Part I
EUROPE
CHAPTER 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 systemin the European theater of World War II was laid during World War I. Many of thecampaigns in Europe in the Second World War were fought over the samebattlegrounds of the only major theater in which American Forces were involvedin the First World War. The AEF (American Expeditionary Forces) in World War Ieventually developed a full-fledged system of consultation in both medicine andsurgery. Lessons learned in the metamorphosis of the consultant system duringthe first great conflict were recorded and available for reference in themedical history of that war. Thus, a review of consultation in surgery in theEuropean theater during World War II must begin with World War I.
CONSULTANT SYSTEM IN WORLD WAR I
At first glance, it would appear that the AEF in World War I wasamply supplied with consultants.1 Atvarious times, consultants were assigned to every echelon of command from combatdivisions to the Chief Surgeon's Office and in headquarters and hospitalcenters of the base sections. The system under which the consultants wereappointed, organized, and operated took two quite distinct forms during the war.The earlier of the two may be simply characterized as a more-or-lessunsystematic form in which consultants worked independently and entirely ontheir own. The second, and later, form may be said to have been an attempt atsystematization and unification of the professional services.
Under the first system, there were eight"directors" in the Office of the Chief Surgeon, AEF. A director wasappointed for each of the following: General medicine; general surgery;orthopedic surgery; surgery of the head; urology, and skin and genitourinarydiseases; laboratories; psychiatry; and roentgenology. This "director"system was implemented throughout the army corps, administrative sections of thelines of communications, larger hospitals, and other commands. Many assistantconsultants 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).
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lons of the medical service. At the start, each infantrydivision also had a surgical consultant. The assistants and consultants at thedivision level were commonly known as junior consultants.
Under this system, each consultant was directly under eitherthe surgeon of a command or the commander of a hospital center. The ChiefSurgeon's circular establishing the system emphasized that professionalauthority did not include administrative control. This was indeed an open-endstatement since nothing was said as to what, specifically, "professionalauthority" entailed. At General Headquarters, AEF, the directors weresupposedly under the control of the Hospitalization Division of the ChiefSurgeon's Office at Chaumont, some 45 kilometers from where the directors werestationed at Neufchateau. Their activities were uncoordinated. Each directorsought to solve in his own way the very different and difficult problemswhich confronted him. No specific instructions had been issued governing theirstatus.
The confusion which often resulted is readily understandableunder the circumstances. First, the new professional directors did not have themilitary background and experience which would have made their tasks easier ofaccomplishment. Moreover, there was really nobody to help them. Each directorwas an enthusiast in his own specialty, and his zeal-as well as themisnomer of his title, "director"-not infrequently led him tomisdirected activities. Some of the best clinicians were assigned to divisionsand other commands which had little need or use for their talents during most ofthis period. Even the seemingly simplest matters became problems of no smallproportions. For example, someone in authority had most generously ruled thateach director at General Headquarters, AEF, was authorized the use of anautomobile for unlimited periods of time! Considerable embarrassment was causedby a shortage of automobiles for this purpose and by the absence of an arbiterto coordinate the use of the few vehicles that were available from timeto time.
In spite of the difficulties encountered, the initial workaccomplished by the specialists was of very great importance, and there weremany basic similarities in their modes of operation. As their functions becamemore clearly defined, it was evident that consultants were expected to directand supervise the professional services in all echelons of the medical service,to provide for continuity of treatment from front to rear, to modify, as needbe, accepted methods of treatment, and to inaugurate new treatment methods.
On 18 April 1918, the Chief Surgeon appointed Lt. Col. (laterCol.) William L. Keller, MC, Director of Professional Services for the purposeof coordinating professional medical activities. Among the missions givenColonel Keller, the following were most significant:
By virtue of this appointment, you areempowered to represent the chief surgeon, A.E.F., in all matters pertaining tothe 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 theproper sorting, distribution, and evacuation of sick and wounded through thechannels that will best insure efficient treatment from the front to the rear.
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All requests for the movement of personnel andsupplies originating in the professional services will be forwarded by orthrough you to the chief surgeon, A.E.F., or to some one designated by him.
* * * * * * *You will direct the compilation of aclassified roster by each chief consultant, of all professional personnel, suchas specialists, consultants, or surgical teams among the various army units ofour own and allied formations, so as to facilitate their proper distribution andutilization in emergencies as well as in routine. When the organization of theprofessional service is completed, you will direct its workings, either fromgeneral headquarters or such other places as best serves the interests of theservice.
