CHAPTER I
The Medical Department in 1939
In September 1939, when President Roosevelt proclaimed a limited nationalemergency, the U.S. Army Medical Department was serving an army whose meanannual strength was 191,551 officers and men.1 The Medical Departmentfunctioned as one of six services; the others were the Chemical WarfareService, the Corps of Engineers, the Ordnance Department, the QuartermasterCorps, and the Signal Corps. Its officer strength, 2,185, was considerablyhigher than that of any of the other services, being slightly more thantwice the number in the Quartermaster Corps, the service next highest inofficer strength. Its strength in enlisted men, 9,478, was greater thanthat of any of the other services except the Quartermaster Corps.
Unlike officer personnel in the other services, those of the MedicalDepart-ment of the Regular Army were organized into several corps: theMedical, Dental, Veterinary, and Medical Administrative Corps. (Membersof the Army Nurse Corps, a fifth component nominally constituting a corps,did not then have officer status.) Considered as a whole, the officer personnelof the Medical Department was more highly specialized than that of theother services, for members of the Medical, Dental, and Veterinary Corpshad all obtained degrees in their respective fields before obtaining commissionsin the Army, and the technical education which they had received in civilianlife was supplemented in the Army by courses in military aspects of theirdisciplines.
Additional medically trained officers were available to the Army, wheneverthe need should arise, in the Organized Reserves and the National Guardof the United States. Within the Officers Reserve Corps, part of the OrganizedReserves, there existed the following corps, constituting the Medical DepartmentReserve: Medical Corps Reserve, Dental Corps Reserve, Medical AdministrativeCorps Reserve, Veterinary Corps Reserve, and Sanitary Corps Reserve. TheSanitary Corps Reserve had no counterpart in the Regular Army, while theArmy Nurse Corps had no counterpart in the Reserves. The National Guardof the United States had a Medical Corps, a Dental Corps, a Medical AdministrativeCorps, and a Veterinary Corps, as well as a complement of enlisted menwith Medical Department training.
The Medical Department also had an important asset in its affiliationwith a number of agencies and institutions, public and private, preparedto aid it in medical research, in procuring and training qualified personnel,and in various
1Annual Report of The Surgeon General, U.S.Army, 1940. Washington: U.S. Government Printing Office, 1941, p. 1.
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other aspects of its work. In addition to continuous liaison with theBureau of Medicine and Surgery of the Navy and with the Veterans` Administration,especially with respect to the hospitalization of military personnel, theMedical Department kept in close touch with the American Medical Association,the American Veterinary Medical Association, the American Dental Association,the American College of Surgeons, the American College of Physicians, variouscivilian nursing groups, and other recognized professional associations.Its relations with the first-named were particularly close, for nearlyall doctors in the United States, including Army medical officers, weremembers of the American Medical Association. The American National RedCross, chartered by act of Congress in 1905, could be counted on to aidthe Army Medical Department with certain medical supplies and auxiliarypersonnel in the event of war. It maintained a register of medical technologists,and more important, a reserve of nurses for the use of both Army and Navywhich compensated in a measure for the lack of a Nurse Corps reserve. Anotheragency empowered to support the Army Medical Service was the National ResearchCouncil, set up in 1916 by the National Academy of Sciences at PresidentWilson`s request. The Council`s Division of Medical Sciences was preparedto give the Army Medical Department advice on technical problems. For aidin research the Medical Department could draw upon a number of educationalinstitutions and research foundations.
ORGANIZATION OF THE MEDICAL DEPARTMENT WITHIN THE
WAR DEPARTMENT
In September 1939 the Office of The Surgeon General in Washington, D.C.,was, as it had been for many years, the office which directed the workof the Army Medical Department. The Surgeon General was appointed by thePresident of the United States, with the advice and consent of the Senate,for a 4-year term. In the absence of The Surgeon General the chief of thePlanning and Training Division usually acted in his stead; this officerwas sometimes referred to as the Deputy Surgeon General. Maj. Gen. JamesC. Magee had become Surgeon General on 1 June 1939, succeeding Maj. Gen.Charles R. Reynolds (fig. 1). He headed an office, located in War DepartmentAnnex No. 1 at 401 Twenty-third St. NW. (fig. 2), staffed with about 30officers and nurses and about 160 civilian employees.2
Together with the other services, the Medical Department had been locatedat staff level in the War Department since 1903, when the General Staffwas created. In 1939 it was an element of the War Department Special Staff,and The Surgeon General had direct access to the Chief of Staff. The Chiefof Staff and the General Staff were charged with coordinating the developmentof the separate arms and services in such a way as to insure an efficientmilitary
2Annual Report of The Surgeon General, U.S.Army, 1939. Washington: U.S. Government Printing Office, 1940, p. 163.
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team, but their relations with the chiefs of services, including TheSurgeon General, remained about the same as those established in 1903.Measures which the Surgeon General`s Office desired to put into effectthroughout the Army had to clear through one or more of the five divisionsof the General Staff: G-1, Personnel; G-2, Military Intelligence; G-3,Operations and Training; G-4, Supply; and the War Plans Division. Mostmeasures called for the concurrence of G-1 or G-4, or both. The supervisionof G-4 over medical service was closer than that exercised by any otherof the General Staff elements, for in addition to G-4`s general responsibilitiesfor Army supply, it was specifically charged with preparing plans and policiesfor the evacuation and hospitalization of troops and animals, and for supervisingthese activities. The War Plans Division had the task of formulating plansfor employment of troops in theaters of operations, but in peacetime itssupervision over the medical service was limited to the coordination ofthe medical phases of such plans with other phases.3
The Office of The Surgeon General also had close contact with the Officeof the Assistant Secretary of War, for the latter was charged by legislationwith
3(1) 39 Stat. 168. (2) Annual Report of theSecretary of War, 1916. Washington: U.S. Government Printing Office, 1917,pp. 49ff. (3) Army Regulations No. 10-15, 18 Aug. 1936.
