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    This volume, one of the total series that tells the story of the U.S. Army Medical Department in World War II, is the first of two books devoted to the activities of the surgical consultants. It deals with their work in the Office of The Surgeon General; the extension of the system to the Service Commands in the Zone of Interior; and its operation in the U.S. field armies overseas. The second volume, which will appear shortly, deals with activities of the surgical consultants on the theater level in Europe and in the Asiatic-Pacific theaters of war.

    Although a skeleton consultant system had operated in the Medical Department in World War I, there was no formal provision for such a system before the outbreak of World War II, and that lack was to plague the consultants throughout the war. It also plagued the command surgeons under whom the consultants worked. Position vacancies were not always available. Lines of authority were not always clear. Questions of rank were often embarrassing. Perhaps most trying of all, consultants overseas were hampered in their activities by the inconvenience and actual inefficiency caused by absence of direct channels of communication between themselves and the consultants in the Office of The Surgeon General. The great convenience of such unofficial channels as were developed made the general deficiency even clearer. In the Zone of Interior, this difficulty did not long exist. Within a very short time, there was close liaison between the consultants in the Office of The Surgeon General and those in the various Service Commands, and standardization of medical care--a wartime necessity--was accomplished more readily, and medical care was more efficient, as a result.

    The Professional Services Division that had existed before the war in the Office of The Surgeon General can perhaps be regarded as the predecessor of the World War II consultant system, but its scope was limited and its functions were chiefly administrative. Among its seven subdivisions was the Subdivision of Medicine and Surgery, a combination of specialties so obviously impractical that it made further subdivision inevitable. The appointment of the late Col. (later Brig. Gen.) Fred W. Rankin, MC, as Chief Surgical Consultant to The Surgeon General on 1 March 1942 was shortly afterward followed by the establishment of a separate Surgery Branch, with subdivisions of its own. After other reorganizations, this branch became the Surgical Consultants Division, which operated under, and reported directly to, The Surgeon General.

    When Colonel Rankin reported for duty, he found no definition of the functions of a surgical consultant, a deficiency that did not long handicap a person of his dedication and tremendous energy. Nonetheless, many obstacles had to be overcome in setting up necessary positions and otherwise putting the consultant system into operation.

    The tacit understanding early in the war was that the consultants were to confine themselves to clinical problems. The understanding was soon abrogated. Before the war ended, the consultants everywhere had extended their activities, with the full approval of those in authority, to a variety of administrative considerations, of which the assignment of professional personnel on the basis of evaluation of their experience and ability was probably the most important.

    Early in the war, the assignment of newly commissioned medical officers by the Office of The Surgeon General and other responsible headquarters was necessarily somewhat arbitrary. Those responsible for this function usually had only paper qualifications to work with, and paper qualifications, even when there is every attempt to make the presentation honest and objective, can never tell the full truth. The consultants, handpicked themselves, in turn hand picked key personnel in their areas of jurisdiction. Fresh from peacetime practice, they personally knew the capacities of many of the physicians who were entering military service, and when they did not know the new officers personally, they had ways of finding out about their abilities.

    The consultants in the Office of The Surgeon General recommended the appointment of the consultants for Service Commands in the Zone of Interior and for oversea theaters and field armies; for the surgical staffs of hospitals; and for the newly organized auxiliary surgical groups, whose important role in forward surgery they correctly predicted. How well the consultants performed this Particular mission is evident in the analysis made in 1945, by General Rankin, of the assignment of 922 surgical specialists. Exclusive of the 37 who were serving as consultants in the Office of The Surgeon General or in the Service Commands and elsewhere, 96 percent were engaged in practicing their own specialties and were considered to be correctly assigned.

    Among the other functions performed by the surgical consultants in the Office of The Surgeon General in the initiation and extension of the consultant system were the following:

    They revised the equipment lists, eliminating outmoded instruments and apparatus, providing new items, and equalizing distribution.

    They pressed for the establishment of specialized surgical centers and implemented the concept. These centers utilized most efficiently the always limited number of surgical specialists; utilized equipment with equal economy: and constantly improved the treatment of casualties by concentrating those with the same kinds of injuries in the same hospitals and thus providing continued, concentrated experience for the surgeons who treated them.

    The consultants in the Office of The Surgeon General set up central supply services in hospitals. They supervised programs of medical education. They saw to it that libraries were provided with books and journals. They made regular hospital staff conferences mandatory. They organized meetings on general and special problems. They prepared circular letters. They commented on the ETMD's (Essential Technical Medical Data reports) from the theaters of combat, thus providing at least a tenuous link of communication between themselves and the consultants overseas. They tried, unsuccessfully, to set up a similar series of reports in time Zone of Interior.

