CHAPTER VI
Procurement, 1941-45: Medical, Dental, and Veterinary Corps
LEGISLATION
Immediately following Pearl Harbor, two important measureswere passed regarding manpower in the Army. An act, approved on 13 December1941,1 extended the tour of active duty of all officers and enlistedmen,including retired officers in service, to a date 6 months after the end ofthe war. Under it, reservists no longer served a stipulated period of time onactive duty and then reverted to inactive status. Reserve officers who had been relieved fromactive duty following a period of satisfactory servicewere recalled. Restrictions on age-in-grade for service other than with troopunits were removed as weregeographic restrictions on the useof reservists and guardsmen.
A week later, 20 December 1941, an amendment to theSelective Service Act provided for registration of all men between the agesof 18 and 65, and sanctioned militaryservice for those between 20 and 45.The same law permitted the President to defer the military service of drafteesby age groups if this seemed in the national interest. The subsequentlowering of the maximum induction age from 45 to 37 years, which hadcertain adverse effects on the procurement of Medical Department officers, didnot, however, take place until a yearlater.
Believing that it was unnecessary for officers to meet the rigid physical requirementsthen in force in order to perform many types of duty, the War Department about the sametime took steps to relax the physical requirements for Reserveofficers not yet called to active duty and for civilians who might be commissionedas officers.For minor deficiencies such as slight overweight or defective vision, the prospective officers were permitted tosign waivers, subject to final acceptance or rejection byThe Surgeon General in accordance with the recommendations of his Divisionof Physical Standards.2 The "limited service" categorywas later used as a means of designating and classifying suchofficers.
155 Stat. 799.
2(1) Memorandum, Under Secretary of War, for The Surgeon General, 12Dec. 1941. (2) Statement of Dr. Durward G. Hall, to the editor, 27 May 1961.
168
MEDICAL CORPS
Lag in Procurement During the First Months of War
There were three means of getting physicians into the Army:By calling up those who belonged to the Reserve or the National Guard; byorganizing affiliated units to be called into service when needed; and by directcommissions from civilian life. The hard core of the wartime Medical Departmentwas the Reserve, made up for the most part of men who believed in theirobligation to perform military service. The ranks these men held in the Reservewere often lower than those given to men of no greater competence whovolunteered at later dates.
In the first months after Pearl Harbor, the number of doctorsthat came into the Army was relatively quite small. It is true that the Army ingeneral was growing rather slowly. Nevertheless, the Medical Department wishedto have more than enough doctors for immediate needs so as to be well preparedfor the vast increases in the size of the Army that were bound to come.Physicians entering the Army directly from civilian practice needed sometraining in military methods before they could work with full effectiveness;moreover, it was better to have an adequate system of medical care readybeforehand than to build one in the midst of pressing need.
Five months after the declaration of World War II,approximately 3,000 fewer physicians were on active duty with the Army than atthe end of the same length of time after the declaration of World War I.3In the first place, the Army depended on the doctors tovolunteer. In the second place, many doctors misunderstood the functions of theProcurement and Assignment Service and, believing that that agency actually didprocure, waited for some notification from the agency. And, finally, theprevalent rumors about the idleness and misassignment of Reserve doctors afterthey had gone into service undoubtedly discouraged some from accepting activeduty in an Army which, they believed, either did not need them or could not orwould not use them properly. As time went on, the knowledge of affiliated unitswhich had been called early in the war and had remained in this country withoutuseful work confirmed many doctors in their belief that the Army did not-atleast not yet-need additional doctors.
Role of the Procurement and Assignment Service
Organization
Although the Procurement and Assignment Service wasestablished in November 1941, it became an active factor in procurement onlyafter the United States entered the war. For several months, it was engaged insetting up its organization, and functions changed somewhat during the course ofthe war.
3Memorandum, Procurement Branch, MilitaryPersonnel Division, Office of The Surgeon General, for Director, HistoricalDivision, Office of The Surgeon General, 20 Apr. 1944.
169
From the standpoint of governmental organization in general,the Procurement and Assignment Service was one of the agencies in the ExecutiveOffice of the President. There, it occupied a subordinate position, being atfirst directly responsible to the Office of Defense Health and Welfare Services,a branch of the Office for Emergency Management, which in turn was a maindivision of the President`s Executive Office. Later, in April 1942, it wasshifted to the Bureau of Placement of the War Manpower Commission, another main division of the Office for Emergency Management. In both positions, theProcurement and Assignment Service was under the jurisdiction of Paul V. McNutt,at first directly when he was Director of the Office of Defense Health andWelfare Services, and then indirectly when he became Chairman of the WarManpower Commission. Its head throughout the war continued to be Dr. Frank H.Lahey, Chairman of the Volunteer Directing Board. Whatever its position on anorganization chart happened to be, the Procurement and Assignment Service inpractice seems to have worked somewhat independently of control from above otherthan from Mr. McNutt.4
The Procurement and Assignment Service at first concerned itself only withdoctors, dentists, and veterinarians. Eventually, nurses and sanitary engineersalso came within its scope. The Directing Board (fig. 31) was the policymakingbody of the Service and was instrumental in establishing the
4Letter, Mary E. Switzer (Administrative Assistant to Mr. PaulV. McNutt, during World War II), to Col. C.H. Goddard, Office of The Surgeon General, 19 Aug. 1952.
170
central and field organizations. It also created a number ofadvisory committees. Their names indicate the aspects of the Board`s work withwhich it believed it would need special assistance; there was a committee oneach of the following: Allocation of Medical Personnel, Dentistry, Hospitals,Industrial Health and Medicine, Information, Medical Education, Negro Health,Public Health, Sanitary Engineering, Veterinary Medicine, and Women Physicians. In1943, two members of the nursingprofession were appointed to the Directing Board, and a Nursing AdvisoryCommittee and a Nursing Division were created.
To carry out its functions locally, the Procurement and Assignment Serviceearly established a system of committees for the corps areas, States, anddistricts or counties. The committees were composed of members of the medicalprofessions-physicians, dentists, veterinarians, medical and dental educators,hospital administrators, and public health representatives. Later, in 1943, a system of State and local committees onnursing was also organized. Most of this apparatus was modeled on or taken overfrom agencies set up by the national nursing organizations.
Since it was agreed that representatives of the Procurementand Assignment Service should act in an advisory capacity to the SelectiveService System, the relationship between these two agencies was close. Infact for a time (5 December 1942 to 23 December 1943), both were part of theWar Manpower Commission. Other agencies with which the Procurement andAssignment Service worked closely were the National Roster of Scientific andSpecialized Personnel, the National Research Council, and the national medical,dental, and veterinary associations.
Functions
The unique function of the Procurement and Assignment Service was to assurethe continuance of adequate medical care for the civilian population bydetermining minimum local needs and calling a halt to recruitment when thesupply of physicians and dentists dropped to the indicated level. For a shorttime, the Procurement and Assignment Service also assisted in ascertaining theprofessional eligibility of applicants for the Army and Navy, but for thegreater part of the war, this function was carried out in theChicago offices of the American Medical Association by personnel of theOffice of The Surgeon General.
On 21 January 1942, the War Department issued a directive tocorps area and department commanders stating that applications receivedby the Army were to be sent to the Procurement and Assignment Service, who wouldthen determine the eligibility of the applicant according to the requirements ofArmy regulations on the basis ofinformation from the authorities of the National Roster of Scientific andSpecialized Personnel and send eligible applicants forms for appointment.When returned, the completed forms were forwarded to The Surgeon Generaltogether with a statement of the applicant`s
171
eligibility and a description of his classification and evaluation asdetermined by therecent nationwide survey made by the Medical Preparedness Committee of theAmerican Medical Association.5
In May 1942, however, The Surgeon General requestedthe Service to send all applications to him after retaining them only long enough toobtain a statement of the applicant`s availability from theService`s State chairman. Three months later, he recommended revocation of thedirective of 21 January, stating that the Procurement and Assignment Service no longer took any part inprocessing applications.6The reason for The Surgeon General`s action undoubtedly included the need tospeed commissioning as the flow of applications increased, but it alsoreflected some dissatisfaction with the existing state of things. TheProcurement and Assignment Service, with its nonmilitary orientation, protectedthe civilian community better than The Surgeon General could have done, but itwas only as effectiveas its local administration. At this time and throughout the war, theactual recruitment of medical and paramedical personnel for the Army was theprimary business of the Personnel Service in the Office of The Surgeon General.
While the Procurement and Assignment Service ceased to havemuch to do with determining the eligibility of professional men applyingfor appointment in the Army, it continued to need information concerning the qualifications ofcivilian professional personnel. A numberof agencies had been collecting information of this nature sincebefore the war, information which in many instances proved useful to the Medical Department as wellas to the Procurement and Assignment Service. Oneof these agencies was the NationalRoster of Scientific and Specialized Personnel. The National Roster had asits function the registration of all persons trained in the sciences and in other specialized fields, thecoding of their registrations, the machine processing of data, and the machineselection of papers of qualified registrants. As the American MedicalAssociation was engaged in a similar task for physicians, the National Roster at first registeredonly a small specialized group of the medical profession. However, the AmericanMedical Association, the American Dental Association,and the American Veterinary Medical Association made available to the NationalRoster all punchcard files they had collected. Later on, theRoster, cooperating with the Procurement and Assignment Service, developed questionnaires and enrollment formswhich were sent to all physicians, dentists, and veterinarians. The NationalSurveyof Registered Nurses, initiated in 1941 by the Nursing Council for NationalDefense, was also carried on andcompleted in 1941.
5(1) Letter, Office of The Surgeon General, toWar Department GeneralStaff, subject: Appointment of Physicians, Dentists, and Veterinarians in Armyof the United States. (2) Letter, Office of The Adjutant General, to all CorpsArea and Department Commanders, 21 Jan. 1942, subject: Procurement of Officersfor Medical Department, Army of the United States.
6(1) Memorandum, Office of The Surgeon General, forProcurement and Assignment Service, 12 May 1942. (2) Letter, Office of TheSurgeon General (Maj. D. G. Hall), to The Adjutant General, 31 Aug. 1942,subject: Procurement of Officers for Medical Department, Army of theUnited States.
172
In determining minimum local civilian needs and deciding which and how manyprofessional men could be spared for the Armed Forces, the Procurement andAssignment Service began with an individual approach. If the doctor was sonecessary to his community that he could not be permitted to volunteer formilitary service, he was classified as essential and prohibited from accepting acommission. If not, the Service classified him as available and encouraged himto enter the Army or the Navy. This procedure was soon partially superseded, inthe case of doctors, by what amounted to classifying them as essential en masse;that is, the Procurement and Assignment Service prohibited recruitment in anyState which had less than the ratio of doctors to population it considered anecessary minimum. In States having a higher ratio, recruitment was permitted onthe former basis. As the ratios were computed on the basis of each State as awhole, urban areas might conceivably have a much higher ratio than ruraldistricts, but the Procurement and Assignment Service had no power toredistribute doctors.
The Procurement and Assignment Service attempted to classify as available oressential all doctors within the age group which was eligible for militaryservice, but it did not do this fast enough to prevent some doctors from accepting commissions before beingclassified.7 The difficulty would have beenobviated if the Service had promptly classified all applications forcommissions. In some cases, however, this was not done.
The task of classification was performed mainly by the State committees ofthe Service. If an individual objected to the way he was classified, or if hiscommunity or institution protested that he had been wrongly designated"available," an appeal could be carried to the corps area committee,which would reappraise the judgment. If the decision there went against theappellant, he could carry the matter to the Directing Board in Washington, D.C.
Probably the most important of the Directing Board`s advisorycommittees, so far as the Medical Department was concerned, was the Committeeon Allocation of Medical Personnel. This committee obtained information for theDirecting Board and appraised the sources of medical manpower. The committeebased its determination of civilian needs on studies carried on in cooperationnot only with the official agencies concerned (the U.S. Public Health Service,the Children`s Bureau of the Department of Labor, and the Department ofAgriculture) but also with the American Medical Association, the American DentalAssociation, the American Public Health Association, and other similar groups.8It established criteria for determining the minimum personnel requirements ofmedical schools, hospitals, industry, and the civilian population. In thisrespect, it was, to some extent, a "rationing" board. The committeealso determined and set up State quotas of physicians for military service,taking into consideration the overall needs of the civilian population.
7Committee to Study theMedical Department, 1942.
8See footnote 4, p. 169.
173
Since the Procurement and Assignment Service established the criteria whichcontrolled the recruitment of professional personnel for the Medical Departmentof the Army and Navy, the Service could state rather definitely the maximumnumber of doctors, dentists, veterinarians, and other groups which the ArmedForces could contain. It thus restricted, and at the same time promoted, theprocurement of medical personnel for the military forces. It forbade anyprocurement whatever in certain States; in others, it classified certainindividuals as essential to their communities and so kept them from enteringeither the Army or the Navy. On the other hand, by classifying a person asavailable, it directed recruiting effort toward him and in effect told him thathe should be in uniform. True, it had no legal power to compel him to join up-the legal power was all on the side of preventing essential practitionersfrom doing so-but the moral pressure which a committee of professional men couldexert on their colleagues by labeling them "available" must in manycases have been decisive. Another effective influence was the pressure fromlocal medical societies. And back of these intangibles stood the ever-presentthreat that local draft boards could if they chose call up any able-bodied manwithin the prescribed age group, regardless of his professional training.
Medical Officer Recruiting Boards
The Procurement and Assignment Service came too late, and had too little actual authority, to effect Medical Department procurement in the early months of the war. In March 1942, theSurgeon General`s Office had no alternative but to inform Headquarters, Servicesof Supply, that there was a serious shortage of physicians for the Army. The 1940-41 procurement program had fallen 1,500 short at the end of that fiscal year, and was stillfalling behind. There were in fact only 12,465 medicalofficers then on active duty, with orders for another 500 requested,compared with an objective of 28,656 bythe end of 1942. Although theProcurement and Assignment Service was sending applications and related papersto the Office of The Surgeon General at a rate of about 75 a day, an average of only 50 a day could be completed andsent to The Adjutant General, owing to inadequate data. These figures, ifprojected through the remainder of 1942, forecasta shortage of some 4,000 medicalofficers by 1 January 1943.9 Theanalysis impressed both the Services of Supply and the Assistant Chief of Staff,G-l, resulting in the establishment of the Medical Officer Recruiting Board.
