Studies made on obvious defects indicate that slightly less than one-half of those diagnosed as having grave mental or personality disorders had been treated in hospitals for the mentally ill. In other words, the basis for the diagnoses in many of those "obvious" cases was an affidavit from a physician or a mental hospital. Statements of institutional treatment for unspecified mental conditions and indefinite descriptions of mental or personality disorders are included in the subdivision "Mental and personality disorders not classifiable elsewhere." More than one-half of those so classified had "obvious" defects and in all likelihood had either a manic-depressive psychosis or schizophrenia or a history of one of these conditions.

The importance of the various subgroups as causes for rejection at local boards as shown in table 3 reveals that almost one-half of the rejections were due to psychoneurotic disorders; the next largest groups were mental and personality disorders not classifiable elsewhere and grave mental or personality disorders. Psychopathic personality ranked fourth in importance as a cause for rejection, in contrast to second place as a recorded defect among all examined registrants.

Psychoneurotic disorders accounted for only one-third of the Negro rejections for mental and personality disorders, in contrast to one-half for white registrants. A higher proportion of Negro than white rejections were for mental and personality disorders not classifiable elsewhere, psychopathic personality, and chronic inebriety and drug addiction. In the case of psychopathic personality, particularly, the proportion of rejections for this defect among Negroes was twice as great as that among white registrants.

The prevalence of mental and personality disorders during 1942 and 1943 was 67.5 per thousand registrants examined (table 4). They were diagnosed relatively more frequently among white registrants than among Negroes. Psychoneurosis and psychopathic personality were the most frequently recorded mental and personality disorders. Psychopathic personality was the only subgroup which was recorded relatively more often for Negroes than for white registrants. The other specific mental and personality disorders, of a more serious nature, were found only one-third as often among Negroes as among white registrants.

TABLE 4.-Prevalence of mental and personality disorders and percentage distribution of rejections for these defects among registrants physically examined at local boards and induction stations, 1942-43

Psychoneurosis was the most frequent cause for rejection for mental and personality disorders among both races during 1942 and 1943, with psychopathic personality next in importance. Among white registrants, psychoneurosis accounted for twice as many rejections as psychopathic personality. Both defects were equally important as causes for rejection of Negroes, accounting for 9 out of every 10 rejections for mental and personality disorders. Grave mental or personality disorders, although next in importance, accounted for relatively few rejections among both races.

THE AGE FACTOR

In general, it can be stated that with increasing age the rejection rate for mental and personality disorders increased. However, the specific diagnoses differed in importance as causes for rejection when considered in relation to

age. During 1944 the three leading diagnoses of mental and personality disorders were psychoneurosis, emotional instability and asocial and amoral trends. In addition, for the 18-year-olds, emotional immaturity was one of the more important diagnoses. The distribution of these diagnoses in relation to total mental and personality disorder rejections by age is shown in table 5.

TABLE 5.-Percentage of mental and personality disorder rejections due to selected diagnoses, by age 1

1 Based on a sample of reports of physical examination and induction for registrants inducted or rejected during February 1944-May 1944.

2 Less than 0.05 percent.

3 Includes all races other than Negro.

The importance of psychoneurosis as a cause for rejection increased with increasing age-out of every hundred 18-year-olds rejected for mental and personality disorders approximately 30 were rejected for psychoneurosis, whereas the corresponding number among those 30 years of age and over was approximately 65. For emotional instability, the situation was just the reverserelatively more of the younger registrants rejected for mental and personality disorders had emotional instability diagnosed than the older registrants. With respect to asocial and amoral trends, relatively more of the rejections occurred among those under 25 than among those 25 and over. Emotional immaturity was the second leading diagnosis of mental and personality disorders among the 18-year-olds, accounting for over one fifth of the mental rejections. As would be expected, its importance was negligible for those over 19 years of age. These age trends held for white registrants. Among Negroes, however, the only distinct age trends were for psychoneurosis and emotional immaturity.

Emotional immaturity and psychoneurosis accounted for a larger proportion of the mental rejections among white registrants, age for age, than among Negroes, while the reverse was true for emotional instability and asocial and amoral trends. The difference between the races was more pronounced with respect to asocial and amoral trends than for emotional instability.

