THE ORGANIZATION OF THE MEDICAL DEPARTMENT IN THE ZONE OF THE INTERIOR PART I: The Office of The Surgeon General PART II: The Service Commands and General Hospitals by Edward J. Morgan Capto, M0A0C0 and Donald 0» Wagner, Fh.D, This monograph is being made available in manuscript form pending the completion of the official History of the Medical Department in World War II, and must be considered as a draft subject to final editing and revision,, Persons finding errors in facts or important omissions should communicate with the Historical Division, Army Medical Library, Washing- ton 25, Do Co WAR DEPARTMENT OFFICE OF THE SURGEON GENERAL 30 June 194.6 FOKEWOED The following account is a survey of Medical Department organization as it developed at headquarters (Office of The Surgeon General) and in the corps areas or service commands, from the entry of the United States into World -Tar II to the period of demobilization. The Office of The Surgeon General is considered to include its field Installations. Elements of the local structure which will be dealt with in consider- able detail are the corps-area or service-command surgeons’ offices and the general hospitals, including certain, related establishments (the regional hospitals and hospital centers). Less space will be devoted to the post surgeons’ offices. Other agencies, such as the convalescent and station hospitals and the medical services attached to tactical forces, will be mentioned only incidentally.* *Captain Morgan is responsible for the first six chapters of this work; Dr. Wagner, for the following six. The Conclu- sion is a joint product. iii .TABLE 0? CONTENTS Chapter -■ • ’ Page FOREWORD . . . . . *. . • iii PART I TEE OFFICE OF THE SURGEON GENERAL ; I ORGANIZATION OF THE OFFICE OP THE SURGEON GENERAL IN TIME OF PEACE . . . ... . . . 1 II EARLY WARTIME. ORGANIZATION - FIRST REORGANIZATION UNDER THE SERVICES OF'SUPPLY ..... 9 III REORGANIZATION IN 1942-1943. . v . • . , 15 IV REORGANIZATION UNDER THE HSU SURGEON GENERAL . 25 V REORGANIZATION DURING 1944 ... .' . ... 41 The Separation of Professional and Preventive Medicine Activities. . . . . ; Al Reorganization for Operations. . . . . 44 The Reorganization of August 1944, ... 54 VI CONCLUDING WARTIME CHANGES 63 Continued Reorganization for Personnel; • ■ Activities . . 63 The Reorganization of Personnel and Development Activities 67 Concluding Changes in Organization t . . 69 VII FIELD INSTALLATIONS OF THE SURGEON GENERAL* S OFFICE 77 The Relation of Field Installations to the Service Commands 77 The Surgeon General's Control 78 Field Installations for Hospital and Helical Service, 81 Field Installations for Education and Research 82 Field Installations for Finance and Supply . 87 part ii THE SERVICE COMMANDS AND GENERAL HOSPITALS VIII TEE I EDI CAL DEPARTMENT IN THE CORPS AREAS .VC THE BEGINNING OE WORLD WAR II 97 The Corps Area Surgeon's Office .... 97 General Hospitals 102 V IX THE REORGANIZATION OF 1942 ....... 109 The Hew Chain of Command 109 Functions of the Service Command Medical Branch 113 Internal Organization of the Medical Branch . 117 X CRITICISM AND READJUSTMENT, 1942-1943 . . . • 125 Opinions on the Reorganization of 1942 . , 125 •A Hew Status for the Service Command Surgeon . 128 Internal Organization of the Service Command Surgeon’s Office 136 The Question of Air Force Installations , . 13? XI THE ORGANIZATION OF GENERAL AND RELATED HOSPITALS, • 1942-1945 143 Planning a Standard Organization for Hospitals 1-43 The Hew Plan for General Hospitals . . . 145 The Hew Plan for Regional Hospitals . . . 149 Hospital Centers 151 XXI THE SURGEONS' OFFICES 1944-1946; DEMOBILIZATION AND POST-UAR ORGANIZATION IN THE SERVICE .COMMANDS 171 The Service Command Surgeons* Offices and the Post Surgeons* Offices 171 Reorganization of the Har Department in Relation to the- Service Command Medical Establishment 174 XIII • CONCLUSION . . „ . ... . . . 181 vi LIST OF ORGANIZATION CHARTS Chart Following Page I Office? of The Surgeon General, 1936 .... 8 II Office of The Surgeon General, 1 March 1941 . . 8 III Office of The Surgeon General, functional or- ganization, 15 May 1941 ...... 8 XV Office of The Surgeon General, 15 May 1941 . . 8 V Office of The Surgeon General, functional or- ganization, 30 December 1941 10 VI Office of The Surgeon General, 21 February 1942 . 10 VII Office of The Surgeon General, 26 March 1942. . 10 VIII Office of The Surgeon General, functional or- ganization, 9 May 1942 14 IX Office of The Surgeon General, 24 August 1942 . 16 X Office of The Surgeon General, 1 April 1943 . . 20 XI Office of The Surgeon General, 15 June 1943 . . 28 XII Office of The Surgeon General, 10 July 1943 . . 32 XIII Office of The Surgeon General, 3 February 1944 . 46 XEV Office of The Surgeon General, 24 August 1944 . 58 XV Office of The Surgeon General, 1 January 1945 . 64 XVI Office of Tne Surgeon General, 11 October 1945 . 66 XVII Office of The Surgeon General, 25 March 1946. . 66 XVIII Office of The Surgeon General, 9 May 1946 . . 66 XIX Surgeon’s Office, Eighth Corps Area, 31 December 1941 102 XX Service Command Headquarters, 10 August 1942. .112 XXI Medical Branch, Second Service Command, 15 March 1943 120 XXII Service Command Headquarters, 15 December 1943 .136 XXIII Post Headquarters, 15 December 1943 . . , .136 XXIV Service Command Surgeon’s Office (Proposed) 10 December 1943 136 XXV Famed General Hospitals (TM 8-262) 1 July 1945 .146 XXVI Hospital Center (Proposed), ASF Circular Ho. 138, 16 April 1945 ........ .156 XXVII Percy Jones Hospital Center, 4 August 1945 . .156 XXVIII Hospital Center (unpublished plan prepared for insertion in TM 8-262) 156 XXIX Convalescent Hospital (unpublished plan, prepared for insertion in TM 8-262) 162 vxi PARI I TEE OFFICE OF THF SOEGSOH SHEJSAL CHAPTER I -. - ORGANIZATION OF THE OFFICE OF THE SURGEON GENERAL IN TRIE OF PEACE The organization of the Office of The Surgeon General in time of peace, as exemplified during the period from 1931 to 1933,' was simple yet complete; in it lay the genesis of most later developments. The Surgeon General exercised "administrative supervision over the Medical Department... (as th0 .. .adviser to the War Department upon all medical, and sanitary affairs of the Army."-3- As responsible head of the department he reserved to himself final action 'under the War Department on all matters relating to the formulation of policy, planning, estimates for appropriations, recommendations for legis- lation, relations with other branches of the Army and correspondence with the Chief of Staff, the Secretary of- War, or the President.2 In actual operation the office was administered and coordinated by an Executive Officer, acting under instructions of The Surgeon General.-' The mission of the office was "to supervise the health of the Army, including the dental and veterinary service, and,to administer the Army Medical Museum and the Army Medical Library.t,z+ This mission was normally accomplished through the divisions of the office 'under the direction of The Surgeon General, although other office units wore created when needed for the performance of special duties.b In 193$ the office- was organized into five divisions:6 the Adminis- trative, Finance and Supply, Military Personnel, Planning and Train- ing, and Professional Service Divisions. Those were further divided into subdivisions. The Administrative Division enjoyed the most direct contact with The Surgeon General. It administered all general affairs of the Medical Department not specifically assigned to other divisions, was the coordinating agency between the divisions, and managed the general office service.' The Office Management Subdivision handled all asioocts of office civilian personnel. It prepared all estimates for printing and binding and managed all funds allowed for publica- tions , supervised local hospital funds, managed the Central Hospital fund, and administered the admission of patients to the Army and -Tavy General Hospital. In addition to those duties, the subdivision edited the Army Medical Bulletin. Two other subdivisions completed the work of the Administrative Division. The Mail and-Record Sub- division received and distributed all official correspondence and maintained the reference files. The Office Equipment' and Circulation Subdivision was accountable'for all'office supplies; it distributed orders within the office and circular letters of the Department, and was- responsible for all mimeograph ■> The Finance and Supply Division managed the fiscal and supply business of the Medical Department. The chief of the division, as the Fiscal Officer for The Surgeon General, was responsible for 1 preparing and defending all "budget estimates. The Finance Sub- division assisted the chief in the formulation of estimates for appropriations and kept the office control accounts for appro- priations granted. The Supply Subdivision supervised the pur- chase, storage and distribution of medical supplies and equipment. All planning for industrial preparedness for medical supply in time of war was performed by a Procurement Planning Subdivision. Specifications for all items were developed in the Specification Subdivision. The Cost Accounting Subdivision compiled costs of operating Army hospitals, preaudited the valup of supplies issued to other services, and made estimates of funds necessary to re- plenish the stock issued. The examination and records of claims against the Medical Depart rent was the chief function of the Claims Subdivision. A Civilian Personnel Subdivision supervised the over-all management of civilian employees in depots and other field installations.9 The Military Personnel Division was the advisor to The Sur- geon General in all matters relating to the selection, classifi- cation, and disposition of commissioned and enlisted,personnel. The Commissioned, Enlisted, and Reserve Subdivisions managed and supervised the functions of the division.^ All planning and training policies were developed In the Planning and Training Division. These included Regular Army and Reserve activities and the routine business of the Medical Depart- ment relating to the Civilian Conservation Corps. The division was divided into the Planning and Training Subdivisions, The Planning Subdivision performed important duties in connection with Medical Department preparedness. It prepared war plans, tables of organizations and tables of basic allowances. It supervised the development of field equipment and formulated manuals, and administrative regulations. It was the pilot-house for Medical Department activities. The Training Subdivision planned training activities and supervised their execution.^ The Professional Service Division was the largest, the most complicated, and the most widely extended of all the divisions in the office. It was charged with "the administrative manage- ment of the professional services rendered-by the Medical Depart- ment." The following eight subdivisions were employed to carry out the mission of the division during this period: Medicine, Preventive Medicine, Hospital, Statistics, Army Medical Library, Dental, Veterinary and Nursing. Three of those subdivisions were more administrative-than professional, and the chief of these non-professional units was the Hospital Subdivision. Its functions were to supervise the administration of general hospitals and to cxerciSG advisory supervision over the administration of other hospitals and dispensaries; to prepare preliminary plans for new hospitals; and to offer advisory supervision over the preparation of definitive hospital plans, new construction, or maintenance 2 and repair of existing hospital facilities. The Statistics Sub- division was the second administrative unit in the, division. It received and corrected reports of sick and wounded* compiled vital statistics/ and edited the Annual Report of The Surgeon General. The third administrative function assigned to the division was the supervision of the Array Medical Library. In actual operation the library was..administered by the officer in charge of the Library Subdivision. All reference's were niade -to the Army Medical Library; the1, designation as a subdivision appears .‘ to be purely a matter of organisational convenience.-L-l \ In, addition to the purely administrative functions* three non-medical -specialties were included within the Professional •Service Division. The Dental* Veterinary and. Nursing Subdivisions were'responsible for the administrative* professional* and advisory supervision of matters relating directly to these phases of pro- fessional activities• In a large measure they constituted sepa- rate areas of autonomy.1'4 ■ In 1035 the Professional Service Division was divested of these six subdivisions. The functions* records* and personnel of the Hospital Subdivision which related to the planning* construc- tion* maintenance and repair of hospitals* were transferred to the Planning and Training Division in August 1935.All purely professional matters relating to hospitalization were retained by the division* but the Hospital Subdivision completely disappeared as a unit. In November the Statistical* Library* Dental* Veteri- nary, and Nursing Subdivisions were established as divisions*1^ This left the division with two subdivisions. The Medicine Sub- division developed medical and surgical policies, including plans for new’ methods of treatment* .rendered professional opinions on medical matters* and approved selection of personnel for key pro- fessional assignments. The Preventive medicine Subdivision formu- lated physical standards for military personnel* reviewed reports of physical examinations* and exercised..advisory supervision over military sanitation* the control of communicable diseases* and Army laboratories. It maintained the necessary liaison with the Quartermaster Department and with the Public Health Service. With the changes of 1935 the office reverted to an organiza- tional pattern which had been in effect for 'a number of years prior to 1931 The claim that "the results of this reorganiza- tion have been highly satisfactory"19 appears to have been sustained by the fact, that no further major change was-made in the peace years. The basic organization continued, to consist of the Administrative* Finance and Supply* Military Personnel* Planning and Training, Pro- fessional Services* Statistical, Library* Dental* Veterinary, and Nursing Divisions.20 The first break in this structure was made during the period of. the "limited emergency" when' important changes were made to better coordinate and administer the large volume of work incident to the national defense program,2-1 All reorganization in the period immediately preceding the war related directly to the expanding functions and duties of the professional services. In May 1940 the Professional Service Division, which only a year "before had reported a ’’satisfactory bracketing of activities into definite subdivisions...impracticable,”22 was reorganized into the Preventive Medicine; Medicine and Surgery; Physical Standards, US Military Academy and Regular Army; Physical Standards, Officers Reserve Corps and National Guard; Army Medical Museum; and Miscellaneous Subdivi- jn addition, it continued to supervise the ’’professional service rendered by the Army Medical Corps. The increasing scope and amount of professional work to be accomplished led to the establishment, in February 1941, of a Food and nutrition Subdivision26 and the re-establishment of a Hospitalization Subdivision. The appended organization charts for June 1936 'and March 1941 illustrate the major changes actually made during time of peace. It was apparent that the growing pressure to coordinate and develop plans and policies for the operation of military hospitals would require full divisional stature for that phase of professional activities.29 Similarly, planning in the field of preventive medi- cine promised to be of greater importance as the possibility in- creased for direct participation in the war. The Professional Service Division, therefore, was again reorganized, and the acti- vities of the Hospitalization and Preventive Medicine Subdivisions were transferred from the division and made full divisions on April 18, 1941.1 The Hospitalization Division was charged with develop- ment and promulgation of policies and the treatment of military personnel. It, was responsible for the supervision of named general hospitals and the advisory supervision of all other Army hospitals. Olio division was authorized to develop and control a system of bed credits to regulate the flow of patients to the general hospitals and it directed the assignment to general hospitals of patients transferred from overseas. Two subdivisions wore organized to perform these duties,34 Dio Division of Preventive Medicine was created to supervise all activities related to the ’’prevention or control of disease among troops and the maintenance and conservation of the health of the Army.To achieve these objectives wide liaison respon- sibilities were imposed. - Five subdivisions were provided to fulfill its mission: Epidemiology, Disease Control, and Industrial Hygiene Sanitation, Hygiene,, and Laboratories Sanitary Engineering .Venereal Disease Medical Intelligence and Tropical Medicine9^ The emphasis on the professional character of the work of the Professional Service Division was reaffirmed in the same reorganiza- tion by the establishment of a Liaison Subdivision to further cooper- ate with civilian and other governmental agencies.-^ 4 The divisional organization of the Office of The Surgeon G-eneral was supplemented by a number of standing boards and other •units designed to perform special duties.36 The functions of these units were limited to specific problems and the necessary personnel was designated in office orders.3' In 1935 eight boards and two committees were in active operation;38 by 1941 this number had increased to fourteen special boards. Boards were established to review manuscripts for publication; to review books and periodicals for procurement; to examine procurement specifications; to approve civilian efficiency ratings; to examine applications for appointments in Army hospitals; to consider and grade examination papers for increased enlisted grades: to consider candidates for promotion to assistant superintendent and chief nurse, Army Nurse Corps; to consider memorials, tablets and por- traits of Medical Department officers; to study methods for sim- plifying administrative detail in the Medical Department; to determine annual and general ratings of Medical Department officers; to survey the Reference Library; to revise the Medical Department Supply Catalog; to supervise chest x-rays of all recruits and draftees; and to coordinate Medical Department research.39 The first five of the above boards and the two committees were in continuous existence from 1935 to 1941.40 liaison officers in- creased from three to five during the same period, and in 1941 were assigned to; The Personnel Bureau, TACO; the American Red Cross; the Procurement Division, Treasury Department; the Quarter- master Corps Technical Committees; fyid the Health and Medical Committee, federal Security The Property Officer and Custodian of the Central Hospital fund performed continuing func- tions. 42 jn 19hi a Military Intelligence Section was added.43 5 1T0ISS FOR CHAPTER I ly Regulations 4-0-5, Par 3., Jan 15, 1926. Office Order 76, July 30„ 1931; Office Order 1, Jan 2, 1935. - 4Idld.1935, Par 2. 5Ioid.-, 1935, Par.3. of Organization 707-P, Approved July 23, 1931. 7SGO Office Order 1, Sec II, 2 Jan 1935. , pp 4-5. 9Ibid., pp 5-6. 10Ibid., p. 6. Ibid., p. 7. 12Ibid., p. 7. ■ 4-0-405 Office Order 1, 2 Jan 36, pp 7-8. •'* ■ 13SGC Office Order 79, Aug 21, 1935. loSGO Office Order 114, Nov 29, 1935. 17SG0 Office Order 1, Jan 2, 1935, par 29. 18 SGO Annual Report 1936, p. 122. 19Ibid., p. 123. 20 Annual Reports, SGO, 1936-1940. Annual Report 1941, p. 126. 27SGO Annual Report 1939, p. 190. Office Order 51, May 9, 1940; Sec Chart II of this study. 2ASG0 Annual Report, 1940, p. 153. Annual Report, 1940, p. 193, 26SG0 Office Order 31 Reh 17, 1941. 2/SG0 Office Order 32, Rob 17, 1941. Charts I and II of this study. 29 SCO .Annual Report 1941, p. 169. 3°SGO Office Order 87, April 18, 1941; See Chart IV of this study. , .Annual Report of the Operations Service to The Surgeon General, 1942 (SCO Historical Division 319.1-2.) 32SG0 Annual Report 1941. p. 173 (SCO Historical Division). 33Ihid. 3f[bld., pp 174-181. 35rbld., Charts III and IV. 3 “SGO Annual Report 1939, p. 163; 19 40, p. 158. Office Order 1, Jan 2, 1935, pair 40: SGO Office Order 1, Jan 21, 1941, par 52. Office Order 1, Jan 2, 1934, pp 10-11. 39 SGO Office Order 1, Jan 2, 1941, parts 53-57; 60-65; 67-71. Office Order 1, Jar. 2, 1935, pie 10-11. SGO Office Order 1, Jar. 2, 154-1, par 66. Ibid.. p. 10. 3SGO Office Order 1, Jan 2, 1941. 7 NURSING DIVISION Organization chart, Office of The Surgeon General, United States Army, Annual Report 1936, page 123. STATISTICAL DIVISION TABULATING AND CODING STATISTICS REPORTS PLANNING ft TRAINING DIVISION PLANNING TRAINING HOSPITAL CONSTRUCTION AND REPAIR FINANCE AND SUPPLY DIVISION PROCURMENT PLANNING SPECIFICATION COST ACCOUNTING CIVILIAN PERSONNEL FIELD FINANCE SUPPLY CLAIMS ADMINSTRA- TIVE DIVISION OFFICE MANAGEMENT MIMEOGRAPH AND CIRCULATION MAIL AND RECORD OFFICE SUPPLIES THE SURGEON GENERAL EXECUTIVE OFFICER CHIEF CLERK LIBRARY DIVISION ADMINISTRA- TIVE LIBRARY SERVICE INDEX CATALOGUE STATISTICAL AND DOCUMENTS PROFESSIONAL SERVICE DIVISION LABORATORIES PREVENTIVE MEDICINE MEDICINE AND SURGERY ARMY MEDICAL MUSEUM MILITARY PERSONNEL DIVISION commissioned! ENLISTED RESERVE VETERINARY DIVISION ANIMAL SERVICE MEAT ft DAIRY HYGIENE DENTAL DIVISION CHART I vaster chart PEACETIME ORGANIZATION CHART SURGEON GENERAL * 3 OFFICE. WAR DEPARTMENT THE SURGEON GENERAL A EXECUTIVE OFFICE! A CHIEF CLERK A DOTAL DIVISION B VETERINARY DIVISION C MILITARY PERSONNEL DIVISION PROFESSIONAL SERVICE DIVISION LIBRARY DIVISION F ADMINIS- TRATIVE DIVISION FINANCE AND SUPPLY DIVISION PLANNING AND TRAINING DIVISION STATISTICAL DIVISION I NURSING DIVISION J SUBDIVISIONS SUBDIVISIONS SUBDIVISIONS SUBDIVISIONS SUBDIVISIONS SUBDIVISIONS SUBDIVISIONS SUBDIVISIONS ANIMAL SERVICE COMITSSTQWEn PREVENTIVE MEDICINE ADMINIS- TRATIVE OFFICE MAWAOnflBIT FINANCE PLANNING TABULATING AND CODING ENLISTED SUPPLY TRAINING MEAT k DAIRY HYGIENE RESERVE MEDICINE AND SURGERY LIBRARY SERVICE MATT. AND RECORD PROCUREMENT PLANNING HOSPITAL CONSTRUCTION AND REPAIR STATISTICS REPORTS PHYSICAL STANDARDS U.S. MIL. ACAD. AND RSO. ARMY INDEX CATALOGUE OFFICE SUPPLIES SPECIFI- CATIONS STATISTICAL AND documents MIMEOGRAPH AND CIRCULATION COST AC CO LUTING PHYSIC AX STANDARDS O.R.C. AND N.O. OF U.S. CLADB CIVILIAN PlRSOlttEL (FIELD) ARMY MEDICAL STATISTICAL POOD AM) APPROVED: * mama 0, I Major General, U.S. Army The Surgeon General March 1, 1*41 HOSPITALIZATION MISCELLANEOUS CHART II FUNCTIONAL ORGANIZATION CHART _ OFFICE OF TW SISGBON CXJOAL, VAR DEPART**! m uuiir 5up»t»i•ion over the health of t hr a ray and adviser of t hr lor rWfiirtvnt upon all -rr. Coorl icst tom {including vital statistics). Manuscripts, portraits etc preparation and Vindication of the Indes Cats Adam i st rat ion of the general • ((airs of the Nedical Depart sent not spec i f ics 11 jr assigned to other divisions and Manage ■ ml of the service of the office Management of the fiscal a( (airs of the Nedical men! supervision of the pur chase storage, and issue of Medical supplies and equipment, formulation of plans for the procurement of supplies and equipment for wartiwe use supervision of the employment of the civilian field force of the Nedical Department eiaa mltion and adjudication of claims against Ihf Nedical TV partmrnt . DOvel opairnt of policies regard ing t he piannins and training activities of the Nedical IV par tMent and its units hospi tal construction and repair. Medical service of the Civilian Conservat ion Corps. deception and correction of sick and Mounded reports (ex- cept amasls) and weekly sta- tistical reports, computation and compilation of vital sta- tistics and preparations of. for distribution of a monthly re- view of the health of thr Army, preparation and editing of the annual report of The Surgeon General. Daaalopnaol of policies ralatiaa to tha hospitaliaalion aod traatoant of nilitary personnel. Maaaiialratiao. paafaaaioaal. and adviaery aayamaiaa aaroa Ika aaniac utaica of (ka Ar^- Amm r-W'AU j i. v, VJ Janas C. Ms«v*. , Major General, U.S.A^qr, The Surgeon General. Mky 15. 1941 CHART III 48 7878 wsrm chait ORGANIZATION CHART OFFICE 0 F THE SURGEON GENERAL. WAR DEPARTMENT THE SURGEON GENERAL A EXECUTIVE OFFICER A CHIEF CLERK A PLAMMIMO AMD traimimo DIYISIDM j MQRSIMO DIVISION L DOTAL XSVX8Z0M B MSBDBRY □max (■ c MILITARY H—L nr vision PREVENT ITE MEDICI IB DIVB»E PROFESSIONAL SERVICE DIVISIOM LIBRARY DIVI3I0II 0 ADMINIS- TRATIVE DIVISIOM FIMAMCS AMD SUPPLY DIYISIDM STATISTICAL DIVISION J HOSPITAL- IZATION diviskjn SDBDZVISnB SUBDITISIOMb STUD IV E TONS STBD17BJDHS SUBDIVISIONS SUBDIYBIOBS SOBDXVXS IONS STBDJflEXDMi SUBDTV1SIONN SUBDIVISIONS laSCELUUODUS OGMdSSIONSD EPIDEMIOLOGY, DISEASE PRE- VBMTIOM AMD INDUSTRIAL RTQIEM MEDIC DO AMD StHOBTY ADMIMIS- TRATITE OFFICE mama ana rr FINANCE PLAMMIMO TABULATING AMD COD mo HOSPITALS ANIMAL SERVICE ENLISTED MAIL AMD RECORD SUPPLY training PXRSOMMEL WAT AND dairy noma RESERVE PHYSICAL STAMDARDS, O.R.C., R.O.T.C. AMD C.M.T.C. LIBRARY SWTICE PROCUREMBfT PLAKMIMO HOSPITAL CONSTRUCTION AID repair STATISTICS EQUIPMENT VE3TOSAL DISEASE CONTROL INDEX CATALOGUE OFFICE SUPPLIES, CIRCULATION AS) REPRODUCTION SPBCIFI- CATIOMS REPORTS UBPECT10W3 STATISTICAL AMD documents SANITATION, BTOIBS AND LABORATORIES PHYSICAL STANDARDS, D.S.MILITARY ACADDCT AMD REGULAR ARMY COST AOCOUMTiNO SANITARY BMGINEERINa CLAIMS FOOD AMD NUTRITION CimiAM PSRSOMMEL (FIELD) MEDICAL intelligence AMD TROPICAL MEDICINE LIAISON iBMT MEDICAL MUSEUM STATISTICAL MISCELLANEOUS APPROVED' Major Oavil, U.S. Amy, THa Surgeon General May IS, 1941. CHAP.T IV CHAPTER II EARLY WAR-TIME ORGANIZATION* - FIRST REORGANIZATION ■ UNDER THE SERVICES OR SUPPLY -■ • . • At the outbreak of hostilities on December 7 j • 1941, the Office of The Surgeon-General consisted of 12'major was staffed by a force of 112 officers and 778 civilians,-. The office was organized, under The Surgeon'General and his Executive, Officer into the Administrative, Military Personnel, Planning and'Training, Finance and Supuly, Statistical, Library, Professional Service, Preventive Medicine, Hospitalization, Dental,-Veterinary,-and Pur- sing Divisions. The duties of each division were indicated in the functional chart of the office published in December 194-1,1 [Sec Chart v0 The mobilization program had placed, enormous demands upon the office; the entry into war promised an oven greater/” volume of work to be done. Organisation expanded piece-meal in the effort to moot the crisis.. The greatly increased amount of work in pathology inci- dent to; expanded the activities of the -Army Medi- cal Museum, and that subdivision of the Professional Service Divi- sion was created as a separate division in January 1942.3 The rapid growth of training activities, due to the great expansion in the field forces and the projected needs for medical units and troops, dictated a stronger organization for training in the office and the Training Subdivision was detached from the Plans and Train- ing Division. A new Training Division composed of three functional units was created to include the Officers Training, Enlisted Train- ing, and Publications The increased demands for hospital construction gave rise to another new division, when the Hospital Construction and Repair Subdivision of the Planning and Training Division was reorganized into the Hospital Construction Division.3 ihc number of divisions was thus increased to 15. Come less important revisions were made under the division level. The Professional Service Division established separate branches for Medicine, Surgery and Neuropsychiatry in order to handle more expertly and with greater facility the problems arising within these specialties. The Preventive Medicine Division established a new Occunational Hygiene Branch to supervise a program for the protection of workers against industrial and health hazards in the growing number of industrial plants with which the Army had contracts. Public relations and historical activities were given branch status and added to the Administrative Division.^ Ihe sprawling organization of the offico provided for neces- sary decentralization of functions and operations but made coopora- ion between the divisions difficult. Some attempt to bridge the gap was made early in 1942 when The Surgeon General directed that division Chiefs meet together at frequent intervals, ... Ho '-‘-isseminate information in order to promote orientation and assist 9 in attaining intelligent and cooperative prosecution of our efforts as a unit,”' He considered it Happarent that ... divisions should he combined under fewer and more comprehensive headings.A logical opportunity for such reorganization presented itself when the Office of The Surgeon General was made an operating of the newly created Services of Supply.No specific directive was published by higher authority to reorganize, but the office was made to. conform with the organizational pattern of Headquarters, Service of Supply on March 26, 19-42.il MAL1 divisions and branches were organized, under The Surgeon General, a Deputy Surgeon General, and the Executive Officer, into nine services of equal functional These services included the Finance and Supply, Profes- sional, Preventive Medicine, Personnel, Administrative, Operations, Dental, Veterinary, and the Nursing Service. The major re-grouping of functions occurred in the organization of the Operations and Administrative Services. The Planning, Training, Hospitalization and Hospital Construction Divisions were brought together under the Operations Service. The Administrative Service included all the- functions of the old Administrative Division together with important additions. 13 Two of its old subdivisions, Historical and Intelligence, were raised to divisional status and included in the new service. The Statistics, Army Medical Library and Army Medical Museum divisions were annexed without essential change of organization. In addition, two new and urgently needed divisions were created within the Administrative Service. The first of these was a new Civilian Personnel Division organized to centralize the management of all civilian personnel under the control of The Surgeon General. This responsibility had been a divided function. Hie Administrative Division was formerly responsible only for those civilians actually working in the office; it now added the control of those in the field installations who were, .previously under the jurisdiction of the Finance and .Supply Division. Unification of these functions provided the necessary machinery for economical use of the increased number of civilians employed in the Medical Department. The now Research and Development Division was the second addition to the Administrative Service. It centralized the elements of the research and development program, the sepa- rate phases of which, had been allotted previously to other divi- sions of the office. The duties performed by each of the services and divisions subsequent to reorganization arc indicated by the subdivisions sot forth on the organization chart, anwroved March.26, 19-42. (Chart VII). 10 INK tORGION 0 I N K ■ A L*t OfFICl «AI DtFAITNBNT FUNCTIONAL ORGANIZATION CNART THB BURGBOW 1BWKKJL Supervision ov«r tha h-alth of the Army and adviser of the Bar Depart - sent upon all sedloal and sanitnr} affalra of th* Army. Coordination of nativities at Tha Surgeon General'* Offlo*. BCRClBIVd OFF ICKR BMft DTTM10B wan DTrmoa •nmn wm. wtibios PBOTMBIOklL BMVIC* DIV18I0B LIBRARY DIVXSfGh ADMINISTRATIVE DIVISION FINANC* AM) SOPFLY D1VIB10M PMviirrivB m::« divjbiob VITAL STATISTICS DIYI8I0M plimih i mum orvrsios BaarrraLixiTiaa ormioa Mm nrara Alalalatratlre, fraTisatiaal, aal alalaarf aaferrlalaa aaar thalaotal aarrtaa af tka Mf MMrir--**— (r«raMta»l, aal a»t«g| aafirrtataa aaar tka rstarlaarj aar-rl aa tka •rm- Milaaa; aafaraUlaa orar tka aaIssiiss, alaaslf last las. aal llafaalllaa at aaaail aalaaaB ari aallaM far a aa aal aT tka Mall, aal Dapartaaat, laalallal tka kallaal Dafartsaat aaatlaa at {ha laaarra Car fa. idilnlftrttlvr, prof«>alon«l anl tl>laor|r sufarvlaloa orer llw ffo/*aaloaal aaraloaa at the Irar Hidleal Cor fa. Alai Diet rat lor at the Araf Mad- laal Llkrarf, laoladlal the aa- lastioa, psrohasa, alaaalflaa- tloa, Inleilnl, aal aara at .aallsal fiMllaatlaaa (Inalallal ‘vital statist las), aaausortfts, portraits, ata; yrafarstlea sal fakllast lea at the «••»- -iat - Adalnlatration of the general affalra of tha Madioal Depart - •ant not specifics lip assigned to other divisisns and aanag*- ■ant of tha service of tha off loa. Manages*nt of tha fisoal af- fairs of tha Madioal Dapart- aant; supervision of tha pur - ohasa, storage, and issue of nodical supplies and equipment; femulation of plans for the iproouranant of supplies and equipnant for sartina use; supervision of tha oaplopaant of tha civilian field foroa of tha Msdioal Dapartnant; siaa- Inatlon and adjudication of oleins against tha Madioal De- part sent. dialnlatratIra and profeaaloa- •1 aupervloloa at ofllealolo|/, dlaraar preventioa, laaunlaa- 1 Ion, the Ifilealo Board, la. duatrlal hf|lene, sanitation, lahorator lea, aaaltarf ea|l- oeerla4, asllaal latellljaaoe, trofloal allolne, aalarla oon- trol, aal venereal disease aoa- trol la the Arajr. Reception and oorreotloa of slow and sounded reports (sw- eep! aniaals) and aaekljr sta- tist loa 1 reports; ooaputatioa and ooapllatioa of vital sta- tistics and preparation of for distribution of a aonthlp re- vive of tha health of tha Arapi preparation and of the annual report of Tha Surgeon General. Aaalpsia of induc- tion hoard findings on solao- taas. PrtfaralUa aalloal aaatloaa <* aar flaaa. T*B aal T/»i for aalloal salts; aafara la ioa la. ralefaaa* Ball aal full a*slf- aaati aatlaattaa kalloal Da. fartaaat faraoaael ■aala; aafarrlataa tralala| •all aal Da far toast; aafarat- aloa fra far at 1 oa Vra 1 al a| aaa- aala, sakalalaa aal gallas; •oarllaatlea aalloal tralalaf •1th tar Da fart as at tratalal folia las; afaatf laattoas far hoafltal katlltaja aal flat flaaa; ooorliaatloa alia soa- •trastloa a^aastes. Alalalstrat Ira aa safe asst af tka gaaaral kaafttala; air la - «7 aafarrlslaa of fcaafttalt. •attaa of atlltarj faraaaaaa 1 aal laralofaaat al faltalaa fartalalal tkarats. ptfwlatl, Ml i>t«M| n«wUlM mr %k» mill MnlM a* im *rw »«■*■« ». ua CHART V 48 7878 ORGANIZATION CHART OFFICE OF THE SURGEON GENERAL U. S. ARMY WAR DEPARTMENT THE SURGEON GENERAL ASSISTANTS TO THE SURGEON GENERAL EXECUTIVE OFFICER CHIEF CLERK NURSING DIVISION MILITARY PERSONNEL D iVI SION HOSPITAUZATlOh DIVISION VETERINARY DIVISION PLANNING OIVI SION PROFESSIONAL SERVICE DIVISION PREVENTIVE MEDICINE DIVISION ADMINISTRATIVE D I V I SION VITAL STATISTICS DIVISION FINANCE and SUPPLY 01 VI SION !Si DIVISION m£(?i*£al LIBRARY DIVISION HOSPITAL CONSTRUCTION DIVISION TRAINING DIVISION DENTAL DIVISION Subdivisions Subdivisions Subdivisions Su bd ivision^ Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Subdivisions Nursing Service Commissioned Hospito I inspection Animal Service War Plans and Move ments Physical Standards Officer and WO. Reg. Army. Army Nurse Corps U S. Mil Academy Sanitation Office Management Reports P i s e a I Pathology Administrative Planning end Estimates Dental Service Meat and Dairy Hygiene Occupational and Military Hygiene Mail and Records Officer Personnel Reserve e Bed Credits Organization Physical Standards Enlisted Men Reg Army. N.G. S Selective Service Statistics Claims Museum Library Service Construction and Conversion Enlisted Personnel Enlisted Liaison Inspection Equipment Physical Standards Officer and WO. N.G .Reserve and Army of the U S. R.OTC CM.TC ft Aviation Cadets Laboratories Office Supplies, Circulation and Reproduction Medical Records Index Catalogue Momtenancs and Repairs Venereal 0 i s e a sc Control Requirements Photography Publications Personnel, Statistics and Plans and Training Inspection Drags, Instruments and Professional Equipment I nfeclious Disease Control Public Relations and Intelligence Machine Tabulation Statistical Registries Statistical and Documents Food and Nutrition Se lective Service Civilian PersonneI (field) Neuropsychiatry Epidemiology Historical Medicine Sanitary Engineering Production Planning Surgery Liaison Miscellaneous Medical Intelligence Purchase, Storage and Issue V-UAJOR GENERA* THE SURGEON GENERAL Februorv 21. 