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HISTORY OF VENEREAL DISEASES
Mental deficiency showed an under average of cases withprevious venereal history, while alcoholism, drug addiction, and neurologicalconditions showed an over average. (See Table 25.) The remaining five groups,especially representative of abnormal mental states, werepractically the same in that they gavea venereal history in about 25 per cent of the cases. This is probably under theaverage of young men in general. As elsewhere, the colored gave higher averagesthan the whites, especially in reference to syphilis.
ALCOHOLIC HABITS
From the percentage of intemperate men, 5.7 percent, and of abstainers 48.6 per cent, among cases ofpsychoneuroses, it appears that alcohol does not play a prominent r?le in thesedisorders. (See Table 26.) In regard to the use of alcohol, the psychoneurotics,both white and colored, showed up better than any other neuropsychiatricpatients except the endocrine cases.
MARITAL STATUS
Twenty-three and eight-tenths of the psychoneurotics hadmarried (Table 27), the proportion being higher than any of the neuropsychiatricgroup, and more than 10 per cent above the married percentage of Class I men asa whole. The colored showed a still higher married percentage.
HOME ENVIRONMENT-URBAN OR RURAL
There was a slight preponderance of urban as opposed to ruralresidence among these cases. (See Table 28.)
STATE OF RESIDENCE (WITH GAIN OR LOSS FROM MIGRATION ORIMMIGRATION)
Twenty-four States, namely, Alabama, Arkansas, Colorado,Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Louisiana,Massachusetts, Minnesota, Mississippi, New Hampshire, New York, North Carolina, Ohio,Oregon, Rhode Island, South Carolina, Utah, Wisconsin, Wyoming, District ofColumbia, exceeded the United States distribution rate of 17. (SeeTables 29 and 31.) Owing to differences in classification, the neuropsychiatricaverages in these States can not be compared with the average attained at thelocal boards.
NATIVITY
Twelve per cent of the psychoneurotics were of foreign birth,being below the average of Class I men and above the average of foreign born inthe total number of neuropsychiatric cases considered.
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
There were only slight variations in the distribution of thepsychoneuroses as between either States or races. Inone-half the States the average exceeded the United Statesaverage of 17 per cent (Table 40). But the average excess was not remarkable.The widest variation in these States in other groups was found in reference toendocrine disturbances, the average percentages of these latter sinking to 1.3below the United States average of 7.4.
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In all the States which exceeded the United States rate forpsychoneuroses by several points, viz, Arkansas, Louisiana, Mississippi, NewHampshire, Wyoming, and the District of Columbia, there was a marked drop in theendocrine rate.
Of the classified races (see Table 34), in the AmericanIndian and the Mexican the psychoneuroses fell far below the United Statesaverage of 17 per cent (see Table 40). Both of them had an under average ofendocrine disturbances and an excess of mental deficiency. The Greeks and theHebrews greatly exceeded the United States average of 17 per cent; and both of these fell below the United Statesaverage for endocrine troubles.
State of residence | Psycho- | Mental deficiency | Psy- | Neuro- | Epi- | Constitu- | Endocrin- | Drug addiction | Alcohol- |
United States | 17.0 | 29.2 | 12.1 | 10.0 | 8.6 | 9.7 | 7.4 | 3.0 | 3.0 |
Alabama | 20.1 | 26.0 | 11.8 | 9.9 | 9.3 | 7.3 | 4.0 | 1.2 | .5 |
Arkansas | 21.0 | 43.7 | 9.1 | 7.2 | 8.4 | 6.4 | 1.4 | 2.6 | .2 |
Colorado | 18.2 | 24.8 | 14.5 | 10.7 | 11.8 | 9.5 | 6.4 | 2.1 | 2.1 |
Connecticut | 17.8 | 26.7 | 15.9 | 7.7 | 10.6 | 10.3 | 3.1 | 2.9 | 4.9 |
Florida | 18.4 | 31.1 | 14.5 | 9.2 | 11.2 | 8.8 | 3.5 | 2.9 | .4 |
Illinois | 20.6 | 19.9 | 13.8 | 10.7 | 8.3 | 9.1 | 9.8 | 1.5 | 6.2 |
Indiana | 20.0 | 23.3 | 8.8 | 14.3 | 7.5 | 14.5 | 8.3 | .6 | 2.8 |
Iowa | 17.8 | 25.3 | 16.4 | 9.9 | 8.4 | 9.3 | 8.2 | 2.6 | 2.1 |
Kansas | 18.2 | 21.6 | 10.4 | 13.5 | 6.3 | 9.8 | 15.4 | 2.5 | 2.2 |
Louisiana | 30.8 | 28.7 | 9.1 | 6.2 | 12.1 | 7.6 | 2.3 | 2.5 | .6 |
Massachusetts | 18.1 | 25.7 | 14.4 | 6.9 | 10.4 | 12.2 | 1.7 | 2.7 | 7.9 |
Minnesota | 19.5 | 22.2 | 14.0 | 10.9 | 7.8 | 7.1 | 12.0 | 2.2 | 4.3 |
Mississippi | 23.2 | 35.4 | 9.8 | 8.3 | 10.9 | 6.7 | 2.1 | 3.1 | .6 |
New Hampshire | 23.4 | 27.7 | 10.2 | 7.3 | 10.2 | 12.4 | 1.5 | 2.9 | 4.4 |
New York | 18.3 | 19.8 | 11.6 | 8.8 | 10.0 | 13.1 | 6.3 | 8.4 | 3.5 |
North Carolina | 17.7 | 46.7 | 8.0 | 6.6 | 9.6 | 3.9 | 6.1 | .7 | .6 |
Ohio | 19.7 | 23.9 | 11.3 | 10.9 | 7.7 | 8.6 | 12.8 | 2.7 | 2.3 |
Oregon | 19.1 | 18.1 | 19.7 | 8.9 | 9.5 | 16.4 | 5.3 | 2.6 | .3 |
Rhode Island | 18.8 | 29.3 | 9.9 | 7.2 | 9.4 | 9.9 | 4.0 | 4.9 | 6.7 |
South Carolina | 19.6 | 43.4 | 7.0 | 8.2 | 8.9 | 4.1 | 6.1 | 1.9 | .8 |
Utah | 19.2 | 20.5 | 18.5 | 6.0 | 7.9 | 12.6 | 4.0 | 7.9 | 3.3 |
Wisconsin | 19.2 | 27.0 | 12.6 | 11.6 | 6.8 | 6.2 | 12.6 | .7 | 3.2 |
Wyoming | 24.3 | 21.7 | 8.7 | 11.3 | 8.7 | 9.6 | 5.2 | 2.6 | 7.8 |
District of Columbia | 23.6 | 16.1 | 19.9 | 14.3 | 6.2 | 8.79 | 6.2 | 2.5 | 2.5 |
As between the native and foreign born there were nosignificant differences. Thus the above correlations furnish little informationas to the relationships between the psychoneuroses and mental deficiency; and they donot support the idea of an intricate association between functional nervousdisorders and the ductless gland systems. In fact the indications would supportthe reverse of this idea.
PSYCHOSES
In previous military statistics "insanity" and"mental alienation" were used as terms to express a great variety ofpathological behavior defects. Not only mental diseases, but the psychoneuroses,mental deficiency and in fact nearly all mental conditions, with the exceptionof epilepsy and inebriety, were embraced under these headings. Theclassification adopted herein permits a finer differentiation of the variousconditions than was heretofore possible. Viewed in relation to the three phasesof war time-the mobilization, the campaign, and the resulting readjustment andafter care-the psychoses or mental diseases proved to be the most importantcondition in the neuropsychiatric group, so far as the Government is concerned.
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These patients put heavy burdens on the hospitals and onpersonnel not only in the United States during mobilization but also in theAmerican Expeditionary Forces; long delays were inevitable in effectingdischarge, and most of the patients required one or more trained attendants toconduct them back to their homes. When insane soldiers were returned to theUnited States from overseas, policy demanded that they be retained in themilitary hospitals for a period of from four to six months, in order that areasonable chance be afforded them to recover, and to avoid being sent to"lunatic asylums."
While third in order of frequency during the mobilization inthe American Expeditionary Forces the psychoses took over first place in thisrespect; and after the war they constituted 70 per cent of all neuropsychiatriccases (March 1921). In addition, the Government had assumed a certainresponsibility toward the whole Army with respect to ex-soldiers who might, as aresult of military service, become insane. This liability deserves seriousconsideration in reference to future Government policy in these cases and shouldbe considered in reference to what is known concerning the occurrence ofinsanity in general.
It is only recently that reliable statistics in relation toinsanity in the United States have been available, and even to-day they areavailable for certain localities only. Many of the States make inadequateprovision for the insane, and consequently are not in a position to collectstatistics concerning them. New York is an exception. The hospitals of theState of New York are adequate in that all patients for whose admissionapplication is made are received; and the New York State Hospital Commission hasfor years maintained an excellent statistical department. From its statisticscertain important information has been gained as to the occurrence of insanityin civil populations, which are comparable to the population of New York. Thesemay be made use of for the purpose of checking the numbers of insane which cometo light as a result of the mobilization of troops, of home service, or offoreign service.
The New York statistics are compiled for quinquennial agegroups from 20 to 70. There are practically no admissions before 20 years ofage, and data are not separately compiled for the advanced age periods. The rateof admission is approximately 1 per 1,000 population each year. On the basis ofdata compiled from reports of the State hospitals, together with those of the1910 census, it appears that approximately 1 in 25 males will become insaneduring the life period of the group. So heavy an incidence of mental diseasewill surprise many, and may lead to some reconstruction of popular ideas inrelation to the effects of the World War in the production of mental disease.
The mobilization affected an age group of 20-30 years.There were discharged or rejected approximately 15,000a cases of insanity in the 4,500,000 men examined, a ratioapproximately of 3 per 1,000. This is, on the one hand, a smaller age group thanproduces the 1 per 1,000 yearly admissions in New York State hospitals; on theother hand, the time was one and one-half years and in addition included, inmany States where the hospitals are inadequate, cases which, in localities wherehospitals are adequate, would have been in State hospitals and so inaccessibleto the draft. It may be surmised that the
aThis number is estimated from the most reliable sourcesavailable and is approximately correct.
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incidence of insanity among mobilized troops did not greatlyexceed the normal incidence of insanity throughout the country as a whole in thecivil population. In other words, the Government, through the War Department,brought to light about the same amount of insanity as would have been brought tolight had the various States been provided with proper facilities foridentifying and caring for their insane.
To compare the incidence of insanity in the Army as finallyformed, and especially in the American Expeditionary Forces, is more difficult,as there we are dealing with a selected group-a group from which many caseshad been eliminated by the examinations at draft boards and at camps.
The total admissions to Base Hospital No. 214, A. E. F., formental cases invalided home during approximately one and one-half years, was2,694.2 During the year 1918, when the mean annual strength of the AmericanExpeditionary Forces was about 1,000,000, the admissions numbered 1,359, or 1.4per 1,000 troops. It will be noted that this incidence is only 0.4 per thousandhigher than the yearly admissions to the New York State hospitals. The groupfrom which the incidence rate is made up was selected, in that many insanecases, but not all, had been eliminated from it in the United States, and it wasa younger group as to years, in that it included the age period 20-35 only.
Previous observations as to the relations between war andinsanity have left out of account the steady, yearly, and so far inevitable,production of mental disease in every population. When an identified mechanismlike an army has unearthed these cases, the inference has been drawn that thearmy produced them. It would, of course, be absurd to maintain that change ofenvironment, and especially the absence from home and friends such as isnecessary to foreign service, didnot cause mentally predisposed persons to break down. But the precedingstatements make it plain also that much of the insanity which a war discloses isnot caused by the war, but is merely a part of the psychological evolution of apeople. If we profit by the lesson and make better provision for the insane, wewill have fewer to deal with during war time.
This subject is also extremely important from the point ofview of after-the-war compensation. There is certain to be a yearly developmentof mental cases in veterans for the next 30 years. In determining theresponsibility of the Government for these cases, the amount of insanity that is"normal" every year for the community should be borne in mind.
CLINICAL CLASSIFICATION
Including the alcoholic psychoses, the distribution of thedifferent forms of psychoses discovered in the Army during the World War wassubstantially the same as that found among admissions in the same age groups incivil hospitals.
In the distribution certain differences are to be noted asbetween the whites and the colored. (See Table 6.) The negroes presented agreater number of atypical and undiagnosed forms. They developed only five casesof alcoholic insanity, and a slightly higher percentage of insanity with mentaldeficiency than the whites. They were lower both in dementia pr?cox andmanic-depressive pyschoses and higher in epileptic psychoses.
