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HISTORY OF THE OFFICE OF MEDICAL HISTORY
STRENGTH OF MEDICAL DEPARTMENT COMPONENTS
Although the Medical Department might estimate its personnel requirements for any fiscal year, the number it was allowed was fixed by Congress or by the War Department within congressional appropriation. Congress had set the quotas for officers of the Regular Army until 1939 and for enlisted men until 1940. Until 1916, the quotas were in terms of numbers of individuals. The National Defense Act of 19161 and its amendments, which formed the National Defense Act of 1920,2 based the number of officers and enlisted men on the total enlisted strength of the Army, the ratio varying for each corps. In time of actual or threatened hostilities, however, the Secretary of War was permitted to procure such additional numbers of enlisted men as might be required. Thus, in World War I, the maximum strength figure of the Medical Department-343,394-was 92.52 per 1,000 total Army strength or 98.52 per 1,000 Army enlisted strength.3 In 1922, Congress abandoned the ratio system for officers and again authorized an absolute number for each corps.
The authorized officer strength of the Medical Department just prior to the emergency period was established by act of 3 April 1939 at 1,424 Medical, 316 Dental, 126 Veterinary, and 16 Medical Administrative Corps officers in the Regular Army, to be reached by 30 June 1949 through 10 approximately equal annual increments.4 Officers appointed in the Medical Administrative Corps after the passage of this act were to be selected from candidates who were graduates of a 4-year course in pharmacy from an approved school. It was contemplated that the then current members of the corps would have left the military service by 30 June 1949. The Medical Administrative Corps was never reduced to 16 members. Normal attrition had brought the total down only to 58 by 1943, at which time the members were absorbed in the newly created Pharmacy Corps. No further changes occurred in authorizations for Medical Department Regular Army officers during the remainder of the emergency and the the war period.
Until 1940, the enlisted strength of the Medical Department remained at 5 percent of the total Army strength, the ratio set by the National Defense Act of 1920.
Between 9 April and 22 June 1940, all of Western Europe except England fell under German control. These events in Europe had a tremendous effect on the U.S. military preparedness program. On 13 June, Congress appropriated sufficient funds to bring the Regular Army to its full statutory strength of 280,000 set by the National Defense Act of 1920. Before this could be accomplished, when the enlisted strength was still only 249,441, Congress passed a bill allowing the Army to be increased to 375,000.5
No further limitations were placed on the size of the Regular Army. The third supplemental appropriations act for fiscal year 1941 (approved on 8 October 1940) made it clear that the only limit on the Regular Army's strength was that which cash appropriations would impose.6
On 31 May 1940, the President asked Congress for authority to bring the National Guard into Federal service without the existing restriction which forbade use of the guard outside the United States. The request met with considerable opposition, and it was not until 27 August that the President was authorized to call up for a period of 12 months the National Guard and other Reserve components, which however were not to be employed "beyond the limits of the Western Hemisphere except in the territories and possessions of the United States, including the Philippine Islands."7
On 16 September 1940, Congress passed the first peacetime selective service act in the history of the United States. Like the National Guard-Reserve Act of 27 August of that year, the inductees were to serve for 12 months only, and the same limitation on oversea service was included.8 In August 1941, the President was empowered to extend indefinitely the length of service for the National Guard, selective service trainees, and Reserve officers should Congress find our national interest to be imperiled.
WAR DEPARTMENT RESPONSIBILITIES
Army Nurse Corps
The strength of the Army Nurse Corps was never set by Congress but rather by the War Department within the limits of congressional appropriations. In June 1939, the strength was set at 675; a year later, 949. This was the Regular Army nurse component, the only one on active duty until September 1940, when Reserve nurses began to be appointed for that purpose. The authorization for Regular Army nurses continued to be raised, however, reach-
ing 1,875 in March 1945. Until 1941, the basis for the calculation of requirements was 1 nurse per 270 military personnel (3.7 per 1,000). In that year, the War Department General Staff, on recommendation of The Surgeon General, changed the formula to 120 nurses for each 1,000 hospital beds, or approximately 6 nurses per 1,000 of Army strength.9
During the emergency and war years, Congress placed no statutory limitations on the number of non-Regular Army officers of the Medical Department. Like the nurses, the number to be added became the responsibility of the War Department, acting within the limits of congressional appropriation. For example, an act of 3 April 1939 which permitted the calling of 300 Reserve officers of the Corps of Chaplains and of the Medical Department to extended active duty did not specify how many of each branch were to be called. The General Staff in making the decision allotted 255 of these officers to the Medical Department.10 In December 1939, the General Staff, in anticipation of supplemental appropriations, authorized the corps area commanders to call up an additional 508 Medical Department Reserve officers. In the following September, it authorized the calling of 4,019 Reserve nurses to active duty, the first time such action was taken during the emergency. The number was increased by 1,000 in January 1941.
