Part II
ADMINISTRATIVE CONSIDERATIONS IN THE SURGEON GENERAL'S OFFICE
CHAPTER II
Status and Development
Malcolm J. Farrell, M.D.
EARLY ORGANIZATION
On 19 July 1917, The Surgeon General authorized the establishment of a Neurology and Psychiatry Division as a part of the Surgeon General's Office.1 This division functioned throughout World War I under the direction of Col. Pearce Bailey, MC, formerly of the Neurological Institute, New York, N.Y. With the cessation of hostilities, the division became a section on 30 November 1918, under the chief consultant in medicine.2 Between World Wars I and II, no psychiatrist served in the Surgeon General's Office until a neuropsychiatrist, Lt. CoL (later Col.) Patrick S. Madigan, MC, a Regular Army medical officer, was assigned to the Professional Service Division on 1 August 1940. His chief functions, however, were to review Army retiring board proceedings, reports of line-of-duty findings of accidents and injuries, and correspondence regarding psychiatric matters.
In February 1942, Maj. Gen. James C. Magee, The Surgeon General, following the example of the previous wartime Surgeon General,3 established a separate Neuropsychiatry Branch. Colonel Madigan was appointed chief of the new branch. This branch, however, unlike the independent division of World War I, was one of several branches under the Professional Service Division.
Within a short time, the degree and complexity of functions made it apparent that the branch would require expansion. Without an adequate staff, it was impossible to visit the various field installations and investigate psychiatric problems at firsthand. Accordingly, Maj. (later Lt. Col.) Malcolm J. Farrell, MC (fig. 1),4 was assigned, on 10 April 1942, to assist Colonel Madigan.
Despite the lessons learned in World War I and recorded in the history of that war, no plans were made for meeting the problems of World War II. Therefore, much of the time of the newly organized branch was spent in attempting to solve problems which, in many instances, were repetitions of those of the last war.
1War Department Special Orders No. 166, 19 July 1917, par. 137.
2Office Order No. 97, Surgeon General's Office, 30 Nov. 1918.
3Maj. Gen. William C. Gorgas, The Surgeon General, 16 Jan. 1914-3 Oct. 1918.
4Formerly Assistant Superintendent, Walter E. Fernald State School, Waverly, Mass., and instructor of psychiatry, Boston University Medical School, Boston, Mass.
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The Neuropsychiatry Branch was severely handicapped by lack of personnel, information, and statistics. In the last-named case, there was one period when the wartime statistics were retarded almost 2 years. Only after a complete reorganization of the Statistical Division, SGO (Surgeon General's Office), could the Neuropsychiatry Consultants Division obtain reliable statistical data upon which to base a true estimate of the neuropsychiatric situation.
Because Colonel Madigan was to be transferred to the Adjutant General's Office, The Surgeon General sought a replacement. He had been made aware of the need of support from civilian psychiatric groups and thus requested Dr. Winfred Overholser, secretary of the American Psychiatric Association, to submit a list of possible replacements. The list was to include outstanding, well-known, and mature psychiatrists who would have ability, recognition, and civilian support to assume the duties of the chief of the branch and, therefore, those of the chief consultant in neuropsychiatry for the Army. After due deliberation, Dr. Roy D.
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Halloran5 was selected. Colonel Madigan was transferred on 15 August 1942, and Dr. Halloran reported for duty on 17 August 1942 in the rank of colonel (fig. 2).
CHANGING CONCEPTS
During early mobilization in 1940, the consensus of prominent civilian and military psychiatrists was that a major effort should be made to eliminate potential psychiatric casualties by screening at the induction level. It was believed that this procedure would eliminate or at least mitigate serious psychiatric problems, if any, during the war. As a result, the main function of psychiatrists in the Army would be to detect and screen out the men who had escaped detection at the induction station. As the war progressed, it was discovered that this reliance upon selection and elimination failed to prevent the appearance of large numbers of psychiatric cases. It also soon became apparent that neuropsychiatric difficulties
5Formerly Superintendent, Metropolitan State Hospital, Waltham, Mass., and professor of clinical psychiatry, Tufts College Medical School, Boston, Mass.
