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ACCESS TO CARE
Procurement, 1941-45: Other Military Components
Among the various specialties represented in the Sanitary Corps, the largest was the group of sanitary engineers. On 1 January 1943, the Procurement and Assignment Service, at the request of the National Research Council's Committee on Sanitary Engineering, extended its jurisdiction over this profession. The committee, in making its request, cited the Army's large need for these men and the depletion of State health department rolls through losses to the military forces and the U.S. Public Health Service. The committee suggested that a system of procurement and assignment should be instituted promptly, and that the Procurement and Assignment Service should, after study, recommend the proper allocation of the limited supply. Mr. Abel Wolman, Professor of Sanitary Engineering at The Johns Hopkins University and Chairman of the Committee on Sanitary Engineering of the National Research Council, was made a member of the Directing Board of the Procurement and Assignment Service. About 1 June 1943, an Adviser on Sanitary Engineers was appointed in each State, under the Procurement and Assignment Service; in most States, the Chief Sanitary Engineer of the State health department was designated the State adviser.
On 30 September 1943, the Sanitary Corps comprised 2,054 officers, having grown almost 80 percent since the preceding December.1 Of this number, some 600 were sanitary engineers, the bulk of the members of the profession in the United States who were of military age and physically fit. As late as January 1945, of the more than 970 sanitary engineers then in the Sanitary Corps, approximately 75 percent had come from the civilian profession-largely from State and local boards of health. A "rough check" at that time revealed that about 22 percent had entered the corps from State health departments and 17 percent from city and county health departments. A further 20 percent had come from other governmental health agencies, while 20 percent more had been consulting engineers. In recognition of the limitations of procurement from these services, the experience requirement was reduced from 4 to 2 years.
The Army had to draw upon other sources, however, not only to meet its need for sanitary engineers but for other types of specialists represented in the Sanitary Corps. In 1943, it was decided to make use of the Army Specialized Training Program to train enlisted personnel to serve as sanitary engineers. Of the men so trained, 153 became officers in the Medical Department. Upon completing their college course, they were sent to Medical Administrative Corps officer candidate schools to obtain commissions; after their appointment in that corps, they were detailed to the Sanitary Corps.
From the beginning of the war, it had been possible to commission men directly, not only from civil life but from the noncommissioned ranks of the Army, if they possessed special qualifications that would justify their appointment as officers.2 As part of its effort to enlarge the Sanitary Corps in this manner, the War Department issued Circular No. 333 on 15 August 1944 to encourage enlisted men and warrant officers to apply for commissions in the corps, stating that a need existed for sanitary engineers, medical entomologists, serologists, biological chemists, parasitologists, and industrial hygiene engineers. A month later, the Medical Department succeeded in having a similar opportunity offered to enlisted members of the Women's Army Corps who could qualify as bacteriologists, biochemists, and serologists. In this case, however, the successful applicants were not to be commissioned in the Sanitary Corps but in the Women's Army Corps, being simply assigned to and immediately detailed to the Sanitary Corps.3
In addition, the Medical Department received permission to use Women's Army Corps officers who were trained in Sanitary Corps specialties. In December 1944, the War Department directed that every effort be made to utilize in medical installations such of these officers as were qualified in technical work appropriate to commissioned rank; the specialties mentioned as examples were those of laboratory officer, bacteriologist, biochemist, parasitologist, serologist, "and other positions established for Sanitary Corps officers."4 No permission was granted, however, to commission women in the Sanitary Corps directly from civilian life. These moves followed a campaign begun in the spring of 1944 to recruit members for the Women's Army Corps to serve in medical installations.
On 7 December 1944, The Surgeon General stated that the reservoir of bacteriologists, biochemists, and parasitologists in civilian practice was almost exhausted and asked the Officer Procurement Service to stop procurement from this source.5 Two months later, at his request, the War Department revoked the section of Circular No. 333 which encouraged applications for
appointment in the Sanitary Corps. Enough applications from the types of specialists referred to in the circular had been received to meet the existing needs of the Medical Department.6
During the period from 1 September 1943 through June 1945, 649 commissions were granted in the Sanitary Corps. Of these, 392 went to enlisted personnel, 239 to persons coming directly from civilian life, and the rest to various others.7 The corps reached its peak strength of 2,560 in April-May 1945 (table 1). In May of that year, it contained 980 sanitary engineers, 521 bacteriologists, and 342 biochemists, each of the other specialties having smaller numbers.8
In the effort to build up the Sanitary Corps as rapidly as possible, men had been commissioned who did not have the scientific background to fit them for such work; they were, however, suitable for the Medical Administrative Corps. On the other hand, some who did have this background had been commissioned in the Medical Administrative Corps. In the fall of 1944, approximately 200 misassigned officers in each of the two corps were transferred to the corps for which their education and experience fitted them, and The Surgeon General took steps to prevent officers without an education in science from becoming members of the Sanitary Corps in the future.9
When the Pharmacy Corps was created in July 1943, 58 members of the Regular Army Medical Administrative Corps were transferred to it. No new members were added to it, and the strength of the corps remained the same throughout that year. During 1944, The Surgeon General brought about the appointment of 14 officers to the Pharmacy Corps. The American Institute of Pharmacy, however, complained in 1945 that he was dilatory in building up the corps to full strength (72, exclusive of members taken over from the Regular Army Medical Administrative Corps), and that he had failed to make it a corps in function as well as in name by not naming a chief administrator. Further, he had not requested consultative service from a pharmaceutical association. In reply, The Surgeon General pointed out that the new officers for the corps were to be procured under such regulations and after such exami-
nations as the Secretary of War might prescribe; that officials had promulgated rules for the expansion of the corps similar to those that existed for the expansion of other corps and the Regular Army as a whole. Examinations had been given, but The Surgeon General held that "it was not contemplated that all seventy-two appointments * * * would be made at one time." He maintained that to form an integrated corps it was necessary to build it up over a period of years so that it would have new officers coming in year by year to provide continuity of changing personnel and distribution of ranks and seniority. He reminded critics that the law had not intended that every pharmacist inducted into the Army should be commissioned. Three thousand men were engaged in pharmacy work in the Army at that time (1945); approximately half were registered pharmacists, the remainder being men trained in Army schools in pharmacy duties directed particularly to Army needs. In addition, he pointed out that Army pharmacy service differed materially from that of civilian life. Many drugs and prescriptions customarily filled in civilian life by pharmacists were provided to the Army by the manufacturer ready for use. Thus, compounding of drugs and medicines by pharmacists was reduced to a minimum, and could be performed satisfactorily by specially selected and trained enlisted men. The character of this work was not such as to justify commissioned status.10
At the end of the war, the strength of the Pharmacy Corps was 68; the peak strength, 70, was reached in April 1945.
MEDICAL ADMINISTRATIVE CORPS
The Medical Department obtained Medical Administrative Corps officers from three sources, in addition to calling up those in the Reserve: (1) Civilians who by reason of their education and experience it believed qualified for commissions, including nonprofessional men who were hospital administrators and graduates of the American College of Hospital Administration; (2) enlisted men who, having had several years of Medical Department service, could also receive direct commissions in the corps; and (3) enlisted men who could be commissioned as second lieutenants upon completing a course in a Medical Administrative Corps officer candidate school.11 Rank granted to individuals in the first two groups was not necessarily limited to that of second lieutenant, and many were given higher initial rank. In the Zone of Interior, the first two sources, although supplying several hundred officers, furnished a very much smaller group than those who were commissioned after completing a course at an officer candidate school.