    The Surgical Consultants Division, Office of The Surgeon General, planned various clinical studies, including those on penicillin and streptomycin. It analyzed special problems such as hernia, varicose veins, and pilonidal sinuses. The consultants in surgery in the First Service Command collected and analyzed 594 operations for pilonidal sinus; within a very short time, as a result, the management of this condition was completely altered.

    The work of the surgical consultants in the Service Commands, the oversea theaters, and the field armies followed the same patterns of endeavor as those just described, adapted, as necessary, to the special conditions which each consultant had to meet. Their activities in these armies were of major importance. It was in the forward areas that initial wound surgery was performed and, very frequently, determined the end result of an injury in terms of survival, morbidity, or permanent deformity versus complete restoration to normal. The chapters in this volume dealing with the work of Army consultants deserve the most careful reading.

    This volume tells, in summary, the dramatic story of the blood program in World War II. (It is told in detail in another volume in this series.) This story is a frank and forthright, narrative, which makes clear that very few can escape the blame for unthinking acceptance of the original misleading concept that plasma is a satisfactory substitute for whole blood. This volume also tells other stories: The story of the aural rehabilitation program and of the program for the rehabilitation of blinded casualties (both told in detail in another volume in this series); the story of the development of prosthetic devices for amputees and of the rehabilitation of these men and, finally, the story of the preparation for chemical warfare, which, mercifully, never came to pass.

    This book describes frankly and realistically the difficulties encountered, and the obstacles that had to be overcome, by the surgical consultants in all areas as they set about their tasks. Some of their troubles arose, it must be granted, because of their own inexperience in military matters. But more of them stemmed from an initial failure to appreciate the potentials and implications of this new system. Most of the consultants, from their own Peacetime clinical experience, correctly envisaged their own functions, and, because they were imaginative, resourceful, and willing, they were soon able to translate peacetime concepts to wartime actualities. They sometimes had to school themselves, at least at first, to working in headquarters and organizations that were at best indifferent and that sometimes were frankly hostile. It is a tribute to the tact of the consultants as well as to their competence that the original opposition to them promptly disappeared and that the consultant system spread from a few commands in the Zone of Interior to oversea theaters and to field armies. It is an even greater tribute to their work that in the areas in which the consultant system did not operate the desire for it was repeatedly expressed.

    The consultants performed many functions, but they never lost sight of the fact that their first duty was the provision of good medical care for wounded casualties. The importance of this mission requires no elaboration. Its success is best estimated in terms of lives saved and in the decreased mortality and generally normal status of those who survived their injuries--their often incredibly severe injuries.

    I am impressed, as I have been in all previous volumes of this historical series, by the amount of factual material in this volume; by the frankness with which the story is told; and by the interest, which it holds for readers, even readers who, of necessity, already know a great deal about it. The consultant system was wonderfully successful, and we have reason to be thankful that it is now an integral part of medical care in the Regular peacetime Army and an important component of the professional training program of the Army Medical Service.

    As the editor of this volume has stressed in his preface, there could not have been a more felicitous choice for the post of Chief Surgical Consultant to The Surgeon General than the late Brig. Gen. Fred W. Rankin. He came to his military duties with a fine background of personal surgical competence and experience and with the deep respect of his confreres. Widely informed on the personnel to be assigned, he insisted that they be placed on the basis of their ability and experience. He recognized the major problems of surgical care without ever becoming lost in their trivia. He slashed through administrative complications. His standards were undeviating. When his personal convictions were at stake, he was completely undeterred by rank. The remarkable success of the surgical consultant system stemmed in large measure from his own personal performance in the Office of The Surgeon General.

    The contributors to this volume deserve thanks for taking on the task. As its editor points out, they were willing to undertake it because they realized that the consultant system was responsible to a major degree for the surgical advances in the care of wounded casualties in World War II and therefore must be recorded for practical clinical reasons as well as for historical reasons.

    I express my gratitude to the consultants who wrote this story and who helped to accomplish the achievements related in this volume and in the volume to follow; to the editors, particularly the special editor for these two volumes, the former Col. B. Noland Carter, MC; and to my associates who are helping me to carry out one of the truly important missions of my own office, the preparation and publication of this history of the U.S. Army Medical Department in World War II.

    Lieutenant General,
    The Surgeon General.