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

HISTORY OF THE OFFICE OF MEDICAL HISTORY

AMEDD BIOGRAPHIES

AMEDD CORPS HISTORY

BOOKS AND DOCUMENTS

HISTORICAL ART WORK & IMAGES

MEDICAL MEMOIRS

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

ORGANIZATIONAL HISTORIES

THE SURGEONS GENERAL

ANNUAL REPORTS OF THE SURGEON GENERAL

AMEDD UNIT PATCHES AND LINEAGE

THE AMEDD HISTORIAN NEWSLETTER

Chapter VI

AMEDD Corps History > Medical Specialist > Publication

Training in World War II

Colonel Emma E. Vogel, USA (Ret.),
Colonel Katharine E. Manchester, AMSC, USA,
Major Helen B. Gearin, USA (Ret.), and
Major Wilma L. West, AMSC, USAR

Wartime training programs in dietetics, physical therapy, and occupational therapy were designed to accomplish two major objectives: To provide military orientation of civilian-trained personnel and to increase the number of qualified graduates available for Army service. The physical and occupational therapists also conducted training programs for enlisted technicians. Although dietitian, physical therapy, and occupational therapy groups undertook training programs in these basic areas at different times and in various ways, there was considerable similarity in both approach and content of their respective solutions to the problem of training personnel for military hospital service.

Section I. Basic Military Orientation for Newly Appointed Personnel

DIETITIANS

From October 1940 to late 1941, all dietitians sent to Walter Reed General Hospital, Washington, D.C., as replacements were civilian trained. Upon completion of approximately 6 months' duty at the hospital, these dietitians were transferred to other Army hospitals to organize dietetic departments. This kind of assignment was, in a sense, the first orientation for newly appointed dietitians in World War II.

Special training in administrative procedures peculiar to military service was approved for civilian-trained dietitians on 15 February 1941 by the Surgeon General's Office. This training was initiated at fixed Army hospitals from 2 to 4 weeks before the dietitians were to be transferred to newly constructed installations.1

In April 1942, The Surgeon General authorized establishment of six training pools for civilian dietitians who were designated for duty outside the continental United States and who had had no experience in the Medical Department.2 In addition, oversea volunteers from the American National Red Cross, upon their request, were appointed and assigned for observation and training at these pools. The course of instruction included lectures on organization of Army hospitals, Army

1Manchester, Katharine E.: History of the Army Dietitian. [Official record.]
2Circular Letter No. 34, Office of The Surgeon General, U.S. Army, 16 Apr. 1942.


138

regulations, organization of the mess department, relationship of dietitians with other personnel in the mess department as well as other departments of the hospital, personnel records, hospital fund reports, and procurement of food. Dietitians were given on-the-job experience in each section of the hospital mess so that they would be familiar with all phases of management: procuring, preparing, and serving food, and planning special diets. Assignments to these pools were discontinued in December 1942 when military status was authorized.

Dietitians assigned to affiliated hospital units scheduled for oversea service went on active duty training with the units at specified Army posts. They worked with the post hospital dietitian to become familiar with procedures and methods and often participated in maneuvers to learn to work and live under field conditions. These maneuvers made the dietitians conscious of ways to improve or improvise equipment and to substitute certain foods to relieve various ration shortages.

A special 60-hour course in "Cooking of Dehydrated Foods," course K, was made available to dietitians selected for oversea service either as members of numbered medical units being prepared for shipment or as replacements or fillers for units already overseas. The methods of production of dehydrated foods, principles of packaging and storing, newest procedures for reconstituting foods, planning menus, and actual preparation of meals were studied. Special training was given in the preparation of dehydrated food under field conditions (fig. 35) as well as in maintenance and operation of cooking equipment and sanitation in field messes. These dietitians subsisted on dehydrated foods or combinations of dehydrated foods and fresh rations for certain periods during the course.

In October 1943, the Army Nurse Corps established basic training centers throughout the country for nurses going overseas and for those new to military service. During this training, nurses attended classes in routine military hospital procedures, treatment of chemical casualties, care of battle fatigue, field sanitation, and evacuation of the sick and wounded. They drilled, went on road marches, pitched tents, practiced the proper use of the gas mask, and received instructions on what to do in an air raid. Among the many other subjects covered were military courtesy and discipline, organization of the Medical Department, military law, and the Articles of War.

It was not until 1944 that dietitians assigned to oversea hospital units and those entering the Army were sent to the training course for nurses. Dietitians already on Army hospital staffs were sent at the discretion of the service command commander.

The first change in the nurses' training course to include dietitians deleted 23 hours of nursing subjects and substituted 23 hours of dietetic subjects.3 In 1945, 53 hours of instruction were deleted from the nurses' training course and other appropriate material substituted

    3Army Service Forces Circular No. 163, 27 Dec. 1943.


    139

    FIGURE 35-Class in dehydrated food preparation using field equipment, Fort Sam Houston, Tex.

    for the basic training of dietitians.4 This program provided 17 hours of lectures and demonstrations to be conducted by dietitians and 36 hours of on-the-job understudy in the hospital mess.

    PHYSICAL THERAPISTS

    Since many of the physical therapists joining affiliated units at the point of origin had had no Army experience, it seemed advisable to establish training courses for them. It was planned that this period of observation and orientation would include on-the-job training, instruction in customs of the service, organization of the Medical Department, procurement of supplies, and organization and administration of physical therapy clinics in Army hospitals.5 Orientation courses were to be

    4War Department Mobilization Training Program No. 8-7, 16 June 1945.
    5See footnote 2, p. 137.


    140

    established in 1942 at several Army general hospitals, but so far as is known, Walter Reed General Hospital was the only hospital which activated such a program. This program, an excellent idea, was without supervision from the Surgeon General's Office. There was much confusion as to command responsibility, and as a result, this training was not well executed.

    In 1943, it was recognized that newly appointed physical therapists who had not been trained in one of the Army physical therapy courses were also in need of military orientation. Since courses had already been established at several military installations for newly appointed nurses and dietitians, it was deemed expedient to include physical therapists as well.

    For the hours scheduled for professional orientation of nurses and dietitians, substitute hours were planned for physical therapists. These covered the organization and administration of a physical therapy clinic in an Army hospital, clarified their relationship to other hospital personnel, and familiarized them with the treatment of patients not normally seen in civilian hospitals. Particular attention was given to the treatment of amputees and patients with injuries of the central and peripheral nervous systems; muscle, sensory, and electrodiagnostic tests; measurements of joint range of motion; bandaging adaptions of exercise apparatus; and utilization of floor space.

    In September 1945, following V-J Day, all of these basic military training courses were terminated. The orientation proved to be so valuable, however, that an orientation course has been conducted almost continuously since 1948 for newly appointed female officers at the Medical Field Service School, Fort Sam Houston, Tex.

    OCCUPATIONAL THERAPISTS

    Orientation courses for occupational therapists were also necessary. However, since these personnel were civilians, they could not be integrated into the basic military training programs that had already been established for nurses and adapted for dietitians and physical therapists.

    Accordingly, 2-week indoctrination courses for newly appointed occupational therapists were established in October 1943 at Lovell General Hospital, Ayer, Mass., Lawson General Hospital, Atlanta, Ga., and Letterman General Hospital, San Francisco, Calif.6 Of the 96 hours of instruction, 36 were devoted to applicatory experience in which trainees worked with orthopedic and psychiatric patients, in convalescent shops, and on wards under the direct supervision of experienced occupational therapists. The remaining hours of lectures, conferences, demonstrations, and tours were scheduled to provide a variety of instructional material each day of the 12-day course. This schedule

    6Letter, Headquarters, Army Service Forces, to Commanding Generals, First to Ninth Service Commands, 7 Oct. 1943, subject: Orientation Course for Occupational Therapists.


    141

    avoided solid blocks of time on any given subject. Students had access to the medical library and sat in on roundtable discussions in which problems and questions were discussed with members of the occupational therapy staff.7

    The orientation courses were discontinued in July 1944.8 By this time, the majority of chief occupational therapists had attended the course and could indoctrinate the new personnel on their staffs.

    Section II. Professional Training Programs

    While it was a relatively simple matter to arrange short military orientation courses, a far greater need and problem were faced in providing the additional numbers of qualified personnel that were needed in all three professions to staff Army hospital programs. Neither the start of the war in Europe nor the authorization for program expansion made possible by the September 1940 Selective Service Act had brought these medical specialists into military service in numbers adequate to meet the Army's need. Although the draft provided hospitals with personnel in many of the professional categories, female dietitians, physical therapists, and occupational therapists were not subject to military service and had to be recruited from among volunteers.

    It had been established early that the total number of qualified dietitians, physical therapists, and occupational therapists in the entire United States was not sufficient to meet both civilian and military needs. Thus, if the Army was to fulfill its responsibilities in the care of its patients, it was imperative that emergency training programs for all three specialist groups be put into operation as soon as possible.

