History

CHAPTER II

The Emergency Period: 1940-41

During 1940 and 1941, before the United States entered the war, theMedical Department`s responsibilities increased enormously. Three developmentsof those years added to its task a rapid increase in the size of the Army,the advent of large-scale economic and military aid to foreign countries,and the acquisition of new Atlantic bases.

The congressional resolution of 27 August 1940 calling up the NationalGuard, many of the Reserves, and some retired Army personnel, and the generaldraft in September brought about large increases in Army troop strength.In May 1940 the War Department had obtained from Congress an increase inthe authorized strength of enlisted medical personnel after repeated requestsby the Surgeon General`s Office. The new legislation had permitted MedicalDepartment personnel to increase to 7 percent instead of 5 percent of thestrength of the Army, with additional limited increases possible at thediscretion of the President in the event of hostilities. The first newAtlantic bases were occupied pursuant to the agreement between the UnitedStates and Great Britain in September 1940, and the formal lend-lease program,by which the United States undertook to send supplies (including medicalsupplies) abroad to aid the enemies of Nazi Germany and Fascist Italy,was initiated in March 1941. All these measures added to the responsibilitiesof the Medical Department and led to changes in its organization, as wellas increased liaison between the Surgeon General`s Office and other governmentaland private agencies. They also complicated problems of administrationin various fields, such as medical supply, hospitalization, training, andthe acquisition and use of personnel.

THE SURGEON GENERAL`S OFFICE

During 1940 and 1941 the Surgeon General`s Office underwent considerableexpansion in personnel. By the end of June 1940 personnel had not increasedgreatly over the figure for 1939, but between 30 June 1940 and 30 June1941 it more than doubled. At the end of June 1940 there were 43 officersand nurses and 201 civilians in the office; a year later the numbers hadincreased to 102 officers and nurses and 717 civilian employees. In January1941 the expanding office moved from its former location into a portionof the Social Security Building at 4th and C Streets, S.W., Washington,D.C. In December it moved to 1818 H Street, N.W., Washington, D.C., whereit remained till the end of the war.

During 1940-41 only two new divisions developed in the Surgeon General`sOffice, although many new subdivisions, some of which were later to attaindivi-

Chart 2.- Organization of the Officeof The Surgeon General, 15 May 1941

sion rank, sprang up as the office was given added duties (chart 2).These were the Hospitalization Division and the Preventive Medicine Division,formerly a subordinate element of the Professional Service Division. Theexpansion of the professional services and the carving up of the ProfessionalService Division into a number of subdivisions, with the emergence of preventivemedicine in particular strength, were the chief developments of the emergencyperiod.

The Professional Services

In 1940 The Surgeon General, foreseeing expanding problems in sanitationand control of disease, particularly of malaria and venereal disease, in

Army camps and adjacent areas, established close liaison with the U.S.Public Health Service, the Bureau of Medicine and Surgery of the Navy,the Rockefeller Foundation, the National Research Council, and other Governmentand private agencies. Growing problems in preventive medicine receivedformal recognition when a Preventive Medicine Subdivision was set up inthe Professional Service Division in May. Five other subdivisions formallyset up at that time in the same division, then headed by Col. (later Brig.Gen.) Charles C. Hillman, MC (fig. 11), were: Medicine and Surgery; PhysicalStandards, U.S. Military Academy and Regular Army; Physical Standards,Officers Reserve Corps, and National Guard; Army Medical Museum; and Miscellaneous.

Medicine and Surgery Subdivision

The Medicine and Surgery Subdivision developed medical and surgicalpolicies, including new methods of treatment, rendered professional opinions,and, in liaison with the Military Personnel Division, selected personnelfor key professional positions in Army medical installations. The two PhysicalStandards Subdivisions formulated physical standards for the military elementsindicated in their titles and took action on reports of physical examinationsof applicants for admission to the schools or to the various military elements

and applicants for commissions in the Regular Army. The administrationof the Army Medical Museum was handled by the subdivision of that name.The functions of the Miscellaneous Subdivision are worth noting: "Officeaction on line of duty boards pertaining to Regular Army personnel; correspondencepertaining to enlisted personnel, CCC enrollees, and veterans; miscellaneouscorrespondence on professional subjects; office action on medical aspectsof claims against the government; liaison between the Offices of The SurgeonGeneral and The Adjutant General." ¹ The variety of dutiesassigned to this subdivision shows that thinking as to the organizationof those activities regarded as professional as opposed to those of administrativecharacter had still not crystallized by the middle of 1940. It illustratesthe great difficulty encountered in a medicomilitary organization in divorcingthe two types of activity.

Preventive Medicine Subdivision

Lt. Col. (later Brig. Gen.) James S. Simmons, MC (fig. 12), Chief ofthe Preventive Medicine Subdivision, had been brought into the Office earlyin 1940 by The Surgeon General to head the work in preventive medicine.²and remained in that capacity throughout the war. The principal activitiesof his subdivision were at that date envisioned as advisory supervisionover military sanitation and the control of communicable disease; maintenanceof liaison with the Quartermaster Department in matters relating to foodand water supplies, waste disposal, insect control, choice of housing sites,use of sanitary appliances, and maintenance of sanitary conditions in bathingpools; advisory supervision over Medical Department laboratories; and maintenanceof liaison with the U.S. Public Health Service and other health agencies.The activities of the Preventive Medicine Subdivision in the field of sanitationwere greatly stimulated by the Selective Training and Service Act of September1940, which stipulated that adequate sanitary facilities should be establishedat Army camps in advance of the arrival of inductees.

Health and sanitation under military government.-Before mid-1940the Preventive Medicine Subdivision had embarked on a project which ledto two programs of future importance, later made the responsibility oftwo organizational elements of the Surgeon General`s Office. Three SanitaryCorps officers were brought into the Preventive Medicine Subdivision byColonel Simmons in May to prepare a section on health and sanitation ina manual of military government being drafted by the Office of the Chiefof Staff. Issued as Field Manual 27-5, 30 July 1940, the document was designedas a guide both for planning and for administering military governmentin territory occupied by U.S. Army troops. The plan for medical organizationwithin military government devised by the Sanitary Corps officers pointedto the need for advance information on health and sanitary conditions incountries

¹Office Order No. 51, Office of The SurgeonGeneral, 7 May 1940.
²(1) Office Order No. 20, Office of The Surgeon General, 26Feb. 1940. (2) Testimony, Committee to Study the Medical Department, 1942,p. 244. HU :321.6.

where troops might be stationed. Firsthand surveys were made of Newfound-landand Bermuda, where the British had granted bases, and of some Caribbeanand South American areas. These paved the way for the extensive systemof similar surveys of areas throughout the world which developed in 1941and 1942; that is, the work which came to be known as "medical intelligence."The plan for health organization for civilians in areas of troop locationoverseas was the beginning of a comprehensive "medical civil affairs"program for which The Surgeon General was eventually given direct responsibility.The pro-gram was ultimately to embrace, after the Army`s advances intoenemy-held territory, wide-range activities in the prevention and treatmentof disease among the civil populations in the liberated countries, designedboth to pre-serve civilian health and to protect U.S. Army troops. Thesurveys also constituted a forward step in planning in still a third field,sanitary engineering, which embraces engineering activities in connectionwith water purification, garbage disposal, sewage treatment, and controlof insect and rodent carriers of disease.³

Laboratory service.-In July 1940 the need of the expanded Armyfor

³(1) Memorandum, Capt. Tom Whayne, MC, forChief, Preventive Medicine Division, 2 Sept. 1941, subject: General Outlinefor Activities of Subdivision of Medical Intelligence, Preventive MedicineDivision, Including Studies Completed for August 1941. (2) Committee toStudy the Medical Department, Exhibits 45, 41, and 19.

an enlarged medical laboratory service was recognized when the PreventiveMedicine Subdivision recommended the activation of corps area and departmentlaboratories in the nine corps areas and the Panama Canal and Puerto RicanDepartments. After War Department approval they were established in 1941.This system of laboratories, planned since 1925 but not needed in peacetime,was designed to provide a central laboratory in each corps area or departmentto deal with epidemiological and sanitary matters relating to the healthof all troops in the area, in contradistinction to the laboratories ofsta-tion and general hospitals; the latter handled, for the most part,diagnostic work required in the care of individual patients. War brokeout while similar laboratories were being considered for the Hawaiian andPhilippine Departments.⁴

Industrial health hazards.-The Surgeon General became concernedover potential hazards to the health of employees in Army-owned munitionsplants. Congressional legislation of July 1940 authorized the Secretaryof War to provide plans for manufacturing and storing military equipmentand supplies. Although the War Department was not charged by legislationwith providing medical service for civilian employees at the plants, theMedical Department soon assumed some responsibility, for the legislationhad made the Secretary of War responsible for efficient operation of theplants. In 1938 the Chief of Ordnance had asked the Medical Departmentto make periodic physical examinations of civilian employees engaged indangerous work; for example, the handling of TNT, at ordnance plants. Civiliancontract surgeons had been hired by the Medical Department for the purpose,but at some plants their service had been limited to the giving of firstaid treatment. The pro-gram had not developed along the broader plan ofattempting to forestall occupational injuries and diseases. Realizing thatthe program needed establishment upon a sounder and more comprehensivebasis, The Surgeon General proposed in December 1940 to assign MedicalDepartment personnel to serve Air Corps and Quartermaster Corps depotsas well as Ordnance plants, and to ask the U.S. Public Health Service tomake surveys to determine existing industrial hygiene hazards. The surveysgot underway about May 1941. This move initiated what was to become anextensive health program with a coverage of about 1 million civilians.⁵It eventually grew administratively complex as a result of several factors:the widening of coverage as lend-lease commitments, and, later, the PearlHarbor attack spurred on expansion of the Army`s industrial facilities;

⁴(1) Committee to Study the Medical Department,Exhibit 42. (2) Memorandum, The Surgeon General, for The Adjutant General,12 Dec. 1940, subject: Personnel for Corps Area and Department Laboratories.(3) Memorandum, Executive Officer, Office of The Surgeon General, for Surgeon,Panama Canal Department, 27 Dec. 1940, subject: Establishment of CorpsArea and Department Laboratories. (4) Report of Conference, The SurgeonGeneral and the Corps Area surgeons, 14-16 Oct. 1940.
⁵(1) 54 Stat. 712. (2) Annual Report, Subdivision of Epidemiology,Disease Prevention, and Industrial Hygiene, Office of The Surgeon General,1940, 1941. (3) Cook, W. L., Jr.: Preventive Medicine, Occupational HealthDivision, 1 July 1946. [Official record.]

addition of new types of care; local variation in degree and types ofservice rendered, depending upon the closeness of the relations of theArmy with the groups involved and the adjacency of the area to good civilianmedical facilities; and variations in the allocation of cost between theArmy and the civilian patients served.

Statistical studies.-Analysis and interpretation of data on theincidence of various diseases also developed during 1940. The StatisticalDivision supplied information on incidence of disease among Army personnel,and the U.S. Public Health Service furnished similar information as tothe civilian population in the United States. Toward the end of the yearthe surveys of foreign areas mentioned above began to provide this informationfor foreign areas.

