History

194

TABLE 25.-Neuropsychiatric cases admittingand denying venereal infection previous to entering the Army

Diagnoses	Total	White
		Total	Syphilis		Gonorrhea		Other venereal infection
		Total	Admitted	Denied	Admitted	Denied	Admitted	Denied
Mental deficiency	21,858	17,803	517	17,286	2,231	15,572	171	17,632
Psychoneuroses	11,443	10,343	446	9,897	1,860	8,483	114	10,229
Psychoses	7,910	7,354	640	6,714	1,409	5,945	163	7,191
General paralysis	530	487	255	232	159	328	19	468
Alcoholic	292	287	35	252	93	194	11	276
Manic-depressive	1,385	1,304	69	1,235	256	1,048	29	1,275
Dementia pr?cox	4,738	4,433	205	4,228	752	3,681	83	4,350
Epileptic	131	112	2	110	18	94	2	110
Other forms	834	731	74	657	131	600	19	712
Nervous diseases and injuries	6,916	6,116	1,669	4,447	1,594	4,522	176	5,940
Chorea	264	252	11	241	35	217	3	249
Hemiplegia	258	210	26	184	45	165	4	206
Injuries to nervous system	554	428	23	405	79	349	4	424
Meningitis	279	242	4	238	32	210	2	240
Multiple sclerosis	511	483	16	467	88	395	1	482
Neuritis	222	213	5	208	35	178	2	211
Paralysis	340	282	15	267	52	230	5	277
Poliomyelitis	211	191	6	185	27	164	2	189
Sciatica	137	127	7	120	26	101	3	124
Syphilis C.N.S.	2,462	2,161	1,345	816	862	1,299	102	2,059
Tabes dorsalis	333	294	135	159	107	187	11	283
Tic	200	183	8	175	29	154	2	181
Tremor	243	212	22	190	38	174	7	205
Other forms	902	838	46	792	139	699	28	810
Epilepsy	6,388	5,273	182	5,091	819	4,454	69	5,204
Constitutional psychopathic states	6,196	5,941	360	5,581	1,142	4,799	117	5,824
Endocrinopathies	4,805	4,506	131	4,375	591	3,915	46	4,460
Drug addiction	2,020	1,823	390	1,433	847	976	74	1,749
Alcoholism	1,858	1,834	210	1,624	583	1,251	39	1,795
Total	69,394	60,993	4,545	56,448	11,076	49,917	969	60,024

Diagnoses	Total	Colored
		Syphilis		Gonorrhea		Other venereal infection
		Admitted	Denied	Admitted	Denied	Admitted	Denied
Mental deficiency	4,055	949	3,106	1,846	2,209	166	3,889
Psychoneuroses	1,100	240	860	506	594	65	1,035
Psychoses	556	145	411	220	336	25	531
General paralysis	43	31	12	17	26	5	38
Alcoholic	5	2	3	3	2	---	5
Manic-depressive	81	9	72	33	48	4	77
Dementia pr?cox	305	58	247	117	188	10	295
Epileptic	19	6	13	8	11	4	15
Other forms	103	39	64	42	61	2	101
Nervous diseases and injuries	800	349	451	404	396	39	761
Chorea	12	5	7	3	9	---	12
Hemiplegia	48	20	28	24	24	4	44
Injuries to nervous system	126	31	95	66	60	5	121
Meningitis	37	8	29	9	28	---	37
Multiple sclerosis	28	9	19	14	14	---	28
Neuritis	9	2	7	5	4	---	9
Paralysis	58	15	43	32	26	1	57
Poliomyelitis	20	6	14	13	7	---	20
Sciatica	10	2	8	5	5	---	10
Syphilis C.N.S.	301	188	113	153	148	23	278
Tabes dorsalis	39	30	9	22	17	2	37
Tic	17	7	10	6	11	1	16
Tremor	31	10	21	21	10	1	30
Other forms	64	16	48	31	33	2	62
Epilepsy	1,115	273	842	557	558	45	1,070
Constitutional psychopathic states	255	71	184	133	122	9	246
Endorinopathies	299	85	214	148	151	18	281
Drug addiction	197	75	122	112	85	16	181
Alcoholism	24	8	16	7	17	1	23
Total	8,401	2,195	6,206	3,933	4,468	384	8,017

195

Table 26 shows that an almost equal percentage of the whiteand colored neuropsychiatric cases abstained from the use of alcohol, and thatthe ratio of moderate drinkers was also about the same. The ratio for the whitesexceeded that for the colored in the number who were classed as intemperate. Itwill be observed that a little less than one-half of the individuals werereported as moderate drinkers.

No information is obtainable which might permit a comparisonof the alcoholic habits of neuropsychiatric cases with similar habits insoldiers generally; but Table 26 permits of a comparison of the alcoholic habitsamong the different neuropsychiatric groups. There are noteworthy widevariations between the percentage of "abstinent" and"intemperate" in the various groups.

CHART XIV

TABLE 26.-Habits of neuropsychiatric cases as to alcohol

Diagnoses	Total	White					Colored
Diagnoses	Total	Total	Absti- nent	Mod- erate	Intem- perate	Unascer- tained	Total	Absti- nent	Mod- erte	Intem- perate	Unascer- tained
Mental deficiency	21,858	17,803	6,873	8,100	1,556	1,274	4,055	1,626	1,989	358	82
Psychoneuroses	11,443	10,343	4,824	4,554	541	424	1,100	522	470	84	24
Psychoses	7,910	7,354	2,383	3,102	1,278	591	556	183	261	76	36
General paralysis	530	487	81	244	121	41	43	12	20	8	3
Alcoholic	292	287	---	14	259	14	5	---	---	4	1
Manic-depressive	1,385	1,304	446	589	162	107	81	26	40	6	9
Dementia pr?cox	4,738	4,433	1,586	1,914	603	330	305	105	138	42	20
Epileptic	131	112	40	28	18	26	19	10	9	---	---
Other forms	834	731	230	313	115	73	103	30	54	16	3
Nervous diseases and injuries	6,916	6,116	2,010	2,880	741	485	800	274	395	111	20
Chorea	264	252	141	98	6	7	12	5	4	2	1
Hemiplegia	258	210	101	76	16	17	48	21	25	2	---
Injuries to nervous system	554	428	189	181	31	27	126	46	54	19	7
Meningitis	279	242	129	84	12	17	37	21	14	1	1
Multiple sclerosis	511	483	173	218	38	54	28	11	12	5	---
Neuritis	222	213	82	93	29	9	9	6	2	1	---
Paralysis	340	282	125	124	12	21	58	15	33	9	1
Poliomyelitis	211	191	105	70	5	11	20	12	7	1	---
Sciatica	137	127	43	62	8	14	10	7	2	---	1
Syphilis C.N.S.	2,462	2,161	371	1,206	437	147	301	79	160	55	7
Tabes dorsalis	333	294	48	142	60	44	39	8	22	9	---
Tic	200	183	84	76	10	13	17	10	7	---	---
Tremor	243	212	96	89	15	12	31	10	17	3	1
Other forms	902	838	323	361	62	92	64	23	36	4	1
Epilepsy	6,388	5,273	2,245	2,274	343	411	1,115	501	525	66	23
Constitutional psychopathic states	6,196	5,941	2,186	2,548	913	294	255	91	114	46	4
Endocrinopathies	4,805	4,506	2,151	1,930	198	227	299	105	154	34	6
Drug addiction	2,020	1,823	567	838	319	99	197	72	100	22	3
Alcoholism	1,858	1,834	---	---	1,771	63	24	---	---	22	2
Total	69,394	60,993	23,239	26,226	7,660	3,868	8,401	3,374	4,008	819	200

196

MARITAL STATUS

Table 27 shows the marital status of the neuropsychiatriccases. Therein it is seen that 54,166, or 78 Percent, of the 69,394 neuropsychiatric cases were single, as compared with 89.5Percent of the draft men (Class I) who were single.⁴Marriages inboth groups include widowed and divorced. There are several explanations for the excess in the percentages ofmarried men among the neuropsychiatric cases: One was the tendency of the localboards to place in Class I men who had no families to support; another is theprobability that some benedicts enlisted on account of domestic troubles,which are frequent among those handicapped by nervous and mental disease ordefects.

CHART XV

CHART XVI

It will be noticed that the number of marriages among thecolored exceeds that of the whites, the ratio more than double, and that thereis a very slight increase in the ratio of divorces among the colored.

197

TABLE 27.-Marital status ofneuropsychiatric cases

Diagnoses	Total	White						Colored
Diagnoses	Total	Total	Single	Mar- ried	Wid- owed	Divor- ced	Unascer- tained	Total	Single	Mar- ried	Wid- owed	Divor- ced	Unascer- tained
Mental deficiency	21,858	17,803	15,161	1,813	87	128	614	4,055	2,724	1,158	85	73	15
Psychoneuroses	11,443	10,343	7,882	2,062	56	131	212	1,100	670	381	21	21	7
Psychoses	7,910	7,354	5,989	932	69	115	249	556	359	160	11	8	18
General paralysis	530	487	322	105	16	27	17	43	26	14	1	---	2
Alcoholic	292	287	221	31	7	20	8	5	3	---	1	1	---
Manic-depressive	1,385	1,304	1,018	209	10	19	48	81	50	24	3	1	3
Dementia pr?cox	4,738	4,433	3,798	440	29	35	131	305	201	87	3	3	11
Epileptic	131	112	86	19	---	2	5	19	11	7	1	---	---
Other forms	834	731	544	128	7	12	40	103	68	28	2	3	2
Nervous diseases and injuries	6,916	6,116	4,553	1,128	69	122	244	800	483	263	23	22	9
Chorea	264	252	199	46	1	3	3	12	5	6	1	---	---
Hemiplegia	258	210	170	32	2	4	2	48	35	10	2	1	---
Injuries to nervous system	554	428	316	83	1	6	22	126	71	42	5	4	4
Meningitis	279	242	191	44	1	3	3	37	26	11	---	---	---
Multiple sclerosis	511	483	382	67	3	8	23	28	21	7	---	---	---
Neuritis	222	213	161	40	3	3	6	9	4	5	---	---	---
Paralysis	340	282	228	43	1	---	10	58	37	18	1	2	---
Poliomyelitis	211	191	163	24	---	---	4	20	15	4	---	---	1
Sciatica	137	127	89	29	1	3	5	10	9	1	---	---	---
Syphilis C.N.S.	2,462	2,161	1,552	436	35	68	70	301	172	105	8	12	4
Tabes dorsalis	333	294	186	59	10	9	30	39	19	18	2	---	---
Tic	200	183	136	36	1	4	6	17	8	8	1	---	---
Tremor	243	212	167	33	3	2	7	31	18	9	1	3	---
Other forms	902	838	613	156	7	9	53	64	43	19	2	---	---
Epilepsy	6,388	5,273	4,009	926	47	68	223	1,115	662	420	18	12	3
Constitutional psychopathic states	6,196	5,941	4,857	803	31	83	167	255	162	89	2	2	---
Endocrinopathies	4,805	4,506	3,570	792	21	28	95	299	197	94	7	1	---
Drug addiction	2,020	1,823	1,367	355	20	41	40	197	125	66	4	2	---
Alcoholism	1,858	1,834	1,379	282	45	74	54	24	17	6	---	1	---
Total	69,394	60,993	48,767	9,093	445	790	1,898	8,401	5,399	2,637	171	142	52

HOME ENVIRONMENT-URBAN OR RURAL

Neuropsychiatric examiners were instructed to classify allplaces of 2,500 people or over as urban, in accordance with the classificationused in the reports of the United States Census Bureau.