Besides setting quotas for personnel on active duty with the peacetime Army, the War Department provided for the establishment of a procurement objective for each section of the Officers Reserve Corps. No procurement objective was established for the Red Cross nurses' reserve; it might therefore recruit members without limit.
In 1939, the elements to be considered in establishing a procurement objective were reviewed and restated; according to a memorandum prepared in G-1 (8 June 1939), a number of misunderstandings about the objective had arisen, among others that it "should include all officers needed for a maximum effort. Actually, the peacetime procurement objective should be limited to the needs to fill early requirements during mobilization until such time as mobilization procurement can catch up with current needs."11 A month later, the War Department published a set of figures giving the procurement objectives for Reserve personnel to be assigned to the corps areas. Comparison of these figures with the actual membership of the Medical Department Reserve Corps
1The large excess of actual
strength of the Dental Corps Reserve over the procurement objective is not
easily reconciled with the later statement (see p. 57) that procurement was
stopped when actual strength of that corps slightly exceeded the objective.
Either the figures themselves are incorrect or, possibly, a larger procurement
objective was in operation at the time the actual strength was computed. It also
seems possible that authorities may have continued to appoint men in the Dental
Corps Reserve even after the procurement objective had been exceeded.
about the same time (30 June 1939) will give some idea of how adequate-in the opinion of the General Staff-the existing Reserves were to meet anticipated needs (table 2). The comparison is necessarily a rough one, as the figures for the procurement objective covered only allotments to the corps areas, not to other using agencies. The latter agencies, however, ordinarily received only a very small proportion of total personnel.
In September 1939, The Surgeon General estimated the requirements of a fully mobilized Army of 4 million, which was the maximum contemplated by the War Department's Protective Mobilization Plan with its several augmentations. Reduced to ratios (number of medical personnel per 1,000 of total Army strength), his estimates were as follows: For the Medical Corps, 7.5; for the Dental Corps, 1.875; for the Veterinary Corps, 0.375; for the Nurse Corps, 6.25; for the Sanitary and Medical Administrative Corps, 0.75; and for the enlisted complement, 75.00.12 This estimate was based on World War I experience.
Although the total Medical Department strength of the Officers Reserve Corps (including members on duty and those not yet called) was below the procurement objective, The Surgeon General, as late as November 1939, expressed the opinion that the Reserves were sufficient for the basic force of
1,150,000 contemplated in the War Department Protective Mobilization Plan. He was doubtful however that they contained enough of the right types of specialists.13 Appointments in the Dental Corps Reserve had been suspended in 1938 with the consent of The Surgeon General, Maj. Gen. Charles R. Reynolds (fig. 17), when membership slightly exceeded the procurement objective.14 In December 1939, the General Staff ordered a partial suspension of appointments to all sections of the Officers Reserve Corps, although neither the Medical Corps nor the Medical Administrative Corps had reached their authorized procurement objectives. However, the suspension order excepted the following categories: Graduates of the Reserve Officers Training Corps; applicants for the Air Corps Reserve; and recent graduates in medicine, dentistry, and veterinary medicine who were qualified for duty with the Regular Army.15
FACTORS AFFECTING DETERMINATION OF REQUIREMENTS
Medical Department Officer Shortages
After Congress enacted the legislation just discussed, the responsibility for its implementation fell on the War Department. With no statutory restrictions remaining on strength, outside those imposed by congressional appropriations, the Army increased from a total strength of 264,118 on 30 June 1940 to 1,455,565 on 30 June 1941.16
