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The Medical Department in 1939
In September 1939, when President Roosevelt proclaimed a limited national emergency, the U.S. Army Medical Department was serving an army whose mean annual strength was 191,551 officers and men.1 The Medical Department functioned as one of six services; the others were the Chemical Warfare Service, the Corps of Engineers, the Ordnance Department, the Quartermaster Corps, and the Signal Corps. Its officer strength, 2,185, was considerably higher than that of any of the other services, being slightly more than twice the number in the Quartermaster Corps, the service next highest in officer strength. Its strength in enlisted men, 9,478, was greater than that of any of the other services except the Quartermaster Corps.
Unlike officer personnel in the other services, those of the Medical Depart-ment of the Regular Army were organized into several corps: the Medical, Dental, Veterinary, and Medical Administrative Corps. (Members of the Army Nurse Corps, a fifth component nominally constituting a corps, did not then have officer status.) Considered as a whole, the officer personnel of the Medical Department was more highly specialized than that of the other services, for members of the Medical, Dental, and Veterinary Corps had all obtained degrees in their respective fields before obtaining commissions in the Army, and the technical education which they had received in civilian life was supplemented in the Army by courses in military aspects of their disciplines.
Additional medically trained officers were available to the Army, whenever the need should arise, in the Organized Reserves and the National Guard of the United States. Within the Officers Reserve Corps, part of the Organized Reserves, there existed the following corps, constituting the Medical Department Reserve: Medical Corps Reserve, Dental Corps Reserve, Medical Administrative Corps Reserve, Veterinary Corps Reserve, and Sanitary Corps Reserve. The Sanitary Corps Reserve had no counterpart in the Regular Army, while the Army Nurse Corps had no counterpart in the Reserves. The National Guard of the United States had a Medical Corps, a Dental Corps, a Medical Administrative Corps, and a Veterinary Corps, as well as a complement of enlisted men with Medical Department training.
The Medical Department also had an important asset in its affiliation with a number of agencies and institutions, public and private, prepared to aid it in medical research, in procuring and training qualified personnel, and in various
1Annual Report of The Surgeon General, U.S. Army, 1940. Washington: U.S. Government Printing Office, 1941, p. 1.
other aspects of its work. In addition to continuous liaison with the Bureau of Medicine and Surgery of the Navy and with the Veterans' Administration, especially with respect to the hospitalization of military personnel, the Medical Department kept in close touch with the American Medical Association, the American Veterinary Medical Association, the American Dental Association, the American College of Surgeons, the American College of Physicians, various civilian nursing groups, and other recognized professional associations. Its relations with the first-named were particularly close, for nearly all doctors in the United States, including Army medical officers, were members of the American Medical Association. The American National Red Cross, chartered by act of Congress in 1905, could be counted on to aid the Army Medical Department with certain medical supplies and auxiliary personnel in the event of war. It maintained a register of medical technologists, and more important, a reserve of nurses for the use of both Army and Navy which compensated in a measure for the lack of a Nurse Corps reserve. Another agency empowered to support the Army Medical Service was the National Research Council, set up in 1916 by the National Academy of Sciences at President Wilson's request. The Council's Division of Medical Sciences was prepared to give the Army Medical Department advice on technical problems. For aid in research the Medical Department could draw upon a number of educational institutions and research foundations.
ORGANIZATION OF THE MEDICAL DEPARTMENT WITHIN THE
In September 1939 the Office of The Surgeon General in Washington, D.C., was, as it had been for many years, the office which directed the work of the Army Medical Department. The Surgeon General was appointed by the President of the United States, with the advice and consent of the Senate, for a 4-year term. In the absence of The Surgeon General the chief of the Planning and Training Division usually acted in his stead; this officer was sometimes referred to as the Deputy Surgeon General. Maj. Gen. James C. Magee had become Surgeon General on 1 June 1939, succeeding Maj. Gen. Charles R. Reynolds (fig. 1). He headed an office, located in War Department Annex No. 1 at 401 Twenty-third St. NW. (fig. 2), staffed with about 30 officers and nurses and about 160 civilian employees.2
Together with the other services, the Medical Department had been located at staff level in the War Department since 1903, when the General Staff was created. In 1939 it was an element of the War Department Special Staff, and The Surgeon General had direct access to the Chief of Staff. The Chief of Staff and the General Staff were charged with coordinating the development of the separate arms and services in such a way as to insure an efficient military
2Annual Report of The Surgeon General, U.S. Army, 1939. Washington: U.S. Government Printing Office, 1940, p. 163.
team, but their relations with the chiefs of services, including The Surgeon General, remained about the same as those established in 1903. Measures which the Surgeon General's Office desired to put into effect throughout the Army had to clear through one or more of the five divisions of the General Staff: G-1, Personnel; G-2, Military Intelligence; G-3, Operations and Training; G-4, Supply; and the War Plans Division. Most measures called for the concurrence of G-1 or G-4, or both. The supervision of G-4 over medical service was closer than that exercised by any other of the General Staff elements, for in addition to G-4's general responsibilities for Army supply, it was specifically charged with preparing plans and policies for the evacuation and hospitalization of troops and animals, and for supervising these activities. The War Plans Division had the task of formulating plans for employment of troops in theaters of operations, but in peacetime its supervision over the medical service was limited to the coordination of the medical phases of such plans with other phases.3
The Office of The Surgeon General also had close contact with the Office of the Assistant Secretary of War, for the latter was charged by legislation with
3(1) 39 Stat. 168. (2) Annual Report of the Secretary of War, 1916. Washington: U.S. Government Printing Office, 1917, pp. 49ff. (3) Army Regulations No. 10-15, 18 Aug. 1936.
supervising the procurement of all military supplies and assuring adequate provision for mobilizing materiel and industrial organizations for wartime needs. The Assistant Secretary's office maintained liaison with manufacturing companies and industrial facilities. The Surgeon General dealt with G-4 on the military aspects of medical supplies and equipment and with the Office of the Assistant Secretary on business or industrial aspects.4
Internal Organization and Functions
Divisions of the Surgeon General's Office
The 10 divisions which made up General Magee's office in 1939 were: Administrative, Finance and Supply, Military Personnel, Planning and Training, Professional Service, Statistical, Library, Dental, Veterinary, and Nursing (chart 1). The organization had existed in substantially this form since 1935.5
4 (1) 41 Stat. 764. (2) Lecture, Brig. Gen.
