U.S. Army Medical Department, Office of Medical History
Skip Navigation, go to content

HISTORY OF THE OFFICE OF MEDICAL HISTORY

AMEDD BIOGRAPHIES

AMEDD CORPS HISTORY

BOOKS AND DOCUMENTS

HISTORICAL ART WORK & IMAGES

MEDICAL MEMOIRS

AMEDD MEDAL OF HONOR RECIPIENTS External Link, Opens in New Window

ORGANIZATIONAL HISTORIES

THE SURGEONS GENERAL

ANNUAL REPORTS OF THE SURGEON GENERAL

AMEDD UNIT PATCHES AND LINEAGE

THE AMEDD HISTORIAN NEWSLETTER

Chapter III

Contents

CHAPTER III

The Medical Department Under the Services of Supply,
March-September 1942

In the months following the attack on Pearl Harbor, the chief development affecting the administration of the Surgeon General's Office was the reorganization of the War Department in March 1942. This resulted in a change in the position of The Surgeon General and his office within the War Department, as well as a number of changes in the internal organization of the office.

CHANGES IN THE SURGEON GENERAL'S OFFICE
DECEMBER 1941 TO MARCH 1942

After the entry of the United States into war in December 1941, the Surgeon General's Office, in common with many Federal agencies in Washington, "mushroomed," new divisions and branches being created to handle increased responsibilities.

Training and Hospital Construction

Among the immediate problems were those of increasing the number of Medical Department units and intensifying their training. In January the Secretary of War approved plans for an expansion of the Army to 3,600,000 enlisted men by the end of the year, with special emphasis on expansion of training in the schools and replacement training centers. More hospitals would be necessary for the expanding Army. Thus two activities, training and hospital construction, emerged, with the advent of war, from the realm of planning and became fields of immediate operations. In February 1942 the Training Subdivision achieved the status of a division, with Planning left as a separate division. The former Hospital Construction and Repair Subdivision of the Planning and Training Division was reorganized into the Hospital Construction Division. As the Protective, Mobilization Plan of 1939 had contemplated, the administration of the Army Medical Museum, formerly a function of the Professional Service Division, was raised in the same month to the level of a division, for increased work in pathology had also resulted from the expanded medical work of the Army. Early in 1942, therefore, the office was made up


70

of 15 divisions, with personnel of approximately 150 officers and 1,000 civilians by
March (chart 4).1

Expanding Activities

The office subdivisions most significant for future development were those of the Preventive Medicine Division, especially Occupational and Military Hygiene which became for the first time a separate subdivision; those of the Finance and Supply Division; those handling medical specialties, such as neuropsychiatry, medicine and surgery, in the Professional Service Division; and, finally, two new subdivisions added to the Administrative Division, the Public Relations and Intelligence Subdivision and the Historical Subdivision. Most of these rose to divisional status during 1942.

The historical program.-The month of August 1941 had witnessed the genesis of the Medical Department's historical program. The Surgeon General, "feeling that some steps should be taken for the organization of the historical work of the Medical Department," had recalled Col. Albert G. Love, MC, Chief of the Plans and Training Division from April 1938 to his retirement in mid-1941, to active duty to head this work. His action anticipated by some months the inception of the general War Department historical program, which developed under the impetus of President Roosevelt's expressed interest. In 1941 the only other organizational unit of the War Department engaged in historical work was the Historical Division of the Army War College, in existence since World War I. The Medical Department, which had maintained a historical unit in the years 1917-29 and had produced during those years a comprehensive account of its activities in World War 1,2 was more "history-conscious" than most offices of the War Department.

However, the scope of the historical work then contemplated was quite limited, since the United States was not at war and the Medical Department had undergone only the expansion of the emergency period. Moreover, the Division of Medical Sciences of the National Research Council then planned to sponsor a history of medical activities, both military and civilian, during the emergency period. The Chief of the Historical Subdivision, mindful of difficulties encountered by the editor of the history of the First World War (Col. Frank W. Weed) and convinced that the Council was in a better position than the Medical Department to obtain qualified personnel, cooperated with the plans of that body. He limited his own plans to the production of some volumes on the administrative and tactical phases of the Medical Department's work not

    1(1) Morgan, Edward J., and Wagner, Donald O.: Organization of the Medical Department in the Zone of Interior (1946), p. 9. [Official record.] (2) Annual Report, Operations Service, Office of The Surgeon General, 1942. (3) Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S. Government Printing Office, 1942, p. 172. (4) Letter, The Adjutant General, to Commanding Generals, Army Air Forces, Army Ground Forces, and Services of Supply, 7 Apr 1942, and inclosure: Mobilization and Training Plan (15 Jan. 1942).
    2The Medical Department of the United States Army in the World War. Washington: U.S. Government Printing Office, 1923-29, vols. I-XIII.


71

Chart 4.-Organization of the Office of The Surgeon General, 21 February 1942


72

included in the Council's program.3 Later in the war the scope of the Medical Department's official history was greatly broadened.

WAR DEPARTMENT REORGANIZATION OF MARCH 1942

In a general War Department reorganization of March 1942, the Medical Department was placed under the Services of Supply or the Army Service Forces as the command was later called. This reorganization had a good deal to do with determining the structure of the Medical Department throughout the war. Some changes in organization of the medical service at various levels in the Army resulted from a natural coordination of the subordinate service with the new superstructure, others from direct orders and recommendations of Services of Supply headquarters (figs. 21, 22).

Effect Upon the Medical Department's Position in the
War Department

The Surgeon General and the Medical Department, along with the Corps of Engineers, the Quartermaster Corps, and the rest of the supply services (later termed "technical services"), were placed in March under the direct com-

    3(1) Office Order No. 237, Office of The Surgeon General, 22 Aug. 1941. (2) Love, Albert G.: The Historical Division, 1 Aug. 1941-28 July 1945. [Official record.]


73

mand of Maj. Gen. (later Lt. Gen.) Brehon B. Somervell, Commanding General of the Services of Supply. The Army Ground Forces (replacing General Headquarters as a Training Command) and the Army Air Forces, established as major commands along with the Services of Supply, were to be provided by the latter with "services and supplies to meet military requirements," except "those peculiar to the Army Air Forces" (chart 5).

With the reorganization, the operating functions of the Office of the Under Secretary of War and of G-1 and G-4 of the War Department General Staff were transferred to the Services of Supply. Thus the reorganization led to the interposition of the Commanding General, Services of Supply, between The Surgeon General and the Secretary of War and between The Surgeon General and the Chief of Staff. Under the original setup General Somervell had a Chief of Staff, a Chief of Procurement and Distribution, and a "functional staff " consisting of an officer in charge of each of certain functions, such as operations, control, training, personnel requirements, and defense aid. With all of these, or, at later dates, with their successors, the Medical Department had close relations. The divisions of the Surgeon General's Office which handled functions relating to civilian and military personnel and to training, for example, dealt with their obvious counterparts in the Services of Supply. Relations of the Surgeon General's Office with G-1, G-3, and G-4 of the War Department General Staff continued also, although it was intended that the reorganization should make close relations with the General Staff unnecessary.


74

Chart 5.-The Medical Department within the War Department structure, August 1942


75

The Services of Supply Operations Division

The reorganization led to a shift of some of the medical offices and medical responsibilities assigned to elements of the War Department other than the Surgeon General's Office to new positions in War Department and Army structure. By August 1942 medical offices were located in other elements of the War Department than the Surgeon General's Office (chart 5). The functions in the field of planning for medical supply handled by Maj. (later Col.) William L. Wilson in G-4 of the War Department General Staff were transferred under the March reorganization to the Operations Division, headed by Brig. Gen. (later Lt. Gen.) LeRoy Lutes, of the Services of Supply. Major Wilson was stationed in General Lutes' office until the middle of 1943. Under the original setup, General Lutes' office was given responsibility for preparing plans and instructions on projected and current operations in order to coordinate the work of the supply services and that of the corps areas in troop movements and the movements of supplies and equipment. In this work it was to maintain close liaison with divisions of the War Department General Staff and those of the Army Ground Forces and the Army Air Forces. In April 1942 the functions of General Lutes' Operations Division, the only division in the upper structure of the Services of Supply which contained a medical officer for purposes of liaison, were redefined and extended to include the planning of requirements as to equipment and supply for troops overseas. To the extent that medical matters fell within the scope of these activities, Major Wilson promoted at that time to lieutenant colonel, and to full colonel in October was responsible for liaison with the Surgeon General's Office.4

Colonel Wilson carried on his liaison work while assigned to the Miscellaneous Branch of the Planning Subdivision of General Lutes' Operations Division. He emphasized the constant staff work which he had to undertake and informed General Lutes of his belief that a medical section, to be headed by a medical officer of the rank of colonel, should be established in the Miscellaneous Branch. When General Lutes' title was changed in July from Director of the Operations Division, Services of Supply, to Assistant Chief of Staff for Operations, Services of Supply, and the scope of his activities was broadened, a Hospitalization and Evacuation Branch, headed by Colonel Wilson, was created within the Plans Division of General Lutes' office. The duties of the Hospitalization and Evacuation Branch, Services of Supply, which included several other Medical Department officers late in the year, embraced liaison with surgeons of the Western Task Force in planning the handling of medical

    4(1) Memorandum, Commanding General, Services of Supply, for Chiefs of all Supply Arms and Services, Corps Area Commanders, etc., 9 Mar. 1942, subject : Initial Directive for the Organization of Services of Supply. (2) History of Planning Division, Army Service Forces, ch. XIX. [Official record.] (3) Services of Supply Circular No. 7, 25 April 1942. (4) Leighton, Richard M. : History of Control Division, Army Service Forces, 1942-45 (April 1946). [Official record.] (5) General Orders No. 4, Services of Supply, 9 April 1942 ; and No. 24, 20 July 1942. (6) See also Millet, John D.: The Organization and Role of the Army Service Forces. U.S. Army in World War II. Washington: U.S. Government Printing Office, 1954.


76

supplies for the landing in French Morocco and the evacuation of the wounded back to the United States. As the responsibilities of this medical office broadened, disagreement arose over its responsibilities vis-a-vis those of the Surgeon General's Office in the preparation of plans for hospitalization and evacuation and other phases of medical administration.

Medical functions at other levels

In addition to this shift of Medical Department representation from G-4 of the General Staff to Operations, Services of Supply, the reorganization brought about changes in the relations of the Surgeon General's Office with some of the other War Department and Army offices where medical officers were stationed. (Medical representation on the National Guard Bureau had disappeared in late 1941, for the Bureau's activities declined as the National Guard was absorbed into the Army, and no medical officer was stationed there again until after the war.) Relations with the Medical Division of the Chemical Warfare Service were scarcely affected by the reorganization, as the Office of the Chief of Chemical Warfare Service was shifted, like the Surgeon General's Office, to the jurisdiction of the Services of Supply and remained on the same level with the Surgeon General's Office.

Under the reorganization the Headquarters, Army Ground Forces, succeeded General Headquarters as the chief command for training ground troops, and the group of medical officers constituting the Medical Section, General Headquarters, were transferred to Army Ground Force headquarters at the Army War College, Washington, D.C., with Col. Frederick A. Blesse as surgeon and head of the staff medical section.5

Although the new organization placed the Army Ground Forces on the same level with the Services of Supply (chart 5) and hence the Ground Surgeon on the same level as The Surgeon General, only minor difficulties developed in the course of the war in the relations of the two offices. The story of the relations between the Surgeon General's Office and the Medical Division of the Army Air Forces, however, is quite otherwise. In spite of the role of the Army Service Forces as the supply agency for the War Department and Army, the Medical Division of the Army Air Forces used the fact that it was now operating under a jurisdiction on the same organizational level as the Services of Supply as leverage for developing a medical service independent of the Surgeon General's Office. It took the position that The Surgeon General had been reduced by the March reorganization to the status of surgeon for elements of the Services of Supply alone. The Ground Surgeon, who might also have taken this position, apparently never did so.

The Chief of the Medical Division of the Inspector General's Office, Brig. Gen. Howard McC. Snyder, was actually at a higher level under the new organization than was The Surgeon General, for the Inspector General remained on

    5Annual Report, Personnel Service, Office of The Surgeon General, 1942.


77

the War Department Special Staff. Inspections of medical installations made by General Snyder's office were those directed by the Secretary of War, the Chief of Staff, or those requested by the commanding generals of Army Ground Forces, Army Air Forces, and the Services of Supply. Despite General Snyder's responsibility, under the direction of higher authority, for making critical appraisal of the work done at various Medical Department installations, including those overseas, no serious friction developed between his office and the Surgeon General's Office.

Attempts to clarify the Medical Department's new relationships

In the early months after the reorganization, much effort was devoted to clarifying the Medical Department's new relationships with other segments of the War Department. At the outset General Magee called to General Somervell's attention certain problems that his office had encountered in the administration of the Army medical service under the previous organization by reason of having to deal with several sections of the War Department General Staff and other War Department agencies. He stressed the difficulty of obtaining decisions on Medical Department proposals from a single War Department element with final authority. In the case of some proposals, he reported, a good many months had elapsed before he could get any action. He noted conflicting decisions or instructions received by his office from various segments of the General Staff and from General Headquarters. The failure of higher authority to furnish his office promptly with full information as to type, size, and destination of task forces had made it difficult to plan properly for hospitals, tactical medical units, and supplies to accompany forces overseas. A third problem lay in the issuance, upon some occasions, of Army regulations, or other official documents affecting Medical Department operations, without prior submission of drafts to the Surgeon General's Office: resultant errors had made revisions necessary. In certain War Department planning The Surgeon General's responsibility for directing the medical service of the Air Corps had not been taken into consideration. Finally, many tactical medical units, such as hospitals, medical supply depots, and laboratories, had passed from the control of The Surgeon General to that of the field armies. They had later been emasculated by the removal of key personnel to other units. Tactical medical units, Magee maintained, should remain under his jurisdic-tion until assigned to a task force. He made three major recommendations: that definite uniform staff channels be followed, that prompt information on task forces be furnished the Surgeon General's Office, and that official direc-tives affecting the Medical Department be submitted to it prior to issuance.6

General Lutes, Director of the Operations Division, replied for General Somervell, advising a use of the "judicious shortcuts" advocated in the circular reorganizing the War Department as a method of obviating difficulties in get-

    6Memorandum, The Surgeon General, for Commanding General, Services of Supply, 16 Mar. 1942.


