Hartung[102] in 1918 reported a study of 780 cases of war neuroses treated by him at Thal. About ninety-eight per cent were cured by psychic and mechanical treatments. One hundred and sixty-two cases showed hysterical paralysis, the lower limbs being affected twice as often as the upper. Tremors of the head or upper limbs were present in twenty-eight per cent, hysterical convulsions in eight per cent, speech disturbances in five per cent, hearing disorders in one per cent, cardiac and respiratory symptoms in 1.5 per cent, neuroses of the digestive system in 1.5 per cent, and bladder disturbances in 1.5 per cent of the cases. Neurasthenia "in the strictest sense of the word" was present in twenty per cent. Hurst[103] and others have spoken of endocrine disturbances in war neuroses. He includes hyperadrenalism and hyperthyroidism due to an over-stimulation of the sympathetic nervous system, resulting from such emotions as anger and fear. Rapid pulse, enlargement of the heart, and high blood pressure were common symptoms. The patients in some cases showed conditions strongly suggesting Graves' disease. In addition to the circulatory disturbances there was paroxysmal sweating, the eyes were slightly prominent, sometimes with von Graefe's sign, and pilomotor reflexes were present.

An important contribution to the discussion as to the etiology of war neuroses was the statement made by Major General Ireland[104] to the Senate Committee on Military Affairs, that of the twenty-five hundred cases of shell shock awaiting transportation to the United States, twenty-one hundred recovered within a day or two after the armistice was declared. He gave the incidence of mental and nervous diseases in the forces in camps in this country as 2.5 per thousand and ten per thousand overseas. Another interesting phase of shell shock was the surprising results which various German observers obtained by the so-called "Kaufmann" treatment, the sudden application of a strong faradic current. One of the most significant contributions to the psychiatric history of the war as far as this country is concerned is the statement made by Col. Salmon[105] that in the latter part of December, 1920, of the beneficiaries of the War Risk Insurance thirty-two per cent were suffering from general diseases; forty-one per cent from tuberculosis; and twenty-seven per cent from various neuropsychiatric disorders. "The vague idea that all these men are suffering from "shell shock" or other mysterious maladies developed under the stress of modern warfare was replaced by the realization that more than two-thirds of all neuropsychiatric patients have one or another type of insanity." Of these cases sixty-six per cent had well developed psychoses; nineteen per cent psychoneuroses; five per cent epilepsy; two per cent mental deficiency; and eight per cent organic nervous diseases or injuries. On December 16, 1920, there were five thousand five hundred cases receiving hospital treatment.

CHAPTER XII
ENDOCRINOLOGY AND PSYCHIATRY

The important influence exercised by the glandular structures on the human organism has long been recognized. Perhaps the earliest evidence of this is the study of alterations due to the removal of the sexual glands. Eunuchoidism was described by Larrey as early as 1812 in his well-known account of the Egyptian campaign. In 1845 Bouchardat advanced the theory that pancreatic lesions were responsible for the development of diabetic disorders. Thomas Addison in 1855 showed the existence of a very definite disease process caused by pathological conditions in the adrenals. Mongolianism was recognized as a distinct entity by Langdon-Down in 1866. Gigantism was studied very thoroughly by von Langer in 1872. The existence of the parathyroids was unknown until they were described by Sandström in 1880. Weiss in 1881 showed that the extirpation of the thyroid sometimes caused tetany. After myxedema had been studied clinically by Charcot and others the fact that it was clearly related to disturbances of the functions of the thyroid gland was demonstrated by Kocher and Reverdin in 1882. Adipositas Dolorosa was described by Dercum as a form of dysthyroidia in the same year. Acromegaly was originally defined by Pierre Marie in 1886 and its relation to the hypophysis was pointed out by him. In 1886 Möbius called attention to the part played by the ductless glands in Basedow's disease, Grawitz in 1888 showed the significance of thymic hyperplasia and Paltauf in the following year described the "lymphato-chlorotic constitution." The pancreatic origin of diabetes was elaborately outlined by von Mering and Minkowski in 1889. The influence exerted by glandular secretions on general metabolism was demonstrated by Brown-Sequard in the same year. Lemoine and Launois in 1891 reported the existence of sclerosis of the blood and lymph vessels in the pancreas and Laguerse in 1893 found that the Islands of Langerhans were often involved in diabetes. Thyroigenic obesity was reported by von Hertoghe in 1896. The isolation and chemical definition of adrenalin by Takamine in 1901 was a decided step in advance. Fröhlich in 1901 suggested that obesity, infantilism of the genitalia and myxedematous alterations of the skin pointed to tumors of the hypophysis. In the same year Neumann thoroughly reviewed the subject of growths in the epiphysis, submitting a study of twenty-two cases. The various types of dwarfism were first described by von Hansemann in 1902. Thyroplasia and myxedema were exhaustively studied by Pineles in 1910 and 1912. The literature on the subject of the ductless or so-called endocrine glands has grown enormously during the last two or three decades and is shown in full by Falta and Meyers.[106]

The endocrine syndromes as now understood have been briefly summarized by Blumgarten[107] in a very graphic form as follows:—

Thyroid Stigmata

Symptoms of So-called Hyperactivity