CHAPTER VI
The Surgeon General`s Office, 1942-1945
Aside from the relatively small number of changes in organization madeas an immediate outgrowth of the Wadhams Committee investigation, the structureand functions of the Surgeon General`s Office evolved gradually in responseto the growing requirements of the war. Neither General Magee nor his successorwas able to reassert effective control over the Air Forces medical service,nor to escape entirely the pattern of relationships imposed by the Servicesof Supply, but these failures were only administrative roadblocks to beworked around, not irrevocable disasters. There were substantial gainsbefore the end of 1942 in other areas, the most notable of them being inpreventive medicine.
PREVENTIVE MEDICINE, SEPTEMBER 1942-JUNE 1943
During the latter part of General Magee`s administration, developmentof measures and organizational elements to handle several major programs-malariacontrol, typhus control, quarantine at ports, and the health program forcivilians in occupied countries-went on as part of the normal planningof the Surgeon General`s Office. The investigation of the Medical Departmentprobably gave some impetus to the planning for malaria and typhus control,for Secretary Stimson had stressed disease problems in oversea areas inhis opening remarks to the committee. In the latter part of 1942, the EpidemiologyBranch of the Preventive Medicine Division planned the "special organizationfor malaria control" to be sent to theaters of operations where malariapresented a serious threat to troops. A new agency, the United States ofAmerica Typhus Commission, was established to combat possible outbreaksof typhus, and another to cope with problems of quarantine caused by theentry of large numbers of U.S. Army troops into foreign areas. Planningfor these programs had been done by the Preventive Medicine Division, SurgeonGeneral`s Office, from the years of the emergency period. Finally, thelast 5 months of General Magee`s administration (January-May 1943) witnessedfurther developments in planning for medical work among citizens of occupiedcountries. This last program, however, was still largely planned, as previously,at War Department staff levels rather than in the Surgeon General`s Office.
Malaria Control
The "special organization for malaria control" devised bythe Surgeon General`s Office in 1942 was a flexible organization consistingof one malariologist, one or more assistant malariologists, one or moresurvey units, and one or more control units. It was designed to plan andput into effect malaria control measures for a theater of operations andwas to be available for assign-
188
ment to a theater on request. It would instruct troops on antimalariameasures, survey areas for the occurrence of mosquitoes, determine theprevalence of all mosquitoborne diseases, including filariasis, dengue,and yellow fever as well as malaria, and undertake measures to controlthem. The malariologist was to have immediate administration of the programunder the direct supervision of the theater surgeon and to act as consultantto the latter on all problems. The assistant malariologists were to beactive in administering all phases of the program, particularly in developingindividual preventive measures on the part of soldiers.
The malaria survey unit consisted of an entomologist and a parasitologist(both Sanitary Corps officers) and 11 enlisted men. It would act as a mobilemalaria laboratory, making surveys to determine the prevalence of mosquitoesin various areas, or their breeding places, and would investigate the occurrenceof malaria parasites among troops and civilians. The malaria control unitconsisted of a sanitary engineer (a Sanitary Corps officer) who had hadspecial experience in malaria control, and 11 enlisted men. Its task wasto plan the control measures, supervising the drainage and larvicidal workin areas where the surveys had determined antimosquito work to be necessary.Civilian antimalaria gangs were to be hired to do the drainage and larvicidalwork if they were available in the area; if not, medical sanitary companieswere to be used.
This machinery for malaria control was proposed by the Surgeon General`sOffice on 21 September 1942; G-1 gave its approval on 9 October. On 24October the Surgeon General`s Office informed the surgeons of oversea theatersin which malaria was a serious threat of the plans for this network forcontrol, asking them to send in their requests for the malariologists andunits they needed. By the middle of December the office had received requestsfrom the South and Southwest Pacific Areas. Malariologists and units werenot available, however, until February and March of 1943. After that datethey were sent not only to the Pacific areas, where the majority were located,but also to the China-Burma-India theater, North African theater, the Africa-MiddleEast theater, and to U.S. Army Forces in the South Atlantic (in Brazil).By April 1945, 70 survey units and 153 control units were working in theoversea theaters. In the course of the war 76 malaria survey units werecreated; 72 were sent overseas or were organized in oversea areas. A totalof 161 control units were organized and sent overseas (or activated overseas);16 others organized and trained in the United States were still there whenthe Japanese surrendered. About two-thirds of each group served in oneof the Pacific areas.1
1(1) Memorandum, The Surgeon General, for CommandingGeneral, U.S. Army Forces in the Middle East, 24 Oct. 1942, subject: MalariaControl. Similar memorandum for commanding generals of other oversea theaters.(2) Memorandum, Executive Officer, Office of The Surgeon General, for CommandingGenerals of Theaters of Operations and Service Commands, 24 Mar. 1943,subject: Special Organization for Malaria Control. (3) Simmons, J. S.:Control of Malaria in the United States Army. In Boyd, Mark F.,ed.: Malariology. Philadelphia: W. B. Saunders, 1949, vol. II, pp. 1455-1468.(4) Medical Department, United States Army, Preventive Medicine in WorldWar II. Volume VI. Communicable Diseases: Malaria. [In press.]
189
The United States of America Typhus Commission
In the late months of 1942 there was a growing awareness, further stimulatedby the Wadhams Committee investigation, of the magnitude of the Army`sproblem in disease prevention. Reports that louseborne epidemic typhuswas on the increase in North Africa and other Mediterranean areas, as wellas in eastern Germany, had reached the Surgeon General`s Office just aspreparations for the Allied invasion of North Africa were getting underway.These reports had precipitated a conference of Army, Navy, and U.S. PublicHealth Service representatives in August 1942, at which plans for a typhuscommission were discussed, and personnel from the three services tentativelyselected.
The United States of America Typhus Commission was established by ExecutiveOrder No. 9285 on 24 December 1942. It was created as an interdepartmentalorganization in the War Department to be staffed by personnel of the Army,Navy, and U.S. Public Health Service, and civilians to be appointed bythe Secretary of War, who was also to name the Commission`s Director. Underthe overall direction of the Secretary of War, the Typhus Commission wasto serve with the Army of the United States to prevent and control typhusfever wherever it was or might become a threat. Although as a special agencyof the War Department the Commission was in a sense placed at a level abovethe Surgeon General`s Office, there was never any conflict of authority.After the first month of its operation, the headquarters of the Commissionwere located in the Preventive Medicine Service of the Office of The SurgeonGeneral. Its second and third directors and its Field Director were allbrigadier generals in the Medical Corps. The Director was given broad responsibilitiesfor making arrangements for the study of typhus fever by establishing fieldgroups overseas for the purpose and maintaining research units at Governmentlaboratories. The aid of other U.S. Government agencies with equipmentand personnel was assured to the Secretary of War and the director of thecommission. The Executive order also established a United States of AmericaTyphus Commission Medal, "including suitable appurtenances,"to be awarded, by the President or at his direction, to persons who should"render or contribute meritorious service in connection with the workof the Commission."
The original membership of the Commission, as of the end of 1942, consistedof 16 representatives, mostly medically trained men of the Army, Navy,U.S. Public Health Service, and the Rockefeller Foundation. Capt. CharlesS. Stephenson of the Navy was made director and given the rank of rearadmiral in order to bestow on him the prestige desirable for dealing withstate and military authorities of foreign countries. The administrativeaffairs of the Commission were handled by a rear echelon in Washingtonheaded by Maj. Gen. LeRoy Lutes, then Assistant Chief of Staff for Operations,Services of
190
Supply, and including a representative of each of the three Federalmedical services. The remaining members, the so-called "field group"headed by the director, went to Cairo early in 1943 to collect strainsof typhus virus and experiment with control by means of various antilousepowders. The membership of the two Rockefeller Foundation experts was tobe only temporary; they were specifically assigned by the foundation todevelop methods for the control of typhus in civilian populations.2
The organization of the U.S.A. Typhus Commission underwent significantchanges from the date of its establishment to its discontinuation in 1946.Although members of the Medical Department who had been active in creatingthe Commission had originally pooled the resources of a number of agencies,civil and military, the long-range trend was toward greater control ofthe Commission by the War Department and Army, with less by the other agenciesrepresented. The Commission remained interdepartmental in membership, havingsome representatives of the Navy and the U.S. Public Health Service asmembers to the end of its existence, but the Medical Department (with thePreventive Medicine Division, Surgeon General`s Office, taking the lead)largely assumed direction of its work. After the Navy director became ill,a number of Army officers connected with the Commission pointed out thattyphus was primarily an Army, not a Navy, problem since larger numbersof ground troops would come into contact with civilians infected with typhusin invaded areas. Col. (later Brig. Gen.) Leon A. Fox, MC, was made directorof the Commission in February 1943 and undertook supervision of the fieldgroup in Cairo as his predecessor had done. He was instrumental in makingsubstantial changes in the character of the membership by arranging forremoval of some members of the Cairo group, particularly several Navy officers.The commissioning of one typhus expert from the Rockefeller Foundationby the Army and the departure of the other to head a separate typhus controlprogram in the North African theater, previously planned by the foundation,made the field group largely an instrument of the Medical Department bymid-1943.
Centralized control of the Commission`s work in the Surgeon General`sOffice in Washington-rather than, as in the early months, ill Cairo,-cameabout as the need developed for suppressing dissension in the Cairo officeand as it became clear that additional field offices in other typhus-riddenareas would be necessary. About mid-1943, the deputy director of the PreventiveMedicine Service, Col. Stanhope Bayne-Jones, MC (fig. 47) , assumed theduties of director and General Fox was made field director at his own request.General Fox had been moving rapidly about the world since 1940 in severalmedical capacities and was thus able to continue various duties of a liaisonnature in the typhus control program, particularly ill connection withthe allocations of typhus vaccine by the United States to foreign governments.
2Letter, Dr. Fred L. Soper, to Director, TheHistorical Unit, 10 Aug. 1955.
191
From then on to the close of the war, control of the Commission`s fieldgroups was exercised from Washington. During the early months of the Commission`sexistence, a strong desire for individual recognition and a good deal ofrivalry developed among its members. The rivalry was in part personal orprofessional and in part factional by reason of the various organizations,civilian and military, represented. It sprang up chiefly among the fieldgroup in Cairo, where jealousy developed between Army and Navy membersand between Army and Rockefeller Foundation members. Nevertheless, therivalry, which, along with the lack of accessible typhus epidemics, delayedaccomplishments by the Cairo field group, only seems to have spurred theCommission on to greater efforts whenever serious epidemics were encountered.General Fox stated on the eve of the Naples epidemic in the winter of 1943:"This is no time for fights over jurisdiction. There will be moretyphus control before spring than all can handle * * *."3Success in Naples by means of widespread spraying of the population withantilouse powder settled the difference of opinion which had previouslyexisted as to the relative merits of antilouse powder and typhus vaccinefor controlling epidemics. From that date on a good deal more cooperationwas in evidence.
3Coded Message CM-IN-8358, Teheran to Cairoand AGWAR, 13 Dec. 1943.
192
Field groups of typhus experts worked effectively in most of the majortheaters of operations. The field party of the Commission in a theaterwas administratively subject to theater control, but assignments were madeto the various theaters by the Washington office of the Commission. TheCairo group worked in various countries of the Africa-Middle East theater,-as well as in the Naples area of the Mediterranean theater during thewinter of 1943-44 and in the Balkans in the spring of 1945, effectivelychecking a number of incipient epidemics among the civil populations andthus protecting the health of Allied troops. Other groups of typhus expertsserved in the European theater, where large-scale outbreaks in the Rhinelandand Austria were suppressed; in the China-Burma-India theater and SouthwestPacific Area, where important work was done on scrub typhus; and laterin Korea and Japan. The medal was awarded by June 1945 to 35 individuals,including not only Officers of the Army, Navy, and U.S. Public Health Serviceand Rockefeller Foundation experts who were assigned or attached to theCommission but also a few British Army medical officers, several Egyptianpublic health officials, and the American Ambassadors to Italy and Turkey.4
Port Quarantine
During the last months of General Magee`s administration the MedicalDepartment also embarked upon a program of cooperation with the U.S. PublicHealth Service as to quarantine procedures at ports. An interdepartmentalquarantine commission was first discussed early in 1943 at the instanceof U.S. Public Health Service officials. The U.S. Public Health Servicewas responsible for preventing the carriage of certain diseases (cholera,smallpox, plague, epidemic typhus, yellow fever, and leprosy) into theUnited States and its territories by ships and planes. The increased volumeof war traffic, particularly of planes, the necessary secrecy of movementsof military ships and planes, their entry into areas which had no quarantineregulations, and the breakdown of quarantine systems in some areas underwartime conditions had led U.S. Public Health Service officials to a realizationthat revision of quarantine procedures was necessary.
The U.S. Public Health Service lacked sufficient personnel to cope withits wartime quarantine problems. To tackle the problem, the Surgeons Generalof the Army, Navy, and U.S. Public Health Service formed the InterdepartmentalQuarantine Commission, appointing a representative from each of their respectiveservices in mid-1943. The Commission did special work in coping with thethreat of the transfer of Anopheles gambiae to Brazil from West Africaby planes. By mid-1944, when it submitted its final report, it had workedout the mutual responsibilities of the Army, Navy, and U.S. Public
4A fully documented account of the organizationand activities of the U.S.A. Typhus Commission, prepared by Brig. Gen.Stanhope Bayne-Jones, USA (Ret.), is included in a forthcoming volume,Medical Department, United States Army. Preventive Medicine in World WarII. Volume VII. Communicable Diseases: Arthropodborne Diseases Other ThanMalaria. [In preparation.]
193
Health Service for various phases of quarantine procedure in overseaareas. The Secretary of War made The Surgeon General responsible for establishingand supervising quarantine procedures of the Army in foreign countries.The Surgeon General appointed an Army quarantine liaison officer to keepin touch with the program of the U.S. Public Health Service and the Navyand to integrate the Army`s quarantine procedures with those of foreigncountries and areas beyond the domain of the U.S. Public Health Service.Modernization of the military regulations relating to quarantine, especiallyof Air Force regulations, resulted. The fieldwork of the quarantine liaisonofficer`s unit the Quarantine Branch of the Epidemiology Division, PreventiveMedicine Service-included many studies of quarantine procedures and problemsat U.S. Army facilities and on U.S. Army carriers at home and abroad.5
Major developments in the planning of medical programs for civiliansin occupied countries also took place in the first half of 1943. Throughoutthe emergency period and the first year of war, the Surgeon General`s Officehad participated in medical aspects of the planning for the Army`s conductof civil affairs in occupied countries which various elements of the WarDepartment had undertaken. In 1942 it had assigned personnel to lectureon public health at the School of Military Government at Charlottesville,Va. (under the direction of the Provost Marshal General), and suppliedthe school with its basic medical intelligence data on foreign countries.As the training for military government progressed with the establishmentof similar schools at various universities, the Surgeon General`s Officeaided in organizing whole courses, in public health. It sent to the schoolsfor training, Medical Department officers of the several corps who appliedthrough military channels, U.S. Public Health officers assigned to theArmy, and medically trained civilians commissioned by The Surgeon Generalspecifically for civil affairs work.
In January 1943, major responsibility for recruiting personnel to handlethe medical aspects of civil affairs and for developing a medical programwas vested in Col. Ira V. Hiscock, SnC (fig. 48), who had previously workedon the program both in the Preventive Medicine Division, Surgeon General`sOffice, and at the School of Military Government. He was assigned to theOffice of the Provost Marshal General to select, in conjunction with theDirector of Personnel, Surgeon General`s Office, and the Director of theMilitary Government Division, Provost Marshal General`s Office, medicallytrained personnel to be given training as public health officers at theschools operated by the Provost Marshal General. He also assembled materialto aid the Army, Navy, and various agencies in planning their relief andrehabilitation work in occupied countries.
