CHAPTER V
The Wadhams Committee Investigation
In August 1942, Lt. Gen. Brehon B. Somervell, Commanding General, Servicesof Supply, decided to undertake an investigation of Medical Departmentadministration. The investigation had significant repercussions not onlyon organization and administration of the Surgeon General`s Office buton most major phases of the Medical Department`s program. The fact thatan investigation was ordered implied distrust of the Medical Department`seffectiveness. On the other hand, certain findings of the committee becamea boomerang to the Services of Supply. Irrespective of results, the investigationwas of value to those concerned with Medical Department administrationin bringing out into the open most of the administrative problems facedby the Surgeon General`s Office at that date and the chief differencesbetween that office and Services of Supply headquarters as to advisablemethods and policies for administration of Army medical service.
REASONS FOR THE INVESTIGATION
It is clear that in undertaking an investigation, General Somervellintended to inquire into the organization and administration of the MedicalDepartment rather than into any of the technical aspects of its work. BothGeneral Somervell and the Chief of Staff had become doubtful of the abilityof the Surgeon General`s Office to cope with its mounting problems. GeneralMarshall had become impatient of prophecies by the Surgeon General`s Officethat epidemics might result from the doubling up of soldiers in cantonments,as well as its objections to limitations on personnel. He took the positionthat The Surgeon General must devise means of dealing with all sorts ofshortages and more expeditious ways of doing business.1
Several controversial phases of the Medical Department`s program hadgiven rise to public criticism. Although the investigation took its originfrom within the War Department, public criticism may have helped to bringit about. Several heads of Government agencies handling programs relatedto those of the Medical Department were summoned before the committee togive their views on controversial matters, and the committee probed ratherdeeply into the issues involved.
Public Criticism
Controversy had developed between the Surgeon General`s Office and afew civilian agencies over the handling of health problems in which civilian
1Minutes, Meeting of General Council, Officeof Deputy Chief of Staff, vol. I, 11 Aug. 1942.
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and military interests impinged upon, or were at variance with, eachother. One of these problems had been the Army`s handling of venereal diseasein the United States. By the fall of 1942 this controversy had largelydied down. There had been no basic disagreement between the U.S. PublicHealth Service and the Medical Department over the desirability of couplingthe program for control of venereal disease with a program to repress prostitutionaround Army areas. Tempers had flared up because officials of the U.S.Public Health Service had attacked the Medical Department, along with lineofficers, the Secretary of War, and the General Staff, for an insufficientemphasis upon the effort to repress prostitution. By the summer of 1942those concerned with the venereal disease problem were awaiting the practicalresults of invocation of the May Act in areas around Fort Bragg, N.C.,and Camp Forrest, Tenn.
Other controversies arose over the allocation of hotels for conversionto hospitals in case of emergency and efforts to reconcile Army demandsfor doctors with civilian needs. In August 1942 the Chief of Staff directedthe Surgeon General`s Office to develop plans for converting certain hotelsto hospitals in the event of sudden epidemic in the Army; General Marshallwas determined that the Surgeon General`s Office should not be in a positionto "explain away any epidemic because of the fact that men have beendoubled up in cantonments."2 The Office of Civilian Defense,which had plans for the use of hotels as hospitals for civilians, becamealarmed over the possibility of their diversion to Army use, as well asthe possibility of the Army`s using civilian doctors in these facilitiesto take care of military personnel. By comparison with some other moreserious problems, the "hotels for hospitals" controversy seemssomething of a tempest in a teapot. Nonetheless it became the subject ofa good deal of heated discussion between the Surgeon General`s Office andthe Office of Civilian Defense. It began shortly before the investigatingcommittee was appointed and continued throughout the life of the committee.It Was discussed at high levels, for the Executive Secretary of the Healthand Medical Committee of the Office of Defense Health and Welfare Services,Dr. James A. Crabtree, informed by General Magee, brought the Army`s plansfor the use of hotels to the attention of the President, and General Marshalltook responsibility for having directed the Surgeon General`s Office toundertake the use of hotels.3
More serious than the controversy with the Office of Civilian Defensewas disagreement with the War Manpower Commission over the procurementof medical manpower for the Army. The Surgeon General`s Office was mainlyconcerned with getting sufficient doctors into the Army. The Procurementand Assignment Service for Physicians, Dentists, and Veterinarians of theWar
2See footnote 1, p. 145.
3(1) Interview, Maj. Gen. James C. Magee, 10 Nov. 1950. (2)Smith, Clarence McKittrick : The Medical Department : Hospitalization andEvacuation, Zone of Interior. United States Army in World War II. The TechnicalServices. Washington: U.S. Government Printing Office, 1956, pp. 81-83.
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Manpower Commission became concerned over the removal of doctors fromcivilian life and complained of the aggressiveness of the Medical OfficerRecruiting Boards working in the various service commands to get doctorsinto the Army. Higher officials of the War Department, including the DeputyChief of Staff, were uncertain of the validity of estimates of Army requirementsfor doctors by the Surgeon General`s Office vis-a-vis differing estimatesby the Procurement and Assignment Service and other Government agenciesinterested primarily in protecting civilian medical interests. The DeputyChief of Staff directed the Inspector General to investigate the assignmentsof medical officers within the Office of The Surgeon General (as well asassignments to the offices of some other chiefs of services), with a viewto determining whether the number so assigned could be cut. This separateinvestigation of medical personnel in the Surgeon General`s Office wenton concurrently with the general investigation of the Medical Departmentdiscussed here.4
In the fall of 1942, a congressional investigation of the medical manpowerresources of the United States took place. A special subcommittee of theSenate Committee on Education and Labor conducted it as one phase of aninquiry into the total manpower resources of the country. At the subcommittee`shearings, presided over by Senator Claude E. Pepper, representatives ofthe Procurement and Assignment Service and of the Surgeons General of theArmy, Navy, and U.S. Public Health Service presented their points of viewon the supply of, and demand for, medical manpower. Senator Pepper`s questioningthroughout was directed at pointing out the lack of any governmental agencywith final authority to allocate doctors as between military and civilianlife.5
In the spring and summer of 1942 frequent complaints of the Army`s discriminationagainst certain minority groups with medical training appeared in the publicpress. Various organizations representing these groups protested discriminationagainst women doctors, Negro doctors, and such unrecognized medical groupsas the chiropractors and osteopaths. Their formal resolutions, along withletters from individuals voicing similar criticism, appeared widely inthe open-forum columns of newspapers in 1942, and a number of magazinearticles were written on these themes. The fact that the Medical Departmentwas actively attempting to recruit additional doctors gave more color tothe criticism of its failure to commission members of the unrecognizedgroups.6
4(l) Medical Department, United States Army.Personnel in World War II, ch. VI. [In press.] (2) Memorandum, Brig. Gen.LeRoy Lutes, for Commanding General, Services of Supply, 2 Sept. 1942.(3) Memorandum, no signature, for the Inspector General, 30 Oct. 1942,subject: Report of Investigation of the Present Organization of the SurgeonGeneral`s Office. (4) Minutes, Meeting of General Council, Office of DeputyChief of Staff, vol. I, 7 Sept. 1942.
5Hearings on Senate Resolution 291, 77th Congress, 2d Session,Investigation of Manpower Resources. Washington: U.S. Government PrintingOffice, 1942, 1943, pts. 1 and 2.
6(1) Committee to Study the Medical Department, Testimony, pp.24-25, 34-37., (2) Medical Department, United States Army. Personnel inWorld War II, chs. V, X. [In press.]
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The "yellow jaundice epidemic" had been a cause for alarmin the spring and summer of 1942. By midsummer thousands of cases had occurredamong Army personnel in the United States and overseas. The cause of theapparent epidemic, certain lots of yellow fever vaccine furnished by theRockefeller Foundation, had been suspected early. In April, The SurgeonGeneral had recalled all yellow fever vaccine then in use, substitutingfor it a limited supply furnished by the U.S. Public Health Service. Bylate summer the Medical Department had established the cause and natureof the so-called "epidemic," but attacks on the Army for the"epidemic" continued to appear in the public press, for no officialstatement had been given out on the subject.
Criticism Within the War Department
Major criticisms of the Surgeon General`s Office arising within theWar Department revolved around feared shortages of medical supplies andpersonnel and certain matters which had been the subject of disagreementbetween Col. William L. Wilson, MC (Chief, Hospitalization and EvacuationBranch, Plans Division, Services of Supply), and staff officers of theSurgeon General`s Office. Precisely how the difficulties over supply affectedthe decision to hold an investigation is not clear. It is significant thatconcern within the Surgeon General`s Office over the status of medicalsupply reached a crescendo in the fall of 1942. While the Committee toStudy the Medical Department was in session, The Surgeon General expressedextreme concern over the situation to the Chief Surgeon of the Europeantheater, stressing the detrimental effects of exorbitant lend-lease demandsand transportation difficulties. He termed the United States "thelast remaining bastion of medical supply" and declared we are headinginto a catastrophic situation." He expressed fear that "we arevery close to a major scandal."7
The part played by the disagreements on certain policies between ColonelWilson and staff officers of the Surgeon General`s Office in instigatingthe investigation is likewise obscure. Some of the major disagreementshave already been recounted. They were thoroughly aired during the investigationas a result of charges against The Surgeon General based on the files ofColonel Wilson`s Hospitalization and Evacuation Branch and were clearlyof major importance in leading the Commanding General, Services of Supply,to undertake an investigation.
MACHINERY FOR THE INVESTIGATION
When General Somervell initiated the investigation in late August 1942he apparently intended his own organization, the Services of Supply, toselect members of the investigating committee and direct the inquiry. Heinformed the director of his Control Division, Col. Clinton F. Robinson,that he wanted
7Letter, The Surgeon General, to Chief Surgeon,European Theater of Operations, 18 Oct. 1942.
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a thorough survey made of the Surgeon General`s Office and of the MedicalDepartment by a highly qualified group with Colonel Robinson as ExecutiveSecretary. He asked for a survey of the following phases of the MedicalDepartment`s administration: The general organization; personnel, includingthe use of top medical men in the organization of the, Surgeon General`sOffice, the use of specialists throughout the Medical Department, the procurementof medical officers and nurses, and the use of Medical Administrative Corpsand Sanitary Corps officers; psychiatry, including the use of modern psychiatricmethods and psychiatrists in the Medical Department, policies used by SelectiveService to preclude the entry of potential neuropsychiatric cases intothe Army, and provision for care of psychiatric casualties; procurementof medical supplies, including research, development, design, requirements,production followup, and inspection; operations, including operation ofdepots, distribution of medical supplies in the United States and overseas,mobilization, training, and plans for use of tactical units; hospital managementand operation; and vital statistics.8
Within a few days a brief, tentative plan, including suggestions formembership on the committee, was drawn up, presumably by the Control Division,Services of Supply. The committee contemplated was to include representativesof the following groups: The "elder statesmen" of Army medicine;the leading civilian medical authorities; the Services of Supply, includingrepresentation from the offices of the Assistant Chiefs of Staff for Personnel,Materiel, and Operations; and the Surgeon General`s Office. Certain namessuggested for the committee were: Maj. Gen. Merritte W. Ireland, MC (fig.37), formerly Surgeon of the American Expeditionary Forces in World WarI and later The Surgeon General; Col. William L. Keller, MC (fig. 38),Consultant to Walter Reed Hospital; and Dr. Louis I. Dublin, Director ofVital Statistics of the Metropolitan Life Insurance Co.