Naturally, this tremendous increase in such a short period of time created many problems. One of the biggest problems in the Medical Department was the shortage of officers. As early as August 1940, before actual augmentation took place, The Surgeon General reported to The Adjutant General and to the Assistant Chief of Staff, G-1, that an acute shortage of Medical Department officers has been the subject of "very grave concern" to his office for some time and that as of 25 July the deficits for the various corps were as follows (based on an authorized troops strength of 375,000): Medical Corps, 1,527; Dental Corps, 391; Veterinary Corps, 223. He predicted that if the National Guard were called into Federal service the shortages would rise to the following figures: Medical Corps, 5,295; Dental Corps, 1,259; Veterinary Corps, 657. Should "some form of Selective Service" increase the Army still further, the Surgeon General's Office estimated that in April 1941 the following shortages would obtain: Medical Corps, 8,455; Dental Corps, 2,044; Veterinary Corps, 1,049.17
Problems Created by National Guard Induction
At the time of induction into Federal service (27 August 1940), the National Guard brought with it a complement of Medical Department officers and enlisted men. National Guard officers had the same rights of resignation as members of the Officers Reserve Corps.18 Many were also relieved from assignment because they were deemed necessary in an industry or occupation essential to the public interest. Upon mobilization, the medical service of the National Guard consisted of personnel assigned to tactical units only. In the middle of 1941, these units comprised 306 medical detachments, 20 medical regiments, and 1 medical battalion. The guard had no medical personnel of its own for fixed hospital service or for administrative overhead;19 National
Guard units, including medical units, were far below full strength when they were called into Federal service, so that personnel from Regular and Reserve components had to be assigned to them,20 and National Guard officers could not be readily shifted to meet changing needs since certain restrictions on their reassignment were not removed until September 1941. These three factors considerably increased the demand on the Army for medical personnel at the time of the induction of more than 250,000 guardsmen.
In September 1940, the Army had, aside from the medical units that were organic parts of existing divisions, only the following field medical units: Two surgical hospitals, two evacuation hospitals, two medical regiments, one medical supply depot, and one medical laboratory. In December, this was increased to 8 medical battalions, 8 medical regiments, 1 medical supply depot, 1 medical laboratory, 1 general dispensary, 15 evacuation hospitals, 6 surgical hospitals, 22 general hospitals, and 22 station hospitals. By the end of June 1941, all units had been activated.21
The next problem was the personnel to staff these units. In October 1940, The Surgeon General asked the War Department General Staff to remove the partial suspension of appointments to the Reserve imposed in December 1939, and to restore the situation that had existed before that date. This meant that appointments would be permitted in all corps of the Medical Department up to their procurement objectives, and the General Staff granted the request in December 1940 in that sense, with the proviso that applicants must agree to accept active duty when called upon.22 Apparently, The Surgeon General had either disregarded the fact that the Dental, Veterinary, and Sanitary Corps had already passed these objectives or had felt at the time that their uncalled Reserves were sufficiently large and accessible for all purposes. Two months later, however, he pointed out that the authority granted did not permit commissioning additional dentists or veterinarians in the Reserves and urgently recommended that it be "expanded to cover" both of these corps. The recommendation was unfortunately worded; what he wanted was not an expansion of the authority to cover these corps-the authority already covered them-but permission to exceed their procurement objectives. He further recommended that in view of prospective needs during 1941 and 1942 the existing procurement objectives for all Medical Department corps be suspended "until
in the opinion of The Surgeon General an adequate Reserve is available for the defense program with rapid expansion, if such should be required."23 This did not mean that The Surgeon General was willing to accept unlimited numbers in the Reserves. If the surplus became larger than necessary to meet future needs, it might mean granting virtual deferment of service to a considerable group.24