1942 CHART VI Services of Supply Office of The Surgeon General THE SURGEON GENERAL DEPUTY SURGEON GENERAL EXECUTIVE OFFICER CONTROL DIVISION Finance and Supply Service Profession a I Service Preven ti ve Medicine S ervice Personn eI Service Administrative Service Operations Service Dental Service Veterinary Service Nursing S er v ice tue«L POST ASSIGNMENT J OFIICt I | MAN A 8 6 M t M T | WAR PLANS PROEESSIONAL REMOUNT Finance Division • (SUlGCMCMm TRORICAL Sanitation Division FIELD lomm.teioned Division ■IclassificationI Adminietrafivf Division MAIL AND RECORDS Planning Division ORGANIZATION Dental Service Division Animal Service Division rTTHiTtTgr I AND RSFQRTS Nursing Service Division RESOURCES CLAIMS Medicine Division ■IrueEncuLOSiG I GENERAL I MEDICINE | Laboratories Division J—SaniTaHy i SANITARY PROMOTION FNOCUNEMCNT JcoiWSbSfics 1 U PUlLICATlQNll PUSLIC RELATIONS | WOVE MENT OFFICERS J STATISTICS ANO I ~\ STANDARDS | jpERSONNEL I VITERINAHT 1 HOSPITALS ffflE FMOCuMMCNT PU RCNAIE [SPECIALIZED I DIAGNOSTIC Reserve Oivition I CLASSIFICATION Intelligence Division ■4 INTELLIGENCE Training Division ENLISTED Miscellaneous Division EQUIPMENT Meat a Dairy - Hygiene - Division INSPECTION Nursing Personnel Divilion Procurement Division STOCK CONTROL ALLOTMENTS JPROCUREMENT I t ADVISORY Medical \ - Intelligence Division [W HEMISPHERE AFRICA nn EUROPE FROMOTIOR Historical Division RED CROSS LIAISON REPORTS {TRAIN! NO PUSLICATIQNS JPLANS ANO 1 ESTIMATES 1 dental | I PUSLICATlONSl J STATISTICAL I uwo ggomj J VETERINARY I I PUSLlCATlONS| f«omctioh I jlMTfRMATlOMAL Miscellaneous Division J PROFESSIONAL I Ipugucationg] Occupational Hygiene Division JmuVIKCKSR Enlisted Division [ CLASSIFICATION Vital Statistics Division STATISTICS Hospital Construction Division construction] Mocetateoue Division J VETERINARY 1 PERSONNEL Storage and Ittue Oivition t»u ■ SiTlONS -4FIELD UNITS ORTHOPEDIC j MECHANIZA- |TION HAZARD {PREVENTIVE MEASURE* RROMOTIOM MEDICAL RECORDS J machine I |TASULATINS [ J MAINTENANCE |ANO REPAIRS iLflUlPMLHT I ItoWWir IcmuMvcTian IToJ P.^ALsI Surgery Division ilMHAL SU RGERY Venereal Disease Control Oiv. ■j EDUCATION i»n Hospital- ization Division J TT5 1cm PITS STORAGE C 0 N TRQ L [PRODUCTION PL ANN INS REGIONAL SURGERY RADIOLOGY ] "jcOllASORATlQN IMMUNIZATION Research a Development Division J FIELD | EQUIPMENT i PROFESSIONAL ] EQUIPME NT | EVACUATION Production Control Division PRIORITIES Epidemiology Division JrHORKAt S5ESI I CONTROL { {FISCAL [INDUSTRY LIAISON PLANT I PROTECTION Neuro- psychiatry ■ Division PSYCHIATRY NEUROLOGY riN«4f.6ui ] IDWtASI CONTROL] JEPtOlMOLDAICAlJ | INVE8TTGATION iLijuwwmiuwq I IB I SERVICE TACTICAL i ADMINISTRATION WAR NEUROSES Army Medical Library Division I TnTTTx 1 |CATALOGUE| Inspection Division PROFESSIONAL — ■. RMsceeoneoue Oivition MACHINE RECORDS STATISTICAL O R C NATIONAL GUARD {STATISTICAL A I DOCUMENTS | PATHOLOGY 1 SUPPLY hospitals Adi-Genera I Liaison Division ARMV.U S Army Medical Museum ]photographic] T8TT C M T C. A t. C Civilian Pcrtonnel Oivition REGISTRY FIELD Food and Nutrition Division NUTRITIONAL J departmental] RATIONS ANO MESSES [SELECTIVE SERVICE ENLISTMENTS Physical Standards Division c c. c «. A. A. C. Technical Supervision Command Control Approved : NO * I I t J MAJOR GENERAL THE SURGEON GENERAL March 26, 1942 CORPS AREA SURGEONS DEPARTMENT SURGEONS MEDICAL SECTIONS GENERAL DEPOTS MEDICAL SERVICE ARMY GROUND FORCES MEDICAL SERVICE ARMY AIR FORCES MEDICAL DEPARTMENT SCHOOLS MEDICAL DEPARTMENT REPLACEMENT CENTERS MEDICAL DEPOTS NAMED GENERAL HOSPITALS CHART VII nIn general tho organization ... accomplished a functional consolidation of ... the increased activities of the office that had been emphasized and expanded by tho war effort. Farther study was made to determine tho activities actually per- formed by each division.d? All divisions were directed by The Surgeon General Mto supply data for a functional chart of tho office ... to parallel the recently published organizational chart.This data was consolidated by the newly created Con- trol into a chart, approved Hay 9, 1942, which con- firmed the March reorganization and set forth the functions of all major divisions of the office.20 (Chart VIII). The organization of March had hardly gone into effect when an exhaustive study was initiated, in conjunction with Head- quarters, Services of Supply, nto physically separate the fis- cal and supply functions of the Finance and Supply Service ..., and to consolidate all fiscal functions ... into a separate Fiscal Division-, in accordance with policies promulgated by Headquarters, SOS. This plan was adopted July 1, 1942.n2d Tho Chief of the Fiscal Division was redesignated ,as Fiscal Officer for The Surgeon Goneral. .Two branches were established to carry on the work of the new division: the Fiscal Subdivision and tho Claims Subdivision.22 The reorganization was not limited, however, to mere separation of fiscal and supply functions. The SurVLy Service itself was reorganized as follows: The Production Control Division became the Production Planning Division: cur- rent procurement was designated as a function of the Purchase Division; the Miscellaneous Division was abolished; and A Re- quirements Division was added. The Distribution Division re- fined unchanged. The Defense Aid Subdivision had been re- designated the International Division in order to conform to the nomenclature of the general organization of the Services of Sup- ply. 24 It was now given divisional status within the Supply Service. • A major change was made also in tho position of the Army Medical Library and the Army Medical Museum. The then current appropriations act required that civilian personnel of those organizations be transferred from departmental to field status, TlioSo Institutions, therefore, were eliminated as divisions of the Professional Service and were given field status under the direct supervision of Tho Surgeon General on July 1, 19l2.2^ 11 NOTES FOR CHAPTER II Functional Organization Chart, Office of The Surgeon General,- approved December 30, 1941, Chart Y of this study. 2SG0 Annual Report, 1941, p. 172, 3SGO Office Order 29, Jan 31, 1942. Report of Operations Service to The. Surgeon General, 1942, p. 3 (Historical Division, SGO, 319.1-2). 3SG0 Office Order 1, par. 29, Jan 2, 1941. to Memorandum for Director, Control Division, SOS, from Director, Control Division, SCO, as required by SPX ■319.1, 9-24-42, S? 1CY-MP-H, Oct 6, 1942. (SGO SPMC 024.-1). See chart VI, approved Feb 21, 1942. 7Mcmo for Division Chiefs, SGO, Jan 6, 1942. %cmo for Director of Control, Control Div, Hq SOS [not dtd, circa Dec 1, 1942) (SGO Historical Division SPMC 024.-1). ?Initial Directive for the organization of the Services of . Supply, ■ March 9, 1942, Chart D. Circular 39, March 2, 1942. Report of TSG to the CG, ASF, for 1942, -p:. 28 (His torlcal Division, SGO 319.1-2). 2Soo footnote 8; SGO Organization Chart, approved March 26, 1942. Chart IV. Office Order 119, April 29, 1942. Footnote S. Office Order 123, May 1, 1942 (actual order confirming the establishment of the Research and Development Division). from the Director, Control Division, SGO. to the Director of Control, Control Div, SOS, not dtd (Historical Division, SGO, 024.-1). 17 Control Division Procedure Assignment No. nAu in files of Director, Control Division, SGO, 18SG0 Office Memo, April 30, 1942. 12 19SGO Office Order 103, Aoril 20, 1942. 20Chart VIII of the study; Control Division Procedure Assign- ment Humber A, supra. Annual Report to the Commanding G-eneral, Services of Supply, 1942, p. 28 (Historical Division, SCO, 319.0). 22SC0 Office Order 230,. June 26, 1942. 23SGO Office Order 340, Sept, 1, 1942, Office Order 111, April 23, 1942. 2%cmorandom from Control Division, SCO, "Report on Administra- tive Developments," cited in footnote 16. 26SGO Office Order 237, July 1, 19-42. 13 thi surgeon atnsuL Supervision over the health of the Arsy end edvieer of th* Var Depart- sent upon ell eedlcel s*M sanitary effelre of the Army, rORCTIOMAL 0JM3AH1 TAt ClAIT t»i ICfQBOs P T i B RAt'lQFF 1CI> «AJ DBPilTtt'lf T EXECUTIVE Off ICEB Conduote a continuous review of the Tganizaticn and adxirvlstration and analy- sis of the reports of the various divisions of The Surg-on leneral's Cffloe. tfekes reocosendation* with a view to en- '■erclng and expeditirg the output of each oat-gory of servloe furnished, Maintains liaison with the Control Branch, 3. 0.S. 00met DIVISION Coordinetion of activities of The Surgeon General's Office. PDU5CS AJC SDPPLI SBWTCM renasicML skmcs rwvwrrw mdicdc *wex fwaowsi anocs ADMINlaHUTT/I SRVrX owutiob mmx dwial awrc* vnums amntx ■(■Bin TTf Divisiop. losputes requiresents f Medioal Departsent supplies, equi(MCt, •od ra* aateriala and tarpo data on tadi- 3*1 Departsent item reaouroe*. Audit* alaisa against tta Medlosl Departaent ate prepare* ooctraot* for speotaolea ate -a-ndry aervioe. Prepare* ate defend* “*t.eat•*; apportiocs ate allots fund*, aiperviee* proccrMent cf atcrage apace. &~oouresent Dlviaion. Superviae* pro- =ur»a*nt of *11 eupp 11** ate equipment for tta tadioal Department ate for Defense Aid. ZbOLrol* depot stocw ate allot* f ink to procuring depots and to individual teationa within tta Dblted States. *°rM and Issue DivjxiioB. Develop# ate executes sssesbly of .capital and field ate super-rises tta s' n pMQt of oon- troiled Itess. talctaina peoerd of stocM in depots, in tramlt, and in hands cf troops. fVoductioc Control Division. Conduct* loduMrlal surreys ate (rodutelaB at tele*, hjreaeit* Tta &rgeon -Jensral in levity Mtters; oocrdinstes reqxilrwMi** to pro- duct lot ospaolty, ate tevlaM in Batters » Ddvtslo. derate* nactalaa eeoerd* ate premiss all ststiStinsl dots fB' prifsateinml orob- laas. Sanitation Division. Initiates polloies and handles probleas pertaining to post and field sanitation, inoluding the pro- gau at aster purifioatlon, waste dis- posal and disease bearing inseot and vermin control. Advises on the aeot and assigned cf personnel utilised under this specialty. laboratories Division, formulates, ad- vises and assists in the aoocapl ishsent of policies regarding the eetablishsent, function, sod operation cf Medioal Depart- sent labor a* cries, sanitary aid llagrastio. tadioal Intelligence Division. Collect a, oorrelatea sod files sediosl and sanita- tion irforaatlon on fcrelgn countries and (repsree asdlcnl surveys on the** countries for Bar Departsent use. Maintain* saps on ■arid distribution cf ooasunlosbls dim- eases sad ttair otrred inoldenoe. OooupstionsI Hygiene Division. Conducts a profr-as cf control and reaesrotr fn ooou- pstlocal hygiene in oonneotion with tta genial health hassrds enbountered at Amy operated industrial plants and inoidad to seatanlaed ssrf are. Vbnereal Disease Codrol Diwlsion. Inl- tlstee poliolea and plans and assists in tta m loot ion and (reparation rf qualified psrsonnsl la conducting a of v*- nareal dlesasa control at silltary eta- tloea Bpltesiology Division. Istsbllshss polio}** and procedures far tta prsvantion and control of Infectlou* dlosasss ln- olodlng tta Initiation and guidance of appropriate rsassroh actlvltlcc to this sod. tal Mioned Diwlalon. Reoossends aaalgn- arnt, reaMlgiaent and proaotlon of tadi- oal Departsent officer* of the Regular Ar*y and alao prooiree and olaMlfles of- floera of the Medical Corps and tadioal Adsiniatrative Corps. Maintains allat- sent*ooatrol and station aiaignssflt reoerda on Medioal Departaent offioera of *11 com- ponents. flBserwe Diwiaion. Prooeaee* for appoint- ment and olaMlfles all tadioal Departaent trral‘a Offloe and distributes and aooounta for all property and supplies used therein, operates a sail and reoords aubdivlslon which handle* all ooMunloat lore pertain- ing to The Surgeon leneral'a Office, classifying, indexing, extracting, and Mintaining a permanent file reoganieation and Tables- y 3asio Allowance*. Supervises develop- aent, testing and standardisation of tadioal Departaent field equlpoeit. Establishes policies, forsulates plans, supervises and co- ordinates the teohniosl and field trainirg f HttflM • ITtaMft iwatl •araftaa ■rank aummSfS*amL •cxnr or onuw»t»ATm avn OUU OF (JVBA1IGM onv or mananomL WKB cnvjrjmf ■wg ftltfT ftftt mat# • mil • it i» loft C IT IIIftft ■•ft Oft ftftt • IT Ift in rat iiin ft IT IS 10ft PUCIL • It Ift I Oft ■ft ICftL murici • it ift iftft win n irt ■•RIO ►O IS f •ft Wi L • IT Ift Iftft nrT«ft iftftftT • huin ■ ■UN Wit him •aalal •ar* lea •vaari !■> l*r» •r«Ml (•••!••I*a*ft rara*aa* I • raa* ft Caplftfftaftt •raft*ft •ftp laeftftftftt Tra lalag Cftatftr ■raft*ft • «ft«ftt • ra»« ft • •rgftrf ■ raaaft kaaltatlaa • raatft ftalaal ■raat ft Bar*la| C la*. If iratlfti t «a«* t«a|a- a raft*ft Tra la lag • **tr la* • raa* ft tec ftftftta ft I* f*r t• •raft* ft Baft I* l •raaaft laallarf lailaatriai •raarb llaaallaaaaM • raw ft ft ftairr »»«»•• kaw ft • alaa I laa ft llaNtM* • r«Mk Tralata# ftr ftftftl ftraae ft t*a* ft* r tftftlt •raa* ft Ulaaalar laa ■raaab •umIUwmi IrtBtl V a I la t*4 ftr a aP • 'ftflftfftft Halt Tralalag ftraae ft lag*aft ItftPft • a a« I fa la Ntr It laa •raaaft ttwraal ftlaaaaa Caairal r*sfk f»•14 ter t t «ft it »*»** • I* laa Bran* ft ft ftfta I* ary ftraae ft • tapallaaal •Tftka. • raa* ft riacal ft ftapplf Iraaet ( Ml taalfala ■ raft* ft HjaUal •aatrftl'ft ttataaa ftr>aK ft lailaal latalllgaaaa ftraaaft Pftft left 1 ■ taaAarfta •ran ft I^Maaalai; •raa«l oft u 9 tftftiaifttftttlot ft it it in» • nu ftftt «•»• * rt i» i op RCftlftftCft ft • rti tapftftftT »It ift Iftft ft Ift TAB 1C at ft It Ift 10ft PUN » It Ift Iftft NftPITILIIlTIOI ft ItftC CtT Iftft »ItIftlot MMT41 rotiriKTiM ft It Ift iftft W*KTI*» PUHIN » I* If lft« UlOniHVTt • IVUIM Wit IMS • n him »tan nvriM >tVUIM milMf (NIL ft If f» IB* tail** la I ft «•*!#• ftraae ft ini* mi ftaearft* •raa* ft c I* II laa tiaia** Bftftll laftt iftft •raa« ft ft*ft Craft it* ft ft*** ftfttIftft •r • »« ft ilr (a»pa • a*lilt Iftft •raaaft PMlIllla* Br«Mk itfftiitt IMMI CMtrcl IM>I •l«t • Mivtl i>wl •M*. » a* 11 ft ■•rarft* na It ft •apart* • raaaft •aaa Itfuat •ran ft •rgaataat I** ftraaab •r • •• ft •raaaft fraaf tft«lilt toft •rftMk •riMl rtiiw ftriari •U«lM Nt*mm •vtMk iff !*• can. * B#r**ftaat •ran ft •tat Iftt ••• I taaljra to •raaaft ftaaaaeeft • raa* ft rift ift ItalpaaM •Mifti Minim Pa* I) It la* Caat*ri|ftt •mm* P*«|r»a ftr»Mft •apa*lt lag •r«Ml • •» n IftlfWBl IrftMl MairMta* IHMI ■WW1 ftftf fWta MyUr fttft ••> ■a • ft I a* a •raaaft Irtatfe NlMt Iftft •art la* •raa* ft U»|« iMWl mm ■Mil SSCTS* mm mm mm mm* mm MU AlMMnV ■mi GRAB* TT raised to staff level, as stated above. The .Au.gu.st 1942 reorganization relieved the' Chief of the Operations Service from control of the Training Division. Inspection activities, formerly the work of a separate divi- sion, were distributed to other divisions of the service. The chief continued to coordinate all matters relating to planning hospitalization, evacuation, and hospital construction. The Plans Division was reconstituted to include the mobilization, organization, and field equipment branches, The Hospitaliza- tion Division became the Hospitalization and Evacuation Divi- sion. The Bed Credits and Evacuation Branch of this division allotted bed credits, controlled the transfer of patients to named general hospitals, and coordinated the operation plans for hospitalization and evacuation. A now Miscellaneous Branch of the division was created to correlate activities and to carry on the necessary liaison with the Personnel, Supply, and Professional Services.^0 Two operating divisions in the Office of The Sirgeon General.were deemed of sufficient specialized Importance to merit an organization separate from the services. It will be recalled that the Fiscal Division (formerly the Finance Branch of the Finance and Supnly Service) was established as a separate division on July 1, 1942. The two units of its primary organization had developed since that date into six individual branches. The Budget Branch prepared, defended and reviewed all matters relating to appropriations. The Account and Reports Branch prepared all allotments of appro- priated funds, reviewed field reports, and kept current the status of all Medical Department funds. The Voucher Audit Branch audited and cleared all items which required periodic payment. The Expenditure Analysis Brandi analyzed reports from field installations regarding costs of operations and developed procedures for obtaining supplementary and sup- porting cost data. Closely allied to the work of this branch, the Cost Analysis Branch acted as the fact-finding unit with respect to prices on all 7far Department contracts assigned to the Office of The Surgeon General for renegotiation. The Field Accounting and Audit Supervision Branch supervised all fiscal functions in field stations and in field offices; Inspected and conducted special audits of field offices\ and examined fiscal records for Held stations.H • The Training Division w{is also given much needed sepa- rate status in the reorganization of August 1942. Since March 1942 it had operated a,s a subdivision within the Operations Service, This subordinate position was satis- factory so long as The Surgeon General exercised little or no control over the actual training of field units. This had been the situation prlol to May 1942, for all field medical units were under the control of the Commanding t n ■*. i General, Army Ground Forces. In May, however, .the control of such units "became the responsibility of the Commanding General Services of Supply. This: change brought all medical field units under the direct or. indirect control of The Surgeon General.He was directly responsible for all numbered medi- cal units at Class IV medical installations. Under authority of the Director of Military Training, ...Services of Supply... and through the Commanding Generals of the Service Commands, The Surgeon General supervised and inspected the technical training of medical units at Class I installations, and at Class IV installations under the control of Chiefs of other branches.13 jn order to supervise.this unit training, the Unit Training Branch was, created' in the Training Division in August 1942. At the same time the other three branches were redesignated as the Replacement Training Branch, the School Branch, and the Training Doctrine Branch, designations which were maintained until May ffith the redesignation of the branches, the Training Division was allotted 14 officers and assigned the following specific duties: To coordinate all training policies, plans, and activities of the Medical Department; To establish policies, formulate plans, super- vise, and coordinate training in medical replacement training centers, special serb vice and enlisted technicians schools, Medi- cal Administrative Corps Officer Candidate schools, Medical Department pools and or- ganized medical units assigned or attached to Army Service Forces in unit training centers of the Medical Department; To establish policies, formulate plans, super- vise, direct and coordinate training of medical personnel in civilian and vocational institutions and in industries; To nrepare estimates for instruction and main- tenance of appropriate schools and replace- ment training centers, and coordinate'the suballotment and expenditures of training funds allocated to the Medical Department; To establish policies, formulate plans, and coordinate training in Medical ROTC, Offi- cer Reserve Corps, and organized Reserves of medical units assigned or attached to Army Service Forces; To initiate, develop,- direct, and coordinate training doctrine for.all*types of medical units; IB To allocate quotas to medical units and installations of the Army Ground Forces, Army Air Forces, and Army Service Forces, and direct training of quotas in various schools, conduct training inspections of schools, replacement training centers, officer candidate schools, unit training centers, and medical units of the Army Service Forces; and To recommend and coordinate the assignment to medical units of all unassigied gradu- ates of enlisted technicians schools.15 Complaint was made that the "restrictive ceilings in per- sonnel, the reorganization of the Army into three distinct echelons and decentralization of control and authority along with decentralization of execration, have not facilitated the ability of The Surgeon General or the Training Division to discharge assigned functions or responsibilities."16 The organization of August 1942 successfully reduced the number of divisions reporting directly to The Surgeon General It carried out the fundamental principle of decentralization of authority, yet allowed for a functional grouping of activi- ties. It clarified the duties assigned to subordinate units. This major reorganization established the pattern for office organization during the war years. The reorganization consummated in August-1942 continued, with two exceptions on the staff level, until'the spring of 1943. In September 1942 the v7ar Department changed its policies with regard to the handling of military information and directed that each agency "operating in the field of public relations ... be known as an Office of Technical In- formation. The Public Relations Division subsequently was renamed-the office of Technical Information and con- tinued to operate without change in por n0 apparent reason it was soon reduced from the.status of a staff division to that of a branch in the Office Adminis- tration Division.it continued on branch level until April 1943 when it was again restored to staff level as the Office of Technical Information.^ A second and more important change on the staff level was the creation of a Legal Division. The necessity for a group of legal specialists in the Office of The Surgeon General had long been recognized. A small legal staff had been acquired to assist the Chief of the Supply Service. Although it was decided to increase the functions of this staff and to insure its services to all divisions of the office, the functions of the newly created Legal Division 19 dealt largely with supply matters.21 The division was to serve as legal advisor to The Surgeon General; act as general counsel for the New'York and St. Louis Medical Procurement Districts and other contracting officers; supervise contracts and bids; draft procurement directives; and act as counsel in causes of price adjustments of renegotiated contracts. The division served in an advisory capacity on all matters concern- ing statutes, regulations, and directives from higher authority. Throughout the summer and fall of 1942 the operations of The Surgeon General’s Office were subjected to searching inquiry by a committee appointed for that purpose by the Secretary of War. One of the many questions raised by the committee con- cerned the effectiveness of the operation of the Supply Ser- vice. One basic recommendation-of the committee was, ’’that non-medical men of appropriate training and experience be placed in key positions in the Supply Service, Procurement Districts, and Supply Depots and commissioned with sufficient rank ..,”23 The Surgeon General, fortunately, had foreseen this necessity and had on 13 November 1942” ... engaged the services of a special civilian assistant for the purpose of aiding in more adequate operation of the Supply Service.'' Intensive study of supply operations by the special civilian assistant over a period of months led to recommendations for the reorganization of the service. On 26 February 1943 the Supply Service was reorganized ”and the duties of the various divisions distributed into smaller groups of activities which were closely related.”2^ In the rearrangement of the service, an Assistant Chief of the Supply Service was empowered to act as coordinator. A Materiel Office, reporting directly to the Chief, coordinated procurement and scheduling activities among the divisions. The remainder of the service was organized into two separate branches on the staff level (Supply Personnel and Office Management) and seven divisions, as follows: Requirements, International, Resources, Procurement (formerly Purchases), Price Analysis and Renegotiation (formerly Price Adjustment), Specialties, and Distribution. Some of these divisions were new and require., at this point, a few words of explanation.^ The Resources Division devoted its attention to allevia- ting the raw material shortage which, during this period, was hampering the production of medical supplies and equipment. To accomplish this purpose, it was divided into four branches; Program Analysis, Materials Requirements, Priorities and Allocation, and Conservation. 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DCPT. rnocrmytn DISTRICTS ■DICAL PEPOTB ABUT HDIQAL CETE ABUT ■DICAL ABUT MEDICAL act me vi svrjsob ;b?ul tfVL i. ms CHART X and to carry out the terns of the renegotiation statutes which had "been enacted hy Congress in 1942 and 194-3. The division was formed hy joining the functions of the old Price Adjust- ment Division, Supply Service, and the Cost Analysis' Branch of the Fiscal Division. The Specialties.Division, which included an Optical Branch Laundry Branch, and X-Eay Service Branch, was not an operating division. Rather, its function was to study the peculiar pro- blems encountered- in the procurement and distribution of cer- tain specialized items and to make this Information available to the other divisions. It had administrative and coordinating functions almost entirely. Although there were many alterations within each division, the functions of the other divisions remained substantially, unchanged. • •. On 3 May 1943, further changes were made. A Storage and Maintenance Division was established, which embraced the func- tions of the Depot Branch of the Distribution Division and the packing and erasing activities of the Office of the Assis- tant Chief.2? The Organizational changes made in the spring of 1943 brought to an end a year of successive attempts to organize the Office of The Surgeon General on a functional basis. The basics reorganization,under the Army Service Forces had been modified to meet the increased demands placed upon The Surgeon General. No further changes were indicated. NOTES FOR CHAPTER III ■*"SGO Control Division Procedure Assignment 5, July 22, 1942, in file of Director, Control Division, SCO. 0 Ibid., also Procedure Assignment 15, Aug 19, 1942. , Services of Supply Organization Manual published Sep 30, 1942; SCO Office Order 340, Sop 1, 1942. Chart, SOS, Office of The Surgeon .General, approved Aug 24, 1942; Chart IX, this study. Office Order 340, par 2, Sep 1, 1942. 6Ibid., SCO, Office Order 372, Sep 23, 1942. 7SGO Office Order Sep 2, 1942. • • J 8Ibid. 9Ibid. Report of Operations Service, 1943 (Historical Divi- sion, SGO, 319.1-2). of Supply- Organization Manual, Sep 2, 1942, p. 304.07. X Report of the Operations Service, 1942-43, p. 30 (Historical Division, SGO, 319.1-2). 13IW., p. 33. pp. 3—4; Menorandun for Historian, Operations Ser- vice, SGO, from Director, Training Division, Subject: His- tory of Operations Service, Jun 30, 1944 (Historical Division, SGO, 314.7-1). , up. 3-A. ~^Ibid., p. 4. 7V© TAGO Memorandum No V; 600-13-42, Sep 21, 1942, Subject; Reorganization of Public Relations Agencies (SGO Record Room 020.4-1), 18SGO Office Order 396, Oct 13, 1942 19SGO Office Order 441, Hoy 2, 1942. 22 for the Historical Division, SGO, Subject; Annual Report of Control Division, Jul 16, 19-43 (Historical Division, SGO, 024.-8). 2^rbid,, p. 2; SGO, Fiscal Year Report to CG, SOS, 1942, p, 28 (Historical Division, SGO, 319.-1). 22SG0 Office Order 496, Nov 30, 1942. from the Commanding General, Services of Supply, to The Surgeon General, Nov 26, 1942 - Recommendation 76, Copy included in ’’Report of The Wadhams Committee” (Histori- cal Division, SGO). Report of the Control Division, SGO, 1943, p. 2 (His- torical Division, SGO 024,-8). 25Ibid., p. U. HIchard E., The Procuronont and Distribution of Modi- cal Supplies in the Zone of the Interior during ITorld vfar II, p. 58 (Historical Division, SGO); Chart X. 27 Annual Report of the Control Division, SGO, 1943, p. 4 (His- torical Division, SGO 024.-8). 23 CHAPTER IV REORGANIZATION UNDER THE HEW SURGEON GENERAL On 1 June 1943 Major General Norman T. Kirk ’became The Sur- geon General, The new head of the Medical Department found him- self confronted by a serious dilemma. He inherited an office which had seriously exceeded its officer allotment; yet he acutely needed additional officers in professional divisions to supervise new activities t such as the reconditioning of soldier- With characteristic vigor, he attacked the problem of sotting his now official house in order. Within 15 days after assuming command he promulgated sweeping changes in the organization of the office which provided for the grouping of functional activities. All separate divisions, with the excep- tion of two remaining at staff level, were placed under control of the five services. The Legal Division and the Fiscal Divi- sion thus became part of the Administrative Service; and the Training Division, with no change in internal organization, was placed under the supervision of the Chief of the Operations Service. The Research and Development Division, formerly a part of the Administrative Service, was reduced to branch level and became part of the Plans Division, Operations Service. To meet the increased demands placed upon the office, The Surgeon General established two new divisions in the Profes- sional Service. The Surgical Branch of the Medical Practice Division became the Surgical Division, with its functions divided among three branches. The Surgery Branch retained all the duties of the old branch. In addition it afforded consultation and advice on all matters pertaining to surgery and assisted in the identification and proper allocation of specialists. The Radiation Branch and the Physical Therapy Branch were created to provide similar facilities in their respective areas. A Reconditioning Division was organized for the purpose of studying and planning policies relating to the rehabilitation and convalescence of patients who no longer needed ward care, but who were not able to return to active duty. To carry out the mission of the new division the War Exhaustion, Physical Reconditioning, and Occupational Therapy Branches were established. Since all surgical activities had been transferred from it, the name of the Medical Practice Division was changed to Medical Division.2 The now plan also provided that nationally known specialists in the various fields of medicine would be appointed as consultants to The Surgeon General and to the Chief of the Service. As a general efficiency measure and also to free the officer allotment for the professional purposes mentioned 25 above, The Surgeon General and his advisors made extensive changes in the organization of the Supply Service. This ser- vice 'was one of the largest in the office. At the beginning of June 1943 it consisted of 114 officers and 52-4 civilians. An intensive study was made by the'.Control Division and the .... newly appointed Acting Chief of.the Supply Service,’ with the ' hope'of reducing the number of officer and civilian personnel.