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Chapter I


Part I



Surgical Consultants in the European Theater of Operations

Col. James C. Kimbrough, MC, USA (Ret.)

It may be said that the foundation for the consultant system in the European theater of World War II was laid during World War I. Many of the campaigns in Europe in the Second World War were fought over the same battlegrounds of the only major theater in which American Forces were involved in the First World War. The AEF (American Expeditionary Forces) in World War I eventually developed a full-fledged system of consultation in both medicine and surgery. Lessons learned in the metamorphosis of the consultant system during the first great conflict were recorded and available for reference in the medical history of that war. Thus, a review of consultation in surgery in the European theater during World War II must begin with World War I.


At first glance, it would appear that the AEF in World War I was amply supplied with consultants.1 At various times, consultants were assigned to every echelon of command from combat divisions to the Chief Surgeon's Office and in headquarters and hospital centers of the base sections. The system under which the consultants were appointed, organized, and operated took two quite distinct forms during the war. The earlier of the two may be simply characterized as a more-or-less unsystematic form in which consultants worked independently and entirely on their own. The second, and later, form may be said to have been an attempt at systematization and unification of the professional services.

Under the first system, there were eight "directors" in the Office of the Chief Surgeon, AEF. A director was appointed for each of the following: General medicine; general surgery; orthopedic surgery; surgery of the head; urology, and skin and genitourinary diseases; laboratories; psychiatry; and roentgenology. This "director" system was implemented throughout the army corps, administrative sections of the lines of communications, larger hospitals, and other commands. Many assistant consultants were appointed in various eche-

1Most of the material in this section is based on the discussion of the professional services, AEF, contained in "The Medical Department of the United States Army in the World War, Volume II, Administration, American Expeditionary Forces" (Washington: U.S. Government Printing Office, 1927).


lons of the medical service. At the start, each infantry division also had a surgical consultant. The assistants and consultants at the division level were commonly known as junior consultants.

Under this system, each consultant was directly under either the surgeon of a command or the commander of a hospital center. The Chief Surgeon's circular establishing the system emphasized that professional authority did not include administrative control. This was indeed an open-end statement since nothing was said as to what, specifically, "professional authority" entailed. At General Headquarters, AEF, the directors were supposedly under the control of the Hospitalization Division of the Chief Surgeon's Office at Chaumont, some 45 kilometers from where the directors were stationed at Neufchateau. Their activities were uncoordinated. Each director sought to solve in his own way the very different and difficult problems which confronted him. No specific instructions had been issued governing their status.

The confusion which often resulted is readily understandable under the circumstances. First, the new professional directors did not have the military background and experience which would have made their tasks easier of accomplishment. Moreover, there was really nobody to help them. Each director was an enthusiast in his own specialty, and his zeal-as well as the misnomer of his title, "director"-not infrequently led him to misdirected activities. Some of the best clinicians were assigned to divisions and other commands which had little need or use for their talents during most of this period. Even the seemingly simplest matters became problems of no small proportions. For example, someone in authority had most generously ruled that each director at General Headquarters, AEF, was authorized the use of an automobile for unlimited periods of time! Considerable embarrassment was caused by a shortage of automobiles for this purpose and by the absence of an arbiter to coordinate the use of the few vehicles that were available from time to time.

In spite of the difficulties encountered, the initial work accomplished by the specialists was of very great importance, and there were many basic similarities in their modes of operation. As their functions became more clearly defined, it was evident that consultants were expected to direct and supervise the professional services in all echelons of the medical service, to provide for continuity of treatment from front to rear, to modify, as need be, accepted methods of treatment, and to inaugurate new treatment methods.

On 18 April 1918, the Chief Surgeon appointed Lt. Col. (later Col.) William L. Keller, MC, Director of Professional Services for the purpose of coordinating professional medical activities. Among the missions given Colonel Keller, the following were most significant:

By virtue of this appointment, you are empowered to represent the chief surgeon, A.E.F., in all matters pertaining to the administration, direction, and coordination of the professional services. You are responsible for such professional matters relating to hospitalization, evacuation, laboratories, sanitation, and other activities as may pertain to the proper sorting, distribution, and evacuation of sick and wounded through the channels that will best insure efficient treatment from the front to the rear.