78

ting prompt and final decision. He also listed for the information of The Surgeon General and his staff the staff elements of the Services of Supply with which they should deal in handling specific matters. These included various subdivisions of his own Operations Division, which were to be consulted on current war planning, on the activation, organization, and tables of organization of units, on the movements of troops and supplies, and on coordination of supply. The Miscellaneous Subdivision (to which Maj. William L. Wilson, MC, was assigned) was to be consulted on hospitalization and evacuation and miscellaneous matters not coming within the jurisdiction of other Services of Supply divisions. All medical matters involving the Army Ground Forces or the Army Air Forces were to be submitted for approval to General Somervell. With regard to the complaint as to lack of information on task forces, General Lutes stated that the War Plans Division (soon to be renamed Operations Division) of the General Staff was making every effort to allow more time in the planning of units and supplies for task forces.7

Information on task forces.-Some of these difficulties of the Surgeon General's Office, particularly the problems of relations with the Army Air Forces medical organization and the lack of information on task forces, persisted. This last problem was not peculiar to the Medical Department, for the interests of secrecy information on troop movements was limited to as few officers as possible. A number of other War Department offices, including Headquarters, Services of Supply, voiced the same complaint at intervals. Within the Surgeon General's Office, officers of the Preventive Medicine Division in particular stressed the necessity of their being kept informed of the destination and composition of task forces and the general military situation at the location, as well as the types of medical installations planned. They needed the information in order to provide troops with advance detailed information on methods of controlling communicable diseases in specific areas and to select such specialized personnel as malariologists, sanitary engineers, and laboratory staff members to accompany forces overseas.

On the other hand, members of the Surgeon General's Office who dealt directly with higher War Department officials engaged in setting up task forces were somewhat unsympathetic with the point of view of the specialists in preventive medicine. They appear to have accepted the necessity for confining information on the destination of task forces to four or five officers in the War Department, pointing out that even the commander of a task force sent to Australia, for example, would not be informed of its ultimate destination in the Pacific. They minimized the need for advance information on the size of the task force and its mission, stating that malaria would be a problem in Gambia, whatever the size and the mission of the task force. Apparently they were implying that preventive measures could be taken against malaria upon

    7(1) Memorandum, The Surgeon General, for Commanding General, Services of Supply, 16 Mar. 1942, first indorsement thereto, Brig. Gen. LeRoy Lutes, 23 Mar. 1942. (2), Memorandum, Brig. Gen. Larry B. McAfee, for Training Division, Services of Supply, 31 Mar. 1942.


79

arrival of the force and were ignoring the thesis of the preventive medicine experts that specialists in preventive medicine should be assigned to a task force in numbers proportionate to its size. Arrangements for keeping military plans secret, especially those concerning troop movements, continued to put some hindrance in the way of medical planning.8

Relations with Army Air Forces.-Toward the end of March, General Magee attempted to obtain an official statement which would clarify the Medical Department's responsibilities under the new regime. Apparently he did not at the outset grasp the full scope of difficulties he would encounter in operating the medical service under it. He had reason to think that General Somervell would give the Medical Department some backing in its efforts to regain control of the medical service of the Army Air Forces. In the interests of greater coordination of the supply services and of thoroughgoing control by his own headquarters, General Somervell could hardly favor the growth of a medical hierarchy in the Army Air Forces or the Army Ground Forces. However, War Department Circular No. 59, which had outlined the new War Department organization in March, had assigned to the Army Air Forces "command and control of all Army Air Force stations and bases not assigned to defense commands or theater commanders and all personnel, units, and installations thereon." Although General Magee noted that the passage quoted prevented "parallel procedure in rendering medical service to the Ground Forces and the Air Forces," in his opinion the new organization did not "alter in any respect the duties of the Medical Department of the Army or the responsibilities of The Surgeon General." Nevertheless, he attempted to obtain a clear statement of policy in writing, and the fact that he confined his attention to the Air Forces indicates that he considered the Ground Forces less likely to cause difficulties. On 25 March he proposed to General Somervell certain major policies to govern relations between the Medical Department and the Army Air Forces, designed primarily to maintain existing administrative procedures.9

Clarification of medical activities.-These proposals initiated a series of memoranda and conferences among representatives of the Surgeon General's Office, the Operations Division and the Training Division, SOS, G-3 of the War Department General Staff, the Army Air Forces, and the Army Ground Forces. Colonel Wilson, then in the Operations Division, Services of Supply, attempted to amalgamate all of General Magee's proposals into a document,

    8(1) Memorandum, Chief, Preventive Medicine Division, for Chiefs, Plans and Training and Military Personnel Divisions, 28 Mar. 1942, subject: Planning for the Control of Communicable Diseases in Theaters of Operation. (2) Memorandum, Col. H. T. Wickert, for Brig. Gen. Larry B. McAfee, 7 Apr. 1942. (3) Memorandum, Executive Officer, Office of The Surgeon General, for Lt. Louis S. Gimbel, Jr., Chief, Intelligence Section, Ferrying Command, 12 May 1942, subject: Dissemination of Medical Information.
    9(1) Memorandum, The Surgeon General, for Commanding General, Services of Supply, 5 Mar. 1942. (2) Memorandum, The Surgeon General, for Commanding General, Services of Supply, 25 Mar. 1942, subject: Medical Service of the Army, (3) War Department Circular No. 59, 2 Mar. 1942, sections 6, 7. (4) Coleman, Hubert S.: Organization and Administration, Army Air Forces Medical Service in the Zone of Interior, pp. 90 ff. [Official record.]


80

acceptable to all parties concerned, to clarify the relations of the Medical Department under the Services of Supply with the Army Ground Forces and the Army Air Forces. Many changes in wording were proposed by all these offices. The wording of the final statement of policy was substantially agreed on by April 1942. As issued, with amendments in June, to all corps area commanders and other authorities concerned, it was broader in scope than the proposals of General Magee, although it embodied most of them.10 The substance of this document appears below (with some omission of insignificant phraseology); a few sections of it were to be cited at intervals by interested parties in support of their effort to gain added control, to deny increased control to other claimants, or to maintain the status quo:

1. Supplementary to War Department Circular No. 59, 1942 the following general policies will govern medical activities within your command:

a. [Reference to pertinent sections of Circular No. 59.]

b. Sanitation in the continental United States other than that provided by units under tactical control will be administered by the Medical Department under command of the Commanding General, Services of Supply.

c. Hospitalization and evacuation for the Army Ground Forces in the continental United States, other than that provided by field medical units operating under tactical control, will be furnished by the Medical Department under command of the Commanding General, Services of Supply.

d. The routine conduct of Medical Department activities with the Army Air Forces shall be a responsibility of each local surgeon acting under the Air Surgeon, who is responsible to The Surgeon General for the efficient operation of Medical Department technical activities with the Air Forces. In accomplishing his mission the Air Surgeon will operate in advisory and administrative capacities-advisory in his relation as a staff officer and administrative in his conduct of Medical Department technical service under control of the Commanding General, Army Air Forces.

In order to determine the status of these Medical Department activities the Commanding General, Services of Supply, may direct necessary technical inspections of Army Air Forces stations and commands with deficiencies to be reported to the Commanding General, Army Air Forces, for corrective action.

e. The activation, organization, and training of field medical units listed in the Mobilization and Training Plan, 1942, is a responsibility of the Army Ground Forces, except as provided in paragraph 1 f, below.

f. In view of the fact that the Services of Supply controls the majority of instal-lations suitable for certain unit training of field medical units, the Services of Supply will organize and train numbered station and general hospitals and such other medical units as may be requested by the Commanding Generals, Army Air Forces or Army Ground Forces.

g. Due to responsibilities for operations placed upon commanders concerned (corps area, air, etc.), training operations will be administered by them in such manner as to permit adaptation of training to concurrent operations.

h. Insofar as practicable, medical equipment and supplies will be provided to the Army Air Forces and the Army Ground Forces by the Services of Supply. Require-ments in excess of those authorized by tables of allowances [equipment authorized for

    10Letter, Commanding General, Services of Supply, to all Corps Area Commanders and The Surgeon General, 26 May 1942, subject: Medical Activities Under War Department Circular No. 59, 1942, and Amendment of 4 June.


81

posts, camps, and stations] and tables of basic allowances [equipment authorized for units and individuals] plus normal maintenance will be estimated by Army Air Forces and Army Ground Forces and reported to the Services of Supply.

i. In the discharge of his duties, the Air Surgeon will utilize the services available in the Services of Supply to the maximum degree consistent with the proper control of the Medical Department within the Army Air Forces. No activity of the Office of The Surgeon General will be duplicated, with the exception of those procedures necessary for the proper control of Medical Department personnel while under the jurisdiction of the Army Air Forces and of Medical Department activities under the jurisdiction of the Army Air Forces.

j. Basic reports required by The Surgeon General and estimates for all funds shall be submitted by station surgeons through corps area surgeons with separate consolidation of estimates for Medical Department activities of the Army Air Forces by the corps area surgeon to be forwarded to The Surgeon General.

k. The medical supply policy for the Army Air Forces shall be as follows:

    (1) The Surgeon General shall establish medical sections in Air Forces depots. They shall be stocked with initial and maintenance stocks for the supply of tactical medical units attached to the Air Forces.

    (2) Supply for fixed medical installations of the Air Forces, Zone of Interior, to continue under present War Department policy, or under changes as announced.

2. With reference to paragraph 1 b preceding, corps area commanders were to procure and allocate funds for, and effect inspections and general supervision over, necessary sanitary procedures in all posts, camps, or stations in their respective corps areas.

3. With reference to paragraph 1d each corps area commander was to act as a direct representative of The Surgeon General, directing technical inspections necessary to determine the efficiency of operation of Medical Department activities. In addition to disposition of reports as directed in paragraph 1 d, a copy of each report of deficiencies noted should be forwarded to The Surgeon General, who will report to the Commanding General, Services of Supply, those matters the correction of which are beyond his control.

4. With reference to paragraphs 1 e, f, and g attention is invited to letter (SPRTU 353 (5-20-42)) this headquarters, subject: "Unit Training of Field Medical Units by the Services of Supply," which will govern the training of numbered station and general hospitals, and of such other field medical units as may be requested by the Commanding Generals, Army Air Forces and Army Ground Forces.

5. [Reference to an attached table outlining the proper channels for routing of all station hospital reports.]

This document was not limited to defining the powers and functions of the Commanding General, Army Air Forces (and his surgeon) vis-a-vis those of The Surgeon General, as The Surgeon General had proposed. It attempted to specify the powers and duties of the three new War Department commands-the Army Ground Forces, the Army Air Forces, and the Army Service Forces-with respect to provision of hospitalization, training of Medical Department units, medical supply inspections, and submission of reports. With two exceptions the policies defined were essentially those which had prevailed before the March reorganization. One exception lay in paragraph f above; it marked the beginning of the shift in responsibility for the organization and training of Medical Department units (as well as those of the other services) intended for use in the communications zone of a theater of operations from


82

the field armies to the Services of Supply. The other significant change was embodied in paragraph i; it gave the Army Air Forces a claim to greater autonomy in its handling of Medical Department matters. The Army Air Forces had insisted upon excepting from the stipulation as to nonduplication of the Surgeon General's Office's activities not only activities as to Medical Department personnel under control of the Army Air Forces but also any Medical Department activities under control of the Army Air Forces. As noted above, Circular No. 59 had already given the Army Air Forces control of its stations and bases (not assigned to defense commands or theater commanders) and all personnel, units, and installations thereon, including station complement personnel and activities. The policies in the supplementary document specified for the Army Air Forces these broad powers with respect to the Medical Department in particular. The addition of the word "activities" provided an additional weapon to the already well-stocked arsenal of the Air Surgeon's battle for autonomy, which paralleled the similar struggle of the Air Forces themselves.11

Effect on Medical Department administration

The total effect of the War Department reorganization upon Medical Department administration appeared only in the course of the war. Certain problems arose from the fact that The Surgeon General, whose responsibility for medical policies and services was Army-wide, was put under a command which, in spite of its own responsibilities for furnishing supplies and services to the Army Ground Forces, Army Air Forces, and their subordinate elements on an Army-wide basis, was only coordinate in the command structure with these other two major Army commands in the United States. These, equally with the Services of Supply, were subordinate to the General Staff (chart 5). The Surgeon General's technical instructions on the prevention and treatment of diseases and injuries, issued in the form of circular letters, went, of course, to all Army Commands. However, efforts of the Surgeon General's Office to have certain measures requiring a command decision (which the Office considered essential to good medical service) adopted throughout the Army were hindered at times by the necessity for obtaining the concurrence of the staff elements of a number of commands. Under the previous organization of the War Department the Surgeon General's Office could have issued, after obtaining concurrence from the appropriate divisions of the War Department General Staff, command directives which went to all the subordinate commands of the Army. An entire level of command was now inserted between The Surgeon General and the General Staff, and in order to bring about issuance of a directive by the Chief of Staff, the Surgeon General's Office had to obtain

    11Craven, Wesley F., and Cate, James L., editors: The Army Air Forces in World War II. Volume VI, Men and Planes. Chicago: University of Chicago Press, 1955, pp. 374ff.


83

the concurrence of the appropriate staff elements of the Services of Supply as well as subsequent concurrence by elements of the General Staff.

During the ensuing months the allocation of major responsibilities and functions among the three major commands was established: Medical Department personnel, installations, and Medical Department tactical units were split among the Services of Supply, the Army Ground Forces, and the Army Air Forces. Hence, although the Services of Supply was designed, under the theory back of the reorganization, to furnish the other two commands, primarily made up of tactical forces, with the necessary services, including medical service, in practice the assignment of the so-called "medical means" of the Army and certain medical functions to the two other commands led to many breaches of this principle. Some questions of jurisdiction, particularly as between the Services of Supply and the Army Air Forces, led to conflict. Many, on the other hand, were solved amicably, and rapid decisions attained through extensive liaison and conferences among the staff surgeons concerned, frequently with representatives of the general staffs of these commands in attendance.

