History

CHAPTER III

The Medical Department Under the Services ofSupply,
March-September 1942

In the months following the attack on Pearl Harbor, the chief developmentaffecting the administration of the Surgeon General`s Office was the reorganizationof the War Department in March 1942. This resulted in a change in the positionof The Surgeon General and his office within the War Department, as wellas a number of changes in the internal organization of the office.

CHANGES IN THE SURGEON GENERAL`S OFFICE
DECEMBER 1941 TO MARCH 1942

After the entry of the United States into war in December 1941, theSurgeon General`s Office, in common with many Federal agencies in Washington,"mushroomed," new divisions and branches being created to handleincreased responsibilities.

Training and Hospital Construction

Among the immediate problems were those of increasing the number ofMedical Department units and intensifying their training. In January theSecretary of War approved plans for an expansion of the Army to 3,600,000enlisted men by the end of the year, with special emphasis on expansionof training in the schools and replacement training centers. More hospitalswould be necessary for the expanding Army. Thus two activities, trainingand hospital construction, emerged, with the advent of war, from the realmof planning and became fields of immediate operations. In February 1942the Training Subdivision achieved the status of a division, with Planningleft as a separate division. The former Hospital Construction and RepairSubdivision of the Planning and Training Division was reorganized intothe Hospital Construction Division. As the Protective, Mobilization Planof 1939 had contemplated, the administration of the Army Medical Museum,formerly a function of the Professional Service Division, was raised inthe same month to the level of a division, for increased work in pathologyhad also resulted from the expanded medical work of the Army. Early in1942, therefore, the office was made up

of 15 divisions, with personnel of approximately 150 officers and 1,000civilians by
March (chart 4).¹

Expanding Activities

The office subdivisions most significant for future development werethose of the Preventive Medicine Division, especially Occupational andMilitary Hygiene which became for the first time a separate subdivision;those of the Finance and Supply Division; those handling medical specialties,such as neuropsychiatry, medicine and surgery, in the Professional ServiceDivision; and, finally, two new subdivisions added to the AdministrativeDivision, the Public Relations and Intelligence Subdivision and the HistoricalSubdivision. Most of these rose to divisional status during 1942.

The historical program.-The month of August 1941 had witnessedthe genesis of the Medical Department`s historical program. The SurgeonGeneral, "feeling that some steps should be taken for the organizationof the historical work of the Medical Department," had recalled Col.Albert G. Love, MC, Chief of the Plans and Training Division from April1938 to his retirement in mid-1941, to active duty to head this work. Hisaction anticipated by some months the inception of the general War Departmenthistorical program, which developed under the impetus of President Roosevelt`sexpressed interest. In 1941 the only other organizational unit of the WarDepartment engaged in historical work was the Historical Division of theArmy War College, in existence since World War I. The Medical Department,which had maintained a historical unit in the years 1917-29 and had producedduring those years a comprehensive account of its activities in World War1,² was more "history-conscious" than most officesof the War Department.

However, the scope of the historical work then contemplated was quitelimited, since the United States was not at war and the Medical Departmenthad undergone only the expansion of the emergency period. Moreover, theDivision of Medical Sciences of the National Research Council then plannedto sponsor a history of medical activities, both military and civilian,during the emergency period. The Chief of the Historical Subdivision, mindfulof difficulties encountered by the editor of the history of the First WorldWar (Col. Frank W. Weed) and convinced that the Council was in a betterposition than the Medical Department to obtain qualified personnel, cooperatedwith the plans of that body. He limited his own plans to the productionof some volumes on the administrative and tactical phases of the MedicalDepartment`s work not

¹(1) Morgan, Edward J., and Wagner, DonaldO.: Organization of the Medical Department in the Zone of Interior (1946),p. 9. [Official record.] (2) Annual Report, Operations Service, Officeof The Surgeon General, 1942. (3) Annual Report of The Surgeon General,U.S. Army, 1941. Washington: U.S. Government Printing Office, 1942, p.172. (4) Letter, The Adjutant General, to Commanding Generals, Army AirForces, Army Ground Forces, and Services of Supply, 7 Apr 1942, and inclosure:Mobilization and Training Plan (15 Jan. 1942).
²The Medical Department of the United States Army in the WorldWar. Washington: U.S. Government Printing Office, 1923-29, vols. I-XIII.

Chart 4.-Organization of the Officeof The Surgeon General, 21 February 1942

included in the Council`s program.³ Later in the war thescope of the Medical Department`s official history was greatly broadened.

WAR DEPARTMENT REORGANIZATION OF MARCH 1942

In a general War Department reorganization of March 1942, the MedicalDepartment was placed under the Services of Supply or the Army ServiceForces as the command was later called. This reorganization had a gooddeal to do with determining the structure of the Medical Department throughoutthe war. Some changes in organization of the medical service at variouslevels in the Army resulted from a natural coordination of the subordinateservice with the new superstructure, others from direct orders and recommendationsof Services of Supply headquarters (figs. 21, 22).

Effect Upon the Medical Department`s Position in the
War Department

The Surgeon General and the Medical Department, along with the Corpsof Engineers, the Quartermaster Corps, and the rest of the supply services(later termed "technical services"), were placed in March underthe direct com-

³(1) Office Order No. 237, Office of The SurgeonGeneral, 22 Aug. 1941. (2) Love, Albert G.: The Historical Division, 1Aug. 1941-28 July 1945. [Official record.]

mand of Maj. Gen. (later Lt. Gen.) Brehon B. Somervell, Commanding Generalof the Services of Supply. The Army Ground Forces (replacing General Headquartersas a Training Command) and the Army Air Forces, established as major commandsalong with the Services of Supply, were to be provided by the latter with"services and supplies to meet military requirements," except"those peculiar to the Army Air Forces" (chart 5).

With the reorganization, the operating functions of the Office of theUnder Secretary of War and of G-1 and G-4 of the War Department GeneralStaff were transferred to the Services of Supply. Thus the reorganizationled to the interposition of the Commanding General, Services of Supply,between The Surgeon General and the Secretary of War and between The SurgeonGeneral and the Chief of Staff. Under the original setup General Somervellhad a Chief of Staff, a Chief of Procurement and Distribution, and a "functionalstaff " consisting of an officer in charge of each of certain functions,such as operations, control, training, personnel requirements, and defenseaid. With all of these, or, at later dates, with their successors, theMedical Department had close relations. The divisions of the Surgeon General`sOffice which handled functions relating to civilian and military personneland to training, for example, dealt with their obvious counterparts inthe Services of Supply. Relations of the Surgeon General`s Office withG-1, G-3, and G-4 of the War Department General Staff continued also, althoughit was intended that the reorganization should make close relations withthe General Staff unnecessary.

Chart 5.-The Medical Department withinthe War Department structure, August 1942

The Services of Supply Operations Division

The reorganization led to a shift of some of the medical offices andmedical responsibilities assigned to elements of the War Department otherthan the Surgeon General`s Office to new positions in War Department andArmy structure. By August 1942 medical offices were located in other elementsof the War Department than the Surgeon General`s Office (chart 5). Thefunctions in the field of planning for medical supply handled by Maj. (laterCol.) William L. Wilson in G-4 of the War Department General Staff weretransferred under the March reorganization to the Operations Division,headed by Brig. Gen. (later Lt. Gen.) LeRoy Lutes, of the Services of Supply.Major Wilson was stationed in General Lutes` office until the middle of1943. Under the original setup, General Lutes` office was given responsibilityfor preparing plans and instructions on projected and current operationsin order to coordinate the work of the supply services and that of thecorps areas in troop movements and the movements of supplies and equipment.In this work it was to maintain close liaison with divisions of the WarDepartment General Staff and those of the Army Ground Forces and the ArmyAir Forces. In April 1942 the functions of General Lutes` Operations Division,the only division in the upper structure of the Services of Supply whichcontained a medical officer for purposes of liaison, were redefined andextended to include the planning of requirements as to equipment and supplyfor troops overseas. To the extent that medical matters fell within thescope of these activities, Major Wilson promoted at that time to lieutenantcolonel, and to full colonel in October was responsible for liaison withthe Surgeon General`s Office.⁴

Colonel Wilson carried on his liaison work while assigned to the MiscellaneousBranch of the Planning Subdivision of General Lutes` Operations Division.He emphasized the constant staff work which he had to undertake and informedGeneral Lutes of his belief that a medical section, to be headed by a medicalofficer of the rank of colonel, should be established in the MiscellaneousBranch. When General Lutes` title was changed in July from Director ofthe Operations Division, Services of Supply, to Assistant Chief of Stafffor Operations, Services of Supply, and the scope of his activities wasbroadened, a Hospitalization and Evacuation Branch, headed by Colonel Wilson,was created within the Plans Division of General Lutes` office. The dutiesof the Hospitalization and Evacuation Branch, Services of Supply, whichincluded several other Medical Department officers late in the year, embracedliaison with surgeons of the Western Task Force in planning the handlingof medical

⁴(1) Memorandum, Commanding General, Servicesof Supply, for Chiefs of all Supply Arms and Services, Corps Area Commanders,etc., 9 Mar. 1942, subject : Initial Directive for the Organization ofServices of Supply. (2) History of Planning Division, Army Service Forces,ch. XIX. [Official record.] (3) Services of Supply Circular No. 7, 25 April1942. (4) Leighton, Richard M. : History of Control Division, Army ServiceForces, 1942-45 (April 1946). [Official record.] (5) General Orders No.4, Services of Supply, 9 April 1942 ; and No. 24, 20 July 1942. (6) Seealso Millet, John D.: The Organization and Role of the Army Service Forces.U.S. Army in World War II. Washington: U.S. Government Printing Office,1954.

supplies for the landing in French Morocco and the evacuation of thewounded back to the United States. As the responsibilities of this medicaloffice broadened, disagreement arose over its responsibilities vis-a-visthose of the Surgeon General`s Office in the preparation of plans for hospitalizationand evacuation and other phases of medical administration.

Medical functions at other levels

In addition to this shift of Medical Department representation fromG-4 of the General Staff to Operations, Services of Supply, the reorganizationbrought about changes in the relations of the Surgeon General`s Officewith some of the other War Department and Army offices where medical officerswere stationed. (Medical representation on the National Guard Bureau haddisappeared in late 1941, for the Bureau`s activities declined as the NationalGuard was absorbed into the Army, and no medical officer was stationedthere again until after the war.) Relations with the Medical Division ofthe Chemical Warfare Service were scarcely affected by the reorganization,as the Office of the Chief of Chemical Warfare Service was shifted, likethe Surgeon General`s Office, to the jurisdiction of the Services of Supplyand remained on the same level with the Surgeon General`s Office.

Under the reorganization the Headquarters, Army Ground Forces, succeededGeneral Headquarters as the chief command for training ground troops, andthe group of medical officers constituting the Medical Section, GeneralHeadquarters, were transferred to Army Ground Force headquarters at theArmy War College, Washington, D.C., with Col. Frederick A. Blesse as surgeonand head of the staff medical section.⁵

Although the new organization placed the Army Ground Forces on the samelevel with the Services of Supply (chart 5) and hence the Ground Surgeonon the same level as The Surgeon General, only minor difficulties developedin the course of the war in the relations of the two offices. The storyof the relations between the Surgeon General`s Office and the Medical Divisionof the Army Air Forces, however, is quite otherwise. In spite of the roleof the Army Service Forces as the supply agency for the War Departmentand Army, the Medical Division of the Army Air Forces used the fact thatit was now operating under a jurisdiction on the same organizational levelas the Services of Supply as leverage for developing a medical serviceindependent of the Surgeon General`s Office. It took the position thatThe Surgeon General had been reduced by the March reorganization to thestatus of surgeon for elements of the Services of Supply alone. The GroundSurgeon, who might also have taken this position, apparently never didso.

The Chief of the Medical Division of the Inspector General`s Office,Brig. Gen. Howard McC. Snyder, was actually at a higher level under thenew organization than was The Surgeon General, for the Inspector Generalremained on

⁵Annual Report, Personnel Service, Office ofThe Surgeon General, 1942.

the War Department Special Staff. Inspections of medical installationsmade by General Snyder`s office were those directed by the Secretary ofWar, the Chief of Staff, or those requested by the commanding generalsof Army Ground Forces, Army Air Forces, and the Services of Supply. DespiteGeneral Snyder`s responsibility, under the direction of higher authority,for making critical appraisal of the work done at various Medical Departmentinstallations, including those overseas, no serious friction developedbetween his office and the Surgeon General`s Office.

Attempts to clarify the Medical Department`s new relationships

In the early months after the reorganization, much effort was devotedto clarifying the Medical Department`s new relationships with other segmentsof the War Department. At the outset General Magee called to General Somervell`sattention certain problems that his office had encountered in the administrationof the Army medical service under the previous organization by reason ofhaving to deal with several sections of the War Department General Staffand other War Department agencies. He stressed the difficulty of obtainingdecisions on Medical Department proposals from a single War Departmentelement with final authority. In the case of some proposals, he reported,a good many months had elapsed before he could get any action. He notedconflicting decisions or instructions received by his office from varioussegments of the General Staff and from General Headquarters. The failureof higher authority to furnish his office promptly with full informationas to type, size, and destination of task forces had made it difficultto plan properly for hospitals, tactical medical units, and supplies toaccompany forces overseas. A third problem lay in the issuance, upon someoccasions, of Army regulations, or other official documents affecting MedicalDepartment operations, without prior submission of drafts to the SurgeonGeneral`s Office: resultant errors had made revisions necessary. In certainWar Department planning The Surgeon General`s responsibility for directingthe medical service of the Air Corps had not been taken into consideration.Finally, many tactical medical units, such as hospitals, medical supplydepots, and laboratories, had passed from the control of The Surgeon Generalto that of the field armies. They had later been emasculated by the removalof key personnel to other units. Tactical medical units, Magee maintained,should remain under his jurisdic-tion until assigned to a task force. Hemade three major recommendations: that definite uniform staff channelsbe followed, that prompt information on task forces be furnished the SurgeonGeneral`s Office, and that official direc-tives affecting the Medical Departmentbe submitted to it prior to issuance.⁶

General Lutes, Director of the Operations Division, replied for GeneralSomervell, advising a use of the "judicious shortcuts" advocatedin the circular reorganizing the War Department as a method of obviatingdifficulties in get-

⁶Memorandum, The Surgeon General, for CommandingGeneral, Services of Supply, 16 Mar. 1942.

ting prompt and final decision. He also listed for the information ofThe Surgeon General and his staff the staff elements of the Services ofSupply with which they should deal in handling specific matters. Theseincluded various subdivisions of his own Operations Division, which wereto be consulted on current war planning, on the activation, organization,and tables of organization of units, on the movements of troops and supplies,and on coordination of supply. The Miscellaneous Subdivision (to whichMaj. William L. Wilson, MC, was assigned) was to be consulted on hospitalizationand evacuation and miscellaneous matters not coming within the jurisdictionof other Services of Supply divisions. All medical matters involving theArmy Ground Forces or the Army Air Forces were to be submitted for approvalto General Somervell. With regard to the complaint as to lack of informationon task forces, General Lutes stated that the War Plans Division (soonto be renamed Operations Division) of the General Staff was making everyeffort to allow more time in the planning of units and supplies for taskforces.⁷

Information on task forces.-Some of these difficulties of theSurgeon General`s Office, particularly the problems of relations with theArmy Air Forces medical organization and the lack of information on taskforces, persisted. This last problem was not peculiar to the Medical Department,for the interests of secrecy information on troop movements was limitedto as few officers as possible. A number of other War Department offices,including Headquarters, Services of Supply, voiced the same complaint atintervals. Within the Surgeon General`s Office, officers of the PreventiveMedicine Division in particular stressed the necessity of their being keptinformed of the destination and composition of task forces and the generalmilitary situation at the location, as well as the types of medical installationsplanned. They needed the information in order to provide troops with advancedetailed information on methods of controlling communicable diseases inspecific areas and to select such specialized personnel as malariologists,sanitary engineers, and laboratory staff members to accompany forces overseas.