    ACCELERATION AND EMERGENCY TRAINING PLANS

    Dietitians

    The need for training student dietitians in Army hospitals had been recognized shortly after World War I. In 1922, a course was established at Walter Reed General Hospital. Throughout the peacetime period and before World War II, a sufficient number of qualified dietitians were graduated from this course to supply the demand of all Army hospitals authorized to employ them.

    These graduates, by virtue of their Army professional training, were well qualified for duty in other Army hospitals. The training program at Walter Reed General Hospital gave sound theory as well as practical on-the-job experience. In addition, students were given an opportunity for staff experience since they served in positions of responsibility during their training program.

    7Program of Instruction for Occupational Therapists, Lawson General Hospital, Atlanta, Ga., 8-20 Nov. 1944.
    8Army Service Forces Circular No. 229, 22 July 1944.


    142

    By August 1942, 211 dietitians had been graduated from the student dietitian training course at Walter Reed General Hospital.9 Even though this course had met the needs of the Army in the past, it was obvious that accelerated programs for the training of student dietitians would have to be established at other hospitals to meet the needs of World War II.

    Since the number of dietitians being trained in civilian hospitals before the war had more or less been governed by position vacancies, the wartime emergency found an extreme shortage of dietitians for the Army. To meet this shortage, the number of training courses in civilian hospitals was increased from 38 to 60. However, this was not enough. Other plans had to be developed to meet the increased need for dietitians. Consideration was given to a combination civilian and Army student training course and more frequent classes in civilian and Army hospitals. This would increase the number of dietitians trained who were orientated to Army procedures and methods. The training patterns which finally evolved are shown in chart 2.

    On 17 July 1942, a meeting was held in the Surgeon General's Office to discuss the possible methods of training dietitians for the Army. Miss Nelda Ross, president of the American Dietetic Association, and Miss Gladys Hall, educational director of that organization, were present. In addition, Miss (later Lt. Col.) Helen C. Burns,10 Chief Dietitian, Walter Reed General Hospital, and on part-time duty in the Surgeon General's Office; representatives from the Training and Civilian Personnel Divisions, Surgeon General's Office; as well as the Assistant Examiner, Education and Psychology Unit, Civil Service Commission, attended.

    An accelerated student-apprentice dietitian training program was agreed upon. Two plans were recommended. Plan A provided that the student dietitian program conducted in Army hospitals would be divided into two sections, the student dietitian course and the apprentice dietitian course. Plan B provided for the establishment of a 6-month student dietitian program in approved civilian hospitals from which the students would be transferred to an Army hospital for the 6-month Army hospital apprentice course. The minimum educational qualifications were the same as those previously established for the student dietitian program. The first class, 16 students appointed under Plan A, entered on duty at Walter Reed General Hospital on 24 August 1942.

    Six-month Army hospital student course

    In revising the student dietitian training curriculum to meet the requirements of a shortened course, most of the didactic work and basic on-the-job training, as well as experience required in infant and

    9For detailed information concerning educational requirements, salaries, and the number of students trained before World War II, see Appendixes B, p. 595, and C, 597.
    10Later Maj. Helen B. Gearin, WMSC.


    143

    CHART 2-Dietitian training patterns, 1942-47

    child feeding in pediatrics and in teaching student nurses, was planned for the 6-month course. Facilities for the different types of training or experience were not available at most of the Army hospitals in which the course was to be given.

    The curriculum established for the student dietitian course at Walter Reed General Hospital was used as a guide for setting up three additional Army hospital student dietitian training courses, all approved by the American Dietetic Association. In May 1943, Fitzsimons General Hospital, Denver, Colo., started a course under the direction of Capt. Mildred G. Allbritton. The course at Brooke General Hospital, Fort Sam Houston, Tex., started in July 1943 under the direction of Capt. (later Col.) Nell Wickliffe. The last student dietitian course was established at Lawson General Hospital, in September 1943, under the direction of Capt. (later Lt. Col.) Hilda M. Lovett.

    The object of the course was to furnish thorough training in the


    144

    diet in health and disease and in the organization and administration of a dietetic department in an Army hospital. Over 200 hours of lectures were given in diet therapy and administration. The theory of dietetics as it related to medical and surgical patients was taught by Medical Corps officers and heads of dietary departments.

    On-the-job training in therapeutics totaled 11 weeks and included writing special diets, diet instruction to ward and clinic patients, supervision of ward kitchen, and participation in ward rounds. A minimum of 2 weeks each was spent in the surgical, cardiac, urological, and pediatric wards, gastrointestinal (fig. 36) and diabetic sections (fig. 37), and in the infant formula room.

    Fourteen weeks were spent in administrative on-the-job training. A comprehensive program afforded experience in all areas of administration: menu planning; purchasing, ordering, preparing (fig. 38), and serving food; inventory and portion control; cost accounting; and personnel management.

    Six-month civilian hospital student course

    To establish the student dietitian program in civilian hospitals, in September 1942, Miss Ross sent a letter to the director of each of the 60 approved civilian training courses for dietitians. She wanted to determine which civilian hospitals had facilities to cooperate with the Army in this new training program. In her letter, Miss Ross stated that students who successfully completed this program would meet the 1-year requirement for membership in the American Dietetic Association.

    Letters from directors of the approved civilian dietitian courses indicated that the plan was generally acceptable in hospitals where at least 10 or more students were enrolled. However, individual problems with staff and facilities at some civilian hospitals made it impossible for them to participate in the program. Some chief dietitians believed that the release of students after 6 months would lead to rather disorganized dietary departments, particularly in view of the problems encountered because of the excessive turnover of employees caused by the war. Other chief dietitians, who had already rearranged their training plan to provide for enrollment of student dietitians twice a year for the duration of the war, believed that it would be difficult to add a 6-month Army student program to their already increased training schedule.

    The civilian internship directors who participated in the program were commended by The Surgeon General for their active cooperation during the war. Noteworthy of particular mention was the support given by Miss Phyllis Rowe, Director of the Dietetic Internship, Johns Hopkins Hospital, Baltimore, Md. Through her untiring efforts, Miss Rowe planned a student apprentice program, recruited dietitians for it, and sucessfully trained 28 of the 67 students who enrolled, in addi-


    145

    FIGURE 36-Medical officer lecturing on gastrointestinal diseases to student and staff dietitians. (U.S. Army photograph.)

    tion to conducting an affiliation program for 2 student dietitians from Walter Reed General Hospital each month during the war.

    The on-the-job training in the civilian hospital student dietitian courses included 6 weeks of special diet kitchen and ward service; 2 weeks of private patient service; 4 weeks of pediatrics, including formula preparation; 4 to 6 weeks of outpatient clinics; 6 to 8 weeks of administration, including purchasing, ordering, accounting, and menu planning; as well as some work with personnel and preferably experience in a cafeteria or dining room. It was required that the classes include lectures in diet therapy and infant feeding and experience in teaching dietetics to student nurses.

    Six-month Army hospital apprentice course

    It was obvious that the 6-month apprentice course established in 32 Army hospitals would have to be tailored to provide the apprentices with experience that would qualify them for membership in the American Dietetic Association and better prepare them for service in Army hospitals.

    Dietitians trained in the 6-month civilian hospital student course


    146

    FIGURE 37-Apprentice dietitian participating in therapeutic phase of food service activities. (Top) Assembles food for a patient with diabetes. (Bottom) Discusses patients' diet with medical officer. (U.S. Army photographs.)


    147

    FIGURE 38-Student dietitian discussing recipe with head cook. (U.S. Army photograph.)

    had different types of experiences than those trained in the 6-month Army hospital student course. Every effort was made to establish appropriate programs at designated hospitals where civilian-trained students as well as Army-trained students could be assigned for their apprentice training. (See Appendixes D, p. 599, E, p. 601.) When qualified experience was substituted for the student dietitian training course, another appropriate apprentice training course was established.

    In 1943, the apprentice training course followed a recommended course of instruction outlined by The Surgeon General. The plan for the apprentice training program was published by The Surgeon General, on 1 May 1944, and provided a more detailed guide for instructors. These courses were adapted locally to meet the needs of particular apprentice dietitians in training at each hospital.

    Practical experience was emphasized in the 26-week apprentice program: 16 weeks, administration of food service sections; 8 weeks,


    148

    therapeutic phases of food service activities; and 2 weeks, lectures as indicated by subject matter. Assignment in a supervisory capacity was scheduled during the last several months of apprentice training to meet American Dietetic Association requirements for staff experience during dietetic internship.