All requests for the movement of personnel and supplies originating in the professional services will be forwarded by or through you to the chief surgeon, A.E.F., or to some one designated by him.

*    *    *    *    *    *    *

You will direct the compilation of a classified roster by each chief consultant, of all professional personnel, such as specialists, consultants, or surgical teams among the various army units of our own and allied formations, so as to facilitate their proper distribution and utilization in emergencies as well as in routine. When the organization of the professional service is completed, you will direct its workings, either from general headquarters or such other places as best serves the interests of the service.

With the three original divisions, medicine, surgery, and laboratories as a basis, you will so coordinate the activities of the subdivision thereof that scientific research and clinical proficiency may be effectually promoted.2

With the appointment of the Director of Professional Services, a reorganization-actually an organization-of the rest of the professional services was directed on a trial basis. The organization was fully adopted and officially announced by General Orders No. 88, General Headquarters, AEF, on 6 June 1918. This was the beginning of the second system previously referred to, that of a coordinated professional service for the AEF. The titles of directors were at this time changed to consultants. The publication of these general orders gave them a status which they had not previously enjoyed and promoted broader appreciation of their responsibilities.

Under the Director of Professional Services, who, incidentally, was still under the Hospitalization Division, were a Chief Consultant in Surgery and a Chief Consultant in Medicine. The Chief Consultant in Surgery was Brig. Gen. John M. T. Finney, MC. He was given the overall responsibility for supervising the professional activities of the surgical subdivisions in the AEF. He was instructed to organize and coordinate these subdivisions in a manner which would permit him to anticipate and request, as far in advance as possible, necessary changes in personnel. He was charged with the formation and functioning of surgical teams and collecting timely reports from them. He was to make recommendations for inspections as to technical procedure and instruction in the specialty of surgery.

Under the Chief Consultant in Surgery were nine senior consultants in various specialties representing the subdivisions of surgery which were to be recognized in the AEF. These were surgical research; roentgenology; neurosurgery; orthopedic surgery; ear, nose, and throat surgery; general surgery; venereal and skin diseases and genitourinary surgery; maxillofacial surgery; and ophthalmology. The mission of these senior consultants was to coordinate professional activities relating to their specialties in subordinate commands. They were specifically instructed to make recommendations to the Chief Consultant so that instructions relative to professional subjects could be directed to subordinate commands with dispatch and executed promptly.

2Letter, Chief Surgeon, AEF, to Lt. Col. W. L. Keller, MC, 18 Apr. 1918, subject: Detail as Director of Professional Division, A.E.F.


A consultant who reported directly to the Chief Consultant in Surgery on professional matters was appointed in each army corps. His title was senior divisional surgical consultant. He was responsible for the supervision and direction of all surgical activities in the infantry divisions, a responsibility, formerly, of the division surgical consultant. It was the duty of the senior divisional surgical consultant to relieve division surgeons of the necessity for supervising strictly technical work, since it was considered that division surgeons would have their hands full with other operational and administrative matters. Aiding the senior divisional surgical consultant-who, it is to be remembered, was assigned to an army corps-were divisional surgical consultants. These were assigned to the corps, usually on the basis of one per division, to supervise the immediate surgical activities of operating teams within the divisions. Toward the end of hostilities, these divisional surgical consultants were withdrawn as superfluous when the First and Second U.S. Armies were organized with their full complement of consultants.

To round out the surgical services of the AEF, there were consultants at hospital centers, specialists in base hospitals and tactical divisions, and surgical teams. Consultants at the hospital centers were named in the various specialties, as required, and were available for consultation to nearby units as well as within the hospitals of the center. While the need for them was evident early, it was not until near the end of hostilities that they could be supplied in any number. At the end of 1918, 16 hospital centers had surgical consultants. Specialists were also designated at hospitals in eight of the nine surgical specialties previously mentioned. (There were no consultants or specialists locally designated in surgical research.) Each infantry division had a specialist in orthopedic surgery and one in urology. In 1918, surgical teams were first organized from personnel of base hospitals. These teams, numbering some three hundred by the end of October 1918, were used wherever necessary, including the division areas, and were composed of one operator, an anesthesiologist, two nurses, and two orderlies.

