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The Surgeon General's Office, 1942-1945
Aside from the relatively small number of changes in organization made as an immediate outgrowth of the Wadhams Committee investigation, the structure and functions of the Surgeon General's Office evolved gradually in response to the growing requirements of the war. Neither General Magee nor his successor was able to reassert effective control over the Air Forces medical service, nor to escape entirely the pattern of relationships imposed by the Services of Supply, but these failures were only administrative roadblocks to be worked around, not irrevocable disasters. There were substantial gains before the end of 1942 in other areas, the most notable of them being in preventive medicine.
PREVENTIVE MEDICINE, SEPTEMBER 1942-JUNE 1943
During the latter part of General Magee's administration, development of measures and organizational elements to handle several major programs-malaria control, typhus control, quarantine at ports, and the health program for civilians in occupied countries-went on as part of the normal planning of the Surgeon General's Office. The investigation of the Medical Department probably gave some impetus to the planning for malaria and typhus control, for Secretary Stimson had stressed disease problems in oversea areas in his opening remarks to the committee. In the latter part of 1942, the Epidemiology Branch of the Preventive Medicine Division planned the "special organization for malaria control" to be sent to theaters of operations where malaria presented a serious threat to troops. A new agency, the United States of America Typhus Commission, was established to combat possible outbreaks of typhus, and another to cope with problems of quarantine caused by the entry of large numbers of U.S. Army troops into foreign areas. Planning for these programs had been done by the Preventive Medicine Division, Surgeon General's Office, from the years of the emergency period. Finally, the last 5 months of General Magee's administration (January-May 1943) witnessed further developments in planning for medical work among citizens of occupied countries. This last program, however, was still largely planned, as previously, at War Department staff levels rather than in the Surgeon General's Office.
The "special organization for malaria control" devised by the Surgeon General's Office in 1942 was a flexible organization consisting of one malariologist, one or more assistant malariologists, one or more survey units, and one or more control units. It was designed to plan and put into effect malaria control measures for a theater of operations and was to be available for assign-
ment to a theater on request. It would instruct troops on antimalaria measures, survey areas for the occurrence of mosquitoes, determine the prevalence of all mosquitoborne diseases, including filariasis, dengue, and yellow fever as well as malaria, and undertake measures to control them. The malariologist was to have immediate administration of the program under the direct supervision of the theater surgeon and to act as consultant to the latter on all problems. The assistant malariologists were to be active in administering all phases of the program, particularly in developing individual preventive measures on the part of soldiers.
The malaria survey unit consisted of an entomologist and a parasitologist (both Sanitary Corps officers) and 11 enlisted men. It would act as a mobile malaria laboratory, making surveys to determine the prevalence of mosquitoes in various areas, or their breeding places, and would investigate the occurrence of malaria parasites among troops and civilians. The malaria control unit consisted of a sanitary engineer (a Sanitary Corps officer) who had had special experience in malaria control, and 11 enlisted men. Its task was to plan the control measures, supervising the drainage and larvicidal work in areas where the surveys had determined antimosquito work to be necessary. Civilian antimalaria gangs were to be hired to do the drainage and larvicidal work if they were available in the area; if not, medical sanitary companies were to be used.
This machinery for malaria control was proposed by the Surgeon General's Office on 21 September 1942; G-1 gave its approval on 9 October. On 24 October the Surgeon General's Office informed the surgeons of oversea theaters in which malaria was a serious threat of the plans for this network for control, asking them to send in their requests for the malariologists and units they needed. By the middle of December the office had received requests from the South and Southwest Pacific Areas. Malariologists and units were not available, however, until February and March of 1943. After that date they were sent not only to the Pacific areas, where the majority were located, but also to the China-Burma-India theater, North African theater, the Africa-Middle East theater, and to U.S. Army Forces in the South Atlantic (in Brazil). By April 1945, 70 survey units and 153 control units were working in the oversea theaters. In the course of the war 76 malaria survey units were created; 72 were sent overseas or were organized in oversea areas. A total of 161 control units were organized and sent overseas (or activated overseas); 16 others organized and trained in the United States were still there when the Japanese surrendered. About two-thirds of each group served in one of the Pacific areas.1
1(1) Memorandum, The Surgeon General, for Commanding General, U.S. Army Forces in the Middle East, 24 Oct. 1942, subject: Malaria Control. Similar memorandum for commanding generals of other oversea theaters. (2) Memorandum, Executive Officer, Office of The Surgeon General, for Commanding Generals of Theaters of Operations and Service Commands, 24 Mar. 1943, subject: Special Organization for Malaria Control. (3) Simmons, J. S.: Control of Malaria in the United States Army. In Boyd, Mark F., ed.: Malariology. Philadelphia: W. B. Saunders, 1949, vol. II, pp. 1455-1468. (4) Medical Department, United States Army, Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. [In press.]
The United States of America Typhus Commission
In the late months of 1942 there was a growing awareness, further stimulated by the Wadhams Committee investigation, of the magnitude of the Army's problem in disease prevention. Reports that louseborne epidemic typhus was on the increase in North Africa and other Mediterranean areas, as well as in eastern Germany, had reached the Surgeon General's Office just as preparations for the Allied invasion of North Africa were getting underway. These reports had precipitated a conference of Army, Navy, and U.S. Public Health Service representatives in August 1942, at which plans for a typhus commission were discussed, and personnel from the three services tentatively selected.
The United States of America Typhus Commission was established by Executive Order No. 9285 on 24 December 1942. It was created as an interdepartmental organization in the War Department to be staffed by personnel of the Army, Navy, and U.S. Public Health Service, and civilians to be appointed by the Secretary of War, who was also to name the Commission's Director. Under the overall direction of the Secretary of War, the Typhus Commission was to serve with the Army of the United States to prevent and control typhus fever wherever it was or might become a threat. Although as a special agency of the War Department the Commission was in a sense placed at a level above the Surgeon General's Office, there was never any conflict of authority. After the first month of its operation, the headquarters of the Commission were located in the Preventive Medicine Service of the Office of The Surgeon General. Its second and third directors and its Field Director were all brigadier generals in the Medical Corps. The Director was given broad responsibilities for making arrangements for the study of typhus fever by establishing field groups overseas for the purpose and maintaining research units at Government laboratories. The aid of other U.S. Government agencies with equipment and personnel was assured to the Secretary of War and the director of the commission. The Executive order also established a United States of America Typhus Commission Medal, "including suitable appurtenances," to be awarded, by the President or at his direction, to persons who should "render or contribute meritorious service in connection with the work of the Commission."
The original membership of the Commission, as of the end of 1942, consisted of 16 representatives, mostly medically trained men of the Army, Navy, U.S. Public Health Service, and the Rockefeller Foundation. Capt. Charles S. Stephenson of the Navy was made director and given the rank of rear admiral in order to bestow on him the prestige desirable for dealing with state and military authorities of foreign countries. The administrative affairs of the Commission were handled by a rear echelon in Washington headed by Maj. Gen. LeRoy Lutes, then Assistant Chief of Staff for Operations, Services of
Supply, and including a representative of each of the three Federal medical services. The remaining members, the so-called "field group" headed by the director, went to Cairo early in 1943 to collect strains of typhus virus and experiment with control by means of various antilouse powders. The membership of the two Rockefeller Foundation experts was to be only temporary; they were specifically assigned by the foundation to develop methods for the control of typhus in civilian populations.2
The organization of the U.S.A. Typhus Commission underwent significant changes from the date of its establishment to its discontinuation in 1946. Although members of the Medical Department who had been active in creating the Commission had originally pooled the resources of a number of agencies, civil and military, the long-range trend was toward greater control of the Commission by the War Department and Army, with less by the other agencies represented. The Commission remained interdepartmental in membership, having some representatives of the Navy and the U.S. Public Health Service as members to the end of its existence, but the Medical Department (with the Preventive Medicine Division, Surgeon General's Office, taking the lead) largely assumed direction of its work. After the Navy director became ill, a number of Army officers connected with the Commission pointed out that typhus was primarily an Army, not a Navy, problem since larger numbers of ground troops would come into contact with civilians infected with typhus in invaded areas. Col. (later Brig. Gen.) Leon A. Fox, MC, was made director of the Commission in February 1943 and undertook supervision of the field group in Cairo as his predecessor had done. He was instrumental in making substantial changes in the character of the membership by arranging for removal of some members of the Cairo group, particularly several Navy officers. The commissioning of one typhus expert from the Rockefeller Foundation by the Army and the departure of the other to head a separate typhus control program in the North African theater, previously planned by the foundation, made the field group largely an instrument of the Medical Department by mid-1943.
Centralized control of the Commission's work in the Surgeon General's Office in Washington-rather than, as in the early months, ill Cairo,-came about as the need developed for suppressing dissension in the Cairo office and as it became clear that additional field offices in other typhus-ridden areas would be necessary. About mid-1943, the deputy director of the Preventive Medicine Service, Col. Stanhope Bayne-Jones, MC (fig. 47) , assumed the duties of director and General Fox was made field director at his own request. General Fox had been moving rapidly about the world since 1940 in several medical capacities and was thus able to continue various duties of a liaison nature in the typhus control program, particularly ill connection with the allocations of typhus vaccine by the United States to foreign governments.
2Letter, Dr. Fred L. Soper, to Director, The Historical Unit, 10 Aug. 1955.
From then on to the close of the war, control of the Commission's field groups was exercised from Washington. During the early months of the Commission's existence, a strong desire for individual recognition and a good deal of rivalry developed among its members. The rivalry was in part personal or professional and in part factional by reason of the various organizations, civilian and military, represented. It sprang up chiefly among the field group in Cairo, where jealousy developed between Army and Navy members and between Army and Rockefeller Foundation members. Nevertheless, the rivalry, which, along with the lack of accessible typhus epidemics, delayed accomplishments by the Cairo field group, only seems to have spurred the Commission on to greater efforts whenever serious epidemics were encountered. General Fox stated on the eve of the Naples epidemic in the winter of 1943: "This is no time for fights over jurisdiction. There will be more typhus control before spring than all can handle * * *."3 Success in Naples by means of widespread spraying of the population with antilouse powder settled the difference of opinion which had previously existed as to the relative merits of antilouse powder and typhus vaccine for controlling epidemics. From that date on a good deal more cooperation was in evidence.
3Coded Message CM-IN-8358, Teheran to Cairo and AGWAR, 13 Dec. 1943.
Field groups of typhus experts worked effectively in most of the major theaters of operations. The field party of the Commission in a theater was administratively subject to theater control, but assignments were made to the various theaters by the Washington office of the Commission. The Cairo group worked in various countries of the Africa-Middle East theater, -as well as in the Naples area of the Mediterranean theater during the winter of 1943-44 and in the Balkans in the spring of 1945, effectively checking a number of incipient epidemics among the civil populations and thus protecting the health of Allied troops. Other groups of typhus experts served in the European theater, where large-scale outbreaks in the Rhineland and Austria were suppressed; in the China-Burma-India theater and Southwest Pacific Area, where important work was done on scrub typhus; and later in Korea and Japan. The medal was awarded by June 1945 to 35 individuals, including not only Officers of the Army, Navy, and U.S. Public Health Service and Rockefeller Foundation experts who were assigned or attached to the Commission but also a few British Army medical officers, several Egyptian public health officials, and the American Ambassadors to Italy and Turkey.4
During the last months of General Magee's administration the Medical Department also embarked upon a program of cooperation with the U.S. Public Health Service as to quarantine procedures at ports. An interdepartmental quarantine commission was first discussed early in 1943 at the instance of U.S. Public Health Service officials. The U.S. Public Health Service was responsible for preventing the carriage of certain diseases (cholera, smallpox, plague, epidemic typhus, yellow fever, and leprosy) into the United States and its territories by ships and planes. The increased volume of war traffic, particularly of planes, the necessary secrecy of movements of military ships and planes, their entry into areas which had no quarantine regulations, and the breakdown of quarantine systems in some areas under wartime conditions had led U.S. Public Health Service officials to a realization that revision of quarantine procedures was necessary.
The U.S. Public Health Service lacked sufficient personnel to cope with its wartime quarantine problems. To tackle the problem, the Surgeons General of the Army, Navy, and U.S. Public Health Service formed the Interdepartmental Quarantine Commission, appointing a representative from each of their respective services in mid-1943. The Commission did special work in coping with the threat of the transfer of Anopheles gambiae to Brazil from West Africa by planes. By mid-1944, when it submitted its final report, it had worked out the mutual responsibilities of the Army, Navy, and U.S. Public
4A fully documented account of the organization and activities of the U.S.A. Typhus Commission, prepared by Brig. Gen. Stanhope Bayne-Jones, USA (Ret.), is included in a forthcoming volume, Medical Department, United States Army. Preventive Medicine in World War II. Volume VII. Communicable Diseases: Arthropodborne Diseases Other Than Malaria. [In preparation.]
Health Service for various phases of quarantine procedure in oversea areas. The Secretary of War made The Surgeon General responsible for establishing and supervising quarantine procedures of the Army in foreign countries. The Surgeon General appointed an Army quarantine liaison officer to keep in touch with the program of the U.S. Public Health Service and the Navy and to integrate the Army's quarantine procedures with those of foreign countries and areas beyond the domain of the U.S. Public Health Service. Modernization of the military regulations relating to quarantine, especially of Air Force regulations, resulted. The fieldwork of the quarantine liaison officer's unit the Quarantine Branch of the Epidemiology Division, Preventive Medicine Service-included many studies of quarantine procedures and problems at U.S. Army facilities and on U.S. Army carriers at home and abroad.5
Major developments in the planning of medical programs for civilians in occupied countries also took place in the first half of 1943. Throughout the emergency period and the first year of war, the Surgeon General's Office had participated in medical aspects of the planning for the Army's conduct of civil affairs in occupied countries which various elements of the War Department had undertaken. In 1942 it had assigned personnel to lecture on public health at the School of Military Government at Charlottesville, Va. (under the direction of the Provost Marshal General), and supplied the school with its basic medical intelligence data on foreign countries. As the training for military government progressed with the establishment of similar schools at various universities, the Surgeon General's Office aided in organizing whole courses, in public health. It sent to the schools for training, Medical Department officers of the several corps who applied through military channels, U.S. Public Health officers assigned to the Army, and medically trained civilians commissioned by The Surgeon General specifically for civil affairs work.
In January 1943, major responsibility for recruiting personnel to handle the medical aspects of civil affairs and for developing a medical program was vested in Col. Ira V. Hiscock, SnC (fig. 48), who had previously worked on the program both in the Preventive Medicine Division, Surgeon General's Office, and at the School of Military Government. He was assigned to the Office of the Provost Marshal General to select, in conjunction with the Director of Personnel, Surgeon General's Office, and the Director of the Military Government Division, Provost Marshal General's Office, medically trained personnel to be given training as public health officers at the schools operated by the Provost Marshal General. He also assembled material to aid the Army, Navy, and various agencies in planning their relief and rehabilitation work in occupied countries.