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METHODS OF DISCOVERING CASES
Relatively more negroes than whites were discoveredimmediately. (See Table 8.) A smaller percentage of psychoses were discovered atthe routine neuropsychiatric examination than of any other clinical group. Thedelay in identification was due partly to the fact that continued observation isso often necessary for the recognition of mental disease, and partly becausemental symptoms, dormant at the time of enlistment, are brought to the fore bythe change in environment.
In the routine examinations neuropsychiatrists were obligedto rely chiefly on past history (previous commitments, etc.) and on the soldier'sappearance and manner. Such patients came to attention of medical officersattached to organizations with especial frequency. Mental symptoms appearedwhile the patients were under treatment for some other condition, or they soughtmedical advice in the same way they got to civil hospitals, because they aredepressed, thinking of suicide, feel that they are not being treated right, andsimilar ideas.
Commanding officers also were more instrumental in theidentification of mental cases than of any other group except the constitutionalpsychopathic states. Absence without leave, strange attitudes and actions,inability to get along with others, and epileptic attacks were among the causesthat brought these soldiers to the attention of their commanders.
One conspicuous conclusion derived from these particularstatistics is that an observation period is essential for discovering mentalcases. Such examinations as were held by draft boards can not hope fully toaccomplish the object in view. More time, more extended facilities than arepossible there are necessary, if the insane are to be kept out of the Army, orif the Government is to be saved from ranking with the disabled veterans men whowere insane prior to entrance in the Army.
LENGTH OF SERVICE PRIOR TO DISCOVERY
The information available under this heading substantiateswhat was stated above in regard to the comparative delay in the appearance ofpsychoses in the military service.
As shown in Table 10, mental casesgave longer service than any other neuropsychiatricgroup, the negroes rendering a shorter service than the whites. This might beput in another way: A longer time was required for their detection than for thedetection of other neuropsychiatric patients. Twenty-two and three-tenths percent had not been detected before the expiration of six months training period,as compared to 9.4 per cent of the mental defectives. The insane wereconsiderably above the average of the whole neuropsychiatric classification inrespect to length of service. For example, 52.6 per cent of the whole group hadbeen identified in less than one month, as compared with36.7 per cent of the mental cases identified in the same period, and 86.7 percent of the former had been identified before six months, as compared to 77.7per cent of the latter. As regards extreme length of service (Volunteers), themental cases were also the highest, with the exception of alcoholics.
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The inferences which follow seem justifiable from thefigures. In a relatively greater number of cases, breakdowns resultingfrom purely mental causes do not make themselvesimmediately apparent; although delayed, their appearance is none the lessinevitable, inasmuch as the psychoses occupy thirdplace in order of frequency in the whole neuropsychiatric classification. Itwould seem, therefore, that it was not the first shock of being dislocated froma civil to a military environment that brought the psychosisto notice, but rather the continued separation, thecontinued strain of service conditions, even though these latter are gonethrough with in the home area. In considering service as an aggravating cause ofpsychoses, it should not be left out of account that, even under civilconditions, in the age groups between 20 and 50 years,there is a regular occurrence of insanity of about one perthousand each year, and also that the greater bulk of the cases, as shown in thesucceeding paragraph, gave a history of time of onset a year or more beforeentering the service.
TIME OF ONSET
In approximately one-half of the cases, the time of onset ofthe psychosis was determined. (SeeTable 11.) In these 3,512, or 87 per cent, the psychosis antedatedentrance into the Army.
Table 11 shows that3,063, or 87.3 per cent, of the cases of psychoses gave a historyof development of more than one year prior to enlistment, a smaller percentagethan any other neuropsychiatric group. This is in accord with former knowledgeas to the nonappearance of psychoses in very young persons. Of the 712 cases inwhich the symptoms developed after entering the service, in only 92 was theonset immediate; i. e., two months or less after arrival at camps. It is evidentthat it is not the abrupt change from home surroundings to camps thatprecipitates the psychoses.
RECOMMENDATIONS FOR DISPOSITION
As between the whites and the negroes, there were only slightdifferences either as to the recommendations or dispositions of insane soldiers.
As a group, a higher percentage (91.4 percent) of cases of psychoses were recommended for dischargethan for any other clinical condition. (See Table 12.) A medium number of caseswas recommended for treatment, but few for limited service and still fewer werereturned to duty.b
There were 39 deaths from psychoses distributed as follows:
White | Colored | White | Colored | ||
Senile | 1 | --- | Manic-depressive | 10 | 2 |
With cerebral arteriosclerosis | 1 | --- | Dementia pr?cox | 7 | 1 |
General paralysis | 2 | --- | 35 | 4 | |
Alcoholic | 12 | --- | |||
With other somatic diseases | 2 | 1 |
bDuring demobilization, instructions were issued from theSurgeon General's Office to the effect that patients who had suffered frompsychoses, and who had a record to that effect, even though they had made aclinical recovery, should none the less be discharged on surgeon's certificateof disability. This was intended to prevent the reenlistment of such a soldierin future years.
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DELINQUENCY
The psychoses were second in theorder of furnishing delinquency cases, although not entitled to second place bythe actual size of the group. Of the total of 7,910 insane, 404, or 5.1 percent, were referred for examination by reason of misconduct, the highestpercentage in any group. This excess is partly explained by the nature of themental disease itself.
FAMILY HISTORY
More than one-half of the cases of psychoses gave a historyof family neuropathic taint of some kind (Tables 13 to 17), but they wereexceeded in this respect by epilepsy, endocrinopathies, constitutionalpsychopathic states, and the psychoneuroses. In both white and colored thecharacter of the taint was 28 per cent mental, others, in order, being nervousdiseases, inebriety, and mental deficiency. The psychoses showed more mentaldisease in the family than any other clinical group.
AGE
With the exception of a somewhat higher percentage of whiteas compared to the colored in the younger age group, the information as to agein cases of psychoses has noparticular significance. (See Table 20.)
EDUCATION
Excluding the mental defectives, the cases of psychoses, as agroup, were below the general neuropsychiatric average in education as regardsgrades, but the percentage approached the average as regards high schools and,with the exception of constitutional psychopathic states, the psychoses had thehighest percentage of attendance at college. The group average was lowered bythe colored. For example, 32.5 of the colored had had no schooling at all, ascompared with 7.2 per cent of the white, and the number of insane negroes whohad been in college was very small. (See Table 23.)
ECONOMIC CONDITIONS
There were more cases in comfortable circumstances among theinsane than among the mental defectives, constitutional psychopaths, epileptics,alcoholics, or drug addicts. Both white and colored were below the average as tomarginal circumstances. (See Table 24.)
HISTORY OF VENEREAL DISEASE
Mental cases presented nothing worthy of special remark inreference to the history of venereal diseases that has not already been stated.(See Table 25.)
ALCOHOLIC HABITS
Insane soldiers gave a more frequent history of intemperancethan the members of any other clinical group except alcoholics themselves. (SeeTable 26.) Also, a relatively small percentage of them were abstinent. Amongdrug
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addicts alone was the percentage of abstinent persons lower.This evidence as to the relationship between intemperance and insanity isconditioned somewhat by the fact that the present classification includes 292cases of alcoholic insanity. In the psychotic group the whites admitted agreater alcoholic indulgence than the colored.
MARITAL STATUS
Mental cases as a class were well below the neuropsychiatricaverage in respect to marriage, but still above that of Class I men. When thewhite and colored cases are contrasted it is seen that among the colored thesingle were relatively less frequent andthe married relatively more frequent. (See Table 27.)
HOME ENVIRONMENT-URBAN OR RURAL
Mental cases are to be classed among those with a preferencefor the cities. (See Table 28.) Of the whole group, 59 per cent gave urbanresidence and 41 per cent rural. Among the colored these percentages as to urbanand rural were reversed, owing to the higher percentage of rural residence amongthe general colored population.
STATE OF RESIDENCE (WITH GAIN OR LOSS THROUGH MIGRATION ORIMMIGRATION)
Twenty-four States exceeded the United States distributionaverage of 12.1 per cent for psychoses for the whites. (Tables 41 and 42.) It isnot possible to determine the full significance of this excess, since, owing todifferences in classifications, these statistics can not be compared with thoseof the local boards.
TABLE 41.-Statesof residence of cases of psychoses
State of residence | White | Colored | State of residence | White | Colored | ||||
Number | Per cent | Number | Per cent | Number | Per cent | Number | Per cent | ||
Alabama | 130 | 11.8 | 49 | 5.0 | New Hampshire | 14 | 10.2 | --- | --- |
Arizona | 20 | 16.7 | 2 | 33.3 | New Jersey | 191 | 13.4 | 7 | 11.3 |
Arkansas | 80 | 9.1 | 20 | 5.4 | New Mexico | 19 | 5.5 | --- | --- |
California | 297 | 17.4 | 3 | 8.6 | New York | 746 | 11.6 | 11 | 6.8 |
Colorado | 70 | 14.5 | --- | --- | North Carolina | 112 | 8.0 | 20 | 5.3 |
Connecticut | 97 | 15.9 | 1 | 7.7 | North Dakota | 33 | 12.6 | --- | --- |
Delaware | 11 | 12.0 | 2 | 5.0 | Ohio | 427 | 11.3 | 8 | 4.7 |
Florida | 71 | 14.5 | 18 | 13.8 | Oklahoma | 141 | 11.8 | 3 | 1.8 |
Georgia | 205 | 13.4 | 37 | 8.3 | Oregon | 60 | 19.7 | --- | --- |
Idaho | 42 | 25.5 | 1 | 50.0 | Pennsylvania | 621 | 11.0 | 22 | 7.8 |
Illinois | 546 | 13.8 | 16 | 11.0 | Rhode Island | 22 | 9.9 | 1 | 10.0 |
Indiana | 157 | 8.8 | 5 | 11.6 | South Carolina | 51 | 7.0 | 34 | 6.2 |
Iowa | 155 | 16.4 | 5 | 20.8 | South Dakota | 32 | 10.5 | --- | --- |
Kansas | 95 | 10.4 | 2 | 3.9 | Tennessee | 127 | 9.6 | 25 | 3.6 |
Kentucky | 130 | 6.9 | 8 | 4.6 | Texas | 285 | 17.6 | 43 | 12.6 |
Louisiana | 87 | 9.1 | 46 | 6.7 | Utah | 28 | 18.5 | --- | --- |
Maine | 30 | 7.7 | --- | --- | Vermont | 15 | 13.3 | --- | --- |
Maryland | 92 | 10.4 | 21 | 4.9 | Virginia | 133 | 9.2 | 47 | 8.2 |
Massachusetts | 224 | 14.4 | 1 | 4.8 | Washington | 78 | 17.7 | --- | --- |
Michigan | 288 | 13.5 | 6 | 13.0 | West Virginia | 99 | 8.2 | 10 | 12.5 |
Minnesota | 165 | 14.0 | 1 | 9.1 | Wisconsin | 170 | 12.6 | --- | --- |
Mississippi | 85 | 9.8 | 47 | 6.4 | Wyoming | 10 | 8.7 | --- | --- |
Missouri | 233 | 8.5 | 10 | 3.6 | District of Columbia | 32 | 19.9 | 7 | 7.7 |
Montana | 56 | 20.8 | --- | --- | State unascertained and others | 454 | --- | 17 | --- |
Nebraska | 77 | 15.5 | --- | --- | United States | 7,354 | 12.1 | 556 | 6.6 |
Nevada | 11 | 18.3 | --- | --- | |||||
Percentages are based on total neuropsychiatric cases of each color from eachState.