    Qualified experience apprentice entrance plan

    During the 1943 recruitment from the scarce category of qualified dietitians, home economists with Bachelor of Science degrees who met the educational qualifications but lacked the internship or the hospital experience qualification, evinced interest in appointments as Medical Department dietitians. When it was determined that sufficient numbers of these individuals with varied and valuable experiences in fields related to dietetics were available and interested, The Surgeon General recommended and the American Dietetic Association approved the qualified experience apprentice entrance plan. This plan permitted substitution of certain categories of experience in lieu of the 6-month Army hospital student course or the 6-month civilian hospital student course. (See Appendix F, p. 603.) The minimum educational qualifications remained unchanged; namely, Bachelor of Science degree with a major in foods and nutrition or a major in institution management with specific courses required by the American Dietetic Association.11

    At different times during the war, enlisted members of the Women's Army Corps expressed an interest in the Army student dietitian training course. There were several women in this corps with backgrounds in home economics who thought they might qualify for either student or apprentice training. Thus, on 6 March 1945, enlisted women were permitted for the first time to apply for assignment to the 6-month apprentice training course.12 The Surgeon General's Office gave authority for the establishment of the first training course for enlisted members of the Women's Army Corps at McCloskey General Hospital, Temple, Tex., with authorization for 10 apprentices in each class. However, only five applied and these were accepted. Upon completion of the course, they were commissioned as Medical Department dietitians. The course was begun on 15 June 1945 and was discontinued on 1 January 1946. This was the only dietitian course for enlisted women given during World War II.

    Since procurement objectives for all officers were canceled after V-J Day, a study was made to determine whether additional dietitians were needed. Authority was received to proceed with the training of those students on duty as of 1 October 1945 and to tender them commissions upon successful completion of the course. All outstanding

    11See footnote 1, p. 137.
    12War Department Circular No. 71, 6 Mar. 1945.


    149

    appointments of individuals who had not yet begun training were canceled.

    By October 1946, all training courses for dietitians, except the one at Brooke General Hospital, were terminated. The student courses were closed at Fitzsimons General Hospital on 1 November 1945 and at Lawson and Walter Reed General Hospitals on 1 March 1946.

    Physical Therapists

    In 1941, a Central Physical Therapy Board was established in the Surgeon General's Office to work with the Subcommittee on Physical Therapy, National Research Council, and the Federal Security Agency on problems associated with the expansion of the physical therapy program in Army hospitals.13 Among the problems presented to this board was the subsidization of civilian physical therapy training courses. In this connection, a survey made by the Council on Medical Education and Hospitals, American Medical Association, early in 1942, revealed that civilian physical therapy training courses which required payment of tuition were experiencing great difficulty in maintaining full enrollment. To assist these courses in supporting maximum enrollment and to more effectively contribute to the procurement of physical therapists for the Army, it had been suggested several times that the War Department subsidize these courses. In view of the planned expansion of the Army physical therapy training program, it was The Surgeon General's opinion that the subsidy of civilian training courses could not be justified or supported.14

    The expansion of the Army physical therapy training program was accomplished by the establishment of courses directed to three groups:

    1. Civilian students who would take all of their training in Army hospitals.

    2. Military students (enlisted members of the Women's Army Corps) who would take all of their training in Army hospitals or who would take the apprenticeship phase of their training in Army hospitals following completion of didactic instruction in selected civilian institutions.

    3. Civilian students who would take the apprenticeship phase of their training in Army hospitals following completion of didactic instruction in a civilian institution.

    Civilian students

    Plans for an emergency physical therapy training course were proposed by The Surgeon General early in 1941. This course, consisting of 6 months of didactic instruction followed by 6 months of applicatory training which was given at Walter Reed General Hospital, replaced

    13Office Order No. 348, Office of The Surgeon General, U.S. Army, 21 Nov. 1941.
    14Memorandum, Col. John A. Rogers, MC, Office of The Surgeon General, for Chief of Staff, G-3, attention: Colonel West, 10 June 1942.


    150

    FIGURE 39-Instruction and practice in bandaging techniques, physical therapy course for civilian students, Walter Reed General Hospital, Washington, D.C.

    the regular 9-month course previously conducted at that hospital.15 The proposal was approved by the Council on Medical Education and Hospitals. This Council also approved a plan whereby civilian institutions could conduct 6 months of didactic instruction to be followed by 6 months of supervised apprentice type of experience in selected Army hospitals.

    On 1 July 1941, the first Army emergency course was initiated at Walter Reed General Hospital. Ten students were authorized and concurrent classes were conducted at quarterly intervals. The 26 weeks of didactic instruction included intensive study in anatomy, physiology, pathology, kinesiology, and allied subjects and thorough study and practice in the techniques of the various physical therapeutic procedures (fig. 39) and their application to the specialized fields of military medicine. Particular emphasis was placed on the treatment of patients with combat injuries.

    A comparison of the curriculums of the regular and emergency courses is shown in table 7.

    Since it was already obvious that the expansion of one course would not be sufficient to meet increasing personnel needs, additional courses

    15The 3-month increase in the emergency program provided a full 6-month period to be concentrated on the applicatory phase. In the courses conducted before the war, the applicatory phase hours had been scattered throughout the entire course. Since the applicatory phase or apprenticeship was to be taken in a hospital other than the one in which the didactic phase was given and since the graduates of the emergency course would be more immediately involved with a larger number of patients with more complex injuries, the longer and more concentrated applicatory phase was considered necessary.


    151

    FIGURE 40-Anatomy instruction, physical therapy course for civilian students, Brooke General Hospital, Fort Sam Houston, Tex.

    were established in October 1942 at the Fort Sam Houston Station Hospital, Tex. (later Brooke General Hospital, fig. 40), Army and Navy General Hospital, Hot Springs, Ark., O'Reilly General Hospital, Springfield, Mo., and Fitzsimons General Hospital. All were conducted on the same plan as the course in operation at Walter Reed General Hospital.

    While the number of civilian enrollees for the Army physical therapy training courses increased considerably during 1943, the newly established training courses did not operate at full capacity. It was becoming increasingly apparent that the authorized capacities of these courses could not be maintained by the selection of students from registers compiled by the Civil Service Commission. Because college graduates with a physical education background were being offered increasingly attractive and lucrative positions by industry and the other military services, the number interested in Army physical therapy training was declining.

    In 1944, a series of meetings was held under the auspices of the Officer Procurement Service, Army Service Forces, in San Francisco, Los Angeles, Chicago, Boston, and New York. These meetings, featuring talks and War Department films, resulted in a noticeable upswing of interest in the Army physical therapy training programs. Although there were only enough eligible civilian applicants to fill one class of trainees in January 1944, the influx in the number of certified appli-


    152

    TABLE 7-Comparison of class hours in regular and emergency physical therapy courses, Medical Department, U.S. Army, 1940-41

    cants in the succeeding months indicated that consideration should be given to further expansion of this program. Subsequently, therefore, two additional courses for civilian students were established, one at Bushnell General Hospital, Brigham City, Utah, on 10 July 1944, and the other at Ashford General Hospital, White Sulphur Springs, W. Va., on 10 August 1944.

    Civilian students enrolled in the courses subsequent to August 1944 were also required to meet the physical standards for commission on the basis of a final-type physical examination performed at a military installation not more than 3 months before enrollment. This policy was recommended by the Physical Standards Division, Surgeon General's Office, in an effort to reduce attrition because of later failure to


    153

    meet the physical requirements for commission as established by Army regulations.

    Military students

    In July and August 1943, conferences initiated by the director of physical therapists were held with the directors of the Training Division and the Women's Army Corps to discuss the possibility of making Army physical therapy courses available to qualified enlisted women. It was believed that such a program would not only assist in meeting the procurement requirements for physical therapists, but it would also offer an opportunity for professional as well as military advancement to these women since they would be eligible to apply for commissions as second lieutenants upon successful completion of the course. The program was approved in August 1943,16 and the institutions selected to undertake such training under War Department contract were Stanford University, Palo Alto, Calif.; University of Wisconsin, Madison, Wis.; and the D. T. Watson School of Physiotherapy, Leetsdale, Pa. These courses,17 outlined by The Surgeon General, began in October 1943, and continued in operation until October 1944. By that time, the courses conducted in Army general hospitals had expanded sufficiently to accommodate the increasing number of applicants.

    Under the terms of the three contracts, the War Department paid for tuition, board, and room and provided textbooks and other teaching aids. Medical attention was available at the nearest Army hospital or dispensary. An officer in the Women's Army Corps, assigned with each group of students, was responsible for pertinent military administrative procedures. Army physical therapy training was available to enlisted women who were under 44 years of age, who had no dependents under 14 years of age, and who had an Army General Classification Test score of 110 or over.18

    In December 1943, the Secretary of War authorized the direct recruitment of women qualified for the Women's Army Corps for the specific purpose of attending physical therapy training courses, with the assurance of a commission as a physical therapist upon satisfactory completion of the course if otherwise qualified.19 That this was a productive program was evidenced by the fact that the number of women recruited for this specific program comprised more than half of the total military enrollment in these courses.

