The Medical Department Of The United States Army in The World War
CHAPTER II
REPRESENTATION OF THE MEDICAL DEPARTMENT ON THE GENERAL STAFF, A. E. F.
Before the organization of the American Expeditionary Forces littleattention had been given to the subject of Medical Department representationon the general staff, but as early as July, 1917, it became apparent thatsuch representation was essential for coordinated action.1 Amemorandum was formulated on this subject at this time but no action resulted.1In February, 1918, in conformity with a request of the commander in chieffor frank discussion, another memorandum was prepared, again inviting attentionto the necessity for Medical Department representation on the general staffand stating the reasons for this.1 But until February 16, 1918,when General Orders, No. 31, general headquarters, A. E. F., was published, representatives of the chief surgeon's office continued to take upwith the section of the general staff concerned, all Medical Departmentmatters which required their coordination or execution.1
When the American Expeditionary Forces were reorganized, as describedin Chapter I, the chiefs of the 10 technical staff services (includingthe Medical Department) which were transferred from headquarters, A. E.F., at Chaumont, to that of the Services of Supply at Tours, were authorizedin their discretion to designate officers of their respective servicesto represent them with each general staff section at general headquarters.2In conformity with this plan the chief surgeon, on February 22, 1918, recommendedthat certain officers of the Medical Department remain at general headquartersto represent him with the several sections of the general staff.3As his immediate representative he designated a medical officer who wasalso the liaison officer with the central bureau of the Franco-Americansection and with the French mission at general headquarters. The officeforce left to assist this officer consisted of two officers of the SanitaryCorps and eight clerks.3 The medical officers who were assignedas assistants to the chief surgeon's representative were attached to theseveral sections of the general staff as follows: One to G-1, 1 (who wasalso attending surgeon at general headquarters) to G-2, 1 to both G-3 andG-5, and 2 to G-4.3 The chief surgeon stated that when moremedical officers were available one would be attached to G-3 and anotherto G-5 instead of having one officer attached to both these sections, butthis plan was never realized.3 By May, 1918, representationwith the second section of the general staff was found to be unnecessaryand was discontinued.4
There was also assigned to duty with the chief surgeon's representativeat Chaumont, an officer who was designated director of professional services.4He was not attached to any section of the general staff, but was stationedat Chaumont largely to lend him the facilities needed in administeringhis important activities.4
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Technically the medical officers who were assigned to duty with theseveral sections of the general staff at general headquarters were assistantsto the chiefs of those sections, but from another point of view they were,as stated above, assistants to the chief surgeon's representative there.1
On March 15, 1918, the chief surgeon endeavored to have created a MedicalDepartment section of the general staff. His letter on the subject is asfollows:5
Recently there has been a considerable readjustment inthe organization of these headquarters. It is stated in General Orders,31, c. s., that the organization there prescribed had been arrived at aftera careful study of both the French and British Armies. The American ExpeditionaryForces organization recently adopted resembles very closely the Frenchorganization which has been in existence for some time.
It is pertinent to review briefly a few of the more importantsteps in the development of the French organization since the beginningof the war especially in reference to its sanitary service. It was earlyfound necessary to provide for Medical Department representation in theGovernment, and this was done by creating the office of sous secrétaired'etat du service de santé. Gradually it was learned by bitter experiencethat in order to insure coordination of effort and the prevention of unnecessarysacrifice of life actual medical department participation in the plansfor combat activities was necessary; that is, representation on the generalstaff. Consequently, several medical officers were assigned to the generalstaff of the G. Q. G. and one to the general staff of each army.
While better coordination was secured the results werenot entirely satisfactory. Since the Champagne offensive of April, 1917,which was accompanied with a terrible death toll and very great unnecessarysuffering there has been a growing feeling that steps should be taken toprevent the recurrence of a similar catastrophe. It was well recognizedthat a repetition of this unfortunate occurrence might well have aprofoundand possible disastrous effect on the morale of a people already exhaustedand harassed by the unavoidable hardships of a long war.