Direct Commissioning of Civilians
In the spring of 1942, The Surgeon General initiated a drive to recruit Medical Administrative Corps officers among civilian hospital administrators. A request for authority to appoint 100 in this category was approved, and The Surgeon General was directed to expand the field to include qualified hotel and restaurant managers. These men could be used as assistant executive officers, hospital inspectors, and medical supply officers in general hospitals and large station hospitals. By the end of September 1942, when The Surgeon General asked for an increase in the authorization to 200, 81 appointments had been recommended.12
On 13 October 1943, the commissioning of civilians in the corps was stopped. Some 8 months later, when The Surgeon General needed officers for his reconditioning program, he was again empowered to commission civilians in the Medical Administrative Corps, although Army Service Forces headquarters directed him to make his appointments from warrant officer and enlisted ranks as far as practicable.13
Direct Commissioning of Enlisted Men
Zone of Interior
With regard to the second source, enlisted men having had service in the Medical Department, the individual must have had a minimum of 8 years' service in the Department, 4 of them as warrant officer or first or master sergeant, technical sergeant, or staff sergeant. In the fiscal year 1943, The Surgeon General commissioned 222 of this group, 138 in the rank of captain or first lieutenant and 84 as second lieutenants. Finally in October 1943, deciding that practically all who would make acceptable officers had been commissioned, the Surgeon General's Office discontinued the program in the Zone of Interior.14
The Medical Administrative Corps in the theaters also was augmented by direct commissioning of certain warrant officers and enlisted men. Originally, this took place under special authorizations, granted to individual
theater commanders early in the war, to commission individuals of warrant or enlisted status in the Army of the United States.15 In July 1943, however, the authority of direct commissioning by theater commanders was restricted to the commissioning of flight officers, warrant officers, and enlisted men who had demonstrated their fitness for such advancement in actual combat. Furthermore, the appointments were limited to those needed to fill table-of-organization or table-of-allotment vacancies within the command.16
In the North African theater, at least, the restrictions did not prevent the direct commissioning in the Medical Administrative Corps of personnel from combat divisions, even if they themselves had not actually participated in combat. The Seventh U.S. Army while in that theater seems to have met most of its requirements for battalion surgeon's assistants in that manner. In the Fifth U.S. Army, over 85 enlisted men received direct combat appointments in the Medical Administrative Corps between June and December 1944.17 To other Medical Department enlisted men, such as those with experience limited to general and station hospitals, this path to advancement was barred. Even when in December 1943 general prohibition of noncombat appointments was relaxed, they gained no relief. At that time, the War Department adopted a policy of permitting a limited number of second lieutenant vacancies in noncombat units to be filled by warrant officers and enlisted men who, though without combat experience, had demonstrated competence of an exceptionally high order in the performance of their duties. The authority to make such appointments was vested in commanding generals already possessing a similar power with regard to persons who had demonstrated their fitness for such appointments in combat. Vacancies in medical units, however, were specifically excluded from the operation of this provision.18
Nevertheless, the North African theater, probably because of its lack of an officer candidate school, was authorized early in August 1944 to make 30 direct noncombat appointments to the Medical Administrative Corps.19 Later in the year, with greatly increased need for Medical Administrative Corps officers and the inability of the Zone of Interior to meet this need, the War Department, at The Surgeon General's request, temporarily empowered the commanders of various combat theaters to appoint second lieutenants to that corps from
among Medical Department warrant officers and enlisted men without combat experience. Other personnel, including enlisted members of the Women's Army Corps, were also eligible for direct appointment, but decisive action on applications from them was left to the War Department.20
It was under this active encouragement on the part of the War Department that the great bulk of the direct commissioning of oversea personnel in the Medical Administrative Corps took place. On 15 January 1945, for example, 85 noncommissioned officers and warrant officers in the Pacific were given commissions in the corps, albeit after a brief "refresher" course.21 Probably about 1,300 or 1,400 warrant officers and Medical Corps enlisted men in oversea areas became Medical Administrative Corps officers by direct appointment. The number so commissioned in the European theater, it has been estimated, was as large as 500.
War Department policy opposed the return of enlisted men directly commissioned to their old units, and in the European theater, this policy was observed at least in the communications zone.22 A different procedure prevailed in the Seventh U.S. Army prior to coming under the command of the European Theater of Operations. The medical personnel officer of that command stated:
The War Department offered to send us a number of MAC's as trained assistant battalion surgeons and we did take a certain number from the War Department, but most of our requirements were filled by direct commissions, battlefield commissions, as a rule, in the tactical units. The technical sergeant in the Infantry regiment had been there for a long time and he was qualified for the job. The man who had done "on the job" work was commissioned and kept in the same position, and this worked out very satisfactorily. I am not saying that those that came over from the United States were not satisfactory, because they were, but the units liked the men that were commissioned from within their own unit. The personnel that were commissioned in this manner had the confidence of the troops.23
Officer Candidate Schools
Zone of Interior
At the beginning of the war, the only Medical Department officer candidate school was located at the Medical Field Service School, Carlisle Barracks, Pa. In April 1942, The Surgeon General pointed out that units not included in the planning for 1942 were being activated and declared that the activation of these units required the Medical Department to take personnel from other units that were already operating short of authorized strength. He suggested,
and the Assistant Chief of Staff, G-3, and the Services of Supply authorized, a second officer candidate school to produce Medical Administrative Corps second lieutenants. G-3 originally established the school's capacity at 750; it opened in May 1942 at Camp Barkeley, Tex., where a Medical Department replacement training center was located,24 and graduated its first class in July of that year. The number of second lieutenants commissioned thereupon stepped up sharply, although not enough to meet all needs.
Eighty-five percent of the peak strength of the Medical Administrative Corps on duty during World War II were former enlisted men or warrant officers who had been graduated from officer candidate schools. The great majority of these graduates (74.0 percent of the first 31 of a total of 40 classes turned out by the Camp Barkeley school) were men inducted by selective service. Many had civilian backgrounds in fields that were of direct use to the Medical Department; for example, there were laboratory, medical, and surgical technicians, male nurses, teachers, and men from supply and wholesale firms, whose understanding of warehousing and shipping proved useful in medical depots. Furthermore, great numbers of them were acquainted at least in an elementary way with the work of the Medical Department, having been assigned to it before attending these schools.
The Officer Candidate School located at Carlisle Barracks turned out an average of 177 per month in 1942. Unfortunately, it became necessary to close this school on 27 February 1943 to make room for other officer training, and even an increased output at the Camp Barkeley school failed to attain what the two schools could have produced.
From July through December 1942, the officers produced by these schools averaged 670 per month, or a total of 4,024. Output, however, did not meet demand until the fall of 1943 when large numbers of Medical Administrative Corps officers were in replacement pools in this country. On 31 October 1943, the total strength of the corps was 13,867, enough to justify a sharp curtailment at the Camp Barkeley school.
In March 1944, the decision to substitute a Medical Administrative Corps officer for one of the two Medical Corps officers serving as battalion surgeons, and to make similar replacements in other positions,25 caused a heavy drain on the numbers in replacement pools. The officers chosen to become battalion surgeons' assistants were sent to Camp Barkeley for special training. As class after class was sent to this school, it became evident that the entire corps would have to be enlarged, and in May and June 1944 both officer candidate schools were reopened. By this time, not only had the facilities been
scattered, but Medical Administrative Corps officers wanted for instructors were scarce in the United States. Hence, there was some difficulty in recruiting staffs for the reopened schools.26 In any event, these schools produced no new graduates until September 1944.
The necessity and difficulty of accelerating the production of Medical Administrative Corps officers in 1944 and 1945 might have been at least partially avoided if the real situation had been appreciated and the demand foreseen and if, therefore, production had been maintained at a constant rate. The presence, in the United States, of large numbers of Medical Administrative Corps officers in pools during 1943 was deceptive, for although these officers were presumably free for assignment elsewhere, the service commands had actually been using them and when they were withdrawn for training as battalion surgeons' assistants and for other assignments the service commands were left inadequately manned.27 The Surgeon General's Office may have hoped in 1943 that enough additional appointees for the Medical Corps could be obtained without supplementing them to a much greater extent by Medical Administrative Corps officers; the Surgeon General's Office was always conservative in its estimates of how many of them could be used to replace doctors in administrative work. It is true also that one officer candidate school had to be closed in 1943 for reasons unconnected with any supposed surplus of Medical Administrative Corps officers-the facilities of the Medical Field Service School were converted to training doctors in military subjects when a large number of newly commissioned officers entered the Army as the result of the procurement efforts during the summer of 1942.
In the period from 1 September 1943 through June 1945, the Medical Administrative Corps had 6,346 accessions:28
Of these, 5,328 were graduates of the officer candidate schools, while the next largest number, 877, were from the ranks of enlisted personnel; other sources-civilian life, warrant officers, and members of the Officers' Reserve Corps-furnished smaller numbers.