Colonel Keller and Dr. Dublin were among the group finally chosen, butthe complexion of the committee as a. whole was considerably differentfrom the one that General Somervell`s Control Division had planned. Thoseappointed were: Col. Sanford H. Wadhams, MC, USA (Ret.) (fig. 39), Chairman;Col. William L. Keller, MC, USA (Ret.) ; Dr. John Herr Musser, internist,Tulane University; Dr. Evarts Ambrose Graham, professor of surgery, WashingtonUniversity; Dr. Arthur Hiler Ruggles, psychiatrist, Butler Hospital, Providence,R.I.; Dr. J. Ben Robinson, Dean of the University of Maryland Dental School;Dr. James Hamilton, Superintendent of New Haven Hospital; Dr. Louis 1.Dublin; Dr. Lewis H. Weed, Director, Medical School, The Johns HopkinsUniversity; Mr. Corrington Gill, Consultant to the Wax Department sinceMay 1942.9
8Memorandum, Commanding General, Services ofSupply, for Director, Control Division, Services of Supply, 25 Aug. 1942,subject: Survey of the Surgeon General`s Office.
9Committee to Study the Medical Department, Report, Tab: Authorityof Committee.
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The committee thus consisted of six civilian doctors, two retired Armydoctors, one hospital administrator, and only one man, Corrington Gill,who can be said to have been primarily interested in the administrationof the Surgeon General`s Office as it affected the Services of Supply.Mr. Gill was an economist and statistician, a specialist in unemploymentproblems, and a top-level Government administrator. He had held major postsin the Federal Emergency Relief Administration and the Works Progress Administrationand recently in the Office of Civilian Defense. Dr. Weed acted as The SurgeonGeneral`s representative on the committee. Colonel Keller had been an operatingsurgeon with the American Expeditionary Forces in France in World War I;Colonel Wadhams had been Deputy to the Chief Surgeon, American ExpeditionaryForces. Two members of the committee, Dr. Hamilton and Dr. Graham, hadbeen suggested to the Secretary`s office and to the Commanding General,Services of Supply, by Mr. G. K. Dorr, one of the Secretary`s assistants.Former Surgeon General Merritte W. Ireland had also been consulted, atthe suggestion of the Chief of Staff, in the selection of the committee.10
10(1) Memorandum, G. K. Dorr, for General Somervelland Harvey H. Bundy, 29 Aug. 1942, subject: Personnel Survey Group-MedicalSituation. (2) Memorandum, Chief of Staff, for General Pershing, 27 March1943. (3) Interview, Brig. Gen. Albert G. Love and Maj. Gen. Merritte W.Ireland, 2 Dec. 1947.
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On 24 September, the day before the first meeting of the committee,the Secretary of War announced to the press that he had appointed a committeeof well-known medical men at the request of General Somervell and GeneralMagee to study the medical service of the Army. He stated that the mainpurpose of the study was to assure Army personnel the best of medical careand to aid the Medical Department "to maintain the high standardsof professional efficiency and devotion which have been the finest traditionsof the American medical profession and of the Medical Department of theArmy." General Magee, however, had had nothing to do with initiatingthe investigation and had been informed of it only shortly before the committeewas actually appointed.11
Between 25 September and 24 November, when the Committee to Study theMedical Department submitted its final report to General Somervell, thecommittee held a number of sessions, some on Saturdays and Sundays. Atthese, about 100 witnesses, including officers of the Medical Departmentand representatives of various offices of the War Department and otherGovernment agencies concerned in some way with the medical service of theArmy, appeared and
11(1) Transcript of Press Conference of Secretaryof War, 24 Sept. 1942. (2) See footnote 10 (3), p. 150.
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gave oral testimony.12 Nearly all of the Army medical officerscalled appeared originally during the first 3 days` sessions of the committee,but The Surgeon General and a few others were recalled for questioning.Medical Department officers who appeared before the committee included,in addition to The Surgeon General and his executive officer, the chiefsof services and directors of divisions in the Surgeon General`s Office;the Ground Surgeon; the Air Surgeon; the Chief of the Medical ResearchDivision of the Chemical Warfare Service; the surgeons of the First, Second,Third, Fourth, and Fifth Service Commands; and the Chief of the Hospitalizationand Evacuation Branch, Services of Supply. With some of these a few assistants,officers or civilians, also appeared. Representatives of the followingorganizational elements of the Services of Supply testified at committeehearings: The Control Division, the Military Personnel Division, and theSpecial Service Division, each represented by its director; the InternationalDivision, represented by the director and other officers; the Fiscal Division;and the Purchases Division.
The Surgeon General of the Navy, Rear Adm. Ross T. McIntire, and theSurgeon General of the U.S. Public Health Service, Dr. Thomas Parran, alsoappeared before the committee. Selective Service was represented by itsdirector, Maj. Gen. L. B. Hershey, and two Army medical officers assignedto that organization. Brig. Gen. F. T. Hines appeared as the Administratorof Veterans` Affairs and Chairman of the Federal Board of Hospitalization.
12The testimony was recorded, but extant copiesshow that certain subjects were discussed "off the record."
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Mr. Paul V. McNutt, then Administrator of the Federal Security Agency,Director of Defense Health and Welfare Service, and Chairman of the WarManpower Commission, testified, together with a. number of doctors andother assistants of the Procurement and Assignment Service. Dr. GeorgeBaehr, Director of the Medical Division of the Office of Civilian Defense,represented his organization. Miss Mary Beard, the Director of Nursingof the American National Red Cross, together with representatives of otheragencies concerned with nurses, discussed nursing problems. A few doctorsof the National Research Council, the Rockefeller Foundation, and the U.S.Public Health Service testified as experts on certain technical medicalproblems, particularly problems of disease. Another witness was Dr. MorrisFishbein, editor of the Journal of the American Medical Association.13
Some witnesses read written statements, while others made informal oralstatements. All were questioned by various committee members who resummonedsome witnesses and put to them formally prepared questions. Many MedicalDepartment officers supported their statements to the committee, or furnishedsupplementary information, by means of organization charts, summaries ofthe assignments or functions of various officers, and histories of theplanning and work of their divisions from the outset of the emergency.Mr. Gill instituted further inquiry into certain points made by MedicalDepartment officers, calling for memorandums to supplement their oral statements.A document of major significance in the records of the committee was areport signed by Mr. Gill and based on the files of the Hospitalizationand Evacuation Branch of the Assistant Chief of Staff for Operations, Servicesof Supply, which stated that the Services of Supply had found it necessaryto formulate plans and policies for which The Surgeon General was responsibleand had had to follow up its directives to the Surgeon General`s Officerepeatedly in order to obtain definitive action. A lengthy reply by TheSurgeon General was of similar importance.14
Four administrative surveys initiated by Headquarters, Services of Supply,prior to the convening of the committee on 25 September were consideredpart of the investigation. About the middle of August the Director of thePurchases Division of the Services of Supply, Col. (later Brig. Gen.) A.J. Browning, had initiated a study of the Supply Service of the SurgeonGeneral`s Office. When the committee convened, some of his staff were inthe midst of this survey, which included a survey of the New York and St.Louis Procurement Offices as well as of the Supply Service of the SurgeonGeneral`s Office. A Special Consultant to the Secretary of War, H. AlexanderSmith, Jr., was engaged in a study of possible duplication of activitiesby the Surgeon General`s Office and the Office of the Air Surgeon. A thirdsurvey Was a study of the Control Division, Surgeon General`s Office, undertakenby the Director
13Committee to Study the Medical Department,1942, Report, Tab: Index of Witnesses.
14The Surgeon General`s reply was prepared by Tracy S. Voorhees,according to Voorhees` statement to the author, 22 Sept. 1950.
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of the Control Division, Services of Supply. This survey had resultedfrom a statement by General Somervell on 9 September that the work of theControl Division, Surgeon General`s Office, had not been satisfactory andhis request, that General Magee remove its director on the ground of unsuitabilityfor the position. Finally, Mr. Gill, after discussion with The SurgeonGeneral, had assigned John C. Russell, then with the Fiscal Division, Servicesof Supply, and a small staff of technicians in public administration andbusiness management to survey the following organizational elements ofthe Surgeon General`s Office The entire Personnel Service; the Fiscal Division,then at staff level; and one division of the Administrative Service, theOffice Administration Division. These organizational units were concernedwith general administrative functions rather than with medical or medicomilitaryproblems.15
In addition to its other activities, the committee visited and inspectedvarious medical installations in the service commands, including LovellGeneral Hospital at Camp Devens, Mass., and LaGarde General Hospital andLivingston Station Hospital in Louisiana. At the committee`s request theSpecial Service Division, Services of Supply, conducted a poll of some5,000 soldiers in 14 camps to determine the opinion held by enlisted menof the medical care they were getting in the Army.16 However,the committee appears to have relied mainly on the oral testimony, thefour formal surveys, and the other supporting documents mentioned, andnot to have acquired any great amount of firsthand information on the efficiencyof the functioning of medical installations and the quality of medicalservice rendered in the United States. Nor did the committee`s inquirytouch upon any phase of medical work in the theaters of operations exceptas it brought out policies established by the Surgeon General`s Officewith respect to theater medical service.
TESTIMONY ON ORGANIZATION AND ADMINISTRATION
Some of the evidence presented to the committee dealt directly withorganizational matters: the internal structure of the Surgeon General`sOffice and the position of that office and of the offices of service commandsurgeons within Army structure. However, the bulk of it dealt with broadadministrative policies and plans with respect to the handling of medicalpersonnel and supplies, hospitalization and evacuation, and preventionof disease.
15(1)Committee to Study the Medical Department,1942, Testimony, pp. A-21,193-195. (2) Smith, H. Alexander, Jr.: ProposedTransfer of the Medical Department of the Army Air Forces to the Controland Authority of the Surgeon General`s Office, 15 Sept. 1942. [Officialrecord.] (3) Memorandum, Commanding General, Services of Supply, for TheSurgeon General, 9 Sept. 1942. (4) Memorandum, O. A. Gottschalk, SpecialAssistant, Control Division, Services of Supply, for Director, ControlDivision, Services of Supply, 24 Sept. 1942, subject: Report on ControlDivision, Surgeon General`s Office. (5) Russell,. John C.: Survey of Non-TechnicalSegments of the Surgeon General`s Office, 24 Sept.-10 Oct. 1942. [Officialrecord.]
16(l) Memorandum for record by Dr. Arthur H. Ruggles, no date,subject: Visit with Mr. James Hamilton to Camp Devens, Massachusetts. (2)Memorandum for record by Dr. J. H. Musser, no date, subject: Visit to LouisianaHospital Installations. (3) Committee to Study the Medical Department,1942, Report, Tab: Introduction.
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Internal Administration of the Surgeon General`s Office
The Control Division.-The Control Division was discussed beforethe committee by its director, Col. John Welch, MC, who summarized his6 months` experience as head of it. He stated that he had not had sufficientcivilian personnel for the key positions in his division until July. Thesurvey by the Control Division, Services of Supply, of the Control Division,Surgeon General`s Office, concluded that progress in the latter had beenslow until after a July meeting of the control officers of all the servicescalled by the Control Division, Services of Supply. The survey found thatthe organization, staff, and program of the Control Division, Surgeon General`sOffice, were now of a quality to enable it to realize substantially theobjectives of the Control Division, Services of Supply, although a shortageof personnel still existed. It recommended that the personnel which thedivision had requested be approved at once, that its director remain inthe position for 60 days, and that the division`s work be reappraised atthat time.17
The Russell Survey.-The survey under the direction of Mr. JohnC. Russell, which covered the Personnel Service, the Fiscal Division, andthe Office Administration Division, reached certain conclusions not onlyon these segments, but also on the Control Division, and on administrativepractice in the Surgeon General`s Office as a whole. It included a studyof the following phases of administrative management: Office space; personnel,including numbers, rank of officers and grades of civilians, absenteeism,and so forth; filing systems and storage problems; use of production records;procedures and use of procedure manuals; and many other phases. It foundthat the Fiscal Division, newly established in July 1942 and now made upof 15 officers and about 120 civilians, was on the whole the best administeredof the segments surveyed. It had regular staff meetings with regular agenda.Its planning was well carried out, and its system of reporting to The SurgeonGeneral was adequate. The chiefs of its branches understood their placein the structure. The survey, as well as oral testimony before the committee,indicated that this division had been organized, and its branch officesin the service commands set up, in such a way as to coordinate the fiscalprogram of the Medical Department satisfactorily with the total programof the Services of Supply.