In the examination of the records of 200,000 selectedregistrants from urban and rural districts, 21.7 Percent of those from urbandistricts were rejected, while the rejections from the rural districts were 16.9Percent.⁵In other words, according to the Provost Marshal General,considerable physical advantage accrues to the boy reared in the country.⁵Ofthe general population of the United States, 49 Percent of the whites and 73Percent of the colored reside in rural districts.

Table 28, which shows the home environment of theneuropsychiatric cases during the World War indicates no striking differencebetween the percentage of white and colored population and the percentage ofwhite and colored neuropsychiatric cases living in the urban and ruralcommunities. A slightly higher rate of neuropsychiatric cases is to be foundamong people living in the cities, but in individual clinical conditions thereis more variation as between urban and rural environments.

198

CHART XVII

TABLE 28.-Home environment of neuropsychiatric cases

Diagnoses	Total	White				Colored
Diagnoses	Total	Total	Urban	Rural	Unascer- tained	Total	Urban	Rural	Unascer- tained
Mental deficiency	21,858	17,803	6,081	11,022	700	4,055	1,088	2,944	23
Psychoneuroses	11,443	10,343	5,889	4,167	287	1,100	429	666	5
Psychoses	7,910	7,354	4,228	2,759	367	556	216	323	17
General paralysis	530	487	374	87	26	43	28	14	1
Alcoholic	292	287	209	63	15	5	2	3	---
Manic-depressive	1,385	1,304	800	438	66	81	24	54	3
Dementia pr?cox	4,738	4,433	2,400	1,837	196	305	118	178	9
Epileptic	131	112	55	49	8	19	6	13	---
Other forms	834	731	390	285	56	103	38	61	4
Nervous diseases and injuries	6,916	6,116	3,703	2,127	286	800	406	385	9
Chorea	264	252	131	115	6	12	6	5	1
Hemiplegia	258	210	116	85	9	48	19	28	1
Injuries to nervous system	554	428	242	167	19	126	52	71	3
Meningitis	279	242	110	125	7	37	23	14	---
Multiple sclerosis	511	483	257	198	28	28	14	14	---
Neuritis	222	213	121	83	9	9	3	6	---
Paralysis	340	282	161	113	8	58	28	30	---
Poliomyelitis	211	191	115	72	4	20	6	14	---
Sciatica	137	127	72	49	6	10	5	4	1
Syphilis C.N.S.	2,462	2,161	1,510	565	86	301	178	120	3
Tabes dorsalis	333	294	196	69	29	39	20	19	---
Tic	200	183	107	68	8	17	10	7	---
Tremor	243	212	95	109	8	34	19	12	---
Other forms	902	838	470	309	59	64	23	41	---
Epilepsy	6,388	5,273	2,802	2,215	256	1,115	391	722	2
Constitutional psychopathic states	6,196	5,941	3,672	2,073	196	255	140	113	2
Endocrinopathies	4,805	4,506	2,502	1,917	87	299	123	176	---
Drug addiction	2,020	1,823	1,614	163	46	197	188	7	2
Alcoholism	1,858	1,834	1,470	305	59	24	20	4	---
Total	69,394	60,993	31,961	26,748	2,284	8,401	3,001	5,340	60

199

STATES OF RESIDENCE AND BIRTH (WITH GAIN OR LOSS FROMIMMIGRATION OR MIGRATION)

Table 29 shows the number of residents of each State includedin the present series of neuropsychiatric cases. Table 30 shows the State ofbirth of neuropsychiatric cases. In reference to the occurrence of nervous andmental diseases or defect in the individual States, a question presents itself:Are the cases found among the residents of the State the State's own people?Table 31 shows, by States, the gains or losses of neuropsychiatric cases throughforeign immigration and State migration. It will be observed that all but nineStates have more cases living in the State than were born there. Table 31 shows in detail whether the problem for each State isone of foreign immigration or is of State migration of either the white orcolored. Those interested may ascertain how immigration is related to the Stateproblem in regard to any clinical group. For instance, as concerns mentaldeficiency in Connecticut and Rhode Island, the foreign-born mental defectivesconstituted about one-half of all the cases. In New York and Massachusetts aboutone-third of the cases were of foreign birth. In New Jersey, Pennsylvania,Michigan, California, and Washington the foreign-born equaled from one-fourth toone-fifth of the total. In many of the other States the ratios were fromone-sixth to one-ninth of the totals.

Thus it may be determined in reference to any condition howmany cases more or less were residing in the State than were born there. Forinstance, the residents of Alabama gave birth to 435 of the white and 711 of thecolored mental defectives. The same State had only 397 of the whites and 656 ofthe colored mental defectives living there. In other words, the other States hadamong their mental defectives 38 whites and 55 colored which were received fromAlabama (for which the latter State received 9 in return).

The residents of the State of New York gave birth to 814 ofthe white and 12 of the colored mental defectives, and 412 of the whites came tothe State from foreign countries. Deducting the last figure from the totalwhites, it is found that the State of New York received 45 white and 35 coloredmental defectives from the other States.

Calculations similar to the ones made in the precedingparagraphs may be made by those interested for each of the different clinicalconditions for every State in the Union. The results may be of no greatpractical value because of the inability to prevent neuropsychiatric individualsfrom going where they are taken by their parents. The information may proveuseful, however, to those who wish to determine the localities that furnish morethan their quota of neuropsychiatric conditions.

200-205

TABLE 29.-State of residence of neuropsychiatric cases

206-210

TABLE 30.-State of birth of neuropsychiatric cases

211

TABLE 31.-Gain or loss of neuropsychiatriccases resulting from immigration or migration^a

	Total gain or loss	State migration		Foreign immigration		Total gain or loss	State migration		Foreign immigration
	Total gain or loss	White	Colored	Foreign immigration		Total gain or loss	White	Colored	Foreign immigration
Alabama	-211	-98	-120	+7	Nevada	+48	+35	+1	+12
Arizona	+98	+76	+6	+16	New Hampshire	+37	+4	---	+33
Arkansas	+2	-55	+53	+4	New Jersey	+782	+437	+37	+308
California	+1,223	+924	-26	+325	New Mexico	+30	+17	+4	+9
Colorado	+252	+198	-2	+56	New York	+3,769	+1,980	+117	+1,672
Connecticut	+438	+244	+4	+190	North Carolina	-133	-39	-99	+5
Delaware	+32	+7	+12	+13	North Dakota	+157	+106	-2	+53
Florida	+118	+87	+12	+19	Ohio	+1,079	+555	+103	+421
Georgia	-38	+42	-96	+16	Oklahoma	+778	+677	+80	+21
Idaho	+101	+86	+2	+13	Oregon	+130	+117	-19	+32
Illinois	+1,417	+693	+96	+628	Pennsylvania	+2,514	+1,321	+148	+1,045
Indiana	+137	+38	+17	+82	Rhode Island	+154	+75	+3	+76
Iowa	-114	-177	+13	+50	South Carolina	-100	-3	-99	+2
Kansas	-7	-32	-5	+30	South Dakota	+75	+49	-2	+28
Kentucky	-288	-251	-48	+11	Tennessee	-126	-151	+20	+5
Louisiana	+10	+19	-23	+14	Texas	+22	+2	-28	+48
Maine	+101	+42	---	+59	Utah	+28	+13	-1	+16
Maryland	+181	+87	+45	+49	Vermont	+11	-1	---	+12
Massachusetts	+896	+448	+7	+441	Virginia	+138	+117	+5	+16
Michigan	+1,033	+558	+36	+439	Washington	+354	+273	---	+81
Minnesota	+381	+201	+8	+172	West Virginia	+298	+215	+43	+40
Mississippi	-131	-42	-96	+7	Wisconsin	+233	+80	+2	+151
Missouri	+171	+1	+81	+89	Wyoming	+102	+80	+2	+20
Montana	+259	+200	+4	+53	District of Colombia	+111	+65	+29	+17
Nebraska	+16	-40	+9	+47

^aDataunascertained for 2,755 cases.

RACE

Table 32 shows the distribution of neuropsychiatricconditions among the races concerned. From it may be seen the distributionaverages attained by the several races. Table 33 furnishes information in regardto the four foreign-born peoples of which the numbers were adequate. This tableoffers opportunity for comparing the occurrence of neuropsychiatric conditionsbetween the native and foreign born in the four peoples.

The results as to the different races classified worthy ofnotice are summarized below.

AFRICAN (NEGRO)
(Number classified, 8,401)

A high distribution rate of mental defect and a lowdistribution rate of alcoholism is found in this race. The low alcoholicdistribution exists in spite of the fact that the alcoholic habits of Negroesare about the same as of whites. From this comparison it appears that the Negrocan be practically as intemperate as the white man without paying the samepenalty for it. On the other hand, he has a higher ratio of venereal disease.(See Table 25.) By reason of this, it would seem that some modification might bemade in the views of those who place alcohol as the chief factor in the spreadof venereal diseases. A similar, though less marked, resistance to the invasionof the central nervous system by syphilis is shown by the Negro. Amongneuropsychiatric patients the previous history of syphilis was more than threetimes as frequent in the colored asin the whites, but the invasion of the central nervous system was about equal inthe two classes.

