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Chapter II

Contents

CHAPTER II

The Emergency Period: 1940-41

During 1940 and 1941, before the United States entered the war, the Medical Department's responsibilities increased enormously. Three developments of those years added to its task a rapid increase in the size of the Army, the advent of large-scale economic and military aid to foreign countries, and the acquisition of new Atlantic bases.

The congressional resolution of 27 August 1940 calling up the National Guard, many of the Reserves, and some retired Army personnel, and the general draft in September brought about large increases in Army troop strength. In May 1940 the War Department had obtained from Congress an increase in the authorized strength of enlisted medical personnel after repeated requests by the Surgeon General's Office. The new legislation had permitted Medical Department personnel to increase to 7 percent instead of 5 percent of the strength of the Army, with additional limited increases possible at the discretion of the President in the event of hostilities. The first new Atlantic bases were occupied pursuant to the agreement between the United States and Great Britain in September 1940, and the formal lend-lease program, by which the United States undertook to send supplies (including medical supplies) abroad to aid the enemies of Nazi Germany and Fascist Italy, was initiated in March 1941. All these measures added to the responsibilities of the Medical Department and led to changes in its organization, as well as increased liaison between the Surgeon General's Office and other governmental and private agencies. They also complicated problems of administration in various fields, such as medical supply, hospitalization, training, and the acquisition and use of personnel.

THE SURGEON GENERAL'S OFFICE

During 1940 and 1941 the Surgeon General's Office underwent considerable expansion in personnel. By the end of June 1940 personnel had not increased greatly over the figure for 1939, but between 30 June 1940 and 30 June 1941 it more than doubled. At the end of June 1940 there were 43 officers and nurses and 201 civilians in the office; a year later the numbers had increased to 102 officers and nurses and 717 civilian employees. In January 1941 the expanding office moved from its former location into a portion of the Social Security Building at 4th and C Streets, S.W., Washington, D.C. In December it moved to 1818 H Street, N.W., Washington, D.C., where it remained till the end of the war.

During 1940-41 only two new divisions developed in the Surgeon General's Office, although many new subdivisions, some of which were later to attain divi-


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Chart 2.- Organization of the Office of The Surgeon General, 15 May 1941

sion rank, sprang up as the office was given added duties (chart 2). These were the Hospitalization Division and the Preventive Medicine Division, formerly a subordinate element of the Professional Service Division. The expansion of the professional services and the carving up of the Professional Service Division into a number of subdivisions, with the emergence of preventive medicine in particular strength, were the chief developments of the emergency period.

The Professional Services

In 1940 The Surgeon General, foreseeing expanding problems in sanitation and control of disease, particularly of malaria and venereal disease, in


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Army camps and adjacent areas, established close liaison with the U.S. Public Health Service, the Bureau of Medicine and Surgery of the Navy, the Rockefeller Foundation, the National Research Council, and other Government and private agencies. Growing problems in preventive medicine received formal recognition when a Preventive Medicine Subdivision was set up in the Professional Service Division in May. Five other subdivisions formally set up at that time in the same division, then headed by Col. (later Brig. Gen.) Charles C. Hillman, MC (fig. 11), were: Medicine and Surgery; Physical Standards, U.S. Military Academy and Regular Army; Physical Standards, Officers Reserve Corps, and National Guard; Army Medical Museum; and Miscellaneous.

Medicine and Surgery Subdivision

The Medicine and Surgery Subdivision developed medical and surgical policies, including new methods of treatment, rendered professional opinions, and, in liaison with the Military Personnel Division, selected personnel for key professional positions in Army medical installations. The two Physical Standards Subdivisions formulated physical standards for the military elements indicated in their titles and took action on reports of physical examinations of applicants for admission to the schools or to the various military elements


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and applicants for commissions in the Regular Army. The administration of the Army Medical Museum was handled by the subdivision of that name. The functions of the Miscellaneous Subdivision are worth noting: "Office action on line of duty boards pertaining to Regular Army personnel; correspondence pertaining to enlisted personnel, CCC enrollees, and veterans; miscellaneous correspondence on professional subjects; office action on medical aspects of claims against the government; liaison between the Offices of The Surgeon General and The Adjutant General." 1 The variety of duties assigned to this subdivision shows that thinking as to the organization of those activities regarded as professional as opposed to those of administrative character had still not crystallized by the middle of 1940. It illustrates the great difficulty encountered in a medicomilitary organization in divorcing the two types of activity.

Preventive Medicine Subdivision

Lt. Col. (later Brig. Gen.) James S. Simmons, MC (fig. 12), Chief of the Preventive Medicine Subdivision, had been brought into the Office early in 1940 by The Surgeon General to head the work in preventive medicine.2 and remained in that capacity throughout the war. The principal activities of his subdivision were at that date envisioned as advisory supervision over military sanitation and the control of communicable disease; maintenance of liaison with the Quartermaster Department in matters relating to food and water supplies, waste disposal, insect control, choice of housing sites, use of sanitary appliances, and maintenance of sanitary conditions in bathing pools; advisory supervision over Medical Department laboratories; and maintenance of liaison with the U.S. Public Health Service and other health agencies. The activities of the Preventive Medicine Subdivision in the field of sanitation were greatly stimulated by the Selective Training and Service Act of September 1940, which stipulated that adequate sanitary facilities should be established at Army camps in advance of the arrival of inductees.

Health and sanitation under military government.-Before mid-1940 the Preventive Medicine Subdivision had embarked on a project which led to two programs of future importance, later made the responsibility of two organizational elements of the Surgeon General's Office. Three Sanitary Corps officers were brought into the Preventive Medicine Subdivision by Colonel Simmons in May to prepare a section on health and sanitation in a manual of military government being drafted by the Office of the Chief of Staff. Issued as Field Manual 27-5, 30 July 1940, the document was designed as a guide both for planning and for administering military government in territory occupied by U.S. Army troops. The plan for medical organization within military government devised by the Sanitary Corps officers pointed to the need for advance information on health and sanitary conditions in countries

    1Office Order No. 51, Office of The Surgeon General, 7 May 1940.
    2(1) Office Order No. 20, Office of The Surgeon General, 26 Feb. 1940. (2) Testimony, Committee to Study the Medical Department, 1942, p. 244. HU :321.6.


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where troops might be stationed. Firsthand surveys were made of Newfound-land and Bermuda, where the British had granted bases, and of some Caribbean and South American areas. These paved the way for the extensive system of similar surveys of areas throughout the world which developed in 1941 and 1942; that is, the work which came to be known as "medical intelligence." The plan for health organization for civilians in areas of troop location overseas was the beginning of a comprehensive "medical civil affairs" program for which The Surgeon General was eventually given direct responsibility. The pro-gram was ultimately to embrace, after the Army's advances into enemy-held territory, wide-range activities in the prevention and treatment of disease among the civil populations in the liberated countries, designed both to pre-serve civilian health and to protect U.S. Army troops. The surveys also constituted a forward step in planning in still a third field, sanitary engineering, which embraces engineering activities in connection with water purification, garbage disposal, sewage treatment, and control of insect and rodent carriers of disease.3

Laboratory service.-In July 1940 the need of the expanded Army for

    3(1) Memorandum, Capt. Tom Whayne, MC, for Chief, Preventive Medicine Division, 2 Sept. 1941, subject: General Outline for Activities of Subdivision of Medical Intelligence, Preventive Medicine Division, Including Studies Completed for August 1941. (2) Committee to Study the Medical Department, Exhibits 45, 41, and 19.


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an enlarged medical laboratory service was recognized when the Preventive Medicine Subdivision recommended the activation of corps area and department laboratories in the nine corps areas and the Panama Canal and Puerto Rican Departments. After War Department approval they were established in 1941. This system of laboratories, planned since 1925 but not needed in peacetime, was designed to provide a central laboratory in each corps area or department to deal with epidemiological and sanitary matters relating to the health of all troops in the area, in contradistinction to the laboratories of sta-tion and general hospitals; the latter handled, for the most part, diagnostic work required in the care of individual patients. War broke out while similar laboratories were being considered for the Hawaiian and Philippine Departments.4

Industrial health hazards.-The Surgeon General became concerned over potential hazards to the health of employees in Army-owned munitions plants. Congressional legislation of July 1940 authorized the Secretary of War to provide plans for manufacturing and storing military equipment and supplies. Although the War Department was not charged by legislation with providing medical service for civilian employees at the plants, the Medical Department soon assumed some responsibility, for the legislation had made the Secretary of War responsible for efficient operation of the plants. In 1938 the Chief of Ordnance had asked the Medical Department to make periodic physical examinations of civilian employees engaged in dangerous work; for example, the handling of TNT, at ordnance plants. Civilian contract surgeons had been hired by the Medical Department for the purpose, but at some plants their service had been limited to the giving of first aid treatment. The pro-gram had not developed along the broader plan of attempting to forestall occupational injuries and diseases. Realizing that the program needed establishment upon a sounder and more comprehensive basis, The Surgeon General proposed in December 1940 to assign Medical Department personnel to serve Air Corps and Quartermaster Corps depots as well as Ordnance plants, and to ask the U.S. Public Health Service to make surveys to determine existing industrial hygiene hazards. The surveys got underway about May 1941. This move initiated what was to become an extensive health program with a coverage of about 1 million civilians.5 It eventually grew administratively complex as a result of several factors: the widening of coverage as lend-lease commitments, and, later, the Pearl Harbor attack spurred on expansion of the Army's industrial facilities;

    4(1) Committee to Study the Medical Department, Exhibit 42. (2) Memorandum, The Surgeon General, for The Adjutant General, 12 Dec. 1940, subject: Personnel for Corps Area and Department Laboratories. (3) Memorandum, Executive Officer, Office of The Surgeon General, for Surgeon, Panama Canal Department, 27 Dec. 1940, subject: Establishment of Corps Area and Department Laboratories. (4) Report of Conference, The Surgeon General and the Corps Area surgeons, 14-16 Oct. 1940.
    5(1) 54 Stat. 712. (2) Annual Report, Subdivision of Epidemiology, Disease Prevention, and Industrial Hygiene, Office of The Surgeon General, 1940, 1941. (3) Cook, W. L., Jr.: Preventive Medicine, Occupational Health Division, 1 July 1946. [Official record.]


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addition of new types of care; local variation in degree and types of service rendered, depending upon the closeness of the relations of the Army with the groups involved and the adjacency of the area to good civilian medical facilities; and variations in the allocation of cost between the Army and the civilian patients served.

Statistical studies.-Analysis and interpretation of data on the incidence of various diseases also developed during 1940. The Statistical Division supplied information on incidence of disease among Army personnel, and the U.S. Public Health Service furnished similar information as to the civilian population in the United States. Toward the end of the year the surveys of foreign areas mentioned above began to provide this information for foreign areas.