The administrative measures which led to the provision of replacements for Medical Administrative Corps officers included the grant of commissions to medical enlisted personnel who attended officer candidate schools in the
European theater and in the Pacific.29 A special branch of the Officer Candidate School in the Southwest Pacific was devoted to the preparation of Medical Administrative Corps officers. It began to function in March 1943. By the end of August 1945, the branch school had graduated 153 men, some of whom may originally have been warrant officers.30 Eighteen men were trained as Medical Administrative Corps officers at the Officer Candidate School in New Caledonia prior to 31 August 1945. In the European theater, there was no special course for Medical Administrative Corps personnel, but perhaps as many as 50 men were commissioned in that corps after having taken the general course for officers.
ARMY NURSE CORPS
During the first 2 years of war, the number of nurses in the Army rose steadily, but never to a point where the Army decided it had enough for all present and future needs. The Personnel Service of the Surgeon General's Office supplemented the familiar appeals to the humanity and patriotism of civilian nurses by active steps that resulted in improvements in the pay and status of Army nurses and ultimately benefited the whole nursing profession. The provision of more attractive uniforms (figs. 34 and 35) was another recruiting device. Failure to fill the gap completely by these methods resulted in several expedients: The reduction of authorized nurses in the tables of organization, the use of enlisted women without professional training who could perform some of the minor nursing functions, and improved classification of Army nurses to make better use of those already in service. It is safe to say, however, that much of this ancillary personnel would have been brought in even if the nurse quota had been filled, for it came to be recognized that such assistants could perform certain duties quite as well as nurses.
In the months following Pearl Harbor, the number of nurses placed on active duty increased sharply, probably as a consequence of a keener desire of many to serve their country now that it was at war. An immediate lag in
processing applicants was overcome by February 1942 when procurement of 1,219 nurses tripled the figure for December. Over 18,000 nurses were brought on active duty in 1943, the peak year for procurement during the war.31 One factor that contributed to this was the news that more Americans were fighting on more fronts and that casualties were beginning to reach the United States in sizable number. The procurement effort itself, however, together with the removal of certain obstacles to recruitment, must also have been largely responsible.
Early procurement agencies, 1942
During the war, the Nursing Division of the Surgeon General's Office, headed by the Superintendent of the Army Nurse Corps, continued to have as one of its functions a share in the procurement of nurses.32 In late 1942, it was estimated that approximately two-thirds of the nurses who entered the Army came in by way of the Red Cross after enrollment in its First Reserve (renamed the War Reserve in December 1942). Membership in this Reserve, however, made a nurse eligible not only for active duty in the Army but for the Red Cross "disaster service," and some nurses were unwilling to commit themselves to the latter. Some also feared that even if brought into Army service they would be placed in a Red Cross unit and thereby lack the protection which military status gave them.33 This fear proved groundless; Red Cross hospitals were used in the First but not in the Second World War. For these and other reasons, the effectiveness of the Red Cross as a procurement agency was somewhat reduced.
Although some members of the Medical Department complained that the necessity of working through the Red Cross slowed procurement unnecessarily, the arrangement continued until after the close of hostilities. In fact, when testifying before the Committee to Study the Medical Department of the Army (in the fall of 1942), both The Surgeon General and the Superintendent of the Army Nurse Corps spoke approvingly of the help received from the Red Cross. Asked if he would favor setting up his own organization for the procurement of nurses, The Surgeon General said: "I would hate to see anything arise to disrupt that fine recruiting scheme that the Red Cross has established."
The function of the Red Cross in nurse procurement was not limited to obtaining members for its Reserve. One of the most valuable services it rendered the Army was the examination of nurses' credentials for professional qualifications. Beginning in 1942, the Red Cross performed that service on the papers of nurses who entered the Army directly, as it had done previously in the case of nurses joining the First Reserve.
Other organizations continued to take part in the drive for nurses. Early in 1942, the Subcommittee on Nursing of the Medical and Health Committee, Office of Defense Health and Welfare Services, the Federal agency engaged in such matters, voted to "transfer the further development of a plan for initiating the procurement and assignment of nurses through local nursing councils to the Nursing Council on National Defense," the association of nursing organizations.34
In April, the Council (renamed at this time the National Nursing Council for War Service) established a Supply and Distribution Committee. This committee laid down a program which included among other tasks that of helping through its State nursing councils (1) to recruit nurses into the Red Cross First Reserve and (2) to distribute nurses for civilian needs. The committee also decided to set State recruiting quotas, thereby giving the States something definite to aim at; State nursing councils would be responsible for breaking these quotas down to local ones. The State quotas were "determined on 75 percent of the number of nurses eligible"; that is, the unmarried nurses under 40 years of age, as shown in the National Inventory. Presumably, the figure of 75 percent was chosen to allow for the physically unfit, those with heavy obligations, or those who could not accept military duty for other reasons.35 It was to be understood that these quotas were temporary and would be raised as needs increased.
Measures to speed procurement
Various steps were taken during the early war period, some along well-tried lines, to bring more nurses into the Army. The Army Nurse Corps and the American Red Cross carried on a publicity campaign, using radio and magazine announcements and nurses' conventions to broadcast the need for more Army nurses. Nurses served, too, in various cities with the Army War Shows, Inc., with a view to interesting civilian nurses in Army service. No figures are available on the numbers of nurses persuaded by these means to accept Army duty, but the Nurse Corps stated that reports on the Army War Shows indicated "that interest is being shown in each city visited"; apparently, too, more nurses applied for assignment to affiliated units as a consequence of these meetings.36
As another means of filling the gap, the Army Air Forces in September 1942 took steps toward procuring its own nurses. Because of shortages, assignment of the required number of nurses to Air Forces installations was often delayed. It was usual for new hospitals to be established without an adequate number of nurses, and at times, there were none for a matter of months; it was necessary to use enlisted men in nursing duties until adequate numbers of
nurses could be assigned.37 In February 1943, the Air Surgeon's Personnel Division began the processing of applications received from nurses. From that date until March 1944, when recruiting by the Air Surgeon's Office came to an end, 4,152 applications were completed and sent to the Nursing Section for appointment and assignment.38
About the time that the Air Surgeon was moving to procure his own nurses, the Secretary of War's Committee to Study the Medical Department was somewhat critical of the procurement activities of The Surgeon General's Nursing Division. The committee stated that while there was conflicting testimony on the relative merits of procurement through the Red Cross or by the Army directly, it felt that "with more aggressive leadership and stronger administration in the Army Nurse Corps the present system of recruitment would in all probability be satisfactory." Finding that the number of nurses, although adequate at the time, might become critical in the coming year, the committee believed that the Director of the Nursing Division (the Superintendent of the corps) was too complacent about the future and had apparently given insufficient thought to the methods by which the number of nurses available for Army duty could be materially increased.
The Surgeon General's Nursing Division showed somewhat less confidence than the committee in the ability of the Red Cross to produce the number of nurses required and late in 1942 favored employing another agency to conduct a recruiting campaign.39 The Secretary of War disapproved the proposal.
At this time, also, the Director of the Military Personnel Division, Services of Supply, instructed the Army Nurse Corps to formulate a plan which would use not more than 50 Army nurses in recruiting activities, this plan to utilize the services of the Officer Procurement Service and the Red Cross. The Officer Procurement Service had offices in many cities of the country, which provided space and facilities, but the Red Cross, still responsible for all publicity and paper work in connection with the nurse procurement program, furnished clerical assistance. The Officer Procurement Service acted in an advisory capacity to the Army nurses, arranging administrative details for conferences and physical examinations at dispensaries, but it was forbidden to engage in procuring, processing or presenting for appointment candidates for the Army Nurse Corps. The Red Cross not only retained these prerogatives, but complained when it believed the Officer Procurement Service was encroaching on Red Cross functions by using the recruiting nurses for direct recruiting work rather than as liaison to the Red Cross.40
Various measures were introduced during 1942-43 relaxing nurses' qualifications and improving their conditions of service, most of which may have had, or were intended to have, a favorable effect on recruitment. Two early restrictions were age and marital status. When the United States entered the war, the Army Nurse Corps would accept neither married women nor women over 30 years of age. In the spring of 1942, the Army raised the age limit from 30 to 45 years for Reserve nurses joining the Army to serve in affiliated units or in a special assignment, such as anesthetist, operating-room supervisor, chief nurse, and instructor;41 and the following year, it accepted nurses up to 45 years of age for general assignment.42 The age for entering the Regular Army Nurse Corps was not raised above 30 years, but this limitation ceased to have meaning in January 1943 when procurement of Regular Army nurses was stopped.