On the other hand, members of the Surgeon General`s Office who dealtdirectly with higher War Department officials engaged in setting up taskforces were somewhat unsympathetic with the point of view of the specialistsin preventive medicine. They appear to have accepted the necessity forconfining information on the destination of task forces to four or fiveofficers in the War Department, pointing out that even the commander ofa task force sent to Australia, for example, would not be informed of itsultimate destination in the Pacific. They minimized the need for advanceinformation on the size of the task force and its mission, stating thatmalaria would be a problem in Gambia, whatever the size and the missionof the task force. Apparently they were implying that preventive measurescould be taken against malaria upon

⁷(1) Memorandum, The Surgeon General, for CommandingGeneral, Services of Supply, 16 Mar. 1942, first indorsement thereto, Brig.Gen. LeRoy Lutes, 23 Mar. 1942. (2), Memorandum, Brig. Gen. Larry B. McAfee,for Training Division, Services of Supply, 31 Mar. 1942.

arrival of the force and were ignoring the thesis of the preventivemedicine experts that specialists in preventive medicine should be assignedto a task force in numbers proportionate to its size. Arrangements forkeeping military plans secret, especially those concerning troop movements,continued to put some hindrance in the way of medical planning.⁸

Relations with Army Air Forces.-Toward the end of March, GeneralMagee attempted to obtain an official statement which would clarify theMedical Department`s responsibilities under the new regime. Apparentlyhe did not at the outset grasp the full scope of difficulties he wouldencounter in operating the medical service under it. He had reason to thinkthat General Somervell would give the Medical Department some backing inits efforts to regain control of the medical service of the Army Air Forces.In the interests of greater coordination of the supply services and ofthoroughgoing control by his own headquarters, General Somervell couldhardly favor the growth of a medical hierarchy in the Army Air Forces orthe Army Ground Forces. However, War Department Circular No. 59, whichhad outlined the new War Department organization in March, had assignedto the Army Air Forces "command and control of all Army Air Forcestations and bases not assigned to defense commands or theater commandersand all personnel, units, and installations thereon." Although GeneralMagee noted that the passage quoted prevented "parallel procedurein rendering medical service to the Ground Forces and the Air Forces,"in his opinion the new organization did not "alter in any respectthe duties of the Medical Department of the Army or the responsibilitiesof The Surgeon General." Nevertheless, he attempted to obtain a clearstatement of policy in writing, and the fact that he confined his attentionto the Air Forces indicates that he considered the Ground Forces less likelyto cause difficulties. On 25 March he proposed to General Somervell certainmajor policies to govern relations between the Medical Department and theArmy Air Forces, designed primarily to maintain existing administrativeprocedures.⁹

Clarification of medical activities.-These proposals initiateda series of memoranda and conferences among representatives of the SurgeonGeneral`s Office, the Operations Division and the Training Division, SOS,G-3 of the War Department General Staff, the Army Air Forces, and the ArmyGround Forces. Colonel Wilson, then in the Operations Division, Servicesof Supply, attempted to amalgamate all of General Magee`s proposals intoa document,

⁸(1) Memorandum, Chief, Preventive MedicineDivision, for Chiefs, Plans and Training and Military Personnel Divisions,28 Mar. 1942, subject: Planning for the Control of Communicable Diseasesin Theaters of Operation. (2) Memorandum, Col. H. T. Wickert, for Brig.Gen. Larry B. McAfee, 7 Apr. 1942. (3) Memorandum, Executive Officer, Officeof The Surgeon General, for Lt. Louis S. Gimbel, Jr., Chief, IntelligenceSection, Ferrying Command, 12 May 1942, subject: Dissemination of MedicalInformation.
⁹(1) Memorandum, The Surgeon General, for Commanding General,Services of Supply, 5 Mar. 1942. (2) Memorandum, The Surgeon General, forCommanding General, Services of Supply, 25 Mar. 1942, subject: MedicalService of the Army, (3) War Department Circular No. 59, 2 Mar. 1942, sections6, 7. (4) Coleman, Hubert S.: Organization and Administration, Army AirForces Medical Service in the Zone of Interior, pp. 90 ff. [Official record.]

acceptable to all parties concerned, to clarify the relations of theMedical Department under the Services of Supply with the Army Ground Forcesand the Army Air Forces. Many changes in wording were proposed by all theseoffices. The wording of the final statement of policy was substantiallyagreed on by April 1942. As issued, with amendments in June, to all corpsarea commanders and other authorities concerned, it was broader in scopethan the proposals of General Magee, although it embodied most of them.¹⁰The substance of this document appears below (with some omission of insignificantphraseology); a few sections of it were to be cited at intervals by interestedparties in support of their effort to gain added control, to deny increasedcontrol to other claimants, or to maintain the status quo:

1. Supplementary to War Department Circular No. 59, 1942the following general policies will govern medical activities within yourcommand:

a. [Reference to pertinent sections of Circular No. 59.]

b. Sanitation in the continental United States other thanthat provided by units under tactical control will be administered by theMedical Department under command of the Commanding General, Services ofSupply.

c. Hospitalization and evacuation for the Army GroundForces in the continental United States, other than that provided by fieldmedical units operating under tactical control, will be furnished by theMedical Department under command of the Commanding General, Services ofSupply.

d. The routine conduct of Medical Department activitieswith the Army Air Forces shall be a responsibility of each local surgeonacting under the Air Surgeon, who is responsible to The Surgeon Generalfor the efficient operation of Medical Department technical activitieswith the Air Forces. In accomplishing his mission the Air Surgeon willoperate in advisory and administrative capacities-advisory in his relationas a staff officer and administrative in his conduct of Medical Departmenttechnical service under control of the Commanding General, Army Air Forces.

In order to determine the status of these Medical Departmentactivities the Commanding General, Services of Supply, may direct necessarytechnical inspections of Army Air Forces stations and commands with deficienciesto be reported to the Commanding General, Army Air Forces, for correctiveaction.

e. The activation, organization, and training of fieldmedical units listed in the Mobilization and Training Plan, 1942, is aresponsibility of the Army Ground Forces, except as provided in paragraph1 f, below.

f. In view of the fact that the Services of Supply controlsthe majority of instal-lations suitable for certain unit training of fieldmedical units, the Services of Supply will organize and train numberedstation and general hospitals and such other medical units as may be requestedby the Commanding Generals, Army Air Forces or Army Ground Forces.

g. Due to responsibilities for operations placed uponcommanders concerned (corps area, air, etc.), training operations willbe administered by them in such manner as to permit adaptation of trainingto concurrent operations.

h. Insofar as practicable, medical equipment and supplieswill be provided to the Army Air Forces and the Army Ground Forces by theServices of Supply. Require-ments in excess of those authorized by tablesof allowances [equipment authorized for

¹⁰Letter, Commanding General, Services of Supply,to all Corps Area Commanders and The Surgeon General, 26 May 1942, subject:Medical Activities Under War Department Circular No. 59, 1942, and Amendmentof 4 June.

posts, camps, and stations] and tables of basic allowances[equipment authorized for units and individuals] plus normal maintenancewill be estimated by Army Air Forces and Army Ground Forces and reportedto the Services of Supply.

i. In the discharge of his duties, the Air Surgeon willutilize the services available in the Services of Supply to the maximumdegree consistent with the proper control of the Medical Department withinthe Army Air Forces. No activity of the Office of The Surgeon General willbe duplicated, with the exception of those procedures necessary for theproper control of Medical Department personnel while under the jurisdictionof the Army Air Forces and of Medical Department activities under the jurisdictionof the Army Air Forces.

j. Basic reports required by The Surgeon General and estimatesfor all funds shall be submitted by station surgeons through corps areasurgeons with separate consolidation of estimates for Medical Departmentactivities of the Army Air Forces by the corps area surgeon to be forwardedto The Surgeon General.

k. The medical supply policy for the Army Air Forces shallbe as follows:

(1) The Surgeon General shall establish medical sectionsin Air Forces depots. They shall be stocked with initial and maintenancestocks for the supply of tactical medical units attached to the Air Forces.

(2) Supply for fixed medical installations of the AirForces, Zone of Interior, to continue under present War Department policy,or under changes as announced.

2. With reference to paragraph 1 b preceding, corps areacommanders were to procure and allocate funds for, and effect inspectionsand general supervision over, necessary sanitary procedures in all posts,camps, or stations in their respective corps areas.

3. With reference to paragraph 1d each corps area commanderwas to act as a direct representative of The Surgeon General, directingtechnical inspections necessary to determine the efficiency of operationof Medical Department activities. In addition to disposition of reportsas directed in paragraph 1 d, a copy of each report of deficiencies notedshould be forwarded to The Surgeon General, who will report to the CommandingGeneral, Services of Supply, those matters the correction of which arebeyond his control.

4. With reference to paragraphs 1 e, f, and g attentionis invited to letter (SPRTU 353 (5-20-42)) this headquarters, subject:"Unit Training of Field Medical Units by the Services of Supply,"which will govern the training of numbered station and general hospitals,and of such other field medical units as may be requested by the CommandingGenerals, Army Air Forces and Army Ground Forces.

5. [Reference to an attached table outlining the properchannels for routing of all station hospital reports.]

This document was not limited to defining the powers and functions ofthe Commanding General, Army Air Forces (and his surgeon) vis-a-vis thoseof The Surgeon General, as The Surgeon General had proposed. It attemptedto specify the powers and duties of the three new War Department commands-theArmy Ground Forces, the Army Air Forces, and the Army Service Forces-withrespect to provision of hospitalization, training of Medical Departmentunits, medical supply inspections, and submission of reports. With twoexceptions the policies defined were essentially those which had prevailedbefore the March reorganization. One exception lay in paragraph f above;it marked the beginning of the shift in responsibility for the organizationand training of Medical Department units (as well as those of the otherservices) intended for use in the communications zone of a theater of operationsfrom

the field armies to the Services of Supply. The other significant changewas embodied in paragraph i; it gave the Army Air Forces a claim to greaterautonomy in its handling of Medical Department matters. The Army Air Forceshad insisted upon excepting from the stipulation as to nonduplication ofthe Surgeon General`s Office`s activities not only activities as to MedicalDepartment personnel under control of the Army Air Forces but also anyMedical Department activities under control of the Army Air Forces. Asnoted above, Circular No. 59 had already given the Army Air Forces controlof its stations and bases (not assigned to defense commands or theatercommanders) and all personnel, units, and installations thereon, includingstation complement personnel and activities. The policies in the supplementarydocument specified for the Army Air Forces these broad powers with respectto the Medical Department in particular. The addition of the word "activities"provided an additional weapon to the already well-stocked arsenal of theAir Surgeon`s battle for autonomy, which paralleled the similar struggleof the Air Forces themselves.¹¹

Effect on Medical Department administration

The total effect of the War Department reorganization upon Medical Departmentadministration appeared only in the course of the war. Certain problemsarose from the fact that The Surgeon General, whose responsibility formedical policies and services was Army-wide, was put under a command which,in spite of its own responsibilities for furnishing supplies and servicesto the Army Ground Forces, Army Air Forces, and their subordinate elementson an Army-wide basis, was only coordinate in the command structure withthese other two major Army commands in the United States. These, equallywith the Services of Supply, were subordinate to the General Staff (chart5). The Surgeon General`s technical instructions on the prevention andtreatment of diseases and injuries, issued in the form of circular letters,went, of course, to all Army Commands. However, efforts of the SurgeonGeneral`s Office to have certain measures requiring a command decision(which the Office considered essential to good medical service) adoptedthroughout the Army were hindered at times by the necessity for obtainingthe concurrence of the staff elements of a number of commands. Under theprevious organization of the War Department the Surgeon General`s Officecould have issued, after obtaining concurrence from the appropriate divisionsof the War Department General Staff, command directives which went to allthe subordinate commands of the Army. An entire level of command was nowinserted between The Surgeon General and the General Staff, and in orderto bring about issuance of a directive by the Chief of Staff, the SurgeonGeneral`s Office had to obtain

¹¹Craven, Wesley F., and Cate, James L., editors:The Army Air Forces in World War II. Volume VI, Men and Planes. Chicago:University of Chicago Press, 1955, pp. 374ff.

the concurrence of the appropriate staff elements of the Services ofSupply as well as subsequent concurrence by elements of the General Staff.

During the ensuing months the allocation of major responsibilities andfunctions among the three major commands was established: Medical Departmentpersonnel, installations, and Medical Department tactical units were splitamong the Services of Supply, the Army Ground Forces, and the Army AirForces. Hence, although the Services of Supply was designed, under thetheory back of the reorganization, to furnish the other two commands, primarilymade up of tactical forces, with the necessary services, including medicalservice, in practice the assignment of the so-called "medical means"of the Army and certain medical functions to the two other commands ledto many breaches of this principle. Some questions of jurisdiction, particularlyas between the Services of Supply and the Army Air Forces, led to conflict.Many, on the other hand, were solved amicably, and rapid decisions attainedthrough extensive liaison and conferences among the staff surgeons concerned,frequently with representatives of the general staffs of these commandsin attendance.

In addition to its effect upon the administration of the Medical Departmentat home, the placement of the Surgeon General`s Office at the Servicesof Supply level also made communication with the surgeons of oversea theatersmore circuitous. Like the offices of the chiefs of other services, theSurgeon General`s Office often noted the difficulty of communication throughthe Chan-nels above it with the offices of surgeons at theater headquartersoverseas. Like the chiefs of some of the other services, The Surgeon General,and some of his staff as well, made use of personal correspondence, whichdid not have to go through channels, as a means of speeding communicationwith Medical Department officers overseas. By mid-1943, the Surgeon General`sOffice developed a system of periodic reports from the oversea theaters;these were the so-called ETMD`s (Essential Technical Medical Data) whichfor the first time gave the Office adequate information on the medicalsituation overseas.