R. C. Moore, Deputy Chief of Staff, before Army Industrial College, 24
Aug. 1940, subject: The Supply Division, G-4 of the War Department General
Staff. (3) Yates, Richard E. : The Procurement and Distribution of Medical
Supplies in the Zone of Interior During World War II, pp. 4-13. [Official
Chart 1.- Office of the Surgeon General, October 1939
Administrative Division.-Major functions of the Administrative Division were the handling of mail and records, the handling of matters relating to the civilian personnel of the office, the administration of certain hospital funds and the admission of patients to the Army and Navy General Hospital, the issuance of office supplies, the management of funds for various publications, and the editing of The Army Medical Bulletin, a journal containing articles of medicomilitary interest published by the Medical Department since 1919.
Finance and Supply Division.-Fiscal functions and functions relating to the purchase, storage, and issue of medical supplies and equipment were handled in the Finance and Supply Division. In the procurement of medical supplies and equipment this division worked closely with the Assistant Secretary of War. It prepared budget estimates for The Surgeon General and kept control accounts for appropriations granted the Medical Department. The merging of the supply function with fiscal activities was a natural development, as medical supply and equipment was the major item of expenditure handled by this division. The fact that the division also had general control of civilian employees in field installations indicates that the management of civilian employees was then considered largely a routine fiscal matter. The procurement and induction of civilian employees for extensive use in the Surgeon General's Office and field installations of the Department was not yet, as it later became, a pressing problem.
Military Personnel Division.-The Military Personnel Division selected, classified, and assigned commissioned medical personnel of the Regular Army
and the Reserve Corps. It also maintained records on enlisted medical personnel.
Planning and Training Division.-The Planning and Training Division, made up of the subdivisions of Planning and of Training, developed major policies in those two fields. Although Medical Department planning had to deal with supply, personnel, and so forth, as well as training, the last-named had been closely associated with planning since 1923, when the two functions of planning and training were assigned to a single division. This division prepared tables of organization (numbers, ranks, and duties of personnel and their unit equipment) for new medical units and detachments and revised those for current ones. It also planned the development of medical field equipment. Its work in training included making plans for the technical training of enlisted men, the tactical training of medical units, and the training of National Guard and reserve officers at Army professional schools, summer camps, and certain medical civilian centers. The division also developed plans for hospital construction and repair in conjunction with the Office of the Quartermaster General. In 1939 it was still concerned also with developing medical policies for the Civilian Conservation Corps.
Professional Service Division.-Policies on physical standards for the Regular Army and the Reserve Corps were prepared in the Professional Service Division. This division reviewed papers concerned with the physical examinations of officers and nurses. It also reviewed the examinations of applicants for commissions, the medical records of candidates for service schools, and complaints and claims involving personnel of the Civilian Conservation Corps and trainees of the Citizens Military Training Camps and Reserve Officers' Training Corps. It drafted Army-wide regulations relating to health, sanitation, and preventive medicine and the Medical Department forms to be used for reporting the health of Army troops, as well as the regular circular letters which the Department distributed to field installations. These were designed to standardize professional policies and maintain uniform professional standards in hospitals. It supervised the work of the Army Medical Museum, which classified and displayed medical specimens, equipment, and photographs, particularly of a pathological nature.
Dental, Veterinary, and Nursing Divisions.-The Dental, Veterinary, and Nursing Divisions handled administrative and professional matters relative to the Dental, Veterinary, and Army Nurse Corps respectively. In the fields of personnel and training for their respective corps they were practically autonomous.
Statistical Division.-The Statistical Division tabulated and analyzed reports on disease and mortality in the Army and the Civilian Conservation Corps. Data on individual soldiers played an important role in decisions on pension and disability claims. Statistical summaries kept the Medical Department informed of the major threats to the Army's physical well-being,
thus aiding in the determination of policies as to treatment, and contributed valuable data to medical history.
Library Division.-The functions of the Library Division were the formulation of policies for, and the administration of, the Army Medical Library.
Boards and committees
In addition to the divisional setup in the Surgeon General's Office, a few boards and committees handled certain special problems of an administrative nature. Among the functions handled by boards were, for example, the determination and review of ratings of Medical Department officers and the approval of efficiency ratings of civilian employees.
Liaison With Other War Department Units
Army Air Corps.-Certain units of the War Department other than the Surgeon General's Office had medical functions which they carried out under the aegis of, or in liaison with, the Surgeon General's Office. The major group of this type was the Medical Division of the Air Corps. Since World War I the War Department had recognized that in providing medical service for the Air Corps, it was important to give special consideration to the physical qualifications required of fliers, and to certain diseases and injuries peculiar to, or relatively more common among, fliers. The recognition of the necessity for examination and care of fliers by medical officers specially trained in this work had taken the form of the assignment of a group of Medical Department officers to the Air Corps. Most of these officers were trained as "flight surgeons," a term coined in 1918.