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State of residence | Psy- | Mental defect | Psycho- | Neuro- | Epi- | Constitu- | Endocrin- | Drug addiction | Alcohol- |
United States | 12.1 | 29.2 | 17.0 | 10.0 | 8.6 | 9.7 | 7.4 | 3.0 | 3.0 |
Arizona | 16.7 | 15.0 | 12.5 | 18.3 | 10.8 | 11.7 | 6.7 | 4.2 | 4.2 |
California | 17.4 | 22.0 | 16.7 | 12.2 | 7.7 | 12.7 | 2.7 | 3.3 | 5.3 |
Colorado | 14.5 | 24.8 | 18.2 | 10.7 | 11.8 | 9.5 | 6.4 | 2.1 | 2.1 |
Connecticut | 15.9 | 26.7 | 17.8 | 7.7 | 10.6 | 10.3 | 3.1 | 2.9 | 4.9 |
Florida | 14.5 | 31.1 | 18.4 | 9.2 | 11.2 | 8.8 | 3.5 | 2.9 | .4 |
Georgia | 13.4 | 33.3 | 13.0 | 11.5 | 7.9 | 11.8 | 6.1 | 2.5 | .7 |
Idaho | 25.5 | 26.7 | 10.3 | 8.5 | 7.9 | 6.7 | 14.6 | --- | --- |
Illinois | 13.8 | 19.9 | 20.6 | 10.7 | 8.3 | 9.1 | 9.8 | 1.5 | 6.2 |
Iowa | 16.4 | 25.3 | 17.8 | 9.9 | 8.4 | 9.3 | 8.2 | 2.6 | 2.1 |
Massachusetts | 14.4 | 25.7 | 18.1 | 6.9 | 10.4 | 12.2 | 1.7 | 2.7 | 7.9 |
Michigan | 13.5 | 29.2 | 12.0 | 10.9 | 8.6 | 11.6 | 11.2 | 1.1 | 2.3 |
Minnesota | 14.0 | 22.2 | 19.5 | 10.9 | 7.8 | 7.1 | 12.0 | 2.2 | 4.3 |
Montana | 20.8 | 16.7 | 16.0 | 11.2 | 11.9 | 8.9 | 7.8 | 3.7 | 3.0 |
Nebraska | 15.5 | 25.1 | 14.7 | 12.9 | 7.6 | 9.4 | 10.7 | 2.6 | 1.6 |
Nevada | 18.3 | 18.3 | 11.7 | 18.3 | 8.3 | 6.7 | 1.7 | 1.7 | 15.0 |
New Jersey | 13.4 | 27.6 | 16.6 | 6.8 | 12.6 | 11.2 | 5.7 | 3.0 | 3.2 |
North Dakota | 12.6 | 38.5 | 14.1 | 9.2 | 8.0 | 10.3 | 3.8 | .4 | 3.1 |
Oregon | 19.7 | 18.1 | 19.1 | 8.9 | 9.5 | 16.4 | 5.3 | 2.6 | .3 |
Texas | 17.6 | 25.5 | 14.8 | 12.3 | 13.4 | 8.8 | 2.3 | 4.1 | 1.1 |
Utah | 18.5 | 20.5 | 19.2 | 6.0 | 7.9 | 12.6 | 4.0 | 7.9 | 3.3 |
Vermont | 13.3 | 33.6 | 16.8 | 10.6 | 8.8 | 10.6 | 3.5 | --- | 2.7 |
Washington | 17.7 | 26.1 | 14.1 | 8.2 | 7.5 | 9.5 | 9.3 | 6.8 | .9 |
Wisconsin | 12.6 | 27.0 | 19.2 | 11.6 | 6.8 | 6.2 | 12.6 | .7 | 3.2 |
District of Columbia | 19.9 | 16.1 | 23.6 | 14.3 | 6.2 | 8.7 | 6.2 | 2.5 | 2.5 |
NATIVITY
The psychoses cases hadforeign-born percentage in 13.5 per cent of instances. This is above that ofneuropsychiatric cases in general.
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
When describing the correlations of mental deficiency it wasshown that its distribution average tends to rise when that for the psychoses isbelow average.
Table 42, which tabulates 24 States in whichthe white insanity average exceeded the United States average of 12.1 per cent,affords an opportunity of noting the converse of this and also of noting theaction of the conditions allied to insanity, viz, psychopathic states,alcoholism and drug addiction, in the States when the insanity average is inexcess. This table shows that the converse holds true as far as mental defect isconcerned, as the average for mental deficiency in these 24 Statesis 24.9 per cent, 4.3 per cent below the United Statesaverage for that condition. There were, however, four States, viz, Florida,Georgia, North Dakota, and Vermont, in which mental deficiency average surpassedthe United States average of 29.2. The converse of the proposition did not holdtrue in relation to the other clinical conditions mentioned.
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Race | Number classified | Mental deficiency | Psycho- | Psychoses | Neuro- | Epi- | Constitu- | Endocrin- | Drug addiction | Alcohol- |
United States (white) | --- | 29.2 | 17.0 | 12.1 | 10.0 | 8.6 | 9.7 | 7.4 | 3.0 | 3.0 |
Armenian | 69 | 37.7 | 15.9 | 14.5 | 11.6 | 10.1 | 8.7 | 1.4 | --- | --- |
Dutch | 328 | 26.2 | 14.9 | 13.1 | 11.6 | 10.4 | 10.1 | 10.4 | 1.5 | 1.8 |
German | 4,351 | 28.0 | 17.5 | 12.7 | 9.6 | 7.4 | 10.0 | 10.9 | 1.6 | 2.4 |
Greek | 281 | 23.8 | 24.9 | 13.9 | 8.9 | 13.5 | 8.2 | 5.3 | .4 | 1.1 |
Hebrew | 1,314 | 17.2 | 25.2 | 14.9 | 7.5 | 7.1 | 15.4 | 5.6 | 6.7 | .5 |
Scandinavian | 1,256 | 23.6 | 17.6 | 17.3 | 10.1 | 6.8 | 8.4 | 10.5 | 1.9 | 3.9 |
Scotch | 579 | 12.4 | 18.3 | 12.3 | 16.6 | 9.3 | 10.7 | 10.4 | 4.7 | 5.4 |
Slavonic | 2,474 | 37.0 | 15.3 | 14.5 | 7.3 | 6.6 | 10.0 | 5.7 | 1.2 | 2.5 |
Mixed | 23,604 | 27.5 | 18.4 | 12.2 | 10.2 | 8.7 | 9.9 | 7.2 | 3.7 | 2.3 |
Of the classified races, eight presented an excess ofdistribution average of psychoses. (Table 43.) Of these all but one, theSlavonic, were below the United States average for mental defect; all but theGreek and Scandinavian showed an over average in constitutional psychopathicstates; only the Scandinavian and Scotch showed an over average in alcoholism;the Hebrew, mixed, and Scotch were the only ones which showed an over average indrug addiction.
Of the foreign-born races (see Table 34) the Scandinavians,Irish, and Germans showed an over average for psychoses. Of these three, allshowed an under average for mental defect, constitutional psychopathic statesand drug addiction; two, the Scandinavian and Irish, an over average foralcohol.
NERVOUS DISEASES AND INJURIES
This group is made up of so many quite diverse clinicalconditions that few generalizations concerning it are possible. When thesyphilitic cases are excluded the other clinical conditions have little incommon. The information of importance concerns the distribution of differentdiseases of the nervous system, organic for the most part, among a given agegroup of men. This information is to be found in Table 6.
CLINICAL CLASSIFICATION
Table 6 requires no further explanation in the presentconnection except in reference to the cases of the late effects of syphilis. Todetermine what these effects are, inmen of the given age period, the cases of general paralysis, an unquestionedsyphilitic disease, may be added to the syphilitic cases in the present group.The result is as follows:
General paralysis | 530 |
Syphilis, central nervous system | 2,462 |
Tabes dorsalis | 333 |
| 3,325 |
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The number 3,325, which is 4.8 per cent of the total numberof 69,394 cases, shows the relative position occupied by the late effects ofsyphilis of the central nervous system. If syphilis of the nervous system hadbeen tabulated as a separate clinical group, it would have occupied eighthplace, in order of frequency, in 10clinical groups. The distribution of the syphilis of the central nervous system,of tabes, and of general paralysis among negroes was about the sameas among whites. This is in apparent contradiction to thegeneral opinion as to the immunity of the negro in relation to these diseases.Some immunity, however, he must possess, inasmuch as, with a so much higher rateof venereal infection in the negro, he does not exceed the whites in the laterserious consequences of syphilis.
METHODS OF DISCOVERING CASES
Three thousand one hundred and forty-seven, or 47.2 per cent,of the cases were detected at the routine examinations and 2,324, or 34.9 percent, by medical officers, as was natural in view of the objective symptomspresented by these cases. (See Table 8.) Relatively few were referred bycourts-martial and psychologists.
LENGTH OF SERVICE PRIOR TO DISCOVERY
As shown in Table 10, these cases were identified withremarkable promptness.
RECOMMENDATIONS FOR DISPOSITION
Six thousand and twenty-three of the cases were recommendedfor discharge, the remainder being recommended for treatment, duty, or limitedservice. (See Table 12.) There were 33 deaths. After the war 3.3 per cent of thepatients in hospitals of the Bureau of War Risk Insurance (March, 1921) wereof this group.
DELINQUENCY
Of the 6,916 neurological cases, 19 were reported by reasonof misconduct. Of these 19, 12 were found to be cases of cerebrospinalsyphilis. One was a case of multiple sclerosis, mistaken perhaps for amalingerer.
HISTORY OF VENEREAL DISEASES
The inclusion of the effects of syphilis of the nervoussystem in this group makes thepercentage of cases with a positive history of infection (43.4 per cent) higherthan in any other group, except the drug-addiction group (Table 25).
CORRELATION WITH OTHER CLINICAL CONDITIONS
The correlation of diseases and injuries of the nervoussystem with other conditions gives little information of importance.
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State of residence | Epilepsy | Mental deficiency | Psycho- | Psychosis | Neuro- | Constitu- | Endocrin- | Drug addiction | Alcohol- |
United States | 8.6 | 29.2 | 17.0 | 12.1 | 10.0 | 9.7 | 7.4 | 3.0 | 3.0 |
Alabama | 9.3 | 36.0 | 20.1 | 11.8 | 9.9 | 7.3 | 4.0 | 1.2 | .5 |
Arizona | 10.8 | 15.0 | 12.5 | 16.7 | 18.3 | 11.7 | 6.7 | 4.2 | 4.2 |
Colorado | 11.8 | 24.8 | 18.2 | 14.5 | 10.7 | 9.5 | 6.4 | 2.1 | 2.1 |
Connecticut | 10.6 | 26.7 | 17.8 | 15.9 | 7.7 | 10.3 | 3.1 | 2.9 | 4.9 |
Florida | 11.2 | 31.1 | 18.4 | 14.5 | 9.2 | 8.8 | 3.5 | 2.9 | .4 |
Kentucky | 8.8 | 41.1 | 14.0 | 6.9 | 11.8 | 9.4 | 4.2 | 1.2 | 2.6 |
Louisiana | 12.1 | 28.7 | 30.8 | 9.1 | 6.2 | 7.6 | 2.3 | 2.5 | .6 |
Maine | 9.2 | 51.5 | 13.0 | 7.7 | 5.4 | 8.9 | .5 | 1.3 | 2.6 |
Massachusetts | 10.4 | 26.7 | 18.1 | 14.4 | 6.9 | 12.2 | 1.7 | 2.7 | 7.9 |
Mississippi | 10.9 | 35.4 | 23.2 | 9.8 | 8.3 | 6.7 | 2.1 | 3.1 | .6 |
Montana | 11.9 | 16.7 | 16.0 | 20.8 | 11.2 | 8.9 | 7.8 | 3.7 | 3.0 |
New Hampshire | 10.2 | 27.7 | 23.4 | 10.2 | 7.3 | 12.4 | 1.5 | 2.9 | 4.4 |
New Jersey | 12.6 | 27.6 | 16.6 | 13.4 | 6.8 | 11.2 | 5.7 | 3.0 | 3.2 |
New York | 10.0 | 19.8 | 18.3 | 11.6 | 8.8 | 13.1 | 6.3 | 8.4 | 3.5 |
North Carolina | 9.6 | 46.7 | 17.7 | 8.0 | 6.6 | 3.9 | 6.1 | .7 | .6 |
Oregon | 9.5 | 18.1 | 19.1 | 19.7 | 8.9 | 16.4 | 5.3 | 2.6 | .3 |
Rhode Island | .4 | 29.2 | 18.8 | 9.9 | 7.2 | 9.9 | 4.0 | 4.9 | 6.7 |
South Carolina | 8.9 | 43.4 | 19.6 | 7.0 | 8.2 | 4.1 | 6.1 | 1.9 | .8 |
Texas | 13.4 | 25.5 | 14.8 | 17.6 | 12.3 | 8.8 | 2.3 | 4.1 | 1.1 |
Vermont | 8.8 | 33.6 | 16.8 | 13.3 | 10.6 | 10.6 | 3.5 | --- | 2.7 |
Wyoming | 8.7 | 21.7 | 24.3 | 8.7 | 11.3 | 9.6 | 5.2 | 2.6 | 7.8 |
EPILEPSY
The data in the annual reports of the Surgeon General foryears prior to the World War indicate that epilepsy was the most importantneuropsychiatric condition coming to the attention of recruiting officers. Thepresent statistics indicate that four neuropsychiatric conditions are much morefrequent and that epilepsy constitutes only 9.2 per cent of the problem. Thisfact, together with the almost uniform distribution throughout differentcommunities and races, both foreign-born and native, constitutes the mostimportant information furnished by the present inquiry as to this mysteriousdisease.
