Table of Contents

CHAPTER VIII

The study to be presented here arose originally as somewhatof a military necessity in the American Expeditionary Forces. As Base HospitalNo. 117 was the principal center for training neuropsychiatric personnel for thecare of war neurosis cases, there were constantly passing through the hospitalscores of medical officers sent there for instruction.¹A scientific summary of the clinical material there consequently was consideredhelpful in giving to these student officers a more concrete understanding of thewar neurosis problem than otherwise would have been possible. The materialpresented here is the result of an inquiry made in France into the make-up ofthe patients at Base Hospital No. 117, amplified by later studies carried on inthe United States in 1919 and 1924. It is a description of the characteristics-physicaland mental, military, and social-of men in the American Expeditionary Forceswho developed neurosis and were sent to the only special base hospital in Francefor the treatment of war neuroses. The original tabulation was done over aperiod of several months by a group of well-educated patients under thesupervision of the writer; and later repeated by the writer in The AdjutantGeneral's Office. The cases considered herein include, of course, only casesdiagnosed as psychoneurosis.

MENTAL AND PHYSICAL MAKE-UP

THE AGES FOR THIS GROUP COMPARED WITH THOSE FOR THE ARMYAT LARGE

Whether or not the factor of age is significant in thedevelopment of war neurosis may be discovered by comparing the ages of thepatients of Base Hospital No. 117 (taken at the time of hospitalization) withthe distribution of ages in the Army at large. From the records of the War RiskInsurance Bureau it was possible to tabulate the ages of 3,683,134 soldiers(officers and men), and these serve as a basis for comparison. In interpretingthe comparison between the figures for Base Hospital No. 117 and those for theArmy at large it should be stated here that the latter ages were obtained frominsurance policies taken out shortly after the soldiers' arrival in camp.Ayres² estimated that during the World War theaverage American soldier spent from eight to nine months after the time of hisentering camp before he reached the front; this means that the ages of the menas given on their insurance policies would all have increased by eight months ormore by the time they reached Base Hospital No. 117. With this in mind the tablefollowing was prepared.

430

TABLE 1.-Comparison of ages ofpatients of Base Hospital No. 117 with ages furnished by 3,683,124 applicantsfor war risk insurance on basis of incidence of each age per 2,653 (the numberof psychoneurosis cases on whom ages were obtained)^a

^aThroughout the followingdiscussion the figures obtained from the War Risk Insurance Bureau will beconverted into numbers per 2,653, in order to facilitate comparison with thefigures for Base Hospital No. 117.

The median for the ages of the Army at large is 24.664 years,for the ages at Base Hospital No. 117, 24.662 years. Though the medians of thetwo groups are practically identical, the median for the Base Hospital No. 117group is in reality about eight or nine months less than that for the Army atlarge, for the reason given above, namely, that the ages for the Base HospitalNo. 117 group were taken approximately this length of time later in the soldiers'careers than were the Army at large ages.

In comparing the number of admissions under 21 years of agewith the Army at large figures for the same ages, we find for the Army at large(soldiers under 21 years), 256; for Base Hospital No. 117 (patients under 21years), 322.

Again we must consider when the data were obtained in eachgroup and allow for the eight or nine months' difference in the dates when thetwo sets of ages were taken. The Army at large figures as they stand are toolarge for this group, since approximately two-thirds of the men recorded at age20 would by the time of hospitalization have passed into the 21-year-old group.One hundred and eleven such men (per 2,653) were 20 years old. When two-thirdsof this number is transferred over to 21 years, it leaves the relative numbersas: Army at large (soldiers under 21 years), 182; Base Hospital No. 117(patients under 21 years), 322.

These figures reveal a marked disproportion between theadmissions to the hospital of men under 21 and their number in the Army atlarge, 77 per cent more men from this group being admitted to the hospital thantheir proportion in the Army would lead us to expect. That is, there was amarked tendency for men under 21 to develop neurosis in greater numbers thantheir proportion in the Army would warrant.

