Foreword
During World War II, the U.S. Army Medical Department reached a personnelstrength which it had never before attained. Its peak strength of 700,000 wasthree times that of the entire Regular Army in 1939 and four times that of thecombined Union and Confederate Forces at the Battle of Gettysburg.
In contrast to personnel procurement in most other arms and services, theentire officer corps of the Medical Department, exclusive of the MedicalAdministrative Corps, had to be procured directly from qualified civilianprofessional groups. It could not be obtained through officer candidate schools.Furthermore, the personnel required were in a critical category, and the needfor them was immediate and urgent.
This volume of the history of the U.S. Army Medical Department in World WarII is the story of how the enormous personnel expansion was achieved; of howqualified medical personnel were secured; of how the wartime military medicalestablishment was utilized and the highest standards of professional medicalcare were maintained; and, finally, of how the wartime Medical Department wascontracted to a peacetime level.
The magnitude of the medical achievement in World War II should not bepermitted to obscure the difficulties that attended it. They were numerous andfundamental.
Although the health of the Army rested with The Surgeon General throughoutthe war, he was very early placed in an anomalous situation, which violated allthe principles of sound command, in that he had responsibility without completeauthority. He lost overall control of procurement, classification, promotion,and assignment of personnel, and it was well after V-E Day before he was able toimplement many plans that he made for the utilization of the entire medicalforce. His difficulties were compounded early in 1942, at the highest level ofthe War Department, when a reorganization of the Army interposed theHeadquarters Army Service Forces between The Surgeon General and the GeneralStaff and gave the medical component of the Army Air Forces, along with itsother components, more independence than it had previously possessed.
Emergencies had to be met, and obstacles and obstructions had tobe eliminated, as they were encountered. It was almost impossible to preventthem. Square and round holes both had to be plugged, though those making theassignments and those being assigned frequently did not see eye to eye in thematching process. Tensions were strong. Many newly commissioned medical officersfound it difficult to adapt to military life, while certain medical personnel inthe Regular Army sometimes seemed reluctant to modify, much
less discard, its time-honored traditions, policies and operations and adjustto the larger organization and procedures required by global war.
By the middle of 1943, when Maj. Gen. James C. Magee was succeeded as TheSurgeon General by Maj. Gen. Norman T. Kirk, personnel policies for theremainder of the war had been established for the most part. Many of theproblems, however, which had existed up to this time persisted almost to the endof the war.
1. The most important of these problems was the procurement of sufficientmedical personnel for all purposes, though how many persons were needed in agiven situation depended to a considerable extent upon how those available wereused. A reported shortage might mean a genuine lack of sufficient personnel tocarry out an assigned mission. All too often, however, the so-called shortagehad no reference to real need and was no more than the numerical differencebetween actual and authorized strength. Rank, promotion, pay, and morale werealso part of the general picture.
The absence of an aggressive procurement policy on the partof the Medical Department probably accounts, at least to some extent, for theshortages experienced early in 1942. Shortages became particularly acute a yearlater, when Medical Officer Recruiting Boards were abolished by the ArmyService Forces. Thereafter, medical officers had to be recruited chiefly fromgraduates of medical schools as they completed shortened internships.
Procurement of medical officers from recent graduates was accomplished, andon the whole satisfactorily, by issuing to undergraduates temporary commissionsin the Medical Administrative Corps, and, later, by the Army SpecializedTraining Program. On the other hand, as will be pointed out shortly, the needfor securing initially sufficient numbers of physicians from the civilianprofession, from which most newly commissioned medical officers had to besecured, was less acceptably dealt with, not only from the point of view of theArmy Medical Department but also, perhaps, from that of the national interest.
2. A second major problem was the correct utilization of available personnel.Medical officers were used with increasing efficiency as the war progressed, butlarge increments continued to be necessary, both during the war and immediatelyafterward, when replacements for those who were being separated from militaryservice were the principal need.
To utilize personnel correctly, it was essential on many occasions that anindividual be transferred promptly from one assignment to another as the needfor his services changed. Under the happiest circumstances, this was frequently-particularlyin the Zone of Interior-a somewhat cumbersome process. Under the circumstancesthat prevailed in World War II, it was further complicated by division ofauthority over reassignments, with the result that transfers were often delayedand sometimes were not accomplished at all.
Part of the difficulty has already been mentioned, the lackof authority by The Surgeon General to control disposition of medical personnelplus the interposition of the Army Service Forces Headquarters between him andthe Gen-
eral Staff and his unfortunate subordination to the former.Shortly after this reorganization had occurred, his authority was furtherreduced when the commander of each corps area became virtually the finalauthority on transfer of personnel within his jurisdiction, while at the sametime this commander gained an importantvoice in transfers between his own area and other corps areas. It was not untilalmost the end of the war that this trend was partly reversed and The SurgeonGeneral secured greater control over the reassignment of Medical Departmentpersonnel within the Zone of Interior.