212

TABLE 32.-Races of neuropsychiatric cases

Diagnoses	Total	African (Negro)	American Indian	Armenian	Dutch	English	French	German	Greek	Hebrew	Irish	Italian
Mental deficiency	21,858	4,055	78	26	86	2,651	274	1,217	67	226	936	803
Psychoneuroses	11,443	1,100	6	11	49	1,501	174	761	70	331	662	443
Psychoses	7,910	556	5	10	43	1,070	95	552	39	196	524	237
General paralysis	530	43	---	---	3	74	4	36	3	6	56	12
Alcoholic	292	5	---	---	3	23	---	27	3	1	46	4
Manic-depressive	1,385	81	---	---	5	165	18	115	11	41	70	57
Dementia pr?cox	4,738	305	5	8	22	705	59	332	20	128	288	133
Epileptic	131	19	---	---	---	8	3	3	---	6	6	7
Other forms	834	103	---	2	10	95	11	39	2	14	58	24
Nervous diseases and injuries	6,916	800	5	8	38	913	102	418	25	98	516	191
Chorea	264	12	1	---	3	43	6	14	---	2	27	3
Hemiplegia	258	48	---	1	2	23	8	10	3	5	13	3
Injuries to nervous system	554	126	1	---	3	61	6	40	3	10	31	15
Meningitis	279	37	---	---	1	40	6	18	4	2	23	7
Multiple sclerosis	511	28	---	---	4	74	11	35	---	6	41	10
Neuritis	222	9	---	2	3	40	5	16	---	2	14	13
Paralysis	340	58	---	---	2	45	5	19	---	9	13	10
Poliomyelitis	211	20	---	1	1	22	2	15	1	4	10	11
Sciatica	137	10	---	---	---	14	2	10	---	6	17	11
Syphilis C.N.S.	2,462	301	2	2	12	316	28	125	14	30	212	68
Tabes dorsalis	333	39	---	---	3	37	4	16	---	4	28	8
Tic	200	17	---	---	---	37	6	27	---	3	9	4
Tremor	243	31	---	---	---	33	3	17	---	---	18	4
Other forms	902	64	1	2	4	128	10	56	---	15	60	24
Epilepsy	6,388	1,115	9	7	34	813	102	321	38	93	366	315
Constitutional psychopathic states	6,196	255	11	6	33	975	75	433	23	203	497	228
Endocrinopathies	4,805	299	3	1	34	796	55	474	15	73	287	94
Drug addiction	2,020	197	4	---	5	171	25	70	1	88	222	131
Alcoholism	1,858	24	3	---	6	202	39	105	3	6	452	10
Total	69,394	8,401	124	69	328	9,092	941	4,351	281	1,314	4,462	2,452

Diagnoses	Japanese	Mexican	Filipino	Porto Rican	Scand- inavian	Scotch	Slavonian	Spanish	Welsh	Other peoples	Mixed	Race unascer- tained
Mental deficiency	---	257	3	1	296	72	915	31	13	237	6,490	3,124
Psychoneuroses	1	16	---	2	221	106	378	19	16	123	4,333	1,120
Psychoses	1	18	1	2	217	71	358	11	9	84	2,889	922
General paralysis	---	1	---	---	10	17	17	---	1	5	164	78
Alcoholic	---	---	---	---	5	1	14	---	---	2	120	38
Manic-depressive	---	6	---	---	31	11	63	---	2	13	535	161
Dementia pr?cox	1	10	---	2	152	36	231	9	5	60	1,700	527
Epileptic	---	---	---	---	---	2	2	---	---	---	58	17
Other forms	---	1	1	---	19	4	31	2	1	4	312	101
Nervous diseases and injuries	---	22	---	3	127	96	181	16	16	62	2,406	873
Chorea	---	1	---	---	6	2	1	---	---	---	111	32
Hemiplegia	---	2	---	---	4	3	9	---	1	1	95	27
Injuries to nervous system	---	2	---	---	10	9	15	3	3	3	170	43
Meningitis	---	2	---	---	4	3	1	1	---	1	96	33
Multiple sclerosis	---	1	---	---	16	8	18	1	2	3	198	55
Neuritis	---	3	---	---	8	5	8	---	---	---	78	16
Paralysis	---	1	---	---	5	2	8	1	---	3	131	28
Poliomyelitis	---	---	---	---	4	3	4	2	---	3	91	17
Sciatica	---	1	---	---	1	3	6	2	---	1	47	6
Syphilis C.N.S.	---	4	---	1	44	38	68	5	5	31	802	354
Tabes dorsalis	---	---	---	1	5	3	7	---	1	2	112	63
Tic	---	---	---	---	2	2	3	---	1	4	67	18
Tremor	---	1	---	---	3	2	5	---	---	2	76	48
Other forms	---	4	---	1	15	13	28	1	3	8	332	133
Epilepsy	---	45	2	---	85	54	163	13	5	61	2,046	701
Constitutional psychopathic states	---	15	---	---	105	62	247	12	11	73	2,347	585
Endocrinopathies	---	9	---	---	132	60	141	1	6	33	1,691	601
Drug addiction	---	2	---	---	24	27	29	4	1	10	870	139
Alcoholism	---	---	1	1	49	31	62	2	8	12	532	310
Total	2	384	7	9	1,256	579	2,474	109	85	695	23,604	8,375

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TABLE 33.-Percent distribution ofneuropsychiatric conditions among four different races, with comparisons betweenthe American born and the foreign born

Race	Number classified	Percent of total of each nativity
Race	Number classified	Mental deficiency	Psycho- neuroses	Psychoses	Neurological condition	Epilepsy	Constitutional psychopathic states	Endocrino- pathies	Drug addiction	Alcoholism
Italians:
American born	413	33.9	13.6	11.6	6.5	2.2	10.9	1.0	19.1	1.2
Foreign born	2,039	32.5	19.0	9.3	8.0	15.0	9.0	4.4	2.6	.2
Scandinavians:
American born	890	26.7	17.8	15.4	9.1	6.6	8.3	11.0	2.1	2.8
Foreign born	366	15.8	16.9	21.9	12.6	7.1	8.5	9.3	1.4	6.6
Irish:
American born	4,068	21.6	14.7	10.9	11.6	8.2	11.6	6.6	5.4	9.4
Foreign born	394	15.0	15.7	20.1	10.9	7.9	6.6	4.8	1.0	18.0
German:
American born	4,164	28.1	17.6	12.3	9.6	7.3	10.1	11.0	1.6	2.4
Foreign born	187	25.7	15.5	21.4	10.7	8.6	7.0	7.5	1.6	2.1

TABLE 34.-Races of neuropsychiatric cases.Classification percentage

Race	Total classified		Percent of total of each race
Race	Number	Percent	Mental deficiency	Psycho- neuroses	Psychoses	Neuro- logical	Epilepsy	Consti- tutional psycho- pathic states	Endocrin- opathies	Drug addiction	Alco- holism
African (Negro)	8,401	12.1	48.3	13.1	6.6	9.5	13.3	3.0	3.6	2.3	0.3
American Indian	124	.2	62.9	4.8	4.0	4.0	7.3	8.9	2.4	3.2	2.4
Armenian	69	.1	37.7	15.9	14.5	11.6	10.1	8.7	1.4	---	---
Dutch	328	.5	26.2	14.9	13.1	11.6	10.4	10.1	10.4	1.5	1.8
English	9,092	13.1	29.2	16.5	11.8	10.0	8.9	10.7	8.8	1.9	2.2
French	941	1.4	29.1	18.5	10.1	10.8	10.8	8.0	5.8	2.7	4.1
German	4,351	6.3	28.0	17.5	12.7	9.6	7.4	10.0	10.9	1.6	2.4
Greek	281	.4	23.8	24.9	13.9	8.9	13.5	8.2	5.3	.4	1.1
Hebrew	1,314	1.9	17.2	25.2	14.9	7.5	7.1	15.4	5.6	6.7	.5
Irish	4,462	6.4	21.0	14.8	11.7	11.6	8.2	11.1	6.4	5.0	10.1
Italian	2,452	3.5	32.7	18.1	9.7	7.8	12.8	9.3	3.8	5.3	.4
Mexican	384	.6	66.9	4.2	4.7	5.7	11.7	3.9	2.3	.5	---
Scandinavian	1,256	1.8	23.6	17.6	17.3	10.1	6.8	8.4	10.5	1.9	3.9
Scotch	579	.8	12.4	18.3	12.3	16.6	9.3	10.7	10.4	4.7	5.4
Slavonian	2,474	3.6	37.0	15.3	14.5	7.3	6.6	10.0	5.7	1.2	2.5
Spanish	109	.2	28.4	17.4	10.1	14.7	11.9	11.0	.9	3.7	1.8
Welsh	85	.1	15.3	18.8	10.6	18.8	5.9	12.9	7.1	1.2	9.4
Mixed	23,604	34.0	27.5	18.4	12.2	10.2	8.7	9.9	7.2	3.7	2.3
Other peoples	713	1.0	33.8	17.7	12.3	9.1	8.8	10.2	4.6	1.4	2.0
Race unascertained	8,375	12.1	37.3	13.4	11.0	10.4	8.4	7.0	7.2	1.7	3.7
Total cases	69,394	100.0	31.5	16.5	11.4	10.0	9.2	8.9	6.9	2.9	2.7

With the exception of mental deficiency and epilepsy, the Negro falls belowall United States distribution averages. He is especially low in psychoses,constitutional psychopathic states, and alcoholism. In the psychoneuroses, theNegro presents distinct differences from the white man. He is more prone tohysteria than to neurasthenia, and stammering is nearly twice as frequent with him as is neurasthenia. The psychological mechanism of thedisorder is simple, as these conditions in Negroes were identified morefrequently by examining and discharging officers. In Negroes the psychoneurosesoccurred more frequently in the younger age groups than in the whites. TheNegro is given to early marriage, lives more in the country, and contends withespecially unfavorable circumstances as concerns education and modern standardsof' living.

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AMERICAN INDIAN
(Number classified, 124)

The American Indian is primitive, like the Negro, and exceedseven the latter in mental deficiency. He is not so much below the average inalcoholism or drug addiction as the Negro, but is somewhat below him inepilepsy. In other neuropsychiatric conditions the Indian falls below all UnitedStates averages.

As concerns non-native races, it should be remembered thatthe information which follows stands by itself, and is not supplemented by anyfacts as to the circumstances of residence of these races in this country, noras to the causes of their immigration or nature of occupation. There is noinformation as to whether these individuals are representative of the same racesliving at home.