The usual upper age-limit for Army original enlistment is 35years. This implies a decrease in the desirability for Army service of men abovethat age.

431

Comparison of the two groups for the ages above 35 gives thefollowing figures: Army at large (soldiers over 35 years), 67; Base Hospital No.117 (patients over 35 years), 89.

The total for the Army at large group, at 34 years of age, is13. Two-thirds of 13 must be added to the figures given above to make themcomparable with those of Base Hospital No. 117, because of the eight months'difference in the time of taking ages. Allowing for this discrepancy, we mustadd 8 to the 67, making a total of 75. Including this allowance, there are 19per cent more patients at these ages than the expectation in the Army at large.This difference is significant enough to warrant a second, though less markedconclusion, i. e., that men over 35 had a somewhat greater proportionalliability to develop war neuroses than the numbers of those ages in the Army atlarge would warrant.

FAMILY AND PERSONAL HISTORY

The question of the significance of the place of lessenedresistance in the individual's nervous system is perhaps the most significantproblem for statistical study in connection with the nature and etiology of warneurosis. There has been a widespread tendency to imply nervous or biologicalinferiority in the war neurotic. By this is meant that in the past life of theindividual there had been some incident or some condition in which the neurosiswas latent, that the war merely revived an old or innate weakness. It wasassumed that the pathological factors in the individual's make-up had beenmanifested earlier by such incidents as nervous breakdown, chorea, tics, andspeech disorders. Also, in addition to previous personal weakness, nervousinferiority includes familial defect in the form of direct or collateralexpressions of serious nervous disorders. Yet the following referencesillustrate the existence of a diversity of opinion regarding the relationship ofneuropathic taint to the occurrence of war neuroses.

Mott,³ quiteearly in his experience, found that in the majority of instances of war neurosesthe subject had an inborn or acquired disposition to emotivity. The sameconclusion, he says, was arrived at by eminent French and German authorities.Yet later in the same discussion Mott stated that shock-not only commotionalbut emotional shock-due to terrifying or horrifying conditions of war, mightinduce hysterical manifestations in a neuropotentially sound individual, infact, in a soldier who by his record had shown that he was neither of a timiddisposition nor had any neuropathic tendency. Wolfsohn⁴studied 100 of Mott's cases and found in 74 per cent a positive family historyand in 72 per cent a positive personal history. Whereas Hurst⁵believed the war neuroses might develop in anyone, Babinski, limited liabilityto the supersuggestible. Pollock,⁶ ina study of 200 cases, found positive family history in 4 per cent, positivepersonal history in 23 per cent, mental deficiency in 1 per cent. Salmon⁷held that the constitutional neurotics constituted a large proportion of allcases; however, the number of men of apparently normal make-up who developed warneuroses was very striking. Rhein,⁸ studyingincipient cases in a forward area hospital, found that of 342 cases studied 195had negative family history and 137, positive; of 320 cases studied by him forpersonal history, 174 were negative and 146 positive. He explained his large

432

negative findings by saying that in the active war areas oneacquired in a short time a state of nervous instability which in civil lifewould require months or years to bring about. The shortened period in thegenesis of general paresis in soldiers at the front is a similar fact; Weygandt⁹suggested a similar foreshortening for dementia pr?cox. According to Schwab,¹⁰the percentage of neuropathy never appeared to be greater than 5 per cent. Viets¹¹held that the neuroses all had a history of more or less psychopathicdisposition before the war. Kiely,¹² studying500 cases at a base hospital in the American Expeditionary Forces, found 34 percent with positive family, 42 per cent with positive personal history. Carefulinquiries into the family histories of all people, healthy as well as sick, haveshown that the preponderance of such heredity for the mass of neuroses andpsychoses is but a trifle more than that for healthy individuals.