Procedures
On 12 April 1942, the Director of Military Personnel, Services of Supply,instructed The Surgeon General to prepare a plan embodying the following points:(1) The authority to accept, examine, and commission applicants
9Memorandum, Office of The SurgeonGeneral (Col. G. F. Lull), for Gen. J. E. Wharton, Military Personnel Division,Services of Supply, 20 Mar. 1942, subject: Shortage of Medical Corps Officers.
174
was to be decentralized to 48 State representatives; (2)commissions in sufficient numbers were to be tendered in grades above thelowest to attract qualified applicants, and upper age limits were to be relaxedto provide experienced Medical Corps officers in appropriate grades; (3) corpsarea and station surgeons were to be charged with active participation in thecampaign to recruit Medical Corps officers; and (4) an intensive publicitycampaign would be launched to call the attention of physicians and the public tothe Army`s need for doctors.10
These provisions were carried out, and as his contribution tothe plan, The Surgeon General issued instructions to the new recruiting boards,each board consisting of one Medical Corps officer and one officer whose branchwas not specified (branch immaterial). They were authorized to secureapplications for commissions in the Army of the United States (Reserve officerswere to apply to The Surgeon General himself for active duty) of qualifiedphysicians under the age of 55 and of dentists under 37. The boards were tofunction in cooperation with the Procurement and Assignment Service and wherepossible would obtain office space at or near the headquarters of the Statechairman of the Service. Medical societies also cooperated with the board,rendering them considerable assistance. The boards were to obtain applications,authorize physical examinations at the most convenient Army medicalinstallation empowered to perform such examination, and evaluate theprofessional qualifications and physical findings. They could appoint, withoutfurther delay, applicants under the age of 45 years to the grade of firstlieutenant or captain, the grade to depend upon experience and professionalqualifications. The boards were to administer the oath and forward the completedpapers to The Surgeon General. Regulations which determined rank on the basisof age and professional qualifications were to remain unchanged-applicants underthe age of 37 years were appointed in the grade of first lieutenant, except thatthose who had passed the age of 30 were appointed as captains when they had beencertified by an American specialty board or had completed 3years` residency in a specialty in addition to the required 1 year`s internship;or, if they were older than 36 years and 10 months and would reach 37 yearsabout the time active duty began, they could be appointed in the grade ofcaptain. The boards were not empowered to appoint certain types of applicants,but were to complete the applications and send them to The Surgeon General. Suchwere applicants in the age group from 45 to 54, those applying for a gradehigher than that of captain, Negro physicians, graduates of American substandard or foreign schools, Federal employees, or persons drawing Federalpensions, and others whose qualifications the board questioned.11
10Memorandum, Director, MilitaryPersonnel Division, Services of Supply (Brig. Gen. James E. Wharton), for TheSurgeon General, 12 Apr. 1942.
11Instructions to Medical Officer Recruiting Boards, by Col. John A.Rogers, Executive Officer, Office of The Surgeon General, May 1942.
175
The Surgeon General`s control
Until 1 September 1942, The Surgeon General controlled the boards on behalfof the War Department, and he issued instructions to them either directly orthrough The Adjutant General. His authority included the power not only toestablish but to close a board. He might also be directed by higher authority toopen additional boards.12
Accomplishment of the boards
The boards had remarkable success in recruiting doctors. Bringing todoctors, individually or in groups, for the first time during the war the storyof the Army`s urgent need for their services, clearing up misunderstandings,and having the power to examine and commission directly, they swore in verylarge numbers in their few months of operation. One board reported in Junethat its record for minimum time elapsed between receipt of an applicationand the commissioning of the applicant was 5 daysand that it was prepared to maintain an average of 7 days.13For the most part, the board cooperated closely with the State representativesof the Procurement and Assignment Service, requesting availability clearancefor doctors who expressed willingness for Army service. In some instances,however, the boards, in their enthusiasm, did not await these availabilityrulings.14The Surgeon General informed the Procurement and Assignment Service thatthe need for medical officers was so pressing that it would not be possibleto delay appointment of qualified applicants to ascertain their availability"as determined by anyone other than the applicant himself." ButMr. McNutt complained to the Secretary of War, and The Surgeon General wasdirected to agree not to commission any more medical officers unless they hadbeen cleared by the Procurement and Assignment Service.15Thus, however great his need, The SurgeonGeneral`s attempt to shake off the reins of a civilian agency was unsuccessful.
Air Forces activities
The Army Air Forces, meanwhile, had sought authority asearly as March 1942 to procure its own medical officers, on the ground that TheSurgeon General wasnot able to allot enough physicians to meet Air Forces needs, nor proc-
12(1) Instructions to Medical OfficerRecruiting Boards, by Order of The Surgeon General, 23 May 1942. (2) Memorandum,The Surgeon General, for The Adjutant General, 28 Apr. 1942. (3) Letter, The Surgeon General, toHon. E. D. Smith, Senator from South Carolina, 20June 1942. (This refers to a request to The Adjutant General for remova1 of aboard from South Carolina to another State.) (4) Letter, Director, MilitaryPersonnel Division, Services of Supply (Brig. Gen. James E. Wharton),to The Surgeon General, 23 June 1942, subject: Officer ProcurementProgram Medical Department.
13Letter, Lt. Col. R. F. Olmsted, to Col. J. R. Hudnall,Office of The Surgeon General, 22 June 1942.
14Memorandum, Lt. Col. Durward G.Hall, Office of The Surgeon General, for Director, Historical Division, Officeof The Surgeon General, 20 Apr. 1944, subject: History of Procurement Branch,Military Personnel Division, Personnel Service, Office of The Surgeon General.
15(1) Memorandum, Office of The Surgeon General (Col. F.M. Fitts, MC), for Executive Officer, Procurement and Assignment Service, 15 May 1942. (2) See footnote 7, p. 172.
176
ess them fast enough. The Surgeon General agreed to place AirForces medical officers on duty with the recruiting boards to handle theapplications of those interested in serving with the Air Forces, although eachapplicant`s preference as to branch of service already appeared on the paperssent to The Surgeon General.16
Simultaneously, the General Staff granted the Air Surgeon theright to determine the grade of appointment for doctors in company grade and tosend the papers directly to The Adjutant General; papers recommending appointment in grade of major or above he still had to send to The Surgeon General.17The following tabulation shows the results of the AirSurgeon`s procurement efforts from 21 March 1942 to 1 July 1942:
|
Applicants physically disqualified |
280 |
|
Applicants rejected by the Air Surgeon |
486 |
|
Applicants not desiring Air Forces service (presumably persons who had changed their minds) |
155 |
|
Orders requested for duty with Air Forces |
2,053 |
The figure of 2,053 approximatedthe objective of 2,200 which the AirSurgeon had set for this period.18
Officers in the Surgeon General`s Office were forced to admitthat the Air Surgeon`s efforts had relieved them of the responsibility ofrecruiting for him. Probably the "glamor" which many people attachedto service in the Air Forces, in addition to the aggressiveness with which therecruiting campaign was waged, accounted in a considerable degree for itssuccess. It accounted also for much of the dissatisfaction that later developed,especially among qualified specialists who had come on active duty from theMedical Corps Reserve, often at some personal sacrifice. As the Chief Surgeon ofthe European theater recalled it: "These specially trained menunderstandably expected that their special skills would be used; but the AirForces did not have sufficient beds under their control to utilize all of thistalent * * *. In the E.T.O., from 1944 on, we traded * * * with the Air Forces, giving it good young medical officerswithout special training for qualified specialists."19
Procurement and Assignment Service reaction
In June 1942, Dr. Frank H. Lahey,Chairman of the Directing Board of the Procurement and Assignment Service andPresident of the American Medi-
16(1) Letter, Air Surgeon (Col. David N. W. Grant,MC), to The Surgeon General, 22 June 1942, subject: Medical Corps Officers forDuty. (2) See footnote 12(1), p. 175.
17Letter, The Adjutant General, toCommanding General, Army Air Forces, 6 July 1942, subject: Coordination, TheSurgeon General and The Air Surgeon. (The Army Air Forces Medical Servicehistorian states, however, that it appears that the Air Surgeon never used theauthority to "sign and issue letters of appointment" of Medical Corpsofficers in company grades. See Link, Mae Mills, and Coleman, Hubert A.: MedicalSupport of the Army Air Force in World War II. Washington: U.S. GovernmentPrinting Office, 1955.)
18(1) Memorandum, Chief Clerk, Personnel Division, AirSurgeon`s Office, for Chief, Personnel Division, Air Surgeon`s Office (undated).(2) See publication cited in footnote 17.
19Letter, Maj. Gen. Paul R. Hawley, USA (Ret.), toCol. John B. Coates, Jr., MC, Director, Historical Unit, U.S. Army MedicalService, 12 Mar. 1956.
177
cal Association, and Mr. Paul V. McNutt, Chairman of the War ManpowerCommission, took occasion in addressing the House of Delegates of the AmericanMedical Association in Atlantic City, N.J., to inform doctors of the Army`sgreat need for them. Dr. Lahey stated that he believed that the medicalprofession was still not facing the facts as frankly as it should and that thecountry was still not convinced that its situation was one of urgent necessity.Mr. McNutt spoke much more bluntly, saying: "We are not getting enough[doctor] volunteers." Then, reviewing the armed services` need for doctors,and pointing out the different fields of civilian medicine where needs werelarge, he told the delegates that the careful safeguards that the Procurementand Assignment Service had set up had apparently slowed down the rate ofrecruitment. "The voluntary plan must work and work promptly-or some othermore vigorous plan will have to be produced." After stating that themedical profession was the first to require rationing, he concluded: "Theissue is who shall do the rationing, for America must have the doctors itneeds."20 Althoughhe did not explain what the "more vigorous plan" would be, manybelieved Mr. NcNutt was referring to the possibility of a draft of doctors.
Dental officers assigned to boards
Since the boards had been commissioning dentists as well as doctors and sincethere were few vacancies in the Dental Corps during the first 2 months of theirexistence, the efforts of the two original officers on each board filled theneeds. In July 1942, however, when The Surgeon General received authority toprocure 4,000 more dentists, a Dental Corps officer was added to each of the 30boards then operating in 25 States.(In June 1942, the Services ofSupply had ordered additional recruiting boards created in seven of the morepopulous States-New York, Pennsylvania, Illinois, Ohio, Massachusetts,California, and Texas.)21 Theobjective was soon reached; the Dental Corps officers were removed from theboards on 1 September 1942, and theboards were instructed at that time to process no more dental applicationsexcept for men classified as I-A by selective service-those who might bedrafted.22 The boards did not procure veterinarians or any other MedicalDepartment personnel. In September 1942, theboards were limited to appointing first lieutenants only, forwarding the papersof applicants for all other grades to The Surgeon General, who decided whetherto commission the applicant.23
20(1) Medicine and the War. J.A.M.A.119: 647-648, 20 June 1942. (2) McNutt, P. V.: The Urgent Need for Doctors.J.A.M.A. 119: 605-607, 20 June 1942.
21Seefootnote 12(4), p. 175.
22(1) Medical Department, United States Army. DentalService in World War II. Washington: U.S. Government Printing Office, 1955. (2)Letter, The Adjutant General, to Commanding Generals, all Service Commands, 9July 1942, subject: Dental Corps Member for Certain Medical DepartmentRecruiting Boards.
23(1) War Department Memorandum No. S605-5-42, 1 Sept.1942. (2) Radio, Commanding General, Services of Supply, to Commanding General,each Service Command, 10 Sept. 1942.
178
Civilian reaction
Although the total number enrolled by these boards wasgratifying to The Surgeon General, physicians` responses to the boards` appealsvaried in different sections of the country. Some States went far beyond the1942 quota set by the Procurement and Assignment Service; others lagged. In someareas, critical shortages of doctors for civilian care were developing, due inpart to voluntary enrollment and in part to the shifting of population toindustrial areas. On the other hand, several populous States, where the numberof doctors was relatively large, fell far behind their quotas.
The boards drew criticisms of various kinds, the mostfrequent being that they antagonized doctors and threatened them with beingdrafted if they did not volunteer.24Learning of such conduct by the boards, the Director of the Selective ServiceSystem issued a strong statement declaring that the System had not delegatedthe power to induct and could not if it wished but that, despite this, someboards had told doctors they must accept a commission or they would bedrafted. "This is a half truth and a misrepresentation of the worstpossible kind," he asserted.25
On 20 June 1942, the Surgeon General`s Office, possibly forewarned of theDirector`s concern in this matter, had informed the boards that they were not ina position to threaten induction; they might, however, tell physicians that needfor them was so great that Selective Service might consider inducting them.26
The Chairman of the War Manpower Commission, although he hadtalked sternly to doctors in June about the Army`s great need for them,testified in the fall of 1942 before the Committee to study the MedicalDepartment that in many States the boards "use entirely unwarranted methodsto scare doctors into volunteering * * *. Every possible means wasused, short of shanghaiing, to force the doctors to join up." Hecomplained to the committee that these boards had paid little attention toessential work a doctor might be doing and that before State Chairmen of theProcurement and Assignment Service could complete their lists of essentialdoctors in communities, health departments, the staffs of universities andhospitals, and industry, the boards had taken many essential men. "Wehave had," he said, "occasional instances where they have taken everysingle person [physician] in the community * * *. They have gone in and high-pressuredthese men."