The Surgeon General and his staff also ran into the reverse difficulty,that of getting their plans for oversea medical service-the use of newtypes of Medical Department units, for example-accepted and put into effectby oversea commanders. The dispatch of Medical Department officers of theSurgeon General`s Office on special missions often proved effective inthis respect. The chief consultants in medicine and surgery of the SurgeonGeneral`s Office visited the theater on inspection trips, and experts ontropical medicine investigated the problem of control of malaria in a numberof trouble spots. Medical supply missions went to the Pacific, European,and China-Burma-India theaters. These emissaries, like the personal correspondencebetween The Surgeon General and oversea surgeons, served to bridge thegreat distances and bring about an adjustment between the plans made bythe Surgeon General`s Office and the requirements drawn up by oversea staffmedical officers.

EFFECTS OF THE WAR DEPARTMENT REORGANIZATION UPON
THE INTERNAL STRUCTURE OF THE SURGEON GENERALS
OFFICE

The organizational pattern of the Surgeon General`s Office throughout1942 reflects the influence of the theories on sound organization and administrationwhich prevailed among administrators at Services of Supply headquarters.Certain of General Somervell`s ideas especially left their mark. A fewother changes stemmed from higher authority than the Services of Supply.

Internal Reorganization

One important tenet held by General Somervell was that the number ofindividuals or units reporting directly to a superior should be limitedto the number with which the latter could feasibly keep in close touch.¹²In the face of this doctrine the prevailing organization of the SurgeonGeneral`s Office (chart 4), whereby 15 chiefs of divisions reported toThe Surgeon General, was impracticable. Accordingly, shortly after theSurgeon General`s Office was placed under the new jurisdiction it was reorganizedin terms of the new principle (chart 6). Under the new organization, divisionswere logically grouped under nine "Services"-an arrangement thatcontinued throughout the war. Theoretically this change cut down the numberof officers reporting directly to General Magee to 10 (including the chiefof the Control Division, discussed below, which was placed at staff level).

Nevertheless, "mushrooming" received a fresh impetus underthe new organization, for most of the new "services" were expandeddivisions wherein many of those entities labeled subdivisions in the previousorganization were raised to the status of divisions. The new organizationhad more than 40 divisions in lieu of the 15 in existence the month before.Out of the previous subdivisions of the Preventive Medicine Division, nowa "service," were created six new divisions, and out of thosein the former Professional Service Division, now simply Professional Service,were created seven. Thus, in spite of the consolidation at the top, thereorganization laid the groundwork for further expansion. Insofar as organizationalunits, such as divisions and subdivisions, call for certain numbers ofmilitary personnel of specific rank and civilians of specific civil-servicegrade, the larger number of divisions warranted promotions and increasesin numbers of personnel. More colonels, for example, would be necessaryto head the greater number of divisions now in existence. However, a freezeplaced on the recruitment of civilian personnel throughout the War Departmentduring the summer of 1942 hampered the acquisition of additional civilianemployees about the time that the Surgeon General`s Office was becomingaware of its need for substantial numbers of civilians.

¹²(1) Services of Supply Organization Manual,10 Aug. 1942. (2) See footnote 4(4), p. 75.

Nor did the reorganization limit the men reporting directly to The SurgeonGeneral to those officers who held the positions of chiefs of services.Several of the chiefs of divisions who had had personal access to GeneralMagee and had addressed memoranda directly to him under the previous setupcontinued to do so, although after the March reorganization they shouldtheoretically have dealt with the chiefs of their respective services.This tendency to perpetuate the status quo was perhaps inevitable. Thetop personnel had been placed in their positions by the existing SurgeonGeneral and it was unlikely that long-established relationships would besuddenly changed by an organization chart.

Control Division.-Another idea of General Somervell`s which thereorganization fostered was the establishment of a Control Division inthe Surgeon General`s Office. This device had its origin in General Somervell`sadministrative experience with the Quartermaster Corps and with G-4 beforeand during the emergency period. General Somervell established a ControlDivision, headed by Col. (later Maj. Gen.) Clinton F. Robinson, MC, atServices of Supply headquarters to make surveys and studies of existingorganizational units and procedures, appraise their effectiveness, andrecommend ways of simplifying operations and increasing efficiency. Theplacing of the entire statistical service of the Services of Supply underthe Control Division in July reflected belief in the value of statisticsas a tool of manage-ment and the importance which General Somervell attachedto the principle of control; that is, to the accurate forecasting of productionand the measurement of production accomplished. The program of managementcontrol long existent in most large business enterprises gave the Servicesof Supply its cue. It recommended a counterpart of the Control Divisionin each of the supply services to perform similar functions for its parentorganization.

The Control Division of the Surgeon General`s Office was set up as astaff division in April but did not receive the necessary civilian personnelfor key positions until July. Acting under suggestions for studies thoughtadvisable by the Control Division, Services of Supply, or on its own initiative,the Control Division, Surgeon General`s Office, studied procedural practicesin the various office divisions in order to ascertain their efficiency.It inquired into the use of space assigned the division, the complexityand number of forms in use, the effectiveness of filing systems, the adequacyof training given employees, and so forth. In recommending changes, membersof the Control Division emphasized the necessity of cutting down the numberand length of forms, reducing the number of steps in processing forms,simplifying filing systems by the removal of inactive or relatively unusedfiles, and the training of employees to be alert to discover new meansof attaining efficiency. The Control Division attempted to make more efficientuse of facilities and civilian personnel in the face of growing shortages.

Statements in reports turned out by the Control Division, Surgeon General`sOffice, that a certain operation involved many unnecessary steps were,

86-87

Chart 6.-Organization of the Officeof The Surgeon General, 26 March 1942

of course, critical of past performance or of the ability of certainpeople in administrative positions. Many employees of long service wereunwilling to change established methods. The fact that higher elementsof the War Department, as well as most other Government agencies, werealso applying continued pressure to simplify work and increase efficiencyin this crucial period did not make the two Control Divisions any the morepopular. Personnel of various divisions of the Surgeon General`s Officecharged that constant demands by the Control Divisions for informationon present procedures and for suggestions for improvement hampered theirregular work. Changes in procedures usually created additional work inthe period during which they were being put into effect. Moreover, recommendationsmade in the many reports on surveys by the Control Division called forfurther reports. Consequently it appeared for a time that the control programwas actually leading to an increase in paperwork.

Thus the members of the Control Division, Surgeon General`s Office,like the members of the parent Control Division, Services of Supply, acquiredthe reputation of "snoopers" and were nicknamed "the commissars."At the same time the Control Division, Services of Supply, criticized itsoffspring for its slowness in grasping the concept of "control."In September 1942 members of the former division stated that effectivemeasures for "control" had developed too slowly during the first6 months of the life of the Control Division, Surgeon General`s Office.It is not clear whether the dissatisfaction within the Surgeon General`sOffice with the control program was the fault of the Control Division,Surgeon General`s Office, of the concept which lay back of it, or of theprejudice within the office against it. But General Somervell`s controlprogram did not meet with any warmer welcome in the Surgeon General`s Officethan his theory of limiting the number of personnel reporting directlyto a superior.¹³

Between March and the fall of 1942, a number of changes took place ininternal elements of the Surgeon General`s Office which were traceable,directly or indirectly, to the War Department reorganization of March.In its attempts to coordinate the work of the supply services General Somervell`snew organization naturally tried to establish uniformity in structure andnames of organizational units and in procedures. Uniformity was desirable,in some cases necessary, if the divisions of Services of Supply were todeal effectively with their counterparts in the services. The pressurefor uniformity was brought to bear most directly upon those fields of workwhich

¹³(1) Office Order No. 105, Office of The SurgeonGeneral, 20 Apr. 1942. (2) See footnote 4(4), p. 75. (3) Report on AdministrativeDevelopments in the Surgeon General`s Office, 1 Dec. 1942. [Official record.](4) Memorandum, Commanding General, Services of Supply, for The SurgeonGeneral, 9 Sept. 1942. (5) Gottschalk, O. A. : Report on the Control Divisionof the Surgeon General`s Office, 24 Sept. 1942. [Official record.] (6)Russell, John C. : Survey of Non-Technical Segments of the Surgeon General`sOffice, 24 Sept.-10 Oct. 1942. [Official record.] (7) Gendebien, Albert:Administrative Survey of Selected Portions of the Surgeon General`s Office,September 1942. [Official record.] (8) Interviews, Albert Gendebien, Juneand July 1947. (9) Committee to Study the Medical Department, 1942, Testimony,pp. 1625-1666.

the services had in common, where nevertheless a good deal of diversityhad developed-legal and fiscal work, for example. In order to coordinatethe steps in handling Army supply, it was necessary that the chiefs ofservice develop supply divisions of similar structure in their officesand employ uniform or similar reports and procedures. The training divisionsin the offices of the chiefs of service were also patterned after the TrainingDivision, Services of Supply. The Preventive Medicine Service, the ProfessionalService, and various other technical fields of work in the Surgeon General`sOffice were, on the other hand, little affected by the theories of GeneralSomervell`s administrators.

Legal Division.-The assignment of an officer to wartime legalwork dated from the fall of 1940. Early in 1942 the Office of the UnderSecretary of War undertook the creation of a legal entity in each serviceto handle legal matters peculiar to the service. When the Services of Supplyauthorized a legal officer for each service in March, Tracy S. Voorhees(fig. 23), a New York lawyer brought into the War Department by Under Secretaryof War Patterson, was chosen to head the legal work in the Surgeon General`sOffice. Mr. Voorhees, commissioned as a colonel and assigned to the JudgeAdvocate General`s Department in November 1942, had a prominent part in

molding the organization of the Surgeon General`s Office during thewar years and after the war became an Assistant Secretary of the Army.

His first task was a study, made about mid-1942, of the operations ofthe Procurement Office of the New York Medical Depot. The legal work ofthe Medical Department was then largely concerned with drawing up contractsfor medical supplies and equipment. Colonel Voorhees was impressed at theoutset by the "enormous business responsibility of purchasing allmedical supplies for the Army and for Lend-Lease," the large numberof contracts necessary, and the tremendous dollar volume involved. Thepreparation of standardized contracts in legally enforceable language,the checking of contracts drawn up by the procurement officers, the writingof procurement regulations, and the selection of legal personnel for theprocurement districts were to be the duties of the new legal group assignedto the Supply Service of the Surgeon General`s Office in the summer of1942. This group of civilian lawyers, drawn mainly from large city firmsand headed by Colonel Voorhees, remained under the Supply Service untilNovember. After that date they continued their work under a newly formedLegal Division.¹⁴

Fiscal Division.-The organization of the fiscal work of the SurgeonGeneral`s Office was also affected by the Services of Supply`s effortsto establish uniformity throughout the services. Since the fiscal workat the latter`s headquarters was handled by a single division, the fiscalfunctions of the Surgeon General`s Office were similarly concentrated asof the beginning of the fiscal year 1943-that is, on 1 July 1942. A studymade by the Fiscal Division, Services of Supply, of the handling of fundsin the War Department had indicated the need for a single fiscal divisionin each supply service, a standard accounting system which would reducethe number of authorities allocating funds, and a simplified system ofreporting allocations and expenditures. Concentration of all fiscal activitiesof the Surgeon General`s Office in one spot was brought about by transferringthe functions of the Fiscal and Claims Subdivisions of the old FinanceDivision, Finance and Supply Service, to the new Fiscal Division. Fiscalfunctions with respect to civilian personnel, which had been handled bythe Civilian Personnel Division of the Administrative Service, were alsoturned over to the new division. The Fiscal Division was made directlyresponsible to The Surgeon General, and its procedures were adjusted toconform with those of the Fiscal Division, Services of Supply. In linewith the principle of decentralization advocated by the Services of Supplythe new division established branch fiscal offices in the fall of 1942at distribution depots and at the New York and St. Louis Medical DepartmentProcurement Districts.

¹⁴(1) Administrative Memorandum No. 2, Servicesof Supply, 20 Mar. 1942. (2) Administrative Memorandum No. 11, Servicesof Supply, 11 May 1942. (3) Annual Report, Legal Division, Office of TheSurgeon General, 1943. (4) Memorandum, Director, Administrative Division,Services of Supply, for Chief of Staff Divisions, 15 May 1942, subject:Coordination of Legal Work Within the Offices of the Commanding General,the Staff Divisions, and the Supply Services. (5) Interview, Tracy S. Voorhees,22 Sept. 1950. (6) Office Order No. 496, Office of The Surgeon General,30 Nov. 1942.

The branch offices received allotments of funds from the Fiscal Divisionand made suballotments to several hundred Army stations, thus doing awaywith the necessity for direct allotment from Washington. Authorizationfor local purchases of medical supplies and the auditing of certain accounts,such as those for hospital laundry, were also decentralized to the branchoffices.¹⁵

Programs Established by Higher Authority

Contract renegotiation.-The establishment of certain programsin the Surgeon General`s Office was directed by higher authority than thatof the Services of Supply. The renegotiation of medical supply contractsin cases where costs or profits of contractors were excessive, for instance,grew out of the program for continuous readjustment of war contracts pursuantto shifts in costs to the contractor which was promulgated by an Executiveorder of the President. The War Department established a Price AdjustmentBoard in the spring of 1942, assigned it to the Services of Supply, andthen directed the latter to create in the supply services two types ofunits: price adjustment sections to renegotiate contracts with contractingcompanies, and cost analysis sections to obtain information upon whichrenegotiation could be based. Accordingly, a Cost Analysis Section wasset up in the Fiscal Division of the Surgeon General`s Office and a PriceAdjustment Section in the Supply Service. Colonel Voorhees and his DeputyDirector of the Legal Division selected legal personnel for the new priceadjustment work and made contacts with major medical supply houses in NewYork preliminary to renegotiation.