CLINICAL CLASSIFICATION
Of the 6,388 cases classified withrespect to the different types of epilepsy, in 3,875, or 60.6 per cent, the information desired was notfurnished by the examiners. (See Table 6.) Grand mal was put down as occurringin 2,093 cases, petit mal in 294, grand and petit mal in 31, andJacksonian in 95.
METHOD OF DISCOVERING CASES
The epileptic group is one of the smallest in which caseswere referred for examination by courts-martial and psychologists. (See Table8.) With the exception of the psychoses, the epileptic group had the smallestpercentage (1,963, or 31.7 per cent) found in the routine examinations bypsychiatrists. The patriotism of epileptics was a matter of common remark, andthey were inclined to conceal their defects. A somewhat larger proportion ofnegroes than of whites was found in the routine psychiatric examinations.Perhaps they were more frank than the whites. Epilepsy is a conduct disorder, inthat it so often first comes to light by the attacks. Consequently, a relativelylarger proportion of epileptics (1,660, or 26.8 per cent) was reported bycommanding officers. This is also true for organization medical officers.
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LENGTH OF SERVICE PRIOR TO DISCOVERY
Five thousand five hundred and eighty-nine cases, or 90.5 percent of all cases, were discovered before the expiration of six months. (SeeTable 10.) In this respect epileptics gave briefer service than alcoholics,neurological cases, psychoses, and psychoneuroses, and about the same length ofservice as the others. The negroes were detected much sooner than the others,which confirms the difference between negroes and whites, as remarked in thepreceding paragraph. There were relatively fewer epileptics who served more thanone year, than alcoholics, neurological cases, and psychoses.
TIME OF ONSET
The epilepsy was of long standing, 4,417 cases, or 97.5 percent of the ascertained cases, being of over 1 year duration, and 3,452 cases,or 76.2 per cent, being over 5 years duration. (See Table11.) In this respect there are few differences between the whites and colored.Only 38 cases were reported as originating after entering the service.
RECOMMENDATIONS FOR DISPOSITION
Six thousand one hundred and seventy-nine cases, or 96.7 percent, were recommended for discharge-a larger percentage than any other group.(See Table 12.) Only 209 cases out of the total were recommended for treatment,duty, or limited service.
There were 930 cases of epilepsy reported in the AmericanExpeditionary Forces. It may be said in this connection that some of these casesreported from France during the war period were looked upon, after their arrivalin this country, as not true epilepsies, but hysterical conditions. Five deathsfrom epilepsy were reported.
DELINQUENCY
Only 53 of a total of 6,388 cases of epilepsy were reportedfor examination to explain the cause of misconduct. It would thus seem thatepileptic symptoms, for the most part, were recognized immediately for what theywere.
FAMILY HISTORY
Epilepsy gave the highest ratio of neuropsychiatric familyhistory (61.9 per cent), exceeding that of endocrines by 0.9 per cent. (SeeTables 13 to 17.) In the family histories of epileptics, the existence ofinebriety was comparatively low. It was higher among the colored than among thewhites. From the limited number of epileptic cases analyzed, it appears that thehistory of nervous disease in family was thecommonest form of neuropsychiatric taint. The percentage of positive cases ishigher among negroes than among whites.
AGE
The present statistics add little to what already was knownin reference to age of epileptics, with the exception that the whites averagedsomewhat younger than the negroes. (See Table 16.) Like mental deficiency,epilepsy
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had a relatively higher representation in the younger agegroups and a relatively lower representation in the older age groups.
EDUCATION
In Table 23, it is shown how far below the average ineducation the epileptics are. They came second to mental defectives in respectto having no schooling at all and in representation in the grades.
ECONOMIC CONDITION
There was a somewhat higher proportion of epileptics incomfortable circumstances thanmental defectives, alcoholics, or drug addicts-10.5 per cent as compared to4.6 per cent, 7.8 per cent, and 9 per cent, respectively. (See Table 24.)
HISTORY OF VENEREAL DISEASES
One thousand six hundred and twenty-four cases, or 25.4 percent of the epileptics, admitted having had venereal disease of some kind. (SeeTable 25.) The percentage was much higher among the colored. Four thousand threehundred and sixteen white epileptics, or 81.9 per cent of the white epileptics,denied having had any venereal disease, while 448 negro epileptics, or 40.2 percent of the negroes, made such denial. One hundred and eighty-two whiteepileptics, or 3.5 per cent of white epileptics, admitted syphilis, while 819white epileptics, or 15.5 per cent of white epileptics, admitted gonorrhea.Among the negro epileptics 273, or 24.5 per cent of them, admitted syphilis, and557, or 50 per cent, admitted gonorrhea.
ALCOHOLIC HABITS
There is practically no difference between the white andcolored epileptics in reference to alcoholic habits. (See Table 26.) Twothousand seven hundred and forty-six, or 46.1 per cent, declared themselves asabstainers, this being a considerably higher percentage of abstainers than wasfound among drug users, neurological cases, insane, andconstitutional psychopathic states. In fact, abstainers were more common amongepileptics than among any other group, except psychoneuroses (48.6 per cent) andthe endocrine group (49.3 per cent). In other words, epileptics were third onthe list of the different clinical groups found in order of abstinence andseventh on the list found in order of intemperance.
MARITAL STATUS
Of the draft registrants placed in Class I, 86.8 per centwere single. The epileptics ran below this, 75.8 per cent being single. (SeeTable 27.) There was a higher percentage of single men among alcoholics,psychoses, psychoneuroses, endocrine cases, mental defectives, andconstitutional psychopathic states than among epileptics.
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HOME ENVIRONMENT-URBAN OR RURAL
The distribution of epileptics as to home environment wasabout the same as that for the population as a whole.
STATE OF RESIDENCE (WITH GAIN OR LOSS FROM IMMIGRATION ORMIGRATION)
Table 44 shows 21 States in which the distribution rate forepilepsy exceeded the United States rate of 8.6 per cent. The distributionaverage in these 21 States was 10.6 per cent. Only four States exceeded 5.16per 1,000 rate for epilepsy at the draft boards (see Table 5), showing a greaterdisagreement between the results at draft boards and camps than in otherconditions.
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
The variations in thedistribution of epilepsy throughout both States and races are slight. In the 21States in which the United States average of 8.6 per cent was exceeded theaverage excess was not remarkable, and the excess in individual States did notcorrespond with any excess or decrease in other clinical conditions worthy ofspecial remark. (See Table 44.)
Among the classified races (see Table 34) epilepsy showed ahigh distribution rate in the Negro, Dutch, French, Greek, Italian, and Mexican;as between the foreign born and native born there were no marked differences. Itseems as though this protean disease, epilepsy, were a condition inevitably andmore or less evenly distributed throughout the whole human family, being littleinfluenced in its distribution by race or environment.
CONSTITUTIONAL PSYCHOPATHIC STATES
This group is composed of young men whowere unstable, undependable, ill-balanced emotionally, changeable, and ingeneral asocial. Their asocial qualities were manifested in an inability tocarry out the requirements of organization or in more definite antisocial acts.A considerable number had criminal records, and the tendency to recidivism, todo the same thing over again, whether the thing done was antisocial or not, waspronounced. These persons were for the most part fairly normal in respect to pureintellectualperformance and presented few physical symptoms. They were recognized chieflyby their past records, which came to light either on the questioning theexaminers put them to, on arrival at camp, or when they were referred forexamination for some infraction of discipline. As so many of them were normals,absence without official leave was a common complaint brought against them.
The difference between psychopaths and psychoneurotics wasdistinct. The former never came under attention in the Army service because oftheir own choosing; that is, they did not come to the doctor suffering fromsymptoms, as did the psychoneurotics. They came as delinquents, disciplinarycases, conduct disorders, and inefficiency, because they were referred bycompany commanders or by the military police. They made no complaints themselvesas to their own condition; in fact, they did not think that there was anythingwrong with them. The psychoneurotics, on the other hand, were quite con-
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vinced that there was something wrong with them. Thepsychopaths did not seek treatment but had treatment forced upon them. Thepsychoneurotics turned their fears, inefficiency, and inferiority into hysteria,neurasthenia, and anxiety. With the constitutional psychopaths the defects wereon a little higher plane, being defects of character, in sense of responsibilityand in ability to work in harmony with others. It was a less simple type ofinferiority, on a higher intellectual level, and characteristic of a moreintelligent group of men. In other words, the constitutional psychopathsrepresented the fundamental defect of character and development of moral andethical standards as generally accepted and the psychoneurotics broke at a lowerlevel, often associated with actual physical disability, such as stoopingposture, prominent abdomen, flat feet, a tendency to flushing, sweating, and allthose physical symptoms indicative of a poor physical constitution as well aspoor mental endowment.
It was a fortunate thing for the Army that so many of thesecases were recognized and discharged in the early part of the war. Theirelimination accounts, in large measure, for the low delinquency rate among ourtroops.
CLINICAL CLASSIFICATION
The classification of constitutional psychopaths, as is shownin Table 6, is beset with great difficulties, if it is not an impossible task.Sexual psychopaths, especially homosexuals, constitute amore or less typical group, but to attempt todifferentiate statistically between criminalism, nomadism, inadequatepersonality, etc., could be done only in a very intense inquiry. So the groupingas given in Table 6 is only to show how this great and important group tends tosubdivide itself. It may be noted that there is little difference between thewhites and the colored, with the exception that the colored show a higherpercentage of sexual psychopathy than the whites. This condition, sexualpsychopathy, including homosexuals, seems represented by avery small number, 190 cases in all.
METHOD OF DISCOVERING CASES
The social history of changing occupations, criminal records,unsuccessful meeting of life previously, made the prompt identification of thesecases comparatively easy, and 41.8 per cent of them were found at the routineexaminations. The delinquent tendencies common to this group explain why morecases were reported by commanding officers (31.8 per cent) and as a result ofdelinquency (1.1 per cent) than in other groups. (See Table 8.)
LENGTH OF SERVICE PRIOR TO DISCOVERY
Table 10 gives the length of service of these cases. It willbe noted that the colored were identified much more promptly than the whites.
TIME OF ONSET
Table 11 shows theessentially constitutional character, as opposed to being created byenvironment, of these cases.
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RECOMMENDATIONS FOR DISPOSITION
Practically the same proportion of constitutional psychopathsas of the psychoses were recommended for discharge, and a relatively highpercentage were recommended for limited service. (See Table 12.) Low percentageswere recommended either for treatment or for duty. Six deaths were recorded. Asbetween the whites and the colored, a slightly higher percentage of colored wererecommended for discharge and were discharged; as an exception to the generalrule, a slightly higher percentage of whites were recommended for limitedservice than of colored. After the war these cases disappeared as such, for fewmentions of them were found in March, 1921, as patients in the hospitals of theBureau of War Risk Insurance. It seems probable that, as soon as the opportunityoffered, they resumed the life of change and nomadism that the mobilization hadinterrupted. The evident criminal tendencies of the group lend some support tothe supposition that these are the persons who add to the criminalism which sooften follows wars.
DELINQUENCY
Among those reported for delinquency, 272,or 18.2 per cent, were constitutional psychopaths. Inrelation to the total number of constitutional psychopaths, this was apercentage of 4.5 per cent, thelargest of any one group except thepsychoses.
FAMILY HISTORY
With the exception of endocrine cases and epilepsy,constitutional psychopathic states gave a higher percentage of neuropathicheredity than any other group. (See Tables 13 to 17.) This percentage wasconsiderably higher in the colored than in the white. Nervous diseases wererelatively more frequent in the family in these cases than other conditionsmentioned.
AGE
The constitutional psychopaths formedessentially a young group. (See Table 20.) A higherpercentage of them were under 20 than any other group and only 2,556, or 41.8 per cent, of them were between 20 and 24years, as compared with 62 per cent of Class I men in that agegroup; while 2,050, or 33.6 per cent, were between theages of 25 and 29 years, as compared with 38 per cent of ClassI men in that group. Negroes were somewhat older than the whites. (See Table21.)
EDUCATION
The superior mental qualifications of constitutionalpsychopaths is shown by the statistics on education or schooling. (See Table23.) They ranked above the average soldier as to college education. They wereslightly below as regards high school and grades, though many more were withouteducation. As far as other neuropsychiatric caseswere concerned, the constitutional psychopathsseem to have been better educated than any except,perhaps, alcoholics.
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ECONOMIC CONDITION
In this respect the constitutional psychopaths occupied aboutthe median among neuropsychiatric cases. (SeeTable 24.)
HISTORY OF VENEREAL DISEASES
As in other clinical groups the negro greatly exceeded thewhite in the percentages of positive history of venereal diseases. (See Table25.) As a group the constitutional psychopaths occupied about the median amongneuropsychiatric cases.
