. Occurrence of neuropsychiatric diseases in the Army.
        By Col. PearceBailey, M. C., and Capt. Roy Haber, S. C.

IX. Analysis of special neuropsychiatric reports.  
        By Col. Pearce Bailey, M.C., and Capt. Roy Haber, S. C.

Section 1
Section 2
Section 3

LIST OF TABLES

Table:

1. Neuropsychiatric diseases. Admissions, officers andenlisted men (except native troops), in the United Statesand Europe (except North Russia), April 1, 1917, toDecember 31, 1919. Absolute numbers.

2. Neuropsychiatric diseases. Admissions, officers andenlisted men (except native troops), in the United Statesand Europe (except North Russia), April 1, 1917, toDecember 31, 1919. Rates per 1,000 per annum.

3. Neuropsychiatric diseases. Discharges for disability,officers and enlisted men (except native troops), in theUnited States and Europe (except North Russia), April 1,1917, to December 31, 1919. Absolute numbers.

4. Neuropsychiatric diseases. Discharges for disability,officers and enlisted men (except native troops), in theUnited States and Europe (except North Russia), April 1,1917, to December 31, 1919. Rates per 1,000 per annum.

5. Neuropsychiatric defects noted in the total number of menrejected (549,099) by local boards in the differentStates.

6. Diagnoses of nervous and mental diseases and defects amongcommissioned officers, candidates for commission, and enlisted men.

7. Neuropsychiatric cases found among volunteers at recruitdepots, and drafted men, by clinical groups.

8. Methods of discovering neuropsychiatric cases.

9. Delinquency cases in each clinical group.

10. Length of service of neuropsychiatric cases, prior todiscovery.

11. Time of onset of neuropsychiatric disorders-line ofduty.

12. Recommendations and final disposition of neuropsychiatriccases.

13. Neuropsychiatric cases giving a family history of nervousdisease, mental disease, inebriety, or mental deficiency.

14. Neuropsychiatric cases giving a family history of nervousdisease.

15. Neuropsychiatric cases giving a family history of mentaldisease.

16. Neuropsychiatric cases giving a family history ofinebriety.

17. Neuropsychiatric cases giving a family history of mentaldeficiency.

18. Neuropsychiatric cases giving a family history ofneuropathic taint. Percentage distribution.

19. Family history of principal neuropathic taints amongneuropsychiatric cases.

20. Ages of neuropsychiatric cases.

21. Ages of neuropsychiatric cases. Percentage distribution.

22. Schooling of 80,000 soldiers as determined bypsychological examinations.

23. Schooling of neuropsychiatric cases.

24. Economic condition of neuropsychiatric cases.

25. Neuropsychiatric cases admitting and denying venerealinfection previous to entering the Army.

26. Habits of neuropsychiatric cases as to alcohol.

27. Marital status of neuropsychiatric cases.

28. Home environment of neuropsychiatric cases.

29. State of residence of neuropsychiatric cases.

30. State of birth of neuropsychiatric cases.

31. Gain or loss of neuropsychiatric cases resulting fromimmigration or migration.

32. Races of neuropsychiatric cases.

33. Per cent distribution of neuropsychiatric conditions amongfour different races, with comparisons between theAmerican born and the foreign born.

34. Races of neuropsychiatric cases. Classificationpercentage.

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

36. Classification of family neuropathic taints among mentaldefectives, according to disorder and relatives.

37. State of residence of mental defectives. Percentages.

38. Per cent distribution of neuropsychiatric conditions in 19States in which the rates for mental deficiency exceededthe United States rate of 29.2 per cent.

39. Per cent distribution of neuropsychiatric conditions amongsix races in which the mental deficiency rate exceeded theUnited States mental deficiency white rate of 29.2 percent.

40. Per cent distribution of neuropsychiatric conditions in 24States in which the rate for psychoneuroses exceeded theUnited States rate of 17 per cent.

41. State of residence of cases of psychoses.

42. Per cent distribution of neuropsychiatric conditions in 21States in which the rate for psychoses exceeded the UnitedStates rate of 12.1 per cent.

43. Nine races in which the distribution rate for psychosesexceeded the United States white rate of 12.1 per cent.

44. Per cent distribution of neuropsychiatric conditions in 21States in which the rate for epilepsy exceeded the UnitedStates rate of 8.6 per cent.

45. Per cent distribution of neuropsychiatric conditions in 18States in which the rate for constitutional psychopathicstates exceeded the United States rate of 9.7 per cent.

46. Per cent distribution of neuropsychiatric conditions in 17States in which the rate for endocrinopathies exceeded theUnited States rate of 7.4 per cent.

47. Family history of neuropathic taints among cases of drugaddiction.

48. Classification of family neuropathic taints among cases ofdrug addiction according to disorder and relatives.

49. State of residence of cases of drug addiction.

50. Per cent distribution of neuropsychiatric conditions in 12States in which the rate for drug addiction exceeded theUnited States rate of 3 per cent.