Beginning on 1 October 1942, The Surgeon General at his discretion could retain in service for the duration of the emergency and 6 months thereafter any Army nurse who married. The number of discharges from the Army Nurse Corps declined from the total of 821 in the 4 months prior to October 1942 to only 265 in the first 4 months of 1943.43
In November 1942, the Army announced that it would accept married nurses for the duration of the war and 6 months afterward, but stipulated that they would not be stationed at the same installation as their husbands and that nurses with minor children would be accepted only after providing for their care outside military reservations. Later, no married nurses with children under 14 years of age were accepted.44
The Procurement and Assignment Service
As shortages of nurses increased in certain areas in civilian life, a countrywide control which would effect more equitable distribution both between the Armed Forces and the civilian community itself came to seem necessary to more people. Army and Navy representatives stood against such control, believing it would limit their ability to obtain the numbers needed. The question of how to guarantee nursing service to civilian communities arose during hearings of the Committee to Study the Medical Department of the Army. One committee member even insisted that the procurement activities of the Army Nurse Corps gave no consideration to the protection of community needs. The charge was not sustained by the record, which was good enough, on the whole, to make understandable the reluctance of the Corps Superintendent to accept the intervention of the Procurement and Assignment Service.45
In September 1942, believing that Government assistance was needed, the National Nursing Council for War Service referred to the Subcommittee on Nursing of the Health and Medical Committee the question of the supply and distribution of nurses. In October, the Health and Medical Committee responded with a resolution urging that a Nurse Supply Board be established in the War Manpower Commission. After the War Manpower Commission had suggested a review of the proposal, the Subcommittee on Nursing and the National Nursing Council for War Service voted on 19 December 1942 to make no change in the original recommendation, which presented a fairly cogent argument as follows:
1. The problem of supply and distribution of nurses was essentially the same as that of other types of personnel and should be handled by the same overall agency.
2. Nurses, being women, fell altogether outside the jurisdiction of the Selective Service System-unlike male professional groups-and therefore needed even more than the latter the consideration of the War Manpower Commission.
3. If a supply and distribution system was to function on local, State, and national levels, the prestige, authority, and money of the War Manpower Commission were needed.
4. The U.S. Public Health Service was administering a $3,500,000 appropriation for nursing education and was using the Subcommittee on Nursing of the Health and Medical Committee as its advisory group. Needed expansions in this program could be maintained under the Public Health Service with close liaison with the proposed Nurses Supply Board.46
In January 1943, the Subcommittee on Nursing voted to approve the idea of the establishment of an advisory committee in lieu of a Nurses Supply Board on the ground that such a board would not have fitted in with the War Manpower Commission's organizational policy. In February 1943, the War Manpower Commission approved a Nursing Supply and Distribution Service, and in May, the Chairman of the Commission announced officially that this unit was established under the direction of the War Manpower Commission's Bureau of Placement at the request of the nurses represented by the National Nursing Council for War Service. Meanwhile, he had appointed an Advisory Committee to the new Service, choosing members from a list of names submitted by the Subcommittee on Nursing.
The Nursing Supply and Distribution Service was originally planned as an independent unit in the War Manpower Commission, but in June 1943, it was transferred to the Procurement and Assignment Service, its name changed to Nursing Division, and the Advisory Committee attached to it. The functions of the newly formed Nursing Division were (1) to consider the nursing needs of the Armed Forces and establish a quota for each State to meet these needs; (2) to determine the availability for military service or essentiality for civilian services of all nurses eligible for military service and submit these findings to
the American Red Cross for use in procuring nurses for the Armed Forces; (3) to insure maximum utilization of all members of the profession; (4) to maintain a complete roster of the nursing profession; and (5) to carry out these functions through State and local committees in accordance with policies and recommendations made by the Directing Board of the Procurement and Assignment Service.47
The organization of the Nursing Division followed in general the pattern of that for physicians, dentists, and veterinarians, with State and county chairmen and committees. In general, the State Supply and Distribution Committees of the National Nursing Council for War Service were redesignated State Committees of the Procurement and Assignment Service. Two outstanding members of the nursing profession were appointed as members of the Directing Board of the Procurement and Assignment Service. They were Miss Katherine Tucker of the University of Pennsylvania, and Miss Laura Grant of the Yale-New Haven Hospital.
Local boards classified nurses either as available for military duty or as essential to civilian nursing care. After the State committees had reviewed these classifications, they sent the names of those considered available for military service to the Red Cross recruiting committees in the areas where the nurses resided, and invited the nurses to apply to the Red Cross for military duty.
The Procurement and Assignment Service encountered difficulties in the first months of its jurisdiction over nurses. A questionnaire sent to State committee chairmen and designed to show how many local Nursing Councils for War Service already existed, how many were to be organized, where the State's copy of the National Inventory of Nurses was kept, and whether the committee considered the Inventory up to date, brought forth a picture of lack of uniformity in organization and uncertainty of knowledge. The National Nursing Council for War Service found that efforts to notify nurses of their classification presented difficulties. In an effort to relieve State and local committees at a time when the urgency to fill military quotas was increasing, the Council in September 1943 agreed to inform nurses of their classification only if they were declared eligible for military service, leaving all other nurses to be notified later.48
The procurement of Army nurses, which had proceeded at a fairly rapid rate during the last 3 months of 1943, fell by somewhat more than half in the 3 months following, after which it dropped even more sharply. The net increase in the strength of the Nurse Corps from 31 December 1943 to 31 March 1944 was 1,931; in the succeeding 9 months, the increase was only 3,710 leaving
the corps with a strength of 42,248 at the end of the year. The slowup probably resulted in part from doubt occasioned by certain transactions in late 1943 and early 1944. The supposed cut in the Nurse Corps ceiling, from over 50,000 to 40,000, became widely known in December 1943.
On 21 April 1944, the service commands were notified to cease making appointments to the Nurse Corps. The fact that a week later the War Department raised the authorized strength of the corps from 40,000 to 50,000 and that The Surgeon General took immediate steps to have the service commands resume recruiting does not seem to have dispelled a doubt on the part of civilian nurses and their organizations that the Army really needed many additional nurses; at any rate, procurement continued to lag. This feeling of hesitation was reinforced by a belief that, following the rapid progress of the Allies through Europe in the summer of 1944, the war would end in the fall. Therefore, although casualties mounted, applications for appointments to the Nurse Corps decreased. A recruiting campaign conducted in September failed almost completely; 27,000 letters sent to nurses whom the Procurement and Assignment Service had classified as available for military service brought the Superintendent of the Nurse Corps, Colonel Blanchfield, but 700-odd replies, of which only approximately 200 were from correspondents later found suitable for Army commissions.
The Surgeon General's Personnel Service and the Army Nurse Corps Technical Information Branch were thoroughly alarmed over the failure of nurses to volunteer. In September, when The Surgeon General was arranging to evacuate a large number of patients from Europe, Colonel Blanchfield warned the National Nursing Council for War Service that recruitment activities must be stepped up.
The Surgeon General became increasingly vocal over the nurse shortage and was concerned about restrictions laid down by the Procurement and Assignment Service. In October, he informed the various procurement groups that it was time they all pulled together without regard to credit for their accomplishments.
The Surgeon General's Military Personnel Division (Personnel Service) recommended procedures designed to bring more nurses onto active duty. The division urged, too, that civilian institutions should be restrained from proselytizing cadet nurses and that the Army should exert itself to persuade senior cadets serving in Army hospitals, of which there were only 486 at that time, to enter the Army Nurse Corps.
There was little agreement on why nurses were not volunteering in the numbers desired and on what remedial measures should be taken. The Red Cross admitted that its own procedures and those of the Army in handling nurses' applications took time but did not see how the process could be shortened in the face of the classification requirements imposed by the Procurement and Assignment Service. The Procurement and Assignment Service, on the other hand, believed some recruiting and assignment difficulties arose from lack of uniform appointment procedures. Certainly, the Army was not blameless, for
the service commands were not accepting nurses as soon as they applied. Rather, each service command waited until its own basic training course was beginning. Although the longest wait thus involved was only a month, the delay permitted people to conclude that the Army still did not urgently need nurses. It is possible that if at this time The Surgeon General's Military Personnel Division had been given a free hand it might have simplified appointive procedures and reduced the delays.