ALCOHOLIC HABITS
These cases ranked fourth in order of intemperance (Table26), with practically no difference between the white and the colored.
MARITAL STATUS
Like mental defectives, constitutional psychopaths showed arelatively small number of married men and a larger number of single men. (SeeTable 27.) The youth of these patients should be remembered in this connection.They were much more frequently divorced than the defectives. The coloredconstitutional psychopaths showed a higher proportion of married and a smallerproportion of divorced than the whites. As a group, 83.3 per cent were unmarried, as compared to 86.8 per cent of Class I men.
HOME ENVIRONMENT-URBAN OR RURAL
After the two other antisocial groups, alcoholism and drugaddiction, the constitutional psychopathic group stood third in reference toproportion from urban environment, the percentage being 63.6per cent. (See Table 28.)
STATE OF RESIDENCE (WITH GAIN OR LOSS FROM IMMIGRATION ORMIGRATION)
Eighteen States (Table 45) exceeded the United Statesdistribution average of 9.7 per cent for constitutionalpsychopaths. At draft boards, 12 States (Table 5) exceededthe United States rate for draft boards, of 0.15 per 1,000 men examined. In sovague a condition as constitutional psychopathic states, an absolute agreementin the results obtained by two different sets of examiners is hardly to belooked for. Nevertheless of the 13 States which equaled or exceeded the averagerate at draft boards, nine-California, Maryland, Michigan, New Hampshire, NewYork, Pennsylvania, Rhode Island, Utah, and Vermont- exceededin the neuropsychiatric examinations in the camps.
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
Eighteen States (Table 45) exceeded the United Statesdistribution average for this condition. The excess of the average was 2.2 percent. In these States the only averages of the other clinical conditions to showchanges worthy of note were mental deficiency andendocrine disturbances. These both fell below.
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In the classified races (Table 34) the only significantchanges referred to the Negro and the Mexican. These two races are conspicuousby low averages in the constitutional psychopathic group. In reference to theforeign-born as opposed to the native (Table 33) both the German and Irishforeign-born show a lower percentage of psychopaths than the native.
State of residence | Constitu- | Mental deficiency | Psycho- | Psychoses | Neuro- | Epilepsy | Endocrin- | Drug addiction | Alcohol- |
United States | 9.7 | 29.2 | 17.0 | 12.1 | 10.0 | 8.6 | 7.4 | 3.0 | 3.0 |
Arizona | 11.7 | 15.0 | 12.5 | 16.7 | 18.3 | 10.8 | 6.7 | 4.2 | 4.2 |
California | 12.7 | 22.0 | 16.7 | 17.4 | 12.2 | 7.7 | 2.7 | 3.3 | 5.3 |
Connecticut | 10.3 | 26.7 | 17.8 | 15.9 | 7.7 | 10.6 | 3.1 | 2.9 | 4.9 |
Georgia | 11.8 | 33.3 | 13.0 | 13.4 | 11.5 | 7.9 | 6.1 | 2.5 | .7 |
Indiana | 14.5 | 23.3 | 20.0 | 8.6 | 14.3 | 7.5 | 8.3 | .6 | 2.8 |
Kansas | 9.8 | 21.6 | 18.2 | 10.4 | 13.5 | 6.3 | 15.4 | 2.5 | 2.2 |
Maryland | 10.7 | 44.9 | 13.3 | 10.4 | 7.6 | 4.5 | 4.4 | 1.6 | 2.5 |
Massachusetts | 12.2 | 25.7 | 18.1 | 14.4 | 6.9 | 10.4 | 1.7 | 2.7 | 7.9 |
Michigan | 11.6 | 29.2 | 12.0 | 13.5 | 10.9 | 8.6 | 11.2 | 1.1 | 2.3 |
New Hampshire | 12.4 | 27.7 | 23.4 | 10.2 | 7.3 | 10.2 | 1.5 | 2.9 | 4.4 |
New Jersey | 11.2 | 27.6 | 16.6 | 13.4 | 6.8 | 12.6 | 5.7 | 3.0 | 3.2 |
New York | 13.1 | 19.8 | 18.3 | 11.6 | 8.8 | 10.0 | 6.3 | 8.4 | 3.5 |
North Dakota | 10.3 | 38.5 | 14.1 | 12.6 | 9.2 | 8.0 | 3.8 | .4 | 3.1 |
Oregon | 16.4 | 18.1 | 19.1 | 19.7 | 8.9 | 9.5 | 5.3 | 2.6 | .3 |
Pennsylvania | 12.0 | 27.0 | 15.3 | 11.0 | 9.3 | 7.6 | 9.9 | 2.8 | 5.2 |
Rhode Island | 9.9 | 29.2 | 18.8 | 9.9 | 7.2 | 9.4 | 4.0 | 4.9 | 6.7 |
Utah | 12.6 | 20.5 | 19.2 | 18.5 | 6.0 | 7.9 | 4.0 | 7.9 | 3.3 |
Vermont | 10.6 | 33.6 | 16.8 | 13.3 | 10.6 | 8.8 | 3.5 | --- | 2.7 |
ENDOCRINOPATHIES
The present statistics furnish only a partial record of theendocrinopathies identified during the mobilization, for the reason that only aportion of these cases came under the special observation of neuropsychiatrists.Many of the cases, it is not knownhow many, were regarded as medicaland were disposed of as such. For this reason the present statistics give only apartial idea of the extent of this problem, especially in the central (lake) andnorthwest regions of the United States. The importance of the nervous aspects ofthese troubles, however, is shown by the fact that so many were referred toneuropsychiatrists, and also by the frequency with which a neurotic familyhistory was given.
CLASSIFICATION
Of the 4,805 cases of endocrinopathies,4,501, or 93.7 per cent, concerned the thyroid gland primarily, and 205, or 4.3 per cent, concernedthepituitary gland. (See Table 6.) As between the whites and the negroes, thewhites had a higher percentage of thyroid involvement, and the negroes a higherpercentage of neurocirculatory asthenia.
In view of the classification as givenabove it seems probable that only the outspoken cases were included inthis group. Examiners may have missed some of theless conspicuous evidences of endocrine troubles either classifying them undersome more evident disability or passing over thesymptoms altogether.
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METHODS OF DISCOVERING CASES
As shown in Table 8, two-thirds of the endocrinopathieswere discovered at the routine examinations-the largestpercentage thus discovered in any clinical group. They were medical rather thanbehavioristic, and with the exception of cases of alcoholism, a smallerpercentage of these cases than of any others were referred by commandingofficers.
LENGTH OF SERVICE PRIOR TO DISCOVERY
The nature of the condition rendered the time required foridentification short; 92.5 per cent had been identified before the expiration ofsix months; 97.2 per cent of the colored had been identified in that space oftime. (Table 10.)
TIME OF ONSET
The endocrinopathies were among the cases of longeststanding; 97.7 per cent had existed for from one to five years or over beforeentering the service. (See Table 11.) The percentages were practically the samefor both white and colored. Only 28 cases developed after entering the service,and of these 12 developed during the first six months.
RECOMMENDATIONS FOR DISPOSITION
As endocrinopathies so frequently create a partial ratherthan a complete disability, the percentage of them, 87.3, recommended fordischarge, was smaller than that for many other conditions. (See Table 12.)Eleven and nine-tenths per cent were recommended for limited service. Two deathswere recorded.
As between the whites and the colored a slightly higherpercentage of the latter were recommended for discharge and a slightly smallerpercentage of them were recommended for limited service.
DELINQUENCY
Only 6 cases out of the 4,805 in the endocrine group werereported for examination by reason of misconduct.
FAMILY HISTORY
Although not generally classified withnervous diseases, the endocrinopathies gave a high percentage (61.0 per cent) ofneuropsychiatric taint in the family, being exceeded in this respect by epilepsyalone. (See Tables 13 to 17.) The colored gave a somewhat higher percentage thanthe whites.
Of the neuropsychiatric conditions in the family, the orderas to frequency was nervous diseases, inebriety, mental diseases, mentaldeficiency. The percentage of mental diseases, in the families of endocrinopathswas lower than the average for the other groups.
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AGE
The bulk of these cases, both white and colored, were in theage group of the draft. They had a relatively small representation under 20 yearsand over 30 years. (SeeTable 20.) It seems probable on theone hand that they did not volunteer, and on the other, that they could notstand the strain of service. (See Table 21.)
EDUCATION
The white endocrine cases were somewhat below the averagewhite soldier in relation to schooland college attendance but above the average of neuropsychiatriccases. (See Tables 22 and 23.)
ECONOMIC CONDITION
After the psychoneuroses and neurological conditions theendocrinopathies made the best showing in regard to economic conditions, 15.6per cent of them being incomfortable circumstances. (See Table 24.) This relatively favorable showing wasdue to the whites.
HISTORY OF VENEREAL DISEASES
Table 25 shows the endocrinopathies to have the smallestnumber of histories of venereal diseases. Ofthe whites, 2.9 per cent admittedhaving had syphilis, and 13.1 percent gonorrhea. The coloredpercentages were much higher.
ALCOHOLIC HABITS
The percentage of intemperate men among the endocrinopathies(5.1 per cent) was lower than for any other group, and they furnished thehighest percentage (49.3 per cent) of abstinent men. The colored had higherpercentages as to intemperance and moderate drinking, and a low percentage inrelation to total abstinence. (See Table 26.)
MARITAL STATUS
Eighty per cent of these cases weresingle, which was above the average forneuropsychiatric cases. (See Table 27.) The endocrinopathshad the lowest percentage of divorces.
HOME ENVIRONMENT-URBAN OR RURAL
Somewhat less than one-half ofthese cases, 44.4 per cent, livedin rural surroundings, a fact whichwill appear again in the paragraph on State of residence. (See Table 28.)
STATE OF RESIDENCE (WITH GAIN OR LOSS THROUGH IMMIGRATION ORMIGRATION)
Seventeen States (Table 46) exceeded the United Statesdistribution average of 7.4 per cent for endocrinopathies, the distributionaverage in these States being 11.4 per cent. These States are chiefly those inthe central and north-
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west part of the United States. TheGulf States were remarkably free. (See Table 29.) For example, the averagedistribution in Florida, Alabama, Mississippi, Louisiana, and Texas was 2.7 percent as compared with 11.4 per cent in the 17 States which exceeded the UnitedStates average. If endocrinopathy, as used herein, corresponds with theclassification of "goiter" and "exophthalmic goiter" asemployed by local boards, there is substantial agreement in the results found bydraft boards and by the neuropsychiatric examiners at camps.
State of residence | Endocrino- | Mental deficiency | Psycho- | Psychoses | Neuro- | Epilepsy | Constitutional psychopathic states | Drug addiction | Alcohol- |
United States | 7.4 | 29.2 | 17.0 | 12.1 | 10.0 | 8.6 | 9.7 | 3.0 | 3.0 |
Idaho | 14.6 | 26.7 | 10.3 | 25.5 | 8.5 | 7.9 | 6.7 | --- | --- |
Illinois | 9.8 | 19.9 | 20.6 | 13.8 | 10.7 | 8.3 | 9.1 | 1.5 | 6.2 |
Indiana | 8.3 | 23.3 | 20.0 | 8.8 | 14.3 | 7.5 | 14.5 | .6 | 2.8 |
Iowa | 8.2 | 25.3 | 17.8 | 16.4 | 9.9 | 8.4 | 9.3 | 2.6 | 2.1 |
Kansas | 15.4 | 21.6 | 18.2 | 10.4 | 13.5 | 6.3 | 9.8 | 2.5 | 2.2 |
Michigan | 11.2 | 29.2 | 12.0 | 13.5 | 10.9 | 8.6 | 11.6 | 1.1 | 2.3 |
Minnesota | 12.0 | 22.2 | 19.5 | 14.0 | 10.9 | 7.8 | 7.1 | 2.2 | 4.3 |
Missouri | 8.5 | 33.8 | 15.9 | 8.5 | 11.4 | 6.3 | 9.4 | 3.0 | 3.3 |
Montana | 7.8 | 16.7 | 16.0 | 20.8 | 11.2 | 11.9 | 8.9 | 3.7 | 3.0 |
Nebraska | 10.7 | 25.1 | 14.7 | 15.5 | 12.9 | 7.6 | 9.4 | 2.6 | 1.6 |
Ohio | 12.8 | 23.9 | 19.7 | 11.3 | 10.9 | 7.7 | 8.6 | 2.7 | 2.3 |
Pennsylvania | 9.9 | 27.0 | 15.3 | 1.0 | 9.3 | 7.6 | 12.0 | 2.8 | 5.2 |
South Dakota | 16.1 | 33.1 | 14.4 | 10.5 | 12.8 | 6.6 | 3.9 | .3 | 2.3 |
Virginia | 10.9 | 45.5 | 12.1 | 9.2 | 7.0 | 5.8 | 7.4 | 1.2 | 1.0 |
Washington | 9.3 | 26.1 | 14.1 | 17.7 | 8.2 | 7.5 | 9.5 | 6.8 | .9 |
West Virginia | 15.7 | 38.6 | 12.6 | 8.2 | 9.1 | 6.3 | 7.8 | 1.1 | .7 |
Wisconsin | 12.6 | 27.0 | 19.2 | 12.6 | 11.6 | 6.8 | 6.2 | .7 | 3.2 |
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
Seventeen States (Table 46) exceeded the United Statesdistribution rate for endocrinopathies of 7.4, the average distributionpercentage in these States being 11.4 per cent. The distribution average inthese 17 States for the different clinical conditions showed no markedvariations, mental deficiency, alcoholism and drug addiction fell further belowthe United States average than the others. The United States endocrine averagewas especially exceeded in the North and Northwest. In most of these States thedistribution average for alcohol and drugs was well below the United Statesaverage for these two conditions.
