ITEM No. 24 
FILE No. XXV/III-40 
COPY No. 
GERMAN MILITARY NEUROPSYCHIATRY AND NEUROSURGERY 
COMBINED iNTELLIQENCfe: OBJECTIVES 
SUB-COMMITTEE GERMAN MILITARY NEUROPSYCHIATRY AND NEUROSURGERY • 
Reported by 
LEO ALEXANDER, Major, UC, ADS 
CIOS Item 24 
Medical 
Combined Intelligence Objectives Sub-Committee G-2 
SHARP (Rear) APO 413. TABLE OF CONTENTS 
Sub ject No. 
A, Neuropsychiatry in the G-erman Army 3 
1 , Regulations, memoranda, circular letters and 
reports governing neuropsychiatric practice in 
the G-erman Army. 3 
2, Information obtained from Professor Dr, Kurt 
Schneider, Oberstarzt (Colonel) in the G-erman Army 
Medical Corps, who served as Consulting Psychiatrist 
with various armies in the field, on active war 
fronts in Poland*, Prance and Russia. 46 
3, Information obtained from Oberstabsarzt Dr, Ludwig 
Hochapfel, who served as assistant to the Chief 
* || || 
Consulting Neuropsychiatrist at the Militararzt- 
liche Akademie in Berlin from August 1 943 until 
April 1945, then as Chief of the Neuropsychiatric 
Service at the Reservelazarett in Tutzing, 
Bavaria. 54 
4. Information obtained from Stabsarzt Dr, Eduard Beck, 
member of the Staff of the neuropsychiatric service 
of the Reservelazarett in Tutzing, Bavaria, 58 
5. Information obtained from G-eheimrat Professor 
Dr, 0, Bumke, Chief Consultant Psychiatrist and 
Neurologist to the Heeressanitatstaffel Munchen, 
with the rank of Oberstarzt (Colonel) in the 
German Army Medical Corps, 60 
6, Information obtained from Dr, Alfred Wiskott, 
Professor of Pediatrics, and at present also Dean of 
the University of Munich Medical School, 61 
7, Information obtained at the Psychiatric Clinic of 
the University of Heidelberg Medical School, 62 
8. Information received at the Neurological Depart- 
ment of the Ludolf Krehl Clinic for Internal Diseases 
of the University of Heidelberg Medical School, 62 
9. Information obtained from Oberstabsarzt Dr, Alfred 
Schwenninger, German Army Medical Corps, 65 
10, Information obtained from Oberstarzt (Colonel) 
Professor Dr, Karl Kleist, chief consulting psych- 
iatrist to the 9th (Kassel) Corps Area, 6? 
11, Information received from Oberstabsarzt Dr, Herbert 
Kaltenbach, formerly Consulting Neuropsychiatrist 
with, Romjnel.'s *Afrika Corps (April 1 941-April 1942), 
now; chief1 of a hospital for chronic neuro- 
psydhUatri’d* Casualties in Konigstein in Taunus, near 
Frankfurt on Main. 73 
H-H-*1- Subject No. 
12. Information received from Oberstabsarzt Dr. 
7/alter Kilb, who served as regimental surgeon 
in france from 1 0 May to 1 December 1940 and 
on the Russian front from 24 June 1 941 until 
April 1942, and later served in Germany in 
Neuropsychiatric Army Hospitals until November 
1944, later with army units in Limburg a.d, Lahn. 75 
15. Information received from Dr, Anton Edler von 
Braunmuhl, at present in charge of the Heil-und 
Pflegeanstalt Eglfing-Haar, near Munich. 77 
14. Diagnosis, treatment and disposition of soldiers 
with psychosomatic disorders in the German army, 
based on information given by Dr, Richard E, Siebeck, 
Professor of internal medicine at the University 
of Heidelberg, and consulting Internist to the 
3rd and 12th German Army Corps. 78 
1 5. Information received from Geschwaderarzt 
Professor Dr, Franz Volhard, Professor of medicine 
and director of the medical department of the 
University of Frankfurt on Main Medical school 
and Consultant in Internal Medicine to the 9th 
Corps Area of the army and the navy, 82 
B. Neuropsychiatry in the German Air Force (Luftwaffe) 83 
1 . Information received from Professor Dr, Hans Luxen- 
burger, Oberstarzt (Colonel) der Luftwaffe, Chief 
Consulting Neuropsychiatrist to the Surgeon General 
of the Luftwaffe, 1 941 -April 1945. n 83 
2. Information received from Dr, Gustav E. Starring, 
Stabsarzt der Luftwaffe, Associate Professor of 
Neuropsychiatry at the University of Gottingen (in 
Professor Ewald's Department) - on leave of absence. 89 
C. The precarious state of psychotherapy and psychothera- 
peutic training in Germany before the war, as expressed 
in confidential reports by Professors Kretschmer and 
Mauz. 93 
D. Neurosurgery in the German Army and Air Force 97 
1 . Information received from Generalstabsarzt der 
Luftwaffe Professor Dr. W. Tonnis, Chief Consulting 
Neurosurgeon to the entire German armed forces. 97 
2. Information received from Stabsarzt Dr, Erich 
Fischer-Brugge, Luftwaffe, surgeon and neurosurgeon, 
and Dr. Tonnis*s closest collaborator. 108 
3. Information received from Stabsarzt Dr, W. Rusken, 
neuropsychiatrist, and from Stabsarzt Dr, Ernst 
Dvoracek, the internist on Dr, Tennis’s team. 108 
4. Information received from Stabsarzt der Luftwaffe 
Dr. Carl Theo Dussik, M.D, (Vienna) 1932, Neuro- 
psychiatrist on Dr, Tennis's staff, 113 
3SaH.lv-a Subject No. 
5. Information received from Stabsarzt der Luftwaffe 
Dr, Fritz Linder, formerly a staff member of the 
Neurosurgical Center in Vienna, Austria, at present 
attached to the Surgical Department 
of the University of Heidelberg. 116 
E. General Conclusions 116 
Appendix 1 j29 
Appendix 2 132 
Appendix 3 133 
Appendix 4 134 
Appendix 5 136 
Appendix 6 137 A« Neuropsychiatry in the German Army 
1. Regulations* memoranda, circular letters and reports 
fovernlng neuropsychiatric "‘practice in the German 
my ‘ ’ 
These sources of information were placed at my dis- 
posal for study by Obersta £&arzt Dr* L* Eochapfel, formerly 
assistant to the chief consulting psychiatrist" at the 
Militarfrztlichs Akedemie in Berlin (now chief of the 
neuropsychiatric section at the military Hospital in 
Tutzing, Bavaria), Stabarzt Dr* Eduard Beck, his assistant, 
Oberfeldarzt Dr. E* Spatz and Dr. FV*~Jpmai of Munich, 
and by Gener.alstabsarzt Dr. W. TSnnia~'~tnxBad Ischl. These 
docTunents included a great number which were marked 
secret ("Geheim") or restricted ("Nur fflr den Dienst- 
gebranch") • 
Medical diagnosis and disposition in the German 
Army were governed by Regulation HDv 252/4,MDv £48/4 
LDv 399/4 (comparable to our MR 1 - 9), of 1-4-1944, which 
took the place of the similar older 53 d/62, which was 
last amended on 12-8-194.8* This regulation (Appendix 1, 
No* l) utilizes a schema similar to our profiling system* 
Dispositions are arranged horizontally, diagnoses according 
to organ systems vertically* Dispositions are designated 
by capital" letters; A and B are categories fit for combat 
duty (kriegsverwendungsf8hig«k.v*)j Z indicates temporarily 
unfit for duty (zeitlich untauglich«ZaU.); L indicates 
limited service {bedingt kriegsverwendungsf8hig«bed*k*v*); 
U indicates fit for laboring duty only (arbeitsverwendungs- 
f8hig-a*v*): and vU indicates permanently unfit for duty 
(wehruntaugiich=w*u.)• The diseases of the nervous system 
(anart from epilepsy and the organic diseases of the brain) 
are listed as Nr 15, with 3 subgroups in the various duty 
categories* For instance, "psychically inadequate 
psychasthenics and neuropaths" (which includes 
falling under our concept of hysteria) are classified 
as L-15-1' characteropaths (psychopaths with emotional 
instability end character defects) as A-15-3: the combat 
exhaustion states, temporarily, as Z-15-1* it was common 
practice, however, not to classify psychosomatic disorders 
without overt psychic symptoms under No. 15, but under 
the respective organ systems, such as 49 for fieart,58f°r 
stomach, and so forth. Even bed wetting was classified 
under the heading of bladder and kidney, namely as B or L 
54-1. 
The general procedure for diagnosis, treatment and 
disposition of neuropsyohlatrlc 00£dlt*°n® v 
classify as psychoneurosis or psychopathy respectively, 
is contained in the -Directives for the apprisal of soldiers with psychic-nervous deviations (Psychopaths) and with 
psychic-nervous reactions* and directives for their transfer 
into special formations” (Appendix 1, No* 2) In its 
"general section” this directive states that the first 
diagnostic step should be the distinction of the abnormal 
reactions which occur as a consequence of excessive stress 
and fatigue* from those which occur as a consequence of 
psychopathic constitution* It is to be realized that 
a diminished resistance to such reactions exists among the 
youngest as well as among the oldest age groups, which is 
not to be taken as an expression®of psychopathic constitution, 
but is due rather to immaturity in the young, and worn-out- 
ness and staleness In the old. The young, following break- 
down, are to be re-integrated gradually into combat duty; 
the old. after breakdown, are to be transferred to the rear 
and used within the limits of their capacities. In the 
middle ag© groups, however, constitutional deviation is 
the largest single cause of breakdown. It is stated* 
especially for the attention of regimental and battalion 
surgeons, snap judgment of a moralizing kind should be 
avoided, because, apart from the malevolent (”Schleeht- 
willlge”), a great many patients of fundamentally good will 
("Gutwillige”) will be found among these patients* Further- 
more, it is directed that such terms as "Neurosis”, 
”Psychopatbic reaction”, etc*, are-to b© 
avoided, and are to be replaced by more descriptive terms, 
as given in the special section of the directive, or by 
brief descriptions of the personality of the patient. In 
addition* the directive stresses the importance of careful 
search for organic illnesses* ”Soldiers, who for instance 
complain about disturbances of the stomach* intestines, 
circulation or bladder, belong to the internists. The 
neuropsychiatrist must be consulted only when deemed 
necessary by them.” 
The treatment of psychogenic reactions should bo as 
early as possible# The mildest types of reaction disappear 
quickly under comrad% encouragement* Surgeons and inter- 
nists with troops and In hospitals should be aware of 
psychogenic overlays in their patients and should call a 
neuropsychiatrist in consultation, especially if protective 
postures and contractures persist longer than usual after 
palsies and gunshot wounds of the peripheral nerves# 
[Frequently the transfer of such psychogenic cases to locked 
psychiatric wards, and their placement amid severely 
organically ill patients on such wards, is helpful therapeu- 
tically with patients on whom simple psychotherapy had no 
effect# No patient suffering from psychogenic and hysteric 
symptoms should ever be evacuated to the rear without the 
approval of the chief consulting psychiatrist* In the 
£one of the Interior, all patients with hysteric disturbances 
38**./*,- *- are* never to be discharged as unfit for military service, 
but ■'are to be transferred to special therapeutic hospitals 
for electric treatment. If they are freed from their 
symptoms, they are to be reassigned to limited duty 
according to the limitations of their personality or 
of associated organic defects. Those who remain resistant 
to therapy, are to be transferred to the military sections 
of the State Hospitals for the Insane. 
The special section of this directive gives clear 
cut categories of diagnosis, treatment and disposition, 
which will be summarized in abbreviated form, with 
reference to the corresponding diagnostic categories 
used by our Army. 
Diagnosis 
Treatment and Disposition 
I. Soldiers with good 
physique and with good 
previous personality, but 
with abnormal reactions 
(anxiety, confusion, 
trembling, functional 
palsies) in response to 
catastrophic events or 
exhaustion (our LD-yes 
type of Psychoneurosis, 
stress severe, predispos- 
ition none) 
If comradely or medical encour- 
agement does not help, field 
hospital. There ample nourishment, 
and sedatives. After 8 days, light 
work and military training. Then, 
after brief period of light duty 
or convalescent center, return to 
combat. If hysteric fixation 
persists in spite of this treat- 
ment, further treatment like 
group II c. 
II. Abnormal personal- 
ities with purely psychic 
deviations. 
a. Deviant char- 
acters „ such as ins tab il- 
ity, abnormal desire for 
recognition,, swindlers,, 
asocials and antisocials 
(our "constitutional 
psychopathic state with 
.emotional instability”, 
and it’s variants "with 
pathological lying”, etc.) 
b. Weak people 
(psychasthenics), such as 
the hesitant, irresolute,, 
helpless and anxious. 
(our "constitutional 
psychopathic state with 
inadequate personality”) 
Purely disciplinary disposition 
to special and punishment forma- 
tions. In the Zone of the Inter- 
ior, to ”Bonderabteilung des 
Ersatzheeres”. At the front or 
near the front, to "Peldsonder- 
bataillon”. If these measures 
unsuccessful in improving per- 
formance, transfer into a concen- 
tration camp. 
Comradely encouragement. If 
insufficient, transfer to reserve 
units or other suitable units, 
except to those engaged in 
construction work. 
39m. hh--3- 
5 Diagnosis 
Treatment and Disposition 
Cm Soldiers with 
tendency to prolonged flexed 
abnormal reactions ("hysterics") 
such as those with coarse 
tremors, fits, functional 
palsies, aphonia, hysteric 
deafness etc*j usually in 
response to wishes, desires, 
or needs, frequently produced 
as a result of hospital 
treatment in the rear areas* 
(Our categories of "psycho- 
neurosis, hysteria, due to 
mild 
moderate or severe", or of 
"Constitutional psychopathic 
state with inadequate 
personality and with recourse 
to hysteric conversion 
symptoms")» 
Treatment in the Ifeur©psychiatric 
Section of a military hospital, 
_ preferably in a forward 
area and on the same ward with 
severe organically ill patients, 
by means of suggestion, hypnosis, 
or strong galvanic current* If 
treatment unsuccessful, trans- 
1 fer to the military section 
of a State Hospital for the 
Insane, preferably'in occupied 
territory or close to the borders 
in Germany* They are never to 
be transferred to a hospital 
near their home, or to be dis- 
charged as unfit for duty, until 
their symptoms have completely 
i disappeared. After relief 
from their symptoms, they should 
be tried, If necessary repeat- 
edly, in their previous assign- 
ment; if they relapse repeat- 
edly, they should be returned 
to the military section of a 
State Hospital for the Insane* 
Ill* Personalities with 
mixed psychic and physical 
anomalies* 
a* Soldiers with 
•physical constitutional 
dereots, underdevelopment * 
maldevelopment or infan- 
tllismsT concept of 
immaturity, with or without 
associated constitutional 
psychopathic traits of the 
inadequate type)* 
b* The constitution-* 
ally labile with tendency to 
functional disorders o~f~ 
specific orgarT systems 
[Vasomotor or vegeteTETve 
instability, with tendency 
to fits, disorders of con- 
sciousness, or tetanoid 
symptoms after effort, etc;) 
(Our Heurocirculatory 
Asthenia, effort syndrome, 
vasovagal syncope, etc*) 
Limited Duty* 
Treatment with Bellergal, and 
luminal as stabilizers, metrazol 
and glucose as stimulants* Then 
limited duty according to 
capabilities. 
3%9Lh.H.a Diagnosis 
Treatment and Disposition 
c* Soldiers of the 
older age groups with 
involutional, presclerotic 
or presenile symptoms, 
such as high blood pressure, 
irritability, forgetfulness, 
diminished efficiency# 
Treatment with iodine in the 
form of iodine-calcium-diure- 
tine, then limited service 
according to .capabilities* 
The transfer of psychopaths of the "malevolent" type 
to special or punishment-formations is governed bv this 
and other directives (HDv 209) (Appendix 1, No* 3)* Such 
soldiers, while still in basic training, are to be trans- 
ferred to the "Sonderabteilungen des Srsatzheeres" 
(special formations of the army in the Zone of the Interior)* 
These formation? have the character of special training 
formations for soldiers with difficulties of behavior and 
discipline* If soldiers do not respond favorably to this 
special training due to malevolence, or if such behavior 
difficulties manifest themselves in soldiers who have 
already had their basic training, they are to be trans- 
ferred to "special field battalions" ("Eeldsonderbataillone")* 
These formations have character of punishment-forma- 
tions* If soldiers transferred to them fail here also, 
they are to be transferred to a concentration camp* It 
is specifically stated that soldiers of all categories 
of fitness, with the exception of epileptics and the 
feeble-minded, can be transferred to the "special formations 
or the "special field battalions"* 
Special regulations concerning the treatment of 
patients suffering from psychoses or from neurosyphilis 
(Appendix 1, Nos* 4 and 5), prohibit shock treatments or 
malaria treatment at military hospitals, except the 
administration of a small number of metrazol shocks given 
to facilitate evacuation of patients from hospitals in 
forward areas* All definitive treatment of this type is 
to be carried out at civilian mental hospitals, after 
transfer of the patients to such institutions. The practice 
of provocation of epileptic seizures in epilepsy guspects* 
such as by means of hydration and other methods, is likewise 
ordered discontinued in military hospitals* 
A special memorandum (Appendix 1, No. 6) gives 
directives for the differential diagnosis of convulsive 
disorders, such as epilepsy, focal attacks, vasomotor 
attacks, tetanic attacks, narcoleptic -attacks, and 
psychogenic fits# 
-3s.,a.iv,+ -"• Three regulations concerning alcoholism and drug 
addiction are of interest. A special order by General von 
Brauchitsch of 31-5-40 (Appendix 1, No. 7) prohibits the 
creation of a social atmosphere which encourages or forces 
younger officers to develop the drinking habit, A second 
point he makes is of interest; while it is important that 
a superior officer insists on the subordination of an 
enlisted man even if the enlisted man is drunk, he should 
nevertheless try to avoid any direct contact with the 
intoxicated enlisted man, but should try to arrange it 
so that all the direct handling is done by other enlisted 
men. If personal action of the superior officer is 
unavoidable, it should be done as quietly and comradely 
as possible. Drunkenness should always, in principle, 
be punished by disciplinary action, A special order by 
General G3ring, of 20-3-1939 (Appendix 1, No, 8) prohibits 
the installation of bars in officers* and enlisted men’s 
clubs in the Luftwaffe, A special regulation (Appendix 1, 
No, 9) states that once a member of the armed forces has 
been courtmartialed for addiction to alcohol or narcotics, 
dismissal from the service or dishonorable discharge become 
mandatory; it is therefore directed that the medical court 
experts always recommend treatment in a State Hospital for 
the Insane, in preference'to conviction, 
law 
German concerning criminal responsibility 
is wider than ours, in that it recognizes not only states 
of presence or of absence of responsibility, but also 
states of reduction of responsibility, which call for 
reduction of punishment (Appendix 1, No. 10), The 
paragraph concerning irresponsibility (No, 51) reads; 
Cl) a punishable crime has not been committed, if the 
perpetrator, at the time of the act, and because of 
disturbance of consciousness, mental disease or mental 
defect, was unable to know the difference between right and 
wrong in specific reference to the act, or if he was unable 
to act according to such insight, (2) If the capacity to 
know the difference between right and wrong in specific 
reference to the act or the ability to act according to 
such insight, was, at the time of the act, significantly 
diminished due to the above reasons, the punishment can 
be mitigated to such an extent as to equal the punishment 
prescribed for the mere attempt of the crime committed. 
In regard to the above "paragraph' 51, section 1” it 
is specifically stated, that irresponsibility can be found 
not only in cases of mental disease or mental defect, but 
also in cases of disturbance of mentality due to 
"exceptional states", such as twilight states, pathologic 
intoxication, "senseless intoxication", "full intoxication". 
iezff-fa ~ 9~ in severe drowsiness from sleep, and in psychogenic fugues. 
However, it is ordered that even a soldier of otherwise good 
character, once he has been found irresponsible due to 
severe intoxication or due to a confusions! state incidental 
to exhaustion or overfatigue, can never be returned to his 
own outfit, but must be transferred. In cases in need of 
re-education this transfer should be to a "Sonderabteilung". 
As to section 2 of paragraph 51, it is emphasized that 
diminution of responsibility has to be significant, and that 
the corresponding reduction of punishment is not mandatory, 
but at the*discretion of the Court, While in principle 
psychopaths were not to benefit from this regulation, it 
is pointed out that certain psychopathic states do have 
the "validity of a disease” ("Krankheitswert”), especially 
psychopathies of schizoid, cyclothymic, and paranoid type, 
and the compulsive-obsessional states* It is pointed out 
that in those cases where the Court feels that the state 
of drunkenness has been produced deliberately, the excuse 
of severe or pathologic intoxication becomes invalid; and 
that the court can punish a man even if he has merely 
"carelessly" produced a state of reduced responsibility by 
drinking, with prison up to 2 years, but never in excess 
of the punishment for the crime committed during his state 
of intoxicatlon. An excuse of alcoholic impairment of / 
responsibility can never be brought in any crime 
military subordination, or for anv offense committed4v&/le 
on duty. 
Of special interest are /the re 
homosexuals* (Appendix I., Nos* 11—19}» Homosexual acts, 
ffthe^'SefMan‘Army, always constituted a crime for which 
court action was mandatory; the offenders could not be 
handled by medical or administrative disposition* Up to 
1943. the accepted procedure was for the courts to find out9 
usually with the aid of a psychiatric expert, whether the 
culprits belonged to one of the following two groups; 
(1) Those in whom homosexual inclination is deeply rooted, 
end whose drive in the direction of homosexuality is 
apparently incorrigible; (2) those who are basically 
sexually normal but who have either been seduced or who 
have deviated because of general sexual over-stimulation* 
for the cases grouped under class (1), punishment by 
prison terms was mandatory especially where the crime of 
homosexuality was combined with abuse of disciplinary 
authority. Those falling into class (2), as well as 
officers reduced to enlisted rank because of a homosexual 
offense, could be punished by prison terms within a 
military prison, but after serving the term were given 
n onnortunitv to return to the ranks with a chance to 
-redeem themselves before the enemy** The differentiation 
2SZHJL-Z of these two groups had to be made on the individual merits 
of the case and not on principle* Gases in which superiors 
abused their authority over suboi&nates had to be considered 
in a particularly serious light, and experts were especially 
warned against considering the fact that an act had been 
committed under the influence of alcohol as necessarily 
indicative of the fact that such individuals belonged to 
group (2)* This relatively lenient way of handling things, 
especially the opportunity for homosexuals to redeem them- 
selves by participation in dangerous combat missions, was 
severely criticised by higher party authorities, especially 
by the S.S* end Hitler himself, because in the 3* S, the 
death penalty was mandatory for all offenses of a homosexual 
nature* Finally, in August 1942, Hitler hiself, on the 
occasion of a request for remission of part of the sentence 
of a man condemned because of homosexuality for the 
purpose of giving him the opportunity to redeem himself 
before the enemy (group (2) type of case), expressed his 
opinion that such practice was wrong in principle, that 
homosexuality was always the result of inclination and 
that no one who had been convicted of it, even though he 
was fully intoxicated at the time of the act, should ever 
be allowed to redeem himself before the enemy, but should 
serve his full prison term and should then be dismissed 
from the army* This and preceding criticisms of the way 
the army handled the homosexual problem, led to extensive 
surveys in which the amy authorities reouested the opinion 
of legal authorities, of the Gestapo, of the criminal 
police, the Chief Consulting Psychiatrist of the army, the 
Party, the S* S* and of the S« S* Courts* The result of 
this survey of 12 August 1941 (Appendix 1, No* 12), is of 
great interest* The Ministry 01 Justice gave the opinion 
that any homosexual activity of adult persons always 
indicates a deeply rooted inclination; that such persons 
always constituted a danger for their environment, and 
that any remissions of sentence or pardons should not be 
granted except for offenders who were still in the age 
group of puberty and therefore the only ones vfoc could 
be considered rehabilitable» 
The Gestapo considered that the differentiation between 
homosexuality motivated by deeply rooted inclination and 
those who aberred or were seduced only once could be main** 
tained* Those motivated by deeply-rooted inclination 
eve to be regarded as incorrigible* Those only once 
deviated or seduced, however, could possibly be rehabilitated* 
The Gestapo, on the basis of an intimate knowledge of the 
living habits of practically the entire German population, 
estimated the number of practicing homosexual-s motivated by 
deeply rooted inclination in Germany as 4,000,000* this 
36*^4.-t. figure also included the "limediets borderline group", which 
more likely belongs to group (l) than to group (2)« (This 
is a remarkably high figure considering the male population 
of Germany numbered 44,000,000, and that about half of them 
are either too young or too old to be interested in sexual 
activity* This would make almost every fifth man in 
Germany a homosexual*) 
The criminal police advocated a differentiation 
between/ conditioned cases of homosexuality/ 
end tho%e caused by deeply a 
the problem in the following manner; those apprehended 
at the first offense were specially watched over* After 
repeated convictions or if it became knovffi that they seduced 
others, preventive police custody, usually in a concen- 
tration camp, was ordered* Thus there was an accumulation 
of homosexuals in concentration camps. Oberstabsarzt 
Professor Dr. Goring in the Reichsluftfahrtministerium was 
interested in the psychological therapeutic rehabilitation 
of such people and had reported a certain amount of succees# 
According to the criminal police, the exclusion of homo- 
sexuals from the army was not desirable. On the contrary, 
the criminal police made a practice of releasing homosexuals 
from protective custody and from concentration camps to 
the army for active combat duty. Prom a criminalistic 
point of view this was not considered a danger except in 
the- case of recidivist offenders, and of those homosexuals 
who committed offenses in a promiscuous manner with a _ 
number of different people* However, the criminal police 
took the view that if the army would start discharging 
people after they served their sentence, the Army itself 
would have to take them into protective custody since there 
was hardly enough room available in police and concentra- 
tion camps, and the army would have to consider keeping 
them in their own prisons* 
The Chief Consultant in Psychiatry to the army, took 
the view that any act of homosexuality, even in a state of 
complete intoxication, almost#always pointed with certainty 
to deeply rooted homosexual inclination. Only such acts 
as were committed during the time of puberty could be 
considered differently. An adult man of normal sexual 
inclination could not possibly deviate even in case of 
severe alcoholic intoxication. From the military 
osychologlcal point of view, the Consultant warned against 
the discharge of homosexuals from the army after expiration 
of their sentence. He stated thatln a number of irres- 
uonsible persons this would be an incentive to homosexuality 
for the purpose of being discharged from the army after a 
brief prison term. 
38 - 3L The Party took the view that any Party member who com- 
mitted acts of homosexuality, whether on the basis of deeply 
rooted inclination or not, was to be discharged from the . 
Party on principle* 
The S*S. and the S.S. courts stated that they punished 
all acts of homosexuality occurring within their jurisdiction 
by death# 
On the basis of these and other surveys, Professor 
Wuth, the Chief Neuropsychiatry Consultant to the Surgeon 
General of the Army, made two reports, one to the Surgeon 
General of the Army end the other to the Judge Advocate 
General of the German Army, The report to the Surgeon 
General (Appendix 1, No# 13), stated that there is no 
proof for the heredity of sexual abnormality, but that it 
develops usually under the influence of unfavorable sexual 
experiences on the basis of psychopathic constitution# 
Every man is originally bi-sexual, and first of all 
occupies himseTf physically with his own self# During 
puberty, the sexual drive is not understood in terms of 
a drive toward propagation, and satisfaction is obtained 
by masturbation. Also, mutual masturbation during puberty 
is still to be regarded as normal, although it is a 
dangerous game which may lead to actual sexual deviation 
in puberty# With increasing maturity, the sexual drive in 
the normal individual is directed into normal channels, but 
in sexual deviants it may he diverted into the wrong channel 
under the influences of unfavorable sexual experiences, 
because such deviants are essentially psychopathic person- 
alities with a general uncertainty of instinctual drives. 
The differentiation of those "due to inclination" and "due 
to external factors" is wrong# It should rather be 
"predominantly caused by Inclination" or "predominantly 
caused by external factors". Thus, inclination as well as 
seduction play a* coordinated role* Both should be combatted# 
As to the whole problem of inclination, it should be 
emphasized that inclination never produces an "inescapable 
fate", but can be considered only as a "threatening fate"# 
Inclination never fully abolishes the free exercise of the 
will# While the adult homosexual should not be held 
responsible for the fact that he has the inclination to 
homosexuality, he is fully responsible for the fact that 
he indulges in homosexuality. Furthermore, it is felt that 
a general sexual overexcitability is frequently mistaken 
for homosexual inclination, simply because it happened to 
fall into the homosexual pattern in that instance# The 
important thing is to realize that these people are rarely 
true homosexuals, but rather psychopaths with general 
instinctual uncertainty who also deviate in numerous other 
sazjt-u.- s. respects in the forms of dishonesty, alcoholism, suicide, 
etc* This becomes quite obvious if one looks at the 
criminal record of the homosexual* £4;? of all homosexuals 
have a record of punishment for crimes other than homo- 
sexuality* The conviction for the first homosexual offense 
usually occurs after the 30th year of life, although the 
first honosexuei act is usually committed between, the 16th 
and 21st year of life. 21 $ of all homosexuals have previous 
convictions for homosexuality, 35$ have been tried for 
homosexuality before (including convictions). 33$ of 
homosexuals Who have been convicted once are convicted 
the second time 1-3 years after the first offense. I-any 
homosexuals are actually bi-sexual, ere married, have 
children and show no physical peculiarities. All homosexual 
offenses, also those committed in a setting of general 
sexual overstimulation or during alcoholic intoxication, 
are due to actual inclination and do not occur in normals. 
People who commit such acts are always deviants in the 
general sense of the word, and are not suitable for 
positions as superiors in a military organization. 
In his report to the Judge Advocate General of the 
German Army dated 4 November 1942 (Appendix 1, No. 14), 
the Chief Consultant in Psychiatry goes over the same ground 
again, but adds that a discharge of those members of the 
army who have been punished for homosexual acts is strongly 
advised against because ’’many of these psychopaths would 
regard this as a desirable premium and it would show elements 
disinclined to military service a simple way out of the 
armytt* He reiterates the point that the practical difter* 
anti at ion between culprits who have coramitted a homosexual 
act because of deeply rooted inclination, and those who 
have been seduced, or who have deviated because of general 
sexual overstimulation, is in practice not feasible. 
They are hard to differentiate because the statements of 
these psychopathic personalities are usually not reliable 
and one cannot even know on the basis of an examination 
of the accused whether it was his first offense, unless he 
has a record of previous offenses. The only possible 
exception for a differentiation in terms of allowing some 
to redeem themselves before the enemy before expiration of 
their sentence could be made in the case of those who are 
definitely established as victims of seduction by others. 
As to the proposition now under consideration by the Judge 
Advocate of the Army, namely, whether the death 
for homosexual offenses should be instituted in the ,i.riny, 
it is suggested that it should definitely be restricted 
to those who seduced others, especially young soldiers, 
and to those who abased their position of authority 
toward subordinates. But the Chief Psychiatric Consultant 
adds, that the deterrent effect of the death penalty in such 
- *- cases should not be overestimated: ”Indeed, a deterrent 
effect could only then be exerted if the sentences as well 
as the executions were publicly announced# But whether 
this would be wise in view of enemy propaganda is a problem 
which should be given ample consideration”• There is, of 
course# no objection against the death penalty for homo- 
sexuality in Elite formations, such as the SS, because these 
are voluntary organizations whose members know about these 
rules before they are enrolled. But with the Army, which is 
a peopled army involving obligatory service, things are 
different# 
As to the figures given by the Gestapo, the Chief 
Consultant in Psychiatry considered 4,000,000 too high 
an estimate* He felt that the number of 2,000,000 which 
resulted from a special survey instituted by the S* S* 
newspaper, "Schwarz© Corps” (The Black Guard), is likely 
to be closer to the truth* The Chief Consultant goes on 
to sayj ”It cannot be assumed that the German people are 
on the way of a shift into homosexual inclination* The 
inbrease of the number of homosexual offenses is due to the 
fact that since 1935, not only acts similar to intercourse, 
but also mutual masturbation are considered punishable, 
and furthermore because we are now reaping the effects of 
systematic poisoning of our youth by the "Wandervogel" and 
other youth organizations, because those infected youngsters 
have now grown up into positions of leadership”* (This is 
a remarkably frank statement, considering the fact that 
it was made almost ten years after the Nazis had gained 
power in Germany, which gave them complete control of youth 
organizations, and of which they had already controlled 
large sections long before their actual accession to power)* 
The Chief Consultant made the following practical suggestions; 
(l) Prevention: The sexual need of all ranks should 
ha relieved by, (a) furloughs* and (b) by the institution 
of brothels* It is stressed that an ostrich policy is 
completely out of place in this matter# 
(B) Punishment; Every case should be cleared in all 
its asp©cks . including psychiatric examination* Punishment 
should not be in military prisons, but in such field 
punishment battalions as are in dose contact with the 
enemy* All people convicted of homosexuality, even those 
who committed the crime in complete intoxication and as 
their first offense, must be declared permanently unsuitable 
for holding any commissioned or non-commissioned rank, 
even if they have fought well before the enemy* The only 
exception could be made with seduced Juveniles at their 
first offense* 
(3) Determent; In the case of flagrant seducers of 
ieZM-H-- z~ youngsters there should he no objection to the death penalty* 
Insufficient consideration has been given to the penalty of 
castration, which at the same time is likely to be of benefit 
therapeutically in 70 - $0$ of the cases, since it leads to 
reduction of criminal and sexual ambition* The contemplated 
measure to dismiss people convicted.of homosexuality from 
the army after expiration of their sentence is.strongly 
advised against, A visible physical branding of recidivists 
should be considered. 
The final regulation which emerged from the Chief 
Commanding General of the Army and the rtthrerhauptquartier 
dated 19 May 1943, and supplements of 8*6*43 end 7*8*43 
(Appendix 1, Nos* 15-17), distinguishes three groups of 
culprits• 
(a) those who have committed the act because of deeply 
rooted inclination or because of apparently incorrigible 
drive: 
(b) those who deviated only once, ©specially under the 
influence of seduction, and 
(c) borderline cases in which deeply rooted inclination 
is doubtful* 
Those in group (a) must be punished by long penitentiary 
terms in civilian prisons ("Zuchthaus*)# In severe cases, 
the death penalty is authorized* All those convicted in 
this group are to be dismissed dishonorably from military 
service. Those in group (b) are to be sentenced to terms 
in military prisons and may be given a chance to redeem 
themselves before the enemy, either after serving all or 
part of their sentence* It is specially stressed that the 
mere fact that the man was intoxicated at the time of the 
crime does not automatically place him into this group* 
Those in group (c) are to be given sentences in military 
prison camps at the front, and may be released to field 
punishment battalions under conditions of close supervision# 
If they are found militarily useless, they should be turned 
over to the civilian authorities for completion of their 
■orison term* In the case of relapse, they should be treated 
like those in group (a)* This regulation, which is signed 
by General Keitel, stresses that if a man had been left in 
the army against the regulations as applying to group (a)4 
and this is discovered later* he is to be dismissed even 
if in the interim he had fought well as a soldier* An 
exception can be made only if such a soldier has performed 
extrpmely well for very long periods after his offense* 
The supplement (Appendix 1, No. 17] re-emphasizes that all 
soldiers punished for homosexual offenses and who fall into 
group (aT, have to be dishonorably dismissed from the army. 
These regulations were further supplemented by a new 
2. law concerning all sexual offenses dated 4 July 1943 (Appen- 
dix 1, No* 18), which as an additional deterrent measure 
authorizes the courts to sentence all culprits found guilty 
of abnormal sexual acts, to punitive castration# Abnormal 
sexual acts include; rape, rape of children, 
all injuries committed for the purpose of sexual gratifi- 
cation, all torture of animals for sexual purposes end all 
sexual acts committed in public# Castration can also be 
ordered in those cases in this group who have been found 
legally insane. However, it is stated that castration 
should not be ordered in culpirits under 81 years of age 
aVthe time of the offense# 
/ A regulation dated 15/18/1944 gives/directives^oncelling 
the principles of expert testimony in casis *6f' c'rlmes "agSTtrst 
&UU nature |( Appendix 1, No, 19),~?Eich~w§TO deartved from 
COflfeFeTO&B of the Consulting Psychiatrists of the army, 
of the S*S., and of other consulting legal and medical 
authorities. It is emphasized that a decision whether a 
deeply rooted inclination pHang") exists should be made 
on the basis of the concrete facts of the accused’s life 
history and personality, Ymd not on the basis of an expert’s 
opinion, who on general medical or scientific grounds 
considers it a matter of inborn constitution ot acquired 
sexual peculiarity# The term, •inclination" should be 
interpreted in the criminalistic sense as to whether the 
accused is a personality of the type of'the habitual 
offender, rather than on the basis of biologic consideration. 
As a matter of fact, the Commission goes so far as to 
recommend that the question of whether deeply rooted inclina- 
tion existed should never be put to the medical expert, 
because it is not a medical but a oriminologie category. 
If expert testimony is needed, a special expert from the 
criminal police, the man in charge of its central office 
for combatting homosexuality, is the one to be consulted, 
and not a medical man or a psychiatrist# The term •in- 
clination" should be understood in terms of incorrigibility, 
and this can be the case in the rare individuals Who are 
born homosexuals, as well as in individuals who had been 
seduced in early youth and who then made a habit of 
homosexual practice. The important point is stressed 
that there is no medical or other scientific reason-why 
the crime of homosexuality should in principle be treated 
differently from other crimes, and that the sole medical 
reasons for lack of criminal responsibility should be the 
same ones which apply to other kinds of crime as well, such 
as insanity, organic cerebral disease, diseases of the 
endocrine glands, including actual diseases of the 
testicles, the hypophysis or the thyroid. It is recommen- 
ded, however, that expert psychiatric testimony should 
also be considered in those cases in which offenses 
58 occurred only under the influence of alcohol, or when the 
offense was committed in a state of extreme drowsiness 
from sleep, or when the culprit was under the age of 21* 
In army courts, a medical officer trained in neuropsy- 
chiatry should always be attached to the court* 
A number of interesting points concerning other 
subjects are contained in a collection of directives 
published on 30 September 1944 (Appendix 1, No. 20)* 
First of all it is decreed that the duty of submission 
to treatment does not apply to those patients suffering 
from mental diseases, whose full military usefulness is 
not likely to be restored by therapeutic measures* 
For such patients treatment is optional, except for 
sedation,*as well as a small number of emergency metrazol 
treatments, in states of excitement in forward areas* 
Another exception are those cases of organic psychoses 
that are likely to be restored to duty, and therefore 
have to submit to any treatment likely to lead to res- 
toration to duty (Item 209). Item 225, in the same 
publication, stresses the importance of psychogenic 
overlays in cases of rheumatism and neuritis, which is 
said to be less frequent in cases of polyarthritis than 
in sciatic and other chronic neuritides* Psychological 
guidance by the physicians of rheumatism sections of 
hospitals is considered essential* Sever© and therapy 
resistant cases should be transferred for "suggestion 
treatment" to special neurological treatment sections* 
Item 832 of the same set of regulations leys down 
the terminology for psychogenic functional disorders. 
The terms "neurosis", "war neurosis", "war hysteria", 
are no longer to be used* They are to be replaced by 
the term "psychogenic functional disorder", with the 
addition of the kind of disorder, such as "psychogenic 
speech disorder", "psychogenic g§dt disorder", or 
"psychologically fixed radial palsy" respectively* 
These diagnostic terms should not be all, but should be 
supnlemented by a description of the personality of the 
patient end of the development of the disturbance. 
A memorandum concerning sciatica (Appendix 1, No. 21), 
gives directives for the diagnosis and differential 
diagnosis of sciatic neuritis. A special memorandum on 
cauialgie, dated 27 April 1942, Is of interest. It gives 
« verv good description of the condition and. strongly 
recommends sympathetic gangllonectomy or sympathectomy, 
hy alcohol injection, or by surgical extirpation of the 
stellate ganglion or of the lumbar sympathetic trunk 
respectively. This is highly recommended as the best and 
most effective therapy. Other memoranda Uppendix 1, iMos, 23, 24, and 25) concern the treatment of Bell’s palsy, the 
handling, or gunshot wounds of the peripheral nerves, and 
the specie] care of patients with peripheral nerve palsies* 
A memorandum dated 7 July 1941, (Appendix 1, No. 26J gives 
a good presentation of the reasons why the question as 
to whether cases of multiple sclerosis developed or were 
aggravated during military service should be answered in 
the affirmative*. 
Of special interest is a complete set of collective 
reports (Appendix 1, Nos. 27-36), issued by the Office 
of the Chief Consultant in Psychiatry in the Surgeon 
General’s Department, compiled on the basis o-f* quarterly 
reports sent to him from the various neuropsychiatrists 
in the field with army units as well as with hospitals* 
Study of these reports (the first was issued on 24 July 
1942, the tenth m December 1944) permits one to obtain 
a very good historical survey of the neuropsychiatric 
activities and developments in the German army during that 
important phase of the war beginning before the turn 
of the tide at,El Alaznein and in North Africa, and ending 
at a time when, on the Eastern Front at least, the German 
army was basically beaten. 
The first of these collective reports dated 24 July 
1942 (Appendix 1 No* 27), contains data under a number of 
headings beginning with general matters* It is stated 
that in the North African theater, combat soldiers of 
mixed atlletic-pyknic physical type, especially those 
between 25 and 35 years of age, proved best suited in 
terms of stability and stamina. Another item is the 
recommendation of the institution of warming and rest halls 
along roads at intervals of ©very 300 kilometers. Gases 
of glycol intoxication sustained from contaminated coffee 
are reported, as well as 22 cases of tetra-ethyl lead 
intoxication with Kbrsakow-like and delirious psychoses 
sustained from inhalation of fumes from a wood stain, 
also cases of confusional psychoses after evipan 
anaesthesia* It is furthermore stressed that too many 
neuropsychiatric cases are distributed all over the 
medical sections of field hospitals, instead of being 
concentrated in neuropsychiatric sections. Also improve- 
ment of facilities for spinal fluid diagnosis are urged* 
The neuropsychiatric center in Berlin is reported as being 
overloaded with excessively large groups of unannounced 
entrants from forward areas, and its director (Dr. de 
Crinis), also complains that it is overloaded with 
patients who should never have been inducted into the Army, 
but who should have been recognized as unsuitable for 
military service when they were examined for induction.. Furthermore* it is objected that epileptics are being kept 
in military hospitals too long* sometimes for months* in 
order to wait for an attack. Diagnosis of epilepsy can be 
made on the basis of documented history and associated 
personality changes without such unnecessary delay. 