In addition to its effect upon the administration of the Medical Department at home, the placement of the Surgeon General's Office at the Services of Supply level also made communication with the surgeons of oversea theaters more circuitous. Like the offices of the chiefs of other services, the Surgeon General's Office often noted the difficulty of communication through the Chan-nels above it with the offices of surgeons at theater headquarters overseas. Like the chiefs of some of the other services, The Surgeon General, and some of his staff as well, made use of personal correspondence, which did not have to go through channels, as a means of speeding communication with Medical Department officers overseas. By mid-1943, the Surgeon General's Office developed a system of periodic reports from the oversea theaters; these were the so-called ETMD's (Essential Technical Medical Data) which for the first time gave the Office adequate information on the medical situation overseas.

The Surgeon General and his staff also ran into the reverse difficulty, that of getting their plans for oversea medical service-the use of new types of Medical Department units, for example-accepted and put into effect by oversea commanders. The dispatch of Medical Department officers of the Surgeon General's Office on special missions often proved effective in this respect. The chief consultants in medicine and surgery of the Surgeon General's Office visited the theater on inspection trips, and experts on tropical medicine investigated the problem of control of malaria in a number of trouble spots. Medical supply missions went to the Pacific, European, and China-Burma-India theaters. These emissaries, like the personal correspondence between The Surgeon General and oversea surgeons, served to bridge the great distances and bring about an adjustment between the plans made by the Surgeon General's Office and the requirements drawn up by oversea staff medical officers.


84

EFFECTS OF THE WAR DEPARTMENT REORGANIZATION UPON
THE INTERNAL STRUCTURE OF THE SURGEON GENERALS
OFFICE

The organizational pattern of the Surgeon General's Office throughout 1942 reflects the influence of the theories on sound organization and administration which prevailed among administrators at Services of Supply headquarters. Certain of General Somervell's ideas especially left their mark. A few other changes stemmed from higher authority than the Services of Supply.

Internal Reorganization

One important tenet held by General Somervell was that the number of individuals or units reporting directly to a superior should be limited to the number with which the latter could feasibly keep in close touch.12 In the face of this doctrine the prevailing organization of the Surgeon General's Office (chart 4), whereby 15 chiefs of divisions reported to The Surgeon General, was impracticable. Accordingly, shortly after the Surgeon General's Office was placed under the new jurisdiction it was reorganized in terms of the new principle (chart 6). Under the new organization, divisions were logically grouped under nine "Services"-an arrangement that continued throughout the war. Theoretically this change cut down the number of officers reporting directly to General Magee to 10 (including the chief of the Control Division, discussed below, which was placed at staff level).

Nevertheless, "mushrooming" received a fresh impetus under the new organization, for most of the new "services" were expanded divisions wherein many of those entities labeled subdivisions in the previous organization were raised to the status of divisions. The new organization had more than 40 divisions in lieu of the 15 in existence the month before. Out of the previous subdivisions of the Preventive Medicine Division, now a "service," were created six new divisions, and out of those in the former Professional Service Division, now simply Professional Service, were created seven. Thus, in spite of the consolidation at the top, the reorganization laid the groundwork for further expansion. Insofar as organizational units, such as divisions and subdivisions, call for certain numbers of military personnel of specific rank and civilians of specific civil-service grade, the larger number of divisions warranted promotions and increases in numbers of personnel. More colonels, for example, would be necessary to head the greater number of divisions now in existence. However, a freeze placed on the recruitment of civilian personnel throughout the War Department during the summer of 1942 hampered the acquisition of additional civilian employees about the time that the Surgeon General's Office was becoming aware of its need for substantial numbers of civilians.

    12(1) Services of Supply Organization Manual, 10 Aug. 1942. (2) See footnote 4(4), p. 75.


85

Nor did the reorganization limit the men reporting directly to The Surgeon General to those officers who held the positions of chiefs of services. Several of the chiefs of divisions who had had personal access to General Magee and had addressed memoranda directly to him under the previous setup continued to do so, although after the March reorganization they should theoretically have dealt with the chiefs of their respective services. This tendency to perpetuate the status quo was perhaps inevitable. The top personnel had been placed in their positions by the existing Surgeon General and it was unlikely that long-established relationships would be suddenly changed by an organization chart.

Control Division.-Another idea of General Somervell's which the reorganization fostered was the establishment of a Control Division in the Surgeon General's Office. This device had its origin in General Somervell's administrative experience with the Quartermaster Corps and with G-4 before and during the emergency period. General Somervell established a Control Division, headed by Col. (later Maj. Gen.) Clinton F. Robinson, MC, at Services of Supply headquarters to make surveys and studies of existing organizational units and procedures, appraise their effectiveness, and recommend ways of simplifying operations and increasing efficiency. The placing of the entire statistical service of the Services of Supply under the Control Division in July reflected belief in the value of statistics as a tool of manage-ment and the importance which General Somervell attached to the principle of control; that is, to the accurate forecasting of production and the measurement of production accomplished. The program of management control long existent in most large business enterprises gave the Services of Supply its cue. It recommended a counterpart of the Control Division in each of the supply services to perform similar functions for its parent organization.

The Control Division of the Surgeon General's Office was set up as a staff division in April but did not receive the necessary civilian personnel for key positions until July. Acting under suggestions for studies thought advisable by the Control Division, Services of Supply, or on its own initiative, the Control Division, Surgeon General's Office, studied procedural practices in the various office divisions in order to ascertain their efficiency. It inquired into the use of space assigned the division, the complexity and number of forms in use, the effectiveness of filing systems, the adequacy of training given employees, and so forth. In recommending changes, members of the Control Division emphasized the necessity of cutting down the number and length of forms, reducing the number of steps in processing forms, simplifying filing systems by the removal of inactive or relatively unused files, and the training of employees to be alert to discover new means of attaining efficiency. The Control Division attempted to make more efficient use of facilities and civilian personnel in the face of growing shortages.

Statements in reports turned out by the Control Division, Surgeon General's Office, that a certain operation involved many unnecessary steps were,


86-87

Chart 6.-Organization of the Office of The Surgeon General, 26 March 1942


88

of course, critical of past performance or of the ability of certain people in administrative positions. Many employees of long service were unwilling to change established methods. The fact that higher elements of the War Department, as well as most other Government agencies, were also applying continued pressure to simplify work and increase efficiency in this crucial period did not make the two Control Divisions any the more popular. Personnel of various divisions of the Surgeon General's Office charged that constant demands by the Control Divisions for information on present procedures and for suggestions for improvement hampered their regular work. Changes in procedures usually created additional work in the period during which they were being put into effect. Moreover, recommendations made in the many reports on surveys by the Control Division called for further reports. Consequently it appeared for a time that the control program was actually leading to an increase in paperwork.

Thus the members of the Control Division, Surgeon General's Office, like the members of the parent Control Division, Services of Supply, acquired the reputation of "snoopers" and were nicknamed "the commissars." At the same time the Control Division, Services of Supply, criticized its offspring for its slowness in grasping the concept of "control." In September 1942 members of the former division stated that effective measures for "control" had developed too slowly during the first 6 months of the life of the Control Division, Surgeon General's Office. It is not clear whether the dissatisfaction within the Surgeon General's Office with the control program was the fault of the Control Division, Surgeon General's Office, of the concept which lay back of it, or of the prejudice within the office against it. But General Somervell's control program did not meet with any warmer welcome in the Surgeon General's Office than his theory of limiting the number of personnel reporting directly to a superior.13

Between March and the fall of 1942, a number of changes took place in internal elements of the Surgeon General's Office which were traceable, directly or indirectly, to the War Department reorganization of March. In its attempts to coordinate the work of the supply services General Somervell's new organization naturally tried to establish uniformity in structure and names of organizational units and in procedures. Uniformity was desirable, in some cases necessary, if the divisions of Services of Supply were to deal effectively with their counterparts in the services. The pressure for uniformity was brought to bear most directly upon those fields of work which

    13(1) Office Order No. 105, Office of The Surgeon General, 20 Apr. 1942. (2) See footnote 4(4), p. 75. (3) Report on Administrative Developments in the Surgeon General's Office, 1 Dec. 1942. [Official record.] (4) Memorandum, Commanding General, Services of Supply, for The Surgeon General, 9 Sept. 1942. (5) Gottschalk, O. A. : Report on the Control Division of the Surgeon General's Office, 24 Sept. 1942. [Official record.] (6) Russell, John C. : Survey of Non-Technical Segments of the Surgeon General's Office, 24 Sept.-10 Oct. 1942. [Official record.] (7) Gendebien, Albert: Administrative Survey of Selected Portions of the Surgeon General's Office, September 1942. [Official record.] (8) Interviews, Albert Gendebien, June and July 1947. (9) Committee to Study the Medical Department, 1942, Testimony, pp. 1625-1666.


89

the services had in common, where nevertheless a good deal of diversity had developed-legal and fiscal work, for example. In order to coordinate the steps in handling Army supply, it was necessary that the chiefs of service develop supply divisions of similar structure in their offices and employ uniform or similar reports and procedures. The training divisions in the offices of the chiefs of service were also patterned after the Training Division, Services of Supply. The Preventive Medicine Service, the Professional Service, and various other technical fields of work in the Surgeon General's Office were, on the other hand, little affected by the theories of General Somervell's administrators.

Legal Division.-The assignment of an officer to wartime legal work dated from the fall of 1940. Early in 1942 the Office of the Under Secretary of War undertook the creation of a legal entity in each service to handle legal matters peculiar to the service. When the Services of Supply authorized a legal officer for each service in March, Tracy S. Voorhees (fig. 23), a New York lawyer brought into the War Department by Under Secretary of War Patterson, was chosen to head the legal work in the Surgeon General's Office. Mr. Voorhees, commissioned as a colonel and assigned to the Judge Advocate General's Department in November 1942, had a prominent part in


90

molding the organization of the Surgeon General's Office during the war years and after the war became an Assistant Secretary of the Army.

His first task was a study, made about mid-1942, of the operations of the Procurement Office of the New York Medical Depot. The legal work of the Medical Department was then largely concerned with drawing up contracts for medical supplies and equipment. Colonel Voorhees was impressed at the outset by the "enormous business responsibility of purchasing all medical supplies for the Army and for Lend-Lease," the large number of contracts necessary, and the tremendous dollar volume involved. The preparation of standardized contracts in legally enforceable language, the checking of contracts drawn up by the procurement officers, the writing of procurement regulations, and the selection of legal personnel for the procurement districts were to be the duties of the new legal group assigned to the Supply Service of the Surgeon General's Office in the summer of 1942. This group of civilian lawyers, drawn mainly from large city firms and headed by Colonel Voorhees, remained under the Supply Service until November. After that date they continued their work under a newly formed Legal Division.14

Fiscal Division.-The organization of the fiscal work of the Surgeon General's Office was also affected by the Services of Supply's efforts to establish uniformity throughout the services. Since the fiscal work at the latter's headquarters was handled by a single division, the fiscal functions of the Surgeon General's Office were similarly concentrated as of the beginning of the fiscal year 1943-that is, on 1 July 1942. A study made by the Fiscal Division, Services of Supply, of the handling of funds in the War Department had indicated the need for a single fiscal division in each supply service, a standard accounting system which would reduce the number of authorities allocating funds, and a simplified system of reporting allocations and expenditures. Concentration of all fiscal activities of the Surgeon General's Office in one spot was brought about by transferring the functions of the Fiscal and Claims Subdivisions of the old Finance Division, Finance and Supply Service, to the new Fiscal Division. Fiscal functions with respect to civilian personnel, which had been handled by the Civilian Personnel Division of the Administrative Service, were also turned over to the new division. The Fiscal Division was made directly responsible to The Surgeon General, and its procedures were adjusted to conform with those of the Fiscal Division, Services of Supply. In line with the principle of decentralization advocated by the Services of Supply the new division established branch fiscal offices in the fall of 1942 at distribution depots and at the New York and St. Louis Medical Department Procurement Districts.

    14(1) Administrative Memorandum No. 2, Services of Supply, 20 Mar. 1942. (2) Administrative Memorandum No. 11, Services of Supply, 11 May 1942. (3) Annual Report, Legal Division, Office of The Surgeon General, 1943. (4) Memorandum, Director, Administrative Division, Services of Supply, for Chief of Staff Divisions, 15 May 1942, subject: Coordination of Legal Work Within the Offices of the Commanding General, the Staff Divisions, and the Supply Services. (5) Interview, Tracy S. Voorhees, 22 Sept. 1950. (6) Office Order No. 496, Office of The Surgeon General, 30 Nov. 1942.


91

The branch offices received allotments of funds from the Fiscal Division and made suballotments to several hundred Army stations, thus doing away with the necessity for direct allotment from Washington. Authorization for local purchases of medical supplies and the auditing of certain accounts, such as those for hospital laundry, were also decentralized to the branch offices.15

Programs Established by Higher Authority

Contract renegotiation.-The establishment of certain programs in the Surgeon General's Office was directed by higher authority than that of the Services of Supply. The renegotiation of medical supply contracts in cases where costs or profits of contractors were excessive, for instance, grew out of the program for continuous readjustment of war contracts pursuant to shifts in costs to the contractor which was promulgated by an Executive order of the President. The War Department established a Price Adjustment Board in the spring of 1942, assigned it to the Services of Supply, and then directed the latter to create in the supply services two types of units: price adjustment sections to renegotiate contracts with contracting companies, and cost analysis sections to obtain information upon which renegotiation could be based. Accordingly, a Cost Analysis Section was set up in the Fiscal Division of the Surgeon General's Office and a Price Adjustment Section in the Supply Service. Colonel Voorhees and his Deputy Director of the Legal Division selected legal personnel for the new price adjustment work and made contacts with major medical supply houses in New York preliminary to renegotiation.