Of the classified races (Table 34) five, namely, the Dutch,English, German, Scandinavian, and Scotch, were all much over average inrelation to endocrine troubles. These races showed an under average in mentaldefect, except the English, whose rate just equaled the United States averagefor mental defect.
As between native and foreign born, the foreign born German,Scandinavian, and Irish have a lower distribution average than the native; withthe Italians the reverse is the case. (See Table 33.)
DRUG ADDICTION
By a drug addict is understood one who has become sohabituated to habit-forming drugs-chiefly derivatives of opium-that whensuddenly deprived of them he falls ill with painful symptoms and can not work.This falling ill and inability to work is essential to the definition of drugaddiction. Many, if
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not most, of the habitu?s, as long as they are supplied withwhat they have become dependent on, can work and keep in fairly good health. Butthey go to pieces shortly after withdrawal. It is in this way that the diagnosisof drug addiction is chiefly made-not by direct examination, but by theso-called withdrawal symptoms.
The drug addict has always been unpopular with the Army. Hecan not by any chance make a reliable soldier unless cured of this habit, andthe Army has no facilities for curing him, for cure means not only hospitaltreatment during the period of withdrawal, but a long time of vigilant watchingafterward. Most drug users are proselytors, eager to make others acquire thehabit that enslaves them, and so in any community, and especially in a militarycommunity, they create a focus which fosters bad morale and disobedience. Beforethe World War our Army refused to accept applicants for enlistment who were drugaddicts. But it could take no such attitude under a draft act because of thedanger of drug-taking being feigned as a means to exemption; and also because,if physically sound drug addicts ran into the thousands-no one knew how manythere would be-to have rejected all of them would have entailed too great aloss of man power. So, from the beginning, drug addicts were not accepted, butwere rejected conditionally, so that if the numbers of themproved sufficient to justify it, they could be recalled.6
As a class drug addicts were not conspicuous as malingerers.Some recruits brought syringes, etc., with them, and others had punctured theirskin for the purpose of giving the impression of being old "needlefiends." But most of these were malingerers pure and simple, and not drugaddicts at all. And the number was small. The unbridled stories circulated inthe newspapers in the early days, that many young men were acquiring the habitfor the purpose of evading thedraft, were entirely baseless. According to the total draft figures, drugaddiction occurred in 0.54 men per 1,000 examined.
METHODS OF DISCOVERING CASES
By direct examination alone the only positive reliableevidence of habit are scars and abscesses from needle punctures. Failing to findthese the most skillful physician can not besure that addiction exists from any objective examination. In consequence, drug addictionbelongs to the class of conduct disorders-the blight becomes evident more fromthe way the patient behaves than from medical examination. It appears from Table8 that considerably less than half of the cases were identified by thepsychiatrists in routine examinations. This is explained, partly, by the factthat routine examinations did not disclose the condition, and partly because theaddict brought to camp with him a sufficient supply of heroin or morphine, orwhatever he took, and could carry on for a time. Morecases of alcoholism, neurological and endocrine disorders,and constitutional psychopathic states were found out at the start than of drugaddiction. Other medical officers, on the contrary, discovered them frequentlywhen they reported to hospital for treatment of symptoms of withdrawal or forindependent disorders. Commanding officers also found them frequently. Drugaddicts concerned psychologists but little, and few also came to light throughthe courts-martial or guardhouses.
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LENGTH OF SERVICE PRIOR TO DISCOVERY
The drug addicts gave the shortest service prior to discovery-84.9per cent of them were detected before the expiration of three months, and only3.8 per cent served more than a year. (See Table 10.) This prompt identificationmay be explained in part, at least, by the fact that these soldiers could notget drugs in the cantonments and so were forced to disclose themselves. Policeregulations for the suppression of the traffic seem to have been effective.
TIME OF ONSET
Not all those who tamper with drugs acquire the habit, evenwhen the tampering occurs in the social ways by which drug addiction is mostestablished. Many persons try drug taking, do not like it, and give it up aftera short time. Some months are required for the habit to become fixed. But withinthat time the habit usually does become fixed and the fact that no casesdeveloped in the service indicates definitely that there was not greatprevalence of drug taking among troops. Ninety-eight and eight-tenths per centof the drug addicts (Table 11) had been such for a year or more before they weremobilized. This is in full accord with what was known previously, namely, thatthe drug habit is a long-standing affair, meriting, on account of its verychronicity, being classed with the other degenerative neurotic conditions. Thelong establishment of the habit in the cases reported, furnishes additionalproof that practically no habits were formed for the purpose of evading thedraft.
RECOMMENDATIONS FOR DISPOSITION
Of the drug addicts discovered 90.2 per cent were recommendedfor discharge. (See Table 12.) This percentage was higher for the colored thanfor the white. One death was reported.
The almost complete eradication of drug habitu?s from ourtroops is shown by the fact thathospital admissions in the American Expeditionary Forces for this causenumbered but 70 for the years 1917-18-19.
DELINQUENCY
Only 21 cases of drug addiction were reported for examinationas to misconduct. This is approximately 1 per cent of the total 2,020 drugaddicts.
FAMILY HISTORY
As a class, drug addicts, both colored and white, were amongthe more intelligent of the neuropsychiatriccases, and their answers to questions as antecedents have,therefore, a fair chance of being correct. (See Tables 13 to 17.) Among them,the distribution of family neuropathic taint was about the same as amongalcoholics. It was notably less than in endocrine disturbances and epilepsy.From this it seems evident thatwhile many drug addicts are neurotically predisposed individuals, they, withalcoholics, are less so than the other members of the neurotically degenerategroup.
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Table 47 gives specific information as to which offour specified conditions had existedmost frequently in the families of 907 drug addicts. The importanceof the direct inheritance oftendency to inebriety is shown by the percentage 24 ofhistory of family inebriety. A similar condition exists among alcoholics (33.3per cent) and drug addicts share withalcoholics the lowest percentage of mental disease in the family, of allneuropsychiatric cases. But even then it is found in approximately 10 percent of all cases. It will be observed that the history ofmental disease in the family is much more frequent among negrodrug addicts than among whites. Family history of mental deficiency, 2 percent, is higher than in alcoholism, psychoneuroses, orconstitutional psychopathic states. Table 48 shows arelative excess of inebriety in fathers.
TABLE 47.-Family history of neuropathic taints among cases of drug addiction
Neuropathic taint in family | Total | White | Colored | |||
Number | Per centa | Number | Per centa | Number | Per centa | |
Nervous disease | 266 | 14.9 | 239 | 14.8 | 27 | 15.6 |
Mental disease | 177 | 10.0 | 149 | 9.2 | 28 | 16.2 |
Inebriety | 429 | 24.0 | 382 | 23.7 | 47 | 27.2 |
Mental deficiency | 35 | 2.0 | 33 | 2.0 | 2 | 1.2 |
| 907 | 50.7 | 803 | 49.7 | 104 | 60.1 |
aPercentages are based on the number of cases with eachspecified taint among the total cases with ascertained family history.
WHITE | ||||||
Neuropathic taint in family | Number of cases | Number of relatives | ||||
Father | Mother | Grandparents | Siblingsa | Collateralsb | ||
Nervous disease | 239 | 53 | 106 | 7 | 99 | 25 |
Mental disease | 149 | 26 | 29 | 15 | 45 | 87 |
Inebriety | 382 | 247 | 22 | 13 | 134 | 96 |
Mental deficiency | 33 | 7 | 8 | --- | 24 | 9 |
| 803 | 333 | 165 | 35 | 302 | 217 |
COLORED | ||||||
Nervous disease | 27 | 2 | 16 | 1 | 7 | 2 |
Mental disease | 28 | 4 | 4 | 4 | 3 | 13 |
Inebriety | 47 | 24 | 3 | 1 | 20 | 11 |
Mental deficiency | 2 | --- | --- | --- | 2 | --- |
| 104 | 30 | 23 | 6 | 32 | 26 |
| 907 | 363 | 188 | 41 | 334 | 243 |
aSiblings include brothers andsisters.
bCollaterals include uncles, aunts, and cousins.
AGE
The two groups, drug addiction and alcoholism, contain the smallest number ofindividuals under 20 years of age of any of the neuropsychiatric conditions.(See Table 20.) In contrast to alcoholism, the greatest number,
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83.2 per cent, of drug addicts were found in the age periodof 20 to 30, although negroes averaged somewhat older.Thus, while averaging older than the ages ofClass I men, they were much younger than alcoholics. As a disability, drugaddiction is established much more rapidly than alcoholism. They are primarilyyoungsters who congregate together evolving, meanwhile, a special vocabulary oftheir own, especially necessary since the enactment of laws limiting the use ofdrugs. The vendor must know the gangs' members. Themembers of these gangs are almost invariably young men. Inthe round-ups of addicts which take place from time totime only here and there will be observed anyone morethan 30 or 35 years of age. The others are of about the sameage as those found in the Army.
The fact that drug addicts are so rarely met with after 35 years of age raises an interesting question as toprognosis. What becomes of them? If the current belief that drug addicts areincurable, that they never break the habit, is correct, the only alternativeexplanation is that they all die. But this explanation is not correct, becausethere has never been a high mortality among drug addicts. It must be, therefore,that drug addicts, as they grow older, either do break the habit, or else getadjusted to small doses such as it is possible for them to obtain easily, and sokeep out of trouble. In either event, it would seem that in their maturer yearspersons who have taken drugs cease to be much of a burden either to themselvesor the community.
EDUCATION
The information as to this point bearstestimony to the comparatively high mental development ofdrug addicts. (See Table 23.) There were fewer drug addicts (4.2 per cent)without any education at all than in the other groups, and the percentage ofthose who reached the grades is higher for all other conditions exceptalcoholism. Few drug addicts, however, reached high school, and a very smallpercentage, indeed, got to college. This rather abrupt breaking off of theeducation of drug addicts who were so well represented in the grades, may findsome explanation in the succeeding paragraph.
ECONOMIC CONDITION
Drug addicts (91 per cent), alcoholics(92.2 per cent), and mental defectives (95.4per cent) were in poorer circumstances than representativesfrom the other neuropsychiatric groups. (See Table 24.)Mental defectives are in poor circumstances because they not only are unable to earn much themselves,butalso because one or both parents are so frequentlyinferior in wage-earning ability. The same facts may holdtrue for both drug addiction and alcoholism, although in the latter the habits aloneare sufficient to account for the indigence.
More drug addicts werein comfortable circumstances (9 percent) than alcoholics (7.8 per cent) or defectives (4.6per cent). All the other neuropsychiatricgroups presented a higher percentage in comfortable circumstances than thesethree. It would seem that economic condition is to be held to account, to acertain degree at least, for the sudden cessation of education on the part ofdrug addicts. Economic conditions force them to forego high school and college.
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VENEREAL DISEASES
Among drug addicts venereal disease prior to entering theservice was more frequent than in any other neuropsychiatric conditions-56 percent as compared to 38.8 for alcoholism and 18.5 per cent for endocrinedisturbances. (See Table 25.) Among the colored cases the percentage was evenhigher. Twenty-three per cent of all drug cases admitted syphilis. This ishigher than in any other group except in the nervous disease group, in whichsyphilis is included. The history of gonorrheal infection (47.5 per cent) wasthe highest of all in drug addicts.
This frequency of venereal disease among drug addicts bringsup an important consideration as to theaction of drugs in the spread of venereal disease. Alcoholic intemperance hasalways been put down as the chief extraneous factor in the spread of venerealdisease. Of course alcoholic intemperance is more widely disseminated throughoutthe community, and occupies a more especially important position in relation tothe spread of venereal disease than drug taking, but as an actual incitant ofbehavior which results in venereal infection, alcohol seems materially lessactive than habit-forming drugs.