-2 . The first step taken in the process of reorganization reduced the service overhead by eliminating all such posts except the Chief of the Service and an executive officer. In .the, .next step the Office Management Branch was transferred to the Control Division and the Supply Personnel Branch, was assigned to., the Military Personnel Division. The remainder of the service was then reshuffled. In this process the Office of Assistant Chief, the Materiel Office, the Resources Division and the Specialties Division were abolished, and a large portion of their activities wore reduced or regrouped. The Requirements and the Distribu- tion Divisions were merged to form the Distribution and Require- ments Division, composed of the Storage, Issue, Requirements, Stock Control, and Maintenance Branches, The five branches, of the Procurement Division'were consolidated into the Purchases and Production Branches, The International Division was un- . changed, except that the Coordination and Analysis Branch became the Analysis Branch, The name of the Price Analysis and Renegotiation Division was simplified to Renegotiation , Division. A new Supply Planning and Specialties Division .,. assumed most of the, service overhead in the Catalogue and ’ EquipmentyList, Machine Records, Reports, and Specialties Branches^4 these changes the service was consolidated into a more closely knit organization composed of five divi- sions, and the personnel was reduced to 83 officers , and 4-52 civilians.' This major saving in personnel provided the needed openings for specialists in the professional divisions and helped to bring the office' within its authorized' allotment. The structure of the Personnel Service was thoroughly revised. The duties of the Commissioned Branch, Military Per- sonnel Division, were .segmented and reassigned to four separate branches. The Procurement Branch processed all applications for appointment of commissioned personnel in all corps of the Medical Department. The Classification Branch examined all data concerning the civilian background of officers and placed officers in their proper professional assignments, maintained all the files relating to the classification specialties of officers, and recommended qualified officers for specialized assignments. An Operations Branch issued travel orders for personnel under the control of The Surgeon General, recommended assignments of personnel to The Adjutant General in order to fill vacancies.in new units or task forces, and controlled the promotion of officers under the authority of The Surgeon General. A Records Branch maintained the personnel cards and 26 files for all Medical Department officers. The Enlisted Branch ■> .-continued to exercise administrative control over the warrant officers and enlisted men of the Medical Department and to make recommendations regarding the allotment of enlisted personnel •.. for stations and units.6 Few changes wore made in the civilian Personnel Division. It will be recalled that this division had been thoroughly reorganized in The Brployment Branch, . however, was divided into two parts. The Recruitment and Place- . ment Branch continued to carry on most of the functions of the .old branch but surrendered to the Status, Payroll and Records Branch all processing of personnel papers, preparing payrolls, maintenance of personnel records, and the preparation of all personnel reports.8 ■ In addition to acquiring the Research Coordination Branch, as noted above, the Plans Division of the Operations Service was subjected to further important changes. It was divided into six branches, three of which had been recast from old ones The Mobilization and Overseas Operations Branch continued the functions of the old Mobilization Branch but added the "plan- ning for the mobilization of all types of Medical Department units."9 The Organization Branch became the Organization and Equipment Allowance Branch, and assumed those functions of the Field Equipment Branch which included the preparation of Medi- cal Department Tables of Allowances, Tables of Basic Allowances and Tables of Organization and Equipment. In .addition, it reviewed the medical sections of Tables of Organization and Equipment of other arms and services. The Field Equipment Branch' was reconstituted to supervise and develop new and existing field equipment; to represent The Surgeon General on the- technical committees of other arms and services; and to review the specifications for field equipment prepared by the Supply Service. . Three now branches were designated-within the Plans Division. The change in status of the Research Coordination Branch did not change its functions. It continued to bo re- sponsible for coordinating the administrative details of the Medical Department agencies concerned with research and develop- ment projects, v/ith liaison to government and civilian research agencies, and with the administrative and clerical duties of the Medical Department Technical Committee. The Inspection Branch was reconstituted to coordinate inspections conducted by officers from ail services of The Surgeon General’s Office and the inspection activities of the service commands relating to professional treatment, training, hospital administration, hospital facilities, and sanitation. All other planning activities were placed under a Plans Coordinations Brancn. These included periodic plans involving medical service for occupied areas and medical problems incident to demobiliza- tion. 27 Other divisions of tba- Choc rations Service v/crc little changed. The Hospital Construction Division was continued with no stated alteration in functions. ' A minor rearrange- ment was made in the Hospitalization and Evacuation Division, which divided it into the Hospital Policies Branch and- the Evacuation Branch. The former assumed, most ..of. the duties of the old Miscellaneous Branch, correlated all activities, made inspections of hospital administrative functions, and recom- mended measures to conserve manpower in the treatment of patients. The latter performed all. the duties of the former Bod Credits and Evacuation Branch and added liaison'.with tho Chief of Transportation in order to coordinate.the medical and sanitary activities in Ports of Embarkation and.the medi- cal service on transports and hospital ships. Only one division in .the Administrative Service remained untouched by the new scheme of organization: namely, the Historical Division. As noted before, the. Research and Development Division had been deleted and the Legal and. Fiscal Divisions added to the Administrative Service. No change in function was indicated;in 'either case. The Vital Records Division was renamed tho Medical Statistics Division and continued to operate without modification in actual organization. The Office Administration Division became the Office Service Division. Three branches of this division were little changed. The Mail and Records Branch was charged with pro- viding internal security for classified materials in addition to .its other duties; the Hospital Fund Branch ceased to ap- prove applications for admission of pay patients to the Army and Navy General Hospital; and minor .changes were made when the Office Commodities and Reproduction Branch became the Office Commodities. Branch. The stenographic pool was as- signed to a new General Service., Branch. This branch also edited requisitions for utilities, assigned office space, and performed other general service functions. A Publica- tions Branch was established to review proposed SGO direc- tives and- orders for content and form, maintain distribution lists, edit manuscripts for publication, analyze incoming informational material, and to edit and manage The'iirmy Medical Bulletin. The organization chart implementing the above changes was approved by The Surgeon General and published on 15 June 1943 He then forwarded the chart to the Command- ing General, Army Service Forces, for nconsideration and approval.The Commanding General approved the proposal as a working organization for the immediate future, but ’’desired that consideration be -given to . . . further simplication of the organization by; 28 Combining Issue Branch and'. Stock Control ■ Branch; , : • ■" V Combining Price Adjustment and Cost Analy- sis Branches with the Purchases Branch; Combining the Requirements Branch with the Supply Planning and Specialties Division; Placing the Research and Development Branch under the Chief of Supply Service; and Combining of the Hospital Construction Divi- sion and the Hospital and Evacuation Divi- sion, ”13 The Surgeon General, after careful consideration, sub- mitted a defense of the proposed supply organization in which the first four points had been raised. On the first pro- posal, he pointed out that; The Stock Control Branch performs the func- tion of distribution of material as furnished by manufacturers, and also by effecting inter-depot , transfers when necessary. Constant effort is made to minimize inter-depot transfers to avoid cross hauling. The function of the Stock Control Branch really falls under the classification that has now been designated by Headquarters, a.S.F., as ’’Inven- tory Control,” The Issue Branch is concerned with the issuing of medical supplies and equipment to stations in the Zone of Interior, to tactical units in this country, and to overseas bases. The func- tions of the two branches are entirely distinctive and are not susceptible of amalgamation, . . . The present Stock Control Branch should be redesignated the Inventory Control Branch.13 In addressing himself to the second proposition, The Sur- geon General stated; The Price Adjustment Branch and the Cost Analy- sis Branch constitute the whole of the Renegotiation Division. The question of combining this with the Procurement Division has been considered carefully both in setting up the present organization of the Supply Service and also in the last previous organi- zation, and has been reconsidered in the light of your inquiry. The reasons governing the decision still seem controlling: namely, that the renegotia- tion function is, a reconsideration of what the con- tract-price should be after review of the manufac- turer’s' oweration and experience, thereby involving factors frequently ndt available to the contracting officer at the tine the contract was originally 29 SURGEON GENERAL DEPOT! SURGEON GENERAL crrice ttwical itmaKHATun EXECUTIVE OFFICER OQNnGL DIVISION FLOrBSSISSAL CSSS ALT APTS AT 1ST IOB BBBIC IBB ■BB IS AL “ S SL 1 S |C AL SB SB BPS TC B I ATS 1C FBBTB ST ITB ■BBICIH BIST A L TBTBBISABT BBC OBSTBBCT IBB CHIEF OF IDNniSTRlTIVE SERVICE CHIEF OF OPERATIONS SERVICE CHIEF CP SUPPLY SERVICE CHIEF or PROFESSIONAL SERVICE CHIEF OP PERSONNEL SERVICE DIVISION TRAIN DC DIVISION RJNS DIVISION * MP EVACUATION DIVISION HDGPIT4L CONSTRUCTION PIVISKW DISTRIBUTION k mxJimasTs dtv PROCUOMD-fT nivisiCN SUPPLY FUWre* AM) SPECIALTIES _piYiam DfiwurnaL DIVISION HJMQOTIATICN DIVISION CIV. 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OCCOFAT IOBAL ■TO ISO SS irmsioLMT •AA sc b sssical irriuimci si. MBBICAL BB FT BO A AD RADICAL DIPT. • 001F LAB* ABST MBBICAL C B ST BS ABST MBBICAL HBSSOH ASST VBOICAL LIBAAAT MDICAL BAFOTS MBBICAL Birr. FBOCOLBMST D 1ST OCC BFAT iosal ITS IBS! Ul. BBS IOTA 1 SBI SOTB S IBB SOTB * SBI SOTS « BBS Mft » ion 1 * MD. DOT. HD. WONTS DIBCTLY ID PLANS DIV. . IPMTKIB SERVICE. IOB 2 ■ MB). DMT. WJUT LAB. MKETS DIRECTLY ID RWJETH k DEV BE. . PLANS DIV.. CREATIONS snrvicx. ion 2 . MED. DBPCm WORT DDQCTLY TO DISTTORTirN DIV SIPPLY SWVICL. ion 4 - m>. DEPT. PEDC. DIETS. REPOBT DOTTTLY TD FROTURBENT DIV. . SLTO.Y SWVICE. NOW S * OCCUPATIONAL HVO. LAB. , REPORTS DIRECTLY TO OOCLP AT ICNAL HVG. EE. . PREV1N- rmM). div.. prof spy MAJOR GBNHML. U. 8. AMT TYB MORON GMM. JIMI IS, 1943. CHART XI entered ihtp. Particularly’the cost analysis ■ function is not- one performed by the ’Purchases Division and the procurement officer. The re- lationship is much .the same as that of an .audi- tor to. the accountant whoso work he reviews. It is believed fundamental that these two functions should not report to the•same divisional author- ity.16 His third point sought ,-to explain why it would be impracti- cable to combine the Requirements Branch 'with the "Supply Plan- ning and Specialties Division; The Requirement & Branch was formerly an ;- independent division of the Supply Service hut in the recent reorganization was'- made a branch of Distribution and Requirements Division. A • principal function of this Branch is the compu- tation of - the Array Supply Program, which is .a long-range procurement plan, with the required quantities listed by calendar years only.: some months the Supply Service has been.:consider- ably confused by the fact that this long-range program was not properly coordinated with the comparatively short-term needs for issue and for assembly of unit equipment. These needs had to- be ‘computed by the Distribution Division for its -operations. With the inclusion of Requirements Branch in-the Distribution Division, this compu- tation of short-term needs and the correlation of it with the longer range planning in- the Army Supply Program is assigned to the Requirements Branch; A second important function of the Re- quirements Branch, is the policing of maintenance rates used in computing the Army Supply Program, for.which a closer connection with the depot • issue rales had proven desirable. In the short ■space of a month, the desirability of inclusion of .Requirements Branch in Distribution Division has been proved conclusively to the officers ■directly concerned. The planning function of the Supply-Planning and Specialties Division is quite different from the, function of computing the Army Supply Program. It involves a great deal ,of coordination and liai- son with other services in the Surgeon General’s Office; particularly-various divisions and branches of the Professional Service, representation on the Technical Committee,- and other such groups concerned with the determination of standard Medical Depart- ment items. Based on the information thus obtained, this division plans the Supply Service activity 30 necessary to carry into effect the procurement and issue , of the ,items; decided upon. - A concrete example is the recent decision to supply dyed , bandages and dressings in theaters of operations. Carrying this into effect involves foresighted planning-of a great many detailed steps. The work of the Supply Planning and Specialties Divi- sion-in such cases is proving very beneficial to the operations of the Supply Service.^ The fourth suggestion, that of placing, the Research and Development Branch under the Chief of Supply Service, was dealt with at some length: The Research Coordination Branch (formerly the Research and Development Division) does not correspond in function to the research and develop- ment branches or sections of other technical ser- vices, It exercises no control or authority over the actual execution of research and development projects. It is essentially the coordinating agency for administrative details of tho Medical Depart- ment research program, including consolidation of research estimates and progress reports, corres- pondence with Headquarters, Array Service Forces, and execution of essential stops in each research project including the standardization of any newly developed items or the reclassification of existing items. It carries on all the clerical and adminis- trative activities of the Medical Department Tech- nical Committee, It acts in a liaison capacity with various civilian and federal agencies on research matters. In short, the Research Coordi- nation Branch is administrative in nature rather than technical. The wide range of responsibilities and acti- vities of the Medical Department necessitates the assignment of professional and technical functions to several different divisions, each handling activities within a limited field. Thus the Medi- cal and Surgical Divisions arc responsible for all therapeutic measures, the Preventive Medicine Division for preventive measures, the Veterinary Division for veterinary service, the Dental Divi- sion for dental service, and the Plans Division for the organization and field equipment in addi- tion to tho other functions implied by its title. Each of these divisions is responsible not only for tho administrative handling of matters within its field of activities 'out also for the advance- ment of technical knowledge, supplies, equipment and methods applicable to these activities. 31 Therefore, the responsibility for the technical and professional aspects of research and develop- ment is assigned in part to each of several divi- sions according to the research or development project in question. . . The transfer of the * Research Coordination Branch to the Supply Scr- vice .would bo justified only in the event that it was desired to, separate developmental projects * from those of fundamental professional research. In that event there might be a development branch or division in the Supply Service and a research division or branch in the Professional Service* This immediately would present tho need for the establishment of some central branch or division to consolidate the fiscal activities, progress reports and other administrative details incident to the operation of these two divisions or branches. The Research Coordination Branch fulfills this latter requirement as now organized.L8 The final suggestion made by the Commanding General, iirmy Service Forces, concerned combining hospitalization, evacua- tion, and hospital construction functions of the office. This suggestion was accepted by The* Surgeon General, who proposed that all administrative functions relating to hospitals be brought together under a Hospital Administration Division. At the same time he pointed out that the'control of profes- sional hospital policies would not be included in the new division. He. further proposed to .establish the following branches and functions; The Evacuation Branch to establish bed credits and coordinate the evacuation of patients; A Policies Branch to establish and promulgate hospital administrative policies; . .The Construction Branch charged with all hos- pital construction activities;• and A Liaison Branch to provide' for important liaison activities with the•Transportation Corps in the coordination of movement of hospi- tal trains and the technical; supervision of medical service at ports and-'staging areas;, with’ the 17AC Headquarters for all phases of medical’ service relating to women in the Army; and with the Provost Marshal General for medi- cal service to prisoners of war.19 The Commanding General, Army Service Forces, agreed to all proposals set forth by The Surgeon A new organiza- tion chart of the Office of The Surgeon General was then pub- lished incorporating the .changes in the Hospital Administration : 32 Division.2-1- Liaison officers were placed on duty with the Transportation Corps and with the Women’s Army Corps; and a Prisoner of War Liaison Unit was instituted in the Office of The Provost Marshal General. The Liaison Branch was further designated as ’’the central office for all medical matters pertaining to those agencies” through the Operations Service, 2 An office order confirmed the changes and estab- lished detailed functional descriptions of the entire office find,its component parts.2^ The modus operand! set forth at this time was not re- garded as the final solution to The Surgeon General’s pro- blems of office organization. The very speed with which the new plan was evolved glossed over some areas still badly in need of reform. The situation was not improved by the announced intention of the Army Service Forces to reduce the ceiling on civilian personnel in the office.24 In an effort to meet the proposed reductions without the sacrifice of essential work and to increase the efficiency of the Office of The Surgeon General, representatives of the Control Division commenced intensive study of the Fis- cal Division during July 19-43. The division at this time consisted of the Budget, Accounts and Reports, Ex- penditure Analysis, Voucher Audit, and Field Supervision Branches. The analysis made by the Control Division of the functions of these branches disclosed that the work of the Voucher Audit Branch consisted, in the main, of auditing vouchers which could bo more efficiently audited in the field. It showed further that the Expenditure Analysis Branch analyzed and prepared reports regarding cost of operations which were primarily used as supporting data for the Budget Branch. The investigators believed that most of these activities could be eliminated and that all essential work-could be performed without loss of efficiency by the Budget Branch or by the Accounts and Reports Branch. These conclusions were agreed to by the Director of the Fiscal Division, and the Voucher Audit and Expenditure Analysis Branches were eliminated. No change was made in the operation of the Field Supervision Branch.26 As a direct result of these readjustments, the number of officers in the division was reduced from 11 to 8, and 27 of the 78 civilian employees were released for other duty.2^ The search for ways to improve the utilization of personnel and equipment led to further changes. Both the Statistics Division and the Supply Service had long main- tained separate branches for the production and processing of machine records. Close examination of the type of work done in each branch disclosed a wasteful duplication of effort which would be eliminated if the two branches were 33 SDKGBGM GENERAL DEPUTY SURGEON GENERA1_ EXECUTIVE OFFICER OFFICE TDMOt ngowgriw coma. DIVISION rtlHMIMU CORSRLTAVTS ifliflM MUCIii mien “ EVE14ICAL llWlMTtiUTUC miiiTivi 9991k L TBTBElBftET m»« mwiw CHIEF OP UXHINIsnUTIVE SERVICE CHIEF CP PERSONNEL SERVICE CHIRP CP OPERATIONS SERVICE CHIEF OP SDPPLT SERVICE CRISP OP PROFESSIONAL SERVICE DIVISION CIV. PJRSOTML DIVISION I " TRAINING DIVISION PLANS DIVISION nw>. AMIN. DIVISION nisnmvricN * FBCUTRMNrS DIV memoir division SIPPLY PUVffDC AND SPECIALTIES B1YMCT .-J mnurmi DIVISION RNOGTIATION DIVISION PA ICE AS JUST BEET BA. PAOCUAI0ET BRAKE RIClUITaVT ABE PLACEMENT REPLACE * ET TRA IHIEO CERTXR BRA EC I RISE ARC I COOR- DINATOR BAAMCB POL1C IBS EAAECE •TOAAEB EAAECE PORCEAEBS EAAECE h CATALOE A AQUXP- EBET LIST BE. aealteie EAAECE CLASS IP IC AT ION BRAKE CLASS IP IC AT 1 >N A MAOS SEMIN. BAA EC N TRAINIHC DOCTRIRE BAA EC ■ MOB 1L1SAT 1 OR * OTEAREAS OPE RAT 10 RS RR IT AC OAT I0E ■AAECE *EQUIAB*BTS EAAECE PACE OCT IOH EAAECE EACH IB ABCOAEB IB. ABPORTE AEE ACCORDS EA. CEET A SALTS IS EAAECE OTE RAT IOEE BRAKE TAA1 N INC BRARCN SCHOOL ■AAECE OA0AR1ZAT10H * EQUIP*RT ALLOW ARCS 1AARCE C0MTA0CTI0B EAAECE lAtUE EAAECE SPECIALTIES EAAECE ABE 10 HEBVTt EAAECE URIT TRAIR1RC SAAECB IITBETOAT COB* TROL EAAECE AB POSTS EAAECE ABC OREM BRAKE ■MPLOTBB RELATIONE FLARE COORDIN- ATOR BAA EC H LIAISON EAAECE ■ ■LISTED EAAECE PATROLL STATUS A RECORDS I REFECT I0E BRA EC R EAIETBHAECB (ABPAIR BA.) FIBID 1QUIPKNT DEVELOP* ET HR op? icx smviLs DIVISION UQAL DIVISION FISCAL DIVISION MBD. STATISTICS DIVISION HISTORICAL DIVISION MD1CAL DIVISION SUCKS. DIVISION CENTAL DIVISION ywrmvmr DIVISION mm DIVISION PBWTIVE MDKIM DIV. RKXfOniONINC DIVISION SEVERAL BEAT ICE IE • ACCOOETA A ABPORTS ■AAECE IHDITIOUAL RECORDS EA ISO IC I EE EAAECE SUACKRT EAAECE EKETAL SBETICB EAAECE AEXMAL •B1VICB SR EOAE1B4 »EATICE EA. »ARITATIOE AAA VC I •At ' IX AA OAT I OH EAAHC1 POBLIC AT IOEE EAAECE TOOC BEE AUDIT EA. ■BALTS REPORTS 3R• EKUA0PETCSIAT1T EAAECE AADIATIOE EAAECE DBHTAL POLICIEE EA. MBAT A DAXBT 1TEIBEB »A- ■BASIES POLICIES E» SAEXTAAT KE4IEBEAIE4 EE- PETE ICAL RICOKTT IQRIRO EE ▼ETBAIHAET POLICIEE EA« LAEOAAT OAIIA ■AAECE OCC SPAT I oral T ME APT EE. ■AIL * RECORDS EAAECE 9UE0ET EAAECE STATISTICAL AEALTS IS BR HUT R IT I OH BAA EC ■ PETS ICAL TBiAPT EA. V BREAK A L DXEEAES COETAOL SAAECB EMPITAL PURE SAAECB KZPVED IT DAE AEALTS IB BA. MACEIRBE ■AAECE PROCURE MEET AST It OAT EAAECE OPT ICE COMMODITIES BE PULE SUPEAVISIOH BAS. EKLBCTITB SERVICE RECORDS BRA EC R PETEICAL •TAEEAAEA EA. OCCDPAT I ORAL BTC IEEE EE KFIDBEI0LO4T BRAKE FIELD INS! ILATIONg MED1CAL 1 NT ILL I4RECB EE. an IEEOETRIAL ■YE IEEE LEE. EBB PETE § MEDICAL SEPT. SCABS ME ICAL DIPT. EQUIP. LAE. MEDICAL FIELD SBETICB EC BOOL ARET BED ICAL CEHTKE ARKT MEDICAL HUB EVE ABET BED ICAL LIBAAET MEDICAL DEPOT • HRBICU. DEFT. nocaiiMin diet. SEE ROTE 4 in hot* • ABB HPTt * •BE EOT! * »il 1 - MB. WT. BD MPONTS DDOETLY TO FUNS DIV,, CFBUOTCNS SBOTCK. NOTE 3 - MB). DBPT. EQUIP. LAB, REPORTS DIRECTLY TO RESMCR COOK. BR. . FLANS DIV. . CPBMTIQNS SERVICE. Non 3 - BD. mors KWURT DXRBCTLY to DISTRIBUTION * RBQUIRBBNTS DIV.. SLY. sat. NOTE 4 - MB). tMPT. FKC. DIETS. RRPORT DIRECTLY TO FWOCUmgrfT DIV.. SIPPLY SER. NOTE 3 - AWT IfOJSTRI*. BIG. LAB. REPCRTS DIRECTLY TO OCdPATICNJC. HTC. BR.. FUWWIIIIMP. DIV.. PBCr gRV. MAJOR GSNER/L, U. S. ARMY Hi SLSCBON GENERAL JULY 10. 1V43- CHART XII merged into a single machine records unit. The separate branches we re then abolished and a Machine Records Branch was created in the Office Service Division during August 1943* The new branch continued all the essential functions of the old branches; they punched, sorted, and tabulated cards from Selective Service reports; computed the Army Supply Program; and prepared the'Consolidated Stock Report and other stock control reports. The trend towards simplification in the Supply Service was carried a step further in September 19139 when the Sup- ply Planning and Specialties Division was abolished. The Reports Branch of the division was transferred to the Chief of the Supply Service, and the remaining activities were assigned to the Procurement Division,^7' Within two months, however, further reorganization within the Supply Service reinstated the old Supply Planning and Specialties Division as the Supply Planning Division with expanded functions. In addition to its administrative and coordinating duties for special programs not following routine channels, this division had the responsibility of preparing and distribu- ting the Medical Department Supply Catalogue and Equipment Lists and with aiding in the development of new iterns.30 The reorganization of the Supply Service in November 1913 moved the greater portion of stock control activity to New York City. This important change had been recommended by the Director of the,Control Division and the Acting Chief of the Supply Service.33- Movement was facilitated by the reorganization of the Medical Department Procurement Dis- tricts which had taken place in September 1913• At that time the New York Medical Department Procurement District was redesignated as The Army Medical Purchasing Office with branches in St. Louis and Chicago, and the St, Louis Medi- cal Department District was abolished. The terms of the directive which created the new organization held it "res- ponsible for the actual, procurement of medical supplies, including production control, issuance of priorities, survey of facilities, and inspection of supplies."32 . 306.00. . ?r 10Ihid., p. 306.00 7-8 Organization Chart, approved 15 Jun 194-3; Chart XI of this study. from (The Surgeon General General for the Com- manding General, ASF, subject: Organization of Surgeon General’s.Office, 18 Jun 1943 (Record Hoorn, SGO, 024.-1). , 1st Indorsement, 1 Jul 1943.. , 2nd Indorsement, 7 Jul 1943.. ~^Ibid., par la. 16Ibid., par lb. , par 1c. •^Ibld., par Id. 19Ibid., par 1c. 20Ibid., 3rd Indorsement, 10 Jul 1943. Chart, 10 Jul 1943; Chart XII of this study; Memorandum from the Executive Officer, SGO, to the Control Division, ASF, 28 Aug 1945 (SGO, . Record Room, 300.7-1). Office Order 466, 14 Jul 1943; Annual Report of the Operations Service, SGO (The Prisoner of Jar Liaison Unit), 1944 (Historical Division, SGO, 319.1-2). 23SG0 Office Order Ml, 12 Jul 194). 25faio for all Officers, SGO, 9 ittig 1943 (Historical Divi- sion, SGO); Inclosure 2, Memorandum from the Acting Director, Control Division, SGO, to the Director of the Control Division, aSF, 23 Aug 1943 (Record Room. SGO, SPMC 024,-1). Ibid., Inclosurc 2. °Memorandum from Executive Officer, SGO, to Control Divi- sion, ASF, 23 Aug (Record Room, SGO,' 300.7-1); Army Service Forces Organ!zation Manual (301), Revision of 1 Oct 1943, p. 306.00 (Historical Division, SGO). 4-5 " 27 J 'Memorandum from the Director, Control Division, SGO, to the Director, Historical Division, SGO, 20 Jun 1944, p. 8 (Historical Division, SGO, 319.1-2). 28 'SGO Office Order 630, 26 Aug 1943; ASF Organ! zat ion iianual (301), 1 Oct 1943. p. 306.00. Z 29SG0 Offico Order 64S, I Sop 1943. 30 Yates, opus cited, p. 39; Supply Service Memorandum Ho. 1, 29 Nov 1943. Report of Control Division, June 1943 to June 1944, 16 Jun 1944 (Historical Division, SGO, 319.1-2). II, Army Service Forces Circular Ho. 79, 15 Sep 1943. 33Supply Service Memo randan No. 1, 29 Nov 1943. 34sGO, Office Order 837, 27 Oct 1943. 35sgo Office Order 109, 3 liar 1943. 36SGO Office Order 797, 9 Oct 1943. 37SGO Office Order 823, 21 Oct 1943; Memorandum from the Commanding General, Army Service Forces, for . . . Chiefs of Technical Services, subject: Personnel Control Units, 29 Sep 1943 (Historical Division SGO, 230.-1). 3ciSGO Memorandum for all officers, 28 Aug 1943. 37SGO Memorandum for all officers, 17 Sep 1943; SGO Office Order 725, 20 Sep 1943. Office Order 165, 26 Mar 1943; Office Order 666, 3 Sep 1943. Office Order 702, 14 Sop 1943; Foreword to giro Bui- let in of the U.S. Army Medical Department, V, No. 6, (June 1946). ~ CHAPTER V REORGANIZATIONS DURING 1944 Daring his first six months in office, -The Surgeon General, Major General Norman T. Kirk, had succeeded in mak- ing notable economies in the operation of the fiscal and supply activities of the Medical Department. While problems still remained to be solved in these fields, he was able in the fall of 1943 to devote more attention to securing a more effective Organization to carry out the professional aspects of the,Medical Department mission. In the effort to achieve this erickyi 'a series of readjustments and two additional reor- ganizations were made in the Office of The Surgeon General during the period from November 1943 to September 1944. These reorganizations were designed to provide for greater’decentra- lization of authority; to coordinate, through the Operations Service, the activities of all divisions contributing to Medical Department operations; and to separate administra- tive activities from advisory functions. The Separation of The Professional and Preventive Medicine Activities — Reconstruction of the Office of The Surgeon General, according to the above plan, actually began at the center of professional activity. In November 1943, the Professional Service consisted of an unwieldy grouping of seven more or less unrelated professional divisions. The enormous task of administration for the whole of the service was vested in a single Chief of the Service, who was respoilsible for its entire operation. The Surgeon General apparently believed that the problems relating to the administrative management of the many phases of preventive medicine should be sepa- rated from the purely professional problems peculiar to the rest of the service. Sometime before 3 December 1943, he directed that the Chief of the Professional Service recon- sider the organization of his service, and, together with the Director of the Preventive Medicine Division, develop plans for the separation of the Preventive Medicine Division from the rest of the service. The Director, Control Divi- sion, SGO, was designated to assist -both principals with the planning and to act as coordinator for The Surgeon General in presenting the final proposal to the Control Division, Army Service Forces, for approval.^ The planners agreed that all activities relating to the work of the Nutrition Branch properly belonged in the field of preventive medicine. Following this decision, each -Chief prepared a detailed chart to be used as the 41 working basis for his The result of this activi- ty was published in an office order on 1 January 194-4 which established the Preventive Medicine Service and redefined the organization of the Professional Service.-* _ The reorganized Professional Service consisted of eight divisions and two branches. The two branches, established as activities in the Office of the Chief, had been trans- ferred to this level because they related to the activities of more than one division. The Editorial Branch, formerly located in Preventive Medicine Division, was charged with management and issue of ffho Bulletin of the Army Medical Department. The'Procurement and Advisory Branch, formerly a branch of the Medical Division, was made responsible for rendering professional advice on medical supplies. The most important change made in the service was the establishment of the Neuropsychiatry Branch as a division. This, change had been strongly recommended by the Chief- of the Service in Order to properly care for the great in- crease- in neuropsychiatric problems. It was hoped thai divisional status ’’would facilitate getting an outstanding man, and . . . furnish a strong basis for obtaining a sub- stantial increase in officer and civilian allotment, because of the increase in the Job vdiich necessitated making this a The work of the division was to be accomp- lished through the Psychiatry, Neurology, and Mental Hygiene Branches* Another . important change raised the Physical Standards Branch, Medical Division, to division level in order that physical standards be better formulated and the general supervision over physical examinations, Incident to admission into and separation from the military service, might be more adequately exercised. The activities of the division were conducted by the Induction, Appoint- ments, and Dispositions and Retirements Branches. The Medicine Division (formerly Medical Division) was rearranged into three branches: the Medicine Branch became the General Medicine Branch without essential change in function; a Tropical Disease Treatment Branch was activ- ated to establish policies and procedures for the diagnosis and treatment of tropical diseases in the Army; and the control of tuberculosis in the Army was delegated to a new Tuberculosis Branch. The Medicine Division lost four branches in the process of reorganization, in addition to the above changes. The Nutrition Branch was assigned to the Preventive Medicine Service; the Neuropsychiatry and Physical Standards Branches, were made full divisions in the Professional Service; and the Procurement Advisory Branch was established as an activity directly under the Chief of the Service, 42 A general revision also took place in the Surgery Division (formerly Surgical Division). A General Surgery Branch was established in place of the Surgery Branch; the Physical Therapy Brandi was deleted; and the Orthopedics, Transfusion, and Chemical Warfare Branches were added. No change was made in the Radiation Branch. In the Recondition- ing Division, the War Exhaustion Branch v/as dropped and an Educational and Vocational Rehabilitation Branch added. The specialized problems relating to the war blinded and deafened were to be provided for in a newly-established Blind and Deaf Rehabilitation Branch. The remaining units of the Profes- sional Service were little changed. The Nursing Division added a Nursing Morale Branch in order to provide liaison for the Army Nurse Corps in public relations matters. No changes were made in the organization of the Dental or Veterinary Divisions.5 The Chief of the Service continued to direct and coordi- nate the activities of the Professional Consultants in Avia- tion Medicine , Internal Medicine, Surgery, Neuropsychiatry, Reconditioning, Dentistry, Veterinary Medicine, and Tuber- culosis . The weakest point in the January 19-44 reorganization of the Professional Service was in the failure to provide deputies to assist the Chief of the Service in the over-all administration of professional matters. This shortcoming was soon remedied, however, by the appointment of a Deputy Chief in January and the assignment of an Executive Officer in February. By the end of the fiscal year, an Assistant Chief had been assigned. Further aid, in addition to per- sonnel, was given to free the Chief of Service from many of his administrative tasks when the Deputy Chief assumed responsibility for the Editorial Branch. In addition, a unit,' designated as the Professional Inquiry Branch, was organized in the service to handle the many inquiries for- merly directed to the Chief of the Service, 7hich required professiqnal investigation for the Office of The Surgeon General.