Table of Contents

CHAPTER IX

ANALYSIS OF SPECIAL NEUROPSYCHIATRIC REPORTS

The neuropsychiatric statistics here considered were preparedwith little reference to the number of men examined. In the following pagesestimates as to this number are made, but these are merely estimates. Completereports as to the number examined were not received. The reported total numberof men with neuropsychiatric conditions who entered the military service can notbe considered the correct number, as it has already been shown that theneuropsychiatric examination was not given to all of the first increments ofdrafted men reporting at the camps. Further, many officers and the majority ofthose who served in the Students' Army Training Corps and the National Guardwere not examined. After a careful consideration of all the facts, the total number who underwent this special examination is placed atapproximately 3,500,000.

CHART I.-Diagnoses of neuropsychiatric cases(home forces)

Unless otherwise stated, all percentages given in thischapter refer to the total number of neuropsychiatric cases considered-69,394.For example, as shown in Chart I, of the total number of neuropsychiatric casesidentified in the Army in the United States and available for classification,21,858, or 31.5 per cent, were of mental deficiency, and 11,443, or 16.5 percent, were of psychoneuroses. In certain of the tables which have been preparedthe statistics established how the different conditions were distributed and,referring to States, for example, the percentage given shows the proportion ofany given condition of the total neuropsychiatric conditions found among theresidents of the State. As concerns races, the percentage is in reference to thetotal of neuropsychiatric disorders found among the members of a race, whetherAmerican born or foreign born.

From the foregoing statements it is evident that suchpercentages can not be regarded as indicative of the actual frequency of acondition in the total

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number of men examined or in the representatives of eitherStates or races. Further, as concerns the drafted men of the Army, theneuropsychiatric examinations were made only of those men who had been passed bythe local examining boards under the provisions of the selective service act.

The number of neuropsychiatric cases found among the quotaswhich arrived at the camps depended upon the thoroughness of the examination bylocal boards. The character of the examination varied with different boards, andalso at different periods of the mobilization, with the changing orders whichwere issued from time to time relative to the standards for rejection andclassification. In order that one may understand in what degree the number ofdiagnoses of certain conditions made by the neuropsychiatric officers in campscorresponded with the rate of rejections for the same conditions by the localboards in various States, Table 5 was prepared. This table was compiled from thestatistics given in Defects Found in Drafted Men,¹ and affords information inrespect to a few of the more important clinical groups in which theclassification adopted by the Provost Marshal General corresponds with that usedherein.

TABLE 5.-Neuropsychiatric defects noted inthe total number of men rejected (549,099) by local boards in the differentStates. Rates per 1,000

States	Mental deficiency	Epilepsy	Drug addiction	Constitutional psychopathic states	Alcoholism	States	Mental deficiency	Epilepsy	Drug addiction	Constitutional psychopathic states	Alcoholism
Alabama	8.04	1.99	0.05	0.08	---	New Jersey	6.14	2.63	0.20	0.07	0.21
Arizona	2.00	.95	.35	.09	---	New Mexico	10.52	2.76	.14	---	.20
Arkansas	6.36	2.58	.01	.07	0.01	New York	7.26	3.92	.48	.30	.18
California	6.35	3.54	.64	.22	.38	North Carolina	14.03	3.72	.05	.04	.01
Colorado	6.77	3.27	.20	.07	.07	North Dakota	7.61	2.03	.04	.14	.07
Connecticut	7.96	4.15	.16	.06	.26	Ohio	9.95	3.99	.09	.19	.10
Delaware	5.45	1.36	.27	---	.14	Oklahoma	9.24	3.08	.17	.04	.01
District of Columbia	7.24	2.78	.07	.28	.14	Oregon	6.55	2.40	.04	.04	---
Florida	7.53	2.78	.11	.14	---	Pennsylvania	8.04	3.55	.17	.18	.13
Georgia	8.40	2.17	.14	.09	.01	Rhode Island	13.44	6.03	1.05	.33	1.18
Idaho	4.91	2.12	.06	---	.06	South Carolina	11.18	2.76	.10	.02	.07
Illinois	7.01	3.03	.06	.27	.08	South Dakota	11.34	.79	---	.20	---
Indiana	9.51	4.01	---	.07	.03	Tennessee	15.32	3.36	.15	.14	.03
Iowa	12.13	3.55	.06	.12	.13	Texas	8.42	3.82	.14	.04	---
Kansas	6.93	2.31	.03	.05	.09	Utah	5.95	2.50	.31	.38	---
Kentucky	12.54	3.47	.10	.06	.03	Vermont	27.13	10.18	.10	.40	.30
Louisiana	11.89	3.44	.10	.10	.06	Virginia	13.72	4.25	.10	.13	.01
Maine	16.75	4.45	.12	.08	.08	Washington	6.94	2.96	.49	.04	---
Maryland	20.36	6.03	.23	.64	.14	West Virginia	6.84	2.59	.03	.12	---
Massachusetts	8.00	3.74	.09	.14	.39	Wisconsin	9.70	2.84	.03	.14	.20
Michigan	8.44	2.67	.06	.21	.09	Wyoming	2.40	.58	---	---	.08
Minnesota	9.01	2.53	.16	.11	.09	Total United States rate per thousand, draft boards and camps	14.45	5.15	.54	.55	.31
Mississippi	9.28	2.50	.02	.05	.06	United states average	8.94	3.29	.16	.15	.13
Missouri	9.27	3.49	.15	.12	.23
Montana	2.79	1.74	.05	---	.03
Nebraska	4.77	1.96	.10	.06	.02
Nevada	2.28	2.07	.21	---	---
New Hampshire	7.40	3.58	---	.15	.23

In general, a low rate of rejections by local boardscorresponds with a small number of cases found at the camps. For example, in theexamination of men from Florida, the neuropsychiatric distribution average formental defect was far below that of most of the other Southern States. Thismight be explained by the Florida local boards being unusually on the alert formental defect, thus leaving fewer cases to be detected at the camps. Such was notthe

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case, however, as both local boards and neuropsychiatristsreported a below-average of mental defect in Florida. On the other hand, suchcorrespondence between the findings of the local boards and theneuropsychiatrists was not invariable. For example, Nevada, with a none perthousand local board rejection for alcoholism, showed the highestneuropsychiatric distribution average for alcoholism of any State (see Table42), although the actual number of cases was small.

The totals in all tables refer to diagnosis exclusively. Thediagnoses form the basis of the statistics quite independently of anyrecommendation or action affecting the status of the soldier. That is, anyindividual in whom a diagnosis of neuropsychiatric disease was made and reportedon Form 90 M. D. (see p. 14) is considered in the discussion which follows,irrespective of whether he was discharged from, or retained in, the Army. Insome of the tables herein, in which the information is discussed in detail undersubheads, the totals are not always uniform for the reason that in some of thedifferent items the total of information was not constant.

In the consideration of many items, such as family history,preexistence of venereal disease, and alcoholic habits, the information is basedupon the answers the enlisted men gave to questions asked them. Wheneverpossible their statements, especially as to personal history, were verified bycorrespondence with institutions, family physicians, and relatives. The facts asgiven are regarded as substantially correct. Drafted men, as a class, seemedtruthful; the motives for deception were not strong, and attempts to deceivecould generally be foiled. Again, in dealing with such large numbers,misstatements tend to balance. The compilations of the statistics as they becameavailable at different periods were quite uniform. Thus the percentagesestablished when 600,000 men had been examined were practically identical withthose which covered the examination of 3,500,000. Throughout, also, there was aremarkable uniformity of the information obtained by the examiners at differentstations.

In general it may be said that the present study furnishesmany facts hitherto unknown concerning nervous and mental disease and defectoccurring in a large group of individuals, or in certain selected smallergroups, all among males of a given age period. The neuropsychiatric disabilitiesof volunteers and drafted men are compared; of white and colored; of severalraces, both foreign and native born. Important information is furnished as tothe length of service to be expected from men suffering from the differentdefects; the date of onset of such defects; the family history, age, education,home environment, marital and economic conditions, and alcoholic habits of thoseunder consideration. It must be borne in mind throughout that the cases arediscussed as groups and that the facts and conclusions given apply only to thegroup under consideration.