Because of the difficulties in procuring officers for certain corps, some substitution of one type of officer for another was permitted in meeting requirements. As early as February 1940, the Medical Department received authority to substitute reservists of the Medical Administrative Corps and Sanitary Corps for members of the Medical Corps Reserve in meeting the quotas for active-duty assignments.25 In 1941, after the Medical Replacement Training Centers for enlisted men at Camp Lee, Va., and Camp Grant, Ill., had been functioning for several months, the task of obtaining sufficient numbers of medical, dental, and medical administrative officers to staff them properly led The Surgeon General to suggest that "branch immaterial"26 officers be used in battalion and center headquarters as well as in the companies. The recommendation was approved. At this time, The Surgeon General stated that each company could be adequately and properly staffed with six Reserve officers: Two medical, two dental, one medical administrative, and one branch immaterial.27
With the increased medical facilities, the Medical Department had an additional problem of securing an adequate supply of enlisted personnel. As early as February 1939, General Reynolds, declaring that the 5 percent maximum allowed by the National Defense Act of 1920 would be inadequate in an emergency, recommended that Congress be asked to amend the law so as to permit enlisting "in time of actual or threatened hostilities * * * such additional number of men as the service may require." Higher authority in the War Department, however, rejected the proposal on the ground that the reasons for giving priority to the Medical Department in this matter were not apparent. Several months later (May 1939), The Surgeon General repeated his request, but it was not until 1940 that he achieved his objective when Congress raised the Medical Department's quota to 7 percent and empowered the President
(and hence the War Department) in the event of actual or threatened hostilities to authorize such additional enlistments as he considered necessary.28 This did not insure that the General Staff would immediately raise the Medical Department's authorizations even to 7 percent, for as late as June 1941 these amounted to less than 6 percent, although by that time actual strength had apparently risen to a little more than 7 percent.
Nor did it settle the question as to what ratio of enlisted men should be allocated to tactical units on the one hand and to nontactical units and headquarters other than The Surgeon General's Office on the other. Differences of opinion arose, particularly on the latter point. Until the middle of 1939, The Surgeon General had been using enlisted men for nontactical assignments to the extent of a little more than 4 of the 5 percent authorized him at that time, leaving less than 1 percent for tactical use. At the existing strength of the Army (174,000 enlisted men), this permitted the maintenance in this country of no more than two medical regiments and a medical squadron-all at modified peace strength. Surgeon General Magee reported on 30 June 1939 that the following units were to be organized: Two additional medical regiments, one veterinary company, one ambulance battalion, and one medical squadron. Outside the country, there were two medical regiments, one of which was composed of Filipinos. General Magee did not propose to transfer any personnel from nontactical activities, having (as he asserted) already less than enough for those activities; nevertheless, he called attention to the dearth of medical personnel for tactical units.29 Subsequent increases in the authorized strength of the Army to 227,000 during 1939 made possible the creation of more tactical medical units and detachments. General Magee welcomed this increment; in May and June 1940 when further enlargement of the Army to 375,000 was underway and Congress raised the Medical Department's ratio of enlisted men from 5 to 7 percent or more, he recommended the establishment of more tactical medical units, at least of certain types, than the General Staff was ready to approve-for example, four evacuation hospitals as against two, and four surgical hospitals as against two. No hospitals of either type had yet been activated, and up to this point, the Army was entirely lacking in field units to provide medical service above the division or corps level.30 From then on, expansion of the Army proceeded even more rapidly-especially after the introduction of selective service in 1940-and with it the need for tactical medical units, including those at the divisional level.