Comparison can be made also between the native born and theforeign born of the different races given in Table 33. Certain definitevariations are noticeable; for example, practically all native born are moreaddicted to the use of drugs than are the foreign born. The influence of thiscountry seems to arouse a drug inebriety or to convert an alcoholic inebrietyinto a drug inebriety. Similarly, foreigners seem to undergo a decrease ininsanity from residence in this country.

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

Country of birth	Number classified	Percent of total of each nativity
Country of birth	Number classified	Mental deficiency	Psycho- neuroses	Psychoses	Neuro- logical	Epilepsy	Consti- tutional psycho- pathic states	Endo- crino- pathies	Drug addiction	Alco- holism
Austria-Hungary	462	31.8	14.9	19.0	5.6	11.0	8.7	6.5	1.1	1.3
Canada	337	21.4	16.6	13.4	12.8	9.2	10.1	4.5	3.0	9.2
Denmark, Norway, Sweden	366	15.8	16.9	21.9	12.6	7.1	8.5	9.3	1.4	6.6
England, Scotland, Wales	323	9.3	24.5	12.1	12.4	8.4	15.2	5.0	3.1	10.2
France	49	20.4	16.3	10.2	24.5	14.3	8.2	2.0	2.0	2.0
Germany	187	25.7	15.5	21.4	10.7	8.6	7.0	7.5	1.6	2.1
Greece	242	24.0	23.1	15.3	9.1	14.5	7.4	6.2	.4	---
Holland	50	18.0	16.0	24.0	4.0	20.0	8.0	8.0	---	2.0
Ireland	394	15.0	15.7	20.1	10.9	7.9	6.6	4.8	1.0	18.0
Italy	2,039	32.5	19.0	9.3	8.0	15.0	9.0	4.4	2.6	.2
Poland	331	43.5	15.1	13.0	6.9	6.9	9.1	4.2	.3	.9
Russia	1,675	32.1	21.1	15.3	7.2	5.7	11.3	4.4	1.4	1.5
Switzerland	31	6.5	22.6	25.8	9.7	9.7	6.5	9.7	---	9.7
Others	772	28.9	17.5	17.2	9.5	9.6	11.1	3.6	.8	1.8

DUTCH
(Number classified, 328)

The Dutch come near the United States average in almost all groups. Theydrink more than they take drugs, but in both are below the United Statesaverages. They have a few less neurotics and a few more of the other classifieddisorders, except mental deficiency, alcoholism, and drug addiction.

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ENGLISH
(Number classified, 9,092)

The English, like the Dutch, approximate the United Statesaverage in practically all groups. They are more inclined to drink than to takedrugs, and have a slight excess of epilepsy, endocrine disturbances, andconstitutional psychopathic states. They just reach the United States averagefor mental defect.

FRENCH
(Number classified, 941)

The French show rather a high total of inebriety, being abovethe average in alcoholism, and only a little below it in drugs, their totalinebriety percentage being 6.8 Percent as compared with 4.1 Percent forEnglish, and 4 Percent for the Germans. They also exceed the average inpsychoneuroses, neurological conditions, and epilepsy. They are considerablybelow the average in endocrine disorders and constitutional psychopathic states,and are about equal to the United States average for mental defect. The excessof inebriety in the French may surprise many, as the French are said to be awine-drinking people, and it is a common belief that wine-drinking people do notsuffer from alcoholism. As a matter of fact, alcoholism depends more upon theamount of absolute alcohol imbibed than upon the form in which it is taken. Ifenough wine or beer or any other beverage with comparatively low alcohol contentis taken, a person becomes alcoholic.

AMERICAN-BORN GERMAN
(Number classified, 4,164)

In spite of his reputed beer-drinking customs, the nativeGerman fails to reach the United States average in alcoholism, and is not muchgiven to drugs. On the other hand, he exceeds, slightly, the United Statesaverage in psychoses, psychoneuroses, and constitutional psychopathic states,and by 3.6 Percent in endocrine troubles. He is slightly below United Statesaverage in mental defect.

FOREIGN-BORN GERMAN
(Number classified, 187)

The foreign-born German shows a much higherrate for insanity than the native born, and one considerably lower in endocrinetroubles and mental defect.

GREEK
(Number classified, 281)

The Greeks are very low in inebriety, especially as concernsdrugs, but exceed the United States average in epilepsy, the psychoses, and thepsychoneuroses, an excess particularly noticeable in epilepsy and thepsychoneuroses. They are well below the average in mental defect andconstitutional psychopathic states.

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HEBREW
(Number classified, 1,314)

The American-born Hebrew shows a very striking contrast inhis habits of inebriety as far as the choice of alcohol and drugs is concerned.The number of Hebrew alcoholics is almost negligible, while the percentage ofdrug addicts is more than double the United States rate. The Hebrew is also lowin neurological conditions, epilepsy, endocrine disturbances, and mentaldeficiency. The low percentage of mental defect is particularly striking; theonly classified races which show less being the Scotch. The Hebrew exceeds, onthe other hand, the average representation in the conditions characterized byemotional instability. He is nearly 3 Percent above the United States averagefor insanity, and is very much above it in the psychoneuroses and theconstitutional psychopathic states.

AMERICAN-BORN IRISH
(Number classified, 4,068)

The American-born Irish show the most pronounced tendency toinebriety of any racial group except the foreign-born Irish, and theirintemperance relates to both alcohol and drugs. Inebriety constitutes 14.8 Percent of all their neuropsychiatric disorders. Although they are less thanone-sixteenth of all the neuropsychiatric cases, the native-born Irishcontribute more than one-fifth of all the cases of alcoholism identified by theneuropsychiatric examiners and more than one-tenth of all the cases of drugaddiction. With the exception of inebriety, neurological conditions, andconstitutional psychopathic states, they sink below all United States averages.They are so far below this average in mental defect that they confirm thegeneral law of the incompatibility of alcoholism and mental defect. They alsofurnish an interesting example of a high distribution of alcoholism with anunderaverage of mental disease. It would seem that if alcoholism were animportant cause of insanity, one would find an excess of it, instead of anunderaverage in a group so given to alcoholic intemperance as this one is. Butin this connection it should be remembered that drafted men, as a class, were too young to have developed alcoholicinsanity.

The Irish offer an interesting comparison with the English.They have more inebriety by 11 Percent and less mental defect by 8.2 Percent.The excess of alcoholism and the lesser amount of mental defect would show themto be a livelier, more excitable race than the English, which is rather borne outby theirhaving a slight excess of constitutional psychopaths than the English.

FOREIGN-BORN IRISH
(Number classified, 394)

The foreign-born Irish have a distribution rate of mentaldefect 6.6 Percent lower than that for the native. They have also a lowerdistribution rate of constitutional psychopathic states and endocrine troubles.Insanity and inebriety are much higher among them than among those born in thiscountry. Inebriety changes both in extent and in its own distribution.There is a lessened total rate of inebriety by 4.2 Percent among the native, and even a greater falling off in the distribution rateof alcoholism. Nearly one-half of the decrease

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in alcoholism isaccounted for by an increase in drug addiction among thenative born. It would seem at first sight that the lowering of the distributionrate for insanity among the native-born Irish was to be connected with thelowering of the alcohol rate, but it should be observed that a similar decreasein insanity distribution occurs in the German native born as compared withforeign born, with an increase inalcoholism, and a smaller decrease in insanity among Scandinavian native born,with a large decrease in the alcohol rate.

AMERICAN-BORN ITALIANS
(Number classified, 413)

The native Italians present a distribution ofneuropsychiatric disorders which indicates a sluggish, backward mentality. Asdrug addicts they have a much larger percentage than the Jews, and like the Jewsare little given to alcoholic inebriety. Some races, such as the Jews and theIrish, seem to be able to surpass the average in drug inebriety, and still,through the low percentage of other disorders which indicate racialbackwardness, retain the characteristics of nimble-minded people. For example,the Irish, while they are excessive drug users, are more given to intemperancein alcohol than in drugs; and of the two, alcoholic intemperance seems toindicate a more active mentality than does the secret and solitary use of drugs.Both Irish and Jews, while exceeding the average for drugs, are far below it inmental defect. But the Italians make the poorer choice for the satisfaction oftheir inebriate tendencies; and in addition to that show their racialbackwardness by a preponderance of those other disorders which must be acceptedas indicative of inferiority. In mental defect the native Italians exceed theUnited States average rate by 4.7 Percent, but in epilepsy they fall below theUnited States average by 6.4 Percent. In respect to the distribution ofneuropsychiatric defects in general, they manifest a remarkable correlation withthe two primitive races, the Negro and the American Indians. All three have anexcess of mental deficiency and are below the average in mental diseases. Allthese are low in endocrine troubles, and take drugs more than they drink.

FOREIGN-BORN ITALIANS
(Number classified, 2,039)

The foreign-born Italian shows considerable variation fromthe native in the distribution of neuropsychiatric disorders. The rate forepilepsy and psychoneuroses is much higher among the foreign born, but the ratefor drug addiction is higher among the native, as in fact it is among all thenative-born European races except the Germans, where the two percentages areequal.

MEXICANS
(Number classified, 384)

Of all the races classified the Mexicans have the highestrate for mental defect, 66.9 Percent. They exceed even the Negroes and AmericanIndians. As all percentages arebased on the total neuropsychiatric cases from each race, it is evident thatwhen two-thirds of the total is taken up by a single condition the percentagesof the other eight conditions must be low. So it is with the

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Mexicans. With thesingle exception of epilepsy, they are below the United States average in allother neuropsychiatric groups. There was not a single alcoholic among them, andonly two drug addicts, as contrasted with 45 epileptics and 257 mentaldefectives.

MIXED RACES
(Number classified, 23,604)

The mixed races include those whose ancestors were ofdifferent races. This group, of course, includes most "Americans." Thelarge number (almost one-third of the total cases) makes this groupfundamentally important in the establishment of the United States average.

AMERICAN-BORN SCANDINAVIANS
(Number classified, 890)

Native Scandinavians (Norwegian, Danish, Swedish, Icelandic)show an excess of mental disturbances and endocrine troubles. They slightlyexceed the United States average of psychoneuroses. They are well below theaverage in mental defect and in epilepsy.

FOREIGN-BORN SCANDINAVIANS
(Number classified, 366)

The foreign-born Scandinavians show much less mentaldeficiency than those born here, and, strangely enough, less endocrinopathy. Onthe other hand, they show an excessive percentage of alcoholism and insanity ascompared with the American born.