    In June 1944, the maximum age for enrollment was reduced from 44 to 37 years. This change resulted from a study which revealed that trainees in the upper age group often experienced difficulty in adjust-

    16War Department Memorandum No. W635-18-43, 22 Aug. 1943.
    17Program of Instruction for Physical Therapy Aides in Civilian Installations and Schools Under the Direction of the Medical Department of the Army, 11 Sept. 1943.
    18The Army General Classification Test was given to all enlisted personnel to determine the individual's ability to learn.
    19Letter, The Adjutant General, to Commanding General, First Service Command, Army Service Forces, 14 Dec. 1943, subject: Recruitment of Physical Therapy Aides.


    154

    FIGURE 41-Enlisted student physical therapist adjusting infrared lamp in preparation for treatment of patient's left shoulder, Fort Huachuca Station Hospital, Ariz.

    ing to intensive academic study and to living and working in close association with groups of younger women. A similar change was made in the age requirement for applicants for these courses from within the ranks of the Women's Army Corps.

    The establishment of two all-Negro station hospitals in the United States and the activation of three such hospitals20 for oversea duty raised the question of supplying physical therapists for these hospitals. Consequently, a physical therapy training course for Negro students was established at the Fort Huachuca Station Hospital, Ariz., on 1 October 1943 (fig. 41). As the requirement for Negro physical therapists was met with the commissioning of the trainees in October 1944,

    20Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956, pp. 110, 111, 223.


    155

    the training of both military and civilian Negro students at Fort Huachuca was terminated.

    The enrollment for five courses conducted in Army general hospitals was changed from civilian trainees to military trainees in January and February 1944 (fig. 42). (See Appendix G, p. 605.) Two additional courses for military trainees were established at Lawson General Hospital and at Percy Jones General Hospital, Battle Creek, Mich. An increased number of students were accommodated when authorization was given for concurrent classes to start at quarterly intervals beginning in July 1944. This plan was put into effect in all general hospitals conducting these courses except at Percy Jones General Hospital where housing facilities were inadequate for an overlap period.

    All assignments to physical therapy training courses were terminated in October 1945, as a result of War Department action which canceled all unexpended portions of existing procurement objectives.21 A special procurement objective of 325 physical therapists was authorized to fulfill commitments made to students already enrolled in courses conducted in Army installations.

    Apprentice training program

    The program of apprentice (applicatory) training in selected Army hospitals for graduates of the 6-month civilian emergency physical therapy courses developed slowly. Because the assignment of civilian apprentices was accomplished in the service commands by personnel not familiar with the program, they were often assigned on the basis of personnel requirements with little consideration being given to their need for continued instruction and supervised practice. Management of this program improved when centralized control was vested in the Surgeon General's Office late in 1942.22

    Subsequently, The Surgeon General directed that training would consist primarily of supervised clinical practice in the treatment of patients, both in the physical therapy clinic and on the hospital wards. Particular emphasis was placed on the treatment of combat injuries, such as peripheral nerve, brain, spinal cord, chest and vascular injuries, and amputations. The program included attendance at conferences, participation in ward rounds, and at least 1 hour daily of roundtable discussion of treatment programs and current medical literature. In addition to professional training, instruction was also offered in the administration of a physical therapy clinic, including the preparation of pertinent records and reports, and the procedure for requisitioning supplies. For the applicatory phase of training, enlisted apprentice physical therapists were assigned to 20 general hos-

    21Memorandum, Secretary of War, for The Adjutant General, 2 Sept. 1945, subject: Cancellation of Procurement Objectives.
    22Memorandum, The Adjutant General, for Commanding Generals, All Service Commands, 24 Oct. 1942, subject: Dietetic and Physical Therapy Personnel in Army Hospitals.


    156

    FIGURE 42-Enlisted student physical therapist receiving instruction in use of a walker, Army and Navy General Hospital, Hot Springs, Ark. (Courtesy of National Library of Medicine.)


    157

    FIGURE 43-Apprentice physical therapists in training, Fletcher General Hospital, Cambridge, Ohio. (Top) Civilian apprentice receives instruction in massaging scar tissue. (Bottom) Enlisted apprentice learns to apply short wave diathermy apparatus. (Courtesy of National Library of Medicine.)


    158

    CHART 3-Army hospitals conducting applicatory (apprentice) physical therapy training programs, 1942-45

    pitals and civilian apprentice physical therapists were assigned to 31 other general hospitals (fig. 43).

    After V-J Day, the directors of the civilian emergency physical therapy courses were advised that the 6-month applicatory training in selected Army hospitals would be terminated. Since the Army apprentice program for civilian students was terminated, arrangements were made for students enrolled in the 6-month emergency civilian course to have their apprenticeship experience elsewhere. On 10 October 1945, The Surgeon General wrote to the directors of civilian courses expressing his recognition of the valuable contribution these schools had made to the war effort. Although a large number of emergency courses were conducted in civilian institutions, the attendance at these courses was far below normal expectation except in the two schools where training was tuition free.

    Experience in this program clearly demonstrated that in order to train apprentice physical therapists in the treatment of patients with combat injuries, clinical experience should be afforded in general


    159

    hospitals where such patients could be observed in large numbers. The limited clinical experience available in station and regional hospitals proved to be inadequate for this training; so after 1943, there was a general decrease in use of station and regional hospitals and greater utilization of general hospitals (chart 3). It was also demonstrated that the efficiency of the apprenticeship program was dependent not only on the amount and variety of clinical experience available, but also on the extent of supervision exercised by the chief physical therapist in the hospitals and by the Physical Therapy Branch, Surgeon General's Office.

    Occupational Therapists

    At the outbreak of World War II, 7 December 1941, there were eight qualified occupational therapists and four occupational therapy assistants on duty in five Army hospitals.23 By V-J Day, 899 occupational therapists and apprentices were working in 76 general, convalescent, regional, and station hospitals in the continental United States.

    Recruitment problems

    The decision of Maj. Gen. James C. Magee, The Surgeon General, not to commission occupational therapists but to appoint them as civilian employees of the Medical Department proved a serious handicap to recruitment.24 Another decision of the Surgeon General's Office which adversely affected recruitment efforts was that which limited the establishment of occupational therapy clinics to Army hospitals in the Zone of Interior. This decision was undoubtedly related to a concept of this service as being more valuable for the convalescent patients who were evacuated to the Zone of Interior than for the patients with acute injuries and illnesses hospitalized in the Communications Zone.

    Regardless of these status deterrents, there was a far more serious reason for recruitment problems. It was the close approximation of the Army's estimated need and the total numbers of registered occupational therapists available in this country. By early 1944, so many new Army hospitals had been built or planned for priority construction that the target for personnel needed was set at 1,000.25 At this time, there were scarcely 1,300 graduates in the registry of the professional organization. It was hardly conceivable, therefore, that the Army could hope to recruit over 75 percent of the total civilian supply of occupational therapists and the best solution seemed to be the

    23Fitzsimons General Hospital, Denver, Colo.; Lawson General Hospital, Atlanta, Ga.; Letterman General Hospital, San Francisco, Calif.; Lovell General Hospital, Ayer, Mass.; and Walter Reed General Hospital, Washington, D.C.
    24Letter, Maj. Gen. James C. Magee, The Surgeon General, to Everett S. Elwood, President, American Occupational Therapy Association, 1 Apr. 1940.
    25Willard, Helen S., and Spackman, Clare S. (editors): Principles of Occupational Therapy. 1st edition. Philadelphia: J. B. Lippincott Co., 1947, p. 335.


    160

    establishment of an emergency training program for occupational therapists.

    Design and purpose of War Emergency Course

    The War Emergency Course was outlined by the Occupational Therapy Branch, Surgeon General's Office, in collaboration with the War Manpower Commission and the Committee on Education, American Occupational Therapy Association. The latter body reviewed the course plan at a special meeting on 21 March 1944 and approved it as satisfying the minimum standards for an occupational therapy curriculum established by the Council on Medical Education and Hospitals, American Medical Association.

    The acceleration of this course was based on the experience of civilian schools which had, for several years, been qualifying college graduates in advanced standing courses of 18 months' duration. Prerequisites for these courses, in addition to a college degree, included a specified number of hours in biologic sciences, psychology, and sociology. With this background on which to build, school directors were able to telescope the required professional curriculum into 9 months of academic work and 9 months of supervised clinical experience.

    In an effort to further shorten the professional education, the Army singled out skills and techniques as the most time-consuming subject matter in the curriculum and added these to the prerequisites for the War Emergency Course. Thus, the qualifications of applicants for this training were (1) bachelor of science or bachelor of arts degree, with a major in arts and crafts; industrial art, with teacher training experience; home economics, including manual skills; or fine or applied arts, including manual skills; and (2) basic psychology.26 The only additional requirements of candidates accepted for this training were that they be citizens of the United States and between the ages of 21 and 35.