During the past three and one-half years many changesin organization have been found necessary, changes which viewed in thelight of pre-war days seem radical. All of these changes have tended towarda more complete autonomy of the medical service, and it is believed bythe best thinkers in the French Army that a high degree of autonomy isessential if the Medical Department is to successfully meet the conditionswhich modern warfare have imposed upon it.
The latest change in the Medical Department organizationin the French Army has very recently been published under date of February26, 1918 (see inclosures). This change is so fundamental in character andso far-reaching in its consequence that I feel impelled to bring it toyour attention. By this change the Medical Department had been removedfrom the close administrative control of the fourth bureau of thegeneralstaff. I am informed that M. Clémenceau and General Pétainhave decided, in order that the medical service may have every possibleopportunity to accomplish the difficult task with which it is confronted,to constitute a new section of the general staff of the G. Q. G. This sectionis designated the service de santé, and has as its chief an experiencedofficer of the Medical Corps who is an assistant chief ofstaff.
It seems particularly fitting at this time that inasmuchas our present organization is modeled so closely on that of the Frenchthat we should not appear as having begun our military effort with a medicalorganization which has been found wanting and has been discarded by theFrench. Undoubtedly this step has been taken by the French after most maturestudy, and with the experience of three and a half years of war as a guide.I feel it incumbent upon me to urge careful consideration of this matterand to recommend that a similar organization be adopted for the A. E. F.If this recommendation is approved, as I feel it must be sooner or later,it is my intention to request the detail of one of the several experiencedsenior officers of the Medical Corps now in France as chief of this section.I am convinced that while the recently prescribed organization is a vast improvement over that which hasbeen in effect, the gain in saving of life and the prevention of unnecessarysuffering which may reasonably be expected from adopting the proposed changewill be immeasurably
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greater. The present organization in the American ExpeditionaryForces places a line officer of the general staff in position to pass uponor present for higher consideration all matters of fundamental policy affectingthe Medical Department. He can nullify the most carefully worked out programhaving for its object Medical Department efficiency. I am convinced thatproper coordination of the medical service with the troops in the zone of the armies can be secured in noother way than that outlined above.
This matter was referred to the chief of the fourth section, generalstaff, who reported upon it adversely;6 however, the chief surgeon,on April 30, renewed his recommendation in the following letter:7
On the 15th of March, 1918, a letter was sent you fromthis office calling attention to the fact that the Medical Department washandicapped in its extensive and complex operations by being cut off fromdirect access to the chief of staff and having to operate through two divisionsof the general staff, and suggesting that a remedy be found in the creationof a medical section of the general staff.
In the six weeks which have elapsed since that letterwas forwarded, the transfer of the chief surgeon's office to the Servicesof Supply has been tested in actual operation, and has in many ways greatlyfacilitated the transaction of business, especially in matters concerningsupplies, the distribution and training of personnel, and the constructionof the hospital accommodations for the great Army which is being transferred from the camps of mobilization at home toFrance.
It becomes daily more apparent, however, that it has resultedin a disconnection of the chief surgeon's office from the medical administrationof the front to an extent which makes it practically impossible for thechief surgeon to meet his responsibility for the conduct of medical affairsin the zone of the army.
It is requested, therefore, that a reply be made to thisletter, stating the action taken with regard to it and, if unfavorable,the reasons which rendered favorable action inexpedient. It is hoped thatby a study of these reasons a solution may be arrived at which may be acceptableto the commander in chief and may relieve the very serious administrativedifficulties which now exist.
As the chief surgeon was never informed officially of the objections,he was not in a position to discuss them. This matter lapsed and no MedicalDepartment section of the general staff, comparable to that of the FrenchArmy was created at this time or later.1
None of the medical officers attached to the general staff became membersof that body until some time later. By General Orders, No. 73, G. H. Q.,A. E. F., May 10, 1918, two of them were detailed acting general staffofficers, and by General Orders, No. 138, G. H. Q., A. E. F., August 23,1918, the same official status was given two others.