SCOTCH
(Number classified, 579)

The Scotch exceed the United States average in all groupsexcept that of mental deficiency. The mental deficiency rate is lower than thatof any other race and is 16.8 below the United States average. The inebriety ishigh; but, as in all races which have a low mental-deficiency rate, alcoholismexceeds drug taking.

SLAVONIC
(Number classified, 2,474)

This racial classification includes Bohemian, Bosnian,Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian,Ruthenian, Serbian, Slovak, and Slovenian. The Slays have a highmental-deficiency rate, in spite of which their inebriety is alcoholic ratherthan narcotic. Both varieties of inebriety are below the United States average.The comparative infrequency of epilepsy is worthy of remark, especially in viewof the high mental deficiency. In spite also of the sluggishness indicated bythe excess of mental deficiency, they have an emotional sphere of some activity,as is shown by the excess of psychoses among them.

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CORRELATIONS OF NEUROPSYCHIATRIC WITH OTHER CLINICALCONDITIONS

In the following pages, in which the nine different clinicalgroups are described in detail, it appears that a certain "antagonism"exists between some of the different clinical conditions. That is, where a givencondition exists in excess, other conditions vary in a way that can notaltogether be explained by the variations inevitable in a method of distributionpercentage average of the preponderance on one condition over another. Forexample, the variations between mental defect and alcoholism are constant: Whereone rises, the other falls. With these two this relationship or antagonism isconstant as concerns States' populations and native and foreign born races. Itis believed that the connections of these two conditions have a certainsignificance as to the environmental condition, perhaps of the traits ofcharacter of the peoples concerned. Drug addiction, the psychoses, andendocrinopathies showed a similar disharmony with mental defect, though not soconclusively as with alcoholism. Efforts to establish correlations between thepsychoneuroses and constitutional psychopathic states have been less successful.There seems to be no correlation of symptoms between the psychoneuroses and theendocrine group. The character of epilepsy in this respect is that it so nearlycorresponds in both states and races with the United States average. This matterwill be considered in more detail below under the separate captions.

MENTAL DEFECT

The outstanding features in regard to mental defect, asrevealed by the statistics herein, are its wide distribution throughout theUnited States, with an especial excess in the Negro and the American Indian;its apparent antagonism to alcoholism, in that in the communities and raceswhere it exceeds the United States distribution average, alcoholism falls belowit, and vice versa.

It is a definite clinical entity, classifiable and distinctfrom insanity or any other of thedifferent neuropsychiatric conditions, and is a result of a failure ofdevelopment of the mentality up to a capacity which, as we are dealing only withadults, we may call adult capacity. Among its chief characteristics are lack ofinitiative, undue suggestibility, and lack of ability in meeting new situations.

The distribution of mental deficiency is postulated as anindex of general intelligence, because where it is widely distributed theaverage intelligence can hardly fail to be lowered thereby. The standard ofintelligence is lowered not only by the actual mental defectives, but by thenumber of dull people which the existence of mental defect implies. The standardof mental defect employed in the Army-i. e., a mentality not exceeding that ofa child of 8 years⁶-implies a degree of incompetency so profoundthat the individual, whatever his race or surroundings, could not be counted onto take care of himself. Such a degree of inferiority is found in only arelatively small number of any race or people, but its occurrence has a directbearing on the general intelligence and educability of the people in whom itoccurs. It is probable that for every case of mental defect of the 8-year-oldmentality standard, there are at least 10 cases of backward or retardedmentality.

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In addition to the lowering of the general intelligencethrough a high proportion of mental defectives, together with the dullards whichgo along with them, the quality of the general intelligence is further impairedby the reduction in the chances of the existence of persons of superiorintelligence.

The significance of a high proportion of distinctly inferiorpersons in a community becomes apparent when different countries, and especiallywhen different races, are compared. For example, as concerns mental defect, theAmerican Indian presents a distribution rate of more than double, and the Negroa rate little less than double, that of the rate among whites over the wholeUnited States. This in itself is enough to explain the inability of the tworaces to compete with the average American. The Mexican living in the UnitedStates presents an even higher rate for mental defect (66.9 Percent) but forthem, as in fact for all races which may have immigrated here within recentyears, we can draw no such general conclusions as we can for the indigenousIndian and Negro. The most that can be said for the foreign races which presenta high distribution rate for mental defect, such as the Slavs (37 Percent) andthe Italians (32.7 Percent) is that the ones living here now are distinctlybelow the average United States intelligence. It would be impossible to inferthat these races at home present the same degree of mental inferiority.

The extreme dissemination of so disabling a condition asmental defect throughout men of military age marks this subject as the mostimportant department of public mental hygiene. The combined totals of the draftand camp examinations shows that it existed to such an extent that theindividual was unfit as a soldier in 12.06 out of every 1,000 men examined.There were registered 10,101,506 men between the ages of 21 and 31 years, andthe ratio of 12.06 per 1,000 gives for this number 121,824 unfit from mentaldefect, in this registrant class.

The ratio considered above includes only men who wererejected for military service. In addition there must be considered the numberwho were discharged on this account after they had entered the Army. This numberwas 10,648, or a ratio of 2.60 per 1,000.

If mental deficiency ran uniformly among persons of all agesand of both sexes, there would be, on the basis of 100,000,000 population,1,218,000 mental defectives in the United States. This number would be anunderstatement, however, because, while the distribution of mental defect in thetwo sexes is about equal, many defectives die before reaching the age period onwhich the estimates are based. Also,inasmuch as the standard of rejection in the Army was low, and as for everyrejection there were accepted, without question, several dull, stupid,border-line type recruits, it is easy to see that the figures of 1,218,000 mustbe multiplied several times before the full significance to the country of thecondition is realized.

The general disadvantages of having mental defectives in anarmy are obvious. Their inability to learn and understand orders interferes withthe training of normal recruits. Their lack of judgment makes them unfitted toaccept responsibility. Their failure to reach normal standards and theirundeveloped sense of obligation is a constant source of difficulty andfrequently

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brings them into the military courts. Of the disciplinarycases reported by neuropsychiatrists 42.3 Percent were mental defectives.

When, after the war, disabled ex-soldiers came under thecharge of the Bureau of War Risk Insurance, the mental defectives had almostdisappeared as hospital inmates. The explanation for this may be that they didnot require hospital care, or that they had gone back to work for theirfamilies, chiefly on farms, or that they lacked the enterprise to requesthospitalization.

CLASSIFICATION

In the classification of the mental defectives discovered inthe Army, conventional terms were employed (see Table 6); an imbecile wasconsidered as one capable of guarding himself against common physical danger,but incapable of earning a living; a moron as one capable of earning a livingunder favorable circumstances, but incapable of competing on equal terms withhis normal fellows.

No idiot came under the observation of the neuropsychiatricofficers, and, among the whites, morons constituted approximately two-thirds ofthe mental defectives and imbeciles one-third. The negroes showed a higherpercentage of grave defects, as among them the imbeciles constituted 47.7 Percent of the cases and the morons, or higher grades, sank to 50 Percent with 0.8Percent border-line cases. Of the cases rejected at local boards, as reportedin the report of the Provost Marshal General, no classification as to mentalgrade was made. The present statistics refer to a definite group, and so it isnot possible to compare the classification derived from them withclassifications obtained in civil life.

METHODS OF DISCOVERING CASES

Twenty-eight Percent of the mental defectives discoveredwere referred by medical officers, and 26 Percent by line officers, notablycompany commanders. (See Table 8.) They were referred chiefly because they couldnot understand or learn. These two percentages disclose the satisfactorycooperation that existed between the specialists and the officers of the Army asa whole. As far as medical officers were concerned, any doubt that may haveexisted in their minds as to the nature of the diagnosis was relieved by theconsultation, so that they could proceed confidently to the necessary steps fordischarge on account of disability. Hospital beds were thereby relieved.

In connection with examinations made of members of the Armyby the psychologists, all men falling into the lowest group as a result of thepsychological examinations were to be referred to the psychiatrist as suitablefor discharge. Information as to the exact number of cases so referred has notbeen obtainable. Partial reports of the section of psychology of the SurgeonGeneral's Office give the number as 4,555 from the examination of 1,147,829 men. If a man was considered unfit for service afterreceiving a psychiatric examination he was recommended for discharge by thepsychiatrist and the case was reported to the Office of the Surgeon General onForms 89 and 90 Medical Department, from which the statistical data of thisstudy have been compiled. According

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to the available records, specific recommendations were madeby the psychiatrists on only 936 of the cases referred. Of this number, 175cases, or 18.7 Percent, were found to be not mental defectives. These 175 caseswere diagnosed as follows: Psychoneuroses, 45; psychoses, 28; constitutionalpsychopathic states, 26; nervous disease and injuries, 29; endocrinopathies, 23;epilepsy, 22; and drug addiction, 2.

LENGTH OF SERVICE PRIOR TO DISCOVERY

Prior to the expiration of the average training period,18,858, or about 86 Percent of the total number of mental defectives, had beenidentified. (See Table 10.) There were 1,475 mental defectives recorded at BaseHospital No. 214, the one central receiving point for such cases in the AmericanExpeditionary Forces.² Many of these probably were border-line cases. Of the1,475 reported as admitted to Base Hospital No. 214 as mental defectives, only762 reached the ports of the United States under that diagnosis. Many of theothers may have been put back on a duty status, after treatment in hospital andsubsidence of the reactionary episode-so common among the feebleminded understrain and excitement-that caused their admission.

A higher percentage of colored casesthan of white ones was discovered in the first three months and a lower oneafter the first six months.

RECOMMENDATIONS FOR DISPOSITION

Table 12 shows that only 206 cases, or 1 Percent of thoseidentified, were recommended for full duty. Mental defect was one of theneuropsychiatric conditions for which limited service was allowable, and 2,791,or 12.8 Percent, such recommendations were made. Labor battalions wereregarded as organizations where the Negro, for limited service, could do well,and so a higher percentage of Negroes (16.4 Percent) were recommended forlimited service than whites (11.9 Percent). The proverbial freedom fromphysical illness of mental defectives is substantiated by the fact that only 76cases (0.3 Percent) were retained in the hospital for treatment.