Military history.-The backing given by the President and the Bureau of the Budget to the preparation of an official military history of World War II brought the already established historical program of the Surgeon General's Office within the orbit of the general program. A Historical Section of the Control Division, Services of Supply, coordinated the historical work of the various supply services, beginning about July.16

Public relations.-Higher authority in the War Department built up a pyramidal organization to handle public relations, a field in which a number of overlapping agencies at different levels had grown up. The maintenance of good public relations was centered in the War Department Bureau of Public Relations. Various segments of the War Department provided technical information, and the Bureau of Public Relations cleared it for release. Accordingly an Office of Technical Information was set up in the Services of Supply. The Public Relations Division of the Surgeon General's Office, which by Au-

    15(1) Executive Order No. 9127, 10 Apr. 1942. (2) Memorandum, Col. Paul I. Robinson, MC, for Col. Albert G. Love, MC, 31 Oct. 1942, subject: Report on Administrative Developments in the Fiscal Division of the Surgeon General's Office. (3) See footnote 14(3), p. 90. (4) Memorandum, Chief, Supply Service, for Mr. Guido Pantaleoni, Member, Price Adjustment Board, 25 Aug. 1942, subject : Report of Price Adjustment Division, Supply Service, Office of The Surgeon General.
    16 Memorandum, Executive Officer, Office of The Surgeon General, for chiefs of all services, 31 July 1942, subject: Outline of Historical Work of Services of Supply.


92

gust had developed as a staff division (out of the old Intelligence Division of the Administrative Service), was transformed into the Office of Technical Information. Placed at staff level in the Surgeon General's Office, it provided medical data on the Army for release through higher channels.17

Reorganization of the Surgeon General's Office, August 1942

The process of reorganizing the Surgeon General's Office, which began with the general reorganization of March 1942 and continued with certain piecemeal changes in subsequent months, proceeded still further with a general reorganization in August. It resulted from a survey of the entire office in July by the Control Division of the Surgeon General's Office, followed in August by a communication from Headquarters, Services of Supply, directing The Surgeon General to submit a plan for reorganization. This reorganization reduced the number of services from nine to five (chart 7). Divisions were reduced from 41 to 23, largely by the reduction of many to branch status.

The reorganization also established a more systematic nomenclature for units of the office. These were termed in descending order: service, division, branch, and section; in practice the branch became the lowest recognized level. Services were headed by "chiefs," divisions by "directors," and branches by "chiefs."18

Four divisions remained outside the five services. Two of these, the Public Relations Division (later called the Office of Technical Information) and the Control Division, were termed staff divisions. The other two were operating divisions. One of these was the Fiscal Division, separated in July from the Finance and Supply Service. The other was the Training Division, now removed from the Operations Service and reorganized into branches at the request of the Director of Training, Services of Supply.19 Since these divisions reported directly to The Surgeon General, the reduction in number of services did not produce a corresponding reduction in the number of officers reporting directly to him.

The Supply Service remained largely as it had developed since early July. A major change in the Administrative Service at this date was the removal of the Civilian Personnel Division to the Personnel Service. The latter, formed in March, had heretofore been exclusively concerned with military personnel. This move constituted recognition that the handling of problems relating to civilian employees was a function of growing importance. A Civilian Person-

    17(1) Services of Supply Circular No. 54, 29 Aug. 1942. (2) Office Order No. 396, Office of The Surgeon General, 13 Oct. 1942.
    18(1) Morgan, Edward J., and Wagner, Donald O.: Organization of the Medical Department in the Zone of Interior (1946) pp. 15-20. [Official record.] (2) Office Order No. 340, Office of The Surgeon General, 1 Sept. 1942. (3) Annual Report, Control Division, Office of The Surgeon General, 1943. (4) See footnote 13 (3), p. 88.
    19(1) Memorandum, Director of Training, Services of Supply, for The Surgeon General, 13 Aug. 1942, subject: Organization of a Training Division, with 1st indorsement, Executive Officer, Office of The Surgeon General, to Chief, Control Division, Services of Supply (through Director of Training, Services of Supply), 21 Aug. 1942. (2) See footnote 13(3), p. 88.


93

nel Policy Committee of the Services of Supply, which had a Medical Department representative, had been engaged for some time in planning the organization of civilian personnel divisions for the various supply services. The need for large numbers of civilians to fill jobs in the Supply Service, the Administrative Service, and other elements of the Surgeon General's Office, increased the work in the procurement, classification, placement, and training of civilian employees.20 However, the Civilian Personnel Division did not become an integral part of the Personnel Service at this date because of the emphasis on recruitment of military personnel. The reduction in number of services was achieved by making divisions out of five former services concerned with professional work and placing them under a newly constituted Professional Service. These were the old Professional Service, renamed the Medical Practice Division; the Preventive Medicine Division; the Dental Division; the Nursing Division; and the Veterinary Division. This rearrangement, which interposed the Chief of Professional Service between the Director of the Dental Division and The Surgeon General, was frequently criticized by dental officers. Many had long been wont to resent the subjection of dental service to medical service, and this move seemed to them a further reduction in status.21

OTHER CHANGES IN THE SURGEON GENERAL'S OFFICE

During the process of War Department reorganization from March 1942 to August of that year, some significant developments took place in the organization of the Surgeon General's Office which resulted from the rapidly expanding functions of the office and were not closely related to the changes occurring in the higher ranges of the War Department. They occurred at intervals between the general reorganizations of the Surgeon General's Office in March and August 1942.

The Administrative Service

Research and Development Division.-The major development of this period in the Administrative Service was the addition of a Research and Development Division. As previously pointed out, the Surgeon General's Office had customarily relied upon certain Army installations, as well as certain civilian facilities, for the actual performance of medical research. Hence the, research function assigned to the Surgeon General's Office was chiefly that of supervising and coordinating the research projects farmed out to a number of facilities. A Research and Development Section had been established in the Finance and Supply Division in late 1940, but its duties had been essen-

    20(1) Memorandum, H. M. Watts, Medical Department Representative, Civilian Personnel Policy Committee, for Director of Personnel, Services of Supply, 24 July 1942. (2) Office Order No. 288, Office of The Surgeon General, 4 Aug. 1942.
    21Medical Department, United States Army. Dental Service in World War II. Washington: U.S. Government Printing Office, 1955, p. 7ff.


94-95

Chart 7.- Organization of the Office of the Surgeon General and medical installations under command control, 24 August 1942


96

tially restricted to the maintenance of records on expenditure of funds. A Medical Research Coordinating Board, functioning under the Professional Service Division, had had the task of coordinating research activities supported by Medical Department funds. In the spring of 1942, the Surgeon General's Office undertook for the first time thoroughgoing coordination of all research activities, both projects assigned to War Department facilities and those entrusted to outside agencies by establishing a Research and Development Division in the Administrative Service. The Chief of the new division worked closely with the Division of Medical Sciences of the National Research Council, with the, Health and Medical Committee of the Office of Defense Health and Welfare Services, and with the National Inventors' Council. A proposal for a certain research project might come to the Research and Development Division from one of various sources in the Surgeon Gen-eral's Office or the War Department, or from another Government agency. The division referred the project to whatever segment of the Surgeon Gen-eral's Office had the strongest interest in it. If the appropriate unit considered it worthwhile, the Research and Development Division obtained the approval of the Development Branch, Headquarters, Services of Supply, and notified the laboratory best equipped to do the research, outlining its purpose, the funds to be spent, and so forth. The interested division of the Surgeon General's Office supervised the progress of the research, while the Research and Development Division coordinated the work with that of other research projects.22

Library and Museum.-The Army Medical Library and the Army Medical Museum were placed on field status at this date; hence divisions to conduct their administration were no longer included in the Surgeon General's Office. However, these two installations remained under the direct control of The Surgeon General, and their relations with the Office remained largely as before.23

The Preventive Medicine Service

With the accelerated shift of troops overseas during 1942, the sphere of activities of the Preventive Medicine Service continued to widen. The Sani-tation Division's work, except for the areas assigned to the Laboratories Division and to the Venereal Disease Control Division, included most of the preventive medicine activities of the Army in the years of peace; the activities of the Medical Intelligence, Occupational Hygiene, and Epidemiology Divisions, on the other hand, were largely the result of added wartime responsibilities. The Sanitation Division supervised the Medical Department's con-

    22(1) Research and Development Program, Fiscal Year 1942, 20 Aug. 1941; and Medical Department Project Program, Fiscal Year 1941. [Official record.] (2) Memorandum, Lt. Col. J. F. Lieberman, MC, Executive Officer, Professional Service, for Lt. Col. Francis C. Tyng, MC, 1 May 1942, subject: Professional Service Activities. (3) Office Order No. 123, Office of the Surgeon General, 1 May 1942. (4) Committee to Study the Medical Department, 1942, Testimony, p. 655ff.
    23(1) Office Order No. 237, Office of The Surgeon General, 1 July 1942. (2) See footnotes 13(3), p. 88, and 18(3), p. 92.


97

tinuous work in preserving sanitary conditions in and around Army installations, especially in the preparation of food, and in maintaining systems of garbage and sewage disposal, as well as pure water supply systems, for troops.

Sanitation Division.-In a period of rapid expansion the division's task of maintaining desirable standards was greatly increased. Some outbreaks of food poisoning occurred in 1942, and sanitary reports showed that commanding officers of some posts and camps were not satisfactorily meeting their responsibilities for maintaining sanitary conditions. The struggle of the Surgeon General's Office with higher War Department authority over standards for kitchen and mess sanitation and the maintenance of sufficient airspace in barracks and hospitals, begun in the pre-Services of Supply period, continued. The Services of Supply, rather than the General Staff, now applied the immediate pressure upon the Medical Department to lower standards in order to take into account shortages of materials, labor, or facilities and to cope at the same time with the pressing demands of the expanding Army.24

The Sanitation Division and especially its Sanitary Engineering Branch, through liaison with the Quartermaster Corps and the Corps of Engineers, shared in some of the responsibilities for making repairs, maintaining utilities, and furnishing certain supplies at Army posts and camps. The procurement and distribution of insect repellants and insecticides was a case in point, being variously assigned at different periods. In June 1943 an amusing experience was recorded by a captain of the Medical Corps at Robins Field, Ga., who had been unable to get a supply of carbon disulfide for ant control. His medical supply officer had stated that he was unable to issue it, and the local quartermaster had informed him that he could issue the item only if the ants to be exterminated were inside a building. If they were outside, the responsibility was that of the Engineers. In commenting on his frustration, the captain noted the disinterest of meandering ants in adhering to established Army channels.

Sanitary engineering was assigned in early 1942 to a subdivision of that name within the Sanitation Division as one phase of the general work in sanitation. Engineering problems connected with purifying water and treating sewage and those connected with the operation of swimming pools and the control of insect and rodent carriers of disease were handled in that period, along with the general functions discussed above, by the Sanitation Division, and after August by the Sanitary Engineering Branch, made coordinate with the Sanitation Branch (chart 7). In efforts to control malaria, Sanitary Corps officers attempted to recommend nonmalarious sites for constructing new Army installations.

    24(1) Committee to Study the Medical Department, 1942, exhibits 19, 41, and 45. (2) Memorandum, Lt. Col. Charles L. Kirkpatrick, MC, Acting Executive Officer, Office of The Surgeon General, for Commanding General, Services of Supply, 8 July 1942, subject: Sanitation. (3) Copy of 1st wrapper indorsement (no letter file reference), Capt. Frank C. Owens, Medical Inspector, Station Hospital, Robins Field, Ga., to Medical Supply Officer, Station Hospital, Robins Field, 12 June 1943.


98

Some major projects by the Sanitation Division in 1942 were surveys of water and sewage installations, especially of installations in hotels taken over by the Army Air Forces to house personnel, and preparation of a directive for protection of Army water supplies. In collaboration with the U.S. Fish and Wildlife Service, the U.S. Public Health Service, departments of public health of the various States, and universities, the Sanitation Division undertook a program of rodent control in order to reduce or eliminate endemic typhus fever, and possibly plague in some areas. Specialists in rodent control, commissioned in the Sanitary Corps, were assigned to the Fourth, Eighth, and Ninth Service Commands.

Medical Intelligence Division.-The medical surveys of foreign areas by the Medical Intelligence Division became, with American entry into war, a part of formal War Department planning. The division prepared them for foreign areas upon request by the General Staff, as medical sections of the War Department Strategic Surveys. They contained information on health conditions and the medical resources of specified areas. In this work the officers of the Medical Intelligence Division maintained liaison with Military Intelligence Service, G-2, which prepared other sections of the Strategic Surveys. The medical surveys were also used as the subject matter of lectures given to officers being trained at the School of Military Government at Charlottesville, Va. In addition to the lengthier summaries, the division prepared brief resumes of medical data for surgeons of task forces going overseas.25

Laboratories Division.-By the end of 1941, the Laboratories Division of the Preventive Medicine Service had completed the establishment of the system of corps area laboratories. Each corps area had acquired a laboratory, with the exception of the Third which was served by the laboratories of the Army Medical Center in Washington, and the Ninth Corps Area which had two laboratories. Each laboratory had a veterinary component, consisting of one or more Veterinary Corps officers and enlisted and civilian technicians who performed tests or conducted special investigations in connection with animal disease and foods of animal origin. The Laboratories Division now had the task of planning a system of laboratories for use overseas. It outlined the functions of the diagnostic laboratories of several types of hospitals-surgical, evacuation, station, general, and convalescent-and specified the types and number of personnel needed in each. As an oversea counterpart of the corps area laboratory, it planned the Medical Laboratory, Army or Communications Zone, to serve the field army or the communications zone in an oversea theater. Another type, the Medical Laboratory, General, was designed as a central labo-ratory to serve an entire theater of operations. In addition to its routine functions as an epidemiological and general laboratory for a large area, it was to train any additional laboratory personnel who might be needed within the theater, furnish standardized laboratory techniques and supplies for the theater,

    25(1) Committee to Study the Medical Department, 1942, exhibits 30-35. (2) Interview, Col. Tom Whayne, MC, 29 Sept. 1949.