    On this basis, the general plan of the course provided for a 4-month academic curriculum of medical subjects and the theory and application of occupational therapy followed by 8 months of clinical practice as apprentices in designated Army general hospitals. Thus, it is seen that the academic phase of the emergency course was 5 months shorter than the conventional didactic program, whereas the clinical phase was reduced by only 1 month. Together, these accounted for a 6-month, or 331/3 percent, time cut.

    On 26 April 1944, The Surgeon General forwarded to the Commanding General, Army Service Forces, the official request for the establishment of such an emergency training course and, in late May, this was approved.27 It was another full month, however, before the

    26Memorandum, The Surgeon General, for Commanding General, Army Service Forces, 26 Apr. 1944, subject: Occupational Therapists.
    27Memorandum, War Department, for Office of The Surgeon General, 9 May 1944, subject: Approval of Contract for Training of Occupational Therapists.


    161

    official publication authorizing establishment of this course appeared.28 In addition to specifying the civilian schools which had indicated a willingness to offer the course, this planning memorandum set the numbers required to be trained within 1 year at 600 and requested permission to start negotiations with participating schools. Funds to cover the cost of this training program were allocated to the appropriation "Medical and Hospital Department, Army."

    Contracts with civilian schools participating in this government--subsidizing training course were prepared and executed by the Legal Division of the Surgeon General's Office. The first section of these contracts set forth general provisions relating to disputes, convict labor, antidiscrimination in employment, and the 8-hour-day work law. Other articles specified the facilities, students, instruction, equipment and supplies, course, payment, and termination conditions required. More specific provisions established The Surgeon General's authority to prescribe curriculum, teaching methods, classroom materials, and class schedules, to make inspections of the school facilities and course at any time, to require periodic written reports on the progress of each student, and to remove from the course any student who failed to maintain a satisfactory standing or whom The Surgeon General, for any reason whatsoever, desired withdrawn.

    Academic phase.-As previously noted, the principal means by which the War Emergency Course was accelerated from 18 to 12 months was the requirement of additional prerequisites in the skills and techniques of occupational therapy. While each applicant accepted for training was required to have at least three manual skills, the average possessed by the majority was even greater, because most of the candidates had either majored in art or home economics or had supplementary experience in teaching the creative and manual skills. Although not all were equally qualified, the general level of prior education was such that many courses taught in the traditional curriculum could be eliminated from the academic phase of this course. Over 90 percent of the students had bachelor's degrees, and over 3 percent had master's degrees. The average educational level of the nondegree students was 3.8 years beyond high school.

    In effect, therefore, schools taught only two of the so-called major arts and crafts. At the top of the list, from which these two might be selected by the school in accordance with its facilities, materials, and instructional personnel, were woodworking and printing. Most schools taught these activities although several offered weaving or radio and electrical repair in lieu of printing.

    In contrast with the limited number of media taught was the preponderance of hours devoted to sciences, clinical conditions, and the theory of occupational therapy. These subjects accounted for two-thirds of the total academic curriculum, in both hours and credits, and were in every sense, the backbone of the academic course. The

    28Army Service Forces Circular No. 189, 22 June 1944.


    162

    most notable omissions among these subjects, in comparing the war course with the regular curriculum, were psychology, here made a prerequisite, and pediatrics, a subject of obviously less importance in preparation for work with the war injured in Army hospitals.

    Table 8 outlines the prescribed academic content of the War Emergency Course as it was presented at one of the civilian schools. Both at the time the course was first proposed and on many occasions since the war, there have been questions challenging how so much material could be covered in so short a time. One method used was the scheduling of 24 hours of classes per week and an additional 12 hours per week for visits, field trips, observation, collateral reading, and study. In addition, there were innumerable hours of outside preparation and work required if one were to keep up with this intensive schedule. On the basis of allowing 2 hours outside preparation time for each 1 hour of classwork, even the wartime 48-hour-week would not appear to have been adequate.

    TABLE 8-Outline of emergency 4-month course for occupational therapists, 19441

    Additional factors therefore seem significant, and one of these was the unusual impetus and drive that motivated everyone in the national emergency created by the war. Of still further relevance could be the short timespan over which great concentration and effort were required, as well as the government subsidy for both trainee tuition and living expenses and the ultimate reward of qualification for professional registration available to all who successfully completed the course.
    Clinical phase.-Satisfactory completion of the academic phase of training was certified by the civilian schools to The Surgeon General


    163

    and to the service commands in which the schools were located. The Surgeon General then assigned trainees to selected general hospitals for the 8-month period of clinical affiliation and experience.

    A detailed program of instruction for the 34-week clinical affiliation was published by The Surgeon General in October 194429 to furnish a general guide for applicatory training. Modifications of the standard program to make best use of instructional facilities and resources to conform to local situations were permitted within the general provision that a progressive and balanced training be maintained (fig. 44). The clinical program was intended to provide orientation to the Army and training through application of the principles, processes, and techniques studied in the 4-month didactic phase.

    The clinical affiliation strongly supplemented the academic portion (fig. 45) of the emergency course and afforded an additional means of acceleration. Eighty-seven hours were provided for work with craft activities not given in the academic portion or for the perfecting of techniques with those crafts previously learned. In addition, further practice and exploration of craft techniques were made possible in the work experience periods which were scheduled in all four areas of practice. In this way, time was allocated for learning the creative and manual skills which were so foreshortened in the academic phase of the program.

    Designated to conduct the clinical phase of the War Emergency Course were 40 Army general hospitals geographically distributed throughout the nine service commands. A meeting of the chief occupational therapists of these hospitals and the occupational therapy consultants in those commands which had such personnel was convened in New York, N.Y., on 11, 12, and 13 November 1944, for the purpose of coordinating the clinical training program and discussing problems incident to training requirements.

    In August 1944, the clinical portion of the War Emergency Course was opened to students who had completed the equivalent of the academic education in regular civilian training courses.30 Furthermore, students who had satisfactorily completed some part of the apprentice period of practical experience in accredited civilian hospitals were acceptable for completion of this period in selected Army hospitals. In extending subsidized training to students of regular civilian courses, approximately 150 additional apprentices were enrolled and subsequently employed on the staffs of Army hospitals as graduate occupational therapists.

    On 22 February 1945, The Surgeon General requested permission to increase from 600 to 700 the total number of students to be trained in the War Emergency Course.31 This increase was made necessary

    29Clinical Training Program for Emergency Course Students in Occupational Therapy, 34 Weeks.
    30Army Service Forces Circular No. 263, 15 Aug. 1944.
    31Letter, The Surgeon General, to Commanding General, Army Service Forces, 22 Feb. 1945, subject: Occupational Therapists.


    164

    FIGURE 44-Clinical learning experiences, War Emergency Course, World War II. A. Observation of electroshock therapy in psychiatric section. B. Observation in physical therapy clinic.


    165

    FIGURE 44-Continued. C. Class instruction in fundamentals of electricity. D. Individual practical instruction.


    166

    FIGURE 45-Classes for occupational therapy apprentices, Battey General Hospital, Rome, Ga. (Top) Anatomy. (Bottom) Kinesiology.


    167

    because of the additional requirements of hospitals not anticipated at the time of the original request.

    Some relevant statistics on the War Emergency Course are contained in chart 4, which shows the 18-month period of input of the didactic and clinical phases of the course, and in table 9, which indicates the flow of trainees through the academic and clinical phase of the course.

    APPOINTMENTS, CLASSIFICATIONS, AND SALARIES OF TRAINEES

    The Medical Department had long desired that all civilian positions including that of the student dietitian be brought within competitive classified civil service status. This became effective in February 1939 when all civilian positions in Army hospitals, including student dietitians at Walter Reed General Hospital paid from regular appropriations, were so classified.32 Authority was received by the Surgeon General's Office to give classified status to the 10 student dietitians who entered training on 1 September 1939 and were appointed without civil service examinations. However, positions of these students remained ungraded for another 5 years. They carried an annual cash salary of $420, from which there were deductions of $360 for quarters and subsistence and, after 1940, 3½ percent for retirement. Take-home pay at this time was approximately $45 per annum.

    In 1941, when the emergency training program in physical therapy was initiated, physical therapy students were also classified in ungraded civil service positions, received the same salaries as student dietitians, and were subject to the same deductions. At this time, however, the Civil Service Commission authorized the additional training position of apprentice physical therapist and provided for reallocations from the position of student to that of apprentice and ultimately to that of graduate without prior approval or examination by the commission. The positions of apprentice physical therapist and apprentice dietitian were subprofessional and were designated SP-3. The salary for these positions was $1,440, less $180 for quarters and subsistence.

