CHAPTER XV
The Women's Army Corps
Margaret D. Craighill, M.D.
This is a historical survey of the psychiatric problems incident upon the service of women volunteers in nonprofessional occupations who were recruited for the Army in World War II, during a 3?-year period beginning in June 1942. Occasional reference is made here to the relationship of female volunteers to the male components of the Army. Emphasis in this chapter, however, is upon the administrative policies and professional medical problems of these female volunteers and upon the emotional impact of a new and unusual environment of war upon women military personnel.
DEVELOPMENT
The WAAC (Women's Army Auxiliary Corps) was established by act of Congress on 15 May 1942.1 It was reorganized as the WAC (Women's Army Corps) and incorporated into the AUS (Army of the United States) on 1 July 1943. Some 147,000 women were brought into the Army as Waacs or Wacs: 77,000 under the WAAC program and 70,000 under the WAC program (table 30).
Policies of all kinds had to be made in relation to medical conditions peculiar to this group, both as women and as minority members of the much larger organization of men with whom they were closely associated.
TABLE 30.-Accessions of personnel in the Women's Army Corps (WAAC and WAC), 1942-45
Category | Total | Officers | Enlisted personnel |
WAAC (May 1942 through July 1943) | 76,638 | 5,578 | 71,060 |
WAC (August 1942 through December 1945) | 70,442 | 1,489 | 68,953 |
| Total | 147,080 | 7,067 | 140,013 |
Source: Strength of the Army (STM-30), Department of the Army, 1 February 1948, as revised.
1Treadwell, Mattie E.: Special Studies: The Women's Army Corps. United States Army in World War II. Washington: U.S. Government Printing Office, 1954, p. 45.
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Previously, all female components of the Army had been given officer status, solely because of specialized training, such as nursing, physiotherapy, and dietetics. The professional women in these components were a much more homogeneous group than those in the WAAC or WAC which were composed of heterogeneous elements who had merged together because of a community of interest in the service of the Army. The Waacs or Wacs suffered from, and yet also profited by, a great diversity in social and educational endowment. They represented, to some extent, a cross section of American womanhood coming from the farm and from the factory, from the office and from the home.2
The WAC and other women's components of the Army had three basic characteristics in common which differentiated their psychiatric problems from those of men. Two of these factors were inherent in the Army organization; namely, in that their members were volunteers and were noncombatants. The other was a more fundamental characteristic-they were women. Because the Wacs were all volunteers, there was a self-selection which made them less typical of American womanhood than were the men who were drafted by selective service. This difference, although not the only influence, was reflected in rejection rates, as shown in a 6-month period in 1944, when the ratio of neuropsychiatric rejections for men was twice that for Wacs.3
RELATIONSHIP TO MEDICAL SERVICES
Surgeon General's Office
Although The Surgeon General was technically responsible for the medical care of the WAAC, there was little consultation or supervision until shortly before the inclusion of this auxiliary group into the Army. This function of The Surgeon General was then delegated to the first woman medical officer in the Army of the United States, Maj. (later Lt. Col.) Margaret D. Craighill, MC (fig. 42), in her assignment as Consultant for Women's Health and Welfare to The Surgeon General. This involved liaison with the Director of the WAC, Col. Oveta C. Hobby (fig. 43). Medical policies in relation to Wacs were initiated in the office of the consultant and were processed through appropriate divisions in both the
2Craighill, M. D.: Psychiatric Aspects of Women Serving in the Army: The Motivation of Women Volunteers. Am. J. Psychiat. 104: 226-230, October 1947.
3Another more valid explanation for the higher rejection rates for men as compared to those for Wacs was the deliberate policy of higher rejections for men (see chapter VIII, "Selection and Induction') as contrasted with the strong efforts made to enlist women, disregarding psychiatric standards for induction. Further, women candidates were screened before the medical examination on the basis of the data submitted by them on their applications and a special 'mental alertness test.' Also, as stated by the author, volunteer women were more prone, than were draftees, to conceal symptoms of emotional disorder and past history of mental disease. It should also be recognized that for some time the supply of men was considered to be inexhaustible and, therefore, any doubtful male inductee could be readily rejected. This policy was reversed with women volunteers in order to build up a desired strength of the WAC.-A. J. G.
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FIGURE 42.-Lt. Col. Margaret D. Craighill, MC.
Surgeon General's Office and the WAC headquarters. In this connection, the consultant, although not a psychiatrist, worked closely with the staff of the Neuropsychiatry Consultants Division, SGO (Surgeon General's Office). Recognizing that neuropsychiatric conditions would be the major medical problem, the Surgeon General's Office brought this issue to the attention of the service command and WAC headquarters. Almost a year elapsed, however, before those authorities realized the extent and seriousness of the neuropsychiatric problem.
Medical Care
Medical care of Wacs, both in the Zone of Interior and overseas, was under the appropriate Army medical authority. Wherever there was a large contingent of Wacs, a medical officer was usually assigned especially for their needs, and a dispensary was established for sick call. Hospitalization was accomplished similarly as for other women in, or
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connected with, the armed services. Medical services for the enlistment stations were usually supplied by local induction centers.
Before the commissioning of women as medical officers, there were several women physicians in the WAAC who were assigned to the training centers. Three of these, one a psychiatrist, went overseas with the first WAC contingents. As more women physicians received commissions in the Army Medical Corps, many were assigned to duty with WAC units in various parts of the world. The need for psychiatrists, especially at the WAC training centers, was recognized, and special attention was given to staffing these training centers with qualified medical officers.
PROCUREMENT
Motivation
Motivation for service were almost as divergent as the backgrounds of the women volunteers. There were some who volunteered for purely patriotic reasons and at considerable sacrifice of their own position and comfort. For many, however, this ideal was mixed in varying proportions with, or completely overshadowed by, more personal reasons. Some were influenced by a general masculine identification; others were substituting for a husband, brother, or father who was dead or disabled; and still others were competing with those significant male figures who were living. Women so impelled were usually fairly stable, and their motivation
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was of sufficient strength to carry them through the vicissitudes of military experience.
Another group enlisted in the hope of meeting more men, or for the glamour and excitement. Many of these volunteers were immature women whose enthusiasm could not stand up to the hard reality of discipline and to the monotony of army life. Then, there were the escapists who were running away from either internal conflicts or external problems in their environment. These women included those who wanted relief from rigid, or otherwise intolerable, home situations; those who were seeking substitutes for disappointment in love or marriage; and those who had always been maladjusted and were seeking that "green field" which is never found. Many of the neurotics were in this escapist group, and most were unable to resolve their previous maladjustment. It was mainly the women in this group who were responsible for numerous company problems and who were given disability discharges. A minority of them, however, did find in the orderly and disciplined routine of army life and support and leadership which they had needed, and these women became happy and useful members of the organization.
Another motivation for a large number of volunteers was a desire for occupational change. This change benefited the relatively untrained women because they were given opportunities to learn new skills or become proficient in unfamiliar techniques. However, those who sought such a change of occupation merely because of boredome were frequently disappointed to find themselves doing the same cooking or stenographic work that they were trying to avoid. In some instances, the new work was more menial than the former civilian occupation and intensified frustration.
A study4 of approximately 18,000 women at the training center at Fort Des Moines, Iowa, gave the following statistical information on motivation:
* * * 35.03 percent * * * to satisfy their needs for masculine identification; 16 percent to fulfill a need for justification, guilt, or sacrifice; 16 percent * * * patriotic or service motive; 13 percent * * * escape the monotony of their civilian existence or unpleasant home situation; 8 percent * * * security or benefit themselves; 6 percent * * * hysterical and impulsive motives; and 4 percent * * * to be like other women, to justify the use of women in military service or through a maternal influence.
It was found that neither emotional, practical, or intellectual motivation was a guarantee for success in the WAC. The healthier and more realistically motivated women were usually better adjusted and more efficient in their service. The greater the opportunity given for fulfillment of the motivation for enlistment the greater were the gains both personal and military.
Recruitment
As indicated before, the recruiting resulted in the enrollment of some 147,000 personnel for the WAAC and WAC.
4Preston, Albert, Jr.: History of Psychiatry in the Women's Army Corps, 1946, p. 4. [Official record.]
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Officers
The most outstanding results of recruitment were in the first group of officer candidates. From 30,000 applicants, 360 were initially chosen after a thorough screening process.5 Subsequently, 1,300 more were selected from this group. In commenting on recruitment, Preston6 stated:
The results of this screening procedure were excellent, and with the few exceptions the women selected during this period became the outstanding women of the WAC, not because they were the first chosen but because of their excellent qualifications and selection. Almost all of these women have justified the original opinion concerning their suitability.
No officers, expect the Director, were commissioned directly from civilian life.
After the original group of officer candidates were indoctrinated and commissioned, all subsequent officers were chosen from enlisted personnel and given special training. Preston7 described this selection as follows:
The later officers were selected from the ranks. Every effort was made to assure selection of the best material available but this selection was at times "hit and miss." At one period when there was a great need for WAC officers anyone with an AGCT [Army General Classification Test] score of 110 was considered, regardless of ability and experience; occasionally a woman who had a personality problem in her field unit was sent to OCS [Officers' Candidate School] as a means of changing her assignment; others who had done a clerical job in an efficient manner were sent and those who were popular with their company commanders. Also women who would repeatedly ask to be sent were assigned to OCS without qualification, and women who did one specific assignment well but who had no other qualifications were sent with the idea that they could come back to their original assignment and perform the same duties as an officer. Thus it was recognized early in the history of the Corps that selection of the candidates to attend Officers' Candidate School was an important decision.
Several trial methods of improving selection were instituted until finally a plan was worked out which set up an advisory committee of WAC officers and a psychiatrist and psychologist, who assisted in the selection and continued observation of the candidates. The committee recommendations were "helpful in supplying substantial reasons for elimination at screening boards. It also served to assist the eliminated candidate to accept her failure and to aid the company officers in understanding the personality of the women she trained."
5Rather than screening, this procedure was a selection process by which approximately 1 percent of the best qualified women volunteers were chosen. As stated by Treadwell, op. cit., pages 57-58: "The final selection process was of unequaled intensity. * * * eleven prominent psychiatrists searched the work histories for evidences of mental instability * * *. Answers to the essay question on 'Why I Desire Service' were believed to be particularly revealing. * * * The Director [Colonel Hobby] personally read each of the final papers. * * * Of the selected [360] candidates * * * 99 percent had been successfully employed in civil life * * * 90 percent had college training. * * * The candidates included * * * a dean of women, a school owner and director, a personnel director, a Red Cross official, a former sales manager, and several editors, and there were many more who had been reporters, office executives, lawyers, social workers, Army employees, and teachers."-A.J.G.
6Preston, op. cit., p. 8.
7Ibid., p. 13.
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Under these programs, 5,578 women were commissioned as WAAC officers and 1,489 as WAC officers, or a total of 7,067 officers (including warrant officers) (table 30).
Enlisted women
Recruitment of enlisted women for the WAAC and the WAC was done by quota in the various service commands. Quantity was stressed rather than quality. The requirement of raising a quota prompted inducements which often attracted undesirable persons and was responsible for later disillusionment and dissatisfaction because of false impressions received during recruiting campaigns. The maladjusted woman, lured by the glamour, enlisted as a means of escape. The anxiety to fill the quota, however, was so great that intense pressure for waivers was often exerted by recruiting officers. This was reflected in the variation of rejection rates in the different service commands, which will be noted in more detail later. It was apparent that such differences in rejection rates did not derive from the quality of the candidates but rather from the policy of commands in the procedure of examinations.
Psychiatric examinations were not encouraged in many areas until later experience demonstrated clearly the need for better recruiting procedures. Many recruiting devices were used, even to a guarantee of job or station assignment, according to the applicant's wishes. This was later abandoned because of findings that such practices were neither in the best interest of the service nor of the recruit.
Reenlistments.-In the change from the auxiliary to the AUS, 14,607 enrolled women and 343 officers did not reenlist. More than 75 percent chose to reenlist; that is, a total of 41,177.8 A study made of the reasons for reenlistment indicated: 'Waacs remained at stations where they were wanted and needed in their jobs.'9 They were influenced by association with good WAAC commanders and by the attitude of superior officers, including commanding generals. Those who did not reenlist were disgruntled by experience with faulty classification and assignment and by overstatements and unfulfilled promises of recruiting officers. Many were persuaded by family and friends to leave the service, because of the unfavorable publicity that had been given the WAAC.
Medical reasons also accounted for many of the failures to reenlist. Final-type physical examinations were required of all who had not been examined since 1 March 1943, a period of 6 months before the actual enlistment in the Army of the United States.10 At least one-third were disqualified, because of the more exacting physical standards and the improved
8Treadwell, op. cit., p. 228.
9Ibid., p. 226.
10War Department Circular No. 146, 26 June 1943, sec. III, amended by War Department Circular No. 173, 27 July 1943. sec. II.
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quality of entrance examinations. This is reflected in the increased number of CDD's (certificates of disability for discharge) during the 4 months' period before September 1943, in which the changeover occurred.11
ENLISTMENT PHYSICAL EXAMINATION PROCEDURES
General Considerations
Until after the change to WAC, recruiting centers did not emphasize the importance of physical standards, and few attempted psychiatric evaluations. With pressure from the Surgeon General's Office, which included personal inspection of many of the centers, analysis of the discharge rates for neuropsychiatric disorders, and followups in the service commands of enlistees who were medically discharged within 6 months, the quality of examinations improved. An attempt was made to reduce the number of examining stations to make available more adequate psychiatric consultation, but this plan was never successfully achieved. A special study of Waacs discharged for disability (all causes) by length of service indicated that somewhat over one-half of them (52 percent) were in the service less than 4 months and about three-fourths were in the service less than 5? months (table 31). (The discharges for disability are further discussed in more detail in subsequent sections.)
Length of service (months) | Percent distribution by selected cause of disability discharge | |||
All causes | Neuropsychiatric | Gynecological | Other | |
1 to 2 | 2.4 | 3.3 | 1.7 | 1.7 |
2 to 3 | 23.6 | 15.0 | 33.6 | 27.0 |
3 to 4 | 26.0 | 27.2 | 24.2 | 26.1 |
4 to 5 | 18.3 | 21.1 | 14.7 | 17.4 |
5 to 6 | 11.4 | 13.4 | 9.5 | 10.4 |
6 to 7 | 5.6 | 7.8 | 6.0 | 1.7 |
7 to 8 | 6.8 | 8.3 | 6.0 | 5.2 |
8 to 9 | 3.4 | 3.3 | .9 | 6.1 |
9 to 10 | 2.5 | .6 | 3.4 | 4.4 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
Source: WAC Enrollment Data, Distribution of Waacs Discharged From the Service Due to Disability, by Cause, August 1942 through May 1943. Report No. 3-W, Medical Statistics Division, Office of The Surgeon General, War Department, 17 Aug. 1943.
11Treadwell, op. cit., appendix A, table 12.
