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Chapter II

Contents

The Medical Department Of The United States Army in The World War

CHAPTER II

REPRESENTATION OF THE MEDICAL DEPARTMENT ON THE GENERAL STAFF, A. E. F.

Before the organization of the American Expeditionary Forces little attention had been given to the subject of Medical Department representation on the general staff, but as early as July, 1917, it became apparent that such representation was essential for coordinated action.1 A memorandum was formulated on this subject at this time but no action resulted.1 In February, 1918, in conformity with a request of the commander in chief for frank discussion, another memorandum was prepared, again inviting attention to the necessity for Medical Department representation on the general staff and stating the reasons for this.1 But until February 16, 1918, when General Orders, No. 31, general headquarters, A. E. F., was published, representatives of the chief surgeon's office continued to take up with the section of the general staff concerned, all Medical Department matters which required their coordination or execution.1

When the American Expeditionary Forces were reorganized, as described in Chapter I, the chiefs of the 10 technical staff services (including the Medical Department) which were transferred from headquarters, A. E. F., at Chaumont, to that of the Services of Supply at Tours, were authorized in their discretion to designate officers of their respective services to represent them with each general staff section at general headquarters.2 In conformity with this plan the chief surgeon, on February 22, 1918, recommended that certain officers of the Medical Department remain at general headquarters to represent him with the several sections of the general staff.3 As his immediate representative he designated a medical officer who was also the liaison officer with the central bureau of the Franco-American section and with the French mission at general headquarters. The office force left to assist this officer consisted of two officers of the Sanitary Corps and eight clerks.3 The medical officers who were assigned as assistants to the chief surgeon's representative were attached to the several sections of the general staff as follows: One to G-1, 1 (who was also attending surgeon at general headquarters) to G-2, 1 to both G-3 and G-5, and 2 to G-4.3 The chief surgeon stated that when more medical officers were available one would be attached to G-3 and another to G-5 instead of having one officer attached to both these sections, but this plan was never realized.3 By May, 1918, representation with the second section of the general staff was found to be unnecessary and was discontinued.4

There was also assigned to duty with the chief surgeon's representative at Chaumont, an officer who was designated director of professional services.4 He was not attached to any section of the general staff, but was stationed at Chaumont largely to lend him the facilities needed in administering his important activities.4


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Technically the medical officers who were assigned to duty with the several sections of the general staff at general headquarters were assistants to the chiefs of those sections, but from another point of view they were, as stated above, assistants to the chief surgeon's representative there.1

On March 15, 1918, the chief surgeon endeavored to have created a Medical Department section of the general staff. His letter on the subject is as follows:5

Recently there has been a considerable readjustment in the organization of these headquarters. It is stated in General Orders, 31, c. s., that the organization there prescribed had been arrived at after a careful study of both the French and British Armies. The American Expeditionary Forces organization recently adopted resembles very closely the French organization which has been in existence for some time.

It is pertinent to review briefly a few of the more important steps in the development of the French organization since the beginning of the war especially in reference to its sanitary service. It was early found necessary to provide for Medical Department representation in the Government, and this was done by creating the office of sous secrétaire d'etat du service de santé. Gradually it was learned by bitter experience that in order to insure coordination of effort and the prevention of unnecessary sacrifice of life actual medical department participation in the plans for combat activities was necessary; that is, representation on the general staff. Consequently, several medical officers were assigned to the general staff of the G. Q. G. and one to the general staff of each army.

While better coordination was secured the results were not entirely satisfactory. Since the Champagne offensive of April, 1917, which was accompanied with a terrible death toll and very great unnecessary suffering there has been a growing feeling that steps should be taken to prevent the recurrence of a similar catastrophe. It was well recognized that a repetition of this unfortunate occurrence might well have a profound and possible disastrous effect on the morale of a people already exhausted and harassed by the unavoidable hardships of a long war.

During the past three and one-half years many changes in organization have been found necessary, changes which viewed in the light of pre-war days seem radical. All of these changes have tended toward a more complete autonomy of the medical service, and it is believed by the best thinkers in the French Army that a high degree of autonomy is essential if the Medical Department is to successfully meet the conditions which modern warfare have imposed upon it.