Military history.-The backing given by the President and theBureau of the Budget to the preparation of an official military historyof World War II brought the already established historical program of theSurgeon General`s Office within the orbit of the general program. A HistoricalSection of the Control Division, Services of Supply, coordinated the historicalwork of the various supply services, beginning about July.¹⁶

Public relations.-Higher authority in the War Department builtup a pyramidal organization to handle public relations, a field in whicha number of overlapping agencies at different levels had grown up. Themaintenance of good public relations was centered in the War DepartmentBureau of Public Relations. Various segments of the War Department providedtechnical information, and the Bureau of Public Relations cleared it forrelease. Accordingly an Office of Technical Information was set up in theServices of Supply. The Public Relations Division of the Surgeon General`sOffice, which by Au-

¹⁵(1) Executive Order No. 9127, 10 Apr. 1942.(2) Memorandum, Col. Paul I. Robinson, MC, for Col. Albert G. Love, MC,31 Oct. 1942, subject: Report on Administrative Developments in the FiscalDivision of the Surgeon General`s Office. (3) See footnote 14(3), p. 90.(4) Memorandum, Chief, Supply Service, for Mr. Guido Pantaleoni, Member,Price Adjustment Board, 25 Aug. 1942, subject : Report of Price AdjustmentDivision, Supply Service, Office of The Surgeon General.
¹⁶Memorandum, Executive Officer, Office of The Surgeon General,for chiefs of all services, 31 July 1942, subject: Outline of HistoricalWork of Services of Supply.

gust had developed as a staff division (out of the old IntelligenceDivision of the Administrative Service), was transformed into the Officeof Technical Information. Placed at staff level in the Surgeon General`sOffice, it provided medical data on the Army for release through higherchannels.¹⁷

Reorganization of the Surgeon General`s Office, August 1942

The process of reorganizing the Surgeon General`s Office, which beganwith the general reorganization of March 1942 and continued with certainpiecemeal changes in subsequent months, proceeded still further with ageneral reorganization in August. It resulted from a survey of the entireoffice in July by the Control Division of the Surgeon General`s Office,followed in August by a communication from Headquarters, Services of Supply,directing The Surgeon General to submit a plan for reorganization. Thisreorganization reduced the number of services from nine to five (chart7). Divisions were reduced from 41 to 23, largely by the reduction of manyto branch status.

The reorganization also established a more systematic nomenclature forunits of the office. These were termed in descending order: service, division,branch, and section; in practice the branch became the lowest recognizedlevel. Services were headed by "chiefs," divisions by "directors,"and branches by "chiefs."¹⁸

Four divisions remained outside the five services. Two of these, thePublic Relations Division (later called the Office of Technical Information)and the Control Division, were termed staff divisions. The other two wereoperating divisions. One of these was the Fiscal Division, separated inJuly from the Finance and Supply Service. The other was the Training Division,now removed from the Operations Service and reorganized into branches atthe request of the Director of Training, Services of Supply.¹⁹Since these divisions reported directly to The Surgeon General, the reductionin number of services did not produce a corresponding reduction in thenumber of officers reporting directly to him.

The Supply Service remained largely as it had developed since earlyJuly. A major change in the Administrative Service at this date was theremoval of the Civilian Personnel Division to the Personnel Service. Thelatter, formed in March, had heretofore been exclusively concerned withmilitary personnel. This move constituted recognition that the handlingof problems relating to civilian employees was a function of growing importance.A Civilian Person-

¹⁷(1) Services of Supply Circular No. 54, 29Aug. 1942. (2) Office Order No. 396, Office of The Surgeon General, 13Oct. 1942.
¹⁸(1) Morgan, Edward J., and Wagner, Donald O.: Organizationof the Medical Department in the Zone of Interior (1946) pp. 15-20. [Officialrecord.] (2) Office Order No. 340, Office of The Surgeon General, 1 Sept.1942. (3) Annual Report, Control Division, Office of The Surgeon General,1943. (4) See footnote 13 (3), p. 88.
¹⁹(1) Memorandum, Director of Training, Services of Supply,for The Surgeon General, 13 Aug. 1942, subject: Organization of a TrainingDivision, with 1st indorsement, Executive Officer, Office of The SurgeonGeneral, to Chief, Control Division, Services of Supply (through Directorof Training, Services of Supply), 21 Aug. 1942. (2) See footnote 13(3),p. 88.

nel Policy Committee of the Services of Supply, which had a MedicalDepartment representative, had been engaged for some time in planning theorganization of civilian personnel divisions for the various supply services.The need for large numbers of civilians to fill jobs in the Supply Service,the Administrative Service, and other elements of the Surgeon General`sOffice, increased the work in the procurement, classification, placement,and training of civilian employees.²⁰ However, the CivilianPersonnel Division did not become an integral part of the Personnel Serviceat this date because of the emphasis on recruitment of military personnel.The reduction in number of services was achieved by making divisions outof five former services concerned with professional work and placing themunder a newly constituted Professional Service. These were the old ProfessionalService, renamed the Medical Practice Division; the Preventive MedicineDivision; the Dental Division; the Nursing Division; and the VeterinaryDivision. This rearrangement, which interposed the Chief of ProfessionalService between the Director of the Dental Division and The Surgeon General,was frequently criticized by dental officers. Many had long been wont toresent the subjection of dental service to medical service, and this moveseemed to them a further reduction in status.²¹

OTHER CHANGES IN THE SURGEON GENERAL`S OFFICE

During the process of War Department reorganization from March 1942to August of that year, some significant developments took place in theorganization of the Surgeon General`s Office which resulted from the rapidlyexpanding functions of the office and were not closely related to the changesoccurring in the higher ranges of the War Department. They occurred atintervals between the general reorganizations of the Surgeon General`sOffice in March and August 1942.

The Administrative Service

Research and Development Division.-The major development of thisperiod in the Administrative Service was the addition of a Research andDevelopment Division. As previously pointed out, the Surgeon General`sOffice had customarily relied upon certain Army installations, as wellas certain civilian facilities, for the actual performance of medical research.Hence the, research function assigned to the Surgeon General`s Office waschiefly that of supervising and coordinating the research projects farmedout to a number of facilities. A Research and Development Section had beenestablished in the Finance and Supply Division in late 1940, but its dutieshad been essen-

²⁰(1) Memorandum, H. M. Watts, Medical DepartmentRepresentative, Civilian Personnel Policy Committee, for Director of Personnel,Services of Supply, 24 July 1942. (2) Office Order No. 288, Office of TheSurgeon General, 4 Aug. 1942.
²¹Medical Department, United States Army. Dental Service inWorld War II. Washington: U.S. Government Printing Office, 1955, p. 7ff.

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Chart 7.- Organization of the Officeof the Surgeon General and medical installations under command control,24 August 1942

tially restricted to the maintenance of records on expenditure of funds.A Medical Research Coordinating Board, functioning under the ProfessionalService Division, had had the task of coordinating research activitiessupported by Medical Department funds. In the spring of 1942, the SurgeonGeneral`s Office undertook for the first time thoroughgoing coordinationof all research activities, both projects assigned to War Department facilitiesand those entrusted to outside agencies by establishing a Research andDevelopment Division in the Administrative Service. The Chief of the newdivision worked closely with the Division of Medical Sciences of the NationalResearch Council, with the, Health and Medical Committee of the Officeof Defense Health and Welfare Services, and with the National Inventors`Council. A proposal for a certain research project might come to the Researchand Development Division from one of various sources in the Surgeon Gen-eral`sOffice or the War Department, or from another Government agency. The divisionreferred the project to whatever segment of the Surgeon Gen-eral`s Officehad the strongest interest in it. If the appropriate unit considered itworthwhile, the Research and Development Division obtained the approvalof the Development Branch, Headquarters, Services of Supply, and notifiedthe laboratory best equipped to do the research, outlining its purpose,the funds to be spent, and so forth. The interested division of the SurgeonGeneral`s Office supervised the progress of the research, while the Researchand Development Division coordinated the work with that of other researchprojects.²²

Library and Museum.-The Army Medical Library and the Army MedicalMuseum were placed on field status at this date; hence divisions to conducttheir administration were no longer included in the Surgeon General`s Office.However, these two installations remained under the direct control of TheSurgeon General, and their relations with the Office remained largely asbefore.²³

The Preventive Medicine Service

With the accelerated shift of troops overseas during 1942, the sphereof activities of the Preventive Medicine Service continued to widen. TheSani-tation Division`s work, except for the areas assigned to the LaboratoriesDivision and to the Venereal Disease Control Division, included most ofthe preventive medicine activities of the Army in the years of peace; theactivities of the Medical Intelligence, Occupational Hygiene, and EpidemiologyDivisions, on the other hand, were largely the result of added wartimeresponsibilities. The Sanitation Division supervised the Medical Department`scon-

²²(1) Research and Development Program, FiscalYear 1942, 20 Aug. 1941; and Medical Department Project Program, FiscalYear 1941. [Official record.] (2) Memorandum, Lt. Col. J. F. Lieberman,MC, Executive Officer, Professional Service, for Lt. Col. Francis C. Tyng,MC, 1 May 1942, subject: Professional Service Activities. (3) Office OrderNo. 123, Office of the Surgeon General, 1 May 1942. (4) Committee to Studythe Medical Department, 1942, Testimony, p. 655ff.
²³(1) Office Order No. 237, Office of The Surgeon General, 1July 1942. (2) See footnotes 13(3), p. 88, and 18(3), p. 92.

tinuous work in preserving sanitary conditions in and around Army installations,especially in the preparation of food, and in maintaining systems of garbageand sewage disposal, as well as pure water supply systems, for troops.

Sanitation Division.-In a period of rapid expansion the division`stask of maintaining desirable standards was greatly increased. Some outbreaksof food poisoning occurred in 1942, and sanitary reports showed that commandingofficers of some posts and camps were not satisfactorily meeting theirresponsibilities for maintaining sanitary conditions. The struggle of theSurgeon General`s Office with higher War Department authority over standardsfor kitchen and mess sanitation and the maintenance of sufficient airspacein barracks and hospitals, begun in the pre-Services of Supply period,continued. The Services of Supply, rather than the General Staff, now appliedthe immediate pressure upon the Medical Department to lower standards inorder to take into account shortages of materials, labor, or facilitiesand to cope at the same time with the pressing demands of the expandingArmy.²⁴

The Sanitation Division and especially its Sanitary Engineering Branch,through liaison with the Quartermaster Corps and the Corps of Engineers,shared in some of the responsibilities for making repairs, maintainingutilities, and furnishing certain supplies at Army posts and camps. Theprocurement and distribution of insect repellants and insecticides wasa case in point, being variously assigned at different periods. In June1943 an amusing experience was recorded by a captain of the Medical Corpsat Robins Field, Ga., who had been unable to get a supply of carbon disulfidefor ant control. His medical supply officer had stated that he was unableto issue it, and the local quartermaster had informed him that he couldissue the item only if the ants to be exterminated were inside a building.If they were outside, the responsibility was that of the Engineers. Incommenting on his frustration, the captain noted the disinterest of meanderingants in adhering to established Army channels.

Sanitary engineering was assigned in early 1942 to a subdivision ofthat name within the Sanitation Division as one phase of the general workin sanitation. Engineering problems connected with purifying water andtreating sewage and those connected with the operation of swimming poolsand the control of insect and rodent carriers of disease were handled inthat period, along with the general functions discussed above, by the SanitationDivision, and after August by the Sanitary Engineering Branch, made coordinatewith the Sanitation Branch (chart 7). In efforts to control malaria, SanitaryCorps officers attempted to recommend nonmalarious sites for constructingnew Army installations.

²⁴(1) Committee to Study the Medical Department,1942, exhibits 19, 41, and 45. (2) Memorandum, Lt. Col. Charles L. Kirkpatrick,MC, Acting Executive Officer, Office of The Surgeon General, for CommandingGeneral, Services of Supply, 8 July 1942, subject: Sanitation. (3) Copyof 1st wrapper indorsement (no letter file reference), Capt. Frank C. Owens,Medical Inspector, Station Hospital, Robins Field, Ga., to Medical SupplyOfficer, Station Hospital, Robins Field, 12 June 1943.

Some major projects by the Sanitation Division in 1942 were surveysof water and sewage installations, especially of installations in hotelstaken over by the Army Air Forces to house personnel, and preparation ofa directive for protection of Army water supplies. In collaboration withthe U.S. Fish and Wildlife Service, the U.S. Public Health Service, departmentsof public health of the various States, and universities, the SanitationDivision undertook a program of rodent control in order to reduce or eliminateendemic typhus fever, and possibly plague in some areas. Specialists inrodent control, commissioned in the Sanitary Corps, were assigned to theFourth, Eighth, and Ninth Service Commands.

Medical Intelligence Division.-The medical surveys of foreignareas by the Medical Intelligence Division became, with American entryinto war, a part of formal War Department planning. The division preparedthem for foreign areas upon request by the General Staff, as medical sectionsof the War Department Strategic Surveys. They contained information onhealth conditions and the medical resources of specified areas. In thiswork the officers of the Medical Intelligence Division maintained liaisonwith Military Intelligence Service, G-2, which prepared other sectionsof the Strategic Surveys. The medical surveys were also used as the subjectmatter of lectures given to officers being trained at the School of MilitaryGovernment at Charlottesville, Va. In addition to the lengthier summaries,the division prepared brief resumes of medical data for surgeons of taskforces going overseas.²⁵

Laboratories Division.-By the end of 1941, the Laboratories Divisionof the Preventive Medicine Service had completed the establishment of thesystem of corps area laboratories. Each corps area had acquired a laboratory,with the exception of the Third which was served by the laboratories ofthe Army Medical Center in Washington, and the Ninth Corps Area which hadtwo laboratories. Each laboratory had a veterinary component, consistingof one or more Veterinary Corps officers and enlisted and civilian technicianswho performed tests or conducted special investigations in connection withanimal disease and foods of animal origin. The Laboratories Division nowhad the task of planning a system of laboratories for use overseas. Itoutlined the functions of the diagnostic laboratories of several typesof hospitals-surgical, evacuation, station, general, and convalescent-andspecified the types and number of personnel needed in each. As an overseacounterpart of the corps area laboratory, it planned the Medical Laboratory,Army or Communications Zone, to serve the field army or the communicationszone in an oversea theater. Another type, the Medical Laboratory, General,was designed as a central labo-ratory to serve an entire theater of operations.In addition to its routine functions as an epidemiological and generallaboratory for a large area, it was to train any additional laboratorypersonnel who might be needed within the theater, furnish standardizedlaboratory techniques and supplies for the theater,

²⁵(1) Committee to Study the Medical Department,1942, exhibits 30-35. (2) Interview, Col. Tom Whayne, MC, 29 Sept. 1949.

and produce diagnostic sera, standard chemical solutions, and so forth,if necessary. The scope of laboratory work of this theater unit was tobe comparable to that of the Army Medical Center in Washington.²⁶

A major problem of the Laboratories Division of the Preventive MedicineService was the procurement of enough medical officers to man the MedicalDepartment`s network of laboratories in the United States and overseas.The division aided the Personnel Service in procuring pathologists andother specialists and arranged for special training of additional officersat a few universities. Other responsibilities included the devising oflaboratory procedures for such programs of Army-wide scope as the determinationof the blood group of all Army personnel, continual review of the supplyitems for laboratories listed in the Army Medical Supply Catalog, and thereview and revision of Army regulations pertaining to medical laboratories.

