25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ,...

18
SEa RET Statistical Section HQ First Odn Army 20 Dec 44 3ATTLE EXHAUSTION & BATTLE CASUALTIES 6 Jun 44 to 30 Nov 44 As reported to Stats Sec, Cdn Sec GHQ 2 Ech 21 Army Gp INFANTRY Percentage Battle Z.xhaustion Battle Battle of Ur..tt E:xhauS'tion casualties Total Total R FEGT C 121 978 1099 11.0 RIlL I 81 976 1057 7.7 FC' 3 84 1059 1143 7.4 RHC 158 1356 1511 10.5 R de U.ii. 114 599 713 .16.0 CAUr HIGh33 184 1393 157'7 11.7 F'0S 67 911 978 6.8 CA1,IEiiONS of C 132 1040 1172 11.3 S SASK R 98 1182 1280 7.7 R WPG R 129 1275 1404 9.2 REGINA RIF 98 1333 1431 6.8 1 C SCOT R 149 946 1095 13.6 OOR of C 72 943 1015 7.1 R de CRAUD 252 757 1009 25.0 SHORE R 197 1079 1276 15.4 RLI of' rt v 75 840 915 8.3 3D & G HIGHRS 73 860 933 8.0 Nth NS HIGHRS 119 1175 1294 9.2 ALQ. R 19 822 841 2.3 A & SH of C 90 638 728 12 .. 4 LINC & vELLD R 51 734 785 6.5 lESC INF 151 159 310 49.7 --, ... - "'- 25LS, i I . t .! '. :.,. u ! I' I

Transcript of 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ,...

Page 1: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

SEa RET

Statistical Section HQ First Odn Army 20 Dec 44

3ATTLE EXHAUSTION amp BATTLE CASUALTIES

6 Jun 44 to 30 Nov 44

As reported to Stats Sec Cdn Sec GHQ 2 Ech 21 Army Gp

INFANTRY

PercentageBattle

Zxhaustion Battle Battle of

Urtt ExhauStion casualties Total Total

R FEGT C 121 978 1099 110 RIlL I 81 976 1057 77 FC ~) 3 G(~rf 84 1059 1143 74

RHC 158 1356 1511 105 R de Uii 114 599 713 160 CAUr HIGh33 184 1393 1577 117

F0S ~11 67 911 978 68 CA1IEiiONS of C 132 1040 1172 113 S SASK R 98 1182 1280 77

R WPG R 129 1275 1404 92 REGINA RIF 98 1333 1431 68 1 C SCOT R 149 946 1095 136

OOR of C 72 943 1015 71 R de CRAUD 252 757 1009 250 l~ SHORE R 197 1079 1276 154

RLI of rt v 75 840 915 83

3D amp G HIGHRS 73 860 933 80 Nth NS HIGHRS 119 1175 1294 92

ALQ R 19 822 841 23 A amp SH of C 90 638 728 12 4 LINC amp vELLD R 51 734 785 65

lESC INF 151 159 310 497 -- -~-- - shy

25LS

i I

t

u

tmiddot I

I

SEC RET

Statistical Section HQ First Cdn Army20 Dec 44

BATTLE EXHAUSTION amp BATTLE CASUALTIEsect

BY ARM OF SERVICE

6 Jun 44 to 30 Nov 44

As r~J2orted to ~ta ts Sec Cdn Sec GRC) 2 Ech 21 Army GR

PercentageBattle

Exhaustion Battle Battle of

Arm 9f Service Exhaustion Casualties Total Total

C A C 269 2804 3073 88

R 8 A 284 2523 2807 101

Ii C E 56 941 997 56 rlt

~ vRr S 46 388 434 106 J I C 2514 22109 24623 102

R (~ S C 83 598 681 122

r1 C A Ivi c 45 166 211 213

Misc 72 775 847 85

TOTAL 3369 30304 33673 100

~

C (T 0 P u E v Ii E T

XITAHISU~ 3tiT1LE CASU1LT I rs CDNEiUT

( itES ( ER~I bLJliO i EA~~ THEliTRE

3 Cdn I Jiv (6 Jun - )lt Dec) 11376 3 Brit Div ( 6 Jun 8 Dec) 9269L bull v

-2 Can In + Div (11 Ju1 - 8 Dee) 11340 43 Brit Div (24 Jun 8 Dec) 9452

L dn bull rlDd Div(ll Jul 8 Dec) 4346 Gds Armd Div ( 1 Jul 8 Dec) 3864

c rmd - e (6 J~m - 8 Dec) Ij215 4 Armd Bde ( 6 Jun 8 Dec) 885

28287

Cdn ~~sualties for comparable fmns and over same period (rlpprox) 20( higher than Brit

2 rroportion ed - issing - Vvounded sect~__~t 39 = qv 1944

Brit Cdn

Killed 197 232 middotissing 1-50 -22

347 301

~ 69ltt

1000 1000

- a) gur~s in table 1 ~ere obtained from stQts Sec 21 Army Gp Comoarison of Cdn figures wLth those obtained from Cdn Sec l - 2 Eeh little vc~rL tion

(b) It Vi- im)ossible to obtain figures for identical periods in ins t nce s without ref8reDce to Brit 2 Ech here da tea

of commencement of activity differ tho Brit formation with hi st rate of ca ties has besn used

bullbull T~ tmiddot ~ 1 1 ppChIUl JJ l)J ~i-I _V)middot I

____ _~~ ~_ ~~T1 llJ ~ ~ ~_J l~ ~ ( ) i ___J ____ bull 1 __11 -d ___ _______L _______I _ ~ 8 ___JL ul 1 -_----L lA

l OJ 1 _~ L i) ~ _L 1- ~ ___~__ ~__ ____f~ _ ~_L ~ 1J )0 e) ---~-- ------ shy

1ri~JIG u 13 T LI tiJ i~l I bull J ~~ll) ) v Jj i j

01t Ii t) iCmiddotil Ji a~~l ji lHV l)~ l I~~u ~LL J J i _tLI 1 V

v~~

i JJ~-4 J ~ 1~middotl Ll) J~ ~~l-j1 JUJ IfJ - 1 f _r

____ _______~~~ _ ) rlnr _______ __ ~_________ ______ - jU L J ~ ___l -___ __ ~_ J ---__-- ---~- -- ---~-------- ~- -------------- Div 1 ) 11 rlu Dlir 112 4 )

Grai 3-gt1 1)i V 9 5 2 J

4 CUll ~~-l Di v 2 -) gt I~

3 iir Inf Viv 98 23 15 () Di v

Jl (~

49 ( 1 ) Di v 4 3 51 (a) Div 29

) 3 38

52 (L) Div o 8 53 (In D1v 163 b2 2gtl 2 Cdn Inf Div 2 2 76 1 29 3 Ocln Int Div 15 14 112 16 75