Army Epidemiological Board.-In late 1940 the Medical Departmentembarked on an effort to enlist the aid of civilian specialists in thecontrol of epidemic disease. Upon the recommendation of The Surgeon General,the Secretary of War set up the Board for the Investigation and Controlof Influenza and Other Epidemic Diseases, usually referred to as the "ArmyEpidemiological Board," in January 1941. On the various subsidiarycommis-sions of the Board the civilian medical profession, representedby more than 100 members, collaborated with the Preventive Medicine Subdivisionthrough-out the war in the investigation of potential epidemics in theArmy. As a rule the War Department entered into a research contract withthe civilian institution at which the director of the particular commissionresided.⁶

Immunization program.-The initiation of a large-scale programfor immunizing Army personnel against specific epidemic diseases got underwayin 1940. After conference with specialists in preventive medicine of theNavy, the U.S. Public Health Service, the National Research Council, andthe International Health Division of the Rockefeller Foundation, the PreventiveMedicine Subdivision worked out a coordinated program for immunization.Specifically, the immunization of all Army personnel against tetanus wasrecommended to the General Staff in May 1940, and triple typhoid vaccine,previously used, was readopted in July. The same agencies made variousrecommendations on the use of yellow fever vaccine in the Army and tooksteps toward production of a supply of the vaccine. They began a seriesof conferences late in 1941 to plan an extensive program for immunizingtroops against yellow fever, typhus, cholera, and plague.⁷

⁶(1) Long, Arthur P.: The Epidemiology Division,1 July 1946. [Official record.] (2) Committee to Study the Medical Department,Exhibit 19. (3) Report of the Army Epidemiological Board for 1943.
⁷(1) Simmons, J. S.: Immunization Against Infectious Diseasesin the United States Army. So. Med. Jour. vol. 34. (2) Simmons, J. S.:The Army`s New Frontiers in Tropical Medicine. Ann. Int. Med. vol. 17,December 1942. (3) Memorandum, Col. J. S. Simmons, MC, for Dr. Lewis A.Weed, chairman, Division of Medical Sciences, National Research Council,5 Aug. 1942, subject: Conference on Materials and Procedures for ImmunizationAgainst Typhus, Cholera, and Plague. (4) Committee to Study the MedicalDepartment, Exhibit 47.

Expansion of Professional Service

Early in 1941 Colonel Simmons called the attention of General Mageeto the new responsibilities devolving upon his subdivision since its establishmentin May 1940. He requested the assignment of additional medical officersand the reorganization of the subdivision on a functional basis.⁸The Professional Service Division, of which Colonel Simmons` preventivemedicine subdivision was only a part, faced also the task of expandingthe system of general and station hospitals to serve the growing Army.Accordingly in April 1941 it was split into three divisions: the ProfessionalService, the Preventive Medicine, and the Hospitalization Divisions.⁹Several subdivisions existed within each (chart 2).

Food and Nutrition Subdivisions.-The only part of the ProfessionalService Division, as reorganized, which marked any innovation since 1939was the Food and Nutrition Subdivision. Late in 1940 The Surgeon General,citing the establishment of a Division of Food and Nutrition in the SurgeonGeneral`s Office in the First World War, had requested authorization fora Subdivision of Food and Nutrition in his Professional Service Division,to be headed by a Reserve officer. This subdivision was established earlyin 1941. It had advisory supervision over those aspects of selection andpreparation of Army food which were related to the health of the soldier.It remained in the Professional Service Division when the latter was reorganizedin April.

Hospitalization Division.-The duties of the new HospitalizationDivision were not clearly defined but appear to have been conceived oflargely in terms of policy development and liaison with other areas ofthe Surgeon General`s Office. The division was to work with the Planningand Training Division in preparing total requirements for hospital bedsand training specially qualified persons for hospital work, with the Financeand Supply Division on matters of hospital equipment, and with the ProfessionalService Division on professional care at military stations.¹⁰Little was done during the following year to clarify the organizationalconcepts in this field. The four subdivisions contemplated for the HospitalizationDivision-Personnel, Equipment and Supply, Hospitals, and Inspections-apparentlyremained largely paper units. The meager personnel (four officers and fourclerks), assigned to the division in June 1942, a year after its establishment,gives further proof that hospitalization was not considered a primary functionper se but was thought of as a matter of coordination of the work of otherdivisions. Its failure to attain greater size and to receive a more pointeddelineation of its functions

⁸Memorandum, Lt. Col. J. S. Simmons, MC, forThe Surgeon General, 25 Feb. 1941, subject: The Subdivision of PreventiveMedicine.
⁹(1) Office Order No. 32, Office of The Surgeon General, 17Feb. 1941. (2) Office Order No. 87, Office of The Surgeon General, 18 Apr.1941.
¹⁰See footnote 9 (2).

was noted when its operations were made a subject of attack by the Servicesof Supply in 1942.¹¹

A major problem facing the new Hospitalization Division was that ofregulating the transfer of patients from station to general hospitals fordefinitive care. The so-called "bed-credit system," whereby thestation hospital was allotted a certain number of beds in the nearest generalhospital to which it could transfer its patients, was adopted in June 1941.The division thus acted as a central station to make the most efficientuse of the available hospital beds during a period of rapid change. Inattempting to conserve hospital beds it also undertook to effect, throughrevision of Army Regulations, more expeditious disposition of hospitalcases.¹² Col. Harry D. Offutt, MC (fig. 13), who had undertakenrevision of the equipment lists for Medical Department tactical units,including hospitals for oversea use, while stationed at the Army

¹¹(1) Annual Report, Operations Service, Officeof The Surgeon General, 1942. (2) Memorandum, Director, Control Division,Office of The Surgeon General, for The Surgeon General, 13 Jan. 1944, subject:Proposal for Overall Plan for Modifications in Present Organization.
¹²(1) Letter, Brig. Gen. Harry D. Offutt, to Col. H. W.. Doan,MC, 10 June 1948, and inclosure 1. (2) Memorandum, Col. Harry D. Offutt,MC, for Chief, Operations Service, Surgeon General`s Office, 8 July 1943,subject: List of Personnel Hospitalization Division. (3) Annual Report,Operations Service, Office of The Surgeon General, 1942.

Medical Center, was made Chief of the new Hospitalization Division andretained that office throughout General Magee`s administration.

Medical Supply

Throughout 1940 and 1941 functions relating to medical supplies andequipment continued to be concentrated mainly in the Finance and SupplyDivision of the Surgeon General`s Office. The measures to increase thesize of the Army and the acquisition of Caribbean bases from Great Britainin the latter half of 1940 stimulated the demand for medical supplies andequipment. Additional supplies were needed for the rapidly increasing numberof station hospitals in the United States and for use in the training ofnew tactical medical units to go overseas. Appropriations for buying medicalsupplies and equipment for the fiscal year 1941 increased over those forthe fiscal year 1940 more than 16 times.¹³

The appointment of the Advisory Commission to the Council of NationalDefense with its Commissioner of Industrial Materials, in the middle of1940, the creation by the Reconstruction Finance Corporation in Augustof the Defense Plant Corporation to deal in strategic and critical materials,and the establishment of the original priorities system by the Army-NavyMunitions Board initiated a network of agencies which affected the procurementof medical supplies. With these and their successors medical supply officersin the Finance and Supply Division dealt in their efforts to obtain strategicmaterials, high priority ratings, and other concessions for manufacturersof medical Supplies.¹⁴

Certain legal problems arose in buying medical supplies. On those involvingpolicy the Judge Advocate General of the Army, the Comptroller General,or the Attorney General of the United States (as the case demanded) customarilyrendered decisions. However, an increasing volume of work requiring legalknowledge was developing in connection with contracts for medical suppliesand certain claims arising against the department. A Medical AdministrativeCorps officer with legal training was assigned to the Finance and SupplyDivision in August 1940, to prepare contracts with medi-cal supply housesand research agencies, and to examine and adjudicate claims by variouscivilian and government agencies for medical services rendered to Armypersonnel, Civilian Conservation Corps enrollees, and other groups for

¹³(1) Annual Report of The Surgeon General,U.S. Army, 1941. Washington: U.S. Government Printing Office, 1941, pp.129ff. (2) Robinson, Lt. Col. Paul I.: Major Changes in OrganizationalStructure, Finance and Supply Division, 30 June 1940 to 7 Dec. 1941 (18Nov. 1942) [Official record.] (3) Hearings Before a Special Committee Investigatingthe National Defense Program, United States Senate. 77th Cong., 1st Sess.,on Senate Resolution 71,15 July 1941. Washington: U.S. Government PrintingOffice, 1941.
¹⁴(1) Yates, Richard E.: The Procurement and Distribution ofSupplies in the Zone of Interior During World War II, pp. 77-81. [Officialrecord.]. (2) U.S. Government Manual. Washington U.S. Government PrintingOffice, 1940, pp. 52-53. (3) U.S. Government Manual. Washington: U.S. GovernmentPrinting Office, 1941, pp. 155, 444-45.

whose care the Medical Department was ultimately responsible.¹⁵Other officers with legal training were subsequently assigned to legalwork, but the group did not reach the stature of a division until 2 yearslater.

Research and development.-Other activities which were concentratedin the Finance and Supply Division in 1940 were those pertaining to researchand to the development of special Medical Department equipment. This programhad expanded to include about 36 projects at 4 main scenes of Medical Departmentresearch and developmental work-the Army Medical Center, Washington, D.C.,the Medical Department Equipment Laboratory at Carlisle Barracks, Pa.,the Quartermaster Remount Depot at Front Royal, Va., and Edgewood Arsenal,Md. As these entailed some work on the part of five divisions of the SurgeonGeneral`s Office, a central place to record research data and advise TheSurgeon General of the progress of research projects was necessary. Sincethe Finance and Supply Division had been handling the fiscal affairs ofall these programs, the Research and Development Section was set up inthat division to work out a coordinated research program.¹⁶

Shortages.-Supply problems developed thick and fast in 1941.The loss of certain continental European sources, particularly Germany,for surgical instruments, a possibility foreseen for many years, had itseffect. Export of surgical instruments to France and England during 1940and 1941 constituted a drain on domestic production. In 1941 the Financeand Supply Division surveyed medical supply firms in the attempt to expandtheir manufacturing facilities and to convert factories making other productsto the manufacture of medical supplies and equipment. It computed requirementsfor strategic and critical raw materials and submitted these to the Officeof the Under Secretary of War, to which were transferred in April 1941the supply functions formerly exercised by the Assistant Secretary. Markedshortages had developed in aluminum needed for litters and for operatingroom lamps, and in corrosion-resistant steel for surgical and dental instruments.In an attempt to aid manufacturers of medical supplies and equipment toobtain scarce, materials, the Finance and Supply Division maintained liaisonwith the Army-Navy Munitions Board, which set up the original prioritiessystem and which had taken over in late 1940 the industry advisory committeescreated the previous year by the Medical Department. In 1941 the divisionmaintained liaison with the Office of Production Management, which (precedingthe War Production Board) administered the priorities system throughout1941. In late 1941, the work of the Army-Navy Munitions Board in reviewingpreference ratings granted to Army contractors grew too heavy and was decentralizedto the services. At the order of the Office of the Under Secretary, a PrioritiesCom-

¹⁵(1) Hilsher, Maj. John M.: Summary of LegalActivities (Covers period 1924 through 1941). [Official record.] (2) OfficeOrder No. 126, Office of The Surgeon General, 27 Aug. 1940.
¹⁶(1) Memorandum, Lt. Col. Francis C. Tyng, MC, for The SurgeonGeneral, 30 Oct. 1940, subject: Research and Development Section. (2) OfficeOrder No. 205, Office of The Surgeon General, 3 Dec. 1940.

pliance Section was set up in the Surgeon General`s Office to reviewthe preference ratings granted to subcontractors of medical supplies andequipment.¹⁷

Effect of lend-lease.-The passage of the Lend-Lease Act in March1941 and the swelling list of countries declared eligible for lend-leaseaid accounted in part for the Medical Department`s later difficulties withmedical supply for the Army. At the outset neither the Medical Departmentnor the War Department appear to have been aware of the potential effectsof the lend-lease program on procurement of medical supplies for the Army.Promptly after passage of the Lend-Lease Act the Secretary of War authorizedthe establishment of a Defense Aid Division in the Office of the UnderSecretary to coordinate the lend-lease programs of the supply services.Defense Aid Requirements Committees were established for several servicesat the same time, but none for the Surgeon General`s Office until nearthe end of the summer, when a Defense Aid Medical Requirements Subcommitteewas set up. The Surgeon General`s Office had already established a DefenseAid Subsection in its Finance and Supply Division.