In a move to regain the control he had lost when others were empowered toissue commissions, The Surgeon General stated in the fall of 1942 that as hisOffice possessed the machinery to handle applications and recommend commissions, the few boards still functioning were to do no more actualcommis-
24Letter, Chamber of Commerce, Kalamazoo, Mich., to Senator PrentissW. Brown, 23 Nov. 1942.
25Letter,Director, Selective Service System, to Brig. Gen. James E. Wharton, Director,Personnel Division, Services of Supply, 22 June 1942.
26Information Letter, Office of The Surgeon General, to Medical OfficerRecruiting Boards, 20 June 1942, subject: Instructions.
179
sioning. With all applications for commissions in theMedical Corps passing through his Office, he could exercise tighter control on the initialrank granted an officer and on the classification of each man according to his trainingand experience. The Officer ProcurementService, established in November 1942 under the Commanding General, Services of Supply, to procure officers for the entireArmy, was willing, however, to have the Medical Officer RecruitingBoards complete and send applications to The Surgeon General or the Air Surgeon:those officers then transmitted them to the Officer Procurement Servicefor consideration and for forwarding to the Secretary of War`s PersonnelBoard.27
Closing of the boards
The recruiting boards were closed at different times,beginning with the board in South Carolina in June 1942; the last ones were closed inFebruary or March 1943. As States approached the Procurement and AssignmentService`s quotas of physicians that could be withdrawn from civilian practice,that Service became concerned that civilian medical care mightsuffer unduly and brought pressure on the War Department to close theboards in those States. Furthermore, in States which had reached their 1942quota, the Service refused to declare anymore doctors available for military duty. As a result of pressure from thisService, The Surgeon General in July 1942 ordered the boards in 16 States tobe closed at the earliest practicable date.28
Control shifted to service commanders
At the end of the same month, General Somervell, on beingreminded at a meeting of his service command commanders that the medical officer recruiting boards were underthe orders of The Surgeon General, declared that they were to be "underthe Service Commander, and I don`t want any direct staff control anymore." On 1 September 1942, an order was issued to that effect.29Accordingly, when a week later the Procurement and Assignment Service askedThe Surgeon General to close the recruiting boards in additional States whichhad reached or nearly reached their quotas, the Surgeon General`s Officesuggestedother channels.30 On21 October 1942, a War Department directive terminated the activities of theboards in all remaining States except California, Illinois, Pennsylvania, New York, andMassachusetts.31Early in 1943,
27Memorandum, Chief, Procurement Division, OfficerProcurement Service, for Chief, Field Operations Branch, Officer Procurement Service, 1 Dec. 1942, subject: Appointment ofDoctors of Dentistry, Veterinary Medicine, and Medicine.
28(1) General Report, Second ServiceCommand, 1943, p. 26. (2) Proceedings, Directing Board, Procurement and Assignment Service, 24 July 1942. (Thisorder closed boards in the following States: Delaware, West Virginia, Virginia, North Carolina, Georgia, Mississippi, Alabama, Oklahoma, Indiana, NorthDakota, South Dakota, Idaho, Montana, Wyoming, Nevada, and New Mexico.)
29(1) Conference of Commanding Generals, Services of Supply, Fourth Session, 30 July-1 August 1942,31 July 1942. (2) See footnote 23 (1), p. 177.
30Proceedings of the Directing Board, Procurement and Assignment Service, 19-20 Sept. 1942.
31War Department Memorandum No. S605-14-42, 21 Oct. 1942.
180
the Officer Procurement Service was authorized to recruitdoctors and dentists, but responsibility for processing applications andrecommending their approval still rested with The Surgeon General.
Direct commissions
During the life of the recruiting boards, doctors anddentists were permitted to apply for commissions directly to The Surgeon Generalor to the Procurement and Assignment Service, which would send the papers to TheSurgeon General. In these cases, The Surgeon General did the work of getting allnecessary information from the applicant and evaluating it; if acceptable, TheSurgeon General recommended a grade and assignment and, if physically qualified,requested The Adjutant General to commission the applicant in that grade and toissue orders placing him on duty at the station specified. In all instances,whether the applications were received directly or from the boards, The SurgeonGeneral classified the applicants as to specialty, made an assignment, andrequested The Adjutant General to issue orders placing them on duty.32
Indeed, The Surgeon General often went further than merelyprocessing papers of those who applied for commissions, actively seeking out andpersuading candidates. Among those brought into the Medical Department in thisway were a number of returned medical missionaries, whose intimate knowledge ofclimate, sanitary conditions, and endemic diseases in strategic areas, such asOkinawa, later proved of inestimable value. Many of these men went intopreventive medicine; others devoted themselves to medical intelligencework.33
In late 1942, the Secretary of War, concerned about themethod of appointing noncombat officers in the Army, had had a study made ofthe subject and created the Secretary of War`s Personnel Board. (This groupsucceeded one known as the War Department Personnel Board.) The new boardreviewed all applications for appointment in the Army of the United States fromcivilian life (or from the Army Specialist Corps) before appointments could bemade; it performed a final review before recommending a commission.34
Increase in procurement in 1942
The success of the Medical Officer Recruiting Boards and of the SurgeonGeneral`s Office in getting doctors on duty is indicated by the growth of theMedical and Dental Corps during the time that the boards were in operation(table 1). The increase during the first month or so of their operation, significant though it is, cannot be compared with the numbers the boards brought
32Report, Albert W. Gendebien,Military Personnel Division, Office of The Surgeon General, of Survey ofNon-Technical Segments of the Surgeon General`s Office, 24 Sept.-10 Oct. 1942.This survey was made for the benefit of the Committee to Study the MedicalDepartment.
33Statements of Durward G. Hall, M.D., and Maj. Gen. George F. Lull,USA (Ret.), to the editor, 27 May 1961.
34Memorandum, Deputy Chief of Staff, for Commanding General,Services of Supply, 31 Oct. 1942, subject: Procurement of Officers for Army ofthe United States From Civilian Life.
181
on duty later, after they had become accustomed to theirwork and were bringing the Army`s need for doctors forcibly to the attentionof increasing numbers. So far as the Air Forces was concerned, its most fruitfulperiod for the procurement of doctors was during the 5 months from 1 July to 1December 1942, when 4,576 entered the service; in the following 13 months to January1944, only1,102 came in.35
During that portion of 1942 inwhich the Medical Officer Recruiting Boards functioned, the strength of theMedical Corps of the Army of the United States increased by 24,252; during 1943,afterthese boards had been abolished, the increase was only 4,734. This comparison illustrates, however, not only the successof the boards as compared with that of the Officer Procurement Service thatfollowed them, but likewise the increasing scarcity of physicians whom theProcurement and Assignment Service was willing to declare available in 1943, and the fact that the proportion of doctors whom thisService declared available but who did not apply for military duty increased asthe scarcity became greater in civilian life.
The Officer Procurement Service
Procedures
The OfficerProcurement Service, established on 7 November 1942 under the Commanding General,Services of Supply, dealt directly with the Army Air Forces, Army GroundForces, and the chiefs of supply and administrative services.36It undertook to obtain not only doctors and dentists, as the Medical OfficerRecruiting Boards had done, but also members for other Medical Departmentofficer components. The Service continued the practice, initiated shortly beforethe Medical Officer Recruiting Boards were closed, of sending each applicationto the Secretary of War`s Personnel Board for approval before a commission wasgranted; it never had the power to tender commissions directly to applicants ashad the boards.
The Officer Procurement Service began its work for theMedical Department on 15 January 1943. Theprogram for the procurement of doctors, dentists, and veterinarians constitutedone of its major activities in 1943 and 1944.37In early 1943, the Service had district offices in 38 large cities throughout the country. In practice, it was acountry-wide recruiting office, with its activities at first limited toprocuring officers, although later in the war it also lent its efforts toprocuring certain types of enlisted personnel as well.
35See footnote 17, p. 176.
36War Department Circular No. 367,1942. (The Officer Procurement Service did not handle the appointment ofgraduating aviation cadets, officer candidates, or members of the ReserveOfficers` Training Corps.)
37Memorandum, Central Office,Procurement and Assignment Service, for Col. Robert Cutler, Officer ProcurementService, Services of Supply, through Lt. Col. D. G. Hall, Personnel Division,Office of The Surgeon General, 16 Jan. 1943, subject: Correction Paragraph 6 inCovering Letter From Officer Procurement Service to Officer ProcurementDistrict.
182
The method of procuring physicians under the Officer Procurement Serviceappears to have been cumbersome and time consuming. The Office of The SurgeonGeneral pointed out somewhat later that, although the Officer ProcurementService had been very cooperative, its functioning had of necessity lengthenedthe time required to appoint physicians and dentists from civilian life. Onlythe Procurement Service could solicit a doctor, dentist, or veterinarian, butbefore doing so it had to receive an application from him by way of theProcurement and Assignment Service, which had previously notified him of his"availability," ascertained his preference for the Army or Navy, andchecked his professional qualifications and ethics with the Surgeon General`sOffice. The Officer Procurement Service interviewed him to gain information asto his character, reputation, and other qualifications for commission as anofficer. If these were found satisfactory, it helped him to fill out a properapplication for a commission. Since the Surgeon General`s Office had alreadycleared him as to professional standing and ethics, that Office did not believethe interview by the Procurement Service was necessary. It considered this stepa burden on the individual in time and expense, especially in the Middle West,where the offices of the Procurement Service were too widely dispersed, and inthe densely populated Eastern States, where they were too few in number.38The Surgeon General recommended to G-1 that if by the end of March 1943procurement of doctors and dentists had not reached a satisfactory rate, theOfficer Procurement Service be divested of that function and the Medical OfficerRecruiting Boards be set up again in those States which had not furnished theirquotas.39 G-1 did notpermit him to restore the boards. The Officer Procurement Service had twoadvantages over its predecessor-it saved the time of a small number of MedicalCorps officers who had been in recruiting duties in the field; it also procuredMedical Department officers other than doctors and dentists and recruitedenlisted women as well. But it did not succeed in speeding the procurement ofmedical officers.
Procurement lag in 1943
Information from the Officer Procurement Service showed that in the periodfrom 15 January to 11 February 1943, 24 of its district offices had received thenames of 868 doctors cleared by the State Chairman of the Procurement andAssignment Service. Of these, the Officer Procurement Service had had to abandonaction on 302 (34.6 percent) because of their refusal to complete the papers orfor "other reasons." The names of 103 had been sent to The SurgeonGeneral as ready for his approval. Almost 400 cases (45.6 percent) were
38(1) Memorandum, Office of TheSurgeon General (Lt. Col. Durward G. Hall), for Officers on Duty in the Officeof The Surgeon General, 27 Jan. 1943. (2) Letter, Office of The Surgeon General,to G-1, through Director, Military Personnel, Services of Supply, 16 Feb. 1943,subject: Procurement of Physicians and Dentists. (3) War Department CircularNo. 367, 1942. (4) Field Transmittal-24, Officer Procurement Service, to OfficerProcurement Districts, 27 Jan. 1943, subject: Revision of FT-15 (1-13-43):Processing Doctors, Dentists, and Veterinarians.
39See footnote 38(2).
183
in process, awaiting completion.40Meanwhile, figures issued by the Procurement and Assignment Service for 31January 1943indicated that already a few States had reached their second quota, but these were States whose quota was very small. The States with largequotas for 1943 were ranging between only 70 and 83 percent of them.41
During April, when the total Army strength increased bymore than 200,000, the number of doctors on duty not only did not keep pace with this increase, but actuallydeclined (table 1). Some doctors were procured during this month, but a largernumber evidently left the service. During the month, The Surgeon Generaladvised the Procurement and Assignment Service that the monthly allotmentshould be revised upward in order to take care of losses.42
In July, The Surgeon General reported that between 15January and 2 July 1943 the Procurement and Assignment Service had declared6,357 doctors available. Of that number, the cases of 2,632 (41.4 percent)had already been closed because physicians refused to be processed or becausethey had moved from a State, had already been appointed, were already inprocess of being appointed, or for like reason. Of the remaining 58.6 percent,experience showed that slightly over half would be tendered commissions, theothers being found unsatisfactory for physical or other reasons. In other words, the yield would be about30 percent of the 6,357, or about 1,900. According to The Surgeon General, thetrend wasfor a lower yield from the doctors declared available.43
Meanwhile, The Surgeon General, employing other means to getmore doctors on duty, had, at the suggestion of the Secretary of War,instituted a program of reexamining doctors and dentists previously rejected on physical grounds, using the lowerstandards that had been promulgatedsince their first examination. These standards included more waivers forphysical defects. Under this "reconsideration program," hereexamined over 14,000 doctors and dentists rejected before April 1942 onphysical grounds. The result was that under this program, extended into 1944,700 doctors were found acceptable and were tendered commissions.44The program encountered complications. After failing their original physicalexamination, men had been declared essential to civilian care by the Procurement andAssignment Service; some had
40Memorandum, Field Operations Branch, Officer ProcurementService (Maj. Edward W. Gamble, Executive Officer), for The SurgeonGeneral, 20 Feb. 1943, subject: Report of Referrals of Doctors, Dentists * * *.
41Memorandum,Procurement and Assignment Service (Maj. Harold C. Lueth, MC, Consultant), for State and Corps AreaChairmen for Physicians, 1 Mar. 1943, subject: Percentage of Second Quota forPhysicians Attained.
42Memorandum,The Surgeon General`s Office, for Procurement and Assignment Service, 17 Apr. 1943.
43Memorandum, Office of The Surgeon General (Lt. Col. D. G. Hall),for Special Assistant to Secretary of War, 8 July 1943.
44(1) Annual Report, Military Personnel Division, Officeof The Surgeon General, U.S. Army, 1943-44. (2) Letter, Surgeon General Kirk,to Dr. Guy Caldwell, Secretary-Treasurer, American Board of Orthopedic Surgery,3 Feb. 1944.