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Rejection Rates
WAAC.-No complete data are available on the rejections of Waacs for military service, inasmuch as the first report providing such data was submitted to the Surgeon General's Office in November 1942. (It may be recalled that the WAAC program began in June 1942.) The available rejection data are summarized by race in table 32, and shown by month and by race in table 33.
Some 23 percent of the WAAC candidates failed to meet the medical requirements: 22 percent of the white WAAC candidates and 35 percent of the Negro WAAC candidates. The rejection rates for medical reasons among Negro candidates were thus some 56 percent higher than among the white WAAC candidates. (These data exclude rejections on the basis of personal interview, referred to as administrative separations; they also exclude candidates who were eliminated before the medical examination on the basis of their application and the 'mental alertness test.')
The trend of the rejection rates for medical reasons is reflected in the
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monthly data, shown by race, in table 33 and graphically illustrated in chart 10. The data indicate, in general, a steady increase in the rejection rates, from month to month.
For the total (white and Negro) Waacs, the rejection rate rose from 158.5 in November 1942 to a rate of 328.1, per 1,000 candidates examined in July 1943. The total rejection rate somewhat more than doubled during this period.
This sharp rise in the total rejection rate is due primarily to the increase in the rejection rates of the white WAAC candidates. Their rate increased from 152.3 in November 1942, to 329.4 in July 1943, per 1,000 white candidates examined-an increase of 116 percent.
The increase in the Negro WAAC rejection rates was not so sharp. It must be recognized, however, that the initial rejection rate was much higher (above 50 percent) than that of the white WAAC candidate. At their highest point (May 1943), the Negro rejection rate was 407.2, about 48 percent higher than it was in November 1942 (the rate was then 274.4). (Their lower rejection rates for June and July 1943 relate to rather small numbers of candidates examined and to that extent these rates may not be representative of the broader trend.)
Of the most noted factors associated with the upward trend of medical rejections among WAAC candidates is the fact that the rejection rates increased as the number of WAAC candidates decreased. The indications are that the larger numbers of WAAC candidates in the early months of 1943 represented more physically fit candidates than those examined in the later months. It is also possible that the more desirable candidates were enrolled in the WAAC during the earlier months. Furthermore, the subsequent recruiting campaigns for the WAVES (women accepted for volunteer emergency service), the SPARS (Coast Guard Women's Reserve), and the Marines might have drawn off some of the better material. Also, the
Personnel | Number examined | Number accepted | Rejection rates2 | ||||||
Total | White | Negro | Total | White | Negro | Total | White | Negro | |
WAAC | 77,035 | 71,639 | 5,396 | 59,120 | 55,606 | 3,514 | 232.6 | 223.8 | 348.8 |
WAC | 88,381 | 84,222 | 4,159 | 59,064 | 56,760 | 2,304 | 331.7 | 326.1 | 446.0 |
| Total | 165,416 | 155,861 | 9,555 | 118,184 | 112,366 | 5,818 | 285.5 | 279.1 | 391.1 |
1Based on Surgeon General's Monthly Reports of WAAC and WAC enlistments, SGO Form 467, received from WAAC and WAC recruiting stations. No reports were received before November 1942 and none after December 1944. The number of accepted enlisted candidates as reported here constitutes thus 84.4 percent of the total number (140,000) of WAAC and WAC enlisted from July 1942 through December 1945, as reported in the Strength of the Army (STM-30) under WAAC and WAC accessions. (See table 30.)
2Rate expressed as number rejected per 1,000 examined.
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Month and year | Number examined | Rejection rates2 | ||||
Total | White | Negro | Total | White | Negro | |
WAAC | ||||||
| 1942 | ||||||
November | 5,275 | 5,009 | 266 | 158.5 | 152.3 | 274.4 |
December | 8,056 | 7,572 | 484 | 186.9 | 180.9 | 281.0 |
| 1943 | ||||||
January | 12,558 | 11,595 | 963 | 201.5 | 192.5 | 310.5 |
February | 15,854 | 14,670 | 1,184 | 224.6 | 214.5 | 349.7 |
March | 14,638 | 13,453 | 1,185 | 247.0 | 234.2 | 391.6 |
April | 7,174 | 6,637 | 537 | 255.5 | 244.8 | 387.3 |
May | 5,234 | 4,846 | 388 | 276.3 | 265.8 | 407.2 |
June | 4,534 | 4,305 | 229 | 301.9 | 299.0 | 358.1 |
July | 3,712 | 3,552 | 160 | 328.1 | 329.4 | 300.0 |
| Total | 77,035 | 71,639 | 5,396 | 232.6 | 223.8 | 348.8 |
WAC | ||||||
| 1943 | ||||||
October | 4,944 | 4,709 | 235 | 340.8 | 339.8 | 361.7 |
November | 4,866 | 4,673 | 193 | 313.4 | 310.9 | 373.1 |
December | 4,658 | 4,480 | 178 | 304.4 | 300.4 | 404.5 |
| 1944 | ||||||
January | 5,552 | 5,357 | 195 | 301.3 | 295.5 | 461.5 |
February | 5,819 | 5,574 | 245 | 313.6 | 308.0 | 440.8 |
March | 6,794 | 6,492 | 302 | 327.1 | 320.4 | 470.2 |
April | 6,083 | 5,793 | 290 | 311.7 | 306.1 | 424.1 |
May | 7,159 | 6,808 | 351 | 315.8 | 307.1 | 484.3 |
June | 7,597 | 7,231 | 366 | 328.3 | 323.6 | 420.8 |
July | 6,431 | 6,098 | 333 | 320.0 | 314.7 | 417.4 |
August | 6,745 | 6,427 | 318 | 315.2 | 309.6 | 427.7 |
September | 6,032 | 5,758 | 274 | 342.5 | 337.4 | 448.9 |
October | 6,440 | 6,110 | 330 | 366.9 | 362.0 | 457.6 |
November | 5,099 | 4,784 | 315 | 407.7 | 398.4 | 549.2 |
December | 4,162 | 3,928 | 234 | 390.7 | 384.2 | 500.0 |
| Total | 88,381 | 84,222 | 4,159 | 331.7 | 326.1 | 446.0 |
1See footnote 1 to table 32.
2Rate expressed as number rejected per 1,000 examined.
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increasingly more searching medical examinations and the greater experience of the examiners could have been important factors in increasing the medical rejection rates in the later months.12
The leading diagnostic causes of rejection that were principally responsible for the sharp increase in the rejection rates for medical reasons were the psychiatric and gynecological disorders. For psychiatric conditions, the rejection rate increased from 6.1 per 1,000 examined in the early 3-month period (November 1942 through January 1943), to a rate of 43.5 in the last 3-month period (from May 1943 through July 1943). The rejection rates for gynecological reasons rose during the same periods from a rate of 16.7 to a rate of 41.0 per 1,000 Waacs examined. The other leading selected diagnostic causes of rejections indicate some upward, but evidently by far a less pronounced, trend (table 34, chart 11).
There were noted during this period wide variations in the rejection rates by service command. Even in the last 4 months of this period (from
12WAAC Enrollment Data, Results of Medical Examinations of WAAC Candidates, April-July 1943, Report No. 4-W, Medical Statistics Division, Surgeon General's Office, War Department, 21 Oct. 1943.
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April 1943 through July 1943), when the total rejection rate indicated some signs of leveling off, the differences by service command were still very marked. The total rejection rates ranged from 186.7 in the Fourth Service Command to 342.4 in the Second Service Command, per 1,000 WAAC candidates examined (table 35).
Disease and disorder | WAAC | WAC | ||||||||
1942-43 | 1943 | Total | 1943 | 1944 | Total | |||||
November-January | February-April | May-July | October-December | January-March | April-July | July-September | October-December | |||
Neurological | 5.3 | 8.4 | 13.4 | 8.2 | 10.1 | 5.1 | 3.5 | 8.5 | 8.5 | 6.9 |
Psychiatric | 6.1 | 20.9 | 43.5 | 19.9 | 59.5 | 67.8 | 66.4 | 67.6 | 103.7 | 72.4 |
Gynecological (including urinary) | 16.7 | 20.9 | 41.0 | 23.1 | 57.5 | 53.7 | 61.1 | 60.3 | 65.9 | 59.6 |
Cardiovascular (excluding hypertension) | 18.5 | 24.7 | 20.6 | 21.9 | 25.3 | 26.3 | 27.6 | 22.7 | 27.1 | 25.8 |
Musculoskeletal (excluding hernia and flatfoot) | 4.8 | 7.8 | 8.1 | 6.8 | 8.9 | 6.9 | 7.9 | 9.1 | 13.3 | 9.1 |
Pulmonary tuberculosis | 11.9 | 11.7 | 14.6 | 12.3 | 13.4 | 12.4 | 12.6 | 11.8 | 10.3 | 12.1 |
Respiratory (excluding tuberculosis) | 3.8 | 4.1 | 6.2 | 4.4 | 4.0 | 6.9 | 4.9 | 7.4 | 8.0 | 6.3 |
Eye conditions | 33.9 | 38.4 | 39.6 | 37.1 | 27.1 | 24.8 | 22.5 | 25.6 | 25.9 | 25.0 |
Ear, nose, and throat | 9.1 | 14.8 | 16.5 | 13.2 | 16.1 | 14.9 | 19.2 | 13.8 | 17.3 | 16.3 |
Oral | 7.8 | 6.6 | 3.0 | 6.4 | 11.4 | 13.1 | 7.6 | 8.0 | 7.8 | 9.5 |
Syphilis | 13.0 | 13.5 | 8.2 | 12.4 | 11.4 | 10.6 | 12.9 | 10.7 | 13.8 | 11.9 |
Gonorrhea | 1.4 | 2.5 | 1.9 | 2.0 | 1.2 | 1.5 | 3.2 | 2.2 | 5.1 | 2.7 |
Other venereal diseases | 1.0 | .7 | 1.0 | .8 | .3 | .8 | .7 | .4 | .6 | .6 |
Gastrointestinal | 2.2 | 2.4 | 3.9 | 2.6 | 2.0 | 2.1 | 2.7 | 4.5 | 3.1 | 2.9 |
Flatfoot | 2.1 | 3.5 | 4.5 | 3.2 | 4.6 | 4.6 | 4.3 | 4.5 | 4.6 | 4.5 |
Overweight | 16.3 | 21.4 | 22.0 | 19.8 | 25.7 | 23.4 | 17.9 | 18.9 | 21.8 | 21.2 |
Underweight | 11.4 | 9.9 | 18.0 | 11.8 | 13.3 | 14.2 | 15.9 | 16.6 | 17.3 | 15.5 |
Underheight | 6.7 | 7.2 | 6.8 | 7.0 | 2.5 | 2.4 | 3.1 | 2.7 | 2.3 | 2.6 |
Miscellaneous | 16.1 | 19.8 | 26.4 | 19.7 | 25.6 | 23.4 | 25.0 | 30.1 | 30.1 | 26.8 |
| Total | 188.2 | 239.2 | 299.2 | 232.6 | 319.9 | 314.9 | 319.2 | 325.4 | 386.5 | 331.7 |
Number examined | 25,889 | 37,666 | 13,480 | 77,035 | 14,468 | 18,165 | 20,839 | 19,208 | 15,701 | 88,381 |
Source: Karpinos, Bernard D., and Wann, Marie E.: Certain Characteristics and Medical Findings on WAAC and WAC Candidates. [Unpublished manuscript.]
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[Rate expressed as number rejected per 1,000 examined]
Disease or disorder | Service Command | ||||||||
First | Second | Third | Fourth | Fifth | Sixth | Seventh | Eighth | Ninth | |
Psychiatric | 89.0 | 31.1 | 7.4 | 3.3 | 11.6 | 69.3 | 23.2 | 50.0 | 63.3 |
Eye condition | 29.5 | 84.7 | 29.1 | 33.8 | 17.8 | 31.5 | 46.4 | 26.6 | 50.8 |
Ear, nose, and throat | 25.9 | 15.4 | 11.1 | 10.9 | 12.0 | 26.5 | 16.9 | 8.7 | 21.1 |
Teeth | 1.2 | 1.3 | 4.9 | 3.3 | 5.3 | 1.9 | 1.3 | 5.1 | .7 |
Gynecological | 34.2 | 19.2 | 9.9 | 25.1 | 52.4 | 42.4 | 26.3 | 52.1 | 16.8 |
Urinary (nonvenereal) | 3.5 | 1.9 | 3.7 | 10.9 | 13.3 | 1.6 | 3.8 | 5.1 | 1.8 |
Syphillis | 2.3 | .6 | 3.7 | 9.8 | 6.6 | 1.2 | 3.8 | 18.3 | 1.1 |
Gonorrhea | 1.8 | .4 | .4 | 3.3 | 3.6 | 1.2 | .6 | 3.1 | 1.1 |
Other venereal | 1.0 | .6 | 1.0 | 1.0 | 5.8 | 1.0 | 1.0 | .5 | .7 |
Feet | .6 | 6.4 | 5.7 | 3.3 | 2.7 | 5.0 | 5.6 | 3.1 | 4.3 |
Musculoskeletal | 2.9 | 5.1 | 2.9 | 5.4 | 5.8 | 11.7 | 9.4 | 11.2 | 10.7 |
Cardiovascular | 25.9 | 13.1 | 15.6 | 19.7 | 24.4 | 20.2 | 16.3 | 25.0 | 33.2 |
Gastrointestinal | 1.8 | 1.6 | 3.7 | 1.1 | 4.0 | 1.6 | 2.5 | 5.6 | 5.7 |
Respiratory (except tuberculosis) | 2.9 | 6.1 | 4.1 | 8.7 | 10.2 | 1.2 | 5.0 | 4.1 | 7.9 |
Pulmonary tuberculosis | 8.9 | 14.1 | 22.6 | 5.4 | 14.2 | 20.6 | 8.1 | 10.2 | 11.4 |
Neurological | 6.5 | 12.2 | 3.3 | 2.2 | 28.8 | 4.7 | 22.6 | 21.4 | 14.7 |
Underheight | 2.9 | 19.6 | 8.2 | 6.6 | 2.2 | 3.9 | 5.0 | 5.1 | 3.9 |
Underweight | 6.5 | 37.5 | 18.9 | 18.6 | 11.1 | 9.0 | 11.9 | 12.8 | 6.4 |
Overweight | 5.9 | 51.3 | 21.8 | 6.6 | 7.5 | 14.8 | 21.3 | 17.9 | 9.0 |
Miscellaneous | 8.3 | 20.2 | 19.7 | 8.7 | 38.6 | 15.6 | 24.4 | 26.0 | 35.0 |
| Total | 260.5 | 342.4 | 196.7 | 186.7 | 277.9 | 283.9 | 254.4 | 311.9 | 299.6 |
Number examined | 1,697 | 3,119 | 2,435 | 916 | 2,253 | 2,568 | 1,596 | 1,959 | 2,797 |
1Less than 0.1 of 1 percent.
Source: WAAC Enrollment Data, Results of Medical Examinations of WAAC Candidates, April-July 1943 Report No. 4-W, Medical Statistics Division, Office of The Surgeon General, War Department, 21 Oct. 1943.