43 ~ lJiv 1 4

01nOTAL 446 102 197 246 - 156 5

~ ( ~ R Elliott ) Lt-co1

ior Filst CUD driy

ExtbIO r1rua 0 l dC l1a tlll G bull bullbull

UlREC

9 Mar 45 UDlJDL ltJr Cn u u V Ji ~ ll~u

l22ExllciU3 tionl (Mad)

- -

middot i~ i tmiddotmiddot 1 tI middot1 -1-I- ~ l1 ~ j JIJ J_ ii cPI ~V

~tl~1ut~ Ofil ~1J ~3 ~ tt t )c ~~jjlL ~~t ~_ I1~J j 1 ~~ 1 )1gt~ TlJ ltL ~I lJ(__ t ____ __________________---- bull_ ~______~

-IJIlI 1 I 1 If i)~-lt~Y c 1 rmiddot i bull j 1 l~ - 1 jet1 U -II JL L j ~ ) vmiddot )gtgt J~l - JJ _1IImiddotl 1ll ) 1 C 1 ) i J -------------------------__-------- --~-~~-- --_ _shy~l) I CIoJ U(~I 11 ~~ ~ EliI TI SH 1middot AiI I~L S nu~i l11 S c~ i n F lri I ~~rrJ

WliI iltr~D ~D ~~v lbullLi t~D ~ I ~~~j It l~)ilmiddot~J )1 ti ~-) AJ middot-D ~ ~LD ~V JiD I) DUffY 1e) DUTY ~ C J LJ lY

tol i(pi( Dl v 2 1 11 13r Umd Di v Guards Armd Div 13 2 4 Odn wmd Dlv 3 13X Inf Div 15 (S) I nt D1 v 46 6 55 3 3113 () Div G 59 594 (ill) ViI 2Z 2

+ 3

51 (h) Diy 41 D 40 52 (L) DiV 33 11

7253 (i) Div 5S 13 18 2 2 2 Cdn In D1v 7 7 25 3 19

5 ) 7 13 Odn In Dly r 42 jg 1

TOTAL 2g4 223 131 10 171 I l 2 245

~__~__~____-__________________~__~________~~-~______~_____________bull _____~Mbullbullbull__~~__~____M4______________~~~_____ -------~ -- -w___ ----

I)r )

Jltrj~~-Jb ( Tl QrL111-0t t JJ v- colJ1 ~

AIlH for DD118 Fir 8 t Cd lirmy

Ext 610 liJlI8 81 ~ Le e bullbullbull 11 bullbullbullbullbull

NRE

2 Mar 45

122Exhaustionl (Med)

~ t

l

1

-1J ~1 ~l ~~

i -~~

~- ~1- ~ bull - gt- ~ ~ 1 )~

t( - -tIII_~ - -J

i ~~ --t -- ~~ ~r J

shy ~ gt4 ~

-~ 0

1 ~~ shy-i

- ~

N~ r~

i

i t

f I

t tbull

I I t

-- ~

bull ~1

~

)

~~- J ~ltf

bull bullit

bull t1

-

~ 11

-

RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 2: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

SEC RET

Statistical Section HQ First Cdn Army20 Dec 44

BATTLE EXHAUSTION amp BATTLE CASUALTIEsect

BY ARM OF SERVICE

6 Jun 44 to 30 Nov 44

As r~J2orted to ~ta ts Sec Cdn Sec GRC) 2 Ech 21 Army GR

PercentageBattle

Exhaustion Battle Battle of

Arm 9f Service Exhaustion Casualties Total Total

C A C 269 2804 3073 88

R 8 A 284 2523 2807 101

Ii C E 56 941 997 56 rlt

~ vRr S 46 388 434 106 J I C 2514 22109 24623 102

R (~ S C 83 598 681 122

r1 C A Ivi c 45 166 211 213

Misc 72 775 847 85

TOTAL 3369 30304 33673 100

~

C (T 0 P u E v Ii E T

XITAHISU~ 3tiT1LE CASU1LT I rs CDNEiUT

( itES ( ER~I bLJliO i EA~~ THEliTRE

3 Cdn I Jiv (6 Jun - )lt Dec) 11376 3 Brit Div ( 6 Jun 8 Dec) 9269L bull v

-2 Can In + Div (11 Ju1 - 8 Dee) 11340 43 Brit Div (24 Jun 8 Dec) 9452

L dn bull rlDd Div(ll Jul 8 Dec) 4346 Gds Armd Div ( 1 Jul 8 Dec) 3864

c rmd - e (6 J~m - 8 Dec) Ij215 4 Armd Bde ( 6 Jun 8 Dec) 885

28287

Cdn ~~sualties for comparable fmns and over same period (rlpprox) 20( higher than Brit

2 rroportion ed - issing - Vvounded sect~__~t 39 = qv 1944

Brit Cdn

Killed 197 232 middotissing 1-50 -22

347 301

~ 69ltt

1000 1000

- a) gur~s in table 1 ~ere obtained from stQts Sec 21 Army Gp Comoarison of Cdn figures wLth those obtained from Cdn Sec l - 2 Eeh little vc~rL tion

(b) It Vi- im)ossible to obtain figures for identical periods in ins t nce s without ref8reDce to Brit 2 Ech here da tea

of commencement of activity differ tho Brit formation with hi st rate of ca ties has besn used

bullbull T~ tmiddot ~ 1 1 ppChIUl JJ l)J ~i-I _V)middot I

____ _~~ ~_ ~~T1 llJ ~ ~ ~_J l~ ~ ( ) i ___J ____ bull 1 __11 -d ___ _______L _______I _ ~ 8 ___JL ul 1 -_----L lA

l OJ 1 _~ L i) ~ _L 1- ~ ___~__ ~__ ____f~ _ ~_L ~ 1J )0 e) ---~-- ------ shy

1ri~JIG u 13 T LI tiJ i~l I bull J ~~ll) ) v Jj i j

01t Ii t) iCmiddotil Ji a~~l ji lHV l)~ l I~~u ~LL J J i _tLI 1 V

v~~

i JJ~-4 J ~ 1~middotl Ll) J~ ~~l-j1 JUJ IfJ - 1 f _r

____ _______~~~ _ ) rlnr _______ __ ~_________ ______ - jU L J ~ ___l -___ __ ~_ J ---__-- ---~- -- ---~-------- ~- -------------- Div 1 ) 11 rlu Dlir 112 4 )