5(1) Final Report, Interdepartmental QuarantineCommission, 10 June 1944. (2), Knies, P. T.: Quarantine and Disinsectizationof Aircraft. Air Surg. Bull. 1: 16-18, October 1944. (3) Medical Department,United States Army. Preventive Medicine in World War II. Volume II. EnvironmentalHygiene. Washington: U.S. Government Printing Office, 1955, pp. 278ff.
194
In March 1943 the War Department established the organization to handlethe total program for administering civilian affairs in occupied areasby creating a Civil Affairs Division on the War Department Special Staff.In April, Colonel Hiscock was reassigned to this division to take chargeof what was later called the Public Health Section, and chief responsibilitiesfor the medical phases of the civil affairs program were vested in him.He continued the activities he had engaged in at the Office of the ProvostMarshal General, selecting personnel and assembling material for planning.He maintained liaison with many agencies which shared the responsibilityfor planning the civil affairs program and initiated conferences with membersof the Supply Division, Surgeon General`s Office, and other agencies todiscuss the probable requirements of medical and sanitary supplies forcivilian use. A medical supply board was organized in the Surgeon General`sOffice to prepare estimates of requirements, but it was not until early1944 that the responsibilities of the office, were broadened to includeaspects of the medical program other than supply and that an organizationalunit to handle the program was established in the office.6
6For full discussion and more complete documentation,see Medical Department, United States Army. Preventive Medicine in WorldWar II. Volume VIII. Civil Public Health Problems and Activities. [In preparation.]
195
EFFORTS TO REGAIN CONTROL OF MEDICAL SERVICE IN THE
ARMY AIR FORCES
At another level the Air Surgeon`s bid for autonomy met with reinforcedresistance as a result of the Wadhams Committee`s recommendation that everyeffort be made to bring the medical service of the Army Air Forces underthe control of The Surgeon General or, if this could not be done, thata clear official statement of the respective responsibilities of the AirSurgeon and The Surgeon General be issued. The whole question was reopenedin March 1943 by Maj. Gen. Wilhelm D. Styer, General Somervell`s Chiefof Staff, who asked bluntly whether existing directives furnished a satisfactorybasis for a working relationship between The Surgeon General and the AirSurgeon.7
The Air Surgeon was simultaneously taking steps to add another incrementto his power, proposing that he be officially designated thereafter asthe Air Surgeon General, a title he regarded as no more than commensuratewith the added responsibilities imposed by increased size of the Air Forces.General Magee retorted tartly that it was "inconsistent that the titleof a subordinate responsible for a part of the Army should be that of hissuperior who is responsible for the whole"; nor could he see how achange in title could increase the efficiency of the Air Surgeon`s Office.Replying to General Styer a few days later, General Magee cited specificareas of duplication, including efforts by the Army Air Forces to establishhospitals which were in effect, though not in name, general hospitals.He noted that this effort aggravated the Army-wide demand for highly specializedpersonnel and for medical supplies. He recommended that hospitalizationof Army Air Forces personnel be made a responsibility of the service commands,that only Medical Department personnel attached to field units of the ArmyAir Forces be directly responsible to the Air Surgeon, and that the Chiefof Staff issue an official statement delineating the responsibility ofThe Surgeon General for the health of the entire Army.8
The struggle over control of hospitals was the most important phaseof the total struggle between the Surgeon General`s Office and the AirSurgeon`s Office in 1943. The earlier phase of the conflict had revolvedprimarily around direct recruitment and subsequent control of medical personnelby the Army Air Forces, which by 1943 had recruited the specialized medicalpersonnel to staff a system of hospitals. It established under its controlinstallations which, although not termed general hospitals, were equippedto give the same type of
7Memorandum, Chief of Staff, Services of Supply,for Assistant Chief of Staff for Operations, Services of Supply, 20 Mar.1943, subject: Relationship Between The Surgeon General and the Air Surgeon.
8(1) Memorandum, Chief of Air Staff, for Chief of Staff, 25Mar. 1943, subject: Change in Title of Special Staff Officers, Headquarters,Army Air Forces. (2) Memorandum, The Surgeon General, for Assistant Chiefof Staff, G-1, 7 Apr. 1943. (3) Memorandum, Assistant Chief of Staff forOperations, Services of Supply, for The Surgeon General, 30 Mar. 1943,subject: Relationship Between The Surgeon General and the Air Surgeon,and 1st indorsement, The Surgeon General, for Commanding General, ArmyService Forces, 12 Apr. 1943.
196
definitive medical and surgical care. Success in the effort to havethese installations recognized as general hospitals would have made itpossible for the Army Air Forces to treat in hospitals under its controlmany patients who would normally have been treated in the general hospitalsof the Army Service Forces and would have encroached upon the latter`shospital system.
Prompted by General Lutes, General Somervell pointed out to the Chiefof Staff the increasing confusion over the responsibilities of the SurgeonGeneral`s Office and those of the Air Surgeon`s Office and certain respectsin which their activities duplicated each other. He cited instances ofthe use of station hospitals controlled by the Army Air Forces as generalhospitals and efforts of that command to have patients from overseas sentdirectly to these instead of to the regular general hospitals maintainedby the Army Service Forces. He emphasized various recommendations of theCommittee to Study the Medical Department as to the desirability of greatercontrol by The Surgeon General over the medical service of the Army AirForces, especially Recommendation 55 calling for a clear official delineationof their respective responsibilities, and proposed that the Chief of Staffissue a directive reaffirming the authority of The Surgeon General. Althoughthis authority, he noted, had not been changed by any official utterancesince the reorganization of March 1942, it had not been definitely affirmedsince that date.9
Brig. Gen. David N. W. Grant, the Air Surgeon, objected to the recommendationswith respect to Army Air Forces medical service which had been made inthe report of the Committee to Study the Medical Department. He declaredthat no member of that committee had had more than a slight familiaritywith aviation medical problems, or indeed, with any aspect of aviation.He considered a few members ignorant of the problems, or prejudiced againstthe esprit de corps, of the Army Air Forces. Members of the investigatingcommittee had made only a superficial survey of one or two Army Air Forcesinstallations. He noted that The Surgeon General had had a representativeon the committee, while the Air Surgeon had had none. Finally, the committee`sfull report had never been given to the Air Surgeon.
The Air Surgeon agreed with the thesis of the report that there shouldbe a surgeon general on the special staff of the Chief of Staff. Underthe present organization of the Army, however, he stated, the medical serviceof the Army Air Forces could not be brought under the control. of The SurgeonGeneral without violating command channels; the Army Service Forces couldnot be given command powers over the Army Air Forces, since the two wereon the same level of command.
General Grant emphasized once more the many medical cases-those of flyingstress, aeroneurosis, and occupational rehabilitation following injuries-
9(1) Memorandum, Assistant Chief of Staff forOperations, for Commanding General, Army Service Forces, 30 Apr. 1943,subject: Relationship Between The Surgeon General and the Air Surgeon.(2) Memorandum, Commanding General, Army Service Forces, for Chief of Staff,30 Apr. 1943, subject: Unification of Medical Service of the Army by TheSurgeon General, and tabs A through L.
197
requiring treatment by medical officers familiar with Army Air Forcesoperations and problems. He declared that a close understanding betweenpatient and doctor was characteristic of the medical service of the ArmyAir Forces and contrasted this outlook with the doctrine he attributedto The Surgeon General and the Army Service Forces, that all medical officersshould be pooled and dealt out from time to time like so many trucks fromArmy Service Forces warehouses. Administrative control of medical personnelby the Commanding General, Army Air Forces, had resulted, General Grantclaimed, in the proper assignment of medical officers to their specialties.This feature, he maintained, was peculiar to the medical service of theArmy Air Forces.10
As might be expected, the Air Surgeon`s position, including the thesisthat the Army Air Forces medical service was more efficient than that administeredby The Surgeon General, was loyally supported by his superior officerswithin the Army Air Forces. The general staff, however, was divided inits preferences, and inclined to temporize. For example, Brig. Gen. R.G. Moses, Assistant Chief of Staff, G-4, saw merit in the claims of bothsides. He defined the choice as one between "a definition of authoritieswhich appears to achieve complete unification but which will work effectivelyonly with the enthusiastic concurrence of all concerned and with a considerableimprovement in the medical service of the Army, and, on the other hand,a definition of authorities which will certainly achieve more efficientmedical care for one part of the Army but which is a trend definitely awayfrom unification." The latter alternative he considered preferable,admitting that his choice was partly dictated by expediency but statingthat greater efficiency in one part of the Army should serve as an incentiveto the remainder. He favored reaffirming the responsibility of The SurgeonGeneral and limiting any additional authority granted to the Army Air Forcesto authority over individualized care of combat personnel.11
The Deputy Chief of Staff, Lt. Gen. (later Gen.) Joseph T. McNarney,himself an Air Corps officer, tended to favor the claims of the. Air Surgeon.General McNarney`s office issued a statement on 20 June 1943 to the effectthat existing regulations outlined the functions of The Surgeon Generalsatisfactorily. The statement held that a highly centralized system ofmedical service would not be sufficiently flexible to adjust overall policiesto the special needs of the oversea theaters and the three major commands.The Surgeon General should procure medical personnel, decentralizing thisfunction to the major services insofar as they thought necessary, but theArmy Air Forces should, control station hospitals at its own posts, camps,and stations. Finally, General
10Memorandum, the Air Surgeon, for CommandingGeneral, Army Air Forces, no, date (but commenting on a directive of 30Apr. 1943 prepared by the Commanding General, Army Service Forces, forthe signature of the Chief of Staff).
11(1) Memorandum, Assistant Chief of Air Staff, for CommandingGeneral, Army Service Forces, 25 May 1943, subject: Unification of MedicalService of the Army by The Surgeon General. (2) Memorandum, Assistant Chiefof Staff, G-4, for Chief of Staff, 15 June 1943, subject: Medical Serviceof the Army.
198
McNarney`s office announced that general hospitals necessary to meetthe needs of aviation medicine and give medical treatment to air combatcrews would be assigned to the Army Air Forces upon approval by the Chiefof Staff.12
Both The Surgeon General and the Commanding General, Army Service Forces(as the Services of Supply was rechristened in March 1943), objected stronglyto the transfer of any general hospitals to the Army Air Forces. The SurgeonGeneral, in particular, argued that centralized control of general hospitals,providing as they did the ultimate in professional care in the United States,was absolutely necessary for the proper assignment of all ground and aircombat patients evacuated from overseas to the particular hospital withthe specialized personnel therein which could best meet the individual`sneed for special treatment. He recognized that air combat crews neededspecial reconditioning but maintained that the general hospitals of theArmy Service Forces should provide them both hospitalization and reconditioning.Reconditioning should be given them by medical personnel trained in aviationmedicine but within special facilities established in the general hospitals.13
General Somervell agreed and so informed the Chief of Staff. He didnot believe it was intended to establish two Medical Departments and "twodistinct streams for the evacuation of the sick and wounded." He hadsuggested to the Deputy Chief of Staff that a satisfactory solution wouldbe the assignment of General Grant, to be redesignated Deputy Surgeon Generalfor Aviation Medicine, to the Office of The Surgeon General where his specializedknowledge and point of view would help to improve the entire medical service.He did not admit any superior efficiency on the part of the Army Air Forcesmedical service, but he emphasized the point that the new Surgeon General(General Magee`s term having expired on 31 May) was being held responsiblefor good administration of the Medical Department on an Army-wide basis,as well as for correction of deficiencies of the previous administration.He implied that the transfer of general hospitals to the Army Air Forceswould undermine at the outset this total responsibility.14
The Secretary of War, after conferring with the Deputy Chief of Staff,the Commanding General, Army Service Forces, and representatives of theArmy Air Forces, directed that no general hospitals be turned over to thecontrol of the Army Air Forces, but would continue to operate under theArmy
12Memorandum, Assistant to Deputy Chief ofStaff, for Commanding Generals, Army Air Forces, Army Ground Forces, andArmy Service Forces, 20 June 1943, subject: Medical Service of the Army,January-July 1943.
13(1) Memorandum, Director of Operations, Army Service Forces,for Commanding General, Army Service Forces, 24 June 1943, subject: MedicalService in the Army. (2) Memorandum, The Surgeon General, for Chief ofStaff, 29 June 1943.
14(1) Memorandum, Commanding General, Army Service Forces, forChief of Staff, 30 June 1943. According to General Grant, General McNarneyactually offered him the position suggested by General Somervell of DeputySurgeon General for Aviation Medicine, with the rank of major general,but General Grant, still convinced this expedient would not work, refused.(2) Letter, Maj. Gen. David N. W. Grant, USAF, to Director, The HistoricalUnit, U.S. Army Medical Service, 11 Aug. 1955, commenting on draft manuscriptof this volume.
199
Service Forces. Oversea casualties, including combat crews, returnedto the United States by air or water, would be taken care of in these hospitalsaccording to the general procedures established by the Surgeon General`sOffice. However, flying personnel needing treatment for air fatigue, aswell as all Army Air Forces personnel recovered after treatment in a generalhospital, would be cared for in "convalescent centers" undercontrol of the Army Air Forces. To meet another of the Air Surgeon`s arguments,a flight surgeon was to be assigned to The Surgeon General to advise onspecialized treatment, transfer, and disposition of combat crews. Flightsurgeons would also be assigned to those general hospitals in which flyingcombat crews were being cared for to give advice on the special techniquesof aviation medicine to be used in the care of this group.15
Thus the move initiated by General Styer to effect the recommendationof the Committee to Study the Medical Department that The Surgeon Generalbe given more control over the medical service of the Army Air Forces graduallynarrowed down to a controversy over the control of general hospitals properand ended with a statement by the Secretary of War officially maintainingthe status quo as to control of these hospitals. The course of events hereincluded the following steps, which seem to form a pattern for similarstruggles for control between The Surgeon General and the Air Surgeon:Action by the Army Air Forces to achieve a fait accompli; pressure by theArmy Service Forces and The Surgeon General to get an official directivereasserting control by The Surgeon General; statements by Army Air Forcesrepresentatives that their organization had done nothing contrary to officialdirectives and regulations; under continued pressure by the Army ServiceForces and The Surgeon General, open counterbids by the, Army Air Forcesfor official recognition of their fait accompli, bolstered by claims ofsuperior medical service; resistance by The Surgeon General, put in histurn on the defensive, and by the Army Service Forces; and finally a decisionby the Secretary of War officially maintaining the status quo in largepart, but having little restraining effect upon a renewal of effort bythe protagonists. These paper wars ended in a temporary truce wheneverthe Secretary of War ordered the combatants to cease fighting.
Some generalization may also be made with respect to the usual positionof higher War Department authorities in these controversies. With the exceptionof the Deputy Chief of Staff, who showed a tendency to favor claims ofthe Air Surgeon`s Office, The Surgeon General`s superiors, including theSecretary of War, the Chief of Staff, and the Commanding General, ArmyService Forces, were usually inclined to give The Surgeon General somebacking in his efforts to reestablish greater control over medical serviceof the Army
15(1) Letter, Maj. Gen. Norman T. Kirk, USA(Ret.), to Col. Roger G. Prentiss, MC, Chief, Historical Division, Officeof The Surgeon General, 19 Nov. 1950. (2) Memorandum, Assistant DeputyChief of Staff, for Commanding Generals, Army Air Forces, Army ServiceForces, and Army Ground Forces, 9 July 1943, subject: Hospitalization.
200
Air Forces. However, they were consistently unwilling to disturb thereorganization of the War Department of March 1942, which, so far as medicalservice was concerned, abetted the separatism of the Army Air Forces.