184
made arrangements in civilian practice that rendered it difficult for them toaccept military duty; and others simply refused to apply for a commission.45
Early in 1943, severalindividuals, including the Chairman of the Directing Board of the Procurementand Assignment Service, and the Chairman of the War Manpower Commission,expressed the belief to The Surgeon General and the Secretary of War thatgranting doctors an initial rank higher than that of first lieutenant wouldspeed procurement. The two latter officials demurred against holding out such anenticement, on the ground that records indicated that physicians who refused anappointment as first lieutenant in the Medical Corps because of the grade aloneconstituted a small proportion of the total number declared available by theProcurement and Assignment Service. Neither would such action be fair to otherswho, with no less civilian experience, had entered the Army at lower rank.Further, it would stagnate advancement for doctors already in the Army. Theproposal was renewed at the end of 1943, but was again rejected for much the same reasons.46
The Reynolds Plan
As the Procurement and Assignment Service could not induce ahigh percentage of available physicians to accept commissions, in May 1943 General Magee recommended a special draft of doctors underthe Selective Service Act.47 However, The Surgeon General and the Procurement andAssignment Service soon afterward made an agreement which was designed toaccelerate the procurement of doctors and which continued voluntary recruiting.48Since G-1 preferred this plan, the idea of a draft was not followed up for thetime being. The agreement, later known as the Reynolds Plan, after the Directorof the Military Personnel Division, Army Service Forces, who proposed it, wasconcluded on 22 May 1943.
Under this agreement, the Procurement and Assignment Servicepromised to take the following action: (1) Declare available at once the entirelist of doctors already placed in that category; (2) permit representatives ofthe Officer Procurement Service to try to "persuade" the persons sodesignated to volunteer in the 20 States and the District of Columbia whosequotas had not been filled; (3) report all eligible doctors refusing commissionsto their draft boards for reclassification (thus presumably placing them in thegroup under selective service which was available for immediate induction intothe Armed Forces as enlisted men); (4) establish at once quotas
45Letter, New York State Procurement andAssignment Service, to Comdr. M. E. Laphman, Procurement and Assignment Service,29 Mar. 1943.
46(1) Letter, Secretary of War, to Paul V. McNutt,Chairman, War Manpower Commission, 8 May 1943. (2) Proceedings, Joint SessionWith Representatives of the Several Federal Services and Directing Board,Procurement and Assignment Service, 20 Mar. 1943. (3) Letter, Dr. Frank Lahey,War Manpower Commission, to Commanding General, Army Service Forces, 23 Dec.1943. (4) Transmittal Sheet, Brig. Gen. R. B. Reynolds, Director, MilitaryPersonnel Division, Army Service Forces, to The Surgeon General, 28 Dec. 1943,with endorsement thereto, 5 Jan. 1944.
47Letter, Surgeon General Magee, to G-1, throughDirector, Military Personnel Division, Army Service Forces, 13 May 1943,subject: Procurement of Physicians and Dentists.
48Disposition Form, G-1, to MilitaryPersonnel Division, Army Service Forces, 24 May 1943.
185
by States or "other areas" to be furnished the Armyduring 1943; the quota being arrived at as follows: subtract thetotal number on duty on 31 May 1943 from 48,000 (the current ceiling strengthfor doctors in the Army) and consider the remainder as the total number ofdoctors to be procured, which would be divided into "area quotas." TheArmy, for its part, agreed (1) to clear each doctor with the Procurement andAssignment Service before commissioning him, and not even to approach anydoctor, such as a senior professor in a medical school or certain types ofspecialists in civilian hospitals, whom the Procurement and Assignment Servicehad declared irreplaceable; and, further, (2) to reconsider the physicalqualifications for appointment as officers. The parties also approved ofpublicity to stress the medical needs of the American soldier and sailor.49
A month after this agreement was reached, it was abrogated bythe Procurement and Assignment Service but subsequently (in July 1943) revivedto permit the Army-and the Navy, if it so desired-to solicit physicians forappointment in Illinois and Massachusetts. The abandonment, or curtailment, ofthe plan helped to clear the way for the improvement in favor of a special draftof doctors.50 However, one point about the plan is worth noting.The reference in the agreement to "State or other area" meant thatinstead of keeping the 1:1,500 physician-civilianratio on a statewide basis, the Procurement and Assignment Service would havepermitted the Army to procure doctors in certain well-stocked metropolitanareas, even though the statewide ratio might stand at no more than 1 physicianper 1,500 civilians.It can be seen that by this concession the Procurement and Assignment Servicerecognized the irrationality of setting and attempting to maintain any statewideratio when doctors were concentrated in the cities where the ratio would be muchhigher than 1 to every 1,500 ofpopulation. It also was a clear admission that the Procurement and AssignmentService lacked power to "relocate" doctors from areas of plenty tothose of scarcity. The Service in fact frankly admitted that it had no suchpower of compulsion and, lacking that power, it must have seemed useless both tothe Service and to the representatives of The Surgeon General to insist onstatewide ratios of 1:1,500.
Procurement of doctors subsequent to the partially abortive plan of May 1943showed no marked increase. During the following 7 months, June through December1943, 3,801 doctors accepted commissions; and this figure must have included1,000 or more interns and residents who came on active duty in July, aftercompleting their training.
Thus, in 1943, procurement of doctors fell far short of thegoal set by The Surgeon General. The Procurement and Assignment Servicedesignation of "essential" placed on doctors narrowed the field ofpossible recruits,
49Proceedings, Directing Board, Procurement and Assignment Service, 8 June 1943.
50(1) Memorandum, Lt. Col. D. G. Hall, Office of The SurgeonGeneral, for Chief, Personnel Service, Office of The Surgeon General, 24 June1943. (2) Memorandum, Director, Military Personnel Division, Army ServiceForces, for Deputy Director, Military Personnel Division, Army Service Forces,13 July 1943.
186
and of those available, there were many who refused to accepta commission. It would appear that conscription of medical and allied personnelon a national basis would have obviated many of these problems.
A Special Draft of Doctors Proposed
The failure of doctors to volunteer for Army service in the numbers which The Surgeon General considered necessary led him to recommend stronger means of compulsion. Underthe existing draft law, very few doctors were being brought into militaryservice by that method-only 217 duringthe period from November 1940 toSeptember 1942. Even these includeda number of persons whom The Surgeon General would not have recommended forMedical Corps commissions-unethical practitioners, graduates of unapprovedschools (drafted before The Surgeon General laid down the terms on which hewould accept them as Medical Corps officers), doctors who had not been engagedin practice, and others. During the same period, more dentists (346) and almostas many veterinarians (211) were drafted, although both were much less numerousin civilian life than physicians.51
Probably the main reason why few doctors came into the Army by way of theordinary draft was that local selective service boards wereopposed to depriving their communities of the services of medical men. To inducethe boards to act, the Procurement and Assignment Service in June 1943 agreed to report to their local draft boards all doctorswhom the Service had declared "available" but who had refused tovolunteer for the Army. This plan was soon very much curtailed, but in anyevent, it would have left the final decision in the hands of the local draftboards.
The Surgeon General proposed stronger methods-a "special call" onthe draft boards requiring them to induct physicians. In order to gain his end,several authorities had to be persuaded of the necessity and legality of thestep: The Chairman of the War Manpower Commission, who beginning in December 1942controlled the Selective Service System, his adviser andsubordinate in medical personnel matters, the Procurement and AssignmentService; and The Surgeon General`s own superiors in the War Department. In theend, the decision was made at a White House conference.
A special draft of doctors had been proposed in the Surgeon General`s Officeas early as 5 November 1942. Nothingwas done at that time, and on 16 February 1943, TheSurgeon General recommended planning for it as an eventual step if theprocurement of doctors did not move faster. Three months later (13 May), hecounseled the draft, of both doctors and dentists
51(1) For a period of 9 months beginning in September1941 (the month in which the War Department ordered that appointments in theOfficers` Reserve Corps cease to be made and that all future appointments mustbe made in the Army of the United States), there appears to have been norecognized way of commissioning drafted veterinarians. In July 1942, however,The Surgeon General succeeded in obtaining a quota of 250 from the General Stafffor this purpose. In Medical Department, United States Army. Veterinary Servicein World War II. Washington: U.S. Government Printing Office, 1961. (2)Selective Service in Wartime, Second Report of the Director of SelectiveService, 1941-42. Washington, 1943.
187
under 45 years of age as an immediate necessity.52On 22 June, staff representatives agreed to the measure in principle anddecided that the Secretary of War should be asked to present a proposal to thePresident. Later, G-1 suggested bringing the Navy into the negotiation, a stepwhich was subsequently taken.53
In the following months, further discussion within the WarDepartment took place, having to do with the number of doctors needed andthe legality of the proposed draft. No occupational group hadpreviously been singled out for induction in quite the way that was now suggested. However, War Department authorities decided that this could legallybe done within the terms of the Selective Service Act, and on 18 October 1943,a letter signed by the Secretaries of War and the Navy was sent to the Chairmanof the War Manpower Commission formally requesting a special call on SelectiveService for doctors.
Meanwhile, the Procurement and Assignment Service and the WarManpower Commission had been informed that the Army intended to make such arequest. There was some reason to believe that these agencies wouldsupport it. In October 1940, at the time that the Procurement and AssignmentService was being initiated, the future Chairman of its DirectingBoard, Dr. Frank H. Lahey, had stated, in effect, that a draft of doctorswould be necessary if they failed to volunteer. Moreover, the future Director ofthe War Manpower Commission, Paul V. McNutt,in recommending the establishment of a Procurement and Assignment Agency, hadproposed that it frame legislation to draft medical, dental, and veterinarypersonnel for submission to Congress if the emergency seemed to require it.
In July 1943, while the War Department had its own proposal underconsideration, Dr. Lahey expressed the belief that the only way the Procurementand Assignment Service could obtain more doctors for the armed services wasthrough some means of coercion.54 On thesame day, Mr. McNuttstated that stronger measures would be taken through Selective Service to bringdoctors into the military forces. After October 1943, he said, every physicianunder 45 years of age who was reported to the Selective ServiceSystem as having refused to accept a commission after he had been declaredavailable for military service by the Procurement and Assignment Service wouldbe called for induction by his local board. At the same time, a system ofappeals against the board`s decision enabled the individual tocarry his case as high as the National Headquarters of the Selective ServiceSystem, a procedure which might still have enabled a good many doctors to avoidmilitary service.55
52(1) See footnote 47, p. 184. (2)Memorandum, Commanding General, Army Service Forces, for Chief of Staff, 11Sept. 1943, subject: Special Call on Selective Service for Physicians.
53(1) See footnote 50 (1), p. 185. (2) Memorandum, G-1, for Director, MilitaryPersonnel Division, Army Service Forces, 11 July 1943.
54Proceedings, Directing Board, Procurement and Assignment Service,31 July 1943.
55(1) Memorandum, Chief, Procurement Division, OfficerProcurement Service, for Director, Officer Procurement Service, 2 Aug. 1943,subject: Procurement of Physicians. (2) Letter, Col. Richard H. Eanes, USA(Ret.), to Col. C. H. Goddard, Office of TheSurgeon General, 5 Sept. 1952.
188
Two months later, 8 September 1943, TheSurgeon General made an approach to the problem slightly different from the onehe had previously advocated. After agreeing on the terms of this new proposalwith officials of the Selective Service System, who considered a special draftof physicians "impracticable," he presented it in the form of arequest to G-1 through Army Service Forces headquarters. Instead of a specialcall on Selective Service for doctors, he asked that:
* * * in the next call placed by the War Department with the NationalSelective Service System for the delivery of registrants to the Army forpurposes of induction, 7,000 such registrants between the ages of eighteen andforty-four years, inclusive, be included in said "regular call" whohave the following qualifications: a. Are graduates of a school of medicineapproved by The Surgeon General of the Army. b. Are physically qualified inaccordance with [Mobilization Regulations]. c. Have completed one year ofinternship or its equivalent, as determined by The Surgeon General of the Army,after graduation from medical school.56
This move seems to have brought no results, and The Surgeon General returnedto his original line of action. On 2 October, he and a representative of theNavy met with members of the Directing Board of the Procurement and AssignmentService, a spokesman for the Selective Service System, and others. TheProcurement and Assignment Service felt that it should not initiate a specialcall for doctors, but it would be "glad to endorse and implement" oneif the conditions of the call met with its approval. One indispensablecondition, from the viewpoint of the Procurement and Assignment Service, wasthat only doctors declared available by it should be drafted. The SurgeonGeneral was quite willing to accept this as a condition. Selective Serviceannounced that physicians in the 18 to 45 agegroup could be drafted in given numbers with given qualifications if the WarDepartment`s request was approved by the Director of the War ManpowerCommission.57
On 16 October 1943, 2 daysbefore the Secretaries of War and the Navy made their formal request, at ameeting of the Directing Board of the Procurement and Assignment Service, anassistant to the War Manpower Commission`s Director reported that both Mr.McNutt and the head of Selective Service thought that there was no present needfor a special draft-that "the Army is not that short of doctors." TheActing Chairman of the Directing Board pointed out that he had given only aqualified support to the plan. "I also told General Kirk [The SurgeonGeneral of the Army]," he added, "that it was the feeling of theBoard, for all practical purposes, that the military services have obtained justabout as many doctors as they are going to get under
56(1) Memorandum, Lt. Col. D. G. Hall,Office of The Surgeon General, for Director, Military Personnel Division, ArmyService Forces, 8 Sept. 1943, subject: Inclusion of Physicians and Surgeons inRegular Selective Service Call for Inductees. (2) Memorandum, The SurgeonGeneral, for Assistant Chief of Staff, G-1, through Director, Military PersonnelDivision, Army Service Forces, 8 Sept. 1943.
57(1) Minutesof Session, by Executive Officer, Directing Board, Procurement and AssignmentService, 2 Oct. 1943. (2) Memorandum, Lt. Col. D. G. Hall, Office of The SurgeonGeneral, for G. H. Dorr, Special Assistant to the Secretary of War, 6 Oct. 1943. (3) Proceedings of Directing Board, Procurement and Assignment Service,16 Oct. 1943. (4) Memorandum, The Surgeon General, for G. H. Dorr, SpecialAssistant to the Secretary of War, 30 Nov. 1943.