    By 1944, when the emergency course in occupational therapy was initiated, training positions for these three groups of Medical Department specialists had been improved with reference to both classification and salary. Thus, the ungraded position of student (dietitian, physical therapist, or occupational therapist) was changed to SP-3, at $1,440 per annum, and the position of apprentice in each of these categories was upgraded from SP-3 to SP-4, at $1,620 per annum. Both salaries were enhanced by 20-percent overtime pay for schedules in excess of 40 hours per week. However, both were also subject to a deduction of 5 percent for retirement and $180 for quarters and subsistence.

    Civilian students and apprentices were required to furnish their

    32Executive Order 7916, 24 June 1938.


    168

    CHART 4-The 18-month period of input, didactic and clinical phases,1 occupational therapy, War Emergency Course, 1944-45 [cumulative totals]

    1The input reflects only those initially enrolled in the War Emergency Course. It does not include the approximately 150 regular course students who took only the clinical phase.


    169-170

    TABLE 9-Flow of trainees, occupational therapy, War Emergency Course, 1944-45

    uniforms, textbooks, and all incidental items. In all cases, the uniform was the same as the one authorized for wear by the graduates.

    TRAINING PERFORMANCE REPORTS

    Reports on the performance of apprentices during the clinical phase of their training were a part of the administrative and supervisory procedures followed by all three groups. For dietitian apprentices, these were completed 1 month before the end of the training period and forwarded to the Surgeon General's Office. A record of final physical examination, a photograph, and an application for appointment, in duplicate, accompanied the report.

    For physical therapy apprentices, final reports of performance were completed after the training period by the clinical supervisors and forwarded to The Surgeon General.33 These reports provided information about the trainee's proficiency, the amount of clinical practice completed, personality traits, and adaptability for commissioned military service. They were retained as a part of the trainee's permanent record in the Surgeon General's Office.

    A report on each occupational therapy apprentice34 was completed by the hospitals at periodic intervals during the 34-week program and submitted in duplicate to The Surgeon General. From that office, one copy was sent to the schools in which apprentices had received their academic instruction and from which they would be certified eligible for registration on satisfactory completion of the total course.

    As had been provided for the academic phase, The Surgeon General was not only responsible for overall supervision of the clinical pro-

    33WD AGO Form 8-181, 1 May 1945, [Revised] Report on Apprentice Physical Therapist, Medical Department, U.S. Army.
    34SG Form 951, 21 Dec. 1944, Apprentice Occupational Therapy Report.


    171

    grams but was also authorized to separate an apprentice from a course at any time for failure to maintain satisfactory clinical performance, inability to adjust to hospital service, or other just cause.

    MAINTENANCE OF EDUCATIONAL AND PROFESSIONAL STANDARDS

    As already noted, emergency and accelerated training programs in dietetics, physical therapy, and occupational therapy had been developed in conjunction with officials or committees of the professional organizations concerned. Thus, these courses met the minimum educational requirements of the appropriate accrediting agencies, namely, the American Dietetic Association and, for physical and occupational therapists, the Council on Medical Education and Hospitals, American Medical Association.

    Throughout the war, despite the personnel shortages which beset all three groups, The Surgeon General maintained these educational standards. However, each group had some problems in this respect. In the fall of 1944, the Civil Service Commission questioned the need for the strict educational requirements for student dietitians as a prerequisite for training. The question arose from the Commission's interpretation of the provision in the Veterans' Preference Act of 1944 (Chapter V, pp. 101-136) which eliminated minimum educational requirements as a qualification for other than scientific, technical, or professional positions specified by the Commission.

    The Civil Service Commission's interpretation came as a surprise to the Surgeon General's Office. In a letter of protest, Maj. Gen. George F. Lull, Deputy Surgeon General, stated:35

      The dietitian in the Medical Department of the Army is a commissioned officer. She assists the medical officer by filling his diet prescriptions. It is, therefore, most important that the best qualified individuals be obtained for training. It is highly improbable that this type of personnel could be secured if the educational requirements are discontinued.

    Other points were brought out which stressed the dietitian's duties and responsibilities for planning, supervising, instructing, and maintaining accounts and records.

    A favorable reply was received:36

      In certifying persons for the position of student dietitian, apprentice dietitian, student physiotherapy aide and apprentice physiotherapy aide, only those eligibles will be certified who meet the requirements prescribed by the War Department as necessary for commissioned officers.

    Occupational therapists also had some problems with maintenance of educational standards and with physical standards as well. Although the majority of applicants for the War Emergency Course were qualified

    35Memorandum, Maj. Gen. George F. Lull, Deputy Surgeon General, to U.S. Civil Service Commission, 12 Sept. 1944, subject: Educational Requirements for Dietitians.
    36Letter, M. L. A. Mayer, Executive Director, Civil Service Commission, to Maj. Gen. George F. Lull, Deputy Surgeon General, 24 Oct. 1944.


    172

    and acceptable under the requirements established for eligibility, a small percentage was deemed unsuitable by The Surgeon General for reasons of academic achievement, physical condition, or personality disorder. The Civil Service Commission observed some practices consistent with its founding philosophy but inconsonant with the high standards believed necessary for the emergency course. This complicated the work of the Surgeon General's Office in accepting some of the persons certified. One of these was the advantage given on the basis of preference allowed veterans, the disabled, wives, and widows, which required the acceptance of several candidates neither physically nor educationally qualified according to stated requirements. Another was the tendency toward extreme liberality in substituting experience for education.37 Occasionally, The Surgeon General contested and won his argument against some of these unqualified certifications but, more often, they had to be accepted and subsequently disqualified on the basis of failing to meet the physical or academic standards of training.

    The educational prerequisite of college graduation with major study in physical education for civilian students taking the physical therapy course had been established by the Medical Department as the entrance requirement before 1941. To make this training available to more individuals, approval was requested in May 1944 to change the educational requirement to include graduation from an approved college with major study in the field of biologic sciences. While this revision was not published until October, it was informally approved earlier, and was used in the selection of students enrolled subsequent to August 1944.

    Military applicants for the physical therapy course were required to have completed not less than 2 years (60 semester hours) in an approved college with satisfactory courses in biologic and other sciences. In interpreting the term "satisfactory courses in biology and other sciences," it was established that a minimum of 15 semester hours would be required, selected from among the following subjects: anatomy, bacteriology, biology, chemistry, hygiene, kinesiology, physics, physiology, psychology, and zoology.

    This change in the educational requirement represented a departure from the previously established prerequisite of college graduation or equivalent with major study in physical education for Army physical therapy training courses. In the selection of students with a 2-year college background, there was considerable concern in some military and civilian areas that the Army would jeopardize professional standards. While the Army did depart from its previously established prerequisites, it still conformed to the current minimum standards as established by the Council on Medical Education and Hospitals, American Medical Association.

    37Applicants were permitted to substitute year-for-year up to a maximum of 2 years, 1 year of education in an approved art school for 1 year of the required education, and applicants who had had 2 years of teaching experience in arts and crafts or industrial art could substitute this experience for 1 year only of the required education.


    173

    In October 1944, after completion of the first year of these courses for enlisted women, in order to assure a better selection of students the minimum requirement in science hours was increased from 15 to 26 semester hours, with 6 hours as the minimum in biology. The remaining hours were selected from among courses in anatomy, bacteriology, chemistry, entomology, hygiene, kinesiology, parasitology, physics, physiology, psychology (maximum 3 semester hours), zoology, or other courses listed as biologic or natural sciences. This change was necessary because many of the 2-year college students with only 15 hours in the sciences were not academically prepared to cope with the Army's intensive training program.

    The number of students with a 2-year college background constituted only 9 percent of the total number of enlisted students enrolled from October 1943 to November 1945. The average number of college years for the overall total of these students during this period was 3.7 years (table 10).

    It should be pointed out that the composite training period (student and apprentice phases) for civilian physical therapy students was 12 months, while the composite training period for enlisted students was 9 months. In view of the previous military orientation of enlisted students and the vast amount of clinical material available for observation and practice in general hospitals conducting training programs for these women, it was considered that 3 months of supervised clinical practice would be sufficient. Subsequent experience demonstrated that this assumption was sound.

    Clinical practice hours afforded 97 enlisted apprentice physical therapists during 1944 revealed that the average number of hours was far in excess of the 400 clinical hours then required by the Council on Medical Education and Hospitals, American Medical Association.

    SCHOOLS AND HOSPITALS CONDUCTING TRAINING COURSES FOR THE ARMY

    Emergency training programs which were established during the war to increase the numbers of dietitians, physical therapists, and occupational therapists involved educational institutions and numerous civilian and military hospitals.

    Participating in the training of dietitians were 15 civilian hospitals which conducted the student phase, 33 Army hospitals38 which conducted the apprentice phase, and 4 Army hospitals which conducted both phases. The earliest course began in August 1942. Civilian institutions completed their Army courses in 1945, and all Army accelerated programs except that at Brooke General Hospital, which continued both student and apprentice training into the peacetime years, closed in March 1946.

