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Exclusion of the Mentally Unfit from the Military Services

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Exclusion of the Mentally Unfit from the Military Services EXCLUSION OF THE MENTALLY UNFIT FROM THE MILITARY SERVICES By R. SHEEHAN'::: Paaaed Aniatant Surgeon, United States Navy Naval Medical Officer, Government Hospital for the Insane; lnttructor in Psychiatry, United States Naval Medical School: Member of Staft, U nited States Naval Hospital: Conauhant in Nervou1 D iaeases, United States N aval D ispensary R eprinted from United States Naval Medical Bulletin, Volume 10, No. 2 WASHINGTON GOVERNMENT PRINTING OFFICE 1916 E XCLUSION OF THE MEN TALLY UNFIT FROM TH E MILITAR Y SERVICES. Jl y H. Sm ·: EHA x, P assed Assistant Surgeon, United States Navy. P eru sa 1 of the statistical tables presented in the annual reports of the Surgeon Generals of the Army and Navy makes it immediately npparent, that as a cause of nonefficiency and disability in the serv­ ices, mental and the so-called nervous diseases are far from a negligi­ ble factor. In most cases they represent the total loss of the indi­ vidual, and often a prolonged and therefore large expense to the Government for maintenance and transportation. In addition there is the loss of the money expended in his training, and even the possi­ bility of claim for a pension. Therefore it seems that more decisive measnres should be taken to safeguard our military forces from the entrance into them of those mentally unfit, and this term is quite comprehensive. In the Army during the year 1913 the discharge rate for mental diseases, as is shown below, ·was higher than that for nny other cause. N umber D isease. of cases. Rate. Per cent. -----------------------1--- ------ Mental alienation ........ .. .. .... .. ................ ............ 210 2. 5i 18. 80 'l' ubercttlosis . .. ... ... ... .. _. .. .... ...... ... .. ..... _ 185 2. 26 18. II Venereal diseases .... ... ... ... ............................... ....... 92 1.13 8. 50 67 . 82 7. 52 ~ : ~;~g \;e;..·, i: c:i i s~a,~:: :::::::::::::::::::::::::::::::::::::::::::::::::: :I 34 . 42 4. 04 T he admi ssion rate for mental alienation-that is, the amount of nonefii ciency- was among white enlisted men 3.49 and among col­ ored 2.59. The discharges for both nervous and mental diseases totaled 285. In the ;\rmy, during 1914, 30 officers were retired on account of disability, making a rate for retirement of 6.22 per 1,000. These in­ cluded 3 for psychasthenia, 3 for neurasthenia, 2 for epilepsy, 1 for locomotor ataxia, 1 for paresis, making a total of 10, with a rate of 2.07, for th<lse disorders. For the same year the discharges of enlisted men, with the causes, were as follows : :C isease. Number. Rate. Mental alienation . .......... .... ... .. .. .. ................. ................. .. 259 2. 94 Flat foot ... .......... .. ........ .. .. •. ..... ............. .. ....... .•...... 182 2. 07 Venereal disease ... .............. .......... .. ... .......... ... ... .. 67 • 76 Epilepsy . ..... ........... ... ... .. ... .. ............. ..... .. .. 56 . 64 Organic heart disease ... .. ... .. ... .. ... .. .. ....... ... .. ... ... ... 47 . 53 Mental alienation and epilepsy totaling 315, with a combined rate of 3.58. 28559c- 16 3 4 SHEEHAN-THE MENTALLY UNFIT. In the Navy the disability discharges for nenous and mental dis- eases were as follows: 1909 ------------------------------------------ ------------ 130 1910 ----------- --------- -------- ----------------------- -- 195 1911 ------------------ - - --------------------------------- 408 1912 ------------ ------------------- - --------------------- 431 1913 ------------------- ----------- ---- - - - - - - - --------- - -- 249 1914 --- - - ------------ - - ---------- ----- ---- --- ------------ 285 The nwnber of patients from the Navy and Marine Corps admitted to hospitals for the insane in years past wa s as follows : Etemaining June 30, 1907-- ---- - --- ----- - ---- ----- --- --- -------------- - - 183 During fiscal year ending June 30, 1908 : ~drnitted - - - - - ------- ------- -------------------------------------- 86 Discharged _ ___ ___ __ ___ _ __ _ ___ _ ___ _ __ _ ___ _ __ _ __ _ __ ____ _ __ __ _ __ __ _ _ 57 Etemaining June 30, 1908------- --- - - ------------------------------- 21 2: During fi scal year ending June 30, 1909: ~dmitt e d ----'----- --- - -------_------ ----------------------___ ______ 130 Discharged ------- ----------------------- ---- - ------- -- - ---- - ______ 76 Remaining June 30, 1909----------------------- - - ------------------ 242 During fi scal year ending June 30, 1910: Admitted __ ________ ______ ----- ------------------------ - _______ ___ _ 101 Discharged ~---- - - _______ ---- ---------------- - ---- - - _____ __ _______ 65 Rema ining June 30, 1910---------------------- --------------------- 260- Beginning