The Chief Surgeon, AEF, subsequent to the signing of the armistice, convened a board of officers to investigate and report upon the conduct of the Medical Department, AEF, and to make recommendations with a view to the improvement of that department. This board approved fully the system of professional services which had been developed during the war. Specifically, it stated that the Director of Professional Services should be a colonel selected from that scarce category of Regular Army medical officers who knew the routine of Army administration well and, at the same time, were well informed as to the professional qualifications of large numbers of civilian practitioners so that they could be assigned to duties wherein the greatest efficiency in performance would result. The board went on to say that the Chief Consultant in Surgery should be a medical officer of the highest surgical attainments and that his surgical subdivision of professional services should be further subdivided into the nine surgical specialties heretofore mentioned. The board also recommended assignment of consultants to field armies, corps, and divisions


only during active campaigns. Assuming that the theater surgeon would also function as Surgeon, SOS (Services of Supply), for the administration of base sections, the board emphasized the need for consultants in general surgery and orthopedic surgery to supervise and direct all surgical activities throughout base sections of the Services of Supply.



The activities of the surgical consultants of ETOUSA (European Theater of Operations, U.S. Army) were coordinated by the Chief Consultant in Surgery, Col. (later Brig. Gen.) Elliott C. Cutler, MC. These surgical consultants functioned under the Division of Professional Services, Office of the Chief Surgeon, ETOUSA (chart 1).

CHART 1.-Organization of the Division of Professional Services, Office of the Chief Surgeon, ETOUSA, in 1942


The Division of Professional Services was activated on 19 June 1942 with Col. James C. Kimbrough, MC, as chief (fig. 1). The consultant organization was set up according to the Regular Army surgical service in the large Army hospitals. In such an organization, the general surgeon was chief of the surgical service and the specialist surgeons-such as those in orthopedics, ophthalmology, and neurosurgery-were chiefs of the various surgical sections. (Later, about 1945, specialties in army hospitals were given the status of a service, or department, similar to the organization in large civilian hospitals.) Since all the consultants in the European theater held high positions in university hospitals and medical schools in the United States, this subordination to a general surgeon caused some dissatisfaction. The specialist surgeons objected to the designation "senior consultant," as contrasted to the title "chief consultant." They were, however, all such patriots and of such high caliber as surgeons that this regimentation at no time interfered with their efficiency or their devotion to duty.

FIGURE 1.-Col. James C. Kimbrough, MC.

Anesthesia was represented by a senior consultant functioning under general surgery. In like manner, radiology became a part of the surgical service.

After the Professional Services Division had been established and medical officers to fill the consultant positions began to arrive in the theater, it was necessary to promulgate an official statement relating to the organization for consultation in medicine and surgery. This was done by an unaddressed document, signed by the Chief Surgeon, Col. (later Maj. Gen.) Paul R. Hawley, MC (fig. 2), and dated 18 August 1942. Titled "Organization of Professional Services E.T.O.U.S.A., Services of Supply," the pronouncement read:


FIGURE 2.-Maj. Gen. Paul R. Hawley.

In order to utilize the professional services of the consultants and the specialists of the Medical Department, E.T.O.U.S.A., in a manner that will best facilitate the coordination between the forces, from front to rear, the following instructions are issued:

1. Director of Professional Services-The Director of Professional Services, under the Chief Surgeon, E.T.O.U.S.A. will supervise the professional activities of the Medical Department, E.T.O.U.S.A., and coordinate the work of the consultants and specialists of this department.

2. Chief Consultants-The Chief Consultant, surgical service, will supervise the professional work of the surgical sub-divisions. He will organize and coordinate these sub-divisions in such manner that will permit them to function at the greatest efficiency in carrying out surgical treatment.

Chief Consultant, medical service, will supervise the medical sub-divisions. He will organize and coordinate these sub-divisions in such manner as to ensure the highest possible standard of professional endeavour.

3. Senior Consultants-Under the supervision of the Director of Professional Services and the Chief Consultants in medicine and surgery, consultants for the special sub-division of the Chief Surgeon's office will coordinate the activities relating to their respective specialties.