Army Epidemiological Board.-In late 1940 the Medical Department embarked on an effort to enlist the aid of civilian specialists in the control of epidemic disease. Upon the recommendation of The Surgeon General, the Secretary of War set up the Board for the Investigation and Control of Influenza and Other Epidemic Diseases, usually referred to as the "Army Epidemiological Board," in January 1941. On the various subsidiary commis-sions of the Board the civilian medical profession, represented by more than 100 members, collaborated with the Preventive Medicine Subdivision through-out the war in the investigation of potential epidemics in the Army. As a rule the War Department entered into a research contract with the civilian institution at which the director of the particular commission resided.6

Immunization program.-The initiation of a large-scale program for immunizing Army personnel against specific epidemic diseases got underway in 1940. After conference with specialists in preventive medicine of the Navy, the U.S. Public Health Service, the National Research Council, and the International Health Division of the Rockefeller Foundation, the Preventive Medicine Subdivision worked out a coordinated program for immunization. Specifically, the immunization of all Army personnel against tetanus was recommended to the General Staff in May 1940, and triple typhoid vaccine, previously used, was readopted in July. The same agencies made various recommendations on the use of yellow fever vaccine in the Army and took steps toward production of a supply of the vaccine. They began a series of conferences late in 1941 to plan an extensive program for immunizing troops against yellow fever, typhus, cholera, and plague.7

    6(1) Long, Arthur P.: The Epidemiology Division, 1 July 1946. [Official record.] (2) Committee to Study the Medical Department, Exhibit 19. (3) Report of the Army Epidemiological Board for 1943.
    7(1) Simmons, J. S.: Immunization Against Infectious Diseases in the United States Army. So. Med. Jour. vol. 34. (2) Simmons, J. S.: The Army's New Frontiers in Tropical Medicine. Ann. Int. Med. vol. 17, December 1942. (3) Memorandum, Col. J. S. Simmons, MC, for Dr. Lewis A. Weed, chairman, Division of Medical Sciences, National Research Council, 5 Aug. 1942, subject: Conference on Materials and Procedures for Immunization Against Typhus, Cholera, and Plague. (4) Committee to Study the Medical Department, Exhibit 47.


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Expansion of Professional Service

Early in 1941 Colonel Simmons called the attention of General Magee to the new responsibilities devolving upon his subdivision since its establishment in May 1940. He requested the assignment of additional medical officers and the reorganization of the subdivision on a functional basis.8 The Professional Service Division, of which Colonel Simmons' preventive medicine subdivision was only a part, faced also the task of expanding the system of general and station hospitals to serve the growing Army. Accordingly in April 1941 it was split into three divisions: the Professional Service, the Preventive Medicine, and the Hospitalization Divisions.9 Several subdivisions existed within each (chart 2).

Food and Nutrition Subdivisions.-The only part of the Professional Service Division, as reorganized, which marked any innovation since 1939 was the Food and Nutrition Subdivision. Late in 1940 The Surgeon General, citing the establishment of a Division of Food and Nutrition in the Surgeon General's Office in the First World War, had requested authorization for a Subdivision of Food and Nutrition in his Professional Service Division, to be headed by a Reserve officer. This subdivision was established early in 1941. It had advisory supervision over those aspects of selection and preparation of Army food which were related to the health of the soldier. It remained in the Professional Service Division when the latter was reorganized in April.

Hospitalization Division.-The duties of the new Hospitalization Division were not clearly defined but appear to have been conceived of largely in terms of policy development and liaison with other areas of the Surgeon General's Office. The division was to work with the Planning and Training Division in preparing total requirements for hospital beds and training specially qualified persons for hospital work, with the Finance and Supply Division on matters of hospital equipment, and with the Professional Service Division on professional care at military stations.10 Little was done during the following year to clarify the organizational concepts in this field. The four subdivisions contemplated for the Hospitalization Division-Personnel, Equipment and Supply, Hospitals, and Inspections-apparently remained largely paper units. The meager personnel (four officers and four clerks), assigned to the division in June 1942, a year after its establishment, gives further proof that hospitalization was not considered a primary function per se but was thought of as a matter of coordination of the work of other divisions. Its failure to attain greater size and to receive a more pointed delineation of its functions

    8Memorandum, Lt. Col. J. S. Simmons, MC, for The Surgeon General, 25 Feb. 1941, subject: The Subdivision of Preventive Medicine.
    9(1) Office Order No. 32, Office of The Surgeon General, 17 Feb. 1941. (2) Office Order No. 87, Office of The Surgeon General, 18 Apr. 1941.
    10See footnote 9 (2).


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was noted when its operations were made a subject of attack by the Services of Supply in 1942.11

A major problem facing the new Hospitalization Division was that of regulating the transfer of patients from station to general hospitals for definitive care. The so-called "bed-credit system," whereby the station hospital was allotted a certain number of beds in the nearest general hospital to which it could transfer its patients, was adopted in June 1941. The division thus acted as a central station to make the most efficient use of the available hospital beds during a period of rapid change. In attempting to conserve hospital beds it also undertook to effect, through revision of Army Regulations, more expeditious disposition of hospital cases.12 Col. Harry D. Offutt, MC (fig. 13), who had undertaken revision of the equipment lists for Medical Department tactical units, including hospitals for oversea use, while stationed at the Army

    11(1) Annual Report, Operations Service, Office of The Surgeon General, 1942. (2) Memorandum, Director, Control Division, Office of The Surgeon General, for The Surgeon General, 13 Jan. 1944, subject: Proposal for Overall Plan for Modifications in Present Organization.
    12(1) Letter, Brig. Gen. Harry D. Offutt, to Col. H. W.. Doan, MC, 10 June 1948, and inclosure 1. (2) Memorandum, Col. Harry D. Offutt, MC, for Chief, Operations Service, Surgeon General's Office, 8 July 1943, subject: List of Personnel Hospitalization Division. (3) Annual Report, Operations Service, Office of The Surgeon General, 1942.


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Medical Center, was made Chief of the new Hospitalization Division and retained that office throughout General Magee's administration.

Medical Supply

Throughout 1940 and 1941 functions relating to medical supplies and equipment continued to be concentrated mainly in the Finance and Supply Division of the Surgeon General's Office. The measures to increase the size of the Army and the acquisition of Caribbean bases from Great Britain in the latter half of 1940 stimulated the demand for medical supplies and equipment. Additional supplies were needed for the rapidly increasing number of station hospitals in the United States and for use in the training of new tactical medical units to go overseas. Appropriations for buying medical supplies and equipment for the fiscal year 1941 increased over those for the fiscal year 1940 more than 16 times.13

The appointment of the Advisory Commission to the Council of National Defense with its Commissioner of Industrial Materials, in the middle of 1940, the creation by the Reconstruction Finance Corporation in August of the Defense Plant Corporation to deal in strategic and critical materials, and the establishment of the original priorities system by the Army-Navy Munitions Board initiated a network of agencies which affected the procurement of medical supplies. With these and their successors medical supply officers in the Finance and Supply Division dealt in their efforts to obtain strategic materials, high priority ratings, and other concessions for manufacturers of medical Supplies.14

Certain legal problems arose in buying medical supplies. On those involving policy the Judge Advocate General of the Army, the Comptroller General, or the Attorney General of the United States (as the case demanded) customarily rendered decisions. However, an increasing volume of work requiring legal knowledge was developing in connection with contracts for medical supplies and certain claims arising against the department. A Medical Administrative Corps officer with legal training was assigned to the Finance and Supply Division in August 1940, to prepare contracts with medi-cal supply houses and research agencies, and to examine and adjudicate claims by various civilian and government agencies for medical services rendered to Army personnel, Civilian Conservation Corps enrollees, and other groups for

    13(1) Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, pp. 129ff. (2) Robinson, Lt. Col. Paul I.: Major Changes in Organizational Structure, Finance and Supply Division, 30 June 1940 to 7 Dec. 1941 (18 Nov. 1942) [Official record.] (3) Hearings Before a Special Committee Investigating the National Defense Program, United States Senate. 77th Cong., 1st Sess., on Senate Resolution 71,15 July 1941. Washington: U.S. Government Printing Office, 1941.
    14(1) Yates, Richard E.: The Procurement and Distribution of Supplies in the Zone of Interior During World War II, pp. 77-81. [Official record.]. (2) U.S. Government Manual. Washington U.S. Government Printing Office, 1940, pp. 52-53. (3) U.S. Government Manual. Washington: U.S. Government Printing Office, 1941, pp. 155, 444-45.


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whose care the Medical Department was ultimately responsible.15 Other officers with legal training were subsequently assigned to legal work, but the group did not reach the stature of a division until 2 years later.

Research and development.-Other activities which were concentrated in the Finance and Supply Division in 1940 were those pertaining to research and to the development of special Medical Department equipment. This program had expanded to include about 36 projects at 4 main scenes of Medical Department research and developmental work-the Army Medical Center, Washington, D.C., the Medical Department Equipment Laboratory at Carlisle Barracks, Pa., the Quartermaster Remount Depot at Front Royal, Va., and Edgewood Arsenal, Md. As these entailed some work on the part of five divisions of the Surgeon General's Office, a central place to record research data and advise The Surgeon General of the progress of research projects was necessary. Since the Finance and Supply Division had been handling the fiscal affairs of all these programs, the Research and Development Section was set up in that division to work out a coordinated research program.16

Shortages.-Supply problems developed thick and fast in 1941. The loss of certain continental European sources, particularly Germany, for surgical instruments, a possibility foreseen for many years, had its effect. Export of surgical instruments to France and England during 1940 and 1941 constituted a drain on domestic production. In 1941 the Finance and Supply Division surveyed medical supply firms in the attempt to expand their manufacturing facilities and to convert factories making other products to the manufacture of medical supplies and equipment. It computed requirements for strategic and critical raw materials and submitted these to the Office of the Under Secretary of War, to which were transferred in April 1941 the supply functions formerly exercised by the Assistant Secretary. Marked shortages had developed in aluminum needed for litters and for operating room lamps, and in corrosion-resistant steel for surgical and dental instruments. In an attempt to aid manufacturers of medical supplies and equipment to obtain scarce, materials, the Finance and Supply Division maintained liaison with the Army-Navy Munitions Board, which set up the original priorities system and which had taken over in late 1940 the industry advisory committees created the previous year by the Medical Department. In 1941 the division maintained liaison with the Office of Production Management, which (preceding the War Production Board) administered the priorities system throughout 1941. In late 1941, the work of the Army-Navy Munitions Board in reviewing preference ratings granted to Army contractors grew too heavy and was decentralized to the services. At the order of the Office of the Under Secretary, a Priorities Com-

    15(1) Hilsher, Maj. John M.: Summary of Legal Activities (Covers period 1924 through 1941). [Official record.] (2) Office Order No. 126, Office of The Surgeon General, 27 Aug. 1940.
    16(1) Memorandum, Lt. Col. Francis C. Tyng, MC, for The Surgeon General, 30 Oct. 1940, subject: Research and Development Section. (2) Office Order No. 205, Office of The Surgeon General, 3 Dec. 1940.