DELINQUENCY

Of the total number of mental deficiency cases, 562 white and71 colored men, or 3 Percent, were referred to the neuropsychiatric officersfor opinion as to the causes of misconduct. Mental deficiency heads the list ofneuropsychiatric conditions found among the men tried for military offenses,constituting 40.5 Percent of the white and 64 Percent of the colored. But alarger percentage of constitutional psychopaths and insane were delinquent thanof mental defectives.

Mental deficiency was not so frequent among theneuropsychiatric prisoners at Fort Leavenworth as it was among delinquents inthe camps. This fact may indicate that the mental defectives are in general thepetty offenders and the individuals who commit chiefly misdemeanors.

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TABLE 36.-Classification of family neuropathic taints among mental defectives, according to disorder and relatives

Neuropathic taint in family	Number of cases	Number of relatives
	Number of cases	Fathers	Mothers	Grandparents	Siblings^a	Collaterals^b
	White
Nervous disease	2,967	686	1,542	79	1,419	376
Mental disease	2,146	353	403	194	650	972
Inebriety	2,630	1,963	55	55	781	446
Mental deficiency	1,478	244	243	9	1,339	151
Total	9,221	3,246	2,243	337	4,189	1,945
	Colored
Nervous disease	489	110	196	32	399	139
Mental disease	709	83	113	52	264	432
Inebriety	398	248	18	8	196	87
Mental deficiency	274	32	36	3	292	52
Total	1,870	473	363	95	1,151	710
Total, white and colored	11,091	3,719	2,606	432	5,340	2,655

^aSiblings include brothers andsisters.
^bCollaterals include uncles, aunts, and cousins.

FAMILY HISTORY

The information covering family history is open to thecriticism that it was furnished by a class of patients less qualified to beaccurate about such matters than most representatives of the neuropsychiatricgroup. (See Tables 13 to 17.) Mental defectives, when questioned about theirforbears, may well be suspected of not having the knowledge that would enablethem to give correct answers. They might and probably would know if members ofthe immediate family had been in an institution, but otherwise would be unawareof the existence of psychiatric conditions. This would be particularly the casefor histories of mental deficiency itself which, in certain sections of thecountry, exists as a family characteristic and so would not be remarked bymembers of the family. This probably accounts for the relatively few instancesof mental defect in forbears, as shown in Table 17. About four-fifths of thehistories recorded data on these several points. Psychopathic inheritanceexisted in a little more than one-half of the whites and a little less thanone-half of the colored.

Table 36 shows the large number of mothers among both thewhite and colored who had nervous diseases; also the large number of inebriates,chiefly alcoholics, among the fathers. Mental disease and defects are aboutequally balanced between fathers and mothers among both the white and colored.

The same table shows the large number of brothers and sisters-listedin the table as siblings-who were victims of nervous disease and mentaldefect. This appears to be true for both the white and colored. Mental diseasesalso ran high among the brothers and sisters of the colored mental defectives.The table also shows the small number of mental defectives and the large numberof cases of mental disease among collateral relatives.

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AGE

Relatively few of the colored cases were found to be under 20years of age, the greater percentage being between the ages of 20 and 25 years.(See Table 20.) As already stated, of the men placed in Class I between the agesof 21 and 29 years, 62 Percent were between the ages of 21 and 24 and 38 Percent between the ages of 25 and 29. The corresponding percentages for the casesof mental deficiency are 59.4 and 40.6. The difference of less than 3 Percentwould probably justify the conclusion that between the ages of 21 and 29 thereis no difference of significance between the ages of a group of mentaldefectives and normal individuals.

When the ages of mental defectives are compared with theother groups of neuropsychiatricdisorders, especially those which had a definite time of beginning, differentconclusions appear. About 9 Percent of the white mental-deficiency caseswere under 20 years of age, which percentage is the largest for any group,constitutional psychopaths and epileptics standing next in order of frequency.The percentage of white mental defectives over 30 years of age was smaller thanfor any other group except the endocrinopathies. The percentage of whiteepileptics over 30 was very slightly larger than that of the mental defectives.Among the other groups, the percentages of individuals over 30 years of age ranfrom 5 to over 50 Percent higher than the percentage for the mental defectives.

EDUCATION

Mental defectives, as might be expected, made the poorestshowing in regard to education of any of the neuropsychiatric groups. (SeeTable 23.) The subject is best considered in connection with Table 22, preparedfrom certain selected examinations made by the psychological examiners, whichindicates the results of their inquiries into the education of drafted men as awhole. One is struck, first of all, by the great difference between theeducation given the normal and that given the defective. In considering thedisparity between the two, it should be borne in mind that the class here underdiscussion is composed of the higher grades of defectives, many of whom are, incertain respects, educable. Yet one-third of the whites and two-thirds of thecolored had no education at all. No effort, apparently, was made to keep them inschool. Fifty-nine Percent of the defectives had had some schooling, but only asmall number reached high school, and the only college representatives werefound in the officers' training camps.

The difference in the efforts at education of the Negroes ascompared with the whites is conspicuous. The fact that such a large number ofthe negroes received no education may account in part for the large numberreported by the psychologists as being defective.

ECONOMIC CONDITION

The numbers of the white and the colored mental defectives inmarginal circumstances were larger than the numbers for any other group. (SeeTable 24.) This would be expected, since mental defectives have low earningpower and lack ordinary prudence.

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HISTORY OF VENEREAL DISEASES

Table 25 shows that there were relatively fewinstances of preexisting venereal diseases among mentaldefectives. This corresponds with civil experience as concerns mentallydefective males, as the sexual instincts are frequently dormant in theseindividuals. The rate of admission of the existence of infections of some kindwas about four times as high among the colored as among white mentaldefectives. The rate of syphilitic infection being about eight times and that ofgonorrheal infections about four times as high.

Among the mentally defective whites the percentage for allvenereal diseases was lower than among any other group of neuropsychiatricdisorders; for example, it was 12.8 Percent among white defectives and 54.2 Percent among white drug addicts; among the colored the percentage was lower thanfor any other group of colored except that of alcoholism, of which latterconditions the numbers were too small for the computation of rates.

The rate of syphilitic infections among the mentallydefective whites was relatively low; it was equaled, however, in the endocrinegroup and was not much smaller than the rates for the epileptics and thepsychoneurotics. Among the colored mentally defective the rate for syphiliticinfections was lower than for any other group except that of the psychoneuroses.Gonorrheal infections were comparatively infrequent among the white mentaldefectives; among the colored the rate was higher for mental defectives thanthose for the groups of alcoholism and psychoses.

ALCOHOLIC HABITS

There is practically no difference between the white andcolored cases of mental deficiency, in so far as alcoholic habits are concerned.(See Table 26.) The percentage of moderate drinkers for both white and coloredmental defectives is slightly larger than the percentage for allneuropsychiatric cases. The mental defective group ranked sixth in order offrequency as to intemperance.

MARITAL STATUS

Including the widowed and divorced, 15.7 Percent of mentaldefectives were married, which is a slightly higher percentage than that (13.2Percent) found among the total of Class I men, and a lower percentage than thatof neuropsychiatric cases generally, 19.1 Percent. (See Table 27.) Thepercentage of marriage was about three times as great among the coloreddefectives as among the white, but even in them the percentage was smaller thanfor any other colored group, except alcoholism.

As a class, defectives show less matrimonial inclinationsthan any other neuropsychiatric individuals. This is in contradiction to thecommon theory that lack of general intelligence is the chief factor in earlymarriage. Inasmuch as the mental defectives married relatively less than theother neuropsychiatric groups, and groups in which temperamental instability isconspicuous, it would seem that the explanation of early marriage would be foundin the sphere of the emotions rather than in that of the intelligence. Therelative number

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divorced among defectives was also lower than for any other group, except theendocrine group, although among Negro defectives it was higher than that for thegroup of epilepsy, endocrine disorders, drug addicts, insane, or constitutional psychopathic states.

HOME ENVIRONMENT-URBAN OR RURAL

While 51 Percent of the population of the United Statesresides in communities of 2,500 or more (United States Census, 1920), onlyone-third of the mental defectives of the Army came from such urban communities. (See Table 28.) The rate of mental defectives fromruralenvironment is higher among the colored than among the whites. This is accountedfor by the excess of rural residence of the former.

Of all the neuropsychiatric conditions, mental defect was theonly one for which the percentage of cases coming from rural districts exceededthe percentage of the population residing in rural districts. The generalexplanation is that the great flocking to the cities, so characteristic ofmodern times, is a movement carried out by the more progressive of thecommunity.

STATE OF RESIDENCE (WITH GAIN OR LOSS FROM IMMIGRATION ORMIGRATION)

Among the whites for the entire United States mentaldeficiency constituted 29.2 Percent of all neuropsychiatric disorders. (SeeTable 37.) In 19 States (Table 38) the percentages are larger than for theUnited States as a whole.

TABLE 37.-State of residence ofmental defectives. Percentages^a

State of residence	White		Colored		State of residence	White		Colored
State of residence	Number	Percent	Number	Percent	State of residence	Number	Percent	Number	Percent
Alabama	397	36.0	656	66.4	New Hampshire	36	27.7	---	---
Arizona	18	15.0	1	16.6	New Jersey	393	27.6	13	21.0
Arkansas	384	43.7	231	62.4	New Mexico	210	61.2	---	---
California	377	22.0	5	14.3	New York	1,271	19.8	47	29.2
Colorado	120	24.8	---	---	North Carolina	651	46.7	154	40.8
Connecticut	163	26.7	6	46.2	North Dakota	101	38.5	---	---
Delaware	21	22.8	15	37.5	Ohio	901	23.9	57	33.5
Florida	152	31.1	15	11.5	Oklahoma	398	33.3	95	57.9
Georgia	511	33.3	141	31.7	Oregon	55	18.1	---	---
Idaho	44	26.7	---	---	Pennsylvania	1,522	27.0	119	42.0
Illinois	791	19.9	60	41.1	Rhode Island	65	29.2	4	40.0
Indiana	417	23.3	14	32.6	South Carolina	318	43.4	219	40.0
Iowa	239	25.3	3	12.5	South Dakota	101	333.1	---	---
Kansas	197	21.6	11	21.6	Tennessee	570	43.0	501	71.8
Kentucky	771	41.1	67	38.5	Texas	414	25.5	114	33.4
Louisiana	275	28.7	332	48.3	Utah	31	20.5	---	---
Maine	202	51.5	---	---	Vermont	38	33.6	1	100.0
Maryland	396	44.9	319	74.4	Virginia	656	45.5	280	48.6
Massachusetts	400	25.7	7	33.3	Washington	115	26.1	2	100.0
Michigan	623	29.2	15	32.6	West Virginia	469	38.6	30	37.5
Minnesota	262	22.2	1	9.1	Wisconsin	363	27.0	1	25.0
Mississippi	308	35.4	328	44.6	Wyoming	25	21.7	---	---
Missouri	922	33.8	68	24.4	District of Columbia	26	16.1	48	52.7
Montana	45	16.7	1	25.0	State unascertained and others	901	---	73	---
Nebraska	125	25.1	1	9.1	United States	17,803	29.2	4,055	48.3
Nevada	11	18.3	---	---

^aPercentages are based on the total neuropsychiatric cases of each color fromeach State.