APPOINTMENT OF A NEW SURGEON GENERAL
While the battle over the powers and positions of the Air Surgeon wasin full swing, another and not altogether unrelated battle was in progressover the choice of a new Surgeon General, for the 4-year term beginning1 June 1943. Before the end of February, General Marshall made his recommenda-tionto Secretary Stimson, listing at the same time the factors on which hischoice was based. These were: professional and technical qualificationsin medicine and surgery; military qualifications; administrative and executiveability; high standing among members of the civilian medical profession;training, experience, and reputation among military men as a military doctoror surgeon; record of accomplishment in the Army; and high efficiency rating.On the basis of these factors he listed 11 officers in the grade of colonelor brigadier general as the best qualified candidates for the positionand presented them in the order of his preference. General Magee, Brig.Gen. Howard McC. Snyder, and Brig. Gen. Morrison C. Stayer (then ChiefHealth Officer, Panama Canal Zone) were included in the list of those qualifiedbut were ruled out on the ground that they would attain the statutory ageof retirement before the completion of the 4-year term. He stressed theimportance of "wide military experience" and the "abilityto organize and administer a widespread and complex medical service."He noted that future problems of the new surgeon general would result largelyfrom military operations in "many foreign theaters under diverse andsevere conditions of combat service." With this consideration in mindhe deemed Brig. Gen. Albert W. Kenner, then theater surgeon in North Africa,the best qualified candidate on the list. He pointed particularly to GeneralKenner`s record as surgeon of the Western Task Force with General Pattonin the North African invasion and to his promotion, with General Eisenhower`sconcurrence, to brigadier general on the basis of that service.16
The Chief of Staff was "determinedly opposed to" the reappointmentof the present surgeon general. He considered himself very familiar withMedical Department matters, for he had "maintained a Medical generalofficer in the Inspector General`s Department" for the purpose ofkeeping in close touch with conditions and had talked the situation over,as had the Secretary of War, with a "number of the leading Medicalofficers and surgeons of this country."
16Memorandum, Chief of Staff, for Secretaryof War, no date but approximately 21 Feb. 1943, subject: Appointment ofSurgeon General.
201
In the efforts to locate the proper man, the Secretary of War personallysearched through the entire service records of a number of officers andtalked with some of the medical officers mentioned for consideration. On25 February the Secretary recommended that President Roosevelt appointGeneral Kenner. He repeated in much the same language as General Marshall`sthe belief that in the coming months the chief problems of the medicalservice would arise from combat operations and that the new surgeon generalshould have had "actual service in foreign fields under combat conditions."He urged General Kenner`s early appointment and his return to Washington.17
The President concurred in the appointment of General Kenner but wantedto defer to 1 April the sending of his name to the Senate. He had no objectionto General Kenner`s return to familiarize himself with problems of theSurgeon General`s Office. He added: "I should particularly like himto make a study of the relationship of the Medical Corps of the UnitedStates Army to the General Staff." Many outstanding civilian membersof the medical profession, he stated, thought that the present setup wasnot good. He had received various indications that "the Surgeon Generalof the Army does not have certain responsibilities which might more profitablygo with the Office of The Surgeon General rather than with the GeneralStaff, on which I understand no medical officer-or at least a very juniormedical officer-sits." President Roosevelt also inquired, rather bythe way, as to the "responsibility on the part of the Army for conditionswhich might result from a general epidemic throughout the country"and as to where the General Staff fitted in on this.18
The Secretary informed the President that the nomination of GeneralKenner would be submitted about 1 April and that he would be brought toWashington in order to acquaint himself with the general problems in theSurgeon General`s Office. Early selection had been urged so that the newincumbent might become familiar with the very problems that the Presidenthad mentioned. General Kenner returned to Washington in March, and on 7April was asked by General Somervell to study the report of the WadhamsCommittee. The following day the President wrote the Secretary of War:
"I want you to reconsider the tentative selection made two or threeweeks ago for Surgeon General of the Army. My best advice is that he isa good Doctor but that he would not be regarded as an outstanding choiceby the medical profession.
17(1) Memorandum, Chief of Staff, for GeneralPershing, 27 Mar. 1943. (2) Memorandum, Secretary of War, for the President,25 Feb. 1943, subject: Recommendation for Appointment of Surgeon General,U.S. Army.
18Memorandum, Franklin D. Roosevelt, for the Secretary of War,1 Mar. 1943. The President`s "very junior medical officer" waspresumably Col. William L. Wilson, who was not, of course, on the GeneralStaff but in the Office of the Assistant Chief of Staff for Operations,Services of Supply. Civilian doctors and others who complained of the setuphad not apparently enlightened him as to organizational relationships withinthe War Department or the role of the Services of Supply in Medical Affairs.
202
"As you know, I am in much closer touch with the medical professionin all its ramifications than most people are, and I believe that someother selection could be made which would do more credit to all of us."19
In reply the Secretary noted that "a man with an outstanding reputationfor ability and character in the Medical Corps" would not always havehad the opportunity to become well known in the civilian profession. Hereiterated his belief that General Kenner was "the surgeon with themost outstanding record in the Army today and a man holding a virtuallyunique position among our fighting forces from his performances in Europein 1918 and in Africa this year." However, he proposed the nominationof Brig. Gen. Norman T. Kirk, then commanding officer of the Percy JonesGeneral Hospital at Battle Creek, Mich. He cited comment by Col. WilliamL. Keller, MC (under whom Kirk had served at Walter Reed Hospital), aswell as by General Ireland, as to General Kirk`s ability in orthopedicsurgery and by other officers under whom he had served at various generalhospitals as to his energy, aggressiveness, and administrative ability.He further stated in noting that General Marshall con-curred in the selection:"I have emphasized the comments on his vigor, initiative, aggressivenessbecause in the opinion of the Chief of Staff and myself those qualitiesare the ones at present most needed in the administration of the SurgeonGeneral`s Office."20
General Kirk`s appointment was announced in early May. Thus the choiceof the new surgeon general represented a concession to the insistence ofcertain members of the civilian medical profession, backed by the President,upon a candidate acceptable to the profession, as the committee`s reporthad strongly recommended. The Secretary of War and the Chief of Staff didnot prevail in their effort to appoint a man who had had combat experiencein World War II. However, both sides demanded a surgeon general of vigorand administrative ability, and both appear to have been convinced thatGeneral Kirk possessed these qualities. Although he did not read the WadhamsCommittee report, General Kirk shortly set about the reorganization ofthe Surgeon General`s Office in consonance with certain suggestions byGeneral Somervell.21
INTERNAL ORGANIZATION OF THE SURGEON GENERAL`S
OFFICE
General Kirk inherited an office organization that the previous administrationhad had to create, and methods of dealing with problems that had been devisedin an atmosphere of confusion and scarcity. In the Zone of
19(1) Memorandum, Secretary of War, for thePresident, 6 Mar. 1943, subject: Brig. Gen. Albert W. Kenner. (2) Letter,Franklin D. Roosevelt, to the Secretary of War, 8 Apr. 1943.
20Letter, Secretary of War, to the President, 10 Apr. 1943.
21Letter, Maj. Gen. Norman T. Kirk, USA (Ret.), to Col. RogerG. Prentiss, Jr., MC, Director, Historical Division, Office of The SurgeonGeneral, 24 Nov. 1950.
203
Interior the service command surgeons and the surgeons of tactical andarea commands of both ground and air troops were well established, whileoverseas a medical organization was in being in each of the theaters thatwas to exist during the war. The supply problem was largely solved, andnecessity had already enlarged the sphere in which a solution of the personnelproblem would be worked out. A fund of experience was now available, transmittedfrom the various theaters, that could be applied to the benefit of all.On the other hand, new problems were emerging such as heavy loads of evacueesto care for, a rise in neuropsychiatric cases, reconditioning, rehabilitation,public health in occupied territory, and ultimately problems of demobilization.
The Office of The Surgeon General did not settle down into a staticorganizational pattern which would have indicated that some desirable structurehad at last been achieved, but continued to undergo many changes. Few werethe months from June 1943 to the end of June 1944 that did not witnesssome alteration, in the divisional level or above, in the office structure.Although many changes were piecemeal, they may be conveniently groupedinto the early innovations made by General Kirk, consisting chiefly ofthe selection of new officers for many of the key positions in the office,and two major reorganizations which took place roughly about February 1944and August 1944.
Early Changes of General Kirk`s Administration
General Kirk`s earliest revisions in the structure of his office andchanges in key personnel were in large measure designed to counteract criticismemanating from Headquarters, Army Service Forces. Some changes accordedwith recommendations made by the Committee to Study the Medical Departmentand a few with specific suggestions made by the Commanding General, ArmyService Forces. The reorganization of this period was closely observedby the latter and by the Chief of Staff and the Secretary of War.22
Control Division.-An important appointment made by General Kirkwas that of Col. Tracy S. Voorhees, as Director of the Control Division.Colonel Voorhees had had experience with the legal aspects of the medicalsupply program since mid-1942 and had gained an insight into the relationsof the Surgeon General`s Office with Army Service Forces headquarters throughhis preparation of an answer to the charges brought against the previousSurgeon General in the course of the investigation of the Medical Department.He was apparently considered by both the Surgeon General`s Office and theArmy Service Forces to be a good potential mediator between these two organizationsand thus assumed the role of "troubleshooter" for General Kirk.The latter made it clear at the outset that he would give Colonel Voorheesstrong support. One medical officer commented: "It seemed to me
22Memorandum, Commanding General, Army ServiceForces, for Chief of Staff, 11 Aug. 1943.
204
that General Kirk directly implied that he would accept the recommendationsof Colonel Voorhees `lock, stock, and barrel * * *."23
The new director of the Control Division did not subscribe to the previousconcept of that division`s sphere of action, noting the opposition whichits delving into the internal operations of other divisions had aroused.From now on, the Control Division concentrated on such office-wide problemsas standardizing Medical Department forms, expediting mail through theoffice, decentralizing fiscal work to field offices, and keeping personnelin the Surgeon General`s Office at a minimum number, and so forth. AlthoughColonel Voorhees remained in charge of the division until August 1945,he himself concentrated upon the solution of certain major problems. Hegave General Kirk advice on the reorganization of various elements of theoffice and appraised for him individuals in key positions. Colonel Voorheeswas in part responsible for hiring civilians with wide administrative experience.Most of the year 1944 he spent overseas, looking into problems of medicaladministration in the theaters of operations for The Surgeon General, particularlythe handling of medical supply. He backed General Kirk strongly in thelatter`s efforts to gain more control over the assignments of individualMedical Department officers. Colonel Voorhees frequently supported theSurgeon General`s Office in negotiations with other elements of War Departmentorganization, acting as mediator with Army Service Forces headquarterson several occasions and actively backing General Kirk in his struggleswith the Army Air Forces medical organization. Although he encounteredcriticism on the part of some Medical Department officers who maintainedthat administrators of medical programs should have had medical training,he himself at times drew a line of demarcation between those problems onwhich he considered himself capable of giving advice and those whose technicalnature called for solution by the medically trained. He was, on the whole,a partisan of The Surgeon General and Medical Department, while he continuedto press for greater efficiency within the Surgeon General`s Office andin Army medical administration overseas.24
The personnel situation in the Surgeon General`s Office posed a problemto the new Surgeon General and the chief of his control division from theoutset. In early July 1943, the Surgeon General`s Office had 1,877 employees.Of these, 1,549 were civilians, 304 Medical Department officers, 13 officerson special or temporary duty, and 11 were enlisted men. The office hadseriously
23(1) Memorandum, Director, Control Division,Army Service Forces, for Commanding General, Army Service Forces, 30 June1943. (2) Office Diary, Historical Division, by Col. Albert G. Love, MC,entry for 27 June 1943.
24(1) Annual Report of Control Division for Fiscal Year 1945.(2) Interview, Tracy S. Voorhees, 22 Sept. 1950. (3) Letter, Maj. Gen.Norman T. Kirk, USA (Ret.), to Col. Roger G. Prentiss, Jr., Director, HistoricalDivision, Office of The Surgeon General, 19 Nov. 1950. (4) Office OrderNo. 197, Office of The Surgeon General, 17 Aug. 1945. (5) Memorandum, Director,Control Division, Office of The Surgeon General, for Director, ControlDivision, Army Service Forces, 6 June 1944. (6) Interview, Dr. H. A. Press,9 Oct. 1950. (7) Memorandum, Tracy S. Voorhees, for Executive Officer,Office of The Surgeon General, 29 Dec. 1943, subject: Necessity for Regulationof New Organizations Setup in the Supply Service.
205
exceeded its officer allotment. At the same time some important andgrowing M functions were either inadequately staffed or not staffed atall; for example, hospital management, neuropsychiatry, and the reconditioningservice for hospital patients. Officers engaged in supply, fiscal, andcontrol activities constituted about 40 percent of the officer allotment.Additional officers to staff the more technical functions could be obtainedunder the allotment by moving out of the Surgeon General`s Office businessactivities which could as easily be carried on elsewhere, for elementsmoved out of Washington would not be subject to the limitations of theallotment and the large numbers of qualified civilian personnel neededto carry on business activities could be more readily obtained in otherlocalities. A good deal of the reorganization of the Surgeon General`sOffice from 1943 on was engineered by the director of the Control Divisionwith these considerations in mind.
On 10 July 1943, The Surgeon General issued an organization chart (chart9) which had received the approval of General Somervell. With the exceptionof the Office of Technical Information and the Control Division, all elementsof the office were grouped under the five services. These were about thesame as the services that had existed since August 1942, but their internalorganization underwent some changes, and The Surgeon General replaced withother officers several heads of services and divisions-particularly, thoughnot exclusively, those who had been under fire during the investigationof the Medical Department.
Deputy Surgeon General.-In accordance with a recommendation ofthe Committee to Study the Medical Department, General Kirk appointed afull-time deputy surgeon general-that is, without responsibility for theOperations Service. Brig. Gen. George F. Lull, former Chief of the PersonnelService, was given this post.25
Operations Service.-For Chief of the Operations Service GeneralKirk chose, Col. (later Brig Gen.) Raymond W. Bliss, MC, previously Surgeon,Eastern Defense Command. From the outset of General Kirk`s administrationthe Operations Service assumed a leading role in the administration ofthe office, especially in coordinating the work of various elements ofthe office, as well as the operations of the Surgeon General`s Office withthose of other War Department agencies concerned with Army medical service.The Training Division was added to the Operations Service, the Plans Divisionexpanded, and the former Hospitalization and Evacuation Division and theHospital Construction Division were amalgamated into the Hospital AdministrationDivision.26
25Memorandum, The Surgeon General, for CommandingGeneral, Army Service Forces, 10 Aug. 1943, subject : Interim ProgressReport.
26(1) Office Order No. 351, Office of The Surgeon General, 4June 1943. (2) Memorandum, The Surgeon General, for Commanding General,Army Service Forces, 18 June 1943, subject: Organization of The SurgeonGeneral`s Office. (3) Smith, Clarence McKittrick: The Medical Department:Hospitalization and Evacuation, Zone of Interior. United States Army inWorld War II. The Technical Services. Washington: U.S. Government PrintingOffice, 1956, pp. 176ff.
206-207
Chart 9.-Office of the Surgeon General,10 July 1943
208
The latter change was made at the request of General Somervell, andspecial measures, including the assignment of additional personnel, weretaken to strengthen this division. Colonel Bliss (made brigadier generalin September 1943) brought with him into the office Col. Albert H. Schwichtenberg,MC (fig. 49), a Medical Corps officer who had most recently commanded anAir Forces hospital at Westover Field, as Director of the Hospital AdministrationDivision. Colonel Schwichtenberg`s appointment was made in accordance withthe decision early in July that a flight surgeon would be assigned to theSurgeon General`s Office in the effort to achieve better coordination withthe medical service of the Army Air Forces; Colonel Schwichtenberg headedthe Hospital Administration Division to the end of the war. Early in thefollowing year, General Kirk and Colonel Voorhees also obtained for theHospital Administration Division Dr. Eli Ginzberg (fig. 50), an economistand statistician, then assigned to the Control Division, Army Service Forces.Dr. Ginzberg had previously written reports critical of Army hospital administration,and his appointment was in part an attempt to draw the fangs of the ControlDivision, Army Service Forces.27 Both appointments brought into
27Voorhees, Tracy S.: Recollections of My Workfor The Surgeon General, October 1945. Voorhees` personal file.
209
the office men who had been recently working in the field of Army hospitaladministration and, in the case of Dr. Ginzberg, a civilian with experiencein making the type of statistical estimate of future needs on which ArmyService Forces headquarters placed great reliance.
