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ACCESS TO CARE
The Wadhams Committee Investigation
In August 1942, Lt. Gen. Brehon B. Somervell, Commanding General, Services of Supply, decided to undertake an investigation of Medical Department administration. The investigation had significant repercussions not only on organization and administration of the Surgeon General's Office but on most major phases of the Medical Department's program. The fact that an investigation was ordered implied distrust of the Medical Department's effectiveness. On the other hand, certain findings of the committee became a boomerang to the Services of Supply. Irrespective of results, the investigation was of value to those concerned with Medical Department administration in bringing out into the open most of the administrative problems faced by the Surgeon General's Office at that date and the chief differences between that office and Services of Supply headquarters as to advisable methods and policies for administration of Army medical service.
REASONS FOR THE INVESTIGATION
It is clear that in undertaking an investigation, General Somervell intended to inquire into the organization and administration of the Medical Department rather than into any of the technical aspects of its work. Both General Somervell and the Chief of Staff had become doubtful of the ability of the Surgeon General's Office to cope with its mounting problems. General Marshall had become impatient of prophecies by the Surgeon General's Office that epidemics might result from the doubling up of soldiers in cantonments, as well as its objections to limitations on personnel. He took the position that The Surgeon General must devise means of dealing with all sorts of shortages and more expeditious ways of doing business.1
Several controversial phases of the Medical Department's program had given rise to public criticism. Although the investigation took its origin from within the War Department, public criticism may have helped to bring it about. Several heads of Government agencies handling programs related to those of the Medical Department were summoned before the committee to give their views on controversial matters, and the committee probed rather deeply into the issues involved.
Controversy had developed between the Surgeon General's Office and a few civilian agencies over the handling of health problems in which civilian
1Minutes, Meeting of General Council, Office of Deputy Chief of Staff, vol. I, 11 Aug. 1942.
and military interests impinged upon, or were at variance with, each other. One of these problems had been the Army's handling of venereal disease in the United States. By the fall of 1942 this controversy had largely died down. There had been no basic disagreement between the U.S. Public Health Service and the Medical Department over the desirability of coupling the program for control of venereal disease with a program to repress prostitution around Army areas. Tempers had flared up because officials of the U.S. Public Health Service had attacked the Medical Department, along with line officers, the Secretary of War, and the General Staff, for an insufficient emphasis upon the effort to repress prostitution. By the summer of 1942 those concerned with the venereal disease problem were awaiting the practical results of invocation of the May Act in areas around Fort Bragg, N.C., and Camp Forrest, Tenn.
Other controversies arose over the allocation of hotels for conversion to hospitals in case of emergency and efforts to reconcile Army demands for doctors with civilian needs. In August 1942 the Chief of Staff directed the Surgeon General's Office to develop plans for converting certain hotels to hospitals in the event of sudden epidemic in the Army; General Marshall was determined that the Surgeon General's Office should not be in a position to "explain away any epidemic because of the fact that men have been doubled up in cantonments."2 The Office of Civilian Defense, which had plans for the use of hotels as hospitals for civilians, became alarmed over the possibility of their diversion to Army use, as well as the possibility of the Army's using civilian doctors in these facilities to take care of military personnel. By comparison with some other more serious problems, the "hotels for hospitals" controversy seems something of a tempest in a teapot. Nonetheless it became the subject of a good deal of heated discussion between the Surgeon General's Office and the Office of Civilian Defense. It began shortly before the investigating committee was appointed and continued throughout the life of the committee. It Was discussed at high levels, for the Executive Secretary of the Health and Medical Committee of the Office of Defense Health and Welfare Services, Dr. James A. Crabtree, informed by General Magee, brought the Army's plans for the use of hotels to the attention of the President, and General Marshall took responsibility for having directed the Surgeon General's Office to undertake the use of hotels.3
More serious than the controversy with the Office of Civilian Defense was disagreement with the War Manpower Commission over the procurement of medical manpower for the Army. The Surgeon General's Office was mainly concerned with getting sufficient doctors into the Army. The Procurement and Assignment Service for Physicians, Dentists, and Veterinarians of the War
2See footnote 1, p. 145.
Manpower Commission became concerned over the removal of doctors from civilian life and complained of the aggressiveness of the Medical Officer Recruiting Boards working in the various service commands to get doctors into the Army. Higher officials of the War Department, including the Deputy Chief of Staff, were uncertain of the validity of estimates of Army requirements for doctors by the Surgeon General's Office vis-a-vis differing estimates by the Procurement and Assignment Service and other Government agencies interested primarily in protecting civilian medical interests. The Deputy Chief of Staff directed the Inspector General to investigate the assignments of medical officers within the Office of The Surgeon General (as well as assignments to the offices of some other chiefs of services), with a view to determining whether the number so assigned could be cut. This separate investigation of medical personnel in the Surgeon General's Office went on concurrently with the general investigation of the Medical Department discussed here.4
In the fall of 1942, a congressional investigation of the medical manpower resources of the United States took place. A special subcommittee of the Senate Committee on Education and Labor conducted it as one phase of an inquiry into the total manpower resources of the country. At the subcommittee's hearings, presided over by Senator Claude E. Pepper, representatives of the Procurement and Assignment Service and of the Surgeons General of the Army, Navy, and U.S. Public Health Service presented their points of view on the supply of, and demand for, medical manpower. Senator Pepper's questioning throughout was directed at pointing out the lack of any governmental agency with final authority to allocate doctors as between military and civilian life.5
In the spring and summer of 1942 frequent complaints of the Army's discrimination against certain minority groups with medical training appeared in the public press. Various organizations representing these groups protested discrimination against women doctors, Negro doctors, and such unrecognized medical groups as the chiropractors and osteopaths. Their formal resolutions, along with letters from individuals voicing similar criticism, appeared widely in the open-forum columns of newspapers in 1942, and a number of magazine articles were written on these themes. The fact that the Medical Department was actively attempting to recruit additional doctors gave more color to the criticism of its failure to commission members of the unrecognized groups.6
4(l) Medical Department, United States Army.
Personnel in World War II, ch. VI. [In press.] (2) Memorandum, Brig. Gen.
LeRoy Lutes, for Commanding General, Services of Supply, 2 Sept. 1942.
(3) Memorandum, no signature, for the Inspector General, 30 Oct. 1942,
subject: Report of Investigation of the Present Organization of the Surgeon
General's Office. (4) Minutes, Meeting of General Council, Office of Deputy
Chief of Staff, vol. I, 7 Sept. 1942.
The "yellow jaundice epidemic" had been a cause for alarm in the spring and summer of 1942. By midsummer thousands of cases had occurred among Army personnel in the United States and overseas. The cause of the apparent epidemic, certain lots of yellow fever vaccine furnished by the Rockefeller Foundation, had been suspected early. In April, The Surgeon General had recalled all yellow fever vaccine then in use, substituting for it a limited supply furnished by the U.S. Public Health Service. By late summer the Medical Department had established the cause and nature of the so-called "epidemic," but attacks on the Army for the "epidemic" continued to appear in the public press, for no official statement had been given out on the subject.
Criticism Within the War Department
Major criticisms of the Surgeon General's Office arising within the War Department revolved around feared shortages of medical supplies and personnel and certain matters which had been the subject of disagreement between Col. William L. Wilson, MC (Chief, Hospitalization and Evacuation Branch, Plans Division, Services of Supply), and staff officers of the Surgeon General's Office. Precisely how the difficulties over supply affected the decision to hold an investigation is not clear. It is significant that concern within the Surgeon General's Office over the status of medical supply reached a crescendo in the fall of 1942. While the Committee to Study the Medical Department was in session, The Surgeon General expressed extreme concern over the situation to the Chief Surgeon of the European theater, stressing the detrimental effects of exorbitant lend-lease demands and transportation difficulties. He termed the United States "the last remaining bastion of medical supply" and declared we are heading into a catastrophic situation." He expressed fear that "we are very close to a major scandal."7
The part played by the disagreements on certain policies between Colonel Wilson and staff officers of the Surgeon General's Office in instigating the investigation is likewise obscure. Some of the major disagreements have already been recounted. They were thoroughly aired during the investigation as a result of charges against The Surgeon General based on the files of Colonel Wilson's Hospitalization and Evacuation Branch and were clearly of major importance in leading the Commanding General, Services of Supply, to undertake an investigation.
MACHINERY FOR THE INVESTIGATION
When General Somervell initiated the investigation in late August 1942 he apparently intended his own organization, the Services of Supply, to select members of the investigating committee and direct the inquiry. He informed the director of his Control Division, Col. Clinton F. Robinson, that he wanted
7Letter, The Surgeon General, to Chief Surgeon, European Theater of Operations, 18 Oct. 1942.
a thorough survey made of the Surgeon General's Office and of the Medical Department by a highly qualified group with Colonel Robinson as Executive Secretary. He asked for a survey of the following phases of the Medical Department's administration: The general organization; personnel, including the use of top medical men in the organization of the, Surgeon General's Office, the use of specialists throughout the Medical Department, the procurement of medical officers and nurses, and the use of Medical Administrative Corps and Sanitary Corps officers; psychiatry, including the use of modern psychiatric methods and psychiatrists in the Medical Department, policies used by Selective Service to preclude the entry of potential neuropsychiatric cases into the Army, and provision for care of psychiatric casualties; procurement of medical supplies, including research, development, design, requirements, production followup, and inspection; operations, including operation of depots, distribution of medical supplies in the United States and overseas, mobilization, training, and plans for use of tactical units; hospital management and operation; and vital statistics.8
Within a few days a brief, tentative plan, including suggestions for membership on the committee, was drawn up, presumably by the Control Division, Services of Supply. The committee contemplated was to include representatives of the following groups: The "elder statesmen" of Army medicine; the leading civilian medical authorities; the Services of Supply, including representation from the offices of the Assistant Chiefs of Staff for Personnel, Materiel, and Operations; and the Surgeon General's Office. Certain names suggested for the committee were: Maj. Gen. Merritte W. Ireland, MC (fig. 37), formerly Surgeon of the American Expeditionary Forces in World War I and later The Surgeon General; Col. William L. Keller, MC (fig. 38), Consultant to Walter Reed Hospital; and Dr. Louis I. Dublin, Director of Vital Statistics of the Metropolitan Life Insurance Co.