The latest change in the Medical Department organization in the French Army has very recently been published under date of February 26, 1918 (see inclosures). This change is so fundamental in character and so far-reaching in its consequence that I feel impelled to bring it to your attention. By this change the Medical Department had been removed from the close administrative control of the fourth bureau of the general staff. I am informed that M. Clémenceau and General Pétain have decided, in order that the medical service may have every possible opportunity to accomplish the difficult task with which it is confronted, to constitute a new section of the general staff of the G. Q. G. This section is designated the service de santé, and has as its chief an experienced officer of the Medical Corps who is an assistant chief of staff.

It seems particularly fitting at this time that inasmuch as our present organization is modeled so closely on that of the French that we should not appear as having begun our military effort with a medical organization which has been found wanting and has been discarded by the French. Undoubtedly this step has been taken by the French after most mature study, and with the experience of three and a half years of war as a guide. I feel it incumbent upon me to urge careful consideration of this matter and to recommend that a similar organization be adopted for the A. E. F. If this recommendation is approved, as I feel it must be sooner or later, it is my intention to request the detail of one of the several experienced senior officers of the Medical Corps now in France as chief of this section. I am convinced that while the recently prescribed organization is a vast improvement over that which has been in effect, the gain in saving of life and the prevention of unnecessary suffering which may reasonably be expected from adopting the proposed change will be immeasurably


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greater. The present organization in the American Expeditionary Forces places a line officer of the general staff in position to pass upon or present for higher consideration all matters of fundamental policy affecting the Medical Department. He can nullify the most carefully worked out program having for its object Medical Department efficiency. I am convinced that proper coordination of the medical service with the troops in the zone of the armies can be secured in no other way than that outlined above.

This matter was referred to the chief of the fourth section, general staff, who reported upon it adversely;6 however, the chief surgeon, on April 30, renewed his recommendation in the following letter:7

On the 15th of March, 1918, a letter was sent you from this office calling attention to the fact that the Medical Department was handicapped in its extensive and complex operations by being cut off from direct access to the chief of staff and having to operate through two divisions of the general staff, and suggesting that a remedy be found in the creation of a medical section of the general staff.

In the six weeks which have elapsed since that letter was forwarded, the transfer of the chief surgeon's office to the Services of Supply has been tested in actual operation, and has in many ways greatly facilitated the transaction of business, especially in matters concerning supplies, the distribution and training of personnel, and the construction of the hospital accommodations for the great Army which is being transferred from the camps of mobilization at home to France.

It becomes daily more apparent, however, that it has resulted in a disconnection of the chief surgeon's office from the medical administration of the front to an extent which makes it practically impossible for the chief surgeon to meet his responsibility for the conduct of medical affairs in the zone of the army.

It is requested, therefore, that a reply be made to this letter, stating the action taken with regard to it and, if unfavorable, the reasons which rendered favorable action inexpedient. It is hoped that by a study of these reasons a solution may be arrived at which may be acceptable to the commander in chief and may relieve the very serious administrative difficulties which now exist.

As the chief surgeon was never informed officially of the objections, he was not in a position to discuss them. This matter lapsed and no Medical Department section of the general staff, comparable to that of the French Army was created at this time or later.1

None of the medical officers attached to the general staff became members of that body until some time later. By General Orders, No. 73, G. H. Q., A. E. F., May 10, 1918, two of them were detailed acting general staff officers, and by General Orders, No. 138, G. H. Q., A. E. F., August 23, 1918, the same official status was given two others.

The representative of the chief surgeon, at general headquarters, established his office with that of the two medical officers assigned to the fourth section of the general staff.8 This section as described in Chapter I, was concerned with supply and transportation in the American Expeditionary Forces, initial troop movements, hospitalization, evacuation, utilities, and labor.2 It formulated policies in these matters; the Services of Supply or other agency executed them.1 The assistant chief of staff, G-4, organized in his office a subsection, the medical section, designated "G-4-B." which was charged with Medical Department affairs, and it was with the group composing this section that the chief surgeon's representative identified himself.1

Composition of the medical section, G-4, varied according to circumstances, but on the average included four medical officers of field rank, two officers of the Sanitary Corps for office management, and a small clerical force.1


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On May 2, 1918, the Medical Department officers on duty at headquarters consisted of the representative of the chief surgeon and one assistant, one officer attached to G-1, one attached to G-3 and to G-5, two attached to G-4, an assistant to these last mentioned, who was in charge of records, a director of professional services and his assistant.4