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supervising the procurement of all military supplies and assuring adequateprovision for mobilizing materiel and industrial organizations for wartimeneeds. The Assistant Secretary`s office maintained liaison with manufacturingcompanies and industrial facilities. The Surgeon General dealt with G-4on the military aspects of medical supplies and equipment and with theOffice of the Assistant Secretary on business or industrial aspects.4
Internal Organization and Functions
Divisions of the Surgeon General`s Office
The 10 divisions which made up General Magee`s office in 1939 were:Administrative, Finance and Supply, Military Personnel, Planning and Training,Professional Service, Statistical, Library, Dental, Veterinary, and Nursing(chart 1). The organization had existed in substantially this form since1935.5
4 (1) 41 Stat. 764. (2) Lecture, Brig. Gen.R. C. Moore, Deputy Chief of Staff, before Army Industrial College, 24Aug. 1940, subject: The Supply Division, G-4 of the War Department GeneralStaff. (3) Yates, Richard E. : The Procurement and Distribution of MedicalSupplies in the Zone of Interior During World War II, pp. 4-13. [Officialrecord.]
5 (1) Annual Report of The Surgeon General, U.S. Army, 1939.Washington: U.S. Government Printing Office, 1940, pp. 163-250. (2) AnnualReport of The Surgeon General, U.S. Army, 1924. Washington: U.S. GovernmentPrinting Office, 1925, p. 238.
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Chart 1.- Office of the SurgeonGeneral, October 1939
Administrative Division.-Major functions of the AdministrativeDivision were the handling of mail and records, the handling of mattersrelating to the civilian personnel of the office, the administration ofcertain hospital funds and the admission of patients to the Army and NavyGeneral Hospital, the issuance of office supplies, the management of fundsfor various publications, and the editing of The Army Medical Bulletin,a journal containing articles of medicomilitary interest published by theMedical Department since 1919.
Finance and Supply Division.-Fiscal functions and functions relatingto the purchase, storage, and issue of medical supplies and equipment werehandled in the Finance and Supply Division. In the procurement of medicalsupplies and equipment this division worked closely with the AssistantSecretary of War. It prepared budget estimates for The Surgeon Generaland kept control accounts for appropriations granted the Medical Department.The merging of the supply function with fiscal activities was a naturaldevelopment, as medical supply and equipment was the major item of expenditurehandled by this division. The fact that the division also had general controlof civilian employees in field installations indicates that the managementof civilian employees was then considered largely a routine fiscal matter.The procurement and induction of civilian employees for extensive use inthe Surgeon General`s Office and field installations of the Departmentwas not yet, as it later became, a pressing problem.
Military Personnel Division.-The Military Personnel Divisionselected, classified, and assigned commissioned medical personnel of theRegular Army
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and the Reserve Corps. It also maintained records on enlisted medicalpersonnel.
Planning and Training Division.-The Planning and Training Division,made up of the subdivisions of Planning and of Training, developed majorpolicies in those two fields. Although Medical Department planning hadto deal with supply, personnel, and so forth, as well as training, thelast-named had been closely associated with planning since 1923, when thetwo functions of planning and training were assigned to a single division.This division prepared tables of organization (numbers, ranks, and dutiesof personnel and their unit equipment) for new medical units and detachmentsand revised those for current ones. It also planned the development ofmedical field equipment. Its work in training included making plans forthe technical training of enlisted men, the tactical training of medicalunits, and the training of National Guard and reserve officers at Armyprofessional schools, summer camps, and certain medical civilian centers.The division also developed plans for hospital construction and repairin conjunction with the Office of the Quartermaster General. In 1939 itwas still concerned also with developing medical policies for the CivilianConservation Corps.
Professional Service Division.-Policies on physical standardsfor the Regular Army and the Reserve Corps were prepared in the ProfessionalService Division. This division reviewed papers concerned with the physicalexaminations of officers and nurses. It also reviewed the examinationsof applicants for commissions, the medical records of candidates for serviceschools, and complaints and claims involving personnel of the CivilianConservation Corps and trainees of the Citizens Military Training Campsand Reserve Officers` Training Corps. It drafted Army-wide regulationsrelating to health, sanitation, and preventive medicine and the MedicalDepartment forms to be used for reporting the health of Army troops, aswell as the regular circular letters which the Department distributed tofield installations. These were designed to standardize professional policiesand maintain uniform professional standards in hospitals. It supervisedthe work of the Army Medical Museum, which classified and displayed medicalspecimens, equipment, and photographs, particularly of a pathological nature.
Dental, Veterinary, and Nursing Divisions.-The Dental, Veterinary,and Nursing Divisions handled administrative and professional matters relativeto the Dental, Veterinary, and Army Nurse Corps respectively. In the fieldsof personnel and training for their respective corps they were practicallyautonomous.
Statistical Division.-The Statistical Division tabulated andanalyzed reports on disease and mortality in the Army and the CivilianConservation Corps. Data on individual soldiers played an important rolein decisions on pension and disability claims. Statistical summaries keptthe Medical Department informed of the major threats to the Army`s physicalwell-being,
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thus aiding in the determination of policies as to treatment, and contributedvaluable data to medical history.
Library Division.-The functions of the Library Division werethe formulation of policies for, and the administration of, the Army MedicalLibrary.
Boards and committees
In addition to the divisional setup in the Surgeon General`s Office,a few boards and committees handled certain special problems of an administrativenature. Among the functions handled by boards were, for example, the determinationand review of ratings of Medical Department officers and the approval ofefficiency ratings of civilian employees.
Liaison With Other War Department Units
Army Air Corps.-Certain units of the War Department other thanthe Surgeon General`s Office had medical functions which they carried outunder the aegis of, or in liaison with, the Surgeon General`s Office. Themajor group of this type was the Medical Division of the Air Corps. SinceWorld War I the War Department had recognized that in providing medicalservice for the Air Corps, it was important to give special considerationto the physical qualifications required of fliers, and to certain diseasesand injuries peculiar to, or relatively more common among, fliers. Therecognition of the necessity for examination and care of fliers by medicalofficers specially trained in this work had taken the form of the assignmentof a group of Medical Department officers to the Air Corps. Most of theseofficers were trained as "flight surgeons," a term coined in1918.