The supposition that a pathological nervous incident in thelife of an individual may come to light under the stress of war conditions isunquestionably true. There were many cases at Base Hospital No. 117 in whichsome old symptom had returned, the recurrence being usually in exaggerated form.A man who had stammered a bit in his youth entered the hospital mute or aphonic;tics or choreiform movements of childhood reawakened as generalized coarsetremors. In what might be called the sphere of subjective symptoms, phobias,worries, suspiciousness, to say nothing of those symptoms related to conditionsfalling under the head of constitutional psychopathic states, this sameexaggeration occurred. There were several cases of men who had been previouslyof a slightly suspicious make-up who showed upon admission to the hospitaldistinctly paranoiac symptoms, these usually following upon some severe fatigue.Likewise, in many of the psychasthenics an old fear of the dark, horror for highplaces, self-doubtings, or other similar conditions, were greatly magnified.Several interesting cases in which there had been in childhood or throughout theprevious life of the individual an obsessive fear of the dark were carefullyobserved. These patients entered the hospital, after evacuation from the front,in a state of terror, not only of the dark, but also of the day, and especiallyof being alone at any time. They were often afraid to leave the ward, andgenerally would venture but a short distance from the hospital alone. If theyhad to go anywhere at night they would wait until someone came along who wasgoing in the same direction.

In discussing the casual significance of neuropathic taint,it is pertinent to compare our findings with the proportion of familial andpersonal taint in the average regiment that went overseas and saw service at thefront. Bowman,¹³ described the testing of aregiment at one of the cantonments in the United States in which he found that45.59 per cent of the men gave positive findings; 38.43 per cent were themselvesneuropathic, and positive family histories were noted in 9.84 per cent of hiscases. Only 2.2 per cent of these men were recommended for discharge;^bthe rest probably went to France.

Undoubtedly the attitude of the men in camp in the UnitedStates toward answering many personal questions was different from that ofpatients at the

^bBowman in a personal communication added: "It is also perhaps well to note 24 cases who were picked out from preliminary examination for further study were not studied because of transfer to other organizations, and the actual number recommended for discharge probably would have been higher if these cases could have been studied."

433

war neurosis hospital in France. Men who were eager to crossthe ocean and see action were quite loath to give information which was likelyto jeopardize their chances of going overseas. But how different the attitudetoward disclosing family and personal neuropathy among men who had been throughseveral campaigns, and had been blown up or concussed, and were in a hospitalsuffering from troubles which, to say the least, were mysterious to them. Thenagain, the necessarily hasty mental examinations which were made in thecantonments in the United States could not be compared in acuity with the studywhich the ward surgeons put in upon their cases in the hospital service inFrance. Bowman's figures suggest, however, that probably in all regimentsthere were nearly 50 per cent of the men whose clinical histories if taken wouldshow the presence of neuropathic taint either in their families or inthemselves.

The staff physicians at Base Hospital No. 117 made inquiryregarding each patient's personal and family history. The figures used hereregarding personal and family history are taken from their accounts ofpsychoneuroses cases assigned to their wards. Cases which were written uphastily or superficially by officers on temporary duty were excluded fromconsideration. As the patients were assigned to the various wards by chance thissampling is a fair one.

The data on family and personal history are summarized undertwo headings: Positive and negative. In considering family history, positive includescases in which the family history showed that either the parents or nearrelatives were actually committed to institutions for the insane or sufferedfrom symptoms which the ward surgeon could readily recognize as psychotic orneuropathic. Positive included also frequent occurrence in the patient'sfamily of gross medical difficulties, such as tuberculosis, heart trouble, andthe like. Negative indicates an absence of insanity or excessive diseasein the family.

In taking account of the personal history of the patient, thesame two categories were used: Under positive were included numeroustypes of difficulties-psychoses, psychopathic personality, alcoholism, mentaldeficiency, premature organic troubles of the heart, lungs, etc., severeneurasthenias, speech defects and hypochondriachal disorders of long standing,neuroticism, timorousness, excitability, effeminacy, temperamentality, and sexand other anxieties. Under negative were cases in which no evidence ofsuch abnormality could be discovered in the previous personal history of thepatient.