Within the Hospital Administration Division the Liaison Branch was established(chart 9) in recognition of the need for closer liaison with certain elementsof War Department organization in order to maintain more effective controlwithin the Surgeon General`s Office over the provision of hospitalizationfor three classes of individuals other than the soldier stationed at aregular Army camp. These special groups were the members of the Women`sArmy Corps, prisoners of war, and troops passing through staging areasor ports. This branch put liaison officers on duty with the Women`s ArmyCorps head-quarters, the Office of the Provost Marshal General, and theOffice of the Chief of Transportation to handle problems connected withthese three classes.
The assignment of a liaison officer to the Office of the Chief of Transportationwas the most important of the three, since the Transportation Corps controlledArmy hospitals at ports; medical duties at ports were increasing
210
with the transfer of more and more troops overseas and the return ofpatients to the United States. In April 1943 General Magee had noted theneed of some element in his Operations Service to insure the adoption of,and adherence to, uniform medical policies at the scattered port installationsmaintained by the Transportation Corps and had emphasized the importanceof port surgeons` dealing directly with his office on technical medicalmatters. Representatives of his office, the Office of the Chief of Transportation,and the Hospitalization and Evacuation Section, had concurred in his ideasand it was decided to assign a medical officer as liaison officer withthe Office of the Chief of Transportation. An officer who had been workingon sea evacuation in the Hospitalization and Evacuation Section, Army ServiceForces, was given this assignment. At this date the task was conceivedof as largely that of coordinating the movements of hospital trains operatedby the Transportation Corps in the United States and giving technical supervisionto the medical service afforded at ports and staging areas. The work doneby the Liaison Branch, Surgeon General`s Office, and the officer assignedto the Office of the Chief of Transportation eventually came to includemost of the activities in connection with the evacuation of the woundedfrom overseas formerly carried on by the Hospitalization and EvacuationSection, Army Service Forces. The new setup provided effective machineryfor planning large-scale evacuation of patients from the theaters of operationsto United States ports by ship and from ports to general hospitals by train.28
Supply Service.-Extensive changes were made in the Supply Service,both in personnel and in internal organization. The Committee to Studythe Medical Department had advocated the appointment of men with trainingin industry (instead of doctors) to key positions in the Supply Service(as well as in the procurement offices and depots). Mr. (later Brig. Gen.,MAC) Edward Reynolds (fig. 51), who had come into the office from industryas a special assistant to the chief of the Supply Service, was now madeacting chief. About a year later he was made chief and served in that capacityuntil the end of the war. Civilians with extensive managerial experiencein industry were also placed in two other important positions in the SupplyService. Before the end of 1943 the services of Mr. Charles Harris, whohad had responsible experience, in warehousing operations with large industrialconcerns, were obtained for the Supply Service by the Director of the ControlDivision and Under Secretary of War Patterson. Mr. Harris was made deputychief of the service and given direct responsibility for operating themedical supply
28(1) Memorandum, Maj. Gen. LeRoy Lutes, forThe Surgeon General, 18 May 1943, subject: Coordinated Medical Servicefor Ports of Embarkation. (2) History, Medical Liaison Office to the Officeof Chief of Transportation and Medical Regulating Service, Surgeon General`sOffice. [Official record.] (3) Smith, Clarence McKittrick: The MedicalDepartment: Hospitalization and Evacuation, Zone of Interior. United StatesArmy in World War II. The Technical Services. Washington: U.S. GovernmentPrinting Office, 1956, part IV.
211
depots. The services of Mr. H. C. Hangen (fig. 52), who had worked temporarilywith the Supply Service in solving stock control problems in 1942, hadbeen reenlisted early in 1943, also through the instrumentality of thedirector of the Control Division and the Under Secretary of War. Mr. Harrisand Mr. Hangen accompanied the director of the Control Division on overseamissions in 1944 to deal with problems of medical supply in the theatersof operations.29
The Supply Service, under fire throughout most of 1942, had had to expandgreatly to meet the demands for medical supplies and equipment confrontingit. By April 1943, it consisted of 7 divisions with 27 branches. By thebeginning of June its personnel amounted to 114 officers and 524 civilians,far more than that of any other of the services in the office. An examinationof chart 9 shows that by 10 July the number of divisions was reduced to5 and the number of branches to 16. While not all this reduction was cleargain (since some functions had to be transferred to other segments of theoffice),
29(1) Office Order No. 92, Office of The SurgeonGeneral, 1 May 1944. (2) See footnote 27, p. 208. (3) Director, ControlDivision, Office of The Surgeon General, Report as to Depot Operations,6 May 1944.
212
by late August the personnel of the Supply Service was reduced to 83officers and 452 civilians.30
Additional reductions in the numbers of officers assigned to supplyduties in the Surgeon General`s Office were brought about by shifts ofvarious supply functions from Washington to New York, N.Y., although inthe case of some transfers it was necessary to leave liaison elements inWashington. In September, direct supervision of all Medical Departmentprocurement of supplies and equipment was centered in the New York procurementoffice, newly named the Army Medical Purchasing Office; the separate St.Louis procurement district was abolished. Branch offices were establishedin both St. Louis and Chicago, but from the fall of 1943 to the end ofthe war the buying of medical supplies and equipment remained concentratedin New York. On the recommendation of, Colonel Voorhees and Mr. Reynolds,the greater portion of stock control activities were also moved to NewYork and Mr. Hangen was put in
30Memorandum, Acting Director, Control Division,Office of The Surgeon General, for Director, Control Division, Army ServiceForces, 23 Aug. 1943.
213
charge. Other work connected with procurement, such as legal work onrenegotiation and termination of contracts, was transferred to Now Yorkduring 1944 and 1945.
The process of adjusting the organization and procedures of the SupplyService, Surgeon General`s Office, to conform with the operations of Headquarters,Army Service Forces, continued. At the request of the latter, new unitswere formed to make inspections of medical supply and to report on progressin procurement and distribution. An important development in the fieldof medical supply was the creation of a board to make plans for medicaland sanitary supplies for civilian use in occupied territories. Duringthe early months of 1943, the Public Health Officer of the Civil AffairsDivision of the War Department Special Staff and the International Division,Army Service Forces, had held conferences with the staff of the SurgeonGeneral`s Office on this matter, and before the end of June, General Kirkhad appointed a Civil Affairs Division Board to engage in planning in thisfield.31
Professional Service.-The early months of General Kirk`s administrationwitnessed continued expansion of the Professional Service (still headedby Brig. Gen. Charles C. Hillman) and the network of consultants who preparedtechnical instructions on medical matters for issue by the office. Theelaboration of the Surgical Branch into a division with Surgery, Radiation,and Physical Therapy Branches and the establishment of a ReconditioningDivision (with branches as shown on chart 9) were the chief developments.An Army-wide program for reconditioning convalescent soldiers had beeninaugurated by the Surgeon General`s Office early in 1943, and by Aprilthe program was theoretically underway in hospitals. Only a few hospitalshad developed good programs, however, and plans for reconditioning tooksubstance only after the new division began to assume direction of thetotal program in August. The Reconditioning Division was strengthened bythe addition of personnel, including civilian women trained in occupationaltherapy, late in 1943 and in 1944. Further impetus was given the programin March 1944 when, after a conference held by the Chief of Staff, ArmyService Forces (General Styer), Army Service Forces headquarters orderedthe service commanders to establish a reconditioning branch in the officesof surgeons at their headquarters and authorized personnel to staff them.At the same date, reconditioning programs and personnel were authorizedfor all hospitals controlled by the Army Service Forces.
Planning undertaken by the Reconditioning Division, Surgeon General`sOffice, was affected by various shifts of policy. Throughout 1943 and 1944the scope of the Army`s responsibilities toward convalescent soldiers wasmuch bruited; not until the end of the latter year did policy in this fieldcrystallize.
31(1) Memorandum, Headquarters, Army ServiceForces, for The Surgeon General, 9 Aug. 1943, subject: Inspection Manual.(2) Medical Department, United States Army. Preventive Medicine in WorldWar II. Volume VIII. Civil Public Health Problems and Activities, pt. III.[In preparation.]
214
The reconditioning program was one to which the General Staff and ArmyService Forces headquarters, as well as the President and other highlyplaced Government officials-all sensitive to the public`s growing interestin convalescent veterans-paid continued attention. The reconditioning ofpatients for return to military duties and the rehabilitation of thoseincapable of further duty for return to work in civilian life were usuallyconceived of as two distinct tasks, the Army to be responsible for theformer and the Veterans` Administration for the latter. Early planningwas done with this principle in mind. For several reasons this neat distinctionwas not adhered to, and the difference between so-called "reconditioning"and "rehabilitation" came to be largely one of emphasis. In thefirst place, the Army was responsible for giving its wounded all possiblebenefit of medical treatment before it discharged them. In some cases trainingaimed at rehabilitation could profitably be given to men who had not yetreceived full medical treatment; the giving of vocational training at asearly a stage as possible was a good morale builder. More over, the VeteransAdministration was not yet staffed or equipped to undertake a full programof rehabilitation, and the Army was obliged to assume responsibility. Thefinal policy established by President Roosevelt and his advisers, includingthe Secretary of War, took the trend of placing rather full responsibilityupon the Army Medical Department. In December 1944 the broadening of theArmy`s program for convalescents was clinched by a letter from PresidentRoosevelt to Secretary Stimson. The President decided that before dischargeall oversea casualties should receive from the Army the benefit of "physicaland psychological rehabilitation, vocational guidance, prevocational. trainingand resocialization." Consequently the Medical Department developeda fairly extensive program for convalescent soldiers, including specialprograms for the blind and deaf.32
Reorganization During 1944 and 1945
Other than new organizational units established to handle new functions,the principal changes made in the organization of the Surgeon`s Officeby the new administration in the fall of 1943, as outlined above, wereaimed at achieving more economical operation of the fiscal, personnel,and supply activities of the office-fields of administration which ArmyService Forces headquarters had especially emphasized. The changes of 1944followed a similar pattern, bringing additional activities to ether underthe Operations Service and freeing the Professional Service of certainactivities of an administrative character. Although developments were piecemeal,the changes may be grouped for the sake of convenience into two major reorganizations,one in February 1944 and the other in August of that year.
32(1) Letter, President Roosevelt, to SecretaryStimson, 4 Dec. 1944. (2) Annual Reports, Reconditioning Division, Officeof The Surgeon General, fiscal years 1944, 1945. (3) Medical Department,United States Army. Reconditioning in World War II. [In preparation.]
215
Reorganization of February 1944
The reorganization of early 1944 (chart 10) embodied a number of featuresadvocated in a survey of the Surgeon General`s Office made by the new Directorof the Control Division, who took into account the opinions of senior staffofficers. In this reorganization the Preventive Medicine Service was separatedonce more from the Professional Service. The task of keeping tab on themanifold activities of the Professional and the Preventive Medicine Serviceswas made easier by the appointment of deputy chiefs and assistants to aidthe heads of these two services. The Deputy Chief of the Preventive MedicineService, for instance, acted as Director of the U.S.A. Typhus Commission,relieving his chief of responsibility for this part of the preventive medicineprogram. General Simmons, besides supervising the Preventive Medicine Servicedhad to direct the work of the Army Epidemiological Board, which, throughits commissions located at universities and philanthropic foundations,investigated many epidemic diseases.33
Professional Service.-The rise of the Neuropsychiatry Branchto divisional status, the major change in the Professional. Service atthis date, marked the increase in neuropsychiatric problems facing theMedical Department as a result of increasing numbers of troops in combatareas. Late in 1943 on the death of Colonel Halloran, Lt. Col. (later Brig.Gen) William C. Menninger, MC (fig. 53), formerly medical director of theMenninger Psychiatric Hospital at Topeka, Kans., and more recently a neuropsychiatricconsultant in the Fourth Service Command, came into the office as ChiefNeuropsychiatric Consultant and head of the new division, remaining inthat capacity till the end of the war.34
The Surgery Division of the Professional Service was elaborated by theaddition of three new branches, Orthopedic, Transfusion, and Chemical Warfare.To the Reconditioning Division, a Blind and Deaf Rehabilitation Branchwas added in order to handle special problems related to these two typesof war casualties. The Chief of the Professional Service continued to directthe work of the technical elements of the Surgeon General`s Office. Thesewere headed by consultants who now represented the following fields: Aviationmedicine, internal medicine, surgery, neuropsychiatry, reconditioning,dentistry, veterinary medicine, and tuberculosis.
Preventive Medicine Service.-In the reestablished PreventiveMedicine Service, in which branches were once more raised to the statusof divisions, some new divisions appeared. These were: the Tropical DiseaseControl Divi-
33(1) Memorandum, Director, Control Division,for The Surgeon General, 13 Jan. 1944, subject: Proposal for Overall Plansfor Most Effective Utilization of Officer Allotment, Civilian Personnel,and Space in The Surgeon General`s Office for Modifications in the PresentOrganization. (2) Office Order No. 4, Office of The Surgeon General, 1Jan. 1944.
34Annual Report, Neuropsychiatric Division, Office of The SurgeonGeneral, for fiscal year 1944.
216-217
Chart 10.-Office of The SurgeonGeneral, 3 February 1944
218
sion, which had functioned as a branch of the Preventive Medicine Divisionin 1943; the Nutrition Division, which had functioned as a branch withinthe Professional Service; and the Civil Public Health Division, newly created.
Officers in the Tropical Disease Control Division worked during thelatter war years to strengthen the machinery for malaria control overseas.Until mid-1943 the task had been one of demonstrating to theater commandsthe value of the malaria control and survey units which the Surgeon General`sOffice had designed and recommended for theater use. By the date when GeneralKirk took office, the malaria control organization had proved itself overseas,and the Tropical Disease Control Division concentrated on the task of estimatingthe numbers of malariologists and units that would be needed at futuredates, improving the training of these units and reinforcing the responsibilityof unit commanders for malaria control. Higher officials of the War Departmentwere now more active than previously in warning oversea com-manders ofthe dangers of tropical disease to the success of campaigns. In July 1943,the Chief of Staff warned General Eisenhower in North Africa of the menacewhich malaria posed to troops in that region, stating: "Most confidentiallywe have had grave difficulties in the Pacific and a considerable
219
number of divisions are temporarily out of action as a result, two ofthem for more than six months."35
The work of the Tropical Disease Control Division was effectively supplementedby the efforts of a number of agencies. Toward the close of 1943, Armymedical officers and other doctors with the U.S.A. Typhus Commission andthe Rockefeller Foundation had dramatically demonstrated in Naples thevalue of the newly developed DDT in preventing the spread of typhus. Thisinsecticide proved a valuable agent in control of several tropical diseases,and upon recommendations by The Surgeon General and the Director of theOffice of Scientific Research and Development for production of DDT inlarge quantities, the Army Service Forces directed the creation of theDDT Committee. The appearance of bubonic plague among the populations ofnorthern Africa-particularly at Dakar, where an epidemic broke out amongcivilians in midsummer of 1944-pointed to the need for special effort tocontrol rodents. Accordingly, an Army Committee on Insect and Rodent Controlsuperseded the DDT Committee in November 1944. Besides representativesof the Army (Office of the Director of Materiel, Army Service Forces, severaltechnical services, and the offices of the Ground and Air Surgeons), itincluded officials of a few other interested agencies of the Federal Government.To the end of the wax this committee worked on research problems in controlof both insects and rodents, the training of personnel in control, andthe preparation of manuals outlining methods.36
The establishment of the Civil Public Health Division marked the firsttime that full machinery was set up in the Surgeon General`s Office toundertake large-scale medical work among civilians in the occupied countries.Since mid-1940 the office had done some planning in that field and hadprepared courses of training in public health work at schools of militarygovernment which the Army maintained at various universities, but in theintervening years chief responsibility had rested with a Sanitary Corpsofficer, Col. Ira V. Hiscock, assigned first to the Office of the ProvostMarshal General and later to the Civil Affairs Division of the War DepartmentSpecial Staff. As early as May 1943, when the problem was sharply posedby the final conquest of North Africa, Colonel Hiscock had insisted thatmachinery would have to be set up to insure the medical and sanitary suppliesnecessary to an effective public health program overseas, and General Kirkhad appointed a board of officers to implement such a program. In November1943, the President himself urged the importance of planning relief workfor civilians in occupied countries. The Civil Public Health Division setup in the Surgeon General`s
35Letter, General Marshall, to General Eisenhower,Allied Force Headquarters, Algiers, 13 July 1943.