Grai 3-gt1 1)i V 9 5 2 J

4 CUll ~~-l Di v 2 -) gt I~

3 iir Inf Viv 98 23 15 () Di v

Jl (~

49 ( 1 ) Di v 4 3 51 (a) Div 29

) 3 38

52 (L) Div o 8 53 (In D1v 163 b2 2gtl 2 Cdn Inf Div 2 2 76 1 29 3 Ocln Int Div 15 14 112 16 75

43 ~ lJiv 1 4

01nOTAL 446 102 197 246 - 156 5

~ ( ~ R Elliott ) Lt-co1

ior Filst CUD driy

ExtbIO r1rua 0 l dC l1a tlll G bull bullbull

UlREC

9 Mar 45 UDlJDL ltJr Cn u u V Ji ~ ll~u

l22ExllciU3 tionl (Mad)

- -

middot i~ i tmiddotmiddot 1 tI middot1 -1-I- ~ l1 ~ j JIJ J_ ii cPI ~V

~tl~1ut~ Ofil ~1J ~3 ~ tt t )c ~~jjlL ~~t ~_ I1~J j 1 ~~ 1 )1gt~ TlJ ltL ~I lJ(__ t ____ __________________---- bull_ ~______~

-IJIlI 1 I 1 If i)~-lt~Y c 1 rmiddot i bull j 1 l~ - 1 jet1 U -II JL L j ~ ) vmiddot )gtgt J~l - JJ _1IImiddotl 1ll ) 1 C 1 ) i J -------------------------__-------- --~-~~-- --_ _shy~l) I CIoJ U(~I 11 ~~ ~ EliI TI SH 1middot AiI I~L S nu~i l11 S c~ i n F lri I ~~rrJ

WliI iltr~D ~D ~~v lbullLi t~D ~ I ~~~j It l~)ilmiddot~J )1 ti ~-) AJ middot-D ~ ~LD ~V JiD I) DUffY 1e) DUTY ~ C J LJ lY

tol i(pi( Dl v 2 1 11 13r Umd Di v Guards Armd Div 13 2 4 Odn wmd Dlv 3 13X Inf Div 15 (S) I nt D1 v 46 6 55 3 3113 () Div G 59 594 (ill) ViI 2Z 2

+ 3

51 (h) Diy 41 D 40 52 (L) DiV 33 11

7253 (i) Div 5S 13 18 2 2 2 Cdn In D1v 7 7 25 3 19

5 ) 7 13 Odn In Dly r 42 jg 1

TOTAL 2g4 223 131 10 171 I l 2 245

~__~__~____-__________________~__~________~~-~______~_____________bull _____~Mbullbullbull__~~__~____M4______________~~~_____ -------~ -- -w___ ----

I)r )

Jltrj~~-Jb ( Tl QrL111-0t t JJ v- colJ1 ~

AIlH for DD118 Fir 8 t Cd lirmy

Ext 610 liJlI8 81 ~ Le e bullbullbull 11 bullbullbullbullbull

NRE

2 Mar 45

122Exhaustionl (Med)

~ t

l

1

-1J ~1 ~l ~~

i -~~

~- ~1- ~ bull - gt- ~ ~ 1 )~

t( - -tIII_~ - -J

i ~~ --t -- ~~ ~r J

shy ~ gt4 ~

-~ 0

1 ~~ shy-i

- ~

N~ r~

i

i t

f I

t tbull

I I t

-- ~

bull ~1

~

)

~~- J ~ltf

bull bullit

bull t1

-

~ 11

-

RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 3: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

~

C (T 0 P u E v Ii E T

XITAHISU~ 3tiT1LE CASU1LT I rs CDNEiUT

( itES ( ER~I bLJliO i EA~~ THEliTRE

3 Cdn I Jiv (6 Jun - )lt Dec) 11376 3 Brit Div ( 6 Jun 8 Dec) 9269L bull v

-2 Can In + Div (11 Ju1 - 8 Dee) 11340 43 Brit Div (24 Jun 8 Dec) 9452

L dn bull rlDd Div(ll Jul 8 Dec) 4346 Gds Armd Div ( 1 Jul 8 Dec) 3864

c rmd - e (6 J~m - 8 Dec) Ij215 4 Armd Bde ( 6 Jun 8 Dec) 885

28287

Cdn ~~sualties for comparable fmns and over same period (rlpprox) 20( higher than Brit

2 rroportion ed - issing - Vvounded sect~__~t 39 = qv 1944

Brit Cdn

Killed 197 232 middotissing 1-50 -22

347 301

~ 69ltt

1000 1000

- a) gur~s in table 1 ~ere obtained from stQts Sec 21 Army Gp Comoarison of Cdn figures wLth those obtained from Cdn Sec l - 2 Eeh little vc~rL tion

(b) It Vi- im)ossible to obtain figures for identical periods in ins t nce s without ref8reDce to Brit 2 Ech here da tea

of commencement of activity differ tho Brit formation with hi st rate of ca ties has besn used

bullbull T~ tmiddot ~ 1 1 ppChIUl JJ l)J ~i-I _V)middot I

____ _~~ ~_ ~~T1 llJ ~ ~ ~_J l~ ~ ( ) i ___J ____ bull 1 __11 -d ___ _______L _______I _ ~ 8 ___JL ul 1 -_----L lA

l OJ 1 _~ L i) ~ _L 1- ~ ___~__ ~__ ____f~ _ ~_L ~ 1J )0 e) ---~-- ------ shy

1ri~JIG u 13 T LI tiJ i~l I bull J ~~ll) ) v Jj i j

01t Ii t) iCmiddotil Ji a~~l ji lHV l)~ l I~~u ~LL J J i _tLI 1 V

v~~

i JJ~-4 J ~ 1~middotl Ll) J~ ~~l-j1 JUJ IfJ - 1 f _r

____ _______~~~ _ ) rlnr _______ __ ~_________ ______ - jU L J ~ ___l -___ __ ~_ J ---__-- ---~- -- ---~-------- ~- -------------- Div 1 ) 11 rlu Dlir 112 4 )

Grai 3-gt1 1)i V 9 5 2 J

4 CUll ~~-l Di v 2 -) gt I~

3 iir Inf Viv 98 23 15 () Di v

Jl (~

49 ( 1 ) Di v 4 3 51 (a) Div 29

) 3 38

52 (L) Div o 8 53 (In D1v 163 b2 2gtl 2 Cdn Inf Div 2 2 76 1 29 3 Ocln Int Div 15 14 112 16 75