The representative of the chief surgeon, at general headquarters, establishedhis office with that of the two medical officers assigned to the fourthsection of the general staff.8 This section as described inChapter I, was concerned with supply and transportation in the AmericanExpeditionary Forces, initial troop movements, hospitalization, evacuation,utilities, and labor.2 It formulated policies in these matters;the Services of Supply or other agency executed them.1 The assistantchief of staff, G-4, organized in his office a subsection, the medicalsection, designated "G-4-B." which was charged with Medical Departmentaffairs, and it was with the group composing this section that the chiefsurgeon's representative identified himself.1
Composition of the medical section, G-4, varied according to circumstances,but on the average included four medical officers of field rank, two officersof the Sanitary Corps for office management, and a small clerical force.1
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On May 2, 1918, the Medical Department officers on duty at headquartersconsisted of the representative of the chief surgeon and one assistant,one officer attached to G-1, one attached to G-3 and to G-5, two attachedto G-4, an assistant to these last mentioned, who was in charge of records,a director of professional services and his assistant.4
With the separation of the chief surgeon's office from general headquarters,A. E. F., the chief surgeon's relations with the combat forces virtuallyceased, but no agency was formally provided for the control, direction,or supervision of Medical Department activities in the zone of the armies.1Therefore, his representative at general headquarters supervised all activitiesof the Medical Department during combat.1 Demands upon the medicalsection, G-4, constantly grew, for it soon became the center to which werereferred all matters affecting the Medical Department, whether they aroseat headquarters, A. E. F., or were referred to it from other sources for recommendation or suitableaction.1 Except in matters pertaining to priority shipmentsof supplies and personnel from the United States, training, equipment,and operations, this fourth section controlled most of the policies ofthe Medical Department, not only in the Services of Supply, but throughoutthe American Expeditionary Forces, including the zone of the armies.1It was for this reason that the representative of the chief surgeon hadidentified himself intimately with this section.1 Graduallynearly all the Medical Department activities at general headquarters werecoordinated under the medical section, G-4, and no important questionsof policy were decided until they had been examined by this group.1 The medical officer assignedto G-1 actually served as a member of this group, but was placed with G-1to handle certain specific problems pertaining to ocean tonnage which wereunder control of that section.1 All actions initiated in thegroup were of course executed over the signature of the assistant chiefof staff, G-4. This system was followed, even with questions involvinganother section.1 In this case a memorandum was usually preparedfor the other section of the general staff involved, and transmitted toit through the assistant chief of staff, G-4.1
Orders affecting Medical Department activities in the Services of Supplywere promulgated from that headquarters at the direct instance of the chiefsurgeon, A. E. F., while those affecting service of the Medical Departmentin the American Expeditionary Forces as a whole, as well as in the zoneof the armies, were issued, on request of the chief surgeon's representative,from general headquarters at Chaumont.8
Before they made recommendations concerning the establishment of policiesor took action upon them, the representatives of the chief surgeon invariablysubmitted them to him for approval.8 Daily at 8 a. m., and oftenerin emergencies, the chief surgeon and his deputy discussed by long-distancetelephone the problems demanding solution.8 Mail sent by courierfrom one office to the other reached its destination in 12 hours. By thesemeans and by semimonthly visits to Chaumont for the purpose of attendingconferences, the chief surgeon kept constantly in touch with the activitiesand interests of the Medical Department at general headquarters, and wasable to supervise Medical Department activities in the zone of the armiesand in the American Expeditionary Forces as a whole.8
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The medical officers assigned to duty with G-4 previously had been identifiedwith the hospitalization division of the chief surgeon's office, and inthat capacity had dealt with G-4 directly in matters pertaining to hospitalprocurement.1 As a part of such procurement they had soughtto make provision for field and evacuation hospitals as well as for thebase hospitals in the Services of Supply.1 Also they had supervisedand directed evacuation of patients from divisions in training areas andin quiet sectors. Therefore, it developed that the medical section, G-4,handled all questions relating to hospitalization, evacuation, and otherinterests of the Medical Department throughout the American ExpeditionaryForces which required the attention of general headquarters.1One very important detail of its service was the prosecution of constructionand procurement program, in its relation to hospitalization and depot policiesof the chief surgeon's office.1 Another was support of MedicalDepartment interests when in certain projects these conflicted with thoseof another branch of the service.1 After American troops began to participate in active operations the duties of this group underwenta tremendous increase in scope for it was then charged with general controlof Medical Department activities in the field.1 Questions continuedto arise in connection with the hospitalization and evacuation policiesof the Services of Supply, but aside from these the group now became occupiedchiefly with matters pertaining to field operations and combat activities.1