DISTRIBUTION OF CASES (OFFICERS AND ENLISTED MEN)

The distribution of the cases considered in this series amongofficers, candidates for commission, and enlisted men is shown in Table 6.Assuming 3,500,000 as the total number examined, it is found that about 20 outof every

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1,000 were discovered to have some form of mental or nervousdisease or defect. The distribution of the cases among the military personnelwas:

Officers	533
Candidates for commission	587
Enlisted men	68,274
Total	69,394

OFFICERS AND CANDIDATES FOR COMMISSION

It was not possible to make accurate determinations of thenumber of officers and candidates for commission examined by neuropsychiatrists,except in officers' training camps which were in operation subsequent to thesummer of 1917, no routine psychiatric examinations having been prescribed forthis class of personnel. The high percentage of defects found among thoseattending the officers' training camps is startling. These conditions werediscovered during the routine examinations conducted at certain of the officers'training camps. A greater number of candidates for commission were eliminated atthese few camps by reason of neuropsychiatric disease than among the entireofficer personnel throughout the United States. It is certain that if allcandidates for commission had been subjected to a thorough neuropsychiatricexamination before being accepted many would have been rejected with advantage tothe military service. It was probably the outstanding defect of theneuropsychiatric service during the war that so many individuals werecommissioned and given positions of military responsibility without adetermination of their mental and nervous fitness therefor.

TABLE 6.-Diagnoses of nervous and mental diseases anddefects among commissioned officers,candidates for commission, andenlisted men

Diagnoses	Total	White				Colored, total
		Total	Commissioned officers	Candidates for commission	Enlisted men
Mental deficiency	21,858	17,803	---	7	17,796	4,055
Imbecile	6,817	4,881	---	---	4,881	1,936
Moron	13,242	11,215	---	7	11,208	2,027
Border-line condition	880	846	---	---	846	34
Degree not determined	919	861	---	---	861	58
Psychoneuroses	11,443	10,343	166	124	10,053	1,100
Anxiety neuroses	89	88	3	1	84	1
Angioneuredema	3	3	1	---	2	---
Compulsion neurosis	2	2	---	---	2	---
Enuresis	497	466	1	---	465	31
Hysteria	3,648	3,220	22	18	3,180	428
Migraine	181	178	1	2	175	3
Neurasthenia	3,982	3,800	90	51	3,659	182
Psychasthenia	1,118	1,079	40	19	1,020	39
Stammering	1,343	993	---	2	991	350
Traumatic neurosis	219	175	1	---	174	44
Undiagnosed	361	339	7	31	301	22
Psychoses	7,910	7,354	148	71	7,135	556
Traumatic	51	38	1	---	37	13
Senile	12	12	7	---	5	---
With cerebral arteriosclerosis	4	4	2	1	1	---
General paralysis	530	487	17	12	458	43
With cerebral syphilis	44	33	2	2	29	11
With Hungtington's chorea	1	1	---	---	1	---
With brain tumor	1	1	---	---	1	---
With other brain or nervous diseases	2	2	---	---	2	---
Alcoholic	292	287	4	---	283	5
Drug and toxic	45	36	2	2	32	9
With pellagra	37	33	---	---	33	4
With other somatic diseases	109	92	8	3	81	17
Manic-depressive	1,385	1,304	64	26	1,214	81
Involution melancholia	3	3	2	---	1	---
Dementia pr?cox	4,738	4,433	24	15	4,394	305
Paranoia and paranoid conditions	52	48	3	1	44	4
With mental deficiency	113	100	---	---	100	13
With constitutional psychopathic inferiority	66	64	---	7	57	2
Epileptic	131	112	---	---	112	19
Undiagnosed	294	264	12	2	250	30
Nervous diseases and injuries	6,916	6,116	100	147	5,869	800
Arteriosclerosis	41	41	10	14	17	---
Ataxia:
(a) Friedreich's	4	4	---	---	4	---
(b) Marie's	4	4	---	---	4	---
Atrophy	55	52	---	2	50	3
Beriberi	1	1	---	---	1	---
Brain:
Abscess of	9	8	---	---	8	1
Tumor of	27	27	1	---	26	---
Chorea	264	252	---	---	252	12
Combined sclerosis	3	3	---	---	3	---
Dercum's disease	1	1	---	---	1	---
Ear disease	2	2	---	1	1	---
Erythromelalgia	1	1	---	---	1	---
Hemiplegia	258	210	5	2	203	48
Hematomyelia	3	3	---	---	3	---
Hemorrhage, cerebral	17	16	1	---	15	1
Herpes zoster	2	2	---	---	2	---
Hydrocephalus	13	12	---	---	12	1
Injury:
(a) Brain	337	245	3	2	240	92
(b) Spinal cord	39	33	1	---	32	6
(c) Peripheral nerve	178	150	3	---	147	28
Lateral sclerosis	24	21	---	---	21	3
Little's disease	2	2	---	---	2	---
M?ni?re's disease	3	3	---	---	3	---
Meningitis	279	242	2	1	239	37
Multiple sclerosis	511	483	4	3	476	28
Myasthenia gravis	4	4	---	---	4	---
Myelitis	32	27	---	---	27	5
Myotonia congenita	17	17	---	---	17	---
Neuralgia	5	4	---	---	4	1
Neuritis	222	213	6	---	207	9
Neurofibromatosis	3	3	---	---	3	---
Paralysis agitans	18	16	---	---	16	2
Paramyoclonus multiplex	3	3	---	---	3	---
Paralysis	340	282	3	2	277	58
Paraplegia	34	28	1	---	27	6
Pes planus	23	22	---	---	22	1
Plumbism	13	12	---	---	12	1
Poliomyelitis	211	191	4	1	186	20
Progressive muscular atrophy	61	58	1	1	56	3
Progressive muscular dystrophy	15	14	---	---	14	1
Radiculitis	1	1	---	---	1	---
Retinitis	1	1	---	---	1	---
Raynaud's disease	8	8	---	---	8	---
Sciatica	137	127	5	---	122	10
Syphilis C.N.S.	2,462	2,161	26	50	2,085	301
Syringomyelia	17	16	---	---	16	1
Tabes dorsalis	333	294	11	27	256	39
Tetanus	2	2	---	---	2	---
Tetany	1	---	---	---	---	1
Thrombosis cerebral	5	4	---	---	4	1
Tics	200	183	1	6	176	17
Torticollis	34	27	---	1	26	7
Tremor	243	212	---	4	208	31
Vagatonia	16	16	---	1	15	---
Undiagnosed	377	352	12	29	311	25
Epilepsy	6,388	5,273	9	14	5,250	1,115
Constitutional psychopathic states	6,196	5,941	65	168	5,708	255
Criminalism	323	306	1	---	305	17
Emotional instability	1,915	1,835	21	75	1,739	80
Inadequate personality	2,594	2,500	21	33	2,446	94
Nomadism	28	28	---	---	28	---
Paranoid personality	388	378	9	9	360	10
Pathological liar	28	27	1	---	26	1
Sexual psychopathy	190	171	2	4	165	19
Undiagnosed	730	696	10	47	639	34
Endocrinopathies	4,805	4,506	17	52	4,437	299
(a) Achondroplasia	2	2	---	---	2	---
(b) Adrenal	6	6	---	---	6	---
(c) Gonad	16	15	---	---	15	1
(d) Neurocirculatory asthenia	50	35	---	---	35	15
(e) Pituitary	205	186	---	2	184	19
(f) Thyroid	4,501	4,239	17	50	4,172	262
(g) Polyglandular	25	23	---	---	23	2
Drug addiction	2,020	1,823	20	---	1,803	197
Alcoholism	1,858	1,834	8	1	1,825	24
Grand total	69,394	60,993	533	584	59,876	a8,401

^aAll enlisted men except 3, whowere members of the Officers' Training Corps.

CHART II.-Ratio of neuropsychiatric casesfound among volunteers and drafted men examined by neuropsychiatrists

ENLISTED MEN

The predominance of mental and nervous defects among men whovolunteered as compared with those who were drafted is shown in Table 7 andChart II. The cases considered were collected from reports whichshowed definitely the number of men examined in each of the groups referred to,and how many of these had neuropsychiatric defects. While the number hereconsidered is far less than the total, the results are regarded as typical forthe entire series. In this connection it is noteworthy that manyneurospychiatric patients who might otherwise have entered through the draft hadalready been sifted out by the local board examinations. No such preliminaryelimination had occurred among those enlisting voluntarily.

Table 7 also shows the distribution of neuropsychiatricdisorders among volunteers to be different from that in the Army as a whole.Those applying for voluntary enlistment show proportionately fewer mentaldefectives and drug addicts, and many more alcoholics.