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TABLE 38.-Percent distribution of neuropsychiatric conditions in 19 States in which the rates for mental deficiency exceeded the United States rate of 29.2 Percent

State of residence	Mental deficiency	Psycho- neuroses	Psychoses	Neuro- logical	Epilepsy	Constitutional psycho- pathic states	Endo- crinopa- thies	Drug addiction	Alcoholism
United States	29.2	17.0	12.1	10.0	8.6	9.7	7.4	3.0	3.0
Alabama	36.0	20.1	11.8	9.9	9.3	7.3	4.0	1.2	.5
Arkansas	43.7	21.0	9.1	7.2	8.4	6.4	1.4	2.6	.2
Florida	31.1	18.4	14.5	9.2	11.2	8.8	3.5	2.9	.4
Georgia	33.3	13.0	13.4	11.5	7.9	11.8	6.1	2.5	.7
Kentucky	41.1	14.0	6.9	11.8	8.8	9.4	4.2	1.2	2.6
Maine	51.5	13.0	7.7	5.4	9.2	8.9	.5	1.3	2.6
Maryland	44.9	13.3	10.4	7.6	4.5	10.7	4.4	1.6	2.5
Mississippi	35.4	23.2	9.8	8.3	10.9	6.7	2.1	3.1	.6
Missouri	33.8	15.9	8.5	11.4	6.3	9.4	8.5	3.0	3.3
New Mexico	61.2	7.0	5.5	7.3	8.5	6.1	3.5	.3	.6
North Carolina	46.7	17.7	8.0	6.6	9.6	3.9	6.1	.7	.6
North Dakota	38.5	14.1	12.6	9.2	8.0	10.3	3.8	.4	3.1
Oklahoma	33.3	15.6	11.8	12.7	6.7	6.7	4.0	7.4	1.9
South Carolina	43.4	19.6	7.0	8.2	8.9	4.1	6.1	1.9	.8
South Dakota	33.1	14.4	10.5	12.8	6.6	3.9	16.1	.3	2.3
Tennessee	43.0	14.3	9.6	11.9	8.0	3.8	5.1	3.5	.8
Vermont	33.6	16.8	13.3	10.6	8.8	10.6	3.5	---	2.7
Virginia	45.5	12.1	9.2	7.0	5.8	7.4	10.9	1.2	1.0
West Virginia	38.6	12.6	8.2	9.1	6.3	7.8	15.7	1.1	.7

While all but four ofthese States are southern, the percentages refer towhite cases only. The high degree of mental defect known to exist in the Southis commonly laid to the door of the Negro. The preceding figures indicateplainly that among the southern white population mental defect is moregeneral than among the population of the United States as a whole.

It is possible to form some ideaas to the incidence of this condition in any State by comparing the rate ofrejection by local boards of the State with the number of cases from that State foundat camps by the neuropsychiatric examiners.

Table 5 gives the rate of rejections for mental defect per1,000 men examined by the local draft boards of the different States. Bycomparing these rates with those of the neuropsychiatric identifications atcamps, it will be observed that a high rate of rejection for mental defect atlocal boards did not mean necessarily a low rate of cases found at camps. On thecontrary, it will be seen that, with the exception of Arkansas and Missouri, thehigh rejection rates by local boards were in the States in which a high degreeof mental defect was found by the neuropsychiatric examiners. The local boardsof Vermont rejected proportionately more than those of any other State (27.13per 1,000), but even that large number of rejections was not sufficient tobring Vermont below the United States average of 29.2 Percent as determined bythe neuropsychiatric examinations.

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The following States equaled or fell below the United Statesneuropsychiatric average for white mental defectives:

	Percent		Percent
Arizona	15.0	Colorado	24.8
District of Columbia	16.1	Nebraska	25.1
Montana	16.7	Iowa	25.3
Oregon	18.1	Texas	25.5
Nevada	18.3	Massachusetts	25.7
New York	19.8	Washington	26.1
Illinois	19.9	Idaho	26.7
Utah	20.5	Connecticut	26.7
Kansas	21.6	Pennsylvania	27.0
Wyoming	21.7	Wisconsin	27.0
California	22.0	New Jersey	27.6
Minnesota	22.2	New Hampshire	27.7
Delaware	22.8	Louisiana	28.7
Indiana	23.3	Michigan	29.2
Ohio	23.9	Rhode Island	29.2

In these States, there is again a general, though notabsolute, agreement between the results of the neuropsychiatric examinations andthose of the local boards. For example, in Arizona, which is lowest on the list,only 2 per 1,000 were rejected by home boards, whereas in Rhode Island, which ishighest on the foregoing list, there were 15.18 such rejections per 1,000.

When the colored alone are considered, Table 5 is not of use.The Provost Marshal General's report, upon which this table was based, did notdistinguish between colored and white mental defectives.

The United States distribution average of mental deficiencyamong the colored neuropsychiatric cases was 48.3 Percent. The following Statesexceeded this rate of 48.3 Percent for colored:

	Percent		Percent
Vermont	100.0	Arkansas	62.4
Washington	100.0	Oklahoma	57.9
Maryland	74.4	District of Columbia	52.7
Tennessee	71.8	Virginia	48.6
Alabama	66.4

It is to be noted that Maryland, Tennessee, and Arkansas were also high inmental defect among whites. (See Table 37.)

The States for which the distribution percentages equaled or were less thanthe percentage for the United States colored were as follows:

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	Percent		Percent
Minnesota	9.1	Massachusetts	33.3
Nebraska	9.1	Texas	33.4
Florida	11.5	Ohio	33.5
Iowa	12.5	Delaware	37.5
California	14.3	West Virginia	37.5
Arizona	16.6	Kentucky	38.5
New Jersey	21.0	Rhode Island	40.0
Kansas	21.6	South Carolina	40.0
Missouri	24.4	North Carolina	40.8
Montana	25.0	Illinois	41.1
Wisconsin	25.0	Pennsylvania	42.0
New York	29.2	Mississippi	44.6
Georgia	31.7	Connecticut	46.2
Indiana	32.6	Louisiana	48.3
Michigan	32.6

This list is peculiar in that Florida and Georgia are well below the UnitedStates average for white mental defectives.

Table 39 shows five races in which the distribution of mental defect exceededthe United States mental deficiency average of 29.2 Percent.

TABLE 39.-Percent distribution ofneuropsychiatric conditions among six races in which the mental deficiencydistribution rate exceeded the United States mental deficiency white rate of29.2 Percent

Race	Number classified	Mental deficiency	Psycho- neuroses	Psycho- ses	Neuro- logical conditions	Epi- lepsy	Constitu- tional psycho- pathic states	Endocrin- opathies	Drug addiction	Alcohol- ism
United States (white)	60,993	29.2	17.0	12.1	10.0	8.6	9.7	7.4	3.0	3.0
African (Negro)	8,401	48.3	13.1	6.6	9.5	13.3	3.0	3.6	2.3	.3
American Indian	124	62.9	4.8	4.0	4.0	7.3	8.9	2.4	3.2	2.4
Armenian	69	37.7	15.9	14.5	11.6	10.1	8.7	1.4	---	---
Italian	2,452	32.7	18.1	9.7	7.8	12.8	9.3	3.8	5.3	.4
Mexican	384	66.9	4.2	4.7	5.7	11.7	3.9	2.3	.5	---
Slavonic	2,474	37.0	15.3	14.5	7.3	6.6	10.0	5.7	1.2	2.5

NATIVITY

Two thousand and sixty-one, or 9.5 Percent of theascertained white cases of mental deficiency were of foreign birth. Using allthe neuropsychiatric cases for the purpose of comparison, it is found that 10.5Percent were foreign born. As thispercentage does not differ greatly from the percentage for mental defectivesalone, the conclusion seems warranted that mental deficiency did not exist to a disproportionate extent among the foreignborn.

CORRELATIONS WITH OTHER CLINICAL CONDITIONS

Throughout the present material mental deficiency presentssignificant correlations with the other clinical conditions, and thesecorrelations may be taken as throwing some light on the extent and quality ofthe intelligence of the people concerned.

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As regards psychoses or mental disorders, it might be assumedthat these would be less apt to occur when there was a high rate for mentaldeficiency. The existence of a mental disease implies a developed intelligenceof a character that would possess imagination, ideas, and a certain quickness inmental processes. As is well known, distinct types of mental diseases arepractically unknown in childhood, the period before the intelligence is fullydeveloped. The hypothesis that mental disease implies a developed intelligenceand is less frequent among people where the intelligence is under-developed isborne out by the tables. Nineteen States (Table 38) exceeded the mentaldeficiency distribution rate of 29.2 Percent, and showed among themselves anaverage distribution of mental defect of 39.3 Percent. But the insanitydistribution rate for these States was below that for the United States, beingparticularly low in the States with high distribution of mental defect, viz,Arkansas, Kentucky, Maine, New Mexico, North Carolina, Tennessee, and Virginia.This same correlation holds true for the five classified native-born races(Table 39) which exceeded the distribution rate of 29.2 Percent for mentaldefect (with the exception of the Slavonic), namely, for the Negroes, AmericanIndians, Italians, and Mexicans.

The converse of the above correlations between mental defectand insanity will be shown to hold true when the distribution rate of insanityis above the average.

Between mental deficiency and alcoholism there seems to exista very definite antagonism, in that the two conditions do not exist in greatabundance in the same communities and people. Where the rate for one rises, therate for the other falls. Of the 19 States with an excess distribution of mentaldeficiency, only two have an excessof alcoholism, and in these 19 States the average distribution of alcoholism,including alcoholic psychoses, is 1.6 Percent as compared with 3 Percent-theUnited States distribution average. (Table 38.)