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had become one of the most serious medical and manpower problems facing the Medical Department and the Nation. It was obvious, therefore, that considerable planning and action would be necessary to prevent this ever-increasing loss of manpower. As a step in this direction, The Surgeon General approved the addition to the Neuropsychiatry Branch of an officer whose main interest would be to carry out a preventive program. On 24 March 1943, 1st Lt. (later Maj.) John W. Appel, MC,6 was appointed to the branch. Since it was believed that the morale of soldiers was intimately related to the causes of mental disorders in the Army, close liaison between the Neuropsychiatry Branch and the Special Services Division,7 ASF (Army Service Forces), was considered desirable. Lieutenant Appel was appointed liaison officer with this division (p. 120).
6Formerly psychiatrist on the staff of the Institute of the Pennsylvania Hospital, and instructor in psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pa.
7Later known as the Morale Services Division and, subsequently, as the Information and Education Division.
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Necessity of Treatment
Even before Pearl Harbor, and certainly soon thereafter, the increasing numbers of psychiatric inpatients made evident the need for a treatment program. Early in the war, the Army policy was to discharge psychiatric patients as soon as possible after an adequate diagnosis had been made. Even then, it was necessary to provide treatment for patients awaiting discharge. To aid in furthering the psychotherapeutic and somatic treatment program, Maj. (later Lt. Col.) Walter E. Barton, MC (fig. 3),8 was assigned to the Neuropsychiatry Branch on 22 April 1943. He immediately began to plan for occupational therapy facilities in Army hospitals. Major Barton remained assigned to this branch until the establishment of the Reconditioning Division, which absorbed the occupational therapy functions. Major Barton was then transferred to that division on 19 August 1943. Later in the war, a more definitive type of treatment, rather than mere inpatient activity, became necessary. This definitive treatment became the problem of the Psychiatry Section of the Neuropsychiatry Branch.
8Formerly Assistant Superintendent, Worcester State Hospital, Worcester, Mass., and lecturer in social psychiatry, Smith College, Northampton, Mass.
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Increased Neuropsychiatric Demands and Necessary Changes
The pressure of increasing neuropsychiatric demands became so great that the Neuropsychiatry Branch was forced to eliminate all earlier activities unrelated to psychiatry. Even with this relief, however, the four officers, then assigned, were barely able to cope with the routine activities of the branch. Among the problems showing a decided increase were those of a purely neurological nature. These required expert technical supervision and the formulation of policies at the level of the Surgeon General's Office. Accordingly, Maj. (later Lt. Col.) William H. Everts, MC (fig. 4),9 was transferred to the branch on 3 October 1943 to perform such duties in relation to neurology.
Colonel Halloran continued as chief of the branch until his sudden
9Formerly instructor in neurology, Neurological Institute, New York, N.Y., and attending neurologist, Neurological Institute, French Hospital, New York, N.Y., New Rochelle Hospital. New Rochelle, N.Y., and Grasslands Hospital, Valhalla, N.Y.
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and untimely death on 10 November 1943, which came as a severe shock to his coworkers in the branch and in the field. Colonel Farrell assumed the duties as acting chief until a successor was appointed.
On 17 December 1943, Lt. Col. (later Brig. Gen.) William C. Menninger, MC (fig. 5),10 was appointed as chief consultant in neuropsychiatry and chief of the Neuropsychiatry Branch.
NEUROPSYCHIATRY DIVISION
On 29 November 1943, a plan was proposed to elevate the Neuropsychiatry Branch to the status of a division11 on a level with surgery and medicine. It suggested that the Neuropsychiatry Division be divided into four branches: Psychiatry, Neurology, Preventive Psychiatry, and Clinical Psychology. The plan also detailed the functions of each of these branches.
Maj. Gen. Norman T. Kirk, The Surgeon General, along with Brig. Gen. Charles C. Hillman, Chief, Professional Service, SGO, recognized the nature and magnitude of the neuropsychiatric problem and supported the elevation of the specialty to the status of a division.12 In the subsequent reorganization of the Professional Service, neuropsychiatry was thus recognized, and the specialty was made a representative division of the Surgeon General's Office on 1 January 1944. This change permitted the alteration and expansion of the former Neuropsychiatry Branch; it added more personnel and placed them in positions of more prestige. This permitted the new division to deal with the many tasks and problems that confronted it through more direct contact with higher echelons.