99

and produce diagnostic sera, standard chemical solutions, and so forth, if necessary. The scope of laboratory work of this theater unit was to be comparable to that of the Army Medical Center in Washington.26

A major problem of the Laboratories Division of the Preventive Medicine Service was the procurement of enough medical officers to man the Medical Department's network of laboratories in the United States and overseas. The division aided the Personnel Service in procuring pathologists and other specialists and arranged for special training of additional officers at a few universities. Other responsibilities included the devising of laboratory procedures for such programs of Army-wide scope as the determination of the blood group of all Army personnel, continual review of the supply items for laboratories listed in the Army Medical Supply Catalog, and the review and revision of Army regulations pertaining to medical laboratories.

Occupational Hygiene Division.-Until late in 1941 the Medical Department's concern with problems of industrial hygiene in industrial plants operated by the Army had undergone a gradual evolution, and The Surgeon General had obtained authorization for bit-by-bit expansion of the program. Civilian doctors under contract, or medical officers, and nurses were then unevenly assigned to Ordnance arsenals, Quartermaster depots, and Air Corps depots, the Ordnance plants being favored. Surveys of Army plants by the U.S. Public Health Service had revealed occupational hazards, such as lead poisoning, existing in specific plants, the likelihood of new ones with the growth of the Army's industrial work, and the inadequacy of medical service in the plants. The Surgeon General believed that the Medical Department should assume full responsibility for emergency medical treatment and supervision of industrial hygiene among civilian employees in the plants. In September 1941, he had requested a statement of policy on this matter. Although the Medical Department had assumed some responsibility during the emergency period, the program had lagged, for the War Department had not given The Surgeon General authorization for a general program and hence had not recognized the large personnel needs involved.27

    26(1) Committee to Study the Medical Department, 1942, exhibits 42 and 44. (2) Memorandum, Col. James S. Simmons, MC, for Operations Service, 23 Mar. 1944, subject: Medical General Laboratories. (3) Medical Department, United States Army. Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1962, pp. 429-431. (4) Interview, Maj. Everett B. Miller, VC, 7 Oct. 1949.
    27(1) Memorandum, Executive Officer, Office of The Surgeon General, for Secretary of the General Staff, 17 Sept. 1941, subject: Policy on Medical Service to Civilian Employees in Army-Operated Industrial Plants and Depots. (2) Memorandum, Assistant Chief of Staff, for The Adjutant General, 1 Jan. 1942, subject: Policy. (3) Committee to Study the Medical Department, 1942, exhibit 53. (4) Memorandum, Executive Officer, Office of The Surgeon General, for Commanding General, Services of Supply, 4 Apr. 1942, subject : Status of Contract-Operated Industrial Plants. (5) Annual Report of The Surgeon General, U.S. Army, 1942. [Official record.] (6) See footnote 18(3), p. 92. (7) Memorandum, Executive Officer, Civilian Personnel Division, Services of Supply, for Corps Area Surgeons, 18 June 1942, subject : Responsibility for Industrial Hygiene and Environmental Sanitation in Government-Owned, Privately Operated Munitions Plants, (8) Memorandum, Executive Officer, Office of The Surgeon General, for Chief of Ordnance, 30 June 1942, subject: Industrial Hygiene Survey for Government-Owned, Contractor-Operated Munitions Plants. (9) War Department Circular No. 59. 24 Feb. 1943.


100

Early in January 1942, The Surgeon General received full responsibility for industrial hygiene in plants operated by the Army and the authority to establish dispensaries in them. By April the Occupational Hygiene Division was tackling the total program in conjunction with corps area surgeons and was making plans for an industrial hygiene laboratory at the Army Medical Center. Since it was difficult to find sufficient personnel in Washington, the laboratory was established at the School of Hygiene and Public Health at The Johns Hopkins University in Baltimore, Md. It remained there for the duration of the war. Personnel of the Army Industrial Hygiene Laboratory made surveys of industrial health hazards, studying such factors as the presence of dust and gases and conditions of ventilation and lighting, and analyzed samples and specimens sent in from the plants.

About this time the question came up as to the Army's responsibility for maintaining an industrial hygiene program in plants-chiefly for ordnance production-which it owned but which were operated by private contractors. Under the contracts the provisions of the Workmen's Compensation Act as to the safety of employees applied, the contractor being responsible for industrial safety and hygiene. Since the grounds on which these plants were located were considered Federal reservations, State and local public health authorities had no jurisdiction and lacked authority to inquire into conditions at the plants. Surveys by the Public Health Service had revealed unsatisfactory supervision of health and safety programs in some of them.

Accordingly, The Surgeon General asked for an additional statement of policy as to this group of plants. In June 1942, the Judge Advocate General declared that contractor-operated ordnance plants, as well as Government operated ones, were military reservations, subject to the authority of the corps area commander, and The Surgeon General became responsible for maintaining satisfactory sanitary conditions at the plants operated by contractors. At his request the Division of Industrial Hygiene of the National Institutes of Health of the U.S. Public Health Service sent out men to inspect conditions at each contractor-operated plant.

In August, the Services of Supply charged the Provost Marshal General with responsibility for preparing policies and instructions on methods of preventing accidents at plants and facilities. Because of the close relationship of problems of accident prevention with those of industrial medicine, the Occupational Hygiene Division of the Surgeon General's Office-redesignated a branch in the general downgrading of units under the August reorganization became a part of the War Department machinery for accident control. The chief of the branch served on the War Department Safety Council, which met from December 1942 to the end of the war, along with representatives of the office of the Provost Marshal General, of the other technical services, and of other offices of the War Department, Army Air Forces, and Navy.

During the year the Army's industrial hygiene program grew quite large in certain highly industrialized areas. In the Second Corps Area, for


101

example, a medical officer specializing in industrial medicine was assigned to the corps area surgeon's office, and 40 medical officers and civilian doctors were assigned to 28 plants in that area. Eventually the surgeon's office of every corps area except the First had an officer assigned to industrial hygiene.

By September 1942, the Occupational Hygiene Branch was supervising emergency medical service for more than half a million employees of more than 150 Army-operated plants of the Ordnance Department, Chemical Warfare Service, Quartermaster Corps, Signal Corps, and Army Air Forces, as well as supervising the contractors' programs in about 250 contractor-operated plants. It had aided in organizing the Armored Force Medical Research Laboratory established at Fort Knox, Ky., in the fall of 1942 and was assisting the latter's efforts to determine the hazards of mechanized warfare, including experiments with tanks. It had assigned an industrial hygiene officer to the Surgeon, Air Service Command, and it maintained liaison with the research laboratories of the Air Forces at Wright Field and Randolph Field engaged in work on aviation hazards. The program had become a large field enterprise with continually increasing civilian coverage.

Epidemiology Division.-With the reorganization of the Surgeon General's Office in March 1942, the Epidemiology Division had the four subdivisions shown on chart 6 (p. 86). The Subdivision of Epidemiological Investigation administered the Army Epidemiological Board (formally termed Board for Investigation and Control of Influenza and Other Epidemic Diseases in the Army) as a civilian adjunct to the Epidemiology Division. The Tropical Disease Control Subdivision was established in May, when Dr. (later Col.) Paul F. Russell (fig. 24), a specialist in malariology with the Rockefeller Foundation, was brought into the office.


102

Courses in tropical medicine had been inaugurated at the Army Medical Center late in 1941. The following February, the Commission on Tropical Diseases of the Army Epidemiological Board had been organized with Dr. Wilbur A. Sawyer, Director of the International Health Division, Rockefeller Foundation, as Director. The Chief of the Preventive Medicine Division, Col. James S. Simmons, MC, had noted in April 1942 that from the beginning of the emergency, The Surgeon General had been concerned with the fact that few doctors newly entering the Army had received adequate training in tropical medicine. He pointed out that the Army had neither the facilities nor the time "to remedy so great an educational deficiency" and urged civilian medical schools to offer short intensive courses in tropical medicine.28 In August 1942, the Tennessee Valley Authority agreed to give intensive courses in fieldwork in malariology at Wilson Dam, Ala.

By the date of Colonel Russell's appointment, the low malaria rates among troops in the United States were still further declining, as a result of the joint antimalaria efforts of the Army and the U.S. Public Health Service, termed by Colonel Simmons "the most gigantic mosquito-control campaign carried out in the history of the world." The admission rate for troops in the United States dropped in the course of the war from 1.8 per 1,000 in 1941 to 0.13 for the first half of 1945. But rates among troops in some areas outside continental United States, Panama and Puerto Rico, for example, were rising. High rates in combat areas would seriously interfere with military operations. Accordingly, The Surgeon General sent Colonel Russell and a member of the Tropical Medicine Commission of the Army Epidemiological Board to the Caribbean Defense Command in the fall of 1942. They were to determine whether the spraying of insecticides to destroy anopheline mosquitoes in civilian areas adjacent to Army installations, then more commonly practiced by the British in the Near and Middle East than by the U.S. Army, would be effective in the Caribbean Defense Command. By that date high malaria rates had occurred among troops on the islands of the South Pacific Area and in New Guinea.

The Infectious Disease Control Subdivision made epidemiological investigations, analyzed data on epidemics, and initiated measures to control various infectious diseases. It pointed out, for example, the danger of conducting large-scale troop maneuvers in San Joaquin Valley, Calif., because of the occurrence of coccidioidomycosis, or "valley fever." The Immunization Subdivision investigated various problems connected with immunizing troops and the use of prophylactic biologicals. It maintained close liaison with the Supply Service, which bought biologicals, and with the Subcommittee oil Tropical Disease of the National Research Council, which advised the Medical Department on the desirability of using specific vaccines. An important step taken

    28Simmons, J. S.: The Army's New Frontiers in Tropical Medicine. Ann. Int. Med. 17: 979-988, December 1942.


103

by the Immunization Subdivision in 1942 was the institution of a system of authenticated immunization registers, acceptable to foreign governments, for American military personnel on oversea missions. Previously the personnel of American missions had been denied entry into certain foreign areas, or detained, because they lacked proof of having been immunized against certain diseases or because foreign governments were unwilling to accept the available proof. Through the U.S. State Department, agreements were reached with a number of the governments of African and Asiatic areas and of British-controlled islands of the Pacific as to the type of documentation which each government would accept as proof that U.S. military personnel had been immunized against specific diseases.

Other than malaria, the most serious problem to plague the Epidemiology Division during the months between March and August 1942 was the wide-spread occurrence of jaundice among American soldiers throughout the world. The yellow fever vaccine then being supplied the Army by the International Health Division of the Rockefeller Foundation was shortly suspected as the cause. The Surgeon General ordered the abandonment of this vaccine and the adoption of vaccine supplied by the U.S. Public Health Service. An investigation in the ensuing months traced the disease to specific lots of faulty vaccine.29

Venereal Disease Control Division.-In 1942, the Venereal Disease Control Division was engaged in the study of prophylactic agents and various methods of venereal disease control, the preparation of forms for reports, the analysis of statistical data on venereal disease, and the handling of syphilis registers maintained for individual cases of syphilis among Army personnel. It aided the Personnel Service in obtaining men qualified in venereal disease control and in giving them supplementary training. It prepared material designed to school the individual soldier in avoiding venereal disease infection. (At this date the development of specific methods of treatment for the venereal diseases was a responsibility of the Medicine Division of the Professional Service.)

During the year the division continued its extensive liaison with the U.S. Public Health Service, Navy, American Social Hygiene Association, and other

    29(1) Long, Arthur P.: Preventive Medicine, The Epidemiology Division (1946). [Official record.] (2) Committee to Study the Medical Department, 1942, exhibit 47. (3) Memorandum, Lt. Col. S. Bayne-Jones, MC, for Chief, Preventive Medicine Division, 29 Mar. 1942, subject: Report of Subdivision on Epidemiology for 1 Jan.-29 Mar. 1942. (4) Simmons, J. S.: Progress in the Army's Fight Against Malaria. J.A.M.A. 120: 30-34, 5 Sept. 1942. (5) See footnote 28, p. 102. (6) Memorandum, The Surgeon General, for the Secretary of War, 3 June 1942, subject: Outbreak of Jaundice in the Army. (7) Circular Letter No. 95, Surgeon General's Office, 31 Aug. 1942, subject: Outbreak of Jaundice in the Army.

    For discussion of cases of jaundice associated with yellow fever vaccine, see Medical Department, United States Army. Preventive Medicine in World War II. Volume III. Personal Health Measures and Immunization. Washington: U.S. Government Printing Office, 1955, pp. 307-313; and Volume V. Communicable Diseases Transmitted Through Contact or by Unknown Means. Washington: U.S. Government Printing Office, 1960, pp. 419-431.


104

agencies, through a new medium, the Inter-Departmental Committee on Venereal Disease. After the rift caused by the book "Plain Words About Venereal Disease" (by Drs. Parran and Vonderlehr) between the Surgeon General's Office and the U.S. Public Health Service, the Federal Security Administrator had undertaken the task of reconciliation. Pursuant to President Roosevelt's request for an investigation, Mr. McNutt had stated his confidence in the Army's awareness of the seriousness of the problem and had conferred with the Secretaries of War and Navy. As in other cases of conflict between Government agencies, the attack on Pearl Harbor had probably aided in the closing of this internal breach in Government relations. Mr. McNutt suggested an interdepartmental committee of six, to be composed of two representatives from the Army, Navy, and U.S. Public Health Service. Later representation included the American Social Hygiene Association and the Federal Bureau of Investigation; the latter would be concerned in case of invocation of the May Act which made prostitution a Federal offense in an area in which it was invoked. The Chief of the Venereal Disease Control Division of the Surgeon General's Office acted as one of the Army representatives. In 1942 the Inter-Departmental Committee was largely concerned with problems of control in the United States and the Caribbean Defense Command. It observed closely the operation of the May Act in the two areas in which it was invoked-at Camp Forrest, Tenn., in May and at Fort Bragg, N.C., in July. Both the committee and the Venereal Disease Control Division were aided by utterances of highly placed leaders of the military effort. In March, the Secretary of War sent a letter to all State Governors warning them of the menace of prostitution and venereal disease. In May, President Roosevelt sent the Federal Security Administrator a letter commending the work of the Inter-Departmental Committee, which Mr. McNutt forwarded to more than 8,000 executives of plants engaged in war production. The low rates of venereal disease in- cidence among soldiers stationed in the United States during World War II compared with the rates of World War I testify to the effectiveness of admin- istrative measures adopted to control the venereal diseases, as well as to the advances in treatment achieved since the First World War.30

The Professional Service

Addition of civilian specialists.-The Professional Service, which had remained relatively unchanged during the emergency period as compared with the rapid growth of the Preventive Medicine Service, now entered upon its period of intensive expansion. Less than a month after the United States entered the war, General Magee took steps to obtain for the Professional Service some of the outstanding civilian specialists in major fields of medicine.