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pliance Section was set up in the Surgeon General's Office to review the preference ratings granted to subcontractors of medical supplies and equipment.17

Effect of lend-lease.-The passage of the Lend-Lease Act in March 1941 and the swelling list of countries declared eligible for lend-lease aid accounted in part for the Medical Department's later difficulties with medical supply for the Army. At the outset neither the Medical Department nor the War Department appear to have been aware of the potential effects of the lend-lease program on procurement of medical supplies for the Army. Promptly after passage of the Lend-Lease Act the Secretary of War authorized the establishment of a Defense Aid Division in the Office of the Under Secretary to coordinate the lend-lease programs of the supply services. Defense Aid Requirements Committees were established for several services at the same time, but none for the Surgeon General's Office until near the end of the summer, when a Defense Aid Medical Requirements Subcommittee was set up. The Surgeon General's Office had already established a Defense Aid Subsection in its Finance and Supply Division.

Even before the passage of the Lend-Lease Act some demands for aid to potential Allies had been made on the Medical Department. These included litters for Yugoslavia and $1,200,000 worth of medical supplies requested by the Chinese for use by the U.S. Public Health Service in the medical care of workers on the Yunnan-Burma Railway, which was to become a supply line for lend-lease itself. The work of the Medical Department in filling these early requisitions involved the following steps: Receipt of the requisition from the Defense Aid Medical Requirements Subcommittee; identification of the requested items in Medical Department or American commercial terms; computation of cost; the forwarding of purchase requisition to the procurement depot, after receipt of allotment of funds from the War Department Budget Officer; and finally the forwarding of shipping instructions from the foreign government to the appropriate defense-aid depot for action after the Secretary of War (through the Defense Aid Division) had authorized the transfer. This was a complicated procedure. Authorities of the War Department involved were: The Defense Aid Subsection of the Surgeon General's Office and the medical procurement districts and medical supply depots; the Defense Aid Medical Requirements Subcommittee; and the Defense Aid Division in the Office of the Under Secretary. Outside the War Department were the Division of Defense Aid Reports of the Office for Emergency Management, superseded by the Office of Lend-Lease Administration in October, and the Washington office, whether embassy or supply mission, of the country making the requisition. By December 1941, after the submission of the First Russian Protocol outlining

    17(1) Yates, Richard E.: The Procurement and Distribution of Supplies in the Zone of Interior During World War II, pp. 33-36. [Official record.] (2) See footnote 13 (1) and (3), p. 36. (3) Memorandum, Director, Production Branch, Office of the Under Secretary of War, for The Surgeon General, 13 Oct. 1941, subject: Establishment of a Priority Compliance Section in the Offices of the Chiefs of Supply Arms and Services. (4) Memorandum, Lt. Col. C. G. Gruber, MC, for Lt. Col. F. C. Tyng, MC, 22 Oct. 1941, subject: Compliance Section of Procurement Planning Subdivision.


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Russian lend-lease requirements, Medical Department supply officers had become more cognizant of the impact which the lend-lease program would have upon the procurement of medical supply. One of them noted that the "astronomical" figures of the Russians were already materially affecting the procurement program.18

RELATIONS OF THE SURGEON GENERAL'S OFFICE WITH OTHER
AGENCIES CONCERNED WITH MEDICAL SERVICE

Under pressure of the national emergency, relations of the Surgeon General's Office with established Government and private agencies engaged in medical programs became closer. A number of new Government agencies, usually termed "defense" agencies, were created. Some were assigned functions relating to medicine or public health which supplemented-or in some cases conflicted with-the Army's medical program. While these agencies, and the U.S. Public Health Service, for the most part worked harmoniously with the Army Medical Department, occasional disagreements developed over matters of policy or in areas of conflicting interests.

U.S. Public Health Service

Increasing health hazards to Army troops, particularly the venereal diseases, were the subject of continued discussion between the Surgeon General's Office and other agencies. During 1940 the U.S. Public Health Service put into effect measures designed to control venereal disease and maintain sanitary conditions in the vicinity of Army camps.19 It made special arrangements for aid to the Army during maneuvers to be held in the southeast that spring and summer. While mutual efforts of the Army Medical Department and the U.S. Public Health Service in sanitation and malaria control worked smoothly, some conflict developed over ways and means of controlling venereal disease. An informal conference of representatives of the Medical Department and of the U.S. Public Health Service in March 1940 to lay plans for control of venereal disease during the maneuvers revealed a tendency by both agencies to disclaim

    18(1) Yates, Richard E.: The Procurement and Distribution of Supplies in the Zone of Interior During World War II, pp. 212-214. [Official record.] (2) See footnote 13(2), p. 36. (3) History of Lend-Lease, pt. I, ch. IV, pp. 162ff. [Official record in National Archives.] (4) Historical Report of Lend-Lease Activities of The Surgeon General's Office. [Incomplete official record in THU.] (5) Memorandum, Under Secretary of War, for Secretary of War, 19 Sept. 1941, subject: Lend-Lease Procedure. (6) History of Medical Department Lend-Lease Activities. [Official record.] (7) Memorandum, Lt. Col. C. F. Shook, MC, Office of The Surgeon General, for Under Secretary of War, 4 Dec. 1941, subject : Data on Foreign Countries.
    19(1) Memorandum, Col. Albert G. Love, MC, for the Committee on Medical Care, 15 Oct. 1942, subject: Review of Oral Testimony on Work of the Planning and Training Division, 1Apr. 1938-31 July 1939, Before the Committee to Study the Medical Department. (2) Committee to Study the Medical Department, Exhibit 22. (3) Testimony, Committee to Study the Medical Department, 1942, pp. 351-352. (4) Report, Conference of The Surgeon General with Corps Area Surgeons, 14-16 Oct. 1940. (5) Report, Ad Hoc Subcommittee of Committee on Medicine, National Research Council, to Survey Venereal Disease Control Program, February 1942.


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responsibility for undertaking any measures to suppress prostitution, although they appeared to agree that such measures were desirable. Representatives of the Medical Department pointed out that the Army had no police power outside military reservations.

In May 1940 a conference of State and territorial health officers reached a formal agreement as to services which State and local health agencies and police authorities should provide as their share of the venereal disease control program. State authorities agreed to cooperate with military authorities in educating the civilian and military population in the dangers of venereal disease and in exchanging information as to sources of infection. The agreement recognized the direct responsibility of civilian authorities for isolating and treating infected civilians and the primary responsibility of local police authorities for repressing prostitution.20 The War Department gave its official sanction to this program in June, and in September informed commanding generals of corps areas and departments of their responsibility for supporting it in their respective jurisdictions. The U.S. Public Health Service agreed to assign a liaison officer to each corps area to work with the corps area surgeon on mutual health problems; late in 1940 it put this plan into effect in each corps area and in the Puerto Rican Department.

Nevertheless, the Army was subjected to a good deal of criticism, beginning as early as the fall of 1940 and continuing throughout 1941, when reports of high venereal disease rates among soldiers became widespread. A barrage of attacks emanated from U.S. Public Health Service liaison officers stationed in the corps areas, and from State health department officials, the American Social Hygiene Association, and the public. They criticized the tendency of some Army line officers, according to reports from scattered areas throughout the country, to tolerate segregated red-light districts. In addition, examination of inmates of houses of prostitution as a protective measure by a few medical officers-a practice which was not consonant with previous agreements that the repression of prostitution and rehabilitation of prostitutes was primarily the responsibility of local authorities-gave rise to reports that the Army condoned commercialized prostitution. Although the Medical Department maintained firmly its policy for repressing prostitution, the record shows a good deal of divergence of opinion, on the part of the public and a few health authorities as well as on the part of some Army line officers, as to the necessity for tolerating a certain degree of condoned prostitution.

The Surgeon General's Office recalled to corps area surgeons in January 1941 its previous instructions for carrying out the agreement. In February medical officers of the Army and Navy held a joint conference with a few leading civilian authorities, including the Chairman of the Subcommittee on Venereal Diseases of the National Research Council. The conference renewed

    20Agreement by War and Navy Departments, Federal Security Agency, and State Health Departments on Measures for Control of Venereal Disease in Areas where Armed Forces or National Defense Employees are Concentrated, adopted by conferences of State and Territorial health officers, 7-13 May 1940.


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the established policy of the Medical Department and so informed commanding officers. Gen. George C. Marshall, the Chief of Staff, emphasized the Army's policy in a personal letter to corps area and Army commanders.

In July, at the instance of the American Social Hygiene Association, the May Act, making prostitution a Federal offense in the areas in which it was invoked, was passed by Congress. It was supported by the Surgeons General of the Army, Navy, and U.S. Public Health Service. The War Department shortly afterward issued instructions to commanders of corps areas as to the procedure for invoking the act, and a Division of Social Protection was set up in the Office of Defense Health and Welfare Services in the fall to aid in the repression of commercialized prostitution by working through State and local authorities. The Army was unwilling to invoke the act, however, except as a last resort in areas where local authorities had unquestionably failed to cooperate in its program. It was sensitive to the reaction of local communities, some of which insisted that they wanted to take repressive measures themselves and wanted only the Army's moral backing. Although Charles P. Taft, Assistant Director of the Office of Defense Health and Welfare Services (like the U.S. Public Health Service, under the jurisdiction of the Federal Security Administrator), apparently agreed with the Army's position, in the latter part of 1941 Drs. Thomas Parran and R. A. Vonderlehr, Surgeon General and Assistant Surgeon General of the U.S. Public Health Service, criticized the Army in a jointly written book, "Plain Words About Venereal Disease," for its failure to invoke the May Act.

Medical Department officers resented these attacks and similar ones in the public press. The Truman Committee inquired into the Army's policy during its December hearings on the National Defense Program. In a War Department circular General Marshall reemphasized the responsibility of the unit commander for the enforcement of control measures. The Surgeon General asked the National Research Council to set up a commission to survey and report on the situation as to venereal disease in the Army. In general the commission's report (February 1942) supported both the soundness and the consistency of the Medical Department's policy. Meanwhile The Surgeon General provided for reinforcement of the program by arranging for the assignment of a venereal disease control officer as an assistant to the surgeon of the following commands: Each division, army, communications zone head-quarters, general headquarters, corps area, department, and each station com-plement serving 20,000 or more troops.21

    21 (1) Memorandum, Executive Officer, Office of The Surgeon General, for surgeons of all corps areas and departments and independent stations, 13 Jan. 1941, subject: Cooperation With the U.S. Public Health Service in the Control of Venereal Disease. (2) Hearings Before a Special Committee Investigating the National Defense Program, United States Senate, 77th Cong., 1st Sess., on Senate Resolution 71, 5 Dec. 1941. Washington: U.S. Government Printing Office, 1942, pt. 10, p. 3768. (3) Diary, Historical Division, Surgeon General's Office, entry by Col. Albert G. Love, MC, 15 Nov. 1941. (4) Annual Report, Surgeon, Fourth Corps Area, 1941. (5) Annual Report, Surgeon, Eighth Corps Area, 1941. (6) Sternberg, Lt. Col. Thomas H., and Howard, Maj. Ernest B.: History of Venereal Disease Control and Treatment in Zone of Interior. [Official record.]