With the three original divisions, medicine,surgery, and laboratories as a basis, you will so coordinate the activities ofthe subdivision thereof that scientific research and clinical proficiency may beeffectually promoted.2
With the appointment of the Director of ProfessionalServices, a reorganization-actually an organization-of the rest of theprofessional services was directed on a trial basis. The organization was fullyadopted and officially announced by General Orders No. 88, General Headquarters,AEF, on 6 June 1918. This was the beginning of the second system previouslyreferred to, that of a coordinated professional service for the AEF. The titlesof directors were at this time changed to consultants. The publication of thesegeneral orders gave them a status which they had not previously enjoyed andpromoted broader appreciation of their responsibilities.
Under the Director of Professional Services, who,incidentally, was still under the Hospitalization Division, were a ChiefConsultant in Surgery and a Chief Consultant in Medicine. The Chief Consultantin Surgery was Brig. Gen. John M. T. Finney, MC. He was given the overallresponsibility for supervising the professional activities of the surgicalsubdivisions in the AEF. He was instructed to organize and coordinate thesesubdivisions in a manner which would permit him to anticipate and request, asfar in advance as possible, necessary changes in personnel. He was charged withthe formation and functioning of surgical teams and collecting timely reportsfrom them. He was to make recommendations for inspections as to technicalprocedure and instruction in the specialty of surgery.
Under the Chief Consultant in Surgery were nine seniorconsultants in various specialties representing the subdivisions of surgerywhich 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 seniorconsultants was to coordinate professional activities relating to theirspecialties in subordinate commands. They were specifically instructed to makerecommendations to the Chief Consultant so that instructions relative toprofessional subjects could be directed to subordinate commands with dispatchand 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.
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A consultant who reported directly to the ChiefConsultant in Surgery on professional matters was appointed in each army corps.His title was senior divisional surgical consultant. He was responsible for thesupervision and direction of all surgical activities in the infantry divisions,a responsibility, formerly, of the division surgical consultant. It was the dutyof the senior divisional surgical consultant to relieve division surgeons of thenecessity for supervising strictly technical work, since it was considered thatdivision surgeons would have their hands full with other operational andadministrative matters. Aiding the senior divisional surgical consultant-who,it is to be remembered, was assigned to an army corps-were divisional surgicalconsultants. These were assigned to the corps, usually on the basis of one perdivision, to supervise the immediate surgical activities of operating teamswithin the divisions. Toward the end of hostilities, these divisional surgicalconsultants were withdrawn as superfluous when the First and Second U.S. Armieswere organized with their full complement of consultants.
To round out the surgical services of the AEF, there wereconsultants at hospital centers, specialists in base hospitals and tacticaldivisions, and surgical teams. Consultants at the hospital centers were named inthe various specialties, as required, and were available for consultation tonearby units as well as within the hospitals of the center. While the need forthem was evident early, it was not until near the end of hostilities that theycould be supplied in any number. At the end of 1918, 16 hospital centers hadsurgical consultants. Specialists were also designated at hospitals in eight ofthe nine surgical specialties previously mentioned. (There were no consultantsor specialists locally designated in surgical research.) Each infantry divisionhad a specialist in orthopedic surgery and one in urology. In 1918, surgicalteams were first organized from personnel of base hospitals. These teams,numbering some three hundred by the end of October 1918, were used wherevernecessary, including the division areas, and were composed of one operator, ananesthesiologist, two nurses, and two orderlies.
The Chief Surgeon, AEF, subsequent to the signing of thearmistice, convened a board of officers to investigate and report upon theconduct of the Medical Department, AEF, and to make recommendations with a viewto the improvement of that department. This board approved fully the system ofprofessional services which had been developed during the war. Specifically, itstated that the Director of Professional Services should be a colonel selectedfrom that scarce category of Regular Army medical officers who knew the routineof Army administration well and, at the same time, were well informed as to theprofessional qualifications of large numbers of civilian practitioners so thatthey could be assigned to duties wherein the greatest efficiency in performancewould result. The board went on to say that the Chief Consultant in Surgeryshould be a medical officer of the highest surgical attainments and that hissurgical subdivision of professional services should be further subdivided intothe nine surgical specialties heretofore mentioned. The board also recommendedassignment of consultants to field armies, corps, and divisions
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only during active campaigns. Assuming that the theatersurgeon would also function as Surgeon, SOS (Services of Supply), for theadministration of base sections, the board emphasized the need for consultantsin general surgery and orthopedic surgery to supervise and direct all surgicalactivities throughout base sections of the Services of Supply.