The variations in the rejection rates by service command were even more extreme for specific medical causes than for all medical causes combined. The rejection rate for psychiatric conditions ranged, during this period, from 3.3 in the Fourth Service Command to 89.0 in the First Service Command, per 1,000 Waacs examined. Next in magnitude were the variations for gynecological disorders which ranged from 9.9 per 1,000 candidates examined in the Third Service Command to a rejection rate of 52.4 in the Fifth Service Command. Large differences were also found in the rejection rates for eye conditions; ear, nose, and throat conditions; foot defects; and certain other causes of rejection (table 35).
While certain allowances may be made for these variations by service command to actual geographic difference in the prevalence of these defects,
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it seemed most likely that they were due primarily to lack of uniformity in the interpretation of the medical standards as well as to a certain laxity in the examinations per se. This has led to increased emphasis on the need for more adequate examinations, especially in regard to the psychiatric.
WAC.-Coincident with the conversion of the WAAC to WAC, which took place over a period of time extending from June through September 1943, both the age limits and the medical standards of examination were changed. Formerly, under the WAAC regulations, applicants for enrollment had to be at least 21 and not over 44 years of age; under the WAC standards, the age limits were extended from 20 through 49; and WAAC officer candidates were considered if over 44, but under 50 years of age. At the same time, the medical standards were modified for the Wacs to conform with those prescribed for Army nurses, except for the somewhat more lenient WAC standards for vision, height, and weight, which were retained. Pelvic examinations were made mandatory for all WAC candidates, and the various disqualifying conditions peculiar to women were specifically enumerated. It was further recommended that the pelvic examinations be made by a qualified gynecologist. The instructions pertaining to other phases of the examination were also amplified to require a psychiatric and neurological examination by a neuropsychiatrist. These changes were to make the psychiatric and physical requirements for enlistment in the WAC somewhat more stringent than those for the WAAC.13
The rejection rates of WAC candidates are shown by month, as those of the WAAC, in table 33 and graphically depicted in chart 10. The WAC data cover the period from October 1943 through December 1944. (No data are given for the period of conversion from WAAC to WAC.) The rates relate to medical reasons only. As in the case of the WAAC, these data exclude those WAC candidates who were eliminated before coming up for the medical examination on the basis of information submitted in their application and in most cases through the 'mental alertness test.'
In considering the total periods, namely, WAAC versus WAC, the rejection rates were much higher for the WAC: 331.7 Wacs rejected for medical reasons, as compared with 232.6 rejected Waacs, per 1,000 examined candidates, indicating an increase of 43 percent in the rejection rates. By race, the increase in the WAC rejection rates over those of the WAAC were 46 and 28 percent of white and Negro WAC candidates, respectively. (Although the rejection rates of Negro WAAC candidates were 56 percent higher than those of white WAAC candidates, those of Negro WAC candidates were 37 percent higher than the rejection rate of white WAC candidates.) (See table 32.)
With regard to psychiatric conditions, the rejection rate for the entire period, from October 1943 through December 1944, was 72.4 per 1,000 medically examined WAC candidates (table 34). As may be seen from these
13WAC Enlistment Data, Results of Medical Examinations of White WAC Candidates, Report 5-W, Medical Statistics Division, Surgeon General's Office, Army Service Forces, 6 Mar. 1944.
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data, it rose from a rate of 59.5 in the last quarter of 1943 (October through December 1943); it remained about constant for 9 months (from January 1944 through September 1944), fluctuating around a rate of 67.0, but rose sharply in the last quarter of 1944 (a rate of 103.7) (table 34 and chart 11).
A similar trend of initial increase in the rejection rate, with a tendency to become stabilized, may be noted also in the rejection rates for gynecological disorders. Other defects, such as cardiovascular and ear, nose, and
CHART 12.-Medical rejection rates of WAAC and WAC candidates, by diagnosis
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TABLE 36.-Rejections of white WAC candidates, by specific diagnosis, October 1943 through March 1944
Diagnosis | Rate1 | Percent | Diagnosis | Rate1 | Percent |
Neurological | 7.5 | 2.4 | Respiratory (excluding tuberculosis) | 5.7 | 1.8 |
Psychiatric | 64.7 | 20.7 | Eyes | 25.9 | 8.3 |
| Psychosis | 2.7 | .9 | |||
| Psychoneurosis | 24.1 | 7.7 | Myopia | 8.0 | 2.6 |
| Psychopathic personality | 33.1 | 10.6 | Amblyopia | 8.4 | 2.7 |
| Other psychiatric | 4.8 | 1.5 | Other | 9.5 | 3.0 |
Gynecological (including urinary) | 54.3 | 17.4 | Ear, nose, and throat | 15.7 | 5.0 |
| Lesions of cervix | 11.9 | 3.8 | Otitis media | 5.6 | 1.8 |
| Benign tumors of uterus | 7.5 | 2.4 | Tympanic | 4.2 | 1.3 |
| Relaxed vaginal outlet | 4.9 | 1.6 | Nose, sinus, and throat | 3.6 | 1.2 |
| Menstrual disorders | 3.8 | 1.2 | Other ear defects | 2.3 | .7 |
| Other gynecological | 12.7 | 4.1 | Oral | 11.8 | 3.8 |
| Urinary | 13.5 | 4.3 | Insufficient teeth | 9.3 | 3.0 |
Cardiovascular | 34.4 | 11.0 | Other oral defects | 2.5 | .8 |
| Veins | 6.1 | 2.0 | Venereal diseases | 9.2 | 2.9 |
| Hypertension | 8.9 | 2.8 | Syphilis | 7.5 | 2.4 |
| Other | 19.4 | 6.2 | Gonorrhea and other venereal diseases | 1.7 | .5 |
Musculoskeletal (including hernia and flatfoot) | 13.4 | 4.3 | Gastrointestinal | 2.2 | .7 |
| Ankylosis | 1.5 | .5 | Build | 40.4 | 12.9 |
| Arthritis | 1.1 | .4 | Overweight | 23.9 | 7.6 |
| Deformities | 4.4 | 1.4 | Underweight | 14.0 | 4.5 |
| Flatfoot | 4.4 | 1.4 | Other build defects | 2.5 | .8 |
| Hernia | .7 | .2 | Miscellaneous | 14.7 | 4.7 |
| Other musculoskeletal defects | 1.3 | .4 | Total | 312.6 | 100.0 |
Pulmonary tuberculosis | 12.7 | 4.1 | |||
| Reinfectious type | 7.9 | 2.5 | |||
| Primary | 3.7 | 1.2 | |||
| Other | 1.1 | .4 | |||
1Number rejected per 1,000 Wacs medically examined.
Source: Karpinos and Wann, op. cit. (table 34).
throat, show about constant rejection rates, while the rejection rates for eye conditions indicate a definite decrease (table 34, chart 11). (See also chart 12 for graphic presentation of the WAC rejection rates by diagnosis, compared with those of the WAAC.)
Of additional and important interest are the more specific diagnoses that are presented in table 34. Rejections of white WAC candidates for these medical reasons, during the 6-month period from October 1943 through March 1944, are presented in table 36.
The rejection rate of white WAC candidates for psychiatric reasons was 64.7 and for neurological reasons 7.5, or a rate of 72.2 for neuropsychiatric reasons per 1,000 white Wacs examined.
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The rejection for psychiatric conditions constituted 20.7 percent of all rejections for medical reasons, among which psychopathic personality (10.6 percent) and psychoneurosis (7.7 percent) were the primary causes of the psychiatric rejections. About 23 percent of the Wacs rejected for medical reasons were rejected for neuropsychiatric disorders (20.7 for psychiatric and 2.4 for neurological disorders, table 36).
For the same period, about two out of every five men rejected at induction stations were excluded for such causes. One important reason for this difference arose from the fact that WAC candidates were volunteers, and self-selection operated to some extent to eliminate misfits. Of course, this favorable tendency was offset to some degree by the desire of these candidates to seek WAG service as an escape from, or a solution to, present personal difficulties which might have originally developed as a result of emotional instability. However, the first factor, that of self-selection, probably had the greater effect upon the rejection rate in reducing it below the level for men, who had no such choice regarding military service.
But, even with adequate psychiatric examination, the proper selection of female candidates was a more difficult procedure than it was with men. Women volunteers tried to conceal disabilities, whereas the reverse was often true with male inductees. Also, there was less past experience on which to base criteria for selection of those women who had a potential emotional capacity to adapt to regimentation.
It soon became apparent that, among the many factors that affected the psychiatric suitability of the Wacs, age was most important. Neuropsychiatric rejections for WAC candidates rose steadily with advanced age. Of the WAC candidates under 25 years of age, 56 per 1,000 were rejected for psychiatric reasons. This rate of rejection increased with age until, for the older age group, over 40 years of age, 88 per 1,000 examined candidates were so rejected (table 37).
Marital status made certain differences in the rejection for psychiatric
[Rate expressed as number rejected per 1,000 examined]
Age | Neurological | Psychiatric | Total neuropsychiatric |
Under 25 | 6.3 | 55.7 | 62.0 |
25 to 29 | 7.4 | 60.5 | 67.9 |
30 to 34 | 8.8 | 68.3 | 77.1 |
35 to 39 | 8.3 | 78.9 | 87.2 |
Over 40 | 10.4 | 87.6 | 98.0 |
| Total | 7.5 | 64.7 | 72.2 |
Source: Karpinos and Wann, op. cit. (table 34).
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[Rate expressed as number rejected for psychiatric conditions per 1,000 examined]
Age | Single | Married | Other1 | Total |
Under 25 | 53.9 | 55.0 | 74.5 | 55.7 |
Over 25 | 73.5 | 70.7 | 77.6 | 73.9 |
| Total | 60.7 | 64.5 | 77.0 | 64.7 |
1Refers to widowed, divorced, or separated.
Source: Karpinos and Wann, op. cit., (table 34).
[Rate expressed as number rejected per 1,000 examined]
Disease or disorder | Service Command | ||||||||
First | Second | Third | Fourth | Fifth | Sixth | Seventh | Eighth | Ninth | |
Psychiatric | 96.9 | 56.6 | 7.0 | 43.8 | 56.9 | 123.4 | 32.7 | 82.6 | 43.0 |
Syphilis | 4.2 | 10.8 | 8.1 | 11.6 | 11.6 | 2.0 | 5.7 | 20.1 | 3.3 |
Eye conditions | 16.0 | 67.3 | 30.6 | 16.5 | 18.7 | 25.5 | 19.9 | 18.0 | 19.8 |
Gynecological | 27.8 | 43.6 | 36.5 | 36.4 | 97.0 | 17.8 | 70.4 | 46.5 | 44.1 |
Pulmonary tuberculosis | 11.0 | 10.8 | 16.6 | 3.3 | 14.2 | 15.8 | 6.4 | 14.6 | 19.2 |
Cardiovascular | 21.1 | 15.6 | 23.6 | 29.8 | 31.1 | 20.9 | 17.1 | 30.5 | 38.0 |
Overweight | 13.5 | 51.7 | 22.0 | 11.6 | 28.5 | 22.9 | 43.4 | 9.0 | 17.6 |
Underweight | 1.7 | 31.2 | 10.7 | 17.4 | 16.0 | 7.6 | 14.2 | 11.1 | 9.9 |
Ear, nose, and throat | 11.8 | 17.2 | 24.2 | 8.3 | 13.3 | 19.9 | 19.9 | 15.3 | 13.8 |
Teeth | 1.7 | 19.4 | 30.1 | 2.5 | 28.5 | 2.5 | 5.7 | 1.4 | 3.3 |
Neurological | 1.0 | 3.8 | 9.1 | 5.8 | 11.6 | 2.0 | 22.8 | 22.9 | 16.5 |
Musculoskeletal | 1.7 | 4.3 | 4.3 | 5.8 | 7.1 | 18.4 | 10.7 | 11.1 | 14.3 |
Feet | .8 | 11.9 | 3.2 | 5.8 | .9 | 2.5 | 6.4 | 3.5 | 2.8 |
Genitourinary | 7.6 | 3.2 | 8.1 | 10.7 | 22.2 | 29.1 | 10.0 | 20.8 | 6.1 |
Gonorrhea | 1.0 | .5 | 1.0 | 2.5 | .9 | 1.0 | 1.4 | 3.5 | 1.7 |
Other venereal diseases | 1.0 | 1.0 | 1.0 | .8 | 1.0 | 1.0 | .7 | .7 | .6 |
Respiratory (except tuberculosis) | 1.7 | 2.2 | 2.7 | 10.7 | 8.9 | 1.5 | 2.8 | 2.8 | 6.1 |
Gastrointestinal | 1.7 | .5 | 3.8 | .8 | 1.8 | 1.5 | 2.8 | .7 | 4.4 |
Underheight | 1.0 | 7.0 | 3.2 | 1.7 | 1.8 | 2.0 | 4.3 | 2.1 | 1.0 |
Miscellaneous | 22.7 | 19.4 | 32.7 | 20.7 | 16.0 | 18.9 | 30.6 | 25.7 | 40.2 |
Total | 241.9 | 377.0 | 276.5 | 246.5 | 387.0 | 334.2 | 327.9 | 342.9 | 304.7 |
Number examined | 1,187 | 1,856 | 1,863 | 1,210 | 1,124 | 1,961 | 1,406 | 1,441 | 1,814 |
1Less than 0.1 of 1 percent.
Source: WAC Enlistment Data, Results of Medical Examinations of White WAC Candidates, Report No. 5-W Medical Statistics Division, Office of The Surgeon General, Army Service Forces, 6 Mar. 1944.
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conditions. Compared with married women, the rejection rates for psychiatric conditions were somewhat higher for single women over 25 years of age. The total rejection rate for psychiatric reasons of single women, however, was found to be 60.7 per 1,000 candidates, lower than the rejection rates for married women, which was 64.5. The lower rate for single women is explained by the fact that the single women were relatively younger.
Definite differences were revealed for those classified as 'other'; namely, the widowed, divorced, or separated. The data indicated higher rejection rates for these women by age, as well as for the total. Their total rejection rate for psychiatric reasons was 77.0-clearly much above those for single or married women (table 38).
Despite all the efforts made to bring about uniformity in the processing procedures of the WAC, differences in the rejection rates by service command persisted, as evidenced by the data in table 39. Of course, these rates relate to the earlier period of the WAC program.