This same antagonism is observed in the different races. Noneof the five races which exceeded the United States distribution rate for mentaldeficiency attain the alcoholic distribution rate of 3 Percent. Similarconditions prevail in the foreign-born races classified. The converse will beshown to hold good when the correlations of alcoholism are stated.

As concerns epilepsy, in the States in which the distributionof mental deficiency was over average, there is practically no change; in theraces there is a slight increase.

As concerns the psychoneuroses, States and races with anabove-average rate of mental deficiency show a decrease. Constitutionalpsychopathic states which are akin to mental disorders, have a lowerdistribution average in both the States and the races which show an excessdistribution of mental deficiency.

There is a tendency in some States for endocrine disturbancesto sink when mental defect rises, and vice versa. Correlations exist betweenmental deficiency and drug addiction similar to those mentioned as existingbetween mental deficiency and alcoholism. Of the 19 States over average asregards mental deficiency, only three, Mississippi, Oklahoma, and Tennessee,exceeded

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the average distribution rate for drug addiction. Of the fiveraces in which mental deficiency is over average, only two, namely, the AmericanIndian and the Italian, exceed in drug addiction. (Table 39.) Of the fourforeign-born races (Table 33), the Italian is the only one which exceeds inmental deficiency.

It would seem, therefore, that an excess of mental deficiencyin a people assures a below average amount of alcoholism, insanity, psychopathicstates, and drug addiction; the converse, still to be shown, is that when thelatter conditions are in excess mental deficiency recedes.

PSYCHONEUROSES

The information as to the psychoneuroses obtained by thecompilation of the reports of the neuropsychiatric examinations throws somelight on certain important points concerning them. In the first place, thenumbers alone were surprising. While physicians realized that there were manycomplaining people in hospitals, in dispensaries, and in the world generally,whose symptoms could not be associated with any definite pathological condition,few realized that there were so many young men in the country in whom functionalnervous disease reached a point to constitute a definite disability. But whenmore than 11,000 of them were identified in the camps alone, it is evident thatthese conditions demand the serious attention of a government which hopes toconserve its man power.

The most important question of all in regard to thepsychoneuroses, their essential character, can not at present be decided.Intensive investigation, the need of which the present study makes plain, mustdecide as to the essential characters of these disorders. The evidenceaccumulated throughout the World War, both in this country and in France,indicates plainly that the behavior of psychoneurotics is more stronglymotivated by impulses looking toward an improvement of their own personalsituation than is observed in most people. For the most part their symptomsfluctuate in direct ratio with the unpleasant features of the situation. In thecamps, a rumor of overseas orders would bring about an increased flow ofapplications for admission to the hospitals; overseas, the universal employmentof the term "shell-shock" acted as a kind of moral contagion increating these cases; during thearmistice, more than one came out frankly and said he thought his paralysis, orwhatever the disability was, wouldcause him no further trouble if he could be discharged from the Army.

But while these "selfish" trends in thepsychoneurotic, in the Army as in civil life, areunmistakable, it is yet to be shown in what proportion ofthe patients they are really outside personal control. It is certain that manyhave been labeled psychoneurotics when they should have been recognized assuggestible, credulous, uninformed young men, who really were ready to carry onif they knew how. Both in the home camps and in the American ExpeditionaryForces numerous instances were recorded of timid, immature, frightenedyouthful soldiers who really thought they were ill or"shell-shocked," yet who, under the benefits of rest, explanation, andkindly encouragement, forgot all their symptoms and settled down to their worklike real men. The symptoms most

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frequently complained of which could be explained away werethose referred to the gastrointestinal, cardiovascular, and sexual systems. Thepatients had often worried about them long before the war. In combat areas,recovery from such symptoms became much more assured when beds were set asidein field hospitals for these patients. These individuals, badly frightened,shaken up, or even slightly wounded, were returned to their organizations,instead of being sent, as they would have been sent, under other arrangements,to the rear. This phase of the subject-the phase having to do withpsychotherapeutic reconstruction-touches primary education very closely andwill be less acute when education becomes more generalized, and especially wheneducational programs include character up-building and world contact, as well asscholastic performance.

The association of the psychoneuroses with organic diseasesis of importance. It is quite possible that many conditions were denominatedpsychoneurotics when they should have been denominated in terms of some organiccondition. The superficial reaction was considered as primary, when it shouldhave been recognized as secondary to a more serious organic disability.

The statistics show the psychoneuroses as more frequentlyassociated with alcoholism and less frequently with poor economic conditionsthan in the case of the other neuropsychiatric conditions.

A problem for the future is the determination of therelationship between endocrine disorders and the psychoneuroses. Fromexaminations of individual cases of these "situation neuroses" thereis good ground for believing that they are often associated with some disharmonyor defect in the function of the endocrine glands. The statistics in thischapter can hardly be utilized in support of such theory.

The question of the association of psychoneuroses withmental defect, while not elucidated by the present statistics, is one ofimportance. It was remarked in ourhospitals, as well as in those of other countries, that many of the functionalnervous cases presented inferior intelligence. This seemed to be particularlythe case in hysteria, especially in the variations presenting paralysis andother somatic symptoms. It is to be noted that the negro, in whom mental defectis more prevalent than in the white, had a higher proportion of hysteria thanthat of other psychoneurotic conditions.

CLASSIFICATION

The 11,443 classified cases of psychoneuroses weredistributed as shown in Table 6. There may be some question as to the proprietyof including enuresis in this group, as probably some of these cases were mentaldefectives, others were endocrinopaths. The number of stammerers is notable. Theclinical histories indicated the essentially psychoneurotic character of thisdisability.

The percentages of neurasthenia and psychasthenia were muchhigher among the whites than among the colored, while those of hysteria andstammering were much lower among the whites. The latter conditions comprised70.7 Percent of the colored psychoneurotics.

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METHODS OF DISCOVERING CASES

The neuropsychiatrists apparently found some difficulty inidentifying cases of psychoneuroses at the routine examinations. (See Table 8.) Perhapsthe cases ofpsychoneuroses required some time for the symptoms to come to the front. Morenegroes, 47.8 Percent, as compared to 35.2 Percent of the whites, were identified immediately. That the psychoneuroses aremore conduct disorders than certain of the other groups is shown by the factthat a considerably higher percentage of them, 25.3 Percent, than of endocrinetroubles, alcoholism, or even drug addiction, were referred by organizationcommanders. Forty-five cases were referred by psychologists and 12 cases as aresult of delinquency.

LENGTH OF SERVICE PRIOR TO DISCOVERY

Although not easily identified at first, these cases brokedown promptly, 44.8 Percent of the white and 64.1 Percent of the coloredbeing recognized in less than one month. (See Table 10.) Since a relativelylarger proportion of colored were identified immediately, and a largerproportion of them broke down so early in training, it would seem that themechanism of the psychoneuroses in the colored was asimpler affair than in the whites. Of the whole group, 84.5Percent had been detected before the expiration of six months, leaving 15.5 Percent to break down when the situation became more acute, as it did in thiscountry when overseas orders came.

TIME OF ONSET

Before entering the service 95.1 Percent of the cases hadhad symptoms of their disorder. (See Table 11.) In this respect there waspractically no difference between the whites and the colored. Only 556 casesdeveloped after entering the service. Of these, about half developed before theexpiration of six months.

RECOMMENDATIONS FOR DISPOSITION

Nine thousand one hundred ninety-seven, or 80.4 Percent, ofthe cases were recommended for discharge-the smallest percentage for any onegroup. (See Table 12.) Acomparatively large number were recommended for limited service, especiallyamong the colored cases. Only 1.4 Percent were recommended for duty.

In the American Expeditionary Forces, the distributionpercentage average of the psychoneuroses had increased. It became 30 Percentas compared with the mobilization distribution average of 16.5 Percent. Afterthe war, when the patients had become beneficiaries of the Bureau of War RiskInsurance (March, 1921), the distribution average dropped to 20.2 Percent-lowerthan it was in France, but still higher than in the home camps. Thesedistribution averages, shifting about in this manner under differentcircumstances, are quite in accord with the idea of the pscychoneurosis being asituation neurosis. The situation at home, acute enough as it was, and becoming worseas the war showed no signs of ending, became much moreacute when the troops reached the country where the fighting was actually goingon,

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where many of them even had to engage in it. With the adventof peace some of these cases recovered, almost over night; most of them showed a steady improvement in all symptoms. In some of those left to be hospitalizedby the Bureau of War Risk Insurance, the symptoms had doubtless become fairlywell fixed, and others, in much the same way that litigants in personal injurysuits maintain their symptoms, sought hospitalization for the purpose of beingidle and to secure the compensation accruing to service disability.

DELINQUENCY

Of the misconduct cases, 66, or 4.4 Percent, of the totalwere cases of psychoneuroses. This number is 0.58 Percent of the total group of11,443 cases-a percentage very low when compared with 5.1 Percent for theinsane and 4.4 Percent for the constitutional psychopaths.

FAMILY HISTORY

Evidence in support of the theory that the psychoneurosesdevelop especially in neurotically predisposed individuals is shown in Tables 13to 17. Of the ascertained cases, 57.7 Percent, with little difference betweenthe white and colored, gave a family history of neurotic taint, being exceededonly by epilepsy, endocrine disturbances, and constitutional psychopathicstates. In this respect the percentage for the psychoneuroses exceeded that foralcoholism and for drug addiction by about 17.

The psychoneuroses showed relatively the highest proportionof histories of family nervous diseases (37.5 Percent) and, after alcoholism,the largest proportion of mental deficiency (0.8 Percent). History of inebrietywas also relatively low in thesecases.

AGE

The psychoneuroses followed approximately the agedistribution of the drafted men of the Army as far as the group between theages of 25 and 29 years was concerned. (See Table 20.) They fell below thedistribution in the 20-24 years' period and rose in the group over 29. Thismay be an indication of the psychoneuroses being somewhat more common amongvolunteers. The colored psychoneurotics inclined to younger age periods than thewhites.

EDUCATION

The psychoneurotic group contained persons above theneuropsychiatric average of education (see Table 23), so far as high school andcollege are concerned. On the other hand, a relatively higher proportion of themhad no schooling, than of the insane, neurological cases, constitutionalpsychopaths, endocrine cases, drug addiction, and inebriety.

ECONOMIC CONDITION

A larger percentage (17.7 Percent)of psychoneurotics were in comfortable circumstances (see Table 24) than anyother group. This would indicate that nutrition and similar factors in theprevention of disease were less important in the psychoneuroses than in otherneuropsychiatric conditions.

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