The series of circular letters, training manuals, and other technical documents in which the Surgeon General's Office formulated professional standards for medical, dental, and veterinary service went to Air Corps headquarters and installations as well as to the remainder of the Army. Air Corps medical officers had to keep the same statistical records and fill out the same reports to the Surgeon General's Office as medical officers assigned to other parts of the Army. These served to insure Army-wide uniformity of professional standards. However, medical officers assigned to the Air Corps had to acquaint aviators with the physical and psychological hazards of flying--the physical strain imposed by rapid shifts of altitude and temperature and the mental tension caused by the dangers of flight. Special training was required for either of the two chief assignments in Air Corps medical work the aviation medical examiner, who tested candidates for their ability to withstand the hazards of flight, and the flight surgeon, who treated fliers and had to be versed in the maladies common among them. Since spotting the source of infection is difficult in the case of such a highly mobile force, the standard environmental sanitary measures of the Army were of limited value for air
troops; the Medical Division of the Air Corps had to issue special instructions and set up special procedures for disease control.
In late 1939 the group of medical officers assigned to the Office of the Chief of the Air Corps constituted a division and was a major unit of that office. Although personnel, physical examinations, aviation medicine, and research and statistics were recognized as major fields of work of the division, no true functional breakdown on the basis of personnel assignment existed. Only two Medical Corps officers, with three or four civilian assistants, were then on duty, and the division was primarily concerned with the review of physical examinations for fliers. Other activities were the pursuit of certain research projects, especially investigations of the effects of variation in air pressure upon the efficiency of fliers, the development of oxygen equipment, and the training of medical officers in the principles of aviation medicine to qualify them as aviation medical examiners or flight surgeons.
During the periods between World Wars I and II, Air Corps theory favoring an air force separate from the Army was reflected in the relations between the Office of The Surgeon General and the Medical Corps officers assigned to the Air Corps. The latter sporadically exhibited some tendency to pull away from the jurisdiction of The Surgeon General, insisting from time to time on the special characteristics of Air Corps medical service. During this period, however, the doctrine of separatism among medical officers assigned to the Air Corps was not emphatically voiced; many apparently felt a greater long-range loyalty to the Medical Corps to which they belonged than to the Air Corps. The fact that medical officers with the Air Corps, had been given their assignments by The Surgeon General, or by those previously so assigned by him, helped maintain the chain of loyalty that bound them to The Surgeon General. The need for flight surgeons was not yet fully recognized by Air Corps officers. As late as October 1939 the Chief of the Air Corps, Maj. Gen. (later General of the Army) Henry H. Arnold, irritated by a per-sonal experience, directed the appointment of a board of officers to justify the existence of flight surgeons.6
Medical officers of the Surgeon General's Office were not in complete agreement as to where the group directing medical service for the Air Corps should be located. They frequently stated that they recognized the special problems of medical service for aviators but pointed out that the distinctive features of aviation medicine made it at most a medical specialty rather than a separate science. The "peculiarities" of aviation medicine did not warrant, in their opinion, the assignment of it to a group of officers responsible to the Air Corps. They recognized, however, as a practical consideration in any attempt to transfer medical functions of the Air Corps to the Office of The Surgeon General (and its medical installations to the control of The Surgeon
6Link, Mae Mills, and Coleman, Hubert A.: Medical Support of the Army Air Forces in World War II. Washington: U.S. Government Printing Office, 1955, pp. 26-27.
General) the greater drawing power of the Air Corps in obtaining appropriations from Congress. Public and congressional interest in aviation was so strong that whereas a request for additional appropriations to the Medical Department to take care of medical service for the Air Corps might be turned down, any Air Corps request for an appropriation for the same purpose would be accepted in the general appropriation for the development of Army avia-tion. At the same time they felt that the degree of autonomy already established by the medical group in the Air Corps violated the principle that each supply service of the Army should have a single head.
In early 1939 General Reynolds embarked upon an effort, renewed by General Magee in the fall, to have the medical group of the Air Corps transferred to his office and the School of Aviation Medicine at Randolph Field, Tex., removed to his jurisdiction. This move began a struggle on the part of the Surgeon General's Office for coordination of the entire Army medical service under it and on the part of the medical group in the Air Corps for autonomy, one phase of the general struggle for autonomy of the Army's air forces which continued through the war. Lt. Col. (later Col.) C. L. Beaven, MC (fig. 3), then Chief of the Medical Division of the Air Corps, agreed with The Surgeon General's desires in the matter, while Lt. Col. (later Maj. Gen.) David N. W.
Grant, MC (fig. 4), his assistant who soon succeeded him, favored retention of the Medical Division and the School of Aviation Medicine by the Air Corps. During the early months of his tour of duty, however, Colonel Grant went along with Colonel Beaven's policies, for the latter was still nominally in charge.7
National Guard Bureau.-The Medical Department also had an officer assigned as medical adviser to the National Guard Bureau, the unit of the War Department which handled National Guard Affairs. In 1939 this post in the office of the chief of the bureau was held by Col. (later Maj. Gen.) Howard McC. Snyder, IGD (fig. 5). His duties were primarily the provision of medical care in training camps for the National Guard, direction of the training of medical units, and issue of the necessary medical supplies and equipment.8
7 (1) Coleman, Hubert A.: Organization and Administration, Army Air Forces Medical Service in the Zone of Interior, pp. 33-36, 132-135. [Official record.] (2) Annual Report of The Surgeon General, U.S. Army, 1939. Washington: U.S. Government Printing Office, 1940, p. 259. (3) Armstrong, Harry G.: Principles and Practice of Aviation Medicine. Baltimore: Williams & Wilkins, 1943, pp. 20-27. (4) Letter, 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.