^ The Preventive Medicine Service was established by the same order which recast the Professional Service. The or- ganization of this service, however, provided for both a Chief of the Service and a Deputy Chief. This was a wise decision, for in addition to administering the ten branches established in the service, the Chief of the Service directed the activities of the Board for the Investigation and Control of Influenza and other'Epidemic Diseases in the Army. The Deputy Chief also served as Director of the United States Typhus Commission.1 In the establishment of the service, seven branches of the old Preventive Medicine Division were 43 . ;t ’ . reorganized as divisions. These branches now constituted the Sanitation and Hygiene * Epidemiology, Laboratories, Sanitary Engineering, Venereal Disease Control, Occupa- tional Health, and Medical Intelligence Divisions'; l-'The Tropical Disease Control Section of the former Epidemi- ology Branch also became a separate division and was com- posed of four branches; Control Policies, Education, Field Survey, and Malaria Control. In addition to the divisions which stemmed from former branches, two new divisions were added; the nutrition Division, formerly a branch in the Medical Division, Professional Services*, and the Civil Public Health Division which was estab- lished by The Surgeon General in recognition of the Army1 s responsibilities for the maintenance of the health populations in occupied and liberated countries. The latter division assisted in the selection of specialized personnel, maintained contact with field operations, and integrated its program with those of other agencies.' In order to fulfill its mission the Communicable Disease and Laboratories, Public Health Engineering, Nutritional Defi- ciencies, and Maternal and Child Health Brandies were estab- lished.® To maintain efficient administration over the'ten divisions, an Assistant Chief, Preventive Medicine Service, was designated in February 1941. He exercised general con- trol over the Sanitation and Hygiene, Epidemiology," and Tropical Disease Control Divisions, reporting directly to the Chief of the Service on the activities of these divi- In March the position of Executive Officer, Pre- ventive Medicine Service, was created, , The reorganization of the Professional Service and the separation of preventive medicine activities from the Pro- fessional Service achieved a greater decentralization of authority and constituted the first stage in the marked effort to reorganize the professional activities of the Office of The Surgeon General. *.* ■ Reorganization for Operations The realignment 'Of the Professional and Preventive Medicine Services constituted the first phase in a .compre- hensive program for the reorganization of the Office of The Surgeon General. Planning for the second phase centered around the activities and functions of the Opera- tions Service,’although other services would be affected by the changes made in the control of all operations activi- ties, In the first place, it was believed that the exist- ing organization for hospitalization and evacuation was not adequate to handle the planning for the expected heavy load of casualties from the European Theater. A reorganization 44 and expansion of the Hospital Mministration Division was "believed to he urgently needed. In the second place, The Surgeon General had decided that all matters which required attention from more than one of the operating services in the Office of The Surgeon General should he supervised and correlated hy the Operations The need for coordi- nation was especially apparent in three distinct areas. The first hroad field of activity which needed coordination re- lated to the civil affairs activities in occupied territories. In June 1943 a Board to prepare, develop, and implement the medical portions of the war Department program to aid civil- ian populations in liberated countries had been established. The actual responsibility under this program had been divided between the Supply, Veterinary, Dental, and Preventive Medi- cine Services. The Surgeon General decided that the Opera- tions Service should be responsible for assuring adequate and coordinated action by the several services Involved in this As a. result of this decision, it ms pro- posed to establish a branch for this purpose in a Special Planning Division of the Operations Service. A similar necessity existed to assure adequate and corre- lated actions of the various services in dealing with the medi- cal needs of women in the Army. It will be recalled that an officer had been appointed to maintain liaison with Headquar- ters, Women’s Army Corps in June 1943, but the responsibilities of the various services had never been absolutely fixed. To remedy this condition and to assure greater coordination, it was proposed, to establish a Women’s Medical Unit under the Operations Service. The third area in which greater coordination was needed related to supply planning activities. These activities demanded careful coordination "between the Procurement Advi- sory Branch of Professional Service, the Field Equipment Branch of Operations Service, the Supaly Service in Washing- ton and in the Army Medical Purchasing Office, and at tines, the Medical Field Equipment Laboratory at Carlisle Barracks, The number of agencies Involved in the process had often led to bad teamwork. For example, decisions by the Professional Service, which necessitated immediate changes in the -cat- alog , often upset the routine of the Supply Service. The Supply Service had attempted to Improve supply planning acti- vities by establishing a Supply Planning Division, but this arrangement did not work out to the satisfaction of all agencies involved. The functions assumed by the Supply Plan- ning Division overlapped those of units in the other services. Because of the many difficulties involved, it was ’’believed that the sound solution is, in laccordance with the principal ... followed in other instances involving necessity for action by more than one Service, to assign to the Operations Service the responsibility of seeing that new supply items . . . are promptly developed , f , and that the activities of the Procurement Advisory Branch, Field Equipment Develop- ment Branch and the New York Medical Purchasing Office are properly coordinated. In addition to these recommendations, a very strong argument was advanced to increase the power of the Chief of the Operations Service. It was proposed that a new post of Assistant Surgeon General be created with authority to co- ordinate all the services in the Office of The Surgeon General, and further, that the Chief of Operations serve in both capacities. The Surgeon General was not yet ready to accept this proposal, but held it in abeyance until the success of the other features of the reorganized Operations Service could be determined.13 The neY/ proposal for the reorganization of the Office of The Surgeon was approved on 3 February 1944, although all the features of the plan wore not set into immediate opera- The reorganization of the Operations Service pro- vided for a Chief of Operations and a Deputy Chief of Opera- tions. Two units were made the direct responsibility of these officers. The Medical Department Technical Committee Y/as placed under the direct authority of the Chief of Opera- tions. This committee was one of the most important in the Medical Department, for it reviewed and approved the standard- ization and reclassification of Medical Department supplies and equipment. The committee had been standing committee during the war years; and placing it at this level indicated the importance 'The Surgeon General attached to coordinating research activities in the Operations Service. Provisions were made for Strategic and logistics Plan- ning Unit under supervision of the Deputy Chief. Actually, the functions of this unit .were the -personal responsibility of the Deputy Chief until the unit was established on 15 March 194-4 and a Director was assigned in April. The func- tion of the unit was nto determine the adequacy of all phases of Medical Department operations, and plans therefor, to the extent necessary to insure timely placing of suffi- cient personnel, equipment and supplies to meet all author- ized requirements.”45 The remaining functions of the Operations Service were grouped, with the exception of.,training activities, under the control of a Deputy 'Chief for Plans and Operations and a Deputy Chief for Hospitals and Domestic Operations, The Deputy Chief for Plans and Operations supervised the activi- ties of the Mobilization and Overseas Operation, Special Plan- ning, and Technical Divisions. All these divisions were new and require, at this point, a few words of explanation, 46 ORGANIZATION CHART OFFICE OF THE SURGEON GENERAL WAR DEPARTMENT THE SURGEON GENERAL DEPUTY SURGEON GENERAL EXECUTIVE OFFICER OOMT0OL O*\03*0* HI3TO0IC0L 0*0*3*0* —0900091 OO070OL 0**99 99030**9L 3900*09 00 rg 0*t l 090—111/771— . S1L! 0**99 SU99L7 99*0*09 0**99 09 [09 T*003 3100*09 JWMCAi IMMWfj ciiewTivc omen E=3- 000077 00*07 C777L— 007000 000077 CM*07 700 0000*7019 900 — 090077 00*7 | ■) I I MB—AM L, I —mk mil r 0 0***13 T*07*09 39*01099 CBAAB—ATAT.oJ L'*lWf Mi! ) ylS «ftnj •771— —071— 0*7*0*00 19001 0*0*9*00 0*710100 *90*001 0707*07*00 I 0*1*7007 79000—91 0*7*0*00 C*7*t*00 700SO000L 7U0C0000 0*7*9*00 tit ritmurtom am —WWW mutttom 0170—07*—01 09—007*07*— 700*00*0 0*7*0*00 0000*701 010101— 000H.lt*T,00 000 07009007 000000*00 0*7*0* — 0*7*0*00 700090001 0*7*9*00 •I—L —AVICI •aa a— BAA—A —W—M AT BAAACM BAAACM MICAUITACMT AAA Ll* HOB BAA—M ■▼ABACI AAALTBlB ■ I — C«TIAT%A BAAACM HA.AMHIT ■ TAAIBIBB CIATIA COMBTBUCT — T MCA T1A #1 MOBlLlXAT'BM AIMAABM CCCMM—T >0A MM—ICATM— —A—T BAAACM —ALTM AWAATB BAAAAM CLAMIUCAT I— BBAMCM A AMT MUM— BtAACM } MAM AMUITHAT —Am A«—ATI BAAACM AAAACA PIMB—. 09900 BAAACM TflAIAl— BOCTB— AAA ABM I VACUA T IOB BBAMCM imi awaibb BA*MCA C—AAltATlAA • I - ■—I —AT j ALL AM* A Cl BAA— ■ — IL • AIC — M —A—M MCLB BUMCAVIBIBA AAA BOM BTAT IBTICAL AAALTBIB ABIAATIAMB BAAACM TAAIBIBB BAAACM I — *0—0 —ITC aaaaca 0000V* MIA—A —•mi— —a— BAA— H BCUKTM —AVICI ACCAABB B—ACM ■ICAABA BAAACM — TMBBABT AIBC BAAMOM MNWH AIL* - TiOAl MM ABU IBVIBTOBT CAATAAL AAAMOM I A AMO, M M VAAK) —IT T—IMIMB MV|L— AT Ml AACM —AAA—CL IUMH - A ML ACC—AT BAAACM IT*TUB. BAT BO L Ll MABCM 0**99 0*09900*0*— L 99*9*09 cm 90 9*9V9*T*V9 *99*01*9 —0*77 00*97 0907000— 000099.7—70 0*790*9.01 *90*00* 00*00— A9—07—10707 0900*0*7*0**— 9909*0707 09790—007 *9990—9 70fi0f9k*0*0 00—97 0*097 00*7—10*. | I IMII '•r* — Ipirf a 0707—00 fMttvrnff mwfn AS9I9TA0T —mtr too ZSSZttT**■ ww» 000*0*00 0*00907 0*0*0*— I V——0700*0 70 7 I 0*0*0*— —70*— I 0*0*0*— 900*707*00 0 070*009 9*0*0*00 IffMlll 0*09099 0000901 0*¥*0I00 mrmrtm 0*0*0*— — —0lYo AKIM 0900*0*7*00*00 0*0101— —0701 0*0101— —700*0007 0*7*01 — 0000100 0*0*0*00 00000070*009 0*010*00 00*090*00000 0*0*9*00 r000*901 0*09009 9907000 0*0*9*00 9001 r00 r 000*0900090 0*0*9*00 hmmimh «u 0*0101 — MVM/M HA— — — L —MLAT BCTCMIATBT J A—MAM • ■•MC T IN HMM ■A—ATM—L A —AAML. —A—A ACMTAL MALICl|« AAA AAA AMI—L — AVICI BAAACM MWABlAB MOLICUB BA*MOM •AAlTAAT IAWIIMII BB*ACM MW LABOAATOBT HlWIII MM MM MIAN ML Ml II •AAMM CMIMk HUHM BA* AM MAM* * INIAT tW HAIM IMMTmi •KIMTMI WNtM I UMMtIMM TAAMMAL HA— T—ATM—T —TAA— AMA 9*0*0***T MMTCICAL •I—AAlTl—I — — AVAL —AVI— BAAACM —AT A AAMIT MTM — BAAACM MBITAAV ACAMIVI - 900 —LIBHB bbamcm MB LUOMTIIT TIOAAIC IAAAAW I—NMII4TMA BBAMCM ■A A A AM •AITI MNIAl MM "AA TA—T—AT ••am— MtUNTMAU. > MA1AA — MMH AAALTCM HUM NKH HBAlTH > INMMIIMH • ■AMU A—B— TAA—M— •— B—A —AVAL MTAIIAI —AMAH AMM—ITMA A — TlBIMIBT 0 COMMA TlO—L THIAAMT BAAACM IBWCATlAA tAMM A*U.«|II • IMVIT MAX* MILA IMVIT BAAACM " """I#ATAAL. I HUM MMIIIIIIH HUM MVTBiTiBBAL NDtiiaan MUM ■HflAAl MMTMI MAIM ALI— A MAI • AIMAAILI TATI— A A* A AM BALAAM Mil Ml ABM —C—AMCC 1AM MIAMI MAMA WTIMUI • . BMILB HIALTH MIN* Installations 0*0— *00*001 —70079*07 —0 0070 0 *00*000 7*010 0007*00 000—L 00977 000*001 000700 0007 000*001 009900 0007 090*000 0*00007 MM-M MMM Ml mrt t a—rr /wMrtui 000*9— l00O—7o— NfMMrMr MMMt* KMNM U—07007 Ml MM I — I - —0 09—, 33. 000—70 0*090917 70 0—0-71—0 —00*09 *— 0 - —0 09— 99—9. I— 099—70 0—90717 70 0—077* —0 0000*00 0—0 0 - —009—70 099—7 0-90717 70 00—L 7 —00,00 *•99 A- 7—7 ,0—9.070 i— —00*90 0-90919 90 0—09,00 090 0000 3*90 0 ~ — 0*0 00*00. L0O —00090 00—0917 70 7000007*00 090. 0000 *0700 090907kj0 0. 00*7, 709 —009— 09*9001 0 790—000 *00 0 CBAET HU The Mobilization and Overseas Operation Division was developed from the branch of the same name in the former Plans Division. The division was divided into three branches designed to coordinate The Surgeon General’s planning for field operations. The Theater Branch prepared-the medical sections of war plans, maintained records concerning medical matters for overseas forces, and recommended the medical sup- port essential for new task forces. In order to accomplish these functions, the branch maintained liaison with the Operations Planning Division, War Department General Staff, and 'filth the Planning Division of Headquarters, Army Service Forces. The Troop Units Branch planned and recommended the number and type of Army Service Forces medical units required for overseas duty and scheduled the activation of units of this type. In this planning the branch closely coordinated its activities with those of the Theater Branch and the Train- ing Division, Operations Service. The Inspection Branch was the third branch of the division. This branch, formerly a branch of the old Plans Division, continued to receive and review overseas reports; maintained the current records of all inspection trips made by personnel in the Office of The Surgeon General; and interviewed and circulated the reports of interviews wfIth medical personnel returned from overseas. A Special Planning Division was established which re- placed the Plans Coordination Branch of the old Plans Divi- sion. It was established with the express purpose of coordi- nating certain functions relating to the activities of more than one division. The first of these, planning for demobi- lization, had been a major function of the old branch, and was continued in the Demobilization Branch. The branch co- ordinated all planning activities within the Office of The Surgeon. General and all liaison with outside agencies re- lating to demobilization. A Civil Affairs Branch was estab- lished in the Special Planning Division to coordinate all activities relating to medical relief, including supplies, sanitation, training, personnel,’ and medical and veterinary service in occupied countries during the period of military responsibility. The branch maintained liaison for all civil affairs matters, except for those functions which were speci- fically delegated to the Civil Public Health Division, Pre- ventive Medicine Later, the Civil Affairs Branch was charged with developing the program for medical and sanitary supplies for. civilians in occupied and liberated areas. In -this program it utilized the advice and assis- tance of The, Surgeon General’s Civil Affairs' Supply Board.I8 A third division established' under the Deputy. Chief for Plans and Operations was designed to provide a single unit through which would flow all material relating to the develop- ment, modification, or -classification of items of supply or changes in their bases of issue. The new unit, named the 47 Technical Division, merged the personnel and functions of the He search Coordination and Field Equipment' Development Branches of the Plans Division, the Procurement Advisory Branch of the Professional Service, and in addition, absorbed a portion of the personnel and functions of the Supply'Planning Division, Supply Service. The primary functions of the Technical Divi- sion Included the development and classification of Medical Department supplies and equipment; the determination of their bases of issue; the preparation and review of Tables of Organi- zation and Equipment, Medical Department Equipment Lists, and Tables of Allowances; the execution of the administrative de- tails of the Medical Department Research Program; and the preparation of reports relating to that program. The division was responsible for coordination and review of specifications for Medical Department supplies, and for the administrative and clerical activities of the Medical Department Technical Committee. While much of nthe actual research and review of scientific material would continue to be the responsibility of other units in the Office of The Surgeon General, it was, how- ever, the responsibility of the (Technical Division) to trans- late recommendations made by the various professional groups into concrete plans on which may be based procurement and issue of items of supnly and tables of organization for1their employ- ment. The division (was) in a sense a clearing house between the,Supply Service and the other divisions and services of The Surgeon General’s Office.”^ 'The reorganization of the Operations Service in February 1944 combined all functions relating to Zone of the Interior hospitalization and evacuation under a Deputy Chief for Hos- pitals and Domestic Operations. This officer, who also served as Director of the Hospital Division, was responsible to the Chief, Operations Service. This scheme made it possible for the Operations Service to concentrate the increasing respon- sibility for Zone of Interior medical operations. To assist the Deputy Chief in the discharge of his duties, a Hospital Division composed of four branches was organized, and four separate liaison units were established. The first of these units was the Women’s Medical Unit. It v/as established, under the direction of a woman medical officer, to develop policies and coordinate all activities within the Office of The Surgeon General relating to the medical care and welfare of women in, or connected with, the Army. .. The chief of this unit had served(as The Surgeon General’s Liaison Officer to the Women’s Army Corps, and was designated in February 1944 as Consultant for Women’s Health and The chief problems handled in the unit concerned the medical care, physical fitness, and the utilization of Women’s Army Corps personnel in Medical Department installations. The second separate unit, the Prisoner of War Liaison Unit, had been established during July 1943'in the Office of The Provost Marshal to represent* The Surgeon General in all matters relating to sick and wounded prisoners of war. A third unit, known as the Army Air Forces Liaison Unit, was charged with the coordination of planning for hospitalization in Army Air Forces hospitals in the Zone of the' Interior. The Transportation Liaison Unit was the fourth separate unit established under the direction of the Deputy Chief for Hospitals and'Domestic Operations, This unit was designed to strengthen -the posi- tion of Transportation Liaison Officer, and formed -the basis for a much more comprehensive plan to coordinate the efforts of the Chief of Transportation and The Surgeon General in planning for the evacuation of the sick and wounded from overseas commands. It was apparent that both of these major agencies would be forced to pool their information and re- sources if the anticipated requirements in connection with evacuation were to be met. It was equally clear that in order-to meet these requirements, The Surgeon General would be forced to control bed space in the named general and other hospitals used for the treatment of patients evacua- ted from overseas and, together with The Chief of Trans- portation, have the authority to direct the transfer of patients to any available space. In order to accomplish this mission, it was necessary to obtain authority to cut across command channels. The authority to coordinate the efforts of both technical services was granted, and a Medi- cal Regulating Unit was established in May This unit actually operated under the Deputy Chief for Hospitals and Domestic Operations, but was physically located with the Movements Division, Office of The Chief of Transporta- tion, in; order to provide closer coordination and greater accessibility of information. The Transportation Liaison Unit was" absorbed into the now unit; and the Evacuation Branch was transferred from the Hospital Division, Opera- , tions Service, to become -the Bed Credit Section of the Medical Regulating Unit. The new unit provided the means * to evacuate and transport thousands of overseas patients to a place of definitive treatment with the least possible delay and confusion. One of the primary reasons for the'reorganization of the’ Operations Service in February 194A was the belief that the Hospital Administration Division was inadequately or- ganized and staffed to carry the responsibility of planning for the heavy load of casualties expected during 1941, Careful study of'the problem, made at the request- of The Surgeon • General, led the’Director of the Control Division to report; MA reorganization arid largo expansion of this division, to make plans- to handle the expected heavy load of casualties within the next few months, is urgently necessary. This matter is of such paramount moment as to deserve, I believe, your fullest support , . . Immediate "broad scale effort and planning seem to be urgently needed."22 The expansion of the Hospital Administration Division to form the Hospital Division constituted a major part of the reorganization of the Operations Service, and four branches Fere established to accomplish its mission. The Evacuation Branch of the old Hospital Administration Division was con- tinued for a short time as a branch in the new plan, but was soon detached from the division to form the Bed Credit Sec- tion of the Medical Regulating Unit. A Facilities Utiliza- tion Branch was established to study the means of obtaining maximum use of facilities and personnel in Array hospitals. The first study undertaken by the branch was that of estima- ting the number of evacuees which could be expected, once major operations began. As a result of this study, steps were taken to increase the number of beds under the control of general hospitals and to provide convalescent facilities in order to care for potential needs. Detailed studies were made, at the direction of the Deputy Chief of Staff, U.S. Army, to determine the feasibility of an integrated plan of hospitalization in the Zone of the Interior without respect to command jurisdiction. These investigations resulted in an agreement with the Army Air Forces, vdiich led to the establishment of 60 regional hospitals designed to relieve . the burden on general hospitals. The adoption of this plan led to economy in the use of personnel and equipment. Addi- tional studies were made to determine work loads in general and station hospitals, and to assess the degree of success- ful utilization of specialized personnel in all medical establishments.23 The studies and proposals of the Facilities Utilization Branch proved to be increasingly useful to the Chief, Operations Service, and to The,, Surgeon General; and the responsibilities of the branch steadily developed to the point where it seemed desirable to raise the branch to the status of a division. The Resources Analysis Division was established in October 1944 "to analyze and evaluate the current and prospective mission of the Medical Depart- ment in the major commands . , . and to submit recommenda- tions to the Chief of Operations Service . . . (showing) how available means can be utilized to maximum efficiency." All planning in personnel matters, "except for such aspects as related to personnel as individuals" (which were the continued responsibility of the Personnel Service), was made the direct responsibility of the Resources Analysis Division. In assuming these functions, the division absorbed most of the functions of the Strategic and Logistics Planning Unit which had been established in April 1944, and the Strategic and Logistics Planning Unit was abolished in November,26 No essential changes were made in the organization or the respon- sibility of thq Resources Analysis Division for the remainder of the war, 50 The two remaining branches established in the Hospital Division in February 1944: continued as branches of the divi- sion for the remainder of the war. An Administrative Branch maintained advisory supervision over the administration of Army Hospitals, inspected the administrative procedures of hospitals in the effort to increase efficiency in operation, and rendered advice to the Director, Hospital Division, on all phases of the Medical Department laundry program. The Construction Branch coordinated the efforts of the Office of The Surgeon General and Office of The Chief of Engineers in approving hospital sites, developing and changing plans for new hospitals, and surveying civilian facilities offered for medical use. The branch collaborated with representatives of the Transportation Corps in preparing plans for hospital ships and hospital facilities on other ships. It was charged with maintaining contact with the Requirements Section, Head- quarters, ASF, in determining the need for hospital construc- tion and with Headquarters, Army Air Forces, in matters of hospital needs at Army Air Forces stations. In addition, it represented The Surgeon General in all contacts with the Federal Board of Hospitalization.2? It should bo pointed out that no change was made in the organization of Training Division during the general reor- ganization of the Operations Service. At the expressed desire of the Chief, Operations Service, the Director of the Training Division continued to report directly to him, and the division was not placed under the control of either Deputy Chief.28 In February 1944, the Training Division consisted of a Director’s office and the Replacement Train- ing Center, School, Training Doctrine, and Unit Training', Branches. In May 1944, in conformity with changes in the method of training Army Service Forces troops, the names of the branches were redesignated as the Regular Training, School, Training Doctrine, and Readiness and Requirements Branches, To understand the reasons which brought about these new designations, a brief statement concerning the changes in the .method of training Army Service Forces troops is necessary. Before April 1944, medical units had been activated and then placed in training. On 15 April 1944, this plan for training was abolished.30 Henceforth, personnel for Army Service Forces medical units would be trained at Medical Replacement Training Centers or Medical Department Enlisted Technicians Schools prior to the actual activation of the unit. The new plan for training placed greater responsibil- ity on each Medical Department Training Center for, in addi- tion to training loss replacements, those centers now con- ducted preactivation training of the men destined for nedi-' cal units. In order to provide supervision over the train- ing center participation in the plan, tho Replacement Training Center Branch of the Training Division was reorganized as the Regular Training Branch with greatly enlarged supervisory functions. More effectively to carry out the preactivation training plan, the Unit Training Branch was reorganized as the Readiness and Requirements Branch. The "branch was charged with.the responsibility of providing training plans of all medical units in preactivation training, with furnishing all enlisted technicians not actually trained within the centers, and with the inspection of units to insure their readiness for movement. Both "branches had vital parts in the program, and close cooperation and liaison were maintained "between the Readiness and Requirements Branch and the Regular:Train- ing Branch to insure its success. The School Branch con- tinued to develop, and direct plans for the operations of the special service and technical schools of the Medical Depart- ment, including the Medical Administrative Corps officer candidate schools; and to formulate policies, coordinate, supervise, and inspect the technical training of Medical Department personnel in military installations and civilian institutions. The Training Doctrine Branch was charged with continued responsibility for the promulgation of training doctrine through visual training aids and training litera- The organization of the Training Division, as re- vised in May 1944, continued, unchanged during the remainder of the war, although a later change in the organization of the Operations Service placed the division under the control of the Deputy Chief for Flans and Operations. Tho reorganization of the Office of The Surgeon General ■ in February 1944 carried out important changes in the Opera-., tions Service designed to inprove the direction and super- vision of Medical Department functions and activities. Con- currently, realignments were made in other services- and divi- sions which supplemented the developments in the Operations All plans for more export hospitalization and faster evacuation ultimately depended upon medical personnel to pro- vide the needed services at the right time and at the right place. ’ But The Surgeon General did not have control ..over medical personnel. The assignment of r>0rsonnel, except those under the direct authority of The'Surgeon General in Class TV installations and in his own Headquarters, had "been decentra- lized to the Service Commands, Thus, in order to obtain the needed specialists in various'medical installations,. The Surgeon General was compelled to' obtain the consent of the Service Commander in each individual case,’ The inevitable delay, red tape, and complications caused by this: procedure delayed the program and convinced The Sur’gebn General that he needed greater authority over the assignment of medical personnel-in the Army. In the hope that such.authority .; would be 'granted, he planned to'., improve the organization of the Personnel Service in his own office. At his request the Director, Control Division, SGO, surveyed the Personnel Service. The results of this study were incorporated, in a report made hy the Director, Control Division, which indi- cated that Headquarters, Army Service Forces, and,many senior officers in the Office of The Surgeon General had little confidence in the adequacy of the Personnel Service, This lack of confidence appeared to he based upon three factors. In the first place, it was thought that the ser- vice did not possess records adequate enough to enable The Surgeon General to select and assign specialists; in the second place, it was believed that no long range planning for the utilization of personnel was carried on, a.s distin- guished from day to day action in individual cases; and, in the third place, it was believed unwise for the Personnel Service to make assignments without reference to other ser- vices in the office. The report concluded that: "the power to ration medical personnel from a central source should be vested in The Surgeon General. But while such power is ur- gently needed, my information Indicates that such request at this time would be. unlikely to succeed because of the attitude of Headquarters (ASl) toward the inadequacy of records and the organization to utilize such power ... Steps were taken immediately to strengthen the Personnel Service. A Personnel Control Branch was established in the Chief of Personnel to provide for the "effective utilization of personnel in the Office of The Surgeon General and in the field installations." This branch acted as the clearing- house for The Surgeon General’s Personnel Control A Personnel Planning and Placement Branch was established in the Military Personnel Division in order to provide the means for long range planning and to coordinate with other interested services and divisions the placement of key personnel. It was hoped that the creation of these two branches would correct the major weaknesses in the organization of the service. .In addition, the Army Purse, Hospital Dietitian, and Physical 'Therapy Aides Branches were added in the Military Personnel Division to control the planning for and utilization of the women’s components of the Medical Department.^4 The 1944 reorganizations were marked by certain changes in the Supply Service. The Supply, Planning Division was abolished in February, and most of its planning functions Were- transferred to the Technical Division,, Operations Ser- vice.- Most of the remaining functions were transferred to the Supoly Service overhead; the Catalog Branch ?