5(1) Final Report, Interdepartmental Quarantine Commission, 10 June 1944. (2), Knies, P. T.: Quarantine and Disinsectization of Aircraft. Air Surg. Bull. 1: 16-18, October 1944. (3) Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, pp. 278ff.
In March 1943 the War Department established the organization to handle the total program for administering civilian affairs in occupied areas by creating a Civil Affairs Division on the War Department Special Staff. In April, Colonel Hiscock was reassigned to this division to take charge of what was later called the Public Health Section, and chief responsibilities for the medical phases of the civil affairs program were vested in him. He continued the activities he had engaged in at the Office of the Provost Marshal General, selecting personnel and assembling material for planning. He maintained liaison with many agencies which shared the responsibility for planning the civil affairs program and initiated conferences with members of the Supply Division, Surgeon General's Office, and other agencies to discuss the probable requirements of medical and sanitary supplies for civilian use. A medical supply board was organized in the Surgeon General's Office to prepare estimates of requirements, but it was not until early 1944 that the responsibilities of the office, were broadened to include aspects of the medical program other than supply and that an organizational unit to handle the program was established in the office.6
6For full discussion and more complete documentation, see Medical Department, United States Army. Preventive Medicine in World War II. Volume VIII. Civil Public Health Problems and Activities. [In preparation.]
EFFORTS TO REGAIN CONTROL OF MEDICAL SERVICE IN THE
At another level the Air Surgeon's bid for autonomy met with reinforced resistance as a result of the Wadhams Committee's recommendation that every effort be made to bring the medical service of the Army Air Forces under the control of The Surgeon General or, if this could not be done, that a clear official statement of the respective responsibilities of the Air Surgeon and The Surgeon General be issued. The whole question was reopened in March 1943 by Maj. Gen. Wilhelm D. Styer, General Somervell's Chief of Staff, who asked bluntly whether existing directives furnished a satisfactory basis for a working relationship between The Surgeon General and the Air Surgeon.7
The Air Surgeon was simultaneously taking steps to add another increment to his power, proposing that he be officially designated thereafter as the Air Surgeon General, a title he regarded as no more than commensurate with the added responsibilities imposed by increased size of the Air Forces. General Magee retorted tartly that it was "inconsistent that the title of a subordinate responsible for a part of the Army should be that of his superior who is responsible for the whole"; nor could he see how a change in title could increase the efficiency of the Air Surgeon's Office. Replying to General Styer a few days later, General Magee cited specific areas of duplication, including efforts by the Army Air Forces to establish hospitals which were in effect, though not in name, general hospitals. He noted that this effort aggravated the Army-wide demand for highly specialized personnel and for medical supplies. He recommended that hospitalization of Army Air Forces personnel be made a responsibility of the service commands, that only Medical Department personnel attached to field units of the Army Air Forces be directly responsible to the Air Surgeon, and that the Chief of Staff issue an official statement delineating the responsibility of The Surgeon General for the health of the entire Army.8
The struggle over control of hospitals was the most important phase of the total struggle between the Surgeon General's Office and the Air Surgeon's Office in 1943. The earlier phase of the conflict had revolved primarily around direct recruitment and subsequent control of medical personnel by the Army Air Forces, which by 1943 had recruited the specialized medical personnel to staff a system of hospitals. It established under its control installations which, although not termed general hospitals, were equipped to give the same type of
7Memorandum, Chief of Staff, Services of Supply, for Assistant Chief of Staff for Operations, Services of Supply, 20 Mar. 1943, subject: Relationship Between The Surgeon General and the Air Surgeon.
8(1) Memorandum, Chief of Air Staff, for Chief of Staff, 25 Mar. 1943, subject: Change in Title of Special Staff Officers, Headquarters, Army Air Forces. (2) Memorandum, The Surgeon General, for Assistant Chief of Staff, G-1, 7 Apr. 1943. (3) Memorandum, Assistant Chief of Staff for Operations, Services of Supply, for The Surgeon General, 30 Mar. 1943, subject: Relationship Between The Surgeon General and the Air Surgeon, and 1st indorsement, The Surgeon General, for Commanding General, Army Service Forces, 12 Apr. 1943.
definitive medical and surgical care. Success in the effort to have these installations recognized as general hospitals would have made it possible for the Army Air Forces to treat in hospitals under its control many patients who would normally have been treated in the general hospitals of the Army Service Forces and would have encroached upon the latter's hospital system.
Prompted by General Lutes, General Somervell pointed out to the Chief of Staff the increasing confusion over the responsibilities of the Surgeon General's Office and those of the Air Surgeon's Office and certain respects in which their activities duplicated each other. He cited instances of the use of station hospitals controlled by the Army Air Forces as general hospitals and efforts of that command to have patients from overseas sent directly to these instead of to the regular general hospitals maintained by the Army Service Forces. He emphasized various recommendations of the Committee to Study the Medical Department as to the desirability of greater control by The Surgeon General over the medical service of the Army Air Forces, especially Recommendation 55 calling for a clear official delineation of their respective responsibilities, and proposed that the Chief of Staff issue a directive reaffirming the authority of The Surgeon General. Although this authority, he noted, had not been changed by any official utterance since the reorganization of March 1942, it had not been definitely affirmed since that date.9
Brig. Gen. David N. W. Grant, the Air Surgeon, objected to the recommendations with respect to Army Air Forces medical service which had been made in the report of the Committee to Study the Medical Department. He declared that no member of that committee had had more than a slight familiarity with aviation medical problems, or indeed, with any aspect of aviation. He considered a few members ignorant of the problems, or prejudiced against the esprit de corps, of the Army Air Forces. Members of the investigating committee had made only a superficial survey of one or two Army Air Forces installations. He noted that The Surgeon General had had a representative on the committee, while the Air Surgeon had had none. Finally, the committee's full report had never been given to the Air Surgeon.
The Air Surgeon agreed with the thesis of the report that there should be a surgeon general on the special staff of the Chief of Staff. Under the present organization of the Army, however, he stated, the medical service of the Army Air Forces could not be brought under the control. of The Surgeon General without violating command channels; the Army Service Forces could not be given command powers over the Army Air Forces, since the two were on the same level of command.
General Grant emphasized once more the many medical cases-those of flying stress, aeroneurosis, and occupational rehabilitation following injuries-
9(1) Memorandum, Assistant Chief of Staff for Operations, for Commanding General, Army Service Forces, 30 Apr. 1943, subject: Relationship Between The Surgeon General and the Air Surgeon. (2) Memorandum, Commanding General, Army Service Forces, for Chief of Staff, 30 Apr. 1943, subject: Unification of Medical Service of the Army by The Surgeon General, and tabs A through L.
requiring treatment by medical officers familiar with Army Air Forces operations and problems. He declared that a close understanding between patient and doctor was characteristic of the medical service of the Army Air Forces and contrasted this outlook with the doctrine he attributed to The Surgeon General and the Army Service Forces, that all medical officers should be pooled and dealt out from time to time like so many trucks from Army Service Forces warehouses. Administrative control of medical personnel by the Commanding General, Army Air Forces, had resulted, General Grant claimed, in the proper assignment of medical officers to their specialties. This feature, he maintained, was peculiar to the medical service of the Army Air Forces.10
As might be expected, the Air Surgeon's position, including the thesis that the Army Air Forces medical service was more efficient than that administered by The Surgeon General, was loyally supported by his superior officers within the Army Air Forces. The general staff, however, was divided in its preferences, and inclined to temporize. For example, Brig. Gen. R. G. Moses, Assistant Chief of Staff, G-4, saw merit in the claims of both sides. He defined the choice as one between "a definition of authorities which appears to achieve complete unification but which will work effectively only with the enthusiastic concurrence of all concerned and with a considerable improvement in the medical service of the Army, and, on the other hand, a definition of authorities which will certainly achieve more efficient medical care for one part of the Army but which is a trend definitely away from unification." The latter alternative he considered preferable, admitting that his choice was partly dictated by expediency but stating that greater efficiency in one part of the Army should serve as an incentive to the remainder. He favored reaffirming the responsibility of The Surgeon General and limiting any additional authority granted to the Army Air Forces to authority over individualized care of combat personnel.11
The Deputy Chief of Staff, Lt. Gen. (later Gen.) Joseph T. McNarney, himself an Air Corps officer, tended to favor the claims of the. Air Surgeon. General McNarney's office issued a statement on 20 June 1943 to the effect that existing regulations outlined the functions of The Surgeon General satisfactorily. The statement held that a highly centralized system of medical service would not be sufficiently flexible to adjust overall policies to the special needs of the oversea theaters and the three major commands. The Surgeon General should procure medical personnel, decentralizing this function to the major services insofar as they thought necessary, but the Army Air Forces should, control station hospitals at its own posts, camps, and stations. Finally, General
10Memorandum, the Air Surgeon, for Commanding General, Army Air Forces, no, date (but commenting on a directive of 30 Apr. 1943 prepared by the Commanding General, Army Service Forces, for the signature of the Chief of Staff).
11(1) Memorandum, Assistant Chief of Air Staff, for Commanding General, Army Service Forces, 25 May 1943, subject: Unification of Medical Service of the Army by The Surgeon General. (2) Memorandum, Assistant Chief of Staff, G-4, for Chief of Staff, 15 June 1943, subject: Medical Service of the Army.
McNarney's office announced that general hospitals necessary to meet the needs of aviation medicine and give medical treatment to air combat crews would be assigned to the Army Air Forces upon approval by the Chief of Staff.12
Both The Surgeon General and the Commanding General, Army Service Forces (as the Services of Supply was rechristened in March 1943), objected strongly to the transfer of any general hospitals to the Army Air Forces. The Surgeon General, in particular, argued that centralized control of general hospitals, providing as they did the ultimate in professional care in the United States, was absolutely necessary for the proper assignment of all ground and air combat patients evacuated from overseas to the particular hospital with the specialized personnel therein which could best meet the individual's need for special treatment. He recognized that air combat crews needed special reconditioning but maintained that the general hospitals of the Army Service Forces should provide them both hospitalization and reconditioning. Reconditioning should be given them by medical personnel trained in aviation medicine but within special facilities established in the general hospitals.13
General Somervell agreed and so informed the Chief of Staff. He did not believe it was intended to establish two Medical Departments and "two distinct streams for the evacuation of the sick and wounded." He had suggested to the Deputy Chief of Staff that a satisfactory solution would be the assignment of General Grant, to be redesignated Deputy Surgeon General for Aviation Medicine, to the Office of The Surgeon General where his specialized knowledge and point of view would help to improve the entire medical service. He did not admit any superior efficiency on the part of the Army Air Forces medical service, but he emphasized the point that the new Surgeon General (General Magee's term having expired on 31 May) was being held responsible for good administration of the Medical Department on an Army-wide basis, as well as for correction of deficiencies of the previous administration. He implied that the transfer of general hospitals to the Army Air Forces would undermine at the outset this total responsibility.14
The Secretary of War, after conferring with the Deputy Chief of Staff, the Commanding General, Army Service Forces, and representatives of the Army Air Forces, directed that no general hospitals be turned over to the control of the Army Air Forces, but would continue to operate under the Army
12Memorandum, Assistant to Deputy Chief of Staff, for Commanding Generals, Army Air Forces, Army Ground Forces, and Army Service Forces, 20 June 1943, subject: Medical Service of the Army, January-July 1943.
13(1) Memorandum, Director of Operations, Army Service Forces, for Commanding General, Army Service Forces, 24 June 1943, subject: Medical Service in the Army. (2) Memorandum, The Surgeon General, for Chief of Staff, 29 June 1943.
14(1) Memorandum, Commanding General, Army Service Forces, for Chief of Staff, 30 June 1943. According to General Grant, General McNarney actually offered him the position suggested by General Somervell of Deputy Surgeon General for Aviation Medicine, with the rank of major general, but General Grant, still convinced this expedient would not work, refused. (2) Letter, Maj. Gen. David N. W. Grant, USAF, to Director, The Historical Unit, U.S. Army Medical Service, 11 Aug. 1955, commenting on draft manuscript of this volume.
Service Forces. Oversea casualties, including combat crews, returned to the United States by air or water, would be taken care of in these hospitals according to the general procedures established by the Surgeon General's Office. However, flying personnel needing treatment for air fatigue, as well as all Army Air Forces personnel recovered after treatment in a general hospital, would be cared for in "convalescent centers" under control of the Army Air Forces. To meet another of the Air Surgeon's arguments, a flight surgeon was to be assigned to The Surgeon General to advise on specialized treatment, transfer, and disposition of combat crews. Flight surgeons would also be assigned to those general hospitals in which flying combat crews were being cared for to give advice on the special techniques of aviation medicine to be used in the care of this group.15
Thus the move initiated by General Styer to effect the recommendation of the Committee to Study the Medical Department that The Surgeon General be given more control over the medical service of the Army Air Forces gradually narrowed down to a controversy over the control of general hospitals proper and ended with a statement by the Secretary of War officially maintaining the status quo as to control of these hospitals. The course of events here included the following steps, which seem to form a pattern for similar struggles for control between The Surgeon General and the Air Surgeon: Action by the Army Air Forces to achieve a fait accompli; pressure by the Army Service Forces and The Surgeon General to get an official directive reasserting control by The Surgeon General; statements by Army Air Forces representatives that their organization had done nothing contrary to official directives and regulations; under continued pressure by the Army Service Forces and The Surgeon General, open counterbids by the, Army Air Forces for official recognition of their fait accompli, bolstered by claims of superior medical service; resistance by The Surgeon General, put in his turn on the defensive, and by the Army Service Forces; and finally a decision by the Secretary of War officially maintaining the status quo in large part, but having little restraining effect upon a renewal of effort by the protagonists. These paper wars ended in a temporary truce whenever the Secretary of War ordered the combatants to cease fighting.
Some generalization may also be made with respect to the usual position of higher War Department authorities in these controversies. With the exception of the Deputy Chief of Staff, who showed a tendency to favor claims of the Air Surgeon's Office, The Surgeon General's superiors, including the Secretary of War, the Chief of Staff, and the Commanding General, Army Service Forces, were usually inclined to give The Surgeon General some backing in his efforts to reestablish greater control over medical service of the Army
15(1) Letter, Maj. Gen. Norman T. Kirk, USA (Ret.), to Col. Roger G. Prentiss, MC, Chief, Historical Division, Office of The Surgeon General, 19 Nov. 1950. (2) Memorandum, Assistant Deputy Chief of Staff, for Commanding Generals, Army Air Forces, Army Service Forces, and Army Ground Forces, 9 July 1943, subject: Hospitalization.
Air Forces. However, they were consistently unwilling to disturb the reorganization of the War Department of March 1942, which, so far as medical service was concerned, abetted the separatism of the Army Air Forces.