In order to cope more effectively with the increasing problems, Colonel Menninger submitted a second memorandum13 to General Hillman in which he recommended an increase in the number of officer personnel
10Consultant in Neuropsychiatry, Fourth Service Command, 25 November 1942-10 December 1943. Formerly medical director, Menninger Psychiatric Hospital, and president, board of governors, The Menninger Foundation, Topeka, Kans.
11Memorandum, Lt. Col. Malcolm J. Farrell, MC, Acting Chief, Neuropsychiatry Branch, for Brig. Gen. Charles C. Hillman, Chief, Professional Service, SGO, 29 Nov. 1943, subject: Proposed Plan of Reorganization of a Division of Neuropsychiatry.
12It would be a serious deficiency in this history not to record the assistance and encouragement given to neuropsychiatry by General Kirk, The Surgeon General. In many instances, his active and personal support carried through measures which otherwise never would have materialized. The best example of this is the part he played in the winning of the final approval of the appointment of division psychiatrists. Efforts had been made constantly since September 1942 to reestablish the position of division psychiatrist. In November 1942, the European theater requested approval by the War Department. Approval was repeatedly blocked by the Operations Service of the Surgeon General's Office and the Army Ground Forces in spite of the proved usefulness of such officers in World War I. When General Kirk returned from his visit to North Africa, he was convinced of the need for these officers. One of his first acts as The Surgeon General, following his appointment on 1 June 1943, was to reopen the question. Determined opposition was encountered from Army Ground Forces, the argument presented being that the position was not necessary and that no such position could be allotted in the new streamlined triangular division. General Kirk personally appeared at the hearing called by G-1 of the War Department to listen to the arguments on both sides. General Kirk's own vigorous argument in favor of such appointments without doubt resulted in approval by the War Department in November 1943.-M. J. F.
13Memorandum, Lt. Col. William C. Menninger, Director, Neuropsychiatry Division, for Brig. Gen. Charles C. Hillman, Chief, Professional Service, SGO, 22 Jan. 1944, subject: Father Organization of the Neuropsychiatric Division.
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from 4 to 10. He gave a brief analysis of the situation, divided the division into three branches, and detailed the function and job description of each of his assistants. The three branches were designated Psychiatry, Neurology, and Mental Hygiene.
Personnel Additions
The assignment of three additional officers was finally approved. On 7 February 1944, Capt. (later Maj.) Ivan C. Berlien, MC,14 was transferred to the Psychiatry Branch of the new division. Major Berlien's principal duties were centered upon problems of induction, personnel, division psychiatry, and disciplinary problems. Maj. (later Lt. Col.) Norman Q. Brill, MC (fig. 6),15 was assigned to the division on 13 March 1944 as chief of
14Formerly instructor in psychiatry, Wayne State University College of Medicine, Detroit, Mich.
15Formerly instructor in neurology, Columbia University College of Physicians and Surgeons, New York, N.Y.
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the Psychiatry Branch. Capt. (later Maj.) David W. Hilger, MC (fig. 7),16 was transferred to the division on 29 April 1944 and assigned as assistant chief of the Mental Hygiene Branch.
The mental hygiene consultation services at replacement training centers had since their inception17 been considered a very important function of the Army psychiatric program. To provide more effective supervision, coordination, and standardization of the clinics, Maj. (later Lt. Col.)
16Reserve medical officer called to active duty on 3 July 1941 after completion of residency at University of Minnesota; transferred from Schick General Hospital, Clinton, Iowa, where he served as chief of the neuropsychiatry section.
17At least three such clinics were functioning before they were officially approved and authorized in October 1942: The Signal Corps Replacement Training Center, Fort Monmouth, N.J., by Lt. Harry L. Freedman, MC; the Engineer Replacement Training Center, Fort Belvoir, Va., by Capt. Bernard A. Cruvant, MC; and the Anti-Aircraft Replacement Training Center, Camp Callan, Calif., by Capt. Julius Schreiber, MC.
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Manfred S. Guttmacher, MC (fig. 8),18 was assigned to the division on 15 September 1944. Since the majority of psychiatric social workers in the Army were assigned to the consultation services, Major Guttmacher had the additional duty of supervising these workers.
Further Reorganization
In the further reorganization of the Surgeon General's Office, the Office of the Chief of Professional Service was abolished on 25 August 1944. The Neuropsychiatry Division was redesignated as the Neuropsychiatry Consultants Division and, as a separate division, was directly responsible to the Deputy Surgeon General and the Executive Officer. As a result, the function of the Neuropsychiatry Consultants Division became more professional, and administrative matters were handled by or directly with the chief of the Professional Administrative Service or the chief of
18Formerly Chief Medical Officer of the Supreme Bench of Baltimore; instructor in psychiatry, Johns Hopkins University School of Medicine.