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National Research Council

Another agency with which the Army Medical Department established close liaison during the emergency period was the National Research Council. In May 1940 The Surgeon General asked the Division of Medical Sciences of the Council to establish committees to advise the Medical Department on technical problems.22 This request initiated the appointment of a number of civilian physicians and medical officers from the Army, Navy, and U.S. Public Health Service. These rendered significant service to the Medical Department in giving technical advice on advanced methods of prevention and treatment of various diseases. The Surgeon General's Office based a number of its most technical circular letters on advice given by the committees and subcommittees of the Council.

American Medical Association

In June 1940 at the annual meeting of the American Medical Association, the major professional organization of physicians with which the Medical Department maintained close contact, The Surgeon General's representatives solicited the aid of the association in procuring medical officers for the Army. They asked the association to survey doctors in the United States and their qualifications and to determine which doctors could be considered available for military service and which should remain in civilian life because they were essential to the health of the community.23 The American Medical Associa-tion unanimously agreed to give the aid requested and created a Preparedness Committee of civilian doctors representing each corps area. During the remainder of 1940 and the following year, the committee conducted a survey of the medical profession and began to give information to the Surgeon General's Office on the availability of certain doctors for military service. However, the machinery created at this date for procurement of medically trained personnel for the Army was soon superseded by Federal machinery created for the purpose.

Schools and Hospitals

The aid of civilian schools and hospitals was also enlisted through the revival of the affiliated units under the plan developed the previous year. The details of the plan as approved by the War Department were published in January 1940. The Surgeon General's Office began efforts to interest selected civilian institutions, explaining to each affiliating institution the procedure for affiliation, policies as to appointment in the Reserve Corps, the positions to be filled, training required, mobilization, and issue of equipment. By

    22Report, Committee to Study the Medical Department, November 1942, Tab: Relations with Others.
    23See footnote 19 (1), p. 39.


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mid-1941, 41 general hospitals, 11 evacuation hospitals, and 4 surgical hospitals had been organized at universities and hospitals.24

Defense Agencies

The year 1940 also witnessed the inception of several Federal defense agencies which were designed to promote civilian health as an essential aspect of the defense effort and to handle special civilian health problems arising therefrom.

In some fields civilian and military claims to supplies, labor, and facilities had already begun to clash with each other. The field of medicine was no exception, and the Medical Department of the Army on occasion locked horns with agencies devoted primarily to civilian interests. These agencies sprang up rapidly during the emergency period and underwent various changes of jurisdiction. Responsibility for most of the health and medical aspects of national defense was eventually vested in the Federal Security Administrator, Paul V. McNutt.

Office of Defense Health and Welfare Services.-By the fall of 1941 Mr. McNutt had been made Director of the Office of Defense Health and Welfare Services. A major committee in this office was the Health and Medical Committee, on which General Magee served, along with the Surgeons General of the Navy and U.S. Public Health Service. The Surgeon General's Office worked closely with the Health and Medical Committee and its subcommittees, as well as with certain other elements of the Office of Defense Health and Welfare which cooperated with State and local agencies in a broad attack on the problem of venereal disease. The office of the Federal Security Administrator provided a point of contact for military and civilian authorities in areas, particularly those near defense industrial establishments, in which military and civilian health impinged upon each other. The U.S. Public Health Service was under the jurisdiction of the Federal Security Administrator, as was, at a later date, the chief Federal civilian agency concerned with problems of medical manpower, the War Manpower Commission. The latter, through its Procurement and Assignment Service, attempted to solve the problem of allocating sufficient medical personnel to government agencies, including the military forces, while retaining adequate numbers in civilian practice-the task for which the Medical Department had previously enlisted the aid of the American Medical Association.25

    24(1) Memorandum, The Adjutant General for The Surgeon General, 26 Jan. 1940, subject: Officers of Affiliated Medical Units-Appointment, Reappointment, Promotion, and Separation. (2) Memorandum, Executive Officer, Office of The Surgeon General for each Affiliating Institution, 16 May 1940, subject: Affiliated Units, Medical Department, U.S. Army. (3) Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, pp. 101-114. See also Medical Department, United States Army, Personnel in World War II, ch. V. [In press.]
    25For full discussion, see Medical Department, United States Army, Personnel in World War II, ch. VI. [In press.]


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Office of Civilian Defense.-The Office of Civilian Defense which made plans for community health programs and medical care of civilians in the event of military attack upon the United States, was created by the President in May 1941. Although it was not put under jurisdiction of the Federal Security Administrator, it belongs with the series of agencies just named in that it, too, claimed a quota of the available medical personnel, supplies, and facilities. It was particularly interested in the Army's development of protective measures, should the enemy resort to gas warfare against the civilian population, and in certain medical supplies which the Army might make available for civilian defense. In the latter part of 1941 the liaison officers of the U.S. Public Health Service on duty with corps area surgeons were assigned to serve as medical consultants with the local district offices (serving areas conterminous with Army corps areas) of the Office of Civilian Defense.26

Office of Scientific Research and Development.-In June 1941 the President set up the Office of Scientific Research and Development which was authorized, among other duties, to "initiate and support scientific research on medical problems affecting the national defense." Its Committee on Medical Research, with Col. James S. Simmons, MC, as Army representative, was to advise the Director of the Office of Scientific Research and Development as to the need for, and character of, medical research contracts which the Office should make with hospitals and universities. This agency and the National Research Council were the two agencies which contributed most heavily to the alleviation of the Army's heavy needs for medical research during the war. Both these agencies worked in collaboration with the U.S. Department of Agriculture laboratory at Orlando, Fla., in developing DDT for widespread Army use in the control of insect-borne diseases. Both also had responsibilities in connection with the research program, then largely civilian controlled, into methods of treatment of gas casualties.27

Research to counter biological warfare.-The antibiological warfare program also led to the creation of new agencies. Biological warfare has both offensive and defensive aspects, and defense against potential biological warfare on the part of the enemy is a civilian as well as a military problem. Consequently, research into the potentialities of biological warfare and programs to counteract the effects of any such warfare in which the enemy might engage were undertaken at a number of levels of Government organization, both within and without the War Department. A major problem, so far as the

    26(1) U.S. Government Manual. Washington: U.S. Government Printing Office, September 1941, pp. 69-72. (2) Report of Committee to Study the Medical Department, 1942, Tab : Relations With Others.
    27(1) Millett, John D.: United States Army In World War II. The Organization and Role of the Army Service Forces. Washington : U.S. Government Printing Office, 1954, pp. 236ff. (2) Report of Committee to Study the Medical Department, 1942, Tab: Research Program. (3) Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, pp. 251-269. (4) Brophy, Leo P., Miles, Wyndham D., and Cochrane, Rexmond C.: U.S. Army in World War II. The Chemical Warfare Service: From Laboratory to Field. Washington: U.S. Government Printing Office, 1959, pp. 75-100.


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Medical Department was concerned, was to confine its responsibility, as in the case of chemical warfare to the defensive aspects. Bacteriological warfare methods had been studied jointly by the Chemical Warfare Service and the Medical Department for many years.

When the Secretary of War became alarmed over the potentialities of biological warfare in 1941, he informally placed some responsibilities for research in this field upon the Chemical Warfare Service and asked the National Academy of Sciences in Washington, D.C., to study the problem. In November 1941 the Academy appointed the WBC Committee to undertake the study.28 Col. (later Brig. Gen.) Raymond A. Kelser, VC (fig. 14), Chief of the Veteri-nary Division, Office of The Surgeon General, was a member, for the introduction of disease among cattle in the United States was recognized as a serious threat to the nation's food supply. The committee's reports in 1942 delineated various means of biological warfare which threatened human beings, plants, and animals, stressing the danger of the spread of rinderpest among cattle.

    28According to Brophy, Miles, and Cochrane, on p. 103 of the volume cited in footnote 27 (4), p. 44, the initials stood for "War Bureau of Consultants." However, it is the recollection of Brig. Gen. Stanhope Bayne-Jones, MC, USA (Ret.), then Deputy Chief of the Preventive Medicine Division, Office of The Surgeon General, and one of The Surgeon General's representatives in the group, that the initials stood for "Biological Warfare Committee," deliberately scrambled for security reasons. Statement of General Bayne-Jones to the editor, 12 Oct. 1961.


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Secretary Stimson indicated to the President the two main considerations which he deemed of importance in setting up a body to take action on the committee's report: selection of the right men and entrustment of the program to a civilian agency. The latter measure, he stated, "would help in preventing the public from being unduly exercised over any ideas that the War Department might be contemplating the use of this weapon offensively." He noted that a knowledge of offensive possibilities was indispensable to the preparation of an adequate defense, comparing biological warfare in this respect to chemical warfare, for which research into both offensive and defensive possibilities had been found necessary.29

To avoid alarming the public, a civilian-controlled War Research Service in the Federal Security Agency was authorized in May 1942, superseding the WBC Committee. Through the Surgeon General's Office the War Research Service developed antibiological warfare programs in the Hawaiian Department Civilian Defense Command, the military districts of the United States, and the oversea theaters of operations. General Kelser was made a liaison member of a new advisory group-arbitrarily called the ABC Committee-set up in October by the National Research Council and the National Academy of Sciences to give technical and professional aid to the War Research Service. He also became co-chairman of a joint United States-Canadian commission (appointed by the Secretary of War and the Canadian Minister of National Defense) to plan measures for protecting North American cattle against the introduction of rinderpest. The Medical Department's participation in the antibiological warfare program was thus largely limited in the early war years to the use of some of its personnel by, or in liaison with, other agencies to which direct responsibility for the program was assigned.30

MEDICAL OFFICES IN OTHER BRANCHES OF THE ARMY

At the beginning of 1940, medical officers held positions in three major branches of the War Department other than the Surgeon General's Office the National Guard Bureau, the Office of the Chief of the Air Corps, and the Chemical Warfare Service. During that year medical officers were assigned to four other branches-the Office of the Inspector General; the G-4 section of the General Staff; General Headquarters (a new creation of this period); and the Corps of Engineers-and in mid-1941, to the Armored Force (chart 3). Some of these assignments reflected the Army's expanding medical activities;

    29Letter, Secretary of War, to the President, 29 Apr. 1942.
    30(1) Medical Department, United States Army. Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1962, p. 433. (2) Brophy, Leo P., Miles, Wyndham D., and Cochrane, Rexmond C.: U.S. Army in World War II. The Chemical Warfare Service: From Laboratory to Field. Washington: U.S. Government Printing Office, 1959, pp. 101-122. (3) Letter, Brig. Gen. R. A. Kelser, VC, USA (Ret.), to Director, Historical Division, Office of The Surgeon General, 10 July 1951, with attachment, commenting on preliminary draft of this chapter.