    30(1) See footnote 27(5), p. 99. (2) Sternberg, T. H., and Howard, Ernest B. : History of Venereal Disease Control and Treatment in the Zone of Interior (1946). [Official record.]


105

This group of men were known as consultants.31 Under that title, specialists in the three major fields of internal medicine, surgery, and neuropsychiatry were assigned to the Surgeon General's Office. Their chief functions were the establishment of Army-wide policies on diagnosis and treatment of injuries and diseases in their special fields, and the appraisal of the qualifications and performance of fellow specialists, particularly in the hospitals. In retrospect the latter function, the "constant assessment and reassessment" of the assignment of key professional individuals, stood out as a major contribution in the opinion of the Chief Surgical Consultant in the Surgeon General's Office.32

Early in 1942, General Magee appointed Dr. Hugh J. Morgan (fig. 25), then Professor of Medicine at Vanderbilt University School of Medicine, as Chief Consultant in Medicine and Dr. Fred W. Rankin (fig. 26), Clinical Professor of Surgery at the University of Louisville, as Chief Consultant in Surgery. These two fields, which had been lumped together in one Subdivision of Professional Service during the emergency period, were now to be handled by separate subdivisions; with the March reorganization, they became full divisions. The Neuropsychiatry Subdivision, which also became a division in March, was headed as of August by Col. Roy D. Halloran, MC (fig. 27), formerly superintendent of the Metropolitan State Hospital at Waltham, Mass., and Professor of Clinical Psychiatry at Tufts College Medical School in Boston. Drs. Morgan and Rankin were later given the rank of brigadier general, and headed their respective programs to the end of the war.

These three fields-internal medicine, surgery, and neuropsychiatry each headed by a chief consultant charged with the coordination of matters pertaining to his special field throughout the Army, were the fields recognized in 1942 by the Surgeon General's Office as of primary importance. A number of subspecialties were later recognized with similar appointments, and staffs of the three mentioned above increased gradually.

From the inception of their offices, the consultants assisted The Surgeon General in the preparation of written instructions as to methods of treatment

    31This discussion is concerned only with the network of commissioned consultants brought into the Surgeon General's Office and later introduced into the corps areas and oversea theaters for purposes here described. Many other specialists, frequently remaining in civilian status and used mostly in an advisory capacity, were referred to as "consultants" during World War II. Specialists in tropical medicine assigned to the Army Medical Center in 1941 to inaugurate courses in tropical medicine were known as "consultants," while members of the Army Epidemiology Board were termed "consultants to the Secretary of War."
    32(1) Rankin, Fred W.: Mission Accomplished: The Task Ahead. Ann. Surg. 130: 289-309, September 1949. (2) Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 1-141. (3) Memorandum, The Surgeon General, for Commanding General, Services of Supply, 28 May 1942, subject: Coordination of Medical Service in Corps Area Installations. (4) Memorandum, The Surgeon General, for Commanding General, Services of Supply, 23 June 1942, subject: Coordination and Supervision of Medical Service in Station Hospitals. (5) Beck, Claude S.: Surgical History, Fifth Service Command. [Official record.] (6) Office Order No. 337, Office of The Surgeon General, 31 Aug. 1942. (7) Annual Report, Eighth Service Command Medical Branch, 1942. (8) Annual Report of the Surgeon General, U.S. Army, 1943. [Official record.] (9) Medical Department, United States Army. Neuropsychiatry in World War II. Volume II. Oversea Theaters, ch. V. [In preparation.]


106

for Army-wide use, supplementing and to some extent superseding the tech-nical role of advisory committees of the National Research Council. As more and more civilian doctors entered the Army, with great diversity of training and experience, and as troops were sent in increasing numbers to oversea regions with various patterns of endemic disease, the Professional Service needed a staff of specialists directly assigned to the task. The new group of specialists from civilian life was to further the use of advanced methods of diagnosis and treatment by continued scrutiny of techniques in current use and by suggestions for new methods or modifications of old ones. Among the advantages of having an advisory group on technical matters integrated into the Surgeon General's Office and commissioned in the Army was the fact that specialists within the Office would become better acquainted with the conditions imposed by military organization and tactical situations in oversea areas than could specialists outside the Army. Moreover, as officers, they could be held responsible for their decisions.

Extension of the consultant system to corps areas.-Brig. Gen. Charles C. Hillman, Chief of the Professional Service, and his chief consultants agreed that this system should be decentralized by placing a consultant in each of the major specialties, internal medicine, surgery, and neuropsychiatry, in the office


107

of each corps area surgeon to supervise methods of treatment in their special fields employed in hospitals throughout the corps areas. Consultants in the Surgeon General's Office could supervise in the general hospitals, then under direct control of The Surgeon General, but specialists were also needed to observe and assess performance in the station hospitals. The latter, controlled by various jurisdictions, including the Army Air Forces, were rapidly increasing in number, and were acquiring more and more specialists from civilian practice with varied training and experience. A consultant assigned to the corps area surgeon could, by frequent visits to the station hospitals, supervise techni-cal practices in his specialty throughout the corps area. The assignment of consultants to corps areas would provide specialists where they were needed, and at the same time would conserve scarce medical personnel.

The War Department authorized the appointment of consultants to the corps areas in July. By fall a number had been assigned to four corps areas where troops, and hence station hospitals, were heavily. concentrated: the Fourth, Seventh, Eighth, and Ninth. They acted as consultants to hospital staffs; evaluated new therapeutic techniques, drugs, and other therapeutic agents; coordinated professional practices among the various hospital staffs; and evaluated the professional qualifications of medical personnel. Installations which they served included, in addition to the hospitals for Army and Air


108

Forces troops, induction stations, internment camps, and Army-operated industrial facilities. Consultants in the three major specialties were later appointed to the remaining corps areas, to the medical staffs of field armies both in the United States and overseas, and at various levels of command in the oversea theaters of operations.

The Surgeon General's Office came in for some criticism, beginning as early as 1942, because of internal disagreements among its specialists. The always touchy question of venereal disease, for example, was one on which experts sharply disagreed. In November 1942, the sole responsibility for issuing in-structions on methods of treatment, as well as for policies on control and prevention, was established in the Venereal Disease Control Branch of the Preventive Medicine Division. That branch cooperated closely with the Medical Practice Division, as well as with the consultants in medicine assigned to the service commands, in working out policies for both control and treatment. Nevertheless, some of the specialists in internal medicine found this arrangement unconventional and organizationally unsound. Although the Chief Consultant in Medicine admitted that it worked, he considered the assignment of venereal disease control to men with public health training and little clinical


109

experience "a glaring example of inconsistency and improvisation in Medical Department organization."33

The Operations Service

The Operations Service as originally established in March consisted of four divisions: Training, Planning, Hospital Construction, and Hospitalization.34 It remained the coordinating agency of the Surgeon General's Office until the end of the war.

Training Division.-The Training Division had the job of establishing all training policies for the various Medical Department schools and for the Medical Department training centers established in 1941 and early 1942, as well as for the medical training courses given to officers and men in general War Department schools. It developed training manuals and training films, allocated quotas of personnel to medical units and installations, prepared estimates for construction and maintenance of schools and replacement training centers, and inspected these installations. In the course of 1942, the Training Division received responsibility for planning the training of the Medical Department nondivisional units commonly used in the communications zone of an oversea theater, such as the general, station, and field hospitals and various types of laboratories and medical supply units, which were turned over to the Services of Supply for activation and training. In August the Services of Supply directed a reorganization of the Division to conform to the organization of the corresponding division at the Services of Supply level. It was to include a Unit Training Branch to take care of the additional responsibilities with respect to units. At this time the Training Division, Surgeon General's Office, was removed from the Operations Service and made a staff division.35

Planning Division.-The work of the, Planning Division was to recom-mend and prepare tables of organization (numbers of officers and enlisted men by specialty and rank) and tables of basic allowances (of equipment) for Medical Department units and medical detachments. It recommended medical units for inclusion in the troop basis, as well as the types and numbers for medical service in oversea theaters, and prepared on request the medical sec-

    33See footnote 30 (2), p. 104.
    34An Inspection Division indicated on charts in 1942 was never created.
    35(1) Memorandum, Chief, Administrative Branch, Services of Supply, for Directors and Chiefs of Staff Divisions, Services of Supply, 9 May 1942, subject: Clarification of Responsibilities of Chief of Supply Services in Relation to Army Ground Forces and Army Air Forces. (2) Memorandum, Chief, Training Division, Office of The Surgeon General, for Chief, Control Division, Office of The Surgeon General, 29 Oct. 1942, subject: Report on Administrative Developments. (3) Memorandum, Director, Training Division, Services of Supply, for The Surgeon General, 13 Aug. 1942, subject: Organization of a Training Division, with 1st indorsement, Executive Officer, Office of The Surgeon General, to Chief, Control Division, Services of Supply, 21 Aug. 1942. (4) Annual Report, Training Division, Office of The Surgeon General, 1942-43. (5) Medical Department, United States Army. Training in World War II. [In preparation.]


110

tions of War Department plans. It also supervised the development and testing of medical field equipment.

Hospital Construction Division.-The Hospital Construction Division was charged with preparing plans for the construction and repair of hospitals and all construction activities in which The Surgeon General was interested, including hospital ships and quarters for patients on Army transports. It worked closely with the Office of the Chief of Engineers, which had been re- sponsible since December 1941 for constructing Army hospitals-previously a function of the Office of the Quartermaster General .36

Hospitalization Division.-The Hospitalization Division (renamed Hospitalization and Evacuation Division in the August reorganization) was primarily concerned with developing policies on hospitalization and treatment, with administrative supervision of the named general hospitals in the United States and advisory supervision over the administration of other hospitals, with allotment to station hospitals of bed credits in the named general hospitals, and with assignment to the latter of patients transferred from overseas.

The activities and policies of this division were largely responsible for the steadily worsening relations between the Medical Department and the Services of Supply between March and September 1942. The friction went back to February, when Lt. Col. William L. Wilson, then assigned to G-4, had followed up a tour of the corps areas with charges that the Medical Department had no adequate plans for evacuating and hospitalizing civilian or military wounded should the United States be bombed. Brig. Gen. LeRoy Lutes, who came to the Services of Supply Operations Division from command of an anti-aircraft brigade in the Los Angeles, Calif., area, had become concerned over the lack of a plan for hospitalization if the city were bombed and had asked Colonel Wilson to inquire as to what the situation was throughout the United States. Colonel Wilson and General Lutes believed that the Surgeon General's Office had not anticipated a possible declaration of martial law and the Medical Department's responsibilities for civilians, as well as military, in the event of bombing. Colonel Wilson found corps area surgeons concerned over possible confusion as to lines of authority if it should become necessary to evacuate wounded civilians and soldiers from one corps area to another. He and General Lutes considered a plan by each corps area surgeon and a master plan by the Surgeon General's office essential.37

    36(1) Annual Report, Hospital Construction Division, Office of The Surgeon General, 1942. (2) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 61-63.
    37(1) Working papers for report by Lt. Col. William L. Wilson, MC, on his survey of corps areas. HU: Wilson files. (2) Memorandum, Brig. Gen. LeRoy Lutes, for Lt. Gen. Brehon B. Somervell, 19 Apr. 1942, subject : Coordination of Medical Activities, Air and Ground Forces, and Services of Supply. (3) Letter, Lt. Gen. LeRoy Lutes, to Director, Historical Division, Office of The Surgeon General, 8 Nov. 1950. (4) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 55-56.


111

In March, General Lutes directed The Surgeon General to submit a basic Army-wide plan for hospitalization and evacuation. In May, he informed General Somervell. that The Surgeon General had failed to publish an Army- wide hospitalization and evacuation plan and that the one he had finally submitted at the direction of General Lutes' office was unsuitable. General Lutes' office (that is, Colonel Wilson) had had to prepare, such a plan and submit it through G-4. General Lutes coupled this charge with an implication that administration of the Medical Department had been deficient by stating that The Surgeon General had only five officers with "basic military training" in "key positions" in his office and that two of the four Army surgeons had not had such training. He recommended to General Somervell that The Surgeon General be required to study and report upon the status of medical personnel in his office and make recommendations for correction of deficiencies.38

In reply, General Magee pointed out the lack of a definition of "key positions" and of "basic military training." He assumed that by the latter term General Lutes intended reference to training in the Command and General Staff School and/or the Army War College. He stated that 54 of his medical officers had graduated from either or both of those schools and that he had exercised great care in the appointment of officers to key positions. Of the four Army surgeons-Col. Raymond W. Bliss, MC, First U.S. Army (fig. 28) ; Col. Frank H. Dixon, MC, Second U.S. Army (fig. 29); Col. John H. Dibble, MC, Third U.S. Army (fig. 30); and Col. Condon C. McCornack, MC, Fourth U.S. Army-all except Colonel Bliss were graduates of one, or both of these schools, and Colonel Bliss (later Major General and The Surgeon General), he emphasized, was a man "of high intelligence, wide experience, and great industry."39 The controversy was finally halted, if not resolved, with the issuance of a jointly developed hospitalization and evacuation directive in November 1942.