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TABLE 7.-Neuropsychiatric cases foundamong volunteers at recruit depots, and drafted men, by clinical groups

	Number of neuropsychiatric cases
	Number of men examined	Total cases	Mental deficiency	Psycho- neuroses	Psychoses	Nervous diseases or injuries	Constitutional psychopathic states	Drug addiction	Alcoholism
Volunteer recruits	81,881	2,066	413	108	138	682	232	480	13
Drafted men	626,825	10,812	3,952	1,681	453	3,356	750	99	521
Total	708,706	12,878	4,365	1,789	591	4,038	982	579	534

METHODS OF DISCOVERING CASES

The neuropsychiatric cases which comprise the present seriescame under the observation of the neuropsychiatrist through five sources (Table8): (1) During the routine examination of all men on their arrival at amobilization camp; (2) reference by other medical officers; (3) reference bycommanding officers of organizations; (4) reference by psychologists; (5)reference by a court-martial or in connection with delinquency.

More cases were detected by the neuropsychiatrists during thepreliminary physical examination than in any other manner, 27,836 cases, or 40.1per cent of the total number reported, having been discovered in this way. Casesreferred by other medical officers are regarded as consultation cases.

The cooperation of line officers was generally securedthrough talks given to them by the neuropsychiatrists. Their attention wasinvited to those particular traits which might indicate mental abnormality; andthey were requested to refer to neuropsychiatrists, men in whom suchcharacteristics were noted, for special examination. The success attending theseefforts is indicated in the 16,336 positive cases which came to light throughthis channel.

One of the striking features of Chart III is the small numberof cases reported as referred by the psychologists. Several explanations may beoffered for this. As the psychological group examinations were conducted afterthe physical examinations were completed the greater number of cases of mentaldeficiency were discovered before the psychological examination began. Anotherexplanation is, that many of the soldiers who received low grades in thepsychological tests were sent to the development battalions where they weregiven an opportunity to display their ability. If their service wasunsatisfactory they were later referred to the neuropsychiatrists by thecommanding officers or surgeons of the organizations to which attached. Finalrecommendations in such cases were made, not alone upon failure to be placed ina particular psychological group, but upon failure to get along properly undertraining as well.

Whenever possible a psychologist was assigned to duty withthe neuropsychiatric board for the purpose of conducting individualpsychological examinations of men referred to them by the neuropsychiatrists.Their services were highly esteemed. Psychological ratings were therebyestablished, and the time of medical officers was economized.

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TABLE 8.-Methods of discoveringneuropsychiatric cases

CHART III

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DELINQUENCY 

The number of cases brought to the attention ofneuropsychiatric examiners by reason of misconduct was small. Out of the totalof 69,394 neuropsychiatric cases there were only 1,498 (see Chart IV) which werereferred by reason of delinquency. So small a representation of misconduct froma group of disorders of which the symptoms are primarily behavioristiccontradicts civil experience. This contradiction may be interpreted in two ways.The first is that at the entrance examinations the neuropsychiatric officersdetected most of the mentally irresponsible who were likely to turn out to be"bad actors," and succeeded in having them kept out of the Army. Suchan interpretation is borne out by the unexpectedly low delinquency rate reportedthroughout the Army, both in this country and overseas. But even thisinterpretation does not altogether account for the low delinquency ratefound among the neuropsychiatric cases. The conclusion can not be avoided thatmore misconduct cases would have been identified had there been a more thoroughneuropsychiatric examination of all offenders prior to their trails bycourts-martial. Such a view is borne out by the fact that of the 1,498 cases ofmisconduct, 575, or more than one-third, were reported from the Fort LeavenworthDisciplinary Barracks. In other words, the true nature of one-third of thesecases was recognized, not as it should have been, at the point where the offensewas committed, but at the point to which the individual had been sent aftercourt-martial, for reformation or punishment.

CHART IV

With only 923 reported from all mobilized troops, it isevident from all previous experience with delinquency and mentalirresponsibility, that many irresponsible soldiers were treated as delinquents.

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TABLE 9.-Delinquency cases in eachclinical group

Clinical groups	Number of neuro- psychiatric cases	Number of delinquent	Per cent delinquent	Clinical groups	Number of neuro- psychiatric cases	Number of delinquent	Per cent delinquent
Psychoses	7,910	404	5.1	Epilepsy	6,388	53	0.8
Constitutional psychopathic states	6,196	272	4.4	Psychoneuroses	11,443	66	.6
Mental deficiency	21,858	633	2.9	Nervous diseases and injuries	6,916	19	.3
Alcoholism	1,858	24	1.3	Endocrinopathies	4,805	6	.1
Drug addiction	2,020	21	1.0	Total	69,394	1,498	2.2

CLINICAL CLASSIFICATION

The neuropsychiatric examiners were instructed by the Surgeon General to use the following diagnostic terms in reference to classification:^a

CLASSIFICATION OF DISEASES, INJURIES AND DEFECTS

I. Mental deficiency:

Imbecile.
Moron.
Border-line condition.

II. Psychoneuroses:

Enuresis.
Hysteria.
Neurasthenia.
Psychasthenia.
Stammering.
Other forms (specify) .
Undiagnosed.

III. Psychoses:

In designating the mental disease on the statistical card, the group and type of the psychosis will be given whenever possible.

1. Traumatic psychoses.
2. Senile psychoses.
3. Psychoses with cerebral arteriosclerosis.
4. General paralysis.
5. Psychoses with cerebral syphilis.
6. Psychoses with Huntington's chorea.
7. Psychoses with brain tumor.
8. Psychoses with other brain or nervous diseases (specify when possible).
9. Alcoholic psychoses.

(a) Pathological intoxication.
(b) Delirium tremens.
(c) Acute hallucinosis.
(d) Korsakow's psychosis.
(e) Chronic paranoid type.
(f) Other types, acute or chronic.

10. Psychoses due to drugs and other exogenous toxins.

(a) Morphine, cocaine, bromides, chloral, etc., alone or combined (to be specified).
(b) Metals, as lead, arsenic, etc. (to be specified).
(c) Gases (to be specified).
(d) Other exogenous toxins (to be specified).

11. Psychoses with pellagra.

^aThe classification of mental diseases is the one adopted in May, 1917, by the American Medico-Psychological Association, now the American Psychiatric Association.

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III. Psychoses-Continued.

12. Psychoses with other somatic diseases (specify disease).
13. Manic-depressive psychoses.

(a) Manic type.
(b) Depressive type.
(c) Stupor.
(d) Mixed type.
(e) Circular type.

14. Involution melancholia.
15. Dementia pr?cox.

(a) Paranoid type.
(b) Catatonic type.
(c) Hebephrenic type.
(d) Simple type.

16. Paranoia and paranoid conditions.
17. Psychoses with mental deficiency.
18. Psychoses with constitutional psychopathic inferiority.
19. Epileptic psychoses.
20. Undiagnosed psychoses.

IV. Nervous diseases and injuries:

Abscess-

Brain (specify location).
Spinal cord (specify location).

Arteriosclerosis- 

Cerebral.
General.
Spinal.

Beriberi.
Bulbar palsy.
Chorea.
Combined sclerosis.
Ear disease.
Embolism and thrombosis.
Eye diseases.
Facial palsy.
Hemorrhage (specify location).
Herpes zoster.
Hydrocephalus.
Injury (specify kind)- 

Brain (specify location).
Spinal cord (specify location).
Peripheral nerve (specify nerve).
Lateral sclerosis.
Lumbago.
M?ni?re's disease.
Meningitis- 

Cerebrospinal.
Tuberculous.
Other forms (specify).

Migraine.
Multiple sclerosis (disseminated sclerosis).
Myasthenia gravis.
Myelitis- 

Transverse.
Traumatic.

Myotonia congenita (Thomsen's disease).
Neuralgia (specify nerve).

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IV.  Nervous diseases and injuries-Continued.

Injury (specify kind)-Continued.

Neuritis (specify nerve)-

Diphtheritic.
Multiple-

Alcoholic.
Traumatic.

Other forms.

Pachymeningitis cervicalis.
Paralysis agitans.
Paramyoclonus multiplex.
Pes planus.
Plumbism.
Poliomyelitis.
Progressive muscular atrophy.
Progressive muscular dystrophies.
Sciatica.
Syphilis of central nervous system.
Syringomyelia.
Tabes dorsalis (locomotor ataxia).
Tics.
Torticollis.
Tremor-

Chronic progressive.
Brain (specify location).
Spinal cord.
Peripheral nerve (specify nerve).