36(1) Medical Department, United States Army. Preventive Medicinein World War II. Volume II. Environmental Hygiene. Washington: U.S. GovernmentPrinting Office, 1955, pp. 251-269. (2) Office of the Chief of MilitaryHistory : Historical Report of Services of Supply Troops in Dakar, July1944. [Official record.] (3) War Department Memorandum No. 40-44, 8 Nov.1944. (4) War Department Circular No. 163, 4 June 1945.
220
Office on 1 January 1944, and transferred to the Preventive MedicineService by the February reorganization, was a logical followup. At thesame time a Civil Affairs Branch was established in the Special PlanningDivision of the Operations Service, with functions that included estimatingrequirements and developing medical supply kits for various purposes.37
The Civil Public Health Division was headed by Col. Thomas B. Turner,MC (fig. 54), Professor of Bacteriology at The Johns Hopkins University.Colonel Turner was made Director of the new Civil Public Health Divisionin the Preventive Medicine Service, Surgeon General`s Office. He spentthe early months of 1944 in the Mediterranean and European theaters reviewingthe Army`s setup for public health programs for populations of the coloniesand countries of North Africa and Europe. From then on responsibility forplanning public health work in the occupied areas was concentrated in theSurgeon General`s Office. The Civil Public Health Division shared its responsibilitieswith other parts of the office, for the nature of the program made it necessaryto get advice and aid from specialists in other fields as well as frommembers of the Personnel and Supply Services.38
37(1) Office Order No. 419, Office of The SurgeonGeneral, 28 June 1943. (2) Letter, President Roosevelt, to Secretary Stimson,12 Nov. 1943. (3) Daily Diary, Civil Affairs Branch, Office of The SurgeonGeneral, 5 Feb. 1944-30 Sept. 1944.
38Medical Department, United States Army. Preventive Medicinein World War II. Volume VIII. Civil Public Health Problems and Activities,pt. III. [In preparation.]
221
Operations Service.-The emphasis upon the Operations Service,which characterized General Kirk`s administration, continued with the reorganizationof February 1944. The reorganized Operations Service had a chief, Brig.Gen. Raymond W. Bliss, and two deputies. The divisions of the OperationsService were placed directly under the two deputies, except for the TrainingDivision, which reported directly to the chief. The Deputy Chief for Plansand Operations, Col. Arthur B. Welsh, MC, was responsible for providinghospitals for the oversea, theaters. All three divisions under ColonelWelsh developed from former branches. The Mobilization and Overseas OperationsDivision, of which Colonel Welsh himself acted as head, coordinated theplanning for field operations, working closely with two higher elementsof the War Department, the Planning Division of Army Service Forces headquartersand the Operations Division of the War Department General Staff. The SpecialPlanning Division of the Operations Service coordinated Medical Departmentactivities in two fields-demobilization and supply for the public healthprogram in occupied areas-which demanded the cooperation of several divisions.The third division supervised by the Deputy Chief for Plans and Operationswas the Technical Division; it coordinated all steps involved in the development,modification, and classification of items of Medical Department suppliesand equipment, determined the amounts, types, and schedules of issue tounits and installations, and prepared and reviewed tables of organizationand equipment, Medical Department equipment lists, and tables of basicallowances.
All functions having to do with hospitalization and evacuation withinthe United States were placed under the Deputy Chief for Hospitals andDomestic Operations, Colonel Schwichtenberg, who also acted as chief ofthe lone division under his direction, the Hospital Division. The FacilitiesUtilization Branch of this division-headed by Dr. Eli Ginzberg, who hadbeen brought into the division early in. the year-was of special importanceto long-range planning for hospitalization in the United States. It investigatedways of making more efficient use of hospital facilities and personneland hence was in accord with the thinking of Headquarters, Army ServiceForces, which consistently sponsored long-range studies aimed at achievingmore effective use of the personnel and facilities of all the technicalservices. The new branch, for example, made studies on the number of evacueesto be expected from overseas, on an integrated plan for hospitalizationin the United States irrespective of command channels. The scope of itswork was later expanded to a more comprehensive one of appraising the currentand prospective mission of the Medical Department.
Medical Regulating Unit.-Of the four liaison units under thedirection, of the Deputy Chief for Hospitals and Domestic Operations, themost important was the one in the Office of the Chief of Transportation,which was enlarged in May 1944 into the Medical Regulating Unit. In anticipationof the return of heavier loads of wounded from overseas, it was vital tomaintain
222
in a single office all records of bed vacancies in the general hospitalsin the United States and regulate the transfers of patients to them. Hencethe Evacuation Branch of the Hospitalization Division, Surgeon General`sOffice, which had had control over the allocation of beds, was transferredto the new Medical Regulating Unit. Located within the Office of the Chiefof Transportation, but under the direction of the Deputy Chief for Hospitalsand Domestic Operations, Surgeon General`s Office, the Medical RegulatingUnit became the nerve center for the distribution of patients from overseasto the general and convalescent hospitals. Its personnel worked closelywith a medical regulating officer in the Air Surgeon`s Office, with servicecommand surgeons, port surgeons, and hospital surgeons. The orderly transferof patients from ports to hospitals called for the amassing and transmissionof much data-on capacities of hospital ships and trains, and of transportsand planes used in evacuation, on numbers of patients arriving on specificdates, as well as on the numbers of beds available in the general hospitals.The existence of the Medical Regulating Unit and its authority to dealdirectly with the surgeons of the various commands concerned with the returnof patients from overseas made it possible to carry out transfers of patientsmore speedily and efficiently than would have been the case if commanddecisions had had to be obtained at each step.39
The emphasis placed upon coordinating a number of activities under thelabel of "operations" led to an increase in the number of officersassigned to the Operations Service. Of 321 Medical Department officersserving with the office in early September 1944, 76 were allotted to theOperations Service, whereas the large Preventive Medicine Service and elementsof the Supply Service in Washington had only about 50 each.40
Control of assignments.-The effort to achieve more centralizedcontrol over assignment of Medical Department personnel continued. Successin the efforts to improve the Army`s hospital system depended ultimately,The Surgeon General argued, upon the power to place in any key positionthe man with the most suitable medical training and experience. Controlover assignments of Medical Department personnel, except those assignedto the Surgeon General`s Office and to installations under command controlof The Surgeon General, was exercised by the commanders of service commands,defense com-mands, oversea theaters, and other commands. The debate betweenhigher War Department authority and The Surgeon General over the latter`sdegree of control over assignments continued throughout 1943 and 1944.General Kirk`s efforts resulted only in limited gains in centralized controlover the assignments of certain specialized personnel within the Army ServiceForces chain of command.
39(1) Army Service Forces Circular No. 147,19 May 1944. (2) History of Medical Liaison Office to the Office of theChief of Transportation and Medical Regulating Service, Office of The SurgeonGeneral. [Official record.]
40Office Order No. 186, Office of The Surgeon General, 7 Sept.1944. A number of elements of the Supply Service were in New York by thisdate.
223
Personnel Service.-The Director of the Control Division (ColonelVoorhees) emphasized the development of a more effective Personnel Serviceas a key to more centralized control by The Surgeon General over all MedicalDepartment personnel. He stated that many officers at Headquarters, ArmyService Forces, as well as senior officers in the Office of The SurgeonGeneral, lacked confidence in the Personnel Service`s records on the assignmentsof specialists and that Army Service Forces officials doubted that theSurgeon General`s Office had prepared adequate plans for more effectiveuse of Medical Department personnel. They considered assignments by thePersonnel Service without recourse to other services in the Surgeon General`sOffice inadvisable. Colonel Voorhees concluded that more general confidencein the working of the Personnel Service was an indispensable preliminaryto the success of The Surgeon General`s efforts to obtain more thoroughcontrol over the assignments. Consequently late in 1943 several steps weretaken to strengthen the Personnel Service. A branch was set up in the officeof the chief to work for a more effective use of personnel in the Officeof The Surgeon General and in-the field installations. A Personnel Planningand Placement Branch was created to do long-range planning on the placementof key military personnel. Finally, three branches-the Army Nurse, HospitalDietitian, and Physical Therapy Aide Branches-were added to the MilitaryPersonnel Division to handle matters related to the procurement and useof personnel in the three chief professional fields in which women wereused.41
Supply Service.-In midsummer another reorganization of the SupplyService took place. At that time two deputy chiefs were assigned to theSupply Service, one for storage operations and the other for supply control.The latter had the task of coordinating the work of the Supply Servicein Washington with the activities of the Army Medical Purchasing Officein New York. In accordance with the long-range trend toward shifting medicalsupply functions to New York, the Renegotiation Division was transferredto the New York office, only a liaison unit remaining in Washington. Elementsof the Supply Service remaining in Washington had now declined considerablyin size; before the close of 1944 the large New York office had a staffof 182 officers and 547 civilian employees.42
Historical Division.-The year 1944 witnessed the expansion ofthe Medical Department`s historical program, which had been deliberatelyrestricted in scope to avoid duplicating work projected by the NationalResearch Council. The Council`s Division of Medical Sciences had undertakenan ambitious plan for producing a history of wartime medicine in the UnitedStates, which would include the more technical or "clinical"aspects of the Medical Department`s wartime work. In 1944, however, responsibilityfor writing the history of all the Medical Department`s wartime experience,"administrative" and "clinical,"
41See footnote 33 (1), p. 215.
42Yates, Richard E. : The Procurement and Distribution of MedicalSupplies in the Zone of Interior During World War II (1946), p. 63.[Officialrecord.]
224
was shifted to the Historical Division of the Surgeon General`s Office.By that date War Department officers directing the historical program,including some Medical Department officers, had concluded that the MedicalDepartment`s history should conform to the Government-wide historical programcommitting each agency to produce its own history.43
Reorganization of August 1944 and later developments
The second major reorganization of the Surgeon`s General`s Office in1944 had taken place, for the most part, by August (chart 11). It stemmedin large measure from proposals made by Colonel Voorhees, Chief of theControl Division, who felt that since some of the changes made as a resultof the Wadhams Committee investigation had proved unsatisfactory, The SurgeonGeneral need no longer be bound by the committee`s recommendations. ColonelVoorhees proposed the appointment of an assistant surgeon general (in additionto the deputy surgeon general already functioning); the placing of theMilitary and Civilian Personnel Divisions directly under the AdministrativeService instead of maintaining a separate Personnel Service; and the separationof the advisory functions of the heterogeneous, unwieldy Professional Servicefrom its variety of operating functions. Only the first proposal went intoeffect without modification, the Chief of the Operations Service beinggiven the additional title of Assistant Surgeon General, with power toact for The Surgeon General in all internal affairs of the Surgeon General`sOffice.44
The second and third proposals met with objections from the ControlDivision, Army Service Forces. Colonel Voorhees had advocated the abolitionof the Personnel Service and the removal of the Military and Civilian PersonnelDivisions to the Administrative Service on the ground that their work shouldbe limited to issuing assignment orders and keeping personnel records.The Army Service Forces, however, refused to make an exception to its fixedpolicy for combination of military and civilian personnel activities withineach technical service under a single head. The Personnel Service remainedan entity, but a stipulation that it might make assignments of key personnelonly with the concurrence of the service or division concerned with, orhaving special knowledge of, the qualifications of the officer proposedfor the assignment (as well as of the special requirements of the job)limited its power over assignments.
The third proposal, for separation of the advisory and operating functionsof the Professional Service, called for a thoroughgoing breakup of thatservice. Since the Control Division, Army Service Forces, objected to thison the
43(1) Love, Albert G. : The Historical Division,1 Aug. 1941-28 July 1945. [Official record.] (2) Fulton, J. F.: Prospectusof a Medical History of the War, 1941 to 19--. War Med. 2: 847- 859, September1942. (3) A New Approach to the Medical History of World War II. Bull.U.S. Army M. Dept. 77: 67-72, June 1944.
44Memorandum, Tracy S. Voorhees and Eli Ginzberg, for The SurgeonGeneral, 17 Aug. 1944, and inclosure 1, subject : Proposal for Changesin Office Organization of the Surgeon General`s Office, 19 June 1944 (draftNo. 2).
225
Chart 11.- Office of The Surgeon General,24 August 1944
ground that the report of the Committee to Study the Medical Departmenthad advocated maintaining it as a separate service, a compromise was adopted.Both the Professional and Administrative Services were dissolved, and amore clear-cut distinction was made between professional and administrativeduties. The Professional Administrative Service was set up to embody thethree divisions shown on chart 11. From the old Professional Service wereformed four divisions embracing the work of major groups of consultants:Medical Consultants, Surgical Consultants, Neuropsychiatric Consultants,and Reconditioning Consultants Divisions. These and the Dental and VeterinaryDivisions were all advisory in function and were made staff divisions.In General Kirk`s opinion the elimination of the Chief of ProfessionalService would make possible a closer integration of the professional consultantswith the Hospital Division and consequently more effective applicationof the expert technical knowledge of consultants to treatment of all hospitalpatients, especially battle casualties.45
This change was directly contrary to General Somervell`s theory thatthe number of officers reporting to a superior should be strictly limited.A glance at the chart shows that in addition to these six professionaladvisory divisions, six other divisions, as well as the Ave services, wereat top level. On the other
45Memorandum, The Surgeon General, for CommandingGeneral, Army Service Forces, 8 Aug. 1944, subject: Visits to Field Installations.
226
hand, The Surgeon General now had in his immediate office both a deputyand an assistant to aid him in dealing with all these elements.46
The major elements of the Surgeon General`s Office-that is, of divisionlevel or above-remained unchanged between August 1944 and the end of thewar. In October the Resources and Analysis Division (the former FacilitiesUtilization Branch of the Hospital Division) was established. Headed byEli Ginzberg, who reported directly to the chief of the Operations Service,this division engaged in personnel planning on a broad scale and planningfor the most effective use of Medical Department facilities. Its predecessor,the Facilities Utilization Branch of the Hospital Division, had been limitedto planning the use of domestic resources; the new division kept recordson the distribution of Medical Department personnel and evaluated the currentand prospective programs of the Medical Department in major commands bothin the United States and overseas. It also undertook some planning of theinternal organization of the Surgeon General`s Office and worked out certainrecommendations for the internal organization of a theater surgeon`s office.The latter had formerly been a matter for decision by the theater surgeonand the theater command, and the Surgeon General`s Office had not engagedin much planning in that field. During 1944, as well as in early 1945,theater surgeons and Medical Department officers returning from theaterassignments or special missions had stressed the lack of centralized controlof medical service from a high level and inadequate staffing of theatersurgeons` offices. From early 1945 on, the Surgeon General`s Office madespecial efforts to enlarge the staffs of theater and Services of Supplysurgeons overseas with the best personnel available.47
Even the end of the war led to no immediate major changes in the structureof the Surgeon General`s Office. With the reduction in size of the Army,retrenchment in the Operations Service, particularly in training activities,was in order. The gradual consolidation of organizational elements of theSurgeon General`s Office, urged by Army Service Forces headquarters fromand after September 1945, to suit its mission in the expected years ofpeace, took place in the postwar years.
Responsibility for medical defense against special methods of warfare
No formal organizational element was ever officially set up in the SurgeonGeneral`s Office in the course of the war with major responsibility foreither of two special fields of military medicine, chemical warfare andbiological (or bacteriological) warfare medicine. Both were neverthelessregarded as functions of military preventive medicine, and the PreventiveMedicine Service was
46(1) Office Order No. 175, Office of The SurgeonGeneral, 25 Aug. 1944. (2) Annual Report of the Control Division, Officeof The Surgeon General, for fiscal year 1945.