They will make such recommendations to the Chief Consultants as are considered necessary for the instructions of consultants and specialists in hospitals, divisions and other army formations,

4. Consultants-Under the supervision of the Senior Consultants, the Consultants for the army, corps, divisions, hospitals, base sections and other formations will supervise and coordinate the work of the specialists under their respective sub-divisions.


5. Specialists-Under the supervision of the Consultants, the specialists on duty with hospitals, divisions and other formations will organize and carry out the work of their respective specialties in the most efficient manner possible.

The surgical consultants in the European theater were eventually arranged in five groups (chart 2):

1. Consultants assigned to the Chief Surgeon's Office. This group consisted of Col. Elliott C. Cutler, MC, as chief and the surgical specialists functioning under the overall supervision of the Chief Surgeon.

2. Base section surgical consultants. These changed frequently and functioned under the direction of the base surgeons.

3. Regional consultants and coordinators in the hospital centers. These were usually the senior outstanding surgeons of one of the general hospitals of the center who performed the duties of consultant in addition to their duties as chiefs of the surgical services or sections of the hospitals to which they were assigned.

CHART 2.-Organization of the consultant system in ETOUSA, 1944


4. Army surgical consultants. Each field army had an assigned surgical consultant who functioned under the direction of the army surgeon.

5. The Army Air Forces developed a limited system of consultation as necessary within their own commands.

As the continental activities increased, appropriate continental base sections and advance sections were set up after the Chief Surgeon's headquarters was moved to continental Europe. All activities in the United Kingdom were consolidated under Headquarters, United Kingdom Base Section.


The following individuals were consultants to the Chief Surgeon:

1. Col. Elliott C. Cutler, MC, Moseley Professor of Surgery, Harvard Medical School, was chosen Chief Consultant in Surgery and reported to Headquarters, ETOUSA, on 9 August 1942.

2. Lt. Col. (later Col.) James B. Brown, MC, professor of clinical and oral surgery, Washington University, St. Louis, Mo., reported for duty as Consultant in Plastic Surgery  on 8 June 1942.

3. Colonel Brown was accompanied by Maj. (later Lt. Col.) Eugene M. Bricker, MC, from Washington University, who eventually succeeded Colonel Brown on 12 January 1943 and rendered superior service in that department.

4. Lt. Col. (later Col.) Loyal Davis, MC, professor of surgery, Northwestern University, Evanston, Ill., reported as Consultant in Neurosurgery in September 1942.

5. Lt. Col. (later Col.) Ralph M. Tovell, MC, Hartford Hospital, Hartford, Conn., arrived on 28 September 1942 and was placed in charge of anesthesia.

6. Lt. Col. (later Col.) Derrick T. Vail, MC, professor of opthalmology, University of Cincinnati, came in on 5 October 1942 to become Consultant in Opthalmology.

7. During the fall of 1942, Lt. Col. (later Col.) Rex L. Diveley, MC, of Kansas City reported to take over the role of orthopedic consultant.

8. Lt. Col. (later Col.) Norton Canfield, MC, professor of otolaryngology, Yale University School of Medicine, came in to take charge of otolaryngology in January 1943.

9. Lt. Col. (later Col.) Kenneth D. A. Allen, MC, radiologist, Presbyterian Hospital and other hospitals of Denver, reported on 9 February 1943 in charge of radiology.

10. Maj. (later Lt. Col.) William J. Stewart, MC, reported on 17 January 1943 and acted as the consultant in orthopedic surgery when Colonel Diveley was absent in North Africa and continued to assist in orthopedics until the arrival of Lt. Col. Mather Cleveland, MC.

11. Maj. (later Lt. Col.) Ambrose H. Storck, MC, Charity Hospital, New Orleans, reported on 2 March 1943 as Consultant in General Surgery.

12. Lt. Col. (later Col.) Robert M. Zollinger, MC, professor of surgery, Harvard Medical School, took over from Colonel Storck on 1 July 1944.


13. Maj. (later Lt. Col.) John E. Scarff, MC, assistant professor of neurosurgery, Columbia University, succeeded Colonel Davis on 10 September 1943.