Colonel Keller and Dr. Dublin were among the group finally chosen, but the complexion of the committee as a. whole was considerably different from the one that General Somervell's Control Division had planned. Those appointed were: Col. Sanford H. Wadhams, MC, USA (Ret.) (fig. 39), Chairman; Col. William L. Keller, MC, USA (Ret.) ; Dr. John Herr Musser, internist, Tulane University; Dr. Evarts Ambrose Graham, professor of surgery, Washington University; Dr. Arthur Hiler Ruggles, psychiatrist, Butler Hospital, Providence, R.I.; Dr. J. Ben Robinson, Dean of the University of Maryland Dental School; Dr. James Hamilton, Superintendent of New Haven Hospital; Dr. Louis 1. Dublin; Dr. Lewis H. Weed, Director, Medical School, The Johns Hopkins University; Mr. Corrington Gill, Consultant to the Wax Department since May 1942.9
8Memorandum, Commanding General, Services of
Supply, for Director, Control Division, Services of Supply, 25 Aug. 1942,
subject: Survey of the Surgeon General's Office.
The committee thus consisted of six civilian doctors, two retired Army doctors, one hospital administrator, and only one man, Corrington Gill, who can be said to have been primarily interested in the administration of the Surgeon General's Office as it affected the Services of Supply. Mr. Gill was an economist and statistician, a specialist in unemployment problems, and a top-level Government administrator. He had held major posts in the Federal Emergency Relief Administration and the Works Progress Administration and recently in the Office of Civilian Defense. Dr. Weed acted as The Surgeon General's representative on the committee. Colonel Keller had been an operating surgeon with the American Expeditionary Forces in France in World War I; Colonel Wadhams had been Deputy to the Chief Surgeon, American Expeditionary Forces. Two members of the committee, Dr. Hamilton and Dr. Graham, had been suggested to the Secretary's office and to the Commanding General, Services of Supply, by Mr. G. K. Dorr, one of the Secretary's assistants. Former Surgeon General Merritte W. Ireland had also been consulted, at the suggestion of the Chief of Staff, in the selection of the committee.10
10(1) Memorandum, G. K. Dorr, for General Somervell and Harvey H. Bundy, 29 Aug. 1942, subject: Personnel Survey Group-Medical Situation. (2) Memorandum, Chief of Staff, for General Pershing, 27 March 1943. (3) Interview, Brig. Gen. Albert G. Love and Maj. Gen. Merritte W. Ireland, 2 Dec. 1947.
On 24 September, the day before the first meeting of the committee, the Secretary of War announced to the press that he had appointed a committee of well-known medical men at the request of General Somervell and General Magee to study the medical service of the Army. He stated that the main purpose of the study was to assure Army personnel the best of medical care and to aid the Medical Department "to maintain the high standards of professional efficiency and devotion which have been the finest traditions of the American medical profession and of the Medical Department of the Army." General Magee, however, had had nothing to do with initiating the investigation and had been informed of it only shortly before the committee was actually appointed.11
Between 25 September and 24 November, when the Committee to Study the Medical Department submitted its final report to General Somervell, the committee held a number of sessions, some on Saturdays and Sundays. At these, about 100 witnesses, including officers of the Medical Department and representatives of various offices of the War Department and other Government agencies concerned in some way with the medical service of the Army, appeared and
11(1) Transcript of Press Conference of Secretary of War, 24 Sept. 1942. (2) See footnote 10 (3), p. 150.
gave oral testimony.12 Nearly all of the Army medical officers called appeared originally during the first 3 days' sessions of the committee, but The Surgeon General and a few others were recalled for questioning. Medical Department officers who appeared before the committee included, in addition to The Surgeon General and his executive officer, the chiefs of services and directors of divisions in the Surgeon General's Office; the Ground Surgeon; the Air Surgeon; the Chief of the Medical Research Division of the Chemical Warfare Service; the surgeons of the First, Second, Third, Fourth, and Fifth Service Commands; and the Chief of the Hospitalization and Evacuation Branch, Services of Supply. With some of these a few assistants, officers or civilians, also appeared. Representatives of the following organizational elements of the Services of Supply testified at committee hearings: The Control Division, the Military Personnel Division, and the Special Service Division, each represented by its director; the International Division, represented by the director and other officers; the Fiscal Division; and the Purchases Division.
The Surgeon General of the Navy, Rear Adm. Ross T. McIntire, and the Surgeon General of the U.S. Public Health Service, Dr. Thomas Parran, also appeared before the committee. Selective Service was represented by its director, Maj. Gen. L. B. Hershey, and two Army medical officers assigned to that organization. Brig. Gen. F. T. Hines appeared as the Administrator of Veterans' Affairs and Chairman of the Federal Board of Hospitalization.
12The testimony was recorded, but extant copies show that certain subjects were discussed "off the record."
Mr. Paul V. McNutt, then Administrator of the Federal Security Agency, Director of Defense Health and Welfare Service, and Chairman of the War Manpower Commission, testified, together with a. number of doctors and other assistants of the Procurement and Assignment Service. Dr. George Baehr, Director of the Medical Division of the Office of Civilian Defense, represented his organization. Miss Mary Beard, the Director of Nursing of the American National Red Cross, together with representatives of other agencies concerned with nurses, discussed nursing problems. A few doctors of the National Research Council, the Rockefeller Foundation, and the U.S. Public Health Service testified as experts on certain technical medical problems, particularly problems of disease. Another witness was Dr. Morris Fishbein, editor of the Journal of the American Medical Association.13
Some witnesses read written statements, while others made informal oral statements. All were questioned by various committee members who resummoned some witnesses and put to them formally prepared questions. Many Medical Department officers supported their statements to the committee, or furnished supplementary information, by means of organization charts, summaries of the assignments or functions of various officers, and histories of the planning and work of their divisions from the outset of the emergency. Mr. Gill instituted further inquiry into certain points made by Medical Department officers, calling for memorandums to supplement their oral statements. A document of major significance in the records of the committee was a report signed by Mr. Gill and based on the files of the Hospitalization and Evacuation Branch of the Assistant Chief of Staff for Operations, Services of Supply, which stated that the Services of Supply had found it necessary to formulate plans and policies for which The Surgeon General was responsible and had had to follow up its directives to the Surgeon General's Office repeatedly in order to obtain definitive action. A lengthy reply by The Surgeon General was of similar importance.14
Four administrative surveys initiated by Headquarters, Services of Supply, prior to the convening of the committee on 25 September were considered part of the investigation. About the middle of August the Director of the Purchases Division of the Services of Supply, Col. (later Brig. Gen.) A. J. Browning, had initiated a study of the Supply Service of the Surgeon General's Office. When the committee convened, some of his staff were in the midst of this survey, which included a survey of the New York and St. Louis Procurement Offices as well as of the Supply Service of the Surgeon General's Office. A Special Consultant to the Secretary of War, H. Alexander Smith, Jr., was engaged in a study of possible duplication of activities by the Surgeon General's Office and the Office of the Air Surgeon. A third survey Was a study of the Control Division, Surgeon General's Office, undertaken by the Director
13Committee to Study the Medical Department,
1942, Report, Tab: Index of Witnesses.
of the Control Division, Services of Supply. This survey had resulted from a statement by General Somervell on 9 September that the work of the Control Division, Surgeon General's Office, had not been satisfactory and his request, that General Magee remove its director on the ground of unsuitability for the position. Finally, Mr. Gill, after discussion with The Surgeon General, had assigned John C. Russell, then with the Fiscal Division, Services of Supply, and a small staff of technicians in public administration and business management to survey the following organizational elements of the Surgeon General's Office The entire Personnel Service; the Fiscal Division, then at staff level; and one division of the Administrative Service, the Office Administration Division. These organizational units were concerned with general administrative functions rather than with medical or medicomilitary problems.15
In addition to its other activities, the committee visited and inspected various medical installations in the service commands, including Lovell General Hospital at Camp Devens, Mass., and LaGarde General Hospital and Livingston Station Hospital in Louisiana. At the committee's request the Special Service Division, Services of Supply, conducted a poll of some 5,000 soldiers in 14 camps to determine the opinion held by enlisted men of the medical care they were getting in the Army.16 However, the committee appears to have relied mainly on the oral testimony, the four formal surveys, and the other supporting documents mentioned, and not to have acquired any great amount of firsthand information on the efficiency of the functioning of medical installations and the quality of medical service rendered in the United States. Nor did the committee's inquiry touch upon any phase of medical work in the theaters of operations except as it brought out policies established by the Surgeon General's Office with respect to theater medical service.
TESTIMONY ON ORGANIZATION AND ADMINISTRATION
Some of the evidence presented to the committee dealt directly with organizational matters: the internal structure of the Surgeon General's Office and the position of that office and of the offices of service command surgeons within Army structure. However, the bulk of it dealt with broad administrative policies and plans with respect to the handling of medical personnel and supplies, hospitalization and evacuation, and prevention of disease.
15(1)Committee to Study the Medical Department,
1942, Testimony, pp. A-21,193-195. (2) Smith, H. Alexander, Jr.: Proposed
Transfer of the Medical Department of the Army Air Forces to the Control
and Authority of the Surgeon General's Office, 15 Sept. 1942. [Official
record.] (3) Memorandum, Commanding General, Services of Supply, for The
Surgeon General, 9 Sept. 1942. (4) Memorandum, O. A. Gottschalk, Special
Assistant, Control Division, Services of Supply, for Director, Control
Division, Services of Supply, 24 Sept. 1942, subject: Report on Control
Division, Surgeon General's Office. (5) Russell,. John C.: Survey of Non-Technical
Segments of the Surgeon General's Office, 24 Sept.-10 Oct. 1942. [Official
Internal Administration of the Surgeon General's Office
The Control Division.-The Control Division was discussed before the committee by its director, Col. John Welch, MC, who summarized his 6 months' experience as head of it. He stated that he had not had sufficient civilian personnel for the key positions in his division until July. The survey by the Control Division, Services of Supply, of the Control Division, Surgeon General's Office, concluded that progress in the latter had been slow until after a July meeting of the control officers of all the services called by the Control Division, Services of Supply. The survey found that the organization, staff, and program of the Control Division, Surgeon General's Office, were now of a quality to enable it to realize substantially the objectives of the Control Division, Services of Supply, although a shortage of personnel still existed. It recommended that the personnel which the division had requested be approved at once, that its director remain in the position for 60 days, and that the division's work be reappraised at that time.17
The Russell Survey.-The survey under the direction of Mr. John C. Russell, which covered the Personnel Service, the Fiscal Division, and the Office Administration Division, reached certain conclusions not only on these segments, but also on the Control Division, and on administrative practice in the Surgeon General's Office as a whole. It included a study of the following phases of administrative management: Office space; personnel, including numbers, rank of officers and grades of civilians, absenteeism, and so forth; filing systems and storage problems; use of production records; procedures and use of procedure manuals; and many other phases. It found that the Fiscal Division, newly established in July 1942 and now made up of 15 officers and about 120 civilians, was on the whole the best administered of the segments surveyed. It had regular staff meetings with regular agenda. Its planning was well carried out, and its system of reporting to The Surgeon General was adequate. The chiefs of its branches understood their place in the structure. The survey, as well as oral testimony before the committee, indicated that this division had been organized, and its branch offices in the service commands set up, in such a way as to coordinate the fiscal program of the Medical Department satisfactorily with the total program of the Services of Supply.