With the separation of the chief surgeon's office from general headquarters, A. E. F., the chief surgeon's relations with the combat forces virtually ceased, but no agency was formally provided for the control, direction, or supervision of Medical Department activities in the zone of the armies.1 Therefore, his representative at general headquarters supervised all activities of the Medical Department during combat.1 Demands upon the medical section, G-4, constantly grew, for it soon became the center to which were referred all matters affecting the Medical Department, whether they arose at headquarters, A. E. F., or were referred to it from other sources for recommendation or suitable action.1 Except in matters pertaining to priority shipments of supplies and personnel from the United States, training, equipment, and operations, this fourth section controlled most of the policies of the Medical Department, not only in the Services of Supply, but throughout the American Expeditionary Forces, including the zone of the armies.1 It was for this reason that the representative of the chief surgeon had identified himself intimately with this section.1 Gradually nearly all the Medical Department activities at general headquarters were coordinated under the medical section, G-4, and no important questions of policy were decided until they had been examined by this group.1 The medical officer assigned to G-1 actually served as a member of this group, but was placed with G-1 to handle certain specific problems pertaining to ocean tonnage which were under control of that section.1 All actions initiated in the group were of course executed over the signature of the assistant chief of staff, G-4. This system was followed, even with questions involving another section.1 In this case a memorandum was usually prepared for the other section of the general staff involved, and transmitted to it through the assistant chief of staff, G-4.1

Orders affecting Medical Department activities in the Services of Supply were promulgated from that headquarters at the direct instance of the chief surgeon, A. E. F., while those affecting service of the Medical Department in the American Expeditionary Forces as a whole, as well as in the zone of the armies, were issued, on request of the chief surgeon's representative, from general headquarters at Chaumont.8

Before they made recommendations concerning the establishment of policies or took action upon them, the representatives of the chief surgeon invariably submitted them to him for approval.8 Daily at 8 a. m., and oftener in emergencies, the chief surgeon and his deputy discussed by long-distance telephone the problems demanding solution.8 Mail sent by courier from one office to the other reached its destination in 12 hours. By these means and by semimonthly visits to Chaumont for the purpose of attending conferences, the chief surgeon kept constantly in touch with the activities and interests of the Medical Department at general headquarters, and was able to supervise Medical Department activities in the zone of the armies and in the American Expeditionary Forces as a whole.8


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The medical officers assigned to duty with G-4 previously had been identified with the hospitalization division of the chief surgeon's office, and in that capacity had dealt with G-4 directly in matters pertaining to hospital procurement.1 As a part of such procurement they had sought to make provision for field and evacuation hospitals as well as for the base hospitals in the Services of Supply.1 Also they had supervised and directed evacuation of patients from divisions in training areas and in quiet sectors. Therefore, it developed that the medical section, G-4, handled all questions relating to hospitalization, evacuation, and other interests of the Medical Department throughout the American Expeditionary Forces which required the attention of general headquarters.1 One very important detail of its service was the prosecution of construction and procurement program, in its relation to hospitalization and depot policies of the chief surgeon's office.1 Another was support of Medical Department interests when in certain projects these conflicted with those of another branch of the service.1 After American troops began to participate in active operations the duties of this group underwent a tremendous increase in scope for it was then charged with general control of Medical Department activities in the field.1 Questions continued to arise in connection with the hospitalization and evacuation policies of the Services of Supply, but aside from these the group now became occupied chiefly with matters pertaining to field operations and combat activities.1

When the medical section, G-4, was organized it had not been anticipated that control of field operations of the Medical Department would devolve upon it, but no other agency was provided and such devolution was in fact a logical development for the reasons noted above.8 The deputy of the chief surgeon at general headquarters, and the other members of the group attached to G-4, constituted the only connecting link between the chief surgeon, A. E. F. and the medical service of armies, corps, and divisions.8

From the beginning of our military operations the medical section, G-4, was called upon to meet the daily emergencies of battle situations as they arose, and to cooperate in developing and applying the general policies of the entire Medical Department of the rapidly growing American Expeditionary Forces.8 During the more important operations two officers of the group were almost constantly at the front where they represented G-4 in the coordination of hospitalization, evacuation, and medical supply.8 Before corps and armies of the American Expeditionary Forces were organized they performed, in addition to their other duties, duties comparable to those of a corps or army surgeon, for at that time there was no other agency through which the higher coordinative functions of the Medical Department could be exercised during combat. For example, representatives of the medical section, G-4, supervised and directed hospitalization and evacuation of the 1st Division at Cantigny; of the divisions and corps constituting the Paris group in the Marne area; and of the 42d Division in the Champagne sector.8 Before a chief surgeon for the First Army was designated in July, 1918, members of G-4-B, therefore, discharged such duties as then devolved upon that office.8 They also effected evacuation from corps and divisions serving under control of the French or British and provided for their supply of Medical Department matériel.8