43 ~ lJiv 1 4

01nOTAL 446 102 197 246 - 156 5

~ ( ~ R Elliott ) Lt-co1

ior Filst CUD driy

ExtbIO r1rua 0 l dC l1a tlll G bull bullbull

UlREC

9 Mar 45 UDlJDL ltJr Cn u u V Ji ~ ll~u

l22ExllciU3 tionl (Mad)

- -

middot i~ i tmiddotmiddot 1 tI middot1 -1-I- ~ l1 ~ j JIJ J_ ii cPI ~V

~tl~1ut~ Ofil ~1J ~3 ~ tt t )c ~~jjlL ~~t ~_ I1~J j 1 ~~ 1 )1gt~ TlJ ltL ~I lJ(__ t ____ __________________---- bull_ ~______~

-IJIlI 1 I 1 If i)~-lt~Y c 1 rmiddot i bull j 1 l~ - 1 jet1 U -II JL L j ~ ) vmiddot )gtgt J~l - JJ _1IImiddotl 1ll ) 1 C 1 ) i J -------------------------__-------- --~-~~-- --_ _shy~l) I CIoJ U(~I 11 ~~ ~ EliI TI SH 1middot AiI I~L S nu~i l11 S c~ i n F lri I ~~rrJ

WliI iltr~D ~D ~~v lbullLi t~D ~ I ~~~j It l~)ilmiddot~J )1 ti ~-) AJ middot-D ~ ~LD ~V JiD I) DUffY 1e) DUTY ~ C J LJ lY

tol i(pi( Dl v 2 1 11 13r Umd Di v Guards Armd Div 13 2 4 Odn wmd Dlv 3 13X Inf Div 15 (S) I nt D1 v 46 6 55 3 3113 () Div G 59 594 (ill) ViI 2Z 2

+ 3

51 (h) Diy 41 D 40 52 (L) DiV 33 11

7253 (i) Div 5S 13 18 2 2 2 Cdn In D1v 7 7 25 3 19

5 ) 7 13 Odn In Dly r 42 jg 1

TOTAL 2g4 223 131 10 171 I l 2 245

~__~__~____-__________________~__~________~~-~______~_____________bull _____~Mbullbullbull__~~__~____M4______________~~~_____ -------~ -- -w___ ----

I)r )

Jltrj~~-Jb ( Tl QrL111-0t t JJ v- colJ1 ~

AIlH for DD118 Fir 8 t Cd lirmy

Ext 610 liJlI8 81 ~ Le e bullbullbull 11 bullbullbullbullbull

NRE

2 Mar 45

122Exhaustionl (Med)

~ t

l

1

-1J ~1 ~l ~~

i -~~

~- ~1- ~ bull - gt- ~ ~ 1 )~

t( - -tIII_~ - -J

i ~~ --t -- ~~ ~r J

shy ~ gt4 ~

-~ 0

1 ~~ shy-i

- ~

N~ r~

i

i t

f I

t tbull

I I t

-- ~

bull ~1

~

)

~~- J ~ltf

bull bullit

bull t1

-

~ 11

-

RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 4: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

bullbull T~ tmiddot ~ 1 1 ppChIUl JJ l)J ~i-I _V)middot I

____ _~~ ~_ ~~T1 llJ ~ ~ ~_J l~ ~ ( ) i ___J ____ bull 1 __11 -d ___ _______L _______I _ ~ 8 ___JL ul 1 -_----L lA

l OJ 1 _~ L i) ~ _L 1- ~ ___~__ ~__ ____f~ _ ~_L ~ 1J )0 e) ---~-- ------ shy

1ri~JIG u 13 T LI tiJ i~l I bull J ~~ll) ) v Jj i j

01t Ii t) iCmiddotil Ji a~~l ji lHV l)~ l I~~u ~LL J J i _tLI 1 V

v~~

i JJ~-4 J ~ 1~middotl Ll) J~ ~~l-j1 JUJ IfJ - 1 f _r

____ _______~~~ _ ) rlnr _______ __ ~_________ ______ - jU L J ~ ___l -___ __ ~_ J ---__-- ---~- -- ---~-------- ~- -------------- Div 1 ) 11 rlu Dlir 112 4 )

Grai 3-gt1 1)i V 9 5 2 J

4 CUll ~~-l Di v 2 -) gt I~

3 iir Inf Viv 98 23 15 () Di v

Jl (~

49 ( 1 ) Di v 4 3 51 (a) Div 29

) 3 38

52 (L) Div o 8 53 (In D1v 163 b2 2gtl 2 Cdn Inf Div 2 2 76 1 29 3 Ocln Int Div 15 14 112 16 75

43 ~ lJiv 1 4

01nOTAL 446 102 197 246 - 156 5

~ ( ~ R Elliott ) Lt-co1

ior Filst CUD driy

ExtbIO r1rua 0 l dC l1a tlll G bull bullbull

UlREC

9 Mar 45 UDlJDL ltJr Cn u u V Ji ~ ll~u

l22ExllciU3 tionl (Mad)

- -

middot i~ i tmiddotmiddot 1 tI middot1 -1-I- ~ l1 ~ j JIJ J_ ii cPI ~V

~tl~1ut~ Ofil ~1J ~3 ~ tt t )c ~~jjlL ~~t ~_ I1~J j 1 ~~ 1 )1gt~ TlJ ltL ~I lJ(__ t ____ __________________---- bull_ ~______~

-IJIlI 1 I 1 If i)~-lt~Y c 1 rmiddot i bull j 1 l~ - 1 jet1 U -II JL L j ~ ) vmiddot )gtgt J~l - JJ _1IImiddotl 1ll ) 1 C 1 ) i J -------------------------__-------- --~-~~-- --_ _shy~l) I CIoJ U(~I 11 ~~ ~ EliI TI SH 1middot AiI I~L S nu~i l11 S c~ i n F lri I ~~rrJ

WliI iltr~D ~D ~~v lbullLi t~D ~ I ~~~j It l~)ilmiddot~J )1 ti ~-) AJ middot-D ~ ~LD ~V JiD I) DUffY 1e) DUTY ~ C J LJ lY

tol i(pi( Dl v 2 1 11 13r Umd Di v Guards Armd Div 13 2 4 Odn wmd Dlv 3 13X Inf Div 15 (S) I nt D1 v 46 6 55 3 3113 () Div G 59 594 (ill) ViI 2Z 2

+ 3

51 (h) Diy 41 D 40 52 (L) DiV 33 11

7253 (i) Div 5S 13 18 2 2 2 Cdn In D1v 7 7 25 3 19

5 ) 7 13 Odn In Dly r 42 jg 1

TOTAL 2g4 223 131 10 171 I l 2 245

~__~__~____-__________________~__~________~~-~______~_____________bull _____~Mbullbullbull__~~__~____M4______________~~~_____ -------~ -- -w___ ----