APPOINTMENT OF A NEW SURGEON GENERAL
While the battle over the powers and positions of the Air Surgeon was in full swing, another and not altogether unrelated battle was in progress over the choice of a new Surgeon General, for the 4-year term beginning 1 June 1943. Before the end of February, General Marshall made his recommenda-tion to Secretary Stimson, listing at the same time the factors on which his choice was based. These were: professional and technical qualifications in medicine and surgery; military qualifications; administrative and executive ability; high standing among members of the civilian medical profession; training, experience, and reputation among military men as a military doctor or surgeon; record of accomplishment in the Army; and high efficiency rating. On the basis of these factors he listed 11 officers in the grade of colonel or brigadier general as the best qualified candidates for the position and presented them in the order of his preference. General Magee, Brig. Gen. Howard McC. Snyder, and Brig. Gen. Morrison C. Stayer (then Chief Health Officer, Panama Canal Zone) were included in the list of those qualified but were ruled out on the ground that they would attain the statutory age of retirement before the completion of the 4-year term. He stressed the importance of "wide military experience" and the "ability to organize and administer a widespread and complex medical service." He noted that future problems of the new surgeon general would result largely from military operations in "many foreign theaters under diverse and severe conditions of combat service." With this consideration in mind he deemed Brig. Gen. Albert W. Kenner, then theater surgeon in North Africa, the best qualified candidate on the list. He pointed particularly to General Kenner's record as surgeon of the Western Task Force with General Patton in the North African invasion and to his promotion, with General Eisenhower's concurrence, to brigadier general on the basis of that service.16
The Chief of Staff was "determinedly opposed to" the reappointment of the present surgeon general. He considered himself very familiar with Medical Department matters, for he had "maintained a Medical general officer in the Inspector General's Department" for the purpose of keeping in close touch with conditions and had talked the situation over, as had the Secretary of War, with a "number of the leading Medical officers and surgeons of this country."
16Memorandum, Chief of Staff, for Secretary of War, no date but approximately 21 Feb. 1943, subject: Appointment of Surgeon General.
In the efforts to locate the proper man, the Secretary of War personally searched through the entire service records of a number of officers and talked with some of the medical officers mentioned for consideration. On 25 February the Secretary recommended that President Roosevelt appoint General Kenner. He repeated in much the same language as General Marshall's the belief that in the coming months the chief problems of the medical service would arise from combat operations and that the new surgeon general should have had "actual service in foreign fields under combat conditions." He urged General Kenner's early appointment and his return to Washington.17
The President concurred in the appointment of General Kenner but wanted to defer to 1 April the sending of his name to the Senate. He had no objection to General Kenner's return to familiarize himself with problems of the Surgeon General's Office. He added: "I should particularly like him to make a study of the relationship of the Medical Corps of the United States Army to the General Staff." Many outstanding civilian members of the medical profession, he stated, thought that the present setup was not good. He had received various indications that "the Surgeon General of the Army does not have certain responsibilities which might more profitably go with the Office of The Surgeon General rather than with the General Staff, on which I understand no medical officer-or at least a very junior medical officer-sits." President Roosevelt also inquired, rather by the way, as to the "responsibility on the part of the Army for conditions which might result from a general epidemic throughout the country" and as to where the General Staff fitted in on this.18
The Secretary informed the President that the nomination of General Kenner would be submitted about 1 April and that he would be brought to Washington in order to acquaint himself with the general problems in the Surgeon General's Office. Early selection had been urged so that the new incumbent might become familiar with the very problems that the President had mentioned. General Kenner returned to Washington in March, and on 7 April was asked by General Somervell to study the report of the Wadhams Committee. The following day the President wrote the Secretary of War:
"I want you to reconsider the tentative selection made two or three weeks ago for Surgeon General of the Army. My best advice is that he is a good Doctor but that he would not be regarded as an outstanding choice by the medical profession.
17(1) Memorandum, Chief of Staff, for General Pershing, 27 Mar. 1943. (2) Memorandum, Secretary of War, for the President, 25 Feb. 1943, subject: Recommendation for Appointment of Surgeon General, U.S. Army.
18Memorandum, Franklin D. Roosevelt, for the Secretary of War, 1 Mar. 1943. The President's "very junior medical officer" was presumably Col. William L. Wilson, who was not, of course, on the General Staff but in the Office of the Assistant Chief of Staff for Operations, Services of Supply. Civilian doctors and others who complained of the setup had not apparently enlightened him as to organizational relationships within the War Department or the role of the Services of Supply in Medical Affairs.
"As you know, I am in much closer touch with the medical profession in all its ramifications than most people are, and I believe that some other selection could be made which would do more credit to all of us."19
In reply the Secretary noted that "a man with an outstanding reputation for ability and character in the Medical Corps" would not always have had the opportunity to become well known in the civilian profession. He reiterated his belief that General Kenner was "the surgeon with the most outstanding record in the Army today and a man holding a virtually unique position among our fighting forces from his performances in Europe in 1918 and in Africa this year." However, he proposed the nomination of Brig. Gen. Norman T. Kirk, then commanding officer of the Percy Jones General Hospital at Battle Creek, Mich. He cited comment by Col. William L. Keller, MC (under whom Kirk had served at Walter Reed Hospital), as well as by General Ireland, as to General Kirk's ability in orthopedic surgery and by other officers under whom he had served at various general hospitals as to his energy, aggressiveness, and administrative ability. He further stated in noting that General Marshall con-curred in the selection: "I have emphasized the comments on his vigor, initiative, aggressiveness because in the opinion of the Chief of Staff and myself those qualities are the ones at present most needed in the administration of the Surgeon General's Office."20
General Kirk's appointment was announced in early May. Thus the choice of the new surgeon general represented a concession to the insistence of certain members of the civilian medical profession, backed by the President, upon a candidate acceptable to the profession, as the committee's report had strongly recommended. The Secretary of War and the Chief of Staff did not prevail in their effort to appoint a man who had had combat experience in World War II. However, both sides demanded a surgeon general of vigor and administrative ability, and both appear to have been convinced that General Kirk possessed these qualities. Although he did not read the Wadhams Committee report, General Kirk shortly set about the reorganization of the Surgeon General's Office in consonance with certain suggestions by General Somervell.21
INTERNAL ORGANIZATION OF THE SURGEON GENERAL'S
General Kirk inherited an office organization that the previous administration had had to create, and methods of dealing with problems that had been devised in an atmosphere of confusion and scarcity. In the Zone of
19(1) Memorandum, Secretary of War, for the President, 6 Mar. 1943, subject: Brig. Gen. Albert W. Kenner. (2) Letter, Franklin D. Roosevelt, to the Secretary of War, 8 Apr. 1943.
20Letter, Secretary of War, to the President, 10 Apr. 1943.
21Letter, Maj. Gen. Norman T. Kirk, USA (Ret.), to Col. Roger G. Prentiss, Jr., MC, Director, Historical Division, Office of The Surgeon General, 24 Nov. 1950.
Interior the service command surgeons and the surgeons of tactical and area commands of both ground and air troops were well established, while overseas a medical organization was in being in each of the theaters that was to exist during the war. The supply problem was largely solved, and necessity had already enlarged the sphere in which a solution of the personnel problem would be worked out. A fund of experience was now available, transmitted from the various theaters, that could be applied to the benefit of all. On the other hand, new problems were emerging such as heavy loads of evacuees to care for, a rise in neuropsychiatric cases, reconditioning, rehabilitation, public health in occupied territory, and ultimately problems of demobilization.
The Office of The Surgeon General did not settle down into a static organizational pattern which would have indicated that some desirable structure had at last been achieved, but continued to undergo many changes. Few were the months from June 1943 to the end of June 1944 that did not witness some alteration, in the divisional level or above, in the office structure. Although many changes were piecemeal, they may be conveniently grouped into the early innovations made by General Kirk, consisting chiefly of the selection of new officers for many of the key positions in the office, and two major reorganizations which took place roughly about February 1944 and August 1944.
Early Changes of General Kirk's Administration
General Kirk's earliest revisions in the structure of his office and changes in key personnel were in large measure designed to counteract criticism emanating from Headquarters, Army Service Forces. Some changes accorded with recommendations made by the Committee to Study the Medical Department and a few with specific suggestions made by the Commanding General, Army Service Forces. The reorganization of this period was closely observed by the latter and by the Chief of Staff and the Secretary of War.22
Control Division.-An important appointment made by General Kirk was that of Col. Tracy S. Voorhees, as Director of the Control Division. Colonel Voorhees had had experience with the legal aspects of the medical supply program since mid-1942 and had gained an insight into the relations of the Surgeon General's Office with Army Service Forces headquarters through his preparation of an answer to the charges brought against the previous Surgeon General in the course of the investigation of the Medical Department. He was apparently considered by both the Surgeon General's Office and the Army Service Forces to be a good potential mediator between these two organizations and thus assumed the role of "troubleshooter" for General Kirk. The latter made it clear at the outset that he would give Colonel Voorhees strong support. One medical officer commented: "It seemed to me
22Memorandum, Commanding General, Army Service Forces, for Chief of Staff, 11 Aug. 1943.
that General Kirk directly implied that he would accept the recommendations of Colonel Voorhees 'lock, stock, and barrel * * *."23
The new director of the Control Division did not subscribe to the previous concept of that division's sphere of action, noting the opposition which its delving into the internal operations of other divisions had aroused. From now on, the Control Division concentrated on such office-wide problems as standardizing Medical Department forms, expediting mail through the office, decentralizing fiscal work to field offices, and keeping personnel in the Surgeon General's Office at a minimum number, and so forth. Although Colonel Voorhees remained in charge of the division until August 1945, he himself concentrated upon the solution of certain major problems. He gave General Kirk advice on the reorganization of various elements of the office and appraised for him individuals in key positions. Colonel Voorhees was in part responsible for hiring civilians with wide administrative experience. Most of the year 1944 he spent overseas, looking into problems of medical administration in the theaters of operations for The Surgeon General, particularly the handling of medical supply. He backed General Kirk strongly in the latter's efforts to gain more control over the assignments of individual Medical Department officers. Colonel Voorhees frequently supported the Surgeon General's Office in negotiations with other elements of War Department organization, acting as mediator with Army Service Forces headquarters on several occasions and actively backing General Kirk in his struggles with the Army Air Forces medical organization. Although he encountered criticism on the part of some Medical Department officers who maintained that administrators of medical programs should have had medical training, he himself at times drew a line of demarcation between those problems on which he considered himself capable of giving advice and those whose technical nature called for solution by the medically trained. He was, on the whole, a partisan of The Surgeon General and Medical Department, while he continued to press for greater efficiency within the Surgeon General's Office and in Army medical administration overseas.24
The personnel situation in the Surgeon General's Office posed a problem to the new Surgeon General and the chief of his control division from the outset. In early July 1943, the Surgeon General's Office had 1,877 employees. Of these, 1,549 were civilians, 304 Medical Department officers, 13 officers on special or temporary duty, and 11 were enlisted men. The office had seriously
23(1) Memorandum, Director, Control Division, Army Service Forces, for Commanding General, Army Service Forces, 30 June 1943. (2) Office Diary, Historical Division, by Col. Albert G. Love, MC, entry for 27 June 1943.
24(1) Annual Report of Control Division for Fiscal Year 1945. (2) Interview, Tracy S. Voorhees, 22 Sept. 1950. (3) Letter, Maj. Gen. Norman T. Kirk, USA (Ret.), to Col. Roger G. Prentiss, Jr., Director, Historical Division, Office of The Surgeon General, 19 Nov. 1950. (4) Office Order No. 197, Office of The Surgeon General, 17 Aug. 1945. (5) Memorandum, Director, Control Division, Office of The Surgeon General, for Director, Control Division, Army Service Forces, 6 June 1944. (6) Interview, Dr. H. A. Press, 9 Oct. 1950. (7) Memorandum, Tracy S. Voorhees, for Executive Officer, Office of The Surgeon General, 29 Dec. 1943, subject: Necessity for Regulation of New Organizations Setup in the Supply Service.
exceeded its officer allotment. At the same time some important and growing M functions were either inadequately staffed or not staffed at all; for example, hospital management, neuropsychiatry, and the reconditioning service for hospital patients. Officers engaged in supply, fiscal, and control activities constituted about 40 percent of the officer allotment. Additional officers to staff the more technical functions could be obtained under the allotment by moving out of the Surgeon General's Office business activities which could as easily be carried on elsewhere, for elements moved out of Washington would not be subject to the limitations of the allotment and the large numbers of qualified civilian personnel needed to carry on business activities could be more readily obtained in other localities. A good deal of the reorganization of the Surgeon General's Office from 1943 on was engineered by the director of the Control Division with these considerations in mind.
On 10 July 1943, The Surgeon General issued an organization chart (chart 9) which had received the approval of General Somervell. With the exception of the Office of Technical Information and the Control Division, all elements of the office were grouped under the five services. These were about the same as the services that had existed since August 1942, but their internal organization underwent some changes, and The Surgeon General replaced with other officers several heads of services and divisions-particularly, though not exclusively, those who had been under fire during the investigation of the Medical Department.
Deputy Surgeon General.-In accordance with a recommendation of the Committee to Study the Medical Department, General Kirk appointed a full-time deputy surgeon general-that is, without responsibility for the Operations Service. Brig. Gen. George F. Lull, former Chief of the Personnel Service, was given this post.25
Operations Service.-For Chief of the Operations Service General Kirk chose, Col. (later Brig Gen.) Raymond W. Bliss, MC, previously Surgeon, Eastern Defense Command. From the outset of General Kirk's administration the Operations Service assumed a leading role in the administration of the office, especially in coordinating the work of various elements of the office, as well as the operations of the Surgeon General's Office with those of other War Department agencies concerned with Army medical service. The Training Division was added to the Operations Service, the Plans Division expanded, and the former Hospitalization and Evacuation Division and the Hospital Construction Division were amalgamated into the Hospital Administration Division.26
25Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 10 Aug. 1943, subject : Interim Progress Report.
26(1) Office Order No. 351, Office of The Surgeon General, 4 June 1943. (2) Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 18 June 1943, subject: Organization of The Surgeon General's Office. (3) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 176ff.
Chart 9.-Office of the Surgeon General, 10 July 1943
The latter change was made at the request of General Somervell, and special measures, including the assignment of additional personnel, were taken to strengthen this division. Colonel Bliss (made brigadier general in September 1943) brought with him into the office Col. Albert H. Schwichtenberg, MC (fig. 49), a Medical Corps officer who had most recently commanded an Air Forces hospital at Westover Field, as Director of the Hospital Administration Division. Colonel Schwichtenberg's appointment was made in accordance with the decision early in July that a flight surgeon would be assigned to the Surgeon General's Office in the effort to achieve better coordination with the medical service of the Army Air Forces; Colonel Schwichtenberg headed the Hospital Administration Division to the end of the war. Early in the following year, General Kirk and Colonel Voorhees also obtained for the Hospital Administration Division Dr. Eli Ginzberg (fig. 50), an economist and statistician, then assigned to the Control Division, Army Service Forces. Dr. Ginzberg had previously written reports critical of Army hospital administration, and his appointment was in part an attempt to draw the fangs of the Control Division, Army Service Forces.27 Both appointments brought into
27Voorhees, Tracy S.: Recollections of My Work for The Surgeon General, October 1945. Voorhees' personal file.
the office men who had been recently working in the field of Army hospital administration and, in the case of Dr. Ginzberg, a civilian with experience in making the type of statistical estimate of future needs on which Army Service Forces headquarters placed great reliance.