/as..estab- lished as an activity under the newly created post of Execu- tive Officer of the Supply Service; and a Materiel Demobil- ization Unit was added in the Office of the Chief, A much more thorough reorganization of the Supply Service followed in June 1944. At this time the Distribution and Requirements Division was abolished, and the Storage and Maintenance, Issue, and Stock Control Divisions were established. The Renegotia- tion Division was transferred to the Army Medical Purchasing Office, although certain renegotiation activities continued in Washington under the control of a Liaison Unit of the Rene- gotiation Division. At the same time certain Supply Service activities were grouped under the office of the Deputy Chief for Supply Control, who coordinated the activities of the Stock Control and Purchase Divisions and acted as advisor to the Chief of the Supply Service in matters pertaining to these divisions, An office of Deputy Chief for Storage Operations was also established, which provided an advisor to the Chief, Supply Service, for depot operations.35 Certain other changes were made in the organization of the Office of The Surgeon General during 1944 which should be noted at this time. The Historical Division was removed from the Administrative Service and established as a separate divi- sion under the direct control of the Deputy Surgeon General, whore it remained for the rest of the war. The Office of Technical Information was dissolved' IfT February 1944, and a Technical Information Branch was established in the Control Division, This branch apparently carried on all- of the func- tions of the Office of Technical Information. The new arrange' ment did not work out satisfactorily, and a Technical Infor- mation Division was organized in May to operate as tife sole representative of The Surgeon General and all personnel in the Office of The Surgeon General in all public relations matters.-36 Any inquiries made by the press or other publi- city media were to be answered directly by the Technical In- formation Division. Jhrther, the text of all public addresses and all manuscripts was subject to review by this agency be- fore publication. In addition to these duties, the division was charged with the preparation of a long range public rela- tions program for the Medical Department. To carry out its functions, the new division absorbed the Technical Informa- tion Branch and the Nursing Morale Branch, Nursing Division, Professional Service. The Reorganization of August 1944 The reorganization of the Office of The Surgeon General in August 1944 was the final phase in a long series of de- velopments designed to decentralize authority, to coordinate all activities contributing to Medical Department operations, and to separate administrative activities from advisory func- tions. The ways in which to achieve these ends had been the subject of continuous study by the advisors of The- .Surgeon General. The informal preliminary report of their investi- gations, made in June 1944, embraced all three aspects of the problem. 54 Tile Surgeon General was urged to delegate all.powers ’’aside from your functions of overfall supervision, deci- ' • slons of major policies and conduct of matters which no one • else can handle” to his aides. An additional fulltime assis- tant was recommended’. The Deputy Surgeon General would repre- sent The Surgeon General in all matters except where the for- mer’s personal appearance was absolutely necessary"; he would determine the matters on which The Surgeon. General should he informed; and would have the blanket authority to take action on all the rest.’ A second assistant,- or Assistant Surgeon General,,,would be appointed who would have clear Relegation of authority to act for The Surgeon General on all '‘matters - inside the Office of The Surgeon General. It was further proposed that the Chief, Operations Service, would be named as the Assistant General in order to make certain that all matters of importance would clear through the Operations Service. The Surgeon General had repeatedly approved of this idea in principle, but, in actual practice the plan had never worked out because the Operations Service was on a parity with other services and was not recognized as having authority over them. The second recommendation concerned the operation of the Personnel Service. It.was believed that all assignments of medical personnel should be made upon the recommendation of the division concerned, and that the Personnel Service should do the same general character of work done for the whole Army by The. Adjutant General. The service would keep the records, issue orders,, and carry out all administrative work incident to those functions, but it should not exercise discretionary' decisions .-over It will be re- called that proposals similar to the first and second recom- mendations, had been made-to The Surgeon General before the February 19reorganization, but subsequent reorganizations had not -put them into force, . To insure that the second sug- gestion would bear fruit, the Director of the Control Divi- sion further recommended that both divisions of the Personnel Service be abolished and that they be made separate divisions in the Administrative Service; The third proposal pertained to the organization of the Professional Service., It stressed the fact that the service was an ’’artificial.composite of hetrogeneous elements, many of which have no real-connection with the others.”39 it further pointed out that the service engaged in operations activities which overlapped the work of the Operations Ser- vice, and that the Directors of the Medicine, Surgery, and Neuropsychiatry Divisions reported, not to the Chief of the Service, but directly to The Surgeon General. It was recog- nized, however, that these advisors in three of the principal fields of The Surgeon General’s activities should not be 55 separated from him. Because of those facts, four major recom- mendations were made. First, the advisory groups (comprising Medicine, Surgery, Neuropsychiatry, and Reconditioning) should determine the policies of their respective groups and report directly to The Surgeon General. To do this, these groups, should be separated from the Professional Service and set up as Staff Divisions on a separate level from the operating services of the office. In so far as their work Involved pro- posals for changes in hospitalization (such, for illustration, as setting up reconditioning camps or hospitals, or.of psy- chiatric hospitals, or making changes which would affect the operation of hospitals), their policies and advice would be carried into effect through the Hospital Division of the Opera- tions Service. Second, the Dental and Veterinary Divisions should be established as separate divisions and report directly to The Surgeon General or to the Assistant Surgeon General. Third, the Nursing Division should be incorporated in the Hos- pital Division, except for those functions which related en- tirely to personnel activities. This proposal was regarded as logical, because of the similarity of the activities in the Hospital and Nursing Divisions. Fourth, the Physical Standards Division should be divided under this plan; the professional decisions as to policy would be made the responsibility of the Medicine, Surgery, and Neuropsychiatry Divisions respectively, and the actual operating work of reviewing records or applying Eolicies to specific cases would be placed in the Operations ervice. Apparently, The Surgeon General was willing to accept the proposals set forth in the June report. The plan presenting these proposals was then submitted for approval to the Direc- tor of the Control Division, Army Service Forces. The pro- posal to demote the Personnel Service was disapproved by the Director, Control Division, ASF, because it was the fixed policy of the Army Service Forces to insist that all civilian and military personnel activities' in a technical service be combined under a single head. The-plan was then revised in the Control Division, SGO, and a scheme which maintained the existing Civilian and Military Personnel Divisions, was pre- sented to The Surgeon General with the suggestion that the Chief of the Personnel Service could also serve as the Direc- tor of the Military Personnel Hie Director, Control Division, ASF, had also objected to the plan for revision of the Professional Service and did not deem it advisable to formally end the service as a unit.. To overcome the objec- tions made by the Director, Control Division, ASF, The Surgeon General’s advisors proposed that: The Professional Service be limited to Medical, Surgical, Psychiatric, Dental, and Veterinary Divi- sions, all of which would, as a practical matter, operate separately. 56 The Women’s Medical Unit, a professional unit which did not belong in the Operations Service, should he made a unit in the Professional Service. Tile personnel aspects of the work of the Nurs- ing Division should he absorbed into the Military Personnel Division, and a Nursing Branch should he established under the Hospital Division. The Physical Standards Branch should he trans- ferred to the Administrative Service in order to parallel the structure of Headquarters, ASP. The Reconditioning Division should he renamed the Reconditioning and Convalescence Division to take cognizance of the large convalescent program in which it was interested, and that it he made a branch of the Hospital Division.^ The suggestions of the Control Division were adopted in part by The Surgeon General, who approved a new organizational chart incorporating the changes on 2-4 August 19-42 (See Chart XIV). This was followed by an office order which set the new organization plan in operation and included the following features: The post of Assistant Surgeon General was established. The Assistant Surgeon General will act for The Surgeon General in coordinating the work of the Operations Service, the various professional divisions, the Military Personnel Divisions, and such activities for other divisions and services as affect operations. Detailed arrange- ments to this end will be worked out by The Assis- tant Surgeon General in accordance with the follow- ing principles: Acts involving operations will be cleared through Operations Service. The Operations Service will hereafter be respon- sible for personnel planning. The Military Personnel Division will keep all military personnel records and will process all military personnel actions. Assignments of key personnel will be made only with the concurrence of the appropriate service or division particularly concerned with, or possessing special knowledge of, the qualification of the officer and the require- ments of specialty assignments. 57 The Administrative Service was dissolved and the Fiscal, Legal, and Office Service .Divisions were directed to report to the Executive Officer. In reality, this caused little change in existing arrangements, for the Executive Officer had acted as Chief of the Administrative Service. The Professional Service was dissolved and four profes- sional divisions were created: Medical Consultants, Surgical Consultants, Neuropsychiatric Consultants, and Reconditioning Consultants. Divisions.^ The Dental and Veterinary Division were continued without change. The Nursing Division, as such, was dissolved, tut all personnel matters and related aspects of the Army Nurse Corps program were made the responsibility of the Army Nurse Branch of the Military Personnel Division.^1 All policy making as- pects of the Army Nurse Corps were transferred to the Nursing Division, Professional Administrative Service. A Professional Administrative Service was formed in place of the Administrative Service envisaged "by the plan of the Control Division. This service grouped together the follow- ing divisions and units: The Physical Standards Division, which was for- merly part of the Professional Service; The Nursing Division, including only policy mak- ing aspects; The Medical Statistics Division, which formerly reported directly to the Executive Officer; The Professional Inquiries Unit, formerly part of the Professional Service; and The Women’s Health and Welfare Unit, formerly the Women’s Medical Unit in the Operations Service. The Professional Administrative Service was charged with the processing of all changes in Army Regulations requested "by other units in the Office of The Surgeon G-eneral. ** T1 .’kiterial Branch, which had "been a part of the Profes- sional was made a separate unit and was ordered to report directly to the Deputy Surgeon Generali8 The changes made in the organization of the Office of The Surgeon General in August 19 AA completed all phases of the program to decentralize authority, to coordinate the activities of all operating divisions, and to separate the administrative 58 ORGANIZATION CHART OFFICE OF THE SURGEON GENERAL ARMY SERVICE FORCES THE SURGEON GENERAL CONTROL DIVISION DEPUTY SURGEON GENERAL historical INFORMATION DIVISION DIVISION ASSISTANT SURGEON GENERAL EXECUTIVE CTTICER OFFICE SERVICE DIVISION LEGAL DIVISION FISCAL DIVIS ION MEDICAL CONSULTANTS DIVISION SURGICAL CONSULTANTS DIVISION leUROPSTCHlATRI CONSULTANTS DIVISION RECONDITIONING CONSULTANTS DIVISION DENTAL DIVISION VETERINARY DIVISION CHIEF OPERATIONS SERVICE CHIEF SUPPLY SERVICE CHIEF PERSONNEL SERVICE CHIEF PREVENTIVE NEDICDC SERVICE caizr PROFESSIONAL ADMINISTRATIVE SIR Via i PHYSIOL STANDARDS DIVISION MILITARY PERSONNEL DIVISION CIVILIAN PERSONNEL DIVISION SANITATION It HYGIENE DIVISION LABORATORIES DIVISION IffDICAL STATISTICS DIVE TON DEPUTY CHIEF for hospitals AND DO*STIC OPERATIONS DEPUTY CHIEF FOR PLANS AMD OPERATIONS DEPUTY CHIEF FOR SUPPLY CONTROL DEPUTY CHIEF FOR STORAGE OPERATIONS EPIDEMIOLOGY DIVISION TROPICAL DISEASE CONTROL DIVISION NURSING DIVISION SANITARY ENGINEER DO DIVISION HOSPITAL DIVISION TRAINING DIVISION TECHNICAL DIVISION PURCHASE DIVISION STORAGE AND MAINTENANCE DIVISION VENEREAL DISEASE CONTROL DIVISION MOBILIZATION It OVERSEAS OPERA- TIONS DIVISION SPECIAL PLANNING DIVISION STOCK CONTROL DIVISION OCCUPATIONAL HEALTH DIVISION MEDICAL INTELLIGENCE DIVISION ISSUE DIVISION RENEGOTIATION DIVISION INTERNATIONAL DIVISION NUTRITION DIVISION CIVIL PUBLIC HEALTH DIVISION (CAD) FIELD INSTALLATION APPROVED i CHART XIV I DU, mjo* 0«n*r«l, L'. S. krmj, Th« Surgeon General. ?U 19Uii duties from advisory functions. This reorganization was the last major change to affect the entire structure of the Office of The Surgeon General. NOTES ON CHAPTER V Memorandum from the Director, Control Division, SCO, to The Surgeon General, subject; Interim report on changes in Surgeon General’s chart, 3 December 19-43 (Control Division, SCO). 2Ibld. 3SGO Office Order 4, 1 Jan 1944. Memorandum from the Director, Control Division, SCO, to The Surgeon General, 3 Dec 1943 (Control Division, SCO). Memorandum for the Director, Historical Division, subject: Annual Report of the Professional Service, 1943-1944 , 20 June 1944 (Historical Division, SGO, 319.1-2). 6Ibid. Office Order 4, 1 Jan 1944. o condensed Report of Activities and Accomplishments of the Preventive Medicine Service for the Plscal Year 1944 (His- torical Division, SGO, 319,1-2). 9Ibld. from Director, Control Division, SGO, for General Kirk, subject; Proposal for overall plan for most effective utilization of officer allotment, civilian personnel, and space in The Surgeon General’s Office and for modifications in present organization, dated 13 Jan 1944, p. 15 (Control Division, SGO). •^Ibid.; also see SGO Office Order 419, 28 Jun 1943 and Office Order 776, 1 Oct 1943. from Director, Control Division, SGO, for General Kirk, see above Rote 10, pp. 17-34. 13Ibld. , -j), 10-14. Chart, approved 3 Feb 1944 (Chart XIII of this study). Office Order 84, 19 Apr 1944; Annual Report of the Operations Service 1944, Inclosure 1 (Historical Division, SGO, 319.1-2). 60 Report of the Operations Service, 19M (&ist$J*i4al Division, SGO, 319,1-2); Office of The Surgeon 5ehbra& Manual,. bf Organization and Standard Practices, p. 3.OS* dated 15 Mar 1944T ' Organization Manual, p. 3.08, dated 15 Mar 194/-, - 7 18Ibid., p, 3,08, dated 1 liay 19/4;- 7 Bcport of the Operations Service (Technical Divi- sion), 194/, p. 2 (Historical Division, SGO,,319,1-2), v 20SG0 Office Order 29, 10 Feb 19/4. ' 21Sce Par. 9, Department Circular 1/0, 11 Apr 1944;. Section JI, Aimy Service Forces Circular No. 147, 19 May 19/4; Annual Heport of Operations Service (Hospital Division), 1944, p. 12 (Historical Division, SGO, 319.1-2), from Director, Control Division, SGO, for General Kirk, subject; Proposal for . , , modifications in present organization, dated 13 Jan 19/4, p. 16 (Control Division, SGO), Report of Operations Service (Hospital Division), 1944, p. 1 (Historical Division, SGO, 319.1-2). Report, Resources Analysis Division, 19/5, p. 2 (Historical Division, SGO, 319.1-2); SGO Office Order 208, 23 Oct 1944. Office Order 175, 25 Aug 1944; Office Order 208, 23 Oct 1944. 26SG0 Office Order 217, 2 Nov 1944. Report of Operations Service (Hospital Division), 1944, pp. 2-4 (Historical Division, SGO, 319,1-2); SGO Organization Manual. dated 15 May 1944, p. 3.08. ■ 28Memorandum from the Director, Control Division, SGO, for General Kirk, dated 13 Jan 1944, p. 15 (Control Division, SGO). Report of the Training Division, SGO, 1944 (His- torical Division. SGO, 319.1-2); SGO Organization Manual. pD. 3.08 and 3.08, dated 15 May 1944. 2 Service Forces Circular 104, 15 Apr 19/4, Report of the Training Division, SGO, 1944; ASF Organization Manual (301), p. 306.00, dated 15 Aug 1944. l2 61 32 Memorandum from Director, Control Division, SCO, for General Kirk, dated 13 Jan 1944, pp. 18-23 (Control Divi- sion, SCO). 33SGO Office Order 24, 28 Jan 1944. 3<+SGO Organization Manual, po-. 3.07, dated 13 Mar 1944; pp. 3.02, dated 1 May 1944. 1-3 1-3 33SGO Organization Manual, pp. 3.C9, dated 24 June 1944. 36SC0 Office Order 111, 26 May 1944. 37 4 Set forth in a Secret Communication from the Director, Control Division, SGO, to The Surgeon General, subject; Draft of proposal for changes in Office Organization of SGO, dated 19 June 1944 (Control Division, SGO). 38IbiA.. p. 3. 39Ibid., p. A. Memorandum from The Director, Control Division, SGO, to The Surgeon General, dated 17 Aug 1944 (Control Division SGO). ., par. 3c. ’ ' 2, SGO Office Order 175, 25 Aug 1944. , pan. 3. 3Ibid., par. 4. 46 Ibid., oar. 5 and 6. 7Ibid.. par. 7 and 8. . 48 Ibid-, par.'9. 62 CHAPTER VI CONCLUDING WAR-TIME' CHANGES IN THE ORGANIZATION OP THE OPFIGE OP THE SURGEON GENERAL The reorganizations of the Office of The Surgeon General in 1944- established the organizational pattern for the remainder of the war. This is shown by the fact that no attempts were made to revise The Surgeon General’s Manual of Organization, and only one organization chart was published during the remain- der of the war period. This last chart, published in January 1945, does not reach below the division level and reveals no major changes in the structure of the organization. Two addi- tional charts were issued to illustrate post-war developments and a fourth established the adjustment to a peace-time organi- zation. The realignment of functions traced in these later plans will be discussed in the third section of this chapter. Hi thin the broad pattern of organization, however, major developments were made for the more effective utilization of personnel and for the conduct of research and development activities. Continued Reorganization of Personnel Activities He have seen in Chapter V that various changes were made in the organization of the Personnel Service during 1944 to improve the operations of personnel activities in the Office of The Surgeon General. In the main, these inprovements were designed to enrich the records of the provide for better planning in the utilization of personnel, and to pro- mote more effective coordination with other services, in order that The Surgeon General could request authority for greater control over Medical Department personnel. The expansion of the service apparently accomplished one desired result, for The Surgeon General obtained authority in May 1944 to assign Medical Corps officers and nurses among the various organiza- tional elements of the Army Service Forces.-*- He was empowered to request or supply key personnel by name for the general and regional hospitals, and to clear all requests for Medical Corps officers through his. office before assignment by The Adjutant General. The organization of the Personnel Service, however, failed to provide the most effective machinery to discharge these responsibilities. The Control Division, SGO, was pre- pared to make a study of the service with a view to increasing its efficiency, when the Personnel Service arranged for an independent study to be made by a civilian agency. The investi- gation was conducted by representatives of the Industrial Hala- tions Counselors, Inc., during February and March 1945. The results of the. study were submitted in a comprehensive Report 63 on Organization for Personnel Administration in the Office of The Surgeon General, 'which recommended; That the responsibilities of the Personnel Ser- vice he definitely determined; That the personnel administration of all but key specialists should be decentralized to service-commands; and that the records now kept in the Office of The’ Sur- , . goon General for other than key personnel should be eliminated; That a post of Deputy Chief of the Personnel Ser- vice be created and that a Director of the Military Personnel Division separate from the Chief of Personnel be appointed; That all requisitions for bulk numbers of personnel to be sup-oiled over a period of time belonged to the Operations Service, and that the transfer of records and personnel to accomplish this purpose be made from the Records and Statistics Branch of Military Personnel Divi- sion to the Resources "nalysis Division, Operations Ser- vice; That a Policy Branch be established; That Staff Assistants for enlisted personnel and women Medical Department officers be appointed, subor- dinate to and reporting to the Director of Military Personnel; and ' - That the Army Horse, Physical Therapist and Hospi- tal Dietitian Branches, and the Enlisted Section of the Operations Branch be abolished. . The Director of the Control Division, SCO, analyzed the proposals, and, while agreeing with most of them in-principle, wrote: •* . . . . two main points are raised by the report: a;. To see that the plan of office order 175 (which established the principle of coordinating V - all operations activities relating to personnel ; - through the Operations Service) is understood and carried out, and the work of the Military Personnel Division is, under it, properly coordinated with the Resources Analysis Division, b. To make a determination as to whether the de- centralization to service commands of assignments of other than key personnel is to be fully adopted; 64 ORGANIZATION CHART OFFICE OF THE SURGEON GENERAL ARMY SERVICE FORCES Td SOBOBd OBBOUL cornu*. omsid dTOTT SOBOBd l*11 ASSISTAMT SOBOBd OBKRAL nCRMICAL nPdHATId omsid HISTdICAL omsid UKbvrin opncB CPPZd SKSVICE omsid LBOAL omsid FISCAL omsid *BB)ICAL oomourb omsid SdOICAL CdBULXAMIS omsid BDBOPSTCHIATSX CdSDLTAPTS omsid MKdDrridm CdSOLSAMTS omsid mm Dins it* fcmnJLn omsid anr fUVUllll BDICDB ■m cnv VB0PBS8I0BA1 aobimistsativ* sans cum omuTids sonez ana supply some* chup msowL sand mam8 omsid MTUTMCT omsid cmmi omsid wrana * non Dinsid UBOUICUB DITX3 KB pbbical standards DITISId bdical STATISTICS DITBIOB own amp Pd hospitals AM) DOBSTIC emu Tint own chup Pd PUB AMD OmUTIOB own cmr rat srdAd onaunoB srmaaoLcor ditis id mncu ■ DTSKASS CCRBCL omsid bbsibo omsid nnu omsid taatwtw omsid TBCBMICAL omsid rasausi omsid STOMflB UK) ■lDHI—TI omsid sArruiT BDDmOD pmsid mmiT DISSASS OdTROL Dmaia rnuundft ovosias arnu- wdB pmsid OCCDPATIdAL ■alii nmsio* SPBCIAL pujomc pmsid | STOCK CdBKX. omsid sns omsid BDICAL muioncs omsioii mmol nmaioi CiVU. PdUC win omsid «a°) gpMoorund omsid nwnidi omsid nzu) nemunoe chabt rr 1 JANUARY 1945 and if'so to define key personnel and to adjust records. As to this, it is believed that key personnel should include all spe- cialists, and that complete records of such- specialist groups should he maintained here, whereas records on others should he cut to a minimum.^ Major changes in organization of the Personnel Service were not made immediately following these reports; hut the functioning of the service was greatly altered, and the pro- posed changes were carefully Two of the recommenda- tions were carried out. The Records and Statistics Branch (formerly Personnel Planning and Placement) surrendered all its requirements studies to the Resources Analysis Division, Operations Service, and plans were developed to merge this branch with the Classification In addition, a Direc- tor was appointed to head the Military Personnel Division.8 In September 1945 further reorganizations along the func- tional lines recommended in the reports were made in the Per- sonnel Service, which included the appointment of a Special Assistant to the Chief of Personnel and three Assistants to the Director, Military Personnel Division, . In this inter- mediate step the personnel of the Enlisted Personnel Section, Operations Branch, and those of the Physical Therapy and Dietitians Branches were transferred to the office of Direc- tor, Military Personnel Division, and their chiefs hecaine Assistants to the Director for their respective specialists; the Records and Statistics Branch and the Classification Branch were combined to form the Classification and Records Branch; the Operations Branch, minus the Enlisted Personnel Section, was redesignated a,s the Assignment Branch; and the increased duties of the Procurement Branch were stressed, arid its title changed to Procurement, Separations and Reserve On 11 October 1945 the division was again reorgan- ized to form the Procurement, Separation and Reserve; Classi- fication and Assignment Operations; and Records Planning and Placement Branches.8 In March 1946 the division was again regrouped Into the Assignments; Classification and Records; Procurement, Separations and Reserve; and Army Durse Branches.9 The problem of adequate personnel control for military personnel within the jurisdiction of The Surgeon General was vigorously attacked, and by the end of the war period, it appears to have been solved. Much of the credit for "policing" The Surgeon General’s officer allotment was due to the Person- nel Control Branch. In January 1945, following various oral directives from Headquarters, Army Service Forces, a full-time Personnel Control Branch was established in the Personnel Ser- vice. This Branch was responsible to The Surgeon General’s 65 Personnel Authorization Board in three major fields; 1. Administering the control of personnel allotments; 2. Maintaining records for authorizations, compiling reports for and maintaining liaison with the Military Personnel Divi- sion, Army Service. Forces; and » : 3. Making studies to determine the need for personnel.^ In order to accomplish the mission of the branch, four sections were established. The Strength and Authorization Section received authorizations jof personnel from Headquarters Army Service Forces, and in turn "established sub-authoriza- tions under the Jurisdiction of The Surgeon General. These authorizations continually fluctuated, and constant super- vision on the part of the section was necessary in order to remain within established ceilings. A Promotion Section processed all recommendations for promotions of officers in the SGO; and upon approval of The Surgeon General’s Promotion ■' Board, indorsed.and forwarded them to higher authority. The Unit Personnel Section maintained the, personnel records for •all officers within the Office of The Surgeon General and pre- pared all necessary reports relating to these records. The Statistical Section was established to compile all recurring reports directed by higher authority. The branch was also charged with performing the operating functions of the. Per- sonnel Authorization Board. In December 19-4$ the Personnel Authorization Board was delegated The Surgeon General’s exe- • cutive power to make and modify personnel authorizations. At this time the Personnel Control Branch was reconstituted to form a Personnel Control Unit and-placed under the direct authority of the Executive Officer, SGO, in order to carry :out the' service functions of the board,^ ’ M During 194-5 the responsibilities for readjustment and re- r deployment planning devolved in part upon the Personnel Ser- vice.- 'The actual planning was coordinated in the Special •’ Planning Division, Operations Service, but many details con- cerning requirements and availabilities were worked out by the Personnel Service and the Resources Analysis Division, Operations Service. All policies relating to the separation of Medical Department personnel were likewise Joint respon- sibilities. One phase of this problem led to the estab- lishment of a board to formulate policies concerning the relief of Medical Department, personnel, in order to deter- mine the essentiality of Medical Department officers in the Army Service Forces who. were .separation from the 66, ORGANIZATION CHART OFFICE OF THE SURGEON GENERAL ARMY SERVICE FORCES - TMi MBibN AAWBTAI cans KfUIV WHEW KKML aamair non seneml urn hoicm. MFUIKIT UHMOI «N KHUMIT nan BBOirnc OFF rat CMWIM m CMTMi MMltai w WHS can. nan HMICH i—awn awrmmni aann McaairwiM caatmn MTU ca«uun nniiun canal tui n emet wtaict Kami it met an n» item aaeaiat Keaan uaai lEcaaiui laratMTiat NISTMICM. nscAi FCMMKL Kttiu ftfVUTlVI MOICIM soviet » CfUUTIMS soviet MMHWTIK ■M NflT WM mntmm aa*wA MINTWl ■HUM LT. nm mm wmiwwi m mHMTIML tmtm m% ■NT WTIPI tnTuM? Mi I TAM HPVBATIM MA ■MAM C4AAAIFKATIM UtlMMOT -mamm nmiin m nmmmi CAATVAl MIT civilim ■CM) MBIT Ml fLACOMBT ClAMIFICATIM MA MAM AAIWBT fTAlAA-AATAfU. Clftl malic nun Ml HTIITIM MtICAi IIQUIKKI Ml MAIM open MAM. imitatim Ml IMITAfT —pf MHtTIM II MAM CMTM AAAflT£L MM MCtTlC moltmm CMMTVKTIM mmaivtaatim TUIIIH TIM ntftw NW«UI*TIM m mnui MUTW Ml mwt win MMMmil Mtm ftMIM «» fumm CVMUKfNT WHUl MIMMfMT • IMAMS UIMTMT *MW MOICAI ■tSCAMCH UIMr«T * MAICA1 ■Ktina WMMTMT orr ic* mmtr» i * CMIIUI aswuca* MM hmhim mWM UMMTM* (UlUl MNfl CHART XVI 11 0CTQ32H 1
