CHAPTER VIII
OCCURRENCE OF NEUROPSYCHIATRIC DISEASES IN THEARMY
The reports received in the Office of the Surgeon Generalconcerning the occurrence of neuropsychiatric diseases in the Army were of twoentirely distinct classes. The first was the report card of sick and wounded(Form 52, Medical Department) which is forwarded for every officer or soldieradmitted to sick report. In the second group were the special reports, requiredby the division of neuropsychiatry, which will be referred to at greater lengthin the following chapter.
The statistics compiled from the report cards of sick andwounded for all diseases are given in full in Volume XV, Part II, Medical andCasualty Statistics. From these statistics certain facts pertaining to theoccurrence of neuropsychiatric diseases are recorded in Tables 1, 2, 3, and 4below.
In Tables 1 and 2 every admission to sick report isconsidered. The only possible duplication would be that an individual may havebeen admitted more than once with the same diagnosis. This did not occur in anygreat number of instances, and the fact that it did occur among all the classestabulated would tend to equalize the percentage of occurrence for purposes ofcomparison.
Table 2 shows for the following conditions a relativelyhigher degree of incidence among officers than enlisted men: Encephalitis,locomotor ataxia, apoplexy, neurasthenia, "shell-shock," neuritis,general paralysis of the insane, psychasthenia, psychoneurosis, andmanic-depressive psychosis. The inclusion in this group of many of thoseindefinite functional disorders which usually are placed under the general termof psychoneuroses is of special interest. On the other hand, certain conditionsoccur much more frequently among the enlisted personnel. The markedpreponderance in this respect of epilepsy, enuresis, constitutional psychopathic states, mental deficiency, and dementia pr?cox is striking.
Table 2 shows, also, the higher incidence rate among officersserving abroad than among those in the United States. Further, it is seenreadily that while for the total Army the percentage of neuropsychiatricdiseases existing among officers was higher than among enlisted men, among thoseserving in Europe this disproportion was even greater.
As noted before, the special neuropsychiatric examination wasnot given as a routine to commissioned officers of the Army. This fact readilyexplains the higher percentage of this type of defect existing among officersand also why this percentage was increased among those serving in Europe. (Whenneuropsychiatric surveys of troops were made, officers were seldom required toundergo the special examination.) Ordinarily, we would expect a considerablylower rate of neuropsychiatric disease among the type of men included in theofficer group than in the general type representing the enlisted men. Thefailure of this corollary to hold true is explained by the elimination of a
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large percentage of men, suffering from this class ofdisease, from the enlisted forces as a result of the efforts of theneuropsychiatrists.
A comparison of the ratio of these diseases occurring amongenlisted men in the whole Army and among those serving in the United States andin Europe shows a much lower percentage for practically all neuropsychiatricdiseases among the enlisted men in Europe. This marked reduction in thenoneffective rate for this class of disease among the troops abroad isundoubtedly evidence of the efficiency of the neuropsychiatrists in detectingthis type of defect before the soldiers had finished their period of training inthis country. The general statement made above with reference to enlisted men asa whole applies similarly with reference to white and colored troops whenconsidered separately.
In a comparison of the occurrence of neuropsychiatricdiseases among white and colored troops, Table 2 discloses that the followingdiseases were recorded proportionately more often in white soldiers:Encephalitis, multiple sclerosis, neurasthenia, neurosis,"shell-shock," chorea, constitutional psychopathic state, dementiapr?cox, psychasthenia, psychoneurosis, alcoholic psychosis, andmanic-depressive psychosis. The following diseases occurred in a higher ratioamong the colored soldiers: Simple meningitis, locomotor ataxia, apoplexy,facial paralysis, paraplegia, epilepsy, Jacksonian epilepsy, enuresis,neurocirculatory asthenia, hysteria, neuralgia, neuritis, defective speech,general paralysis of the insane, and mental deficiency and malingering. Ingeneral, the ratio of occurrence of neuropsychiatric diseases in white andcolored troops corresponds for the whole Army-the Army in the United Statesand the Army in Europe.
A comparison of Tables 3 and 4 with Tables 1 and 2 shows asmaller number discharged on certificate of disability than might have beenexpected for defects of this character. It must be remembered, however, that acertain number died, some remained in hospital, and disposition at the finaldate included, in the statistics, a considerable number who were regarded as fitfor the performance of some military duty and who were retained in the service;an appreciable number, after the signing of the armistice, were discharged uponthe demobilization of their organizations who, if the war had not ended, wouldhave been discharged for disability.
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TABLE 2.-Neuropsychiatricdiseases. Admissions, 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
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TABLE 3.-Neuropsychiatricdiseases. 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.
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TABLE 4.-Neuropsychiatricdiseases. 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