Data were obtained from approximately 1,000 case histories.The discrepancy in numbers is due to incompleteness in some of the casehistories. The following tabulation summarizes the findings:

434

By comparison with Bowman's figures of 45.59 per centpositive findings for combined personal and family history in a"normal" regiment, the members of which had previously, whenrecruited, been given a medical examination, and of which only a small numberwere discharged from the service, one finds that the supposition of anoverwhelming probability of previous neuropathic taint in the war neurosisvictim does not hold true for the patients of Base Hospital No. 117. There is nogainsaying that the war neurosis tended to include symptoms which had occurredin the individual's past life, and, similarly, to strike any latent weaknesswith telling force; but to go further and define the causation and occurrence ofwar neuroses in terms of these mental or nervous weak spots would be taking anextreme view, and one scarcely warranted by the fact that more than one-third ofthe number of cases studied in this group gave no evidence of such neuropathicbackground.

PHYSICAL STIGMATA

It is a traditional habit to connect psychoneurosis with theso-called physical stigmata. Jones, for instance, writing of war neuroses, said:¹⁴

The type known to neurologists as"degenerate," which contains many epileptics in its ranks, with thephysical characteristics of narrow palate and crowded teeth, simian hand andcoarse skin, has been found frequently among these patients; I have come toregard a narrow palate as indicating a bad prognosis.

There were few notations of physical stigmata on the casehistories of patients at Base Hospital No. 117; less than one-half of 1 percent. Anomalies of growth, such as marked facial asymmetry, Hutchinson teeth,feminine type of breast and pubic hair distribution, did occur, but these wererare in view of the total number of cases admitted.

WOUNDS

The number of men admitted to the hospital who had been woundedor injured was very small. There were some few cases of traumatic hysteriadeveloping upon an injury suffered from an accident with horses, mules, orcamions. The total number of patients admitted who had been seriously woundedwas 18, or less than 1 per cent; slightly wounded, 187, or 7 per cent. Thesecases had recovered from their wounds at the time of hospitalization in BaseHospital No. 117. Kiely,¹² studying500 cases, found only 6 per cent who had been wounded at all-only 1 or 2 ofthese being wounded about the head. These facts bear out the usual theory thatthe soldier who is taken prisoner or physically wounded rarely develops aneurosis.

EFFECTS OF GASSING

It was difficult to differentiate cases in which gassing hadbeen present and those in which it was assumed or imagined. If questioned, mostof the men would remember having been exposed to poisonous gas at one time oranother. There were 148 cases, or 5.51 per cent, in which the history of gasinjury was noted by the ward surgeon in his summary, the scar of the burn oftenbearing out the man's assertion.

435

DRUG ADDICTION

Of all the admissions to the hospital there were only threeindividuals who gave evidence of being drug users. These were in no sensepronounced cases. The cases of psychoses of this sort in the AmericanExpeditionary Forces were not many and when they occurred they were sent tohospitals handling mental cases. The relationship of drug addiction to theetiology of war neurosis, if present, is very insignificant.

ALCOHOLISM

Opinion varies regarding the significance of alcohol in theetiology of war neuroses. Canadian authorities believed an alcoholic 35 years orolder a sure candidate for war neurosis. Kiely,¹²in his study of 500 cases, found 4 per cent alcoholics. L?pine,¹⁵on the basis of 6,000 cases observed, claimed that alcohol was the primaryand sole cause in one-third of his cases, and that more than half, perhapstwo-thirds, were influenced by it. He likened it to malarial disease in thepathology of certain countries. Read,¹⁶ onthe contrary, was emphatic in his denial of the significance of alcohol asanything but contributory in the causation of war neurosis.

One of the most interesting cases of complete amnesia seen bythe writer began to clear up under alcohol. The patient returned to thehospital, after imbibing freely, very much excited over some visual imagesrelated to his lost memories which were passing before him. In a short time, bysimple association means, a good part of this man's memory returned.