Relation to discharge rates.-During the 10-month period of the WAAC, from August 1942 through May 1943, some 1,200 Waacs were discharged for disability.14 Neuropsychiatric disorders accounted for 44.3
Disease or disorder | Percent distribution | Disease or disorder | Percent distribution |
Neuropsychiatric diseases | 44.3 | Gastrointestinal | 4.3 |
| Psychoneurosis | 38.2 | Gastric and duodenal ulcers | 1.0 |
| Schizophrenia | 2.0 | Hernia | .7 |
| Epilepsy | 2.0 | Other | 2.6 |
| Other | 2.1 | Eye, ear, nose, and throat | 1.5 |
Gynecological | 28.2 | Eyes | .3 |
Infections and general disease | 7.8 | Ears | .7 |
| Arthritis | 3.8 | Nose and throat | .5 |
| Endocrine system | 1.4 | Respiratory (except tuberculosis) | 1.4 |
| Other | 2.6 | Venereal disease | .2 |
Musculoskeletal defects or disease | 7.6 | Syphilis | .1 |
| Musculoskeletal disease | 3.9 | Gonorrhea | .1 |
| Feet | 3.6 | Tuberculosis | .2 |
| Other | .1 | Total | 100.0 |
Cardiovascular | 4.5 | ||
| Organic heart disease | 2.1 | ||
| Varicose veins | 1.7 | ||
| Other | .7 | ||
Source: WAAC Enrollment Data, Distribution of Waacs Discharged From the Service Due to Disability, by Cause, August 1942 through May 1943. Report No. 3-W, Medical Statistics Division, Office of The Surgeon General, War Department, 17 Aug. 1943.
14Derived from Treadwell, op. cit., appendix A, tables 9 and 12.
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Length of service | Under 25 | 25 and over | Total |
Less than 3 months | 24.0 | 23.0 | 23.4 |
3 to 6 months | 34.8 | 31.5 | 32.7 |
6 to 9 months | 28.9 | 29.3 | 29.2 |
9 months and over | 12.3 | 16.2 | 14.7 |
| Total | 100.0 | 100.0 | 100.0 |
Source: Karpinos and Wann, op. cit. (table 34).
percent of the WAAC discharges for disability, among which psychoneurosis was the main diagnostic cause (38.2 percent of all disability discharges) (table 40). The discharges for disability for neuropsychiatric disorders were most likely to occur between the third and fifth months after enrollment (table 31). As reported by the Control Division, ASF (Army Service Forces), 28 May 1943-
Most of the physical disabilities resulting in discharge of WAAC auxiliaries existed prior to enrollment, * * * indicating that thorough physical examination is not being given in many cases. Proper screening of enrollees would also result in rejection of many of the neurotics now being admitted only to be discharged later.
Of the Wacs separated for disability, about one-fourth (23.4 percent) had less than 3 months' service. Somewhat more than one-half of them (56.1 percent) were discharged within 6 months of their enlistment; 85.3
Cause of separation | Percent distribution and length of service | ||
Less than 6 months | 6 months and over | Total | |
Neuropsychiatric | 54.3 | 59.2 | 56.5 |
Genitourinary | 19.7 | 19.0 | 19.4 |
Infections and general diseases | 4.6 | 4.6 | 4.6 |
Musculoskeletal | 6.7 | 2.9 | 5.1 |
Cardiovascular | 4.6 | 3.8 | 4.2 |
Eye, ear, nose, throat, and respiratory diseases (excluding tuberculosis) | 4.0 | 4.6 | 4.2 |
Gastrointestinal | 1.9 | 1.9 | 1.9 |
Other | 4.2 | 4.0 | 4.1 |
| Total | 100.0 | 100.0 | 100.0 |
Source: Karpinos and Wann, op. cit. (table 34).
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percent of the discharged had less than 9 months of service (table 41, last column).
Above one-half (56.5 percent) of the WAC separations for disability were for neuropsychiatric disorders (table 42, last column). Again, as in the case of the WAAC, the WAC discharges for neuropsychiatric disorders were mainly for psychoneurosis: 44.3 percent of all disability discharges. In other words, somewhat above three-fourths (78.4 percent) of the neuropsychiatric discharges were for psychoneurosis (table 43).
The rates of the WAC disability discharges for all causes indicated an increase with age, marked especially in the '40 and over' age group (table 44). The same age pattern could be observed with respect to separations for neuropsychiatric disorders.
The disability discharge rates were much higher among married and 'other' (widowed, divorced, or separated), than among single women (table 45).
When viewed from the point of view of the total WAAC and WAC experience, the separation data indicate that 8.3 percent of the enlisted Waacs and Wacs were separated for disability, prior to demobilization (table 46).
The disability discharge rates, relating to the mean annual strength, are presented by year in table 47. The high disability discharge in 1943 is to be attributed to the conversion procedures, from WAAC to WAC, which
Cause of separation | Percent distribution | Cause of separation | Percent distribution |
Neuropsychiatric | 56.5 | Cardiovascular | 4.2 |
| Psychoneurosis | 44.3 | Organic heart disease (including valvular) | 1.4 |
| Psychosis | 17.1 | Varicose veins | 1.2 |
| Other | 5.1 | Other | 1.6 |
Genitourinary | 19.4 | Eye, ear nose, throat, respiratory (excluding tuberculosis) | 4.2 |
| Gynecological (excluding menopause) | 10.3 | Respiratory (excluding tuberculosis) | 2.4 |
| Menopause | 7.8 | Other | 1.8 |
| Other | 1.3 | Gastrointestinal | 1.9 |
Infections and general disease | 4.6 | Result of traumatism | .7 |
| Arthritis | 3.5 | Other | 1.8 |
| Other | 1.1 | Total | 100.0 |
Musculoskeletal | 5.1 | ||
| Feet | 2.1 | ||
| Other | 3.0 | ||
1Includes 4.2 percent for schizophrenia.
Source: Karpinos and Wann, op. cit. (table 34).
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[Rate expressed as number separated per 1,000 accepted]
Age | Less than 6 months | Total |
Under 25 | 15.9 | 27.1 |
25 to 29 | 20.1 | 37.8 |
30 to 34 | 22.2 | 40.3 |
35 to 39 | 27.0 | 53.5 |
40 and over | 52.3 | 92.2 |
| Total | 22.2 | 39.5 |
1These data relate to Wacs who enlisted during the period from October 1943 through March 1944 and were separated on certificates of disability for discharge during the period from October 1943 through October 1944.
Source: Karpinos and Wann, op. cit. (table 34).
[Rate expressed as number separated per 1,000 accepted]
Marital status | Less than 6 months | Total |
Single | 14.4 | 24.7 |
Married | 36.7 | 64.8 |
Other1 | 31.9 | 60.7 |
| Total | 22.2 | 39.5 |
1See footnote 1 to tables 38 and 44. 'Marital Status' at the time of enlistment.
Source: Karpinos and Wann, op. cit. (table 34).
required a final type of physical examination for all Waacs who had not been examined within 6 months prior to their enlistment.
Psychiatric Screening
The need for more adequate psychiatric screening of Wacs was given impetus in October 1943 by recommendations from the National Committee for Mental Hygiene which met at the Surgeon General's Office. This committee recommended that a social history record of the candidate be made available to the psychiatrist at the examining station.15 This recommendation was implemented by the Neuropsychiatry Consultants Division, SGO,
15Memorandum, Col. Oveta Culp Hobby, WAC, for Assistant Secretary of War (thru: Commanding General, Army Service Forces), 8 Dec. 1943, subject: Plan for Psychiatric Screening of Applicants for Enlistment in the Women's Army Corps.
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Cause of separation | Number | Percent |
Medical reasons | 22,324 | 16.3 |
| Disability discharges | (11,387) | (8.3) |
| Pregnancy | (10,937) | (8.0) |
Inaptitude or unsuitability | 1,322 | 1.0 |
Commissioned as officers | 7,872 | 5.7 |
Honorable discharges1 | 61,155 | 44.6 |
Discharges other than honorable2 | 1,212 | .9 |
Dishonorable discharges | 71 | 3.0 |
Deaths (nonbattle) | 160 | .1 |
Demobilization | 43,093 | 31.4 |
| Total | 137,209 | 100.0 |
1Includes separations for overage, minority, dependency, importance to national health, safety, or interest, and so forth. Also included in this category are 14,199 enlisted Waacs separated at their request at the time of conversion to the WAC.
2Includes undesirable habits or traits of character and misconduct.
3Less than 0.1 of 1 percent.
NOTE.-Figures in parentheses are subtotals.
Source: Derived from: Treadwell, Mattie E.: Special Studies: The Women's Army Corps. United States Army in World War II. Washington: U.S. Government Printing Office, 1954, appendix A, tables 9 and 12.
TABLE 47.-Discharges for disability and pregnancy of Waacs and Wacs, by year, 1942-46
[Rate expressed as number of discharges per 1,000 mean strength per year]
Year | Discharges for- | |||
Disability | Pregnancy | |||
Number | Rate | Number | Rate | |
1942 | 47 | 18.6 | 16 | 6.4 |
1943 | 3,497 | 81.3 | 766 | 17.8 |
1944 | 3,094 | 44.1 | 3,612 | 51.5 |
1945 | 4,322 | 53.5 | 5,691 | 70.5 |
1946 | 427 | 22.5 | 852 | 45.0 |
| Total | 11,387 | 52.9 | 10,937 | 50.8 |
Source: Derived from Treadwell, op. cit.,appendix A, tables 1, 9, and 12.
and the services of skilled social workers were obtained to organize and implement this phase of the psychiatric screening program. A WAC Selection Conference at Fort Des Moines, in July 1944, explained the social history procedure and emphasized the need for such data to appropriate WAC officers in all service commands.
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An instructional guide in psychiatric screening was prepared in the Surgeon General's Office and, subsequently, issued on 4 October 1944 as War Department Technical Bulletin (TB MED) 100. This bulletin provided the psychiatrist with background information on the basic training and subsequent life in the WAC. It listed the requirements for enlistment other than physical and psychiatric. It outlined the procedures for, and the problems peculiar to, WAC enlistment. Further, it set forth the objective of the WAC neuropsychiatric examination, which was 'to re-evaluate the individual in relation to the new environment, to exclude the unfit individual * * * and to protect the individual from dislocation from her home and introduction into an environment in which she cannot reasonably expect to adjust adequately.'
Following this effort to improve psychiatric screening, one of the training centers reported: 'The quality of recruit improved; psychiatric problems were reduced and the disability rate was decreased as a result of the * * * procedures.'16
MENTAL HYGIENE CONSULTATION SERVICES
Fort Des Moines was the first WAC training center, and from its inception in 1942, there was a realistic approach to psychiatric problems, owing in large part to the influence of Maj. Albert Preston, Jr., MG,17 the chief psychiatrist. Although the need for a mental hygiene consultation service was recognized and efforts in this direction made by both the Director. WAC, and the Surgeon General's Office, 2 years elapsed before it was possible to establish a mental hygiene consultation service at Fort Des Moines18 and, a few months later, at Fort Oglethorpe, Ga. Major Preston described the mental hygiene consultation services as follows:
* * *. Originally centered in the Station Hospital at Fort Des Moines, the Consultation Service was moved to the Training Center Area, in June 1946, * * * in close proximity to Personnel and easily accessible to all of the trainees.
The functions of the Consultation Service were to give psychiatric first aid to the enlisted women, trainees, or assigned personnel, through individual and group psychotherapy; give psychiatric counseling to the officers; advise with the commanding officer regarding matters of mental health of the command; give psychiatric consultation service to the Station Hospital, advise with Classification concerning proper utilization of enlisted women; and give talks on Mental Hygiene to officers and enlisted women.
Cooperation between all units of the post was excellent and all assistance possible was given by headquarters to 'maintain the mission' of the Consultation Service. Favorable reception of the facilities of the Consultation Service was probably greater
16Preston, op. cit., p. 11.
17The material in this section has been drawn either verbatim or with modifications from Major Preston's manuscript (see footnote 4, p. 421), and unless otherwise indicated, quoted paragraphs have been cited from this source.-M. D. C.18Memorandum, Maj. Gen. Norman T. Kirk, The Surgeon General, for Commanding General, Headquarters, Seventh Service Command, Omaha, Neb., (attn: The Surgeon), 10 Apr., 1944, subject: Establishment of a Neuropsychiatric Consultation Service at the WAC Training Center at Des Moines, Iowa.
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by women than by men and less resentment was shown to psychiatric referrals. This was illustrated by the fact that 5.4% of all referrals were self referred. Acceptance by the WAC company officers was slow at first, * * * many of the women officers did not like to admit that there were failures of adjustment in their command and felt that the Consultation Service was invading their own advisory fields. Later, this was overcome and 54.3% of all referrals to the Consultation Service came through the basic company commanders. A relatively small number of referrals came through medical channels, 26.9%. All of this may be due to the fact that in women 'the socially acknowledged and permitted emotionalism' is accepted and not judged as a conflict, stigma, or weakness, as in men. This accounts also in part for the different manifestations seen in the type of disorders treated in a Consultation Service at a WAC Training Center.
The staff of the Consultation Service consisted of a Psychiatrist (male), Clinical Psychologist, Psychiatric Social Workers (two SSN 263), clerical assistants (three), and a Red Cross Unit made up of a well-qualified Psychiatric Social Worker and a stenographer. This staff worked closely as a team. Upon referral of a case and receipt of the written reasons for the referral, the patient was interviewed by the 263 [social worker] who took a detailed personal, social, and military history. Then a case conference was held with the psychiatrist or psychologist; indicated psychological tests were given, and the case referred to either the psychiatrist or the psychologist. Therapeutic aims were outlined and treatment instituted at the appropriate level, the Company Commander, the 263 [social worker], the ARC [American Red Cross], the psychologist, or the psychiatrist. From 1 to 10 interviews were utilized in treatment, the average number being 2. A small number of cases were referred to the hospital for consultation with other specialties or a brief period of hospitalization. All psychotics and severe psychoneurotics were admitted to the Station Hospital for observation for discharge or transfer to a General Hospital.
Mental Hygiene lectures were given in the Post Theater to groups of one basic company. Three lectures at weekly intervals were given. Better results could have been achieved if the lectures had been given at the platoon level and in closer sequence, since it was seen that better response was obtained when the mental hygiene talks were given to smaller groups. The lectures followed in general the outline of TB MED 21, emphasizing * * * normalcy of symptom development following such disabilities. Attempts were made also to give a simplified developmental psychology of women in an effort to achieve a greater understanding of the basic mechanisms of adjustment and maladjustment in women. These lectures were illustrated by charts, chalk talks, and a group of slides, 'Jane and Mame,' an adaption for women of 'Mack and Mike,' done with the permission of Lt. Col. R. Robert Cohen, MC, of Aberdeen Proving Ground, Md.
It became more and more obvious to the officers that as the war progressed the enlisted women needed psychiatric guidance, and frequent calls were made for group counseling by the company officers and by groups of enlisted women.
The Consultation Service worked in close liaison with the Director of Training. Through the study of emotionally disturbed women referred to the Service, recommendations were made which often alleviated the temporary maladjustment of the trainees. These suggestions related to teaching methods and to the interpersonal relationships of the instructor with the student. Group discussions with the cadre and officers were used to point out psychological problems and their solutions.
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HEALTH EDUCATION
Because of early unfortunate publicity regarding the moral standards of the WAAC, the Director was extremely cautious about any type of educational material on health matters.
Training Pamphlet
A training bulletin was prepared by the WAAC office, with some medical advice, but it was inadequate. This bulletin, issued on 27 May 1943 as War Department Pamphlet No. 35-1, consisted of six lectures. The pamphlet was described by the WAC historian, Lt. Col. Mattie E. Treadwell,19 as follows: 'This was, however, an unsensational document, part of the routine training course, which prescribed standard subjects no more radical than those given in high schools and colleges-and which said nothing whatever about the issue of contraceptives.' This pamphlet sounded more like a moral than a medical discourse, and in the opinion of annoyed medical officers, a more Victorian approach to the facts of life could scarcely have been contrived.