8 (1) Annual Report of the Chief, National Guard Bureau, 1939. Washington: U.S. Government Printing Office, 1940, p. 1. (2) Interview by the author with staff members, National Guard Bureau, 28 June 1948.
MEDICAL FIELD OFFICES AND INSTALLATIONS
The Surgeon General's Office directed the medical work of the Army throughout the United States and the oversea possessions where elements of the Army were stationed. Nearly 75 percent of Army troops were stationed in the United States; most of the remainder were in Hawaii, Panama, the Philippines, and Puerto Rico.9 At major Army headquarters there existed a network of medical administrative offices which carried out the policies established by the Washington office. Policies and procedures established by the office with respect to hospitalization, medical supply, and equipment, as well as the technical instructions which the office drew up for the prevention and treatment of disease, were embodied in the series of circular letters, issued and revised regularly since 1918. These were distributed to corps areas and departments, general hospitals, and the surgeons of stations and tactical installations.
Medical Research Division, Edgewood Arsenal
At the chief field installation maintained by the Chemical Warfare Service, Edgewood Arsenal, Md., certain Medical Department officers constituting a
9Annual Report of The Surgeon General, U.S. Army, 1940. Washington: U.S. Government Printing Office, 1941, p. 1.
Medical Research Division, were engaged in research on preventive and cura-tive measures to counteract chemical warfare agents. Research in this field dated from the widespread use of gases in World War I. During the pre World War II period, research in chemical warfare medicine had not progressed rapidly. Various factors had made it difficult to procure and retain highly qualified civilian personnel, including poor pay, the semi-isolation of the arsenal, and the fact that the nature of the work prevented publication of much of the research. Appropriations had been meager, and frequent rotation of officers had handicapped the continuity of the research.
In 1935 the Medical Department had recognized that progress to date was unsatisfactory, and The Surgeon General had endorsed proposals to the Chief of the Medical Research Division at Edgewood Arsenal for more thorough research into methods of definitive treatment of gas casualty cases; the latter had pointed out recent developments in chemistry which enlarged the possibilities of effective treatment. The Surgeon General had increased funds allotted to the work, and research in chemical warfare medicine had then entered upon a period of more direct guidance by the Medical Department. This was the setup in 1939, which prevailed throughout most of General Magee's administration. In 1939 and preceding years two or three Medical Department officers received training annually in the Chemical Warfare School at Edgewood Arsenal.10
Corps Areas and Territorial Departments
In 1939 the United States was divided into nine corps areas, each in charge of a corps area commander. On the commander's special staff was a corps area surgeon. Three territorial departments (four before the close of the year) were the corresponding units for certain of the U.S. possessions overseas: the Hawaiian, Philippine, and Panama Canal Departments. The corps area or department surgeon was responsible for the training of Medical Department personnel in his area; for recommendations as to the construction and repair of Medical Department buildings, particularly hospitals; for coordinating inspections to determine sanitary conditions, the efficiency of medical personnel, and the adequacy of medical supplies throughout the corps area; and for making recommendations as to the transfer of medical personnel from station to station within the corps area or department; and for transfer of patients from station hospitals to the general hospitals which gave more advanced or definitive treatment. He prepared regular reports for The Surgeon General on the efficiency of medical officers serving directly under him and
10 (1) Cochrane, Rexmond C. : Medical Research in Chemical Warfare, Chemical Warfare Service, 1947. [Official record.] (2) Army Regulations No. 50-5, 31 May 1939. (3) Report on Training of Medical Department Officers, 1 July 1939-30 June 1944, p. 19. [Official record.] See also Brophy, Leo P., Miles, Wyndham D., and Cochrane, Rexmond C.: United States Army in World War II, The Chemical Warfare Service: From Laboratory to Field. Washington: U.S. Government Printing Office, 1959.
annual reports to The Surgeon General on the health of troops stationed within the area. In the effort to lay some responsibility upon line officers for health conditions within their commands, Army regulations held commanding officers of all grades responsible for the enforcement of measures to control and prevent disease, including regulations on sanitation and hygiene and the, control of venereal disease. The cooperation of commanders of troop elements within the corps area in the enforcement of these measures was important to the corps area surgeon.
The corps area surgeon's office
The corps area surgeon's office was small and did not require a divisional breakdown. Usually three or four medical officers, with perhaps an additional Medical Administrative Corps officer, and about the same number of civilian clerical personnel were assigned to the office. The corps area surgeon, or a representative from his office, customarily visited each medical installation in the corps area in the course of a year. Complaint of shortage of personnel, particularly dental, throughout the corps area was fairly common. In the maintenance of medical service for the Civilian Conservation Corps--an additional responsibility to which corps area surgeons attributed in part their personnel shortages--medical, dental, and veterinary Reserve officers were sometimes employed on a civilian status, along with civilian dentists and nurses.11
The Surgeon General's relationship with corps area surgeons and medical installations in the corps areas involved both technical and command control. The Surgeon General had technical control over all Medical Department officers and offices, including those of the Air Corps; technical instructions issued by his office were applied throughout the Army. The channels of technical control extended downward from The Surgeon General to corps area surgeons, and from them to station and unit surgeons. In theory this technical control could be nullified by the commanding general of a corps area, who exercised command authority over all medical personnel within his jurisdiction, but in practice The Surgeon General's orders were rarely questioned. The corps area surgeon had direct access to his commander by virtue of his staff position, and in peacetime, at least, enjoyed a considerable degree of autonomy.12
The prevailing practice was that the corps area commander should have command of installations within the geographical boundaries of his corps area. Hospitals or dispensaries located at posts or stations within corps areas
11 (1) Army Regulations No. 170-10, 18 Aug.