TP> TMJ ■TOUT" ATOM 4S1 coMnaa. I anaMc' COMMANOMC 6CMCAA4. MRVKCS or MfW •COMCt COMMMOU o*t r or statt »ac*ML 1 ■ mnmjt MOC HCl>TlOMS MANCN TAAItoiM* IMWM | I MSTCCTOO CCMCIUL feOUlMAt a«m3« r—I, JL-, ,, "MOCUVMDr* »AA>K* wi rCBMNNCL WMMN mltuat WWOMNC, won. KMCI nu«c< anrae OVliM >wyL «AAC aoftacx OMUM 1 M*rr KjCNAMOt 1 US MUMCS I iAOMIMlSTIUTTVC owmou ADA/TAWT OCMPUL •AAMCM JUOOC 0 proposal was an indorsement only in the: technical sense. The Commanding- General> Services of Supply, answered that the, transfer of the hospitalization, evacuation, and sanitation functions from the supply divi- sion to the‘ personhel division of.service command headquar- ters would "in no sense 'disintegrate' the medical activities at Headquarters." (it will be remembered that this particu- lar change had been introduced shortly after ‘‘of the first organization manual, which had .assigned .medical functions tb the"supply division.) The only medical func- tions still retained by the supply division, he continued, were matters of:medical supply, which were "minor in charac- ter since local procurement of medical supplies is handled • at" posts and in-small amounts," Otherwise, £ h : this is exactly the same situation as. existed . •'previously. V . The -,Chief Medical Officer, Fill ' ‘ : •'■have'direct access to the Service Commander on • all’matters relating to the health of the i , Command. . . Under the above organ!Zcatipnal. , arrangement, 1 fail "to see how the technical ■ . ■ .activities of the medical department _will" ■■ . suffer. It is 'my' desire'-that this plan'be. given a fair trial with full cooperation and support from your office.3 Mdch later the Surgeon Of1'the Second Service Command remarked that-this transfervof the medical branch to the personnel division was 15an even more unsatisfactory organi- 1 t zational arrangement than under the Supply and Services The-new arrangement, in fact, did not long persist, As has already been mentioned', the organization manual of 24 December 1942, not much more than six weeks after the exchange of letters, restored the medical branch to the supply and service division. However, the larger issue' of raising the medical branch to divisional level, directly responsible;;to the service com- mander, continued to be a subject of debate*. The Surgeon of the Third Service Command, it is true, reported that placing the medical branch in the supply and service division has not interfered with the operation of the Medical Service. The surgeon still has direct contact with the Commanding General and Chief of Staff on matters directly affecting the health of the command. Author- ity for chiefs of sections in the medical branch to sign communications in .the name of the Commanding General has expedited for- warding of communications and reports. It is the opinion of the undersighed/Chief of the Medical BrancJ}?that the reorganization of the Service Command Headquarters and of the Surgeon’s Office has increased the effi- ciency of the medical service.> •Affairs were not arranged so amicably in the Fourth Service.Command. On 1 January 1943 the Chief of the Medical Branch addressed a letter to the Service Commander pointing out that matters affecting medical personnel were divided between the .Medical Branch and Military Personnel Branch, that the latter had been given eighteen of the twenty persons engaged in medical personnel work, and that the Medical Branch was communicated with,’’usually by telephone,” for the purpose of requesting station assignments. ThiS> it was alleged, permitted division of authority and responsibility, caused delay and unnecessary duplication of work, and was. ’’confusing, irritating and altogether unsatisfactory.” Since, according to the new organization manual, the Chief of the Medical . Branch was a personal advisor to the Service Commander ori ■ all matters concerning the health of personnel,and since... proper care of health depended largely on the qualifications of medical personnel,.it was recommended that all activities of the Medical Department Personnel Division should be re- turned to the Surgeon and placed directly under his control* The Chief of Staff referred this communication to the. Director of the Personnel Division, The latter replied that the . matter had again been investigated ”as .on three or four previous occasions,” The agreement to refer certain matters by telephone., he added, had been made.”in the interest of 127 harmony father because of necessity to mollify the surgeon who was bitterly opposed to compliance with direc- tions from Headquarters, SOS, and also this Headquarters.” He admitted that faults, existed, but they were "primarily in the.mind of the Surgeon. , ; The former system was tried, found wanting $nd condemned by the Commanding General, SOS.” To this analysis of his recommendation and motive’s, the sur- geon responded in a letter to the Chief.of Staff, assuring him he "was aware that no change in the.existing order could be made without War Department authority; his ..purpose was merely to inform the Commanding General that the present system; was not efficient. He also noted that “this office does not appreciate the "general tone of the remarks" made in the answer to his letter. After this exchange the Surgeon forwarded copies of the correspondence to The Surgeon Gener- al's Office with the comment; "You will notice we got nowhere in a Hell of a hurry. I am going to keep pounding at them, and hope some day to be able to run the Medical Department as efficiently as it could be if they, would lot us handle our own • ; Meanwhile the Wadhams Committee finished its inquiry and made its recommendations. .-The Commanding General,- Serv- ices of Supply, sent these proposals.to The Surgeon General's Offico for comment. Of the ninety-eight recommendations only one need be mentioned■here. It proposed that “within each service command there should be a unified Medical Division the Director of which should be on the staff of the Service Commander in charge of all medical activities." This merely repeated the recommendation already submitted by The Surgeon General himself as described above (p. 126). The Surgeon General's Office therefore simply referred to this earlier correspondence, a copy of which it attached, and remarked that "since this recommendationwas disapproved, this office will cooperate in every way to make tjhis organization work." (incidentally these comments seem to have been prepared by some person or persons other than The Surgeon General, as the only remark appended to’ another recommendation is that "in the absence of The Surgeon General from this country, comments'-are omitted,")^ L New Status for the Service Command Surgeon , Undeterred by the .setback which his predecessor had received, a' new;Surgeon General renewed-, the campaign to raise, the status of service command* surgeons. On IVJune 1943, shortly after taking off ice General Kirk- assembled a conference of chiefs;, of service command medical branches to discuss their problems. 11 Recently,” he reported to this.’ meeting, I had a talk with General Somervell /Command *- ing General, Army Service Forces/ end from 128 what I heard it struck me that v/e had more or less lost control in the service commands as far as the Medical Department was concerned and that the job there was being done on per- sonalities and not on organization. I asked him if he would entertain a proposal that we might bring to him as to where we thought the surgeon of the service command should be and his relation to the Commanding General of the service command in order to carry out the responsibilities placed on The Surgeon General of the Army, I told him what I thought these responsibilities were and that everybody knows we couldn’t carry on unless we had authority. He then suggested that you come here for.a- conference. ; . . The Surgeon General also announced that "v/e will appoint a board to study this and submit a report,'* the board to consist of throe members assisted by the Chief of the Control Division, Army Service Forces,® Throe days later (17 June 19A3) the board, or committee, made its report to The Surgeon General. The committee stated that after consultation with the chiefs of the nine service command medical branches it believed certain changes must be made in the Service Command and Air Force organization for the care of the sick, if The Surgeon General was to carry- out his mission for the entire Army. The changes needed wore two. in number: ■ -• First, place the Medical Service of the Serv- ice Connand on the sane level as other Divi- .r sions of the Service Command instead,of subor- . dinating it as a branch operating under one Division uhen it has varied relations with all Divisions, Second,, plfi.ee the responsibility upon the Service Commander for all medical service including hospitalization, evacuation and sanitation of all fixed installations within the geographical limits of the■ Service Command, .v ... ■. ”This,11 the committee pointed out, nwill relieve the Army Air Forces of all medical service functions at fixed installations and permit it to devote its tine and personnel .to.tactical, and combat problems, the same as is now.done for the Army Ground Forces.11 The report presented a list of textual changes to be made in thc_ organization, manual for , the purpose of carrying out these recommendations. One such change specifically mentioned the training responsibilities of the service command ,• medical division, the. first time such- 129 a direct statement would have been introduced into the manual. The medical division, the proposed clause readj ’’supervises Service Command training activities relating to medical units in accordance with training policies of the Training Division /of the Service Comraantj7."^ The Surgeon General sent this report to the Commanding General, Army Service Forces, expressing the belief that the service command surgeons could not carry out their responsi- bilities to The Surgeon General unless they had control of Medical Department personnel, hospitalization and evacuation, and training, "the latter applying particularly to Medical Department A.S.F. overseas units.** At the recent conference, he said, 11 it was found that-there was not a uniformity of procedure. Some /surgeons/ are operating more or less under the above plan while others are able to'function because of . personal contact rather than basically sound organization. It is believed that the Medical Branch should'become a Divi- sion, operating under the Chief of Staff."10 In reply, the Commanding General, Army Service Forces, expressed himself as "favorably disposed towards the plan,*’ But before putting it into effect he wanted the views of the service commanders and for that purpose was sending, them copies of the plan in preparation for a discussion at the forthcoming Service Command Conference,H The conference met in Chicago on 22 July 19A3. In his opening remarks the Commanding General, Army' Service Forces, spoke of the position of the service command surgeon as one of the topics to be discussed. However, only one of the service commanders, in their formal speeches to the conference, referred to the subject. The Commanding General of the First Service Command recommended that the Medical Branch of the Supply and Service Division be made a sepa- rate division, and that all medical service for'all fixed installations, including Air- Forces' installations , within the service command'bo'made the responsibility of .-’the- service commanded. Unification of control and training of medical personnel appear clearly desirable.12 The Surgeon General restated his own position in the matter. He drew attention -to his relation as a staff officer to the Commanding General,’Array Service Forces, and suggested that the service command surgeon be given the same status with respect to the' service commander, namely that of a divi- sion chief answering directly to the latter. So placed,the surgeon could render better service, "In some service 130 commandshe .pointed out, “Mepical Department personnel constitutes approximately‘$0$ 'of the .total duty personnel. The duties of the ‘Medical. Department, concern all of the other staff divisions and the senior medical officer should be in a position to deal direct with, those division heads i*’ He urged the service commanders to consult their senior medical officer on all medical matters, .At present he might or might not be consulted as to assignments. Vhile the per- sonnel division was charged with the assignment, transfer, reassignment and promotion of Medical Department personnel, “no one -except a senior Medical Department 'officer is quali- fied to''interpret or Judge the professional qualifications of individual officers, nurses, dietitians ..and physical thera- pists . , ♦ to determine and evaluate; their ability for spe- cial assignment to duty,” The same applied to, a less extent to medical department enlisted men. Likewise, the technical character of medical training required that its-inspection and supervision should be a matter of close cooperation between'the heads of the medical, personnel, and training divisions. “TJe are not," he concluded, “asking for more authority or power, but for an organization that makes for • ‘ Toward the end of the’conference a hint Was dropped'that the decision on The Surgeon General’s main proposal would be unfavorable. The Deputy Chief of Staff for service commands, Army Service Forces, remarked that every branch chief would naturally prefer to deal directly with the service commander, and that if one technical branch was raised to division level the others would feel entitled to the same elevation. But the purpose of the original reorganization, had, been to keep the: • number of primary divisions at a minimum and the machine had grown too big to depart from tho principle now. However, he could hot imagine a division chief’s neglecting to take the appropriate branch chief with him when called in to advise tho service* commander. 1/+ . < : In his summary remarks at the end of the•conference the Commanding General, Army Service Forces, gave his promised decision in the matter. It was adverse to The Surgeon General; I am going to disapprove the recommendation that the senior medical officer in each service . command be established in a position- where he: ■ reports direct to, the commanding general of . the service commapd, If I did otherwisethere' would be equal reason'to put all the other service chiefs in exactly the same fix* and ; ■ '■'iJQ should lose all the benefits.,that we- have ; gained’so'far* • * I do not want to-,suggest : . any changes in your organisations *■You have.-' ** bebn through a number of those, and I hate to suggest any others. . . Certainly you have got to talk to your doctor.. You have got to know what he has to say, and I expect you to do that. But for the moment I do not .want to say anything more,15 • The last sentence perhaps conveyed a suggestion that the question might he reopened at some future date. If so, it was almost the only crumb of satisfaction the The Surgeon General could carry away. Almosty hut not quite, for there was no doubt that the' Commanding, General, Army Service Forces, and his, deputy for service commands considered’ as highly essential the maintenance of•• close'contact between the serv- ice commander and‘his surgeon, no matter what the formal organ- ization-might be. •> Other matters-which also directly or indirectly con- cerned the., position and functions of the Medical Department in the service commands were discussed at the Chicago con- ference. One such point was the question of medical service .at Air Force installations, which will be dealtrwith later on.16 Another was the relationship between The’Surgeon General and; the service commanders. The Director of the. Control Division, Army Service Forces, in describing the position of the technical'services in Washington with re- spect to the service commands, used The Surgeon General’s Office as,his illustration. The Surgeon General, he pointed out, 11 is the senior authority in the Army in all matters- medical.11 If the" service commander was dissatisfied with the medical personnel in his command, he should, take up the mat- ter with The Surgeon General, and"vice versa if The Surgeon General found the medical service inadequate'in a service command, "Between the two of them they should be able to . find the proper man for the job.", If not, the next step, was to enlist the aid’ of the Director of Personnel, Army Service Forces, Still failing to reach a solution-they might.put the matter up to the Commanding General, Army Service Forces,- "who, I am sure will reach a decision. Now this sounds' like A,B,C, but it is the violation of this, very simplc: method of operations that-is responsible for nine-tenths of the difficulties between the technical services in Washington and the service,'command,ers,"!? ■ Some days after the Chicago conference, the Surgeon of the First Service Command wrote to The Surgeon General sym- pathizing with him on the failure - of higher headquarters to create a division status for the. medical branch. "You put up a real fight for it, and we can function efficiently despite,the. present organization." The Surgeon General’s reply' showed that- he- had by no .means given-up; hope, "I be- lieve," he wrote, "that- eight'dpt of the nine 'service com- mands wolild hare gone-along. With us .and /J?7 been told that General Somervell himself hasn't his mind ma.de up and it may yet come through. This was told me by somebody pretty close to hin."-^ The Surgeon General's informant was correct. Three months afterward, on 12 November 194-3, a letter to all serv- ice commanders from Headquarters, Army Service Forces, announced a desire that. 11 the’ headquarters of each service command be made' to conform as closely as practicable to the organization of the Headquarters, Army Service Forces . . . by 15 December 194-3.A new organization chart and list of functions was attached. On the chart-the "service command surgeon" (now officially so called for the first time), to- gether with the chiefs of other technical services, had a line of communication direct to the service commander and his chief of, staff. Though still not technically a division (a term reserved for certain other "staff" elements)., the surgeon's office no longer formed part of the supply division, but stood on an equal footing with it from the standpoint of command. Certain.changes were made in the statement of func- tions partly to conform with this new position. Thus it was no longer necessary to state that the surgeon was directly responsible to the service commander when acting as an advi- sor on all matters concerning the health of personnel. And since the surgeon's office was now separated from the supply division its supply functions had to be specified. These two matters wore taken care of by sections stating that the service command surgeon (1) Supervises the performance of all func- tions relating to medical activities which are the responsibility of the serv- ice command, including the procurement, distribution, issue, storage, inspection, maintenance, repair, replacement, and reclamation,of medical supplies and equip- ment, and.the provision of hospitalization and medical and veterinary service, (2) Supervises and renders technical advice on all medical activities under the juris- diction of the service commander. However the supply division kept its responsibility for "insuring the proper performance of service command activities relating to the storage, issue, distribution, maintenance,, and repair of supplies and■equipment." The former provision regarding personnel was strengthened. Besides making."recommendations for the assignment and transfer of medical personnel within the service command," the surgeon now in addition- "supervises the proper utilization of the 1- 133 specialties and-technical qualifications -of such personnel.” The'personnel division,, while still charged with arranging for the selection -and placing .of all military personnel, was to make its assignments hereafter ”upon recommendation of serv- ice command Technical Services”.(including the surgeon’s office). a ‘ ’* -• How this collaboration might be worked out was indicated in a memorandum from the. Director of the Control Division, Army Service Forces, to The Surgeon General: The Director of Personnel should handle the • mechanics of paper ?/ork of assignments of medical personnel in the same manner as is . done for all other personnel in the service command. In all cases, however, before any assignments Of medical personnel are- made, the recommendations of the Service Command Surgeon should be secured and these recom- mendations should bo followed unless they are : contrary to general policies laid down to the Director of Personnel by the Service Commander. In addition the Service Command Surgeon should initiate action to assign and reassign medical personnel, using the office of the Director of Personnel for implementing such actions. The Director of personnel should maintain such records on medical personnel as he maintains on all personnel under the jurisdiction of the Service Commander, Special records of medical personnel, particularly with respect to qualifications and specialties can be main- tained either under the Director of Personnel or under the Service Command Surgeon, depend- ing upon which is the most convenient method of operation in view of physical location and other factors The new organization described in the memorandum of 12 November 1943 was not intended to be the final and unalter- able plan. A week later-the Chief of Staff, Arny Service Forces, addressed letters to the nine service commanders asking for suggestions which might be embodied in the final draft. He notified them, however, than one matter was beyond dispute: ”It should-be borne in mind that a decision has al- ready been made to have-Technical Service units in the Service Command Headquarters correspond to the Technical Services in our Headquarters in Washington.” In other words, the posi- tion of the service command surgeon and his colleagues was now definitely changed to one of direct responsibility to the service commander.21 134 At least one service commander did not wait for further orders. The Commanding General of the Fifth Service Command reported that the reorganisation had been effected in his command on 27 November.22 A second version of the plan appeared on 8 December, the final date for compliance being pushed back to 31 December 1943• It contained one addition and one revision affecting the service command surgeon, A statement was inserted that the Technical Service officers [including the surgeon] of the Service Command supervise the performance of activities of the seven Tech- nical Services of the Army Service Forces in the ■■ ■ service commands and act as technical advisors . to the Commanding General and.to the staff agencies in the establishment of policies and procedures pertaining to these activities. In the performance of these duties the Technical Service officers, will function in the manner established for staff elements in Sections IO3.O3 and 103.04> Part X, Army Service Forces Organization Manual, 15 July 1943. The sections referred to specified as staff functions the rendering of advice to,the commanding general; the formu- lation of plans, policies, and procedures; the rendering of advice and assistance to subordinate components; and the constant "follow-up" on performance throughout the organiza- tion—all of course pertaining to a particular field of re- sponsibility such as medical,service. The revision now introduced affected the veterinary aspect of the surgeon's responsibility. He still supervised "all veterinary inspections incident to the procurement q£ meat and food supplies "within the service command," whereas previously he might, at the Quartermaster General's reouest, assist in inspecting other procurements of meat and food, the Quartermaster General was now made responsibile for "all veterinary inspections within the Quartermaster Depots and within the metropolitan area in which the respective Quartermaster Depot is located."23 The plan of 8 December was included in the new organi- zation manual of■15 December 1943 without further changes affecting the service command surgeon (see Chart XXII). The realignment accomplished some of the objectives for which two Surgeons General, as well as a number of service command surgeons, had been striving since 1942, although one service.■ command did not conform to the new plan until The- surgeons‘Were again, as they had been before the reorgani- 135 zation of 1942, essentially staff members.. This conflicted, at least superficially, with' the principle of increasing decentralization which the Commanding General, Army Service Forces, had insisted upon* But the. service command structure now more truly reflected that of Headquarters, Army Service Forces, since the surgeon’s office, as. well as the other technical services, answered directly to the commanding general instead of reporting to an intermediary ’such as the director of supply. At the Chicago conference in July 1943 the Commanding General, Army Service Forces, had Called attention to the "tremendous strides" made ih decentralizing authority from his Headquarters to,, the service commanders. But "I am not so sure," he, remarked, "that the same decentralization has ‘been passed to post'commanders. Most ,of you assure me that it* has. I would just like for you to check on that a little and find out to what extent this has been done. The new organization chart for post headquarters,. however, retained the- same structure as the previous one. It was more elaborate, but it still showed the post surgeon and',the other technical staff members reporting directly to the post commander. Post headquarters, were to become practically copies in petto of service command headcuarters, as the chart for 15 December 1943 indicates (spe Chart XXIII). Internal Organ!zation. of the Service Command Surgeon’s Office While the recasting of service command" headquarters was being planned, a model for the surgeon’s office was also con- structed for presentation to the Service Command Surgeons Con- ference" called by The Surgeon General on 10 December 1943 (see Chart" ’XXIV). It wap "considered desirable, that the office of each service command surgeon be. organized in a manner approximating that of The Surgeon General of the U. S. Army," with services responsible for administration, personnel, medical supply, and" professional care. The plan contained detailed suggestions as to the internal arrangements of each ."division. For, example, it was. proposed that the service com- mand surgeon should himself act as chief of professional service, and that the divisions of medicine, neuropsychiatry, .and nutrition should be headed by the consultant assigned to each of those particular fields. Each division chief would ■deal directly with the service command surgeon.26 In his annual report for 1943 the Surgeon of the Sixth Service Command stated that his office had been,'organized "approximating that pf The Surgeon General,11 'and indicated that, most .of the above suggestions had .be.eh carried out.27 The available evidence is insufficient to indicate whether or not the other service ccmnandsv'followed this example (before the end of 1943)• At that.time the surgeon’s office, Second Revised 15 Dec 1943 465.00A MAINTENANCE Division PURCHASES DIVISION OPERATIONS DIVISION I DIRECTOR OF SUPPLY 1111 1 ... I SERVICE COMMAND TRANSPORTATION OFFICER * ONE'S Of TIDMCM SERVICES ACT Aft ftTAff Off Cl AS AND ADViftORS , me commandma cewerac on tmc« tccmucal ksvkc fgwcnoMft. L public RELATIONS Office STOCK CONTROL DIVISION STORAGE DIVISION SALVAGE A REDISTRIBUTION DIVISION SERVICE COMMAND SURGEON SERVICE COMMAND INSPECTOR general SERVICE COMMAND HEADQUARTERS ORGANIZATION OF SERVICE COMMAND HEADQUARTERS SERVICE COMMAND JUDGE ADVOCATE AUDIT DIVISION I special Financial SERVICES Division control DIVISION FISCAL DIRECTOR SERVICE COMMAND SIGNAL OFFICER SUCCET AND ACCOUNTS DIVISION RECEIPTS AND DISBURSEMENTS DIVISION SERVICES* COMMANDING GENERAL CHIEF Of STAFF DIVISIONS i SERVICE COMMAND ADJUTANT GENERAL SERVICE COMMAND CHEMICAL WARFARE OFFICER staff security a INTELLIGENCE DIVISION TECHNICAL SERVICE COMMAND ENGINEER 1 I SERVICE COMMAND DIRECTOR WMC MIUTARY TRAINING DIVISION DIRECTOR Of MILITARY TRAINING ARMY SPECIALIZED TRAINING DIVISION AIR LIAISON OFFICER SERVICE COMMAND ORDNANCE OFFICER LASOR •RANCH CIVILIAN FERSONNEL DIVISION ©met* PROCUREMENT DIVISION I MORALE SERVICES j DIVISION DIRECTOR Of PERSONNEL SERVICE COMMAND QUARTERMASTER MILITARY PERSONNEL DIVISION SERVICE COMMAND CHAPLAIN SPECIAL SERVICES DIVISION Chart XXII Revised 15 Dec 1943 406.00A POST ORGANIZATION CHART MILITARY TRAINING DIVISION Sa pUet< aaSaf Paraaaaal Civilian If apaelal circuiNiltnctt da Ml warrant a aaparata Si«iiiaa. *Mai Ml Ba aaeaaatry ia small iaaiallaliaaa. FISCAL DIVISION POST TRANSPORTATION OFFICER I * INSPECTOR GENERAL I SECURITY AND INTELLIGENCE DIVISION POST SURGEON maintenance BRANCH CONTROL OFFICER STOCK CONTROL BRANCH SUPPLY DIVISION 1 POST SIGNAL OFFICER COMMANDING OFFICER EXECUTIVE 1 STORAGE BRANCH I PURCHASING BRANCH POST CHEMICAL WARFARE OFFICER Civilian PERSONNEL BRANCH POST CHAPLAIN ' I ‘ MORALE SERVICES branch PERSONNEL DIVISION I POST ENGINEER I MILITARY personnel BRANCH SPECIAL SERVICES BRANCH I PUBLIC RELATIONS OFFICER POST ORDNANCE OFFICER ‘I » POST JUDGE ADVOCATE POST QUARTERMASTER POST ADJUTANT Chart XXIH VETERINARY DIVISION SUPPLY SERVICE NURSING DIVISION L_, DENTAL DIVISION (Copy of chart from "The Surgeon General's Conference with Service Command Surgeons, To be held in the Office of The Surgeon General, Commencing December 10, 1943.") ORGANIZATION OF SERVICE COMMAND SURGEO N'S OFFICE I OPERATIONS SERVICE VENEREAL DISEASE CONTROL DIVISION SERVICE COMMAND SURGEON EXECUTIVE OFFICER PREVENTIVE MEDICINE DIVISION FIELD INSTALLATIONS PROFESSIONAL SERVICE I NUTRITION DIVISION PERSONNEL SERVICE _ J-r I PHYSICAL STANDARDS DIVISION NEURO- PSYCHIATRY DIVISION ADMINISTRATIVE SERVICE SURGICAL DIVISION MEDICAL ! DIVISION j Chart XXIV Service Command, still retained the same nomenclature for six of its seven main subdivisions as earlier in 1943 (above, Chart XXI), having merely dropped the training section and added a personnel branch. The Eighth Service Command also showed little variation from its set-up of 1942 (above, Chart X3X), and the changes, made had nothing to do with the events of late 1943. Thus in March 1943 the Procurement and Assign- ment of Personnel Subsection (Plans and Training Section) was redesignated'Assignment Section and charged with the assign- ment of Medical Department officer personnel. In the same month*a Hospitals arid Hospitalization Section was created, made up of the .administrative portion of the Medical Educa- tion Program and the Hospital Construction and Campsite Sub- sections of the Plans ‘and Training Section. The Plans and Training Section disappeared. The. Consultants Section.was redesignated the Professional Services Section’in July 1943. However, as wo shall see, the office' underwent further remod- eling before the end of 1944, which brought it more into con- formity with the layout of The Surgeon General’s Office,'2® Apparently the reorganization of service command head- quarters did not necessarily, affect the structure or even the business of the surgeon’s office. This may seem strange in view of the restatements of functions contained in the direc- tives and organization manual of December 1943, but it was probably because techniques had already been worked out in individual service commands which anticipated these directives. There may have been other reasons also: perhaps the author- ities in some service commands were slow in adopting the new interpretations or saw in them nothing essentially new. Thus the Surgeon of the Sixth Service Command stated positively that the manual of December 1943 made no changes in his func- tions or activities. Nevertheless, as we have seen, he an- nounced the reorganization of his office to conform to that of The Surgeon Gonopal.2^ The Question of Air Force Installations While the status of the service command surgeon with respect to the service was under discussion and revision, the surgeon’s authority in Air Force installations remained a subject of debate. Circulars and directives issued in 1942 and 1943 did not settle the matter completely. The recommendation of The Surgeon General's committee, already referred to (above p„ 129), had been anticipated a few days previously by The Surgeon General himself. Ah. the conference with service command-surgeons in. June 1943 he•stated the question-in broad .terms; ■ v. The Air Corps operates some 250 hospitals in the Zone of the Interior. • . Fe think that all Army hospitalization should be under one 137 control. It all belongs .-under the service . v commands -and wo hope* to. take all that over. The Flight Surgeon has a very definite place as a .specialist;and--he*11 unite the prescrip- tion on-fell flying personnel training and flying. will,treat the fractured log, hernia.or what not, and when we finish with them they will be turned over' to the flight surgeon for-reconditioning and to be kept in flying condition. We'll see that /the Flight Surgeon/ has the necessary facilities—‘swim- ming pools, golf, courses, bands, or anything else he wants, and give him all we can.30 The subject came up again a month later at the Chicago conference of service commanders. The Commanding General of the Eighth Service Command advocated the abolition of all exempted stations and the-1 concentration of responsi - bility for all service functions in the service commanders. He considered The Surgeon General’s proposal an important step in this direction. Such action would make it possible to ical service to both Class II and III /Ground and Air Forces/ installations with less per- sonnel and with better utilization of the specialized abilities of the medical offi-“ cers available in the area. Thu service com- mander has responsibility for sanitation in /Air Forces/ installations, but he has • no responsibility for the care of the sick and wounded. I think you will agree that a duplication of personnel and an uneco- nomical use of professional personnel is inevitable' •* rThile the,Air Forces had no general hospitals, he added, there existed two pools of medical personnel within the service command, over one of which the latter had no control. The Surgeon General reported that he had nnot made much headway” with his proposal to take over the 250 Air Forces station hospitals, but that certain kinds of cases would be transferred from Air Forces hospitals to general hospitals, A spokesman for the Air Forces admitted lack of infor- mation on hospitals but thought that ”these differences should be. solved,”, and that nit is a matter of personali- ties, probably in the lower echelons, because , , , we haven't had any difficulties from the service commands.”31 138 However, the Surgeon of the Second Service Command reported at the end of .1943 that his limited supervision .of medical activities in Air Forces installations and •certain of .the. Army Service Forces * installations controlled from Washington .“'made it quite difficult to provide that degree of ..overall medical care .considered as most desirable and most likely ...to meet the. continuing objectives of the Far Depart- ment bqhcern.lrig, conservation-, of '.personnel and facilities.1132 .. One particular difficulty arose over the activities of medical, .who were assigned, to the offices of serv- ice" command' surgeons but who also operated- in Air Forces in- stallations. The matter had been brought up in testimony before the Wadhams Committee in 1942. At that time the chief of The, Surgepp General’s .Medical Practice Division stated that while the. Air,Corps, sometimes cooperated, and while “of course we,feel/perfectly free to. go intp Air Corps hospitals,11 there was “some uncertaintyr-in view of conflicting directives — ... on the part of service command surgeons as to their responsibilities and prerogatives in this matter.1133 A War Department circular of 6 December 1943 stated that “these consultants will be made available to the medical in- stallations not under control of the service command. Their visits will bo made in accordance with arrangements agreed upon between the commands concerned.“34 This did not, however, resolve all difficulties. In February 1944 the Surgeon of the Fourth Service Command transmitted to The Surgeon General a document which he described as “distasteful to the service command consultants,11 This was an extract from a medical bul- letin issued by the Surgeon of the Third Air Force, which Vreminded” station hospital surgeons that service command con- sultants wore limited specifically to professional matters of a technical nature. These visits are not a military inspection. Consultants will be given only such data as directly relate to the specific technical problem for which consulta- tion was requested. Information regarding strength, number of professional personnel, gen- eral administrative procedures, etc., will not be given. Station surgeons will carefully scrutinize reports of consultants and when the contents of the report coyer any phase of hospital administra- tion other than the technical problem specifi- cally under consultation, exception v/ill be taken in the indorsement and channelled to this office for action. The Surgeon General answered that the relation of consul- tants to Air Forces station hospitals was under study and that 139 ''something definite”' would.' result *yV”’I •think . this will- change things' materially..' .' Let' them run' their installations the way they1: Want if you desire, and' use your consultants where their work will be appreciated.!t35. . 4 new Wap Department circular dated.some weeks later ’merely statedI. that-the technical reports “ of consultants. Would "be.forwrJrded • to- The Surgeon General through medical channels within the'Army Ground Forces, -Army Air Forces, or Army Service Forces,36 phis changed the- previous' rule, under Which the.consultant’s report on an Air Forces installation was sent through command channels to the Commanding General, Army Air Forces, an information copy going to the service, commander for the attention of his surgeon.37 -* . :W . ;■ . i.