The statistics of the cases at Base Hospital No. 117,regarding the use of alcohol, as elicited by the ward surgeons in their clinicalhistories, were the following: Negative-ranks from abstainer and moderatedrinker to those who had been intoxicated once or twice in their lives, 2,295,or 92.73 per cent. Positive-men who gave a history of frequent alcoholicdissipation, including "demonstrations" during their hospitalization,180, or 7.27 per cent.

Inasmuch as these figures were obtained from the men'sreplies to questions the ward surgeons asked them, undoubtedly there may havebeen some misrepresentations. However, observation of the men's behavior innearby towns and about the grounds of the hospital showed that there were fewamong the group that tended to alcoholism. Furthermore, the inability of the menat the front to obtain alcoholic beverages in large amounts, practicallyeliminates alcohol as an important etiologic factor in war neurosis in theAmerican Expeditionary Forces. Its part as a contributory factor, however, isdifficult to determine.

BIRTHPLACE

The cosmopolitan origin of the American Expeditionary Forcesis interestingly brought out by inspection of the birthplaces of the patients inBase Hospital No. 117. Sixty-four were born in Italy, 49 in Russia, 19 inIreland, 15 in Poland, and 14 each in Canada and England. Besidesrepresentatives from European countries other than those cited, Cuba,Switzerland, Armenia, South Africa, Brazil, and the "high seas" wererepresented. The following

436

tabulation contains the figures for the various countriesfrom which the foreign-born psychoneurosis patients of the hospital came:

In view of the great amount of moving from State to State thefigures for the birthplace of the men are less significant than those for homeaddresses in drawing inferences regarding the social background of the warneurotic group.

STATE OF RESIDENCE AND OCCUPATIONAL ENVIRONMENT

The States which the enlisted men who were patients of BaseHospital No. 117 gave as their homes were compared with the percentages ofenlistments in the Army as a whole coming from the same States. It must beremembered in interpreting such a comparison that a determining factor in theincidence of psychoneurosis in various divisions of the Army is the severity andduration of the campaigns in which the troops in question were used. There is,of course, no assurance that soldiers from the various States were subjected tosimilar severity of military stress. Yet the coefficient of correlation by therank method^c between thepercentage of Base Hospital No. 117 patients from each State and the percentageof the total Army enlistments by States is plus 0.841 (P. E. + 0.0297). Thiscorrelation would indicate that from the standpoint of proportionaterepresentation from the States our selection of cases is in general tendencyadequately representative of the constitution of the Army as a whole.

Significant interpretations regarding the types of localitiesfrom which these men came are obtained from the consideration of the percentageof urban and rural residents, density of population, percentage of foreign born,and number of males 10 years of age and over engaged in agricultural work in thevarious States. Tables 2 to 5 give the results of this tabulation. When eitherthe 10 highest ranks are compared with the 10 lowest (by the addition of thepercentages) or the 24 highest with the 24 lowest for the above-mentioned fourconsiderations, the data are all similar in tendency. The States in which therewere the highest percentages of native stock, of rural residents and ofagricultural workers, and the least density of population, gave much smallerquotas of psychoneurosis patients than did the States high in density ofpopulation, urban residents, foreign born, and nonagricultural workers.

Or viewed from another angle, these facts are further definedby the coefficient of correlation by the rank method between Base Hospital No.117 percentages ranked for the four qualities under study and the rank order ofpercentage of enlistment in the total Army. Rho is positive for density of popu-

  (footnote)

437

lation (plus 0.609, P. E ? 0.123), for percentage of urban residents(plus 0.464, P. E. ? 0.079), for percentage of foreign born (plus 0.104,P. E. ? 0.090), and negative for percentage of males 10 years and overengaged in agricultural work (minus 0.507, P. E. ? 0.072).

TABLE 2.-Rank orderof States from the standpoint of percentage of urban residents^drelated to percentages of the total Army enlistments and of Base Hospital No.117 patients from those States

^dObtained from Abstract of the FourteenthCensus of the United States, Government Printing Office, 1920, page 75. IncludesDistrict of Columbia and omits Iowa, rank 25.