When the medical section, G-4, was organized it had not been anticipatedthat control of field operations of the Medical Department would devolveupon it, but no other agency was provided and such devolution was in facta logical development for the reasons noted above.8 The deputyof the chief surgeon at general headquarters, and the other members ofthe group attached to G-4, constituted the only connecting link betweenthe chief surgeon, A. E. F. and the medical service of armies, corps, anddivisions.8
From the beginning of our military operations the medical section, G-4,was called upon to meet the daily emergencies of battle situations as theyarose, and to cooperate in developing and applying the general policiesof the entire Medical Department of the rapidly growing American ExpeditionaryForces.8 During the more important operations two officers ofthe group were almost constantly at the front where they represented G-4in the coordination of hospitalization, evacuation, and medical supply.8Before corps and armies of the American Expeditionary Forces were organizedthey performed, in addition to their other duties, duties comparable tothose of a corps or army surgeon, for at that time there was no other agencythrough which the higher coordinative functions of the Medical Departmentcould be exercised during combat. For example, representatives of the medicalsection, G-4, supervised and directed hospitalization and evacuation ofthe 1st Division at Cantigny; of the divisions and corps constituting theParis group in the Marne area; and of the 42d Division in the Champagnesector.8 Before a chief surgeon for the First Army was designatedin July, 1918, members of G-4-B, therefore, discharged such duties as thendevolved upon that office.8 They also effected evacuation fromcorps and divisions serving under control of the French or British andprovided for their supply of Medical Department matériel.8
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So far as their jurisdiction extended the chief surgeons of the First,Second, and Third Armies relieved the deputy of the chief surgeon at G-4of the duties pertaining to hospitalization, evacuation, and medical supplywhich the latter previously had discharged for corps and divisions at thefront.8
The hospitalization and evacuation plans for the St. Mihiel and Meuse-Argonneoperations, in so far as procurement and evacuation were concerned, werelargely prepared in G-4-B and placed into effective operation through personalconsultation with the chief surgeons of the First and later the SecondArmies.1 Careful estimates of prospective battle casualtieswere formulated and every available resource drawn upon to care for them.Owing to limited resources, it frequently became necessary to move sanitaryformations and resources from one army to another, or to the service ofdetached divisions.1
The difficulties of contact, between the general staff and the MedicalDepartment engaged in the service of the front, which had occurred duringthe battles in the Marne area, were greatly ameliorated when medical officerswere detailed to the various sections of the general staff at general headquarters,and when a newly appointed assistant chief of staff took over the dutiesof G-4.8 This officer now uniformly acquainted members of themedical section G-4 with plans, situations, and policies so that they wereable to make preliminary arrangements to the best advantage and to promoteintelligently the efforts of the chief surgeons of the various armies,corps, and divisions concerned.8 As the group kept in closecontact with those officers, and learned their facilities and needs forfuture requirements it was thus in a position to render them prompt assistancewhen required.8
The machinery for coordination of effort, consolidation of resources,and elasticity of control of limited resources, as reflected in the authorityof the assistant chief of staff, G-4, permitted the maximum utilizationof facilities.8 Without the interest which was manifested bythe assistant chief of staff, G-4, in the activities of this subsectionand his practice of notifying it of impending battles, or movements oftroops, it would have been impossible for G-4-B to have met emergencieswhich continually arose.8
The geographical location of general headquarters permitted the maintenanceof close contact between members of G-4-B and the surgeons of divisions,corps, and armies.8 It was possible for a member of this groupnot only to reach rapidly almost any part of the front occupied by Americantroops, but also through an excellent system of telephone and telegraphcommunication to know at all times exactly the conditions to be met.8Largely because of this fact the representatives of the chief surgeon withG-4 were able to meet the daily problems which arose from the lack of authorizedpersonnel, sanitary units and equipment with the troops; such problemsthey met by moving from one sector to another, on orders which G-4 initiated,casual personnel, operating teams, and sanitary units, ambulance companies,field, evacuation, and mobile hospitals.8 Limitations of personnelwere such that without this machinery for coordination of effort and consolidationof resources, evacuation, and hospitalization of battle casualties wouldhave been well nigh impossible.8 The activities of this groupwhich pertained to supervision of medical service at the front are furtherdiscussed in Volume VIII of this history.