The survey found that the organizational plan for the Personnel Servicelaid down in August 1942 (chart 7) had not been fully put into effect.Although head of the entire Personnel Service, Col. (later Maj. Gen.) GeorgeF. Lull, MC (fig. 40), devoted his energies almost exclusively to the MilitaryPersonnel Division. The implication that the Services of Supply patternof organization was being willfully circumvented was probably justifiedto
17(1) Committee to Study the Medical Department,1942, Testimony, pp. 193-194; 1625ff. (2) Memorandum, Officer in Charge,Control Division, for Executive Officer, Office of The Surgeon General,24 Aug. 1942, subject : Request for Additional Personnel. (3) See footnote15(4), p. 154. (4) Memorandum, Director, Control Division, Services ofSupply, for The Surgeon General, 25 Sept. 1942, subject: Approval of Report.
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the extent that from the point of view of the Medical Department, theproblem of military personnel at that time was overriding. The survey wenton to show that the Nursing Division of the Surgeon General`s Office wasperforming duties which should have belonged to the Nursing Branch thathad never been established in the Military Personnel Division. On the otherhand, the old Reserve Division (chart 6) had never been abolished and stillhandled the procurement, classification, grading, appointment, and initialassignment of officers in the Army of the United States. Col. Francis M.Fitts, MC (fig. 41), though in name Director of the Military PersonnelDivision, the capacity in which Colonel Lull actually operated, in realityacted as the head of this old Reserve Division. According to the currentorganization chart, the latter should have been only a section of the CommissionedPersonnel Branch. Colonel Lull`s primary interest in the Military PersonnelDivision was reflected not only in his having narrowed the scope of hisown activities but also in the fact that the Director of the Civilian PersonnelDivision reported to the Surgeon General`s Executive Officer, Col. (laterBrig. Gen.) John A. Rogers, MC (fig. 42), rather than to Colonel Lull.The survey found supervision of civilian personnel functions by the ExecutiveOfficer the better procedure, pointing out that the combination of militarypersonnel and civilian
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personnel functions in one branch was rarely effective "inasmuchas the officer in charge is almost always interested in only the militaryactivities."
The survey found certain defects in the procedures of the Military PersonnelDivision: the lack of scheduled staff meetings, written procedures, clear-cutstatements of responsibility of officers, and production statistics, togetherwith the tendency of medical officers to perform routine or minor dutiesthat could be delegated to civilian clerks. The internal organization ofthe newly established Civilian Personnel Division, on the other hand, wasgiven a fairly clean bill of health on the grounds that its structure andfunctions, like those of the Fiscal Division, followed the standard patternadvocated by Headquarters, Services of Supply.
The Office Administration Division handled mail, records, and officesupplies, and reproduced and distributed documents for circulation throughoutthe Surgeon General`s Office. Hence the survey of this division dealt largelywith the efficiency of its procedures in handling and filing large quantitiesof records, adequacy of the division`s personnel, its use of statisticson workload and production, and like problems. Specific findings includedrecommendations for certain internal changes in procedures, as well asfor increased personnel, higher grades for civilian personnel, additionalspace, and better conditions of lighting and ventilation.
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Mr. Russell and his assistants arrived at certain Conclusions as tothe effectiveness of the Control Division through their contacts with officersand civilians in the divisions which they surveyed. They discovered a feelingof enmity on the part of some responsible administrators of the SurgeonGeneral`s Office toward the Control Division. Apparently Control Divisionpersonnel had emphasized the "control" aspects of their workinstead of trying to convince administrators of their ability to aid inimproving office procedures. The Russell Group apparently subscribed toGeneral Somervell`s belief in the potential efficacy of a control divisionand laid the blame for the unpopularity of the Control Division, SurgeonGeneral`s Office, at the door of its personnel.
The report of the Russell committee noted the following general defectsin the administration of the Surgeon General`s Office: The failure of theorganization chart of August 1942 to reflect the organization accurately;the lack of coordination in the office, by means of clearly written delegationsof responsibility, procedure manuals, and regular staff meetings; the lackof adequate support by higher echelons of programs developed in lower echelons;participation by medical officers in tasks not commensurate with theirtraining; the dearth of good work records and production statistics; andinadequate staffing. A good many difficulties had developed within theoffice, the report stated, because of a lack of understanding of the reorganizationof the Services
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of Supply and a failure to arrive at satisfactory relationships withvarious elements of the War Department. The report recommended the followingmeasures: The development of a logical organizational structure with writtendelegations of responsibility and commensurate authority; regular reportson program development and operations by the lower echelons to The SurgeonGeneral; transmission of proposed programs by The Surgeon General to divisionchiefs; the development of procedural manuals in major organizational units;and restatement of functions of the Control Division in providing managementtechniques. It also advocated the holding of regular staff meetings byThe Surgeon General and the initiation of a series of conferences withHeadquarters, Services of Supply, and other offices to bring about awarenessof the Army`s current medical problems. It proposed a survey of requirementsfor personnel in the higher grades in order to determine the relative needsfor medical and administrative officers.18
The Nursing Division.-Testimony with respect to the Nurse Corpsestablished the fact that the Nursing Division of the Surgeon General`sOffice was largely an office for procuring nurses and keeping personnelrecords on nurses. The committee probed into the part played by the RedCross in the recruitment of nurses for the Army Nurse Corps. The AssistantSuperintendent of the Army Nurse Corps, Lt. Col. (later Col.) FlorenceA. Blanchfield, ANC (fig. 43, indicated some dissatisfaction with recruitmentby the Red Cross; some nurses objected to enrolling with the Red Crossfor fear that they would be called by this organization for relief workin case of disaster instead of for work with the Army medical service inwhich they were interested. The National Director of Nursing of the AmericanNational Red Cross and Miss Mary Switzer, Special Assistant to Mr. McNutt,stated their conviction that the Red Cross was doing a more effectual checkon nurses` qualifications than the Army Nurse Corps was presently equippedto do. General Magee took the position that the Red Cross was doing aneffective job which he did not wish to disrupt and that the assumptionof direct recruitment of nurses by the Army Nurse Corps would entail anenormous amount of work.19
Supply Service.-With regard to medical supply, the Chief of theSupply Service, Surgeon General`s Office (Col. Francis C. Tyng, MC), notedthat the War Department was now faced with "a grave emergency in procurementand distribution of medical supplies." This situation he attributedto two factors: insufficient money appropriated during the emergency periodas a result of public doubt that the United States would enter the war,and the lack of per-
18(1) See footnote 15(5), p. 154. (2) Committeeto Study the Medical Department, 1942, Testimony, pp, 617-648; 1246. (3)Memorandum, Director, Fiscal Division, Office of The Surgeon General, forDirector, Historical Division, 31 Oct. 1942, subject: Report on AdministrativeDevelopments in Fiscal Division. (4) Memorandum, Brig. Gen. C. C. Hillman,MC, for Corrington Gill, 26 Oct. 1942, subject: Data for InvestigatingCommittee. (5) Memorandum, Maj. Gen. James C. Magee, for the Secretaryof War, through Commanding General, Services of Supply, 14 Sept. 1942,subject: Requirements in Personnel and Space in The Surgeon General`s Office.
19Committee to Study the Medical Department, 1942, Testimony,pp. 563-601; 751ff.; 1135-1159; 1667-1726.
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sonnel in the Supply Service, Surgeon General`s Office, the procurementoffices, and the depots. Lack of personnel he regarded as the most Seriouscurrent threat to the medical supply program. Any deficiencies that mightexist in the records on medical supply he attributed to that factor. Heasserted that a loss of civilian personnel in the New York ProcurementOffice had resulted from the stud by the Services of Supply advocatingconsolidation of the New York Office with the St. Louis Office. The "freeze"on civilian personnel in the War Department had prevented obtaining thelarge numbers of additional civilian clerks which he had recommended forall the medical supply offices. He pointed out that his International Divisionhandling lend-lease medical supply was operating a $200 million businesswith 5 officers and 17 clerks. He lacked men in the executive class, difficultto get in any case because of the financial loss they would incur if theyleft good positions to enter the Army, and presently impossible to getbecause of the limitation on the number of officers in the Surgeon General`sOffice.20 Much further difficulty had come about, he stated,as a result of failure by foreign governments to state their total
20Mr. Gill informed the committee on the dayfollowing Colonel Tyng`s statements that General Somervell had authorizedthe immediate commissioning of 40 additional officers for the PurchasingDivision of the Supply Service.
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requirements for lend-lease medical supplies. Requisitions to date hadbeen spot demands, and some had been exorbitant. A few, indeed, had beenfor quantities of certain items in excess of total U.S. production, whileothers had been for items not procurable in any foreign market then accessible.The White House transmitted these requests as firm requirements, althoughthey had not been reviewed by experts in medical Supply.21
Colonel Tyng and other witnesses stated that the complicated handlingof lend-lease requisitions had also hampered the medical supply program.Representatives of the International Division, Services of Supply, pointedout Obstacles created by the earmarking of specific stockpiles of medicalsupplies for certain countries. They stated that a general lend-lease medicalstockpile, to be held in the custody of The Surgeon General physicallyseparated from Army medical stores, was being created. The system of ageneral stockpile had worked well for the other services, but the MedicalDepartment had been tardy in adopting this arrangement because, accordingto Col. (later Brig. Gen.) John B. Banks, Director of the InternationalDivision, Services of Supply, it was "one of the last services toreally appreciate the importance of lend-lease and its effect on the wholeWar Department program."22
Col. Albert J. Browning, Director, Purchases Division, Office of theAssist- ant Chief of Staff for Materiel, Services of Supply, and Lt. Col.(later Col.) Bryan Houston, Chief of the Purchase Service Branch of thatdivision, agreed with Colonel Tyng that the medical supply procurementprogram had been understaffed both in Washington and in the procurementoffice and depots. Colonel Browning also agreed that exorbitant lend-leasedemands had had a seriously adverse effect upon procurement. He statedthat inventory records of medical supplies in the depots were not in verygood shape and attributed the unsatisfactory situation largely to lackof civilian clerks for medical supply duties in the depots. (Colonel Tyngstated that the records were in good shape in all depots except the St.Louis Medical Depot.) Colonels Browning and Houston also noted that theresponsibilities laid upon medical supply officers, including accountabilityfor expenditure of large sums, were heavy in proportion to the militaryrank of these officers. The procurement job of Colonel Tyng was likenedto that of the heads of such large concerns as Montgomery Ward & Co.,Inc.23
Two steps toward solving the problems of the Supply Services were takenbefore the investigating committee made its final report. On 1 Octoberits needs for officer personnel, established by surveys by the Servicesof Supply and the committee testimony, were recognized; the allotment ofofficers for the Supply Service, Surgeon General`s Office, and for theNew York and St. Louis Procurement Offices was increased by 163. Then,in November, at the sugges-
21(1) Committee to Study the Medical Department,1942, Testimony, pp. 93-136. (2) Letter, Col. F. C. Tyng, MC, to ChiefSurgeon, European Theater of Operations, 18 Oct. 1942.
