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line cases in neuropsychiatry, with the exception of certain cases of mental deficiency and drug addicts. Thus many of the slighter degrees of neurasthenia and psychoneurosis, which were puzzling before, are now clearly dischargeable; and many mental defectives, capable of simple work under direction, but incapable of general military service, can be retained who before had to be discharged.
II. Some of the kinds of cases and of difficulties that confront the psychiatrist can be illustrated by our experience at Camp Sherman.
The feeble-minded make up the largest single group of cases. Up to May 1, 134 out of 468 cases recommended for discharge were of this group. Before the order of April 2 was issued, it had been our custom to recommend the discharge of those who measured below ten years. Since then we have recommended the retention“ for domestic service only” of two men who would have been wholly unfit for general military service. They measured between nine and ten years intellectual development, but were strong and healthy, industrious, willing, good-natured, orderly, with no asocial or antisocial tendencies, and had some sense of responsibility. They had been at work in the quartermaster's department for six months or more, one sweeping out warehouses, helping load trucks, etc., the other keeping latrines clean and looking after a small boiler for heating water. Their work was satisfactory, and they were only sent up for examination because the examiners in making their survey recognized their mental deficiency.
On the other hand, a man measuring about 13 was forgetful, had so little sense of responsibility that he could not be depended upon to carry out orders, went off without leave, and was not cleanly. He was unsuited even for stable work or general labor, so his discharge was recommended.
Those measuring 12 years old and over were regarded as suitable material for the army unless they were of unstable make-up, had shown economic or social inadaptabilities, or had some general physical disability, even though the latter were not sufficient in itself to be a cause for rejection.
At Camp Sherman the epileptics formed the next largest single diagnostic group. If the epileptics and organic nervous diseases are grouped together, this whole group is a trifle larger than that of the feeble-minded. Most of the patients could give a char
acteristic description of the onset of attacks, but in two there seemed to be absolute amnesia for them, and for having had them. One had a typical grand mal seizure, seen and described by a young physician; the other made a suicidal attempt in barracks and later in the hospital; no recollection whatever of either attempt could be elicited either by ordinary questioning nor when hypnotism was attempted. No other cause for the suicidal attempt could be unearthed than a probable epileptic crepuscular condition.
Among the officers referred for examination, manic-depressive depressions predominated, and these were the most frequent of the actual psychoses seen at Camp Sherman. Of my own personal cases, 22 out of 30 psychoses were manic-depressive cases. There were only four cases of dementia præcox in this personal series.
There were many cases of neurasthenia following trauma or severe illness, and it was often a difficult matter to determine whether it was a real or an assumed disability. These cases were usually kept under observation several weeks, and information was sought from physicians who had attended them in civil life. Consultation with the orthopädists or other specialists was frequently held. X-ray examinations were usually negative, as were the results of spinal puncture and Wassermann tests. There were other types of neurasthenia, some with a number of vagotonic or hyperthyroid symptoms, without thyroid enlargement. These were recommended for discharge on the ground that they were not capable of standing the strain of general military service, nor even of domestic service. By searching inquiry one can elicit from almost all men an occasional neurasthenic or fatigue symptom. But of the 388 men whom I personally examined carefully only 29 showed enough symptoms to make it evident that they could not endure.
When a large number of drafted men are received there are always a few cases of alcoholism, delirium tremens, and drug addiction. The confirmed habitués could not be kept in the base hospital long enough to be reconstructed, and once they were in the ranks they could comparatively easily get the drug. One told me that previously, when in the base hospital, he had been able to get it, even there.
There were not many constitutional psychopaths (35 in all), but a few, sexual perverts, paranoid personalities, and inadequate personalities, were found and recommended for discharge.
The cases examined with reference to whether they should be brought to trial or not were principally for repeated absences without leave, or for desertion. One case was for forgery, another for stealing, and one, dementia præcox case, for refusing to obey orders. Some were clearly feeble-minded, and proceedings against them were stopped and the men were discharged. Two measured between 12 and 13 years, but had good understanding of what they were doing—desertion in the one case, stealing in the other—and were allowed to stand trial. Another, measuring 14 or 15 years, had a long insane hospital and penitentiary record, and was also regarded as being sufficiently developed to stand trial for forgery. The decision in these cases has to be made with different conditions in mind from those which obtain in civil life. There is no indeterminate sentence or probation. It is either full acquittal and return to the ranks, or sentence to the military prison at Fort Leavenworth.
A number of cases of persistent enuresis were under observation. Most of these were mental defectives, with rather small bladder capacity (280 to 350 C. c.). One was a very intelligent fellow whose father corroborated all the essentials in his claims of never having been able to control his bladder while asleep. He, like the others, was discharged,
The following summary of the work done at Camp Sherman up to May 1, 1918, may be of interest: Examined in general survey
25,025 Drafted men
THE NURSING PROBLEM AS RELATED TO
PSYCHOPATHOLOGY.* BY RICHARD DEWEY, A. M., M. D., WAUWATOSA, Wis. With a view of eliciting discussion of the conditions and prospects in the sphere occupied by the immediate caretaker, nurse or attendant upon psychopathic patients, I will endeavor to state some of the elements and factors concerned in this particular problem.
de regarding the available nursing forces. Con
ation may be briefly outlined as
ates a total of between 80,000 ses—the head of public
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, and half of it is preventable sickness.
* Read at the seventy-fourth annual meeting of the American MedicoPsychological Association, Chicago, June 4-7, 1918.