CONSULTANT SYSTEM IN WORLD WAR II
Organization
The activities of the surgical consultants of ETOUSA (EuropeanTheater of Operations, U.S. Army) were coordinated by the Chief Consultant inSurgery, Col. (later Brig. Gen.) Elliott C. Cutler, MC. These surgicalconsultants functioned under the Division of Professional Services, Office ofthe Chief Surgeon, ETOUSA (chart 1).
CHART 1.-Organization of the Division of Professional Services, Office of the Chief Surgeon, ETOUSA, in 1942
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The Division of Professional Services was activated on 19June 1942 with Col. James C. Kimbrough, MC, as chief (fig. 1). The consultantorganization was set up according to the Regular Army surgical service in thelarge Army hospitals. In such an organization, the general surgeon was chief ofthe 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 aservice, or department, similar to the organization in large civilianhospitals.) Since all the consultants in the European theater held highpositions in university hospitals and medical schools in the United States, thissubordination to a general surgeon caused some dissatisfaction. The specialistsurgeons objected to the designation "senior consultant," ascontrasted to the title "chief consultant." They were, however, allsuch patriots and of such high caliber as surgeons that this regimentation at notime interfered with their efficiency or their devotion to duty.
FIGURE 1.-Col. James C. Kimbrough, MC.
Anesthesia was represented by a senior consultant functioningunder general surgery. In like manner, radiology became a part of the surgicalservice.
After the Professional Services Division had been establishedand medical officers to fill the consultant positions began to arrive in thetheater, it was necessary to promulgate an official statement relating to theorganization for consultation in medicine and surgery. This was done by anunaddressed document, signed by the Chief Surgeon, Col. (later Maj. Gen.) PaulR. Hawley, MC (fig. 2), and dated 18 August 1942. Titled "Organization ofProfessional Services E.T.O.U.S.A., Services of Supply," the pronouncementread:
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FIGURE 2.-Maj. Gen. Paul R. Hawley.
In order to utilize the professional services ofthe consultants and the specialists of the Medical Department, E.T.O.U.S.A., ina manner that will best facilitate the coordination between the forces, fromfront to rear, the following instructions are issued:
1. Director of Professional Services-The Directorof Professional Services, under the Chief Surgeon, E.T.O.U.S.A. will supervisethe professional activities of the Medical Department, E.T.O.U.S.A., andcoordinate the work of the consultants and specialists of this department.
2. Chief Consultants-The Chief Consultant, surgicalservice, will supervise the professional work of the surgical sub-divisions. Hewill organize and coordinate these sub-divisions in such manner that will permitthem 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 thesesub-divisions in such manner as to ensure the highest possible standard ofprofessional endeavour.
3. Senior Consultants-Under the supervision of theDirector of Professional Services and the Chief Consultants in medicine andsurgery, consultants for the special sub-division of the Chief Surgeon'soffice will coordinate the activities relating to their respective specialties.
They will make such recommendations to the Chief Consultantsas are considered necessary for the instructions of consultants and specialistsin hospitals, divisions and other army formations,
4. Consultants-Under the supervision of the SeniorConsultants, the Consultants for the army, corps, divisions, hospitals, basesections and other formations will supervise and coordinate the work of thespecialists under their respective sub-divisions.
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5. Specialists-Under the supervisionof the Consultants, the specialists on duty with hospitals, divisions and otherformations will organize and carry out the work of their respective specialtiesin the most efficient manner possible.
The surgical consultants in the European theater wereeventually arranged in five groups (chart 2):
1. Consultants assigned to the Chief Surgeon's Office. Thisgroup consisted of Col. Elliott C. Cutler, MC, as chief and the surgicalspecialists functioning under the overall supervision of the Chief Surgeon.