189
the present legal setup. There may be 2,000 or 3,000 more, plus theincrement from [medical school] classes."58
The Secretaries` letter to Mr. McNutt stated that "despite the greatest effort"on the part of their departments "in cooperation with agencies under your leadership, including successive reductions in ratios of medicalofficers to personnel it has been found impossible to induce a sufficient numberof qualified physicians to accept appointment as medical officersvoluntarily." The shortage was "so critical as to endanger the healthof our forces." The procurement measure remained "which the servicesfeel must now be utilized in order to meet requirements. We are attachinghereto requests for a special call on the Selective Service System for 12,000physicians (Army, 5,000 * * * Navy, 7,000)."59
The verbal reaction of Mr. McNutt was hardly propitious; hetold G-1 that the Army and Navy "would get such a special call only overhis dead body."60 TheSecretaries` letter, transmitted to the Procurement and Assignment Service, drew the charge from that agency that the termsof the proposed special call violated the understanding between the Armed Forcesand itself in two ways: It was not limited to men marked available by theService, and the total number of doctors asked for exceeded that"calculated in previous negotiations with the military forces to allow asafe reserve for the care of the civil population." Accordingly, theProcurement and Assignment Service authorized a letter to Mr. McNutt statingthat it would approve a draft only if one could be legally formulated whichwould meet the original conditions; it believed that "at present not morethan 7,000 additional withdrawals from the civilian medical profession would bewise." While the Procurement and Assignment Service thought that thedraft "may prove to be the only method of securing any considerable numberof additional medical officers," it should first "be determined thatthe actual need of the armed services, not merely an assumed or traditionalneed, is great enough to justify"such a "serious change of policy."61
On 23 November 1943, following a White House conference attended by theSurgeons General of the Army and Navy, Assistant Secretary of War John J.McCloy, and Mr. McNutt, Mr. McNutt formally replied to the Secretary of War.62 In this reply,Mr. McNutt stated that a special draft ofdoctors would be approved if it was possible to formulate one with therestrictions that he and the Procurement and Assignment Service deemedessential. But they must first assure themselves by "a thorough study ofthe present needs of the military services and constant reevaluation of themanner in which physicians are employed" that such a call was necessary. He added that the Navy seemed
58See footnote 57(3), p. 188.
59Proceedings of Directing Board, Procurement and Assignment Service, 6 Nov. 1943.
60Memorandum Routing Slip, 26 Oct. 1943, attached to draft of proposed letter,The Surgeon General, to Chairman, Directing Board, Procurement and AssignmentService.
61Proceedings of Directing Board, Procurement andAssignment Service, 6 and 20 Nov. 1943.
62Letter, Paul V. McNutt, Federal Security Administrator, to Secretary of War, 23 Nov. 1943.
190
to be in more urgent need of doctors than the Army and shouldtherefore have prior claim on the remaining doctors in civilian life "up toat least 3,000 or 3,500." This did not mean that "a number ofphysicians will not be added to the Army Medical Corps as a result of therecruiting campaign now under way and planned." While he would not objectto a draft in the last resort,
* * * a survey of the legal situation * * * appears to make itexceedingly doubtful whether the draft of doctors could be as selective as wouldbe necessary to preserve the balance of distribution worked out by theProcurement and Assignment Service * * *. I believe you will agree that it is inthe public interest to accomplish our objective or come close to it withoutresorting to a special call. It has been decided, therefore, that final actionon the special call will bepostponed until after the first of the year [1944] at which time the matter willbe reviewed again by our respective staffs and appropriate recommendations madeto the President.
In commenting on this letter, The Surgeon General felt that one reason forMr. McNutt`s rejection of the special call was that the Secretaries had failedto include in their request the proviso that only doctors declared available bythe Procurement and Assignment Service should be drafted. He had advisedincluding it, but it "was omitted * * * I understand, for the reason that, as Mr.McNutt controlled both Procurement and Assignment Service and SelectiveService, he could take appropriate steps to see that the proper action wastaken to make this plan effective." As to the magnitude of the numbersrequested, he stated that although the Navy had asked for 7,000, when the WhiteHouse conference was called the Surgeon General of the Navy had said that hecould get along with half that number; he himself, on the other hand, havingalready cut down his estimate to 5,000, which he considered a minimum, feltand still felt that no further reduction should be made. He rejected Mr.McNutt`s implication that the requirements of the Army were overstated andinsisted that "the War Department and the War Department alone should * **determine the need for Medical Corps officers * * *. This office hascertain views relative to the needs of the civil population, but has acceptedthe arbitrary figure adopted by the Procurement and Assignment Service which isbased on their opinion solely.``63
Although there were further discussions of a draft of doctorsduring 1944, TheSurgeon General`s efforts in that direction during the remainder of the war cameto nothing.
Procurement in 1944
Recruiting attempts
The number of doctors brought into active duty from civilianpractice became very small during the 12 months preceding November 1944, when the War Department ordered procurement from thatsource stopped. Beginning in the fall of 1943, teams composed of representatives of the Surgeon General`sOffice, the Procurement and Assignment Service (national and State), the Navy,and the U.S. Public Health Service visited many large cities in an effort
63See footnote 57(4), p. 188.
191
to procure additional civilian doctors. These visits werepredicated on the belief that apersonal appeal would get many who had been declared available to volunteer. Ateam first informed representatives of local and State medical associations andleaders in the medical profession of the need for doctors, then held a publicmeeting of doctors who had been certified as available. Interviewswith these doctors followed the meeting. During the interviews, the members ofthe teams were able to clear up many of the problems that had been troubling these doctors, andaccording to The Surgeon General`srepresentative, the conferences resulted in "a considerable number"of applications for active duty with the Army.
Probably, for several reasons, the success of these teams did not match that of the Medical OfficerRecruiting Boards of 1942. They functioned only in large cities, where, to be sure, the proportion of doctors tocivilian population was highest. But more important was the fact that by thistime, and owing in no small part to the activities of theBoards in 1942, the surplus of doctors above civilian needs had been drainedoff. Probably, too, those left in civilian practice were more confident thanever that draft boards, feeling pressure from fellow citizens, would not inductthem.
Supplementing and abetting the work of these traveling teams,other means, such as publicity by press and radio, were used to impress upondoctors the Army`s need for their services. The Surgeon General complained inDecember 1943 that most of such publicity up to that time had stressed the need of retaining sufficientphysicians in civilian and industrial practice. He suggested that an organizedprogram pointed directly at doctors and involving the use of posters, pamphlets, radioannouncements and programs,magazine articles, and other available means should be employed to stressmilitary needs. Such a campaign was launched in early 1944, aimed at procuring nurses as wellas doctors.64
Complaints of doctors` idleness in Army service continued tobe made, and in February 1944, the Surgeon General`s Office took cognizanceof their bad effect on those still in civilian life whom it was endeavoringto persuade to accept commissions. An officer in The Surgeon General`s Military Personnel Division admitted to a superior that "in manyinstances officers and CommandingOfficers themselves, apparently, have too much free time, which is a factthat is generally known in the civilian profession." In thesecircumstances, The Surgeon General decided to draw to such an extent on servicecommand installations for Medical Corps officers in order to filltable-of-organization units that those remaining in those installations would"be completely and economically utilized even though on an overtimebasis * * *."65
64(1) Letter, Deputy SurgeonGeneral, to Appointment and Induction Branch, Office of The Adjutant General, 3 Dec. 1943, subject: Recruiting Publicity Program. (2) Memorandum, Lt.Col. D. G. Hall, Military Personnel Division, Office of The Surgeon General,for The Surgeon General, 2 Jan. 1944, subject: Procurement and Assignment Meeting With Surgeons General.
65(1) Memorandum, Lt. Col. D. G. Hall, MilitaryPersonnel Division, Office of The Surgeon General, for The Surgeon General,through Chief, Personnel Service, Office of The Surgeon General, and Director,Training Division, Office of The Surgeon General, 7 Feb. 1944. (2) RoutingSlip, Lt. Col. Hall, to Col. J. R. Hudnall, Col. F. B. Wakeman, and others, 7Feb. 1944.
192
The 9-9-9 plan
As already noted, service in the Army for students graduating from medicalschool had been deferred for at least the 1-year internship. At the end of thatyear, some received a further deferment of service for a junior residency andfollowing that a senior residency. There was no assurance beforehand, however,that such deferments for residencies would be given, with the result thatcivilian hospitals, to fill their vacancies for residents, could dependdefinitely only on an inadequate number of women and of men who were physicallydisqualified for military service. A change in the system of internships andresidencies, requested in the summer of 1943 by the civilian hospitals,concurred in by the medical schools and the Procurement and Assignment Service,and implemented by the Armed Forces, altered this situation to the advantage ofthe hospitals and at the same time speeded the production of interns andresidents for the benefit of the Army. The new system provided that, beginningon 1 January 1944, internships and each class of residency should run for only 9months apiece. This program applied to all personnel, both civilian andmilitary. Furthermore, one-third of the interns holding military commissionswere to be deferred for a junior residency and one-half of the latter number(one-sixth of the total) could be deferred for a senior residency. Thus, theArmy got each intern who was not deferred for additional training 3 monthsearlier than previously; the greatest possible postgraduate deferment formilitary personnel became 27 months instead of the previous 36. It developedspecialists not only for the armed services, but for the civilian population aswell. Likewise, civilian hospitals received a guarantee of getting some numberof both junior and senior residents. Those not under military control-physicallydisqualified male and all female doctors-although having a 9-month limitationfor each of the three periods, might be continued on the staff of a civilianhospital as long as the hospital desired them.
When the Directing Board proposed this thing, which came to be known as the"9-9-9 plan," The Surgeon General stated that although he would acceptit and take officers into the Medical Corps who had only a 9-month internship,he would not assume any responsibility for the plan or for persuading civilianhospitals to accept it. He made one proviso-that civilian hospitals should seekto fill the internships and residencies only with women and overage, orphysically disqualified, men.66
A professional organization-the Association of AmericanMedical Colleges-and individuals, too, criticized the plan, asserting that inshortening the internship it lowered the standards of medical education. TheCouncil on Education and Hospitals of the American Medical Association, replyingthat while everyone interested in high standards of medical education andmedical service shared the concern felt by critics of the plan, approved it asthe best
66Annual Report, MilitaryPersonnel Division, Office of The Surgeon General, U.S. Army, 1944.
193
one under conditions then existing.67 TheSurgeon General for his part directed (December 1943) that the 9-month internswho entered the Army be given not only 6 weeks of basic military training(either at the Medical Field Service School or a replacement training center),but an additional 6 weeks at a named general hospital. Nor were they to be sentoverseas without having served a minimum of 60 days after completing their basicmilitary training.68
After the 9-9-9 program had been underway for a year, the American SurgicalAssociation in a long appeal to the President requested him to direct that themilitary service of resident surgeons in teaching hospitals throughout theUnited States be deferred. The Surgeon General stood out against this step,arguing that an exception could hardly be made in favor of one group whenmedical training generally was being curtailed. If the service of surgicalresidents was deferred, he foresaw "immediate requests for deferment ofresidents in all other specialties."69The matter was droppedwithout action.
Procurement of doctors from all sources during 1944 was only alittle larger than it had been in 1943-6,897 as against 6,678. An additional 916doctors came in from January to June 1945. Almost all of them were recentgraduates; after November 1944, appointment of practicing physicians virtuallyceased.
Training Medical Specialists
Throughout the war, the Army found it more difficult to procure qualified specialists than general practitioners. Therefore, in order to combat the procurement lag, the Army commissioned general practitioners and then trained them, either at military installations or in civilian schools, in the various specialties. While approximately 8,000 doctors completed some specialty training during the war, there is no record of how many of those 8,000 were actually classified as specialists at the end of the war or ever served in a specialist capacity.
Pressure From Civilian Sources
While military procurement was not entirely toblame for the decline of civilian medical service (other factors were theremoval of doctors from rural to urban, and more lucrative areas and the rapidgrowth of war-boom towns), it was certainly an important cause and one ofgrowing concern to the civilian population. The Surgeon General, therefore,encountered attempts to prevent or offset the effects of procurement of civilianphysicians for the Army.
67(1) Letter, Chairman, Executive Council, Association ofAmerican Medical Colleges, to The Surgeon General, 29 Oct. 1943. (2) Letter tothe Editor, the Journal of AmericanMedical Association, 1 Jan. 1944, with reply ofCouncil on Education and Hospitals.
68Report, The Surgeon General`s Conference With ServiceCommand Surgeons, 10 Dec. 1943.
69(1) Letter, W. M. Firor, Secretary, American SurgicalAssociation, to President Roosevelt, 19 Feb. 1945. (2) Memorandum, DeputySurgeon General, for William D. Hassett, Secretary to the President, 5 Mar.1945.
194
As early as December 1942, a subcommittee of the Senate Committee onEducation and Labor conducted hearings on the procurement objectives of the Armyand the adequacy and distribution of doctors remaining in civilian life.70The subcommittee does not seem to have issued a final report. However, evenbefore it had heard testimony from representatives of the Surgeon General`sOffice, the Procurement and Assignment Service, or any other members of themedical profession, it released (29 October 1942) apreliminary report on the recruitment of physicians for the armed services. Thatreport shows clearly that the subcommittee, after almost a year of war, wasalarmed at a maldistribution of doctors in civilian life-some communitieshaving none at all or far too few-and was concerned by the heavy procurement ofdoctors for the armed services.