I)r )

Jltrj~~-Jb ( Tl QrL111-0t t JJ v- colJ1 ~

AIlH for DD118 Fir 8 t Cd lirmy

Ext 610 liJlI8 81 ~ Le e bullbullbull 11 bullbullbullbullbull

NRE

2 Mar 45

122Exhaustionl (Med)

~ t

l

1

-1J ~1 ~l ~~

i -~~

~- ~1- ~ bull - gt- ~ ~ 1 )~

t( - -tIII_~ - -J

i ~~ --t -- ~~ ~r J

shy ~ gt4 ~

-~ 0

1 ~~ shy-i

- ~

N~ r~

i

i t

f I

t tbull

I I t

-- ~

bull ~1

~

)

~~- J ~ltf

bull bullit

bull t1

-

~ 11

-

RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 5: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

- -

middot i~ i tmiddotmiddot 1 tI middot1 -1-I- ~ l1 ~ j JIJ J_ ii cPI ~V

~tl~1ut~ Ofil ~1J ~3 ~ tt t )c ~~jjlL ~~t ~_ I1~J j 1 ~~ 1 )1gt~ TlJ ltL ~I lJ(__ t ____ __________________---- bull_ ~______~

-IJIlI 1 I 1 If i)~-lt~Y c 1 rmiddot i bull j 1 l~ - 1 jet1 U -II JL L j ~ ) vmiddot )gtgt J~l - JJ _1IImiddotl 1ll ) 1 C 1 ) i J -------------------------__-------- --~-~~-- --_ _shy~l) I CIoJ U(~I 11 ~~ ~ EliI TI SH 1middot AiI I~L S nu~i l11 S c~ i n F lri I ~~rrJ

WliI iltr~D ~D ~~v lbullLi t~D ~ I ~~~j It l~)ilmiddot~J )1 ti ~-) AJ middot-D ~ ~LD ~V JiD I) DUffY 1e) DUTY ~ C J LJ lY

tol i(pi( Dl v 2 1 11 13r Umd Di v Guards Armd Div 13 2 4 Odn wmd Dlv 3 13X Inf Div 15 (S) I nt D1 v 46 6 55 3 3113 () Div G 59 594 (ill) ViI 2Z 2

+ 3

51 (h) Diy 41 D 40 52 (L) DiV 33 11

7253 (i) Div 5S 13 18 2 2 2 Cdn In D1v 7 7 25 3 19

5 ) 7 13 Odn In Dly r 42 jg 1

TOTAL 2g4 223 131 10 171 I l 2 245

~__~__~____-__________________~__~________~~-~______~_____________bull _____~Mbullbullbull__~~__~____M4______________~~~_____ -------~ -- -w___ ----

I)r )

Jltrj~~-Jb ( Tl QrL111-0t t JJ v- colJ1 ~

AIlH for DD118 Fir 8 t Cd lirmy

Ext 610 liJlI8 81 ~ Le e bullbullbull 11 bullbullbullbullbull

NRE

2 Mar 45

122Exhaustionl (Med)

~ t

l

1

-1J ~1 ~l ~~

i -~~

~- ~1- ~ bull - gt- ~ ~ 1 )~

t( - -tIII_~ - -J

i ~~ --t -- ~~ ~r J

shy ~ gt4 ~

-~ 0

1 ~~ shy-i

- ~

N~ r~

i

i t

f I

t tbull

I I t

-- ~

bull ~1

~

)

~~- J ~ltf

bull bullit

bull t1

-

~ 11

-

RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

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- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 6: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

~ t

l

1

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i -~~

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RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 7: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

RLrUd- OF lJ~hS UF hXk~jI01 dL TlllmiddotD TC~J lDICC~dGgtu FOi bull11 I)LJ)ll)iHL )JJJ01 - f 11~( ~tITTl-1~ ~-)i c~ ~ I I ~~~---_v-~7t-l---(---f7l-middotmiddot-r-~- ~ ~ __I di JlpoundIh I vlh 1-( ~_1hl11-pound~Ll bd)J G _~J~~~~-V(jl~~_L _J_Uf~

J DI iJlu UJij Of 3hllIil PI~jIL bull Ci1tlJ101)Iiittu ~)_ IL~J~l In 1 LI

1~1J 1 i]liti~i~D LIV J~) ~1) 1 u~ll~t~Ll) iJVlj d_~lA 1 llflJJ 1- ~ L) LV ~(j_Ae~llDl

--------~----------- 0 Jj j-___-___ tI-_---shy --_shy - shy JC ) li--__ -- shy -----~-----------

Polish Arml1 Hiv ~-) ) 2

4 Can UInd Div 2 2 2-Gua d Armd Div - l5(S) Int Div 2 1 shy43 (j) Div 4 4 53 u) Div 510I) Div

1 20

1 7

2 Cdn Div 3 Cdn Div 49 CR) Div

1 6

- 26

7 21

) )

IOTAL 34 21 30 2 10 5 3 2

- shyNOT~ Total admissions as taken frol Divisional exhaustion oases Heturn is 69

Total Mm1asions for exhaustion hS taken from Cas Heturn and Health ~3tate is 16 Divisional breakdown taken from Cas Returns Dnd Health Stete is given belo - udnissioHs only are shown

-Pol Div 4 Cdn Goo rds hlmd 15 (S) 43 ( Ii) 53 ( w) 5100 2 3 Can 49 (Ui) TOTAL

Dlv Div Div Div Div Div Div Div Div ------------------------~----------------~------------------------------------------~------------------------Cases Adm1tted to Med Un ts 1 2 25 3 60 16 11 18 6 142

Diva total of 142 plus 2 fropoundl1 1 Corps Tps and 12 fro1ll 30 001p3 Tps is 156

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 8: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