Even before the passage of the Lend-Lease Act some demands for aid topotential Allies had been made on the Medical Department. These includedlitters for Yugoslavia and $1,200,000 worth of medical supplies requestedby the Chinese for use by the U.S. Public Health Service in the medicalcare of workers on the Yunnan-Burma Railway, which was to become a supplyline for lend-lease itself. The work of the Medical Department in fillingthese early requisitions involved the following steps: Receipt of the requisitionfrom the Defense Aid Medical Requirements Subcommittee; identificationof the requested items in Medical Department or American commercial terms;computation of cost; the forwarding of purchase requisition to the procurementdepot, after receipt of allotment of funds from the War Department BudgetOfficer; and finally the forwarding of shipping instructions from the foreigngovernment to the appropriate defense-aid depot for action after the Secretaryof War (through the Defense Aid Division) had authorized the transfer.This was a complicated procedure. Authorities of the War Department involvedwere: The Defense Aid Subsection of the Surgeon General`s Office and themedical procurement districts and medical supply depots; the Defense AidMedical Requirements Subcommittee; and the Defense Aid Division in theOffice of the Under Secretary. Outside the War Department were the Divisionof Defense Aid Reports of the Office for Emergency Management, supersededby the Office of Lend-Lease Administration in October, and the Washingtonoffice, whether embassy or supply mission, of the country making the requisition.By December 1941, after the submission of the First Russian Protocol outlining

¹⁷(1) Yates, Richard E.: The Procurement andDistribution of Supplies in the Zone of Interior During World War II, pp.33-36. [Official record.] (2) See footnote 13 (1) and (3), p. 36. (3) Memorandum,Director, Production Branch, Office of the Under Secretary of War, forThe Surgeon General, 13 Oct. 1941, subject: Establishment of a PriorityCompliance Section in the Offices of the Chiefs of Supply Arms and Services.(4) Memorandum, Lt. Col. C. G. Gruber, MC, for Lt. Col. F. C. Tyng, MC,22 Oct. 1941, subject: Compliance Section of Procurement Planning Subdivision.

Russian lend-lease requirements, Medical Department supply officershad become more cognizant of the impact which the lend-lease program wouldhave upon the procurement of medical supply. One of them noted that the"astronomical" figures of the Russians were already materiallyaffecting the procurement program.¹⁸

RELATIONS OF THE SURGEON GENERAL`S OFFICE WITH OTHER
AGENCIES CONCERNED WITH MEDICAL SERVICE

Under pressure of the national emergency, relations of the Surgeon General`sOffice with established Government and private agencies engaged in medicalprograms became closer. A number of new Government agencies, usually termed"defense" agencies, were created. Some were assigned functionsrelating to medicine or public health which supplemented-or in some casesconflicted with-the Army`s medical program. While these agencies, and theU.S. Public Health Service, for the most part worked harmoniously withthe Army Medical Department, occasional disagreements developed over mattersof policy or in areas of conflicting interests.

U.S. Public Health Service

Increasing health hazards to Army troops, particularly the venerealdiseases, were the subject of continued discussion between the SurgeonGeneral`s Office and other agencies. During 1940 the U.S. Public HealthService put into effect measures designed to control venereal disease andmaintain sanitary conditions in the vicinity of Army camps.¹⁹It made special arrangements for aid to the Army during maneuvers to beheld in the southeast that spring and summer. While mutual efforts of theArmy Medical Department and the U.S. Public Health Service in sanitationand malaria control worked smoothly, some conflict developed over waysand means of controlling venereal disease. An informal conference of representativesof the Medical Department and of the U.S. Public Health Service in March1940 to lay plans for control of venereal disease during the maneuversrevealed a tendency by both agencies to disclaim

¹⁸(1) Yates, Richard E.: The Procurement andDistribution of Supplies in the Zone of Interior During World War II, pp.212-214. [Official record.] (2) See footnote 13(2), p. 36. (3) Historyof Lend-Lease, pt. I, ch. IV, pp. 162ff. [Official record in National Archives.](4) Historical Report of Lend-Lease Activities of The Surgeon General`sOffice. [Incomplete official record in THU.] (5) Memorandum, Under Secretaryof War, for Secretary of War, 19 Sept. 1941, subject: Lend-Lease Procedure.(6) History of Medical Department Lend-Lease Activities. [Official record.](7) Memorandum, Lt. Col. C. F. Shook, MC, Office of The Surgeon General,for Under Secretary of War, 4 Dec. 1941, subject : Data on Foreign Countries.
¹⁹(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, 1Apr. 1938-31 July 1939, Beforethe Committee to Study the Medical Department. (2) Committee to Study theMedical Department, Exhibit 22. (3) Testimony, Committee to Study the MedicalDepartment, 1942, pp. 351-352. (4) Report, Conference of The Surgeon Generalwith Corps Area Surgeons, 14-16 Oct. 1940. (5) Report, Ad Hoc Subcommitteeof Committee on Medicine, National Research Council, to Survey VenerealDisease Control Program, February 1942.

responsibility for undertaking any measures to suppress prostitution,although they appeared to agree that such measures were desirable. Representativesof the Medical Department pointed out that the Army had no police poweroutside military reservations.

In May 1940 a conference of State and territorial health officers reacheda formal agreement as to services which State and local health agenciesand police authorities should provide as their share of the venereal diseasecontrol program. State authorities agreed to cooperate with military authoritiesin educating the civilian and military population in the dangers of venerealdisease and in exchanging information as to sources of infection. The agreementrecognized the direct responsibility of civilian authorities for isolatingand treating infected civilians and the primary responsibility of localpolice authorities for repressing prostitution.²⁰ The War Departmentgave its official sanction to this program in June, and in September informedcommanding generals of corps areas and departments of their responsibilityfor supporting it in their respective jurisdictions. The U.S. Public HealthService agreed to assign a liaison officer to each corps area to work withthe corps area surgeon on mutual health problems; late in 1940 it put thisplan into effect in each corps area and in the Puerto Rican Department.

Nevertheless, the Army was subjected to a good deal of criticism, beginningas early as the fall of 1940 and continuing throughout 1941, when reportsof high venereal disease rates among soldiers became widespread. A barrageof attacks emanated from U.S. Public Health Service liaison officers stationedin the corps areas, and from State health department officials, the AmericanSocial Hygiene Association, and the public. They criticized the tendencyof some Army line officers, according to reports from scattered areas throughoutthe country, to tolerate segregated red-light districts. In addition, examinationof inmates of houses of prostitution as a protective measure by a few medicalofficers-a practice which was not consonant with previous agreements thatthe repression of prostitution and rehabilitation of prostitutes was primarilythe responsibility of local authorities-gave rise to reports that the Armycondoned commercialized prostitution. Although the Medical Department maintainedfirmly its policy for repressing prostitution, the record shows a gooddeal of divergence of opinion, on the part of the public and a few healthauthorities as well as on the part of some Army line officers, as to thenecessity for tolerating a certain degree of condoned prostitution.

The Surgeon General`s Office recalled to corps area surgeons in January1941 its previous instructions for carrying out the agreement. In Februarymedical officers of the Army and Navy held a joint conference with a fewleading civilian authorities, including the Chairman of the Subcommitteeon Venereal Diseases of the National Research Council. The conference renewed

²⁰Agreement by War and Navy Departments, FederalSecurity Agency, and State Health Departments on Measures for Control ofVenereal Disease in Areas where Armed Forces or National Defense Employeesare Concentrated, adopted by conferences of State and Territorial healthofficers, 7-13 May 1940.

the established policy of the Medical Department and so informed commandingofficers. Gen. George C. Marshall, the Chief of Staff, emphasized the Army`spolicy in a personal letter to corps area and Army commanders.

In July, at the instance of the American Social Hygiene Association,the May Act, making prostitution a Federal offense in the areas in whichit was invoked, was passed by Congress. It was supported by the SurgeonsGeneral of the Army, Navy, and U.S. Public Health Service. The War Departmentshortly afterward issued instructions to commanders of corps areas as tothe procedure for invoking the act, and a Division of Social Protectionwas set up in the Office of Defense Health and Welfare Services in thefall to aid in the repression of commercialized prostitution by workingthrough State and local authorities. The Army was unwilling to invoke theact, however, except as a last resort in areas where local authoritieshad unquestionably failed to cooperate in its program. It was sensitiveto the reaction of local communities, some of which insisted that theywanted to take repressive measures themselves and wanted only the Army`smoral backing. Although Charles P. Taft, Assistant Director of the Officeof Defense Health and Welfare Services (like the U.S. Public Health Service,under the jurisdiction of the Federal Security Administrator), apparentlyagreed with the Army`s position, in the latter part of 1941 Drs. ThomasParran and R. A. Vonderlehr, Surgeon General and Assistant Surgeon Generalof the U.S. Public Health Service, criticized the Army in a jointly writtenbook, "Plain Words About Venereal Disease," for its failure toinvoke the May Act.

Medical Department officers resented these attacks and similar onesin the public press. The Truman Committee inquired into the Army`s policyduring its December hearings on the National Defense Program. In a WarDepartment circular General Marshall reemphasized the responsibility ofthe unit commander for the enforcement of control measures. The SurgeonGeneral asked the National Research Council to set up a commission to surveyand report on the situation as to venereal disease in the Army. In generalthe commission`s report (February 1942) supported both the soundness andthe consistency of the Medical Department`s policy. Meanwhile The SurgeonGeneral provided for reinforcement of the program by arranging for theassignment of a venereal disease control officer as an assistant to thesurgeon of the following commands: Each division, army, communicationszone head-quarters, general headquarters, corps area, department, and eachstation com-plement serving 20,000 or more troops.²¹

²¹(1) Memorandum, Executive Officer, Officeof The Surgeon General, for surgeons of all corps areas and departmentsand independent stations, 13 Jan. 1941, subject: Cooperation With the U.S.Public Health Service in the Control of Venereal Disease. (2) HearingsBefore a Special Committee Investigating the National Defense Program,United States Senate, 77th Cong., 1st Sess., on Senate Resolution 71, 5Dec. 1941. Washington: U.S. Government Printing Office, 1942, pt. 10, p.3768. (3) Diary, Historical Division, Surgeon General`s Office, entry byCol. Albert G. Love, MC, 15 Nov. 1941. (4) Annual Report, Surgeon, FourthCorps Area, 1941. (5) Annual Report, Surgeon, Eighth Corps Area, 1941.(6) Sternberg, Lt. Col. Thomas H., and Howard, Maj. Ernest B.: Historyof Venereal Disease Control and Treatment in Zone of Interior. [Officialrecord.]

National Research Council

Another agency with which the Army Medical Department established closeliaison during the emergency period was the National Research Council.In May 1940 The Surgeon General asked the Division of Medical Sciencesof the Council to establish committees to advise the Medical Departmenton technical problems.²² This request initiated the appointmentof a number of civilian physicians and medical officers from the Army,Navy, and U.S. Public Health Service. These rendered significant serviceto the Medical Department in giving technical advice on advanced methodsof prevention and treatment of various diseases. The Surgeon General`sOffice based a number of its most technical circular letters on advicegiven by the committees and subcommittees of the Council.