Rumor.-Perhaps the title, 'Sex Hygiene Course, Officers and Officer Candidates, WAAC,' was unfortunate in provoking curiosity. The pamphlet served to climax a previous whispering campaign about the morals of the Waacs, for on 8 June 1943, the Washington Times-Herald published a sensational article which stated, among other things, that 'contraceptives and prophylactic equipment will be furnished to members of the WAAC, according to a supersecret agreement by high-ranking officers.' This gave fuel to the slander campaign to such an extent that the Army's Military Intelligence Service made an extensive investigation all over the Nation of the rumors and drew the following conclusions as to the origin and source of those stories:
Army personnel * * * who resent members of the WAAC * * *.
Soldiers' wives.
Jealous civilian women.
Gossips: Thoughtless gossiping men and women. Men [who] like to tell off-color stories.
Fanatics: Those who cannot get used to women being in any place except the home.
Waacs: Disgruntled and discharged Waacs.
The intensity of the rumors decreased after testimony before various House Committees and denials by President and Mrs. Franklin D. Roosevelt, Gen. George C. Marshall, and other military and civilian leaders. However, the effect on the future policies in regard to medical education of the WAC was profoundly affected by the Director's fears, and her attitude stemmed largely from this experience.
19The quoted passages in this section are from Treadwell, op. cit., pp. 203-206.
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Instructors
There were not sufficient medical personnel to give proper instruction outside of the training centers. Therefore, a plan20 was devised in the Surgeon General's Office to develop capable instructors from a selected group of about 83 WAC officers, by means of an intensive training course at the Johns Hopkins School of Hygiene, Baltimore, Md., under the title 'Preventive Medicine.' This course was conducted by outstanding civilian specialists. It included the anatomy, physiology, and pathology of the reproductive system, but the major portion of the time was given to lectures and to discussion groups in psychiatry. The topics were 'Psychological Approach,' 'Normal Psychology of Sex,' 'Emotional Maturity,' 'Common Forms of Psychiatric Conditions,' and 'Sexual Maladjustment.'
These officers were then assigned to all WAC installations in rotation to initiate a basic training program in health education to the already enlisted women of the Corps. Subsequently, all such instructions were to be given during the regular training program.
Training Aids and Literature
Efforts were made to have the material from the training course printed for use by the instructors. Approval for its publication was never obtained. In October 1944, however, a simplified but inadequate form for training purposes was made available. Later, in May 1945, War Department Pamphlet No. 35-1 was revised so that it followed more closely the outline of the Johns Hopkins lectures, and this was incorporated in the regular health education courses under the direction of the Training Division of the Surgeon General's Office.
Repeated attempts by the Surgeon General's Office to supply printed or illustrated material for health education, especially concerning psychiatry or venereal diseases, were blocked at different levels of command, including the WAC Director and public relations officials, for fear of misinterpretation by the public. Late in the war, some movies were allowed, and one on personal hygiene was even planned and then filmed in Hollywood, under the supervision of the Surgeon General's Office. Some educational pamphlets were prepared on various medical aspects, including oversea health problems. These were illustrated in cartoon style by professional artists.
UTILIZATION OF WAC PERSONNEL
Objective
The objective of the WAAC was stated to be 'for the purpose of
20Memorandum, Maj. Margaret D. Craighill, MC, for Director, Preventive Medicine Division, SGO 28 July 1943, subject: Conference on Preventive Medicine, Baltimore, Maryland, 12-18, July 1943.
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making available to the national defense the knowledge, skill, and special training of the women of the nation * * * to replace men.'21 This placed the emphasis on the use of qualified women to replace men in jobs requiring skilled workers, especially those in which critical shortages existed. When possible, women with civilian skills were recruited so that only basic military training was needed before assignment. However, this goal was not achieved, and according to Major Preston:
* * * only 35% were skilled civilian workers, 31% semiskilled, and 34% unskilled.
Classification and assignment officers in the WAC had the problem of correlating the military needs, the skills presented by the recruits, the utilization of large numbers of unskilled women and the wishes of women in assignment. Early in the history of the WAAC, Classification and Assignment procedures paid little attention to the desires of the recruits or to their psychological needs.
Classification and Assignment
After the Consultation Service was established at Fort Des Moines, there were frequent referrals by classification officers, which 'led to assignments based on the fulfillment of ability, motivation, and psychological suitability for the job. It is well known that to give a person a job she wants, likes, and is able to do is a prime prerequisite for good adjustment and mental health.'
For the Wac, particularly in the early days, there was frequent serious doubt in her own mind and in the minds of her associates about the importance of her job in the war effort. She was unhappy because she compared the usefulness of her Army job with what she might otherwise have been contributing in civilian life. It took the Army a long time to learn how to use these women effectively who finally proved their value so well that the demand for their services far exceeded the supply, both in the Zone of Interior and overseas.
Wacs were more difficult to place than men, because all women's assignments were to positions in which training, special aptitudes, or qualifications were required. There were no menial tasks such as continuous KP (Kitchen Police) or orderly work, nor could the untrained be absorbed, as were men, in the great groups of combat troops. Women, thus, came in direct competition with men for skilled jobs and actually replaced them. This was one of the largest causes of friction and jealousy from men. Soldiers so replaced and sent to combat duty naturally resented it, and their hostility was directed toward the WAC rather than toward the less tangible military necessity.
The proper utilization of Wacs was, therefore, dependent on the special aptitudes and intelligence of the women coming from civilian life. While over 80 percent of the Wacs were in the three upper grades of AGCT (Army General Classification Test), the 18 percent who were in the two lowest
21U.S. Public Law 554, Secs. 1 and 12, 14 May 1942.
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grades presented problems out of proportion to their numbers because there were no assignments for which they qualified. Also, many of these women were emotionally unstable, and few had a civilian skill which could be utilized successfully by the military service. Special provision had to be made for them.
Training
Several types of programs were given for women of varying potentialities, such as the 'Opportunity School,' the 'Special Training Unit,' the 'Leadership School,' and the 'School for WAC Personnel Administration.'
Opportunity School.-The purpose of this school was 'to give special training to enlisted women who had no skill or use to the Army.'22 Of the 552 women sent to this school, 388 were in Grade IV or V, AGCT. Major Preston commented:
After psychiatric examination of many of these women it was found that they had been sent to the school as disciplinary problems, or as problems of adjustment, after being transferred from station to station or job to job, rather than as women lacking in skill.
Most of the women resented the name of the school, feeling that 'Opportunity' had definite degrading connotations.
Because of the nature of the women sent to the school, plus the low morale and the poor attitude of the students, psychiatric problems were many and administrative discharges frequent. All of these psychiatric problems were based on character disorders, emotional instability, or mental deficiency.
The school was closed in 9 months (on 19 May 1944) because results did not justify its existence.
Special Training Unit.-Just before closing the Opportunity School, another attempt to train women of Grade V, AGCT, was made at Fort Des Moines. Trainees in this grade were sent to a STU (Special Training Unit). In addition, enlisted women who, in their first 3 weeks of basic training, showed unsatisfactory learning ability or aptitude were also transferred to this unit. It soon became the dumping ground into which company commanders sent their misfits. As Preston stated: 'The combination of the low intellectual group and the group with maladjustment and behavior problems was the root of many difficulties and created a training situation which could not be combated.'
A review of the 425 women trained in STU showed that the largest problem of these women was that of emotional instability. A large number had poor work records, a history of poor civilian adjustment regarding behavior, including arrests, prostitution, and the like. It was necessary to discharge 19 percent of these women for administrative reasons during their training period in this unit.
After investigation by the Military Training Division, ASF, some
22Army Service Forces Circular No. 88, 24 Sept. 1943.
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changes were made in methods of administration. The Consultation Service was more fully utilized before assignment in an effort to salvage some of these women.
The situation was later sufficiently relieved by the WAC selection procedure, which reduced the number of women enlisted in Grade V, AGCT, so that the STU could be deactivated. All women in this lowest grade who were subsequently received at Fort Des Moines were immediately referred to the Consultation Service where they were aided in adjustment and assignment, or recommended for early discharge. In this connection, Major Preston remarked: 'In a volunteer organization such as the WAC, the problem of women with low intelligence should not exist.'
The Leadership School.-An altogether different program, started in June 1944 'to train selected enlisted personnel or potential noncommissioned officers,' was known as the Leadership School.
The number of women who attended this course was the same as for the 'Opportunity School,' but the results were far better. The selection of women was made on the basis of outstanding ability in basic training. The candidates were screened by the Consultation Service, and the selected women were emotionally mature and stable and were thus qualified to help in guiding others. The success of the Leadership School and its graduates as noncommissioned officers in contributing to better training and morale within the training companies fully justified the length of time in training.
The Leadership School was continued for 15 months and was deactivated in September 1945.
School for WAC Personnel Administration.-Another type of training, the 'School for WAC Personnel Administration,' was established at Purdue University, Lafayette, Ind., in April 1945. This school trained approximately 900 officers in its nine separate classes, each of 3 weeks' duration. The object of the school was to give additional training in leadership, in order to assist the officers in personnel management within WAC detachments and units. The instructors consisted of WAC staff officers (fig. 44) and faculty members of Purdue University. The utilization of the faculty at Purdue University gave the students a civilian intellectual orientation not possible from Army sources: 'The recognition of the WAC staff officers of the severity of psychiatric problems, the necessity for understanding of human behavior and adjustment was illustrated by the 15.6 percentage of time allotted to formal lectures on psychology, psychiatry and mental health.'
Attempts were made to provide specialized training in courses such as those given in the Cooks and Bakers School, Clerks School, School for Motor Vehicle Operators, and Medical Technicians School. The details of training in the various programs will not be considered here except to point out some of the psychological concomitants. There was an adverse effect upon morale of trainees who developed an 'attitude that attendance at any of these was an unnecessary delay from a field assignment.' This was especially
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true if the school assignment corresponded to the previous civilian job from which the woman was trying to escape by enlistment in the WAC.
Cooks and Bakers School.-This attitude was particularly noticeable in the Cooks and Bakers School where high sick call rates and minor psychiatric casualties resulted from lack of interest and motivation. Other adverse factors were the lack of orientation as to the need for cooks, the low intelligence of 50 percent of the students, in whom there was a high incidence of emotional instability, and the resentment of other student women with higher intelligence to the assignment. The fact that these women
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were used only in WAC messes made them feel less useful to the war effort than those who were 'replacing a man.'
School for Motor Vehicle Operators.-One of the most satisfactory schools was the one for motor vehicle operators, in which approximately 3,000 women trained. Preston commented on this, as follows:
Little screening for emotional stability or intellectual ability was done. Difficulty was experienced by the assignment of personnel with low AGCT scores who could not make dependable drivers. Although assignment of the personnel to the school, without screening can be criticized, the low sick call rate, 45% of drivers not going to sick call in a six-month period and 40% going only one time in the same period, the minimum psychiatric referrals, the lack of serious menstrual difficulties other than irregularity and the presence of the least amount of fatigue in a comparative study of fatigue in occupations illustrates the advantage of assignments fulfilling motivation for enlistment. However, this led to the development of marked masculine traits and unwarranted criticism of the women drivers because of their masculine uniforms, appearance, and mannerisms.
Medical Technicians School.-From the Wacs' viewpoint, the Medical Technicians School was the most successful program. Over 7,000 women were enlisted in a 4 months' period after the Battle of the Bulge in 1945, for 'the opportunity to enlist as a medical technician was grasped by numbers of women who desired hospital training and experience, who had relatives among the casualties, and who were motivated to 'help the suffering'.' These women were encouraged to enlist by the guarantee of a technician, fifth grade, rating upon successful completion of their training and of the opportunity to choose a hospital near their home. The high initial ratings caused resentment in other enlisted men and women. Some of these new recruits lacked intelligence, education, and ability. About 20 percent were in the two lowest AGCT grades.
Of the 7,084 women trained in the Medical Technicians School, 'there were only three AWOL's [absent without leave], 228 failures, and 360 discharges for various reasons; that is, 8.2 percent of eliminees.'
Fatigue Study
Research design
In 1945, just before and after V-J Day, an effort was made to evaluate WAC assignments in the field in relation to fatigue through a study conducted under the direction of the Surgeon General's Office.23 A sample of 4,572 WAC enlisted personnel, divided proportionately among the Army Ground, Army Service, and Army Air Forces, were interviewed by a survey team; each Wac then completed a questionnaire. Fatigue was defined
23Memorandum, Capt. Miriam Mills, MC, Assistant, Women's Health and Welfare Unit, for Chief, Professional Administrative Service, 5 Dec. 1945 (approved by Lt. Col. Margaret D. Craighill, MC, Consultant, Women's Health and Welfare Unit), subject: Study of Factors of Fatigue Influencing the Effectiveness of WAC Personnel.
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as a state of weariness which does not respond to the usual form and amount of relaxation. It was divided into physical and psychological fatigue.
Results
Physical fatigue was found to be related to age, military occupation, and working and living conditions; psychological fatigue, to morale factors such as interest in work, family responsibilities, and promotion. Many health factors, including changes in general health and the influence of nervousness, depression, sick call visits, dysmenorrhea, menstrual irregularity, and alcohol consumption, were also considered in fatigue. Nervousness and depression were not defined, but the presence, increase, or decrease of these conditions, by age group, was ascertained objectively by replies to specific questions. Increased nervousness and depression were over twice as frequent in the group under 40 as in those over 40. The age group of 40 years and over showed a marked decrease in the proportion of women claiming fatigue. General health and various specific health conditions showed the same improvement after the age of 40. This was probably due to the fact that disability rates in this age group had been very high, and therefore, those who remained in service had survival qualities above the average.
The presence of fatigue was manifested in 38.7 percent of those interviewed. Among the six occupational groups used in this study, cooks and mess attendants indicated the most fatigue (48 percent) and drivers the least (31 percent). The mess personnel, however, showed the least incidence of depression and nervousness. The occupational conditions, including types and hours of work, were closely correlated with fatigue. Subsidiary to these factors were environmental living conditions.
From the various factors considered, it was apparent that the incidence of fatigue was influenced more by psychological than physical factors. Interest in the job outweighed all other single factors in importance. There was a general upward trend in fatigue with increased time in service, with the greatest change occurring at the end of 6 months of service.
The association between health and fatigue, as demonstrated by the factors considered for both, was very close, and the results of the study were remarkably consistent.
OVERSEA ASSIGNMENT
This section has been written almost exclusively from the experience and reports of the author based primarily on observations made in the various theaters of operations during an inspection, covering the last quar?