H.R. 2277: the nurse draft
Fanned by public relations releases, the nation's press was at this time adopting the nurse shortage as headline material. Beginning in November 1944, increasingly critical articles were appearing, some of them denouncing what they termed "bureaucratic delays." On the other hand, rumors of a nurse draft persisted, some coming from members of the Procurement and Assignment Service and the National Nursing Council for War Service, groups which had discussed such a possibility much earlier. Despite the diverse ideas on why nurses were not volunteering in the desired numbers, the two segments of the Surgeon General's Office that were most closely concerned with the problem-the Nursing Division and the Military Personnel Division-agreed on one thing-nurses should not be drafted.
On 19 December 1944, however, Walter Lippmann, a nationally syndicated columnist, after conferring with The Surgeon General wrote a column entitled "American Women and Our Wounded Men,'' which focused the attention of the American people on the Army's nurse shortage. In the article which appeared in the 19 December 1944 issue of the Washington Post, Mr. Lippmann asserted that he was reporting only the stark truth, which was well known to the Army and to the leaders of the medical professional, that American soldiers were not receiving the nursing care they must have. It was Lippmann's article that precipitated the draft issue. Later the same day, the Secretary of War, having read the article, asked The Surgeon General informally to clarify the nursing situation. The Surgeon General assured him that Mr. Lippmann actually portrayed a nearly hopeless situation. The Secretary of War then decided in favor of a draft of nurses. The necessary legislation was prepared on Christmas Eve by Col. Durward G. Hall, MC, and Mr. Goldthwaite Dorr, Special Assistant to the Secretary of War, who worked through the night.49 The proposal to draft nurses was incorporated into the President's State of the Union message delivered to Congress on 6 January 1945. The President told Congress that recent estimates had increased the total number of Army nurses needed to 60,000.
Bills were introduced and hearings held in both Houses of Congress. The ceiling on the corps, raised from 50,000 to 55,000 about 30 January 1945, was further boosted a week later to 60,000, the figure the President had mentioned
in his message to Congress. A member of the Army Nurse Corps from the Personnel Division of the Surgeon General's Office, testifying before the House Military Affairs Committee, estimated that before 1 June 1945 the Army would need 60,000 nurses to assure sick and wounded soldiers adequate nursing care,50 an estimate that the Superintendent of the Army Nurse Corps felt was too high.51
Late in February 1945, the House Military Affairs Committee approved the draft bill; as thus approved, the bill left the maximum age at 44 years, but raised the minimum age to 20 years (instead of 18, as suggested by the President); it provided that all nurses, married and single, were to register, although married ones would not be drafted; the Procurement and Assignment Service was designated as the authority to declare which nurses would be available for military service; and cadet nurses were to be inducted first.52 The House passed the bill on 7 March.
Three weeks later (28 March), the Senate Military Affairs Committee approved a draft of nurses, but while a bill to that effect awaited further Senate action, events occurred which indicated that it might not be needed after all. The response to the President's message had been immediate. In February, the monthly increase, which recently had been measured in hundreds and sometimes fewer, reached nearly 1,900; in March, it was over 4,100. Beginning in April, the rate of increase fell off although the total strength of the corps continued to increase to the end of August, when it amounted to 55,950, or 13,702 more than the strength at the end of December 1944.
In April while the European theater reported a shortage of 2,000 nurses, it stated that the problem was only potential: There were always enough nurses in staging areas who could be transferred to units needing temporary assistance.53 At the same time, the chief nurse of the theater, Lt. Col. Ida W. Danielson, ANC, requested an officer from The Surgeon General's Military Personnel Division to report, upon his return to the United States, to the Superintendent of the Army Nurse Corps that the theater required no additional nurses; so many were there already that there was no housing at the hospitals for them.54 The Superintendent of the Nurse Corps questioned whether there was any real shortage of nurses either in the European or the Mediterranean theater at this
time. Early in April 1945, she returned from a tour of inspection of these theaters with assurances from the respective chief surgeons that their requirements for nurses would be limited to prompt replacements. She concluded that even though "there may be a shortage of nurses based on T/O allotments in Medical Department units, there was no shortage based on need at the time of [her] visit."55
Meanwhile, procurement had been so good that on 4 May 1945 the Surgeon General's Office advised Army Service Forces headquarters that current assignments then amounted to 52,000 and it was estimated that 1,000 more would join in the next 2 months. As requirements after the defeat of Germany would amount only to 52,800, the Surgeon General's Office recommended to Army Service Forces headquarters that the War Department cease to press for legislation to draft nurses.56 As a consequence, a letter was addressed on 24 May to the appropriate member of the Senate stating that the War Department believed there was no longer a need for special draft legislation. Some time earlier, action in the Senate had already been stalled by a decision on the part of the acting majority leader not to call up the draft bill when Senators Edwin C. Johnson and Robert A. Taft signified their intention of opposing it. Shortly after these events, recruiting for the Army Nurse Corps came to an end.
DIETITIANS AND PHYSICAL THERAPISTS
As the expansion of medical facilities continued and the need for dietitians and physical therapists grew more acute, it became apparent that The Surgeon General needed assistance in recruiting them. Although his Office was informed as to the availabilities of these personnel, it was unable to exploit them because it lacked the means of publicizing the Army's needs.57 Needing a salesman, he turned to the Officer Procurement Service of the Army Service Forces, which performed the task very satisfactorily. By bringing information to the public about work in dietetics and physical therapy, that agency assisted the Medical Department immeasurably not only in immediate but in long-range procurement.58 The Officer Procurement Serv-
ice succeeded in recruiting about 250 physical therapists for the Medical Department.
A nationwide survey in 1942 demonstrated that the number of dietitians and physical therapists available was inadequate to meet both civilian and military needs. On the recommendation of the Directors of the two groups, therefore, The Surgeon General undertook the most extensive program of training in dietetics and physical therapy ever conducted by a civilian or military organization in the United States. Without such action, the Army's needs could not have been met. In the course of the war, the Medical Department conducted 10 programs for physical therapists in selected Army general hospitals, and 3 on a contract basis in civilian institutions. It also established a student-apprentice program for dietitians, the students being trained at four Army general and several civilian hospitals, and the apprentices at other selected Army hospitals. In addition, the Medical Department provided short physical therapy technician courses for enlisted members of the Women's Army Corps. Graduates were qualified to relieve the physical therapist of many nonprofessional duties, thus enabling her to devote most of her time to the actual care of patients. This program was undertaken in 1945 when it appeared that the number of fully qualified physical therapists was too small to care for the large number of patients then arriving from overseas. The program produced 413 trained technicians.59
Earlier, in 1944, believing that a certain number of women, though properly qualified to be commissioned as dietitians and physical therapists, had entered the Women's Army Corps, The Surgeon General made arrangements permitting such women, whether officers or enlisted personnel, to be discharged from the corps and commissioned as dietitians or physical therapists.60 In 1945, an opportunity was offered to properly qualified enlisted women to become second lieutenants in the dietitians group upon completion of a 6 months' course given by the Medical Department.61
Despite all the measures taken, the numbers on duty never reached the largest objective set for them (in May 1945)-2,150 in the case of the dietitians, 1,700 in that of the physical therapists.62 The peak active-duty strength of the former was 1,580; of the latter, 1,300 (table 1). Procurement figures for dietitians and physical therapists, which began only in December 1944, show the following acquisitions for the 7-month period ending on 30 June 1945: Dietitians, 205; and physical therapists, 293.
Enlisted Men, Zone of Interior
The number of enlisted men in the Medical Department increased from 108,674 in November 1941 to a peak of 567,268 in August 1944, whence it declined to 454,989 in September 1945 at the conclusion of the war (table 1). These figures represent men on duty, not authorized strength; in the middle of 1942, for example, The Surgeon General presented figures to show that the Medical Department had 35 to 45 percent less than its authorized enlisted complement.63
The method of procuring enlisted men for the Medical Department did not differ greatly during the war years from what it had been previously. Only a comparatively small number of enlisted men were earmarked for the Medical Department before or at the time they were inducted. Affiliated units were permitted to enroll technicians in the Enlisted Reserve Corps for future duty with those units. For a short time, persons enlisted voluntarily could choose the branch of service (medical or other) they preferred, but volunteers were not accepted after December 1942.