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G-4-B was also closely in touch with the American Red Cross, especiallyin projects concerning hospitalization, and convalescent homes.8The relations of that society to G-4-B were so intimate and so importantthat an attempt was made to have it transferred from the jurisdiction ofG-1 (which had control of all such societies operating in the service ofthe American Expeditionary Forces), to that of G-4, in order to expeditetransaction of business between the two offices, but this was unsuccessful.1The representative of the Medical Department with G-1 coordinated the activitiesof the American Red Cross with the policies of the Medical Department,in so far as they pertained to that department, the hospitalization enterpriseof the American Red Cross being undertaken in conformity with requestsof the medical group with G-4.8
On September 20, 1918, the chief surgeon's deputy, general headquarters,submitted the following memorandum to the acting chief of staff, G-4, concerningthe organization of the medical section, G-4:9
The following table exhibits the personnel that I believewill be necessary to carry on the functions now devolving upon this subsectionof your office. It contemplates no radical departure from the organizationwhich has been in effect.
Brigadier general, 1; colonels, 2; lieutenant colonels,2; majors, 2; captains or first lieutenants, 4; total commissioned, 11.Civilian clerk, 1; master hospital sergeant, 1; hospital sergeants, 2;sergeants, 1st class, 3; sergeants, 3; corporals, 2; privates, 1st class,4; privates, 1; total enlisted, 16.
The table proposed off hand may appear to be top heavy.As a matter of fact the personnel estimated will barely be sufficient tocarry on the work which is now coming to this subsection. As G-4 handlespractically all the medical matters coming to general headquarters; itis believed that all technical matters affecting the Medical Departmentshould be referred to this subsection. While General Orders 31, contemplatedthat we should have a representative in each section of the General Staff,it is believed that better results will accrue if we concentrate all theauthorized personnel in this section excepting the officer assigned toG-5 for training purposes. Until recently we had attached to G-l a medicalofficer who was assigned to the General Staff. Instead of replacing himin that section it is believed that the work carried on by him there shouldbe performed by an officer in this subsection of G-4.
Until the organization of the First Army headquarters,this office was in fact the office of the chief surgeon of the army. Atthe present time it is carrying some of the duties of that army, and allof such duties in connection with certain other more or less detached combatunits. The chief surgeon's office is, from the point of view of distance,remote from the front, and its contact with combat units is correspondinglyslight. The necessity of providing the details of organization,instruction, mobilization of new equipment and personnel for combat units,the initiation of movement orders, etc., must all originate from this section.As a matter of fact the duties which have devolved upon and are now beingperformed by this subsection have been much broader in scope than it wasbelieved by the chief surgeon was contemplated in the plan of organizationat the time General Orders 31 was adopted.
Every effort has been made to decentralize, as far aspossible, all details concerning the Medical Department and to devote thetime of officers on duty here to constructive work, which is graduallyassuming greater and more pressing proportions. Up to the present, withthe number of officers now available this has practically been impossible,as the entire time of officers now connected with the subsection have beentaken up with routine daily matters. It is daily becoming more evidentthat the chief surgeon's office, per se, has become what might properlybe called a surgeon's general's office in France, and is occupied withthe provision of matériel and personnel necessary to secure properfunctioning of the Medical Department of the American Expeditionary Forces.There is another and most important side to the Medical Department's activities,and this is the relation of the department to combat operations. From aMedical Department viewpoint, supply is a comparatively
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minor consideration. The care of the sick and woundedand the evacuation and hospitalization of these cases is always more orless an emergency measure and requires very complicated machinery to securethe desired results. The present organization, as prescribed by GeneralOrders 31, does not provide the elasticity or necessary facilities forthis most important part of the Medical Department duties. It is understoodthat General Orders 31 is now being rewritten with a view of correctingits organizational defects and incorporating features which have been theoutgrowth of our experience under its operation.