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ter of 1944 and the first 6 months of 1945.24 The survey started in the European theater and was completed in the South Pacific Area, so that it preceded by only a few months the actual end of hostilities in the various zones. For example, France was visited in the period about 6 weeks after the Allied occupation of Paris and within 2 weeks of the Battle of the Bulge. In a comparable situation, the Southwest Pacific Area was seen at approximately the same period after the recapture of Manila in the Philippines, and about 2 months before the defeat of Japan. These observations showed the influence on personnel of newly occupied territory still in combat zones. Other equally as important from the psychiatric viewpoint was the reaction of those individuals 'left behind' by the onward sweep of the war in such areas as Africa and Australia. England, Italy, and India might be considered as intermediate areas in that they were all active zones administratively, although for the most part they had passed through the combat phase. On the other extreme were such isolated locations as Burma and China in which the Americans and British had been pushed back and where the commands were poised to reconquer lost territory.
Morale
The aforementioned status of military operations was an important factor affecting the state of morale of Army Wacs, which was also influenced by the length of time overseas, the living and working conditions, the recreational facilities and needs, and the sense of usefulness in promoting the war effort.
Health.-The state of morale was reflected in medical conditions as noted in sick call, hospitalization and evacuation rates, and especially in the specific incidence of such diagnoses as psychoneuroses and pregnancy, which were the major causes of evacuation in most theaters.
In the less tangible conditions of fatigue, dysmenorrhea, and headache, there were also noticeable differences, according to the morale factors. This was observed in various areas and was more accurately noted by the study from a questionnaire filled out by women, both nurses and Wacs, in India and Burma. Another indicator of morale was evident in the increased frequency of specific medical conditions, such an anemia, malaria, dysentery, and dermatitis. Many of these conditions reflected the woman's own habits and personal precautions, which were influenced by her state of emotional adjustment.
Climate.-The extremes in climate affected the emotional as well as
24Memorandums, Maj. Margaret D. Craighill, MC, for The Surgeon General, as follows: (1) 30 Nov. 1944, subject: Health Conditions of Nurses and Wacs in ETOUSA. (2) 1 Jan. 1945, subject: Health Conditions of Nurses and Wacs in MTOUSA. (3) 8 Jan. 1945, subject: Health Conditions of Nurses and Wacs in USAFIME. (4) 27 Jan. 1945, subject: Health Conditions of Nurses in Persian Gulf Command. (5) 11 Mar. 1945, subject: Conditions Affecting Women Personnel in China. (6) 30 Mar. 1945, subject: Medical and Social Conditions of Women in Military Service in the India-Burma Theater. (7) 6 Apr. 1945, subject: Medical and Social Conditions of Women in Military Service in Ceylon. (8) 8 June 1945, subject: Medical and Social Conditions of Women in Military Service in Southwest Pacific Area.
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the physical reaction of individuals. This was observed specifically in the Persian Gulf area, which had the most intense dry heat, and in Burma, especially during the monsoon season, with extremes of humidity and heat. Marked apathy, depression, and fatigue were characteristic of the personnel in these locations, and the intensity of discomfort was an index of the person's state of morale. Extremes of cold or heat were better tolerated, if not accompanied by rain. This was observed in northern France where the cold, with rains and flooding, was so demoralizing, as compared to northern Italy where the cold was present with dry snow and ice. When clothes and bedding were constantly wet, when shoes mildewed, and when mobility was limited by floods, the morale of units deteriorated.
Age and time overseas.-Length of time overseas and age were very important factors in withstanding hardships. The incidence of medical evacuations, particularly for psychoneuroses, was highest in the older age group. It was the opinion of many medical officers that, with few exceptions, women over 35 should not be sent overseas. Also, that after 18 months of oversea service, there was a definite tendency toward increase in morbidity and medical evacuation.
Work satisfaction.-Practically all the observations mentioned, thus far, applied to women personnel in whatever component of the Army. The nurses showed more variations because they had been overseas for longer periods, but the trends were much the same. The theme was repeated, over and over again, that environmental conditions were less important than satisfaction in the job, whether in oversea service or in the United States. The best morale was noted among those women, in active combat areas, who were working hard on assignments which were obviously important and in which they felt needed.
Group solidarity.-A comparison of two WAC units in the U.S. Army Forces in the Middle East brought out very interesting contrasts relating to group solidarity. The WAC unit at Cairo, Egypt, was composed of 139 women who had been overseas for 19 months and had good morale. It was considered a well-adjusted group with only minor emotional problems, largely due to frustration at being in an inactive war zone. This unit had made provisions for informal activities, including a workshop in the barracks equipped with tools for carpentry or the finer arts.
Another WAC unit of 157 women at Accra, West Africa, had been overseas only 3 months. They had been sent overseas before many of them had been in the Army long enough to become adjusted. The group had been together only 2 weeks before oversea shipment and had arrived at Accra in small groups. They never became amalgamated into a cohesive unit and did not even know the other women in their company. The women had no duties or responsibilities other than office jobs, because their quarters, laundry, and mess were taken care of by native servants. This group, then, was introduced into an isolated camp of several thousand men who had been overseas for a long time, and who were eager for the companion-
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ship of American women. Thus, they were precipitated into a situation of great competition for their society. It was not surprising that some Wacs took full advantage of this unusual opportunity and remained stable; while others, unable to handle the situation, 'cracked up' under the strain (see p. 455). Drinking was reported as habitual and excessive. Psychiatric conditions were already a major problem. Two women had been sent back for neuropsychiatric causes, and it was estimated that more would follow, until the group became stabilized and adjusted to the environment.
Living Conditions
There were Wacs in all the theaters of operations visited during the survey, except in the Persian Gulf area, Burma, and China. Also, there was a group in Ceylon, and later, some Wacs were stationed in China. As of December 1944, there were in all oversea theaters some 13,817 Wacs (officers and enlisted women), as follows: European theater, 5,931; Mediterranean theater, 1,576; Africa and Middle East, 252; China-Burma-India, 326; Pacific areas, 4,343; and other, 1,389.25
There were many similarities in the living conditions of the various theaters. In general, Wacs had better living accommodations than nurses in comparable locations. There were some exceptions. The Wacs in the forward zone with the Fifth U.S. Army in Italy lived in pyramidal tents and had much the same quarters as did nurses. Elsewhere, Wacs were quartered, insofar as possible, in already existing buildings, such as apartment houses, schools, barracks, or hotels. Some of these accommodations were quite luxurious.
By contrast, where no fixed facilities were available, as in the Southwest Pacific Area, tents or prefabricated huts, with or without floors, were used, according to terrain or military necessity. Overcrowding was common. Outside latrines, in blocks with no separating partitions, and open showers were installed with no opportunity for individual privacy. Except in such primitive areas, dayrooms and date rooms were usually provided, as were laundry facilities and hairdressing arrangements.
Unusual living conditions were established in Hastings Mill, outside Calcutta, India, where all 256 Wacs were housed together in one big barracks, which had been a jute mill. WAC officers' quarters, one room for sickbay, and a room for the cooks were all separated by partial partitions of hemp cloth. These crowded conditions produced tension which showed in instability and depression, but these symptoms were offset by the feeling of doing a good job in a situation in which they were needed.
Working Conditions
The working conditions varied somewhat in the different commands.
25Treadwell, op. cit., appendix A, table 7.
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In most areas, Wacs were assigned to headquarters units as clerks, or to communications, and were not overworked. In fact, there were many complaints about insufficiency of work, especially in some rear areas.
Two special groups of Wacs exhibited the effects of occupational strain. One was a Signal Corps detachment working with the British in Ceylon. This group of 14 women had been in this organization for about a year and had worked shifts around the clock, rotating every 4 days. A high incidence of illness occurred among them; 10 of the Wacs had an average of two hospital admissions each, and the other 4 had a record of many sick calls. Their difficulties were attributed to irregularity in meals and to loss of sleep due to interruptions in the normal sleep cycle because of constantly shifting hours of work.
The other instance of occupational stress was found in a group of WAC officers serving a censorship function for the Southwest Pacific Area, on the island of Biak. Examinations, after a year, showed that over one-half had marked visual disturbances. An additional psychic trauma to these women was the pornographic material in the letters and the complaints of the men, particularly about marital problems. No special criteria of personnel selection had been used in choosing the WAC officers for this assignment, which obviously required considerable emotional maturity and stability.
Recreational and Leave Facilities
Provisions for recreation were particularly important in isolated areas, especially where the women's activities were so largely restricted to their own quarters. For example, in New Guinea and on Guam, Wacs and other female personnel could not leave their housing areas after dark except with an armed escort. In all locations, there were more than enough dances, but the competition among the men for partners became so great, and the demand for the company of women so intense, that the girls soon tired of this form of group activity and would refuse dates except on an individual basis. The women missed the familiar things, such as hot dogs and Coca-Cola, and found themselves instead drinking alcoholic liquors for sociability or because of urging by the men. Many Wacs were unfamiliar with alcoholic drinks and their inability to know their capacity, especially in hot climates, was sometimes disastrous. The lack of dayrooms in which women could gather together for sociability or of date rooms where they could properly receive male friends caused many social complications and resulted in morale problems. The WAC unit in Cairo, with the high morale, had both dayrooms and date rooms; the unit at Accra had neither.
The provision of rest areas for women was less common than it was for men, except in the European theater. Here, a unique rest home, called the Rookery, in Oxford, England, was operated by Wacs for the rest or convalescence of enlisted women. In Italy, there was a rest area on the
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island of Capri. WAC officers could go to certain hotels, but in Rome the only hotel for women was not popular. WAC officers, like nurses, usually preferred a general hotel to a segregated rest home. There was definite resentment among women officers to the attitude of protection and mistrust. They wished to be treated like adult individuals, responsible for their own conduct.
Rotation policies did not affect the Wacs because they had not been overseas for a sufficient length of time. The first Waacs, a group of five officers, went to North Africa in December of 1942, by ship which was torpedoed in transit. The first WAC unit with enlisted women arrived in North Africa a month later, and from then on the total oversea WAC strength was built up to a maximum of 17,035 by July 1945.26
Social Situations
Both men and women suffered from extreme lonesomeness in unfamiliar surroundings which resulted in quick friendships and marked dependence on one person, either of the same or of the opposite sex. Married men, especially, missed their wives and were prone to make liaisons with women who perhaps might not have seemed so attractive under other or more normal circumstances. It was hard for some Wacs to maintain objectivity and emotional balance and to remember that circumstances rather than their own charms were responsible for such popularity. The social pressure on Wacs by large numbers of lonesome men was 'terrific.' Many methods from command attendance to extravagant inducements were used to secure their companionship. The tension of keeping up with work and with too much social activity, as well as the stress of emotional conflict required by these relationships, was the cause of many psychiatric disturbances. The social situation was particularly difficult among members of male and female units long isolated together, who became very dependent on one another. Their past and future lives were vague and unreal, and only the present was of importance. The present was viewed as an interlude in life and whatever made it more bearable seemed justifiable. Men were apparently better able to partition off this segment of their lives so that they did not as readily become deeply or permanently emotionally involved. They were, therefore, less liable to lasting psychic trauma from these intense but temporary attachments. Some of these relationships continued after the war, but most were severed, sometimes with tragic sequelae, especially to the women involved.
Medical Evacuations
The two leading medical causes for evacuation in all oversea theaters were psychiatric disorders and pregnancy.
26Treadwell, op. cit., p. 772.
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Psychiatric disorders
There was a tendency among medical officers everywhere not to 'stigmatize' a woman with a psychiatric label, if any other diagnosis could be used. There was, however, a need for some type of combined administrative and medical procedure whereby those Wacs clearly unsuited for oversea service could be returned before they became completely unfit for duty, even in the Zone of Interior.
In the European theater, 11 percent of medical evacuations among the Wacs were for neuropsychiatric conditions; in the Mediterranean theater, it was 27 percent. These were the two theaters which had the most Wacs who had the longest oversea service. In the Southwest Pacific Area, with an average strength of about 5,200 Wacs, the rate was 27 per 1,000 per annum. In the Southwest Pacific Area, the factors involved were as follows:
1. Inadequate psychiatric screening on enlistment.
2. Poor selection for oversea duty by sending misfits and women who did not want oversea duty.
3. Misassignment of trained personnel.
4. Disillusionment about oversea duty.
5. Frustration due to lack of work or the relative importance of a job.
Pregnancy
In the various theaters, over one-half the medical evacuations were for pregnancy. In the European theater, there were 56 percent. In the Southwest Pacific Area, for a period of 9 months, the rate per 1,000 personnel per annum was 19.82. Of the approximately 26,000 American women in military service in the European theater, the rate was 2.2 per 1,000. In all areas, the rate increased with length of time overseas. The varying marriage policies in the theaters seemed to have had little effect on the pregnancy rate. It was unofficially stated that approximately one-half of the oversea Wacs were married. In the European theater, there was an arbitrary geographic separation of married couples within the theater. In Italy, the fact of intermarriages between officers and enlisted women, or vice versa, was recognized to the extent that, in social conditions, the husband's military status took precedence, this even applying to billeting in hotels or leave areas. In the India-Burma theater, marriages of Wacs were not allowed until about the end of the war, on penalty of fines and other forms of punishment by court-martial. In almost all areas, there were some pregnancies discovered overseas which had occurred before leaving the United States. In one such case, the WAC commander in the Zone of Interior had asked for discharge of the woman before oversea shipment.
The method of handling the return of pregnant female personnel to the Zone of Interior caused them some embarrassment. These women were returned through the medical evacuation chain with the diagnosis of preg?
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nancy entered on the jacket of the field medical records which had to be shown on demand. Also, on some ships, the patient list, including diagnosis, for embarkation was also the official passenger list. This procedure was corrected with the issuance of WD Circular No. 430, on 22 September 1944.
Information on the incidence of self-induced abortions was probably inaccurate, but patients with sequelae of hemorrhages or infections were relatively rare. In fact, there was an apparent trend toward pregnancy as a means for getting home rather than an effort being made to terminate an otherwise unwanted pregnancy.27 The occurrence of venereal disease was also probably much higher than the officially recorded rates which increased markedly after the Wacs moved to Paris.
Selection
Originally, selection of Wacs for oversea duty was on a volunteer basis, but this policy was not followed consistently, as the need for special work assignments increased. Volunteers adjusted better than those who came unwillingly. One of the most apparent and frequent sources of difficulty noted in all theaters was the deficiency of psychiatric and medical screening before oversea shipment. Many women had inadequate examinations on enlistment because of the pressure of recruiting. Even had better initial examinations been required, many conditions might have been overlooked or might have developed after coming into service, which would not necessarily have been apparent without further examination after entry into the service. An additional source of stress was that female military personnel were more conspicuous than the male military personnel in oversea theaters, and any deviation from the normal was emphasized out of proportion to its usual importance. Also, overseas, women were subject to more tension than men, because of their relative scarcity, their more restricted personal freedom, and their increased emotional pressure, as already described.
THE PSYCHIATRIC PROBLEM
Diagnostic Categories
Reiterating, of the major diagnostic categories, psychopathic personality and psychoneurosis were the major causes of rejection of Wacs for military service (table 36). The same might have been true of the discharges for disability, except that character and behavior disorders were not differentiated in these instances as such, and were included presumably under psychoneurosis (tables 40 and 43). Psychoses were by far less frequent. It is estimated that, of the Waacs discharged for disability during
27Some 11,000 Waacs and Wacs were discharged from the service for pregnancy, constituting 8.0 percent of all separations (tables 46 and 47).