Within the Hospital Administration Division the Liaison Branch was established (chart 9) in recognition of the need for closer liaison with certain elements of War Department organization in order to maintain more effective control within the Surgeon General's Office over the provision of hospitalization for three classes of individuals other than the soldier stationed at a regular Army camp. These special groups were the members of the Women's Army Corps, prisoners of war, and troops passing through staging areas or ports. This branch put liaison officers on duty with the Women's Army Corps head-quarters, the Office of the Provost Marshal General, and the Office of the Chief of Transportation to handle problems connected with these three classes.
The assignment of a liaison officer to the Office of the Chief of Transportation was the most important of the three, since the Transportation Corps controlled Army hospitals at ports; medical duties at ports were increasing
with the transfer of more and more troops overseas and the return of patients to the United States. In April 1943 General Magee had noted the need of some element in his Operations Service to insure the adoption of, and adherence to, uniform medical policies at the scattered port installations maintained by the Transportation Corps and had emphasized the importance of port surgeons' dealing directly with his office on technical medical matters. Representatives of his office, the Office of the Chief of Transportation, and the Hospitalization and Evacuation Section, had concurred in his ideas and it was decided to assign a medical officer as liaison officer with the Office of the Chief of Transportation. An officer who had been working on sea evacuation in the Hospitalization and Evacuation Section, Army Service Forces, was given this assignment. At this date the task was conceived of as largely that of coordinating the movements of hospital trains operated by the Transportation Corps in the United States and giving technical supervision to the medical service afforded at ports and staging areas. The work done by the Liaison Branch, Surgeon General's Office, and the officer assigned to the Office of the Chief of Transportation eventually came to include most of the activities in connection with the evacuation of the wounded from overseas formerly carried on by the Hospitalization and Evacuation Section, Army Service Forces. The new setup provided effective machinery for planning large-scale evacuation of patients from the theaters of operations to United States ports by ship and from ports to general hospitals by train.28
Supply Service.-Extensive changes were made in the Supply Service, both in personnel and in internal organization. The Committee to Study the Medical Department had advocated the appointment of men with training in industry (instead of doctors) to key positions in the Supply Service (as well as in the procurement offices and depots). Mr. (later Brig. Gen., MAC) Edward Reynolds (fig. 51), who had come into the office from industry as a special assistant to the chief of the Supply Service, was now made acting chief. About a year later he was made chief and served in that capacity until the end of the war. Civilians with extensive managerial experience in industry were also placed in two other important positions in the Supply Service. Before the end of 1943 the services of Mr. Charles Harris, who had had responsible experience, in warehousing operations with large industrial concerns, were obtained for the Supply Service by the Director of the Control Division and Under Secretary of War Patterson. Mr. Harris was made deputy chief of the service and given direct responsibility for operating the medical supply
28(1) Memorandum, Maj. Gen. LeRoy Lutes, for The Surgeon General, 18 May 1943, subject: Coordinated Medical Service for Ports of Embarkation. (2) History, Medical Liaison Office to the Office of Chief of Transportation and Medical Regulating Service, Surgeon General's Office. [Official record.] (3) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, part IV.
depots. The services of Mr. H. C. Hangen (fig. 52), who had worked temporarily with the Supply Service in solving stock control problems in 1942, had been reenlisted early in 1943, also through the instrumentality of the director of the Control Division and the Under Secretary of War. Mr. Harris and Mr. Hangen accompanied the director of the Control Division on oversea missions in 1944 to deal with problems of medical supply in the theaters of operations.29
The Supply Service, under fire throughout most of 1942, had had to expand greatly to meet the demands for medical supplies and equipment confronting it. By April 1943, it consisted of 7 divisions with 27 branches. By the beginning of June its personnel amounted to 114 officers and 524 civilians, far more than that of any other of the services in the office. An examination of chart 9 shows that by 10 July the number of divisions was reduced to 5 and the number of branches to 16. While not all this reduction was clear gain (since some functions had to be transferred to other segments of the office),
29(1) Office Order No. 92, Office of The Surgeon General, 1 May 1944. (2) See footnote 27, p. 208. (3) Director, Control Division, Office of The Surgeon General, Report as to Depot Operations, 6 May 1944.
by late August the personnel of the Supply Service was reduced to 83 officers and 452 civilians.30
Additional reductions in the numbers of officers assigned to supply duties in the Surgeon General's Office were brought about by shifts of various supply functions from Washington to New York, N.Y., although in the case of some transfers it was necessary to leave liaison elements in Washington. In September, direct supervision of all Medical Department procurement of supplies and equipment was centered in the New York procurement office, newly named the Army Medical Purchasing Office; the separate St. Louis procurement district was abolished. Branch offices were established in both St. Louis and Chicago, but from the fall of 1943 to the end of the war the buying of medical supplies and equipment remained concentrated in New York. On the recommendation of, Colonel Voorhees and Mr. Reynolds, the greater portion of stock control activities were also moved to New York and Mr. Hangen was put in
30Memorandum, Acting Director, Control Division, Office of The Surgeon General, for Director, Control Division, Army Service Forces, 23 Aug. 1943.
charge. Other work connected with procurement, such as legal work on renegotiation and termination of contracts, was transferred to Now York during 1944 and 1945.
The process of adjusting the organization and procedures of the Supply Service, Surgeon General's Office, to conform with the operations of Headquarters, Army Service Forces, continued. At the request of the latter, new units were formed to make inspections of medical supply and to report on progress in procurement and distribution. An important development in the field of medical supply was the creation of a board to make plans for medical and sanitary supplies for civilian use in occupied territories. During the early months of 1943, the Public Health Officer of the Civil Affairs Division of the War Department Special Staff and the International Division, Army Service Forces, had held conferences with the staff of the Surgeon General's Office on this matter, and before the end of June, General Kirk had appointed a Civil Affairs Division Board to engage in planning in this field.31
Professional Service.-The early months of General Kirk's administration witnessed continued expansion of the Professional Service (still headed by Brig. Gen. Charles C. Hillman) and the network of consultants who prepared technical instructions on medical matters for issue by the office. The elaboration of the Surgical Branch into a division with Surgery, Radiation, and Physical Therapy Branches and the establishment of a Reconditioning Division (with branches as shown on chart 9) were the chief developments. An Army-wide program for reconditioning convalescent soldiers had been inaugurated by the Surgeon General's Office early in 1943, and by April the program was theoretically underway in hospitals. Only a few hospitals had developed good programs, however, and plans for reconditioning took substance only after the new division began to assume direction of the total program in August. The Reconditioning Division was strengthened by the addition of personnel, including civilian women trained in occupational therapy, late in 1943 and in 1944. Further impetus was given the program in March 1944 when, after a conference held by the Chief of Staff, Army Service Forces (General Styer), Army Service Forces headquarters ordered the service commanders to establish a reconditioning branch in the offices of surgeons at their headquarters and authorized personnel to staff them. At the same date, reconditioning programs and personnel were authorized for all hospitals controlled by the Army Service Forces.
Planning undertaken by the Reconditioning Division, Surgeon General's Office, was affected by various shifts of policy. Throughout 1943 and 1944 the scope of the Army's responsibilities toward convalescent soldiers was much bruited; not until the end of the latter year did policy in this field crystallize.
31(1) Memorandum, Headquarters, Army Service Forces, for The Surgeon General, 9 Aug. 1943, subject: Inspection Manual. (2) Medical Department, United States Army. Preventive Medicine in World War II. Volume VIII. Civil Public Health Problems and Activities, pt. III. [In preparation.]
The reconditioning program was one to which the General Staff and Army Service Forces headquarters, as well as the President and other highly placed Government officials-all sensitive to the public's growing interest in convalescent veterans-paid continued attention. The reconditioning of patients for return to military duties and the rehabilitation of those incapable of further duty for return to work in civilian life were usually conceived of as two distinct tasks, the Army to be responsible for the former and the Veterans' Administration for the latter. Early planning was done with this principle in mind. For several reasons this neat distinction was not adhered to, and the difference between so-called "reconditioning" and "rehabilitation" came to be largely one of emphasis. In the first place, the Army was responsible for giving its wounded all possible benefit of medical treatment before it discharged them. In some cases training aimed at rehabilitation could profitably be given to men who had not yet received full medical treatment; the giving of vocational training at as early a stage as possible was a good morale builder. More over, the Veterans Administration was not yet staffed or equipped to undertake a full program of rehabilitation, and the Army was obliged to assume responsibility. The final policy established by President Roosevelt and his advisers, including the Secretary of War, took the trend of placing rather full responsibility upon the Army Medical Department. In December 1944 the broadening of the Army's program for convalescents was clinched by a letter from President Roosevelt to Secretary Stimson. The President decided that before discharge all oversea casualties should receive from the Army the benefit of "physical and psychological rehabilitation, vocational guidance, prevocational. training and resocialization." Consequently the Medical Department developed a fairly extensive program for convalescent soldiers, including special programs for the blind and deaf.32
Reorganization During 1944 and 1945
Other than new organizational units established to handle new functions, the principal changes made in the organization of the Surgeon's Office by the new administration in the fall of 1943, as outlined above, were aimed at achieving more economical operation of the fiscal, personnel, and supply activities of the office-fields of administration which Army Service Forces headquarters had especially emphasized. The changes of 1944 followed a similar pattern, bringing additional activities to ether under the Operations Service and freeing the Professional Service of certain activities of an administrative character. Although developments were piecemeal, the changes may be grouped for the sake of convenience into two major reorganizations, one in February 1944 and the other in August of that year.
32(1) Letter, President Roosevelt, to Secretary Stimson, 4 Dec. 1944. (2) Annual Reports, Reconditioning Division, Office of The Surgeon General, fiscal years 1944, 1945. (3) Medical Department, United States Army. Reconditioning in World War II. [In preparation.]
Reorganization of February 1944
The reorganization of early 1944 (chart 10) embodied a number of features advocated in a survey of the Surgeon General's Office made by the new Director of the Control Division, who took into account the opinions of senior staff officers. In this reorganization the Preventive Medicine Service was separated once more from the Professional Service. The task of keeping tab on the manifold activities of the Professional and the Preventive Medicine Services was made easier by the appointment of deputy chiefs and assistants to aid the heads of these two services. The Deputy Chief of the Preventive Medicine Service, for instance, acted as Director of the U.S.A. Typhus Commission, relieving his chief of responsibility for this part of the preventive medicine program. General Simmons, besides supervising the Preventive Medicine Serviced had to direct the work of the Army Epidemiological Board, which, through its commissions located at universities and philanthropic foundations, investigated many epidemic diseases.33
Professional Service.-The rise of the Neuropsychiatry Branch to divisional status, the major change in the Professional. Service at this date, marked the increase in neuropsychiatric problems facing the Medical Department as a result of increasing numbers of troops in combat areas. Late in 1943 on the death of Colonel Halloran, Lt. Col. (later Brig. Gen) William C. Menninger, MC (fig. 53), formerly medical director of the Menninger Psychiatric Hospital at Topeka, Kans., and more recently a neuropsychiatric consultant in the Fourth Service Command, came into the office as Chief Neuropsychiatric Consultant and head of the new division, remaining in that capacity till the end of the war.34
The Surgery Division of the Professional Service was elaborated by the addition of three new branches, Orthopedic, Transfusion, and Chemical Warfare. To the Reconditioning Division, a Blind and Deaf Rehabilitation Branch was added in order to handle special problems related to these two types of war casualties. The Chief of the Professional Service continued to direct the work of the technical elements of the Surgeon General's Office. These were headed by consultants who now represented the following fields: Aviation medicine, internal medicine, surgery, neuropsychiatry, reconditioning, dentistry, veterinary medicine, and tuberculosis.
Preventive Medicine Service.-In the reestablished Preventive Medicine Service, in which branches were once more raised to the status of divisions, some new divisions appeared. These were: the Tropical Disease Control Divi-
33(1) Memorandum, Director, Control Division, for The Surgeon General, 13 Jan. 1944, subject: Proposal for Overall Plans for Most Effective Utilization of Officer Allotment, Civilian Personnel, and Space in The Surgeon General's Office for Modifications in the Present Organization. (2) Office Order No. 4, Office of The Surgeon General, 1 Jan. 1944.
34Annual Report, Neuropsychiatric Division, Office of The Surgeon General, for fiscal year 1944.
Chart 10.-Office of The Surgeon General, 3 February 1944
sion, which had functioned as a branch of the Preventive Medicine Division in 1943; the Nutrition Division, which had functioned as a branch within the Professional Service; and the Civil Public Health Division, newly created.
Officers in the Tropical Disease Control Division worked during the latter war years to strengthen the machinery for malaria control overseas. Until mid-1943 the task had been one of demonstrating to theater commands the value of the malaria control and survey units which the Surgeon General's Office had designed and recommended for theater use. By the date when General Kirk took office, the malaria control organization had proved itself overseas, and the Tropical Disease Control Division concentrated on the task of estimating the numbers of malariologists and units that would be needed at future dates, improving the training of these units and reinforcing the responsibility of unit commanders for malaria control. Higher officials of the War Department were now more active than previously in warning oversea com-manders of the dangers of tropical disease to the success of campaigns. In July 1943, the Chief of Staff warned General Eisenhower in North Africa of the menace which malaria posed to troops in that region, stating: "Most confidentially we have had grave difficulties in the Pacific and a considerable
number of divisions are temporarily out of action as a result, two of them for more than six months."35
The work of the Tropical Disease Control Division was effectively supplemented by the efforts of a number of agencies. Toward the close of 1943, Army medical officers and other doctors with the U.S.A. Typhus Commission and the Rockefeller Foundation had dramatically demonstrated in Naples the value of the newly developed DDT in preventing the spread of typhus. This insecticide proved a valuable agent in control of several tropical diseases, and upon recommendations by The Surgeon General and the Director of the Office of Scientific Research and Development for production of DDT in large quantities, the Army Service Forces directed the creation of the DDT Committee. The appearance of bubonic plague among the populations of northern Africa-particularly at Dakar, where an epidemic broke out among civilians in midsummer of 1944-pointed to the need for special effort to control rodents. Accordingly, an Army Committee on Insect and Rodent Control superseded the DDT Committee in November 1944. Besides representatives of the Army (Office of the Director of Materiel, Army Service Forces, several technical services, and the offices of the Ground and Air Surgeons), it included officials of a few other interested agencies of the Federal Government. To the end of the wax this committee worked on research problems in control of both insects and rodents, the training of personnel in control, and the preparation of manuals outlining methods.36
The establishment of the Civil Public Health Division marked the first time that full machinery was set up in the Surgeon General's Office to undertake large-scale medical work among civilians in the occupied countries. Since mid-1940 the office had done some planning in that field and had prepared courses of training in public health work at schools of military government which the Army maintained at various universities, but in the intervening years chief responsibility had rested with a Sanitary Corps officer, Col. Ira V. Hiscock, assigned first to the Office of the Provost Marshal General and later to the Civil Affairs Division of the War Department Special Staff. As early as May 1943, when the problem was sharply posed by the final conquest of North Africa, Colonel Hiscock had insisted that machinery would have to be set up to insure the medical and sanitary supplies necessary to an effective public health program overseas, and General Kirk had appointed a board of officers to implement such a program. In November 1943, the President himself urged the importance of planning relief work for civilians in occupied countries. The Civil Public Health Division set up in the Surgeon General's
35Letter, General Marshall, to General Eisenhower, Allied Force Headquarters, Algiers, 13 July 1943.