The special section of this report points out in 
reference to brain injuries that too many cases with 
vasomotor disturbances or Parkinsonian pictures after 
cranio-cerebral trauma are being mistaken for neuropathy; 
that 25/o of gunshot wounds of the brain show aphasia; 
that hypertonic glucose should be given intravenously 
while lumbar punctures are being performed; that 
psychological disturbances are frequent in lesions of the 
temporal lobe; and the warning is issued against too 
frequent transfers of patients with organic brain lesions 
from one hospital to another. 
An interesting chapter deals with the neuropsychiatric 
complications of typhus. The following occur: mental 
cloudiness., delirium* confusion* self-inflicted injuries* 
aggressive outbursts against others* frontal ataxia* mashed 
facies* deafness* pyramidal signs* epileptic fits* all 
kinds of focal syndromes of the hemispheres* and catatonic 
states. Of special interest was the observation of 
recrudescence of symptoms of old* apparently healed 
diseases of the central nervous system under the influence 
of typhus fever. It is urged that experimental treatment 
aimed at the prevention of these cerebral complications 
be carried out in prisoner of war camps. The following 
are recommended: prescjod (10 cc daily intravenously); 
Argotropin* Argochrom* Urotropin and Trypaflavin ( 
intravenously); prostigmin against muscular weakness; 
and serum from convalescents in the early stages of the 
disease. It is further stated that in typhus occipital 
puncture is preferable to lumbar* because of the 
associated edema of the brain. 
In regard to other problems* the special section states 
that cases of true epidemic encephalitis lethargica have 
been observed; further* that meningococcus meningitis 
has become relatively frequent and that sulfonamides give 
good results in this condition* but that it should be 
differentiated from the meningitis incidental to Pappafcaci 
fever and trichinosis. Of the latter condition* 1 20 cases 
have been observed. There have been sporadic cases of 
poliomyelitis. In regard to lesions of the peripheral 
nervous system* the report stresses the importance of 
rehabilitation centers for patients with peripheral nerve 
palsies. It is further stressed that gunshot wounds of the 
-3. peripheral nerves, after healing of the primary wound, should 
not be re operated on for purposes of nerve repair before 
four months have elapsed because otherwise normal tendency 
to healing would be interfered with- The frequency of 
post-diphtheric paralyses is emphasized and overlooking of 
the associated paralysis of accommodation is warned against. 
As to treatment of causalgia, this report states that 
opinions as to the best treatment are divided; the different 
treatments with high doses of vitamin 3, insulin and 
vaocineurin, periarterial sympathectomy, and with alcohol 
injection or extirpation of the stellate ganglion are all 
recommended. It is stressed that the number of near!tides 
end polyneurit ides has increased greatly during the last 
winter, most of them being post-diphtheritic, especially 
due to wound diphtheria. In addition, there were numerous 
cases of polyneuritis caused by dysentery,. atabrin treatment, 
and treatment of gonorrhoea with sulfonamides* Furthermore, 
there were polyneurit ides during the winter campaign in 
Russia, due to marked emaciation caused by the hardships 
of the campaign, and poor nutrition. There were also 
polyneuritides in pappataci fever* Of the psychoses, those 
occurring in typhus and dysentery were emphasized. 
It is stated that depressions, especially reactive 
ones, and especially those with hypochondriac complaints, 
were too often mistaken for other illnesses and were not 
seen often enough in consultation by the psychiatrists* 
■The neuroses and psychopathies are reported under the 
heading of reactions” ("Abartige Reaktionen”) . 
Bumke is quofeT^r*3 view of the deep scooping 
out of the armed strength, the number of psychopaths is 
increasing”. Sioli, another consultant, is quoted as 
saying; ”used-upness in older officers in the age group 
of 40 - 49 years, is leading to frictions which interfere 
with the performance of duty”* Gross hysterical disturbances 
ere described as rare* It is stressed that the differential 
t*ea diagnosis between schizophrenia and psychogenic 
reactions to catastrophic events can be difficult. 
The second report was issued in February 1943 
(Appendix 1, No. 28). As to brain injuries, the operative 
removal of traumatized brain is urged even in those cases 
in which the dura was not injured,'"although an exceptional 
case may become infected and die from purulent encephalitis* 
It is stated that in the beginning of illness from 
meningitis the patients become delirious and excited, while 
at the stage where the infection progresses through the 
brain toward the ventricle, psychomotor inhibition or 
stupor manifest themselves. The use of pneumoencephalo- 
graphy in the localization of brain abscesses is urged* 
It is stated that cerebral damage after wounds involving the carotid artery occurs, after ligation of the carotid, 
due to thrombosis and embolism# In the chapter on ence- 
phalitis, the occurrence of encephalitis japonica in 
Gemany is reportsd# The disease begins with pseudone-urasth- 
enic weakness, including tremors, difficulty in concentra- 
tion and emotional lability; sometimes epileptiform attacks 
occur* The spinal fluid may show only positive cell changes, 
without other characteristic changes* Cases of encephalitis 
due to pappataci fever are also reported, with increase of 
cells (15 - 227), and with increased sugar of about 151 
mg$, but without increase of protein* This report also 
includes a detailed discussion of several groups of 
altogether 75 cases of polyneuritis, or rather polyradiculo- 
neuritis, including some'with ascending paralysis of the 
Landry type, which occurred in the form of small local 
epidemics# The differential diagnosis, .especially 
differences in the spinal fluid findings, from the 
Guillain-Barre syndrome, of which several cases have likewise 
been observed,* are elaborated upon# In reference to other 
lesions of the peripheral nerves, the opinion is recorded 
that some .of the peculiar contractures with sympathetic 
disturbances are not psychogenic but possibly represent 
a motor counterpart to sensory causalgia. They are 
considered-"sympathogenic", because they respond well to 
extirpation of the ganglion stellatum, like the cases of 
causalgia of the sensory type* Excellent results with 
rehabilitation programs following peripheral nerve lesions, 
obtained in military hospital in Vienna are reported* 
As to the iieural manifestation of typhus, this report adds 
the observation of spinal symptoms, including paralysis of 
the bladder* It is stressed that as late as three months 
after recovery.from the disease, patients convalescing 
from typhus may show an increased irritability leading to 
conflicts with their environment, such as was found in a series 
of 120 cases# This should be given due consideration when 
living medico-legal expert testimony in such cases* Further- 
more, it is stated that even some of the post-diphtheric 
paralyses may show a tendency to ascend in the characteristic 
manner of the Landry tyjpe of paralysis* The good therapeutic 
results in treating causalgia with sympathectomy are 
emphasized, although other authors report favorable results 
with insulin (Mauz)# A special chapter deals with the 
condition described by the Germans as wHussian headache 
fe verwwhich is a brief illness of 2 — 6 days duration, 
beginning with pain in the occiput and over the eyes; later 
full fledged meningism, with slight increase of spinal fluid 
pressure but insignificant changes of protein and cells 
develop# The good prognosis of these patients is stressed 
and their treatment within the troop unit without admission 
to a hospital is recommended# 
SVf.U.h. -i~ In regard to epilepsy, it is stated that a great number 
of patients referred as epileptics to hospitals from, troop 
units are not cases of epilepsy, but other types of seizures 
which occur in vasolabile people under the influence of 
prolonged fatigue, hunger, exhaustion, ingestion of alcohol 
after long periods of abstinence, psychological stress, and 
so forth« As to the psychoses, it is emphasized that the 
diagnosis of schizophrenia is being made too often, as 
illustrated in a group of 8 soldiers evacuated to the rear 
for schizophrenia, of *hom 7 turned out to be suffering 
from psychogenic reactive confusion states. On the other 
hand, it is stated that the diagnosis of cyclothymic illness 
is not being made often enough; because while medical reports 
of cases of this diagnostic category are rare, the inspection 
of court cases and the. reports of suicides stress the fact 
that the condition is probably more frequent than assumed, 
but remains unrecognized clinically# As to mental deficiency, 
it is stated that among deserters the number of mental 
defectives is very high. It is stressed that mental defectives 
usually fail under field conditions even though they may 
have performed well under training conditions, and that 
mental defectives should either be assigned for labor duty 
only, or be discharged from the service* 
As to the '"deviant reactions", it is reported that a 
disproportionately high number of.hysteric disturbances 
occur in Hungarian soldiers and officers, particularly 
psychogenic disturbances of the gait, palsies, and loss 
of speech, hearing and vision. However, it is added that 
a significant spread of disturbing war neurosis had not 
occu2»d among German troops. Sioli stresses the importance 
of early treatment of states of psychological failure, 
psychopathic reactions and hysteric reactions. This 
section of the report goes on to say that there has been 
only a slight increase of psychogenic disturbances, which 
necessitated the creation of a new department in the form of 
a military section attached to the neuropsychiatric clinic 
of the university of Munich Medical School, so that the 
Consultant in Psychiatry could exert a continuous influence 
upon the war tremblers. Up to now, it is stated one was 
able to cone with them effectively during this war. 
In addition, this report mentions three fatal cases 
of arsphenamine encephalitis. It warns against the indis- 
criminate dusting of sulfonamide powder into cerebral 
wounds, as paralysis has occurred due to penetration of 
such sulfonamide powders into the spinal canal. An unusual 
case of acute porphyrinuria with epileptic convulsions is 
also reported* 
The third report was issued in March 1943 (Appendix 1, 
No. 29). It stresses that in medical examinations preceding 
58 2-/U+-- Z induction into the military service too many.cases of 
schizophrenia, mental deficiency and’ epilepsy fail to be 
recognized, and that individuals thought to be afflicted 
with mental deficiency, epilepsy or neuresthenia, should 
not be accepted into the military service without checking 
information collected by the local police# 
As to lesions of the brain, it is stressed that 
psychologists in examining them tend too much to go their 
own ways, to collect too much useless material, and to 
perform too many useless tests which interfere with the 
morale of the brain injured patients.. It is further' 
stated that contusions with definite focal symptoms are 
too frequently mistaken for simple concussions# It is 
again stressed that personality changes may be an early 
symptom of organic disease of the brain, including 
brain tumors. 
An interesting chapter on encephalitis deals with 
differential diagnosis* The encephalitic symptoms of 
typhus" are described as similar to encephalitis lethar- 
gies, including the late symptoms such as masked facies, 
eye muscle palsies, etc# So-called "late summer ence- 
phalitis" was identified as encephalitis japonica. 
An interesting case of encephalitis japonic© is reported 
in detail* There was high.fever'(40.6°G), and marked 
choreo-athetotic Jjyperkinesis • the spinal fluid showad 
marked increase of cells (262) and increase in protein. 
This case responded well to sulfanilamide (Eubasin). 
It is again stressed that too many patients with post-*’ 
encephalitic and other extrapyramidal syndromes are 
mistaken for "war tremblers". The case of a post- 
encephalitic was quoted who ..was inducted in 193 9 in 
spite of a full-blown syndrome of post-encephalitic 
tremor, but who whs used as drummer in the regimental 
band because of this infirmity# It was not until July 
1942 that’he was returned to the Zone of the Interior in 
Germany because of "brain weakness", and it took until 
November for the correct diagnosis of his condition to 
be established. 
In regard to polyneuritides, it is again stressed that 
the diagnosis of polyneuritis can be 
made from the history of palsy of the velum palatinum 
in the early stage of the disease# ■ Interesting is the 
description of polyneuritic residuals in cases of 
poliomyelitis anterior. In addition to the polyneuritides 
following dysentery and other known illnesses and toxic 
states, the number of polyneuritides of unexplained etiology 
is' described as great; and' too many Mare diagnosed as 
malingerers or gold-bricks in the early stages of their illness* A case Is quoted in which a so tie what immature 
soldier suffering from an undiagnosed polyneuritis 
caused by dysentery of the Flexner type of several 
months* duration, finally committed a self-inflicted 
Injury by shooting himself through- one hand "in order to 
get to a hospital". The diagnostic importance of spinal 
fluid examinations in this and similar conditions is 
stressed* A case of polyneuritis was also observed in 
a soldier who handled Russian diesel oil which contained 
an admixture of a yet undetermined nature« It is further 
stated that peripheral nerve injuries were frequent in gun- 
shot wounds of the extremities. * They were present in 7 
out of 25 cases. Neurological disturbances"of Parkin- 
sonian type are described as frequent following typhus, 
and typhus patients who show such symptoms during con- 
valescence are particularly intolerant to alcohol* In 
regard to convulsive disorders, it is stressed that 
genuine epilepsy should be distinguished from vasomotor 
fainting spells, tetanoid attacks and symptomatic 
epilepsy. Furthermore, it is stressed that harmless 
attacks of fainting following severe effort are not 
infrequently utilized later in a purposeful manner* It 
is stated that epileptics usually are very eager to stay 
in combat and in the army, and that such eagerness is 
usually a symptom in favor of epilepsy. Abstinence 
from alcoholic beverages is urged in all cases of 
epilepsy, as exemplified in the case of a 52-year old 
officer whose doctor ordered cognac for the control of 
his epileptic fits, which were due to "late epilepsy" 
on an arteriosclerotic basis, with distinctly adverse 
results* In regard to the psychoses, the differential 
diagnosis between schizophrenia and exogenous psychoses 
of the amentia type is discussed and medical officers are 
reminded that even meningitis may begin with delirium. 
Furthermore, it is stressed that not enough medical officers 
consldor the likelihood of an in 
patients who complain of indefinite malaise, sleeplessness, 
anxious tension, and loss of energy and courage, and that 
this resulted in several cases of suicide due'to a 
combination of the following factors; (1) the regimental 
surgeon did not think of the nosstbility..of a depression, 
(E) the regimental surgeon did not take a history from 
the members of the patient’s outfit, and (3) members of 
the patient’s outfit didnot transmit their observations 
to tfi-e regimental surgeon. 
As to the "deviant reactions", thQ report stresses that 
too many soldiers suffering from organic illnesses are 
being suspected of mellnering or aggravation; and that 
electro-shock treatment should not'be considered in 
psychogenic stupors, because It does not leave a memory 
record T A special small chapter is devoted to pellagra of 
which several cases had occurred in severely emaciated 
soldiers after long periods of diarrhoea- A note on 
tetanus states that cases have been observed in soldiers 
in spite of previous inoculations against tetanus* 
The Iburth report was issued, in July 1943 (Appendix 
1, No. 30). It is stressed that the new regulations 
concerning military fitness do not apply to the i 
psychopaths. They" retnairTa purely educational, d iset* / 
legal problem, unless they deviate to such" 
a severe degree that they must he considered legally 
insane. Psychopaths are defined as people of normal 
physical fitness hut with defects of character (the 
criminal, the malevolent, the anti-social, the homo- 
sexual, etc)* 
In regard to neurological matters, it is urged that 
patients suffering from multiple sclerosis be discharged 
from military service. In regard to causalgia, the 
excellent andximmediate therapeutic results of sympathec- 
tomy or ganglfonectomy are emphasized* However, care in 
theproner differential diagnosis of the causalgic syn- 
drome is urged, particularly its differentiation from 
traumatic neurltides, among others those caused by- 
missiles pressing upon a nerve. The latter, for instance, 
are benefitted by removal of the missile, but not by 
sympathectomy or ganglion©ctomy* The also contains 
a statement concerning a rather curious electro-thera- 
peutlc device built by an engineer in Vienna, and 
reported bv a Dr. Fuchs, which is constructed on the 
nrinclpie of transforming action currents from healthy 
muscles into currents which stimulate adjacent paralyzed 
but faradically excitable muscle* 
As to injuries of the hrain, the use of encephalo- 
graphy was emphasized, especially for the detection of 
indirect lesions of the brain caused by gunshot wounds 
of the face without direct injury of the skull capsule* 
It is further stated that personality changes caused 
bv brain injuries are too often mistaken for psychogenic 
or constitutional ones* Brain trauma can create a 
transitory state of release from inhibit tons, especially 
after injury of the frontal looes, and a person^thus 
injured can deviate toward, the asocial and criminal 
side. A special case is reported in which a man vtoo, 
after a* t*3r>ugh-and-through gunshot wound of the head, 
d°ve3 oped a ouadrantiQ hemianopia as the only neurological 
symptom, in addition to a paranoid personality change. 
Two cases of cerebral vascular accidents in young people 
are described. Among, the residuals of spinal injuries, 
especially blunt ones, development of arachnitis fibrosa 
S'KS.W'*' cyst ice some distance from, the original injury is 
described as a point to remember * 
As to the psychogenic disturbances”, it is stressed 
that if possible "war tremblers” should-.be treated on 
mixed psychiatric-neurological wards« In view of cases 
of suicide which occurred, physicians in charge of 
venereal sections are urged to send soldiers, especially 
married ones who express the fear that they may be infec- 
ted with venereal disease, to a psychiatrist for consul- 
tation* As to epilepsy, it is stated that special 
attention should be paid to the proper diagnostic differ- 
entiation of cases of genuine epilepsy from cases of 
the Jacksonian type and other conditions v&ich are 
different from epilepsy* The proneness to fits seems to 
be quite generally increased due to the influences of 
war* Often, however, these fits are not epileptic but 
are veso-vagal attacks in patients with an otherwise 
normal cardiovascular system, but with signs of increased 
vasolability and increased nervous reactivity* 
In regard to the psychoses, it is stressed that 
too many patients are still being diagnosed as cases of 
schizophrenia who in reality are suffering from functional 
disorders, psychogenic reactions, homesickness reactions, 
exhaustion stated or other episodic states of excitation, 
in some cases even exogenous psychoses, especially typhus, 
which feeoquently produces catatonic-hyperkinetic states* 
A special"chapter of this report reprints, and urges 
the compliance with, the "regulations concerning hysteria 
and malingering with special re-fere nee to psychogenic 
overlays in cases of organic injuries”, which were issued 
as supplements to the directive of 31 August 1942 (H.Dv* 
209/ —2, Sheet 126« See ivppennxx 1, Po* 2} * Thus supple- 
ment is essentially a re-emphasis of the points made 
there* A very interesting chapter in the report deals 
with the differential diagnosis between poliomyelitis, 
virus raeningitides, epidemic encephalitis, the panence- 
phalitides (including typhus encephalitis and the endemic 
periencephalitis which is probably encephalitis japonica), 
the demyelinizing encephaiomyslitides, mononeuritis, 
piexusnearit is and polyneuritis* This discussion of 
differential diagnosis also includes directives for treat- 
ment of these various conditions. For the post-diphtheric 
palsies, treatment with malaria is described as useful* 
The fifth report was issued September 1943 (Appendix 
1, No* 31)• The first general chapter deals with several 
interesting points. The veterans administration complained 
that the question of contributory action of exogenous 
5«**- *--2. influences incidental to war service upon the development 
of neurologic and psychiatric conditions was being neglected, 
end was being denied in dogmatic form# This complaint went 
on to state that the manner in which everything was being 
attributed to constitution, and the role of all exogenous 
influences was being periled purely on principle did 
violent injustice to the facts* Furthermore, the veterans* 
administration suspected that this was not being done on the 
merits of individual c&ses, but due t© fear on the part of 
the neuropsychiatrists to set a precedent* In regard to 
this complaint, the Chief Neuro-Psychiatric Consultant urged 
that neur©psychiatric medical officers should consider 
every case on its own merits* 
The chapter on medico-legal matters stated that lack 
of criminal responsibility was being found too often and 
"too generously" by court experts* In one case, intense 
homesickness was found to have produced a state of inability 
to distinguish between right and wrong in reference to an 
act of absence without leave# "It is emphasized again that 
it is not the purpose of the law to protect psychopaths, 
but to protect the community from psychopaths#" On the 
other hand, it is urged to avoid the expression of 
"malingering" because "there is nor such thing according 
to military law", and besides, in three out of five cases 
of "malingering!? the complaints were on review found to 
have been due to organic disease in three, and due to 
genuine neurotic fixation in the other two. One of the or- 
ganic cases even showed a marked increase of sedimen- 
tation rate; it is pointed out that the least that could oe 
expected of medical officers before they use the word 
"malingerer" would be to conduct a careful clinical 
examination* 
This report contains an instructive review of spinal 
fluid diagnosis by Zucker* In the chapter on brain 
injuries, a case is reported in which a pistol ball that 
entered the right frontal lobe migrated into the right 
temporal lobe.outside the ventricular system without 
causing an abscess* Furthermore, two casesof injury 
of the central nervous system due to lightning are 
reported by t. Baeyer. One of them showed bilateral Babinski, 
clouding of consciousness, and ample blood in the sP^nf-l 
fluid* It is further stressed that gunshot wounds of the 
back, even if they leave the spin© untouched, can cause 
a suberachnoid haemorrhage due to a peculiar remote effect* 
Lumbar puncture is urged in those cases, especially as 
diagnostic measure, because too many of the spinal symptoms 
complained of by these patients are mistaken for functional 
ones, unless the cases are properly examined# An interest. ing case of post-diphtheric polyneuritis with involvement of 
the temporal and masseter muscles with resulting inability 
to chew, caused by bilateral involvement of the third branch 
of the trigeminal nerve, is described* The patient gave 
a typical history of paralysis of the velum palatinum 
end accommodation at the beginning of his illness• the 
protein content of the spinal fluid was elevated* It is 
stressed that in such cases elevation of protein in the 
spinal fluid may persist for 3-4 months, and that for this 
and other reasons patients should be on limited duty for at 
least 3-4 months after recovery from post-diphtheric palsy# 
The report contains a description of a rare and interesting 
case of true blast injury* Several hours after an explosion 
in close proximity this patient developed hiccoughs and tic- 
like movements of the head toward the left, at the same time 
elevation of temperature to 39°C and deep cloudiness of 
consciousness# All these symptoms disappeared on the next 
day but and fatigue remained* Injury of the 
brain stem causing an ephemeral ©ncephalitis-lik© picture 
was considered* 
The chapter on neuropsychiatric residuals following 
typhus lists and describes marked and prolonged pseudo- 
neurasthenic states, neuritides, sometimes with marked 
trophic changes suggesting malum perforans, optic neuritides, 
vascular cerebral focal lesions with hemiplegias and 
aphasias, and with enormous dilatation of the ventricles of 
the brain, paranoid and schizophreniform states and 
narcolepsy-like syndromes# It is urged that convalescents 
from typhus be placed only on very light duty and not be 
sent through strenuous rehabilitation programs# Instead, 
clerical work tor typhus convalescents is recommended# 
Cases of lymphocytic meningitis which start as status 
epilepticus, as well as neuritides are described in cases 
of African relapsing fever* Neuritides are likewise des- 
cribed in Wolhynian fever* 
As to psychogenic disturbances, the psychogenic 
fixation of physical symptoms, for instance, wrist drop 
after radial palsy, is stressed and the fact that treatment 
is too often delayed id such cases is emphasized. BClrger- 
Prinz reported the results of insulin shock treatment in 
psychogenic disturbances. He claimed to have obtained 
good results and made the interesting observation that the 
severe therapy-resistent cases which he selected for the 
treatment behaved in many respects like schizophrenias, 
especially in regard to their marked tolerance to insulin# 
In one remarkable case of hysteric palsy 350 units were 
necessary to produce coma, in other cases 250 units. The sixth report wa_s Issued in March 3 944 (Append?x 1, 
No. 32). It states that f p," f s T1I " A tor 
are not eligible for induction Into the array, 
but that*affl6 se who were inducted before this new regulation 
should not be discharged from the array. Furthermore* the 
importance of careful physical examinations and .laboratory 
studies in medico-legal cases was stressed. On the other 
hand, experts were urged in cases of doubt not to find that 
the condition of paragraph 51, Sections (diminution of 
criminal responsibility) exists, but rather to content 
themselves with a psychiatric-psychological description of 
the accused in order to make it possible for the court to 
appreciate the accusedTs psychological motivations, rather 
than to take too active a*hand in judicial matters. Further- 
more, the statement is made that a number of cases of 
psychic disturbances during the incubation period of 
typhus have become known and that this fact should be taken 
into account when typhus patients who committed crimes during 
the incubation period are under medico-legal consideration. 
The report also"contains an interesting review of self- 
mutilation, on the basis of a study of 25 cases by von 
Baeyer. Cf the conclusions, the following are of interest; 
(l) Self-mutilations are committed by predominantly young 
enlisted men from rural districts and occupations. Only 
a small minority have a previous criminal record* 
(2} All self-mutilations were by small arms fire# 
(3) All culprits were either in a combat area, near 
combat area, or on the way 9 combat they committed 
the crime during a lull in combat. Particularly predisposed 
were people who recently returned to a combat zone after 
long neriods in military hospitals in the rear. 
(4) All these culprits had slight abnormal traits in the 
sense of low intelligence and slight psychopathic deviation, 
of an anxious, soft end infantile type, but me need abnormal 
reactions such as real acute emotional disturbances, 
psychotic statesypT psychogenic fugue states were found 
only rarely. A . , 
(5) 'The decisive motive is usually fear for the soldier’s 
own life* More rarely the desire to escape from the 
efforts and difficulties of front life are contributory, as 
well as disagreements with comrades or superiors, disa- 
ppointed desire for recognition, or homesickness. Yon 
Baeyer makes the following interesting observation• mosc 
of the neopls who committed the crime of self-inflicted 
inlurv did not count with the fact that it was possible 
to''discover the self-inflicted nature of the injury without 
such observation having been made by eye-witnesses, end 
thev stated they would not have done it had they known it 
could be found out, in spite of the feet that there were 
no eye-witnesses to the act. Dr. Yon Bayer raenes .he interesting recommendation to present self-inflicted injuries 
by a program of instruction for soldiers, especially those 
returning to the front ffom long periods of leave or 
hospitalization in the Zone of the Interior, telling them 
that medical experts can reoogni'ze self-inflicted injuries# 
He feels that most of them are the type of personality who 
can benefit from comradely encouragement and admonition, 
as well as from information concerning the likelihood of the 
discovery and the conseouences of such acts, and that they 
could t'-.us be restrained from committing the act? that most 
of them are harmless, rather we 11-integrated social types, 
end that fundamentally rotten or criminalistic natures were 
very rare among self-mutilators* 
Von Beeyer also made e report concerning epileptoid 
personalities, that is people who come from families 01 
epileptics without having seizures themselves, but who show 
the personality characteristics of epileptics, such as 
circumstantiality, slowness, and decreased efficiency* 
He accepted for these people the term "enechetic constitu- 
tion”, which had been first coined by Mauz, and he stated 
that they were generally more useful in the rear than at 
the front* 
Among the psychoses, the importance of manic episodes, 
especially among violators of military discipline was 
stressed. In one of such oases, a manic episode expressed 
by undisciplined behavior occurred in a soldier of 
previously immaculate disciplinary record, after a severe 
air raid. BCrger-Prinz reported that after the severe 
bombing of Hamburg there was a rapid turnover in manic-de- 
pressive patients. Some apparently were shocked out of 
their depressions by the raid, in others depressions were 
elicited by the raids. Cases of exogenous psychosis 
produced by "canned heat**, and by atroplBfc intoxication 
derived from captured Russian eggs, were imported. In 
regard to suicide, it is stated that the danger of the 
♦•suicide of convalescents returned to duty”was being under** 
estimated, especially in older worn-out people* 
Of great interest is a report on the results of 
treatment with strong galvanic currents (usually of 
60-10 0 mi 111 ampere s J in the MniPOi 01 psychogenic 
and hysteric disturbances, which was contributed by Dr* 
Pause, the originator of the method* The method was 
supposed to work like a charm and produced cures in cases 
resistant to all other forms of therapy. Two rather 
extraordinary examples were presented; 
Case 1; A non-commissioned officer, on 25.5.40, suffered a penetrating gunshot wound through the left shoulder 
with an extensive flesh wound. Six weeks later he developed 
the typical picture of hysterical shaking palsy, which became 
aggravated when he heard that his brother had been killed in 
action. During August he was treated with relaxation treat- 
ments which were unsuccessful, but on 28 October 1940, he was 
discharged from the hospital as fit for garrison duty in the 
Zone of the Interior, and given a long furlough. The army, 
however, could not use him even in a limited service assign- 
ment because of his tremor, and he was discharged from 
military service as permanently unfit for duty on 22 May 
1941, A week later he applied for a pension. When he was 
examined two months later some residuals of the shoulder 
injury were found, for which he received some compensation, 
but for the remainder of his illness psychotherapeutic 
treatment was recommended. Three months later he applied 
for a full pension, because he claimed to be entirely 
unable to do any work. He was admitted to a special 
neuropsychiatric hospital in Berlin vhere he was treated 
for three months by hpynosis and narcohypnosis and strong 
faradic currents* Finally, prolonged sustained sleep 
treatment of 8-days duration was given. This treatment 
been recommended on 2o January 1942, after an examination 
at the institute of Professor G. in Berlin (I suppose that 
Professor GBring is meant), and it was carried out at the 
University clinic for Nervous Diseases at the Charity in Berlin, 
where the patient stayed from 15.7.42 to 8*10*42. The tremor, 
however, remained unabated, nor did an attempt to use this 
patient in his old Job as cashier succeed in removing the 
teemor. Finally the Chief Psychiatric Consultant to the 
Surgeon General of the army recommended tieatment by intense 
galvanic currents at Dr* Passers department * Dr. Pansc found 
a shaking of the head similar to sfgn language saying "no", and 
marked, shaking of the left ana, which increased with active 
motion* From 4 August to 16 August 1945, the patient was 
treated with strong galvanic currents with simultaneous 
suggestion* After the first two treatments, improvement 
of the strength in the left arm resulted, while the shaking 
of head and arm remained unchanged. On 16 August 1943,finally, 
by applying strong currents to the head, th® shaking was 
completely eliminated* The patient expressed profuse 
gratitude for his cure* Shaking was abolished and the 
strength of the left arm was completely normal. However, 
because of slight stiffness in the left shoulder the 
patient could not lift the left arm for more than 160 * 
The patient was described as a "weak human being" with de- 
ficiency of psychic endurance and with marked tendency to 
psychogenic reactions* It was considered unfavorable to 
re-induct him into the military service, and he *ms dis- 
charged to his home as fit for civilian, work. Ou±ya small 
pension was granted to him on the basis of the slight organic 
3&a.»+H.-a.. stiffness of his left shoulder joint* 
Case 2 concerns an enlisted, man who on 5 June 1940 
sustained a gunshot wound in the left side of his neck, 
while simultaneously a falling tree hit him on the head 
end knocked liim unconscious for nine hours- Following that 
he developed lockjaw, but no defect of the eardrum or 
fracture of the skull had occurred* On 2 October 1940, he 
developed paralysis of the left arm and left leg, vtoich 5 
weeks later was recognized as hysteric• Repeated daily 
faradic treatments until January 1942 (?) (should obviously 
read 1941) brought about very slight improvement* In March 
1941 it is stated that "the neurosis of this patient is 
firmly established in a rut end psychologically irremediable”* 
On 25 June 1941, he was dismissed as fit for labor only* 
Following this ho was supposed to be trained to become a 
hardware salesman, but he failed in the examinations and 
as father of 8 children faced starvation* In order to cure 
the psychogenic paralysis of the left arm and leg he was 
sent for special treatment to a neuropsychiatrio university 
hospital through the Veterans1 Administration, where he 
stayed from 13 January to 19 April 1943* He refused 
hypnotic treatment and electric shock treatment* Treatment 
with strong faradic currents had no effect* II© was Judged 
resistant to therapy and it was recommended that he be 
sent as a war neurotic to the military section of a abate 
hospital for the insane* However, the consulting psychia- 
trist referred this patient to Dr, Pause rs hospital for 
treatment with strong galvanic currents, combined with 
suggestive influence. After the first treatment on 23 
August 1943, and in spite of definite initial success, the 
patient refused further treatment by the current. Since 
in view of the status of the patient as a veteran he 
could not be forced, to submit to the treatment against 
his will, his peinduction into the service was arranged. 
He received his notice of reinduction on 5 September 1943, 
and on 8 September 1943 he was again treated with strong 
galvanic currents and simultaneous suggestive influence,. 
Already after brief use of the current he was able to move 
the left arm and leg again, with complete freedom* He 
expressed gratitude* In order to stabilize the success, he 
received another brief treatment with strong galvanic current 
on 13 September 1943, After that he used his left arm and 
leg completely normally, and became a diligent•worker in 
the labor platoon of the hospital. This patient is 
considered an outspoken hysterical character. In view 
of severe psychic deviations it was not recommended to 
return this patient to combat at the front. Furthermore, 
he is the father of 8 sons. He was discharged ec fit for 
limited service. 
■a»a.Hj+.a Other 1 terns of the report include enceDhalitis after 
inoculation against dysentery, Parkinsonian and thalamic 
sequelae of iVolbynian fever, cerebral haemorrhages in young 
people censed by he man e i ome' ta, frontal lob=r syndromes follow- 
ing injury of the frontal lobes; and a review of the 
operative care for gunshot wounds of the brain, especially 
after directives worked out by Ttfnnis, which will be 
reviewed in a special section of this report. An interesting 
incidental finding in this review is the statement that the 
statistical results in terms of operative mortality became 
worse the better evacuation of wounded functioned between 
the battle field and the hospital, especially when it was 
possible to use Stork planes for rapid evacuation of the 
wounded# The reason for this was seen in the fact nh the 
improved evacuation of the wounded let to admission into 
the hospital of greater numbers of patients who were poor 
operative risks, than when transportation conditions were 
difficult and the poor operative risks did not survive the 
-hardships of transport* Another part of the report deals 
with nervous symptoms of thalamic-diencephalic type in 
cases of muscular rheumatism, and also mentions the occurrence 
of typical chorea minor in this condition* A therapeutic 
chapter deals'with the good results which iontophoresis 
treatment with iodine exerted upon indurated and painful 
scars with contractures. 
Again a ereat ‘increa'se ‘of post-dinhthsric polvneuritides,. 
was reported, 'and the definite 
post-diphtheric polyneurit5des are always preceded'10 - 14 
days earlier by transitory palsies of the velum palatinum 
and of ocular accommodation, and that the history of 
preceding palsy of the velum palatinum and of accommodation 
is diagnostic for post-diphtheric polyneuritis* .It is also 
stated that the prognosis of cases in which paralysis of 
the limbs involves predominantly the distal parts is better 
than the prognosis where the proximal parts are predominantly 
involved* The spinel fluid in post-diphtheric yneuritides 
usually shows increase in protein and slight increase in 
cells/ Two cases are reported in which post-diphtheric 
palsies ascended in the fashion of Landry’s paralysis ana 
ended fatally* 
Other tiolyneuritidss were secondary to enterocolitis 
end other known infectious agents, and sometimes due to 
vitamin deficiencies and toxic agents- A series of Pft 
cases was reported which were caused by drinking a 
solution of raetatricresyl-phosnhate which was frequently 
misused as an intoxicating beverage on the Eastern front 
and which always led to paralysis, sometimes after a 
oonsidereble period of latency* The seventh report was likewise issued in March 1944 
(Appendix 1, lio* 33)* Thiele reported another interesting 
case of blast injury. Ee stated that in blast injuries 
focal and generalized cerebral injuries could be caused 
without necessarily unconsciousness having been produced 
at the time of the blast, and he warned against mistaking 
the resulting psychic alterations for psychogenic states. 
His case was that of an officer of excellent qualifications 
and superior previous .record, who, after being exposed to 
severe blast, began to commit all kinds of silly offenses 
which he carried out with poor judgment and in a clumsy 
manner* Later he 'also began to complain of vegetative 
disturbances and dizziness, arid he developed epileptiform 
seizures, a generalized reduction of spontaneous motility 
marked circumstantiality, lability of affect, a certain 
degree of deafness which was -at first regarded as psycho- 
genic, until a spinal fuild examination revealed, marked 
increase of cells and of pressure* After a few weeks, the 
whole syndrome cleared up and his previous excellent 
personality and stamina in combat returned. The, pi cture 
was interpreted as a transitory hydrocephalic episode, 
due to some interference within the spinal fluid system 
caused by the blast. 
Other reports of organic cases concerned a traumatic 
Syndrome 01 a case of rigor offends and 
PW'gers, cue to an isolated contralateral lesion of the 
pallidum, and a case of contusion with cerebellar signs 
and narcolepsy-like attacks* Again the occurrence of 
brain damage due to mere gunshot wounds of the face 
without involvement of the cranial capsule is stressed. 
There is a statement which warns of the danger of causing 
the spread of meningitis from an infected gunshot wound 
of the brain by the practice of insufflation of air through 
the spinal route* Again it is stressed that Parkinsonian 
changes are too fequently mistaken for functional ones* 
The good results of work therapy in the rehabilitation of 
patients with of the brain, especially the 
results of supervised reintegration into manufacturing 
plants, is stressed* There is a report of excellent results 
following operative removal of scars in cases of traumatic 
epilepsy* 30$ are reported as completely free from seizures; 
50$ are reported as improved* hut it is not stated how much 
time elapsed after the operations. Treatment of causalgia 
is again discussed and the relative merits of sympathectomy, 
of ’’expectant and psychotherapeutic attitude”, end of 
insulin treatment (25 units daily in combination with 
ephetonin such as recommended by SchaItenbrand) ere dis- 
cussed* It is again stressed that causalgia should not be 
mistaken with traumatic neuritides* Por the latter group 
none of the above treatments but resection of the nerve 
or other direct operative remedial measures such as removal 
of a pressing shell fragment, are necessary. Another chaptei 
aft'a.H-H.-a. deals with the cerebral complications of malaria* including 
vascular accidents and hallucinatory psychoses. 
The chapter on peripheral nerves gives figures for 
spontaneous restitution after various nerve injuries, A 
case is reported of high lesion of the sciatic nerve 
which had resulted in loss of function of only the tihial 
portion: spontaneous restitution began 16 months after the 
injury* and was complete with full restitution of function 
26 months after the injury. In another case of gunshot wound 
of the sciatic nerve in the gluteal region which had led 
to loss of function of the peroneal portion only* restitu- 
tion began 13 months after the injury. In the case of a 
gunshot wound of the radial nerve sustained in the lower 
third of the left upper arm* restitution began 9 months 
after the injury. It is stated that in lesions of the 
ulnar nerve, even if they are operated on* the prognosis 
for restitution of function of the small muscles of the 
hand is relatively poor. 
A report by Kleist stressed the fact that not infre- 
quently depressions are mistaken for internal medical 
illnesses in army hospitals. Their true nature is frequently 
not recognized until the patients commit suicide or make an 
attempt to do so. He gives the example of a case of an 
enlisted man who* up to the time of his suicide* was 
treated for a long time on the medical service of a military 
hospital under the diagnosis of "increased blood pressure* 
damage of the heart muscle, thyro-toxicosis"* while nobody 
paid attention to the fact that he was constantly in a state 
of excitement* that he considered himself very ill* that 
he frequently appeared depressed* that he uttered dire 
fears in regard to his future* that he made statements 
about the fact that he did not know any more where to 
turn and that he finally ceased to talk to anybody at all. 
The chief consulting psychiatrist added the following note 
to this report: "it is quite probable that a great number 
of monosymptomatic endogenous depressions are residing 
on hospital services other than the neuropsychiatric one 
where they were admitted because of complaints concerning 
such other organ systems and are not being diagnosed as 
mental illnesses until they either make an attempt at 
suicide or actually commit it. Unless such events occur 
they frequently remain unrecognized. Such patients abound 
especially on the venereal wards of military hospitals* where 
they get themselves admitted as venereal disease suspects. 
The incorrigible fear of venereal disease which brings such > 
patients to the doctor* is to be considered as a symptom of 
depression. Furthermore* many of such patients reside on the medical of military hospitals with the diagnosis 
of cardiac neurosis or gastric neurosis* The survey of the 
reports of suicides received at this office shows that 
particular attention should be paid to these cases." 
JCn a brief final chapter on the psychogenic disturbances, 
Panse reports excellent results of his "suggestive treatment 
with high galvanic currents" in bed-wetters as well as in 
stutterers* The treatment was effective not only in those 
who started to stutter during the war but also in those who 
had already stuttered during their school years, but had 
lost stuttering after termination of their schooling* 
Report No* 8 (Appendix 1, No. 34) was issued in June 
1944* It stresses the fact that schizophrenias should not 
be overlooked and illustrates this lesson with the case 
of a patient who whs mistaken for a reactive depression 
and discharged tio duty, where he promptly killed a fellow 
soldier, and wounded another by gunfire in a fit of 
reexacerbation of his illness* The report then dwells 
on the neuropsychiatric complications of typhus and 
Wolhynian fever which alsa included causalgic states and 
Parkinsonian pictures. The prohibition of the practice 
of provocation of seizures by means of hydration, or by 
combination of hydration with tonephin, was reiterated, and 
the practice of provocation of epileptic seizures in patients 
with head injuries for purposes of testing their seizure-4 
proneness by means of me travel was likewise prohibited*' 
Polyneuritic, nephritic, and the thalamic complications 
with tonus changes and sensory changes, in rheumatic 
syndromes are discussed. 
A very interesting report was one by Klimke who 
the increasing incidence of complaints concerning 
potency on the part of soT'STers 'on home furlough* Distress 
abouFthe T&flt their wives 
was their only complaint, and they usually worried about 
their future ability to produce offspring, but they had no 
other psychogenic or hysteric complaints* They were 
usually between the ages of 25 - 35, had been soldiers 
since the beginning of the war, and had always been with 
combat troops at the front. Theyusually responded well to 
encouragement and general information on the problem. Von 
Baeyer reported similar observations, end stated that 
soldiers on furlough from the Eastern front predominated 
among these cases. 
The chapter on psychogenic disturbances gives interest- 
ing instructions in regard to the proper technique of the 
suggestion-therapy with high galvanic currents." It is stated that if the proper technique is followed, therapy resistant 
cases are very rare, although the creation of a suitable 
milieu may not be as ideally possible elsewhere as in 
Ensen (pause’s own hospital service)* It is stressed that 
it is of great importance that the physician carrying out 
the treatment should never show signs of anger or impatience 
when the soldier reacts poorly 'ot in an evasive manner at 
first, but should always exhibit a medical end consequent 
attitude focussed purely upon the therapeutic result. 