The series of circular letters, training manuals, and other technicaldocuments in which the Surgeon General`s Office formulated professionalstandards for medical, dental, and veterinary service went to Air Corpsheadquarters and installations as well as to the remainder of the Army.Air Corps medical officers had to keep the same statistical records andfill out the same reports to the Surgeon General`s Office as medical officersassigned to other parts of the Army. These served to insure Army-wide uniformityof professional standards. However, medical officers assigned to the AirCorps had to acquaint aviators with the physical and psychological hazardsof flying--the physical strain imposed by rapid shifts of altitude andtemperature and the mental tension caused by the dangers of flight. Specialtraining was required for either of the two chief assignments in Air Corpsmedical work the aviation medical examiner, who tested candidates for theirability to withstand the hazards of flight, and the flight surgeon, whotreated fliers and had to be versed in the maladies common among them.Since spotting the source of infection is difficult in the case of sucha highly mobile force, the standard environmental sanitary measures ofthe Army were of limited value for air
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troops; the Medical Division of the Air Corps had to issue special instructionsand set up special procedures for disease control.
In late 1939 the group of medical officers assigned to the Office ofthe Chief of the Air Corps constituted a division and was a major unitof that office. Although personnel, physical examinations, aviation medicine,and research and statistics were recognized as major fields of work ofthe division, no true functional breakdown on the basis of personnel assignmentexisted. Only two Medical Corps officers, with three or four civilian assistants,were then on duty, and the division was primarily concerned with the reviewof physical examinations for fliers. Other activities were the pursuitof certain research projects, especially investigations of the effectsof variation in air pressure upon the efficiency of fliers, the developmentof oxygen equipment, and the training of medical officers in the principlesof aviation medicine to qualify them as aviation medical examiners or flightsurgeons.
During the periods between World Wars I and II, Air Corps theory favoringan air force separate from the Army was reflected in the relations betweenthe Office of The Surgeon General and the Medical Corps officers assignedto the Air Corps. The latter sporadically exhibited some tendency to pullaway from the jurisdiction of The Surgeon General, insisting from timeto time on the special characteristics of Air Corps medical service. Duringthis period, however, the doctrine of separatism among medical officersassigned to the Air Corps was not emphatically voiced; many apparentlyfelt a greater long-range loyalty to the Medical Corps to which they belongedthan to the Air Corps. The fact that medical officers with the Air Corps,had been given their assignments by The Surgeon General, or by those previouslyso assigned by him, helped maintain the chain of loyalty that bound themto The Surgeon General. The need for flight surgeons was not yet fullyrecognized by Air Corps officers. As late as October 1939 the Chief ofthe Air Corps, Maj. Gen. (later General of the Army) Henry H. Arnold, irritatedby a per-sonal experience, directed the appointment of a board of officersto justify the existence of flight surgeons.6
Medical officers of the Surgeon General`s Office were not in completeagreement as to where the group directing medical service for the Air Corpsshould be located. They frequently stated that they recognized the specialproblems of medical service for aviators but pointed out that the distinctivefeatures of aviation medicine made it at most a medical specialty ratherthan a separate science. The "peculiarities" of aviation medicinedid not warrant, in their opinion, the assignment of it to a group of officersresponsible to the Air Corps. They recognized, however, as a practicalconsideration in any attempt to transfer medical functions of the Air Corpsto the Office of The Surgeon General (and its medical installations tothe control of The Surgeon
6Link, Mae Mills, and Coleman, Hubert A.: MedicalSupport of the Army Air Forces in World War II. Washington: U.S. GovernmentPrinting Office, 1955, pp. 26-27.
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General) the greater drawing power of the Air Corps in obtaining appropriationsfrom Congress. Public and congressional interest in aviation was so strongthat whereas a request for additional appropriations to the Medical Departmentto take care of medical service for the Air Corps might be turned down,any Air Corps request for an appropriation for the same purpose would beaccepted in the general appropriation for the development of Army avia-tion.At the same time they felt that the degree of autonomy already establishedby the medical group in the Air Corps violated the principle that eachsupply service of the Army should have a single head.
In early 1939 General Reynolds embarked upon an effort, renewed by GeneralMagee in the fall, to have the medical group of the Air Corps transferredto his office and the School of Aviation Medicine at Randolph Field, Tex.,removed to his jurisdiction. This move began a struggle on the part ofthe Surgeon General`s Office for coordination of the entire Army medicalservice under it and on the part of the medical group in the Air Corpsfor autonomy, one phase of the general struggle for autonomy of the Army`sair forces which continued through the war. Lt. Col. (later Col.) C. L.Beaven, MC (fig. 3), then Chief of the Medical Division of the Air Corps,agreed with The Surgeon General`s desires in the matter, while Lt. Col.(later Maj. Gen.) David N. W.
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Grant, MC (fig. 4), his assistant who soon succeeded him, favored retentionof the Medical Division and the School of Aviation Medicine by the AirCorps. During the early months of his tour of duty, however, Colonel Grantwent along with Colonel Beaven`s policies, for the latter was still nominallyin charge.7
National Guard Bureau.-The Medical Department also had an officerassigned as medical adviser to the National Guard Bureau, the unit of theWar Department which handled National Guard Affairs. In 1939 this postin the office of the chief of the bureau was held by Col. (later Maj. Gen.)Howard McC. Snyder, IGD (fig. 5). His duties were primarily the provisionof medical care in training camps for the National Guard, direction ofthe training of medical units, and issue of the necessary medical suppliesand equipment.8
7 (1) Coleman, Hubert A.: Organization andAdministration, Army Air Forces Medical Service in the Zone of Interior,pp. 33-36, 132-135. [Official record.] (2) Annual Report of The SurgeonGeneral, U.S. Army, 1939. Washington: U.S. Government Printing Office,1940, p. 259. (3) Armstrong, Harry G.: Principles and Practice of AviationMedicine. Baltimore: Williams & Wilkins, 1943, pp. 20-27. (4) Letter,Maj. Gen. David N. W. Grant, MC, USAF (Ret.), to Col. John Boyd Coates,Jr., MC. Director, The Historical Unit , U.S. Army Medical Service, 11Aug. 1955, subject: Comments on preliminary draft of this volume.
8 (1) Annual Report of the Chief, NationalGuard Bureau, 1939. Washington: U.S. Government Printing Office, 1940,p. 1. (2) Interview by the author with staff members, National Guard Bureau,28 June 1948.