- ■ * • , ‘ ; .. v • V ‘ ’ - /% Having discussed the changes in' organization- of the- serv- ice command Surgeon's office as they developed to the end of 1913, we may now"return to the .subject of hospital organiza- tion during the remainder of,the war' and the period immediately following it. ‘ : 1 v . ' ' ' • " . - ■ ' . • ''-NOTES OF’CHAPTER X ; Iwadhams Committee, pp. 16-17, 192. 2 Me mo from Maj. Gen, J. C, -Magee for Lt, Gen,; Somervell, 7 Nov 1912 (Record Room, SGO, 323.3-2). 3fnd, to above, Lt, Gen, Somervell to Maj. Gen. Magee, 12 Nov 1942* loc.cit. - . Office of the Second Corps Area and Second Service Command (Historical Division,. SGO).- . 5Annual Report, Third Service Command, 1912 (Historical Division.,- SGO) ■ • ■ S, v?, French to_CoI. G. F. Lull, 13 Jan 1913 (Record Room, SGO,- 323.3-2 /ith Service . Command/). .Committee, Recommendations No. 58 and-62 (Historical Division, SGO). ' ; ■ 8Report of Surgeon General's Conference with Chiefs, Medical Branch of Service Commands, 11-17 Jun 1913 (Record Room, SGO, 337.1). -‘Memo for The Surgeon General from Cols, W. Lee Kart, E, C, Jones, and C. M, Faison, 17 Jun 1913 (Record Room, SGO, 300.7-1). • . ... .. . i . l°Memo for the CG, ASF, from the SG, 18 Jun 1913 (Record Room, SGO, 300.7-1). /: to above, undated, loc.cit. 12Army Service. Forces Conference, of Commanding Generals Service Commands, 22-21 Jul 1913, pp. 6, 77 (Record- Room, 5G0), 13Ibid., 128, 131-132. Hlbid., 318, 35jbid., 381. ' - • ■ ■ ' ‘ ' :’ p, 137. . t~- • , p, 99. • *’ ■': . - *' * J, J. Reddy to Major Gen, Kirk, 1 Aug 1913; Major ’ ' Gen. Col, Reddy, 7 Aug 1913 (Record Room, SGO, 323.3-2 /ist Service Command/ AA). ■^Headquarters, ASF, to Commanding Generals, all Service Commands, 12 Nov 1943 (Record Room, SGO, 323.3-2). 2%emo for SG from Director, Control Division, ASF, 13 Nov 1943 (Administrative Records, CG, ASF, 321 /Service Commands/). j, Gen, Styer to CG, First (etc) Service Command, 19 Nov _ 1943 (Administrative Records, CG, ASF, 321 /Service Commands/}. 22CG, 5th Service Command to CG, ASF, 1 Dec.1943, loc.cit. ASF, to CG’s, all Service•Commands (Record Room, SGO, 323,3-2). • from Col, R. J, Carpenter, Executive Officer, Surgeon General’s Office. Service Forces Conference of Commanding Generals Service Commands, 22-24 Jul 1943 (Record Room, SGO). * The Surgeon General’s Conference with Service *Coiftmand Sur- geons to be held in the Office of The Surgeon General, com- mencing 10 Dec 1943 (Record Room, SGO, 337,-1), Apparently this is the agenda for, not a report of * the conference, 2?Annual Report, 1943, Sixth Service Command (Historical • Division, SGO), Reports, Second and Eighth Service Commands, 1943 (Historical Division, SGO). 29Annual Report, Sixth Service Command, 1944-(Historical. Division, SGO). 3°Report of Surgeon General’s Conference with Chiefs, Medical Branch of Service Commands, 14-17 Jun 1943 (Record Room, SGO, 337.1). 3lArmy Service Forces Conference of Commanding Generals Serv- ice Commands, 22-24 Jul 1943, pp. 250, 251, 255 (Record Room, SGO). 32Annual Ret-ort, Second Service Command, 1943 (Historical Division, -GO), Committee, p, 435 (Historical Division, SGO). Cir. ?16, I, 2b(2)(b), 6 Dec 1943. 35col. French to Major Gen. Kirk, 22 Feb 1944; Major Gen. Kirk to Col, French, 28 Feb 1944 (Record Room, SGO, 323.3-2 /4th Service Command/ AA). 3%) Cir. 140, 2d 11 Apr 19U. • . 1 . Cir. 316, I, 2b(2)(b), 6 Dec 19A3, CHAPTER XI .. THE ORGANIZATION OF GENERAL AND RELATED.HOSPITALS 1942 - 194,5 As already noticed (above p„ 115), the relations of the general hospitals and of the service command surgeons1 offices to higher authority changed simultaneously in the middle of 19AZ* At that time, the surgeons’ offices became branches of the supply divisions, while the general hospitals were, with cer- tain exceptions, removed from the jurisdiction of The Surgeon General and placed under the authority of the service com- manders This settled the position of the service command surgeons’ offices and the general hospitals in the War Department struc- ture (at. least for the time being), but it did not directly affect their internal arrangements.. However, a standard plan for the. surgeons ’ offices was put forward at the end of 194-3, as we have seen (above p„136). A similar project was already under way for the hospitals. Planning a Standard Organization for Hospitals Late in 1942 the authorities in Washington began to scru- tinize the organization of the general hospitals and to work out projects of reform. This envisaged changes in administra- tive procedures and in the system of personnel allotment, but only the structural.and functional aspects of the reorganiza- tion will be.considered here. In 1942 the only guides to the ordering of a,general hos- pital were still the technical manual of 16 July 1941 and a few pages in the Military Medical 'Manual, an unofficial publi- cation of 194P* As new activities were added to the functions of general hospitals, the commanding-officers in some cases merely hung them on the old framework with no attempt to work out a logical, efficient In November 1942 the Wadhams Committee cited the case of a general hospital where thirty- three officers in charge of various sections reported directly to the commanding officer, The committee expressed the be- lief that the organization of larger hospitals could be altered for more efficient and economical operation with resultant savings in medical and administrative manpower, and suggested a model arrangement to achieve that end. This plan provided for a commanding officer's staff to consist of an executive officer, a medical officer of the day, and an administrative officer of the day. The other sections would be grouped in three divisions;; (1) a medical division supervised by a chief medical officer, comprising the medical service., surgical service, dental service, nursing service, admission s.ervice, 143 and records; (2) an administrative division headed by a chief administrative officer, comprising the office of adjutant, the supply section, the office of special services, the dieti- tians department, the office of inspection, and the medical detachment; and (3) a service division under a chief service officer, handling maintenance of buildings and grounds, motor transport, laundry, fire protection, and police protection, A simplified plan of this sort, the committee stated, ’’would coordinate and expedite the activity of the various depart- ments and would also afford the commanding officer sufficient time to make inspections and develop long-time planning,11 The Commanding General, Services of Supply, transmitted this proposal to the Office of The Surgeon General for comment. In reply the latter expressed doubt that thirty-three sections reported directly to the commanding officer in any hospital: they, would report to the executive officer; moreover, the 11 most elaborately organized hospital" had no more than six professional services (medical, surgical, eye-ear-nose-and- throat, neuropsychiatric, x-ray, and laboratory) in addition to the medical detachment, detachment of patients, Array Nurse Corps, civilian personnel, quartermaster’s department, and utilities. The latter were under the administrative control of the executive officer and adjutant, only questions of policy reaching the commanding officer. The Surgeon General’s Office referred to the manual of 194.1 as representing long experience and the opinion of able officers, and concluded that Mno ad-, vantage would appear to accrue for /from ?/ any major change at this time.'* The response of Headquarters, Services of Supply, was brief: "The Office of The Surgeon General will take immediate steps to effect /the committee’s recommendations/ and report thereon by 15 January 19/3.“ The Surgeon General’s Office answered on 16 January that it was negotiating with Dr. B. C. MacLean, Superintendent of the Strong Memorial Hospital, Rochester,. New York, to make a comprehensive study of mili- tary hospital organization and administration. A later re- port (8 March 194-3) stated that Dr. MacLean was unable to accept immediately.! In April 19/3, however, he was brought into the Office of The Surgeon General and took part in the projected investigation.4- Dr. MacLean became a member of the Hospitalization and Evacuation Division with the rank of lieutenant colonel and made a series of field trips to collect material for the study. Then and later in 19/3 he was joined by other investigators, some of whom were brought- in from the service commands. The study was carried on in collaboration with the Control Divi- sion, Surgeon General’s Office.5 Lieutenant Colonel MacLean left the service in September 19//, but the working out of new procedures and organizational plans for Army hospitals continued, -Meanwhile;'the Control Division, Array-Service Forces, had also entered the field; As early as October 19A3 survey teams were sent to Camp Blanding (Fla.), Fort Jackson (S*'C.), Fort ;SiU (Okla.), Camp Hood (Tex.), and Fort Lewis (Wash.) for the purpose of collecting information on the operation of field installations, including hospitals. At first The Surgeon General's Office and Army Service Forces operated separately in the matter. Later, however, they combined forces, and the new technical manual on hospital administration which ulti- mately appeared was a joint product.6 In the course of the study, organizational charts of various hospitals were collected and subjected to scrutiny. A message from the Office of The Surgeon General to the Fourth Service Command on 2 March 1944 indicated the trend of thought at.Washington. It," was critical of the general hospital charts of that command as showing an "unwarranted number" of independ- ent services directly, responsible to the commanding officer, and expressed the opinion that, in line with Army Service For- ces policy, the number of separate services should not exceed four or five. The communication also mentioned that an organ- izational chart for general hospitals was under study with a view to issuing it as a directive,7. Such a chart was actually approved but not published,^ While the organisation of general and-station hospitals was being considered, the scope of the planning operation was Broadened to include the new regional and convalescent/', hospi- tals, created during the first half of 1944, and the new hos- pital centers that followed a year later,9 Early in 194-5 at a, conference of service command surgeons the subject of standard hospital procedure and organization was discussed.10 About the same,time, in February, the first fruits of the hospital inquiry appeared when the War Depart- ment began the issuance (in parts) of a new technical manual, "Administration of Fixed Hospitals, Zone of Interior" (;TM 8*262), The purpose of issuing the manual piecemeal was to enable the sections to be tested individually in the field and to facili- tate their adoption by overworked hospitals.11 The manual had been approved by the Army Air Forced, which worked out.the plan of Aviation and Medical Service in the section on ‘regional hos- pitals ,12. " •' The New Plan for General Hospitals Chapter I on "Hospital Organizations" (TM-8-262) was dated 1 July 194-5, some two months after V-E.day. The, first section dealt with "Standard Functional Organization of Named General Hospitals1'." It .provided charts and descriptive mater- ial on, the'functional aspects of hospital organization. The administrative side was treated more fully than the profes- 145 sional, since the latter was "subject to .constant variation by reason of changes in types of patients." To economize on personnel, the functions of more than one division might be performed Toy one person,- or if the duties of a single divi- sion were too onerous a second.ill command, or deputy, might be appointed, but the standard plan was to he adhered to; While hospitals vary as to the type of special- ized medical treatment offered, their primary mis- sion and general functions are the same. The adop- tion of a standard organization will result in im- proved operation, make possible more effective utilization of personnel,.and permit simplification of procedure. Deviations from this standard organi- zation will not be permitted unless prior authori- zation is granted individual installations by the Service Commander having jurisdiction,^ The new manual was thus more exacting in its requirements than the previous one had been.3-4 The organization it pre- scribed was also more elaborate, as its chart indicates (see Chart XXV),3-5 The hospital organization was still divided into three parts; (1) the group of functionaries in or imme- diately connected with the office of the commanding officer (formerly called the "unit staff"), (2) the administrative staff divisions, and (3) the professional staff divisions. But the make-up and functions of these parts had been consi- derably altered. (1) The commanding officer himself, in addition to his usual responsibilities, had one hot previously mentioned: he was to coordinate the hospital administration with outside activities such as the American Red.Cross, United States Em- ployment Service, Veterans Administration, United States Civil Service Commission, and Selective Service. He also had two new assistants in direct relationship with himself; the control officer and the public relations officer. In addition, the medical inspector (formerly the hospital in- spector) had been moved up from the administrative service. Among his duties were now mentioned, specifically, oversight of sanitation, venereal disease control, inspection of train- ing, discipline and morale, and investigation of complaints of the hospital complement and patiepts.3-6 On the other hand, the adjutant, chaplain, medical supply officer, and personnel officer were relegated to the administrative staff level, the chaplains’ office becoming a branch of the personnel division.3-7 (2) The administrative divisions increased from eight to eleven. Wholly new agencies in this echelon were the judge advocate's division, the fiscal division, and the security and intelligence division. If no judge advocate was assigned to the command a legal assistance officer was to take his place for TM 8-262 CHAPTER I MMBUH t N5H smM |»IM m* Hunofi OfTKB I IttfilUl Min- MBt « FilHTi HOWTT 4 RIBlNOa KT5M [I11UI wn mn mure p**ani BMO STANDARD ORGANIZATION CHART FOR NAMED GENERAL HOSPITALS « HH mv» not mn warn SMQ & taut mn (0ITI01 omen VtlBIAIUI Nfimc MVBM JilVAM i n» nnmo» mn mtm Hisra | mn rtwB MtUIM mn «mt MV5IN (ONMARDIK OFFICII IIICRTIFI OFFICII m I oust MUfl SHUl mn rwarr tun rnnm - UTW uin order to hasten the recovery of convalescents," required the operation of a convalescent section in each hospital wherein patients may be reconditioned, who no longer require daily medical and nursing care, but who are not sufficiently recovered to return to duty. Sep- arate zone of interior convalescent hospitals pri- marily for the reconditioning and rehabilitation of war casualties may be established. . . . The Com- manding Generals, Army Air Forces and Array Service Forces are authorized to place , , , convalescent hospitals (Zl) under the direct jurisdiction of commanding generals of service commands or of Army Air Forces commands or air forces, respectively, when such action is deemed to be in the interest of efficient use of such hospitals.33 During the following months of 19AA lists of Service Forces and Air Forces convalescent hospitals were designated by the war Department, and in August seven general hospitals were renamed "general and convalescent1* hospitals,3A The new convalescent program was outlined in a letter from the Office of The Surgeon General to service command headquarters on A August 19AA*' ••This was amplified and revised by an Army Service Forces circular in the following December.35 The latter contained detailed organization charts of a conva- lescent hospital as a separate Installation without indicating what would be the structure of a general convalescent hospital. 152 Judging from the annual reports for 1944- of four of the seven general convalescent hospitals, the new aspect of their activity occasioned little basic change in the hospital struc- ture; A convalescent unit was already in operation at Brooke General Hospital before the issuance of the new directives. Neither there nor at Wakeman General Hospital were separate administrative services allocated to the convalescent units. At England and Percy Jones General Hospitals the case was somewhat different, Percy Jones consisted of three separate plants: the main hospital, the annex, and the convalescent facility. Each of these had an assistant executive officer, and most of the administrative departments operated sub-de- partments at the facility and the annex, A chart of the hospital about this time shows an administrative staff for the convalescent facility of an assistant mess officer, an assistant supply officer, an assistant personnel officer, and an assistant registrar. At England the convalescent facility was joined with the hospital reconditioning section to form the reconditioning service, which had its own administrative group. This included a plans and training officer, a physical record officer, an inspector, guard and billeting officer, a supply officer, and a mess officer,36 By the end of 1944> therefore, convalescent hospitals as separate institutions and general hospitals with convalescent facilities attached had become regular parts of the hospital system in the zone of the interior. It remained to combine these.two elements—the result being the hospital center. The occasion for the combination was the great influx of patients from overseas at the beginning of 194-5. This neces- sitated the creation of convalescent accomodations on a scale not hitherto required. The program of expansion was hastened by a letter from President Roosevelt to the Secretary of War (A December 1944-). In it the President expressed himself as deeply concerned over the physical and emotional condition of disabled men returning from the war. I feel, as I know you do, that the ultimate ought to be done for them to return them as useful citi zens—useful not only to themselves but to the community. I wish you would issue instructions to the effect that it should be the responsibility of the military authorities to insure- that no over- seas casualty is discharged from the armed forces until he has received the maximum benefits of hospitalization, vocational guidance, pre-voca- tional training, and resocialization,37 The new situation was different from, that which had earlier resulted in the attachment of convalescent facilities to general hospitals. Those facilities had been established to provide for the overflow of partially recovered.patients from within the hospital itself. Now' certain of the hospitals were receiving in addition many, patients from overseas and elsewhere who might need ..no general hospital care but whom it was desirable to keep within reach of the specialists of general hospitals. Tv.ro prob- lems, confronted the hospitals; how.to secure additional accomo- dations for convalescents ‘and how to administer the enlarged .plant with greater efficiency and economy of manpower. The problem of accomodation was solved by taking over and convert- ing some.of the now empty barracks at training camps where, or near, which, hospitals ;• we re located,3° The. problem of administration was more complex. It was tackled on the spot at Percy Jones Hospital by-the Office of The Surgeon General, One of the chief difficulties proved to be the handling of patients-’ records in such a way as to permit a smooth flow.of patients within the installationy unhampered by delays and errors in admissions, transfers, and dispositions. Representatives of ‘The Surgeon General’s' Office39 visited the hospital in March 194-5 and in cooperation with the service command and .hospital authorities worked out .•$ new plan of or- ganization. 4.0 it involved the creation of a ’’hospital center” and waited only on the issuance of proper authority to bo put in operation. - ■ p - . This was obtained early in1 April-194-5. The first move in that direction was a War Department circular (4--April 194-5) authorizing the establishment of hospital centers in the zone of the interior. Such a center was to be composed of center headquarters, two or more gen- eral hospitals, two or more convalescent hospitals or a combination of general and convalescent hos- pitals with such additional medical installations at the same station-,‘ such as regional and station hospitals, infirmaries, dispensaries, laboratories, dental clinics, etc., as. nay be collectively admin- istered under the center headquarters, ., Hospital centers (21) will be established only-in localities having multiple medical installations in close prox- imity to each.other. • • In order tc conserve person- nel and facilities common administrative functions will be combined to maximum extent possible. Re- ceiving, evacuation, medical supply, general sup- ply, sanitation, transportation, laboratories, registrar, hospital fund, finance, andpostal ser- vice are. among the bommon activities-that may be -w *•••*: ., : • ; 154 .A second War Department circular, dated seven days later (11 April. 1945) , established nine hospital centers, each con- sisting of one general and one convalescent hospital, under control of the service commands ,4-2 This was followed shortly afterward (16 April 194-5) by an Army Service Forces circular which amplified the recent instructions. It stated that where a hospital center was located on a post (Class I or II instal- lation) the post commander would furnish to the center such post administrative and overhead services as were common to all Army Service Forces activities on the post, but that the hospital center commander would report directly to the ser- vice commander for the operation and technical administration of the center. The circular included a “suggested standard organization chart which is furnished as a guide for the establishment of a hospital center11 (see Chart XXVI).A3 This chart was by no means the final word on hospital- center organization so far as the Office of The Surgeon General was concerned. Three months later, in early July 194-5, the Chief of the Operations Service, SGO, addressed a letter to the commanding generals of service commands where hospital centers were located. He referred to the "established policy of this office that a basic standard administrative structure is a prerequisite to standardized administrative procedures" and submitted charts of the Percy Jones Hospital Center, "the result of considerable study" by the service command, and hos- pital authorities, and the Office of The.Surgeon General. Comments on the charts by the service commanders were requested and, if the latter so desired, by their control divisions and the local hospital centers, (For the main Percy Jones chart as-modified in certain particulars, see Chart XXVII).AA The reaction to the Percy Jones plan was somewhat varied. Several commentators believed the organization to be basically sound. But there were a'number of criticisms. The authori- ties of the Fourth Service Command suggested more than one- headquarters commandant, more than one mess department, and two patients detaphments coordinated by the registrar. The Ninth-Service Command, on the other hand,believed that some consolidation was desirable to reduce the number of staff officers reporting to the center commander; for instance, all technical service might be concentrated under supply. The Fifth Service Command’s opinion ran .along similar lines; the commander of Wakeman Hospital'Center remarked that the Percy Jones' organization was 11 somewhat centralized in its character.11 At Wakeman, he pointed out, the, headquarters staff of the cen- ter was 11 primarily the eyes and' ears of the commanding officer.41 Its function was not .mainly operating but advisory and correc- tive. .-Moreover, the number of :units responsible to a super- visor was kept sufficiently Small to permit effective coordi- 155 nation, "It is my opinion," wrote the Fakeman commander, "that decentralization rather than centralization should be the basis of good staff organization and,.an efficient oper- ating structure for k Hospital Center."■ ■The Surgeon of the Fifth Service Command stated that the Hakeman Center had at first been organized in a manner similar to that of Percy Jones, but that the system did not function well and had therefore been decentralized as the result of study by the control division and the surgeon’s off ice. 4-5 The authori- ties at Percy Jones, however, hold to their own theory: "There are many advocates of decentralizationx but it was felt by the Commanding General /of the center/ that to carry out the thought behind the 'establishment of a Hospital Center, the only course was centralization in all At the same time, only a small number of staff officers reported directly to the. commanding general; the rest reported in mat- ters of routine to his executive officer.A? Criticism of the Percy Jones plan reflected, to some extent, the fact that requirements varied from one center to another. This was particularly true where a center was located on a post, as several commentators pointed out. The Percy Jones Center constituted a post in itself. T.7ith the operating experience of the. new hospital cen- ters to draw upon, the Office: of The Surgeon General pro- ceeded to formulate, for inclusion in TM 8-262, a standard plan of hospital center organization. It was designed for centers "which in themselves constitute a military instal- lation. "49 For the chart of the headquarters staff and cen- tral services see Chart XXVIII. , . -r- ' • The, general plan and. statement of functions1 'of the en- tire center were similar, in many respects to those of a general hospital as described in TM 8-262. This was true of-both the administrative .and professional sides of the organization. There however, a numbep7of differences. Thus, the center had three commanding officers instead of one.—a commander of the center and his subordinates, the commanders of the" general hospital and the’convalescent hospital. The center commander, in addition to the func- tions, .ascribed to the head of a general hospital in TM 8-262, was "responsible for carrying .out the migsioh of .'the Hospi- tal Center (Zl) and the centralization and coordination of of its components." The commander of the convalescent hospital ?• a. Is directly responsible to" the command- ing officer of the Hospital Center- ;(Zl) for the proper performance of’the assigned'Ms sion of the Convalescent Hospital and exercise's all command functions relevant to its operation. 156 b. Establishes policies for, and coordinates and directs the activities and services rendered by divisions and services of the Convalescent Hos- pital to assure that all patients obtain maximum hospitalization benefits,50 • ; ■’ The functions of the general hospital commander were sub- stantially the same.51 Other innovations in the administrative staff were intro- duced. Three new officers were added to the top echelon—a director of professional services, a director of dental ser- vice, and a director of nursing service, with the following du- ties: Director of Professional Services „• a,. Acts as advisor to the Commanding Officer of the Hospital Center (Zl) on all professional matters. b. Is responsible for directing and estab- lishing policies and procedures governing the oper- ations of the respective professional services functioning at both the General Hospital and the Convalescent Hospital. c. Assures that all directives, regulations, orders, bulletins, etc., affecting operation of the professional services are complied with through- out the Hospital Center (Zl). d. Senior medical-officer on duty with pro- fessional services at the Hospital Center (Zl) ordi- narily act s as Director of Professional Services in addition to his other duties. Director of Dental Service ■ - ■ a„ Advises the Commanding Officer of the Hospital Center (Zl) through the Director of Pro- fessional Services, on all deamtal matters. b. Is responsible for the -dental service program for all military personnel within the Hos- pital Center c. Coordinates use of dental facilities and utilization of dental, personnel. d. Is responsible for the preparation of ne- cessary dental statistical data. ’ . o. Senior dental officer on duty at the Hos- pital Center (Zl) ordinarily acts as Director of 157 Dental Service in addition to his other duties. Director of Nursing Service a. Advises the Commanding Officer of the Hospital Center (Zl), through" the; Director of Professional Services, on all matters pertaining to the Nursing Service* b. Supervises and coordinates, the operation of the Nursing Service at the General Hospital and at the Convalescent Hospital. c, Senior nurse'on duty at the Hospital Center (Zl), ordinarily acts as Director of Nurs- ing Service in addition to her other duties. It appears from these statements that the directors of the dental and nursing services were intended to be subordi- nate to the director of professional services, at least where matters of policy wore concerned, although the chart gives a.ll three services an equal footing* The reconditioning council, an instrumentality of the director of professional services a. Advises the Commanding Officer of the Hospital Center (Zl), through the Director* of Professional Services, on all matters pertaining to the reconditioning program in both the General and Convalescent Hospitals. b. Formulates policies to be followed in the reconditioning programs in the General and Convales- cent Hospitals.52 The staff members of the second administrative echelon of the hospital center were the same in name and number as those of the general hospital described in TM 8-262. But there were some differences in components and duties. Thus the registrar's office had a new functionary, the custodian of patients' funds, who "acts as custodian of patients' funds and valuables" and "makes proper disposition of money, valu- ables, and other personal effects of deceased and insane patients," The admissions and dispositions branch of the registrar's office, instead of examining patients prior to admission and assigning then to the proper v/ards, "examines patients referred to the General Hospital," and "assigns patients to the proper wards or refers then to the Convales- cent Hospital in appropriate cases." This branch also "checks all patients arriving at or departing from the General Hospi- tal on admission, discharge, pass, leave or furlough."53 158 1 Detaehaaat Radical • where h capital oMt«n are located at Claaa I or Claaa II Inatallatlona, tho poet ooanaodar will fbnalah poot edainl.tmtiTe and orertcad aarricaa mm to all 1ST aetlrltloa located tbaraat la ordar to prevent duplication of offort and paiaonnal. •a For duty personnel. Inclosure to ASF Circular Ho. 135, 1945 Director | of Tmininn**l » Public Da la tl one Adadsaioa and Cbpoa It ion Convalescent Hoapital C.D, Registrar Control Engineer* • Dl motor of Supply* Baapital Can- tor (tl) C.O. Executive Officer I Director of Personnel fiscal* Radical Inapaotor Security and Intel ligax* Veterinary Off!oar Director of Ciatatlea Cana ml Hospital L— teflj Judjp Advocate Adjutant Chart XXVI ■CCOMOITIOH- «OC MWKf nvt wonn vnu on SOMKAL urn Ktv ice ORGANIZATIONAL CHART OF PERCY J0NE5 HOSPITAL CENTER FORT CUSTER. MICHIGAN COT— t tor— PfHC. FT Cm NM •tVSMO-4 OMMV—0 director OP OSPPlV potr siomaa. omect MWtt ' ACO—i icawcg | ooSkT POST TAJMIPONTAT—1 QMKtf | Aff—U OV M. MiMMJIA moKM- - - DCNAMTMCT SCHOOLS POST ftCO'CAL SNPPiV QPPKH 1 OIBCCTOB OP TtAfMIMQ •NO— I COTCAT— •NANCM PNT CHtSNCM. m—rstt omcot omccn to SMUTAtV T9AINMM SAAMCII POST QMANTCCMAJTCA ' ~ T —IcoNreoiONwaM | -\p—ut mmw m\ E3 HQ t «V CD PJCH J S47 ASP • AMO 454 AST •AMO I me set SOT ONOMAHCt omtfM HCAOOUASrfd “ COMMANDANT HQ C MQ CO PJHC MQi «V 00 PJCN U» MAC HOSM CO lOf STAC HOSf CO SAM MAC HQ3P CO i ... SC CONS tCOi—NT COMMANDING CtHCtAL CVCCVTIVC OFflCta F=1 ' , wcKCuocc mma | ±1 CD -- m CD iece - AOltTMKI QIUMCW | POST CMC tout T oiotcrot or MOflSNOUl SttVfCU m OiBtcroe Of morviOAMu. Miticu | CHAflAMI soioicts Mr- mcs r«oc«M» orricts post aosmtat POSTAL QfftCf TCAMNU4. MfAKI SNAUCW I*-*"! | post NOAtcnoM |- J picul service QNMICH 1*1^1 I MOST ttomfcNT y-1 NOVMT ■ lAWOt POST JtfOCZ ASVOCATt ,. I... HOJTUA osier of OCTAL M evicts •eCUOlTY AMO IHTUUCCNCC DIVISION ; T COmUtCfT MOST HAL , I I — 1 UHjy MMCN CO--CD cD-ks E3 MTUUUNa i FlKM. Pl«CCTO< pisowf me or net* i mr iitttON post ventiHMiuui . | 01 BIX rot op Mmms MCtKM. I tmnrrwm saamcm| —1 OlRtCTOi or NISONNU. rcuoMci CONTMOC IMW CIVU.WNI rctjOMCL ••ATM MUlUi KIVKl ««• aetntt _ Of«TM Mtmi imuiiHUw UNIT ssl ttfOQM mmta\ ttcfrvmc tm OIKNMICC SNNClCAi WWtt Chart XXVII REGISTRAR CUSTODIAN PATIENTS' - FUND detachment OF - PAT IE RTS ADMISSION B OiSPO- VTlON BRANCH DIRECTOR Of NURSING SERVICE JUDGE ADVOCATE * TRAIMN6 BRANCH J CONVALESCENT HOSPITAL STANDARD ORGANIZATION OF A HOSPITAL CENTER (Zl) Civilian PERSONNEL BRANCH personal AFFAIRS BRARCH special SERVICES BRANCH DIRECTOR OF PROFESSIONAL SERVICES PERSONNEL DIVISION RECONDITIONING Cov tic a MILITARY personnel BRANCH PERSONNEL CONTROL BRANCH CHAPLAINS BRANCH INFORMA- TION B EDUCATION BRANCH STATION COMPLEMENT COMMANDING OFFICER DIRECTOR Of DENTAL SERVICE ENGINEER MANAGE IK NT I BRANCH -J MAINTE- NANCE B REPAIR BRANCH EXECUTIVE OFFICER UTILITIES BRANCH FINE PREVENTERS BRANCH AUDIT BRANCH I special FINANCIAL SERVICES BRANCH PUBLIC RELATIONS OFFICER FISCAL DIVISION BUDGET B ACCOUNTS BRANCH I RECEIPT B DISBURSE- MENTS BRANCH SEC S INTELL DIVISION CONTROL OFFICER VETERINARIAN GENERAL HOSPITAL SIGNAL BRANCH QUARTER- MASTER BRASS CM PROPERTY BRANCH SUPPLY DIVISION SALVAGE ■ REDIS- TRIBUTION BRANCH MEDICAL INSPECTOR PURCHASES BRANCH TRANSPOR- TA TON BRANCH LINEN SUPPLY BRANCH RED CROBB USES VET ADM. USCS.C SCL SERE DIETETICS DIVISION I— OFFICE SERVICE BRANCH INFORMA- TION BRANCH