7 Data on mental and personality disorders of 18- and 19-year old registrants, examined during December 1942-February 1943 are included in Rowntree, L. G.; McGill, K. H., and Edwards, T. I.: Causes of Rejec tion and Incidence of Defects Among 18- and 19-Year Old Registrants, J. A. M. A. 123: 181-185 (Sept. 25) 1943.

THE OCCUPATIONAL FACTOR

The relationship of occupation and rejections for mental and personality disorders is shown in table 6. In evaluating these data it should be borne in mind that selective-service policies with regard to occupational deferment have resulted in physical examination of relatively fewer men in some occupational groups than in others, and that, therefore, the occupational groups vary in their representativeness with respect to physical or mental condition. The farm group is probably the least representative of their group in the general population, owing to the passage of the Tydings amendment, which deferred certain classes of agricultural workers. At the other extreme are the clerical, sales, and service workers, and the emergency workers and unemployed.

Rejections for mental and personality disorders were highest among farmers and farm managers (143.4 per thousand examined) and emergency workers, unemployed and nonclassifiable (142.5). Students had the lowest rejection rate for this condition (72.9). The low rejection rate for students is probably due to their youth more than to any other factor.

TABLE 6. Rejection rates for mental and personality disorders per thousand registrants examined, by occupation 1

1 Based on a sample of reports of physical examination and induction for registrants examined during November 1943-December 1943. 2 Nonclassifiable constitute a negligible proportion of this group.

Psychoneurosis rejection rates were highest for the professional and managerial and lowest for students. Farmers and farm managers had a rate of 50 percent higher than that for farm laborers. Rejections for reasons other than psychoneurosis were highest for the emergency workers, unemployed and nonclassifiable and lowest for professional and managerial. It can also be noted that farm laborers, students, and emergency workers, unemployed and nonclassifiable were less apt to be rejected for psychoneurosis than for other mental conditions, which consist mainly of emotional instability and asocial and amoral trends, and that the reverse was true for all other occupations. In addition, a comparison of the rejection rate for craftsmen with that for operatives and laborers reveals a higher rejection rate for psychoneurosis and a lower rate for other mental disorders among the skilled workers than among the semiskilled and unskilled. If only gainfully employed workers are considered (thus excluding students and the emergency worker group) it can be seen that professional and managerial workers had the highest psychoneurosis rejection rate and the lowest rate for all other mental conditions, while farm laborers had the lowest rate for psychoneurosis and the highest for all other mental conditions.

MEDICAL SURVEY PROGRAM

During the operation of the Selective Service System much information has been provided by the System bearing on the mental and personality status of registrants. This information has furnished the basis in many instances for acceptance or rejection of registrants by the armed forces. Prior to October 4, 1943, many of the States developed some plan for obtaining medical and social histories of each registrant facing induction. On October 4, 1943, a medical survey program was initiated by the Selective Service System to coordinate and unify procedures for obtaining (1) additional medical and social histories on

registrants classified or about to be classified into a class immediately available for service and (2) education histories from secondary schools for potential registrants 15 years of age and over and registrants classified or about to be classified into a class immediately available for service.8

Salient features of the medical survey program include (1) appointment on a voluntary basis of one or more persons in each local board area who are qualified to do health or social work as medical field agents and (2) procurement by the State director of educational histories of registrants for use by the induction stations. The medical field agents obtain medical and social histories of registrants from such sources as the registrant's personal physician, social service exchanges, hospitals and clinics, and correctional institutions or agencies. At present there are more than 9,000 medical field agents, and medical survey information is being supplied for a substantial percentage of the registrants considered for induction.

SUMMARY

A review of prevalence and rejections for mental and personality disorders among selective service registrants shows that:

1. The majority of rejections for mental and personality disorders were made by armed forces' psychiatrists; these rejections were made on the basis of unfitness for military life, although not all the disorders were handicapping in civilian life. 2. Mental and personality disorders were the principal cause for rejection of 801,700, or approximately 17.8 percent, of registrants aged 18-37 in rejected classes on January 1, 1945.

3. The rejection rate for this type of disorder increased from 22.3 per thousand examined in peacetime to 120.2 per thousand examined in 1944.

4. The rise in the rejection rate was not solely due to increased nervous tension among examined registrants. Other factors to be considered are changes in examining procedure, lowering of standards in other defect categories and stricter interpretation of standards for mental and personality disorders by the armed forces' psychiatrists.