1936 and 10 Oct. 1939. (2) Annual Reports of the Corps Area Surgeons, 1938,
1939. 319.1-2 (CAS) AA. (3) Army Regulations No. 40-5, 15 Jan. 1926, with
change 1, 9 June 1938; Army Regulations No. 40-205, 15 Dec. 1924; Army
Regulations No. 40-210, 21 Apr. 1923; Army Regulations No. 40-235, 11 Oct.
1939; Army Regulations No. 40-270, 21 Apr. 1923.
were therefore within the corps area chain of command, with certain exceptions. However, a tendency existed to give the chief of a service, or a combat arm, command control over stations concerned exclusively (or perhaps primarily) with the work of that service or arm. Thus an ordnance arsenal was under command of the Chief of Ordnance; thence the station hospital at the arsenal was within the Ordnance Department's chain of command. A station hospital might be within the command channel of one of the arms or services or of the corps area commander.
Major medical installations
Other than station hospitals, major medical installations in the United States in 1939 were of the four following main types: General hospitals, which received patients needing advanced or definitive treatment without regard to the corps area in which the patient has been stationed; the service schools of the Medical Department; the medical supply depots; and medical laboratories. Over most of these The Surgeon General had command control.13 In the course of the war the extent of his command over some of these installations underwent considerable change.
The principal Medical Department installation commanded by The Surgeon General was the Army Medical Center (fig. 6), in Washington, D.C.; it
13See Army Regulations No. 170-10, 10 Oct. 1939, for detailed list of stations and installations commanded by The Surgeon General.
was made up of three of the types mentioned above--a general hospital (Walter Reed); the Medical, Dental, and Veterinary Schools; and the Medical, Dental and Veterinary Laboratories.14 Two other installations located in Washington were the Army Medical Library and the Army Medical Museum. Both of these, as well as the Army Medical Center, remained under The Surgeon General's command throughout the war.
General hospitals.-General hospitals then in existence in the United States (in addition to Walter Reed) were: Army and Navy in Hot Springs, Ark.; Fitzsimons in Denver, Colo.; Letterman in San Francisco, Calif.; and William Beaumont in El Paso Tex. These installations were under the command control of The Surgeon General, because they received patients from various corps areas. It was desirable that the Surgeon General's Office exercise central control over the transfer of a patient from a station hospital to the general hospital, located in whatever corps area, which could best give him the definitive treatment which he needed. On the other hand, the two general hospitals in the departments--Tripler in Hawaii and Sternberg in the Philippines--were under the command of the department commander. The remoteness of the Pacific island territories made command by the local department commander more feasible than command from Washington. Any general hospital that might function in a theater of operations would similarly come under the command of the tactical commander within whose jurisdiction it was located.15
Service schools.-Schools under command control of The Surgeon General were the three professional schools at the Army Medical Center and the Medical Field Service School at Carlisle Barracks, Pa. At the professional schools in Washington, Medical Department officers and enlisted technicians received training in medical specialties and in the military aspects of the medical, dental, and veterinary services. The school at Carlisle Barracks trained medical, dental, veterinary, and Medical Administrative Corps officers, as well as enlisted men in the fieldwork of the Medical Department, emphasizing such matters as administration, training, military art, and sanitation. The School of Aviation Medicine, which dated from World War I, had been located at Randolph Field, Tex., since 1931. In name and function a medical school, it was under command control of the Air Corps, specifically the Air Corps Training Center, although it was planned to transfer it to The Surgeon General's jurisdiction in the event of mobilization.16
Medical supply depots.-In 1939 the only depot handling medical supplies exclusively was the St. Louis Medical Depot. It was under the command
14Army Regulations No. 40-600, 31 Dec. 1934.
control of The Surgeon General. Three of the general depots, under the command control of the Quartermaster General, had medical sections along with sections for the other supply services: the New York, San Francisco, and San Antonio General Depots. The Medical Section, New York General Depot, which was larger than the St. Louis Medical Depot as well as larger than the medical sections of either of the other two general depots, bought the great bulk of medical supplies and equipment, as most of the medical supply firms were concentrated in northeastern United States. It stored and issued medical supplies as well. The St. Louis Medical Depot and the medical sections of the San Antonio and San Francisco General Depots acted primarily as storage and issue depots.17
Medical Department laboratories.-The Medical Department's laboratory system was made up of units concerned with problems of general medicine, veterinary medicine, dentistry, or aviation medicine. The Army Medical Center in Washington had laboratories of the first three types. During 1938 the Dental Division, Surgeon General's Office, had been engaged in establishing five central dental laboratories, including the dental laboratory at the Army Medical Center, to give prosthetic service to troops in specified corps areas. By the middle of 1939 these were in operation. Except for the laboratory at the Center, they were under the command control of the commanding officer of the Army station where they were located. In addition to its research, its diagnostic work with animal diseases, and the preparation of veterinary biological products, the veterinary laboratory at the Army Medical Center made examinations of samples of meat, meat food, and dairy products supplied to the Army. In the fall of 1939 the Veterinary Division, Surgeon General's Office, undertook the establishment of a new laboratory, the Veterinary Research Laboratory, to work on problems of animal disease, especially equine influenza and periodic ophthalmia, at the Quartermaster Depot (Remount) at Front Royal, Va. This, too, was under the command control of the commanding officer of the installation.18
Research installations.-In the fall of 1939 the single separate installation of the Medical Department which had been designed exclusively for research, the Army Medical Research Board in Panama, was discontinued for lack of money. For several years it had undertaken studies in malaria, the dysenteries, and various animal diseases. Research on problems of aviation medicine was carried on at two Air Corps installations, the School of Aviation Medicine mentioned above, and the Aero-Medical Research Unit, later called
17(1) See footnote 4(3), p. 4. (2) Memorandum,
Director, Storage and Maintenance Division, Office of The Surgeon General,
for Historical Division (later Historical Unit), 16 Nov. 1944, subject:
Supply Depot Historical Highlights.