Vagotonia.
Undiagnosed.

Conditions secondary to other diseases-

Aphasia.
Bulbar syndrome.
Hemiplegia.
Jackson's syndrome.
Optic atrophy.
Paraplegia.

V. Constitutional psychopathic states:

Criminalism.
Emotional instability.
Inadequate personality.
Nomadism.
Paranoid.
Pathological liar.
Sexual psychopathy.
Other forms (specify).
Undiagnosed.

VI. Epilepsy:

Idiopathic.
Jacksonian.

VII. Endocrinopathies:

Achondroplasia.
Adrenal.
Gonad.
Neurocirculatory asthenia.
Pituitary.
Polyglandular.

VIII. Drug addiction.

IX. Alcoholism.

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The number of cases concerned was so large that the assembledmaterial may be accepted as representing every variety of nervous and mentaldisease or defect occurring in men in the given age period in the United States.Larger collections of statistics concerning individual conditions exist, butnone dealing with the whole subject of neuropsychiatry are known which parallelthe present series. They furnish a complete compilation, not only of disorderswhich affect conduct primarily, such as the psychoses and the constitutionalpsychopathic states, but also the organic and functional disorders which affectthe nervous system in structure and function.

To divide the diagnoses into distinct groups was not difficult, and it isbelieved that the several groups represent essentially different conditions, notonly in regard to origin, but also as to characteristics, management, and otherfactors. The fringes of each group overlap, observable especially in the merging into each other of suchconditions as are without definite physical symptoms.Under such circumstances the diagnosis and group assignment were made on the basis of the majordisability. There was some question as tothe proper group assignment of the 292 cases of alcoholic psychoses. (See Table 6.) These disorders, beinginduced by alcohol, belong to the alcoholism group, but any discussion of the psychoses must also include them.So they belong to both groups. They are counted with the psychoses in the general clinical classification and inthe tables; but in the itemized information concerning the psychoses and alcoholism, they appear in both places.Similarly there were placed under psychoses 45 cases of "drug and other toxic psychoses." Of these no furtheraccount is made. The numbers finally placed in each group are shown in Table6. The order of arrangement established in Table 6 is the order followedthroughout this chapter.

CHART V

LENGTH OF SERVICE

The neuropsychiatric examinations, except those made of themen of the first draft and the men in the National Guard and the Regular Army,were conducted eventually as a part of the routine physical examination giventhe men upon arrival at a mobilization camp. As a result of this system, most ofthe individuals who were rejected left the service before the Government hadproceeded to any great length with their military training. Information as tohow long the men of this series were in service prior to discovery was obtained

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170

for all but 2,635 cases. (Chart V.) Of the number for whichthe data were obtained, 52.6 per cent of all cases were discovered before theyhad been in the service one month, and 74.7 per cent were discovered before theyhad been in the Army three months, 86.7 per cent of all cases were identifiedbefore the expiration of six months, which was the average training periodbefore men went overseas.

The period of service for the entire group of cases would have been reduced considerably if the final perfected system of conductingneuropsychiatric examinations had been in operation at the time the first draftwent to camp. The men who were not examined immediately were givenneuropsychiatric examinations by special boards after their training wasstarted; in some instances the delay reached three months. Eliminating the casesfound in this delayed group, which numbered about 13,000, the conclusion thatmost neuropsychiatric cases can be found by experienced neuropsychiatrists inone month does not seem to be unreasonable.

TABLE 10.- Length of service ofneuropsychiatric cases prior to discovery

Diagnoses	Total	White
		Total	Under 1 month	1 to 3 months	4 to 6 months	7 to 12 months	Over  1 year to 2 years	Over  2 years	Unascertained
Mental deficiency	21,858	17,803	9,212	3,753	2,178	1,320	377	99	864
Psychoneuroses	11,443	10,343	4,516	2,510	1,403	1,039	411	209	255
Psychoses	7,910	7,354	2,522	1,773	1,099	895	435	293	337
General paralysis	530	487	299	56	38	28	9	42	15
Alcoholic	292	287	163	42	11	23	20	17	11
Manic-depressive	1,385	1,304	445	315	186	161	78	66	53
Dementia pr?cox	4,738	4,433	1,352	1,146	741	592	271	123	208
Epileptic	131	112	44	34	11	9	4	5	5
Other forms	834	731	219	180	112	82	53	40	45
Nervous diseases and injuries	6,916	6,116	3,312	1,114	554	500	214	185	237
Chorea	264	252	137	51	21	29	4	2	8
Hemiplegia	258	210	118	40	22	16	2	6	6
Injury to nervous system	554	428	226	73	51	37	18	12	11
Meningitis	279	242	77	37	34	54	31	3	6
Multiple sclerosis	511	483	313	76	36	26	10	11	11
Neuritis	222	213	62	54	35	32	15	8	7
Paralysis	340	282	146	68	29	16	11	6	6
Poliomyelitis	211	191	129	31	15	10	2	3	1
Sciatica	137	127	34	31	19	17	7	12	7
Syphilis C.N.S.	2,462	2,161	1,199	356	169	175	67	87	108
Tabes dorsalis	333	294	191	39	12	18	6	13	15
Tic	200	183	95	48	17	8	4	1	10
Tremor	243	212	155	31	13	3	1	3	6
Other forms	902	838	430	179	81	59	36	18	35
Epilepsy	6,388	5,273	2,624	1,363	548	343	145	65	185
Constitutional psychopathic states	6,196	5,941	2,246	1,484	908	701	294	133	175
Endocrinopathies	4,805	4,506	2,994	722	354	227	95	27	87
Drug addiction	2,020	1,823	1,165	254	139	74	41	28	122
Alcoholism	1,858	1,834	1,287	101	102	106	90	68	80
Total	69,394	60,993	29,878	13,074	7,285	5,205	2,102	1,107	2,342

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171

TABLE 10.-Length of service of neuropsychiatric causes prior to discovery-Continued

Diagnoses	Colored
	Total	Under 1 month	1 to 3 months	4 to 6 months	7 to 12 months	Over  1 year to 2 years	Over  2 years	Unascertained
Mental deficiency	4,055	2,496	781	438	120	29	19	172
Psychoneuroses	1,100	688	233	85	49	12	6	27
Psychoses	556	249	177	47	43	8	14	18
General paralysis	43	22	13	2	1	1	4	---
Alcoholic	5	4	1	---	---	---	---	---
Manic-depressive	81	35	28	7	6	1	1	3
Dementia pr?cox	305	138	90	28	31	5	6	7
Epileptic	19	8	7	3	---	---	1	---
Other forms	103	42	38	7	5	1	2	8
Nervous diseases and injuries	800	520	122	64	43	11	13	27
Chorea	12	11	---	1	---	---	---	---
Hemiplegia	48	36	8	1	---	---	1	2
Injury to nervous system	126	80	23	8	6	---	---	9
Meningitis	37	26	2	3	5	1	---	---
Multiple sclerosis	28	19	6	3	---	---	---	---
Neuritis	9	2	3	3	---	1	---	---
Paralysis	58	41	9	2	2	1	1	2
Poliomyelitis	20	15	2	---	2	---	---	1
Sciatica	10	5	1	3	---	---	---	1
Syphilis C.N.S.	301	182	47	25	23	7	9	8
Tabes dorsalis	39	26	7	2	2	---	1	1
Tic	17	13	2	1	---	---	---	1
Tremor	31	25	3	---	2	---	1	---
Other forms	64	39	9	12	1	1	---	2
Epilepsy	1,115	713	267	74	30	3	1	27
Constitutional psychopathic states	255	151	59	22	14	2	3	4
Endocrinopathies	299	241	39	3	7	1	---	8
Drug addiction	197	167	16	1	---	---	3	10
Alcoholism	24	20	2	---	1	---	1	---
Total	8,401	5,245	1,696	734	307	66	60	293

LINE OF DUTY

It appears, as far as the determination by medical officers is concerned,that 96.1 per cent of the cases discovered did not have a disability which arosein line of duty; that is, the disability was not due to service in the Army. Inonly 2.8 per cent was "in line of duty" established. (See Table 11.)

As most of the cases were considered as "not in line of duty" thedate of onset of the disease is of little importance from a military point ofview, but the records contain important clinical data, especially as to theessential chronicity of nervous and mental disorders.