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the Operations Service.19 At this time, the director of the division became eligible for membership on The Surgeon General's special staff. Until then, no representative of neuropsychiatry had attended meetings of that special staff.
Clinical Psychology
Clinical Psychology did not become a branch of the Neuropsychiatry Consultants Division until 1 September 1945.20 The few commissioned psychologists in the Sanitary Corps, assigned to general hospitals, and those assigned elsewhere, all came under the jurisdiction of the Adjutant General's Department. Although clinical psychology was considered an important adjunct in the diagnosis and management of psychiatric cases, all earlier efforts to bring psychology under the supervision of The Surgeon General, and more specifically neuropsychiatry, failed until the very end of the war. Fortunately, chiefs of psychiatric services and sections in the field recruited and trained mostly enlisted personnel, with or without prior training, in some of the functions of the clinical psychologist. When the transfer of responsibility was made, commissioned psychologists also transferred to the Medical Administrative Corps. Lt. Col. Morton A. Seidenfeld, MAC,21 Chief Clinical Psychologist, Adjutant General's Department, was transferred in that same capacity to the Surgeon General's Office and became Chief, Psychology Branch, Neuropsychiatry Consultants Division. Capt. (later Maj.) Lawrence I. O'Kelly, MAC,22 also transferred, continued as assistant to Colonel Seidenfeld.
Psychiatric Social Workers
The need for the utilization of psychiatric social workers was made evident in the Army (p. 626), even in the early operations of Selective Service. Other contributions that they made to the neuropsychiatry program were particularly demonstrated in the function of the mental hygiene consultation services. In February 1943, the Chief of the Neuropsychiatry Branch expressed his desire to have on his staff a qualified psychiatric social worker who could supervise other workers in this specialty. It was not until 18 October 1943, however, that MOS (Military Occupational Specialty) 263 was established for this type of personnel. From that time on, the services and numbers of psychiatric social workers increased considerably. Despite almost herculean efforts, however, the Psychiatric Social Work Section was not established until 1 July 1945,
19It would be amiss here not to express appreciation for the active interest and support that General Hillman gave this division during his tenure as Chief of Professional Service. He was unusually well oriented psychiatrically and was keenly aware of the psychiatric problem in the Army.-M. J. F.
20War Department Circular No. 264, 1 Sept. 1945.
21Formerly Director of Rehabilitation, Chicago and Cook County Tuberculosis Institute.
22Formerly instructor in psychology, University of Colorado, Denver, Colo.
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with Maj. Daniel E. O'Keefe, MAC,23 on loan to this office from the Adjutant General's Office. Major O'Keefe was formally transferred to the Surgeon General's Office and became chief of the Psychiatric Social Work Branch which was established on 10 September 1945.
Later Personnel Changes
The policy of the Army Service Forces, as described in ASF Circular No. 151, 27 April 1945, resulted in a change of station for several personnel assigned to the Neuropsychiatry Consultants Division. This circular
23Formerly director of social service, U.S. Public Health Service Hospital, Lexington, Ky.
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required that all full-duty personnel and those on limited duty who could serve overseas and had not had the opportunity of serving there permanently be replaced by officers returning from overseas. Accordingly, Major Hilger, Assistant Chief of the Mental Hygiene Branch, was reassigned on 9 June 1945 and was replaced by Maj. Herbert S. Gaskill, MC,24 from the China-Burma-India theater. Colonel Farrell was reassigned on 15 June 1945 and was replaced by Col. S. Alan Challman, MC,25 who returned after more than 3 years' service as neuropsychiatric consultant for the Southwest Pacific Area. On 24 July 1945, Colonel Everts, Chief of the Neurology Branch, was replaced by Maj. Alexander T. Ross, MC (fig. 9),26 from the 96th General Hospital in England. Major Berlien, Chief of Professional Supervision Section, was replaced on 16 July 1945 by Maj. John M. Flumerfelt, MC,27 from the 38th General Hospital at Cairo, Egypt.