A special regulation on the part of the Surgeon General of 
the armed forces prohibited the use of electric treatment 
as a means of differential diagnosis between true psychogenic 
illness and malingering, because mistakes are too easily made 
and because anxiety, especially due to fear of punishment, 
may produce genuine stuporous reactions which do not respond 
to electric treatment, but which are nevertheless not 
malingered, and may be motivated by strong emotional needs, 
for instance, shame. A recent case reported as that of a 
malingerer turned out to be a case of purulent meningitis 
with delirious confusion*, 
In the chapter on medico-legal activity, the criticism 
was made that too many people were being declared irrespon- 
sible due to severe alcoholic intoxication* 
Of organic illnesses, tuberculous meningitis is 
discussed, as well ss polyneuritides following inoculation 
against cholera. Two other interesting cases of blast 
injury were reported, both of them complicated by herpetic 
eruptions which were assumed to be due to injury of the 
spinal roots caused by the blast. Two cases of injury 
of the medulla oblongata caused by suboccipital puncture 
were reported as a warning against the performance of such 
punctures by the inexperienced, who were urged to practice 
on a cadaver before performing such tests in the living* 
A special chapter dealt with the excellent results 
of the occupational therapy system for patients partly 
disabled by injuries of the brain or spinal cord. The 
patients, while being integrated into the industrial system, 
were seen every week by their physician. ‘The factories 
into which such partly disabled men were sent, expressed 
themselves as extremely pleased with them, especially since 
patients formed a nucleus of people with soldierly 
behavior and soldierly discipline within their organizations, 
the laboring force of which consisted largely of foreigners*. 
The assignment of these convalescents to these factories 
resulted in a greatly reduced incidence of sabotage* i*ost 
of the convalescents were advanced after a comparatively 
short time to the status of foremen; especially the Ostmark 
3 8 2- aircraft factories were Interested in maintaining this 
system,of infiltration of their laboring force with 
partly disabled military personnel who remained members of 
thejfrmy, but were paid at the same rate as civilian employees 
pfjfrhe army hospital system* 
Cere in regard to paravertebral anaesthesia for 
neuralgic complaints following in t-hsciatic nerve 
is recommended because of occasional compiicatrms 
of febrile reactions with spinal symptoms and inflammatory 
spinal fuild reactions* Kretschmer again recommended that 
patients, even if apparently recovered from multiple sclerosis 
or tabes should never be inducted into the army and should 
be discharged if found in the army. The report ends with 
a review of the fourth conference of consulting physicians, 
where those in the specialty group-psychiatry and neurology 
discussed the theme of heurosis* The assembly came to the 
conclusion that the word "neurosis" interfered with the 
proper understanding, and caused misunderstandings of the 
true nature of this condition* Therefore, the following 
directives were issued to supplant the-term neurosis.by 
better end simpler terms* The following decisions were 
made; 
"(1) Abnormal emotional reactions which are purely 
in the psychic sphere and do not cause any physical 
functional disorders are to he calledfabnormai reactions 
to events’ (abnorme Eriebnisreaktionen)-, as, for instance, 
depression -caused 'by sad events, anxiety reaction, fear 
reaction, and so forth. These abnormal reactions to 
events can occur in normal individuals, In people with 
character peculiarities, and in outright psychopathic 
personalities* The physician should never forget, however, 
that even some quite abnormal personalities, especially if 
they suffer frcminnsaturity or personality disturbances 
are accessible to medioal psychotherapeutic treatment to 
a large extent* 
"(2) The physical manifestations which occur in the 
course of abnormal emotional reactions, are to be called 
psychogenic functional disorders caused by events’ (psycho- 
gene erlebnlshedingte HunktionsstOrangen)* They include 
the so-called war neuroses in the form of trembling, 
shaking, stuttering, fits, palsies, protective postures, 
contractures, bladder disturbances, gastric and intestinal 
disturbances, i.e*, a number of manifestations which 
hitherto were called’hysteric’* However, it is ordered that 
such terms as ’war neurotic®, ’war trembler’, ’war hysteric’ 
should be avoided entirely.- The proper sub-diagnosis should 
be, for example, psychogenic vomiting, psychogenic gait 
disturbance, psychogenic speech defect, or psychogsnically 
fixed radial palsy, respectively." The ninth report, of August 1944 (Appendix I, KijS 25), 
opened with a note on p-arabr-Hl arteri aT:uV,err.s1 a. It stated 
that recently an increasing number of older men, usually about 
50 years of age, who had a number of non-characteristic 
complaints or symptoms of fatigue, were being suspected of 
malingering or aggravation, and subsequently were roughly 
handled* If they finally succeeded, usually after an 
attempt at suicide, in being admitted to a hospital, examina- 
tion often revealed the existence of a significant degree of 
arterio-sclerosis in these patients. Consideration was to 
be given to the fact that such men, if overburdened by 
stress or work, broke down completely after a short time, 
while under conditions of a moderate load they could remain 
useful for long periods# The report also described cases of 
cysticerosis of the brain, of paroxysmal paralysis, and a 
case of muscular atrophy of the leg caused by thrombosis 
of the femoral artery# The report also contained an 
extensive discussion of narcolepsy with or without associated 
catapletic symptoms* It is of interest that the Chief 
Consultant came to the conclusion that a diagnosis of 
narcolepsy always constitutes permanent unfitness for the 
military service* 
This report stated that an extraordinary increase of 
nost-diphtheric polyneuritides had occurred- Post- 
diphtheric polyneuritides constituted 3*63$ of all admissions 
to"the neuropsychiatric center in Schwerin, and in several 
centers,at Schwerin included, the total number was 
twice that of the polyneuritides of all other etiologies 
combined* Good results were reported with the treatment 
of post-diphtheric polyneuritides by malaria and artificial 
fever (pyr"lfer)* A special chapter dealt with the increase 
of neuropsychietric complications of Wolhynian fever* 
Among these complications were myalgic complaints, cranial 
nerve symptoms, especially pupillary changes and nystagmus, 
pyramidal signs, weakness of the lower extremities, and 
brain stem symptoms, including muscular rigidity, masked 
and oily facies, sleep disturbance and ceusalgic, 
polyneuritic and polyradioulitic symptoms* Sleep dis- 
turbances 'reminiscent of trne prolonged sleep of epidemic 
encephalitis was observed in four cases of trichinosis of 
the brain. 
The treatment o£ causal&ia was rediscussed The 
resuitf wUh sympaWetic ganglionectomy or sympa- 
thectomy were considered far superior to those of any 
other treatment, although the importance of accurate 
diagnostic differention, especially from traumatic 
neuritides, was stressed. Cases of injury to the ulnar 
nerve in telephone operators due to stretching of, and pressure on the nerve caused by supporting the elbow on a 
table, were reported and headsets for soldiers assigned as 
telephone operators were recommended* 
The chapter on psychogenic disturbances included an 
historically important note by Kleist* Kleist stated that 
the treatment of psychogenic disturbances with strong 
galvanic currents which was carried out by Stabsarzt Dr. Gerum 
in his corps area had in the past led to cures in 89,6$ of 
the patients, 46$ of whcmwere discharged as fit for combat 
duty, 59.6$ as fit for limited duty, after two or three 
treatments in the majority of cases* Dr. Kleist went on to 
say that the treatment in the past had always created a 
favorable psychic atmosphere which expressed itself 
repeatedly in spontaneous cures upon mere admission to the 
ward before application of the electric current itself* 
Also in the past, patients not cured ddring the first 
session, themselves asked for a repetition of the treatment* 
Furthermore, presumably due to the Cured patients spreading 
the news of the good results among their relatives end 
friends, private individuals suffering from nervous 
disorders had come and asked for "the treatment”* The 
subsequent occupational therapy, especially in cooperation 
with armament factories, likewise played a great role in 
giving support to the results of the treatment. Recently, 
however, results have been becoming less good* Dr. Kleist 
felt that this was probably due to tha fact that there had 
been an increasing number of "hysteric patients of poor 
character and malevolent personality”, who not only did not 
benefit from the treatment themselves, but also had an 
adverse effect in influencing public opinion on the wards 
against the treatment* Characteristic of this ”unfortunate 
situation” was the fact that one day recently the apparatus 
used for the treatment had been sabotaged end a number of 
essential parts removed and hidden* On the following day, 
however, while the perpetrators were not yet found, the 
missing parts were discovered in front of the door of the 
treatment room* Kleist made the significant statement that 
"until now such unpleasant occurrences have been only 
sporadic”* 
Another interesting note in regard to psycnogenic 
disorders dealt with the disturbances in potency among 
soldiers on furlough from the Russian front» The problem 
had been increasing and special consultation centers for 
that.complaint had been established, such as the one in the 
Gau Westfalen-Nord. The patients usually came to these 
centers with the complaint of fear of sterility* The Chief 
Neuropsychiatric consultant objected that at roost of these 
special consultation stations for so-called "sterility”. 
38 X. a gynecologist and a uermato]ogist are available, but no 
psychiatrist. He stated In his report that "our medical men 
think too much of the organic and forget that man also still 
has a soul". The complaint Is to be considered as 
ore dominan11y psychi c♦ 
3arl Schneider warns against the careless diagnosis of 
"psychogenic complaint" because numerous cases of myelitis, 
typhus, tuberculosis, and cancer of the lungs had been 
diagnosed as psychogenic complaints. Fe stressed the 
fact that psychogenic disturbance should not be diagnosed 
by exclusion only. He added interesting observations in 
cases in which the differential diagnosis of sympathogenic 
and psychogenic contractures ana trophic changes"of the 
limbs was made only with great difficulty, end he stressed 
that such contractures may be psychogenic although there 
may be no other*overt manifestations of a psychic distur- 
bance* Ho told of a case in which a very severe contrac- 
ture which developed after a palsy of the leg due to 
typhus, had been completely cured by treatment with strong 
galvanic current. The diagnosis of a psychogenic con- 
tracture in this case was particularly difficult because 
the contracture had persisted under very deep anaesthesia. 
Fe suggested that the treatments with strong galvanic current 
be spaced at B-day intervals* 
In the chapter on medico-legal matters, there was an 
interesting statement concerning the fact that time and 
again soldiers who had been sterilized for mental reasons 
during civilian life, have come before courts-martial, 
in spite of the many directives for rejection and discharge 
of such patients from the army* An interesting observation 
was the fact that a good many of these sterilized people, 
especially those sterilized for mental deficiency, had 
been doing we11 in the army, usually up to such time when 
they were promoted and given added responsibility. A 
39-year old enlisted man, an engineer in civilian life, 
had been treated for a severe querulous-paranoid schizo- 
phrenia in civilian life, but was court-martialed six times 
because of disobedience and obstreperousness, until his 
true condition was rediscovered. 
Yon Baeyer reported that the increasing number of 
very young soldiers placed new difficulties before the 
army psychiatrist because he was suddenly faced with 
military offenses which were actually nothing but the 
normal manifestations of puberty, including pranks, such 
as were commonplace in schools and could easily be handled 
by a teacher with disciplinary means, but which, in the 
setting of the army, tended to look like more serious misbehavior. He mentioned especially the- unauthorized 
wearing of badges and decorations by olds, being 
AWOL, inconsiderate remarks, whit© lies,etc. He concluded 
"they are so young that the experiences hitherto made with 
juvenile soldiers are not sufficient to provide the basis 
for proper action”. 
The last report, issued in December 1944 (Appendix 1, 
No. 36), dealt extensively with psychogenic disturbances* 
Schizophreniform reactions of short duration were described 
and interpreted as the expression of latent schizophrenic 
reaction patterns which were brought to manifestation by 
physical stress, heat, infectious diseases, 
injuries, imprisonment, etc# 
The German miraculous cure-all, namely the treatment 
JGrith strong painful galvanic currents, appearect £o Eave" 
a severe breakdown at this point* Maus reported 
that because of the great increase of psychogenic 
paralyses which swamped his treatment center, he saw himself 
forced to resort to ambulatory treatment with strong galvanic 
currents instead of dispensing it exclusively to in-patients* 
To his surprise, however, it turned out that the ambulatory 
treatment was a complete failure* The emotional reactions 
of the patients to the treatment became increasingly poor* 
The soldiers complained about the treatment and assumed a 
definitely hostile attitude* This finding was in complete 
contrast to his previous experiences with "in-patient" 
treatment. This complete failure of the ambulatory applica- 
tion of electro-suggestive treatment was considered as due 
to two factors: firstly, the therapeutic atmosphere of 
the ward in which the patient used to reside for 2-3 days 
before the treatment, was absent* Mauz felt that the 
association of the new patient with cured cases during this 
preparatory period brought him into a state of therapeuti- 
cally positive expectant tension which made it possible 
for the patient to be cured practically at the beginning 
of the eictro-suggestive treatment* The second factor was 
that the equally important after-treatment was also missing. 
This after-treatment consisted in arranging that the 
patientTs elated feeling of happiness after a successful 
cure was immediately shared by the doctors, the nurses 
and the fellow patients in the ward, and was frequently 
reiterated during the following days by demonstrating and 
exercising the restored functions, end by giving the stamp 
of legality and normality to the completion of the cure* 
This great experience of restoration of function which 
pervaded the whole community of the ward, and .the strength 
and conviction of the simplicity, the durability and the 
inescapability of the cure, which after the cure continued ,to grow from day to day, were decisive factors in securing 
end^preserving the excellent results obtained by the 
"in-patient" treatment* Because of the vast difference 
in results achieved by the "out-patient" 
treatment, as compared to the previous results with ’’in- 
patient" treatment, all out-patient treatment of electro- 
suggestive type was discontinued completely. 
Another aithor, Klaubert, reported good results in the 
treatment of 113 cases of psychogenic bladder disturbances, 
including enuresis, with electro-suggestive treatment* 
40-60 milliamperes were used, and in 93% of the patients 
the cure was perfect after the first treatment* The cases 
included one of psychogenic we aidless of the bladder which 
followed a penetrating gunshot wound with impacted mis sale 
in the shaft of the penis* This patient recovered after six 
sessions of the treatment* It is stated that the cure had 
to be fortified morally and physically by sport and drill* 
A chapter on epilepsy reported acute fatigue from loss 
of sleep as eliciting the manifestation of epileptic fits 
in people who had no such fits under other conditions# 
Several cases of cysticercosis of the brain were 
described, it iS 51aTecT '^mber of 
gunshot wounds of the heed occured because an increasing 
number of soldiers failed to wear steel helmets* In regard 
to subdural haematoma, it was stated that a good diagnostic 
hint as to the location of the haemorrhage was provided 
by the fact that dilatation of the pupil (mydriasis) was 
usually on the side of the haemorrhage, Several cases of 
blast injury of the brain were studied. Only one showed posi- 
tive spinal Sind findings, namely, increase of pressure 
and protein, and slight increase of cells, 10 per cmm* 
Three cases of indirect injury of the brain following 
gunshot wounds of the neck were reported, two of them due 
to traumatic aneurysm of the carotid artery, one of .them 
without clinical evidence of an arterial lesion* Another 
report concerned the fact that following severe infectious 
diseases such as malaria, dysentery, Wolhynian fever, or 
paratyphoid fever, neurological signs and symptoms of all 
post—traumatic (post—concussional or post—contusional) 
disorders may become reexacerbated. A special chapter 
dealt with the encephalomyelitides following inoculations, 
including T.A.B* and cholera inoculations. Another chapter 
mentioned polvneuritides following treatment with sulfo- 
namides, especially Italian sulfonamides, and arsphenamine * 
It was again not to' perform re-operations, in cases of 
Perinhere!"nerve injury until four months have elapsed after 
the injury. Paravertebral injections were considered 
useful*in' ischialgias, but care should be taken not to 
fail to reco psychogenic pseudo-sciatica* 
bsxMJt-z. In the section on medico-legal cases, Stauder reported 
that the various punishment formations, including the 
special field formations, contained a significant number of 
victims of the formes frustas of infantile paralysis, with 
athetoid movements, varying degrees of atrophy, and 
pathologic associated movements* 
An interesting report was one by Yon Baeyer concerning 
the increasing occurrence of trials for ’’corrosion of the 
armed forces”, and for "spread of discontent in the army” 
on the Eastern front* Yuli "Baeyer "said that "these crime's 
are even today still relatively rare”* Ke considered mc& 
of the perpetrators of these crimes as odd, sometimes 
fanatical, psychopaths. They were considered legally 
responsible, but psychiatric testimony was helpful in "re- 
vealing the characterological roots” of the odd ideational 
contents to the courts, and to recommend a mitigation of 
judgment in view of the constitutional personality de- 
ficiencies of these individuals# The description of the 
various crimes is interesting in that they indicate early 
cracks in the morale of . the German army in the East# One 
36-year old medical officer who had been decorated for 
bravery in the field with the EK1, stated that he would not 
retreat with the rest of the army but would stay on and 
attempt to convert the Russians to National Socialism* 
For this purpose he had already prepared insignia depicting 
the Soviet star white on a red background# He felt he 
was qualified to do so because he felt related to the 
Romanoffs through his own Norman ancestors. This man had 
always been considered queer. He had a long standing 
interest in astrology, and had at one time wanted to become 
a missionary* He was declared legally sane and sentenced 
to three years in prison and to loss of rank for "corrosion 
of the army." However, higher authority considered that 
his psychopathy had "the validity of disease" and reduced 
the sentence, in conformity with paragraph 51, Section 2# 
A 25-year old non-commissioned officer one day declared 
that he would no longer fight against the Russians because 
if he did so he would have to shoot at his father and 
brothers* He stated that he was the son of a former 
Russian prisoner-of-war in Germany during the last war, a 
fact which appeared quite credible as his nickname in his 
home village had been "Russ" for that reason, and because 
he actually looked Russian; but the odd thing was that he 
had not mentioned‘this fact before, and apparently had not 
been disturbed by it* He likewise was an odd personality 
who spent his free time constructing a perpetuum mobile 
(non-stop machine)* However, he was considered legally sane 
38LH-h- - * In addition, there were a number of perfectly normal 
people who committed similar offenses«. Among them was a 
47-year old Colonel with en excellent combat record, who 
suddenly started to talk in a pessimistic manner about the 
war situation and expressed his opinion that capitulation 
was unavoidable. lie tried to make arrangements to create 
a small guerilla band among his officers for the purpose 
of hiding in the Russian woods for at least two years, and 
then fighting his way back into Germany gradually in 
guerilla fashion. He was condemned to 5 years imprisonment 
for taking a pessimistic view of the situation and for 
exerting en unfavorable Influence over his officers, but 
without questioning his honorable intentions* 
A 28-year old soldier made critical remarks about 
the Nazi party and the German State, and announced that 
he would either kill himself or desert to the Russians* 
This man was considered as a moody individual, with an 
abnormal need for recognition, partly motivated by 
dissatisfaction due to lack of promotion. He was con- 
sidered sane, but the psychological root of his moods was 
explained to the court* 
Another individual who had always been depressive, 
did not take much part in group activity and always sang 
sad songs, made statements t- at he would give himself up 
to the Russians when they made their next break through* 
He was considered a fearful, sensitive, and depressive 
personality who should never have been sent to the front, 
and he thus escaped the death penalty. 
A final small chapter deals with the interpretation 
of the new regulations concerning the finding of "inclina- 
tion” in cases of homosexuality. 
Of ecual interest are the various reports of the 
meetings of the consulting physicians of the various 
specialties* A report of the third annual meeting 
(Appendix 1, No* 37) contains interesting chapters on 
hysteria and malingering, with special consideration of 
psychogenic overlay in organic diseases, by Panse (images 
217-219, with discussion and directives). There^is a 
report on the malaria treatment of post-diphtheric palsies 
bv*Fuchs (pa«ea 225-227), as well as an interesting chapter 
on malingering and hysteria with special reference to visual 
disturbances by Collin* (pages? 33-34)* 
*83-UH-- X 2. Informetion obtained from Irofesscr Dr» Aurt Bchneioer, 
Gberst. vGolonelj In the German Army lledical Gores . 
who served as Consulting Bsychianris-t with various 
armies in the field, on active war fronts in Polanda 
ffrance and Aussie. 
Jr. Schneider was interviewed, on 28 May 1945, at the 
Schwa.binger Iirenkenh.sus in Munich, where he is- in charge of 
Clinical 'Psychiatry, as the senior member of the Psychiatric 
Section of the Deutsche Eors chungsan start ffr Isychiatrie. 
The Army had returned him to inactive reserve status to his 
civilian work, one year ago. 
Dr. Schneider was first asked about selection. He 
stated that no neuropsychiatrists took part in the medical 
examinations of spldiers about to be inducted into the 
German Army. These were performed entirely 
by general medical men, who did not recognize or weed out 
any but the grossest neuropsychiatric disorders. In such 
cases they .could arrange for neuropsychiatric examination 
through the Standortarzt at netfropsychiatrio outpatient 
departments of nearby military hospitals, Sven there 
standards varied a greet deal as the war progressed. A 
severely psychopathic personality, who might have been 
rejected in 1939, was definitely accepted in 1945. Before 
the war, psychiatric-psychological selection was practiced 
in the case*of officer candidates, and candidates for the 
civil service only, but never in the case of enlisted 
personnel of the Army. At the beginning of the war, even 
the psychiatric-psychological examination for officers and 
civil service officials was abolished "at the stroke of a 
neh*w before the war, this examination had consisted of a 
half-hour*s interview* the examiner Inquired about the 
candidate’s interests and why he wanted‘to become an officer, 
"Soft people, people with an excessive need for recognition, 
or people who lacked power of decision, were eliminated*" 
During"the war as well as before, newly conscripted men were 
well observed during the first 14 days of their service, 
end those who "aroused attention" were sent to special 
examination centers, usually the.neuropsychiatric outpatient 
department of the nearest military hospital, for expert 
opinion. Most of the neurotics' used to report sick three 
days after their induction. All military hospitals had 
outpatient departments, including facilities for psychiatric 
consultation.* Each army at the front had a number of 
medical and surgical consultants attached bo it: usually 
3 surgeons, 1 hygienist, 1 internal medical man, 1 pathologist, 
and 1 neuropsychietrist• later an eye-and an ear-nose- 
and throat man were added. A German Army was usually composed 
of 12 to 25 Divisions of up to 5000 men each; most armies 
numbered 60,000, including officers* In addition to the 
SZXh-H- - 2. neuropsychiatric consultant, every Army had one or two junior 
neuropsychiatrists at its disposal., who ran the neuropsychia- 
tric service, including wards and outpatient facilities, of 
the field hospital attached to that particular army. The 
number of active cases occupying neuropsychiatric ward beds 
at the same time was usually 80. Half of them were usually 
organic cases,, such as postconcussional disorders, multiple 
sclerosis, or tabes. One fourth of them were usually 
occupied by psychoses. The "abnormal reactions”, including 
the exhaustion states, the psychopaths and the true neurotics 
occupied the other fourth of the beds; the "true neurotics" 
usually occupied 5 of the 20 beds occupied by the "abnormal 
reactions". Dr. Schneider went on to say that the number of 
neurotics in German armies at the front in this war was 
much less than in the last war. Further interrogation, 
however, brought out the fact that the psychosomatic 
disorders in patients who showed no other obvious signs of 
emotional distress and the postconcussional headache states 
were not included under the diagnostic category of neurosis. 
As to the treatment in Army organization and field hospitals 
under his jurisdiction, Dr. Schneider* states that the best 
prophylactic measure was a good encouraging talk by the 
regimental surgeon; it was not psychotherapy, just encour- 
agement. In field hospitals, exhaustion states were allowed 
to rest, preferably without the use of sedatives. Neurotics 
needed no active treatment either; most of them pulled 
themselves up by their own bootstraps after a little time, 
as long as they were at or near the front. At home things 
were more difficult to handle, because there "all the 
neurotics evacuated from the war fronts accumulated." 
Therefore psychopaths and neurotics were whenever possible 
not evacuated from the fronts, but, if necessary, transferred 
from combat units to quartermaster units at the same front 
instead. Those who had to be evacuated to hospitals in the 
Zone of the Interior, v\rere there treated with painful 
electric currents "as in the last war". This time strong 
galvanic currents v/ere used, according to Panse’s modifi- 
cation of the old "Kauffmann treatment". The line of duty 
in cases of neurosis was always "no", and the patients were 
not discharged from the Army either, since neurosis was not 
recognized as a disabling condition for which discharge 
from the military service was authorized. However, no 
disciplinary measures were used, the handling was entirely 
medical. There were no "malingerers": "How can one separate 
the psychogenic from the demonstrative?" 
"Of course we have asked ourselves how does it happen 
in this war that we saw only about 1y6 of the number of 
neurotics that we saw in the last war. One school of thought 
was that in this war the neuroses were for the most part ?,ra3ske d" (3a tamt), ii\ that the y appe arsd in the f orm of 
gastric (especially ulcus-13 ke ), or circulatory symptoms, 
without showing any obvious signs of emotional distress or 
disturbance* But that does not solve the whole problem# 
15y opinion is this; in the last war we had two theories 
ab'out neurosis, (l) a psychogenic theory, and (2) an 
organic theory, s-uch as for instance Oppenhelm’s idea about 
a Cerebral molecular disturbance due to "shell shock"• In 
this war a united medical front against neurosis was formed 
from the very beginning” This united front included all 
medical echelons, beginning with the regimental surgeon# 
It expressed itself most effectively in the prophylactic' 
activity performed by the regimental surgeon, who could nip 
nadroses in the bud by encouragement and by controlling 
evacuation to the rear# 
Cases of [self-inflicted wounds/were not considered 
beuropsychiatrfrh -pyiroxems, But pttpel y legal ones* They 
were tried and usually. condemned to death, but the death 
penalty was rarely executed, and the culprit was usually 
allowed to "redeem himself in combat"* "This was due 
to a clever and modern administration of Justice#" The 
Judicial principle was "to penalize the deed and not the 
one who happened to commit It** If he was otherwise a 
decent fellow, who Just happened to run away or to shoot at 
himself in a state of anxiety or of panicky fear, he did 
not even go to prison but was already back with his outfit 
after a week and was handed a gun "to redeem himself." 
Dr. Schneider added: "Military Justice was the only clean 
and honest Justice in Germany since the Third Reich#-" 
This was in stark contrast to German civilian Justice, 
which had become completely corrupt under the Nazis. 
"Ranking Nazi Party members and members of the S. S* of 
all ranks could do as they pleased, as far as the civilian 
courts were concerned•" Dr* Schneider himself did a great 
deal of work as psychiatric expert to courts-martial in 
France, where b.oth German military offenders and French 
civilian offenders were tried by military courts, and in 
Russia, whereonly German military personnel was tried by 
Army Courts-martial* Of French civilians whom he declared 
legally insane, he remembers a schizophrenic who fired 
some shots at a German soldier,, and a senile individual who 
committed acts of sabotage by cutting cables* German 
military personnel served only their briefer prison terms 
in military prisons; those condemned to lodg prison terms 
were at the same time declared "unworthy to bear arms" 
("Wehrunwftrdigkeit") and handed over to the civilian police 
for transfer to civilian penitentiaries {"£uchth£user") 
where they were to serve their terms* Confirmed.homosexuals 
were likewise disposed of in this way# The final decision 
38 concerning "unworthiness to bear arms” was passed by the 
Judge Advocate's Department of the supreme command of the 
Wehrmacht. Dr. Schneider does not recall any trials for 
rape; but he recalls the case of a SA-PtLhrer who was condemn- 
ed to several years "Zuchthaus" for "racial disgrace" 
("Hassenschande") in Poland, 
Cases of suicide "were always very numerous"* in the 
Army as well as in the civilian population. When asked what 
"very numerous" meant* Dr. Schneider could not recall any 
figures concerning incidence among given numbers of population* 
but he stated that 700 civilian cases of serious attempted 
suicide passed through his 80-bed Neuropsychiatric Service 
at the Schwabinger Krankenhaus in Munich during the past 
5 years. In the Army* cases of suicide increased during the 
lull after the battle of Prance, Dr. Schneider thinks that 
relaxation of discipline and excessive drinking were the 
main causes contributing to this increase during that period. 
For exact figures and statistics he referred to the files in 
the Surgeon General’s Department (Wehrmachts-SanitMtsinspek- 
tion) which kept special statistics on suicides. 
As to the practical handling and disposition of the 
neurotics* the main point according to Dr. Schneider was 
their clinical separation into those of good will ("Gutwillige"' 
and those of essentially malevolent attitude ("Btfswillige"). 
It was an assay of moral attitude* and the "benevolent" 
were not necessarily "benign” in the clinical sense of 
the word* because although they tended to improve* they 
were subject to frequent relapses. The thing to do was 
to find the proper assignment that would exert the proper 
amount of pressure which they were constitutionally capable 
of bearing and under which they were capable of performing. 
The main effort was directed to finding and* if necessary* 
creating the proper environment for the soldier with 
neuropsychiatric limitations. Psychotherapy was not used 
in the German Army* in contrast.to the air force* where 
psychotherapy was an authorized part of the neuropsychiatric 
rehabilitation procedure* Usually administered by lay 
therapists who had been trained in Professor Goring’s 
Psychotherapeutic Institute in Berlin (the form Psycho- 
analytic Institute). 
When Dr. Schneider was asked about abreaction treatments* 
he stated that he had never, heard of such a thing. When he 
was told that it was initiated by the slow administration 
of a barbiturate* he stated he was on principle opposed 
to the use of barbiturates* especially intravenously 
administered. So far as he knew intravenous barbiturates had 
been used in Germany only in psychotics* especially schizophrenics. Insulin shock treatment was likewise limited 
to schizophrenics. Dr. Schneider had never heard of insulin 
subshock treatment. 
Dr. Schneider was then asked whether he was familiar 
with a clinical condition manifested by anxious tension* 
sleep disturbance* loss of appetite* vague gastric complaints 
without positive X-ray findings* and weight loss of about 
1 lbs. Dr. Schneider replied: "I would not consider that 
condition psychogenic* when it is associated with weight 
loss,” This led to a discussion of psychosomatic illnesses 
in general. Dr. Schneider took the view that it was by no 
means proven that the functional illnesses of the gastro- 
intestinal tract or the cardiovascular system which now 
tend to be referred to as ’’psychosomatic” are actually caused 
by psychological or emotional factors* but that on the 
contrary* such functional illnesses* in view of the 
discomfort which they cause to the patient* may actually 
be the source and the cause of a certain amount of 
psychological discomfort and emotional upset. He definitely 
disagreed with Siebeck and other internists who look upon 
these functional illnesses as definitely and necessarily 
psychogenic. While the scientific merits of the point 
could still be argued* he felt that this new viewpoint* 
whatever its scientific merits* was not yet well enough 
proven to serve as the basis of practical military-medical 
procedure. Therefore he has always resisted the efforts 
of the internists to shove those patients off to the 
psychiatrist. "Whenever such patients 'were sent to me 
for consultation* and I found that they were not definitely 
psychopathic personalities* and if they did not express 
an urgent wish to go home or to get out of combat* I have 
always sent them back to the internists* where they belonged.” 
It became quite obvious from our conversation that Dr. 
Schneider did not accept any patients with functional 
gastric or circulatory complaints as neuropsychiatric 
problems* as long as they gave lip service to* or expressed 
an actual conscious desire of staying at the battle front. 
I then asked Dr. Schneider what the internists did with 
those patients after he sent them back to them* and he 
replied: "Well* those people finally were always sent home 
one way or another. They were a considerable group. It 
was the same problem with the postconcussional disorders. 
We had people who could not wear steel helmets* because of 
some accident they had in civilian life or in the Army, 
They were difficult to evaluate, I always hesitated to 
make the diagnosis of neurosis in order not to do the man 
an injustice. The term neurosis implied the stamp of moral 
disapproval.” Thus*the diagnosis neurosis was in most cases 
389-Htv.V not. made unless the psychiatrist felt that the nan was 
morally oh jectionable, or otherwise definitely substandard, 
or overtly emotionally upset; although Dr, Schneider per- 
sonally felt that the moralizing attitude was quite wrong, 
and did his best to change it by teaching and writing. 
Dr. Schneider’s constitutional bias which pervades 
his book, even its most recent edition (Appendix, Ho* 3) 
did not completely blind him to the importance of external 
events in producing abnormal mental states, or in modifying 
and coloring abnormal mental states not primarily caused 
by such events. He discussed these problems in an interest- 
ing paper on "The differential diagnosis between schizo- 
phrenic psychoses and experiential reactions under combat 
conditions" (Appendix 2, Ho. !)• *1 already saw one such 
case during the Polish campaign, and then an increasing 
number of such cases in France and at the Russian front, 
in which a definite differential diagnosis, at first at 
least, was impossible." He feels that as far as the 
contents of the abnormal mental states are concerned, battle 
contents not only fill the utterances of the patients 
suffering from psychogenic battle reactions, but also those 
of the schizophrenics and those suffering from organic mental 
disturbances, such as those caused by infections, toxic 
states and head injuries, all of which are much richer in 
symptoms and in expressions of terrifying experiences than 
their counterparts in civilian life. The dreams of the 
normal frontline soldier are already mors vivid and filled 
with war content; restless sleep with nightmare-like dreams 
in which soldiers jump up and grab a gun are not infrequent 
and may in themselves sometimes constitute the sole cause 
of admission to e field hospital* However, not only the 
psychogenic battle reactions, but all other abnormal mental 
states are also filled with the terrifying battle and 
danger contents of war; and since everybody is experiencing 
special events, it is frequently difficult to decide 
whether a particular soldier was merely experiencing 
something that everybody else was experiencing too, or 
whether he was exposed to very special experiences* Among 
these "very special experiences" causing psychogenic 
battle reactions Dr. Schneider enumerates; severe losses 
amons immediate comrades, narrow escapes, being cut off, 
or unusually terroi&ing or grinding bombardment by dive 
bombers or by the "Staiin organ" (presumably mortar type 
rocket shells fired from multiple rocket launchers). 
Nevertheless, all abnormal mental states, irrespective of 
etiology, have certain traits in common under combat 
conditions* the 7 all show anxious excitation and confusion, 
anxiety, misrecognition of persons, talk about the enemy and 
38*.*.*. - J, attacks* attempt to get away* grab guns* threaten or at- 
tack those about them. There may be a peculiar solemn 
tension* or apathetic stupor* or Ganser-like syndromes 
with talking beside the points mannerisms or seemingly 
demonstrative tearing of clothes or smashing of objects. 
They all showed an apprehensive misinterpretation of their 
environment* saw enemies* or heard shots being fired. 
Outbursts of anxiety alternated with sudden outbursts of 
exaltation or with empty apathy. One frequently had the 
impression of a clouding of consciousness or of twilight 
states* even if no drugs were used. There is either a 
deterioration or a stiffening up of military attitude. 
Dr. Schneider feels however* that even in this setting 
which gives a new battle coloring to all kinds of mental 
abnormalities* there are certain symptoms which are indica- 
tive to schizophrenia* and which he calls schizophrenic 
symptoms of first order. They are: hearing one’s own 
thoughts* hearing of voices in the form of complete 
conversations with answers* voices which accompany the 
soldier’s actions with^comments * feeling of physical 
’’influences"* withdrawing and instilling of thoughts* 
and the experiencing of feelings* impulses and desires 
"made" by others. But Dr. Schneider stresses the fact 
that it is the more common error to diagnose schizophrenia 
too often* rather than not often enough; and that he 
himself has mistaken anxious-confused mental states for 
cases of schizophrenia* which later turned out to be mere 
psychogenic experiential reactions (battle reactions). 
Dr. Schneider is against the use of drugs in these 
conditions* especially if given by injection* because a 
number of deaths have been caused by overdosage or by 
excessive repetition of administration of sedatives. 
He feels that if restraint is necessary* the use of 
physical means* such as by restraint jackets* tends to 
be less harmful. Dr. Schneider concludes his paper with 
a plea not to condemn these people in a moralizing manner; 
"In conclusion I should like to advise* not to moralize in 
regard to the abnormal experiential reactions. I have 
hardly ever seen purposeful reactions of this type at the 
front. Also the best and bravest can react in an abnormal 
manner under the stress of a certain weight of experiences. 
Combat soldiers know that* and therefore such occurrences 
have been dealt with with remarkable understanding in 
field outfits. Everyone there has the dim feeling that he 
himself is also not quite sure of becoming likewise 
afflicted* that such a thing could happen to him too some 
day. " 
In an interesting paper entitled \,The neuroses from 
the point of view of clinical (Appendix 2P 
No, 2) Dr. Schneider complains that the t\rm neurosis is "being 
3«aivH.-3L used too glibly and too all-inclusively by internists* 
pediatricians and psychotherapists than would appear 
Justified from the standpoint of clinical psychiatry* He 
particularly opposes Siebeck’s inclusion of those functional 
disturbances of inner organs which he designates as 
psychosomatic without being able to prove their actual 
psychic origin; although Dr. Schneider admits that such 
functional disturbances may occasionally be elaborated on 
in a neurotic manner by certain neurotic or psychopathic 
personalities* This, however, does not prove that the func- 
tional physical disturbance actually had a psychic origin 
even in these cases* He would like to limit the term 
neurosis and synonymous or associated terms to those 
disorders whose psychic origin can actually be proven. 
He suggests the following diagnostic categories; 
(1) Psychic syndromes; a* abnormal reactions to external 
experiences or events, h. reactions to inner conflicts 
(inner tensions, struggles, drives, etc.)* (2) Physical 
syndromes; a* organ neuroses, h* "animalistic*1 neuroses 
such as psychogenic trembling, stuttering, psychogenic pal- 
sies, speech disturbances, sensory disturbances, etc*, 
we re seen in the last war by the thousands and which 
we again today see in moderate numbers”* Hut Schneider 
urged that the diagnosis of "psychogenic physical syndromes” 
strictly to those in which it is proven that 
they originated and were fixed by purely and definitely 
psychic mechanisms* Dr* Schneider states that although 
among the soldiers who develop psychogenic physical 
syndromes there are a good many who are psychopathic 
personalities, asthenics or hypochondriac self observers, 
by no means all of them, not even those with "animalistic 
neurotic reactions” are psychopathic inferiors, because 
even animalistic neuroses may develop in soldiers with 
previously good personalities* He cites two cases as 
examples. One of them is that of a sharpshooter^who for 
weeks on ©nd spent ©very day in a burnt-out Hussi an tank 
in no-manT s-lend* From this position he picked off 
Russian officers: after a direct hit on the tank which 
did not injure him nhysically, he developed tremors and 
stuttering, "It would have been entirely unjustified 
to say that this man was a psychopath.” The other case is 
tv.at of a 22 year old non-com, who during a shock troop 
attack, which he led, lost all his men, and who reacted 
to this event with a tremor-neurosis in which he brooded 
over the thoughc that he had caused the death of his 
comrades by uncautious leadership. 
The fact ttftt Dr. Schneider’s general views were 
motivated less by therapeutic considerations, but more by 
considerations of fairness in administrative disposition 
and of fair veteran1 s administration policies is oui^te 
38* fUi--I obvious, and he expressed It quite strikingly In the 
concluding sentences of his paper; "Let me conclude my 
remarks as a defense counsel makes his final plea at a 
criminal trial; I herewith move that my clients Vj 
acquitted of the crime of neurosis. If you should not 
to decide upon an acquittal, then please, consider 
my explanations and grant mitigating circumstances in the 
use of the term neurosis. In other words, I move that the 
term neurosis be strictly limited to those functional 
disturbances which have originated through purely psychic 
mechanisms and which have remained fixed by purely 
psychic means.” 
3. j Information obtained from Cberstabsarzt Dr. Ludwip. 
I -Tochaofel, who served as assistant to the Chief 
<: Consultinn ,\europsychlatrist at the iiilit BrBrzt- 
lliche AkaJein.ie in Berlin from august 194$.until 
] 945, r..hei» as Chie-T of the N'europsychiatri c 
‘Service at the ne serve lezarett in Tut zing, 
Saveria. “ 
Dr. :lochapfel, v/ho is a medical officer in the 
regular German irmy, was very cooperative, and had a very 
intimate knowledge of regulations and policies, and of 
their development and application. The bulk of 
official documents] reported on In the first chapter of 
this report, was found in his office and was discussed 
with him in detail. Dr* Hochapfel gave the following 
additional personal information; The Chief Neuropsy- 
chiatric Consultants of the three-main branches of 
the armed forces were directly under the "Chef des 
V/ehrmachts-SanitStswesens", who was General-Oberstabsarzt 
Dr. Handloser. The Chief.Neuropsychiatric Consultant 
for the Army was, from the beginning of the war until 
October 1944 Professor Auth• he was then succeeded by 
Professor de Crinis of Berlin. The Chief Neur©psychiatric 
Consultant for the German Navy was Professor Kreuzfald 
of Kiel, and the Chief Neuropsychiatric Consultant for 
the Luftwaffe was Professor Luxenburger. 
The greatest single neuropsychiatric problem end 
one of the most important problems in Army medicine in 
General, were the psychopaths! This diagnostic category 
included the pSVd'KogenTc emotional disturbances previously 
called neuroses] as well as the psychogenic physical 
disturbances, which included particularly the hysterias. 
It did not include the organ-neuroses (stomach end 
circulatory neuroses), or psychosomatic disorders. The 
latter groups were exclusively treated by internal medical 
men, and were not regarded as falling into the province of 
neuropsychiatric practice. 
SSUfc'Z. The methods of neuropsychiatric treatment were fundamentally 
different in the Army and in the Luftwaffe. The Luftwaffe relied 
mainly on psychotherapy. In the Army, however, the treatment of 
choice was 11 electro-suggestive therapy*1, \diich had "been developed 
'by Dr. Panse in Berlin. This treatment was similar to the old Kauff- 
man treatment, which had “been used in the last war, hut the creation 
of the **suggestive milieu” was better. It was the policy, if 
possible, to keep the hysteric patients who were treated, on the same 
wards which were also used for patients suffering from severe organic 
nervous and mental disorders. Particular care was taken not to treat 
the patients as if they were "gold-bricks”, but as sick patients. 
Particularly frequent among the patients which were selected for the 
electro-suggestive treatment were patients with psychogenic palsy of 
an arm or leg; but eases of also responded well to this 
treatment, especially at a special electric treatment center for bed- 
wetters which had been organized at Eodewisch In Saxony. The dis- 
position of the cured patients was usually to limited service. The 
internists likewise discharged the improved psychosomatic cases to 
limited servoce. There were special formations for specific kinds 
of disability, of which the best known were the "stomach battalions” 
which constituted a considerable portion of the troops of occupation 
used in Prance. The soldiers in these battalions received a 
special diet and whenever possible the commanding officer of such a 
battalion was chosen from among medical officers familiar with gastric 
diseases. 
Dr, Hochapfel feels that the handling and utilization of these 
partly disabled individuals in the German Army worked very well, and 
that the solution of the creation of a special environment in which 
a specific group of specifically disabled people could function, was 
a success. He feels that the Air Force did not do so well with its 
personnel because its discipline was corroded, and because corruption 
and alcoholism were rampant in the Luftwaffe, He feels that this was 
due to the fact that the Luftwaffe people were given too many special 
privileges, (This criticism should not be taken too seriously, since 
it seems to be the standard type of criticism made of an airforce in 
any country by members of its non-flying brother services). 