American Medical Association

In June 1940 at the annual meeting of the American Medical Association,the major professional organization of physicians with which the MedicalDepartment maintained close contact, The Surgeon General`s representativessolicited the aid of the association in procuring medical officers forthe Army. They asked the association to survey doctors in the United Statesand their qualifications and to determine which doctors could be consideredavailable for military service and which should remain in civilian lifebecause they were essential to the health of the community.²³The American Medical Associa-tion unanimously agreed to give the aid requestedand created a Preparedness Committee of civilian doctors representing eachcorps area. During the remainder of 1940 and the following year, the committeeconducted a survey of the medical profession and began to give informationto the Surgeon General`s Office on the availability of certain doctorsfor military service. However, the machinery created at this date for procurementof medically trained personnel for the Army was soon superseded by Federalmachinery created for the purpose.

Schools and Hospitals

The aid of civilian schools and hospitals was also enlisted throughthe revival of the affiliated units under the plan developed the previousyear. The details of the plan as approved by the War Department were publishedin January 1940. The Surgeon General`s Office began efforts to interestselected civilian institutions, explaining to each affiliating institutionthe procedure for affiliation, policies as to appointment in the ReserveCorps, the positions to be filled, training required, mobilization, andissue of equipment. By

²²Report, Committee to Study the Medical Department,November 1942, Tab: Relations with Others.
²³See footnote 19 (1), p. 39.

mid-1941, 41 general hospitals, 11 evacuation hospitals, and 4 surgicalhospitals had been organized at universities and hospitals.²⁴

Defense Agencies

The year 1940 also witnessed the inception of several Federal defenseagencies which were designed to promote civilian health as an essentialaspect of the defense effort and to handle special civilian health problemsarising therefrom.

In some fields civilian and military claims to supplies, labor, andfacilities had already begun to clash with each other. The field of medicinewas no exception, and the Medical Department of the Army on occasion lockedhorns with agencies devoted primarily to civilian interests. These agenciessprang up rapidly during the emergency period and underwent various changesof jurisdiction. Responsibility for most of the health and medical aspectsof national defense was eventually vested in the Federal Security Administrator,Paul V. McNutt.

Office of Defense Health and Welfare Services.-By the fall of1941 Mr. McNutt had been made Director of the Office of Defense Healthand Welfare Services. A major committee in this office was the Health andMedical Committee, on which General Magee served, along with the SurgeonsGeneral of the Navy and U.S. Public Health Service. The Surgeon General`sOffice worked closely with the Health and Medical Committee and its subcommittees,as well as with certain other elements of the Office of Defense Healthand Welfare which cooperated with State and local agencies in a broad attackon the problem of venereal disease. The office of the Federal SecurityAdministrator provided a point of contact for military and civilian authoritiesin areas, particularly those near defense industrial establishments, inwhich military and civilian health impinged upon each other. The U.S. PublicHealth Service was under the jurisdiction of the Federal Security Administrator,as was, at a later date, the chief Federal civilian agency concerned withproblems of medical manpower, the War Manpower Commission. The latter,through its Procurement and Assignment Service, attempted to solve theproblem of allocating sufficient medical personnel to government agencies,including the military forces, while retaining adequate numbers in civilianpractice-the task for which the Medical Department had previously enlistedthe aid of the American Medical Association.²⁵

²⁴(1) Memorandum, The Adjutant General forThe Surgeon General, 26 Jan. 1940, subject: Officers of Affiliated MedicalUnits-Appointment, Reappointment, Promotion, and Separation. (2) Memorandum,Executive Officer, Office of The Surgeon General for each Affiliating Institution,16 May 1940, subject: Affiliated Units, Medical Department, U.S. Army.(3) Annual Report of The Surgeon General, U.S. Army, 1941. Washington:U.S. Government Printing Office, 1941, pp. 101-114. See also Medical Department,United States Army, Personnel in World War II, ch. V. [In press.]
²⁵For full discussion, see Medical Department, United StatesArmy, Personnel in World War II, ch. VI. [In press.]

Office of Civilian Defense.-The Office of Civilian Defense whichmade plans for community health programs and medical care of civiliansin the event of military attack upon the United States, was created bythe President in May 1941. Although it was not put under jurisdiction ofthe Federal Security Administrator, it belongs with the series of agenciesjust named in that it, too, claimed a quota of the available medical personnel,supplies, and facilities. It was particularly interested in the Army`sdevelopment of protective measures, should the enemy resort to gas warfareagainst the civilian population, and in certain medical supplies whichthe Army might make available for civilian defense. In the latter partof 1941 the liaison officers of the U.S. Public Health Service on dutywith corps area surgeons were assigned to serve as medical consultantswith the local district offices (serving areas conterminous with Army corpsareas) of the Office of Civilian Defense.²⁶

Office of Scientific Research and Development.-In June 1941 thePresident set up the Office of Scientific Research and Development whichwas authorized, among other duties, to "initiate and support scientificresearch on medical problems affecting the national defense." ItsCommittee on Medical Research, with Col. James S. Simmons, MC, as Armyrepresentative, was to advise the Director of the Office of ScientificResearch and Development as to the need for, and character of, medicalresearch contracts which the Office should make with hospitals and universities.This agency and the National Research Council were the two agencies whichcontributed most heavily to the alleviation of the Army`s heavy needs formedical research during the war. Both these agencies worked in collaborationwith the U.S. Department of Agriculture laboratory at Orlando, Fla., indeveloping DDT for widespread Army use in the control of insect-borne diseases.Both also had responsibilities in connection with the research program,then largely civilian controlled, into methods of treatment of gas casualties.²⁷

Research to counter biological warfare.-The antibiological warfareprogram also led to the creation of new agencies. Biological warfare hasboth offensive and defensive aspects, and defense against potential biologicalwarfare on the part of the enemy is a civilian as well as a military problem.Consequently, research into the potentialities of biological warfare andprograms to counteract the effects of any such warfare in which the enemymight engage were undertaken at a number of levels of Government organization,both within and without the War Department. A major problem, so far asthe

²⁶(1) U.S. Government Manual. Washington: U.S.Government Printing Office, September 1941, pp. 69-72. (2) Report of Committeeto Study the Medical Department, 1942, Tab : Relations With Others.
²⁷(1) Millett, John D.: United States Army In World War II.The Organization and Role of the Army Service Forces. Washington : U.S.Government Printing Office, 1954, pp. 236ff. (2) Report of Committee toStudy the Medical Department, 1942, Tab: Research Program. (3) MedicalDepartment, United States Army. Preventive Medicine in World War II. VolumeII. Environmental Hygiene. Washington: U.S. Government Printing Office,1955, pp. 251-269. (4) Brophy, Leo P., Miles, Wyndham D., and Cochrane,Rexmond C.: U.S. Army in World War II. The Chemical Warfare Service: FromLaboratory to Field. Washington: U.S. Government Printing Office, 1959,pp. 75-100.

Medical Department was concerned, was to confine its responsibility,as in the case of chemical warfare to the defensive aspects. Bacteriologicalwarfare methods had been studied jointly by the Chemical Warfare Serviceand the Medical Department for many years.

When the Secretary of War became alarmed over the potentialities ofbiological warfare in 1941, he informally placed some responsibilitiesfor research in this field upon the Chemical Warfare Service and askedthe National Academy of Sciences in Washington, D.C., to study the problem.In November 1941 the Academy appointed the WBC Committee to undertake thestudy.²⁸ Col. (later Brig. Gen.) Raymond A. Kelser, VC (fig.14), Chief of the Veteri-nary Division, Office of The Surgeon General,was a member, for the introduction of disease among cattle in the UnitedStates was recognized as a serious threat to the nation`s food supply.The committee`s reports in 1942 delineated various means of biologicalwarfare which threatened human beings, plants, and animals, stressing thedanger of the spread of rinderpest among cattle.

²⁸According to Brophy, Miles, and Cochrane,on p. 103 of the volume cited in footnote 27 (4), p. 44, the initials stoodfor "War Bureau of Consultants." However, it is the recollectionof Brig. Gen. Stanhope Bayne-Jones, MC, USA (Ret.), then Deputy Chief ofthe Preventive Medicine Division, Office of The Surgeon General, and oneof The Surgeon General`s representatives in the group, that the initialsstood for "Biological Warfare Committee," deliberately scrambledfor security reasons. Statement of General Bayne-Jones to the editor, 12Oct. 1961.

Secretary Stimson indicated to the President the two main considerationswhich he deemed of importance in setting up a body to take action on thecommittee`s report: selection of the right men and entrustment of the programto a civilian agency. The latter measure, he stated, "would help inpreventing the public from being unduly exercised over any ideas that theWar Department might be contemplating the use of this weapon offensively."He noted that a knowledge of offensive possibilities was indispensableto the preparation of an adequate defense, comparing biological warfarein this respect to chemical warfare, for which research into both offensiveand defensive possibilities had been found necessary.²⁹

To avoid alarming the public, a civilian-controlled War Research Servicein the Federal Security Agency was authorized in May 1942, supersedingthe WBC Committee. Through the Surgeon General`s Office the War ResearchService developed antibiological warfare programs in the Hawaiian DepartmentCivilian Defense Command, the military districts of the United States,and the oversea theaters of operations. General Kelser was made a liaisonmember of a new advisory group-arbitrarily called the ABC Committee-setup in October by the National Research Council and the National Academyof Sciences to give technical and professional aid to the War ResearchService. He also became co-chairman of a joint United States-Canadian commission(appointed by the Secretary of War and the Canadian Minister of NationalDefense) to plan measures for protecting North American cattle againstthe introduction of rinderpest. The Medical Department`s participationin the antibiological warfare program was thus largely limited in the earlywar years to the use of some of its personnel by, or in liaison with, otheragencies to which direct responsibility for the program was assigned.³⁰

MEDICAL OFFICES IN OTHER BRANCHES OF THE ARMY

At the beginning of 1940, medical officers held positions in three majorbranches of the War Department other than the Surgeon General`s Officethe National Guard Bureau, the Office of the Chief of the Air Corps, andthe Chemical Warfare Service. During that year medical officers were assignedto four other branches-the Office of the Inspector General; the G-4 sectionof the General Staff; General Headquarters (a new creation of this period);and the Corps of Engineers-and in mid-1941, to the Armored Force (chart3). Some of these assignments reflected the Army`s expanding medical activities;

²⁹Letter, Secretary of War, to the President,29 Apr. 1942.
³⁰(1) Medical Department, United States Army. Veterinary Servicein World War II. Washington: U.S. Government Printing Office, 1962, p.433. (2) Brophy, Leo P., Miles, Wyndham D., and Cochrane, Rexmond C.: U.S.Army in World War II. The Chemical Warfare Service: From Laboratory toField. Washington: U.S. Government Printing Office, 1959, pp. 101-122.(3) Letter, Brig. Gen. R. A. Kelser, VC, USA (Ret.), to Director, HistoricalDivision, Office of The Surgeon General, 10 July 1951, with attachment,commenting on preliminary draft of this chapter.

Chart 3.- Organization of the Army,showing assignment of medical officers to major offices, June 1941

others the increased staff work calling for technical advice by MedicalDepartment officers or the General Staff`s growing awareness of medicalproblems.