The survey found that the organizational plan for the Personnel Service laid down in August 1942 (chart 7) had not been fully put into effect. Although head of the entire Personnel Service, Col. (later Maj. Gen.) George F. Lull, MC (fig. 40), devoted his energies almost exclusively to the Military Personnel Division. The implication that the Services of Supply pattern of organization was being willfully circumvented was probably justified to
17(1) Committee to Study the Medical Department, 1942, Testimony, pp. 193-194; 1625ff. (2) Memorandum, Officer in Charge, Control Division, for Executive Officer, Office of The Surgeon General, 24 Aug. 1942, subject : Request for Additional Personnel. (3) See footnote 15(4), p. 154. (4) Memorandum, Director, Control Division, Services of Supply, for The Surgeon General, 25 Sept. 1942, subject: Approval of Report.
the extent that from the point of view of the Medical Department, the problem of military personnel at that time was overriding. The survey went on to show that the Nursing Division of the Surgeon General's Office was performing duties which should have belonged to the Nursing Branch that had never been established in the Military Personnel Division. On the other hand, the old Reserve Division (chart 6) had never been abolished and still handled the procurement, classification, grading, appointment, and initial assignment of officers in the Army of the United States. Col. Francis M. Fitts, MC (fig. 41), though in name Director of the Military Personnel Division, the capacity in which Colonel Lull actually operated, in reality acted as the head of this old Reserve Division. According to the current organization chart, the latter should have been only a section of the Commissioned Personnel Branch. Colonel Lull's primary interest in the Military Personnel Division was reflected not only in his having narrowed the scope of his own activities but also in the fact that the Director of the Civilian Personnel Division reported to the Surgeon General's Executive Officer, Col. (later Brig. Gen.) John A. Rogers, MC (fig. 42), rather than to Colonel Lull. The survey found supervision of civilian personnel functions by the Executive Officer the better procedure, pointing out that the combination of military personnel and civilian
personnel functions in one branch was rarely effective "inasmuch as the officer in charge is almost always interested in only the military activities."
The survey found certain defects in the procedures of the Military Personnel Division: the lack of scheduled staff meetings, written procedures, clear-cut statements of responsibility of officers, and production statistics, together with the tendency of medical officers to perform routine or minor duties that could be delegated to civilian clerks. The internal organization of the newly established Civilian Personnel Division, on the other hand, was given a fairly clean bill of health on the grounds that its structure and functions, like those of the Fiscal Division, followed the standard pattern advocated by Headquarters, Services of Supply.
The Office Administration Division handled mail, records, and office supplies, and reproduced and distributed documents for circulation throughout the Surgeon General's Office. Hence the survey of this division dealt largely with the efficiency of its procedures in handling and filing large quantities of records, adequacy of the division's personnel, its use of statistics on workload and production, and like problems. Specific findings included recommendations for certain internal changes in procedures, as well as for increased personnel, higher grades for civilian personnel, additional space, and better conditions of lighting and ventilation.
Mr. Russell and his assistants arrived at certain Conclusions as to the effectiveness of the Control Division through their contacts with officers and civilians in the divisions which they surveyed. They discovered a feeling of enmity on the part of some responsible administrators of the Surgeon General's Office toward the Control Division. Apparently Control Division personnel had emphasized the "control" aspects of their work instead of trying to convince administrators of their ability to aid in improving office procedures. The Russell Group apparently subscribed to General Somervell's belief in the potential efficacy of a control division and laid the blame for the unpopularity of the Control Division, Surgeon General's Office, at the door of its personnel.
The report of the Russell committee noted the following general defects in the administration of the Surgeon General's Office: The failure of the organization chart of August 1942 to reflect the organization accurately; the lack of coordination in the office, by means of clearly written delegations of responsibility, procedure manuals, and regular staff meetings; the lack of adequate support by higher echelons of programs developed in lower echelons; participation by medical officers in tasks not commensurate with their training; the dearth of good work records and production statistics; and inadequate staffing. A good many difficulties had developed within the office, the report stated, because of a lack of understanding of the reorganization of the Services
of Supply and a failure to arrive at satisfactory relationships with various elements of the War Department. The report recommended the following measures: The development of a logical organizational structure with written delegations of responsibility and commensurate authority; regular reports on program development and operations by the lower echelons to The Surgeon General; transmission of proposed programs by The Surgeon General to division chiefs; the development of procedural manuals in major organizational units; and restatement of functions of the Control Division in providing management techniques. It also advocated the holding of regular staff meetings by The Surgeon General and the initiation of a series of conferences with Headquarters, Services of Supply, and other offices to bring about awareness of the Army's current medical problems. It proposed a survey of requirements for personnel in the higher grades in order to determine the relative needs for medical and administrative officers.18
The Nursing Division.-Testimony with respect to the Nurse Corps established the fact that the Nursing Division of the Surgeon General's Office was largely an office for procuring nurses and keeping personnel records on nurses. The committee probed into the part played by the Red Cross in the recruitment of nurses for the Army Nurse Corps. The Assistant Superintendent of the Army Nurse Corps, Lt. Col. (later Col.) Florence A. Blanchfield, ANC (fig. 43, indicated some dissatisfaction with recruitment by the Red Cross; some nurses objected to enrolling with the Red Cross for fear that they would be called by this organization for relief work in case of disaster instead of for work with the Army medical service in which they were interested. The National Director of Nursing of the American National Red Cross and Miss Mary Switzer, Special Assistant to Mr. McNutt, stated their conviction that the Red Cross was doing a more effectual check on nurses' qualifications than the Army Nurse Corps was presently equipped to do. General Magee took the position that the Red Cross was doing an effective job which he did not wish to disrupt and that the assumption of direct recruitment of nurses by the Army Nurse Corps would entail an enormous amount of work.19
Supply Service.-With regard to medical supply, the Chief of the Supply Service, Surgeon General's Office (Col. Francis C. Tyng, MC), noted that the War Department was now faced with "a grave emergency in procurement and distribution of medical supplies." This situation he attributed to two factors: insufficient money appropriated during the emergency period as a result of public doubt that the United States would enter the war, and the lack of per-
18(1) See footnote 15(5), p. 154. (2) Committee
to Study the Medical Department, 1942, Testimony, pp, 617-648; 1246. (3)
Memorandum, Director, Fiscal Division, Office of The Surgeon General, for
Director, Historical Division, 31 Oct. 1942, subject: Report on Administrative
Developments in Fiscal Division. (4) Memorandum, Brig. Gen. C. C. Hillman,
MC, for Corrington Gill, 26 Oct. 1942, subject: Data for Investigating
Committee. (5) Memorandum, Maj. Gen. James C. Magee, for the Secretary
of War, through Commanding General, Services of Supply, 14 Sept. 1942,
subject: Requirements in Personnel and Space in The Surgeon General's Office.
sonnel in the Supply Service, Surgeon General's Office, the procurement offices, and the depots. Lack of personnel he regarded as the most Serious current threat to the medical supply program. Any deficiencies that might exist in the records on medical supply he attributed to that factor. He asserted that a loss of civilian personnel in the New York Procurement Office had resulted from the stud by the Services of Supply advocating consolidation of the New York Office with the St. Louis Office. The "freeze" on civilian personnel in the War Department had prevented obtaining the large numbers of additional civilian clerks which he had recommended for all the medical supply offices. He pointed out that his International Division handling lend-lease medical supply was operating a $200 million business with 5 officers and 17 clerks. He lacked men in the executive class, difficult to get in any case because of the financial loss they would incur if they left good positions to enter the Army, and presently impossible to get because of the limitation on the number of officers in the Surgeon General's Office.20 Much further difficulty had come about, he stated, as a result of failure by foreign governments to state their total
20Mr. Gill informed the committee on the day following Colonel Tyng's statements that General Somervell had authorized the immediate commissioning of 40 additional officers for the Purchasing Division of the Supply Service.
requirements for lend-lease medical supplies. Requisitions to date had been spot demands, and some had been exorbitant. A few, indeed, had been for quantities of certain items in excess of total U.S. production, while others had been for items not procurable in any foreign market then accessible. The White House transmitted these requests as firm requirements, although they had not been reviewed by experts in medical Supply.21
Colonel Tyng and other witnesses stated that the complicated handling of lend-lease requisitions had also hampered the medical supply program. Representatives of the International Division, Services of Supply, pointed out Obstacles created by the earmarking of specific stockpiles of medical supplies for certain countries. They stated that a general lend-lease medical stockpile, to be held in the custody of The Surgeon General physically separated from Army medical stores, was being created. The system of a general stockpile had worked well for the other services, but the Medical Department had been tardy in adopting this arrangement because, according to Col. (later Brig. Gen.) John B. Banks, Director of the International Division, Services of Supply, it was "one of the last services to really appreciate the importance of lend-lease and its effect on the whole War Department program."22
Col. Albert J. Browning, Director, Purchases Division, Office of the Assist- ant Chief of Staff for Materiel, Services of Supply, and Lt. Col. (later Col.) Bryan Houston, Chief of the Purchase Service Branch of that division, agreed with Colonel Tyng that the medical supply procurement program had been understaffed both in Washington and in the procurement office and depots. Colonel Browning also agreed that exorbitant lend-lease demands had had a seriously adverse effect upon procurement. He stated that inventory records of medical supplies in the depots were not in very good shape and attributed the unsatisfactory situation largely to lack of civilian clerks for medical supply duties in the depots. (Colonel Tyng stated that the records were in good shape in all depots except the St. Louis Medical Depot.) Colonels Browning and Houston also noted that the responsibilities laid upon medical supply officers, including accountability for expenditure of large sums, were heavy in proportion to the military rank of these officers. The procurement job of Colonel Tyng was likened to that of the heads of such large concerns as Montgomery Ward & Co., Inc.23
Two steps toward solving the problems of the Supply Services were taken before the investigating committee made its final report. On 1 October its needs for officer personnel, established by surveys by the Services of Supply and the committee testimony, were recognized; the allotment of officers for the Supply Service, Surgeon General's Office, and for the New York and St. Louis Procurement Offices was increased by 163. Then, in November, at the sugges-
21(1) Committee to Study the Medical Department,
1942, Testimony, pp. 93-136. (2) Letter, Col. F. C. Tyng, MC, to Chief
Surgeon, European Theater of Operations, 18 Oct. 1942.