Dr. Hochapfel then explained the principles of diagnosis and 
determination of duty status already discussed in Chapter 1. The 
main diagnostic categories among the functional nervous deviations 
and illnesses were those with vegetative abnormalities, and those 
with psychic abnormalities. Mild cases in either grorq> could be 
classified as fit for combat duty, such as Group A15 - 1 and A15-3 
of the diagnostic schema, while the more severe cases such as 
L15 - 1 were classified for limited service. However, more impor- 
tant than those diagnostic categories was the basic appraisal of 
fundamental attitude which was utilized in dividing patients into 
two major groups. Those who did not want to perform were Classi- 
fied "disturbers”, and those who could not perform, "folder-i^ppers". 
56IA-H- - Z There was no discharge from the German Army for neuropsychiatric 
reasons except into concentration camps or into a State Hospital for 
the Insane; the former for "disturbers11, and the latter for those who 
"folded up". Even before the war soldiers who were found to he in- 
adaptahle for reasons of asocial tendencies were put into concentra- 
tion camps. During the war, transfer to concentration camps was not 
immediate, hut such individuals were first assigned to special forma- 
tions which were assigned to especially dangerous work such as digging 
up mine fields or similar arduous and dangerous operations which did 
not require too much individual initiative. Dr. Hochapfel stated 
that he did not know how well these formations actually performed* 
except that "suh finem bolli"men in these formations began to run away 
and desert in considerable numbers. There were "special formations" 
called "Sonderabteilungen des Brsatzheeres", for soldiers who had not 
yet completed their basic training, and special formations for sol- 
diers whose behavior difficulties did not begin or were not disco- 
vered, until after they had their basic training, or who became in- 
adaptable during front-line service. These were called "Eeldsonder- 
batalllone". These were the battalions which performed especially 
dangerous and arduous missions in the front-lines, such as removing 
mines, and so forth. The soldiers nicknamed them "Heaven-Commandos" 
("Hinmelfahrtskommandos"). These included criminals on probation, 
who were thus given a chance to redeem themselves. The numbers of 
soldiers in these special battalions was not known to Dr.Hochapfel 
or to any medical echelon, because transfers to these formations 
were a purely administrative matter, the Regimental Surgeon 
had to pass candidates as physically fit before the transfer. Any 
soldier who incurred frequent punishment for AWOL, drunkenness, 
refusal of duty —— in other words, any soldier who was an educatio- 
nal or administrative problem, became eligible for transfer to these 
battalions. As officers and non-commissioned officers for these 
battalions, especially tough people were selected, preferably such 
officers and non-commissioned officers who had some SS training and 
indoctrination, i.e. "ex SS executioners" ("frtthere SS - Henkersfc- 
nechte"). 
Dr. Hochapfel was then asked whether he knew anything about the 
incidence of neuroses and psychopathy in the German Army, and whether 
he knew anything about the numbers of relapses following electro- 
suggestive therapy. Dr. Hochapfel stated that he did not know figures 
which included ail periods of the war, but that he had a set of fig- 
ures which resulted from a survey made in October 1944.According to 
this survey, during the month of October 1944, the number of patients 
with psychogenic illnesses in all Germah Army hospitals at the time, 
numbered 3432, of which 2103 were first admissions, the rest recurren- 
ces. Dr, Hochapfel stated that this figure, of course, did not include 
those diagnosed as psychopaths or characteropaths, and that it likewise 
did not include those diagnosed as psychosomatic illnesses, organ 
neuroses, gastric or cardiac neuroses, etc., since the latter were never 
taken to the psychiatrists. 
Dr. Hochapfel had heard from internists that in addition to the 
psychosomatic group there had been a marked increase of real cases of 
Graves’ disease, in spite of the fact that only those who had baiic 
metabolic rates above 4" 30 were diagnosed as Graves* disease. 
seu+J*.- a. Of outstanding large neuro-psychiatric hospitals, Dr. Hochapfel 
mentioned the neuro-psychiatric center headed by Professor Mauz in 
Konigsberg (1000 beds), the special center for bed-wetters at Rodev/isch 
(1000 beds), and the neuro-psychiatric center in Vienna, which special- 
ized in work therapy and re-integration of neuro-psychiatric casualties 
into labor services and industries. These people who performed labor i 
duty in industry still retained their enlisted status in the Army, which 
the patients tended to like, because it gave them certain special / 
privileges and immunities enjoyed only by members of the armed forcu:/. 
A special problem were jfcho homosexuals* | The estimate as to their 
number throughout Germany varied. estimate was two million, 
and the maximum estimate four million, among the German male population 
of mature age. During the war 5806 homosexuals were tried and convicted 
by Army court-martials, and turned over to civilian prisons for long 
prison terms. In S3 formations homosexuality was punished by death. 
The Luftwaffe, on the other hand, was very lenient, and regarded homo- 
sexuals as a medical problem which was handled by psycho-therapy, 
performed by lay therapists especially trained at the Psychotherapeutic 
Institute of Professor Goring in Berlin. Professor Goring took an 
essentially psycho-analytic view. In the Army the policy ms to 
regard homosexuality as a legal and administrative, not as a medical 
problem. Court martials usually after conviction sentenced a homosexual 
to two to six years in a civilian prison. After serving the full 
prison sentence, he was subjected to sterilization or castration, and 
dishonorably discharged from the service. Confirmed homosexuals were 
never regarded as worthy of a chance to redeem themselves by participat- 
ing in dangerous combat missions in special formations, except in cases 
of incidental homosexuality, especially if due to seduction, in cases 
of first offenses only. Dr. Hochapfel added that there was a constant 
pressure from higher authorities, especially Himmler and Hitler himself, 
to make the death penalty mandatory for homosexuality in the Army. 
The Army legal, authorities resisted for a long time, but finally did 
make the concession to authorize the death panalty in oases of ’’incorr- 
igible inclination", but not in the case of incidental offenders, or 
offenders considered victims of seduction. The differentiation of these 
groups became for a time the duty of the medical court expert, who 
tended to shift emphasis away from the "incorrigible inclination", and 
especially adjudged many offenses as having been committed during 
"pathological intoxication", which abolished criminal responsibility 
in regard to the offense. However, later Hitler himself cracked down 
on that practice, and decreed that alcoholism should never be considered 
as a defense in cases of homosexual behavior. The whole matter of 
expert testimony in such cases, consisting merely in the adjudication 
or denial of inclination ("Hang"), was taken out of the hands of the 
medical experts and placed entirely in the hands of criminologists. 
In the SS, not only homosexuals who committed offenses daring 
alcoholic intoxication, but other incorrigible alcoholics as well, were 
condemned to death. Alcoholism and drug addiction were a considerable 
problem in the G-erman Army. During the war, one thousand drug-addicted 
medical officers passed through the neuro-psychiatric services of 
Army hospitals. 
5SXA-U ~Z Dr. Hochapfel was then asked whether psychopathic personalities 
were ever selected for jobs as "bullies" in concentration camps, such 
as the notorious "Beast of Belsen", and similar characters in lesser 
positions. Dr. Hochapfel gave the interesting answer that psychopathic 
personalities had been quite early found unsuitable for such positions 
by the Nazi party. On the contrary, specially reliable and stable 
people were selected for these positions, who wero then brutalized 
by a special process of indoctrination. Their brutal performance 
pattern was then established and further fortified by practice. 
Dr, Hochapfel stated that only stable and stolid persons, real "boss" 
natures ("Richtige Bonzen"), performed well (according to Nazi standards, 
of course) in these positions; and that psychopathic personalities were 
not reliable enough for such jobs, especially in view of their natural 
rebellion against authority. He supposed that psychopaths occasionally 
got into such positions, but that most of them had soon to be disposed 
of again, which, of course, by SS standards, meant execution. Therefore, 
real psychopaths didn't last long in such positions, and the SS soon 
caught on to the selection of persons for such jobs on the basis of 
reliability and stolidity. 
Of neurologic problems, the neuro-psychiatric complications of 
typhus, Russian headache fever, other moningo-encephalitides, and the 
Guillain-Barre syndrome, were among the biggest problems. 
An interesting and quite general observation was that most psycho- 
genic reactions at the front occurred during periods of relative quiet, 
and practically none during advances. Monotony was found to be the 
most disintegrating experience. Psychogenic reactions were also far 
more frequent in the Zone of the Interior than at the front. The fear 
of going to the front was more devastating than actually being at 
the front, and the fear aroused by enemy air attacks over German terr- 
itory was greater than the fear aroused by combat activities at the 
front. Dr. Hochapfel concluded by saying that he had no comparative 
data concerning the civilian population, but thought that Dr. Kleist 
had interesting data concerning the reactions of the civilian populat- 
ion in Frankfurt. 
4• Information obtained from Stabsarzt Dr. Eduard Beck, member 
of the Staff of the neuropsychiatric service of the Reservelazarett in 
Tut zing, Bavaria. Dr. Beck was very cooperative, and it is definitely 
due to his efforts that his chief. Dr. Hochapfel, was likewise drawn 
into an atmosphere of frank discussion without reservations. Dr. Beck 
is an astute observer and research man, who has not only contributed 
important work to the finer anatomy of the brain, but who also had 
become an accomplished psychotherapist during his many years of assoc- 
iation with Dr. Oscar Vogt in Berlin. 
In spite of Dr, Beck's qualifications, his utilization during 
3-aa-v^.a. 
58 the war had not always been in neuropsychiatry, but because of his 
interests in the comparative anatomy of the brain he had first been 
placed in charge of a veterinary hospital for horses (,,PferdelazarettB) 
from which assignment he was finally extricated the efforts of 
Professor Smoke in Munich. At present he was found to be in charge 
of about 250 patients, most of whom were organic cases, mostly gunshot 
vrounds and closed injuries of the head. There were very few neuroses 
at the Tutzing hospital, because most of them were transferred to Dr, 
Ziehen*s military section at the Neuropsychiatric University clinic 
in Munich. The main treatment there consisted of electro-shock treat- 
ment and of treatment with strong galvanic currents, the latter being 
a modification of the old Kauffmarm tr&atment. However, Dr. Beck saw 
a good deal of the general turnover of neuropsychiatric cases in 
other departments and anpy hospitals. 
Dr. Beck stated that in general during this war there were 
"practically no tremblers: in this war the stomach was everything"• 
Dr. Beck feels that there are two reasons responsible for this shift 
in symptomatology. One reason was the generally severe regimentation 
and handling of army personnel which especially discouraged any mani- 
festations which looked or sounded like psychiatric ones. Hence, 
things were repressedjto deeper psychosomatic levels. But Dr. Beck 
feels that this is not the entire explanation, and that another 
more simple explanation may actually be the more crucial one. Dr. 
Beck had been a regimental surgeon in the front lines in the last war 
and he had then made the experience that in the cold chill of the 
trenches under the simultaneous influence of normal tension incidental 
to artillery barrages a good many more people had briefer or longer 
episodes of trembling than later turned out to be actual neurotic 
tremblers. Dr. Beck feels that an occasional episode of trembling 
was quite a normal episode under the above conditions, and that it 
occurred in the bravest and strongest as well, and at times when they 
had no conscious subjective feeling of fear; but that neurotic per- 
sonalities seized upon this quite general symptom as it provided them 
with a clue on the choice of symptoms for their neurotic illness. In 
other words, trembling was the normal key sensation and experience, 
which the neurotic personality seized and fixed as a nucleus for his 
symptoms expressing manifestation of disability. The same role which 
the occasional and transitory trembling had played in trench warfare, 
especially during winter, was played by gastric disturbances in the 
present war of movement. In a war of movement, due to the inevitable 
irregularity, shortcomings of preparation, lack of balance of 
hastily consumed cold meals, everyone — even the strongest and 
bravest — developed at many periods various degrees of gastric 
These normal and widespread, gastric disturbances, however, 
again gave the clue in the symptom—choice to the neurotics in this 
war, which was essentially a war of movement. (Dr. Beck*s 
38 Xti-H-l. explanation is indeed very illuminating and his observations in regard 
to episodes of non-meaningful trembling during trench warfare in nor- 
mals are confirmed by two striking observations which Lord Moran 
contributed in his recent book entitled "The Anatomy of Courage". One 
of them is an observation on himself. On a chilly winter evening, 
during an artillery barrage, he found himself suddenly gripped by an 
uncontrollable shaking, which he at first attributed to the cold 
temperature. But, so he said, the tremor did not stop even after he put 
on his "British warms". It was not until his attention was distracted 
by taking care of the wounded coming in that the tremor ceased. Lord 
Moran stated that he had not been conscious of any particular 
feeling of fear at the time of his trembling attack. The other 
observation concerned a line officer with whom he had long been assoc- 
iated and who had never before or after shovm any signs of undue fear 
or apprehension, or of neurosis. One day this man was standing on the 
top of a ladder looking out of the trenches through his field glasses. 
There was a high wind and an artillery barrage was in progress. Lord 
Moran suddenly noticed that the ladder next to which he stood began 
to shake rhythmically, T/hen he looked up he saw that the tremor 
originated from his fellow officer who stood on top of the ladder, but 
who gave neither then nor at any other time any indication that he had 
been conscious of any fear at the time. I have had a very similar 
experience in the chill of the East Anglian winter myself. 
Dr. Beck, who used to live off the post, had made some observa- 
tions concerning the emotional effect of the aerial bombardment in 
the Munich area. The women particularly were in a continuous state of 
anxiety, and hysterical shrieking fits were not infrequent during raids. 
Another way in which war nerves manifested themselves in the civilian 
population was the way in which superstition, especially the belief 
in astrology, increased. In one month or another an astrologer pred- 
icted a heavy raid on Munich on "the 27th", and people ran away in 
droves and spent the night in the woods. People also looked for signs 
and portents in other ways. The Munich edition of the "Volkischer Beo- 
bachter" comes out at times with two or three little stars on the front 
page, the meaning of which is unknown and probably unimportant, People, 
however, began to assume that on the days when this newspaper came out 
with those little stars, the stars had been put there by the Nazi 
Party to tip its members off that a heavy attack was expected that 
night. This likewise led to mass exodus. It was generally believed 
that the Nazis got special messages from England. Dr. Beck feels that 
the bombing attacks decided the war. The nutritional situation was 
never bad. 
5• Information obtained from G-eheimrat Professor Dr« 0. Burake, 
Chief Consultant Psychiatrist and Neurologist to the Heeressanitatsst- 
affel Munchen, with the rank of Oberstarzt (Colonel) in the G-erman 
Army Medical Corps. 
Professor Bumke had jurisdiction over 25 specialized military 
Neuropsychiatric hospitals (Lazarette) in 10 different locations, with 
a total bed capacity of 3000 beds* The largest single number of patients 
were those with gun shot wounds of the peripheral nerves. 
stoMv-*. This well known neuropsychiatrist and author of a well known 
text book which is. in widespread use in many countries including the 
United States, was interviewed on 7 June 1945 and was asked a number 
of specific questions. My first question was: "Was the problem of 
neurosis well handled in the German Army?" Dr. Bumke answered "No". 
When asked to qualify this statement he said: "In one respect it 
was handled well in that it was prevented from playing a groat practical 
numerical role. This was due to the policy of not evacuating neurotics 
from the front to the zone of the interior, but of keeping them at 
the front in whatever limited duty capacity was possible. But what I 
disapproved of was the Kauffmann-type of electric treatment with which 
people were freed from their symptoms and good symptomatic results 
were achieved without making good soldiers or more stable human 
beings out of them. Furthermore, I considered the whole way in 
which the treatment Y/as given as non-medical and unsoldi or ly. I 
never could get myself to even look at it because I did not like the 
whole idea". 
My next question was: "What were your experiences with psychoso- 
matic illnesses?" Dr. Bumke replied: "Those we left completely to 
the internists. My decision in that respect was confirmed by the 
following experience: One day my internal medical colleagues took me 
to Bad Tolz" (which Y/as the large Gastric Department of the Internal 
Medical Service) "and asked me to look over some of their functional 
stomach cases, and to give them opinions in regard to my findings, which 
they were then to compare with their organic findings. The only 
patient v/hom I thought I could identify as an essentially psychopathic 
deviant was one who had a massive positive Roentgen finding, and was 
a definite ulcer case. From then on I left them all to the internists. 
They have treated them and then discharged them into special stomach 
battalions." 
6 • Information obtained from Dr« Alfred TTiskott. Professor of 
Pediatrics, and at present also Dean of the University of Munich 
Medical School: 
The main purpose of my visit to Professor Wiskott was to 
question him about the medical school curriculum in Germany during the 
war (v/hich will be reported on in a separate report); but I also asked 
him whether ho had observed any new diseases, especially of the nervous 
system, in children during the war, and what the incidence of encephal- 
itis of various types Y/as in children. Dr. Wiskott said that sporadic 
cases of Japanese type encephalitis had occurred in children during 
the war. The only new disease observed by him was a myocarditis 
in infants in the second half of the first year of life, Y/hich, however, 
was probably contracted in utero because of the intense scarring found 
at autopsy. It occurred with increased frequency in families and twins. 
3%i».hh-V 
61 He observed 50 - 60 cases since the beginning of the war. He named the 
disease "myocarditis of sucklings" (Sftuglingsmyocarditis), Also since 
the war, an increase in abscess forming pneumonias in children was 
observed. 
7* Information obtained at the Psychiatric Clinic of the 
University of Heidelberg Medical School, 
The director of this clinic, Professor Dr. Carl Schneider, who 
held SS rank, fled at the arrival of the American armies because of 
his participation in the executions of the insane (which are the 
subject of a forthcoming report). The present acting director, 
Stabsarzt Dr. Hans Joachim Rauch, Army Medical Corps, was interviewed. 
He stated that the military section of the clinic was mainly a diagnos- 
tic center, which admitted particularly patients with various psycho- 
ses, especially early diagnostically unclear cases that did not need 
closed ward facilities, post-traumatic states, convalescents from 
typhus with neuropsychiatric complications, and neurotics. There was 
also a small section with facilities for electro-suggestive treatment. 
Dr. Bauch, and especially his assistant Stabsarzt Dr, Friedrich 
Schmieder, German Army Medical Corps, who was likewise interviewed, 
were particularly interested in the neuropsychiatric sequelae of 
typhus. Dr. Schmieder has written an excellent and comprehensive 
monograph on the subject (Appendix 3, Ho*l). He found a great 
number of dystonlc states similar to postencephalitic dystonia, as 
well as milder cases with predominantly vegetative symptoms which 
he called "vegetative dystonias". An interesting observation by Dr* 
Schmieder was the one concerning the prevalence of constitutional 
anomalies of the hypophysis (enlargements, underdevelopments and 
"bridge formations" in the X-ray pictures of the sella) among patients 
with neuropsychiatric sequelae following typhus as compared to uiw 
selected normal controls, which he interpreted as an expression of 
constitutional predisposition for the development of such sequelae. 
Dr* Rauch himself had been at the Russian front for half a year. He 
stated that he was lousy from the day he got there until the day be 
left. There was no effective remedy against infestation with lice, 
except an occasional steam delousing. In the first year of the 
Russian campaign practically everybody above the age of 50 years 
contracted typhus, as well as a good many others in the middle age 
groups, especially officers, flying personnel, doctors, and sanitary 
personnel. Later the incidence increased still further, even in- 
cluding the younger age groups. Typhus was one of the most sig- 
nificant problems of the German army in the East* 
3. Information received at the Neurological Department of the 
Ludolf Krehl Clinlp, for Internal Diseases of the University of 
Heidelberg Medical School. 
At my first interview with the second in command, Stabsarzt Dr* 
E. Bay, he stated that 40 beds in the department were reserved for 
civilians, and 50 beds reserved for military personnel, predominantly 
army men, of whom the majority were suffering from organic neurolo- 
gical disturbances. This was due to deliberate selection of patients 
because the department made a point of not admitting more than 5 
psychogenic cases at a time, although it is obvious that they could have- 
33 X.UU. - admitted more had they d.esired. Their main material consisted of gun- 
shot wounds of nerves and post-diphtheric palsies, and the psychogenic 
cases were likewise limited to cases with symptoms referred, to the 
extremities, especially psychogenic palsies. Dr. Bay had. a particular 
interest in patients with psychogenic fixation after recovery of an 
originally organic palsy, and. ho published, a paper on the subject 
(Appendix 3? //'<+)• 
Dr. Bay stated that all functional cardiac and. gastric cases in 
the Heidelberg military hospital system were treated, by the internist 
Dr. Siebock. Dr. Bay stated that in his opinion the organ-neuroses wore 
by far the largest group of all psychogenic cases combined. 
Other scientific interests of Dr. Bay were the etiology and 
therapy of multiple sclerosis (Appendix 3. and problems of 
cerebral localization (Appendix 3?/z?/3), especially tactile Agnosia 
(Appendix 3,/b). 
Dr. Bay stated, that in the civilian section of the department 
numerous psychogenic cases were treated. He stated that many psycho- 
genic reactions to the bombing attacks occurred when they began and 
were relatively light, especially among women, and that the second peak 
of incidence of psychogenic cases occurred later when the attacks became 
really serious, especially in nearby Mannheim. 
The former head of the department, Professor von Weizsacker, left 
in 1941, when he was transferred to Breslau to become Forster’s successor, 
and he took most of his physiological experimental equipment with him. 
Some of it has been stored in Zinsheim in order to be protected' from 
air raids. Dr. von Veizsacker’ s successor, Professor Paul Vogel, was 
mainly interested in clinical work and was doing no laboratory experi- 
ments, except some concerning optic disturbances in the brain-injured.. 
The head, of the department, Obertabsarzt (Army Medical Corps) 
Professor Dr. Paul Vogel, was seen later. Professor Vogel stated that 
40 out of the 50 military patients on his wards were usually organic 
cases, the other 10 were neurotics. The types of neuroses which he 
admitted and. treated were usually some of the less spectacular 
hysteric shaking palsies and hysteric contractures. His main interest 
was in the hysteric overlays over organic palsies of arm or log follow- 
ing gunshot wounds of the nerve. The treatment used in his department 
v/as a combination of psychotherapeutic discussions with massage and 
gymnastics. He did not use the Panse treatment because he had an 
aversion to that "massive and brutal method". However, Panse treatment 
was given in the Psychiatric clinic by a Dr. Wendt, and occasionally 
-SL Vogel transferred to it those of his patients in whom he could obtain 
no results with his own more subtle methods, or those who developed 
entirely without any original organic basis such as on the basds of a 
transitory organic nerve palsy# 
Dr, Vogel then discussed the general problem of neurosis in this 
war as conrpared with the last war. He stated that in the last war most 
neuroses were “motor neuroses*1, hut in this war they were “vegetative 
neuroses**. These vegetative neuroses in this war were almost ex- 
clusively treated hy internists. The means of treatment which the 
internists used were mainly atropine, hydrotherapy, and psychotherapy 
of a sort, which was sometimes given hy a consulting neurologist with 
interest in psychotherapy, called into consultation hy the internist. 
Dr* Vogel himself had one psychotherapist on his staff, namely Dr, 
Alexander Mitscherlich, who was a trained psychoanalyst, and a 
graduate of the “Berlin Institute for Psychotherapy and Depth- 
Psychology” headed hy Professor M,E, G&ring.Doctor Schulz-Henke, and 
Dr, J,H, Schultz. There the classical type of psychoanalytic graining, 
including teaching analysis, was available. 
As to neuroses among the civilian population. Dr, Vogel said 
that shaking neuroses after bombing attacks, were likewise less fre- 
quent than expected, and that as in the army, the predominant 
psychogenic syndromes were neurasthenic pictures with sleep dis- 
turbance, symptoms of vegetative lability, palpitation of the heart 
and gastric disturbances. He feels that the new shift in symptom 
choice existed not only in military personnel', but in the civilian 
population as well, i,e. a shift of the hysteric symptomatology 
from the tremors and paralyses of the extremities to the vegetative 
system. Pure classical anxiety neuroses, however, were not very 
frequent, and were less common in the military than in the civilian 
population. 
All functional illnesses in the army showed a steep increase 
in the second half of 1944; they increased rapidly by 100$ over what 
they had been up to that time* Dr, Vogel thinks that the cause of 
this 100$ increase was the fact that the younger age groins, 
especially 17 - 19 years, were suddenly drawn into strenuous mili- 
tary service and that these age groups were more susceptible to the 
development of neurotic reactions. 
Dr, Vogel served in Berlin as neurologic and psychotherapeutic 
consultant to Dr, T6nnisfs neurosurgical center from 19S9 - 1940, 
Dr, Vogel* s main job was to treat by means of psychotherapy patients 
admitted to Dr, T6nnis*s clinic as brain tumor or brain injury suspects 
and who turned out to be cases of neurosis. He used a modified analytic 
method for his psychotherapy. Dr. Vogel s$a$es that of Dr, Tbnnisfs 
60 beds at that time, four of five were usually occupied by neurotics, 
I then asked Dr, Vogel about his ideas concerning “Hirnleistungsscb- 
wftche" (brain performance weakness). He stated that the concept had 
essentially been evolved by Dr,Reichardt and he described it as 
basically similar to our concept of post-traumatic syndrome. Dr. 
Vogel stated that practically no such cases were seen after concussion 
and he considered the post-concussional syndrome when it lasted any 
38*.*.*--;!, length of time as essentially due to neurotic fixation; but that the 
syndromes occurring after contusions can be due to organic post- 
traumatic cerebral damage. 
The greatest single neurological 'problem was the many polyneur- 
itides, most of which were post-infectious namely due to panaritium, 
abscesses etc. These patients had sensory changes, ataxia, flaccid 
weakness, but no pain. The number of those polyncuritides increased 
progressively throughout the duration of the war. Such cases originally 
came from the Africa Corps and later in increasing numbers from 
Russia. They were clinically like post diphtheric palsies, and the 
purulent lesions which festered for a long time were probably wound 
diphtherias. In some cases the lesions actually yielded diphtheria 
bacilli. The increase of wound, diphtheria could be ascribed, to an 
increasing deterioration of hygiene as the hardships of front life 
increased during the progress of war. Dr. Vogal states that these poly- 
neurit ides following festering wounds had. been known for a long time, 
but that they had not been identified as post diphtheric palsies until 
this war. Bannwarth, who had originally described, these palsies as 
''polyneuritis after ulcus cruris" regarded them as an allergic reaction 
to the purulent infection, but they are now properly identified a.s 
post-diphtheric. Diphtheria on the whole was very frequent in Germany. 
The diphtheric wounds usually fester for about nine weeks; the post- 
diphtheric polyncuritides get well about three to four months after- 
wards. Dr. Vogel has seen no cases of respiratory paralysis in post- 
diphtheric polyneuritis. His treatment was bedrest, strychnia, 
administration of high doses of vitamins, massage, and exercise. 
His publications during the war deal with general reviews 
(Appendix 3? especially on lesions of the peripheral nerves 
(Appendix 3? ,/?? 8 & 9) and on the vegetative system in brain stem 
lesions (Appendix 3> 
9« Information obtained from Qberstabsarzt Dr. Alfred Schwenn- 
inger, G-erman Army Medical Corps. 
Dr. Schwenninger (MD, Munich 1912), is a trained neurologist and 
psychiatrist, who has been in the army since 1939* Throughout that 
time he has been in charge of the military section of the State Hospital 
for the insane in ITiesloch (.Badische Heil-und Pflegeansta.lt Hiesloch, 
near Heidelberg), His hospital section at present numbers 1290 beds. 
Originally 300 of those were neuropsychiatric beds. Of these usually 
200-400 were occupied by cases of brain injuries, 180 by patients with 
injuries of the peripheral nerves, 30 by patients suffering from other 
cerebro-spinal organic diseases, and the rest by psychonourotics and 
psychopaths. At present 1193 patients arc in his hospital section, of 
whom only 69 are neuropsychiatric patients. Thirty arc patients with 
gunshot wounds of the head, 13 are psyohotics and the remainder 
neurotics and psychopaths. Ho did not use the electro-suggestive 
treatment: "I do not think much of the Pansc treatment; that was nothin 
but brutality, one cannot really dignify it by the word 'suggestion’ Dr, Schwenninger himself feels that the really effective treatment of 
the neurotics, whatever fancy method was used, was actually accomplished 
by the simple fact that they were put on limited service. He himself 
preferred a modification of Binswanger’s therapy, which v/as nothing 
but simple suggestion by "talking it over”. He feels that the results 
by this treatment were as good or even better than any obtained by 
the more rjopular brutal methods. Binswanger1 s system consisted first 
in a period of complete rest, then gradual activation and talking it 
over. The whole course of treatment lasted usually 4 - 5 weeks. All 
hysteric symptoms such as stuttering, aphonias, gait disorders such as 
astasia-abasia, as well as postural abnormalities, responded very well, 
but the real therapeutic point was that the patients got to know by 
grapevine that after they got well they would not be sent back to the 
front, especially not to Russia, All. limited service men were sent to 
Prance: "that is probably why those armies folded up so easily". 
The Germans1 claim that "there v/ere no war neurotics in this 
v/ar", Y/hich they made in the early phases, v/as nothing but a cla.im, 
Carl Schneider used to say "in this v/ar there are no more neurotics. 
That has been taken care of by the political education of the people," 
There were really no neurotics to speak of in 1939 - 1940, but that v/as 
duo to the rapid and successful events of that war period; but in the 
last few years the neuroses increased enormously "in doubtful person- 
alities”, To be sure, there were no discharges from the German army 
for either neurosis of psychopathy; the psychopaths were all put into 
prisons or into punishment battalions and the neurotics were sent to 
limited service or hospitalized in state hospitals for the insane, but 
they too remained in the army. 
The administration of justice in this v/ar was much more severe 
than in the last v/ar. Dr, Schwenninger himself had a very extensive 
military medico-legal practice; ho had to deliver one expert opinion 
per day. The usual crimes were desertion, unauthorized wearing of 
decorations, impersonating an officer and so forth. Most of these 
cases came from the big army prison in Gerraersheim, which had a 
capacity usually fully utilized for 1200 milita.ry prisoners. Some 
of the prisoners were also sent to the psychiatric clinic in Hiedel- 
berg for expert appraisal. 
As to the psychoses in army personnel, they are in no v/ay differ- 
ent from psychoses in civilian life. 
Every punishment company consisted of 150-200 men. Some of 
these companies v/ere used in rear areas, for farm work and construction 
work in Russia,, Others v/ere used as "redemption battalions", doing 
dangerous chores in particularly exposed areas in ba.ttle. If they 
survived and performed well for a certain time under such comba.t 
conditions, they v/ere sometimes pardoned and returned to the regular 
combat roops. The officers of these special punishment and redemption 
battalions and companies, as well as the non-commissioned officers 
were especially trained for these assignments. In view of the draconic punishments for certain crimes, particularly 
homosexuality, it became the accepted practice among experts to go all 
out in finding the accused criminally not responsible, ”T7e always 
excused them (the homosexuals) and sent them right back to the 
troops”. The causes for abolition of criminal responsibility some- 
times required some heavy thinking. Dr, Schwenninger recalls that in 
one case of homosexucality he explained it as having been due to an 
old fracture of the skull in the region of the hypophysis (since the 
law concerning homosexuality excused people with endocrine abnormal- 
ities) , Vfhen nothing else could be found one declared them to bo 
due to pa.thologica.1 or severe intoxica/fcion. 
Of neurological cases, cases of wound diphtheria, with polyneuritis, 
were particularly numerous, ’’There were a. lot of festering wounds and 
most of them were due to v/ound diphtheria.”, of gunshot wounds 
of peripheral nerves recovered spontaneously. 
Dr, Schwenninger treated six cases of polyneuritis due to 
tetraethyl-lead intoxication, two of whom had delirious mental 
disturbance. The intoxication was sustained while washing cars with 
avialion gasoline; all were Air Force ground crew men. One of his 
assistants, Oberarzt Dr. Martin Klitemeyer, prepared a special report 
on these cases which was sent to Berlin, together with the case histories. 
There was some disagreement about the diagnosis in these cases as 
Dr. Vogel in Heidelberg, the consulting neurologist, had dia-gnozed 
some of them as multiple sclerosis, but Dr, Schwenninger recalls that 
they did have blood changes characteristic of lead poisoning. 
10. Information obtained from Oberstarzt (Colonel) Professor Dr. 
Karl Kleist," chief consulting psychiatrist to the 9th (Kassel)"Corps, 
Area, 
Dr. Kleist was visited at the university clinic for nervous and 
mental diseases in Frankfurt on Main of which he had remained the 
director throughout the war. However, during the war, in addition to 
teaching, he had spent most of his time with his military duties 
leaving the major part of his civilian work to his second in command, 
namely Dr. Karl Leonhard, associate professor in neuropsychiatry at the 
University of Frankfurt on Main. Dr. Kleist was very coopeiai-ive 
and expressed a great deal of pleasure at my visit j I had studied 
under him before the war. Dr. Kleist had just "been reinstated in 
his former position after a brief period of suspension from his post 
because of the fact that he joined the Nazi party in 1940. He gave 
up his original attitude of passive objection to the Nazi government 
at that time because he thought that the war was practically won and 
that he had to come to terms with them in order to be able to continue 
his resea.rch. However, he stated that he had used his position in many 
ways to o.ttempt the exertion of a moderating influence upon them, es- 
pecially in regard to their illconceived policy of exterminating the 
insane by neglect, which he has criticized as far as he considered feas- 
ible "without committing suicide myself". This had related policies 
3Kk.M-H-3- concerning the mentally ill will he dealt with in a separate report. 
Dr, Kleist gave me access to reprints of his published papers 
as well as to a complete set of his unpublished quarterly reports to 
higher army authorities. These quarterly reports are very instructive 
because they are detailed and include a good many individual case 
reports, including reports of medical legal cases which allow a very 
concrete realization of the problems confronting the German Corps 
Area consultant in psychiatry. In 1944 Dr, Kleist published a 
summary of his reports of 1943 (Appendix 4* $ 1), in which he stated 
that in terms of total numbers of cases under his care, peripheral 
nerve lesions were the most numerous, followed in the order of numbers 
of cases by the psychopaths and the psychogenic reactions, then in 
the third place by the injuries of the brain including contusions 
and concussions. Then, after a considerable interval came the 
following: organic diseases of the peripheral nerves, organic diseases 
of the brain and spinal cord, mental deficiency, and the convulsive 
disorders. Injuries of the spinal cord and the psychoses are the 
smallest groups. 
Of the polyneuritides, those due to wound diphtheria were the 
most frequent, followed by the toxic polyneuritides which were part- 
icularly frequent in Russian prisoners-of-war who mistook industrial 
alcohol for potable beverages. Then came polyneuritides of the 
Landry type, some of them associated with metabolic disorders, espec- 
ially haemat©porphyrinuria. Of the mononeurititides, sciatic 
neuritis was the most frequent; but Dr, Kleist emphasized that this 
type of neuritis is very often aggravated by functional mechanisms 
and frequently represented an entirely functional syndrome. Dr, 
Kleist felt that the functional variant of sciatic neuritis was highly 
"infectious”, especially if too many sciatic patients were concentrated 
in one hospital. He felt that single cases distributed over hospital 
wards filled with patients of other types did better. Dr, Kleist 
emphasized that lumber punctures should be performed in all such 
cases, since the organic variant frequently showed increased protein 
in the spinal fluid and a lesser increase in cells. He stated that 
encephalomyelitides, especially optic neuro-myelitis, had increased, 
and that similar syndromes have occurred as complications of typhus. 
Post-encephalitic Parkinsonian states with predominant personality 
disorders had been discovered in patients who were originally 
considered disciplinary problems. There were a number of sympto- 
matic psychoses in febrile illnesses. Dr, Kleist emphasized that 
multiple sclerosis should be considered as a condition incurred or 
aggravated in line of duty, because physical hardships may have 
definite aggravating effect upon it. Dr, Kleist made the inter- 
esting statement that he has come to consider Adie’s syndrome as 
due to an avitaminosis. It responded to high doses of vitamin B and 
C. Dr. Kleist mentioned that hyperthyroidism had greatly increased, bait he stressed that even marked increase of the basal metabolic rate 
was not necessarily a proof of its organic causation, although it was 
too often considered as such. He stated that hyperpnea in anxiety states 
or even volitional hype?nea may frequently be a source of technical 
error. Dr. Kleist mentioned the occurrence of vascular accidents in 
young people under the combined influence of excessive smoking, ex- 
cessive intake of coffee, emotional excitement, escessive physical 
strain and hot weather. As to the psychoses, Dr. Kleist stated that for 
more psychotic disturbances were being mis-diagnosed as schizophrenias 
than vice versa. In particular, psychogenic and anxiety depressions 
as well as symptomatic psychoses caused by physical illness were too 
"Often mistaken for schizophrenia. On the other hand. Dr, Kiilst 
stated that too many psychoses were not recognized at all, especially 
melancholias and anxiety depressions. Sometimes these patients commit 
suicide before their mental state is appreciated in the proper light. 
Dr. Kleist stated that in such cases the question as to whether the 
condition was incurred in line of duty shooild be answered in the affir- 
mative because of the existence of Mspecial conditions of military 
service. In that symptoms of illness were insoifficlently appreciated 
thus constituting a lack of medical and specialized attention”. Dr. 
Kleist mentioned another case of catatonic schizophrenia who was mis- 
taken for a malingerer and assigned to a special punishment batta- 
lion where the true nature of his condition was finally discovered. 
Of the 100 suicides that were referred to Dr. Kleist for appraisal 
during the year 1943, diagnostic categories grouped themselves as 
follows : 
Melancholia 10 
Anxiety depressions 6 
Hypochondriac depressions 11 
Beactive depressions (in the 
presence of depressive,cyclo- 
thymic* emotionally labile 
or sensitive personality) 28 
Affective reactions in charac- 
teropaths 25 
Synptomatic psychoses of 
depressive coloring 7 
Schizophrenia 2 
Depressive states incidental to 
other diseases: 
(epilepsy: 1 
mental deficiency: 1, 
traumatic brain weakness; 2 
alcoholism: 3), 7 
tfnclear cases 4 
Dr. Kleist stated, in discussing these cases, that depressive 
remarks and inhibitions in soldiers are too frequently mistaken as 
expressions of laziness or recalcitrance and unwillingness for 
duty, anfl that when depressives seek solitude they are frequently 
reproached with lack of comradellness* Among the hypochondriac 
Z depressions, the predominant fear was that of having contracted venereal 
disease* with the attendant worries and self-reproaches because of 
extramarital sex relationships. This was particularly so in married 
soldiers. Dr, Kleist also mentioned that on the internal medical services 
many patients we re being studied and observed for vague and hypothet- 
ical physical abnormalities* such as high blood pressure, heart muscle 
damage or thyrotoxicosis, and that the true nature of their condition 
ms not being discovered until after they committed suicide or attempted 
to do so. In the group of reactive depressions among sensitive 
personalities* the predominant motive was hurt pride especially as a 
consequence of reprimands, but conditions incidental to military service 
were only responsible for half of these cases* while in others suicide 
was caused by marital discord, love affairs or financial worries. 
In the chapter on/hysteric reactions jDr, Kleist emphasized that 
proper and thorough examinations were -tileonly method to avoid pampering 
hysterics on the one hand* or subjecting people suffering from 
organic nervous illnesses to strenuous and for them injurious methods 
of treatment on the other. This applies especially to cases with 
tremor and other hyperkineses* organic variants of which’were too 
often mistaken for hysteria and subjected to Pause’s strong electric 
currents. On the other hand* hysteric states* especially sciatic 
neuritis* were frequently mistaken for organic ones. Dr, Kleist 
emphasized that organic and hysteric disturbances may be coexistent* 
and that a careful history was always necessary to unravel complicated 
cases. Bizarre multiplicity of symptoms was usually suggestive of 
hysteria* such as in the case of a soldier who was injured by shell 
fragments on the left side of the neck and the left upper arm and 
who developed a bizarre picture of disability consisting in the 
fact that whenever he, or somebody else passively, elevated his left 
upper arm his voice became reduced to a whisper. Another patient 
developed fits vdth palpitation, vomiting and crying* after he had 
been injured by a shell splinter in the gluteal region. Dr. Kleist 
stressed that psychological understanding was necessary in those cases 
because most of these patients due to heightened autosuggestion had 
an honest conviction of being disabled. Even severe psychotic 
hysteric disturbances with incoherence, stupor and pseudodementia may 
occur in the wake of debilitating diseases such as dysentery, if 
associated with loss of weight and strength as occurred in a case of 
a soldier whose mother too had a severe post-traumatic neurosis. 
Another soldier born in Poland who was somewhat primitive and 
unintelligent and had already had one hysteric reaction while he was 
still fighting with the Polish Army against the Germans, developed a 
severe fugue state with pseudodementia, incoherence, trembling and 
weakness when he was taken over into the German army. This man 
recovered after treatment on the closed ward for excited patients* on 
a regime of prolonged baths and rest in a darkened room. Dr, Kleist 
warned against letting any such psychotherapeutic measures appear as 
punishment because the hysteric as such was no malingerer, although 
there were some people who were both. Thus psychotherapeutic results 
achieved must always be supported and reaffirmed by occupational therapy. 
3«an-H- -*■ 
70 Of the characteropaths* most of them were seen because of offences 
that they had committed or because of attempts to escape punishment by 
suicide. Among the offences* the most numerous were AWOL and desertion. 
Furthermore* there were thefts* "corrosion of the armed forces", 
self-mutilations* unauthorized wearing of ranks* badges and decorations. 
A quarterly report by Dr, Kleist at a later period of the war 
deals with the period up to December 31? 1944* (Appendix 4* 2). Of 
1980 patients* 1108 had lesions of the peripheral nerves* 1013 of 
them injuries by missiles* 95 neuritides and polyneuritides. There 
were 99 spinal cord cases* 82 of them injuries* 17 diseases. There 
were 591 organic brain lesions* 527 of them injuries. There was a total 
of 182 psychogenic cases. Dr. Kleist stated that the most striking 
change was the great increase of the neuritides and polyneuritides 
which had jumped to 95? from 22 during the preceding period. The 
report contained reviews of interesting medico-legal cases* such as 
one involving murder followed by suicide* in the case of an officer 
who killed a fellow officer and himself in the course of an evening in 
which they wined and dined with two ladies, presumably in a fit of 
jealousy. Other medico-legal problems included AWOL* desertion* assault* 
disobedience* resisting arrest, attempted rape* subversion of the armed 
forces, hostile utterances against the state* unauthorized wearing of 
decorations* perjuries* fraud and unauthorized medical practice. Of 
30 cases* 12 were found not responsible for pyschiatric reasons* in 
four diminished responsibility was found. Among these excused were 
two mental defectives who ran away in hapless panic on the day follow- 
ing their induction into the military service. One of them* -when 
brought back and hospitalized, was in a state of acute disturbance. 
He thought one patient looked like a snake* another soldier was the 
Black Satan himself* and others were Bolshevik agents* or disguised spies. 
Voices whispered to him at night that his hour had come* black shadows 
moved about him and looked like dead people; sometimes he felt a cold 
hand grabbing him by the neck. This picture was interpreted as a 
reactive anxiety state in a mentally defective individual. 