J r--r I DI

~)f4~ Ct-3 ~c middot~~H D T D DI5CHJdlGSD F DIVISIOilAL DICIL

vITS I ~ IGT OD jilHY 1) I-aIm ~K DLG GAluDAY 2 AT USOO Has

DlUllSH ))lI~TS U)~-Jt~DIJJ_ l)~~IlII S ~l 11 I ~-jJ5 ~nlaAL U~ITS OF

r t A--) I ) ~ vLD ~VACUATEDrJtITTED middot)TU1IIiD EV1CUhlU AOHrTSD lL~Tu~LZD v v ______ DGJY10 DULY fa DUTY

rO1 Armd Div 3 2 it CdnArmd Diy 2 Cdn Int Div 3 Cdn Int Div 1

I

2 4 10

0 1 4 7

49 Br Int Diy Guards Armd Div

9 1 0

9 1

15 (8) Int Diy 53 (W) Int Diy 51 (H) Int Div TOTAL

la1 1 ~

12 o 1

12 16 o 12 3 2

WEEK ENDnn SArtNDAY 3 FEB 1945 AT leaO HRS

BRITISH PATIENTS CANADIAN PATIENTS OTHER PATIENTS MEDICAL UNIISOS

i ADMITTED RETURNED EVACUATED

TO DUTY AD1ltITTED RETURNED SVACUATED ADMITTED RETURNED

TO DUTY TO DUTY rVACUATED

t1 Armd Div 6 2 1 Odn Armd D1Y 11 2 3

Guards Armd Diy 15 (8) Int Div 43 (w) D11 53(w) Div 51 (H) D1y2 Odn Inf Diy ~ Cdn Int D1Y

9(WR) Int 011

1 0 1 Nil 2 2 Nil -Nil

- -4 4

3 f411

TOTAL 9 2 g 25 2 25 6 2 1

X--- t 1) Feb 45 (D L MacLean)Lt-ool21bbaU8Uoal (Ked) ADH tor DDMS Fir s t ~ Arrq _

---~ ------lt -------~-- -~ ~ --~ shy

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 9: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

SECRE

-2-STATSStatistical Seotion Adm HQ First Cdn Army 16 Mar 4

Cdn ciec 1 Ech HQ 21 A Gp(Attn Adviser in Neuropsychiatry)

Whaustlon Case~ Repoaters

1 Ref conversation (Lt-Co1 Richardson - capt West) ruld our letter 5-2-STATS dated 24 Feb 4 regarding the rn subject

2 Herewith intm regarding repeaters as shown by the record of exhaustion cases compiled by this Seci

Total Cases ~ RepeatersReviewed ReReater to 42tal Csel

Cdn 2804 121 43 Brit 1489 2sect lt2 Total 4223 142 l1 3 It ls emphasized that this record ot exhaustion cases is not a complete one A likely explanation of the lovlCr of Brlt repeaters ls that when tmns passtrom First Cdn Army to comd second Brit Army records of exhaustion caSGS a1e Hot available to us and vIe would have no means at cur disposal of checdng ttJ9 number of repeaters subseshyquently occurring

~ (A L S Ireton) Major

DAAG state

Ext Adm 29 tor GOe-in-C First Cdn Army

rwr Time ot signaturet~ ~1 hJs

DRLSPOST

111 c

0-

Jbull L

f -~

)

I __-lt- J c ( bull f lll

f - - i --i

J J I 1 1st i I

~- Jshy

((

-I

~ica1 ~~ - -8

- middot~middotC-~ LL ~ ~QrJcrJS

c I

11 1 2 1 2

r

2 2 1 c_

J 1)

2 2 6 3 2 8 3 -4 -) shy

2 2 3 6 J 2

1

1 1

1

66 176

84 37 47 97

956 45 31 29

4 11

1 7

50 11q

79 83

1~6 10) lS~-

(r-1

122 96

12 i7 92

146 10

244 194

71 71

117 17 87 45 10 81 45

10 16

9 1

6 3

13

5 1

115 3254

J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 10: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

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J

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 11: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

CANADIAN SECTION GHQ I ECHELON

21 ARMY GROUP

7 Dec 44

Memo - ADMS

Memorandum on the Disposal of Exhaustion Cases in Rear of ArmY

1 This is an attempt to provide the information requested by fa jor Stats First Cdn Army 2 Dec 44 To fully clarify such a report it would probably be necessary to describe in some detail the policy and principles involved in our Neuropsychiatric organizashytion in this theatre For brevity and expediency the technical psychiatric details will be very condensed in this letter

2 Exhaustion cases are being handled by giving necessary treatment and assessing future fitness at a series of levels from Field Regiments to Base The soldier with exhaustion requiring evacuation from his regiment is first seen at a Divisional FDS 1 acting as a Divisional Exhaustion Centre There the milder cases are treated and of them usually about 6~b are returned to their uni ts wi thin a few days

3 From the Divisional FOS cases requiring more prolonged treatment are admitted to the Corps exhaustion Centre Of such cases admitted to Corps Exhaustion Centres 30 to 40 are usually returned via the forward Reinforcement Company to their regiments either directly or after 3 to 6 weeks change of employment at 19 Special EmploYlllent Company Some cases admitted to the Corps Exhaustion Centre (About 20 to 30) are evacuated to 1 Cdn Neuroshypsychiatric Wing (at a general hospital) because of the severityof the condition or because of the need for more detailed diagnosticprocedures

4 The cases in 19 Special Employment Company from Corps Exhaustion centre are repeatedly re-assessed by Psychiatrists and tend to fall into three groups a) Stable individuals fully recovershying from their breakdowns who are left in Sl Pulhems rating and returned to their units b) Those with perSistent mild instability keeri~ them unfit for full combatant duties These are downgraded to S3 c) Those who seem with further observation to be unfit for any but Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S3s in 19 Special Employment Company where they carryon at employment in Corps Area until in many cases t they may be sent to other L of G posting by the SPO detachment of ff3 CRG The S4s are returned to CBRG for reallocation to some Base posting or to 20 or 21 SEGs In the past month Since 19 Spacial Employment Company has moved to its present Site an attempt has been made to improve the effectiveness of that unit by better co-ordination by improving the provision of adequate work by a better training program and by closer medical psychiatric co-operation Vtatters have improved but not yet to the opti~m The figures as to disposal from that unit for Oct amp Nov are not yet available to me and they will be of doubtful significance in this changing plaSC Below are figures from the quarterly report of 1 Cdn Exhaustion Unit of 1 Jul - 30 Sep 44shy

Disposal of Cases sent to 19 Spec Em~toybull

August amp September

Total cases interviewed psychiatrist)

(by visi titlE$ 420

~~ned to Unit Slgraded to S3

To Psychiatric Hospital

150 247

23

3 )~middot1middot

s~ i oS $

( 1 40P lfii wtd

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 12: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

- 2 shy

i) The Base lieuropsychiatric fing receives patienis from ~he Corps Exhaustion Centre also from the other cess and from other Canadian amp British Hospitals At t~e3 locations may be SUCh~h~t it will receive eXhaustion cases directly from divisions and mctiorlil like the Corps Exhaustion Centre that happened during Oct A rtlen the Corps Exhaustion Centre was back at Ghent and the neJlosychiatric wing was with No 8 Odn General Hospital in Antwerp Ordi~arlly the admissions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