22Committee to Study the Medical Department, 1942, Testimony,pp. 126-131; 1183-1214.
23Committee to Study the Medical Department, 1942, Testimony,pp. 1215-1245; 2074-2104.
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tion of Col. Tracy Voorhees, JAGD, Director of the Legal Division, SurgeonGeneral`s Office, General Magee appointed Mr. Edward Reynolds, presidentof the Columbia Gas & Electric Corp., as special assistant to The SurgeonGeneral in the procurement of medical supplies. Under ordinary circumstances,General Magee told the committee, he still believed that medical suppliesand equip-ment could be more effectively procured by medical officers whohad been given some specialized business training than by businessmen,no matter how experienced, who had no medical knowledge. But the circumstanceswere not ordinary, and he now thought it best to obtain a businessman ofthe type widely used by various Government agencies. He recognized thata man "primarily trained in executive duties of great magnitude"should act for him in all the nonprofessional aspects of procurement ofmedical supplies.24
Professional Service.-The committee inquired into the most recentre-organization of the Surgeon General`s Office whereby former "Services"performing professional work had been placed under the Professional Service.Brig. Gen. Raymond A. Kelser, VC, Director of the Veterinary Division,expressed the opinion that going through an intermediary (the Chief ofProfes-sional Service) to The Surgeon General for decision might conceivablyslow up the work of his division. Brig. Gen. Robert H. Mills, DC (fig.44), Director of the Dental Division, took much the same position and addedthat reduction from a Dental Service to a Dental Division tended to lowerthe status of dentistry. The Director of the Control Division, SurgeonGeneral`s Office, defended the recent reorganization of the Surgeon General`sOffice, which had brought about these changes, on the grounds that it aimedat decentralization, a basic concept of General Somervell`s, and had beenapproved by the Control Division, Services of Supply.25
Place of the Medical Department in War Department Structure
Much discussion took place with respect to the place of the MedicalDepartment and of The Surgeon General within the War Department. Medicalofficers stressed the difficulties of the Medical Department in operatingunder the War Department reorganization of the preceding March and potentialhindrances created by the more recent service command reorganization ofAugust. Their statements were in part supported by the heads of other largeGovernment medical programs. Some. medical officers, particularly thoseof the Preventive Medicine Division, declared that negative or delayeddecisions by higher War Department authority had interfered with certainof their recommendations-those aimed at maintaining standards of properdisinfection
24(1) Memorandum, Col. A. J. Browning, Director,Purchases Division, Services of Supply, for Committee Appointed to Studythe Medical Department of the Army, 5 Nov. 1942, subject : Surgeon General`sSupply Service. (2) Committee to Study the Medical Department, 1942, Testimony,pp. 1667-1726. (3) Letter, Maj. Gen. James C. Magee, to Col. Sanford H.Wadhams, 10 Nov. 1942. (4) Interview, Tracy S. Voorhees, 22 Sept. 1950.
25Committee to Study the Medical Department, 1942, Testimony,pp. 508; 538-539; 1625-1666.
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of dishes in messhalls and sufficient airspace in barracks, for example.The Surgeon General and most of his staff emphasized various difficultiescreated by the following developments: The subordination of The SurgeonGeneral and his office to the Services of Supply and the consequent strengthenedautonomy of medical administration in the Army Air Forces; the Servicesof Supply policy of decentralizing many matters to the service commands;loss by the Surgeon General`s Office of control over transfer and reassignmentof individual medical officers; and the subordination of the service commandsurgeon to a position in which he was answerable to the head of a divisionat service command headquarters rather than to the commanding general ofthe service command. Officers of the Services of Supply countered withthe charge that medical officers of the Surgeon General`s Office did notunderstand the prevailing War Department organizational structure and hadnot mastered the tech-nique of accomplishing their medical aims throughthe proper channels.26
Maj. Gen. (later Lt. Gen.) Wilhelm D. Styer, Chief of Staff, Servicesof Supply, informed the committee that a study of the testimony showedthat various officers in the Surgeon General`s Office had failed to graspthe funda-
26Committee to Study the Medical Department,1942, Testimony, pp. 167-193; 245; 273-280; 769-813.
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mental principles of the current War Department structure. Commandinggenerals of service commands, he said, were direct subordinates of theCommanding General, Services of Supply, and were his field representatives.The Surgeon General was the staff agent of the Commanding General, Servicesof Supply, in the direction of functions relating to the health of theArmy. "The authority and responsibility of The Surgeon General forthe maintenance of the health of the Army and the conduct of medical activitiesnecessary to the full accomplishment thereof is that of the CommandingGeneral, Services of Supply." Hence, General Styer pointed out, theServices of Supply Organization Manual clearly gave The Surgeon Generalthe authority to issue instructions to the commanding generals of the,service commands in his own name under the authority of the CommandingGeneral, Services of Supply, either with or without invoking such authority.27
General Styer went on to say that for the exercise of authority withrespect to medical matters in the field forces (the Army Ground Forces,defense commands, and theaters of operations), The Surgeon General hadto deal with the Commanding General, Services of Supply, and the War DepartmentChief of Staff. The Surgeon General had authority, however, to issue instructionson technical medical matters directly to the surgeons of these commands.For the exercise of authority over matters of Army-wide application, TheSurgeon General similarly submitted recommendations through General Somervellto General Marshall. However, it was his responsibility at all times tocall to the attention of the latter (through General Somervell) all mattersrequiring corrective action which were beyond his power to remedy. TheSurgeon General had no authority over the internal organization of servicecommands, General Styer pointed out. The current scope of Army activitiesmade direct control from Washington over movement of personnel within aservice command and from one service command to another impractical. Nevertheless,in practice, he stated, the recommendations of The Surgeon General werefollowed on all matters involving medical activities in the field, includingthe transfer of medical specialists.
Service command surgeons noted their lack of control over certain medicalinstallations and offices within the boundaries of their respective servicecommands, especially station hospitals controlled by the Army Air Forcesand those assigned to the ports of embarkation. The Surgeon, Second ServiceCommand, for example, thought that the staffs of these two types of hospitalsshould come under his control. In other words, the service command surgeonsargued for control of all Army medical service within the service commandto which they were assigned .28
Position of The Surgeon General.-As to the position of The Surgeon
27(1) Memorandum, Maj. Gen. W. D. Styer, forCorrington Gill, 14 Oct. 1942, subject: Authority and Responsibility ofThe Surgeon General. (2) Services of Supply Organization Manual, 10 Aug.1942, sec. 403.02.
28Committee to Study the Medical Department, 1942, Testimony,pp. 1341-1519.
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General within the War Department structure, several witnesses, includingthe Air Surgeon, expressed the opinion that The Surgeon General was hamperedin the performance of his duties by lack of access to the Secretary ofWar. They contrasted his position with that of the Surgeon General of theNavy, Admiral Ross T McIntire, who had direct access to the Secretary ofthe Navy. Admiral McIntire expressed the opinion that the placing of theSurgeon General`s Office under the Services of Supply organization wasa mistake, as it added another echelon to the channels above. He thoughtthat, while decentralization of responsibilities for the procurement ofmedical supplies might work well, centralized control over personnel wasvital. In the prevailing organization of the Navy, he had full power ofappointment and re-moval of medical officers on ships and of district medicalofficers. Members of the committee evinced strong interest in this matterof the position of The Surgeon General within the War Department. Questioned,General Magee expressed the opinion that he should be on the War DepartmentSpecial Staff.29
A few witnesses ventured an opinion as to the personality of the presentSurgeon General. Dr. Harvey Stone of the Procurement and Assignment Service,War Manpower Commission, thought that The Surgeon General and his officehad not been sufficiently aggressive in asserting their rights.
Both Lt. Col. Bryan Houston, Chief of Purchase Service Branch, PurchasesDivision, Services of Supply, and Col. A. J. Browning, Director, PurchasesDivision, Services of Supply, believed that The Surgeon General had notbeen aggressive enough in his requests for personnel-a failing attributedby Colonel Houston to General Magee`s medical education.30
Relations with the service command surgeons.-The surgeons ofservice commands (First, Second, Third, Fourth, and Fifth), called in togive their opinion of the most recent service command reorganization, werein general agreement that the scattering of medical functions through variousdivisions (supply, personnel, training, and so forth) of the office ofthe commanding general of the service command was unsatisfactory. Someservice command surgeons were placed under the chief of the supply divisionor the chief of the personnel division of service command headquartersinstead of directly under the commanding general. Although they found theirsituations agreeable, as their commanding generals and chiefs of the divisionsunder whom they immediately functioned let them run their medical servicewithout serious interference31 they agreed that the presentorganizational scheme was fraught with danger. They found it hard to maintaincontrol over medical personnel assigned to divisions of the service commandother than the one in which they
29Committee to Study the Medical Department,1942, Testimony, pp. 128ff.; 727ff.; 906-939; 1008-1043; 2039-2074.
30Committee to Study the Medical Department, 1942, Testimony,pp. 730ff.; 1215-1245.
31Col. Sanford W. French, MC, Surgeon, Fourth Service Command,dissented from the general view. He regarded the existing organizationas both theoretically and personally unsatisfactory. See Committee to Studythe Medical Department, 1942, Testimony, pp. 1451-1489.
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themselves were placed. An organization so wholly dependent upon closecooperation of officers immediately above them was ill-advised, they thought.
Most officers of the Surgeon General`s Office agreed with this pointof view. The chief of the Operations Service declared that there was notrue service command surgeon in the former sense of the title. He was onlya senior medical officer heading the medical branch of a division of theservice command. General Magee noted that he had already recommended toGeneral Somervell that all medical personnel in the service command beplaced under the direct authority of the senior medical officer there,with the latter as head of a medical division and on the special staffof the commanding general.32
Officers of the Services of Supply tended to minimize the difficultiescaused the Medical Department by the recent reorganization of the servicecommands. Col. Kilbourne Johnston of the Control Division, Services ofSupply, declared that although medical responsibilities had been splitamong three or more divisions in the service commands, the commanding generalof each service command used his senior medical officer as his adviseron all medical matters throughout the command. Colonel Johnston drew adistinction between the position of service command surgeon and post surgeonwhich, he stated, had been a factor in changing the position of servicecommand surgeon, while the post surgeon had remained in staff relationshipto the post commander. The work of the post surgeon, who would likely haveresponsibility for running a large hospital with 50 or more doctors andwas charged with large medical supply and distribution functions, was anoperating job. The post surgeon should therefore be on the staff of thepost commander (who reported in turn to the service commander) and shouldset up the large medical operation under him to suit himself. The functionof the service command surgeon, on the other hand, as Colonel Johnstonconceived it, was almost entirely that of an inspector. He expressed doubtas to whether the incumbents of the positions of service command surgeonswere the best administrative types that the Surgeon General`s Office couldproduce.33
Officers of the Surgeon General`s Office stressed their loss of controlover certain medical matters within service commands and certain problemsarising between, service commands as a result of the present organizationof the War Department. General Hillman, Chief of Professional Service,thought that the loss of control over personnel in the service commandsby the Surgeon General`s Office to the commanding general of the servicecommand, plus the split of medical functions among service command divisionshandling personnel, supply, training, and others, had resulted in separatinghimself from the men doing the professional work for which he was heldresponsible. Channels of communication were more circuitous than formerly.Letters on personnel matters arrived from the service commands withoutindication of any partici-
32Committee to Study the Medical Department,1942, Testimony, pp. 46-47; 2039-2074.
33Committee to Study the Medical Department, 1942, Testimony,pp. 769-813.