Another borderline mental defective ran away during an air raid 
into a forest where he hid himself and walked about without direction 
for several days and nights* until some farmers picked him up. He had 
a previous similar episode during an air raid whilst serving on the 
Italian front. Even during observation in hospital he showed marked 
anxiety during air raids. A patient with hydrocephalus had committed 
an assault against a sergeant for which he had complete amnesia. He 
was likewise declared irresponsible. 
Dr. Kleist mentioned that some patients with residual symptoms 
following typhus or diphtheria had been unjustly suspected of malingering. 
On the other hand*, cases referred as organic at first were * upon thor- 
ough diagnostic study* revealed as functional and successfully treated 
at the electro-suggestive treatment center of Stabsarzt Professor Dr, 
Gerum at the Reichsschulungsburg Oberursel, 
A. The publications by Dr, Kleist and his co-workers concerned the 
following subjects: Anxiety Psychoses (Appendix 4, #3); episodic bouts 
of sleeping in endrocrine, especially hypophysial disturbances (Appendix 
4,#4); the epileptoid -Dsychopathies (Appendix 4, #5); liver function 
in thyrnergasic psychoses (Appendix 4, #6); paranoid schizophrenia 
(Apuendi 4, #7,8 & 9); catatonia (Appendix 4,#10); .spinal fluid 
studies in endogenous psychoses (Appendix 4,#11); an interesting 
study of facial expression with particular attention to those parts 
of the face which do not primarily participate in expressive mimic 
activity (Appendix 4, #12); on optic spacial ideas involved in 
calculation (Appendix 4,#13); on dyspraxia and dysphonia (Appendix 4, 
#14); Alzheimer's disease (Appendix 4.#15); cerebral manifestations in 
Buerger's disease (Appendix 4,#16); frontal lobe tumors (Appendix 4, 
#17); central pain and hyperpathy in lesions of the cerebral cortex 
(Appendix 4,#18); on symptomatic psychosis in pituitary dwarfism 
(Appendix 4,#19); and on thinking disorders in post-traumatic states 
(Appendix 4,#20). 
In a personal conversation. Dr, Kleist stated that gross hysteric 
disorders, such as hysterical shaking palsies, increased during the 
latter part of this war, but the greatest number of neuroses still 
remained the "masked neuroses", by which he meant psychosomatic illnesses. 
One of the greatest problems in terms of numbers of patients were the 
post-diphtheric polyneuritides. Even apart from 
played an entirely colossal role in this war". Some cases occurred 
in scarlet fever; "and on the whole it can be said that there was not 
an infectious disease in* the German army that did not cause many 
polyneuritides". Furthermore, "there has not been a war before in which 
so many wound diphtherias occurred." Dr. Kleist treated the post- 
diphtheric polyneuritides with diphtheria serum and vitamins. 
The von Econorao type of encephalitis was very rare, but did occur. 
Post-infectious encephalomyelitides were quite frequent. Post-enceph- 
alitic personality changes were pretty important as a medico-legal 
problem because it made the soldiers so afflicted "sleepy and sassy". 
The fact that so many of these cases turned up in the army was due 
to the fact that there was no specialized examination of 
inductees. Only after the soldier had aroused attention was he sent 
to a psychiatrist. Dr. Kleist had a special neuropsychiatric out- 
patient department for soldiers in his clinic. He feels that a 
considerable number of neuropsychlatrlc abnormalities were entirely 
overlooked, because a good many were handled as purely disciplinary 
problems. Dr. Kleist himself had nothing to do with the special 
formations and battalions because they were, on the whole, organized 
and Administered without participation of medical or psychiatric 
echelons. There were many psychopaths in these formations. Dr, 
Kleist said that he himself never visited any such formations and he 
does not really know whether the whole system of these formations was 
useful from the point of view of the war effort or not. The special 
field formations probably were. The main point in those formations 
was a very severe discipline and the maintenance of a high pace of 
continued strenuous activity. Every German array, particularly in 
Russia, had such formations. Dr. Kleist said that he learned most 
38 UtJi-Z about those formations through Professor von Stockert, who was consul- 
ting psychiatrist with sin army at the Russian front, where he was later 
captured by the Russians. Another of Dr. Heist*8 pupils, Dr. Roll©, 
was likewise captured by the Russians* 
Dr. Heist’s second in command, associate Professor Karl Leonhard, 
handled most of the civilian work at the clinic during the war. About 
civilian casualties, he added to the information received from other 
sources and reported above, one more of the psychologic effects of the 
heavy air bombardment upon the mentality of the civilian population* 
He stated that one of the most striking and appalling mental changes 
of the population as a whole was a quite generalized 
regression” (negoistisch zur&ckgeschraubt8ein,,)# This symptom mani- 
fested itself in a completely egocentric focussing upon the individual’s 
personal problems alone* If a man1 s house had not been hit but the 
rest of Frankfurt was wiped out, he was happy* If his own possessions 
had been destroyed but the rest of the town got off lightly, he was 
convinced it was the worst raid! This was particularly appalling to 
Professor Leonhard after the big raid of 22 March 1944, when people 
whose houses had been spared were openly rejoicing* 
11* Information received from O'beratabsarzt Dr, Herbert Kalten- 
bach. formerly Consulting Neuronsychlatrlst with Rommel13 Afrlka Corps 
(April 1941 April 1943) v now chief physician of a hospital for 
chronic nonroporchiatrlc casaalUeii In K8nlgsteln lm Taunus. near 
Frankfurt on Main. 
Dr. Kaltenbach is at present in charge of a 112-bed military 
hospital, which used to be his own private sanitorium before the war, 
but was requisitioned by the army at the beginning of the war. Dr. 
Kaltenbach himself enlisted in 1940 to serve as neuropsychiatric 
consultant with various armies, at first during the campaign in Prance, 
later with Pieldmarshall Rommel in Africa* Dr. Kaltenbach stated 
that although the average age limit for officers in the Afrika Corps 
was 45, he received a special waiver for his age of 52 because he knew 
the climate conditions from various zoological expeditions in 
which he took part as an amateur zoologist* In April 1942, however, 
the rule regarding the age limit was tightened up and he had to return 
to medical axisy service in the zone of the interior. Later, he 
happened to be stationed at his own former private hospital. His 
patients consisted for the most part of organic traumatic spinal 
paralyses, a few cases of multiple sclerosis, in addition to a number 
of patients with functional disorders* 
Dr, Kaltenbach stated that since the end of 1943, there had 
been a general increase in the incidence of functional nervous 
disorders, but he felt that even with this increase there were 
387JlH- ~ X significantly fewer than in the last war. In this war there had been 
a particularly large number of disturbances expressing themselves in 
fits3 especially of the vasomotor type. The latter were treated by 
a regime consisting of rest, luminal and glucose, but most of them were 
discharged from the army under one organic diagnosis or another. 
Dr, Kaltenbach said that the Afrika Corps was the only German 
army corps in which the principle of selection was extensively applied. 
It also was the only army corps which did not contain any special or 
punishment battalions. General Rommel did not think much of them and 
he did not want to have any. 
The main stress in North Africa was the intense heat, which caused 
the development of nervousness and headache, particularly in leptosomic 
individuals, Pyknics did much better. All individuals who developed 
neurasthenic complaints were immediately shipped back to Germany, where 
most of them quickly recovered. This active weeding-out policy 
was decided on by General Rommel because he felt that soldiers who could 
not stand the climate were only a burden to his troops and a great 
deal of effort was concentrated on keeping the entire body of troops 
as healthy as possible. He feels that in other outfits in other 
locations, many of the soldiers removed from the Afrika Corps would have 
been handled by disciplinary means, punishment companies etc, not 
necessarily deliberately but because their true conditions would not 
have been recognized. In North Africa they y/ere simply weeded out 
and shipped back. 
Dr, Kaltenbach was then asked y/hether he thought that the punish- 
ment formations had proved their practical usefulness elsewhere, or 
whether Rommel's view in finding them altogether undesirable would 
have been the right one to take, not only in North Africa, but in other 
theaters of war as well. Dr. Kaltenbach replied that he does not 
think that these punishment formations were worth yrhile from a military 
point of view, because the types of psychopaths who were put into 
them were completely inaccessible to discipline. He considers the 
possibility that some of them may have stood the test of sharp combat 
actions, but he does not know the general overall picture. Dr, 
Kaltenbach then stated that while Rommel had no special or punishment 
battalions, he did have two regiments of the former French and 
Spanish Foreign Legions, These two regiments proved remarkably good. Dr, Kaltenhach rem- 
embers no single instance of neurosis among these troops. This at 
first surprised him because the Foreign Legion had been composed 
exclusively of people v/ho v/ere black sheep at home, got into 
difficulties and then joined the Foreign Legion, These regiments 
consisted of 4?000 men. Those who survived combat were av/arded 
German citizenship. They v/ere supposed to have been horn Germans. 
They v/ere all people of remarkable resourcefulness, "if you put 
one of them naked into the middle of the desert, after an hour he 
would come hack to you with full kit". They v/ere at perfect ease / 
in practically any situation, no matter how tough, and v/ere no / 
doubt the best single body of troops in the Afrika Corps. There / 
was no such thing as a neuropsychiatric casualty among them. / 
As to treatment 3 Dr. Kaltenhach stated that he never uscM 
method/neither here nor in Africa, Dr. Kaltenhach added 
"Tha{;"Tanshgs' method was not really used much until 1943* It was 
only since then that it was used to any significant extent. There 
was an electro-suggestive treatment center near here in Oherursel 
at the Heichsschulunghurg, headed hy Dr, Gerum, who is now supposed 
to he in American captivity. His treatment center had 120 beds, and 
was one of two in the 9th Corps Area (\7ehrkreis), He received all 
his cases hy referral from other military hospitals. Most of the 
patients sent there were patients with gross hysterical paralysis, 
not anxiety states. Dr. Kaltenhach knows about 5 or 10 patients 
who v/ere treated there. In general3 Dr. Kaltenhach found that 
among the patients suffering from psychogenic nervous disturbances,, 
those who had symptoms of excitation reacted better than those 
with symptoms of inhibition. His own preferred treatment in early 
cases was hy baths, various medicines, and a measure of psychother- 
apy. Only if such treatment was unsuccessful and if the patient 
did not react to any treatment for half to three quarters of a 
year in a military hospital, was the chief consultant in psychiatry 
called in to decide whether he should he transferred to a special 
center for electric treatment. This decision was usually made hy 
Dr. ICLeist for this corps area. At the treatment center galvanic 
currents of 100 milliamperes v/hich were exceedingly painful v/ere 
used. One treatment v/as usually enough to produce results. In 
rare oases two v/ere required. Every corps area had one or two treat- 
ment centers and the men in charge of them were specially trained 
hy Dr. Panse, Dr. Gerum too v/as a graduate of Dr. Pause’s course. 
There v/ere no follow-up studies as far as Dr, Kaltenhach knows, hut 
every patient v/as told on discharge that if he suffered a relapse 
he v/ould he returned to a similar type of hospital. 
1 2. Information received from Qberstabsarzt Dr, Falter Kilb* 
who served as regimental surgeon in France from 10 May to j December 
T940 and'orT the Russian front from 24 June until April 1942* 
and later served in Germany in Neuropsychriatric Army Ho spit ads_ 
until November 1 944? later with army units in Limourg a.d. Lahn, 
During and following the French campaign in 1940, hardly any 
neurotics or psychopaths were seen hy Dr. Kill among troops under his jurisdiction* There were several cases of alcoholism, patholog- 
ical intoxication etc. which were handled by legal procedure. One 
man who assumed a threatening attitude to a non-commissioned officer 
was sentenced to 4-J- years in prison, although the non-commissioned 
officer was a friend of his. These punishments were definitely det- 
errent. There were several cases of desertion. Toward the end of 
1939, several desertions with flight into Switzerland occurred. Those 
who were caught, including the son of a rather prominent man, were 
given life imprisonment. 
During the Russian campaign Dr. Kilb saw some more psychopa- 
thic behavior, including theft of cigarettes and Christmas parcels 
from comrades. In the zone of the interior, where he returned in 
May 1942, he was in charge of a hospital section for gunshot wounds 
of the nerves; among the 130 patients on that section usually 5-6 
were psychogenic, most of these showing pseudoradial or pseudoperon- 
eal palsies. 
Early in 1943 Dr. Kilb was sent to attend a special 10 day 
course in Heidelberg where he was to be trained in Panse*s electro- 
suggestive therapy. He considered this method of treatment ”pure 
and unadulterated sadism”. It impressed him that the personnel was 
poorly trained and inexperienced. On discharge the patients were 
given a yellow slip which was attached to their service record and 
got them back to Heidelberg in case they had a relapse. Dr. Kilb 
feels that the Pause treatment was handled worse in Heidelberg than 
in other places. ”They used to'put some of them through the wringer 
for an hour, and then not get any results”. The treatment was 
carried out much better at the treatment center in Cologne, where they 
first gave psychotherapy for half an hour, and then electric current 
for only 2-3 minutes. Dr. Kilb*s experience on assignment to 
troop units, convinced him that all these patients ultimately relapsed 
” except when they got anywhere near Heidelberg, when they quickly 
recovered”. 
Since 1943 there was a great increase in the number of hysteric 
palsies, most of them pseudoradial and pseudoperoneal palsies. At 
the same time there was an increase in caurt martials for desertion. 
Prom May to November 1944, when Dr. Kilb served at the Hospital for 
the brain injured in Bad Homburg, he saw a good many patients with 
hysteric overlays in terms of headache and dizziness. In his opin- 
ion of the so-called brain injured were actually psychogenic cases. 
They were all discharged as unfit for further military service under 
an organic diagnosis but many of them were put into the Volkssturm 
at the end of the war. 
As soon as the Americans crossed the Rhine, desertions went 
way up. Dr# Kilh observed this while he was assigned to troops in 
Limburg from January to May 1945, He was in charge of an army aid 
station. Apart from the open desertions, there were lots of people 
who came back from the front with big bandages over tiny little 
scratches# They were likewise classed as deserters# The vast 
3BXM.H--JL 
76 majority of them were sentenced to death and a number of them actually 
executed. Dr. Kilb knows about that because his duties as a physician 
included the painting of the heart over the chest of the soldiers con- 
demned to die. On 20 March 1945, i.e. 7 days before the Americans 
came into Limburg, six cases were triad. One was declared irrespon- 
sible because of feeble-mindedness and turned over to the civilian 
authorities. Five were shot. During the period from 6-27 March 
1945, 6 - 8 deserters were shot daily by the troop unit to which Dr. 
Kilb was assigned. 
Dr. Kllb then discussed the special formations. In his 
opinion they were essentially made up of psychopaths. People who were 
stubborn or thought that the non-commissioned officers were picking 
on them were put into those formations. There they were given rugged 
drill and lessons in blind obedience, which included the climbing of 
stairs Interrupted by laying down and getting up every other step. 
In the field they were used mostly to remove mines. The vast majority 
of the soldiers in those special formations have proven useful. They 
were distinguished from other soldiers by the fact that they were not 
allowed to wear any badges. Those who did well were transferred back 
to the regular combat troops, where they could wear insignia of rank 
and badges again. The army was constantly looking for energetic non- 
commissioned officers and officers to staff those special formations. 
Dr. Kilb feels that the system was good and that it proved 
although he feels that Hone might have afforded to treat the men a 
little better, still strict and severe, but a little more decently11 • 
13* Information received from Dr. Anton Idler V^J^wtthV 
at J3rasenl_lri. ...charge Q_t the Hell- uad PflefieanatftXt Iglf jng-flaar. 
near Munich, 
Dr. Von Braunmflhl contributed'information on the treatment 
of psychotics, especially schizophrenias and other endogenous psy- 
choses. During the past 3 yeans, he treated 1700 cases with a 
combination of electro—shock and insulin shock treatment. Dr. von 
BraunmtLhl kept very extensive records which sure particularly in- 
teresting in that they also include cooperative weight curves. Dr. 
von Braunmtthl made some observations on senfcltizatlon to insulin 
which occurs when the regular dose is lowered once. He has writtam 
a book on his methods, which are quite ingenious modifications of 
the standard ones. This book is being held as a manuscript by the 
Julius Springer publishing company. 
Dr. von Braunraflhl , on 3 June 1945, also gave me valuable 
information on execution of the insane in the Munich area and turned 
over documents, which, on the following day, were shown by me to a 
SIC Investigator and turhed over to the 7th Army Document Center. The 
information given by Dr. von Braunmtthl in regard to these matters 
will be dealt with in a separate report. 
38 Ifi-H- - I 14• Diagnosis, treatment and disposition of soldiers with psycho- 
somatic disorders in the german army, based on Information given by 
Dr* Richard E. Siebeck. Professor of internal medicine at the University 
of Heidelberg, and consulting internist to the 3rd and 12th 
Corps. 
Dr* Slebeck* who succeeded Dr* Krehl in 1931, but left Heidelberg 
for Berlin whence he returned to Heidelberg in 1941 to resume his 
previous position as Krehl1 e successor, was interviewed at his hospital 
in Heidelberg. He was very cooperative and appeared to have a very 
thorough understanding of the problem of psychosomatic diseases. His 
medical department of the University hospital bad 150 beds reserved for 
members of the armed forces, but he usually had only 120 military 
patients at one time in that hospital. An additional 150 beds were in 
a special military hospital, likewise under his direction. He confirmed 
what had been told to us from other sources, namely that the psycho- 
somatic illnesses and the organ-neuroses, especially cardiac and gastric 
neuroses, were exclusively handled by internal medical men in the German 
army. These cases were very frequent. The most numerous were the gas- 
tric cases. They were far more numerous than the cardiac cases. A good 
many of these gastric neuroses gradually developed actual ulcers. Par- 
ticularly predisposed were soldiers who had been severely exhausted; 
but a good many among them were individuals who should never have been 
inducted into the military service or at least should not hare been sent 
to combat. They are predominant among those whose system failed in 
this manner. 
Dr. Slebeck added modestly: HI really cannot call myself a psychia- 
trist or psychotnerapist; I have merely read a good deal about that 
and have been much interested”. 
In addition to his 120 patients in the university hospital* he bad 
a special military section (Lazarett) for stomach cases only. The 150 
beds there were always in demand. The groups of patients in the 120 
beds in the main University hospital distributed themselves as follows: 
usually 20 gastric neuroses, 20 heart neuroses, the rest infectious 
diseases, articular rheumatism and polyarthritides. To his surprise* 
he never had any functional arthralgias. 
The gastric and cardiac neuroses were listed statistically under 
the diagnostic categories of stomach and heart respectively* and were 
not included in the statistics of neuroses or illnesses of the nervous 
system. Apart from the figures given above* concerning relative 
representation among the patients on his service* Dr* Siebeck did not 
know any overall figures* De* Siebeck said the only figures which 
had significance were available at the Milit&raztliche Akademle in 
Berlin, Scharnhorstatrasse; "we did not know any overall figures". 
Professor Vuth and the other consultants in Berlin did collect 
statistics. But Dr* Siebeck is certain that the organ-neuroses were 
far more frequent than other types of neuroses. Dr* Siebeck feels 
that the fact that trembling was no longer recognized as a disabling 
condition may be the main cause accounting for the shift in symptoma- 
tology to the inner organs. " Trembling became morally 
•38 Zu-H'-Z disreputable". "I always used to say '1:0-day the stomach does the 
trembling 1. " 
Apart from the stomach cases which were numerically the most 
important, there were numerous functional circulatory disturbances, 
particularly in young people who on admission showed slight elevat- 
ions of blood pressure and circulatory lability. This occurred 
especially in people of the type that "fold up easily". Also some 
of the stomach cases had additional complaints suggesting associated 
circulatory disorders such as dizziness. In many of them there was 
marked loss of weight. 
The treatment was usually initiated by taking an analytically 
oriented history which in itself had an indirect therapeutic effect. 
Special care was taken to find out "where the shoe was pressing the 
patient'1. Dr. Siebeck stated that he had a very able assistant, a 
female lay psychotherapist, who had been trained in Berlin at Prof- 
essor Goring 's institute, by a man who was a Jung student. "But the 
psychotherapeutic treatment must flow into the medical treatment in these 
patients." The main thing is to activate them. In the heart cases 
exercise, in the stomach cases diet, but above all keep them occup- 
ied and active. In. the heart cases Dr. Siebeck found a system of 
graduated exercises with gymnastics and medicine ball to have 
excellent therapeutic effect, but the main thing was to see to it 
that after they got well they were assigned to limited duty, prefer- 
ably garrison duty. That applied equally to the heart cases and the 
stomach cases, which were never sent back to combat duty. At one 
time some were sent back to combat duty, because of independent 
action on the part of administrative echelons, but they immediately 
folded up again and had to be returned to the hospital. Dr. Siebeck 
had seen cases who were returned to him three or four times. 
In the more severe cases with gastric symptoms, dizziness and 
marked loss of weight, an initial period of bed-rest with a special 
diet was considered necessary. In many cases Dr. Siebeck performed 
trial stimulations of the circulation with strophantine, to see 
whether there was an additional circulatory factor. Dr. Siebeck 
feth rather strongly about the interplay of circulatory mechanisms, 
even in those cases in which the symptoms were predominantly gastric. 
He usually gave J mgm, once daily for 3-4 days, and in many cases 
this caused a striking initial improvement which created sufficient 
momentum to facilitate the therapeutic effect of other measures. I 
then asked Dr, Siebeck whether he ever gave insulin in those patients 
and he answered in the negative, I asked him whether he ever used 
the method of deep narcotherapy, and he replied "in the last few 
years, hardly. We gave these people some luminal to make them sleep 
at night, Bellergal (Sandoz), which contained a mixture of luminal, 
belladonna and gynergen (ergotamine tartrate), was very helpful." 
3sau.it -x Ho intravenous barbiturates were given and Dr. Siebeck had not used, 
nor was he familiar with, any of the types of abreaction treatment. 
Dr. Siebeck was then qjsked what his explanation was of the fact 
that these essentially neuropsychiatric conditions were exclusively 
treated by internists like himself in the German army. He replied: 
"our psychiatrists were adverse to psychotherapy and did not concern 
themselves with these problems". Dr* Siebeck went on to say: "psycho- 
therapy is a curious development of medicine and although in other 
countries it sprang from psychiatry, in this country it somehow did 
not fit into the pattern of German classical psychiatry. Our 
psychiatry essentially originated from an interest in and a know- 
ledge of, the organic diseases of the brain, and that was not help- 
ful in developing an active psychotherapeutic interest. The same 
happened to our psychopathology which remained essentially hide-bound 
in the concept of constitution in a fixed and static way, as for 
instance in Jaspers. Therefore, even our psychopathology never 
progressed beyond schizophrenia, or rather did not concern itself 
with changes more subtle than schizophrenia. Uius our psychiatrists 
were all negativistic to therapy until the advent of the shock ther- 
apy with insulin, metrazol and electric shock, and that made them 
still less susceptible to an interest in psychotherapy. They did 
think in terms of occupational therapy, work therapy and farm ther- 
apy, but on the whole one must say that the attitude of psychiatry 
during the past few years became one of increasing therapeutic nihilism. 
Therefore, the psychotherapists belonged more and more to internal medicine. 
W© wanted them. There is an institute for psychotherapy in Berlin 
which offered courses. This institute was headed by Professor Gdring, 
who is Marshall G8ring*s cousin. He was a stimulating man who collected 
all those interested in psychotherapy about himself. One of his 
pupils, von Hattingberg, worked for a time In my department". 
I then put the question to Dr* Siebeck whether he himself was 
satisfied with the way in which he had handled the problems of 
psychosomatic illness and organ neurosis in his department* He 
replied; "the demand was enormous. At the beginning things went pretty 
well, but then the population was scooped out to the depth for 
soldiers. We have taken people into the army of whom I had said it 
was nonsensical to take them. It became increasingly difficult. 
The neuroses always increased enormously when there was war of pos- 
ition. When there was an advance, even the stomach people did well, 
then when we stopped or when there was a retreat, there came the 
stomachs. But that was not the whole story. People with mild organic 
defects such as emphysema or compensated valvular defects of the heart 
also foiled up then. More and more people were conscripted who 
failed with increasing readiness* Sometimes the stomach and heart 
cases were spotted at induction centers and sent for specialized 
examinations, but usually were inducted just the same. According 
to regulations, people with positive X-ray findings were supposed 
to have been rejected, but even those were taken time and again. 
The stomach battalions were supposed not to be used in combat, but 
once - at the breakthrough of the Americans near Metz - a stomach 
i9X.U4t.-i. battalion was sent into the line, and failed miserably. Most of 
them had to be taken to hospitals before they even reached the line, 
but the interesting thing was that a lot of them not only got complaints 
but developed actual haemorrhages at that point. Of course, they 
were supposed to be nothing but garrison troops. But even now, 
after combat is all over, I am getting a lot of new admissions from 
prisoner-of-war camps. The external and the internal stress, the 
tensions, sorrows, worry, grief, unresolved inner emotional conflicts, 
especially the difficulties encountered in maintaining one's loyalty 
were very great on our side, and expressed themselves in psychosomatic 
disorders. Many of our young men had become Nazis in their first 
burst of enthusiasm and against the background of unemployment. When 
all the brutality that was behind it came to light, disappointment 
followed, but it was too late. This caused an inner split in many 
otherwise fine people". 
Dr. Siebeck was then asked about neuroses in the civilian pop- 
ulation, especially in relation to aerial bombardment. He answered 
that most of them were acute anxiety states which responded well to 
treatment, such as rest, removal from the danger zone, and luminal. 
Most of them were women, but then most of everything was women in 
the zone of the interior. Neighboring Mannheim had a heavy raid 
practically every night. He also saw many severe acute neuroses from 
the Darmstadt area; most of them with tachycardia, circulatory 
disturbances, slight thyrotoxicosis, sleeplessness, fearfulness etc. 
They were easily startled by the slightest noise, but the main 
problem was sleeplessness in these anxiety states. 
Of organic medical problems incidental to the war, Dr. 
Siebeck mentioned field nephritis, which was particularly prevalent 
in the cold climate of the Russian front. Dr. Siebeck considered 
it as an infection of the kidneys and the vascular system. One of 
his pupils published a monograph about it (Appendix 5, No.6), 
Dr. Siebeck wrote about some of his experiences with psychosa* 
matic reactions, orean-neuroses and other disturbances of tlie yeget- 
.five .-/stem. Some of these writings have been published (Appendix pf 
JTds"“T,""? rlflW1131), but some are still unpublished. In one of his 
unpublished papers (Appendix 5, No.4), he stressed the interplay of 
emotional and physical factors such as fatigue and exhaustion, 
incidental infections and so forth. He makes the statement that there 
is nothing pyschic without something somatic, and nothing somatic 
without something psychic. He also stressed the importance of exer- 
cise during the period of treatment and rehabilitation. In a more 
recent paper on neuroses (Appendix 5, No. p), Dr. Siebeck stated, 
in obvious reference to the diagnostic policy of the army, that there 
was too much neurotic fear of the word ’neurosis’. In this paper 
he also gave a very interesting explanation of the shift o± neurotic 
symptom choice from the musculo-skeletal system to tne vegetative 
system, which had occurred during this war. He stated that frequently 
the organ choice can be determined by incidental physical factors. 
He quoted the case of a female patient who originally had a cardiac 
neurosis, but after an actual episode of dysentery, ceased to react neurotically with her heart, and developed an intestinal neurosis* 
Another patient* a young, emotionally somewhat labile man, who at one 
time had experienced an industrial carbon disulphide poisoning, always 
reacted by vomiting whenever he became frightened during air raids. But 
that - Dr. Siebeck goes on to say - is/the only explanation for the 
fact that the trembling of the last war was replaced by vegetative re- 
actions in this war, a great deal of it is due to attitudes in the 
social environment* "The realization that trembling does not hold the 
rank of an illness has obviously quite generally penetrated into the 
general consciousness. There is the ease and success of its treatment 
and the attitude of its rejection by the Veterans1 Administration 
authorities. These facts have definitely hammered it in that trembling 
is no disease; but instead we see neurotic reactions within the realm 
of the vegetative system, in the circulatory system and especially in 
the stomach. Trembling*with one*s extremities does not count any more, 
and therefore the stomach now does the trembling. This is not the only 
cause of the many stomach patients with and without ulcers* but it is 
certainly not the smallest cause*. Actual experiences during stress 
may he contributory, such as the normal acceleration of the heart,the 
normal reactivity of the stomach to unpleasant stimuli. All that 
plays a part, but is taken up by the personality as a whole, so that 
the functional and the organic interplays in an inextricable manner. 
There are all kinds of transitions and combinations of reactions 
Ariginally set vp by psychological factors, and reactions originally 
set up by somatic factors; but the most important pathogenic point 
is the neurotic response to these original sensations and reactions. 
While it is embarrassing at times to overlook an ulcer because of 
preoccupation with the neurotic mechanisms of ths patient, it is not 
lees fateful an error to overlook the psychogenic features in the 
pathogenesis of the lesion, 'because of preoccupation with the organic 
aspects of the ulcer. It is the vicious circle between functional 
disorders and organic lesions that has to be approached therapeu- 
tically; and therapy should likewise combine an analytically 
oriented understanding with the proper fonctionalsomatio therapy of 
gradual stepping up of physical training after a preliminary period 
of complete relaxation* It is most important of Al, however, to 
exercise insight and understanding without pampering the patient, 
and yet build up a readiness in him to function In spite of hie 
disturbances, and develop an ambition to respond to the demands 
placed upon him. 
15. lagormatloa received fm Profeaaor Dr. 
Trant Tolhard. Professor of ««dleina and director of the aedlctl 
dwartaeat of the Uaty«r»ltT of Tri‘1VT"yt Main —dleal »ebool. 
and Ooniwl taot in Intamal Medicine to th> 9th Coma If, of the 
army and the narr. In addition to his military and private 
hospitals. Dr* Tolhard supervised a special stomach hospital, 
which was ran hy his assistant Stahearzt Dr* Hamsmmn in Bad 
Nauheim* Dr, Tolhard stated that Professor Qutzeit in Breslau 
gave an excellent report on ulcers of the stomach at the last 
meeting of consulting physicians held last winter* Dr*Tolhard 
stated that the stomach battalions did as well as could he 
S8X4J, -3L expected of them, especially in view of the fact that special diet 
kitchens were instituted for them. There were also special "ear 
battallona” for the hard of hearing. Those suffering from cardiac 
neuroses, however, were not utilized for military duty. 
There also was a good deal of Jaundice in the German Army. Dr. 
Yolhard saw no deaths from Jaundice, hut he heard of some. Of other 
significant illnesses during the war. Dr. Yolhard mentioned the many 
post-diphtheric polyneurit Ides, as well as the many polyneurit ides 
of other etiology. Toward the end of the war, when difficulties 
of transport increased, he saw also hunger states with oedemas which 
were taken to hospital from isolated pockets of troops, that had not 
been properly supplied- Another striking group of illnesses were 
the many nephritides. which Increased particularly during the second 
winter in Russia. Dr. Yolhard feels that cold and humidity were 
predisposing factors, hut that cases also occurred in wall heated 
offices and among nurses in hospitals. Professor Qutzelt, who re- 
viewed the problem, thought of a new kind of infection. The best 
treatment was the method of hunger and thirst for a period of 8 
days, then the oedemas were flooded out and the heart recuperated. 
Recently, Dr. Yolhard saw 20 Poles and 400 Russians with various 
radial and peroneal palsies, which were caused by methyl-alcohol 
poisoning throe weeks after ingestion of the alcohol. Many died 
immediately, others became blind immediately, but some developed 
polynauritides after a three week period. The toxic fluid was 
obtained by these patients at an artificial leather factory. 
B. Neuropsychiatry la _the German AlrJ’orce (Luftwaff&l. 
1. Information received from Professor 
Qheratarzt (Colonel) der.Luftwaffe. Chiel j&naultAng 
•psychiatrist to the frqrgeon General of the Luftwaffe#, 1941 
April 1945 . 
Dr. Luxenburger was interviewed at the Air Force hospital in 
Posaenhofen, Bavaria, where he was In charge of the neuropsychia- 
tric service since 15 April 1945, in addition to his duty as con- 
sul tant. This hospital was predominantly a medical and surgical 
hospital, and the neuropsychiatric cases were scattered all over 
the other services* Among the 800 patients, usually 20 — 30 were 
neuropsychiatric ratients. The number was so small because as soon 
as a diagnosis was made the patients were quickly transferred to 
special neuropsychiatric hospitals, such as in Mttnchen-Schwabing 
or Eglfing-Haar. 
Dr. Luxehburger was first asked about selection. There was 
no neuropsychiatric selection of air force ground personnel# The 
examining physician at induction - as in the army - weeded out those 
with obvious gross neuropsychlatrlc defects# usually 3 — 2$ of the 
conscripts. 
383U**.- X Plying personnel was selected from a neuropsychiatric point 
of view. All flying personnel, officers as well as enlisted men. 
were volunteers, apart from a few exceptions. These volunteers cam© 
to the air force either directly or from the array. The neuropsy- 
chiatric part of the selection consisted in a half-hour interview, 
either with a psychiatrist or a flight surgeon, who had neuropsychia- 
trie training but was not necessarily a specialist in neuropsychiatry. 
Host of the regular air force flight surgeons were graduates of the 
“Jlrztliche Akademie der Luftwaffe in Berlin-Wittenau11. In spite of 
the fact that the expressed desire of the candidate to join as a 
flier was considered'an important factor, usually only 70$ of the 
applicants wore found fit for pilot training, as the result of the 
first interview, and 20$ were usually definitely rejected. The 
remaining 10$ - or frequently fewer - were held for observation in 
the Idiegersichtungstelle (screening station for flying personnel) 
for $ - 4 weeks, where they were appraised from the neuropsychiatric 
and psychological points of view. The main enphasis in this obser- 
vation was on character and not on intelligence. 
Teste were not used at all after 1941, because it was found 
that there was no correlation between the results of these tests and 
future performance. Dr. Luzenburger had never anything to do with 
those tests, even before. The tests were experimental-psychological 
ones and had been devised or selected by Professor Otnther Lehmann 
of the K&iser Wilhelm Institut fftr Arbeitsphysiologic in Berlln- 
Dahlem, which was later evacuated to Dortmund, finally to Bad Eras. 
Another contributor to these tests was Professor Hans Pischer, 
professor of psychological physiology at the University of Marburg. 
Dr. Luzenburger feels that the contributory cause tot the abolishing 
of all psychological tests in 1941, which was done on Field Marshall 
Goring*s personal orders, was the fact t&at a number of boys with a 
good youth movement and party record, as well as sons of important 
party fuhctionarles, were rejected; but Dr. Luzenburger feels that 
the tests had really serious limitations because as far as he kndw, 
the dead scoring itself was never a reliable Indication of the 
ability, but that additional interpretation on the 
part of the psychologist was required which was only correct when 
the psychologist also happened to be a good amateur psychiatrist, 
and a man of common sense. Hence it was justified, in Dr .Luzon* 
burger* s estimation, to replace the psychological tost procedure by 
a coramonsense and psychiatric appraisal of the personality. Within 
that setting a certain number of tests of a more general nature 
remained in use, but at the Sichtungsabteilungen (screening stv j.ons) 
only. These tests were evaluated in a general, “almost layman-like 
ganner”, and were not really scored. These tests included mathe- 
matical tests, writing of themes etc. There were tests in com- 
petitive athletics, tests of courage and of powers of decision,for 
which broad jumps, scaling walls and so forth could be used. The 
minimum of education for enlisted flying personnel was eight years 
of grammar school, i.e. elementary school education, obtained 
between the ages of 6 - 14 years (Volksschule), For officers, 
38Z4-*-- *. gymnasium (equivalent to high school and two years of junior college) 
was required. At the beginning of the war, the majority of the 
pilots were officers, but later there was a relative increase of 
enlisted pilots. 
The psychiatric half-hour interview mentioned above, consisted 
in taking a family history, personal history, health record, 
educational record and statements about emotional preferences, hopes 
and plans. It was aimed at an appraisal of the total personality, 
especially of the character, although it was appreciated that char- 
acter and intelligence were hard to separate. The speed of understand- 
ing, apperception and decision, the ability to concentrate, and the 
adaptability of the candidate, were evaluated in this interview, but 
not by tests. Each psychiatrist completed the examination of 20 men 
per day. Dr. Luxenburger admitted that the examination frequently 
took less than half an hour. The greatest factor in coming to the 
right conclusion was common sense, aided by psychiatric knowledge of 
human beings, and experience. 
After the candidate for flying service was accepted following 
this interview, further elimination for neuropsychiatric reasons 
occurred only if and when the man showed abnormal traits. Dr. Luxen- 
burger had no figures as to how many were eliminated during their 
training period. Records were destroyed, some by bombing, others 
deliberately before the enemy came. All the figures and statistics 
were in the hands of the Chef des Sanitatswesens Generaloberstabsarzt 
Schri'der at Lager Saalow near Zossen, Berlin. 
Dr. Luxenburger stated that as far as fitness of the German air 
force from the neuropsychiatric point of view was concerned, things 
went well until the summer of 1943. Since then the intelligence 
standard dropped and the qualities of adaptability, "hard courage”, 
tensile strength and endurance was lacking in increasing numbers of 
flying personnel. Dr. Luxenburger was asked as to what he ascribed 
this turn in events. He said, "first of all the examiners were 
younger and not as experienced, and accepted people who should have 
been turned down; secondly, the requirements for quantity became 
greater, especially on the Eastern front; thirdly, training became 
poorer because of lack of aviation gasoline. The result was that more 
and more people were under observation in screening stations, and 
there was an accumulation of personnel which was obviously less capable 
of bearing stress and more fatiguable than before, and the admissions 
to rest homes increased. " 
The treatment used for these increasing breakdowns was an 
educational form of psychotherapy, with therapy of the vegetative 
disturbances. The psychotherapeutic measures used were persuasion, 
hypnosis, suggestion and psychocatharsis of the Jungian type. No 
drugs were used. Benzedrine had been used at first, but was soon 
abandoned. Narcotherapy, insulin shock or insulin sub-shock were 
not given, nor were the methods of narcotherapy and insulin sub-shock 
known to Dr. Luxenburger. No abreactions were performed either, 
attain -“i. and Dr. luxenburger did not appear to have any knowledge of the use of 
abreaction treatment in the neuroses. Dr. luxenburger said that most 
of system of treatment had been worked out by Professor J.A. Schultz, 
der Luftwaffe, who was the Chief of the Luftwaffe depart- 
ment at the German Institute for Psychology and Psychotherapy in 
W* 62, Keiths trasse 41. 
The word coined for these [neuroses in flying personnel/was 
”abgeflogensein” (which freely translated meanss ’^to as 
a flyer*, or’to have had it as a flyer’). Dr. Luxenburger considered 
this as an unfortunate term:0first of all because everyone familiar 
with psychiatry knew of course what it really was* This condition 
occurs not only in aviators, but can be elicited by any excessive stress. 
It is a sort of neurasthenia or neurasthenic anxiety neurosis. There 
is nothing in this 1abgeflogensein* that is not also perfectly well 
expressed by the good old psychiatric categories, anxiety neurosis or 
neurasthenia. To be sure, this neurosis in aviators has a certain 
coloring different from a similar neurosis in a civilian, but no more 
so than a neurosis in a minister of the gospel differs from the neurosis 
of a coalminer”. Apart from this unfortunate term, a great number of 
cases of neuroses in the German air force went under other different 
names, namely under names of various organic diseases and under the 
name of psychopathy. But whatever the name, neurosis became a sizeable 
problem after 1943. Dr. Luxenburger estimates that 15$ of the flying 
personnel in the German air force became disabled by neurosis, if one 
includes those diagnosed a® psychopathy and psychosomatic illnesses. 
If the latter two groups are excluded, and only those diagnosed as 
neurosis or ’’abgeflogensein” are counted, their number would account 
for 5$. As psychopaths. Dr. Luxenburger defines ”variants of personality 
who are negative in terms of value and who are poorly adapted to their 
environment, so that there is constant conflict with the environment, 
in the course of which a psychopath may develop a neurosis”. Before 
1943, there were very few such psychopaths in the German air force, 
but after 1943 they increased. When Dr. Luxenburger was asked as to 
what he regarded as the cause for this increase, he replied s ”Poor 
selection, because the material became poorer and the need greater. 
There were many accidents, many losses on the Eastern front, also in 
the Mediterranean, especially over Malta"• 
I then asked Dr. Luxenburger the question as to what he considered 
the most important neurosis-producing factor in the flying stress 
of German flying personnel. He replied; "Expectation”. "They sit 
and wait in the cockpit on the alert ready to take off, that is nerve 
racking. These fighter pilots got only three hours sleep, then they 
were called again on the alert”. Dr. Luxenburger w.v>s then asked what 
the main neurosis-producing stress factor was in bombardment personnel, 
including pilots. He replied; "Neurosis in bomber personnel has 
played only a very small role. There hardly ever were any, especially 
in the last three years, but even before that the incidence of neurosis 
in bomber personnel was insignificant". Dr Luxenburger felt that 
38 this striking difference in the incidence of neurosis was due to the 
fact that the fighter pilots were younger and more difficult people. 
Dr. Luxenhurger stated that there was no limitation of tour, i.e. 
no operational limit for flying personnel in the German air force, 
and that every flyer had to keep on going until he was cither killed, 
severely wounded, or until there were some disabling nervous symptoms, 
which indicated he had come to the natural limit of his resiliency to 
flying stress, and had to be considered wabgeflogen,,. However, it was 
noticed that the excessive waiting at the start led to premature 
failure. For that reason some prophylactic measures were taken and it 
was arranged that after a certain number of hours of waiting in the 
cockpit, the pilot was relieved; and in addition a certain number of 
days of full rest were instituted. That long waiting on the alert ws.s 
necessitated by the fact that while the Gorman air force had been 
warned through their detector devices of an approaching allied bomber 
fleet, they had no way of predicting exactly where it was going, and 
therefore fighter pilots had to be put on the alert in their cockpits 
ready to take off and to attack and ram the enemy bomber formations, 
over a relatively wide area. 
Every German air force aviator was entitled to 2 - 3 weeks leave 
per year. He could receive additional leave only on medical grounds. 
Since it was generally felt that 2-3 weeks leave per year was decidedly 
not enough, an opinion in which all commanding officers agreed, much 
use was made of medical leaves. The usual medical leave at a rest 
home for flying personnel was of 4 - 6 weeks duration. Then the chief 
physician at the rest home could request an additional home leave through 
the flyer1 s commanding officer of usually 14 days duration. In severe 
cases of flying fatigue, this could be prolonged again and again, up 
to 6 months in a rest home. This policy was "slightly infectiousH and 
led to aggravation, although Dr. Luxenburger feels that cases of out- 
right malingering had not occurred. If there was any suspicion of 
aggravation, the patient was sent to a screening station. There was 
a screening station connected with every air force hospital. 