2. Base section surgical consultants. These changedfrequently and functioned under the direction of the base surgeons.
3. Regional consultants and coordinators in the hospitalcenters. These were usually the senior outstanding surgeons of one of thegeneral hospitals of the center who performed the duties of consultant inaddition to their duties as chiefs of the surgical services or sections of thehospitals to which they were assigned.
CHART 2.-Organization of the consultant system in ETOUSA, 1944
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4. Army surgical consultants. Each field army had an assigned surgicalconsultant who functioned under the direction of the army surgeon.
5. The Army Air Forces developed a limited system of consultation asnecessary within their own commands.
As the continental activities increased, appropriate continental basesections and advance sections were set up after the Chief Surgeon'sheadquarters was moved to continental Europe. All activities in the UnitedKingdom were consolidated under Headquarters, United Kingdom Base Section.
Personnel
The following individuals were consultants to the Chief Surgeon:
1. Col. Elliott C. Cutler, MC, Moseley Professor of Surgery, Harvard MedicalSchool, 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 oralsurgery, Washington University, St. Louis, Mo., reported for duty as Consultantin 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 12January 1943 and rendered superior service in that department.
4. Lt. Col. (later Col.) Loyal Davis, MC, professor of surgery, NorthwesternUniversity, Evanston, Ill., reported as Consultant in Neurosurgery in September1942.
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 inOpthalmology.
7. During the fall of 1942, Lt. Col. (later Col.) Rex L. Diveley, MC, ofKansas 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 inJanuary 1943.
9. Lt. Col. (later Col.) Kenneth D. A. Allen, MC, radiologist, PresbyterianHospital and other hospitals of Denver, reported on 9 February 1943 in charge ofradiology.
10. Maj. (later Lt. Col.) William J. Stewart, MC, reported on 17 January 1943and acted as the consultant in orthopedic surgery when Colonel Diveley wasabsent in North Africa and continued to assist in orthopedics until the arrivalof Lt. Col. Mather Cleveland, MC.
11. Maj. (later Lt. Col.) Ambrose H. Storck, MC, Charity Hospital, NewOrleans, 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.
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13. Maj. (later Lt. Col.) John E. Scarff, MC, assistant professor ofneurosurgery, Columbia University, succeeded Colonel Davis on 10 September 1943.
14. Col. Roy A. Stout, DC, was placed in charge of maxillofacial surgery on 8November 1943.
15. Capt. (later Maj.) Charles D. Rancourt, MC, was designated AssistantConsultant in Radiology, on 14 June 1943.
16. Lt. Col. (later Col.) Mather Cleveland, MC, assistant professor ofanatomy and instructor of orthopedic surgery, College of Physicians andSurgeons, Columbia University, was placed in charge of orthopedic surgery afterColonel Diveley became chief of the separate Rehabilitation Division on 3January 1944.
17. Lt. Col. (later Col.) R. Glen Spurling, MC, clinical professor of surgery(neurosurgery), University of Louisville School of Medicine, became Consultantin Neurosurgery on 15 March 1944.
18. Maj. (later Lt. Col.) John N. Robinson, MC, Columbia University, wasdesignated Consultant in Urology in the spring of 1943.
19. Lt. Col. (later Col.) Paul C. Morton, MC, was designated surgicalconsultant for the United Kingdom Base Section on 10 September 1944.
20. Lt. Col. James N. Greear, Jr., MC, came in as Consultant inOphthalmology, succeeding Colonel Vail in March 1945.
In considering the great achievements of this group of eminent surgeons, itis believed that never before has an army at any time had available such expertadvice in caring for and treating every type of casualty (fig. 3).
Base section and regional consultants.-The base section and regionalconsultants changed so many times that it is impracticable to attempt to listthem by name. They all rendered superior service.
Surgical consultants to the field armies - Each field army had asurgical consultant whose duty it was to supervise the treatment andtransportation of patients from aid stations through the evacuation hospitals.They had technical control of the auxiliary surgical groups assigned to the armyand in general were advisers to the army surgeons concerning the treatment andtransportation 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 theThird U.S. Army; Col. Frank B. Berry, MC, for the Seventh U.S. Army; Col. GordonK. Smith, MC, for the Ninth U.S. Army; and Col. William F. MacFee, MC, for theFifteenth U.S. Army.