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So far as their jurisdiction extended the chief surgeons of the First, Second, and Third Armies relieved the deputy of the chief surgeon at G-4 of the duties pertaining to hospitalization, evacuation, and medical supply which the latter previously had discharged for corps and divisions at the front.8

The hospitalization and evacuation plans for the St. Mihiel and Meuse-Argonne operations, in so far as procurement and evacuation were concerned, were largely prepared in G-4-B and placed into effective operation through personal consultation with the chief surgeons of the First and later the Second Armies.1 Careful estimates of prospective battle casualties were formulated and every available resource drawn upon to care for them. Owing to limited resources, it frequently became necessary to move sanitary formations and resources from one army to another, or to the service of detached divisions.1

The difficulties of contact, between the general staff and the Medical Department engaged in the service of the front, which had occurred during the battles in the Marne area, were greatly ameliorated when medical officers were detailed to the various sections of the general staff at general headquarters, and when a newly appointed assistant chief of staff took over the duties of G-4.8 This officer now uniformly acquainted members of the medical section G-4 with plans, situations, and policies so that they were able to make preliminary arrangements to the best advantage and to promote intelligently the efforts of the chief surgeons of the various armies, corps, and divisions concerned.8 As the group kept in close contact with those officers, and learned their facilities and needs for future requirements it was thus in a position to render them prompt assistance when required.8

The machinery for coordination of effort, consolidation of resources, and elasticity of control of limited resources, as reflected in the authority of the assistant chief of staff, G-4, permitted the maximum utilization of facilities.8 Without the interest which was manifested by the assistant chief of staff, G-4, in the activities of this subsection and his practice of notifying it of impending battles, or movements of troops, it would have been impossible for G-4-B to have met emergencies which continually arose.8

The geographical location of general headquarters permitted the maintenance of close contact between members of G-4-B and the surgeons of divisions, corps, and armies.8 It was possible for a member of this group not only to reach rapidly almost any part of the front occupied by American troops, but also through an excellent system of telephone and telegraph communication to know at all times exactly the conditions to be met.8 Largely because of this fact the representatives of the chief surgeon with G-4 were able to meet the daily problems which arose from the lack of authorized personnel, sanitary units and equipment with the troops; such problems they met by moving from one sector to another, on orders which G-4 initiated, casual personnel, operating teams, and sanitary units, ambulance companies, field, evacuation, and mobile hospitals.8 Limitations of personnel were such that without this machinery for coordination of effort and consolidation of resources, evacuation, and hospitalization of battle casualties would have been well nigh impossible.8 The activities of this group which pertained to supervision of medical service at the front are further discussed in Volume VIII of this history.


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G-4-B was also closely in touch with the American Red Cross, especially in projects concerning hospitalization, and convalescent homes.8 The relations of that society to G-4-B were so intimate and so important that an attempt was made to have it transferred from the jurisdiction of G-1 (which had control of all such societies operating in the service of the American Expeditionary Forces), to that of G-4, in order to expedite transaction of business between the two offices, but this was unsuccessful.1 The representative of the Medical Department with G-1 coordinated the activities of the American Red Cross with the policies of the Medical Department, in so far as they pertained to that department, the hospitalization enterprise of the American Red Cross being undertaken in conformity with requests of the medical group with G-4.8

On September 20, 1918, the chief surgeon's deputy, general headquarters, submitted the following memorandum to the acting chief of staff, G-4, concerning the organization of the medical section, G-4:9

The following table exhibits the personnel that I believe will be necessary to carry on the functions now devolving upon this subsection of your office. It contemplates no radical departure from the organization which has been in effect.

Brigadier general, 1; colonels, 2; lieutenant colonels, 2; majors, 2; captains or first lieutenants, 4; total commissioned, 11. Civilian clerk, 1; master hospital sergeant, 1; hospital sergeants, 2; sergeants, 1st class, 3; sergeants, 3; corporals, 2; privates, 1st class, 4; privates, 1; total enlisted, 16.