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MEDICAL FIELD OFFICES AND INSTALLATIONS
The Surgeon General`s Office directed the medical work of the Army throughoutthe United States and the oversea possessions where elements of the Armywere stationed. Nearly 75 percent of Army troops were stationed in theUnited States; most of the remainder were in Hawaii, Panama, the Philippines,and Puerto Rico.9 At major Army headquarters there existed anetwork of medical administrative offices which carried out the policiesestablished by the Washington office. Policies and procedures establishedby the office with respect to hospitalization, medical supply, and equipment,as well as the technical instructions which the office drew up for theprevention and treatment of disease, were embodied in the series of circularletters, issued and revised regularly since 1918. These were distributedto corps areas and departments, general hospitals, and the surgeons ofstations and tactical installations.
Medical Research Division, Edgewood Arsenal
At the chief field installation maintained by the Chemical Warfare Service,Edgewood Arsenal, Md., certain Medical Department officers constitutinga
9Annual Report of The Surgeon General, U.S.Army, 1940. Washington: U.S. Government Printing Office, 1941, p. 1.
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Medical Research Division, were engaged in research on preventive andcura-tive measures to counteract chemical warfare agents. Research in thisfield dated from the widespread use of gases in World War I. During thepre World War II period, research in chemical warfare medicine had notprogressed rapidly. Various factors had made it difficult to procure andretain highly qualified civilian personnel, including poor pay, the semi-isolationof the arsenal, and the fact that the nature of the work prevented publicationof much of the research. Appropriations had been meager, and frequent rotationof officers had handicapped the continuity of the research.
In 1935 the Medical Department had recognized that progress to datewas unsatisfactory, and The Surgeon General had endorsed proposals to theChief of the Medical Research Division at Edgewood Arsenal for more thoroughresearch into methods of definitive treatment of gas casualty cases; thelatter had pointed out recent developments in chemistry which enlargedthe possibilities of effective treatment. The Surgeon General had increasedfunds allotted to the work, and research in chemical warfare medicine hadthen entered upon a period of more direct guidance by the Medical Department.This was the setup in 1939, which prevailed throughout most of GeneralMagee`s administration. In 1939 and preceding years two or three MedicalDepartment officers received training annually in the Chemical WarfareSchool at Edgewood Arsenal.10
Corps Areas and Territorial Departments
In 1939 the United States was divided into nine corps areas, each incharge of a corps area commander. On the commander`s special staff wasa corps area surgeon. Three territorial departments (four before the closeof the year) were the corresponding units for certain of the U.S. possessionsoverseas: the Hawaiian, Philippine, and Panama Canal Departments. The corpsarea or department surgeon was responsible for the training of MedicalDepartment personnel in his area; for recommendations as to the constructionand repair of Medical Department buildings, particularly hospitals; forcoordinating inspections to determine sanitary conditions, the efficiencyof medical personnel, and the adequacy of medical supplies throughout thecorps area; and for making recommendations as to the transfer of medicalpersonnel from station to station within the corps area or department;and for transfer of patients from station hospitals to the general hospitalswhich gave more advanced or definitive treatment. He prepared regular reportsfor The Surgeon General on the efficiency of medical officers serving directlyunder him and
10 (1) Cochrane, Rexmond C. : Medical Researchin Chemical Warfare, Chemical Warfare Service, 1947. [Official record.](2) Army Regulations No. 50-5, 31 May 1939. (3) Report on Training of MedicalDepartment Officers, 1 July 1939-30 June 1944, p. 19. [Official record.]See also Brophy, Leo P., Miles, Wyndham D., and Cochrane, RexmondC.: United States Army in World War II, The Chemical Warfare Service: FromLaboratory to Field. Washington: U.S. Government Printing Office, 1959.
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annual reports to The Surgeon General on the health of troops stationedwithin the area. In the effort to lay some responsibility upon line officersfor health conditions within their commands, Army regulations held commandingofficers of all grades responsible for the enforcement of measures to controland prevent disease, including regulations on sanitation and hygiene andthe, control of venereal disease. The cooperation of commanders of troopelements within the corps area in the enforcement of these measures wasimportant to the corps area surgeon.
The corps area surgeon`s office
The corps area surgeon`s office was small and did not require a divisionalbreakdown. Usually three or four medical officers, with perhaps an additionalMedical Administrative Corps officer, and about the same number of civilianclerical personnel were assigned to the office. The corps area surgeon,or a representative from his office, customarily visited each medical installationin the corps area in the course of a year. Complaint of shortage of personnel,particularly dental, throughout the corps area was fairly common. In themaintenance of medical service for the Civilian Conservation Corps--anadditional responsibility to which corps area surgeons attributed in parttheir personnel shortages--medical, dental, and veterinary Reserve officerswere sometimes employed on a civilian status, along with civilian dentistsand nurses.11
The Surgeon General`s relationship with corps area surgeons and medicalinstallations in the corps areas involved both technical and command control.The Surgeon General had technical control over all Medical Department officersand offices, including those of the Air Corps; technical instructions issuedby his office were applied throughout the Army. The channels of technicalcontrol extended downward from The Surgeon General to corps area surgeons,and from them to station and unit surgeons. In theory this technical controlcould be nullified by the commanding general of a corps area, who exercisedcommand authority over all medical personnel within his jurisdiction, butin practice The Surgeon General`s orders were rarely questioned. The corpsarea surgeon had direct access to his commander by virtue of his staffposition, and in peacetime, at least, enjoyed a considerable degree ofautonomy.12
The prevailing practice was that the corps area commander should havecommand of installations within the geographical boundaries of his corpsarea. Hospitals or dispensaries located at posts or stations within corpsareas
11 (1) Army Regulations No. 170-10, 18 Aug.1936 and 10 Oct. 1939. (2) Annual Reports of the Corps Area Surgeons, 1938,1939. 319.1-2 (CAS) AA. (3) Army Regulations No. 40-5, 15 Jan. 1926, withchange 1, 9 June 1938; Army Regulations No. 40-205, 15 Dec. 1924; ArmyRegulations No. 40-210, 21 Apr. 1923; Army Regulations No. 40-235, 11 Oct.1939; Army Regulations No. 40-270, 21 Apr. 1923.
12History, Office of the Surgeon, II Corps Area and Second ServiceCommand, 9 September 1940-2 September 1945. [Official record.]
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were therefore within the corps area chain of command, with certainexceptions. However, a tendency existed to give the chief of a service,or a combat arm, command control over stations concerned exclusively (orperhaps primarily) with the work of that service or arm. Thus an ordnancearsenal was under command of the Chief of Ordnance; thence the stationhospital at the arsenal was within the Ordnance Department`s chain of command.A station hospital might be within the command channel of one of the armsor services or of the corps area commander.