ALCOHOLIC HABITS
With the exception of alcoholism, relatively fewer drugaddicts were abstainers than were found in any other neuropsychiatric group.(See Table 26.) With the exception of the neurological and mental deficiencygroups there were proportionately more moderate drinkers among the drug addicts(48.9 per cent). After the alcoholism and the psychoses, they gave the mostfrequent history of intemperance.
MARITAL STATUS
The endocrine, mental defective, psychoses and constitutionalpsychopathic groups contain substantially more single menthan the others. (See Table 27.) In the remaining groupthe proportion of single men was about the same throughout. Exceptions to thismust be made in the case of the colored drug addictswho had more married men and fewerdivorces. In this connection, however, it should beremembered that the colored drug addicts averaged olderthan the whites. The married drug addicts did not seem to getalong very well domestically, as the divorces among them weremore frequent than among any group except the alcoholicand the nervous disease groups.
HOME ENVIRONMENT-URBAN OR RURAL
Table 28 shows that 91.4 per cent of thedrug addicts come from cities having over 2,500inhabitants. Among negroes the percentage was 95.4 per cent,as compared with 36 per cent of colored neuropsychiatriccases as a whole, and 27 percent of the colored population as a whole. Drug addictionis the urban variety of neuropsychiatric disorder parexcellence, being followed by alcoholism (82.8 per cent), constitutional psychopathic states (63.6percent), and nervous diseases (62.1 per cent). This overwhelmingpreponderance of narcotic drug habits among city dwellers suggestsseveral interesting observations. One of them is the follyof estimating the number of drug addicts in the country as a whole from thenumbers found in cities. In the past it has been
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inferred that in New York, for example, where drug addictsare registered in accordance with the State law, the distribution rate in NewYork might be made to apply for some State, such as Kansas, which has no verylarge cities.
Another inference concerns control. Inasmuch as drugaddiction is essentially an affair of largemunicipalities, its local control, in addition to Federal,should be placed in the hands of municipal authorities. The problem ofsuppressing it is local, and is essentially a municipal and not a State problem.This point will come out plainly when the different localities are compared, asthen it will appear that cities in some sections of the country have a muchhigher distribution of drug addiction than others.
Another inference to be drawn from Table 28 is that drugaddiction is essentially a matter of social custom. It is well known that somedrug addicts acquire the habit after the administration of morphine or otherpain-relieving drugs by physicians.The drugs have been given after surgical operations or during the course ofpainful diseases. The physician either has been careless in not stopping themedicine soon enough, or the patient has continued the use of the drug withoutthe physician's knowledge, or in spite of it. But such a modeof origin of drug addiction comprisesonly a small proportion of the cases. This is known to beso from analyses of the histories of individual drug addicts,and would seem to be proven by the great preponderance ofdrug addiction in cities as compared to rural districts.If maladministration of drugs by physicians was a common cause of the habit, wewould expect to find the same rate of it in country as in city communities, ascountry doctors and city doctors treat their patients in very much the same way.But as this is not so, the conclusions seems plain that it is the urbanatmosphere which fosters this variety of inebriety through example, imitation,and social associations, in much the same waythat alcoholic intemperance is fostered.
TABLE 49.-State of residence ofcases of drug addiction
State of residence | White | Colored | State of residence | White | Colored | ||||
Number | Per cent | Number | Per cent | Number | Per cent | Number | Per cent | ||
Alabama | 13 | 1.2 | 1 | 0.1 | New Hampshire | 4 | 2.9 | --- | --- |
Arizona | 5 | 4.2 | 1 | 16.7 | New Jersey | 43 | 3.0 | 12 | 19.4 |
Arkansas | 23 | 2.6 | 1 | .3 | New Mexico | 1 | .3 | --- | --- |
California | 56 | 3.3 | 20 | 57.1 | New York | 541 | 8.4 | 33 | 20.5 |
Colorado | 10 | 2.1 | --- | --- | North Carolina | 10 | .7 | 1 | .3 |
Connecticut | 18 | 2.9 | 1 | 7.7 | North Dakota | 1 | .4 | --- | --- |
Delaware | 9 | 9.8 | 14 | 35.0 | Ohio | 101 | 2.7 | 6 | 3.5 |
Florida | 14 | 2.9 | 1 | .8 | Oklahoma | 88 | 7.4 | 8 | 4.9 |
Georgia | 38 | 2.5 | 1 | .2 | Oregon | 8 | 2.6 | 4 | 100.0 |
Idaho | --- | --- | --- | --- | Pennsylvania | 157 | 2.8 | 17 | 6.0 |
Illinois | 59 | 1.5 | --- | --- | Rhode Island | 11 | 4.9 | 2 | 20.0 |
Indiana | 11 | .6 | 1 | 2.3 | South Carolina | 14 | 1.9 | --- | --- |
Iowa | 25 | 2.6 | 4 | 16.7 | South Dakota | 1 | .3 | --- | --- |
Kansas | 23 | 2.5 | 4 | 7.8 | Tennessee | 46 | 3.5 | 5 | .7 |
Kentucky | 22 | 1.2 | 4 | 2.3 | Texas | 66 | 4.1 | 5 | 1.5 |
Louisiana | 24 | 2.5 | 2 | .3 | Utah | 12 | 7.9 | --- | --- |
Maine | 5 | 1.3 | --- | --- | Vermont | --- | --- | --- | --- |
Maryland | 14 | 1.6 | --- | --- | Virginia | 17 | 1.2 | 3 | .5 |
Massachusetts | 42 | 2.7 | 3 | 14.3 | Washington | 30 | 6.8 | --- | --- |
Michigan | 24 | 1.1 | 3 | 6.5 | West Virginia | 13 | 1.1 | 2 | 2.5 |
Minnesota | 26 | 2.2 | --- | --- | Wisconsin | 9 | .7 | --- | --- |
Mississippi | 27 | 3.1 | --- | --- | Wyoming | 3 | 2.6 | --- | --- |
Missouri | 82 | 3.0 | 30 | 10.8 | District of Columbia | 4 | 2.5 | 1 | 1.1 |
Montana | 10 | 27.3 | 2 | 50.0 | State unascertained and others | 49 | --- | 2 | --- |
Nebraska | 13 | 2.6 | 3 | 27.3 | United States | 1,823 | 3.0 | 197 | 2.3 |
Nevada | 1 | 1.7 | --- | --- | |||||
Percentages are based on total neuropsychiatric cases of each color from eachState.
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State of residence | Drug addiction | Mental deficiency | Psycho- | Psychoses | Neuro- | Epi- | Consti- | Endo- | Alco- |
United States | 3.0 | 29.2 | 17.0 | 12.1 | 10.0 | 8.6 | 9.7 | 7.4 | 3.0 |
Arizona | 4.2 | 15.0 | 12.5 | 16.7 | 18.3 | 10.8 | 11.7 | 6.7 | 4.2 |
California | 3.3 | 22.0 | 16.7 | 17.4 | 12.2 | 7.7 | 12.7 | 2.7 | 5.3 |
Delaware | 9.8 | 22.8 | 12.0 | 12.0 | 14.1 | 7.6 | 8.7 | 6.5 | .5 |
Mississippi | 3.1 | 35.4 | 23.2 | 9.8 | 8.3 | 10.9 | 6.7 | 2.1 | 0.6 |
Montana | 3.7 | 16.7 | 16.0 | 20.8 | 11.2 | 1.9 | 8.9 | 7.9 | 3.0 |
New York | 8.4 | 19.8 | 18.3 | 11.6 | 8.8 | 10.0 | 13.1 | 6.3 | 3.5 |
Oklahoma | 7.4 | 33.3 | 15.6 | 11.8 | 12.7 | 6.7 | 6.7 | 4.0 | 1.9 |
Rhode Island | 4.9 | 29.2 | 18.8 | 9.9 | 7.2 | 9.4 | 9.9 | 4.0 | 6.7 |
Tennessee | 3.5 | 43.0 | 14.3 | 9.6 | 11.9 | 8.0 | 3.8 | 5.1 | .8 |
Texas | 4.1 | 25.5 | 14.8 | 17.6 | 12.3 | 13.4 | 8.8 | 2.3 | 1.1 |
Utah | 7.9 | 20.5 | 19.2 | 18.5 | 6.0 | 7.9 | 12.6 | 4.0 | 3.3 |
Washington | 6.8 | 26.1 | 14.1 | 17.7 | 8.2 | 7.5 | 9.5 | 9.3 | .9 |
STATE OF RESIDENCE (WITH GAIN OR LOSS FROM MIGRATION ORIMMIGRATION)
Drug addiction constituted 2.9 percent of the total of neuropsychiatric cases; 3 per cent for thewhites, and 2.3 per cent for thecolored. (See Table 49.) Among the colored the average of 2.3 percent was greatly exceeded in the States of Arizona,California, Delaware, Iowa, Massachusetts, Missouri, Montana, Nebraska, NewJersey, New York, Oregon, and Rhode Island. Illinois furnished no cases amongthe colored. Among the whites the following States exceeded the United Statesaverage: Arizona, California, Delaware, Mississippi, Montana, New York,Oklahoma, Rhode Island, Tennessee, Texas, Utah,and Washington. (See Table 50.) Of the total, New York furnished morethan one-quarter of the cases; and more than half werefurnished by the States of New York, Ohio, Pennsylvania, California, andMissouri. These statistics show how essentially local drug addiction is.
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
In preceding paragraphs on correlation ithas been indicated that drug addiction, in common with psychoses and alcoholism,tends to sink below the distributionaverage in both States and races,when mental deficiency rises above it. How far theconverse of this holds true in theStates is shown in Table 50, which enumerates 12 States that exceed the UnitedStates distribution average of 3 per cent for drugaddiction. For all these clinical conditions named, theconverse holds true as far as the average of the whole 12 States is concerned.For example, the average for these States for mental deficiency is 25.8 percent, for drug addiction, 5.6 per cent. The converse does not hold true forevery State. As to mental deficiency, Mississippi, Oklahoma, and Tennesseeexceed the average; as to psychoses, 6 fall below; as to alcoholism, 5 fallbelow.
Of the classified races (Table 34) six-Indian, Hebrew,Irish, Italian, Scotch, and mixed-exceed the United States distribution ratefor drug addiction of 3 per cent. Of these six, all but the Indian and theItalian fall below the mental deficiency average. No foreign-bornrace reaches the United States average of 3 per cent fordrug addiction.
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From this it appears that drug addiction is antagonistic tomental deficiency, with the tendency to group itself with the conditions whichindicate a higher mentality, such as psychoses andalcoholism. This tendency is less marked than in alcoholism. It further appearsthat those born in America are more prone to drug taking than those born abroad.It might be advisable to consider both alcoholism and drugs under a common titleof inebriety.
Perhaps the two conditions are interchangeable means ofexpressing a common mental tendency or predisposition. Forexample, the foreign-born Irish drink heavily and arelittle given to drugs; while the native Irish drink much lessthan their foreign born brothers do, but take drugs morefreely. (See Table 33.) There seems to be adistinct tendency for drug taking to become higher innative as opposed to foreign born stock, a fact to be explained, perhaps, by theproselyting traffic in drugs which exists in the large cities in the UnitedStates. It may be that drug taking is an expression of a tendency to inebrietywhich finds particularly favorable conditions here.
ALCOHOLISM, INCLUDING THE ALCOHOLIC PSYCHOSES
The most noteworthy facts, established as to the distributionof chronic alcoholism among recruits, were thesmall number found, the excess among volunteers ascompared to drafted men, the excess ofalcoholism in communities and races low in mentaldeficiency, and the excess of mental deficiency in communitiesand races low in alcoholism-a factespecially clear as regards negroes.
It must beunderstood that, as used here, theterm chronic alcoholism signifies more than intemperance, and the termalcoholic, more than a drinking man. Alcoholic, as usedhere, means a person physically sound in other respects, who hasbecome poisoned by alcohol to a degree to be unfit to beararms. Of the total 69,394neuropsychiatric cases under consideration, 1,858, or 2.7 percent, were chronic alcoholics. (See Table 6.)
How many intemperate men were accepted for service and madegood under military conditions we have no means of knowing; we know only thenumber of those whose habits had broughtabout disabilities so serious that the Government did notthink it worth while to try to reconstruct them. These, during theirbrief time of service, caused comparatively littletrouble. They were quickly identifiedand discharged.
The relatively small number of cases identified raises thequestion whether all possible ones were included, or ifother reasons existed which might explain it. It should be remembered that thenumber 1,858, as given in Table 6, does not include the 292 cases of alcoholicpsychoses. To express fully the effects of alcohol on recruits these 292 casesshould be added, making a total of 2,150 camp cases. If the local board casesapproximate 1,000 the grand total of alcoholics for the mobilization ofapproximately 3,500,000 men examined would be 3,150, or less than 1 perthousand.