The Critical Services: Personnel and Supply

In 1942 the Personnel Service and the Supply Service were the elements of the Surgeon General's Office in which the two major problems confronting the Medical Department appeared. The Chief Surgeon, European Theater of Operations, informed the Chief of Staff, Services of Supply, in September, that the medical service in the European Theater of Operations had "suffered badly from shortage of personnel and somewhat less from shortage of

    38Memorandum, Brig. Gen. LeRoy Lutes, for Lt. Gen. Brehon B. Somervell, 8 May 1942, subject: Activities of The Surgeon General. For detailed account of the dispute, see Smith, Clarence McKittrick : The Medical Department : Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 63-67.
    39Memorandum, Lt. Gen. Brehon B. Somervell, for Maj. Gen. James C. Magee, 8 May 1942, with 1st indorsement by General Magee, 12 May 1942.


112

supplies."40 The term "shortage" is relative, of course, and in this case applies to a particular time and situation. Whether or not there were ever actual widespread shortages, a strong fear of future shortages of medical personnel and supplies permeated the Surgeon General's Office in 1942 and was reflected in the oversea theaters. It appeared doubtful that the established requirements could be met.

Personnel Service.-The prospective shortage of medical personnel was the more serious, for it posed graver problems and would be the harder to overcome. The Army, as well as the rest of the military forces, was in competition with civilians for available medical personnel. The transfer to the Army of a goodly number of doctors who were considered necessary to the well-being of their communities would have a deteriorating effect on civilian morale. The time required to train additional doctors precluded any appre-ciable increase in the number of those available at an early date. Higher officials of the War Department, including the Chief of Staff and the Secretary of War, as well as officers at Services of Supply headquarters, exhibited growing

    40Memorandum, Chief Surgeon, Services of Supply, European Theater of Operations, for Chief of Staff, Services of Supply, 10 Sept. 1942.


113

concern over this situation. Procurement was the major job of the Personnel Service throughout 1942.41

The chief difficulty in getting doctors into the Army was that in effect they were not subject to the draft and that as late as several months after Pearl Harbor they were not volunteering in the numbers hoped for by the Medical Department. In late 1941 the President had approved the establishment in the Office of Defense Health and Welfare of an agency termed the Procurement and Assignment Service for Physicians, Dentists, and Veterinarians. Originally proposed by the American Medical Association, this agency had the support of the Surgeons General of the Army, Navy, and Public Health Service. Its purpose was to coordinate "the various demands made on the medical, dental and veterinary personnel of the Nation" and to promote "the most efficient use of medically trained personnel."42

After April 1942 the Procurement and Assignment Service functioned under the War Manpower Commission, headed by Paul V. McNutt. One of the Commission's tasks was the allocation of personnel between military and civilian interests. By that date it had become abundantly clear that the United States was threatened with a shortage of doctors. A clash of civilian and military interests now ensued over the allocation of medical personnel-only one

    41For detailed discussion, see Medical Department, United States Army. Personnel in World War II, ch.VI. [In press.]
    42Letter, Paul V. McNutt, Federal Security Administrator, to the President, 30 Oct. 1941.


114

phase of the struggle over allocation of the general labor supply throughout the United States. Whereas the Procurement and Assignment Service became in-creasingly concerned in the latter half of 1942 over the difficulty of retaining in civilian life sufficient doctors, strategically located, to protect civilian health, the Medical Department was chiefly interested in getting into the Army the numbers which it considered essential to maintain the health of troops. The shortage of physicians led to pressure from the General Staff and from the Services of Supply upon the Medical Department to reduce, after conducting practical tests, the number of doctors in the tables of organization of certain medical installations and tactical units. They also urged wider use of Medical Administrative Corps officers or other officers in administrative jobs which did not require professional medical training.43

A Medical Officer Recruiting Board was set up in each State by early May after the Director of the Military Personnel Division, Services of Supply, ordered procurement decentralized to the States. These boards had authority to commission applicants in the lower ranks directly, without recourse to the

    43(1) Memorandum, Director of Military Personnel, Services of Supply, for The Surgeon General, 12 May 1942, subject: Availability of Physicians. (2) Memorandum, Col. John M. Welch, for Chief, Control Branch, Services of Supply, 13 June 1942.


115

traditional method of commissioning by The Adjacent General's Office. As a result of their drive for faster commissioning, the number of doctors procured for the Medical Department skyrocketed in the summer and fall of 1942.44

In June 1942 the Control Division, Services of Supply, made a report on the procurement of medical officers pursuant to a suggestion from Mr. Goldthwaite Dorr, Special Assistant to the Secretary of War, after Mr. McNutt had raised certain medical personnel problems at a Cabinet meeting. The report recommended that a thorough survey of the procurement of Medical Corps officers be made by a committee to be appointed by the Commanding General, Services of Supply. General Somervell disapproved of the study recommended. He criticized the office of his Director of Military Personnel (then containing 68 officers) severely for lack of imagination and for dealing in reams of studies and platitudes. He did, however, approve a recommendation for fresh study of the whole organization of the Medical Department for the purpose of determining the number of medical officers that could be released to fulltime medical duties by substituting officers of the Medical Administrative Corps, the Sanitary, and other corps. A committee which the Secretary of War appointed in September to study Medical Department administration tackled this matter along with many other problems.45

By fall the Medical Officer Recruiting Boards had been withdrawn from all but five States at the request of members of the Procurement and Assignment Service who believed that too many doctors were being withdrawn from civilian life. In October problems in allocating medical personnel between civilian and military interests came up before a subcommittee of the U.S. Senate Committee on Education and Labor. At the hearings of the subcommittee, Medical Department officers defended the Surgeon General's Office's statement of its requirements. Dr. Frank H. Lahey, Chairman of the Directing Board of the Procurement and Assignment Service, noted the difficulty of getting definite information on Army Medical Department requirements for personnel because of The Surgeon General's position under the Services of Supply. In his opin-ion The Surgeon General of the Army worked at a great disadvantage compared with the Surgeon General of the Navy; the latter had direct control over the assignments of Navy medical officers. About the same time General Magee himself pointed out his limited control over the assignment of Army doctors.

    44(1) Memorandum, Lt. Col. Durward Hall, MC, for Director, Military Personnel Division, Army Service Forces, 22 July 1943, subject: Procurement of Physicians and Dentists. (2) See footnote 13(6), p. 88. (3) Committee to Study Medical Departments, 1942, exhibit 15-B. (4) Memorandum, Director, Military Personnel Division, Services of Supply, for The Surgeon General, 12 Apr. 1942. (5) Memorandum, Col. George F. Lull, MC, for The Adjutant General, 16 Apr. 1942.
    45(1) Memorandum, Chief, Control Division, Services of Supply, for Commanding General, Services of Supply, 16 June 1942. (2) Memorandum, Chief of Staff, Services of Supply, for Director, Military Personnel Division, Services of Supply, 20 June 1942, and reply of 23 June. (3) Memorandum, Director of Military Personnel, Services of Supply, for The Surgeon General, 23 June 1942. (4) Memorandum, Director of Military Personnel, Services of Supply, for The Adjutant General, 10 July 1942, subject: Relief of Medical Corps Officers From Duties Which Do Not Require Professional Medical Training.


116

Protesting to the Chief of Staff against a reduction in the, numbers of medical officers on the grounds that it would tend to lower the standards of medical Service, he stated: "I wish to point out that I have a very limited supervision and control of the medical service of the Air Forces." In his opinion, many duplications existed in the medical services controlled by his office and those under control of the Air Surgeon. A similar, though lesser, duplication existed with respect to medical services directed by the Ground Surgeon. The Surgeon General believed that more direct control of allotments and assignments of medical officers by his own office would eliminate duplications and free medical personnel for use in other positions.46

Supply Service.-Whereas the shortage of medically trained personnel in 1942 attracted the attention of highly-placed officials of the legislative and executive branches of the Government, the potential shortage of medical supplies was dealt with largely within the War Department. Both in the Surgeon General's Office and in Services of Supply headquarters grave doubts arose as to whether the Medical Department would be able to meet increasing demands for medical supplies for the Army and for our allies. Lend-lease requisitions included medical items for the use of civilians as well as of military forces, in the beneficiary country. The feeling of being swamped by lend-lease demands for medical supplies and equipment was well expressed by one medical officer: "It seemed for a time that we are running sort of an international WPA."47

It is not clear to what extent the extreme concern over the status of medical supplies was justified; rather few general shortages seem to have existed. Spot shortages apparently developed as a result of hoarding by various commands and installations, maldistribution of stocks, or inadequate transportation. Some of the uncertainty undoubtedly derived from inadequate stock records.

In the course of efforts by Services of Supply headquarters and the Surgeon General's Office to speed the procurement of medical supplies and equipment, sharp differences in the outlook of the two agencies showed up. The Services of Supply concentrated from the outset on achieving efficient procurement of the items used by the various supply services. It aimed at eliminating the competition among them for scarce raw materials, skilled labor, and manu- facturing facilities. Headed by men of Engineer, Quartermaster, and G-4 experience and staffed by many men from industry, it established statistical methods for planning goals for procurement, for forecasting procurement, and

    46(1) Hearings Before a Subcommittee of the Committee on Education and Labor, United States Senate, 77th Cong., 2d Sess., on Senate Resolution 291, Investigation of Manpower Resources, Part I, October 15-November 20, 1942, and Part II, December 14-16, 1942. Washington: U.S. Government Printing Office, 1942, 1943. (2) Memorandum, The Surgeon General, for the Chief of Staff, 23 Oct. 1942.
    47(1) Lecture, Lt. Col. Carl R. Darnall, before Fiscal Officers Training Class, 6 Oct.-14 Nov. 1942. (2) Medical History, 1 Troop Carrier Command, 30 Apr. 1942 to 31 Dec. 1944. [Official record.] (3) Medical Department, United States Army. Medical Supply in World War II. [In preparation.] (4) Medical Department, United States Army. Dental Service in World War II. Washington: U.S. Government Printing Office, 1955, pp. 165ff.


117

for periodical reporting of quantities bought. Tending to stress the similarities of supply problems among the services, it attempted to standardize procedures for the procurement of Army supplies and to eliminate managerial weaknesses in methods of procurement used by the services. Administrators of the Services of Supply conceived all supply activities of the Army as a single immense operation, in which the major steps were determination of requirements, procurement, storage, distribution, etc. This way of thinking, if carried to an ultimate consistency, would have largely eliminated the Medical Department as the procurement agency for items used by it-an arrangement that had already been tried without success after World War I.48

The Surgeon General's Office, on the other hand, emphasized the tech-nical problems encountered in selecting and buying medical supplies and equipment, and maintained that the job of procurement could be satisfactorily handled only by medically trained men, for only the medically trained could properly assess the quality, as well as use, of these technical tools. For these reasons it consistently attempted to exercise, considerable autonomy in handling the medical supply program and to oppose the hiring of civilians with experience in industrial management-a measure consistently advocated by the Services of Supply.

In other respects, the divergence in point of view of the Surgeon General's Office and that of the Services of Supply was primarily one of emphasis. The Surgeon General's Office did not actually deny the importance of formulating statistical goals and making statistical forecasts, but laid considerably less emphasis than did the Services of Supply upon their value. From time to time, it opposed changes in the medical supply system which Services of Supply headquarters advocated in the name of economy or efficiency on the ground that the Medical Department's experience indicated that the proposed changes were actually less efficient or would tend to lower the quality of the medical supplies and equipment used by Army doctors.49

The Supply Service of the Surgeon General's Office received direction from two large organizational elements of Headquarters, Services of Supply. These were the Offices of the Assistant Chief of Staff for Materiel (Brig. Gen. Lucius D. Clay) and the Assistant Chief of Staff for Operations (General Lutes). The Supply Service dealt with the former largely with respect to problems of requirements for medical supply, including those for lend-lease purposes, and problems of procurement. From the outset the Office of the Assistant Chief of Staff for Operations exercised supervision over the storage and warehousing activities of all the supply services, but its added respon-

    48(1) Annual Report of The Surgeon General, U.S. Army, 1919. Washington: U.S. Government Printing Office, 1919, p. 1190. (2) Annual Report of The Surgeon General, U.S. Army, 1920. Washington: U.S. Government Printing Office, 1920, pp. 357-358. (3) Annual Report of The Surgeon General, U.S. Army, 1921. Washington: U.S. Government Printing Office, 1921, pp. 161-162.
    49(1) Memorandum, Commanding General, Services of Supply, for The Surgeon General (and others), 27 Apr. 1942, subject: Management Service. (2) Millett, J. D. : The Direction of Supply Activities in Our War Department. Ann. Pol. Sci. Rev. 38: 249, 475, April, June 1944.