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172

CHART VI

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173-174

TABLE 11.-Time of onset ofneuropsychiatric disorders-line of duty

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175

RECOMMENDATIONS OF PSYCHIATRISTS AND DISPOSITION OF CASES

Table 12 gives in detail the final disposition of the cases. Ninety-ninedeaths were reported; 27 cases were absent without leave. These 126 cases and the 10,893 cases represented as retained include 2,142 more cases thanthe number recommended for retention. Adding these 2,142 cases to the 6,498 (unreported) cases upon which no action was taken, it seems probable that

CHART VII

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176 

8,640 cases were retained which were at one time recommendedfor discharge by the neuropsychiatrists. In other words, 8,640 cases of nervousand mental diseases discovered in the United States were retained in the servicewhile, in the opinion of neuropsychiatric officers, they should have beenseparated from it.

Some light as to the wisdom of retaining cases of nervous andmental diseases in the Army, especially among troops destined to go overseas, isshown by the statistics of the nervous and mental cases reported from France.

Between the dates of January 1, 1918, and July 1, 1919, thetotal number of cases of nervous and mental disease occurring in France andevacuated home, passed through General Hospital No. 214, A. E. F.² Thetotal number of them was 8,772, which is close correspondence between the numberthat the neuropsychiatrists had recommended unavailingly to be prohibited fromgoing to France. These figures do not include the cases which were treated inhospitals and returned to duty.

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177-179

TABLE 12.-Recommendations and finaldisposition of neuropsychiatric cases

FAMILY HISTORY

Tables 13 to 17 gave details concerning the members of familieshaving a history of nervous or mental disease, inebriety, and mental deficiency.

Tables 18 and 19 summarize information as to family history inthe different clinical groups. Table 19 indicates the distribution throughoutthe nine

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180

clinical groups of family history of nervous disease, mentaldisease, inebriety and mental deficiency in the 39,484 cases classified underthese headings. Later in the chapter, for each clinical group an additionalsummary is made in accordance with disorder and relatives. The number of theclassified cases which serves as a basis of this summary is small. Theinformation is interesting but too much weight should not be given to it.

CHART VIII

TABLE 13.-Neuropsychiatric cases giving afamily history of nervous disease, mental disease, inebriety, or mentaldeficiency

Diagnoses	Total	White cases				Colored cases
		Total	Family history of neuropathic taint			Total	Family history of neuropathic taint
			Positive	Negative	Unascer- tained		Positive	Negative	Unascer- tained
Mental deficiency	21,858	17,803	6,624	8,103	3,076	4,055	1,598	1,430	1,027
Psychoneuroses	11,443	10,343	5,486	4,187	670	1,100	577	445	78
Psychoses	7,910	7,354	3,441	2,850	1,063	556	232	187	137
General paralysis	530	487	137	263	87	43	10	20	13
Alcoholic	292	287	116	122	49	5	2	3	---
Manic-depressive	1,385	1,304	652	484	168	81	31	33	17
Dementia pr?cox	4,738	4,433	2,143	1,675	615	305	137	93	75
Epileptic	131	112	52	33	27	19	12	5	2
Other forms	834	731	341	273	117	103	40	33	30
Nervous diseases and injuries	6,916	6,116	2,164	3,215	737	800	360	336	104
Chorea	264	252	162	78	12	12	7	5	---
Hemiplegia	258	210	72	116	22	48	17	27	4
Injury to nervous system	554	428	140	241	47	126	52	49	25
Meningitis	279	242	76	145	21	37	19	14	4
Multiple sclerosis	511	483	226	193	64	28	18	7	3
Neuritis	222	213	56	141	16	9	3	5	1
Paralysis	340	282	85	173	24	58	24	28	6
Poliomyelitis	211	191	55	120	16	20	14	5	1
Sciatica	137	127	36	77	14	10	4	6	---
Syphilis C.N.S.	2,462	2,161	692	1,188	281	301	135	124	42
Tabes dorsalis	333	294	75	149	70	39	17	15	7
Tic	200	183	89	72	22	17	11	6	---
Tremor	243	212	122	79	11	31	20	11	---
Other forms	902	838	278	443	117	64	19	34	11
Epilepsy	6,388	5,273	2,859	1,867	547	1,115	714	333	68
Constitutional psychopathic states	6,196	5,941	3,108	2,188	645	255	144	70	41
Endocrinopathies	4,805	4,506	2,549	1,645	312	299	180	100	19
Drug addiction	2,020	1,823	648	967	208	197	66	107	24
Alcoholism	1,858	1,834	608	999	227	24	18	5	1
Total	69,394	60,993	27,487	26,021	7,485	8,401	3,889	3,013	1,499

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181

TABLE 14.-Neuropsychiatric cases giving afamily history of nervous disease

Diagnoses	Total	White
		Number of cases	Number of relatives with nervous disease
			Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	3,456	2,967	686	1,542	79	1,419	376	11,427	3,409
Psychoneuroses	4,009	3,587	1,025	2,301	128	2,110	402	6,015	759
Psychoses	1,534	1,438	360	768	52	735	210	4,646	1,270
General paralysis	74	64	15	37	1	27	1	337	86
Alcoholic	38	36	6	11	1	19	4	198	53
Manic-depressive	294	282	77	140	7	170	53	815	207
Dementia pr?cox	927	873	211	485	38	420	127	2,804	756
Epileptic	32	27	10	12	2	21	7	50	35
Other forms	169	156	41	83	3	78	18	442	133
Nervous diseases and injuries	1,572	1,389	354	690	59	643	196	3,870	857
Chorea	129	124	32	69	5	81	27	113	15
Hemiplegia	48	44	8	21	2	18	8	145	21
Injuries to nervous system	94	71	24	39	3	29	3	309	48
Meningitis	62	56	7	33	3	25	8	160	26
Multiple sclerosis	176	169	41	83	7	85	23	234	80
Neuritis	34	33	4	12	1	23	10	160	20
Paralysis	71	56	12	25	2	19	12	202	24
Poliomyelitis	45	37	14	18	4	10	7	138	16
Sciatica	27	25	10	13	---	13	1	87	15
Syphilis C.N.S.	458	379	81	205	11	153	45	1,431	351
Tabes dorsalis	37	32	10	18	1	15	1	187	75
Tic	74	68	18	31	3	34	20	95	20
Tremor	110	93	39	41	7	44	7	107	12
Other forms	207	202	54	82	10	94	24	502	134
Epilepsy	2,036	1,525	432	875	111	1,251	395	3,083	665
Constitutional psychopathic states	1,616	1,535	394	947	59	839	192	3,611	795
Endocrinopathies	1,180	1,045	417	1,024	85	988	250	111	350
Drug addiction	266	239	53	106	7	99	25	1,321	263
Alcoholism	224	221	43	102	3	78	23	1,343	270
Total	15,893	13,946	3,764	8,355	583	8,162	2,069	35,409	8,638

Diagnoses	Colored
	Number of cases	Number of relatives with nervous disease
		Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	489	110	196	32	399	139	2,383	1,183
Psychoneuroses	422	104	138	11	343	62	596	82
Psychoses	96	21	26	3	50	18	314	146
General paralysis	10	6	2	---	1	5	19	14
Alcoholic	2	---	---	---	2	---	3	---
Manic-depressive	12	---	4	---	9	2	49	20
Dementia pr?cox	54	10	14	3	23	8	175	76
Epileptic	5	2	2	---	4	3	9	5
Other forms	13	3	4	---	11	---	59	31
Nervous diseases and injuries	183	42	73	11	102	25	491	126
Chorea	5	---	3	1	2	---	7	---
Hemiplegia	4	1	2	1	3	1	40	4
Injuries to nervous system	23	5	8	1	10	2	70	33
Meningitis	6	1	3	---	3	---	27	4
Multiple sclerosis	7	2	3	1	2	1	17	4
Neuritis	1	---	---	---	1	---	7	1
Paralysis	15	5	6	3	4	5	40	3
Poliomyelitis	8	2	3	---	11	---	11	1
Sciatica	2	---	1	---	---	3	---	8
Syphilis C.N.S.	79	14	31	2	40	9	175	47
Tabes dorsalis	5	3	1	---	---	2	24	10
Tic	6	3	3	1	6	---	11	---
Tremor	17	5	8	1	14	---	14	---
Other forms	5	1	1	---	6	2	48	11
Epilepsy	511	82	166	30	362	94	525	79
Constitutional psychopathic states	81	17	39	6	41	16	120	54
Endocrinopathies	135	35	58	15	65	15	145	19
Drug addiction	27	2	16	1	7	2	40	30
Alcoholism	3	2	1	---	1	6	20	1
Total	1,947	415	713	109	1,370	377	4,634	1,720