5. Relatively more white registrants than Negroes have been rejected for mental and personality disorders.

6. Psychoneurotic disorders and psychopathic personality account for more than 8 out of every 10 rejections for mental and personality disorders.

7. Psychopathic personality is more prevalent among Negroes than among white registrants, while the reverse is true for psychoneurosis.

8. With increasing age, relatively more registrants are rejected for psychoneurotic disorders.

9., Among 18-year-olds more than one-fifth of the rejections for mental and personality disorders are due to emotional immaturity.

10. Of those gainfully employed, the psychoneurosis rejection rate was highest for professional and managerial workers and lowest for farm laborers, while the rate for other mental and personality disorders (consisting mainly of emotional instability and asocial and amoral trends) was lowest for the former and highest for the latter.

Mr. PRIEST. Colonel Challman. Colonel, before you start, I wish. to make this explanation. It may be necessary to interrupt your testimony for Mr. Eugene Meyer, who has a very pressing engagement, and who is scheduled at 10.30. Because of the other engagement he has, we might have to ask you to discontinue your statement for a while.

Colonel CHALLMAN. That will be all right.

STATEMENT OF COL. SAMUEL A. CHALLMAN, DEPUTY DIRECTOR, DIVISION OF NEUROPSYCHIATRY, SURGEON GENERAL'S OFFICE, WAR DEPARTMENT

Mr. PRIEST. Give the reporter your name and title.

Colonel CHALLMAN. Col. Samuel A. Challman, Deputy Director of the Division of Neuropsychiatry, Surgeon General's office. General Meninger is on the west coast today and could not get in.

8 Full details are given in Medical Circular No. 4, issued by the Selective Service System on October 18, 1943.

I want to present to the committee some of the experience of the Army as to the magnitude of the problem and the resources available in the Army for dealing with psychiatric cases, and also some of the results we can get.

The Army Medical Service found itself up against a tremendous problem in mental illness of all types. Mental illness was the greatest cause of noneffectiveness or loss of manpower that we met. It not only affected a large number of men in the Army, but it affected them over long periods of time and repeatedly caused hospitalization and absence from duty. I think this is the more surprising, in view of the testimony we have just heard from General Hershey, that before men were taken into the service they were carefully screened at the induction stations, and that such a large percentage, between 15 and 20 percent of all the young men, who we would expect to be the healthiest in mind and body, had to be rejected because of neuropsychiatric disorders. Yet in spite of that we found that 85 percent of the cream of the crop which was accepted for service showed a tremendous amount of emotional disease in the Army, and had to be treated by the medical services.

The resources that we were able to gather together in the medical service to handle this problem were very skimpy indeed. We were short constantly of medical officers qualified to treat neuropsychiatric diseases adequately. We found it necessary to establish schools for training medical officers in psychiatry, so that we might have the benefit of their services.

During the wartime, in order to accomplish our mission, we had to start in and train people and take time out to do that in order to handle this problem, which was considerable of a handicap.

Mr. PRIEST. Colonel, may I interrupt there to ask one question? Colonel CHALLMAN. Yes.

Mr. PRIEST. Approximately how many medical officers in the Medical Corps of the Army, at the beginning, without this training program you have found it necessary to institute, were available that you would consider were well qualified to treat neuropsychiatric disorders?

Colonel CHALLMAN. About 600.

Mr. PRIEST. About 600?

Colonel CHALLMAN. About 600; yes, sir.

Mr. PRIEST. In an Army of 8,000,000?

Colonel CHALLMAN. In an Army of 8,000,000. We are actually using a lot more men than that. We have actually 2,400 medical officers doing psychiatric work, but many of them are people who have been instructed under wartime conditions to do the best they can. And so we are very appreciative of the need for further training of medical officers to handle this manifold problem.

The second point I would like to make is that we have demonstrated in the Army that these cases can be dealt with effectively if you have qualified personnel operating in a clinic or a hospital that is organized properly to treat psychiatric cases. The question has often been raised, as to whether there is anything effective that can be done about the psychoneurotic individual, whether he can be made to adapt himself to the difficult reality that he finds, and many medical officers feel somewhat pessimistic about it. However, the experience we have had has shown that a very high percentage of the soldiers