The plan devised before war broke out whereby technicians of value to the Medical Department registered with the Red Cross with a view to being assigned to medical organizations upon entering the Army probably served to produce but few trained men for the Medical Department. Early in 1943, the Acting Surgeon General stated that the "normal" functioning of selective service did not permit calling civilians into the Army to fill a particular need, although at the same time he expressed confidence that the Army classification system was funneling the great majority of drafted medical technologists into the Medical Department.64 With few exceptions, therefore, enlisted men found their way into medical units and installations after being drafted and with no previous claim on them by the Department.
Problem of illiterates
Dependence on the draft was in one way more satisfactory than having to rely upon volunteers, the system by which the Medical Department had to fill its officer corps; instead of conducting recruiting campaigns it could bank with reasonable certainty on receiving each month a stipulated number of enlisted men from reception centers. On the other hand, in recruiting officers, the Department could establish minimum educational and professional qualifications; in accepting enlisted men from The Adjutant General, it had no direct control over the amount or type of training and experience of those it
received. In fact, the Department's most serious problem seems to have been not a failure to obtain enough enlisted personnel but the difficulty of obtaining the right kind and of keeping them after they had been obtained. The low quality, both physical and mental, of many men assigned to the Medical Department posed a continuous problem.
The mental aptitude for Army service of enlisted men caused some concern. Medical cadres shipped to the Air Forces early in the war were filled largely with men whose scores in the Army General Classification Test-the device for measuring this aptitude-fell in groups IV and V (the lowest categories). At Coffeyville, Kans., for example, of 97 medical recruits who joined an initial cadre of less than 30 men, all had scores in groups IV, V, or were illiterate. At Hondo, Tex., 75 percent of almost 250 medical recruits added to an initial cadre of 34 "were in group V or below."65 The War Department took notice of the problem in August 1942 when it limited the percentage of illiterates (defined as those unable to read and write English of 4th grade level) to be included in each shipment of men from reception centers to Services of Supply replacement training centers. By this order, enlisted men assigned to the Medical Department were to include 2½ percent illiterates. In comparison, the Chemical Warfare Service, Engineer Corps, Ordnance Department, Quartermaster Corps, and Signal Corps were each to receive 31/3 percent of their enlisted manpower in illiterates. Only the Finance Department and the Military Police were required to take none at all.66
Complaints about the equality of enlisted men seem to have centered chiefly, however, on those who were designated as "limited-service"; that is, incapable of bearing the full rigors of military duty, especially in oversea areas.67 Hospitals frequently charged that this type of personnel was physically unable to do the heavy and long-sustained work required in such institutions or were without previous medical instruction and had to be trained on their jobs. Some had too low mentality and too little education to absorb technical training. At first, the Army did not make a practice of accepting limited-service men. Nevertheless, some were inducted, and in December 1941, the authorities ordered Field Forces units to transfer all their men of that type to Services of Supply installations, including hospitals and other Medical Department facilities in the Zone of Interior. Unfortunately, in some instances, the Field Forces seized this opportunity to get rid of their "problem" men and promoted others before transferring them, thereby creating a morale problem in the installations to which they were sent.
Some months later (July 1942), the Army adopted the policy of inducting limited-service men and sending them exclusively to these Army Service Forces installations, at the same time requiring the latter to requisition such men in numbers equal to 60 percent of the assigned strength. This was raised to 80 percent in April 1943. This in effect required Zone of Interior installations to replace most of their personnel with limited-service men whereas, formerly the hospitals had absorbed their share of these men by simply adding them to their existing force.68
The policy appears to have had an indirect effect on the staffing of oversea units. In October 1942, The Surgeon General stated that the Medical Department was receiving too many limited-service men in service command installations to permit it to continue to man units destined for overseas with the type of personnel they required. According to a report from The Adjutant General, he stated, medical units intended for theaters of operations were receiving from 50 to 95 percent limited-service personnel. Moreover, in one such unit, whose complement was 500 enlisted men, information showed that of 436 men sent to it, 16 were illiterate and 131 had an Army General Classification Test score below 70; the average test grade for the 436 was 82. A score of 100 was considered normal. In addition, many of the men lacked teeth or had arthritic joints. General Magee felt that excessive numbers of limited-service men were being assigned to medical units, and he recommended that action be taken to correct the situation. Headquarters, Services of Supply, responded that medical battalions were there receiving their full strength of general-service men and that evacuation hospitals and hospitals designed for a communications zone were being given varying percentages of limited-service personnel. Services of Supply reminded The Surgeon General that "the key to the efficient utilization of limited-service personnel is careful assignment on the part of the Unit commander."69
In December 1942, The Surgeon General tried to obtain a commitment from Services of Supply headquarters that at least 10 percent of the limited-service men assigned to the Medical Department should have high mental and educational attainments. The attempt was unsuccessful.
In the following April, The Surgeon General established a training regiment for 2,400 limited-service men to relieve the hospitals of some of their problems in using them. The regiment was located at the Medical Replacement Training Center, Camp Barkeley. It was planned, after men in it had completed basic training, to send about 20 percent of them to enlisted technicians' schools for training in the technical specialties peculiar to the Medical Department. The regiment was not at first, however, built up to full strength as planned. During the first 12-week period after it was established, in which
it had been planned to send 2,400 men to it, only about 850 were dispatched. The remainder of the 2,400 who arrived in that period were classified as general service.70
The problem of keeping as many able-bodied men as possible in the Medical Department became perhaps most troublesome when highly trained technicians were involved. A War Department directive of November 1943 requiring that the use of enlisted men should be based on their physical capacity was followed 2 months later by an order of Army Service Forces headquarters dealing with the same subject. The latter directive specified that Army Service Forces enlisted men up to the age of 35 who had been in the Army for a year or longer, who had not served overseas although qualified for duty there, and who were serving in "operating" positions71 in the United States were to be reassigned to units or installations destined for overseas. The order excepted a few types of Medical Department enlisted men, such as "those few rare technical specialists developed through long periods of individual technical training whose special skills cannot be fully utilized in any unit destined for overseas;" this exception, it was stated, covered certain key surgical, dental, and laboratory technicians.72
About the time this directive appeared, The Surgeon General, commenting on the original War Department order, expressed to the Commanding General, Army Service Forces, the fear that the document might be interpreted so as to deprive the Medical Department of key technicians capable of oversea service and replace them by men of limited physical capacity and inadequate technical experience. He suggested that no medical technician should be removed until a fully qualified replacement was available and that replaced technicians should be assigned to medical installations which could properly utilize them.73 Perhaps in response to this suggestion, the Commanding General, Army Service Forces, some weeks later (16 February 1944) "reminded" commanders under his jurisdiction that trained Medical Department enlisted men would be required in large numbers for assignment to units destined for oversea service and pointed out that many of these men were scarce in civil life as well as in the Army. He directed that when a physically qualified enlisted technician was judged available for oversea service he be reported to the commanding general of the service command for assignment to a medical unit. If there was no appropriate vacancy in a unit under the jurisdiction of the com-
mander of the service command, that officer must report the man to The Adjutant General for reassignment.74
A few months later, Army Service Forces headquarters issued another order directing the removal of enlisted men qualified for oversea service from its installations and units. On this occasion, however, the Medical Department succeeded in having most of its key technicians exempted from the order.75
In April 1944, the General Staff stipulated that certain qualified enlisted men who were in the United States might volunteer for duty in the infantry; scarce category specialists of all branches were excepted, however; hence, although some Medical Department soldiers undoubtedly transferred to the infantry under this authorization, highly trained technicians were kept in the Medical Department.76
The foregoing orders, although they exempted from their operation most highly qualified Medical Department technicians, resulted in the transfer from the Department of numerous men who, though less skilled, were nevertheless trained in medical work. This imposed a serious burden on the Medical Department, in view of the increased flow of oversea casualties to the United States. In January 1945, therefore, The Surgeon General urged the Secretary of War to reconsider "the recent action diverting to the infantry medically trained personnel in the Zone of Interior, until all current personnel replacements for medical service have been adequately met."77 Whether or not this plea had any effect, it did not alter the fact that many valuable men had already been lost. The results were less severe than they might have been, but only because, as an Air Forces historian put it, there were "no severe, widespread epidemics during January and February of 1945, when hospital staffs were in their leanest period."78
The steps taken to insure the Medical Department, and other technical services, against the loss of their highly trained technicians through transfer to assignments overseas in which their capabilities could not be fully used were accompanied by the introduction of a new procedure for channeling men of this caliber who were just entering the Army into the proper branch of the service, medical and other. Along with this procedure, there also developed a new method by which certain enlisted technicians already at work in the Army but assigned to jobs outside their specialties could be transferred to tasks suitable to their training. The procedure was outlined in War Department Memorandum W615-44 entitled "List of Critically Needed Specialists," published on 29 February 1944, the first of a series. It directed that men well qualified in the occupations listed should be assigned by reception centers to the
replacement training centers of the arm or service that had a critical need for them. The list included some 90 specialties, several of them representing requirements of the Medical Department. Somewhat later, the General Staff directed that reception centers assign men in the listed specialties directly to units as well as to replacement training centers; certain priorities were to be followed in sending them.