The necessity of having a deputy of the chief surgeonat these headquarters has become generally recognized. Under our presentscheme of organization it is necessary that the chief surgeon should haveat these headquarters an officer who truly represents him and whose dutiesare more particularly those which pertain to Medical Department functionswith and relations to combat troops. To produce satisfactory results requiresa considerable organization. In every action of magnitude representativesfrom these headquarters must leave for the front for the purpose of coordinatinghospitalization and evacuation until activities again assume a normal trend.It seems only logical that, inasmuch as all Medical Department activitiesare coordinated by G-4 of the general staff, its senior medical officerwith that section of the general staff should be the chief surgeon's deputy.That is the situation which has gradually evolved since the chiefs of theservices were divorced from these headquarters. As stated above, the desirabilityof not only continuing this organization, but recognizing the responsibilitiesand duties of the senior medical member of G-4 seems apparent. Becauseof the nature of the work and responsibilities devolving upon the chiefsurgeon's deputy, it is believed that the officer who occupies that positionshould have the rank of a general officer. On a recent visit to these headquartersthe chief surgeon announced that it was his intention to recommend thathis deputy here be a brigadier general. For that reason one brigadier generalis shown on the above table. If the functions to be carried out by thissubsection of your office are to be successfully accomplished the personnelindicated will be absolutely essential. The enlisted personnel given functionlargely in the same capacity as do field clerks in other subsections.
On August 14, 1918, the commander in chief, upon being advised by thechief of staff that the Medical Corps had asked for fuller representationon the general staff, stated he desired this request to be complied with.10Accordingly, a medical officer who had been on duty with G-1 was made anacting general staff officer,11 and all divisions of the generalstaff were advised that he should be consulted on:10
(a) All affairs of the Red Cross that have anypossible connection with the Medical Department; (b) all Tablesof Organization of medical units or which should show medical personnelattached; (c) changes in the type of equipment or clothing or ration,so far as they may affect health, or where, in the case of equipments,it is for the Medical Corps; (d) miscellaneous questions affectingthe Medical Department.
The representative of the Medical Department with G-3 was concernedchiefly with movement of medical units; e. g., evacuation hospitals. Itappeared advisable that the Medical Department should be represented onG-3 in order that its plans might be coordinated with combat operationsin general.1 This representative of the chief surgeon also servedwith G-5, and, in that assignment, was in charge of the training of MedicalDepartment personnel whether they were members of units in the Joinvilletraining area, of units or detachments with divisions, or in attendanceat the Sanitary School at Langres.1
In his final report the deputy of the chief surgeon at General Headquarterswrote concerning Medical Department representation on the general staffwith especial reference to that with its fourth section as follows:1
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The present method of providing for Medical Departmentrepresentation on and with the general staff is ideal, and is favored overall other previous propositions. Medical Department representation on thegeneral staff as conceived by the acting chief of staff, G-4, more nearlyapproaches the ideal of organization than any other plan which has beenproposed. It is hoped that the policy inaugurated by the chief of the fourth section in this respect will havedemonstrated its value, and will be perpetuated in any future reorganizationof the general staff. It is also hoped that the results obtained by thissection of the general staff have amply demonstrated the wisdom of havingadequate Medical Department representation on the general staff.
Under this organization (General Orders, No. 31) the chiefsurgeon's office became merely an agency for the procurement and distributionof supplies and personnel and was completely separated from the MedicalDepartment activities connected with the Zone of Active Operations.
The classification of the Medical Department among thesupply services is questionable. Its functions are so intimately connectedwith combat activities that it becomes a very difficult matter to administerthis branch of the service if it is placed on the same basis as the purelysupply departments.