7 Disposal of Oases of No 1 Odn Base Neuropsychtatric Wing Of 783 cases handled between 5 Aug and 8 NOv 44 (not a final total figure) shy

124 were returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 were returned to t he UK

8 3 Cdn Reallocation Centre receives cases from CBRG via other Canadian amp British General Hospitals as well as from the Base Neuropsychiatric Wing and the Special Employment Coyso The following information as to reallocation by that unit is from its report of 1 Aug - 30 SeE 4~-

972 men were reallocated during that period934 men were medically reboarded and of

those 836 were psychiatric Thus psyshychiatric cases constituted about 90 and these QIiell are almost entirely ~middotagtt~ labelled lteXhaustionU in the field

Total Reallocations 972 100 To Spec Ernp Coy 235 24 To full operational d~y 1~ l~~ To L of C Fmns 504 52 Returned to UK 115 12 - (of these

only 2 were psychiatric cases 102 had physical disabilities 9 were average and 2 were NCOs unemployable in this theatre)~

9 The following data was obtained to-day as to disposal of cases by NobullJ) CRC in the months of October amp November 1944 They are rough figures hurriedly obtained to-day and subject to fur~~er confirmationshy

Total Reallocations 866 100 (of these 596 were psychiatric)

To Spec Ernpl Coys 161 18$ To full Operationalduties 79 ~ To L of C Fmns 535 62 Returned to UK 91 11$

10 The total picture as to the final disposal of psychiatriccasualties (exhaustion cases) from this theatre is not finally shown by the above date as to cases handled by exhaustion centres neuroshypsychiatric Hospital wing and 3 CRC Many cases have also been evacuated to me through other general hospitals and a large number of these had a diagnosis of allle physical disability until a final opinion was eventually possible in UK In the earliest weeks of this campaign when no holding of cases was pOSSible a large proportionreached the UK in recent months the number has been much smaller

have tried without full success to get the figures of cases returned to UK The follOwing data was sent me by Advisor in Neuroshypsychiatry CMHQ

Cases of psychiatric illness admitted to Canadian Hospitals in trA from Western European Theatreshy

June 221 July 370 August 239

I

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 13: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

- 3 shy

The figures for September amp October are not yet available It was roughly estimated at CMHQ that 300 to 400 neuropsychiatric cases returned to UK between 23 Jul amp 13 Oct 44

10 The statistics accumulated by Major Stats 1 Cdn Army as to the incidence of exhaustion have been of considerable interest to us from the psychiatric viewpoint The problem of battle exhaustiontt has many a~pects related to morale discipline reallocation other medical disabilities etc The Whole picture must be visualized in drawing conclusions from statistics and in planning prevention and disposal

( JC Richardson) Lt-Col Advisor in Heuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 ArmyGp

1 i 1

bull I 1

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 14: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

(- 1 P CANADIAN SECTION G-middotH~-fdiELON

21 AR~UP S B C_ILlSI

5llNP323 Dec 44

GOC in C HeadquartersFirst Cdn Army

Attn Major 8tats

Exhaustion Statistics IE bull

1 Your diagramatic representation of the disposal of 1000 exhaustion cases has impressed me as being much too optimistic in regard to returning men to full dutyThe figures on which you based this chart seemed roughly accurate and I have been trying to find the possible errors

2 From reports of exhaustion ce~res and the hospshyital neuropsychiatric wing and CRC I think the following can be said as a reasonable approximation

(a) From Div Exhaustion Centres 50 are returned to full duties (81)

(b) From Corps Exhaustion Centre 30 are returned to full duties

(c) From Base NP Wing 15 are returned to full duties

(d) From CRC 10 are returned to full duties

3 The following discrepancies tend to lower these percentages A certain umber of more severe exhaustion cases arriving at Div FDS are immediately sent on to Corps and at ti~es have not been shown with the Div FD8 figuresSome cases discharged from hospital NP wing for full duties are foundto be pretty shaky at CBRG and are referred again to psychiatrists and down graded The largest other wastageis from cases evacuated to general hospitals with minor wounds or illness or given a symptomatic physical diagnoseswho later are recognized as psychiatriC and downgraded under 8

4 From the records of ADMS 1 Ech the following numbers of cases were downgraded by medical boarding 1 8ap 44 - 25 Nov 44

Ml 83 535 Total 83 - 727 Ml 83R - 7 Total 84 - 86 Ml S4 63 M2 83 150 M2 84 - 22 M483 - 35 M4 S4 1 M48l - --2 Total 822

5 During the same period records from 2 Ech show the incidence of 1486 cases of Exhaustion With the usual disposalof cases in regular psychiatric channels this should account

2 ) (FA x trp~ S72f HlS L

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 15: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

6 E Q H E T

( 2 )

for only about 550 men downgraded to S3 or S4 The reshymaini~~ 300 odd cases will have passed through various other channels - particularly general hospitals

6 In preparing your diagram to roughly indicate the usual disposal of 1000 cases of exhaustion I thir~ it would be well to add a note explaining the fact that the complete picture is not shown Eg - NB - This diagram is only apprOXimate and presents the averagedisposal of cases evacuated as ftExhaustionllthrough regular psychiatric channels Other psychiatric cases of the same type are only labelled as such in generalhospitals and at CBRG and are not here included ft Moreshyover I thi~~ it would be safer to use the following percentages of RTU in your diagram

- From Div FDS - 40 - From Corps Exhaustion Centre - 30 - From Base NP Wing - 10 - From 3 CRC - 10

7 I am sorry we cannot get more accurate figuresfrom the general hospitals and CBRG but I dontt think it would be reasonable to ask for more returns EventshyualJ y we will get further data from machine records at Acton

ci~~-I--~--I

~ (Je Richardson) Lt-Col Advisorin Neuropsychiatry Cdn Sec GRQ 1 Ech - 21 A Gp

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 16: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

ftC 0 P y CANADIAN SECTION GHQ 1 ECHELON

21 ARMY GROTJP 7 Dec 44

Memo - ADMS

TemorndurrJ on -ehe Dispos~l of Exhau3Cion Cases in Rear of Army

1 This is an aCtem9C to provide the information requesCed oy jcr SCaCs Firc~t Cdn Army 2 Dec 44 To fully clarify such a report it would probablyoe necessary Co describe in some detail

the DOllCY and nrinciples involved in our Neuropsychiatric organizashytion in this CheaCre For orevity and expediency the technical psyc1datrlc detBils will be very condensed in this letter

lt SXhausClon c ses arc Deing nandled oy giving necessary (reaCment tinct assessing future fi tness at a series of levels from ela =tegiments to Sase The soldier with exhaustion rquirinr

evaCUBCmiddotOr1 from nis regiment is first seen at a Divisional FDS acCini~ 8f a )1 visional 3xhaust ion Centre There the milder cases are CreaCe t 1 and of them usually aoo~t 60 are returned to their unlts w1Chin a few days