Major medical installations
Other than station hospitals, major medical installations in the UnitedStates in 1939 were of the four following main types: General hospitals,which received patients needing advanced or definitive treatment withoutregard to the corps area in which the patient has been stationed; the serviceschools of the Medical Department; the medical supply depots; and medicallaboratories. Over most of these The Surgeon General had command control.13In the course of the war the extent of his command over some of these installationsunderwent considerable change.
The principal Medical Department installation commanded by The SurgeonGeneral was the Army Medical Center (fig. 6), in Washington, D.C.; it
13See Army Regulations No. 170-10, 10 Oct.1939, for detailed list of stations and installations commanded by TheSurgeon General.
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was made up of three of the types mentioned above--a general hospital(Walter Reed); the Medical, Dental, and Veterinary Schools; and the Medical,Dental and Veterinary Laboratories.14 Two other installationslocated in Washington were the Army Medical Library and the Army MedicalMuseum. Both of these, as well as the Army Medical Center, remained underThe Surgeon General`s command throughout the war.
General hospitals.-General hospitals then in existence in theUnited States (in addition to Walter Reed) were: Army and Navy in Hot Springs,Ark.; Fitzsimons in Denver, Colo.; Letterman in San Francisco, Calif.;and William Beaumont in El Paso Tex. These installations were under thecommand control of The Surgeon General, because they received patientsfrom various corps areas. It was desirable that the Surgeon General`s Officeexercise central control over the transfer of a patient from a stationhospital to the general hospital, located in whatever corps area, whichcould best give him the definitive treatment which he needed. On the otherhand, the two general hospitals in the departments--Tripler in Hawaii andSternberg in the Philippines--were under the command of the departmentcommander. The remoteness of the Pacific island territories made commandby the local department commander more feasible than command from Washington.Any general hospital that might function in a theater of operations wouldsimilarly come under the command of the tactical commander within whosejurisdiction it was located.15
Service schools.-Schools under command control of The SurgeonGeneral were the three professional schools at the Army Medical Centerand the Medical Field Service School at Carlisle Barracks, Pa. At the professionalschools in Washington, Medical Department officers and enlisted techniciansreceived training in medical specialties and in the military aspects ofthe medical, dental, and veterinary services. The school at Carlisle Barrackstrained medical, dental, veterinary, and Medical Administrative Corps officers,as well as enlisted men in the fieldwork of the Medical Department, emphasizingsuch matters as administration, training, military art, and sanitation.The School of Aviation Medicine, which dated from World War I, had beenlocated at Randolph Field, Tex., since 1931. In name and function a medicalschool, it was under command control of the Air Corps, specifically theAir Corps Training Center, although it was planned to transfer it to TheSurgeon General`s jurisdiction in the event of mobilization.16
Medical supply depots.-In 1939 the only depot handling medicalsupplies exclusively was the St. Louis Medical Depot. It was under thecommand
14Army Regulations No. 40-600, 31 Dec. 1934.
15See footnote 14.
16(1) Report on the Training of Medical Department Officers,1 July 1939-30 June 1944, pp. 3-5. [Official record.] (2) Coleman, HubertA.: Organization and Administration, Army Air Forces Medical Service inthe Zone of Interior, pp. 243-244. [Official record.] (3) Annual Reportof The Surgeon General, U.S. Army, 1939. Washington: U.S. Government PrintingOffice, 1940, pp. 180-182. (4) Armstrong, Harry G.: Principles and Practiceof Aviation Medicine. Baltimore: Williams & Wilkins, 1943, p. 12.
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control of The Surgeon General. Three of the general depots, under thecommand control of the Quartermaster General, had medical sections alongwith sections for the other supply services: the New York, San Francisco,and San Antonio General Depots. The Medical Section, New York General Depot,which was larger than the St. Louis Medical Depot as well as larger thanthe medical sections of either of the other two general depots, boughtthe great bulk of medical supplies and equipment, as most of the medicalsupply firms were concentrated in northeastern United States. It storedand issued medical supplies as well. The St. Louis Medical Depot and themedical sections of the San Antonio and San Francisco General Depots actedprimarily as storage and issue depots.17
Medical Department laboratories.-The Medical Department`s laboratorysystem was made up of units concerned with problems of general medicine,veterinary medicine, dentistry, or aviation medicine. The Army MedicalCenter in Washington had laboratories of the first three types. During1938 the Dental Division, Surgeon General`s Office, had been engaged inestablishing five central dental laboratories, including the dental laboratoryat the Army Medical Center, to give prosthetic service to troops in specifiedcorps areas. By the middle of 1939 these were in operation. Except forthe laboratory at the Center, they were under the command control of thecommanding officer of the Army station where they were located. In additionto its research, its diagnostic work with animal diseases, and the preparationof veterinary biological products, the veterinary laboratory at the ArmyMedical Center made examinations of samples of meat, meat food, and dairyproducts supplied to the Army. In the fall of 1939 the Veterinary Division,Surgeon General`s Office, undertook the establishment of a new laboratory,the Veterinary Research Laboratory, to work on problems of animal disease,especially equine influenza and periodic ophthalmia, at the QuartermasterDepot (Remount) at Front Royal, Va. This, too, was under the command controlof the commanding officer of the installation.18
Research installations.-In the fall of 1939 the single separateinstallation of the Medical Department which had been designed exclusivelyfor research, the Army Medical Research Board in Panama, was discontinuedfor lack of money. For several years it had undertaken studies in malaria,the dysenteries, and various animal diseases. Research on problems of aviationmedicine was carried on at two Air Corps installations, the School of AviationMedicine mentioned above, and the Aero-Medical Research Unit, later called
17(1) See footnote 4(3), p. 4. (2) Memorandum,Director, Storage and Maintenance Division, Office of The Surgeon General,for Historical Division (later Historical Unit), 16 Nov. 1944, subject:Supply Depot Historical Highlights.
18(1) Medical Department, United States Army. Dental Servicein World War II. Washington: U.S. Government Printing Office, 1955, p.217. (2) Annual Report of The Surgeon General, U.S. Army, 1939. Washington:U.S. Government Printing Office, 1940, pp. 200, 205. Annual Report of TheSurgeon General, U.S. Army, 1940. Washington: U.S. Government PrintingOffice, 1941, p. 211. (3) Medical Department, United States Army. VeterinaryService in World War II. Washington: U.S. Government Printing Office, 1962,pp. 429-431.