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pation by service command surgeons. The prevailing service command organizationled to confusion and delay.34
The Surgeon General`s staff voiced discontent at their loss of controlover the assignment and use of medical personnel once the latter were assignedto a service command. The commanding general of a service command couldmove a medical officer assigned to his service command about within hisarea at will, and the Surgeon General`s Office could not transfer him toanother service command where he might be more needed. The Director ofthe Training Division stated that since the March reorganization of theWar Department, The Surgeon General had no authority to order a particularindividual to fake a particular course of training. Nor could he specifythe locality where an individual trained in tropical medicine at the ArmyMedical Center should go to make use of that training. Once the traineecompleted his course he was returned to service command control, whetheror not the service command had any use for his most recent training. ColonelLull noted that he could send the record of a man`s special qualificationswith him upon the latter`s initial assignment to a service, command, butcould not insure that these qualifications were taken into considerationin any reassignment the man received. In moving men from one service commandto another, he had to specify the number of men and their grade or rankand could not request individuals by name. It was up to the service commander,presumably with the advice of his surgeon, to pick out the men to be transferred.35
Services of Supply officers declared that the real authority for transferof a medical officer rested with General Somervell. They noted that theServices of Supply preferred the handling of transfers in terms of theassignments to be filled rather than in terms of individuals to be moved.It was precisely this Point that the Medical Department disputed. The SurgeonGeneral main-tained consistently that his office needed to control theassignment of individual doctors in order to use their specialized trainingeffectively. The Services of Supply, on the other hand, regarded the assignmentof medical personnel as only one phase of its larger job of staffing theservice commands and their installations. If The Surgeon General founda service command surgeon objectionable, he should call the commandinggeneral of the service command on the telephone or talk the matter overwith the Military Personnel Division, Services of Supply, and convincethem of the need for a transfer. In the event of a disagreement betweenThe Surgeon General and the commanding general the surgeon could be orderedout by Headquarters, Services of Supply.36
Col. Harry D. Offutt, MC, Director of the Hospitalization and EvacuationDivision, pointed out a dual threat to the work of his division in theloss of control over personnel assigned to service commands plus the recentloss of
34Committee to Study the Medical Department,1942, Testimony, p. 1803ff.
35Committee to Study the Medical Department, 1942, Testimony,pp. 78-79; 1738-1754.
36Committee to Study the Medical Department, 1942, Testimony,pp. 167-193; 769-813.
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control of general hospitals to the service commands. A plan of TheSurgeon General to concentrate specialists in certain diseases or injuries-ofthe chest, for example-in a general hospital in order to equip it to givethe best possible treatment in a specialized field might be thwarted bythe removal of personnel from this hospital to some other installationby the service commander.37
Relation with the Army Air Forces.-The semiautonomy of the ArmyAir Forces medical service became the subject of much discussion. In histestimony before the committee, Brig. Gen. David N. W. Grant, MC, the AirSurgeon, attempted to justify the separatist tendencies of Army Air Forcesmedical personnel on the usual grounds: the "peculiar" stressesto which flying personnel were subjected; the necessity for giving specialtraining in aviation medicine to doctors who were to deal with their healthproblems; the need for special physical and psychological tests for airpilots, bombardiers, and gunners and for training men to devise and administerthem; and, finally, the favorable atmosphere for the flowering of the newscience of aviation medicine created by the independence of the medicalorganization of the Army Air Forces from the Surgeon General`s Office.He declared that airmen needed, individual medical attention, that a medicalofficer in the Army Air Forces should be a "loyal and integral member"of that combat arm, and that the Army Air Forces should operate its ownhospitals so that flight surgeons could be intimately associated with theactivities of these hospitals.38
General Grant maintained that his office was doing a more effectivejob than that of The Surgeon General, and attributed this claim to twomajor factors: too great subordination of The Surgeon General, as wellas the service command surgeons, under the existing scheme of War Departmentorganization and the inefficiency of certain segments of the Surgeon General`sOffice. Alluding to the position of the Medical Department under the Servicesof Supply, he justified control of hospitals by the Army Air Forces onthe ground that the Surgeon General`s Office was not "functioningunder the medical profession" but was "controlled by the commands."He emphasized his own relatively advantageous position on the staff ofthe Commanding General, Army Air Forces. He also pointed to the lowly positionof the service command surgeon under a supply or personnel division comparedwith his former position as a staff officer for the commanding generalof the service command.
General Grant justified direct recruiting of medical personnel by hisoffice oil the grounds that the Surgeon General`s Office had f ailed tofurnish him with sufficient medical personnel. He charged the MilitaryPersonnel Division of the Surgeon General`s Office with loss of papersrelating to applicants for commissions and made similar strong chargeswith respect to the Nursing Division. He could not get the nurses neededby the Army Air Forces because they had been "lost in the Nurse Corps."He stated that in answer to charges
37Committee to Study the Medical Department,1942, Testimony, pp. 199-215.
38Committee to Study the Medical Department, 1942, Testimony,pp. 814-823.
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sometimes made by members of the Surgeon General`s Office that he haddisrupted their service, he had replied that his service was working whiletheirs was not. He quoted a complaint of the European theater surgeon,Brig. Gen. (later Maj. Gen.) Paul R. Hawley, MC (fig. 45), that the ArmyAir Forces had furnished medical supplies through its own channels to airforce troops by air delivery in England. General Hawley had protested thatthe sick doughboy was entitled to as good service as the aviator. GeneralGrant countered with the claim that his separate furnishing of medicalsupplies in the European theater proved the superior functioning of themedical service in the Army Air Forces.39
General Magee saw no reason for the separatism of the medical serviceof the Army Air Forces, for only two phases of its work could be consideredpeculiar to the Army Air Forces-the work of the flight surgeon and theconduct of investigative medicine related to aviation-and these had beencustomarily delegated to the Air Forces. The treatment of sick aviatorsand "sick ground airmen," he thought, should be the same as thatof any other soldiers. In his opinion, service command surgeons shouldsupervise and
39Committee to Study the Medical Department,1942, Testimony, p. 128ff.
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direct technical procedures in hospitals at stations of the Army AirForces as well as the Army Ground Forces.40
Officers of the Surgeon General`s Office pointed out several difficultieswhich they had encountered in making their policies effective throughoutthe War Department and the Army. Although these were matters of medicaladministration in the service commands, they stemmed primarily from thetop organizational structure of the War Department and the semiautonomyof the Army Air Forces. One complaint was lack of control of medical personnelassigned to the Army Air Forces. Colonel Lull, Chief of the Personnel Service,Surgeon General`s Office, pointed out that he had no say as to the reassignmentof medical personnel once they had been initially assigned to the ArmyAir Forces. In other words, no one office in the War Department was ina I position to make effective reassignments in order to make the, bestuse of medically trained men.41 Another problem was lack ofcontrol over activities of Air Forces medical installations. The directorof the Dental Division noted that his dental officers assigned to the servicecommand surgeon could not inspect dental installations of the Army AirForces, although he could transfer dental personnel out of the Army AirForces to some other jurisdiction. The Chief of Professional Services stated:"Under the current Army organization the Medical Practice Divisionfeels decidedly out of touch with the actual professional work going onin our military hospitals." He was concerned over the effectivenessof the work of his consultants assigned to the service commands. The weaknessto which he called attention was that of confusion occasioned a technicalservice by overlapping commands within a given geographic area. The variouscommands set up by the Army Air Forces (Air Service Command, Flying TrainingCommand, and others) had their own area jurisdictions, cutting across theboundaries of the service commands. It was impossible to obtain enoughhighly trained specialists to assign to all the area divisions of thesecommands. To date, consultants in the three major specialties of internalmedicine, surgery, and neuropsychiatry had been assigned to the servicecommands with the greatest number of hospital beds, the Fourth, Seventh,Eighth, and Ninth. Service command surgeons were uncertain as to theirresponsibilities for furnishing the services of consultants to hospitalsvariously assigned to one or another of the Army Air Forces commands. Thedirector of the Veterinary Division, on the other hand, minimized difficultiesoccasioned the operations of the veterinary service by the current WarDepartment organization and complex channels of command. He believed thatthe standardized training given Army veterinary personnel enabled the VeterinaryDivision to maintain its standards of meat and dairy food inspection uniformlythroughout the various commands.42
40Committee to Study the Medical Department,1942, Testimony, pp. 1667-1726.
41Committee to Study the Medical Department, 1942, p. 244.
42Committee to Study the Medical Department, 1942, pp. 431;434-438; 509-511; 539-542.
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Col. Kilbourne Johnston of the Control Division, Services of Supply,maintained that the duplicate medical program conducted by the Army AirForces in the United States was not justified, noting that the Army GroundForces had not established a duplicate medical service. The division ofresponsibility for tactical medical units, whether of ground or air forces,as between the Services of Supply, on the one hand, and the Army Air Forcesand Army Ground Forces, on the other, was clear enough. Field armies andair forces admittedly should train their own medical units and controltheir own medical personnel, for they would be going overseas where theywould be under a theater commander. However, the Army Air Forces was nomore justified in maintaining its own hospitals than the Army Ground Forces.Although most representatives of the Services of Supply who appeared beforethe committee did not take any strong stand for or against the bid of theArmy Air Forces medical organization for independence, this question wasone on which the point of view of the Services of Supply largely coincidedwith that of the Surgeon General`s Office.43
H. Alexander Smith, Jr., consultant to the Control Division, Servicesof Supply, at first proposed, in his investigation into medical activitiesof the Air Surgeon`s Office in relation to those of the Surgeon General`sOffice, that matters be left as they were for the duration of the war.He noted that the Army Air Forces was contemplating the eventual establishmentof an Air Forces Medical Department entirely divorced from the Servicesof Supply to support an Army Air Forces entirely divorced from commandrelationship with the Army. The issue of eventual separation should notbe raised while the war was in progress, he thought; the duplication ofactivities was not great enough to warrant interference with the Army AirForces medical service, which was working effectively. By the end of September,however, he had apparently become somewhat more cognizant of the conflictsof authority and duplications of activities resulting from the currentorganization. Accordingly he proposed that the Air Surgeon be designated"Deputy Surgeon General for Air" and that his office and activitiesbe transferred from the command of the Army Air Forces to a position directlysubject to the authority of The Surgeon General. He was to act as an adviserto The Surgeon General on all routine medical activities of the Air Forcesbut to be directly responsible for all specialized medical activities peculiarto the Army Air Forces. In substance, this solution was backed by a subcommitteeof the Committee to Study the Medical Department, which was appointed toexamine further the medical activities of the Army Air Forces.44
43(1) Committee to Study the Medical Department,1942, Testimony, pp. 769-813. (2) Memorandum, Director, Control Division,Services of Supply, for Commanding General, Services of Supply, 21 Sept.1942, subject: Incidents Indicating Concerted Campaign of Army Air Forcesfor Independence.
44(1) Memorandum, H. Alexander Smith, Jr., for Col. KilbourneJohnston, 15 Sept. 1942, subject: Extent to Which the Army Air Forces ShallControl Its Medical Activities. (2) Memorandum, H. Alexander Smith, Jr.,for Col. C. F. Robinson, MC, 28 Sept. 1942, subject: Proposed Transferof Medical Department of Army Air Forces to Control and Authority of TheSurgeon General. (3) Memorandum, Col. Sanford Wadhams, for Commanding General,Services of Supply, 13 Nov. 1942.