Army Air Forces Medical Division

The Medical Division of the Air Corps grew in size and stature duringthe emergency period in consonance with the rapid expansion of the airforces. The running argument in 1939 and 1940 over General Magee`s effortto transfer the Medical Division to his jurisdiction had died down largelybecause the Air Corps had claimed that if the establishment of the ArmyAir Forces, already contemplated, took place, the new organization musthave complete jurisdiction over its medical personnel. When the Army AirForces was set up as the highest Air Force Command in mid-1941 and givencontrol of its stations and all assigned personnel, The Surgeon Generalrecommended that the Medical Division of the Air Corps be moved to thehigher headquarters. In October Col. David N. W. Grant, MC, was transferredfrom the Medical Division, Office of the Chief of the Air Corps, to Headquarters,Army Air Forces (with an additional reassignment to the Chief of the AirCorps). At the same time he was designated "the Air Surgeon."By February 1942 he had succeeded in having the Medical Division, Officeof the Chief of the Air Corps, transferred to his office. His office remainedthe major medical office within the Army Air

Forces throughout the war.³¹ By mid-1941, some 8 months beforethe transfer took place, this office, which in the preemergency periodhad possessed only two medical officers, had acquired enough military andcivilian personnel to staff a functional organization of several sections.At that time slightly more than 1,000 Medical Department officers (includingReserve officers), the majority qualified as aviation medical examinersor flight surgeons, were on duty with the various elements of the expandingAir Corps. As the year 1941 wore on it became obvious that the medicalservice of the Army Air Forces was becoming independent of The SurgeonGeneral except for the latter`s technical supervision in professional mattersand his control over the procurement of medical personnel and supplies.³²

Office of the Inspector General

The appointment of a medical officer to the staff of the Inspector Generalwas an outgrowth of the Chief of Staff`s dissatisfaction with the informationhe was receiving concerning needs for Army hospitals. In the spring of1940 General Magee had prefaced a survey of the current status of hospitalfacilities with the words: "There devolves upon me, as Surgeon Generalof the Army, the inescapable duty of bringing to the attention of higherauthority the unpreparedness of the Medical Department for war."³³He resubmitted a pre-vious request for authorization for 17,500 beds instation and general hospitals-less than half the number called for by theProtective Mobilization Plan.

The General Staff, particularly G-4, tended to minimize somewhat TheSurgeon General`s estimate of requirements for hospital beds and equipment.Among other considerations which made the staff hesitate to give them highpriority was the possibility of using civilian hotels for Army hospitals.The General Staff also believed that General Magee was not giving due weightto the increased productive capacity, since the First World War, of themanufacturing facilities which produced medical supplies and equipment.

The draft removed this problem, under consideration throughout the Summerof 1940, from the ranks of academic questions, for the need for increasesin all types of Army supplies and facilities was now apparent. However,the Chief of Staff, Gen. George C. Marshall, still puzzled over the conflictingstatements as to requirements. Accordingly he asked the Inspector Generalfor confidential information on the medical problems which would resultfrom large troop concentrations. He was skeptical of requirements

³¹(1) Coleman, Hubert A.: Organization andAdministration, Army Air Forces Medical Service in the Zone of Interior,pp. 36, 69-77. [Official record.] (2) Army Regulations No. 95-5., 20 June1941.
³²(1) Annual Report of The Surgeon General, U.S. Army, 1941.Washington: U.S. Government Printing Office, 1941, pp. 256-257. (2) Craven,Wesley F., and Cate, James L., Eds.: Army Air Forces in World War II. VolumeVI, Men and Planes. Chicago: University of Chicago Press, 1955, pp. 362-397.
³³Memorandum, The Surgeon General, for The Adjutant General,10 May 1940, subject: Status of Medical Department for War.

estimates by technical services, and expressed doubt as to whether theSurgeon General`s Office really needed all it had asked for. He remarkedon the tendency of the War Department supply services to ask for more thanthey expected to get, thus clearing their skirts in advance of a possibleinvestigation. He was under the impression that both G-4 and the SurgeonGeneral`s Office were giving him a "desk reaction" instead ofa reaction based on direct observation of conditions in the Army at large.³⁴

The request made of the Inspector General was an effort to get advicefrom an impartial unit of the War Department. In October General Marshallappointed a medical officer, Brig. Gen. Howard McC. Snyder, then medicaladviser to the National Guard Bureau, as Assistant to The Inspector General.Before this date nearly all inspections of Medical Department installationsby the Office of the Inspector General had been made by nonmedical officers.The Chief of Staff impressed upon General Snyder his own concern that allshould go well with the medical service for the new inductees. GeneralSnyder remained at his post throughout the war and, with the aid of hisassistants in the Medical Division of the Office of the Inspector General,conducted inspections of various aspects of the medical service, both inthe Zone of Interior and overseas, including hospitalization and evacuation,personnel, training, and other activities. He was instrumental in findingways of making the most efficient use of hospital facilities and medicalpersonnel.³⁵

G-4 Medical Liaison

Shortly after General Snyder`s appointment, Lt. Col. (later Brig. Gen.)Frederick A. Blesse, MC (fig. 15), one of several officers recommendedby The Surgeon General, was assigned to G-4. Colonel Blesse`s appointmentenabled G-4 to get more direct professional advice on matters of medicalsupply and hospitalization and evacuation than formerly. He was a firmbeliever in effective staff work and attributed some of the difficultieswhich the Surgeon General`s Office experienced in getting acceptance ofits proposed policies to the lack of training and experience of some membersof the Office in staff work. In G-4 a strong interest in plans for hospitalizationand evacuation and various problems related to medical supplies for troopsdeveloped after Colonel Blesse was succeeded by Maj. (later Col.) WilliamL. Wilson, MC (fig. 16), as The Surgeon General`s representative on G-4in 1941. Late in the year

³⁴(1) Memorandum, The Surgeon General, forThe Adjutant General, 6 Apr. 1940, subject: Status of Medical Departmentfor War. (2) See footnote 33, p. 48. (3) Memorandum, Acting Assistant Chiefof Staff, for The Surgeon General, 10 Aug. 1940, and indorsements, subject:Increase in Number of General Hospitals. (4) Memorandum, Chief of Staff,for the Inspector General, 14 Sep. 1940, subject: General Hospitals. (5)Memorandum, Chief of Staff, for Deputy Chief of Staff, 13 Nov. 1940, subject:General Hospitals.
³⁵(1) Interview, Maj. Gen. Howard McC. Snyder, 25 May 1948.(2) Memorandum, Assistant Inspector General, for the Inspector General,10 Nov. 1942, subject: Survey of Hospital Facilities and Their Utilization.(3) Inspector General`s Report, 13 Jan. 1944, subject: Utilization of MedicalCorps Officers in the Zone of Interior.

and early in 1942, additional Medical Department officers were assignedto G-4 in a liaison capacity.³⁶

Assignments of medical officers to G-4 of the General Staff and to theOffice of the Inspector General were intended to establish more immediatesources of information on medical matters than the Surgeon General`s Officeafforded within the prevailing organization of the War Department. Theyalso furnished a means by which the General Staff might appraise, withoutapproach to the Surgeon General`s Office, the efficiency of Army medicalservice. The placing of certain functions relative to the medical servicein Army elements other than the Office of The Surgeon General, however,created the potential difficulty of disagreement on policy between theSurgeon General`s Office and medical representatives at other levels ofArmy organization.

While no serious difficulties ever grew out of the relations of theSurgeon General`s Office with the Office of the Inspector General, strainedrelationships between G-4 and the Surgeon General`s Office developed bylate 1941.

³⁶(1) Memorandum, The Surgeon General, forActing Assistant Chief of Staff, G-4, 20 Sept. 1940, subject: Detail ofa Medical Officer for Duty in G-4. (2) Letters, Brig. Gen. Frederick A.Blesse, MC, USA (Ret.), to Director, Historical Division, Office of TheSurgeon General, 5 Dec. 1950 and 6 Sept. 1951, commenting on preliminarydraft of this volume.

Controversy originally arose over policy on the issuance of unit medicalequipment to units in training in the United States. About May 1941 whenMajor Wilson entered on duty in G-4, G-4 began pressing The Surgeon Generalto issue equipment to "numbered" or tactical units, largely hospitals,being trained for oversea duty. The Surgeon General opposed issuance ofthe equipment for several reasons: the stations where units were assignedlacked space to store the equipment, the equipment might deteriorate orbe damaged when handled by inexperienced troops, motor transport for movingit was lacking, and the units had adequate equipment for training purposes.His policy on the issuance of medical equipment was not in line with G-4`scurrent policy for the issuance of all authorized equipment to units beingtrained for oversea duty. Although not emphasized at this time, a majorreason for withholding hospital equipment was the fact that it was in shortsupply.

At a conference early in 1942 between The Surgeon General and Maj. Gen.(later Gen.) Brehon B. Somervell, then Assistant Chief of Staff, G-4, acompromise was effected. It was decided that units in training would receivesoldiers` individual equipment, equipment necessary for field training,and motor transport. The full assemblage would be stored and would be issuedonly at the time the unit was specifically assigned by the War Departmentto a mission involving the care of the sick and wounded. Meanwhile GeneralSomervell authorized Major Wilson to proceed on a tour of the United States

extensive enough to permit a study of units being trained for hospitalizationand evacuation and of their equipment. Major Wilson`s findings with respectto the need for issuing equipment to units and his impressions as to lackof plans in the corps areas for hospitalization and evacuation in the eventthe United States was bombed led to conflict between him and members ofthe Surgeon General`s staff in 1942.³⁷

General Headquarters Medical Liaison

Medical representation was also established at General Headquartersset up in July 1940 to supervise the training of the field forces in continentalUnited States-the four armies then being built up. In November a MedicalCorps officer was assigned to the special staff of Maj. Gen. (later Lt.Gen.) Lesley J. McNair at the Army War College in Washington, D.C. Thework of General Headquarters expanded in mid-1941 to include the planningand command of military operations. Medical Department officers assignedto its staff were charged with preparing the medical phases of operatingplans for the base commands accompanying task forces sent overseas andfor whatever expeditionary forces the course of events might require. Amedical section was organized in July 1941, and Lt. Col. Frederick A. Blesse,MC (previously with G-4), became its head with the title of Surgeon, GeneralHeadquarters. His medical section, to which several Medical Corps officerswere assigned in late 1941, prepared the medical plan for the Iceland TaskForce and similar plans for other task and expeditionary forces. In planningthe medical personnel and supplies to accompany a particular force, hisoffice was aided by the appropriate division of the Surgeon General`s Officeor of the Air Surgeon`s Office. This medical section had increased planningresponsibilities throughout 1941. In the course of that year, the Bermuda,Newfoundland, and Greenland Base Commands were put under General Head-quarters,as well as the Caribbean Defense Command, and soon after the Japanese assaulton Pearl Harbor the Northeastern and Western Defense Commands, transformedinto the Eastern and Western Theaters of Operations, also came under itscontrol. Early in 1942 it had brief command of the forces in the BritishIsles, and Colonel Blesse`s office prepared the medical plan for V Corps.³⁸

Armored Force Medical Section.-In mid-1941 a small medical sectionwas also established at the Fort Knox headquarters of the Armored Force,created as a subcommand of General Headquarters. It consisted originally

³⁷Smith, Clarence McKittrick: The Medical Department:Hospitalization and Evacuation, Zone of Interior. United States Army inWorld War II. The Technical Services. Washington: U.S. Government PrintingOffice, 1956, pp. 141-142, 151-152.
³⁸(1) Greenfield, Kent R., and Palmer, Robert R.: Origins ofthe Army Ground Forces, General Headquarters, U.S. Army, 1940-1942. StudyNo. 1, Historical Section, Army Ground Forces, 1946. [Official record.](2) Interview, Brig. Gen. Charles B. Spruit, MC, USA (Ret.), 31 Oct. 1947.(3) Annual Report, Medical Section, General Headquarters, U.S. Army, 1941.