PUBLICATION BRANCH ADJUTANT POSTAL BRANCH “Chart XXVIII Title. Adjutant of the center, unlike his opposite number of the general' hospital in TM 8-262,commands the band.” His office service branch provided ”stenographic service for dispo- sition and other boards” but its duties did not include furnish- ing ration service for the complement personnel. . His informs--' ’■ tion branch (new) “operates the Hospital Center (Zl) information service” and'“maintains the Hospital Center (Zl) locator files,” Operating the postal locator service is not mentioned among the duties, of the postal branch.54- In the personnel division, the authorization officer of the general hospital (TM 8-262) became the personnel control branch of the center, with identical duties.55 As to the fiscal division, the difference here was that the audit branch did not have among its stated functions the duty of insuring the “audits are adequate in order to detect irregularities,” etc,,- although the omission perhaps had no sinister significance.56 The dietetics division, as its new function, “details officers of the division to duty with the General Hospital and the Convalescent Hospital to act as liaison officers between this Division and the component hospitals.”57 Finally a linen exchange branch was added to the supply division. This branch (.1) Provides for the receipt, storage and issue of linens, towels, and hospital clothing for patients in the General and Convalescent Hospitals. (2) Arranges for the laundering and minor re- pairs of linen supplies used by the command. (3) Segregates and makes proper disposition of worn-out linen supplies.5° In the standard plan the administrative side of the center included, besides the headquarters echelons just dealt with, certain agencies in the constituent hospitals. The commanding officers of these hospitals and their duties have already been mentioned. Each had an administrative assistant who assists the Commanding Officer, as directed, in the performance o£ his duties, . . Provides mail, messenger, files, stenographic, and other miscellaneous service for the General (Conva- lescent) Hospital. Acts as liaison officer to the Executive Officer of the Hospital Center (Zl), 159 Their duties were differently stated on only one point; the administrative assistant of the General Hospital uacts directly, in accordance with policies established by the Com- manding Officer, on matters not requiring the personal atten- tion of the Commanding Officer,11 while the administrative assis- tant of the convalescent hospital "supervises the work of the staff and coordinates matters of concern or interest to more than one operating division."59 ■ , On the level which would correspond to the professional services of the general hospital, the convalescent''hospital in the standard plan had several branches whose duties.were largely administrative in character; namely, the "retiring and disposition service” and the "convalescent regimentsTheir functions were stated as follows: * ' Receiving and Disposition Service a. Receiving. Company (1) Receives patients assigned to the Con- valescent Hospital by the Admission and'Disposition Branch or admitted directly from other hospitals. (2) Insures that preliminary medical exam- ■} , inations is given to all patients., upon , reception, prepares necessary-admission records. (3) Conducts initial orientation program for all patients. (l) Insures that all patients are equipped with required authorized clothing, and issues such articles as are lacking. ■ (5*) Recommends convalescent furloughs or sick leaves for personnel in Receiving Company, when appropriate, (6) Checks all patients arriving at, or departing from the convalescent hos- pital on admission, discharge, pass, furlough and leave, (7) Accomplishes assignment of all patients - ’ to Convalescent Regiments, Insures that enlisted patients suffering from neuropsychiatric disorders are assigned to the First Convalescent Regiment; en- listed patients suffering from general medical disorders are assigned to the Second; and enlisted patients suffering 160 from general surgical disorders are assigned to the Third, In case of officer patients, to Officer Patientfe Company, (The senior psychiatrist on duty acts as Commanding Officer of the First Convalescent Regiment. The Chief of Medical Service acts as Com- , manding Officer of the Second Conva- lescent Regiment. The Chief of Sur- gical Service acts as Commanding Of- ficer of the Third Convalescent Reg- iment .) (8) Provides for proper housing, feeding, treating, and other care for convales- cent patients during residence in the Receiving Company. b_, Disposition Company (1) Accomplishes receiving and billeting of patients prior to return to duty, separation from the service, or re- lease from active duty. (2) Arranges special departure ceremony for patients physically unfit for further active duty. Convalescent Regiments ,.. a. Insure, through battalion and company officers, that patients attend all sche- duled formations, classes, and other re- quired activities, such as consultations and examinations. Supervise, through the' company officers, the manner in which patients participate in activities which; the entire company attends as a unit. • * ..J " b. Enforce, through the company officers, observation of limitations and re- strictions imposed on the patients! acti- vities by the regimental medical officers, and execution of all special exercises and other activities prescribed by the medical officers. c. Company officers will recommend passes, furloughs•,, and leaves for patients assigned to their respective companies, d. Company commanders will prepare morning • reports for the Convalescent Companies 161 and Officer Patients’ Company daily for forwarding to higher echelon.60 ■'The professional staff functions as stated in the standard plan for’hospital centers, .differed in only one or two particu- lars from those assigned-to the professional staff of general Hospitals in TM 8-262. ’ The -reconditioning service, hov/ever, was transferred from the general to the convalescent hospital and its functions were restated: the service a. Operates physical reconditioning, educa- tional reconditioning, occupational ther- apy, and classification and counseling sections. b. Supervises and- schedules the use of all facilities of the service; schedules all recreation activities during duty hours, and supervises the operation of gymnasia and swimming pools. c. . Maintains all records, charts, and statis- tical data of the service; advises and assists staff and professional officers in .the preparation of master and detailed schedules. The plan for hospital centers, just described, was ready for publication early in 194-6. A suggestion was made that the plan (together with one for separate convalescent hospitals Isee Chart XXIX7, also, completed at this time)62 should be printed and added to TM 8-262 "in order, that the manual will be available as a complete unit for training and future mobil- ization planningdespite ’’the contemplated discontinuance of convalescent hospitals and hospital centers (ZI) during the postwar period.1163 The suggestion was not approved and the sections remained unpublished; that on hospital centers, there- fore, ,,has been given in more-than usual detail here, 4- The plan for a hospital center as finally evolved by the Office of The Surgeon General differed in some respects from the scheme which it had- been' mainly responsible for establish- ing at the Percy Jones Center and which continued to govern that center. In.the standard plan a.somewhat smaller number of divi- sions than at Percy Jones (eighteen as against twenty-four) re- ported to the commanding-officer. The top echelon at Percy Jones contained no nursing service, but it had directors of supply, personnel, and individual services. The standard plan placed the first two in the second echelon and had no separate individual service.- On the.other hand, no reconditioning council appeared on the Percy-Jones chart. The standard plan provided for an admissions and dispositions office directly ■CMTWUI of PATIENT* 0rtP0S«Yoi •nano* I OFFICER patient* COMPANY SCCURTTV G INTELLIGENCE DIVISION STANDARD ORGANIZATION OF CONVALESCENT HOSPITALS (ASF) PUBLIC RELATIONS OFFICER NANA6IMCNT I UTiliTCS MANCM ENGINEER FlNf PREVENTION MANCM HANlTCNANCC B NMAlS ••ANCM 4f« H"hai 0€»Ui. mhvmx ?** N'liio 0 C 5 | 1 I VETERINARIAN J J THIRD CONVALESCENT REGIMENT l».l—•/ 166 38Information from Lt, Col. McGibony and Lt. Col. 'Wm, T. Smith, Hospital and Domestic Operations Division, SG*0, '30 Apr 194-6. of Headquarters, ASF, were also present, but confined themselves to supporting The Surgeon General’s dele- gates. (information from Mr. R. R. Ranney, Control Division, SGO, 26 Apr 194-6.) 4°Ibid. 4%D Cir. 105, II, 1. 4%D cir. 115, I, 3. : 43ASF Cir. 135. U9 Jul 194-5 (Record Room, SGO, 323.3 /Ist, 3rd, 4th, 5th, 7th and 9th Service Commands/ AA)* 4-5 Ac ting Surgeon, First Service Command, to SG, 24 Jul 1945 Record Room,. SGO, 323*3 /ist Service Command/ AA); CG, Fourth Service Command, to SG, 28 Jul 1945 (Record Room, SGO, 323.3 /Zth Service Command/ AA); Surgeon, Ninth Service Command,, to Commanding General,_ASF attention the SG, 26 Jul 1945 (Record Room, SGO, 323.3 /Percy Jones General Hospi- tal/ K). 4-6Annual Report, Percy Jones Hospital Center, 1945, p. 3 (Historical Division SGO). . 4-7 inf or mat ion from Ma j . R. E. Garrett, Control Division, SGO, 2 May 194-6. Maj,. Garrett was largely responsible for plan- ning the new organization at Percy Jones.. Surgeon, First Service Command, to 3G,_24 Jul 1945 (Record Room, SGO, 323.3 /Tst Service Command/ AA); CO, Hospital Center, Fourth Service Command, to CG, Fourth Service Command, 19 Jul- 1945 (Record Room, SGO, 323.3 /7th Service Command/ AA); Surgeon, Ninth Service Command, to CG, ASF, attention SG, 26 Jul 1945 (Record Room, SGO, 323,3 /Percy Jones General Hosp/ K);Surgeon, Seventh Service Command,- to SG,__24 Jul 1945 (Record Room, SGO, 323.3 /7th Service .Command/ AA). , 4- of Proposed War Department Technical'Manual,. Administra- tion of Fixed Hospitals, Zone of the.Interior, Chapter I, Hos- pital Administration,•• Section 4 (a copy in the files of the Control Division, SGO,. dated Jan 1946), p. 2. p. 32. ' . . 5- Ibid., p, 27 52ibid., pp. 6 - 7 : 167 53ibid,, p,. 26 - 27. t * • .£; ' OK c. 34-lbid.. pp, 7 - 8. ' \; 35ibid.. p;:12, ., v .. .. 56Ibid. , p, 11 f ;r .; ' , ,. „ ' ' 57ibld.. p. 22. ' • SSlbid., p. 21. 39ibid.. pp. 28, 32. * ‘ : * " . . 6oIbid.. pp. 33-34, 35. ‘ . 6ljbid., p, 34. 62praft of Proposed War Department Technical Manual, Admini- stration of Fixed Hospitals, Zone of the Interior, Chapter I, Hospital Organization, Section 3, Standard Functional Or- ganization of Convalescent Hospitals (ASF), Jan 1946 ( a copy- in the files pf the Control Division, SCO). 63Memo, Chief, Administrative Branch, Hospital and Domestic Operations Division, SCO, to Director,,Control Division, SCO, 5 Mar 1946 (files, Control Division, SCO), 64The SCO plan for separate convalescent hospitals represented essentially a combination of the.administrative organization of the general hospital (described in TM 8-262) with the,con- valescent structure of; the hospital center just dealt with. The stated administrative functions were, with one or two exceptions, almost the' same, word for word, in both cases. One difference was that the convalescent hospital had a linen exchange branch as part of the supply division (although this is not shown on the chart). Als.o, the admissions and., dispositions branch of the registrants office (unlike that • of the. general hospital) had only ;twp functions: it "prepares the Consolidated Ward Corning Report’,and ’Admission and: Dis- position Sheets11 and "-maintains .Statistical Locator File." The main difference On the professional side Was that the separate convalescent hospital contained an infirmary division, which "a. Furnishes hospital type treatment to all patients as required, b. Maintains clinics for consultation'purposes • as required, c. Operates medical, surgical, dental and such other services as. may be required.by the needs of the' patients assigned to the hospital, d. Maintains, and processes clin- ical records and progress charts . Otherwise the profes- _sional functions of the separate convalescent hospital were given as almost identical to those of the convalescent part of the hospital center. ■' . ’ ' 168 6Annual Report, Percy Jones Hospital Center, 1945, p. 159 (Historical Division, SCO). 66;mnual Reports, Brooke, Butner, Carson and Wakeman Hospital Centers, 1945 (Historical Division, SGO). r 169 CHAPTER XII THE SURGEONSf OFFICES, 1944 - 1946; DEMOBILIZATION AND POSTWAR ORGANIZATION IN THE SERVICE COMMANDS The Service Command Surgeons’ Offices and the Post Surgeons’ Offices After the restoration of the service command surgeon to a position of direct responsibility to the service commander in December 1943 (above, Chapter X), no further changes in the former’s status occurred during the rest of the war. Some time afterward, however, actions were taken which affected or might have affected the surgeon’s position. Thus the Commands ing General of the First Service Command in September 1945 re- commended rescinding the mandatory provisions of the Army Ser- vice Forces manual (M-301) so far as they 'applied to headquar- ters organization in order that service commanders might have ’’maximum latitude” in remodelling their headquarters to meet changed requirements. This recommendation, however, was dis- approved by Headquarters, Army Service Forces. The reorgani- zation of the War Department in June 1946 involved the service command surgeons as well as all other members of the Medical Department and will be considered further on. The status of the service command surgeon, therefore, remained unchanged up to June 1946. His functions, however, together with those of the post surgeon, were somewhat modified subsequent to 1943, Certain changes were introduced shortly after V-E Day by a revision of the Army Service Forces organi- zation manual (15 June 1945.), In the case of the service com- mand surgeon these changes were minor.- To the clause giving him authority to supervise hospitalization and medical service was added ’’dental service, ... sanitary measures, and other protective measures.” The clause on veterinary inspections was elaborated, assigning him responsibility for making ’’nu- tritional evaluation of soldiers’ ration and daily menu” and ’’inspection of mess operations from the standpoint of health.” Where formerly the quartermaster had been ’’responsible for all veterinary inspections within the Quartermaster Depots and within the" metropolitan area in which the Quartermaster Depot is located,” the surgeon now ’’supervises inspection service incident to Service Command procurement of dairy, meat, and food supplies, and, as requested by the Quartermaster General, assists in inspection incident to other procurement of dairy, meat, and food supplies,” This restored almost the precise wording of the manual of 24 December 1942. 171 Certain added responsibilities had already been placed upon the service command surgeons in connection with planning and carrying out demobilization after the anticipated, defeat of Ger- many and Japan. As early; asADecember 194-3; the Office of The Surgeon General, in its •own 'demobilization plan, provided that each service command surgeon should "prepare detailed plans for the functions which he will be called upon to- perform during demobilization'^;Somewhdt-later Array Service Forces Headquar- ters issued a demobilization plan for Period I (the interval between the expected defeat of Germany and that of Japan). As implemented early in 194-5 by the various service commands, this plan assigned certain'specific duties to.the surgeon. In the Third Service Command, for example, he was directed to establish procedure for the evacuation of sick .and wounded’and'to acceler- ate, their movement as required.3 in the Fourth- Service Command all technical'services (including the. surgeon's office) were to take action for "determination of surplus command installa- tions, redistribution of excess military property, arrangement for proper rehabilitation, repair or servicing of military property, establishment of a reserve of serviceable training equipment for redeployment training, in the-United States," and "reduction or elimination of activities, during Period I."^' Almost a year after the end of the war (April 194-6) one important phase of the service command surgeon's authority was abolished; his command of general, regional, and conval- escent hospitals. The circumstances of this change will be dealt with later.5 _ , . Between 1942 and 19A5 the functions of the post surgeon, as stated in successive organizations manuals, varied less than those of the service command surgeon.•"The 10 August 1942 edi- tion ’of the manual described the. post' surgeon's functions as a. Furnishing medical service and supplies on ■ ' ’ •”* the post. . . *•- . ’ •* , «l b, 'Operation of dental clinics on the post., • c. Inspection of meat, dairy products., and ’ ’ forage on the post and the'conduct of “ _ . other,veterinary activities, including,. "A the operation and maintenance of'veJer-A inary station hospitals, ■ ■■ d . Operation of. station hospitals, including t tactical..-hospitals"when placed'under ser- ’ vice command-control, • ; - • *** r r 4 • • * " e. Conduct of evacuation activities. 172 . Inspection of the;-sahitation arid cleanli- ness of the post. " ■ • ■ ■ ' ■ w ' # The edition of 15 'December:1943:amplified the Reference to the supply,.function: ' the surge on lC!’’ ■ - •i g* stores, 'and Issues' • medical ■ supplies; Under the; of thei-Supply Division.' 1 , f ~ ’• ~ h, .Advises the Director of Supply’on the main- tenance and repair of medical equipment and classifies such equipment as serviceable or . * unserviceable. The edition of 15 June 194-5 dropped the "last function and added:. “Disposes of materiel returns and excesses according to latest instructions,11 “Responsible for the maintenance of pro- per stock levels,w and “finintains first and second echelon re- pair of medical technical ’equipment.1* The duties as to inspect- ing forage and conducting “other veterinary activities’* (“c“ above) wore eliminated. This manual tilso dropped the_reforence to tactical hospitals in ud”. ■ (The previous manual 194-3/ had slightly changed this clause to read, MOperates and trains station.hospitals,' including numbered medical units.”) The clause now read simply, “Operates the station hospital, infirmaries, and dental clinics.” Finally, a new function was added: “Advises the Post Commander on all medical matters; conducts necessary inspections to insure that policies and in- structions are applied and carried out particularly,as- to train- ing-, supply, maintenance, salvage and reclamation.” While the functions of both the service command surgeons and the post surgeons varied somewhat during 1944--194-6, the changes were less radical than those which occurred in the internal structure of the service command surgeons* offices. However, no complete1 uniformity of structure among these offices was ever achieved. As we have-seen (above p. 136 ) the Office' of' The Surgeon General at the end of 194-3 had suggested a standard type, of organization based on its own administrative structure. During 1944 and 194-5' that office, itself underwent some;structural' changes. To Its. main services—administrative, personnel, operations;-supply, and professional—preventive medicine-(formerly a division,of the professional service) and a number of consultants divisions-wore added during 1944* The available charts from seven of the nine service commands indi- cate that hone of the. surgeons 1 offices conformed exactly to The Surgeon General's organization, even so,far as this top echelon Was concerned. The,,nearest approach to it was in the Eighth Service Command during 1944* Even here, however, the consul- tants were carried as a section of the professional service branch, and by the end of 194-5 the organisation had been recast 173 almost outrof recognition. The ohly main elements like those of The Surgeon General’s Office were ..nor/ the administration and professional branches., To these had been added an assign- ment branch (similar to personnel)'and a hospital branch. Supply and operations were now sections of the latterr while Veterinary and preventive medicine became sections of the pro- fessional branch,6 In the First Service, Command the Surgeon’s Office showed an approach to the structure of The Surgeon Gen- eral’s Office between 194-3 and 194-^,. at least so far as nomen- clature was concerned. The chart for 15 May 194-3 exhibits six sections which later disappeared: hospitalization,.evacuation and industrial hygiene; medical inspections; medical, service; sanitary; venereal disease control; and management; and four others which were retained in 194-5: supply, Army nurses, vet- erinary, and dental. The chart for 15 October 1945 includes the latter group together with personnel, preventive medicine, administrative, consultants, and operations (combined with supply), which, wore parallel to services of The. Surgeon General’s Office.'7 As we have seen (above p, 13<$, the Surgeon Of the Sixth Service Command--stated in his report for 1943 that his office had an organization ’’approximating that of The Surgeon General.” But his chart for 20 March 1945 does not indicate that the approxi- mation at that'time was very close*® • ‘i .... - Reorganization of the Mar Department in Relation to the Service Command Medical Establishment ■At a service command conference held late in January 194® the question was raised whether a standard organization (pre- sumably a new one) would, be established for the service commands, and whether it would be coordinated with Headquarters, Army Ser- vice Forces. The reply was that,the organization of Army Ser- vice Forces, and the service commands was being studied by the Mar Department and that no definite Answer could be given at that time.9 ■ The study referred to had been inaugurated in October 1945 with the•appointment of a board of officers, known as the Patch Committee, whose purpose was to determine the future organization of the entire Mar Department. This board, appointed on 19 Octo- ber 1945, was reconstituted on the following 6 December.under the presidency of .'Lieutenant General M. H,.Simpson.10 jn its report of 28-December 1945 (with revisions as of 18 January 194®) the board made numerous proposals. Among' other things,,it ex- pressed", the belief that '•with the personnel, restrictions which will exist in v ■the postwar.Army, the number of large headquarters • should be reduced the minimum.. .As a material step ‘ in'this direction and as a further measure of- dec'on- "" 174 tralization it is believed that the nine Service Commands should be discontinued and replaced by six Army Areas. . . The functions of the Service Com- mands with respect to ground troops and stations, excluding exempted stations and activities-, would be taken over by the Army Areas, each under command of an Army commander, who would be responsible for area supervision and could report to the Commanding General, The Army Group, on all training matters and on the tactical preparation of troops, and di- rect to the War Department on all administrative, supply and service matters, ... Stations and estab- lishments that experience has indicated should be under command of appropriate chiefs of services would be exempted from the Army commanders,11 • The report was submitted for comment to the chief officers of the War Department, including The Surgeon General, Mean- while', the.Hospital and Domestic Operations Division of The Surgeon General’s Office had recommended that all general hospitals be placed under direct control of The, Surgeon General. With the reduction in the number of general hospitals it- is believed that bettor control and maintenance of standards of care desired by The Surgeon General can be main- tained if direct control is kept within the Office of The Surgeon General,1^ In his comment on the Simpson .Board’s Report The Surgeon General adopted this suggestion, recommending that explicit provision bo made for placing general hospitals under the, com- mand of The Surgeon General. A committee headed by the Acting Assistant Chief of Staff, G-3, took a different stand. It believed that general hospitals and Finance offices should be con- tinued ’under the Armies, • . During the war both gen- eral hospitals and United States Finance offices operated unde'r the jurisdiction of the Service Com- mands. . . In accordance with the decentralization, principle stated in the'Report of the Board , . . the Committee is of opinion that.their activities should remain under the Armies, and that it would be a backward step in decentralization to place them un- der the jurisdiction.of the appropriate Chiefs of Services The Simpson Board, 'however, rejected the suggestion at least in part; • The Board 'does not concur in tho recommendation that general hospitals bo continued under the Army Areas. It is the belief of the Board that The Surgeon General is unduly hampered in the perform- ance of his mission if general hospitals are under the command of the Army Areas. This is particu- larly true with respect to the assignment and utilization of medical and surgical specialists. Accordingly the Board will recommend to the Chief of Staff that general hospitals be classified as exempt stations.15 Cn 14. March 194-6 The Surgeon General was notified by the War Department General Staff that "classification of general hospitals and convalescent hospitals as exempted stations under the command of The Surgeon General is concurred in,1116 A month before the directive on reorganizing the War Department appeared, an Army Service Forces circular ordered the transfer of all hospital centers, general hospitals, and convalescent hospitals from the control of the service commands to that of The Surgeon General’s Office, effective 15 April 194-6.19 "Housekeeping" matters such as utilities, postal service, fi- nance, and quartermaster activities at these institutions re- mained under the supervision of the service commands.16 The Simpson Board’s complete plan for Far Department reorganization was published on 14- May 194-6, to become effec- tive on 11 June following, Besides assigning the command of general hospitals to The Surgeon General (a step already taken), the plan touched upon the status and functions of the Medical Department in the service commands in several' other ways. By substituting six Army areas for the nine service commands, it reduced the number, of service command surgeons and abolished their old title, Fitji the elimination of the Army Service Forces command, it altered the relations between the surgeons and the War Department General Staff, For their medical responsibilities, the .Army (area) commanders were to "communicate direct with the War Department," • t These responsibilities appear to have differed little from those .previously assigned to the service commanders and their surgeons. They comprised Medical and dental service (except at medical cen- ters and general hospitals) including — (a) All hospital facilities, except facilities assigned to the .Army Air Forces, including regional and station hospitals, general . dispensaries, and medical and dental labora- tories, (b) Industrial medical program. (c) Preventive medicine, including sanitation and hygiene, communicable disease control, venereal disease control, nutrition, and liaison with civil health agencies, . , ■ Veterinary services, except as provided below. (a) Veterinary services at quartermaster and gen- ■ / eral depot's charged .with supply of food prod- , ■ , ucts and veterinary food inspection within the metropolitan areas in which such depots are located. (b) Veterinary service at quartermaster remount depots and remount area headquarters. The medical responsibilities of Army commanders at exempt (Class II) installations were similar to the' above, except that the "industrial medical program” was not mentioned. Nor were any medical functions ,for Army commanders indicated at Air Forces (Class III) installations. The provision regarding sani- tation ,(ASF -Organization Manual, 15 December 1943* 4.02,02) did not reappear in the new directive. The account of medical organization in the service commands may well conclude with the projected ending or transformation of the service commands themselves. By 194-6 the regional structure of the Army had returned, :in some respects, to its pre-war starting point. The service commands were preceded and were to bo followed by mixed tactical and service organizations: the corps areas and the Army areas• The regional surgeons had been members of the corps nfea special staff; long before the end of the war they returned to a similar if not to precisely the same position, -The general hospitals, after a period of sub- ordination to the service commanders, were restored to the control of The Surgeon General. In the first case the cycle appears to represent, in large part, the shift from peace to war and back again. In the two other instances, it was the result of experience gained by trial and error. 177 NOTES FOR CHAPTER XII 3-Memo for Director, Control Division ASF, from Deputy • Chief of Staff for Service Commands,ASF, and reply, 21 Sept 1945 (Administrative Records, C; G,, ASF jjfc 1 Ser- vice Commands7 ). • •• I,. * Surgeon General's Tentative Demobilization Plan, 7 December 1943 > P* 3 (Historical Division, SGO). 3office of CGj Third Service Command to CGs and COs, Posts, Camps and Stations, Third Service Command, 27 April 1945 (files of Planning Branch,,.Hq*, ASF). Service Command Flan for Period I, 23 April 1945 - (files of Planning Branch, Kq. ASF). , p, . • ' '• ; * Reports, Eightli Service Command; 1944,-1945 • (Historical Division, SGO).. : • Service Command,.Organizational and Functional Charts, 15 fey 1945. Chart 2. Annual Report, First Service Command, 194-5 (Historical .Division, SGO), ®Annual Report, Sixth Service Command., 1944- (Historical Div- ision, SGO). ■ Semi-Annual Service Comand Conference, 2,4-25 Jan 194-6 (Record Room, SGO). 3-OMomo for Lt, General Simpson, etc., from Asst Deputy Chief of Staff, War Department, 29 Nov 1945 (files of Deputy Director of,Plans, SGO). llReport of Board of Officers on Organization of War Depart- ment, 28 *DeC 1945, with revisions as of 18 Jan 1946 (files of Deputy Director for Plans, SGO). 12lfcmo for record by Deputy Director> Special Planning Divi- sion, SGO, 8 Jan 1946 (files of Deputy Director for Plans, SGO). 3-3SG TO CG, ASF, 5 Feb 1946 (files of Deputy Director for Plans, SGO). 3-4Memo for President of Board of Officers for Organization of the War Department, 4 March 1946 (files of Deputy Direc- tor for Plans, SGO), 178 for Brig. General C. L. Eberle, Acting Asst, Chief of Staff, G-3, from Lt, General Simpson, 5 March 194-6 (files of Deputy Director for Plans, SGO). for SG from Deputy Chief of Staff, War Department (Control), 14- March 194-6 (files of Deputy Director for Plans, SGO), Cir. 92, Part Two, 11 April 194.6, Order 134, SGO, 18 April 1946. Cir. 138, 1946. 179 CHAPTER XIII • - C01TCEUSI0H ■ It is easier to trace the changing outlines of Medical Department organization than to find reasons for the changes. An old branch withered away or a new one sprouted, often with no explanation of the process in the form of a written record or even as a recollection of the persons concerned. Thus while conversations and verbal understandings could produce important and speedy transformations in an office structure, such agreements loft small pickings for history. Even where documents exist there is sometimes a strong indication that they do not tell the whole story. Influences of a personnel nature may have been decisive in producing certain realign- ments and delegations of authority, but they were not apt to find, their way into the record. As the foregoing chapters indicate, however, at least one main purpose is discernible behind many changes in Medi- cal Department administration during and after the war period; namely, the decentralization of authority both in the head- quarters and the local organization. So far as structure was concerned, this meant a reduction in the number of services reporting to a particular chief—The Surgeon General, the commanding officer of a hospital, etc.—and the devolution of greater authority on lower echelons. This process, how- ever, did not prevent the establishment of the Operations Service in the Office of The Surgeon General as the coordinat- ing center of Medical Department activities. All functions of The Surgeon General’s Office were gradually brought into alignment for this purpose, arid the Chief of the Operations Service became The Surgeon General’s principal aide in carry- ing forward the mission of the Medical Department. The policy of decentralization was not always realized in practice to the extent at first considered feasible by higher authority; occasionally a project was abandoned or considerably watered down after a period of trial and some- times before it could be put into effect. Instances of this are the restoration of the service-command surgeons to their staff positions and the working out of a model hospital or- ganization that left more direct supervision in the hands of the hospital commander than was at first thought desirable. Under the policy of decentralization an attempt was made to standardize, in a general way, the plan of head- quarters organization, whether the headquarters happened to be the Office of The Surgeon General, the service-command surgeons’ offices, or the offices of hospital commanders. 181 Some uniformity of this sort was achieved, hut it was far from complete—much less so than the directives of the Commanding General, Army Service Forces, and The Surgeon General seemed to envisage. But in spite of this deficien- cy, if such it was, business could he and frequently was transacted outside the formal channels of authority. Or- ganization had the power to expedite or obstruct, hut not to: insure or utterly prevent, the effective conduct of medi- cal affairs. . ' 182