in 1911 cognizance "-as taken only of those men re­ maining in hospitals who were actually in the service. During fi scal year encling June 30, l Ull : "~d 1n it te d ----------------------------- - - -------------------------- 1 1 ~ Dischar ged --------------------------------------- ---------------- 94 Remaining June 30, 191L----------,---------------- ----------------- 21 During fi scal year ending June 30, 1912 : Admitted ________________ -' __________ -~ _ _ __ __ _ __ __ _ __ _ __ _ __ _ __ _ __ _ _ 96 Discha rged -----------------------__ ____ -------------- ----___ ___ ___ 84 Hemaining .June 30, 1912---------------------- --------------------- 33- During fi scal year ending June 30, 1913 : Adn1itted - ---- -- ------ ------------------- --- -- - - - ---- ~------------ 78 Discharged ------------------------------- - ----------------------- 59 Etemaining June 30, Hi13___________ __ ________ __ ___________ ______ ___ 19 · During fis cal year ending June 30, 1914: Ad1nitted - -- - - ---- -~- ---- ------ - --------- -- ---------- - - -- --------- 102 Discharged ------------------------------------------------- - ------ 72 Remaining June 30, 1914~ ----------------------- -- - ------ ,------ - -- -- 30 Statistics for the entire senice for 1913 and 1914 show nervous and mental diseases as follows: IA dmitted . D ied. I n va lided . Sick days. -M-en-{-~}-3~-~s-_e_a--~-~s-_: _-__- _-__ -__- _--- ---------------_-__ -__- _-__ -__- _-- _-__-_ -- ---_I 285 5 123 18,458 Ner!~~~- iliseases:- --·-·- ·---- --·· -- ·--- -- ·- -- ·- --- --- -- - ~ 276 3 142 18, 205 1913.------.- -.-- -.- .. ----.- ----- -.- -.---------.---- 45-1 7 126 20, 11 7 1914 . -·-- - --- -·- - ---- ·---- -- - -------- - --- - ---------- 476 7 143 18,355 SHEEliAK- THE MENTALLY UNFIT. 5 The total number of sick days for these disorders is only exceeued by syphilis and tuberculosis. The total damage,1 235.26, almost equals that due to wounds and injuries, and exceeds that due to diseases of the digestive system, and is almost twice that due to respiratory dis­ eases. It is exceeded only by infectious and venereal diseases. During the year 1913 there was a slight increase in the rate for mental diseases over the previous year. The rate per 1,000 of those invalided from the ser vice for mental disorders during the year 1913 was larger for the Marine Corps than for the Navy, the rate for the X avy being 1.81 per 1,000 and that for the marines 2.33 per 1,000. About 10 per cent of those admitted for mental diseases during the year were sun·eyed from the service within four months of the time of enlistment. In 1914 the naYal admission rate for mental diseases was the same as the preceding year. There are at present in the GoYemment Hospital for the Insane, ns patients from the Navy and Marine Corps, 27 men and officers on the nctive list, 10 retired, and 241 who ha,·e been discharged from the se n ·ice; this making a total of 278. Besides, there are 39 supernumeraries. Of the 27 on the acti ,-e list, it is considered that in 24 the disability is " not in the line of duty." T " ·o are ginn i.n " line of duty," :mel in 1 thi s C]H estion has not been decided. It is estimated that of the cases admitted about 54 per cent show predisposition to mental disease prior to enlistment. As to the form of insanity which service men are most likely to de l"<:- lop the records show that m·er 56 per cent were diagnosed as dementia precox. That of general paresis was made in about 20 pe r cent. cerebrnl syphilis 3 per cent, manic-depressi-re psychosis about 2 per cent, and miscellaneous in about 20 per cent of the admis­ sions. It is seen immediately that mo1:e than half of the cases ad­ mitted "·ere of the dementia precox type. This is not surprising \rhen it is considered that the Navy is composed largely of men under 30 years. of age, and that dementia p recox is a mental disease essen­ t iall y of the adolescent period. Becau se of the marked preponderance of this form of insanity it seems important to consider it more in detail and to endeavor to determine and aggregate the signs that portend the later development of the symptom-complex or group which has been designated de­ mentia precox. This, to remind you, is a progressi ,-e, dementi.ng process of n fairly definite and specific character. It shows itself in the end pha ses in a typical di sturbance of conduct ba sed upon the deterioration or destruction of certain basal mental mechanism;;: . 1 T otnl cln mnge is in term s of iodi\·idu:-tls w hO ~C' loss of se r vice by SiCl\ness, d isclHll'ge ft·om sen ·ic<', o t· d enfh would be r ctH'ese nt·ecJ ns continuous t hrou ghou t t he y enr. 6 SHEEHAN-THE MENTALLY UNFIT. It may be assumed that what "·e re~ ogni:..:e as the disease prop e r ~ which from its inception travels a well-beaten track, is made possible by the occurrence of a fairly fixed constitutional
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