51. Per cent distribution of neuropsychiatric conditions in 17States in which the rate for alcoholism, includingalcoholic psychoses, exceeded the United States rate of3.5 per cent.

LIST OF CHARTS

CHART:

I. Diagnoses of neuropsychiatric cases (home forces).

II. Ratio of neuropsychiatric cases found among volunteers anddrafted men examined byneuropsychiatrists.

III. Number of neuropsychiatric cases discovered by differentmethods.

IV. Diagnoses of disciplinary cases reported byneuropsychiatrists.

V. Length of service of 66,759 neuropsychiatric cases (homeforces).

VI. Time of onset of disease before entering service.

VII. Recommendations and final dispositions ofneuropsychiatric cases.

VIII. Family history of 60,410 neuropsychiatric cases.

IX. Age groups of 67,569 neuropsychiatric cases.

X. Schooling of neuropsychiatric cases, compared with that ofother soldiers.

XI. Economic condition of 65,716 neuropsychiatric cases.

XII. Ratio of neuropsychiatric cases admitting and denyingvenereal infection.

XIII. Neuropsychiatric cases admitting and denying syphiliticand gonorrheal infection.

XIV. Alcoholic habits of 65,326 neuropsychiatric cases.

XV. Marital status of neuropsychiatric cases, compared withthat of the men placed in Class I.

XVI. Marital status of 67,444 neuropsychiatric cases.

XVII. Home environment of 67,050 neuropsychiatric cases,compared with population of the United States in 1910.

SECTION II.-IN THE AMERICAN EXPEDITIONARYFORCES

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

CHAPTER:

I. General view of neuropsychiatric activities.
        By Col. Thomas W. Salmon,M. C.

II. Division, Corps, and Army neuropsychiatric consultants.
        By Lieut. Col. Edwin G. Zabriskie, M.C., Lieut. Col. John H. W. Rhein, M. C., Maj. Edward A.Strecker, M. C., Maj. Samuel Leopold, M. C., Maj. MortimerW. Raynor, M. C., and Capt. Harry A. Steckel, M. C.

III. Army neurological hospitals.
        By Lieut. Col. JohnH. W. Rhein, M. C., and Maj. Roscoe W. Hall, M. C.

IV. Hospital for war neuroses (Base Hospital No. 117).
        By Lieut. Col. FrederickW. Parsons, M. C.

V. War neuroses as a medico-military problem.
        By Maj. Sidney I. Schwab, M.C., and Sergt. Norman Fenton, M. D.

VI. The care and disposition of cases of mental disease.
        By Lieut. Col. MichaelJ. Thornton, M. C., and Lieut. Col. Sanger Brown, II, M. C.

VII. In the Army of Occupation.
        By Maj. S. W. Hamilton, M. C.

VIII. Study of case histories of a typical group of warneuroses.
        By Sergt. NormanFenton, M. D.

IX. A post-war study of a typical group of war neuroses casesin 1919-20 and 1924-25.
        By Sergt. Norman Fenton, M. D.

LIST OF TABLES

Table:

1. Comparison of ages of patients of Base Hospital No. 117,with ages furnished by 3,683,124 applicants for war riskinsurance on basis of incidence of each age per 2,653.

2. Rank order of States from the standpoint of percentage of urban residents related to percentages of the total Army enlistments and of BaseHospital No. 117 patients from those States.

3. Rank order of States from the standpoint of density ofpopulation related to the percentage of the total Armyenlistments and of the patients of Base Hospital No. 117from those States.

4. Rank order of States from the standpoint of theirpercentage of foreign-born population related to the percentage of the totalArmy enlistments and of Base Hospital No. 117 patientsfrom those States.

5. Rank order of States from the standpoint of theirpercentage of males 10 years and over engaged inagricultural work related to the percentage of the total Army enlistmentsand of the patients of Base Hospital No. 117 from those States.

6. Comparison of distribution of types of occupation of BaseHospital No. 117 patients with certain other groups.

7. Comparison of the 1919-20 follow-up group and the totalBase Hospital No. 117 service in regard to physicalclassification.

8. A. E. F. physical classification of 1919-20 follow-up groupin relation to condition in 1919-20.

9. Frequency of usage of diagnoses and physicalclassifications of psychoneurosis cases discharged fromBase Hospital No. 117.

10. Comparison of the 1919-20 follow-up group and the totalpopulation of Base Hospital No. 117 in regard todiagnosis.

11. Condition in 1919-20 in relation to diagnosis in France.

12. Condition in 1919-20 in relation to diagnosis and physicalclassification.

13. Rank order of diagnoses on the basis of the percentage ofthose carrying on in civilian life in 1919-20.

14. Ages at hospitalization in France of follow-up group inrelation to condition in 1919-20.

15. Distribution of cases within the normal, neurotic,fatigued, and disabled groups according to age.

16. Distribution of cases within each age group according tocondition in 1919-20.

17. Family and personal histories (positive and negative) inrelation to condition in 1919-20, numbers and percentages.

18. Family and personal histories (positive and negative) offollow-up cases compared with 1,000 unselected cases fromBase Hospital No. 117, numbers and percentages.