tion of Col. Tracy Voorhees, JAGD, Director of the Legal Division, Surgeon General's Office, General Magee appointed Mr. Edward Reynolds, president of the Columbia Gas & Electric Corp., as special assistant to The Surgeon General in the procurement of medical supplies. Under ordinary circumstances, General Magee told the committee, he still believed that medical supplies and equip-ment could be more effectively procured by medical officers who had been given some specialized business training than by businessmen, no matter how experienced, who had no medical knowledge. But the circumstances were not ordinary, and he now thought it best to obtain a businessman of the type widely used by various Government agencies. He recognized that a man "primarily trained in executive duties of great magnitude" should act for him in all the nonprofessional aspects of procurement of medical supplies.24
Professional Service.-The committee inquired into the most recent re-organization of the Surgeon General's Office whereby former "Services" performing professional work had been placed under the Professional Service. Brig. Gen. Raymond A. Kelser, VC, Director of the Veterinary Division, expressed the opinion that going through an intermediary (the Chief of Profes-sional Service) to The Surgeon General for decision might conceivably slow up the work of his division. Brig. Gen. Robert H. Mills, DC (fig. 44), Director of the Dental Division, took much the same position and added that reduction from a Dental Service to a Dental Division tended to lower the status of dentistry. The Director of the Control Division, Surgeon General's Office, defended the recent reorganization of the Surgeon General's Office, which had brought about these changes, on the grounds that it aimed at decentralization, a basic concept of General Somervell's, and had been approved by the Control Division, Services of Supply.25
Place of the Medical Department in War Department Structure
Much discussion took place with respect to the place of the Medical Department and of The Surgeon General within the War Department. Medical officers stressed the difficulties of the Medical Department in operating under the War Department reorganization of the preceding March and potential hindrances created by the more recent service command reorganization of August. Their statements were in part supported by the heads of other large Government medical programs. Some. medical officers, particularly those of the Preventive Medicine Division, declared that negative or delayed decisions by higher War Department authority had interfered with certain of their recommendations-those aimed at maintaining standards of proper disinfection
24(1) Memorandum, Col. A. J. Browning, Director,
Purchases Division, Services of Supply, for Committee Appointed to Study
the Medical Department of the Army, 5 Nov. 1942, subject : Surgeon General's
Supply Service. (2) Committee to Study the Medical Department, 1942, Testimony,
pp. 1667-1726. (3) Letter, Maj. Gen. James C. Magee, to Col. Sanford H.
Wadhams, 10 Nov. 1942. (4) Interview, Tracy S. Voorhees, 22 Sept. 1950.
of dishes in messhalls and sufficient airspace in barracks, for example. The Surgeon General and most of his staff emphasized various difficulties created by the following developments: The subordination of The Surgeon General and his office to the Services of Supply and the consequent strengthened autonomy of medical administration in the Army Air Forces; the Services of Supply policy of decentralizing many matters to the service commands; loss by the Surgeon General's Office of control over transfer and reassignment of individual medical officers; and the subordination of the service command surgeon to a position in which he was answerable to the head of a division at service command headquarters rather than to the commanding general of the service command. Officers of the Services of Supply countered with the charge that medical officers of the Surgeon General's Office did not understand the prevailing War Department organizational structure and had not mastered the tech-nique of accomplishing their medical aims through the proper channels.26
Maj. Gen. (later Lt. Gen.) Wilhelm D. Styer, Chief of Staff, Services of Supply, informed the committee that a study of the testimony showed that various officers in the Surgeon General's Office had failed to grasp the funda-
26Committee to Study the Medical Department, 1942, Testimony, pp. 167-193; 245; 273-280; 769-813.
mental principles of the current War Department structure. Commanding generals of service commands, he said, were direct subordinates of the Commanding General, Services of Supply, and were his field representatives. The Surgeon General was the staff agent of the Commanding General, Services of Supply, in the direction of functions relating to the health of the Army. "The authority and responsibility of The Surgeon General for the maintenance of the health of the Army and the conduct of medical activities necessary to the full accomplishment thereof is that of the Commanding General, Services of Supply." Hence, General Styer pointed out, the Services of Supply Organization Manual clearly gave The Surgeon General the authority to issue instructions to the commanding generals of the, service commands in his own name under the authority of the Commanding General, Services of Supply, either with or without invoking such authority.27
General Styer went on to say that for the exercise of authority with respect to medical matters in the field forces (the Army Ground Forces, defense commands, and theaters of operations), The Surgeon General had to deal with the Commanding General, Services of Supply, and the War Department Chief of Staff. The Surgeon General had authority, however, to issue instructions on technical medical matters directly to the surgeons of these commands. For the exercise of authority over matters of Army-wide application, The Surgeon General similarly submitted recommendations through General Somervell to General Marshall. However, it was his responsibility at all times to call to the attention of the latter (through General Somervell) all matters requiring corrective action which were beyond his power to remedy. The Surgeon General had no authority over the internal organization of service commands, General Styer pointed out. The current scope of Army activities made direct control from Washington over movement of personnel within a service command and from one service command to another impractical. Nevertheless, in practice, he stated, the recommendations of The Surgeon General were followed on all matters involving medical activities in the field, including the transfer of medical specialists.
Service command surgeons noted their lack of control over certain medical installations and offices within the boundaries of their respective service commands, especially station hospitals controlled by the Army Air Forces and those assigned to the ports of embarkation. The Surgeon, Second Service Command, for example, thought that the staffs of these two types of hospitals should come under his control. In other words, the service command surgeons argued for control of all Army medical service within the service command to which they were assigned .28
Position of The Surgeon General.-As to the position of The Surgeon
27(1) Memorandum, Maj. Gen. W. D. Styer, for
Corrington Gill, 14 Oct. 1942, subject: Authority and Responsibility of
The Surgeon General. (2) Services of Supply Organization Manual, 10 Aug.
1942, sec. 403.02.
General within the War Department structure, several witnesses, including the Air Surgeon, expressed the opinion that The Surgeon General was hampered in the performance of his duties by lack of access to the Secretary of War. They contrasted his position with that of the Surgeon General of the Navy, Admiral Ross T McIntire, who had direct access to the Secretary of the Navy. Admiral McIntire expressed the opinion that the placing of the Surgeon General's Office under the Services of Supply organization was a mistake, as it added another echelon to the channels above. He thought that, while decentralization of responsibilities for the procurement of medical supplies might work well, centralized control over personnel was vital. In the prevailing organization of the Navy, he had full power of appointment and re-moval of medical officers on ships and of district medical officers. Members of the committee evinced strong interest in this matter of the position of The Surgeon General within the War Department. Questioned, General Magee expressed the opinion that he should be on the War Department Special Staff.29
A few witnesses ventured an opinion as to the personality of the present Surgeon General. Dr. Harvey Stone of the Procurement and Assignment Service, War Manpower Commission, thought that The Surgeon General and his office had not been sufficiently aggressive in asserting their rights.
Both Lt. Col. Bryan Houston, Chief of Purchase Service Branch, Purchases Division, Services of Supply, and Col. A. J. Browning, Director, Purchases Division, Services of Supply, believed that The Surgeon General had not been aggressive enough in his requests for personnel-a failing attributed by Colonel Houston to General Magee's medical education.30
Relations with the service command surgeons.-The surgeons of service commands (First, Second, Third, Fourth, and Fifth), called in to give their opinion of the most recent service command reorganization, were in general agreement that the scattering of medical functions through various divisions (supply, personnel, training, and so forth) of the office of the commanding general of the service command was unsatisfactory. Some service command surgeons were placed under the chief of the supply division or the chief of the personnel division of service command headquarters instead of directly under the commanding general. Although they found their situations agreeable, as their commanding generals and chiefs of the divisions under whom they immediately functioned let them run their medical service without serious interference31 they agreed that the present organizational scheme was fraught with danger. They found it hard to maintain control over medical personnel assigned to divisions of the service command other than the one in which they
29Committee to Study the Medical Department,
1942, Testimony, pp. 128ff.; 727ff.; 906-939; 1008-1043; 2039-2074.
themselves were placed. An organization so wholly dependent upon close cooperation of officers immediately above them was ill-advised, they thought.