The report stated that it was submitted at that time "because of theneed of speedy action to prevent an immediate peril to the health of theNation." Conditions were so acute and dangerous, it continued, that thispreliminary report was made public with the recommendation that at the earliestpossible moment the following steps should be taken: (1) The President shouldorder a survey of oversupply and undersupply of medical personnel for both theArmed Forces and civilian needs; (2) a reallocation should be made wherever itwas determined an oversupply or undersupply existed; and (3) the War ManpowerCommission should be ordered to cease its procurement drive for doctors in allStates where quotas had already been attained. The report further suggestedthat "an overall civilian authority should be established at once tosupervise and control the drafting and recruiting of doctors," and declaredthat "no recruiting of doctors for the armed forces should be permitteduntil this authority was actually functioning." There is no indicationthat any action was taken on this report.
In late 1943, a member of Congress proposed to the Secretary of Warthat Army doctors befurloughed to civilian life until "a more pressing need for their servicesarose [in theArmy]." About the same time, the dean of a medical school requested thedischarge of a doctor to replace a retiring professor. The Surgeon Generalturned down both requests off theground of the Army`s acute need for doctors.71
Eventually, however, the pressure of members of Congress on the War Department to do something to prevent further draining off of doctors fromcivilian practice became so intense that in October 1944 The Surgeon Generalasked that the General Staff stop procurement in all but cases involvingindividuals commissioned for specific vacancies. The request was complied with.72
70Hearings before a Subcommittee ofthe Committee on Education and Labor, U.S. Senate, 77th Cong., 2d sess., on S. Res. 291, Investigation of Manpower Resources (Washington, 1943), Part 2,14, 15, and 16 Dec. 1942.
71(1) Letter, Representative A. WillisRobertson (Va.), to John J. McCloy, Assistant Secretary of War, 23 Nov. 1943.(2) Letter, Lt. Col. P. A. Paden, Military Personnel Division, Office of The Surgeon General, to A.Willis Robertson, 1 Dec. 1943. (3) Letter, Surgeon General Kirk, to Dr. WilliamPepper, Dean, University of Pennsylvania School of Medicine, 4 Dec. 1943.
72(1) Memorandum,Executive Officer, Office ofThe Surgeon General, for Commanding General, Army Service Forces, 14 Oct. 1944.(2) Memorandum, The Surgeon General, for General Somervell, 14 Nov. 1944.
195
The discontinuance was not to affect interns who completedthe Army Specialized Training Program or residents. Since neither group had beenengaged in civilian practice, they could be commissioned and placed on activeduty without further adversely affecting the existing medical provision forcivilians. Naturally, those male medical students who had accepted MedicalAdministrative Corps commissions pending completion of their medical trainingwere not affected; they were considered military personnel, not civilians, andwould be commissioned in the Medical Corps upon finishing their training. TheSurgeon General also requested that he be permitted to continue to commissionindividuals for specific vacancies; what he had in mind was probably highlytrained specialists for the most part.
In these ways, the Army was continuing to draw into its service manyphysicians who had just completed their education and who might otherwise haveentered civilian practice. But it could no longer be charged with denuding thecivilian community by taking large numbers of physicians who were alreadypracticing civilian medicine.
DENTAL CORPS
The procurement of dentists did not become a serious problemuntil virtually the end of the war.73 When, in July 1942,The Surgeon General received authorization for 4,000 moredentists, he anticipated some difficulty in procuring them and thereforeobtained permission from The Adjutant General to make appointments fromgroups not previously considered eligible; that is, dentists who were between37 and 45 years of age, or who were qualified only for limited service, orwhose training and experience justified an appointment above the rank oflieutenant. Procurement under this quota was so successful, however, thatbetween September and November 1942 applications were discouraged. In November,The Surgeon General obtained an additional quota of 7,500 to bring the totalstrength of the Dental Corps to 17,248. The Procurement and Assignment Serviceshortly afterward agreed to declare 400 civilian dentists a month available formilitary service; the remainder were expected to come fromthe output of the Army Specialized Training Program, from recent graduatesholding interim Medical AdministrativeCorps commissions, and from dentists inducted into the serviceas enlisted men.
The procurement program lagged somewhatin early 1943, but the response improved by May of that year, and by Septemberthe Dental Corps was only 1,700 below the ceilingof 15,200 imposed upon it at that time. The procurement agencies werenotified not to accept applications from dentists over 38 years of age or fromthose fit only for limited service. Early in 1944, the Dental Corps waswithin a few hundred of its ceiling strength, and a surplus appeared likelyas a result of the coming influx of graduates from the Army Specialized TrainingProgram.
73See footnote 22(1), p. 177.
196
There were several possible methods of dealing with the anticipated surplus-the ceiling on the strength of the Dental Corps could be raised, somedentists already in the service could be discharged and replaced by others whowere graduating under Army control, or the Army could give up its claim to someof the graduates. The last method would involve reducing the Army`s commitmentsunder the Army Specialized Training Program, since graduates of the Programconstituted the principal source of supply. To all intents, the first of thesealternatives was not resorted to; the peak strength of the Dental Corps, reachedin November 1944, exceeded theceiling by only about 100. Instead, the Army discharged some of its dentists tomake way for new men; it also reduced its commitments under the Army SpecializedTraining Program. With regard to this latter action, the 900 members of the class of June1944 werereleased from their obligations to the Army and-what was moreimportant-theProgram for dental students who would graduate after July1945 was discontinued.
During 1944, out of about 1,400dentists procured, some 70 percent came from the Army Specialized TrainingProgram; 23 percent directly from the civilian profession; and the remainder-aside from a handful inducted under SelectiveService-from graduateswho had held temporary Medical Administrative Corps commissions.
Early in 1945, although theDental Corps was near its maximum authorized strength (15,200), prospective replacements from the curtailed ArmySpecialized Training Program and from future graduates holding interim MedicalAdministrative Corps commissions numbered less than 300. Procurement duringJanuary-June was almost precisely the same. After V-E Day, The Surgeon Generalsuggested certain measures to encourage procurement and advised that the DentalCorps be maintained at 15,000 untilthe end of 1945. The measures werenot expected to produce any large increment of dentists and, even thoughadopted, the strength of the Corps declined rapidly to about 9,600 by the end of the year.
At least as late as October 1945, noserious difficulty in meeting the dental needs of the Army during demobilizationseems to have been anticipated, although the possibility that demobilizationmight cause a temporary increase in the demand for dental treatment had beenmentioned 4 months before. Full-scaledemobilization brought the problem to a climax, however, and in 1946, a draft of dentists became a necessity.
VETERINARY CORPS
Up to the beginning of 1945, theVeterinary Corps was on the whole in a better position with regard toprocurement than any other corps of the Medical Department, mainly because itentered the war with a Reserve unusually large in comparison to its needs. Until well into 1942, it drewalmost exclusively on the Reserve for additional active-duty strength. In fact,at
197
one time, the Veterinary Corps had placed more of its Reserves on active dutythan it actually needed.
The possible sources of procurement for the Veterinary Corps wereveterinarians still in civilian practice, veterinarians who had been drafted asenlisted men, and graduates of veterinary schools who held student commissionsin the Medical Administrative Corps or who had obtained their education underthe Army Specialized Training Program.
In October 1943, G-1, WarDepartment General Staff, restricted procurement of veterinary officers to thelatter group, except in special cases which were to be referred to G-1 fordecision. Later, however, permission was granted to commission veterinarians whohad entered the Army by way of the draft.74
As late as March 1944, TheSurgeon General`s Chief of the Veterinary Service stated that the commissioningof graduates of the Army Specialized Training Program and those holdingtemporary Medical Administrative Corps commissions was more than sufficient tomeet the needs of the Veterinary Corps, and that graduates in these categoriesfor whom no vacancies existed were being discharged from the Army.75In May 1944, the veterinary phase ofthe Army Specialized Training Program was ordered discontinued after thegraduation of the current senior class and the completion of current terms forother classes.76
In January 1945, thenewly established ceiling strength of 2,150 wasonly 100 above existing strength, but very few additional officers could beobtained from the permitted sources.77 Consequently, the strength ofthe corps never rose above 2,070 during the remainder of the war. The previouspractice of discharging graduates of the Army Specialized Training Program andthose holding temporary Medical Administrative Corps commissions when novacancies existed for them at the time of graduation eventually made itdifficult to find new officers. It also, in the opinion of Col. George L.Caldwell, VC, (fig. 32), assistant chief of The Surgeon General`s VeterinaryDivision, caused much dissatisfaction among Reserve officers who had entered theservice early in the war and were compelled to remain in it till the end ofhostilities: "They felt, and quite properly, that these men who were partlyeducated at Army expense should repay their government with active duty serviceand by so doing permit the release of * * * officers with long service."78
74(1) Letter, The Adjutant General, toThe Surgeon General, 26 Oct. 1943, subject: Requirements for Veterinarians. (2) Annual Report, VeterinaryDivision, Office of The Surgeon General, U.S. Army, 1944.
75Letter, Maj. Gen. G. F. Lull, to Hon. George H.Mahon, House of Representatives, 23 Mar. 1944.
76ArmyService Forces Circular 164, 13 May 1944.
77Semiannual Report, Procurement Branch, MilitaryPersonnel Division, Office of The Surgeon General, U.S. Army, 1. Jan.-31 May 1945.
78History of Procurement of Veterinary Corps Officers.[Official record.] For further details concerning procurement for the Veterinary Corps, see publication citedin footnote 51(1), p. 186.
198
The following numbers of veterinarians accepted Armycommissions during the war years:
|
September-December 1943 |
87 |
|
January-June 1944 |
47 |
|
July-December 1944 |
26 |
|
January-June 1945 |
33 |
Of this total, 174 were described as coming from "enlisted" ranksand 14 from "civil lifeand other"; 3 were reported as flight officers, and 2 as members of the Officers Reserve Corps. Some few among the 174 wereveterinarians who were commissioned after having been drafted; the rest weregraduates of the Army Specialized Training Program.
DEFERMENT OF PROFESSIONAL STUDENTS
Early Methods
The outbreak of war, with the consequent acceleration of thedraft, increased the pressure to grant students in all 4 years of dental andveterinary as well as medical schools some type of status that would not onlypermit them
199
to become practitioners in their chosen field but assure their service inthat capacity in the Armed Forces. About a month after Pearl Harbor, theNational Director of Selective Service, in an effort to protect the country`ssupply of doctors and dentists, advised his State directors of "thenecessity of seriously considering for deferment" students in specializedprofessional fields, stating that the number of doctors and dentists needed bythe Army and Navy would not be available "if those students who showreasonable promise * * * are inducted prior to becoming eligible forcommissions."79 This put a further damperon drafting students in themedical schools for service as enlisted men but left where it was the problem ofeventually getting them into service as officers. For the time being, the onlysolution was to offer more categories of students a military status whilepermitting them to continue at school.
Medical Administrative Corps commissions
After some discussion, the Secretary of War approved the planof The Surgeon General, and on 11 February 1942, corps area commanders receivedauthority to commission as second lieutenants in the Medical AdministrativeCorps, Army of the United States, all physically qualified male citizens who hadbeen accepted for matriculation at approved medical schools within the UnitedStates.80 This was later changed to "within or without the UnitedStates," thus including American students in approved Canadian schools.Officers so appointed would not be ordered to active duty until eligible forappointment as first lieutenants in the Medical Corps, which meant after theyhad completed their internship. The authority also stated the circumstancesunder which an officer`s commission would be terminated, which were essentiallythose already in operation for third- and fourth-year students.
There remained, however, the problem of protecting the futuresupply of dentists and veterinarians. On 17 April 1942, the War Departmentgranted authority to corps area commanders to appoint as second lieutenants inthe Medical Administrative Corps, Army of the United States, all physicallyqualified male citizens who were accepted matriculants in approved dental andveterinary schools in the United States. The terms were similar to thosepreviously announced for commissioning medical students.81
As with individuals accepted for medical schools although notentered, those accepted as dental and veterinary students were likewise to becommissioned. Students in dentistry and veterinary medicine, however, receivedonly 3 months` instead of a year`s grace after graduation in whichto apply for
79Memorandum I-347, NationalHeadquarters, Selective Service System, for all State Directors, 12 Jan. 1942,subject: Supplement to Memorandum 1-62: Occupational Deferment of Doctors,Internes, Medical Students, Dental Students, and Instructors (III).
80(1) Memorandum, The Surgeon General,for Special Assistant to the Secretary of War, 23 Jan. 1942. (2) Letter, TheAdjutant General, to all Corps Area Commanders and The Surgeon General, 11 Feb.1942, subject: Commissions for Medical Students.
81(1) Letter, Secretary of War,to Paul V. McNutt, Office of Defense Health and Welfare Service, 14 Apr. 1942.(2) Letter, The Adjutant General, to Corps Area Commanders, 17 Apr. 1942,subject: Commissions for Dental and Veterinary Students.
200
commissions in the professional corps. A month later, malecitizens above the age of 18 years who were students at approved dental andveterinary schools outside the United States were included, and although thedirective specified that all such students be physically qualified, it alsostated that appointment would be made without physical examination.82 It seemsinconceivable that the Army would commission anyone clearly unfit; it must haveplanned, however, to accept the student`s word that he had no hiddendisabilities. The deans of the schools and the corps area commanders playedimportant roles in the processes by which these commissions were issued.
The measures to protect medical, dental, and veterinarystudents raised certain problems. The provision that a student`s commission inthe Medical Administrative Corps would be terminated if he failed to secure anappointment in the Medical, Dental, or Veterinary Corps within a specified timeafter graduation made it possible for him to obtain his release from the Armysimply by taking no action to convert his commission. The Surgeon General, infact, recommended the discharge of certain dental students on these grounds. In1943, however, the War Department prohibited such discharges and directed thatstudents who failed to convert their commissions should be called to active dutyin the Medical Administrative Corps.83 Since professional men werenot apt to prefer service in that corps, it is improbable that many delayedconverting their commissions after the order was published.