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Relations with the Army Ground Forces.-Testimony with respectto the office of the surgeon of the Army Ground Forces indicated that relation-ships between his office and that of The Surgeon General had not led toany serious problems. Brig. Gen. Frederick A. Blesse, Surgeon, Army GroundForces, stated that his office was primarily concerned with seeing thattask forces being prepared to go overseas had everything they needed inthe way of trained medical men and supplies and equipment. The questionthat had come up earlier in the year as to the respective jurisdictionof the Army Ground Forces and the Services of Supply over tactical medicalunits had by now been largely settled, he thought, as the Army Ground Forcesnow had control of most tactical medical units which were normally assignedto armies in an oversea theater, while The Surgeon General controlled thenumbered station and general hospitals usually assigned to a services ofsupply. Unlike the Air Surgeon, the Ground Surgeon had done no direct recruitingof personnel.45
Relations with the Hospitalization and Evacuation Branch, Servicesof Supply.-The committee probed thoroughly into the relations of theHospitalization and Evacuation Branch (consisting of the HospitalizationSection and Evacuation Section) of the Plans Division, Services of Supply,with the Surgeon General`s Office. A good deal of rather fruitless discussiondeveloped over the interpretation of the following section in the Servicesof Supply Organization Manual of 10 August 1942. This read as follows:
(a) The Hospitalization Section reviews plans forand coordinates activities related to military hospitalization overseasand within continental United States; and insures provision of adequatemeans for military hospitalization.
(b) The Evacuation Section reviews plans for andcoordinates activities related to evacuation of sick, injured, and othercasualties from overseas and within the continental United States deliveredto the control of the Commanding General, Services of Supply; insures provisionof all means required for evacuation of sick and wounded; and coordinateswith Commanding General, Army Air Forces, on the development and operationof air evacuation.46
It was the duty of Headquarters, Services of Supply, as Colonel Wilson,Chief of the Hospitalization and Evacuation Branch, conceived it, to reviewplans of the Surgeon General`s Office, along with the plans of the othersupply services, and coordinate them; for example, to attune The SurgeonGeneral`s medical plans for certain oversea operations to the availabletransportation. He made the point that the staff officer had the responsibilityfor revising plans, for example, for a certain number of hospital beds,upward or downward. He declared that he was trying to protect the interestsand standards of the Medical Department, and that in taking that positionhe was sometimes under fire from staff officers. He advised the AssistantChief of Staff for Operations, General Lutes, to the best of his ability,but the latter as his superior had the power of
45Committee to Study the Medical Department,1942, pp. 409-426.
46Services of Supply Organization Manual, 10 Aug. 1942, sec.302.10 (6).
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decision. Whenever the Services of Supply lowered the standards of medicalcare or reduced the quantities of medical personnel or supplies, ColonelWilson was then blamed by the Medical Department, although the circumstanceswere beyond his control.
Theoretical discussion revolved around the word "insure" inthe passage above. Colonel Wilson interpreted the phrase "insuresprovision of adequate means" to mean that if the Surgeon General`sOffice did not make plans when it was asked to do so, it was the responsibilityof his office to make them. If plans had not been properly made, it wasthe duty of his office to revise them. Colonel Wilson expressed the opinionthat very few medical officers knew how to write papers addressed to staffofficers in such a way as to insure definite decision by that body. Inother words, many medical officers, he thought, had not mastered the techniqueof preparing memorandums and plans in the proper form for staff consideration.Thus, although the Surgeon General`s Office had not failed to make plansin the broad sense, it had failed to put its proposals in standard staffterms. Colonel Wilson attributed slowness in obtaining approval of certainpolicies, such as immunization of all Army troops against tetanus, to thisfailure.
Colonel Wilson thought that the General Staff had neglected the MedicalDepartment in the period prior to late 1940. In those days, when no MedicalDepartment officer had been assigned to that office, a nonmedical officerhad made staff decisions affecting the medical service. Colonel Wilsonemphasized the fact that in order to issue a directive binding on all concerned,the Medical Department had to get staff approval. It was better for a medicalofficer to be assigned to a position where he could exercise influenceover staff decisions on medical matters than for such decisions to be leftentirely to nonmedical officers.47
In General Magee`s interpretation, the phrase "insures provisionof adequate means for military hospitalization" meant that the Hospitalizationand Evacuation Branch would perform the necessary staffwork to insure thatThe Surgeon General`s recommendations were carried out by the War Department.Presumably Services of Supply headquarters had considered it desirableto establish a Hospitalization and Evacuation Branch in order to coordinatematters relative to the hospitalization and evacuation of the sick andinjured among the various services. The Surgeon General had had nothingto do with establishing the branch or with preparing the description ofits duties embodied in the Services of Supply Organization Manual. He hadassigned Colonel Wilson originally as a medical supply officer in G-4 andwould not have appointed him to his present position. The Hospitalizationand Evacuation Branch had undertaken to criticize recommendations by theSurgeon General`s
47(1) Committee to Study the Medical Department,1942, Testimony, pp. 1272-1340; 1869-1964. (2) Letter, Lt. Gen. LeRoy Lutes,to Director, Historical Division, Office of The Surgeon General, 8 Nov.1950.
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Office with respect to hospitalization and evacuation, and to supersedethese with recommendations of its own.48
The Chief of the Operations Service, Surgeon General`s Office, Brig.Gen. Larry B. McAffee, MC (fig. 46), declared that his group had alwaystried to cooperate with the Hospitalization and Evacuation Branch, Servicesof Supply, on matters of hospitalization and evacuation, but that in manyinstances Colonel Wilson`s policies had not represented those of The SurgeonGeneral. Colonel Wilson`s office had carried on actual medical operationsto a certain extent, he said, and had conducted activities for which TheSurgeon General was responsible, whereas in theory it was engaged in planningonly. General Magee also thought that Colonel Wilson had engaged in "operations";in his opinion an officer assigned to such a position should act as adviseronly and should express the views of the Surgeon General`s Office. Hisconcept differed markedly from that of Colonel Wilson (and presumably thatof Services of Supply officials), for Colonel Wilson consistently emphasizedthe fact that he acted under the direction of General Lutes. Undoubtedlythe fact that Colonel Wilson was junior to some of the officers whose workbe had criticized had added to the acrimony of the debates.49
48Committee to Study the Medical Department,1942, Testimony, pp. 2039-2074.
49Committee to Study the Medical Department, 1942, Testimony,pp. 1727-1728; 2010-2022.
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Charges embodied in a document, signed by Corrington Gill, consistingof briefs of memorandums from the files of Colonel Wilson`s office, reviewedthe major points of conflict between General Lutes` office and the Officeof The Surgeon General. These included some whose origin dated back tothe days when Colonel Wilson was assigned to G-4: the question of issuanceof unit equipment to troops, charges that the Surgeon General`s Officehad failed to make adequate hospitalization and evacuation plans, and soforth. The document concluded with a statement that the summaries provedthat the staff of the Services of Supply had found it necessary to formulateplans and policies which were obviously the responsibility of The SurgeonGeneral to prepare and that it had repeatedly had to follow up directivesissued to him in order to get action on them. The Surgeon General readbefore the committee a refutation prepared by Mr. Tracy S. Voorhees, thenin charge of the legal work connected with medical supply contracts. Thecommittee apparently reached the conclusion that this refutation, togetherwith additional evidence obtained from Colonel Wilson and The Surgeon Generalin reappearances before the committee, disproved the charges.50No mention of the charges or of the refutation appeared in the final reportof the committee.
FINAL REPORT OF THE INVESTIGATING COMMITTEE
The final report of the Committee to Study the Medical Department wassubmitted on 24 November 1942. It appeared in the form of sections entitled"Standards of Professional Service," "Adequacy of MedicalCare," "Adequacy of Hospitalization," and the like. Thethree copies of the report were given to officials of the Services of Supply.No full copy of the report was sent to The Surgeon General, but the Chiefof Staff, Services of Supply, forwarded to him, on 26 November, 85 of atotal of 98 detailed recommendations, for specific changes in organizationor policy which were within The Surgeon General`s power to put into effect.Those not sent him had to do mainly with relations with the Army Air Forcesand with the organizational position of The Surgeon General in the WarDepartment; they were mostly matters for decision of higher authority.51
50(1) Report to Committee to Study the MedicalDepartment by Corrington Gill, no date, subject: Data From Files of Hospitalizationand Evacuation Branch, Plans Division, Services of Supply. (2) Interview,H. Alexander Smith, Jr., 28 Oct. 1947. (3) Memorandum, The Surgeon General,for Col. Sanford H. Wadhams, 7 Nov. 1942, subject: Transmitting "CorrectingInformation to Confidential Document Submitted by Mr. Gill, entitled `Reportto Committee on Data from Files of Hospitalization and Evacuation Branch,Plans Division, Services of Supply.` " (4) Interview, Tracy S. Voorhees,22 Sept. 1950. (5) Report of Subcommittee to Examine Col. Wilson`s Criticismof the Surgeon General`s Office, no signature, no date.
51(1) Memorandum, Col. Sanford Wadhams, for Commanding General,Services of Supply, 24 Nov. 1942. (2) Memorandum, Chief of Staff, Servicesof Supply, for Commanding General, Services of Supply, 25 Nov. 1942. (3)Memorandum, Chief of Staff, Services of Supply, for The Surgeon General,26 Nov. 1942. (4) Memorandum for Record [by Corrington Gill], 12 Apr. 1943.(5) Memorandum, Director, Control Division, Services of Supply, for Chiefof Staff, Services of Supply, 29 Nov. 1942. (6) Memorandum, CommandingGeneral, Services of Supply, for Secretary of War, 16 Dec. 1942, subject:Report of Committee on the Study of the Medical Department of the Army.
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In early January, General Magee asked for a copy of the complete report,stating that the extracts which he had received gave only "an incompleteand unsatisfactory idea" of the findings. The Chief of Staff, Servicesof Supply, replied that Services of Supply headquarters must await releaseof the report by Secretary Stimson. Although General Magee brought furtherpressure, he did not receive the report at that time. Neither had membersof the committee received copies of the report, which they had signed underpressure of time without having an opportunity to read the final text.In February, Dr. Lewis H. Weed and Dr. Evarts A. Graham saw the Secretaryof War and asked that the report be released. . Former Surgeon GeneralMerritte W. Ireland complained to the Chief of Staff, General Marshall,of the aggressively critical attitude toward the Medical Department exhibitedduring the committee sessions by the Services of Supply representative,Mr. Corrington Gill, and of the failure to release the report. GeneralMarshall took these matters up with the Chief of Staff, Services of Supply.In the words of the latter, General Marshall was very much alarmed at thefact that this report had not been furnished to The Surgeon General."After reaching decision on major points raised by General Somervell, SecretaryStimson approved release of the report to The Surgeon General. Copies weresent to members of the committee on 25 February, and The Surgeon Generalapparently received a copy at that date or soon afterward.52
RECOMMENDATIONS AND ACTION TAKEN
As to the position of the Medical Department within the War Department,the committee declared that the medical service was a "highly developedprofessional service" rather than a supply service and could not operateeffectively within the present organization of the War Department. TheSurgeon General should be at staff level; surgeons in the Army Ground Forces,the Army Air Forces, oversea forces, and service command headquarters shouldalso have staff position. The committee found that the "existenceof a semi-independent Medical Department within the Air Forces" hadled to administrative confusion and duplication of effort. Every feasiblemeans should be used to bring the Army Air Forces` medical service underthe control of The Surgeon General or, failing this, a clear delineationof the Air Surgeon`s functions under The Surgeon General should be made.The report accordingly recommended that the Office of The Surgeon Generalbe placed on the special
52(1) Memorandum, The Surgeon General, forthe Commanding General, Services of Supply, 12 Jan. 1943. (2) Memorandum,The Surgeon General, for the Secretary of War, through the Commanding General,Services of Supply, 12 Jan. 1943, and indorsements. (3) Letters, Col. SanfordH. Wadhams, to Dr. Lewis H. Weed, 25 Nov. 1942, 1 Dec. 1942; Dr. Weed toCol. Wadhams, 28 Nov. 1942; Dr. Evarts A. Graham to Dr. Weed, 21 Jan. 1943,10 Feb. 1943, 3 Mar. 1943; Dr. Weed to Dr. Graham, 13 Feb. 1943. Personalfile of Dr. Lewis H. Weed. (4) Memorandum, Chief of Staff, Services ofSupply, for Commanding General, Services of Supply, 16 Feb. 1943, and inclosures,subject: Publicity Regarding Medical Department. (5) Memorandum, Chiefof Staff, for H. H. Bundy, Special Assistant to Secretary of War, 25 Feb.1943.