14. Col. Roy A. Stout, DC, was placed in charge of maxillofacial surgery on 8 November 1943.

15. Capt. (later Maj.) Charles D. Rancourt, MC, was designated Assistant Consultant in Radiology, on 14 June 1943.

16. Lt. Col. (later Col.) Mather Cleveland, MC, assistant professor of anatomy and instructor of orthopedic surgery, College of Physicians and Surgeons, Columbia University, was placed in charge of orthopedic surgery after Colonel Diveley became chief of the separate Rehabilitation Division on 3 January 1944.

17. Lt. Col. (later Col.) R. Glen Spurling, MC, clinical professor of surgery (neurosurgery), University of Louisville School of Medicine, became Consultant in Neurosurgery on 15 March 1944.

18. Maj. (later Lt. Col.) John N. Robinson, MC, Columbia University, was designated Consultant in Urology in the spring of 1943.

19. Lt. Col. (later Col.) Paul C. Morton, MC, was designated surgical consultant for the United Kingdom Base Section on 10 September 1944.

20. Lt. Col. James N. Greear, Jr., MC, came in as Consultant in Ophthalmology, succeeding Colonel Vail in March 1945.

In considering the great achievements of this group of eminent surgeons, it is believed that never before has an army at any time had available such expert advice in caring for and treating every type of casualty (fig. 3).

Base section and regional consultants.-The base section and regional consultants changed so many times that it is impracticable to attempt to list them by name. They all rendered superior service.

Surgical consultants to the field armies - Each field army had a surgical consultant whose duty it was to supervise the treatment and transportation of patients from aid stations through the evacuation hospitals. They had technical control of the auxiliary surgical groups assigned to the army and in general were advisers to the army surgeons concerning the treatment and transportation of surgical casualties.

Col. J. Augustus Crisler, Jr., MC, was consultant surgeon for the First U.S. Army; Lt. Col. Thomas B. Jones, MC, and later Col. Charles B. Odom, MC, for the Third U.S. Army; Col. Frank B. Berry, MC, for the Seventh U.S. Army; Col. Gordon K. Smith, MC, for the Ninth U.S. Army; and Col. William F. MacFee, MC, for the Fifteenth U.S. Army.

The great responsibility of the surgical consultants can best be appreciated when it is realized that approximately 80 percent of the battle casualties in the European theater required surgical management. The excellent results obtained are everlasting testimony to the outstanding ability of these surgeons who supervised and directed the transportation and treatment of the wounded. The great personal and professional sacrifices made by this group in voluntarily leaving their families and professional activities is outstanding evidence of their great patriotism and their intense desire to serve their country.


FIGURE 3.-Consultant group at Cheltenham, England, mid-1944, before the move of the Office of the Chief Surgeon, ETOUSA, to the Continent. First row, left to right, Lt. Col. Ralph M. Tovell, MC, Col. Donald M. Pillsbury, MC, Col. Derrick T. Vail, MC, Col. Roy A. Stout, DC, Col. James C. Kimbrough, MC, Col. Elliott C. Cutler, MC, Col. Lloyd J. Thompson, MC, Col. Thomas H. Lanman, MC, and Lt. Col. Mather Cleveland, MC. Second row, left to right, Lt. Col. Gordon E. Hein, MC, Lt. Col. Kenneth D. A. Allen, MC, Lt. Col. Norton Canfield, MC, Capt. Marion C. Loizeaux, MC, Capt. Wayne H. Jonson, MAC, Lt. Col. Eugene M. Bricker, MC, Maj. John N. Robinson, MC, Lt. Col. Robert M. Zollinger, MC, and Lt. Col. R. Glen Spurling, MC.


Policies for the operation of the Professional Services Division were established early and set the pattern for the many activities in which the various surgical consultants later became engaged (fig. 4).3 These policies were stated as follows:

1. Supervision of Professional Services:

a. It is the policy of this division to implement plans whereby the personnel of the American forces shall receive promptly the highest standard of medical and surgical care.

b. The Consultants' Section will ascertain as often as necessary the condition of all patients reported seriously ill in U.S. Army hospitals.

c. The condition of all patients admitted to British hospitals will be verified as often as necessary.

d. In order to maintain adequate bed capacity for the sick and wounded, only the complicated venereal diseases and those intolerant to the usual therapy will be hospitalized

3Letter, Director, Professional Services (Col. James C. Kimbrough, MC) to Chief Surgeon, SOS, ETOUSA, 9 Dec. 1942, subject: Policies for the Operation of the Division of Professional Services.


