U.S. Army Medical Department, Office of Medical History
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During World War II, the U.S. Army Medical Department reached a personnel strength which it had never before attained. Its peak strength of 700,000 was three times that of the entire Regular Army in 1939 and four times that of the combined Union and Confederate Forces at the Battle of Gettysburg.

In contrast to personnel procurement in most other arms and services, the entire officer corps of the Medical Department, exclusive of the Medical Administrative Corps, had to be procured directly from qualified civilian professional groups. It could not be obtained through officer candidate schools. Furthermore, the personnel required were in a critical category, and the need for them was immediate and urgent.

This volume of the history of the U.S. Army Medical Department in World War II is the story of how the enormous personnel expansion was achieved; of how qualified medical personnel were secured; of how the wartime military medical establishment was utilized and the highest standards of professional medical care were maintained; and, finally, of how the wartime Medical Department was contracted to a peacetime level.

The magnitude of the medical achievement in World War II should not be permitted to obscure the difficulties that attended it. They were numerous and fundamental.

Although the health of the Army rested with The Surgeon General throughout the war, he was very early placed in an anomalous situation, which violated all the principles of sound command, in that he had responsibility without complete authority. He lost overall control of procurement, classification, promotion, and assignment of personnel, and it was well after V-E Day before he was able to implement many plans that he made for the utilization of the entire medical force. His difficulties were compounded early in 1942, at the highest level of the War Department, when a reorganization of the Army interposed the Headquarters Army Service Forces between The Surgeon General and the General Staff and gave the medical component of the Army Air Forces, along with its other components, more independence than it had previously possessed.

Emergencies had to be met, and obstacles and obstructions had to be eliminated, as they were encountered. It was almost impossible to prevent them. Square and round holes both had to be plugged, though those making the assignments and those being assigned frequently did not see eye to eye in the matching process. Tensions were strong. Many newly commissioned medical officers found it difficult to adapt to military life, while certain medical personnel in the Regular Army sometimes seemed reluctant to modify, much

less discard, its time-honored traditions, policies and operations and adjust to the larger organization and procedures required by global war.

By the middle of 1943, when Maj. Gen. James C. Magee was succeeded as The Surgeon General by Maj. Gen. Norman T. Kirk, personnel policies for the remainder of the war had been established for the most part. Many of the problems, however, which had existed up to this time persisted almost to the end of the war.

1. The most important of these problems was the procurement of sufficient medical personnel for all purposes, though how many persons were needed in a given situation depended to a considerable extent upon how those available were used. A reported shortage might mean a genuine lack of sufficient personnel to carry out an assigned mission. All too often, however, the so-called shortage had no reference to real need and was no more than the numerical difference between actual and authorized strength. Rank, promotion, pay, and morale were also part of the general picture.

The absence of an aggressive procurement policy on the part of the Medical Department probably accounts, at least to some extent, for the shortages experienced early in 1942. Shortages became particularly acute a year later, when Medical Officer Recruiting Boards were abolished by the Army Service Forces. Thereafter, medical officers had to be recruited chiefly from graduates of medical schools as they completed shortened internships.

Procurement of medical officers from recent graduates was accomplished, and on the whole satisfactorily, by issuing to undergraduates temporary commissions in the Medical Administrative Corps, and, later, by the Army Specialized Training Program. On the other hand, as will be pointed out shortly, the need for securing initially sufficient numbers of physicians from the civilian profession, from which most newly commissioned medical officers had to be secured, was less acceptably dealt with, not only from the point of view of the Army Medical Department but also, perhaps, from that of the national interest.

2. A second major problem was the correct utilization of available personnel. Medical officers were used with increasing efficiency as the war progressed, but large increments continued to be necessary, both during the war and immediately afterward, when replacements for those who were being separated from military service were the principal need.

To utilize personnel correctly, it was essential on many occasions that an individual be transferred promptly from one assignment to another as the need for his services changed. Under the happiest circumstances, this was frequently-particularly in the Zone of Interior-a somewhat cumbersome process. Under the circumstances that prevailed in World War II, it was further complicated by division of authority over reassignments, with the result that transfers were often delayed and sometimes were not accomplished at all.

Part of the difficulty has already been mentioned, the lack of authority by The Surgeon General to control disposition of medical personnel plus the interposition of the Army Service Forces Headquarters between him and the Gen-

eral Staff and his unfortunate subordination to the former. Shortly after this reorganization had occurred, his authority was further reduced when the commander of each corps area became virtually the final authority on transfer of personnel within his jurisdiction, while at the same time this commander gained an important voice in transfers between his own area and other corps areas. It was not until almost the end of the war that this trend was partly reversed and The Surgeon General secured greater control over the reassignment of Medical Department personnel within the Zone of Interior.