36(1) Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, pp. 251-269. (2) Office of the Chief of Military History : Historical Report of Services of Supply Troops in Dakar, July 1944. [Official record.] (3) War Department Memorandum No. 40-44, 8 Nov. 1944. (4) War Department Circular No. 163, 4 June 1945.
Office on 1 January 1944, and transferred to the Preventive Medicine Service by the February reorganization, was a logical followup. At the same time a Civil Affairs Branch was established in the Special Planning Division of the Operations Service, with functions that included estimating requirements and developing medical supply kits for various purposes.37
The Civil Public Health Division was headed by Col. Thomas B. Turner, MC (fig. 54), Professor of Bacteriology at The Johns Hopkins University. Colonel Turner was made Director of the new Civil Public Health Division in the Preventive Medicine Service, Surgeon General's Office. He spent the early months of 1944 in the Mediterranean and European theaters reviewing the Army's setup for public health programs for populations of the colonies and countries of North Africa and Europe. From then on responsibility for planning public health work in the occupied areas was concentrated in the Surgeon General's Office. The Civil Public Health Division shared its responsibilities with other parts of the office, for the nature of the program made it necessary to get advice and aid from specialists in other fields as well as from members of the Personnel and Supply Services.38
37(1) Office Order No. 419, Office of The Surgeon General, 28 June 1943. (2) Letter, President Roosevelt, to Secretary Stimson, 12 Nov. 1943. (3) Daily Diary, Civil Affairs Branch, Office of The Surgeon General, 5 Feb. 1944-30 Sept. 1944.
38Medical Department, United States Army. Preventive Medicine in World War II. Volume VIII. Civil Public Health Problems and Activities, pt. III. [In preparation.]
Operations Service.-The emphasis upon the Operations Service, which characterized General Kirk's administration, continued with the reorganization of February 1944. The reorganized Operations Service had a chief, Brig. Gen. Raymond W. Bliss, and two deputies. The divisions of the Operations Service were placed directly under the two deputies, except for the Training Division, which reported directly to the chief. The Deputy Chief for Plans and Operations, Col. Arthur B. Welsh, MC, was responsible for providing hospitals for the oversea, theaters. All three divisions under Colonel Welsh developed from former branches. The Mobilization and Overseas Operations Division, of which Colonel Welsh himself acted as head, coordinated the planning for field operations, working closely with two higher elements of the War Department, the Planning Division of Army Service Forces headquarters and the Operations Division of the War Department General Staff. The Special Planning Division of the Operations Service coordinated Medical Department activities in two fields-demobilization and supply for the public health program in occupied areas-which demanded the cooperation of several divisions. The third division supervised by the Deputy Chief for Plans and Operations was the Technical Division; it coordinated all steps involved in the development, modification, and classification of items of Medical Department supplies and equipment, determined the amounts, types, and schedules of issue to units and installations, and prepared and reviewed tables of organization and equipment, Medical Department equipment lists, and tables of basic allowances.
All functions having to do with hospitalization and evacuation within the United States were placed under the Deputy Chief for Hospitals and Domestic Operations, Colonel Schwichtenberg, who also acted as chief of the lone division under his direction, the Hospital Division. The Facilities Utilization Branch of this division-headed by Dr. Eli Ginzberg, who had been brought into the division early in. the year-was of special importance to long-range planning for hospitalization in the United States. It investigated ways of making more efficient use of hospital facilities and personnel and hence was in accord with the thinking of Headquarters, Army Service Forces, which consistently sponsored long-range studies aimed at achieving more effective use of the personnel and facilities of all the technical services. The new branch, for example, made studies on the number of evacuees to be expected from overseas, on an integrated plan for hospitalization in the United States irrespective of command channels. The scope of its work was later expanded to a more comprehensive one of appraising the current and prospective mission of the Medical Department.
Medical Regulating Unit.-Of the four liaison units under the direction, of the Deputy Chief for Hospitals and Domestic Operations, the most important was the one in the Office of the Chief of Transportation, which was enlarged in May 1944 into the Medical Regulating Unit. In anticipation of the return of heavier loads of wounded from overseas, it was vital to maintain
in a single office all records of bed vacancies in the general hospitals in the United States and regulate the transfers of patients to them. Hence the Evacuation Branch of the Hospitalization Division, Surgeon General's Office, which had had control over the allocation of beds, was transferred to the new Medical Regulating Unit. Located within the Office of the Chief of Transportation, but under the direction of the Deputy Chief for Hospitals and Domestic Operations, Surgeon General's Office, the Medical Regulating Unit became the nerve center for the distribution of patients from overseas to the general and convalescent hospitals. Its personnel worked closely with a medical regulating officer in the Air Surgeon's Office, with service command surgeons, port surgeons, and hospital surgeons. The orderly transfer of patients from ports to hospitals called for the amassing and transmission of much data-on capacities of hospital ships and trains, and of transports and planes used in evacuation, on numbers of patients arriving on specific dates, as well as on the numbers of beds available in the general hospitals. The existence of the Medical Regulating Unit and its authority to deal directly with the surgeons of the various commands concerned with the return of patients from overseas made it possible to carry out transfers of patients more speedily and efficiently than would have been the case if command decisions had had to be obtained at each step.39
The emphasis placed upon coordinating a number of activities under the label of "operations" led to an increase in the number of officers assigned to the Operations Service. Of 321 Medical Department officers serving with the office in early September 1944, 76 were allotted to the Operations Service, whereas the large Preventive Medicine Service and elements of the Supply Service in Washington had only about 50 each.40
Control of assignments.-The effort to achieve more centralized control over assignment of Medical Department personnel continued. Success in the efforts to improve the Army's hospital system depended ultimately, The Surgeon General argued, upon the power to place in any key position the man with the most suitable medical training and experience. Control over assignments of Medical Department personnel, except those assigned to the Surgeon General's Office and to installations under command control of The Surgeon General, was exercised by the commanders of service commands, defense com-mands, oversea theaters, and other commands. The debate between higher War Department authority and The Surgeon General over the latter's degree of control over assignments continued throughout 1943 and 1944. General Kirk's efforts resulted only in limited gains in centralized control over the assignments of certain specialized personnel within the Army Service Forces chain of command.
39(1) Army Service Forces Circular No. 147, 19 May 1944. (2) History of Medical Liaison Office to the Office of the Chief of Transportation and Medical Regulating Service, Office of The Surgeon General. [Official record.]
40Office Order No. 186, Office of The Surgeon General, 7 Sept. 1944. A number of elements of the Supply Service were in New York by this date.
Personnel Service.-The Director of the Control Division (Colonel Voorhees) emphasized the development of a more effective Personnel Service as a key to more centralized control by The Surgeon General over all Medical Department personnel. He stated that many officers at Headquarters, Army Service Forces, as well as senior officers in the Office of The Surgeon General, lacked confidence in the Personnel Service's records on the assignments of specialists and that Army Service Forces officials doubted that the Surgeon General's Office had prepared adequate plans for more effective use of Medical Department personnel. They considered assignments by the Personnel Service without recourse to other services in the Surgeon General's Office inadvisable. Colonel Voorhees concluded that more general confidence in the working of the Personnel Service was an indispensable preliminary to the success of The Surgeon General's efforts to obtain more thorough control over the assignments. Consequently late in 1943 several steps were taken to strengthen the Personnel Service. A branch was set up in the office of the chief to work for a more effective use of personnel in the Office of The Surgeon General and in-the field installations. A Personnel Planning and Placement Branch was created to do long-range planning on the placement of key military personnel. Finally, three branches-the Army Nurse, Hospital Dietitian, and Physical Therapy Aide Branches-were added to the Military Personnel Division to handle matters related to the procurement and use of personnel in the three chief professional fields in which women were used.41
Supply Service.-In midsummer another reorganization of the Supply Service took place. At that time two deputy chiefs were assigned to the Supply Service, one for storage operations and the other for supply control. The latter had the task of coordinating the work of the Supply Service in Washington with the activities of the Army Medical Purchasing Office in New York. In accordance with the long-range trend toward shifting medical supply functions to New York, the Renegotiation Division was transferred to the New York office, only a liaison unit remaining in Washington. Elements of the Supply Service remaining in Washington had now declined considerably in size; before the close of 1944 the large New York office had a staff of 182 officers and 547 civilian employees.42
Historical Division.-The year 1944 witnessed the expansion of the Medical Department's historical program, which had been deliberately restricted in scope to avoid duplicating work projected by the National Research Council. The Council's Division of Medical Sciences had undertaken an ambitious plan for producing a history of wartime medicine in the United States, which would include the more technical or "clinical" aspects of the Medical Department's wartime work. In 1944, however, responsibility for writing the history of all the Medical Department's wartime experience, "administrative" and "clinical,"
41See footnote 33 (1), p. 215.
42Yates, Richard E. : The Procurement and Distribution of Medical Supplies in the Zone of Interior During World War II (1946), p. 63.[Official record.]
was shifted to the Historical Division of the Surgeon General's Office. By that date War Department officers directing the historical program, including some Medical Department officers, had concluded that the Medical Department's history should conform to the Government-wide historical program committing each agency to produce its own history.43
Reorganization of August 1944 and later developments
The second major reorganization of the Surgeon's General's Office in 1944 had taken place, for the most part, by August (chart 11). It stemmed in large measure from proposals made by Colonel Voorhees, Chief of the Control Division, who felt that since some of the changes made as a result of the Wadhams Committee investigation had proved unsatisfactory, The Surgeon General need no longer be bound by the committee's recommendations. Colonel Voorhees proposed the appointment of an assistant surgeon general (in addition to the deputy surgeon general already functioning); the placing of the Military and Civilian Personnel Divisions directly under the Administrative Service instead of maintaining a separate Personnel Service; and the separation of the advisory functions of the heterogeneous, unwieldy Professional Service from its variety of operating functions. Only the first proposal went into effect without modification, the Chief of the Operations Service being given the additional title of Assistant Surgeon General, with power to act for The Surgeon General in all internal affairs of the Surgeon General's Office.44
The second and third proposals met with objections from the Control Division, Army Service Forces. Colonel Voorhees had advocated the abolition of the Personnel Service and the removal of the Military and Civilian Personnel Divisions to the Administrative Service on the ground that their work should be limited to issuing assignment orders and keeping personnel records. The Army Service Forces, however, refused to make an exception to its fixed policy for combination of military and civilian personnel activities within each technical service under a single head. The Personnel Service remained an entity, but a stipulation that it might make assignments of key personnel only with the concurrence of the service or division concerned with, or having special knowledge of, the qualifications of the officer proposed for the assignment (as well as of the special requirements of the job) limited its power over assignments.
The third proposal, for separation of the advisory and operating functions of the Professional Service, called for a thoroughgoing breakup of that service. Since the Control Division, Army Service Forces, objected to this on the
43(1) Love, Albert G. : The Historical Division, 1 Aug. 1941-28 July 1945. [Official record.] (2) Fulton, J. F.: Prospectus of a Medical History of the War, 1941 to 19--. War Med. 2: 847- 859, September 1942. (3) A New Approach to the Medical History of World War II. Bull. U.S. Army M. Dept. 77: 67-72, June 1944.
44Memorandum, Tracy S. Voorhees and Eli Ginzberg, for The Surgeon General, 17 Aug. 1944, and inclosure 1, subject : Proposal for Changes in Office Organization of the Surgeon General's Office, 19 June 1944 (draft No. 2).
Chart 11.- Office of The Surgeon General, 24 August 1944
ground that the report of the Committee to Study the Medical Department had advocated maintaining it as a separate service, a compromise was adopted. Both the Professional and Administrative Services were dissolved, and a more clear-cut distinction was made between professional and administrative duties. The Professional Administrative Service was set up to embody the three divisions shown on chart 11. From the old Professional Service were formed four divisions embracing the work of major groups of consultants: Medical Consultants, Surgical Consultants, Neuropsychiatric Consultants, and Reconditioning Consultants Divisions. These and the Dental and Veterinary Divisions were all advisory in function and were made staff divisions. In General Kirk's opinion the elimination of the Chief of Professional Service would make possible a closer integration of the professional consultants with the Hospital Division and consequently more effective application of the expert technical knowledge of consultants to treatment of all hospital patients, especially battle casualties.45
This change was directly contrary to General Somervell's theory that the number of officers reporting to a superior should be strictly limited. A glance at the chart shows that in addition to these six professional advisory divisions, six other divisions, as well as the Ave services, were at top level. On the other
45Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 8 Aug. 1944, subject: Visits to Field Installations.
hand, The Surgeon General now had in his immediate office both a deputy and an assistant to aid him in dealing with all these elements.46
The major elements of the Surgeon General's Office-that is, of division level or above-remained unchanged between August 1944 and the end of the war. In October the Resources and Analysis Division (the former Facilities Utilization Branch of the Hospital Division) was established. Headed by Eli Ginzberg, who reported directly to the chief of the Operations Service, this division engaged in personnel planning on a broad scale and planning for the most effective use of Medical Department facilities. Its predecessor, the Facilities Utilization Branch of the Hospital Division, had been limited to planning the use of domestic resources; the new division kept records on the distribution of Medical Department personnel and evaluated the current and prospective programs of the Medical Department in major commands both in the United States and overseas. It also undertook some planning of the internal organization of the Surgeon General's Office and worked out certain recommendations for the internal organization of a theater surgeon's office. The latter had formerly been a matter for decision by the theater surgeon and the theater command, and the Surgeon General's Office had not engaged in much planning in that field. During 1944, as well as in early 1945, theater surgeons and Medical Department officers returning from theater assignments or special missions had stressed the lack of centralized control of medical service from a high level and inadequate staffing of theater surgeons' offices. From early 1945 on, the Surgeon General's Office made special efforts to enlarge the staffs of theater and Services of Supply surgeons overseas with the best personnel available.47
Even the end of the war led to no immediate major changes in the structure of the Surgeon General's Office. With the reduction in size of the Army, retrenchment in the Operations Service, particularly in training activities, was in order. The gradual consolidation of organizational elements of the Surgeon General's Office, urged by Army Service Forces headquarters from and after September 1945, to suit its mission in the expected years of peace, took place in the postwar years.
Responsibility for medical defense against special methods of warfare
No formal organizational element was ever officially set up in the Surgeon General's Office in the course of the war with major responsibility for either of two special fields of military medicine, chemical warfare and biological (or bacteriological) warfare medicine. Both were nevertheless regarded as functions of military preventive medicine, and the Preventive Medicine Service was
46(1) Office Order No. 175, Office of The Surgeon General, 25 Aug. 1944. (2) Annual Report of the Control Division, Office of The Surgeon General, for fiscal year 1945.