The second list of "Critically Needed Specialists," dated 29 May 1944, divided the various types of specialists into two categories, those for which the need was continuous and those for which it was temporary. Reception centers were to assign those in the first category to specified training centers; members of this category who were already in jobs other than their specialty were to be reported to The Adjutant General for reassignment. None of these persons were to be placed in the infantry simply because they volunteered for it. Personnel in the category of temporarily needed specialists were to be assigned to other units in accordance with their specialty only if they were in reception or reassignment centers.
This list reappeared at frequent intervals and proved extremely valuable in the proper assignment of Medical Department specialists. The staff officer in the Surgeon General's Office in charge of enlisted personnel wrote that the monthly report be submitted requesting that certain types of Medical Department technicians be included in the next issue of the list, was perhaps the most important one compiled on enlisted personnel. Through the aid of this list, he asserted, the Army Service Forces was receiving scarce category personnel from the Army Air Forces and Army Ground Forces; previously, this had been impossible.79
Army Service Forces maintained an independent list of key military specialists which was of primary concern to its own technical services and staff divisions.80 The list was designed to assure the proper utilization of certain skills that were scarce in the Army Service Forces, but did not meet the definition of a critically needed skill within the meaning of the War Department memorandum; this also helped the Medical Department to obtain the trained technicians it needed. Moreover, in January 1945, 2 months before Army Service Forces promulgated its own list of specialists, that headquarters "in view of the increasing need for both officer and enlisted personnel of the Medical Department" ordered all its commands to reassign medical personnel to appropriate medical duties if they were not already so assigned. For that purpose, Army Service Forces directed its redistribution stations (where soldiers reported upon returning from overseas) to make a "continuing search" for "trained and experienced Medical Department personnel." It also ordered all other Army Service Forces commands not to transfer such personnel to other arms or services or to use them in any position that individuals outside the
Medical Department could fill. These instructions appear to have covered not merely highly skilled technicians but all members of the Medical Department.81
After the end of hostilities in Europe, the War Department modified its list of critically needed specialists to include individuals who had skills that were particularly necessary during redeployment. Such persons were to be retained in the Army even though normally eligible for separation.82
Enlisted Men, Oversea Theaters
In meeting the need for personnel above their assigned strength, hospitals in oversea areas were able to make some use of convalescent patients. This practice also was in accordance with traditional Army procedures and was reinforced by the principles of the reconditioning program which aimed to restore patients to full duty in the shortest possible time.83 At the 42d General Hospital, located in the Southwest Pacific, patients were used from the time this installation began to operate in September 1943. They helped in the care of grounds, maintenance of neatness in and around the establishment, food preparation, and dispensing food in dining rooms. Occasionally, they were used for ward duties, provided that they displayed particular aptitude for such work.84 At the 96th General Hospital in the European theater, similar use was made of patients, who were also employed in clerical tasks.85
The European and Mediterranean theaters were distinguished by intensive attempts to obtain from the Medical Department enlisted personnel suitable for combat duty and to replace them through the reinforcement system by men, regardless of the branch or service to which they originally had been assigned, who had become incapacitated for such duty. In accordance with War Department policies already mentioned, the theaters began to plan for this interchange early in 1944.86 By July 1944, certain hospitals were replacing general-
assignment troops with limited-assignment personnel, but the substitutions at that time were only small proportions of the hospitals' enlisted complements.87
In the European theater, a directive of 7 August 1944 stated that in military installations of the communications zone it would be "suitable" to have 50 percent of the basic labor strength and 50 percent of certain specified specialist positions filled by limited-assignment personnel, and each communications zone unit was required to submit periodic reports to the Commander, Ground Force Replacement System, detailing the number of limited-assignment personnel assigned and the number of additional positions to which more could be assigned.88
As the drain on general-assignment personnel in the medical installations of the communications zone continued, they were often replaced by former soldiers of the combat arms released from the theater's hospitals. Replacements of this kind were not satisfactory for several reasons. Few of them had any Medical Department training or experience prior to their new assignment; hence, they had to receive on-the-job instruction after they had been assigned to the hard-pressed communications zone units.89 Many of them were not physically capable of doing the manual labor, such as moving supplies and patients, which the men they replaced had performed.90 Furthermore, they could not perform duties for the Medical Department commensurate with the rank they had earned in a combat arm, and a great deal of reshuffling and individual reassignment was made necessary on that account.91 Finally, a high percentage of these replacements did not want to be "pill-rollers," objected to their noncombatant status and the loss of combat pay, and, in general, presented serious problems of cooperation and discipline.92
Victims of combat exhaustion were especially difficult to retrain and assimilate, and after unsuccessful attempts to use them in the hospitals of the Advance Section, Communications Zone, of the European theater, it became necessary to establish the policy that replacements of this type would not be sent to medical units located in areas subject to aerial attack, V-bombs, and artillery fire.93 Indeed, as early as 1943, it was noted in the Mediterranean theater that "Class B" (limited assignment) enlisted men were not satisfactory replacements for
an evacuation hospital, and normally, large numbers of this type of personnel were not assigned forward of the communications zone.94
How extensive was the replacement of general-assignment enlisted men by men who had become disabled for full duty cannot be stated with much precision. There is reason to believe that resistance to the practice was more extensive and more successful in the European theater than in the Mediterranean. It is certain that, during the period of land combat in the European theater, not more than one-fifth of the enlisted replacements obtained by the Medical Department were in the limited-assignment category, that some of these came from the Zone of Interior, that others came from the Medical Department itself, and that this maximum proportion would not constitute more than 6 or 7 percent even of the communications zone medical enlisted strength (100,680-15 March 1945) in the period approaching V-E Day. It also appears that the Medical Department was not required to accept a significantly larger proportion of replacements unable to perform general duty than was the Army as a whole. Since it may be assumed that the combat arms received few replacements in this category, the Medical Department apparently was compelled to take a smaller proportion of these than were other services. That only a minority of the enlisted replacements supplied to the Medical Department were in the limited-assignment category does not mean that all vacancies created in the Department above the number filled by limited-assignment men were filled by general-assignment personnel, for many vacancies remained unfilled.95
The resistance of the European theater to the use of limited-assignment enlisted replacements also did not prevent the development of a large body of personnel in the communications zone medical installations that was incapable of general duty. As already noted, men in this category comprised nearly 38 percent of the strength of such installations in mid-March 1945. Since the great majority of these did not reach the units through the theater replacement system, the logical inference is that they came with them from the Zone of Interior.