FIGURE 4.-Weekly meetings of the consultant group were initiated early in the European theater to discuss and solve problems and to establish policy. Left to right, Lieutenant Colonel Tovell, Colonel Cutler, Colonel Kimbrough, Lt. Col. James B. Brown, MC, Lt. Col. William S. Middleton, MC, and Lieutenant Colonel Thompson, Cheltenham, England, 6 January 1943.

in station and general hospitals. Uncomplicated venereal disease will be treated at the local infirmaries.

e. In order to maintain and stimulate professional morale and disseminate recent medical information, it is considered advisable that medical meetings be held regularly at general hospitals and station hospitals. The type and frequency of these meetings will depend on local conditions at each hospital and the general condition of the activities of the armed forces.

f. It is desired that Commanding Officers of general and station hospitals prepare plans for the management of casualties in large numbers, possibly in train load lots.

g. It is hoped that the Commanding Officers and Chiefs of Professional Services in all medical installations in the European Theater of Operations will stimulate and encourage among the officers in their commands the compilation of medical data for publication whenever such data would seem to be of interest to members of professional medicine either here or at home.

h. Each general hospital will maintain a blood bank.

i. United States Army Medical Officers will be encouraged to register with the British Medical Council and to become members of the Royal Society of Medicine.

2. Co-ordination of Consultants

a. The Consultants in Medicine and Surgery will make written reports daily of their activities to Director of Professional Services through the Chief Consultants in Medicine and Surgery. These reports will be consolidated by the Chief Consultants and Director of Professional Services for transmission to the Chief Surgeon.

b. Request for consultation service for medical units in the SOS, ETO, will be made to the Division of Professional Services, Chief Surgeon's Office. The manner and time of transmitting these requests will be determined by the merits in each individual case. At night the request for such service may be made to the Consultant concerned at his billet.


It is the policy of this division to have consultation service immediately available at all times.

c. Arrangements have been made with the British authorities whereby the consultants are made available to American personnel in the hospitals of the British Naval, Army and Air Forces and the Emergency Medical Service hospitals, and the Canadian Military hospitals.

3. Liaison with British Research and Development in Professional Services

a. The appropriate personnel of the Division of Professional Services will be authorized to attend the meetings of the British Medical Research Council and other medical conferences pertaining to their respective specialty.

b. The attendance of meetings and conferences and professional contact with British personnel and institutions with a view to promoting general good will and obtaining professional knowledge is encouraged.

4. Physical Standards

a. In reviewing the physical examination of applicants for commission, promotion, re-classification, etc., the standards provided in Army Regulations governing each type of case will be maintained.

5. Professional Training

a. Arrangements will be encouraged whereby United States Medical Officers may be assigned to British hospitals for the observation of their activities for periods of one to two weeks. Allotment of United States Medical Officers to British service and civilian medical courses has been arranged.

b. Courses of instruction for the medical department personnel of base section, divisions, station and general hospitals will be carried out.

Duties and Functions

To implement the policies mentioned, the Director of Professional Services circulated the following statement of the duties of consultants for the information and guidance of all concerned and as a directive to the consultants themselves:

1. The consulting staff of the Chief Surgeon's Office will function under the direction of the Division of Professional Services and are the responsible advisers to the Chief Surgeon on all professional and technical matters pertaining to their particular branch of medicine.

2. They will submit their reports and recommendations, thru the Director of Professional Services to the Chief Surgeon.

3. They will be available to visit Medical Department Units for the purpose of giving their opinion and assistance with regard to technical and professional matters.

4. They will advise on the selections and assignment of junior consultants and specialists and will report from time to time on the standard of professional efficiency maintained by such officers.

5. They will be instrumental, in collaboration with the Operations Division, Chief Surgeon's Office, in arranging Courses of Instruction, Medical Meeting, and Training Schools, and will keep the officers of the Medical Department in touch with the latest developments in medical science.

6. They will initiate and carry out research and investigations with a view to conserving manpower in the field and restoring to health the sick and wounded.