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the Aero-Medical Research Laboratory (fig. 7), at Wright Field, Ohio.The latter, under the Materiel Division of the Air Corps, had as commandantCapt. (later Maj. Gen.) Harry G. Armstrong, MC (fig. 8), who became SurgeonGeneral of the Air Force in the postwar period. The research projects ofthe School of Aviation Medicine and the Aero-Medical Research Unit overlappedsomewhat. The theory expressed at intervals was that the School of AviationMedicine should be concerned with the psychological and physiological effectsof flying, whereas the Aero-Medical Research Unit, under the jurisdictionof a command concerned largely with supply and maintenance, should dealwith problems of adaptation of planes and equipment to the human organism.However, it was difficult to divorce the two fields, and the question continuedto come up for discussion.19
The oversea departments
The organization of medical service in the oversea departments correspondedgenerally to that in the corps areas, and the headquarters organizationwas similarly small and uncomplicated. Medical officers in the departmentsurgeon`s office were usually termed simply "assistants," onebeing assistant in charge of supply, another of personnel, and so forth.The medical work of
19(1) Folder, Aero-Medical Laboratory, WrightField, Ohio, HU: TAS. (2) Armstrong, Harry G.: The Principles and Practiceof Aviation Medicine. Baltimore: Williams & Wilkins, 1943, p. 16. (3)Annual Report of The Surgeon General, U.S. Army, 1934. Washington: U.S.Government Printing Office, 1935, p. 154. Annual Report of The SurgeonGeneral, U.S. Army, 1938. Washington: U.S. Government Printing Office,1939, p. 178. Annual Report of The Surgeon General, U.S. Army, 1940. Washington:U.S. Government Printing Office, 1941, p. 195.
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the department surgeon`s office corresponded to that of the office ofthe corps area surgeon except for certain programs made necessary by localconditions in the departments. The department surgeon`s office directedthe usual dental and veterinary, as well as medical, services and reportedto the Surgeon General`s Office on disease rates and the general healthof the command. Malaria and venereal disease control demanded special effortin the Panama Canal and Philippine Departments. The office of the departmentsurgeon directed certain field training programs, although the number ofofficers and enlisted personnel was not usually large enough to permitextensive field medical training for Regular Army personnel. In the Philippines,the 12th Medical Regiment of Philippine Scouts, which later rendered effectiveservice at Bataan and Corregidor, was undergoing training, and in the HawaiianDepartment, the largest of the departments in troop strength, a few reserveofficers were trained on active duty status.20
20(1) Whitehill, Buell: Administrative Historyof Medical Activities in the Middle Pacific (1946). [Official record.](2) History of Medical Department Activities in the Caribbean Defense Commandin World War II, vol. I. [Official record.] (3) Annual Report of the DepartmentSurgeon, Panama Canal Department, 1939. (4) Annual Report of the DepartmentSurgeon, Philippine Department, 1939. (5) Annual Report of the DepartmentSurgeon, Hawaiian Department, 1939. (6) Cooper, Wibb E.: Medical DepartmentActivities in the Philippines from 1941 to 6 May 1942, and Including MedicalActivities in Japanese Prisoner of War Camps. [Official record.]
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In each department the Medical Department maintained a number of installationsof the same types as those in the corps areas. In the Philippine Department,for instance, were Sternberg General Hospital, five station hospitals,and a medical supply depot at Manila. At each of three station hospitals,as well as at Sternberg, was a dental clinic. Sternberg also had a laboratory(including a veterinary section) and a general and station dispensary service.These installations provided medical service for approximately 30,000 personnel,of whom about two-thirds were civilians.
Panama Canal Department.-In the Panama Canal Department, wheretroop strength averaged between 14,000 and 15,000 in 1939, a unique medicalorganization existed, a result of the control of the administration ofthe Canal Zone by the War Department. The Governor of the Canal Zone wascustomarily a retired Engineer officer, appointed by the President of theUnited States and responsible to the Secretary of War. At the head of theHealth Department of the Canal Zone and reporting directly to the governorwas the chief health officer, who was a Medical Department officer designatedfor the position by The Surgeon General. In 1939 Col. (later Maj. Gen.)Morrison C. Stayer, MC (fig. 9), was chief health officer.
The Chief Health Officer was responsible for environmental sanitation,the prevention and control of transmissible diseases, and the enforcementof quarantine regulations in the Canal Zone and the terminal cities ofPanama and Colon. It was important that the orderly passage of ships throughthe Canal should proceed unhampered by adverse health conditions. In generalthe work of the Panama Canal Health Department resembled that of a largecity health
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department. It was also responsible for such tasks as garbage collectionand street cleaning for which a department of sanitation was usually responsiblein cities in the United States. In addition it ran several hospitals, includingthe well-known Gorgas Hospital, and a number of dispensaries to care forU.S. Government employees and their dependents in the Canal Zone. The Surgeon,Panama Canal Department, whose office was at Quarry Heights, was responsiblefor the health of U.S. Army troops in the Canal Zone and controlled theusual Army Medical Department installations there. He reported to the departmentcommander. Some disagreement existed between the chief health officer onthe one hand and The Surgeon General and department surgeon on the otheras to the respective responsibilities of the chief health officer and thedepartment surgeon. The Surgeon General apparently took the position thatthe department surgeon, his representative, should rule on all medicomilitarypolicies in the Canal Zone. Colonel Stayer contended that his positionas adviser to the Governor and his many civilian contacts put him in abetter position than the department surgeon to be chief adviser to theArmy commander in the area; that is, to advise on military as well as civilhealth problems. In spite of this disagreement as to proper jurisdiction,effective coordination of the work of the two officers prevailed in specificfields. Cooperation was particularly close in the fieldwork undertakenby the Division of Sanitation of the Health Department and the Field SanitaryForce of the department surgeon`s office to eliminate the breeding groundsof mosquitoes, a major health project of the Zone.21
Puerto Rican Department.-On 1 July 1939 a fourth oversea departmentcame into being when the Puerto Rican Department was established, includingboth Puerto Rico and the Virgin Islands, with headquarters at San Juan,P.R. Before that date the two military installations in Puerto Rico, thePost of San Juan and Henry Barracks, both staffed with Puerto Rican troops,had been attached to the Second Corps Area, but the surgeon at San Juanhad been even then in effect a department surgeon. The station hospitalat the Post of San Juan provided hospitalization for the department.22
Field Tactical Units
The only tactical units of the Medical Department in existence in June1939 were four medical regiments and a medical squadron organized at peacetimestrength. The 11th Medical Regiment and the 12th, the latter made up ofPhilippine Scouts, were stationed in Hawaii and the Philippines, respectively.