This state of affairs contrasted with the situation in the Mediterranean theater, where, in spite of the probability that the proportion of limited-assignment enlisted men in the medical installations of the communications zone was even greater, that is, about 50 percent, than it was in the European theater, the great majority of the men so classified were excombat men provided locally. Units reaching the Mediterranean theater came almost entirely before the end of 1943, when the manpower situation permitted organiza-
tions in the Zone of Interior destined for overseas to be filled very largely with personnel capable of full duty. On the other hand, many units sent to the European theater received their personnel when it no longer was possible to be so selective. A survey of February 1945 revealed, however, that the substitution of the less competent limited-service men had occurred at a time when hospitals were not overburdened and that they had been successfully absorbed. Nevertheless, some of the units were not satisfied with the situation.96
In order to increase the availability of their personnel for replacement uses, Medical Department units were directed to provide special training for their members. For example, in April 1943, the Surgeon, U.S. Army Services of Supply (Southwest Pacific Area), issued instructions requiring all enlisted personnel to act as "medical and surgical nursing assistants, for possible future assignment in hospitals of the mobile types to replace female nurses when necessary because of the tactical situation."97 Some months later, in November 1943, he issued the following statement:
It is the duty of the Commanding Officer of all hospital units in this theater to conduct courses of instruction for the training of their enlisted personnel in technical duties. There are no experienced personnel available in the United States, and hospital units, especially those on the mainland of Australia, must serve as pools from which efficient, well-trained personnel may be obtained for units incurring casualties.98
Enlisted Women, Zone of Interior
Procurement of technicians
In the early part of 1944, The Surgeon General, having many unfilled requisitions for members of the Women's Army Corps, recommended that Army Service Forces headquarters initiate a program to recruit them directly for the Medical Department.99 The transfer of numerous trained Medical Department enlisted men to other branches of the Army at that time made the need for these women more urgent. Hence, in the spring of 1944, the Women's Army Corps began a program called Procurement of Female Technicians for Medical Installations.100
Recruitment under this procurement program was designed to be selective, bringing in only women qualified as bacteriologists, pharmacists, optometrists, psychiatric social workers, orthopedic mechanics, and numerous other
types of technologists. Specifications were set for education, training, and experience. As women were exempt from the draft, recruiting campaigns using various publicity mediums were necessary; to get these technologists, The Surgeon General turned to the Officer Procurement Service. Women joining any branch of the Army under this program were beneficiaries of the Station and Job Assignment Recruiting Plan, which enabled them to choose not only their station but also their job in the Army. The Army, of course, determined, on the basis of aptitude and training, whether they were fit for the job.
Procurement of these women specialists progressed reasonably well considering the relatively high qualifications which the Medical Department had stipulated. By September 1944, about 1,800 women had joined the Women's Army Corps for jobs in the Medical Department, and at that time, about 200 were entering basic training each week. A special school to train members of the Women's Army Corps for Medical Department work was established at Fort McPherson, Ga.
Another campaign for enlisted women to be trained as medical and surgical technicians was conducted simultaneously, but by the regular recruiting stations, not by the Officer Procurement Service. This campaign aimed at recruiting women for 3 months' training as technicians. Prerequisites for dental, laboratory, and X-ray technicians included graduation from high school, while others needed only 2 years of high school credit; certain minimum scores also had to be attained in Army tests.101 The women recruited ordinarily had had little or no experience in matters relating to medicine. The campaign had progressed well enough by the fall of 1944 that the Surgeon General's Office recommended it be stopped.102
Beginning in September 1944, however, a heavy flow of casualties to the United States and the winter fighting in Europe, which added to the prospective patient load in the United States, made the situation tighter. The position of the Medical Department planners was not made easier by the knowledge that they were short of nurses, that the Army had failed to obtain more than a few hundred cadet nurses, and that the Medical Department was being forced to release enlisted men for training as combat soldiers. The Surgeon General's Office accordingly asked for 8,500 enlisted personnel-men or women-to be trained as technicians to replace men who had been transferred to the Army Ground Forces.103 The Surgeon General later recommended that all the technicians be women.
Organization of Women's Army Corps companies
Complaints that women were being used in minor jobs, after joining the Army with the understanding that they would be medical and surgical technicians, induced Col. Oveta Culp Hobby, Director of the Women's Army Corps, to oppose assigning more women to hospitals unless assurance was given that recruiting promises could be fulfilled. General Marshall, for his part, expressed the opinion that sufficient women of the high caliber desired could not be recruited unless they were guaranteed a technical job and rating. If this guarantee were not given, he refused to sanction any further procurement of enlisted women for Army hospitals. Since such assurance could not be made under the current system, he proposed that the new members of the Women's Army Corps be assigned to hospitals in table-of-organization companies. Such a unit carried its own allotment of grades and also specified the exact job of each member. Hospital commanders could change neither the job nor the grade. Such identical, inflexible units might be expected to work satisfactorily in general hospitals, since all had similar functions and organizations and all used technicians.
The tables of organization, as drafted in a meeting between representatives of The Surgeon General and the Women's Army Corps, called for 100 enlisted women per hospital company. Since all were to be skilled technicians or clerks, the lowest rating was technician, fifth grade. Companies were allotted to named general hospitals in proportion to the number of beds.104 Each hospital desiring such a company could requisition it and women would be recruited with assurance of assignment to that hospital and of at least a fifth grade technician's rating if they performed satisfactorily.
With intensive publicity to promote it, the general hospital campaign was a success. General Marshall solicited the assistance of State Governors: "The care of the increasing number of casualties arriving in the United States, together with an acute shortage of nurses and hospital personnel generally, necessitates urgent measures being taken to recruit and rapidly train women for service in Army hospitals."105 A quota of about 6,000 by 1 May 1945 was established; about halfway through the campaign, it was raised to 7,000. Nevertheless, recruiters passed that number a month ahead of schedule. In fact, recruiting was so successful that in 1945 the Surgeon General's Office was embarrassed by a surplus of enlisted women.
A total of 120 Women's Army Corps hospital companies served in this country, each with a table of organization calling for 101 members. So far as possible, the enlisted women working in hospitals before the companies were created in early 1945 were absorbed by the new units. Those left out were generally in assignments not included in the tables of organization of the hos-
pital companies. A serious drawback to the use of Women's Army Corps companies in Zone of Interior hospitals was that they were too large and too inflexible to meet the requirements of the smaller hospitals.
Enlisted Women, Oversea Theaters
It is doubtful whether the total number of Women's Army Corps personnel used by the Medical Department overseas prior to V-J Day numbered much more than 400. No Women's Army Corps hospital companies went overseas, and it is unlikely that any member of the corps arrived there as part of a Medical Department unit. A few may have arrived as members of a Women's Army Corps headquarters company; in that case, they were assigned to the company and merely allotted to the medical section of the headquarters.
The limited use of Wacs overseas is explained by the small numbers available for such service and the fact that their utilization was being questioned until the very close of hostilities, with the result that certain of the oversea authorities, medical and other, were reluctant to use them.106
The majority of the Wacs who served the Medical Department overseas were employed in nonprofessional types of jobs, such as clerks, typists, and chauffeurs, located mainly in theater and base headquarters. In the Office of the Chief Surgeon, European theater, most of the Wacs were concentrated in the Medical Records Section of the Administrative Division. About the middle of 1944, virtually all enlisted male personnel in the Chief Surgeon's Office, U.S. Army Forces in the Middle East, were replaced by enlisted members of the Women's Army Corps, who provided very satisfactory service and remained in their jobs until the theater was inactivated. At the end of 1944, a total of 12 enlisted women were used in the Office.107
Although most of the Wacs possessing medical skills were needed in the Zone of Interior, a few were used in at least three theaters. In the Southwest Pacific, during the latter part of 1944, nurses who were needed in hospitals as a result of increased admissions occasioned by the campaign in the Philippines were relieved from duty in dispensaries caring for Wacs and replaced by Women's Army Corps medical technicians.108 At the 133d General Hospital in the same theater during the first part of 1945, on a trial basis, Wacs were used as technicians in dental and medical laboratories, but the trial was not successful.109 During the second half of 1944, the Hastings Air Base Medical Unit, located in the India-Burma theater, used one WAC dental technician and two WAC medical technicians.110
On 1 August 1945, 1.7 percent of the Women's Army Corps enlisted personnel in the European theater were serving as medical or dental laboratory technicians.111 Since the number of Women's Army Corps enlisted personnel in the theater on that date was 7,007, the number of these technicians must have been about 130. On 1 July 1945, a Women's Army Corps detachment was activated at the 116th General Hospital, Nuremberg, Germany, in the same theater. Wacs were ordinarily assigned to the units in which they worked, but were attached to units of their own (called detachments) for housekeeping and similar purposes. Not long afterward, this detachment was transferred to the 98th General Hospital in Munich, Germany. It is not certain, however, that even a majority of the members of the detachment functioned as Medical Department technicians.112