Another problem, as the Chief of The Surgeon General`sVeterinary Division saw it, was that the Veterinary Corps would not be able toabsorb all veterinary students graduating with Medical Administrative Corpscommissions, since he believed that the Veterinary Corps Reserve containedenough officers to meet war needs. If on the other hand it should absorb them,he feared that the civilian supply would be entirely cut off. Accordingly, TheSurgeon General persuaded the War Department to direct that no more graduates beselected for veterinary and dental commissions than these corps actuallyrequired.84 Why the Dental Corps was included is not apparent.
Not all newly eligible students accepted MedicalAdministrative Corps commissions, even though physically qualified, probably formuch the same reasons that had deterred many third- and fourth-year medicalstudents. Other arrangements were made for students then enrolled in ReserveOfficers` Training Corps units in branches other than medical who intended toenter medical schools. No mention seems to have been made of dental orveterinary schools. If time permitted them to fulfill requirements for acommission, before they entered medical school, they were to be commissioned inthe branch in which they had been trained. But even if commissioned in anotherbranch, they were
82Letter, The Adjutant General, to all CorpsArea and Department Commanders and The Surgeon General, 18 May 1942, subject:Commissions for Dental and Veterinary Students.
83(1) Memorandum, The Surgeon General, for TheAdjutant General, 4 Aug. 1943, subject: Discharge of Medical AdministrativeOfficers. (2) Letter, The Adjutant General, to all Services (and others), 15Mar. 1943, subject: Authority to Order to Active Duty.
84(1) Memorandum, Brig. Gen. R. A.Kelser. Army Veterinary Service, for Chief, Personnel Division, Office of The Surgeon General, 3 Apr. 1942. (2) See footnote 82.
201
not be called to active duty until they had completed theirmedical education. If they could not complete the requirements for a commissionbefore entering medical school, they were permitted to withdraw from theiradvanced Reserve Officers` Training Corps contracts with the Government. Medicalunits of the Reserve Officers` Training Corps were suspended in 1943 for the remainder of the war.85
Students who accepted interim commissions received no financial benefit fromthe Army. In July 1942, however,Congress appropriated $5 million to be loaned to students whose education intechnical and professional fields, including medicine, dentistry, and veterinarymedicine, could be completed within 2 years.86
Enlisted Reserve Corps
The Army and Selective Service insured the scholastic careersnot only of full-fledged students and matriculants in medicine, dentistry, andveterinary medicine but of students who were in the preliminary stages of theirtraining. Besides granting interim Medical Administrative Corps commissions, theArmy permitted a number of premedical, predental, and preveterinary students toenter the Enlisted Reserve Corps and retain an inactive status in it while theycontinued their schooling. When, in September 1942, theArmy announced that members of the Enlisted Reserve Corps would be called toactive duty immediately upon reaching draft age (20 years,reduced 2 months later to 18), itexempted such of these students as had acceptances from professional schools forthe 1943 and 1944 entering classes. Moreover, in March 1943, the Selective Service System granted deferment of serviceto premedical, predental, and preveterinary students who held acceptances fromprofessional schools and who would finish their preprofessional training in 24 months.
The Army Specialized Training Program
The Army Specialized Training Program and the Navy CollegeTraining Program (V-12) were established in December 1942 underthe auspices of the appropriate departments. The Army Specialized TrainingProgram applied not only to students of medicine, dentistry, and veterinarymedicine, but to all students of specialized or professional subjects who mightconstitute officer material for the Army at large. Enlisted men selected for theprogram were placed in training units at numerous colleges and universitiesthroughout the country, where they began (or continued, if already students) theregular course of instruction.87
85(1) Letter, TheAdjutant General, to all Corps Area and Department Commanders, 12 May 1942,subject: Commissions for Medical Students. (2) Information obtained from AlbertMcIntyre, Reserve Officers` Training Corps Unit, Officer Procurement Branch,Personnel Division, Office of The Adjutant General, October 1953.
8656 Stat. 562.
87This section is based, almost in its entirety, onFinal Report, Col. Francis M. Fitts, MC, Chief, Curricular Branch, ArmySpecialized Training Division, Army Service Forces, subject: Training inMedicine, Dentistry, and Veterinary Medicine, and in Preparation Therefor, Underthe Army Specialized Training Program, 1 May 1943 to 31 December 1945.
202
FIGURE 33.-Col. Francis M. Fitts, MC, Director of Military Training Army Service Forces.
To enter the Army Specialized Training Program, medical students who weremembers of the Medical Administrative Corps might resign their commissions andenlist in the Enlisted Reserve Corps, after which they, together with othermedical students who were already members of the Enlisted Reserve Corps, werecalled to active duty with the program without interrupting their studies. Themedical aspects of the program were handled in the Office of the Director ofMilitary Training, Army Service Forces, by Col. Francis M. Fitts, MC (fig. 33).
Members of the program had the status and perquisites of privates, orprivates first class, in the Army. The Army likewise defrayed all theirexpenses, including food, clothing, lodging, and the cost of schooling. Formedical students, school costs, such as tuition, books, and laboratory fees,amounted to $62.47 per man per month; for dental students, $61.10; and forveterinary students, $45.50.
Upon graduation, students in these fields were to be commissioned in the Armyof the United States. Graduation from other fields, such as sanitaryengineering, gave students no similar assurance of a commission. It did notpreclude them from receiving one, either directly (as may have happened in somecases) or after successfully completing a course at an officer candidate
203
school. But the mere fact of graduation did not necessarilyenhance their opportunities in these respects, and the understanding was thatunless such opportunities occurred they would continue to serve in an enlistedstatus.
Dental trainees were commissioned in the Dental Corps and called to activeduty as soon as they graduated. Since the demand for Veterinary Corps officerswas less acute, students newly commissioned in that corps were called up as thesituation required. Medical trainees, commissioned upon graduation, were notcalled to active duty until they had completed a minimum of 9 months` civilian hospital intern training. In order tomeet the needs of civilian hospitals, and so that the military service mightprofit by the additional postgraduate training, a small fraction was not calledto duty until after 9 months` additional experience; an even smaller fractionuntil after total of 27 months` graduate training as residents.
At the time the program was set up, The Surgeon Generalestimated that the existing body of professional and preprofessional studentsas they were graduated would meet his needs until 1947; that is, 4 yearslonger. If the war lasted so long, new students brought in by the program wouldfrom then on furnish most if not all of the supply. To obtain the proper quotaof graduates after 1947, alarge number of new students would have to be placed in the pipeline of theprogram considerably before that date. The Surgeon General`s Office decided thatenough veterinary students had already been blanketed into the program so thatno additional ones were needed. To meet the requirements for doctors anddentists after 1947, studentswere to be selected from among those who had successfully completed two or threeterms of the "Basic Curricula" of the program-the introductory coursewhich all new students had to enter.
By the end of 1943, the Army Specialized Training Program and its Navy counterpart had absorbed most of the male students of medicine,dentistry, and veterinary medicine who were in the professional andpreprofessional stages of their training and who were physically qualified formilitary service. In addition, they were beginning to take, in students of thesesubjects who were just entering upon their academic careers; like the others,they were committed to enter medical service of the Armed Forces upon completionof their studies.
Curtailment of the program
When the War and Navy Departments had first announced the program a muchlonger war had seemed inevitable. By late 1943, moreover, the men enrolled wereurgently needed for combat duty. The Army Ground Forces had never expressedenthusiasm for the program, and by then, the Army Air Forces wanted to usethose of their men who were assigned to the program. In March 1944, the War Departmentannounced that the entire program wouldbe cut back from 145,000 mento 35,000.
A month later, Army Service Forces headquarters announced that the Army`sshare of the classes entering medical schools during 1945 would be 28
204
percent instead of the previously planned 55 percent, and fordental schools 18 percent instead of 35 percent; no commitments would be made atthat time to cover classes to start in 1946.88
Meanwhile, the question of reducing the dental ArmySpecialized Training Program was becoming involved with that of dischargingdentists already in the service.89 In March 1944, the Dental Corpsreached its ceiling strength and had in immediate prospect more than enoughgraduates of the program to meet its needs in the way of replacements at theexisting rate of attrition. On 18 July, the War Department announced thetermination of the dental Army Specialized Training Program. Only those who wereseniors in July continued under the program, and the dental Army SpecializedTraining Program came to an end with the classes graduating in April 1945.
In May 1944, the veterinary phase of the Army SpecializedTraining Program had been marked for closure with the approval of The SurgeonGeneral. Apparently, his Veterinary Division considered this program no longernecessary since the Veterinary Corps was near its authorized strength andlittle difficulty was to be anticipated in inducing veterinarians in civil lifeto join the corps-a source of procurement which, in fact, the Director of theDivision seems to have preferred.
The future of the medical phase of the Army SpecializedTraining Program was a matter of more concern to the Surgeon General`s Office.The collapse of Japan brought discussion of whether the Army should continue tospend money to help meet civilian needs for doctors by maintaining the medicalpart of the program. Some War Department authorities feared the Army might becriticized for the lack of medical training during the war period if it did notcontinue such training, while others believed that the Army should limit itsmedical training to meet its own future needs.90 General Somervell,believing that the Army could not justify large expenditures in continuing theArmy Specialized Training Program as then contemplated, recommended, among otherthings, that medical courses be terminated during the school year 1945-46.91The Surgeon General for his part stated that his policy had been, and would befor the duration of the emergency, to order to active duty young medicalofficers who had received their education at Government expense. They were beingused as replacements, he said, to accelerate the return of those older medicalofficers who had served for long periods of time.92
Two months after the defeat of Japan, the DeputySurgeon General recommended to G-3 that the program be continued as a source ofreplacements. He
88Memorandum, Brig. Gen. W. L.Weible, G-3, for The Surgeon General, 18 Apr. 1944, subject: War DepartmentPolicy Governing Training in Medicine and Dentistry Under Army SpecializedTraining Program.
89A complete discussion of this phase of the ArmySpecialized Training Program is contained in the publication cited in footnote22(1), p. 177.
90Letter, Maj. Gen. I. H. Edwards, G-3, to Prof. Philip LawrenceHarrison, Bucknell University, 23 Aug. 1945.
91Memorandum, Lt. Gen. Brehon Somervell, Commanding General, Army ServiceForces, for Chief of Staff, 4 Sept. 1945, subject: Future of Army SpecializedTraining Program.
92Letter, Surgeon General Kirk, to Hon. Mendel Rivers,U.S. Congressman from North Carolina, 16 Oct. 1945.
205
said he could not view lightly the potential loss of 5,000 medical officers if the program terminated in June1946, as had been suggested. He mentioned the difficultiesexperienced in the past in getting volunteers for the Regular Army MedicalCorps.
The Chief of Staff, however, recommended that the medical program beterminated on 1 July 1946; men whohad not graduated by that date should be dropped as soon as possible, but inaccordance with a plan that would allow time for students and schools to makeadjustments.93 Thispolicy was announced in November 1945. Inthe same month, the War Department ordered that Army Specialized TrainingProgram students who were scheduled to graduate before 1 July 1946 should not be separated for either of two reasonsapplicable to other persons-their adjusted service rating score or thepossession of three or more dependent children under 18 years of age. Theymight, however, be discharged for certain reasons that also applied to others-hardship (as in the case of enlisted personnel generally) or theirimportance to the national health, safety, or interest. Moreover, a claim basedon the possession of dependents-though not the standard one justmentioned-mightbe considered sufficient to warrant their discharge.94 The Army wanted all others of this group to graduate asdoctors available for service in the Medical Corps, a desire expressed by the Secretary of War not long before. On the otherhand, medical students who were scheduled to graduate after 1 July 1946 were directed to be separated from the program duringMarch 1946. Enlisted men soseparated who planned to continue their study of medicine and who wereacceptable to an approved medical school were, upon their request, transferredto an inactive status in the Enlisted Reserve Corps. They were subject to recallto active duty if they quit school or made unsatisfactory progress in theirstudies. Those who did not plan to continue the study of medicine or who wereunacceptable to an approved school were discharged if eligible or transferred toother duties upon separation from the program. The latter group of studentscould be discharged from the Army when they became eligible.95
Thus, the medical phase of the Army Specialized TrainingProgram ended a year later than that of the veterinary or dental phases,enabling proportionately more medical graduates to become available forcommissions and permitting the Medical Corps to solve its postwar personnelproblem with less strain than the Dental Corps experienced. Assignment was not,however, automatic. Immediately after the war, the Navy Surgeon General, who wasalso the President`s personal physician, persuaded the Commander in Chief todivert a thousand of these fledgling doctors, just through with theirinternships, to the Navy.
93Memorandum, Chief of Staff, for Secretary of War, 20Nov. 1945, subject: Medical Training Under Army Specialized Training Program.
94Disposition Form, Maj. Gen. W. S. Paul, G-1, toCommanding General, Army Service Forces, through Deputy Chief of Staff, 29 Nov. 1945, subject: PolicyRegarding Separation of Army Specialized Training Program Medical Students.
95(1) Army Service Forces Circular 7, 9 Jan. 1946. (2) Army Service Forces Circular 56, 6 Mar. 1946.
206
TABLE 17.-The Army SpecializedTraining Program: Students of medicine, dentistry, and veterinary medicineassigned, separated, and discharged and transferred through curtailment of theprogram
[Figures in parentheses aresubtotals]
|
Student status |
Medicine |
Dentistry |
Veterinary medicine |
|
Assigned |
20,336 |
7,734 |
1,660 |
|
Separated |
15,216 |
3,031 |
679 |
|
By graduation |
(13,373) |
(2,458) |
(598) |
|
By failure |
(1,045) |
(472) |
(41) |
|
For other reasons |
(798) |
(101) |
(40) |
|
Curtailment |
5,120 |
4,703 |
981 |
|
Discharged |
(5,120) |
(4,651) |
(940) |
|
Transferred |
--- |
(52) |
(41) |
Source: (1) Final Report, Col. Francis M. Fitts, MC, Chief,Curricular Branch, Army Specialized Training Division, Army Service Forces,subject: Training in Medicine, Dentistry, and Veterinary Medicine, and inPreparation therefor, Under the Army Specialized Training Program, 1 May 1943 to31 December 1945. (2) Letter, Col. Francis M. Fitts, MC, to Col. John B. Coates,Jr., MC, Director, Historical Unit, U.S. Army Medical Service, 15 Nov. 1955.