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the 10-month period from August 1942 through May 1943, some 450 Wacs (38.2 percent, table 40) were discharged for psychoneurosis, and of the Wacs discharged for disability from August 1943 through December 1944, some 2,200 (44.3 percent, table 43) were discharged for psychoneurosis.28
An analysis29 of the diagnoses of 7,639 patients seen in the Mental Hygiene Consultation Service at the First WAC Training Center at Fort Des Moines is shown as follows:
| Diagnosis | Percent |
Psychoneuroses: | |
| Anxiety | 5.01 |
| Gastric | .18 |
| Cardiac | .29 |
| Hysteria | 3.01 |
| Obsessive compulsive | 1.22 |
| Unclassified | 4.70 |
Total | 14.41 |
Psychoses: | |
| Schizophrenia | 2.27 |
| Manic depressive | .43 |
Total | 2.70 |
Character disorders: | |
| Nocturnal enuresis | 0.59 |
| Psychopathic personality | 7.60 |
| Cyclothymic personality | 1.60 |
| Schizoid personality | 2.54 |
| Lack of adaptability | 1.10 |
| Personality problem | 2.03 |
| Emotional instability | 2.40 |
| Alcoholism | .76 |
Total | 18.62 |
Neurological: | |
| Organic | 0.70 |
| Epilepsy | .55 |
Total | 1.25 |
Mental deficiency | 19.18 |
Maladjustment: | |
| Situational | 17.36 |
| Assignment | 2.70 |
| Personal | 1.90 |
| Absent without leave | 8.80 |
Total | 30.76 |
Medical conditions: | |
| Organic | 2.00 |
| Syphilis | .13 |
| Menstrual | 8.23 |
| Pregnancy | .72 |
Total | 11.08 |
Administrative (miscellaneous) | 2.00 |
| Grand total | 100.0 |
| The following shows the disposition of these 7,639 patients: | |
| Percent | |
| Return to duty | 60.60 |
| Reassignment | 12.00 |
| Certificate of disability for discharge | 3.90 |
| Hospitalization | 6.20 |
| Discharge under the provisions of AR 615-368 [Unfitness] | 3.20 |
| Discharge under the provisions of AR 615-369 [Inaptitude or unsuitability] | 10.00 |
| Minority | 2.75 |
| Dependency, resignation, death | 1.35 |
Total | 100.0 |
28Dr. Bernard D. Karpinos, Assistant for Manpower Studies, Medical Statistics Agency, Office of The Surgeon General, in his statistical review of this chapter, 24 Nov. 1964, commented, as follows: 'There are no data on the diagnostic distribution of the separations for disability after October 1944. Should we assume that the neuropsychiatric diagnosis of those discharged for disability after October 1944 through December 1946 were the same as those for the October 1943 through October 1944 period (table 43), then the estimate is that of all the WAAC and WAC separations for disability (table 46), 6,300 Waacs and Wacs were discharged for neuropsychiatric disorders, among whom 5,000 Waacs and Wacs were discharged for psychoneurosis.'
29Preston, op. cit., pp. 37-38.
Infrequency of certain conditions.-Two conditions which were serious problems with men were negligible for women. Enuresis was almost never found. Why there is so much sex difference in this symptom has not been satisfactorily explained. Also, homosexuality was much less of a problem than was expected. It was anticipated that military life might attract overt homosexuals, but this was true only to a very limited extent. When homosexuals were found, they created a more difficult situation than with men, but too frequently a worse problem was that of false rumors and witch hunting. Any girl with marked masculine tendencies or any two girls with close friendships were under suspicion and practically convicted by a whispering campaign with little opportunity to defend themselves. There are no available records on discharges for homosexuality. Any such discharges were probably classified under some other category. Instruction on the subject was considered, and in a communication dated 7 September 1944, the following policy was recommended by the Surgeon General's Office: 30
1. It is the opinion of this office that instruction to the WAC in homosexuality should not be emphasized.
2. It is recommended that the psychiatrists in charge of the Consultation Service at the Training Centers incorporate the subject in the lectures on Personal Adjustment Problems now currently given in compliance with WD Circular No. 48, 1944, according to TB MED 12 and 21.
30Letter, Col. Oveta Culp Hobby, The Director, WAC, to Commanding General, Army Service Forces (Attn: Director, Military Training Division), 26 Aug. 1944, subject: Course of Instruction on Homosexuality, with 2d endorsement thereto, 7 Sept. 1944.
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461
Hospitalization Rates
Only partial data are available in regard to the health of the Wacs while in the service. Such available health data, in terms of hospital admissions, are presented in table 48 and graphically shown in charts 13 and 14. The admission rates, expressed as the number admitted per 1,000 mean strength per year, are shown for both the WAC and the total Army, for comparative evaluation. The admissions are given separately for all causes and for neuropsychiatric disorders.
The data on admissions for all causes clearly indicate higher rates for Wacs. This holds true throughout the entire period. It seems that these higher rates were due mainly to higher incidence of common respiratory diseases, influenza, diarrhea, and dysentery among Wacs (see chart 14).
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[Rate expressed as number of admissions per 1,000 strength per year]
Year and month | All causes | Neuropsychiatric disorders | ||
Total Army | Wacs | Total Army | Wacs | |
| 1944 | ||||
June | 553 | 898 | 33 | 38 |
July | 544 | 786 | 32 | 38 |
August | 543 | 903 | 36 | 46 |
September | 572 | 849 | 46 | 37 |
October | 578 | 901 | 48 | 33 |
November | 558 | 875 | 47 | 37 |
December | 568 | 906 | 47 | 41 |
| 1945 | ||||
January | 660 | 995 | 47 | 48 |
February | 677 | 1,003 | 44 | 42 |
March | 648 | 981 | 46 | 50 |
April | 595 | 742 | 44 | 37 |
May | 591 | 719 | 43 | 28 |
June | 568 | 706 | 41 | 31 |
July | 519 | 755 | 39 | 21 |
August | 522 | 769 | 37 | 26 |
September | 478 | 795 | 25 | 22 |
October | 474 | 821 | 23 | 12 |
November | 502 | 798 | 23 | 10 |
December | 535 | 893 | 21 | 13 |
| Total average (1944-45) | 566 | 856 | 39 | 34 |
Source: Derived from data published for (1) Total Army: Morbidity and Mortality in the U.S. Army, 1940-45; and (2) Wacs: Weekly Health Reports, 7 July-29 Dec. 1944; 5 Jan-29 June 1945; 6 July-28 Dec. 1945; and 4 Jan.-27 Dec. 1946; Office of The Surgeon General.
With respect to admissions for neuropsychiatric conditions, no trend can be noted. In certain months, the admission rates of Wacs for neuropsychiatric disorders were higher than those for men; in other months, they were lower. There was a definite decline in the neuropsychiatric admission rates of Wacs toward the end of 1945. It is possible that these lower rates were a reflection of the ending of the war-a trend that was demonstrated after V-J Day in the fatigue study previously described. Most of the admissions of Wacs for neuropsychiatric reasons were for relatively minor emotional disturbances and did not require prolonged hospitalization.
For the whole period, for which health data are available, the admis?sion rate for all causes was 856 for Wacs and 566 for the total Army, per 1,000 mean strength per year. The WAC admission rate for all causes was thus somewhat above 50 percent higher than that of the total Army. The
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admission rate for neuropsychiatric disorders for this period was 34 for the WAC, as compared with 39 for the total Army (table 48). (See chart 14 for comparative rates of Wacs and the total Army, for selected diagnoses.)
Associated Medical Conditions
Dysmenorrhea
Dysmenorrhea was not given special consideration by the Medical Department because it was deemed more advisable to consider it as a normal psychological function and not to encourage feelings of disability. Exercise and the regular pursuit of work were recommended except in unusually severe cases. In many of these, a large psychological component was recognized.
Pregnancy
Pregnancy was a cause of discharge as soon as certified by a medical officer. The early WAAC policy31 was separation from the service with an administrative honorable discharge, regardless of the origin of the condition. This was a very wise and humane regulation but was not adopted by the Army Nurse Corps until sometime after incorporation into the Army of the United States. Finally, with extreme reluctance, the administrative honorable discharge for pregnancy was accepted as the policy for all women components of the Army.32 Illegal abortion, however, was 'regarded as misconduct.'
A related problem of providing maternity care was also opposed by the Army Nurse Corps as well as by many persons in the War Department. It was, however, endorsed by The Surgeon General and by the Director, WAC, and after 2 years' effort, War Department Circular No. 430 was finally issued in late 1944. This directive also provided for the care and return from overseas of pregnant military personnel and for the care of their babies, if necessary. These controversial issues aroused great emotional reactions in many persons in positions of authority, whose prejudices and fears influenced them to take a moralistic and punitive viewpoint rather than a broad medical and social one.
The loss of personnel because of pregnancy was high. Discharges for pregnancy were more frequent than for all other medical conditions combined. This is evidenced by the data presented in table 47. In 1944, the discharge rate of Wacs for pregnancy was 51.5, as compared with 44.1 for disability, per 1,000 mean strength per year. In 1945, the discharge rate was 70.5 for pregnancy, compared with 53.5 for disability, and in 1946 the
31WAAC Circular No. 17, 29 Dec. 1942.
32Army Regulations No. 40-20, 9 Jan. 1944.
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discharge rates were 45.0 and 22.5 for pregnancy and disability, respectively. Altogether, the total number of Waacs and Wacs discharged for pregnancy was about the same for disability: 10,937 for pregnancy and 11,387 for disability (table 47).
As the war continued, some women were restless because they were getting older and wanted to have children before it was too late. Some, who had previously considered themselves sterile, were able to achieve pregnancy when they rejoined their husbands after separation in the Army. This was apparently influenced by the more regulated and routine life in the WAC as well as by the heightened pleasurable anticipation of reunion. Others saw pregnancy as a means of leaving the Army. Many had unplanned pregnancies, either with or without marriage. This was especially true in oversea areas where groups of young women were closely associated with men isolated together in tension-charged situations. The inevitable result was, frequently, marriage. These women were willing to forego pregnancy for a short period of time, but as the war dragged on, many became increasingly impatient to start a family. Some used pregnancy as an excuse for return from overseas. Others, as in civilian life, were swept away by strong emotions, especially under the added stress of oversea life. In one theater, marriage between Army personnel was prohibited unless pregnancy had occurred. The result was the highest illegitimacy rate of any oversea command, until the regulation was changed in April 1945.33
Menopause
With the increasing age group of the WAC, the problem of how to handle women with symptoms attributed to the menopause became urgent. Reports from the field medical installations showed considerable confusion. It soon became evident that the diagnosis of menopause was being used rather indiscriminately, covering many conditions of a psychiatric nature, as well as gynecological disorders. Policies of diagnoses, treatment, and disposition were recommended as early as August 1944, but it was not until May 1945 that TB MED 158, covering the subject, was issued. In this bulletin, the psychiatric components were emphasized, and it was stated: 'Separation because of menopausal syndrome should not be accomplished without consultation with an internist, a gynecologist and a neuropsychiatrist, when such specialists are available.' A 6 months' treatment program was recommended before considering discharge for menopause.
Venereal diseases
The problem of control and incidence of venereal diseases in the WAC was psychological as well as medical. Problems developed early in relation
33Personal communication, Lt. Gen. Don J. Sulton, to Maj. Margaret D. Craighill, MC, 26 Apr. 1945, subject: Marriage Policy.
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to the inclusion of Wacs in the prescribed monthly physical inspections for venereal diseases that were required for men. The confusion was finally resolved with the issuance, on 1 January 1944, of Circular Letter No. 1, Office of The Surgeon General, outlining an acceptable procedure for women. Educational material was made available to the WAC on the subject of venereal diseases but not on contraception or prophylaxis. The incidence of venereal diseases was watched carefully, but it was so universally low that no great problem was presented.
SPECIFIC PROBLEMS OF FEMALE MILITARY PERSONNEL
Discipline
A frequent attitude in the Army was that 'nothing could be done to Wacs who break rules.' There was resentment among the men who felt that the 'Wacs have all the good things of the Army: promotions, furloughs, assignments, but none of the restrictions.'34 Clear-cut policies of discipline were long delayed because of numerous complicated attitudes and situations. Some of the difficulties were related to the volunteer nature of the group, others were influenced by public-relation considerations, and still others to the inconsistent attitudes of company commanders, which varied from that of the overprotective mother to that of the hard-boiled woman policeman. These uncertainties, in themselves, 'increased the number of disciplinary problems which ultimately were referred to the psychiatrist, not with the view of therapy but for elimination from the service.'35
Court-martial.-Wacs were subject to court-martial proceedings with penalties identical to those for men. Legally, this was true, but practically, there were considerations which modified the sentences. Military courts, composed only of men, were uncertain of how to impose penalties because of lack of experience in dealing with infractions of regulations by women. Here, again, the inconsistency was apparent in the two extremes of either too great leniency or too severe harshness. The Director, WAC, therefore, attempted to introduce the WAC point of view by having a WAC officer on every court-martial in which women were being tried. This change was ineffective because the WAC officer was always junior in grade to the other members and could rarely exert much influence. Recommendations to have lawyers who were in the WAC selected expressly for service on courts-martial try WAC personnel were not approved.
Confinement.-The lack of suitable places of detention for Wacs raised many problems. No guardhouses were available. In civilian communities, the only places of confinement were civilian jails. In military installations where WAC contingents were stationed, the company barracks or cadre rooms had to be used for confinement. But this created resentment from
34Preston, op. cit., p. 41.
35Ibid.
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other occupants of the barracks, particularly if the personnel so confined belonged to some other WAC command. In the event of long-term imprisonment, the problem became still more complicated. In one situation observed by the author, a whole barracks room was given over to the detention of one Wac. The space for the offender was partitioned off by wire from the guards, a regular detail of three able-bodied military police. To alleviate her 'sufferings,' she communicated freely through the windows with visitors bearing gifts and sympathy.
Colonel Hobby's recommendation for the establishment of a disciplinary barracks at one of the training centers was disapproved by the War Department. The only recourse was to send female personnel who had been given long-term sentences to the Federal Industrial Reformatory for Women, at Alderson, W. Va. As described by Treadwell:36
Cases accepted, however, were only those in which the individual had committed a felony or violated a civil law. Still undisposed of were sentences * * * that were imposed for violation of military regulations only.
As the only alternative, a confidential letter was sent to all commands stating that, while courts would adjudge sentences as usual, the reviewing authority would direct discharge instead of confinement for Wacs who could not be transferred to Alderson and who did not appear to be useful members of the Corps.
Subsequently, all women's services adopted a similar policy with the explanation, in part, that it was presumed that if volunteers were no longer in a position to fill a military mission, they should be returned to civilian life.