Occupational Hygiene Division.-Until late in 1941 the MedicalDepartment`s concern with problems of industrial hygiene in industrialplants operated by the Army had undergone a gradual evolution, and TheSurgeon General had obtained authorization for bit-by-bit expansion ofthe program. Civilian doctors under contract, or medical officers, andnurses were then unevenly assigned to Ordnance arsenals, Quartermasterdepots, and Air Corps depots, the Ordnance plants being favored. Surveysof Army plants by the U.S. Public Health Service had revealed occupationalhazards, such as lead poisoning, existing in specific plants, the likelihoodof new ones with the growth of the Army`s industrial work, and the inadequacyof medical service in the plants. The Surgeon General believed that theMedical Department should assume full responsibility for emergency medicaltreatment and supervision of industrial hygiene among civilian employeesin the plants. In September 1941, he had requested a statement of policyon this matter. Although the Medical Department had assumed some responsibilityduring the emergency period, the program had lagged, for the War Departmenthad not given The Surgeon General authorization for a general program andhence had not recognized the large personnel needs involved.²⁷

²⁶(1) Committee to Study the Medical Department,1942, exhibits 42 and 44. (2) Memorandum, Col. James S. Simmons, MC, forOperations Service, 23 Mar. 1944, subject: Medical General Laboratories.(3) Medical Department, United States Army. Veterinary Service in WorldWar II. Washington: U.S. Government Printing Office, 1962, pp. 429-431.(4) Interview, Maj. Everett B. Miller, VC, 7 Oct. 1949.
²⁷(1) Memorandum, Executive Officer, Office of The Surgeon General,for Secretary of the General Staff, 17 Sept. 1941, subject: Policy on MedicalService to Civilian Employees in Army-Operated Industrial Plants and Depots.(2) Memorandum, Assistant Chief of Staff, for The Adjutant General, 1 Jan.1942, subject: Policy. (3) Committee to Study the Medical Department, 1942,exhibit 53. (4) Memorandum, Executive Officer, Office of The Surgeon General,for Commanding General, Services of Supply, 4 Apr. 1942, subject : Statusof Contract-Operated Industrial Plants. (5) Annual Report of The SurgeonGeneral, U.S. Army, 1942. [Official record.] (6) See footnote 18(3), p.92. (7) Memorandum, Executive Officer, Civilian Personnel Division, Servicesof Supply, for Corps Area Surgeons, 18 June 1942, subject : Responsibilityfor Industrial Hygiene and Environmental Sanitation in Government-Owned,Privately Operated Munitions Plants, (8) Memorandum, Executive Officer,Office of The Surgeon General, for Chief of Ordnance, 30 June 1942, subject:Industrial Hygiene Survey for Government-Owned, Contractor-Operated MunitionsPlants. (9) War Department Circular No. 59. 24 Feb. 1943.

100

Early in January 1942, The Surgeon General received full responsibilityfor industrial hygiene in plants operated by the Army and the authorityto establish dispensaries in them. By April the Occupational Hygiene Divisionwas tackling the total program in conjunction with corps area surgeonsand was making plans for an industrial hygiene laboratory at the Army MedicalCenter. Since it was difficult to find sufficient personnel in Washington,the laboratory was established at the School of Hygiene and Public Healthat The Johns Hopkins University in Baltimore, Md. It remained there forthe duration of the war. Personnel of the Army Industrial Hygiene Laboratorymade surveys of industrial health hazards, studying such factors as thepresence of dust and gases and conditions of ventilation and lighting,and analyzed samples and specimens sent in from the plants.

About this time the question came up as to the Army`s responsibilityfor maintaining an industrial hygiene program in plants-chiefly for ordnanceproduction-which it owned but which were operated by private contractors.Under the contracts the provisions of the Workmen`s Compensation Act asto the safety of employees applied, the contractor being responsible forindustrial safety and hygiene. Since the grounds on which these plantswere located were considered Federal reservations, State and local publichealth authorities had no jurisdiction and lacked authority to inquireinto conditions at the plants. Surveys by the Public Health Service hadrevealed unsatisfactory supervision of health and safety programs in someof them.

Accordingly, The Surgeon General asked for an additional statement ofpolicy as to this group of plants. In June 1942, the Judge Advocate Generaldeclared that contractor-operated ordnance plants, as well as Governmentoperated ones, were military reservations, subject to the authority ofthe corps area commander, and The Surgeon General became responsible formaintaining satisfactory sanitary conditions at the plants operated bycontractors. At his request the Division of Industrial Hygiene of the NationalInstitutes of Health of the U.S. Public Health Service sent out men toinspect conditions at each contractor-operated plant.

In August, the Services of Supply charged the Provost Marshal Generalwith responsibility for preparing policies and instructions on methodsof preventing accidents at plants and facilities. Because of the closerelationship of problems of accident prevention with those of industrialmedicine, the Occupational Hygiene Division of the Surgeon General`s Office-redesignateda branch in the general downgrading of units under the August reorganizationbecame a part of the War Department machinery for accident control. Thechief of the branch served on the War Department Safety Council, whichmet from December 1942 to the end of the war, along with representativesof the office of the Provost Marshal General, of the other technical services,and of other offices of the War Department, Army Air Forces, and Navy.

During the year the Army`s industrial hygiene program grew quite largein certain highly industrialized areas. In the Second Corps Area, for

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example, a medical officer specializing in industrial medicine was assignedto the corps area surgeon`s office, and 40 medical officers and civiliandoctors were assigned to 28 plants in that area. Eventually the surgeon`soffice of every corps area except the First had an officer assigned toindustrial hygiene.

By September 1942, the Occupational Hygiene Branch was supervising emergencymedical service for more than half a million employees of more than 150Army-operated plants of the Ordnance Department, Chemical Warfare Service,Quartermaster Corps, Signal Corps, and Army Air Forces, as well as supervisingthe contractors` programs in about 250 contractor-operated plants. It hadaided in organizing the Armored Force Medical Research Laboratory establishedat Fort Knox, Ky., in the fall of 1942 and was assisting the latter`s effortsto determine the hazards of mechanized warfare, including experiments withtanks. It had assigned an industrial hygiene officer to the Surgeon, AirService Command, and it maintained liaison with the research laboratoriesof the Air Forces at Wright Field and Randolph Field engaged in work onaviation hazards. The program had become a large field enterprise withcontinually increasing civilian coverage.

Epidemiology Division.-With the reorganization of the SurgeonGeneral`s Office in March 1942, the Epidemiology Division had the foursubdivisions shown on chart 6 (p. 86). The Subdivision of EpidemiologicalInvestigation administered the Army Epidemiological Board (formally termedBoard for Investigation and Control of Influenza and Other Epidemic Diseasesin the Army) as a civilian adjunct to the Epidemiology Division. The TropicalDisease Control Subdivision was established in May, when Dr. (later Col.)Paul F. Russell (fig. 24), a specialist in malariology with the RockefellerFoundation, was brought into the office.

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Courses in tropical medicine had been inaugurated at the Army MedicalCenter late in 1941. The following February, the Commission on TropicalDiseases of the Army Epidemiological Board had been organized with Dr.Wilbur A. Sawyer, Director of the International Health Division, RockefellerFoundation, as Director. The Chief of the Preventive Medicine Division,Col. James S. Simmons, MC, had noted in April 1942 that from the beginningof the emergency, The Surgeon General had been concerned with the factthat few doctors newly entering the Army had received adequate trainingin tropical medicine. He pointed out that the Army had neither the facilitiesnor the time "to remedy so great an educational deficiency" andurged civilian medical schools to offer short intensive courses in tropicalmedicine.²⁸ In August 1942, the Tennessee Valley Authority agreedto give intensive courses in fieldwork in malariology at Wilson Dam, Ala.

By the date of Colonel Russell`s appointment, the low malaria ratesamong troops in the United States were still further declining, as a resultof the joint antimalaria efforts of the Army and the U.S. Public HealthService, termed by Colonel Simmons "the most gigantic mosquito-controlcampaign carried out in the history of the world." The admission ratefor troops in the United States dropped in the course of the war from 1.8per 1,000 in 1941 to 0.13 for the first half of 1945. But rates among troopsin some areas outside continental United States, Panama and Puerto Rico,for example, were rising. High rates in combat areas would seriously interferewith military operations. Accordingly, The Surgeon General sent ColonelRussell and a member of the Tropical Medicine Commission of the Army EpidemiologicalBoard to the Caribbean Defense Command in the fall of 1942. They were todetermine whether the spraying of insecticides to destroy anopheline mosquitoesin civilian areas adjacent to Army installations, then more commonly practicedby the British in the Near and Middle East than by the U.S. Army, wouldbe effective in the Caribbean Defense Command. By that date high malariarates had occurred among troops on the islands of the South Pacific Areaand in New Guinea.

The Infectious Disease Control Subdivision made epidemiological investigations,analyzed data on epidemics, and initiated measures to control various infectiousdiseases. It pointed out, for example, the danger of conducting large-scaletroop maneuvers in San Joaquin Valley, Calif., because of the occurrenceof coccidioidomycosis, or "valley fever." The Immunization Subdivisioninvestigated various problems connected with immunizing troops and theuse of prophylactic biologicals. It maintained close liaison with the SupplyService, which bought biologicals, and with the Subcommittee oil TropicalDisease of the National Research Council, which advised the Medical Departmenton the desirability of using specific vaccines. An important step taken

²⁸Simmons, J. S.: The Army`s New Frontiersin Tropical Medicine. Ann. Int. Med. 17: 979-988, December 1942.

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by the Immunization Subdivision in 1942 was the institution of a systemof authenticated immunization registers, acceptable to foreign governments,for American military personnel on oversea missions. Previously the personnelof American missions had been denied entry into certain foreign areas,or detained, because they lacked proof of having been immunized againstcertain diseases or because foreign governments were unwilling to acceptthe available proof. Through the U.S. State Department, agreements werereached with a number of the governments of African and Asiatic areas andof British-controlled islands of the Pacific as to the type of documentationwhich each government would accept as proof that U.S. military personnelhad been immunized against specific diseases.

Other than malaria, the most serious problem to plague the EpidemiologyDivision during the months between March and August 1942 was the wide-spreadoccurrence of jaundice among American soldiers throughout the world. Theyellow fever vaccine then being supplied the Army by the InternationalHealth Division of the Rockefeller Foundation was shortly suspected asthe cause. The Surgeon General ordered the abandonment of this vaccineand the adoption of vaccine supplied by the U.S. Public Health Service.An investigation in the ensuing months traced the disease to specific lotsof faulty vaccine.²⁹

Venereal Disease Control Division.-In 1942, the Venereal DiseaseControl Division was engaged in the study of prophylactic agents and variousmethods of venereal disease control, the preparation of forms for reports,the analysis of statistical data on venereal disease, and the handlingof syphilis registers maintained for individual cases of syphilis amongArmy personnel. It aided the Personnel Service in obtaining men qualifiedin venereal disease control and in giving them supplementary training.It prepared material designed to school the individual soldier in avoidingvenereal disease infection. (At this date the development of specific methodsof treatment for the venereal diseases was a responsibility of the MedicineDivision of the Professional Service.)

During the year the division continued its extensive liaison with theU.S. Public Health Service, Navy, American Social Hygiene Association,and other

²⁹(1) Long, Arthur P.: Preventive Medicine,The Epidemiology Division (1946). [Official record.] (2) Committee to Studythe Medical Department, 1942, exhibit 47. (3) Memorandum, Lt. Col. S. Bayne-Jones,MC, for Chief, Preventive Medicine Division, 29 Mar. 1942, subject: Reportof Subdivision on Epidemiology for 1 Jan.-29 Mar. 1942. (4) Simmons, J.S.: Progress in the Army`s Fight Against Malaria. J.A.M.A. 120: 30-34,5 Sept. 1942. (5) See footnote 28, p. 102. (6) Memorandum, The SurgeonGeneral, for the Secretary of War, 3 June 1942, subject: Outbreak of Jaundicein the Army. (7) Circular Letter No. 95, Surgeon General`s Office, 31 Aug.1942, subject: Outbreak of Jaundice in the Army.

For discussion of cases of jaundice associated with yellowfever vaccine, see Medical Department, United States Army. Preventive Medicinein World War II. Volume III. Personal Health Measures and Immunization.Washington: U.S. Government Printing Office, 1955, pp. 307-313; and VolumeV. Communicable Diseases Transmitted Through Contact or by Unknown Means.Washington: U.S. Government Printing Office, 1960, pp. 419-431.

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agencies, through a new medium, the Inter-Departmental Committee onVenereal Disease. After the rift caused by the book "Plain Words AboutVenereal Disease" (by Drs. Parran and Vonderlehr) between the SurgeonGeneral`s Office and the U.S. Public Health Service, the Federal SecurityAdministrator had undertaken the task of reconciliation. Pursuant to PresidentRoosevelt`s request for an investigation, Mr. McNutt had stated his confidencein the Army`s awareness of the seriousness of the problem and had conferredwith the Secretaries of War and Navy. As in other cases of conflict betweenGovernment agencies, the attack on Pearl Harbor had probably aided in theclosing of this internal breach in Government relations. Mr. McNutt suggestedan interdepartmental committee of six, to be composed of two representativesfrom the Army, Navy, and U.S. Public Health Service. Later representationincluded the American Social Hygiene Association and the Federal Bureauof Investigation; the latter would be concerned in case of invocation ofthe May Act which made prostitution a Federal offense in an area in whichit was invoked. The Chief of the Venereal Disease Control Division of theSurgeon General`s Office acted as one of the Army representatives. In 1942the Inter-Departmental Committee was largely concerned with problems ofcontrol in the United States and the Caribbean Defense Command. It observedclosely the operation of the May Act in the two areas in which it was invoked-atCamp Forrest, Tenn., in May and at Fort Bragg, N.C., in July. Both thecommittee and the Venereal Disease Control Division were aided by utterancesof highly placed leaders of the military effort. In March, the Secretaryof War sent a letter to all State Governors warning them of the menaceof prostitution and venereal disease. In May, President Roosevelt sentthe Federal Security Administrator a letter commending the work of theInter-Departmental Committee, which Mr. McNutt forwarded to more than 8,000executives of plants engaged in war production. The low rates of venerealdisease in- cidence among soldiers stationed in the United States duringWorld War II compared with the rates of World War I testify to the effectivenessof admin- istrative measures adopted to control the venereal diseases,as well as to the advances in treatment achieved since the First WorldWar.³⁰

The Professional Service

Addition of civilian specialists.-The Professional Service, whichhad remained relatively unchanged during the emergency period as comparedwith the rapid growth of the Preventive Medicine Service, now entered uponits period of intensive expansion. Less than a month after the United Statesentered the war, General Magee took steps to obtain for the ProfessionalService some of the outstanding civilian specialists in major fields ofmedicine.