of two Medical Corps officers, who had previously served at headquartersof I Armored Corps, and four enlisted men. Since German successes withtanks in the invasion of France during the summer of 1940 had made it appearlikely that the Armored Force would achieve the status of a combatant armseparate from the infantry, the Army began building up armored divisionsin greater proportion to infantry divisions. As General Magee pointed out,in protesting the tendency of Air Forces medical officers to emphasizethe peculiar psychology of the airman and his special medical needs, themen in tanks also faced dangerous environmental conditions and specialcombat hazards. "Moreover," he stated, "in his steel-enclosedquarters, from which escape is difficult, with the firing of artilleryin immediate proximity, with the presence of noxious gases from rapidlyfiring guns and the operation of motors, with the possibility of beingblown to bits by landmines or being incinerated from the ignition of ammunitionor gasoline, one would be slow to decide that the support of his moraleor the furtherance of his physical recuperation is less in need of attentionthan that of the airman." Although they faced medical problems ofa specialized character, the staff medical section at Armored Force headquartersapparently never developed any doctrine of separatism from the medicalservice of the rest of the Army.³⁹

Corps of Engineers, Eastern Division.-Late in 1940 Lt. Col. (laterBrig. Gen.) Leon A. Fox, MC (fig. 17), was assigned as chief health officerfor the newly created Eastern Division of the Corps of Engineers. Thisassignment differed from the other assignments noted above in that ColonelFox had concrete responsibilities for the furnishing of medical servicewhereas the others were mainly concerned with planning and with liaison.The task of the Health Division (within the Eastern Division) headed byColonel Fox was to provide medical care for civilian employees of privatebusiness firms which had contracted with the Corps of Engineers for theconstruction of airbases at the sites (in Newfoundland, Bermuda, the Bahamas,Jamaica, Antigua, St. Lucia, Trinidad, and British Guiana) acquired bythe destroyer-base agree-ment of September 1940 with the British.⁴⁰Colonel Fox`s assignment and that of other medical officers to this workresulted in the development of a medical organization responsible to theChief of Engineers rather than to The Surgeon General. It pioneered inestablishing Army health service in foreign areas outside continental UnitedStates and the Army overseas depart-ments. Colonel Fox`s headquarters wasoriginally with the Eastern Division

³⁹(1) The Armored Force Command and Center.Study No. 27, Historical Section, Army Ground Forces, 1946. [Official record.](2) Memorandum, Surgeon, Headquarters, Armored Force, for The Surgeon General,22 Jan. 1943, subject: Record of Activities of the Armored Force Surgeon`sOffice From Date of Activation to 31 Dec. 1942. (3) Memorandum, The SurgeonGeneral, for Commanding General, Services of Supply, 13 Oct. 1942, subject:Specialized Hospitals and Recuperative Facilities for Army Air Forces Personnel.
⁴⁰For more detailed and documented treatment, see Wiltse, CharlesM. : The Medical Department: Medical Service in the Mediterranean and MinorTheaters. United States Army in World War II. The Technical Services. [Inpreparation.]

headquarters in Washington, but he and certain assistants spent thefirst half of 1941 making sanitary surveys of the territories concerned,preparatory to selecting sites for the bases. The survey typically containedinformation on existing health facilities and specific disease hazardsof the region. In the late summer of 1941, when the Caribbean Divisionand the Atlantic Division, both with headquarters in New York, supersededthe Eastern Division, Colonel Fox was put in charge of the medical servicefor both. From late 1940 his office sent Medical Corps officers to theEngineer districts which served as the agencies for carrying out constructionand other activities of the Corps of Engineers in the Caribbean area, Bermuda,and Newfoundland, and later in 1941 to the districts in Iceland and Greenland.By the end of 1941 one or more Medical Corps officers (11 at Trinidad)had been sent to each of the bases, and in several a Dental Corps officerwas present. For a brief period the Engineer medical service, which includedsome small hospitals, existed side by side with the medical service developingfor troops at the bases, but was withdrawn or merged with the latter asground and Air Force units replaced engineer troops. Medical Departmentpersonnel assigned to the base setup were in a chain of command which ledback to the General Staff through

General Headquarters (through the Caribbean Defense Command as an additionalechelon in the case of bases in the Caribbean).

RELATIONS WITH THE GENERAL STAFF

During 1940 and 1941 the War Department General Staff gave increasinglyclose supervision to the administration of Army medical service. Changesin requirements for medical supplies and accompanying storage space, increasedhospital bed requirements to accord with increases in the authorized strengthof the Army, and the adoption of standard plans for hospital constructionled to closer contact between the Surgeon General`s Office and G-4 as didthe question of the issuance of unit assemblages to troop.⁴¹Personnel guides proposed by the Surgeon General`s Office for manning additionalstation and general hospitals in the United States, the office`s calculationsof the increased requirements for doctors, dentists, veterinarians, andnurses, and its plans for procuring, classifying, and assigning MedicalDepartment officers and enlisted men required the approval of G-1. Thedispatch of troops to oversea bases called for recommendations by the SurgeonGeneral`s Office as to the immunizations to be given them and other preventivemeasures to be taken for their protection; these had to be cleared withthe War Plans Division of the General Staff as well as with G-4 and G-1.

Officers in the Surgeon General`s Office stressed the importance ofadopting certain preventive measures which they believed would maintainhigh standards of health in the growing Army. Acutely mindful of the heavytoll of the influenza epidemics of World War I, preventive medicine officersattempted, beginning late in 1939, to maintain adequate standards of airspace, floor space, and ventilation in new hospitals under construction,as well as in barracks. In this effort they came into conflict with G-3which was anxious to get as many soldiers into training as possible andhence wanted to house more men in the available barrack space than preventivemedicine officers of the Surgeon General`s Office thought desirable.⁴²The Chief of Staff and the General Staff hesitated to adopt in full someof the recommendations of the Surgeon General`s Office for immunizationsfor troops. In the case of recommendations for certain task forces slatedto go overseas, for instance, the uncertainty as to their destination andthe time of their departure led to delay in staff approval. Although relationsof the Surgeon General`s Office with the General Staff remained formallythe same as they had been in the prewar period, the staff became of necessitymore ^{involved than formerly with the details of operations of themedical service.}

⁴¹(1) Memorandum, Acting Assistant Chief ofStaff, G-4, for Assistant Chief of Staff, G-1, 25 Nov. 1940, subject: Detailof Medical Officer to G-4. (2) Smith, Clarence McKittrick: The MedicalDepartment: Hospitalization and Evacuation, Zone of Interior. United StatesArmy in World War II. The Technical Services. Washington : U.S. GovernmentPrinting Office, 1956, ch. II-IV.
⁴²Committee to Study the Medical Department, 1942, Exhibit 41.

LOCAL AGENCIES AND FIELD UNITS PROVIDING MEDICAL
SERVICE

During 1940 and 1941, field installations engaged in Medical Departmentwork increased markedly in number and size. The surgeon`s offices of thecorps areas and departments underwent similar expansion, while medicaloffices were created for the new defense commands and field armies, therapidly growing air commands, and the new Atlantic bases. A few medicalofficers accompanied the military missions sent overseas to keep in touchwith the war situation in various friendly countries. When the United Statesentered the war these officers became the nuclei of the medical sectionsof theater commands. Several became chiefs of service in their respectivetheaters of operations.

Field Installations

During 1940 and 1941 the field installations under command control ofThe Surgeon General increased in number and were augmented by one new type-themedical replacement training center. The Surgeon General still had commandof the Army Medical Center with its Professional Service Schools and WalterReed General Hospital, of the other "named" general hospitalsin the United States (13 by October 1941), of the Medical Field ServiceSchool at Carlisle Barracks, and of the medical depots. During 1941 thefloor space allotted to the medical depot system expanded almost fivefold.By the end of the year there were three medical depots, a depot havingbeen established at Savannah and one at Toledo in addition to the St. LouisMedical Depot, and medical sections in nine general depots at the followinglocations: Chicago, Columbus (Ohio), New Cumberland (Pa.), New Orleans,New York, Ogden (Utah), San Antonio, San Francisco, and Schenectady.⁴³

Early in 1941 two Medical Department replacement training centers wereset up, one at Camp Lee, Va., in the Third Corps Area and the other atCamp Grant, Ill., in the Sixth Corps Area. These, designed to train enlistedmen for Medical Department units, were originally placed, along with mostreplacement training centers, under direct control of the corps area commander.The Surgeon General, through the Plans and Training Division, exercisedjurisdiction over such technical matters as the content of courses, thetables of organization for the various units, and so forth. Late in theyear another medical replacement training center was established at CampBarkeley, Tex., and soon afterward the three replacement training centerswere placed under the direct jurisdiction of The Surgeon General. Witha capacity of several thousand men each, they gave basic military trainingand certain specialized training for the position of medical and surgicaltechnician, clerk, cook, chauffeur, and auto mechanic.⁴⁴

⁴³Yates, Richard E. : The Procurement and Distributionof Supplies in the Zone of Interior During World War II, pp. 43, 157. [Officialrecord.]
⁴⁴Annual Report of The Surgeon General, U.S. Army, 1941. Washington:U.S. Government Printing Office, 1941, pp. 159-161.

Corps Areas, Departments, and Bases

Corps area medical service.-During the emergency period the organizationof the corps area surgeon`s office underwent a general expansion in numbersof personnel.⁴⁵ Four field armies were being built up, and untillate in 1940 the headquarters of several corps areas served also as theheadquarters for a field army. The Medical Department annexes to the CorpsArea Protective Mobilization Plans formulated by corps area surgeons` officesin 1939 had anticipated expansion in the event of mobilization. They hadvaried widely as to the number of officers, enlisted men, and civilianswhich they calculated a corps area surgeon`s office would need in the eventof mobilization, and as to the organization of his office. The plan forthe Seventh Corps Area contemplated setting up 12 divisions, 11 of whichtallied with the 12 contemplated for the Surgeon General`s Office in itsplan of 1939. A separate museum division for each corps area was unnecessary,of course. The twelfth was to be an Inspection Division. The plan for thesame corps area for 1940, however, exhibited a tendency toward greaterconcentration of functions, listing only eight divisions. It contemplateda single Inspection, Preventive Medicine, and Vital Statistics Divisioninstead of a full division for each of these functions, and it omittedthe previously listed Nursing and Library Divisions.

In general the plans exhibited a lack of uniformity in unit designation,in numbers of personnel contemplated, and in organizational pattern. Nordid most of them specify the extent to which Medical Administrative Corpspersonnel would be substituted for professionally trained officers andthe extent to which enlisted men and civilian personnel would be used inclerical positions. Wide divergencies thus render rather fruitless anyattempt to indicate the degree to which the actual setup of the corps areasurgeons` offices in 1940 and 1941 followed the medical annexes to theCorps Area Protective Mobilization Plans. The expansion which took placein the relatively large surgeon`s office in the Second Corps Area seemstypical enough to give an idea of general trends in expansion. In September1940 this office consisted simply of four officers, six civilian clericalemployees (three of whom were paid from Civilian Conservation Corps funds),one civil-service physician acting as Assistant Surgeon for the CivilianConservation Corps, and six enlisted men. The corps area surgeon, who was,of course, on the special staff of the corps area commander, also servedas surgeon of the First U.S. Army. The other three medical officers werea colonel of the Medical Corps, a captain of the Medical AdministrativeCorps, and a captain of the Medical Corps Reserve. The following monththe assignment of the Reserve officers to the handling of professionaladministrative matters and training constituted the initial step towardthe organization of the office on a functional basis as contemplated inthe plan for the corps area.