TABLE 3.-Rank orderof States^e from the standpoint of density of population related tothe percentages of the total Army enlistments and of the patients of BaseHospital No. 117 from those States

^eObtained from Abstract of Fourteenth Censusof the United States, page 22. Includes District of Columbia and omits Iowa,rank 25.

438

TABLE 4.-Rank order of States^ffrom the standpoint of their percentage of foreign-bornpopulation related to percentage of the Army enlistments and of Base HospitalNo. 117patients from those States

^fObtained from Abstractof Fourteenth Census of the United States, p. 103. Includes District of Columbiaand omits Ohio, rank 25.

TABLE 5.-Rank order of States^gfrom the standpoint of their percentage of males 10 years andoverengaged in agricultural work related to the percentage of the total Armyenlistments andof the patients of Base HospitalNo. 117 from those States

Rank	State	Per cent B.H. No. 117	Per cent of Army	Rank	State	Per cent B.H. No. 117	Per cent of Army
1	Mississippi	0.52	1.44	26	Oregon	0.32	0.80
2	Arkansas	.59	1.62	27	Wyoming	.16	.30
3	North Dakota	.63	.69	28	Utah	.32	.46
4	South Carolina	.87	1.42	29	Colorado	.63	.92
5	South Dakota	.12	.79	30	Indiana	1.92	2.83
6	Georgia	1.07	2.28	31	Maine	1.27	.65
7	North Carolina	.67	1.94	32	Arizona	.08	.28
8	Alabama	1.31	1.99	33	West Virginia	1.27	1.48
9	Tennessee	.79	2.02	34	Washington	1.15	1.20
10	Idaho	.32	.51	35	Nevada	.08	.14
	10 highest ranks	(6.89)	(14.70)
11	Kentucky	1.11	2.00	36	Delaware	.16	.20
12	Oklahoma	1.39	2.13	37	Michigan	4.08	3.61
13	New Mexico	.24	.33	38	California	1.66	2.98
14	Texas	3.05	4.29	39	New Hampshire	.95	.24
15	Nebraska	1.11	1.27	40	Maryland	1.43	1.25
16	Louisiana	.59	1.76	41	Ohio	5.74	5.33
17	Iowa	2.14	2.63	42	Illinois	5.39	6.68
18	Montana	.59	.97	43	Pennsylvania	14.70	7.96
19	Kansas	1.19	1.69	44	New York	12.80	9.79
20	Virginia	1.98	1.94	45	Connecticut	3.17	1.33
21	Minnesota	1.27	2.64	46	New Jersey	4.28	2.80
22	Vermont	.47	.25	47	Massachusetts	7.57	3.53
23	Wisconsin	4.49	2.61	47	Rhode Island	.87	.45
24	Florida	.33	.89	48	District of Columbia	.39	.42
	Totals	26.84	40.10	49	10 lowest ranks	(56.34)	(39.51)
					Totals	70.39	55.60

^gObtained from Abstract of Fourteenth Census of theUnited States, p. 501. Agricultural work as the term used in thecensus tabulations also included forestry and animal husbandry. IncludesDistrict of Columbia and omits Missouri, rank 25.

---

439

When the draft quotas were being filled, it was found thatthe different parts of the country varied in physical readiness and vitality.Ayres,¹⁷ after presenting theofficial statistics for the physical fitness of the various States as expressedin the percentage of men accepted of all those called for national service,says: "In general, it is noteworthy that the best records are made by thoseStates that are agricultural rather than industrial and where the numbers ofrecently arrived immigrants are not large." It should be observed, whilenoting the striking similarity for these data and those of Ayres, that thereneed not necessarily be any relationship between the percentage of physicaldefect among recruits and the percentage of neuropathic tendency among thoseselected after an examination for physical fitness has eliminated the unfit.

Another aspect of the problem, which should be considered inattempting a definition of the gross environment factors from which the warneurotics were recruits, is occupation. This has already been touched upon fromone angle (agricultural work).