The table proposed off hand may appear to be top heavy. As a matter of fact the personnel estimated will barely be sufficient to carry on the work which is now coming to this subsection. As G-4 handles practically all the medical matters coming to general headquarters; it is believed that all technical matters affecting the Medical Department should be referred to this subsection. While General Orders 31, contemplated that we should have a representative in each section of the General Staff, it is believed that better results will accrue if we concentrate all the authorized personnel in this section excepting the officer assigned to G-5 for training purposes. Until recently we had attached to G-l a medical officer who was assigned to the General Staff. Instead of replacing him in that section it is believed that the work carried on by him there should be performed by an officer in this subsection of G-4.

Until the organization of the First Army headquarters, this office was in fact the office of the chief surgeon of the army. At the present time it is carrying some of the duties of that army, and all of such duties in connection with certain other more or less detached combat units. The chief surgeon's office is, from the point of view of distance, remote from the front, and its contact with combat units is correspondingly slight. The necessity of providing the details of organization, instruction, mobilization of new equipment and personnel for combat units, the initiation of movement orders, etc., must all originate from this section. As a matter of fact the duties which have devolved upon and are now being performed by this subsection have been much broader in scope than it was believed by the chief surgeon was contemplated in the plan of organization at the time General Orders 31 was adopted.

Every effort has been made to decentralize, as far as possible, all details concerning the Medical Department and to devote the time of officers on duty here to constructive work, which is gradually assuming greater and more pressing proportions. Up to the present, with the number of officers now available this has practically been impossible, as the entire time of officers now connected with the subsection have been taken up with routine daily matters. It is daily becoming more evident that the chief surgeon's office, per se, has become what might properly be called a surgeon's general's office in France, and is occupied with the provision of matériel and personnel necessary to secure proper functioning of the Medical Department of the American Expeditionary Forces. There is another and most important side to the Medical Department's activities, and this is the relation of the department to combat operations. From a Medical Department viewpoint, supply is a comparatively


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minor consideration. The care of the sick and wounded and the evacuation and hospitalization of these cases is always more or less an emergency measure and requires very complicated machinery to secure the desired results. The present organization, as prescribed by General Orders 31, does not provide the elasticity or necessary facilities for this most important part of the Medical Department duties. It is understood that General Orders 31 is now being rewritten with a view of correcting its organizational defects and incorporating features which have been the outgrowth of our experience under its operation.

The necessity of having a deputy of the chief surgeon at these headquarters has become generally recognized. Under our present scheme of organization it is necessary that the chief surgeon should have at these headquarters an officer who truly represents him and whose duties are more particularly those which pertain to Medical Department functions with and relations to combat troops. To produce satisfactory results requires a considerable organization. In every action of magnitude representatives from these headquarters must leave for the front for the purpose of coordinating hospitalization and evacuation until activities again assume a normal trend. It seems only logical that, inasmuch as all Medical Department activities are coordinated by G-4 of the general staff, its senior medical officer with that section of the general staff should be the chief surgeon's deputy. That is the situation which has gradually evolved since the chiefs of the services were divorced from these headquarters. As stated above, the desirability of not only continuing this organization, but recognizing the responsibilities and duties of the senior medical member of G-4 seems apparent. Because of the nature of the work and responsibilities devolving upon the chief surgeon's deputy, it is believed that the officer who occupies that position should have the rank of a general officer. On a recent visit to these headquarters the chief surgeon announced that it was his intention to recommend that his deputy here be a brigadier general. For that reason one brigadier general is shown on the above table. If the functions to be carried out by this subsection of your office are to be successfully accomplished the personnel indicated will be absolutely essential. The enlisted personnel given function largely in the same capacity as do field clerks in other subsections.

On August 14, 1918, the commander in chief, upon being advised by the chief of staff that the Medical Corps had asked for fuller representation on the general staff, stated he desired this request to be complied with.10 Accordingly, a medical officer who had been on duty with G-1 was made an acting general staff officer,11 and all divisions of the general staff were advised that he should be consulted on:10

(a) All affairs of the Red Cross that have any possible connection with the Medical Department; (b) all Tables of Organization of medical units or which should show medical personnel attached; (c) changes in the type of equipment or clothing or ration, so far as they may affect health, or where, in the case of equipments, it is for the Medical Corps; (d) miscellaneous questions affecting the Medical Department.