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Chart 3.- Organization of the Army, showing assignment of medical officers to major offices, June 1941

others the increased staff work calling for technical advice by Medical Department officers or the General Staff's growing awareness of medical problems.

Army Air Forces Medical Division

The Medical Division of the Air Corps grew in size and stature during the emergency period in consonance with the rapid expansion of the air forces. The running argument in 1939 and 1940 over General Magee's effort to transfer the Medical Division to his jurisdiction had died down largely because the Air Corps had claimed that if the establishment of the Army Air Forces, already contemplated, took place, the new organization must have complete jurisdiction over its medical personnel. When the Army Air Forces was set up as the highest Air Force Command in mid-1941 and given control of its stations and all assigned personnel, The Surgeon General recommended that the Medical Division of the Air Corps be moved to the higher headquarters. In October Col. David N. W. Grant, MC, was transferred from the Medical Division, Office of the Chief of the Air Corps, to Headquarters, Army Air Forces (with an additional reassignment to the Chief of the Air Corps). At the same time he was designated "the Air Surgeon." By February 1942 he had succeeded in having the Medical Division, Office of the Chief of the Air Corps, transferred to his office. His office remained the major medical office within the Army Air


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Forces throughout the war.31 By mid-1941, some 8 months before the transfer took place, this office, which in the preemergency period had possessed only two medical officers, had acquired enough military and civilian personnel to staff a functional organization of several sections. At that time slightly more than 1,000 Medical Department officers (including Reserve officers), the majority qualified as aviation medical examiners or flight surgeons, were on duty with the various elements of the expanding Air Corps. As the year 1941 wore on it became obvious that the medical service of the Army Air Forces was becoming independent of The Surgeon General except for the latter's technical supervision in professional matters and his control over the procurement of medical personnel and supplies.32

Office of the Inspector General

The appointment of a medical officer to the staff of the Inspector General was an outgrowth of the Chief of Staff's dissatisfaction with the information he was receiving concerning needs for Army hospitals. In the spring of 1940 General Magee had prefaced a survey of the current status of hospital facilities with the words: "There devolves upon me, as Surgeon General of the Army, the inescapable duty of bringing to the attention of higher authority the unpreparedness of the Medical Department for war."33 He resubmitted a pre-vious request for authorization for 17,500 beds in station and general hospitals-less than half the number called for by the Protective Mobilization Plan.

The General Staff, particularly G-4, tended to minimize somewhat The Surgeon General's estimate of requirements for hospital beds and equipment. Among other considerations which made the staff hesitate to give them high priority was the possibility of using civilian hotels for Army hospitals. The General Staff also believed that General Magee was not giving due weight to the increased productive capacity, since the First World War, of the manufacturing facilities which produced medical supplies and equipment.

The draft removed this problem, under consideration throughout the Summer of 1940, from the ranks of academic questions, for the need for increases in all types of Army supplies and facilities was now apparent. However, the Chief of Staff, Gen. George C. Marshall, still puzzled over the conflicting statements as to requirements. Accordingly he asked the Inspector General for confidential information on the medical problems which would result from large troop concentrations. He was skeptical of requirements

    31(1) Coleman, Hubert A.: Organization and Administration, Army Air Forces Medical Service in the Zone of Interior, pp. 36, 69-77. [Official record.] (2) Army Regulations No. 95-5., 20 June 1941.
    32(1) Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, pp. 256-257. (2) Craven, Wesley F., and Cate, James L., Eds.: Army Air Forces in World War II. Volume VI, Men and Planes. Chicago: University of Chicago Press, 1955, pp. 362-397.
    33Memorandum, The Surgeon General, for The Adjutant General, 10 May 1940, subject: Status of Medical Department for War.


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estimates by technical services, and expressed doubt as to whether the Surgeon General's Office really needed all it had asked for. He remarked on the tendency of the War Department supply services to ask for more than they expected to get, thus clearing their skirts in advance of a possible investigation. He was under the impression that both G-4 and the Surgeon General's Office were giving him a "desk reaction" instead of a reaction based on direct observation of conditions in the Army at large.34

The request made of the Inspector General was an effort to get advice from an impartial unit of the War Department. In October General Marshall appointed a medical officer, Brig. Gen. Howard McC. Snyder, then medical adviser to the National Guard Bureau, as Assistant to The Inspector General. Before this date nearly all inspections of Medical Department installations by the Office of the Inspector General had been made by nonmedical officers. The Chief of Staff impressed upon General Snyder his own concern that all should go well with the medical service for the new inductees. General Snyder remained at his post throughout the war and, with the aid of his assistants in the Medical Division of the Office of the Inspector General, conducted inspections of various aspects of the medical service, both in the Zone of Interior and overseas, including hospitalization and evacuation, personnel, training, and other activities. He was instrumental in finding ways of making the most efficient use of hospital facilities and medical personnel.35

G-4 Medical Liaison

Shortly after General Snyder's appointment, Lt. Col. (later Brig. Gen.) Frederick A. Blesse, MC (fig. 15), one of several officers recommended by The Surgeon General, was assigned to G-4. Colonel Blesse's appointment enabled G-4 to get more direct professional advice on matters of medical supply and hospitalization and evacuation than formerly. He was a firm believer in effective staff work and attributed some of the difficulties which the Surgeon General's Office experienced in getting acceptance of its proposed policies to the lack of training and experience of some members of the Office in staff work. In G-4 a strong interest in plans for hospitalization and evacuation and various problems related to medical supplies for troops developed after Colonel Blesse was succeeded by Maj. (later Col.) William L. Wilson, MC (fig. 16), as The Surgeon General's representative on G-4 in 1941. Late in the year

    34(1) Memorandum, The Surgeon General, for The Adjutant General, 6 Apr. 1940, subject: Status of Medical Department for War. (2) See footnote 33, p. 48. (3) Memorandum, Acting Assistant Chief of Staff, for The Surgeon General, 10 Aug. 1940, and indorsements, subject: Increase in Number of General Hospitals. (4) Memorandum, Chief of Staff, for the Inspector General, 14 Sep. 1940, subject: General Hospitals. (5) Memorandum, Chief of Staff, for Deputy Chief of Staff, 13 Nov. 1940, subject: General Hospitals.
    35(1) Interview, Maj. Gen. Howard McC. Snyder, 25 May 1948. (2) Memorandum, Assistant Inspector General, for the Inspector General, 10 Nov. 1942, subject: Survey of Hospital Facilities and Their Utilization. (3) Inspector General's Report, 13 Jan. 1944, subject: Utilization of Medical Corps Officers in the Zone of Interior.


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and early in 1942, additional Medical Department officers were assigned to G-4 in a liaison capacity.36

Assignments of medical officers to G-4 of the General Staff and to the Office of the Inspector General were intended to establish more immediate sources of information on medical matters than the Surgeon General's Office afforded within the prevailing organization of the War Department. They also furnished a means by which the General Staff might appraise, without approach to the Surgeon General's Office, the efficiency of Army medical service. The placing of certain functions relative to the medical service in Army elements other than the Office of The Surgeon General, however, created the potential difficulty of disagreement on policy between the Surgeon General's Office and medical representatives at other levels of Army organization.

While no serious difficulties ever grew out of the relations of the Surgeon General's Office with the Office of the Inspector General, strained relationships between G-4 and the Surgeon General's Office developed by late 1941.

    36(1) Memorandum, The Surgeon General, for Acting Assistant Chief of Staff, G-4, 20 Sept. 1940, subject: Detail of a Medical Officer for Duty in G-4. (2) Letters, Brig. Gen. Frederick A. Blesse, MC, USA (Ret.), to Director, Historical Division, Office of The Surgeon General, 5 Dec. 1950 and 6 Sept. 1951, commenting on preliminary draft of this volume.


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Controversy originally arose over policy on the issuance of unit medical equipment to units in training in the United States. About May 1941 when Major Wilson entered on duty in G-4, G-4 began pressing The Surgeon General to issue equipment to "numbered" or tactical units, largely hospitals, being trained for oversea duty. The Surgeon General opposed issuance of the equipment for several reasons: the stations where units were assigned lacked space to store the equipment, the equipment might deteriorate or be damaged when handled by inexperienced troops, motor transport for moving it was lacking, and the units had adequate equipment for training purposes. His policy on the issuance of medical equipment was not in line with G-4's current policy for the issuance of all authorized equipment to units being trained for oversea duty. Although not emphasized at this time, a major reason for withholding hospital equipment was the fact that it was in short supply.

At a conference early in 1942 between The Surgeon General and Maj. Gen. (later Gen.) Brehon B. Somervell, then Assistant Chief of Staff, G-4, a compromise was effected. It was decided that units in training would receive soldiers' individual equipment, equipment necessary for field training, and motor transport. The full assemblage would be stored and would be issued only at the time the unit was specifically assigned by the War Department to a mission involving the care of the sick and wounded. Meanwhile General Somervell authorized Major Wilson to proceed on a tour of the United States


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extensive enough to permit a study of units being trained for hospitalization and evacuation and of their equipment. Major Wilson's findings with respect to the need for issuing equipment to units and his impressions as to lack of plans in the corps areas for hospitalization and evacuation in the event the United States was bombed led to conflict between him and members of the Surgeon General's staff in 1942.37

General Headquarters Medical Liaison

Medical representation was also established at General Headquarters set up in July 1940 to supervise the training of the field forces in continental United States-the four armies then being built up. In November a Medical Corps officer was assigned to the special staff of Maj. Gen. (later Lt. Gen.) Lesley J. McNair at the Army War College in Washington, D.C. The work of General Headquarters expanded in mid-1941 to include the planning and command of military operations. Medical Department officers assigned to its staff were charged with preparing the medical phases of operating plans for the base commands accompanying task forces sent overseas and for whatever expeditionary forces the course of events might require. A medical section was organized in July 1941, and Lt. Col. Frederick A. Blesse, MC (previously with G-4), became its head with the title of Surgeon, General Headquarters. His medical section, to which several Medical Corps officers were assigned in late 1941, prepared the medical plan for the Iceland Task Force and similar plans for other task and expeditionary forces. In planning the medical personnel and supplies to accompany a particular force, his office was aided by the appropriate division of the Surgeon General's Office or of the Air Surgeon's Office. This medical section had increased planning responsibilities throughout 1941. In the course of that year, the Bermuda, Newfoundland, and Greenland Base Commands were put under General Head-quarters, as well as the Caribbean Defense Command, and soon after the Japanese assault on Pearl Harbor the Northeastern and Western Defense Commands, transformed into the Eastern and Western Theaters of Operations, also came under its control. Early in 1942 it had brief command of the forces in the British Isles, and Colonel Blesse's office prepared the medical plan for V Corps.38

Armored Force Medical Section.-In mid-1941 a small medical section was also established at the Fort Knox headquarters of the Armored Force, created as a subcommand of General Headquarters. It consisted originally

    37Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 141-142, 151-152.
    38(1) Greenfield, Kent R., and Palmer, Robert R.: Origins of the Army Ground Forces, General Headquarters, U.S. Army, 1940-1942. Study No. 1, Historical Section, Army Ground Forces, 1946. [Official record.] (2) Interview, Brig. Gen. Charles B. Spruit, MC, USA (Ret.), 31 Oct. 1947. (3) Annual Report, Medical Section, General Headquarters, U.S. Army, 1941.