47(1) Weekly Diary of Resources Analysis Division for week ending2 June 1945, (2) Letter, Eli Ginzberg, to Col. Calvin H. Goddard, MC, Editor-in-Chief,History of the Medical Department, U.S. Army in World War II, 5 Nov. 1951,and inclosure. See also the chapters of this volume dealing with the overseatheaters.
227
concerned with studies of chemical and biological warfare, and withprepara-tions for combating them, throughout the war. Since the use ofpoisonous gases or germ-disseminating agents by the enemy was a potentialthreat to the civilian population of the United States, primary responsibilityfor inquiry into methods of defense against them rested during the earlywar years with special agencies set up for the purpose outside militarychannels. However, when concern over potential use of these agents by theenemy increased late in 1943 and early 1944-spurred on in the case of biologicalwarfare by reports from the Office of Strategic Services that the Germanswere planning to conduct germ warfare-the War Department assumed a moreactive role in these two fields. Although the Medical Department consistentlyrefrained from participation in the offensive aspects of gas and germ warfare,Medical Department officers participated in most of the defensive aspects-research,development of ways and means of protection, training, procurement of itemsused in prevention, and treatment of casualties.
Chemical warfare.-Until mid-July 1943, medical research on chemicalwarfare medicine had been carried out by a group at Edgewood Arsenal, Md.,a field installation of the Chemical Warfare Service. Outside the War Departmentboth the National Research Council and the Office of Scientific Researchand Development conducted investigations into chemical warfare medicine.In the spring of 1943, when it appeared that a staff officer was neededin the Chemical Warfare Service to coordinate the activities of the variousagencies, it was decided to establish in that service a Medical Divisionat staff level. General Magee and the Chief of the Chemical Warfare Servicereached agreement as to the responsibilities of the new division whichwas created soon after General Kirk assumed office. Among its functionswas the preparation of reports on methods of treating casualties causedby chemical warfare agents and the study of hazards to the health of personneldoing research on these agents or engaged in producing them. The divisionalso prepared official War Department manuals and handbooks for the treatmentof gas casualties among workers at Chemical Warfare Service arsenals andplants and among troops in the field, and developed special items and kitsfor treatment of such casualties. Two laboratories at Edgewood Arsenal,the Medical Research and Toxicological Laboratories, were under its direction,as were similar laboratories established at a few other Army posts in theUnited States.
A Chemical Warfare Branch of the Surgical Consultants Division, Officeof The Surgeon General, maintained liaison with the Medical Division ofthe Chemical Warfare Service. The Surgeon General`s Office made all contractsfor procuring items and kits used in the treatment of gas casualties. Duringthe period September 1942-April 1945, nearly 2,000 Army doctors receivedtraining in all aspects of the care of gas casualties at the Chemical WarfareSchool at Edgewood Arsenal. Veterinary Corps officers and laboratory workerstrained in veterinary techniques made studies of the toxicologic effectsof chemical warfare agents on animals and foods. They also undertook tode-
228
velop, protective devices for military animals and food supplies (orto improve upon old ones) and methods for their decontamination or treatment.48
Biological warfare.-Study of the potentialities of biologicalwarfare had been informally made the responsibility of the Chemical WarfareService in 1941 at the instance of the Secretary of War; a small unit ofthe agency and several civilian organizations of the Federal Governmenthad engaged in research in this field. By 1943 the need for more directmilitary participation had become, apparent and the War Research Service,the civilian agency of chief responsibility had charged the Chemical WarfareService with the military phases of the programs. Early in 1944 SecretaryStimson placed direct responsibility for preparation for biological warfareon the Chemical Warfare Service (the War Research Service was dissolved)and called for the cooperation of The Surgeon General in the defensiveaspects of this type of combat.
After this date the Medical Department took a somewhat more active partin the program, although the Chemical Warfare Service had chief responsibilityfor both the offensive and defensive aspects of biological warfare. Thechief participation by the Surgeon General`s Office consisted of a BiologicalWarfare Committee which The Surgeon General established in the office toadvise him on policy, and a Special Protection Unit in the Preventive MedicineService to coordinate medical aspects of biological warfare, includingprocurement and storage of biological supplies which the Chemical WarfareService had developed for protection of personnel against biological agents.Special protective clothing and masks, chemical decontaminating agents,chemotherapeutic agents, disinfectants, antibiologicals, vaccines, andtoxoids-all these became the means of antibiological warfare which emergedfrom the joint effort. Many of them were the same means with adaptations,used to prevent infectious diseases occurring in nature and hence wereclosely kin to the preventive medicine program. As in the case of chemicalwarfare, some of the methods and supplies and equipment developed to protectworkers at the plants and laboratories producing the means of offensivewarfare were later developed into instruments of protection for the soldierin the field. Various handbooks dealing with means of defense against biologicalwarfare were issued, and 70 Medical Department officers were trained, alongwith Navy medical officers and Chemical Warfare Service officers, in antibiologicalwarfare Service at the school maintained for the purpose by the ChemicalWarfare Service at Camp Detrick, Md. As for direct contribution to researchfindings in the field, a major contribution of the Army Medical Departmentwas the work done by Veterinary Corps officers and veterinary techniciansat Chemical Warfare Service installations doing special research on thethreat of animal disease,
48(1) Cochrane, R. C.: Medical Research inChemical Warfare (1 Mar. 1947), pp. 56ff. [Official record, Office of theChief of Military History.] (2) Brophy, Leo P., and Fisher, George J. B.:The Chemical Warfare Service: Organizing for War. U.S. Army in World WarII. Washington: U.S. Government Printing Office, 1959, pp. 34-36,104-106.
229
particularly rinderpest.49 As neither gas nor germ warfarewas employed in World War II, despite repeated reports of its imminentuse in various oversea theaters, the adequacy of the Medical Department`sparticipation in the defen-sive program never received a sure test.
Atomic warfare.-A third field of special warfare-atomic-developedfor the first time in World War II. Throughout the history of the ManhattanProject on the atomic bomb until the bomb was used in Japan, the SurgeonGeneral`s Office had no responsibility for studying or obtaining informationon the medical and physiologic effects of the new weapon on the human body.In the fall of 1943 a few Medical Department officers were assigned thetask of selecting and commissioning doctors to care for the health of personnelworking on the secret project, but no organizational element was set upin the Surgeon General`s Office to handle any phase of atomic energy medicine.A liaison officer in the Surgeon General`s Office handled requests foradditional personnel and requisitions for medical supplies which the ArmyMedical Department furnished; in the early months of 1944 about 25 MedicalDepartment officers were on duty with the project. After the atomic bombexplosions in Japan, The Surgeon General took action to obtain all availableinformation and to start special investigation of medical problems connectedwith atomic warfare.50
POSITION OF THE SURGEON GENERAL AND HIS OFFICE
WITHIN THE WAR DEPARTMENT
Relations With the Army Service Forces
During General Kirk`s administration, relations between the SurgeonGeneral`s Office and elements of the Army Service Forces organization weresomewhat more cordial than they had been during the previous administration.The decline and dissolution (in February 1944) of the Hospitalization andEvacuation Branch at Headquarters, Army Service Forces, removed one sourceof friction. The assignment of some of its medical officers to the SurgeonGeneral`s Office gave the latter a few officers with experience in theadjustment of Medical Department needs to Army Service Forces requirements.51
49(1) Report, George W. Merck, Special Consultantto the Secretary of War, 24 Oct. 1945, attached as Tab D to Final Reportto U.S. Biological Warfare Committee. (2) Memorandum, The Surgeon General,for Commanding General, Army Service Forces, 5 May 1944, subject: ProgressReport on "X" Toxoid. (3) Brophy, Leo P., Miles, Wyndham D.,and Cochrane, Rexmond C.: The Chemical Warfare Service: From Laboratoryto Field. United States Army in World War II. Washington: U.S. GovernmentPrinting Office, 1959, pp. 101-122. (4) Statement of Brig. Gen. StanhopeBayne-Jones, MC, USA (Ret.), to the editor, 12 Oct. 1961.
50(1) Transcript, conference of staff members, Office of TheSurgeon General and Corps of Engi-neers, 21 Sept. 1943. (2) Memorandum,Executive Officer, Medical Section, Corps of Engineers, for The SurgeonGeneral, through the Chief of Engineers, 9 Nov. 1943, subject: Procurementand Transfer of Medical Corps Officers. (3) Memorandum, The Surgeon General,for the Chief of Staff, 13 Sept. 1945, subject: Commission on the MedicalAspects of Atomic Bombing.
51(1) Letter, The Surgeon General, to Col. Roger G. Prentiss,Jr., Editor-in-Chief, History of the Medical Department, U.S. Army in WorldWar II, and attachment, 19 Nov. 1950. (2) Army Service Forces AdministrativeMemorandum, No. S-85, 10 Nov. 1945.
230
The record for the period from June 1943 to the end of the war showsa good deal more personal contact between The Surgeon General and the CommandingGeneral, Army Service Forces, than in the period from March 1942 to May1943. General Kirk and General Somervell conferred frequently on the MedicalDepartment`s personnel problems and various aspects of the hospitalizationand rehabilitation programs. General Somervell noted any criticisms ofArmy medical service that had come to his attention, and from time to timeasked General Kirk to submit a list of current and anticipated problems.In early 1944, for example, he requested to be kept informed on the progressof the Surgeon General`s Office in solving major problems with respectto physical standards, the Army Specialized Training Program, the assignmentand control of medical personnel, and hospitalization. His list of specifictasks and problems with respect to hospitalization indicates the importancewhich he attached to the efficient handling of oversea, casualties: estimateof hospital requirements for the United States and oversea areas, especiallythe European theater; prompt removal from hospitals of personnel not inneed of hospitalization; improvement in hospital administration; the possibilityof moving casualties directly from ports to hospitals where they couldbe treated, thus bypassing the hospitals at ports; and the program forrehabilitating the sick and wounded.52
General Kirk nevertheless experienced the same handicaps in servingunder the Army Service Forces instead of at the War Department SpecialStaff level that General Magee had complained of, and disagreements betweenArmy Service Forces headquarters and the Surgeon General`s Office overmatters of policy and procedures continued to spring up. In the case ofsome, no solution satisfactory to both parties was ever reached. Controversiesdeveloped, for example, over the handling of medical supplies and equipment.The problems of large-scale procurement, about which many debates betweenArmy Service Forces headquarters and the Surgeon General`s Office had revolvedduring 1942 and early 1943, had largely been solved. But late in 1943 disagreementarose over efforts by Army Service Forces headquarters to improve the systemof storing and issuing supplies handled by all the services. In the interestof greater efficiency, Army Service Forces headquarters wanted to makethe Quartermaster Department responsible for storing and issuing as manyitems as possible in its general depots and to consolidate responsibilityfor the remainder, insofar as feasible, within a few of the technical services.It proposed, for instance, that the Signal Corps be responsible for someitems of electrical equipment used by the Medical Department--X-ray machines,cardiographic units, and radiographic units. Under this system, the Medical
52(1) Memorandum, Chief of Staff, Army ServiceForces, for The Surgeon General, 15 Jan. 1944, subject: Current and AnticipatedMedical Problems. (2) Memorandum, Commanding General, Army Service Forces,for The Surgeon General, 18 Jan. 1944. (3) Memorandum, The Surgeon General,for Commanding General, Army Service Forces, 19 Jan. 1944, subject: Currentand Anticipated Army Service Forces Problems. (4) Memorandum, Chief ofStaff, Army Service Forces, for The Surgeon General, 1 Mar. 1944.
231
Department`s separate depot system would have been greatly curtailed,and the medical sections would no longer have been maintained as distinctentities in the general depots.53
The Director of the Surgeon General`s Control Division, Colonel Voorhees,strongly supported by the group of experts in retail merchandising fromcivilian life then assigned to the Supply Service, led the opposition tothis move on the part of Army Service Forces headquarters. Using the idiomof Ring Lardner, he called the attention of the Director of the ControlDivision, Army Service Forces, Brig. Gen. Clinton F. Robinson, to the delaysand mixups in the distribution of medical supplies which would result fromthis "switching of the signals" by Army Service Forces headquarters.He complained to "Robbie" that "our team don`t get muchchanct any more to pittch or to play against the Black Sox [the Germans]or the Yellow Sox [the Japanese] because we have to keep pittchin all thetime to them Big League players from the Headquarters Club what owns us,just so they can take battin practice out of us." General Robinsonreplied in opposing tenor but similar vein. To his way of thinking therewas only one team, with the technical services constituting the infieldand the outfield. The Medical Department, which he termed the "leftfielder who wears skin fitting rubber gloves" (and one such player,lie said humorously, was enough), was apparently trying to set up a clubof its own.54
While conflicts of this sort were similar to those that had occurredduring General Magee`s administration, the Surgeon General`s Office nowhandled them somewhat differently. In the first place, General Kirk was,like General Somervell, both quick and forthright in asserting his views.Moreover, he had the aid of a small group of administrators from civillife in key positions in his office to lead the counterattack wheneverhe opposed policies and procedures which the Army Service Forces headquartersurged as more economical or efficient. Instead of arguments based on thenecessity for control of the medical supply system by those who had hadmedical training, the group from industry advanced arguments based on thepracticability or efficiency of the proposed changes. Not only did theyhave reputations as experts in manage-ment techniques; in some controversieswith the Army Service Forces they were in a position to appeal to the UnderSecretary of War. The possible abolition of Medical Department depots,for example, was called to the attention of Mr.
53(1) Memorandum, Col. Tracy S. Voorhees, Director,Control Division, Office of The Surgeon General, for Director, ControlDivision, Army Service Forces, 15 Oct. 1943, subject: Atlanta Experimentin Depot Operations. (2) Memorandum, Director of Supply, Army Service Forces,for Chiefs of Services, 9 Dec. 1943, subject: Review of Present OrganizationalStructure of the Army, and related documents. (3) Memorandum, Col. TracyS. Voorhees, for Brig. Gen. C. F. Robinson, 16 Dec. 1943, subject : DistributionSystem Plan, etc. The medical depots, it will be recalled, were the chieftype of installation under the command of The Surgeon General, and a largeproportion of the personnel commanded by him were in the depots.
54(1) Letter, Col. Tracy S. Voorhees, to Brig. Gen. ClintonF. Robinson, 10 Dec. 1943. (2) Letter, Brig. Gen. Clinton F. Robinson,to Col. Tracy S. Voorhees, 16 Dec. 1943.
232
Patterson by Colonel Voorhees, who pointed out the embarrassment tothe Under Secretary if the large system of medical depots were abolishedat a time when the Under Secretary had just succeeded in persuading a reluctantcompany (Butler Bros.) to release its operations vice president (Mr. CharlesHarris) to the Army for the purpose of managing those depots. This factorseems to have contributed to the demise of the Army Service Forces, "DistributionSystem Plan."55
During General Kirk`s administration the installations commanded byThe Surgeon General remained about the same, in type and number, as thosewhich his predecessor had commanded after August 1942 when the generalhospitals were removed from his control and put under service command jurisdiction.In March 1944, field installations under General Kirk`s direct commandwere the Army Medical Center, including its general hospital, the schools,and laboratories; the Army Medical Museum and Army Medical Library; theMedical Field Service School at Carlisle Barracks, Pa.; three laboratories;the Army Medical Purchasing Office in New York, and its Chicago branch;and eight medical depots. The Center had as a Subsidiary activity the BiologicProducts Laboratory at Lansing, Mich. The Army Medical Library had a branchat Cleveland, Ohio, while the Medical Field Service School included theMedical Department Equipment Laboratory. The three laboratories commandedby The Surgeon General (besides the installations at the Army Medical Center,in Lansing, and Carlisle Barracks) were the Army Industrial Hygiene Laboratoryat The Johns Hopkins University, Baltimore, Md.; the Armored Medical ResearchLaboratory at Fort Knox, Ky.; and the Respiratory Diseases Commission Laboratoryat Fort Bragg, N.C. The eight medical depots which he commanded were atBinghamton, N.Y., Chicago, Denver, Kansas City, Los Angeles, Louisville,St. Louis, and San Francisco. The large general hospitals, under servicecommand control, amounted to more than 60 at the peak of their developmentduring General Kirk`s administration.