    38One of these, McCloskey General Hospital, Temple, Tex., conducted only one course, from 15 June 1945 to 1 January 1946, for five members of the Women's Army Corps.


    174

    TABLE 10-Educational background of enlisted members of the Women's Army Corps enrolled in Army physical therapy training courses, 1943-45

    A large number of both schools and hospitals were concerned in the training programs for physical therapists. Fifteen civilian institutions conducted 38 courses of the 6-month didactic phase of emergency physical therapy training (table 11). This was followed by 6 months of apprentice training in Army hospitals. In addition, 10 Army hospitals conducted 33 emergency 6-month didactic courses for civilian students and 28 for enlisted students. The first emergency course was started in July 1941, but civilian schools did not start this program until 1942. These emergency physical therapy training programs were discontinued soon after V-J Day. However, the Army hospitals which had conducted the didactic phase of training continued in operation until 10 February 1946 and hospitals accepting these students for applicatory training were necessarily involved for another 6 months.

    The 21 emergency courses for occupational therapists were given at 8 civilian schools, while the clinical phase of this program was conducted at 40 Army hospitals. The school courses started in July 1944 and terminated in November 1945. However, the applicatory phase of training for this final group extended 8 months beyond the war and reductions in force during this period necessitated transfer of the last 51 apprentices, who were scheduled to graduate in July 1946, to Veterans' Administration hospitals for both pay and training in the last few months of their educational program.

    EVALUATION OF EMERGENCY TRAINING PROGRAMS

    The procurement of qualified medical specialist personnel in sufficient numbers to meet the needs of the Army could not have been accomplished without the emergency training programs. Both dietitians and physical therapists numbered approximately 1,600 at the peak of their strengths. Although the dietitians procured only 21 percent of their strength from Army training courses, physical therapists realized approximately 55 percent of their wartime strength from this source. Occupational therapists, although the smallest group numer-


    175

    TABLE 11-Emergency physical therapy training courses conducted by civilian institutions, 1942-45

    ically, trained 78 percent of their strength of approximately 900 through the emergency courses. In each case, the professional group concerned thought that the conduct of the applicatory phase of training in military hospitals was of value in familiarizing students with Army procedures. This was especially true for physical and occupational therapists with reference to experience provided in treatment of war injuries.

    There was another value which dietitians, physical therapists, and occupational therapists attributed to the emergency training courses. This was the effect these educational programs had on the profession as a whole. The impetus to recruitment that was felt in all three of these health fields resulted in increases in the number of civilian schools during the war period, as follows: Dietetic internships, from 38 to 60; physical therapy, from 15 to 36; and occupational therapy, from 5 to 21.

    Both during and after the war, there was considerable comment about the lowering of standards inherent in the accelerated and emergency physical therapy training programs conducted by the Army. In


    176

    1945, Dr. Frances A. Hellebrandt, Medical Director, Baruch Center of Physical Medicine, Medical College of Virginia, Richmond, Va., made a careful analysis of the didactic 6-month phase of the Medical Department physical therapy course.39 Doctor Hellebrandt had served as medical director of the physical therapy training course for enlisted members of the Women's Army Corps conducted under War Department contract at the University of Wisconsin from October 1943 to October 1944. The following observations by this outstanding leader in the field of physical medicine are of interest:

      * * * Careful study of the scope and content of the WAC course suggests that in reality it surpasses anything previously attempted by the average apprentice type of approved hospital technician training school.

    * * * * * * *

      The Army has demonstrated that the essentials of subject matter in a variety of technical fields can he taught effectively by new methods which drastically shorten the learning period. * * * We would be short sighted indeed if we failed to study the pedagogical experiments of the war. * * *.

    Perhaps the most convincing testimonial to success of the emergency course in occupational therapy lies in the unanimous agreement favoring establishment of a similar program in event of a similar future need, among both school and clinical personnel involved in the training. Commenting on an overall evaluation of the course, they singled out the following as reasons for its success: A high degree of maturity; prior level of education, preparation in skills, or prior teaching experience; high motivation; and selection. Other positive values noted included supplying personnel for the emergency and placement of the academic portion in regular schools and the clinical phase in on-the-job training.

    Section III. Other Training Programs During Wartime and Postwar Periods

    POSTWAR PERIOD IN DIETETICS

    Effective in September 1946, the dietitian training course at Brooke General Hospital included both student and apprentice phases. The training of student dietitians at Brooke General Hospital was not terminated at the end of the war because of the continued critical shortage of dietitians in the Army. When students were appointed for training, they were required to sign a statement that they understood that, upon successful completion of the course, they were expected to accept a commission as dietitian in the Medical Department. Several months prior to the completion of training they were contacted to start processing application papers for their commission.

    These students were trained during a period of postwar instability.

    39Hellebrandt, F. A.: Analysis of the WAC Emergency Physical Therapy Training Program. Arch. Phys. Med. 26: 502-514, August 1945.


    177

    In addition, there was a large turnover in the staff at Brooke General Hospital because many dietitians were anxious to return to civilian life upon completion of their military commitments. The status of the student as a civilian in a military organization was still most difficult. As a result, out of the class of 14 students who entered Brooke General Hospital in July 1945 only 7 accepted commissions upon completion of training in July 1946. All of the class of 10 student dietitians who entered training in September 1946 graduated; none accepted commissions. For the course beginning in September 1947, eight student dietitians were selected; only two completed training and accepted commissions. Even though statements acknowledging service obligation were required there was a tendency on the part of the students to feel no obligation to give any service to the Military Establishment in return for their government education. With the impetus and pressure of war gone, since 1945, there was an entirely different attitude toward the acceptance of a commission.

    Many of the problems that were encountered in the training of dietetic interns after V-J Day were the same as those encountered by staff dietitians early in the war who were civilians in a military organization. Since dietitians were responsible for directing and supervising large numbers of both civilian and military employees, it was felt that during the training period a student dietitian should be taught to accept responsibility within the organization and to direct personnel when in actuality they did not have this authority within the military organization. There appeared to be only one proper solution. It was hoped that when Army dietitians received Regular Army status, the student dietitians could be commissioned in the Reserves and serve 2 years' active duty. This would include the 1 year of training after which the Medical Department would be assured of the services of these dietitians for at least another year.

    ADVANCED COURSE IN MESS ADMINISTRATION FOR DIETITIANS

    In May 1946, The Surgeon General established a program of advanced instruction in mess administration for dietitians at the Medical Field Service School (then known as the Army Medical Department Schools). The purpose of this course was to give additional training to dietitians in procurement of food, cost accounting, and equipment and acquaint them with newer trends in administration. Classes of 2 weeks' duration were scheduled at a frequency of one class per month, 12 officers each; the first class began on 15 June 1946. Fourteen courses were given in 1946 and 1947, and were attended by 136 Army, 8 Air Force, and 2 Veterans' Administration dietitians.

    The 80 hours of classwork presented at this course included organization of a dietetic division and relation of that division to various divisions and services in a hospital, 2 hours; personnel in a dietetic


    178

    division and ward diet kitchens, 5 hours; menus and food procurement, 23 hours; food inspection, 9 hours; food storage, 1 hour; stock control, 1 hour; food preparation and service, 13 hours; equipment, 8 hours; accounting procedures for hospital funds, 10 hours; examinations, 2 hours; and military time, 6 hours.

    The course was an important milestone in the progress of the Army dietitian. Since permanent military status had become a certainty, this course prepared the Army dietitians for the additional responsibilities they would be expected to assume as Regular Army officers. In addition to updating administrative and dietetic knowledge, the course provided an opportunity for roundtable discussion of problems. Recommendations for future improvements in the food service of Army hospitals were developed from those problem-solving sessions.

    VOLUNTEER PROGRAMS IN PHYSICAL THERAPY

    In July 1945, it was unofficially learned that civilian women volunteers were assisting in the physical therapy department at Billings General Hospital, Fort Benjamin Harrison, Ind. These women of varied backgrounds had been recruited by the Marion County Civil Defense Council. Before coming to this hospital, they had completed approximately 32 hours of orientation in physical therapy procedures at the Veterans' Administration Hospital, Indianapolis, Ind.

    Early in 1945, the Commanding Officers of Thayer General Hospital, Nashville, Tenn., and Crile General Hospital, Cleveland, Ohio, asked The Surgeon General for permission to train civilian women patriotically inspired to contribute in the war effort by assisting in the physical therapy department. The Surgeon General interposed no objection to these plans, provided-

    1. The program was coordinated with the hospital chapter of the Red Cross, since this was the only organization authorized to render volunteer assistance to the Medical Department.40

    2. The commanding officers of these hospitals assumed the responsibility for this instruction.

    3. A copy of the instructional program was furnished The Surgeon General.

    4. The commanding officers concerned would assume full responsibility as far as liability was concerned.

    It was further stressed that in no sense was it to be construed that those who completed this training were to be considered physical therapists, since they were to be trained only to assist physical therapists and to relieve them of many time-consuming nonprofessional duties.