21(1) Letters, Maj. Gen. Morrison C. Stayer,MC, USA (Ret.), to Col. Roger G. Prentiss, Jr., MC, Director, HistoricalDivision (later The Historical Unit), Office of The Surgeon General, 17Jan. 1950 and 1 Feb. 1950. (2) History of Medical Department Activitiesin the Caribbean Defense Command in World War II, vol. I, ,p. 127. [Officialrecord.]
22(1) Memorandum, The Adjutant General, for the Commanding General,Second Corps Area, 1 May 1939, subject: Establishment of the Island ofPuerto Rico, Including the Virgin Islands, as a Territorial Department.(2) Army Regulations No. 170-10, 10 Oct. 1939. (3) Annual Report of theDepartment Surgeon, Puerto Rican Department, 1939. (4) History of MedicalDepartment Activities in the Caribbean Defense Command in World War II,vol. I, pp. 105ff. [Official record.]
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The 1st Medical Regiment was in training at Carlisle Barracks (fig.10), where it was used as a demonstration unit for the Medical Field ServiceSchool and for the training camps for the Organized Reserves and the ReserveOfficers` Training Corps units conducted at Carlisle Barracks. The 2d MedicalRegiment, stationed at Fort Sam Houston, Tex., was taking part in extensiveexercises and maneuvers with the streamlined infantry division then undergoingtest as a new combat unit. In addition to the medical regiments the 1stMedical Squadron (cavalry) at Fort Bliss, Tex., was partially organized.By the date the President declared the limited emergency a few additionalmedical regiments, squadrons, and smaller units had been activated.23
DEVELOPMENTS OF LATE 1939: PLANNING
The work of the Planning and Training Division in 1939 reflected theprospects of war and the War Department`s plans for defense. As the additionsto the Panama garrison and the expanding Air Corps made increased demandson the medical service, the division began planning the construction ofadditional hospitals. It renewed efforts of previous years to increaseto 7 percent the quota of enlisted men in the Medical Department, limitedsince 1920 to 5 percent of the Army`s enlisted strength.24 In1939 the division was
23(1) Annual Report of The Surgeon General,U.S. Army, 1939. Washington: U.S. Government Printing Office, 1940, p.172. Annual Report of The Surgeon General, U.S. Army, 1941. Washington:U.S. Government Printing Office, 1942, p. 153. (2) Annual Report of theStation Hospital, Schofield Barracks, Territory of Hawaii, 1941.
24(1) Memorandum, Col. Albert G. Love, MC, for the Committeeon Medical Care, 15 Oct. 1942, subject: Review of Oral Testimony on Workof the Planning and Training Division, 1 Apr. 1938-31 July 1939, Beforethe Committee to Study the Medical Department. (2) Annual Report of TheSurgeon General, U.S. Army, 1939. Washington: U.S. Government PrintingOffice, 1940, pp. 176-190.
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also busy preparing medical plans called for by the revised War DepartmentProtective Mobilization Plan of that year. It estimated the number andtypes of medical units and personnel necessary to support the War Departmentplan and established policies for their training. As a means of providingthe hospitals which the plan called for, the division undertook to revivecertain reserve hospital units formerly established in civilian medicalschools and hospitals and staffed with their personnel. Similar so-called"affiliated units" had acquitted themselves creditably in WorldWar I, but during the thirties when the War Department had shifted to apolicy of decentralizing the administration of Reserve Corps affairs tothe control of corps area commanders, the Office of The Surgeon Generalhad lost touch with the affiliated units. In August 1939 the War Departmentgave approval to their revival, and the Medical Department set about thistask.25
The Protective Mobilization Plan
The Surgeon General`s Protective Mobilization Plan for 1939, which appearedin final form in December, included plans for expanding medical facilitiesin the United States as well as plans for increase in personnel for hospitals,supply, and other matters. It contemplated only limited expansion in theSurgeon General`s Office in the event of mobilization. Two major functionsof the existing Professional Service Division would be raised to divisionalstatus and become the Preventive Medicine Division and the Museum Division.The Professional Service Division itself would become the Hospital andProfessional Service Division.
Recognition of the coming significance of preventive medicine and ofhospital administration was prophetic; these functions soon became thebasis for principal organizational segments of the Surgeon General`s Office.Plans of several years earlier, in fact, had recognized the wartime importanceof not only preventive medicine but also hospital construction, as wellas hospital administration, and of certain professional specialties suchas internal medicine, surgery, and neuropsychiatry. Planning documentsof earlier years had also recommended setting up an inspection divisionin the Surgeon General`s Office, which would be charged with inspectingall administration and tech-nical activities of the Medical Departmentat large. The question of the role of this division vis-a-vis that of theInspector General`s Department and, indeed, vis-a-vis possible inspectionof field activities by divisions currently
25(1) Memorandum, The Surgeon General (Reynolds),for The Adjutant General, 17 Mar. 1939, subject: Affiliation of MedicalDepartment Units With Civil Institutions and Appointment and Promotionin the Medical Corps Reserve. (2) Memorandum, The Adjutant General, forThe Surgeon General, 3 Aug. 1939, subject: Affiliation of Medical DepartmentUnits With Civil Institutions and Appointment and Promotion in the MedicalCorps Reserve. (3) Annual Report of The Surgeon General, U.S. Army, 1939.Washington: U.S. Government Printing Office, 1940, p. 179. (4) Memorandum,The Adjutant General, for The Surgeon General, 26 Jan. 1940, subject: Officersof Affiliated Medical Units-Appointment, Reappointment, Promotion, andSeparation. (5) See footnote 24(l), p. 21.