Most officers of the Surgeon General's Office agreed with this point of view. The chief of the Operations Service declared that there was no true service command surgeon in the former sense of the title. He was only a senior medical officer heading the medical branch of a division of the service command. General Magee noted that he had already recommended to General Somervell that all medical personnel in the service command be placed under the direct authority of the senior medical officer there, with the latter as head of a medical division and on the special staff of the commanding general.32
Officers of the Services of Supply tended to minimize the difficulties caused the Medical Department by the recent reorganization of the service commands. Col. Kilbourne Johnston of the Control Division, Services of Supply, declared that although medical responsibilities had been split among three or more divisions in the service commands, the commanding general of each service command used his senior medical officer as his adviser on all medical matters throughout the command. Colonel Johnston drew a distinction between the position of service command surgeon and post surgeon which, he stated, had been a factor in changing the position of service command surgeon, while the post surgeon had remained in staff relationship to the post commander. The work of the post surgeon, who would likely have responsibility for running a large hospital with 50 or more doctors and was charged with large medical supply and distribution functions, was an operating job. The post surgeon should therefore be on the staff of the post commander (who reported in turn to the service commander) and should set up the large medical operation under him to suit himself. The function of the service command surgeon, on the other hand, as Colonel Johnston conceived it, was almost entirely that of an inspector. He expressed doubt as to whether the incumbents of the positions of service command surgeons were the best administrative types that the Surgeon General's Office could produce.33
Officers of the Surgeon General's Office stressed their loss of control over certain medical matters within service commands and certain problems arising between, service commands as a result of the present organization of the War Department. General Hillman, Chief of Professional Service, thought that the loss of control over personnel in the service commands by the Surgeon General's Office to the commanding general of the service command, plus the split of medical functions among service command divisions handling personnel, supply, training, and others, had resulted in separating himself from the men doing the professional work for which he was held responsible. Channels of communication were more circuitous than formerly. Letters on personnel matters arrived from the service commands without indication of any partici-
32Committee to Study the Medical Department,
1942, Testimony, pp. 46-47; 2039-2074.
pation by service command surgeons. The prevailing service command organization led to confusion and delay.34
The Surgeon General's staff voiced discontent at their loss of control over the assignment and use of medical personnel once the latter were assigned to a service command. The commanding general of a service command could move a medical officer assigned to his service command about within his area at will, and the Surgeon General's Office could not transfer him to another service command where he might be more needed. The Director of the Training Division stated that since the March reorganization of the War Department, The Surgeon General had no authority to order a particular individual to fake a particular course of training. Nor could he specify the locality where an individual trained in tropical medicine at the Army Medical Center should go to make use of that training. Once the trainee completed his course he was returned to service command control, whether or not the service command had any use for his most recent training. Colonel Lull noted that he could send the record of a man's special qualifications with him upon the latter's initial assignment to a service, command, but could not insure that these qualifications were taken into consideration in any reassignment the man received. In moving men from one service command to another, he had to specify the number of men and their grade or rank and could not request individuals by name. It was up to the service commander, presumably with the advice of his surgeon, to pick out the men to be transferred.35
Services of Supply officers declared that the real authority for transfer of a medical officer rested with General Somervell. They noted that the Services of Supply preferred the handling of transfers in terms of the assignments to be filled rather than in terms of individuals to be moved. It was precisely this Point that the Medical Department disputed. The Surgeon General main-tained consistently that his office needed to control the assignment of individual doctors in order to use their specialized training effectively. The Services of Supply, on the other hand, regarded the assignment of medical personnel as only one phase of its larger job of staffing the service commands and their installations. If The Surgeon General found a service command surgeon objectionable, he should call the commanding general of the service command on the telephone or talk the matter over with the Military Personnel Division, Services of Supply, and convince them of the need for a transfer. In the event of a disagreement between The Surgeon General and the commanding general the surgeon could be ordered out by Headquarters, Services of Supply.36
Col. Harry D. Offutt, MC, Director of the Hospitalization and Evacuation Division, pointed out a dual threat to the work of his division in the loss of control over personnel assigned to service commands plus the recent loss of
34Committee to Study the Medical Department,
1942, Testimony, p. 1803ff.
control of general hospitals to the service commands. A plan of The Surgeon General to concentrate specialists in certain diseases or injuries-of the chest, for example-in a general hospital in order to equip it to give the best possible treatment in a specialized field might be thwarted by the removal of personnel from this hospital to some other installation by the service commander.37
Relation with the Army Air Forces.-The semiautonomy of the Army Air Forces medical service became the subject of much discussion. In his testimony before the committee, Brig. Gen. David N. W. Grant, MC, the Air Surgeon, attempted to justify the separatist tendencies of Army Air Forces medical personnel on the usual grounds: the "peculiar" stresses to which flying personnel were subjected; the necessity for giving special training in aviation medicine to doctors who were to deal with their health problems; the need for special physical and psychological tests for air pilots, bombardiers, and gunners and for training men to devise and administer them; and, finally, the favorable atmosphere for the flowering of the new science of aviation medicine created by the independence of the medical organization of the Army Air Forces from the Surgeon General's Office. He declared that airmen needed, individual medical attention, that a medical officer in the Army Air Forces should be a "loyal and integral member" of that combat arm, and that the Army Air Forces should operate its own hospitals so that flight surgeons could be intimately associated with the activities of these hospitals.38
General Grant maintained that his office was doing a more effective job than that of The Surgeon General, and attributed this claim to two major factors: too great subordination of The Surgeon General, as well as the service command surgeons, under the existing scheme of War Department organization and the inefficiency of certain segments of the Surgeon General's Office. Alluding to the position of the Medical Department under the Services of Supply, he justified control of hospitals by the Army Air Forces on the ground that the Surgeon General's Office was not "functioning under the medical profession" but was "controlled by the commands." He emphasized his own relatively advantageous position on the staff of the Commanding General, Army Air Forces. He also pointed to the lowly position of the service command surgeon under a supply or personnel division compared with his former position as a staff officer for the commanding general of the service command.
General Grant justified direct recruiting of medical personnel by his office oil the grounds that the Surgeon General's Office had f ailed to furnish him with sufficient medical personnel. He charged the Military Personnel Division of the Surgeon General's Office with loss of papers relating to applicants for commissions and made similar strong charges with respect to the Nursing Division. He could not get the nurses needed by the Army Air Forces because they had been "lost in the Nurse Corps." He stated that in answer to charges
37Committee to Study the Medical Department,
1942, Testimony, pp. 199-215.
sometimes made by members of the Surgeon General's Office that he had disrupted their service, he had replied that his service was working while theirs was not. He quoted a complaint of the European theater surgeon, Brig. Gen. (later Maj. Gen.) Paul R. Hawley, MC (fig. 45), that the Army Air Forces had furnished medical supplies through its own channels to air force troops by air delivery in England. General Hawley had protested that the sick doughboy was entitled to as good service as the aviator. General Grant countered with the claim that his separate furnishing of medical supplies in the European theater proved the superior functioning of the medical service in the Army Air Forces.39
General Magee saw no reason for the separatism of the medical service of the Army Air Forces, for only two phases of its work could be considered peculiar to the Army Air Forces-the work of the flight surgeon and the conduct of investigative medicine related to aviation-and these had been customarily delegated to the Air Forces. The treatment of sick aviators and "sick ground airmen," he thought, should be the same as that of any other soldiers. In his opinion, service command surgeons should supervise and
39Committee to Study the Medical Department, 1942, Testimony, p. 128ff.
direct technical procedures in hospitals at stations of the Army Air Forces as well as the Army Ground Forces.40
Officers of the Surgeon General's Office pointed out several difficulties which they had encountered in making their policies effective throughout the War Department and the Army. Although these were matters of medical administration in the service commands, they stemmed primarily from the top organizational structure of the War Department and the semiautonomy of the Army Air Forces. One complaint was lack of control of medical personnel assigned to the Army Air Forces. Colonel Lull, Chief of the Personnel Service, Surgeon General's Office, pointed out that he had no say as to the reassignment of medical personnel once they had been initially assigned to the Army Air Forces. In other words, no one office in the War Department was in a I position to make effective reassignments in order to make the, best use of medically trained men.41 Another problem was lack of control over activities of Air Forces medical installations. The director of the Dental Division noted that his dental officers assigned to the service command surgeon could not inspect dental installations of the Army Air Forces, although he could transfer dental personnel out of the Army Air Forces to some other jurisdiction. The Chief of Professional Services stated: "Under the current Army organization the Medical Practice Division feels decidedly out of touch with the actual professional work going on in our military hospitals." He was concerned over the effectiveness of the work of his consultants assigned to the service commands. The weakness to which he called attention was that of confusion occasioned a technical service by overlapping commands within a given geographic area. The various commands set up by the Army Air Forces (Air Service Command, Flying Training Command, and others) had their own area jurisdictions, cutting across the boundaries of the service commands. It was impossible to obtain enough highly trained specialists to assign to all the area divisions of these commands. To date, consultants in the three major specialties of internal medicine, surgery, and neuropsychiatry had been assigned to the service commands with the greatest number of hospital beds, the Fourth, Seventh, Eighth, and Ninth. Service command surgeons were uncertain as to their responsibilities for furnishing the services of consultants to hospitals variously assigned to one or another of the Army Air Forces commands. The director of the Veterinary Division, on the other hand, minimized difficulties occasioned the operations of the veterinary service by the current War Department organization and complex channels of command. He believed that the standardized training given Army veterinary personnel enabled the Veterinary Division to maintain its standards of meat and dairy food inspection uniformly throughout the various commands.42
40Committee to Study the Medical Department,
1942, Testimony, pp. 1667-1726.
Col. Kilbourne Johnston of the Control Division, Services of Supply, maintained that the duplicate medical program conducted by the Army Air Forces in the United States was not justified, noting that the Army Ground Forces had not established a duplicate medical service. The division of responsibility for tactical medical units, whether of ground or air forces, as between the Services of Supply, on the one hand, and the Army Air Forces and Army Ground Forces, on the other, was clear enough. Field armies and air forces admittedly should train their own medical units and control their own medical personnel, for they would be going overseas where they would be under a theater commander. However, the Army Air Forces was no more justified in maintaining its own hospitals than the Army Ground Forces. Although most representatives of the Services of Supply who appeared before the committee did not take any strong stand for or against the bid of the Army Air Forces medical organization for independence, this question was one on which the point of view of the Services of Supply largely coincided with that of the Surgeon General's Office.43
H. Alexander Smith, Jr., consultant to the Control Division, Services of Supply, at first proposed, in his investigation into medical activities of the Air Surgeon's Office in relation to those of the Surgeon General's Office, that matters be left as they were for the duration of the war. He noted that the Army Air Forces was contemplating the eventual establishment of an Air Forces Medical Department entirely divorced from the Services of Supply to support an Army Air Forces entirely divorced from command relationship with the Army. The issue of eventual separation should not be raised while the war was in progress, he thought; the duplication of activities was not great enough to warrant interference with the Army Air Forces medical service, which was working effectively. By the end of September, however, he had apparently become somewhat more cognizant of the conflicts of authority and duplications of activities resulting from the current organization. Accordingly he proposed that the Air Surgeon be designated "Deputy Surgeon General for Air" and that his office and activities be transferred from the command of the Army Air Forces to a position directly subject to the authority of The Surgeon General. He was to act as an adviser to The Surgeon General on all routine medical activities of the Air Forces but to be directly responsible for all specialized medical activities peculiar to the Army Air Forces. In substance, this solution was backed by a subcommittee of the Committee to Study the Medical Department, which was appointed to examine further the medical activities of the Army Air Forces.44
43(1) Committee to Study the Medical Department,
1942, Testimony, pp. 769-813. (2) Memorandum, Director, Control Division,
Services of Supply, for Commanding General, Services of Supply, 21 Sept.