I then asked Dr. Luxenburger whether neurosis was a considerable 
problem In the German air force. He replied in the affirmative. It 
was greater than in the armed forces as a whole, just as in the navy 
It was a greater problem with submarine personnel. He felt that flying 
personnel and submarine personnel had the greatest incidence of neurosis 
in the German armed forces. I then asked him whether neurosis was the 
greatest single medical problem in the German air force. He replied, "No. 
The greatest problem was the gastric and intestinal diseases, as they 
were also in the army, due to nutritional factors. The next biggest 
problem were the neuroses." Dr. Luxenburger then continued : 
38 2./*/#. - Z. '■What was as good as completely missing, were the shaking palsies of 
the type seen in the last war. I hare only seen five of these cases 
in this war. Their place was taken hy the gastric ne\proses in this 
war. It is due to this fact that different diets became available 
in practically every army and air force post. Those patients were 
first diagnosed and listed as stomaqh diseases pure and simple, then 
in hospital attempts were made to differentiate them". 
Dr. Luxenburger said that he had seen very few cases of air 
sickness. A not infrequent complaint was 'grey-out' on quick ascent 
or descent, and some became neurotically fixed. Dr. Luxenburger 
stated that passing out in the air was not a great problem. It 
occurred practically exclusively from true anoxia at great heights, 
although he admitted that in some cases similar syndromes developed 
from an expectation neurosis. He continued: nWe like to avoid the 
term •hysteric* and call it •psychogenic*. Hysteria is all tied up 
with ideas of wishes and desires and has a bad taste. We also 
avoided the word 'neurosis'. We simply said 'psychogenic' and added 
a descriptive term of the organ system involved." 
Dr* Luxenburger then expounded on J.H. Schultz*s theory of the 
neuroses which he considers a workable one, and which he adopted in 
hie own thinking and terminology* J*H« Schultz distinguishes four 
types: 1: the "extrinsic neuroses11 (Premdneuroeen), which are mild, 
frequently merely imitative; 2% the Mmarginal neurosea* (EancU 
neurosen), which occupy the margin of the psychic personality, and 
which particularly include the psychosomatic states and the organ-, 
neuroses; 3: the ttlayer neuroses* (Schichtneurosen), which pene- 
trate into a deeper layer of the personality and include the ob- 
sessive-compulsive neuroses; and 4: the nuclear neuroses (Kernneu- 
rosen), which are the most severe because they involve the nucleus 
of the personality, which include the sexual abnormalities such as 
homosexuality and other deviations caused by early childhood 
experiences* 
Dr* Luxenburger was then asked how many of his treated cases of 
neuroses were returned to flying duties. He replied 30$. The 
remaining 70$ were sent to ground duties. Nobody was discharged. 
"We had a special flak battery for neurotics in Dortmund. The 
commanding officer of that battery was a psychotherapist, trained 
by Professor Gdring, as was the station physician. Good results 
were reported from there, but it was only in existence for six 
months. A good many people who were assigned to that flak battery 
improved sufficiently to be transferred to other ground duties.11 
Dr. Luxenburger then reiterated that for the D-boat personnel 
in the navy, the problem of psycho neuroses w#s of similar relative 
magnitude, as for flying personnel in the Luftwaffe. He referred me 
to Dr. Creutzfeld, a former student of Dr. Bonhoeffer in Berlin, 
now professor of psychiatry in Kiel, and chief neuropsychiatric 
consultant to the German navy. 
38**.*.- * ' Dr. Luxenburger believed that the post-traumatic syndrome called 
"Hirnleistungsschwache" was predominantly an organic condition. It 
occurred in post-concussional and post-contusional syndromes. 
Dr. Luxenburger recalled that in the early days of the Battle 
of Britain, there was a condition in bomber personnel known as "channel 
stomach", but he does not remember anything about it but the name. 
That was before he was officially connected with the air force. 
As to suicides, Dr. Luxenburger feels there was no significant 
difference in incidence between the army and the air force. In 1941, 
when Dr. Luxenburger made his survey, the percentage was very low, under 
maybe even under one per thousand. There were also very few self- 
inflicted wounds. Dr. Luxenburger saw only very few of these cases 
medico-legally "and they were nothing but poor soldiers”. According 
to J, H. Schultz, who later worked on this problem, suicides did not 
significantly increase except for suspected suicides masked as 'accidents’. 
Accidents increased greatly in 1943 and J„ H. Schultz considered the 
possibility that a good many of them may have been actually suicides. 
Dr, Luxenburger does not think much of the recent chief consult- 
ing psychiatrist to the army. Dr. De Crinis, 
Dr, Luxenburger saw no new diseases and no cases of epidemic 
encephalitis in the German air force. 
2. Information received from Dr, Gustav E. Storring, 
Stabsarzt der Luftwaffe, Associate Professor of Neuropsychiatry at the 
University of Gottingen (in Professor Ewald's Department) - on leave of 
absence. 
Dr. Starring had a great deal of experience with Luftwaffe flying 
and ground personnel. He had interesting assignments as special 
welfare officer for psychiatry and mental hygiene, with combat install- 
ations of the Luftwaffe in Prance, In addition, he was for several 
years in charge of the neuropsychiatric section of the large Luftwaffe 
hospital in Paris-Crdchy. In the latter place he had diagnostic, 
psychotherapeutic and medico-legal experience. 
Dr. Storring was interviewed at Dr. Kaltenbach’s hospital in 
Konigstein in Taunus, near Frankfurt on Main, where he is the medical 
officer representing the Luftwaffe, Dr. Storring is the sou of the 
well known philosopher and psychologist of the same name. He is tne 
author of a paper which for the first time pointed out the fundamental 
differences in pattern betv/een the neuroses in the last war and those 
in the present war, and he first described the shift of the syndromes 
with shaking and palsies of the last war, to the psychogenic headache 
syndromes, and the functional gastric and cardiac manifestations of 
the present war. In his paper: "Die lerschiedenheiten cier psycho— . 
pathologischen Erfahrungen im Weltkriege und im jetzigen Krieg und 
ihre Ursachen" Munchener Medizinische Wochenschrift, No.2, 25, '942, Dr. Stdrring also discussed the fact that at that time of the war (the 
paper includes the period up to 1941), neuroses on the whole had been 
less frequent than in the last war. He ascribed this to factors of 
morale engendered by the intensive National Socialist indoctrination of 
the soldiers. Dr. Starring now feels that his estimate may have been 
somewhat optimistic because he underestimated, even then, the true 
extent of the psychosomatic gastric and cardiac afflictions, and he 
feels now that the far greater support of morale came from the success 
and relative ease of tho combat activities during that period, than 
from the far less decisive element of indoctrination which later 
proved less effective when things got tough. He stated, with a smile, 
he wished now he had never written that paper. 
Dr* Stdrring is a‘rather pleasant, vivacious and sensitive man, 
who, one understands, can easily be swayed by his emotions to over- 
estimate one or the other factor. He is now engaged in writing a 
criticism of the fundamentals of the Nazi regime from the psychopatho- 
logies! point of view entitled "the Psychopathology of Hitlerism11, in 
which he also attempts to discover for what emotional reasons the 
German people originally accepted it. He is doing this work, together 
with a Dr. Pfander, a lawyer in Darmstadt, where he lives on Hdhenweg 
83. Dr. Stdrring can be expected again to be swayed emotionally by 
one side or another in his efforts, as he was obviously carried away 
by his emotions in his first famous paper on the war neurosfcs. Still 
he is a man of understanding and originality, who may be expected to 
come up with something illuminating, as it cannot be denied that he did 
hit on something important, namely the shift of symptomatology of the 
neuroses, in his earlier paper. 
Dr. Starring had been in Kdnigstein since 1 May 1945. He particularly 
enjoyed his work as psychiatric welfare officer ( Wehrbet^euungB8anitAtsofficier,,) 
with the air force on the Western Front. He handled all kinds of psychological 
problems, with what w&s essentially preventive psychiatry. Every case of dev- 
iation as it occurred among troops, every case of attempted suicide, every 
case of AWOL, was gone into* Unfortunately all records were destroyed by 
the High Command. Punishments were more severe, especially in AWOL cases, 
than during the last war. 
There was no operational limit for flying personnel* People 
could only be grounded on medical grounds at the commanding officer’s 
discretion. 3he predominating symptoms in flying fatigue ("abgeflogeneein") 
were: dizziness, headaches, anxiety, sleeplessness, and other neurasthenic 
complaints. 
Dr* Stdrring feels that the single most effective preventive 
measure against ’’flying fatigue” was stimulation of ambition for 
decorations. (Therefore new decorations were always brought out. 
Ihe flying personnel were under the spell of ribbons, and the majority 
of them wore them at all times. "The German reacts to praise and 
blame like a child. He is a man of feeling, with all its assets 
and liabilities". Dr* Starring then stated that in his book on the 
sez-H-H- - x psychopathology of Hitlerism, he discusses this quality and how Hitler- 
ism arose from the fundamental German character. 
Dr, StBrring stated that his treatment of the neuroses in avia- 
tors and other combat and ground personnel was strictly psychothera- 
peutic, and Included utilization of group ;;herapy. His line of approach 
was "to tell the patient *we all have a sort of low animal in us 
("tnnerer Schweinehu. i"), hut we have to cope with it and overcome it* 
We all have that in U8,ft. Tims an Identification with the patient was 
established. If i scecsary this could be reinforced by bellowing at the 
patient in a loud and forceful voice ("anbrMlerf*'): "We all must eat 
dirt in war, and so must you". It could also be implied that the 
patient was lucky to be treated medically instead of being tried on a 
charge of cowardice, which would lead to his being shot, and it was all- 
right to threaten the patient with the "drawing up of charges unless he 
was successful in controlling himself and getting well". The patients 
were grateful for that treatment and they thought the doctor understood 
them. They also took the threat that charges could be brought against 
them quite seriously. Then he used to tell them: "If you do not pull 
yourself out of this» end if you have a relapse, you come back here, 
but then we will not let mercy come before Justice again". "Then I 
would have to say, *you are a coward1. Now I think that you merely 
had an episode of softness which can happen to any of us. Then after 
that preamble, T made a point of talking about the worries and sad 
experiences of the patient, and tried to discuss them and help him 
solve them. People who broke down, frequently had real worries. 
Others were somewhat heavy, slow individuals, and some were borderline 
mental defectives. We estimated that 15$ of .the ground personnel who 
broke down were in the latter category. The predominant reactions 
nmnyig these were either to run away or to commit or attempt suicide." 
The general directives for psychological treatment >/ere worked 
out hy the nprinclpal expert for psychiatry and mental hygiene of 
social welfare medical officers, and National Socialist Leadership 
medical officers”, («Sachbearheiter fttr Psychiatric und seelisch© 
Hygiene der Wehrbetreuungssanithts-offiziere, und N S UHShrung Sanitftts- 
Offiziere”). Dr, Starring feels that the Wehrhetreuungssanitftts- J 
offlzlere (psychiatric social welfare officers) were an excellent 
institution in the German air force, and were able to do a great 
of preventive work* Dr* Starring himself was in this capacity ijr 
charge of an area in western Prance* 
As to the success of (the treatment of Pr>Sto»rir% 
said that in the first years o? 1 th«1 ted patlenfs returned 
to flying, usually after 4-8 weeks in a rest home* There was a 
generally great preference for flying as compared with ground status* 
Probably the shortages of petrol contributed in keeping up an appre- 
ciation of flying, which was always regarded as a privilege* Furthermore, 
there was pressure of opinion whicn forced uhe aviator,whenever 
he could, to stay on flying status. But the quite general desire for 
flying helped to reinforce this attitude. There were cases of lack 
of moral fibre, but determination and disposition of these was a 
xazM-H.- *■ command function and not a medical problem. Commanding officers in 
general tended to assume that every hysteric reaction v/as at the least 
a semiconscious evasive reaction. Dr, Starring feels that this 
policy was definitely overemphasized. Professor Gbring, on the other 
hand, had seen to it that the psyche was recognized officially, but 
a commanding officer whom Starring remembers used to say angrily: "There 
is no psyche. There is only combat readiness or no combat readiness". 
Commanding officers have frequently been unjust to fliers with genuine 
neuroses, Dor cowardice before the enemy, the death penalty was 
mandatory. Dr, Starring saw such cases for medico-legal appraisal. 
One of them was sleepless, inhibited and depressed. Dr, Starring 
excused him on medical grounds; later the man recovered and returned 
to flying. This is the only case who had been condemned to death for 
cowardice before the enemy of whom Dr, Starring had personal knowledge. 
He has no personal knowledge of anyone who actually had been executed, 
but the flying personnel thought that some cases had been pxecuted and 
that is probably all that mattered, Generalfeldmarshall Sperrle was 
in charge of all these policies in the air force, and probably 
could give more detailed information. 
Dr, Starring does not know whether any officers ever lost their 
rank because of failure as a flier. Dr, Starring feels that the 
threat implied in the attitude that neurotic weakness constituted a 
form of cowardice for which a man could be charged, tried and condemned 
to death, had a bracing, reactivating effect in some of these neurotic 
ca.ses, A man could also be condemned to death as a ma.lingerer if it 
could be proven that he had attempted to escape dangerous or hazardous 
duty; the patients knew that and many tended to reproach themselves 
for such intentions. Therefore, it was particularly useful to give the 
patient a face-saving concept of a temporary attack of softness, which 
raised their self-respect and increased their determination to pull 
themselves out of it in order not to fall really into disreputable 
cowardice. 
Other cases requiring medico-legal examinations which Dr. Starring 
performed, were particularly various crimes and misdemeanors committed 
under pathologic intoxication. Dr, Starring found that twilight states 
under alcohol were much more frequent in the air force than in civilian 
life. An offence committed under pathological intoxication, usually 
resulted in the man being declared irresponsible for the crime committed 
while in that state; but officers who committed such offences even 
if declared not responsible legally usually lost their rank according 
to pa.ra.gra.ph 33a of the legal code. They were not broken by the comm- 
anding officer, but through higher echelons by way of Berlin, In the 
cases of air force officers, loss of rank had to bo confirmed either 
by Gfiring or Hitler, AH cases of death penalty had to be signed by 
Hitler himself, A deterrent measure, which Dr, Starring thought very 
ingenious and helpful, was to put officers in regular rotation on orders 
to v/itness trials of people for crimes committed during alcoholic 
intoxication, so that they could see for themselves that otherwise 
decent officers could commit beastly things after they were drunk ("Schweinereien"). Dr. Starring feels that this "visual instruction" 
was very effective. He regrets, however, that it was not carried out 
more consequently and extensively. 
Homosexuals were very severely punished. They all got long 
terms in prison ("Zuchthaus"). 
Dr. Starring stated that flying fatigue ("abgeflogensein") was 
far more prevalent in fighter pilots than in bomber pilots and other 
bombardment crew members. He feels that this was due to the fact 
that the bomber personnel was made up of "harder types of human beings". 
Weaknesses in the personality of the more mercurial fighter pilots were 
pointed out in a book by Skawran, entitled "Der Jagdflieger" (The 
lighter Pilot). This book was withdrawn from circulation because it 
was not too flattering to the personalities of the fighter pilots. 
The book did not consider greater stress as a cause of the greater number 
of breakdowns among fighter pilots, nor does Dr* Starring think that 
different degrees of stress play a great role in that problem. It is 
mainly the constitutional type of the personality of the sort of man 
who becomes s fighter pilot that is at fault. 
While not realizing that the differences of stress which were 
placed upon fighter and bomber pilots respectively in the German air 
force. Dr. Starring did recognize stress as a factor of general import- 
ance, when the discussion came to the psychosomatic illnesses. Dr. 
Starring volunteered the following : "There was an immense number of ulcer 
cases because the emotional load really acted upon the stomach. Baere were 
also heart cases, mostly due to the "fact that there was a habit of 
senseless smoking rampant among young people. Many young people died 
from heart disease at the age of 20 years". 
Of organic neurological illnesses. Dr. Stdrring saw a number 
of cases that developed epileptic seizures following carbon tetrach- 
loride poisoning, also some cases of tetraethyl-lead poisoning in 
persons who filled air planes with aviation gasoline. In addition, 
was interested in cases with pseudopsychopathic reactions in thalamiqf 
lesions. 
c. The precarious state of psychother^p^-an^ 
training in Germany “before the war, as expressed In confidential jfeports 
~by Professor Kretschmer and Maaz. 
These confidential reports were found when I made a rather 
superficial search of Professor confidential files at the 
Deutsche Forschungsanstalt fdr Psychiatric in Munich. These reports 
were occasioned by observations made at the 9th International Congress 
for Psychotherapy in Copenhagen in 1937, and their purpose was to 
stimulate interest in the creation of facilities for psychotherapeutic 
training at German Medical Schools. Biey were addressed to Professor 
Dr. Wirz, principal expert on the Staff of the Vice-Pdhrer (Eeichsamts- 
leiter am Stabe des Stellvertreters des Pdhrers), and copies were 
sutuu--x transmitted to Professor Rfldln in Munich, In his letter of transmittal 
to Professor Rttdin,Professor Kretschmer writes; " It will be very 
important to give additional weight to these reports by personal 
representation with Mr. Wirz. Since the older separate schools (of 
psychotherapy) have hardly any supply of yovng trainees* it is not 
necessary on our part to interfere in any way with the personal activi- 
ties, in their own private circles, of these single representatives 
themselves. But it is urgently required to oppose energetically their 
repeated attempts tc advance their position by means of organizational 
activity and to assume the role of official representatives of German 
psochotherapy. This would be an equally great danger for psychiatry 
and the practicing neurologist, as for a healthy development of psycho- 
therapy itself. With friendly greeting, your E.Kretschmer". 
In his confidential report of the proceedings of the Congress, 
entitled “Vertraulicher Bericht HLer den 9. Internatlonalen Kongress 
ftLr Psychothersnie in Kopenhagen vom 2, hie 4, Oktober 1937", dated 
11 October 1937, Professor Mauz reported that among the foreign (non- 
German) delegates the adherents of the psychoanalytic school (Freud) 
predominaced, The German participants, however, were split into three 
groups# namely the Freudism, the Adlerian “in its advanced new 
development by Ztlnkel", and the Jungian. Professor Mans stated that 
“Foreign Individual-Psychologists seem not to have been present’’, 
because “the name Adler was not mentioned throughout the entire 
proceedings"• After a discussion of the various divergences of 
opinion among the German representatives of psychotherapy. Dr.Mauz 
made the statement that be was impressed with the fact that a supply 
of young recently trained medical graduates was completely lacking 
among the psychotherapists. He continued: "Even Herr Gdring and also 
Herr Boehm are fundamentally not very favorably disposed toward the 
training of lay-psychotherapists. Nevertheless they are forced to 
propagate it, because, as they admit themselves, any stcpply of 
young medical graduates interested in such training is completely 
lacking. One could hear the opinion expressed, that this was merely 
due to the fact that the psycho therapists had no opportunities to 
teach at medical schools. If I carried away one definite conviction 
from this congress it is the one that a transplantation of these 
single residual representatives into universities would not contribute 
toward the goal of winning the young physician for a medical psycho© 
therapy and awakening in him the desire for training in medical psycho- 
therapy. None of the three schools are excepted. The goal can only 
be a medical psychotherapy within the whole of medicine. This is essen- 
tially also Professor goal. He has the right intention and 
labors for it according to the best of his powers. But I believe that 
he fights on a forlorn post. He realizes the weaknesses and dangers of 
the present state of affairs and understandably seeks for explanation# 
Fundamentally I think he realizes at times that little could be gained 
by simply transplanting the single representatives Into universities. 
On the other hand, he is of the opinion that the students are far too 
much biassed by materialistic thought and have no interest yet at all 
in psychotherapy". Dr.Mauz did not agree with the latter view,"because 
382 we could not confirm it on the basis of 11 years' experience at the 
clinic in Marburg, For many years, three of us (Kretschmer, Mauz 
and Enke) have held clinical lectures which are interspersed with 
medical psychology and psychotherapy and in part are devoted exclusive- 
ly to those problems. Every one of us had in all semesters a full 
lecture hall and could confirm the existence of greatest interest for 
these questions in our young medical men." "One can therefore not say 
that the young medical man and the German physician had no interest 
in medical psychotherapy, or that clinical psychiatry had no opport- 
unity to satisfy that interest," 
Dr, Kretschmer in his report of 25 October 19379 stressed the 
opinion that it was unlikely that the split up separate schools of 
psychotherapy in Germany could achieve a real synthesis or create 
an imposing whole on a large scale, "All these schools orginated from 
the disciples of Freud, among whom Adler and Jung later created 
their own schools and independent accomplishments of thought. New 
results in the field of psychotherapy can only be obtained slowly 
in research extending over decades. It is therefore clear to anyone 
who knows these conditions, that it is, with all apprecia.tion of good 
intentions, quite impossible to place the old teachings of Freud and 
Adler and the schools built thereupon, upon an entirely new spiritual 
and methodological basis within the short span of a few years. Their 
adaptation to the new conditions can only be a merely formal one, and 
their amalgamation can only be, in the main, one of external organization. 
"The need of German medicine and especially of neuropsychiatrists 
(Nervendrzte) for a good psychotherapy is great. But it is my firm con- 
viction that a psychotherapy recognized by German science and assimil- 
able by medical practitioners cannot be founded upon the old foundations 
of Freud and Adler, nor on the ba.sis of the split-up old special schools. 
It may be possible, so far as generally valid observations are contained 
therein, to take them over into our armamentarium of medical knowledge 
after a thorough critical sifting. But the basis for the new edifice 
of our psychotherapy can only be gained upon broad clinical foundations, 
as we have started to do for a number of years. The meaning of our 
clinical psychotherapy is not primarily the analytic splitting of 
psychic life, although analysis in critically limited form cannot be 
dispensed with. Its starting point is rather the constitutionally 
and hereditarily bound total personality; its goal the building and 
forming of the personality according to its inner biological laws. 
"The interest for this kind of psychotherapy which was funda- 
mentally developed by myself and,my disciples, was extraordinarily 
great on the part of students and physicians, and the attendance of 
classes and lectures on this subject was always lively. Also in 
other psychiatric university clinics, tendencies, at least, in this 
direction are present. A special section for psychotherapy has been 
organized for several years already by the German Association for Neur- 
ology and Psychiatry, according to the expressed desire of the national- 
socialist government for large scale coordination. As soon a.s some of 
my disciples shall occupy chairs of psychiatry, the scientific and 
practical training of a good supply of young psychotherapists will be achieved quite automaticelly. This organic development will progress 
the speedier end the more successfully, the less it will be disturbed 
by the attempts of the representatives of the older special schools, 
which have been united only on the surface, to penetrate, by means 
of special organizations, local groups, teaching appointments, official 
courses and other means into the mangement of medical practice and of 
the universities. 
'•Also we have on principle the gravest objections to the training 
of ley psychotherapists, frequently practiced there. On the other hand 
it is far from us, to make any difficulties for those medical 
psychotherapists concerned, as long as their activities are limited 
to their private work and to their internal scientific exchange of 
ideas among themselves, in so far as the state itself approves of 
that. 
"May I beg you to keep this report strictly confidential- and to 
use it only for your personal orientation. I am gladly at your 
disposal for further verbal explanations if you give me the opport- 
unity to do so.” 
“Hell HitlerI 
Signed: Kretschmer". 
It is not surprising, therefore, in view of all these confusions 
and professed limitations, such as Kretschmer's "building and forming 
of the constitutionally and hereditarily bound total personality 
according to its inner biological laws", that a reasonably good quality 
of psychotherapy was not practiced in the G-erman armed forces, except 
by a few inspired internal medical men such as Dr. Siebeck, and by 
the few of Professor Spring's associates and teams of lay therapists 
in the Luftwaffe. The neuropsychiatrists themselves confined their 
therapeutic activities to the repressive-suggestive treatment of the 
conversion symptoms of gross hysteria by means of strong and painful 
galvanic currents, and to shock treatment of the psychoses; they aband- 
oned the psychosomatic disorders and the organ neuroses, the one main 
field which cannot be handled without psychodynsmlc understending 
and psychotherapeutic endeavour, completely, and left them at the 
mercies of the specialists in internal medicine. In the overall picture 
of dealing with neuropsychiatric casualties, the German aimed forces 
relied mainly on administrative organizational measures for the utiliz- 
ation of partly disabled personnel in the environmental setting of 
special formations, such as the special formations and punishment 
formations for the psychopaths, and the stomach batallions, the special 
flak batteries and other limited service formations for the neurotics. 
5SXML- ?- D, Neurosurgery in the German Army and Air Force. 
1 , Information received from Generalstahsarzt der 
Luftwaffe Professor Dr. W. Tonnis, Chief Consulting Neurosurgeon to 
the entire German armed forces. General Tonnis was consulting 
surgeon to the Luftwaffe from the beginning of the war till December 
1 94.1 , after which he became Chief consulting Neurosurgeon to the 
Luftwaffe in December 1 94-1 , and Chief consulting Neurosurgeon to 
the entire German armed Forces in 1943. He held the latter position 
until the end of the war. General Tonnis was interviewed on May 
29, 3*3 and 31 at the German army and airforce medical center in 
Bad Ischl, Austria, where his Neurosurgical Center, formerly located 
at Berlin-Reinickendorf, was evacuated to in October 194-3. This 
interview was held jointly with Wing Commander Dennis Williams, R,A,P,M,C,, 
and Major George E. Smyth, R.A.M.C,, who submitted separate reports. 
General Tonnis and his associates were very cooperative in imparting 
information freely, and in putting their publications, as well as 
publications of other colleagues, their own unpublished statistics 
and notes and their excellent motion picture records at our disposal. 
The publications reviewed included the following subjects: the air 
transport of the sick and wounded as a medical problem (appendix 6, No,l); 
circulatory disorders after brain operations (appendix 6, No,2); the 
indications for myelography (appendix 6, No.3); the operative exposure 
of the lumbo-sacral plexus after gunshot wounds of the pelvis (appen- 
dix 6, No,A); pathogenesis and treatment of the gunshot wounds of 
the brain (appendix 6, No, 3); the injuries of the brain, spinal cord 
and peripheral nerves as handled by the Medical Corps of the Finnish 
Army during the Russo-Fimish war of 1939-1940 (appendix 6, Nos, 6 and 
7); gunshot wounds of the brain (appendix 6, No,8); the origin of 
increased intracranial pressure and of prolapse caused by brain wounds 
and their sequelae (appendix 6, No,9); the damage to the brain caused 
by the injury of blood vessels incidental to open wounds of the brain 
(appendix 6, No,10); late abscesses of the brain caused by war injuries 
and their treatment by total exstirpation (appendix 6, No,1l); closed 
injuries of the brain (appendix 6, No.12); the treatment of gunshot • 
wounds of the spinal cord (appendix 6, Nos, 13 and 21); the operative 
treatment of gunshot wounds of the peripheral nerves and its chances 
for success (appendix 6, No,14); directives for the treatment of the 
gunshot wounds of the brain and the evaluation of their sequelae 
(appendix 6, No,1h); the associated movements of the extremities in 
brain-injured patients (appendix 6, No.16); the pathology of traum- 
atic meningitis due to gunshot wounds of the brain (appendix 6, No, 
17); a review of the subject of head-injury (appendix 6, No.18); 
the medical and surgical care of injuries of the brain (appendix 
6, No,19); the proper time for operative treatment of gunshot 
wounds of the peripheral nerves (entitled; "When shall the gunshot 
wounds of peripheral nerves be operated upon?") (appendix 6, No.20); 
and the possibilities of using sound waves of high frequency as an 
aid in diagnosis (appendix 6, No,22). 
SSra^-a. 
97 Late in 1939 a special military hospital for injuries of the cent- 
ral nervous system and the peripheral nerves ( “Fachlazarett ftlr G-ehim- 
und i'ervenverletzte*’) was founded in Berlin-Reinickendorf and Dr. 
Tennis was put in charge of it- In addition* he supervised the work 
of neurosurgical units in the field, and spent himself various periods 
operating and teaching at the active war f~onts, later especially in 
Russia. The central neurosurgical hospital, in Berlin had 2000 teds; 
this, according to Dr. Tdnnis, was ,fmerely a drop in the bucket", and 
the main purpose of the Berlin hospital was to serve ns a model and 
teaching center, and as a center for research. There complete 
statistics on all patients were kept, from the time of injury until 
3 years after discharge from the hospital. One of the main departments 
of the hospital in Berlin-Reinickendorf was its rehabilitation center, 
which included the former Olympic Stadium in Berlin, with its 
athletic fields, arenas and its facilities for water sports, which were 
part of the hospital area. All brain injured were put through a very 
active rehabilitation program, a» soon as their physical state and the 
surgical state of their wounds permitted and if they were free from 
epileptic fits. This rehabilitation program was aimed at increasing 
exercise tolerance by intensive sports and competitive athletics, in 
order to prevent invalidism from .posttraumatic syndrome ("Himleistungs- 
schw&che, which literally translated means •fyrain performance weakness11). 
The whole program of rehabilitation usually required a year in cases 
with severe injuries. A period of rest of up to 2 to 3 months duration 
was followed by a period of special remedial exercises adapted to the 
specific disability, then, in increasing measure, by individual athletics, 
group athletics and competitive athletics and sports. Professor Tdnnis 
then demonstrated a motion picture sound film taken by himself and his 
collaborator, Dr. H. Pittrich, which gave a very excellent account of 
this rehabilitation program in all its aspects, including also a spec- 
ial part devoted to the speech training of aphasics. An interesting 
incidental finding encountered in the rehabilitation trai .ng and well 
illustrated in this documentary motion pi cture film was the fact that 
cases with cerebellar ataxia, even severe ones, swim remarkably well 
and with apparently excellent coordination of swimming movements, as 
compared to the severe ataxia of the gait and of voluntary purposeful 
movements of the extremities. 80$ of the patients in the Berlin Neuro- 
surgical center were army personnel, 5$ civilians, a very small percen- 
tage Navy personnel, and the remainder air force personnel. 
Neuorsurgery in the field was in the bonds of specialized neuro- 
surgical teams, altogether 6 in number, which were shifted to those 
parts of the war fronts where they were most urgently needed at the 
time. At first their policy was to evacuate as many patients as 
possible by air to Berlin; but later, as distances increased and aviat- 
ion gasoline became scarcer, en increasing amount of definitive 
neurosurgical treatment was carried out at the front. In 1942 those 
neurosurgical teems were motorized. The teams had special neurosurgical 
hospitals at their disposal. Patients were admitted to these 
hospitals directly from first aid stations in the field. The 
time which elapsed between the injury and admission to these hospitals 
varied from 1 hour to 6 days. According to a very excellent motion 
38 Z.UH-- 2. picture record of "Neurosurgery under field conditions" which Dr. 
Tdnnis shoved to us and of which he later gave m© a copy consisting 
of 5 reels of sound film taken for the purpose of teaching, (this 
film van turned over to CIOS Secretariat), the time of admission of 
the eases shown in this teaching film was between 3 and 5 days after 
the injury* .Autopsies were performed in all cases of death, even in 
those patients who reached the hospital dead or in a moribund state. 
Bie postoperative mortality was highest in the group of patients 
admitted on the third and fourth days, presumably because the patients 
admitted earlier had a better chance to benefit from the treatment 
given, and because among the patients admitted later only the good operas 
tive risks had survived the hardships of transport (table l)* 
* ' ■ ' ■"—* ' I ’I11 ’ — " **■ '■ ‘ - — 
TABLE I 
He suit a of treatment of 66 uncomplicated penetrating gunshot wounds with 
positive hacterioXogic findings in the hrain wound. 
Bay after 
Injury on 
nhich pat- 
ient va* 
first% 
treated. 
No. of 
patients 
Surface 
infection 
Infection 
only 
extradural 
Infection 
also intra- 
dural 
Deaths 
from 
menin- 
gitis 
Deaths 
from 
other 
causes 
1st Bay 
3 
3 
— 
mm 
- 
2nd Bay 
16 
6 
9 
1 
1 
3 
3rd Bay 
18 
6 
8 
4 
3 
1 
4th Bay 
12 
3 
6 
3 
3 
- 
5th Bay 
11 
3 
6 
2 
1 
- 
6th Bay 
6 
1 
5 
mm 
mm 
- 
66 
28 34 
56(84.8#) 
10 
(15.1$) 
e 4 
(13.1#) 
Apart from these factors, the skill of the neurosurgeon or neurosurgical 
team taking care of the injured greatly affected the results. The 
mortality among groups of patients inadequately taken care of was two 
to four times that of patients taken care of by Dr. Tdnnis himself 
while on detached Service with frontline Neurosurgical Units (table 2). 
TABLE 2 
Hesults of treatment of uncomplicated penetrating wounds (Type l) of 
the cranial vault. 
Quality of surgical 
care 
Ho. 
Deaths from 
meningitis 
i 
Inadequate 
96 
35 
36,4 
adequate 
151 
34 
15*9 
adequate 
106 
10 
9.4 
SSXH-H- - Z. Table 2 gives comparative mortality figures for % cases who had been 
cared for inadequately (bacteriological findings in that group are 
unknown), wit!b two series of 1 fi and 106 cases respectively of whom I 
took care myself. The mortality rate in the former was and 
contrasted to my own of 1 5. jfo and 9,1$ respective!y. 
The main objective of neurosurgical treatment of the wounded were 
removal of hemorrhage and prophylaxis against infection, Removal of 
all hemorrhage was considered so important because it was found that 
all subdural empyemata were due to infected subdural hematomata. 
The steps of neurosurgical care, which were initiated after a prepar- 
atory blood transfusion was given, were as follows; 1, Debridement. 
2, Closure of the gap in the dura, in order to avoid secondary infect- 
ion, 3. Prophylaxis against infection of the spinal fluid, which was 
begun as early as possible after repeated lumbar punctures had 
revealed the presence of more than 200-300 cells in the spinal fluid. 
This prophylactic treatment consisted in daily replacement of the 
spinal fluid by insufflation of air through the lumbar route, which was 
continued as long as the spinal fluid cell count remained elevated 
beyond the above mentioned limit. This treatment was always carried 
out under anesthesia (with scopolamine, eukodal and evipan) in order 
not to upset the circulation. These treatments were given in all 
neurosurgical installations under Dr, Tennis's direction even in 
forward areas. Dr, Tonnis stated that death from meningitis was due 
to toxic paralysis of the vital centers in the brain stem, and that 
this treatment prevented the infection of the spinal fluid from reach- 
ing toxic proportions. 
Dr, Tonnis then discussed some of the statistics concerning the 
results obtained by him and his collaborators. The prognosis of 
patients with tangential shots which opened the dura was particularly 
good, (table 3)? the total mortality being 12fo. In a series of 226 cases 
of fronto-basal penetrating gunshot wounds the mortality was 23.66$ 
(see table 1+). 
TABLE 3 
Tangential shots which opened the dura (1 , 3QQ cases). 
Intradural infection occurred in : 15% 
Of those died: (or 80f0 of those in whom infection had 
occurred). Most of those died from progressive purulent 
encephalitis, only {j% of the infected ones) from 
meningitis. 
of those in whom infection had occurred (or J/o of the 
total) survived their infection. 
ssa.KH.-'a. 
100 TABLE 4 
End results in 226 cases of fronto-basal penetrating 
gunshot wounds of the brain. 
Total mortality: 38 = 25,66 $ 
Survivors: 168 = 74.34$ 
Discharged to duty: 128 = 56.64$ 
Pit for general duty: 23 = 10.18 $ 
Pit for limited service 
(garrison duty) 57 = 25.22 % 
Pit for laboring duty 
only: 48 = 21.24$ 
Discharged from the Service: 40 = 17.70 $ 
56.62|fo could be returned to duty in the Army, 10.18jo as fit for 
general duty, 25.224 as fit for limited duty (garrison duty), 21,244 
as fit for laboring duties only. (40 cases) had to be invalided 
out of the Army, for the following reasons: 16 because of posttraum- 
atic syndrome ("Hirnleistungsschwache'’); 8 because of frontal lobe 
syndrome; 5 because of the fact that they had recovered from meningitis; 
2 because of occasional Jacksonian attacks; 3 because of reduction of 
vision in one eye and loss of the other eye; 2 because of bilateral 
amaurosis; 5 because of the magnitude of the bone defect which was 
to be repaired at a later date; 1 because of severe labyrinthine 
damage. Not considered among these causes are 21 instances of unil- 
ateral amaurosis among these discharged cases. 
Of particular interest were four series of gunshot wounds of the 
brain in which the ventricles and the basal cisterns had been opened 
by the missile and which had been treated by various combinations of 
surgical and of local and general sulfonamide treatment (table 5). 
The mortality became progressively reduced in the later series, espec- 
ially since replacement of the spinal fluid by insufflated air was 
added to the therapeutic armamentarium. The low mortality of the 
later series, of 22,7/3 and respectively, was in striking cont- 
rast to the results of the same types of injuries in the last war, 
when, according to Dr, Tennis the mortality in cases in which the 
ventricle was opened by,a missile was 1004, that of cases in which the 
ventricle was opened by bbne splinters varied between 40 and 60^, 
TABLE 5 
Results of treatment in cases in which the ventricle and the cisterns 
were opened directly by the injury. 
3*631*. -3- 
101 Method of treatment 
No. 
Deaths 
Percentage 
Surgical and generalized 
sulfonamide treatment 
26 
20 
76.5^ 
Surgical care and general and 
local sulfonamide treatment 
25 
11 
kU $ 
Surgical care, local and 
generalized sulfonamide treat- 
ment and early replacement of 
spinal fluid by insufflation 
of air 
79 
18 
22.1$ 
Surgical care, general sulfon- 
amide treatment and early re- 
placement of spinal fluid by 
insufflation of air. 
112 
12 
10.7$ 
Among a group of 929 unselected cases of gunshot wounds of the 
brain the mortality was 33»4$. 53*3$ were discharged to duty 
(military duty and laboring duty), 13.3$ remained in need of hospital 
treatment and care (table 6). 
TABLE 6 
Of 929 patients with gunshot wounds of the brain: died 31 0 33*^2 
Admitted in moribund condition 28 
Died from other causes 45 
Of those: 
Pneumonia 29 
Generalized infection 6 
Injuries of the chest 4 
Injuries of the neck 2 
Gas infection 1 
Tetanus 1 
Embolism 1 
Injury of the spinal cord 1 
' 45 '73' 
929 310 
-73 -73 
856 237(27.6^) Of those died; from meningitis (abscess & encepha- 
litis) 191 (84*8^ 
from edema of the brain 46 (15.2^) 
The 619 survivors were discharged from the hospital as of 1 April 19A2: 
" as in need for further hospital care”: 13*1$ 
11 as fit for labor or military duty”: 53*3^ 
The results became better as the war progressed because of 
perfection in methods of surgical treatment, sulfonamide treatment 
and other methods of prophylaxis against infection. Table 7 shows 
two series of otherwise comparable groups of cases. The mortality 
in the 1941 series was that in 1943 10.99j£. Penicillin or 
penicillin like substances were never used by General Tonnis nor by 
any other surgeon he knew of In the German army or air force. General 
Tonnis added that penicillin was unknown in Germany, apart from a 
rumor about it which arose shortly before the end of the war. 
TABLE 7 
Progress of prophylaxis against infection in intradural fronto-basal 
penetrating gunshot wounds: 
194-1 (Orscha series),.. 1 04 cases: of those died 4-7 
1 9 due to severity of injury 19 
1 from other causes 1 
Of the remaining 84 cases died from 
meningitis 27 = 32,14/^ 
194-3 (Kuban series).., 60 cases: of those died 11 
3 due to severity of injury 5 
0 from other causes 0 
Of the remaining 35 cases died 
from meningitis 6 = 10,95*^ 
Dr, Tonnis continued to say that he always strove to close the 
dural defects in the primary operation except in cases with prolapse 
or with extensive tranatization and swelling of the brain, or in 
cases in which there was prolonged unconsciousness. 
Sulfonamides were given into the brain wounds and into the wounds 
of the sdft tissue. Prophylactic general sulfonamide treatment was given 
only if there was perforation of the ventricular system. In all other 
cases sulfonamides were held off until after meningitis was present; 
then it was given as therapy. 
Dr. Tonnis stressed again that his own material was merely a 
smpll -oart of the entire neurosurgical material of the German army and air force; that his results represented the optimum and were not repres- 
entative of the whole 5 because he had the opportunity to do things 
under optimum conditions and with optimum resources because the army 
and air force authorities regarded his organization as a research,, 
testing* and teaching center. Although he tiled and may have contributed 
to bring up the remainder of neurosurgical care in the German armed 
forces to his own standards* he quite realized that this certainly 
could not have been fully accomplished. Dr, T&nnis added that as 
the war progressed* injuries became increasingly severe and complic- 
ated because of the relative increase in the use of mines with very 
small fragments. 
In discussing Table 6* Dr, Tonnis added that from this table it 
is obvious that 21% of the patients died from the brain injury itself* 
and 6% from complications not connected with the brain injury, 66% 
survived; of the who were discharged to labor or army service* 
only 27% were discharged to military duty* and most of those to limited 
service. Dr. Tonnis added: "that does not depend alone on the injury 
but also upon the patient's personality; also what the patient had 
been thin - his experiences* losses in his family and other factors 
influenced the results. In another series* we have returned 
of the patients to the armed forces. At a re-examination three years 
later* we re still with the armed forces. In that group 6%° 
were fit for full military duty* i.e. combat duty. A high percentage 
of those were regular army officers, I recall a fighter pilot who was 
returned to flying combat duty following convalescence from a fronto- 
basal gunshot wound of the brain. After he returned to duty he 
accounted for an additional 1+6 enemy aircraft. Each case lias to be 
evaluated according to its own merits. Von Vfeizsdcker always wanted 
to issue general directives* such as 'no man who had a brain injury 
should return to combat1 or even to any military duty. They should 
have all been sent to labor duty. But I have always opposed such gene- 
ral policies because things are different in every case. There are 
some soldiers* especially among officers* who would probably do very 
poorly if sent to anything but full military combat duty; others do 
well in labor assignments* but the decision will always have to bt 
made strictly ipdividually," When I expressed the desire at this 
point to see Dr, Tennis's records* especially concerning the problem 
of disposition* he stated that he sent all his records on gunshot wounds 
of the brain to Professor Krayenbiihl in Zurich* and those on the 
peripheral nerves to Issny in the Allgau in western Bavaria* near 
Kempten. These records also include all his data on the building up 
of tolerance to exercise by athletics and sports* his photographs* etc. 