The representative of the Medical Department with G-3 was concerned chiefly with movement of medical units; e. g., evacuation hospitals. It appeared advisable that the Medical Department should be represented on G-3 in order that its plans might be coordinated with combat operations in general.1 This representative of the chief surgeon also served with G-5, and, in that assignment, was in charge of the training of Medical Department personnel whether they were members of units in the Joinville training area, of units or detachments with divisions, or in attendance at the Sanitary School at Langres.1

In his final report the deputy of the chief surgeon at General Headquarters wrote concerning Medical Department representation on the general staff with especial reference to that with its fourth section as follows:1


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The present method of providing for Medical Department representation on and with the general staff is ideal, and is favored over all other previous propositions. Medical Department representation on the general staff as conceived by the acting chief of staff, G-4, more nearly approaches the ideal of organization than any other plan which has been proposed. It is hoped that the policy inaugurated by the chief of the fourth section in this respect will have demonstrated its value, and will be perpetuated in any future reorganization of the general staff. It is also hoped that the results obtained by this section of the general staff have amply demonstrated the wisdom of having adequate Medical Department representation on the general staff.

Under this organization (General Orders, No. 31) the chief surgeon's office became merely an agency for the procurement and distribution of supplies and personnel and was completely separated from the Medical Department activities connected with the Zone of Active Operations.

The classification of the Medical Department among the supply services is questionable. Its functions are so intimately connected with combat activities that it becomes a very difficult matter to administer this branch of the service if it is placed on the same basis as the purely supply departments.

In providing the necessary medical supplies for an army only one of the comparatively unimportant functions of the Medical Department has been fulfilled. The demands made upon the Medical Department by combat activities can not be satisfied if the prevailing conception of that department as a supply department is adhered to.

The organization of headquarters, general headquarters, A. E. F., as first outlined in General Orders, No. 8, 1917, followed very closely that in operation in the French Army at the time, except that for the latter army generous provision was made in the way of Medical Department representation on the fourth bureau of the general staff and none was provided for ours. As stated above, this defect was corrected some months later, after representation had again been made by the chief surgeon.

In the meantime a reorganization of the French general staff went into effect in March, 1918. This change created an additional or fifth bureau of the general staff, which was made up entirely of medical officers and was known as the Medical Department bureau. The senior officer of the section was a major general, with the title of assistant chief of staff, with the same responsibilities and privileges as his brother officers of the line of other bureaus of the general staff.

A short time before the French had published this change in staff organization, a memorandum for the commander in chief had been prepared in the office of the chief surgeon recommending this identical organization. This recommendation was never approved or disapproved, and the lack of action in the matter was a source of bitter disappointment to the chief surgeon.

In so far as general representation on the general staff is concerned, not only at headquarters, A. E. F., but also at headquarters, Services of Supply, the chief surgeon expressed his opinion on March 24, 1919, as follows:12

It is not believed at this time that a separate or medical section of the general staff should be created, but the medical services of the American Expeditionary Forces should be placed under G-4, general headquarters. The chief surgeon should be represented by a deputy on G-4, of high rank. In his relations with the general staff, general headquarters, he should be represented by one or more assistants on G-l, G-3, and G-5, as well as the necessary additional medical officers on G-4. It is not believed that there is any necessity for representation on G-2, general headquarters.

The chief surgeon has no executive jurisdiction over his own corps in the armies except through the executive branches of the general staff, general headquarters. He also is so dependent upon the other supply departments for operating hospitals, supplies, and evacuation as to make it impossible for him to function without the executive assistance of the general staff, Services of Supply.

Therefore, in order to make the machinery move rapidly and smoothly, it is absolutely necessary to have general staff representation in both general headquarters and Services of


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Supply so as to insure the rapid and coordinate dissemination of information of daily changes at the front and to meet all demands intelligently and rapidly with the proper equipment, personnel, etc.

Under the present arrangement, in which the deputy chief surgeon is attached to G-4, general headquarters, the operation has functioned in an admirable manner, but this is recognized as being due in a large measure to the admirable cooperation given to the deputy chief surgeon on G-4 by the assistant chief of staff, G-4.

In this connection, attention is called to the fact that there was no medical representative on G-3, the G-4 group performing the functions that should have been delegated to the G-3 representatives. It is believed that representation on G-3 is necessary.