In providing the necessary medical supplies for an armyonly one of the comparatively unimportant functions of the Medical Departmenthas been fulfilled. The demands made upon the Medical Department by combatactivities can not be satisfied if the prevailing conception of that departmentas a supply department is adhered to.
The organization of headquarters, general headquarters,A. E. F., as first outlined in General Orders, No. 8, 1917, followed veryclosely that in operation in the French Army at the time, except that forthe latter army generous provision was made in the way of Medical Departmentrepresentation on the fourth bureau of the general staff and none was providedfor ours. As stated above, this defect was corrected some months later,after representation had again been made by the chief surgeon.
In the meantime a reorganization of the French generalstaff went into effect in March, 1918. This change created an additionalor fifth bureau of the general staff, which was made up entirely of medicalofficers and was known as the Medical Department bureau. The senior officerof the section was a major general, with the title of assistant chief ofstaff, with the same responsibilities and privileges as his brother officersof the line of other bureaus of the general staff.
A short time before the French had published this changein staff organization, a memorandum for the commander in chief had beenprepared in the office of the chief surgeon recommending this identicalorganization. This recommendation was never approved or disapproved, andthe lack of action in the matter was a source of bitter disappointmentto the chief surgeon.
In so far as general representation on the general staff is concerned,not only at headquarters, A. E. F., but also at headquarters, Servicesof Supply, the chief surgeon expressed his opinion on March 24, 1919, asfollows:12
It is not believed at this time that a separate or medicalsection of the general staff should be created, but the medical servicesof the American Expeditionary Forces should be placed under G-4, generalheadquarters. The chief surgeon should be represented by a deputy on G-4,of high rank. In his relations with the general staff, general headquarters,he should be represented by one or more assistants on G-l, G-3, and G-5,as well as the necessary additional medical officers on G-4. It is notbelieved that there is any necessity for representation on G-2, generalheadquarters.
The chief surgeon has no executive jurisdiction over hisown corps in the armies except through the executive branches of the generalstaff, general headquarters. He also is so dependent upon the other supplydepartments for operating hospitals, supplies, and evacuation as to makeit impossible for him to function without the executive assistance of thegeneral staff, Services of Supply.
Therefore, in order to make the machinery move rapidlyand smoothly, it is absolutely necessary to have general staff representationin both general headquarters and Services of
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Supply so as to insure the rapid and coordinate disseminationof information of daily changes at the front and to meet all demands intelligentlyand rapidly with the proper equipment, personnel, etc.
Under the present arrangement, in which the deputy chiefsurgeon is attached to G-4, general headquarters, the operation has functionedin an admirable manner, but this is recognized as being due in a largemeasure to the admirable cooperation given to the deputy chief surgeonon G-4 by the assistant chief of staff, G-4.
In this connection, attention is called to the fact thatthere was no medical representative on G-3, the G-4 group performing thefunctions that should have been delegated to the G-3 representatives. Itis believed that representation on G-3 is necessary.
In connection with the headquarters, Services of Supply,the chief surgeon should have had an office with a deputy in charge tooperate the Services of Supply activities of supply, hospitalization, statistics,finance and accounting, Services of Supply personnel, dental service, andveterinary service.
The office of the chief surgeon should be representedby assistants on G-l and G-4 of the general staff, Services of Supply,this in view of the fact that the hospitalization division is intricatelyconnected with and dependent upon every other supply department, and inorder to maintain the proper service, should be represented on G-l andG-4 of the general staff with such executive power as to be able to securehospital construction or procurement by lease or rent, as well as transportationof supplies, personnel, and sick and wounded.
THE CHIEF SURGEON IN CONNECTION WITH THE ARMIES
It is well understood that orders of execution can onlybe given to the army through the different sections of the general staffat general headquarters, but in view of the chief surgeon's responsibilityfor the sanitary personnel, equipment, professional services, hygiene,etc., of the armies, he should be in close touch with the surgeons of thearmies, army corps, and divisions. The chief surgeon of an army shouldhave a medical representative on each G-l and G-4 of the army.
The following table is submitted:
Location.
Operations-G.H. Q.
Chief surgeon.
Personnel (for army areas only).