In Table 6, the Bureau of the Census data on occupations arecompared directly, for each type of work, with the occupations given by the BaseHospital No. 117 patients (officers and enlisted men) in their clinical records.Several items, viz., mining, manufacturing, trade, and public service, involvingabout 50 per cent of the group, were similar in proportion in both sets of data.It is noteworthy, however, that whereas the percentage of males over 10 years inthe United States in employment of some kind who were doing agricultural workwas 29.8 per cent in 1920, only 11.5 per cent of the hospital patients gaveagricultural work as their occupation when questioned at the hospital. On theother hand, the professional quota in the census is 3.4 per cent, while in thetotal hospital groups it is 7.2 per cent; likewise, the percentage of men inclerical work in the country at large was 5.11 per cent, while among thehospital groups it was 15.91 per cent; work related to transportation took in13.8 per cent of the hospital groups and but 8.6 per cent of the males of thecountry at large. There were fewer (2.5 per cent) of the hospital group engagedin domestic work than the quota for the country at large (3.7 per cent). Thelast might be accounted for by alien exemptions and the ages of men engaged indomestic work. While recognizing the obvious tendencies of the data, it shouldalso be remembered that 293 patients gave their occupation as "labor"and 124 were students. These cases, comprising 15.50 per cent of the group, arenot used in the computations in Table 6 because of the indefiniteness ofdescription and the inability to allocate them in terms of the Bureau of theCensus classification. The data taken in comparison with the census figuresunmistakably indicate that so far as occupational milieu was concerned men whowere engaged in clerical, professional, or transportation work were liable todevelop war neurosis in greater proportion than their quota in the total malepopulation would warrant.

---

440

TABLE 6.-Comparison of distribution oftypes of occupation of Base Hospital No. 117 patientswithcertain other groups

Type of work defined by 1920 census	Base Hospital 117 total group		1920 Census2		Enlisted men in A.E.F.3		Enlisted men, Base Hospital No. 117 patients
	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent
1. Agriculture	261	11.5	9,869,030	29.8	161,975	29.9	257	12.1
2. Extraction of minerals	53	2.3	1,087,359	3.3	12,239	2.3	52	2.5
3. Manufacturing and mechanical trades	789	34.7	10,888,183	32.9	151,429	28.0	780	36.6
4. Transportation	313	13.8	2,850,528	8.6	70,231	13.0	312	14.7
5. Trade	253	11.1	3,575,187	10.8	36,816	6.8	214	10.1
6. Public Service	45	2.0	748,666	2.3	18,099	3.3	26	1.3
7. Professional	163	7.2	1,127,391	3.4	34,748	6.4	117	5.5
8. Domestic Service	57	2.5	1,217,968	3.7	4,535	0.8	57	2.7
9. Clerical	339	15.9	1,700,425	5.1	51,429	9.5	319	14.5
Total1	2,273	100.0	33,064,737	100.0	541,501	100.0	2,134	100.0

¹Does not include 4,937 of AmericanExpeditionary Forces given as "education, extent of" and 37,034 givenas "laborer" (total, 7.2 per cent). Likewise for Base Hospital No. 117total group, 293 who gave occupation of laborer and 124 as students are omitted(total, 15.50 per cent).
²Fourteenth Census of the United States, 1920, iv, 3.
³Personnel System of the U. S. Army, Vol. I, U. S. GovernmentPrinting Office, 1919, i, 213-216.

There are available some occupation statistics on over half amillion enlisted men of the American Expeditionary Forces, which are useful forcomparison with our own. These data are arranged in Table 6 according to thecensus categories for the purpose of comparison. As indicated in the footnote toTable 6, two groups are omitted as inadequately descriptive and incapable ofbeing fitted into this classification. Otherwise the group totals 541,501. Asone would expect, these figures show that the enlisted men of the Army in Francewere not a perfect sampling of the occupational cross section of the maleworkers of the country; especially is the variation from the census notable inprofessional and clerical work, domestic service, transportation, and trade.Only in the agricultural figures are the two sets of facts practicallyidentical.