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of two Medical Corps officers, who had previously served at headquarters of I Armored Corps, and four enlisted men. Since German successes with tanks in the invasion of France during the summer of 1940 had made it appear likely that the Armored Force would achieve the status of a combatant arm separate from the infantry, the Army began building up armored divisions in greater proportion to infantry divisions. As General Magee pointed out, in protesting the tendency of Air Forces medical officers to emphasize the peculiar psychology of the airman and his special medical needs, the men in tanks also faced dangerous environmental conditions and special combat hazards. "Moreover," he stated, "in his steel-enclosed quarters, from which escape is difficult, with the firing of artillery in immediate proximity, with the presence of noxious gases from rapidly firing guns and the operation of motors, with the possibility of being blown to bits by landmines or being incinerated from the ignition of ammunition or gasoline, one would be slow to decide that the support of his morale or the furtherance of his physical recuperation is less in need of attention than that of the airman." Although they faced medical problems of a specialized character, the staff medical section at Armored Force headquarters apparently never developed any doctrine of separatism from the medical service of the rest of the Army.39

Corps of Engineers, Eastern Division.-Late in 1940 Lt. Col. (later Brig. Gen.) Leon A. Fox, MC (fig. 17), was assigned as chief health officer for the newly created Eastern Division of the Corps of Engineers. This assignment differed from the other assignments noted above in that Colonel Fox had concrete responsibilities for the furnishing of medical service whereas the others were mainly concerned with planning and with liaison. The task of the Health Division (within the Eastern Division) headed by Colonel Fox was to provide medical care for civilian employees of private business firms which had contracted with the Corps of Engineers for the construction of airbases at the sites (in Newfoundland, Bermuda, the Bahamas, Jamaica, Antigua, St. Lucia, Trinidad, and British Guiana) acquired by the destroyer-base agree-ment of September 1940 with the British.40 Colonel Fox's assignment and that of other medical officers to this work resulted in the development of a medical organization responsible to the Chief of Engineers rather than to The Surgeon General. It pioneered in establishing Army health service in foreign areas outside continental United States and the Army overseas depart-ments. Colonel Fox's headquarters was originally with the Eastern Division

    39(1) The Armored Force Command and Center. Study No. 27, Historical Section, Army Ground Forces, 1946. [Official record.] (2) Memorandum, Surgeon, Headquarters, Armored Force, for The Surgeon General, 22 Jan. 1943, subject: Record of Activities of the Armored Force Surgeon's Office From Date of Activation to 31 Dec. 1942. (3) Memorandum, The Surgeon General, for Commanding General, Services of Supply, 13 Oct. 1942, subject: Specialized Hospitals and Recuperative Facilities for Army Air Forces Personnel.
    40For more detailed and documented treatment, see Wiltse, Charles M. : The Medical Department: Medical Service in the Mediterranean and Minor Theaters. United States Army in World War II. The Technical Services. [In preparation.]


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headquarters in Washington, but he and certain assistants spent the first half of 1941 making sanitary surveys of the territories concerned, preparatory to selecting sites for the bases. The survey typically contained information on existing health facilities and specific disease hazards of the region. In the late summer of 1941, when the Caribbean Division and the Atlantic Division, both with headquarters in New York, superseded the Eastern Division, Colonel Fox was put in charge of the medical service for both. From late 1940 his office sent Medical Corps officers to the Engineer districts which served as the agencies for carrying out construction and other activities of the Corps of Engineers in the Caribbean area, Bermuda, and Newfoundland, and later in 1941 to the districts in Iceland and Greenland. By the end of 1941 one or more Medical Corps officers (11 at Trinidad) had been sent to each of the bases, and in several a Dental Corps officer was present. For a brief period the Engineer medical service, which included some small hospitals, existed side by side with the medical service developing for troops at the bases, but was withdrawn or merged with the latter as ground and Air Force units replaced engineer troops. Medical Department personnel assigned to the base setup were in a chain of command which led back to the General Staff through


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General Headquarters (through the Caribbean Defense Command as an additional echelon in the case of bases in the Caribbean).

RELATIONS WITH THE GENERAL STAFF

During 1940 and 1941 the War Department General Staff gave increasingly close supervision to the administration of Army medical service. Changes in requirements for medical supplies and accompanying storage space, increased hospital bed requirements to accord with increases in the authorized strength of the Army, and the adoption of standard plans for hospital construction led to closer contact between the Surgeon General's Office and G-4 as did the question of the issuance of unit assemblages to troop.41 Personnel guides proposed by the Surgeon General's Office for manning additional station and general hospitals in the United States, the office's calculations of the increased requirements for doctors, dentists, veterinarians, and nurses, and its plans for procuring, classifying, and assigning Medical Department officers and enlisted men required the approval of G-1. The dispatch of troops to oversea bases called for recommendations by the Surgeon General's Office as to the immunizations to be given them and other preventive measures to be taken for their protection; these had to be cleared with the War Plans Division of the General Staff as well as with G-4 and G-1.

Officers in the Surgeon General's Office stressed the importance of adopting certain preventive measures which they believed would maintain high standards of health in the growing Army. Acutely mindful of the heavy toll of the influenza epidemics of World War I, preventive medicine officers attempted, beginning late in 1939, to maintain adequate standards of air space, floor space, and ventilation in new hospitals under construction, as well as in barracks. In this effort they came into conflict with G-3 which was anxious to get as many soldiers into training as possible and hence wanted to house more men in the available barrack space than preventive medicine officers of the Surgeon General's Office thought desirable.42 The Chief of Staff and the General Staff hesitated to adopt in full some of the recommendations of the Surgeon General's Office for immunizations for troops. In the case of recommendations for certain task forces slated to go overseas, for instance, the uncertainty as to their destination and the time of their departure led to delay in staff approval. Although relations of the Surgeon General's Office with the General Staff remained formally the same as they had been in the prewar period, the staff became of necessity more involved than formerly with the details of operations of the medical service.

    41(1) Memorandum, Acting Assistant Chief of Staff, G-4, for Assistant Chief of Staff, G-1, 25 Nov. 1940, subject: Detail of Medical Officer to G-4. (2) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington : U.S. Government Printing Office, 1956, ch. II-IV.
    42Committee to Study the Medical Department, 1942, Exhibit 41.


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LOCAL AGENCIES AND FIELD UNITS PROVIDING MEDICAL
SERVICE

During 1940 and 1941, field installations engaged in Medical Department work increased markedly in number and size. The surgeon's offices of the corps areas and departments underwent similar expansion, while medical offices were created for the new defense commands and field armies, the rapidly growing air commands, and the new Atlantic bases. A few medical officers accompanied the military missions sent overseas to keep in touch with the war situation in various friendly countries. When the United States entered the war these officers became the nuclei of the medical sections of theater commands. Several became chiefs of service in their respective theaters of operations.

Field Installations

During 1940 and 1941 the field installations under command control of The Surgeon General increased in number and were augmented by one new type-the medical replacement training center. The Surgeon General still had command of the Army Medical Center with its Professional Service Schools and Walter Reed General Hospital, of the other "named" general hospitals in the United States (13 by October 1941), of the Medical Field Service School at Carlisle Barracks, and of the medical depots. During 1941 the floor space allotted to the medical depot system expanded almost fivefold. By the end of the year there were three medical depots, a depot having been established at Savannah and one at Toledo in addition to the St. Louis Medical Depot, and medical sections in nine general depots at the following locations: Chicago, Columbus (Ohio), New Cumberland (Pa.), New Orleans, New York, Ogden (Utah), San Antonio, San Francisco, and Schenectady.43

Early in 1941 two Medical Department replacement training centers were set up, one at Camp Lee, Va., in the Third Corps Area and the other at Camp Grant, Ill., in the Sixth Corps Area. These, designed to train enlisted men for Medical Department units, were originally placed, along with most replacement training centers, under direct control of the corps area commander. The Surgeon General, through the Plans and Training Division, exercised jurisdiction over such technical matters as the content of courses, the tables of organization for the various units, and so forth. Late in the year another medical replacement training center was established at Camp Barkeley, Tex., and soon afterward the three replacement training centers were placed under the direct jurisdiction of The Surgeon General. With a capacity of several thousand men each, they gave basic military training and certain specialized training for the position of medical and surgical technician, clerk, cook, chauffeur, and auto mechanic.44

    43Yates, Richard E. : The Procurement and Distribution of Supplies in the Zone of Interior During World War II, pp. 43, 157. [Official record.]
    44Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, pp. 159-161.


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Corps Areas, Departments, and Bases

Corps area medical service.-During the emergency period the organization of the corps area surgeon's office underwent a general expansion in numbers of personnel.45 Four field armies were being built up, and until late in 1940 the headquarters of several corps areas served also as the headquarters for a field army. The Medical Department annexes to the Corps Area Protective Mobilization Plans formulated by corps area surgeons' offices in 1939 had anticipated expansion in the event of mobilization. They had varied widely as to the number of officers, enlisted men, and civilians which they calculated a corps area surgeon's office would need in the event of mobilization, and as to the organization of his office. The plan for the Seventh Corps Area contemplated setting up 12 divisions, 11 of which tallied with the 12 contemplated for the Surgeon General's Office in its plan of 1939. A separate museum division for each corps area was unnecessary, of course. The twelfth was to be an Inspection Division. The plan for the same corps area for 1940, however, exhibited a tendency toward greater concentration of functions, listing only eight divisions. It contemplated a single Inspection, Preventive Medicine, and Vital Statistics Division instead of a full division for each of these functions, and it omitted the previously listed Nursing and Library Divisions.

In general the plans exhibited a lack of uniformity in unit designation, in numbers of personnel contemplated, and in organizational pattern. Nor did most of them specify the extent to which Medical Administrative Corps personnel would be substituted for professionally trained officers and the extent to which enlisted men and civilian personnel would be used in clerical positions. Wide divergencies thus render rather fruitless any attempt to indicate the degree to which the actual setup of the corps area surgeons' offices in 1940 and 1941 followed the medical annexes to the Corps Area Protective Mobilization Plans. The expansion which took place in the relatively large surgeon's office in the Second Corps Area seems typical enough to give an idea of general trends in expansion. In September 1940 this office consisted simply of four officers, six civilian clerical employees (three of whom were paid from Civilian Conservation Corps funds), one civil-service physician acting as Assistant Surgeon for the Civilian Conservation Corps, and six enlisted men. The corps area surgeon, who was, of course, on the special staff of the corps area commander, also served as surgeon of the First U.S. Army. The other three medical officers were a colonel of the Medical Corps, a captain of the Medical Administrative Corps, and a captain of the Medical Corps Reserve. The following month the assignment of the Reserve officers to the handling of professional administrative matters and training constituted the initial step toward the organization of the office on a functional basis as contemplated in the plan for the corps area.