7. They will maintain liaison with consultants and specialists in all branches of medicine of the British armed forces and civilian practice.

8. They will advise as to the suitability of drugs, instruments, equipment, and accommodations and on other matters pertaining to the health of the Armed Forces.


Specifically for the Chief Consultant in Surgery, the Director of Professional Services dictated the following duties:

1. He will advise the Chief Surgeon thru the Director of Professional Services on questions of surgical policy.

2. He will advise on the selection and allocation of surgical equipment.

3. He will advise, in collaboration with the Chief Consultant in Medicine, on the selection of drugs for use in the ETOUSA.

4. He will advise the Chief Surgeon regarding the selection and duties of surgical consultants and specialists.

5. He will visit Medical Department Units and correlate the military surgical procedure as a whole.

6. He will establish liaison with the surgical service of the Medical Department of other U.S. Forces and with the medical service of the British Forces both civilian and military.

Significant Activities

It was the chief concern of the surgical consultants to initiate and implement the policies of surgical treatment for the theater. This duty involved the methods of transportation of the wounded and the selection and allocation of surgical equipment.

Contact was maintained with the hospitals in England, and the surgical procedures and end results of treatment were supervised. After landing on the Continent, they followed the armies in the field and supervised the treatment and methods of evacuation. On several occasions, they made visits to the Zone of Interior in order to ascertain the condition in which the wounded reached the Zone of Interior hospitals.

Upon arrival in the theater, each medical unit was visited, the qualifications of the personnel were verified by the appropriate consultant, and recommendations were made to effect the most efficient assignments.

Special treatment facilities were set up in hospitals under the supervision of the appropriate consultant for patients requiring highly specialized treatment such as those with cold injury and burns and those requiring neurosurgical, urological, and plastic procedures. These special hospitals were usually located in the hospital centers.

During the summer of the Normandy invasion, it was realized that the supply of blood for transfusion which was obtainable in the European theater would be inadequate and that supplies from the Zone of Interior would be necessary. Colonel Cutler, Colonel MacFee, and Maj. (later Lt. Col.) Robert C. Hardin, MC, returned to Washington to inform The Surgeon General of the urgent need for whole blood from the United States. The plan for procurement, preservation and transportation of this blood from the Zone of Interior to the European theater was implemented by the Office of The Surgeon General under the supervision of Lt. Col. (later Col.) Douglas B. Kendrick, Jr., MC. The actual transportation of blood early became a function of the supply service. At no time was there an overall shortage in the supply of whole blood for the American wounded.



In June 1942, at the time of arrival of the U.S. Army in the United Kingdom, the rehabilitation facility had become a well-established institution of the British Army Medical Service. These rehabilitation hospitals were visited and the organization was reviewed by Colonel Cutler and Colonel Diveley. Under the supervision of Colonel Diveley, a rehabilitation "camp" was set up at Bromsgrove, England, on 1 April 1943. In the beginning, an 8 weeks' course of training was carried out, designed to prepare the recently recovered wounded for the hardships of field duty. The activities increased so rapidly that it was necessary to move the "camp" to more extensive quarters at Stoneleigh, which had a capacity of 300 (fig. 5). Rehabilitation activities were released from the Professional Services Division and established in a separate division-the Rehabilitation Division-on 3 January 1944 under the direction of Colonel Diveley, who was replaced by Colonel Cleveland as Consultant in Orthopedic Surgery.

Colonel Diveley visited the Zone of Interior to advise The Surgeon General on the establishment of rehabilitation facilities in the Zone of Interior. These facilities were the forerunners of the convalescent hospitals in the United States.

Miscellaneous Activities

In order to insure a uniformity in the management of the wounded, the European Theater Manual of Therapy was prepared by the consultants of the Chief Surgeon's Office. The manual was published before D-day (6 June 1944) and made available to all medical officers of the theater. The value of this booklet justified the great amount of labor expended in its preparation and publication.

The Medical Department supply tables of surgical instruments and drugs were reviewed with a view to eliminating unnecessary items. The equipment obtained from the British was cataloged to correspond to the item numbers of the U.S. Army supply tables. This work was carried out by the consultants in cooperation with the medical supply service.