the Aero-Medical Research Laboratory (fig. 7), at Wright Field, Ohio. The latter, under the Materiel Division of the Air Corps, had as commandant Capt. (later Maj. Gen.) Harry G. Armstrong, MC (fig. 8), who became Surgeon General of the Air Force in the postwar period. The research projects of the School of Aviation Medicine and the Aero-Medical Research Unit overlapped somewhat. The theory expressed at intervals was that the School of Aviation Medicine should be concerned with the psychological and physiological effects of flying, whereas the Aero-Medical Research Unit, under the jurisdiction of a command concerned largely with supply and maintenance, should deal with problems of adaptation of planes and equipment to the human organism. However, it was difficult to divorce the two fields, and the question continued to come up for discussion.19
The oversea departments
The organization of medical service in the oversea departments corresponded generally to that in the corps areas, and the headquarters organization was similarly small and uncomplicated. Medical officers in the department surgeon's office were usually termed simply "assistants," one being assistant in charge of supply, another of personnel, and so forth. The medical work of
19(1) Folder, Aero-Medical Laboratory, Wright Field, Ohio, HU: TAS. (2) Armstrong, Harry G.: The Principles and Practice of Aviation Medicine. Baltimore: Williams & Wilkins, 1943, p. 16. (3) Annual Report of The Surgeon General, U.S. Army, 1934. Washington: U.S. Government Printing Office, 1935, p. 154. Annual Report of The Surgeon General, U.S. Army, 1938. Washington: U.S. Government Printing Office, 1939, p. 178. Annual Report of The Surgeon General, U.S. Army, 1940. Washington: U.S. Government Printing Office, 1941, p. 195.
the department surgeon's office corresponded to that of the office of the corps area surgeon except for certain programs made necessary by local conditions in the departments. The department surgeon's office directed the usual dental and veterinary, as well as medical, services and reported to the Surgeon General's Office on disease rates and the general health of the command. Malaria and venereal disease control demanded special effort in the Panama Canal and Philippine Departments. The office of the department surgeon directed certain field training programs, although the number of officers and enlisted personnel was not usually large enough to permit extensive field medical training for Regular Army personnel. In the Philippines, the 12th Medical Regiment of Philippine Scouts, which later rendered effective service at Bataan and Corregidor, was undergoing training, and in the Hawaiian Department, the largest of the departments in troop strength, a few reserve officers were trained on active duty status.20
20(1) Whitehill, Buell: Administrative History of Medical Activities in the Middle Pacific (1946). [Official record.] (2) History of Medical Department Activities in the Caribbean Defense Command in World War II, vol. I. [Official record.] (3) Annual Report of the Department Surgeon, Panama Canal Department, 1939. (4) Annual Report of the Department Surgeon, Philippine Department, 1939. (5) Annual Report of the Department Surgeon, Hawaiian Department, 1939. (6) Cooper, Wibb E.: Medical Department Activities in the Philippines from 1941 to 6 May 1942, and Including Medical Activities in Japanese Prisoner of War Camps. [Official record.]
In each department the Medical Department maintained a number of installations of the same types as those in the corps areas. In the Philippine Department, for instance, were Sternberg General Hospital, five station hospitals, and a medical supply depot at Manila. At each of three station hospitals, as well as at Sternberg, was a dental clinic. Sternberg also had a laboratory (including a veterinary section) and a general and station dispensary service. These installations provided medical service for approximately 30,000 personnel, of whom about two-thirds were civilians.
Panama Canal Department.-In the Panama Canal Department, where troop strength averaged between 14,000 and 15,000 in 1939, a unique medical organization existed, a result of the control of the administration of the Canal Zone by the War Department. The Governor of the Canal Zone was customarily a retired Engineer officer, appointed by the President of the United States and responsible to the Secretary of War. At the head of the Health Department of the Canal Zone and reporting directly to the governor was the chief health officer, who was a Medical Department officer designated for the position by The Surgeon General. In 1939 Col. (later Maj. Gen.) Morrison C. Stayer, MC (fig. 9), was chief health officer.