1942, subject: Incidents Indicating Concerted Campaign of Army Air Forces
Relations with the Army Ground Forces.-Testimony with respect to the office of the surgeon of the Army Ground Forces indicated that relation- ships between his office and that of The Surgeon General had not led to any serious problems. Brig. Gen. Frederick A. Blesse, Surgeon, Army Ground Forces, stated that his office was primarily concerned with seeing that task forces being prepared to go overseas had everything they needed in the way of trained medical men and supplies and equipment. The question that had come up earlier in the year as to the respective jurisdiction of the Army Ground Forces and the Services of Supply over tactical medical units had by now been largely settled, he thought, as the Army Ground Forces now had control of most tactical medical units which were normally assigned to armies in an oversea theater, while The Surgeon General controlled the numbered station and general hospitals usually assigned to a services of supply. Unlike the Air Surgeon, the Ground Surgeon had done no direct recruiting of personnel.45
Relations with the Hospitalization and Evacuation Branch, Services of Supply.-The committee probed thoroughly into the relations of the Hospitalization and Evacuation Branch (consisting of the Hospitalization Section and Evacuation Section) of the Plans Division, Services of Supply, with the Surgeon General's Office. A good deal of rather fruitless discussion developed over the interpretation of the following section in the Services of Supply Organization Manual of 10 August 1942. This read as follows:
(a) The Hospitalization Section reviews plans for and coordinates activities related to military hospitalization overseas and within continental United States; and insures provision of adequate means for military hospitalization.
(b) The Evacuation Section reviews plans for and coordinates activities related to evacuation of sick, injured, and other casualties from overseas and within the continental United States delivered to the control of the Commanding General, Services of Supply; insures provision of all means required for evacuation of sick and wounded; and coordinates with Commanding General, Army Air Forces, on the development and operation of air evacuation.46
It was the duty of Headquarters, Services of Supply, as Colonel Wilson, Chief of the Hospitalization and Evacuation Branch, conceived it, to review plans of the Surgeon General's Office, along with the plans of the other supply services, and coordinate them; for example, to attune The Surgeon General's medical plans for certain oversea operations to the available transportation. He made the point that the staff officer had the responsibility for revising plans, for example, for a certain number of hospital beds, upward or downward. He declared that he was trying to protect the interests and standards of the Medical Department, and that in taking that position he was sometimes under fire from staff officers. He advised the Assistant Chief of Staff for Operations, General Lutes, to the best of his ability, but the latter as his superior had the power of
45Committee to Study the Medical Department,
1942, pp. 409-426.
decision. Whenever the Services of Supply lowered the standards of medical care or reduced the quantities of medical personnel or supplies, Colonel Wilson was then blamed by the Medical Department, although the circumstances were beyond his control.
Theoretical discussion revolved around the word "insure" in the passage above. Colonel Wilson interpreted the phrase "insures provision of adequate means" to mean that if the Surgeon General's Office did not make plans when it was asked to do so, it was the responsibility of his office to make them. If plans had not been properly made, it was the duty of his office to revise them. Colonel Wilson expressed the opinion that very few medical officers knew how to write papers addressed to staff officers in such a way as to insure definite decision by that body. In other words, many medical officers, he thought, had not mastered the technique of preparing memorandums and plans in the proper form for staff consideration. Thus, although the Surgeon General's Office had not failed to make plans in the broad sense, it had failed to put its proposals in standard staff terms. Colonel Wilson attributed slowness in obtaining approval of certain policies, such as immunization of all Army troops against tetanus, to this failure.
Colonel Wilson thought that the General Staff had neglected the Medical Department in the period prior to late 1940. In those days, when no Medical Department officer had been assigned to that office, a nonmedical officer had made staff decisions affecting the medical service. Colonel Wilson emphasized the fact that in order to issue a directive binding on all concerned, the Medical Department had to get staff approval. It was better for a medical officer to be assigned to a position where he could exercise influence over staff decisions on medical matters than for such decisions to be left entirely to nonmedical officers.47
In General Magee's interpretation, the phrase "insures provision of adequate means for military hospitalization" meant that the Hospitalization and Evacuation Branch would perform the necessary staffwork to insure that The Surgeon General's recommendations were carried out by the War Department. Presumably Services of Supply headquarters had considered it desirable to establish a Hospitalization and Evacuation Branch in order to coordinate matters relative to the hospitalization and evacuation of the sick and injured among the various services. The Surgeon General had had nothing to do with establishing the branch or with preparing the description of its duties embodied in the Services of Supply Organization Manual. He had assigned Colonel Wilson originally as a medical supply officer in G-4 and would not have appointed him to his present position. The Hospitalization and Evacuation Branch had undertaken to criticize recommendations by the Surgeon General's
47(1) Committee to Study the Medical Department, 1942, Testimony, pp. 1272-1340; 1869-1964. (2) Letter, Lt. Gen. LeRoy Lutes, to Director, Historical Division, Office of The Surgeon General, 8 Nov. 1950.
Office with respect to hospitalization and evacuation, and to supersede these with recommendations of its own.48
The Chief of the Operations Service, Surgeon General's Office, Brig. Gen. Larry B. McAffee, MC (fig. 46), declared that his group had always tried to cooperate with the Hospitalization and Evacuation Branch, Services of Supply, on matters of hospitalization and evacuation, but that in many instances Colonel Wilson's policies had not represented those of The Surgeon General. Colonel Wilson's office had carried on actual medical operations to a certain extent, he said, and had conducted activities for which The Surgeon General was responsible, whereas in theory it was engaged in planning only. General Magee also thought that Colonel Wilson had engaged in "operations"; in his opinion an officer assigned to such a position should act as adviser only and should express the views of the Surgeon General's Office. His concept differed markedly from that of Colonel Wilson (and presumably that of Services of Supply officials), for Colonel Wilson consistently emphasized the fact that he acted under the direction of General Lutes. Undoubtedly the fact that Colonel Wilson was junior to some of the officers whose work be had criticized had added to the acrimony of the debates.49
48Committee to Study the Medical Department,
1942, Testimony, pp. 2039-2074.
Charges embodied in a document, signed by Corrington Gill, consisting of briefs of memorandums from the files of Colonel Wilson's office, reviewed the major points of conflict between General Lutes' office and the Office of The Surgeon General. These included some whose origin dated back to the days when Colonel Wilson was assigned to G-4: the question of issuance of unit equipment to troops, charges that the Surgeon General's Office had failed to make adequate hospitalization and evacuation plans, and so forth. The document concluded with a statement that the summaries proved that the staff of the Services of Supply had found it necessary to formulate plans and policies which were obviously the responsibility of The Surgeon General to prepare and that it had repeatedly had to follow up directives issued to him in order to get action on them. The Surgeon General read before the committee a refutation prepared by Mr. Tracy S. Voorhees, then in charge of the legal work connected with medical supply contracts. The committee apparently reached the conclusion that this refutation, together with additional evidence obtained from Colonel Wilson and The Surgeon General in reappearances before the committee, disproved the charges.50 No mention of the charges or of the refutation appeared in the final report of the committee.
FINAL REPORT OF THE INVESTIGATING COMMITTEE
The final report of the Committee to Study the Medical Department was submitted on 24 November 1942. It appeared in the form of sections entitled "Standards of Professional Service," "Adequacy of Medical Care," "Adequacy of Hospitalization," and the like. The three copies of the report were given to officials of the Services of Supply. No full copy of the report was sent to The Surgeon General, but the Chief of Staff, Services of Supply, forwarded to him, on 26 November, 85 of a total of 98 detailed recommendations, for specific changes in organization or policy which were within The Surgeon General's power to put into effect. Those not sent him had to do mainly with relations with the Army Air Forces and with the organizational position of The Surgeon General in the War Department; they were mostly matters for decision of higher authority.51
50(1) Report to Committee to Study the Medical
Department by Corrington Gill, no date, subject: Data From Files of Hospitalization
and Evacuation Branch, Plans Division, Services of Supply. (2) Interview,
H. Alexander Smith, Jr., 28 Oct. 1947. (3) Memorandum, The Surgeon General,
for Col. Sanford H. Wadhams, 7 Nov. 1942, subject: Transmitting "Correcting
Information to Confidential Document Submitted by Mr. Gill, entitled 'Report
to Committee on Data from Files of Hospitalization and Evacuation Branch,
Plans Division, Services of Supply.' " (4) Interview, Tracy S. Voorhees,
22 Sept. 1950. (5) Report of Subcommittee to Examine Col. Wilson's Criticism
of the Surgeon General's Office, no signature, no date.
In early January, General Magee asked for a copy of the complete report, stating that the extracts which he had received gave only "an incomplete and unsatisfactory idea" of the findings. The Chief of Staff, Services of Supply, replied that Services of Supply headquarters must await release of the report by Secretary Stimson. Although General Magee brought further pressure, he did not receive the report at that time. Neither had members of the committee received copies of the report, which they had signed under pressure of time without having an opportunity to read the final text. In February, Dr. Lewis H. Weed and Dr. Evarts A. Graham saw the Secretary of War and asked that the report be released. . Former Surgeon General Merritte W. Ireland complained to the Chief of Staff, General Marshall, of the aggressively critical attitude toward the Medical Department exhibited during the committee sessions by the Services of Supply representative, Mr. Corrington Gill, and of the failure to release the report. General Marshall took these matters up with the Chief of Staff, Services of Supply. In the words of the latter, General Marshall was very much alarmed at the fact that this report had not been furnished to The Surgeon General." After reaching decision on major points raised by General Somervell, Secretary Stimson approved release of the report to The Surgeon General. Copies were sent to members of the committee on 25 February, and The Surgeon General apparently received a copy at that date or soon afterward.52
RECOMMENDATIONS AND ACTION TAKEN
As to the position of the Medical Department within the War Department, the committee declared that the medical service was a "highly developed professional service" rather than a supply service and could not operate effectively within the present organization of the War Department. The Surgeon General should be at staff level; surgeons in the Army Ground Forces, the Army Air Forces, oversea forces, and service command headquarters should also have staff position. The committee found that the "existence of a semi-independent Medical Department within the Air Forces" had led to administrative confusion and duplication of effort. Every feasible means should be used to bring the Army Air Forces' medical service under the control of The Surgeon General or, failing this, a clear delineation of the Air Surgeon's functions under The Surgeon General should be made. The report accordingly recommended that the Office of The Surgeon General be placed on the special
52(1) Memorandum, The Surgeon General, for the Commanding General, Services of Supply, 12 Jan. 1943. (2) Memorandum, The Surgeon General, for the Secretary of War, through the Commanding General, Services of Supply, 12 Jan. 1943, and indorsements. (3) Letters, Col. Sanford H. Wadhams, to Dr. Lewis H. Weed, 25 Nov. 1942, 1 Dec. 1942; Dr. Weed to Col. Wadhams, 28 Nov. 1942; Dr. Evarts A. Graham to Dr. Weed, 21 Jan. 1943, 10 Feb. 1943, 3 Mar. 1943; Dr. Weed to Dr. Graham, 13 Feb. 1943. Personal file of Dr. Lewis H. Weed. (4) Memorandum, Chief of Staff, Services of Supply, for Commanding General, Services of Supply, 16 Feb. 1943, and inclosures, subject: Publicity Regarding Medical Department. (5) Memorandum, Chief of Staff, for H. H. Bundy, Special Assistant to Secretary of War, 25 Feb. 1943.
staff of the Chief of Staff that a position of Chief Surgeon, Services of Supply (with rank and responsibilities corresponding to those of the Air Surgeon and the Ground Surgeon), be created on the staff of the Commanding General, Services of Supply, and that a unified medical division be set up in each service command, headed by a surgeon on the staff of the commanding general.
