Foreword
In order to meet the challenge of World War II the Medical Departmentof the United States Army expanded from a service equipped to support apeacetime army of some 200,000 men, based largely in the Zone of Interior,to one that provided the best in medical and surgical care for more than8,000,000 American soldiers, serving on a war footing on every continentand under the most varied conditions of climate and terrain. The organizationby means of which this global wartime mission was carried out, with efficiencyand technical skill despite many potential sources of friction, is thetheme of this volume in the administrative history of the Medical Departmentin World War II.
The book begins with an account of the structure and activities of theOffice of The Surgeon General in the fall of 1939, when the long-impendingoutbreak, of war in Europe led to the declaration of a national emergencyin the United States. Over the next 2 years, leading up to the attack onPearl Harbor that precipitated American entry into the war, both the Armyand the geographical area in which it operated grew rapidly in size. TheSelective Service Act, the acquisition of Atlantic bases from Iceland toTrinidad, the inception of the lend-lease program, all compelled expansionof the Army`s medical service to keep pace with the demands made upon it.Outstanding authorities in a great variety of the medical and surgicalspecialties, in the allied sciences, and in the fields of supply and administrationwere called upon to advise The Surgeon General, while new organizationalelements were added to deal with sanitation and other health needs in Armycamps across the continent and in island garrisons along the air and sealanes to Europe and the Middle East.
This rapid expansion of the medical service brought out rival demandsfrom civilian and military interests for the allocation of medical suppliesand the control of medically trained personnel, adding measurably to theadministrative burden. By early 1942 the 10 prewar divisions of the SurgeonGeneral`s Office had increased to 40. Centralized as it was in Washington,the Medical Department had become topheavy, with too many officers reportingto The Surgeon General and the threads of too many functions in his hands.
In March of that year the Medical Department was placed under the Servicesof Supply--later known as the Army Service Forces--as part of a sweepingreorganization of the War Department. Internal changes in the structureof the Surgeon General`s Office resulted in a wider delegation of responsibilityand in more efficient administration of the expanding functions of theMedical Department, but these could not outweigh the disadvantages of subordinationto an intermediate headquarters. Thereafter, until The Surgeon Generalwas restored to a position on the War Department Special Staff in 1946,medical matters affecting the entire Army reached the Chief of Staff onlythrough the Commanding General of the Army Service Forces. Many expedientswere devised to minimize the unfortunate effects of the new organization,but as this volume clearly shows, the overall effect of interposing anadditional level of authority between The Surgeon General and the Chiefof Staff was to make efficient administration of the medical service moredifficult.
From Washington the organizational story moves out to the service commands,and finally to the great oversea theaters where the basic mission of theMedical Department was fulfilled. A reorganization at the service commandlevel parallel to that of the War Department downgraded the various servicecommand surgeons from staff to divisional positions and dispersed theirmedical sections among several offices of the various service command headquartersaccording to function. This change made it difficult for the medical sectionat service command headquarters to operate as a unit, or for the servicecommand surgeon, to direct its work effectively. The transfer of the generalhospitals located within the service commands from command of The SurgeonGeneral to that of the commanding generals of the service commands hadthe effect of further weakening The Surgeon General`s control and supervisionover Medical Department installations and activities in the United States.
The Surgeon General`s control of the medical service overseas was alsoless than complete. While Medical Department officers in Washington couldcommunicate directly with theater surgeons overseas, and frequently didso, directives from The Surgeon General could be transmitted only in thename of the Chief of Staff, to whom The Surgeon General had no immediateaccess. Other factors tending to restrict The Surgeon General`s controlstemmed from local conditions in the different theaters, such as climate,terrain, the endemic disease pattern, and the degree of contact with civilianpopulations; and from the extent, frequency, and nature of combat operations.
A broad uniformity in the activities of the medical service in the differenttheaters was nevertheless achieved. Among the factors tending to bringabout this uniformity were the standard tables of organization and equipmentfor Medical Department units; War Department directives such as those placingresponsibility for certain preventive measures upon commanding officers;the use of consultants; a standard organization for malaria control, andanother for administering public health measures in occupied areas; specialcommissions, such as the U.S.A. Typhus Commission, which sent specialiststo epidemic areas; and the dispatch of individuals on special missionsoverseas to empha-size the standards and practices advocated by the SurgeonGeneral`s Office. Lastly, but certainly not least in importance, were theknowledgeable medical officers who served overseas in positions of greatresponsibility. These men were highly intelligent and experienced. Manyhad served as instructors at the Medical Field Service School at CarlisleBarracks, Pa., and at other service schools in the prewar years. They werefamiliar with theater medical organization and administration. Some hadassisted in the formulation of War Department doctrine covering these matters.Their understanding, loyal co-operation, and aggressive direction of themedical services in the oversea theaters contributed largely to the successfulaccomplishment of the medical mission.
The oversea story is told necessarily from the point of view of themajor commands, such as the offices of theater and army surgeons, and themedical sections of the more important subordinate elements of both combatand communications zones. Only at this level is it possible to see in perspectivethe whole organizational pattern of the war, and the place of the MedicalDepartment in the total structure.
Except for the imposition of an Allied command in some theaters, andthe quasi-independent status of the Army Air Forces in most, the commandstructure under which the Medical Department served in an oversea areafollowed the general outlines laid down in the prewar manuals. The theatercommand was the highest U.S. Army command in an area; only a surgeon assignedto such a command could exercise overall responsibilities with respectto the health and medical care of all U.S. Army troops in the theater.On the other hand, the medical job at the headquarters of the various communicationszones included the operation of the large medical installations in an overseatheater--the fixed hospitals which furnished most of the definitive medicalcare, and the large medical supply depots. In some cases the same man servedas chief surgeon at both the theater and service forces headquarters. Insome the entire medical section for the two headquarters was the same,being physically located at one of the two, or, in some cases, split betweenthem. In the case of certain groups with special training sent to the theatersby the Surgeon General`s Office to fill specific needs, such as the consultantsand the malariologists, the question arose in some theaters as to whetherthey could be most effectively assigned to theater headquarters or to communicationszone headquarters.
Medical Department officers consistently maintained that the chief surgeonof any command should have a position on the commander`s staff. Only bybeing placed at staff level can the surgeon gain the ear of his commanderand participate appropriately in the activities and responsibilities inwhich the surgeon has primary interest. Since the command surgeon is largelyan advisor and lacks command authority except in instances in which itis specifically delegated to him, he needs direct access to the commanderin order to make known the needs of the medical service. In time of war,guns and ammunition are apt to take priority over medical matters; buildingsfor warehouses may be constructed in advance of those for hospitals. Yetevery commander expects the wounded to be treated, evacuated from the combatzone, and hospitalized with precision and dispatch. If one single lessonstands out among those learned by the Medical Department in World War II,it is this: That at every important level of command the surgeon, if heis to carry out his mission effectively and well, must be an active anddistinct member of the commander`s staff. His position should not be subordinatednor included within any other staff member`s office.
No other volume in the Medical Department series, nor even in the officialhistory of the United States Army in World War II, gives so complete aworldwide picture of Army organization as this volume, which for that reasonalone will undoubtedly find wide use outside of the U.S. Army Medical Serviceas well as internally. It presents clearly and at usable length the wartimeorganizational framework and the command structure within which the ArmyMedical Department functioned, and so forms an indispensable introductionto the other volumes of the series, clinical as well as administrative.
LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.