The Chief Health Officer was responsible for environmental sanitation, the prevention and control of transmissible diseases, and the enforcement of quarantine regulations in the Canal Zone and the terminal cities of Panama and Colon. It was important that the orderly passage of ships through the Canal should proceed unhampered by adverse health conditions. In general the work of the Panama Canal Health Department resembled that of a large city health
department. It was also responsible for such tasks as garbage collection and street cleaning for which a department of sanitation was usually responsible in cities in the United States. In addition it ran several hospitals, including the well-known Gorgas Hospital, and a number of dispensaries to care for U.S. Government employees and their dependents in the Canal Zone. The Surgeon, Panama Canal Department, whose office was at Quarry Heights, was responsible for the health of U.S. Army troops in the Canal Zone and controlled the usual Army Medical Department installations there. He reported to the department commander. Some disagreement existed between the chief health officer on the one hand and The Surgeon General and department surgeon on the other as to the respective responsibilities of the chief health officer and the department surgeon. The Surgeon General apparently took the position that the department surgeon, his representative, should rule on all medicomilitary policies in the Canal Zone. Colonel Stayer contended that his position as adviser to the Governor and his many civilian contacts put him in a better position than the department surgeon to be chief adviser to the Army commander in the area; that is, to advise on military as well as civil health problems. In spite of this disagreement as to proper jurisdiction, effective coordination of the work of the two officers prevailed in specific fields. Cooperation was particularly close in the fieldwork undertaken by the Division of Sanitation of the Health Department and the Field Sanitary Force of the department surgeon's office to eliminate the breeding grounds of mosquitoes, a major health project of the Zone.21
Puerto Rican Department.-On 1 July 1939 a fourth oversea department came into being when the Puerto Rican Department was established, including both Puerto Rico and the Virgin Islands, with headquarters at San Juan, P.R. Before that date the two military installations in Puerto Rico, the Post of San Juan and Henry Barracks, both staffed with Puerto Rican troops, had been attached to the Second Corps Area, but the surgeon at San Juan had been even then in effect a department surgeon. The station hospital at the Post of San Juan provided hospitalization for the department.22
Field Tactical Units
The only tactical units of the Medical Department in existence in June 1939 were four medical regiments and a medical squadron organized at peacetime strength. The 11th Medical Regiment and the 12th, the latter made up of Philippine Scouts, were stationed in Hawaii and the Philippines, respectively.
21(1) Letters, Maj. Gen. Morrison C. Stayer,
MC, USA (Ret.), to Col. Roger G. Prentiss, Jr., MC, Director, Historical
Division (later The Historical Unit), Office of The Surgeon General, 17
Jan. 1950 and 1 Feb. 1950. (2) History of Medical Department Activities
in the Caribbean Defense Command in World War II, vol. I, ,p. 127. [Official
The 1st Medical Regiment was in training at Carlisle Barracks (fig. 10), where it was used as a demonstration unit for the Medical Field Service School and for the training camps for the Organized Reserves and the Reserve Officers' Training Corps units conducted at Carlisle Barracks. The 2d Medical Regiment, stationed at Fort Sam Houston, Tex., was taking part in extensive exercises and maneuvers with the streamlined infantry division then undergoing test as a new combat unit. In addition to the medical regiments the 1st Medical Squadron (cavalry) at Fort Bliss, Tex., was partially organized. By the date the President declared the limited emergency a few additional medical regiments, squadrons, and smaller units had been activated.23
DEVELOPMENTS OF LATE 1939: PLANNING
The work of the Planning and Training Division in 1939 reflected the prospects of war and the War Department's plans for defense. As the additions to the Panama garrison and the expanding Air Corps made increased demands on the medical service, the division began planning the construction of additional hospitals. It renewed efforts of previous years to increase to 7 percent the quota of enlisted men in the Medical Department, limited since 1920 to 5 percent of the Army's enlisted strength.24 In 1939 the division was
23(1) Annual Report of The Surgeon General,
U.S. Army, 1939. Washington: U.S. Government Printing Office, 1940, p.
172. Annual Report of The Surgeon General, U.S. Army, 1941. Washington:
U.S. Government Printing Office, 1942, p. 153. (2) Annual Report of the
Station Hospital, Schofield Barracks, Territory of Hawaii, 1941.
also busy preparing medical plans called for by the revised War Department Protective Mobilization Plan of that year. It estimated the number and types of medical units and personnel necessary to support the War Department plan and established policies for their training. As a means of providing the hospitals which the plan called for, the division undertook to revive certain reserve hospital units formerly established in civilian medical schools and hospitals and staffed with their personnel. Similar so-called "affiliated units" had acquitted themselves creditably in World War I, but during the thirties when the War Department had shifted to a policy of decentralizing the administration of Reserve Corps affairs to the control of corps area commanders, the Office of The Surgeon General had lost touch with the affiliated units. In August 1939 the War Department gave approval to their revival, and the Medical Department set about this task.25
The Protective Mobilization Plan
The Surgeon General's Protective Mobilization Plan for 1939, which appeared in final form in December, included plans for expanding medical facilities in the United States as well as plans for increase in personnel for hospitals, supply, and other matters. It contemplated only limited expansion in the Surgeon General's Office in the event of mobilization. Two major functions of the existing Professional Service Division would be raised to divisional status and become the Preventive Medicine Division and the Museum Division. The Professional Service Division itself would become the Hospital and Professional Service Division.
Recognition of the coming significance of preventive medicine and of hospital administration was prophetic; these functions soon became the basis for principal organizational segments of the Surgeon General's Office. Plans of several years earlier, in fact, had recognized the wartime importance of not only preventive medicine but also hospital construction, as well as hospital administration, and of certain professional specialties such as internal medicine, surgery, and neuropsychiatry. Planning documents of earlier years had also recommended setting up an inspection division in the Surgeon General's Office, which would be charged with inspecting all administration and tech-nical activities of the Medical Department at large. The question of the role of this division vis-a-vis that of the Inspector General's Department and, indeed, vis-a-vis possible inspection of field activities by divisions currently
25(1) Memorandum, The Surgeon General (Reynolds), for The Adjutant General, 17 Mar. 1939, subject: Affiliation of Medical Department Units With Civil Institutions and Appointment and Promotion in the Medical Corps Reserve. (2) Memorandum, The Adjutant General, for The Surgeon General, 3 Aug. 1939, subject: Affiliation of Medical Department Units With Civil Institutions and Appointment and Promotion in the Medical Corps Reserve. (3) Annual Report of The Surgeon General, U.S. Army, 1939. Washington: U.S. Government Printing Office, 1940, p. 179. (4) Memorandum, The Adjutant General, for The Surgeon General, 26 Jan. 1940, subject: Officers of Affiliated Medical Units-Appointment, Reappointment, Promotion, and Separation. (5) See footnote 24(l), p. 21.
responsible for them, was not fully clarified.26 The concept apparently constituted recognition that a more thoroughgoing system than the existing one for examining the quality of medical service in field installations would become necessary as installations multiplied rapidly during an emergency period.