As to the internal administration of the Surgeon General's Office, the committee found that the Personnel, Administrative, and Professional Services, as well as the Fiscal and Training Divisions, deserved particular commendation. In general, the report stated, the Supply and Operations Services had done a good job in spite of their difficulties. On the other hand, the two important staff functions of vital records and medical intelligence had not been developed in proportion to their importance. The report termed the administration of the Army Nurse Corps weak, and strongly advocated the reorganization and strengthening of the Nursing Division. It praised the Office of The Surgeon General for "the excellent medical and nursing care" and preventive measures being provided the Army, and commended The Surgeon General for his "foresight in securing the cooperation and support of the medical profession and of the national medical organizations." However, the committee stated its belief that The Surgeon General had not protested strongly enough against certain financial and personnel restrictions and military orders not in consonance with the best medical practices. It believed that "aggressive presentation of the medical aspects of a military problem should always be a prime function of administration." It also found that The Surgeon General had not held frequent enough staff conferences on administrative matters, and it advocated continuing study of administrative procedures. It made certain recommendations for specific changes in the structure of the Surgeon General's Office. Finally, the committee pointed out the unique importance, among medical administrative positions, of the position of Surgeon General of the Army. It named the following qualities as those which The Surgeon General should possess in a marked degree: "Outstanding ability and experience in the medical profession," aggressiveness, and administrative ability.53
The report contained a detailed list of recommendations prepared by extracting from the major sections of the report, which were rather discursive, all definite statements that could be considered recommendations for specific action. In forwarding 85 of these recommendations to The Surgeon General, the Commanding General, Services of Supply, indicated those on which the Surgeon General's Office was to take immediate action and those on which a report was to be made by a specific date. Throughout most of the remaining
53Committee to Study the Medical Department, 1942, Report, Tab: Administration, pp. 25-30. On the other hand, the concurrent inquiry into the internal organization of the Surgeon General's Office and its use of officer personnel, which the Deputy Chief of Staff had directed the Inspector General to make, found that the Office was appropriately organized for the accomplishment of its mission and was economical in its use of commissioned personnel in supervisory positions. See Memorandum for the Inspector General, 30 Oct. 1942, subject: Report of Investigation of the Present Organization of the Surgeon General's Office.
months of General Magee's tenure as The Surgeon General, various segments of his office were engaged in replying to or following up one or another of this group of recommendations. Only those relating primarily to matters of organization and administration are discussed below.54
One recommendation (No. 28) stipulated that the staff of the Surgeon General's Office and of certain service commands should include a trained consultant on hospital administration. This recommendation. was tied in with a more general proposal in the committee's report to make wider use of lay hospital administrators in responsible positions concerned with hospital administration. The Surgeon General's Office originally replied that it considered the work of the commanding officer of an army hospital more confined to technical medical duties than was that of the usual civilian hospital administrator. It noted that in military service many functions of hospital administration-for example, new construction, employment of personnel, solicitation of funds and so forth-were handled by other branches of the War Department than the Medical Department or by Federal Government processes outside the War Department. However, by January 1943, the Surgeon General's Office had begun negotiations for the commissioning of Dr. Basil McLean, superintendent of the Strong Memorial Hospital in Rochester, N.Y., in order to assign him to the Surgeon General's Office to study the organization and administration of military hospitals. The office met with some difficulty in obtaining the release of Dr. McLean from several serious commitments in civilian life. After he came, he appears to have been given little responsibility; he left the following year.55
A recommendation (No. 33) that the Hospital Construction Division be headed by a nonmedical man experienced in hospital planning came to naught. The Surgeon General answered in his original reply to the recommendations that the Director of the Hospital Construction Division was a Regular Army medical officer of over 25 years' experience and that "only a doctor with long experience in handling patients under Army conditions can be fully aware of the needs in Army hospital units." Any plan for hospital construction would have to be reviewed "by active medical men" before The Surgeon General could approve it. The reply also noted, as proof that this division was not using medically trained officers in positions where nonmedical men would have sufficed, that the division contained three nonmedical officers, two medical officers who were overage for field duty, and a number of civilians trained in architecture or previously connected with architectural firms of national repu-tation. Apparently nothing further developed from this reply.
A recommendation (No. 34) that the Surgeon General's Office become more currently informed on sicknesses and casualties in oversea theaters eventu-
54Unless otherwise noted, the following discussion
of the committee's recommendations and action taken on them is based on
a notebook kept by Corrington Gill, the committee's executive secretary,
entitled "Action on Recommendations of Committee to Study the Medical
ally led to significant improvement in the Office's knowledge of medical developments in the oversea theaters. Before the report of the committee appeared, the Surgeon General's Office sent to each oversea theater of operations and the Eastern, Western, and Caribbean Defense Commands a request that the command forward on the 1st and 15th of each month a brief summary on the status of the following phases of the medical program within the command: Matters of organization; location of major medical units, supplies, and equipment; problems in preventive medicine; unusual diseases; and so forth. The Commanding General, Caribbean Defense Command, protested against the sending of this report on the ground that a commander ought not to be bypassed by the reporting of a special staff officer directly to a chief of service. The Office of the Inspector General agreed with this point of view. In late October 1942, the Hospitalization and Evacuation Branch of the Services of Supply had already sent to some of the same commands a request for a similar report, which met no opposition, presumably because it called for a single, not a recurrent, report.56
These requests not only duplicated each other in part but to some extent duplicated information already being received, although late, from established reports. They also further illustrated the prevailing confusion, if further evidence were needed, as to the mutual authority and responsibility of the Hospitalization and Evacuation Branch, Services of Supply, and the Surgeon General's Office. The General Staff called the attention of the Services of Supply to the duplication, and General Somervell ordered rescission of the request from the Surgeon General's Office, asking the office to use the proper channels henceforth. After consultation between the Hospitalization and Evacuation Branch, Services of Supply, and the Surgeon General's Office, commanders of forces outside the United States were asked in January 1943 to submit the data wanted by the Surgeon General's Office regularly in the monthly sanitary report. Purely technical information was to be extracted and sent in advance not later than the fifth day after the end of the month, by V-mail or airmail. Out of this procedure developed in July 1943 a report entitled "Essential Technical Medical Data" which to the end of the war was a regular report furnishing valuable information on medical matters overseas.
With respect to a recommendation (No. 50) that a consultant psychiatrist be assigned to each service command, the Surgeon General's Office noted that consultant psychiatrists had already been assigned to the Fourth and Eighth Service Commands and that others were being selected for all service commands except the Sixth, where the supervisory work in psychiatry did not appear to
56(1) Memorandum, Executive Officer, Office of The Surgeon General, for the Adjutant General, 12 Nov. 1942, subject: Request for Medical Reports. (2) Routing slip, Deputy Inspector General, to Deputy Chief of Staff, 30 Nov. 1942, subject: Reports Required of the Commanders by The Surgeon General and Reports Required of Machine Records Branch, Adjutant General's Office. (3) Memorandum, Col. William L. Wilson, for Assistant Chief of Staff for Operations, 4 Dec. 1942, subject: Reports Required of Theater Commanders.
justify full-time work by a staff of consultants. No action was taken on recommendation No. 58, calling for a unified medical division within each service command, the director to serve on the staff of the service commander. General Somervell had disapproved General Magee's request of 7 November that this scheme be adopted in the service commands, and General Magee stated that in view of General Somervell's opposition, his office would cooperate to make the existing organization work.57
Following up a recommendation (No. 59) that the Nursing Division be reorganized and strengthened, the Superintendent of the Army Nurse Corps asked to be retired. Her successor, Lt. Col. (later Col.) Florence A. Blanchfield, was named in February, effective I June 1943. The Control Division, Surgeon General's Office, began reorganizing and simplifying office procedures of the Nursing Division, and the Surgeon General's Office and the Red Cross began a concerted recruiting drive to get nurses into the Army. In 1943, one or more members of the Army Nurse Corps were assigned to the Officer Procurement Districts in the service commands to accelerate recruiting of nurses.58
A number of the detailed recommendations (Nos. 60, 61, 65, 67, 68, 69, and 70) of the committee's report related to the work of the Vital Statistics Division. The committee advocated the establishment of a Statistical Division to include administrative statistics as well as medical statistics; in other words, the entire field of statistics compiled by the Surgeon General's Office. This division, it maintained, should be a staff division and should be headed by an outstanding statistician versed in both fields of statistics. The Surgeon General's Office took the position that records pertaining to health of the Army constitute a specialized branch of statistics which should not be organizationally consolidated with other types. The major field in which statistics were compiled in the Surgeon General's Office, other than vital statistics, was that of medical supply. Medical supply statistics were directly related to the work of the Supply Service which was then being reorganized, and the Surgeon General's Office stated that it was more feasible to leave the handling of such records to the Supply Service. The two functions remained separate.