    45This discussion of corps area medical services is based on : (1) Protective Mobilization Plans, First, Second, Fifth, Sixth, Seventh, and Eighth Corps Areas, 1939. (2) Annual Reports, all corps area surgeons, 1940 and 1941. (3) History, Office of The Surgeon, Second Corps Area and Second Service Command, From 9 September 1940 to 2 September 1945. [Official record.]


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By the end of the year the Headquarters of the First U.S. Army had been separated from that of the Second Corps Area. The corps area surgeon, Col. (later Brig. Gen.) Charles M. Walson, MC (fig. 18), had 10 officers assigned to him, as well as a chief nurse, an assistant surgeon for the Civilian Conservation Corps, and a liaison officer of the U.S. Public Health Service. During 1941, four officers were added. There were then in the Second Corps Area sur-geon's office 26 civilian employees and 17 enlisted men of the Medical Department, who with the 15 officers and the chief nurse made an aggregate of 59 in the office, exclusive of the assistant surgeon for the Civilian Conservation Corps and the liaison officer from the U.S. Public Health Service.

So long as the offices of the corps area surgeons remained small, the lack of clear-cut organizational lines presumably caused little trouble. Apparently the theory prevailed that a flexible organization with personal control exercised by the corps area surgeon, who might make frequent changes in assignment accord-ing to his needs, produced better results than a fixed organization with demarcation of duties. The corps area surgeon was able to keep in touch with all his staff. With continuous expansion of the corps area surgeon's office, however, this personal type of organization ceased to be feasible. The difficulty of making efficient assignment and classification of civilian personnel, especially of newcomers, under an organization with no fixed pattern was pointed out in a classification survey made of the civilian positions in the surgeon's office of the


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Eighth Corps Area in July 1941. With the rapid growth of corps area surgeon's offices in both military and civilian personnel, more detailed organizational charts and clearer delineation of function became necessary for efficient administration. By the end of 1941 the surgeon's office of the Eighth Corps Area, as well as that of one or two other corps areas, showed a more definite organizational pattern. The surgeon, his executive officer, the office administrator, and a chief clerk constituted the executive staff of the Eighth Corps Area surgeon's office. The following divisions existed: Professional, Finance and Supply, Dental, Civilian Conservation Corps, Veterinary, and Personnel. The Civilian Conservation Corps Division handled the corps area surgeon's responsibilities for providing medical service to Civilian Conservation Corps camps in the Eighth Corps Area; this work was an important task of corps area surgeons until the Civilian Conservation Corps was abolished in 1942. The surgeon's office of most corps areas had not attained the degree of organizational development reached by that of the Eighth Corps Area, but specific divisions and sections were emerging in all of them, including sections concerned with civilian personnel. These latter were a result of the rapid increase in use of civilians in hospitals in the corps areas.46

Two innovations in corps area medical service before the United States entered the war have already been recounted: the assignment of U.S. Public Health Service officers to corps area surgeons' offices, and the establishment of corps area laboratories. The assignment of a dental surgeon to each corps area headquarters in October 1940 was also a uniform development in the expansion of corps area medical organization.47 About the same date it was decided at a conference of corps area surgeons that a nurse in the grade of assistant superintendent would be assigned to each corps area surgeon's office to supervise the expanding nursing service throughout the corps area.48

Another development in corps area medical service, authorized in 1940 but not put into effect until 1941, was the establishment of the position of camp surgeon separate from that of hospital commander. It had been customary for camp or station surgeons to act also as hospital commanders, as the work involved in the two functions could be headed by a single medical officer. With the tremendous expansion of many Army camps after the draft, however, new duties developed which were distinct from the administration of the hospital proper, such as medical aspects of the processing of new recruits throughout the corps area, preparation of an increasing number of medical reports, and work on multiplying sanitary problems. At the same time the work of directing the expanding hospitals became a full-time activity.

    46Memorandum, Col. Achilles Tynes, MC, for Corps Area Surgeons and Department Surgeons, 12 Sept. 1940, subject: The Use of Civilian Personnel in Army Hospitals. 231.1 (Hawaiian Department)AA.
    47Medical Department, United States Army. Dental Service in World War II. Washington: U.S. Government Printing Office, 1955, p. 31.
    48Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, p. 245.


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The obvious solution was to divorce the two jobs of hospital commander and camp surgeon in the larger installations and to assign additional personnel to the office of the new camp surgeon to carry out the general duties noted above.

Departments and bases.-The establishment of the Caribbean Defense Command in the spring of 1941 was intended to coordinate the military activities of the Panama and Puerto Rican Departments with those of the Caribbean bases acquired from Great Britain under the agreement of September 1940. The command headquarters was located at Quarry Heights, C.Z., and the commanding general served in the additional capacity of commanding general of the Panama Canal Department. Three "sectors," the Panama, Trinidad, and Puerto Rican Sectors, were set up. The area was neither geographically nor politically cohesive. The Puerto Rican Sector included the Virgin Islands, Jamaica, Cuba, and Antigua; and the Trinidad Sector eventually included Dutch, British, and French Guiana, as well as St. Lucia, Aruba, and Curaçao. Moreover, the Commanding General, Caribbean Defense Command, apparently preferred to keep his special staff small in order to preserve the mobility of his headquarters in the event of enemy attack. The creation of a staff medical section was postponed, and the surgeons of the departments and of the multiplying base commands in this area continued to report directly to the War Department. The medical service maintained by the Corps of Engineers for civilians employed on Army construction in the bases existed side by side with the usual Army medical service for ground and air troops and further complicated the structure of Army medical organization within the bases. The Caribbean Air Force, which was established in May 1941, absorbing the previous Panama Canal Department Air Force, had its own surgeon and medical organization. Thus Army medical service in the Caribbean Defense Command was directed by, and reported through, three command channels during early war years. Although the regions around the Caribbean presented a homogeneity of medical problems, no unification of Army medical service under a surgeon at Caribbean Defense Command headquarters took place until October 1943.49

Except for a general expansion to furnish medical care for increasing forces, few significant changes took place in the organization of medical service in the Hawaiian and Philippine Departments until the Pearl Harbor attack. No surgeon was appointed for the new tactical command, the U.S. Army Forces in the Far East, organized in the Philippines in July 1941. The departmental surgeon continued as head of the medical service in that area.

Armies and Continental Defense Commands

Field army surgeons.-The offices of field army surgeons were revived when the headquarters of the four field armies were established separately from

    49(1) History of Medical Department Activities in the Caribbean Defense Command in World War II, vol. 1, pp. 105ff and 155ff. [Official record.] (2) Annual Reports, Surgeon, Puerto Rican Department, 1940, 1941. (3) Annual Reports, Surgeon, Panama Canal Department, 1940, 1941. (4) Annual Reports, Surgeon, Hawaiian Department, 1940, 1941. (5) Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, pp. 40-41.


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the headquarters of four corps areas with which they had previously been integrated. The offices of army surgeons did not differ greatly from the offices of corps area surgeons; during the initial stages of their development, they rather resembled the corps area surgeons' offices of 1939 in smallness and simplicity.

When separate headquarters were established, the Army surgeon's office consisted of the surgeon and one or two officers and enlisted men. The War Department at that time authorized one Reserve medical officer in addition to the Regular Army surgeon, with a provision for later increase to three Reserve officers. The Surgeon General and the army surgeons recommended that all four officers be of the Regular Army; other than the surgeon, a plans and training officer, who would act as executive assistant to the surgeon; the army dental surgeon; and the army veterinary surgeon. Believing that Reserve officers had not had sufficient experience to qualify them for training duties, The Surgeon General stressed the importance of having a Regular Army officer fill the position of plans and training officer, who would be the normal alternate for the surgeon. In December the four Regular Army officers were authorized. In April 1941 the number of officers was increased to six and in September to eight. The number of enlisted men allotted to the Army surgeon's office increased proportionately.

In 1941 medical officers were not available in the numbers needed to fill all the positions for which they were authorized, and the number assigned to the army surgeon's office was not usually equal to that allotted. Although the army surgeons' offices were theoretically set up on a functional basis by this date, it was thus not always possible to establish all of the organizational subdivisions called for. Some units of an army surgeon's office originally thought necessary were found to be necessary only during maneuvers. Except in one or two instances permanent assignments of dental and veterinary surgeons were found unnecessary during the emergency period as the corps area medical organization provided the requisite service. The fact that during maneuvers an army's units might be dispersed among several corps areas seemed to argue against a settled functional pattern for the office of an army surgeon, subject as it was to periodic unsettlement.50 The supervision of training was an important function of both the corps area surgeon and the army surgeon, but neither was responsible for all the training of medical troops within his jurisdiction. In general the tactical medical units of armies received technical training in hospitals under the jurisdiction of corps areas, while personnel assigned to the medical installations of corps areas were given tactical training with the armies. Sanitation was

    50(1) Bronk, William W. : History of the Eastern Defense Command, 1945. [Official record.] (2) History of the Western Defense Command, 17 March 1941-30 September 1945. [Official record.] (3) Annual Report, Surgeon, Headquarters, Eastern Theater of Operations, and First U.S. Army, 1941. (4) Annual Report, Surgeon, Eastern Defense Command and First U.S. Army, 1942. (5) Annual Report, Surgeon, Second U.S. Army, 1941. (6) Annual Reports, Surgeon, Third U.S. Army, 1941 and 1942. (7) Annual Report, Surgeon, Fourth U.S. Army, 1941.


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primarily a responsibility of corps area command, but the army surgeon was responsible for sanitary precautions in the field. While the army remained at its home base the corps area command furnished it hospitalization and medical supplies. On maneuvers hospitalization became a concern of the army surgeon, but responsibility beyond the stage of the evacuation hospital rested with the station and general hospitals of the corps area within which particular army units were stationed. As for dental treatment and training in dentistry, the regimental dispensaries and aid stations of armies confined themselves to making dental surveys and to providing emergency treatment and training in the handling of emergency cases. Cases requiring definitive treatment or specialized dental equipment were handled in the camp dental clinics and hospital dental clinics of corps areas, and the clinics gave instruction in the care of such cases.