0 From Che LvJsionl FDS cases requiring more prolongedtrelCment are l(jmi CCed to the Corps Exhaustion Centre Of such cas s admitted to Corps E_~~austion Centres 30 to 40~ are usually re Cu ~ned via the forward Reinforcement Company to their re giments eitGer dlrecCly or afC3r 3 Co 6 weeks change of employment at 19 Special Employm~nt Company ~ome cases admitted to the Corps EL~au~Cion Centre (aoout ~u to 60~) are evacuated to 1 Cdn NeuroshypsycnLatric ing (aC a general hospital ) because of the severity of CDG condi tion or because of the need for more detailed aiagnostic nrocedures

t The C~ises in 1119 cial Employment Company from Corps Sj~austion Centre are repeatedly re-assessed by physhiatrlsts dUd tend to fall into tl~ee groups (a) Stable individualS fully recovershying from theIr breaEdowns who ar(~ left in SIn PUlhems rating and reCurned to their univs (b) Those with perSistent mild instability keening them unfiC for fu~l combatant duties These are downgraded to lS3 (c) Those who seem with f-2rther ob~ervation liO be unfit for any out Base duties These are downgraded to S4

5 Our newly adopted procedure is to hold S6s in 19 SpeCial Employment Company where they carryon at employment in Corps Area unC~_l ln many cases they may be sent to other L of C posting oy -che SPO detechment of 6 CRC The tlS4stt are returned to CBRG for rallocation liO some Base posting or to 20 or 21 SECs In the past month since 19 Special Employment liompany has moved to its presenC gti Ce an attempt htis -Deen made to improve the efiectiveness

of Cnat unit by betCer so-ordination by improving the provision of aaequ8Ce work by a better training program and hy closer medical Jsycloiatric co-opeLation Matters have improved but not yet to tno )T)Cimum The figures as to disposal from that unit for Vct amp Fov 14 are not yen ava1lalieco me and they will be of doubtful sigmIl cance in this changing phasemiddot Below are figures from the quarCerly report of 1 Can Exnaustion Unit of 1 Jul - 30middotep 44shy

Disposal of Cases sent to 19 Spec Emp Coy

August and September

Totdl cases interviewed (by visiting CiS ycrda trls t ) 420

turned to Unjt (Sl) 150 Downgraded to S3 To psychiaCric Eo~pital

247 23

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 17: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

- 2 - C 0 P yll

7 DisDosal of of 7f3 C~ges handled

~ 6 The Base Neuropsychiatric Wing receives patients from the Corps Exh~ustion Centre~ also from the other CCSs and from other Canadian amp British Hospitals At times locations may be such that it will receive exhaustion cases directly from divisions and junctions 1 ike the Corps E)_haustioD_Centre that harlpened during Oct 4l when the Corps Exhaustion Centre was back at Ghent and the neuropsychiatric wing was with No c Cdn General Hospital in Antwerp Ordinarily the ad~issions here are the more severe neurotic states more serious mental illnesses and organic neurological conditions

figure)shy

124 ~ere returned to full duties 562 were referred to 3CRC for downgrading

and reallocation to non-combatant duties 97 ~ere returned to the UK

8 i t3 Cdn Reallocation Centre receives cases frGm CBRG via other Canadian amp British General Hospitals as well as froD the ESt se NeUl(psyc(ieJ tric Ving dnd the Spec ial Employment Cays The fcmiddotoine informbticn a3 to reallocation by that unit is from its r t of 1 nug - 30 SeQ 411shy

972 men were reallocated during that period 934 men were medically reboarded and of

those 836 were psychiBtric Thus psyshychi~tric c~ses constituted about 90 and these are almost entirely cases labelled exhaustionll in the field

Total Reallocations 97~ 100 To Spec Emp Coy 235 24 To full operational duty 107 11 To L of C Frnns 504 52 Returned to UK 115 12 - (of these

0~ly ~ w~re psychi2tric cases 102 had physical disabilities 9 w~re ~ver~ and 2 were NCOs unemploya~le in this theatre)

C The following data was obtained to-day as to disposal cmiddotf Cases by No J ChC in the months of October amp November It44 Ihey are rough figures hurriedly obtained to-dampy and subjec to r~rther ccnfirmationshy

Total Reallocations 866 100 (of these )96 were psychiatric)

To Spec Empl Coys 161 18 To full Operational duties 79

To L of C Fmns 535 6~~ Returned to UK 91 11

I 10 The total picture as to the final disposal of psychiatric j

casualties (exhaustion cases) from thiB theatre is not finally shown lt

by the above date as to cases handled by exhaustion centres neuroshypsychlctric Hospital wing and 3 CRG Many cases have also been eVdcnEted to UK through other general hospitals and a large nmnber of tbese had a diagnosis of physical disability until a final opinion was eventually possible in UK In the earliest weeks of this c~~paign when ho holidng of cases Was possible a large proportion reached the UK in recent months the number has been much smaller I have tried wtthout full success to get the figures of cases returned to T_T~~ The following data was sent me by Advisor in Neuropsychiatry CfIQ

Gases of psychiatric illness admitted to Canadian Sf i tal s in UK from Viestern European Theatreshy

June 221 July 370 August 239

l_

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp

Page 18: 25LS, · nce s without ref8reDce to Brit 2 Ech .,;here datea of commencement of activity differ, tho Brit formation with hi st rate of ca ties has besn used.

IIC 0 Uti - 3 shy

The figures for September amp October are not yet available It Was IJughly estimated at CltHQ that 300 to 400 neuropsychihtric cases returned to UK beyween 23 Jul amp 13 Oct 44

11 The statistics accumuhted by Major stats 1 Gdn Army as to the i~cidence of exhaQstian have been of considerable interest to us frcr the ~)sychiutric viewpoint The problem of b2ttle exshyhI ust ~(Hl h8 s many aspects related to morale discipline reallocshyation other medical disabilities etc The whole picture must be visualized in drampNilg conclusions from statistics and in planning preve~ticn and disposal

(SIGNED)

(JC Richardson) Lt-Col Advisor in Neuropsychiatry - Cdn Sec

GHQ 1 Echelon - 21 Army Gp