47(1) Weekly Diary of Resources Analysis Division for week ending 2 June 1945, (2) Letter, Eli Ginzberg, to Col. Calvin H. Goddard, MC, Editor-in-Chief, History of the Medical Department, U.S. Army in World War II, 5 Nov. 1951, and inclosure. See also the chapters of this volume dealing with the oversea theaters.
concerned with studies of chemical and biological warfare, and with prepara-tions for combating them, throughout the war. Since the use of poisonous gases or germ-disseminating agents by the enemy was a potential threat to the civilian population of the United States, primary responsibility for inquiry into methods of defense against them rested during the early war years with special agencies set up for the purpose outside military channels. However, when concern over potential use of these agents by the enemy increased late in 1943 and early 1944-spurred on in the case of biological warfare by reports from the Office of Strategic Services that the Germans were planning to conduct germ warfare-the War Department assumed a more active role in these two fields. Although the Medical Department consistently refrained from participation in the offensive aspects of gas and germ warfare, Medical Department officers participated in most of the defensive aspects-research, development of ways and means of protection, training, procurement of items used in prevention, and treatment of casualties.
Chemical warfare.-Until mid-July 1943, medical research on chemical warfare medicine had been carried out by a group at Edgewood Arsenal, Md., a field installation of the Chemical Warfare Service. Outside the War Department both the National Research Council and the Office of Scientific Research and Development conducted investigations into chemical warfare medicine. In the spring of 1943, when it appeared that a staff officer was needed in the Chemical Warfare Service to coordinate the activities of the various agencies, it was decided to establish in that service a Medical Division at staff level. General Magee and the Chief of the Chemical Warfare Service reached agreement as to the responsibilities of the new division which was created soon after General Kirk assumed office. Among its functions was the preparation of reports on methods of treating casualties caused by chemical warfare agents and the study of hazards to the health of personnel doing research on these agents or engaged in producing them. The division also prepared official War Department manuals and handbooks for the treatment of gas casualties among workers at Chemical Warfare Service arsenals and plants and among troops in the field, and developed special items and kits for treatment of such casualties. Two laboratories at Edgewood Arsenal, the Medical Research and Toxicological Laboratories, were under its direction, as were similar laboratories established at a few other Army posts in the United States.
A Chemical Warfare Branch of the Surgical Consultants Division, Office of The Surgeon General, maintained liaison with the Medical Division of the Chemical Warfare Service. The Surgeon General's Office made all contracts for procuring items and kits used in the treatment of gas casualties. During the period September 1942-April 1945, nearly 2,000 Army doctors received training in all aspects of the care of gas casualties at the Chemical Warfare School at Edgewood Arsenal. Veterinary Corps officers and laboratory workers trained in veterinary techniques made studies of the toxicologic effects of chemical warfare agents on animals and foods. They also undertook to de-
velop, protective devices for military animals and food supplies (or to improve upon old ones) and methods for their decontamination or treatment.48
Biological warfare.-Study of the potentialities of biological warfare had been informally made the responsibility of the Chemical Warfare Service in 1941 at the instance of the Secretary of War; a small unit of the agency and several civilian organizations of the Federal Government had engaged in research in this field. By 1943 the need for more direct military participation had become, apparent and the War Research Service, the civilian agency of chief responsibility had charged the Chemical Warfare Service with the military phases of the programs. Early in 1944 Secretary Stimson placed direct responsibility for preparation for biological warfare on the Chemical Warfare Service (the War Research Service was dissolved) and called for the cooperation of The Surgeon General in the defensive aspects of this type of combat.
After this date the Medical Department took a somewhat more active part in the program, although the Chemical Warfare Service had chief responsibility for both the offensive and defensive aspects of biological warfare. The chief participation by the Surgeon General's Office consisted of a Biological Warfare Committee which The Surgeon General established in the office to advise him on policy, and a Special Protection Unit in the Preventive Medicine Service to coordinate medical aspects of biological warfare, including procurement and storage of biological supplies which the Chemical Warfare Service had developed for protection of personnel against biological agents. Special protective clothing and masks, chemical decontaminating agents, chemotherapeutic agents, disinfectants, antibiologicals, vaccines, and toxoids-all these became the means of antibiological warfare which emerged from the joint effort. Many of them were the same means with adaptations, used to prevent infectious diseases occurring in nature and hence were closely kin to the preventive medicine program. As in the case of chemical warfare, some of the methods and supplies and equipment developed to protect workers at the plants and laboratories producing the means of offensive warfare were later developed into instruments of protection for the soldier in the field. Various handbooks dealing with means of defense against biological warfare were issued, and 70 Medical Department officers were trained, along with Navy medical officers and Chemical Warfare Service officers, in antibiological warfare Service at the school maintained for the purpose by the Chemical Warfare Service at Camp Detrick, Md. As for direct contribution to research findings in the field, a major contribution of the Army Medical Department was the work done by Veterinary Corps officers and veterinary technicians at Chemical Warfare Service installations doing special research on the threat of animal disease,
48(1) Cochrane, R. C.: Medical Research in Chemical Warfare (1 Mar. 1947), pp. 56ff. [Official record, Office of the Chief of Military History.] (2) Brophy, Leo P., and Fisher, George J. B.: The Chemical Warfare Service: Organizing for War. U.S. Army in World War II. Washington: U.S. Government Printing Office, 1959, pp. 34-36,104-106.
particularly rinderpest.49 As neither gas nor germ warfare was employed in World War II, despite repeated reports of its imminent use in various oversea theaters, the adequacy of the Medical Department's participation in the defen-sive program never received a sure test.
Atomic warfare.-A third field of special warfare-atomic-developed for the first time in World War II. Throughout the history of the Manhattan Project on the atomic bomb until the bomb was used in Japan, the Surgeon General's Office had no responsibility for studying or obtaining information on the medical and physiologic effects of the new weapon on the human body. In the fall of 1943 a few Medical Department officers were assigned the task of selecting and commissioning doctors to care for the health of personnel working on the secret project, but no organizational element was set up in the Surgeon General's Office to handle any phase of atomic energy medicine. A liaison officer in the Surgeon General's Office handled requests for additional personnel and requisitions for medical supplies which the Army Medical Department furnished; in the early months of 1944 about 25 Medical Department officers were on duty with the project. After the atomic bomb explosions in Japan, The Surgeon General took action to obtain all available information and to start special investigation of medical problems connected with atomic warfare.50
POSITION OF THE SURGEON GENERAL AND HIS OFFICE
WITHIN THE WAR DEPARTMENT
Relations With the Army Service Forces
During General Kirk's administration, relations between the Surgeon General's Office and elements of the Army Service Forces organization were somewhat more cordial than they had been during the previous administration. The decline and dissolution (in February 1944) of the Hospitalization and Evacuation Branch at Headquarters, Army Service Forces, removed one source of friction. The assignment of some of its medical officers to the Surgeon General's Office gave the latter a few officers with experience in the adjustment of Medical Department needs to Army Service Forces requirements.51
49(1) Report, George W. Merck, Special Consultant to the Secretary of War, 24 Oct. 1945, attached as Tab D to Final Report to U.S. Biological Warfare Committee. (2) Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 5 May 1944, subject: Progress Report on "X" Toxoid. (3) Brophy, Leo P., Miles, Wyndham D., and Cochrane, Rexmond C.: The Chemical Warfare Service: From Laboratory to Field. United States Army in World War II. Washington: U.S. Government Printing Office, 1959, pp. 101-122. (4) Statement of Brig. Gen. Stanhope Bayne-Jones, MC, USA (Ret.), to the editor, 12 Oct. 1961.
50(1) Transcript, conference of staff members, Office of The Surgeon General and Corps of Engi-neers, 21 Sept. 1943. (2) Memorandum, Executive Officer, Medical Section, Corps of Engineers, for The Surgeon General, through the Chief of Engineers, 9 Nov. 1943, subject: Procurement and Transfer of Medical Corps Officers. (3) Memorandum, The Surgeon General, for the Chief of Staff, 13 Sept. 1945, subject: Commission on the Medical Aspects of Atomic Bombing.
51(1) Letter, The Surgeon General, to Col. Roger G. Prentiss, Jr., Editor-in-Chief, History of the Medical Department, U.S. Army in World War II, and attachment, 19 Nov. 1950. (2) Army Service Forces Administrative Memorandum, No. S-85, 10 Nov. 1945.
The record for the period from June 1943 to the end of the war shows a good deal more personal contact between The Surgeon General and the Commanding General, Army Service Forces, than in the period from March 1942 to May 1943. General Kirk and General Somervell conferred frequently on the Medical Department's personnel problems and various aspects of the hospitalization and rehabilitation programs. General Somervell noted any criticisms of Army medical service that had come to his attention, and from time to time asked General Kirk to submit a list of current and anticipated problems. In early 1944, for example, he requested to be kept informed on the progress of the Surgeon General's Office in solving major problems with respect to physical standards, the Army Specialized Training Program, the assignment and control of medical personnel, and hospitalization. His list of specific tasks and problems with respect to hospitalization indicates the importance which he attached to the efficient handling of oversea, casualties: estimate of hospital requirements for the United States and oversea areas, especially the European theater; prompt removal from hospitals of personnel not in need of hospitalization; improvement in hospital administration; the possibility of moving casualties directly from ports to hospitals where they could be treated, thus bypassing the hospitals at ports; and the program for rehabilitating the sick and wounded.52
General Kirk nevertheless experienced the same handicaps in serving under the Army Service Forces instead of at the War Department Special Staff level that General Magee had complained of, and disagreements between Army Service Forces headquarters and the Surgeon General's Office over matters of policy and procedures continued to spring up. In the case of some, no solution satisfactory to both parties was ever reached. Controversies developed, for example, over the handling of medical supplies and equipment. The problems of large-scale procurement, about which many debates between Army Service Forces headquarters and the Surgeon General's Office had revolved during 1942 and early 1943, had largely been solved. But late in 1943 disagreement arose over efforts by Army Service Forces headquarters to improve the system of storing and issuing supplies handled by all the services. In the interest of greater efficiency, Army Service Forces headquarters wanted to make the Quartermaster Department responsible for storing and issuing as many items as possible in its general depots and to consolidate responsibility for the remainder, insofar as feasible, within a few of the technical services. It proposed, for instance, that the Signal Corps be responsible for some items of electrical equipment used by the Medical Department--X-ray machines, cardiographic units, and radiographic units. Under this system, the Medical
52(1) Memorandum, Chief of Staff, Army Service Forces, for The Surgeon General, 15 Jan. 1944, subject: Current and Anticipated Medical Problems. (2) Memorandum, Commanding General, Army Service Forces, for The Surgeon General, 18 Jan. 1944. (3) Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 19 Jan. 1944, subject: Current and Anticipated Army Service Forces Problems. (4) Memorandum, Chief of Staff, Army Service Forces, for The Surgeon General, 1 Mar. 1944.
Department's separate depot system would have been greatly curtailed, and the medical sections would no longer have been maintained as distinct entities in the general depots.53
The Director of the Surgeon General's Control Division, Colonel Voorhees, strongly supported by the group of experts in retail merchandising from civilian life then assigned to the Supply Service, led the opposition to this move on the part of Army Service Forces headquarters. Using the idiom of Ring Lardner, he called the attention of the Director of the Control Division, Army Service Forces, Brig. Gen. Clinton F. Robinson, to the delays and mixups in the distribution of medical supplies which would result from this "switching of the signals" by Army Service Forces headquarters. He complained to "Robbie" that "our team don't get much chanct any more to pittch or to play against the Black Sox [the Germans] or the Yellow Sox [the Japanese] because we have to keep pittchin all the time to them Big League players from the Headquarters Club what owns us, just so they can take battin practice out of us." General Robinson replied in opposing tenor but similar vein. To his way of thinking there was only one team, with the technical services constituting the infield and the outfield. The Medical Department, which he termed the "left fielder who wears skin fitting rubber gloves" (and one such player, lie said humorously, was enough), was apparently trying to set up a club of its own.54
While conflicts of this sort were similar to those that had occurred during General Magee's administration, the Surgeon General's Office now handled them somewhat differently. In the first place, General Kirk was, like General Somervell, both quick and forthright in asserting his views. Moreover, he had the aid of a small group of administrators from civil life in key positions in his office to lead the counterattack whenever he opposed policies and procedures which the Army Service Forces headquarters urged as more economical or efficient. Instead of arguments based on the necessity for control of the medical supply system by those who had had medical training, the group from industry advanced arguments based on the practicability or efficiency of the proposed changes. Not only did they have reputations as experts in manage-ment techniques; in some controversies with the Army Service Forces they were in a position to appeal to the Under Secretary of War. The possible abolition of Medical Department depots, for example, was called to the attention of Mr.
53(1) Memorandum, Col. Tracy S. Voorhees, Director, Control Division, Office of The Surgeon General, for Director, Control Division, Army Service Forces, 15 Oct. 1943, subject: Atlanta Experiment in Depot Operations. (2) Memorandum, Director of Supply, Army Service Forces, for Chiefs of Services, 9 Dec. 1943, subject: Review of Present Organizational Structure of the Army, and related documents. (3) Memorandum, Col. Tracy S. Voorhees, for Brig. Gen. C. F. Robinson, 16 Dec. 1943, subject : Distribution System Plan, etc. The medical depots, it will be recalled, were the chief type of installation under the command of The Surgeon General, and a large proportion of the personnel commanded by him were in the depots.
54(1) Letter, Col. Tracy S. Voorhees, to Brig. Gen. Clinton F. Robinson, 10 Dec. 1943. (2) Letter, Brig. Gen. Clinton F. Robinson, to Col. Tracy S. Voorhees, 16 Dec. 1943.
Patterson by Colonel Voorhees, who pointed out the embarrassment to the Under Secretary if the large system of medical depots were abolished at a time when the Under Secretary had just succeeded in persuading a reluctant company (Butler Bros.) to release its operations vice president (Mr. Charles Harris) to the Army for the purpose of managing those depots. This factor seems to have contributed to the demise of the Army Service Forces, "Distribution System Plan."55
During General Kirk's administration the installations commanded by The Surgeon General remained about the same, in type and number, as those which his predecessor had commanded after August 1942 when the general hospitals were removed from his control and put under service command jurisdiction. In March 1944, field installations under General Kirk's direct command were the Army Medical Center, including its general hospital, the schools, and laboratories; the Army Medical Museum and Army Medical Library; the Medical Field Service School at Carlisle Barracks, Pa.; three laboratories; the Army Medical Purchasing Office in New York, and its Chicago branch; and eight medical depots. The Center had as a Subsidiary activity the Biologic Products Laboratory at Lansing, Mich. The Army Medical Library had a branch at Cleveland, Ohio, while the Medical Field Service School included the Medical Department Equipment Laboratory. The three laboratories commanded by The Surgeon General (besides the installations at the Army Medical Center, in Lansing, and Carlisle Barracks) were the Army Industrial Hygiene Laboratory at The Johns Hopkins University, Baltimore, Md.; the Armored Medical Research Laboratory at Fort Knox, Ky.; and the Respiratory Diseases Commission Laboratory at Fort Bragg, N.C. The eight medical depots which he commanded were at Binghamton, N.Y., Chicago, Denver, Kansas City, Los Angeles, Louisville, St. Louis, and San Francisco. The large general hospitals, under service command control, amounted to more than 60 at the peak of their development during General Kirk's administration.