Leadership
The problem of leadership37 in the Army was of the highest importance, both for men and for women. Menninger38 discussed leadership in some detail for men, but all he said on the subject was also applicable to women, as follows:
The effects of 'good' or 'bad' leadership were apparent so frequently in the Army as to drive home the simple fact that if a leader met the emotional needs of his men adequately they were greatly supported against personality disturbances. * * * If anything happened to his leader, he was particularly vulnerable to a psychological break.
Women were said to be more dependent on the company commander than were most men. A poor commander had an exaggerated effect upon women, and field commands noted that one of the Corps' most pressing needs was for good WAC detachment commanders; those sent out were frequently found to be deficient in their training, the experience, and the temperament for leadership.
36Treadwell, op. cit., pp. 506-507.
37The material in this section has been drawn from Treadwell, op. cit., pp. 669-683, and unless otherwise indicated, quoted passages have been cited from this source.-M. D. C.38Menninger, William C.: Psychiatry in a Troubled World: Yesterday's War and Today's Challenge. New York: The Macmillan Co., 1948, pp. 73, 83.
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Also, as was pointed out: 'The strongest and most direct motivation is identification * * *. People gain emotional security by modeling themselves on a leader in whom they have confidence * * * attitudes, mannerisms, gestures, even voice tones are contagious.'
Several studies on leadership indicated clearly that WAC commanders had to have positive qualities of leadership. The conclusions were: 'The human values, and these values only, constituted the ability to lead women * * *-fairness, friendliness, unselfishness, sincerity, courage and a genuine concern for women.' One of the training center commanders, Col. Frank U. McGoskrie, said: 'You don't command women-you lead them.'
The value of instruction in leadership came to be discounted except as emphasizing to women already possessing the necessary character qualifications, their importance and some techniques for their best utilization. It was recognized that leaders could not be made. Some of the problems of leadership in the WAC undoubtedly came from the general lack of experience of women in such a role. In this connection, Dr. Hildegarde Durfee, a psychologist, made the following pertinent comments in her study of the WAC officer:
They [the WAC officers] are newcomers in a male setting; hence tend to feel on trial and under special pressure to make good * * *. Women as a whole have had less experience in group discipline and leadership. Theirs has been at once an over privileged and under privileged status in our society. They have been given more attention and consideration, but the price of this has been less opportunity and recognition.
She also commented that women tend to want to please and not to offend.
There was much evidence, however, which pointed to the existence of successful women leaders. Many surveys among enlisted women showed the stimulation of group loyalty by the commanders. 'When not so inspired, a WAC unit seemed particularly liable to degenerate into feuding cliques and factions.'
The effect of leadership on medical conditions was very apparent in the incidence of psychiatric disturbances, pregnancy, and sickness. In reference to the cause of widely different pregnancy rates among unmarried women at five units studied under similar conditions, Maj. (later Lt. Col.) Margaret Janeway, MC,39 observed: 'In those detachments where there has been continuous good leadership, the pregnancy rate has been low.' As Menninger40 said:
There were countless recorded instances when the efficiency of a particular group was increased or decreased out of all proportion to the numerical strength by an unusually able or poor leader. * * * As he could gain satisfaction in a passive dependence upon his leader, the new soldier was able to give up his personal initiative, wishes, preferences and liberty to become submissive and obedient. These processes operated equally in the WAC.
39Memorandum, Maj. Margaret Janeway, MG, for Col. Arden Freer, Surgeon General's Office, 27 Sept. 1944, subject: Visit to WAC Detachments at New York Port of Embarkation and Separation Center, Fort Dix, N.J.
40Menninger, op. cit., pp. 83, 84.
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Feminine Attitudes
The environment of the Army was modified to a great extent by the attitudes of the women themselves. In general, it may be said that, for women, military life tended to emphasize femininity rather than masculinity. So much of masculinity was forced upon them that the women overreacted in the opposite direction. Therefore, most of the differences peculiar to women as contrasted to men in military service were related to inherent or acquired feminine characteristics, or to unresolved internal bisexual conflicts.
Individuality.-One of the more marked differences was a tendency toward individuality rather than group activity. Regimentation and discipline were difficult for women because of previous experience and mode of life. Women working in the home are their own bosses, and even those working in offices are inclined to give only lip service to 'the Boss.'
Also, women are much more independent in matters of social conformity, particularly in regard to clothing. They conform to fashion trends, but each woman has to be different and exhibit her own interpretation of the styles, whereas a man is very 'unhappy' if he varies from the uniformity of the group. Feminine modifications of the military uniform were further influenced by the desire for adornment, as demonstrated by corsages of flowers and pigtails tied with ribbons. The latter additions were more prevalent overseas when a longing for beauty in the midst of war was especially acute.
Personal habits.-Women placed much greater emphasis on keeping up personal appearances. Even under very adverse conditions, as in New Guinea where slacks were worn constantly, the women washed their clothes in cold water and ironed them meticulously, while the men wore theirs roughdried. Hairdressing, too, was a not to be forgotten ritual. It was a great morale factor both for the women themselves and for the men who saw them. Beauty parlors, at least as important as barbershops, were arranged with much ingenuity in the most unlikely situations. There was, for example, one in the middle of Burma, set up under a teakwood tree with only a bucket of cold water for equipment, but with an operator from 'Charles of the Ritz,' then temporarily a private in the 'Engineers.'
Another manifestation of femininity was the universal practice by women of decorating their living quarters. They were clever in finding local material, such as parachutes, for making bedcovers or curtains, and so-called 'moonlight requisitions' were sources of supply for material to make furniture.
Eating habits also showed a feminine attitude. WAC messes with the regular Government-issue rations always had better cooked and more invitingly served food because the women demanded it. The palatability and attractiveness of food meant so much to them that sometimes they refused to eat adequately in combined messes where the esthetic element
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as neglected. This attitude occasionally became pathological, resulting in loss of weight or severe anemia.
One great hardship for women was the lack of privacy in the Army. Throughout their lives, they were accustomed to regard this privilege highly. Living in a crowded dormitory and using a community shower room and latrine were somewhat traumatic experiences for many women. Overseas, this lack of privacy was a definite factor in increasing tension and in precipitating emotional disorders, especially after a period of a year or more.
Socialization.-The social life of women in the Army presented many complications peculiar to the service. Women of various strata were thrown together intimately in a way which is much less common to them than to men. Class differences are customarily maintained by women, and the necessity for them to break down these barriers, and to adapt to the leveling effect of the Army was usually difficult.
Their social contacts with men were abnormal because of rank distinctions. For example, nurses were frequently more congenial with the younger enlisted men than with the older and usually married medical officers, and WAC enlisted women might find appropriate contemporaries among male officers. But fraternizing between officers and enlisted personnel was against military regulations. This became a serious problem in isolated areas, where, with a scarcity of women, male officers attempted to usurp all available female companionship, regardless of rank.
The attitude of many men, both in and out of service, that all women in uniform were 'on the make' was disturbing to the majority of women who were not so motivated. That the sex standards of many women did change while in the Army cannot be disputed, but this exemplified a wartime tendency not limited to military service but rather to a change in ethical standards facilitated by absence from the home community. Nevertheless, in the Army, there were definite restraints exercised by group opinion and lack of privacy.
TERMINATION PROBLEMS
In considering transition to civil life, this account will not extend much beyond January 1946, when the author left the Office of The Surgeon General. However, as Consultant to the Veterans' Administration for another 5 years, she became aware of some of the postwar problems of women veterans.
Discharge Policies
Timing for the discharge41 of Wacs after the war terminated was a matter of considerable controversy among all concerned. Colonel Hobby
41Unless otherwise indicated, quoted paragraphs are from Treadwell, op. cit., pp. 726-749.
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expressed the opinion that the: 'WAC should be disbanded as soon as possible after the war was over.' However, the Special Planning Division of the War Department overruled this and stated that the only determining factor was 'military necessity.' The number of points required for discharge, which related to length of service and other factors, fluctuated for both the men and the women and was never adequately adjusted. This, probably, produced more dissatisfaction among the women than the men because, as volunteers, the women believed that they should be released now that the job was done. However, there appeared great pressure in most commands to retain the WAC contingents. The reluctance to effect their discharge was-
generally related to the discovery that the need for skills common among female personnel had been underestimated, to an extent that raised doubts as to whether enlisted women could be allowed to leave at the same rate as enlisted men. Oversea theaters in particular had resolutely refused to face the fact that the WAC could never be entirely demobilized, as required by law, until male replacements were accepted for discharged Wacs.
The uncertain discharge policies were further complicated by the desire and planning of the Regular Army for inclusion of women. Maj. Gen. Willard S. Paul, Assistant Chief of Staff for Personnel, so stated before a Senate Committee in January 1946 and said: 'The Women have done an outstanding job in this war.' Even members of the WAC were themselves divided on the advisability of such as organization. One of the senior WAC officers said: 'Peacetime Army life, as contrasted to emergency wartime service presented an unnatural situation for a woman.' She pointed out especially the difficulties relative to establishing an adequate family life.
In spite of resistance on the WAC staff level, pressure on Congress increased for WAC inclusion in the Regular Army, which caused further vacillation in discharge policies and more uncertainty in the enlisted women. Finally in late 1946, General Paul called for volunteers among the WAC and permitted the release of all others.
In an attempt to convince Congress, Gen. Dwight D. Eisenhower, who initially had opposed the WAAC, reversed himself and said:
In tasks for which they are particularly suited, Wacs are more valuable than men, and fewer of them are required to perform a given amount of work. * * * In the disciplinary field they were, throughout the war, a model for the Army. * * * More than this, their influence throughout the whole command was good * * * resulting in improved conduct on the part of all.
So in the attempt to be released from military duty, the Wac was somewhat belatedly showered with appreciation.
Separation Centers
Plans for separation centers for the various military components were
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being formulated in early 1944. In a memorandum on the subject for the Deputy Director of Mobilization, Plans and Operations, ASF, the Consultant for Women's Health and Welfare42 made recommendations which were only partially accepted. The recommendations, herewith included because the future problems which developed later were anticipated, were as follows:
a. That consideration be given to the utilization of the present WAC Training Centers at Fort Oglethorpe and Fort Des Moines * * *.
(1) Facilities for housing, mess, recreation, and hospitalization are available for large numbers without further expansion.
(2) The overhead administrative staff is familiar with the problems peculiar to women personnel.
(3) The medical staff would need minimum additions.
(a) The personnel is accustomed to type of examination required for women in military service.
(4) The women would be separated from the men personnel at a time when discipline may be lax.
(5) These centers would be available because new recruits would not be in training at that time.
(6) Any additional cost of transportation would be more than compensated for by the use of already existing facilities.
The separation centers finally selected were five in number, with Fort Des Moines added later. Except for Fort Des Moines, the facilities were inadequate in respect to numbers processed per day, from 3 to 35, the long periods of waiting, inadequate housing, and a loss of morale due to many other unsatisfactory conditions. As early as September 1944, Major Janeway43 reported after a visit to the Separation Center at Camp Dix, N.J.:
Problems of discipline and morale have already arisen. The WAC officers do not have sufficient control over the itinerants, who mix with the enlisted women airing their complaints and spreading discontent among them. There have been occasions when the individuals separated had considerable of their mustering out pay stolen from them.
Because of many complaints, finally a War Department inspection team made a survey of the centers. Only Fort Des Moines received unqualified praise from this team.
A woman medical officer was assigned to each center in order to improve the procedure of the medical examinations. In most centers, very little counseling was given before discharge, and a minimum of preparation was made to help the Wac returning to civilian life.
Readjustment to Civilian Life
The Wacs had their own peculiar problems of readjustment (fig. 45). They soon found that they missed many of those intangibles which they had
42Memorandum, Maj. Margaret D. Craighill, MC, for Col. G. M. Powell, 5 July 1944, subject: Designation of Separation Centers for Separation of Female Personnel of the Army.
43See footnote 39, p. 467.
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FIGURE 45.-Cartoon, 'Grin and Bear It.' Reprinted by permission of Chicago Times, Inc.
learned to value in the Army, such as group comradeship and an interest in world affairs. They found themselves accorded little honor as veterans, and their military training was discounted by prospective employers. Even more than men, the women had become unsuited to the civilian environment because the change in their pattern of life had been more radical. They had become quite different persons from the women who enlisted 4 years before. Most of them had matured, had broader interests, and had developed a new and finer sense of values. These changes were not always understood or appreciated by their families and former associates. A study made for a thesis by a former WAC lieutenant pointed up some of the attitudes. Many of the symptoms noticed suggested strong depressive trends, such as 'a lost feeling,' 'lack of initiative,' 'lack of
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interest in former friends and environment,' 'nervousness and a feeling of strangeness,' and 'tiredness.'
Those Wacs returning to civilian life who desired employment frequently found it difficult to obtain work. Some Wacs had learned new technical skills for which there was no demand in civil life, or the positions that were available had been filled through reemployment rights of the male veteran. In August 1946, a law was passed according the Wacs similar reemployment benefits, but by this time, the need for such rights was long past.
Upon return to civil life, some took advantage of their veteran's rights to obtain more education, some married, and others returned to former professions. Women veterans who had the most difficult time of adjusting were those who, because of military training and broader interests, desired to undertake new fields of endeavor. After considerable delay, some civilian groups, stimulated by the WAC's National Civilian Advisory Committee, did organize local committees to aid in these employment problems.
Hospitalization was made available in veterans' facilities for former Wacs. Soon after the war, a woman physician was appointed in each area to coordinate the medical policies for women under the jurisdiction of the consultant in the Veterans' Administration, who personally visited all Veterans' Administration hospitals in which there were facilities available or planned for women.
SUMMARY AND CONCLUSIONS
The use of women to 'replace men' was a great experiment which was the object of much criticism and subject to many prejudices. From the mass of evidence, it appears to have more advantages than otherwise.
In this chapter, the disadvantages have been emphasized. Psychiatric conditions in the WAC were of more than usual importance, because they occurred in a conspicuous minority group. The actual number involved was small, probably about one-tenth of the Corps, compared to the magnitude of the problems created.
The volunteer status was responsible for many difficulties in its effect on the selection of recruits and the proper utilization of individuals, as well as on public opinion.
Women experienced unusual hardships from loss of individuality, unaccustomed group living, and regimentation with discipline. They profited, however, by gains in maturity, in adaptability, and in breadth of vision and interest.
With proper leadership, satisfactory assignment in a job, and a feeling of being needed, they performed with skill and enthusiasm. The use of women as staff directors was a help in bringing better understanding to higher commands of the special problems of the Corps. The women
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company commanders served an important role in promoting group identification and solidarity.
The social situation with men brought out clearly the desirability of removing the 'caste system' in a citizen's Army to permit off-duty association of personnel of opposite sexes, regardless of rank. Restrictions which are commonly observed in civilian employment would be applicable, such as the custom of supervisors not dating junior employees working directly under them.
Assignment of women for oversea duty would be more effective if given as a reward for good service. Better psychiatric screening, with limitation usually to those under the age of 36, would prevent many medical casualties. A limitation of 2-year tours of duty overseas would promote efficiency and return women who were still useful for service in the Zone of Interior.
The proper utilization of the Wac did not come until too late in the war to be appreciated fully.