³⁰(1) See footnote 27(5), p. 99. (2) Sternberg,T. H., and Howard, Ernest B. : History of Venereal Disease Control andTreatment in the Zone of Interior (1946). [Official record.]

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This group of men were known as consultants.³¹ Under thattitle, specialists in the three major fields of internal medicine, surgery,and neuropsychiatry were assigned to the Surgeon General`s Office. Theirchief functions were the establishment of Army-wide policies on diagnosisand treatment of injuries and diseases in their special fields, and theappraisal of the qualifications and performance of fellow specialists,particularly in the hospitals. In retrospect the latter function, the "constantassessment and reassessment" of the assignment of key professionalindividuals, stood out as a major contribution in the opinion of the ChiefSurgical Consultant in the Surgeon General`s Office.32

Early in 1942, General Magee appointed Dr. Hugh J. Morgan (fig. 25),then Professor of Medicine at Vanderbilt University School of Medicine,as Chief Consultant in Medicine and Dr. Fred W. Rankin (fig. 26), ClinicalProfessor of Surgery at the University of Louisville, as Chief Consultantin Surgery. These two fields, which had been lumped together in one Subdivisionof Professional Service during the emergency period, were now to be handledby separate subdivisions; with the March reorganization, they became fulldivisions. The Neuropsychiatry Subdivision, which also became a divisionin March, was headed as of August by Col. Roy D. Halloran, MC (fig. 27),formerly superintendent of the Metropolitan State Hospital at Waltham,Mass., and Professor of Clinical Psychiatry at Tufts College Medical Schoolin Boston. Drs. Morgan and Rankin were later given the rank of brigadiergeneral, and headed their respective programs to the end of the war.

These three fields-internal medicine, surgery, and neuropsychiatry eachheaded by a chief consultant charged with the coordination of matters pertainingto his special field throughout the Army, were the fields recognized in1942 by the Surgeon General`s Office as of primary importance. A numberof subspecialties were later recognized with similar appointments, andstaffs of the three mentioned above increased gradually.

From the inception of their offices, the consultants assisted The SurgeonGeneral in the preparation of written instructions as to methods of treatment

³¹This discussion is concerned only with thenetwork of commissioned consultants brought into the Surgeon General`sOffice and later introduced into the corps areas and oversea theaters forpurposes here described. Many other specialists, frequently remaining incivilian status and used mostly in an advisory capacity, were referredto as "consultants" during World War II. Specialists in tropicalmedicine assigned to the Army Medical Center in 1941 to inaugurate coursesin tropical medicine were known as "consultants," while membersof the Army Epidemiology Board were termed "consultants to the Secretaryof War."
³²(1) Rankin, Fred W.: Mission Accomplished: The Task Ahead.Ann. Surg. 130: 289-309, September 1949. (2) Medical Department, UnitedStates Army. Internal Medicine in World War II. Volume I. Activities ofMedical Consultants. Washington: U.S. Government Printing Office, 1961,pp. 1-141. (3) Memorandum, The Surgeon General, for Commanding General,Services of Supply, 28 May 1942, subject: Coordination of Medical Servicein Corps Area Installations. (4) Memorandum, The Surgeon General, for CommandingGeneral, Services of Supply, 23 June 1942, subject: Coordination and Supervisionof Medical Service in Station Hospitals. (5) Beck, Claude S.: SurgicalHistory, Fifth Service Command. [Official record.] (6) Office Order No.337, Office of The Surgeon General, 31 Aug. 1942. (7) Annual Report, EighthService Command Medical Branch, 1942. (8) Annual Report of the SurgeonGeneral, U.S. Army, 1943. [Official record.] (9) Medical Department, UnitedStates Army. Neuropsychiatry in World War II. Volume II. Oversea Theaters,ch. V. [In preparation.]

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for Army-wide use, supplementing and to some extent superseding thetech-nical role of advisory committees of the National Research Council.As more and more civilian doctors entered the Army, with great diversityof training and experience, and as troops were sent in increasing numbersto oversea regions with various patterns of endemic disease, the ProfessionalService needed a staff of specialists directly assigned to the task. Thenew group of specialists from civilian life was to further the use of advancedmethods of diagnosis and treatment by continued scrutiny of techniquesin current use and by suggestions for new methods or modifications of oldones. Among the advantages of having an advisory group on technical mattersintegrated into the Surgeon General`s Office and commissioned in the Armywas the fact that specialists within the Office would become better acquaintedwith the conditions imposed by military organization and tactical situationsin oversea areas than could specialists outside the Army. Moreover, asofficers, they could be held responsible for their decisions.

Extension of the consultant system to corps areas.-Brig. Gen.Charles C. Hillman, Chief of the Professional Service, and his chief consultantsagreed that this system should be decentralized by placing a consultantin each of the major specialties, internal medicine, surgery, and neuropsychiatry,in the office

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of each corps area surgeon to supervise methods of treatment in theirspecial fields employed in hospitals throughout the corps areas. Consultantsin the Surgeon General`s Office could supervise in the general hospitals,then under direct control of The Surgeon General, but specialists werealso needed to observe and assess performance in the station hospitals.The latter, controlled by various jurisdictions, including the Army AirForces, were rapidly increasing in number, and were acquiring more andmore specialists from civilian practice with varied training and experience.A consultant assigned to the corps area surgeon could, by frequent visitsto the station hospitals, supervise techni-cal practices in his specialtythroughout the corps area. The assignment of consultants to corps areaswould provide specialists where they were needed, and at the same timewould conserve scarce medical personnel.

The War Department authorized the appointment of consultants to thecorps areas in July. By fall a number had been assigned to four corps areaswhere troops, and hence station hospitals, were heavily. concentrated:the Fourth, Seventh, Eighth, and Ninth. They acted as consultants to hospitalstaffs; evaluated new therapeutic techniques, drugs, and other therapeuticagents; coordinated professional practices among the various hospital staffs;and evaluated the professional qualifications of medical personnel. Installationswhich they served included, in addition to the hospitals for Army and Air

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Forces troops, induction stations, internment camps, and Army-operatedindustrial facilities. Consultants in the three major specialties werelater appointed to the remaining corps areas, to the medical staffs offield armies both in the United States and overseas, and at various levelsof command in the oversea theaters of operations.

The Surgeon General`s Office came in for some criticism, beginning asearly as 1942, because of internal disagreements among its specialists.The always touchy question of venereal disease, for example, was one onwhich experts sharply disagreed. In November 1942, the sole responsibilityfor issuing in-structions on methods of treatment, as well as for policieson control and prevention, was established in the Venereal Disease ControlBranch of the Preventive Medicine Division. That branch cooperated closelywith the Medical Practice Division, as well as with the consultants inmedicine assigned to the service commands, in working out policies forboth control and treatment. Nevertheless, some of the specialists in internalmedicine found this arrangement unconventional and organizationally unsound.Although the Chief Consultant in Medicine admitted that it worked, he consideredthe assignment of venereal disease control to men with public health trainingand little clinical

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experience "a glaring example of inconsistency and improvisationin Medical Department organization."³³

The Operations Service

The Operations Service as originally established in March consistedof four divisions: Training, Planning, Hospital Construction, and Hospitalization.³⁴It remained the coordinating agency of the Surgeon General`s Office untilthe end of the war.

Training Division.-The Training Division had the job of establishingall training policies for the various Medical Department schools and forthe Medical Department training centers established in 1941 and early 1942,as well as for the medical training courses given to officers and men ingeneral War Department schools. It developed training manuals and trainingfilms, allocated quotas of personnel to medical units and installations,prepared estimates for construction and maintenance of schools and replacementtraining centers, and inspected these installations. In the course of 1942,the Training Division received responsibility for planning the trainingof the Medical Department nondivisional units commonly used in the communicationszone of an oversea theater, such as the general, station, and field hospitalsand various types of laboratories and medical supply units, which wereturned over to the Services of Supply for activation and training. In Augustthe Services of Supply directed a reorganization of the Division to conformto the organization of the corresponding division at the Services of Supplylevel. It was to include a Unit Training Branch to take care of the additionalresponsibilities with respect to units. At this time the Training Division,Surgeon General`s Office, was removed from the Operations Service and madea staff division.³⁵

Planning Division.-The work of the, Planning Division was torecom-mend and prepare tables of organization (numbers of officers andenlisted men by specialty and rank) and tables of basic allowances (ofequipment) for Medical Department units and medical detachments. It recommendedmedical units for inclusion in the troop basis, as well as the types andnumbers for medical service in oversea theaters, and prepared on requestthe medical sec-

³³See footnote 30 (2), p. 104.
³⁴An Inspection Division indicated on charts in 1942 was nevercreated.
³⁵(1) Memorandum, Chief, Administrative Branch, Services ofSupply, for Directors and Chiefs of Staff Divisions, Services of Supply,9 May 1942, subject: Clarification of Responsibilities of Chief of SupplyServices in Relation to Army Ground Forces and Army Air Forces. (2) Memorandum,Chief, Training Division, Office of The Surgeon General, for Chief, ControlDivision, Office of The Surgeon General, 29 Oct. 1942, subject: Reporton Administrative Developments. (3) Memorandum, Director, Training Division,Services of Supply, for The Surgeon General, 13 Aug. 1942, subject: Organizationof a Training Division, with 1st indorsement, Executive Officer, Officeof The Surgeon General, to Chief, Control Division, Services of Supply,21 Aug. 1942. (4) Annual Report, Training Division, Office of The SurgeonGeneral, 1942-43. (5) Medical Department, United States Army. Trainingin World War II. [In preparation.]

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tions of War Department plans. It also supervised the development andtesting of medical field equipment.

Hospital Construction Division.-The Hospital Construction Divisionwas charged with preparing plans for the construction and repair of hospitalsand all construction activities in which The Surgeon General was interested,including hospital ships and quarters for patients on Army transports.It worked closely with the Office of the Chief of Engineers, which hadbeen re- sponsible since December 1941 for constructing Army hospitals-previouslya function of the Office of the Quartermaster General .³⁶

Hospitalization Division.-The Hospitalization Division (renamed Hospitalizationand Evacuation Division in the August reorganization) was primarily concernedwith developing policies on hospitalization and treatment, with administrativesupervision of the named general hospitals in the United States and advisorysupervision over the administration of other hospitals, with allotmentto station hospitals of bed credits in the named general hospitals, andwith assignment to the latter of patients transferred from overseas.

The activities and policies of this division were largely responsiblefor the steadily worsening relations between the Medical Department andthe Services of Supply between March and September 1942. The friction wentback to February, when Lt. Col. William L. Wilson, then assigned to G-4,had followed up a tour of the corps areas with charges that the MedicalDepartment had no adequate plans for evacuating and hospitalizing civilianor military wounded should the United States be bombed. Brig. Gen. LeRoyLutes, who came to the Services of Supply Operations Division from commandof an anti-aircraft brigade in the Los Angeles, Calif., area, had becomeconcerned over the lack of a plan for hospitalization if the city werebombed and had asked Colonel Wilson to inquire as to what the situationwas throughout the United States. Colonel Wilson and General Lutes believedthat the Surgeon General`s Office had not anticipated a possible declarationof martial law and the Medical Department`s responsibilities for civilians,as well as military, in the event of bombing. Colonel Wilson found corpsarea surgeons concerned over possible confusion as to lines of authorityif it should become necessary to evacuate wounded civilians and soldiersfrom one corps area to another. He and General Lutes considered a planby each corps area surgeon and a master plan by the Surgeon General`s officeessential.³⁷

³⁶(1) Annual Report, Hospital ConstructionDivision, Office of The Surgeon General, 1942. (2) Smith, Clarence McKittrick:The Medical Department: Hospitalization and Evacuation, Zone of Interior.United States Army in World War II. The Technical Services. Washington:U.S. Government Printing Office, 1956, pp. 61-63.
³⁷(1) Working papers for report by Lt. Col. William L. Wilson,MC, on his survey of corps areas. HU: Wilson files. (2) Memorandum, Brig.Gen. LeRoy Lutes, for Lt. Gen. Brehon B. Somervell, 19 Apr. 1942, subject: Coordination of Medical Activities, Air and Ground Forces, and Servicesof Supply. (3) Letter, Lt. Gen. LeRoy Lutes, to Director, Historical Division,Office of The Surgeon General, 8 Nov. 1950. (4) Smith, Clarence McKittrick:The Medical Department: Hospitalization and Evacuation, Zone of Interior.United States Army in World War II. The Technical Services. Washington:U.S. Government Printing Office, 1956, pp. 55-56.

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In March, General Lutes directed The Surgeon General to submit a basicArmy-wide plan for hospitalization and evacuation. In May, he informedGeneral Somervell. that The Surgeon General had failed to publish an Army-wide hospitalization and evacuation plan and that the one he had finallysubmitted at the direction of General Lutes` office was unsuitable. GeneralLutes` office (that is, Colonel Wilson) had had to prepare, such a planand submit it through G-4. General Lutes coupled this charge with an implicationthat administration of the Medical Department had been deficient by statingthat The Surgeon General had only five officers with "basic militarytraining" in "key positions" in his office and that twoof the four Army surgeons had not had such training. He recommended toGeneral Somervell that The Surgeon General be required to study and reportupon the status of medical personnel in his office and make recommendationsfor correction of deficiencies.³⁸

In reply, General Magee pointed out the lack of a definition of "keypositions" and of "basic military training." He assumedthat by the latter term General Lutes intended reference to training inthe Command and General Staff School and/or the Army War College. He statedthat 54 of his medical officers had graduated from either or both of thoseschools and that he had exercised great care in the appointment of officersto key positions. Of the four Army surgeons-Col. Raymond W. Bliss, MC,First U.S. Army (fig. 28) ; Col. Frank H. Dixon, MC, Second U.S. Army (fig.29); Col. John H. Dibble, MC, Third U.S. Army (fig. 30); and Col. CondonC. McCornack, MC, Fourth U.S. Army-all except Colonel Bliss were graduatesof one, or both of these schools, and Colonel Bliss (later Major Generaland The Surgeon General), he emphasized, was a man "of high intelligence,wide experience, and great industry."³⁹ The controversywas finally halted, if not resolved, with the issuance of a jointly developedhospitalization and evacuation directive in November 1942.