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182

TABLE 15.-Neuropsychiatric cases giving afamily history of mental disease

Diagnoses	Total	White
		Number of cases	Number of relatives with mental disease
			Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	2,855	2,146	353	403	194	650	972	12,252	3,405
Psychoneuroses	1,744	1,551	255	292	159	399	781	7,890	902
Psychoses	1,855	1,729	357	384	208	561	940	4,427	1,198
General paralysis	42	41	11	10	2	9	21	366	80
Alcoholic	40	40	8	10	3	14	24	195	52
Manic-depressive	390	373	86	102	41	119	176	736	195
Dementia pr?cox	1,182	1,101	222	221	128	371	612	2,625	707
Epileptic	27	23	7	3	5	5	17	57	32
Other forms	174	151	23	38	29	43	90	448	132
Nervous diseases and injuries	653	515	97	102	67	113	309	4,782	819
Chorea	34	33	9	6	6	7	46	200	19
Hemiplegia	26	24	2	3	3	4	11	157	29
Injuries to nervous system	53	34	6	4	3	6	16	345	49
Meningitis	34	24	2	4	2	6	16	196	22
Multiple sclerosis	61	50	10	12	4	9	24	353	80
Neuritis	19	17	4	1	---	6	7	178	18
Paralysis	26	20	3	6	3	1	12	237	25
Poliomyelitis	17	16	3	1	2	3	7	158	17
Sciatica	11	10	1	2	1	---	7	101	16
Syphilis C.N.S.	210	149	34	34	23	42	87	1,710	302
Tabes dorsalis	33	26	7	3	5	6	5	192	76
Tic	22	17	4	6	---	4	12	143	23
Tremor	37	30	3	9	4	6	20	165	17
Other forms	70	65	9	11	11	13	39	647	126
Epilepsy	1,035	747	110	181	114	198	357	3,745	781
Constitutional psychopathic states	1,061	999	206	248	123	268	586	4,111	831
Endocrinopathies	543	496	75	102	52	116	238	3,612	398
Drug addiction	177	149	26	29	15	45	87	1,417	257
Alcoholism	115	113	18	9	8	27	52	1,460	261
Total	10,038	8,445	1,497	1,750	940	2,377	4,322	43,696	8,852

Diagnoses	Colored
	Number of cases	Number of relatives with mental disease
		Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	709	83	113	52	264	432	2,239	1,107
Psychoneuroses	193	18	22	23	62	121	826	81
Psychoses	126	28	23	10	45	64	292	13
General paralysis	1	---	1	---	---	---	29	138
Alcoholic	---	---	---	---	---	---	5	---
Manic-depressive	17	2	6	1	7	12	45	19
Dementia pr?cox	81	19	12	6	24	40	150	74
Epileptic	4	1	1	---	3	3	13	2
Other forms	23	6	3	3	11	9	50	30
Nervous diseases and injuries	138	23	11	19	50	73	529	133
Chorea	1	---	---	---	1	---	9	2
Hemiplegia	2	2	---	1	2	4	43	3
Injuries to nervous system	19	4	3	1	3	9	73	34
Meningitis	10	1	1	---	8	4	23	4
Multiple sclerosis	11	4	---	2	5	4	15	2
Neuritis	2	---	---	---	2	4	6	1
Paralysis	6	2	---	2	2	1	48	4
Poliomyelitis	1	---	1	---	---	---	18	1
Sciatica	1	---	---	---	---	1	9	---
Syphilis C.N.S.	61	6	6	10	14	33	184	56
Tabes dorsalis	7	2	---	1	5	6	22	10
Tic	5	---	---	---	5	1	12	---
Tremor	7	1	---	1	---	4	21	3
Other forms	5	1	---	1	3	2	46	13
Epilepsy	288	39	49	30	109	139	729	98
Constitutional psychopathic states	62	13	12	8	21	29	136	57
Endocrinopathies	47	2	6	9	17	27	233	19
Drug addiction	28	4	4	4	3	13	144	25
Alcoholism	2	---	---	---	1	1	21	1
Total	1,593	210	240	155	572	899	5,149	1,659

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183

TABLE 16.-Neuropsychiatric cases giving afamily history of inebriety

Diagnoses	Total	White
		Number of cases	Number of relatives with inebriety
			Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	3,028	3,630	1,963	55	55	781	446	11,810	3,363
Psychoneuroses	1,566	1,434	926	18	68	337	334	7,917	992
Psychoses	1,403	1,326	988	27	45	358	240	4,745	1,276
General paralysis	63	61	49	---	7	21	17	340	86
Alcoholic	112	110	57	1	3	47	22	119	51
Manic-depressive	215	206	153	3	8	38	36	884	214
Dementia pr?cox	834	789	620	19	21	172	135	2,897	747
Epileptic	13	12	10	---	---	5	1	61	39
Other forms	166	148	99	4	6	75	29	444	139
Nervous diseases and injuries	970	822	559	15	25	254	153	4,454	840
Chorea	43	42	30	---	2	5	8	187	23
Hemiplegia	32	26	19	1	---	6	7	157	27
Injuries to nervous system	82	48	30	---	1	17	12	332	48
Meningitis	23	21	10	4	2	2	9	198	23
Multiple sclerosis	110	103	63	---	5	16	22	301	79
Neuritis	21	20	18	---	1	3	3	174	19
Paralysis	40	27	17	---	1	13	4	228	27
Poliomyelitis	21	14	9	---	---	10	4	159	18
Sciatica	16	13	9	---	---	7	10	97	17
Syphilis C.N.S.	402	349	240	5	5	121	42	1,496	316
Tabes dorsalis	33	30	26	3	1	11	10	187	77
Tic	19	17	16	1	---	5	2	140	26
Tremor	29	22	17	---	1	3	3	172	18
Other forms	99	90	55	1	6	35	17	626	122
Epilepsy	894	681	599	20	27	210	195	3,841	751
Constitutional psychopathic states	1,167	1,119	861	32	44	254	219	4,037	785
Endocrinopathies	737	675	462	12	23	129	152	3,451	380
Drug addiction	429	382	247	22	13	134	96	1,191	250
Alcoholism	542	531	355	18	17	183	116	1,077	226
Total	10,736	9,600	6,960	219	317	2,640	1,951	42,523	8,863

Diagnoses	Colored
	Number of cases	Number of relatives with inebriety
		Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	398	248	18	8	196	87	2,463	1,195
Psychoneuroses	132	96	5	4	45	28	879	89
Psychoses	77	52	6	---	41	16	340	139
General paralysis	2	2	1	---	---	2	27	14
Alcoholic	2	1	1	---	---	---	3	---
Manic-depressive	9	3	---	---	3	4	53	19
Dementia pr?cox	45	32	3	---	29	9	186	74
Epileptic	1	1	---	---	---	---	15	3
Other forms	18	13	1	---	9	1	56	29
Nervous diseases and injuries	148	69	2	1	43	39	541	111
Chorea	1	1	1	---	---	---	9	2
Hemiplegia	6	5	---	---	2	---	38	4
Injuries to nervous system	34	5	---	---	5	6	77	15
Meningitis	2	1	---	---	1	---	30	5
Multiple sclerosis	7	2	---	---	1	8	20	1
Neuritis	1	---	---	---	1	---	7	1
Paralysis	13	4	---	---	7	2	42	3
Poliomyelitis	7	4	---	---	4	---	12	1
Sciatica	3	2	---	---	---	1	6	1
Syphilis C.N.S.	53	32	1	1	10	20	197	51
Tabes dorsalis	3	3	---	---	1	---	24	12
Tic	2	1	---	---	1	---	14	1
Tremor	7	4	---	---	7	---	24	---
Other forms	9	5	---	---	3	2	41	14
Epilepsy	213	116	---	---	104	35	806	96
Constitutional psychopathic states	48	29	4	---	17	35	153	54
Endocrinopathies	62	36	5	4	40	13	212	25
Drug addiction	47	24	3	1	20	11	125	25
Alcoholism	11	9	1	---	6	5	7	6
Total	1,136	679	43	18	512	269	5,525	1,740