The Surgeon General's Office and the Services of Supply made strenuous efforts throughout the first half of 1943 to expedite the work of the Vital Statistics Division. Many changes in personnel took place. Another officer was made director of the division in February, but in April General Somervell asked that he be relieved. In June, Capt. Harold F. Dorn, SnC, previously
57Memorandum, The Surgeon General, for the
Commanding General, Services of Supply, 7 Nov. 1942, and 1st indorsement,
Commanding General, Services of Supply, for The Surgeon General, 12 Nov.
of the U.S. Public Health Service, was made director by the new Surgeon General.59
Some disagreement in policy on administration of the medical statistics program between the Surgeon General's Office and the Services of Supply derived from differences in concept as to the use to be made of vital statistics. The Surgeon General's Office apparently stressed the importance of these records for historical research and for long-range planning. Some officers of the Services of Supply believed that accurate statistical estimates, if they could be made promptly enough, were of value for operating purposes. These officers criticized the Surgeon General's Office for its failure to develop statistics as a tool of current operations, instead of relying upon the judgment of the medical officers concerned.60 No examples were given, however, of any situation that could have been handled more effectively on the basis of statistical compilations than by direct personal contact. From The Surgeon General's point of view, the time factor was overriding.
Two major causes of large backlogs of work in the Vital Statistics Division were late reception of forms from overseas and lack of technically trained personnel and clerks. The report of the Committee to Study the Medical Department recognized the lack of personnel as a serious factor in delaying the work of the division. Between July 1942 and June 1943, civilian personnel in the Vital Statistics Division increased from about 220 to about 300. In July and August 1943, a few statistical experts from the Metropolitan Life Insurance Co. reported for duty in the division.61
Two recommendations (Nos. 62 and 15), for more aggressive presentation of the medical aspects of military problems and of medical needs, were concerned with the personality of The Surgeon General. As General Magee was then inspecting Army medical service in North Africa and the United Kingdom, his office refrained from making any comment. General Magee did not admit to any lack of aggressiveness. His concept of The Surgeon General's responsibilities was later expressed in these words: "The needs of the Medical Department were fully presented, as occasion arose, within the limits of proper military procedure. It is not contemplated that an officer in the position of The Surgeon General should be required to throw his hat on the ground and dance on it in an effort to command attention."62
In answer to a recommendation (No. 63) for regular staff meetings in the Surgeon General's Office, the office pointed out that all medical men recog-
59(1) Office Diary, Col. Albert G. Love, MC,
entries for February-June 1943. (2) Memorandum, Director, Control Division,
Army Service Forces, for Commanding General, Army Service Forces, 30 June
nized the value of these, as staff meetings were regularly conducted in all large hospitals. They stated that the office had only recently discontinued its weekly staff meetings of chiefs of divisions when it appeared that they interfered with the work of the office "without compensating advantages." Staff meetings were now held whenever the need arose. The Surgeon General's Office stated that regular meetings at 2-week intervals would be undertaken. These were apparently initiated by January 1943.63
One recommendation (No. 65) specified those divisions which the committee thought should report directly to The Surgeon General, or in the semimilitary terminology of public administration, should be at "staff level." The Public Relations Division, which had been changed to the Office of Technical Information in accordance with the nomenclature used by the Services of Supply and which had become a staff division in the August reorganization, had by November, for no apparent reason, been reduced to a branch of the Office Administration Division. The Surgeon General's Office stated that its personnel now consisted of one officer and two clerks and that no particular objective would be attained by putting it again at staff level. It was nevertheless restored to a staff position in April 1943. The office also opposed placing the Medical Intelligence Branch of the Preventive Medicine Division at staff level, on the grounds that its work was largely concerned with military preventive medicine and consequently needed correlation with the plans ,and policies of the Preventive Medicine Division. The organizational element handling medical intelligence continued to be a part of the Preventive Medicine Division (or Service) throughout the war.64
Another recommendation (No. 66) advocated the grouping of major divisions under three "services" instead of the prevailing five. The committee hoped to bring about still greater reduction in the number of officers reporting directly to The Surgeon General than the reorganizations of 1942 had theoretically effected. The scheme tallied with the existing organization insofar as the Professional and Supply Services were concerned. The major change proposed was that of grouping the Training and Fiscal Divisions, now staff divisions, and the two large Operations and Personnel Services, together with the divisions of the existing Administrative Service (Office Administration, Research and Development, and Historical), under a new and large Administrative Service. The Surgeon General's Office replied that the proposed new Administrative Service would group 11 diversified functions under I head. One of these, the Fiscal Division, had been placed at staff level by War Department directive. It also pointed out that the heads of only seven operating agencies now reported directly to The Surgeon General or his deputy.
63Memorandum, Director, Control Division, for
the Commanding General, Services of Supply, 27 Jan. 1943, subject: Investigation
of Administrative Matters of the Surgeon General's Office.
Thus very few of these detailed changes advocated for the internal structure of the office were adopted. Not one of those recommendations which directly advised the regrouping or relocation of functions (Nos. 60 and 61, 65, 66, and 68) was put into effect. A number of changes made in the organization of the Supply Service in February 1943 show continuing efforts to cope with the problems of that service, but they were of short duration. In June another reshuffle of functions of the Supply Service was made by the new Surgeon General and his advisers.65
In the first half of 1943 a good many changes in procedures and a good deal of expansion in space and in personnel, especially civilian, took place in such segments of the Surgeon General's Office as the Supply Service and the Vital Statistics Division for which experience of the past year had clearly demonstrated the need. The addition of civilian personnel was perhaps the most important internal development which the investigation brought about in the office. With the advent of a new Surgeon General, some key officer personnel, including the heads of some services and divisions whose work had been criticized, were replaced by new appointees.
One result of the committee's work, which was not dealt with in its report or in any recommendations, was the decline in the activities and the eventual abolition of the Hospitalization and Evacuation Branch of the Plans Division, Services of Supply. Although it remained in existence until February 1944, a new medical officer assigned as head of this unit by General Lutes tended to minimize its activities. He took the position that the work of coordinating hospitalization and evacuation activities which the unit had attempted to effect more properly belonged to the Office of The Surgeon General or could be handled by direct liaison between the Surgeon General's Office and the other agencies concerned.66
The detailed recommendations not sent to The Surgeon General were concerned with the matter of his position within the War Department, his relationships with the Air Surgeon's office, and the degree of his control over medical service of the Army Air Forces. They were as follows:
43. The Air Corps should not be permitted to establish a school for training Medical Administrative Corps personnel.
44. Medical officers attached to the Air Corps should be assigned to special courses such as tropical disease now being given in civilian institutions and in military installations.
45. The number of experienced neuropsychiatrists for work with the Army Air Forces should be increased. They should be selected directly by the Office of The Surgeon General.
54. The Surgeon General should function as a staff adviser to the Combined Chiefs of Staff and to the Joint Chiefs of Staff.
65Morgan, Edward J., and Wagner, Donald O.:
The Organization of the Medical Department in the Zone of Interior, pp.
25-26. [Official record.]
55. Every practicable effort should be made to bring medical service in the Air Force under the supervision, authority, and control of The Surgeon General, failing which a clear and concise delimitation of authority, responsibility, and functions of the Air Surgeon under The Surgeon General should be formulated and issued by proper authority.
56. The Office of The Surgeon General should be on the special staff of the Chief of Staff.
57. There should be created on the staff of the Commanding General, Services of Sup-ply, the position of "Chief Surgeon," Services of Supply, with rank commensurate with the position and involving responsibility and authority corresponding to that of the Air Surgeon and of the Ground Surgeon within their respective commands.
64. There should be a Deputy Surgeon General serving full time.
82. The Air Surgeon should not undertake procurement of medical personnel except through the Office of The Surgeon General.
97. Research on the physiological and psychological problems in flying should be more closely coordinated with other research problems of the Medical Department.
For the most part these recommendations called for decision by higher War Department authority. They involved three basic problems: the organizational position of The Surgeon General and his office in the War Department; relationships of The Surgeon General and his office with the medical organization of the Air Forces; and problems relative to the post of Surgeon General and his Deputy, who acted primarily as Chief of the Operations Service. General Somervell presented these matters to the Secretary of War for decision on 16 December.
Apropos of the committee's recommendations that The Surgeon General report directly to the Chief of Staff, General Somervell stated that this change would be contrary to the basic purpose of the March reorganizations; that is, to relieve the Chief of Staff of direct administrative relationship with the various services. The individualistic character of the profession of medicine, which he termed one of its best characteristics, made desirable a general administrative supervision of its work which neither the Secretary of War nor the Chief of Staff should be expected to give. On the other hand, he thought that the proposal that The Surgeon General have the same authority over medical organization in the Army Air Forces as over that in other branches of the Army was organizationally sound. He had previously discussed with the Chief of Staff the recommendation of the committee as to the appointment of a full-time deputy surgeon general to be placed in training as successor to the present Surgeon General.67
On 16 February Secretary Stimson agreed that there should be no Army organizational change with respect to the status of The Surgeon General. "In principle" it seemed wise to him that the authority of The Surgeon General
67Memorandum, Commanding General, Services of Supply, for Secretary of War, 16 Dec. 1942, subject: Report of Committee to Study the Medical Department of the Army.
over Air Forces medical organization should be the same as that over other branches of the Army. Secretary Stimson did not commit himself as to the selection of a new surgeon general, but noted that the matter of an appointment at the end of the present term would "receive prompt consideration."68
RESULTS OF THE INVESTIGATION
It is not clear whether the investigation of the Medical Department was primarily undertaken as an effort to remove General Magee from his position as The Surgeon General.69 If so, it failed of its purpose. Although the Surgeon General's Office began remedial action on a number of the detailed recommendations early in 1943, including those on matters of organization and administration, few changes in the internal organization of the office, other than the addition of substantial numbers of personnel to some divisions of the office, occurred before General Magee's 4-year term as The Surgeon General ended. The committee's ideas as to the improvement of the position of the Medical Department within the War Department structure received short shrift from the Commanding General, Services of Supply, and the Secretary of War, and presumably were similarly disapproved by the Chief of Staff. Hence the problems inherent in the position of The Surgeon General in War Department structure and the scattering of medical responsibilities throughout a number of elements of the War Department and Army remained. Nevertheless the investigation had the effect of stimulating awareness by both the Medical Department and the War Department of some of the Department's most pressing problems and spurring on, development of measures to cope with them.
68(1) Memorandum, Secretary of War, for Chief
of Staff, 16 Feb. 1943. (2) Memorandum, Chief of Staff, Services of Supply,
for Commanding General, Services of Supply, 16 Feb. 1943. It is clear from
(2) that General Somervell and General Marshall had a candidate for General
Magee's successor under consideration, but Secretary Stimson was not so