⁴⁵This discussion of corps area medical servicesis based on : (1) Protective Mobilization Plans, First, Second, Fifth,Sixth, Seventh, and Eighth Corps Areas, 1939. (2) Annual Reports, all corpsarea surgeons, 1940 and 1941. (3) History, Office of The Surgeon, SecondCorps Area and Second Service Command, From 9 September 1940 to 2 September1945. [Official record.]

By the end of the year the Headquarters of the First U.S. Army had beenseparated from that of the Second Corps Area. The corps area surgeon, Col.(later Brig. Gen.) Charles M. Walson, MC (fig. 18), had 10 officers assignedto him, as well as a chief nurse, an assistant surgeon for the CivilianConservation Corps, and a liaison officer of the U.S. Public Health Service.During 1941, four officers were added. There were then in the Second CorpsArea sur-geon`s office 26 civilian employees and 17 enlisted men of theMedical Department, who with the 15 officers and the chief nurse made anaggregate of 59 in the office, exclusive of the assistant surgeon for theCivilian Conservation Corps and the liaison officer from the U.S. PublicHealth Service.

So long as the offices of the corps area surgeons remained small, thelack of clear-cut organizational lines presumably caused little trouble.Apparently the theory prevailed that a flexible organization with personalcontrol exercised by the corps area surgeon, who might make frequent changesin assignment accord-ing to his needs, produced better results than a fixedorganization with demarcation of duties. The corps area surgeon was ableto keep in touch with all his staff. With continuous expansion of the corpsarea surgeon`s office, however, this personal type of organization ceasedto be feasible. The difficulty of making efficient assignment and classificationof civilian personnel, especially of newcomers, under an organization withno fixed pattern was pointed out in a classification survey made of thecivilian positions in the surgeon`s office of the

Eighth Corps Area in July 1941. With the rapid growth of corps areasurgeon`s offices in both military and civilian personnel, more detailedorganizational charts and clearer delineation of function became necessaryfor efficient administration. By the end of 1941 the surgeon`s office ofthe Eighth Corps Area, as well as that of one or two other corps areas,showed a more definite organizational pattern. The surgeon, his executiveofficer, the office administrator, and a chief clerk constituted the executivestaff of the Eighth Corps Area surgeon`s office. The following divisionsexisted: Professional, Finance and Supply, Dental, Civilian ConservationCorps, Veterinary, and Personnel. The Civilian Conservation Corps Divisionhandled the corps area surgeon`s responsibilities for providing medicalservice to Civilian Conservation Corps camps in the Eighth Corps Area;this work was an important task of corps area surgeons until the CivilianConservation Corps was abolished in 1942. The surgeon`s office of mostcorps areas had not attained the degree of organizational development reachedby that of the Eighth Corps Area, but specific divisions and sections wereemerging in all of them, including sections concerned with civilian personnel.These latter were a result of the rapid increase in use of civilians inhospitals in the corps areas.⁴⁶

Two innovations in corps area medical service before the United Statesentered the war have already been recounted: the assignment of U.S. PublicHealth Service officers to corps area surgeons` offices, and the establishmentof corps area laboratories. The assignment of a dental surgeon to eachcorps area headquarters in October 1940 was also a uniform developmentin the expansion of corps area medical organization.⁴⁷Aboutthe same date it was decided at a conference of corps area surgeons thata nurse in the grade of assistant superintendent would be assigned to eachcorps area surgeon`s office to supervise the expanding nursing servicethroughout the corps area.⁴⁸

Another development in corps area medical service, authorized in 1940but not put into effect until 1941, was the establishment of the positionof camp surgeon separate from that of hospital commander. It had been customaryfor camp or station surgeons to act also as hospital commanders, as thework involved in the two functions could be headed by a single medicalofficer. With the tremendous expansion of many Army camps after the draft,however, new duties developed which were distinct from the administrationof the hospital proper, such as medical aspects of the processing of newrecruits throughout the corps area, preparation of an increasing numberof medical reports, and work on multiplying sanitary problems. At the sametime the work of directing the expanding hospitals became a full-time activity.

⁴⁶Memorandum, Col. Achilles Tynes, MC, forCorps Area Surgeons and Department Surgeons, 12 Sept. 1940, subject: TheUse of Civilian Personnel in Army Hospitals. 231.1 (Hawaiian Department)AA.
⁴⁷Medical Department, United States Army. Dental Service inWorld War II. Washington: U.S. Government Printing Office, 1955, p. 31.
⁴⁸Annual Report of The Surgeon General, U.S. Army, 1941. Washington:U.S. Government Printing Office, 1941, p. 245.

The obvious solution was to divorce the two jobs of hospital commanderand camp surgeon in the larger installations and to assign additional personnelto the office of the new camp surgeon to carry out the general duties notedabove.

Departments and bases.-The establishment of the Caribbean DefenseCommand in the spring of 1941 was intended to coordinate the military activitiesof the Panama and Puerto Rican Departments with those of the Caribbeanbases acquired from Great Britain under the agreement of September 1940.The command headquarters was located at Quarry Heights, C.Z., and the commandinggeneral served in the additional capacity of commanding general of thePanama Canal Department. Three "sectors," the Panama, Trinidad,and Puerto Rican Sectors, were set up. The area was neither geographicallynor politically cohesive. The Puerto Rican Sector included the Virgin Islands,Jamaica, Cuba, and Antigua; and the Trinidad Sector eventually includedDutch, British, and French Guiana, as well as St. Lucia, Aruba, and Curaçao.Moreover, the Commanding General, Caribbean Defense Command, apparentlypreferred to keep his special staff small in order to preserve the mobilityof his headquarters in the event of enemy attack. The creation of a staffmedical section was postponed, and the surgeons of the departments andof the multiplying base commands in this area continued to report directlyto the War Department. The medical service maintained by the Corps of Engineersfor civilians employed on Army construction in the bases existed side byside with the usual Army medical service for ground and air troops andfurther complicated the structure of Army medical organization within thebases. The Caribbean Air Force, which was established in May 1941, absorbingthe previous Panama Canal Department Air Force, had its own surgeon andmedical organization. Thus Army medical service in the Caribbean DefenseCommand was directed by, and reported through, three command channels duringearly war years. Although the regions around the Caribbean presented ahomogeneity of medical problems, no unification of Army medical serviceunder a surgeon at Caribbean Defense Command headquarters took place untilOctober 1943.⁴⁹

Except for a general expansion to furnish medical care for increasingforces, few significant changes took place in the organization of medicalservice in the Hawaiian and Philippine Departments until the Pearl Harborattack. No surgeon was appointed for the new tactical command, the U.S.Army Forces in the Far East, organized in the Philippines in July 1941.The departmental surgeon continued as head of the medical service in thatarea.

Armies and Continental Defense Commands

Field army surgeons.-The offices of field army surgeons wererevived when the headquarters of the four field armies were establishedseparately from

⁴⁹(1) History of Medical Department Activitiesin the Caribbean Defense Command in World War II, vol. 1, pp. 105ff and155ff. [Official record.] (2) Annual Reports, Surgeon, Puerto Rican Department,1940, 1941. (3) Annual Reports, Surgeon, Panama Canal Department, 1940,1941. (4) Annual Reports, Surgeon, Hawaiian Department, 1940, 1941. (5)Annual Report of The Surgeon General, U.S. Army, 1941. Washington: U.S.Government Printing Office, 1941, pp. 40-41.

the headquarters of four corps areas with which they had previouslybeen integrated. The offices of army surgeons did not differ greatly fromthe offices of corps area surgeons; during the initial stages of theirdevelopment, they rather resembled the corps area surgeons` offices of1939 in smallness and simplicity.

When separate headquarters were established, the Army surgeon`s officeconsisted of the surgeon and one or two officers and enlisted men. TheWar Department at that time authorized one Reserve medical officer in additionto the Regular Army surgeon, with a provision for later increase to threeReserve officers. The Surgeon General and the army surgeons recommendedthat all four officers be of the Regular Army; other than the surgeon,a plans and training officer, who would act as executive assistant to thesurgeon; the army dental surgeon; and the army veterinary surgeon. Believingthat Reserve officers had not had sufficient experience to qualify themfor training duties, The Surgeon General stressed the importance of havinga Regular Army officer fill the position of plans and training officer,who would be the normal alternate for the surgeon. In December the fourRegular Army officers were authorized. In April 1941 the number of officerswas increased to six and in September to eight. The number of enlistedmen allotted to the Army surgeon`s office increased proportionately.

In 1941 medical officers were not available in the numbers needed tofill all the positions for which they were authorized, and the number assignedto the army surgeon`s office was not usually equal to that allotted. Althoughthe army surgeons` offices were theoretically set up on a functional basisby this date, it was thus not always possible to establish all of the organizationalsubdivisions called for. Some units of an army surgeon`s office originallythought necessary were found to be necessary only during maneuvers. Exceptin one or two instances permanent assignments of dental and veterinarysurgeons were found unnecessary during the emergency period as the corpsarea medical organization provided the requisite service. The fact thatduring maneuvers an army`s units might be dispersed among several corpsareas seemed to argue against a settled functional pattern for the officeof an army surgeon, subject as it was to periodic unsettlement.⁵⁰The supervision of training was an important function of both the corpsarea surgeon and the army surgeon, but neither was responsible for allthe training of medical troops within his jurisdiction. In general thetactical medical units of armies received technical training in hospitalsunder the jurisdiction of corps areas, while personnel assigned to themedical installations of corps areas were given tactical training withthe armies. Sanitation was

⁵⁰(1) Bronk, William W. : History of the EasternDefense Command, 1945. [Official record.] (2) History of the Western DefenseCommand, 17 March 1941-30 September 1945. [Official record.] (3) AnnualReport, Surgeon, Headquarters, Eastern Theater of Operations, and FirstU.S. Army, 1941. (4) Annual Report, Surgeon, Eastern Defense Command andFirst U.S. Army, 1942. (5) Annual Report, Surgeon, Second U.S. Army, 1941.(6) Annual Reports, Surgeon, Third U.S. Army, 1941 and 1942. (7) AnnualReport, Surgeon, Fourth U.S. Army, 1941.

primarily a responsibility of corps area command, but the army surgeonwas responsible for sanitary precautions in the field. While the army remainedat its home base the corps area command furnished it hospitalization andmedical supplies. On maneuvers hospitalization became a concern of thearmy surgeon, but responsibility beyond the stage of the evacuation hospitalrested with the station and general hospitals of the corps area withinwhich particular army units were stationed. As for dental treatment andtraining in dentistry, the regimental dispensaries and aid stations ofarmies confined themselves to making dental surveys and to providing emergencytreatment and training in the handling of emergency cases. Cases requiringdefinitive treatment or specialized dental equipment were handled in thecamp dental clinics and hospital dental clinics of corps areas, and theclinics gave instruction in the care of such cases.