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184

TABLE 17.-Neuropsychiatric cases givingfamily history of mental deficiency

Diagnoses	Total	White
		Number of cases	Number of relatives with mental deficiency
			Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	1,752	1,478	244	243	9	1,339	151	12,376	3,949
Psychoneuroses	84	34	21	23	8	190	91	9,406	967
Psychoses	307	280	42	53	3	232	89	5,644	1,430
General paralysis	7	5	---	1	---	3	2	390	92
Alcoholic	1	1	---	---	---	2	---	231	55
Manic-depressive	48	47	8	7	---	49	13	1,038	219
Dementia pr?cox	207	194	25	35	2	134	57	3,369	870
Epileptic	12	10	1	1	---	8	3	58	44
Other forms	32	23	8	9	1	36	14	558	150
Nervous diseases and injuries	125	89	5	5	4	69	35	5,248	956
Chorea	6	5	---	---	---	4	---	222	25
Hemiplegia	6	5	---	---	---	3	2	172	33
Injuries to nervous system	10	3	---	---	---	2	1	368	57
Meningitis	2	1	---	---	---	1	1	198	43
Multiple sclerosis	19	14	1	1	1	8	6	388	81
Neuritis	3	2	---	---	---	1	3	188	23
Paralysis	4	2	---	---	---	3	---	254	26
Poliomyelitis	4	4	1	1	---	3	---	170	17
Sciatica	6	5	1	1	---	4	4	104	18
Syphilis C.N.S.	31	19	---	1	2	17	9	1,809	333
Tabes dorsalis	3	1	---	1	---	3	---	212	81
Tic	3	3	---	---	---	6	---	155	25
Tremor	10	7	---	---	---	5	2	186	19
Other forms	18	18	2	---	1	9	7	695	127
Epilepsy	288	208	19	19	7	165	69	4,194	871
Constitutional psychopathic states	53	35	81	31	7	167	90	5,003	903
Endocrinopathies	165	152	7	8	3	93	21	3,907	447
Drug addiction	35	33	7	8	---	24	9	1,504	286
Alcoholism	8	8	1	---	---	4	3	1,512	314
Total	2,817	2,317	427	390	41	2,282	557	48,596	10,080

Diagnoses	Colored
	Number of cases	Number of relatives with mental deficiency
		Fathers	Mothers	Grandparents	Siblings	Collaterals	Denied	Unascer- tained
Mental deficiency	274	32	36	3	292	52	2,535	1,246
Psychoneuroses	50	9	8	1	52	21	958	126
Psychoses	27	7	5	---	18	5	382	147
General paralysis	2	---	---	---	2	---	27	14
Alcoholic	---	---	---	---	---	---	4	1
Manic-depressive	1	---	---	---	1	3	58	22
Dementia pr?cox	13	5	3	---	7	---	213	79
Epileptic	2	---	---	---	2	---	14	3
Other forms	9	2	2	---	6	2	66	28
Nervous diseases and injuries	36	4	4	2	24	7	606	160
Chorea	1	---	---	---	2	---	9	2
Hemiplegia	1	---	---	---	1	1	47	---
Injuries to nervous system	7	1	2	1	1	2	81	38
Meningitis	1	---	---	---	3	---	30	6
Multiple sclerosis	5	1	---	---	3	1	19	4
Neuritis	1	---	---	---	1	---	7	1
Paralysis	2	---	---	---	2	---	42	14
Poliomyelitis	---	---	---	---	---	---	20	---
Sciatica	1	---	---	---	---	1	9	---
Syphilis C.N.S.	12	1	2	---	7	2	226	63
Tabes dorsalis	2	1	---	---	1	---	24	13
Tic	---	---	---	---	---	---	16	14
Tremor	3	---	---	---	3	---	24	4
Other forms	---	---	---	1	---	---	52	14
Epilepsy	80	8	11	2	79	15	909	126
Constitutional psychopathic states	18	2	4	---	1	11	165	72
Endocrinopathies	13	1	---	1	5	8	247	39
Drug addiction	2	---	---	---	2	---	175	20
Alcoholism	---	---	---	---	---	---	23	1
Total	500	63	68	9	470	119	5,970	1,931

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185

TABLE 18.-Neuropsychiatriccases giving family history of neuropathic taint. Percentage distribution^a

Family history of neuropathic taint	Total cases		Per cent of cases ascertained as to family history in each clinical groups
	Number	Per cent	Mental deficiency	Psycho- neuroses	Psychoses	Neurological	Epilepsy	Constitutional psychopathic states	Endo- crinopathies	Drug addiction	Alcoholism
Positive	31,376	51.9	46.3	56.7	54.7	41.5	61.9	59.0	61.0	39.9	38.4
Negative	29,034	48.1	53.7	43.3	45.3	58.5	38.1	41.0	39.0	60.1	61.6
Total ascertained	60,410	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0

^aThere were 8,984 cases ofwhich the family history of neuropathic taint was unascertained.

TABLE 19.-Family history of principalneuropathic taints among neuropsychiatric cases

Specified neuropathic taint in family	Cases with each taint		Per cent of cases with each specified taint among the total cases with ascertained family history in each clinical groups
	Number	Per cent	Mental deficiency	Psycho- neuroses	Psychoses	Neuro- logical	Epilepsy	Constitutional psychopathic states	Endocrino- pathies	Drug addiction	Alcoholism
Nervous diseases	15,893	26.3	19.5	37.5	22.9	25.9	35.3	29.3	26.4	14.9	13.7
Mental diseases	10,038	16.6	16.1	16.3	27.6	10.7	17.9	19.3	12.1	10.0	7.1
Inebriety	10,736	17.8	17.1	14.6	20.9	16.0	15.5	21.2	16.5	24.0	33.3
Mental deficiency	2,817	4.7	9.9	.8	4.6	2.1	5.0	1.0	3.7	2.0	.5
Total neuropathic taints	39,484	65.4	62.5	69.2	76.0	54.7	73.7	70.7	58.7	50.7	54.5

AGE

In Table 20 it is possible to compare the ages ofthe white with the colored neuropsychiatric cases. This table shows thepredominance of neuropsychiatric disorders among colored between the ages 20 and24 years. There is little difference in the percentages for the other groups,except the colored naturally fall below the whites on account of the increase inthe percentage for the colored in the age group from 20 to 24 years.

Table 21 summarizes information as to age in the differentclinical groups.

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186

CHART IX

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187

TABLE 20.-Ages of neuropsychiatric cases

Diagnoses	Total	White
		Total	Under 20 years	20 to 24 years	25 to 29 years	30 to 34 years	35 years and over	Unascer- tained
Mental deficiency	21,858	17,803	1,685	7,878	5,782	1,692	143	623
Psychoneuroses	11,443	10,343	445	4,200	3,962	1,331	242	163
Psychoses	7,910	7,354	334	2,551	2,694	1,158	382	235
General paralysis	530	487	4	37	158	165	110	13
Alcoholic	292	287	2	33	107	95	36	14
Manic-depressive	1,385	1,304	31	427	500	220	84	42
Dementia pr?cox	4,738	4,433	254	1,781	1,634	549	85	130
Epileptic	131	112	10	44	42	10	4	2
Other forms	834	731	33	229	253	119	63	34
Nervous diseases and injuries	6,916	6,116	184	1,831	2,264	1,171	480	186
Chorea	264	252	19	136	75	20	---	2
Hemiplegia	258	210	1	71	98	29	7	4
Injuries to nervous system	554	428	11	165	172	55	9	16
Meningitis	279	242	10	125	83	19	2	3
Multiple sclerosis	511	483	29	168	183	71	16	16
Neuritis	222	213	7	78	76	33	13	6
Paralysis	340	282	12	111	109	37	6	7
Poliomyelitis	211	191	7	107	50	19	2	6
Sciatica	137	127	---	40	55	21	8	3
Syphilis C.N.S.	2,462	2,161	45	382	820	589	266	59
Tabes dorsalis	333	294	3	29	87	93	60	22
Tic	200	183	7	74	74	22	3	3
Tremor	243	212	1	67	88	48	3	5
Other forms	902	838	32	278	294	115	85	34
Epilepsy	6,388	5,273	358	2,383	1,790	497	57	188
Constitutional psychopathic states	6,196	5,941	537	2,438	1,960	745	174	87
Endocrinopathies	4,805	4,506	161	2,293	1,545	410	28	69
Drug addiction	2,020	1,823	12	665	845	238	28	35
Alcoholism	1,858	1,834	13	131	489	652	513	36
Total	69,394	60,993	3,729	24,370	21,331	7,894	2,047	1,622