The Critical Services: Personnel and Supply

In 1942 the Personnel Service and the Supply Service were the elementsof the Surgeon General`s Office in which the two major problems confrontingthe Medical Department appeared. The Chief Surgeon, European Theater ofOperations, informed the Chief of Staff, Services of Supply, in September,that the medical service in the European Theater of Operations had "sufferedbadly from shortage of personnel and somewhat less from shortage of

³⁸Memorandum, Brig. Gen. LeRoy Lutes, for Lt.Gen. Brehon B. Somervell, 8 May 1942, subject: Activities of The SurgeonGeneral. For detailed account of the dispute, see Smith, Clarence McKittrick: The Medical Department : Hospitalization and Evacuation, Zone of Interior.United States Army in World War II. The Technical Services. Washington:U.S. Government Printing Office, 1956, pp. 63-67.
³⁹Memorandum, Lt. Gen. Brehon B. Somervell, for Maj. Gen. JamesC. Magee, 8 May 1942, with 1st indorsement by General Magee, 12 May 1942.

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supplies."⁴⁰ The term "shortage" is relative,of course, and in this case applies to a particular time and situation.Whether or not there were ever actual widespread shortages, a strong fearof future shortages of medical personnel and supplies permeated the SurgeonGeneral`s Office in 1942 and was reflected in the oversea theaters. Itappeared doubtful that the established requirements could be met.

Personnel Service.-The prospective shortage of medical personnelwas the more serious, for it posed graver problems and would be the harderto overcome. The Army, as well as the rest of the military forces, wasin competition with civilians for available medical personnel. The transferto the Army of a goodly number of doctors who were considered necessaryto the well-being of their communities would have a deteriorating effecton civilian morale. The time required to train additional doctors precludedany appre-ciable increase in the number of those available at an earlydate. Higher officials of the War Department, including the Chief of Staffand the Secretary of War, as well as officers at Services of Supply headquarters,exhibited growing

⁴⁰Memorandum, Chief Surgeon, Services of Supply,European Theater of Operations, for Chief of Staff, Services of Supply,10 Sept. 1942.

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concern over this situation. Procurement was the major job of the PersonnelService throughout 1942.⁴¹

The chief difficulty in getting doctors into the Army was that in effectthey were not subject to the draft and that as late as several months afterPearl Harbor they were not volunteering in the numbers hoped for by theMedical Department. In late 1941 the President had approved the establishmentin the Office of Defense Health and Welfare of an agency termed the Procurementand Assignment Service for Physicians, Dentists, and Veterinarians. Originallyproposed by the American Medical Association, this agency had the supportof the Surgeons General of the Army, Navy, and Public Health Service. Itspurpose was to coordinate "the various demands made on the medical,dental and veterinary personnel of the Nation" and to promote "themost efficient use of medically trained personnel."⁴²

After April 1942 the Procurement and Assignment Service functioned underthe War Manpower Commission, headed by Paul V. McNutt. One of the Commission`stasks was the allocation of personnel between military and civilian interests.By that date it had become abundantly clear that the United States wasthreatened with a shortage of doctors. A clash of civilian and militaryinterests now ensued over the allocation of medical personnel-only one

⁴¹For detailed discussion, see Medical Department,United States Army. Personnel in World War II, ch.VI. [In press.]
⁴²Letter, Paul V. McNutt, Federal Security Administrator, tothe President, 30 Oct. 1941.

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phase of the struggle over allocation of the general labor supply throughoutthe United States. Whereas the Procurement and Assignment Service becamein-creasingly concerned in the latter half of 1942 over the difficultyof retaining in civilian life sufficient doctors, strategically located,to protect civilian health, the Medical Department was chiefly interestedin getting into the Army the numbers which it considered essential to maintainthe health of troops. The shortage of physicians led to pressure from theGeneral Staff and from the Services of Supply upon the Medical Departmentto reduce, after conducting practical tests, the number of doctors in thetables of organization of certain medical installations and tactical units.They also urged wider use of Medical Administrative Corps officers or otherofficers in administrative jobs which did not require professional medicaltraining.⁴³

A Medical Officer Recruiting Board was set up in each State by earlyMay after the Director of the Military Personnel Division, Services ofSupply, ordered procurement decentralized to the States. These boards hadauthority to commission applicants in the lower ranks directly, withoutrecourse to the

⁴³(1) Memorandum, Director of Military Personnel,Services of Supply, for The Surgeon General, 12 May 1942, subject: Availabilityof Physicians. (2) Memorandum, Col. John M. Welch, for Chief, Control Branch,Services of Supply, 13 June 1942.

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traditional method of commissioning by The Adjacent General`s Office.As a result of their drive for faster commissioning, the number of doctorsprocured for the Medical Department skyrocketed in the summer and fallof 1942.⁴⁴

In June 1942 the Control Division, Services of Supply, made a reporton the procurement of medical officers pursuant to a suggestion from Mr.Goldthwaite Dorr, Special Assistant to the Secretary of War, after Mr.McNutt had raised certain medical personnel problems at a Cabinet meeting.The report recommended that a thorough survey of the procurement of MedicalCorps officers be made by a committee to be appointed by the CommandingGeneral, Services of Supply. General Somervell disapproved of the studyrecommended. He criticized the office of his Director of Military Personnel(then containing 68 officers) severely for lack of imagination and fordealing in reams of studies and platitudes. He did, however, approve arecommendation for fresh study of the whole organization of the MedicalDepartment for the purpose of determining the number of medical officersthat could be released to fulltime medical duties by substituting officersof the Medical Administrative Corps, the Sanitary, and other corps. A committeewhich the Secretary of War appointed in September to study Medical Departmentadministration tackled this matter along with many other problems.⁴⁵

By fall the Medical Officer Recruiting Boards had been withdrawn fromall but five States at the request of members of the Procurement and AssignmentService who believed that too many doctors were being withdrawn from civilianlife. In October problems in allocating medical personnel between civilianand military interests came up before a subcommittee of the U.S. SenateCommittee on Education and Labor. At the hearings of the subcommittee,Medical Department officers defended the Surgeon General`s Office`s statementof its requirements. Dr. Frank H. Lahey, Chairman of the Directing Boardof the Procurement and Assignment Service, noted the difficulty of gettingdefinite information on Army Medical Department requirements for personnelbecause of The Surgeon General`s position under the Services of Supply.In his opin-ion The Surgeon General of the Army worked at a great disadvantagecompared with the Surgeon General of the Navy; the latter had direct controlover the assignments of Navy medical officers. About the same time GeneralMagee himself pointed out his limited control over the assignment of Armydoctors.

⁴⁴(1) Memorandum, Lt. Col. Durward Hall, MC,for Director, Military Personnel Division, Army Service Forces, 22 July1943, subject: Procurement of Physicians and Dentists. (2) See footnote13(6), p. 88. (3) Committee to Study Medical Departments, 1942, exhibit15-B. (4) Memorandum, Director, Military Personnel Division, Services ofSupply, for The Surgeon General, 12 Apr. 1942. (5) Memorandum, Col. GeorgeF. Lull, MC, for The Adjutant General, 16 Apr. 1942.
⁴⁵(1) Memorandum, Chief, Control Division, Services of Supply,for Commanding General, Services of Supply, 16 June 1942. (2) Memorandum,Chief of Staff, Services of Supply, for Director, Military Personnel Division,Services of Supply, 20 June 1942, and reply of 23 June. (3) Memorandum,Director of Military Personnel, Services of Supply, for The Surgeon General,23 June 1942. (4) Memorandum, Director of Military Personnel, Servicesof Supply, for The Adjutant General, 10 July 1942, subject: Relief of MedicalCorps Officers From Duties Which Do Not Require Professional Medical Training.

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Protesting to the Chief of Staff against a reduction in the, numbersof medical officers on the grounds that it would tend to lower the standardsof medical Service, he stated: "I wish to point out that I have avery limited supervision and control of the medical service of the AirForces." In his opinion, many duplications existed in the medicalservices controlled by his office and those under control of the Air Surgeon.A similar, though lesser, duplication existed with respect to medical servicesdirected by the Ground Surgeon. The Surgeon General believed that moredirect control of allotments and assignments of medical officers by hisown office would eliminate duplications and free medical personnel foruse in other positions.⁴⁶

Supply Service.-Whereas the shortage of medically trained personnelin 1942 attracted the attention of highly-placed officials of the legislativeand executive branches of the Government, the potential shortage of medicalsupplies was dealt with largely within the War Department. Both in theSurgeon General`s Office and in Services of Supply headquarters grave doubtsarose as to whether the Medical Department would be able to meet increasingdemands for medical supplies for the Army and for our allies. Lend-leaserequisitions included medical items for the use of civilians as well asof military forces, in the beneficiary country. The feeling of being swampedby lend-lease demands for medical supplies and equipment was well expressedby one medical officer: "It seemed for a time that we are runningsort of an international WPA."⁴⁷

It is not clear to what extent the extreme concern over the status ofmedical supplies was justified; rather few general shortages seem to haveexisted. Spot shortages apparently developed as a result of hoarding byvarious commands and installations, maldistribution of stocks, or inadequatetransportation. Some of the uncertainty undoubtedly derived from inadequatestock records.

In the course of efforts by Services of Supply headquarters and theSurgeon General`s Office to speed the procurement of medical supplies andequipment, sharp differences in the outlook of the two agencies showedup. The Services of Supply concentrated from the outset on achieving efficientprocurement of the items used by the various supply services. It aimedat eliminating the competition among them for scarce raw materials, skilledlabor, and manu- facturing facilities. Headed by men of Engineer, Quartermaster,and G-4 experience and staffed by many men from industry, it establishedstatistical methods for planning goals for procurement, for forecastingprocurement, and

⁴⁶(1) Hearings Before a Subcommittee of theCommittee on Education and Labor, United States Senate, 77th Cong., 2dSess., on Senate Resolution 291, Investigation of Manpower Resources, PartI, October 15-November 20, 1942, and Part II, December 14-16, 1942. Washington:U.S. Government Printing Office, 1942, 1943. (2) Memorandum, The SurgeonGeneral, for the Chief of Staff, 23 Oct. 1942.
⁴⁷(1) Lecture, Lt. Col. Carl R. Darnall, before Fiscal OfficersTraining Class, 6 Oct.-14 Nov. 1942. (2) Medical History, 1 Troop CarrierCommand, 30 Apr. 1942 to 31 Dec. 1944. [Official record.] (3) Medical Department,United States Army. Medical Supply in World War II. [In preparation.] (4)Medical Department, United States Army. Dental Service in World War II.Washington: U.S. Government Printing Office, 1955, pp. 165ff.

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for periodical reporting of quantities bought. Tending to stress thesimilarities of supply problems among the services, it attempted to standardizeprocedures for the procurement of Army supplies and to eliminate managerialweaknesses in methods of procurement used by the services. Administratorsof the Services of Supply conceived all supply activities of the Army asa single immense operation, in which the major steps were determinationof requirements, procurement, storage, distribution, etc. This way of thinking,if carried to an ultimate consistency, would have largely eliminated theMedical Department as the procurement agency for items used by it-an arrangementthat had already been tried without success after World War I.⁴⁸

The Surgeon General`s Office, on the other hand, emphasized the tech-nicalproblems encountered in selecting and buying medical supplies and equipment,and maintained that the job of procurement could be satisfactorily handledonly by medically trained men, for only the medically trained could properlyassess the quality, as well as use, of these technical tools. For thesereasons it consistently attempted to exercise, considerable autonomy inhandling the medical supply program and to oppose the hiring of civilianswith experience in industrial management-a measure consistently advocatedby the Services of Supply.

In other respects, the divergence in point of view of the Surgeon General`sOffice and that of the Services of Supply was primarily one of emphasis.The Surgeon General`s Office did not actually deny the importance of formulatingstatistical goals and making statistical forecasts, but laid considerablyless emphasis than did the Services of Supply upon their value. From timeto time, it opposed changes in the medical supply system which Servicesof Supply headquarters advocated in the name of economy or efficiency onthe ground that the Medical Department`s experience indicated that theproposed changes were actually less efficient or would tend to lower thequality of the medical supplies and equipment used by Army doctors.⁴⁹

The Supply Service of the Surgeon General`s Office received directionfrom two large organizational elements of Headquarters, Services of Supply.These were the Offices of the Assistant Chief of Staff for Materiel (Brig.Gen. Lucius D. Clay) and the Assistant Chief of Staff for Operations (GeneralLutes). The Supply Service dealt with the former largely with respect toproblems of requirements for medical supply, including those for lend-leasepurposes, and problems of procurement. From the outset the Office of theAssistant Chief of Staff for Operations exercised supervision over thestorage and warehousing activities of all the supply services, but itsadded respon-

⁴⁸(1) Annual Report of The Surgeon General,U.S. Army, 1919. Washington: U.S. Government Printing Office, 1919, p.1190. (2) Annual Report of The Surgeon General, U.S. Army, 1920. Washington:U.S. Government Printing Office, 1920, pp. 357-358. (3) Annual Report ofThe Surgeon General, U.S. Army, 1921. Washington: U.S. Government PrintingOffice, 1921, pp. 161-162.
⁴⁹(1) Memorandum, Commanding General, Services of Supply, forThe Surgeon General (and others), 27 Apr. 1942, subject: Management Service.(2) Millett, J. D. : The Direction of Supply Activities in Our War Department.Ann. Pol. Sci. Rev. 38: 249, 475, April, June 1944.