Defense command surgeons.-In March 1941 the continental UnitedStates was divided into four defense commands, the Northeastern, Central,Southern, and Western. The Northeastern Defense Command was redesignatedthe Eastern Theater of Operations in December 1941, which in turn was renamedthe Eastern Defense Command 3 months later. The Eastern and Western DefenseCommands exceeded the others in importance, as they comprised most of theeastern and western coastal areas. The commanding generals of the armieslocated in them took over the administration of these defense commands.Hence in 1942 the surgeon of the First U.S. Army, Col. (later Brig. Gen.)Frank W. Weed, MC (fig. 19), was also surgeon of the Eastern Defense Command,which eventually included (though it did not supersede) not only the First,Second, Third, Fifth, and Sixth Corps Areas, and that portion of the FourthCorps Area that comprised the Carolinas, Georgia, and Florida, but alsothe base commands in Iceland, Greenland, Newfoundland and Bermuda. Thesurgeon`s office was at the joint headquarters of the First U.S. Army andthe Eastern Defense Command on Governors Island, N.Y. Col. (later Brig.Gen.) Condon C. McCornack, MC (fig. 20), surgeon of the Fourth U.S. Army,became similarly surgeon at the joint headquarters of Fourth U.S. Armyand Western Defense, Command at the Presidio of San Francisco. The Alaskagarrison which had grown rapidly during 1940, being then attached to theNinth Corps Area, had become the Alaska Defense Command early in 1941 andwas now assigned to the Western Defense Command.

Medical installations within the boundaries of the defense commandswere for the most part under corps area jurisdiction, but a few stationhospitals in the Atlantic bases and in Alaska-immediately under the basecommands were within the defense command chain of control.⁵¹

During the southern maneuvers of 1941, certain problems of medical administration,already prophesied by army surgeons, developed. The army

⁵¹(1) See footnote 50 (1) and (2), p. 61. (2)McNeil, Gordon H.: History of the Medical Department in Alaska in WorldWar II (1946). [Official record.]

surgeons` offices had to split up, a portion going forward with troops,and the rest remaining at headquarters. Certain officers, especially dentaland veterinary, and a medical inspector, had to be added temporarily duringmaneuvers. This situation strengthened, if it did not clinch, the argumentfor sufficient medical personnel in the army surgeon`s office to allowfor such divided operation during maneuvers. A similar need for additionalpersonnel later developed in oversea theaters whenever large headquarterssplit into forward and rear echelons. During the maneuvers many units ofthe army for whose health the army surgeon was responsible were stationedin, or moving about, territory outside their home corps area. The corpsarea surgeon was interested in reports on the sick and wounded, and onsanitary conditions, from stations within the geographic limits of thecorps area. The army surgeon was interested in getting the same statisticsfrom the units of the army command. Aside from the intrinsic value of thereports for information as to the health of the command, it was desirableto train the medical officers in units to prepare the reports which theywould have to make if their units were moved overseas. It became a specialproblem for the army surgeon to obtain the necessary reports whenever unitsof the army were stationed in some corps

area other than the army`s home territory. The problem was finally solvedby negotiation between army surgeons and corps area surgeons and by clarifyingregulations issued by the War Department.⁵²

Medical Units for Oversea Service

Field units.-While the army surgeon`s offices were building up,the medical elements of subordinate commands of the field army-that is,the tactical medical units-were being activated. The Plans and TrainingDivision of the Surgeon General`s Office was engaged throughout the emergencyperiod in reorganizing these units and revising their tables of equipment.The reduction in strength of the standard field army, army corps, and divisionwhich was underway at this date, and the concomitant transformation ofthe division from a unit composed of four regiments (the "square division")into one composed of three regiments (the "triangular division"),made necessary much revision of standard medical units. The medical regiment,which had served the corps and the square division, was replaced by themedical battalion as the largest unit. However, the field forces were notat once completely reorganized, and

⁵²See footnote 50 (3), p. 61.

some medical regiments continued to exist until after the entry of theUnited States into the war. The structure of the medical detachments "organic"to combat regiments and of the evacuation and surgical hospitals normallyattached to field armies also underwent revision.

Communications Zone units.-The planning of the emergency periodfurther included the medical units which were to operate in the communicationszone of an oversea theater, such as the station and general hospitals,the medical laboratories, and the medical supply depots. These were distinctfrom their counterparts in the Zone of Interior in having a standard structureor "table of organization." The Planning and Training Divisionalso developed new types of medical units to serve with such new typesof Army units as the armored division airborne division, and mountain division.

Subordinate Air Commands

Throughout the emergency period and the war, surgeons` offices sprangup in the shifting commands and forces under the Air Corps and, after June1941, the Army Air Forces. These commands had a surgeon on the specialstaff of the commanding officer, although few had any appreciable numberof medical personnel at headquarters until late in 1941.

A few air commands undertook medical work peculiar to the air forces.These were chiefly of two types: the training commands, concerned withthe training of aircrews (usually referred to as "flying training")and with the training of technicians for ground crews (called "technicaltraining"), and the service or maintenance commands, concerned withsupply and maintenance. The major departure from the standard Army patternof medical service developed in the training commands, which were engagedin selecting a body of men for flight training and combat training on thebasis of special physical and psychological attributes.

Air training commands.-Besides the general administration ofmedical service resembling the work of the surgeon`s office of any command,the air training commands administered a series of elaborate tests, whichwent considerably beyond the usual physical and mental tests, to candidatesfor pilot training. Until July 1940 the Air Corps Training Center at RandolphField, San Antonio, Tex., was responsible for the training of all fliers.At that date it was split into three centers, located at Randolph Field,at Moffett Field, Calif., and at Maxwell Field, Ala. The staffs of thesecenters eventually included a surgeon who headed a small office. Amongthe early duties of the training center surgeons was the task of passingupon the healthfulness of potential sites for Army flying schools and thatof sites of civilian flying schools under consideration for contract bythe Air Corps. When schools were established or selected, the surgeonshad the responsibility of making arrangements for

medical service for trainees at each school either through the assignmentof medical personnel to the school or through contract with civilian doctors.⁵³

In the fall of 1941 and in early 1942 three Air Corps replacement trainingcenters were set up, one under the jurisdiction of each of the trainingcenters, at the following locations: Maxwell Field; Kelly Field, Tex.;and Santa Ana, Calif. At these were established "psychological researchunits" to put into effect the results of a psychological researchproject begun about mid-1941 in the Medical Division, Office of the Chiefof the Air Corps. The latter had been working not only on physical andmental tests but also on psycho-motor tests to measure the muscular coordination,equilibrium, and so forth, of pilot candidates. The new psychological researchunits, staffed with officers trained in psychology, were to apply the tests,experimentally at first, to candidates at the replacement training centersand carry on research in this field.

Until March 1941 the training for ground crews in mechanics, photography,radio, and so forth, was conducted by the Air Corps Technical School atChanute Field, Ill. Out of the staff surgeon`s office developed the officeof the surgeon for the Air Corps Technical Training Command (with headquartersfirst at Chanute, Field, later at Tulsa, Okla.), which was establishedin March 1941 with responsibility for technical training for the Air Corpsthroughout the United States. For this training, as well as for flyingtraining, contracts were made with civilian schools, in some cases thesame schools as those used for flying training. As in the case of the flyingtrainees, medical service was insured for technical trainees either byproviding in the contract for the services of school physicians, by makingspecial contracts with civilian doctors, or by assigning Army medical officersto the work whenever the number of trainees so warranted.

Supply and maintenance commands.-The second type of air command,that dealing with supply and maintenance, also existed in two separatecommands in the latter part of the emergency period: The Materiel Division(later termed the Materiel Command), and a succession of commands whichfinally became in October 1941 the Air Service Command. The principal functionof the Materiel Division was that of procuring supplies for the Army AirForces. Its one function in the special field of aviation medicine wasthe administration of the Aero-Medical Research Unit at Wright Field. Thework of the Aero-Medical Research Unit was hampered by lack of technicallytrained personnel until a group of specialists sponsored by the NationalResearch Council began to arrive in early 1941. Not until early 1942 wasthe name of the unit changed to Aero-Medical Research Laboratory and con-

⁵³(1) Coleman, Hubert A.: Organization andAdministration, Army Air Forces Medical Service in the Zone of Interior,pp. 157-183. [Official record.] (2) History of the Army Air Forces FlyingTraining Command and its Predecessors, 1 January 1939-7 July 1943 (1 March1945), vols. I, II. [Official record.] (3) History of the Army Air ForcesTechnical Training Command and Its Predecessors, 1 January 1939-7 July1943 (1 March 1945), vol. I. [Official record.] (4) History of The ArmyAir Forces Training Command, 1 January 1939-V-J Day (15 June 1946), vol.II. [Official record.] (5) Annual Report, Office of The Air Surgeon, 1942.

struction of a main building to house the laboratory undertaken at WrightField. The Air Service Command determined requirements and handled distributionof supplies for the Army Air Forces. Neither it nor its predecessors hadany functions peculiar to the field of aviation medicine, but as the commandemployed thousands of civilians, its headquarters surgeon supervised alarge program of industrial medicine. The functions of his office wereclosely related to those of the Occupational Hygiene Branch (later Division)of the Surgeon General`s Office and in some respects duplicated them.⁵⁴

Numbered air forces.-Soon after the four Army defense commandswere announced in March 1941 and their administration combined with thatof the four armies, four similarly numbered air forces were set up to operateunder Headquarters, Army Air Forces. The office of the air force surgeon,or flight surgeon, who was on the special staff of the air force commander,consisted originally only of the surgeon and one or two enlisted men. Themedical section advised the commanding general on the health and sanitationof the air force under his command, the training of all personnel in sanitationand first aid, and on hospitalization and evacuation; supervised the operationof medical service in subordinate units and the training and inspectionof Medical Department troops; handled the procurement, storage, and distributionof medical, dental, and veterinary equipment through the usual channels;and prepared records and reports. The four numbered air forces, under commandof the Air Corps, were charged with air defense of the United States andwith giving intensive training to aircrews and attached ground personnel.Although the areas assigned to them did not coincide entirely with theboundaries of the defense commands, they were coordinated with the defensecommands as follows: First Air Force, Eastern Defense Command; Second AirForce, Central Defense Command; Third Air Force, Southern Defense Command;and Fourth Air Force, Western Defense Command. Like the First and FourthU.S. Armies, identified with the Eastern and Western Defense Commands,respectively, the First and Fourth Air Forces were those concerned primarilywith defense of the coastal areas. The operations of the Second and ThirdAir Forces were eventually confined largely to training.⁵⁵

Like the combat arm it served, the medical organization of the air forceswas building up all through 1941. In addition to operational activities,the air force surgeon`s office set up the necessary medical reporting system,and aided in surveying sites for new air bases. Additional medical personnelcame in with units sent to the new bases, and air base surgeons were assigned.In

⁵⁴(1) Medical History, Air Technical ServiceCommand, 1 January 1945. [Official record.] (2) Mitchell, T. W., Walker,Imogene B., and Smith, Duane D.: History of the Army Air Forces ServiceCommand, 1921-1944 (1945). [Official record.] (3) History of the Army AirForces Materiel Command, 1926-1941, vols. I, II. [Official record.] (4)History of the Aero-Medical Laboratory, 1935-1943. [Official record.]
⁵⁵(1) Coleman, Hubert A.: Organization and Administration, ArmyAir Forces Medical Service in the Zone of Interior, pp. 185-219. [Officialrecord.] (2) History of The First Air Force. Vol. I, Organization Development.[Official record.] (3) History of Headquarters, Second Air Force, vol.I. [Official record.]

February 1941, while trying to straighten out the matter of source ofpayment to civilian employees requested for the surgeons` offices, theSurgeon General`s Office referred to them as "new organizations withwhich this office has had no previous experience, and on which informationavailable to The Surgeon General is relatively meager." These officeswere small and expanded only slightly during 1941. Among the personneladded at intervals were an assistant flight surgeon and a veterinary officer(added to the staff of each air force surgeon about the middle of 1941).The surgeons` offices of air forces did not find it necessary to adopta fully functional pattern of organization until about the end of 1942.

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