Diagnoses	Total	Colored
		Under 20 years	20 to 24 years	25 to 29 years	30 to 34 years	35 years and over	Unascer- tained
Mental deficiency	4,055	78	2,273	1,168	353	42	141
Psychoneuroses	1,100	34	569	365	110	8	14
Psychoses	556	9	227	216	70	15	19
General paralysis	43	---	8	19	9	5	2
Alcoholic	5	---	---	3	2	---	---
Manic-depressive	81	1	35	33	7	1	4
Dementia pr?cox	305	8	138	111	35	4	9
Epileptic	19	---	6	10	1	1	1
Other forms	103	---	40	40	16	4	3
Nervous diseases and injuries	800	7	310	315	138	17	13
Chorea	12	---	6	5	1	---	---
Hemiplegia	48	---	26	13	6	2	1
Injuries to nervous system	126	---	58	46	17	2	3
Meningitis	37	---	19	11	6	1	---
Multiple sclerosis	28	1	13	11	3	---	---
Neuritis	9	---	5	4	---	---	---
Paralysis	58	---	26	18	11	1	2
Poliomyelitis	20	---	8	11	---	---	1
Sciatica	10	---	5	4	1	---	---
Syphilis C.N.S.	301	1	91	133	63	9	4
Tabes dorsalis	39	---	11	14	13	1	---
Tic	17	1	9	6	1	---	---
Tremor	31	---	9	15	5	1	1
Other forms	64	4	24	24	11	---	1
Epilepsy	1,115	19	598	388	87	11	12
Constitutional psychopathic states	255	5	118	90	35	5	2
Endocrinopathies	299	6	163	90	36	2	2
Drug addiction	197	2	54	88	50	3	---
Alcoholism	24	---	3	12	7	2	---
Total	8,401	160	4,315	2,732	886	105	203

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188

TABLE 21.-Ages of neuropsychiatric cases.Percentage distribution

Age on enlistments	Total with ascertained ages		Per cent distribution of ascertained ages in each clinical group
	Number	Per cent	Mental deficiency	Psycho- neuroses	Psychoses	Neuro- logical	Epilepsy	Constitutional psychopathic states	Endocrino- pathies	Drug addiction	Alcoholism
Under 20 years	3,889	5.8	8.4	4.3	4.5	2.8	6.1	8.9	3.5	0.7	0.7
20 to 24 years	28,685	42.5	48.1	42.3	36.3	31.9	48.2	41.8	51.9	36.2	7.4
25 to 29 years	24,063	35.6	32.9	38.4	38.0	38.4	35.2	33.6	34.5	47.0	27.5
30 to 34 years	8,780	13.0	9.7	12.8	16.0	19.5	9.4	12.8	9.4	14.5	36.2
35 years and over	2,152	3.2	.9	2.2	5.2	7.4	1.1	2.9	.7	1.6	28.2
Total cases with ascertained ages	67,569	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0

Ages unascertained of 1,825 cases.

SCHOOLING

From the data which were compiled by the division ofpsychology of the Surgeon General's Office, reasonably accurate informationwas obtained as to the literacy of the men who made up the Army.³ Thestatements as to schooling, which were given by the men subjected to thepsychological examinations, were not verified, and if there is any error it isprobable that the facts were overstated by the men, as it is believed there wasa general tendency for them to exaggerate their previous training.

From the entire group of men tested by the psychologists,about 80,000 records were carefully selected as a fair sample of the men in theArmy. (Table 22.) The tabulation upon which the report of the division ofpsychology is based, is used herein for purposes of comparison.

The neuropsychiatric records are perhaps somewhat moreaccurate in reference to education than the psychological records, because ofthe opportunities for verification. Each case was personally interviewed by theneuropsychiatrist, and the records corrected if misstatements were found.

TABLE 22.-Schooling of 80,000 soldiers asdetermined by psychological examinations

Schooling	White  (per cent)	Colored  (per cent)
None	3.2	13.5
Grades	75.2	76.0
High school	16.6	8.9
College	5.0	1.6
Total	100.0	100.0

Source of information. Report of division of psychology of the SurgeonGeneral's Office.

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189

CHART X

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190-191

TABLE 23.-Schooling of neuropsychiatriccases

The facts clearly indicate that the neuropsychiatric cases did not measureup to the educational standards of the average soldier. This may be due to thelarge number of mental defectives included in the group of neuropsychiatriccases. Further comparisons will be made in the discussion of the different groups ofneuropsychiatric cases.

ECONOMIC CONDITION

In compiling information on the economic condition, thecases were placed into two groups: Those in marginal and those in comfortablecircumstances. (See Table 24.) Persons were considered as being in marginalcircumstances who were not able to live without working for four months, withoutbecoming objects of charity. This classification does not include"dependents" as the number of dependent men accepted by local boardswas negligible. The table shows that 50,181, or 87 per cent of the whites and 8,005,or 97 per cent of the colored neuropsychiatric cases were in marginalcircumstances.

The facts give no light on the question of whether poverty isthe cause or the result of mental disease or defect. They do, however, show a closerelationship

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192

and agree with previous statistics, the best of which have been compiled bythe New York State Hospital Commission, that neuropsychiatric disorders are relatively more frequent among persons in marginal circumstances.

CHART XI

TABLE 24.-Economic condition ofneuropsychiatric cases

Diagnoses	Total	White				Colored
		Total	Marginal	Comfortable	Unascertained	Total	Marginal	Comfortable	Unascertained
Mental deficiency	21,858	17,803	15,865	927	1,011	4,055	3,951	32	72
Psychoneuroses	11,443	10,343	7,992	1,901	450	1,100	1,037	37	26
Psychoses	7,910	7,354	5,777	1,053	524	556	493	38	25
General paralysis	530	487	362	88	37	43	38	3	2
Alcoholic	292	287	233	32	22	5	5	---	---
Manic-depressive	1,385	1,304	941	268	95	81	75	4	2
Dementia pr?cox	4,738	4,433	3,654	481	298	305	266	25	14
Epileptic	131	112	88	13	11	19	17	1	1
Other forms	834	731	499	171	61	103	92	5	6
Nervous diseases and injuries	6,916	6,116	4,618	1,035	463	800	739	41	20
Chorea	264	252	213	34	5	12	11	1	---
Hemiplegia	258	210	170	29	11	48	44	2	2
Injuries to nervous system	554	428	325	71	32	126	118	5	3
Meningitis	279	242	196	33	13	37	37	---	---
Multiple sclerosis	511	483	351	75	57	28	26	2	---
Neuritis	222	213	135	60	18	9	7	1	1
Paralysis	340	282	201	65	16	58	53	4	1
Poliomyelitis	211	191	155	27	9	20	18	2	---
Sciatica	137	127	91	30	6	10	9	---	1
Syphilis C.N.S.	2,462	2,161	1,698	313	150	301	277	14	10
Tabes dorsalis	333	294	190	65	39	39	36	3	---
Tic	200	183	144	30	9	17	15	2	---
Tremor	243	212	170	28	14	31	29	1	1
Other forms	902	838	579	175	84	64	59	4	1
Epilepsy	6,388	5,273	4,355	602	316	1,115	1,061	35	19
Constitutional psychopathic states	6,196	5,941	4,801	791	349	255	233	12	10
Endocrinopathics	4,805	4,506	3,567	704	235	299	290	8	1
Drug addiction	2,020	1,823	1,602	159	62	197	177	16	4
Alcoholism	1,858	1,834	1,604	138	92	24	24	---	---
Total	69,394	60,993	50,181	7,310	3,502	8,401	8,005	219	177

VENEREAL DISEASE

Data on venereal infections at some time previous to entering the servicewere obtained from statements of the soldiers comprising this series. (See Table25.) Verifications of the statements, being difficult, were not made except in such instances as required Wassermann examinations.

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193

The usual motive for denying the existence of venereal disease did not existin the Army, and neuropsychiatric examiners were impressed with the franknesswith which soldiers spoke of their past life in this respect. The figures here presented must stand by themselves, as the Army statisticsrelative to venereal diseases refer only to the actual existence of them, not topast histories. It is impossible, therefore, to state how the neuropsychiatricindividuals compared with soldiers in general as to a venereal history.

CHART XII

Table 25 shows the great predominance of history of precedingvenereal infection in the colored cases.

CHART XIII

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