One of those so transferred turned out to be the son of anArmy dentist who promptly explained to The Surgeon General in two pages ofwell-chosen words that he had not raised his boy to be a sailor.96 The totalenrollment in and output of professional courses in medicine, dentistry, andveterinary medicine as a result of the Army Specialized Training Program areshown in table 17.
The maximum enrollment of members of the program in thesecourses was reached in March 1944, when 21,581 enlisted men were underinstruction: 14,042 in medicine, 6,143 in dentistry, and 1,396 inveterinary medicine. The number of students receiving preprofessional trainingin the same fields under the program attained its peak in April 1944 with 4,093 enlistedmen enrolled.97 Satisfactory figures for the total number of ArmySpecialized Training Program students enrolled in preprofessional courses duringthe life of the program are not available, but approximately 3,500 were assigned to premedical, about1,400 to predental, and an unknown number to preveterinarystudies.98
THE AFFILIATED UNITS AFTER PEARL HARBOR
The affiliated units constituted one of the most importantsources of officer personnel available to the Medical Department. Many of thephysicians who entered the Army by this route were ones who would not have
96The incident is recalledin a letter, Maj. Gen. George F. Lull, USA (Ret.), to Col. John Boyd Coates,Jr., MC, Director, Historical Unit, U.S. Army Medical Service, 31 May 1961.
97(1) See "FinalReport" cited in footnote 87, p. 201. (2) Memorandum, G-1 (Brig. Gen. M. G.White), for Combined Chiefs of Staff, 30 June 1943, subject: Training of FemaleStudents Under Government Program.
98(1) See "Final Report"cited in footnote 87, p. 201. (2) Letter, Col. Francis M. Fitts, MC, to Col.John B. Coates, Jr., MC, Director, Historical Unit, U.S. Army Medical Service,21 Nov. 1955.
207
volunteered as individuals, but were willing to acceptmilitary service as part of a familiar organization. The role was rendered moreattractive by the deferment it carried until the unit was actually called up.Only the officers, however, were procured in peacetime. Nurses and other femaleelements, and enlisted men, all were added when the affiliated hospitals becameeligible for activation with the actual advent of war.
The Surgeon General directed that nurses for the staff mustbe obtained exclusively from the Red Cross Reserve, though at least one hospitalenrolled nurses first and then persuaded them to join the Reserve. Nurses and enlisted technicians could be recruited by these hospitals before activation. TheSurgeon General urged nurses so recruited to volunteer for active dutyimmediately, thus making their services available anywhere in the Army. Heassured them that they would be returned to their unit when it was activated. Inthe case of technicians recruited before activation, the General Staff permittedthe units to place them in the Enlisted Reserve Corps, and in this way toprotect them from the draft, pending activation of the unit. If, however,activation did not take place within 6 months, these men would be called toactive duty elsewhere. With this exception, the corps area commander procuredenlisted men for the affiliated units through the regular channels. Women couldjoin these units as dietitians, physical therapists, or dental hygienists.Female dental hygienists could join them in civilian status, as could thedietitians and physical therapists before they attained military status.
Problems Connected With Keeping the Units Intact
Although The Surgeon General and other Army authorities didnot commit themselves to a policy of untouchability where affiliated units wereconcerned, such a policy was nevertheless implied. In practice, the right ofthese units-or at least their commanding officers-to be consulted beforeremoving any of the officers was recognized, and in general there were fewchanges in organization as long as the units remained in the United States.Keeping their intact had unduly divergent results. On the one hand, the members,particularly the officers, felt a certain esprit de corps, drawn as they werefrom a single institution. On the other hand, restriction of personnel to asingle unit limited promotion and could have affected morale, for once theorganization was completed there were no opportunities for advancement exceptwhen vacancies resulting from attrition within the unit occurred. One method ofcircumventing this problem was to initially give the officers a grade lower thanthe highest permitted by their tables of organization, thereby enablingpromotions to be given later.
Restrictions on the transfer of personnel also had an adverse effect onmedical service generally, if it prevented a man from being placed where he wasmost needed. Affiliated units were generally well staffed with specialists-sometimes with several of equal professional standing in the samespecialty-
208
who were in greater demand than were any other category ofpersonnel. If a specialist was kept from being transferred to a unit where histalents could be best utilized, it was a distinct loss to the medical serviceand a waste of personnel.
It is true that by no means all these units were kept intact,especially after their movement overseas. The Chief Surgeon of the Europeantheater has stated that he was able to persuade the members of affiliated unitswithin his jurisdiction to place regard for the needs of the Army above loyaltyto their units and that this enabled him to use the affiliated units partly asspecialist pools from which to staff or strengthen other units less fortunatelyprovided.99 In the SouthPacific, affiliated units upon arrival were assured that they would remainintact, but that if they found themselves overstaffed they might apply to thesurgical consultant or theater surgeon for transfer of the excess personnel to aunit where opportunities for promotion existed. This method proved veryeffective and was the only one used in that theater for removing a surplus ofqualified personnel from the affiliated units.100
In several instances, The Surgeon General saw fit to causechanges in the category of certain affiliated general hospitals while they werestill in this country. For example, shortly after Pearl Harbor, three medicalschools responded to his request by forming a second unit to be affiliated withthe school, at the same time reducing the bed capacity of the first from 1,000to 500 beds. Moreover, in 1943, he recommended the disbandment of the 71stGeneral Hospital, sponsored by the Mayo Clinic, while it was still in thiscountry; the personnel that had been in that unit then formed two 500-bedstation hospitals. In another case, the 30th General Hospital, activated in 1942with only a 600-bed capacity, was increased to 1,000 after it reached thetheater of operations.101Nevertheless, the understanding that affiliated units should usually be keptintact seems to have prevented the best possible use of all their members, atleast so long as they remained in the United States. Early in 1942, when anumber of institutions were applying for permission to organize new affiliatedunits, The Surgeon General refused many more of these requests than he approvedon the ground that he needed doctors as individuals, available for assignmentwhen and where they were required, and that he did not believe that still moredoctors should be immobilized in groups.102
This is not to say that the drawbacks connected with the useof affiliated units outweighed the advantages; it is likely that if the Army hadnot virtually promised to keep these units intact many highly competentprofessional men
99Interview, Medical Departmenthistorians, with Maj. Gen. Paul R. Hawley, 18 Apr. 1950.
100Letter, Brig. Gen. Earl Maxwell, to Col. John B. Coates, Jr., MC,Director, Historical Unit, U.S. Army Medical Service, 22 Nov. 1955.
101(1) Letter, Surgeon General Magee,to Dr. Elliott C. Cutler, Harvard University Medical School, 9 Mar. 1942. (2)Annual Reports, 42d and 105th General Hospitals, 1942. (3) Memorandum, Office ofThe Surgeon General (Lt. Col. D. G. Hall), for Officer Procurement Service, ArmyService Forces, 4 Sept. 1943. (4) Letter, Headquarters, 233d Station Hospital,Charleston, S.C., to The Surgeon General, 24 June 1943, subject: Inactivation of71st General Hospital. (5) Annual Report, 30th General Hospital, 1943.
102Letter, Lt. Col. Francis M. Fitts, MC, Office of TheSurgeon General, to David P. Stearns, Boston, Mass., 22 Mar. 1942.
209
would have refused to join them, and that the Army would therefore have beendeprived of their services, at least for the time being.
Other Problems
The slow rate at which the affiliated units were activatedand sent overseas by the War Department was believed to have had adverse effectson the procurement of doctors and nurses generally.103 Numerous units, organized either before or afterhostilities began, continued for long periods on inactive status during theprogress of the war. Even when activated, they frequently waited for many monthsbefore being sent overseas, while their personnel received necessary fieldtraining and supplemented the staffs of post, camp, and station hospital.104
Of some 70 affiliated hospital units activated during thewar, only about 20 were sent overseas within 3 months. Of the remainder, about20 stayed in this country for a year or more (2 for nearly 18 months), while therest averaged about 8 months.105Meanwhile, the War Department was urging more doctors to join the Army or, ifalready in the affiliated Reserve, to accept active duty. Some doctors in theinactive affiliated units refused to heed the call until their own units werebrought into service, probably on the theory that if they were really needed theunits themselves would be called to duty,106and that units already activated would be put to full use. Other doctors wereprobably discouraged from entering the Army for much the same reasons; one ofThe Surgeon General`s procurement officers stated that activation of the lastaffiliated units (in June 1943) would remove an obstacle to procurement.107
A problem of internal morale resulted from the length of timethat elapsed between activation of some of the affiliated units and theirdeparture for overseas. One of the original purposes of these units had been toprovide the Army
103Major General Kirk, who became The Surgeon Generalwhen the last of these units were being activated, has stated his belief thatthe delay resulted from enemy submarine activity and from the fact that thetroops whom these units were expected to serve did not expand in numbers orcomplete their training as rapidly as was anticipated. (Letter, Major GeneralKirk, to Col. J. B. Coates, Jr., MC, Director, Historical Unit, U.S. ArmyMedical Service, 12 Dec. 1955.) Colonel Paden has interpreted the delay in aslightly different fashion which may supplement that of General Kirk. In hisopinion, sections of the War Department General Staff responsible for furnishinghospitals to particular theaters competed with one another for units and oftencaused affiliated hospitals to be activated before they were actually needed.(Letter, Colonel Paden, to Col. J. H. McNinch, Office of The Surgeon General, 17Jan. 1950.)
104According to Lt. Col. Paul A. Paden, in hisletter (17 Jan. 1950) to Colonel McNinch, "The Surgeon General`s Officegenerally (as far as I know) and particularly the Personnel Service, did notknow exactly when or where affiliated units were to be employed." He feltthat The Surgeon General should have had this information. Troop movement bases"were available late in the war, but these were only very roughestimates, often reflecting the desires of General Staff Section, subject tofrequent change, and late publication and distribution tended to nullify theirvalue."
105Smith, Clarence McKittrick: The MedicalDepartment: Hospitalization and Evacuation, Zone of Interior, United States Armyin World War II. The Technical Services. Washington: U.S. Government PrintingOffice, 1956, tables 6 and 7.
106Letter, Chairman, Ohio Procurement andAssignment Service Committee for Physicians, to Executive Officer, Procurementand Assignment Service, War Manpower Commission, 26 Mar. 1943, subject: BaseHospital Unit 25, Cincinnati, Ohio.
107Address by Chief, Procurement Branch,Military Personnel Division, Office of The Surgeon General, before DistrictOfficers, Officer Procurement Service, 17 June 1943.
210
with a group of medical units which would be ready tofunction in a theater of operations with a minimum of delay, and no doubt themembers expected that their units would go into action promptly once they wereactivated. As might have been expected, idleness and delay in shipment causeddissatisfaction. One Medical Department authority reported that "we have hadmany letters about * * * people [in the affiliated units] twiddling their thumbswhen we knew that they should have been under some kind of trainingprogram."108
Unaffiliated Units
During the emergency period and also after Pearl Harbor,individual physicians or groups of physicians offered to organize hospitals forservice with the Army. In 1941, The Surgeon General declined these offers on theground that he was authorized to accept only groups which were sponsored by andassociated with a medical school or hospital capable of furnishing an adequatestaff; in other words, only officially affiliated units were acceptable.109In 1942, however, the policy changed. The Surgeon General accepted a number ofoffers to form unaffiliated units and encouraged the sponsors to recruit staffsfor them.110 In one instance, he suggested that if the inquirer couldrecruit a balanced staff of about 16 medical officers for a 250-bed stationhospital they could be commissioned and assigned as a group to such a hospital.However, he could not guarantee that officers so assigned would be kepttogether, since other hospitals might have greater need for them.111
It is unlikely that more than a very few hospitals wereorganized in this manner. One exception was the 61st Station Hospital, formed bya group of physicians and nurses from Camden, N.J. At the intercession of theexecutive assistant to the Medical Society of New Jersey, Dr. Norman M. Scott,the group was accepted and assigned to the 500-bed 61st Station Hospital,constituting its entire professional complement. All the members were drawn fromthe staff of the Cooper Hospital, a civilian institution, which approved theirenterprise, but the military hospital was never considered a formally affiliatedunit. The hospital arrived in North Africa in December 1942, and the groupremained intact, except for two or three members who were evacuated because ofillness, until September 1945, when it was relieved from duty with the 61stStation Hospital for return to the United States from the Mediterranean theater.At the request of Dr. Scott, The Surgeon General awarded the unit thecertificate of appreciation customarily granted to affiliated hospitals.112
108Report, The Surgeon General`s Conference withChiefs, Medical Branches, Service Commands, 14-17 June 1943.
109Letters, The Surgeon General, toDr. L. A. Andrew, Jr., Winston-Salem, N.C., 1 July 1941; Hon. Charles O.Andrews, Washington, D.C., 29 Dec. 1941; and Mr. C. V. Morris, Snyder, Tex., 30Dec. 1941.
110Letters, The Surgeon General, to Dr. C. F. Fisher,Clarksburg, W. Va., 18 Aug. 1942;Dr. Addison G. Brenizer, Charlotte, N.C., 28 Nov. 1942; and Dr. A. K. Lewis,Homestead, Pa., 2 Jan. 1943.
111Letter,The Surgeon General, to Col. Charles P. Stahr, Lancaster General Hospital,Lancaster, Pa., 22 June 1942.
112(1) Letter, Dr. Norman M. Scott,to The Surgeon General, 8 Apr. 1946. (2) Letter, The Surgeon General, to Dr.Norman M. Scott, 24 Apr. 1946. (3) Letter, Mr. LeRoi N. Ayer, to The SurgeonGeneral, 1 May 1946