Expanding Functions
The function and scope of the Neuropsychiatry Consultants Division increased constantly and consistently from a very modest beginning, when the work consisted mainly of reviewing board proceedings, until long before the end of the war, when the division was concerned with a major source of manpower loss which confronted the Medical Department and the War Department. It dealt with a subject which was intangible and which captured a tremendous amount of public interest and concern. In order to cope with the problems, functional units operating as branches and sections were created as needed. Eventually, on 4 July 1945, the division had expanded to four branches and four sections. The Psychiatry Branch included the Professional Supervision Section, the General Psychiatry Section, the Training Center Section, and the Psychiatric Social Work Section. The other branches were: the Neurology Branch, the Mental Hygiene Branch, and the Clinical Psychology Branch. A fifth branch, the Psychiatric Social Work Branch, was elevated from a section in September 1945.
The division functioned as a closely coordinated team, with each officer responsible for a particular field activity. Each officer developed his own assignment and was responsible for planning or initiating changes in Army regulations, circulars, and technical medical bulletins relating to his specialty. He had the responsibility of keeping himself informed as to developments within the division so that, in an emergency, he would be competent
24Formerly resident in psychiatry, Pennsylvania Hospital, Philadelphia, Pa.
25Formerly director, Child Guidance Clinic, Minneapolis, Minn., and clinical professor of psychiatry, Medical School, University of Minnesota.
26Formerly assistant professor of neuropsychiatry, Indiana University School of Medicine, Indianapolis, Ind.
27Formerly Rockefeller Fellow in Psychiatry at Pennsylvania Hospital for Mental and Nervous Diseases, and research psychiatrist, Department of Hygiene, Howard University, Washington, D. C.
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to give information about, or to carry out, a particular activity other than his own. This was made possible largely through staff meetings wherein each officer discussed developments within his own sphere.
During the period of 1942-46, the personnel assigned to the Neuropsychiatry Consultants Division, SGO, were as follows:
Director: | Dates |
| Lt. Col. (later Col.) Patrick S. Madigan | 21 Feb.-15 Aug. 1942 |
| Col. Roy D. Halloran | 17 Aug. 1942-10 Nov. 1943 |
| Lt. Col. Malcolm J. Farrell1 | 10 Nov. -12 Dec. 1943 |
| Lt. Col. (later Brig. Gen.) William C. Menninger | Dec. 1943-26 June 1946 |
Assistant Director: | |
| Lt. Col. Malcolm J. Farrell | 10 Apr. 1942-15 June 1945 |
| Col. S. Alan Challman | 8 Sept.-7 Oct. 1945 |
| Lt. Col. Norman Q. Brill | Oct. 1945-15 Mar. 1946 |
Chief, Mental Hygiene Branch: | |
Capt. (later Maj.) John W. Appel | 1 Jan. 1944-3 June 1946 |
Chief, Neurology Branch: | |
| Maj. (later Lt. Col.) William H. Everts | 1 Jan. 1944-6 July 1945 |
| Maj. (later Lt. Col.) Alexander T. Ross | 24 July-20 Dec. 1945 |
Chief, Psychiatry Branch: | |
| Maj. (later Lt. Col.) Norman Q. Brill | 13 Mar. 1944-8 Oct. 1945 |
| Maj. Herbert S. Gaskill | 9 Oct.-21 8 Oct. 1945 |
Chief, Psychology Branch: | |
| Lt. Col. Morton A. Seidenfeld | 7 Sept.-15 Nov. 1945 |
| Capt. Lawrence I. O'Kelly | 15 Nov. 1945-22 Feb. 1946 |
Chief. Psychiatric Social Work: | |
| Maj. (later Lt. Col.) Daniel E. O'Keefe | 18 June 1945-12 Feb. 1946 |
Other members: | |
| Capt. (later Maj.) David W. Hilger | 29 Apr. 1944-9 June 1945 |
| Capt. (later Maj.) Ivan C. Berlien | 7 Feb. 1944-5 Aug. 1945 |
| Maj. (later Lt. Col.) Manfred S. Guttmacher | 15 Sept. 1944-30 July 1945 |
| Maj. John M. Flumerfelt | 16 July 1945 4 Jan. 1946 |
| Maj. Herbert S. Gaskill | 2 June-8 Nov. 1945 |
| Maj. (later Lt. Col.) Walter E. Barton | 22 Apr.-19 Aug. 1943 |
1Acting.