Dr. Tennis's work was subdivided into various departments* each 
one under an associate whom he selected for specific competence. The 
following sub-divisions were organized: 
1. Brain surgery; 2: surgery of the spinal cord and peripheral 
nerves; 3: an internal medical department; J+: A department for treatment of 
the frequently associated injuries of the jaws; 5: ear? nose and throat 
department; 6: an after-treatment department with facilities for neurological and psychological examinations; 7; the rehabilitation 
center, which included the Olympic stadium with its facilities for 
sports including water sports, the speech training school, other train- 
ing schools and workshops • 
Dr. TSnnls was then asked how he dealt with bone defects* He 
stated that he always excised the hard scars which remain after 
operations for brain abscess, that he then closed the dural defect 
with fascia lata, and that he closed the bone defect if it was cos- 
metically necessary with a plastic called npallodonn* Whenever that 
was not cosmetically necessary, such as for instance in small bone 
defects, he used bone from the tibia* 
Dr* TBnnis was then asked as to his technique of nerve suture 
in peripheral nerve injuries (see also Appendix 6, Nos.14 & 20). He 
stated at first that he never used transplants, hut in the next sen- 
tence he modified this statement and said that he had used them very 
rarely in a very few cases. His method of choice was the nerve su- 
ture. He claimed that 97$ of the nerves sttured by himself and his 
staff regenerated, with full restitution of function in 57$* He used 
no tantalum sleeves* Dr.fBnnis felt that the most important things 
in nerve suture were intensive physiotherapeutic pre-treatment of the 
Joints, and care in fixing the Joint in a good end position* It was 
likewise important to let a sufficient amount of time lapse after the 
injury (preferably four months) in order to allow for spontaneous 
regeneration and in order not to disturb the latter by operative 
interference if it was in progress* Dr* TBnnis stated that he had 
devised a special method for high repair of sciatic nerve injuries in 
the pelvis (see Appendix 6, no*4), In some of his operative cases, 
he claimed to have obtained regeneration of the sciatic nerve 10 - 12 
months after the injury. Dr. TBnnis added that the peripheral nerve 
department* including the sub-department for neurosurgical treatment 
and for physiotherapeutic after-treatment* had been evacuated to 
Is any in April 1945* At the same time* representatives of the Swiss 
Bed Cross visited Dr* TBnnis and took his other records to Zftrich 
shortly before the Americans entered Bad Iscbl on 6 May 1945* 
The spinal cord injuries were likewise treated in this separate 
department of which Dr* Hans Schmidt, Oberstabsarzt, was in charge. 
The prognosis was always bad* The policy in acute cases was to hold 
off treatment until the patient had recovered from shock* Laminectomy 
was always done In case of block or in case of an intra—canalicular 
metallic foreign body* In all cases of spinal paralysis of the bla- 
dder which were treated in installations under Dr. direction, 
a supra—public bladder fistula was produced* But Dr* T6nnls stated 
that this was not done generally throughout the medical and surgical 
services of the armed forces* Tidal drainage was not used* not even in 
rear areas. According to Dr* Tdnnis’s opinion the supra—pubic fistula 
anrj the subsequent practice of manual expression of the bladder 
sufficed to prevent significant infection* 
J582M.U- 2. Dr, Tttnnls does not recall the exact figure of how many closed 
head injuries he or his organization treated, hut he thinks that otfi 
half of his clinical material consisted of closed head injuries* 
In all cases convalescing from head injuries* closed or open* 
who showed persistence of symptoms without neurological signs* psycho- 
logical studies were carried out aimed at determining the presence or 
absence of *Hirnleistungsschw8che* (brain performance weakness), the 
approximate equivalent of our non-committal term *post-traumatic 
syndrome* • Dr* Pittrich* who also took part in supervising the re- 
habilitation program, carried out special psychological investigations 
in this condition# for which he also used the Rorschach teat* the 
Pauli test, and other tests* especially those aimed at testing the 
various local!zable functions of the brain, according to the princi- 
ples of Eleist* by whoa Dr. Pittrich had been trained* He has found 
in this work that in right-handed persons the left hemisphere is more 
likely to eause localizable losses of function* His method of tes- 
ting also revealed frontal lobe syndromes, specific disturbances of 
pallets! lobe functions and other focal disturbances in these patients* 
Dr. TSnnis stressed the point that the concept 5f Hirileistungs- 
schw&ohe was that of an organic category of disease. When I asked 
Dr. Tftnnis whether a neurosis coexisted in some cases or whether in 
some cases the main presenting symptomatology may have been neurotic* 
Dr. TSnnis emphatically replied: *No* No.* He distinguished three 
major types of phases of Hirileistungssehwftche* namely: Is latent; 
2: compensated; 3; decompensated* Dr* TSnnis considers Eirnleis- 
tungaachwftche as due -to * damage of the brain stem with disturbances 
in the realm of the vasomotor nerve apparatus** Pneumoenceph&lo- 
graphic and eleetroeneephalographic examinations were carried out 
in all cases of Hlrhlsistungsachwftchs. There was a 
parallelism* between abnormal KEG and Hlmleistungsschw&che» but no 
positive correlation in individual eases* There was a search for 
such an Objective test* for Hirnlsistungssehwftehe* but the MO 
did not turn out to be that test because many oases had normal MGs, 
who nevertheless were suffering from definite Hirnleistungssehw&che. 
Dr. TSnnis stated that he has arrived at his conclusion regarding 
•Hirnleistungsschw&che* with the cooperation of a number of psychia- 
trists who served in his department and who had been well trained by 
first rate neuropsychiatrists * such as Heist, PStzl,Rslchardt ,Kehrer* 
Schuster (who was well known for his frontal lobe work)* and Goldstein. 
Dr. TSnnis claimed that in contrast to the cases treated by Yon 
leizs&eker, none of the cases treated by hie rehabilitation program 
have taken on superimposed neurotic trends. He felt that this was 
due to Intensive rehabilitation treatment with effective elevation 
of exercise tolerance by means of coaqpotitlYs sports and athletics* 
which not only prevented neuroses * but also improved or cured many 
of the definitely organic disturbances associated with Hirnlelstung- 
ssohw&che, including rigidity, masksa facies* and decrease of 
spontaneity of the type seen in Parkinsonian disorders. 
3QXM-H-- 2 Dr. Tdnnis was then asked about his experiences with operations 
for traumatic epilepsy. Dr. Tdnnis stated that he operated continuously 
on cases of traumatic epilepsy, hut did not recall exact figures. 
His technique for excision of epileptogenic foci Is to cut right 
through into the ventricle and to excise not only the scar, hut also 
the subjacent tissue between the scar and the ventricle. The final 
result is a cerebral defect with free flow of cerebrospinal fluid 
from ventricle to subarachnoid space. The rationale for this pro- 
cedure was the -"lew that contact of the cut brain surface with cerebro- 
spinal fluid prevented gliosis. Dr. Tdnnis felt that the ventricular 
dilatation was an early effect of traumatization of the brain and was not 
due to shrinkage of scars as had been assumed by Foerster and by Penfield. 
Dr. Tftnnis stated that he made a practice of excising also non- 
epileptogenic scars, in order to prevent circulatory disturbances in 
the vicinity of the scar caused by mechanical factors. Dr. Tdnnis 
felt strongly that "shackling" of the ever motile brain - ever motile 
because of its constant respiratory and pulsatory movements - to the 
scar, produced circulatory disturbances in the vicinity of the scar, 
and thus a progressive growth of the area of damage and destruction of 
cerebral tissue. 
For the prevention of adhesions Dr. Tdnnis uses a rubber membrane 
such as devised by Cushing, which is being inserted temporarily until 
new arachnoid is formed. If there is an open communication with the 
ventricle no such membrane is necessary. 
Dr. Tdnnis stated that recurrences in his series of cases operated 
on for traumatic epilepsy were exceedingly rare. He claimed that 87 - 
88$ of his cases operated on for traumatic epilepsy remained free from 
recurrences. Dr. Tdnnis was then asked whether he ever observed bio- 
electric recurrences in BEG re-examinations. He replied that he 
recalled no such findings, but stated that his material was not compl- 
etely studied yet. He stated that he has not observed the phenomenon 
of spread to, or "learning" of abnormal wave patterns by other parts of 
the brain which were not originally involved. Bie usual number of 
patients in Dr. Tdnnis*s neurosurgical center was 1,600 - 2,000. Of 
these 200-350 were usually bed patents under active neurosurgical 
treatment, 500 were neurological conditions including "Himleistungs- 
schwtche" following closed head injuries, 300 were peripheral 
nerve wounds under active treatment, the remainder convalescents in 
various phases of the rehabilitation program. Altogether 10,500 cases 
went through Dr. Tdnnis*s center, complete records of which have been 
kept and are available, most of them in Zurich where they are in the 
hands of Dr. Krayenbdhl. The total number of cases with injuries of 
the brain, spinal cord end peripheral nerves in the German armed forces 
which passed through neurosurgical hospitals in addition-to Dr. Tdnnis*s 
center was about 50,000. 
582*./+- I Of Dr. Tennis's associates? a number of them were interviewed? 
some in detail. The information obtained from them is reported in 
the following 3 chapters. 
2. Information received from Stabsarzt Dr, Erich Eischer-Brugge? 
Luftwaffe? surgeon and neurosurgeon? and Dr. Tennis's closest collab- 
orator. Dr, Pischer-Brugge stated that cases of blast were included 
among the closed head injuries treated at the center. Dr, Pischer- 
Brugge stated that a particularly high percentage of blast injury cases 
developed Hirnleistungsschw&che in the later course of their illness. 
Another observation made by Dr. Pischer-Brugge was that shell frag- 
ments follov/ing perforating injuries of the brain y/hich come to rest 
within the brain substance? frequently lodge closely to larger arterioles? 
presumably because they were•caught by the elastic arterial string. 
This is a point to remember Y/hen removing such splinters, 
3. Information received from Stabsarzt Dr. W, Riisken, neuro- 
psychiatrist? and from Stabsarzt Dr. Ernst Dvoracek, the internist on 
Dr. TBnnis's team. Stabsarzt der Luftwaffe Dr, Wilhelm Rusken? M,D, 
(Hamburg; 1932? is a neurologist and psychiatrist? trained by Professor 
in Berlin, His main fields of activity in Dr. Tonnis’s 
organization included psychiatric consultations? and the diagnosis 
and the treatment of epilepsy. Furthermore, he was in charge of the 
after-treatment? the rehabilitation program and the work therapy of 
the brain-injured. 
Stabsarzt der Luftwaffe Dr, Ernst Dvoracek? M.D, (Vienna) 1937j 
is a specialist in internal medicine? trained in Dr, Eppinger's medical 
department at the University of Vienna, 
Dr. Rusken and Dr. Dvoracek were interviewed together. First Dr, 
Rusken was asked about his concept of Hirnleistungsschwache. He 
replied that it was a non-localizable organic cerebral disorder which 
was first described by Reichardt and Poerster. It consisted in the 
main of the combination of two syndromes: 
(1) a vegetative syndrome 
(2) a psychopathological syndrome consisting of difficulty in 
concentrating? disturbance of memory and emotional Y/eakness, 
The only effective treatment of Hirnlei stungss chw&che was work 
therapy and therapy aimed at raising exercise tolerance by athletic 
activity and sports. 
Hirnleistungsschw&ohe was more frequent and of longer duration 
follovdng closed head injuries than it Y\/as following open head injuries. 
Of patients treated for Hirnleistungsschwache at Dr, Tennis’s 
108 neurosurgical center, 20fa were restored to military duty status; most 
of them to limited duty status, only a small percentage to full 
military duty status, practically only in the case of regular army 
officers who strongly desired such status. were discharged as 
fit for labor in civilian life, while 15/^-25% remained unfit for work. 
Dr. Riisken added that like the category of concussion, the category 
of Hirnleistungssohw&che is a vague and ill defined one; but he believed 
that it was fundamentally an organic one. 
Dr, Dvoracek, as the internist of the team* had keen mainly1'inter- 
ested in symptomatology of the post-traumatic syndrome 
(IH rnlei sTTmgs schwaclie) ana lie ba5'v'?:5ked te- teid,- vsomot-hing about his' 
work and ideas in this field. He stated that the disturbances of 
circulation which could be observed in Hi rnlei stungsschwache were 
similar to those which we classified as neuro-circulatory asthenia, 
but which he ascribed in Hi rnlei stungsschwache, to organic disturbances 
of the physiology of circulation. Dr, Dvoracek stated that he 
performed thorough studies of the circulation in patients suffering 
from Hi rnlei stungsschwache "in order to narrow down the category of 
neurosis". His aim was "to find something tangible that would entitle 
us to eliminate the term 'neurosis’," The tests which Dr, Dvoracek 
performed in all his patients included daily repeated measurements of 
the blood pressure in a recumbent position, in a standing position, and 
while in motion, tests of the influence of exercise upon the circulation 
similar to the Schneider test; blood sugar and sugar tolerance tests, 
the latter both in response to insulin and to adrenalin; tests of 
temperature tolerance in the hot box; gastric function tests including 
free acidity, total acidity, and total amount of secretion in res- 
ponse to test meals and to caffein; and the usual kidney function tests. 
In addition, the stomach was observed by gastroscopy. Dr, Dvoracek 
felt that he has found all degrees of gradual transition from the 
normal to the organic brain-injured, neurosis occupying the intermediate 
ranges of abnormality. Because of this observation, Dr, Dvoracek felt 
that the neurotic was actually an organically abnormal person in whom 
we could not yet grasp the nature of the pathological change involved. 
Dr, Dvoracek admitted that even some of the extreme degrees of neuro- 
circulatory and vegetative instability observed in cases of Hirnleist- 
ungsschweLche were similar to those found in organ-neuroses, especially 
cardiac neurosis. Dr, Dvoracek was rather fascinated with the similarity 
of the neurociroulatory and vegetative changes encountered in post- 
traumatic syndrome (Hirnleistungsschwache) with those of the neuro- 
circulatory neuroses and asthenias, but he did not draw the conclusion 
from it that possibly or probably neurotic mechanisms played into the 
mechanism of the post-traumatic syndrome, but that on the contrary 
organic neurociroulatory imbalance played a part in the neuroses. 
3tta.iv i*. i Dr, Dvoracek then quoted the case of a young soldier who, 
following the fracture of a leg, began complaining of heart trouble. 
Studying his vegetative system Dr, Dvoracek found that the changes 
in this soldier were similar to those of his cases of Hirnleistungss- 
chwache. When Dr, Dvoracek was asked what treatment he employed in 
this soldier, he replied: ”1 wanted to treat him by implantation of 
a hypophysis, but he refused". He was discharged from the hospital 
to limited service as "LU 49" which meant "limited service due to 
heart disease", I then asked Dr, Dvoracek what he would have done if 
he had considered this soldier a case of neurosis. He replied that he 
would have then found him fit for full military duty and that he would 
have classified him as A 49. When I asked him why 1491 (which meant 
heart) and not ’15% which meant nerves* die replied "because it 
manifested itself in his heart", and he added that the organ-neurotics 
were not supposed to be classified under 113‘* Dr, Dvoracek stated 
that as the war went on the cardiac neuroses played an ever increasing 
role, both in terms of numbers and in severity of disabilities. At 
the beginning of the war, there was very little cardiac neurosis, 
probably due to the enthusiasm of war. The mumber of cardiac neuroses 
were steadily increasing up to the end, when they reached their peak 
values. 
Dr. Dvoracek had extensive experience on battle fronts in Russia, 
He stated that nervous exhaustion cases we re returned home for 2-3 
months; after three months they were re-examined and reassigned. He 
continued: "as physicians out at the front, we have always tried to 
prove the existence of an organic illness because the diagnosis of 
’neurosis1 was discriminating. I have never made that diagnosis. 
Besides, there was always something organically wrong with everybody. 
Everybody had either diarrhoea or some circulatory disturbance, and 
we have diagnosed them as such. In Russia we had a lot of dysentery 
without bacteriologic findings. In those cases we were rather stringent 
in refraining from recommending evacuation, A .curious thing was that 
as soon as active battle was joined and shooting went on, we internal 
medical men had nothing to do, but as soon as the front became quiet 
we suddenly had a lot to do". Dr, Dvoracek estimated that 3% of the 
cases in evacuation hospitals at the front (Kriegslazarette) were 
cases of functional disorders. The remaining vast majority were 
organic conditions, among which cases of "field nephritis" predominated. 
This was an infectious type of glomerulo-nephritis which developed in 
some relationship to cold and dampness. 
Dr, Dvoracek who was commissioned in the Luftwaffe, also had some 
experience in screening stations for flying personnel (Siohtungsstellen 
fur fliegendes Personal), The condition known as "Abgeflogensein" (fly- 
ing fatigue) consisted in a state of weakness, with tremors, sleep- 
lessness, complaints referred to the inner organs, failure in keeping 
up levels of accomplishment, and lack of confidence in flying. Dr. Dvoracek considered this condition as an exhaustion state which 
occurred in perfectly normal and "psychopathologically non-suspect" 
human beings. Dr. Dvoracek felt that environmental conditions 
and training did have a lot to do with nervous failure. Ho stated 
that in the winter of 1943 when a great number of personnel were 
transferred out of the Luftwaffe and put into infantry combat format- 
ions, practically all the transferred Luftwaffe personnel broke down 
because they did not have the experience and the training in infantry 
combat • 
Plying fatigue was treated at mountain homes, especially ski-ing 
homes. Fatigued flying personnel were sent there for 4 “6 weeks 
at a time. 
Dr. Dvoracek stated (also Dr. Tonnis had called my attention to 
it) that there was a particular special type of flying fatigue which 
occurred during the Battle of Britain. Plying personnel which was 
sent on combat missions to Britain, especially those flying in single 
engined planes, frequently developed gastric complaints. This condit- 
ion was then called "channel stomach", because some of the afflicted 
aviators thought that it was due to looking out of their cockpits at 
the waves of the channel, and that just looking at the waves under- 
neath with nothing else visible, made them sick to the stomach. Dr. 
Dvoracek added "we thought this was due to the cold, irregular meals 
out of tin cans, because these aviators flew all the time, practically 
ceaselessly, on a number of missions throughout the day, and they almost 
always missed their regular meals." Dr. Dvoracek did not know any- 
thing about another obviously neurotic condition, which likewise Dr. 
Tonnis had mentioned to us, which was said to have afflicted a number 
of G-erraan troops fighting at Tobruk, and which had then been known as 
"Tobruk heart". 
Dr. Rusken then added to this discussion that in this war no 
cases of "typical war neuroses" or "pension neuroses" were seen, which 
T/ere so typical of the last v/ar. Dr. Rusken felt that the major 
contribution to keeping down the incidence of neuroses among patients 
who had had a brain injury was made by the very definite policy that 
a man with real head injury was never sent back to combat or to the 
front unless he himself wanted to go there. This may have contributed 
to giving a feeling of security to the brain-injured patient and 
eliminated the incentive to evade or to "goldbrick". The program of 
rehabilitation in the hospitals, likewise, was kept healthy and stim- 
ulating. The program on rehabilitation wards was approximately as follows: 
0800 hours: ward details. 
0900 hours: medical rounds. 
1000 hours: rehabilitation treatment: sports, athletics, work- 
shops, physiotherapy and remedial exercises, and 
school classes. 
1200 hours: Lunch. 
111 1300 - 1430 hours: Bed rest. 
1300 - 1830 hours: Rehabilitation treatment like at 1000 hours. 
1900 - 2200 hours: Supper, then free time for elective activities. 
Three times per week lectures were given during that period. Dr. 
Rusken felt that all this activating program definitely prevented 
the development of neuroses in the hospital, but he stated that some 
patients who had been discharged without neurosis as fit for work 
came back later with neurosis. This, Dr. Rusken felt, was due to 
poor handling on the part of outside agencies, and therefore later 
a policy of continued collaboration between the treatment center for 
the brain injured and the employing echelons was organized. A 
special institution for the social welfare for the brain-injured was 
founded., called ’'special military hospital organization for the social 
welfare of the brain-injured" (bonderlazarett zur Betreunung der 
Hirnverletzten;. Such social welfare centers were attached to all 
treatment centers for the brain injured, including the one at Berlin. 
Every soldier before discharge from the hospital was examined by the 
medical staff of this Sonderlazarett, who gave exact directives to the 
Veterans' Administration, about how to handle and to employ this 
particular patient. It has been found that originally the Veterans' 
Administration was not cooperative in that the general practitioners 
who performed the re-examinations there did sometimes declare a man 
well who had been discharged from the- hospital for the brain-injured, 
although there'wore definite regulations against any change of evaluation 
of disability by the general practitioners employed by the Veterans' 
Administration. The law always required a specialist for any signif- 
icant re-evaluation. It was observed that the feeling of insecurity 
produced in the brain-in jured soldier by such sudden and uncoiled for 
re-evaluations of his disability status threw some soldiers with 
organic Hirnleistungsschwache into additional neurotic reactions. 
Dr. Rusken had seen several, such patients taking this turn 1% - 2i> 
years after discharge from the hospital. Since then the policy was to 
give every man discharged from the hospital a "work-test-furlough" 
(Arbeitserprobungsurlaub) of 2 - 3 months duration, during which time 
the doctor from the special hospital center for qocial welfare of the brain- 
injured followed up and checked his performance in order to help him 
reach a satisfactory work adjustment. 
The therapy for acute neurotic reactions consisted in mild, sedation 
and athletic therapy. Especially the athletic and sports therapy had 
excellent results in organic and. psychological illnesses as well. Dr. 
Rusken used no abreaction therapy and no sustained narcotherapy; 
neither did he use insulin, except for the psychoses. 
Dr. Rusken saw several cases of blast injury who were unconscious 
for 1-3 days. Treatment of these oases consisted in prolonged bed. 
rest of many weeks duration. Later the usual rehabilitation treatment 
was instituted, but Dr. Rusken found that cases of blast injury did 
3»a*vH--a- not stand the systematic raising of exercise tolerance by this treatment 
as well as other cases. On the whole, the open head injuries did 
better with this treatment than the closed head injuries. 
4. Information received from Stabsarzt der Luftwaffe Dr, Carl 
M,D. (Vienna) 1932, Neuro-psychiatrist _on . Pr,_Tdnnls'n 
staff. Dr Dussik is a neuro-psychiatrist trained by Dr. Pdtzl in 
Vienna* His main scientific interests were in the neuropsychiatric 
aspects of carbohydrate metabolism and of anoxia and hypoxia, in 
the diagnostic use of ultra-sound-waves, and in the problems of the 
post-traumatic syndrome (HimlelstungsschwAche). 
Dr. Dussik served in an examination center for flying personnel 
from 1940-1942, where he was mainly engaged in neuropsychiatric 
selection. He stated that 30$ of the applicants for flying status 
were rejected for psychoneurosis or psychopathy, another 10$ for 
physical reasons. Bae interview on tdiich neuropsychiatric selection 
was based was held in the form of an informal conversation Bie first 
point to be considered was "why do you want to fly", then came the life 
history. It was sometimes useful to let the applicant write out his 
own course of life or another thesis on a subject of interest to him, 
before the interview. At the beginning of the war there had been 
psychological tests also, but they were given up. Dr.Dussik felt 
that an additional significant amount of selection wets performed by 
the flight surgeon and the company commander during elementary flying 
training. Dr. Dussik stated that the aim was to obtain "people who 
had aptitude in the practical aspects of life and who were of decent 
character". Basse qualities were worth more in flying than great 
giftedness. On the other hand, there was a policy not to reject too 
many* People who came with a sincere will were accepted in spite of 
phsyical, emotional, or intellectual shortcomings. The qualities of 
reliability and comradeliness, and a manly, courageous attitude in the 
performance of sports, were important positive assets* 
There was no operational limit in the Oeman air force. The 
result of this fact was that "a certain neurasthenic development 
occurred in all flyers". The institution of rest homes tended to 
control this trend sufficiently. Flyers in whom these neurasthenic 
symptoms were not taken care of by rest home treatment were sent to 
screening centers for flying personnel, such as the one in Frankfurt 
on Main, which was headed by Col. Von Dicrlngshofen. Dr. Dussik 
expressed the opinion that flying fatigue (Abgeflogensein) was 
partly an organic condition, which may have been due — at least in 
part - to the organic effects of vibration and acceleration of aircraft. 
He admitted that in a part of this group of cases this condition may 
have been entirely psychogenic, but he insisted that in another 
significant group of these cases, this condition must have been due 
to "not well definable organic fundamentals". He cited the case of a 
flyer who had hypoglycemic attacks which occurred only in flying and 
which were associated with dizziness, sweating and hemienopic restriction 
of the visual field. These attacks first developed after this flyer had 
an attack of hepatitis, presumably of the epidemic type, and they were 
possibly hypoglycemic. They only occurred when he was flying and usually after he had been 20 minutes in the air, independent of the 
altitude, that is it occurred at 12,000 feet as well as at lower 
altitudes. But the important point was that the hypoglycemic attack 
always came on after 20 minutes of flying, when this patient was 
tested pharmacologically, he was found to be more sensitive to insulin and 
to adrenalin than most normal human beings. Dr. Dussik felt that 
this constituted proof of an organic disturbance of vegetative regulation 
of slight degree. He felt that such slight regulative disturbances 
may have played a role in many cases of flying fatigue, (abgeflogonsein), 
although in most cases their existence could only be surmised clinically. 
Dr. Dussik continued: ’’maybe some day we may be able to express in 
organic terms what most people now consider psychological”. 
Dr. Dussik stated that all aviators who survived a long series 
of combat missions developed some degree of neurasthenic weakness 
and irritability, but not necessarily to the point of ’’abgeflogen- 
sein.” The incidence of disability from abgeflogensein was unknown to 
Dr. Dussik, He stated that neurotic reactions in aviators increased 
greatly at the Western front when the air superiority shifted to the 
Allies, while neurotic complaints did not increase significantly among 
aviators at the Eastern front, where up to the final defeat on the 
ground a certain measure of air superiority remained in the hands of 
the G-erman airforce. Dr. Dussik admitted that this observation 
implied that there was a psychological factor in these conditions. 
But again he felt that organic factors incidental to an unfavorable 
combat situation, such as loss of sleep, lack of food and loss of 
weight, were equally or more important. The best treatment was 
always the rest home, not the flier’s own home because of the adverse 
influence of home environment upon combat personnel. During the 
first week of rest-home treatment, mild sedatives were given. After 
3-6 months in a rest-home, fliers with persistent fatigue states or 
neuroses were used for a while as instructors, but in view of the 
reduction of air force training not many assignments as instructor 
were available. After a time spent on this or other non-combat duties, 
e.g, ground duties, the patients were re-examined at the nearest 
screening station for flying personnel. Dr, Dussik was asked how many 
patients were then returned to combat flying. He answered, with a 
smile, "that number was not very great”. Dr. Dussik felt that that 
was mainly due to the fact that the time of recuperation was too short. 
He felt that after a period of recuperation lasting 1-2 years, such 
fliers would have become fit to fly in combat again. 
Dr. Dussik stated that the neuroses in infantry personnel had 
greatly increased toward the end of the war. 
At one time, in a 200-bed hospital, Dr. Dussik v/as in charge of 
a neuropsychiatric section with 30 beds, 10 of which were always 
occupied by patients suffering from various neuroses. The latter 
included people who had psychopathic traits and who reacted with 
3 neuroses to environmental change. The other 20 beds were occupied 
by neuritides and other organic nervous illnesses. 
In regard to the general policies of the handling of neurosis by 
the air force and the army, Dr. Dussik stated "one has always tried to 
decree the neuroses out of existence and not to take notice of them 
in soldiers, but in spite of that one could not keep these people with 
the troops - not for their own sake - but for the sake of the others 
in their environment". There were cases of malingering of a clumsy 
kind, usually during examination by the ear or eye specialist. Such 
attempts were easily recognised. The culprits were not court-martialed 
but dealt with by educational measures on the part of the physicians 
in charge. 
Dr. Dussik stated that he found thatAn^tl^^^cl^rosl^l'/;as 
relatively frequent in the German army at nomcT-^"weT3*l the 
front. If it occurred at the front it was considered as incurred in 
line of duty, A special survey concerning the incidence of multiple 
sclerosis in the German armed forces during the year 1944 was made in 
Luftgau 17• It was found that among 6,000 soldiers who were discharged 
during that year for medical reasons, 490, or 8%, were discharged for 
reasons of nervous or mental illnesses, which included also the gun- 
shot wounds and other injuries of the brain, spinal cord and peripheral 
nerves. Among these 490 cases who were thus discharged for reasons of 
nervous and mental disability, 19, or 3*88%, wore discharged because 
of multiple sclerosis. The percentual representation of multiple 
sclerosis among discharges of troops for medical reasons in this 
area was therefore 0.32%. In 14 of these 19 cases, the first symptoms 
of multiple sclerosis had occurred during military service; in 
cases the condition had existed before, and in the other three cases 
no definite decision was made. Those patients who died during their 
military service were not included in this survey. The medical officer 
in charge of conscription and discharge in that area, Oberstabsarzt 
Zehetbauer, had stated on several occasions that the incidence of 
multiple sclerosis had increased during the war, while that of mental 
disease had decreased. It appeared that multiple sclerosis was 
generally far more frequent in the German armies, including those at 
the fighting fronts, than in our own armies, where it was practically 
non-existent overseas. In 1p: years of overseo.s service, as Chief of 
the neuropsychiatric section of a general hospital, I have seen only 
one case of multiple sclerosis. This patient had a previous attack 
7 yeans ago while living at his home in one of the north-eastern states 
of the Union. There was another case of acute encephal©myelo- 
radiculitis of unclear etiology, but I saw no other cases of multiple 
sclerosis or of related conditions which could have readily been 
confused with it. In the British army and air force on the other 
hand, multiple sclerosis did occur. This brings to my mind a tentative 
explanation which was once suggested to me by Lt.Col. Persons. He 
felt that the fact that multiple sclerosis occurred among British 
troops camped in our vicinity, while it was absent among our own troops, 
may have had some relationship to the fact that all the milk ingested 
by American soldiers was canned milk, while the British troops had 
a«n.WH.-?U a supply of fresh milk. According to Dr, Dussik, all food consumed 
by the German army and air force was fresh food, including the milk. 
He stated that multiple sclerosis was the most frequent single neuro- 
logical disease causing discharge from the German armed forces. 
Dr. Dussik had made some observations on muscular and joint 
rheumatism without X-ray changes in military personnel, but he had 
no definite opinion as to the nature of these conditions. 
Other associates of Dr, Tennis's included Stabsarzt Dr. Krucke, 
in charge of neuropathology, Stabsarzt Dr. Sorgo, neurosurgeon, 
Stabsarzt Dr. Frankenstein, who was in charge of the archives of the 
research section, and Oberstarzt Dr. Lohrentz, who was in charge of 
medical administration. 
5. Information received from Stabsarzt der Luftwaffe Dr. Fritz 
Linder, formerly a staff member of the Neurosurgical Center in Vienna. 
Austria, at present attached to the Surgical Department of the Univer- 
sity of Heidelberg. 
Dr. Linder was interviewed in Heidelberg on 18 Juno 1945* In 
1943 and 1944 he was attached to Oberstabsarzt Prinz Auersperg1s 
section of the Neurosurgical Department of the Luftwaffe Hospital in 
Vienna, Dr. Linder himself was in charge of the treatment section 
for convalescents from brain injuries, which consisted of 300-400 
beds; in view of the long periods of treatment, Dr. Linder saw about 
800 patients through their complete course of treatment, including 
rehabilitation treatment.' of his patients were convalescing from 
open injuries, from closed injuries of the brain. Dr. Linder did 
some research on 'Vegetative" hemiplegias due to cortical lesions. 
He observed "neurotization" in a certain portion of his cases. This 
occurred in simple people who sought social security and social ascent 
by means of their injury. Most of those were unskilled laborers in 
civilian life, who were eager to rise into positions of permanent 
employment by the Government postal service or the Government Railway 
Service, The average time of hospitalization at the treatment center 
was one year. The system of therapy by means of sports and athletic 
activity was helpful. The patients, after discharge, were placed 
in industries under continued medical supervision by special medical 
staff from the treatment center. The preferred final disposition was 
re-integration into their previous home environment. 
E. General Conclusions 
There was no neuropsychiatric selections in the Gorman army and 
air force, except for flying personnel. 
There was no discharge from the German army or air force for 
neuropsychiatric reasons, except to a state hospital for the insane in 
the case of neurotics, and to a concentration camp in the case of psycho- 
paths, However, the psychosomatic illnesses and the organ neuroses such 
as gastric and cardiac neuroses were not included in the diagnostic category of neurosis, because of a generally prevalent strong bias 
in favor of organic diagnoses which allowed patients with neurosis show- 
ing vegetative symptoms to be included in the neuro-psychiatric 
category only if they also exhibited obvious symptoms of emotional 
disturbance. The organ neuroses and the psychosomatic states who did 
not show overt signs of emotional disturbance were exclusively 
handled by internists on general medical wards or on special heart 
or stomach wards. From there they were discharged to limited service, 
frequently in special formations, such as the stomach battalions. Only 
a few of the most severe cases of heart neurosis or of neurocirculatory 
asthenia were discharged, under the general diagnostic category of 
heart disease. 
The re was one other exception to the army policy of not discharg- 
ing neurotics, likewise facilitated by the prevailing organic bias, 
namely in those cases in which neurosis was superimposed upon a wound 
or an injury. Then the organic aspects of the wound or injury could 
be stressed to the point of being considered the grounds for a discharge, 
such as is exemplified in one of the cases reported by Panse, which is 
cited in Chapter 1 of this report. When this man's neurotic symptoms, 
however, increased subsequent to his discharge, thereby making it 
obvious that the neurosis had been the main cause of his disability,J 
he was reinducted into the army, treated with repressive electrotherapy, 
and assigned to limited duty. 
The strong organic bias is likewise responsible for the rather/ 
evasive and confused way in which the problem of fatigue" j 
("Abgeflogensein") was handled in the German air ' Ttkr"problcm 
was handled mainly by means of long leaves in rest homes in rural 
surroundings, with facilities for outdoor sports such as hunting and 
fishing. These leaves were prolonged whenever necessary, frequently 
up to six months. If improvement did not supervene then, the men were 
simply grounded and ground jobs for such men seemed to have been 
plentiful. This rather evasive handling of the problem seemed to have 
been due to the above mentioned under-current or organic bias. While 
some of the ranking experts appeared to have been quite aware that the 
condition of "abgeflogensein" was essentially a form of neurasthenia 
or of anxiety neurosis, this view was by no means generally accepted 
or officially disseminated because some of the younger men held the 
view that organic mechanisms such as "the effects of vibration and of 
acceleration of aircraft" played a fundamental part in the causation 
of this syndrome. Furthermore, the over-emphasis of minor findings in 
the electroencephalograms of such fatigued aviators, which had been 
reported on in a previous report ("Neuropathology and Neurophysiology, 
including electroencephalography in war-time Germany"), seemed to have 
given additional support to the undercurrent of feeling that the 
fatigue states in aviators were fundamentally and essentially organic 
conditions, and facilitated the grounding of fatigued flying personnel 
on a fancied organic diagnosis. The assumption that a neurotic reaction was essentially something disgraceful may have added temptation to 
that shift of emphasis upon an assumed organic background of those 
neurotic reactions which occurred in combat men with previously good 
personality and record. The feeling was quite general that one could 
not label a man as neurotic who came to the hospital or to the screen- 
ing station with a chest covered with ribbons for bravery. This point 
of view appears to have motivated even experienced psychiatrists, such 
as Kurt Schneider for instance, who felt that nervous symptoms in a 
man who had lost weight during strenuous combat activity could not 
possibly be anything psychic, but were of course merely secondary 
reactions to the physical exhaustion expressed in the weight loss, and 
hence were a symptomatic reaction to a physical disease which placed the 
entire syndrome in the field of physical illness, which was not the 
proper domain of the neuropsychiatrist. The possibility that both, 
the nervous reactions and the weight less, could be coordinated res- 
ponses to emotional stress was entirely rejected by him. However, it 
must be said to his credit that the main motivation of this policy was 
a desire for fairness in administrative disposal and in Veterans1 
Administration policies which would not have been feasible under 
existing German regulations had a diagnosis of a neuropsychiatric 
disorder been made. 
It is quite obvious, however, that this organic bias which in 
part may have been motivated by the prevailing moral bias against 
neurosis was definitely a hindrance in the proper treatment of these 
neuro-psychiatric conditions. Uhe treatment of the neuroses with 
only vegetative or circulatory overt symptoms was entirely in the 
hands of internists. Vlhile some informed and inspired medical men, 
like Dr. Slebeck in Heidelberg, did a splendid job of psychotherapy 
sometimes with the aid of trained lay-psychotherapists who were avail- 
able from Professor Gdring's institute in Berlin, the vast bulk of 
these cases handled by less well-informed and less inspired men were 
given merely palliative medicinal treatment and then assigned to 
limited service. In the army, neuropsychiatrists treated the gross 
hysterias by repressive-suggestive measures, namely by Pansc*s 
"electro-suggestive therapy" with strong and painful galvanic currents. 
Then after being freed of their conversion symptoms, the hysterics were 
likewise used in limited service assignments. In the army, the other 
neuroses with obvious emotional disturbances were treated by rest and 
mild sedatives and stimulants, and then were likewise assigned to 
limited service whenever possible; if they could not be used at all, 
they were sent to military sections of state hospitals for the insane. 
In the air force, on the other hand, psychotherapeutic aid was available 
for these conditions and electro-suggestive treatment was not used. 
Psychotherapy in the air force was in the hands of a small group of 
Professor associates, and of a larger group of lay-therapists 
who had been trained at Professor Gflring*s institute. While these 
psychotherapists in the Luftwaffe included well trained men such as 
Professor Immo Von Hattingberg, they also included some empiricists, 
such as Professor Gustav E.* Starring, who used a rather bold and 
primitive brand of psychotherapy, such as exemplified in the account 
58 7.Uk- “ X. given by him during our interview reported in the body of this paper. 
Still, in the air force psychotherapy was practiced and an effort at 
psychotherapeutic rehabilitation, as well as prophylaxis was made. 
The organic bias also expressed itself strongly in the evaluation 
of the post-traumatic syndromes, especially the post-concussional and 
post-contusional states which were all considered due to an essentially 
organic condition, entitled "Hirrleistungsschwache" (brain performance 
weakness). In spite of the fact, however, that this condition was 
not understood properly in its entirety, the treatment of the particular 
condition, such as practiced at Dr. Tflnnis's neurosurgical rehabilitation 
center in Berlin-Reinickendorf, which included the former Olympic 
Stadium, was nevertheless effective and of high quality. The intensive 
rehabilitation treatment with raising of exercise tolerance by sports 
and athletics is to be classed as a superior form of rehabilitation 
treatment, which could not have been done better had the underlying 
condition been more thoroughly understood. In other words, in spits 
of the exclusive organic bias in this condition, German neuropsych- 
iatrists and neurosurgeons found empirically the right form of treat- 
ment, and organized it well. 
Another limitation of German neuropsychiatric thought which prevented 
proper understanding and cohtrol of flying stress, was the constitut- 
ional bias, German air force neuropsychiatrists were puzzled by the 
fact that the incidence of "flying fatigue" and other neurotic states 
was disproportionately high among fighter pilots, as compared to the 
low incidence of these conditions among bomber pilots, and other 
bombardment crew members. This discrepancy was explained entirely on 
the basis of an assumed constitutional difference in the personality 
of people who became fighter pilots as compared with those who became 
bomber pilots. This view was held not only by Dr. Luxenburger, the 
Chief Neuropsychiatric Consultant, but also by others, including 
Dr. Starring and even Professor Strughold (the statements of the latter 
were embodied in a previous report, entitled: "Neuropathology and 
Neurophysiology, including electro-encephalography in war-time Germany"), 
and this view was also expressed in a special book on the personality 
of the fighter pilot by Skawran (entitled "Die Psychologie des Jagd- 
fliegers") which was later supressed, not because the explanation 
presented was disagreed with, but because it was feared that this 
book would exert an adverse influence upon the morale of fighter 
personnel. It is interesting in this connection to compare the 
German experience with our own. In the Eighth U.B0 Air Force there was 
likewise a marked difference in the incidence of neuroses in fighter 
pilots as compared with bomber pilots and other bombardment crew 
members, but the difference was the other way around. In our air 
force neuroses were far more frequent in bomber personnel than in 
fighter personnel. We understood the meaning of this difference, 
namely as due to difference in combat stress, and we took the right 
measures, namely by arranging for for operational limits graded according 
to the prevailing operational stress. It was felt by those of us who took care of neuropsychiatric problems of the 8th Air Force 
that the particular reason why bombardment personnel was afflicted more 
keavily with neuroses than fighter personnel was due not only to the 
greater amount of the stress, but to a special peculiarity of the stress 
which placed the bomber personnel in a position comparable to Pavlov*s 
conditioning box. At the usual time of greatest stress? from flak ancl 
filter attacks, namely on the way from the I.P. to the target, the 
bomber pilot was not free to manoeuver and. to take evasive action such as 
would have suggested itself from a purely tactical point of view, because 
this would have interfered with the aim of the bombing pattern of the 
formation, therefore, he h«i to take the stress without the freedom of 
manoeuyering in meeting it. He had to keep on flying along a pre-arranged 
straight course, undeflected by heavy flak or filter attacks without 
freedom to manoeuver according to his tactical Judgment. The American 
filter pilot on the other hand, when he went into combat, was free to 
manoeuver, to attack and to evade his opponents as he saw it tactically 
necessary. I«i the German air force the position was entirely the reverse. 
The bomber attacked singly and at night, and not only was flak leas 
accurate and devastating In dealing with single, fast and low-flying 
planes at nigit than it was in dealing with our dense formations 
flying in daylight, but most important of all* the German bomber 
pilot had full freedom to manoeuver and to take evasive action as he 
saw tactically fit. This is exactly the freedom which our bombers 
lacked at the height of the attack against them. The German fighter, 
however, enjoyed no such freedom. He was in the psychological position 
of our bomber. He had to rise straight up at the arrival of our 
formations and attack them head-on, if necessary ram them, without 
deflection of his course by tactical manoeuvers or evasive action 
whenever he met superior fire power. He had to keep up a straigit 
line of attack, unde fleeted by individual tactical combat consider- 
ations, exactly as our bombers had to do* Furthermore, attacking 
in daylight, he saw the losses of comrades which his outfit incurred, 
as did our daylight bombers, while the German night bombers were lest 
aware of each other* s losses. The losses of our fighters in individual 
actions were usually less than the enemy’s due to their superior 
tactical skill. It is therefore quite obvious that the main combat 
impact occurred between our bombers and the German fighters, and it is 
revealing Indeed as to the nature of neurosis-producing stress* 
that the neuroses in our air force predominated in bomber personnel, 
while the neuroses in the German air force predominated in their 
figiter personnel. It is furthermore important to realize that the 
psychological conditions of Pavlov*s 'conditioning box’ were inherent 
in our. bomber tactics and in the German fighter tactics, due to the 
exclusion of freedom to manoeuver, to meet stress according' to 
tactical Judgment, or to depart by deflecting evasive action from the 
pre-arranged course of attack. This fact supports the view that mech- 
anisms of conditioning by threatening experiences in Pavlov's sense are 
operative in the development of combat neurosis. That differences 
In resiliency to stress exist among different people goee without 
saying, and Pavlov himself was by no means blind to that fact. The 
Germans, however, overlooked the Pavlovian stress factor completely 
and, ascribed everything to assumed pre-existing personality factors. 