The great responsibility of the surgical consultants can best be appreciatedwhen it is realized that approximately 80 percent of the battle casualties inthe European theater required surgical management. The excellent resultsobtained are everlasting testimony to the outstanding ability of these surgeonswho supervised and directed the transportation and treatment of the wounded. Thegreat personal and professional sacrifices made by this group in voluntarilyleaving their families and professional activities is outstanding evidence oftheir great patriotism and their intense desire to serve their country.
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PoliciesPolicies for the operation of the Professional Services Division wereestablished early and set the pattern for the many activities in which thevarious surgical consultants later became engaged (fig. 4).3These policies were stated as follows:
1. Supervision of Professional Services:
a. It is the policy of this division to implement plans whereby thepersonnel of the American forces shall receive promptly the highest standard ofmedical and surgical care.
b. The Consultants' Section will ascertain as often asnecessary thecondition of all patients reported seriously ill in U.S. Army hospitals.
c. The condition of all patients admitted to British hospitalswill beverified as often as necessary.
d. In order to maintain adequate bed capacity for the sick andwounded, only the complicated venereal diseases and those intolerant to the usualtherapy 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.
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in station and general hospitals. Uncomplicated venerealdisease 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.
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It is the policy of this division to have consultation service immediatelyavailable at all times.
c. Arrangements have been made with the British authorities wherebytheconsultants are made available to American personnel in the hospitals of theBritish 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 beauthorized to attend the meetings of the British Medical Research Council andother medical conferences pertaining to their respective specialty.
b. The attendance of meetings and conferences and professional contact withBritish personnel and institutions with a view to promoting general good willand 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 Regulationsgoverning each type of case will be maintained.
5. Professional Training
a. Arrangements will be encouraged whereby United States Medical Officersmay be assigned to British hospitals for the observation of their activities forperiods of one to two weeks. Allotment of United States Medical Officers toBritish service and civilian medical courses has been arranged.
b. Courses of instruction for the medical department personnel of basesection, divisions, station and general hospitals will be carried out.
Duties and FunctionsTo implement the policies mentioned, the Director of Professional Servicescirculated the following statement of the duties of consultants for theinformation and guidance of all concerned and as a directive to the consultantsthemselves:
1. The consulting staff of the Chief Surgeon's Office will function underthe direction of the Division of Professional Services and are the responsibleadvisers to the Chief Surgeon on all professional and technical matterspertaining to their particular branch of medicine.
2. They will submit their reports and recommendations, thru the Director ofProfessional Services to the Chief Surgeon.
3. They will be available to visit Medical Department Units for the purposeof giving their opinion and assistance with regard to technical and professionalmatters.
4. They will advise on the selections and assignment of junior consultantsand specialists and will report from time to time on the standard ofprofessional efficiency maintained by such officers.
5. They will be instrumental, in collaboration with the OperationsDivision, Chief Surgeon's Office, in arranging Courses of Instruction,Medical Meeting, and Training Schools, and will keep the officers of theMedical Department in touch with the latest developments in medical science.
6. They will initiate and carry out research and investigationswith a view to conserving manpower in the field and restoring to health the sick andwounded.
7. They will maintain liaison with consultants and specialists in allbranches 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 thehealth of the Armed Forces.
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Specifically for the Chief Consultant in Surgery, theDirector of Professional Services dictated the following duties:
1. He will advise the Chief Surgeon thru the Director ofProfessional Services on questions of surgical policy.
2. He will advise on the selection and allocation of surgicalequipment.
3. He will advise, in collaboration with the ChiefConsultant in Medicine, on the selection of drugs for use in the ETOUSA.
4. He will advise the Chief Surgeon regarding the selectionand duties of surgical consultants and specialists.
5. He will visit Medical Department Units and correlate themilitary surgical procedure as a whole.
6. He will establish liaison with the surgical service of theMedical Department of other U.S. Forces and with the medical service of theBritish 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 thesurgical procedures and end results of treatment were supervised. Afterlanding on the Continent, they followed the armies in the field and supervisedthe treatment and methods of evacuation. On several occasions, they made visitsto the Zone of Interior in order to ascertain the condition in which the woundedreached 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 underthe supervision of the appropriate consultant for patients requiring highlyspecialized treatment such as those with cold injury and burns and thoserequiring neurosurgical, urological, and plastic procedures. These specialhospitals were usually located in the hospital centers.