This situation underwent little modification to the end of the war exceptas certain of the medical depots were closed. The Surgeon General`s commandover installations was substantially enlarged only in April 1946 when hiscommand control over general hospitals was restored and when all hospitalcenters and convalescent hospitals in the United States were transferredto his command. By this date a general contraction of the Army`s hospitalizationsystem in the United States was well underway.56
55Voorhees, Tracy S. : Recollections of MyWork for The Surgeon General, October 1945. [Official record.]
56(1) Office Order No. 59, Office of The Surgeon General, 21Mar. 1944. (2) Office Order No. 183, Office of The Surgeon General, 4 Sept.1944. (3) Morgan, Edward J., and Wagner, Donald O.: The Organization ofthe Medical Department in the Zone of the Interior, ch. VII and XII. [Officialrecord.] (4) Smith, Clarence McKittrick: The Medical Department: Hospitalizationand Evacuation, Zone of Interior. United States Army in World War II. TheTechnical Services. Washington: U.S. Government Printing Office, 1956,pp. 281-282.
233
Relations With the Army Ground Forces and the Army Air Forces
Conflicts with other echelons of the War Department (or with the officesof their surgeons), stemming from The Surgeon General`s position of subordinationto Army Service Forces headquarters, continued. The solution of such problemsas could not be resolved by agreement or compromise was attained only byWar Department decision. Some opposition developed within the Army GroundForces in July 1943 when General Kirk assigned Brig. Gen. Albert W. Kenneras his assistant to inspect the training of medical units in the groundforces. Army Ground Forces headquarters did not recognize any in-herentright by the chief of a technical service to make any type of inspectionof troops or installations of the Army Ground Forces. The official WarDepartment document which straightened out the matter provided for "visits"by representatives of chiefs of the technical services at installationsof the Army Ground Forces, Army Air Forces, service commands, and defensecommands in continental United States. Such visits could be made only byarrangement of the chief of the technical service with the commanding generalof the major command concerned, and the visiting, representatives wereto be concerned only with "technical matters."57
The difficulty over inspections appears to have been one of the veryfew problems to arise in connection with the medical service of the groundtroops, partly because of a cooperative nature and disinterest in empirebuilding on the part of the men who filled the position of Ground Surgeon.On the other hand, problems of relationships between The Surgeon Generaland the Air Surgeon`s Office continued unabated. In December 1943 the CommandingGeneral, Army Air Forces, recommended to the Chief of Staff of the Armythat the Air Surgeon (Maj. Gen. David N. W. Grant) be made a member ofthe Federal Board of Hospitalization, an advisory agency to the Bureauof the Budget which consisted of the Surgeons General of the Army, Navy,and U.S. Public Health Service, and other officials handling large Federalhospital programs. He also wanted the Air Surgeon made his representative,with the same status as the three surgeons general, at meetings of theexecutive committee of the Procurement and Assignment Service of the WarManpower Commission. He based his request on the numbers of Medical Departmentpersonnel and the magnitude of the hospital program for which, he stated,he was solely responsible.58 The Surgeon General`s Office opposedthe suggested
57(1) Memorandum, Commanding General, ArmyGround Forces, for Chief of Staff, 7 Sept. 1943, subject : Technical Inspectionof Troops and Installations of the AGF and of the AAF, etc. (2) OfficeOrder No. 480, Office of The Surgeon General, 17 July 1943. (3) Memorandum,The Surgeon General, for Commanding General, Army Ground Forces, 7 Aug.1943, subject: Technical Inspections of Medical Troops and Installationsof AGF. (4) Memorandum, Commanding General, Army Service Forces, for Chiefof Staff, 27 Aug. 1943, subject: Technical Inspection of Troops and Installationsof the AGF and the AAF by Representatives From the Chiefs of TechnicalServices of the ASF. (5) War Department Memorandum No. W265-1-43, 22 Sept.1943.
58The Air Surgeon`s figures included 239 station hospitals witha total of 75,461 beds, 146 dispensaries, and 324 infirmaries. Of the 16,000Medical Corps officers then on duty with the Army Air Forces, the Air Surgeonstated that he had procured and assigned about 10,000.
234
appointments for the Air Surgeon on the ground that The Surgeon Generalcould handle matters of hospitalization for all air and ground forces,calling upon the Air Surgeon or the Ground Surgeon for aid whenever necessary.Officers assigned to G-1, War Department General Staff, stated that TheSurgeon General could represent the War Department adequately at the meetingsof both these organizations and recommended that he ask the Air Surgeonto attend any meetings at which he wished his aid in discussion of problemsrelating to Army Air Forces medical installations. The Air Surgeon didnot receive either of the appointments requested; he attended, by invitation,some of the meetings of the executive committee of the Procurement andAssignment Service.59
For The Surgeon General, a chief problem continued to be the dividedresponsibility for Army hospital administration in the United States, mainlyas between the Army Service Forces and the Army Air Forces, The generalhospitals were run by the Army Service Forces; they were under the immediatejurisdiction of the commanding generals of the service commands. The stationhospitals were about equally divided between the Army Service Forces andthe Army Air Forces, although those of the latter were considerably smalleron the average than those of the former. Those assigned to the Army ServiceForces were directly under its various subordinate commands, while thestation hospitals of the Army Air Forces were located at airbases assignedto a number of subordinate air commands. The Army Ground Forces controlledonly a few hospitals, while the defense commands, which were directly subordinateto the War Department General Staff, also operated a few, mainly at theAtlantic bases which were a part of the Eastern Defense Command.
The Surgeon General could not make estimates of the requirements ofmen and supplies for hospitals assigned to the Army Air Forces or allocatethese medical means suitably among hospitals in the United States. Difficultiesincreased with renewed efforts by the Air Surgeon to extend the Air Forces`sphere of control over hospitals. He made, a consistent attempt to addgeneral hospitals, or hospitals approaching these in scope of treatment,to the hospital system of the Army Air Forces in the United States andto place hospitals under the Air Forces chain of command in the overseatheaters. The struggles between the Air Surgeon and The Surgeon Generalover these two problems were settled as to major points by the spring of1944.
The effort to gain control of general hospitals, or hospitals whichgave similarly definitive treatment, within the United States continueduntil the Air Forces medical group partially attained its ends. By placinghighly specialized medical personnel in station hospitals at airbases,the Army Air Forces had made of some of its station hospitals institutionswhich could give
59Letter, Maj. Gen. David N. W. Grant, MC,USAF (Ret.), to Col. John Boyd Coates, Jr., MC, Director, The HistoricalUnit, U.S. Army Medical Service, 11 Aug. 1955, subject: Comments on preliminarydraft of this volume.
235
treatment of the scope of that theoretically within the province ofgeneral hospitals only. Air force medical officers were in a position torefuse to send air force patients to the regular general hospitals of theArmy Service Forces, since these patients could receive all necessary treatmentin Army Air Forces station hospitals. A protracted struggle ensued betweenThe Surgeon General and the Army Service Forces, on the one hand, and theAir Surgeon and the Army Air Forces, on the other. General Kirk and thecommanding generals of some service commands took the view that all fixedhospitals, including the station hospitals controlled by the Army Air Forces,should be under the command control of the commanding generals of servicecommands. A board of officers, with experience as service command surgeons,appointed by The Surgeon General to study problems of medical administrationin the service commands advocated making the commanding general of theservice command responsible for all medical service (including hospitalization,evacuation, and sanitation at all fixed installations) within the servicecommand`s boundaries. Under this recommendation, which would have removedthe fixed medical installations of the Army Air Forces from the chain ofArmy Air Forces command, The Surgeon General would have had more directtechnical control of this large group of hospitals, with the service commandsurgeon exercising immediate technical control as he now did over the generalhospitals. This recommendation for highly centralized control of medicalinstallations in the United States on an area basis went a step beyondthe Medical Department`s usual position in that it positively advocatedremoving from Army Air Forces` supervision the station hospitals whichthat command had controlled since it was established in June 1941.
A report by the medical adviser, Maj. Gen. Howard McC. Snyder, of theInspector General`s Office, recognized that the Army Air Forces had succeededin developing hospitals which could give advanced treatment and recommendedthat arrangements be worked out for hospitalizing patients of other armsand services, as well as of the Air Forces, in them. The upshot was thatin the spring of 1944 both the Army Air Forces and the Army Service Forceswere given the right to operate in the United States "regional hospitals"which would receive patients from all station hospitals (whether undercommand of the Army Ground Forces, the Army Air Forces, or the Army ServiceForces) within a 75-mile radius.
The regional hospitals gave treatment of a type formerly given onlyby the general hospitals but could receive only patients from station hospitalsin the United States and not oversea patients. The latter were to be sentto the general hospitals, operated exclusively by the Army Service Forces,for definitive treatment. At the same time it was stipulated that all fourmain types of fixed hospitals-station, convalescent (also established asa type to be operated by both Army Service Forces and Army Air Forces atthis date), regional, and general-were to serve all troops on an area basis,regardless of the command to which the patient or the hospital was assigned,and a hospital was to
236
transfer patients to another hospital only if it could not provide therequisite medical care. The result of these arrangements was to weakensomewhat the position of The Surgeon General. The Army Air Forces had nowsucceeded in getting recognition of its jurisdiction over installationsgiving treatment of the type afforded by the general hospitals. As theArmy Air Forces at one time operated 30 regional hospitals (compared with32 operated by the Army Service Forces), giving treatment of the type formerlygiven only by the general hospitals, it had achieved a significant advancein establishing what the Army Service Forces termed in retrospect "aduplicating medical and hos-pital service in the United States."60
The victory of the Army Air Forces medical group had been gained oncemore through obtaining official War Department recognition of a fait accompli.The assignment of specialists to hospitals already under its control hadgiven the Army Air Forces a distinct advantage. From now on those who wereunwilling to allow the Army Air Forces hospitals to give definitive treatmentcould be accused of indifference to the effective use of specialized personnel.The addition of "regional hospitals" to Army Air Forces jurisdictionwas not only a step toward autonomy of the medical service administeredby the Air Surgeon but also toward the severance of the Air Forces andits medical service from the rest of the Army, a development which wascompleted in the postwar years pursuant to the National Security Act of1947.61
The effort of the Army Air Forces to gain control of station hospitalsat air force bases overseas was kept alive by the Air Surgeon during visitsto various theaters in 1944, being given further impetus by a questionnairewhich he sent in the spring to the surgeons of numbered air forces overseas.Among the rather leading questions put to each air force surgeon were thefollowing: What percentage of bases operated by his air force were notwithin 50 miles of a hospital maintained by the theater services of supply;did he have any difficulty in keeping in contact with hospitalized troopsof his air force; was it satisfactory that the date of releasing air forcepatients and the dispositions made of them (that is, their return to duty,evacuation to the United States, or other kind of discharge) should bedetermined by a surgeon of the service forces. In July 1944 the Air Surgeonasked for an estimate on the savings in personnel time that would resultfrom control by the oversea, air forces of hospitals for air force patients.He received replies of varying tenor. While most air force surgeons agreedwith him on the theoretical advantages of con-
60(1) Report, Army Service Forces, Logisticsin World War II, 1 July 1947. (2) Smith, Clarence McKittrick: The MedicalDepartment: Hospitalization and Evacuation, Zone of Interior. United StatesArmy in World War II. The Technical Services. Washington: U.S. GovernmentPrinting Office, 1956, pp. 103-104, 182ff.
61(1) Millett, John D. : Organizational Problems of the ArmyService Forces, 1942-1945. [Official record, Office of the Chief of MilitaryHistory.] (2) See footnote 51(l), p. 229. (3) Memorandum, Chief, Hospitalizationand Evacuation Section, Army Service Forces, for Executive Officer, Officeof The Surgeon General, 1 June 1943, subject: Conference of Surgeons ofService Commands. (4) See footnote 60(l). (5) Transcript, Army ServiceForces Conference of Commanding Generals, of Service Commands, 22-24 July1943, Chicago, Ill. (6) Transcript, Army Service Forces Conference of CommandingGenerals of Service Commands, 17-19 Feb. 1944, Dallas, Tex.
237
trol of hospitals overseas by the Army Air Forces, some pointed outcertain factors in their own theaters which argued against it. The ArmyAir Forces never succeeded in getting official authorization from the WarDepartment for such a system, but for various reasons and by various devicessome air forces elements overseas succeeded in having a few hospitals assignedto them. Out of the oversea experience of the medical officers assignedto the air forces evolved the strongest argument for air force controlof all types of hospitals: that in order to return the flyer to duty withall possible speed and thus make the maximum use of its highly trainedpersonnel in combat, the Air Forces must retain continuous control of thepatient throughout the days of his evacuation and hospitalization.62
Efforts to Regain Staff Position for The Surgeon General
At some indeterminate date in 1944 the War Department General Staffbegan to reassume some of the functions which it had turned over to theArmy Service Forces in March 1942. The control of the Army Service Forcesover the Surgeon General`s Office was somewhat weakened as more directcontact began to take place between elements of the General Staff and theSurgeon General`s Office, particularly as G-1 became increasingly concernedwith the problem of worldwide allocation of Army doctors. The problem washighlighted by General Kirk himself who informed General Somervell. thathe had frequently been "amazed and perplexed" by the numerousWar Department agencies involved in "strategic decisions" affectingthe Medical Department. He listed only the most important of these agencies,omitting-perhaps unintentionally-the Operations Division of the War DepartmentGeneral Staff: The Deputy Chief of Staff ; the War Department ManpowerBoard; the Assistant Chiefs of Staff G-1, G-3, and G-4; the Inspector General;the Director of Plans and Operations, Army Service Forces; the MilitaryPersonnel Division, Army Service Forces; the Ground Surgeon; and the AirSurgeon. He gave several examples of discussions of Medical Departmentproblems at some of these higher level offices at which no Medical Departmentrepresentative was present, and noted mistaken conclusions reached on thebasis of insufficient or inaccurate information.63
An opportunity to reopen the question once more, this time at the highestlevel, came early in 1945 when The Surgeon General was asked by the Secretaryof Wax to gage the adequacy of the medical personnel and facilities athis disposal for a prolonged war in Europe and the Pacific. General Kirk`sanswer stressed the problems posed for him by the coequal status of theArmy
62(1) Memorandum, The Surgeon General, forthe Chief of Staff, Army Service Forces, 1 Nov. 1943, subject: Hospitalizationof Air Corps Battle Casualties and Casual Sick. (2) Memorandum, Col. E.C. Cutler, MC, for Col. J. C. Kimbrough, MC, 11 Sept. 1943, subject: RelationshipBetween Our Hospitals and the 8th Air Forces. (3) See footnote 51 (1),p. 229. (4) Letter, Maj. Gen. Norman T. Kirk, to Brig. Gen. Guy B. Denit,28 Nov. 1944. (5) Letter, Brig. Gen. Denit to Maj. Gen. Kirk, 8 Dec. 1944.See also the chapters of this volume dealing with the oversea. theaters.
63Memorandum, The Surgeon General, for Commanding General, ArmyService Forces, 4 Oct. 1944, subject: The Determination of Policies AffectingHospitalization and Evacuation.