This situation underwent little modification to the end of the war except as certain of the medical depots were closed. The Surgeon General's command over installations was substantially enlarged only in April 1946 when his command control over general hospitals was restored and when all hospital centers and convalescent hospitals in the United States were transferred to his command. By this date a general contraction of the Army's hospitalization system in the United States was well underway.56
55Voorhees, Tracy S. : Recollections of My Work for The Surgeon General, October 1945. [Official record.]
56(1) Office Order No. 59, Office of The Surgeon General, 21 Mar. 1944. (2) Office Order No. 183, Office of The Surgeon General, 4 Sept. 1944. (3) Morgan, Edward J., and Wagner, Donald O.: The Organization of the Medical Department in the Zone of the Interior, ch. VII and XII. [Official record.] (4) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 281-282.
Relations With the Army Ground Forces and the Army Air Forces
Conflicts with other echelons of the War Department (or with the offices of their surgeons), stemming from The Surgeon General's position of subordination to Army Service Forces headquarters, continued. The solution of such problems as could not be resolved by agreement or compromise was attained only by War Department decision. Some opposition developed within the Army Ground Forces in July 1943 when General Kirk assigned Brig. Gen. Albert W. Kenner as his assistant to inspect the training of medical units in the ground forces. Army Ground Forces headquarters did not recognize any in-herent right by the chief of a technical service to make any type of inspection of troops or installations of the Army Ground Forces. The official War Department document which straightened out the matter provided for "visits" by representatives of chiefs of the technical services at installations of the Army Ground Forces, Army Air Forces, service commands, and defense commands in continental United States. Such visits could be made only by arrangement of the chief of the technical service with the commanding general of the major command concerned, and the visiting, representatives were to be concerned only with "technical matters."57
The difficulty over inspections appears to have been one of the very few problems to arise in connection with the medical service of the ground troops, partly because of a cooperative nature and disinterest in empire building on the part of the men who filled the position of Ground Surgeon. On the other hand, problems of relationships between The Surgeon General and the Air Surgeon's Office continued unabated. In December 1943 the Commanding General, Army Air Forces, recommended to the Chief of Staff of the Army that the Air Surgeon (Maj. Gen. David N. W. Grant) be made a member of the Federal Board of Hospitalization, an advisory agency to the Bureau of the Budget which consisted of the Surgeons General of the Army, Navy, and U.S. Public Health Service, and other officials handling large Federal hospital programs. He also wanted the Air Surgeon made his representative, with the same status as the three surgeons general, at meetings of the executive committee of the Procurement and Assignment Service of the War Manpower Commission. He based his request on the numbers of Medical Department personnel and the magnitude of the hospital program for which, he stated, he was solely responsible.58 The Surgeon General's Office opposed the suggested
57(1) Memorandum, Commanding General, Army Ground Forces, for Chief of Staff, 7 Sept. 1943, subject : Technical Inspection of Troops and Installations of the AGF and of the AAF, etc. (2) Office Order No. 480, Office of The Surgeon General, 17 July 1943. (3) Memorandum, The Surgeon General, for Commanding General, Army Ground Forces, 7 Aug. 1943, subject: Technical Inspections of Medical Troops and Installations of AGF. (4) Memorandum, Commanding General, Army Service Forces, for Chief of Staff, 27 Aug. 1943, subject: Technical Inspection of Troops and Installations of the AGF and the AAF by Representatives From the Chiefs of Technical Services of the ASF. (5) War Department Memorandum No. W265-1-43, 22 Sept. 1943.
58The Air Surgeon's figures included 239 station hospitals with a total of 75,461 beds, 146 dispensaries, and 324 infirmaries. Of the 16,000 Medical Corps officers then on duty with the Army Air Forces, the Air Surgeon stated that he had procured and assigned about 10,000.
appointments for the Air Surgeon on the ground that The Surgeon General could handle matters of hospitalization for all air and ground forces, calling upon the Air Surgeon or the Ground Surgeon for aid whenever necessary. Officers assigned to G-1, War Department General Staff, stated that The Surgeon General could represent the War Department adequately at the meetings of both these organizations and recommended that he ask the Air Surgeon to attend any meetings at which he wished his aid in discussion of problems relating to Army Air Forces medical installations. The Air Surgeon did not receive either of the appointments requested; he attended, by invitation, some of the meetings of the executive committee of the Procurement and Assignment Service.59
For The Surgeon General, a chief problem continued to be the divided responsibility for Army hospital administration in the United States, mainly as between the Army Service Forces and the Army Air Forces, The general hospitals were run by the Army Service Forces; they were under the immediate jurisdiction of the commanding generals of the service commands. The station hospitals were about equally divided between the Army Service Forces and the Army Air Forces, although those of the latter were considerably smaller on the average than those of the former. Those assigned to the Army Service Forces were directly under its various subordinate commands, while the station hospitals of the Army Air Forces were located at airbases assigned to a number of subordinate air commands. The Army Ground Forces controlled only a few hospitals, while the defense commands, which were directly subordinate to the War Department General Staff, also operated a few, mainly at the Atlantic bases which were a part of the Eastern Defense Command.
The Surgeon General could not make estimates of the requirements of men and supplies for hospitals assigned to the Army Air Forces or allocate these medical means suitably among hospitals in the United States. Difficulties increased with renewed efforts by the Air Surgeon to extend the Air Forces' sphere of control over hospitals. He made, a consistent attempt to add general hospitals, or hospitals approaching these in scope of treatment, to the hospital system of the Army Air Forces in the United States and to place hospitals under the Air Forces chain of command in the oversea theaters. The struggles between the Air Surgeon and The Surgeon General over these two problems were settled as to major points by the spring of 1944.
The effort to gain control of general hospitals, or hospitals which gave similarly definitive treatment, within the United States continued until the Air Forces medical group partially attained its ends. By placing highly specialized medical personnel in station hospitals at airbases, the Army Air Forces had made of some of its station hospitals institutions which could give
59Letter, Maj. Gen. David N. W. Grant, MC, USAF (Ret.), to Col. John Boyd Coates, Jr., MC, Director, The Historical Unit, U.S. Army Medical Service, 11 Aug. 1955, subject: Comments on preliminary draft of this volume.
treatment of the scope of that theoretically within the province of general hospitals only. Air force medical officers were in a position to refuse to send air force patients to the regular general hospitals of the Army Service Forces, since these patients could receive all necessary treatment in Army Air Forces station hospitals. A protracted struggle ensued between The Surgeon General and the Army Service Forces, on the one hand, and the Air Surgeon and the Army Air Forces, on the other. General Kirk and the commanding generals of some service commands took the view that all fixed hospitals, including the station hospitals controlled by the Army Air Forces, should be under the command control of the commanding generals of service commands. A board of officers, with experience as service command surgeons, appointed by The Surgeon General to study problems of medical administration in the service commands advocated making the commanding general of the service command responsible for all medical service (including hospitalization, evacuation, and sanitation at all fixed installations) within the service command's boundaries. Under this recommendation, which would have removed the fixed medical installations of the Army Air Forces from the chain of Army Air Forces command, The Surgeon General would have had more direct technical control of this large group of hospitals, with the service command surgeon exercising immediate technical control as he now did over the general hospitals. This recommendation for highly centralized control of medical installations in the United States on an area basis went a step beyond the Medical Department's usual position in that it positively advocated removing from Army Air Forces' supervision the station hospitals which that command had controlled since it was established in June 1941.
A report by the medical adviser, Maj. Gen. Howard McC. Snyder, of the Inspector General's Office, recognized that the Army Air Forces had succeeded in developing hospitals which could give advanced treatment and recommended that arrangements be worked out for hospitalizing patients of other arms and services, as well as of the Air Forces, in them. The upshot was that in the spring of 1944 both the Army Air Forces and the Army Service Forces were given the right to operate in the United States "regional hospitals" which would receive patients from all station hospitals (whether under command of the Army Ground Forces, the Army Air Forces, or the Army Service Forces) within a 75-mile radius.
The regional hospitals gave treatment of a type formerly given only by the general hospitals but could receive only patients from station hospitals in the United States and not oversea patients. The latter were to be sent to the general hospitals, operated exclusively by the Army Service Forces, for definitive treatment. At the same time it was stipulated that all four main types of fixed hospitals-station, convalescent (also established as a type to be operated by both Army Service Forces and Army Air Forces at this date), regional, and general-were to serve all troops on an area basis, regardless of the command to which the patient or the hospital was assigned, and a hospital was to
transfer patients to another hospital only if it could not provide the requisite medical care. The result of these arrangements was to weaken somewhat the position of The Surgeon General. The Army Air Forces had now succeeded in getting recognition of its jurisdiction over installations giving treatment of the type afforded by the general hospitals. As the Army Air Forces at one time operated 30 regional hospitals (compared with 32 operated by the Army Service Forces), giving treatment of the type formerly given only by the general hospitals, it had achieved a significant advance in establishing what the Army Service Forces termed in retrospect "a duplicating medical and hos-pital service in the United States."60
The victory of the Army Air Forces medical group had been gained once more through obtaining official War Department recognition of a fait accompli. The assignment of specialists to hospitals already under its control had given the Army Air Forces a distinct advantage. From now on those who were unwilling to allow the Army Air Forces hospitals to give definitive treatment could be accused of indifference to the effective use of specialized personnel. The addition of "regional hospitals" to Army Air Forces jurisdiction was not only a step toward autonomy of the medical service administered by the Air Surgeon but also toward the severance of the Air Forces and its medical service from the rest of the Army, a development which was completed in the postwar years pursuant to the National Security Act of 1947.61
The effort of the Army Air Forces to gain control of station hospitals at air force bases overseas was kept alive by the Air Surgeon during visits to various theaters in 1944, being given further impetus by a questionnaire which he sent in the spring to the surgeons of numbered air forces overseas. Among the rather leading questions put to each air force surgeon were the following: What percentage of bases operated by his air force were not within 50 miles of a hospital maintained by the theater services of supply; did he have any difficulty in keeping in contact with hospitalized troops of his air force; was it satisfactory that the date of releasing air force patients and the dispositions made of them (that is, their return to duty, evacuation to the United States, or other kind of discharge) should be determined by a surgeon of the service forces. In July 1944 the Air Surgeon asked for an estimate on the savings in personnel time that would result from control by the oversea, air forces of hospitals for air force patients. He received replies of varying tenor. While most air force surgeons agreed with him on the theoretical advantages of con-
60(1) Report, Army Service Forces, Logistics in World War II, 1 July 1947. (2) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 103-104, 182ff.
61(1) Millett, John D. : Organizational Problems of the Army Service Forces, 1942-1945. [Official record, Office of the Chief of Military History.] (2) See footnote 51(l), p. 229. (3) Memorandum, Chief, Hospitalization and Evacuation Section, Army Service Forces, for Executive Officer, Office of The Surgeon General, 1 June 1943, subject: Conference of Surgeons of Service Commands. (4) See footnote 60(l). (5) Transcript, Army Service Forces Conference of Commanding Generals, of Service Commands, 22-24 July 1943, Chicago, Ill. (6) Transcript, Army Service Forces Conference of Commanding Generals of Service Commands, 17-19 Feb. 1944, Dallas, Tex.
trol of hospitals overseas by the Army Air Forces, some pointed out certain factors in their own theaters which argued against it. The Army Air Forces never succeeded in getting official authorization from the War Department for such a system, but for various reasons and by various devices some air forces elements overseas succeeded in having a few hospitals assigned to them. Out of the oversea experience of the medical officers assigned to the air forces evolved the strongest argument for air force control of all types of hospitals: that in order to return the flyer to duty with all possible speed and thus make the maximum use of its highly trained personnel in combat, the Air Forces must retain continuous control of the patient throughout the days of his evacuation and hospitalization.62
Efforts to Regain Staff Position for The Surgeon General
At some indeterminate date in 1944 the War Department General Staff began to reassume some of the functions which it had turned over to the Army Service Forces in March 1942. The control of the Army Service Forces over the Surgeon General's Office was somewhat weakened as more direct contact began to take place between elements of the General Staff and the Surgeon General's Office, particularly as G-1 became increasingly concerned with the problem of worldwide allocation of Army doctors. The problem was highlighted by General Kirk himself who informed General Somervell. that he had frequently been "amazed and perplexed" by the numerous War Department agencies involved in "strategic decisions" affecting the Medical Department. He listed only the most important of these agencies, omitting-perhaps unintentionally-the Operations Division of the War Department General Staff: The Deputy Chief of Staff ; the War Department Manpower Board; the Assistant Chiefs of Staff G-1, G-3, and G-4; the Inspector General; the Director of Plans and Operations, Army Service Forces; the Military Personnel Division, Army Service Forces; the Ground Surgeon; and the Air Surgeon. He gave several examples of discussions of Medical Department problems at some of these higher level offices at which no Medical Department representative was present, and noted mistaken conclusions reached on the basis of insufficient or inaccurate information.63
An opportunity to reopen the question once more, this time at the highest level, came early in 1945 when The Surgeon General was asked by the Secretary of Wax to gage the adequacy of the medical personnel and facilities at his disposal for a prolonged war in Europe and the Pacific. General Kirk's answer stressed the problems posed for him by the coequal status of the Army
62(1) Memorandum, The Surgeon General, for the Chief of Staff, Army Service Forces, 1 Nov. 1943, subject: Hospitalization of Air Corps Battle Casualties and Casual Sick. (2) Memorandum, Col. E. C. Cutler, MC, for Col. J. C. Kimbrough, MC, 11 Sept. 1943, subject: Relationship Between Our Hospitals and the 8th Air Forces. (3) See footnote 51 (1), p. 229. (4) Letter, Maj. Gen. Norman T. Kirk, to Brig. Gen. Guy B. Denit, 28 Nov. 1944. (5) Letter, Brig. Gen. Denit to Maj. Gen. Kirk, 8 Dec. 1944. See also the chapters of this volume dealing with the oversea. theaters.
63Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 4 Oct. 1944, subject: The Determination of Policies Affecting Hospitalization and Evacuation.