In connection with the headquarters, Services of Supply, the chief surgeon should have had an office with a deputy in charge to operate the Services of Supply activities of supply, hospitalization, statistics, finance and accounting, Services of Supply personnel, dental service, and veterinary service.

The office of the chief surgeon should be represented by assistants on G-l and G-4 of the general staff, Services of Supply, this in view of the fact that the hospitalization division is intricately connected with and dependent upon every other supply department, and in order to maintain the proper service, should be represented on G-l and G-4 of the general staff with such executive power as to be able to secure hospital construction or procurement by lease or rent, as well as transportation of supplies, personnel, and sick and wounded.

THE CHIEF SURGEON IN CONNECTION WITH THE ARMIES

It is well understood that orders of execution can only be given to the army through the different sections of the general staff at general headquarters, but in view of the chief surgeon's responsibility for the sanitary personnel, equipment, professional services, hygiene, etc., of the armies, he should be in close touch with the surgeons of the armies, army corps, and divisions. The chief surgeon of an army should have a medical representative on each G-l and G-4 of the army.

The following table is submitted:

Location.
  Operations-G. H. Q.
   Chief surgeon.
  Personnel (for army areas only).
  Army equipment, medical, from advance medical supply depots.
  Evacuation of sick and wounded.
Hospital trains.
Ambulance and motor transport.
   Operations of same.

Supplies-S. O. S.
  Deputy chief surgeon.
   Hospitalization.
   Supply department.
   Statistics-sick and wounded.
   Personnel (S. O. S.).
   Hospital trains, ambulances, and motor transport.
   Supply and equipment of same.
   Finance and accounting.
   Dental service.
   Veterinary service.
   Professional services.
   General sanitation-inspecting, epidemiology, laboratories.
Relations with the general staff.


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The chief surgeon's representation on the general staff should be as follows:

G. H. Q.:

  G-l. An assistant in connection with supply problems, railway and automatic overseas tonnage.

G-3. An assistant to coordinate the chief surgeon's office with combat operations in general, and change of stations of army units.

G-4. A deputy chief surgeon and necessary assistants in connection with the evacuation of sick and wounded, hospitalization, all construction and procurement of buildings, assignment of units.

G-5. An assistant in connection with Medical Department training.

S .O. S.:

G-4. One or more assistants in connection with hospitalization and evacuation of sick
and wounded.

G-1. One assistant in connection with all tonnage and problems.

Army headquarters:

G-l. An assistant to the chief surgeon of the army.

G-2. An assistant to the chief surgeon of the army.

  Corps and division headquarters: No representation of general staff deemed necessary.

REFERENCES

(1) Report from Col. S. H. Wadhams, M. C., the chief of the medical group, fourth section, general staff, general headquarters, A. E. F., to the chief of G-4, general staff, general headquarters, A. E. F., December 31, 1918. Subject: Activities of G-4 "B," 4.

(2) General Orders, No. 31, General Headquarters, A. E. F., February 16, 1918.

(3) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February 22, 1918. Subject: Designation of medical officers to represent chief surgeon at general headquarters. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(4) Memorandum from the representative of the chief surgeon, A. E. F., with general headquarters, A. E. F., medical section, general staff, to the chief of staff, A. E. F., May 2, 1918. Subject: Duties of officers of Medical Department at general headquarters, A. E. F., G-4-B. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(5) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15, 1918. Subject: Organization. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(6) Memorandum from acting assistant chief of staff, G-4, to the chief of staff, April 6, 1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(7) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., April 30, 1918. Subject: Need for medical section, general staff. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(8) Wadhams, S. H., Col., M. C., and Tuttle, A. D., Col., M. C.: Some of the early problems of the Medical Department, The Military Surgeon, Washington, D. C., 1919, xlv, No. 6, 636.

(9) Memorandum from the medical representative of the chief surgeon, general headquarters, A. E. F., fourth section, general staff, to the acting chief of staff, G-4, September 20, 1918. Subject: Plan of organization for the medical or "B" division of G-4. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(10) Report from the commander in chief, A. E. F., to The Adjutant General of the Army (undated), part 8, Vol. I, "Activities of G-1," 29. On file, General Headquarters, A. E. F. Records.

(11) General Orders, No. 138, General Headquarters, A. E. F., August 23, 1918.

(12) Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., March 24, 1919. Subject: Relation of chief surgeon's office to S. O. S., G. H. Q., and the armies. On file, A. G. O., World War Division, chief surgeon's files (321.6).

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