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staff of the Chief of Staff that a position of Chief Surgeon, Servicesof Supply (with rank and responsibilities corresponding to those of theAir Surgeon and the Ground Surgeon), be created on the staff of the CommandingGeneral, Services of Supply, and that a unified medical division be setup in each service command, headed by a surgeon on the staff of the commandinggeneral.
As to the internal administration of the Surgeon General`s Office, thecommittee found that the Personnel, Administrative, and Professional Services,as well as the Fiscal and Training Divisions, deserved particular commendation.In general, the report stated, the Supply and Operations Services had donea good job in spite of their difficulties. On the other hand, the two importantstaff functions of vital records and medical intelligence had not beendeveloped in proportion to their importance. The report termed the administrationof the Army Nurse Corps weak, and strongly advocated the reorganizationand strengthening of the Nursing Division. It praised the Office of TheSurgeon General for "the excellent medical and nursing care"and preventive measures being provided the Army, and commended The SurgeonGeneral for his "foresight in securing the cooperation and supportof the medical profession and of the national medical organizations."However, the committee stated its belief that The Surgeon General had notprotested strongly enough against certain financial and personnel restrictionsand military orders not in consonance with the best medical practices.It believed that "aggressive presentation of the medical aspects ofa military problem should always be a prime function of administration."It also found that The Surgeon General had not held frequent enough staffconferences on administrative matters, and it advocated continuing studyof administrative procedures. It made certain recommendations for specificchanges in the structure of the Surgeon General`s Office. Finally, thecommittee pointed out the unique importance, among medical administrativepositions, of the position of Surgeon General of the Army. It named thefollowing qualities as those which The Surgeon General should possess ina marked degree: "Outstanding ability and experience in the medicalprofession," aggressiveness, and administrative ability.53
The report contained a detailed list of recommendations prepared byextracting from the major sections of the report, which were rather discursive,all definite statements that could be considered recommendations for specificaction. In forwarding 85 of these recommendations to The Surgeon General,the Commanding General, Services of Supply, indicated those on which theSurgeon General`s Office was to take immediate action and those on whicha report was to be made by a specific date. Throughout most of the remaining
53Committee to Study the Medical Department,1942, Report, Tab: Administration, pp. 25-30. On the other hand, the concurrentinquiry into the internal organization of the Surgeon General`s Officeand its use of officer personnel, which the Deputy Chief of Staff had directedthe Inspector General to make, found that the Office was appropriatelyorganized for the accomplishment of its mission and was economical in itsuse of commissioned personnel in supervisory positions. See Memorandumfor the Inspector General, 30 Oct. 1942, subject: Report of Investigationof the Present Organization of the Surgeon General`s Office.
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months of General Magee`s tenure as The Surgeon General, various segmentsof his office were engaged in replying to or following up one or anotherof this group of recommendations. Only those relating primarily to mattersof organization and administration are discussed below.54
One recommendation (No. 28) stipulated that the staff of the SurgeonGeneral`s Office and of certain service commands should include a trainedconsultant on hospital administration. This recommendation. was tied inwith a more general proposal in the committee`s report to make wider useof lay hospital administrators in responsible positions concerned withhospital administration. The Surgeon General`s Office originally repliedthat it considered the work of the commanding officer of an army hospitalmore confined to technical medical duties than was that of the usual civilianhospital administrator. It noted that in military service many functionsof hospital administration-for example, new construction, employment ofpersonnel, solicitation of funds and so forth-were handled by other branchesof the War Department than the Medical Department or by Federal Governmentprocesses outside the War Department. However, by January 1943, the SurgeonGeneral`s Office had begun negotiations for the commissioning of Dr. BasilMcLean, superintendent of the Strong Memorial Hospital in Rochester, N.Y.,in order to assign him to the Surgeon General`s Office to study the organizationand administration of military hospitals. The office met with some difficultyin obtaining the release of Dr. McLean from several serious commitmentsin civilian life. After he came, he appears to have been given little responsibility;he left the following year.55
A recommendation (No. 33) that the Hospital Construction Division beheaded by a nonmedical man experienced in hospital planning came to naught.The Surgeon General answered in his original reply to the recommendationsthat the Director of the Hospital Construction Division was a Regular Armymedical officer of over 25 years` experience and that "only a doctorwith long experience in handling patients under Army conditions can befully aware of the needs in Army hospital units." Any plan for hospitalconstruction would have to be reviewed "by active medical men"before The Surgeon General could approve it. The reply also noted, as proofthat this division was not using medically trained officers in positionswhere nonmedical men would have sufficed, that the division contained threenonmedical officers, two medical officers who were overage for field duty,and a number of civilians trained in architecture or previously connectedwith architectural firms of national repu-tation. Apparently nothing furtherdeveloped from this reply.
A recommendation (No. 34) that the Surgeon General`s Office become morecurrently informed on sicknesses and casualties in oversea theaters eventu-
54Unless otherwise noted, the following discussionof the committee`s recommendations and action taken on them is based ona notebook kept by Corrington Gill, the committee`s executive secretary,entitled "Action on Recommendations of Committee to Study the MedicalDepartment, 1942-43."
55(1) Interview, Dr. H. A. Press, formerly with Control Division,Office of The Surgeon General, 9 Oct. 1950. (2) See footnote 50(4), p.175.
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ally led to significant improvement in the Office`s knowledge of medicaldevelopments in the oversea theaters. Before the report of the committeeappeared, the Surgeon General`s Office sent to each oversea theater ofoperations and the Eastern, Western, and Caribbean Defense Commands a requestthat the command forward on the 1st and 15th of each month a brief summaryon the status of the following phases of the medical program within thecommand: Matters of organization; location of major medical units, supplies,and equipment; problems in preventive medicine; unusual diseases; and soforth. The Commanding General, Caribbean Defense Command, protested againstthe sending of this report on the ground that a commander ought not tobe bypassed by the reporting of a special staff officer directly to a chiefof service. The Office of the Inspector General agreed with this pointof view. In late October 1942, the Hospitalization and Evacuation Branchof the Services of Supply had already sent to some of the same commandsa request for a similar report, which met no opposition, presumably becauseit called for a single, not a recurrent, report.56
These requests not only duplicated each other in part but to some extentduplicated information already being received, although late, from establishedreports. They also further illustrated the prevailing confusion, if furtherevidence were needed, as to the mutual authority and responsibility ofthe Hospitalization and Evacuation Branch, Services of Supply, and theSurgeon General`s Office. The General Staff called the attention of theServices of Supply to the duplication, and General Somervell ordered rescissionof the request from the Surgeon General`s Office, asking the office touse the proper channels henceforth. After consultation between the Hospitalizationand Evacuation Branch, Services of Supply, and the Surgeon General`s Office,commanders of forces outside the United States were asked in January 1943to submit the data wanted by the Surgeon General`s Office regularly inthe monthly sanitary report. Purely technical information was to be extractedand sent in advance not later than the fifth day after the end of the month,by V-mail or airmail. Out of this procedure developed in July 1943 a reportentitled "Essential Technical Medical Data" which to the endof the war was a regular report furnishing valuable information on medicalmatters overseas.
With respect to a recommendation (No. 50) that a consultant psychiatristbe assigned to each service command, the Surgeon General`s Office notedthat consultant psychiatrists had already been assigned to the Fourth andEighth Service Commands and that others were being selected for all servicecommands except the Sixth, where the supervisory work in psychiatry didnot appear to
56(1) Memorandum, Executive Officer, Officeof The Surgeon General, for the Adjutant General, 12 Nov. 1942, subject:Request for Medical Reports. (2) Routing slip, Deputy Inspector General,to Deputy Chief of Staff, 30 Nov. 1942, subject: Reports Required of theCommanders by The Surgeon General and Reports Required of Machine RecordsBranch, Adjutant General`s Office. (3) Memorandum, Col. William L. Wilson,for Assistant Chief of Staff for Operations, 4 Dec. 1942, subject: ReportsRequired of Theater Commanders.
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justify full-time work by a staff of consultants. No action was takenon recommendation No. 58, calling for a unified medical division withineach service command, the director to serve on the staff of the servicecommander. General Somervell had disapproved General Magee`s request of7 November that this scheme be adopted in the service commands, and GeneralMagee stated that in view of General Somervell`s opposition, his officewould cooperate to make the existing organization work.57
Following up a recommendation (No. 59) that the Nursing Division bereorganized and strengthened, the Superintendent of the Army Nurse Corpsasked to be retired. Her successor, Lt. Col. (later Col.) Florence A. Blanchfield,was named in February, effective I June 1943. The Control Division, SurgeonGeneral`s Office, began reorganizing and simplifying office proceduresof the Nursing Division, and the Surgeon General`s Office and the Red Crossbegan a concerted recruiting drive to get nurses into the Army. In 1943,one or more members of the Army Nurse Corps were assigned to the OfficerProcurement Districts in the service commands to accelerate recruitingof nurses.58
A number of the detailed recommendations (Nos. 60, 61, 65, 67, 68, 69,and 70) of the committee`s report related to the work of the Vital StatisticsDivision. The committee advocated the establishment of a Statistical Divisionto include administrative statistics as well as medical statistics; inother words, the entire field of statistics compiled by the Surgeon General`sOffice. This division, it maintained, should be a staff division and shouldbe headed by an outstanding statistician versed in both fields of statistics.The Surgeon General`s Office took the position that records pertainingto health of the Army constitute a specialized branch of statistics whichshould not be organizationally consolidated with other types. The majorfield in which statistics were compiled in the Surgeon General`s Office,other than vital statistics, was that of medical supply. Medical supplystatistics were directly related to the work of the Supply Service whichwas then being reorganized, and the Surgeon General`s Office stated thatit was more feasible to leave the handling of such records to the SupplyService. The two functions remained separate.
The Surgeon General`s Office and the Services of Supply made strenuousefforts throughout the first half of 1943 to expedite the work of the VitalStatistics Division. Many changes in personnel took place. Another officerwas made director of the division in February, but in April General Somervellasked that he be relieved. In June, Capt. Harold F. Dorn, SnC, previously
57Memorandum, The Surgeon General, for theCommanding General, Services of Supply, 7 Nov. 1942, and 1st indorsement,Commanding General, Services of Supply, for The Surgeon General, 12 Nov.1942.
58(1) Assignment No. 46, Nursing Division, Report No. 1, Recommendationsre: Organization and Procedure, 15 Dec. 1942. (2) Blanchfield, FlorenceA., and Standlee, Mary W.: The Army Nurse Corps in World War II, vol. II,p. 430. [Official record.]
