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Foreword

Contents

Foreword

In order to meet the challenge of World War II the Medical Department of the United States Army expanded from a service equipped to support a peacetime army of some 200,000 men, based largely in the Zone of Interior, to one that provided the best in medical and surgical care for more than 8,000,000 American soldiers, serving on a war footing on every continent and under the most varied conditions of climate and terrain. The organization by means of which this global wartime mission was carried out, with efficiency and technical skill despite many potential sources of friction, is the theme of this volume in the administrative history of the Medical Department in World War II.

The book begins with an account of the structure and activities of the Office of The Surgeon General in the fall of 1939, when the long-impending outbreak, of war in Europe led to the declaration of a national emergency in the United States. Over the next 2 years, leading up to the attack on Pearl Harbor that precipitated American entry into the war, both the Army and the geographical area in which it operated grew rapidly in size. The Selective Service Act, the acquisition of Atlantic bases from Iceland to Trinidad, the inception of the lend-lease program, all compelled expansion of the Army's medical service to keep pace with the demands made upon it. Outstanding authorities in a great variety of the medical and surgical specialties, in the allied sciences, and in the fields of supply and administration were called upon to advise The Surgeon General, while new organizational elements were added to deal with sanitation and other health needs in Army camps across the continent and in island garrisons along the air and sea lanes to Europe and the Middle East.

This rapid expansion of the medical service brought out rival demands from civilian and military interests for the allocation of medical supplies and the control of medically trained personnel, adding measurably to the administrative burden. By early 1942 the 10 prewar divisions of the Surgeon General's Office had increased to 40. Centralized as it was in Washington, the Medical Department had become topheavy, with too many officers reporting to The Surgeon General and the threads of too many functions in his hands.

In March of that year the Medical Department was placed under the Services of Supply--later known as the Army Service Forces--as part of a sweeping reorganization of the War Department. Internal changes in the structure of the Surgeon General's Office resulted in a wider delegation of responsibility and in more efficient administration of the expanding functions of the Medical Department, but these could not outweigh the disadvantages of subordination to an intermediate headquarters. Thereafter, until The Surgeon General was restored to a position on the War Department Special Staff in 1946, medical matters affecting the entire Army reached the Chief of Staff only through the Commanding General of the Army Service Forces. Many expedients were devised to minimize the unfortunate effects of the new organization, but as this volume clearly shows, the overall effect of interposing an additional level of authority between The Surgeon General and the Chief of Staff was to make efficient administration of the medical service more difficult.

From Washington the organizational story moves out to the service commands, and finally to the great oversea theaters where the basic mission of the Medical Department was fulfilled. A reorganization at the service command level parallel to that of the War Department downgraded the various service command surgeons from staff to divisional positions and dispersed their medical sections among several offices of the various service command headquarters according to function. This change made it difficult for the medical section at service command headquarters to operate as a unit, or for the service command surgeon, to direct its work effectively. The transfer of the general hospitals located within the service commands from command of The Surgeon General to that of the commanding generals of the service commands had the effect of further weakening The Surgeon General's control and supervision over Medical Department installations and activities in the United States.

The Surgeon General's control of the medical service overseas was also less than complete. While Medical Department officers in Washington could communicate directly with theater surgeons overseas, and frequently did so, directives from The Surgeon General could be transmitted only in the name of the Chief of Staff, to whom The Surgeon General had no immediate access. Other factors tending to restrict The Surgeon General's control stemmed from local conditions in the different theaters, such as climate, terrain, the endemic disease pattern, and the degree of contact with civilian populations; and from the extent, frequency, and nature of combat operations.

A broad uniformity in the activities of the medical service in the different theaters was nevertheless achieved. Among the factors tending to bring about this uniformity were the standard tables of organization and equipment for Medical Department units; War Department directives such as those placing responsibility for certain preventive measures upon commanding officers; the use of consultants; a standard organization for malaria control, and another for administering public health measures in occupied areas; special commissions, such as the U.S.A. Typhus Commission, which sent specialists to epidemic areas; and the dispatch of individuals on special missions overseas to empha-size the standards and practices advocated by the Surgeon General's Office. Lastly, but certainly not least in importance, were the knowledgeable medical officers who served overseas in positions of great responsibility. These men were highly intelligent and experienced. Many had served as instructors at the Medical Field Service School at Carlisle Barracks, Pa., and at other service schools in the prewar years. They were familiar with theater medical organization and administration. Some had assisted in the formulation of War Department doctrine covering these matters. Their understanding, loyal co-operation, and aggressive direction of the medical services in the oversea theaters contributed largely to the successful accomplishment of the medical mission.

The oversea story is told necessarily from the point of view of the major commands, such as the offices of theater and army surgeons, and the medical sections of the more important subordinate elements of both combat and communications zones. Only at this level is it possible to see in perspective the whole organizational pattern of the war, and the place of the Medical Department in the total structure.

Except for the imposition of an Allied command in some theaters, and the quasi-independent status of the Army Air Forces in most, the command structure under which the Medical Department served in an oversea area followed the general outlines laid down in the prewar manuals. The theater command was the highest U.S. Army command in an area; only a surgeon assigned to such a command could exercise overall responsibilities with respect to the health and medical care of all U.S. Army troops in the theater. On the other hand, the medical job at the headquarters of the various communications zones included the operation of the large medical installations in an oversea theater--the fixed hospitals which furnished most of the definitive medical care, and the large medical supply depots. In some cases the same man served as chief surgeon at both the theater and service forces headquarters. In some the entire medical section for the two headquarters was the same, being physically located at one of the two, or, in some cases, split between them. In the case of certain groups with special training sent to the theaters by the Surgeon General's Office to fill specific needs, such as the consultants and the malariologists, the question arose in some theaters as to whether they could be most effectively assigned to theater headquarters or to communications zone headquarters.

Medical Department officers consistently maintained that the chief surgeon of any command should have a position on the commander's staff. Only by being placed at staff level can the surgeon gain the ear of his commander and participate appropriately in the activities and responsibilities in which the surgeon has primary interest. Since the command surgeon is largely an advisor and lacks command authority except in instances in which it is specifically delegated to him, he needs direct access to the commander in order to make known the needs of the medical service. In time of war, guns and ammunition are apt to take priority over medical matters; buildings for warehouses may be constructed in advance of those for hospitals. Yet every commander expects the wounded to be treated, evacuated from the combat zone, and hospitalized with precision and dispatch. If one single lesson stands out among those learned by the Medical Department in World War II, it is this: That at every important level of command the surgeon, if he is to carry out his mission effectively and well, must be an active and distinct member of the commander's staff. His position should not be subordinated nor included within any other staff member's office.

No other volume in the Medical Department series, nor even in the official history of the United States Army in World War II, gives so complete a worldwide picture of Army organization as this volume, which for that reason alone will undoubtedly find wide use outside of the U.S. Army Medical Service as well as internally. It presents clearly and at usable length the wartime organizational framework and the command structure within which the Army Medical Department functioned, and so forms an indispensable introduction to the other volumes of the series, clinical as well as administrative.

LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.

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