3 ~ * To ascribe such personality factors, however, to an entire group of 
people such as fighter pilots as a group, is indeed the reductio ad 
absurdum of this fundamental German constitutional concept. 
In the handling of the problem of psychopathic personalities, 
hov/ever, the Germans were on relatively safe ground in their constit- 
utional philosophy. Their policy was to create an environment in 
which the constitutional psychopath could function. They conceived this 
environment as one in which the defective social integration of the 
constitutional psychopath would be forcibly strengthened from the 
outside by a system of discipline more rigid and compelling than that 
in which the normal soldier functions best. They therefore instituted 
special training battalions, as well as special field battalions for 
psychopaths. There is no doubt that thus they succeeded in utilizing 
a good many individuals, the counterparts of which we dismissed from 
our army under AR 615-360, Section VIII. In these battalions they 
gave these various chronic disciplinary offenders, criminals and homo- 
sexuals, the opportunity to "redeem themselves before the enemy". 
They were usually given arduous and dangerous chores to do which did 
not require too much individual initiative, but which were associated 
with high casualty rates, such as the removal of mine fields. There 
is no doubt that this aspect of German military policy was handled well 
and effectively, and that the training and utilization respectively 
of psychopaths in such special formations was preferable to our early 
policy of Section VIII discharge. Similarly, we had later ourselves 
established a special training formation for psychopaths in the 
ETO, namely the "SOS Recovery Center", which worked well and successfully, 
but which, compared with the German set-up, handled this problem on a 
very small scale. There is no doubt that this particular aspect of 
German military policy is worth further investigation. Some of its 
main principles, especially the educational ones, could be very well 
included into the educational activities which a democratic army of a 
democratic nation owes to those of its problem citizens who by 
virtue of psychopathic deviation are not able to benefit xrom the ordin- 
ary teaching methods of military discipline in time of war. 
The special formations for neurotics and other partly disabled 
personnel such as utilized in the stomach battalions, the ear battalions., 
the special flak battalions for neurotics, and others, are far less 
deserving of consideration by other nations, unless very hard presse 
for any form of manpower, even disabled manpower, such as was included 
in those battalions. Furthermore, there can be no doubt that the 
utilization of this manpower without any but the most superficial 
patch-up treatment could by no means be described as economic or 
desirable from a public health point ox view. 
As stated above, the repressive electro-suggestive treatment was 
given only to those patients manifesting gross hysteric states. Other 
foms of treatment, such as by abreaction, sustained narco therapy or 
insulin sub-shock, were practically unknown. None of the authorities interviewed knew anything about them, although the reports quoted 
in the first chapter of this paper reveal that Professor Goring had 
recommended an 8-day course of narcotherapy in one patient, which, 
however, in that case did not result in a therapeutic success. 
Insulin shock treatment (not Sargant's subshock treatment) was given to 
one series of neurotics by Burger-Prinz. Psychotics were treated with 
the usual shock methods. In the air force, psychotherapy by a few of 
Professor Goring's associates and teams of lay-psychotherapists was 
available. 
Of particular interest was the statement by Dr, Hochapfel that the 
S.S, did not utilize psychopathic personalities for the jobs of 
bullies and killers employed in concentration camps, but that on the 
contrary, the S.S, had found them undesirable in such positions. They 
preferred to select normal, stable and stolid people of the conforming, 
authority-respecting type for such jobs, whom they then "brutalized" 
by a special course of indoctrination. Dr, Hochapfel further stated that 
of course psychopaths occasionally drifted into such positions, but 
that they were soon found unable to conform and to keep out of conflict 
with their environment, even in this primitive social setting of 
hired and trained bullies and killers, and that they therefore had to 
be soon eliminated from such positions. Elimination from such positions, 
of course, was always by execution. Dr, Hochapfel could not tell me 
how the army-discarded psychopaths who had been unable to adjust even 
in special or punishment battalions, were faring in concentration camps, 
and I made a point to find out on some of my visits to these camps what 
had happened to them. In the first camp which I visited only three 
weeks after its liberation by American armies, namely the concentration 
camp in Ebensee, near Bad Ischl in Austria, there were no such army- 
discarded psychopaths. The inmates of this camp, at the time of my 
visit consisted almost entirely of unfortunates who had been taken 
there for racial or religious reasons, including a large proportion 
of young adolescents. Even purely political prisoners were rare. I 
shall always remember this horror camp, and the stench of the indignities 
inflicted on innocent human beings by the Germans will probably never 
leave my nostrils. In Dachau, which I visited later, there was a 
greater proportion of political prisoners, but I found only one army- 
discarded psychopath there. I obtained a fairly complete story about 
another one from ex-prisoners, namely from Mr, John Bauduin, Chairman 
of the "Investigation Committee for Medical S.S, Crimes", Dr, Paul 
Hussarek, at present Chief of the Dachau press-office, and Mr, Oscar 
Hausermann, The man they told me about was a certain Galbavy, who had 
proved unadaptable in the army because of repeated instances of 
aggressive violence, drunkenness and AWOL, After his arrival in Dachau 
he was made into a "Capo", which is the barracks chief of a block. Re 
immediately became the terror of the people under his sway. He began 
beating and killing people unchecked but applauded by the S.S, guards, 
who enjoyed witnessing such activities. He himself bragged that he 
had strangled 600 Jews to death with his own hands. The S.S, personnel 
122 on the whole preferred watching such acts of brutality by specially 
selected prisoners to committing the atrocities themselves, G-albavy 
utilized the terror inflicted by his brutalities to extort things 
from the other prisoners, especially their butter rations. It was 
his custom, after their meagre butter rations had been passed out to 
the prisoners, to order them to turn them over to him, callously 
stating that he and some other "Capos’* needed the butter in order 
to roast their potatoes. Those who did not immediately turn over the 
butter with a polite: "Yes, Herr Capo", were brutally beaten or 
strangled by him on the spot. Finally, however, Galbavy's excessive 
desire for attention and recognition on the part of the S.S, made him 
obnoxious even to them, and so one day they selected him to serve as 
a human guinea pig for a particular set of experiments which consisted 
in the surgical removal of the entire omentum, Mr, Bauduin not 
quite sure whether a large scale experiment of this sort was/performed 
with subsequent studies of gastro-intestinal function, or whether it 
was merely an excuse to torture Galbavy or to play a practical joke on 
him, S.S, fashion. At any rate, Galbavy’s omentum was |r amoved in toto 
and in one piece, I saw it in a jar in the pathologiciJr museum at 
Dachau, which had been collected there by S.S, doctorsT This museum 
also includes a good deal of material on phlegmons of the legs which 
was known as Dachau disease". Shortly after this so-called exper- 
iment Galbavy was 1 by tfl'B1 S.S, 
The other army-discarded psychopath whose name became known to me 
was examined by me on 21 June 1945? at the American military prison 
in Dachau, He was Rudolf Zimmermann, originally a member of the Waffen 
S.S, In the Waffen S.S, he had committed numerous breaches of discip- 
line, including AWOL, and he finally deserted in 1942. He rationalized 
his final desertion with the statement that he had become an anthropo- 
sopher. After attempts at disciplinarjr re-education, he was sent to 
the Dachau concentration camp as an inmate. On arrival at the camp 
he became the fair-haired child of the S.S,, probably because of his 
engaging good looks, which indeed are those of "Hitler’s dream 
picture of a Nordic youth." His good looks are enhanced by the typical 
engaging personality of the unstable psychopath who often succeeds so 
well in making favorable first Impressions, The S.S, gave him a job 
as camp policeman, but in this position he soon was found unreliable 
in terms of not appearing for duty when required, lying about the 
rounds he had made, and other irregularities. It must be said to his 
credit, however, that he did not abuse his position by being brutal to 
his less fortunate fellow prisoners. The redeeming feature about this 
kind of unstable psychopath which Zimmermann represents is the fact 
that because of their resentment against authority, probably condit- 
ioned by early childhood experiences, their sympathies on the whole are 
with the oppressed and not with those in charge and in a position of 
authority. By reason of the above mentioned disciplinary irregularities 
he was taken to the S.S, stronghouse of the prison in Dachau, called 
123 the "Bunker”. The liberating American army found him there and because 
of his good record in the treatment of his fellow prisoners while he 
was prison police man? he was not only liberated but specially trusted 
by the liberating American authorities. Again he is understood to have 
made an exceedingly favorable first impression. At his request he was 
entrusted with the job of rounding up S.S, hiding in nearby parts and 
of retrieving the motor cars which the S.S. had taken with them* and 
which were needed to help with the transportation problem in bringing 
food to Dachau, In this capacity he did help in rounding up S.S, and 
he did round up oars ? but while he turned in some he withheld others 
and sold them on the black market. It is quite obvious that his resent- 
ment of authority and egocentric self-interest brought him into conflict 
with the liberating force as definitely as he had been in conflict with 
the S.S, 3 and when his embezzlement of motor cars became known3 the 
Americans had to take him back to the same stronghouse from wiiere they 
had liberated him originally3 but which was now under different 
management. When I examined Zimmermann? I found him to be the typical 
unstable psychopathic personality with strong resentment of all 
authority3 but with great capacity for engaging charm when he wished 
to make a good impression. When he was first brought to me he assumed 
a haughty air;, obviously in order to impress me with the fact that he 
considered himself wronged., but when he learned that my main purpose 
Y/as to question him about entirely different matters? and that I was 
not concerned wdth the legal status of his case? he changed his 
attitude entirely? became friendly and amiable and gave me freely 
and helpfully all information desired. He wras obviously eager to make 
a very favorable impression on me? tried to show me what an astute ob- 
server and intelligent? helpful and useful individual he v/as? obviously 
in order to gain favors from me in return. He had the typical vivacious 
charm of the psychopath? and the same tendency to take liberties vd.th 
the truth whenever he felt that it suited him. There is no doubt that 
this man is entirely unadjustable in any social setting? unless he could 
be helped to mature? which may assist him in achieving reintegration. 
I found no other army-discarded psychopaths? nor could I obtain 
significant histories of an additional number? because many of them 
after-fairly brief stays in the concentration camp? were sent back to 
the fighting services in one capacity or another. Hov/ever? this 
problem should by no means be regarded as settled and further search 
and study may reveal more material on this subject. 
There is no reason to Relieve that the incidence of neurosis in 
the German armed forces ms less than in ours* especially if one 
includes the very numerous organ neuroses and psychosomatic illnesses; hut 
neurosis did not figure as a cause of discharge from the German armed 
forces because of their policy in hanging on to their neurotically 
disabled personnel for whatever residual services they could get out 
of them. There is indeed reason to assume that the organ neuroses and psychosomatic illnesses were more numerous in the German Army than in 
ours, although also in our armed forces there was a general shifjp of 
neurotic symtomatology in that direction during this war. 
Hhe organ neurosee and psychosomatic illnessesj under whatever 
orgajattrygeud^p^^ey. did not 
figure in significant number* among the discharged, for they were 
usually retained on limited service status. It seems that there were 
innumerable limited service jobs available in the zone of the interior 
in Germany, especially among prison guards and in industrial assign- 
ment*. My colleague Major George Smyth, Hoyal Army Medical Corps, 
an experienced Neurologist trained at Qpeen*s Square National Hospital 
in London, who spent four years in a prisoner of war camp in Germany, 
told me that practically all the guards he eVer came in contact with 
were confirmed neurotics, who sooner or later would always consult 
him about their various complaints which they attributed, and which 
frequently were officially attributed, to ,,MagengeschwJlr,, of 
tzundung”. Also officers in these prisoner of war camps isere odd 
characters who used to act as if they believed that spectacular loud- 
ness in the pitch of their voices, with which they constantly 
reprimanded their subordinates, constituted their only chance for 
promotion. 
Constitutional psychopaths were likewise by no means less frequent 
in Germany than in our own country, and there is a great deal of 
reason to assume that some types of psychopaths, especially the homo- 
sexuals, were far more frequent in Germany then in our country. The 
Gestapo, as reported in the body of this paper, estimated the number 
of active homosexuals among the mature male population in Germany as 
4,000,000, the "Schwarzes Coras " (the S.S. news magazine) as 2,000,000. 
This would mean that 10 - 20f of the sexually mature male population 
in Germany were homosexuals. (Comparable estimates of homosexuality 
among the sexually mature male population of England and of the United 
States indicate an incidence of 5$j.) Nevertheless, homosexuality was 
always considered a legal problem in the German Army. Homosexuals 
as well as other psychopaths were likewise never discharged from the 
Service, except to prisons in the case of homosexuals and perpetrators 
of all kinds of crimes punishable by long prison terms, or to 
concentration camps in the case of other unadjustable disciplinary 
problems due to psychopathy. All those who were considered remediable, 
disciplinary offenders, criminals and included, as well as 
those homosexuals and other criminals who were found irresponsible or 
of reduced responsibility by medical experts for reasons other than 
psychosis or mental deficiency, were placed on probation in the special 
field battalions (punishment battalions) and given a chance to "redeem 
themselves before the enemy". 
In the neuroses, the shift in symptom choice toward the inner 
organs which was recognized early in this war by Starring and others, 
was of particular interest and its possible causes were discussed with 
38Xfc.*.- X a number of German observers. Professor H. Siebeck and Dr* E* Beck, 
who seem to have given a great deal of thought to this problem, felt 
that the social attitude was of greatest importance in causing this Shift 
in symptomatology, in that it brought about the condition that 
trembling or other overt manifestations of emotional upheaval were no 
longer regarded as a cause of disability, but that gastric and cardio- 
vascular disturbances still were** 
1 quite agree that the social attitude in regard to "what const- 
itutes disabling illness" is an important factor in the symptom 
choice and the symbolic expression of disability on the part of the 
neurotically disabled patient* The neurotic generally expresses his 
disability in such terms as are accepted in his social community as 
constituting disabling illness* I made this observation for the 
first time when I removed the location of my neuropsychiatric activity 
from Boston, Massachusetts, to Durham, North Carolina, in 1941. During 
my 8 years in Boston I had found gross hysterical conversion symptoms 
extremely rare; but when I came to North Carolina, I was suddenly 
confronted with a vast number of hysterical monoplegias and 
asia syndromes in young girls who had some emotional problems, as well 
as in tired housewives. After seeing six such cases in one after- 
noon in my private consulting practice, and in the public clinic, I 
almost felt as if I had been catapulted back in time into the early 
days of Charcot at the SaltpAtriAre. It sooned dawned upon me, 
however, what that situation meant. In Boston and surrounding New 
England, possibly because of the effects of urbanization, headaches and 
states of emotional tension and anxiety were accepted as causes of 
disability, both in work contacts as well as in the family setting. 
In the rural Betting of North Carolina, however, nothing Short of an 
actual paralysis of a limb or complete inability to stand or walk, was 
accepted as a significant disability which would Interfere with farm 
work or the performance of household chores, and call for the help of 
a physician* In this rural setting, the symptom choice for the purpose 
of symbolic expression of emotionally conditioned disability fell 
invariably upon the limbs. 
Other observers too had noted that social approval or disapproval 
may determine fashions of symptom choice* An anthropologist, whose 
name has escaped my mind for the moment, told once in a lecture at 
Duke Hospital, that among a certain group of natives in Madagascar 
violent hysterical fits which the natives called "trumps", bad 
become rather fashionable among the younger and less privileged 
dhildren of large families, obviously as a means of expressing 
emotional reaction to frustration and in order to receive attention* 
A rather elaborate system of exorcism which entailed a good deal of 
expense because of the hiring of native witch doctors and the wining 
and dining of friends and relatives incidental to the ceremony, 
regularly succeeded in curing the symptoms. However, when this "trump*" 
became increasingly fashionable, some bright light among the natives 
had the smart idea of saving expense by omitting the exorcism and 
instead tying the excited and convulsing victim up in ropes and shipping 
&8ZUH-- 5L him to the nearest French hospital at the coast, where treatment was 
far less colorful and fanciful than in the native village. It was 
found that this inexpensive method cured the ,,trumpa,{ Just as well as 
the previous expensive exorcism, and had the additional effect of shift- 
ing the expression of emotional upheaval completely away from the 
symptomatology of spectacular hysteric fits. The anthropologist did not 
state if the anxiety states or the organ-jpeuroses and psychosomatic 
illnesses increased instead, hut there is no doubt that these mechanisms 
play a strong role in symptom choice. 
Dr. Siebeck, and, more so. Dr. Eduard Beck, considered an additional 
factor, namely the suggestive influence of fairly normal and common- 
place reactions, in motivating symptom choice for neurotics In terms 
of supplying cues. The cue in the last war, and which led to the marked 
tremor states of neurotics of that war, was the fact that briefer or 
longer episodes of trembling were quite commonplace when tense, though 
not necessarily frightened men, huddled together in chilly wet trenches 
during an artillery barrage. In the present war, this cue was provided 
by the incidental gastric disturbances, which are a quite common 
occurrence during the active days of a war of movement because of the 
irregularity of poorly prepared and hastily consumed meals, tfhile the 
normal person pays little attention to these incidental episodes and 
soon forgets them, in the neurotic they serve as the cues for neurotic 
fixation to the particular organ system involved. Similar “cues*' 
are provided by the normal sensations of strained activity of the 
heart in excessive fatigue, during forced marches or after exhausting 
crawling and running during attacks under eremy fire* 
As stated above, even the which were very frequent 
in Germany, probably more frequent than in our army, did not figure 
significantly among the numbers of those discharged for medical reasons 
from the army. In that respect, it is important to realize that what- 
ever the goals of the neurotic in the German army were, desire for 
discharge did not figure as an Important one. The desired goal was 
rather a limited service assignment within the army in the zone of the 
interior, or, better still, an assignment on laboring duty in an indust- 
rial organization in the zone of the interioi in Germany, while 
still wearing-army uniform. The reason for that was that to the 
average German soldier who was not a Nazi party member the fact that 
he belonged to the army provided a certain amount of protection from 
the indignities and dangers which threatened the average non-party- 
member civilian at the hands of the S.S. and other Nazi organizations. 
Furthermore, the position of soldier gave him otner special privileges 
and considerations which the civilian lacked. Therefore, the average 
German found it desirable to remain a member of the armed forces in 
preference to discharge. This indicates, that if civilian life is made 
into a sufficiently abhorrent proposition replete with oovious threats 
and hidden dangers, it ceases to be a goal aimed at by the neurotic; 
but this circumstance by no means prevents or cures neurosis. Things 
were different in the case of members of the Nazi party. Large 
38Ui-H -?v numbers of Nazi party members of substance and consequence did. manage 
to stay out of the armed forces on various so-called ”essential” 
civilian assignments, especially in industries and in various political 
and administrative positions• 
With the exception of the rehabilitation program for the brain- 
injured, it was the policy of the German army on the whole not so 
much to readapt the disabled soldier to the service, but to create 
within the service conditions designed to allow his utmost utilization. 
As to the strictly neurosurgical treatment in the German armed 
forces, it was probably as ‘good as neurosurgery could be without 
penicillin, and without the use of tantalum foil and tantalum plates; 
and without some of the refinements of surgical subtlety in handling 
brain tissue, which are more indigenous to American and British neuro- 
surgery than to German neurosurgery. 
Of all the methods and procedures observed, I found onljr two 
which appear worthy of further scrutiny and consideration, with a 
possible view toward adapting them for our own use. These two 
procedures ares 
(1) The intensive rehabilitation program such as was offered at the 
treatment center for the brain-injured in Berlin-Reinlckendorf, which 
included the former Olympic stadium, and 
(2) The special training and redemption battalions for psychopaths, 
criminals and homosexuals. 
2 August 19h% 
Leo Alexander, Major M.C. 
3SX.U-II- -2. APPENDIX 1 
LIST OF REGULATIONS,MEMQRANDA,CIRCULAR LETTERS AND REPORTS GOVERNING NEUP.O- 
PSYCEIATRIC PRACTICE IN THE GERl.iAN ARM! 
1. Vorsohrift ftbor wohrmaohtilrztliche Untersuohusgen im Kriogo,$rztliche 
Anweisung zur Bourteilung der Kriegsbrauohbarkeit bei Kriegsmusterungen 
(V.U. Win. Toil 4) vom 1,4.1944 HDv 252/4, MDv 248/4 LDv. 399/4 
2. Richtlinien fftr die Beurteilung vom mit seelisch-nerv&sen Abartig- 
keiten (Psych op a then) und soelisch-nervBssn Reaktionen sowie fur die tJber- 
woisung in lungen. 
3, Sondor— odor Strafformationen. EDv 209 Richtlinien fUr die Bourteilung 
dor Soldaton mit soelisoh-nervbsen Abartigkoiten, 
4, DionstunfBhigkoit bei Sohizopnrenie. Anordungen zua Hrztliohen Dionst 
Nr. 1-4 Ziffer 19 
5* Bohandlung 'dor Goisteskranken und Metaluikor. Anordnung zum Srztlichen 
Dionst Nr, 6, Ziffer 129 
6, llorkblatt &bor zorabrale Krampfanf&llo 
7, 328, Verhalton gogenttbor betrunkenen Soldaten. Heores-Verordnungsblatt 
8, 90, Alkohol- und Nikotinmissbrauch. Luftwaffen-Verordnungsblatt 5 Jehr- 
gang Berlin, dem 3 April 1939 Nr. 16 Teil A. 
9, Unterbringung von Alkohol- und Rauschgiftslichtigen. Anordnungen zum 
ftrztlichen Dionst Nr. 5 Ziffer 102 
10. Gutachten. Der Keeres-Sanit&tsinspekteur. 50 c 21 
S, Jh/fti G (1) 26/41 30 Mai 1941 
11. Die Entwioklung dos Homosexu©Hen-Probleas in der Wohrmacht. GEHE1M 
12. Auszug aus Vortragsvormerk ftir Eerrn Feldmarschall, Chef WR 
14 n 19 WR (ll/7) Tgb. Nr. 753/42g 12 August 1941 GEHEIM 
13. Vortragsvermerk fttr Herrn Generaloberstabsarzt Prof. Dr. Handloser 
4 November 1942 GEREIM 
14. Zum Vortrarsvormork ffir Herrn Feldmarschall Chef V; R 4 November 1942 
GEHEIM 
15. Ri'chtlinien ffir die Behandlung von Strafsachen v;egen widernatllr Richer 
Un*uoht (SS 175, 175a und 350a RStGB); Der Chef des Cberkommandofl der Wehr 
macht 14 rr 19 WR (H) 58/43 g 19.5.43 
129 
jlif - x. 16* Abdruok zur Kenntnis. Oberkommando das Heeres, Der Chef das Heeresjust- 
izwesens, Ag Hr Wes (1Y b/l) 653/43 g 8 Juni 1943 GEHEIM " 
17# Entlassung Ton Soldaten aus dem aktivon Wehrdionst wegen widernat&rlicher 
Unzucht. AHM Vom 7.8.43 S.. 390, Ziffer 623 GEHEIM 
18. Entwurf• Gesetz Eber die Behandlung Gemeinsohaftsfremdor, Stand 4.7.1943 
GEHEIM 
19. Betr.j ‘Begutaohtung von wegen widornatErlioher Unzucht an don 
Beratenden Psychiater beim Heeres-San. Inspekteur. 15.12. 1944 
20. Anordnungen sum Erztllchen Dienst Nr. 10. (Pie Anordnungen zun Erzt- 
liohen Dienst sind in die E. Dv. 209/2 einzuhafton) Der Heeres- 
SanitEtsinspekteur. Az B 49a 12 Beih. Wi 6 (lb) 6160/44. 30 September 
1944 • 
21. Diagnostisohe Einweise zum Ischiassyndrom* 
22. An WehrkreisErzte 1-X1, Xlll, XV111, XX, XXI Leit. San. Offz. b. 
Wehrm. Bevollm. Prag. Res. Xriegs#laz. Gruppe A und B Leit. San. Offz. b. 
MilitErbefehlshaber Generalgouvernement. Der Seeres-SanitEtsinepekteur 
S In/fri G (1) 2454/42. 27 April 1942 .(;;:emorapdli’n on . 
23. Behandlung rheuxoatisober FaoialislEhmungen. Anordnungen zum Erztliohen 
Dienst Nr. 6 Ziffer 121% 
24. Nervensohussverletzungen. Anordnungen zum Erztliohen Dienst Nr. 6 Ziffer 
123* 
25. An Verteiler. Betr.i Eberwaohung von Verwundeten mit peripheren Llhmungen. 
Der Eeeres-SanitStsinspekteur. 50 c 2l/S In/Wi G (1) 7143/41. 15 Dez 1941 
MilitErztliohe Akademie 23. 12. 1941. Akz. 60c « 
26. WehrkreisErzte1 1-X111 und XVI1, XV111, XX, XXI. Aus der Praxis Erztlicher 
GutachtertEtigkeit. Oberkonnnando der Wehrmacht, 30 u. 50 S jn/VFV 5540/41 
Bekanntgabe 65j 7 Juli 1941* 
27. An die Beratenden'Psychiater des Feld- und Ersatzheeres, Beratender psychi- 
ater beim Heeren-SanitEtsinspekteur. 24 Juli l£M2. 
28. Sammelberioht 2, Reihenfolge* SirnsohEdigungen, Enoephalitif, Polyneuritis 
unklare LEhmungen etc. Beratender Psychiater beim Hoeres-Sanitltsinspek- 
teur. Februar 1943# 
29. Sammelberioht 3. Reihenfolge* Aligemeines Seite 1, Sulfomanide Seito 1, 
HirnsohEdigungen Seite 1 etc. Beratender Psychiater beim Heeres-SanitEtsin- 
spekteur. MErz 1943. 
30. Sammelberioht 4. Reihenfolgei Allgemeines Seite 1, Isleurologie Seite 1, 
Kausalgio Seite 1, etc. Beratender Psychiater beim Heeres San.-Inspekteur. 
Juli 1943# 
130 
38M4-- X 31* SammeIbericht Nr. 5. Reihenfolgei Allgemeinea Seite 1, Taugliohkeit 
Geisteskranker land WdB-Fragen etc. Beratender Psychiater beim 
Heeres-SanitBtsiaapekteur, September 1943# 
32. SammeIbericht Nr. 6. Reihenfolgei Vorbemerkung Seite 1, Wehrpflioht 
von Seite 1, Farensisches Seite 1, etc. Beratender 
Psychiater beim Heeres-SanitRtsinspekteur, MBrz 1944* 
33. SammeIbericht Nr. 7. Vorbemerkung, HirnsohBdiguagen, etc. Beratender 
Psychiater beim Heeres-SanitStainspekteur. Mftrz 1944. 
34. SamineIbericht Nr. 8. Psyohosen, Psychose bei typhus, 
Keuropsyohische bei Wolhynisohem Fieber. etc. Beratender 
Psychiater beim Heeres-Sanit8tsiaspekteur. Juni 1944* 
35. Ibericht Nr. 9. Beratender Psychiater beim Heeres-Sanitfttsinapekteur, 
August 1944# 
36. SananeIbericht Nr. 10. Beratender Psychiater beim Heeres-SanitBtsinspekteur, 
Dezember 1944 . 
37. Berioht Bber die 3.Arbeitstagung Ost der Beratonden Faohirzte, vom 24. 
-26. Mai 1943 in der Militirlrztlichen Akademie Berlin. 
M-h - %. APPENDIX 2 
QUOTED mi TINGS BY 0BERSTAR2T PROFESSOR DR. KURT SCHNEIDER. 
1. Die Differentialdiagnose zwischen sohizophrenen Geistesatfcrungen imd 
Erlebniareaktionon im Felde. Referat, 2. Arbeitstagung Ost, Fach- 
gruppe Psyohiatrie, MilitWbrztliche Akademie Berlin. 30* 11. 1942 
Unpublished manuscript. 
Z* Die Neuroaen vosn Standpunkt der Flinischen Psyohiatrie. Referat, 4. 
Arbeitstagung der Beratenden Jtrzte, Faohgruppe Psyohiatrie, Lazarett 
Hohenlyohen, 16 May 1944. 
Unpublished manuscript. 
3. Die Psychopathisohen PersBnlichkeiten. 7th. Edition. F. Deutioke, 
Vienna, 1944. 1-V11, 1-125 
39XUH.-X. APPENDIX if 3 
LIST OF WRITINGS FROM THE PSYCHIATRIC JKD NEUROLOGICAL DEPARTMENTS OF THE 
UNIVERSITY OP HEIDELBERG MEDIEAL SCHOOL 
1. Sohmieder, Friedrich.: $ber Sp&tschEden des Fleokfiebers• Klinisohe Unter- 
suchungen Uber nerrBse Sp&tzust&nde naoh Fleokfieber. Zu- 
gleioh ein Beltrag zur Diagnostik und Pathogenese psychi scher 
Defektsyndrome. Unpublished manuscript, 302 pages, with 44 
illustrations,61 graphs and 12 tables. Approved by the 
"Oberkommando der Wehrmanht” on 18 September 1944. 
2. Bay, E. : Die heutigen Renntnisse ftber &tiologie land Therapie der 
multiplen Sklerose. Zeitsohrift fttr Erztliche *ortbildung 
41, 342-346, 1944 
3. Bay, E.: Problome der Hirnlokalisation. Der Nervenarzt: 16, 383-389, 
1943. 
4. Bay, E.: Die Fallhand nach Sohussverletzungen des Armes als funktion- 
elles Symptom. Der Deutsche Milit&rarzt 9, 435-437, 1944 
5. Bav. E.: Zum Problem der takilen Agnosie, Deutsche Zeitsohrift fftr 
Nervenheilkunde 156, 64-96, 1944 
6. Vogel, Paul.: Arzt und Kranker, Zentralblatt f&r Psyohotherapie und ihre 
Grenzgebiete, 15, 157-139, 1941. 
7. Vogel, Paul.: Die Versorgung der Nervenrerletzten Soldaten. Zeitsohrift 
fttr Srztliche Fortbildung. 58, 225-230, 1941 
8. Vogel, Paul.: Neurologische Gesichtspunkte zur Beurteilung mad Behandlung 
der Verletzungen peripherer Nerven. Deutsche Medizinisohe 
Wochenschrift, Nr. 30, 807, 1941 
9. Vogel, Paul.: flber Verletzungen des axillaren Gef&ssnervenstranges. Der 
Nervenarzt: 14, 484-493, 1941 
10. Vogel, Paul.: BeitrEge zur Frage des vegefativen Systems mad Stammhirns, 
Deutsche Medizinisohe Wochenschrift: Nr. 39/40, 548, 1944 
133 
18 X M-H- APPENDIX 4 
PUBLISHED AND UNPUBLISHED WRITINGS BY PEERSTARZT PROFESSOR DR. X. KLEIST AND 
COLLABORATE 
X* Kleist, Prof. Dr., Beratendor Psychiater beim Wehrkreisarzt IXj Beobaoh- 
tungen auf dem Neurologisoh-psychiatrisohen Faohgebiet ia 
Jahre l943(l-10) . 
2. Kleist,Prof. Dr.: Erfahrungsberioht‘fiber wiohtige kriegs&rztliohe Beobaoh- 
tungen fftr das Vierteljahr ▼om 1.10 -31. 12. 1944 
Bezug: Wehrkreisarzt IX Ref. VI1 Az 21 ai B«r. v. 14.3.44 
Dem Wehrkreisarzt beim Wehrkreiskonanando IX. 
Kassel 
Der Beratendo Psychiater beim Wehrkreisarzt IX. Frankfurt aM 
-Niederrad, 10.2. 1945 UniTersitatsnervenklinik. 1-14 
3. Leonhard, K.iDi© Angstpsyohostin Werniokes und Kraepelins Betraohtungsweise. 
Zeitsohrift fttr gesamte Neurologie und Psyohiatrie 165, 75-78 
1939. 
4. Grosoh, H.: Poriodisohe mad episodisohe SohlafzustRnde mit ©ndokriner, 
besondors hypophslrer Dysfunktion. Allgemein© Zeitsohrift 
ftir Psyohiatrie und ihr© Grenzgebiet© 122, 115-162, 1945 
5. Persoh, R.: Beitrag zur Frag© der ©pileptoiden Psyohopathie. Allgemein© 
Zeitsohrift fftr Psyohiatrie und ihre Grenzgebiete 119, 
229-238. 1942 
6. Albert, B#i tJber Leberinsuffizienz bei Psyohosen aus dem manisoh-depress- 
iven Fonnenkreis und deren G&nstige Boeinflussung mit Nioot- 
ins&ure. Inaugural-Dissertation zur Erlangung der Doktorwftrde 
in der geeamten Medizin der Hohen Medizinisohen Fakultlt dor 
Johann-Wolfgang-Goethe-Universitlt zu Frankfurt am Main. 
September 1944 
7. Schwab, Hans.:Di© paranoiden Sohizophrenen auf Grund katamnestlsober Unter- 
suohungen H.Teil. Zeitsohrift flir die gesamte Neurologie 
und Psyohiatrie. 173, 38-108, 1941 
8. Fleele, E. und Kleist, K.i Die paranoiden Sohizophrenien auf Grund kata- 
mnestisober Untersuohungen. Zeitsohrift fttr die gesamte 
Neurologie und Psyohiatrie 175, 4-67, 1942 
9. Meyer, G., Leonhard, K. und Kleist, K. Die paranoiden Sohizophrenien auf 
Grund katamnestisober Untersuohungen. Zeitsohrift fttr die 
gesamte Neurologie und Psyohiatrie 177, 114-172, 1944 
10. Kleist, K.: Die Katatomien. Der Nervenarzt, 16-, 1-10, 1943 
38X*.*.- i a.1. Lehmann-Facius, E.: ftber Kolloid-Phtnomene des Liquors Lei endogenen 
Psychosen, mit Besonderer FerCcksichtigung der Salzs&ure- 
Kollargol-Reaktion. Zeitsohrift fflr die gesante Neur- 
ologie und Psyohietrie. 173, 472-494, 1941 
12. Leonhard, K.t Die Mienen der ausdruoksarmen Gebiete des Gesiohts. 
Psychiatriaoh-Neurologisohe Woohenschrift. 45, 127-130, 
1943 
IS. Leonhtrd, K.* Die Bedeutung optisch-r&umlioher Vorstellungen ftir das 
elementare Reohnen. Zeitsohrift ffir die geaamte Neuro- 
logi© und Psycbiatrie 164, 321-351, 1939 
14. Daus, P, und Frank, H.E.t . ftber einon Fall von intermittierender Dyapraxie 
und Dysphonie. Deutsche Medizinische 
Hr. 43, 1185, 1940 
15. Pittrioh. Alzheimer*sohe Krankheit. Reichsanstalt ffifFilm und 
Bild in Wissensohaft und Unterrioht,Hoohsohulfilm C 
387/1941 
16. Pittrioh. Mlttelhimsyndrom mit Greifreflex bei v. Winiwarter- 
Buerger*|Joher Krankheit. Reiohsanstalt fftr Film und 
Bild in,Wissensohaft und Unterricht,Hoohsohulfilm 0 
388/1941^ 
?• Pittrioh, H.t Stirnhirngeaohwftlate. ArohiT fftr Psychiatri© und 
Nervenkrankheiteh 113, 1-60, 1941 
8. Speokmann Klaus. » flber zentral© Sohmerzen und bei Verlotz- 
ungen des Grosshims, insbesondere der Hirnrinde. Der 
Nervenarzt. 16, 2D8-220, 1943 
L Habel, Hand, s Symptomatiaohe Psychose im Verlaufe der Hypophysen-Zwisoh- 
enhirninauffioienz bei einem Fall von eohter Nanosomia 
infantilis. Allgemeine Zeitsohrift fQr Psycbiatrie und 
ihre Grenzgebiete. 122, £85-337, 1943. 
0. Pittrioh, H.* DenkstSrungen bei Hirnverletzten. Sammlung psyohiat- 
rischer und neurologiaoher Einzeldarstellungen, G. Biieme, 
Leipzig, 1944 APPENDIX 5 
V«RITINGS BY PROFESSOR DR. R. SIEEECK AND ONE BY AN ASSOCIATE 
1. Siebeck, R.j Einleitung. Begriff und Stellung der Medizin, Der Arzt und 
seine Aufgabe, Der Kranke und seine Lage. Lehrbuoh der 
Inneren Medizin, Berlin/* Julius Springeryl942., 1-46. 
2, Siebeok, R.* Neurotisch© Raaktionan und Funktiooalla Stfirungen des Vag- 
©tativen Systems. Lehrbuoh der Inneren Medizin, Berlin** Julius 
Springer, 686-732, 
S. Siebeok, R.: Vegetatives System und Staramhirn. Deutsche Kedizinisohe Wooh- 
enschrift. Nr. 39/40, 543, 1944 
4. Siebeok, H*s Die Bedeutung des regetativen Systems ffir Diagnose und Therapie 
Unpublished manuscript. 1-9. 
5. Siebeok, R.t Referat fiber Neurose. Beratende-Tagung der Sanitfitsinspektion, 
16 May, 1944, in Eobenlychen. Unpublished manuscript. 1-11. 
6. Arnold, O.H.: Die Sogenannte Feldnephritis. Sohriftenreihe zur Deutsohen 
Medizinischea Woohensohrift, Leipzig/ (G.Thieme) 1944. 
1-154. 
'SS7-UU-J, 
136 APPENDIX 6 
PUBLICATIONS BY GENERALSTABARZT PROFESSOR DK. V7. TDI'INIS AND COLLEAGUES 
1* T5NNXS,W. : Der Lufttransport von Verwundeten und &ranken ale Srzt- 
liohes Problem* Der Deutsche Milit&rarzt, 5* 5-7, 1940. 
2. TCfNNIS,W•j KroislaufstBrungen naoh Eirnoperationen. Arohiv fftr 
Klinisohe Chirurgie, 200: 179-184, 1940. 
3. T0NNIS,W.: Anzeigestellung zur Myelographie• Der Chirurg, 12: 
119-122, 1940. 
4. TQNNIS,W.: Operative Freilegung des Plexus lutnbo-sacralis bei 
Sohussverletzungen des Beokens. Zentralblatt fttr 
Chirurgie, 68: 1007-1011, 1941. 
6*. TbNNIS,W.: Sohussverletzungen des Gehirns. Beriohte hber die 
Irztlichen Tagungen der Luftflotte 2, Januar und M&rz 
1941, Heft 6, 3-14, 1941. 
6. SNELLMAN,A.: Die Gehirn-, Rtiokenmarks- uad Nervenverletzungen und 
der SanitEtsdienst der finnisohen Armeo w&hrend des Krieges 
1939-1940 uad nachhor. Zentralblatt fhr Neuroohirurgie, £: 
101-106, 1941. 
7. BJORKESTEN*G. af : ftber Nervenverletzungen im Finnisoh-Russisohen 
Kriege 1939-1940. Zentralblatt fbr Neuroohirurgie, 6- : 
107-113, 1941. 
8. TONNIS,Vtf•: Sohussverletzungen des Gehirns. Zentralblatt fiir Neuroohirur- 
gie, 6 : 113-151, 1941. 
o 
9. ZIJLCH,K.J. Die Entstehung des Gehirndruokes,insbesondere des Prolapses 
bei Eirnwunde und ihren Folgezust&nden. Zentralblatt fUr 
Neuroohirurgie, : 212-232, 1941. 
10. FISCHER,E.: Gefftssbedingte Sch&diguagen bei offenen Hirnverletzungen. 
Zentralblatt fUr Neuroohirurgie, J5 : 232-274, 1941. 
11. LBMKE,J.E.: ttber SpRtabzesse des Gehirns nach Kriegsverletzungen und 
ihre Behandlung duroh Zentralblatt fftr 
Neuroohirurgie, j5 : 2.7$-289, 1941. 
12. TONNIS W.Beriohte hber die ilrztlichen Tagungen der Luftflotte 2, 
Januar und M&rz 1941, Heft 9, 2-7, 1942, 
13 TOHEIS W.. Di. Behandlung der Sohussverletzungen des Hiiokemarks. 
15. TONUS,*.* £^richte ftber6die Jntliohen Tagger, der Luftflotte 2. 
Januar und iSrz 1941, Heft 13, 3-6, 1942. 
14. TOmS.W.und GOTZE.W.: Zur operation Eehandlung der Sohussverletz- 
ungen der peripheren Nerven und ihre Erfolgsaussiohten. Ler 
Deutsche Milit&rarzt, % « 245-253, 1942. J.5. T$NF1S,W. * Hiohtlinien f&r die Behandlung der Schussvorletzungen 
des Gehirns und die Beurteilung ihrer Folgezust&nde. 
Mftnchen-Eerlin (J.F, Lehmann), 1942,1-73 
16. Z$LCH,K.J.j Die Mitbewegungen bei Hirnverletzten. Zentralblatt fl\r 
Neuroohirurgie, £ s 160-186, 1942 
17* N0ETZEL,H.: ftber die pathologisohe Anatomic der traunatischen Meningitis 
bei Hirnschussverletzung. Archiv fttr Psyohiatrio 115* 
392-418, 1943. 
18. TENNIS ,W,, Seifert,E. und RIECHERT,T.t Kopfverletzungen. Taschen- 
bftcher des Truppenarztes, Volume 2. M&nchen-Berlin (J.F.Lehmann) 
1943, 1-215. 
19* T&MIS,W.: Die Versorgung der Schussverletzungen des Gehirns (Januar 
1945), (Appendix to No.18) 
2X). TENUIS,V.t,: Wann sollen die Schussverletzungen der peripheren Nerven 
operiert werden? Der Deutsche MilitHrarzt. £ : 175-177, 
1944. 
21. TENNIS ,W.4* Die Behandlung der Schussverletzungen des Hftckenmarks, Der 
Deutsche Milit&rarzt, £ s 146-148, 1944. 
22, DIJSSIK, KARL THEO.: tSber die Mfcglichkeit, hoohfrequente mechanische 
Schwingungen als diagnostisohes Hilfsmittel zu verwerten. 
Zeitschrift fttr die gesamte Neurologi© uad Fsvchiatrie, 174 ; 
153-168, 1942. * 
jtsezfut. - z too 7>/d p. n? «/««■ p p r