Defense command surgeons.-In March 1941 the continental United States was divided into four defense commands, the Northeastern, Central, Southern, and Western. The Northeastern Defense Command was redesignated the Eastern Theater of Operations in December 1941, which in turn was renamed the Eastern Defense Command 3 months later. The Eastern and Western Defense Commands exceeded the others in importance, as they comprised most of the eastern and western coastal areas. The commanding generals of the armies located in them took over the administration of these defense commands. Hence in 1942 the surgeon of the First U.S. Army, Col. (later Brig. Gen.) Frank W. Weed, MC (fig. 19), was also surgeon of the Eastern Defense Command, which eventually included (though it did not supersede) not only the First, Second, Third, Fifth, and Sixth Corps Areas, and that portion of the Fourth Corps Area that comprised the Carolinas, Georgia, and Florida, but also the base commands in Iceland, Greenland, Newfoundland and Bermuda. The surgeon's office was at the joint headquarters of the First U.S. Army and the Eastern Defense Command on Governors Island, N.Y. Col. (later Brig. Gen.) Condon C. McCornack, MC (fig. 20), surgeon of the Fourth U.S. Army, became similarly surgeon at the joint headquarters of Fourth U.S. Army and Western Defense, Command at the Presidio of San Francisco. The Alaska garrison which had grown rapidly during 1940, being then attached to the Ninth Corps Area, had become the Alaska Defense Command early in 1941 and was now assigned to the Western Defense Command.

Medical installations within the boundaries of the defense commands were for the most part under corps area jurisdiction, but a few station hospitals in the Atlantic bases and in Alaska-immediately under the base commands were within the defense command chain of control.51

During the southern maneuvers of 1941, certain problems of medical administration, already prophesied by army surgeons, developed. The army

    51(1) See footnote 50 (1) and (2), p. 61. (2) McNeil, Gordon H.: History of the Medical Department in Alaska in World War II (1946). [Official record.]


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surgeons' offices had to split up, a portion going forward with troops, and the rest remaining at headquarters. Certain officers, especially dental and veterinary, and a medical inspector, had to be added temporarily during maneuvers. This situation strengthened, if it did not clinch, the argument for sufficient medical personnel in the army surgeon's office to allow for such divided operation during maneuvers. A similar need for additional personnel later developed in oversea theaters whenever large headquarters split into forward and rear echelons. During the maneuvers many units of the army for whose health the army surgeon was responsible were stationed in, or moving about, territory outside their home corps area. The corps area surgeon was interested in reports on the sick and wounded, and on sanitary conditions, from stations within the geographic limits of the corps area. The army surgeon was interested in getting the same statistics from the units of the army command. Aside from the intrinsic value of the reports for information as to the health of the command, it was desirable to train the medical officers in units to prepare the reports which they would have to make if their units were moved overseas. It became a special problem for the army surgeon to obtain the necessary reports whenever units of the army were stationed in some corps


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area other than the army's home territory. The problem was finally solved by negotiation between army surgeons and corps area surgeons and by clarifying regulations issued by the War Department.52

Medical Units for Oversea Service

Field units.-While the army surgeon's offices were building up, the medical elements of subordinate commands of the field army-that is, the tactical medical units-were being activated. The Plans and Training Division of the Surgeon General's Office was engaged throughout the emergency period in reorganizing these units and revising their tables of equipment. The reduction in strength of the standard field army, army corps, and division which was underway at this date, and the concomitant transformation of the division from a unit composed of four regiments (the "square division") into one composed of three regiments (the "triangular division"), made necessary much revision of standard medical units. The medical regiment, which had served the corps and the square division, was replaced by the medical battalion as the largest unit. However, the field forces were not at once completely reorganized, and

    52See footnote 50 (3), p. 61.


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some medical regiments continued to exist until after the entry of the United States into the war. The structure of the medical detachments "organic" to combat regiments and of the evacuation and surgical hospitals normally attached to field armies also underwent revision.

Communications Zone units.-The planning of the emergency period further included the medical units which were to operate in the communications zone of an oversea theater, such as the station and general hospitals, the medical laboratories, and the medical supply depots. These were distinct from their counterparts in the Zone of Interior in having a standard structure or "table of organization." The Planning and Training Division also developed new types of medical units to serve with such new types of Army units as the armored division airborne division, and mountain division.

Subordinate Air Commands

Throughout the emergency period and the war, surgeons' offices sprang up in the shifting commands and forces under the Air Corps and, after June 1941, the Army Air Forces. These commands had a surgeon on the special staff of the commanding officer, although few had any appreciable number of medical personnel at headquarters until late in 1941.

A few air commands undertook medical work peculiar to the air forces. These were chiefly of two types: the training commands, concerned with the training of aircrews (usually referred to as "flying training") and with the training of technicians for ground crews (called "technical training"), and the service or maintenance commands, concerned with supply and maintenance. The major departure from the standard Army pattern of medical service developed in the training commands, which were engaged in selecting a body of men for flight training and combat training on the basis of special physical and psychological attributes.

Air training commands.-Besides the general administration of medical service resembling the work of the surgeon's office of any command, the air training commands administered a series of elaborate tests, which went considerably beyond the usual physical and mental tests, to candidates for pilot training. Until July 1940 the Air Corps Training Center at Randolph Field, San Antonio, Tex., was responsible for the training of all fliers. At that date it was split into three centers, located at Randolph Field, at Moffett Field, Calif., and at Maxwell Field, Ala. The staffs of these centers eventually included a surgeon who headed a small office. Among the early duties of the training center surgeons was the task of passing upon the healthfulness of potential sites for Army flying schools and that of sites of civilian flying schools under consideration for contract by the Air Corps. When schools were established or selected, the surgeons had the responsibility of making arrangements for


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medical service for trainees at each school either through the assignment of medical personnel to the school or through contract with civilian doctors.53

In the fall of 1941 and in early 1942 three Air Corps replacement training centers were set up, one under the jurisdiction of each of the training centers, at the following locations: Maxwell Field; Kelly Field, Tex.; and Santa Ana, Calif. At these were established "psychological research units" to put into effect the results of a psychological research project begun about mid-1941 in the Medical Division, Office of the Chief of the Air Corps. The latter had been working not only on physical and mental tests but also on psycho-motor tests to measure the muscular coordination, equilibrium, and so forth, of pilot candidates. The new psychological research units, staffed with officers trained in psychology, were to apply the tests, experimentally at first, to candidates at the replacement training centers and carry on research in this field.

Until March 1941 the training for ground crews in mechanics, photography, radio, and so forth, was conducted by the Air Corps Technical School at Chanute Field, Ill. Out of the staff surgeon's office developed the office of the surgeon for the Air Corps Technical Training Command (with headquarters first at Chanute, Field, later at Tulsa, Okla.), which was established in March 1941 with responsibility for technical training for the Air Corps throughout the United States. For this training, as well as for flying training, contracts were made with civilian schools, in some cases the same schools as those used for flying training. As in the case of the flying trainees, medical service was insured for technical trainees either by providing in the contract for the services of school physicians, by making special contracts with civilian doctors, or by assigning Army medical officers to the work whenever the number of trainees so warranted.

Supply and maintenance commands.-The second type of air command, that dealing with supply and maintenance, also existed in two separate commands in the latter part of the emergency period: The Materiel Division (later termed the Materiel Command), and a succession of commands which finally became in October 1941 the Air Service Command. The principal function of the Materiel Division was that of procuring supplies for the Army Air Forces. Its one function in the special field of aviation medicine was the administration of the Aero-Medical Research Unit at Wright Field. The work of the Aero-Medical Research Unit was hampered by lack of technically trained personnel until a group of specialists sponsored by the National Research Council began to arrive in early 1941. Not until early 1942 was the name of the unit changed to Aero-Medical Research Laboratory and con-

    53(1) Coleman, Hubert A.: Organization and Administration, Army Air Forces Medical Service in the Zone of Interior, pp. 157-183. [Official record.] (2) History of the Army Air Forces Flying Training Command and its Predecessors, 1 January 1939-7 July 1943 (1 March 1945), vols. I, II. [Official record.] (3) History of the Army Air Forces Technical Training Command and Its Predecessors, 1 January 1939-7 July 1943 (1 March 1945), vol. I. [Official record.] (4) History of The Army Air Forces Training Command, 1 January 1939-V-J Day (15 June 1946), vol. II. [Official record.] (5) Annual Report, Office of The Air Surgeon, 1942.


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struction of a main building to house the laboratory undertaken at Wright Field. The Air Service Command determined requirements and handled distribution of supplies for the Army Air Forces. Neither it nor its predecessors had any functions peculiar to the field of aviation medicine, but as the command employed thousands of civilians, its headquarters surgeon supervised a large program of industrial medicine. The functions of his office were closely related to those of the Occupational Hygiene Branch (later Division) of the Surgeon General's Office and in some respects duplicated them.54

Numbered air forces.-Soon after the four Army defense commands were announced in March 1941 and their administration combined with that of the four armies, four similarly numbered air forces were set up to operate under Headquarters, Army Air Forces. The office of the air force surgeon, or flight surgeon, who was on the special staff of the air force commander, consisted originally only of the surgeon and one or two enlisted men. The medical section advised the commanding general on the health and sanitation of the air force under his command, the training of all personnel in sanitation and first aid, and on hospitalization and evacuation; supervised the operation of medical service in subordinate units and the training and inspection of Medical Department troops; handled the procurement, storage, and distribution of medical, dental, and veterinary equipment through the usual channels; and prepared records and reports. The four numbered air forces, under command of the Air Corps, were charged with air defense of the United States and with giving intensive training to aircrews and attached ground personnel. Although the areas assigned to them did not coincide entirely with the boundaries of the defense commands, they were coordinated with the defense commands as follows: First Air Force, Eastern Defense Command; Second Air Force, Central Defense Command; Third Air Force, Southern Defense Command; and Fourth Air Force, Western Defense Command. Like the First and Fourth U.S. Armies, identified with the Eastern and Western Defense Commands, respectively, the First and Fourth Air Forces were those concerned primarily with defense of the coastal areas. The operations of the Second and Third Air Forces were eventually confined largely to training.55

Like the combat arm it served, the medical organization of the air forces was building up all through 1941. In addition to operational activities, the air force surgeon's office set up the necessary medical reporting system, and aided in surveying sites for new air bases. Additional medical personnel came in with units sent to the new bases, and air base surgeons were assigned. In

    54(1) Medical History, Air Technical Service Command, 1 January 1945. [Official record.] (2) Mitchell, T. W., Walker, Imogene B., and Smith, Duane D.: History of the Army Air Forces Service Command, 1921-1944 (1945). [Official record.] (3) History of the Army Air Forces Materiel Command, 1926-1941, vols. I, II. [Official record.] (4) History of the Aero-Medical Laboratory, 1935-1943. [Official record.]
    55(1) Coleman, Hubert A.: Organization and Administration, Army Air Forces Medical Service in the Zone of Interior, pp. 185-219. [Official record.] (2) History of The First Air Force. Vol. I, Organization Development. [Official record.] (3) History of Headquarters, Second Air Force, vol. I. [Official record.]


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February 1941, while trying to straighten out the matter of source of payment to civilian employees requested for the surgeons' offices, the Surgeon General's Office referred to them as "new organizations with which this office has had no previous experience, and on which information available to The Surgeon General is relatively meager." These offices were small and expanded only slightly during 1941. Among the personnel added at intervals were an assistant flight surgeon and a veterinary officer (added to the staff of each air force surgeon about the middle of 1941). The surgeons' offices of air forces did not find it necessary to adopt a fully functional pattern of organization until about the end of 1942.

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