Role of the U.S. Public Health Service.-In 1939 the question came up as to the type of aid which the Medical Department should request of the U.S. Public Health Service in the event of war. By legislation of 1902 the President had been authorized to use this Federal agency in time of actual or threatened war in such a way as, in his opinion, best promoted the public interest. Accordingly, President Wilson had issued an Executive order in April 1917 ordering that in time of actual or threatened war the U.S. Public Health Service should constitute part of the military forces of the United States. Various moves had been made towards amalgamating civilian and military agencies handling public health programs. However, Secretary of the Treasury William G. McAdoo had opposed a bill to transfer functions relating to sanitary measures in areas near military establishments, then being exercised by the U.S. Public Health Service under his jurisdiction, from the Treasury Department to the War Department. Moreover, legal interpreta-tion had held that the U.S. Public Health Service could not be considered a part of the Army or Navy and had prevented the granting of Army pensions to U.S. Public Health Service officers detailed to the Army. During World War I the U.S. Public Health Service had continued to provide extracantonment sanitation in cooperation with the Army and State and local health au-thorities. The Medical Department concluded that it would be wise to follow the same general plan in the current emergency.27
A foreshadowing of the inevitable expansion of activities in the field of preventive medicine and of concomitant liaison with the U.S. Public Health Service appeared on the horizon concurrently with The Surgeon General's Protective Mobilization Plan. After discussion with the General Staff in October 1939, The Surgeon General recommended making use of the facilities of the Public Health Service in preserving good health conditions in areas adjacent to Army camps. His detailed plan to this effect (December 1939) called for control of extracantonment, sanitation by the U.S. Public Health Service, in cooperation with local and State health authorities, and for the use of the services of that agency in inter-State quarantine measures, prevention of pollution of streams, and control of venereal disease. A report by the American Social Hygiene Association, a civilian organization which had
26Lecture, Maj. Gen. Charles R. Reynolds, The
Surgeon General, at Army War College, 30 Nov. 1936, subject: The Medical
Service of the Army and the Development of the Medical Resources of this
Country in War.
cooperated with the Medical Department in the control of venereal disease during World War I, that serious vice conditions prevailed in areas near several Army camps added weight to the argument for the aid of the U.S. Public Health Service. In February 1940 the Secretary of War made arrangements with Federal Security Administrator Paul V. McNutt, who had jurisdiction over the U.S. Public Health Service, for the cooperation of that agency in safeguarding the health of soldiers through extramilitary area sanitation.28
Role of the American Red Cross.-The Surgeon General's Protective Mobilization Plan contained the nucleus of a plan for aid by the American National Red Cross in the event of mobilization. In March 1938 the Military Relief Committee of that organization had asked, in a preliminary report to the War Department, that some definite task relative to emergency aid to the Army be assigned it. The Protective Mobilization Plan of 1939 stipulated that the Red Cross should provide at every Army hospital of 250-bed capacity or higher a recreational building, that it should continue its present system of enrolling and classifying nurses for the Army and undertake the same work with respect to medical technicians and dietitians, and that it should furnish occupational therapy equipment and the necessary personnel for its use, as well as certain nonstandard medical equipment.29 Thus was laid in 1939 a firm groundwork for still closer cooperation in time of war with certain public and private agencies engaged in medical work with which The Surgeon General's Office had kept in contact in peacetime.
Medical Supplies and Equipment
A growing awareness of coming difficulties in procuring medical supplies for the Army was in evidence after the declaration of the limited emergency. The Surgeons General of the Army and the Navy decided to enlist the aid of manufacturers of medical supplies and set up several industry advisory committees in certain major fields of medical supply. These committees consisted of representatives from medical supply houses, together with medical officers of the War and Navy Departments. The following committees were constituted: Drugs Resources Advisory Committee, Dental Supplies Advisory Committee, and Medical and Surgical Instruments Advisory Committee. The major function of these, and of similar committees established later in other fields of medical supply, was to keep the Army and Navy informed as to the productive capacity of the industries which they represented.
At the beginning of the emergency the immediate assets of the Medical
28(1) See footnote 24(l), p. 21. (2) Memorandum,
The Adjutant General, for The Surgeon General, 21 Oct. 1939, and indorsements,
subject: Utilization of the U.S. Public Health Service During the Emergency.
(3) Letter, American Social Hygiene Association to Col. J. E. Baylis, MC,
8 Jan. 1940, and indorsement, The Surgeon General to The Adjutant General,
16 Jan. 1940. (4) Memorandum, The Surgeon General to The Adjutant General,
16 Jan. 1940, subject: Utilization of the U.S. Public Health Service. (5)
Letter, Federal Security Administrator to Secretary of War, 12 Feb. 1940.
Department in trained personnel and reserves of medical supplies and equipment were adequate for the peacetime Army. The Surgeon General's Office was organized on an adequate peacetime basis. It maintained close affiliation with other governmental agencies and with private institutions capable of supporting it with medical research and additional personnel and supplies. Very little theory existed as to how the Surgeon General's Office should be set up in wartime, although certain immediate steps which mobilization would call for were envisioned. After September 1939 the Medical Department faced an emergency expansion in almost every phase of its work, and the Surgeon General's Office took steps late in the year to enlist the aid of other agencies.