238
Ground Forces and the Army Air Forces. Without having a position onthe War Department Staff, General Kirk argued, he could not effectivelysupervise hospitals assigned to these two commands or to various commandsscattered throughout the oversea theaters. He dwelt again on the lack ofcentral command control at the staff level over the assignment and reassignmentof highly skilled Medical Department personnel, emphasizing the difficultyof reassigning skilled officers to a command more in need of their services.In necessity for fitting skilled personnel into allotments by rank, hesaw only a waste of scarce specialists and a loss of efficiency.64
The Secretary of War asked the commanding generals of the Army ServiceForces, Army Ground Forces, and Army Air Forces, as well as elements ofthe General Staff, to comment on General Kirk`s appraisal of his position.He professed himself satisfied with current Army medical service in theEuropean theater on the basis of his observation during a recent visitthere, but expressed concern over prospective heavy demands on medicalservice in both Europe and the Pacific. A conference was held in Januaryof Officers representing the commanding generals of the Army Air Forcesand Army Service Forces, The Surgeon General, the Air Surgeon, the WarDepartment Manpower Board, and G-3, G-4, and the Operations Division ofthe War Department General Staff. At the end of January, General Bliss,acting under instructions of the conference, prepared the draft of a circularwhich The Surgeon General proposed for issue by the War Department in orderto reestablish his position on the War Department Staff as it had existedbefore the War Department reorganization of March 1942. The draft emphasizedthe position of The Surgeon General as the chief medical adviser to theSecretary of War and the Chief of Staff, and authorized direct channelsof communication between The Surgeon General, on the one hand, and theChief of Staff, the General and Special Staffs, and major components ofthe Army, on the other. Numerous written comments, telephone conversations,and revisions of the draft favorable to their own positions and purposesensued on the part of the participants. The Director of the Control Division,Surgeon General`s Office, and the Assistant Surgeon General (Brig. Gen.Raymond W. Bliss) conducted the negotiations to elevate the position ofThe Surgeon General.65
In arguments over the wording of the circular, the Army Air Forces andthe Air Surgeon`s Office continued to insist that the. medical organizationand hospital system within the Army Air Forces were functioning efficiently.They blamed most of The Surgeon General`s difficulties upon his positionwithin the Army Service Forces organization and the consequent necessityfor clearing all his plans with the various organizational elements atArmy Service Forces
64Memorandum, The Surgeon General, for theSecretary of War, 10 Jan. 1945, subject: The Medical Mission Reappraised.
65Draft for circular marked as submitted to the Chief of Staff(through Commanding General, Army Service Forces), 29 Jan. 1945. Thereare numerous other drafts in the files of the various agencies represented.
239
headquarters; that is, with the latter`s various staff directors ofplans and operations, of supply, of materiel, and so forth. In their opiniona small group of qualified medical officers, representing the three majorcommands equally, headed by an "assistant chief of staff for medicalservices of the Army," and located on the War Department General Staff,should direct Army-wide medical service. The commanding general of eachof the three major commands and of each theater, who should be responsiblefor the organization and operation of the medical service of his particularcommand, should have a senior medical officer on his staff to advise himon medical matters and exercise technical control over the medical servicewithin the command. The Surgeon General agreed with the Army Air Forcesand the Office of the Air Surgeon as to the desirability of having a SurgeonGeneral located at the general staff level. However, neither the GeneralStaff nor Army Service Forces headquarters was willing at that date torevise substantially the War Department structure established in March1942. The Army Service Forces organization was particularly averse to beingbypassed by granting The Surgeon General the right of direct access tothe General Staff.
Nevertheless, participants in the January conference had agreed thatThe Surgeon General should be recognized as staff adviser to the War Departmentand that direct communication should be authorized between The SurgeonGeneral and higher War Department authority on health matters of Army-widescope. Additional strength accrued to The Surgeon General`s position inthat the Secretary of War had asked for his views and indicated from theoutset that he intended to give them serious consideration. Moreover, variouselements of the Medical Department had succeeded by this date in popularizingto some extent their dissatisfaction with the position of The Surgeon Generalwithin the War Department. The Director of the Control Division of theSurgeon General`s Office called attention to the "unmistakably risingtide of criticism of the present unsound position of the Medical Departmentin the Army" appearing in the popular press and the medical journals.66
War Department Circular No. 120 was finally issued on 18 April 1945.It announced that The Surgeon General was the chief medical officer ofthe Army and the chief medical adviser to the Chief of Staff and the WarDepartment. He was to make recommendations to the Chief of Staff and theGeneral and Special Staffs on matters pertaining to the health of the Army,prepare for publication War Department directives on general policies andtechnical procedures on health matters of Army-wide application, exercisetechnical staff supervision to assure the maximum use of available medicalresources, and make technical inspections relative to matters pertainingto health of the Army. All plans and policies of medical import with Army-wideapplication were to be cleared with The Surgeon General. Communicationson plans and poli-
66(1) Memorandum, Director, Control Division,for Col. John R. Hall, 4 Feb. 1945, and attached documents. (2) Davis,L.: Organization of the Red Army Medical Corps. Surg., Gynec. & Obst.79: 329-332, September 1944. (3) Remarks, Rep. Frances P. Bolton (R., Ohio),12 Dec. 1944. Cong. Rec., 78th Cong., 2d sess., pp. 9422-9425.
240
cies were to be addressed to the Chief of Staff or to The, Surgeon Generaland were to be sent through the Commanding General, Army Service Forces,who was to forward them with appropriate recommendations with the leastpossible delay. Direct communication among The Surgeon General, the WarDepartment, and the three major commands on routine medical matters wasauthorized. Nevertheless, the fact that The Surgeon General was under thecommand of the Commanding General, Army Service Forces, was reaffirmed,and the commanding generals of the major forces, commands, departments,or theaters were to be held responsible for the internal organization andthe efficient operation of the medical service of their respective commands.
The wording of the circular followed a draft proposed by G-1 and wasa document of compromise. It contained an essential contradiction in thatthe organizational subordination of The Surgeon General to the CommandingGeneral, Army Service Forces, was maintained, while it authorized directcommunication between The Surgeon General and commands coordinate withthe Army Service Forces or higher. At the same time the limitation of thisdirect communication to "routine medical matters" seemed to weakenits force. Shortly before it was issued, the Secretary of War issued thefollowing, statement: "I consider that the care of the sick and woundedand the character of the hospitalization in the Army are matters for thedirect responsibility of the Secretary of War; also that The Surgeon Generalshould be his principal adviser in regard to these vital matters. To thatend I wish it clearly understood that I am to have direct access to himand he to me on such matters whenever either of us deems it to be essential."The letter seems to represent a recognition of the essential weakness ofthe circular and at the same time the Secretary`s determination to makeclear his personal sympathy with the attitude of The Surgeon General. InOctober 1945 the new Secretary of War, Robert P. Patterson, assigned ColonelVoorhees to his office to aid him in "carrying out the responsibilitiesof the Secretary of War as outlined in his memorandum dated 6 April 1945,with reference to the care of the sick and wounded and the character ofthe hospitalization in the Army and matters relating thereto." Mr.Voorhees, who later became Assistant Secretary of War, acted as the Secretary`sadviser on matters of administration of the Army Medical Department inthe postwar period.67
The practical effect of Circular No. 120 and of the Secretary of War`sletter is difficult to gage. Although The Surgeon General apparently didnot make use of his power of access to the Secretary of War, the fact thathe had the right of access gave him some bargaining strength. Both theSurgeon General`s Office and the Army Service Forces organization regardedthe
67(1) Memorandum, Deputy Chief of Staff, forCommanding Generals, Army Air Forces, Army Ground Forces, and Army ServiceForces; for Assistant Chiefs of Staff, G-1, G-3, and G-4 ; for OperationsDivision; and The Surgeon General, 13 Apr. 1945, subject: War DepartmentCircular Clarifying Responsibilities of The Surgeon General, and RelatedPapers. (2) Memorandum, Secretary of War, for Deputy Chief of Staff, 15Oct. 1945, subject: Col. Tracy S. Voorhees. (3) Memorandum, Secretary ofWar, for Deputy Chief of Staff, 12 Dec. 1945.
241
circular and the Secretary`s letter as a partial victory for The SurgeonGeneral and a corresponding loss of authority by the Army Service Forces,although the latter minimized its practical effect.68
MEDICAL ORGANIZATION IN THE SERVICE COMMANDS
At the beginning of his administration, General Kirk continued to attack,as General Magee had done, the problem of the position of the service commandsurgeon within service command headquarters. Since the reorganization ofAugust 1942, the service command surgeon-or chief of the medical branch,as he was now termed-had been subordinated to either the supply or thepersonnel division of service command headquarters and reported to thecommanding general of the service command only through the director ofthe division in which he was placed. At the same time some officers ofthe medical branch had been placed in divisions other than the one to whichthe chief of the branch was assigned. Obviously the chief of the medicalbranch had no direct control over their work, and the so-called "medicalbranch" could hardly operate as an entity. Nothing had come of eitherGeneral Magee`s efforts to reestablish staff position for the service commandsurgeon or of the recommendation of the committee which had surveyed theMedical Department late in 1942 that his position be restored. Althougha Services of Supply organization manual of December 1942 had made it clearthat the surgeon was still responsible for advising the commanding generalof the service command on health matters affecting personnel of the command,it had not changed outright his status or that of his medical branch. Shortlyafter taking office General Kirk renewed the struggle. At the suggestionof General Somervell, he called a conference of service command surgeonsto discuss the matter. A board of three officers, appointed to make recommendationson medical administration in the service commands, proposed that the medicalbranch be made into a division of the office of the commanding general.General Somervell raised the problem at the regular conference of commandinggenerals of service commands in Chicago in July, but although he had expressedtentative concurrence with the plan proposed by The Surgeon General`s board,he finally disapproved it. His main objection was that it threatened, bygiving all the technical services a similar claim to the right of reportingdirectly to the commanding general of the service command, to nullify thebenefits gained by the reorganization of service command headquarters inAugust 1942; that is, a reduction in the number of officers reporting directlyto the commanding general.
In spite of his refusal at this date to interfere with the formal organizationof service command headquarters, General Somervell stressed to the command-
68(1) Letter, Chief. Personnel Service, Officeof The Surgeon General, to theater and defense command surgeons, 17 May1945. (2) Memorandum, Commanding General, Army Service Forces, for Chiefof Staff, 6 Aug. 1945, subject: Position of Army Service Forces in theWar Department. (3) See footnote 60 (1), p. 236.
242
ing generals of service commands the importance of their keeping inclose touch with their respective chief surgeons. As he put it, "certainlyyou have, got to talk to your doctor." Probably this remark indicatedsome shift in his point of view, for in November Army Service Forces headquartersindicated its desire that each service command headquarters be reorganizedto conform as closely as possible with the parent headquarters. The chiefsof technical services, including the Service command surgeon, were thusgiven staff position and put in direct line of communication with the commandinggeneral of the service command and his chief of staff. They bore the samerelation to the commanding general at their headquarters that the chiefsof technical services in Washington bore to General Somervell. The servicecommand surgeon thus reachieved Staff position and retained it to the endof the war. Post surgeons, it may be noted, had never lost staff status.69The Army Service Forces did not again attempt to put into effect a functionalscheme of organization at service command headquarters, nor in its ownheadquarters. Throughout the war the organization of Headquarters, ArmyService Forces, retained at staff level both the chiefs of the technicalservices and the chiefs of its functional elements such as the Personneland Supply Divisions. Abandonment of the functional scheme of organizationfor service command headquarters-and with it, any strict limitation onthe number of officers reporting to a Superior--was probably due in somemeasure to the Medical Department`s continued protest against it.
The reorganization of service command headquarters at the end of 1943offered an opportunity to reorganize the offices of the service commandsurgeons on a uniform basis. The pattern proposed was the same divisioninto five "services" that then existed in the Office of The SurgeonGeneral, but few service command surgeons adopted the scheme. As we haveseen, the Office of The Surgeon General itself underwent other major reorganizationsbefore the end of the war, and service command surgeons` offices made littleattempt to keep pace with these . A general exception was the additionof a reconditioning branch to parallel the Reconditioning Division, SurgeonGeneral`s Office, after early 1944.
Variations in medical problems from one service command to another logicallyled to considerable diversity in organization and variations in size oftheir surgeons` offices. The geographic area of the service command, itsArmy strength, its climate, the disease pattern, concentration of population,indus-trialization, the presence of prisoner-of -war camps, the presenceof ports of embarkation-all these factors affected the work of the surgeon`soffice. A strong industrial hygiene program for civilians working in warplants developed in the Second, Seventh, and Eighth Service Commands. Thevenereal disease control program, important in all service commands, wasmore serious in those with highly industrialized areas or with heavy troopconcentrations.
69Morgan, Edward J., and Wagner, Donald O.: The Organization of the Medical Department in the Zone of the Interior,chs. IX and X. [Official record.]
243
Large-scale efforts at malaria control were primarily limited to theFourth, Seventh, and Ninth Service Commands, The responsibility of medicalcare for prisoners of war fell mainly upon the surgeons` offices of theSecond, Fourth, Sixth, and Seventh Service Commands, since prisoner-of-warcamps were concentrated in these areas. Surgeons of the service commandsalong the coast cooperated with medical men of the Navy and the Coast Guard,as well as with Army port surgeons, in attempting to maintain sanitaryconditions in coastal areas and in receiving Army and prisoner-of -warpatients evacuated from overseas. In the Ninth Service Command, many MedicalDepartment officers received training at the Civil Affairs Staging andHolding Area, (established in June 1944) at Fort Ord, Calif., later atthe Presidio of Monterey, Calif., to prepare them for medical work amongcivilian populations in the Far East.70
In all service commands, some officers had to be assigned to liaisonduties with various health agencies, including the U.S. Public Health Serviceand State and local health departments, and with the medical sections ofsome of the commands whose jurisdictional boundaries coincided with, oroverlapped, those of the service commands-defense commands, air force commands,field armies, and air forces. Special efforts were made in some servicecommands to pool the highly trained Medical Department personnel of thevarious commands. The Seventh Service Command, for example, reached anagreement with the Army Air Forces Training Command, the Troop CarrierCommand, the Air Transport Command., and the Second and Third Air Forcesthat these commands would use the chiefs of medicine, surgery, neuropsychiatry,and dermatology at the general hospitals of the Army Service Forces andat the regional hospitals of the Army Air Forces, as regional consultantsin their respective station hospitals. Consultants in the various servicecommand headquarters continued to advise the service command surgeons onthe proper assignments of specialists on the basis of their observationsof the latters` work. In 1945, dietitians and physical therapists wereassigned as consultants to the staffs of service commands and gave similaradvice on the assignments of personnel in these fields.71
The status of the service command surgeon remained unchanged from late1943 to June 1946, and his functions were changed only slightly. Pursuantto demobilization plans drawn-up by Army Service Forces headquarters, hehad to make plans for hospitalization and evacuation and, along with thechiefs of the other technical services, participate in disposing of surplusinstallations and property in the service commands and in establishinga reserve of training equipment for redeployment training in the UnitedStates. In
70See footnote 38, p. 220.
71(1) Annual Reports of the Service Command Surgeons, 1942-1945.(2) Memorandum, Chief, Occupational Hygiene Branch, for Deputy Chiefs ofService Commands, 29 Sept. 1943, subject : Procedures for Industrial HygieneInspections and Surveys in Ordnance Explosives Plants. (3) Memorandum,The Adjutant General, for Commanding Generals of Service Commands, Chiefof Ordnance, Chief of Chemical Warfare Service, 29 Nov. 1943, subject :Procedure for Industrial Hygiene Inspections and Surveys in Army-OwnedOrdnance and Chemical Warfare Service Explosives Plants.
244
June 1946, when the Army Service Forces was abolished, a major reorganizationof the regional structure of the Army, which marked a return to the pre-wararea organization of the Army within the United States, took place. Whenthe nine service commands under the Army Service Forces were abolished,six army areas were created to operate directly under the War Department.Like the prewar corps areas, these were mixed tactical and service organizations,and the duties of the new army area surgeons closely resembled those ofthe former corps area surgeons. Moreover, the elimination of the Army ServiceForces organization above The Surgeon General put the army area surgeonin the same position with respect to The Surgeon General as the corps areasurgeon had been before March 1942. Shortly before these Army-wide changeswent into effect the control of general hospitals, as well as hospitalcenters and convalescent hospitals, was returned to The Surgeon General.This move restored the channels of control of these installations whichhad prevailed before August 1942.