It was noted early that the Zone of Interior clinical record for patients was too extensive for use in the European theater. A special clinical record was prepared. This record was of such size that it could be carried in the field medical record envelope so that, on return to the Zone of Interior, the entire history and record of treatment were in a single cover.

The European Theater School of Medicine and Surgery and the Medical Field Service School at Shrivenham were contributed to in great measure by the surgical consultants who served as supervisors and instructors in these schools.

The auxiliary surgical groups were under the control of the Operations Service of the Chief Surgeon's Office and were allotted to field armies where their activities were administered by the army surgical consultants. Teams


FIGURE 5.-Convalescent patients at 307th Station Hospital, Stoneleigh Park, Warwickshire, England, negotiate a Jacob's ladder on the obstacle course.

from the auxiliary surgical groups functioned at the evacuation hospitals or field hospitals of a field army.

A mobile field surgical unit was implemented by Colonel Zollinger at the 5th General Hospital. This unit was completed in November 1943 and delivered to the 3d Auxiliary Surgical Group. The plan eventually evolved into the mobile army surgical hospital later adopted by the Army. The unit was complete with equipment, tentage, beds, and the like, to care for emergency surgical cases at the frontline level.

Colonel Allen, Senior Consultant in Radiology, assembled a mobile field X-ray unit which was delivered to the 3d Auxiliary Surgical Group of the First U.S. Army in November 1943.

A simple field blood transfusion unit was created by Maj. (later Lt. Col.) Charles P. Emerson, Jr., MC, and Maj. (later Lt. Col.) Richard V. Ebert, MC, of the 5th General Hospital.

Liaison with the British medical service - In 1942, the surgical consultants had arranged with the medical services of the British Army and Royal Air Force for the attendance of U.S. Army medical officers at the following schools and courses: Antigas school at Aldershot; London School of Hygiene and Tropical Medicine; Army School of Hygiene; gas school, Leeds University; blood transfusion school, Southmead Hospital, Bristol; and neurosurgical train-


ing at Oxford. These courses were arranged by the surgical consultants in their individual fields.

Liaison with the Russian medical service - In order to obtain information regarding the medical service of the Soviet Army and to promote amicable diplomatic relations with the U.S.S.R., a commission of prominent surgeons from the Allied armies was selected to visit Russia. The United States was represented by Colonel Cutler and Colonel Davis.

Major Robinson, Consultant in Urology, visited the Zone of Interior in November and December 1944 for the purpose of presenting information to the Office of The Surgeon General regarding the management of wounds of the urogenital tract.

Medical Society, ETOUSA - Early in the medical activities of the European theater, the Medical Society, ETOUSA, was organized. Meetings were held at general hospitals until the dispersion of the facilities made such meetings impractical, at which time the meetings were conducted under the direction of the base surgeons. The surgical consultants contributed materially to the programs of this society.

Operational research - In May 1944, the Operational Research Section of the Professional Services Division was established at Cambridge Military Cemetery. With the cooperation of quartermaster graves registration personnel, facilities were established for studying the killed-in-action with a view to determining the types of wounds causing deaths, the missiles producing fatal wounds, and the circumstances under which death occurred. This operation was supervised by the surgical consultants who assembled a great deal of valuable information.

D-day activities on 6 June 1944 - During the early part of the continental liberation the members of the consultant group were present at the reception points on the beaches in England and at the transit hospitals supervising the care of the wounded transported back from Normandy. As a result of this observation, Circular Letter 101, Office of the Chief Surgeon, ETOUSA, concerning care of battle casualties was published on 30 July 1944.

Liaison with the French - On arrival of the Office of the Chief Surgeon in Paris, the surgical consultants were welcomed to the French National Academy of Surgery and the Val de Grāce Military Hospital (French).


It is not practicable to mention even a few of the numerous outstanding contributions rendered by individual consultants. All surgical consultants were on duty constantly, giving the American soldier the best surgical care that has ever been recorded in the history of warfare (fig. 6).


FIGURE 6.-Officers, enlisted men and women, and British civilian employees of the Professional Services Division, Office of the Chief  Surgeon, ETOUSA, after V-E Day, Versailles, 1945.