When mobilization began in 1940, the classification of civilian occupations was still sketchy, and military occupational specialties had not yet been devised. It is only fair to say that, in spite of its inflexibility in certain respects, the Medical Department early recognized the need for improved classification of medical personnel and developed this method more thoroughly than any other branch of service. As the classification processes improved, genuine shortages were reduced or eliminated by employment of available personnel to the best possible advantage. By the end of the war, the great majority of medical officers were properly classified and were assigned where it was believed that they would be most useful, even if, in some instances, the assignment was not always in conformity with the officer's precise classification.

There were a number of ways in which medical personnel in short supply were used with great efficiency. An outstanding example was the establishment of centers for specialized treatment and the use of specialist personnel in them. Another was the replacement, whenever possible, of scarcer categories of personnel with those more easily obtained. The use of Medical Administrative Corps officers instead of Medical Corps officers in many types of administrative work was an illustration. The substitution was frankly repugnant to many officers steeped in the traditions of the prewar Medical Department, and some urging was necessary before the potentialities of this plan were fully investigated and implemented. Before the war ended, however, the 7,500 Medical Administrative Corps officers envisaged by The Surgeon General in April 1942 had grown to 20,000. Another similar, and similarly fruitful, policy was the substitution of members of the Women's Army Corps for able-bodied enlisted men in the performance of many specialized duties.

3. Even after the Medical Department adopted a strengthened procurement policy in 1942, procurement difficulties continued, chiefly because other branches of the military were involved and more comprehensive action was required than this Department could provide alone. No single agency existed for this purpose, or, at least, none that could reconcile the conflicting demands of the Army, the Navy, and other Federal services with those of the civilian community; that could determine how many physicians each of these groups should have; and that could then see that each of them received its proper share of physicians through the exercise, if necessary of compulsion on individuals.

The closest approach to such an agency was the Procurement and Assignment Service, which could, and did, fix the minimum physician-civilian popu-

lation ratio that must be maintained in any given area. This Service, however, operated under decided limitations. For one thing, it could neither compel physicians who were in excess of minimum requirements in any area to serve the Government nor could it determine how physicians recruited for military and other public service were to be divided among claimant agencies. About the only power the Service exerted over these agencies was to prevent them, in the course of their recruiting efforts, from encroaching upon the minimum physician-population ratios which it had established. Within that limit, it was of considerable assistance in obtaining volunteers.

The Procurement and Assignment Service was further handicapped by the fact that it could not compel civilian practitioners to move from areas of lesser need to those of greater need. All that it could do in this respect was to use persuasion, and persuasion was, in many instances, much less than what the situation called for. The Surgeon General contended, and correctly, that the real source of complaints about inadequate civilian medical care was not the inroads of the Armed Forces upon the professional supply but the concentration of physicians in some parts of the country far above the minimum established by the Procurement and Assignment Service and the inability of that Service to distribute them equitably.

On the other hand, while the Procurement and Assignment Service saw to it, within the limitations just mentioned, that medical service was in adequate supply for civilian communities, many were of the opinion that its assistance to the military left much to be desired. Attempts of the Armed Forces to obtain a draft of physicians under special rules came to nothing, chiefly because of the opposition of this Service, whose successful resistance to this policy demonstrated that such powers of compulsion as it possessed were chiefly directed against the military. It proved able not only to prevent the armed services from recruiting physicians on a voluntary basis beyond the limits it had established but also proved able to enjoin them from drafting physicians even within these limits.

In short, the Selective Service System was the only agency with power to compel physicians to enter the Armed Forces, and its authority was limited to persons within the general draft age, which meant that it could not affect a very large number of the physicians in the United States. The effectiveness of the Selective Service System was further limited by the hesitancy of local draft boards in drafting physicians, even within the specified age group.

Procurement difficulties continued into the postwar period. When the war ended, large numbers of casualties were in Army hospitals in the Zone of Interior, as well as overseas, many of them still to receive definitive treatment and many of them requiring specialized care. Yet this was the very time that tremendous pressure was brought upon The Surgeon General for the early, and sometimes the immediate, release of physicians, not only by civilian groups and communities, but also by members of the U.S. Congress.

It would be unfair to end this foreword on such a note. It is true that conflicts and misunderstandings were numerous and that they persisted

throughout the war, but it is equally true that working cooperation and the desire to get on with the job generally prevailed on local levels. It was an enormous task to assemble the Medical Corps and allied medical services; to utilize them to the best purposes during the war; to accomplish this task with as little disruption of civilian medical service as possible; and then to return these personnel to civilian life. The task was, nonetheless, carried out competently and sometimes brilliantly, and the U.S. Army received from its Medical Department the best medical service an army at war had ever known.

No history of the personnel, including civilian employees, of the U.S. Army Medical Department in World War II would be complete without testimony to their skill, loyalty and devotion, both as a group and as individuals. Officers and enlisted personnel, those who were in the Regular Army and those who entered service from civilian life, gave of themselves unstintingly throughout the entire war. They shared the dangers of combat. Many of them were wounded. Some of them lost their lives. To each of those who served, the U.S. Army Medical Department, the U.S. Army, and the Nation will be forever indebted.

Lieutenant General, 
The Surgeon General.