This result is so small, so far below any estimates that hadbeen made, that one immediately inquires if the youth of the men of our army hadsomething to do with it; for it iswell established that a long period of steady drinkingis necessary for the development of alcoholism,a fact substantiated by the present statistics;and in our Army, at least, the average age of alcoholicswas shown to
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be above the average age of recruits. In response to this itmay be said that approximately one-half of the alcoholics identified were notdrafted men, but were volunteers, a group which averaged higher in age thandrafted men. If the 1,199 alcoholics who were volunteers are subtracted from the3,150 total alcoholics, there remain only 1,951 cases of drafted men who werefound alcoholic. Even if only one-third of thedraft had reached the age most favorable to alcoholism, the above number of themis so small that it is plain that alcoholism can not be considered as affectingto any degree the military strength of the United States.
Among negro troops alcoholism practically did not exist-therewere only 29 cases, including 5 cases of alcoholic psychoses, as compared with4,055 cases of mental defect. The great disparity between these two conditionsin negroes made it necessary, in constructing United States distributionaverages, to leave the negro out of account, and to make theaverages on the basis of whites.
State of residence | Alcoholism (including alcoholic psychoses) | Mental defect | Psycho- | Psychoses | Neuro- | Epi- | Consti- | Endo- | Drug addiction |
United States | 3.5 | 29.2 | 17.0 | 12.1 | 10.0 | 8.6 | 9.7 | 7.4 | 3.0 |
Arizona | 5.0 | 15.0 | 12.5 | 16.7 | 18.3 | 10.8 | 11.7 | 6.7 | 4.2 |
California | 6.0 | 22.0 | 16.7 | 17.4 | 12.2 | 7.7 | 12.7 | 2.7 | 3.3 |
Connecticut | 5.7 | 26.7 | 17.8 | 15.9 | 7.7 | 10.6 | 10.3 | 3.1 | 2.9 |
Delaware | 8.7 | 22.8 | 12.0 | 12.0 | 14.1 | 7.6 | 8.7 | 6.5 | 9.8 |
Illinois | 7.0 | 19.9 | 20.6 | 13.8 | 10.7 | 8.3 | 9.1 | 9.8 | 1.5 |
Massachusetts | 8.8 | 25.7 | 18.1 | 14.4 | 6.9 | 10.4 | 12.2 | 1.7 | 2.7 |
Minnesota | 4.9 | 22.2 | 19.5 | 14.0 | 10.9 | 7.8 | 7.1 | 12.0 | 2.2 |
Montana | 3.7 | 16.7 | 16.0 | 20.8 | 11.2 | 11.9 | 8.9 | 7.8 | 3.7 |
Nevada | 18.3 | 18.3 | 11.7 | 18.3 | 18.3 | 8.3 | 6.7 | 1.7 | 1.7 |
New Hampshire | 4.4 | 27.7 | 23.4 | 10.2 | 7.3 | 10.2 | 12.4 | 1.5 | 2.9 |
New Jersey | 3.6 | 27.6 | 16.6 | 13.4 | 6.8 | 12.6 | 11.2 | 5.7 | 3.0 |
New York | 4.3 | 19.8 | 18.3 | 11.6 | 8.8 | 10.0 | 13.1 | 6.3 | 8.4 |
Pennsylvania | 6.0 | 27.0 | 15.3 | 11.0 | 9.3 | 7.6 | 12.0 | 9.9 | 2.8 |
Rhode Island | 7.2 | 29.2 | 18.8 | 9.9 | 7.2 | 9.4 | 9.9 | 4.0 | 4.9 |
Wisconsin | 3.9 | 27.0 | 19.2 | 12.6 | 11.6 | 6.8 | 6.2 | 12.6 | 0.7 |
Wyoming | 7.8 | 21.7 | 24.3 | 8.7 | 11.3 | 8.7 | 9.6 | 5.2 | 2.6 |
District of Columbia | 3.7 | 16.1 | 23.6 | 19.9 | 14.3 | 6.2 | 8.7 | 6.2 | 2.5 |
CLASSIFICATION
The only effort made to classify thedifferent varieties of alcoholism was to separate the alcoholic psychoses fromthe chronic form of poisoning. As has already been stated, in grouping the wholeneuropsychiatric material, the alcoholic psychoses were considered as belongingto the psychoses. If they were omitted from an intensive study on alcoholism introops, the result would be an incomplete picture, and so, in this section onalcoholism, the general statistical information includes the psychoses due toalcohol.
METHODS OF DISCOVERING CASES
The neuropsychiatric examinations wereusually near the head of the list of the camp examinations, andconsequently were in a favorable position as regards theprompt identification of conditions whichpresented physical
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symptoms. Of all the neuropsychiatricgroups, alcoholism and endocrine disturbances presentedmore physical symptoms than the others. These two groups,therefore, furnished the highest proportion of casesdetected by the routine examinations, 63.9 per cent in the case of alcoholism.(See Table 8). Of the other methods of discovering cases, 26.9 per cent of thecases were referred by other medical officers, these cases being in large partthose requiring treatment for such conditions as deliriumtremens. Only 8.9 per cent were referred by commandingofficers and only a few cases by the courts martial and bythe psychologists.
LENGTH OF SERVICE PRIOR TO DISCOVERY
The alcoholics were sifted out verypromptly. Table 10 shows 71.6 per cent of all alcoholiccases were identified before they had been in service onemonth, which is the shortest servicerendered by any one group.
TIME OF ONSET
Only five of the cases of alcoholism and six of alcoholicpsychoses gave the date of onset after entering the service. (See Table 11.) Thelarge majority of cases whose time of onset wasascertained gave a history of alcoholism for more than five years beforeentering the service. The essentialchronicity of alcoholism which disabled for militaryservice is thereby shown.
RECOMMENDATIONS FOR DISPOSITION
As the greater number of the cases of alcoholism were of long standing,theywere considered as of little value to the service, and 1,844, or 85.8 per cent,were recommended for discharge or rejection, and 306, or14.2 per cent, for treatment, duty, and limitedservice. (See Table 12.) Excepting the epilepsies andpsychoses, recommendations for discharge and rejection ran higher among the alcoholics than in any ofthe othergroups of neuropsychiatric cases.
DELINQUENCY
Thirty-one cases of alcoholism were referred for examinationas to misconduct. These constituted 2.1 per cent of the totalneuropsychiatric misconduct cases.
FAMILY HISTORY
Of the 1,873 cases analyzed under this heading 744, or 39.7per cent, have a history of some hereditary neuropathic taint. (See Tables 13 to17.) These figures indicate the clearest neuropathic inheritance of anyneuropsychiatric group. The negro cases form an exception. When individualfamily neuropsychiatric conditions are investigated, it appears that inebrietytakes precedence of all others. Family inebriety occurs with a greater relativefrequency among alcoholics than among any other group. Alcoholism in fathersappears especially prominent.
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AGE
Table 20, which gives the ages of the cases of alcoholism,shows that 36.2 per cent of the caseswere between the ages of 30 and 34. The increased ages ofalcoholics found in the Army whencompared with the statistics relating to theother groups is as follows:
Age, 30 to 34: |
|
Alcoholism | 36.2 |
Nervous diseases and injuries | 19.5 |
Psychoses | 16.0 |
Drug addiction | 14.5 |
Psychoneuroses | 12.8 |
Constitutional psychopathic states | 12.8 |
Mental deficiency | 9.7 |
Endocrinopathies | 9.4 |
Epilepsy | 9.4 |
The ages of alcoholics can not be consideredwithout noticing the conditionsaffecting volunteers and drafted men, a subject referred to elsewhere.
EDUCATION
Table 23 indicates that 89.6 per cent of the cases did notpass beyond the grades; that 8.2 percent entered high school, and thatan additional 2.1 per cent entered college. Whencompared with the statistics of the other groups ofneuropsychiatric cases, with the exception of mentaldeficiency, one finds the smallest percentage to enter highschool and college among the alcoholics. On the other hand they shared with drugaddicts the distinction of being only a little behind the averagesoldier in having had some schooling.
ECONOMIC CONDITION
Only 170, or 7.8 per cent, of thealcoholics were in comfortable circumstances. Not one of the 29 colored alcoholicswas in comfortable circumstances. The whites were 4.5 percent below the average for allneuropsychiatric white cases. Withthe exception of mental defectives, thepercentage in comfortable circumstances is lower than forany other group. Next in order come drug addicts.
HISTORY OF VENEREAL DISEASES
Venereal infections of all kinds werefar more frequent among the white alcoholicsthan among any other group of neuropsychiatric cases, except the drug addicts and the group ofnervous diseases and injuries. Among the colored thisdid not hold true. (See Table 25.)
MARITAL STATUS
Marriages were about as frequent among thealcoholics as among the other groups of neuropsychiatric disorders; divorces,however, were twice as frequent among them. (See Table27.)
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HOME ENVIRONMENT-URBAN OR RURAL
One thousand seven hundred and one, or82.8 per cent, were from the urbandistricts. The percentages for urban residences werelargest for alcoholics and drug addicts.(See Table 28.)
STATE OF RESIDENCE
Seventeen States exceeded the UnitedStates distribution average of 3.5 per cent as toalcoholism, viz, Arizona, California, Connecticut, Delaware, Illinois, Massachusetts, Minnesota, Montana, Nevada, New Hampshire,New Jersey, New York, Pennsylvania, Rhode Island, Wisconsin,Wyoming, District of Columbia. (See Table 51.)
When the States exceeding the neuropsychiatric (camp) rate for alcoholism are comparedwiththe States which exceeded the localboard rate, as given in Table 5, it is found that asubstantial agreement exists between the results of examinations bylocal boards and at camps. In 11 of the States mentioned-California,Connecticut, Delaware, District of Columbia,Massachusetts, Minnesota, New Hampshire, New Jersey, New York,Rhode Island, and Wisconsin-the average alcoholic ratewas exceeded at both draft boards and at camps. OneState, Pennsylvania, which exceededthe camp rate, just equaled the local boardrate. Of the States in which the camp examinations showedan over-average and the draft board examinations didnot, in four-Arizona, Montana, Nevada, and Wyoming-thenumbers covered in the campexaminations were too small to be ofgreat significance. In Illinois there was a distinct disagreement between the two sets of figures. There wereonly four States-Maryland, Missouri, New Mexico, andVermont-in which an excess in the average at draft boards failed to correspondwith an excess at the camps.
It would seem, therefore, that ingeneral an excess of alcoholism in the population of anyState was remarked by both draft examiners and camp examiners.
NATIVITY
Two hundred and sixty-four, or 12.3 percent of all cases, of alcoholism wereforeign born. This is considerably below the percentageof foreign born in Class I men (17 percent) and above the percentage (10 per cent) of the foreignborn in the whole neuropsychiatric group.
CORRELATIONS WITH OTHER CLINICAL CONDITIONS
In the discussion of mental defect,attention was drawn to the fact that in States and races where mental defect wasover-average, alcoholism was under-average. The converse ofthis also holds true. Among the 17States (Table 51) which exceeded the United States distribution average foralcoholism, none exceeded the United States distribution rate for mentaldeficiency. One only, Rhode Island, equaled it. The others all fell below.
Further correlations of alcoholism with other clinicalconditions show few rates ofparticular significance except in the cases of psychoses. The latter
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appear to have an excess distribution rate in States highin alcoholism. In explanation of this, two hypotheses are possible: Thatintemperance increases insanity, or that men of the psychotic group are prone to excess in alcoholicindulgences. The correlation of alcoholism with otherconditions in both native and foreign-born races is inagreement with those observed in the States. In otherwords, among races in which thealcoholism rate is high, the mental-deficiencyrate is low, while the rate forpsychoses is usually high. (See Table 34.) An exception isto be noted in the case of the Irish,where the alcoholism rate is high,but the rate for psychoses is belowthe average except for the foreign born.
REFERENCES
(1) Defects found in Drafted Men. Statistical Information. Compiled from the Draft Records. Washington, Government Printing Office. 1920.
(2) Based on: History of Base Hospital No. 214, by the commanding officer. On file, Historical Division, S. G. O.
(3) Psychological Examining in the United States Army. Memoirs of the National Academy of Sciences, Volume XV. Washington, Government Printing Office, 1921, 553.
(4) Second Report of the Provost Marshal General, to the Secretary of War, on the Operations of the Selective Service System to December 20, 1918. Washington, Government Printing Office, 1919, 118.
(5) Ibid., 159.
(6) Special Regulations, No. 65, W. D., 1918.