During the summer of the Normandy invasion, it was realizedthat the supply of blood for transfusion which was obtainable in the Europeantheater would be inadequate and that supplies from the Zone of Interior would benecessary. Colonel Cutler, Colonel MacFee, and Maj. (later Lt. Col.) Robert C.Hardin, MC, returned to Washington to inform The Surgeon General of the urgentneed for whole blood from the United States. The plan for procurement,preservation and transportation of this blood from the Zone of Interior tothe European theater was implemented by the Office of The Surgeon General underthe supervision of Lt. Col. (later Col.) Douglas B. Kendrick, Jr., MC. Theactual transportation of blood early became a function of the supply service. Atno time was there an overall shortage in the supply of whole blood for theAmerican wounded.
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Rehabilitation
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 TheSurgeon General on the establishment of rehabilitation facilities in the Zoneof Interior. These facilities were the forerunners of the convalescent hospitalsin 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 instrumentsand drugs were reviewed with a view to eliminating unnecessary items. The equipment obtained fromthe British was cataloged to correspond to the itemnumbers of the U.S. Army supply tables. This work was carried out by theconsultants in cooperation with the medical supply service.
It was noted early that the Zone of Interior clinical recordfor patients was too extensive for use in the European theater. A specialclinical record was prepared. This record was of such size that it could becarried in the field medical record envelope so that, on return to the Zone ofInterior, 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 atShrivenham were contributed to in greatmeasure by the surgical consultants who served as supervisors and instructorsin these schools.
The auxiliary surgical groups were under the control of theOperations Service of the Chief Surgeon's Office and were allotted to fieldarmies where their activities were administered by the army surgicalconsultants. Teams
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from the auxiliary surgical groups functioned at the evacuationhospitals or field hospitals of a field army.
A mobile field surgical unit was implemented by ColonelZollinger at the 5th General Hospital. This unit was completed in November 1943and delivered to the 3d Auxiliary Surgical Group. The plan eventually evolvedinto the mobile army surgical hospital later adopted by the Army. Theunit was complete with equipment, tentage, beds, and the like, to care foremergency surgical cases at the frontline level.
Colonel Allen, Senior Consultant in Radiology, assembled amobile field X-ray unit which was delivered to the 3d Auxiliary Surgical Groupof 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 - In1942, thesurgical consultants had arranged with the medical services of the BritishArmy and Royal Air Force for the attendance of U.S. Army medical officers at the following schools and courses: Antigas school at Aldershot; London Schoolof Hygiene and Tropical Medicine; Army School of Hygiene; gas school, LeedsUniversity; blood transfusion school, Southmead Hospital, Bristol; andneurosurgical train-
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ing at Oxford. These courses were arranged by the surgicalconsultants in their individual fields.
Liaison with the Russian medical service - In order toobtain information regarding the medical service of the Soviet Army and topromote amicable diplomatic relations with the U.S.S.R., a commission ofprominent surgeons from the Allied armies was selected to visit Russia. TheUnited States was represented by Colonel Cutler and Colonel Davis.
Major Robinson, Consultant in Urology, visited the Zone ofInterior in November and December 1944 for the purpose of presenting information tothe Office of The Surgeon General regarding the managementof wounds of the urogenital tract.
Medical Society, ETOUSA - Early in the medicalactivities of the European theater, the Medical Society, ETOUSA, was organized.Meetings were held at general hospitals until the dispersion of thefacilities made such meetings impractical, at which time the meetings wereconducted under the direction of the base surgeons. The surgicalconsultants contributed materially to the programs of this society.
Operational research - In May 1944, the OperationalResearch Section of the Professional Services Division was established atCambridge Military Cemetery. With the cooperation of quartermaster gravesregistration personnel, facilities were established for studying thekilled-in-action with a view to determining the types of wounds causing deaths,the missiles producing fatal wounds, and the circumstances under which deathoccurred. This operation was supervised by the surgical consultants whoassembled a great deal of valuable information.
D-day activities on 6 June 1944 - During the early partof the continental liberation the members of the consultant group were presentat the reception points on the beaches in England and at the transit hospitalssupervising the care of the wounded transported back from Normandy. As a resultof 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 ofthe Chief Surgeon in Paris, the surgical consultants were welcomed to the FrenchNational Academy of Surgery and the Val de Gr?ce Military Hospital (French).
SUMMARY
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).
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