Ground Forces and the Army Air Forces. Without having a position on the War Department Staff, General Kirk argued, he could not effectively supervise hospitals assigned to these two commands or to various commands scattered throughout the oversea theaters. He dwelt again on the lack of central command control at the staff level over the assignment and reassignment of highly skilled Medical Department personnel, emphasizing the difficulty of reassigning skilled officers to a command more in need of their services. In necessity for fitting skilled personnel into allotments by rank, he saw only a waste of scarce specialists and a loss of efficiency.64
The Secretary of War asked the commanding generals of the Army Service Forces, Army Ground Forces, and Army Air Forces, as well as elements of the General Staff, to comment on General Kirk's appraisal of his position. He professed himself satisfied with current Army medical service in the European theater on the basis of his observation during a recent visit there, but expressed concern over prospective heavy demands on medical service in both Europe and the Pacific. A conference was held in January of Officers representing the commanding generals of the Army Air Forces and Army Service Forces, The Surgeon General, the Air Surgeon, the War Department Manpower Board, and G-3, G-4, and the Operations Division of the War Department General Staff. At the end of January, General Bliss, acting under instructions of the conference, prepared the draft of a circular which The Surgeon General proposed for issue by the War Department in order to reestablish his position on the War Department Staff as it had existed before the War Department reorganization of March 1942. The draft emphasized the position of The Surgeon General as the chief medical adviser to the Secretary of War and the Chief of Staff, and authorized direct channels of communication between The Surgeon General, on the one hand, and the Chief of Staff, the General and Special Staffs, and major components of the Army, on the other. Numerous written comments, telephone conversations, and revisions of the draft favorable to their own positions and purposes ensued on the part of the participants. The Director of the Control Division, Surgeon General's Office, and the Assistant Surgeon General (Brig. Gen. Raymond W. Bliss) conducted the negotiations to elevate the position of The Surgeon General.65
In arguments over the wording of the circular, the Army Air Forces and the Air Surgeon's Office continued to insist that the. medical organization and hospital system within the Army Air Forces were functioning efficiently. They blamed most of The Surgeon General's difficulties upon his position within the Army Service Forces organization and the consequent necessity for clearing all his plans with the various organizational elements at Army Service Forces
64Memorandum, The Surgeon General, for the Secretary of War, 10 Jan. 1945, subject: The Medical Mission Reappraised.
65Draft for circular marked as submitted to the Chief of Staff (through Commanding General, Army Service Forces), 29 Jan. 1945. There are numerous other drafts in the files of the various agencies represented.
headquarters; that is, with the latter's various staff directors of plans and operations, of supply, of materiel, and so forth. In their opinion a small group of qualified medical officers, representing the three major commands equally, headed by an "assistant chief of staff for medical services of the Army," and located on the War Department General Staff, should direct Army-wide medical service. The commanding general of each of the three major commands and of each theater, who should be responsible for the organization and operation of the medical service of his particular command, should have a senior medical officer on his staff to advise him on medical matters and exercise technical control over the medical service within the command. The Surgeon General agreed with the Army Air Forces and the Office of the Air Surgeon as to the desirability of having a Surgeon General located at the general staff level. However, neither the General Staff nor Army Service Forces headquarters was willing at that date to revise substantially the War Department structure established in March 1942. The Army Service Forces organization was particularly averse to being bypassed by granting The Surgeon General the right of direct access to the General Staff.
Nevertheless, participants in the January conference had agreed that The Surgeon General should be recognized as staff adviser to the War Department and that direct communication should be authorized between The Surgeon General and higher War Department authority on health matters of Army-wide scope. Additional strength accrued to The Surgeon General's position in that the Secretary of War had asked for his views and indicated from the outset that he intended to give them serious consideration. Moreover, various elements of the Medical Department had succeeded by this date in popularizing to some extent their dissatisfaction with the position of The Surgeon General within the War Department. The Director of the Control Division of the Surgeon General's Office called attention to the "unmistakably rising tide of criticism of the present unsound position of the Medical Department in the Army" appearing in the popular press and the medical journals.66
War Department Circular No. 120 was finally issued on 18 April 1945. It announced that The Surgeon General was the chief medical officer of the Army and the chief medical adviser to the Chief of Staff and the War Department. He was to make recommendations to the Chief of Staff and the General and Special Staffs on matters pertaining to the health of the Army, prepare for publication War Department directives on general policies and technical procedures on health matters of Army-wide application, exercise technical staff supervision to assure the maximum use of available medical resources, and make technical inspections relative to matters pertaining to health of the Army. All plans and policies of medical import with Army-wide application were to be cleared with The Surgeon General. Communications on plans and poli-
66(1) Memorandum, Director, Control Division, for Col. John R. Hall, 4 Feb. 1945, and attached documents. (2) Davis, L.: Organization of the Red Army Medical Corps. Surg., Gynec. & Obst. 79: 329-332, September 1944. (3) Remarks, Rep. Frances P. Bolton (R., Ohio), 12 Dec. 1944. Cong. Rec., 78th Cong., 2d sess., pp. 9422-9425.
cies were to be addressed to the Chief of Staff or to The, Surgeon General and were to be sent through the Commanding General, Army Service Forces, who was to forward them with appropriate recommendations with the least possible delay. Direct communication among The Surgeon General, the War Department, and the three major commands on routine medical matters was authorized. Nevertheless, the fact that The Surgeon General was under the command of the Commanding General, Army Service Forces, was reaffirmed, and the commanding generals of the major forces, commands, departments, or theaters were to be held responsible for the internal organization and the efficient operation of the medical service of their respective commands.
The wording of the circular followed a draft proposed by G-1 and was a document of compromise. It contained an essential contradiction in that the organizational subordination of The Surgeon General to the Commanding General, Army Service Forces, was maintained, while it authorized direct communication between The Surgeon General and commands coordinate with the Army Service Forces or higher. At the same time the limitation of this direct communication to "routine medical matters" seemed to weaken its force. Shortly before it was issued, the Secretary of War issued the following, statement: "I consider that the care of the sick and wounded and the character of the hospitalization in the Army are matters for the direct responsibility of the Secretary of War; also that The Surgeon General should be his principal adviser in regard to these vital matters. To that end I wish it clearly understood that I am to have direct access to him and he to me on such matters whenever either of us deems it to be essential." The letter seems to represent a recognition of the essential weakness of the circular and at the same time the Secretary's determination to make clear his personal sympathy with the attitude of The Surgeon General. In October 1945 the new Secretary of War, Robert P. Patterson, assigned Colonel Voorhees to his office to aid him in "carrying out the responsibilities of the Secretary of War as outlined in his memorandum dated 6 April 1945, with reference to the care of the sick and wounded and the character of the hospitalization in the Army and matters relating thereto." Mr. Voorhees, who later became Assistant Secretary of War, acted as the Secretary's adviser on matters of administration of the Army Medical Department in the postwar period.67
The practical effect of Circular No. 120 and of the Secretary of War's letter is difficult to gage. Although The Surgeon General apparently did not make use of his power of access to the Secretary of War, the fact that he had the right of access gave him some bargaining strength. Both the Surgeon General's Office and the Army Service Forces organization regarded the
67(1) Memorandum, Deputy Chief of Staff, for Commanding Generals, Army Air Forces, Army Ground Forces, and Army Service Forces; for Assistant Chiefs of Staff, G-1, G-3, and G-4 ; for Operations Division; and The Surgeon General, 13 Apr. 1945, subject: War Department Circular Clarifying Responsibilities of The Surgeon General, and Related Papers. (2) Memorandum, Secretary of War, for Deputy Chief of Staff, 15 Oct. 1945, subject: Col. Tracy S. Voorhees. (3) Memorandum, Secretary of War, for Deputy Chief of Staff, 12 Dec. 1945.
circular and the Secretary's letter as a partial victory for The Surgeon General and a corresponding loss of authority by the Army Service Forces, although the latter minimized its practical effect.68
MEDICAL ORGANIZATION IN THE SERVICE COMMANDS
At the beginning of his administration, General Kirk continued to attack, as General Magee had done, the problem of the position of the service command surgeon within service command headquarters. Since the reorganization of August 1942, the service command surgeon-or chief of the medical branch, as he was now termed-had been subordinated to either the supply or the personnel division of service command headquarters and reported to the commanding general of the service command only through the director of the division in which he was placed. At the same time some officers of the medical branch had been placed in divisions other than the one to which the chief of the branch was assigned. Obviously the chief of the medical branch had no direct control over their work, and the so-called "medical branch" could hardly operate as an entity. Nothing had come of either General Magee's efforts to reestablish staff position for the service command surgeon or of the recommendation of the committee which had surveyed the Medical Department late in 1942 that his position be restored. Although a Services of Supply organization manual of December 1942 had made it clear that the surgeon was still responsible for advising the commanding general of the service command on health matters affecting personnel of the command, it had not changed outright his status or that of his medical branch. Shortly after taking office General Kirk renewed the struggle. At the suggestion of General Somervell, he called a conference of service command surgeons to discuss the matter. A board of three officers, appointed to make recommendations on medical administration in the service commands, proposed that the medical branch be made into a division of the office of the commanding general. General Somervell raised the problem at the regular conference of commanding generals of service commands in Chicago in July, but although he had expressed tentative concurrence with the plan proposed by The Surgeon General's board, he finally disapproved it. His main objection was that it threatened, by giving all the technical services a similar claim to the right of reporting directly to the commanding general of the service command, to nullify the benefits gained by the reorganization of service command headquarters in August 1942; that is, a reduction in the number of officers reporting directly to the commanding general.
In spite of his refusal at this date to interfere with the formal organization of service command headquarters, General Somervell stressed to the command-
68(1) Letter, Chief. Personnel Service, Office of The Surgeon General, to theater and defense command surgeons, 17 May 1945. (2) Memorandum, Commanding General, Army Service Forces, for Chief of Staff, 6 Aug. 1945, subject: Position of Army Service Forces in the War Department. (3) See footnote 60 (1), p. 236.
ing generals of service commands the importance of their keeping in close touch with their respective chief surgeons. As he put it, "certainly you have, got to talk to your doctor." Probably this remark indicated some shift in his point of view, for in November Army Service Forces headquarters indicated its desire that each service command headquarters be reorganized to conform as closely as possible with the parent headquarters. The chiefs of technical services, including the Service command surgeon, were thus given staff position and put in direct line of communication with the commanding general of the service command and his chief of staff. They bore the same relation to the commanding general at their headquarters that the chiefs of technical services in Washington bore to General Somervell. The service command surgeon thus reachieved Staff position and retained it to the end of the war. Post surgeons, it may be noted, had never lost staff status.69 The Army Service Forces did not again attempt to put into effect a functional scheme of organization at service command headquarters, nor in its own headquarters. Throughout the war the organization of Headquarters, Army Service Forces, retained at staff level both the chiefs of the technical services and the chiefs of its functional elements such as the Personnel and Supply Divisions. Abandonment of the functional scheme of organization for service command headquarters-and with it, any strict limitation on the number of officers reporting to a Superior--was probably due in some measure to the Medical Department's continued protest against it.
The reorganization of service command headquarters at the end of 1943 offered an opportunity to reorganize the offices of the service command surgeons on a uniform basis. The pattern proposed was the same division into five "services" that then existed in the Office of The Surgeon General, but few service command surgeons adopted the scheme. As we have seen, the Office of The Surgeon General itself underwent other major reorganizations before the end of the war, and service command surgeons' offices made little attempt to keep pace with these . A general exception was the addition of a reconditioning branch to parallel the Reconditioning Division, Surgeon General's Office, after early 1944.
Variations in medical problems from one service command to another logically led to considerable diversity in organization and variations in size of their surgeons' offices. The geographic area of the service command, its Army strength, its climate, the disease pattern, concentration of population, indus-trialization, the presence of prisoner-of -war camps, the presence of ports of embarkation-all these factors affected the work of the surgeon's office. A strong industrial hygiene program for civilians working in war plants developed in the Second, Seventh, and Eighth Service Commands. The venereal disease control program, important in all service commands, was more serious in those with highly industrialized areas or with heavy troop concentrations.
69Morgan, Edward J., and Wagner, Donald O. : The Organization of the Medical Department in the Zone of the Interior, chs. IX and X. [Official record.]
Large-scale efforts at malaria control were primarily limited to the Fourth, Seventh, and Ninth Service Commands, The responsibility of medical care for prisoners of war fell mainly upon the surgeons' offices of the Second, Fourth, Sixth, and Seventh Service Commands, since prisoner-of-war camps were concentrated in these areas. Surgeons of the service commands along the coast cooperated with medical men of the Navy and the Coast Guard, as well as with Army port surgeons, in attempting to maintain sanitary conditions in coastal areas and in receiving Army and prisoner-of -war patients evacuated from overseas. In the Ninth Service Command, many Medical Department officers received training at the Civil Affairs Staging and Holding Area, (established in June 1944) at Fort Ord, Calif., later at the Presidio of Monterey, Calif., to prepare them for medical work among civilian populations in the Far East.70
In all service commands, some officers had to be assigned to liaison duties with various health agencies, including the U.S. Public Health Service and State and local health departments, and with the medical sections of some of the commands whose jurisdictional boundaries coincided with, or overlapped, those of the service commands-defense commands, air force commands, field armies, and air forces. Special efforts were made in some service commands to pool the highly trained Medical Department personnel of the various commands. The Seventh Service Command, for example, reached an agreement with the Army Air Forces Training Command, the Troop Carrier Command, the Air Transport Command., and the Second and Third Air Forces that these commands would use the chiefs of medicine, surgery, neuropsychiatry, and dermatology at the general hospitals of the Army Service Forces and at the regional hospitals of the Army Air Forces, as regional consultants in their respective station hospitals. Consultants in the various service command headquarters continued to advise the service command surgeons on the proper assignments of specialists on the basis of their observations of the latters' work. In 1945, dietitians and physical therapists were assigned as consultants to the staffs of service commands and gave similar advice on the assignments of personnel in these fields.71
The status of the service command surgeon remained unchanged from late 1943 to June 1946, and his functions were changed only slightly. Pursuant to demobilization plans drawn-up by Army Service Forces headquarters, he had to make plans for hospitalization and evacuation and, along with the chiefs of the other technical services, participate in disposing of surplus installations and property in the service commands and in establishing a reserve of training equipment for redeployment training in the United States. In
70See footnote 38, p. 220.
71(1) Annual Reports of the Service Command Surgeons, 1942-1945. (2) Memorandum, Chief, Occupational Hygiene Branch, for Deputy Chiefs of Service Commands, 29 Sept. 1943, subject : Procedures for Industrial Hygiene Inspections and Surveys in Ordnance Explosives Plants. (3) Memorandum, The Adjutant General, for Commanding Generals of Service Commands, Chief of Ordnance, Chief of Chemical Warfare Service, 29 Nov. 1943, subject : Procedure for Industrial Hygiene Inspections and Surveys in Army-Owned Ordnance and Chemical Warfare Service Explosives Plants.
June 1946, when the Army Service Forces was abolished, a major reorganization of the regional structure of the Army, which marked a return to the pre-war area organization of the Army within the United States, took place. When the nine service commands under the Army Service Forces were abolished, six army areas were created to operate directly under the War Department. Like the prewar corps areas, these were mixed tactical and service organizations, and the duties of the new army area surgeons closely resembled those of the former corps area surgeons. Moreover, the elimination of the Army Service Forces organization above The Surgeon General put the army area surgeon in the same position with respect to The Surgeon General as the corps area surgeon had been before March 1942. Shortly before these Army-wide changes went into effect the control of general hospitals, as well as hospital centers and convalescent hospitals, was returned to The Surgeon General. This move restored the channels of control of these installations which had prevailed before August 1942.