A year or more before the outbreak of the war, planning for the number of units (and therefore of enlisted men as well as officers) which would be
needed in the event of actual hostilities had produced disagreements between The Surgeon General and the General Staff. General Magee regarded the War Department's Protective Mobilization Plans for 1939 and 1940 as totally inadequate in the number of hospital centers and general and station hospitals projected for tactical use in wartime. The General Staff hesitated to increase this number, presumably because of the limited initial force contemplated in the mobilization plans and also because of a desire to emphasize in them combat units rather than service units. Eventually, however, in August 1940, the Staff modified its plans so as to include the number of general hospitals asked for by The Surgeon General-102-instead of the 32 originally specified. It was in connection with the mobilization plans and in order to create a reserve of officers to staff these hospitals that The Surgeon General obtained permission to revive affiliated units in various civilian medical schools and hospitals.31
The quota of enlisted men for nontactical units and headquarters was less easily agreed upon than the size of the Medical Department's tactical force, just discussed. In February 1940, General Magee declared that Medical Department enlisted strength for these purposes was below the 4.0715-percent ratio which had prevailed before 1 July 1939 and which, he said, was itself inadequate. In June 1940, he proposed 4.85 percent of total Army strength as the desirable ratio and continued to argue in terms of this figure until at least the middle of 1941. The argument was bound up with his objection to "displacing" enlisted men by civilian employees in nontactical hospitals to the extent of more than 20 percent. (His use of the word "displacement" may not have been quite apt. Little or no actual displacement of enlisted men had taken place-civilians had been employed mainly if not entirely to supplement them.) If a permanent displacement of 50 percent were accepted, where, he asked, would the Medical Department, whose hospitals were continually losing trained personnel to form cadres, get trained cadres for new nontactical hospitals and tactical units? He argued further that a displacement of more than 20 percent would seriously impair the training of tactical units then being activated, for personnel of the latter must receive their instruction as understudies in nontactical hospitals actually in operation and rendering patient care. Enlisted men of tactical units could not receive their training as understudies of civilian employees in nontactical hospitals when the civilians themselves had to be trained, and furthermore did not stay very long in their jobs. The Surgeon General's Office justified the 4.85-percent ratio on the ground that this figure was indicated conclusively by "the experience of the Medical Department extending over many years, both in peace and war."32
In September 1940, when General Magee presented the 4.85-percent ratio as a formula for allocating newly inducted personnel of the National Guard and selective service to the Medical Department, the reaction of the General Staff was mixed. G-1 considered the ratio reasonable. G-3 (operations) thought it might be acceptable for planning purposes, but proposed that as no "studied determination" of medical personnel requirements for nontactical units and headquarters had apparently been made, the actual needs of each such entity should be determined; The Surgeon General should then meet part of their requirements by "affiliating"33 with them the tactical units of a similar type-it seemed to G-3 that such affiliation would also facilitate the training of these units. Commenting that the allotments already tentatively made seemed generous, G-3 recommended that no change be made in them for the present. A notation in the file containing this correspondence dated 1 January 1941 states that General Magee's recommendations were "adjusted" in conference, and in a memorandum dated 16 April, G-1 promised that any further increases in Army strength would include a recommendation that Medical Department personnel be allocated in the ratio of 4.8 percent. The context of the latter document indicates that the 4.8 percent applied to nontactical units and headquarters and was therefore very close to General Magee's 4.85 percent for these purposes. But in May 1941,34 and probably until the very end of this period (December 1941), actual authorizations ran far below the desired ratio.
Although the War Department General Staff allotted a much smaller number of enlisted men to nontactical units and headquarters than the Surgeon General's Office and G-1 thought proper, it authorized the employment of considerable numbers of civilians to make up the difference. In April 1941 when the enlisted allotment was only 2.2 percent, the civilian authorization amounted to 15,000 or 33 percent of the total allotment, military and civilian. This, according to G-l, still left a shortage of 22,000 enlisted men (on the basis of the 4.85-percent ratio). In terms of actual strength, comparable figures for which are lacking, the proportion of civilians may of course have been somewhat different. In December 1941, General Magee reported that it had been necessary to supplement the enlisted men allotted to hospitals by civilians to the extent of 50 percent, and by the temporary employment of tactical hospital units in nontactical hospitals.35 He agreed that civilians might replace enlisted men in certain technical positions (those in which an enlisted man could not hope to attain proficiency without long education) and certain "scullery jobs" (which had no training value for him).36 But he contended that the hiring of civilians itself presented problems; for example,
their housing, messing, and the impermanence of their employment if they were later replaced by enlisted men. Such problems proved to be matters of some moment, although apparently they did not prevent the hospitals from rendering adequate service. Moreover, the use of new and relatively untrained enlisted men also presented some difficulties.