    In the Crile General Hospital program, these women were given 86 hours of basic instruction and demonstration at the Cleveland Clinic Foundation and the Cleveland Rehabilitation Center. This was fol-

    40Army Regulations No. 850-75, 30 June 1943.


    179

    lowed by 40 hours of demonstration and instruction at the hospital.

    At Thayer General Hospital a more comprehensive program, planned by the director of physical therapy, was coordinated with Vanderbilt University, Nashville, Tenn., which granted 4 hours of college credit for satisfactory completion of the course and subsequent practical experience. The class was composed of college graduates, graduate nurses, and physical education students in either their third or fourth year at George Peabody College for Teachers, also in Nashville, or at nearby Vanderbilt University. These women showed a great interest in physical therapy and were sincere in their efforts to be of service. Here a monitor system was adopted by which each staff physical therapist was responsible for a designated number of volunteer workers.

    TRAINING ENLISTED PHYSICAL THERAPY TECHNICIANS

    The Medical Department had long recognized that trained enlisted assistants were necessary to the operation of a physical therapy clinic. Before the war, the training of male enlisted assistants had been conducted entirely as an on-the-job activity. The necessity for formal training, however, was not demonstrated until World War II. Due to the loss of trained male technicians to combat units, in early 1945, the service commands were requested to forward information relative to their needs for enlisted women trained as physical therapy technicians. On the basis of this information, a formal training program was established. Applicants for these courses were required to have satisfactorily completed 2 months' training at the Medical Department Enlisted Technicians School (now Medical Field Service School). Those selected to attend were carefully screened for adaptability and interest in this field by the staff of the school, the medical director of physical therapy, and the chief physical therapist, Brooke General Hospital.

    The program of instruction prepared by the Physical Therapy Branch, Surgeon General's Office, and approved by the Director of Military Training, War Department,41 consisted of a 4-week course (192 hours) in theory and practice in selected physical therapy procedures and a general orientation in this field of therapeutics. To prepare enlisted women for hospital assignments as rapidly as possible, courses were established in 13 general hospitals.42 Graduates were eligible for the classification of enlisted physical therapy technician.43

    By V-E Day, the number of technicians on duty and in training was

    41Program of Instruction for Theoretical and Applicatory Training of Physical Therapy Technicians (WAC), approved by War Department, Army Service Forces, on 2 Apr. 1945.
    42Army and Navy General Hospital, Hot Springs, Ark.; Borden General Hospital, Chickasha, Okla.; Cushing General Hospital, Framingham, Mass.; England General Hospital, Atlantic City, N.J.; Fletcher General Hospital, Cambridge, Ohio; Harmon General Hospital, Longview, Tex.; Kennedy General Hospital, Memphis, Tenn.; Mayo General Hospital, Galesburg, Ill.; Nichols General Hospital, Louisville, Ky.; Northington General Hospital, Tuscaloosa, Ala.; Oliver General Hospital, Augusta, Ga.; Valley Forge General Hospital, Phoenixville, Pa.; Wakeman General Hospital, Camp Atterbury, Ind.
    43War Department Technical Manual 12-427, 12 July 1944; Change 1, 12 Apr. 1945.


    180

    anticipated to be sufficient to meet the needs of the Medical Department. This training program, therefore, was terminated upon completion of the course beginning on 9 July 1945. Four hundred and thirteen enlisted women were successfully trained in this program.44

    The utilization of these assistants contributed materially to the successful operation of physical therapy clinics and clearly demonstrated the value of the formal training program. The commissioned physical therapists welcomed this assistance as it enabled them to devote more of their time to professional duties. Even before the courses were terminated, preliminary planning was initiated for a more comprehensive course at a later date, should a resumption of the program be indicated. This proved to be true, and in 1949, the course was resumed at the Medical Field Service School and continued to be offered whenever there was a requirement for assistant personnel.

    With the expansion of physical therapy activities overseas, additional personnel was needed. There was not only an inadequate supply of physical therapists, but the enlisted personnel assigned to the clinics were, as a general rule, untrained and unfamiliar with physical therapy procedures. Training was necessary and this was done either through on-the-job training or by establishing formal courses of instruction.

    In the Territory of Hawaii, for example, on 20 November 1943, formal physical therapy training courses of 3 months each were begun at Tripler General Hospital, North Sector General Hospital, and the 147th General Hospital. These courses were given at the direction of Lt. Gen. Robert C. Richardson, Jr., Commander, Pacific Ocean Areas.45 Each hospital in the area at that time was directed to send one nurse and one enlisted man. Any nurse who was interested was eligible as was any enlisted man who had previous experience or who was interested in further study in this field. After completing the course, the graduates were assigned to general, station, and field hospitals.46 They did not in any way replace physical therapists but they filled the gap until more physical therapists were available.

    COURSE FOR OCCUPATIONAL THERAPY ASSISTANTS

    If either the recruitment of graduate occupational therapists had yieided larger numbers or the War Emergency Course had been instituted at an earlier date, the training course for occupational therapy assistants would not have been necessary. However, by June 1944, there were only 180 occupational therapists on duty in Army general hospitals and the prospect of more than a year's time elapsing before graduates of the War Emergency Course could be qualified for staff appointments.

    44Medical Department, United States Army. Personnel in World War II. Washington: U.S. Government Printing Office, 1963, p. 232.
    45Physical Therapy History of Pacific Ocean Areas and Middle Pacific, pp. 5, 6. [Official record.]
    46Report, 1st Lt. Barbara M. Robertson, MDPT [February 1946], Physical Therapy in Saipan, p. 7.


    181

    The need for still further means of alleviating the personnel shortage was acute.

    On 2 August 1944, the director of the Reconditioning Consultants Division, Surgeon General's Office, reported to The Surgeon General that a program for training enlisted women as occupational therapy assistants had been submitted.47 The 1-month course was approved by the Army Service Forces on 16 November 1944.48

    In January 1945, recruitment for this course was closed, and, during the remaining 10 months of its operation, service commands submitted requests for quotas to send to the course personnel already in the Women's Army Corps and on duty in their installations. Under this plan, the Surgeon General's Office approved qualifications of candidates, allotted quotas to the service commands, and return trainees, on completion of the course, to the service commands for assignment to hospitals having established occupational therapy programs.

    Applicants for training as occupational therapy assistants were required to present the following prerequisites in addition to completion of basic military medical training: A civilian background of teaching experience plus some knowledge of a handicraft or expert ability in some handicraft plus high school education and an aptitude for teaching.

    Halloran General Hospital, Staten Island, N.Y., was selected as the site of training, and Capt. Josephine E. Springer, WAC, chief occupational therapist at Tilton General Hospital, Fort Dix, N.J., was transferred to Halloran General Hospital and placed in charge of this program. Since these trainees were enlisted personnel, it was thought advisable to have their course under the direct supervision of a commissioned officer in the same corps. Experience proved that this was a wise decision from the point of view of both discipline and instruction. Captain Springer was assisted in conduct of training by WAC Sgt. Martha Gilbert (registered occupational therapist) and by Misses Orvilla Yost and Marguerite Silverman of Halloran's civilian occupational therapy staff.

    On 9 December 1944, a group of 14 students reported for the first class, and with the enrollment of the fifth class, in April 1945, 141 students had attended the course. At this time, a request for discontinuance of the course was made on the basis of assignment of all recruits and this was readily approved. The following month, however, a request for reestablishment of the course had to be submitted on the basis of need for personnel because of the expanding convalescent hospital program. Once more, Army Service Forces approved The Sur-

    47Memorandum, Col. Augustus Thorndike, MC, for The Surgeon General, 2 Oct. 1944, subject: Semimonthly Report of the Reconditioning Consultants Division for the Period 16-30 September 1944.
    48Memorandum, Brig. Gen. R. W. Bliss, Chief, Operations Service, Office of The Surgeon General, for Commanding General, Army Service Forces, 4 Nov. 1944, subject: Orientation Training for Occupational Therapy Assistants (WAC), with 1st indorsement thereto, 16 Nov. 1944.


    182

    geon General's request.49 The promptness of each action and the unexpected supply of recruits in the interim period enabled the classes to run consecutively to completion later in the year.

    With graduation of the eleventh class, on 27 October 1945, the occupational therapy assistants training course for enlisted members of the Women's Army Corps was discontinued. Of the 295 students enrolled in this course, 278 satisfactorily completed requirements and were subsequently assigned to selected Army hospitals where they assumed much of the burden of the diversional activity programs.

    49Transmittal sheet, Col. S. M. Prouty, G.S.C., Executive, Office of the Director of Military Training, Army Service Forces, to The Surgeon General, 7 June 1945, subject: Orientation Training for Occupational Therapy Assistants (WAG), with inclosure 1 thereto, 28 May 1945.