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sibility for logistical planning for troops moving overseas soon enlargedthe supply functions of General Lutes` office considerably beyond the provinceof storage and distribution. Hence in the summer of 1942 the Hospitalizationand Evacuation Branch (headed by Colonel Wilson) in the Planning Divisionof General Lutes` office became concerned with the status of Medical Departmentsupply and estimates of future production in relation to meeting the needsof troops going overseas. Throughout 1942, the Offices of the Assist-antChiefs of Staff for Materiel and for Operations brought pressure on theSupply Service of the Surgeon General`s Office to adopt certain measureswhich they believed would lead to more rapid procurement and more efficienthandling of medical supply.⁵⁰

A barrage of criticisms of the Supply Service of the Surgeon General`sOffice and proposals for reform emanated from Services of Supply headquarters.The major difficulties, noted chiefly by officials of the Office of theAssistant Chief of Staff for Materiel, may be summarized as follows: Lackof personnel trained in large problems of management, such as purchasingprocedures, inventory control, and warehouse methods; too high a degreeof centralization of work in Washington; and unsatisfactory records oncurrent and future production, on stocks, and on shortages in the Washingtonoffice, the procurement office, and the depots. The critics recognizedas contributory causes certain factors largely outside the control of theMedical Department: Shortages of critical raw materials, lack of officespace, insufficient allotment of personnel, and small allocations to theDepartment for supply purchasing prior to the fiscal year 1940. Small appropriations,an old military ghost, had served to nullify in part the well-planned programfor training of medical officers in the handling of medical supply in the1930`s. Only two officers had been given this training per year, and theyhad not received the experience with large-scale purchasing which officersengaged in procurement now sorely needed.⁵¹

⁵⁰(1) General Order No. 4, Services of Supply,9 Apr. 1942. (2) General Order No. 22, Services of Supply, 11 July 1942.(3) General Order No. 24, Services of Supply, 20 July 1942. (4) See footnote4(4), p. 75. (5) Memorandum, Assistant Chief of Staff for Operations, Servicesof Supply, for Chiefs of Services, 22 Aug. 1942, subject: Supply PlanningPersonnel.
⁵¹(1) Wilson, Clara B.: History of Medical Supplies in WorldWar II, Distribution and Accomplishments, Zone of Interior Depots (1949).[Official record.] (2) Memorandum, Priority Representative, Office of TheSurgeon General, for Priorities Division, Army-Navy Munitions Board, 1May 1942. (3) Memorandum, Priority Representative, Office of The SurgeonGeneral, for Technical Advisor, Office of the Under Secretary of War, 10June 1942. (4) Memorandum, C. Tyler Wood, Office of Director of Procurement,Services of Supply; Lt. Col. Fred C. Foy, Purchases Division, Servicesof Supply; and Maj. Philip W. Smith, Ordnance Department Purchases Division,Services of Supply, for Director of Procurement, Services of Supply, 27July 1942, subject: Summary of Findings at New York and St. Louis MedicalProcurement Offices, 24 and 25 July 1942. (5) Memorandum, Lt. Col. FredC. Foy and C. Tyler Wood, for Director of Procurement, Services of Supply,11 Aug. 1942, subject: Summary of Report on Decentralization of Operationsof Supply Division, inclosure to memorandum, Director of Procurement, forThe Surgeon General, 12 Aug. 1942. (6) Memorandum, Lt. Col. William L.Wilson, for Assistant Chief of Staff for Operations, 23 Aug. 1942, subject:Status of Procurement of Medical Supplies. (7) Memorandum, Director, PurchasesDivision, for Assistant Chief of Staff for Operations, 26 Aug. 1942, subject:Procurement of Medical Equipment and Supplies.

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Two important measures which the Services of Supply undertook in theeffort to improve the efficiency of the medical supply system were theseparation from the supply organization of all functions which were onlyindirectly related to supply and the decentralization of all supply functionsthat could conveniently be moved out of Washington to various field offices.Both efforts began about mid-1942, but the major moves out of Washingtondid not take place until after the fall of 1943.

A survey of the Finance and Supply Service of the Surgeon General`sOffice and the medical supply depots, including the procurement officesof the New York and St. Louis depots, by the Control Division, Servicesof Supply, in June 1942 showed a number of weaknesses in the medical supplysystem. Medical Corps officers were being used for work in depots wheretechnical skill was unessential. Depot procedures varied, and the territorieswithin which the New York and St. Louis procurement offices bought medicalsupplies and equipment overlapped. A report made by the Control Division,Services of Supply, recommended the following measures: Substitution ofnonmedical officers and civilians, especially women, for Medical Corpsofficers in depot operations (except distributing depots, where technicalknowledge was needed); standardization of depot procedures and of depotreports for comparative purposes; and procurement of nonmedical items byservices other than the Medical Department. It also proposed to transferto St. Louis, where it was easier to obtain civilian personnel, variouscomponents of the Supply Service in Washington, especially those handlingpurchase, storage, and issue functions, as well as the procurement functionsof the New York Medical Depot. Finally, the report recommended the divorceof fiscal functions of the Surgeon General`s Office from supply functions.

This last recommendation was promptly carried out, and a new SupplyService headed by Col. Francis C. Tyng, MC (fig. 31), was established.Promulgation of most of the others was begun, but the recommended moveof the Purchasing and Contracting Office of the New York Medical Depotto St. Louis aroused a good deal of opposition in the Surgeon General`sOffice, as well as in the New York office. A resurvey of the situationby representatives of the Office of the Assistant Chief of Staff for Materielof the Services of Supply pointed out the heavy concentration of medicalsupply manufacturers in the New York area and the importance of close contactbetween procurement officers and manufacturers. The move was accordinglycanceled, but not until the morale of New York office employees had beendamaged and the flow of procurement hampered by the unstable situation.Pursuant to the recommendations of the resurvey, the Surgeon General`sOffice established in August the New York and St. Louis Medical ProcurementOffices separate from their respective depots. The New York and St. Louisoffices purchased nearly all the medical supplies bought by the Army incontinental United States during the war. The heaviest year of procurementby far was 1943, during which the

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estimated dollar value of Medical Department items delivered was $305,064,000,more than twice the amount delivered in any other year.⁵²

The separation of procurement functions from the depots in New Yorkand St. Louis had a parallel development in the separation of similar functionsin the Supply Service, Surgeon General`s Office. A Purchases Division anda Distribution Division were established in the new Supply Service. ThePurchases Division supervised the preparation of contracts for medicalsupplies and equipment, handled matters relating to prices and their adjustment,prepared statements of policy for procurement officers in the field, andmaintained statistics on current production and procurement as a checkon the status of

⁵²(1) Memorandum, Lt. Col. Kilbourne Johnson,W. C. Nunnecke, Col. M. E. Griffith, and Col. Silas B. Hays, for CommandingGeneral, Services of Supply, and The Surgeon General, 20 June 1942, subject:Survey of Supply Functions of The Surgeon General`s Office. (2) Memorandum,Julius H. Amberg, Special Assistant to the Secretary of War, for Col. C.F. Robinson, 29 July 1942, subject: Senate Investigation. (3) Committeeto Study the Medical Department, 1942, testimony, p. 103ff. (4) Yates,Richard E.: Procurement and Distribution of Medical Supplies in the Zoneof Interior During World War II, p. 60ff. [Official record.] (5) See footnote51(4), p. 118. (6) Memorandum, The Surgeon General, for the CommandingGeneral, Services of Supply, 14 Aug. 1942, subject: Medical DepartmentProcurement Districts. (7) See footnote 51(5), p. 118. (8) Memorandum,Director, Purchases Division, Services of Supply, for Committee to Studythe Medical Department, 5 Nov. 1942, subject: Surgeon General`s SupplyService. (9) Crawford, Richard H., and Cook, Lindsley F.: Statistics; Procurement,9 Apr. 1942. [Official record, subject to revision.]

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individual items. The Distribution Division was responsible for maintainingadequate storage space and stocks in depots and good standards of warehousing,and for issuing field equipment and supplies to troops at home and abroad.Most other major changes in the Supply Service of the Surgeon General`sOffice accompanied, or followed close upon, the reorganization of the Servicesof Supply in July and the divorce of fiscal and supply functions of theSurgeon General`s Office (chart 7, p. 94). The Requirements Division andthe International Division were newly added. The computation of requirementsof raw materials and finished items had formerly been a function of theFinance Branch of the old Finance and Supply Division,. while the InternationalDivision grew out of the old Defense Aid Branch. The functions of the oldProduction Control Division which were related to current production wereassigned to the Purchases Division, and the new Production Planning Divisioncame into existence.⁵³

SERVICE COMMAND MEDICAL ORGANIZATION

In addition to the organizational changes which the Services of Supplyadvocated for the Washington offices of the supply services, it undertookin July 1942 and subsequent months a thoroughgoing decentralization ofMany functions to the corps areas, now renamed service commands. The intentwas to make each service command a field agency for administering the supplyservices and fixed installations within its boundaries and to achieve uniformityin the organization of the nine service command headquarters. Up to thistime the chiefs of the various services in Washington, including The SurgeonGeneral, had controlled within the service commands a number of activities,including fiscal operations and the recruitment of civilian personnel,and certain installations pertaining to their particular services. TheServices of Supply wished to eliminate duplication of effort in these fields.

In the effort to reduce the number of staff officers reporting to thecom-manding general of the service command (as it had attempted to decreasethe number of officers reporting directly to the chiefs of services inWash-ington), Services of Supply Headquarters directed that service commandhead-quarters be reorganized along functional lines-that is, into divisionshandling training, personnel, supply, and so forth-so as to include thefunctions of all the supply services in each of these fields. In the newsetup the office of the service command surgeon was placed, along withthe offices of the chiefs of other services, under the supply divisionof the service command. His office was usually termed the "medicalbranch," and he was given the title of "chief of the medicalbranch." Thus the service command surgeon was now respon-sible toa director of supply and through him to the commanding general of the servicecommand. In a word, he had lost his staff position. Moreover, he

⁵³Yates, Richard E. : The Procurement and Distributionof Medical Supplies in the Zone of Interior During World War II, pp. 56-58.[Official record.]

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had no direct official channel of Communication to The Surgeon General.The latter had to issue instructions on matters of policy in the name ofthe commanding general, Services of Supply, to the commanding general ofthe service command for the attention of the surgeon. Besides this changein the position of the service command surgeon, a major change in medicalorganization took place with the removal to service command control ofcertain medical installations and units. Of the 15 general hospitals inoperation in August 1942, all except Walter Reed were transferred fromthe direct control of The Surgeon General to that of the commanding generalsof the service commands. The Surgeon General succeeded in retaining theimportant function of allocating the beds at general hospitals reservedfor patients transferred from station hospitals; he also continued to controlallotments of medical officers to the staffs of general hospitals untilApril 1943, when this power, too, was transferred to the service commands.In addition to the general hospitals, the following installations and unitswere placed under control of the service commands: Medical and dental laboratories,except for those at the Army Medical Center in Washington; the generaldispensaries (established in the larger cities to care for troops absentfrom station), except the General Dispensary, Washington, D.C.; and theMedical Officer Recruiting Boards operating in the various States. MedicalDepartment schools and replacement training centers also passed to thecontrol of the service command, but as in the case of the general hospitalsThe Surgeon General succeeded in keeping control of certain activitiesin these centers. Such matters as the issuance of training doctrine, thescheduling of programs, supervision of training, and the selection andassignment of faculty personnel remained under control of The Surgeon Generalacting through Headquarters, Services of Supply. The service commands werealso given control of prisoner-of-war camps, formerly assigned to the ProvostMarshal General. This change was of greater significance to the MedicalDepartment for the future than the present, as hospitals for these installationswere only just getting under way.⁵⁴

Other than the Army Medical Center (including Walter Reed General Hospitaland the professional schools and laboratories), the General Dispensary,the Army Medical Library, and the Army Medical Museum-all in Washington,D.C.-the installations still under command of The Surgeon General werethe New York and St. Louis Medical Department Procurement Districts (separatedabout this date from the respective depots) and the eight medical

⁵⁴(1) See footnote 4(4), p. 75. (2) Staff Conference,Reorganization of Service Commands, Headquarters, Services of Supply, 4Aug. 1942. [Official record.] (3) Millett, John D.: Organization and Roleof the Army Service Forces. United States Army in World War II. Washington:U.S. Government Printing Office, 1954, ch. XXI. (4) Lecture, Lt. R. H.Fuchs, Services of Supply, before Fiscal Officers Training Class, 6 Oct.-Nov.1942., (5) Memorandum, Executive Officer, Office of The Surgeon General,for Director, Control Division, Services of Supply, 1 Aug. 1942. (6) Report,Conference of Commanding Generals, Services of Supply, 30 July-l Aug. 1942.(7) Memorandum, Chief of Staff, Services of Supply, for all Chiefs of SupplyServices, 22 July 1942, subject: Relationships Between Service Commandsand Headquarters, Services of Supply and the Administrative and SupplyServices of the Services of Supply. (8) Army Regulations No. 170-10, 10Aug. 1942, and change 2, 14 Aug. 1943.

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depots then in operation at Binghamton (N.Y.), Savannah, Toledo, St.Louis, Kansas City, Denver, Los Angeles, and San Francisco (chart 7). Thusin-stallations handling medical supplies were the major type remainingunder his direct control. In addition to the medical depots the MedicalDepartment then maintained medical sections within eight Quartermasterdepots at the follow-ing locations: Schenectady, New Cumberland (Pa.),Atlanta, Columbus (Ohio), Chicago, San Antonio, Ogden (Utah), and Seattle.These depots were under control of the Quartermaster General.⁵⁵

Jurisdiction over station hospitals under this reorganization remainedunchanged for the most part. Medical officers commanding hospitals at postshousing ground force troops were under a post commander responsible tothe commanding general of the service command. Hospitals at airfields wereunder the control of the Army Air Forces.

The difficulty immediately foreseen by General Magee in the new servicecommand organization was that under the new setup the service commandermight make undesirable transfers of medical personnel-as, for example,the transfer of specialized personnel from a hospital staff to his ownoffice. In the opinion of General Somervell and some Services of Supplyofficers, the presence of the right kind of service command surgeon wouldobviate this difficulty. General Somervell also stated that The, SurgeonGeneral could communicate with the service commander by telephone in suchcases in order to make his position known. Services of Supply personnelfrequently stressed the possibility of bypassing, by telephone communication,the circuitous lines of communication established by the reorganizationof July. Over the long run the Medical Department found this pattern ofinternal organization of service command headquarters (which prevaileduntil the end of 1943) unsatisfactory, as did the other technical services.

In addition to these direct and specific changes in organizational structure,Services of Supply headquarters instituted a continuing pressure, on theMedical Department as on the other services, for decentralization of variousfunctions to service command control. It asked the commanding generalsof service commands to submit lists of activities, including medical ones,which they thought should be decentralized to service command jurisdiction.It requested The Surgeon General to review certain powers of decision reservedto him by existing Army regulations and to point out those which mightfeasibly be transferred to the service commands. All were of relativelyminor importance. The Surgeon General readily agreed to transfer controlof some of these powers, such as authorizing certain types of hospitaladmissions and procuring various items locally, to the commanding generalsof service commands; others

⁵⁵(1) Memorandum, Col. Joseph F. Battley, ControlDivision, Services of Supply, for Control Division, Office of The SurgeonGeneral, 24 Aug. 1942., subject: Field Installations. (2) See footnote13(3), p. 88. (3) Millett, John D. : Organization and Role of the ArmyService Forces. United States Army in World War II. Washington: U.S. GovernmentPrinting Office, 1954, pp. 300-302. (4) Memorandum, Chief, Machine RecordsBranch, Adjutant General`s Office, for The Surgeon General, 11 Sept. 1942,subject: Strength Returns.

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he desired to retain. Jurisdiction over specific detailed functions,as between service command and the Surgeon General`s Office, continuedunder discussion by the Headquarters, Services of Supply, and the SurgeonGeneral`s Office in 1942 and early 1943.⁵⁶

⁵⁶(1) Memorandum, Chief of Staff, Servicesof Supply, for The Surgeon General, 27 Aug. 1942, subject: Decentralizationof Actions to Service Commands. (2) Memorandum, Chief of Staff, Servicesof Supply, for The Surgeon General, 5 Feb. 1943, subject: Decentralizationof Function. (3) See footnote 18 (3), p. 92.

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