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responsible for them, was not fully clarified.26 The conceptapparently constituted recognition that a more thoroughgoing system thanthe existing one for examining the quality of medical service in fieldinstallations would become necessary as installations multiplied rapidlyduring an emergency period.
Role of the U.S. Public Health Service.-In 1939 the questioncame up as to the type of aid which the Medical Department should requestof the U.S. Public Health Service in the event of war. By legislation of1902 the President had been authorized to use this Federal agency in timeof actual or threatened war in such a way as, in his opinion, best promotedthe public interest. Accordingly, President Wilson had issued an Executiveorder in April 1917 ordering that in time of actual or threatened war theU.S. Public Health Service should constitute part of the military forcesof the United States. Various moves had been made towards amalgamatingcivilian and military agencies handling public health programs. However,Secretary of the Treasury William G. McAdoo had opposed a bill to transferfunctions relating to sanitary measures in areas near military establishments,then being exercised by the U.S. Public Health Service under his jurisdiction,from the Treasury Department to the War Department. Moreover, legal interpreta-tionhad held that the U.S. Public Health Service could not be considered apart of the Army or Navy and had prevented the granting of Army pensionsto U.S. Public Health Service officers detailed to the Army. During WorldWar I the U.S. Public Health Service had continued to provide extracantonmentsanitation in cooperation with the Army and State and local health au-thorities.The Medical Department concluded that it would be wise to follow the samegeneral plan in the current emergency.27
A foreshadowing of the inevitable expansion of activities in the fieldof preventive medicine and of concomitant liaison with the U.S. PublicHealth Service appeared on the horizon concurrently with The Surgeon General`sProtective Mobilization Plan. After discussion with the General Staff inOctober 1939, The Surgeon General recommended making use of the facilitiesof the Public Health Service in preserving good health conditions in areasadjacent to Army camps. His detailed plan to this effect (December 1939)called for control of extracantonment, sanitation by the U.S. Public HealthService, in cooperation with local and State health authorities, and forthe use of the services of that agency in inter-State quarantine measures,prevention of pollution of streams, and control of venereal disease. Areport by the American Social Hygiene Association, a civilian organizationwhich had
26Lecture, Maj. Gen. Charles R. Reynolds, TheSurgeon General, at Army War College, 30 Nov. 1936, subject: The MedicalService of the Army and the Development of the Medical Resources of thisCountry in War.
27(1) Memorandum, Col. Albert G. Love, MC, for The Surgeon General(Reynolds), 9 Jan. 1939, subject: Utilization of the U.S. Public HealthService. (2) Memorandum, Col. Albert G. Love, MC, for The Surgeon General(Magee), 31 July 1939, subject: Utilization of the U.S. Public Health Service.(3) Memorandum, Lt. Col. Charles B. Spruit, MC, for Col. Albert G. Love,MC, 18 Dec. 1939, subject: Utilization of the U.S. Public Health Servicein Cooperation With the Army in Connection With the Present Increase inthe Regular Army, and attachments.
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cooperated with the Medical Department in the control of venereal diseaseduring World War I, that serious vice conditions prevailed in areas nearseveral Army camps added weight to the argument for the aid of the U.S.Public Health Service. In February 1940 the Secretary of War made arrangementswith Federal Security Administrator Paul V. McNutt, who had jurisdictionover the U.S. Public Health Service, for the cooperation of that agencyin safeguarding the health of soldiers through extramilitary area sanitation.28
Role of the American Red Cross.-The Surgeon General`s ProtectiveMobilization Plan contained the nucleus of a plan for aid by the AmericanNational Red Cross in the event of mobilization. In March 1938 the MilitaryRelief Committee of that organization had asked, in a preliminary reportto the War Department, that some definite task relative to emergency aidto the Army be assigned it. The Protective Mobilization Plan of 1939 stipulatedthat the Red Cross should provide at every Army hospital of 250-bed capacityor higher a recreational building, that it should continue its presentsystem of enrolling and classifying nurses for the Army and undertake thesame work with respect to medical technicians and dietitians, and thatit should furnish occupational therapy equipment and the necessary personnelfor its use, as well as certain nonstandard medical equipment.29Thus was laid in 1939 a firm groundwork for still closer cooperation intime of war with certain public and private agencies engaged in medicalwork with which The Surgeon General`s Office had kept in contact in peacetime.
Medical Supplies and Equipment
A growing awareness of coming difficulties in procuring medical suppliesfor the Army was in evidence after the declaration of the limited emergency.The Surgeons General of the Army and the Navy decided to enlist the aidof manufacturers of medical supplies and set up several industry advisorycommittees in certain major fields of medical supply. These committeesconsisted of representatives from medical supply houses, together withmedical officers of the War and Navy Departments. The following committeeswere constituted: Drugs Resources Advisory Committee, Dental Supplies AdvisoryCommittee, and Medical and Surgical Instruments Advisory Committee. Themajor function of these, and of similar committees established later inother fields of medical supply, was to keep the Army and Navy informedas to the productive capacity of the industries which they represented.
At the beginning of the emergency the immediate assets of the Medical
28(1) See footnote 24(l), p. 21. (2) Memorandum,The Adjutant General, for The Surgeon General, 21 Oct. 1939, and indorsements,subject: Utilization of the U.S. Public Health Service During the Emergency.(3) Letter, American Social Hygiene Association to Col. J. E. Baylis, MC,8 Jan. 1940, and indorsement, The Surgeon General to The Adjutant General,16 Jan. 1940. (4) Memorandum, The Surgeon General to The Adjutant General,16 Jan. 1940, subject: Utilization of the U.S. Public Health Service. (5)Letter, Federal Security Administrator to Secretary of War, 12 Feb. 1940.
29(1) See footnote 24(l), p. 21. (2) The Surgeon General`s ProtectiveMobilization Plan, 1939.
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Department in trained personnel and reserves of medical supplies andequipment were adequate for the peacetime Army. The Surgeon General`s Officewas organized on an adequate peacetime basis. It maintained close affiliationwith other governmental agencies and with private institutions capableof supporting it with medical research and additional personnel and supplies.Very little theory existed as to how the Surgeon General`s Office shouldbe set up in wartime, although certain immediate steps which mobilizationwould call for were envisioned. After September 1939 the Medical Departmentfaced an emergency expansion in almost every phase of its work, and theSurgeon General`s Office took steps late in the year to enlist the aidof other agencies.