118

sibility for logistical planning for troops moving overseas soon enlarged the supply functions of General Lutes' office considerably beyond the province of storage and distribution. Hence in the summer of 1942 the Hospitalization and Evacuation Branch (headed by Colonel Wilson) in the Planning Division of General Lutes' office became concerned with the status of Medical Department supply and estimates of future production in relation to meeting the needs of troops going overseas. Throughout 1942, the Offices of the Assist-ant Chiefs of Staff for Materiel and for Operations brought pressure on the Supply Service of the Surgeon General's Office to adopt certain measures which they believed would lead to more rapid procurement and more efficient handling of medical supply.50

A barrage of criticisms of the Supply Service of the Surgeon General's Office and proposals for reform emanated from Services of Supply headquarters. The major difficulties, noted chiefly by officials of the Office of the Assistant Chief of Staff for Materiel, may be summarized as follows: Lack of personnel trained in large problems of management, such as purchasing procedures, inventory control, and warehouse methods; too high a degree of centralization of work in Washington; and unsatisfactory records on current and future production, on stocks, and on shortages in the Washington office, the procurement office, and the depots. The critics recognized as contributory causes certain factors largely outside the control of the Medical Department: Shortages of critical raw materials, lack of office space, insufficient allotment of personnel, and small allocations to the Department for supply purchasing prior to the fiscal year 1940. Small appropriations, an old military ghost, had served to nullify in part the well-planned program for training of medical officers in the handling of medical supply in the 1930's. Only two officers had been given this training per year, and they had not received the experience with large-scale purchasing which officers engaged in procurement now sorely needed.51

    50(1) General Order No. 4, Services of Supply, 9 Apr. 1942. (2) General Order No. 22, Services of Supply, 11 July 1942. (3) General Order No. 24, Services of Supply, 20 July 1942. (4) See footnote 4(4), p. 75. (5) Memorandum, Assistant Chief of Staff for Operations, Services of Supply, for Chiefs of Services, 22 Aug. 1942, subject: Supply Planning Personnel.
    51(1) Wilson, Clara B.: History of Medical Supplies in World War II, Distribution and Accomplishments, Zone of Interior Depots (1949). [Official record.] (2) Memorandum, Priority Representative, Office of The Surgeon General, for Priorities Division, Army-Navy Munitions Board, 1 May 1942. (3) Memorandum, Priority Representative, Office of The Surgeon General, for Technical Advisor, Office of the Under Secretary of War, 10 June 1942. (4) Memorandum, C. Tyler Wood, Office of Director of Procurement, Services of Supply; Lt. Col. Fred C. Foy, Purchases Division, Services of Supply; and Maj. Philip W. Smith, Ordnance Department Purchases Division, Services of Supply, for Director of Procurement, Services of Supply, 27 July 1942, subject: Summary of Findings at New York and St. Louis Medical Procurement Offices, 24 and 25 July 1942. (5) Memorandum, Lt. Col. Fred C. Foy and C. Tyler Wood, for Director of Procurement, Services of Supply, 11 Aug. 1942, subject: Summary of Report on Decentralization of Operations of Supply Division, inclosure to memorandum, Director of Procurement, for The Surgeon General, 12 Aug. 1942. (6) Memorandum, Lt. Col. William L. Wilson, for Assistant Chief of Staff for Operations, 23 Aug. 1942, subject: Status of Procurement of Medical Supplies. (7) Memorandum, Director, Purchases Division, for Assistant Chief of Staff for Operations, 26 Aug. 1942, subject: Procurement of Medical Equipment and Supplies.


119

Two important measures which the Services of Supply undertook in the effort to improve the efficiency of the medical supply system were the separation from the supply organization of all functions which were only indirectly related to supply and the decentralization of all supply functions that could conveniently be moved out of Washington to various field offices. Both efforts began about mid-1942, but the major moves out of Washington did not take place until after the fall of 1943.

A survey of the Finance and Supply Service of the Surgeon General's Office and the medical supply depots, including the procurement offices of the New York and St. Louis depots, by the Control Division, Services of Supply, in June 1942 showed a number of weaknesses in the medical supply system. Medical Corps officers were being used for work in depots where technical skill was unessential. Depot procedures varied, and the territories within which the New York and St. Louis procurement offices bought medical supplies and equipment overlapped. A report made by the Control Division, Services of Supply, recommended the following measures: Substitution of nonmedical officers and civilians, especially women, for Medical Corps officers in depot operations (except distributing depots, where technical knowledge was needed); standardization of depot procedures and of depot reports for comparative purposes; and procurement of nonmedical items by services other than the Medical Department. It also proposed to transfer to St. Louis, where it was easier to obtain civilian personnel, various components of the Supply Service in Washington, especially those handling purchase, storage, and issue functions, as well as the procurement functions of the New York Medical Depot. Finally, the report recommended the divorce of fiscal functions of the Surgeon General's Office from supply functions.

This last recommendation was promptly carried out, and a new Supply Service headed by Col. Francis C. Tyng, MC (fig. 31), was established. Promulgation of most of the others was begun, but the recommended move of the Purchasing and Contracting Office of the New York Medical Depot to St. Louis aroused a good deal of opposition in the Surgeon General's Office, as well as in the New York office. A resurvey of the situation by representatives of the Office of the Assistant Chief of Staff for Materiel of the Services of Supply pointed out the heavy concentration of medical supply manufacturers in the New York area and the importance of close contact between procurement officers and manufacturers. The move was accordingly canceled, but not until the morale of New York office employees had been damaged and the flow of procurement hampered by the unstable situation. Pursuant to the recommendations of the resurvey, the Surgeon General's Office established in August the New York and St. Louis Medical Procurement Offices separate from their respective depots. The New York and St. Louis offices purchased nearly all the medical supplies bought by the Army in continental United States during the war. The heaviest year of procurement by far was 1943, during which the


120

estimated dollar value of Medical Department items delivered was $305,064,000, more than twice the amount delivered in any other year.52

The separation of procurement functions from the depots in New York and St. Louis had a parallel development in the separation of similar functions in the Supply Service, Surgeon General's Office. A Purchases Division and a Distribution Division were established in the new Supply Service. The Purchases Division supervised the preparation of contracts for medical supplies and equipment, handled matters relating to prices and their adjustment, prepared statements of policy for procurement officers in the field, and maintained statistics on current production and procurement as a check on the status of

    52(1) Memorandum, Lt. Col. Kilbourne Johnson, W. C. Nunnecke, Col. M. E. Griffith, and Col. Silas B. Hays, for Commanding General, Services of Supply, and The Surgeon General, 20 June 1942, subject: Survey of Supply Functions of The Surgeon General's Office. (2) Memorandum, Julius H. Amberg, Special Assistant to the Secretary of War, for Col. C. F. Robinson, 29 July 1942, subject: Senate Investigation. (3) Committee to Study the Medical Department, 1942, testimony, p. 103ff. (4) Yates, Richard E.: Procurement and Distribution of Medical Supplies in the Zone of Interior During World War II, p. 60ff. [Official record.] (5) See footnote 51(4), p. 118. (6) Memorandum, The Surgeon General, for the Commanding General, Services of Supply, 14 Aug. 1942, subject: Medical Department Procurement Districts. (7) See footnote 51(5), p. 118. (8) Memorandum, Director, Purchases Division, Services of Supply, for Committee to Study the Medical Department, 5 Nov. 1942, subject: Surgeon General's Supply Service. (9) Crawford, Richard H., and Cook, Lindsley F.: Statistics; Procurement, 9 Apr. 1942. [Official record, subject to revision.]


121

individual items. The Distribution Division was responsible for maintaining adequate storage space and stocks in depots and good standards of warehousing, and for issuing field equipment and supplies to troops at home and abroad. Most other major changes in the Supply Service of the Surgeon General's Office accompanied, or followed close upon, the reorganization of the Services of Supply in July and the divorce of fiscal and supply functions of the Surgeon General's Office (chart 7, p. 94). The Requirements Division and the International Division were newly added. The computation of requirements of raw materials and finished items had formerly been a function of the Finance Branch of the old Finance and Supply Division,. while the International Division grew out of the old Defense Aid Branch. The functions of the old Production Control Division which were related to current production were assigned to the Purchases Division, and the new Production Planning Division came into existence.53

SERVICE COMMAND MEDICAL ORGANIZATION

In addition to the organizational changes which the Services of Supply advocated for the Washington offices of the supply services, it undertook in July 1942 and subsequent months a thoroughgoing decentralization of Many functions to the corps areas, now renamed service commands. The intent was to make each service command a field agency for administering the supply services and fixed installations within its boundaries and to achieve uniformity in the organization of the nine service command headquarters. Up to this time the chiefs of the various services in Washington, including The Surgeon General, had controlled within the service commands a number of activities, including fiscal operations and the recruitment of civilian personnel, and certain installations pertaining to their particular services. The Services of Supply wished to eliminate duplication of effort in these fields.

In the effort to reduce the number of staff officers reporting to the com-manding general of the service command (as it had attempted to decrease the number of officers reporting directly to the chiefs of services in Wash-ington), Services of Supply Headquarters directed that service command head-quarters be reorganized along functional lines-that is, into divisions handling training, personnel, supply, and so forth-so as to include the functions of all the supply services in each of these fields. In the new setup the office of the service command surgeon was placed, along with the offices of the chiefs of other services, under the supply division of the service command. His office was usually termed the "medical branch," and he was given the title of "chief of the medical branch." Thus the service command surgeon was now respon-sible to a director of supply and through him to the commanding general of the service command. In a word, he had lost his staff position. Moreover, he

    53Yates, Richard E. : The Procurement and Distribution of Medical Supplies in the Zone of Interior During World War II, pp. 56-58. [Official record.]


122

had no direct official channel of Communication to The Surgeon General. The latter had to issue instructions on matters of policy in the name of the commanding general, Services of Supply, to the commanding general of the service command for the attention of the surgeon. Besides this change in the position of the service command surgeon, a major change in medical organization took place with the removal to service command control of certain medical installations and units. Of the 15 general hospitals in operation in August 1942, all except Walter Reed were transferred from the direct control of The Surgeon General to that of the commanding generals of the service commands. The Surgeon General succeeded in retaining the important function of allocating the beds at general hospitals reserved for patients transferred from station hospitals; he also continued to control allotments of medical officers to the staffs of general hospitals until April 1943, when this power, too, was transferred to the service commands. In addition to the general hospitals, the following installations and units were placed under control of the service commands: Medical and dental laboratories, except for those at the Army Medical Center in Washington; the general dispensaries (established in the larger cities to care for troops absent from station), except the General Dispensary, Washington, D.C.; and the Medical Officer Recruiting Boards operating in the various States. Medical Department schools and replacement training centers also passed to the control of the service command, but as in the case of the general hospitals The Surgeon General succeeded in keeping control of certain activities in these centers. Such matters as the issuance of training doctrine, the scheduling of programs, supervision of training, and the selection and assignment of faculty personnel remained under control of The Surgeon General acting through Headquarters, Services of Supply. The service commands were also given control of prisoner-of-war camps, formerly assigned to the Provost Marshal General. This change was of greater significance to the Medical Department for the future than the present, as hospitals for these installations were only just getting under way.54

Other than the Army Medical Center (including Walter Reed General Hospital and the professional schools and laboratories), the General Dispensary, the Army Medical Library, and the Army Medical Museum-all in Washington, D.C.-the installations still under command of The Surgeon General were the New York and St. Louis Medical Department Procurement Districts (separated about this date from the respective depots) and the eight medical

    54(1) See footnote 4(4), p. 75. (2) Staff Conference, Reorganization of Service Commands, Headquarters, Services of Supply, 4 Aug. 1942. [Official record.] (3) Millett, John D.: Organization and Role of the Army Service Forces. United States Army in World War II. Washington: U.S. Government Printing Office, 1954, ch. XXI. (4) Lecture, Lt. R. H. Fuchs, Services of Supply, before Fiscal Officers Training Class, 6 Oct.-Nov. 1942., (5) Memorandum, Executive Officer, Office of The Surgeon General, for Director, Control Division, Services of Supply, 1 Aug. 1942. (6) Report, Conference of Commanding Generals, Services of Supply, 30 July-l Aug. 1942. (7) Memorandum, Chief of Staff, Services of Supply, for all Chiefs of Supply Services, 22 July 1942, subject: Relationships Between Service Commands and Headquarters, Services of Supply and the Administrative and Supply Services of the Services of Supply. (8) Army Regulations No. 170-10, 10 Aug. 1942, and change 2, 14 Aug. 1943.


123

depots then in operation at Binghamton (N.Y.), Savannah, Toledo, St. Louis, Kansas City, Denver, Los Angeles, and San Francisco (chart 7). Thus in-stallations handling medical supplies were the major type remaining under his direct control. In addition to the medical depots the Medical Department then maintained medical sections within eight Quartermaster depots at the follow-ing locations: Schenectady, New Cumberland (Pa.), Atlanta, Columbus (Ohio), Chicago, San Antonio, Ogden (Utah), and Seattle. These depots were under control of the Quartermaster General.55

Jurisdiction over station hospitals under this reorganization remained unchanged for the most part. Medical officers commanding hospitals at posts housing ground force troops were under a post commander responsible to the commanding general of the service command. Hospitals at airfields were under the control of the Army Air Forces.

The difficulty immediately foreseen by General Magee in the new service command organization was that under the new setup the service commander might make undesirable transfers of medical personnel-as, for example, the transfer of specialized personnel from a hospital staff to his own office. In the opinion of General Somervell and some Services of Supply officers, the presence of the right kind of service command surgeon would obviate this difficulty. General Somervell also stated that The, Surgeon General could communicate with the service commander by telephone in such cases in order to make his position known. Services of Supply personnel frequently stressed the possibility of bypassing, by telephone communication, the circuitous lines of communication established by the reorganization of July. Over the long run the Medical Department found this pattern of internal organization of service command headquarters (which prevailed until the end of 1943) unsatisfactory, as did the other technical services.

In addition to these direct and specific changes in organizational structure, Services of Supply headquarters instituted a continuing pressure, on the Medical Department as on the other services, for decentralization of various functions to service command control. It asked the commanding generals of service commands to submit lists of activities, including medical ones, which they thought should be decentralized to service command jurisdiction. It requested The Surgeon General to review certain powers of decision reserved to him by existing Army regulations and to point out those which might feasibly be transferred to the service commands. All were of relatively minor importance. The Surgeon General readily agreed to transfer control of some of these powers, such as authorizing certain types of hospital admissions and procuring various items locally, to the commanding generals of service commands; others

    55(1) Memorandum, Col. Joseph F. Battley, Control Division, Services of Supply, for Control Division, Office of The Surgeon General, 24 Aug. 1942., subject: Field Installations. (2) See footnote 13(3), p. 88. (3) Millett, John D. : Organization and Role of the Army Service Forces. United States Army in World War II. Washington: U.S. Government Printing Office, 1954, pp. 300-302. (4) Memorandum, Chief, Machine Records Branch, Adjutant General's Office, for The Surgeon General, 11 Sept. 1942, subject: Strength Returns.


124

he desired to retain. Jurisdiction over specific detailed functions, as between service command and the Surgeon General's Office, continued under discussion by the Headquarters, Services of Supply, and the Surgeon General's Office in 1942 and early 1943.56

    56(1) Memorandum, Chief of Staff, Services of Supply, for The Surgeon General, 27 Aug. 1942, subject: Decentralization of Actions to Service Commands. (2) Memorandum, Chief of Staff, Services of Supply, for The Surgeon General, 5 Feb. 1943, subject: Decentralization of Function. (3) See footnote 18 (3), p. 92.

Return to the Table of Contents