19. Relation of pre-war occupation to condition in 1919-20.

20. Relation of 1919-20 condition to pre-war occupation.

21. Rank order of percentage of men of each occupation of the1919-20 follow-up group now able to work.

22. Comparison of physical classification in the AmericanExpeditionary Forces and the 1919-20 condition of thefollow-up group, arranged so as to show cases discharged from the hospitalbefore the armistice and during the armistice.

23. Comparison of the 1924-25 follow-up group and the totalBase Hospital No. 117 service in regard to physicalclassification.

24. Physical classification of the 1924-25 follow-up group inrelation to condition in 1924-25.

25. Comparison of the 1924-25 follow-up group and the totalpopulation of Base Hospital No. 117 in regard todiagnosis.

26. Condition in 1924-25 in relation to diagnosis in France.

27. Rank order of diagnoses on the basis of the percentages ofthose carrying on in civilian life in 1924-25.

28. Ages of follow-up group in relation to condition in1924-25.

29. Distribution of cases within the normal, neurotic,fatigued, and disabled groups, according to age.

30. Distribution of cases within each age group according tocondition in 1924-25.

31. Family and personal histories in relation to condition in1924-25.

32. The follow-up cases (1924-25) compared with 1,000unselected cases from Base Hospital No. 117.

33. Relation of occupation (1924-25) of follow-up group andtotal patients of Base Hospital No. 117 to workingcapacity.

34. Relation of condition in 1924-25 to occupation in 1924-25.

35. Rank order of percentage of men of each occupation of the1924-25 follow-up group now normal.

36. Rank order of percentage of men of each occupation of the1924-25 follow-up group now either neurotic or fatigued.

37. Direct comparison of physical classification in France andcondition in 1924-25 of the follow-up group.

LIST OF FIGURES

Figure:

1. Map showing the locations ofarmy neurological hospitals during the Meuse-Argonne operation.

2. Plan of psychiatric group atBazoilles hospital center, A. E. F.

3. Plan of psychiatric clinicgroup at Savenay hospital center, A. E. F.

APPENDIX:

A bibliography of American contributions to warneuropsychiatry. By Norman Fenton, Ph. D.

Letter from Pearce Bailey, M. D., Stewart Paton, M. D., andThomas W. Salmon, M. D., April 12, 1917, to the Surgeon General, United StatesArmy.

The Care and Treatment of Mental Diseases and War Neuroses("Shell Shock") in the British Army. By Maj. Thomas W. Salmon, M. C.

 

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AT
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LETTER OF TRANSMISSION

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I have the honor to submit herewith Volume X ofthe history of the MEDICAL DEPARTMENT OF THE UNITED STATESARMY IN THE WORLD WAR. The volume submitted is entitled,"NEUROPSYCHIATRY."

                                   M. W. IRELAND,
                       Major General, the Surgeon General.

The SECRETARY OF WAR.

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Lieut. Col. FRANK W. WEED, M. C., Editor in Chief.
LOY MCAFEE, A. M., M. D., Assistant Editor inChief.

EDITORIAL BOARD

Col. BAILEY K. ASHFORD, M. C.
Col. FRANK BILLINGS, M. C.
Col. THOMAS R. BOGGS, M. C.
Col. GEORGE E. BREWER, M. C.
Col. W. P. CHAMBERLAIN, M. C.
Col. C. F. CRAIG, M. C.
Col. HAVEN EMERSON, M. C.
Brig. Gen. JOHN M. T. FINNEY, M. D.
Col. J. H. FORD, M. C.
Lieut. Col. FIELDING H. GARRISON, M. C.
Col. H. L. GILCHRIST, M. C.
Brig. Gen. JEFFERSON R. KEAN, M. D.
Lieut. Col. A. G. LOVE, M. C.
Col. CHARLES LYNCH, M. C.
Col. JAMES F. MCKERNON, M. C.
Col. S. J. MORRIS, M. C.
Col. R. T. OLIVER, D. C.
Col. CHARLES R. REYNOLDS, M. C.
Lieut. Col. G. E. DE SCHWEINITZ, M. C.
Col. J. F. SILER, M. C.
Brig. Gen. W. S. THAYER, M. D.
Col. A. D. TUTTLE, M. C.
Col. WILLIAM H. WELCH, M. C.
Col. E. P. WOLFE, M. C.
Lieut. Col. CASEY A. WOOD, M. C.
Col. HANS ZINSSER, M. C.

^aThe highest rank held during the World Warhas been used in the case of each officer.