When mobilization began in 1940, the classification of civilian occupationswas still sketchy, and military occupational specialties had not yet beendevised. It is only fair to say that, in spite of its inflexibility in certainrespects, the Medical Department early recognized the need for improvedclassification of medical personnel and developed this method more thoroughlythan any other branch of service. As the classification processes improved,genuine shortages were reduced or eliminated by employment of availablepersonnel to the best possible advantage. By the end of the war, the greatmajority of medical officers were properly classified and were assigned where itwas believed that they would be most useful, even if, in some instances, theassignment was not always in conformity with the officer`s preciseclassification.
There were a number of ways in which medical personnel in short supply wereused with great efficiency. An outstanding example was the establishment ofcenters for specialized treatment and the use of specialist personnel in them.Another was the replacement, whenever possible, of scarcer categories ofpersonnel with those more easily obtained. The use of Medical AdministrativeCorps officers instead of Medical Corps officers in many types of administrativework was an illustration. The substitution was frankly repugnant to many officers steeped in the traditions of the prewar MedicalDepartment, and some urging was necessary before the potentialities of thisplan were fully investigated and implemented. Before the war ended, however, the7,500 Medical Administrative Corps officers envisaged by The Surgeon Generalin April 1942 hadgrown to 20,000. Anothersimilar, and similarly fruitful, policy was the substitution of members of theWomen`s Army Corps for able-bodied enlisted men in the performance of manyspecialized duties.
3. Even after the Medical Department adopted a strengthenedprocurement policy in 1942, procurementdifficulties continued, chiefly because other branches of the military wereinvolved and more comprehensive action was required than this Department couldprovide alone. No single agency existed for this purpose, or, at least, nonethat could reconcile the conflicting demands of the Army, the Navy, and other Federal services with those ofthe civilian community; that could determine how many physicians each of thesegroups should have; and that could then see that each of them received itsproper share of physicians through the exercise, if necessary of compulsion onindividuals.
The closest approach to such an agency was the Procurement and AssignmentService, which could, and did, fix the minimum physician-civilian popu-
lation ratio that must be maintained in any given area. ThisService, however, operated under decided limitations. For one thing, it couldneither compel physicians who were in excess of minimum requirements in any areato serve the Government nor could it determine how physicians recruited formilitary and other public service were to be divided among claimant agencies.About the only power the Service exerted over these agencies was to preventthem, in the course of their recruiting efforts, from encroaching upon theminimum physician-population ratios which it had established. Within that limit,it was of considerable assistance in obtaining volunteers.
The Procurement and Assignment Service was further handicapped by the factthat it could not compel civilian practitioners to move from areas of lesserneed to those of greater need. All that it could do in this respect was to usepersuasion, and persuasion was, in many instances, much less than what thesituation called for. The Surgeon General contended, and correctly, that thereal source of complaints about inadequate civilian medical care was not theinroads of the Armed Forces upon the professional supply but the concentrationof physicians in some parts of the country far above the minimum established bythe Procurement and Assignment Service and the inability of that Service todistribute them equitably.
On the other hand, while the Procurement and Assignment Service saw to it,within the limitations just mentioned, that medical service was in adequatesupply for civilian communities, many were of the opinion that its assistanceto the military left much to be desired. Attempts of the Armed Forces to obtaina draft of physicians under special rules came to nothing, chiefly because ofthe opposition of this Service, whose successful resistance to this policydemonstrated that such powers of compulsion as it possessed were chieflydirected against the military. It proved able not only to prevent the armedservices from recruiting physicians on a voluntary basis beyond the limits ithad established but also proved able to enjoin them from drafting physicianseven within these limits.
In short, the Selective Service System was the only agency with power tocompel physicians to enter the Armed Forces, and its authority was limited topersons within the general draft age, which meant that it could not affect a very large number of the physicians in the United States.The effectiveness of the Selective Service System was further limited by thehesitancy of local draft boards in drafting physicians, even within thespecified age group.
Procurement difficulties continued into the postwar period.When the war ended, large numbers of casualties were in Army hospitals in theZone of Interior, as well as overseas, many of them still to receive definitivetreatment and many of them requiring specialized care. Yet this was the verytime that tremendous pressure was brought upon The Surgeon General for theearly, and sometimes the immediate, release of physicians, not only by civiliangroups and communities, but also by members of the U.S. Congress.
It would be unfair to end this foreword on such a note. It is true thatconflicts and misunderstandings were numerous and that they persisted
throughout the war, but it is equally true that working cooperation and thedesire to get on with the job generally prevailed on local levels. It was anenormous task to assemble the Medical Corps and allied medical services; toutilize them to the best purposes during the war; to accomplish this task withas little disruption of civilian medical service as possible; and then to returnthese personnel to civilian life. The task was, nonetheless, carried outcompetently and sometimes brilliantly, and the U.S. Army received from itsMedical Department the best medical service an army at war had ever known.
No history of the personnel, including civilian employees, of the U.S. ArmyMedical Department in World War II would be complete without testimony to theirskill, loyalty and devotion, both as a group and as individuals. Officers andenlisted personnel, those who were in the Regular Army and those who enteredservice from civilian life, gave of themselves unstintingly throughout theentire war. They shared the dangers of combat. Many of them were wounded. Someof them lost their lives. To each of those who served, the U.S. Army MedicalDepartment, the U.S. Army, and the Nation will be forever indebted.
LEONARD D. HEATON,
Lieutenant General,
The SurgeonGeneral.