Army equipment, medical, from advance medical supply depots.
Evacuation of sick and wounded.
Hospital trains.
Ambulance and motor transport.
Operations of same.
Supplies-S. O. S.
Deputy chiefsurgeon.
Hospitalization.
Supply department.
Statistics-sick and wounded.
Personnel (S. O. S.).
Hospital trains, ambulances, and motor transport.
Supply and equipment of same.
Finance and accounting.
Dental service.
Veterinary service.
Professional services.
General sanitation-inspecting, epidemiology, laboratories.
Relations with the general staff.
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The chief surgeon's representation on the general staffshould be as follows:
G. H. Q.:
G-l. An assistant in connectionwith supply problems, railway and automatic overseas tonnage.
G-3. An assistant to coordinate thechief surgeon's office with combat operations in general, and change ofstations of army units.
G-4. A deputy chief surgeon and necessaryassistants in connection with the evacuation of sick and wounded, hospitalization,all construction and procurement of buildings, assignment of units.
G-5. An assistant in connection withMedical Department training.
S .O. S.:
G-4. One or more assistants in connectionwith hospitalization and evacuation of sick
and wounded.
G-1. One assistant in connection withall tonnage and problems.
Army headquarters:
G-l. An assistant to the chief surgeonof the army.
G-2. An assistant to the chief surgeonof the army.
Corps and divisionheadquarters: No representation of general staff deemed necessary.
REFERENCES
(1) Report from Col. S. H. Wadhams, M. C., the chief ofthe medical group, fourth section, general staff, general headquarters,A. E. F., to the chief of G-4, general staff, general headquarters, A.E. F., December 31, 1918. Subject: Activities of G-4 "B," 4.
(2) General Orders, No. 31, General Headquarters, A. E.F., February 16, 1918.
(3) Letter from the chief surgeon, A. E. F., to the commanderin chief, A. E. F., February 22, 1918. Subject: Designation of medicalofficers to represent chief surgeon at general headquarters. On file, A.G. O., World War Division, chief surgeon's files (321.6).
(4) Memorandum from the representative of the chief surgeon,A. E. F., with general headquarters, A. E. F., medical section, generalstaff, to the chief of staff, A. E. F., May 2, 1918. Subject: Duties ofofficers of Medical Department at general headquarters, A. E. F., G-4-B.On file, A. G. O., World War Division, chief surgeon's files (321.6).
(5) Letter from the chief surgeon, A. E. F., to the commanderin chief, A. E. F., March 15, 1918. Subject: Organization. On file, A.G. O., World War Division, chief surgeon's files (321.6).
(6) Memorandum from acting assistant chief of staff, G-4,to the chief of staff, April 6, 1918. On file, A. G. O., World War Division,chief surgeon's files (321.6).
(7) Letter from the chief surgeon, A. E. F., to the commanderin chief, A. E. F., April 30, 1918. Subject: Need for medical section,general staff. On file, A. G. O., World War Division, chief surgeon's files(321.6).
(8) Wadhams, S. H., Col., M. C., and Tuttle, A. D., Col.,M. C.: Some of the early problems of the Medical Department, The MilitarySurgeon, Washington, D. C., 1919, xlv, No. 6, 636.
(9) Memorandum from the medical representative of thechief surgeon, general headquarters, A. E. F., fourth section, generalstaff, to the acting chief of staff, G-4, September 20, 1918. Subject:Plan of organization for the medical or "B" division of G-4. On file, A.G. O., World War Division, chief surgeon's files (321.6).
(10) Report from the commander in chief, A. E. F., toThe Adjutant General of the Army (undated), part 8, Vol. I, "Activitiesof G-1," 29. On file, General Headquarters, A. E. F. Records.
(11) General Orders, No. 138, General Headquarters, A.E. F., August 23, 1918.
(12) Letter from the chief surgeon, A. E. F., to the chiefof staff, A. E. F., March 24, 1919. Subject: Relation of chief surgeon'soffice to S. O. S., G. H. Q., and the armies. On file, A. G. O., WorldWar Division, chief surgeon's files (321.6).