When the enlisted men of the Base Hospital No. 117 patientsare compared with the American Expeditionary Forces, figures for occupations ofenlisted men, we find certain items in disagreement. The quotas of patients,especially for agriculture, and also for public service and domestic service areconsiderably less than expectation, whereas the quotas for manufacturing andmechanical trades, clerical work, and trade, are greater than expectation. Themost striking difference is again in the small percentage in the agriculturalgroup, while the greater proportion in clerical and domestic work and in tradeare the most significant differences in the other direction, namely, toward agreater representation among the psychoneurosis patients than their proportionalquotas. There is a slightly smaller percentage of the patients in professionalwork than the proportion of the American Expeditionary Forces, soldiers. Thisdifference may be accounted for by errors in the collection of the AmericanExpeditionary Forces, data; the very small number who gave the occupation"student" being indicative of a possible exaggeration of occupationalstatus by these individuals into the professional ranks. In general, thetendency is for the patients to be engaged in bookish, indoor, commercial workin greater proportion than the Army in general and to have a lesser proportionof men engaged in agricultural work. Unfortunately these data on the BaseHospital No. 117

---

441

group do not lend themselves to interpretation by any of the occupationalscales now obtainable. In the succeeding chapter this problem will be reviewedin the light of more adequate data. For the present, however, it may be notedthat the war neurotic group, which is high in the trade and clerical types ofwork and low in agricultural work when compared with the enlisted men of theAmerican Expeditionary Forces, is probably at least the equal of the latter ingeneral occupational rating.

REFERENCES

(1) History of Base Hospital No. 117, A. E. F., prepared bythe commanding officer of the hospital. On file, Historical Division, S. G. O.

(2) Ayres, L. P.: The War with Germany. Washington, GovernmentPrinting Office, 1919.

(3) Mott, F. W.: War Neuroses. British Medical Journal, 1919,i, 439.

(4) Wolfsohn, Julian M.: The Predisposing Factors of WarPsychoneuroses, Journal American Medical Association, 1918, lxx, No. 5,303-308.

(5) Hurst, Arthur F.: Hysteria in the Light of the Experienceof War. Archives of Neurology and Psychiatry, 1919, ii, 563.

(6) Pollock, Lewis J.: An Analysis of a Number of Cases of WarNeuroses. Illinois Medical Journal, 1920, xxviii, No. 3, 209.

(7) Salmon, Thomas W.: The Care and Treatment of MentalDiseases and War Neuroses ("Shell Shock") in the British Army. MentalHygiene, New York, 1917, i, No. 4, 509-547.

(8) Rhein, John H. W.: Neuropsychiatric Problems at the Frontduring Combat. Journal of Abnormal Psychology, 1919-20, xiv, No. 1, 1.

(9) Weygandt, W.: Versorgung der Neurosen und Psychocen imFelde. Medizinische Klinik, 1914, x, No. 39, 1503.

(10) Schwab, Sidney I.: The War Neuroses as PhysiologicConservations. Archives of Neurology and Psychiatry, Chicago, 1919, i,No. 5, 525-653.

(11) Viets, Henry: Neuroses and Psychoses in Base Hospital No.33. Albany Medical Journal, 1919, xl, No. 1, 17.

(12) Kiely, Charles E.: Five Hundred Cases of Shell-Shock. OhioMedical Journal, 1919, xv, No. 11, 711-718.

(13) Bowman, K. M.: Report of the Examination of the -- Regiment,U. S. A., for Nervous and Mental Disease. American Journal of Insanity, 1919,lxxiv, 555-6.

(14) Jones, D. W. Carmalt: War-Neurasthenia, Acute andChronic. Brain, New York and London, 1919-20, xlii, October, 176.

(15) L?pine, Jean: Troubles mentaux de Guerre, Paris, 1917,Mason et Ci?.

(16) Read, C. Stanford: Military Psychiatry in Peace and War.H. K. Lewis & Co., London, 1920, 34.

(17) Ayers, -- : Op. cit. 21.

RETURN TO TABLE OF CONTENTS