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of the U.S. Public Health Service, was made director by the new SurgeonGeneral.59
Some disagreement in policy on administration of the medical statisticsprogram between the Surgeon General`s Office and the Services of Supplyderived from differences in concept as to the use to be made of vital statistics.The Surgeon General`s Office apparently stressed the importance of theserecords for historical research and for long-range planning. Some officersof the Services of Supply believed that accurate statistical estimates,if they could be made promptly enough, were of value for operating purposes.These officers criticized the Surgeon General`s Office for its failureto develop statistics as a tool of current operations, instead of relyingupon the judgment of the medical officers concerned.60 No exampleswere given, however, of any situation that could have been handled moreeffectively on the basis of statistical compilations than by direct personalcontact. From The Surgeon General`s point of view, the time factor wasoverriding.
Two major causes of large backlogs of work in the Vital Statistics Divisionwere late reception of forms from overseas and lack of technically trainedpersonnel and clerks. The report of the Committee to Study the MedicalDepartment recognized the lack of personnel as a serious factor in delayingthe work of the division. Between July 1942 and June 1943, civilian personnelin the Vital Statistics Division increased from about 220 to about 300.In July and August 1943, a few statistical experts from the MetropolitanLife Insurance Co. reported for duty in the division.61
Two recommendations (Nos. 62 and 15), for more aggressive presentationof the medical aspects of military problems and of medical needs, wereconcerned with the personality of The Surgeon General. As General Mageewas then inspecting Army medical service in North Africa and the UnitedKingdom, his office refrained from making any comment. General Magee didnot admit to any lack of aggressiveness. His concept of The Surgeon General`sresponsibilities was later expressed in these words: "The needs ofthe Medical Department were fully presented, as occasion arose, withinthe limits of proper military procedure. It is not contemplated that anofficer in the position of The Surgeon General should be required to throwhis hat on the ground and dance on it in an effort to command attention."62
In answer to a recommendation (No. 63) for regular staff meetings inthe Surgeon General`s Office, the office pointed out that all medical menrecog-
59(1) Office Diary, Col. Albert G. Love, MC,entries for February-June 1943. (2) Memorandum, Director, Control Division,Army Service Forces, for Commanding General, Army Service Forces, 30 June1943.
60(1) Report on Vital Records Division by the Control Division,3 Apr. 1943. (2) General Statement, Interim Report by Statistics and ProgressBranch, Services of Supply, on the Vital Records Division, 3 May 1943.
61(1) Memorandum, Director, Medical Statistics Division, Officeof The Surgeon General, for Director, Historical Division, 24 July 1943.(2) Weekly Reports by Director, Medical Statistics Division, to ExecutiveOfficer, July and Aug. 1943.
62Letter, Maj. Gen. James C. Magee, USA (Ret.), to Director,Historical Division, 3 Dec. 1951.
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nized the value of these, as staff meetings were regularly conductedin all large hospitals. They stated that the office had only recently discontinuedits weekly staff meetings of chiefs of divisions when it appeared thatthey interfered with the work of the office "without compensatingadvantages." Staff meetings were now held whenever the need arose.The Surgeon General`s Office stated that regular meetings at 2-week intervalswould be undertaken. These were apparently initiated by January 1943.63
One recommendation (No. 65) specified those divisions which the committeethought should report directly to The Surgeon General, or in the semimilitaryterminology of public administration, should be at "staff level."The Public Relations Division, which had been changed to the Office ofTechnical Information in accordance with the nomenclature used by the Servicesof Supply and which had become a staff division in the August reorganization,had by November, for no apparent reason, been reduced to a branch of theOffice Administration Division. The Surgeon General`s Office stated thatits personnel now consisted of one officer and two clerks and that no particularobjective would be attained by putting it again at staff level. It wasnevertheless restored to a staff position in April 1943. The office alsoopposed placing the Medical Intelligence Branch of the Preventive MedicineDivision at staff level, on the grounds that its work was largely concernedwith military preventive medicine and consequently needed correlation withthe plans ,and policies of the Preventive Medicine Division. The organizationalelement handling medical intelligence continued to be a part of the PreventiveMedicine Division (or Service) throughout the war.64
Another recommendation (No. 66) advocated the grouping of major divisionsunder three "services" instead of the prevailing five. The committeehoped to bring about still greater reduction in the number of officersreporting directly to The Surgeon General than the reorganizations of 1942had theoretically effected. The scheme tallied with the existing organizationinsofar as the Professional and Supply Services were concerned. The majorchange proposed was that of grouping the Training and Fiscal Divisions,now staff divisions, and the two large Operations and Personnel Services,together with the divisions of the existing Administrative Service (OfficeAdministration, Research and Development, and Historical), under a newand large Administrative Service. The Surgeon General`s Office repliedthat the proposed new Administrative Service would group 11 diversifiedfunctions under I head. One of these, the Fiscal Division, had been placedat staff level by War Department directive. It also pointed out that theheads of only seven operating agencies now reported directly to The SurgeonGeneral or his deputy.
63Memorandum, Director, Control Division, forthe Commanding General, Services of Supply, 27 Jan. 1943, subject: Investigationof Administrative Matters of the Surgeon General`s Office.
64Morgan, Edward J., and Wagner, Donald O.: The Organizationof the Medical Department in the Zone of Interior, p. 19. [Official record.]
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Thus very few of these detailed changes advocated for the internal structureof the office were adopted. Not one of those recommendations which directlyadvised the regrouping or relocation of functions (Nos. 60 and 61, 65,66, and 68) was put into effect. A number of changes made in the organizationof the Supply Service in February 1943 show continuing efforts to copewith the problems of that service, but they were of short duration. InJune another reshuffle of functions of the Supply Service was made by thenew Surgeon General and his advisers.65
In the first half of 1943 a good many changes in procedures and a gooddeal of expansion in space and in personnel, especially civilian, tookplace in such segments of the Surgeon General`s Office as the Supply Serviceand the Vital Statistics Division for which experience of the past yearhad clearly demonstrated the need. The addition of civilian personnel wasperhaps the most important internal development which the investigationbrought about in the office. With the advent of a new Surgeon General,some key officer personnel, including the heads of some services and divisionswhose work had been criticized, were replaced by new appointees.
One result of the committee`s work, which was not dealt with in itsreport or in any recommendations, was the decline in the activities andthe eventual abolition of the Hospitalization and Evacuation Branch ofthe Plans Division, Services of Supply. Although it remained in existenceuntil February 1944, a new medical officer assigned as head of this unitby General Lutes tended to minimize its activities. He took the positionthat the work of coordinating hospitalization and evacuation activitieswhich the unit had attempted to effect more properly belonged to the Officeof The Surgeon General or could be handled by direct liaison between theSurgeon General`s Office and the other agencies concerned.66
The detailed recommendations not sent to The Surgeon General were concernedwith the matter of his position within the War Department, his relationshipswith the Air Surgeon`s office, and the degree of his control over medicalservice of the Army Air Forces. They were as follows:
43. The Air Corps should not be permitted to establisha school for training Medical Administrative Corps personnel.
44. Medical officers attached to the Air Corps shouldbe assigned to special courses such as tropical disease now being givenin civilian institutions and in military installations.
45. The number of experienced neuropsychiatrists for workwith the Army Air Forces should be increased. They should be selected directlyby the Office of The Surgeon General.
54. The Surgeon General should function as a staff adviserto the Combined Chiefs of Staff and to the Joint Chiefs of Staff.
65Morgan, Edward J., and Wagner, Donald O.:The Organization of the Medical Department in the Zone of Interior, pp.25-26. [Official record.]
66(1) Memorandum, Director, Planning Division, Services of Supply,for Col. Robert C. McDonald, 24 Mar. 1943. (2) Diary, Hospitalization andEvacuation Branch, Services of Supply, entry of 4 May 1943.
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55. Every practicable effort should be made to bring medicalservice in the Air Force under the supervision, authority, and controlof The Surgeon General, failing which a clear and concise delimitationof authority, responsibility, and functions of the Air Surgeon under TheSurgeon General should be formulated and issued by proper authority.
56. The Office of The Surgeon General should be on thespecial staff of the Chief of Staff.
57. There should be created on the staff of the CommandingGeneral, Services of Sup-ply, the position of "Chief Surgeon,"Services of Supply, with rank commensurate with the position and involvingresponsibility and authority corresponding to that of the Air Surgeon andof the Ground Surgeon within their respective commands.
64. There should be a Deputy Surgeon General serving fulltime.
82. The Air Surgeon should not undertake procurement ofmedical personnel except through the Office of The Surgeon General.
97. Research on the physiological and psychological problemsin flying should be more closely coordinated with other research problemsof the Medical Department.
For the most part these recommendations called for decision by higherWar Department authority. They involved three basic problems: the organizationalposition of The Surgeon General and his office in the War Department; relationshipsof The Surgeon General and his office with the medical organization ofthe Air Forces; and problems relative to the post of Surgeon General andhis Deputy, who acted primarily as Chief of the Operations Service. GeneralSomervell presented these matters to the Secretary of War for decisionon 16 December.
Apropos of the committee`s recommendations that The Surgeon Generalreport directly to the Chief of Staff, General Somervell stated that thischange would be contrary to the basic purpose of the March reorganizations;that is, to relieve the Chief of Staff of direct administrative relationshipwith the various services. The individualistic character of the professionof medicine, which he termed one of its best characteristics, made desirablea general administrative supervision of its work which neither the Secretaryof War nor the Chief of Staff should be expected to give. On the otherhand, he thought that the proposal that The Surgeon General have the sameauthority over medical organization in the Army Air Forces as over thatin other branches of the Army was organizationally sound. He had previouslydiscussed with the Chief of Staff the recommendation of the committee asto the appointment of a full-time deputy surgeon general to be placed intraining as successor to the present Surgeon General.67
On 16 February Secretary Stimson agreed that there should be no Armyorganizational change with respect to the status of The Surgeon General."In principle" it seemed wise to him that the authority of TheSurgeon General
67Memorandum, Commanding General, Servicesof Supply, for Secretary of War, 16 Dec. 1942, subject: Report of Committeeto Study the Medical Department of the Army.
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over Air Forces medical organization should be the same as that overother branches of the Army. Secretary Stimson did not commit himself asto the selection of a new surgeon general, but noted that the matter ofan appointment at the end of the present term would "receive promptconsideration."68
RESULTS OF THE INVESTIGATION
It is not clear whether the investigation of the Medical Departmentwas primarily undertaken as an effort to remove General Magee from hisposition as The Surgeon General.69 If so, it failed of its purpose.Although the Surgeon General`s Office began remedial action on a numberof the detailed recommendations early in 1943, including those on mattersof organization and administration, few changes in the internal organizationof the office, other than the addition of substantial numbers of personnelto some divisions of the office, occurred before General Magee`s 4-yearterm as The Surgeon General ended. The committee`s ideas as to the improvementof the position of the Medical Department within the War Department structurereceived short shrift from the Commanding General, Services of Supply,and the Secretary of War, and presumably were similarly disapproved bythe Chief of Staff. Hence the problems inherent in the position of TheSurgeon General in War Department structure and the scattering of medicalresponsibilities throughout a number of elements of the War Departmentand Army remained. Nevertheless the investigation had the effect of stimulatingawareness by both the Medical Department and the War Department of someof the Department`s most pressing problems and spurring on, developmentof measures to cope with them.
68(1) Memorandum, Secretary of War, for Chiefof Staff, 16 Feb. 1943. (2) Memorandum, Chief of Staff, Services of Supply,for Commanding General, Services of Supply, 16 Feb. 1943. It is clear from(2) that General Somervell and General Marshall had a candidate for GeneralMagee`s successor under consideration, but Secretary Stimson was not soinformed.
69Maj. Gen. Howard McC. Snyder and Mr. Tracy S. Voorhees statedin interviews with the writer on 25 May 1948 and 22 September 1950, respectively,that the removal of General Magee was the primary purpose of the investigation.