The War Department General Staff enabled nontactical installations and activities of the various services, including those of the Medical Department, to utilize personnel of the field forces. In October 1940, when the latter were placed under commands separate from those of the corps areas, their commanders were required to furnish the corps area commanders with such commissioned and enlisted personnel as they might request to operate their installations, pending procurement of the required personnel in the corps areas. In February 1941, announcement was made that field force personnel would be used to augment station complements whenever field forces were present on a post. This was part of a policy which aimed at restricting permanent station complements to the size necessary to maintain services when tactical forces were absent. It represented a departure from the former policy of providing station complements large enough for all contingencies so that tactical units could devote the proper amount of time to training. According to the General Staff, this expedient was necessary in order to prevent a material reduction of the number of troops assigned to field forces. Whether or not the policy resulted in a diminution of the allotments of Medical Department personnel to nontactical installations, it certainly enabled the latter to increase their complement of enlisted men, at least on a temporary basis.37
G-3's opinion that a study of the personnel needs of individual Medical Department installations would afford a firmer basis for allotments was probably not shared by the Surgeon General's Office; at any rate, no such studied determination seems to have been made. If it were not made, the reason may have been that the number of officers then available did not permit them to spend the time away from their day-to-day operations. Whether such a study would have enabled allotments to be calculated with complete accuracy may be doubted. To achieve that end in a period of rapid expansion, when the workload and other responsibilities of medical installations were constantly shifting, the study would have had to be continuous. Nevertheless, a thorough survey of the personnel situation at each hospital, for example, might have disclosed facts of considerable value to the policymakers. If it did not buttress General Magee's demand for an enlisted ratio of 4.85 percent, the survey might have enabled him to see a little more clearly how he could get along without it-as he actually had to do.
One substitute for such a detailed study was an estimate of needs according to the size of installations. For nontactical station hospitals, an estimate of this kind existed in the form of a table of organization showing the normal
personnel requirements for station hospitals of various bed capacities in the Zone of Interior in time of war.38 Early in 1940, the War Department issued directions on the use of this table in responding to a request from a corps area commander for instructions concerning the employment of civilians in the event of mobilization. The table was to serve as a guide, the local situation determining actual need, pending issuance of a new table similar in purpose which would be included in Mobilization Regulations. The old table stated requirements only in terms of military personnel; the General Staff therefore at the same time publicized a list of "appropriate positions recommended by The Surgeon General that may be filled by civilians in Station and General Hospitals, Zone of Interior, during mobilization."39 This list was reissued in June 1940.
Meanwhile, General Magee was asked for recommendations as to the form and content of a new table for converting bed requirements into personnel requirements. The General Staff probably expected that the new table would state requirements in terms of civilian personnel. General Magee, however, in December 1940 submitted a guide for determination of Medical Department personnel in Zone of Interior station hospitals, which followed the form of the old table of organization in specifying only military personnel, and merely stated that corps area commanders and chiefs of arms and services could "replace in part, decrease or augment the authorized enlisted men shown in the guide by qualified civilian employees." When G-4 (logistics) asked for a revision of the guide to show requirements for civilian as well as military personnel, General Magee's Office gave assurance that the substitution would be made on a man-to-man basis, an explanation which satisfied G-4.40 The new guide also, however, raised the requirements for enlisted men above those of the old table of organization. This caused discussion within the General Staff as to whether if the the guide was approved it might not compel larger allotments to the Medical Department than those already made, which had been based upon the old table. The final decision was that it would not, and the guide was published on April 1941 with the understanding that it embodied requirements, not availabilities. Thus, the General Staff saved itself from sanctioning an increased allotment. On the other hand, General Magee avoided the necessity of again committing himself, except in vague terms, to the principle of substituting civilian employees for enlisted men. Nor did the Surgeon General's Office apparently use the guide as a new factor in estimating the general requirements for enlisted men in nontactical units and headquarters, for that Office continued to talk in terms of the 4.85-percent ratio. The Acting Surgeon
General urged publication of the guide so that it could be used for planning purposes and for the assistance of corps area surgeons in procuring properly balanced staffs.
No global figure or ratio was set during the emergency period to determine the number of civilians who could be employed by the Medical Department. The only formula affecting them which appears to have been discussed at this time was the proper percentage to be employed in nontactical hospitals-a proportion which, as we have seen, The Surgeon General held should not exceed 20 percent.